bluuebunny/crossref_metadata_2025 huggingface dataset:
Intergenerational Ambivalence and Loneliness in Later Life
Authors: Hua Cassandra L. , Brown J. Scott , Bulanda Jennifer R.
Published: September 2020

Objective

This brief report examined the relationship between intergenerational ambivalence and loneliness in later life among a group of older adults with at least one child.

Background

Previous work has explored the links between intergenerational ambivalence and other indicators of well‐being but has not examined loneliness. Although studies show an association between positive and negative relationship quality with children and loneliness, there are conflicting findings, and there is also insufficient exploration of the role of gender.

Method

Utilizing pooled data from the 2012 and 2014 waves of the Health and Retirement Study (HRS) (n = 10,967) (
https://hrs.isr.umich.edu/documentation), structural equation models were used to examine the hypothesized relationships, and multiple group analysis was utilized to assess potential gender differences.

Results

The results indicated that greater intergenerational ambivalence was associated with increased loneliness in later life. However, there were no significant gender or marital status differences in the relationships.

Conclusion

This study adds to the existing literature on ambivalence and well‐being by showing that ambivalent relationships are related to loneliness. Results underscore the emotional complexity of parent–child relationships and suggest the need for investigating the consequences of holding contradictory feelings.
Artemisia vulgaris, a new host of 16SrV‐C phytoplasma related strains infecting black alder in Poland
Authors: Jurga Marta , Zwolińska Agnieszka
Published: September 2020

Yellowing of leaf tissue and strongly deformed shoots were observed in common mugwort (Artemisia vulgaris L.) growing in a nature reserve in Southern Poland. Similar foliage chlorosis together with abnormal shoot proliferation was noticed on alder tree (Alnus glutinosa Gaertn.) growing next to the common mugwort. DNA specific fragments coding 16S rRNA and ribosomal proteins (rp) were amplified from mugwort and alder samples using direct and nested PCR (Polymerase Chain Reaction) assays. Phylogenetic relationships inferred from 16S and rps3 genes indicated that strains infecting mugwort and alder were most closely related to phytoplasmas of subgroups 16SrV‐C and 16SrV‐D. Based on the restriction fragment length polymorphism (RFLP) analysis of the 16S rDNA, the investigated phytoplasma strains were classified to subgroup 16SrV‐C. Two sequence variants of the rps3 gene which differed by a single nucleotide were detected in all analysed samples by pairwise analysis of the aligned reads. Taking into account that this single‐nucleotide polymorphism (SNP) occurs among 16SrV‐C and 16SrV‐D related phytoplasmas and that the phytoplasmas have a single copy of rp operon, we concluded that each plant species was infected by two distinct, closely related phytoplasma strains. To the best of our knowledge, this is the first report of group 16SrV‐C related phytoplasmas infecting common mugwort worldwide, adding a new host species that is possibly linked to the spread of the alder pathogen in Eastern Europe. Although alder yellows phytoplasma has been frequently found in Europe, this is the first detection of phytoplasmas associated with alder in Poland.
The ultrasonographic medullary “rim sign” versus medullary “band sign” in cats and their association with renal disease
Authors: Cordella Alessia , Pey Pascaline , Dondi Francesco , Dunn Marilyn , Caramazza Chiara , Cipone Mario , Diana Alessia
Published: September 2020

Background

Medullary rim sign (MRS) refers to a hyperechoic line in the renal medulla, reported on ultrasound examination (US) in both dogs and cats with and without kidney disease (KD).

Objective

To describe the different aspects of MRS in cats and to assess its association with KD.

Animals

Cats that underwent US examination, with MRS (study group) with and without KD and without MRS with and without KD (control groups).

Methods

Retrospective case‐control study: cats with MRS, with or without KD (rim sign groups) and cats without MRS, with or without KD (control groups). Ultrasonographic images were blindly reviewed with attention given to the thickness and margins of the MRS recorded.

Results

Eighty‐four cats with MRS were included and 60 cats recruited for each control group. The MRS had 2 distinct aspects: a thin hyperechoic line with well‐defined margins (MRS‐line) in 50/84 cats (59%) and a thick hyperechoic band with ill‐defined margins (MRS‐band) in 34/84 cats (41%). Twenty of 50 (40%) cats with MRS‐lineand 25/34 (74%) of cats with MRS‐bandhad KD. The frequency of MRS‐linewas higher in cats without KD, whereas the presence of MRS‐bandwas more frequent in cats with KD (P= .003).

Conclusions and Clinical Importance

A thick hyperechoic ill‐defined band (for which the term medullary band sign is proposed) was more frequently associated with KD, whereas a thin hyperechoic well‐defined line (true MRS) may be seen in cats with or without KD.
“Far more poetry than justice.” The economics of austerity in the America of Paul Auster
Authors: Tedde Adriano
Published: September 2020

