bluuebunny/crossref_metadata_2025 huggingface dataset:
P26 Exploring socioeconomic disparities effect on patient understanding of antimicrobial resistance: a Southwest Devon study
Authors: Meftahpour Kerim , Segireddy Rishika , Macrostie Alexandra , Hartley Evangeline , Bond-Kendall Lewis , Walch Marcus , Marwaha Raveena
Published: August 2024

Background

With projections indicating 10 million annual deaths worldwide by 2050 due to AMR,1 understanding public perceptions is crucial. Primary care settings, where antibiotic prescribing is prevalent (>81% in the UK),2 are especially important. Assessing the impact of deprivation on patient behaviours is essential. St Levan Surgery (PL21JR) and Buckfastleigh Medical Centre (TQ110DE) represent areas with varying levels of deprivation. St Levan Surgery (PL2 1JR) is surrounded by an area of 1st to 4th decile for Index of Multiple Deprivation, contrasting with Buckfastleigh Medical Centre’s (TQ110DE) 4th to 7th decile.3 Investigating differences between these primary care services can provide insight into the socioeconomic disparities affecting AMR awareness and stewardship.

Objectives

This cross-sectional study investigates patient perceptions of antimicrobial resistance (AMR) across two differing socioeconomic areas in Southwest Devon. The aim is to assess patient knowledge of AMR, attitudes towards antibiotic use and factors influencing behaviours to better understand the effect of deprivation on AMR awareness and understanding and potentially inform targeted interventions for mitigating AMR in primary care.

Methods

A questionnaire was administered to patients prescribed antibiotics in the past six months through face-to-face interactions, QR codes and NHS-approved texting services. Responses were collected from 72 patients at St Levan Surgery (November 2023) and 110 patients at Buckfastleigh Medical Centre (March 2024).

Results

Analysis revealed disparities in patient awareness and antibiotic usage between the two regions. Awareness of treatable infections: Patients at St Levan showed lower awareness, especially regarding fungal infections such as thrush. Awareness of AMR: Buckfastleigh patients exhibited higher awareness, indicating potential knowledge gaps in St Levan. Understanding of AMR causes: Neither group showed substantial awareness, highlighting the need for educational interventions. Antibiotic prescribing discrepancies: Buckfastleigh patients received more antibiotic prescriptions, possibly influenced by patient characteristics and healthcare provider behaviours.

Conclusions

While Buckfastleigh exhibited higher overall awareness, both areas could benefit from addressing gaps in understanding AMR causes and treatable infections. The study emphasizes the necessity for tailored interventions, particularly in deprived areas such as St Levan Surgery, to enhance patient knowledge and combat AMR effectively. Differences in prescribing practices should also be further investigated and may be related to the inverse care law.
Racial and Ethnic Disparities in Testing of Hepatitis C Virus–Exposed Children Across the United States
Authors: Epstein Rachel L , Kurnellas Anna , Munroe Sarah , Curtis Megan R , Biondi Breanne , Wachman Elisha M
Published: August 2024

Background

Despite rising hepatitis C virus (HCV) prevalence among pregnant individuals in the United States, HCV testing among exposed infants remains low. Although recent guidelines recommend early ribonucleic acid (RNA) testing for HCV-exposed children to help improve testing rates, national studies describing factors associated with HCV testing and the type of testing completed are lacking.

Methods

In this retrospective national study, we characterized HCV testing and care among HCV-exposed infants born between 2010 and 2020 captured in the electronic health record-based TriNetX Research Network. We analyzed factors associated with appropriate HCV testing completion (negative or positive HCV RNA testing or negative HCV antibody testing at any age through study end in 2022) and with RNA compared with antibody testing using univariable and multivariable logistic regression with clustered standard errors by healthcare organization.

Results

Of 8516 HCV-exposed children, 45.8% completed any HCV testing and 42.1% completed appropriate testing (25% of whom had RNA testing only). A total of 182 (5.1% of appropriately tested children) had evidence of HCV infection. Of 104 treatment-eligible children, 14.4% were treated. Black (odds ratio [OR]: 0.38, 95% confidence interval [CI]: 0.26–0.55), Asian/Pacific Islander (OR: 0.06, 95% CI: 0.03–0.11), and Hispanic/Latinx (OR: 0.56, 95% CI: 0.36–0.88) children had lower odds of appropriate testing compared with White and non-Hispanic/Latinx children.

Conclusions

Fewer than half of HCV-exposed children in this national sample were tested for HCV, with lower testing odds among Black, Asian/Pacific Islander, and Hispanic/Latinx children. Substantial work to increase testing and treatment and decrease disparities in testing among HCV-exposed children is needed to help reach US HCV elimination goals.
Evaluation of lacrimal gland vascularization using superb microvascular imaging: A potential diagnostic tool in Sjögren’s syndrome
Authors: Salbas Ciğdem Samur , Uslu Sadettin , Salbas Ender
Published: August 2024

Objectives

The aim of this study is to evaluate the superb microvascular imaging (SMI) findings of the lacrimal glands for the sonographic diagnosis of primary Sjögren’s syndrome (pSS).

Methods

Twenty-one patients with pSS and 20 healthy groups were evaluated. Dry eye symptoms and their effects on vision-related functions were evaluated with McMonnies and Ocular Surface Disease Index (OSDI) questionnaires. Lacrimal glands were evaluated by power Doppler ultrasonography (PDUS), colour Doppler ultrasonography (CDUS), and SMI.

