bluuebunny/crossref_metadata_2025 huggingface dataset:
An empirical, accessible definition of “ghosting” as a relationship dissolution method
Authors: Kay Caitlyn , Courtice Erin Leigh
Published: May 2022

“Ghosting” as a method of relationship dissolution has entered both popular media and academic discussion as a topic of interest. Journalists and researchers have used both observation and qualitative methods to define this breakup strategy with varying and sometimes contradictory results. The goal of this study was to create an accessible and empirical definition of ghosting and to resolve discrepancies between existing definitions. To do so, we asked 499 participants (321 cisgender women, all residing in Canada and aged 17–29) two open‐ended questions about ghosting. Participants provided their own definition of ghosting, and then identified behaviors that they associated with ghosting. Next, we conducted inductive qualitative analyses with four cycles of coding to determine the key components of the behavior that distinguish ghosting from other methods of relationship dissolution. Based on participant responses and language, we derived the following definition of ghosting: “One way that people can end a relationship is by ghosting. Ghosting is when one person suddenly ignores or stops communicating with another person, without telling them why.” Our proposed definition of ghosting addresses shortcomings presented by previous and concurrently developed definitions and provides a starting point for future research on ghosting in romantic relationships, friendships, workplaces, and beyond.
Synthesis and Self‐Aggregation of Chlorophyll‐a Derivatives Possessing a Hydroxymethyl Group in the C20‐Substituent with Ethynylene and/or Phenylene Linkers
Authors: Nakano Takeo , Hashimoto Yuki , Tamiaki Hitoshi
Published: May 2022

Chlorophyll(Chl)‐a derivatives containing some rigid linkers in the C20 substituents, which were inserted between a hydroxymethyl group and the chlorin π‐skeleton, were synthesized and their self‐aggregation abilities were investigated. Measurements of electronic absorption, circular dichroism and infrared absorption spectra revealed that the zinc complex of a Chl‐a derivative bearing a (p‐ethynyl)benzyl alcoholic moiety at the C20‐position gave its J‐aggregates in an aqueous micellar solution through the hydrogen and coordination bonding. These results exhibited the potential of Chl‐a derivatives bearing a hydroxyl group in the C20 substituents as the model compounds for chlorosomal light‐harvesting antennas.
Competitive trading in forward and spot markets under yield uncertainty
Authors: Shao Lusheng , Wang Derui , Wu Xiaole
Published: May 2022

Many agricultural commodities are traded in both forward and spot markets. This paper studies the interplay of random yield and forward market in a hybrid market with spot and forward transactions. We examine two main questions: (a) How does yield uncertainty (yield risk and yield correlation) affect the equilibrium outcome in this hybrid market? (b) How does the existence of a forward market influence the firms' strategic behaviors and spot price volatility, and how does yield uncertainty mediate the role of the forward market? In our baseline model that considers two firms and no withholding behavior by the firms, it is found that as yield risk increases, firms may sell less in the forward market, and counterintuitively, higher yield risk may benefit firms and make the spot price less volatile. The existence of a forward market leads to greater spot price volatility; that is, a forward market destabilizes spot prices. We identify a mitigating effect of yield variability, but an enhancing effect of yield correlation, on the role of the forward market. Finally, we extend our baseline model to the case with more than two firms and the setting where the firms may withhold some products and demonstrate that some of the key results in the baseline model carry over to these extensions. Nevertheless, the firms' withholding behavior represents a new driving force that changes some results. For example, the decreasing trend of spot price volatility in yield risk disappears in the withholding model.
Effect of high‐intensity interval training on hippocampal metabolism in older adolescents
Authors: Valkenborghs Sarah Ruth , Hillman Charles H. , Al‐Iedani Oun , Nilsson Michael , Smith Jordan J. , Leahy Angus Aaron , Harries Simon K. , Ramadan Saadallah , Lubans David Revalds
Published: May 2022

Although well‐evidenced in older adults, the effects of exercise on the hippocampus in youth are relatively unknown. This study examined the impact of a 6‐month school‐based physical activity intervention on hippocampal metabolism in adolescents using magnetic resonance spectroscopy. A subset of lower fit older adolescents [N = 56, 61% female, 16.1 ± 0.4 years] was included from four secondary schools (10 classes) in New South Wales, Australia, who were participating in a larger cluster randomized controlled trial. Participants were randomized to the Burn 2 Learn (B2L) intervention (five classes, 30 participants) or a control group (five classes, 26 participants). Changes in hippocampal metabolism were assessed using linear mixed models adjusted for clustering at the class level. We observed group‐by‐time effects for the B2L intervention on N‐acetylaspartate (NAA) (+2.66 mmol/L, 95% CI 0.20 to 5.11, d = 0.66) and glutamate+glutamine (Glx) (+3.38 mmol/L, 95% CI 0.34 to 6.42, d = 0.67) in the left hippocampus. Increases in left hippocampal NAA and Glx concentrations were associated with improvements in cardiorespiratory fitness (NAA: rs = 0.52, p = .016; Glx: rs = 0.57, p = .007), lower body muscular fitness (NAA: rs = 0.49, p = .018; Glx: rs = 0.59, p = .003), and working memory (NAA: rs = 0.42, p = .032; Glx: rs = 0.43, p = .028) in the intervention group. Our findings suggest physical activity may improve hippocampal metabolism in lower fit older adolescents with implications for working memory. Further studies involving larger samples are needed to replicate our findings.
Quantitative analyses of misclassification rates in the hazard classification of environmental chemicals: Evaluation of procedures for deriving predicted no‐effect concentrations in the Chemical Substance Control Law in Japan
Authors: Hayashi Takehiko I. , Furuhama Ayako , Yokomizo Hiroyuki , Yamamoto Hiroshi
Published: May 2022

