bluuebunny/crossref_metadata_2025 huggingface dataset:
Treating Caregiver Grief With Narrative Therapy
Authors: Matta Tara
Published: March 2022

Dementia, a devastating neurodegenerative disease with over 10 million new diagnoses each year, is characterized by many symptoms including memory loss .Individuals with memory less experience changes in mood, personality, behavior, cognition and activities of daily living which affect their daily lives. These monumental life shifts often occur rapidly, leaving caregivers unprepared to deal with the changes. Caregivers face a unique situations navigating anticipatory grief and changes in their relationships with their loved ones. Current psychological intervention for caregivers includes utilization of cognitive-behavioral therapy and psychoeducation. More recently, intriguing research has emerged regarding the efficacy of narrative therapy for couples where one partner experiences memory loss. However, treating the anticipatory grief component specifically for caregivers has been largely overlooked in these studies. Narrative therapy revolves around identifying the current story that caregivers utilize as their cognitive framework, helping to find alternative plotlines and to process their newly-built cognitive framework. It involves externalizing the problem (in this case, dementia) and locating strengths that the caregiver and their care receiver share to “fight” the problem. Insights from both the current literature and the field have demonstrated a promising outlook on the use of narrative therapy. Such insights imply a need for more research regarding this modality specifically for caregivers, as its core ideas can be easily disseminated to gerontologists, mental health professionals and caregivers.
The Unhurried Hermeneutics of Anti-Black Violence in Toni Morrison’sParadise
Authors: Castromán Soto Margarita M
Published: March 2022

The opening lines of Toni Morrison’s Paradise (1997) are undeniably some of her most famous: “They shoot the white girl first. With the rest they can take their time. No need to hurry out there… . there is time and the day has just begun” (3). While the novel eventually reveals the identity of those who constitute the “they” of the opening action, in a move that has received much critical attention, it famously leaves the first victim anonymous. This essay, however, draws our attention to “the rest.” What of the infamous black women of Paradise for whom the violence is slow and drawn out or the many more in our country whose names we say to rebuke a system of injustice that continues to insist that there is “no need to hurry” for “there is time and the day has just begun”?

Privileging a reading of time over space, the essay puts Morrison’s Paradise in conversation with Rob Nixon’s Slow Violence and the Environmentalism of the Poor (2011) and Moya Bailey’s Misogynoir Transformed: Black Women’s Digital Resistance (2021) in order to address the urgent need for a temporal reframing of anti-Black violence. Paying particular care to what Karla Holloway describes as the “comparative laxity” to which Black women in this country have historically been subjected and the extent to which that comparative laxity persists in the face of spectacular scenes of violence, the essay concludes with an examination of Breonna Taylor’s murder in 2020. It considers how the events that resulted in her death, like the fictional raid that frames Morrison’s novel, are byproducts of white supremacist systems of slow violence and misogynoir designed to wear down the opposition by attrition.
Learning through practice
Authors: Sensenig Julia A.
Published: March 2022

Service-learning experiences have been shown to improve nursing students' clinical and cultural awareness skills. This article discusses the implications of a collaborative service-learning program at a nursing center, particularly in improving nursing students' communication skills, and its potential for successful replication in other community health nursing settings.
Nurses' beliefs, attitudes, and opinions regarding a smoking ban in a psychiatric hospital
Authors: De Oliveira Renata Marques , Santos Jair Lício Ferreira , Furegato Antonia Regina Ferreira
Published: March 2022

Purpose:

This study aims to identify the beliefs, attitudes, and opinions of nursing professionals associated with tobacco smoking and its prohibition in a psychiatric hospital in Brazil.

Methods:

Using a cross-sectional epidemiologic study, a total of 73 nursing professionals in a smoke-free psychiatric hospital were interviewed. The Varimax Rotation and the Fisher's exact test at a 5% significance level were used to analyze the responses.

Findings:

Most nursing professionals reported observations of patients becoming calmer after smoking (n = 59, 80.8%) and tobacco withdrawal worsening patients' mental health symptoms, suggesting agreement among professionals that some psychiatric patients need to smoke tobacco. Most respondents stated that patients with mental health disorders have more difficulty with smoking cessation (79.4%) and are less interested in quitting smoking than those without disorders (95.9%). While one-third mentioned having used cigarettes as a reward or bribe, the majority (83.6%) was in favor of continuing the smoking ban, with more support observed from those working on a night shift and those who worked in the public psychiatric wards. Over 71% noted improvements in their health after the smoking ban.

Conclusion:

The nursing professionals were surprised by the effectiveness of the smoking ban and highlighted the improvement in the hospital environment after its implementation.

Clinical relevance:

As trusted healthcare professionals, nurses are essential in the fight against smoking and can contribute to awareness promotion, supporting patients during nicotine withdrawal, and decision-making processes for health policies.
Outcomes and Cost of Reduction of Overriding Pediatric Distal Radius Fractures
Authors: Bradley Hallie , Hartman Courtney A. , Crawford Shellye E. , Ramo Brandon A.
Published: March 2022

Background:

This study compared radiographic outcomes of pediatric patients undergoing closed reduction of 100% displaced distal radius fractures to a historical, published cohort treated with casting alone. We also examined the expense associated with sedated reduction.

Methods:

Single-center, retrospective cohort study examining radiographic outcomes following reduction of 100% translated distal radius fractures in 50 consecutive pediatric patients. Radiographic outcomes were compared with a historical cohort published by Crawford and colleagues. Charges associated with emergency department (ED) and clinic visits were compared between the reduction cohort and a comparison cohort of 13 patients with fractures not requiring reduction.