Results

Dry eye symptoms, as determined by McMonnies and OSDI, were significantly more severe in patients with pSS than in the control group (P = .001 and P = .021, respectively). Lacrimal gland vascular activity rates and hypoechoic areas were significantly higher in pSS patients compared to the control group (P < .05). The detection rates of the degree of vascularity in the lacrimal glands of patients with pSS were higher with SMI compared to CDUS and PDUS. In addition, SMI positively correlated with CDUS, PDUS, OSDI, and McMonnies.

Conclusions

Evaluation of the lacrimal gland by the SMI was found to be excellent in predicting the likelihood of individuals having pSS compared to CDUS and PDUS. This technique may serve as a reliable and noninvasive adjunctive tool for assessing the degree of lacrimal vascularity in pSS.
Earlier peak photosynthesis timing potentially escalates global wildfires
Authors: Lai Gengke , Li Jialing , Wang Jun , Wu Chaoyang , Zhang Yongguang , Zohner Constantin M , Peñuelas Josep , Ge Quansheng
Published: August 2024

More intense fire weather due to climate change is implicated as a key driver of recent extreme wildfire events. As fuel stock, the role of vegetation and its phenology changes in wildfire dynamics, however is not fully appreciated. Using long-term satellite-based burned areas and photosynthesis observations, we reveal that an earlier peak photosynthesis timing (PPT) potentially acts to escalate subsequent wildfires, with an increase in the global average burned fraction of 0.021% (∼2.20 Mha) for every additional day of PPT advancement. Satellite observations and Earth System modeling consistently show that this fire escalation is likely due to intensified drought conditions and increased fuel availability associated with the climate feedback arising from earlier PPT. Current fire-enabled dynamic global vegetation models can reproduce the observed negative correlation between PPT and burned area but underestimate the strength of the relationship notably. Given the continued PPT advancement owing to climate change, the bioclimatic effects of vegetation phenology change suggest a potentially pervasive upward pressure on future wildfires.
Experiencing Psychosis and Shame: A Systematic Review and Meta-analysis of the Strength and Patterns of Association
Authors: Davies Kimberley , Lappin Julia M , Gott Chloe , Steel Zachary
Published: August 2024

Background and Hypothesis

Shame has been linked to the experience of psychosis, with implications for clinical outcomes, however, a meta-analysis of the relationship has not yet been conducted. This systematic review and meta-analysis aimed to examine the strength of the association between shame and psychosis, and any variations between clinical and non-clinical populations and shame type (internal vs external shame).

Study Design

Searches were conducted in CINAHL, EMBASE, PsycInfo, PubMed, Scopus, and Web of Science from the inception of the e-databases until July 2023. For inclusion, studies reported a quantitative association between psychosis and shame, or data that could be used to identify a relationship. From 11 372 unique retrieved records, 40 articles met the inclusion criteria and 38 were included in the meta-analyses.

Study Results

A significant large pooled estimate of the psychosis-shame association was identified (Zr = 0.36, [95% CI: 0.28, 0.44], P < .001), indicating that higher levels of shame were associated with greater severity of psychotic symptoms. The strength of the association was similar across clinical and non-clinical populations, however, differed by type of shame and psychosis symptom measured. External shame was strongly associated with paranoia suggesting possible confounding. Only a minority of studies met the highest quality criteria.

Conclusions

Shame is strongly associated with the severity of psychotic symptoms in clinical and non-clinical populations. Given the overlap with paranoia, measurement of external shame alone is not advised. Larger studies in clinical populations, with measures of a range of psychosis symptoms, are needed to better understand the relationship between shame and specific symptoms.
Maternal RSV Vaccine—Weighing Benefits and Risks
Authors: Rasmussen SA , Jamieson DJ
Published: August 2024

(N Engl J Med. 2024;390(11):1050–1051. doi:10.1056/NEJMe2401072)

Respiratory syncytial virus (RSV) is an infection with detrimental effects, especially for infants. In fact, it is the leading cause of hospitalization for infants in the United States. The Food and Drug Administration (FDA) approved the first RSV vaccine for pregnant mothers. It is based on the RSV prefusion F protein (RSVPreF). This article discusses a phase 3 trial that assessed the effects of a maternal RSV vaccine (RSVPreF3-Mat) on extreme RSV-type cases in young infants.
Feasibility of Focused Cardiac Ultrasound Performed by Trainees During Cesarean Delivery
Authors: Ortner CM , Sheikh M , Waseem Athar M , Padilla C , Guo N , Carvalho B
Published: August 2024

(Anesth Analg. 2023 Dec 21. doi: 10.1213/ANE.0000000000006747)

Cardiovascular diseases are the primary cause of maternal deaths in developed nations. The improved survival of children with congenital heart issues and the rising risk factors among women of childbearing age have led to a growing population of pregnant women with heart conditions. Due to factors like increasing maternal age, comorbidities, and assisted reproductive technologies, experts in anesthesiology advocate for formal training in maternal critical care, including the use of focused cardiac ultrasound (FCU) in high-risk obstetric units. Although expert-performed FCU has been well-documented, there is limited evidence of its feasibility when done by trainees or less-experienced physicians. Pregnancy's physiological changes make FCU optimal, but challenges arise in intraoperative settings, prompting a need for standardized FCU training in obstetric anesthesia residency and fellowship programs.
Association of Labor Neuraxial Analgesia With Maternal Blood Transfusion
Authors: Guglielminotti J , Landau R , Daw J , Friedman AM , Li G
Published: August 2024

(Anesthesiology 2023;139(6):734–745. doi: 10.1097/ALN.0000000000004743)