The quality of chemical management depends more or less on practical procedures used to assess chemicals. This study quantitatively assessed the efficacy of a derivation procedure for calculating no‐effect concentrations for screening assessment of environmental hazards under the Chemical Substance Control Law in Japan. We first evaluated the derivation procedure by applying a series of test ecotoxicity datasets to the procedure and calculating the resulting misclassification rates of the hazardous class of chemicals. In this study, a chemical was deemed to have been misclassified if its classification differed from its classification based on the full dataset (chronic toxicity data for three trophic levels), which was defined as the correct assignment. We also calculated the effects of additional uncertainty factors to decrease the variance (i.e., to improve the consistency) of the misclassification rates among cases with different data availability in the derivation procedure. The results showed that the derivation procedure resulted in very high rates of misclassification when only particular sets of ecotoxicity data were available (e.g., only chronic toxicity data of algae were available). Our analyses also showed that the use of additional uncertainty factors improved the consistency of the misclassification rates within the derivation procedure. Our study presents a broadly applicable calculation framework for quantifying error rates in assessment procedures and serves as a case study for future development and reforms of chemical assessment processes and policies, while additional analyses using more extensive ecotoxicity data with various modes of actions are needed in the future.
Sedimentology and diagenesis of Pleistocene calcareous, non‐dolomitic, interdune sediments, Coorong Coastal Plain, South Australia
Authors: James Noel P. , Bone Yvonne
Published: May 2022

The Coorong Coastal Plain in the south‐east of South Australia is a series of uplifted and stranded Pleistocene, beach‐dune, aeolianite complexes (Bridgewater Formation) that range in age from Middle Pleistocene to Holocene. Aeolianite ridges are separated by elongated corridors, the sites of interdune sedimentation. The youngest corridors, sites of Holocene lacustrine deposition, are also locations of syndepositional dolomite formation. These lakes, particularly south of the Coorong Lagoon, are world‐famous and extensively studied. The older corridors, by contrast, are poorly understood. This study investigates the numerous corridor sediments and limestones between aeolianites across the coastal plain. There are two formations: (i) the Padthaway Formation, a middle Pleistocene, Marine Isotope Stage 15 to Marine Isotope Stage 2 deposit with three facies; and (ii) the Glanville Formation, a younger late Pleistocene Marine Isotope Stage 5e, unit with one facies containing warm‐water biota that is not present in the area today. These carbonates are interpreted to record deposition in palaeoenvironments ranging from lacustrine to estuarine–lagoonal. There is very little dolomite in the deposits. Aragonite and Mg‐calcite are present and most abundant in corridors younger than 350 ka. There are only seven samples of Padthaway Formation carbonates that contain any dolomite, with only two containing more than 50%. Limestone and dolomite stable isotopes are similar with negative δ13C values (−3.9 to −8.6‰) and variable δ18O numbers (+3.0 to −2.4‰). Such values are quite unlike those for younger synsedimentary dolomites. Mineralogy and geochemistry suggest original low‐magnesium calcite‐rich sediment that has been modified to varying degrees by meteoric diagenesis. Lack of synsedimentary dolomite is ascribed mainly to more humid climatic conditions in the past. The study emphasizes that lacustrine synsedimentary dolomite forms under semi‐arid conditions when lakes, fed by Mg‐rich and Ca‐rich resurging groundwaters and under bacterial mediation, are evaporated to dryness.
Incidence and risk factors for the development of cytomegalovirus viremia in a steroid sparing liver transplant center
Authors: Viehl Emily , Lichvar Alicia , Chan Christine , Choi David
Published: May 2022

Background

Cytomegalovirus (CMV) is a common opportunistic infection in patients after liver transplant (LT). Guidelines recommend 900 mg daily of valganciclovir; however, valganciclovir commonly causes dose‐dependent hematologic toxicities. Use of a low‐dose valganciclovir (450 mg) has been used to prevent these adverse effects, but the data regarding this dosing strategy are not as robust in a steroid sparing LT center.

Methods

Retrospective chart review of adult LT recipients between January 1, 2008 and June 30, 2019. All patients received low‐dose valganciclovir 450 mg PO daily for CMV prophylaxis. Primary outcome was the incidence of CMV viremia in LT recipients at 12 months post‐LT. Secondary outcomes include time to CMV viremia, risk factors for the development of CMV viremia, and incidence of breakthrough CMV viremia while on valganciclovir prophylaxis.

Results

A total of 266 patients were included. Overall, the majority were male (63.2%) and Caucasian (45.5%). The most common indication for transplant was decompensated cirrhosis (82%). The incidence of CMV at 1 year posttransplant was 7.9%. Independent risk factors included high risk status (OR 5.97, 95% CI 2.14–16.61, p = .001) as well as having an episode of rejection (OR 5.99, 95% CI 2.16–16.66, p = .001).

Conclusion

Low‐dose valganciclovir can be effective in the prevention of CMV viremia in LT patients and may be a beneficial strategy for CMV prophylaxis in a steroid‐sparing transplant center. Further studies may be needed to determine appropriate length of prophylaxis therapy for different risk groups.

