bluuebunny/crossref_metadata_2025 huggingface dataset:
Systematic Review and Meta-analysis for Surgery Versus Stereotactic Radiosurgery for Jugular Paragangliomas
Authors: Campbell James C. , Lee Jessica W. , Ledbetter Leila , Wick Cameron C. , Riska Kristal M. , Cunningham Calhoun D. , Russomando Alessandra C. , Truong Tracy , Hong Hwanhee , Kuchibhatla Maragatha , Kaylie David M.
Published: February 2023

Objective

Comprehensively analyze tumor control and treatment complications for jugular paraganglioma patients undergoing surgery versus stereotactic radiosurgery (SRS).

Databases Reviewed

EMBASE, Medline, and Scopus.

Methods

The databases were searched for English and Spanish articles from January 1, 1995, to January, 1, 2019, for studies reporting tumor control and treatment side effects regarding patients with jugular paraganglioma treated with surgery or SRS. Main outcome measures included short-term and long-term tumor recurrence, as well as postintervention complications.

Results

We identified 10,952 original abstracts, 705 eligible studies, and 107 studies for final data extraction. There were 3,498 patients—2,215 surgical patients and 1,283 SRS patients. Bayesian meta-analysis was applied to the extracted data, with tau measurements for study heterogeneity. SRS tumors were larger (3.9 cm3 versus 8.1 cm3). Meta-analysis results demonstrated low rates of long-term recurrence for both modalities (surgery, 15%; SRS, 7%), with SRS demonstrating lower rates of postintervention cerebrospinal fluid leak, dysphagia, and cranial nerve Vll, lX, X, Xl, or Xll palsies.

Conclusions

This study demonstrates excellent control of jugular paragangiomas with both surgery and SRS, with higher rates of lower cranial neuropathies, dysphagia, and cerebrospinal fluid leaks among surgical patients.
Readability and Quality of English and Spanish Online Health Information about Cochlear Implants
Authors: Nix Evan , Willgruber Abbigayle , Rawls Chase , Kinealy Brian P. , Zeitler Daniel , Schuh Marissa , Bush Matthew
Published: February 2023

Objective

According to the American Medical Association, Internet web site health information should be written at or below a 6th grade reading level. The purpose of this study was to evaluate the readability and quality of cochlear implant web site health information.

Study Design

Cross-sectional web site analysis.

Setting

Four Internet search engines involving the top 200 web sites (English and Spanish).

Intervention/Methods

“Cochlear implant” was queried in four Internet search engines, and the top 200 English and Spanish web sites were aggregated. After removing duplicates, the web sites were evaluated for readability by using the following validated online readability calculators: Flesch Reading Ease score for English web sites and the Fernandez–Huerta Formula for Spanish web sites. Information quality was assessed using the validated DISCERN quality criteria and the presence of Health on the Net Code of Conduct (HONcode) certification.

Results

A total of 80 non-industry-sponsored (43 English and 37 Spanish) and 11 industry-sponsored (4 English and 7 Spanish) cochlear implant health information web sites were included in the study. English web sites were written at a higher reading level (mean = 50.88, SD = 11.98) compared with Spanish web sites (mean = 59.79, SD = 6.04) (p < 0.01). For both English and Spanish web sites, these scores correlate to the reading level of the average 10th to 12th grade student. Only 12% of Spanish web sites and 27% of English web sites were HONcode certified. The average DISCERN quality score was 41.67 for English web sites and 43.46 for Spanish, indicating significant concerns for quality. There was no association found between readability and quality of the web sites analyzed.

Conclusions

Patient-directed English and Spanish web sites regarding cochlear implantation were written at reading levels that significantly exceed those recommended by the AMA. Furthermore, these web sites have significant quality shortcomings. Patients would benefit from more rigorous editing to improve readability and quality of content.
Institutional Experience With Cochlear Implants Falling Under the 2020 FDA Corrective Action
Authors: Schwam Zachary G. , Perez Enrique , Goldin Lisa , Wong Kevin , Fan Caleb , Oh Samuel , Wanna George B. , Cosetti Maura K.
Published: February 2023

Objective

To determine the rate of device failure for those cochlear implants falling under the 2020 Food and Drug Administration (FDA) voluntary corrective action.

Study Design

Retrospective chart review.

Setting

Tertiary otology-neurotology practice.

Patients

Those with cochlear implant failure falling under the FDA corrective action.

Interventions

Cochlear implant explant and reimplantation.

Outcome Measures

Reason for cochlear implant failure, time to failure, symptoms of failure, and benefit from reimplantation.

Results

The overall failure rate was 20.0% (18 of 90 ears); of the failures, 15 of 18 (83.3%) were hard device failures, and 3 of 18 (16.7%) were medical or surgical failures. All hard device failures were confirmed with integrity testing as performed by the company. The average time to integrity testing was 38.0 months. Of the hard failures, 14 of 15 had successful initial activation and benefit. Lack of expected progress was seen in 7 of 15 and a sudden decline in function in 8 of 15. Electrodes 9 to 16 were most often defunct. Significant drops in speech perception were often seen in device failure cases. Three medical/surgical failures were explanted; one had migration of the receiver/stimulator causing discomfort, and the other two had electrode migration after partial insertion. Of the reimplanted patients, 11 of 12 are deriving benefit from their new devices.

