bluuebunny/crossref_metadata_2025 huggingface dataset:
Letrozole and Clomiphene Compared With Letrozole Alone for Ovulation Induction in Women With Polycystic Ovary Syndrome: A Systematic Review and Meta-analysis [ID 2683666]
Authors: Eskandar Karine , Queiroz Almeida Juliana Vieira , Chavez Matheus P. , Meirelles Dias Yasmin Jardim , Isabela de Araujo Zotti Ana , Mora de Marco Novellino Andrea
Published: May 2024

INTRODUCTION:

Nearly 70% of patients with polycystic ovary syndrome (PCOS) have anovulatory infertility. One therapeutic option is letrozole; however, its comparative efficacy and safety when compared with the association of letrozole and clomiphene citrate are unclear. Therefore, we aimed to compare letrozole and the combined use of letrozole and clomiphene citrate for ovulation induction in PCOS.

METHODS:

We systematically searched EMBASE, PubMed, and Cochrane databases for randomized controlled trials (RCTs) and observational studies comparing letrozole and clomiphene citrate versus letrozole alone in patients with PCOS. The primary endpoints rate of mature follicles and ovulation were calculated via a random-effects meta-analysis. Statistical analysis was performed using RevMan 5.4.1. Heterogeneity was assessed with I2 statistics and random-risk effect was used.

RESULTS:

Two RCTs and one observational study comprising 223 patients (mean age, 28.7 years; 49.3% combined therapy) were included. The combined therapy was associated with a higher number of women with mature follicles (>15 mm) (odds ratio [OR] 2.94; 95% CI, 1.66–5.21; P=.0002; I2=0) and ovulations (OR 3.31; 95% CI, 1.91–5.73; P<.0001; I2=0). There was no significant difference between groups in the number of pregnancies and thickness of the endometrial lining. Adverse events, including headache, abdominal bloating, fatigue, back pain, breast discomfort, and night sweats, were similar between groups.

CONCLUSION:

In women with PCOS and anovulatory infertility, letrozole and clomiphene citrate combined therapy promoted a significant benefit for the maturation of follicles and ovulation, with a similar safety profile compared to letrozole alone.
Risks of Vaginally and Sexually Transmitted Infections With Contraceptive Vaginal Rings Compared to Oral Contraceptives [ID 2683643]
Authors: Arceneaux Amy , Karam Kathleen , Vincent Kathleen L. , Pyles Richard , Villarreal Elvia L. , Mansingka Nandika
Published: May 2024

INTRODUCTION:

Use of combined contraceptive vaginal ring (CCVR) has been found to upregulate immune-related genes in the endocervix and mediators within the cervicovaginal fluid. Attachment and infection rates of certain pathogens within this tract can vary based on hormones within the local environment. Rat studies have shown treatment with estrogen prior to chlamydial infections was protective. Continued clinical safety analyses are critical as CCVR use continues to increase. We calculated risk of vaginal infections associated with CCVR compared to oral contraceptive pills (OCPs) via retrospective chart review.

METHODS:

De-identified data was collected from TriNetX. Using ICD-10 and RxNorm codes, study cohorts included women receiving etonogestrel and ethinyl estradiol CCVRs without segesterone, versus women on OCPs without vaginal hormones. Cohorts (n=30,796 each) were matched for age, race, and ethnicity. Statistical analysis within 1 year of CCVR placement used risk ratios (RRs); P<.05 was considered significant.

RESULTS:

Combined contraceptive vaginal rings showed increased risk of HSV-2 (RR 1.790; P<.0005), acute vaginitis (RR 1.722; P<.0005), subacute/chronic vaginitis (RR 1.904; P<.0005), subacute/chronic vulvitis (RR 1.969; P<.0005), acute vulvitis (RR 1.894; P<.0005), candidiasis (RR 1.464; P<.0005), trichomoniasis (RR 2.162; P<.0005), and pelvic inflammatory disease (PID) (RR 2.984; P<.0005). Combined contraceptive vaginal rings showed a decreased risk of chlamydia (RR 0.760; P=.047). There were no differences in risk of gonorrhea, syphilis, HIV, or anogenital warts between the CCVR and OCP cohorts

CONCLUSION:

In this chart review, women using CCVRs had increased risks for HSV-2, vaginitis, vulvitis, PID, trichomoniasis, and candidiasis and decreased risk of chlamydia compared to OCPs. Further study of local hormone delivery on the vaginal mucosa is warranted.
Transgender and Gender Nonbinary Individuals' Assigned Female at Birth Experiences and Preferences With Gendered Advertisement and Packaging of Contraception [ID 2683586]
Authors: Costley Lauren K. , Maguire Karla , Cook Jake , Abern Lauren , Harris Miles
Published: May 2024

INTRODUCTION:

Transgender and gender nonbinary individuals assigned female at birth (TGNB-AFAB) use contraceptives for a variety of reasons including menstrual suppression or pregnancy prevention. However, the use of contraceptives could trigger gender dysphoria and deter use. Our goal is to determine the effect of gendered advertisement on the use of contraceptives in this population.

METHODS:

TGNB-AFAB individuals, ages 18 and older, participated in an online anonymous survey about their experiences with sexual and reproductive health care. The study was IRB approved by Emory University.

