bluuebunny/crossref_metadata_2025 huggingface dataset:
Central Nervous System Coccidioidomycosis in Children: A Retrospective Case Series
Authors: Naeem Fouzia , Laningham Fred , Giglio Linda , Sharma Julia , Clerkin Patricia Quebada , McCarty James M.
Published: February 2023

Background:

Published literature on central nervous system (CNS) coccidioidomycosis in children is limited. Here we describe a large case series of pediatric CNS coccidioidomycosis from a tertiary care center in an endemic region.

Method:

This is a retrospective case review of patients ≤21 years old with a diagnosis of CNS coccidioidomycosis from January 1, 2000, to December 31, 2018.

Results:

Thirty patients (median age 10.8 years) were identified and most (93%) were previously healthy. Fever (90%), headache (70%), vomiting (53%), and fatigue (57%) were the most common presenting clinical manifestations, with focal neurological signs/symptoms present in 14 (47%). The initial serum Coccidioides compliment fixation (CF) titer was ≤ 1:8 in 33%. Most patients had extra-axial brain involvement (83%) and seven (23%) had associated spinal cord disease. Shunt placement was required in 70% and 62% required revision. Fluconazole was the initial treatment in 22 (73%), with treatment failure occurring in 50%. Most patients (77%) stabilized and were maintained on suppressive therapy, 4 (13%) experienced relapses and/or progressive disease, and one (3%) died, while long-term neurological complications occurred in 17%.

Conclusions:

CNS coccidioidomycosis is an uncommon and sometimes devastating complication of disseminated coccidioidomycosis. Many patients present with relatively low CF titers and hydrocephalus is common. Fluconazole treatment failures are common, and management remains difficult despite recent advances in therapy. Most patients do well once the disease is stabilized and require lifelong therapy. Newer therapeutic agents are needed.
Evaluation of a visual acuity eHealth tool in patients with cataract
Authors: Wanten Joukje C. , Bauer Noël J.C. , Claessens Janneau L.J. , van Amelsfort Thomas , Berendschot Tos T.J.M. , Wisse Robert P.L. , Nuijts Rudy M.M.A.
Published: February 2023

Purpose:

To validate the Easee web-based tool for the assessment of visual acuity in patients who underwent cataract surgery.

Setting:

University Eye Clinic Maastricht, Maastricht, the Netherlands.

Design:

Prospective method comparison study.

Methods:

Subjects aged between 18 and 69 years who underwent cataract surgery on 1 or both eyes at the Maastricht University Medical Center+ were eligible to participate in this study. The uncorrected (UDVA) and corrected distance visual acuity (CDVA) assessments were performed using the web-based tool (index test) and conventional ETDRS and Snellen charts (reference tests). The outcomes of the different tests were expressed in logMAR, and a difference of <0.15 logMAR was considered clinically acceptable.

Results:

46 subjects with 75 operated eyes were included in this study. The difference of the UDVA between the web-based tool and ETDRS or Snellen was −0.05 ± 0.10 logMAR (P < .001 [0.15; −0.26]) and −0.04 ± 0.15 logMAR (P = .018 [0.24; −0.33]), respectively. For the CDVA, these differences were −0.04 ± 0.08 logMAR (P < .001 [0.13; −0.21]) and −0.07 ± 0.10 logMAR (P < .001 [0.13; −0.27]), respectively. The Pearson correlation coefficients between the web-based tool and ETDRS were maximally 0.94 and compared with Snellen 0.92. In total, 73% to 88% of the visual acuity measurement differences were within 0.15 logMAR.

Conclusions:

The web-based tool was validated for the assessment of visual acuity in patients who underwent cataract surgery and showed clinically acceptable outcomes in up to 88% of patients. Most of the participants had a positive attitude toward the web-based tool, which requires basic digital skills.
Ten-year outcomes of pseudophakic mini-monovision correction of hyperopic presbyopia
Authors: Wróbel-Dudzińska Dominika , Moura-Coelho Nuno , Palma-Carvajal Francisco , Zebdeh Abdulah , Manero Felicidad , Güell José Luis
Published: February 2023

Purpose:

To evaluate long-term efficacy, safety, and spectacle independence after the treatment of hyperopic presbyopia with pseudophakic mini-monovision using standard monofocal intraocular lenses (IOLs) after bilateral cataract surgery.

Setting:

Private practice in Barcelona, Spain.

Design:

Retrospective, noncomparative case series.

Methods:

Patients with hyperopic presbyopia underwent bilateral cataract surgery with pseudophakic mini-monovision using standard monofocal IOLs between 2008 and 2018. Main outcomes analyzed were uncorrected distance visual acuity (UDVA), uncorrected near distance visual acuity (UNVA), and rates of spectacle independence at postoperative day 1 (POD1), months 1, 6 and 12, and at 5 and 10 years (Y10) postoperatively.

Results:

The study enrolled 463 patients. Both UDVA and UNVA significantly improved postoperatively (P < .05). The mean binocular UDVA improved from 0.47 ± 0.3 logMAR preoperatively to 0.096 ± 0.14 at POD1 to 0.16 ± 0.2 at Y10 (P = .0033). The binocular UNVA was 0.05 logMAR at Y10, whereas in preoperative visits, all patients needed spectacles. The mean UDVA for the dominant eye ≤0.20 logMAR was achieved in 84.29% at the Y10. Self-reported and measured complete spectacle independence for near vision was achieved in 79.61% of patients at POD1 and 71.92% at Y10 postoperatively. For distance, respectively, in 86.29% of patients at POD1 and 78.43% at Y10. The achieved results were stable. No serious events were reported, as well as no photic phenomena.

