bluuebunny/crossref_metadata_2025 huggingface dataset:
Association of Epileptiform Activity With Outcomes in Toxic-Metabolic Encephalopathy
Authors: Chen Patrick M. , Stekhoven Sophie Schuurmans , Haider Adnan , Jing Jin , Ge Wendong , Rosenthal Eric S. , Westover M. Brandon , Zafar Sahar F.
Published: May 2023

IMPORTANCE:

The clinical significance of epileptiform abnormalities (EAs) specific to toxic-metabolic encephalopathy (TME) is unknown.

OBJECTIVES:

To quantify EA burden in patients with TME and its association with neurologic outcomes.

DESIGN, SETTING, AND PARTICIPANT:

This is a retrospective study. A cohort of patients with TME and EA (positive) were age, Sequential Organ Failure Assessment Score, Acute Physiology and Chronic Health Evaluation II (APACHE-II) score matched to a cohort of TME patients without EA (control). Univariate analysis compared EA-positive patients against controls. Multivariable logistical regression adjusting for underlying disease etiology was performed to examine the relationship between EA burden and probability of poor neurologic outcome (modified Rankin Score [mRS] 4–6) at discharge. Consecutive admissions to inpatient floors or ICUs that underwent continuous electroencephalography (cEEG) monitoring at a single center between 2012 and 2019. Inclusion criteria were 1) patients with TME diagnosis, 2) age greater than 18 years, and 3) greater than or equal to 16 hours of cEEG. Patients with acute brain injury and cardiac arrest were excluded.

MAIN OUTCOMES AND MEASURES:

Poor neurologic outcome defined by mRS (mRS 4–6).

RESULTS:

One hundred sixteen patients were included, 58 with EA and 58 controls without EA, where matching was performed on age and APACHE-II score. The median age was 66 (Q1–Q3, 57–75) and median APACHE II score was 18 (Q1–Q3, 13–22). Overall cohort discharge mortality was 22% and 70% had a poor neurologic outcome. Peak EA burden was defined as the 12-hour window of recording with the highest prevalence of EAs. In multivariable analysis adjusted for Charlson Comorbidity Index and primary diagnosis, presence of EAs was associated with poor outcome (odds ratio 3.89; CI [1.05–14.2], p = 0.041). Increase in peak EA burden from 0% to 100% increased probability of poor discharge neurologic outcome by 30%.

CONCLUSIONS AND RELEVANCE:

Increasing burden of EA is associated with worse discharge outcomes in patients with TME. Future studies are needed to determine whether short-term treatment with anti-seizure medications while medically treating the underlying metabolic derangement improves outcomes.
Interactive or tailored digital interventions to increase uptake in cervical, breast, and colorectal cancer screening to reduce health inequity: a systematic review
Authors: Richardson-Parry Afua , Silva Mitchell , Valderas Jose M. , Donde Shaantanu , Woodruff Seth , van Vugt Joris
Published: May 2023

Background and objectives

Significant health inequities exist in screening uptake for certain types of cancer. The review question was to identify and describe interactive, tailored digital, computer, and web-based interventions to reduce health inequity in cancer screening and review the effectiveness of such interventions in increasing screening rates versus usual care.

Methods

We searched four medical literature databases for randomized control trials (RCTs) published until 12 January 2023 that evaluated interventions aimed at increasing the percentage of breast, prostate, cervical, or colorectal cancer screening uptake. Meta-analysis was not conducted due to heterogeneity among studies.

Results

After screening 4200 titles and abstracts, 17 studies were included. Studies focused on colorectal (n = 10), breast (n = 4), cervical (n = 2), and prostate (n = 1) cancer screening. All were based in the USA except two. Most studies focused on ethnicity/race, while some included low-income populations. Intervention types were heterogeneous and used computer programs, apps, or web-based methods to provide tailored or interactive information to participants about screening risks and options. Some studies found positive effects for increasing cancer screening uptake in the intervention groups compared to usual care, but results were heterogeneous.

Conclusion

Interventions that use individual and cultural tailoring of cancer screening educational material should be further developed and investigated outside of the USA. Designing effective digital intervention strategies, with components that can be adapted to remote delivery may be an important strategy for reducing health inequities in cancer screening during the coronavirus disease 2019 pandemic.
Cicatricial Entropion in Chronic Cicatrizing Conjunctivitis: Potential Pathophysiologic Mechanisms and Long-Term Outcomes of a Modified Technique
Authors: Singh Swati , Basu Sayan , Jakati Saumya
Published: May 2023

Purpose:

The purpose of this study was to assess the long-term outcomes of severe cicatricial entropion repair with mucous membrane grafting in patients with chronic cicatrizing conjunctivitis and report histopathological changes in the eyelid margin area.

Methods:

Prospective interventional study included 19 patients with severe cicatricial entropion with trichiasis (N = 20 eyelids; 19 upper and 1 lower eyelid) who underwent anterior lamellar recession (with back cuts) and mucous membrane grafting cover for bare anterior tarsus, lid margin, and 2 mm of marginal tarsus, and had a minimum 6 months of follow-up. The anterior lamella and metaplastic eyelid margins were sent for routine Haematoxylin and Eosin and special staining with Masson trichrome stain.

