bluuebunny/crossref_metadata_2025 huggingface dataset:
Neurologic Complications of Patients With COVID-19 Requiring Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-Analysis
Authors: Li Cathy Meng Fei , Densy Deng Xiaoxiao , Ma Yu Fei , Dawson Emily , Li Carol , Wang Dong Yao , Huong Lynn , Gofton Teneille , Nagpal Atul Dave , Slessarev Marat
Published: March 2023

OBJECTIVES:

In COVID-19 patients requiring extracorporeal membrane oxygenation (ECMO), our primary objective was to determine the frequency of intracranial hemorrhage (ICH). Secondary objectives were to estimate the frequency of ischemic stroke, to explore association between higher anticoagulation targets and ICH, and to estimate the association between neurologic complications and in-hospital mortality.

DATA SOURCES:

We searched MEDLINE, Embase, PsycINFO, Cochrane, and MedRxiv databases from inception to March 15, 2022.

STUDY SELECTION:

We identified studies that described acute neurological complications in adult patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection requiring ECMO.

DATA EXTRACTION:

Two authors independently performed study selection and data extraction. Studies with 95% or more of its patients on venovenous or venoarterial ECMO were pooled for meta-analysis, which was calculated using a random-effects model.

DATA SYNTHESIS:

Fifty-four studies (n = 3,347) were included in the systematic review. Venovenous ECMO was used in 97% of patients. Meta-analysis of ICH and ischemic stroke on venovenous ECMO included 18 and 11 studies, respectively. The frequency of ICH was 11% (95% CI, 8–15%), with intraparenchymal hemorrhage being the most common subtype (73%), while the frequency of ischemic strokes was 2% (95% CI, 1–3%). Higher anticoagulation targets were not associated with increased frequency of ICH (p = 0.06). In-hospital mortality was 37% (95% CI, 34–40%) and neurologic causes ranked as the third most common cause of death. The risk ratio of mortality in COVID-19 patients with neurologic complications on venovenous ECMO compared with patients without neurologic complications was 2.24 (95% CI, 1.46–3.46). There were insufficient studies for meta-analysis of COVID-19 patients on venoarterial ECMO.

CONCLUSIONS:

COVID-19 patients requiring venovenous ECMO have a high frequency of ICH, and the development of neurologic complications more than doubled the risk of death. Healthcare providers should be aware of these increased risks and maintain a high index of suspicion for ICH.
Characteristics and Outcomes of ICU Patients Without COVID-19 Infection—Pandemic Versus Nonpandemic Times: A Population-Based Cohort Study
Authors: Leafloor Cameron W. , Imsirovic Haris , Qureshi Danial , Milani Christina , Nyarko Kwadjo , Dickson Sarah E. , Thompson Laura , Tanuseputro Peter , Kyeremanteng Kwadwo
Published: March 2023

IMPORTANCE:

Outcomes for critically ill COVID-19 are well described; however, the impact of the pandemic on critically ill patients without COVID-19 infection is less clear.

OBJECTIVES:

To demonstrate the characteristics and outcomes of non-COVID patients admitted to an ICU during the pandemic, compared with the previous year.

DESIGN:

A population-based study conducted using linked health administrative data comparing a cohort from March 1, 2020, to June 30, 2020 (pandemic) to a cohort from March 1, 2019, to June 30, 2019 (nonpandemic).

SETTING AND PARTICIPANTS:

Adult patients (18 yr old) admitted to an ICU in Ontario, Canada, without a diagnosis of COVID-19 during the pandemic and nonpandemic periods.

MAIN OUTCOMES AND MEASURES:

The primary outcome was all-cause in-hospital mortality. Secondary outcomes included hospital and ICU length of stay, discharge disposition, and receipt of resource intensive procedures (e.g., extracorporeal membrane oxygenation, mechanical ventilation, renal replacement therapy, bronchoscopy, feeding tube insertion, and cardiac device insertion). We identified 32,486 patients in the pandemic cohort and 41,128 in the nonpandemic cohort. Age, sex, and markers of disease severity were similar. Fewer patients in the pandemic cohort were from long-term care facilities and had fewer cardiovascular comorbidities. There was an increase in all-cause in-hospital mortality among the pandemic cohort (13.5% vs 12.5%; p < 0.001) representing a relative increase of 7.9% (adjusted odds ratio, 1.10; 95% CI, 1.05–1.56). Patients in the pandemic cohort admitted with chronic obstructive pulmonary disease exacerbation had an increase in all-cause mortality (17.0% vs 13.2%; p = 0.013), a relative increase of 29%. Mortality among recent immigrants was higher in the pandemic cohort compared with the nonpandemic cohort (13.0% vs 11.4%; p = 0.038), a relative increase of 14%. Length of stay and receipt of intensive procedures were similar.

CONCLUSIONS AND RELEVANCE:

We found a modest increase in mortality among non-COVID ICU patients during the pandemic compared with a nonpandemic cohort. Future pandemic responses should consider the impact of the pandemic on all patients to preserve quality of care.
Which characteristics are associated with changes in medication status for lower urinary tract symptoms among patients with prostate cancer receiving external beam radiotherapy?
Authors: Kyoda Yuki , Hashimoto Kohei , Takahashi Atsushi , Maehana Takeshi , Tachikawa Kimihito , Muranaka Takashi , Kato Shuichi , Kurisu Tomoyo , Fukuta Fumimasa , Kirisawa Takahiro , Okada Manabu , Kobayashi Ko , Tanaka Toshiaki , Hinotsu Shiro , Masumori Naoya
Published: March 2023

Background

We clarified the predictive factors for changes in the status of medications for lower urinary tract symptoms (LUTS) 2 years after local radiotherapy for nonmetastatic prostate cancer.

