bluuebunny/crossref_metadata_2025 huggingface dataset:
Current rodent models for the study of empathic processes
Authors: Cox Stewart S. , Reichel Carmela M.
Published: November 2020

Empathy is a complex phenomenon critical for group survival and societal bonds. In addition, there is mounting evidence demonstrating empathic behaviors are dysregulated in a multitude of psychiatric disorders ranging from autism spectrum disorder, substance use disorders, and personality disorders. Therefore, understanding the underlying drive and neurobiology of empathy is paramount for improving the treatment outcomes and quality of life for individuals suffering from these psychiatric disorders. While there is a growing list of human studies, there is still much about empathy to understand, likely due to both its complexity and the inherent limitations of imaging modalities. It is therefore imperative to develop, validate, and utilize rodent models of empathic behaviors as translational tools to explore this complex topic in ways human research cannot. This review outlines some of the more prevailing theories of empathy, lists some of the psychiatric disorders with disrupted empathic processes, describes rat and mouse models of empathic behaviors currently used, and discusses ways in which these models have elucidated social, environmental, and neurobiological factors that may modulate empathy. The research tools afforded to rodent models will provide an increasingly clear translational understanding of empathic processes and consequently result in improvements in care for those diagnosed with any one of the many psychiatric disorders.
Translational models of cannabinoid vapor exposure in laboratory animals
Authors: Moore Catherine F. , Stiltner Jeffrey W. , Davis Catherine M. , Weerts Elise M.
Published: November 2020

Cannabis is one of the most frequently used psychoactive substances in the world. The most common route of administration for cannabis and cannabinoid constituents such as Δ-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) is via smoking or vapor inhalation. Preclinical vapor models have been developed, although the vaporization devices and delivery methods vary widely across laboratories. This review examines the emerging field of preclinical vapor models with a focus on cannabinoid exposure in order to (1) summarize vapor exposure parameters and other methodological details across studies; (2) discuss the pharmacological and behavioral effects produced by exposure to vaporized cannabinoids; and (3) compare behavioral effects of cannabinoid vapor administration with those of other routes of administration. This review will serve as a guide for past and current vapor delivery methods in animals, synergize findings across studies, and propose future directions for this area of research.
TRPV1 blockers as potential new treatments for psychiatric disorders
Authors: Iglesias Lia P. , Aguiar Daniele C. , Moreira Fabrício A.
Published: November 2020

The transient receptor potential vanilloid-1 channel (TRPV1) is responsible for decoding physical and chemical stimuli. TRPV1 is activated by capsaicin (a compound from chili peppers), heat (above 43°C) and acid environment, playing a major role in pain, inflammation and body temperature. Molecular and histological studies have suggested TRPV1 expression in specific brain regions, where it can be activated primarily by the endocannabinoid anandamide, fostering studies on its potential role in psychiatric disorders. TRPV1 blockers are effective in various animal models predictive of anxiolytic and antipanic activities, in addition to reducing conditioned fear. In models of antidepressant activity, these compounds reduce behavioral despair and promote active stress-coping behavior. TRPV1 blockers also reduce the effects of certain drugs of abuse and revert behavioral changes in animal models of neurodevelopmental disorders. The main limiting factor in developing TRPV1 blockers as therapeutic agents concerns their effects on body temperature, particularly hyperthermia. New compounds, which block specific states of the channel, could represent an alternative. Moreover, compounds blocking both TRPV1 and the anandamide-hydrolyzing enzyme, fatty acid amide hydrolase (FAAH), termed dual TRPV1/FAAH blockers, have been investigated with promising results. Overall, preclinical studies yield favorable results with TRPV1 blockers in animal models of psychiatric disorders.
Investigational Anti–Atrial Fibrillation Pharmacology and Mechanisms by Which Antiarrhythmics Terminate the Arrhythmia: Where Are We in 2020?
Authors: Burashnikov Alexander
Published: November 2020

Antiarrhythmic drugs remain the mainstay therapy for patients with atrial fibrillation (AF). A major disadvantage of the currently available anti-AF agents is the risk of induction of ventricular proarrhythmias. Aiming to reduce this risk, several atrial-specific or -selective ion channel block approaches have been introduced for AF suppression, but only the atrial-selective inhibition of the sodium channel has been demonstrated to be valid in both experimental and clinical studies. Among the other pharmacological anti-AF approaches, “upstream therapy” has been prominent but largely disappointing, and pulmonary delivery of anti-AF drugs seems to be promising. Major contradictions exist in the literature about the electrophysiological mechanisms of AF (ie, reentry or focal?) and the mechanisms by which anti-AF drugs terminate AF, making the search for novel anti-AF approaches largely empirical. Drug-induced termination of AF may or may not be associated with prolongation of the atrial effective refractory period. Anti-AF drug research has been largely based on the “suppress reentry” ideology; however, results of the AF mapping studies increasingly indicate that nonreentrant mechanism(s) plays an important role in the maintenance of AF. Also, the analysis of anti-AF drug-induced electrophysiological alterations during AF, conducted in the current study, leans toward the focal source as the prime mechanism of AF maintenance. More effort should be placed on the investigation of pharmacological suppression of the focal mechanisms.
Comparative Efficacy of Glucagon-like Peptide 1 Receptor Agonists and Sodium Glucose Cotransporter 2 Inhibitors for Prevention of Major Adverse Cardiovascular Events in Type 2 Diabetes: A Network Meta-analysis
Authors: Qiu Mei , Ding Liang-Liang , Wei Xu-Bin , Liu Shu-Yan , Zhou Hai-Rong
Published: November 2020

