bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of Rotavirus Vaccination Varies by Level of Access to Piped Water and Sewerage: An Analysis of Childhood Clinic Visits for Diarrhea in Peru, 2005–2015
Authors: Delahoy Miranda J. , Cárcamo César , Ordoñez Luis , Vasquez Vanessa , Lopman Benjamin , Clasen Thomas , Gonzales Gustavo F. , Steenland Kyle , Levy Karen
Published: April 2020

Background:

We conducted a national impact evaluation of routine rotavirus vaccination on childhood diarrhea in Peru, accounting for potential modifying factors.

Methods:

We utilized a dataset compiled from Peruvian governmental sources to fit negative binomial models investigating the impact of rotavirus vaccination, piped water access, sewerage access and poverty on the rate of diarrhea clinic visits in children under 5 years old in 194 Peruvian provinces. We considered the interaction between these factors to assess whether water access, sanitation access, or poverty modified the association between ongoing rotavirus vaccination and childhood diarrhea clinic visits. We compared the “pre-vaccine” (2005–2009) and “post-vaccine” (2010–2015) eras.

Results:

The rate of childhood diarrhea clinic visits was 7% [95% confidence interval (CI): 3%–10%] lower in the post-vaccine era compared with the pre-vaccine era, controlling for long-term trend and El Niño seasons. No impact of rotavirus vaccination was identified in provinces with the lowest access to piped water (when <40% of province households had piped water) or in the lowest category of sewerage (when <17% of province households had a sewerage connection). Accounting for long-term and El Niño trends, the rate of childhood diarrhea clinic visits was lower in the post-vaccine era by 7% (95% CI: 2%–12%), 13% (95% CI: 7%–19%) and 15% (95% CI: 10%–20%) in the second, third and fourth (highest) quartiles of piped water access, respectively (compared with the pre-vaccine era); results for sewerage access were similar.

Conclusion:

Improved water/sanitation may operate synergistically with rotavirus vaccination to reduce childhood clinic visits for diarrhea in Peru.
Eyelid Lesion as a Presenting Sign of Pancreatic Adenocarcinoma
Authors: Yadav Sonal P. , Puntambekar Anirudha , Patil Tushar , Deshpande Rahul
Published: April 2020

Eyelid metastases are relatively rare, and they can occasionally lead the way to an unknown primary malignancy elsewhere. The authors report a case of 65-year-old diabetic gentleman with a right-sided eyelid lesion that was present for 1 month and turned out to be a presenting sign of a previously undiagnosed pancreatic adenocarcinoma. The eyelid mass had been treated elsewhere for 2 weeks for a presumed infectious lesion, using systemic antibiotics and was then referred to us in view of no response. The right-sided lesion involving the subbrow and eyelid area was tender and showed surface ulceration, as well as induration with scabbing. An incision biopsy of the mass was performed followed by computed tomography imaging. Histopathologic findings were suggestive of adenocarcinoma of a probable secondary origin. A whole-body positron emission tomography (PET) scan along with raised serum tumor markers (carcinoembryonic antigen 125 [CEA 125] and carbohydrate antigen 19-9 [CA-19-9]) was helpful in diagnosing a stage IV probable primary carcinoma of the pancreas, with metastasis to paraaortic nodes, liver, lungs, and eyelid. After a detailed systemic work-up, the patient was put on systemic chemotherapy with carboplatin and capacitabane. He responded well to the treatment. At a follow up of 12 months, upon clinical examination and PET imaging, he showed a complete resolution of eyelid, lung, and liver disease and a near-complete resolution of the pancreatic lesion. This case delineates the role of a prompt biopsy and histopathologic evaluation of an atypical eyelid mass in diagnosing asymptomatic primary malignancy.
Panophthalmitis and Visual Loss as a Complication of Acute Dacryocystitis
Authors: Bothra Nandini , Agarwal Komal , Ali Mohammad Javed
Published: April 2020

Acute dacryocystitis causing visual loss due to development of orbital complications like central retinal artery or ophthalmic artery occlusion, retinal vein occlusions, and optic neuritis is rare but a known entity. However, development of scleral abscess and panophthalmitis as a complication of acute dacryocystitis, leading to loss of vision, has not been described earlier. To the best of the authors’ knowledge, this is the first report describing this mode of visual loss in acute dacryocystitis.
Premonitory symptoms in glyceryl trinitrate triggered migraine attacks: a case-control study
Authors: Onderwater Gerrit L.J. , Dool Jitze , Ferrari Michel D. , Terwindt Gisela M.
Published: April 2020

Spontaneous and pharmacologically provoked migraine attacks are frequently preceded by nonheadache symptoms called premonitory symptoms. Here, we systematically evaluated premonitory symptoms in migraine patients and healthy controls after glyceryl trinitrate (GTN) infusion. In women with migraine without aura (n = 34) and age-matched female controls (n = 24), we conducted systematically a semistructured interview assessing 21 possible premonitory symptoms every 15 minutes in the 5 hours after GTN infusion (0.5 µg/kg/min over 20 minutes). Migraine-like headaches occurred in 28/34 (82.4%) migraineurs (GTN responders). After GTN, 26/28 (92.9%) responders, 6/6 (100%) nonresponders, and 13/24 (54.2%) controls reported at least one possible premonitory symptom. Concentration difficulties (P= 0.011), yawning (P= 0.009), nausea (P= 0.028), and photophobia (P= 0.001) were more frequently reported by those migraineurs who developed a migraine-like attack vs healthy controls. Importantly, concentration difficulties were exclusively reported by those who developed a migraine-like attack. Thus, our findings support the view that GTN is able to provoke the naturally occurring premonitory symptoms and show that yawning, nausea, photophobia, and concentration difficulties are most specific for an impending GTN-induced migraine-like headache. We suggest that these symptoms may also be helpful as early warning signals in clinical practice with concentration difficulties exclusively reported by those who develop a migraine-like attack.
Hunting severe acute respiratory syndrome coronavirus 2 (2019 novel coronavirus): From laboratory testing back to basic research
Authors: Yang De-Ming , Chang Tai-Jay , Wang Mong-Lien , Tsai Ping-Hsing , Lin Ta-Hsien , Wang Chin-Tien , Liang Kung-Hao
Published: April 2020

