bluuebunny/crossref_metadata_2025 huggingface dataset:
Patient and operative factors associated with unanticipated intensive care admission and outcomes following posterior fossa decompressions in children: A retrospective study
Authors: Benzon Hubert A. , Tantoco Anthony , Longhini Anthony , Hajduk John , Saratsis Amanda , Suresh Santhanam , McCarthy Robert J. , Jagannathan Narasimhan
Published: May 2022

Introduction

Posterior fossa decompression for Chiari I Malformation is a common pediatric neurosurgical procedure. We sought to identify the impact of anesthesia‐related intraoperative complications on unanticipated admission to the intensive care unit and outcomes following posterior fossa decompression.

Methods

Medical records of all patients <18 years who underwent surgery for Chiari I malformation between 1/1/09 and 1/31/21 at the Ann & Robert H. Lurie Children's Hospital of Chicago were included. Records were reviewed for patient characteristics, anesthesia‐related intraoperative complications, postoperative complications, and surgical outcomes. The primary outcome was the incidence of unanticipated admission to the intensive care unit, and the primary variable of interest was an anesthesia‐related intraoperative complication. Patient, surgical characteristics, and year of surgery were also compared between patients with and without an unanticipated admission to the intensive care unit, and a multi‐variable adjusted estimate of odds of unanticipated admission to the intensive care unit admission following an anesthesia‐related intraoperative complication was performed. Secondary outcomes included anesthesia factors associated with an anesthesia‐related intraoperative event, and postoperative complications and surgical outcomes between patients admitted to the intensive care unit and those who were not.

Results

Two hundred ninety‐six patients with Chiari I Malformation were identified. Clinical characteristics associated with an unanticipated admission to the intensive care unit were younger age, American Society of Anesthesiologist (ASA) physical status >2 and an anesthesia‐related intraoperative complication. 29 anesthesia‐related intraoperative complications were observed in 25 patients (8.4%). Two of 25 patients (8%) with an anesthesia‐related intraoperative complication compared with 3 of 271 (1%) patients without anesthesia‐related intraoperative complication had an unanticipated admission to the intensive care unit, odds ratio 7.8 (95% CI 1.2–48.8, p = .010). When adjusted for age, sex, ASA physical status, presenting symptoms, concomitant syringomyelia, previous decompression surgery and year of surgery, the odds ratio for an unanticipated admission to the intensive care unit following an anesthesia‐related intraoperative complication was 5.9 (95% CI 0.51–59.6, p = .149). There were no differences in surgical outcomes between patients with or without an unanticipated admission to the intensive care unit.

Conclusion

Our study demonstrates that although anesthesia‐related intraoperative complications during posterior fossa decompression are infrequent, they are associated with an increased risk of an unanticipated admission to the intensive care unit.
Early post‐liver transplant thrombocytopenia in children: Clinical characteristics and significance
Authors: Tal Noa , Waisbourd‐Zinman Orith , Kaplan Eytan , Kadmon Gili , Gendler Yulia , Gurevich Michael , Nahum Elhanan , Weissbach Avichai
Published: May 2022

Background

Post‐liver transplant thrombocytopenia is common and associated with worse outcome in adults. In children, however, the prevalence, course, and significance of post‐liver transplantation thrombocytopenia are not described. Therefore, we aimed to assess this phenomenon in children.

Methods

A retrospective chart review of children who underwent liver transplantation at a single tertiary center between 2004 and 2021.

Results

Overall, 130 pediatric liver transplantations were reviewed. During the first 28 POD, thrombocytopenia was evident in 116 (89%, 95% CI 83%–94%). The median nadir platelet count was 54 K/μl (IQR: 37–99). Nadir platelet count was reached in half the patients by the third POD (IQR: 1–6). In multivariate analysis, preoperative platelet count (p = .024), volume of intraoperative packed cell transfusion (p = .045), and hypersplenism (p = .007) were associated with lower postoperative platelet counts. Patients with platelet count lower than the 50th centile on the first POD suffered from a more complicated course leading to a longer PICU admission (p = .039).

Conclusions

Early post‐liver transplant thrombocytopenia appears to be common in children and associated with preoperative thrombocytopenia, hypersplenism, and higher intraoperative blood transfusion volumes. A low first POD platelet count (<86 K/μl) was found to be independently associated with a more complicated postoperative course, suggesting the need for heightened surveillance.
The erosion of the administrative state under President Trump: Citizens' pushback against individual and institutional racism
Authors: Wright James E. , Thomas Michael Blair
Published: May 2022

President Trump encouraged bad state actors within the administrative state to contribute to inequities for civilians. We highlight how Trump's actions and rhetoric led to increased individual, institutional, and systemic racism and violence. As a response to this increased violence and rhetoric, we discuss the role civilians (including professional athletes) played in engaging in protests and the 2020 election. Given that more individuals voted in that election cycle, we emphasize the importance for public administration to adapt, evolve, and engage with new actors concerned with administrative action or inaction.
Long‐term effects of chemotherapy and radiation received during early childhood on the developing dentition of pediatric cancer patients
Authors: Rahul Morankar , Atif Mohammad , Ganguly Shuvadeep , Pushpam Deepam , Tewari Nitesh , Mathur Vijay , Bakhshi Sameer
Published: May 2022

Introduction

The short‐term effects of chemotherapy and irradiation are well documented; however, there is paucity regarding their long‐term effects, especially in children and adolescents.

