bluuebunny/crossref_metadata_2025 huggingface dataset:
Disclosure status of HIV-positive children and associated factors among children in public health facilities in East Arsi zone, Oromia regional state, South Eastern Ethiopia: A cross-sectional study
Authors: Yami Dereje Bikila , Tuji Techane Sisay , Gelete Bedasa W/Michael , Beyene Workie Kassahun
Published: January 2022

Objectives:

This study aims to assess the disclosure status of HIV-positive children and its associated factors in selected hospitals in East Arsi zone, Oromia regional state, Ethiopia, 2020.

Methods:

Institutional-based cross-sectional study design was conducted on 410 sample size. Four hospitals were randomly selected among hospitals that currently gave service. Data were collected from caregivers/biological parents by interviewing from 30 July 2020 to 30 August 2020 using the systematic random sampling technique. In logistic regression analysis, the variables which had independent correlations with dependent variable were identified based on adjusted odds ratio and a p value <0.05 with 95% confidence interval was claimed as statistically significant.

Results:

Disclosure status of HIV-positive children was 59.8%, 95% confidence interval (54.9, 64.1). Children diagnosed at the age of <5 (adjusted odds ratio = 0.25, 95% confidence interval (0.126, 0.49)), antiretroviral therapy follow-up for 6–15 years (adjusted odds ratio = 2.08, 95% confidence interval (1.013, 4.29)), children diagnosed at the appropriate age of ⩾12 years (adjusted odds ratio = 1.95, 95% confidence interval (1.09, 3.49)), and children diagnosed at the age of <11 years (adjusted odds ratio = 4.5, 95% confidence interval (3.45, 8.38)) were positively associated factors to disclose status.

Conclusion:

The disclosure status of HIV-positive children was low in this study. Antiretroviral therapy follow-up for 6–15 years, children diagnosed at the appropriate age of ⩾12 years, children diagnosed at the age of <5 years, and children who aged below 11 years were positively associated with disclosure status. Thus, we recommended, health care providers and all stakeholders should give age-appropriate counseling regarding when and why to disclose their status.
Incidence of postoperative, major, adverse cardiac events in patients undergoing carotid endarterectomy: A single-center, retrospective study
Authors: Suphathamwit Aphichat , Leewatchararoongjaroen Chutima , Rujirachun Pongprueth , Poopong Kittipatr , Leesakul Apichaya , Junyavoraluk Apichaya , Ruangsetakit Chanean
Published: January 2022

Objective:

This study aimed to determine the incidence of postoperative major adverse cardiac events for patients undergoing carotid endarterectomy.

Methods:

This single-center, retrospective study recruited 171 carotid endarterectomy patients between January 1999 and June 2018. Patients who received a carotid endarterectomy in conjunction with other surgery were excluded. The primary outcomes were the incidences of major adverse cardiac events (comprising myocardial infarction, significant arrhythmias, congestive heart failure, and cardiac death) within 7 days, 7–30 days, and > 30 days–1 year, postoperatively. The secondary outcomes were the factors related to major adverse cardiac events and the incidence of postoperative stroke. The patients’ charts were reviewed, and direct contact was made with them to obtain information on their status post discharge.

Results:

The incidences of major adverse cardiac events within 7 days, 7–30 days, and >30 days–1 year of the carotid endarterectomy were 3.5% of patients (95% confidence interval: 0.008–0.063), 1.2% (95% confidence interval: 0.004–0.028), and 1.8% (95% confidence interval: 0.002–0.037), respectively. The major adverse cardiac events occurring within 7 days were arrhythmia (2.3% of patients), cardiac arrest (1.8%), myocardial infarction (1.2%), and congestive heart failure (1.2%), while the corresponding postoperative stroke rate was 4.7%.

Conclusion:

The 7-day incidence of major adverse cardiac events after the carotid endarterectomy was 3.5%. The most common major adverse cardiac event during that period was cardiac arrhythmia.
Linear IGA bullous dermatosis potentially triggered by vaccination
Authors: Corrà Alberto , Bonciolini Veronica , Quintarelli Lavinia , Verdelli Alice , Caproni Marzia
Published: January 2022

Linear IgA bullous dermatosis (LABD) is a mucocutaneous autoimmune blistering disease affecting both adults and children. It is caused by IgA antibodies targeting multiple antigens along the basement membrane zone, leading to disruption of dermoepidermal junction and development of bullous lesions which often presents in characteristic arrangement. Although most LABD cases have been reported to be idiopathic, different triggers have been described, including several drugs and infection. However, the occurrence of vaccine-induced cases of LABD is not widely known and accepted due to the few reports available. We present two cases of LABD occurred following different triggers, rising the suspicion for a possible pathogenetic role of vaccines.
Disparities in Offered Anxiety Treatments Among Minorities
Authors: Samander Laura J. , Harman Jeffrey
Published: January 2022

Purpose

The primary purpose of this article was to determine if race and ethnicity played a role in if primary care physicians offered anxiety treatment in office visits by adult patients who were diagnosed with an anxiety disorder(s).

Methods

This study pooled data from the 2011 to 2018 National Ambulatory Medical Care Survey (NAMCS) that included adult patients with an anxiety disorder and the type of treatment offered to them. Logistic regressions were performed to examine the odds of offered anxiety treatment in office visits by non-Hispanic Black, Hispanic, and other race/ethnicity patients compared to office visits by non-Hispanic White patients.

