bluuebunny/crossref_metadata_2025 huggingface dataset:
Lysophosphatidylcholine 16:0 mediates chronic joint pain associated to rheumatic diseases through acid-sensing ion channel 3
Authors: Jacquot Florian , Khoury Spiro , Labrum Bonnie , Delanoe Kévin , Pidoux Ludivine , Barbier Julie , Delay Lauriane , Bayle Agathe , Aissouni Youssef , Barriere David A. , Kultima Kim , Freyhult Eva , Hugo Anders , Kosek Eva , Ahmed Aisha S. , Jurczak Alexandra , Lingueglia Eric , Svensson Camilla I. , Breuil Véronique , Ferreira Thierry , Marchand Fabien , Deval Emmanuel
Published: January 2022

Rheumatic diseases are often associated to debilitating chronic pain, which remains difficult to treat and requires new therapeutic strategies. We had previously identified lysophosphatidylcholine (LPC) in the synovial fluids from few patients and shown its effect as a positive modulator of acid-sensing ion channel 3 (ASIC3) able to induce acute cutaneous pain in rodents. However, the possible involvement of LPC in chronic joint pain remained completely unknown. Here, we show, from 2 independent cohorts of patients with painful rheumatic diseases, that the synovial fluid levels of LPC are significantly elevated, especially the LPC16:0 species, compared with postmortem control subjects. Moreover, LPC16:0 levels correlated with pain outcomes in a cohort of osteoarthritis patients. However, LPC16:0 do not appear to be the hallmark of a particular joint disease because similar levels are found in the synovial fluids of a second cohort of patients with various rheumatic diseases. The mechanism of action was next explored by developing a pathology-derived rodent model. Intra-articular injections of LPC16:0 is a triggering factor of chronic joint pain in both male and female mice, ultimately leading to persistent pain and anxiety-like behaviors. All these effects are dependent on ASIC3 channels, which drive sufficient peripheral inputs to generate spinal sensitization processes. This study brings evidences from mouse and human supporting a role for LPC16:0 via ASIC3 channels in chronic pain arising from joints, with potential implications for pain management in osteoarthritis and possibly across other rheumatic diseases.
Revision arthroplasty using a custom-made implant in the course of acetabular loosening of the J&J DePuy ASR replacement system - case report
Authors: Augustyn Aleksander , Stołtny Tomasz , Rokicka Dominika , Wróbel Marta , Pająk Jan , Werner Krystian , Ochocki Karol , Strojek Krzysztof , Koczy Bogdan
Published: January 2022

Rationale:

Resurfacing arthroplasty using the J&J DePuy ASR system was withdrawn from surgical treatment due to the necessity of frequent revision procedures after its application. There have been many studies concerning treatment of acetabular bone loss using different operating techniques. However, we felt that data of custom - made implant usage in such cases is highly insufficient, and there is lack of evidence on its application in treatment of loosening of the previous implant. The aim of the study was to evaluate the effectiveness of surgical treatment with a custom-made implant in a patient with extensive acetabular bone loss after aseptic loosening of the acetabular component of the J&J DePuy ASR surface prosthesis in the early period of observation.

Patient concerns:

A 74-year-old patient was taken to the Orthopaedic Trauma Emergency Room due to increasing pain in the right hip for about 3 months. Nine years earlier he underwent resurfacing arthroplasty of the right hip using the J&J DePuy ASR method.

Diagnoses:

The imaging diagnostics (X-ray, computed tomography, ultrasound) revealed the presence of a pseudotumor and lysis around the acetabular implant, which caused a fracture in the acetabulum.

Interventions:

Revision arthroplasty of the right hip joint was performed with the removal of the ASR implant. During the procedure extensive bone defects were visualized, preventing the insertion of the revision acetabulum. After extensive plasticization of the defects with the use of allogeneic cancellous chips the “hanging hip” was left with the intention of making another attempt to insert the implant after the reconstitution of the acetabular bone. A computed tomography examination 2.5 years after the ASR removal revealed the lack of an adequate degree of bone remodeling for the planned implant. Arthroplasty using custom - made aMace Acetabular Revision System by Materialize was performed 3 years after the removal of ASR.

Outcomes:

Optimal implant adherence to the bone base and full osseointegration with the pelvic bone bearing has been achieved. Significant improvement in clinical parameters has been noted, with no complications in the postoperative period.

Lessons:

The use of an individual custom-made implant in extensive acetabular bone loss after aseptic loosening of the acetabular component of the J&J DePuy ASR surface prosthesis in patients is an effective method of surgical treatment.
Endoscopic coblation-assisted and partial arytenoidectomy for infants with idiopathic bilateral vocal cord paralysis
Authors: Tan Letian , Chen Chao , Li Qi
Published: January 2022

To review our experience with endoscopic coblation-assisted and partial arytenoidectomy (ECPA) in treating idiopathic bilateral vocal cord paralysis (BVCP).

A retrospective analysis of thirty-three infants (19 boys and 14 girls, aged 1–10 months) with idiopathic BVCP undergoing ECPA was performed. The therapeutic process and outcomes (surgical success, swallowing function, and voice) were reviewed. The follow-up period was >33 months.

