bluuebunny/crossref_metadata_2025 huggingface dataset:
Periocular Cutaneous Soft-Tissue Giant Cell Tumor in a Pediatric Patient
Authors: Hogeboom Adriana G. , Gallardo Ruben , Delgado-Muñoz Maria , Rodriguez-Peralto Jose L. , Garrido Maria C.
Published: July 2021

Giant cell tumor of soft tissue (GCTST) is a rare neoplasm genetically unrelated but histopathologically indistinguishable to its osseous counterpart. Histologically, GCTST is characterized as a multinodular proliferation of bland histiocytoid mononuclear cells intermixed with osteoclast-like giant cells. GCTST most commonly presents as a soft-tissue mass located in the extremities of middle-aged adults. In this report, we describe a case of a dermal GCTST arising in the periocular region of a 3-year-old girl. This is the youngest patient diagnosed with GCTST reported in the literature and is also singular because of its anatomic location: Only a handful of head and neck GCTSTs have been reported to date. Furthermore, GCTST most often presents as a superficial or deep soft-tissue mass and much less commonly as a dermal-based skin tumor, as was our case. On microscopic examination, the resected lesion demonstrated classical features including numerous osteoclast-like giant cells embedded in a background of mononuclear ovoid cells which displayed brisk mitotic activity and were surrounded by variable stromal hemorrhage. Tumor cells presented a vaguely fascicular arrangement. Immunohistochemical profile demonstrated positivity for smooth muscle actin and CD68 and negativity for desmin, myo-D1, S100, HMB-45, Melan-A, p16, and NKIC3. The unusual characteristics of this case emphasize the clinicopathologic heterogeneity of GCTST.
Multimodality cardiac imaging and new display options to broaden our understanding of the tricuspid valve
Authors: Volpato Valentina , Badano Luigi P. , Figliozzi Stefano , Florescu Diana R. , Parati Gianfranco , Muraru Denisa
Published: July 2021

Purpose of review

The prognostic impact of tricuspid regurgitation (TR) and the subsequent development of percutaneous procedures targeting the tricuspid valve (TV), has brought to the forefront the role of imaging for the assessment of the forgotten valve. As illustrated in several studies and summarized in this review, currently a multimodality imaging approach is required to understand the pathophysiology of TR, due to the complex TV anatomy and the close relationship between the severity of TR and the extent of the remodeling of the right heart chambers.

Recent findings

Recently, the advance in the tranhscatheter treatment of the TV has led to a growing interest in the development of dedicated software packages and new display modalities to increase our understanding of the TV. As a consequence, a transversal knowledge of the different imaging modalities is required for contemporary cardiac-imaging physicians.

This review highlights the main features, and the pros and cons of echocardiography, cardiac computed tomography, cardiac magnetic resonance and emerging technologies, as 3D printing and virtual reality, in the assessment of patients with TR.
USING RETeval SYSTEM FLICKER ELECTRORETINOGRAPHY FOR EVALUATION OF DENSE VITREOUS HEMORRHAGE
Authors: Han Kyu Jin , Moon Haein , Woo Je Moon , Min Jung Kee
Published: July 2021

Purpose:

To determine whether the RETeval electroretinography (ERG) system can be used to evaluate eyes with dense vitreous hemorrhage (VH).

Methods:

This retrospective case series study included 69 eyes of 69 patients with acute dense VH. Flicker ERGs were recorded by the RETeval system, an ERG device with adhesive skin electrodes. We evaluated the flicker ERG amplitudes in eyes with VH and the ratio of the VH eye amplitudes compared with the fellow eye amplitudes for each VH cause.

Results:

In patients with rhegmatogenous retinal detachment, the amplitude ratios were extremely low (0.08 ± 0.03). To detect rhegmatogenous retinal detachment, the area under the receiver operating characteristic curve was 0.977 (95% confidence interval, 0.943–1.000) (best rhegmatogenous retinal detachment cutoff value, 0.14; sensitivity, 100.0%; and specificity, 95.4%). The flicker ERG amplitude was not significantly correlated with the initial visual acuity (ρ = −0.189, P = 0.120) but was positively correlated with the postoperative visual acuity in eyes with VH (ρ = −0.328, P = 0.006).

Conclusion:

The RETeval ERG system was found to be a useful diagnostic option in situations where dense VH precluded fundus examination or posterior vitreous detachment was indistinguishable from rhegmatogenous retinal detachment.
NOVEL MFRP MUTATION WITH NANOPHTHALMOS, OPTIC DISK DRUSEN, AND PERIPHERAL RETINOSCHISIS IMAGED WITH ULTRA-WIDEFIELD OPTICAL COHERENCE TOMOGRAPHY
Authors: Kovacs Kyle D. , Van Tassel Sarah H. , Gupta Mrinali P.
Published: July 2021

Purpose:

To describe with multimodal imaging including the use of ultra-widefield optical coherence tomography imaging a distinct phenotype of autosomal recessive nanophthalmos associated with a novel mutation of the MFRP gene (membrane-type frizzled-related protein).

Methods:

Case report of a single patient followed by the Weill Cornell Medicine Department of Ophthalmology Retina and Glaucoma Services, and review of the relevant literature.

Results:

A patient with a novel homozygous mutation in the MFRP gene (c.472C>T) presented with nanophthalmos, optic disk drusen, foveal hypoplasia, and extensive peripheral retinoschisis, which was revealed to be multilevel retinoschisis on ultra-widefield optical coherence tomography. Unlike other reported cases, the findings associated with this novel mutation did not include foveoschisis or clinically obvious retinitis pigmentosa. The patient underwent prophylactic peripheral laser iridotomy in both eyes.