Materials and methods

We retrospectively included patients who underwent local external radiotherapy for nonmetastatic prostate cancer in 8 institutions between April 2001 and March 2016. Patients were divided into the medication and no-medication group based on the use of drugs for LUTS before radiotherapy. We defined improvement of LUTS as when the patient did not require medication for LUTS at 24 months after radiotherapy in the medication group and as deterioration when medication was required in the no-medication group. Logistic regression analysis was used to evaluate predictive factors for changes in medication status.

Results

Altogether, 505 patients were divided into a no-medication group (n = 352) and a medication group (n = 153). The number of patients with deterioration and improvement in LUTS was 49 (14%) and 36 (23%), respectively. In the multivariate analysis, the predictive variables for deterioration were the International Prostate Symptom Score (≥8; odds ratio [OR], 2.21; p = 0.014) and the biopsy Gleason score (≤3 + 4 = 7; OR, 2.430; p = 0.008) in the no-medication group, whereas those for improvement were age (<75 years old; OR, 5.81; p = 0.002), the quality of life score (<3; OR, 3.15; p = 0.028), and a positive biopsy core rate (≥50%; OR, 2.530; p = 0.027) in the medication group.

Conclusions

These predictive factors for changes in the status of medications for LUTS at 2 years after external radiotherapy may help determine the definitive therapy for nonmetastatic prostate cancer.
Effect of Different Types and Dosages of Proprotein Convertase Subtilisin/Kexin Type 9 Inhibitors on Lipoprotein(a) Levels: A Network Meta-analysis
Authors: Yu Zongliang , Hu Lanqing , Sun Changxin , Wang Zeping , Zhang Xiaonan , Wu Min , Liu Longtao
Published: March 2023

Lipoprotein(a) [Lp(a)] has become an important component of the residual risk of cardiovascular diseases. Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors display promising effects in controlling Lp(a) levels. However, the effects of different types and dosages of PCSK9 inhibitors on Lp(a) have not been studied in detail. These include 2 monoclonal antibodies, alirocumab and evolocumab, and inclisiran, a small interfering RNA. We searched PubMed, Web of Science, Embase, and Cochrane Library for randomized controlled trials to investigate the efficacy of PCSK9 inhibitors at the Lp(a) level. Although changes in Lp(a) levels were not the primary endpoint in any of these studies, they all described these valuable data. Forty-one randomized controlled trials with 17,601 participants were included, involving 23 unduplicated interventions. Most PCSK9 inhibitors significantly reduced Lp(a) levels compared with placebo. The pairwise comparison demonstrated no significant difference among most PCSK9 inhibitors. However, in the comparison among different dosages of alirocumab, the dosage of 150 mg Q2W showed a significant reduction in Lp(a) levels compared with the dosages of 150, 200, and 300 mg Q4W. In addition, the comparison results demonstrated the significant efficacy of evolocumab 140 mg Q2W compared with alirocumab at a dosage of 150 mg Q4W. The cumulative rank probabilities demonstrated that evolocumab 140 mg Q2W showed the highest efficacy. This study showed that PCSK9 inhibitors reduced Lp(a) levels by up to 25.1%. A biweekly dose of either 140 mg evolocumab or 150 mg alirocumab was the best treatment option. However, the reduction in Lp(a) levels with a single kind of PCSK9 inhibitor alone did not demonstrate sufficient clinical benefit. Therefore, for patients with very high Lp(a) levels who remain at high residual risk in the context of statin administration, it may be acceptable to use a kind of PCSK9 inhibitor, but the clinical benefit needs further investigation.
Declining rates of opioid/acetaminophen combination product overdose: 2011–2020
Authors: Harris Elizabeth , Harms Michael , Cao Dazhe , Prestwood Courtney , DeBinya Lister , Kleinschmidt Kurt , Young Amy , Saha Srishti , Rule Jody , Alvarez Kristin , Das Sandeep R. , Lee William M.
Published: March 2023

Background:

During the opioid epidemic, misuse of acetaminophen-opioid products resulted in supratherapeutic acetaminophen ingestions and cases of hepatotoxicity. In 2014, the US Food and Drug Administration (FDA) limited the amount of acetaminophen in combination products to 325 mg, and the US Drug Enforcement Administration (DEA) changed hydrocodone/acetaminophen from schedule III to schedule II. This study assessed whether these federal mandates were associated with changes in acetaminophen-opioid supratherapeutic ingestions.

Methods:

We identified emergency department encounters at our institution of patients with a detectable acetaminophen concentration and manually reviewed these charts.

Results:

We found a decline in acetaminophen-opioid supratherapeutic ingestions after 2014. A downtrend in hydrocodone/acetaminophen ingestions accompanied a relative increase in codeine/acetaminophen ingestions from 2015 onwards.

