bluuebunny/crossref_metadata_2025 huggingface dataset:
The Diagnostic Yield of Routine Admission Blood Cultures in Critically Ill Patients
Authors: Verboom Diana M. , van de Groep Kirsten , Boel C. H. Edwin , Haas Pieter Jan A. , Derde Lennie P. G. , Cremer Olaf L. , Bonten Marc J. M.
Published: November 2020

OBJECTIVES:

Although the Surviving Sepsis Campaign bundle recommends obtaining blood cultures within 1 hour of sepsis recognition, adherence is suboptimal in many settings. We, therefore, implemented routine blood culture collection for all nonelective ICU admissions (regardless of infection suspicion) and evaluated its diagnostic yield.

DESIGN:

A before-after analysis.

SETTING:

A mixed-ICU of a tertiary care hospital in the Netherlands.

PATIENTS:

Patients acutely admitted to the ICU between January 2015 and December 2018.

MEASUREMENTS AND MAIN RESULTS:

Automatic orders for collecting a single set of blood cultures immediately upon ICU admission were implemented on January 1, 2017. Blood culture results and the impact of contaminated blood cultures were compared for 2015–2016 (before period) and 2017–2018 (after period). Positive blood cultures were categorized as bloodstream infection or contamination. Blood cultures were obtained in 573 of 1,775 patients (32.3%) and in 1,582 of 1,871 patients (84.5%) in the before and after periods, respectively (p < 0.0001), and bloodstream infection was diagnosed in 95 patients (5.4%) and 154 patients (8.2%) in both study periods (relative risk 1.5; 95% CI 1.2–2.0; p = 0.0006). The estimated number needed to culture for one additional patient with bloodstream infection was 17. Blood culture contamination occurred in 40 patients (2.3%) and 180 patients (9.6%) in the before period and after period, respectively (relative risk 4.3; 95% CI 3.0–6.0; p < 0.0001). Rate of vancomycin use or presumed episodes of catheter-related bloodstream infections treated with antibiotics did not differ between both study periods.

CONCLUSIONS:

Implementation of routine blood cultures was associated with a 1.5-fold increase of detected bloodstream infection. The 4.3-fold increase in contaminated blood cultures was not associated with an increase in vancomycin use in the ICU.
Tyrosine kinase inhibitors as induction therapy in nonsmall-cell lung cancer
Authors: Gong Juejun , Zhang Li
Published: November 2020

Purpose of review

TKI therapy has shown excellent efficacy and favorable tolerability in patients with mutation-positive nonsmall cell lung cancer. However, there is no clear consensus on the role of TKI as induction therapy. In this article, we reviewed recently published studies to analyze the benefits of tyrosine kinase inhibitors, in particular, EGFR TKIs and ALK TKIs, as inducible treatments for NSCLC.

Recent findings

Several clinical trials have recently presented their latest data, giving analysis of patient's survival benefits and adverse events. Initial results have demonstrated promising efficacy and safety data. Some clinical case reports and retrospective analysis demonstrated that EGFR/ALK TKIs can significantly improve PFS and the rate of radical surgery. However, there was no statistically significant difference in overall survival time of almost all clinical trials.

TKIs are increasingly accepted by clinicians as induction therapy in NSCLC. Many studies have demonstrated that neoadjuvant therapy increases the likelihood of surgery and is associated with good resection rates, as evidenced by high prospective downstaging rates in patients with locally advanced NSCLC. However, the risk of recurrence remains high with no evidence of overall survival benefits being reported. Now that more clinical trials are being conducted and more data will be available for analysis, a clearer and more comprehensive view of what role TKIs play in induction therapy will emerge.
Lung cancer in China: current and prospect
Authors: Wu Fengying , Wang Lei , Zhou Caicun
Published: November 2020

Purpose of review

To describe the current status of lung cancer in China, including incidence, prevention, molecular testing and treatment.

Recent findings

Lung cancer presents a major public health issue and an enormous burden on society in China, because of its increasing incidence and high mortality. Several distinct gene profiles were associated with lung cancer in China: high EGFR mutation rate, low KRAS mutation rate and more comorbidity of HBV infection. Thus, local Chinese Society of Clinical Oncology Guidelines with more consideration of drug accessibility, regional development differences were highly recommended for clinical practice. For treatment, targeted therapy has achieved fruitful progress. Immunotherapy in China was a little bit lag behind previously and now there is a surge of immunotherapeutic drugs under investigation. For future, more preventive strategies and more trials considering chrematistics of Chinese lung cancer are needed.