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Gravitoelectromagnetism: Removing action-at-a-distance in teaching physics
Authors: Herrmann Friedrich , Pohlig Michael
Published: May 2022

Gravitation is still taught largely in a way that suggests the existence of action-at-a-distance. A theory without such shortcomings, gravitoelectromagnetism, was proposed by Heaviside in 1893, but it did not become well-established because many effects it describes are very small and the later emergence of general relativity seemed to make a theory of gravitoelectromagnetism superfluous. We argue that gravitoelectromagnetism still retains relevance in the physics curriculum because it by no means describes only tiny effects and does not demand the mathematical level of general relativity.
Effects of stimulus naturalness and contralateral interferers on lexical bias in consonant identification
Authors: Roberts Brian , Summers Robert J. , Bailey Peter J.
Published: May 2022

Lexical bias is the tendency to perceive an ambiguous speech sound as a phoneme completing a word; more ambiguity typically causes greater reliance on lexical knowledge. A speech sound ambiguous between /g/ and /k/ is more likely to be perceived as /g/ before /ɪft/ and as /k/ before /ɪs/. The magnitude of this difference—the Ganong shift—increases when high cognitive load limits available processing resources. The effects of stimulus naturalness and informational masking on Ganong shifts and reaction times were explored. Tokens between /gɪ/ and /kɪ/ were generated using morphing software, from which two continua were created (“giss”–“kiss” and “gift”–“kift”). In experiment 1, Ganong shifts were considerably larger for sine- than noise-vocoded versions of these continua, presumably because the spectral sparsity and unnatural timbre of the former increased cognitive load. In experiment 2, noise-vocoded stimuli were presented alone or accompanied by contralateral interferers with constant within-band amplitude envelope, or within-band envelope variation that was the same or different across bands. The latter, with its implied spectro-temporal variation, was predicted to cause the greatest cognitive load. Reaction-time measures matched this prediction; Ganong shifts showed some evidence of greater lexical bias for frequency-varying interferers, but were influenced by context effects and diminished over time.
Hope for a Better Future in an Uncertain Present: A Social Justice Reflection in Sport Psychology
Authors: Compton Bernadette “Bernie”
Published: May 2022

In recent years, some sport psychology professionals have called for research and praxis embracing social justice, intersectionality, and inclusion. This special issue in the Journal of Clinical Sport Psychology also points toward the importance of embracing social justice work within the field. In the following article, I share my journey and reflections about my experience with social justice and sport psychology. The story is deeply personal and provides examples I have found integral in my journey. Recommendations from my personal journey will be provided for sport psychology professionals interested in social justice work.
Pharmacokinetic/Pharmacodynamic Target Attainment of Different Antifungal Agents in De-escalation Treatment in Critically Ill Patients: a Step toward Dose Optimization Using Monte Carlo Simulation
Authors: Xie Jiao , Yang Qianting , Han Xinyan , Dong Yuzhu , Zhang Tao , Li Youjia , Ji Meixi , Liu Chenwei , Cai Yan , Wang Yan
Published: May 2022

Differences in pharmacokinetics/pharmacodynamics (PK/PD) target attainment are rarely considered when antifungals are switched in critically ill patients. This study intends to explore whether the antifungal de-escalation treatment strategy and the new intermittent dosing strategy of echinocandins in critically ill patients are able to achieve the corresponding PK/PD targets. The published population PK models of antifungals in critically ill patients and a public data set from the MIMIC-III database (
n
 = 662) were employed to evaluate PK/PD target attainment of different dosing regimens of antifungals.
Comparative Analysis of the Mechanism of Resistance to Silver Nanoparticles and the Biocide 2,2-Dibromo-3-Nitrilopropionamide
Authors: Alhajjar Rehab K. , Roche Kayley M. , Techtmann Stephen M.
Published: May 2022

Antimicrobials such as nanoparticles and biocides are used to control microbial growth. We used
Escherichia coli
to study the process of acquired resistance to silver nanoparticles (Ag-NP) and the industrial biocide DBNPA when grown in sub-MICs.
Novel Neplanocin A Derivatives as Selective Inhibitors of Hepatitis B Virus with a Unique Mechanism of Action
Authors: Toyama Masaaki , Watashi Koichi , Ikeda Masanori , Yamashita Atsuya , Okamoto Mika , Moriishi Kohji , Muramatsu Masamichi , Wakita Takaji , Sharon Ashoke , Baba Masanori
Published: May 2022

Novel neplanocin A derivatives have been identified as potent and selective inhibitors of hepatitis B virus (HBV) replication
in vitro
. These include (1S,2R,5R)-5-(5-bromo-4-methyl-7H-pyrrolo[2,3-d]-pyrimidin-7-yl)-3-(hydroxymethyl)cyclopent-3-ene-1,2-diol (AR-II-04-26) and (1S,2R,5R)-5-(4-amino-3-iodo-1H-pyrazolo[3,4-d]pyrimidin-1-yl)-3-(hydroxylmethyl)cyclopent-3-ene-1,2-diol (MK-III-02-03).
High-Dosage Fosfomycin Results in Adequate Plasma and Target-Site Exposure in Morbidly Obese and Nonobese Nonhyperfiltration Patients
Authors: Busse D. , Simon P. , Petroff D. , El-Najjar N. , Schmitt L. , Bindellini D. , Dietrich A. , Zeitlinger M. , Huisinga W. , Michelet R. , Wrigge H. , Kloft C.
Published: May 2022

The objectives of this study were the identification in (morbidly) obese and nonobese patients of (i) the most appropriate body size descriptor for fosfomycin dose adjustments and (ii) adequacy of the currently employed dosing regimens. Plasma and target site (interstitial fluid of subcutaneous adipose tissue) concentrations after fosfomycin administration (8 g) to 30 surgery patients (15 obese/15 nonobese) were obtained from a prospective clinical trial.
The Insect Pathogen Photorhabdus luminescens Protects Plants from Phytopathogenic Fusarium graminearum via Chitin Degradation
Authors: Dominelli Nazzareno , Platz Fabio , Heermann Ralf
Published: May 2022