Moving beyond the modernist and postmodern metaphors of hunger that the writing of Paul Auster (b. 1947) suggests, this article explores Auster as a writer who responds to the so‐called public economic austerity that has dominated the political economic agenda in the United States during the past four decades. This reading suggests that there is a realist quality in Auster's work, notwithstanding its postmodern play. In presenting this argument, I believe that the writer's body of work discloses the history of post‐1960s American economy in a plethora of poverty‐stricken people that form the social background of his stories (downtrodden), in the insecurity that thwarts the main characters' existence (the newly dispossessed) and in the personal choices of the author himself to live his life as a starving artist (the penniless hero). Such an history of US economy is accompanied by a criticism of neoliberal ethos that restores the dignity of marginalized poor Americans.
Covert hepatic encephalopathy and spontaneous portosystemic shunts increase the risk of developing overt hepatic encephalopathy
Authors: Greinert Robin , Zipprich Alexander , Simón‐Talero Macarena , Stangl Franz , Ludwig Christiane , Wienke Andreas , Praktiknjo Michael , Höhne Kevin , Trebicka Jonel , Genescà Joan , Ripoll Cristina
Published: September 2020

Aim

The aim of the study was to evaluate the presence of covert hepatic encephalopathy (cHE) and its characteristics according to the presence of spontaneous portosystemic shunts (SPSS) and their influence on the development of overt hepatic encephalopathy.

Methods

Secondary analysis of a multicentre study, which evaluated the association between SPSS and complications of cirrhosis. The present study population includes those patients who also underwent cHE diagnostic evaluation. Presence of SPSS was evaluated by cross‐sectional imaging and quantified by total SPSS‐area. Logistic and Cox‐regression competing risk analyses were performed.

Results

About 65 patients were included of age 58 (IQR 50‐66), MELD 15 (IQR 10‐20), with alcoholic liver disease 63%. Thirty‐two patients (49%) had cHE, had higher MELD [16 (IQR 12‐24) vs 13 (IQR 9‐17), P = .027], a greater proportion of SPSS [n = 18 (56%) vs n = 8 (24%); P = .008] and a higher total cross‐sectional SPSS‐area [28.3 (0‐94.2) vs 0 (0‐14.1); P = .005]. On multivariate analysis MELD [OR 1.11 (95% CI 1.01‐1.21)] and presence of SPSS [OR 3.95 (95% CI 1.22‐12.80)] were independently associated to cHE at baseline. During follow‐up cHE was an independent predictor of oHE [cHE: HR 6.93 (95% CI 2.64‐18.20). The effect of cHE on the development of oHE was greater in patients with SPSS [only cHE: HR 5.66 (95% CI 1.82‐17.62), cHE and SPSS: HR 8.63 (95% CI 3.15‐23.65)].

Conclusions

cHE is independently associated to the presence of SPSS (and total cross‐sectional SPSS‐area) and MELD. Furthermore, the presence of SPSS seems to increase the risk of cHE of developing of overt hepatic encephalopathy.
A realist review of scholarly experiences in medical education
Authors: Cornett Marian , Palermo Claire , Wallace Megan J. , Diug Basia , Ward Bernadette
Published: September 2020

Context

Scholarly experiences have been increasingly employed to support the development of scholarly skills for medical students. How the characteristics of the various scholarly experiences contributes to scholarly outcomes or the complexities of how the experiences build skills warrants further exploration.

Objectives

To identify how medical students’ scholarly experiences lead to scholarly outcomes under what circumstances.

Methods

A realist review was conducted with a search of Ovid MEDLINE, CINAHL, Scopus and ERIC databases using the terms “medical student” and “scholarly experience” and related synonyms. Studies involving the engagement of medical students in a range of compulsory scholarly experiences including quality improvement projects, literature reviews and research projects were included. Key data were extracted from studies, and realist analysis was used to identify how contexts and mechanisms led to different outcomes.

Results

From an initial 4590 titles, 28 studies of 22 scholarly experiences were identified. All were primarily focused on research‐related scholarly experiences. Organisational research culture that valued research, dedicated time, autonomy and choice of experience were found to be key contexts. Adequately supported and structured experiences where students can see the value of research and quality supervision that builds student's self‐efficacy were identified as mechanisms leading to outcomes. Outcomes included increased research skills and attitudes, scholarly outputs (eg publications) and future interest in research or other scholarly endeavours.

Conclusions

The design of scholarly experiences for medical students needs to ensure protected time, adequate supervision and autonomy, to achieve scholarly outcomes. Much of the focus is on research and traditional outcomes with little known about the role or outcomes associated with other scholarly work.
Computational morphogenesis of free‐form grid structures with Voronoi diagram
Authors: Su Yan , Wu Yue , Ji Wei , Sun Xiaoying
Published: September 2020

Free‐form grid structures have developed increasingly with the development of computer‐aided design and advanced construction technology. However, the grid generation is still a difficulty for designing free‐form grid structures. The computational morphogenesis of free‐form grid structures with the Voronoi diagram is proposed to solve this difficulty. Voronoi diagram is introduced to form the irregular grid of structures. Morphologies of plane and curved surface Voronoi grid structure are formulated to realize parametric modeling of the structural grid. A comprehensive structural index is proposed for evaluating free‐form grid structures quantitatively from the aspects of both architectural and structural behaviors. Taking the seeds as optimization variables and the comprehensive structural index as optimization objective, the grid generation problem is transformed into an optimization problem. Numerical examples show that the proposed morphogenesis is feasible and effective for the grid generation of free‐form structures. The free‐form grid structures generated by the proposed method have not only appealing geometry but also good mechanical behavior. The consideration of the symmetry can accelerate the grid generation process. Different grid distributions can be realized with different supports.
The impact of temperature at depth on estimates of thermal habitat for short‐finned pilot whales
Authors: Adamczak Stephanie K. , McLellan William A. , Read Andrew J. , Wolfe Christopher L. P. , Thorne Lesley H.
Published: September 2020