Results:

Forty-nine children (mean age 4.7 y) were included in this study. Duration of casting averaged 51 days and ED visit duration was 6.6±2.5 hours. Mean sagittal and coronal angulation at time of injury were 16.4 and 15.6 degrees, respectively, and were 13.2 and 9.4 degrees at the time of final follow-up. All fractures achieved radiographic union. Eighteen patients underwent a total of 21 unexpected cast changes. No patients required repeat sedation or surgical management.

Angulation after casting was significantly better in the reduction cohort compared with the casting-only cohort initially, however, at final follow-up, both coronal and sagittal angulation were significantly worse in the reduction cohort compared with the casting-only cohort (coronal angulation 8.59 vs. 0.75, P<0.0001; sagittal angulation 13.49 vs. 2.2, P<0.0001).

Charge analysis compared 46 patients in the reduction cohort to 13 patients with unreduced fractures from the same institution during the same time period. Mean clinic charges were similar ($1957 vs. $2240, P=0.3008). ED charges were higher in the reduction cohort compared with the nonreduction cohort ($7331 vs. $3501, P<0.001), resulting in higher total charges in the reduction cohort ($9245.04 vs. $5740.99, P<0.001).

Conclusions:

While closed reduction of 100% translated distal radius fractures in the pediatric population improves angulation initially, casting alone may provide similar or better radiographic outcomes, expedited care, reduced patient exposure to the risks of procedural sedation, and avoidance of ED charges associated with procedural sedation.

Level of Evidence:

Level III—therapeutic.
Comparison of Fusion Rate and Functional Outcome Between Local Cancellous Bone Plus Demineralized Bone Matrix and Local Bone in 1-Level Posterior Lumbar Interbody Fusion
Authors: Ko Sangbong , Jun Chungmu , Nam Junho
Published: March 2022

Study Design:

Retrospective study with prospectively collected data.

Objective:

The purpose of this study is to investigate the difference in fusion rate and clinical outcome of patients with local bone as filler for the graft and demineralized bone matrix (DBM) plus only the cancellous bone from local bone as a filler for cage in 1-level posterior lumbar interbody fusion (PLIF) with cage.

Summary of Background Data:

Cancellous bone is more advantageous than cortical bone in the local bone for improving bone formation in spine fusion surgery. There are little studies on the difference in fusion rate and reduction of fusion time using only these cancellous bones.

Methods:

Of the 40 patients who underwent 1-level PLIF using cage, 20 patients in group A used local bone and 20 patients in group B used mixture of cancellous bone extracted separately from local bone and commercially available DBM as filler for cage. Changes in fusion rate and intervertebral spacing were measured using lateral radiography, and fusion was determined as nonunion using the Brantigan-Steffee classification. The clinical outcome was evaluated.

Results:

There was no difference in height change over time between the two groups. Regarding union grade, group B showed better union grade than group A. However, no difference in union grade change over time was observed between the 2 groups. In group B, Oswestry Disability Index (ODI), Rolland-Morris Disability Questionnaire (RMDQ), and SF-36 mental component score (MCS) significantly decreased, but there was no difference in change over time.

Conclusions:

In 1-level PLIF for degenerative lumbar disease, better fusion rate was observed in the group that used only cancellous bone from local bone plus DBM than that in the group that used local bone; however, there was no difference in fusion grade change over time in the 2 groups.
Conduit over conduit reconstruction of retracted and fibrosed ileal conduit in severe abdominal adhesions
Authors: Wani Mudassir , Bhat Tahir , Sheriff Matin
Published: March 2022

We report a unique case of a patient who underwent cystectomy with ileal conduit for nonmalignant bladder disease. Patient postoperatively developed stomal necrosis which was managed conservatively but after few months there was severe stomal stenosis and retraction and patient ended up with bilateral nephrostomies. On planned open abdominal exploration with intention to refashion stoma, after resection of distal stenosed segment we found that it was impossible to mobilize proximal portion of conduit due to severe small bowel adhesions. We used a unique approach of creating one more ileal conduit, bringing it as a new stoma on one side and anastomosing its other side with proximal one (ileal conduit over conduit) to augment deficient portion. This technique is not mentioned in the literature and as such we are reporting same as it can help many urologists who may encounter such problems.
Heat-related mortality prediction using low-frequency climate oscillation indices: Case studies of the cities of Montréal and Québec, Canada
Authors: Masselot Pierre , Ouarda Taha B.M.J. , Charron Christian , Campagna Céline , Lavigne Éric , St-Hilaire André , Chebana Fateh , Valois Pierre , Gosselin Pierre
Published: March 2022

Background:

Heat-related mortality is an increasingly important public health burden that is expected to worsen with climate change. In addition to long-term trends, there are also interannual variations in heat-related mortality that are of interest for efficient planning of health services. Large-scale climate patterns have an important influence on summer weather and therefore constitute important tools to understand and predict the variations in heat-related mortality.

Methods:

In this article, we propose to model summer heat-related mortality using seven climate indices through a two-stage analysis using data covering the period 1981–2018 in two metropolitan areas of the province of Québec (Canada): Montréal and Québec. In the first stage, heat attributable fractions are estimated through a time series regression design and distributed lag nonlinear specification. We consider different definitions of heat. In the second stage, estimated attributable fractions are predicted using climate index curves through a functional linear regression model.