Case Description

This paper discusses the long‐term effects of chemotherapy and/or radiation received by the patients during their early childhood on the developing dentition. It comprises the compilation of 11 cases with alteration in the dental development screened from 138 cases of the childhood cancer patients who received the chemotherapy and/or radiation as a part of anticancer therapy.

Results and Conclusion

The findings revealed that the age of initiation of anticancer therapy along with the synergistic effect of chemo‐irradiation, and the dose of radiation used were the principal determinants for the dental abnormalities. The root‐related abnormalities were found to be varied and more common as compared to the missing teeth and defects related to the tooth crown.
Vulnerable and dominant: Bright and dark side personality traits and values of individuals in organized crime in Denmark
Authors: Gøtzsche‐Astrup Oluf , Overgaard Bjarke , Lindekilde Lasse
Published: May 2022

In this paper, we build on a robust literature on push and pull factors to focus on the personality traits and values of individuals involved in organized crime. We distinguish organized crime from other kinds of criminal activity and recruit a unique sample of non‐incarcerated individuals verified by the Danish National Police to be involved in organized crime. We use comprehensive standardized psychological assessments of their big five personality traits, maladaptive dark traits and core values and drivers to compare them to an adult norm group. Danish individuals involved in organized crime are much less emotionally stable (d = 1.84), ambitious and self‐confident (d = 1.50), agreeable (d = 0.87) and conscientious (d = 0.65) than the norm group. At the same time, they have substantially higher scores on all but one of the 11 dark traits (Cohen's d ranging from 0.39 to 3.10). They are characterized by a high need for security (d = 1.14) as well as material (d = 0.96) and financial success (d = 0.81). While these patterns fit results previously found in the criminological literature, a latent class analysis reveals two separate groups. A subset of one third of our sample had somewhat less depressed scores on the big five and more moderate scores on the dark traits, indicating more adaptive personality structures. We consider this novel finding in terms of potential exits from a milieu of organized crime.
Antecedents of COVID‐19 rumination: A three‐wave study
Authors: Caniëls Marjolein C. J. , Nikolova Irina , Hatak Isabella , de Weerd‐Nederhof Petra C.
Published: May 2022

The COVID‐19 pandemic has affected nearly every aspect of our lives and has caused a considerable rise in psychological complaints such as anxieties and depression. The majority of studies so far has focused on outcomes of the COVID‐19 pandemic. To augment current knowledge, we focus on the antecedents of COVID‐19 rumination. Specially, we examine how negative and positive work events prior to the outbreak influence individuals' coping capacity with regard to COVID‐19 (i.e., the extent to which individuals have recurrent negative thoughts about COVID‐19). Drawing on Conservation of Resources Theory (COR), we maintain that positive and negative work events prior to the pandemic can affect one's self‐efficacy experiences and in turn can impact recurrent negative thoughts about COVID‐19. Alongside exploring the proposed theoretical mediation model, we test one of the key assumptions of the COR theory: the notion of primacy of negative over positive affect that results from negative (vs. positive) work events. Three‐waved data was collected among Dutch employees (T1 = 302; T2 = 199; T3 = 171); two prior to the pandemic and one at the onset of the outbreak. Results showed that positive work events increased self‐efficacy, which in turn reduced COVID‐19 rumination. Contrary to the expectation of primacy of the effects of negative work events, we found no significant impact of negative work events on individuals' COVID‐19 rumination.
Defining upstream enhancing and inhibiting sequence patterns for plant peroxisome targeting signal type 1 using large‐scale in silico and in vivo analyses
Authors: Deng Qianwen , Li He , Feng Yanlei , Xu Ruonan , Li Weiran , Zhu Rui , Akhter Delara , Shen Xingxing , Hu Jianping , Jiang Hangjin , Pan Ronghui
Published: May 2022

Peroxisomes are universal eukaryotic organelles essential to plants and animals. Most peroxisomal matrix proteins carry peroxisome targeting signal type 1 (PTS1), a C‐terminal tripeptide. Studies from various kingdoms have revealed influences from sequence upstream of the tripeptide on peroxisome targeting, supporting the view that positive charges in the upstream region are the major enhancing elements. However, a systematic approach to better define the upstream elements influencing PTS1 targeting capability is needed. Here, we used protein sequences from 177 plant genomes to perform large‐scale and in‐depth analysis of the PTS1 domain, which includes the PTS1 tripeptide and upstream sequence elements. We identified and verified 12 low‐frequency PTS1 tripeptides and revealed upstream enhancing and inhibiting sequence patterns for peroxisome targeting, which were subsequently validated in vivo. Follow‐up analysis revealed that nonpolar and acidic residues have relatively strong enhancing and inhibiting effects, respectively, on peroxisome targeting. However, in contrast to the previous understanding, positive charges alone do not show the anticipated enhancing effect and that both the position and property of the residues within these patterns are important for peroxisome targeting. We further demonstrated that the three residues immediately upstream of the tripeptide are the core influencers, with a ‘basic‐nonpolar‐basic’ pattern serving as a strong and universal enhancing pattern for peroxisome targeting. These findings have significantly advanced our knowledge of the PTS1 domain in plants and likely other eukaryotic species as well. The principles and strategies employed in the present study may also be applied to deciphering auxiliary targeting signals for other organelles.
First multigene phylogeny of Cumacea (crustacea: Peracarida)
Authors: Gerken Sarah , Meland Kenneth , Glenner Henrik
Published: May 2022