Conclusion:

This experience at one large safety net hospital suggests a beneficial impact of the FDA ruling in reducing likely unintentional acetaminophen supratherapeutic ingestions, carrying a risk of hepatotoxicity, in the setting of intentional opioid ingestions.
Stage migration as a surrogate of survival in hepatocellular carcinoma treated with transarterial chemoembolization
Authors: Kassab Ihab , Singal Amit G. , Ali Aamir , Narasimman Manasa , Arvind Ashwini , Ahmed Muneeb , Joshi Sagar , Manzoor Komal , Rich Nicole , Chen Vincent L , Zhao Zhe , Sarwar Ammar , Parikh Neehar D.
Published: March 2023

Background & Aims:

Locoregional therapies, including transarterial chemoembolization (TACE), are recommended for the treatment of HCC; however, clinical trials evaluating their effectiveness have been complicated by a lack of validated surrogate outcomes. We aimed to evaluate if stage migration could serve as a potential surrogate of overall survival in patients undergoing TACE.

Approach:

We conducted a retrospective cohort study of adult patients with HCC who underwent TACE as initial therapy from 3 centers in the US from 2008 to 2019. The primary outcome was overall survival from the date of the first TACE treatment, and the primary exposure of interest was Barcelona Clinic Liver Cancer stage migration to a more advanced stage within 6 months of TACE. Survival analysis was completed using Kaplan-Meier and multiple Cox proportional hazard models adjusted by the site.

Results:

Of 651 eligible patients (51.9% Barcelona Clinic Liver Cancer stage A and 39.6% stage B), 129 (19.6%) patients experienced stage migration within 6 months of TACE. Those with stage migration had larger tumors (5.6 vs. 4.2 cm, p < 0.01) and higher AFP levels (median 92 vs. 15 ng/mL, p < 0.01). In multivariate analysis, stage migration was significantly associated with worse survival (HR: 2.82, 95% CI: 2.66–2.98), with a median survival of 8.7 and 15.9 months in those with and without stage migration. Other predictors of worse survival included the White race, higher AFP levels, a higher number of tumors, and a larger maximum HCC diameter.

Conclusion:

Stage migration is associated with increased mortality after TACE in patients with HCC and could serve as a surrogate end point in clinical trials evaluating locoregional therapies such as TACE.
Alcohol-induced tubulin post-translational modifications directly alter hepatic protein trafficking
Authors: Adhikari Raghabendra , Mitra Ramyajit , Bennett Robert G. , McVicker Benita L. , Tuma Pamela L.
Published: March 2023

Background:

Chronic ethanol exposure leads to enhanced protein acetylation and acetaldehyde adduction. Of the multitude of proteins that are modified on ethanol administration, tubulin is among the best studied. However, an open question is whether these modifications are observed in patient samples. Both modifications have also been implicated in promoting alcohol-induced defects in protein trafficking, but whether they do so directly is also unanswered.

Methods and Results:

We first confirmed that tubulin was hyperacetylated and acetaldehyde-adducted in the livers from ethanol-exposed individuals to a similar extent as observed in the livers from ethanol-fed animals and hepatic cells. Livers from individuals with nonalcohol-associated fatty liver showed modest increases in tubulin acetylation, whereas nonalcohol-associated fibrotic human and mouse livers showed virtually no tubulin modifications. We also asked whether tubulin acetylation or acetaldehyde adduction can directly explain the known alcohol-induced defects in protein trafficking. Acetylation was induced by overexpressing the α-tubulin–specific acetyltransferase, αTAT1, whereas adduction was induced by directly adding acetaldehyde to cells. Both αTAT1 overexpression and acetaldehyde treatment significantly impaired plus-end (secretion) and minus-end (transcytosis)–directed microtubule-dependent trafficking and clathrin-mediated endocytosis. Each modification led to similar levels of impairment as observed in ethanol-treated cells. The levels of impairment by either modification showed no dose dependence or no additive effects suggesting that substoichiometric tubulin modifications lead to altered protein trafficking and that lysines are not selectively modified.

Conclusions:

These results not only confirm that enhanced tubulin acetylation is observed in human livers but that it is most relevant to alcohol-induced injury. Because these tubulin modifications are associated with altered protein trafficking that alters proper hepatic function, we propose that changing the cellular acetylation levels or scavenging free aldehydes are feasible strategies for treating alcohol-associated liver disease.
Adherence of those With Self-Reported Glaucoma in the United States to Eye Examination Visits
Authors: Hou Chiun-Ho , Shih Shu-Fang , Pu Christy
Published: March 2023

Précis:

The adherence of American patients with self-reported glaucoma to the follow-up recommendations is extremely low. Estimated adherence rate is lower than that obtained by previous studies that did not use a US nationally representative sample.

Purpose:

To evaluate adherence to ophthalmic outpatient follow-up visits and vision examinations in the American population aged 40 years or above.

Methods:

The percentage of American patients aged≥40 years who adhered to glaucoma treatment guidelines was estimated using 2015–2019 Medical Expenditure Panel Survey (MEPS) data. Adherence was defined according to the International Council of Ophthalmology guidelines. We also compared individuals with and without self-reported glaucoma who have made at least one ophthalmic outpatient visit and at least 1 vision examination visit within a year. Differences in means and percentages were estimated to account for the covariance due to the complex sampling design.

Results:

Approximately 4.4 million people aged or above 40 years had self-reported glaucoma in 2019 (3.21%). The rate of prevalence significantly differed with race, with Black people having the highest prevalence in all studied years. Only 7.1% (95% CI: 0.049–0.102) and 2.67% (95% CI: 0.0137–0.0519) of this population underwent at least 1 ophthalmic outpatient examination or 1 vision examination per year. Older age, never married status, higher education, eye conditions, and diabetes were significantly associated with a higher probability of ophthalmic health care use.