Among the thirty-three infants with idiopathic BVCP, surgery was successful in twenty-nine cases but failed in four cases. Twenty-one, nine, and three patients underwent right, left, and bilateral ECPA, with surgical success rates of 90.5%, 100.0%, and 33.3%, respectively. In addition, four and six cases were combined with subglottic stenosis (SGS) and laryngomalacia, respectively. The surgical success rates of BVCP alone and BVCP+ other airway abnormalities were 95.6% and 70.0%, respectively. During the follow-up, five infants had slight difficulty swallowing, 12 infants had partial or complete recovery movement of at least one vocal cord with satisfactory voice outcome, and five infants had early granuloma formation, which disappeared spontaneously.

ECPA appears to be a promising alternative to tracheostomy and initial management in infants with idiopathic BVCP who are free of other airway abnormalities.
Venous thromboembolism risk factors and usefulness of a risk scoring system in lower limb orthopedic surgery
Authors: Akamine Akihiko , Takahira Naonobu , Kuroiwa Masayuki , Tomizawa Atsushi , Atsuda Koichirou
Published: January 2022

We previously developed a computerized clinical decision support system based on national consensus guidelines and previous studies. This system was used to assess the risk of venous thromboembolism. In this study, we examined the risk factors for venous thromboembolism in patients who underwent lower limb orthopedic surgery using our risk scoring system, to investigate the association between the total risk score and the occurrence of venous thromboembolism.

We retrospectively evaluated the records of 649 patients who underwent lower limb orthopedic surgery at a tertiary care center in Japan between January 2015 and August 2018. Venous thromboembolism was confirmed using ultrasonography or computed tomography angiography. The computerized clinical decision support system was used throughout the hospitalization period. Independent risk factors for postoperative venous thromboembolism were identified using logistic regression analysis.

Age (≥68 years) was significantly associated with an increased risk of venous thromboembolism (adjusted odds ratio: 1.06, 95% confidence interval: 1.03–1.09; P < 0.001). Furthermore, the Cochran–Armitage trend test revealed a significant positive correlation between the total risk score and the occurrence of venous thromboembolism (P < 0.001).

Our risk scoring system may be used preoperatively to determine the need for venous thromboembolism prophylaxis. This study suggests that age (≥68 years) may be a risk factor for venous thromboembolism after lower limb orthopedic surgery. Additional studies are needed to validate these results.
Prevalence and characteristics of multivitamin-multimineral (MVMM) use among Saudi populations in Riyadh, Saudi Arabia
Authors: Alwalan Saleh I. , Alrasheed Abdullah A. , Aldossari Khaled K. , Al-Zahrani Jamaan M. , Alshahrani Abdullah Mohammed , Batais Mohammed A. , Almigbal Turky H.
Published: January 2022

Use of multivitamin multimineral (MVMM) preparations is prevalent and growing worldwide, contributing to major health expenditure. Minimal literature on prevalence and characteristics of MVMM use is available from Saudi Arabia.

The study was conducted to determine the prevalence and characteristics of MVMM use among Saudi population in Riyadh, Saudi Arabia.

A cross-sectional study was conducted at 6 shopping malls located in the different regions of Riyadh city for 6 months from February 01, 2019, to July 31, 2019. A well-structured English questionnaire was developed, translated into Arabic language, and validated by the experts. A pertinent inclusion and exclusion criteria were established. After having informed consent to be included in the study, the printed copies of the questionnaire were distributed among the participants using a convenient sampling technique. The data were collected and analyzed using SPSS version 24. Descriptive statistics were presented as numbers, percentages, means, and standard deviations. A P value of ≤.05 and 95% confidence intervals were used to report the statistical significance.

Out of 1200 surveys distributed, 1105 were returned by the participants (response rate 92%). Prevalence of MVMM supplements use turned out to be 47%. The study revealed statistically significant association between MVMM use and gender, marital status, education, regular exercise, smoking, following special diet, and eating fruits and vegetables (P ≤ .05). Majority of the participants used MVMM on daily basis (57.9%), and hospital prescriptions (57.9%) were the most common reason of MVMM use. Majority of the participants used MVMM for diet supplements (32.2%), health promotion (29.4%), and treatment of disease (16%).

The MVMM use is prevalent in Saudi population, warranting sound regulatory policies for their judicial use and increase awareness about the benefits and side effects of dietary supplements.
Low dose naloxone for pruritus in systemic sclerosis
Authors: Meridor Katya , Berookhim Joshua , Levy Yair
Published: January 2022

Rationale:

Pruritus is a common symptom in patients with systemic sclerosis and has a tremendous effect on the quality of life. Nevertheless, current therapeutic options are limited. The pathogenesis of pruritus in systemic sclerosis is not completely understood; however, opiate-mediated neurotransmission has been postulated to be involved.

Patient concerns and diagnosis:

We describe 4 female patients with systemic sclerosis suffering from severe pruritus, with an average 5D-itch score of 22.75.

Intervention and outcomes:

Low-dose oral naloxone was initiated, followed by a significant improvement in the level of pruritus, reaching an average 5D-itch score of 7.5, after 6 and 12 months of treatment. None of the patients experienced side effects.

Lessons:

Low-dose naloxone plays an important role in the management of pruritus in systemic sclerosis.
CT findings of type A acute aortic dissection that did and did not result in prehospital death
Authors: Sueyoshi Eijun , Murakami Tomonori , He Xi , Koike Hirofumi , Nagayama Hiroki , Uetani Masataka
Published: January 2022

The differences between the pathologies of cases of type A acute aortic dissection (AAD) that did and did not result in prehospital death (PHD) have not been fully elucidated.