Results:

The etiologies were chronic Stevens-Johnson syndrome (N = 6), chemical injury (N = 11), and drug-induced pseudopemphigoid (N = 2). Five eyes had undergone entropion correction in the past, and 9 had electroepilation for trichiasis. Entropion was well corrected (without residual trichiasis) in 85% of eyelids with primary surgery. The etiology-wise success rates were 100% for Stevens-Johnson syndrome, 72.7% for chemical injury, and 100% for drug-induced pseudopemphigoid. Three eyelids with failure belonged to chemical injury, and trichiasis in these eyes could be managed with subsequent interventions except in 1 case. All eyelids had no entropion at a mean follow-up of 10.8 months (range, 6–18). Histopathological evaluation of anterior lamella (N = 10) and eyelid margins revealed significant fibrosis in subepithelial, perimysium (muscle of Riolan), and perifollicular areas.

Conclusion:

Anterior lamellar recession combined with mucous membrane grafting achieves good cicatricial entropion correction except in eyes with chemical injury. The eyelid margins in these eyes have persistent inflammation, and fibrosis involving lash follicles.
Nomogram development and validation for predicting minimally invasive step-up approach failure in infected necrotizing pancreatitis patients: a retrospective cohort study
Authors: Li Gang , Li Shuai , Cao Longxiang , Mao Wenjian , Zhou Jing , Ye Bo , Zhang Jingzhu , Ding Ling , Zhu Yin , Ke Lu , Liu Yuxiu , Tong Zhihui , Li Weiqin
Published: May 2023

Background:

Previous studies have shown that minimally invasive treatment for infected necrotizing pancreatitis (INP) may be safer and more effective than open necrosectomy (ON), but ON is still irreplaceable in a portion of INP patients. Furthermore, there is a lack of tools to identify INP patients at risk of minimally invasive step-up approach failure (eventually received ON or died), which may enable appropriate treatment for them. Our study aims to identify risk factors that can predict minimally invasive step-up approach failure in INP patients and to develop a nomogram for early prediction.

Methods:

Multivariate logistic regression was performed to evaluate the association between minimally invasive step-up approach failure and factors regarding demographics, disease severity, laboratory index, and the location of extrapancreatic necrotic collections. A novel nomogram was developed, and its performance was validated both internally and externally by its discrimination, calibration, and clinical usefulness.

Results:

There were 267, 89, and 107 patients in the training, internal, and external validation cohorts, respectively. Multivariate logistic regression demonstrated that the computed tomography severity index (CTSI) greater than 8 points, Acute Physiology and Chronic Health Evaluation II (APACHE II) score of 16 points or more, early spontaneous bleeding, fungi infection, granulocyte and platelet decrease within 30 days of acute pancreatitis onset, and extrapancreatic necrosis collection located in small bowel mesentery were independent risk factors for minimally invasive step-up approach failure. The area under the curve and coefficient of determination (R
2) of the nomogram constructed from the above factors were 0.920 and 0.644, respectively. The Hosmer–Lemeshow test showed that the model had good fitness (P=0.206). In addition, the nomogram performed well in both the internal and external validation cohorts.

Conclusions:

The nomogram had a good performance in predicting minimally invasive step-up approach failure, which may help clinicians distinguish INP patients at risk of minimally invasive step-up approach failure early.
Infections in Patients With Left Ventricular Assist Devices: Current State and Future Perspectives
Authors: Inglis Sara S. , Suh Gina A. , Razonable Raymund R. , Schettle Sarah D. , Spencer Philip J. , Villavicencio Mauricio A. , Rosenbaum Andrew N.
Published: May 2023

Mechanical circulatory support is increasingly being used as bridge-to-transplant and destination therapy in patients with advanced heart failure. Technologic improvements have led to increased patient survival and quality of life, but infection remains one of the leading adverse events following ventricular assist device (VAD) implantation. Infections can be classified as VAD-specific, VAD-related, and non-VAD infections. Risk of VAD-specific infections, such as driveline, pump pocket, and pump infections, remains for the duration of implantation. While adverse events are typically most common early (within 90 days of implantation), device-specific infection (primarily driveline) is a notable exception. No diminishment over time is seen, with event rates of 0.16 events per patient-year in both the early and late periods postimplantation. Management of VAD-specific infections requires aggressive treatment and chronic suppressive antimicrobial therapy is indicated when there is concern for seeding of the device. While surgical intervention/hardware removal is often necessary in prosthesis-related infections, this is not so easily accomplished with VADs. This review outlines the current state of infections in patients supported with VAD therapy and discusses future directions, including possibilities with fully implantable devices and novel approaches to treatment.
Association of Arterial Blood pH at Cannulation With 1 Year Survival Among Veno-Arterial Extracorporeal Membrane Oxygenation Recipients: The Three Seven Rule
Authors: Dib Nabil , Belaroussi Yaniss , Mansour Alexandre , Anselmi Amedeo , Auffret Vincent , Nesseler Nicolas , Flécher Erwan
Published: May 2023