Conclusions:

Adherence to follow-up among patients with self-reported glaucoma in this population-level study was lower than that in previously reported American, non-nationally representative studies. Barriers to adherence at the population level should be assessed to inform the design of future policy or program interventions.
Spontaneous Subperiosteal Orbital Hematoma Associated With Cocaine-Induced Midline Destructive Lesion
Authors: Li Wendy , Kinde Benyam , Clauss Kevin D. , Tse Brian C.
Published: March 2023

The authors present a case of a non-traumatic, spontaneous subperiosteal orbital hematoma in a woman with a history of chronic pansinusitis and absence of midline nasal cavity structures due to chronic inhalational cocaine use. The patient underwent left orbitotomy and drainage of the lesion, showing mostly blood with a small amount of purulence that grew methicillin-resistant Staphylococcus aureus when cultured. The patient received 4 weeks of intravenous antibiotics in addition to functional endoscopic sinus surgery. At 1 month after surgery, her vision had returned to baseline, and proptosis was resolved. Fewer than 20 cases of subperiosteal orbital hematomas associated with chronic sinusitis have been reported. To the authors’ knowledge, this is the first reported case of a subperiosteal orbital hematoma associated with cocaine-induced midline destructive lesions. Patient consent to obtain photographs was obtained and archived. All collection and evaluation of patient health information were compliant with the Health Insurance Portability and Accountability Act, and this report adheres to the Declaration of Helsinki.
When the Cost of Vaping Is an Eye: A Case of an Open Globe and Superior Orbital Roof Fracture
Authors: Mukit Fabliha A. , Laplant Jacquelyn F. , Wallace David , Troy Christopher , Einhaus Stephanie L. , Fowler Brian T.
Published: March 2023

The authors report a penetrating orbitocerebral vape pen injury necessitating a primary enucleation and craniotomy to remove the foreign body fragments. A 31-year-old male presented with acute right vision loss after a modifiable vape pen explosion launched multiple projectile fragments into his right eye. CT revealed a deformed globe with multiple radiodense curvilinear fragments in the superior orbital roof and intracranial space. A right frontal craniotomy and orbitotomy with removal of vape pen fragments, reconstruction of the orbital roof, primary enucleation, and eyelid repair were performed in conjunction with neurosurgery. To the best of the authors’ knowledge, this is the first reported penetrating globe injury from a vape pen explosion.
Human pain ratings to electrical sinusoids increase with cooling through a cold-induced increase in C-fibre excitability
Authors: Pakalniskis Julius , Soares Sabrina , Rajan Suhasini , Vyshnevska Alina , Schmelz Martin , Solinski Hans Jürgen , Rukwied Roman , Carr Richard
Published: March 2023

Low-frequency sinusoidal current applied to human skin evokes local axon reflex flare and burning pain, indicative of C-fibre activation. Because topical cooling works well as a local analgesic, we examined the effect of cooling on human pain ratings to sinusoidal and rectangular profiles of constant current stimulation. Unexpectedly, pain ratings increased upon cooling the skin from 32 to 18°C. To explore this paradoxical observation, the effects of cooling on C-fibre responses to stimulation with sinusoidal and rectangular current profiles were determined in ex vivo segments of mouse sural and pig saphenous nerve. As expected by thermodynamics, the absolute value of electrical charge required to activate C-fibre axons increased with cooling from 32°C to 20°C, irrespective of the stimulus profile used. However, for sinusoidal stimulus profiles, cooling enabled a more effective integration of low-intensity currents over tens of milliseconds resulting in a delayed initiation of action potentials. Our findings indicate that the paradoxical cooling–induced enhancement of electrically evoked pain in people can be explained by an enhancement of C-fibre responsiveness to slow depolarization at lower temperatures. This property may contribute to symptoms of enhanced cold sensitivity, especially cold allodynia, associated with many forms of neuropathic pain.
Efficacy of extended microthrombolysis in an elderly lady with purpura fulminans
Authors: Ames Paul R.J. , Nale Krsty , Malone Colin
Published: March 2023

Purpura fulminans is a thrombotic emergency affecting small vessels of skin and of internal organs that may rapidly progress into necrotizing fasciitis, critical limb ischaemia and multiorgan failure; it often develops during an infection or as a postinfective ‘autoimmune’ disorder. Although supportive care and hydration are important, anticoagulation ought to be started to prevent further occlusions alongside blood products according to need. Herein, we describe the case of an elderly woman who received extended intravenous low-dose recombinant tissue plasminogen activator at the onset of purpura fulminans that salvaged her skin and prevented the development of multiorgan failure.
Never too soon to be thinking about heparin-induced thrombocytopenia! A case report of early onset heparin-induced thrombocytopenia
Authors: Said Bassil N.
Published: March 2023

Heparin-induced thrombocytopenia (HIT) is a serious complication that can affect a small percentage of patients receiving heparin. Atypical HIT presentations like delayed onset HIT have been described. We present an atypical case of early onset HIT in a patient presenting with ACS with no prior heparin exposure and shed light on the various atypical HIT and HIT-like presentations.
The interplay between hypovitaminosis D and the immune dysfunction in the arteriovenous thrombotic complications of the sever coronavirus disease 2019 (COVID-19) infection
Authors: AlNafea Haifa M. , Korish Aida A.
Published: March 2023

