bluuebunny/crossref_metadata_2025 huggingface dataset:
Factors influencing TCM syndrome types of acute cerebral infarction: A binomial logistic regression analysis
Authors: Zhang Shuning , Yang Ji
Published: November 2023

Background:

Acute cerebral infarction, characterized by a rapid onset and high fatality rate, presents a significant global challenge in terms of timely and effective treatment. In recent years, research focusing on the combined approach of traditional Chinese medicine (TCM) and Western medicine has demonstrated promising results in improving therapeutic outcomes in patients with acute cerebral infarction.

Diagnosis:

This study adhered to the latest edition of Internal Medicine of Traditional Chinese Medicine, published by the China Press of Traditional Chinese Medicine, as a reference. It selects eight commonly encountered TCM syndrome differentiations for accurate diagnosis.

Methods:

This study included 151 patients admitted to the hospital between 2019 and 2022 with acute cerebral infarction. Data on various diagnostic indicators were meticulously collected and subjected to single-factor analysis.

Results:

Among the multiple factors analyzed, those exhibiting a significance level of P < 0.05 included blood pressure, uric acid, glucose level, triglyceride level, total cholesterol level, homocysteine level, duration of disease, and cerebral infarction site. Subsequently, a binary logistic regression analysis was performed to assess the impact of these factors on different TCM syndrome types.

Conclusion:

The findings of this study indicate that Wind Phlegm Obstruction syndrome, triglyceride levels, location of cerebral infarction, uric acid levels, and disease duration significantly influence the development and progression of acute cerebral infarction. Additionally, blood pressure and cerebral infarction site were found to have a statistically significant impact on the Wind Yang Disturbance syndrome. Uric acid level and blood pressure were also identified as statistically significant factors. Moreover, total cholesterol and homocysteine levels were found to significantly affect phlegm stasis-blocking collateral syndrome. The insights gained from this study will contribute to the advancement of integrated treatment approaches, combining traditional Chinese and Western medicine, for acute cerebral infarction. Furthermore, these findings can serve as a valuable reference for the general population in terms of preventive measures against this condition.
Cervical kyphosis surgery using a cervical pedicle screw placed with a U-shaped wire that enables observation of the lateral edge of the cortical bone of the spinal canal: A case report and literature review
Authors: Ushiku Chikara , Akiyama Shoshi , Kanai Tomoaki , Sawada Naomu , Saito Mitsuru
Published: November 2023

Rationale:

A cervical pedicle screw (CPS) serves as an important anchor for cervical surgeries. Its placement requires the development of a highly safe and easy-to-handle method. Considering that the lateral end of the cortical bone of the spinal canal (LE point) is the most crucial for CPS placement, we devised a U-shaped wire capable of identifying LE points under direct vision and reliably confirming the site with C-arm lateral fluoroscopy.

Patient concerns:

A 65-year-old male, who had been aware of numbness in both hands, mild finger dexterity disorder, and gait disturbance for half a year, visited our hospital due to the progression of his symptoms in the previous 2 months.

Diagnosis:

The patient presented with mild muscle weakness and tendon hyperreflexia in the upper and lower extremities on both sides, and magnetic resonance imaging revealed moderate spinal canal stenosis at the C4/5 and 5/6 levels. Based on the local third cervical vertebra (C3)/4 angle of −10 degrees and the C2/7 angle of −15 degrees, the patient was diagnosed with cervical myelopathy with cervical kyphosis. He had a Japanese Orthopaedic Association score for cervical myelopathy of 10.

Interventions:

We placed CPSs at C3 using a U-shaped wire. After placing an anchor in the range of C3-T1, laminectomy from C4 to C7 was performed. Subsequently, corrective fixation was performed to reduce kyphosis, followed by bone grafting in the range of C3-T1 and complete posterior cervical decompression fixation.

Outcomes:

The CPSs were placed at C3 without deviation and intra- or postoperative complications. The surgery resulted in improvement in kyphosis with a C2/7 angle of −5 degrees and recovery in spinal cord disorder with a Japanese Orthopedic Association score for cervical myelopathy of 13.

Lessons:

A U-shaped wire, which can be prepared inexpensively and easily, is a useful tool, especially for inexperienced surgeons, for safe CPS placement by capture of LE points accurately.
Acute exacerbation of immunoglobulin A nephropathy complicated by alveolar hemorrhage after coronavirus disease 2019 vaccination: A case report
Authors: Uchida Takahiro , Sakai Takashi , Hoshino Takahiko , Kojima Aki , Konno Osamu , Yamada Muneharu , Iwamoto Hitoshi , Oda Takashi
Published: November 2023

Rationale:

Reports have suggested a relationship between coronavirus disease 2019 (COVID-19) vaccination and new-onset or recurring renal diseases, of which immunoglobulin A (IgA) nephropathy is a representative disease. Alveolar hemorrhage in patients with IgA nephropathy is rare but reportedly has a high mortality and morbidity. To our knowledge, there have been no reports regarding the development of IgA nephropathy with alveolar hemorrhage following COVID-19 vaccination.

Patient’s concern:

A 23-year-old Japanese man presented with hemoptysis and peripheral edema a few days after receiving a second dose of a COVID-19 mRNA vaccine. Severe renal failure and alveolar hemorrhage were noted thereafter, and renal biopsy showed crescentic glomerulonephritis with mesangial proliferation accompanied by mesangial electron-dense deposits containing IgA. Renal biopsy tissue also showed chronic histological changes suggestive of acute exacerbation of preexisting IgA nephropathy.

