bluuebunny/crossref_metadata_2025 huggingface dataset:
Association of trabecular bone score with disease parameters and vertebral fractures in axial spondyloarthritis
Authors: Daflaoui Meryem , Azzouzi Hamida , Boutaibi Houssam , Chennouf Fadoua , Ichchou Linda
Published: May 2024

Objectives

We aimed to study trabecular bone score (TBS) association with disease parameters and vertebral fractures (VFs) in patients with axial spondyloarthritis.

Methods

Patients diagnosed with axial spondyloarthritis were included in this cross-sectional study. Dual-energy X-ray absorptiometry was used to measure BMD in the lumbar spine and TBS. Low TBS was defined as ≤1.31. The association between TBS and disease parameters including Ankylosing Spondylitis Disease Activity Score (ASDAS), BASDAI, BASFI and BASMI was studied using logistic regressions.

Results

Our study included 56 patients, with a mean age of 38.9 ± 13.5 years and a mean disease duration of 12.7 ± 7.7 years. Patients with low TBS were significantly older and had higher waist circumference and body mass index. These patients also showed greater clinical activity, as evidenced by higher ASDAS-CRP, BASFI and BASMI scores (P < 0.05). In multivariate logistic regression, low TBS was associated with all disease parameters, except for BASMI: BASDAI (OR [95% CI] = 3.68 [1.48–9.19], P = 0.005), ASDAS-CRP (OR [95% CI] = 2.92 [1.20–7.10], P = 0.018), BASFI (OR [95% CI] = 1.04 [1.01–1.08], P = 0.018), BASMI (OR [95% CI] = 1.36 [0.99–1.87], P = 0.062). However, no association was observed between TBS and VFs.

Conclusion

TBS was associated with active spondyloarthritis, suggesting increased bone fragility in these patients. However, TBS failed to demonstrate an association with VFs.
Familial Mediterranean fever in patients with inflammatory bowel diseases: a nationwide study from the epi-IIRN
Authors: Kori Michal , Buchuk Rachel , Goldzweig Ofra , Weisband Yiska Loewenberg , Tal Noa , Ben-Tov Amir , Ledderman Natan , Matz Eran , Freiman Moti , Dotan Iris , Turner Dan , Shouval Dror S
Published: May 2024

Objective

Inflammatory bowel diseases (IBD) and familial Mediterranean fever (FMF) are auto-inflammatory diseases with common clinical and biological features. We aimed to determine their association and characterize the natural history in patients with both diagnoses.

Methods

Utilizing data from the epi-IIRN cohort, which includes 98% of Israel's population, we calculated the adjusted prevalence of FMF among IBD patients vs non-IBD controls. Case ascertainment of IBD was determined according to validated algorithms and for FMF by ICD-9 codes and colchicine purchase.

Results

In total, 34 375 IBD patients (56% Crohn's disease [CD] and 44% ulcerative colitis [UC]) were compared with 93 602 matched controls. Among IBD patients, 157 (0.5%) had FMF compared with 160 (0.2%) of non-IBD controls (OR = 2.68 [95%CI 2.2–3.3]; P < 0.001). Pediatric-onset IBD had a higher prevalence of FMF compared with adult-onset IBD (30/5243 [0.6%] vs 127/29 132 [0.4%]), without statistical significance (OR = 1.31 [0.88–1.96]; P = 0.2). FMF was more prevalent in CD (114/19 264 [0.6%]) than UC (43/15 111 [0.3%]; OR = 2.1 [1.5–3.0], P < 0.001). FMF diagnosis preceded that of IBD in 130/157 cases (83%). FMF was associated with a more severe disease activity in UC patients at diagnosis, but not in CD patients. Outcomes were comparable between patients with CD+FMF vs CD alone; however, in patients with UC+FMF, time to biologic treatment was shorter.

Conclusion

FMF is more prevalent in IBD patients than in the general population, particularly in CD. The diagnosis of FMF precedes the diagnosis of IBD in most cases, and may be associated with a more severe course in UC.
Comparison of rituximab efficacy in treatment-naïve and refractory inflammatory myopathies: experiences from a tertiary care centre
Authors: Manwatkar Abhilasha , Naresh Kancha , Mathew John , Nair Aditya V , Goel Ruchika , Yadav Bijesh , Prakash John Antony Jude , Das John Kumar , Sivadasan Ajith
Published: May 2024

Objectives

To determine whether rituximab (RTX) is effective in ‘treatment-naïve’ idiopathic inflammatory myopathies (IIM), and whether there could be differential treatment responses between ‘treatment-naïve’ and treatment ‘refractory’ IIM.

Methods

Data were obtained from a prospectively maintained database comprising patients with IIM treated with RTX. Patient details were obtained at baseline, 3- and 6-months intervals, and at subsequent follow-up visits. Treatment response was categorized as improved, worsening or stable based on Manual Muscle Testing 8 (MMT8) scores, patient global and physician global improvement for skin and joint symptoms improvement, and spirometry at 6 months. The time to clinical improvement and remission were noted and survival analysis curves were constructed.

Results

Sixty patients with IIM (including 18 with anti-signal recognition particle myopathy) were included, of whom 33 who received RTX were treatment naïve. The remaining 27 were started on RTX for refractory myopathy. The mean age was 39 years (s.d. 12.58) in the ‘treatment-naïve’ group and 43 years (s.d. 12.12) in the ‘refractory’ group. At 6 months of follow-up, 48/55 (87%) patients showed response, 31/31 (100%) in ‘treatment-naïve’ and 17/24 (70%) in ‘refractory’ cases, P = 0.006*. In the refractory group, seven (29%) had stable disease. The mean changes in MMT8 were significantly more in the ‘treatment-naïve’ group [13.41 (s.d. 7.31)] compared with ‘refractory’ IIM [8.33 (s.d. 7.92)] (P = 0.017*). The majority of patients were able to reduce the dose to <5 mg/day before 6 months. No major adverse events were reported over the median follow-up of 24 (interquartile range 36) months.