Thromboembolic complications including cerebrovascular accidents, pulmonary embolism, myocardial infarction, deep vein thrombosis and disseminating intravascular coagulopathy are serious encounters in sever coronavirus disease 2019 (COVID-19) infected patients. This worsens the prognosis and may lead to death or life long morbidities. The laboratory finding of the disturbed haemostasias and the hyperinflammatory response are almost invariably present in COVID-19 patients. Multiple treatment modalities are utilized by the healthcare professionals to overcome the cytokine storm, oxidative stress, endothelial dysfunction, and coagulopathy in these patients. The combined actions of vitamin D (VitD) as a steroid hormone with anti-inflammatory, immunomodulatory, and antithrombotic properties increase the potential of the possible involvement of hypovitaminosis D in the thromboembolic complications of COVID-19 infection, and stimulated researchers and physicians to administer VitD therapy to prevent the infection and/or overcome the disease complications. The current review highlighted the immunomodulatory, anti-inflammatory, antioxidative and hemostatic functions of VitD and its interrelation with the renin–angiotensin–aldosterone system (RAAS) pathway and the complement system. Additionally, the association of VitD deficiency with the incidence and progression of COVID-19 infection and the associated cytokine storm, oxidative stress, hypercoagulability, and endothelial dysfunction were emphasized. Normalizing VitD levels by daily low dose therapy in patients with hypovitaminosis D below (25 nmol/l) is essential for a balanced immune response and maintaining the health of the pulmonary epithelium. It protects against upper respiratory tract infections and decreases the complications of COVID-19 infections. Understanding the role of VitD and its associated molecules in the protection against the coagulopathy, vasculopathy, inflammation, oxidative stress and endothelial dysfunction in COVID-19 infection could lead to new therapeutic strategies to prevent, treat, and limit the complications of this deadly virus infection.
Mechanisms of non-alcoholic fatty liver disease development in normal-weight individuals
Authors: Muriel Pablo , Cardoso-Lezama Irina , Vargas-Pozada Eduardo E. , Ramos-Tovar Erika
Published: March 2023

While non-alcoholic fatty liver disease (NAFLD) without inflammation or fibrosis is considered a relatively ‘benign’ disease, non-alcoholic steatohepatitis (NASH), by contrast, is characterized by marked inflammation in addition to lipid accumulation, and may include fibrosis, progression to cirrhosis and hepatocellular carcinoma. Obesity and type II diabetes are frequently associated with NAFLD/NASH; however, a significant number of lean individuals may develop these diseases. Little attention has been paid to the causes and mechanisms contributing to NAFLD development in normal-weight individuals. One of the main causes of NAFLD in normal-weight individuals is the accumulation of visceral and muscular fat and its interaction with the liver. Myosteatosis (triglyceride accumulation in the muscle) induces a loss of muscle by reducing blood flow and insulin diffusion, contributing to NAFLD. Normal-weight patients with NAFLD exhibit higher serum markers of liver damage and C-reactive protein levels, as well as more pronounced insulin resistance, compared to healthy controls. Notably, increased levels of C-reactive protein and insulin resistance are strongly correlated with the risk of developing NAFLD/NASH. Gut dysbiosis has also been associated with NAFLD/NASH progression in normal-weight individuals. More investigation is required to elucidate the mechanisms leading to NAFLD in normal-weight individuals.
Endoscopic retrograde cholangiopancreatography-oriented surgery for accomplished treatment of Mirizzi syndrome: a single-center experience
Authors: Karaahmet Fatih , Kekilli Murat
Published: March 2023

Background

Mirizzi syndrome is a gallstone disease characterized by compression of extrahepatic biliary duct with an impacted stone. Our aim is to identify and describe the incidence, clinical presentation, operative details and the association postoperative complication of Mirizzi syndrome in patients undergoing endoscopic retrograde cholangiopancreatography (ERCP).

Methods

The ERCP procedures were held in Gastroenterology Endoscopy Unit and retrospectively evaluated. The patients were divided into two groups, the cholelithiasis + common bile duct (CBD) stone group and the Mirizzi syndrome group. These groups were compared with the demographic characteristics, ERCP procedures, types of Mirizzi syndrome and surgical technique.

Results

A total of 1018 consecutive patients who underwent ERCP were scanned retrospectively. Of the 515 patients fulfilling the criteria for ERCP, 12 had Mirizzi syndrome and 503 had cholelithiasis and CBD stones. Half of the Mirizzi syndrome patients were diagnosed with pre-ERCP ultrasonography. The mean diameter of choledoc was found to be 10 mm in ERCP. ERCP-related complication rates (pancreatitis, bleeding and perforation) were the same in the two groups; 66.6% of the Mirizzi syndrome patients applied cholecystectomy and placement of T-tube surgical procedures, and there were no postoperative complications.

Conclusion

Surgery is the definitive treatment of Mirizzi syndrome. Thus patients should have a correct preoperative diagnosis for an appropriate and safe surgery. We think that ERCP could be the best guide for this. Also, we believe that intraoperative cholangiography with ERCP and hybrid procedures for guiding surgical treatment may become an advanced treatment option in the future.
Accuracy and concordance of two-dimensional shear-wave elastography using transient elastography as the reference in chronic viral hepatitis and HIV infection in Rio de Janeiro, Brazil
Authors: Coelho Mariana , Fernandes Flavia , Cardoso Sandra W. , Piedade Juliana , Torres da Silva Marcos Vinícius , Santos Ricardo , Veloso Valdilea G. , Grinsztejn Beatriz , Pereira Gustavo Henrique , Perazzo Hugo
Published: March 2023

Objectives

Evaluate the accuracy and agreement of two-dimensional shear-wave elastography (2D-SWE) LOGIQ-S8 with transient elastography in patients from Rio de Janeiro, Brazil.