The rapid spread of coronavirus disease 2019 (COVID-19) in many countries causes citizens of daily inconvenience and even life-threat for elderly population. The invasion of the main pathogen, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; 2019 novel coronavirus [2019-nCoV]), into human body causes different levels of impact to various patients. One of the most important issues for COVID-19 is how to defend this virus with the ability to foresee the infected targets. Thus, we maintain the quarantined essentially as for as others saved from COVID-19. So far, the routine laboratory test to confirm whether infected by SARS-CoV-2/2019-nCoV or not is through real-time reverse transcription polymerase chain reaction (rRT-PCR; quantitative polymerase chain reaction [qPCR]) with certain sequence regions that recognize SARS-CoV-2/2019-nCoV RNA genome. The heavy loading of rRT-PCR (qPCR) machine and handling labor have tight-packed the instruments as well as the manpower almost in every country. Therefore, the alternative approaches are eagerly waiting to be developed. In this review article, we sort out some state-of-the-art novel approaches that might be applied for a fast, sensitive, and precise detection of SARS-CoV-2/2019-nCoV not only to help the routine laboratory testing but also to improve effective quarantine.
Prolonged Ketamine and Norketamine Excretion Profiles in Urine After Chronic Use
Authors: de Jong Lutea A.A. , Qurishi Rouhollah , Stams Marieke P.J. , Böttcher Michael , de Jong Cornelis A.J.
Published: April 2020

Purpose/Background

Ketamine (K) is used as a party drug with hallucinogenic properties with a half-life of about 2.5 hours. Data are available with respect to the detection window (ie, when a person is still tested positive for the drug and/or metabolite after use) of K after single use. Nevertheless, no data are available with respect to the detection window of K in urine after chronic use.

Methods/Procedures

This retrospective case series describes 7 patients with K dependency as their main addiction who have been admitted to an addiction center for K detoxification. Their abstinence-oriented care involved routine urinary screening of K and its metabolites, as well as traditional drugs of abuse, such as cocaine and cannabinoids.

Findings/Results

Urine samples remained positive for all the cases identified after 22 to 96 days. A peak detection period of 61, 40, and 96 days for K, norketamine, and dehydronorketamine, respectively, measured using liquid chromatography–tandem mass spectrometry at a cutoff concentration of 1.0 ng/mL, is defined. The K/norketamine and K/dehydronorketamine ratios varied over time between 0.33 and 3.06, and 0.01 and 0.36 for all patients, respectively, implying a large interindividual variation in K metabolism.

Implications/Conclusions

Ketamine and its metabolites have a prolonged excretion profile in urine, which requires frequent measurements (at least weekly) to guide abstinence treatment. Further research is needed to develop an algorithm that can differentiate new K use from residual urinary K excretion in urine of chronic daily users.
An Alzheimer Disease Challenge Model: 24-Hour Sleep Deprivation in Healthy Volunteers, Impact on Working Memory, and Reversal Effect of Pharmacological Intervention
Authors: Chan Kwong Anna , Cassé-Perrot Catherine , Costes-Salon Marie-Claude , Jouve Elisabeth , Lanteaume Laura , Audebert Christine , Rouby Franck , Lefebvre Marie-Noëlle , Ranjeva Jean-Philippe , Beck Arnaud , Deplanque Dominique , Ponchel Amélie , Vervueren Céline , Truillet Romain , Babilon Claudio , Auffret Alexandra , Richardson Jill C. , Payoux Pierre , Bartrés-Faz David , Blin Olivier , Bordet Régis , Micallef Joëlle
Published: April 2020

Purpose/Background

Alzheimer disease (AD) is a public health issue because of the low number of symptomatic drugs and the difficulty to diagnose it at the prodromal stage. The need to develop new treatments and to validate sensitive tests for early diagnosis could be met by developing a challenge model reproducing cognitive impairments of AD. Therefore, we implemented a 24-hour sleep deprivation (SD) design on healthy volunteers in a randomized, double-blind, placebo-controlled, crossover study on 36 healthy volunteers.

Methods/Procedure

To validate the SD model, cognitive tests were chosen to assess a transient worsening of cognitive functions after SD and a restoration under modafinil as positive control (one dose of 200 mg). Then, the same evaluations were replicated after 15 days of donepezil (5 mg/d) or memantine (10 mg/d). The working memory (WM) function was assessed by the N-back task and the rapid visual processing (RVP) task.