Conclusions:

Pseudophakic mini-monovision in hyperopic presbyopes is a safe, effective, and low-cost approach for the long-term correction of presbyopia. It significantly reduces spectacle dependence and fulfils patients' expectations after bilateral cataract surgery.
Comparison of the New Hoffer QST with 4 Modern Accurate Formulas.
Authors: Taroni Leonardo , Hoffer Kenneth J , Pellegrini Marco , Lupardi Enrico , Savini Giacomo
Published: February 2023

Purpose:

To investigate the new Hoffer QST (Savini/Taroni) formula (HQST) and compare it to the original Hoffer Q (HQ) and 4 latest generation formulas.

Setting:

I.R.C.C.S. - G.B. Bietti Foundation, Rome

Design:

Retrospective case series

Methods:

Refractive outcomes of the HQST, Barrett Universal II (BUII), EVO 2.0, HQ, Kane and RBF 3.0 formulas were compared. Subgroup analysis was performed in short (<22 mm) and long (>25 mm) axial length (AL) eyes. The standard deviation (SD) of the prediction error (PE) was investigated using the heteroscedastic method.

Results:

A Caucasian group of eyes (n = 696), implanted with the AcrySof SN60AT (Alcon Labs), and an Asian group (n =563), implanted with the AcrySof SN60WF (Alcon Labs), were investigated. In the Caucasian group, the SD of the EVO (0.464 D), HQST (0.471 D) and Kane (0.474 D) formulas was significantly lower compared to that of the BUII (0.538 D), HQ (0.535 D) and RBF (0.503 D). In the Asian group, the heteroscedastic method did not disclose any significant difference among the SD of the 4 modern formulas (range from 0.333 to 0.346 D), whereas the SD of the HQ formula (0.384 D) was significantly higher.

Compared to the original HQ, in both Caucasian and Asian groups, the HQST avoided the mean myopic PE in short eyes and the mean hyperopic PE in long eyes.

Conclusions:

The new HQST was superior to the original HQ and reached statistical and clinical results comparable to those achieved by the BUII, EVO, Kane and RBF formulas.
Efficacy and tolerability of 0.1% adapalene with 1% clindamycin versus 0.1% adapalene with 2.5% benzoyl peroxide in the treatment of acne vulgaris
Authors: Inbamani Annie Priya Dharshini , Manickam Navakumar , Gopalan Kannan
Published: February 2023

Objective:

To compare the efficacy and tolerability of 0.1% adapalene with 1% clindamycin versus 0.1% adapalene with 2.5% benzoyl peroxide (BPO) in the treatment of acne vulgaris.

Methods:

This study was conducted over a period of 1 year at our dermatology outpatient department. All patients aged 14 to 30 years with mild to moderate acne vulgaris were included.

Results:

One-hundred patients with mild to moderate acne vulgaris were randomly allocated to two equal groups (n=50 in each group). The patients received a topical combination of 0.1% adapalene with 1% clindamycin and topical combination of 0.1% adapalene with 2.5% BPO, respectively. After 12 weeks of treatment, there were no significant differences between the adapalene-clindamycin and adapalene-BPO groups in the mean reductions in the numbers of non-inflammatory lesions (11.16 ± 8.01 and 11.12 ± 8.62,respectively), inflammatory papules (49.78 ± 37.57 and 50.48 ± 36.57,respectively), and total lesions(67.5 ± 44.59 and 70.12 ± 46.83,respectively). The incidence of a burning sensation was significantly greater in the adapalene-BPO group than the adapalene-clindamycin group (32% versus 6%;P = 0.002).

Conclusion:

Topical adapalene plus clindamycin and adapalene plus BPO had similar efficacies in the treatment of acne. Adapalene with clindamycin was better tolerated than adapalene with BPO.
Visual clues for the histopathological diagnosis of psoriasis
Authors: Song Hao , Yang Xian-Hong , Jiang Yi-Qun
Published: February 2023

Objective:

The histopathologic diagnosis of psoriasis remains challenging. This study aimed to uncover visual clues for the histopathologic diagnosis of psoriasis in patients whose lesions required differentiation from other inflammatory skin disorders.

Methods:

A retrospective analysis was conducted of 100 psoriasis biopsy sections. Sections of other inflammatory skin diseases were included as the control group. The psoriasis and control groups were compared regarding the pathological characteristics, including the ñ sign, hypogranulosis, and neutrophilic infiltration or pustules within the epidermis. We also summarized the clinical information and the classic and non-classic histological features of psoriasis.

Results:

Biopsy sections from 190 patients were analyzed. Of these patients, 100 had a confirmed clinicopathological diagnosis of psoriasis, while 90 were diagnosed with an inflammatory skin disorder other than psoriasis (control group). The ñ sign was present in 79.0% and 21.11%, respectively, of the lesional biopsy samples from the psoriasis and control groups. The combination of the ñ sign and neutrophil infiltration in the upper epidermis was present in 74.0% and 10.0%, respectively, of the lesional biopsy samples from the psoriasis and control groups. The combination of these two features had a sensitivity of 0.89 and specificity of 0.76 in distinguishing between the psoriasis and control groups.