Results:

Results indicate that the Atlantic Multidecadal Oscillation is the best predictor of heat-related mortality in both Montréal and Québec and that it can predict up to 20% of the interannual variability.

Conclusion:

We found evidence that one climate index is predictive of summer heat-related mortality. More research is needed with longer time series and in different spatial contexts. The proposed analysis and the results may nonetheless help public health authorities plan for future mortality related to summer heat.
Low-Dose Ferrous Bisglycinate Chelate Supplementation in Chronic Kidney Disease and Hemodialysis Patients
Authors: Hsu Cheng-Yi , Chen Jui-Ching , Tsai Yu-Cheng , Chen Tzen-Wen
Published: March 2022

Background:

Provision of parenteral or oral iron supplementation can restore iron stores and maintain stable hemoglobin levels in chronic kidney disease (CKD) and hemodialysis (HD) patients. The route for oral or intravenous (IV) administration of iron depends on the acuity of anemia, costs and patient tolerance. IV iron can restore iron stores rapidly but also carries higher risks for allergy and infection. Oral iron supplementation is limited by high gastrointestinal adverse effects.

Methods:

We conducted an open label trial to study the efficiency of a film-coated iron supplementation tablet, which contains ferrous bisglycinate chelate, vitamin C and folic acid, in CKD stage 3b to 4 and HD patients.

Results:

27 HD patients and 20 CKD patients participated this study. After a 16 week intervention, low dose ferrous bisglycinate chelate improved serum iron concentration (67.8 vs 87.2 mg/dL, p=0.04) and transferrin saturation (24.7% vs 31.3%, p=0.03) in stage 3~4 CKD patients, restored iron loss and maintained stable hemoglobin levels in HD patients. No GI upset events were reported.

Conclusion:

Ferrous bisglycinate chelate is a well-tolerated oral iron supplementation for CKD and HD patients.
Flow diverter manages very small aneurysm of the internal carotid artery
Authors: Lee Chien-Hui , Luo Chao-Bao , Lai Yen-Chun , Chang Feng-Chi , Lin Chung-Jung
Published: March 2022

Background:

Endovascular aneurysm coiling is a minimally invasive method to manage intracranial aneurysms. However, aneurysm coiling may fail in very small aneurysms (VSAs); thus, flow diverter (FD) is recommended as an alternative in these difficult aneurysms. Herein, we report our experience and outcomes of FD to treat VSA of the internal carotid artery (ICA).

Methods:

Over a 3-year period, a total of 70 patients with 87 unruptured VSAs of the ICA were managed by FD. There were 54 men and 16 women, with a mean age of 57 (range, 41–75) years. We retrospectively assessed the clinical data, aneurysm characteristics, and angiographic as well as clinical outcomes of patients treated by FD and compared with larger aneurysms.

Results:

Fifty aneurysms (58%) were located in the supraclinoid ICA, followed by paraclinoid ICA (n = 31, 36%) and cavernous ICA (n = 6, 7%). Most aneurysms (n = 72, 83%) were between 2 and 3 mm in size. The mean aneurysm size was 2.3 mm (range, 1.5–3 mm). Follow-up angiographic data (mean, 13 months) were available in 54 patients with 68 aneurysms. Successful FD deployment in an ideal position to bride aneurysm was achieved in 86 of 87 aneurysms (99%). Complete obliteration (CO) was achieved in 63 aneurysms (93%). Compared with larger aneurysms (>3 mm), VSAs had the tendency to achieve CO (p < 0.05) in a midterm follow-up. Two patients (2.8%) had intraprocedural complications, including in-stent thrombosis (n = 1) and distal embolism (n = 1). One patient (1.4%) suffered from mild limb weakness.

Conclusion:

The use of FD to manage VSA was technically feasible, and the procedure was simpler than those of larger aneurysms. FD stenting of VSAs was confirmed to be effective and safe and had higher CO rate than those in larger aneurysms in a midterm angiographic follow-up.
Renal recovery after acute kidney injury in a minority population of hospitalized COVID-19 patients
Authors: Sarwal Amara , Gomez Edgar , Perez-Gutierrez Victor , Carlos Alex , Afzal Afsheen , Sivakumar Mangai , Rabah Sami , Kasubhai Moiz , Gnanasekaran Isaiarasi , Menon Vidya
Published: March 2022

This study aimed to characterize survivors of Coronavirus disease 2019 (COVID-19) infection and acute kidney injury (AKI) that recover their renal function or progress to acute kidney disease (AKD) on discharge; and determine factors associated with progression to AKD during hospital stay.

One thousand seventy four patients with COVID-19 infection were followed up until discharge/death. The incidence of AKI was 59.7%. Two hundred and sixty-six patients were discharged alive and included in the analysis, 71.8% had renal recovery (RR) while 28.2% were discharged with AKD. The AKD subset has higher rate of chronic kidney disease (CKD) ≥3 (33.4% vs 14.1%, P = .001), congestive heart failure (18.7% vs 5.8%, P = .001), use of non-invasive mechanical ventilation (10.7% vs 3.7%, P = .026) and vasopressors (25.3% vs 12.0%, P = .007). Of 19 patients in the AKI survivor cohort who received renal replacement therapy, 1 had RR while 18 progressed to AKD on discharge. Predictors to progression to AKD were CKD ≥3 (Odds Ratio [OR]: 3.23, 95% confidence interval [CI] 1.59-6.56, P = .001), congestive heart failure (OR: 4.59, 95% CI 1.76-11.78, P = .002), AKI on admission (OR: 2.71, 95% CI, 1.14-6.46, P = .025), and ongoing diarrhea (OR: 3.19, 95% CI, 1.02-9.96, P = .025).