Short‐finned pilot whales (Globicephala macrorhynchus) experience dramatic changes in temperature during deep dives, but studies of pilot whale habitat use typically rely solely on surface temperature measurements. We quantified vertically integrated thermal habitat for short‐finned pilot whales using a novel metric, degree‐hours, developed using data from digital acoustic recording tags (DTAGs) deployed off Cape Hatteras along with interpolated temperature profiles at depth from the Met Office Hadley Centre EN4 oceanographic data set. We then compared estimates of thermal habitat calculated from surface waters with estimates of vertically integrated thermal habitat calculated using EN4 data collected along the eastern seaboard of the U.S. to understand how available thermal habitat is influenced by seasonal and spatial variability in water temperature. Estimates of vertically integrated thermal habitat were typically lower than estimates produced using surface temperatures, and the difference was greatest at intermediate latitudes and in warmer seasons, where and when there is a high degree of variability between surface and bottom temperatures. Our work highlights the importance of considering temperature at depth to accurately assess the thermal habitat of deep‐diving marine vertebrates, and presents a means of quantifying thermal habitat that will be useful for understanding the thermal ranges of these species.
Short‐ and long‐term effects of fire on stem hydraulics inPinus ponderosasaplings
Authors: Partelli‐Feltrin Raquel , Smith Alistair M.S. , Adams Henry D. , Kolden Crystal A. , Johnson Daniel M.
Published: September 2020

Understanding tree physiological responses to fire is needed to accurately model post‐fire carbon processes and inform management decisions. Given trees can die immediately or at extended time periods after fire, we combined two experiments to assess the short‐ (one‐day) and long‐term (21‐months) fire effects onPinus ponderosasapling water transport. Native percentage loss of conductivity (nPLC), vulnerability to cavitation and xylem anatomy were assessed in unburned and burned saplings at lethal and non‐lethal fire intensities. Fire did not cause any impact onnPLC and xylem cell wall structure in either experiment. However, surviving saplings evaluated 21‐months post‐fire were more vulnerable to cavitation. Our anatomical analysis in the long‐term experiment showed that new xylem growth adjacent to fire scars had irregular‐shaped tracheids and many parenchyma cells. Given conduit cell wall deformation was not observed in the long‐term experiment, we suggest that the irregularity of newly grown xylem cells nearby fire wounds may be responsible for decreasing resistance to embolism in burned plants. Our findings suggest that hydraulic failure is not the main short‐term physiological driver of mortality forPinus ponderosasaplings. However, the decrease in embolism resistance in fire‐wounded saplings could contribute to sapling mortality in the years following fire.
Action spectrum of the redox state of the plastoquinone pool defines its function in plant acclimation
Authors: Mattila Heta , Khorobrykh Sergey , Hakala‐Yatkin Marja , Havurinne Vesa , Kuusisto Iiris , Antal Taras , Tyystjärvi Taina , Tyystjärvi Esa
Published: September 2020

The plastoquinone (PQ) pool mediates electron flow and regulates photoacclimation in plants. Here we report the action spectrum of the redox state of the PQ pool in Arabidopsis thaliana, showing that 470–500, 560 or 650–660 nm light favors Photosystem II (PSII) and reduces the PQ pool, whereas 420–440, 520 or 690 nm light favors Photosystem I (PSI) and oxidizes PQ. These data were used to construct a model predicting the redox state of PQ from the spectrum of any polychromatic light source. Moderate reduction of the PQ pool induced transition to light state 2, whereas state 1 required highly oxidized PQ. In low‐intensity PSI light, PQ was more oxidized than in darkness and became gradually reduced with light intensity, while weak PSII light strongly reduced PQ. Natural sunlight was found to favor PSI, which enables plants to use the redox state of the PQ pool as a measure of light intensity.
Does parasitism mediate water mite biogeography?

Authors: Yagui Hiromi , Valdecasas Antonio G.
Published: September 2020

The biogeography of organisms, particularly those with complex lifestyles that can affect dispersal ability, has been a focus of study for many decades. Most Hydrachnidia, commonly known as water mites, have a parasitic larval stage during which dispersal is predominantly host-mediated, suggesting that these water mites may have a wider distribution than non-parasitic species. However, does this actually occur? To address this question, we compiled and compared the geographic distribution of water mite species that have a parasitic larval stage with those that have lost it. We performed a bootstrap resampling analysis to compare the empirical distribution functions derived from both the complete dataset and one excluding the extreme values at each distribution tail. The results show differing distribution patterns between water mites with and without parasitic larval stages. However, contrary to expectation, they show that a wider geographic distribution is observed for a greater proportion of the species with a non-parasitic larval stage, suggesting a relevant role for non-host-mediated mechanisms of dispersal in water mites.
Coping Amongst Elite-Level Sports Coaches: A Systematic Review
Authors: Olsen Maja Gunhild , Haugan Jan Arvid , Hrozanova Maria , Moen Frode
Published: September 2020