Labor neuraxial analgesia is used in about 70% of births in the United States. It may help lower the risk of postpartum hemorrhage, which is the strongest indication for a mother requiring a blood transfusion during childbirth. This study analyzed the link between labor neuraxial analgesia with maternal blood transfusion using data from birth certificates from the Natality File of the National Vital Statistics System for vaginal (VD) and intrapartum cesarean (CD) deliveries between January 2015 to December 2018 in all 50 states and the District of Columbia. Data were excluded if they had missing information in any of the following categories: labor neuraxial analgesia, maternal outcome, maternal ethnicity, or residence or hospital county and race. Other exclusion criteria were if the mother did not live in the United States or if a child was not birthed in a hospital.
The Association Between Labour Epidural Analgesia and Postpartum Depression in Primiparous Patients: A Historical Cohort Study
Authors: Jin S , Munro A , George RB
Published: August 2024

(Can J Anaesth. 2023;70(12):1909–1916. doi: 10.1007/s12630-023-02568-2)

Postpartum depression (PPD) poses a significant public health concern, impacting ~6.5% to 12.9% of postpartum patients. There is a known link between peripartum pain and PPD, with labor epidural analgesia (LEA) potentially playing a role in mitigating this risk. Recent meta-analyses have yielded varying results: 2 found no correlation between LEA and PPD, whereas a third reported a decreased risk of PPD with LEA in a high-prevalence subgroup and an increased risk in a low-prevalence subgroup. Considering these findings, the current study sought to investigate the association between LEA and PPD specifically among primiparous patients.
Inadequate Neuraxial Anaesthesia During Caesarean Delivery: A Survey of Practitioners
Authors: Patel R , Russell R , Plaat F , Bogod D , Lucas N
Published: August 2024

(Int J Obstet Anesth. 2023;56:103905. doi:10.1016/j.ijoa.2023.103905)

Inadequate neuraxial anesthesia during cesarean delivery can result in intraoperative pain and poor maternal mental health, as well as possible litigation. This cross-sectional study explored many facets including consent, neuraxial block assessment, and intraoperative pain management by surveying obstetric anesthetic practitioners. The questionnaire was given live at the virtual Obstetric Anaesthetists’ Association (OAA) Annual Scientific Meeting in 2021 using an audience response system, but was first assessed for validity using the Content Validity Index.
Opioid-Sparing Multimodal Analgesia Use After Cesarean Delivery Under General Anesthesia: A Retrospective Cohort Study in 729 U.S. Hospitals
Authors: Zanolli NC , Fuller ME , Krishnamoorthy V , Ohnuma T , Raghunathan K , Habib AS
Published: August 2024

(Anesth Analg. 2023;137(2):256–266. doi: 10.1213/ANE,00000000000069428)

Current guidelines recommend multimodal analgesia (MMA) for patients who have had a cesarean delivery (CD) under neuraxial anesthesia but not as much is known about how the same approach could work for patients who had CD under general anesthesia (GA). CDs under GA make up only 6% of CDs and studies show that these patients have higher postoperative pain and higher opioid use compared with patients receiving neuraxial anesthesia. MMA consists of using non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen, opioids as needed, and regional anesthetic techniques.
A Quality Improvement Project to Reduce Unplanned Extubations in the Neonatal Intensive Care Unit
Authors: Caprio Adelaide B. , Niewinski Krystle N. , Murphy Sara , Geistkemper Anne , Seske Laura M.
Published: August 2024

Background:

Unplanned extubations (UEs) continue to be one of the most common adverse events in the neonatal intensive care unit (NICU). Management of endotracheal tubes (ETTs) can be particularly challenging in neonates due to the unique needs and physical characteristics of this patient population.

Purpose:

The purpose of this quality improvement project was to decrease the rate of UEs from 0.76 to less than 0.5 per 100 ventilator days in an urban level III NICU in the Midwest, United States.

Methods:

A newly formed interprofessional team created an evidence-based, standardized, bedside nurse-led care bundle for intubations and ETT care in the NICU. This project also created standardized, clear, closed-loop communication for the transition of bedside staff at shift change.

Results:

The UE rate decreased from 0.76 to 0 per 100 ventilator days, reaching the goal of less than 0.5 per 100 ventilator days, during the 10-week project implementation period from December 2021 to February 2022.

Implications for Practice and Research:

Many NICUs focus on reducing UEs due to the impact on healthcare resource utilization, acute complications, and long-term outcomes for infants. The development of a standardized, nurse-led care bundle for ETTs decreased the rate of UEs. Future research is needed to study the potential for generalization to different units and beyond the scope of the neonatal population.
Pregnancy Outcomes in Patients With Hepatitis C Virus Infection
Authors: Hughes Brenna L. , Sandoval Grecio J. , Saade George R. , Clifton Rebecca G. , Reddy Uma M. , Bartholomew Anna , Salazar Ashley , Chien Edward K. , Tita Alan T.N. , Thorp John M. , Metz Torri D. , Wapner Ronald J. , Sabharwal Vishaka , Simhan Hyagriv N. , Swamy Geeta K. , Heyborne Kent D. , Sibai Baha M. , Grobman William A. , El-Sayed Yasser Y. , Casey Brian M. , Parry Samuel , Macones George A. , Prasad Mona ,   for the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network
Published: August 2024

OBJECTIVE:

To evaluate the risks of adverse maternal and neonatal outcomes associated with pregnancies complicated by hepatitis C virus (HCV) infection.

METHODS:

This is a secondary analysis of a multicenter prospective cohort study of HCV infection in pregnancy. Participants were screened for HCV infection with serum antibody tests, and each participant with a positive HCV result (case group) was matched with up to two individuals with negative HCV results (control group) prospectively by gestational age (±2 weeks) at enrollment. Maternal outcomes included gestational diabetes, abruption, preeclampsia or gestational hypertension, cholestasis, and preterm delivery. Neonatal outcomes included hyperbilirubinemia, admission to neonatal intensive care (NICU); small-for-gestational-age (SGA) birth weight; and neonatal infection, defined as sepsis or pneumonia. Models were adjusted for maternal age, body mass index, injection drug use, and maternal medical comorbidities.