We aimed to describe the clinical outcomes of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) therapy in our institution considering clinical context and pH at cannulation. All patients treated by VA-ECMO during the 2005–2020 period with 1 year complete follow-up were included. Our cohort was divided in three groups according to the pH level at cannulation: pH <7 (group 1), pH 7–7.2 (group 2), and pH>7.2 (group 3). Survival was analyzed using Kaplan–Meier method. Association between pH group and survival was estimated using a Cox model. A total of 572 patients were included: 60 patients in group 1, 115 in group 2, and 397 in group 3. Refractory cardiogenic shock (36%) was the main indication. One year survival rates were 13%, 36%, and 43% in groups 1, 2, and 3, respectively (p < 0.001). Death mainly occurred within the first month. The strong correlation between pH and lactates led to propose a simple “three seven rule”: pH <7 and lactate >7 was associated with <7% survival. Veno-arterial extracorporeal membrane oxygenation should be considered with caution in patients with pH <7. Lactates and pH might be important parameters to elaborate a new score to predict survival in this population. The “three seven rule” can be very relevant when facing emergency situations.
Micronutrients, genetics and COVID-19
Authors: Kotur Nikola , Stankovic Biljana , Pavlovic Sonja
Published: May 2023

Purpose of review

Marked inter-individual differences in the clinical manifestation of coronavirus disease 2019 (COVID-19) has initiated studies in the field of genetics. This review evaluates recent genetic evidence (predominantly in the last 18 months) related to micronutrients (vitamins and trace elements) and COVID-19.

Recent findings

In patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), altered circulating levels of micronutrients may serve as prognostic markers of disease severity. Mendelian randomization (MR) studies did not find significant effect of variable genetically predicted levels of micronutrients on COVID-19 phenotypes, however, recent clinical studies on COVID-19 point out to vitamin D and zinc supplementation as a nutritional strategy to reduce disease severity and mortality. Recent evidence also points to variants in vitamin D receptor (VDR) gene, most notably rs2228570 (FokI) “f” allele and rs7975232 (ApaI) “aa” genotype as poor prognostic markers.

Since several micronutrients were included in the COVID-19 therapy protocols, research in the field of nutrigenetics of micronutrients is in progress. Recent findings from MR studies prioritize genes involved in biological effect, such as the VDR gene, rather than micronutrient status in future research. Emerging evidence on nutrigenetic markers may improve patient stratification and inform nutritional strategies against severe COVID-19.
Using transfixion irrigation with negative pressure drainage (TINPD) minimally invasive to manage infratemporal fossa (ITF) abscess
Authors: Chang Caiwang , Zhou Zhilin , Xie Mengjia , Gao Juanjuan , Shao Miaomiao , Huang Jinhua , Meng Zhibing
Published: May 2023

Rationale:

The treatment of abscess in the infratemporal space is still controversial and bedside and operative intraoral drainage is often used to resolve the abscess. However, it can be difficult to control the infection quickly.[1] In this report, the authors present a new technique of using transfixion irrigation with negative pressure drainage for minimally invasive management of infratemporal fossa abscess.

Patient concerns:

A 45-year-old man with type 2 diabetes complained of painful swelling and trismus in the right lower facial region for 10 days. The patient was weak, with mild anxiety, and gradually aggravated.

Diagnoses:

The patient was misdiagnosed and received dental pulp treatment for the right mandibular first molar and was given oral cefradine capsules (500 mg 3 times per day). Computed tomography scan and puncture revealed an abscess in the infratemporal fossa.

Intervention:

The authors used transfixion irrigation with negative pressure drainage from different directions to reach the abscess cavity. Saline solution was infused through 1 tube and allowed to flow out through the other tube to flush out the pus and debris from the abscess.

Outcome:

On day 9, the drainage tube was removed and the patient was discharged. One week later, the patient was followed up in the outpatient clinic and the impacted mandibular third molar was removed. This technique is less invasive and leads to faster recovery times and fewer complications.

Lessons subsections:

The report highlights the importance of proper preoperative evaluation, using a thoracic drainage tube as soon as possible, and continuous flushing. A double-lumen drainage tube with a suitable diameter and combined flushing should be designed for future reference. Moreover, the use of drugs can effectively eliminate emboli formation, allowing for faster and more minimally invasive control and removal of the infection.[2]
Rapid absorption of frontal lobe contusion and laceration with hematoma: A case report and review of literature
Authors: Wu Yangzong , Liu Penghui , Lin Yuanxiang , Qian Shuiqing , Chen Xiaoxin , Fan Zhiquan
Published: May 2023

Rationale:

It is rare for a traumatic intracranial hematoma to self-absorb rapidly after conservative treatment. To the best of our knowledge, there has been no report in the relevant literature of rapid absorption of hematoma formation following cerebral contusion and laceration.

Patient concerns:

A 54-year-old male was admitted to our hospital with head trauma at 3 hours prior to admission. He was alert and oriented, glasgow coma scale score of 15. Head computed tomography (CT) showed left frontal brain contusion with hematoma, however, a reexamination of CT about 29 hours following the trauma revealed that the hematoma had been absorbed.

Diagnoses:

A diagnosis of contusion and laceration of left frontal lobe with hematoma formation was made based on the CT images.

Interventions:

The patient underwent conservative treatment.

Outcomes:

After treatment, dizziness and headache subsided for the patient, and no special discomfort was reported.