Results

Physicians offered anxiety treatment in more than half of office visits where the patient was diagnosed with an anxiety disorder. Providers offered counseling or talk therapy in less than 13% of all office visits. Office visits by non-Hispanic Black patients had half the odds of being offered counseling/talk therapy ( P = .068) compared to those by non-Hispanic White patients.

Conclusions

These findings suggest that statistically significant differences in the offering of any anxiety treatments in office visits to minorities compared to non-Hispanic White patients do not exist; however, there are still differences in the rates of counseling/talk therapy offered in office visits by minorities versus non-minorities. Future studies may want to examine reasons for lower rates of counseling/talk therapy offered to minority and majority patients and the specific pharmacological or therapeutic treatments offered to different races.
Anti-Blackness is the American Way: Assessing the Relationship Between Chattel Slavery, Lynchings, & Police Violence During the Civil Rights Movement
Authors: Echols Courtney M.
Published: January 2022

Research finds that historical anti-Black violence helps to explain the spatial distribution of contemporary conflict, inequality, and violence in the U.S. Building on this research, the current study examined the spatial relationship between chattel slavery in 1860, lynchings of Black individuals between 1882 and 1930, and anti-Black violence during the Civil Rights Movement era in which police or other legal authorities were implicated. I draw on an original dataset of over 300 events of police violence that occurred between 1954 and 1974 in the sample state of Louisiana, and that was compiled from a number of primary and secondary source documents that were themselves culled from archival research conducted in the state. Path analysis was then employed using negative binomial generalized structural equation modeling in order to assess the direct and indirect effects of these racially violent histories. The implications for social justice, public policy, and future research are also discussed.

Keywords Slavery, lynchings, anti-Black violence, civil rights movement, police
Toward a Technological and Methodological Shift in Music Learning in Spain: Students’ Perception of Their Initial Teacher Training
Authors: Serrano Rosa M. , Casanova Oscar
Published: January 2022

Current education requires the integration of digital technology. It is necessary to analyze the impact of the use of this technology on the educational process, and how they can be adequately integrated. This study, carried out over seven academic years in a Spanish University, gathers the perceptions of 91 education students who were training to become schoolteachers: based on their own previous experience as students, and after having participated in a technological-methodological project. By applying qualitative methodology, we conclude that the effective integration of technology in the teaching process requires continual feedback between technology, curricular content, and pedagogy. To achieve this, university-trained schoolteachers need to offer their students a sequenced technological-methodological empowerment process. It is necessary to implement a technological and methodological modification of the teaching-learning process in the first years of university training, with the aim of achieving long-term repercussions on all educational levels.
Coordination in Planning and Implementing Professional Development Programs for Teachers: A Much-needed Component in Rural Areas
Authors: Nawab Ali , Sharar Tajuddin
Published: January 2022

Coordination among stakeholders has been considered as a significant influential factor in providing teachers with quality Professional Development (PD) opportunities. The importance of coordination intensifies when a variety of PD providers work on the capacity building of teachers in the same region such as in some rural areas of Pakistan. The current research explored the nature of coordination among various stakeholders while designing and implementing PD programs for teachers in rural Pakistan. To achieve this aim, qualitative case study approach was used and data were generated through focused group interviews from PD providers, education managers, school leaders, and teachers. The results indicated a limited coordination among the stakeholders leading to a variety of issues such as overlapping programs, conflicting expectations from teachers, and selection of irrelevant teachers for PD. Drawing on the experience of the stakeholders who participated in this research, the paper suggests a model of coordination which the educational reformers, especially the PD providers and education managers, should consider while designing and implementing the capacity building programs for teachers.
Moral Injury, Traumatic Stress, and Threats to Core Human Needs in Health-Care Workers: The COVID-19 Pandemic as a Dehumanizing Experience
Authors: Hagerty Sarah L. , Williams Leanne M.
Published: January 2022

The pandemic has threatened core human needs. The pandemic provides a context to study psychological injury as it relates to unmet basic human needs and traumatic stressors, including moral incongruence. We surveyed 1,122 health-care workers from across the United States between May 2020 and August 2020. Using a mixed-methods design, we examined moral injury and unmet basic human needs in relation to traumatic stress and suicidality. Nearly one third of respondents reported elevated symptoms of psychological trauma, and the prevalence of suicidal ideation among health-care workers in our sample was roughly 3 times higher than in the general population. Moral injury and loneliness predict greater symptoms of traumatic stress and suicidality. We conclude that dehumanization is a driving force behind the psychological injury resulting from moral incongruence in the context of the pandemic. The pandemic most frequently threatened basic human motivations at the foundational level of safety and security relative to other higher order needs.
Insall–Salvati index is associated with anterior cruciate ligament tears in men: A Case-controlled study
Authors: GÜVEN Necip , ÖZKAN Sezai , TURKOZU Tulin , YOKUS Adem , ADANAS Cihan , GOKALP Mehmet Ata , TOKYAY Abbas
Published: January 2022

Purpose

Many factors in the etiology of anterior cruciate ligament (ACL) tears, predisposing factors related to knee morphology have also been reported. This study aimed to determine whether the Insall–Salvati (IS) index, which measures patella height, is a predisposing risk factor for ACL tears.