There are achievements and shortcomings for lung cancer prevention and treatment in China. More work considering distinct characteristic of lung caner in China are needed.
Bariatric Surgery as a Bridge to Heart Transplantation in Morbidly Obese Patients
Authors: Lee Yung , Anvari Sama , Sam Soon Melissa , Tian Chenchen , Wong Jorge A. , Hong Dennis , Anvari Mehran , Doumouras Aristithes G.
Published: November 2020

Class 2 obesity or greater [body mass index (BMI) >35 kg/m2] is a relative contraindication for heart transplant due to its associated perioperative risks and mortality. Whether bariatric surgery can act as a potential bridging procedure to heart transplantation is unknown. The aim of this systematic review and meta-analysis is to investigate the role of bariatric surgery on improving transplant candidacy in patients with end-stage heart failure (ESHF). MEDLINE, EMBASE, CENTRAL, and PubMed databases were searched up to September 2019 for studies that performed bariatric surgery on patients with severe obesity and ESHF. Outcomes of interest included incidence of patients listed for heart transplantation after bariatric surgery, proportion of patients that successfully received transplant, the change in BMI after bariatric surgery, and 30-day complications. Pooled estimates were calculated using a random-effects meta-analysis of proportions. Eleven studies with 98 patients were included. Mean preoperative BMI was 44.9 (2.1) kg/m2 and BMI after surgery was 33.2 (2.3) kg/m2 with an absolute BMI reduction of 26.1%. After bariatric surgery, 71% [95% confidence interval (CI), 55–86%] of patients with ESHF were listed for transplantation. The mean time from bariatric surgery to receiving a heart transplant was 14.9 (4.0) months. Of the listed patients, 57% (95% CI, 39–74%) successfully received heart transplant. The rate of 30-day mortality after bariatric surgery was 0%, and the 30-day major and minor complications after bariatric surgery was 28% (95% CI, 10–49%). Bariatric surgery can facilitate sustained weight loss in obese patients with ESHF, improving heart transplant candidacy and the incidence of transplantation.
Controversies Regarding Postmenopausal Hormone Replacement Therapy for Primary Cardiovascular Disease Prevention in Women
Authors: Taylor Jennifer E. , Baig Mariam S. , Helmy Tarek , Gersh Felice L.
Published: November 2020

The debate over the safety and benefit of hormone replacement therapy (HRT) in postmenopausal women for primary prevention of cardiovascular disease (CVD) has been ongoing for the past several decades. Observational trials in the 1980s suggested a benefit of HRT for primary CVD prevention. However, randomized controlled trials in the 1990s suggested potential harm. Because of these discrepancies, recommendations from authorities on the usage of postmenopausal HRT have fluctuated. Many believed that the timing of HRT initiation relative to the onset of menopause, also known as the “timing hypothesis,” was the factor that could explain the differences among these studies. Some recent investigations have concluded that HRT initiated in postmenopausal women near the onset of menopause confers a cardioprotective benefit, while others simply showed that HRT does not cause harm. Research has expanded to evaluate alternative doses, preparations, routes, and formulations, including selective estrogen receptor modulators, to demonstrate their suitability for this purpose. This article is a review of the major research studies of HRT in postmenopausal women with respect to its safety and efficacy for the primary prevention of CVD.
Inflammatory Cardiomyopathy: Case-based Review on Clinical Presentation, Diagnosis, and Management
Authors: Li Boyangzi , Lento Patrick A. , Pan Stephen
Published: November 2020

Inflammatory cardiomyopathy is a broad term encompassing any disease leading to myocardial inflammation with associated cardiac dysfunction. While endomyocardial biopsy remains the gold standard for diagnosis, noninvasive imaging techniques, such as cardiac magnetic resonance imaging and positron emission tomography, have become powerful tools to facilitate the identification of underlying myocardial inflammation. This review presents a series of clinical cases with some common etiologies of inflammatory cardiomyopathy, including diagnosis and management.
Fetal Supraventricular Tachycardia: What the Adult Cardiologist Needs to Know
Authors: Purkayastha Sutopa , Weinreich Michael , Fontes Joao D. , Lau Joe F. , Wolfe Diana S. , Bortnick Anna E.
Published: November 2020