Conclusion:

Here, we present a patient with nanophthalmos, optic disk drusen, and foveal hypoplasia associated with extensive peripheral retinoschisis imaged by ultra-widefield optical coherence tomography, but not foveal retinoschisis or prominent retinitis pigmentosa. The findings may expand the clinical spectrum of MFRP-associated nanophthalmos.
Neonatal Fournier’s Gangrene
Authors: De La Torre Manuel , Solé Carolina , Fanjul María , Berenguer Beatriz , Arriaga-Redondo María , de Tomás Elena , Lorca-García Concepción
Published: July 2021

Fournier’s gangrene is a necrotizing fasciitis of the scrotal and inguinal region, associating high mortality and complication rates. It is extremely rare in the neonatal period and may be life threatening. We present an exceptional case of a 24-day-old boy who consulted to the emergency department for fever (39 °C) and an indurated, fluctuating and painful erythema in both groins, left hemiscrotum, left anterior femoral region and perineum for the last 6 hours. Blood analysis showed increased acute phase reactants without leukocytosis. Ultrasound revealed significant soft-tissue involvement. Due to high clinical suspicion and hemodynamic instability (tachycardia and prolonged capillary filling), urgent fasciotomy, placement of Penrose drains and intensive irrigation was performed. Wound care with irrigations was performed 3 times a day. During the 12 days neonatal intensive care unit admission, he required hemodynamic support and orotracheal intubation and sedation for pain control. Broad-spectrum antibiotic therapy (with cefotaxime, clindamycin and cloxacillin) was administered for 2 weeks. Ampicillin-sensitive Streptococcus pyogenes (Group A) was isolated in blood culture at 4th day of admission allowing antibiotic de-escalation. He was discharged on postoperative day 24. He has minimal, inconspicuous scars and no functional sequelae. Fever in neonates requires close observation considering the use of empirical broad-spectrum antibiotics and hospitalization. Early diagnosis, prompt surgical management and broad-spectrum antibiotic therapy are essential to prevent complication. Early fasciotomy with intensive irrigation and close survey may avoid extensive skin debridement.
Predicting Neonatal Early Onset Sepsis
Authors: van der Hoeven Alieke , van der Beek Martha T. , Lopriore Enrico , Steggerda Sylke J. , Bekker Vincent
Published: July 2021

Background:

In many infants, treatment is started for suspicion of early onset sepsis (EOS), of whom the majority do not have an infection. Early prediction of the absence of a culture-proven sepsis (CPS) would significantly reduce the time of antibiotic treatment and hospitalization. Our objective was to analyze 3 criteria in infants with CPS: positive blood culture (BC) at 24 hours after the onset of suspicion of EOS (OSEOS), C-reactive protein (CRP) ≥10 mg/L and clinical signs of infection, so we can consequently consider to stop antibiotic treatment in infants without these criteria.

Methods:

We included all infants with suspicion of EOS from 2007 until 2020. The proportion was calculated of (1) infants with CPS with, at 24 hours, a positive BC and/or CRP ≥10 mg/L and/or clinical signs of infection and (2) infants without CPS with CRP <10 mg/L between 12 and 24 hours after OSEOS.

Results:

The BC showed growth of a pathogenic microorganism in 50 of 4120 included infants (1.2%). Time to positivity was ≥24 hours in 8 (16%) infants, of whom 7 infants had a raised CRP and/or clinical symptoms of infection within 24 hours. In 1095 (74%) of infants without CPS in whom CRP was measured between 12 and 24 hours after OSEOS, CRP was <10 mg/L.

Conclusion:

A combination of BC, CRP, and clinical signs of infection can diagnose 98% (49/50) of infants with CPS 24 hours after OSEOS. Based on normal CRP and the absence of a positive BC, the decision to stop antibiotics could have been brought forward to 24 hours in 74% of infants.
Gender Authorship Trends in the Ophthalmic Plastic and Reconstructive Surgery Literature
Authors: Gervasio Kalla A. , Sklar Bonnie A. , Nguyen Anne X. , Wu Albert Y.
Published: July 2021

Purpose:

Despite increasing numbers of women oculoplastic surgeons, they remain underrepresented within the subspecialty. The purpose of this study was to analyze trends in gender authorship within the field of ophthalmic plastic and reconstructive surgery.

Methods:

This retrospective observational study sampled articles published in Ophthalmic Plastic and Reconstructive Surgery (OPRS) and Orbit during the years 1985, 1995, 2005, 2015, and 2020. Data reviewed included article type, total number of authors, and the gender of each article’s first and senior author.

Results:

Nine hundred ninety-nine articles were analyzed, including 701 in OPRS and 298 in Orbit. Of 3,716 total authors, 1,151 (31%) were women, including 297 (29.7%) first authors, and 191 (21.5%) senior authors. Women authorship in OPRS in 1985 (first, 3.9%; senior, 3.3%; all, 3.2%) significantly increased by 2020 (first, 44.6%; senior, 27.9%; all, 42%). Women authorship in Orbit in 1985 (first, 0%; senior, 4.5%; all, 7.4%) also significantly increased by 2020 (first, 43.3%; senior, 34%; all, 42.9%). In a subanalysis of OPRS original investigations alone, women first authorship increased from 3.1% in 1985 to 35.8% in 2020 (p < 0.001) and women senior authorship increased from 4.3% in 1985 to 25% in 2020 (p = 0.001). In a subanalysis of Orbit original investigations alone, women first authorship increased from 0% in 1985 to 65.4% in 2020 (p < 0.001) and women senior authorship increased from 5.3% in 1985 to 42.3% in 2020 (p < 0.001).