Cumaceans are small peracarid crustaceans that can be remarkably diverse and important benthic organisms. Despite their ubiquitous presence in soft sediments, no well‐resolved phylogeny currently exists, which impedes ecological and evolutionary studies of the group. We present a phylogeny based on Bayesian inference of six markers (18S, 28S, 12S, 16S, CytB and COI), which recovers monophyly of the order, a deep split between telson and pleotelson bearing groups, and monophyly of four of the seven included families, including monophyletic Pseudocumatidae, Lampropidae, Bodotriidae and Nannastacidae. The only species representing the family Gynodiastylidae in our dataset was positioned among members of Diastylidae in the phylogenetic analyses. However, this result is based on a single partial COI sequence; thus, we consider it doubtful, and the family Diastylidae are otherwise recovered as a monophyletic family. The family Leuconidae is split into two well‐supported clades, a clade containing Antarctic members of the genus Leucon and a separate clade containing non‐Antarctic members of the genera Leucon and Eudorella. The phylogeny is a great stride forwards, as it supports most families as monophyletic, making generic level phylogenies a plausible endeavour in the future.
Reinforcement Learning-Based Sequential Batch-Sampling for Bayesian Optimal Experimental Design
Authors: Ashenafi Yonatan , Pandita Piyush , Ghosh Sayan
Published: May 2022

Engineering problems that are modeled using sophisticated mathematical methods or are characterized by expensive-to-conduct tests or experiments are encumbered with limited budget or finite computational resources. Moreover, practical scenarios in the industry, impose restrictions, based on logistics and preference, on the manner in which the experiments can be conducted. For example, material supply may enable only a handful of experiments in a single-shot or in the case of computational models one may face significant wait-time based on shared computational resources. In such scenarios, one usually resorts to performing experiments in a manner that allows for maximizing one’s state-of-knowledge while satisfying the above-mentioned practical constraints. Sequential design of experiments (SDOE) is a popular suite of methods that have yielded promising results in recent years across different engineering and practical problems. A common strategy that leverages Bayesian formalism is the Bayesian SDOE, which usually works best in the one-step-ahead or myopic scenario of selecting a single experiment at each step of a sequence of experiments. In this work, we aim to extend the SDOE strategy, to query the experiment or computer code at a batch of inputs. To this end, we leverage deep reinforcement learning (RL)-based policy gradient methods, to propose batches of queries that are selected taking into account the entire budget in hand. The algorithm retains the sequential nature, inherent in the SDOE while incorporating elements of reward based on task from the domain of deep RL. A unique capability of the proposed methodology is its ability to be applied to multiple tasks, for example, optimization of a function, once its trained. We demonstrate the performance of the proposed algorithm on a synthetic problem and a challenging high-dimensional engineering problem.
High-Resolution Thermal Profiling of a Combustor in a Non-Dedicated Test Using Thermal History Coatings
Authors: Peral David , Zaid Ahmed , Benninghoven Christoph , Araguás-Rodríguez Silvia , Kluß David , Karagiannopoulos Solon , Krewinkel Robert , Feist Jörg P.
Published: May 2022

The requirement for reduced emissions and the growing demand for gas turbine efficiency are in part met through increasing firing temperatures. However, development budgets leave only limited time for dedicated thermal testing. Consequently, manufacturers are seeking novel temperature measurement technologies to validate new engine designs. This paper will demonstrate how a new temperature mapping technology can be utilized for non-dedicated (multi-cycling) testing while still delivering high-resolution temperature data in a non-dedicated test on a combustor of an industrial gas turbine. Typically, thermocouples are used to monitor the temperature during tests, but they only provide one data point. Color-changing thermal paints are used to deliver measurements over complete surfaces, but they require dedicated testing with short-duration exposure, necessitating dismantling and re-assembling the engine for further testing. Thermal History Coatings (THC) present an alternative solution to providing high-density temperature information. This coating permanently changes consistent with the maximum temperature of exposure during the test. A laser-based instrumentation technique is then used to obtain temperatures. The maximum temperature profile of the surface can be determined through a customized calibration. Given the complex cooling system of a combustor, the high temperatures, and the long-time exposure, this case offers a unique possibility for the testing of the coating under real engine conditions. The coated region covered the external surface of the can. Highly significant is the number of measurement points above 7000 (2 × 2 mm resolution), which enables advanced analysis. This provides insight into the impact of local features, e.g., the region adjacent to a cooling hole. The temperature profile is compared to a computational fluid dynamics-conjugate heat transfer model and thermocouple measurements for the calibration of cooling pre-design methods.
Determining Susceptibility in
Candida
Vaginal Isolates
Authors: Sobel Jack D. , Akins Robert
Published: May 2022

Antifungal drug susceptibility tests (AST) for
Candida albicans
are increasingly demanded for women with refractory or recurrent
Candida
vaginitis due to fluconazole resistance. Given reduced activity of azole drugs at pH levels found in women with
Candida
vaginitis, it is proposed that AST be performed at pH 4.5, since testing at only the recommended pH 7.0 is likely to miss a significant number of clinically relevant azole-resistant
C. albicans
vaginal isolates.
Extremophile Metal Resistance: Plasmid-Encoded Functions in Streptomyces mirabilis
Authors: Brangsch Hanka , Höller Marlene , Krauβe Thomas , Waqas Mohammed , Schroeckh Volker , Brakhage Axel A. , Bunk Boyke , Spröer Cathrin , Overmann Jörg , Kothe Erika
Published: May 2022