The current study presents a systematic review of six empirical research studies that have explored coping amongst elite-level sport coaches. The study was carried out employing Fletcher et al.’s meta-model of stress, emotions, and performance as a basis for the review. The present results clearly revealed that, despite being an important aspect of coaches’ functioning, coping is almost never researched in its full complexity, and scarce attention is given to cognitive appraisals and long-term outcomes. To our knowledge, current research has so far been limited to the perceived stressors and employed coping strategies. Compared with problem-focused coping, emotion-focused coping is less frequently reported. Emotion-focused coping also has some limitations regarding occurrence and diversity in reported strategies. The reasons for this are not well-known due to the lack of comprehensiveness in the research. Hence, researchers are encouraged to further investigate coping amongst elite-level coaches and to do so by treating it as a concept affected by appraisals and personal and situational characteristics that exist in the context of a larger stress process.
Next One Up! Exploring How Coaches Manage Team Dynamics Following Injury
Authors: Van Woezik Rachel A. , Benson Alex J. , Bruner Mark W.
Published: September 2020

Injuries are commonplace in high-intensity sport, and research has explored how athletes are psychologically affected by such events. As injuries carry implications for the group environment in sport teams, the authors explored what occurs within a team during a time period of injury from a coach perspective and how high-performance coaches manage a group at this time. Semistructured interviews were conducted with 10 Canadian university basketball head coaches. Thematic analysis revealed four high-order themes in relation to how coaches managed group dynamics from the moment of the injury event to an athlete’s reintegration into the lineup. Strategies to mitigate the negative effects of injury on the group environment while prioritizing athlete well-being involved remaining stoic at the time of an injury event, maintaining the injured athlete’s sense of connection to the team, and coordinating with support staff throughout the recovery and reintegration process.
The hallmarks of cancer are also the hallmarks of wound healing
Authors: MacCarthy-Morrogh Lucy , Martin Paul
Published: September 2020

Many of the mechanisms that drive cancer development and progression also promote wound healing.
Quantitative kinase and phosphatase profiling reveal that CDK1 phosphorylates PP2Ac to promote mitotic entry
Authors: Nasa Isha , Cressey Lauren E. , Kruse Thomas , Hertz Emil P. T. , Gui Jiang , Graves Lee M. , Nilsson Jakob , Kettenbach Arminja N.
Published: September 2020

The kinase CDK1 directly and indirectly inhibits PP2A holoenzyme formation to promote mitosis.
Asian paleomonsoon variation linked to “tripolar” environmental changes
Authors: Zhisheng* An , Weijian Zhou , Zeke* Zhang , Youbin Sun , Yanjun Cai , Li Li , Zhengguo Shi , Hong Chang , Hong Yan
Published: September 2020

Global warming and ice melting in the “tripolar” regions, namely, Antarctica, the Arctic, and the Tibetan Plateau, might lead to a reorganization of the global climate system. Understanding the dynamic links between the “tripolar” environments and the Earth climate system is crucial to improving our capability to project future climate variability. “Tripolar” changes have influenced the onset and evolution of the Asian paleomonsoon system through various atmospheric and/or oceanic mechanisms. Here, we summarize previously reported Asian paleomonsoon variations that can be linked to “tripolar” environmental changes, from tectonic to millennial time scales, and explore linkages between the “tripolar” regions and global climate changes.
Problem-solving in clinical practice: breathing difficulty and muscle weakness following allogeneic haematopoietic stem cell transplantation
Authors: Albulushi Bashaer , Thabet Farah , Alshahwan Saad , Elborai Yasser , Alkhayat Nawaf , Alshahrani Mohamed , Tabarki Brahim
Published: September 2020

Acute weakness and dyspnoea are unusual presentation after allogeneic haematopoietic stem cell transplantation (HSCT) complicated by chronic graft-versus-host disease (GVHD). The differential diagnosis and management are challenging for the paediatrician. This case chronicles the diagnostic journey of a child who presented with weakness, dyspnoea and difficulty in speech, 2 years after allogeneic HSCT and GVHD and explores the approach to neurological manifestations in this context.
Mania presenting as a VZV encephalitis in the context of HIV
Authors: George Oliver , Daniel Jessica , Forsyth Sophie , Enright David
Published: September 2020

Acute encephalitis can be life-threatening, especially in the immunocompromised population. Viruses are the main infectious agents, with varicella zoster virus (VZV) a common cause. Neuropsychiatric symptoms are well documented, but it is rare for mania to be the only symptom on presentation. Here, we report a case of hypomania in a 31-year-old white British heterosexual man who following investigation was found to be HIV positive and subsequently diagnosed with VZV encephalitis. To date, we are unaware of any similarly reported cases. It is important to raise awareness of atypical HIV presentations to improve clinical outcomes for patients.
Duplication of the inferior vena cava with thrombotic complication: incidentally detected
Authors: Oulare Fode Bangaly , Clemens Robert Karl Josef , Pfammatter Thomas , Meier Thomas Oleg
Published: September 2020