This study aimed to compare the CT findings and clarify the differences between the pathologies of such cases.

Ninety four consecutive type A AAD patients between 2010 and 2020 were enrolled in this study. There were 47 males and 47 females (mean age: 69.0 ± 14.4 years). The patients were divided into those that did (n = 25, 27%) and did not (n = 69, 73%) suffer PHD. We retrospectively evaluated the CT or postmortem CT findings of each case and analyzed the relationships between clinical factors (CT findings and clinical characteristics) and PHD using logistic regression analysis.

Bloody pericardial effusion (96% vs 35%, P < .0001), bloody pleural effusion (40% vs 1%, P < .0001), and mediastinal hematomas (88% vs 14%, P < .0001) were significantly more common in the PHD group than in the no PHD group.

In the multivariate logistic regression analysis, bloody pericardial effusion and lung consolidation were found to be significant risk factors for PHD (odds ratio: 21.29 [95% confidence intervals {CI}: 1.19–248.29] and 13.72 [95% CI: 1.79–105.06], respectively; P = .014 and P 
= .012, respectively). AD affecting the abdominal aorta was identified as a significant negative risk factor for PHD (odds ratio: 0.02 [95% CI: 0.01–0.65]; P = .0042).

Most PHD due to type A AAD are associated with hemorrhaging. Bleeding into the pericardium and type A AAD confined to the thoracic aorta are significant risk factors for PHD. Secondary respiratory failure might contribute to PHD in such cases.
The efficacy and safety of acupuncture assisted anesthesia (AAA) for postoperative pain of thoracoscopy
Authors: Liu Xinyi , Meng Dan , Zhao Qinyu , Yan Chunchun , Wang Jingyu
Published: January 2022

Background:

Enhanced recovery after surgery suggests the use of multimodal analgesia to optimize the perioperative pain management scheme. At present, studies have shown that the application of acupuncture combined anesthesia in thoracoscopy has achieved good curative effect. However, there is no relevant systematic evaluation. Our study is the first meta-analysis of the effectiveness and safety of acupuncture combined anesthesia in pain management after thoracoscopy, in order to provide strong evidence for clinical support.

Methods:

A comprehensive and systematic literature searching will mainly perform on 7 electronic databases (PubMed, the Cochrane Library, Embase, China National Knowledge Infrastructure, Chongqing VIP Information, and WanFang Data, Chinese Biomedical Database) from their inception up to November 30, 2021. We will also search for ongoing or unpublished studies from other websites (eg, PROSPERO, ClinicalTrials.gov, Chinese Clinical Trial Registry) and do manual retrieval for potential gray literature. Only the relevant randomized controlled trials published in English or Chinese were included. Two independent investigators will independently complete literature selection, assessment of risk bias, and data extraction, the disagreements will be discussed with the third party for final decisions. The primary outcome measures: visual analog scale, intraoperative anesthetic dosage, and the consumption of postoperative analgesics. The secondary outcome measures: Pittsburgh Sleep Quality Index, the total sleep time after operation, residence time in the anesthesia recovery room, the duration of hospitalization, and the incidence of adverse reactions and serious events. Assessment of bias risk will follow the Cochrane risk of bias tool. Data processing will be conducted by Stata 15.0 software.

Results:

We will evaluate the efficacy and safety of acupuncture assisted anesthesia for postoperative pain after thoracoscopy based on randomized controlled trials.

Conclusion:

This study can provide more comprehensive and strong evidence whether acupuncture assisted anesthesia is efficacy and safe for postoperative pain in thoracoscopy.

Registration:

The research has been registered and approved on the INPLASY website. The registration number is INPLASY 2021120129.
Combination of low-dose rituximab, bortezomib and dexamethasone for the treatment of autoimmune hemolytic anemia
Authors: Yao Mingkang , Zhang Jingjing , Li Ying , Lv Linlin , Jia Lu , Yang Chunyan , Huang Yu , Liu Haihui , Wang Jian , Chen Mingtai , Zhang Hao
Published: January 2022

Autoimmune hemolytic anemia (AIHA) therapy may be associated with severe complications such as diabetes, hypertension, obesity, osteoporosis, peptic ulcers, infection, and some other diseases. To reduce those effects, we used low-dose rituximab, bortezomib and dexamethasone (LowR-BD regimen) to treat AIHA. The purpose of this study was to evaluate the efficacy and safety of this regimen.

Seven patients with warm AIHA (wAIHA) admitted from March 2020 to October 2020 were treated with LowR-BD regimen: Rituximab 100 mg by intravenous infusion on day 1 combined with bortezomib 1.3 mg/m2 by subcutaneous injection on day 2 plus dexamethasone 20 mg by intravenous infusion on days 2, 3. Clinical efficacy and safety were assessed at the regular reexamination of relevant indicators and follow-up.

After 4 cycles of the LowR-BD regimen, the overall response rate (ORR) was 85.71% with a complete response (CR) of 28.57% and a partial response (PR) of 57.14%. After a median follow-up of 12 (range 7–13) months, 5 patients achieved CR and 2 patients had PR status, including 1 patient who did not respond to LowR-BD treatment and reached CR after using methylprednisolone combined with cyclophosphamide. One patient relapsed and achieved PR after retreatment of 2 cycles LowR-BD regimen. The patients tolerated the treatment well and did not complain of apparently adverse reactions except a patient with Sjogren's syndrome and bronchiectasis who developed a severe infection during treatment.

