bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy of diathermy on healing power of cesarean section scar: A randomized control trail
Authors: Mehawed Amgad Mohamed Abdel Monem , Elsenity Mohamed Abd Elfattah , Labib Kareem Mohamed , NasrAdDeen Mohammed AbdElHameed M
Published: October 2021

Background

Over several decades, has come to a dramatic increase In the number of cesarean sections performed across the world, especially in developed country The use of diathermy in the opening of anterior abdominal wall during CS decreases blood loss and operative time. The current study will investigate if diathermy cutting from skin through anterior abdominal is better or the same in cosmoses and post-operative pain

Objective

To compare the effects of electro-surgery on healing power of CS scar as a primary outcome (from skin to the peritoneum. A randomized controlled trial

Data Sources

Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal) and all materials available in the Internet till 2019.

Data Extraction

If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was gained, eligibility criteria specified, appropriate controls, and adequate information and defined assessment measures.

Conclusion

Our study showed that with the use of diathermy for incising skin during CS is not inferior to the use of scalpel regarding healing power of the scar but also adds benefits of decreasing post-operative pain. Therefore the use of diathermy can be safely recommended for the opening of the skin during cesarean sections as it decrease post-operative pain and blood loss.
Alpha Feto-Protien as a Biochemical Marker in Prediction of Morbidly Adherent Placenta
Authors: Khairy Hassan Tawfik , El Safty Mohammed Saeed Eldin , El Hadi Rasha Medhat Abd , Marzok Kyrollos Refat Khalf
Published: October 2021

Background

Placenta accreta is a potentially life-threatening obstetric condition that requires a multidisciplinary approach to management. The incidence of placenta accreta has increased and seems to parallel the increasing cesarean delivery rate. Women at greatest risk of placenta accreta are those who have myometrial damage caused by a previous cesarean delivery with either an anterior or posterior placenta previa overlying the uterine scar. Diagnosis of placenta accreta before delivery allows multidisciplinary planning in an attempt to minimize potential maternal or neonatal morbidity and mortality.

Aim of the Work

To compare between alpha-fetoproteine as biological marker & ultrasound & Doppler findings for prenatal predication of morbid adherent placentation in anterior placenta on scar of previous cesarean section.

Patients and Methods

The current study is a prospective cohort study, conducted at a tertiary center: Ain Shams University Maternity Hospital during the period between February 2018 and April 2019,where 150 pregnant women having placenta previa covering scar of previous uterine surgery had been recruited from the outpatient obstetrics clinic or emergency room and admitted to antepartum inpatient high risk service, but 50 patients were dropped out due to loss in follow up because of emergency antepartum haemorrhage & C.S., others escaped follow up.

Results

The results of the current study showed a significant association between all criteria of the 3DPD with multislice view and presence of placental adherence, need for added surgical steps, CS hysterectomy and bladder injury with sensitivity 83% & specificity 57%, PPV 76%, NPV 66%.

Conclusion

The current study suggests that AFP assay, it isn't good test alone as regards its sensitivity &specificity &its level of accuracy 55% as compared to 2D &3D power doppler with multislice view, so it is unreliable test alone for antenatal diagnosis of morbidly adherent placenta.
The effect of the duration between the previous ceserian section and the current pregnancy on the incidence of placenta accreta spectrum: A Case Control Study
Authors: Abdelrahman Rehab M , Raafat Tarek Aly , Abdelnasser Ahmed Gamal , Farag Allah Elghatwary Safaa Bakr
Published: October 2021

Background

Placenta accreta spectrum is a serious obstetric disorder that is characterized by deeply penetrating villi which are abnormally attached to the myometrium of the uterus. This prevents its complete dissociation during the third stage of labor that may cause severe bleeding, with its marked risk on the mother life. All recent studies confirm that the occurrence of placenta accreta increased dramatically in the recent years with the increasing number of caesarean sections. The number of previous caesarean deliveries accompanied by placenta previa markedly increase the risk for placenta accreta. There is a continued need to study risk factors of abnormally adherent placenta to improve the antenatal diagnosis .

Objective

The current study aims to evaluate the effect of the short duration between the perior caesarean delivery and the current pregnancy on the occurence of placenta accreta spectrum.

Patients and Methods

a case control study which was performed in the Maternity Hospital of Ain Shams University. It compare the duration between the perior caesarean section and the current pregnancy in the placenta accreta cases and the matched controls to determine if it increases the occurrences of placenta accreta or not. It include all pregnant ladies with placenta accreta spectrum diagnosed radiologically or surgically in the period of the beginning of June 2019 to the beginning of December 2019 with in the inclusion criteria, also the matched controls.

Results

there was no difference with a statistical significance between control group and patients group regarding inter pregnancy interval.

Conclusion

this study reveals that there was no effect of the short duration between the previous caesarean delivery and the current pregnancy on the occurence of placenta accreta spectrum.
Oral Lactoferrin versus Ferrous Sulfate for the Treatment of Iron Deficiency Anemia during Second Trimester among Egyptian ladies
Authors: Bayoumy Karam M , Elghareeb Nermeen A. M , Ragab Samar G
Published: October 2021

Background

Iron deficiency anemia (IDA) is a major public health problem in Egypt, especially among pregnant women. The most commonly used treatment is oral administration of iron as ferrous sulfate which often fails to exert significant effects with many adverse effects. Lactoferrin is a glycoprotein which belongs to proteins capable of binding and transferring iron. This study was done to evaluate the effectiveness, safety and acceptability of lactoferrin in comparison to ferrous sulfate.