Although the duplication of the inferior vena cava (IVCD) is usually clinically silent and often detected incidentally by image analysis, it may have important relevance during retroperitoneal surgery and endovenous procedures. Furthermore, IVCD may represent the primary provocating factor of unilateral iliofemoral vein thrombosis in patient with hypoplasia or thrombosis of one of the caval veins. This was the case in a 37-year-old man with acute painful swelling of the right leg. The patient was treated successfully by endovenous reconstruction of the occluded caval vein. A review of the pathophysiology, clinical manifestation and treatment of the IVCD is provided here.
Nocardia farcinicamasquerading as intracerebral metastases in advanced metastatic prostatic cancer
Authors: Livings Claire , Uemura Mayu , Patel Reena , Afshar Mehran
Published: September 2020

A 67-year-old man with metastatic prostate cancer and underlying asymptomatic pancytopenia presented with a 1-week history of general malaise, left leg weakness and facial numbness. Initial brain imaging demonstrated two rim-enhancing lesions felt to represent intracerebral metastasis. Following neurosurgical referral, a multidisciplinary meeting decision was made for best supportive care and dexamethasone was given. He developed multiple cutaneous lesions, which on incision and drainage revealedNocardia farcinica. Repeat brain imaging showed enlargement of the existing cavitating lesions and appearance of new lesions, now typical of cerebral abscesses. A diagnosis of disseminated nocardiosis with cutaneous and intracerebral infection was reached. He started taking empirical treatment with intravenous meropenem, co-trimoxazole and subsequent addition of amikacin, with little improvement. On further review of sensitivities, moxifloxacin was added. Following over 1 month of antimicrobial treatment, his neurological symptoms, cutaneous lesions and repeat MRI of the brain had improved.
Erector spinae catheter for post-thoracotomy pain control in a premature neonate
Authors: Swenson Schalkwyk Anna , Flaherty James , Hess Donavon , Horvath Balazs
Published: September 2020

Ensuring respiratory stability with early tracheal extubation and adequate pain control is challenging in premature neonates after thoracotomy. Continuous erector spinae plane (ESP) block, a relatively new truncal nerve block, has the potential to provide analgesia for thoracic surgeries while reducing opioid use. However, there have been only a few reports utilising this technique in infants, and none in preterm neonates. We present the perioperative pain management of a preterm neonate requiring thoracotomy. Epidural analgesia was deemed contraindicated due to coexisting coagulopathy; therefore, an ESP catheter was placed. The patient was extubated at the end of the surgery and had excellent pain control with rectal acetaminophen, chloroprocaine infusion via the ESP catheter and with minimal opioid requirement. Continuous ESP block may be safe and effective for postoperative pain management in coagulopathic premature neonates. Chloroprocaine is an effective local anaesthetic in the erector spinae compartment, which has not been previously reported.
Generalised urticaria following ingestion of a nickel-plated coin in a 4-year-old girl
Authors: Duchesnay Isabelle , Livingston Michael H , VanHouwelingen Lisa , Walton J Mark
Published: September 2020

We report the case of a 4-year-old girl who presented to the emergency department after ingestion of a nickel-plated coin. Abdominal radiographs confirmed the presence of a coin in her stomach but she was otherwise asymptomatic. She was discharged with assurances that the foreign body would pass spontaneously. The patient developed significant generalised urticaria the next day, which became progressively more severe. Her symptoms prompted endoscopic removal of the nickel-plated coin and a postoperative course of corticosteroids and antihistamine therapy. This is the first reported case of generalised urticaria secondary to ingestion of a coin with nickel plating only (2% nickel content overall). A review of similar cases is provided.
Transient facial nerve palsy following dental local anaesthesia
Authors: Jenyon Thomas , Panthagani Jesse , Green David
Published: September 2020

Facial nerve palsy is a rare but known complication of dental local anaesthesia and may be underreported. We describe a case of a transient facial nerve palsy following the administration of an inferior alveolar nerve block and discuss the immediate practical management. Knowing the likely transient nature of this complication means the patient can be reassured and unnecessary referral avoided. While the blink reflex is inhibited, steps are needed in order to protect the cornea and prevent secondary infection and scarring.
A rare case of coexisting tuberculosis with hydatid disease from North India with review of literature
Authors: Verma Prashant Kumar , Rohilla Ranjana , Natarajan Vivekanand , Gupta Puneet Kumar
Published: September 2020

Coexisting tuberculosis (TB) and hydatid disease in an immunocompetent individual is an extremely rare occurrence. Given the similarities in the clinical manifestations and morbidities of both, specific diagnosis in individuals coinfected with these is difficult. We, hereby present a case of a 17-year-old adolescent man diagnosed to be a coinfection of pulmonary TB with pulmonary and cardiac hydatid disease, with the review of cases having a similar presentation. The coexistence of these infections should be considered in endemic areas. Management can only be done by a multidisciplinary approach including surgical, microbiological, histopathological and radiological facilities. Complete surgical excision of the cyst is the treatment of choice and medical therapy for both aetiologies should be appropriate to achieve cure.
A rare case of bilateral sequential posterior scleritis in an elderly woman
Authors: Belenje Akash , Rani Padmaja Kumari
Published: September 2020

A 63-year-old woman came with complaints of decreased vision and minimal pain on extraocular movements in the left eye and, after investigations, was diagnosed with posterior scleritis. Systemic steroid treatment helped resolve the symptoms and signs. One year later, she presented with right eye involvement. She was evaluated for systemic illness and, based on clinical and investigational findings, it was deduced that probably a sarcoidosis was predisposing her to the eye problem. She was provisionally diagnosed with bilateral sequential posterior scleritis secondary to sarcoidosis. She was prescribed oral steroids, which helped resolve her eye problem. She was next referred to a rheumatologist and a pulmonologist for further evaluation and treatment.
Systemic sarcoidosis revealed by venepunctures: a very rare but rewarding cutaneous manifestation
Authors: Killian Martin , Habougit Cyril , Monard Eric , Gramont Baptiste
Published: September 2020