Methods

The IS index, patellar length (PL), and patellar tendon length (PTL) values of patients (study group) that underwent arthroscopic reconstruction for ACL tears obtained by preoperative magnetic resonance imaging (MRI) were compared with the index values in the preoperative MRIs of patients that underwent knee arthroscopy for reasons besides ACL tears. In addition, the anterior tibial translation (ATT) of both groups was also measured and compared on MRI images. The MRI findings of the subjects included in both study groups were arthroscopically confirmed.

Results

The mean ages of the study group (n = 120) and control group (n = 90) were 29.1 ± 8.2 years and 31.8 ± 9.8 years, respectively. There was a statistically significant difference between the study and control groups in terms of the PL and PTL values ( p = 0.016 and p = 0.001, respectively). The IS index was statistically significantly higher in the study group with ACL tears ( p = 0.009). The ATT was 8.61 ± 4.68 mm in the study group and 3.80 ± 1.92 mm in the control group. The ATT results of both groups were evaluated, and it was found that the study group was significantly higher than the control group ( p = 0.001)

Conclusions

As a result of our current study, we observed higher IS index values in patients with ACL tears than in patients without ACL tears. It should be kept in mind that patella alta, which is associated with a high IS index as one of the factors of knee morphology associated with ACL tears, may play a role in the etiology of ACL tears.
Remnant preservation with tensioning can improve the clinical outcome after anterior cruciate ligament reconstruction
Authors: Suh Dong Won , Yeo Woo Jin , Han Seung Beom , So Sang-Yeon , Kyung Bong Soo
Published: January 2022

Background

Many studies exist about remnant preservation in anterior cruciate ligament (ACL) reconstruction. However, concern remains for development of a cyclops lesion during remnant preservation. To prevent this, a tensioning method has been suggested. Current study evaluated the clinical and radiologic results of remnant preservation in ACL reconstruction with tensioning compared to classical ACL reconstruction.

Methods

From January 2016 to June 2017, ACL reconstruction patients who underwent magnetic resonance imaging (MRI) 2 years postoperatively were enrolled. For comparison, all participants were divided in two groups: remnant preservation with tensioning (group R) and controls (group C). Clinically, Hospital for Special Surgery (HSS), International Knee Documentation Committee (IKDC), Lysholm scores, and incidence of symptomatic cyclops lesions were evaluated. Radiologically, signal-to-noise quotient (SNQ) and size of the synovium on MRI as well as anterior instability in Telos stress radiographs were evaluated.

Results

A total of 64 patients were enrolled (42 in group R and 22 in group C). The IKDC score in group R (70) was better than that in group C (62; p < 0.05). One patient in group R had a cyclops lesion with clinical symptoms and arthroscopic excision was recommended. Radiologically, the SNQ, synovium area, and anterior instability on Telos radiography showed no difference between the two groups.

Conclusion

Remnant preservation with tensioning is a good option for ACL reconstruction without the development of a cyclops lesion.
A 66-Year-Old Man With Subacute Cough and Worsening Dyspnea Previously Diagnosed With COVID-19 Pneumonia
Authors: Quan Michelle A. , Hoerger Joshua L. , Mullins Elizabeth H. , Kuhn Brooks T.
Published: January 2022

A 66-year-old man presented with subacute cough and worsening dyspnea. Labs were notable for moderate peripheral eosinophilia, and computed tomography (CT) scan demonstrated extensive crazy-paving throughout bilateral upper lung fields. Bronchoalveolar lavage (BAL) revealed macrophages with lipid-filled vacuoles and negative periodic acid-Schiff (PAS) stain. Further history obtained from the patient and family was notable for daily application of commercially available vapor rub to nares and intentional deep inhalation of nebulized fluids containing scented oils. The patient was diagnosed with exogenous lipoid pneumonia through an unusual route of lipid administration.
Race, Geography, and School Choice Policy: A Critical Analysis of Detroit Students’ Suburban School Choices
Authors: Singer Jeremy , Lenhoff Sarah Winchell
Published: January 2022

The purpose of this study is to advance our thinking about race and racism in geospatial analyses of school choice policy. To do so, we present a critical race spatial analysis of Detroit students’ suburban school choices. To frame our study, we describe the racial and spatial dynamics of school choice, drawing in particular on the concepts of opportunity hoarding and predatory landscapes. We find that Detroit students’ suburban school choices were circumscribed by racial geography and concentrated in just a handful of schools and districts. We also find notable differences between students in different racial groups. For all Detroit exiters, their schools were significantly more segregated and lower quality than those of their suburban peers. We propose future directions for research on families’ school choices as well as school and district behavior at the intersection of race, geography, and school choice policy.
The Use of Complementary Medicine During Childbearing Years: A Multi-Country Study of Women From the Middle East
Authors: Arabiat Diana , Whitehead Lisa , Gaballah Samia , Nejat Nazi , Galal Ebtehal , Abu Sabah Eman , Smadi Nazek , Saadeh Inas , Khlaif Randa
Published: January 2022

The prevalence of self-prescribed complementary medicine (CM) use is an area of concern across the Middle East. We conducted a descriptive qualitative study to describe women’s use of CM during their childbearing years in Egypt, Jordan, Saudi Arabia and Iran. The study conducted using face to face audio-recorded interviews with 70 participants. Our findings showed that women used several herbal plants to ease pain and discomfort during menstruation and/or during pregnancy and in postpartum care. Acupuncture, meditation, and massage were less likely to be used by women. The impact of CM was often described in relation to perceived usefulness and safety of herbs. Cultural beliefs and roles of women contributed to the use of herbs among women. Given the high use of herbal medicine, there is a need for discussion about the potential of adverse effects of some plants or their metabolites following self-medication during the childbearing years.
How to re-enchant workplaces and organizations? An introduction to the special issue
Authors: Beltrán Martín Inmaculada , Mª Rodríguez Sánchez Alma , Xanthopoulou Despoina
Published: January 2022