Findings/Results

The accuracy of the N-back task and the reaction time of the RVP revealed the alteration of the WM with SD and its restoration with modafinil (changes in score after SD compared with baseline before SD), respectively, in the placebo group and in the modafinil group (−0.2% and +1.0% of satisfactory answers, P = 0.022; +21.3 and +1.9 milliseconds of reaction time, P = 0.025). Alzheimer disease drugs also tended to reverse this deterioration: the accuracy of the N-back task was more stable through SD (compared with −3.0% in the placebo group, respectively, in the memantine group and in the donepezil group: −1.4% and −1.6%, P = 0.027 and P = 0.092) and RVP reaction time was less impacted (compared with +41.3 milliseconds in the placebo group, respectively, in the memantine group and in the donepezil group: +16.1 and +29.3 milliseconds, P = 0.034 and P = 0.459).

Implications/Conclusions

Our SD challenge model actually led to a worsening of WM that was moderated by both modafinil and AD drugs. To use this approach, the cognitive battery, the vulnerability of the subjects to SD, and the expected drug effect should be carefully considered.
Lurasidone Improves Psychopathology and Cognition in Treatment-Resistant Schizophrenia
Authors: Meltzer Herbert Y. , Share Daniel B. , Jayathilake Karu , Salomon Ronald M. , Lee Myung A.
Published: April 2020

Purpose/Background

In addition to clozapine, other atypical antipsychotic drugs pharmacologically similar to clozapine, for example, olanzapine, risperidone, and melperone, are also effective in a similar proportion of treatment-resistant schizophrenia (TRS) patients, ~40%. The major goal of this study was to compare 2 doses of lurasidone, another atypical antipsychotic drug, and time to improvement in psychopathology and cognition during a 6-month trial in TRS patients.

Methods/Procedures

The diagnosis of TRS was based on clinical history and lack of improvement in psychopathology during a 6-week open trial of lurasidone 80 mg/d (phase 1). This was followed by a randomized, double-blind, 24-week trial of lurasidone, comparing 80- and 240-mg/d doses (phase 2).

Findings/Results

Significant non–dose-related improvement in the Positive and Negative Syndrome Scale—Total and subscales and in 2 of 7 cognitive domains, speed of processing and executive function, were noted. Twenty-eight (41.8%) of 67 patients in the combined sample improved ≥20% in the Positive and Negative Syndrome Scale—Total. Of the 28 responders, 19 (67.9%) first reached ≥20% improvement between weeks 6 and 24 during phase 2, including some who had previously failed to respond to clozapine.

Implications/Conclusions

Improvement with lurasidone is comparable with those previously reported for clozapine, melperone, olanzapine, and risperidone in TRS patients. In addition, this study demonstrated that 80 mg/d lurasidone, an effective and tolerable dose for non-TRS patients, was also effective in TRS patients but required longer duration of treatment. Direct comparison of lurasidone with clozapine in TRS patients is indicated.
Body Mass Index as a Moderator of Treatment Response to Ketamine for Major Depressive Disorder
Authors: Freeman Marlene P. , Hock Rebecca S. , Papakostas George I. , Judge Heidi , Cusin Cristina , Mathew Sanjay J. , Sanacora Gerard , Iosifescu Dan V. , DeBattista Charles , Trivedi Madhukar H. , Fava Maurizio
Published: April 2020

Purpose/Background

Major depressive disorder (MDD) and obesity commonly co-occur. We sought to assess the impact of body mass index (BMI) on the acute antidepressant effects of ketamine in patients with treatment-resistant depression.

Methods/Procedures

Post hoc analyses were conducted from a multisite, randomized, double-blind, placebo-controlled trial designed to assess the rapid-onset effects of intravenous ketamine. Patients (n = 99) were randomized to a single dose administration of ketamine 0.1 mg/kg (n = 18), ketamine 0.2 mg/kg (n = 20), ketamine 0.5 mg/kg (n = 22), ketamine 1.0 mg/kg (n = 20), or active placebo, midazolam 0.045 mg/kg (n = 19). Patients were stratified for BMI. For patients randomized to ketamine (n = 80), BMI was assessed as a continuous variable and also categorically (obese, overweight, not obese/overweight [reference]). The primary outcome measure was the change on the 6-item Hamilton Depression Rating Scale 24 hours after treatment. Outcomes at day 3 were also assessed.

Findings/Results

The 6-item Hamilton Depression Rating Scale change scores at 24 hours were inversely associated with BMI (−0.28 ± 0.12,P= 0.02). With BMI operationalized categorically, both obese (−4.15 ± 1.41,P= 0.004) and overweight (−1.99 ± 1.14,P= 0.08) categories were inversely related to the 6-item Hamilton Depression Rating Scale change score at 24 hours, statistically significant for the obese category, as compared with the reference group. Similar but weaker findings were observed at 72 hours after infusion.

Implications/Conclusions

Higher BMI and obesity were associated with a more robust acute antidepressant response to ketamine. This may have clinical relevance for a great number of patients who have both MDD and obesity.

Clinical Trial Registration: NCT01920555.
Scholarly Productivity and Occupational Stress Among Physician Assistant Educators
Authors: Hegmann Theresa E.
Published: April 2020

Purpose

Academic scholarship continues to challenge physician assistant (PA) educators in the United States, who typically enter academia with little experience in research or publication. Consequently, difficulty with navigating the promotion process might be expected to impact both job satisfaction and retention of PA faculty. Providing reasonable benchmarks for scholarship is one focus of this project, along with exploration of relationships among publication success, gender, job stressors, program support, and intent to leave academia.