This study demonstrates a higher proportion of RR among survivors of COVID-19 infection in our minority predominant cohort. Early identification and appropriate management of patients at-risk to progress to AKD could improve outcomes, reduce long term sequalae of CKD/end stage renal disease, and have a major impact on health outcome and financial strain on healthcare system.
Demographic predictors of treatments and surgical complications of lumbar degenerative diseases
Authors: Al Jammal Omar M. , Shahrestani Shane , Delavar Arash , Brown Nolan J. , Gendreau Julian L. , Lien Brian V. , Sahyouni Ronald , Diaz-Aguilar Luis Daniel , Shalakhti Omar S. , Pham Martin H.
Published: March 2022

This was a national database study.

To examine the role of comorbidities and demographics on inpatient complications in patients with lumbar degenerative conditions.

Degenerative conditions of the lumbar spine account for the most common indication for spine surgery in the elderly population in the United States. Significant studies investigating demographic as predictors of surgical rates and health outcomes for degenerative lumbar conditions are lacking.

Data were obtained from the National Inpatient Sample from 2010 to 2014 and International Classification of Diseases, 9th revision, Clinical Modification codes were used to identify patients with a primary diagnosis of degenerative lumbar condition. Patients were stratified based on demographic variables and comorbidity status. Multivariate regression analyses were used to determine whether any individual demographic variables, such as race, sex, insurance, and hospital status predicted postoperative complications.

A total of 256,859 patients were identified for analysis. The rate of overall complications was found to be 16.1% with a mortality rate of 0.10%. Female, Black, Hispanic, and Asian/Pacific Islander patients had lower odds of receiving surgical treatment compared to White patients (P<.001). Medicare and Medicaid patients were less likely to be surgically managed than patients with private insurance (OR = 0.75, 0.37; P<.001, respectively). Urban hospitals were more likely to provide surgery when compared to rural hospitals (P < .001). Patients undergoing fusion had more complications than decompression alone (P < .001). Females, Medicare insurance status, Medicaid insurance status, urban hospital locations, and certain geographical locations were found to predict postoperative complications (P < .001).

There were substantial differences in surgical management and postoperative complications among individuals of different sex, races, and insurance status. Further investigation evaluating the effect of demographics in spine surgery is warranted to fully understand their influence on patient complications.
Effects of low-FODMAP diet on irritable bowel symptoms in patients with quiescent inflammatory bowel disease
Authors: Gu Baijian , Yu Zhe , Shi Chong , Yan Chengqiu , Chen Bixin , Zhou Jianhua
Published: March 2022

Background:

Inflammatory bowel disease (IBD) is a chronic disease whose etiology is not yet fully understood, and their course is characterized by periods of exacerbation and remission. In quite a few cases, actual disease remission may also accompany with inflammatory bowel disease (IBS)-like symptoms such as abdominal pain, bloating, flatulence, and diarrhea, may greatly impact quality of life. An army of strong evidence to support the FODMAPs diet (LFD) compounds as an effective dietary approach to IBS treatment. However, there is no significant evidence showing the effectiveness of LFD in treating quiescent IBD and its side effects; this lack of evidence is also an important factor hindering its promotion in the treatment of IBD and its complications. Therefore, this systematic review and meta-analysis will evaluate the efficacy and safety of LFD in the treatment of quiescent IBD patients with IBS-like symptoms.

Method:

We searched the following databases from their establishment until December 2021: PubMed, Web of Science, Embase, Cochrane Library, CNKI, VIP, and Wanfang databases. No restrictions regarding publication date or language were applied. Keywords such as “Crohn’s disease,” “ulcerative colitis,” “inflammatory bowel disease,” and “FODMAPs” have been combined for search. Ongoing and unpublished research in the Clinical Trials Registry Research will also be included. At the same time, we will manually search all reference lists from relevant systematic reviews for other eligible studies. The selected studies were randomized controlled clinical trials. We will meta-analyze the selected literature by Review Manager software (REVMAN v5.4 Cochrane Collaboration). Two researchers will independently review the research selection, data extraction, and research quality assessments. Finally, we will observe the outcome measures.

Results:

This study will provide evidence-based data for TFD treatment of IBD and provide new treatment options for future clinical applications.

Ethics and dissemination:

The protocol of the systematic review does not require ethical approval because it does not involve humans. This article will be published in peer-reviewed journals and presented at relevant conferences.

Registration Number:

INPLASY202220060
Comparative efficacy and safety of glyburide, metformin, and insulin in treatment of gestational diabetes mellitus
Authors: Lin Jing , Tu Rong-zu , Hong Xun-yu
Published: March 2022

Background:

The increased prevalence of gestational diabetes mellitus (GDM) has caused a huge societal economic and healthy burden at both the population and individual levels. We aimed to assess the comparative efficiency and safety of the use of glyburide, metformin, and insulin in GDM from a protocol for systematic review and meta-analysis.

Methods:

Two individual researchers conducted the platform searches on the PubMed, Cochrane Library, and Embase databases from inception to February 2022. Literature retrieving was carried out through a combined searching of subject terms (“MeSH” on PubMed and “Emtree” on “Embase”) and free terms on the platforms of PubMed and Embase, and through keywords searching on platform of Cochrane Library. Systematic review and meta-analysis of the data will be performed in STATA13.0 software according to the Preferred Reporting Items of Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Two authors independently performed the literature searching, data extraction, and quality evaluation. Risk of bias was assessed using the Cochrane Risk of Bias Tool for randomized controlled trials.