Conclusions

RTX is effective and safe across the spectrum of IIM. Early use in disease is associated with better outcomes.
ROUX-en-Y gastric bypass surgery improves metabolic syndrome–related erectile dysfunction in mice via the IRS-1/PI3K/AKT/eNOS pathway
Authors: Hu Zhenxing , Chen Keming , Dai Haitao , Lv Zhiyong , Li Jian , Yu Puguang , Feng Jiajing , Abdulkarem Alqaisi Mohammed , Wu Haifeng , He Rui , Li Guangyong
Published: May 2024

Objective

Although many clinical studies have shown that ROUX-en-Y gastric bypass (RYGB) surgery significantly improves metabolic syndrome–related erectile dysfunction (MED), the role and mechanism are unclear.

Aim

In this study we used a mouse model to explore how RYGB improves MED induced by a high-fat diet (HFD).

Methods

We established a mouse model of metabolic syndrome by feeding an HFD for 16 weeks. The mice were randomly assigned to the standard chow diet (SCD), HFD, or RYGB groups. Body weight, fasting blood glucose, plasma insulin, and total plasma cholesterol were analyzed. Erectile responses were evaluated by determining the mean systolic blood pressure and the intracavernosal pressure (ICP). Penile histologic examination (Masson’s trichrome and immunohistochemical stain) and Western blot were performed.

Result

Compared with the SCD group, the ICP in the sham group was significantly lower, and the ICP of the RYGB was significantly increased. Masson’s trichrome and immunohistochemical staining showed that the content of endothelium and smooth muscle in the corpus cavernosum of mice with MED was significantly reduced. Western blot analysis showed a significant decrease in α-smooth muscle actin and a significant increase in osteopontin in penile tissue in the sham group, which was improved by RYGB surgery. Furthermore, RYGB significantly increased IRS-1/PI3K/Akt/eNOS phosphorylation.

Clinical Translation

In this study we explored the mechanism of bariatric surgery to improve erectile dysfunction associated with metabolic syndrome and provided a theoretical basis for clinical research.

Strengths and Limitations

First, we did not investigate the mechanism by which RYGB affects the IRS-1/PI3K/Akt/eNOS signaling pathway. Second, the effect of the IRS-1/PI3K/Akt/eNOS signaling pathway on the function of corpus cavernosum endothelial cells and smooth muscle cells remains to be investigated in cellular studies.

Conclusion

This study demonstrated that RYGB may not only improve metabolic parameters but also restore erectile function in MED patients. The mechanism of the therapeutic effect of RYGB may be reactivation of the IRS-1/PI3K/Akt/eNOS pathway.
Analysis of evidence on nutraceutical interventions for Peyronie’s disease: a guideline-based critical review
Authors: Tienforti Daniele , Hoxha Malvina , Di Pasquale Alfonso Boris , Rizza Vinicio , Barbonetti Arcangelo
Published: May 2024

Introduction

The management of Peyronie's disease (PD) is a challenge for the clinician. Despite the lack of etiologic therapy, different nonsurgical approaches have often been empirically proposed. The most used treatment is based on nutraceutical drugs with antioxidant activity, although such an intervention remains controversial.

Objectives

We reviewed the evidence from the randomized controlled trials included in the recommendations of the American Urological Association (AUA), Canadian Urological Association (CUA), European Association of Urology, and International Society for Sexual Medicine.

Methods

We searched PubMed, Scopus, Web of Science, and Cochrane Library for randomized controlled trials, reviews, and guidelines on nutraceutical interventions for PD.

Results

Our analysis provides detailed information on potential interventions, underlying the inconsistent evidence. Acetyl esters of carnitine, although not recommended by any of the available guidelines, showed potential benefit in some selected studies. Omega-3 fatty acids are not recommended due to withdrawn study evidence. The CUA and AUA were the only societies to consider the use of coenzyme Q10. While the CUA suggested that it might be offered as a treatment option, the AUA refrained from taking a definitive stance due to insufficient evidence. Similarly, conflicting recommendations have been produced on potassium para-aminobenzoate. While the CUA considers potassium para-aminobenzoate potentially useful in slowing PD progression, the AUA deems the evidence insufficient. Conversely, both the International Society for Sexual Medicine and European Association of Urology do not recommend its use.