RESULTS:

Ninety-two TGNB-AFAB individuals responded. The mean age was 34 (SD 7.8). The majority of respondents identified as White (89.3%) and non-Hispanic (94.0%). 66 (78.6%) were college educated. 33 (38.4%) respondents currently use contraception. Primary forms of contraception include oral contraceptives (15.6%), condoms (21.9%), intrauterine devices, and implants (21.9%). 38 (45.2%) reported gendered advertisement or packaging makes them less likely to use contraceptives and 62 (73.8%) believed gendered advertisement makes other TGNB-AFAB individuals less likely to use contraceptives. 36 (42.9%) respondents said they would be more likely to use contraceptives if the packaging were gender neutral or gender inclusive and 33 (39.3%) if it was marketed specifically for trangender and gender-diverse individuals. The data from this study are preliminary.

CONCLUSION:

Contraceptive use is common in TGNB-AFAB; however, gendered advertising and packaging can be a deterrent for these individuals. Gender-neutral and/or gender-inclusive advertisement could potentially increase the use of contraceptives in this population.
Reusable Menstrual Management Products: Perceptions and Use Among Hispanic Women in Puerto Rico [ID 2683545]
Authors: Castro Alexandra Alfonso , Trujillo Alejandra Alfonso , Morales-Pomalaza Bianka L. , Fernandez Molinary Karla S. , Romaguera Josefina , Schwarz Susan
Published: May 2024

INTRODUCTION:

Reusable menstrual products offer much-needed eco-friendly and cost-effective alternatives for managing menstruation, yet disposables continue to dominate the market and public awareness. This study aims to explore women’s perceptions and knowledge of menstrual care options, revealing barriers to reusable products and the need for enhanced education.

METHODS:

A cross-sectional study was done using Survey Monkey. A 53-item questionnaire was administered covering sociodemographics, practices, and general knowledge. Recruitment primarily targeted university-aged women (21+) living in Puerto Rico via social media flyers. We employed descriptive statistics for analysis. The research was IRB-approved.

RESULTS:

Among 208 participants (85% completion rate), 20% combined reusable and disposable products. Motivations included waste reduction (31%), cost savings (26%), and friend recommendations (15%). Intriguingly, a substantial segment (30–44%) of nonusers (66%) expressed a willingness to switch, citing environmental concerns (42%) and desiring a progressive choice (18%). Hindrances to adoption encompassed perceived unhygienic aspects (29%) and lack of awareness (25%). Participants advocated for increased education, with only 12% having received information from their primary care physicians, 50% feeling their physicians lacked knowledge about available products, 81% expressing their doctors should initiate these conversations, and 87% believing menstrual management should be included in school curricula.

CONCLUSION:

Although the majority of respondents use disposable products, a noteworthy proportion is exploring reusable options or willing to switch to eco-friendly alternatives for waste reduction. Participants highlighted the need for primary care physicians and educators to incorporate menstrual management alternatives in their discussions, which could potentially result in large-scale cost savings and environmental benefits.
Fertility Preservation Knowledge and Attitudes Among Medical Students as Future Practitioners [ID 2683445]
Authors: Armstrong Austin , Schuknecht Taryn L. , Keomany Jennifer , Okut Hayrettin , Grainger David , Duncan Francesca E.
Published: May 2024

INTRODUCTION:

Medical students are the next generation of physicians and provide a current snapshot of medical education. The objective of the study was to gain insight into the knowledge and attitudes regarding fertility preservation among medical students.

METHODS:

Medical students at The University of Kansas School of Medicine (KUSM) participated in a prospective, cross-sectional web-based survey study. Survey questions included knowledge-based questions based on the American Society for Reproductive Medicine fertility preservation guidelines, and attitudes towards fertility preservation were measured using Likert scales. This study was IRB approved.

RESULTS:

Most respondents (N=123; response rate: 14.1%) were aged 20–29 years (94.3%; n=116) and were pursuing family medicine (18.7%; n=23). In terms of training, 16.5% of respondents (n=20) reported having formal lectures on fertility preservation and 31.7% (n=38) on assisted reproduction technology. More than 45% of clinical students reported not being exposed to reproductive endocrinology and infertility or fertility preservation on clinical rotations (n=32/70). Only 1.6% of respondents (n=2) correctly answered at least 75% of knowledge questions about fertility preservation. Almost half (49.5%; 51/103) of respondents reported discomfort discussing fertility preservation with patients needing fertility preservation. Patient prognosis, finances, and age were the top factors influencing the professional decision to provide a patient with fertility preservation information.

CONCLUSION:

Students indicate poor familiarity and comfort with discussing fertility preservation, which in the future, may reduce and/or delay patient access to this option. Thus, medical student curriculum focused on reproductive endocrinology and fertility preservation represents an important educational opportunity to improve patient care and outcomes.
Navigating Intimate Partner Violence: A Comparative Analysis Between ACOG and ChatGPT on Patient Education [ID 2683552]
Authors: Cadiente Angelo , Patel Puja , Oladipo Antonia F.
Published: May 2024

INTRODUCTION:

With the surge in artificial intelligence usage, there is an increasing need to assess its applicability in conveying public health information. We compare the readability and quality of responses between ChatGPT and the American College of Obstetricians and Gynecologists (ACOG) in answering frequently asked questions (FAQs) on intimate partner violence (IPV).

METHODS:

Twelve questions from ACOG's “Intimate Partner Violence” FAQs were posed to ChatGPT-3.5 (July 19 Version). Readability and grade-level scores were determined. The quality of responses were also graded by two obstetrician–gynecologists using a 1–4 scale, where 1 represents a comprehensive response and 4 indicates an incorrect response. Statistical analysis utilized a two-tailed t-test. A weighted Cohen’s kappa coefficient evaluated interrater reliability.