The enteric enterobacterium
Photorhabdus luminescens
is already being used as a bioinsecticide since it is highly pathogenic toward a broad range of insects. However, the bacteria exist in two phenotypically different cell types, called 1° and 2° cells.
Light Regulates
Acinetobacter baumannii
Chromosomal and pAB3 Plasmid Genes at 37°C
Authors: Squire Mariah S. , Townsend Hope A. , Islam Aminul , Actis Luis A.
Published: May 2022

As a facultative pathogen,
Acinetobacter baumannii
persists in various environments by sensing different environmental cues, including light. This report provides evidence of light-dependent regulation at 37°C of the expression of genes coding for a wide range of functions, including those involved in the conjugation of the pAB3 plasmid.
Enterovirus Replication and Dissemination Are Differentially Controlled by Type I and III Interferons in the Gastrointestinal Tract
Authors: Wells Alexandra I. , Grimes Kalena A. , Coyne Carolyn B.
Published: May 2022

Echovirus infections are associated with a broad spectrum of illness, particularly in neonates, and are primarily transmitted through the fecal-oral route. Little is known regarding how echoviruses infect the gastrointestinal tract and how the intestinal epithelium controls echoviral replication.
The Tyrosine Phosphatase PRL Regulates Attachment of Toxoplasma gondii to Host Cells and Is Essential for Virulence
Authors: Yang Chunlin , Blakely William J. , Arrizabalaga Gustavo
Published: May 2022

Infection with
Toxoplasma gondii
can lead to severe and even life-threatening diseases in people with compromised or suppressed immune systems. Unfortunately, drugs to combat the parasite are limited, highly toxic, and ineffective against the chronic stage of the parasite.
An Experimental Adult Zebrafish Model for
Shigella
Pathogenesis, Transmission, and Vaccine Efficacy Studies
Authors: Howlader Debaki R. , Bhaumik Ushasi , Halder Prolay , Satpathy Aishwarya , Sarkar Sounak , Ghoshal Mrinalini , Maiti Suhrid , Withey Jeffrey H. , Mitobe Jiro , Dutta Shanta , Koley Hemanta
Published: May 2022

Shigellosis is a diarrheal disease that is prevalent in developing countries and especially dangerous in young children. Currently, animal models for shigellosis are unable to model some aspects of the infectious cycle. Here, we describe a new shigellosis model in adult zebrafish, an increasingly common model organism for studying bacterial pathogens. The zebrafish model can be used to study
Shigella
colonization, transmission, and immune responses, as well as test vaccine efficacy.
Derivation and Validation of a Clinical Prediction Score to Identify the Isolation of Pseudomonas in Pneumonia
Authors: Maskov Yana , Sanders James M. , Tilahun Belen , Hennessy Sara A. , Reisch Joan , Johns Meagan
Published: May 2022

In this study, we aimed to develop a locally derived clinical prediction model for
Pseudomonas
-mediated pneumonia. Utilizing a locally validated prediction score may help direct therapeutic management and be generalizable to other clinical settings and similar populations for the selection of appropriate antimicrobial coverage when data are lacking.
Detectable Duration of Viable SARS-CoV-2, Total and Subgenomic SARS-CoV-2 RNA in Noncritically Ill COVID-19 Patients: a Prospective Cohort Study
Authors: Phuphuakrat Angsana , Pasomsub Ekawat , Srichatrapimuk Sirawat , Kirdlarp Suppachok , Suksatu Ampa , Srisaowakarn Chanya , Manopwisedjaroen Suwimon , Ludowyke Natali , Purwono Priyo Budi , Priengprom Thongkoon , Wongsa Artit , Thakkinstian Ammarin , Hongeng Suradej , Malathum Kumthorn , Thitithanyanont Arunee , Tassaneetrithep Boonrat
Published: May 2022

Our study, combined with existing evidence, suggests the feasibility of the use of subgenomic RNA RT-PCR as a surrogate marker for SARS-CoV-2 infectivity. The kinetics of SARS-CoV-2 subgenomic RNA should be further investigated in immunocompromised patients.
Candida albicans Hyphal Extracellular Vesicles Are Different from Yeast Ones, Carrying an Active Proteasome Complex and Showing a Different Role in Host Immune Response
Authors: Martínez-López Raquel , Hernáez Maria Luisa , Redondo Esther , Calvo Guillermo , Radau Sonja , Pardo Mercedes , Gil Concha , Monteoliva Lucía
Published: May 2022

This first analysis of HEVs of
C. albicans
has shown clear differences between them and the YEVs of
C. albicans
, showing their relevance and possible use in the discovery of new diagnostic markers and treatment targets against
C. albicans
infections. The data obtained point to different mechanisms of biogenesis of YEVs and HEVs, as well as different involvements in cell biology and host interaction.
Performance Evaluation of a Dengue IgG Rapid Diagnostic Test Designed to Determine Dengue Serostatus as Part of Prevaccination Screening
Authors: Liberal Vasco , Forrat Remi , Zhang Cong , Pan Charles , Bonaparte Matthew , Yin Wushan , Zheng Lingyi , Viscardi Valeria , Wu Yukun , Ataman-Önal Yasemin , Savarino Stephen , Chen Catherine
Published: May 2022

Dengue remains a significant public health issue, with over 5.2 million cases reported to the World Health Organization (WHO) in 2019. The tetravalent dengue vaccine (CYD-TDV) is currently licensed for use in those aged ≥9 years; however, vaccinees with no previous exposure to dengue experience an increased risk of hospitalized and severe dengue upon subsequent heterotypic infection.
Bilayer Graphene–Stone–Wales Graphene: Structure, Stability, and Interlayer Thermal Conductivity
Authors: Podlivaev A. I.
Published: May 2022