Methods

This randomized clinical trial was conducted in outpatient clinic under supervision of department of Obstetrics and Gynecology, Faculty of medicine, Ain Shams University, Cairo, Egypt from August 2019 to February 2020. 140 women with iron deficiency anemia in second trimester were recruited and randomly assigned to either group. First group received lactoferrin 200 mg sachets once daily and second group received 100 mg of dried ferrous sulfate capsules twice daily for 4 consecutive weeks. Hemoglobin, hematocrit levels, mean corpuscular volume, and serum ferritin were assessed before and after therapy.

Results

The increase in haemoglobin was significantly higher in lactoferrin group. Number of cases achieved Hb level ≥10.5 was significantly more frequent in lactoferrin group. Compliance was significantly more frequent in lactoferrin group than in ferrous sulfate group. Maternal side effects were significantly less frequent in lactoferrin group than in ferrous sulfate group.

Conclusion

Oral lactoferrin is well tolerated and effective as compared to traditional treatment by ferrous sulfate.
Effect of Intramuscular Administration of Dexamethasone on Shortening of the Duration of Induction of Labor
Authors: Sammour Hazem M , Ashoush Sherif A , Elhawwary Gihan E , Rekaby Sara H
Published: October 2021

Background

Induction of labor refers to iatrogenic stimulation of uterine contractions to accomplish delivery prior to the onset of spontaneous labor. Induction of labor is undertaken when both of the following criteria are met: Continuing the pregnancy is believed to be associated with greater maternal or fetal risk than intervention to deliver the pregnancy, and there is no contraindication to vaginal birth.

Aim of the Work

to evaluate the effect of intramuscular administration of dexamethasone on the duration of vaginal delivery in women undergoing induction of labor.

Patients and Methods

This double-blinded randomized controlled study was conducted on 60 termed pregnant women who were divided into two groups, Dexamethasone group: injected with 2 ml of the product (dexamethasone®) 12 hours before initiation of labor induction and placebo group: injected with 2 ml distilled water 12 hours before initiation of labor induction. The two groups were induced by the same standard protocol. Determination of interval between initiation of induction and beginning of active phase, duration of active phase, duration of 2nd stage and duration 3rd stage have been detected for both groups and statistically analyzed.

Results

There were significant statistical differences between the two studied groups as regard rate of cervical dilatation. There were high significant statistical differences between the two studied groups as regard duration between initiation of labor induction and beginning of active phase of labor, duration of active phase of labor and duration of second and third stage of labor.

Conclusion

an intramuscular injection of dexamethasone before labor induction is found to shorten the duration of labor induction by decreasing the interval between the initiation of induction and the beginning of the active phase, duration of active phase and duration of second stage of labor with no observed maternal or neonatal complications.
Effect of Mediterranean diet versus low caloric diet on rheumatoid arthritis disease activity
Authors: Saleh Lobna A , Sebaie Mona A , El Shishtawy Heba F , Ahmed Sahar F
Published: October 2021

Background

Rheumatoid arthritis Is a systemic connective tissue disease affecting predominantly joints. The disease develops in a course of autoimmune inflammatory process triggered by environmental factors in genetically predisposed person .One such environmental factors is the diet . A basic explanation of a low calorie diet is described as a diet that provides fewer than 1,200 calories per day. .Low calorie diets are known for getting individuals mind excited about losing the weight without the actual motivation to exercise. The Mediterranean diet is not a single prescribed diet, but rather a general food-based eating pattern, which is marked by local and cultural differences throughout the Mediterranean region.Diet is generally characterized by a high intake of plant-based foods (e.g. fresh fruit and vegetables, nuts, and cereals) and olive oil. Also it is characterized by moderate intake of fish and poultry, and low intakes of dairy products (mostly yoghurt and cheese), red and processed meats, and sweets.

Objectives

To assess the effect of Mediterranean diet versus low caloric diet on disease activity of rheumatoid arthritis

Patient and methods

The present study included 30 patients with Rheumatoid Arthritis diagnosed according to 2010 ACR\EULAR criteria every patient is subjected to full clinical examination ;BMI DAS28, CDAI, laboratory investigations, ESR, CRP, CBC, lipid profile, ALT, AST and serum creatinine. Patients were randomly assigned into one of two groups ; group 1 included 15 patients who received low caloric diet and group 2 included 15 patients who received Mediterranean diet for 6 weeks to be reassessed at the end of study.