Conclusion:

The ñ sign is a useful visual clue for the histopathological diagnosis of psoriasis. However, for some inflammatory skin disorders that are very similar to psoriasis, such as pityriasis rubra pilaris, the combination of the ñ sign and neutrophil infiltration in the upper epidermis is needed to distinguish the condition from psoriasis.
Neutrophilic panniculitis associated with myelodysplastic syndrome/myeloproliferative neoplasm: a case report and literature review
Authors: Cohen Alexa J. , Gleason Laura K. , Bhatti Safiyyah A. , Nikbakht Neda
Published: February 2023

Introduction:

Neutrophilic panniculitis (NP) is a rare subtype of neutrophilic dermatosis, a group of neutrophil-rich inflammatory skin disorders that can present in association with myeloid neoplasms. NP is defined by the presence of a neutrophilic infiltrate in the fat lobules of the subcutis in the absence of either infection or vasculitis. We herein describe a 65-year-old woman with a recent diagnosis of myelodysplastic syndrome/myeloproliferative neoplasm overlap syndrome (MDS/MPN) who abruptly developed painful, pruritic nodules consistent with NP.

Case presentation:

A 65-year-old woman with MDS/MPN presented for evaluation of painful and pruritic nodules on her upper and lower extremities. A biopsy revealed a lobular neutrophilic infiltrate in the subcutis without evidence of microorganisms or vasculitis. The patient was diagnosed with NP and treated with oral prednisone. Within 1 month of treatment, she reported complete resolution of the nodules.

Discussion:

Similar to other neutrophilic dermatoses, NP may arise in association with hematologic malignancies of myeloid origin, such as MDS/MPN. A literature review revealed that most cases of NP associated with MDS occur after the onset of MDS and respond to systemic corticosteroids, not antibiotics. Infection should be ruled out before initiating treatment with systemic steroids.

Conclusion:

Although the mechanism is still unknown, it is important for clinicians to be aware that NP is associated with MDS; thus, hematological malignancies should be investigated upon diagnosis of NP. Once diagnosed, NP is easily treated and has an excellent response to systemic corticosteroids.
Assessing the Mental Health Impact of the COVID-19 Pandemic on US Fire-Based Emergency Medical Services Responders
Authors: Raposa Madison E. , Mullin Gabrielle , Murray Regan M. , Shepler Lauren J. , Castro Katherine C. , Fisher Alexandra B. , Gallogly Victoria H. , Davis Andrea L. , Resick Christian J. , Lee Jin , Allen Joseph A. , Taylor Jennifer A.
Published: February 2023

Objective

This study aimed to examine the COVID-19 pandemic's impact on fire service safety culture, behavior and morale, levers of well-being, and well-being outcomes.

Methods

Two samples (Stress and Violence against fire-based EMS Responders [SAVER], consisting of 3 metropolitan departments, and Fire service Organizational Culture of Safety [FOCUS], a geographically stratified random sample of 17 departments) were assessed monthly from May to October 2020. Fire department–specific and pooled scores were calculated. Linear regression was used to model trends.

Results

We observed concerningly low and decreasing scores on management commitment to safety, leadership communication, supervisor sensegiving, and decision-making. We observed increasing and concerning scores for burnout, intent to leave the profession, and percentage at high risk for anxiety and depression.

Conclusions

Our findings suggest that organizational attributes remained generally stable but low during the pandemic and impacted well-being outcomes, job satisfaction, and engagement. Improving safety culture can address the mental health burden of this work.
Relationship Between Work-Family Conflict and Depressive Symptoms Among Male Firefighters in China
Authors: Yu Yebo , Yang Fan , Fu Mingqi , Ahmed Farooq , Shahid Muhammad , Guo Jing
Published: February 2023

Objectives

This study aims to examine the relationship between work-family conflict and depressive symptoms while considering job types and family structure as moderators.

Methods

In July and August 2021, 1328 male Chinese firefighters completed an online cross-sectional survey.

Results

The results indicated that work-family conflicts among Chinese firefighters presented a significant association with worse depressive symptoms. More specifically, strain conflict and behavioral conflict had positive relationships with worse depressive symptoms, while time conflict had a negative relationship. In addition, job types moderated the association between work-family conflict, strain conflict, and behavior conflict with depressive symptoms.

Conclusions

This study shows that work-family conflict is significantly associated with depressive symptoms among Chinese firefighters. Our findings advocate working system reform for Chinese firefighters, and more attention is needed on their mental health protection in the future.
Burnout Among Public Health Workers During the COVID-19 Pandemic in South Korea
Authors: Lee Jakyung , Jang Soong-Nang , Kim Nam-Soon
Published: February 2023

Objective

This study aimed to investigate the prevalence of burnout experiences and factors associated with burnout among Korean health care workers during the coronavirus disease 2019 (COVID-19) pandemic.

Methods

A nationwide survey was conducted in 2021, and the sample comprised 1000 public health center employees. Multivariate linear regression was used to examine the factors associated with burnout among the participants during the COVID-19 pandemic. Perceived factors contributing to burnout were also analyzed using an open-ended question.

Results

Personal (e.g., age, gender, and self-rated health) and work-related factors (e.g., type of job tasks and COVID-19–related discrimination experience) affected burnout among health care workers. However, organizational support, including emotional support and sufficient financial compensation, was associated with lower burnout.

Conclusions

Ensuring sufficient support and rewards for health care workers is essential to guaranteeing their well-being during the current public health crisis.
Comorbidities and Causes of Death of Patients With Asbestosis
Authors: Keskitalo Eerika , Salonen Johanna , Nurmi Hanna , Vähänikkilä Hannu , Kaarteenaho Riitta
Published: February 2023

Objective

Comorbidities are common and affect the prognosis of patients with interstitial lung diseases, but few previous studies have investigated patients with asbestosis.