A 67-year-old man was referred to our department for the onset of cutaneous lesions following venepunctures. His recent medical history included brief flu-like syndrome, persistent cough, dyspnoea, dry mouth, blurred vision and weight loss. The extensive clinical, biological and radiological check-up showed signs consistent with systemic sarcoidosis: right uveitis, hypercalcemia, renal failure, inflammatory syndrome, elevated levels of ACE, alveolitis with elevated CD4+/CD8+ T cell ratio, hilar and mediastinal lymphadenopathy, bilateral pulmonary infiltrates, mild bronchial obstruction and lowered diffusing capacity of the lungs for carbon monoxide. Multiple biopsy samples (bronchus, accessory salivary glands and one of the skin lesions) eventually confirmed the diagnosis. Corticosteroids resulted in skin lesions resolution in a few days and overall clinical, biological and lung function improvement. The infiltration of scars by granulomatous tissue is well recognised in sarcoidosis but its onset in venepuncture sites is a very rare but easily recognisable condition, which can be helpful for quick diagnosis purpose.
Congenital absence of the nasal septum in a Nigerian newborn with multiple congenital anomalies
Authors: Abdulkadir Isa , Musa Sani , Abdullahi Fatima Lami , Hassan Laila
Published: September 2020

Congenital absence of the nasal septum (hyporhynia) is infrequently reported in the literature. We report a rare case in a newborn with multiple congenital anomalies with the aim to highlight its rarity and compatibility with life in a resource-limited setting. The case notes of the child were summarised and the relevant literature reviewed to give the report a context. A 2-hour-old term baby boy presented with a history of abnormal facie characterised by a single nostril and noisy breathing. On examination, he had stridulous breathing, bilateral proptosis, sloping of the forehead, depressed nasal bridge absent nasal septum, absence of columella and hypoplastic mid-face, among other dysmorphic features. A diagnosis of hyporhynia in a baby with multiple congenital anomalies was made and managed accordingly. The baby was discharged to continue follow-up. Congenital absence of the nasal septum is rare and could present without respiratory distress and may be compatible with life.
Autoimmune pancytopenia occurring late after simultaneous pancreas and kidney transplantation
Authors: Bull Tom , Jolley Ruth , Martin-Cabrera Pedro , Thomas William
Published: September 2020

A 35-year-old woman presented with a widespread petechial rash and pancytopenia. She underwent simultaneous pancreas and kidney transplantation for type 1 diabetes 8 years previously followed by a renal transplant 1 year prior to presentation, and was taking tacrolimus as long-term immunosuppression. The full blood count showed haemoglobin 97 g/L, platelet count 2×109/L and neutrophil count 0.22×109/L. Peripheral blood film examination confirmed genuine thrombocytopenia in the absence of any haemolytic or malignant features. Serological testing identified autoantibodies against all three blood lineages, consistent with a diagnosis of autoimmune pancytopenia. Treatment with steroids, intravenous immunoglobulins, romiplostim and mycophenolate mofetil achieved only fleeting remissions. Blood counts eventually normalised following the administration of rituximab and a change from tacrolimus to ciclosporin immunosuppression. Cytopenias are a well-recognised complication of post-transplantation care but we believe this to be the first reported case of autoimmune pancytopenia following solid organ transplantation. In this case report, we discuss the approach to investigation of haematological abnormalities post-transplant and the rationale for, and outcome of, the management of this rare case.
Rare case ofPrevotella pleuritidislung abscess
Authors: Asif Abuzar Ali , Roy Moni , Ahmad Sharjeel
Published: September 2020

Prevotellagenus comprises of obligate anaerobic, gram-negative bacteria that are commensal organisms of oral cavity, gut and vaginal mucosa. Although manyPrevotellaspecies have well-established pathogenicity with respect to pulmonary infections, rarely hasPrevotella pleuritidisbeen isolated as a cause of lung abscess. We present a rare case of left lower lobe lung abscess due toP. pleuritidisidentified using next-generation sequencing of microbial cell-free DNA testing. A brief review of the literature regardingPrevotellaspecies pulmonary infections, use of next-generation cell-free DNA testing early in the evaluation, antibiotic susceptibility and resistance is also a part of this report.
IsCHEK2a moderate-risk breast cancer gene or the younger sister of Li-Fraumeni?
Authors: De Silva Dilanka L , Winship Ingrid
Published: September 2020

TheCHEK2gene is mostly considered as a moderate breast cancer gene with the result that many clinicians have a narrow focus. We present the 10-year journey of a man who had five different cancers and had iterative genetic testing including for Li-Fraumeni syndrome, eventually to discover a pathogenic variant in theCHEK2gene, possibly explaining his numerous cancers. This diagnosis offered him closure which he had desperately sought for well over a decade. A pathogenic variant in theCHEK2gene can potentially explain these cancers because of its function as a tumour suppressor gene. Consideration is warranted of what this means for individuals withCHEK2variants who may develop multiple cancers, their prognosis and whether different treatment modalities such as chemotherapy, radiotherapy or target agents would need modification. We encourage more research into the many faces of theCHEK2gene and the potential for predisposition to multiple cancers.
An interesting case of small vessel pathology following coronavirus infection
Authors: Ramadan Shadi M , Kasfiki Eirini V , Kelly Ciaran WP , Ali Irshad
Published: September 2020