Results

Both groups ;low caloric diet group and Mediterranean diet had significant improvement on BMI, number of tender joints, DAS and CDAI mHAQ, ESR CRP,TC p < 0.05 There was non significant change between both groups as regard previously mentioned parameters however regarding percent of change between both groups. There was significant difference regarding only BMI with more reduction in group 2 versus group 1

Conclusion

both regimens are effective in lowering RA activity. Both have positive impacts on quality of life of RA patients,
Comparative study between transcranial direct current and repetitive transcranial electromagnetic stimulation in the rehabilitation of primary fibromyalgia
Authors: Ragab Sahar Y , Reda Mervat A , Ezz-Eldin Dalia M , EL-Badawy Mohja A
Published: October 2021

Background

Fibromyalgia syndrome (FMS) is a complex disorder where a widespread musculoskeletal pain (without a clear lesion basis) is associated with a great variety of symptoms including affective disturbances, central fatigue, cognitive dysfunction and even a particular skin reactivity to several chemical substances. Despite intense research effort, especially in the last years, the pathophysiology of the disease remains to be explained. The treatment recommendations were classified as pharmacological therapies, non-pharmacological treatments, and complementary non-pharmacological therapies. Also, particular interest has been raised by techniques able to perform effective modulation of brain areas through magnetic or electric currents applied to the scalp like transcranial magnetic and electrical stimulation such as direct current (TMS and tDCS). Objective: To compare the efficacy of Repetitive transcranial magnetic stimulation (r-TMS) and transcranial direct current stimulation (t-DCS) as non- invasive brain stimulation techniques in the rehabilitation of patients with primary (1ry) fibromyalgia (FM).

Patients and Methods

The present study included 30 patients with 1ry FM, equally divided into 2 groups. Group I included 15 patients who received 8 sessions of rTMS and Group II included 15 patients who received 8 sessions of anodal tDCS. Differences in visual analogue scale (VAS) of pain, tender point scale, Fibromyalgia Impact Questionnaire (FIQ) and Hospital Anxiety and Depression Scale (HADS) were assessed before and after completion of assigned treatment sessions.

Results

Pain VAS, tender point scale, FIQ and HADS showed significant decrease between baseline and follow-up assessments for both groups. Moreover, a significant change in all assessment scales was observed post treatment when compared between both groups with more significant improvement in the group received rTMS.

Conclusion

Both rTMS and tDCS techniques showed marked improvement in symptoms of pain, functional status and quality of life in patients with 1ry fibromyalgia. Both techniques can be considered as promising alternatives therapeutic options in the treatment of FM in order to reduce side effects of long-term use of drugs.
Evidence of research mastery: How applicants argue the feasibility of their research projects
Authors: Barlösius Eva , Blem Kristina
Published: September 2021

Although many studies have shown that reviewers particularly value the feasibility of a proposed project, very little attention has gone to how applicants try to establish the plausibility of their proposal’s realization. With a sample of 335 proposals, we examined the ways applicants reason the feasibility of their projects and the kinds of evidence they provide to support those assertions. We identified three kinds of evidence for mastering research: the scope of scientific skills, the presence of different assets, and the use of stylistic techniques. Applicants draw on them to align the project with scientific standards, embed it in the current state of research, and meet the scientific field’s expectations of how scientists should conduct a project. These kinds of evidence help substantiate a project’s feasibility and to distinguish the project from other proposals. Such evidence seems to correspond with a project’s positive review and approval (grant success). Evidence of research mastery was cited more often by the authors of the successful (approved) proposals than by the authors of the unsuccessful ones. The applicants of the successful proposals gave details of their planned experiments, emphasized their broad methodological and technical competence, and referred to their own preliminary scientific work.
In systemic sclerosis, the TAPSE/sPAP ratio can be used in addition to the DETECT algorithm for pulmonary arterial hypertension diagnosis
Authors: Colalillo Amalia , Grimaldi Maria Chiara , Vaiarello Valentina , Pellicano Chiara , Leodori Giorgia , Gigante Antonietta , Romaniello Antonella , Rosato Edoardo
Published: October 2021

Objective

Early detection of pulmonary arterial hypertension (PAH) is crucial for improving patient outcomes. The aim of this study was to compare the positive predictive value (PPV) of the echocardiography-derived tricuspid annular plane systolic excursion/systolic pulmonary artery pressure (TAPSE/sPAP) ratio with that of the DETECT algorithm for PAH screening in a cohort of SSc patients.

Methods

Fifty-one SSc patients were screened for PAH using the DETECT algorithm and echocardiography.

Results

Echocardiography was recommended by the DETECT algorithm step 1 in 34 patients (66.7%). Right heart catheterization (RHC) was recommended by the DETECT algorithm step 2 in 16 patients (31.4%). PAH was confirmed by RHC in 5 patients. The DETECT algorithm PPV was 31.3%. The TAPSE/sPAP ratio was higher in SSc patients not referred for RHC than in SSc patients referred for RHC according to the DETECT algorithm step 2 [0.83 (0.35–1.40) mm/mmHg vs 0.74 (0.12–1.09)  mm/mmHg, P < 0.05]. Using a cut-off of 0.60 mm/mmHg, 8 (15.7%) SSc patients had a TAPSE/sPAP ratio of ≤0.60 mm/mmHg. PAH was confirmed by RHC in 5 patients. The PPV of TAPSE/sPAP was 62.5%. In multiple regression analysis, TAPSE/sPAP was associated with age [β coefficient = −0.348 (95% CI: −0.011, −0.003); P < 0.01], DETECT algorithm step 1 [β coefficient = 1.023 (95% CI: 0.006, 0.024); P < 0.01] and DETECT algorithm step 2 (β coefficient = −1.758 [95% CI: −0.059, −0.021]; P < 0.0001).