RESULTS:

The 249 individuals in the case group were prospectively matched to 486 individuals in the control group who met eligibility criteria. There were significant differences in demographic characteristics between the groups, including race, socioeconomic markers, education, insurance status, and drug and tobacco use. The frequencies of maternal outcomes of gestational diabetes, preeclampsia, and abruption were similar between the case and control groups. Preterm birth was similar between groups, but neonates born to individuals in the case group were more likely to be admitted to the NICU (45.1% vs 19.0%, adjusted odds ratio [aOR] 2.6, 95% CI, 1.8–3.8) and to have SGA birth weights below the 5th percentile (10.6% vs 3.1%, aOR 2.9, 95% CI, 1.4–6.0). There were no increased odds of hyperbilirubinemia or neonatal infection.

CONCLUSION:

Despite no increased odds of preterm birth or other adverse maternal outcomes in adjusted analyses, maternal HCV infection was associated with twofold increased odds of NICU admission and nearly threefold increased odds of SGA birth weight below the 5th percentile.
Utility and Outcomes of Ovarian Tissue Cryopreservation and Transplantation for Gynecologic Cancers
Authors: Erden Murat , Gayete-Lafuente Sonia , Vural Nazli Aylin , Oktay Kutluk H.
Published: August 2024

OBJECTIVE:

To evaluate the utility, success, and safety of ovarian tissue cryopreservation and autologous cryopreserved ovarian tissue transplantation for fertility preservation in patients with gynecologic cancers.

DATA SOURCES:

A comprehensive search was performed of the MEDLINE, EMBASE, ClinicalTrials.gov, and Cochrane Library databases to identify relevant studies on the utility and outcomes of ovarian tissue cryopreservation and autologous cryopreserved ovarian tissue transplantation for gynecologic cancers from inception until January 23, 2024.

METHODS OF STUDY SELECTION:

Two reviewers independently performed the study selection, data extraction, and risk-of-bias assessment, and the results were then reviewed together. Twenty-three studies were included in the current systematic review.

TABULATION, INTEGRATION, AND RESULTS:

The resultant data were meta-analyzed to produce a pooled-effect estimate of the utility of ovarian tissue cryopreservation and autologous transplantation in gynecologic cancers as a proportion of all indications. We found that 7.5% and 9.6% of women undergoing ovarian tissue cryopreservation and autologous transplantation, respectively, had gynecologic cancers. In comparison, hematologic malignancies and breast cancer accounted for approximately 66.0% of all indications for these procedures. The return rate for autologous cryopreserved ovarian tissue transplantation in gynecologic cancers (6.0%) was not statistically different from those for other indications. Among women with gynecologic cancer who underwent ovarian stimulation, 27.3% had at least one child, and the ovarian endocrine function was restored in 78.1% of the women after autologous transplantation. The median graft longevity was 32 months, and no graft-site recurrence was reported after autologous transplantation in women with gynecologic cancer.

CONCLUSION:

Our results suggest that ovarian tissue cryopreservation and autologous transplantation are feasible options for preserving ovarian function in women with gynecologic cancers, although ovarian tissue cryopreservation is underutilized, and further studies are needed to determine the longer-term outcomes of autologous transplantation.

SYSTEMATIC REVIEW REGISTRATION:

PROSPERO, CRD42024498522.
Acute carpal tunnel syndrome after atraumatic rupture of the flexor tendons: a case report
Authors: Flores Meca Alberto , Sánchez López Raquel , Tapia Fernández Pedro Javier
Published: August 2024

Acute carpal tunnel syndrome (ACTS) is a rare entity, mainly associated with traumatic causes, although patients with predisposing factors such as taking anticoagulants or tendinopathies may debut with an atraumatic ACTS. This case study presents the case of a 77-year-old male patient, anticoagulated, who began with rapidly progressive pain and swelling in the right wrist, radiating towards the medial territory, with no history of traumatic triggering event. Examination showed paraesthesia in the volar aspect of the first to third fingers of the hand and increased pain on passive mobilisation of the fingers. Given the progressive evolution of the condition and the lack of response to both physical and pharmacological measures, the carpal tunnel was opened surgically. During surgery, a significant haematoma was observed secondary to the rupture of the deep flexor tendons of the fourth and fifth fingers inside the canal. Following release of the carpal tunnel, complete recovery of the symptomatology occurred. In conclusion, a high degree of clinical suspicion is necessary in a patient with an examination suggestive of ACTS. The treatment of choice is urgent surgical decompression of the carpal tunnel. Early intervention allows resolution of symptoms and reduces complications.
Cross-tissue organization of myeloid cells in scleroderma and related fibrotic diseases
Authors: Odell Ian D.
Published: August 2024

Purpose of review

Scleroderma and other fibrotic diseases have been investigated using single-cell RNA sequencing (scRNA-Seq), which has demonstrated enrichment in myeloid cell populations in multiple tissues. However, scRNA-Seq studies are inconsistent in their nomenclature of myeloid cell types, including dendritic cells, monocytes, and macrophages. Using cell type-defining gene signatures, I propose a unified nomenclature through analysis of myeloid cell enrichment across fibrotic tissues.

