bluuebunny/crossref_metadata_2025 huggingface dataset:
IBRUTINIB FOR CONTROL OF CHOROIDAL AND ORBITAL METASTASIS FROM CHRONIC LYMPHOCYTIC LEUKEMIA
Authors: Sieburth Rebecca M. , Weaver Christopher D. , Kirzhner Maria , Shildkrot Yevgeniy
Published: January 2021

Purpose:

To describe a case of choroidal and orbital metastasis of chronic lymphocytic leukemia controlled with ibrutinib monotherapy, an oral tyrosine kinase inhibitor.

Methods:

Single case report.

Results:

A 69-year-old man with a past medical history of chronic lymphocytic leukemia diagnosed 1 year previously was referred with a foveal lesion in the right eye and was found to have hyperopic shift in the right eye. Optical coherence tomography demonstrated choroidal infiltration in the right eye, and computed tomography of the orbits demonstrated a left orbital mass. Biopsy of the left orbital mass confirmed chronic lymphocytic leukemia/small lymphocytic leukemia. Oral ibrutinib monotherapy of 140 mg three times daily was initiated for treatment of these choroidal and orbital metastases, and at 6 months, there was clinical resolution of disease. Cessation of ibrutinib monotherapy was followed 7 months later by recurrence of choroidal disease. Reinitiation of ibrutinib monotherapy 140 mg three times daily led again to clinical disease resolution, and durable remission has been attained on a well-tolerated low maintenance dose of ibrutinib 140 mg two times daily.

Conclusion:

This is the first reported case of control of choroidal and orbital metastasis of chronic lymphocytic leukemia with ibrutinib monotherapy, confirmed with choroidal recurrence on drug cessation and clinical resolution of disease on re-treatment.
Comparative Analysis of the Clinical Aspects and Treatment Outcomes of Stenotrophomonas maltophilia Keratitis and Pseudomonas aeruginosa Keratitis
Authors: Cho Chan-Ho , Lee Sang-Bumm
Published: January 2021

Objectives:

We analyzed the clinical aspects and treatment outcomes of Stenotrophomonas maltophilia (SM) keratitis and Pseudomonas aeruginosa (PA) keratitis.

Methods:

Medical records of 55 inpatients with culture-proven SM (n=21) and PA (n=34) keratitis were retrospectively reviewed. Predisposing factors, clinical characteristics, and treatment outcomes were compared between the SM and PA groups.

Results:

The mean symptom duration was longer in the SM group than in the PA group (10.4:4.3 days; P=0.012). The most common predisposing factor was corneal trauma (47.6%) in the SM group and contact-lens wear (38.2%) in the PA group. There were no differences in the mean epithelial defect size (12.7:11.9 mm2; P=0.861), hypopyon (33.3%:44.1%; P=0.428), surgical treatment (4.8%:14.7%; P=0.390), or poor clinical outcomes (26.8%:30.3%; P=0.760) between the SM and PA groups. In multivariate logistic regression, risk factors for poor clinical outcomes were hypopyon (odds ratio [OR], 52.00; P=0.010) in the SM group and symptom duration≥7 days (OR, 44.32; P=0.015), age≥60 years (OR, 21.13; P=0.019), and hypopyon (OR, 15.20; P=0.038) in the PA group.

Conclusion:

Compared with PA keratitis, SM keratitis had slower progression, and its clinical characteristics and treatment results were not worse. In both groups, hypopyon was the risk factor for a poor clinical outcome.
The Impacts of Face Mask Use on Standard Automated Perimetry Results in Glaucoma Patients
Authors: Bayram Nurettin , Gundogan Medine , Ozsaygili Cemal , Vural Esra , Cicek Ayse
Published: January 2021

Purpose:

The coronavirus disease 2019 (COVID-19) spread rapidly worldwide, causing a severe outbreak. Because the disease is easily transmitted, face masks are a vital tool to slow the spread. The aim of this study is to investigate the impacts of face mask use on standard automated perimetry (SAP) results in glaucoma patients.

Materials and Methods:

All follow-up glaucoma patients who underwent SAP between May and October 2020 were enrolled in this study. In patients with low test reliability and/or visual field changes, SAP was repeated after repositioning and taping patients’ face masks.

Results:

A total of 127 patients (59 female and 68 male) with a mean age of 59.8±10.3 years were included in the study. While 101 patients (79.5%) wore surgical face masks, 26 patients (20.5%) wore cloth face masks. Low SAP reliability appeared in 23 patients (18.1%), and inferior visual field defects were present in 3 patients (2.4%). The main effects of poorly fitting face masks on SAP reliability were increased fixation losses and false-positive errors (for both, P=0.001). Low SAP reliability was significantly higher in patients wearing cloth face masks than in those wearing surgical face masks (47.8% vs. 9.9%; P=0.0001). The face mask–related fogging of eyeglasses before SAP is a strong predictor of fogging of the trial lenses–related low SAP reliability (odds ratio: 27, 95% confidence interval: 5.48-132.92, P=0.0001). In all repeated SAPs, the patients’ reliability parameters improved, and inferior visual field artifacts disappeared.