Fetal supraventricular tachycardia management is challenging, with consequences for both the fetus and the mother. If left untreated, fetal hydrops may ensue, at which point delivery and treatment of the arrhythmia is preferred. However, if the fetus is not at term nor near-term, significant doses of antiarrhythmics may be needed to achieve adequate transplacental bioavailability. Although digoxin has classically been the mainstay of treatment, the use of flecainide or sotalol as monotherapy or in combination with digoxin is being studied. Interdisciplinary team management and shared decision-making between the physician and patient are key to achieving successful outcomes. Adult cardiologists, particularly inpatient consultation services or through burgeoning cardio-obstetrics programs, may, in some practice settings, be asked to evaluate or comanage pregnant women with fetal arrhythmia.
Outcomes of Veno-Arterial Extracorporeal Membrane Oxygenation for In-Hospital Cardiac Arrest
Authors: Guglin Maya , Sira Manpreet , Joshi Shiksha , Shringi Sandipan
Published: November 2020

Veno-arterial extracorporeal membrane oxygenation is increasingly used in cardiac arrest. Currently, public registries report the outcomes of cardiac arrest regardless of the setting (out-of-hospital versus in-hospital). Meanwhile, in-hospital cardiac arrest represents a more favorable setting for extracorporeal membrane oxygenation-assisted cardiopulmonary resuscitation than out-of-hospital cardiac arrest. Survival to discharge varies, but looks promising overall, ranging from 18.9% to 65%, with the bulk of the studies reporting survival to discharge between 30% and 50%, with about one-third to half of the patients discharged with no or minimal neurologic deficit. Based on the reported outcomes, in-hospital cardiac arrests can become a next focus for studies on successful implementation of veno-arterial extracorporeal membrane oxygenation.
Laser Plume From Human Papillomavirus–Infected Tissue: A Systematic Review
Authors: Cox Surget V. , Dobry Allison S. , Zachary Christopher B. , Cohen Joel L.
Published: November 2020

BACKGROUND

Laser procedures are becoming more prevalent across multiple medical specialties for a variety of indications. The plumes created by these lasers have raised concern for the dissemination of an infectious material.

OBJECTIVE

To review and summarize the information on viral dissemination in laser plumes available in the literature.

MATERIALS AND METHODS:

Data Sources A systematic review was performed on English and non-English articles using the PubMed and the Cochrane databases. A manual search of bibliographies from relevant articles was also performed to collect additional studies.

Study Selection

Only articles in the English language with full texts available that pertained to viral particles in laser plumes were included. Data Extraction Two authors performed independent article selections using predefined inclusion and exclusion criteria.

RESULTS

There have been case reports of possible transmission of human papillomavirus (HPV) by inhalation of laser-produced aerosols. Multiple investigators have attempted to recreate this scenario in the laboratory to qualify this risk. Others have conducted clinical experiments to determine the presence of HPV in laser plumes.

CONCLUSION

The current body of the literature suggests that laser surgeons are at a risk for HPV exposure by inhalation of laser-derived aerosols. We offer best practice recommendations for laser operators.
A 12-Month Study to Evaluate Safety and Efficacy of Polymethylmethacrylate-Collagen Gel for Correction of Midface Volume Loss Using a Blunt Cannula as Measured by 3-D Imaging
Authors: Katz Bruce , Lehman Alayne , Misev Valerija , Vachon Ginny , Saeed Sidra
Published: November 2020

BACKGROUND

Although polymethylmethacrylate (PMMA)-collagen gel is approved for correction of nasolabial folds, there are no reports characterizing safety and efficacy in the midface, an area where fillers are often used in clinical practice.

OBJECTIVE

To determine the safety and efficacy of PMMA-collagen gel for long-term volume restoration in the midface.

METHODS

In this prospective, single-center, 12-month study, 23 subjects with a pretreatment Midface Volume Deficit Scale (MFVDS) grade of 3, 4, or 5 were treated with PMMA-collagen gel. Efficacy was measured by the investigator and blinded reviewers using the MFVDS at 3, 6, and 12 months. Subject Global Aesthetic Improvement Scale (SGAIS) and physician GAIS (PGAIS) ratings were collected at 3, 6, and 12 months.

RESULTS

Improvement in the MFVDS score from baseline was significant at all post-treatment time points (p < .0001). All subjects with baseline MFVDS grades of 5 (severe) or 4 (significant) had a grade of 0 (none) or 1 (minimal) at 12 months. Subject GAIS (SGAIS) and PGAIS ratings of improved or much improved were 100% at Month 3 and were maintained at 12 months (PGAIS = 100%, SGAIS = 91.3%). All adverse events were minor.