Recent findings

scRNA-Seq of human blood and skin identified a new subset of dendritic cells called DC3. DC3 express similar inflammatory genes to monocytes, including FCN1, IL1B, VCAN, S100A8, S100A9, and S100A12. DC3 can be distinguished from monocytes by expression of EREG and Fc receptor genes such as FCER1A and FCGR2B. scRNA-Seq analyses of scleroderma skin and lung, idiopathic pulmonary fibrosis (IPF), COVID-19 lung fibrosis, myelofibrosis, and liver, kidney, and cardiac fibrosis all showed enrichment in myeloid cell types. Although they were called different names, studies of scleroderma skin and lung as well as liver cirrhosis datasets demonstrated enrichment in DC3. By contrast, lung, heart, and kidney fibrosis were enriched in SPP1 macrophages. High numbers of DC3 in the skin was associated with worse SSc skin and lung fibrosis severity.

scRNA-Seq of multiple diseases showed enrichment of DC3 in fibrotic skin, lung, and liver, whereas SPP1 macrophages occurred in fibrotic lung, heart, and kidney. Because DC3 and SPP1 macrophages showed organ-specific enrichment, understanding their signaling mechanisms across tissues will be important for future investigation.
“Ultralow-dose” CT Without Sedation in Pediatric Patients With Neuromuscular Scoliosis
Authors: Yee Nicholas J. , Iorio Carlo , Shkumat Nicholas , Rocos Brett , Lebel David , Camp Mark
Published: August 2024

Background:

Children with neuromuscular scoliosis undergoing scoliosis surgery face substantial rates of complications. To mitigate surgical risks such as blood loss in pediatric patients with neuromuscular scoliosis, this study focuses on enabling instrumentation planning for their abnormal vertebral and pelvic anatomy and osteopenia. This study assessed the feasibility of an “ultralow-dose” CT (ULD CT) protocol without sedation in pediatric patients with neuromuscular scoliosis who often have comorbid movement disorders. Our prospective quality improvement study aims: (1) to determine if ULD CT without sedation is feasible in this patient group; (2) to quantify the radiation dose from ULD CT and compare it with preoperative spine radiographs (XR); and (3) to assess if ULD CT allows accurate anatomical assessment and intraoperative navigation given the prevalence of movement disorders.

Methods:

Children with neuromuscular scoliosis underwent spine XR and ULD CT scans. Chart reviews assessed disease etiology and comorbidities. Radiation dose was quantified through Monte-Carlo simulations giving dose indices and effective dose, with statistical analysis done using a paired student’s t-test (α=0.05). CT image quality was assessed for its use in preoperative planning and intraoperative navigation.

Results:

Fourteen patients (5 males, 9 females, average age 14±3 y) participated. One patient needed sedation due to autism spectrum disorder and global developmental delay. The radiation dose for spine XR was 0.5±0.2 mSv, and ULD CT was 0.6±0.1 mSv. There was no statistically significant difference in radiation doses between methods. All ULD CT scans had adequate quality for preoperative assessment of pedicle diameter and orientation, obstacles impeding pedicle entry, S2 Alar-Iliac screw orientation, and intraoperative navigation.

Conclusions:

ULD CT without sedation is feasible for children with neuromuscular scoliosis. Radiation doses were comparable to standard radiographs. ULD CT provided accurate anatomical assessments and supported intraoperative navigation, proving beneficial despite movement disorders in these patients.

Level of Evidence:

Level 2—Development of diagnostic criteria on basis of consecutive patients (with universally applied reference widely accepted standard).
Tuberculosis in infertility and in vitro fertilization-embryo transfer
Authors: Gai Xiaoyan , Chi Hongbin , Li Rong , Sun Yongchang
Published: August 2024

Tuberculosis (TB) is a prominent infectious disease globally that imposes a substantial health burden. Genital TB (GTB), an extrapulmonary manifestation, leads to complications such as tubal adhesions, blockage, and diminished ovarian function, culminating in infertility, and is recognized as a prevalent cause of infertility in nations with high-burden TB. In regions with low TB rates, infertility and active TB during pregnancy have been reported to be most common among female immigrants from countries with high-burden TB. In the context of TB, pregnant women often exhibit exacerbated symptoms afterin vitrofertilization-embryo transfer (IVF-ET), heightening the risk of dissemination. Miliary pulmonary TB and tuberculous meningitis pose a serious threat to maternal and fetal health. This article integrates recent epidemiological data and clinical research findings, delineating the impact of TB on infertility and assisted reproduction and particularly focusing on the diagnosis and treatment of GTB, underscored by the imperative of TB screening before IVF-ET. Our objective is to increase awareness among respiratory and reproductive health professionals, promoting multidisciplinary management to enhance clinical vigilance. This approach seeks to provide patients with judicious reproductive plans and scientifically rigorous pregnancy management, thereby mitigating adverse pregnancy outcomes related to TB activity.
Efficacy and Outcomes of Stenting Versus Balloon Angioplasty for Chronic Limb-Threatening Ischemia in Infrapopliteal Peripheral Arterial Disease: A Meta-Analysis of Randomized Controlled Trials
Authors: Jain Hritvik , Odat Ramez M. , Pervez Neha , Dey Debankur , Singh Jagjot , Jain Jyoti , Goyal Aman , Ahmed Mushood , Patel Nandan , Jha Jagriti , Passey Siddhant
Published: August 2024