Methods

We collected comorbidities and death causes of 116 patients with asbestosis treated in Oulu University Hospital. Causes of death were confirmed by autopsy in 68% of the cases.

Results

The most common comorbidities of asbestosis patients were pleural plaques (96%) and coronary artery disease (CAD; 67%). The prevalence of rheumatoid arthritis was 8.6%. The most common underlying causes of death were asbestosis (36%), CAD (24%), and lung cancer (LC) (10%). CAD and LC were associated with shorter survival in adjusted analyses.

Conclusions

Patients with asbestosis have multiple comorbidities. Prevention and treatment of CAD and LC may influence the prognosis of asbestosis patients.
Genetics and Genomics Education for Physician Assistant Students: A Review of the Literature
Authors: Patterson Wesley G. , Ward Linda D.
Published: February 2023

Introduction

The purpose of this article was to critically review the literature and determine what is known about genetics-genomics education for physician assistants (PAs).

Methods

A rapid review method was used to search CINAHL, MEDLINE, PubMed, and Web of Science databases. The review is presented historically to describe the development of genetics-genomics education in PA programs.

Results

Of 594 publications retrieved, 11 articles met inclusion criteria. Retained articles include an assessment of PA programs, genetics-genomics competencies, educational efforts developed by PA programs regarding genetics-genomics, and continuing education programs for PAs.

Discussion

A paucity of published literature regarding genetics-genomics education for PAs was found. The few studies retrieved describe content being taught in PA programs, the number of genetics-genomics contact hours that PA students receive, and recommendations for continuing education programs. Most of the available literature is outdated, leaving a need for more current information to inform the education of genetic- and genomic-competent PAs. Recommendations for future research include assessment of PA programs regarding genetics-genomics education; development and validation of an assessment tool to measure genetics-genomics knowledge; and utilization of the RISE2 Genomics standards to plan, implement, evaluate, and report educational interventions. These recommendations are necessary to build an evidence base regarding genomics education for PA students and practicing PAs.
The Effect of Prosthetic Ankle Dorsiflexion Stiffness on Standing Balance and Gait Biomechanics in Individuals with Unilateral Transtibial Amputation
Authors: Vaca Miguel , Stine Rebecca , Hammond Paul , Cavanaugh Michael , Major Matthew J. , Gard Steven A.
Published: February 2023

Introduction

Modular prosthetic ankle components have been shown to improve walking in transtibial prosthesis users, but they may reduce stability during standing. Therefore, the stiffness of the prosthetic foot-ankle components may need to be appropriately tuned to provide a balance between walking mobility and standing balance. The present research investigates both concepts to improve our knowledge about how prosthetic ankle stiffness influences standing and walking performance.

Methods

Ten individuals with unilateral transtibial amputation and categorized as minimum K3-level ambulators participated. Standing balance and gait analyses at three self-selected speeds were performed at three different levels of ankle dorsiflexion stiffness (Soft, Medium, and Firm) using the College Park Venture foot (College Park Industries, Warren, MI, USA). Repeated-measures analyses of variance (ANOVAs) were performed on relevant standing balance, gait spatiotemporal, and roll-over shape (ROS) outcomes. Gait kinetic and kinematic data were analyzed using a one-dimension statistical parametric analysis.

Results

Ankle dorsiflexion stiffness influenced balance and gait. Overall, the Firm dorsiflexion stiffness provided a smaller body sway on standing balance, a ROS radius close to the one of able-bodied individuals, and reduced step length asymmetry while walking. Furthermore, walking speed had an influence on ROS radii, resulting in a larger radius for slow walking speeds and a smaller one for fast walking speeds.

Discussion

The Firm stiffness appeared to offer the most advantages for balance and gait. The radius of ROS under the Firm condition, close to the radius of able-bodied individuals, could have caused the improvement in step length symmetry by a greater progression of the center of pressure, resulting in further progression of the prosthetic side. This information, in addition to the observed walking speed effect on ROS radii, encourages us to develop studies to examine the effect of walking speed on foot performance and improve prosthetic foot design to maintain the same gait characteristics under different walking speeds.

Clinical Relevance

These results improve our understanding of how a specific prosthetic ankle dorsiflexion stiffness affects standing balance and gait, which supports the prosthetist's evaluation process to determine specific individual stiffness for each prosthesis user.
Predicting Severity of Head Collision Events in Elite Soccer Using Preinjury Data: A Machine Learning Approach
Authors: Tarzi Gabriel , Tarzi Christopher , Saha Ashirbani , Cusimano Michael D.
Published: February 2023

Objective:

To develop machine learning (ML) models that predict severity of head collision events (HCEs) based on preinjury variables and to investigate which variables are important to predicting severity.

Design:

Data on HCEs were collected with respect to severity and 23 preinjury variables to create 2 datasets, a male dataset using men's tournaments and mixed dataset using men's and women's tournaments, to perform ML analysis. Machine learning analysis used a random forest classifier based on preinjury variables to predict HCE severity.

Setting:

Four elite international soccer tournaments.

Participants:

Elite athletes participating in analyzed tournaments.

Independent Variables:

The 23 preinjury variables collected for each HCE.

Main Outcome Measures:

Predictive ability of the ML models and association of important variables.

Results:

The ML models had an average area under the receiver operating characteristic curve for predicting HCE severity of 0.73 and 0.70 for the male and mixed datasets, respectively. The most important variables for prediction were the mechanism of injury and the event before injury. In the male dataset, the mechanisms “head-to-head” and “knee-to-head” were together significantly associated (P = 0.0244) with severity; they were not significant in the mixed dataset (P = 0.1113). In both datasets, the events “corner kicks” and “throw-ins” were together significantly associated with severity (male, P = 0.0001; mixed, P = 0.0004).