CONCLUSION

Polymethylmethacrylate-collagen gel is safe and effective for long-lasting correction of midface volume deficit.
Vaginal Rejuvenation: A Retrospective Review of Lasers and Radiofrequency Devices
Authors: Juhász Margit L.W. , Korta Dorota Z. , Mesinkovska Natasha Atanaskova
Published: November 2020

BACKGROUND

Vaginal rejuvenation is a topic of interest to multiple specialties, including dermatologists, plastic and reconstructive surgeons, urologists, and gynecologists. Evidence suggests that minimally invasive, energy-based devices—radiofrequency and laser therapy—are effective at vaginal tightening and decreasing symptoms of genitourinary syndrome of menopause (GSM) and/or vulvovaginal atrophy (VVA).

MATERIALS AND METHODS

A systematic review was completed using PubMed in November 2018 with search terms “vaginal” or “vagina” and “rejuvenation” or “tightening” or “laxity” or “radiofrequency” or “laser,” as well as “genitourinary syndrome of menopause,” “pelvic prolapse,” “atrophic vaginitis,” “vulvovaginal atrophy,” “sexual function,” “urinary incontinence,” and “radiofrequency” or “laser.” Inclusion criteria were articles written in English and clinical trials or case reports/series dealing with human subjects.

RESULTS

We identified 59 studies (3,609 women) treated for vaginal rejuvenation using either radiofrequency or fractional ablative laser therapy. Studies report improvement in symptoms of GSM/VVA and sexual function, high patient satisfaction, and minor adverse events, including treatment-associated pain, swelling, or vaginal discharge.

CONCLUSION

This review demonstrates radiofrequency and laser are efficacious for the treatment of vaginal laxity and/or atrophy. Further research needs to be completed to determine which specific pathologies can be treated, if maintenance treatment is necessary, and long-term safety concerns.
A Multicenter Study to Evaluate Subject Satisfaction With Two Treatments of AbobotulinumtoxinA a Year in the Glabellar Lines
Authors: Schlessinger Joel , Cohen Joel L. , Shamban Ava , Jacob Carolyn , Karimi Kian , Maas Corey , Lane Vanessa , Coquis-Knezek Sarah , Meckfessel Matthew
Published: November 2020

BACKGROUND

Real-world re-treatment intervals for botulinum toxins vary, but most subjects receive treatment less frequently than the manufacturer-recommended minimum intervals. In subjects receiving treatment with AbobotulinumtoxinA (ABO) less frequently, high levels of satisfaction and psychosocial improvements in well-being, self-confidence, and quality of life are observed.

OBJECTIVE

To evaluate subject satisfaction with a twice yearly re-treatment schedule.

METHODS AND MATERIALS

This open-label, multicenter, interventional study evaluated subject satisfaction following injections of ABO 50 U in the glabellar lines at baseline and 6 months. The primary end point was subject satisfaction at 12 months. Secondary endpoints included subject satisfaction, FACE-Q scales, and glabellar line severity scale (GLSS).

RESULTS

Ninety-five percent of the 120 subjects were “highly satisfied” or “satisfied” with their treatment outcomes at 12 months. FACE-Q total scores suggested that subjects were less bothered by glabellar lines and felt better about their facial appearance with each treatment versus baseline. Approximately half of subjects had ≥1-grade improvement from baseline in GLSS at 12 months. Median onset of effect was 2 days.

CONCLUSION

The majority of subjects (95%) were satisfied with ABO treatment every 6 months; results were supported by high subject satisfaction, long duration, rapid onset, natural-looking results, and overall psychological wellness and safety.
The Correlation Between Immunohistochemistry Findings and Metastasis in Squamous Cell Carcinoma: A Review
Authors: Lobl Marissa , Grinnell Madison , Phillips Andrew , Abels Joshua , Wysong Ashley
Published: November 2020

BACKGROUND

Cutaneous squamous cell carcinoma (SCC) is the second most common type of skin cancer. Only 2% to 5% of SCCs metastasize; however, those do carry a poor prognosis. Immunohistochemistry (IHC) is widely used by pathologists to characterize skin cancers and provide clinically useful information.

OBJECTIVE

To evaluate the potential prognostic associations between IHC findings and metastasis in SCC.

METHODS

Searches were conducted in MEDLINE via PubMed for articles published between 1999 and 2019. Search criteria included key words “immunohistochemistry” and “cutaneous squamous cell carcinoma.” Six hundred and fifty-three articles were returned and screened, which ultimately left 31 for inclusion in our manuscript.