Conclusions:

Unsuitable face masks can cause either visual field artifacts, which may be interpreted as glaucoma progression or low test reliability. Taping the face masks’ upper edges is an effective technique to prevent visual field artifacts and obtain good test reliability.
Low-energy Selective Laser Trabeculoplasty Repeated Annually: Rationale for the COAST Trial
Authors: Realini Tony , Gazzard Gus , Latina Mark , Kass Michael
Published: January 2021

The recent Laser in Glaucoma and Ocular Hypertension Trial provided the evidentiary basis for a paradigm shift away from the historical medication-first approach to glaucoma--which has numerous limitations, the most important of which is poor adherence to therapy --and toward a laser-first approach. Now 20 years after its commercialization, selective laser trabeculoplasty (SLT) is routinely performed consistently with its initial description, with energy titrated to the appearance of fine, champagne-like cavitation bubbles. A recent data set suggested that lower energy SLT, applied as primary therapy and repeated annually irrespective of intraocular pressure--rather than pro re nata when its effect wanes and irrespective of intraocular pressure rises --yields longer medication-free survival than standard energy SLT repeated pro re nata. A new study--Clarifying the Optimal Application of SLT Therapy --has been initiated to explore this preliminary finding in a pair of consecutive randomized trials. Herein, we provide an evidence-based rationale for the use of low-energy SLT repeated annually as primary therapy for mild to moderate primary open-angle glaucoma or high-risk ocular hypertension.
High Prevalence of Nontuberculous Mycobacteria in Cystic Fibrosis Patients in Tropical French Reunion Island
Authors: Ho Didier , Belmonte Olivier , Andre Michel , Gazaille Virgile , Perisson Caroline , Gachelin Elsa , Allyn Jérôme , Payet Annabelle , Coolen-Allou Nathalie
Published: January 2021

Background:

Reunion Island is a French overseas department located in a tropical area, where cystic fibrosis incidence is high. Cystic fibrosis (CF) patients are at risk of developing nontuberculous mycobacteria (NTM) infection. Epidemiologic studies are lacking in Reunion Island.

Methods:

From 2002 to 2015, a retrospective review was performed in university hospitals on Reunion Island. All CF patients having at least 1 positive NTM isolate were included. Clinical, radiologic, and microbiologic data were collected from patient records.

Results:

Fifty-one CF patients were included. The overall estimated prevalence of NTM was 26.4% in total CF population and 36.9% in patients over 12 years of age. Mycobacterium abscessus and Mycobacterium avium were the most frequently identified species found in 31 patients (60.8%) and 14 patients (27.4%), respectively. A rare NTM species: Mycobacterium simiae was found in 4 patients (7.8%). Twenty-nine patients (56.9%) met the American Thoracic Society (ATS) criteria for infection. They were more likely younger with a low body mass index and more frequently infected by Mycobacterium abscessus (22/29).

Conclusion:

The overall prevalence of NTM in tropical Reunion Island is 3 times higher than in metropolitan France. A different environmental exposure in a tropical climate or risk factors related to cystic fibrosis or its treatment in Reunion patients could explain it.
Evaluation of COVID-19 Vaccine Refusal in Parents
Authors: Yigit Metin , Ozkaya-Parlakay Aslinur , Senel Emrah
Published: January 2021

Objective:

The frequency of vaccine refusal, which is associated with many factors, is increasing worldwide. The aim of this study was to predict the frequency of vaccine refusal against domestic and foreign COVID-19 vaccines and identify the factors underlying refusal.

Methods:

A survey consisting of 16 questions about COVID-19 vaccination was conducted either face-to-face or online with 428 parents who agreed to participate in the study. The parents had children who were inpatients or outpatients in the Children’s Hospital of Ankara City Hospital. In the survey, parents were asked about family sociodemographic characteristics, opinions on domestic and foreign COVID-19 vaccines, and reasons for vaccine refusal.

Results:

While 66.1% of parents were reluctant to receive foreign COVID-19 vaccines, only 37.4% were reluctant to receive domestic COVID-19 vaccines. The participants’ preference for the domestic vaccine was significantly higher for themselves and their children (P < 0.05). Women were less likely to be willing to receive foreign vaccines than men (P < 0.05). As the education level increased, fewer parents preferred the domestic vaccine for themselves (P = 0.046) and their children (P = 0.005). Both domestic and foreign vaccine acceptability for parents and their children was higher among parents with high anxiety levels regarding COVID-19 infection (P < 0.05). The most common reasons for refusal were anxiety about vaccine side effects, lack of knowledge about the effectiveness of vaccines, and distrust of vaccines originating from abroad.

Conclusion:

Most of the participants were hesitant about COVID-19 vaccines. This study demonstrates that vaccine uptake can be increased by considering the higher preference for domestic vaccines.
Dermatology Assessment
Authors: Maghfour Jalal , Jacob Sharon E.
Published: January 2021

Dermatology Assessment represents a novel readership-based tutorial module. Each question links to the Journal of the Dermatology Nurses' Association articles (for members) and Journal of the American Academy of Dermatology article citations associated with the topic.
Skin Cancer: Back to Basics
Authors: Onoday Heather
Published: January 2021

There are more than a million cases of cutaneous squamous cell carcinoma that occur annually, with incidences increasing over the past 30 years. This common skin cancer has a variety of risk factors, with ultraviolet radiation and increasing age being two of the greatest known associated risks. This article is a review of the epidemiology and other risk factors of this common skin cancer and is also an update on its pathophysiology and treatment.
Multistakeholder Perceptions on Lower-Limb Prosthetic User Requirements and the Development of Neuroprostheses: A Contextual Inquiry
Authors: Valgeirsdóttir Vigdís Vala , Sigurðardóttir Jóna Sigrún , Jóhannesson Ómar I. , Alexandersson Ásgeir , Kristjánsson Árni
Published: January 2021

Introduction

Neuroprosthetic systems that can work with prosthetic legs are currently being developed to provide individuals with lower-limb amputation with intent control over their device and sensory feedback. No such system is commercially available, and the effects of providing functions that have previously not been available to lower-limb prosthetic users are unclear.