Conclusions:

ML models accurately predicted the severity of HCE. The mechanism and event preceding injury were most important for predicting severity of HCEs. These findings support the use of ML to inform preventative measures that will mitigate the impact of these preinjury factors on player health.
Individual Symptom Report Prevalence in Children and Adolescents With One, Two, and Three or More Persistent Symptoms After Concussion: A Brief Report
Authors: Chandler Madison C. , Bloom Josh , Fonseca Janna , Ramsey Kristen , DeMaio Valerie J. , Callahan Christine E. , Register-Mihalik Johna K.
Published: February 2023

Objective:

To examine differences in individual symptom report prevalence between children and adolescents experiencing 1 to 2 versus ≥3 persistent postconcussion symptoms.

Design:

A prospective cohort study.

Setting:

Three community practice concussion clinics within a family practice network.

Patients:

Children and adolescents aged 8 to 18 years presenting to clinics within 72 hours of a sport-related or recreation-related concussion. Those with complete symptom data from a 1-month follow-up time point (n = 236) were included in analyses.

Independent Variables:

One hundred thirty-six patients (n = 136) reported 0 symptoms as worse than preinjury at the 1-month time point. Participants reporting 1+ symptoms as worse than preinjury at 1 month were assigned to groups based on the number of symptoms endorsed: those with 1 to 2 (n = 38) compared with those experiencing ≥3 (n = 62).

Main Outcome Measures:

Fisher exact tests were used to compare symptom report prevalence for each item of the Rivermead Postconcussion Symptoms Questionnaire. This research question was formulated and examined after completion of data collection.

Results:

Across both groups, headache and fatigue were the most commonly reported persistent postconcussion symptoms. Several emotional symptoms (eg, irritability, depression) were primarily or only present in those reporting ≥3 persistent symptoms.

Conclusions:

Findings provide detail regarding the clinical manifestation of experiencing fewer versus more persistent postconcussion symptoms, underscoring the importance of developing individualized, multifaceted rehabilitation programs.
The Association of Sport Specialization and Concussion History on Self-Reported Depressive Symptoms and Quality of Life Among High School Athletes
Authors: Chou Tsung-Yeh , Biese Kevin , Leung Willie , Bell David , Kaminski Thomas , McGuine Timothy
Published: February 2023

Objective:

To assess the association of sport specialization combined with sport-related concussion (SRC) history on depression and health-related quality of life (HRQoL) in a population of high school athletes.

Design:

Cross-sectional study.

Setting:

High schools.

Participants:

Two thousand four hundred fifty-three athletes through the State of Wisconsin.

Independent Variables:

Sport specialization and SRC history.

Main Outcome Measures:

Athletes completed questionnaires reporting their SRC history, sports participation (single-sport or multisport), Patient Health Questionnaire-9 (PHQ-9), and Pediatric Quality of Life 4.0 (PedsQL). We used multivariate binary logistic regression to assess the odds ratio (OR) for depressive symptoms based on SRC and sport participation history. Separate multilinear regression evaluated the association between the PedsQL, SRC, and sport participation history. The interaction of sport specialization and SRC history was explored in both regression models.

Results:

High school athletes who participated in single-sport activities had a greater odds of reporting higher severity of depressive symptoms on PHQ-9 scores (OR, 1.50; 95% CI, 1.11-2.02) and reduced PedsQL (P < 0.001) compared with their multisport counterparts. There were no associations between SRC history and either PHQ-9 or PedsQL scores. Statistically significant interactions between sport specialization and SRC were not found among all models.

Conclusion:

Single-sport high school athletes reported a reduction in HRQoL measures along with higher depressive symptoms when compared with the multisport athletes. The SRC history did not have a lingering effect on depression or HRQoL in this study. These findings raise some interesting concerns regarding the quality of mental health in adolescent athletes solely focused on single-sport endeavors.
The Impacts of the COVID-19 Pandemic on Doctor of Physical Therapy Students: A National Survey
Authors: Ge Weiqing , Ball Meghan , Balog-Bickerstaff Nicole , Kerns Lucy
Published: February 2023

Introduction.

Since the lockdown in March 2020, the COVID-19 pandemic has inevitably affected all individuals across the world. The purpose of this study was to determine the perceived impacts of the pandemic on doctor of physical therapy (DPT) students and if there were any statistically significant differences based on minority status, gender, or class standing.

Review of Literature.

Literature suggested that DPT students experienced negative impacts of the pandemic on academic success and mental health. However, there is a lack of comprehensive understanding of the perceived physical, mental, financial, and academic impacts of the COVID-19 pandemic by physical therapist students nationally.

Subjects.

Convenience sampling was used to recruit all students enrolled in physical therapist programs in the United States.

Methods.

The research design was a cross-sectional survey administered electronically using the Alchemer survey platform with 12 Likert scale items compiled in the physical, mental, financial, and academic domains. All items were designed to evaluate the perceived impacts of the pandemic on a 5-point scale from 1 (strongly disagree) to 5 (strongly agree).

Results.

A total of 1,230 completed responses were received. The mean responses were 3.45 (SD 1.12), 3.48 (SD 0.92), 2.74 (SD 1.03), and 3.33 (SD 0.93) for the physical, mental, financial, and academic domains, respectively. No significant difference was found based on minority status. A statistically significant difference was found in the mental domain, with female students perceiving a more negative impact by the pandemic. First-year students reported a significantly higher negative impact in the physical domain compared with second-year students. The perceived impact in the academic domain was significantly higher for both first- and second-year students than third-year students.