Methods

Deidentified data from the online 2017 Faculty & Directors Survey was obtained from the Physician Assistant Education Association (PAEA), including gender, academic rank, program role, degree, publication numbers, and variables measuring program support, stressors, and intent to leave the institution or academia. Individual response rate was 60.3%, N = 1009. SPSS-v25 was used for data analysis.

Results

Respondents were 65% female. The mean number of total publications was 2.7 (down from 4.2 in 2010); the median was zero with 50.6% reporting no publications during their career. Almost half (45.5%) of PA faculty were stressed by research or publishing demands; 53.6% were stressed by the promotion process. Physician assistant educators stressed by promotion were more likely to consider leaving their institution or academia as a whole (Fisher's exact, P < .001 for both).

Conclusion

This study updates publication benchmarks for PA educators. Scholarship levels have dropped since 2010, likely related to the recent influx of junior faculty. Navigating the promotions process is a significant occupational stressor for PA educators and is associated with faculty intent to leave academia.
Stress During Pregnancy and Epigenetic Modifications to Offspring DNA
Authors: Nowak Alexandra L. , Anderson Cindy M. , Mackos Amy R. , Neiman Emily , Gillespie Shannon L.
Published: April 2020

Offspring born preterm (ie, before 37 weeks of gestation) are more likely to die or experience long-standing illness than full-term offspring. Maternal genetic variants (ie, heritable, stable variations in the genetic code) and epigenetic modifications (ie, chemical modifications to the genetic code that can affect which genes are turned on or off) in response to stress have been implicated in preterm birth. Fetal genetic variants have been linked to preterm birth though the role of offspring epigenetics in preterm birth remains understudied. This systematic review synthesizes the literature examining associations among stress during pregnancy and epigenetic modifications to offspring DNA, with 25 reports identified. Ten reports examined DNA methylation (ie, addition/removal of methyl groups to/from DNA) across the epigenome. The remainder examined DNA methylation near genes of interest, primarily genes linked to hypothalamic-pituitary-adrenal axis function (NR3C1, FKBP51), growth/immune function (IGF2), and socioemotional regulation (SLC6A4, OXTR). The majority of reports noted associations among stress and offspring DNA methylation, primarily when perceived stress, anxiety, or depression served as the predictor. Findings suggest that differences in offspring epigenetic patterns may play a role in stress-associated preterm birth and serve as targets for novel interventions.
Periviability
Authors: Cypher Rebecca L. , Foglia Lisa M.
Published: April 2020

One of the most complex clinical problems in obstetrics and neonatology is caring for pregnant women at the threshold of viability. Births near viability boundaries are grave events that carry a high prevalence of neonatal death or an increased potential for severe lifelong complications and disabilities among those who survive. Compared with several decades ago, premature infants receiving neonatal care by today's standards have better outcomes than those born in other eras. However, preterm labor at periviability represents a more complex counseling and management challenge. Although preterm birth incidence between 200/7 and 256/7 weeks has remained unchanged, survival rates at earlier gestational ages have increased as perinatal and neonatal specialties have become more adept at caring for this at-risk population. Women face difficult choices about obstetric and neonatal interventions in light of uncertainties around survival and outcomes. This article reviews current neonatal statistics in reference to short- and long-term outcomes, key concepts in obstetric clinical management of an anticipated periviable birth, and counseling guidance to ensure shared-decision making.
Pharmacology for Preterm Labor
Authors: Garfield Lindsey , Chin Emily
Published: April 2020

Preterm birth occurs with 10% of deliveries and yet accounts for more than 85% of perinatal morbidity and mortality. Management of preterm labor prior to delivery includes a multipronged pharmacologic approach targeting utilization of reproductive hormones for continuation of pregnancy, advancement of fetal lung maturity, and the decrease of uterine contractility (tocolysis). This article will review and compare guidelines on pharmacologic management of preterm labor as recommended by the American College of Obstetricians and Gynecologists and the European Association of Perinatal Medicine. The classifications of drugs discussed include exogenous progesterone, corticosteroids, and tocolytics (β-adrenergic agonists, magnesium sulfate, calcium channel blockers, prostaglandin inhibitors, nitrates, and oxytocin receptor blockers). For each of these drug classes, the following information will be presented: mechanism of action, maternal/fetal side effects, and nursing implications.
Association of Nurse Staffing With Nosocomial Infections of Very Low-Birth-Weight Infants
Authors: Lee Young Joo , Lee Taewha , Cho Eunhee , Park Sohee , Park Choon Seon
Published: April 2020

Prior studies have reported inconsistent findings regarding the relationship between nurse staffing and nosocomial infections in very low-birth-weight (VLBW) infants. Little is known about whether similar associations occur in Korea. The purpose of this study was to identify the nurse staffing of neonatal intensive care units (NICUs) in Korea and to verify the association between nurse staffing and nosocomial infections among VLBW infants in NICUs. We selected 4654 VLBW infants admitted to 52 hospitals. Nosocomial infections were defined as incidence of bloodstream infection, urinary tract infection (UTI), or rotavirus infection. The average number of NICU patients per nurse was 4.51(minimum-maximum: 2.38-8.16). Hospitals with a higher number of patients per nurse exhibited a significant increased UTI rate (P = .005) and rotavirus infection rate (P = .025) in the univariate analysis. After adjusting for all patient and hospital characteristics, UTI significantly increased with increasing number of patients per nurse (odds ratio [OR] = 1.79; 95% confidence interval, 1.29-2.47), while bloodstream infection (OR = 0.93; 95% confidence interval, 0.79-1.09) and rotavirus infection (OR = 1.14; 95% confidence interval, 0.92-1.41) were not significant. These findings revealed that a nurse staffing in NICUs is an important factor for preventing UTI among VLBW infants.
NICU Maternal-Infant Bonding
Authors: Dunham Melissa M. , Marin Terri
Published: April 2020