Conclusion

In SSc patients with a DETECT algorithm step 2 total score of >35, the TAPSE/sPAP ratio can be used to further select patients requiring RHC to confirm PAH diagnosis.
Validation of the Substance Abuse Scale of the Personal and Relationships Profile
Authors: Lee Kerry A , Hayward R Anna , Sacco Paul
Published: October 2021

There have been limited measurement studies of the substance abuse scale of the Personal and Relationships Profile (PRP) and the impact of social desirability on alcohol and drug use reporting. This study aimed to (a) model the factor structure of the eight-item substance abuse scale of the PRP and (b) examine the relationship of substance use factors with sociodemographic variables—race, income, age, marital status—and social desirability on substance use reporting among a sample of low-income fathers. The study included secondary data analysis of 665 fathers, who participated in a fatherhood program between 2011 and 2015. The two-factor model with the addition of two error covariances exhibited acceptable fit to the data. Sociodemographic characteristics were significantly associated with alcohol and drug use among the sample with social desirability being the strongest predictor of lower alcohol and drug use reporting. Findings suggest that alcohol and drugs are distinct constructs that should be assessed separately, despite being correlated. In social work practice and research, the influence of social desirability in reporting should be accounted for when assessing substance use.
Olmsted Syndrome
Authors: Anderson Sara , Paradise Jacquelyn , Esser Media
Published: October 2021

Background:

Olmsted syndrome is a rare and complex skin disorder affecting 46 (published) infants as of 2012. The infants affected in this case were born premature at 28 weeks' gestation. Infants affected by this syndrome demonstrate numerous plaques on several specific areas of the skin. Common treatments include exfoliation in addition to psoriasis treatments. The extremely fragile nature of the premature infants' skin complicates treatment modalities.

Clinical Findings:

The progression of the infants' dermatologic findings and plaque formation is discussed in this case study.

Primary Diagnosis:

The primary diagnosis of Olmsted syndrome was made with the assistance of a multidisciplinary team to work through several differential diagnoses presenting with severe forms of palmoplantar keratoderma.

Interventions:

The management of skin plaques in twin premature infants is presented in this case study. An evidence-based approach, utilizing the model of family-centered care, is presented with multidisciplinary involvement and an outline of the specific plan of care for the extensive skin care regimen used.

Outcomes:

An interdisciplinary skin care regimen was created to provide consistency in transition from hospital to home. Using a consistent approach, the plaques were able to be softened and many removed. Continual maintenance is required to manage continual buildup of skin plaques.

Practice Recommendations:

Premature infants are at increased risk for infection due to the immaturity of their skin. The complexity of their skin complicates the ability to recognize and care for rare skin disorders. This case study illuminates the practicality of a consistent and evidence-based approach to a complex and rare skin disorder.
Implementation and Practice Barriers of Family-Centered Care Encountered by Neonatal Nurses
Authors: Kutahyalioglu Nesibe S. , Scafide Katherine N. , Mallinson Kevin R. , D'Agata Amy L.
Published: October 2021

Background:

Approximately 7 out of every 100 births in the United States result in admission to the neonatal intensive care unit (NICU), which contributes to a delay in initial physical contact between the parents and their newborn. While family-centered care (FCC) increases opportunities for parent–infant connection, implementation barriers persist in clinical practice. Research has yet to examine whether organizational and nursing factors of empowerment and compassion fatigue (CF) in the NICU are associated with FCC practice.

Purpose:

The aim of this study was to determine the relationship between empowerment, CF, and FCC practices among NICU nurses.

Methods:

This quantitative portion of a mixed-methods study used a cross-sectional, descriptive correlational design. Bedside NICU nurses with at least 6-month experience were recruited to complete an anonymous online survey using established, valid, and reliable instruments.

Results:

Except for organizations with Magnet status, there were no significant differences in FCC practice within individual and institutional characteristics. Hierarchical linear regression model indicated nurse empowerment was a strong predictor of FCC practice (β= 0.31, R
2 = 0.35, P < .001). There was only a weak, inverse association between CF and FCC practices (r =−0.199, P < .001).

Implication for Research and Practice:

Further qualitative research will integrate these findings to understand the process by which neonatal nurses engage in FCC practices in the context of NICU setting. Future studies should examine facilitators and barriers of FCC practice in the NICU. Strategies (eg, policies and trainings) to increase nurse empowerment and support for FCC implementation should be developed and evaluated.
Outcomes After Operative Reconstruction of Symptomatic Rib Nonunions
Authors: Ogunleye Temi D. , Carlson Daniel A. , Thomas Claire N. , Schroder Lisa K. , Cole Peter A.
Published: October 2021

Objective:

To assess the outcomes of patients after rib nonunion reconstruction.

Design:

Retrospective case series.

Setting:

Level 1 trauma center.

Patients/Participants:

Between January 2007 and August 2019, 25 consecutive patients with 51 nonunions with disabling pain or chronic instability were treated for nonunited rib fractures.

Intervention:

Rib nonunion reconstructions performed using plate and screw fixation, recannalizing the medullary canal and augmented with autogenous iliac crest bone graft.

Main Outcome Measurements:

Patient demographics, mechanism of injury, number of rib nonunions, and postoperative radiographs were assessed. Satisfaction, patient-reported complications, return to occupation and activity, and general health measures were captured using patient questionnaires.

Results:

In 25 patients, 51 painful rib nonunions were surgically treated. The average length from injury to surgical rib reconstruction was 25.1 months (range = 3–118 months; median = 12 months). Follow-up was obtained in 18 of 25 patients (72%) with a mean of 46.1 months (range = 13–139 months). All ribs achieved radiographic union at an average of 12.3 weeks (range = 8–24 weeks) after surgery. Sixteen of 18 patients (89%) reported satisfaction with surgery and 15 patients (83%) reported mild to no pain at final follow-up. Five patients had complications that all resolved after subsequent treatment.