Diagnosis:

The diagnosis of IgA nephropathy complicated by alveolar hemorrhage was made.

Interventions and outcomes:

Renal function did not recover despite treatment with high-dose steroids; the patient was maintained on hemodialysis and eventually underwent successful renal transplantation.

Lessons:

The present case suggested that although extremely rare, severe renal failure requiring renal replacement therapy could occur in patients with IgA nephropathy after COVID-19 vaccination. Future accumulation of similar cases is needed to predict the risk of renal injury following vaccination.
Severe immediate hypersensitivity to gadolinium contrast agent after targeted treatment in a patient with alveolar soft part sarcoma: A case report and review of literature
Authors: Yan Hongxia , Zhang Jianxin , Cai Xinfeng , Hao Zhiying , Guan Zhe
Published: November 2023

Rationale:

Gadolinium-based contrast agents (GBCAs), benefiting from good tolerance and safety, become the priority contrast agents in magnetic resonance imaging. Serious hypersensitivity reactions caused by GBCAs are rare, but occur occasionally. The “immune surveillance” theory proposes that lowered immune function exists in patients with malignance, which decrease the occurrence of atopy. Natural immunosurveillance that enhanced by effective treatment of malignance may increase the risk of hypersensitivity.

Patient concerns:

A 29-year-old female patient suffering from intensive pain with left leg mass was admitted in our hospital.

Diagnoses:

The patient was diagnosed with alveolar soft part sarcoma by histopathology and revealed destruction of the left fibula and lung metastasis by computed tomography scan, and treated with anlotinib hydrochloride, a multi-targeted tyrosine kinase inhibitor. After 4 cycles of effective targeted therapy, the patient developed severe immediate hypersensitivity due to gadopentetate dimeglumine-enhanced magnetic resonance imaging.

Interventions and outcomes:

The vital signs of the patient returned to normal after rescue. Since then, the patient has not used gadolinium contrast agent again, and currently the condition is stable and still alive.

Lessons:

Severe immediate hypersensitivity might be occurred by gadolinium contrast agent in patients with malignance after effective treatment. We explored the potential mechanism of GBCA-inducing hypersensitivity in detail, by especially focusing on the changes of immune environment. Furthermore, we propose new ideas for the safe use of GBCAs in patients with malignancies.
A review of functional pancreatic neuroendocrine tumors: Exploring the molecular pathogenesis, diagnosis and treatment
Authors: Alshareefy Yasir , Cummins Sinead , Mazzoleni Adele , Sharma Vidushi , Guggilapu Saibaba , Leong Amanda Weng Yee , Wireko Andrew Awuah
Published: November 2023

Pancreatic neuroendocrine tumors (PanNETs) are a rare subtype of pancreatic cancer and can be divided into functional (30–40%) and nonfunctional subtypes. The different subtypes of functional PanNETs (F-PanNETs) have a variety of classical presentations that raise suspicion for an underlying PanNET. It is estimated that 90% of PanNETs are sporadic, and the PI3K-Akt-mTOR and ATRX/DAXX signaling pathways have been recognized as key genetic pathways implicated in the pathogenesis. The other 10% of PanNETs may occur in the context of familial cancer syndromes such as MEN1. Chromogranin A is the most useful biomarker currently; however, several studies have shown limitations with its use, especially its prognostic value. Synaptophysin is a novel biomarker which has shown promising preliminary results however its use clinically has yet to be established. Blood tests assessing hormone levels, cross-sectional imaging, and endoscopic ultrasound remain at the core of establishing a diagnosis of F-PanNET. The treatment options for F-PanNETs include surgical methods such as enucleation, systemic therapies like chemotherapy and novel targeted therapies such as everolimus. The prognosis for F-PanNETs is more favorable than for nonfunctional PanNETs, however metastatic disease is associated with poor survival outcomes. Researchers should also focus their efforts on identifying novel pathways implicated in the pathogenesis of F-PanNETs in order to develop new targeted therapies that may reduce the need for surgical intervention and on the establishment of novel biomarkers that may reduce the need for invasive testing and allow for earlier detection of F-PanNETs.
Effects of extracorporeal shockwave therapy for mild knee osteoarthritis: A pilot study
Authors: Choi I Jun , Jeon Jong Hu , Choi Woo Hwa , Yang Hea-Eun
Published: November 2023

Background:

Extracorporeal shockwave therapy (ESWT) has been widely used for various musculoskeletal disorders, including knee osteoarthritis (OA), and has been shown in several studies to be a safe treatment. Although some studies have confirmed the pain-relieving effect of ESWT for knee OA, research on objectivity for structural changes in knee OA is lacking. The aim of this study was to evaluate the ESWT treatment mechanisms in patients with knee OA by means of clinical symptoms and ultrasound techniques as objective measures.

Methods:

Eighteen patients with mild knee OA were enrolled and randomized to 1 of 2 treatment groups: active or sham. Patients in the experimental group received 0.05 mJ/mm² total energy with 1000 pulses weekly for 3 weeks. We then assessed them before, immediately after, and 1-month after the last treatment using the following measurements: pain on a visual analog scale, Western Ontario and McMaster Universities Osteoarthritis Index, Lequesne index, knee joint range of motion, and ultrasonographic features (articular cartilage thickness, Doppler activity, and joint effusion height).