Enchanting work is a polysemic term that can account for multiple interpretations. It can be defined as a feeling of being connected in an affirmative way to existence. In organizational terms, enchanted workplaces are places of wonder that allow people to be active agents, who can impact on their environment, find meaning in their work, and flourish. In this context, enchantment has been operationalized in organizational and managerial literature in a variety of ways, including being resourceful, happy, resilient, passionate, motivated, or healthy at work, among others. The main purpose of this special issue was to highlight those elements that may promote enchanting work environments, and the processes through which (re-)enchantment may be achieved. Also, we were interested in understanding re-enchantment as an internal process.

JEL CLASSIFICATION: M50
Gender Disparities in Symptoms of Depression After Medical School Exams and Student Coping Strategies for Postexam Depression Symptoms
Authors: Arabatzis Taxiarhia J , Marsidi Jennifer , Ashraf Muhammad , Supino Christina , Smith Ryan
Published: January 2022

CONTEXT

Little research exists to determine if medical students experience symptoms of depression after examinations and if symptoms vary by gender.

OBJECTIVES

Determine if is there a difference between male and female medical students in the number of symptoms of major depressive disorder (MDD) experienced after exams, as well as which coping strategies are used by students to alleviate depression symptoms.

METHODS

An anonymous and secure survey was sent via university email to first, second, and third-year medical students after exams for 2 consecutive exam periods. Surveys that were not fully completed were excluded from the analysis.

RESULTS

A total of 162 out of 550 students completed the survey for a response rate of 30%. Overall, a greater proportion of female students experienced more symptoms of depression compared to males. This was statistically significant for the Diagnostic and Statistical Manual of Mental Disorders 5th Edition symptoms of MDD: depressed mood, anhedonia, changes in sleep, fatigue, and difficulty with concentration after exams compared to their male counterparts. Male first-year medical students experienced higher rates of depression compared to their third-year counterparts. Most students exhibited coping strategies that helped them feel less depressed. The 3 most common coping strategies reported were: reaching out to social support networks, physical activity/exercise, and engaging in hobbies.

CONCLUSIONS

Both gender and year in a medical school play a role in the number of symptoms of depression experienced after medical school exams. Recognizing that examinations can be a trigger of depressive symptoms in medical students, particularly female and first-year students, has important implications on student mental health. Helping students recognize these symptoms and employ healthy coping strategies may further help alleviate these symptoms. Long-term consequences of experiencing symptoms of depression after recurrent exams in medical school are unknown and require further research.
Rare but Potentially Fatal Presentations of Diffuse Large B-cell Lymphoma: Leukemic Phase or Hemophagocytic Syndrome in Bone Marrow
Authors: Wan Mohd Zohdi Wan Awatif , Ismail Ahmad Zulhimi , Yusof Nurasyikin , Ithnin Azlin , Shuib Salwati , Masir Noraidah , Palaniappan Sivakumar , Tumian Nor Rafeah
Published: January 2022

Diffuse large B-cell lymphoma (DLBCL) is a type of non-Hodgkin Lymphoma commonly presenting as a solid tumor either by nodal or extra-nodal manifestations. Here we describe two atypical presentations of lymphoma, finally resulting in the diagnosis of DLBCL. Case 1: A 53-year-old man with a previous history of nasopharyngeal carcinoma presented with a two-week history of B-symptoms and hyperleukocytosis. Peripheral blood film showed 78% abnormal mononuclear cells. Immunohistochemical stain showing Ki-67 of 90%, negative c-myc, BCL2 and BCL6, and negative c-MYC with fluorescence in-situ hybridization studies on the trephine biopsy, concluded the diagnosis of CD5+ DLBCL of ABC subtype. He received intravenous cyclophosphamide and oral prednisolone for cytoreduction, followed by 6 cycles of chemo-immunotherapy. However, he succumbed due to severe sepsis after the completion of therapy. Case 2: A 56-year-old lady who was initially investigated for pyrexia of unknown origin was noted to have hemophagocytosis upon bone marrow aspirate examination. The bone marrow trephine biopsy revealed some atypical clusters of B-cells positive for CD20 which was inconclusive. PET-CT scan noted an enlarged hypermetabolic spleen without lymphadenopathy. Splenic biopsy with immunohistochemical studies revealed DLBCL of ABC subtype. The diagnosis was consistent with primary splenic DLBCL. She became unwell post splenic biopsy and was admitted to the intensive care unit where she passed away 2 weeks later from Candida and Sternotrophomonas septicemia. These cases highlight the atypical presentations of a common subtype of NHL in our center. Arriving at the definitive diagnosis can be difficult especially when patients are acutely ill, hampering the necessary invasive procedures for diagnosis. The outcomes of both cases are briefly discussed hoping to spread awareness among clinicians on the rare and acutely critical presentations of DLBCL.
Proptosis Revealing a Rare Lacrimal Gland Tumor: A Case of Chondroid Syringoma in a 35-year-old Patient
Authors: Efared Boubacar , Kadre Alio Kadre Ousmane , Idrissa Boubacar , Abani Bako Aïchatou Balaraba , Boureima Habiba Salifou , Salèye Ali , Hassan Nouhou
Published: January 2022