Lessons:

It is likely that the reason for rapid absorption in this case is that the hematoma is prone to liquefaction because of abnormal platelet values and coagulation dysfunction. As the liquefaction hematoma breaks into the lateral ventricle, it is redistributed and absorbed in the lateral ventricle and subarachnoid space. Further evidence is required to support this hypothesis.
Self-warming blankets versus active warming by forced-air devices for preventing hypothermia: A systematic review and meta-analysis
Authors: Al-dardery Nada Mostafa , Abdelwahab Omar A. , El-Samahy Mohamed , Seif Ali Mohamed , Mouffokes Adel , Khaity Abdulrhman
Published: May 2023

Background:

Unintended perioperative hypothermia is a significant complication for patients undergoing anesthesia. Different measures are routinely undertaken to prevent hypothermia and its consequences. The evidence comparing the impact of self-warming blankets and forced-air warming is scarce. Therefore, this meta-analysis aimed to evaluate the efficacy of self-warming blankets compared to forced-air devices regarding the incidence of perioperative hypothermia.

Methods:

We searched the Web of Science, Cochrane Central Register of Controlled Trials, PubMed, and Scopus for relevant studies from inception until December 2022. We included comparative studies with patients allocated to undergo warming using a self-warming blanket or forced air warming. All concerned outcomes were pooled as odds ratios or mean differences (MDs) in the meta-analysis models using Review Manager (RevMan version 5.4).

Results:

Our results from 8 studies (597 patients) favored self-warming blankets over forced-air devices in terms of core temperature at 120 and 180 minutes after induction of general anesthesia (MD = 0.33, 95% confidence interval [CI] [0.14–0.51], P = .0006), (MD = 0.62, 95% CI [0.09–1.14], P = .02), respectively. However, the overall effect did not favor either of the 2 groups for the incidence of hypothermia (odds ratio = 0.69, 95% CI [0.18–2.62]).

Conclusion:

Ultimately, self-warming blankets have a more significant effect than forced-air warming systems in terms of maintaining normothermia of core temperature after induction anesthesia. However, the present evidence is not enough to verify the efficacy of the 2 warming techniques in the incidence of hypothermia. Further studies with large sample sizes are recommended.
Scientometric analysis of post-stroke depression research based on CiteSpace
Authors: Tang Saixue , Gao Mingzhou , Cheng Xunshu , Ji Lijin
Published: May 2023

Post-stroke depression (PSD) has served as a severe and common complication leading to a higher level of mortality. Though various studies have been focused on PSD, limited research endeavor has been dedicated to bibliometric analysis in the past. In view of this, the current analysis serves to elucidate the latest status of global research and pinpoint the emerging area of interest for PSD, in order to support further investigation of the field. Publications related to PSD were retrieved from the Web of Science Core Collection database on September 24, 2022, and included in the bibliometric analysis. VOSviewer and CiteSpace software were used to visually analyze publication outputs, scientific cooperation, highly-cited references, and keywords to identify the current status and future trends in PSD research. A total of 533 publications were retrieved. The annual number of publications showed an increasing trend from 1999 to 2022. In terms of country and academic institution, the USA and Duke University have topped the list of PSD research respectively. Meanwhile, Robinson RG and Alexopoulos GS have been the most representative investigators of the field. In the past, researchers focused on the risk factors of PSD, late-life depression, and Alzheimer disease. In recent years, further research effort has been placed on meta-analysis, ischemic stroke, predictor, inflammation, mechanism, and mortality. In conclusion, in the past 20 years, PSD research has been progressing and gaining more attention. The bibliometric analysis successfully unveiled the field’s major contributing countries, institutions, and investigators. Furthermore, current hot spots and future trends in the field of PSD were identified, which included meta-analysis, ischemic stroke, predictor, inflammation, mechanism, and mortality.
Disparities associated with Medicare Part D Star Ratings measures among patients with Alzheimer’s disease and related dementias
Authors: Tsang Chi Chun Steve , Zhang Xiangjun , Barenie Rachel Elizabeth , Cernasev Alina , Miller Nancy A. , Wan Jim Y. , Tsao Jack W. , Wang Junling
Published: May 2023

The Medicare Parts C and D Star Ratings system was established to improve care quality in Medicare. Previous studies reported racial/ethnic disparities in the calculation of medication adherence measures of Star Ratings in patients with diabetes, hypertension, and hyperlipidemia. This study aimed to identify possible racial/ethnic disparities in the calculation of adherence measures of Medicare Part D Star Ratings among patients with Alzheimer’s disease and related dementias (ADRD) and diabetes, hypertension, or hyperlipidemia. This retrospective study analyzed the 2017 Medicare data and Area Health Resources Files. Non-Hispanic White (White) patients were compared to Black, Hispanic, Asian/Pacific Islander (Asian), and other patients on their likelihood of being included in the calculation of adherence measures for diabetes, hypertension, and/or hyperlipidemia. To adjust for the individual/community characteristics, logistic regression was used when the outcome is the inclusion in the calculation of one adherence measure; multinomial regression was used when examining the inclusion in the calculation of multiple adherence measures. Analyzing the data of 1438,076 Medicare beneficiaries with ADRD, this study found that Black (adjusted odds ratio, or OR = 0.79, 95% confidence interval, or 95% CI = 0.73–0.84) and Hispanic (OR = 0.82, 95% CI = 0.75–0.89) patients were less likely than White patients to be included in the calculation of adherence measure for diabetes medications. Further, Black patients were less likely to be included in the calculation of the adherence measure for hypertension medications than White patients (OR = 0.81, 95% CI = 0.78–0.84). All minorities were less likely to be included in calculating the adherence measure for hyperlipidemia medications than Whites. The ORs for Black, Hispanic, and Asian patients were 0.57 (95% CI = 0.55–0.58), 0.69 (95% CI = 0.64–0.74), and 0.83 (95% CI = 0.76–0.91), respectively. Minority patients were generally likely to be included in the measure calculation of fewer measures than White patients. Racial/ethnic disparities were observed in the calculation of Star Ratings measures among patients with ADRD and diabetes, hypertension, and/or hyperlipidemia. Future studies should explore possible causes of and solutions to these disparities.
Atypical symptoms of testicular torsion in a 7-year-old child: A case report
Authors: Guo Bei-Cyuan , Wu Han-Ping
Published: May 2023