Conclusions:

Successful treatment of symptomatic rib nonunion is possible using rib plates in conjunction with bone grafting and has high union rates, satisfactory results, and limited complications.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Bone Mineralization and Spinal Fusion Evaluation of a Truss-based Interbody Fusion Device
Authors: Kiapour Ali , Seim Howard B. , Atkinson Brent L. , Lalor Peggy A. , Block Jon E.
Published: October 2021

Study Design.

Finite element analysis (FEA) and in vivo ovine spinal interbody fusion study.

Objective.

To determine comparative load-induced strain amplitudes, bone mineralization and fusion outcomes associated with different diameter struts in a truss-based interbody fusion device.

Summary of Background Data.

Additive manufacturing technology has been employed to develop implants that actively participate in the fusion process. The truss device enables the optimal transfer of compressive and tensile stresses via the struts. Mechanobiologic principles postulate that strut diameter can be regulated to allow different magnitudes of strain distribution within the struts which may affect fusion rates.

Methods.

Modeling of strain distributions as a function of strut diameter (0.75, 1.0, 1.25, and 1.5 mm) employed FEA that simulated physiologic loading conditions. A confirmatory in vivo ovine lumbar spinal interbody fusion study compared fusion scores and bone histomorphometric variables for cages with 0.75 and 1.5 mm strut diameters. Outcomes were compared at 3-, 6-, and 12-month follow-up intervals.

Results.

FEA showed an inverse association between strut diameter and peak strain amplitude. Cages with 1.0, 1.25, and 1.5 mm struts had peak strain values that were 36%, 60%, and 73% lower than the 0.75 mm strut strain value. In vivo results showed the mean fusion score for the 0.75 mm diameter strut cage was significantly greater by 3-months versus the 1.5 mm strut cage, and remained significantly higher at each subsequent interval (P < 0.001 for all comparisons). Fusion rates were 95%, 100%, and 100% (0.75 mm) and 72.7%, 86.4%, and 95.8% (1.5 mm) at 3, 6, and 12 months. Thinner struts had greater mineralized bone tissue and less fibrous/chondral tissue than the thicker struts at each follow-up.

Conclusion.

Validating FEA estimates, cages with smaller diameter struts exhibited more rapid fusion consolidation and more aggressive osseointegration compared with cages with larger diameters struts.

Level of Evidence: 4
Respiratory Non-Invasive Venous Waveform Analysis for Assessment of Respiratory Distress in Coronavirus Disease 2019 Patients: An Observational Study
Authors: Alvis Bret , Vaughn Lexie , Schmeckpeper Jeffrey , Huston Jessica , Case Marisa , Semler Matthew , Lindenfeld JoAnn , Brophy Colleen , Hocking Kyle
Published: October 2021

OBJECTIVES:

Due to the rapid rate of severe acute respiratory syndrome coronavirus 2 transmission and the heterogeneity of symptoms of coronavirus disease 2019, expeditious and effective triage is critical for early treatment and effective allocation of hospital resources.

DESIGN:

A post hoc analysis of respiratory data from non-invasive venous waveform analysis among patients enrolled in an observational study was performed.

SETTING:

Vanderbilt University Medical Center.

PATIENTS:

Peripheral venous waveforms were recorded from admission to discharge in enrolled coronavirus disease 2019–positive patients and healthy age-matched controls.

INTERVENTIONS:

Data were analyzed in LabChart 8 to transform venous waveforms to the frequency domain using fast Fourier transforms. The peak respiratory frequency was normalized to the peak cardiac frequency to generate a respiratory non-invasive venous waveform analysis respiratory index. Paired Fisher exact tests were used to compare each patient’s respiratory non-invasive venous waveform analysis respiratory index at admission and discharge. A nonparametric one-way analysis of variance was used for multiple comparisons between patients with coronavirus disease 2019 and healthy controls for respiratory non-invasive venous waveform analysis respiratory index.

MEASUREMENTS AND MAIN RESULTS:

Fifty coronavirus disease 2019–positive patients were enrolled between April 2020, and September 2020, and 45 were analyzed; 34 required supplemental oxygen and 11 did not. The respiratory non-invasive venous waveform analysis respiratory index was significantly higher for the 34 patients with coronavirus disease 2019 who received supplemental oxygen (median, 0.27; interquartile range, 0.11—1.28) compared with the 34 healthy controls (median, 0.06; interquartile range, 0.03–0.14) (p < 0.01). For patients with coronavirus disease 2019 who received supplemental oxygen, respiratory non-invasive venous waveform analysis respiratory index was significantly lower at hospital discharge (p = 0.02; 95% CI, 0.10–1.9) compared with hospital admission (median = 0.12; interquartile range, 0.05–0.56). For patients with coronavirus disease 2019, a respiratory non-invasive venous waveform analysis respiratory index of 0.64 demonstrated sensitivity of 92%, specificity of 47%, and positive predictive value of 93% for predicting requirement of supplemental oxygen during the hospitalization.