The interlayer thermal conductivity of two asymmetric bilayer carbon structures has been studied within the nonorthogonal tight binding model. One layer of the first structure proposed in this work for the first time is graphene and the second layer is Stone–Wales graphene, which is recently proposed carbon allotrope. The second asymmetric structure is bilayer graphene, where one layer consists of 12C isotope and the second layer consists of rarer 13C isotope. It has been shown that the interlayer thermal conductivity of asymmetric structures is more than an order of magnitude lower than that for their symmetric analogs, bilayer graphene and Stone–Wales bilayer graphene, with the same isotope composition. A high interlayer thermal conductivity of symmetric structures compared to asymmetric ones is due to the resonant interaction of phonon subsystems of individual layers (phonon spectra of individual layers in symmetric structures coincide, whereas these spectra in asymmetric structures are different). It has been shown that the graphene layer in the unstrained graphene–Stone–Wales graphene structure is flat, whereas the Stone–Wales graphene layer is corrugated. Both layers of this structure biaxially stretched by 5% become flat. The interlayer attraction energy, interlayer distance, activation energy of parallel shear of the layers, and the elastic modulus under vertical compression have been determined for unstrained and deformed structures.
Comparison of regional versus global growth charts for the classification of small-for-gestational age neonates
Authors: Anand Pratima , Thomas Deena , Agarwal Ramesh , Thukral Anu , Deorari Ashok K , Paul Vinod Kumar , Sankar M Jeeva
Published: May 2022

Objective

To compare the performance of regional versus global charts for identifying small-for-gestational age (SGA) neonates with short-term adverse outcomes.

Design

Prospective cohort study.

Setting

Level-3 neonatal unit in India.

Patients

Neonates were categorised into SGA and appropriate-for-gestational age (AGA; 10th−90th centile) using four charts, namely, the AIIMS, Lubchenco, Fenton and Intergrowth 21st charts. They were followed up for adverse outcomes until 28 days.

Outcomes

We evaluated the (1) burden of SGA, (2) sensitivity and diagnostic OR (DOR), (3) relative risk (RR) and number needed to screen (NNS) to detect adverse outcomes in SGA versus ‘optimal’ AGA (50th−90th centile) and (4) RR of morbidities in ‘additional SGA’ (ie, classified as SGA by others but not by AIIMS chart).

Results

Among 1367 neonates, 19.6%, 4.5% and 12.5% were classified as SGA by Intergrowth 21st, AIIMS and Lubchenco charts, respectively. Intergrowth 21st had the highest sensitivity (39.1%) but the least DOR (2.6) to detect adverse outcomes; AIIMS chart had low sensitivity (19.3%) but higher DOR (4.3). RR and NNS were 3.7 and 14; 4.4 and 7; 4.0 and 8; 3.6 and 10 with Intergrowth 21st, AIIMS, Lubchenco and Fenton charts, respectively. ‘Additional SGA’ identified by Intergrowth 21st had lower risk of adverse outcomes than SGA identified by both the charts (RR 0.39; 95% CI 0.19 to 0.82).

Conclusions

Compared with AIIMS and Lubchenco charts, Intergrowth 21st runs the risk of overdiagnosing SGA neonates who may not be at a higher risk of short-term morbidities.
Effect of antibiotics in the first week of life on faecal microbiota development
Authors: Van Daele Emmy , Kamphorst Kim , Vlieger Arine M , Hermes Gerben , Milani Christian , Ventura Marco , Belzer Clara , Smidt Hauke , van Elburg Ruurd M , Knol Jan
Published: May 2022

Background

Infants are frequently exposed to antibiotics (AB) in the first week of life for suspected bacterial infections. Little is known about the effect of AB on the developing intestinal microbiota. Therefore, we studied intestinal microbiota development with and without AB exposure in the first week of life in term born infants.

Methods

We analysed the faecal microbiota from birth until 2.5 years of age by 16S rRNA gene amplicon sequencing in a cohort with 56 term born infants, exposed to AB in the first week of life (AB+) (AB for 2–3 days (AB2, n=20), AB for 7 days (AB7, n=36)), compared with 126 healthy controls (AB-). The effects of AB and duration were examined in relation to delivery and feeding mode.

Results

AB+ was associated with significantly increased relative abundance ofEnterobacteriaceaeat 3 weeks and 1 year and a decrease ofBifidobacteriaceae, from 1 week until 3 months of age only in vaginally delivered, but not in C-section born infants. Similar deviations were noted in AB7, but not in AB2. After AB, breastfed infants had lower relative abundance of potentially pathogenicEnterobacteriaceaecompared with formula fed infants and recovered 2 weeks faster towards controls.

Conclusions

AB exposure in the first week of life alters faecal microbiota development with deviations in the relative abundance of individual taxa until 1 year of age. These alterations can have long-term health consequences, which emphasises the need for future studies aiming at restoring intestinal microbiota after AB administration.
Outpatient parenteral antimicrobial therapy: how young is too young?
Authors: Hodgson Kate Alison , Lim Ruth , Huynh Julie , Nind Ben , Katz Naomi , Marlow Robin , Hensey Conor C , Scanlan Barry , Ibrahim Laila F , Bryant Penelope A
Published: May 2022

Objective

To report the use, and assess the efficacy and outcomes of outpatient parenteral antimicrobial therapy (OPAT) in neonates (≤28 days of age), compared with older infants (1–12 months of age).

Design

A prospective 8-year observational study from September 2012 to September 2020.