RESULTS:

Mean readability favored ACOG over ChatGPT, but only the Coleman Liau Index was statistically significant (ACOG: 12.71; ChatGPT: 15.76; P=.003). Other readability measures demonstrated no significant differences. The ACOG responses were graded with an average of 1.29, alongside a Cohen’s kappa coefficient of 0.375, implying fair agreement between graders. All ChatGPT’s responses were graded a 1 with a Cohen’s kappa coefficient of 1, indicating perfect agreement. The difference in grades between ACOG and ChatGPT was statistically significant (P=.013).

CONCLUSION:

The ACOG FAQ responses are relatively equivalent in readability when compared to ChatGPT-generated responses with only one statistically significant difference across the indices. However, ChatGPT's responses were more comprehensive and accurate. Although patients can use ACOG as a source, ChatGPT provides equivalently clear and more comprehensive information on IPV.
Resident's Training in Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) [ID 2683656]
Authors: Mohr-Sasson Aya , Bhalwal Asha
Published: May 2024

INTRODUCTION:

As the vaginal natural orifice transluminal endoscopic surgery (vNOTES) is becoming a common acceptable approach to perform benign gynecological surgeries, there is need to incorporate it in resident’s curriculum for surgical training. The aim of this study was to estimate the effect of hands-on lab simulation for vNOTES on residents’ perception and confidence in this surgical approach.

METHODS:

This is a prospective observational study conducted at a single tertiary medical center. Study population included 12 fourth-year residents that were evaluated by seven faculty attending surgeons. All residents completed didactic online training of adnexectomy, and vaginal assisted laparoscopic hysterectomy (VALH) performed by vNOTES. Three hands-on simulation labs were scheduled on a monthly base during the study period. Each resident performed both procedures on each encounter. Residents were evaluated by experienced surgeons in vNOTES approach. Survey evaluating the knowledge and confidence in the vNOTES approach was completed by the residents before and after all simulations.

RESULTS:

Forty-nine assessments were completed, of them 23 adnexectomies and 26 VALHs. Competence in VALH and adnexectomy were achieved in 5/12 and 2/12 of the residents, respectively. Feedback was completed by seven residents before and after the simulations. 33% increase in the confidence to perform anterior and posterior colpotomy was reported by the residents. 71% versus 85% reported confidence in transecting the uterosacral ligaments before and after the simulations, respectively. Confidence in transecting the uterine artery was found doubled (14% versus 28%) during vNOTES approach after the simulation. 15% increase in the confidence to perform adnexectomy was noted after the simulation; however, 14% reduction was reported by the residents in choosing vNOTES approach for hysterectomy.

CONCLUSION:

Hands-on simulation in vNOTES approach increases the knowledge and confidence of residents in the surgical steps of adnexectomy and VALH, keeping them up to date with the innovative surgical techniques.
State Abortion Policy and Provider Moral Distress Levels After Dobbs [ID 2683541]
Authors: Rivlin Katherine , Bornstein Marta , Tomu Taylor , Norris Alison H. , Howard Dana
Published: May 2024

INTRODUCTION:

Moral distress occurs when individuals feel powerless to carry out ethically correct actions, including when prevented from providing necessary health care. We aimed to measure self-reported moral distress levels among abortion providers after the Dobbs decision and to assess differences by state-level abortion policy.

METHODS:

In 2023, we surveyed abortion providers nationally through professional listervs. Institutional review board-exempt surveys queried demographics, practice characteristics, and the Moral Distress Thermometer (MDT), a validated psychometric tool that measures moral distress level from 0 (lowest) to 10 (highest). Providers reported whether their moral distress level had changed since Dobbs. We assessed overall moral distress level and differences by state restrictiveness (using Guttmacher’s classifications) using one-way ANOVA (continuous variables) and chi-squared tests (categorical variables).

RESULTS:

In total, 253 practitioners completed the MDT for one or more states where they practiced (N=285 MDTs analyzed), with 56.8% of responses for “protective” states and 43.2% for “restrictive” states. Moral distress levels ranged from 0 to 10 (mean=5.09) and were twice as high for providers in restrictive compared to protective states (mean=7.15 versus 3.52; P<.001). Change in distress post Dobbs differed by state restrictiveness: In restrictive states, 89.4% reported an increase compared to 71.6% in protective states (P<.01).

CONCLUSION:

Moral distress levels for abortion providers were high following Dobbs, and higher in restrictive states. Most providers experienced increased distress across policy contexts. Moral distress has been associated with burnout, errors in patient care, and attrition. High and increasing moral distress levels, especially in abortion restrictive states, may worsen provider shortages, and lead to poor patient outcomes.
Network Meta-analysis and Economic Evaluation of Neurostimulation Interventions for Chronic Nonsurgical Refractory Back Pain
Authors: Eldabe Sam , Nevitt Sarah , Bentley Anthony , Mekhail Nagy A. , Gilligan Christopher , Billet Bart , Staats Peter S. , Maden Michelle , Soliday Nicole , Leitner Angela , Duarte Rui V.
Published: May 2024

Objectives:

Different types of spinal cord stimulation (SCS) have been evaluated for the management of chronic nonsurgical refractory back pain (NSRBP). A direct comparison between the different types of SCS or between closed-loop SCS with conventional medical management (CMM) for patients with NSRBP has not been previously conducted, and therefore, their relative effectiveness and cost-effectiveness remain unknown. The aim of this study was to perform a systematic review, network meta-analysis (NMA) and economic evaluation of closed-loop SCS compared with fixed-output SCS and CMM for patients with NSRBP.