Conclusions:

Despite a significant increase in women authorship over the past several decades, women remain underrepresented within the oculoplastic literature, particularly in regard to senior authorship. When considering original investigations alone, there has been a significant increase in women first and senior authorship in both OPRS and Orbit.
Long-Term Quality of Life in Patients Following Minimally Invasive Conjunctivodacryocystorhinostomy With StopLoss Jones Tube
Authors: Nowak Rafal , Rekas Marek , Ali Mohammad Javed
Published: July 2021

Purpose:

To assess the long-term quality of life outcomes of minimally invasive conjunctivodacryocystorhinostomy with StopLoss Jones tubes.

Methods:

A retrospective interventional case series was performed on all patients diagnosed with proximal bicanalicular obstruction who underwent a minimally invasive conjunctivodacryocystorhinostomy with StopLoss Jones tubes over a period of 5 years from October 2014 to September 2019. The procedure was performed as per standard published protocols of minimally invasive conjunctivodacryocystorhinostomy and StopLoss Jones tubes. Patients were followed for a minimum of 1 year after surgery. The tools employed to study were the “Jones tube satisfaction questionnaire” and the “Nasolacrimal duct obstruction-symptom score.” These tools were employed at every step from the preoperative stage to each of the follow ups. Statistical analysis was performed using the R 4.0.4 (R Project, R Foundation).

Results:

A total number of 44 eyes of 42 patients were studied. Of these, 73.81% (31/42) were females. The mean age of patients was 61.81 years. Approximately 87% and 64% of the patients completed 2 and 3 years of follow up, respectively. For up to 2 months postoperative period, the outcomes were excellent, with the majority (76.74%, 33/43) reporting “moderately satisfied” outcomes on Jones tube satisfaction questionnaire. The dissatisfaction began at the 3-month follow up (4.55%, 3/44) and peaked at 6-month follow up (25%, 11/44), owing to tube-related complications. The mean ± standard deviation nasolacrimal duct obstruction-symptom score scores dipped from 19.98 ± 2.88 at baseline to 5.58 ± 2.99 at the 2-month follow up. Similar to Jones tube satisfaction questionnaire, the scores began worsening at 3-month follow up (9.8 ± 5.86) with the poorest scores at 6 months (12.34 ± 5.96), and these changes were significant as compared with the baseline (p < 0.001). The Jones tube satisfaction questionnaire and the nasolacrimal duct obstruction-symptom score scores showed significant improvements at 1-year follow up, owing to appropriate management of complications. The good outcomes were maintained for up to 3 years of postoperative period.

Conclusions:

The long-term quality of life outcome following minimally invasive conjunctivodacryocystorhinostomy with StopLoss Jones tubes was good. The quality of life significantly suffers between 3 and 6 months following the surgery and improves equally well following appropriate management of complications.
Spheno-Orbital Dermoid Masquerading as Recurrent Orbital Abscess
Authors: Yoon Michael K. , Habib Larissa A.
Published: July 2021

A 10-month-old girl presented with eyelid edema and erythema that did not improve with systemic antibiotics. Due to a lack of improvement, MRI was performed to avoid ionizing radiation from CT. An orbital abscess was recognized and drained. However, the abscess recurred 2 times. CT scan was performed and a tract in the sphenoid bone helped to diagnose a congenital dural sinus tract with dermoid. Definitive surgery was performed with neurosurgery to remove the entire tract including cutaneous connection. CT scan proved critical to diagnosis and should be considered in infants in select cases despite the concern for ionizing radiation in this vulnerable age group.
Acceptability of Physiotherapists in the Emergency Department for the Care of Adults With Musculoskeletal Disorders
Authors: Béland Amélia , Matifat Eveline , Cournoyer Emie , Perreault Kadija , Desmeules FranÇois
Published: July 2021

Purpose:

Over the past decades, pressure on emergency departments (EDs) has been increasing. New ED models of care including physiotherapists in more autonomous roles, often called advanced practice physiotherapy (APP) care, are emerging to improve access to care, especially for patients with musculoskeletal disorders (MSKDs). As such, the purpose of this study was to assess patient' acceptability of APP ED care for patients with MSKDs.

Methods:

Patients consulting for an MSKD were recruited in 1 Canadian ED and completed a 13-question survey assessing their acceptability of ED APP care. Descriptive analyses as well as χ2 and Fisher's exact tests, with associated 95% confidence interval, were performed.

Results:

Forty-one patients completed the survey. A majority of respondents (56%) trusted APPs to provide accurate diagnoses for MSKD in the ED, and 80.5% were confident they would provide safe care. Most participants felt confident that APPs would appropriately order medical imaging tests (73%) or prescribe medication (66%) when necessary. Sixty-six percent of participants agreed that seeing only a physiotherapist without the intervention of a physician would reduce their length of ED stay.

Conclusions:

Within this exploratory survey, participants were favorable to ED APP for the care of MSKD, suggesting that implementation of such models would be accepted by patients with MSKD presenting to an ED.
Reviewing the Existing Observational Tools for Assessment of Circulating Nurses' Nontechnical Skills
Authors: Kalantari Reza , Zamanian Zahra , Jamali Jamshid , Faghihi Aliakbar , Hasanshahi Mehdi , Gheysari Somayeh
Published: July 2021