Vasculitis is a descriptive term for a wide variety of conditions characterised by inflammation of the blood vessels that may occur as a primary process or secondary to an underlying disease. Occlusive vasculopathy is a different clinical entity characterised by skin changes and ulceration of the lower extremities because of thrombosis of the small vessels of the dermis and is usually associated with pre-thrombotic conditions. Both conditions can be confirmed or excluded by skin biopsy. We report the case of a 63-year-old woman presenting with upper and lower respiratory tract symptoms followed by a vasculitic rash on both legs. The patient underwent extensive radiological and laboratory investigations that were negative apart from positive coronavirus OC43. A biopsy of the skin was performed. Considering the clinical presentation and the investigations performed, the diagnosis of small vessel vasculopathy following coronavirus OC43 has been suggested by the authors.
Pneumatosis intestinalis in a patient with COVID-19
Authors: Aiello Paige , Johnson Samuel , Ramos Mercado Abdiel , Hussein Shakir
Published: September 2020

A 73-year-old man with significant medical history including renal transplantation and chronic immunosuppression presented to the hospital with acute respiratory failure. His initial treatment included steroids for concern forPneumocystis jirovecipneumonia, although this was later excluded as the diagnosis. The patient’s illness was consistent with COVID-19; however, he was not diagnosed with the virus until late in his course. The patient was found to have pneumatosis intestinalis that was successfully managed conservatively. Despite his multiple medical comorbidities, the patient had a positive outcome following COVID-19 infection. We discuss the association of pneumatosis intestinalis and COVID-19, and we investigate the various factors, including immunosuppression, that could play a role in this patient’s successful recovery from the virus.
An unusual course of disease in two patients with COVID-19: pulmonary cavitation
Authors: Muheim Michael , Weber Fabio José , Muggensturm Patrick , Seiler Eva
Published: September 2020

Two 59-year-old male patients with COVID-19 pneumonia developed pulmonary cavitation with air-fluid level, accompanied by right-sided chest pain several weeks after first onset of symptoms. Considering a possible bacterial abscess formation, both patients were started on antibiotics. No microbiological pathogen was detected in further investigations (sputum analysis, bronchoscopy with bronchoalveolar lavage and CT-guided drainage of the cavitation). Histopathological analysis of the drained fluid was non-specific, and the aetiology remained not fully understood. We report pulmonary cavitation as a rare finding in late stage COVID-19 pneumonia. As both our patients presented with localised chest pain prior to detection of the lesions, new onset of this symptom should warrant further investigation.
Ocular surface biopsies of patients with xeroderma pigmentosum in the United Kingdom: a retrospective observational case series
Authors: Vekinis John , Morley Ana M Susana
Published: September 2020

Background/Aims

To describe the results of all ocular surface biopsies performed on patients with xeroderma pigmentosum (XP) under the care of the UK Nationally Commissioned XP Service as well as the treatment of any subsequent ocular surface conditions diagnosed.

Methods

Retrospective analysis of medical records. All patients with XP seen by the service from 2010 to 2019 were included and those with ocular surface biopsies were identified. Data was collected on demographics, complementation subgroup (A–G and V), biopsy details, histopathological analysis and subsequent management.

Results

Of 108 patients seen in our service, 17 underwent at least one ocular surface biopsy. 45 biopsy samples were available from 13 patients of which 65% were performed on patients from complementation subgroup C (XP-C). Biopsies were categorised as either non-mapping (clinically abnormal ocular surface tissue) or mapping (multiple sites including clinically normal tissue). 67 percent of non-mapping biopsies had a mass as their indication and 46% showed ocular surface squamous neoplasia. General non-dysplastic damage was seen in 67% of non-mapping biopsies and melanocytic changes were seen in 25% of non-mapping and 81% of mapping biopsies. 47 percent of biopsy outcomes required no additional treatment but, of those that did, 50% received mitomycin C.

Conclusions

This is the largest reported series of ocular surface biopsies in patients with XP. It identifies a background of ocular surface melanocytic, degenerative and inflammatory changes, with patients with XP-C showing the most severe effects. We highlight challenges faced in interpreting their histopathology and in planning subsequent treatments.
UK National Artificial Eye Questionnaire study: comparisons between cosmetic shell and artificial eye users. Part 1: demographics, comfort and satisfaction
Authors: Shapira Yinon , Worrell Emma , Ullrich Katja , Litwin Andre , Malhotra Raman
Published: September 2020

Aims

To compare the unique experiences related to artificial eye (AE) versus cosmetic shell (CS) wear.

Methods

In this observational, cross-sectional study, the National Artificial Eye Questionnaire (NAEQ) was employed nationwide within the National Health Service England. The proportions or mean values of the aetiology of sight or eye loss, demographics, length of prosthesis wear, reported adjustment time to the prosthesis, comfort, discharge and satisfaction of appearance were compared between AE and CS respondents.