Methods:

Databases were searched to September 8, 2023. Randomized controlled trials of SCS for NSRBP were included. The results of the studies were combined using fixed-effect NMA models. A cost-utility analysis was performed from the perspective of the UK National Health Service with results reported as incremental cost per quality-adjusted life-year (QALY).

Results:

Closed-loop SCS resulted in statistically and clinically significant reductions in pain intensity (mean difference [MD] 32.72 [95% CrI 15.69-49.78]) and improvements in secondary outcomes (Oswestry Disability Index [ODI] and health-related quality of life [HRQoL]) compared with fixed-output SCS at 6-month follow-up. Compared with CMM, both closed-loop and fixed-output SCS resulted in statistically and clinically significant reductions in pain intensity (closed-loop SCS vs. CMM MD 101.58 [95% CrI 83.73-119.48]; fixed-output SCS versus CMM MD 68.86 [95% CrI 63.43-74.31]) and improvements in secondary outcomes (ODI and HRQoL). Cost-utility analysis showed that closed-loop SCS dominates fixed-output SCS and CMM, and fixed-output SCS also dominates CMM.

Discussion:

Current evidence showed that closed-loop and fixed-output SCS provide more benefits and cost-savings compared with CMM for patients with NSRBP.
Relationship Between High ACE Score, HIV Risk Behavior, and Previous HIV Testing in the South Carolina BRFSS [ID 2683384]
Authors: Dutra Karley , Lazenby Gweneth B. , Moore Miyonta (Tay)
Published: May 2024

INTRODUCTION:

The incidence of human immunodeficiency virus (HIV) in the United States is stable among women. Due to stigma, 13% of persons with HIV are unaware of their diagnosis. Adverse childhood experiences (ACEs) describe negative events during childhood using a standardized questionnaire. Limited data exist on how ACEs affect HIV screening. Utilizing state-collected data from the Behavioral Risk Factor Surveillance System (BRFSS), we assessed the relationships between high ACE, gender, HIV risk behaviors, and previous HIV testing.

METHODS:

This is a retrospective observational cohort study of the BRFSS from 2014–2016 and 2019–2021. High ACE score was ≥ 4. Using bivariate analyses, we compared percentages of individuals with high versus low ACE scores. We used logistic regression to determine factors associated with HIV risk behaviors and previous HIV testing.

RESULTS:

Over 54,000 individuals were surveyed; 15% had high ACE scores. 4% reported HIV risk behaviors and 35% reported previous HIV testing. The mean ACE was 1.6 (SD 2.1). High ACE demonstrated increased risk of HIV risk behaviors (adjusted odds ratio [aOR] 2.652; 95% CI, 1.987–3.538) and previous HIV testing (aOR 2.340; 95% CI, 2.031–2.696). Female respondents were less likely to report HIV risk behavior (aOR 0.442; 95% CI, 0.336–0.581) and previous HIV testing (aOR 0.822; 95% CI, 0.736–0.919).

CONCLUSION:

Persons with high ACE scores were more likely to engage in HIV risk behaviors and have a history of HIV testing. Our findings suggest ACE scores may be useful for identifying persons at risk for HIV. The stable incidence of HIV and reduced perception of risk among women demonstrate the need for tailored HIV screening for women.
Socio-Demographic and Preoperative Clinical Factors Associated With 5-Year Weight Trajectories After Roux-en-Y Gastric Bypass and Sleeve Gastrectomy
Authors: Patel Sahil , Jiang Chen , Cowan Brandon , Yin Jie , Schaefer Catherine , Dutta Sanjoy , Mostaedi Rouzbeh , Choquet Hélène
Published: May 2024

Objective:

To determine whether socio-demographic and preoperative clinical factors contribute to the percent total body weight loss (%TBWL) after bariatric surgery (BS).

Background:

BS is the most effective long-term treatment for medically complicated obesity. More information is needed about the factors that contribute to postoperative %TBWL in large and ethnically diverse cohorts.

Methods:

This retrospective study conducted in the Kaiser Permanente Northern California region included 7698 patients who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) between January 2009 and March 2015. Trajectory analyses were conducted from 5-year follow-up data to assign patients to “low,” “average,” or “high” postoperative %TBWL groups. We then evaluated whether age, sex, race/ethnicity, neighborhood deprivation index and preoperative body mass index (BMI)/weight loss, diabetes, hypertension, and sleep apnea contributed to postoperative %TBWL using logistic regression models.

Results:

Of 7698 patients (83.2% women), 48.6% underwent a RYGB and 51.4% underwent a SG. Postoperative %TBWL trajectories over 5 years were obtained in 6229 (81%) of 7698 eligible patients. About 27.8% and 29.3% of patients followed the “low” postoperative %TBWL trajectory, for RYGB and SG, respectively. Men, older patients, and Asian, Black, and Hispanic/Latino patients were more likely to be classified in the low postoperative %TBWL group. Patients showing lower postoperative %TBWL had a lower preoperative BMI (but lost less weight before surgery) and were more likely to have preoperative comorbidities.