CONCLUSIONS:

Respiratory non-invasive venous waveform analysis respiratory index represents a novel physiologic respiratory measurement with a promising ability to triage early care and predict the need for oxygen support therapy in coronavirus disease 2019 patients.
Image Navigation Surgery With the Fluorescent Ureteral Catheter of Recurrent Tumors in the Pelvic Cavity
Authors: Hamada Madoka , Matsumi Yuki , Sekimoto Mitsugu , Kurokawa Hiroaki , Kita Masato , Kinoshita Hidefumi
Published: October 2021

INTRODUCTION:

Ureteral injury during pelvic surgery is a serious complication that requires special attention. The fluorescent ureteral catheter near-infrared ray catheter sets are 6.0F catheters containing fluorescent substances along their length that can be recognized by a laparoscopic indocyanine green camera. We present our experience using a near-infrared ray catheter in 6 consecutive patients who underwent surgery for recurrent pelvic tumors.

TECHNIQUE:

The near-infrared ray catheters were inserted into the bilateral ureters in all patients, with the exception of patient 5 (left unilateral), by urologists using a cystoscope with the same technique as that commonly used in placing ureteral stents under general anesthesia. A laparoscopic indocyanine green camera was adapted to identify the ureters. From February 2020 to July 2020, 6 consecutive patients with recurrent pelvic tumors underwent surgery using a near-infrared ray catheter. In 3 patients, recurrent tumors were detected in the pelvic cavity after surgery for colon cancer (1 patient each of peritoneal recurrence behind the seminal vesicles, lymph node metastasis on the residual superior rectal artery, and peritoneal recurrence at the peritoneal reflection). Two patients had postoperative local recurrences of rectal cancer. The last patient had a recurrence of cervical carcinoma invading the rectum.

RESULTS:

All patients underwent surgery under ureteral image navigation using near-infrared ray catheter not only for ureter preservation during the operation (4 patients) but also for the combined resection of the ureter with recurrent tumors (2 patients). One patient experienced postoperative ureteral stenosis on postoperative day 21 that required a ureteral double J-stent placement in the left ureter.

CONCLUSION:

Near-infrared ray catheter has the potential to reduce inadvertent periureteral dissection because the ureter can be identified before approaching it.
MicroRNAs: A Neoteric Approach to Understand Pathogenesis, Diagnose, and Treat Myocardial Infarction
Authors: Sayed-Pathan Nida Irfan , Kumar Pramod , Paknikar Kishore M. , Gajbhiye Virendra
Published: October 2021

Myocardial infarction is a substantial contributor to ischemic heart diseases, affecting a large number of people leading to fatal conditions worldwide. MicroRNAs (miRNAs) are explicitly emerging as excellent modulators of pathways involved in maintaining cardiomyocyte survival, repair, and regeneration. Altered expression of genes in cardiomyocytes postinfarction can lead to the disordered state of the myocardium, such as cardiac hypertrophy, ischemia-reperfusion injury, left ventricular remodeling, and cardiac fibrosis. Therapeutic targeting of miRNAs in cardiomyocytes can potentially reverse the adverse effects in the heart postinfarction. This review aims to understand the role of several miRNAs involved in the regeneration and repair of cardiomyocytes postmyocardial infarction and presents comprehensive information on the subject.
Circ_0002984 Enhances Growth, Invasion, and Migration in PDGF-bb–Induced Vascular Smooth Muscle Cells Through miR-379-5p/FRS2 Axis
Authors: Zheng Xiangni , Liu Jian , Gong Xuepeng , Zhang Xu , Ma Shengting
Published: October 2021

The accumulation of vascular smooth muscle cells (VSMCs) is considered to play important roles in atherosclerosis (AS) development and progression. Circ_0002984 was found to be increased in oxidized low-density lipoprotein (ox-LDL) human VSMCs (HVSMCs). However, the function and mechanism of circ_0002984 in VSMC dysfunction remain unknown. In this study, the expression of circ_0002984, microRNA (miR)-379-5p, and fibroblast growth factor receptor substrate 2 (FRS2) was detected using quantitative real-time polymerase chain reaction and western blot. Cell proliferation, cell cycle, migration, and invasion were detected using Cell Counting Kit-8, flow cytometry, and transwell assays. The binding interaction between miR-379-5p and circ_0002984 or FRS2 was confirmed by the dual-luciferase reporter assay. Collectively, this study found that circ_0002984 was elevated in platelet-derived growth factor type bb (PDGF-bb)-induced HVSMCs. Circ_0002984 knockdown abrogated PDGF-bb–induced proliferation, migration, and invasion in HVSMCs. Mechanistically, circ_0002984 was confirmed to target miR-379-5p, and miR-379-5p upregulation reversed the protective effects of circ_0002984 knockdown on PDGF-bb–induced HVSMCs. Besides, when FRS2 was a target of miR-379-5p, miR-379-5p restoration abolished PDGF-bb–evoked HVSMC dysfunction, which was attenuated by the overexpression of FRS2. Moreover, circ_0002984 could regulate FRS2 expression through sponging miR-379-5p in HVSMCs. Collectively, these results demonstrated that circ_0002984 promoted PDGF-bb–induced VSMC proliferation, migration, and invasion through the regulation of miR-379-5p/FRS2 axis, suggesting a new insight into the pathogenesis of AS and the potential application of circ_0002984 in AS treatment.
The systemic right ventricle in adult congenital heart disease: why is it still such a challenge and is there any hope on the horizon?
Authors: Lluri Gentian , Aboulhosn Jamil
Published: October 2021

Purpose of review

Adult congenital heart disease patients with systemic right ventricle comprise a distinctly clinically challenging group of patients with increased morbidity and mortality. This article aims to review the different subgroups, most common complications and different treatment strategies

Recent findings

Most commons long-term complications include heart failure and arrhythmias. Heart failure medical therapy treatments include several new agents, which show promise in systemic right ventricle patients. In addition, interventional therapies to mitigate atrioventricular valve regurgitation, baffle/conduit stenosis are discussed. Furthermore, several electrophysiological approaches to manage tachyarrhythmias as well as bradycardias are discussed. There is ongoing excitement on the new medical as well as interventional therapies that could provide benefit in additional to standard goal-directed medical therapy.