Lacrimal gland chondroid syringoma is a very rare tumor with classic clinico-radiological symptoms that should be familiar to clinicians for appropriate patients’ management as the tumor has potential for recurrence and malignant transformation. We report herein a case of chondroid syringoma in a 35-year-old patient presenting with progressive painless proptosis for 2 years. He underwent complete surgical removal of the tumor, with subsequent clinical improvement of his symptoms.
Case of Mycotic Pseudoaneurysm of the Common Carotid Artery due to Salmonella typhi Bacteremia
Authors: Nair Sruti P. , Reghukumar Aravind , Gurudas Athul , Sasidharan Kiran Kumar V. , Sivadasan Sreekumar
Published: January 2022

Aneurysm of the extracranial carotid artery is a rare disease, mycotic pseudoaneurysms being even less common. They are a life-threatening complication of systemic infection and atherosclerosis. Immunocompromised people, including patients with HIV, uncontrolled diabetes melltus, those on immunosuppressants like high-dose steroids, and chemotherapy, are at a higher risk for development of mycotic pseudoaneurysms. Due to the high risk of potential complications like rupture and thromboembolic events, mycotic aneurysms always require surgical management. Early detection followed by restoration of blood flow is critical to minimize a fatal outcome. Here we report the case of a 52-year-old man with a past history of hypertension and dyslipidemia who presented with a pulsatile painful neck swelling. On evaluation, the patient was diagnosed to have Salmonella typhi bacteremia, HIV infection, and a mycotic aneurysm of the left common carotid artery.
Inherited human Apollo deficiency causes severe bone marrow failure and developmental defects
Authors: Kermasson Laëtitia , Churikov Dmitri , Awad Aya , Smoom Riham , Lainey Elodie , Touzot Fabien , Audebert-Bellanger Séverine , Haro Sophie , Roger Lauréline , Costa Emilia , Mouf Maload , Bottero Adriana , Oleastro Matias , Abdo Chrystelle , de Villartay Jean-Pierre , Géli Vincent , Tzfati Yehuda , Callebaut Isabelle , Danielian Silvia , Soares Gabriela , Kannengiesser Caroline , Revy Patrick
Published: January 2022

Inherited bone marrow failure syndromes (IBMFSs) are a group of disorders typified by impaired production of 1 or several blood cell types. The telomere biology disorders dyskeratosis congenita (DC) and its severe variant, Høyeraal-Hreidarsson (HH) syndrome, are rare IBMFSs characterized by bone marrow failure, developmental defects, and various premature aging complications associated with critically short telomeres. We identified biallelic variants in the gene encoding the 5′-to-3′ DNA exonuclease Apollo/SNM1B in 3 unrelated patients presenting with a DC/HH phenotype consisting of early-onset hypocellular bone marrow failure, B and NK lymphopenia, developmental anomalies, microcephaly, and/or intrauterine growth retardation. All 3 patients carry a homozygous or compound heterozygous (in combination with a null allele) missense variant affecting the same residue L142 (L142F or L142S) located in the catalytic domain of Apollo. Apollo-deficient cells from patients exhibited spontaneous chromosome instability and impaired DNA repair that was complemented by CRISPR/Cas9-mediated gene correction. Furthermore, patients’ cells showed signs of telomere fragility that were not associated with global reduction of telomere length. Unlike patients’ cells, human Apollo KO HT1080 cell lines showed strong telomere dysfunction accompanied by excessive telomere shortening, suggesting that the L142S and L142F Apollo variants are hypomorphic. Collectively, these findings define human Apollo as a genome caretaker and identify biallelic Apollo variants as a genetic cause of a hitherto unrecognized severe IBMFS that combines clinical hallmarks of DC/HH with normal telomere length.
A randomized phase 3 trial of interferon-α vs hydroxyurea in polycythemia vera and essential thrombocythemia
Authors: Mascarenhas John , Kosiorek Heidi E. , Prchal Josef T. , Rambaldi Alessandro , Berenzon Dmitriy , Yacoub Abdulraheem , Harrison Claire N. , McMullin Mary Frances , Vannucchi Alessandro M. , Ewing Joanne , O'Connell Casey L. , Kiladjian Jean-Jacques , Mead Adam J. , Winton Elliott F. , Leibowitz David S. , De Stefano Valerio , Arcasoy Murat O. , Kessler Craig M. , Catchatourian Rosalind , Rondelli Damiano , Silver Richard T. , Bacigalupo Andrea , Nagler Arnon , Kremyanskaya Marina , Levine Max F. , Arango Ossa Juan E. , McGovern Erin , Sandy Lonette , Salama Mohamad E. , Najfeld Vesna , Tripodi Joseph , Farnoud Noushin , Penson Alexander V. , Weinberg Rona Singer , Price Leah , Goldberg Judith D. , Barbui Tiziano , Marchioli Roberto , Tognoni Gianni , Rampal Raajit K. , Mesa Ruben A. , Dueck Amylou C. , Hoffman Ronald
Published: January 2022