Setting

The Hospital-in-the-Home (HITH) programme of the Royal Children’s Hospital Melbourne.

Patients

Neonatal patients (≤28 days of age) were compared with older infants (1–12 months of age) receiving OPAT.

Interventions

Data were collected including demographics, diagnosis, type of venous access and antibiotic choice.

Main outcome measures

Success of OPAT, antibiotic appropriateness, complications and readmission rate.

Results

There were 76 episodes for which neonates were admitted to HITH for OPAT, and 405 episodes for older infants. Meningitis was the most common diagnosis in both groups (59% and 35%, respectively); the most frequently prescribed antibiotic was ceftriaxone for both groups (61% and 49%). A positive bacterial culture was less frequent in neonates (38% vs 53%, p=0.02). Vascular access complication rate was 19% in neonates compared with 13% in older infants (p=0.2) with no central line-associated bloodstream infection in either group. Rates of appropriate antibiotic prescribing were similarly high between groups (93% vs 90%, p=0.3). The OPAT course was successfully completed in 74 of 74 (100%) neonates and 380 of 396 (96%) older infants (p=0.09). The unplanned readmission rate was low: 4 of 76 (5%) neonates and 27 of 405 (7%) older infants.

Conclusions

OPAT is a safe and effective way of providing antibiotics to selected clinically stable neonatal patients. While appropriate antibiotic use was common, improvements can still be made.
Challenges in managing a critically ill patient with decompensated Eisenmenger syndrome
Authors: Lim Min Xian , Ismail Abdul Jabbar , Yeap Tat Boon
Published: May 2022

Eisenmenger syndrome (ES) is the most severe form of pulmonary arterial hypertension and is associated with congenital heart disease. ES itself is a challenging condition to manage, further compounded if the patient is critically ill and acutely decompensated. We share our experience of managing a critically ill adult patient with ES who presented with acute decompensation due to sepsis.
Novel case of empyema necessitans caused byMycobacterium xenopi
Authors: Hassan Sidra , Berenson Charles S
Published: May 2022

Poorly controlled long-standing empyema can dissect through soft tissues and skin resulting in empyema necessitans. We present the first reported case of empyema necessitans caused byMycobacterium xenopi,which was treated successfully with antimycobacterial therapy. The case highlights the indolent nature of the pathogen and the importance of an accurate diagnosis.
Acquired long QT syndrome due to antiemetics, COVID-19 andBlastocystis hominisinduced exacerbation of congenital chloride losing diarrhoea
Authors: Rajendram Rajkumar , Alghamdi Ahmed Abdullah , Alanazi Mohammed Ayed
Published: May 2022

Congenital chloride losing diarrhoea (CCLD) is a rare disease caused by mutations in an intestinal chloride/bicarbonate ion exchange channel. Few reports describe CCLD in adults and none has described the impact of a parasitic infection on CCLD. Severe diarrhoea may result in hypokalaemia with QT interval prolongation. Treatment with antiemetics may further increase the QT interval. To raise awareness of this preventable complication, we describe the course of a woman in her 20s with CCLD who developed COVID-19 and aBlastocystis hominisinfestation. Treatment with antiemetics and hypokalaemia resulted in prolongation of the QT interval to 640 ms. While, the QT interval normalised with discontinuation of antiemetics and electrolyte replacement, patients with CCLD must take precautions to prevent gastrointestinal infections. Regardless, whenever patients with CCLD present to hospital, the authors recommend monitoring the QT interval and avoiding medications that predispose to torsade de pointes.
Cryptococcus laurentiiendogenous endophthalmitis post COVID-19 infection
Authors: Deepa Muthugaduru Jagadish , Megharaj Chitta , Patil Santosh , Rani Padmaja Kumari
Published: May 2022

A man in mid-50s presented with progressive blurred vision in his left eye for over 6 weeks. He was a known diabetic with history of COVID-19 pneumonia treated with steroids and remdesivir. He had pyelonephritis and urinary culture grownKlebsiella. He was referred as a case of non-resolving vitreous haemorrhage. Visual acuity (VA) was hand movements with fundus showing dense vitritis. He underwent pars plana vitrectomy, vitreous biopsy with intraocular antibiotics (imipenem) suspecting as a case of endogenous bacterial endophthalmitis. Vitreous biopsy did not yield organisms on the smear/culture. The patient’s condition worsened with perception of light and fundus showing dense vitritis with discrete yellowish white deposits on the surface of the retina. A repeat vitreous biopsy done along with intravitreal injection of voriconazole (suspecting fungal aetiology) grown fungal colonies and the organism was identified asCryptococcus laurentii. At 4-month follow-up, the VA improved to 6/24.
PostoperativePseudomonas aeruginosaendophthalmitis associated with asymptomatic bacteriuria
Authors: Chin Melissa , Khan Imran
Published: May 2022

An 86-year-old man with diabetes and a history of prostate cancer, indwelling urinary catheter andPseudomonas aeruginosabacteriuria presented on day 4 post left phacoemulsification cataract extraction and intraocular lens implant with signs and symptoms of postoperative endophthalmitis. Vitreous sample was positive forP. aeruginosa. Prompt treatment with intravitreal antibiotics was initiated followed by anterior chamber washout with pars plana vitrectomy; however, the visual outcome was poor.
Surgical significance of prolonged fixed and dilated pupils in a case of non-traumatic, spontaneously regressing, acute subdural haemorrhage
Authors: Jain Raunak , The Crystallynn Skye , Murphy Mary M , Pandit Anand S
Published: May 2022