Methods

Here we present investigations of the perceptions of multiple stakeholders (prosthetic users, physician, psychologist, physiotherapist, prosthetist, and groups of prosthetic designers and engineers) on prosthetic user problems and the development of neuroprosthetics. The investigation entailed semistructured interviews, focus group discussions, and a contextual inquiry.

Results

Our findings indicate that prosthetic users may face several challenges that can potentially be addressed via neurological interfacing. We further identified criteria perceived as integral for the development of lower-limb neuroprostheses as well as considerations for the actualization of a usable system that reaches end users.

Conclusions

On the whole, the field of neuroprosthetics has great potential to increase the wellbeing, mobility, and quality of life of persons with lower-limb amputation.
A National Survey of Student Loan Debt Accrued by Doctor of Physical Therapy Students
Authors: Berry Justin W.
Published: January 2021

Introduction.

Increasing levels of student loan debt are a concern within many health professions, including physical therapy. This purpose of this study was to determine the levels and potential repayment of student loan debt for graduates of public and private physical therapist educational programs and to determine the relationship between debt management education, student loan debt, and credit card debt in Doctor of Physical Therapy (DPT) students just prior to graduation.

Methods.

Seven hundred thirty-three final year DPT students scheduled to graduate in spring or summer of 2019 completed a survey asking participants their level of student loan and credit card debt; their concerns regarding student loan debt; and if their educational program included curricular information on debt management.

Results.

Ninety-one percent of participants had some level of student loan debt. For participants with student loan debt, the average total student debt balance at the time of graduation was $103,482 for those attending a public institution and $138,361 for those attending a private institution; with the average amount of student loans taken out just for attending a DPT program being $83,087 for those attending a public institution and $112,207 for those attending a private institution. Participants who received debt management education within their DPT program had, on average, $3,520 less student loan debt for attending their DPT program and $570 less credit card debt than those who did not receive this education. For participants with student loans, 81% were concerned about loan repayment and 90.3% were concerned about the ability to make future major purchases, such as a house or car.

Discussion and Conclusion.

Utilizing participants' average estimated starting salary and a 15% debt to income guideline, 75.1% of participants with student loan debt would not meet 10-year loan repayment guidelines, 38.7% would not meet fixed 25-year loan repayment plan guidelines, and 21.4% would not meet 25-year graduated loan repayment plan guidelines. There was no significant difference in debt levels between students who did and did not receive debt management education within their DPT educational programs.
Outcomes of 2 Multimodal Human Anatomy Courses Among Doctor of Physical Therapy Students (Entry-Level): A Quasi-experimental Study
Authors: Maher Sara F. , Doherty Deborah J.
Published: January 2021

Introduction.

Alternative methods of anatomy instruction have increased in popularity; however, cadaveric dissections were not consistently reported as the most effective teaching tool. Subjects from 2 professional (entry-level) physical therapist education programs who were taught anatomy using multimodal strategies and either cadaveric dissection or prosected cadavers were compared. The purposes of this study were to 1) determine subjects' approach to learning (surface or deep), 2) determine the preferred learning style of the subjects, 3) assess the subjects' retention of anatomy at the completion of an anatomy course and 6 months later, and 4) determine how much time subjects spent in learning activities for each anatomy pedagogy.

Methods.

Outcome measures consisted of an anatomy quiz, the Revised 2-Factor Study Process Questionnaire, a Learning Perception Inventory, and the Visual, Auditory, Read/Write, Kinesthetic Questionnaire. Data were collected at 3 points during the study: before anatomy class, immediately at the conclusion of the anatomy class, and 6 months after the class had ended. Data were analyzed using SPSS 25.0 and included descriptive statistics, Wilcoxon signed ranks tests, and Mann–Whitney U tests.

Results.

Subjects in both programs were kinesthetic learners who used a deep learning approach. Subjects were able to retain anatomical knowledge postanatomy and 6 months after the class ended, no matter which learning tools were used. The group who worked with prosected cadavers perceived spending more total time preparing for anatomy class.

Discussion and Conclusion.

Based on these results, cadaveric prosection was as effective as cadaveric dissection in 2 multimodal anatomy classes for subjects in 2 professional (entry-level) physical therapist education programs.
Current Practices in Tranexamic Acid Administration for Pediatric Trauma Patients in the United States
Authors: Cornelius Brian , Cummings Quinn , Assercq Mathieu , Rizzo Erin , Gennuso Sonja , Cornelius Angela
Published: January 2021

Background

Although controversial, early administration of tranexamic acid (TXA) has been shown to reduce mortality in adult patients with major trauma. Tranexamic acid has also been successfully used in elective pediatric surgery, with significant reduction in blood loss and transfusion requirements. There are limited data to guide its use in pediatric trauma patients. We sought to determine the current practices for TXA administration in pediatric trauma patients in the United States.

Methods

A survey was conducted of all the American College of Surgeons-verified Level I and II trauma centers in the United States. The survey data underwent quantitative analysis.