Rationale:

Testicular torsion accounting for 25% of acute scrotal disease, is an acute surgical condition. Atypical presentations of testicular torsion may lead delay diagnosis.

Patient concerns:

A 7-year-old boy was admitted to the pediatric emergency department with continuous and progressive left scrotal pain for 2 days, associated symptoms and signs included left scrotal swelling and erythema. The pain started 4 days ago as left lower abdominal pain which then migrated to the left scrotum.

Diagnoses:

Physical examination showed left scrotum skin redness, swelling, local heat, tenderness, high-riding testis, absence of the left side cremasteric reflex and a negative Prehn’s sign. Subsequent point of care ultrasound of scrotum revealed increased volume of the left testicle, inhomogeneous hypo-echoic left testis, and no detectable flow in the left testis. Left testicular torsion was diagnosed.

Interventions:

Surgical examination confirmed testicular torsion showing 720° counterclockwise rotation of the spermatic cord with ischemic changes in the left testis and epididymis.

Outcomes:

The patient was stabilized and discharged after left orchiectomy, right orchiopexy and antibiotic therapy.

Lessons:

Symptoms of testicular torsion may be atypical, especially in prepubertal age. Detailed history, physical examination, point of care ultrasound usage and timely urologist consultation and intervention are important for prompt rescue to prevent testicular loss, testicular atrophy, and eventual impairment of fertility.
A novel circadian cycle-related gene signature for prognosis prediction of patients with breast cancer
Authors: Hu Yuanyuan , Fan Shuyao , Zhu Yiwan , Xie Xiaohong
Published: May 2023

The extensive and intricate relationships between circadian rhythm and cancer have been reported in numerous studies. However, in breast cancer (BC), the potential role of circadian clock-related genes (CCRGs) in prognosis prediction has not been fully clarified. The transcriptome data and clinical information were downloaded from The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus databases. A CCRGs-based risk signature was established by differential expression analysis, univariate, Lasso and multivariate Cox regression analyses. we conducted a gene set enrichment analysis (GSEA) between groups. A nomogram integrating independent clinical factors and risk score was generated and evaluated by calibration curves and decision curve analysis (DCA). Differentially expression analysis revealed 80 differentially expressed CCRGs, and 27 of them were significantly associated with the overall survival (OS) of BC. BC can be classified into 4 molecular subtypes with significant differences in prognosis based on the 27 CCRGs. Three prognostic CCRGs, including desmocollin 1 (DSC1), LEF1, and protocadherin 9 (PCDH9), were identified to be independent risk factors of BC prognosis and were used to construct a risk score model. BC patients were divided into high- and low-risk groups, and there were significant differences in prognosis between the 2 groups both in the training and validation cohorts. It was found that patients in different groups of race, status, or T stage had significant levels of risk score. Furthermore, patients of different risk levels exhibit varying degrees of sensitivity to vinorelbine, lapatinib, metformin, and vinblastine. GSEA showed that in the high-risk group, immune response-related activities were dramatically repressed whereas cilium-related processes were significantly stimulated. Cox regression analysis demonstrated that age, N stage, radiotherapy and the risk score were independent prognostic risk factors of BC, and a nomogram was established based on these variables. The nomogram exerted a favorable concordance index (0.798) as well as calibration performance, which strongly supports the clinical application of the nomogram. Our study indicated the disruption of the expression of CCRGs in BC and built a favorable prognostic risk model based on 3 independent prognostic CCRGs. These genes may be applied as candidate molecular targets for the diagnosis and therapy of BC.
Bankart repair with subscapularis augmentation: A case control study
Authors: Karakus Ozgun , Oztermeli Ahmet
Published: May 2023