There is an array of medications as well as interventions aimed to treat patients with systemic right ventricle with limited benefits. A multidisciplinary approach with a prudent combination of such therapies to maximize benefit is imperative. This article reviews the data supporting such therapies.
Challenges in diagnosis and management of coarctation of the aorta
Authors: Chetan Devin , Mertens Luc L.
Published: October 2021

Purpose of review

Coarctation of the aorta remains a controversial topic with uncertainties in long-term outcomes.

Recent findings

Recent advances in fetal imaging including echocardiography and MRI offer novel opportunities for better detection and prediction of the need for neonatal intervention.

New imaging techniques are providing novel insights about the impact of arch geometry and size on flow dynamics and pressure gradients. The importance of arch size rather than shape for optimal hemodynamics has been identified. Long-term outcome data suggest a significant increase in mortality risk in coarctation patients beyond the third decade when compared with the general population. Hypertension is highly prevalent not only in adult patients following repair of coarctation but also in normotensive patients presenting with LV diastolic dysfunction and adverse remodelling, indicating that abnormal vascular properties are important. Patients with coarctation undergoing neonatal repair are at risk for adverse neurodevelopmental outcomes and patients could benefit from timely neurocognitive evaluation and intervention.

Optimizing aortic arch size, prevention and aggressive treatment of hypertension and vascular stiffening are important to improve long-term outcomes.
Applicability of the GAIA Maternal and Neonatal Outcome Case Definitions for the Evaluation of Adverse Events Following Vaccination in Pregnancy in High-income Countries
Authors: Watson Gabriella , Dodd Caitlin , Munoz Flor M. , Eckert Linda O. , Jones Christine E. , Buttery Jim P. , Yildirim Inci B. , Kachikis Alisa , Heath Paul T. , Schlaudecker Elizabeth P. , Bond Nanette H. , Santarcangelo Patricia L. , Wilcox Christopher R. , Bellamy Karen , Elmontser Mohnd , Sienas Laura , Simon Rebecca , Khalil Asma , Townsend Rosemary , Sturkenboom Miriam , Black Steve
Published: October 2021

Background:

The Brighton Collaboration Global Alignment of Immunization Safety in Pregnancy (GAIA) project developed case definitions for the assessment of adverse events in mothers and infants following maternal immunization. This study evaluated the applicability of these definitions to data collected in routine clinical care and research trial records across 7 sites in high-resource settings.

Methods:

Data collection forms were designed and used to retrospectively abstract the key elements of the GAIA definitions from records for 5 neonatal and 5 maternal outcomes, as well as gestational age. Level of diagnostic certainty was assessed by the data abstractor and an independent clinician, and then verified by Automated Brighton Case logic. The ability to assign a level of diagnostic certainty for each outcome and the positive predictive value (PPV) for their respective ICD-10 codes were evaluated.

Results:

Data from 1248 case records were abstracted: 624 neonatal and 622 maternal. Neonatal outcomes were most likely to be assessable and assigned by the level of diagnostic certainty. PPV for preterm birth, low birth weight, small for gestational age and respiratory distress were all above 75%. Maternal outcomes for preeclampsia and fetal growth restriction showed PPV over 80%. However, microcephaly (neonatal outcome) and dysfunctional labor (maternal outcome) were often nonassessable, with low PPVs.

Conclusions:

The applicability of GAIA case definitions to retrospectively ascertain and classify maternal and neonatal outcomes was variable among sites in high-resource settings. The implementation of the case definitions is largely dependent on the type and quality of documentation in clinical and research records in both high- and low-resource settings. While designed for use in the prospective evaluation of maternal vaccine safety, the GAIA case definitions would likely need to be specifically adapted for observational studies using alternative sources of data, linking various data sources and allowing flexibility in the ascertainment of the elements and levels of certainty of the case definition.
Kingella kingae Spondylodiscitis
Authors: Keene Aaron , Creighton Julie , Anderson Trevor , Walls Tony
Published: October 2021

Kingella kingae infections generally respond well to most beta-lactam antibiotics. We investigated an antibiotic treatment failure in a 3-year-old with K. kingae L3-4 spondylodiscitis. Her disease progressed even after 19 days of high-dose intravenous flucloxacillin. The clinical isolate did not produce a beta-lactamase and despite phenotypic testing and whole-genome sequencing, the mechanism of flucloxacillin resistance remains unknown.
Acute Cerebellitis in MIS-C
Authors: Akçay Nihal , Oğur Mustafa , Emin Menentoğlu Mehmet , İrem Sofuoğlu Ayşe , Boydağ Güvenç Kübra , Bakirtaş Palabiyik Figen , Şevketoğlu Esra
Published: October 2021

Background:

Coronavirus disease-2019 (COVID-19) is characterized predominantly by respiratory symptoms and has affected a small subset of children. Multisystem inflammatory syndrome in children (MIS-C) has been reported in children following COVID-19. There is increasing report that COVID-19 may also lead to neurologic manifestations. Cerebellar lesions may be observed in viral infections.