Conclusions

The rate of device failure for the cochlear implants of interest is significantly higher in our series than reported in the initial FDA voluntary field corrective action publication.
Hearing After Vestibular Schwannoma Surgery: Is It Preserved Forever?
Authors: Fik Zdenek , Zverina Eduard , Lisy Jiri , Balatkova Zuzana , Vlasak Ales , Chovanec Martin , Lazak Jan , Tesarova Michaela , Peterkova Lenka , Betka Jan
Published: February 2023

Introduction

Currently, it is possible to preserve the auditory nerve in a large number of cases, but the preservation of the hearing itself is unpredictable. Apart from wait and scan strategy and stereoradiotherapy, hearing after vestibular schwannoma surgery is considered to remain stable even in long-term follow-up.

Materials and Methods

Twenty-eight patients had preserved hearing after retrosigmoid suboccipital microsurgery of the vestibular schwannoma between 2008 and 2014. A standard audiological protocol was performed together with an magnetic resonance imaging evaluation of the fluid content of the inner ear.

Results

The mean difference in pure-tone average between the direct and final postsurgical examination was 12.758 dB (p = 2.5E − 06). The word recognition score deteriorated by 17.45% (p = 0.03516). The mean American Academy of Otolaryngology–Head and Neck Surgery score on the second examination was 2.5, and that on the second examination was 3.111 (p = 0.00483). There was no significant deterioration in the healthy ear.

The signal intensity ratio in the basal turn of the cochlea increased by an average of 0.13 points (p < 0.05).

Patients with persistent tumor or nodular enhancement in the internal acoustic meatus deteriorated significantly in hearing according to the American Academy of Otolaryngology–Head and Neck Surgery scale compared with patients without any finding in the meatus (p = 0.01299).

Conclusions

There is a discrete but gradual deterioration of the hearing in the postoperative period. Hearing impairment is more pronounced in patients with a nodular process in the internal acoustic meatus, regardless of whether it is growth active. After surgery, the pathological content of the inner ear normalizes (evaluated on T2 magnetic resonance imaging sequences).
Predictors of Short-Term Changes in Quality of Life after Cochlear Implantation
Authors: Walia Amit , Bao James , Dwyer Noel , Rathgeb Susan , Chen Stephanie , Shew Matthew A. , Durakovic Nedim , Herzog Jacques A. , Buchman Craig A. , Wick Cameron C.
Published: February 2023

Objective

This study aimed 1) to measure the effect of cochlear implantation on health-related quality of life (HR-QOL) using the Cochlear Implant Quality of Life (CIQOL) questionnaire and 2) to determine audiologic, demographic, and non-CI/hearing-related QOL factors influencing the CIQOL.

Study Design

Prospective observational study.

Setting

Tertiary referral center.

Patients and Interventions

Thirty-seven adult patients with sensorineural hearing loss undergoing cochlear implantation.

Main Outcome Measure(s)

CIQOL-global score preimplantation and 6 months postimplantation. Physical function score as measured by the short-form survey, audiologic, and demographic variables.

Results

CIQOL showed significant improvement from preimplantation to 6 months postactivation with a mean difference of 14.9 points (95% confidence interval, 11.3 to 18.5, p < 0.0001). Improvement in CIQOL (ΔCIQOL) correlated linearly with age (r = −0.49, p = 0.001) and improvement in speech perception testing (r = 0.63, p < 0.0001). Multivariate modeling using age and change in consonant–vowel nucleus–consonant (CNC) score explained 46% of the variability measured by the ΔCIQOL-global score.

Conclusions

Nearly all CI recipients achieve significant gains for all domains as measured by the CIQOL. However, younger patients and those with a greater improvement in speech perception performance (CNC) are more likely to achieve a greater CIQOL benefit. Results here suggest the importance of considering preoperative CIQOL and speech perception measures when evaluating predictors of HR-QOL.
Psychometric Properties of the Short Version of the Activities-Specific Balance Confidence Scale in Vestibular Patients
Authors: Castillejos-Carrasco-Muñoz Rodrigo , Ibáñez-Vera Alfonso Javier , Peinado-Rubia Ana Belén , Tapia-Toca Maria Cruz , Paez-Mantilla Daniela , Lomas-Vega Rafael
Published: February 2023

Background

This study aimed to analyze the psychometric properties of the Activities-specific Balance Confidence Scale Short Version (ABC-6) in vestibular patients.

Methods

The sample consisted of 87 subjects aged over 18 years with vestibular pathology. Construct validity, internal consistency, test-retest reliability, concurrent validity, and capacity to discriminate between subjects with or without risk of falling as measured with the ABC-16 standard version were analyzed.

Results

The ABC-6 showed a unifactorial structure. Cronbach's alpha was 0.873. The reliability was moderate for each of the items and substantial for the total score (intraclass correlation coefficient = 0.778). The standard error of measurement was 10.24, with a minimum detectable change of 20.07. The ABC-6 version showed a strong correlation with physical and functional measures, moderate correlation with emotional measures, and poor correlation with the Physical Component Summary of SF-12 and retrospective 12-month falls. A cutoff point ≤55 showed a sensitivity = 94.44% and a specificity = 92.75% in differentiating between patients with or without risk of falling measured with the ABC-16 standard version, with an area under the curve = 0.975.