Results

Of the 363 Level I and II qualifying centers, we received responses from 220 for an overall response rate of 61%. Eighty of 99 verified pediatric trauma centers responded for a pediatric trauma center response rate of 81%. Of all responding centers, 148 (67%) reported they care for pediatric trauma patients, with an average of 513 pediatric trauma patients annually. The pediatric trauma centers report caring for an average of 650 pediatric trauma patients annually. Of all centers caring for pediatric trauma, 52 (35%) report using TXA, with the most common initial dosing being 15 mg/kg (68%). A follow-up infusion was utilized by 45 (87%) of the programs, most commonly dosed at 2 mg/kg/hr × 8 hr utilized by 24 centers (54%).

Conclusion

Although the clinical evidence for TXA in pediatric trauma patients is limited, we believe that consideration should be given for use in major trauma with hemodynamic instability or significant risk for ongoing hemorrhage. If available, resuscitation should be guided by thromboelastography to identify candidates who would most benefit from antithrombolytic administration. This represents a low-cost/low-risk and high-yield therapy for pediatric trauma patients.
Utilizing Frequency and Severity of Injury to Identify Injury Prevention Priorities in the Community
Authors: Budd Matthew , Hofman Nancy , Corpron Cyndy
Published: January 2021

Background

Trauma centers are charged with identifying injury prevention priorities in the community. Hospitals frequently use system and regional injury data based on frequency of injury mechanisms to establish injury prevention priorities.

Objective

This study was conducted to provide insight into how the Injury Prevention Priority Score (IPPS) can be utilized to prioritize injury prevention activities with considerations of both frequency and severity of injury.

Methods:

This descriptive study utilizes a retrospective review of 6,824 patients 15 years and older at one Level I trauma center between July 1, 2014, and June 30, 2019. A previously described and validated IPPS was calculated for injury mechanisms to compare the overall trauma burden for each cause. The IPPS is presented as a T-score with a mean of 50 and a standard deviation of 10.

Results:

In this sample, most injuries (57.1%) occur to those 65 years or older, and the most common injuries are from a fall (66.5%) or were from a motor vehicle occupant (13.3%). The fall group had an average severity of injury, but the frequency was five times higher than the next highest group. The pedestrian and firearm groups had the highest severity, and their IPPSs were the second and third highest.

Conclusions

Injury priorities should not be based on frequency of injury alone. Use of the IPPS provides additional objective data regarding injury prevention priorities in the community. The IPPS has most commonly been used to evaluate pediatric injury prevention needs but effectively evaluates injury prevention needs throughout the lifespan.
Driving high-functioning clinical teams: An advanced practice registered nurse and physician assistant optimization initiative
Authors: Brooks Paula B. , Fulton Megan E.
Published: January 2021

Background:

Rapid changes in the health care marketplace are driving health care systems to modify operations by which the advanced practice registered nurse (APRN) and physician assistant (PA) clinicians serve patients. By identifying more effective and efficient utilization workflows, organizations can meet these demands resulting in high-functioning clinical teams.

Local problem:

With the growing number of APRNs and PAs within a large academic medical center, there was a recognized need to establish effective and efficient utilization practices for these health care providers.

Methods:

Directors of the Advanced Practice Provider Best Practice Center developed an internal nurse practitioner (NP)/certified nurse midwife (CNM)/clinical nurse specialist (CNS)/PA assessment service in which evaluations were conducted to optimize APRN and PA practice at the clinical/department level. This assessment excluded certified registered nurse anesthetists.

Interventions:

Thirty-two clinical areas were evaluated between September 2016 and May 2019. This included an NP/CNM/CNS/PA survey and over 200 individual NP/CNM/CNS and PA provider interviews. Assessments addressed utilization, billing practices, professional development, and communication among team members.

Results:

Qualitative and quantitative reports were compiled. Many common themes were identified. These were broken down into three major categories: productivity, clinical operations, and professional development/support.

Conclusions:

Several recommendations were presented to department leaders regarding NP/CNM/CNS/PA practice. Those departments who implemented several of the recommendations showed positive outcomes. This was evidenced by increased financial gain (increased relative value units, increase in revenue generated), increased patient access (increased clinic densities), and overall NP/CNM/CNS/PA satisfaction.
Low Thyroid-stimulating Hormone Levels Are Associated With Annoying Tinnitus in Adult Women: Korea National Health and Nutrition Examination Surveys
Authors: Kim So Young , Min Chanyang , Kim Hyung-Jong , Choi Hyo Geun
Published: January 2021

Objective:

This study aimed to investigate the relationship between thyroid function and tinnitus.

Study Design:

A cross-sectional study.

Setting:

The Korean National Health and Nutrition Examination Survey from 2013 was used.

Patients and Interventions:

A total of 1,165 participants ≥ 40 years old who were surveyed for the presence of tinnitus and underwent thyroid function tests were included. The presence of discomfort from tinnitus was defined as annoying tinnitus. The control group included participants with “no tinnitus” or “no discomfort from tinnitus.” The participants were divided into the annoying tinnitus group and the control group.

Main Outcome Measures:

The associations of free thyroxine and thyroid-stimulating hormone (TSH) with annoying tinnitus were analyzed using logistic regression with complex sampling methods. Subgroup analyses were performed according to sex.

Results:

The low TSH level group had 2.35-fold greater odds of annoying tinnitus than the control group (95% confidence interval  = 1.10–5.12, p = 0.027). Even in patients with a normal free thyroxine level, a low TSH level was related to 2.78-fold higher odds of annoying tinnitus (95% confidence interval  = 1.21–6.38, p = 0.016). In subgroup analyses, this association was apparent in the female subgroup. The male subgroup did not show a relationship between low TSH levels and annoying tinnitus.