Case report:

We report a child with MIS-C related to severe acute respiratory syndrome coronavirus 2, who developed cerebellar lesion during the disease course. Encephalopathy was the first central nervous system symptom. His consciousness improved but he developed clinical signs of cerebellar dysfunction including ataxia, dysarthria and nystagmus. Brain magnetic resonance imaging (MRI) revealed symmetrical pathological signal changes in both cerebellar hemispheres.

Conclusion:

We demonstrated the first child with MIS-C to develop cerebellar lesion on brain MRI, suggestive of cerebellitis.
Evaluation of the diagnostic accuracy of COVID-19 antigen tests: A systematic review and meta-analysis
Authors: Wang Yuan-Hung , Wu Chia-Chang , Bai Chyi-Huey , Lu Shou-Cheng , Yang Yi-Ping , Lin Yi-Ying , Lai Wei-Yi , Lin Tzu-Wei , Jheng Ying-Chun , Lee Ming-Cheng , Chen Cheng-Chieh
Published: October 2021

Background:

The coronavirus disease 2019 (COVID-19) pandemic continues to affect countries worldwide. To inhibit the transmission of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), testing of patients, contact tracing, and quarantine of their close contacts have been used as major nonpharmaceutical interventions. The advantages of antigen tests, such as low cost and rapid turnaround, may allow for the rapid identification of larger numbers of infectious persons. This meta-analysis aimed to evaluate the diagnostic accuracy of antigen tests for SARS-CoV-2.

Methods:

We searched PubMed, Embase, Cochrane Library, and Biomed Central databases from inception to January 2, 2021. Studies evaluating the diagnostic accuracy of antigen testing for SARS-CoV-2 with reference standards were included. We included studies that provided sufficient data to construct a 2 × 2 table on a per-patient basis. Only articles in English were reviewed. Summary sensitivity and specificity for antigen tests were generated using a random-effects model.

Results:

Fourteen studies with 8624 participants were included. The meta-analysis for antigen testing generated a pooled sensitivity of 79% (95% CI, 66%-88%; 14 studies, 8624 patients) and a pooled specificity of 100% (95% CI, 99%-100%; 14 studies, 8624 patients). The subgroup analysis of studies that reported specimen collection within 7 days after symptom onset showed a pooled sensitivity of 95% (95% CI, 78%-99%; four studies, 1342 patients) and pooled specificity of 100% (95% CI, 97%-100%; four studies, 1342 patients). Regarding the applicability, the patient selection, index tests, and reference standards of studies in our meta-analysis matched the review title.

Conclusion:

Antigen tests have moderate sensitivity and high specificity for the detection of SARS-CoV-2. Antigen tests might have a higher sensitivity in detecting SARS-CoV-2 within 7 days after symptom onset. Based on our findings, antigen testing might be an effective method for identifying contagious individuals to block SARS-CoV-2 transmission.
Factors Associated With Adherence to Fluid Restriction in Patients Undergoing Hemodialysis in Indonesia
Authors: PERDANA Melyza , YEN Miaofen
Published: October 2021

Background

The factors related to fluid intake adherence among patients undergoing hemodialysis have been explored in many studies. However, most of these were conducted in Western countries and have produced inconsistent results. A study of this issue in Indonesia, a tropical country with strong herbal medicine traditions, may show different results. In addition to demographic characteristics, self-efficacy is a standard measurement used in chronic care management activities such as hemodialysis treatment. Understanding the reasons behind patient nonadherence in Indonesia may help nurses better manage the fluid intake of patients.

Purpose

This study was designed to determine the factors that predict patient adherence to fluid intake restrictions.

Methods

A cross-sectional study was conducted on 153 patients undergoing hemodialysis at two hospitals. Intradialytic weight gain over a 1-month period was recorded to assess the participants’ adherence to fluid intake restrictions. Intradialytic weight gains of more than 2 kg was considered to be nonadherent. A daily urine output and level of thirst were also recorded. The participants completed an adapted self-efficacy questionnaire, Swedish Fluid Intake Appraisal Inventory, and the data were analyzed together with demographic characteristic and clinical parameters using hierarchical multiple regression.

Results

The results revealed that most of the respondents did not adequately adhere to fluid intake restrictions (59.5%). Intradialytic weight gain was shown to strongly correlate with self-efficacy (p < .05, β = −.201), gender (p < .05, β = −.179), educational background (p = .05, β = .159), and urine output (p < .05, β = −.168). Demographic characteristic explained 10.6% and self-efficacy explained 3.9% of the variance in fluid adherence.

Conclusions/Implications for Practice

Female participants with higher self-efficacy scores reported the lowest average level of intradialytic weight gain, indicating better adherence to fluid intake restrictions. Several demographic factors as well as self-efficacy were identified as potential predictors of fluid intake restriction adherence. Therefore, measuring self-efficacy periodically is a good initial step toward detecting those patients who are at higher risk of noncompliance with fluid intake restrictions.