The admission of an infant to the neonatal intensive care unit (NICU) presents specialized barriers to the maternal-infant bonding (MIB) process. Virtual visitation (VV) provides a mother with the opportunity to have continual access to her hospitalized infant via a one-way live Web camera. While increasingly used in the NICU, VV remains a novel concept. The objective of this study was to introduce a conceptual model that incorporates the use of VV into the NICU MIB process. Adapted from the Model of Mother-Infant Bonding After Antenatal HIV Diagnosis, a newly developed model of MIB using VV as a bonding enhancement tool is offered. A Model of NICU Maternal-Infant Bonding Incorporating Virtual Visitation presents the NICU bonding process in a chronological manner, with 5 primary propositions and an explanation of their related themes. Virtual visitation is introduced into the bonding process and is shown to act as a moderated variable. A Model of NICU Maternal-Infant Bonding Incorporating Virtual Visitation introduces VV as a tool to enhance the MIB process that occurs in the NICU. The model provides the basis for the development of a research program to examine the multiple potential effects of VV in the NICU.
In-vitro assessment of the effects of fibrinogen, recombinant factor VIIa and factor XIII on trauma-induced coagulopathy
Authors: Budnik Ivan , Shenkman Boris , Morozova Olga , Einav Yulia
Published: April 2020

Trauma-induced coagulopathy (TIC) occurs commonly as a second event following severe injury. We evaluated the effects of fibrinogen, recombinant factor VIIa and factor XIII on blood clotting and fibrinolysis in an in-vitro TIC model. The TIC model included hemodilution, hyperfibrinolysis, acidosis and hypothermia. The extent of clot formation and fibrinolysis was evaluated using rotational thromboelastometry. Clot strength was increased following spiking the TIC blood with either 1.0 mg/ml fibrinogen, 3.0 μg/ml recombinant factor VIIa or 2.0 IU/ml factor XIII. Maximal effect was achieved by all agents in combination approximating the extent of clot formation to those in normal blood. Fibrinolysis was inhibited by factor XIII, while the reduction was stronger using all agents together. When each of the agents used in two times lower concentrations, clot strength was near to threshold. Fibrinogen and factor XIII but not factor VIIa exerted stimulation of clot strength, whereas synergistic effect of fibrinogen and factor XIII was observed. Maximal effect was achieved combining all agents. The antifibrinolytic effect was observed only by co-administration of fibrinogen, factor XIII and factor VIIa. On the basis of our study, we suggest that stimulation of clot formation and inhibition of fibrinolysis may be achieved by combination of FG, rFVIIa an FXIII using each of them at minimal effective concentration. Taken into consideration, multifactorial TIC pathogenesis, this approach may be preferable for improving coagulopathy than separate blood spiking with the essayed factors at high concentrations.
Enzymatic deinduction phenomenon and clinical implications with a focus on direct-acting oral anticoagulants
Authors: Cole Jennifer L.
Published: April 2020

The aim of the study was to describe the deinduction process and clinically relevant cases reported in the medical literature. Performed PubMed database search for key words ‘enzymatic deinduction’. Findings are summarized. Although many unwanted drug interactions occur from the additive effects of combined medications or through competition at binding sites, some interactions occur because of alterations in homeostasis of natural metabolizing pathways. Enzymatic induction is a natural process in which normal metabolizing enzymes are increased because of RNA signaling from xenobiotics. Strong inducing medications can lead to decreased serum levels of other drugs, which are metabolized through these substrates; notably the direct-acting oral anticoagulants are affected. What is less understood, however, is the process of enzymatic deinduction and the clinically relevant sequela of overlooking this interaction. Providers should be aware of enzymatic deinduction and the potentially severe adverse effects of this phenomenon.
Association of gender with clinical outcomes of patients with acute ST-segment elevation myocardial infarction presenting with acute heart failure
Authors: Dharma Surya , Dakota Iwan , Andriantoro Hananto , Firdaus Isman , Rahma Salsabila , Budi Siswanto Bambang
Published: April 2020

Background

There is limited data evaluating the sex differences in outcomes of patients with ST-segment elevation myocardial infarction presenting with acute heart failure. We compared the outcomes between women and men with ST-segment elevation myocardial infarction presenting with acute heart failure (Killip classification ≥II).

Method

All ST-segment elevation myocardial infarction patients presenting to the emergency department of a cardiovascular center in Jakarta, Indonesia, from 1 February 2011 to 30 August 2019 were retrospectively analyzed.