Living in extremely metal-rich environments requires specific adaptations, and often, specific metal tolerance genes are encoded on a transferable plasmid. Here,
Streptomyces mirabilis
P16B-1, isolated from a former mining area and able to grow with up to 130 mM NiSO
4
, was investigated.
The Attenuated Pseudorabies Virus Vaccine Strain Bartha Hyperactivates Plasmacytoid Dendritic Cells by Generating Large Amounts of Cell-Free Virus in Infected Epithelial Cells
Authors: Delva Jonas L. , Van Waesberghe Cliff , Van Den Broeck Wim , Lamote Jochen A. , Vereecke Nick , Theuns Sebastiaan , Couck Liesbeth , Favoreel Herman W.
Published: May 2022

The pseudorabies virus (PRV) vaccine strain Bartha has been and still is critical in the eradication of PRV in numerous countries. However, little is known about how this vaccine strain interacts with host cells and the host immune system.
Structure-Guided Synthesis of FK506 and FK520 Analogs with Increased Selectivity ExhibitIn VivoTherapeutic Efficacy against Cryptococcus
Authors: Hoy Michael J. , Park Eunchong , Lee Hyunji , Lim Won Young , Cole D. Christopher , DeBouver Nicholas D. , Bobay Benjamin G. , Pierce Phillip G. , Fox David , Ciofani Maria , Juvvadi Praveen R. , Steinbach William , Hong Jiyong , Heitman Joseph
Published: May 2022

Due to rising rates of antifungal drug resistance and a limited armamentarium of antifungal treatments, there is a paramount need for novel antifungal drugs to treat systemic fungal infections. Calcineurin has been established as an essential and conserved virulence factor in several fungi, making it an attractive antifungal target.
A Siderophore-Encoding Plasmid Encodes High-Level Virulence in Escherichia coli
Authors: Wang Han , Xu Qi , Chen Kaichao , Chan Bill Kwan Wai , Ye Lianwei , Yang Xuemei , Xie Miaomiao , Liu Xiaobo , Ni Hongyuhang , Chan Edward Wai Chi , Chen Sheng
Published: May 2022

Acquisition of pLVPK-like virulence plasmid by
Klebsiella pneumoniae
converts it to hypervirulent
K. pneumoniae
(HvKP), which has become one of the most important clinical bacterial pathogens. The potential of transmission of this virulence plasmid and its contribution to the virulence of other Enterobacteriaceae, such as
E. coli
, are not clear yet.
Vestibular and balance dysfunction in children with congenital CMV: a systematic review
Authors: Shears Annalie , Yan Georgina , Mortimer Harriet , Cross Elizabeth , Sapuan Shari , Kadambari Seilesh , Luck Suzanne , Heath Paul T , Walter Simone , Fidler Katy J
Published: May 2022

Objective

This systematic review evaluates vestibular and balance dysfunction in children with congenital cytomegalovirus (cCMV), makes recommendations for clinical practice and informs future research priorities.

Design

MEDLINE, Embase, EMCARE, BMJ Best Practice, Cochrane Library, DynaMed Plus and UpToDate were searched from inception to 20 March 2021 and graded according to Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) criteria.

Patients

Children with cCMV diagnosed within 3 weeks of life from either blood, saliva and/or urine (using either PCR or culture).

Intervention

Studies of vestibular function and/or balance assessments.

Main outcome measures

Vestibular function and balance.

Results

1371 studies were identified, and subsequently 16 observational studies were eligible for analysis, leading to an overall cohort of 600 children with cCMV. All studies were of low/moderate quality. In 12/16 studies, vestibular function tests were performed. 10/12 reported vestibular dysfunction in ≥40% of children with cCMV. Three studies compared outcomes for children with symptomatic or asymptomatic cCMV at birth; vestibular dysfunction was more frequently reported in children with symptomatic (22%–60%), than asymptomatic cCMV (0%–12.5%). Two studies found that vestibular function deteriorated over time: one in children (mean age 7.2 months) over 10 months and the other (mean age 34.7 months) over 26 months.

Conclusions

Vestibular dysfunction is found in children with symptomatic and asymptomatic cCMV and in those with and without hearing loss. Audiovestibular assessments should be performed as part of neurodevelopmental follow-up in children with cCMV. Case–controlled longitudinal studies are required to more precisely characterise vestibular dysfunction and help determine the efficacy of early supportive interventions.

PROSPERO registration

CRD42019131656.
Short-course intravenous antibiotics for young infants with urinary tract infection
Authors: Lawrence Jolie , Pittet Laure F , Hikmat Samar , Silvester Eloise J , Clifford Vanessa , Hunt Rodney , Gwee Amanda
Published: May 2022

Objective

Shorter courses of intravenous antibiotics for young infants with urinary tract infection (UTI) have myriad advantages. As practice shifts toward shorter intravenous treatment courses, this study aimed to determine the safety of early intravenous-to-oral antibiotic switch and identify risk factors for bacteraemia with UTI.

Methods

Retrospective audit of infants aged ≤90 days with a positive urine culture at a quaternary paediatric hospital over 4 years (2016–2020). Data were collected from the hospital electronic medical record and laboratory information system. Short-course intravenous antibiotic duration was defined as <48 hours for non-bacteraemic UTI and <7 days for bacteraemic UTI. Multivariate analysis was used to determine patient factors predicting bacteraemia.