Circulating nurses are important members of surgical teams. They need to use nontechnical skills to work safely. This study aims to review the existing observational tools for the assessment of circulating nurses' nontechnical skills. Electronic resources, including Web of Sciences, PubMed, Scopus, ProQuest, CINAHL, Embase, and Google Scholar, were searched, including studies using tools for observational assessment of nontechnical skills in surgery published up to September 2019. The search process relied on the following keywords: circulating/scout/operating room nurse, observational, assessment tools, operating room nontechnical skills, task management, teamwork, communication, situational awareness, leadership, and decision making. The data were pooled from 30 eligible studies using tools for assessment of nontechnical skills in surgeries. Eight tools were found to assess nontechnical skills for the whole surgical team or individuals, including circulating nurses. Although general behaviors for all surgical team members within the tools have been recognized, there is no specific observational tool for the assessment of circulating nurses' nontechnical skills.
Are You Prepared for the Decade of Healthy Aging 2020-2030?
Authors: Chao Shirley , Corish Clare A. , Keller Heather , Rasmussen Helen , Arensberg Mary Beth , Dwyer Johanna T.
Published: July 2021

The World Health Organization's Decade of Healthy Aging began in 2020. This article focuses on nutrition's role in healthy aging with examples of older adult nutrition programs in Canada, the European Union, and the United States, including work of the Canadian Malnutrition Task Force, the European Malnutrition in the Elderly Knowledge Hub, and the Commonwealth of Massachusetts Executive Office of Elder Affairs. These programs have integrated screening for frailty and malnutrition into older adult care across the spectrum of settings, which has become increasingly important during the global COVID-19 pandemic. This article demonstrates the important role of nutrition in promoting healthy aging.
Analysis of Clinical Characteristics and Prognosis of Patients With Periocular Malignant Melanoma in Korea
Authors: Park Na Ri , Kim Sung Eun , Jung Su-Kyung , Yang Suk Woo
Published: July 2021

Objective:

To report the clinical features of 20 patients with malignant melanoma and to evaluate the survival and prognosis of patients with malignant melanoma in Korea

Methods and Analysis:

The medical records of 20 patients with malignant melanoma treated between March 2004 and March 2020 were reviewed retrospectively. The demographic data, clinical characteristics, and outcomes were also reviewed. Outcome measures included local recurrence, metastasis, and tumor-related mortality. Prognostic factors associated with recurrence, metastasis, and survival were analyzed using a Cox proportional hazards model.

Results:

Among the 20 patients with periocular malignant melanoma, 4 (20%) showed local recurrence during follow-up (6.61 ± 6.36 years). The 1-, 5-, and 10-year recurrence rates were 5%, 10.3%, and 24.1%, respectively. 10 (50%) patients developed distant metastasis, mainly involving lung, brain, parotid gland and spine. The 1-, 5-, and 10-year rates of metastasis were 5%, 10.9%, and 35.7%, respectively. Significantly fewer metastases were detected following initial extensive surgical excision (P = 0.04). 8 (40%) patients died of malignant melanoma. The main risk factor for mortality was tumor thickness (HR: 3.88, P < 0.01). Based on Kaplan-Meier survival estimates, the 1-, 5-, and 10-year tumor-related survival rates were 75.8%, 55.6%, and 55.6%, respectively.

Conclusion:

Tumor thickness is a significant prognostic factor affecting the survival rate. It is important to reduce the metastatic rate via extensive resection without leaving any residual tumor in the margin during surgery.
Aesthetic Nasal Lobule Correction Using a Three-Dimensional Printed Polycaprolactone Implant
Authors: Wee Syeo Young , Kim Tae Hyung , Kang Hee Yong , Park Eun Soo
Published: July 2021

Nasal tip plasty is a surgery that determines important rhinoplasty outcomes. A variety of autologous and alloplastic implants are utilized in this procedure, including 1 synthetic material known as polycaprolactone (PCL). This study provides background on the ready-made three-dimensional printed PCL implant for nasal lobule correction, before discussing the usefulness and effectiveness of the implant. A total of 23 patients who visited our hospital between January 2018 and January 2020 were evaluated in this study. We used 3 types of PCL implant to get an ideal shape for the nasal tip: tipball (globular shape), droneball (rugby ball shape), and dumbbell (dumbbell shape). The authors compared nasolabial angle and tip projection at the preoperative and postoperative period via photographic anthropometric analysis. In 4 patients, we also examined the dead space between the implant and soft tissue via ultrasonography. The follow-up period averaged 9.5 months and no serious complications were found after surgery. The nasolabial angle and tip projection had an average postoperative increase of 6.4° and 0.044, respectively. Ultrasonography revealed the attachment of the implant at the insertion site and no dead space was found. This is the first attempt to apply a ready-made three-dimensional printed PCL implant to a nasal lobule correction procedure. As the implant was easy to use and showed good results, it may be useful for aesthetic purposes in future nasal tip plasty procedures.
Characterization of Infraorbital Nerve Sequelae After Orbital Floor or Zygomaticomaxillary Complex Fractures
Authors: Devoti Jean-François , Nicot Romain , Roland-Billecart Thomas , Ferri Joël , Schlund Matthias
Published: July 2021

Introduction:

Neurological sequelae of infraorbital nerve (ION) lesion 6 months after orbital floor or zygomaticomaxillary complex (ZMC) fractures, associated with initial ION injury, were compared according to the treatment performed and the type of fracture. The topographic and symptomatic sequelae at 6 months were described.

Materials and Methods:

Patients with orbital floor or ZMC fracture associated with initial ION injury, between November 2018 and April 2020 and clinically reassessed 6 months after trauma were included. Detailed neurological symptomatology was assessed by a questionnaire.

Results:

A total of 81 patients were included. Forty-two patients (51.8%) showed persistent neurological signs, i.e., isolated hypoesthesia in 28 patients (66.7%), isolated pain in 10 patients (23.8%) and both in 5 patients (9.5%). The most affected area was the cheek (42.8%). Thirty-eight patients (46.9%) presented associated signs, which were intermittent in 78.9% of cases. A pronounced improvement happened for 65.1% of patients and 76.7% were not or only slightly hindered in their daily activities. There were significantly more neurologic symptoms at 6 months in the surgical group than in the observational group and more in the ZMC fracture group than in the orbital floor fracture group.