Conclusions

The ABC-6 showed acceptable psychometric properties for measuring balance confidence and risk of falling in vestibular patients.
Effect of a CI Programming Fitting Tool with Artificial Intelligence in Experienced Cochlear Implant Patients
Authors: Wathour Justine , Govaerts Paul J. , Lacroix Emilie , Naïma Deggouj
Published: February 2023

Objective

Cochlear implants (CIs) are the treatment of choice for patients with severe to profound hearing loss. The hearing results, however, considerably vary across patients. This may partly be due to variability in the CI fitting. We investigated the effect of FOX, a software tool to program CIs using artificial intelligence (AI), on hearing outcomes.

Methods

Forty-seven experienced CI patients who came to our tertiary CI center for their annual follow-up between 2017 and 2020 were recruited for this study. They received a new CI map created by the AI software tool. CI parameters and auditory outcomes obtained with this new map were compared with those of the initial manual map after 15 days of take-home experience. Within-patient differences were assessed. At the end of the study, the patients were offered a choice to continue using the AI map or to revert to their old manual map.

Results

Several auditory outcomes improved with the AI map, namely, pure tone audiometric threshold at 6,000 Hz (median improvement 10 dB, range = −20 to 50 dB, Z = −2.608, p = 0.008), phonemic discrimination scores (median improvement 10%, range = 0% to 30%, Z = −4.061, p = 0.001), and soft-intensity (median improvement of 10%, range = −20% to 90%, Z = −4.412, p < 0.001) to normal-intensity (median improvement of 10%, range = −30% to 60%, Z = −3.35, p < 0.001) speech audiometric scores.

Conclusion

The AI-assisted CI mapping model as a potential assistive tool may improve audiological outcomes for experienced CI patients, including high-frequency pure tone audiometry and audiometric speech scores at low and normal presentation levels.

Clinical trial registration: NCT03700268
Cochlear Implantation after Stereotactic Radiosurgery for Vestibular Schwannoma: Initial Hearing Improvement and Longevity of Hearing Restoration
Authors: Young Kurtis , Grewal Maeher R. , Diaz Rodney C. , Wu Arthur W. , Miller Mia E.
Published: February 2023

Objective

The following research question was asked: In patients with vestibular schwannoma (VS) that underwent stereotactic radiosurgery (SRS) and cochlear implantation, were improvements in hearing function observed, and what was the cochlear implant (CI) failure rate of in these patients?

Data Sources

PubMed/Medline, CINAHL (EBSCOhost), and Web of Science articles without restrictions on publication dates were searched.

Study Selection

Inclusion criteria required that the article was a report, a series, or a retrospective review with individual case data available. Non-English articles were excluded. Inclusion criteria required that patients were with VS and underwent subsequent SRS and cochlear implantation. Patients receiving microsurgery or stereotactic radiotherapy on the ipsilateral ear were excluded from this study.

Data Extraction

Included studies were evaluated using full-text evaluation, and data on study characteristics (author names, gender), clinical data (syndromic information, SRS modality), hearing outcomes, and device failure were extracted.

Data Synthesis

Means and averages were obtained for all continuous variables. Percentages were ascertained for all categorical variables.

Conclusions

The majority of patients undergoing CI placement in VS treated with SRS achieved open-set speech perception (79.2%) or environmental sound awareness (6.8%). Twelve implants (20.3%) failed. Three patterns were associated with failure: 1) immediate-onset failure, 2) initial benefit with delayed failure, 3) poor local control with device explantation.
Variable Sequestration of Antifungals in an Extracorporeal Membrane Oxygenation Circuit
Authors: Lyster Haifa , Pitt Timothy , Maunz Olaf , Diamond Suzanne , Roberts Jason A. , Brown David , Mills Jeremy , Armstrong-James Darius , Gerovasili Vicky , Carby Martin , Dunning John , Simon Andre , Reed Anna
Published: February 2023

Fungal infections are common and frequently associated with clinical failure in patients receiving extracorporeal membrane oxygenation (ECMO). Antifungal drugs have physicochemical characteristics associated with a higher likelihood of sequestration onto ECMO circuitry potentially leading to a subtherapeutic drug concentration. The percentage of sequestration of the antifungal drugs—caspofungin, posaconazole, and voriconazole—was determined using an ex vivo ECMO model. The circuits were primed with whole human blood, sodium chloride 0.9%, and human albumin solution. Serial 2 ml samples were taken at baseline, 0.5, 1, 2, 6, 12, and 24 hours after drug addition, paired with non-ECMO controls stored in a water bath at 37°C. Mean loss from the blood-primed ECMO circuits and controls at 24 hours relative to baseline were 80% and 61% for caspofungin (p = ns), 64% and 11% for posaconazole (p < 0.005), and 27% and 19% for voriconazole (p < 0.05). Calculated AUC0–24 showed a 44% for caspofungin (p = ns), 30.6% posaconazole (p < 0.005), and 9% loss for voriconazole (p = 0.003) compared with the controls, suggesting therapeutic concentrations of these antifungal agents cannot be guaranteed with standard dosing in patients on ECMO. Posaconazole exhibited the greatest loss to the ECMO circuit correlating with both high lipophilicity and protein binding of the drug.
Ventricular Flow Dynamics with an Intra-Ventricular Balloon Pump: An In Vitro Analysis
Authors: Boone Alice C. , Sing Taylor R. , Semenzin Clayton , Liao Sam , Pauls Jo P. , Gregory Shaun D. , Tansley Geoff D.
Published: February 2023