Conclusions.

Developing and promoting access to campus and community resources to address the challenges caused by the COVID-19 pandemic is critical to facilitating student success during and after the pandemic.
Central Vertigo Disorder as Evidence of Creutzfeldt-Jakob Disease: A Case Report
Authors: Costa Villela Ferreira Luiza , Braz Rodrigues da Silva Camila , de Pinho Lilia Gama , Lima Fernanda Vidigal Vilela , Dias Claudia Marques , Bahmad Fayez
Published: February 2023

Objective

To report a case of Creutzfeldt-Jakob disease (CJD) that presented atypical initial manifestations and highlight the importance of complementary investigation to avoid diagnosis delay.

Patients

A 54-year-old female patient who presented with vertigo with positional nystagmus, nausea, and vomiting as initial CJD manifestations.

Intervention

Neuro-otological and brain magnetic resonance images, which showed abnormal hyperintense cortical signal in both hemispheres.

Main Outcome Measure

We reached a presumptive diagnosis of the prion disease after the first magnetic resonance imaging. Eventually, the patient presented with typical neurological findings and met the criteria for probable CJD.

Results

Our case report presents a patient with sporadic CJD who experienced dizziness as an initial manifestation and met the diagnostic criteria for probable CJD a few weeks after symptoms onset.

Conclusion

We believe that this case may serve to help otolaryngologists pay better attention to cases of dizziness associated with neurological signs and highlight the importance of complementary investigation using magnetic resonance imaging and neuro-otological tests to prevent delayed or incorrect diagnosis.
Silencing Pulsatile Tinnitus: A Novel Technique of Periosteal Flap Obliteration for Sigmoid Sinus Diverticulum Variants
Authors: Chua Celeste Ann , Han Jae Sang , Kim Yeonji , Seo Jae-Hyun , Park Shi Nae
Published: February 2023

Objective

Review of a sigmoid sinus diverticuli (SSDi) variants surgically managed with a novel technique using an inferior periosteal flap.

Study Design

Case series.

Setting

Tertiary referral center.

Patients

Patients presenting with pulsatile tinnitus to a tertiary referral center between January 1, 2015, and June 31, 2021, who were diagnosed with SSDi variants on CT temporal bone and who received surgical management for these SSDi variants.

Intervention(s)

Obliteration of SSDi variants using a novel technique with an inferiorly based periosteal flap.

Main Outcome Measure(s)

Pure-tone audiometry, Tinnitus Handicap Inventory score, and visual analogue scale score for tinnitus severity (loudness, awareness, annoyance, and effect on life).

Results

Include statistical measures as appropriate.

Conclusions

We would like to propose the use of an inferiorly based periosteal flap as an option for obliteration and concomitant hemostasis of more sizeable or complex (e.g., bifid) SSDi. Further study of this technique with a long-term follow-up will be needed to evaluate its long-term safety and efficacy.
Is Sudden Sensorineural Hearing Loss an Otologic Emergency? Evidence-Based Cutoff for Optimal Treatment Initiation for Sudden Unilateral Sensorineural Hearing Loss: A Case Series and Meta-Analyses
Authors: Klein Linor , Handzel Ophir , Shilo Shahaf , Oron Yahav , Abu Eta Rani , Muhanna Nidal , Ungar Omer J.
Published: February 2023

Objectives

To study the need for defining unilateral idiopathic sudden sensorineural hearing loss (ISSNHL) as an otologic emergency and establish an evidence-based cutoff for treatment initiation for optimal outcome.

Methods

A systematic literature search of “MEDLINE” via “PubMed,” “Embase,” and “Web of Science” and original case series comparing the outcome of steroidal treatment for ISSNHL as a function of delays of patient presentation, of diagnosis, and of treatment initiation. Total delay was defined as days from ISSNHL onset to first steroidal dose and divided into up to 3 days, up to 7 days, up to 14 days, and >14 days.

Results

The literature search identified 1,469 ears and our original case series contributed 154 ears suitable for study inclusion, resulting in 1,623 ears for statistical analysis. An odds ratio (OR) of 0.42 (95% confidence interval [CI], 0.25–0.71) was calculated for recovery if treatment had been initiated within the third day since the sudden occurrence of a unilateral hearing loss compared with treatment initiation on or after the fourth day (I2 = 40.1%). The calculated OR for recovery was 0.35 (95% CI, 0.26–0.47) when treatment was initiated during the first 7 days after the sudden hearing loss onset compared with a delay of 8 days or more (I2 = 52.1%). The OR was 0.31 (95% CI, 0.21–0.46) when treatment was initiated during the first 14 days after the event compared with a longer delay (I2 = 0.0%).

Conclusion

Unilateral ISSNHL should be considered a medical emergency. Initiating treatment before 3 days have elapsed since the event portends the best outcome.