Conclusions:

Subclinical hyperthyroidism was related to an increased risk of annoying tinnitus. This relationship was apparent in the female subgroup.
Epinephrine for cardiac arrest: knowns, unknowns and controversies
Authors: Soar Jasmeet
Published: January 2021

Purpose of review

The aim of this study was to describe our knowledge about the use of epinephrine in cardiac arrest and discuss the unknowns and current controversies.

Recent findings

A recent large, well conducted, double-blind, randomized placebo-controlled trial of over 8000 patients with out-of-hospital cardiac arrest (PARAMEDIC-2) showed that epinephrine increased return of spontaneous circulation and survival to hospital discharge. The trial's secondary outcomes have raised concerns that epinephrine increases the number of brain damaged survivors. Systematic review and meta-analysis suggest that epinephrine has more pronounced effects for nonshockable rhythms, when given early, and probably increases the number of both good and poor survivors. There remains uncertainty about the optimal use of epinephrine in terms of patient groups, rhythms, dose and timing.

Epinephrine still has a role in the treatment of cardiac arrest; the best way to use epinephrine remains uncertain.
COVID-19: a new burden of respiratory disease among South African miners?
Authors: Naidoo Rajen N. , Jeebhay Mohamed F.
Published: January 2021

Purpose of review

Mineworkers in South Africa experience a triple burden of disease due to their distinct work experience. Silicosis increases their risk of tuberculosis (TB), exacerbated by the HIV epidemic. Work-related factors are likely to increase transmission, severity, and post infection sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Understanding these relationships is important to control the impact of the epidemic.

Recent findings

SARS-CoV-2 infection rates among mineworkers exceed the population rates in the provinces in which those mines are located. Migrant work, living in crowded hostels, working in narrow poorly ventilated shafts mainly underground constitute important factors that increase transmission risk. Mineworkers continue to experience high levels of silica exposure. The prevalences of silicosis, HIV and pulmonary TB, remain high. Interstitial lung disease, pulmonary TB, and HIV have all been associated with poorer outcomes of SARS-CoV-2 infections. Mineworkers with post infection respiratory sequelae are likely to lose their jobs or lose income, due to the physically demanding nature of underground minework.

Further research into the unique work-related risk factors in mining that influence the COVID-19 epidemic is crucial for optimizing current interventions. Reducing SARS-CoV-2 infection transmission, health monitoring of infected and vulnerable workers, and following up of postinfection outcomes is essential to protect the respiratory health of miners.
New guidelines for severe community-acquired pneumonia
Authors: Martin-Loeches Ignacio , Torres Antoni
Published: January 2021

Purpose of review

We highlight the recent advances in the guidelines for treating patients with severe community-acquired pneumonia (sCAP).

Recent findings

sCAP is a significant cause of hospital admissions. We performed an extensive review of the literature, covering studies from the last several years, to summarise the most important points in the diagnosis and treatment of patients hospitalised with sCAP.

sCAP is associated with a high clinical burden. Therefore, deep knowledge is necessary for its management. In general, diagnosis, treatment and management are based on many published guidelines. However, the mortality rate is still unacceptably high, indicating the need for clear recommendations in the management of patients with sCAP. The choice of empirical antibiotic therapy for sCAP depends on multiple factors, such as national and local antimicrobial susceptibility data and the characteristics of the patients, including their risk factors for acquiring infections caused by multidrug-resistant pathogens. Currently, there are several published international guidelines. The aim of this review is to explore the areas that require further knowledge and new recommendations for current clinical practice.
Impact of laparoscopic cholecystectomy on the complexity of endoscopic retrograde cholangiopancreatography
Authors: Seleem Waseem M. , Hanafy Amr S. , Abd-Elsalam Sherief , Badawi Rehab
Published: January 2021

Background and objectives

A scarce number of researches discussed the impact of cholecystectomies on the anatomy of common bile duct (CBD) and intern if this will affect the difficulty of endoscopic retrograde cholangiopancreatography (ERCP). The objective of present study was to assess the impact of complicated cholecystectomy on the complexity and safety of the ERCP procedure

Study design

A total of 100 patients were enrolled after meeting the following inclusion criteria – study group (group A): 50 patients with previous history of complicated laparoscopic cholecystectomy and control group (group B): 50 patients with previous noncomplicated laparoscopic cholecystectomy. ERCP was performed and complexity was judged by a number of cannulation attempts, ERCP time, pancreatic cannulation and post-ERCP pancreatitis.

Results

The study revealed prolonged ERCP procedure duration in noncomplicated cholecystectomy (24.2 ± 8.5 min) and it was significantly more prolonged in complicated cholecystectomy (39.6 ± 10.7 min; P = 0.03). The trials of cannulation attempts were significantly higher in the study group with complicated cholecystectomy (P = 0.009). Pancreatic duct cannulation was frequently higher in the complicated cholecystectomy group (P = 0.03). Difficult or failed stone extraction was significantly prevalent in the complicated cholecystectomy group and the occurrence of post-ERCP pancreatitis (PEP) was significantly higher than the control group.