Results:

All 18 patients completed the 3 treatment sessions without any complication. Both the experimental and control groups improved in terms of OA symptoms, as measured by the visual analog scale, Western Ontario and McMaster Universities Osteoarthritis Index score, and Lequesne index (P < .05). The height of the suprapatellar effusion decreased with time course in the experimental group (P < .05) and showed significant differences with control group at 1-month follow-up (P < .05). The experimental group showed an increase in knee flexion range of motion and Doppler activity immediately following the last treatment session (P < .05), but the effect was not sustained at the 1-month follow-up.

Conclusions:

Although the therapeutic activity itself could improve OA symptoms, objective improvements were only observed after ESWT. Suprapatellar effusion height was reduced after ESWT and the effect was maintained after 1-month. Our results suggest that ESWT may be effective in reducing suprapatellar effusion and improving symptoms in mild knee OA. However, studies with a larger sample size are required.
Fiberoptic bronchoscopy combined with urokinase therapy for the treatment of fatal massive hemoptysis: A case report
Authors: Huang Ju , Zeng Qigang , Wei Chengong , Dai Yong
Published: November 2023

Background:

Fatal massive hemoptysis is a life-threatening emergency in the respiratory system. Currently, the treatment methods and techniques for massive hemoptysis are still limited, and there are often issues of delayed treatment or improper methods in clinical practice, leading to the difficulty of rescuing patients and high mortality rates. When fatal massive hemoptysis occurs, the key to successful treatment lies in whether intrapulmonary blood clots can be effectively cleared and airway patency can be ensured. Our practice of combining fiberoptic bronchoscopy with urokinase treatment to clear intrapulmonary blood clots after fatal massive hemoptysis demonstrates the effectiveness of this method.

Case summary:

We report a 32-year-old female who experienced cough, accompanied by fatal massive hemoptysis with extensive blood clot obstruction in the airway. Considering the difficulty of clearing the airway using conventional methods, it was decided to perform fiberoptic bronchoscopy combined with urokinase therapy after reviewing relevant literature. After treatment, the intrapulmonary blood clots were successfully extracted, thereby relieving airway obstruction. Finally, the patient was successfully weaned off extracorporeal membrane oxygenation, extubated, and evacuated from the ventilator. Currently, the patient’s condition is stable, and follow-up chest X-ray as well as computed tomography scans have shown improvement compared to previous assessments.

Conclusion:

Fatal massive hemoptysis is a intractable emergency in clinical practice. In this case, we confirmed that fiberoptic bronchoscopy combined with urokinase therapy may be effective and safe in the treatment of fatal massive hemoptysis.
Treatment of dermal ulcer with autologous fibrin glue: Two case reports of an exploratory prospective pilot study
Authors: Kawamoto Shinichiro , Shinkawa Eriko , Fujiwara Susumu , Oda Yoshiko , Jimbo Haruki , Nakano Eiji , Fukumoto Takeshi , Ono Ryusuke , Yasuda Takahiro , Minami Hironobu
Published: November 2023

Introduction:

The healing of recurrent and refractory skin ulcers requires a long time, during which there is risk of infection, and hospital admission is occasionally required for surgical or daily conservative treatment. Therefore, the development of promising treatments that promote faster, uneventful healing is a must. Composed of cryoprecipitate and thrombin, fibrin glue has a history of surgical use for preventing bleeding and spinal fluid leakage. Moreover, in-house cryoprecipitates contain higher concentrations of coagulation factors and cytokines that may enhance wound healing than commercially available products. However, the efficacy of completely autologous fibrin glue (AFG) in tissue repair has not yet been fully demonstrated.

Patient concerns:

This study aimed to evaluate the efficacy of AFG in the treatment of refractory skin ulcers in comparison with the conventional treatment.

Diagnosis:

Two patients with skin ulcer on their lower extremities due to trauma or scleroderma who showed resistance to conventional treatment were included in the study. Both study participants were diagnosed with refractory skin ulcer and were ineligible for autologous skin transplantation.

Interventions:

AFG was prepared following autologous blood donation using a Cryoseal® system. Subsequently, AFG was administered to 50% of the area of each ulcer and observed for 4 weeks in comparison with recombinant basic fibroblast growth factor with bucladesine sodium treatment that was administered to the rest of the ulcer.

Outcomes:

The skin ulcer after trauma in participant 1 showed better improvement in the AFG-treated area. Although AFG did not show superiority regarding the ulcer area of a patient with scleroderma, it guarded the continuous exudation from the edge of the swollen skin surrounding the ulcer.

Conclusion:

AFG showed effective and beneficial results for wound healing of refractory skin ulcer and prevented exudation without any severe adverse events.
Endogenous endophthalmitis caused by urinary tract infection: A case report
Authors: Ren Cong , Li Zhongen , Meng Fan , Du Yongle , Sun Hao , Guo Bin
Published: November 2023

Rationale:

Endogenous endophthalmitis is a vision-threatening intraocular infection caused by hematogenous spread of infectious organisms from distant sites.

Patient concerns:

A 71-year-old man with a history of fever and dysuria 5 days prior to presentation presented with sudden loss of vision in his left eye. The patient had no history of ocular surgery or trauma, and ocular examination revealed a large amount of exudative plaque covering the pupil. Therefore, fundus examination was not feasible. B-scan ultrasonography revealed a dome-shaped subretinal mass with an exudative retinal detachment.