To examine the effect on functional shoulder scores of Bankart repair with arthroscopic subscapularis tendon augmentation applied to cases of anterior shoulder instability with < 25% glenoid defect and ligament-labral failure. A total of 83 patients underwent Bankart repair with subscapularis tendon augmentation between 2015 and 2021. The range of movement of the patients was measured by 2 doctors using a goniometer. The Constant Murley score, American Shoulder and Elbow Surgeons score, Rowe score, and the University of California at Los Angeles scores were recorded preoperatively and postoperatively. Statistically significant increases were determined in the postoperative functional scores compared to the preoperative values as mean 41.4 ± 2.08 unit increase in the Constant Murley score, mean 41.4 ± 1.8 unit increase in the American Shoulder and Elbow Surgeons score, mean 13.8 ± 1.45 unit increase in the University of California at Los Angeles and mean 49.3 ± 7.45 unit increase in the Rowe score (P = .001; P < .01). Compared with the preoperative evaluation, there was found to be a postoperative statistically significant unit decrease of 10.2 ± 1.47 in the external rotation measurement (P = .001; P < .01). The number of dislocations was determined to have a negative correlation with the internal rotation measurements (r = −0.305; P = .005; P < .01), and a weak negative statistically significant relationship with external rotation measurements (r = −0.329; P = .002; P < .01). Unlike other techniques, as this repair technique includes both the tendon and the capsule as a single piece, it was seen to be a sufficient and reliable technique that is easy-to apply.
Research progress of Traditional Chinese Medicine (TCM) in targeting inflammation and lipid metabolism disorder for arteriosclerosis intervention: A review
Authors: Xuan Xiaoyu , Zhang Jingyi , Fan Jilin , Zhang Shiliang
Published: May 2023

Atherosclerosis (AS) is a chronic disease caused by inflammation and lipid deposition. Immune cells are extensively activated in the lesions, producing excessive pro-inflammatory cytokines, which accompany the entire pathological process of AS. In addition, the accumulation of lipid-mediated lipoproteins under the arterial intima is a crucial event in the development of AS, leading to vascular inflammation. Improving lipid metabolism disorders and inhibiting inflammatory reactions are the primary treatment methods currently used in medical practice to delay AS progression. With the development of traditional Chinese medicine (TCM), more mechanisms of action of the monomer of TCM, Chinese patent medicine, and compound prescription have been studied and explored. Research has shown that some Chinese medicines can participate in treating AS by targeting and improving lipid metabolism disorders and inhibiting inflammatory reactions. This review explores the research on Chinese herbal monomers, compound Chinese medicines, and formulae that improve lipid metabolism disorders and inhibit inflammatory reactions to provide new supplements for treating AS.
Advances in the genetics of nonalcoholic fatty liver disease
Authors: Ajmera Veeral , Loomba Rohit
Published: May 2023

Purpose of review

Nonalcoholic fatty liver disease (NAFLD) is the most common cause of liver disease in the United States and has a strong heritable component. Advances in understanding the genetic underpinnings of NAFLD have revealed important insights into NAFLD pathogenesis, prognosis, and potential therapeutic targets. The purpose of this review is to summarize data on common and rare variants associated with NAFLD, combining risk variants into polygenic scores to predict NAFLD and cirrhosis as well as emerging evidence on using gene silencing as a novel therapeutic target in NAFLD.

Recent findings

Protective variants in HSD17B13, MARC1 and CIDEB have been identified and a confer 10–50% lower risk of cirrhosis. Together, these as well as other NAFLD risk variants, including those in PNPLA3 and TM6SF2, can be combined to create polygenic risk scores associated with liver fat, cirrhosis, and hepatocellular carcinoma. Genomic analysis of extreme phenotypes including patients with lean NAFLD without visceral adiposity may uncover rare monogenic disorders with pathogenic and therapeutic implications and gene silencing strategies targeting HSD17B13 and PNPLA3 are being evaluated in early phase human studies as treatments for NAFLD.

Advances in our understanding of the genetics of NAFLD will enable clinical risk stratification and yield potential therapeutic targets.
The debate in the diagnosis of coeliac disease – time to go ‘no-biopsy’?
Authors: Shiha Mohamed G. , Raju Suneil A. , Sidhu Reena , Penny Hugo A.
Published: May 2023

Purpose of review

Duodenal biopsies have been central to making a diagnosis of coeliac disease for the last 70 years. Recent paediatric guidelines have reduced the emphasis on duodenal biopsies with the incorporation of a ‘no-biopsy’ arm to the diagnostic pathway. This review discusses the no-biopsy approach in adults and highlights advances in alternative (non-biopsy) diagnostic modalities in coeliac disease.

Recent findings

Evidence suggests that a no-biopsy approach for the diagnosis of adult coeliac disease is accurate. However, a number of factors still favour duodenal biopsy sampling in specific patient groups. Moreover, several factors need to be considered if this pathway is implemented into local gastroenterology services.

Duodenal biopsies remain an important step in the diagnosis of adult coeliac disease. However, an alternative approach that removes the necessity for biopsies may be an option in selected adults. If further guidelines incorporate this pathway, then efforts should focus on supporting a dialogue between primary and secondary care to facilitate the appropriate implementation of this approach.
Immune Reconstitution Inflammatory Syndrome After Hematopoietic Stem Cell Transplantation in a FOXN1-deficient Patient
Authors: Corbali Osman , Gemici Karaaslan Hatice Betul , Aydemir Sezin , Onal Pinar , Kendir Demirkol Yasemin , Nepesov Serdar , Kiykim Ayca , Cokugras Haluk
Published: May 2023