The comparative efficacy of different glucagon-like peptide 1 receptor agonists and sodium glucose cotransporter 2 inhibitors for prevention of major adverse cardiovascular events (MACE) in type 2 diabetes with or without cardiorenal disease is undefined. PubMed and Embase were searched for relevant randomized trials. We conducted network meta-analysis within the Bayesian framework. Effect sizes were measured using hazard ratio (HR) and 95% confidence interval (CI). We calculated surface under the cumulative ranking curve (SUCRA) values to rank drug interventions for different type 2 diabetic subgroups. Albiglutide (HR 0.76, 95% CI 0.63–0.93) and subcutaneous semaglutide (HR 0.71, 95% CI 0.52–0.95), with the maximum SUCRA values, significantly reduced MACE versus lixisenatide in people with diabetes with cardiovascular disease; albiglutide (HRs: 0.69 and 0.72), with the maximum SUCRA value, significantly reduced MACE versus dapagliflozin and exenatide in people with diabetes with heart failure; and canagliflozin (HRs: 0.72 and 0.72) and liraglutide (HRs: 0.68 and 0.68), with the maximum SUCRA values, significantly reduced MACE versus exenatide and lixisenatide in people with diabetes with chronic kidney disease. In preventing MACE in type 2 diabetes, subcutaneous semaglutide and albiglutide are most effective for diabetes with cardiovascular disease, albiglutide is most effective for diabetes with heart failure, and canagliflozin and liraglutide are most effective for diabetes with chronic kidney disease.
CHOROIDAL INFLAMMATION AND CHORIOCAPILLARIS ISCHEMIA IN FOCAL CHOROIDAL EXCAVATION IN COMPARISON TO PACHYCHOROID NEOVASCULOPATHY
Authors: Seo Eoi Jong , Moon Tae Hwan , Kim Dong Yoon , Chae Ju Byung
Published: November 2020

Purpose:

To investigate the choriocapillaris and choroidal characteristics of focal choroidal excavation (FCE) to establish pathomechanisms of the disease.

Methods:

Thirty eyes with FCE, 26 eyes with pachychoroid neovasculopathy (PNV), and 25 participants without any conditions (control group) were analyzed retrospectively. The thickness of both choriocapillaris equivalent and whole choroid was measured at three different points: under the lesion (excavation or neovascularization), in the normal retina, and in the fovea of fellow eye. Indocyanine green angiographic images were collected to confirm choriocapillaris ischemia and the presence of choroidal inflammation.

Results:

In both FCE and PNV, choriocapillaris-equivalent attenuation was observed under the lesion compared with other region of the retina (28.1 ± 11.3 μm vs. 69.4 ± 20.0 μm in FCE; 23.5 ± 9.7 μm vs. 62.3 ± 14.7 μm in PNV; both P < 0.001). We also observed focal thinning of the whole choroid under the lesion (149.7 ± 88.7 μm vs. 296.6 ± 83.2 μm; P < 0.001) in FCE but not in PNV. Pachyvessels distribution on optical coherence tomography and numerous dark areas on indocyanine green angiography implied that choroidal inflammation was related to the FCE occurrence.

Conclusion:

Choriocapillaris ischemia was related to both FCE and PNV. The choroidal thinning under the excavation and adjacent pachyvessels observed in FCE suggested that focal inflammation and scarring may contribute to choriocapillaris ischemia and eventual retinal pigment epithelium retraction with dysfunction in the pathomechanism.
SERUM LEVELS OF ANTIBODIES AGAINST OXIDATION-SPECIFIC EPITOPES ARE DECREASED IN PATIENTS WITH RETINAL VEIN OCCLUSION
Authors: Posch-Pertl Laura , Weger Martin , Pinter-Hausberger Silke , List Wolfgang , Posch Florian , Wedrich Andreas , Michelitsch Katharina , Kozma Maria O. , Woltsche Nora , Binder Christoph J.
Published: November 2020

Purpose:

Oxidative stress and inflammation have been implicated in the development of retinal vein occlusion (RVO). Oxidation-specific epitopes (OSEs) represent products of oxidative stress that can trigger vascular inflammation and thrombosis. Natural occurring antibodies have been shown to bind oxidation-specific epitopes thereby inhibiting their inflammatory potential and promoting their removal.

Methods:

This prospective cross-sectional study included 270 patients with RVO and 81 in-hospital control patients. We measured three types of serum levels of oxidation-specific epitope-specific immunoglobulin M and immunoglobulin G antibodies (anti–copper-oxidized LDL [CuOx-LDL], antiphosphocholine [PC], anti–malondialdehyde-modified LDL [MDA-LDL]). History of arterial hypertension, hyperlipidemia, myocardial infarction, diabetes mellitus, stroke, smoking status, and several laboratory parameters were determined to control for potential confounders.

Results:

Compared with controls, patients with RVO had significantly lower levels of immunoglobulin M and immunoglobulin G antibodies against CuOx-LDL and PC, and significantly lower levels of immunoglobulin G but not immunoglobulin M antibodies against MDA-LDL. The association between RVO patients and lower levels of these antibodies prevailed upon multivariable adjustment.