RESULTS

Thirty-one articles analyzed in this review included a discussion of the expression of a particular IHC marker and the associated risk of metastasis and/or clinical utility of IHC markers in SCC, especially metastatic SCC. Markers that had several or more studies supporting clinical utility were E-cadherin, podoplanin, CD8+ T cells, PD-L1, epidermal growth factor receptor, and Cyclin D1.

CONCLUSION

Immunohistochemistry profiling of SCC may be useful in select cases when providing a prognosis remains challenging and in identification of potential therapeutic targets for high-risk or metastatic tumors.
Correlation of Suture Diameter With Its Ability to Cut Through an Artificial Skin Model
Authors: Xiong Michael Y. , Bennett Richard G.
Published: November 2020

BACKGROUND

Sutures can tear through tissue, but little data exist on the relative ability of different suture gauges and suture types to cut into the skin.

OBJECTIVE

To quantify the relative ability of various sutures to cut into and tear through the skin.

METHODS AND MATERIALS

We tested 4 suture types (polypropylene, nylon, polyglactin 910, and poliglecaprone 25) at 2 gauges each (3-0 and 5-0) in their ability to cut into and tear through an artificial skin substitute comprised of a 1-mm thick silicone sheet. The force required to cut into and through the skin substitute was measured using a digital force gauge that generated a force–time curve. The suture diameters were verified using both a precision caliper micrometer and an eyepiece micrometer with the microscope. Statistical analysis was performed using the Student t-test and analysis of variance.

RESULTS

All 5-0 suture types required less force to cut into and tear through the skin substitute than their 3-0 counterparts. Among each suture gauge, there was no significant difference in tear-through force regardless of the suture type.

CONCLUSION

Compared with larger gauge sutures, smaller gauge sutures more easily cut into and tear through skin substitute.
Comparative Graft Survival Study of Follicular Unit Excision Grafts With or Without Minor Injury
Authors: Kwack Mi Hee , Kim Moon Kyu , You Seung Hyun , Kim NaRae , Park Jae Hyun
Published: November 2020

BACKGROUND

Various types of follicular trauma occur during follicular unit excision (FUE). However, the effects of different types of follicular injury on graft survival have not been reported.

OBJECTIVE

This study was performed to evaluate the differences in hair follicle survival by the type of follicular injury, including paring, fracture, and bulb injury.

METHODS

Seven healthy patients who underwent hair transplant surgery by FUE were enrolled in the study. For each patient, 10 single-hair follicular unit grafts per injury group (paring, fracture, bulb injury, or intact) were differentiated. Using sharp implanters, 10 grafts of each of the 4 injury types were transplanted into mice, and the mice were sacrificed 5 months after transplantation. The skin was excised at each of the 4 locations, and newly formed follicular units were counted and photographed under a microscope.

RESULTS

Of 70 hair follicles in each group, the number of successfully engrafted follicles was 50 (71.43%) in the intact group, 36 (51.43%) in the paring injury group, 9 (12.86%) in the fracture injury group, and 31 (44.29%) in the bulb injury group.

CONCLUSION

Grafts with minor injury had a lower survival rate than intact grafts. Fractured follicles showed the lowest survival rate.
Male Preconception Marijuana Use and Spontaneous Abortion
Authors: Harlow Alyssa F. , Wesselink Amelia K. , Hatch Elizabeth E. , Rothman Kenneth J. , Wise Lauren A.
Published: November 2020

Background:

Male marijuana use has increased steadily over the last decade, but its effect on risk of spontaneous abortion to our knowledge has not been studied.

Methods:

We analyzed data from Pregnancy Study Online, a North American prospective cohort study of pregnancy planners (2013–2019). During the preconception period, male and female participants completed baseline questionnaires on demographics, medical history, and behavioral factors, including marijuana use. Female participants identified pregnancy losses on bimonthly follow-up questionnaires and questionnaires completed in early and late pregnancy. We categorized frequency of male marijuana use in the 2 months before baseline as none, <1 time/week, or ≥1 time/week. We estimated the association between preconception male marijuana use and spontaneous abortion, adjusting for male and female confounders.