The FOXN1 gene mutation is a unique disorder that causes the nude severe combined immunodeficiency phenotype. In patients with severe combined immunodeficiency, hematopoietic stem cell transplantation (HSCT) is life-saving if performed earlier. Thymic transplantation is the curative treatment for FOXN1 deficiency because the main pathology is thymic stromal changes. In this report, we describe the clinical features of a Turkish patient with a homozygous FOXN1 mutation treated with HSCT from his human leukocyte antigen-matched sibling. On follow-up, he showed Bacille Calmette Guerin adenitis and was evaluated as having immune reconstitution inflammatory syndrome. By presenting our patient, we aimed to draw attention to the development of HSCT and subsequent immune reconstitution inflammatory syndrome as a treatment option in patients with FOXN1 deficiency.
Systemic sclerosis associated with primary sclerosing cholangitis and hyperthyroidism: a case report
Authors: Ghassa Ali , Kilani Hatem , Al-Sayed Safa’a , Alsuliman Tamim
Published: May 2023

The association between systemic sclerosis and other immune-mediated diseases such as primary sclerosing cholangitis and hyperthyroidism should be suspected in case the patient presents with similar symptoms. A 43-year-old woman presented to the hospital with progressive jaundice, dark urine, dyspnoea, fatigue, generalized arthralgia, weight loss, and amenorrhoea. In addition, she was diagnosed with systemic sclerosis seven years ago. The patient was diagnosed recently with primary sclerosing cholangitis and hyperthyroidism through laboratory tests and investigations such as magnetic resonance cholangiopancreatography, ultrasound, and computed tomography scan. After appropriate treatment and follow-up, the patient recovered well. Immune-mediated diseases can occur simultaneously or consequently due to the common immunological dysfunction that causes these conditions.
Differences in treatment and outcomes among patients with ST-segment elevation myocardial infarction with and without standard modifiable risk factors: a systematic review and meta-analysis
Authors: Shrestha Biraj , Shrestha Dhan B. , Sedhai Yub R. , Shtembari Jurgen , Oli Prakash R. , Shikhrakar Shreeja , Paudel Bidhya , Roberts Madhur , Patel Nimesh K. , Singh Aniruddha , Singh Karan , Waheed Irfan , Basnyat Soney , Khan Mohammad S. , Kazimuddin Mohammed , Elgendy Islam Y.
Published: May 2023

Background:

There are limited data available on outcomes and pathophysiology behind ST-segment elevation myocardial infarction (STEMI) in populations without standard modifiable risk factors (SMuRFs). The authors carried out this meta-analysis to understand the differences in treatment and outcomes of STEMI patients with and without SMuRFs.

Methods:

A systematic database search was performed for relevant studies. Studies reporting desired outcomes among STEMI patients with and without SMuRFs were selected based on predefined criteria in the study protocol (PROSPERO: CRD42022341389). Two reviewers independently screened titles and abstracts using Covidence. Full texts of the selected studies were independently reviewed to confirm eligibility. Data were extracted from all eligible studies via a full-text review of the primary article for qualitative and quantitative analysis. In-hospital mortality following the first episode of STEMI was the primary outcome, with major adverse cardiovascular events (MACE), repeat myocardial infarction (MI), cardiogenic shock, heart failure, and stroke as secondary outcomes of interest. Odds ratio (OR) with a 95% CI was used to estimate the effect.

Results:

A total of 2135 studies were identified from database search, six studies with 521 150 patients with the first STEMI episode were included in the analysis. The authors found higher in-hospital mortality (OR: 1.43; CI: 1.40–1.47) and cardiogenic shock (OR: 1.59; 95% CI: 1.55–1.63) in the SMuRF-less group with no differences in MACE, recurrent MI, major bleeding, heart failure, and stroke. There were lower prescriptions of statin (OR: 0.62; CI: 0.42–0.91) and Angiotensin converting enzyme inhibitor /Angiotensin II receptor blocker (OR: 0.49; CI: 0.28–0.87) at discharge in SMuRF-less patients. There was no difference in procedures like coronary artery bypass graft, percutaneous coronary intervention, and thrombolysis.

Conclusion:

In the SMuRF-less STEMI patients, higher in-hospital mortality and treatment discrepancies were noted at discharge.
Autoimmune hemolytic anemia associated with COVID-19 infection: a rare case report
Authors: Shhada Eman , Abdullah Lava , Abduljalil Nour , Gharib Ghazal , Barhoom Dima , Ali Sawssan
Published: May 2023

Introduction:

Coronavirus disease 2019 (COVID-19) is an illness due to severe acute respiratory syndrome, symptoms and severity of disease varies from patient to patient, autoimmune hemolytic anemia (AIHA) in children with COVID-19 is rare.

Case presentation:

A 12-year-old female presented with fever, headache, myalgia, and hematuria. At admission, she was hemodynamically stable, severe anemia was present, and severe acute respiratory syndrome coronavirus 2 infection was confirmed by RT-PCR. The diagnosis of AIHA was confirmed and treated.

Discussion:

There are few reports of patients with AIHA and COVID-19. However, the majority of patients in these reports also have autoantibodies and other underlying conditions known to be associated with the development of AIHA.

Conclusion:

In this current pandemic, it should be taken into account that previously healthy children with severe acute respiratory syndrome coronavirus 2 infection have been found to have severe hemolytic anemia in the absence of COVID-19.
The analysis between clinicopathological aspect of early-onset vs. late-onset colorectal cancer and mortality rate: a cross-sectional study
Authors: Lukman Kiki , Mulyawan Andi , Nugrahani Annisa Dewi , Rudiman Reno , Primastari Etis
Published: May 2023

Introduction:

Early-onset colorectal cancer (CRC) has different clinical and pathological characteristics compared with late-onset CRC. Mortality rate as a postoperative outcome is a patient’s postoperative outcome considered based on the state of life or death. The objective of this research is to analyse the comparison between clinicopathological aspect of early-onset vs. late-onset CRC as well as their correlation with the mortality rate in Indonesia to support global data.