Conclusion

This critical comparative analysis of the most recent guidelines produced by the leading scientific societies highlights some inconsistencies in the recommendations on nutraceutical intervention for PD, even within a background of overall ineffectiveness of this treatment approach.
(Joint) Bank Savings, Female Empowerment, and Child Labor in Rural Ethiopia
Authors: Galdo Jose
Published: May 2024

This study examines whether the random allocation of single and joint savings accounts to cash crop farmers in rural Ethiopia is associated with increased savings and changes in decision-making authority and control over resources that could ultimately affect child labor and schooling resource allocations. Consistent with posited channels of intrahousehold bargaining models, women from households assigned to the joint saving treatment group show significant gains in autonomy and control of savings resources, broader financial empowerment, and increased labor participation. Positive effects on school participation and attendance are reported for girls, although point estimates are measured imprecisely. In a setting where schooling and child labor are not mutually exclusive, children work more when joint deposit accounts are available. In the absence of impacts on household income, this increase in child labor is explained by complementarities between adult farm labor and child labor in the household production function, which is reinforced by lumpy investments in labor-intensive agricultural inputs that likely increased the opportunity costs of children's time.
The Likelihood That Remedial Continuing Medical Education (CME) Reduces Disciplinary Recidivism Among Physicians
Authors: Arnhart Katie , Wenghofer Elizabeth , Pei Xiaomei , Young Aaron
Published: May 2024

Purpose

State medical boards are charged through their medical practice acts to regulate physician practice and, when necessary, discipline physicians for incompetent or inappropriate behavior. Boards often authorize remedial continuing medical education (CME) as part of a disciplinary action; however, it is unclear how effective remedial CME is in reducing the likelihood of physicians receiving additional discipline. This study examined the relationship between physicians who were required to complete remedial CME as part of their first discipline by state medical boards and the likelihood of additional discipline.

Method

The national-level sample included 4,061 MD-physicians whose first discipline included license restrictions, probation, or other conditions imposed by state medical boards between 2011 and 2015. A multivariate logistic regression model examined whether physicians required to complete remedial CME as part of their first discipline were less likely to receive additional discipline by boards within 5 years.

Results

Of the 4,061 physicians, 36% (n = 1,449) were required to complete remedial CME as part of their first discipline, and 35% (n = 1,426) received additional discipline within 5 years. After accounting for other factors, physicians who were required to complete remedial CME as part of their first discipline by boards were less likely to receive additional discipline (odds ratio, 0.597; 95% confidence interval, 0.513–0.696; P < .001) within 5 years compared to physicians who were not required to complete remedial CME.

Conclusions

Findings support remedial CME as a means to help reduce physician disciplinary recidivism in certain circumstances. Physicians required to complete remedial CME as part of their first discipline were less likely to receive additional discipline by state medical boards within 5 years.
A High Immediate Postoperative Systemic Immune-inflammation Index Is Associated With Postoperative Symptomatic Cerebral Infarction in Moyamoya Patients Undergoing Combined Revascularization Surgery
Authors: Kim Na young , Shin Kyung Won , Jo Woo-young , Oh Hyongmin , Lee Sung Ho , Cho Won-Sang , Kim Jeong Eun , Park Hee-Pyoung
Published: May 2024

Background:

Inflammation plays a role in the pathogenesis of cerebral infarction. Postoperative symptomatic cerebral infarction (SCI) is a complication after revascularization surgery in patients with moyamoya disease (MMD). We investigated the association between the systemic-immune-inflammation index (SII) and postoperative SCI during hospital stay in such patients.

Methods:

Perioperative data were retrospectively obtained from 681 MMD patients who underwent revascularization surgery. SII cutoff values were identified as those where the sum of sensitivity and specificity associated with SCI were highest. Patients were divided into 4 subgroups according to the preoperative and immediate postoperative cutoff SII: HH (preoperative and postoperative SII high, n=22), LH (low preoperative and high postoperative SII, n=68), HL (high preoperative and low postoperative SII, n=125), and LL (preoperative and postoperative SII low, n=466).

Results:

Postoperative SCI occurred in 54 (7.6%) patients. The cutoff values for preoperative and immediate postoperative SII were 641.3 and 1925.4, respectively. Postoperative SCI during hospital stay was more frequent in the high postoperative SII group than in the low postoperative SII group (25.6% vs. 4.9%; P<0.001). Multivariate analysis revealed that a high immediate postoperative SII was a predictor of postoperative SCI (odds ratio, 11.61; 95% CI: 5.20-26.00; P<0.001). Postoperative SCI was lower in group LL than in group LH (3.6% vs. 23.5%, P<0.008) and was lower in group HL than in groups HH and LH (9.6% vs. 31.8% and 23.5%, both P<0.05).

Conclusions:

A high immediate postoperative SII was associated with postoperative SCI during hospital stay in MMD patients who underwent revascularization surgery.
Clinical Outcome of Lumbar Hybrid Surgery in a Consecutive Series of Patients With Long-term Follow-up
Authors: Shellock Jessica L. , Zigler Jack E. , Blumenthal Scott L. , Guyer Richard D. , Ohnmeiss Donna D.
Published: May 2024

Study Design.

This was a retrospective study combined with attempted prospective patient contact to collect current data.

Objective.

The purpose of this study was to investigate the long-term clinical outcomes of patients undergoing lumbar hybrid surgery (total disk replacement (TDR) at one level and fusion at an adjacent level.

Summary of Background Data.

Many patients with symptomatic lumbar disk degeneration are affected at more than one level. Lumbar TDR was introduced as a fusion alternative; however, some disk levels are not amenable to TDR, and fusion is preferable at such levels. Hybrid surgery was introduced as an option to fusing multiple levels.

Methods.

A consecutive series of 305 patients undergoing lumbar hybrid surgery was identified, beginning with the first case experience in 2005. Operative and clinical outcome data, including visual analog scales (VAS) assessing back and leg pain, Oswestry Disability Index (ODI), and reoperations, were collected. The mean follow-up duration was 67.1 months.

Results.