Results

Of 6557 patients recorded, 929 were women, and 276 (4.2%) presented with acute heart failure. Compared with men with acute heart failure (N = 1540), women who presented with acute heart failure were older (63 ± 10 vs. 57 ± 10 years, P < 0.001), had a greater proportion of thrombolysis in myocardial infarction risk score >4 (85% vs. 73%, P < 0.001), received fewer primary angioplasty and in-hospital fibrinolytic therapy (40% vs. 48%, P = 0.004 and 1.1% versus 3.5%, P = 0.03, respectively), and had longer median door-to-device and total ischemia times (96 vs. 83 minutes, P = 0.001, and 516 versus 464 minutes, P = 0.02, respectively). Multivariate analysis showed that women and men with acute heart failure were each associated with increased risk of in-hospital mortality (odds ratio: 4.70; 95% confidence interval: 3.28–6.73 and odds ratio: 4.75; 95% confidence interval: 3.84–5.88, respectively), and this remained relatively unchanged even among patients with acute heart failure who had undergone reperfusion therapy (odds ratio: 5.35; 95% confidence interval: 3.01–9.47 and odds ratio: 5.19; 95% confidence interval: 3.80–7.08, respectively).

Conclusion

In our population, women with ST-segment elevation myocardial infarction presenting with acute heart failure had relatively similar risk of early mortality with their male counterpart (≈5-fold), thus should receive evidence-based treatment.
The impact of intra-arrest hypothermia
Authors: Nordberg Per , Annoni Filippo , Taccone Fabio S.
Published: April 2020

Purpose of review

To address the impact of therapeutic hypothermia induced already during cardiopulmonary resuscitation (i.e. intra-arrest cooling) and its association with neurologic functional outcome.

Recent findings

Intra-arrest cooling is superior than post-ROSC cooling to mitigate brain injuries in experimental models of cardiac arrest. The delayed initiation of hypothermia in human studies may not have adequately addressed the underlying pathophysiology of ischemia and reperfusion. The assessment of early initiation of cooling has been complicated by increased rate of hemodynamic adverse events caused by infusion of cold intravenous fluids. These adverse events have been more deleterious in patients with initial shockable rhythms. A recent randomized study shows that an alternative intra-arrest cooling method using trans-nasal evaporative cooling was well tolerated and effective to shorten time to target temperature. However, the neurologic outcomes (CPC 1–2 at 90 days) in favor of intra-arrest cooling compared to hospital cooling (34.8% vs 25.9%, P = 0.11) in patients with initial shockable rhythms did not reach statistical significance.

Therapeutic intra-arrest hypothermia can be initiated safely at the scene of the arrest using transnasal evaporative cooling. The potential beneficial effect of intra-arrest cooling on neurologic recovery in patients with initial shockable rhythms should be explored further.
Monitor the quality of cardiopulmonary resuscitation in 2020
Authors: Genbrugge Cornelia , Eertmans Ward , Salcido David D.
Published: April 2020

Purpose of review

The current review will give an overview of different possibilities to monitor quality of cardiopulmonary resuscitation (CPR) from a physiologic and a process point of view and how these two approaches can/should overlap.

Recent findings

Technology is evolving fast with a lot of opportunities to improve the CPR quality. The role of smartphones and wearables are step-by-step identified as also the possibilities to perform patient tailored CPR based on physiologic parameters. The first steps have been taken, but more are to be expected. In this context, the limits of what is possible with human providers will become more and more clear.

To perform high-quality CPR, at first, one should optimize rate, depth and pause duration supported by process monitoring tools. Second, the evolving technological evolution gives opportunities to measure physiologic parameters in real-time which will open the way for patient-tailored CPR. The role of ultrasound, cerebral saturation and end-tidal CO2 in measuring the quality of CPR needs to be further investigated as well as the possible ways of influencing these measured parameters to improve neurological outcome and survival.
Focused ultrasonography for septic shock resuscitation
Authors: Nikravan Sara , Song Pingping , Bughrara Nibras , Díaz-Gómez José L.
Published: April 2020

Purpose of review

Severe sepsis with septic shock is the most common cause of death among critically ill patients. Mortality has decreased substantially over the last decade but recent data has shown that opportunities remain for the improvement of early and targeted therapy. This review discusses published data regarding the role of focused ultrasonography in septic shock resuscitation.

Recent findings

Early categorization of the cardiovascular phenotypes with echocardiography can be crucial for timely diagnosis and targeted therapy of patients with septic shock. In the last few years, markers of volume status and volume responsiveness have been investigated, serving as valuable tools for targeting volume therapy in the care of both spontaneously breathing and mechanically ventilated patients. In tandem, investigators have highlighted findings of extravascular volume with ultrasonographic evaluation to compliment de-escalation of resuscitation efforts when appropriate. Furthermore, special attention has been given to resuscitation efforts of patients in septic shock with right ventricular failure.

Severe sepsis with septic shock is an insidious disease process that continues to take lives. In more recent years, data have emerged suggesting the utility of bedside ultrasonography for early cardiovascular categorization, goal directed resuscitation, and appropriate cardiovascular support based on its changing phenotypes.
Effects of group cognitive-behavioral therapy on psychological distress of awaiting-trial prison inmates
Authors: Amoke Chijioke Virgilus , Ede Moses Onyemaechi , Nwokeoma Bonaventure N. , Onah Sebastian O. , Ikechukwu-Ilomuanya Amaka B. , Albi-Oparaocha Florence C. , Nweke Maduka L. , Amoke Chijioke V. , Amadi Kingsley C. , Aloh Henry E. , Anyaegbunam Emenike N. , Nwajiuba Chinyere A. , Onwuama Onyeyilichukwu P. , Ede Kelechi R. , Ononaiwu Agnes I. , Nweze Tina
Published: April 2020

Background/Objectives:

The level of psychological distress among awaiting-trial inmates is rapidly increasing in Nigeria. Studies have recommended increasing attention and additional psychological intervention that could improve the psychological wellbeing of prisoners. This study evaluates the effect of cognitive behavioral therapy on psychological distress among awaiting-trial prison inmates in Nigeria.