Conclusion

ERCP after complicated laparoscopic cholecystectomy is more complex with increased duration liability of complications.
Real-world clinical and endoscopic outcomes after one year tofacitinib treatment in ulcerative colitis
Authors: Straatmijer Tessa , van Gennep Sara , Duijvestein Marjolijn , Ponsioen Cyriel I.J. , Gecse Krisztina B. , D’Haens Geert R. , Löwenberg Mark
Published: January 2021

Objective

Tofacitinib, an oral Janus kinase inhibitor, is approved for the treatment of moderate to severe ulcerative colitis (UC). We evaluated clinical and endoscopic efficacy, safety and drug survival of tofacitinib up to one year in a real-world cohort.

Methods

In this retrospective cohort study, 36 UC patients were included who received tofacitinib. The primary outcome was combined with steroid-free clinical remission [Simple Clinical Colitis Activity Index (SCCAI) ≤2] and endoscopic improvement (Mayo score ≤1) at 52 weeks. Secondary outcomes included clinical (SCCAI drop ≥3) and endoscopic response (Mayo score drop ≥1), biochemical remission [fecal calprotectin (FC) ≤150 mg/kg and C-reactive protein ≤5 mg/L), safety and drug survival.

Results

Median disease duration was 7 (3–14) years and 89 and 42% of patients failed prior anti-tumor necrosis factor (anti-TNF) and vedolizumab treatment, respectively. Combined corticosteroid-free clinical remission and endoscopic improvement were observed in 8/36 patients (22%), 6/35 (17%) and 12/31 (39%), at 16, 36 and 52 weeks, respectively. Corresponding combined clinical and endoscopic response rates were 15/36 (42%), 12/35 (34%), 15/31 (48%) and biochemical remission rates were 11/33 (33%), 10/32 (31%) and 10/29 (34%). Nine infections (two herpes zoster) led to dose reduction or (temporary) drug withdrawal. Permanent withdrawal occurred in 14/36 patients (33%) after a median duration of 9 (5–30) weeks. Drug survival at 1 year was 60%. Patients that failed anti-TNF were less likely to discontinue tofacitinib treatment early compared to patients without prior anti-TNF use (hazard ratio 0.20, 95% confidence interval 0.06–0.65).

Conclusion

In a refractory UC population, combined steroid-free clinical remission and endoscopic improvement were found in 39% of patients at 1 year.
The age, bilirubin and albumin (ABA) index: a novel noninvasive index for predicting liver fibrosis in patients with chronic hepatitis C infection
Authors: Yilmaz Baris , Kayadibi Huseyin , Yeniova Abdullah O. , Koseoglu Huseyin , Simsek Zahide
Published: January 2021

Aim

It was to assess the diagnostic performance characteristics of a novel index, (ABA), which utilizes age, bilirubin and albumin to predict significant and severe fibrosis, and cirrhosis in patients with chronic hepatitis C infection.

Methods

A total of 114 patients were included in this study. The liver biopsies were graded using the Ishak scoring system. Diagnostic performance of the ABA index was compared to aspartate aminotransferase (AST) to alanine aminotransferase ratio, age platelet index, AST to platelet ratio index, γ-glutamyl transpeptidase (GGT) to platelet ratio index, FIB-4, FibroQ, Goteborg University Cirrhosis Index, King’s score, GGT/international normalization ratio, platelet to lymphocyte ratio, neutrophil to lymphocyte ratio, white blood cell to platelet distribution width ratio and mean platelet volume to platelet distribution width ratio (MPV/PDW) by receiver operating characteristics (ROC) curve analysis.

Results

The ABA index was formulated as 1.5 + (0.065 × age) + (1.85 × bilirubin) − (1.65 × albumin) according to the multivariate logistic regression analysis. According to the ROC curve analyses, the ABA index had the area under these ROC curves (AUROCs) of 0.805 [95% confidence interval (CI), 0.727–0.883] for significant fibrosis, 0.874 (95% CI, 0.804–0.943) for severe fibrosis and 0.895 (95% CI, 0.828–0.961) for cirrhosis.

Conclusion

The ABA index was found to be superior to other evaluated noninvasive indexes of liver fibrosis by use of the cutoff point of 0 and 1. These findings should be confirmed by prospective and multicenter studies in patients with chronic hepatitis C infection.
The Attitudes and Beliefs of Family Physicians Regarding the Use of Medical Cannabis, Knowledge of Side Effects, and Barriers to Use: A Comparison Between Residents and Specialists
Authors: Abo Ziad Ramzi , Grynbaum Mirta Beatriz , Peleg Roni , Treister-Goltzman Yulia
Published: January 2021

Background:

Israel has a regulated system with clearly defined indications for treatment with medical cannabis.

Study Question:

The main question was whether family physicians in southern Israel face barriers/knowledge gaps in prescribing cannabis for medical indications. The secondary question was whether there was a difference between residents and specialists in family medicine.

Study Design:

A questionnaire-based cross-sectional study.

Measures and Outcomes:

Attitudes of the participating physicians on the use of medical cannabis; comparison of attitudes of specialists in family medicine and residents on the use of medical cannabis.

Results:

One hundred and fifty-two family physicians participated in the study including 48 residents. More than 78% supported the use of medical cannabis and about 63% supported it's legalization. About 84% of the physicians believed that medical cannabis helped cancer patients and 82% believed it helped in the chronic pain. Only 28.3% believed that family physicians should recommend the use of medical cannabis. The physicians were well aware of the psychiatric (82%) and the neurological (78%) adverse effects of medical cannabis. Most (68%) were not willing to prescribe medical cannabis. No socio-demographic characteristic was associated with willingness to prescribe cannabis. About 95% of the physicians believed that the main barrier to recommending treatment was its potential for abuse, 66% percent—the danger that it would leak to the general public. About 60% of the specialists were not prepared to undergoing training in the prescription of medical cannabis compared with 31% of the residents (P = 0.004).