Conclusion:

These prospective data show that antibodies against oxidation-specific epitope are lower in patients with RVO compared with control patients and support the concept that oxidative stress and inflammation play key roles in the development and subsequent complications in RVO.
LONG-TERM CHANGES IN CHOROIDAL THICKNESS IN EYES WITH TYPE 3 MACULAR NEOVASCULARIZATION
Authors: Kim Jae Hui , Kim Jong Woo , Kim Chul Gu , Lee Dong Won
Published: November 2020

Purpose:

To evaluate the long-term changes in subfoveal choroidal thickness (SCT) in eyes with Type 3 macular neovascularization that underwent anti–vascular endothelial growth factor therapy.

Methods:

This retrospective study was performed with 47 patients diagnosed with Type 3 macular neovascularization and treated with anti–vascular endothelial growth factor therapy. All the patients initially received three loading injections. The SCT was compared at diagnosis, 3 months, 12 months, and at the final follow-up visit. The velocity of changes in SCT was also compared between each period.

Results:

The mean follow-up period was 52.1 ± 11.0 months. The mean SCT was 143.3 ± 51.2 µm at diagnosis, and it had significantly decreased to 128.6 ± 47.4 µm at 3 months (P < 0.001), 123.2 ± 45.7 µm at 12 months (P < 0.001), and 110.0 ± 43.0 µm at the final follow-up (P < 0.001). The mean velocity of the decrease in SCT was 4.9 ± 3.9 µm per month during the first 3 months, 0.6 ± 1.2 µm per month between the 3rd and the 12th months, and 0.3 ± 0.3 µm per month between the 12th month and the final follow-up. The velocity of the decrease was significantly greater during the first 3 months than during the 3rd to 12th month (P < 0.001) and 12th month to final follow-up (P < 0.001) periods. The difference was not significant between the 3rd to 12th month and 12th months to final follow-up (P = 0.836) periods.

Conclusion:

Subfoveal choroidal thickness continuously decreased over time, with a significant decrease of 23% noted in eyes with Type 3 macular neovascularization. The thickness rapidly decreased during the initial loading phase. Subsequently, a continuous but gradual decrease in the thickness was noted.
Changes in Prices and Eye-Care Providers Prescribing Patterns of Glaucoma Medications in the United States Between 2013 and 2019
Authors: Barayev Edward , Geffen Noa , Nahum Yoav , Gershoni Assaf
Published: November 2020

Precis:

Brand glaucoma medication prices vastly increased in the United States over the past 7 years, despite a reduction in eye-care providers’ tendency to prescribe brand medications over generics.

Purpose:

Determine the changes in prices of brand and generic glaucoma medications and to identify changes in eye-care providers prescribing patterns since 2013.

Materials and Methods:

The National Average Drug Acquisition Cost (NADAC) database (2013-2019) was used analyze per-unit drug price. Medicare Part D prescriber profile was used to identify eye-care providers prescribing patterns between 2013 and 2017.

Results:

Brand-name medication prices increased by 59% between 2013 and 2019, while generic medications decreased by 22%. Brand-name drugs were 13 to 162 times more expensive than their generic counterparts. Eye-care Providers prescribed 25% less brand name medications in 2017 compared with 2013.

Conclusion:

Brand glaucoma medication prices vastly increased in the United States over the past 7 years, despite a reduction in eye-care providers’ tendency to prescribe brand medications over generics. A change in government policy, allowing Medicare medication prices negotiations, could greatly reduce health expenditure on glaucoma treatment.
Ahmed and Baerveldt Drainage Implants in the Treatment of Juvenile Open-angle Glaucoma
Authors: Le Patrick H. , Nguyen Michelle , Humphrey Kris-Ann , Klifto Meredith R.
Published: November 2020

Precis:

Ahmed and Baerveldt implants succeed in 90.7% of cases for lowering intraocular pressure (IOP) <21 mm Hg at 1 year when used for the treatment of juvenile open-angle glaucoma.

Purpose:

The purpose of this study was to report the 1-year outcomes of Ahmed and Baerveldt tubes as the treatment for juvenile open-angle glaucoma at an academic institution.

Patients and Methods:

Patients 18 to 40 years of age at the time of juvenile open-angle glaucoma diagnosis, who had inadequately controlled glaucoma with an IOP of 18 mm Hg or more on maximum tolerated antiglaucoma therapy that underwent tube shunt surgery with at least 6 months of follow-up were eligible for the study. Exclusion criteria included evidence of neovascular, uveitic or inflammatory, steroid-induced or primary congenital glaucoma, or if they did not have light perception vision. Postoperative failure was defined as an IOP, with or without antiglaucoma drops, >21 mm Hg for 2 consecutive visits after 3 months from surgery, <20% decrease in IOP at 1 year, no light perception, or revision of an implant due to high IOP.

Results:

The study population included 32 eyes from 25 patients who underwent tube shunt surgery. The failure rate at 1-year follow-up was 9.3%, and the postoperative complication rate at 1-year follow-up was 9.3%. The average change from baseline to 1 year for IOP was a decrease of 9.8±9.10, for the number of antiglaucoma drops number was a decrease of 0.38±1.06, and for the visual acuity was an increase of 0.03±0.27.