Methods:

A total of 34 awaiting-trial prison inmates in Enugu state Nigeria were used as the study participants. Two measures (perceived emotional distress inventory and general health Questionnaire) were used for data collection. Repeated measures with analysis of variance (ANOVA) were used to examine the effects of the intervention. Effect sizes were also reported with partial Eta Squared (

JOURNAL/medi/04.03/00005792-202004240-00002/inline-graphic2/v/2023-09-15T184447Z/r/image-tiff

).

Results:

The result showed that there was no significant difference in psychological distress between the treatment and no-intervention groups. The results showed that CBT had a significant effect on psychological distress of awaiting-trial prison inmates when compared to their counterparts in the no-intervention group at Time 2. Additionally, the efficacy of CBT on the psychological distress of awaiting-trial prison inmates was significantly sustained at the follow-up measurements (Time 3).

Conclusion:

This study suggests that cognitive behavioral therapy is an effective intervention for decreasing psychological distress among awaiting-trial prison inmates. Additionally, the impactful benefit of the intervention can persist in overtime. Therefore, cognitive behavioral therapists can further explore the efficacy of CBT using various cultures.
Application of polyetheretherketone cages through minimally invasive oblique retroperitoneal approach for the treatment of lumbar polymicrobial spondylodiscitis
Authors: Luo Wei , Zhu Yong , Zhao Zeng-Hui , Ou Yun-Sheng
Published: April 2020

Despite the plethora of evidence in support of the use of structural osseous autograft in lumbar spondylodiscitis, attention has recently been turned to the addition of synthetic materials such as polyetheretherketone (PEEK) to restore anterior vertebral column support.

From January 2015 to April 2017, 7 patients with lumbar polymicrobial spondylodiscitis were surgically treated with a minimally invasive oblique retroperitoneal approach to the infected focus. The patients underwent a standard lateral minimally invasive oblique retroperitoneal approach using direct lateral interbody fusion system. The PEEK cages were loaded with autologous bone graft. All the patients underwent posterior fixation with percutaneous pedicle screw instrumentation. Lumbar function was measured using Oswestry Disability Index, and pain was measured with visual analog scale. Fusion and subsidence were also recorded.

The study included 5 female and 2 male patients. The median age was 58.9 years. The duration of follow-up was 31.8 ± 6.1 months (range: 24–47). All patients recovered from the infection without relapse within 24-month follow-up. Visual analog scale significantly declined from 7.57 ± 0.53 before surgery to 1.57 ± 0.53 at 12-month follow-up. Mean Oswestry Disability Index decreased from 72.14 ± 6.82 before surgery to 22.28 ± 2.13 after surgery. All patients had solid fusion at 2-year follow-up. Fusion occurred at 6 to 15 months (mean 9.8 months).

The specific use of PEEK cages in lumbar polymicrobial spondylodiscitis suggests reliable outcome in terms of clinical and imaging outcomes in our limited cases.
Retroperitoneal fibromatosis presenting as a mesenteric mass
Authors: Xiao Jianchun , Zhou Wenzhe
Published: April 2020

Rationale:

Fibromatoses or desmoid tumors are relatively rare tumors derived from the musculoaponeurotic system. This tumor has no specific clinical symptoms and it is sometimes misdiagnosed as other diseases such as gastrointestinal stromal tumors (GISTs).

Patient concerns:

A 28-year-old man visited Peking Union Medical College for a tangible abdominal mass without abdominal pain or distention.

Diagnoses:

Considering the imaging characteristics and clinical manifestation, this mass was primarily diagnosed as GIST before surgery. During the surgery, the occupancy was found under the ileocecal mesentery, with grayish white appearance, tough texture, and poor mobility, which was not consistent with the character of the GIST. After the surgery, pathological examination and individual immunohistochemistry results demonstrated that the lesion was compatible with the diagnosis of retroperitoneal fibromatosis with purulent inflammation of chronic lymphadenitis.

Interventions:

Therefore, we decided to perform tumor mass resection, right colon resection, partial duodenum resection, and intestinal anastomosis on laparotomy, but the right ureter was retained. After excision of the tumor, the ends of the intestine segment were continuously sutured.

Outcomes:

The patient experienced no intraoperative or postoperative complications, and was discharged 3 days after surgery. Periodic follow-up physical examinations such as the abdominal ultrasound and computed tomography were performed each 3 months, and no evidence of recurrence was observed during the whole 12 months.

Lessons:

To sum up, intra-abdominal fibromatosis is an extremely rare tumor that must be differentiated from other tumors of the digestive tract, and pathological and immunohistochemical examination is a critical part of the diagnosis. Early diagnosis of fibromatosis is essential for the outcome. Extensive resection of the mass minimizes the risk of relapse.
Is dietary fat associated with the risk of age-related macular degeneration? Protocol for a systematic review and meta-analysis
Authors: Xu Yunsheng , Lu Bo , Zhou Yana , Ren Shuxia , Pang Guoming , Deng Aijun
Published: April 2020

Previous studies evaluating the association of dietary fat and risk of age-related macular degeneration (AMD) yield discrepant results. The objective of this systematic review (SR) and meta-analysis is to establish whether an association exists between dietary fat and AMD. This protocol was developed in line with the quality requirements of the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) statement. PubMed and EMBASE will be searched for randomized controlled trials (RCTs), non-randomized trials (NRTs), cross-sectional studies, cohort studies, and case-control studies that evaluate the total incidence of AMD. The data extraction content and quantitative analysis will be carried out systematically. Newcastle-Ottawa Scale (NOS), the Cochrane risk of bias tool, and quality assessment tools will be used for quality assessment. This SR will synthesize evidence to determine if there is an association between dietary fat and AMD. The evidence would provide rationale for future research and serve as a basis for the development of future guidelines. Results are expected to be publicly available in mid 2020.