Due to the high treatment costs associated with durable ventricular assist devices, an intra-ventricular balloon pump (IVBP) was developed to provide low-cost, short-term support for patients suffering from severe heart failure. It is imperative that intraventricular flow dynamics are evaluated with an IVBP to ensure stagnation points, and potential regions for thrombus formation, are avoided. This study used particle image velocimetry to evaluate flow patterns within the left ventricle of a simulated severe heart failure patient with IVBP support to assess left ventricle pulsatility as an indicator of the likelihood of flow stasis. Two inflation timings were evaluated against the baseline severe heart failure condition: IVBP co-pulsation and IVBP counter-pulsation with respect to ventricular systole. IVBP co-pulsation was found to have a reduced velocity range compared to the severe heart failure condition (0.44 m/s compared to 0.54 m/s). IVBP co-pulsation demonstrated an increase in peak velocities (0.25 m/s directed toward the aortic valve during systole, as opposed to 0.2 m/s in severe heart failure), indicating constructive energy in systole and cardiac output (1.7 L/min increase with respect to severe heart failure baseline – 3.5 L/min) throughout the cardiac cycle. IVBP counter-pulsation, while exhibiting the greatest peak systolic velocity directed to the aortic valve (0.4 m/s) was found to counterasct the natural vortex flow pattern during ventricular filling, as well as inducing a secondary ventricular pulse during diastole and a 23% increase in left ventricle end-diastolic volume (indicative of dilation). Ideal IVBP actuation timing did not result in reduced intraventricular pulsatility, indicating promising blood washout.
Safety and efficacy of caplacizumab in a case of thrombotic thrombocytopenic purpura in the postpartum period
Authors: Bruzzese Antonella , Vigna Ernesto , Martino Enrica Antonia , Mendicino Francesco , Lucia Eugenio , Olivito Virginia , Mazzulla Rosanna , De Rose Silvia , Cozza Pietro Pasquale , Bova Carlo , Filippelli Gianfranco , Zinno Francesco , Morelli Michele , Morabito Fortunato , Gentile Massimo
Published: February 2023

Thrombotic thrombocytopenic purpura (TTP) is a rare and life-threatening disease for which pregnancy and the postpartum period represent risk factors. Here, we present the case of a 39-year-old woman at the 31st week of gestation, who presented with cutaneous haemorrhagic symptoms. The complete blood count showed anaemia, thrombocytopenia, increase in haemolysis indices and undetectable ADAMTS13 activity. Acquired TTP was diagnosed, and she started daily plasma exchange (PEX) and methylprednisolone. After 5 days, an emergency caesarean section was performed with success because of pathologic cardiotocographic findings. After 7 days of PEX, the patient showed an initial laboratoristic improvement; unfortunately, 3 days later, she had a recurrence of disease and started daily PEX, caplacizumab and steroid, obtaining a haematological improvement.

No literature data about caplacizumab use in pregnant or breastfeeding patients are available. In the present study, we describe that caplacizumab in the postpartum period could be well tolerated and effective.
Effect of Delayed Endoscopy Protocol on Timing and Safety of Endoscopy for Foreign Body Ingestion and Esophageal Food Impaction
Authors: Karb Daniel , DeLozier Sara , Raad Dany , Dumot John , Mok Shaffer
Published: February 2023

Background and Aims:

Endoscopic procedures for foreign body ingestion (FBI) and esophageal food impactions (EFI) performed during on-call hours are associated with increased stress, risk, and cost. We implemented a Foreign Body Algorithm (FBA) designed to delay all but the most urgent endoscopy for EFI and FBI until regular working hours.

Methods:

Using endoscopy records from multiple academic and community hospitals within a large integrated health system in the United states, we identified esophagogastroduodenoscopy (EGD) performed for food impactions and foreign body ingestions occurring between May 2011 and February 2021.

Results:

We identified 479 EGDs performed for FBI and EFI. The introduction of the FBA was associated with a shorter length of stay (LOS) for overall cases (0.35 vs. 0.8 d P<0.001), day cases (0.16 vs. 1.0 d P<0.001), and night cases (0.40 vs. 0.6 d P=0.03). The introduction of the FBA did not change the rate of overall adverse events (AE) or night AE. AE from the entire cohort was rare (3%; 16 total). Of the AE, most were sedation related. The introduction of the FBA did not affect the overall rate of night cases or AE, but the rate of after-hours endoscopy for intentional ingestions decreased from 17.2% to 3.1% (P=0.01).

Conclusion:

This is one of the largest studies of esophageal impactions and foreign bodies in adults in the United States, and the first to examine the effects of a protocol designed to avoid after-hours endoscopy. These results suggest that postponing after-hours EGD until the daytime is not associated with adverse safety outcomes or increased LOS.
Indirect calorimetry: should it be part of routine care or only used in specific situations?
Authors: Sundström Rehal Martin , Tatucu-Babet Oana A. , Oosterveld Timo
Published: February 2023

Purpose of review

Indirect calorimetry is increasingly recommended to guide energy delivery in the ICU. This review aims to provide a critical overview of current literature in support of these recommendations.

Recent findings

There is insufficient evidence to ascertain a mortality benefit from indirect calorimetry-guided energy delivery. However, large variations in energy expenditure during critical illness pose a risk for significant under- and overfeeding if indirect calorimetry is not routinely used.