Conclusions:

Ahmed and Baerveldt implantation succeeded in lower IOP in 90.7% of patients at 1 year. Continuation of antiglaucoma drops to maintain the IOP after surgery is likely required.
Impaired short-term visual paired associative plasticity in patients with migraine between attacks
Authors: Abagnale Chiara , Ranieri Federico , Di Renzo Antonio , Parisi Vincenzo , Serrao Mariano , Di Lazzaro Vincenzo , Lisicki Marco , Coppola Gianluca , Pierelli Francesco
Published: November 2020

A common experimental neurophysiological method to study synaptic plasticity is pairing activity of somatosensory afferents and motor cortical circuits, so-called paired associative stimulation (PAS). Dysfunctional inhibitory and excitatory PAS mechanisms within the sensorimotor system were described in patients with migraine without aura (MO) between attacks. We have recently observed that the same bidirectional PAS rules also apply to the visual system. Here, we have tested whether dysfunctioning associative plasticity might characterize the visual system of patients with MO. In 14 patients with MO between attacks and in 15 healthy volunteers, we performed a previously validated visual PAS (vPAS) protocol by coupling 90 black-and-white checkerboard reversals with low-frequency transcranial magnetic stimulation pulses over the occipital cortex at 2 interstimulus intervals of −25/+25 ms around the visual-evoked potential (VEP) P1 latency. We recorded VEPs (600 sweeps) before, immediately after, and 10 min after each vPAS session. We analysed VEP N1-P1 amplitude and delayed habituation. Although vPAS-25 significantly enhanced and vPAS + 25 reduced VEP amplitude habituation in healthy volunteers, the same protocols did not significantly change VEP amplitude habituation in MO between attacks. We provide evidence for lack of habituation enhancing and habituation suppressing visual PAS mechanisms within the visual system in interictal migraine. This finding, in combination with those previously obtained studying the sensorimotor system, leads us to argue that migraine disease-related dysrhythmic thalamocortical activity prevents the occurrence of physiological bidirectional synaptic plasticity induced by vPAS.
Understanding Factors Relevant to Self-Injurious Behavior in a High-Risk Secure Psychiatric Sample: Developing the Theory-Driven Measure of Self-Injurious Behavior Engagement
Authors: Caton Charlotte , Ireland Jane L. , Chu Simon , Ireland Carol A. , Cramer Robert J.
Published: November 2020

A measure for the assessment of self-injurious behavior is developed. Commencing with a Delphi composed of 33 experts: detached experts (academics), experts by exposure (staff), and experts by experience (patients), the Theory-driven Measure of Self-Injurious Behavior Engagement is outlined. This is then examined in two samples: high-secure psychiatric male patients (n = 76) and high-secure psychiatric nursing staff (n = 100; 50 men, 50 women). We predicted that all components of the Theory of Planned Behavior and the capacity, belongingness, and burdensomeness elements of the Interpersonal Psychological Theory of Suicidal Behavior would be confirmed as important inclusions. Results initially showed the importance of including intention, perceived behavioral control, affect, capacity, and burdensomeness. The role of environmental and individual factors, such as coping, was captured as additional variables of value. However, the structure of items differed between patients and staff. Being valued consistently represented a core consideration, as did capacity and affect. Directions for future research are indicated.
Physical Activity and Cardiac Self-Efficacy Levels During Early Recovery After Acute Myocardial Infarction: A Jordanian Study
Authors: SHAJRAWI Abedalmajeed , GRANAT Malcolm , JONES Ian , ASTIN Felicity
Published: November 2020

Background

Regular physical activity is important for patients with established coronary heart disease as it favorably influences their coronary risk profile. General self-efficacy is a powerful predictor of health behavior change that involves increases in physical activity levels. Few studies have simultaneously measured physical activity and self-efficacy during early recovery after a first acute myocardial infarction (AMI).

Purpose

The aims of this study were to assess changes in objectively measured physical activity levels at 2 weeks (T2) and 6 weeks (T3) and self-reported cardiac self-efficacy at hospital discharge (T1) and at T2 and T3 in patients recovering from AMI.

Methods

A repeated-measures design was used to recruit a purposive sample of patients from a single center in Jordan who were diagnosed with first AMI and who did not have access to cardiac rehabilitation. A body-worn activity monitor (activPAL) was used to objectively measure free-living physical activity levels for 7 consecutive days at two time points (T2 and T3). An Arabic version of the cardiac self-efficacy scale was administered at T1, T2, and T3. Paired t tests and analysis of variance were used to examine differences in physical activity levels and cardiac self-efficacy scores, respectively.

Results

A sample of 100 participants was recruited, of which 62% were male. The mean age of the sample was 54.5 ± 9.9 years. No statistically significant difference in physical activity levels was measured at 2 weeks (T2) and 6 weeks (T3). Cardiac self-efficacy scores improved significantly between T1, T2, and T3 across subscales and global cardiac self-efficacy.

Conclusions/Implications for Practice

Participants recovering from AMI in Jordan did not increase their physical activity levels during the early recovery phase, although cardiac self-efficacy scores improved. This may be because the increase in cardiac self-efficacy was not matched by the practical skills and knowledge required to translate this positive psychological construct into behavioral change. This study provides a first step toward understanding the complex relationship between cardiac self-efficacy and physical activity in this population. The authors hope that these findings support the design of culturally appropriate interventions to increase physical activity levels in this population.
Early Career Physical Therapist Faculty Connecting With Others for Scholarly Activity: A Grounded Theory Study
Authors: Becker Betsy J. , Shope Ron , Willett Gilbert , Von Essen Susanna , Kennel Victoria
Published: November 2020

Introduction.