PROSPERO registration number: CRD42019137086.
A rare case of thyroglossal duct cyst extending to the sublingual space
Authors: Park Mi Jung , Shin Hwa Seon , Choi Dae Seob , Choi Hye Young , Choi Ho Cheol , Lee Sang Min , Jang Jeong Ho , Lee Jeong-Hee , Park Jung Je , Park Sung Eun
Published: April 2020

Rationale:

Thyroglossal duct cyst (TGDC) is the most common congenital anomaly of midline neck masses. A thyroglossal duct cyst is especially difficult to diagnose and is treated differently when it appears in the sublingual area. Here, we report a rare case of TGDC extending to the sublingual space.

Patient concerns:

A 42-year-old female presented with a history of neck swelling in the submental region.

Diagnosis:

The final pathologic diagnosis was a TGDC.

Interventions:

Sistrunk operation was performed.

Outcomes:

Recurrence of the disease has not been seen for the past year.

Lession:

Clinical awareness of the thyroglossal duct cyst in the sublingual area or on the oral floor area is important for an accurate diagnosis and the appropriated management.
Subjective expectations for future and mortality among middle-aged and older adults
Authors: Choi Jae Woo , Kim Jae-Hyun , Yoo Ki Bong
Published: April 2020

The purpose of this study is to categorize various elements for the expectations for the future using factor analysis and identify association between categories of the subjective expectations for the future and mortality among middle-aged and older adults.

Data from the Korean Longitudinal Study of Aging from 2006 to 2016 was assessed using longitudinal data analysis and 9,844 research subjects were included at baseline in 2006. Our modeling approach was based on Cox proportional hazards models for mortality.

We indicated 3 categories (individual factor, national factor, and combined factor) of 12 subjective expectations for the future using factor analysis. The negative expectations for the future of all factors [individual factor: hazard ratio (HR), 1.65, 95% confidence interval (CI), 1.41–1.93; national factor: HR, 1.20, 95% CI, 1.06–1.37; combined factor: HR, 1.16; 95% CI, 1.02–1.32] were more likely to have an increased risk of all-cause mortality than those in the positive expectations for the future. Older adults were more likely to be affected by negative expectations for the future in national factor compared to middle-aged adults (HR, 1.22; 95% CI, 1.05–1.41).

Increasing positive expectations for the future is an important consideration for improvement in health. Policy makers need to consider that changes of national policy would affect health in older adults.
Postoperative radiotherapy for the young–old patients with thoracic esophageal squamous cell carcinoma
Authors: Ding Wei , Yang Min , Jiang Wanrong , Ge Xiaolin , Sun Xiangdong , Zhou Bin , Liu Feng , Jiang Kai , Shen Fangcheng , Sun Xinchen
Published: April 2020

This study aimed to retrospectively analyze the efficacy and safety of esophagectomy and postoperative radiotherapy (PORT) for patients with thoracic esophageal squamous cell carcinoma (TESCC) in the young–old (aged between 65 and 75 years).

The clinical data of 166 young–old patients with esophageal cancer who underwent esophagectomy and PORT from May 2004 to May 2018 in The First Affiliated Hospital of Nanjing Medical University and The PLA Cancer Center, Jinling Hospital were analyzed. The Kaplan–Meier method was used to calculate overall survival (OS), disease-free survival (DFS), local recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS). The log-rank method was used to test the differences. The Cox regression model was used for the multivariate prognostic analysis.

The follow-up rate was 98.5%, and the median follow-up time was 41.2 months. The whole 1-, 3-, and 5-year OS rates were 92.0%, 69.3%, and 58.3%, respectively, and the median OS was 64.7 months (95% CI, 58.3–71.1). The median DFS was 57.9 months (95% CI, 47.4–68.4), and the 1-, 3-, and 5-year DFS rates were 84.8%, 61.5%, and 44.6%, respectively. The median LRFS was 60.8 months (95% CI, 50.5–71.0), and the 1-, 3-, and 5-year LRFS rates were 85.8%, 64.94%, and 53.9%, respectively. The median DMFS was 65.0 months (95% CI, 60.6–69.6), and the 1-, 3-, and 5-year DMFS rates were 91.9%, 77.0%, and 67.5%, respectively. Pathological T staging, lymph node metastasis, pathologic staging, and Karnofsk Performance Status (KPS) were the main factors affecting prognosis. In addition, T staging, lymph node metastasis are also independent prognostic factors. Little severe toxicity was observed.

The result indicates that PORT for TESCC patients who can tolerate surgery is safe in the young–old. The efficacy is similar to that of previous patients including younger populations. Pathological T and N stage are major factors that affect prognosis. Concurrent chemotherapy may not improve the survival of the young–old patients undergoing postoperative radiotherapy.