Even in the absence of demonstrable clinical benefits, there is a strong physiological rationale in favor of performing indirect calorimetry. Measurements can be prioritized in complex patients and should be repeated during prolonged ICU stay.
Increased blood lactate during enteral nutrition in the critically ill: associations and treatment options
Authors: Piton Gaël , Reignier Jean , Calame Paul
Published: February 2023

Purpose of review

To evaluate the significance of blood lactate increase during enteral nutrition in the critically ill, and to propose diagnostic and therapeutic strategies.

Recent findings

Acute mesenteric ischemia occurs in approximately 1% of critically ill patients treated with catecholamine. Recent literature suggests that enteral nutrition is a risk factor of acute mesenteric ischemia, in particular in case of low cardiac output, by a mechanism of nonocclusive mesenteric ischemia. The association of clinical, biological, and computed tomography imaging might help to evaluate the reversibility of acute mesenteric ischemia.

As enteral nutrition induces an increased metabolic work of the gut, the inadequation between oxygen delivery and demand exposes the gut to a phenomenon of nonocclusive mesenteric ischemia. Before initiation of enteral nutrition,, and before each increase of the enteral nutrition dose, the risk factors of nonocclusive mesenteric ischemia should be searched in order to prevent it. While under enteral nutrition, increased lactate concentration while receiving enteral nutrition requires the urgent search for nonocclusive mesenteric ischemia, and the adaptation of enteral nutrition (reduction, stop, and/or switch to parenteral nutrition or tolerate early nutrient restriction). Early signs of nonocclusive mesenteric ischemia should be searched in order to allow for a rapid diagnosis, before development of irreversible transmural necrosis. After the diagnosis of acute mesenteric ischemia, improving the balance between oxygen demand and delivery to the gut, evaluating the reversibility of the gut ischemia, and performing urgent resection in case of irreversible transmural necrosis should be the main objectives. After the resolution of acute mesenteric ischemia, the benefit risk analysis of enteral nutrition reintroduction should be evaluated.
Nutrition and epigenetic programming
Authors: Carlberg Carsten , Velleuer Eunike
Published: February 2023

Purpose of review

The aim of this study is to highlight the epigenomic programming properties of nutritional molecules and their metabolites in human tissues and cell types.

Recent findings

Chromatin is the physical expression of the epigenome and has a memory function on the level of DNA methylation, histone modification and 3-dimensional (3D) organization. This epigenetic memory does not only affect transient gene expression but also represents long-lasting decisions on cellular fate. The memory is based on an epigenetic programming process, which is directed by extracellular and intracellular signals that are sensed by transcription factors and chromatin modifiers. Many dietary molecules and their intermediary metabolites serve as such signals, that is they contribute to epigenetic programming and memory. In this context, we will discuss about molecules of intermediary energy metabolism affecting chromatin modifier actions, nutrition-triggered epigenetic memory in pre- and postnatal phases of life; and epigenetic programming of immune cells by vitamin D. These mechanisms explain some of the susceptibility for complex diseases, such as the metabolic syndrome, cancer and immune disorders.

The observation that nutritional molecules are able to modulate the epigenome initiated the new nutrigenomic subdiscipline nutritional epigenetics. The concept that epigenetic memory and programming is directed by our diet has numerous implications for the interpretation of disease risk including their prevention.
Nutrition in intestinal transplantation: centre stage or supporting act?
Authors: Van Oosterwyck Aude , Lauwers Nathalie , Pauwels Nelle , Vanuytsel Tim
Published: February 2023

Purpose of review

Intestinal transplantation (ITx), whether isolated or combined with other organs, is now a valid treatment option in some patients with chronic intestinal failure or extensive venous mesenteric thrombosis. The aim in these patients is not only to restore nutritional autonomy, but also to minimize the risk of complications, both short and long term. Despite parenteral nutrition playing a central part in the management of intestinal failure patients, there are little data about the perioperative and postoperative nutritional management of ITx patients, due to small patient populations per centre. In this review, we collected the scientific data available to date.

Recent findings

In this review, we will bundle the limited scientific information about diet after intestinal and multivisceral transplantation combined with recommendations from our own clinical practice in 28 ITx patients in University Hospitals Leuven, Belgium. We will discuss the immediate preoperative period, surgical complications necessitating dietary interventions and the late postoperative phase in a stable outpatient transplant recipient.

Although no specific research has been done in the field of ITx, we can extrapolate some findings from other solid organ transplants. Prehabilitation might prove to be of importance; Preserving kidney and liver function in the pretransplant period should be pursued. Transition from parenteral to enteral and oral nutrition can be complex due to inherent surgical procedures and possible complications. Ultimately, the goal is to give patients nutritional autonomy, while also minimizing the risk of foodborne infections by teaching patients well tolerated food practices.
Relapsing neuromyelitis optica spectrum disorder due to noncompliance to oral corticosteroid therapy
Authors: Terada Hiroki , ISHII Wakako , Kawaguchi Tadayasu , Aoki Ryoji , Kasuga Yuki , Momoki Emiko , Fuchigami Tatsuo , Morioka Ichiro
Published: February 2023

Rationale:

Neuromyelitis optica (NMO) is an inflammatory, demyelinating disease of the central nervous system characterized by severe optic neuritis and myelitis. NMO recurrence can be triggered by infection, pregnancy, and the tapering of oral corticosteroid medication.