Diagnosis:

Endogenous endophthalmitis was diagnosed on the basis of these findings.

Interventions:

The patient underwent pars plana vitrectomy and the early postoperative course was favorable.

Outcomes:

Vitreous cultures grew gram-negative bacilli, identified as Klebsiella pneumonia. Urinalysis revealed white blood cells (++) and urinary tract infection was the only identifiable risk factor for endogenous endophthalmitis.

Lessons:

Urinary tract infection is an independent risk factor for endogenous endophthalmitis.
Three-dimensional printing versus traditional surgery for inveterate pelvic and acetabular fractures: A retrospective study of 37 patients
Authors: Tao Fulin , Li Lin , Wang Dawei , Dong Jinlei , Zhou Dongsheng , Song Wenhao
Published: November 2023

Treatment of deformed pelvic and acetabular fractures is a considerable challenge for orthopedic surgeons. The aim of this study was to assess the availability of a three-dimensional (3D) printing model used in patients with inveterate pelvic and acetabular fractures by comparing 3D printing technology with conventional surgery. We conducted a retrospective review of patients with inveterate pelvic and acetabular fractures treated in our department between January 2008 and June 2020. The patients were divided into 2 groups according to their willingness. Perioperative data and clinical outcomes were compared to evaluate clinical efficacy. The t-test, Fisher exact test, and multivariable logistic regression analysis were conducted. A P value of .05 or less was considered to be statistically significant (two-tailed). Thirty-seven patients were enrolled in our study. Seventeen patients were divided into the case group treated by 3D printing model-assisted preoperative planning, and 20 patients were divided into the control group treated by conventional surgery. Patients treated with the 3D printing model had significantly shorter operation times, less blood loss, and shorter fluoroscopy times. Patients in the case group also showed better pain relief according to visual analog scale scores. However, the elevations in pelvis and hip joint functional outcomes were similar between the 2 groups, and no significant difference was shown in the radiological result. The usage of 3D printing techniques in patients with inveterate pelvic and acetabular fractures is of great importance in preoperative preparation and optimization of surgery but cannot improve postoperative function compared with conventional treatment.
Effects of oxidative stress regulation in inflammation-associated gastric cancer progression treated using traditional Chinese medicines: A review
Authors: Chen Bo , Dong Xinqian , Zhang Jinlong , Wang Wei , Song Yujiao , Sun Xitong , Zhao Kangning , Sun Zhen
Published: November 2023

Gastric cancer (GC) is a global public health concern that poses a serious threat to human health owing to its high morbidity and mortality rates. Due to the lack of specificity of symptoms, patients with GC tend to be diagnosed at an advanced stage with poor prognosis. Therefore, the development of new treatment methods is particularly urgent. Chronic atrophic gastritis (CAG), a precancerous GC lesion, plays a key role in its occurrence and development. Oxidative stress has been identified as an important factor driving the development and progression of the pathological processes of CAG and GC. Therefore, regulating oxidative stress pathways can not only intervene in CAG development but also prevent the occurrence and metastasis of GC and improve the prognosis of GC patients. In this study, PubMed, CNKI, and Web of Science were used to search for a large number of relevant studies. The review results suggested that the active ingredients of traditional Chinese medicine (TCM) and TCM prescriptions could target and improve inflammation, pathological status, metastasis, and invasion of tumor cells, providing a potential new supplement for the treatment of CAG and GC.
To establish a risk prediction model for the occurrence of hypoxemia during painless bronchoscopy
Authors: Yang Nan , Jiang Bei , Jia Zhen , Wang Tongyuan , Huang Yu , Dong Wen
Published: November 2023

The present study was focused on evaluating the clinical predictors of hypoxemia and establishing a multivariable, predictive model for hypoxemia in painless bronchoscopy. A total of 244 patients were enrolled in the study, and data were collected using a self-designed data collection. The retrospective data collected in this study included the relevant data of patients undergoing the painless bronchoscopy, and we used univariate analysis to deal with these influencing factors. Multivariate logistic regression analysis was used to establish the prediction equation, and receiver operating characteristic curve analysis was carried out. Receiver operating characteristic curves and the Hosmer–Lemeshow test were used to evaluate the model performance. P < .05 was considered to indicate statistical significance. Multivariate logistic regression indicated that body mass index (BMI) (odds ratio [OR]: 1.169; 95% confidence interval [CI]: 1.070–1.277), arterial partial pressure of oxygen (PaO2) (OR: 4.279; 95% CI: 2.378–7.699), alcohol consumption (OR: 2.021; 95% CI: 1.063–3.840), and whether the bronchoscope operation time exceeds 30 minutes (OR: 2.486; 95% CI: 1.174–5.267) were closely related to the occurrence of hypoxemia. The prediction model developed by the logistic regression equation was −4.911 + 1.454 (PaO2) + 0.156 (BMI) + 0.703 (Alcohol consumption) + 0.911 (time > 30th minutes). The prediction model showed that the area under the receiver operating characteristic curve was 0.687. The predictive model was well calibrated with a Hosmer–Lemeshow x
2 statistic of 4.869 (P = .772), indicating that our prediction model fit well. The accuracy (number of correct predictions divided by the number of total predictions) was 75%. The prediction model, consisting of BMI, PaO2, alcohol consumption, and whether the bronchoscope operation time exceeds 30 minutes. It is an effective predictor of hypoxemia during sedation for painless bronchoscopy.
Metastasis of endometrial adenocarcinoma masquerading as a primary rectal cancer: A rare case report with literature review
Authors: Li Minhua , Zheng Weiping
Published: November 2023

Rationale:

The majority of rectal malignancies are primary tumors, secondary tumors are unusual. The rectal metastasis of endometrial carcinoma is reported to be extremely rare, especially in the absence of endometriosis.