Material and methods:

The authors performed a case-control study on 170 subjects with CRC from November 2021 to November 2022 in a Tertiary Hospital in Bandung. Data were extracted from electronic medical records CRC Registry. Bivariate and correlation analyses were used to analyse the difference between variables using IBM SPSS 24.0. P less than 0.05 was considered statistically significant.

Results:

Anaemia and tumour location variables were significantly different in the early-onset group compared with the late-onset group (P<0.001). It was also found that anaemia (P<0.001), pathological features (P<0.001), and tumour location (P=0.013) had significantly low correlation with onset of CRC (r=0.325; r=0.397; r=0.342, respectively).

Conclusion:

There is no statistically significant correlation between the clinicopathological features of CRC in both onset and mortality rates in this study.
Prevalence and factors associated with suicide attempts among Moroccan patients with schizophrenia: cross-sectional study
Authors: Koubaa Ibtissam , Aden Mohamed Omar , Barrimi Mohammed
Published: May 2023

Background:

Suicide is an important cause of death among patients affected by schizophrenia. The lifetime prevalence is 10–15%. The identification of factors associated with suicide attempts will help to identify preventive and therapeutic strategies to reduce the toll of suicide.

Aims:

The purpose of this study is to investigate the prevalence of suicide attempts and their sociodemographic and clinical characteristics in Moroccan patients with schizophrenia.

Materials and methods:

This is a cross-sectional study of patients admitted to our Hospital of Psychiatry in Morocco, between year and year, with adiagnosis f schizophrenia.

Results:

In our sample (n=304), 65 (21.4%) had attempted suicide. Suicide attempts were significantly and positively associated with a family history of bipolar disorder, comorbidity with a substance use disorder, a relatively short duration of treatment, poor adherence to medication, and severe general, positive, and depressive symptoms.

Conclusion:

The prevention of suicide risk requires the effective management of depressive and addictive comorbidities, the reduction of schizophrenia symptoms through appropriate treatment and an effort to improve adherence.
Using a Cascading Approach to Improve Multisite Study Procedures
Authors: LaFond Cynthia M. , Hanrahan Kirsten , Bohr Nicole L. , McCarthy Ann Marie
Published: May 2023

Background

Multisite studies offer larger, more diverse samples to successfully capture populations and clinical practices of interest at the point of care. However, investigators face challenges with site recruitment and sampling, differences in clinical practices across sites, and data integrity. Addressing these issues a priori can improve the rigor and reproducibility of the research.

Objective

This article aims to describe a cascading approach to multisite research. An exemplar is provided of a study using this approach, which aimed to evaluate the prevalence of pain and the pain management practices provided to critically ill children in pediatric intensive care units in the United States.

Methods

The cascading approach includes two or more pilot study procedures with a progressively increasing number of sites prior to a full-scale study. Following each pilot, study procedures are evaluated; feedback was obtained from site personnel and content experts; procedures were revised accordingly; approvals were obtained; sites were trained; and the revised procedures are repeated with a larger, more diverse number of sites.

Results

In the exemplar provided, improvements in the efficiency and integrity of data collection were noted for the full-scale study following the pilots. All sites that completed the agreements and approvals for study participation were retained for the duration of the two pilots and full-scale study.

Discussion

Borrowing from principles of process improvement, the cascading approach allows knowledge to be gained regarding site differences and informs the revision of study procedures while potentially maximizing efficiency and data integrity, minimizing site burden, and maintaining site engagement for multisite studies.
Patient Safety Perception Within Hospitals: An Examination of Job Type, Handoffs and Information Exchange, and Hospital Management Support
Authors: Ming Yue , Meehan Rebecca
Published: May 2023

Objectives

The study has 3 aims: (1) to assess to what extent a person’s job role relates to their evaluation of patient safety in the hospital setting; 2) to identify the relationship from hospital management aspects, including level of organizational learning–continuous improvement, level of management support, and level of leader support to patient safety perception in the hospital setting; and 3) to examine the relationship between the rating of the ease of information exchange and clinical handoffs and perceived patient safety in the hospital setting.

Methods

This study used a publicly available, deidentified cross-sectional data set from the 2021 Agency for Healthcare Research and Quality’s Survey on Patient Safety Culture Hospital Survey 2.0. Welch’s analysis of variance and multiple linear regression were used to examine each factor’s impact on patient safety rating.

Results

Supervisors had a higher (P < 0.001) patient safety perception than people in other job types, whereas nurses had a lower (P < 0.001) patient safety perception than other job types. Level of organizational learning–continuous improvement (P < 0.001), level of hospital management (P < 0.001), level of leader support (P < 0.001), and ease of handoffs and information exchange (P < 0.001) were positively related to perceived patient safety.

Conclusions

This study highlights the importance of identifying the unique issues affecting nurses and supervisors, different from other job types, that may explain their lower patient safety ratings. Findings from this study suggest that it is critical for organizations to focus on initiatives and policies that promote leadership, management, ease in information exchange and handoffs, and continuous learning.