Results

Among 427 infants with non-bacteraemic UTI, 257 (60.2%) were treated for <48 hours. Clinicians prescribed shorter intravenous courses to infants who were female, aged >30 days, afebrile and those without bacteraemia or cerebrospinal fluid pleocytosis. Treatment failure (30-day UTI recurrence) occurred in 6/451 (1.3%) infants. All had non-bacteraemic UTI and one received <48 hours of intravenous antibiotics. None had serious complications (bacteraemia, meningitis, death). Follow-up audiology occurred in 21/31 (68%) infants with cerebrospinal fluid pleocytosis, and one had sensorineural hearing loss. Bacteraemia occurred in 24/451 (5.3%) infants, with 10 receiving <7 days intravenous antibiotics with no treatment failure. Fever and pyelonephritis were independent predictors of bacteraemia.

Conclusion

Short-course intravenous antibiotics for <48 hours for young infants with non-bacteraemic UTI should be considered, provided meningitis has been excluded. Treatment failure and serious complications were rare in young infants with UTI.
Changes in adolescents’ planned hospital care during the COVID-19 pandemic: analysis of linked administrative data
Authors: Mc Grath-Lone Louise , Etoori David , Gilbert Ruth , Harron Katie L , Woodman Jenny , Blackburn Ruth
Published: May 2022

Objective

To describe changes in planned hospital care during the pandemic for vulnerable adolescents receiving children’s social care (CSC) services or special educational needs (SEN) support, relative to their peers.

Design

Observational cohort in the Education and Child Health Insights from Linked Data database (linked de-identified administrative health, education and social care records of all children in England).

Study population

All secondary school pupils in years 7–11 in academic year 2019/2020 (N=3 030 235).

Main exposure

Receiving SEN support or CSC services.

Main outcomes

Changes in outpatient attendances and planned hospital admissions during the first 9 months of the pandemic (23 March–31 December 2020), estimated by comparing predicted with observed numbers and rates per 1000 child-years.

Results

A fifth of pupils (20.5%) received some form of statutory support: 14.2% received SEN support only, 3.6% received CSC services only and 2.7% received both. Decreases in planned hospital care were greater for these vulnerable adolescents than their peers: −290 vs −225 per 1000 child-years for outpatient attendances and −36 vs −16 per 1000 child-years for planned admissions. Overall, 21% of adolescents who were vulnerable disproportionately bore 25% of the decrease in outpatient attendances and 37% of the decrease in planned hospital admissions. Vulnerable adolescents were less likely than their peers to have face-to-face outpatient care.

Conclusion

These findings indicate that socially vulnerable groups of children have high health needs, which may need to be prioritised to ensure equitable provision, including for catch-up of planned care postpandemic.
Local nitroglycerin to facilitate peripheral arterial cannulation in children: systematic review and meta-analysis
Authors: Wagh Deepika , Pawale Dinesh , Tan Jason Khay Ghim , Rao Shripada C
Published: May 2022

Background

Neonates and children admitted to intensive care units require peripheral arterial cannulation to monitor their blood pressures and for blood sampling, but many times it is unsuccessful.

Objective

To conduct a systematic review and meta-analysis to evaluate the efficacy and safety of local nitroglycerin (NTG) to facilitate peripheral artery cannulation in neonates and children.

Review methods

PubMed, EMBASE, CINAHL, Emcare and Cochrane library were searched till August 2021. Grey literature was searched through Mednar. Data were extracted by two reviewers independently using a prespecified form and the risk of bias was assessed. Meta-analysis was conducted using a random-effects model. The I2statistic was used to quantify statistical heterogeneity. Certainty of evidence was assessed using the criteria of inconsistency, imprecision, indirectness, publication bias and size of effect as per the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) guidelines.

Results

Two randomised controlled trials (RCTs) were included in this meta-analysis (n=153). One was conducted in children 2–8 years of age and the other was in children <2 years. Both trials found increased success rates with the use of local NTG. Pooling of the two studies found that the first-attempt success rate was significantly higher in the NTG group (risk difference: 0.44, 95% CI 0.05 to 0.83; I2=89%). Overall procedure time was significantly lower in the NTG group (mean difference: −100.28 s, 95% CI −136.74 to –63.82; I2=0%). No major complications secondary to the use of NTG were noted. The GRADE of evidence was very low.

Conclusion

Local NTG may be useful in facilitating peripheral arterial cannulation in children. Adequately powered RCTs are needed to confirm these findings.
Training packages for the use of child development tools in low/middle-income countries: a review
Authors: Neocleous Maria , Hepworth Katelyn , Cavallera Vanessa , Gladstone Melissa
Published: May 2022

Background

We are now moving beyond the focus of ‘child survival’ to an era which promotes children thriving and developing rather than simply ‘surviving’. In doing so, we are becoming more aware of the large variation of child development screening tools available globally, but in particular, those in low/middle-income countries (LMICs).

Methods

This narrative review identifies 24 child development tools used in LMICs. We aimed to identify information on training accessibility and training design, assessment methods and cost of training. For those tools with no training information identified or for any tools identified as providing online training, the tool author was contacted individually to obtain information on the features of the tool’s training package.

Results

Information on training features was identified for 18 tools. All of the tools are identified as screening tools with some also identified as surveillance or assessment tools. The training material for the majority of the tools was not readily accessible and most training packages were proprietary and only available with a face-to-face training design. Other training options included a user manual, training videos or training through an online platform.