The professional relationships of early career physical therapist (PT) faculty aid in career advancement by supporting scholarly activity. A recent study suggested that a professional network structure that is less interconnected is an effective network for more scholarly activity. However, no studies have addressed the process of how early career PT faculty build their network. The purpose of this study is to develop a theoretical model that explains the process that early career PT faculty use to develop effective networks for scholarly activity.

Methods.

Participants were purposely selected to represent variations in scholarly productivity and effectiveness in their professional network. One-on-one interviews were conducted with 20 early career PT faculty, representing 15 institutions from 12 states. Questions focused on why individuals were included in the network, how they were connected, and examples of the outcomes of the relationships. Conceptual depth for the theory development was determined through conceptual maps, coding trees, axial coding, member checking, and peer debriefing.

Results.

We present a theoretical model of the process early career PT faculty members use to develop effective networks for scholarly activity. Motivations to develop network connections were meeting accreditation standards, job requirements, and a desire to contribute to the knowledge base. Network development strategies included reaching out to previously established connections, making new acquaintances within one's current institution, unplanned “fluke” encounters, and “cold calling.” Outcomes of developing network connections were new opportunities, advancing connections, and receiving feedback. Challenges to this process were a lack of time, funding, individual elements, and institutional factors.

Discussion and Conclusion.

This theory improves our understanding of the process early career faculty use to build professional network connections and use the relationships to generate a scholarly agenda. Traditional introductions, self-initiated contact, and taking advantage of chance encounters can all help early career faculty advance their network connections. Implementing these strategies to develop connections is not only the responsibility of the individual faculty member but also must be encouraged by professional associations and educational institutions. This study underscores the importance of early career faculty connecting with others to be successful in higher education.
Female congenital aphallia: a unique case of congenital absence of the clitoris with an ectopic labium majorum
Authors: Almutadares Mahmoud , Evans Jane , Sellers Elizabeth , Morris Amanda , Zapata-Aldana Eugenio
Published: November 2020

The spectrum of disorders of sexual development includes anatomical abnormalities of the external genitalia, the phenotypic variability of which and the underlying causes are numerous. However, female aphallia and ectopia of the labium majorum appear to be some of the rarest forms of external genitalia malformations. Aphallia is mostly described in males with a frequency of less than one per 40 000 male newborns. Although syndromic forms of aphallia in females have been reported, for example, in Robinow, CHARGE, and Prader–Willi syndrome, reports of isolated female aphallia are meager. Here, we describe the first case of isolated agenesis of the clitoris with an ectopic labium majorum and review the literature of this uncommon malformation and its potential dysmorphogenetic mechanism. We emphasize the need for a routine exhaustive physical examination to identify and characterize this unusual malformation correctly so that families can be appropriately counseled as to cause and potential complications.
The indicative role of markers for liver injury on the severity and prognosis of coronavirus disease 2019 patients
Authors: Yang Rongrong , Gui Xien , Ke Hengning , Gao Shicheng , Luo Mingqi , Xiong Yong
Published: November 2020

Background

Liver injury in coronavirus disease 2019 (COVID-19) patients was poorly understood.

Methods

The markers of liver injury, severity of disease and prognosis among 495 COVID-19 patients in Zhongnan Hospital of Wuhan University from 1st January 2019 to 11th March 2019 were retrospectively analyzed.

Results

The levels of aspartate aminotransferase (AST) (50.1 ± 38.4 vs. 31.4 ± 39.1, P < 0.001), gamma-glutamyl transpeptidase (GGT) (70.3 ± 70.2 vs. 34.1 ± 34.7, P < 0.001) and fibrinogen-to-albumin-ratio (FAR) (13.4 ± 4.0 vs. 10.4 ± 3.4, P < 0.001) were greater than mild COVID-19 patients, whereas the levels of albumin(35.0 ± 6.2 vs. 39.9 ± 3.7, P < 0.001) and albumin/globulin (A/G) ratio (1.21 ± 0.24 vs. 1.50 ± 0.31, P < 0.001) were lower in severe COVID-19 patients. By comparing the changes of liver injury markers 7–10 days after hospitalization, the level of albumin deteriorated from 35.0 ± 6.2 to 30.20 ± 5.5 (P < 0.001), A/G ratio from 1.21 ± 0.24 to 1.06 ± 0.25 (P < 0.001), and FAR from 13.4 ± 4.0 to 15.4 ± 2.9(P < 0.001) in severe COVID-19 patients, while the changes of albumin, A/G ratio and FAR showed opposite patterns in mild COVID-19 patients. FAR > 12 [2.566 (1.410–4.670), P = 0.012) on admission and changes of albumin >5g/l [22.489 (6.422–78.757), P = 0.001] were two risk factors for death, and the sensitivity and specificity for the poor prognosis were 80.8% and 64.0%, 82.6% and 76.3%, respectively.

Conclusion

The levels of AST, GGT, albumin and FAR are correlated with disease severity after severe acute respiratory syndrome coronavirus-2 infection. FAR > 12 on admission and changes of albumin > 5 g/l were good predictors for the prognosis of COVID-19 patients.
Effects of the COVID-19 Pandemic on Outpatient Providers in the United States
Authors: Chatterji Pinka , Li Yue
Published: November 2020

Background:

During the COVID-19 pandemic, there is concern that social distancing, fear of contagion, quarantining of providers, cancellation of elective procedures, media coverage about the pandemic, and other factors drastically reduced physician visits, putting severe financial strain on outpatient providers, and having unknown ramifications for health outcomes.