Method

This retrospective study compared liver stiffness measurements (LSMs) using transient elastography (M and XL probes) and 2D-SWE GE-LOGIQ-S8 performed by a single experienced operator on the same day in 348 consecutive individuals with viral hepatitis or HIV infection. Suggestive and highly suggestive compensated-advanced chronic liver disease (c-ACLD) were defined by transient elastography-LSM ≥10 kPa and ≥15 kPa, respectively. Agreement between techniques and accuracy of 2D-SWE using transient elastography-M probe as the reference was assessed. Optimal cut-offs for 2D-SWE were identified using the maximal Youden index.

Results

Three hundred five patients [61.3% male, median age = 51 [interquartile range (IQR), 42–62] years, 24% with hepatitis C virus (HCV) ± HIV; 17% with hepatitis B virus (HBV) ± HIV; 31% were HIV mono-infected and 28% had HCV ± HIV post-sustained virological response] were included. The overall correlation (Spearman’s ρ) was moderate between 2D-SWE and transient elastography-M (ρ = 0.639) and weak between 2D-SWE and transient elastography-XL (ρ = 0.566). Agreements were strong (ρ > 0.800) in people with HCV or HBV mono-infection, and poor in HIV mono-infected (ρ > 0.400). Accuracy of 2D-SWE for transient elastography-M ≥ 10 kPa [area under the receiver operating characteristic (AUROC) = 0.91 (95% confidence interval [CI], 0.86–0.96); optimal cut-off = 6.4 kPa, sensitivity = 84% (95% CI, 72–92), specificity = 89% (95% CI, 84–92)] and for transient elastography-M ≥ 15 kPa [AUROC = 0.93 (95% CI, 0.88–0.98); optimal cut-off = 7.1 kPa; sensitivity = 91% (95% CI, 75–98), specificity = 89% (95% CI, 85–93)] were excellent.

Conclusion

2D-SWE LOGIQ-S8 system had a good agreement with transient elastography and an excellent accuracy to identify individuals at high risk for c-ACLD.
Alcoholic cardiomyopathy in patients with alcoholic liver cirrhosis: a study across 10 years
Authors: Wang Chunya , Gao Hai , Liu Weibin , Chen Jing , Guo Yupeng , Zhao Pan
Published: March 2023

Background and objectives

Available data regarding cardiomyopathy in patients with alcoholic liver cirrhosis (ALC) are very limited because it often requires multidisciplinary assessments. The study aims to evaluate the prevalence of alcoholic cardiomyopathy in ALC and their clinical correlations.

Methods

Adult ALC patients without a previous diagnosis of cardiovascular diseases between January 2010 and December 2019 were included in the study. The prevalence rate of alcoholic cardiomyopathy in patients with ALC was calculated together with a 95% confidence interval (CI) using the Clopper–Pearson exact method.

Results

A total of 1022 ALC patients were included. Male patients predominated (90.5%). ECG abnormalities were observed in 353 patients (34.5%). Prolonged QT interval was most common in ALC patients with ECG abnormalities, which occurred in 109. Thirty-five ALC patients underwent the cardiac MRI examination and only one patient was found with cardiomyopathy. The estimated prevalence rate of alcoholic cardiomyopathy in all the ALC patients was 0.0286 (95% CI, 0.0007–0.1492). There was no statistical difference regarding the prevalence rate between the group of patients with ECG abnormalities and the group without ECG abnormalities (0.0400 vs. 0.0000, P = 1.000).

Conclusion

Although ECG abnormalities, especially QT prolongation, existed in a proportion of ALC patients, cardiomyopathy in the patient population was not common. Further larger-sample studies based on cardiac MRI are needed to verify our results.
Biopsies from ulcer edge yield higher histological activity scores than biopsies from non-ulcerated mucosa in active ulcerative colitis
Authors: Novak Gregor , Sever Nejc , Hanžel Jurij , Koželj Matic , Kurent Tina , Smrekar Nataša , Drobne David , Zidar Nina
Published: March 2023

Background

The appropriate location for biopsy collection in ulcerative colitis is unknown.

Objectives

We aimed to determine the location for biopsy collection in the presence of ulcers which yields the highest histopathological score.

Design and methods

This prospective cross-sectional study enrolled patients with ulcerative colitis and ulcers in the colon. Biopsy specimens were obtained at the edge of the ulcer; at a distance of one open forceps (7–8 mm) from the ulcer edge; at a distance of three open forceps (21–24 mm) from the ulcer edge; further referred to as locations 1, 2 and 3 respectively. Histological activity was assessed using Robarts Histopathology Index and the Nancy Histological Index. Statistical analysis was performed using mixed effects models.

Results

A total of 19 patients were included. Decreasing trends with distance from the ulcer edge (P < 0.0001) were observed. Biopsies procured from the edge of the ulcer (location 1) yielded a higher histopathological score compared to biopsies procured at locations 2 and 3 (P ≤ 0.001).