Peripheral arterial disease (PAD) and its severe complication, chronic limb-threatening ischemia (CLTI) are associated with significant morbidity and mortality worldwide. Conventionally, balloon angioplasty has been regarded as superior to stenting in CLTI associated with infrapopliteal PAD. Stenting is often considered a “rescue” or “bail-out” procedure in managing CLTI. However, stenting using newer generation stents coated with antiproliferative drugs such as paclitaxel has demonstrated noninferior results compared with balloon angioplasty in terms of risk of restenosis. However, the current data comparing stenting to balloon angioplasty for other outcomes is rather inconsistent. Major bibliographic databases were searched systematically to identify randomized controlled trials (RCTs) comparing stenting to balloon angioplasty in CLTI in infrapopliteal PAD patients. Risk ratios (RR) with 95% confidence intervals (CI) were pooled in a random-effects model with statistical significance considered at P < 0.05. 9 RCTs with 1125 patients (634, stenting; 491, balloon angioplasty) were included. Stenting was associated with a statistically significant reduction in the risk of binary restenosis (RR, 0.61; 95% CI, 0.38–0.97; P = 0.04] compared with balloon angioplasty. However, no statistically significant difference in technical success, all-cause mortality, clinically driven target lesion revascularization, major limb amputation, and primary patency was observed between the 2 groups. In infrapopliteal PAD associated with CLTI, stenting is noninferior to balloon angioplasty. Future large multicentric RCTs are warranted, particularly evaluating the newer generation drug-eluting stents, in a diverse patient population with longer follow-up periods to corroborate the results of this meta-analysis.
Management of Ulcers and Lymphorrhea in Lower Limbs after Charles Procedure via Supermicrosurgery
Authors: Zhou Zhegang , Yu Longbiao , Meng Fanbin , Wen Jingjing , Li Aikang , Xiao Yingfeng , Wan Shengxiang , Zeng Hui , Yu Fei
Published: August 2024

An 80-year-old female patient was admitted to the hospital due to recurrent lymphedema, ulcers, and lymphorrhea in the right lower limb for 7 years. The physical examination revealed changes after the Charles procedure below the right knee joint plane, with a 7 × 7 cm2 lymphorrhea area in the lower one-third plane of the anterior tibia area. Continuous lymphatic exudation and scattered ulcers could be seen. The dorsal artery of the foot could not be reached due to the thickening and fibrosis of the dorsal skin of the foot. The peripheral blood circulation was favorable. The glycated hemoglobin test revealed that blood sugar was not high and could be controlled. The color Doppler ultrasound of lower limb blood vessels revealed no obvious stenosis of arteries, with normal venous return. In addition, no varicose veins or deep venous thrombosis were observed. Based on these findings, the patient was diagnosed with primary lymphedema combined with lymphorrhea after the Charles procedure, complicated with diabetes. After admission, the patient underwent lymphaticovenous anastomosis on the right lower limb under general anesthesia. During the follow-up of 2 months after surgery, it was found that the lymphorrhea was alleviated, the ulcer basically healed, and the swelling on the right lower limb decreased. At the follow-up of 6 months after surgery, the lymphorrhea was eliminated and the ulcer was healed. There were 1-cm reduction in leg and back circumference and 10% volume reduction. The lymphedema quality-of-life score of this patient was 57 points after surgery.
Early Experience with Mesh Suture for DIEP Flap Abdominal Site Closures
Authors: Hackenberger Paige N. , Stockslager Caitlin , Selimos Brianna , Teven Chad , Fracol Megan , Howard Michael
Published: August 2024

Background:

The gold standard of microsurgical breast reconstruction is the deep inferior epigastric perforator (DIEP) free flap. As techniques have evolved, DIEP flaps have significantly reduced the morbidity previously caused by transverse rectus abdominis muscle (TRAM) and muscle-sparing TRAM flaps. However, abdominal wall complications continue to persist after DIEP flap surgery, with bulge rates reported as high as 33%.

Methods:

The first 25 patients undergoing DIEP flap surgery with the use of Duramesh (MSI, Chicago, Ill.) by the senior author were identified. A retrospective chart review of patient and surgical details was performed. Charts were reviewed for outcomes, including surgical site infections, surgical site events, incisional hernia formation, and/or bulge. Standard descriptive summary statistics were used for patient characteristics, surgical details, and primary and secondary outcomes.

Results:

Twenty-five patients were reviewed. Average follow-up duration was 216 ± 39 days. One patient (4%) developed a surgical site infection, and four patients (16%) developed a surgical site event. One patient developed a bulge, but no patients developed an incisional hernia.

Conclusions:

Duramesh mesh suture provides a promising opportunity for DIEP surgeons to minimize both abdominal wall morbidity and mesh-related complications. Mesh suture can be used in a similar fashion as other sutures to perform primary closure of the anterior rectus sheath while also providing force-distribution benefits typically unique to planar mesh. This pilot study suggests that Duramesh is a safe, simple alternative to existing techniques in DIEP flap surgery and can be considered by microsurgeons to reduce fascial dehiscence, bulge, and/or hernia formation.
Temporary Conjunctival Flap Plus Medical Treatment Versus Medical Treatment Only for High-Risk Fungal Keratitis: A Randomized Controlled Trial
Authors: Khalil Ahmad S. , Baioumy Shereen A. , Hegab Mohammed A. , Khairy Marwa A. , Ali Ali Goda
Published: August 2024

Purpose:

The purpose of this study was to evaluate the efficacy of temporary conjunctival flap with topical natamycin and oral voriconazole compared with medical treatment only in reducing the rate of perforation in high-risk fungal keratitis.

Methods:

Sixty-two eyes of 62 patients with severe fungal keratitis were examined; only 54 patients were enrolled and divided randomly into 2 groups. The first group received medical treatment only in the form of topical natamycin 5% together with oral voriconazole 200 mg, while the second group received the same medical treatment plus a temporary conjunctival flap that was removed after 2 weeks. Five patients were lost during the follow-up, and only 49 patients were statistically analyzed. All patients were examined frequently until reepithelialization or the development of perforation.