The goal of therapy for patients with essential thrombocythemia (ET) and polycythemia vera (PV) is to reduce thrombotic events by normalizing blood counts. Hydroxyurea (HU) and interferon-α (IFN-α) are the most frequently used cytoreductive options for patients with ET and PV at high risk for vascular complications. Myeloproliferative Disorders Research Consortium 112 was an investigator-initiated, phase 3 trial comparing HU to pegylated IFN-α (PEG) in treatment-naïve, high-risk patients with ET/PV. The primary endpoint was complete response (CR) rate at 12 months. A total of 168 patients were treated for a median of 81.0 weeks. CR for HU was 37% and 35% for PEG (P = .80) at 12 months. At 24 to 36 months, CR was 20% to 17% for HU and 29% to 33% for PEG. PEG led to a greater reduction in JAK2V617F at 24 months, but histopathologic responses were more frequent with HU. Thrombotic events and disease progression were infrequent in both arms, whereas grade 3/4 adverse events were more frequent with PEG (46% vs 28%). At 12 months of treatment, there was no significant difference in CR rates between HU and PEG. This study indicates that PEG and HU are both effective treatments for PV and ET. With longer treatment, PEG was more effective in normalizing blood counts and reducing driver mutation burden, whereas HU produced more histopathologic responses. Despite these differences, both agents did not differ in limiting thrombotic events and disease progression in high-risk patients with ET/PV. This trial was registered at www.clinicaltrials.gov as #NCT01259856.
Addition of shock wave therapy to nail dynamization increases the chance of long-bone non-union healing
Authors: Stolberg-Stolberg Josef , Fuchs Thomas , Lodde Moritz F. , Roßlenbroich Steffen , Garcia Patric , Raschke Michael , Everding Jens
Published: January 2022

Background

Long-bone non-unions after intramedullary nailing can be treated by nail dynamization or focused high-energy extracorporal shock wave therapy (fESWT). The objective of this study was to assess the effect of the combination therapy of nail dynamization and fESWT on long-bone non-unions.

Materials and methods

49 patients with long-bone non-unions (femur and tibia) after nailing were treated with nail dynamization (group D, n = 15), fESWT (group S, n = 17) or nail dynamization in addition to fESWT (group DS, n = 17). Patients were followed up for 6 months retrospectively. Furthermore, age, sex, Non-Union Scoring System (NUSS) score, time intervals from primary and last surgery until intervention and smoking status were analysed for their correlations to bone union.

Results

Union rates were 60% for group D, 64.7% for group S and 88.2% for group DS, with a significant difference between group D and DS (p = 0.024). Successful treatment was correlated with high age (OR 1.131; 95% CI 1.009–1.268; p = 0.034), female gender (OR 0.009; 95% CI 0.000–0.89; p = 0.039), low NUSS score (OR 0.839; 95% CI 0.717–0.081; p = 0.028) and negative smoking status (OR 86.018; 95% CI 3.051–2425.038; p = 0.009).

Conclusions

Data from the present study indicate that the combination therapy of nail dynamization and fESWT leads to a higher union rate than dynamization or fESWT alone.

Level of evidence

Level 3.
Molybdenum Disulfide Nanosheets Decorated with Platinum Nanoparticle as a High Active Electrocatalyst in Hydrogen Evolution Reaction
Authors: Razavi Mina , Sookhakian M. , Goh Boon Tong , Bahron Hadariah , Mahmoud Eyas , Alias Y.
Published: January 2022

Electrochemical hydrogen evolution reaction (HER) refers to the process of generating hydrogen by splitting water molecules with applied external voltage on the active catalysts. HER reaction in the acidic medium can be studied by different mechanisms such as Volmer reaction (adsorption), Heyrovsky reaction (electrochemical desorption) or Tafel reaction (recombination). In this paper, facile hydrothermal methods are utilized to synthesis a high-performance metal-inorganic composite electrocatalyst, consisting of platinum nanoparticles (Pt) and molybdenum disulfide nanosheets (MoS2) with different platinum loading. The as-synthesized composite is further used as an electrocatalyst for HER. The as-synthesized Pt/Mo-90-modified glassy carbon electrode shows the best electrocatalytic performance than pure MoS2 nanosheets. It exhibits Pt-like performance with the lowest Tafel slope of 41 mV dec−1 and superior electrocatalytic stability in an acidic medium. According to this, the HER mechanism is related to the Volmer-Heyrovsky mechanism, where hydrogen adsorption and desorption occur in the two-step process. According to electrochemical impedance spectroscopy analysis, the presence of Pt nanoparticles enhanced the HER performance of the MoS2 nanosheets because of the increased number of charge carriers transport.
Idiopathic multifocal choroiditis (MFC): aggressive and prolonged therapy with multiple immunosuppressive agents is needed to halt the progression of active disease. An offbeat review and a case series
Authors: Papasavvas Ioannis , Neri Piergiorgio , Mantovani Alessandro , Herbort Carl P.
Published: January 2022

Background and purpose

Idiopathic multifocal choroiditis (MFC) is part of the group of choriocapillaritis entities. The clinical definition of the disease has evolved with time. The aim of this article was to undertake a review on MFC, on its present-day appraisal and nomenclature and we also report a series of patients with emphasis on the clinical presentation and the importance of vigorous immunosuppressive management.