Results:

The results will be submitted to a peer-reviewed journal.

Conclusion:

This meta-analysis will provide a comprehensive analysis and synthesis that can be used as an evidence map to inform practitioners and policy makers about the effectiveness of glyburide, metformin, and insulin for patients with GDM.
Risk factors for mortality from sepsis in an intensive care unit in Ecuador
Authors: Vélez Jorge W. , Aragon Davi C. , Donadi Eduardo A. , Carlotti Ana P.C.P.
Published: March 2022

To investigate risk factors for mortality from sepsis in an intensive care unit (ICU) in Quito-Ecuador and their association to adherence to Surviving Sepsis Campaign recommendations.

Prospective cohort study of patients with severe sepsis/septic shock admitted to the ICU of a public Ecuadorian hospital from March, 2018 to March, 2019. Demographic, clinical, treatment, and outcome data were collected from patients’ health records. Patients were divided into 2 groups according to ICU survival or death. Log-binomial regression models were used to identify risk factors for mortality.

In total, 154 patients were included. Patients who died in the ICU (n = 42; 27.3%) had higher sequential organ failure assessment score (median 11.5 vs 9; P<.01), more organ dysfunction (median 4 vs 3; P<.0001), and received greater volumes of fluid resuscitation in the first 6 hours (median 800 vs 600 mL; P = .01). Dysfunction of > 2 organs was a risk factor for mortality (relative risks [RR] 3.80, 95% CI 1.33-10.86), while successful early resuscitation (RR 0.32, 95% CI 0.15-0.70), successful empirical antibiotic treatment (RR 0.38, 95%CI 0.18-0.82), and antibiotic de-escalation (RR 0.28, 95%CI 0.13-0.61) were protective factors.

Dysfunction of >2 organs was a risk factor for mortality from sepsis while successful early resuscitation and appropriate antibiotic treatment were protective.
Comparison of the outcomes of hemorrhoidectomy and PPH in the treatment of grades III and IV hemorrhoids
Authors: Zhang Chaojie , Zhang Weiping , Xu Jian
Published: March 2022

To investigate the clinical effect and outcome of traditional hemorrhoidectomy and procedures for prolapse and hemorrhoid (PPH) for the treatment of grades III and IV hemorrhoids.

We retrospectively reviewed 1003 grades III and IV hemorrhoid patients who presented to our hospital. A total of 585 patients underwent PPH, and 418 patients underwent hemorrhoidectomy. The outcomes were 1-year recurrence, postoperative complications, surgery-related complications, and indicators.

No significant difference between the 2 treatment groups regarding patient demographics. All patients underwent more than 12months of postoperative follow-up. No significant difference between the 2 treatment groups in 1-year recurrence. PPH can markedly improve anal pain, postoperative bleeding, difficult urination, and postoperative resting anal pressure. The operative blood loss, operative time, wound healing time, and wound infection rates were decreased significantly in the PPH group compared with the traditional hemorrhoidectomy group.

Our data suggest that PPH is useful and safe for grades III and IV hemorrhoids. It can reduce postoperative and surgery-related complications. However, this was a single-hospital retrospective study. Therefore, well-designed, multicenter, randomized controlled trials are needed to evaluate the value of PPH for grades III and IV hemorrhoids.
Acute respiratory distress syndrome triggered by marked cytokine storm in a subject with diabetic ketoacidosis
Authors: Horiya Megumi , Anno Takatoshi , Shigemoto Ryo , Koyama Katsumasa , Kawasaki Fumiko , Tomoda Koichi , Kaku Kohei , Kaneto Hideaki
Published: March 2022

Rationale:

Acute respiratory distress syndrome (ARDS) is an acute diffuse inflammatory lung injury. Many causes of acute direct and indirect lung injury have been described as possible initiators of ARDS. According to the literature data, ARDS could be a rare complication associated with the acute onset of diabetic ketoacidosis (DKA). Moreover, it has been suggested that cytokine release during DKA is involved in the above-mentioned acute clinical complications of DKA.

Patientconcerns:

A 48-year-old Japanese woman with a 4-year history of type 1 diabetes mellitus was brought to an emergency room with symptoms of deteriorated consciousness. Three days before, she was diagnosed with influenza A infection.

Diagnosis:

Inflammation markers were markedly elevated and she was under DKA condition. Since her respiratory conditions were suddenly and markedly aggravated 2 days later, we diagnosed her as ARDS and continued systemic management with the ventilator.

Interleukin-6 (IL-6) level was markedly elevated at the onset of ARDS, although IL-6 level was high at the onset of DKA. ARDS was suggested to be caused by marked cytokine storm and DKA.

Interventions:

We continued to treat her hyperglycemic crises. Moreover, we continued systemic management with the ventilator.

Outcomes:

Approximately three weeks later, her general conditions were stabilized and ventilator management was stopped. We successfully treated her ARDS and hyperglycemic crises.

Lessons:

This case is very important because it shows that DKA can induce cytokine storm, which leads to the onset of ARDS. Therefore, monitoring various cytokines such as IL-6, which are associated with ARDS during the period of treatment of DKA is beneficial.
Effectiveness of radiofrequency ablation for treatment of plantar fasciitis
Authors: Kurtoglu Alper , Kochai Alauddin , Inanmaz Mustafa Erkan , Sukur Erhan , Keskin Dogan , Türker Mehmet , Sen Zafer , Daldal Ismail , Avan Laçin Yüksel
Published: March 2022

Plantar fasciitis is the most common cause of heel pain. Pain can be persistent in some patients and interrupt daily activities and sportive activities. There are a lot of treatment options available for plantar fasciitis. We hypothesized that patients with chronic persistent plantar fasciitis can be successfully treated with radiofrequency nerve ablation (RFNA).