Results:

Among 1535 couples who conceived during follow-up, 9% of men reported preconceptional marijuana use <1 time/week and 8% ≥1 time/week. Nineteen percent of pregnancies ended in spontaneous abortion. Compared with no use, adjusted hazard ratios (HRs) for male marijuana use were 1.1 (95% confidence interval [CI] = 0.64, 1.7) for <1 time/week and 2.0 (95% CI = 1.2, 3.1) for ≥1 time/week. The association for ≥1 time/week persisted after restricting to couples where the female partner did not use marijuana (HR = 2.0, 95% CI = 1.1, 3.3), and was stronger for losses at <8 weeks’ gestation (HR = 2.5, 95% CI = 1.4, 4.3) and among males aged ≥35 years (HR = 4.1, 95% CI = 1.54, 11).

Conclusions:

Couples with male partners who used marijuana ≥1 time/week during preconception had greater risk of spontaneous abortion than couples with males who did not use marijuana.
FULL-THICKNESS MACULAR HOLE FORMATION AND SPONTANEOUS CLOSURE DURING INTRAVITREAL RANIBIZUMAB THERAPY FOR CENTRAL RETINAL VEIN OCCLUSION
Authors: Goel Neha
Published: November 2020

Purpose:

To describe the occurrence of full-thickness macular hole formation and spontaneous closure in a case of central retinal vein occlusion treated with intravitreal ranibizumab.

Methods:

A 67-year-old hypertensive man presented with acute central retinal vein occlusion with macular edema in his left eye for which he received intravitreal ranibizumab.

Results:

He developed a FTMH following the second injection, which was kept under observation. Recurrence of intraretinal edema allowed approximation of the MH edges which subsequently achieved closure with further intravitreal RBZ and formation of an epiretinal membrane.

Conclusion:

Full-thickness macular hole formation in acute central retinal vein occlusion after intravitreal ranibizumab, although rare, can occur in eyes with massive macular edema and absence of posterior vitreous detachment after intravitreal pharmacotherapy. Spontaneous closure of secondary holes can take place with improvement in visual acuity.
OCULAR INJURIES ASSOCIATED WITH ELASTIC EXERCISE BANDS
Authors: Ng Caleb C. , Carrera William , Peng Michelle Y. , Agarwal Anita , Chen Judy J. , Johnson Robert N. , Jumper James M. , McDonald Henry R.
Published: November 2020

Purpose:

To discuss the mechanism of injury and characterize the clinical features of ocular trauma associated with elastic cord exercise equipment band injuries in a consecutive series of patients seen at a single vitreoretinal surgery practice.

Methods:

We performed a retrospective review of all patients who were treated for blunt trauma from 2013 to 2020 at a single vitreoretinal practice.

Results:

Thirteen eyes from 11 patients met the inclusion criteria of possessing ocular trauma secondary to recoil from exercise bands. Presenting visual acuity ranged from 20/16 to HM (median: 20/32). The most frequently observed anterior segment pathologies were traumatic iritis (54%) and angle recession (31%). The most common posterior segment findings were vitreous hemorrhage (54%) and peripheral commotio retinae (54%). Three eyes (23%) required surgical intervention. Follow-up intervals ranged from 0 to 10 months (median: 1.75 months). Visual acuity at last examination ranged from 20/13 to 20/400 (median: 20/40).

Conclusion:

A wide spectrum of serious ocular injuries requiring medical and surgical intervention can result from this form of blunt ocular trauma. The frequency of this event would be decreased by the use of sports goggles and careful inspection of equipment for wear and over use.
TRIPLE THERAPY WITH RITUXIMAB, INTRAVENOUS IMMUNOGLOBULIN, AND INTRAVITREAL CORTICOSTEROIDS FOR MELANOMA-ASSOCIATED RETINOPATHY: TTRIIC DOES THE TRICK
Authors: Hamdan Saif A. , Breazzano Mark P. , Daniels Anthony B.
Published: November 2020

Purpose:

Melanoma-associated retinopathy responds poorly to currently-available therapies, with continued chronic decline in visual function being the norm, despite treatment. The purpose of this report is to describe the excellent response of a patient with melanoma-associated retinopathy to a triple therapy regimen of rituximab, intravenous immunoglobulin, and intravitreal corticosteroids.

Methods:

Single interventional case report describing management of melanoma-associated retinopathy and the patient's response to this treatment. Retinal function was monitored by serial visual acuity, fundus exams, Goldmann visual fields, and electroretinography.