Conclusion

Biopsies from the ulcer edge yield higher histopathological scores than biopsies next to the ulcer. In clinical trials with histological endpoints, biopsies should be obtained from the ulcer edge (if ulcers are present) to reliably assess histological disease activity.
Clinical features and outcomes of adult idiopathic megarectum
Authors: Wu Kyle , Little Robert D. , Long Andrew , Khera Angela , Kamm Michael A. , Basnayake Chamara
Published: March 2023

Objective

Idiopathic megarectum is characterized by abnormal, pronounced rectal dilatation in the absence of identifiable organic pathology. Idiopathic megarectum is uncommon and under-recognized. This study aims to describe the clinical features and management of idiopathic megarectum.

Methods

A retrospective review was undertaken on patients diagnosed with idiopathic megarectum with or without idiopathic megacolon over a 14-year period until 2021. Patients were identified from the hospital’s International Classification of Diseases codes, and pre-existing clinic patient databases. Patient demographics, disease characteristics, healthcare utilization and treatment history data were collected.

Results

Eight patients with idiopathic megarectum were identified; half of the patients were female, with the median age of symptom onset being 14 years (interquartile range [IQR] 9–24). The median rectal diameter measured was 11.5 cm (IQR 9.4–12.1). The most common presenting symptom was constipation, bloating and faecal incontinence. All patients required prior sustained periods of regular phosphate enemas and 88% were using ongoing oral aperients. Concomitant anxiety and or depression were found in 63% of patients and 25% were diagnosed with an intellectual disability. Healthcare utilization was high with a median of three emergency department presentations or ward admissions related to idiopathic megarectum per patient over the follow-up period; 38% of patients required surgical intervention during the period of follow-up.

Conclusion

Idiopathic megarectum is uncommon and associated with significant physical and psychiatric morbidity and high healthcare utilization.
Risk factors of nosocomial infection in patients underwent artificial liver support system: a retrospective case–control study
Authors: Zhang Xu , Qin Deyu , Liu Guangwei , Li Feng , Peng Jingjing , Xiang Yanling
Published: March 2023

Background

Although nosocomial infection is one of the most discussed problems in patients undergoing artificial liver support system (ALSS) treatment, only few solutions have been proposed so far. This study aimed to explore the risk factors of nosocomial infection in patients treated with ALSS in order to aid in the development of future preventive measures.

Methods

This retrospective case–control study included patients treated with ALSS at the Department of Infectious Diseases, First Affiliated Hospital of xxx Medical University between January 2016 and December 2021.

Results

One hundred seventy-four patients were included. There were 57 patients in the nosocomial infection group and 117 patients in the non-nosocomial infection group, of them 127 males (72.99%) and 47 females (27.01%) with an average age of 48.15 ± 14.19 years old. Multivariate logistic regression analysis revealed that total bilirubin [odds ratio (OR) = 1.004; 95% confidence interval (CI), 1.001–1.007; P = 0.020], number of invasive procedures (OR = 2.161; 95% CI, 1.500–3.313; P < 0.001), blood transfusion (OR = 2.526; 95% CI, 1.312–4.864; P = 0.006) were independent risk factors and haemoglobin (Hb) (OR = 0.973; 95% CI, 0.953–0.994; P = 0.011) was a protective factor for nosocomial infection in patients treated with ALSS.

Conclusion

The total bilirubin, transfusion of blood products and higher number of invasive operations were independent risk factors for nosocomial infection in patients treated with ALSS, while higher Hb was a protective factor.
A pilot, masked, randomized controlled trial to evaluate local gentamicin versus saline in open tibial fractures (pGO-Tibia)
Authors: Haonga Billy T. , Ngunyale Patrick , von Kaeppler Ericka P. , Donnelley Claire A. , Won Nae Y. , Eliezer Edmund N. , Brown Kelsey , Flores Michael , O'Marr Jamieson M. , Rodarte Patricia , Urva Mayur , Cortez Abigail , Porco Travis , Morshed Saam , Shearer David W.
Published: March 2023

Background:

Open tibial fractures have a high risk of infection that can lead to severe morbidity. Antibiotics administered locally at the site of the open wound are a potentially effective preventive measure, but there are limited data evaluating aminoglycoside antibiotics. The objective of this study was to assess the feasibility of a clinical trial to test the efficacy of local gentamicin in reducing the risk of fracture-related infection after open tibial fracture.

Methods:

This study is a single-center, pilot, masked, randomized controlled trial conducted at the Muhimbili Orthopaedic Institute. Participants were randomized intraoperatively after wound closure to receive gentamicin solution or normal saline solution injected at the fracture site. Follow-ups were completed at 2 weeks, 6 weeks, 3 months, 6 months, 9 months, and 1 year postoperatively. The primary feasibility outcomes were the rate of enrollment and retention. The primary clinical outcome was the occurrence of fracture-related infection.

Results:

Of 199 patients screened, 100 eligible patients were successfully enrolled and randomized over 9 months (11.1 patients/month). Complete data were recorded at baseline and follow-up for >95% of cases. The rate of follow-up at 6 weeks, 3 months, 6 months, 9 months, and 1 year were 70%, 68%, 69%, 61%, and 80%, respectively. There was no difference in adverse events or any of the measured primary and secondary outcomes.