Discussion:

Neurological symptomatology was more frequent in patients treated surgically. Our results suggest the interest of a surgical decompression when orbital or ZMC fracture is associated with nerve damage but more data are needed. Neurological injury requires a careful initial clinical evaluation and regular follow-up to help patients coping, painful symptoms may benefit from specialized care.
Effect of Implant Surface Modification on Bone Mineral Density and Survival Rate in the Maxilla After a Short Period Using Cone Beam Computed Tomography
Authors: Hassan Thair Abdel Lateef , Mohammed Heba Basim
Published: July 2021

This study was aimed to objectively measure the changes in bone density amount obtained through cone-beam computed tomography around dental implants after a short period of time in the maxilla. Thirty-two SLActive Straumann implants were inserted into 12 healthy patients. Changes in bone density were measured at the surgery time (Bone mineral density (BMD)0) and 60 days after investment (Bone mineral density (BMD)60). Statistically, significant differences were observed between traumatic and sinus zones at the time of surgery and after 60 days respectively (P ≤ 0.05). For each group, a significant decrease in density was observed with the following variables (male, age of 18–40 years, sinus zone, and implant diameter of 4.1 mm). The survival rate was 83.8% after 60 days. Implant surface modification has no significant effect on bone mineral density after a short period of time in the sinus zone. Early loading of the prosthesis can be performed in the traumatic zone only.
The Comparison of Piriform Aperture, Paranasal Sinuses, and Cranial Dimensions
Authors: Topal Esin , Ormeci Tugrul , Atasever Alper
Published: July 2021

Objective:

Piriform aperture, paranasal sinuses, and the cranium dimensions were compared with each other and we investigated the alterations depending on the age and gender in these structures. Before the endoscopic sinus surgery, anatomic variations in sinusoidal region and the occurring differences should be considered. The detection of these variations plays important roles in the prevention of complications which may happen in surgery or in obtaining a successful surgical result.

Materials and Methods:

Piriform aperture maximum width, frontal sinuses, sphenoidal sinuses, maxillary sinuses, and cranium widths and height length was measured from the regions that we were determined. Three hundred ninety three cases’ computed tomography images were compared. The individuals without any head trauma, pathology, and surgical history in sinusoidal region were analyzed retrospectively. The detected measurements were studied among the paranasal sinuses, piriform aperture, and calvaria dimensions.

Results:

It was observed that the dimensions of paranasal sinuses were decreased and the dimension of piriform aperture was increased depending on age. In all individuals, a relationship in positive direction in a manner that piriform aperture width increases as the size of the cranium width increases. Morphologic alterations take place in the dimensions of paranasal sinuses as a result of bone deformations occurring in the bone structure depending age and gender in adult individuals.
Myogenic tremor – a novel tremor entity
Authors: Schaefer Jochen , Saak Annika , Bönnemann Carsten G. , Jackson Sandra
Published: July 2021

Purpose of review

Tremor is a common neurological symptom with a plethora of potential etiologies. Apart from physiological tremor, the vast majority of tremor syndromes are linked to a pacemaker in the central nervous system (CNS) or, less common, in the peripheral nervous system. Myogenic tremor is a novel tremor entity, first reported in 2019 and believed to originate in the muscle itself. In this review, we describe the clinical properties of myogenic tremor and discuss its presumed pathogenesis on the basis of all of the patient cases published so far.

Recent findings

Myogenic tremor manifests itself as a high frequency, postural, and kinetic tremor with onset in infancy. To date, only myopathies affecting the contractile elements, in particular myosin and a myosin-associated protein, have been recognized to feature myogenic tremor. The generator of the tremor is believed to be located in the sarcomere, with propagation and amplification of sarcomeric oscillatory activity through CNS reflex loops, similar to neuropathic tremor.

True myogenic tremor must be distinguished from centrally mediated tremor due to myopathies with central nervous system involvement, i.e., mitochondrial myopathies or myotonic dystrophies. The presence of myogenic tremor strongly points toward a sarcomere-associated mutation and may thus be a valuable clinical tool for the differential diagnosis of myopathies.
Nasopharyngeal carriage rates and serotype distribution of Streptococcus pneumoniae among school children with acute otitis media in Central Java, Indonesia
Authors: Wahyono Daniel Joko , Khoeri Mifathuddin Majid , Darmawan Anton Budhi , Wijayanti Siwi Pramatama Mars , Mumpuni Aris , Nawangtantri Gita , Kusdaryanto Wahyu Dwi , Salsabila Korrie , Safari Dodi
Published: July 2021

Streptococcus pneumoniae

is a common bacterial pathogen that causes acute otitis media (AOM) in children. In this study, we investigated nasopharyngeal carriage rates and serotype distributions of

S. pneumoniae

among school children with AOM in Banyumas Regency, Central Java, Indonesia, from 2018 to 2019. Nasopharyngeal swab specimens and demographic data were collected from 122 children between the ages of 6 and 12. The specimens were cultured for the identification of

S. pneumoniae

, and serotyping was performed using a sequential multiplex PCR assay. We found that the

S. pneumoniae

carriage rate was 73 % (89/122) among children with AOM. Serotypes 23A (11 %) and 6A/6B (10 %) were the most common serotypes among the 91 cultured

S. pneumoniae

strains, followed by 3 (8 %), 14 (7 %), 6C/6D (7 %), 11A/11D (6 %), 15B/15C (4 %) and 35 B (4 %). Moreover, 41 % of the strains could be covered by the 13-valent pneumococcal conjugate vaccine, PCV13. In conclusion, high nasopharyngeal carriage rates of