Two hundred sixty-one patients with plantar fasciitis (378 feet) treated with RFNA from February 2017 to January 2019 were retrospectively assessed. All the patients had plantar heel pain for at least 6months. Based on their body mass index (BMI), the enrolled patients were divided into obese (BMI ≥ 30kg/m2) and non-obese (BMI < 30kg/m2) groups. The patients were asked to complete a questionnaire just before and after the procedure and during the final follow-up. The BNS Radiofrequency Lesion Generator was used during a single session. The patients’ information, including their visual analogue scale (VAS) score and American Orthopaedic Foot and Ankle Society (AOFAS) score, was assessed. During their final follow-up, the patients were asked to rate the success of their treatment by choosing one of the following options: completely successful, very successful, moderately successful, marginally successful, or not successful.

The VAS and AOFAS scores of all the patients were evaluated pre-procedure, in the first month after procedure, and during the final follow-up (8-24 months). There was a statistically significant difference between the pre-procedure and postprocedure VAS scores (P < .001), there was no statistically significant difference between the VAS scores in the first month postprocedure and during the final follow-up.

There was a statistically significant difference between the pre-procedure and postprocedure AOFAS scores (P < .001), there was no statistically significant difference between the AOFAS scores in the first month postprocedure and during the final follow-up.

RFNA can be used as an alternative method to surgical procedures for treating plantar fasciitis because it is safe and effective. The advantages of RFNA are that patients can quickly return to their work and resume weight-bearing activities.
Serum antiphospholipid antibody status may not be associated with the pregnancy outcomes of patients undergoing in vitro fertilization
Authors: Tan Xiao-Fang , Xu Li , Li Ting-Ting , Wu Yan-Ting , Ma Wei-Wei , Ding Jia-Yi , Dong Hong-Li
Published: March 2022

Background:

Antiphospholipid syndrome (APS) is an autoimmune disease that is associated with recurrent pregnancy loss. It is still controversial whether the presence of antiphospholipid antibodies (aPL) in the serum of patients with in vitro fertilization-embryo transfer (IVF-ET) has a negative effect on the outcomes. In view of the discrepancies, a meta-analysis of the published data was performed to explore the relationship of aPL and IVF-ET outcomes.

Methods:

We searched for all published articles indexed in PubMed, Web of Science, and Cochrane Library, which were retrieved up to April, 2021. A total of 921 studies were yielded, of which 6 finally met the inclusion criteria. We carried out the meta-analysis by pooling results of these studies with Review Manager 5.3 software. The effect index was measured with 95% confidence intervals (CIs) of the relative risks (RRs).

Results:

Six eligible studies were included in this meta-analysis, involving 3214 patients. Our results showed that positive aPL was not associated with decreased clinical pregnancy rate (RR 0.97; 95% CI 0.91-1.04). There was no correlation between positive aPL and increased miscarriage risk (RR 1.22; 95% CI 0.94-1.58). Only 5 of the 6 studies referred to live birth rate, but still no association was found between them (RR 0.95; 95% CI 0.81-1.11).

Conclusions:

The results showed that the presence of positive aPL neither decreased clinical pregnancy rate and live birth rate, nor increased miscarriage rate in women undergoing IVF, which is differed from the opinion of clinical practice. More prospective studies with high quality and larger sample size are needed to evaluate the relationship between positive aPL and outcomes of IVF-ET.
Palliative Care for Patients With Heart Failure
Authors: Kim Changhwan , Kim Sanghee , Lee Kyunghwa , Choi Jahyun , Kim Sookyung
Published: March 2022

Palliative care should be integrated into routine disease management for all patients with serious illness, regardless of settings or prognosis. The purposes of this integrative review were to identify the features of randomized controlled trials for adult patients with heart failure and to provide basic references for the development of future trials. Using Whittemore and Knafl's integrative literature review method, comprehensive searches of the PubMed, Cochrane Library, CINAHL, EMBASE, and Korean databases were conducted, integrating keywords about heart failure and palliative care interventions. Quality appraisal was assessed using Cochrane risk-of-bias tools. In total, there were 6 trials providing palliative care interventions integrating team-based approaches between palliative care specialists and nonpalliative clinicians, such as a cardiologist, cardiac nurse, and advanced practice nurse across inpatient and outpatient settings. The different types of interventions included home visits, symptom management via phone calls or referral to a specialist team, and the establishment of treatment planning. Patient-reported outcome measures included positive effects of palliative interventions on symptom burden and quality of life. Given that most of the selected studies were conducted in Western countries, palliative care should be culturally tailored to assist heart failure patients worldwide.
Characteristics and Outcomes of Left-sided Ulcerative Colitis With a Cecal/Periappendiceal Patch of Inflammation
Authors: Albayrak Nazire E. , Polydorides Alexandros D.
Published: March 2022