Conclusions

Training is a key factor when selecting a child development screening or surveillance tool particularly in a low-income or middle-income setting where funds may be limited. The accessibility of training can have a key impact on the implementation and utilisation of tools desperately needed for use in LMICs.
Short-term pulmonary and systemic effects of hydrocortisone initiated 7–14 days after birth in ventilated very preterm infants: a secondary analysis of a randomised controlled trial
Authors: Halbmeijer Nienke M , Onland Wes , Cools Filip , Kroon Andre , van der Heide-Jalving Marja , Dijk Peter , van Straaten Henrica L M , te Pas Arjan B , Mohns Thilo , Bruneel Els , van Heijst Arno F J , Kramer Boris , Debeer Anne , Zonnenberg Inge A , Marechal Yoann , Blom Henry , Plaskie Katleen , Merkus Maruschka P , Offringa Martin , van Kaam Anton H
Published: May 2022

Objective

Observational studies in preterm infants suggest that systemic hydrocortisone improves pulmonary condition but may also lead to systemic adverse effects. We report the short-term pulmonary and systemic effects of hydrocortisone initiated in the second week.

Design

Randomised placebo-controlled trial.

Setting

Dutch and Belgian neonatal intensive care units.

Patients

Infants born <30 weeks’ gestation and/or birth weight <1250 g, and ventilator dependent in the second week of life.

Intervention

Infants were randomly assigned to a 22-day course of systemic hydrocortisone (cumulative dose 72.5 mg/kg; n=182) or placebo (n=190).

Main outcome measures

Data on extubation, ventilator settings, glucose levels, and blood pressure were recorded daily and analysed during the first 7 days of treatment using linear mixed-effects models.

Results

Infants in the hydrocortisone group (24.3%) failed extubation less often compared with placebo (38.6%, crude risk difference: −14.3% (95% CI: −23.4% to −4.8%)). The estimated difference in daily rate of change between hydrocortisone and placebo was −0.42 cmH2O (95% CI: −0.48 to −0.36) for mean airway pressure, −0.02 (95% CI: −0.02 to −0.01) for fraction of inspired oxygen, −0.37 (95% CI: −0.44 to −0.30) for respiratory index, 0.14 mmol/L (95% CI: 0.08 to 0.21) for blood glucose levels and 0.83 mm Hg (95% CI: 0.58 to 1.09) for mean blood pressure.

Conclusions

Systemic hydrocortisone initiated between 7 and 14 days after birth in ventilated preterm infants improves pulmonary condition, thereby facilitating weaning and extubation from invasive ventilation. The effects of hydrocortisone on blood glucose levels and blood pressure were mild and of limited clinical relevance.

Trial registration number

Netherlands Trial Register (NTR2768;https://www.trialregister.nl/trial/2640) and European Union Clinical Trials Register (EudraCT, 2010-023777-19).
Oral and Swallowing Abilities Tool (OrSAT) in nusinersen treated patients
Authors: Berti Beatrice , Fanelli Lavinia , Stanca Giulia , Onesimo Roberta , Palermo Concetta , Leone Daniela , de Sanctis Roberto , Carnicella Sara , Norcia Giulia , Forcina Nicola , Coratti Giorgia , Pera Maria Carmela , Giorgio Valentina , Ausili Cefaro Carolina , Finkel Richard , Pane Marika , Mercuri Eugenio
Published: May 2022

Introduction

The aim of the study was to longitudinally assess swallowing abilities in nusinersen-treated patients with type 1 spinal muscular atrophy.

Methods

Twenty infants with type 1 SMA (11 female and 9 male) treated with nusinersen between 3 weeks and 15 months of age, were assessed using the Oral and Swallowing Abilities Tool (OrSAT). The duration of the follow-up after treatment ranged between 12 months and 62 months.

Results

Twelve of the 20 infants had normal swallowing and there was no need for tube feeding at the time treatment started. Ten of the 12 had consistently normal swallowing with no need for tube feeding on follow-up. The other two required tube feeding but they regained the ability to eat some food by mouth.

The remaining 8 infants already had tube feeding inserted at the time treatment started: 4 of them also had tracheostomy and they showed no changes on the OrSAT Scale. The other 4 who had tube feeding but no tracheostomy had partial functional improvement.

Conclusion

Our results suggest that the degree of functional impairment at the time treatment is started can help to predict the progression of swallowing abilities. The use of a structured assessment also helped to detect partial improvements.
Idiopathic chronic eosinophilic pneumonia: a differential diagnosis of lower respiratory tract infection
Authors: Elswood Thomas Robert , Turner Coralie , Hornsby James
Published: May 2022

A 43-year-old woman presented with a presumed lower respiratory tract infection, with symptoms of persistent cough, lethargy, fevers and night sweats. Initial general practitioner assessment revealed raised C reactive protein and a leucocytosis comprising both a neutrophilia and an eosinophilia. The patient was initially treated for bacterial pneumonia. Despite treatment, the patient’s condition did not improve and hospital admission was arranged for further investigation. Initial physical examination was unremarkable. A chest X-ray revealed bilateral, symmetrical, peripheral consolidation with an upper zone predominance. Subsequently, endobronchial washings revealed abundant eosinophils. A diagnosis of idiopathic chronic eosinophilic pneumonia was made, and the patient responded well to oral corticosteroids with complete resolution of radiological appearances 1 month later.
Case of spontaneous intracranial hypotension: clinical, neuroimaging and treatment approach
Authors: Siripurapu Govinda , Pandit Awadh Kishor , Radhakrishnan Divya M , Srivastava Achal Kumar
Published: May 2022