Patient concerns:

Herein we present a rare case of a 68-year-old postmenopausal woman with a history of endometrial adenocarcinoma, metastasizing to the rectum 5 years after a hysterectomy and bilateral salpingo-oophorectomy treatments with pelvic lymphadenectomy were performed.

Diagnoses:

Histological examination of the rectal neoplasm revealed an invasive lesion in submucosal and muscular layers without definitely invaded evidence in the serous membrane and there was also no obvious endometriosis. The results of immunohistochemistry showed the cancer cells were positive for CK7, estrogen receptor, progesterone receptor, and negative for CK20, villin, confirming the diagnosis of metastatic rectal adenocarcinoma originating from uterine endometrial adenocarcinoma. Meanwhile, the results of immunohistochemical staining showed positive expression of MSH2, MSH6, and negative expression of MLH1 and PMS2, hinting at microsatellite instability which may be related to Lynch syndrome.

Interventions:

The Dixon operation with lymph node dissection was performed. Chemotherapy was also performed on this patient for the next 6 months.

Outcomes:

The patient was followed up for the next 6 months after surgery and no recurrence was documented until now.

Lessons subsections:

Though rectal and endometrial adenocarcinoma could share some similar morphologic features, different immunohistochemical profiles could be revealed between them. Most endometrial carcinoma in the colon or rectum develop from endometriosis. Secondary rectal cancer with endometrial origination in the absence of endometriosis and serosal implants was extremely rare. Therefore, we should pay more attention to this rare but possible presentation for appropriate diagnosis and treatment of these patients.
Varicella-associated disseminated intravascular coagulation secondary to Henoch-Schönlein purpura with renal and gastrointestinal system involvement in a child: A case report
Authors: Jiang Jing , Liao Kai , Guo Hui , Chen Xiu-Ying
Published: November 2023

Rationale:

Immunocompromised patients who developed varicella-zoster virus (VZV)-associated disseminated intravascular coagulation (DIC) previously included recipients of bone marrow, hematopoietic stem cell, or organ transplantations, patients with primary nephropathy receiving corticosteroid therapy, cancer patients receiving chemotherapy, and patients with human immune deficiency virus infection. The case reported here is novel because, to our knowledge, there has been no report of VZV-associated DIC after the onset of Henoch-Schönlein purpura (HSP).

Purpose:

To report the successful treatment of a novel pediatric case with VZV-associated DIC secondary to HSP.

Diagnosis and intervention:

An 8-year-old girl developed VZV-associated DIC 24 days after diagnosis of HSP with renal and gastrointestinal involvement. She was treated with methylprednisolone at a local hospital for 19 days, and suddenly developed fever starting from day 4 in our hospital. Her fever persisted with vesicular skin rashes on her back, strong abdominal and lower back pain, epistaxis, hematochezia, erosion and bleeding on her lips, in her mouth and at puncture sites on day 5. She was diagnosed with DIC with the laboratory evidence of dramatically decreased platelet count and fibrinogen, prolonged activated partial thromboplastin time and prothrombin time, and increased fibrin degradation products including d-dimers. She also developed multiple organ dysfunction syndrome. On day 7, the patient VZV nucleic acid result turned out to be positive. Methylprednisolone treatment was discontinued, and she was given a multi-modality therapy including medications of acyclovir and antibiotics, intravenous gamma-immunoglobulin, various blood product transfusions, continuous renal replacement therapy, plasma exchange, and administration of liver and gastrointestinal system protection drugs.

Outcomes:

The patient multi-organ function damage gradually recovered. After VZV control, the patient was treated with oral methylprednisolone again for HSP with nephritis. Urine analysis was normal 1 year later, and oral hormone was discontinued. No complication or relapse occurred during 2 years of follow-up.

Significance:

This case report, for the first time, adds HSP treated with corticosteroids to the spectrum of clinical conditions that progressed to life-threatening secondary varicella-associated DIC. Early identification of varicella infection and DIC, combined with timely antiviral, immunoglobulin transfusion, plasma exchange, and other combined therapies are essential for saving patients’ lives.
Barriers to home dialysis and kidney transplantation for socially disadvantaged individuals
Authors: Rizzolo Katherine , Shen Jenny I.
Published: November 2023

Purpose of review

People with kidney disease facing social disadvantage have multiple barriers to quality kidney care. The aim of this review is to summarize the patient, clinician, and system wide factors that impact access to quality kidney care and discuss potential solutions to improve outcomes for socially disadvantaged people with kidney disease.

Recent findings

Patient level factors such as poverty, insurance, and employment affect access to care, and low health literacy and kidney disease awareness can affect engagement with care. Clinician level factors include lack of early nephrology referral, limited education of clinicians in home dialysis and transplantation, and poor patient-physician communication. System-level factors such as lack of predialysis care and adequate health insurance can affect timely access to care. Neighborhood level socioeconomic factors, and lack of inclusion of these factors into public policy payment models, can affect ability to access care. Moreover, the effects of structural racism and discrimination nay negatively affect the kidney care experience for racially and ethnically minoritized individuals.