S. pneumoniae

were found in school children with AOM, with almost half of the strains being the vaccine-type. This finding provides a baseline for nasopharyngeal carriage of

S. pneumoniae

in school children with AOM and supports the implementation of pneumococcal conjugate vaccines in Indonesia.
Chachezhania sediminis sp. nov., isolated from marine sediment
Authors: Baek Jihye , Kim Jong-Hwa , Yoon Jung-Hoon , Lee Jung-Sook , Sukhoom Ampaitip , Kim Wonyong
Published: July 2021

A Gram-stain-negative, aerobic, non-motile, rod-shaped bacterial strain (CAU 1508T) was isolated from marine sediment collected in the Republic of Korea. Growth was observed at 10–45 °C (optimum, 30 °C), pH 4.0–11.0 (optimum, pH 6.0–8.0) and with 0–8.0 % (w/v) NaCl (optimum, 2–4 %). The isolate formed a monophyletic clade in the phylogenetic analyses using 16S rRNA gene and whole-genome sequences, exhibiting the highest similarity to

Chachezhania antarctica

SM1703T (96.5 %), and representing a distinct branch within the genus

Chachezhania

(family

Rhodobacteraceae

). Its whole genome sequence was 5.59 Mb long, with a G+C content of 65.7 mol% and 2183 predicted genes belonging to six functional categories. The average nucleotide identity and digital DNA–DNA hybridization values between CAU 1508T and

C. antarctica

SM1703T were 79.1 and 22.2 %, respectively. The predominant cellular fatty acids were C19 : 0 cyclo ω8c and summed feature 8 (C18 : 1
 ω7c/C18 : 1
 ω6c). The major polar lipids were diphosphatidylglycerol, phosphatidylglycerol, phosphatidylcholine, phosphatidylethanolamine, two unidentified phospholipids and one unidentified aminophospholipid. The sole isoprenoid quinone was ubiquinone 10. Phenotypic phylogenetic properties supported the classification of CAU 1508T as representing a novel species of the genus

Chachezhania

, with the proposed name Chachezhania sediminis sp. nov. The type strain is CAU 1508T (=KCTC 62999T=NBRC 113697T).
Gulosibacter sediminis sp. nov., isolated from Indian Ocean marine sediment
Authors: Jiang Zhao , Zhang Wei-Hua , Song Dan , Xiao Min , Phurbu Dorji , Liu Bing-Bing , Guo Shu-Xian , Chen Wei , Li Wen-Jun
Published: July 2021

A novel Gram-stain-positive, catalase-positive, oxidase-negative, aerobic, non-motile, rod-shaped bacterium, designated strain YIM M12148T, was isolated from a marine sediment sample collected from the Indian Ocean. The strain grew optimally at 28 °C, pH 8.0 and in the presence of 1–3 % (w/v) NaCl. Phylogenetic analysis based on 16S rRNA gene sequences showed that strain YIM M12148T belongs to the genus

Gulosibacter

, with the highest sequence similarity to

Gulosibacter faecalis

NBRC 15706T (96.12 %). The cell-wall sugars of strain YIM M12148T were rhamnose, ribose, glucose and mannose. The predominant isoprenoid quinones were MK-8 and MK-9. The polar lipids consisted of major amounts of diphosphatidylglycerol, phosphatidylglycerol, phosphatidylethanolamine, one unknown phospholipid and one unknown lipid. Major fatty acids (>5 % of the total) of the novel isolate were anteiso-C15 : 0, iso-C15 : 0, iso-C13 : 0 and anteiso-C13 : 0. The genomic DNA G+C content of strain YIM M12148T was 67.15 mol%. On the basis of genotypic and phenotypic data, it is apparent that strain YIM M12148T represents a novel species of the genus

Gulosibacter

, for which the name Gulosibacter sediminis sp. nov. is proposed. The type strain is YIM M12148T (=KCTC 29660T=DSM 29154T).
An Evaluation of Liver Function Tests in SARS-CoV-2 infection in the backdrop of chronic kidney disease
Authors: Kumar Rajeev , Jana Pratip , Priyadarshini Indu , Roy Smita , Datta Pritha , Das Saswati
Published: July 2021

INTRODUCTION

The SARS-CoV-2 pandemic has emerged as perhaps the most challenging global health problem of this century. The concomitant presence of co-morbidities like chronic kidney disease (CKD), diabetes, chronic heart disease etc. makes the task of patient management difficult.

AIMS AND OBJECTIVES

To assess the patterns of liver test abnormalities in patients of COVID-19 infection with and without CKD and evaluate the probable outcomes.

MATERIALs and METHODS

A cross-sectional retrospective observational study done on 600 patient samples (Group 1 COVID-19 without CKD, Group 2 COVID-19 with CKD and Group 3 non COVID-19 with CKD) which were processed for Liver function test (AST, ALT and ALP) and Renal function test (Urea and Creatinine) in the Department of Biochemistry, Dr. RML Hospital New Delhi.

RESULTS

AST and ALT levels were significantly higher (P < 0.05) in all COVID-19 positive patients - group 1 mean ± 2 SD, (63.63 ± 42.89 U/L & 50.25 ± 46.53 U/L respectively) and group 2 (90.59 ± 62.51 U/L & 72.09 ± 67.24 U/L respectively) as compared to Group 3 (25.24 ± 7.47 U/L & 24.93 ± 11.44 U/L respectively) and also a statistically significant elevation is seen in these two parameters (AST & ALT) in Group 2 as compared to Group 1 (P< 0.05). There was a negative significant correlation between eGFR and AST/ALT levels in Group 1 (p < 0.05). In Group 2, a weak positive correlation was seen with ALT (p < 0.01).