Bilaterally fixed and dilated pupils (BFDP) in traumatic acute subdural haematoma (ASDH) patients represent an ominous sign that portends irreversible brainstem injury and death. Whether patients with spontaneous ASDH and BFDP follow similar outcomes is unknown. We present a mid-60s man, found unconscious, with a Glasgow Coma Scale (GCS) of 4 following 8 days of headaches. Emergency CT imaging demonstrated a large right ASDH and the patient exhibited BFDP for >3 hours despite sedation and mannitol. Neurological improvement and spontaneously reduced SDH thickness were observed 10 hours postadmission, and he was later transferred for craniotomy and ASDH evacuation. His long-term outcomes were good: achieving independence in his activities of daily living and a GCS of 15. To the best of our knowledge, this is the first reported patient with a spontaneous, regressing ASDH and prolonged BFDP who clinically improved. This case raises important questions regarding factors used to determine prognosis and surgical viability for ASDH.
Reactivation of latent tuberculosis in a COVID-19 patient on corticosteroid treatment
Authors: Friedman Aviva , DeGeorge Katharine Claire
Published: May 2022

Though the COVID-19 pandemic has made international headlines since 2020, behind the scenes, tuberculosis (TB) has remained a leading cause of global mortality. According to the WHO, TB is 1 of the top 10 causes of death globally, with about one-quarter of the world’s population infected. This case report highlights a female patient who presented to the emergency department with signs and symptoms of COVID-19 and was admitted to hospital. When the patient demonstrated minimal clinical improvement after initiating treatment for COVID-19, further investigations uncovered concomitant reactivated TB. This case is helpful in underscoring the potential implications of the COVID-19 pandemic and current treatment guidelines on the global burden of TB, which could subsequently impact how practitioners approach screening and management of latent TB infection.
Excipient lung disease secondary to intravenous heroin use
Authors: Colbenson Gretchen A , Kubbara Aahd , Cox Christian W , Yi Eunhee S , Baqir Misbah
Published: May 2022

We present a case of a woman who had progressive shortness of breath and wheezing with a mild restrictive pulmonary function pattern. She was initially diagnosed with eosinophilic granulomatosis with polyangiitis on the basis of peripheral eosinophilia, bronchoalveolar lavage eosinophilia (47%) and surgical lung biopsy findings. Six months following her diagnosis, the patient returned because of persistent symptoms, and a second review of the lung biopsy revealed thrombotic lesions in the pulmonary vessels with polarisable foreign body materials, associated giant cell reactions and numerous eosinophil infiltrates, consistent with intravenous drug abuse. Further investigation showed that she had a history of intravenous heroin overdose, and the diagnosis of excipient lung disease was made. This case highlights the importance of expert pathological, radiological and clinical review of complex presentations and the need for a thorough medication and drug use history review.
Intracranial necrotising sarcoid granulomatosis mimicking petroclival meningioma
Authors: Valappil Ashraf , Sundar S Shyam , Johny Mishal , Ahamed TP Javed
Published: May 2022

We present a unique case of biopsy-proven necrotising sarcoidosis involving the central nervous system in a man in his 40s. The patient presented with a 2-week history of right-sided headache and diplopia. He had right trochlear and abducens nerve palsy, sensory blunting over V1 and V2 segment of right trigeminal sensory nerve and right sensory neural hearing loss. A contrast-enhanced MRI revealed an enhancing dural-based mass lesion in the petroclival area suggestive of probable meningioma. Surgical resection was attempted and intraoperative consultation with frozen section revealed granulomata. So, the lesion was biopsied and surgical intervention was terminated. A diagnosis of necrotising neurosarcoidosis was confirmed on histopathology. He was treated with steroids after excluding other causes of intracranial necrotising granulomas like tuberculosis and he clinically responded favourably. We report one of the very few case reports of histologically proven necrotising sarcoidosis involving the central nervous system mimicking petroclival meningioma.
Isolated sixth nerve palsy: a rare first presentation in multiple sclerosis
Authors: Lim Qi Xun , Ahmed Fahid , Patel Sirjhun
Published: May 2022

True isolated sixth nerve palsy as the initial presentation of multiple sclerosis (MS) is rare. MS is a chronic inflammatory, immune-mediated disease of the central nervous system. This is the most common cause of neurological disability in young adults. Common symptoms include acute episodes of muscle weakness, altered sensation, balance and gait disturbances, visual loss and bladder dysfunction.

Diagnosis of MS is supported with the incidence of symptomatic clinical episodes with subsequent cross-sectional imaging to confirm radiological lesions that are disseminated in space and time.

In the following report, we discuss the case of a woman in her 30s who presented to ophthalmology with a sixth nerve palsy in the absence of ocular or systemic disease. This is the first presentation of MS, a rare clinical event.
Adenoid cystic carcinoma of sinonasal origin masquerading as an intraconal lesion
Authors: Pattabiraman Suhasini , Dhande Rajasbala , Mishra Gaurav Vedprakash , Varma Amruta
Published: May 2022

Adenoid cystic carcinoma is an uncommon tumour of the salivary glands, although affliction of mucin-producing glands present in the oral cavity, oropharynx and paranasal sinuses is not uncommon. Other possible sites are lacrimal, oesophagus, trachea-bronchial tree, lungs, uterus, cervix, prostate. These tumours have a tendency to be aggressive and most show invasion into the adjacent region. Adenoid cystic carcinoma contributes to about 0.3% of all sinonasal tumours.
Giant cerebral tuberculoma mimicking a high-grade tumour in a child
Authors: Van Niekerk Magriet , Goussard Pierre , Van Toorn Ronald , Solomons Regan
Published: May 2022