Conclusions:

This study confirms and extends prior findings of the effects of several demographic and preoperative clinical factors on postoperative weight loss. Findings could improve the support of patients to achieve desired surgical outcomes.
Prevalence and Survival of Prolonged Venovenous Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome: An Analysis of the Extracorporeal Life Support Organization Registry
Authors: Chandel Abhimanyu , Fabyan Kimberly D. , Mendelsohn Sondra , Puri Nitin , Damuth Emily , Rackley Craig R. , Conrad Steven A. , King Christopher S. , Green Adam
Published: May 2024

Objectives:

To examine trends in utilization and outcomes among patients with the acute respiratory distress syndrome (ARDS) requiring prolonged venovenous extracorporeal membrane oxygenation (VV ECMO) support.

Design:

Retrospective observational cohort study.

Setting:

Adult patients in the Extracorporeal Life Support Organization registry.

Patients:

Thirteen thousand six hundred eighty-one patients that required ECMO for the support of ARDS between January 2012 and December 2022.

Interventions:

None.

Measurements and Main Results:

Mortality while supported with VV ECMO and survival to hospital discharge based on ECMO duration were examined utilizing multivariable logistic regression. Among the 13,681 patients supported with VV ECMO, 4,040 (29.5%) were supported for greater than or equal to 21 days and 975 (7.1%) for greater than or equal to 50 days. Patients supported with prolonged VV ECMO were less likely to be discharged alive from the hospital compared with those with short duration of support (46.5% vs. 59.7%; p < 0.001). However, among patients supported with VV ECMO greater than or equal to 21 days, duration of extracorporeal life support was not significantly associated with mortality (odds ratio [OR], 0.99; 95% CI, 0.98–1.01; p = 0.87 and adjusted OR, 0.99; 95% CI, 0.97–1.02; p = 0.48). Even in those supported with VV ECMO for at least 120 days (n = 113), 52 (46.0%) of these patients were ultimately discharged alive from the hospital.

Conclusions:

Prolonged VV ECMO support of ARDS has increased and accounts for a substantial portion of cases. Among patients that survive for greater than or equal to 21 days while receiving VV ECMO support, duration is not predictive of survival to hospital discharge and clinical recovery may occur even after very prolonged VV ECMO support.
Ninerafaxstat in the Treatment of Cardiometabolic Disease: Shifting Metabolic Paradigms
Authors: Whiteson Harris Z. , Grossman Sydney H. , Whiteson Ellis M. , Frishman William H.
Published: May 2024

Cardiovascular disease (CVD) refers to a wide array of conditions that damage the heart muscle and impede its ability to effectively circulate blood throughout the body. In damaged or pathological states, the heart muscle might not function as effectively as it would have had there been no insult to it. Understanding this, certain CVDs can put the heart in a “metabolic disadvantage”—a state in which it cannot synthesize energy stores, in the form of adenosine triphosphate (ATP), as efficiently as it was once able to do. While the heart typically uses fatty acids for its ATP synthesis, the metabolic processes required to do so consume more oxygen per mole than the processes required to convert glucose (or carbohydrates) to ATP. In conditions when oxygen demand outweighs supply—such as angina, heart failure, and certain inherited CVDs—the myocardium can more efficiently run via glucose oxidation. Despite this knowledge, there are no currently approved therapeutics or interventions that encourage this “metabolic shift” in the myocardial cells. Currently in phase II clinical trials, however, is a novel medication called ninerafaxstat. This novel drug is a partial inhibitor of fatty acid oxidation and thus pushes the heart to convert glucose (instead of fatty acids) to ATP—ultimately cutting down on oxygen supply. While still completing clinical trials, ninerafaxstat must undergo further safety and efficacy evaluation before it can be used as a standard of care. If, however, the drug makes it to market, it might offer a unique way to improve both the symptoms and quality of life of the millions of Americans who suffer from CVDs.
Manzaneda’s Tool: Adaptation of the Piezotome for Rib Remodeling Surgery without Incisions
Authors: Manzaneda Cipriani Raúl
Published: May 2024

For rib remodeling surgery without incisions (RibXcar), a piezotome is used, which is a piezoelectric device that allows for selective and delicate manipulation of the bone, thanks to microvibrations that facilitate precise and smooth cuts. The piezotome, in its original form, requires the adaptation of the tip shape to perform costal surgery; therefore, Manzaneda’s tool was created, which is composed of three parts: first, modification of the shape of the tip of the piezotome; second, the experimentation with materials for coating the tip of the piezotome; and third, the sterilization of the piece. We found that the material that best adheres and protects the adapted tip of the piezotome is the Rust-Oleum High Heat. After applying the tip coating, the piece was sterilized, and finally, Manzaneda’s tool was obtained, which is specifically for use in RibXcar rib remodeling surgery. Manzaneda’s tool is a safe and customizable tool for RibXcar surgery.
Natural History and Management of Hepatitis C in Children: 25 Years Experience of a Reference Center in Northern Italy
Authors: Musto Francesca , Stracuzzi Marta , Crivellaro Elisa , Rubinacci Valeria , Cibarelli Alessandro , Porro Cecilia , Ghidoni Elena , Zuccotti Gian Vincenzo , Giacomet Vania
Published: May 2024