Patient concerns:

A 14-year-old girl with no remarkable birth or developmental history was admitted to our hospital after experiencing visual loss in the right eye. The right eye was positive for relative afferent pupillary defects.

Diagnosis:

Orbital magnetic resonance imaging revealed a high-intensity area in the right optic nerve. Serum levels of anti–aquaporin 4 (AQP4) antibodies were high. She was diagnosed with anti-AQP4 antibody-positive right-sided optic neuritis.

Interventions:

Her symptoms improved after repeated intravenous methylprednisolone pulse therapy and intravenous immunoglobulin therapy. Subsequently, she continued to take oral steroids as a long-term preventive measure.

Outcomes:

She relapsed twice, at the ages of 14 and 16 years, due to nonadherence to oral corticosteroid medication at her discretion (fears of steroid side effects and worsening infection without other causes), with anti-AQP4 antibody-positive NMO leading to multiple lesions in the cerebral cortex.

Lessons:

To our knowledge, this is the first report of NMO with increasing recurrence severity due to nonadherence to oral corticosteroid medication. This case demonstrates the importance of oral corticosteroid therapy in preventing relapses of anti-AQP4 antibody-positive NMO and suggests the need to educate patients regarding steroid therapy.
Severe preeclampsia superimposed on secondary and resistant hypertension associated with methamphetamine use
Authors: Phinder-Puente Marian Elizabeth , Rodríguez-Relingh Kim , Bautista-Aguilar Gabriela Alejandra , Deloya-Tomas Ernesto , Pérez-Nieto Orlando R.
Published: February 2023

Introduction:

Preeclampsia (PE) is one of the three main causes of maternal mortality. It is called superimposed PE when, in a pregnant patient with a history of primary or secondary chronic arterial hypertension, blood pressure increases and de novo proteinuria appears or worsens and/or biochemical data such as thrombocytopenia or increased liver enzymes are added. Chronic arterial hypertension predisposes patients to developing it, with a higher risk of complications and severity.

Case presentation:

Here, we present the case of a 25-year-old patient with a history of crystal, crack, and cocaine use for 7 years and a diagnosis of high blood pressure since she was 22 years old, who developed severe PE resistant to antihypertensive drugs.

Conclusions:

The reported case showed severe hypertension in pregnancy (defined as systolic blood pressure ≥160 mm Hg or diastolic blood pressure ≥110 mm Hg), which persisted because severe hypertension continued despite the designated treatment, which, considering the patient’s age, forced us to suspect secondary hypertension. The incidence of secondary hypertension in patients with superimposed PE is rare. According to the American Heart Association, it occurs in 10% of the cases and is associated with greater maternal and fetal complications. This should be suspected in women <35 years of age with severe or resistant hypertension, without a family history of hypertension, or with biochemical parameters for hypokalemia, hyperazotemia, and albuminuria in the early stages of pregnancy.
Metronidazole-induced neurotoxicity
Authors: Hillaker Emily , Lau James , Boomgaardt Jacob , Weppner Justin
Published: February 2023

Rationale:

Nervous system toxicity is a rare complication of metronidazole. Prompt identification of metronidazole toxicity combined with a comprehensive physical rehabilitation program is essential to maximizing the patient’s functional outcome.

Patient concerns:

A 58-year-old female was treated with metronidazole for embolic versus hematogenous spread of bacteria resulting in multifocal brain abscesses. Two weeks after discharge, the patient returned to the emergency department with slurred speech, muscle aches, generalized weakness, inability to ambulate, and poor oral intake.

Diagnosis:

Head magnetic resonance imaging revealed symmetric enhanced T2/FLAIR signaling in the dentate nuclei were also present bilaterally, a finding pathognomonic for metronidazole toxicity.

Intervention:

Metronidazole was discontinued, and the patient was enrolled in a comprehensive rehabilitation program.

Outcomes:

She began inpatient rehabilitation dependent for all activities of daily living and requiring moderate assistance for transfers. She could only walk 10 feet with a front-wheeled walker with a 2-person assist. The patient rapidly improved with a comprehensive rehabilitation program, and due to these improvements, she was discharged after 5 days of inpatient rehabilitation. At the time of discharge, she was independent with all activities of daily living and could walk 160 feet independently with a front-wheeled walker.

Lessons:

Prompt recognition and discontinuation of metronidazole remains the only known effective treatment. A comprehensive approach to treatment and rehabilitation is achieved with an early referral to rehabilitation services. This is crucial to minimize morbidity and optimize functional outcomes in this patient population.
Intrapancreatic accessory spleen
Authors: Patel Jay , Daitch Zachary , Heller Stephen , Lee Woo Jung J. , Cappelle Saraswathi
Published: February 2023

Introduction:

Intrapancreatic accessory spleen (IPAS) is a congenital focus of healthy splenic tissue present outside of the splenic parenchyma. There are numerous locations for IPAS and they are usually found incidentally. The location of ectopic splenic tissue is important as it can often mimic as a neoplasm, most commonly neuroendocrine tumor (NET) due to similar imaging characteristics on nuclear imaging and computed tomography (CT) scan. We report on the finding of an IPAS in the tail of the pancreas for which fine needle aspiration was performed.