Objectives:

We estimate the effect of the pandemic on utilization of outpatient services.

Research Design:

Using 2010–2020 data from a national dataset, the Outpatient Influenza-like Illness Surveillance Network, we estimate the difference in outpatient care utilization during the time period of the COVID-19 pandemic versus the same weeks in prior years.

Results:

Our findings indicate that the pandemic started to reduce visits during the week of March 15–21. The effect on visits grew until reaching a peak during the week of April 5–11, 2020, when the pandemic reduced the total number of outpatient visits per provider by 70% relative to the same week in prior years. We find negative effects of the pandemic on visits for non-flu symptoms as well as on visits for flu symptoms, but the magnitudes of these latter effects tended to be larger in magnitude. The pandemic’s impact declined over time, and by the week of June 28 to July 4, 2020, there was no longer any difference in total visits per provider relative to the same week in prior years. Despite the resurgence of COVID-19 in June and July, we still find no effects on total visits when our data end in July 26 to August 1, 2020.

Conclusions:

Our findings show that one by-product of the COVID-19 pandemic in the United States is a large decline in the use of outpatient care which peaked around the week of April 5–11. Total outpatient visits rebounded completely and remain stable as of July 26 to August 1, 2020.
Patient-reported Outcome Measures in Pediatric Non-Malignant Hematology: A Systematic Review
Authors: Kinahan Julia Y. , Graham Johann M.I. , Hébert Yamilée V. , Sampson Margaret , O’Hearn Katie , Klaassen Robert J.
Published: November 2020

Patient-reported outcome measures (PROMs) are questionnaires completed by patients or caregivers without influence by health care professionals. As such, PROMs show subjective health experiences, enhance the clinical information available to providers, and inform clinical action. The objective of this systematic review is to identify and list which validated PROMs have been used to monitor health-related quality of life in pediatric patients with nonmalignant hematology (hemophilia, immune thrombocytopenia, sickle cell disease, and thalassemia). Databases (MEDLINE, Embase, HaPI, CINAHL, and PsycTESTS) were searched to identify publications that validated or used PROMs as an outcome measure in the 4 disease groups. Overall, 209 articles met the inclusion criteria, identifying 113 PROMs. Of the 113 identified PROMs, 95 are generic and can be used in multiple disease groups. The Pediatric Quality of Life Generic Core Scales was the most frequently used generic PROM (68 studies). The 18 remaining PROMs were disease specific. The results of this review, together with the COSMIN tool for selecting outcome measures, will allow clinicians to evaluate the PROMs that are best suited to their patient population. In addition, the focus groups are currently being conducted with patients, parents, and clinicians to determine the optimal use of PROMs in the clinical environment.
Assessment of aerobic fitness in individuals with and without nonspecific chronic low back pain: a pilot study
Authors: Fernandes Isabela M.C. , Morelhão Priscila K. , Hisamatsu Thalysi M. , Diniz Tiego A. , Gerosa-Neto José , Panissa Valéria L.G. , Lira Fábio S. , Pinto Rafael Z.
Published: November 2020

Aerobic fitness assessment in patients with low back pain (LBP) may help clinicians to plan how to progress the aerobic training. This was a pilot study designed to evaluate the performance of people with LBP on two different aerobic fitness tests performed on a treadmill and to compare the measure of aerobic fitness between people with LBP and healthy individuals. Ten people with LBP and 10 healthy individuals underwent two aerobic fitness protocols, the modified Bruce and maximum incremental test protocols, performed on a treadmill. Data collected during the protocols were: oxygen consumption, heart rate (HR), blood lactate concentration, respiratory quotient, rating of perceived exertion response, and pain intensity. Independent t-test and two-way analysis of variance were used respectively to assess difference between groups characteristics and physiological responses to the protocols. Our results showed that both groups were similar with regards to age (P = 0.839) or HRrest (P = 0.730) but the LBP group showed higher BMI compared to the healthy group (P = 0.031). Regarding the performance of both groups on the aerobic fitness tests, the only significant difference was reported for respiratory quotient which showed a main effect of test (P = 0.015) with higher values favoring the modified Bruce over the incremental test. Our study showed that most people with LBP are able to perform and tolerate both aerobic fitness tests but no significant differences between people with LBP and healthy individuals on both protocols were reported.
Recommendations for Management of Noncytotoxic Vesicant Extravasations
Authors: Ong Jennie , Van Gerpen Ruth
Published: November 2020

To prepare clinicians to treat extravasation of noncytotoxic vesicants with antidotes and thermal compresses, a literature review was performed to identify noncytotoxic vesicants and to create evidence and consensus-based recommendations. The stage of injury and vesicant's mechanism of tissue injury dictate treatment. For a vasopressor extravasation, warm compresses and administration of a vasodilator are recommended. For osmolarity, pH, absorption refractory, and cytotoxic concentration-dependent vesicants, warm compresses and administration of hyaluronidase are recommended. Compared with potentially catastrophic costs of undertreatment, the cost of overtreatment is minimal.
Psychometric Evaluation of the Caring Ability of Family Caregivers of Patients With Cancer Scale–Mothers’ Version for the Mothers of Children With Cancer
Authors: Khademi Fatemeh , Rassouli Maryam , Khanali Mojen Leila , Heidarzadeh Mehdi , Shirinabadi Farahani Azam
Published: November 2020

Background

The experience of caring for cancer patients has adverse outcomes for family caregivers. The ability to care for a sick child is affected by the mother’s health; to empower mothers, it will be necessary to examine their caring ability.