Results:

Fifteen perforations were reported, with a higher rate among the medical group (48%) compared with the conjunctival flap group (12.5%), with P value <0.05. A significant delay was noted in reepithelialization time in the medical group compared with the conjunctival flap group (mean time was 21.69 ± 5.41 and 15.36 ± 2.2 days, respectively), with P value = 0.001. Significant improvement in visual acuity was reported over time when comparing baseline versus 3-month visual acuity in the same group using paired t sample test (P value was 0.003 and <0.001 in the first and second group, respectively).

Conclusions:

Temporary conjunctival flap is associated with a lower perforation rate compared with medical treatment only in severe fungal keratitis, which can provide a cheap and available alternative to therapeutic penetrating keratoplasty.
A Rare Case of Infective Endocarditis and Intracardiac Device Infection by Providencia stuartii With Review of the Literature
Authors: Tehaili Hussein , Saleh Ronny , Malviya Meenal
Published: August 2024

Providenciabacteremia is relatively uncommon but can be rapidly fatal and is often polymicrobial. It is usually associated with long-term indwelling catheter use. Infective endocarditis byProvidenciais seen even less frequently, and only 1 case was found on a PubMed database search and literature review ofProvidencia stuartiiinfective endocarditis, and another withProvidencia rettgeri. A 56-year-old African American man with long-standing lower extremity ulcers presented to the hospital for lower extremity weakness and pain. He had been discharged from the hospital 3 weeks prior for local debridement of lower extremity ulcerations with noted maggot infestation and hadP stuartiibacteremia at the time with associated wound culture positive for gram-negative bacilli. On repeat admission, blood cultures yieldedP stuartiiwith identical resistance patterns noted on susceptibilities. Transthoracic echocardiogram showed vegetations attached to the ICD lead and large tricuspid valve vegetation. A biopsy of the longstanding nonhealing lower extremity ulcer had findings consistent with pyoderma gangrenosum. The risk of cardiac device-related infection in patients with gram-negative bacteremia is lower than those with gram-positive bacteremia, and routine echocardiography is not recommended, especially when a known alternative source of bacteremia is available. This case highlights the importance of prudence when dealing with patients with cardiac devices, and with those who have a recurrence of bacteremia despite adequate treatment.
Determining the Relationship of Bacteria Associated With Dental Disease and Infective Endocarditis
Authors: Indermun Suvarna , Baswaraj Deepa , Regunath Hariharan , Kumar Senthil
Published: August 2024

Objectives

Poor oral hygiene is a risk factor for bacteremia and infective endocarditis (IE). The purpose of this study was to determine the relationship of bacteria commonly associated with dental disease in native valve and prosthetic valve endocarditis patients at a tertiary center in Missouri.

Methods

This retrospective cross-sectional analysis reviewed the electronic medical records of patients diagnosed with definite IE, per the modified Duke criteria, at the University of Missouri Hospital between September 2015 and April 2019. Medical records were screened using International Classification of Diseases, Tenth Edition, code for IE (I 33) and further validated by screening echocardiography for intracardiac vegetations. Demographics, type of IE, echocardiographic findings, blood culture results, and relevant medical and dental data were recorded, and a descriptive analysis performed.

Results

One hundred twenty-seven patients with 134 episodes (mean = 51.1 years, SD ± 17.7 yrs; M: F = 1:1) satisfied the criteria. Of these, 19 (14.2%) episodes were identified to have blood culture results positive for bacteria associated with the oral cavity. Seventy-seven (57.5%) episodes were related to Staphylococcus aureus. Staphylococcus aureus is a constituent of normal oral flora and can contribute to oral disease and IE, but the connection between the 2 remains contentious in both medical and dental practice. Remarkably, 72 (53.8%) medical records lacked documentation of dental history and oral examination.

Conclusions

A significant proportion of IE cases are from bacteria associated with the oral cavity, advocating for routine dental evaluation and treatment as an essential component of care of patients with IE.
Unusual Presentations of the Usual Typhoid Fever
Authors: Doke Purwa , Diwan Arundhati , Makashir Prachee , Gaikwad Naineesh , Nadagoudar Meghana
Published: August 2024

Background

More than half of the global burden of typhoid fever occurred in India in 2017. [1] The incidence of this disease remains high in India as per a study done in 2023. [1] This is due to poor access to safe water and sanitation as well as inadequate vaccination coverage across the country. Typhoid fever can affect multiple organs.

Methods

We have presented 6 patients with atypical presentations seen between February 2020 to June 2022.

Results

There were 3 males and 3 female patients. The youngest patient was 20 years and the oldest was 56 years old. Diagnosis of salmonellosis was based on cultures.

Conclusions

All patients made a complete recovery, and were stable at the time of discharge.
Long-term prognostic effect of serum albumin concentration in diabetic patients with stable coronary artery disease: A multicenter cohort study
Authors: Lu Ting-Wei , Chien Shih-Chieh , Leu Hsin-Bang , Yin Wei-Hsian , Tseng Wei-Kung , Wu Yen-Wen , Lin Tsung-Hsien , Chang Kuan-Cheng , Wang Ji-Hung , Wu Chau-Chung , Yeh Hung-I. , Chen Jaw-Wen
Published: August 2024

Background:

Diabetes and insulin resistance alter the physiological state of serum albumin (SA), which is a prognostic marker for stable coronary artery disease (CAD). However, whether the SA concentration is associated with long-term cardiovascular (CV) outcomes in diabetic patients with stable CAD remains unclear.

Methods:

In total, 1148 patients were retrospectively identified from a nationwide multicenter cohort study on patients with stable CAD. They were categorized into four groups according to their diabetes mellitus (DM) status and SA concentration (cutoff: 4 g/dL).