Patient concerns:

A 66-year-old man with past medical history of prostate cancer managed with brachytherapy presented to his urologist for workup of persistently elevated prostate specific antigen. He underwent a nuclear medicine whole body scan which revealed uptake in the pancreatic tail for which follow up CT was recommended. The patient was seen by the gastroenterology and a CT scan was obtained. CT revealed a 4 cm × 3 cm isoenhancing mass in the tail of the pancreas without invasion to surrounding structures nor communication with the pancreatic ducts. No lymphadenopathy was noted.

Intervention:

The patient subsequently underwent endoscopic ultrasound (EUS) with fine needle aspiration (FNA) of the mass. EUS revealed a hypoechoic, oval, mass-like structure in the distal pancreatic tail measuring ~20 mm × 20 mm in maximal cross-sectional diameter. FNA of the mass was performed.

Diagnosis:

Cytopathology of the specimen revealed small mature lymphocytes and vessels suggestive of IPAS.

Outcome:

The patient remained asymptomatic through the duration of the workup.

Lessons:

All enhancing pancreatic lesions require further workup to rule out malignancy. Typically, patients undergo scintigraphy for further evaluation or FNA biopsy via EUS for confirmation. Currently, there are no established serum markers or radiographic findings with adequate specificity for diagnosing IPAS. It is important to recognize the impact of incidental findings as they frequently require further testing and often result in procedural intervention. IPAS is often confused with NET, frequently necessitating tissue sampling. While the prevalence of intrapancreatic accessory spleen is higher than initially thought, contrary to NET it carries no inherent risk unless its location compromises vital structures. This highlights the importance of recognizing this anomaly.
Variation and Correlation of Potential Unintended Consequences of Antipsychotic Reduction in Ontario Nursing Homes Over Time
Authors: Harris Daniel A. , Maclagan Laura C. , Pequeno Priscila , Iaboni Andrea , Austin Peter C. , Rosella Laura C. , Guan Jun , Maxwell Colleen J. , Bronskill Susan E.
Published: February 2023

Background:

Potentially inappropriate antipsychotic use has declined in nursing homes over the past decade; however, increases in the documentation of relevant clinical indications (eg, delusions) and the use of other psychotropic medications have raised concerns about diagnosis upcoding and medication substitution. Few studies have examined how these trends over time vary across and within nursing homes, information that may help to support antipsychotic reduction efforts.

Objective:

To jointly model facility-level time trends in potentially inappropriate antipsychotic use, antidepressant use, and the indications used to define appropriate antipsychotic use.

Research Design:

We conducted a repeated cross-sectional study of all nursing homes in Ontario, Canada between April 1, 2010 and December 31, 2019 using linked health administrative data (N=649). Each nursing home’s quarterly prevalence of potentially inappropriate antipsychotic use, antidepressant use, and relevant indications were measured as outcome variables. With time as the independent variable, multivariate random effects models jointly estimated time trends for each outcome across nursing homes and the correlations between time trends within nursing homes.

Results:

We observed notable variations in the time trends for each outcome across nursing homes, especially for the relevant indications. Within facilities, we found no correlation between time trends for potentially inappropriate antipsychotic and antidepressant use (r=−0.0160), but a strong negative correlation between time trends for potentially inappropriate antipsychotic use and relevant indications (r=−0.5036).

Conclusions:

Nursing homes with greater reductions in potentially inappropriate antipsychotics tended to show greater increases in the indications used to define appropriate antipsychotic use—possibly leading to unmonitored use of antipsychotics.
Sociodemographic Differences of Hospitalization and Associations of Resource Utilization for Failure to Thrive
Authors: Wu Allison J. , Du Nan , Chen Thomas Yen‐Ting , Fiechtner Lauren
Published: February 2023

Objectives:

This study examines the sociodemographic differences between elective and nonelective admissions for failure to thrive (FTT). We investigate associations between admission type and hospital resource utilization, including length of stay and feeding tube placement.

Methods:

We included children <2 years old with FTT in the nationwide Kids’ Inpatient Database. We described differences between elective and nonelective admissions using Fisher exact and t tests. To assess associations of admission type and hospital resource utilization, we used negative binomial and logistic regression for length of stay and feeding tube placement, respectively.

Results:

In this study of 45,920 admissions (37,224 nonelective vs 8696 elective), we found differences by race and ethnicity, income, and insurance type, among other factors. Compared to elective admissions, nonelective admissions had higher proportions of infants who were Black, Hispanic, and of lower‐income. Nonelective admissions were associated with longer lengths of stay (incidence rate ratio 1.46; 95% CI: 1.37–1.55), independent of child age, sex, neighborhood income, insurance, admission day, chronic conditions, and location. Nonelective admissions were associated with lower odds of feeding tube placement compared to elective admissions (adjusted odds ratio 0.62; 0.56–0.68). In the stratified analyses, children of racial and ethnic minority groups admitted nonelectively versus electively had relatively higher odds of feeding tube placement, while White children had relatively lower odds of feeding tube placement.