Hepatitis C virus (HCV) infection natural history and management in the pediatric population are still debated. We retrospectively evaluated the outcome of a HCV pediatric population managed at the Pediatric Infectious Disease Unit of Luigi Sacco Hospital (Milan, Italy) from January 1997 to January 2022 (median follow-up 10 years) and we focused on the role of new drugs and transient elastography. Fifty-seven patients were enrolled: 8 (14%) had a spontaneous clearance, 33 were treated (58%), 7 (12%) were not treated because they were under 12 years old and 9 were lost at follow-up. HCV RNA was undetectable in all treated patients at the end of therapy, after 12 weeks (SVR12) and for the rest of their follow-up. All patients treated underwent elastography before and 1 year after therapy. Median stiffness pretherapy was 5.6 kPa, and 9 patients (16%) had abnormal transient elastography (>7 kPa, median 8.7 kPa). Median stiffness after treatment in the abnormal group was 6.8 kPa. Direct-acting antiviral agents are a safe and effective therapy for HCV chronic infection in the pediatric population. Liver elastography is normal in many vertically infected children before 12 years, but, when abnormal, it shows a significant improvement after direct-acting antiviral agent treatment. Further studies are needed to evaluate the role of elastography at diagnosis and follow-up in children.
Clinical Characteristics and Management of Children and Adolescents Hospitalized With Pyomyositis
Authors: Weber Sebastian , Schlaeppi Chloé , Barbey Florence , Buettcher Michael , Deubzer Beate , Duppenthaler Andrea , Jaboyedoff Manon , Kahlert Christian , Kottanattu Lisa , Relly Christa , Wagner Noemie , Zimmermann Petra , Heininger Ulrich
Published: May 2024

Background:

Pyomyositis, a bacterial muscle infection, is an important differential diagnosis in children and adolescents with musculoskeletal pain. In contrast to tropical regions, it is rarely recognized in temperate countries, but incidence is increasing and major studies are missing.

Methods:

This retrospective multicenter study included patients <18 years of age hospitalized with pyomyositis in 11 Swiss children’s hospitals between January 2010 and December 2022. Cases were identified by ICD-10 code (Myositis; M60–M60.9), and data was extracted from electronic hospital records.

Results:

Of 331 patients identified, 102 fulfilled the case definition. Patient age at presentation ranged from 2 weeks to 17 years (median 8 years). The majority had no underlying illness and all presented with fever and localized pain. At the respective site of pyomyositis, 100 (98%) had impaired movement and 39 (38%) presented with local swelling. Pelvic (57%) and leg (28%) muscles were mostly affected. Blood or tissue cultures were obtained in 94 (92%) and 59 (57%) patients, respectively. Of those, 55 (58%) blood and 52 (88%) tissue cultures were positive, mainly for Staphylococcus aureus (35 and 19, respectively) and Streptococcus pyogenes (12 and 15, respectively). All patients received antibiotic treatment during hospitalization for a median of 10 days (interquartile range: 7–17), followed by outpatient treatment for a further median of 16 days (interquartile range: 11–22) in 95 (93%) patients. Fifty-nine (57%) patients required surgery.

Conclusions:

Pyomyositis is a challenging diagnosis that requires a high level of awareness. Blood and/or tissue cultures revealed S. aureus and S. pyogenes as the predominant causative agents.
Treatment of Childhood Brucellosis: A Systematic Review
Authors: Lanza Galvão Endi , Miranda Souza Kathiaja , Gonçalves de Freitas Marina , Souza Marina Rocha Fonseca , Gonçalves Moisés Willian Aparecido , Cota Gláucia , Silva Sarah Nascimento
Published: May 2024

Background:

Proper treatment for brucellosis is crucial to eradicate the infection and prevent complications, but there is a notable gap in evidence for pediatric treatment. This study aims to address this gap by reviewing current literature, analyzing the efficacy and safety of brucellosis treatment in children, and identifying areas that require further investigation.

Methods:

A systematic review, following preferred reporting items for systematic reviews and meta-analyses and Cochrane Handbook guidelines, assessed antimicrobial regimens’ efficacy and safety for treating human brucellosis in children. Original human studies with clinical outcomes after drug therapy intervention for children up to 10 years were included. Searches were conducted in Medline, Embase, Cochrane Library and LILACS databases for studies indexed until March 6, 2023. Study selection, data extraction, and bias risk assessment were performed by pairs of reviewers. The quality assessment used Joanna Briggs Institute tools and grading of recommendations assessment, development and evaluation system. Data were analyzed using R software.

Results:

A total of 1773 records were reviewed, yielding 11 eligible studies encompassing 1156 children. All included studies presented an observational design. The most reported treatment approaches included sulfamethoxazole-trimethoprim with rifampicin or aminoglycosides, with summarized failure rates of 2% (95% confidence interval: 0.0–0.49) and 13% (95% confidence interval: 0.06–0.29), respectively (very low certainty of evidence). Adverse events and time to defervescence were not reported.

Conclusions:

Sulfamethoxazole-trimethoprim + rifampicin were the most prescribed antibiotics for brucellosis for pediatrics. The study highlights the need for more research with robust designs, and emphasizes uncertainty regarding the efficacy of antimicrobial regimens, emphasizing the importance of further investigations to guide specific treatment protocols for this population.
Severe Meningococcal Meningitis Revealing a Novel Form of Properdin Deficiency in a Previously Healthy 13-Year-old Child
Authors: Bevacqua Martina , Bastard Paul , Pinhas Yael , Aubart Mélodie , Roux Charles-Joris , Taha Muhamed-Kheir , Cohen Jérémie F.
Published: May 2024

A 13-year-old boy was admitted with severe meningococcal meningitis. Immunologic workup revealed a properdin deficiency, and genetic sequencing of CFP identified a novel, private and predicted pathogenic variant in exon 8. The patient received broad immunizations and penicillin prophylaxis. Children with invasive meningococcal disease should be tested for complement deficiency.
Neurodevelopmental Outcomes Following Childhood Viral Meningitis in Canterbury New Zealand
Authors: Martin Natalie G. , Williman Jonathan , Walls Tony , Sadarangani Manish , Grant Cameron C.
Published: May 2024

Background:

Most childhood meningitis is viral in countries with widespread conjugate vaccine use. This study assessed clinical features and neurodevelopmental outcomes in preschool children following enteroviral and parechoviral meningitis.