A woman in her 40s presented with a 3-month history of intermittent bilateral daily headache of moderate intensity. She had severe headaches for almost 1 month prior to the presentation, which was aggravated by standing and relieved by lying down. She underwent a non-contrast CT of the head followed by MRI of the brain and spine. Neuroimaging of the brain showed features of intracranial hypotension and spine MRI myelography fast imaging employing steady state acquisition sequences confirmed the site of cerebrospinal fluid (CSF) leak. An epidural blood patch (EBP) was placed to close the CSF leakage site. She had significant improvement in her symptoms and repeat MRI at 4 weeks of follow-up showed resolution of imaging abnormalities. She became symptom-free without the requirement of additional EBP. Our report highlights the importance of suspecting and evaluating spontaneous intracranial hypotension in a patient presented with a typical orthostatic headache. Early intervention and keeping a low threshold for evaluation based on a few early clinical and imaging clues can lead to successful management of such cases.
Osteomas of temporal bone: a rare presentation
Authors: Dinakaran Nethra , Balakumar Vivekanandan , Saravanam Prasanna Kumar
Published: May 2022

Osteoma of the temporal bone is an unusual benign slow-growing tumour composed of mature lamellar bone. It is a single pedunculated mass that often occurs unilaterally. Osteomas of external auditory canal are more common than in the other parts of temporal bone. Clinical presentation includes ear pain, hearing loss, tinnitus or vertigo. More often these lesions are an incidental finding during radiographic evaluation. Surgical excision of the osteoma is preferred in cases with impending complications. Here, we report a 36-year-old woman who came with problems of ear discharge, ear pain, hearing loss and occasional bleeding from the ear. She was diagnosed with osteoma of temporal bone with erosion of lateral semicircular canal and facial canal. Osteoma was excised and the defective areas were reconstructed.
Management of a severe bilateral pulmonary embolism as a complication of VITT following vaccination with AstraZeneca COVID-19 vaccine
Authors: Elkoumy Mohammed , Schoen Julika , Loew Andreas
Published: May 2022

Since the start of vaccination against COVID-19 viral infection using adenovirus-based vector vaccine (eg, The Oxford–AstraZeneca vaccine, using the modified chimpanzee adenovirus ChAdOx1, and the Johnson & Johnson vaccine, using human adenovirus serotype 26), a rare, but potentially life-threatening complication called vaccine-induced thrombotic thrombocytopenia (VITT) was reported. As the number of cases increases every day, with the increase in the number of vaccinated people all over the world, this complication is a concern to the medical field. We report a case on the acute management of a patient who presented to us with life-threatening bilateral pulmonary embolism as a complication of VITT after the first dose of vaccination with Oxford–AstraZeneca vaccine against COVID-19.
Fracture of a titanium femoral neck after revision total hip arthroplasty
Authors: Zimmerer Alexander , Ogunleye Philips , Navas Luis , Hauschild Matthias
Published: May 2022

We report a case of a fractured titanium alloy (Ti6Al4V) femoral stem 2 years after revision (debridement, antibiotics and implant retention due to periprosthetic joint infection) total hip arthroplasty (THA). Material analysis revealed a superficial abnormality on the upper neck surface caused by local melting with electrocautery probably acting as a stress amplifier. This lesion presumably was the trigger of a fatigue fracture with typical features on the fracture surface. Electrocautery should therefore be avoided in case of revision THA or used with utmost care to avoid contact with the femoral stem
Lymph node recurrence after right colon resection for cancer: evidence for the utilisation of complete mesocolic excision
Authors: Connelly Tara M , Clancy Cillian , Steele Scott R , Kessler Hermann
Published: May 2022

Complete mesocolic excision (CME) of colon cancer is a resection performed along embryological planes to include the completely intact mesentery surrounding the tumour with a high central vascular ligation. The aim is to remove all lymph nodes draining the cancer. Proponents of the technique cite the significantly decreased local recurrence and improved 5-year survival rates associated with CME versus conventional colectomy. Although increasingly performed in many centres, it has not yet gained widespread acceptance as it is technically more challenging and can incur an increased bleeding risk. A man in his 80s underwent a conventional right hemicolectomy for a pT4aN2aM0 ascending colon cancer at another institution. This was followed by chemotherapy. He presented to our institution 2 years later with an isolated 3.7×3.2 cm mesenteric tumour adjacent to his anastomosis. There was no intraluminal recurrence. He then underwent a repeat extended right colectomy with CME. Pathology confirmed lymph node recurrence. His case demonstrates the importance of CME in reducing carcinoma recurrence risk.
Non-arteritic anterior ischaemic optic neuropathy (NA-AION) and COVID-19 vaccination
Authors: Sanjay Srinivasan , Acharya Isha , Rawoof Abdul , Shetty Rohit
Published: May 2022

A woman in her 50s presented with diminution of vision in her left eye (OS) 4 days after COVISHIELDTMvaccination. She had been diagnosed with non-arteritic anterior ischaemic optic neuropathy (NA-AION) of right eye (OD) 8 months earlier. The present episode revealed a best-corrected visual acuity (BCVA) of 20/50 in OD and 20/20 in OS with grade 1 relative afferent pupillary defect. Fundus evaluation showed pale disc in OD and temporal disc oedema in OS. Humphrey’s visual field analysis showed incomplete inferior altitudinal defect in OD and a centro-caecal scotoma in OS. Systemic investigations were normal. OS was diagnosed with NA-AION. She was started on oral aspirin 75 mg. At 1-month follow-up, disc oedema of OS had resolved with BCVA maintaining at 20/20. The patient was lost to follow-up later. The relationship between the vaccine and the ocular event is temporal with no causal association.
Difficult acute lymphoblastic leukaemia diagnosis in a paediatric patient with mixed presentation of COVID-19 acute respiratory failure and multisystemic inflammatory syndrome
Authors: Domínguez-Rojas Jesús Angel , Rojas-Soto Ninoska , Vásquez-Hoyos Pablo , Coronado Munoz Alvaro J
Published: May 2022