Patient, clinician, and system level factors affect access to and engagement in quality kidney care. Multilevel solutions are critical to achieving equitable care for all affected by kidney disease.
Sodium-glucose cotransporter 2 inhibitors and cardiorenal outcomes in kidney transplantation
Authors: Mahalwar Gauranga , Mathew Roy O. , Rangaswami Janani
Published: November 2023

Purpose of review

This review aims to explore the current evidence regarding cardiovascular and kidney outcomes in patients who undergo treatment with sodium-glucose cotransporter 2 inhibitors (SGLT2i) post kidney transplantation.

Recent findings

Summary findings from individual studies included in this review showed largely favorable results in the kidney transplant recipients (KTRs) being treated with SGLT2i.These outcomes included parameters such as allograft function, glycemic control, proteinuria, blood pressure, weight loss and safety profile, among others. Almost all the studies reported an initial ‘dip’ in eGFR, followed by recovery, after the initiation of SGLT2i treatment. None of the studies reported significant interaction of SGLT2i with immunosuppressive medications. The most common adverse effects noted in these studies were infection-related including UTI and genital mycosis. None of the studies reported acute graft rejection attributable to SGLT2i therapy.

SGLT2i can play a significant role in improving health outcomes in KTRs. However, clinical trials with larger representation of KTRs longer follow-up period are needed to draw more substantial conclusions.
Impact of Severe Acute Respiratory Syndrome, Coronavirus Disease 2019, and Social Unrest on Adult Psychiatric Admissions in Hong Kong
Authors: Ma Chak Fai , Chien Wai Tong , Luo Hao , Bressington Daniel , Chen Eric Yu Hai , Chan Sherry Kit Wa
Published: November 2023

In Hong Kong, two infectious disease outbreaks occurred in 2003 (SARS) and 2020 (COVID-19), and a large-scale social unrest happened in 2019. These were stressful societal events that influenced the mental well-being of the public. We aimed to explore the impact of these events on psychiatric admissions in Hong Kong. Socioeconomic and population-based psychiatric hospital admission data were retrieved from the government and Hospital Authority. Negative binomial time-series regression analysis was applied and we found overall significant reductions of psychiatric admissions during both the SARS and COVID-19 periods (−7.4% to −16.8%). Particularly, the admissions for unipolar disorders (−16.2% to −39.7%) and neuroses (−20.9% to −31.9%) were greatly reduced during the infection outbreaks. But an increase of admissions for schizophrenia (12.0%) was seen during the social unrest period. These findings support introducing early and targeted community mental health care strategies to the vulnerable people during the stressful societal events.
Refractory Depression With Persistent Sore Throat and Hypochondriacal Delusion of SARS-CoV-2 Infection
Authors: Hayasaki Gaku , Terao Takeshi , Hirakawa Hirofumi , Muronaga Masaaki , Kohno Kentaro
Published: November 2023

Herein, we present a case of a female patient with a persistent sore throat, which preceded a hypochondriacal delusion of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. Both the sore throat and hypochondriacal delusion persisted together, despite the repeatedly negative results of reverse transcription polymerase chain reaction (RT-PCR) for SARS-CoV-2 and a moderate improvement in her depression. Four possibilities for the patient's sore throat were discussed: pain symptoms of somatic symptom disorder, pain symptoms of depression, delusion of pain in her throat, and somatic hallucination as a sore throat. Consequently, somatic hallucinations were considered the most likely. In any case, the present findings suggest that sore throat can precede hypochondriacal delusion of SARS-CoV-2 infection in some noninfected patients. When patients continue to complain of a sore throat despite the negative results of SARS-CoV-2 by the RT-PCR test, we should consider that it might be a somatic hallucination and soon hypochondriacal delusions may occur, leading to the manifestation of other symptoms of psychiatric disorders, such as depression, which may be refractory and/or suicidal.
Prevalence of Moral Injury, Burnout, Anxiety, and Depression in Healthcare Workers 2 Years in to the COVID-19 Pandemic
Authors: Lennon Robert P. , Parascando Jessica , Talbot Simon G. , Zhou Shouhao , Wasserman Emily , Mantri Sneha , Day Philip G. , Liu Ryan , Lagerman Makayla , Appiah Annette , Rabago David , Dean Wendy
Published: November 2023

COVID-19 has led to marked increases in healthcare worker distress. Studies of these phenomena are often limited to a particular element of distress or a specific subset of healthcare workers. We administered the Moral Injury Symptom Scale for Healthcare Professionals, Copenhagen Burnout Inventory, Patient Health Questionnaire-9, and Generalized Anxiety Disorder-7 via online survey to 17,000 employees of a large academic medical center between December 2021 and February 2022. A total of 1945 participants completed the survey. Across all roles, the prevalence of moral injury, burnout, depression, and anxiety were 40.9%, 35.3%–60.6%, 25.4%, and 24.8%, respectively. Furthermore, 8.1% had been bothered by thoughts that they would be better off dead or of hurting themselves for “several days” or more frequently. Healthcare workers across all roles and practice settings are experiencing unsustainable levels of distress, with 1 in 12 regularly experiencing thoughts of self-harm.
Addressing the Increasing Mental Health Distress and Mental Illness Among Young Adults in the United States
Authors: Brunette Mary F. , Erlich Matthew D. , Edwards Matthew L. , Adler David A. , Berlant Jeffrey , Dixon Lisa , First Michael B. , Oslin David W. , Siris Samuel G. , Talley Rachel M.
Published: November 2023