There were statistically significant improvements (P<0.01) in the mean values of all three clinical outcome measures: VAS back pain scores improved from 6.7 to 3.3; leg pain improved from 4.3 to 2.0; and ODI scores improved from 45.5 to 24.6. There were no significant differences in pain and function scores for patients with a minimum 10-year follow-up versus those with a shorter follow-up duration. Re-operation occurred in 16.1% of patients, many of which involved removal of posterior instrumentation at the fusion level (6.2% of the study group, 38.8% of re-operations). Reoperation involving the TDR level occurred in 9 patients (2.9%), only 3 of which (1.0%) involved TDR removal/revision.

Conclusion.

This study supports that for many patients with multilevel symptomatic disk degeneration, hybrid surgery is a viable surgical option. Significant improvements were demonstrated in pain and function scores, with no diminished improvement in scores among patients with more than 10-year follow-up.

Level of Evidence.

Level IV
Does Paraspinal Muscle Mass Predict Lumbar Lordosis Before and After Decompression for Degenerative Spinal Stenosis?
Authors: Narayanan Rajkishen , Ezeonu Teeto , Kellish Alec , Somers Sydney , Lee Yunsoo , Khanna Akshay , Labarbiera Anthony , Fras Sebastian , Canseco Jose A. , Kurd Mark F. , Hilibrand Alan S. , Vaccaro Alexander R. , Kepler Christopher , Schroeder Gregory D.
Published: May 2024

Study Design.

Retrospective cohort study.

Objective.

The purpose of this study was to determine whether muscle mass and quality of the lumbar paraspinal muscles was associated with improvements in lumbar lordosis and other sagittal parameters after isolated posterior lumbar decompression surgery for lumbar spinal stenosis.

Summary of Background Data.

Individuals may develop sagittal imbalance over time, either due to degenerative changes or other spinal conditions. In patients with lumbar spinal stenosis, sagittal imbalance can further exacerbate symptoms of pain and radiculopathy. Sarcopenia of paraspinal muscles has been implicated in previous spine research as a variable with influence on surgical outcomes.

Methods.

Sagittal parameters were measured on preoperative and postoperative lateral lumbar radiographs and included lumbar lordosis (LL), sacral slope (SS), and pelvic tilt (PT). Preoperative MRI images were evaluated at the base of the L4 vertebral body to assess muscles mass of the psoas muscle and paravertebral muscles (PVM) and the Goutallier grade of the PVM. Patients were divided into three muscle size groups based on PVM normalized for body size (PVM/BMI): Group A (smallest), Group B, and Group C (largest).

Results.

Patients in group C had greater LL preoperatively (51.5° vs. 47.9° vs. 43.2, P=0.005) and postoperatively (52.2° vs. 48.9° vs. 45.7°, P=0.043). There was no significant difference in the ∆LL values between groups (P>0.05). Patients in group C had larger SS preoperatively (35.2° vs. 32.1° vs. 30.0°, P=0.010) and postoperatively (36.1° vs. 33.0° vs. 31.7°, P=0.030). Regression analysis showed that PVM/BMI was a significant predictor of LL preoperatively (P=0.039) and postoperatively (P=0.031), as well as SS preoperatively (P=0.001) and postoperatively (P<0.001).

Conclusions.

Muscle mass of the paravertebral muscles significantly impacts lumbar lordosis and sacral slope in patients with lumbar spinal stenosis before and after posterior lumbar decompression. These findings highlight the need to address risk factors for poor muscle quality in patients with sagittal imbalance.

Level of Evidence.

Level III.
Significance of metastatic lymph nodes ratio in overall survival for patients with resected nonsmall cell lung cancer: a retrospective cohort study
Authors: Lin Xiaoping , Yao Jianfeng , Huang Baoshan , Chen Tebin , Xie Liutian , Huang Rongfu
Published: May 2024

Objective

The tumor, node and metastasis stage is widely applied to classify lung cancer and is the foundation of clinical decisions. However, increasing studies have pointed out that this staging system is not precise enough for the N status. In this study, we aim to build a convenient survival prediction model that incorporates the current items of lymph node status.

Methods

We performed a retrospective cohort study and collected the data from resectable nonsmall cell lung cancer (NSCLC) (IA-IIIB) patients from the Surveillance, Epidemiology, and End Results database (2006–2015). The x-tile program was applied to calculate the optimal threshold of metastatic lymph node ratio (MLNR). Then, independent prognostic factors were determined by multivariable Cox regression analysis and enrolled to build a nomogram model. The calibration curve as well as the Concordance Index (C-index) were selected to evaluate the nomogram. Finally, patients were grouped based on their specified risk points and divided into three risk levels. The prognostic value of MLNR and examined lymph node numbers (ELNs) were presented in subgroups.

Results Totally,

40853 NSCLC patients after surgery were finally enrolled and analyzed. Age, metastatic lymph node ratio, histology type, adjuvant treatment and American Joint Committee on Cancer 8th T stage were deemed as independent prognostic parameters after multivariable Cox regression analysis. A nomogram was built using those variables, and its efficiency in predicting patients’ survival was better than the conventional American Joint Committee on Cancer stage system after evaluation. Our new model has a significantly higher concordance Index (C-index) (training set, 0.683 v 0.641, respectively; P < 0.01; testing set, 0.676 v 0.638, respectively; P < 0.05). Similarly, the calibration curve shows the nomogram was in better accordance with the actual observations in both cohorts. Then, after risk stratification, we found that MLNR is more reliable than ELNs in predicting overall survival.