Conclusion:

There are various sociodemographic differences between elective and nonelective FTT admissions. Future research is warranted to elucidate drivers of these differences, particularly those related to racial and ethnic disparities and structural racism.
Treatment of NF1-Associated Optic Pathway/Hypothalamic Gliomas in Patients With Diencephalic Syndrome
Authors: Weiser Annette , Hengartner Heinz , Kottke Raimund , Grehten Patrice , Toelle Sandra P. , Gerber Nicolas U. , Grotzer Michael A. , Guerreiro Stucklin Ana S.
Published: February 2023

Diencephalic syndrome is usually associated with tumors in the hypothalamic region, rarely occurring in patients with neurofibromatosis type 1 (NF1)-associated gliomas. We describe the clinical presentation and response to treatment in 3 patients with NF1 presenting with diencephalic syndrome as first symptom of optic pathway/hypothalamic glioma (OPHG). Because of the rarity of this constellation, knowledge about the clinical course and best treatment options for patients with NF1-associated OPHG and diencephalic syndrome is still limited. All 3 patients showed good response to treatment with normalization of body mass index and decrease in tumor volume within 6 months.
Interleukin-1 Receptor Antagonist Gene Polymorphisms in Egyptian Children and Adolescents With Primary Immune Thrombocytopenia: Association With Disease Susceptibility, Response to Therapy, and Outcome
Authors: Al-Tawil Mohammed M. , Kamal Tarek M. , Borham Omnia M. , Abd El-Ghany Shereen M.
Published: February 2023

Immune thrombocytopenia (ITP) is one of the most common hematologic disorders with poorly predictable clinical course and outcome. We studied the distribution of interleukin 1 receptor antagonist (IL-1Ra) gene polymorphism (intron-2) among children and adolescents with ITP and correlated IL-1Ra gene polymorphism to disease susceptibility, response to therapy, and outcome. Sixty children with ITP (mean age: 9.2±4.5 y) and 100 healthy controls (mean age: 8.83±4.05 y) were enrolled. The frequencies of the allele A2 and genotype A1A2 were significantly higher in patients compared with controls (P<0.0001, P=0.0008, respectively). Allele A2 conferred 3.1 times increased relative risk for disease development. Allele A2 and genotypes A1A2 and A2A2 were significantly more frequent among remitted patients (P=0.028 and 0.024, respectively). There was no significant difference between different genotypes and alleles regarding bleeding score (P>0.05). Patients with polymorphic allele A2 (A1A2/A2A2) showed significantly better response to steroids than those with homozygous wild allele A1 (P=0.028). IL-1Ra polymorphism might contribute to the susceptibility to ITP in Egyptian children. The presence of A2 polymorphic allele of IL-1Ra gene was found to be associated with better disease outcome and response to steroids than those with homozygous wild allele.
lncRNA GAS5 and RUNX1 Genes in Children With Primary Immune Thrombocytopenia
Authors: Hodeib Hossam , El Amrousy Doaa , Elaskary Eman , Hablas Nahed , Youssef Amira , Abdelhai Dina
Published: February 2023

We aimed to evaluate the expression levels and the prognostic value of growth arrest specific 5 (GAS5) and runt-related transcription factor 1 (RUNX1) genes in children with ITP. This prospective cohort study included 100 patients with newly diagnosed ITP (patient group) and 100 healthy children of matched age and sex (control group). We evaluated the expression levels of both GAS5 and RUNX1 genes at the time of diagnosis before the introduction of treatment. GAS5 was under-expressed, while RUNX1 was over-expressed among the newly diagnosed ITP children compared with the control group. Patients with GAS5 levels >0.50 had a significantly faster recovery compared with patients with levels≤0.50 while patients with levels of RUNX1≤2.6 had a significantly faster recovery compared with patients with levels >2.6. The best cut-off values of GAS5 and RUNX1 to predict complete recovery of ITP were ˃0.40 and ˂3.18, respectively, yielding a sensitivity of 76.47% and 79.41%, respectively. The best cut-off values of GAS5 and RUNX1 expression that predict chronic ITP were ˂0.17 and ˃4.1, respectively, yielding sensitivity of 88.89% and 77.78%, respectively. GAS5 and RUNX1 could be useful markers in children with primary ITP to predict disease course.
Clinical Profile and Outcome of 806 Pediatric Oncology Patients Treated With Radiotherapy at the Serbian National Cancer Center
Authors: Bokun Jelena , Popović-Vuković Marija , Stanić Dragana , Grujičić Danica , Pekmezović Tatjana , Janić Dragana , Paripović Lejla , Ilić Vesna , Pudrlja Slović Marija , Sarić Milan , Mišković Ivana , Nidžović Borko , Gavrilović Nikola , Milinčić Mirjana , Nikitović Marina
Published: February 2023

Radiotherapy plays an important role in the multimodal treatment of childhood cancer. Our objective was to provide an analysis of pediatric oncology patients treated with radiotherapy in a national referral institution in Serbia. A retrospective chart review of children treated with radiotherapy between January 2007 and July 2018 was conducted. Of the 806 patients who were identified, 767 formed the basis of this study. CNS tumors (31.2%) were the most common tumors followed by leukemias (17.3%) and bone tumors (14.3%). The most common indication for radiotherapy was in adjuvant setting (69.1%). Anesthesia or sedation was performed on 115 patients. The 5-year and 10-year overall survival rates were 65.7% and 62.1%, respectively. A significant difference in survival in relation to tumor type was seen. The best survival rates were obtained in patients with retinoblastoma, followed by lymphomas and nephroblastoma, while patients with bone sarcomas had the worst survival. The intent of radiotherapy treatment was also a parameter associated with survival. Patients treated with palliative and definitive intent lived shorter than patients treated with prophylactic and adjuvant intent. Our study showed that good treatment outcomes can be achieved in specialized centers with an experienced team of professionals who are dedicated to pediatric oncology.