Low-dose rituximab combined with bortezomib and dexamethasone is effective and relatively safe in patients with wAIHA.
Migration of fully covered self-expandable metallic stents used to treat anastomotic strictures after orthotopic liver transplantation
Authors: Ding Songming , Wu Weilin , Lu Jianfang , Zhu Hengkai , Zheng Shusen , Li Qiyong
Published: January 2022

Insertion of a fully covered self-expandable metallic stent (FCEM) through endoscopic retrograde cholangiopancreatography is an effective solution for biliary anastomotic stricture following orthotopic liver transplantation (OLT). However, FCEM migration continues to plague patients. This study aimed to evaluate the FCEM migration rate in our center, and to investigate the factors increasing the migration risk for FCEM.

The study enrolled 43 post-OLT patients with confirmed duct-to-duct AS. The effects of age, gender, albumin, alanine aminotransferase, aspartate aminotransferase (AST), γ-glutamyl transpeptidase, alkaline phosphatase, total bilirubin, direct bilirubin, ABO (blood group system consists of four antigens) incompatibility, stricture length, FCEM brand, FCEM length, donor liver and recipient bile duct diameters, size mismatches between the donor and recipient bile ducts >2 mm, diabetes and/or hypertension status, endoscopic sphincterotomy status, the use of plastic stents or nasobiliary drainage prior to FCEM implantation, duration from OLT to FCEM placement, and OLT etiology on FCEM migration were retrospectively analyzed.

The FCEM migration rate was 48.8% (21/43) at 6 months. The serum AST level was significantly higher in the migration group than that in the nonmigration group (52.48 vs 29.50 U/L, P < .05). A lower serum AST level was associated with a decreased risk of FCEM migration in post-OLT patients with duct-to-duct anastomotic stricture (hazard ratio = 0.968, 95% confidence interval: 0.940–0.996, P = .028).

In this single-center, retrospective cohort study, we showed that an elevated serum AST level was a potential risk factor for FCEM migration.
The influence of empty-nest living on the health of the older people living in the rural areas of Lishui, China
Authors: Hu Naibao , Shi Tala , Xu Lanlan , Pan Guotao , Hu Zhiyong
Published: January 2022

The empty-nest older people are becoming a significant social phenomenon in the rural of China. Most studies on the health of the empty-nest older people contain these older people who have no children or dead children. The emotional experience of the older people with and without children is quite different, our study only chose the empty-nest older people who had children in the rural of Lishui, China. The purpose of this study is to explore the differences of the health conditions between empty-nest and non-empty-nest older people living in the rural areas of China, including items of chronic metabolic diseases, fall injury, and mental health. Our research found that empty-nest older people had higher incidence of fall injury (17.00% vs 6.31%, P = .006) and suffer more severe depression (P = .015) than the non-empty-nest older people. The adjusted odds ratio of fall injury and depression for empty-nest older people compared with the non-empty-nest older people were 2.76 (95% CI, 1.17–6.48) and 2.25 (95% CI, 1.36–3.67), respectively. Our results suggest that empty-nest older people are more likely to suffer from depression and fall injury than non-empty-nest older people living in the rural of China.
Successful subclavian transcatheter aortic valve replacement in a nonagenarian patient
Authors: Oh Seok , Kim Ju Han , Hyun Dae Young , Cho Kyung Hoon , Kim Min Chul , Sim Doo Sun , Hong Young Joon , Ahn Youngkeun , Jeong Myung Ho , Jung Yochun , Lee Kyo Sun
Published: January 2022

Rationale:

In super-aged patients with severe symptomatic aortic stenosis, transcatheter aortic valve replacement (TAVR) is a good treatment option, and the number of TAVR-eligible elderly patients is expected to grow exponentially. We present the case of a nonagenarian woman with severe aortic stenosis who underwent successful subclavian TAVR.

Patient concerns:

A 90-year-old Korean woman was brought to our department with dyspnea. On physical examination, a grade IV systolic murmur was auscultated in both the upper sternal borders and the left lower sternal border.

Diagnosis:

A transthoracic echocardiogram showed heavy calcification of the aortic valve with an increase in both peak velocity (4.36 m/s) and mean pressure (44.8 mm Hg), indicating severe symptomatic aortic stenosis.

Interventions:

After a heart team conference involving interventional cardiologists, cardiac surgeons, and anesthesiologists, subclavian TAVR was performed. Using the left subclavian artery, we successfully deployed a self-expandable valve prosthesis (CoreValveTM Evolut RTM, Medtronic Inc., Minneapolis, MN).

Outcomes:

After TAVR, transthoracic echocardiogram showed a decline in both peak velocity (2.06–2.14 m/s) and mean pressure (7.42–7.95 mm Hg) with an increase in the aortic valve area (1.12 cm2). The patient's dyspnea symptoms improved dramatically.