Conclusion

We developed a nomogram model for NSCLC patients after surgery. This novel and useful tool outperforms the widely used tumor, node and metastasis staging system and could benefit clinicians in treatment options and cancer control.
Skin Tears Preventable With a Gentle Approach
Authors: İlbey Koç Betül , Erbaş Dilay Hacıdursunoğlu , Yankın Samet
Published: May 2024

Skin tears are a major problem for patients and the health care professionals who treat them. Although opinions on their prevalence differ, it is estimated that they are encountered more frequently than pressure sores but are overlooked. Recommendations based on strong evidence were presented for the prevention and treatment of skin tears as classified by the International Skin Tear Advisory Panel. This case series includes the clinical status of 3 patients who developed skin tears while receiving care in the hospital, and the corrective and preventive practices related to skin tears. This article will contribute to raising the awareness of health care professionals in predicting, preventing, evaluating, and treating skin tears.
Wide Local Excision Before Sentinel Lymph Node Biopsy in Melanoma
Authors: Tassavor Michael , Bland Madalyn , Goldenberg Olivia , Tassavor Bryan , Coldiron Brett
Published: May 2024

BACKGROUND

Current guidelines suggest that wide local excision of thick melanomas be delayed until sentinel lymph node biopsies can be performed.

OBJECTIVE

To examine the literature and determine if there is a scientific basis for delaying wide local excision of thick melanomas.

MATERIALS AND METHODS

A narrative review of the literature was undertaken to examine all available studies on the subject.

RESULTS

There is no evidence that prior excision compromises sentinel lymph node identification. There are multiple unsubstantiated suggestions that large rotation flaps may lead to false negatives.

CONCLUSION

There is no basis for delaying wide local excision of thick melanomas until a sentinel lymph node biopsy can be performed.
Discovery, evaluation, prevention, and control of liver injury risk by Polygoni Multiflori Radix
Authors: Tu Can , Gao Yuan , Bai Zhaofang , Xiao Xiaohe , Wang Jiabo
Published: May 2024

In recent years, adverse reactions and events associated with traditional Chinese medicines (TCM) and herbal medicines (HM) have frequently occurred. In particular, with regard to the safety of newly discovered TCM that have been deemed “toxic,” providing a scientifically based answer and developing effective solutions is challenging. Owing to the complexity of TCM/HM products and lack of systematic research, our understanding of the potential causes of TCM/HM-induced liver injury is limited. Therefore, significant advancements in understanding the toxicity of TCM and preventing and managing safety risks are urgently needed to address the safety concerns associated with TCM/HM. Using Polygoni Multiflori Radix (PMR) hepatotoxicity as a typical example, we evaluated the “integrated evidence chain” based on the causality evaluation of TCM-induced liver injury, and confirmed the objective authenticity of PMR hepatotoxicity. Furthermore, we first proposed and established a disease-syndrome-combined toxicology model that was applied to the material basis and analysis of the mechanism of PMR-induced hepatotoxicity. The mechanism hypothesis of “three-factor-induced toxicity” of idiosyncratic hepatotoxicity of TCM was proposed and confirmed. Based on this, the disease characteristics of the population susceptible to PMR idiosyncratic hepatotoxicity were elucidated, and various biomarkers were screened and identified, including the genetic marker HLA-B*35:01 and immunological and metabolomic markers. Finally, the study explored and established a safe medication strategy and method for “host-drug-use” three-dimensional risk prevention and control based on identifying susceptible individuals, controlling susceptible substances, and clinical precision medication. This study provides a foundation for comprehensively understanding the scientific implications of TCM/HM toxic side reactions and establishing scientific and effective risk prevention and control strategies.
Burden of Invasive Group B Streptococcus Infection Among Omani Infants Less Than 90 Days Old: A Multicenter Study
Authors: Al Aamri Rajaa , Al Yazidi Laila , Al Hashami Hilal , Al Jabri Amal , AL Haddabi Rahma , Al Adawi Badriya
Published: May 2024

Background:

Group B Streptococcus (GBS) infection is the leading cause of neonatal morbidity and mortality worldwide. This study aims to investigate the incidence of invasive GBS disease among infants less than 90 days old in Oman and to describe their risk factors, clinical presentations and clinical outcomes.

Methods:

We retrospectively collected the data of less than 90-day-old Omani infants with culture-positive GBS from sterile samples. This study was conducted in 3 tertiary hospitals in Oman from 2009 to 2018.

Results:

Over 10 years, we identified 92 cases of culture-confirmed invasive GBS infection from 178,285 live births in the 3 hospitals, giving an overall incidence of 0.53 per 1000 live births [95% confidence interval (CI): 0.4–0.7)]. Of those, 59 (64.1%) had early-onset neonatal GBS disease and 33 (35.9%) had late-onset neonatal GBS disease. The incidence of invasive GBS disease was significantly higher in the last 5 years from 2014 to 2018 (0.69 per 1000 live births, 95% CI: 0.5–0.9) compared to the previous years from 2009 to 2013 (0.36 per 1000 live births, 95% CI: 0.2‒0.5), (P = 0.004). Infants with late-onset neonatal GBS disease had a higher risk of meningitis compared to infants with early-onset neonatal GBS disease (30.3% vs. 10.2%, P = 0.021). The mortality rate was 13.5%.