No significant correlation existed between eGFR and ALP in groups 1 and 2. In Group 3, eGFR’s showed strong correlations with AST and ALT levels (p < 0.01) and reduction in kidney function correlated well with increase in serum ALP levels, (p < 0.01).

CONCLUSIONS

This study most comprehensively describes that SARS-CoV-2 positive CKD patients show more elevations in serum aminotransferase levels as compared to their non-CKD counterparts, in contrast to non-COVID-19 CKD cases. Serum ALT values in SARS-CoV-2 patients show significant correlation with calculated eGFR values. Elevated ALP values in CKD patients may be used as an indicator of declining kidney function. However, more studies in this direction are needed.
Virlaza™ Inhibits Sars-COV-2-induced Inflammatory Response of Bronchial Epithelial Cells and Pulmonary Fibroblast
Authors: Brandao-Rangel Maysa Alves Rodrigues , Melamed Dobroslav , Silva-Reis Anamei , Brill Boris , Santos Zamarioli Lucas dos , Oliveira Carlos Rocha , Vieira Rodolfo P
Published: July 2021

Coronavirus disease 2019 (COVID-19), which is currently a global public health emergency and beyond vaccines as a prophylactic treatment, no specific and effective therapeutical treatments are available. COVID-19 induces a massive release of proinflammatory cytokines, which drives COVID-19 progression, severity, and mortality. In addition, bronchial epithelial cells are the first pulmonary cells activated by coronavirus-2 (SARS-Cov-2) leading to massive cytokine release, which can hyperactivate lung fibroblasts, resulting in pulmonary fibrosis, a phenomenon observed even in moderate COVID-19 survivors. This in vitro study tested the hypothesis that Virlaza™, a herbal medicine, could inhibit the hyperactivation of human bronchial epithelial cells (BEAS-2B) and pulmonary fibroblasts (MRC-5) induced by SARS-Cov-2. BEAS-2B (5×104/mL/well) and MRC-5 (5×104/mL/well) cells were co-cultivated with 1ml of blood of a Sars-Cov-2 infected patient for 4 hours and Virlaza™ (1ug/mL) was added in the first minute of the co-culture. After 4 hours, the cells were recovered and used for analysis of cytotoxicity by MTT and for mRNA expression of P2X7 receptor E iNOS. The supernatant was used to measure ATP and cytokines. Sars-Cov-2 incubation resulted in increased release of ATP, IL-1beta, IL-6, IL-8, and TNF-alpha by BEAS-2B and MRC-5 cells (p<0.001). Treatment with Virlaza™ resulted in reduction of ATP, IL-1beta, IL-6, IL-8, and TNF-alpha release (p<0.001). In addition, Sars-Cov-2 incubation resulted in increased expression of P2X7 receptor and iNOS (p<0.001), which has been reversed by Virlaza™ (p<0.001). In conclusion, Virlaza™ presents important anti-inflammatory effects in the context of Sars-Cov-2 infection.
Salivary molecular testing for SARS-CoV-2: simplifying the diagnosis without losing accuracy
Authors: Saluzzo Francesca , Mantegani Paola , de Chaurand Valeria Poletti , Cugnata Federica , Rovere-Querini Patrizia , Cilla Marta , Erba Patrizia , Racca Sara , Tresoldi Cristina , Uberti-Foppa Caterina , Di Serio Clelia , Cirillo Daniela Maria
Published: July 2021

Background

Quantitative RT-PCR on NasoPharyngeal Swab (NPS) is still considered the standard for the diagnosis of SARS-CoV-2 infection, even if saliva has been evaluated in several studies as a possible alternative. The use of point of care (POC) platforms, providing highly specific results performed on saliva could simplify the diagnosis of COVID-19 and contribute to contain the spreading of SARS-CoV-2.

Methods

We assess the sensitivity and specificity of molecular testing performed on saliva in comparison to NPS using two different POC platforms (DiaSorin Simplexa™ and Cepheid Xpert®). NPS and saliva were collected prospectically from asymptomatic health care workers and mildly symptomatic patients. Moreover, the stability of saliva samples after storage at -80°C for up to 45 days was tested.

Results

The obtained results in comparison to NPS demonstrated for both DiaSorin Simplexa™ and Xpert® Xpress a specificity of 100% and a sensitivity of 90.24%. The overall agreement between the tests performed on saliva was 98%. A positive correlation in Ct values detected on saliva and on NPS was identified for all the targets shared by the tests in analysis (Orf1ab, E and N2). Both S Ct values and Orf1ab Ct values were not significantly different before and after the freezing in the tested saliva samples.

Conclusion

The obtained results demonstrated an overall performance of saliva comparable to NPS, confirming that RT-PCR performed using POCs on saliva could represent a valid public health solution for controlling SARS-CoV-2 pandemic.
Real-Time SARS-CoV-2 Genotyping by High-Throughput Multiplex PCR Reveals the Epidemiology of the Variants of Concern in Qatar
Authors: Hasan Mohammad R. , Kalikiri Mahesh K. R. , Mirza Faheem , Sundararaju Sathyavathi , Sharma Anju , Lorenz Stephan , Chemaitelly Hiam , El-Kahlout Reham A. , Tsui Kin Ming , Yassine Hadi M. , Coyle Peter V. , Khal Abdullatif Al , Bertollini Roberto , Al Thani Mohamed H. , Abu-Raddad Laith J. , Tang Patrick ,   National Study Group for COVID-19 Epidemiology in Qatar
Published: July 2021