Objective

The aim of this study was to carry out a psychometric evaluation of the Caring Ability of Family Caregivers of Patients With Cancer Scale–Mothers’ Version (CAFCPCS–Mothers’ Version).

Methods

The present study is a psychometric evaluation of the CAFCPCS–Mothers’ Version. The sample consisted of 196 mothers of children in treatment for cancer selected through convenience sampling. The face, content and construct validity, internal consistency, and stability of the scale were measured. Data were analyzed using the software SPSS 19 and LISREL 8.8.

Results

After removing 2 items during confirmatory factor analysis, the values of root-mean-square error of approximation, comparative fit index, and nonnormed fit index were reported to be 0.066, 0.92, and 0.91, respectively. The Cronbach’s α was calculated to be 0.71 and the stability correlation coefficient was 0.75. The final tested scale included 29 items in 5 dimensions: effective role play, fatigue and surrender, trust, uncertainty, and caring ignorance for mothers of children with cancer.

Conclusion

The CAFCPCS–Mothers’ Version has satisfactory content, face, and construct validity and adequate reliability in terms of internal consistency and stability in a sample of mothers of children receiving treatment for cancer.

Implication for Practice

The CAFCPCS–Mothers’ Version can be used to assess the caring ability of Iranian mothers of children with cancer and to determine maternal care needs.
Death in Children After Atractylis gummifera L. Poisoning in Morocco—Report of Three Cases and Review of Literature
Authors: Nya Samir , Abouzahir Hind , Dami Abdellah , Saif Zineb , Najdi Adil , Belhouss Ahmed , Benyaich Hicham
Published: November 2020

Background

Atractylis gummifera L. is a poisonous thistle plant that grows in the Mediterranean regions especially in northern Africa like Morocco and southern Europe. It has been used frequently to treat some diseases in traditional medicine, and its ingestion is a common cause of fatal poisoning. Here, we report 3 death cases in children after accidental ingestion of the Atractylis gummifer L.

Cases reports

We report 3 cases of death in children after accidental ingestion of the poisonous plant Atractylis gummifer L. The poisoned children were admitted to hospital in deteriorated general state with clinical symptoms, such as nausea, vomiting, epigastric, and abdominal pain, diarrhea, followed by coma. However, they died a few hours later. The postmortem investigations were performed, and the diagnosis of Atractylis gummifer L. poisoning was confirmed by toxicological examination (chromatography), the latter showed the presence of atractyloside (potassium atractylate), a toxic compound of the plant Atractylis gummifera L.

Atractylis gummifer L. poisoning was discussed with review through the literature.

Conclusions

Through the presented cases, we show that Atractylis gummifera L. poisoning remains a health problem that involves children in Morocco, where the plant grows spontaneously. Thus, teaching children to recognize dangerous plants will be helpful to prevent accidental ingestion.
Design and Test of a Graphic Medication Dosage Calculator in Paramedic Practice With Children
Authors: Parush Avi , Haim Nitzan , Jaffe Eli , Wacht Oren
Published: November 2020

Background

Children are more vulnerable to medication errors during prehospital care because of paramedic staff having less experience with pediatric patients. One of the possible solutions to this problem is the use of technologies as cognitive aids to medication dosage calculation.

Objective

Design and empirically test a graphic dosage calculator tailored for pediatric medication calculation in prehospital emergency care.

Methods

The design and development of the calculator followed an iterative user-centered design process. Fourteen novice and 16 experienced paramedics participated in the empirical test of the graphic calculator by running 3 pediatric medication scenarios with both the graphic calculator and a pocket handbook used currently to aid calculations.

Results

It took significantly less time to complete the scenarios with the graphic calculator compared with the handbook. Both novice and experienced paramedics expressed similar levels of confidence with using the graphic calculator. Participants expressed a strong preference for the graphic calculator. Finally, the graphic calculator was scored significantly above a standard usability benchmark.

Discussion

The results show that the graphic calculator was usable, more effective, efficient, and preferred compared with the current dosage calculation method. Technologies such as the graphic calculator designed and tested in this study can help not only with the rare cases, such as pediatrics, but might also mitigate skill decay.
Utility of Computed Tomography Overreading and Abdominal Ultrasound in Children With Suspected Appendicitis and Nondiagnostic Computed Tomography at Community Hospitals
Authors: Keating Elizabeth M. , Orth Robert C. , Bisset George S. , Starke Hannah E. , Cruz Andrea T.
Published: November 2020

Objective

The aim of the study was to examine the ability of overreading of computed tomography (CT) and right lower quadrant ultrasound (RLQ US) to diagnose appendicitis for children with suspected appendicitis with equivocal CTs at community hospitals.

Methods

This was a retrospective chart review of all children transferred to a children's hospital from community emergency departments with suspected appendicitis over 2 years for whom both CT and RLQ US were performed.

Results

One hundred eighty-four children were included with a median age of 10.8 years, and 57.6% were female. Community hospitals documented that CTs were equivocal for appendicitis in 110 (59.8%), positive in 63 (34.2%), and negative in 11 (6.0%). Ninety-seven CTs (88.1%) designated equivocal at community hospitals were later deemed interpretable by pediatric radiologists: 21 (19.1%) as appendicitis and 76 (69.1%) as normal. In 13 children (11.8%), both the community and children's hospital CT interpretations were equivocal. In equivocal cases, RLQ US was consistent with appendicitis in 6 (46.2%), normal in 5 (41.7%), and nondiagnostic in 2. κ value between CT interpretations at community versus children's hospital was 0.13 (95% confidence interval, 0.05–0.22), and κ value between CT interpretation at the children's hospital and RLQ US was 0.59 (95% confidence interval, 0.48–0.70).