Results:

A 65-year old man presented with new onset photopsia, decrease visual acuity and nyctalopia in both eyes in the setting of recently-diagnosed Stage IIIB melanoma, initially treated with wide local excision and adjuvant interferon. He was diagnosed with melanoma-associated retinopathy that initially worsened during his course of interferon for treatment of the melanoma. We initiated triple therapy with rituximab, intravenous immunoglobulin, and intravitreal corticosteroids, and this resulted in full return of electroretinography function and resumption of 20/20 visual acuity in both eyes.

Conclusion:

This is the first reported case of the utility of triple therapy with rituximab, intravenous immunoglobulin, and intravitreal steroids for successful management of melanoma-associated retinopathy as demonstrated by improvement in acuity, symptoms, visual fields, and electroretinography.
DELAYED-ONSET STREPTOCOCCUS INTERMEDIUS ENDOPHTHALMITIS FOLLOWING ANTI–VASCULAR ENDOTHELIAL GROWTH FACTOR INTRAVITREAL INJECTION
Authors: Mercer Gareth D. , Politis Michael , Campagnoli Thalmon R. , Galic Ivan J. , Chen John C.
Published: November 2020

Purpose:

Endophthalmitis following intravitreal anti–vascular endothelial growth factor injections is frequently caused by Streptococcus viridans organisms and tends to be aggressive. Herein, we present a case of postinjection Streptococcus viridans endophthalmitis presenting in an atypically delayed fashion with good visual outcome.

Methods:

Single clinical case report.

Results:

A 91-year-old woman treated with aflibercept for exudative age-related macular degeneration of the left eye presented to the emergency department with mild pain and visual acuity decline to counting fingers, pigmented anterior chamber cells and vitreous haze 7 weeks after her most recent intravitreal injection. She had no symptoms of systemic infection. The presumptive diagnosis initially was vitreous hemorrhage. Over 10 days of observation, she developed worsening pain and vitritis suggestive of endophthalmitis, leading us to perform vitrectomy with intravitreal vancomycin and ceftazidime. Vitreous biopsy was culture positive for Streptococcus intermedius, a type of viridans streptococcus typically associated with head and neck abscesses. The infection resolved and the patient's visual acuity returned to her baseline of 20/100, with no recurrence of infection after 4 months of follow-up.

Conclussion:

The virulence of viridans streptococci capable of producing postinjection endophthalmitis may vary widely. Infection ought to be suspected even in cases of delayed-onset intraocular inflammation.
Refractive outcomes and complications following angle supported, iris fixated, and posterior chamber phakic intraocular lenses bilensectomy
Authors: Vargas Veronica , Alio Jorge L.
Published: November 2020

Purpose of review

The manuscript presents a review of published studies regarding the outcomes, causes, and complications of phakic intraocular lens (pIOLs) bilensectomy.

All pIOLs will be explanted at some point, therefore is important to know the visual and refractive outcomes following bilensectomy.

Recent findings

There are few publications about the outcomes following pIOL bilensectomy; in all of them, cataract remains the main cause of bilensectomy. Other causes are endothelial cell density loss and pupil ovalization. The mean time between pIOL implantation and bilensectomy is longer in eyes implanted with an anterior chamber pIOL than in eyes implanted with a posterior chamber pIOL. There is a significant improvement in uncorrected and corrected distance visual acuity after bilensectomy. Some sight-threatening complications like retinal detachment and low endothelial cell density (ECD) after surgery have been reported. Current publications suggest that endothelial cell density loss is more frequent in eyes that underwent bilensectomy for an anterior chamber pIOL.

Good visual and refractive outcomes are achieved after bilensectomy, regular endothelial cell density measurements should be performed in all patients implanted with an anterior chamber pIOL to perform a safe bilensectomy.
A review of late intraocular lens opacifications
Authors: Kanclerz Piotr , Yildirim Timur M. , Khoramnia Ramin
Published: November 2020

Purpose of review

Phacoemulsification cataract surgery is one of the most commonly performed surgical procedure worldwide. In the majority of cases, intraocular lenses (IOLs) are implanted. Due to the increasing life expectancy and the fact that cataract surgery is performed in earlier stages, the anticipated IOL duration in the eye has increased over the last decades. The aim of this study was to review the types and describe the characteristics of late intraocular lens opacifications.

Recent findings

Calcification was the most commonly reported type of opacification in hydrophilic IOLs; it usually negatively impacted the visual function and required IOL explantation. Glistening manifested in hydrophobic acrylic lenses and was frequent in some IOL models. In most cases glistening and subsurface nanoglistenigs do not lead to a decline in visual acuity or require IOL exchange. Current studies indicate that fluid-related phenomena may induce straylight, leading to a decrease of comfort and quality of vision.