Lessons:

In addition to femoral TAVR, subclavian TAVR may be feasible and safe in super-aged patients.
Quality of evidence supporting the role of Chinese herbal medicine for the treatment of poststroke depression
Authors: Shi Hongshuo , Dong Cengda , Liu Wenbin , Peng Min , Si Guomin , Sun Fengshan
Published: January 2022

Background:

Poststroke depression (PSD) is a syndrome that occurs after stroke. The efficacy of Chinese herbal medicine (CHM) for PSD has also received widespread attention, but there is still a lack of clinical evidence because this overview evaluates the published meta-analyses (MAs)/Systematic reviews (SRs). To provide evidence for the clinical application of CHM in the treatment of PSD

Methods:

Two researchers searched 7 databases for SRs/MAs which are about randomized controlled trials on CHM for PSD. Two investigators use the systematic review assessment tool (AMSTAR-2), the risk of bias in systematic scale, the list of preferred reporting items for systematic reviews and meta-analysis, and the classification of recommended assessments for evaluation, development and evaluation system to assess the included SRs/MAs.

Results:

Our findings will be published in peer-reviewed journals.

Conclusion:

This study provides evidence-based medical evidence for the impact of CHM on PSD.

Registration number:

INPLASY202210001
Delayed gait recovery by resolution of limb-kinetic apraxia in a chronic hemiparetic stroke patient
Authors: Jang Sung Ho , Byun Dong Hyun
Published: January 2022

Rationale:

This paper reports on a chronic hemiparetic stroke patient who showed delayed gait recovery due to resolution of limb-kinetic apraxia (LKA).

Patient concerns:

A 49-year-old man underwent comprehensive rehabilitation at a local rehabilitation hospital since 3 weeks after spontaneous intracerebral haemorrhage. However, he could not walk independently because of severe motor weakness in his right leg until 19 months after the onset.

Diagnosis:

At the beginning of rehabilitation at our hospital (19 months after onset), we thought that he had the neurological potential to walk independently because the unaffected (right) corticospinal tract and corticoreticulospinal tract were closely related to the gait potential, representing intact integrities. As a result, we assumed that the severe motor weakness in the right leg was mainly ascribed to LKA.

Interventions:

At our hospital, he underwent comprehensive rehabilitation including increased doses of dopaminergic drugs (pramipexole, ropinirole, amantadine, and carbidopa/levodopa).

Outcomes:

After 10 days to our hospital, he could walk independently on an even floor with verbal supervision, concurrent with motor recovery of the right leg. After 24 days after hospital admission, he could walk independently on an even floor.

Lessons:

We believe that the resolution of LKA in his right leg by the administration of adequate doses of dopaminergic drugs was the main reason for the delayed gait recovery in this patient. The results suggest the importance of detecting the neurological potential for gait ability of a stroke patient who cannot walk after the gait recovery phase and the causes of gait inability for individual patients.
Successful application of extracorporeal membrane oxygenation treatment in the management of severe respiratory failure caused by primary pulmonary lymphoma
Authors: Yu Chao , Xv Lunbing , Peng Xiaochun , Shao Min
Published: January 2022

Rationale:

Primary pulmonary lymphoma (PPL) is a rare disease, and rapid progression of pulmonary exudation leads to severe respiratory failure. Here, we present the case of a critically ill patient with PPL complicated by refractory hypoxemic respiratory failure. The patient was ultimately cured with a successful combination of extracorporeal membrane oxygenation (ECMO) and chemotherapy.

Patient concerns:

A 36-year-old woman was hospitalized because of a 2-month history of cough with fever and shortness of breath. Computed tomography revealed multiple pulmonary nodules, consolidation, and solid pulmonary opacities. Complications of pneumothorax occurred after computed tomography-guided core needle biopsy, and respiratory failure progressively developed (PaO2/FiO2 65 mm Hg).

Diagnosis:

Primary pulmonary lymphoma, respiratory failure, stress cardiomyopathy, cardiogenic shock.

Interventions:

The patient was treated with veno-venous ECMO and chemotherapy.

Outcomes:

The patient was successfully weaned off ECMO after chemotherapy and transferred out of the intensive care unit on day 9. After regular chemotherapy, no obvious lesions were observed in either lung tissue.

Conclusion:

ECMO can be selected as an important salvage treatment for patients with severe cardiopulmonary dysfunction caused by PPL and other malignant tumors that may be cured or transferred to a stable stage.
SARS-CoV-2 (COVID-19) pneumonia patient treated with two doses of infliximab within 2 weeks for acute severe ulcerative colitis
Authors: Alhalabi Marouf , Eddin Kamal Alaa , Ali Fadwa , Abbas Ahmad
Published: January 2022

Rationale:

The ongoing coronavirus pandemic has caused severe acute respiratory syndrome, posing a significant challenge for patients receiving immunotherapy for immune-mediated inflammatory diseases. As of January 2022, immunosuppressants such as tumor necrosis factor inhibitors (anti-TNFα) and azathioprine are inadvisable for an infectious disease caused by the SARS-CoV-2 virus (COVID-19). We continued infliximab as a second induction dose nine days after the onset of COVID-19 symptoms in a patient with acute severe ulcerative colitis.

Patient concerns:

We report the case of a 34-year-old male with 6 to 8 times bloody diarrhea, fever, and cramping abdominal pain. Ulcerative colitis was diagnosed 6 months earlier and treated with mesalamine 80 mg/kg/day and azathioprine 2.5 mg/kg/day. The patient had never undergone surgery before. Sigmoidoscopy revealed multiple ulcerations and spontaneous bleeding, and the colon samples tested negative for cytomegalovirus and Clostridium difficile. However, intravenous corticosteroids did not induce remission. A nasopharyngeal swab tested positive for SARS-CoV-2.