New diagnoses of leukaemia and other malignancies are recently being made in paediatric patients with COVID-19. The rates of mortality and morbidity in some of these children are expected to be higher. In new cases, concurrent diagnosis can be difficult because multisystemic inflammatory syndrome (MIS-C) and malignancies have similar clinical presentations. We present the case of a preteenage child where the diagnosis of leukaemia was complicated and delayed by a multisystem involvement and an inconclusive bone marrow study. Clinical teams managing children with COVID-19 and MIS-C should suspect leukaemia and other malignancies when the clinical course is complicated and bone marrow suppression is persistent. Prompt diagnosis will allow start of treatment on time, minimising complications.
Cushing syndrome due to ectopic ACTH secreting pheochromocytoma
Authors: Naeem Durrani Muhammad , Popal Ubaidullah
Published: May 2022

In this case report, we present a case of a woman in her late 30s who presented with bilateral motor weakness, headache, hyperglycaemia and hypertension. Investigations revealed very high 24-hour urine cortisol of 90 524, ectopic adrenocorticotropic hormone secreting pheochromocytoma, normal metanephrine levels and empty sella, which has never been reported. CT chest and abdomen revealed enlarged left adrenal gland with large necrotic mass 4.7×4.0 cm most likely neoplastic lesion. The patient was cured after surgical removal of the left adrenal mass. Histological examination revealed 3.5×2.5×2 cm mass consistent with pheochromocytoma. After surgery and a short stay in the intensive care unit, the patient started improving and both antihypertensive treatment and insulin injections were withdrawn.
Advances in prenatal diagnosis of fetal otocephaly by 3D imaging
Authors: Kinkel Janis , Rduch Thomas , Abgottspon Désirée , Fischer Tina
Published: May 2022

The case presented here shows the rare diagnosis of fetal otocephaly with lethal prognosis due to impossible airway management after birth. Otocephaly is characterised by fetal agnathia, microstomia and synotia. As in our case, otocephaly is usually not recognised until the third trimester and leads to challenging clinical situations and decision making.

A woman in her 30s presented to our tertiary hospital at 27 weeks of gestation because of an unexplained polyhydramnios. 3D imaging illustrated the complex syndrome of otocephaly and helped understand the present disease patterns. After premature birth, palliative care was agreed on and the newborn was able to pass away peacefully in the arms of his parents.

We recommend the implementation of 3D imaging into routine scans for the assessment of the fetal face and ears, especially in situations of unexplained polyhydramnios.
Salmonella typhimuriumas a causative agent of spontaneous bacterial peritonitis
Authors: Barry Katherine , Finn Arkadiy
Published: May 2022

Spontaneous bacterial peritonitis (SBP) is a common complication of liver cirrhosis and abdominal ascites, usually caused by organisms from the Enterobacteriaceae family. A woman in her 40s with a history of alcoholic liver cirrhosis presented to the hospital with dyspnoea, abdominal distention and diffuse abdominal pain. She was found to have sepsis and abdominal ascites, with elevated ascitic fluid neutrophil counts consistent with SBP. Culture of ascitic fluid revealedSalmonella typhimurium. Further investigation revealed that the patient shared her home with a pet bearded dragon, a reptile known to carrySalmonellaspp. She was treated with intravenous ceftriaxone and oral ciprofloxacin for a total of 14 days.S. typhimurium, likely transmitted to the patient from the pet reptile, is a rare pathogen in SBP and highlights the importance of environmental exposures in the management of this condition.
Delayed drug hypersensitivity reaction to secukinumab in a patient with hidradenitis suppurativa
Authors: Konda Sasank , Shetty Nayha , Friedman Ben , Veenstra Jesse
Published: May 2022

A woman in her 30s presented to the dermatology clinic with widespread, pruritic, red papules and plaques involving the ears, trunk and extremities. The rash developed a few days after receiving her second injection of secukinumab, which was initiated for recalcitrant Hurley stage III hidradenitis suppurativa. Investigations revealed a psoriasiform drug hypersensitivity reaction secondary to secukinumab. In this report, we describe the clinical course, histopathological correlation and treatment of this rarely documented reaction.
Spontaneous haematomas and haematochezia due to vitamin C deficiency in a haemodialysis patient
Authors: Zhou James Q , Velimirovic Marko , Chang Leslie L , Fenves Andrew Z
Published: May 2022

A man in his 50s with dialysis-dependent end-stage renal disease, several weeks history of progressive skin bruising and acute-onset gastrointestinal bleeding presented to the emergency department following a syncopal event during routine haemodialysis owing to profound hypotension. He was found to have a severe normocytic, normochromic anaemia requiring several blood transfusions. He followed a diet lacking fruits and vegetables and stopped taking renal multivitamins. All parameters of coagulation were unremarkable, but serum vitamin C level was undetectable, supporting a diagnosis of scurvy. Although typically associated with individuals who are at risk of malnourishment, such as those with alcohol use disorder, malabsorption, and those who experience homelessness, scurvy should be considered in patients receiving renal replacement therapy as vitamin C is removed during haemodialysis.