Conclusions:

Family physicians are concerned about recommending medical cannabis. It is encouraging that residents are motivated to undergo training to prescribe medical cannabis. There remain medical indications and adverse effects that family physicians are less aware of. Further studies should focus on effective ways to improve the level of physicians' knowledge on the issue.
Regulation of vascular tone and blood pressure by singlet molecular oxygen in inflammation
Authors: Stanley Christopher P. , Stocker Roland
Published: January 2021

Purpose of review

The principle aim of this review is to prompt vascular researchers interested in vascular inflammation and oxidative stress to consider singlet molecular oxygen (1O2) as a potentially relevant contributor. A secondary goal is to propose novel treatment strategies to address haemodynamic complications associated with septic shock.

Recent findings

Increased inflammation and oxidative stress are hallmarks of a range of vascular diseases. We recently showed that in systemic inflammation and oxidative stress associated with models of inflammation including sepsis, the tryptophan catabolizing enzyme indoleamine 2,3-dioxygenase-1 (Ido1) contributes to hypotension and decreased blood pressure through production of singlet molecular oxygen (1O2). Once formed, 1O2 converts tryptophan bound to Ido1 to a vasoactive hydroperoxide which decreases arterial tone and blood pressure via oxidation of a specific cysteine residue of protein kinase G1α.

These works show, for the first time, that 1O2 contributes to arterial redox signalling and that Ido1 contributes to the regulation of blood pressure through production of a novel tryptophan-derived hydroperoxide, thus presenting a new signalling pathway as novel target in the treatment of blood pressure disorders such as sepsis.
Prognostic mutation constellations in acute myeloid leukaemia and myelodysplastic syndrome
Authors: Iacobucci Ilaria , Mullighan Charles G.
Published: January 2021

Purpose of review

In the past decade, numerous studies analysing the genome and transcriptome of large cohorts of acute myeloid leukaemia (AML) and myelodysplastic syndrome (MDS) patients have substantially improved our knowledge of the genetic landscape of these diseases with the identification of heterogeneous constellations of germline and somatic mutations with prognostic and therapeutic relevance. However, inclusion of integrated genetic data into classification schema is still far from a reality. The purpose of this review is to summarize recent insights into the prevalence, pathogenic role, clonal architecture, prognostic impact and therapeutic management of genetic alterations across the spectrum of myeloid malignancies.

Recent findings

Recent multiomic-studies, including analysis of genetic alterations at the single-cell resolution, have revealed a high heterogeneity of lesions in over 200 recurrently mutated genes affecting disease initiation, clonal evolution and clinical outcome. Artificial intelligence and specifically machine learning approaches have been applied to large cohorts of AML and MDS patients to define in an unbiased manner clinically meaningful disease patterns including, disease classification, prognostication and therapeutic vulnerability, paving the way for future use in clinical practice.

Integration of genomic, transcriptomic, epigenomic and clinical data coupled to conventional and machine learning approaches will allow refined leukaemia classification and risk prognostication and will identify novel therapeutic targets for these still high-risk leukaemia subtypes.
The Need for Manual Skills in an Automated World to Obtain Timely Blood Pressures in Trauma Patients
Authors: Farner-Cordell Carly , Bitton Alexandre , Eeten Katelyn , Schmidt Cory , Brenden Misty
Published: January 2021

Background:

Obtaining the first blood pressure (BP) during adult trauma team activations was often delayed. A review of patient charts revealed that the average time to first documented BP was 6.6 minutes when using an automatic BP cuff.

Purpose:

The purpose was to determine whether taking the initial BP using a manual cuff decreases the time it takes to obtain the first BP.

Method:

The Iowa Model Revised was used as the framework for this project.

Intervention:

An algorithm was developed, and staff were educated and validated on their ability to obtain manual BPs. A 2-month practice change pilot was launched on adult full and partial trauma team activations.

Results:

It was determined that taking a BP manually during adult trauma resuscitations was more efficient, allowing for earlier determination of patient status.

Conclusion:

Obtaining the initial BP manually was 54% more timely and led to an evidence-based practice change.
Improving Antibiotic Administration Rate for Patients With Sepsis in the Emergency Department
Authors: Hatozaki Chie , Sakuramoto Hideaki , Okamoto Mayu , Nakajima Hisao , Shimojo Nobutake , Inoue Yoshiaki
Published: January 2021

Background:

Previous studies have demonstrated that delayed antibiotic administration increases the risk of mortality in patients with sepsis.

Local Problem:

In the emergency department, the antibiotic administration rate within 1 and 3 hours for patients with suspected sepsis was low.

Methods/Interventions:

We implemented an educational intervention with the nursing staff, which included training sessions and feedback, to ensure early detection and management of patients with suspected sepsis. Antibiotic administration rates were compared before and after education.

Results:

A total of 503 patients were included. The antibiotic administration rate improved as the phases continued (1 hour: from 5.2% to 15.6%, P = .004; 3 hours: from 35.6% to 49.7%, P = .04; 6 hours: from 74.1% to 89.1%, P = .002). The time to initial antibiotic administration also improved from 229 to 185 minutes (P < .001).