Complementing whole genome sequencing strategies with high-throughput multiplex RT-qPCR genotyping allows for more comprehensive and real-time tracking of SARS-CoV-2 variants of concern. During the second and third waves of COVID-19 in Qatar, PCR genotyping, combined with Sanger sequencing of un-typeable samples, was employed to describe the epidemiology of the Alpha, Beta and Delta variants. A total of 9792 nasopharyngeal PCR-positive samples collected between April-June 2021 were successfully genotyped, revealing the importation and transmission dynamics of these three variants in Qatar.
Irremediable psychiatric suffering in the context of physician assisted death: a Delphi-study
Authors: van Veen Sisco M.P. , Evans Natalie , Ruissen Andrea M. , Vandenberghe Joris , Beekman Aartjan T.F. , Widdershoven Guy A.M.
Published: July 2021

Background

Patients with a psychiatric disorder (PPD) are eligible to request physician assisted death (PAD) in a small but growing number of jurisdictions, including the Netherlands and Belgium. For this request to be granted, most of these jurisdictions demand that the patient is competent in her request, and that the suffering experienced is unbearable and irremediable. Especially the criterion of irremediability is challenging to establish in patients with psychiatric disorders.

Aims

To establish what criteria Dutch and Belgian experts agree to be essential in characterising irremediable psychiatric suffering (IPS) in the context of PAD.

Method

A two round Delphi procedure among psychiatrists with relevant experience.

Results

Thirteen consensus-criteria were established: five diagnostic and eight treatment-related criteria. Diagnostically, the participants deem a narrative description and attention to contextual and systemic elements necessary. Also, a mandatory second opinion is required. The criteria concerning treatment show that extensive biopsychosocial treatment is needed, and the suffering must be present for several years. Finally, in the case of treatment refusal, the participants agree that there are limits to the number of diagnostic procedures or treatments a patient must undergo.

Conclusions

Consensus was found among a Dutch and Belgian expert group on essential criteria for establishing IPS in the context of PAD. These criteria can be used in clinical decision making and can inform future procedural demands and research.
Assessing COVID prevention strategies to permit the safe opening of college campuses in fall 2021
Authors: David Paltiel A. , Schwartz Jason L.
Published: July 2021

Background

Effective vaccines, improved testing technologies, and declines in COVID-19 incidence prompt an examination of the choices available to college administrators to safely resume in-person campus activities in fall 2021.

Objective

To develop a decision support tool that assists college administrators in designing and evaluating customized COVID vaccination, screening, and prevention plans.

Design

Decision analysis linked to a compartmental epidemic model, quantifying the interaction of policy instruments (e.g., vaccination promotion, asymptomatic testing, physical distancing, and other non-pharmaceutical interventions), institutional priorities (e.g., risk tolerance, desire to resume activities), and assumptions about vaccine performance and background epidemic severity.

Participants

Hypothetical cohort of 5000 individuals (students, faculty, and staff) living and working in the close environs of a residential college campus.

Main Outcome(s) and Measure(s)

Cumulative infections over a 120-day semester.

Results

Under Base Case assumptions, if 90% coverage with an 85%-effective vaccine can be attained, the model finds that campus activities can be fully resumed while holding cumulative cases below 5% of the population without the need for routine, asymptomatic testing. With 50% population coverage using such a vaccine, a similar “return to normalcy” would require daily asymptomatic testing of unvaccinated individuals. The effectiveness of vaccination in reducing susceptibility to infection is a critical uncertainty.

Conclusions & Relevance

Vaccination coverage is the most powerful tool available to college administrators to achieve a safe return to pre-pandemic operations this fall. Given the breadth of potential outcomes in the face of uncontrollable and uncertain factors, even colleges that achieve high vaccination coverage should be prepared to reinstitute testing and distancing policies on short notice.
Effectiveness of Covishield vaccine in preventing Covid-19 – A test-negative case-control study
Authors: Pramod Stuti , Govindan Dhanajayan , Ramasubramani Premkumar , Kar Sitanshu Sekhar , Aggarwal Rakesh ,   JIPMER vaccine effectiveness study group, Manoharan Nandhini , Chinnakali Palanivel , Thulasingam Mahalakshmy , Sarkar Sonali , Thabah Molly Mary
Published: July 2021

Introduction

This study was aimed at assessing the vaccine effectiveness (VE) of Covishield, which is identical to the AstraZeneca vaccine, in preventing laboratory-confirmed Covid-19.

Methods

Using a test-negative case-control design, information on vaccination status of cases with Covid-19 among healthcare workers in our institution in Puducherry, India, and an equal number of matched controls, i.e., positive and negative for SARS-CoV-2 by RT-PCR, was obtained. The cases and controls were matched for age (±3 years) and date of testing (±3 days). The groups were compared using multivariable conditional logistic regression to calculate odds ratios (OR), with adjustment for gender, occupational role, presence of symptoms and presence of a comorbidity condition. Per cent vaccine effectiveness (VE) was calculated as 100 x (1-adjusted odds ratio).

Results

Using data from 360 case-control pairs, VE of one dose and of two doses, in providing protection against Covid-19 was 49% (95% CI: 17%-68%) and 54% (27%-71%), respectively. In view of a difference in the proportion of cases and controls who had symptoms, a separate analysis of data from 203 pairs where both the case and the control had symptoms was done, which showed VE of 58% (28%-75%) and 64% (38%-78%) after one dose and two doses, respectively. Among cases with moderately severe disease that required oxygen therapy, VE following any number of vaccine doses was 95% (44%-100%).

Conclusion

Covishield vaccine protected significantly against Covid-19, with the protection after two doses being slightly higher than after one dose, and a particularly high protection rate against severe forms of disease.