Conclusion:

This pilot study is among the first to evaluate locally administered gentamicin in open tibial fractures. Results indicate a rigorous clinical trial with acceptable rates of enrollment and follow-up to address this topic is possible in this setting.
Change in Pediatric Adenotonsillectomy Postoperative Visit Patterns After Opioid Food and Drug Administration Warning
Authors: Cohen Naiomi , Schissler Kathryn , Jeter Justin , Stathas Adam , Lozano Juan , Dave Sandeep , Lowe David
Published: March 2023

Study Objective

This study aimed to determine the association between opioid prescriptions given after tonsillectomy with adenoidectomy (T + A) and pain-related return visit rates in pediatric patients. Determine association between Food and Drug Administration (FDA) black box warning against opioid use in this population and pain-related return visit rates.

Methods

This was a single-institution retrospective cohort study of pediatric patients who underwent T + A between April 2012 and December 2015 and had return visits to the emergency department or urgent care center. Data were obtained from the hospital electronic warehouse using International Classification of Diseases-9/10 procedure codes. Odds ratios (ORs) with 95% confidence intervals (CIs) for return visits were calculated. Multivariate logistic regression analysis was used to measure association between opioid prescriptions and return visit rates as well as FDA warning and return visit rates adjusting for confounders.

Results

There were 4778 patients who underwent T + A, median age, 5 years. Of these, 752 (15.7%) had return visits. Pain-related return visits were higher in patients who received opioid prescriptions (adjusted OR, 1.31; 95% CI, 1.09–1.57). After FDA warning, opioids were prescribed at a lower rate (47.9%) compared with previous (98.6%) (OR, 0.01; 95% CI, 0.008–0.02). Pain-related return visits were lower after FDA warning (OR, 0.73; 95% CI, 0.61–0.87). Steroid prescription rate increased after FDA warning (OR, 415; 95% CI, 197–874).

Conclusions

Opioid prescriptions were associated with higher pain-related return visits after T + A, whereas issuance of FDA black box warning against codeine use was associated with lower pain-related return visits. Our data suggest that the black box warning potentially had unintended benefits in pain management and health care usage.
A Child with an Esophageal Web Treated with Functional Lumen Imaging Probe
Authors: Hohl Brenna , Hoskins Brett , Ng Kenneth
Published: March 2023

A 14-month-old male presented to the emergency department with a 4-day history of vomiting after the intake of liquids or solids. During the admission, imaging studies revealed an esophageal web, a form of congenital esophageal stenosis. He was treated with a combination of Endoluminal Functional Lumen Imaging Probe (EndoFLIP) and controlled radial expansion (CRE) balloon dilation, followed by EndoFLIP and EsoFLIP dilation 1 month later. The patient’s vomiting resolved after treatment, and he was able to gain weight. This report describes one of the first cases of applying EndoFLIP and EsoFLIP to treat an esophageal web in a pediatric patient.
Preoperative Optimization Before Ventral Hernia Repair: A Systematic Review and Meta-analysis
Authors: Marcolin Patricia , Mazzola Poli de Figueiredo Sérgio , Walmir de Araújo Sérgio , Mota Constante Marcella , Moura Fé de Melo Vítor , Ginar da Silva Shana , Mao Rui-Min Diana , DeJesus Jana , Lu Richard
Published: March 2023

Background:

Obesity is associated with an increased risk of ventral hernia development and recurrence rates after ventral hernia repair (VHR). The metabolic derangements caused by obesity can also lead to many postoperative complications. Therefore, it is a common practice to attempt weight loss before VHR. However, there is still no consensus on optimal preoperative management for obese patients with a ventral hernia. This study aims to perform a meta-analysis to evaluate the effect of preoperative weight optimization on VHR outcomes.

Methods:

We performed a literature search of PubMed, Scopus, and Cochrane Library databases to identify studies comparing obese patients who underwent surgical or non-surgical weight loss interventions before undergoing hernia repair surgery to obese patients who underwent hernia repair surgery without prehabilitation. Postoperative outcomes were assessed by means of pooled analysis and meta-analysis. Statistical analysis was performed using RevMan 5.4. Heterogeneity was assessed with I2 statistics.

Results:

One thousand six hundred nine studies were screened and 13 were thoroughly reviewed. Five studies comprising 465 patients undergoing hernia repair surgery were included. No differences in hernia recurrence [odds ratio (OR) 0.66; 95% CI 0.23-1.89; P=0.44; I2=20%], seroma (OR 0.70; 95% CI 0.25-1.95; P=0.50; I2=5%), hematoma (OR 2.00; 95% CI 0.5-7.94; P=0.45; I2=0%), surgical site infection (OR 1.96; 95% CI 0.52-7.40; P=0.32; I2=0%), and overall complication (OR 0.80; 95% CI 0.37-1.74; P=0.58; I2=40%) rates were noted when comparing patients who underwent a preoperative weight loss intervention (prehabilitation or bariatric surgery) versus those who did not. In the subgroup analysis of patients who underwent bariatric surgery, we found no difference in hernia recurrence (OR 0.64; 95% CI 0.12-3.33; P= 0.59; I2=41%) or overall complications (OR 1.14; 95% CI 0.36-3.64; P=0.82; I2=64%). In the subgroup analysis of patients who lost weight versus patients who did not, there was no significant difference in overall complication rates (OR 0.86; 95% CI 0.34-2.21; P=0.76; I2=55%).

Conclusions:

We found similar hernia recurrence, seroma, hematoma, and surgical site infection rates in patients who underwent preoperative optimization. These findings underline the need for prospective studies to define the optimal role of preoperative optimization and weight loss in obese patients undergoing ventral hernia repair.