Ulcerative colitis (UC) is characterized by continuous mucosal inflammation of the rectum, extending uninterrupted to a variable portion of the colon proximally. However, in some patients with distal colitis, a distinct pattern of skip inflammation (so-called patch) involves the cecum and/or appendiceal orifice, but data on this entity are contradictory, and its significance and prognosis are still debated. We identified 102 adult cases of left-sided UC with a cecal/periappendiceal patch and compared them to 102 controls (left-sided UC only) along clinicopathologic characteristics and disease outcomes. In multivariate analysis, patients with a patch were younger (median age: 31 vs. 41 y; P=0.004) and more likely to have rectosigmoid involvement only (58.8% vs. 28.4%; P<0.001), compared with patients without a patch. During follow-up, patients with a patch were more likely to be eventually diagnosed with Crohn disease (CD) (9.8% vs. 1.0%; P=0.022) and to show proximal extension of inflammation (35.6% vs. 10.0%; P=0.021), but showed no differences in rates of neoplasia, colectomy, or pharmacotherapy escalation. Kaplan-Meier analysis confirmed that patients with a biopsy diagnosis of cecal/periappendiceal patch were more likely to show proximal disease extension (P<0.001) and to be diagnosed with CD (P=0.008). In conclusion, cecal/periappendiceal skip inflammation in left-sided UC occurs more often in younger patients and in those with rectosigmoid involvement and is associated with proximal disease extension and, in a small fraction of cases, change of diagnosis to CD. However, it does not portend increased risk of neoplasia, pharmacotherapy escalation, or subsequent colectomy, compared with patients with left-sided UC only.
Cutaneous Myoepithelial Neoplasms on Acral Sites Show Distinctive and Reproducible Histopathologic and Immunohistochemical Features
Authors: Mehta Arjun , Davey Jonathan , Gharpuray-Pandit Deepa , Plaza Jose A. , Billings Steven D. , Balogh Petra , Tchrakian Nairi , Selvan Sharmila , Wiedemeyer Katharina , Hornick Jason L. , Brenn Thomas
Published: March 2022

Cutaneous myoepithelial neoplasms are a heterogenous group of neoplasms with mixed tumors typically affecting the head and myoepitheliomas showing a predilection for the extremities. Their malignant counterparts, myoepithelial carcinoma, and malignant mixed tumor are exceptionally rare in the skin, and the morphologic criteria for malignancy are only poorly defined. The aim of the present study was to characterize the clinicopathologic features of myoepithelial neoplasms presenting on acral skin. The clinical and histopathologic features of 11 tumors were recorded, and follow-up was obtained. Immunohistochemistry was performed for S100, SOX10, glial fibrillary acidic protein, keratins, epithelial membrane antigen, p63, p40, smooth muscle actin, desmin, and PLAG1. The tumors mainly affected the feet of adults (range: 26 to 78 y; median: 47 y) with a predilection for the great toe and a male predominance of 1.8:1. Most tumors (91%) displayed a lobular architecture composed of solid and nested growth of epithelioid cells with plasmacytoid features in a myxoid or angiomatous stroma. Scattered cytologic atypia and rare duct differentiation were frequently noted. Three tumors with confluent cytologic atypia, infiltrative growth, and lymphovascular invasion were classified as malignant. By immunohistochemistry, the tumors were positive for S100, SOX10, keratins AE1/AE3, CK5/6 and CK7, and PLAG1. Local recurrence and bilateral pulmonary metastasis were observed in a patient presenting with a histopathologically benign-appearing tumor. Two patients with malignant tumors experienced local recurrences, and 1 developed metastasis to soft tissue, lung, and mediastinal lymph nodes. All patients are currently alive, all but 1 with no evidence of disease after a median follow-up interval of 96 months (range: 2 to 360 mo). In conclusion, acral myoepithelial neoplasms show distinctive and reproducible histopathologic and immunohistochemical features. They are best regarded as a distinctive subset of mixed tumors with features reminiscent of their salivary gland counterparts. While most tumors pursue a benign disease course, histopathologic features appear to be a poor indicator of prognosis.
Real-life Progression of the Use of a Genetic Panel in to Diagnose Neonatal Cholestasis
Authors: Ito Shogo , Togawa Takao , Imagawa Kazuo , Ito Koichi , Endo Takeshi , Sugiura Tokio , Saitoh Shinji
Published: March 2022

Objectives:

The study aimed to construct an advanced gene panel to ascertain the genetic etiology of patients with neonatal/infantile intrahepatic cholestasis (NIIC), and test patients with NIIC in a clinical setting.

Methods:

From the group of NIIC patients, whom we had previously tested with our old 18-gene panel from May 2013 to September 2017 but could not establish a definitive diagnosis, we included 191 in the retrospective reanalysis group for this study. Additionally, we recruited 124 patients with NIIC into a prospective analysis group from October 2017 to October 2019. Cholestasis was defined as a serum direct bilirubin level >1.0 mg/dL. We constructed a 61-gene panel for targeted next-generation sequencing of the patients.

Results:

In the retrospective reanalysis group, we found mutations in ABCC2, MPV17, NPC1, CFTR, NR1H4, or CYP27A1 in 10 (5.2%) of the 191 patients. In the prospective analysis group, 33 (26.6%) of the 124 patients had a causative mutation in JAG1, NOTCH2, ABCC2, SLC25A13, ABCB11, POLG, NPC1, CFTR, ATP8B1, or ABCB4. The top 3 genetic diagnoses were of Alagille syndrome, neonatal Dubin-Johnson syndrome, and neonatal intrahepatic cholestasis caused by citrin deficiency, which together constitute 78.8% of the genetic causes of cholestasis in Japan. We also identified 3 genotypes associated with Crigler-Najjar syndrome type 2 in the retrospective reanalysis group.