Conclusions:

The incidence of invasive GBS disease in Oman is similar to what was reported worldwide, however, the burden of the disease in terms of mortality is high. In addition, a significant increase in the annual incidence of invasive GBS disease in Omani infants was found over the study period.
HIV and Undetectable = Untransmittable (U=U)
Authors: Bush Larry M. , Nguyen Cynthia , Maska Edlira
Published: May 2024

Advances in development of antiretroviral therapy and increased utilization of pre-exposure prophylaxis agents have effectively decreased the incidence of HIV sexual transmission. Conversely, at the same moment, there is an epidemic of other sexually transmitted infections in similar high-risk populations that is increasing at an alarming rate. This review aims to provide a summary of the origins and benefits of the Undetectable = Untransmittable (U=U) HIV campaign and the positive impact it has had on HIV prevention, while addressing the concomitant need for implementation of effective strategies to prevent further rise in sexually transmitted infections.
Paget-Schroetter Syndrome in a Patient With Posterior Shoulder Subluxation: A Case Report
Authors: Röthlisberger David , Rashid Mustafa S. , Ruijs Peter , Zumstein Matthias A.
Published: May 2024

Paget-Schroetter syndrome describes a primary thrombosis of the subclavian vein induced by effort. In most cases, the clinical presentation includes painful swelling, discoloration, and visible collateral circulation in the arm. Paget-Schroetter syndrome is treated with anticoagulation, rest, and physical therapy. In certain cases, invasive treatment such as thrombolysis and decompression surgery (first rib resection) may be necessary. We present the case of a 28-year-old healthy male patient with effort-induced deep vein thrombosis of the upper extremity after posterior shoulder subluxation. Anticoagulation, rest, and physical therapy were used to treat the patient, who became asymptomatic and was able to resume normal activities without restriction. To our knowledge, this is the first case of effort-induced upper extremity deep vein thrombosis after posterior shoulder subluxation. Paget-Schroetter syndrome is rare diagnosis that requires vigilance during musculoskeletal assessment for shoulder pain and swelling. The early detection, radiological confirmation, and prompt initiation of treatment are essential to successful management of Paget-Schroetter syndrome. The impact of associated posterior shoulder subluxation remains unclear.
Failure in HiRes Ultra Series Recall Devices Does Not Necessarily Lead to Decrement in Performance
Authors: Harvey Erin , Khokhar Muhammad , Harris Michael S. , Adams Jazzmyne , Friedland David R.
Published: May 2024

Objective

To understand the impact on speech perception for patients experiencing Advanced Bionics V1 series Ultra and Ultra 3D cochlear implant failure.

Study Design

Retrospective cohort study.

Setting

Tertiary academic center.

Patients

Adult patients implanted with V1 series devices.

Interventions

Device integrity and speech perception testing.

Main Outcome Measures

consonant–nucleus–consonant and AzBio in quiet speech recognition scores.

Results

At our institution, 116 V1 series cochlear implants were placed in 114 patients. Thirteen devices in prelingual patients were excluded, leaving 103 (89%) for final analysis. Forty-eight (46.6%) devices were considered as failed using the company provided EFI analysis tool. There were 36 (65.5%) of the remaining 55 devices that consistently tested within normal range; the remainder lost to follow-up with unknown status. Among the 48 device failures, 29 were revised and 19 patients were not revised. Among those not revised, 11 self-opted for observation (57.9%). Observed patients, despite impedance changes meeting failure criteria, had no subjective or objective changes in speech perception. Sentence testing scores for failure patients who elected observation (82.9 ± 11.4%) were significantly higher at failure compared with those opting for revision (55 ± 22.8%, p = 0.006). For those undergoing revision surgery, significant improvement in post-activation scores was noted as compared with time of failure with a mean improvement of 12.9% (p = 0.002, n = 24) for consonant–nucleus–consonant word scores and 17.2% (p = 0.001, n = 19) for AzBio in quiet scores.

Conclusions

Proactive monitoring using EFI identifies a higher rate of Ultra Series V1 device failure than previously reported. However, about 20% of these patients may not have subjective change in hearing or objective decline in test scores and could be observed. Should performance worsen, reimplantation provides significant improvement in speech recognition.
Cardiac Reverse Remodeling Mediated by HeartMate 3 Left Ventricular Assist Device: Comparison to Older Generation Devices
Authors: Yin Michael Yaoyao , Maneta Eleni , Kyriakopoulos Christos P. , Michaels Alexander T. , Genovese Leonard D. , Indaram Mahathi B. , Wever-Pinzon Omar , Singh Ramesh , Tseliou Eleni , Taleb Iosif , Nemeh Hassan W. , Alharethi Rami , Tang Daniel G. , Goldstein Jake , Hanff Thomas C. , Selzman Craig H. , Cowger Jennifer , Kanwar Manreet , Shah Palak , Drakos Stavros G.
Published: May 2024

Currently, the fully magnetically levitated left ventricular assist device (LVAD) HeartMate 3 (HM3) is the only commercially available device for advanced heart failure (HF) patients. However, the left ventricular (LV) functional and structural changes following mechanical unloading and circulatory support (MCS) with the HM3 have not been investigated. We compared the reverse remodeling induced by the HM3 to older generation continuous-flow LVADs. Chronic HF patients (n = 405) undergoing MCS with HeartWare Ventricular Assist Device (HVAD, n = 115), HM3 (n = 186), and HeartMate II (HM2, n = 104) at four programs were included. Echocardiograms were obtained preimplant and at 1, 3, 6, and 12 months following LVAD implantation. There were no differences in the postimplant serial LV ejection fraction (LVEF) between the devices. The postimplant LV internal diastolic diameter (LVIDd) was significantly lower for HM2 at 3 and 6 months compared with HVAD and HM3. The proportion of patients achieving “cardiac reverse remodeling responder” status (defined as LVEF improvement to ≥40% and LVIDD ≤5.9 cm) was 11.9%, and was similar between devices. HeartMate 3 appears to result in similar cardiac reverse remodeling as older generation CF-LVADs, suggesting that the fully magnetically levitated device technology could provide an effective platform to further study and promote cardiac reverse remodeling.
Rituximab as a treatment for refractory immune thrombocytopenia during pregnancy
Authors: Sousa Maria I. , Braga António C. , Buchner Graça C. , Braga Jorge S.
Published: May 2024

Immune thrombocytopenia (ITP) is most common in women during their reproductive years. When a low platelet count occurs for the first time during pregnancy, the differential diagnosis includes pregnancy-specific conditions. Although ITP is the most common cause of thrombocytopenia early in pregnancy, pregnancy-related thrombocytopenia develops mainly in late gestation. As maternal and neonatal outcomes are usually favourable, ITP per se is not a contraindication for pregnancy.