Level of Evidence

Level I.
Contralateral Lower Extremity Ischemia on Femoral Veno-Arterial Extracorporeal Membrane Oxygenation
Authors: Arons Danielle , Dave Sagar , Shah Aakash , Deatrick Kristopher B.
Published: February 2023

Ipsilateral lower extremity ischemia is a common and morbid complication during veno-arterial extracorporeal membrane oxygenation (VA-ECMO). The cannula can impede ipsilateral distal arterial flow leading to critical limb ischemia. Cannula size, placement, and utilization of distal perfusion catheters are strategies that have been used to prevent this complication. We report the novel case of a 19-year-old female on VA-ECMO complicated by contralateral lower extremity ischemia. Diagnosis was made by computed tomography, and with repositioning of the femoral arterial cannula, she had a complete resolution of symptoms.
Association Between Early Change in Arterial Carbon Dioxide Tension and Outcomes in Neonates Treated by Extracorporeal Membrane Oxygenation
Authors: Joram Nicolas , Rozé Jean-Christophe , Tonna Joseph E. , Rycus Peter , Beqiri Erta , Pezzato Stefano , Moscatelli Andrea , Robba Chiara , Liet Jean-Michel , Bourgoin Pierre , Czosnyka Marek , Léger Pierre-Louis , Rambaud Jérôme , Smielewski Peter , Chenouard Alexis
Published: February 2023

The primary objective was to investigate the association between partial pressure of carbon dioxide (PaCO2) change after extracorporeal membrane oxygenation (ECMO) initiation and neurologic outcome in neonates treated for respiratory failure. A retrospective analysis of the Extracorporeal Life Support Organization (ELSO) database including newborns supported by ECMO for respiratory indication during 2015–2020. The closest Pre-ECMO (Pre-ECMO PaCO2) and at 24 hours after ECMO initiation (H24 PaCO2) PaCO2 values allowed to calculate the relative change in PaCO2 (Rel Δ PaCO2 = [H24 PaCO2 – Pre-ECMO PaCO2]/Pre-ECMO PaCO2). The primary outcome was the onset of any acute neurologic event (ANE), defined as cerebral bleeding, ischemic stroke, clinical or electrical seizure, or brain death during ECMO. We included 3,583 newborns (median age 1 day [interquartile range {IQR}, 1–3], median weight 3.2 kg [IQR, 2.8–3.6]) from 198 ELSO centers. The median Rel Δ PaCO2 value was −29.9% [IQR, −46.2 to −8.5]. Six hundred nine (17%) of them had ANE (405 cerebral bleedings, 111 ischemic strokes, 225 seizures, and 6 brain deaths). Patients with a decrease of PaCO2 > 50% were more likely to develop ANE than others (odds ratio [OR] 1.78, 95% confidence interval [CI], 1.31–2.42, p < 0.001). This was still observed after adjustment for all clinically relevant confounding factors (adjusted OR 1.94, 95% CI, 1.29–2.92, p = 0.001). A significant decrease in PaCO2 after ECMO start is associated with ANE among neonates requiring ECMO for respiratory failure. Cautious PaCO2 decrease should be considered after start of ECMO therapy.
Implementation of Extracorporeal Membrane Oxygenation Without On-Site Cardiac Surgery or Perfusion Support: A Tale of Two County Hospitals
Authors: Bilodeau Kyle S. , Badulak Jenelle , Bulger Eileen , Stewart Barclay , Mandell Samuel P. , Taylor Mark , Condella Anna , Carlson Michelle D. , Kohl Louis P. , Simpson Nicholas S. , Heather Beth , Prekker Matthew E. , Johnson Nicholas J.
Published: February 2023

Patients with refractory respiratory and cardiac failure may present to noncardiac surgery centers. Prior studies have demonstrated that acute care surgeons, intensivists, and emergency medicine physicians can safely cannulate and manage patients receiving extracorporeal membrane oxygenation (ECMO). Harborview Medical Center (Harborview) and Hennepin County Medical Center (Hennepin) are both urban, county-owned, level 1 trauma centers that implemented ECMO without direct, on-site cardiac surgery or perfusion support. Both centers 1) use an ECMO specialist model staffed by specially trained nurses and respiratory therapists and 2) developed comparable training curricula for ECMO specialists, intensivists, surgeons, and trainees. Each program began with venovenous ECMO to provide support for refractory hypoxemic respiratory failure and subsequently expanded to venoarterial ECMO support. The coronavirus disease 2019 (COVID-19) pandemic created an impetus for restructuring, with each program creating a consulting service to facilitate ECMO delivery across multiple intensive care units (ICUs) and to promote fellow and resident training and experience. Both Harborview and Hennepin, urban county hospitals 1,700 miles apart in the United States, independently implemented and operate adult ECMO programs without involvement from cardiovascular surgery or perfusion services. This experience further supports the role of ECMO specialists in the delivery of extracorporeal life support.
Antiphospholipid syndrome after streptococcal toxic shock syndrome later diagnosed as Behcet's disease
Authors: Kourti Afroditi , Mentesidou Lida , Michalopoulou Aikaterini , Maritsi Despoina , Bachou Theodora
Published: February 2023

Streptococcal toxic shock syndrome is a severe complication of group A streptococci. The production of antiphospholipid antibodies has been associated with streptococcal infections and with autoimmune diseases. Furthermore, streptococcal infections could be a trigger of Behcet's disease. We report a case of a boy who presented antiphospholipid syndrome after streptococcal toxic shock syndrome later he was diagnosed with Behcet's disease.
A new risk factor for predicting stroke in patients with atrial fibrillation: morning blood pressure surge
Authors: Gorcan Ayberk , Argan Onur , Avci Eyup , Kiris Tuncay , Safak Ozgen , Yildirim Seda Tarik , Yildirim Elcim , Lutfi Kisacik Halil , Kadi Hasan
Published: February 2023

Background

Stroke, the most feared complication in patients with atrial fibrillation (AF), is still an important cause of mortality and morbidity. In our study, we aimed to investigate the frequency of stroke and related parameters in patients with atrial fibrillation, for whom 24-h ambulatory blood pressure monitoring (ABPM) was performed.