Conclusions:

The advanced NIIC gene panel successfully uncovered molecular genetic etiologies of NIIC not only in the reanalysis group but also in the prospective cohort. Crigler-Najjar syndrome type 2 patients may be included along with NIIC patients.
Brief Report: Use of Remnant Specimens to Assess Use of HIV PrEP Among Populations With Risk of HIV Infection: A Novel Approach
Authors: Pathela Preeti , Qasmieh Saba , Gandhi Monica , Rozen Elliot , Okochi Hideaki , Goldstein Harris , Herold Betsy C. , Jamison Kelly , Schillinger Julia A. , Nash Denis
Published: March 2022

Background:

HIV-uninfected persons being evaluated for sexually transmitted infections (STIs) may be good HIV pre-exposure prophylaxis (PrEP) candidates. We measured PrEP use in a sentinel STI patient population.

Design:

Cross-sectional study, New York City Sexual Health Clinics (January 2019–June 2019).

Methods:

Remnant serum samples from 644 HIV-uninfected men who have sex with men (MSM) and 97 women diagnosed with chlamydia, gonorrhea, and/or early syphilis were assayed for tenofovir and emtricitabine levels using a validated liquid chromatography–mass spectrometry assay. Using paired test results and medical records, we assessed (1) prevalence and (2) correlates of PrEP use on the day of STI diagnosis (adjusted prevalence ratios [aPRs]).

Results:

PrEP use among 741 patients was 32.7% [95% confidence interval (CI): 29.3 to 36.0]; 37.3% for MSM and 2.1% for women. PrEP use was high among White MSM (46.8%) and lowest among women. Among MSM with rectal chlamydia/gonorrhea or early syphilis, PrEP use was associated with age [aPR = 1.7 (95% CI: 1.2 to 2.4) for ages 25–34 years and aPR = 2.0 (1.4 to 2.9) for ages 35–44 years, vs. 15 to 24 years]; number of recent sex partners [aPR = 1.4 (1.0 to 2.0) for 3–5 partners, aPR = 2.1 (1.5 to 3.0) for 6–10 partners, aPR = 2.2 (1.6 to 3.1) for >10 partners, vs. ≤2 partners]; having sex/needle-sharing partners with HIV [aPR = 1.4 (1.1–1.7)]; and inconsistent condom use [aPR = 3.3 (1.8–6.1)]. Race/ethnicity, past-year STI diagnosis, and postexposure prophylaxis use were not associated.

Conclusions:

One in 3 people with newly diagnosed STIs had detectable serum PrEP, and PrEP use was exceedingly rare among women. Routinely collected remnant samples can be used to measure PrEP use in populations at high risk of HIV acquisition.
Antidepressant psychopharmacology: is inflammation a future target?
Authors: Benedetti Francesco , Zanardi Raffaella , Mazza Mario Gennaro
Published: March 2022

Raised inflammatory setpoints have been associated with major depression and its detrimental consequences on brain function, as they lead to increased production of cytokines, changes in gene expression and activated brain microglia. Three main lines of evidence support immune-inflammatory mechanisms as targets for the treatment of depression. First, higher inflammation hampers response to antidepressants, and effective antidepressant treatment decreases inflammation. Second, conventional antidepressants share immune-modulatory and anti-inflammatory properties, which could affect inflammation during the depression. Third, anti-inflammatory and immune-modulatory treatments proved superior to placebo in randomized controlled antidepressant trials. New targets and new pharmacologic treatment for immune-mediated inflammatory diseases have been identified and tested in several medical settings and interest is warranted for testing them as antidepressants.
Healthcare workers’ perceptions and medically approved COVID-19 infection risk: understanding the mental health dimension of the pandemic. A German hospital case study
Authors: Kuhlmann Ellen , Behrens Georg M. N. , Cossmann Anne , Homann Stefanie , Happle Christine , Dopfer-Jablonka Alexandra
Published: March 2022

Introduction

This study analyses how healthcare workers (HCWs) perceived risks, protection and preventive measures during the COVID-19 pandemic in relation to medically approved risks and organisational measures. The aim is to explore ‘blind spots’ of pandemic protection and make mental health needs of HCWs visible.

Methods

We have chosen an ‘optimal-case’ scenario of a high-income country with a well-resourced hospital sector and low HCW infection rate at the organisational level to explore governance gaps in HCW protection. A German multi-method hospital study at Hannover Medical School served as empirical case; document analysis, expert information and survey data (n=1163) were collected as part of a clinical study into SARS-CoV-2 serology testing during the second wave of the pandemic (November 2020-February 2021). Selected survey items included perceptions of risks, protection and preventive measures. Descriptive statistical analysis and regression were undertaken for gender, profession and COVID-19 patient care.

Results

The results reveal a low risk of 1% medically approved infections among participants, but a much higher mean personal risk estimate of 15%. The majority (68.4%) expressed ‘some’ to ‘very strong’ fear of acquiring infection at the workplace. Individual protective behaviour and compliance with protective workplace measures were estimated as very high. Yet only about half of the respondents felt strongly protected by the employer; 12% even perceived ‘no’ or ‘little’ protection. Gender and contact with COVID-19 patients had no significant effect on the estimations of infection risks and protective workplace behaviour, but nursing was correlated with higher levels of personal risk estimations and fear of infection.

Conclusions

A strong mismatch between low medically approved risk and personal risk perceptions of HCWs brings stressors and threats into view, that may be preventable through better information and risk communication and through investment in mental health and inclusion in pandemic preparedness plans.