Results

Overall, 951 respondents wore an AE, while 238 wore a CS. In both, trauma was the leading cause for the prosthesis (47.6% and 44.1%, respectively); however, these groups differed in the proportions of the other aetiologies (p<0.0001). AE respondents were generally older (p=0.002) and had longer overall prosthesis wear (p<0.0001) compared with CS respondents. The overall comfort score was similarly, relatively high in both AE and CS respondents (80.4±0.73 vs 81.41±1.45; p=0.51). The discharge-related patient satisfaction ranking was relatively low, in both groups, with a small trend towards worse discharge scores among AE wearers (59.41±0.76 vs 62.26±1.52, p=0.094). Self-reported length of time that has taken to adjust to wearing the prosthesis was not significantly different (p=0.17). Appearance of the eye (p=0.032) and motility of the prosthesis (p<0.0001) were ranked superior by CS respondents compared with AE.

Conclusions

This study characterises unique aspects of CS versus AE in a large national cohort. The results should provide reinforcement to the gain in popularity of CS.
Characteristics and outcomes of admitted patients infected with SARS-CoV-2 in Uganda
Authors: Kirenga Bruce , Muttamba Winters , Kayongo Alex , Nsereko Christopher , Siddharthan Trishul , Lusiba John , Mugenyi Levicatus , Byanyima Rosemary K , Worodria William , Nakwagala Fred , Nantanda Rebecca , Kimuli Ivan , Katagira Winceslaus , Bagaya Bernard Sentalo , Nasinghe Emmanuel , Aanyu-Tukamuhebwa Hellen , Amuge Beatrice , Sekibira Rogers , Buregyeya Esther , Kiwanuka Noah , Muwanga Moses , Kalungi Samuel , Joloba Moses Lutaakome , Kateete David Patrick , Byarugaba Baterana , Kamya Moses R , Mwebesa Henry , Bazeyo William
Published: September 2020

Rationale

Detailed data on the characteristics and outcomes of patients with COVID-19 in sub-Saharan Africa are limited.

Objective

We determined the clinical characteristics and treatment outcomes of patients diagnosed with COVID-19 in Uganda.

Measurements

As of the 16 May 2020, a total of 203 cases had been confirmed. We report on the first 56 patients; 29 received hydroxychloroquine (HCQ) and 27 did not. Endpoints included admission to intensive care, mechanical ventilation or death during hospitalisation.

Main results

The median age was 34.2 years; 67.9% were male; and 14.6% were <18 years. Up 57.1% of the patients were asymptomatic. The most common symptoms were fever (21.4%), cough (19.6%), rhinorrhea (16.1%), headache (12.5%), muscle ache (7.1%) and fatigue (7.1%). Rates of comorbidities were 10.7% (pre-existing hypertension), 10.7% (diabetes) and 7.1% (HIV), Body Mass Index (BMI) of ≥30 36.6%. 37.0% had a blood pressure (BP) of >130/90 mm Hg, and 27.8% had BP of >140/90 mm Hg. Laboratory derangements were leucopenia (10.6%), lymphopenia (11.1%) and thrombocytopenia (26.3%). Abnormal chest X-ray was observed in 14.3%. No patients reached the primary endpoint. Time to clinical recovery was shorter among patients who received HCQ, but this difference did not reach statistical significance.

Conclusion

Most of the patients with COVID-19 presented with mild disease and exhibited a clinical trajectory not similar to other countries. Outcomes did not differ by HCQ treatment status in line with other concluded studies on the benefit of using HCQ in the treatment of COVID-19.
‘It is a different type of learning’. A survey-based study on how simulation educators see and construct observer roles
Authors: O’Regan Stephanie , Molloy Elizabeth , Watterson Leonie , Nestel Debra
Published: September 2020

Background

Simulation is reported as an appropriate replacement for a significant number of clinical hours in pregraduate programmes. To increase access for learners, educators have looked to understanding and improving learning in observer roles. Studies report equivalent learning outcomes and less stress in observer roles. However, reports on the prevalence, use and perceived value of observer roles from the educator’s perspective are lacking.

Methods

An exploratory survey for Australian and New Zealand (ANZ) simulation educators based on literature findings was developed and piloted with a small sample (n=10) of like subjects for language, clarity, skip logic and completion time. The final survey comprised 36 questions. Quantitative data were analysed using Pearson’s chi-squared test, Welch’s ANOVA and exploratory factor analysis. Select qualitative data were analysed using content analysis and summarised with frequency counts and categorisation.

Results

Two hundred and sixty-seven surveys were completed, with 221 meeting criteria for analysis. The observer role is widely used in ANZ and most learners experience both hands-on and observer roles. The location of observers is dependent upon several factors including facility design, learner immersion, scenario design and observer involvement. Verbal briefings and/or other guides are provided to 89% of observers to direct their focus and 98% participate in the debrief. Educators value observer roles but tend to believe the best learning is hands-on.

Conclusions

The learning in observer roles is less valued by educators than hands-on roles. Focused observation provides opportunities for noticing and attributing meaning, an essential skill for clinical practice. Learning spaces require consideration of scenario design and learning objectives. Scenario design should include objectives for observer roles and incorporate the observer into all phases of simulation. Attention to these areas will help promote the value of the different type of learning available in observer roles.