Recent surveys show rising numbers of young people who report anxiety and depression. Although much attention has focused on mental health of adolescent youth, less attention has been paid to young people as they transition into adulthood. Multiple factors may have contributed to this steady increase: greater exposure to social media, information, and distressing news via personal electronic devices; increased concerns regarding social determinants of health and climate change; and changing social norms due to increased mental health literacy and reduced stigma. The COVID-19 pandemic may have temporarily exacerbated symptoms and impacted treatment availability. Strategies to mitigate causal factors for depression and anxiety in young adults may include education and skills training for cognitive, behavioral, and social coping strategies, as well as healthier use of technology and social media. Policies must support the availability of health insurance and treatment, and clinicians can adapt interventions to encompass the specific concerns and needs of young adults.
Effectiveness of Problem-Based Learning on Development of Nursing Students’ Critical Thinking Skills
Authors: Wei Baojian , Wang Haoyu , Li Feng , Long Yan , Zhang Qi , Liu Hang , Tang Xiujun , Rao Mingjun
Published: November 2023

Background:

Problem-based learning (PBL) is a student-centered approach to teaching that has been applied in medical and nursing education. The effectiveness of PBL in promoting critical thinking in nursing students has been studied extensively with mixed results.

Purpose:

The meta-analysis aimed to investigate the impact of PBL interventions on critical thinking skills of nursing students.

Methods:

PubMed, Embase, Cochrane, and CINAHL databases were electronically searched. Methodological quality was examined using the Newcastle-Ottawa Scale and version 2 of the Cochrane risk-of-bias tool. Data were analyzed with 95% confidence intervals based on random-effect models.

Results:

Nineteen studies involving 1996 nursing students were included in the analysis. The results of the analysis demonstrated greater improvement in critical thinking skills compared with the control group (overall critical thinking scores: standardized mean difference [SMD] = 0.47, 95% CI = 0.33-0.61, P < .01).

Conclusions:

The meta-analysis indicates that PBL can help nursing students to improve their critical thinking.
Giving Life to Learning Through Rural Maternal Health Immersion Experiences
Authors: Swan Beth Ann , Gibbons Wendy , Kaligotla Lalita
Published: November 2023

Background:

Recruiting, retaining, and educating nursing students is essential to meet the growing need for nurses in rural communities. A nursing school enhanced its prelicensure education in rural and public health nursing, and interprofessional care by expanding experiential learning opportunities.

Purpose:

To describe longitudinal community health-based rural immersion experiences for prelicensure nursing students.

Methods:

A prospective, correlational design evaluated students’ knowledge and confidence in understanding rural characteristics, confidence in achieving public health nursing, and interprofessional education competencies.

Results:

Fourteen prelicensure nursing students participated in rural maternal health immersion experiences and reported being more confident (21/27 items) than knowledgeable (18/27) in understanding rural characteristics. Over 85% reported competency in interprofessional interactions, and there was a significant difference in confidence in achieving public health nursing competencies between the beginning and end of the immersion.

Conclusion:

Using immersion experiences may be effective in enhancing students’ knowledge, confidence, and competency in rural and public health, and interprofessional care.
Management and Outcomes of Necrotizing Otitis Externa: A Retrospective Cohort Study in a Tertiary Referral Center.
Authors: Vosbeek Eleonora G. M. , Straatman Louise V. , Braat Arthur J. A. T. , de Keizer Bart , Thomeer Hans G. X. M. , Smit Adriana L.
Published: November 2023

Objectives:

Necrotizing otitis externa (NOE) is a rare infection of the ear that causes osteomyelitis. We aimed to evaluate treatment outcomes and the role of imaging in diagnosing and monitoring disease resolution in a single-center study of patients with NOE.

Methods:

In this retrospective cohort study, patients with NOE who were diagnosed and treated in a tertiary otology center in Utrecht, The Netherlands, between January 1, 2013 and August 1, 2022, were included. Data were retrieved from the medical records on demographics, symptoms, physical and diagnostic findings, type and duration of treatment, and course of disease.

Results:

A total of 24 cases were included. Patients were often elderly (mean age = 75 years) and diabetic (88%). Pseudomonas aeruginosa was the most commonly found microorganism (63%). Twenty-two cases (92%) received intravenous antibiotic treatment, and 7 cases (29%) received additional systemic antifungal treatment. The mean duration of systemic treatment was 29 weeks. In 20 out of 22 cases (91%), imaging was used to determine the end point of treatment. None of the cases with a total resolution of disease activity (n = 5) on 18F-fluorodeoxyglucose-positron emission tomography-computed tomography imaging at the time of cessation of therapy showed clinical relapse, compared with 1 out of 4 cases on gallium single-photon emission computerized tomography.

Conclusion:

Based on the experience from our center, we demonstrated that patients with NOE can successfully be treated with prolonged systemic treatment. Molecular imaging is reasonably successful for disease evaluation and decision-making on the eradication of disease.
Doxycycline-Induced Intracranial Hypertension Presenting as Unilateral Pulsatile Tinnitus
Authors: Ali Naushin Shabnam , Long Barry Daniel , Manzoor Nauman F. , Sismanis Aristides , Coelho Daniel H.
Published: November 2023

Background:

Pulsatile tinnitus (PT) is increasingly recognized as a cardinal symptom of idiopathic intracranial hypertension (IIH). However, clinicians should remain aware of other causes of nonidiopathic or secondary intracranial hypertension manifesting as PT. We present 2 patients with isolated PT (without accompanying headache, blurred vision, and papilledema) thought to be secondary to tetracycline-induced intracranial hypertension. To our knowledge, these are the first cases of PT as the presenting symptom of this condition.