Diagnosis:

Acute severe ulcerative colitis and SARS-CoV-2 (COVID-19) pneumonia.

Interventions:

The second loading dose of infliximab was administered nine days after the diagnosis of COVID-19.

Outcome:

The patient completed infliximab induction at a dose of 5 mg/kg at weeks 0, 2, and 6, with no complications.

Lessons:

It is unclear whether anti-TNF-α treatment improves or deteriorates COVID-19 patient outcomes, and this case demonstrates that infliximab can be used safely. Current guidelines make a weak recommendation to avoid using anti-TNFα agents in the presence of acute COVID-19 infection. There is an urgent need for research on biologics therapy.
Intubation difficulty scale contributors and time delay in clinical practice
Authors: Kang Ting-Wei , Wang Jung-Der , Tsai Yi-Seng , Lin Chung-Ren , Tseng Chia-Chih Alex
Published: January 2022

The intubation difficulty scale (IDS) includes 7 contributors that provide a comprehensive assessment of difficult intubation. However, the effect of each contributor is unclear, and the scale has not been revalidated recently and has not been validated in orient. This study determined the duration of successful intubation (DSI) for each of these 7 contributors.

The patients were intubated by attending anesthesiologists. The duration and other data were recorded by 2 research assistants. Anaesthesiologists reported the IDS and their perceptions. A linear mixed-effects model with a DSI was constructed using IDS factors.

In total, 1095 patients were enrolled. The average DSI was 23.9 ± 21.8 seconds (37.1% IDS = 0). All 7 factors were independently associated with duration, with the exception of vocal cord adduction. The best model was as follows: DSI (in seconds) = 15.2 + 31.1 (number of additional attempts) + 26.2 (number of additional operators) + 11.4 (number of alternative techniques) + 7.9 (increased lift force) + 4.9 (external laryngeal pressure) + 3.5 (Cormack grade 1). The mixed models were similar except for the regression coefficient for the number of alternative techniques that decreased from 11.4 to 6.9 seconds.

We confirmed that each IDS contributor affects the DSI and validated a prediction model with 6 IDS contributors. This prediction model may facilitate the development of strategic plans for critical airway management. Furthermore, it could improve simulations and monitor learning progress and help provide valuable feedback.
Acupuncture plus massage for cervicogenic headache
Authors: Ding Fangfang , Liu Zhen , Li Rui , Wang Chenying , Lu Yan
Published: January 2022

Background:

Cervicogenic headache (CGH), one of the most common headaches. It is characterized by pain starting from the neck and gradually involving the eyes, frontal and temporal regions. Acupuncture and massage therapy has been widely used in the treatment of CGH, the purpose of this study was to evaluate the effectiveness and safety of acupuncture combined with massage in the treatment of CGH.

Methods:

The databases of PubMed, Embase, Cochrane library, Medicine, Web of Science, China National Knowledge Infrastructure, Wan-Fang Database, China Biomedical Literature Service System, and Chongqing VIP Chinese Science will be searched. This study will include randomized controlled trials of acupuncture combined with massage in the treatment of CGH published before November 2021. The primary outcomes included the overall efficiency, visual simulation score, neck activity score, quality of life score, and adverse reactions as secondary outcomes were assessed. Cochrane bias risk assessment tool will be used for literature data screening and quality evaluation, and using RevMan5.4 to collect data for statistical analysis. We then will use the Grading of Recommendations Assessment, Development, and Evaluation approach to assess the overall quality of evidence supporting the primary outcomes.

Results:

This systematic review will provide a high-quality synthesis to evaluate the efficacy and safety of acupuncture combined with massage therapy in the treatment of CGH, providing a reference for the safe and effective treatment plan.

Conclusion:

This study provides evidence that acupuncture combined with massage is effective and safe for patients with CGH.

Systematic review registration:

INPLASY2021120049U1.
Uncontrolled blood pressure among hypertensive adults with rheumatoid arthritis in Saudi Arabia
Authors: Almalki Ziyad S. , AlOmari Bedor Abdullah , Alshammari Tahani , Alshlowi Areej , Khan Mohd Faiyaz , Hazazi Ali , Alruwaily Maha , Alsubaie Sarah , Alanazi Faten , Aldossary Norah , Albahkali Raseel
Published: January 2022

Despite the availability and advancement of diagnostic and treatments with demonstrated benefits in minimizing cardiovascular morbidity and mortality, hypertension control rates remain suboptimal. Therefore, this research aimed to determine the prevalence of uncontrolled BP in rheumatoid arthritis (RA) patients and understand all potential risk factors for uncontrolled BP.

We conducted a cross-sectional study on RA patients in 2 rheumatology clinics in 2 public hospitals in Riyadh. Patients’ information such as demographics, comorbidities, drug use, and other clinical data were captured through a review of medical records and supplemented by patient interviews. Multivariate logistic regression was utilized for the analysis to identify the significant factors of uncontrolled BP (systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg).

In total, 834 subjects with RA and concomitant BP were involved in this cross-sectional study. The prevalence of uncontrolled BP was found to be 31.65% among all the study population. Multivariate analysis showed that males, subjects above 60 years of age, and smokers had a distinctly higher occurrence of uncontrolled BP. Among the patients with comorbid conditions, those with obesity, hyperlipidemia, diabetes, anemia, cancer, and reflex or gastroesophageal reflux disease also showed a significantly higher risk of uncontrolled BP (P < .05).