We present an 11-year-old girl who manifested with unprovoked right-sided focal motor seizures. CT revealed a large lobulated hypodense mass in the left temporoparietal lobe, with perilesional oedema and postcontrast peripheral enhancement. Diagnostic uncertainty resulted in further neuroimaging, which included MRI with modalities including diffusion-weighted imaging, perfusion imaging, as well as spectroscopy. We discuss the radiological features of the lesion, which steered us in the direction of an infective cause. Definitive diagnosis was achieved by brain needle biopsy, which demonstrated necrotising granulomatous inflammation indicative of tuberculous infection on histology. In addition, GeneXpert yielded a positive result. We believe this unique case highlights the diagnostic dilemma clinicians face in differentiating ring-enhancing lesions on neuroimaging in tuberculosis-endemic regions. It also highlights the potential benefit of a brain needle biopsy (histology and GeneXpert) in cases of uncertainty.
Challenging airway in a postmandibulectomy patient for carcinoma of the buccal mucosa undergoing laparoscopic cholecystectomy
Authors: Iqbal Javaid , Barik Amiya Kumar , Soni Shiv Lal , Bansal Pulkit
Published: May 2022

Failure to secure the airway after administration of induction agent in a postmandibulectomy patient can lead to life-threatening complications; hence, recognising a difficult airway is of immense importance. Preoperative airway evaluation includes, but is not limited to, inter-incisor gap, modified Mallampati grading, neck movement, neck circumference, thyromental distance, sterno-mental distance, upper lip bite test and dental status. This case signifies the challenge encountered in securing the airway and the importance of thorough preoperative airway evaluation and preparedness before induction of anaesthesia in a postmandibulectomy patient for carcinoma of the buccal mucosa.
Case of hidden tooth: mesiodens fortuitously discovered on a cone-beam CT examination
Authors: Perez Alexandre , Stergiopulos Ourania , Lenoir Vincent , Lombardi Tommaso
Published: May 2022

Mesiodens is the most common type of supernumerary tooth, located between the maxillary central incisors. A young man was referred by his orthodontist for management of a supernumerary tooth located in quadrant I, superposed to the bottom of the right maxillary sinus, distally orientated with the crown in contact with the apex of the palatal root of the maxillary first molar. The tooth was found on a panoramic radiography before starting his orthodontic treatment. To remove it and in order to study, its relationship to the anatomical structures a cone-beam CT examination was performed. This revealed the presence of a mesiodens located on the right paramedian maxillary area. Pericoronal tissue submitted for histopathological examination showed an uninflamed dental follicle. Healing was uneventful. This case shows that mesiodens outside the arch, located in the posterior palate, may be not discovered in a panoramic radiograph.
Splenic artery aneurysm rupture in pregnancy: challenges in diagnosis and the importance of multidisciplinary management
Authors: Vaughan Emily , Carlsson Tarryn , Brooks Marcus , Elhodaiby Mohamed
Published: May 2022

This case of acute rupture of a splenic artery aneurysm in a patient 35 weeks pregnant demonstrates the difficulties in diagnosis and importance of multidisciplinary team management for surgical emergencies in pregnancy. A women in her early 30s presented at 35 weeks pregnant with sudden onset of severe epigastric pain and shortness of breath and was found to be tachycardic with a raised lactate. Differentials included a possible vascular event or pulmonary embolism. A CT scan demonstrated free fluid and likely ruptured splenic artery aneurysm. A rapid, thorough preoperative meeting enabled us to integrate multidisciplinary care effectively. She underwent coiling of her splenic artery, which was essential to reduce further intraoperative blood loss, followed by a midline incision for caesarean section of her baby and splenectomy. She had a long stay in the intensive care unit (ITU) and complex postoperative course but was discharged after 2 months to be reunited with her baby who was in good condition.
Bladder stone causing vesicovaginal fistula and migration into the vagina
Authors: Sonawane Parag , Sathish Vyshnavi , Nadeem Mehwash
Published: May 2022

Bladder stone is a known complication in a neurogenic bladder that can very rarely cause vesicovaginal fistula (VVF). We are presenting the case of a woman in her late 70s, bed bound with progressive multiple sclerosis (MS), who was referred to urology for consideration of suprapubic catheter due to difficulty in managing her indwelling urethral catheter. The ultrasonogram (USG) identified a 4.7 cm bladder stone with right-sided hydronephrosis (HN) and left atrophic kidney. A CT scan later showed that a 5 cm bladder stone has migrated through a VVF into her vagina. She had a cystoscopy and transvaginal retrieval of the stone. Given her performance status and intraoperative finding of a small contracted bladder, it was agreed to manage her VVF conservatively.

To the best of our knowledge, this is the first case of a primary bladder stone migrating into the vagina through a VVF.
Tamponade with recurrent chylopericardium in patient with non-Hodgkin’s lymphoma: chemotherapy is the key management after pericardiocentesis
Authors: Alsagaff Mochamad Yusuf , Laksmi Ni Putu Anggun , Maghfirah Irma , Susilo Hendri
Published: May 2022

Cardiac tamponade, the accumulation of fluid in the pericardial space, leads to impaired venous return, loss of left ventricular preload and haemodynamic collapse. Chylopericardium is an unusual cause of the pericardial effusion. This is often secondary to malignancy. Non-Hodgkin’s Lymphoma is a primary malignancy from the lymph node. It can be produced by B lymphocytes, T lymphocytes or natural killer cells. The term chylopericardium refers to a pericardial effusion containing milky fluid within the intrapericardial space. We present a case of a 42-year-old male patient who came with dyspnoea as a result of cardiac tamponade caused by a massive milky pericardial effusion (chylopericardium) secondary to mediastinal non-Hodgkin’s lymphoma.