Method:

A total of 282 patients with permanent AF were included in this study. 24-h ABPM was performed in all patients. Morning blood pressure surge (MBPS) was defined as the difference between the mean SBP in the first 2 h after awakening and the lowest blood pressure (BP) at night. We evaluated parameters associated with stroke in patients with atrial fibrillation using univariate and multivariate Cox regression analysis.

Result

Patients were followed for 19 ± 9.3 months and 22 ischemic strokes were detected during the follow-up period. Also, strokes were significantly lower in atrial fibrillation patients with a dipper BP pattern, whereas strokes were significantly higher in atrial fibrillation patients with a reverse-dipper BP pattern. In multivariate analysis, a history of hypertension (P = 0.020), BP pattern (P < 0.001) and MBPS (P < 0.001) were found to be significantly related to stroke. MBPS levels >32.5 mmHg predicted stroke with a sensitivity of 77% and a specificity of 60% (AUC, 0.741; 95% CI, 0.647–0.834; P < 0.001).

Conclusion

MBPS, BP pattern and presence of hypertension as an independent risk factor in predicting stroke in patients with atrial fibrillation. The reduction of the MBPS may be a new therapeutic target for preventing stroke.
Healthcare Disparities Among Homeless Patients Hospitalized With Gastrointestinal Bleeding
Authors: Subramanian Kavitha , Alayo Quazim A. , Sedarous Mary , Nwaiwu Obioma , Okafor Philip N.
Published: February 2023

Goals:

Examine outcomes among homeless patients admitted with gastrointestinal (GI) bleeding, including all-cause mortality and endoscopic intervention rates.

Background:

Hospitalizations among homeless individuals have increased steadily since at least 2007 but little is known about GI outcomes in these patients.

Study:

The 2010-2014 Healthcare Utilization Project (HCUP) State Inpatient Databases from New York and Florida were used to identify adults admitted with a primary diagnosis of acute upper or lower GI bleed. Homeless patients were 1:3 matched with nonhomeless patients using a propensity-score greedy-matched algorithm. The primary outcome (all-cause in-hospital mortality) and secondary outcomes (30-day readmission rates, endoscopy utilization, length of stay, and total hospitalization costs) were compared.

Results:

We matched 4074 homeless patients with 12,222 nonhomeless patients. Most hospitalizations for homeless individuals were concentrated in 113 (26.4%) of 428 hospitals. Homeless adults were more likely to be younger, male, African American or Hispanic, and on Medicaid. They experienced significantly higher odds of all-cause inpatient mortality compared with nonhomeless patients admitted with GI bleeding (OR 1.37, 95% CI 1.11-1.69). Endoscopy utilization rates were also lower for both upper (OR 0.62, 95% CI 0.55-0.71) and lower (OR 0.76, 95% CI 0.68-0.85) GI bleeding, though upper endoscopy rates within the first 24 hours were comparable (OR 1.11, 95% CI 1.00-1.23). Total hospitalization costs were lower ($9,715 vs. $12,173, P<0.001) while 30-day all-cause readmission rates were significantly higher in the homeless group (14.9% vs. 18.4%, P<0.001).

Conclusions:

Homeless patients hospitalized for GI bleeding face disparities, including higher mortality rates and lower endoscopy utilization.
The Overlap Subgroup of Functional Dyspepsia Exhibits More Severely Impaired Gastric and Autonomic Functions
Authors: Cheng Jiafei , Guo Jie , Xu Luzhou , Shi Zhaohong , Xu Feng , Xu Yuemei , Yan Guangjun , Li Jie , Yang Yi , Duan Zhijun , Yang Jie , Yin Lu , Liu Dengke , Wei Wei , Wang Meifeng , Bu Xiaoling , Sha Weihong , Lv Litao , Wang Jiaxiu , Huang Yan , Feng Qiaoqun , Li Xueliang , Gong Shan , Mao Hua , Jin DanDan , Lin Lin , Chen Jiande D. Z.
Published: February 2023

Goals:

A combination of multiple tests was introduced to noninvasively investigate the differences in pathophysiologies among functional dyspepsia (FD) subgroups, including postprandial distress syndrome (PDS), epigastric pain syndrome (EPS), and overlap.

Background:

It has not been extensively evaluated whether different pathophysiologies are involved in FD subgroups.

Study:

This multicenter study included 364 FD patients fulfilling Rome IV criteria and 47 healthy controls. A combined noninvasive gastric and autonomic function test was performed: The electrogastrogram and electrocardiogram were recorded simultaneously in the fasting state and after a drink test. Symptoms after drinking were recorded using visual analog scale.

Results:

(1) Compared with HC, FD patients showed a decreased maximum tolerable volume (MTV) (P<0.01) and percentage of normal gastric slow waves [normal gastric slow waves (%NSW)] (P<0.01), and increased postdrinking symptoms, anxiety (P<0.01), and depression (P<0.01). The drink reduced %NSW in both FD patients and HC; however, the effect was more potent in patients. (2) The PDS and overlap groups displayed a reduced MTV (P<0.05). The overlap group exhibited a higher symptom score at 30 minutes after drinking, and higher anxiety and depression scores, and a higher sympathovagal ratio than the EPS (P<0.05 for all) and PDS (P<0.01 for all). (3) In the PDS subgroup, the MTV, postprandial sympathovagal ratio, and depression were associated with the overall dyspepsia symptom scale (DSS, P=0.034, 0.021, 0.043, respectively). No significant associations were found in the other 2 subgroups.

Conclusions:

The combination of multiple tests can detect pathophysiological abnormities in FD patients. Overall, patients with overlap symptoms display more severe pathophysiologies.