Methods

A review of the literature and a retrospective case series study which was performed in the Centre for Ophthalmic Specialised care (COS), Lausanne, Switzerland. Patients diagnosed from 1994 to 2020 with idiopathic multifocal choroiditis (MFC) treated with multiple immunosuppressants were included. Exclusion criteria were insufficient follow up and cases not treated with vigorous immunosuppressive therapy. Imaging analysis included spectral domain optical coherence tomography (SD-OCT) / enhanced depth imaging OCT (EDI-OCT), OCT angiography (OCT-A). Fluorescein and Indocyanine angiography (FA, ICGA) before and after the instauration of treatment. Best corrected visual acuity (BCVA), intraocular pressure (IOP), routine ocular examination, laser flare photometry (LFP) were performed at presentation and follow-up. Immunosuppression comprised at minimum two among the following agents: prednisone, cyclosporine, azathioprine, mycophenolic acid or infliximab. Mean duration of therapy was calculated.

Results

26 (52 eyes) of 2102 new patients (1.24%) were diagnosed with MFC. 25 (96%) patients were female and 1 (4%) was male. 43/52 (82%) eyes were myopic with a mean dioptre of − 5.87 ± 2.94, six (12%) eyes were hypermetropic with mean dioptres 2.0 ± 2.68 and three (6%) were emmetropic. 14/52 (27%) eyes had at least 1 anti-VEGF injection because of choroidal neovascularisation (CNVs), 1 eye had a phototherapy laser and 37/52 (71%) had no complication of CNVs during the follow-up. 5/26 (19%) fulfilled the inclusion criteria for our study. Mean age was 26.4 ± 9.3 years. Snellen best corrected visual acuity (BCVA) at presentation was 0.955+/-0.26. Mean follow up was 84+/-55 months. LFP at presentation was 6.34 ± 2.94 ph/ms. None of four patients with prolonged treatment and prolonged follow-up showed disease activity. One patient still under therapy after 4 months’ follow-up still showed an active neovascular membrane.

Conclusion

Treatment with multiple immunosuppressive agents was shown to stop the progression of the disease.
Gender- and age-based differences in outcomes of mechanically ventilated ICU patients: a Chinese multicentre retrospective study
Authors: Ma Jia-Gui , Zhu Bo , Jiang Li , Jiang Qi , Xi Xiu-Ming
Published: January 2022

Background

Previous studies have suggested that the gender and/or age of a patient may influence the clinical outcomes of critically ill patients. Our aim was to determine whether there are gender- and age-based differences in clinical outcomes for mechanically ventilated patients in intensive care units (ICUs).

Methods

We performed a multicentre retrospective study involving adult patients who were admitted to the ICU and received at least 24 h of mechanical ventilation (MV). The patients were divided into two groups based on gender and, subsequently, further grouped based on gender and age < or ≥ 65 years. The primary outcome measure was hospital mortality.

Results

A total of 853 mechanically ventilated patients were evaluated. Of these patients, 63.2% were men and 61.5% were ≥ 65 years of age. The hospital mortality rate for men was significantly higher than that for women in the overall study population (P = 0.042), and this difference was most pronounced among elderly patients (age ≥ 65 years; P = 0.006). The durations of MV, ICU lengths of stay (LOS), and hospital LOS were significantly longer for men than for women among younger patients (P ≤ 0.013) but not among elderly patients. Multivariate logistic regression analysis revealed that male gender was independently associated with hospital mortality among elderly patients but not among younger patients.

Conclusions

There were important gender- and age-based differences in the outcomes among mechanically ventilated ICU patients. The combination of male gender and advanced age is strongly associated with hospital mortality.
Pre-hospital transdermal glyceryl trinitrate in patients with stroke mimics: data from the RIGHT-2 randomised-controlled ambulance trial
Authors: Tunnage Bronwyn , Woodhouse Lisa J. , Dixon Mark , Anderson Craig , Ankolekar Sandeep , Appleton Jason , Cala Lesley , England Timothy , Krishnan Kailash , Havard Diane , Mair Grant , Muir Keith , Phillips Steve , Potter John , Price Christopher , Randall Marc , Robinson Thompson G. , Roffe Christine , Sandset Else , Siriwardena Niro , Scutt Polly , Wardlaw Joanna M. , Sprigg Nikola , Bath Philip M. ,   on behalf of the RIGHT-2 Investigators
Published: January 2022

Background

Prehospital stroke trials will inevitably recruit patients with non-stroke conditions, so called stroke mimics. We undertook a pre-specified analysis to determine outcomes in patients with mimics in the second Rapid Intervention with Glyceryl trinitrate in Hypertensive stroke Trial (RIGHT-2).

Methods

RIGHT-2 was a prospective, multicentre, paramedic-delivered, ambulance-based, sham-controlled, participant-and outcome-blinded, randomised-controlled trial of transdermal glyceryl trinitrate (GTN) in adults with ultra-acute presumed stroke in the UK. Final diagnosis (intracerebral haemorrhage, ischaemic stroke, transient ischaemic attack, mimic) was determined by the hospital investigator. This pre-specified subgroup analysis assessed the safety and efficacy of transdermal GTN (5 mg daily for 4 days) versus sham patch among stroke mimic patients. The primary outcome was the 7-level modified Rankin Scale (mRS) at 90 days.