The rate of uncontrolled BP was found to be alarmingly high in the study population. Age, gender, smoking, diabetes, obesity, hyperlipidemia, cancer, gastroesophageal reflux disease, and osteoporosis are independently linked with lack of BP control.
Modified DIVA Score
Authors: Rizvi Munaza Batool , Silver Ellen J. , Khine Hnin , Sellinger Catherine
Published: January 2022

Objective

This study aims to validate the DIVA (Difficult Intravenous Access) score in our population and to identify any additional patient characteristics that may be associated with difficult access in children.

Methods

This was a cross-sectional study in an urban quaternary pediatric emergency department with patients younger than 21 years and Emergency Severity Index ≥2 who require intravenous (IV) access for their management. In addition to patient characteristics comprising the DIVA score, data were collected on patient “history of difficult access,” hydration status, skin shade, history of sickle cell disease or diabetes, technology dependence, and body mass index. The number of IV cannulation attempts and total time taken were recorded for each patient. “Difficult access” was defined as ≥2 or more attempts or time >30 minutes to achieve successful IV cannulation.

Results

A convenience sample of 300 pediatric patients was enrolled. The DIVA score had a sensitivity of 51% (95% confidence interval [CI], 40.8%–61.14%) and a specificity of 82.99% (95% CI, 76.95%–87.99%) for predicting “difficult access” in our population. Among all patient characteristics examined in this study, only “history of difficult access” improved the identification of “difficult access” patients. The “history of difficult access” variable had a sensitivity of 61% (95% CI, 50.7%–70.6%) and a specificity of 75.7% (95% 95% CI, 69.12%–81.62%) in predicting “difficult access.” With the addition of “history of difficult access” to the original DIVA score, we developed a “modified DIVA score (m-DIVA).” The m-DIVA score had a sensitivity of 78% (95% CI, 68.6%–85.6%) and specificity of 67% (95% CI, 59.9%–73.58%), representing a 52.9% improvement in correctly identifying “difficult access” patients over the original DIVA score.

Conclusions

The m-DIVA score, which incorporates prior history, increases the screening test's sensitivity in identifying “difficult access” patients and should be further investigated as clinical tool.
Monteggia Fracture–Dislocation
Authors: Ramponi Denise R.
Published: January 2022

A Monteggia fracture–dislocation involves a proximal one-third of the ulna fracture with a concomitant dislocation of the radial head proximally at the elbow. This fracture and dislocation often results from a fall on the outstretched hand (FOOSH) low-energy mechanism of injury. One must have a high index of suspicion with any ulnar fractures to look for a radial head dislocation so that the dislocation component is not missed. These injuries often require early orthopedic intervention. Any delays in treatment can lead to poor long-term outcomes including chronic valgus instability and radiocapitellar osteoarthrosis.
ESI Triage Distribution in U.S. Emergency Departments
Authors: Chmielewski Nicholas , Moretz Jason
Published: January 2022

The accurate triage of arriving emergency department (ED) patients is a key component of emergency nursing practice. Overtriage assignment of patients misallocates scarce resources in a time of department overcrowding, whereas patient undertriage can create risks for negative patient outcomes secondary to care delays. Limited evidence is available regarding ED triage accuracy. It is estimated that appropriate adherence to the Emergency Severity Index (ESI) triage tool and assigning triage categories could be as low as 60% (McFarlane, 2019a
,
2019b). The purpose of this retrospective observational study was to examine the 2019 triage distribution of 954,847 ED encounters at 25 hospitals. Comparisons were then made with the spreads identified in the ESI Implementation Handbook (Gilboy, Tanabe, Travers, & Rosenau, 2020). Study results reflect the presence of wide variations in distribution when compared with the expected spread published by Gilboy et al. (2020). These variations illustrate the need for further facility-level evaluation. ESI Level 2 percentages varied from as little as 2.6% to as high as 69% of each facility's ED visit population. Examining an individual facility's annualized triage distribution may serve as a swift method in determining whether additional investigation into triage accuracy is warranted. EDs must implement and sustain an ongoing quality control program to achieve and maintain triage inter- and intrarater reliability. Further research is needed on the value of triage inaccuracy with real-time feedback on nurses' clinical decision-making and patient outcomes. It is also imperative that the expected and observed ESI triage distribution in U.S. EDs is updated when established accuracy quality control programs are present.
Association of Increased Fluvoxamine Use with Reports of Benefit for COVID
Authors: Kojima N , Qato Dima M , Klausner JD
Published: January 2022

Introduction

Several recent studies have found that fluvoxamine decreases the risk of serious disease progression among people with early SARS-CoV-2 infection. In this study, we examined changes in the total number of fluvoxamine tablets dispensed across retail pharmacies in the U.S.

Methods

We hypothesized that fluvoxamine prescriptions would increase substantially since March 2021 as an option for the early treatment of SARS-CoV-2 infection. We used the IQVIA National Prescription Audit (NPA) Weekly nationally projected data for prescriptions dispensed from retail pharmacies for fluvoxamine from 27 December 2019 to 31 December 2021. We performed an interrupted-time series analyses on frequency of dispensing fluvoxamine tablets.

Results

The weekly rate of dispensed tablets of fluvoxamine increased throughout the study period. The weekly number of dispensed tablets of fluvoxamine increased (11.1%) from a baseline of 1,586,154 (95% confidence interval [CI]: 1,563,960 – 1,608,348) to 1,762,381 (95% CI: 1,735,682 – 1,789,080) by December 2021.