Cases:

A 41-year-old female (body mass index [BMI] 29 kg/m2) with ocular rosacea was initially treated with minocycline. Shortly after transitioning to oral doxycycline and erythromycin eye ointment, she noted left-sided PT. Her PT resolved after discontinuing doxycycline. In a second case, a 39-year-old female (BMI 19 kg/m2) with acne presented with a three-year history of left-sided PT while on long-term oral doxycycline for many years. She denied visual or auditory changes and atypical headaches. MRI findings were concerning for intracranial hypertension. Three months later, the patient was seen by neuro-ophthalmology, with findings suggesting prior papilledema. The patient reported PT improvement after discontinuing doxycycline.

Conclusions:

This case series highlights 2 cases of isolated PT as the sole symptom of intracranial hypertension that resolved with tetracycline cessation. The presentation and unexpected improvement following tetracycline discontinuation are atypical compared with previous reports of tetracycline-induced intracranial hypertension. Clinicians should maintain a high index of suspicion for all types of intracranial hypertension (idiopathic and secondary), even in patients with a lower BMI. Current and prior medications should be reviewed when considering the etiology of intracranial hypertension.
Ambient particulate matter and renal function decline in people with HIV/AIDS
Authors: Ma Hongfei , Liang Wei , Han Aojing , Zhang Qian , Gong Shun , Bai Yang , Gao Daiming , Xiang Hao , Wang Xia
Published: November 2023

Objective:

We aimed to explore the effect of particulate matter exposure on renal function in people with HIV/AIDS (PWHA).

Methods:

A total of 37 739 repeated measurements were conducted on eGFR levels, serum creatinine (Scr), and the triglyceride-glucose (TyG) index in 6958 PWHAs. The relationship between 1 and 28 day moving averages of particulate matter concentrations with Scr and eGFR was assessed using linear mixed-effects models. Modified Poisson regression models were employed to assess the associations of cumulative particulate matter exposure with the incidence of chronic kidney disease (CKD). Mediation analyses were used to examine the role of TyG index.

Results:

Short-term exposure to particulate matter was related to reduced renal function. The strongest associations between exposure to particulate matter (PM)1, PM2.5, and PM10 and percentage changes in eGFR were observed at 7-day moving average exposure windows, with a respective decrease of 0.697% (−1.008%, −0.386%), 0.429% (−0.637%, −0.220%), and 0.373% (−0.581%, −0.164%) per IQR increment. Long-term exposure to PM1, PM2.5, and PM10 was positively linked with the incidence of CKD, with each IQR increment corresponding to fully adjusted RRs (95% CIs) of 1.631 (1.446–1.839), 1.599 (1.431–1.787), and 1.903 (1.665–2.175), respectively. TyG index-mediated 8.87, 8.88, and 7.58% of the relationship between cumulative exposure to PM1, PM2.5, and PM10 and increased risk of CKD, respectively.

Conclusion:

Exposure to particulate matter among PWHAs is linked to reduced renal function, potentially contributing to increased CKD incidence, where the TyG index might serve as a partial mediator.
The potential benefits of long-acting injectable cabotegravir in pregnant and breastfeeding women and their infants
Authors: Johnson Leigh F. , Myer Landon , Jamieson Lise , Meyer-Rath Gesine , Delany-Moretlwe Sinead , Joseph Davey Dvora
Published: November 2023

Background:

Pregnant and breastfeeding women (PBW) in sub-Saharan Africa have high HIV incidence rates and associated risk of vertical transmission to their infants. Oral preexposure prophylaxis (PrEP) and injectable PrEP (long-acting cabotegravir, or CAB-LA) can potentially reduce this HIV transmission, but population-level impacts are uncertain.

Methods:

We extended a previously developed model of HIV and PrEP in South Africa to allow for variable PrEP duration and preference in PBW. We considered three potential scenarios for PrEP provision to PBW: oral PrEP only, CAB-LA only, and allowing oral/CAB-LA choice, with uptake and retention assumptions informed by South African data, each compared with a ‘base’ scenario without PrEP for PBW.

Results:

Without PrEP for PBW, the model estimates 1.31 million new infections will occur between 2025 and 2035 in South African adults and children, including 100 000 in PBW, 16 800 in infants at/before birth, and 35 200 in children through breastmilk. In the oral PrEP-only scenario, these numbers would reduce by 1.2% (95% CI: 0.7–1.7%), 8.6% (4.8–12.9%), 4.0% (2.1–5.8%), and 5.3% (3.0–8.2%) respectively. In the CAB-LA-only scenario, the corresponding reductions would be 6.1% (2.9–9.6%), 41.2% (19.8–65.0%), 12.6% (6.0–19.4%), and 29.5% (13.9–46.8%), respectively, and in the oral/CAB-LA choice scenario, similar reductions would be achieved [5.6% (3.4–8.0%), 39% (23.4–55.9%), 12.4% (7.4–16.8%) and 27.6% (16.5–39.9%) respectively].

Conclusion:

CAB-LA has the potential to be substantially more effective than oral PrEP in preventing HIV acquisition in PBW and vertical transmission, and can also modestly reduce HIV incidence at a population level.