Methods:

Children 18–42 months of age in Canterbury, New Zealand were included, who had enterovirus (EV) or parechovirus (HPEV) meningitis from 2015 to 2021. Comprehensive neurodevelopmental assessments were completed by a psychologist using the Bayley Scale for Infant Development-3 (BSID-3). Mean composite and scaled scores and proportion below the cutoff were assessed in each domain. Clinical data was analyzed.

Results:

There were 79 children 18–42 months old with previous EV or HPEV meningitis. BSID assessments were completed for 33 children (55% male), median age 32 months, from 2019 to 2022 including 23 with EV and 10 HPEV meningitis. At diagnosis, 32 (97%) received intravenous/intramuscular antibiotics, and 6 received a fluid bolus. Parents reported developmental speech concerns in 6 children, and delayed motor milestones in 1 child. There was no reported sensorineural hearing loss. BSID mean composite scores were in the expected range for cognition 102 (confidence interval: 98–106), language 96 (93–100) and motor 102 (98–106) domains. Overall, 12/33 (36%) children had below expected scores in 1 developmental domain, including scores 1–2 SD below the normative mean for cognition (2/33; 6%), receptive language (6/33; 18%), expressive language (5/33; 15%) and gross motor (6/33; 18%). There were no differences between scores in EV and HPEV meningitis.

Conclusion:

Following viral meningitis, more than a third of preschool children had a mild developmental delay with comprehensive neurodevelopmental assessment, suggesting targeted follow-up should be considered.
The use of anabolic agents in the treatment of osteoporosis: a clinical update
Authors: Inderjeeth Charles A. , Inderjeeth Diren C.
Published: May 2024

Purpose of review

Anabolic therapies have revolutionized the management of patients with osteoporosis, especially those at very high fracture risk. The current review offers valuable insights into the latest evidence and guidelines on the use of anabolic agents, focusing on their comparative efficacy, safety profiles, and optimal implementation in clinical practice.

Recent findings

Romosozumab, abaloparatide, and teriparatide have shown superior efficacy when compared to antiresorptive therapies in increasing bone mineral density and reducing fracture risk. Notably, sequential treatment strategies, commencing with an anabolic agent followed by an antiresorptive, has emerged as an effective approach for both rapid and sustained reduction of fracture risk in patients at high risk. Additionally, anabolics have shown potential in improving outcomes for patients who have a suboptimal response to antiresorptives. Careful patient selection and vigilant monitoring are essential to optimize therapeutic benefits while mitigating the potential risks. As we gain more clinical experience with these agents, we will better understand how to use them effectively, as part of long term, sequential treatment strategies. Ongoing research into novel anabolic therapies and innovative treatment sequences holds promise for expanding our toolkit against fragility fractures.

Integrating anabolic agents into personalized treatment plans has the potential to significantly improve outcomes and quality of life for patients with severe osteoporosis, highlighting the importance of this therapeutic class in the management of this chronic condition.
Changes in psychosocial distress and the number and types of problems reported by patients with cancer when routine screening is integrated within cancer services
Authors: Faris Mona M. , Shepherd Heather L. , Butow Phyllis N. , Kelly Patrick , He Sharon , Grimison Peter , Kelly Brian ,   The ADAPT Program Group, Shaw Joanne M.
Published: May 2024

Background:

The impact of patient-reported outcome measures on patient outcomes in longitudinal clinical studies is poorly understood. This observational study explored longitudinal changes in distress and problems reported by cancer patients screened and managed in accordance with a clinical pathway for anxiety and depression (ADAPT CP), implemented over 12 months.

Methods:

Patients reported distress using the Distress Thermometer and indicated reasons for distress using the 39-item Problem List across five domains: practical, social, emotional, spiritual/religious, and physical. Repeat screening occurred on average 3 monthly (quarterly).

Results:

Six hundred sixty patients from 10 participating services completed 1,256 screening events over 12 months, reporting 8,645 problems. On average, more emotional (27–34%) and physical (19–22%) issues were reported across all quarters than practical (7–9%) and social (8–9%) issues. Distress and emotional, physical, practical, and social problems reduced from initial to follow-up screens, although the decrease in emotional problems over time was not significantly different than that of the other problems. Worry, fatigue, sleep difficulties, health of family members, and insurance/finances were more persistent problems.