Conclusions:

Nurse-initiated quality improvement improved the early administration of antibiotics for patients with suspected sepsis.
Polymorphic Variants in 5′-UTR Regions of the RAD51 Gene are Associated With RAD51 Expression and Triple-Negative Breast Cancer (TNBC): A Case-Control Study
Authors: Al Hamad Mohammad , Kussaibi Haitham , Alkharsah Khaled R. , Alsayyah Ahmed , El Shawarby Mohammed , Al Tamimi Dalal , Alomari Munther , Bakshi Hamid A. , Tambuwala Murtaza M. , Al Zoubi Mazhar S.
Published: January 2021

Breast cancer is a heterogeneous disease at morphologic and molecular levels, which is considered the most commonly occurring cancer in women. RAD51, a DNA-repairing protein, involves homologous recombination and has a vital role in genome stability. Polymorphism of the RAD51 gene, and its overexpression, has been proposed to be associated with the development of breast cancer. Overexpression of RAD51 in many types of human cancer including metastatic breast cancer may signify its potential use as a biomarker. Considering the numerous reports on the role of the 5′-UTR-RAD51 polymorphism in breast cancer, this study aimed to investigate the utility of RAD51 gene expression and its variants G135C and G172T as a possible foretelling factor of breast cancer development. DNA sequencing and immunohistochemistry of RAD51 were conducted on 103 samples from patients diagnosed with sporadic breast cancer and 80 samples from a control group. The results demonstrated that the RAD51 variants, G135C and G172T, were significantly presented in the breast cancer tissue compared with the control group. RAD51 expression was mainly shown in the cytoplasm of malignant cells (56% of cases) and significantly correlated with p53 and G135C, C135C variants. Moreover, the occurrence of the G172T variant was significantly associated with the expression of estrogen receptor. Interestingly, 21/26 (81%) of the triple-negative breast cancer showed G135C and C135C genotypes that were significantly associated with the expression of RAD51 (73%). In conclusion, the G135C and C135C variants together with the cytoplasmic expression of RAD51 may have clinical potential as a prognostic predictor for breast cancer development and aggressiveness.
Molecular Pathology of Salivary Gland Neoplasms: Diagnostic, Prognostic, and Predictive Perspective
Authors: Toper M. Hasan , Sarioglu Sulen
Published: January 2021

Salivary gland neoplasms are an uncommon and widely heterogeneous group of tumors. In recent years, there has been considerable progress in efforts to reveal the molecular landscape of these tumors, although it is still limited and appears to be only the tip of the iceberg. Genomic aberrations, especially specific chromosomal rearrangements including CRTC1-MAML2 and CRTC3-MAML2 in mucoepidermoid carcinoma, MYB-NFIB and MYBL1-NFIB fusions in adenoid cystic carcinoma, PLAG1 and HMGA2 alterations in pleomorphic adenoma and carcinoma ex pleomorphic adenoma, ETV6-NTRK3 and ETV6-RET in secretory carcinoma, EWSR1-ATF1 and EWSR1-CREM in clear cell carcinoma, provide new insights into the molecular pathogenesis of various salivary gland neoplasms and help to better classify them. These genetic aberrations primarily serve as diagnostic tools in salivary gland tumor diagnosis; however, some also have promise as prognostic or predictive biomarkers. This review summarizes the latest developments in molecular pathology of salivary gland tumors with a focus on distinctive molecular characteristics.
Adamantinoma Mimicking Squamous Cell Carcinoma: A Problem of Anchoring Bias and Confounding Immunohistochemistry (p40) Staining
Authors: Wieditz-Ooms Kaitlyn , Powers Celeste Noelle , Wiles Austin Blackburn
Published: January 2021

Small biopsy and cytopathology specimens rely on patient history submitted by clinicians to provide interpretative context that is necessary to construct an actionable diagnosis. However, that submitted information may be incorrect. We report a case of an adamantinoma demonstrating heretofore unreported immunohistochemical expression of p40 that was interpreted to be a metastatic squamous cell carcinoma on the biopsy. This misdiagnosis can be attributed to anchoring bias from the submitted clinical information and this unreported clinical phenomenon. We discuss the nature of anchoring bias and the breadth and depth of its influence on the practice of pathology, as well as document the heretofore unreported expression of p40 by an adamantinoma.
Psychometric Properties of Segmental Assessment of Trunk Control in Infants and Toddlers With Down Syndrome
Authors: Flores Megan , Mitchell Katy , Bickley Christina , Da Silva Carolyn P.
Published: January 2021

Purpose:

This study investigated infants and toddlers with Down syndrome (DS) to determine: reliability of the Segmental Assessment of Trunk Control (SATCo), concurrent validity of the SATCo with the Gross Motor Function Measure (GMFM), and whether age and SATCo score predict GMFM score.

Methods:

Eighteen infants and toddlers with DS were tested on the SATCo by 2 physical therapist (PT) raters. One PT rater administered the GMFM. After 2 weeks, PT raters rescored their recorded SATCo sessions. A third PT rater also scored the SATCo videos.

Results:

Interrater reliability of the SATCo was moderate to good and intrarater reliability was good to excellent. The SATCo and the GMFM had good to excellent significant correlations. Age and SATCo score were significant predictors of the GMFM.

Conclusions:

Trunk control appears to play a central role in gross motor function of infants and toddlers with DS. The SATCo has good psychometric properties in this population.

What This Adds to the Evidence:

This study contributes to the literature on the psychometric properties of the SATCo and supports its use to measure trunk control in infants and toddlers with DS between the ages of 6 and 24 months.