Conclusions

Most CTs deemed equivocal for appendicitis at community hospitals were interpretable by pediatric radiologists. In a few children for whom CTs were designated nondiagnostic, RLQ US provided a definitive diagnosis in almost 90% of cases. The first step in evaluation of children with suspected appendicitis for whom outside CTs are deemed equivocal should be to have the study reinterpreted by a pediatric radiologist.
Weight Loss in Idiopathic Intracranial Hypertension: A Retrospective Review of Outcomes in the Clinical Setting
Authors: Ang Juan Lyn , Teo Kai Z. , Fraser Clare L.
Published: November 2020

Background:

Weight loss is important in the management of idiopathic intracranial hypertension (IIH); however, extremely caloric restrictive diets have been used in published studies, which may not be practical for all patients. We aim to review the weight loss outcomes of IIH patients and weight loss methods used by patients who achieve clinical remission (CR) in a standard clinical setting.

Methods:

The medical records of IIH patients were retrospectively reviewed. Measures evaluated included: reported symptoms, visual acuity, retinal nerve fiber layer analysis, automated visual fields, optic disc appearance, and cessation of medications. Patients were divided into different outcome groups and weight changes were compared. Patients who achieved CR were contacted to assess weight loss methods used.

Results:

Of the 39 patients included in the analysis, 28 patients (71.8%) achieved CR with concomitant weight loss, 6 patients (15.4%) improved clinically with concomitant weight loss but did not achieve CR. Among the patients with CR, 10 patients (35.7%) were successfully weaned off their medications completely, whereas another 10 patients (35.7%) are in the process of this. Median weight loss from baseline to lowest weight for this group was 10.5 kg (11.5%) achieved using self-directed methods.

Conclusion:

This study demonstrated that a large proportion of IIH patients were able to achieve CR or improvement with self-directed weight loss regimens, reinforcing the evidence and the practicality of weight loss in the management of IIH in the clinical setting.
Characterization of Visual Pathway Abnormalities in Infants With Congenital Zika Syndrome Using Computed Tomography and Magnetic Resonance Imaging
Authors: Henderson Amanda D. , Ventura Camila V. , Huisman Thierry A. G. M. , Meoded Avner , Hazin Adriano N. , van der Linden Vanessa , de Lima Petribu Natacha C. , May William N.
Published: November 2020

Background:

Severe visual impairment is present in nearly all infants with congenital Zika syndrome (CZS); however, ocular abnormalities are present only in a subset of these infants. The purpose of this study was to characterize the visual pathway abnormalities seen on computed tomography (CT) and MRI scans in infants with CZS.

Methods:

Preliminary neuroimaging information was obtained from a referred sample of 105 infants with clinical and epidemiologic data consistent with CZS in the Pernambuco state of Brazil. Subjects were excluded if Zika virus infection was not confirmed by serologic or cerebrospinal fluid studies or if images were nondiagnostic. Of the 105 subjects initially screened, head CT images adequate for interpretation were available for 54, and brain MRI images adequate for interpretation were available for 20. Four patients had both CT and MRI images. Magnetic resonance imaging and CT scans from infants with CZS were systematically reviewed for globe malformations, optic nerve and chiasmal atrophy, occipital cortical volume loss, white matter abnormalities, ventriculomegaly, and calcifications. Neuroimaging findings were correlated with measures of visual function and with ocular examinations in these infants.

Results:

Thirty-three males and 37 females were included in the analysis. The mean age of the infants at the time of neuroimaging was 16.0 weeks (range 0 days–15.5 months), and the mean gestational age at the time of birth was 38 weeks. All patients were from the Pernambuco state of Brazil. Overall, 70 of 74 (95%) scans showed occipital volume loss, whereas 9 (12%) showed optic nerve atrophy, 3 (4%) showed chiasmal atrophy, and 1 (1%) showed an ocular calcification. Sixty-two of the infants underwent ophthalmologic examinations. A total of 34 (55%) infants had at least one documented structural ocular abnormality, and 26 (42%) had at least one structural ocular abnormality documented in both eyes. Of those with available visual acuity data, all had visual impairment. Among those with visual impairment and normal eye examinations, 100% had visual pathway abnormalities on neuroimaging, including 100% with occipital cortical volume loss, 8% with optic nerve atrophy, and 8% with chiasmal atrophy.

Conclusion:

Our results suggest that cortical visual impairment related to structural abnormalities of the occipital cortex is likely an important cause of visual impairment in children with CZS with normal eye examinations.
Multimodal Imaging in Acute Macular Neuroretinopathy
Authors: Botsford Benjamin W. , Kukkar Priyanka , Bonhomme Gabrielle
Published: November 2020

A 44-year-old woman noticed bilateral irregular scotomata associated with photopsias of 6-month duration. Ophthalmoscopic examination demonstrated multiple bilateral, pericentral, hypopigmented, petaloid, macular lesions evident on Amsler grid associated with paracentral hyperreflective lesions on optical coherence tomography in the outer plexiform and nuclear layers. Indocyanine green angiography revealed patches of choroidal ischemia consistent with acute macular neuroretinopathy.