Conclusions:

Although distress and the change in the number of emotional concerns over time did not differ from other problems, rescreening is recommended within oncology settings to allow patients to indicate new or persistent problems and hospital staff to monitor and assess needs. Emotional concerns are high in oncology patients, suggesting the need for the prioritization of psychosocial care. These problems can persist over time due to their clinically challenging nature or because access to, or implementation of, evidence-based interventions are not yet widespread.
Diagnostic and Therapeutic Application of Fibroblast Activation Protein Inhibitors in Oncologic and Nononcologic Diseases
Authors: Nakayama Mariko , Hope Thomas A. , Salavati Ali
Published: May 2024

Fibroblast activation protein inhibitor positron emission tomography (PET) has gained interest for its ability to demonstrate uptake in a diverse range of tumors. Its molecular target, fibroblast activation protein, is expressed in cancer-associated fibroblasts, a major cell type in tumor microenvironment that surrounds various types of cancers. Although existing literature on FAPI PET is largely from single-center studies and case reports, initial findings show promise for some cancer types demonstrating improved imaging when compared with the widely used 18F-fludeoxyglucose PET for oncologic imaging. As we expand our knowledge of the utility of FAPI PET, accurate understanding of noncancerous uptake seen on FAPI PET is crucial for accurate evaluation. In this review, we summarize potential diagnostic and therapeutic applications of radiolabeled FAP inhibitors in oncological and nononcological disease processes.
PET Imaging for Monitoring Cellular and Immunotherapy of Cancer
Authors: Larimer Benjamin M.
Published: May 2024

Cancer immunotherapy, including checkpoint blockade and cellular therapy, has become a cornerstone in cancer treatment. However, understanding the factors driving patient response or resistance to these therapies remains challenging. The dynamic interplay between the immune system and tumors requires new approaches for characterization. Biopsies and blood tests provide valuable information, but their limitations have led to increased interest in positron emission tomography (PET)/computed tomography imaging to complement these strategies. The noninvasive nature of PET imaging makes it ideal for monitoring the dynamic tumor immune microenvironment. This review discusses various PET imaging approaches, including immune cell lineage markers, immune functional markers, immune cell metabolism, direct cell labeling, and reporter genes, highlighting their potential in targeted immunotherapies and cell-based approaches. Although PET imaging has limitations, its integration into diagnostic strategies holds promise for improving patient outcomes and accelerating drug development in cancer immunotherapy.
Enhanced Safety and Efficiency of Ambulatory Cardiology Admissions: A Quality Improvement Initiative
Authors: McLellan Mary C. , Irshad Mariam , Penny Katherine C. , Rufo Michelle , Atwood Sarah , Dacey Heather , Ireland Christina M. , de Ferranti Sarah , Saia Theresa , Fisk Anna C. , Saleeb Susan F.
Published: May 2024

Background:

Pediatric cardiac patients have experienced evolving illnesses progressing to instability while awaiting inpatient admission from ambulatory settings. Admission delays and communication breakdowns increase the risk for tenuous patients. This quality improvement initiative aimed to improve safety and efficiency for patients admitted from an ambulatory Clinic to the Acute Cardiac Care Unit (ACCU) using standardized communication and admission processes within one year.

Methods:

An admission process map, in-clinic nurse monitoring, and communication pathways were developed and implemented. A standardized team handoff occurred via virtual huddle using illness severity, patient summary, action list, situational awareness, and synthesis. Escalation of care events and timeliness were compared pre- and postimplementation.

Results:

There was a reduction of transfers to the intensive care unit within 24 hours of ACCU admission from 9.2% to 3.8% (P = 0.26), intensive care unit evaluations (without transfer) from 5.6% to 0% (P = 0.06), and arrests from 3.7% to 0% (P = 0.16). After the pilot, clinic nurses monitored 100% of at-risk patients. Overall mean time from admission decision to virtual huddle decreased from 81 to 61 minutes and mean time to admission from 144 to 115 minutes, with 41% (n = 33) arriving ≤ 60 minutes (goal). The COVID-19 pandemic negatively affected admission timeliness while safety metrics remained optimized.

Conclusions:

Implementing a standardized admission process between the Clinic and ACCU enhanced safety by reducing admission wait time and escalation of care post-admission. Sustainable, reliable handoff processes, in-clinic monitoring, and standardized admission processes were established. The pandemic hindered admission efficiency without compromising safety.
Telemedicine Quality Improvement during the Corona Virus 2019 Pandemic Increases Pediatric Weight Management Access
Authors: Vallabhan Monique K. , Foos Kathryne , Roldan Patricia , Negrete Sylvia , Page-Reeves Janet M. , Jimenez Elizabeth Y. , Kong Alberta S.
Published: May 2024

Background:

The corona virus 2019 pandemic disrupted care for pediatric patients with chronic conditions, including those with childhood obesity. Lockdowns forced providers to create new ways of caring for this population. Telemedicine was a promising but previously unavailable solution. This quality improvement report details how the Healthy and Fit Children’s Clinic transitioned and improved care via telemedicine.

Methods:

Between March 2020 and April 2021, the quality improvement project team incorporated the Model for Improvement to transition the clinic to telemedicine. The team tracked Healthy and Fit Children’s Clinic appointments, no-shows, billing and reimbursement data, and noted unintended consequences or unanticipated barriers. Patients and their families were given a satisfaction survey at the end of each telemedicine encounter.

Results:

Compared with pre-telemedicine implementation, there was a 120% increase in completed patient clinic visits per week and a sustained positive shift above the established baseline. Telemedicine no-show rates achieved <10%, with an average sustained rate of <20%, compared with unchanged in-person no-show rates of >50% pre- and post-telemedicine implementation. There was a 74% increase in monthly billing and a sustained positive shift above the pre-telemedicine baseline. On average, patients rated all six satisfaction questions ≥92 on the 100-point scale (compared with 83 pre-telemedicine).

Conclusions:

This transition to telemedicine was successful and could be translatable to other clinic sites. Patients attended their clinic visits more consistently and were highly satisfied with their care. In a population where continuity of care is paramount, telemedicine shows promise as a tool to treat childhood obesity.