Results:

The patients’ mean age was 62.5 years, and 83.5% were male. Of the total patients, 405 were included in group 1 (SA ≥4/non-DM), 322 in group 2 (SA <4/non-DM), 201 in group 3 (SA ≥4/DM), and 220 in group 4 (SA <4/DM). Group 4 had the oldest age and a higher prevalence of prior myocardial infarction and stroke. During the median 4.5-year follow-up (interquartile range: 1.5-6.7 years), the highest and lowest survival rates in terms of all-cause and CV mortality were found in groups 1 and 4, respectively. However, no prognostic differences were noted in nonfatal stroke and myocardial infarction among the groups. The data were consistent after covariate adjustment. Using group 1 as the reference, hazard ratio (HRs) (95% CIs) for all-cause mortality in groups 2, 3, and 4 were 3.64 (1.22-10.83), 3.26 (0.95-11.33), and 5.74 (1.92-16.95), respectively, and those for CV mortality were 2.8 (0.57-13.67), 2.62 (0.40-17.28), and 6.15 (1.32-28.58), respectively.

Conclusion:

In diabetic patients with stable CAD, a low SA concentration (<4 g/dL) was associated with increased long-term mortality regardless of all-cause or CV reasons but not nonfatal CV events.
Esketamine vs. placebo combined with erector spinae plane block vs. intercostal nerve block on quality of recovery following thoracoscopic lung resection: a randomized controlled factorial trial
Authors: Hu Jing-hui , Zhong Zhang-zhen , Shi Hai-jing , Wang Jie , Chen Shaomu , Shan Xi-sheng , Liu Hua-yue , Liu Hong , Meng Lingzhong , Ji Fu-hai , Peng Ke
Published: August 2024

Background:

Multimodal analgesic strategy is pivotal for enhanced recovery after surgery. The objective of this trial was to assess the effect of subanesthetic esketamine vs. placebo combined with erector spinae plane block (ESPB) vs. intercostal nerve block (ICNB) on postoperative recovery following thoracoscopic lung resection.

Materials and Methods:

This randomized, controlled, 2×2 factorial trial was conducted at a university hospital in Suzhou, China. One hundred adult patients undergoing thoracoscopic lung surgery were randomized to one of four groups (esketamine-ESPB, esketamine-ICNB, placebo-ESPB, and placebo-ICNB) to receive i.v. esketamine 0.3 mg/kg or normal saline placebo combined with ESPB or ICNB using 0.375% ropivacaine 20 ml. All patients received flurbiprofen axetil and patient-controlled fentanyl. The primary outcome was quality of recovery (QoR) at 24 h postoperatively, assessed using the QoR-15 scale, with a minimal clinically important difference of 6.0.

Results:

The median age was 57 years and 52% were female. No significant interaction effect was found between esketamine and regional blocks on QoR (P=0.215). The QoR-15 score at 24 h was 111.5±5.8 in the esketamine group vs. 105.4±4.5 in the placebo group (difference=6.1, 95% CI: 4.0–8.1; P<0.001); 109.7±6.2 in the ESPB group vs. 107.2±5.6 in the ICNB group (difference=2.5, 95% CI: 0.2–4.9; P=0.033; not statistically significant after Bonferroni correction). Additionally, esketamine resulted in higher QoR-15 scores at 48 h (difference=4.6) and hospital discharge (difference=1.6), while ESPB led to a higher QoR-15 score at 48 h (difference=3.0).

Conclusions:

For patients undergoing thoracoscopic lung resection, subanesthetic esketamine improved QoR after surgery, while ICNB can be used interchangeably with ESPB as a component of multimodal analgesia.
Effects of supplementing extracorporeal shockwave therapy to hyaluronic acid injection among patients with rotator cuff lesions without complete tear: a prospective double-blinded randomized study
Authors: Ko Jih-Yang , Huang Chung-Cheng , Huang Po-Hua , Chen Jeng-Wei , Liao Chin-Yi , Kuo Shu-Jui
Published: August 2024

Background:

The study investigates the combined efficacy of subacromial hyaluronic acid (HA) injections and extracorporeal shockwave therapy (ESWT) in managing rotator cuff lesions without complete tears.

Materials and methods:

Eligible patients were randomized into three groups: three HA injections combined with two sham ESWT (HA), three HA injections combined with one ESWT and one sham ESWT (HA + 1 ESWT), or three HA injections combined with two ESWT (HA + 2 ESWT) with an allocation ratio of 1:1:1. Visual Analogue Scale (VAS), Constant–Murley Score (CMS), range of motion (ROM), and muscle power of shoulder abduction (MP) were assessed preintervention and at 1, 3, 6, and 12 months postinitial HA injection. Shoulder MRI was conducted before and 12 months after the intervention.

Results:

All pertinent parameters showed no significant between-group differences at baseline but demonstrated significant within-group improvement throughout the study. The HA + 1 ESWT group demonstrated superior improvements in MP (P=0.011) and CMS (P=0.018) at 1 month, and in MP (P=0.014) and CMS (P=0.005) at 6 months, compared to the HA group. The HA + 2 ESWT group showed greater improvements in FF (P=0.027), IR (P=0.019), and SROM (P=0.025) at 1 month, and in ABD (P=0.022) at 6 months, compared to the HA group. Notably, the HA + 2 ESWT group exhibited greater improvements in FF (P=0.013), IR (P=0.019), and SROM (P=0.025) at 1 month, and in FF (P=0.007) at 3 months, than the HA + 1 ESWT group. Moreover, no deterioration in tendinopathy grading or tear status occurred in the HA + 1 ESWT group on MRI scans.

Conclusion:

ESWT provides additional benefits when combined with HA injections for patients with rotator cuff lesions lacking complete tears.