We report the case with a literature review of patient with ITP, whose diagnosis was established in early pregnancy. This condition was refractory to first-line treatments, such as high-dose steroids and intravenous immunoglobulin and other splenectomy-sparing approaches, as rituximab, having the control been reached on the third trimester after splenectomy. Although not effective in this case, we still believe that rituximab should be considered before surgery during pregnancy.
Psychiatric Comorbidities of Incarceration in a Patient With Gender Dysphoria
Authors: Gill Gurtej , Segal Yarden , Srinivas Sushma , Laul Anish , Yadav Garima , McMahon Zachary , Korenis Panagiota
Published: May 2024

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition defines gender identity disorder (GID) as a strong and persistent identification with the opposite sex and the distress that may accompany the incongruence between one's experienced or expressed gender and one's assigned gender. The onset of GID commonly begins early in childhood. Gender dysphoria has a higher prevalence of other comorbid psychiatric illnesses, such as mood, anxiety, and adjustment disorders, with increased suicide incidence and self-harming behaviors than the general population. Studies show that some temperamental, environmental, genetic, and psychological factors play a role in developing GID. Approximately 16% of transgender people and 21% of transgender women get incarcerated compared with the general US population. During incarceration, they face many issues, such as victimization, severe verbal harassment, purposeful humiliation, unwanted sexual advances, physical assault, forcible sex, and unwanted strip searches. There is a need for a better understanding of the issues and needs of this population to promote positive outcomes.
Well-Being Therapy for Fibromyalgia
Authors: Olivero Alberto , Cuniberti Francesco , Leombruni Paolo
Published: May 2024

Fibromyalgia syndrome (FMS) is characterized by chronic widespread pain, fatigue, anxiety, depression, and sleep disturbances, significantly impairing quality of life and psychological well-being. Well-being therapy (WBT) is a brief psychotherapeutic intervention aimed at increasing well-being and optimizing functioning, which has proven effective in treating various conditions involving pain and psychological or psychiatric symptoms. We describe a case study of a 22-year-old university student experiencing FMS, highlighting the far-reaching effects of the condition on her quality of life. After eight sessions of WBT, there was a marked improvement in subjective well-being and euthymia, as well as a decrease in pain perception, improved ability to manage stress, reduced allostatic overload despite the presence of stressors, improved social relationships, and increased self-efficacy. The positive effects of WBT continued at 3-month follow-up, suggesting that WBT may represent a short-term effective intervention for patients with FMS.
Predictors of real-world response in adults treated with botulinumtoxin-A for upper limb spasticity
Authors: Fheodoroff Klemens , Jacinto Jorge , Ashford Stephen , Danchenko Natalya , Grandoulier Anne-Sophie , Pietri Guilhem , Bourhis Yann , Spurden Dean , Turner-Stokes Lynne
Published: May 2024

Background:

To explore predictors of treatment response in adults receiving botulinumtoxin-A (BoNT-A) for upper limb spasticity (ULS) and to describe the association between response and concomitant medication, professional physical therapy, and quality of life (QoL).

Methods:

This was a secondary analysis of the longitudinal Upper Limb International Spasticity study (ULIS-III) data set. Eligible patients were adults receiving/initiating BoNT-A treatment for ULS in clinical practice. The treatment response was a goal attainment scaling (GAS) T score change of ≥10 points from baseline to follow-up for each cycle. Concomitant medication was recorded. Time spent on professional physical therapy and self-management was recorded using the Upper Limb Focal Spasticity Therapy Recording (ULSTR) schedule. QoL was assessed using the EQ-5D-5L questionnaire. Baseline patient and clinical characteristics were described. Factors predictive of treatment response were explored using stepwise multivariable regression modeling (linear or logistic as appropriate for the outcome) and backward elimination (α=0.1).

Results:

Overall, 828/981 patients had response data; 71.9% responded to BoNT-A therapy. Potential predictors of response identified were the use of injection guidance techniques (P=0.001), female sex (P=0.031), and abobotulinumtoxin-A therapy (vs. onabotulinumtoxin-A; P<0.001). Compared with nonresponders, responders had marginally lower use of concomitant medication, received marginally more professional physical therapy and (subgroup only) had improved QoL. Age, duration/distribution, severity of impairment, and previous BoNT-A had no predictive value.

Conclusions:

Future analyses of ULIS-III data will aim to validate these findings and further explore determinants of treatment response and the interplay between care modalities.
Quality Improvement Identifies Healthcare Transition Disparities in Adolescents with Congenital Heart Disease and Disabilities
Authors: Allen Catherine C. , Swanson Briana L. , Zhang Xiao , Coller Ryan J. , Olson Krisjon R.
Published: May 2024

Introduction:

We aim to implement healthcare transition (HCT) education for youth with congenital heart disease (CHD) and assess HCT preparedness for cardiac self-care.