Conclusion

Our findings are consistent with a modest increase in the use of fluvoxamine for the treatment of COVID-19 associated with the discovery and media dissemination of the potential clinical benefit of fluvoxamine use.
A re-examination of the impact of COVD-19 deaths on the computation of average life expectancy
Authors: Rao Arni S.R. Srinivasa , Krantz Steven G. , Swanson David A.
Published: January 2022

It is natural to question the impact of COVID-19 on life expectancy. However, a newborn during the 2020-2021 period need not experience the same level of adult mortality found in 2020-2021 because there may be zero COVID-19 related deaths when the newborn reaches adulthood. Thus, life expectancy lost due to COVID-19 cannot be found simply by incorporating excess deaths due to COVID-19 and re-doing the life table computations because: (1) we know that the COVID-19 deaths need not occur every year for the next 20-25 years; and (2) once an adult, a newborn in 2021/2022 need not experience the same mortality rate that current middle and older aged COVID-19 patients experience. Using U.S. data as an example, we estimate an average of 29.68 years of life was lost to those aged 18-64 who died from COVID-19 in the U.S., noting that 74 % of the reported deaths of 18-64 occurred among 50-64 years and 10 % below 40 years. Instead of computing life expectancy years lost due to COVID-19, we recommend computing life years lost due to COVID-19.
Do self-management interventions improve self-efficacy and quality of life in stroke survivors? A literarture review
Authors: Septianingrum Yurike , Nurjanah Siti , Rumambo Pandin Moses Glorino
Published: January 2022

Objective

The aim of this review was to assess the effectiveness of self-management interventions on the self-efficacy and quality of life of stroke survivors compared to usual care.

Method

Article searches were performed using the same keywords in the Pubmed, CINAHL, Scopus and Science Direct databases published from January 2020 to October 16, 2021. A total of 8 articles in randomized controlled trials were identified in this study.

Findings

Eight studies were taken, of which six discussed the effectiveness of self-management interventions on self-efficacy and two literatures measured the quality of life of stroke patients. Almost all participatory studies reported an increase in self-efficacy and quality of life after receiving the self-management intervention. The heterogeneity in this study is reported regarding the form of intervention, duration of implementation, instruments used, and outcomes

Conclusions

There are various self-management interventions, which can be in the form of education, support, coaching, or empowerment. Self-management interventions are reported to improve self-efficacy and quality of life of stroke patients. Future studies are expected to measure the perceived burden of self and self-care in stroke patients
Covaxin (BBV152) Vaccine Neutralizes SARS-CoV-2 Delta and Omicron variants
Authors: Edara Venkata-Viswanadh , Patel Mit , Suthar Mehul S.
Published: January 2022

The SARS-CoV-2 vaccine BBV152/Covaxin is well-tolerated and was shown to be 77.8% efficacious against symptomatic and 93.4% efficacious against severe symptomatic COVID-19 disease in adults. Previous studies have shown that sera from Covaxin vaccinated individuals have neutralizing activity against B.1.1.7 (Alpha), B.1.351 (Beta), B.1.617.2 (Delta), B.1.1.28 (Zeta), and B.1.617.1 (Kappa) SARS-CoV-2 variants. The B.1.1.529 variant (Omicron) recently emerged in November 2021 and has spread throughout the world. The Omicron variant has more than 30 mutations within the spike protein that could impact vaccine-mediated immunity. We used a live virus neutralization assay to evaluate the neutralizing activity against the Omicron variant of sera collected from subjects who received a booster dose (6-month after primary series last dose) of Covaxin. We found that sera from Covaxin boosted individuals showed neutralizing activity against D614G (vaccine strain), Delta, and Omicron variants. One hundred percent of boosted subjects showed neutralizing activity against the Delta variant while over 90% of boosted subjects showed neutralizing activity against the Omicron variant. These findings show that a booster dose of Covaxin can generate robust neutralizing antibody responses against the Omicron variant.
TreatmentPatterns: An R package to analyze treatment patterns of a study population of interest
Authors: Markus Aniek F. , Verhamme Katia M.C. , Kors Jan A. , Rijnbeek Peter R.
Published: January 2022

Background and objectives

There is an increasing interest to use real-world data to illustrate how patients with specific medical conditions are treated in real life. Insight in the current treatment practices helps to improve and tailor patient care. We aim to provide an easy tool to support the development and analysis of treatment pathways for a wide variety of medical conditions.

Methods

We formally defined the process of constructing treatment pathways and developed an open-source R package TreatmentPatterns (https://github.com/mi-erasmusmc/TreatmentPatterns) to enable a reproducible and timely analysis of treatment patterns.

Results

The developed package supports the analysis of treatment patterns of specific populations of interest. We demonstrate the functionality of the package by analyzing the treatment patterns of three common chronic diseases (type II diabetes mellitus, hypertension, and depression) in the Dutch Integrated Primary Care Information (IPCI) database.

Conclusion

TreatmentPatterns is a tool to make the analysis of treatment patterns more accessible, more standardized, and more interpretation friendly. This tool can facilitate and contribute to the accumulation of knowledge on real-world treatment patterns across disease domains. We encourage researchers to further adjust and add custom analysis to the package based on their research needs.