Results

Among 1149 participants in RIGHT-2, 297 (26%) had a final diagnosis of mimic (GTN 134, sham 163). The mimic group were younger, mean age 67 (SD: 18) vs 75 (SD: 13) years, had a longer interval from symptom onset to randomisation, median 75 [95% CI: 47,126] vs 70 [95% CI:45,108] minutes, less atrial fibrillation and a lower systolic blood pressure and Face-Arm-Speech-Time tool score than the stroke group. The three most common mimic diagnoses were seizure (17%), migraine or primary headache disorder (17%) and functional disorders (14%). At 90 days, the GTN group had a better mRS score as compared to the sham group (adjusted common odds ratio 0.54; 95% confidence intervals 0.34, 0.85; p = 0.008), a difference that persisted at 365 days. There was no difference in the proportion of patients who died in hospital, were discharged to a residential care facility, or suffered a serious adverse event.

Conclusions

One-quarter of patients suspected by paramedics to have an ultra-acute stroke were subsequently diagnosed with a non-stroke condition. GTN was associated with unexplained improved functional outcome observed at 90 days and one year, a finding that may represent an undetected baseline imbalance, chance, or real efficacy. GTN was not associated with harm.

Trial registration

This trial is registered with International Standard Randomised Controlled Trials Number ISRCTN 26986053.
Descriptors of living alone for elders: based on Turkey national data
Authors: Adana Filiz , Durmaz Seyfi , Özvurmaz Safiye , Akpınar Ceren Varer , Yeşilfidan Duygu
Published: January 2022

Background

The objective of this study is to analyze the data of the 2018 Turkey Demographic and Health Survey and determine personal and demographic factors associated with elderly who are 60 and older and living alone.

Methods

This cross-sectional study is the secondary analysis of the national data obtained with the 2018 Turkey Demographic and Health Survey. Logistic regression analysis was used to estimate differences in living alone based on gender, age, welfare status, region of residence, urban/rural residence, whether the person is working in a paid job and home ownership. Independent effect of every variable is observed in the first stage and then checked for all variables in the equation.

Results

There is a total of 37,897 participants’ data in the Turkey Demographic and Health Survey Database. In the study, there are 6244 (16.5%) older adults in 11,056 households and 9.79% of the elderly population is alone. The percentage of elderly women living alone is 13.62% while this percentage is 5.48% for elderly men (p < 0.001). The risk of living alone for elderly women is 2.74 times more than elderly men (95% Cl 2.28–3.31). Being poor increases the risk of living alone for elderly people 2.84 fold compared to being rich (95% Cl 2.17–3.71). Those who have high school and higher education level have 2.38 (95% Cl 1.73–3.29) fold higher risk of living alone than people with lower education. Older adults living in the Western region of the country have 3.18 (95% Cl 2.20–4.59) times higher risk of living alone than older adults living in the Eastern region of the country. The risk of living alone for older adults increases 1.90 fold (95% Cl 1.55–2.32) if the house they live in do not belong to a household member.

Conclusion

Based on these findings, needs of older adults under risk should be met to allow them to be healthy and live their lives in better social, economic and cultural conditions.
Optimal encephalitis/meningitis roadmap via precise diagnosis and treatment (IMPROVE): a study protocol for a randomized controlled trial
Authors: Zhang Yi , Zhang Haocheng , Deng Bo , Lin Ke , Jin Lei , Liu Xiaoni , Zhang Yanlin , Chen Xiaohua , Zhang Yanliang , Lu Shengjia , Huang Heqing , Wang Qiujing , Feng Tingting , Zhao Weifeng , Xue Qun , Chen Renfang , Zhang Jingbo , Qian Xiaoyan , Chen Lanlan , Ai Jingwen , Chen Xiangjun , Zhang Wenhong
Published: January 2022

Background

Encephalitis/meningitis brings a heavy disease burden, and the origin of disease remains unknown in 30–40% of patients. It is greatly significant that combinations of nucleic acid amplification and autoimmune antibody testing improves the diagnosis and treatment of encephalitis/meningitis. Moreover, though several diagnostic methods are in clinical use, a recognized and unified diagnosis and treatment process for encephalitis management remains unclear.

Methods

IMPROVE is a multicenter, open label, randomized controlled clinical trial that aims to evaluate the diagnostic performance, applications, and impact on patient outcomes of a new diagnostic algorithm that combines metagenomic next-generation sequencing (mNGS), multiplex polymerase chain reaction (PCR) and autoimmune antibody testing. The enrolled patients will be grouped into two parallel groups, multiplex PCR test plus autoimmune antibody group (Group I) or the mNGS plus autoimmune antibody group (Group II) with a patient ratio of 1:1. Both groups will be followed up for 12 months. The primary outcomes include the initial time of targeted treatment and the modified Rankin scale score on the 30th day of the trial. The secondary outcomes are the cerebrospinal fluid index remission rate on the 14th day, mortality rate on the 30th day, and an evaluation of diagnostic efficacy. The two groups are predicted to comprise of 484 people in total.

Discussion

To optimize the roadmap of encephalitis/meningitis, precise diagnosis, and treatment are of great significance. The effect of rapid diagnosis undoubtedly depends on the progression of new diagnostic tests, such as the new multiplex PCR, mNGS, and examination of broad-spectrum autoimmune encephalitis antibodies. This randomized-controlled study could allow us to obtain an accurate atlas of the precise diagnostic ability of these tests and their effect on the treatment and prognosis of patients.

Trial registration ClinicalTrial.gov, NCT04946682. Registered 29 June 2021, ‘Retrospectively registered’, https://clinicaltrials.gov/ct2/show/NCT04946682?term=NCT04946682&draw=2&rank=1