Methods:

An HCT clinic was implemented at an academic pediatric cardiology clinic for CHD youth 17 years of age and older. An educator used transition readiness assessment questionnaires and discussed HCT material. The percentage of eligible youth who received HCT education and the cause for missed occurrences were tracked. Plan-do-study-act cycles began in August 2020 to improve the number of youths reached. Secondary analyses assessed improvement differences among those without cardiac procedures or disabilities.

Results:

HCT education provision improved from a mean of 38% to 73% in the 17-year and older age group by December 2022. Communication failure was the leading cause of missed visits in 2021 (30%), reduced to 0 by 2022 following plan-do-study-act cycles. Other missed HCT visits included clinic add-ons after screening, limited staff availability, and unidentified eligibility. Readiness assessments were similar for youth with and without prior cardiac procedures, for example, confidence in taking charge of their health care (P = 0.47) and moving to adult care (P = 0.22). Adolescents with disabilities were significantly less confident than those without disabilities in taking charge of their heart health care (6.3 versus 7.5, P = 0.04) and moving to adult care (4.9 versus 7.4, P < 0.001).

Conclusions:

Implementation of a CHD HCT clinic improved successful education delivery. Provider engagement and clinic staffing are important for sustainability. HCT knowledge gaps exist for all adolescents, yet those with disabilities had the greatest deficits.
Comparison and Influence of a Multicomponent Educational Program on the Patient-Reported Outcomes of a Group of Patients With Rheumatoid Arthritis
Authors: Santos-Moreno Pedro , Rodríguez-Vargas Gabriel-Santiago , Rodríguez-Florido Fernando , Rubio-Rubio Jaime-Andrés , Rodríguez Pedro A. , Rojas-Villarraga Adriana
Published: May 2024

Background

Rheumatoid arthritis (RA) is a chronic disease that affects different areas of the patient's body. Patient education and health literacy is essential for them to participate actively in follow-up.

Objectives

The aim of this study was to assess differences between clinimetric measurements done by a medical team and patient-reported outcome measures (PROMs) in RA and understand the impact of patient education strategies in order to identify differences between RA assessment methods.

Methods

This is a longitudinal cohort study. It included adult patients with RA and access to digital tools. These were divided into 3 groups by type of education. Group 1 included patients who participated in a multicomponent RA educational program. Group 2 did not have this multicomponent RA education. Group 3 did not receive any education. The 3 groups performed PROMs. Disease activity scales, functional class, and quality of life were measured. Univariate and bivariate analysis (χ2 and Wilcoxon for paired data) were done.

Results

Twenty-eight patients were included in group 1, 26 in group 2, and 37 in group 3. All were women. In group 1, there were no significant differences in clinimetrics between the medical team and patient's PROMs except for fatigue. In group 2 and group 3, significant differences were found. The RAPID3 and PAS variables did not show significant differences when analyzed by intervention subgroups.

Conclusions

This study shows no differences between clinimetrics/PROMs for patients with a high-level education on RA and physicians. On the other hand, when patient did not have any RA education, the clinimetric results differed from physician measurement.
An Atypical Spindle Cell/Pleomorphic Lipomatous Tumor of the Thigh With a Difficult Imaging Diagnosis That Mimicked a Malignant Lipomatous Tumor
Authors: Fujibuchi Taketsugu , Ichikawa Jiro , Kawasaki Tomonori , Onohara Kojiro , Aoki Kaoru
Published: May 2024

Atypical spindle cell/pleomorphic lipomatous tumor is categorized as a benign lipomatous tumor, but various MRI findings pose accurate diagnostic challenges. In our case, both MRI and PET/CT scans indicated the possibility of atypical lipomatous tumor/well-differentiated liposarcoma or dedifferentiated liposarcoma. Needle biopsy suggested benign to low-grade malignancy; hence, we opted for the wide resection. The final diagnosis of atypical spindle cell/pleomorphic lipomatous tumor was confirmed through histopathology analysis, including immunohistochemistry and fluorescence in situ hybridization. Since achieving an accurate diagnosis solely through imaging can be challenging, histopathology remains essential.
68Ga-DOTATATE PET/CT Imaging of a Solitary Nasopharyngeal Metastasis of Merkel Cell Carcinoma
Authors: Ding Haoyuan , Wang Yudi , He Kaixiang , Liu Ya , Chen Yue
Published: May 2024

Merkel cell carcinoma (MCC) is an uncommon highly aggressive cutaneous neuroendocrine neoplasm with high mortality. Rarer still is nasopharyngeal metastasis of MCC. Herein, we report the 68Ga-DOTATATE PET/CT findings of MCC with metastasis to the nasopharynx in a 53-year-old man who underwent surgery for MCC in his thigh 2 years ago.
Focal Nodular Hyperplasia of the Liver Detected on Myocardial Perfusion PET/CT
Authors: van der Zant Friso M. , Lazarenko Sergiy V. , Knol Remco J.J.
Published: May 2024

A 65-year-old woman with a few episodes of chest pain and progressive dyspnea on exertion was sent to the department of nuclear medicine for myocardial PET/CT. Pharmacological stress was performed with adenosine. During pharmacological stress, neither anginal complaints nor changes in electrocardiogram were observed. The PET/CT showed normal tracer uptake in the myocardium with normal myocardial flow and normal flow reserve. Furthermore, normal wall motion and left ventricle ejection fraction of 74% were observed. Incidentally, four 13N-NH3–avid liver lesions were detected. An additional MRI of the liver showed that these lesions were typical for focal nodular hyperplasia.