Several reports on late IOL opacifications have been published in recent years. In some cases, particularly in glistening, the development of the opacifications might be related to IOL aging. The influence of the fluid-related microvacuoles on the quality of vision requires further research.
Assessment of Lockdown Effectiveness in the Wake of COVID-19 in India Using the Auto Regressive Integrated Moving Average Model
Authors: Joseph Joel Joby , Paul Aby , Saijan Sanjo , Sebastian Stelvin , Joseph Jeeva , Vilapurathu Jobin Kunjumon
Published: November 2020

Background

The novel coronavirus disease (COVID-19) has been recognized as a global threat, and several studies are being conducted using various mathematical models to predict the probable evolution of this epidemic, which are subject to potential bias. In this study, we aimed to assess and compare the impact of lockdown among the Punjab, Delhi, and Gujarat states of India using the Auto Regressive Integrated Moving Average (ARIMA) model by comparing forecasted COVID-19 data with real-time data.

Methods

We analyzed the COVID-19 data of Indian states from the index case until May 17, 2020. Auto Regressive Integrated Moving Average (1,1,3) (0,0,0) model was used to forecast the possible cumulative cases until May 17, from data up to May 3, and compared with real-time data. Recovery rate, case-fatality rate, and test per millions of states were collated.

Results

The trend of cumulative cases in Punjab was moving downward below the forecasted lower confidence limit (R
2 = 0.9799), whereas the cumulative case trend of Delhi was moving along the forecasted upper confidence limit with the forecasted data until May 3 (R
2 = 0.9971) and the trend of cumulative cases was below the forecasted upper confidence limit (R
2 = 0.9992) in Gujarat.

Conclusions

In Gujarat and Delhi, the lockdown was not effective in controlling the rise in COVID-19 cases even after the 56th day of lockdown, whereas the Punjab state succeeded in preventing havoc of COVID-19. In lieu of lockdown, using facemasks and improving ventilation in closed workspace settings, crowded spaces, and close-contact settings are more pragmatic than keeping away from others in India.
A Child With Kawasaki Disease and Coronary Artery Aneurysm During Acute Epstein-Barr Virus Infection
Authors: Rafee Yaseen , Abdel-Haq Nahed
Published: November 2020

Kawasaki disease (KD) is the most common childhood cause of acquired coronary artery disease in the developed world. The diagnosis is often challenging, and atypical presentations may be associated with increased morbidity and mortality. We describe an 18-month-old toddler boy who developed clinical manifestations of KD with coronary artery aneurysmal dilatation and autoimmune hemolytic anemia during Epstein-Barr virus infection. The child had evidence of polyclonal activation of B cells that caused serological tests to be positive for different infections. Our case suggests an unusual immunological response to primary Epstein-Barr virus infection may lead to KD manifestation and coronary artery damage.
Disseminated Herpes Zoster During COVID-19
Authors: Voisin Olivier , Deluca Nina , Mahé Annabelle , Lelorc'h Erwan , Hubert Sidonie , Ménage Elodie , Borie Marie-Françoise , Azria Philippe , Fite Charlotte , Pilmis Benoit , Mourad Jean-Jacques
Published: November 2020

During the SARS-CoV-2 pandemic, a variety of dermatological conditions were reported by physicians. Given the context, these lesions have been labeled as secondary to SARS-CoV-2 infection. We report the case of a recurrence of herpes zoster in a patient hospitalized with an SARS-CoV-2 infection. The rash occurred on the 15th day of hospitalization while the patient was recovering from a severe form. Local swab showed the presence of varicella-zoster virus within the vesicles. Dermatological symptoms secondary to COVID-19 have been frequently described. This is the first case that demonstrates the recurrence of herpes zoster during a SARS-CoV-2 infection.
Coronavirus Disease 2019 in Children
Authors: Osorio María F. , Vaca Richard G.
Published: November 2020

Coronavirus disease 2019 pandemic has spread rapidly to the world. The disease can vary from mild cases to severe respiratory distress; this may increase rapidly and overwhelm the pediatric intensive care units. Lately, there have been various reports about a de novo multisystem inflammatory syndrome in children or pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus 2 infection. We classified the disease into 2 spectrums: the acute phase in severely ill patients and the postinflammatory phase. Neither of them could be classified as mild because there is enough evidence that supports a wide range of complications. The goals of this brief review were to summarize available literature and to give some awareness about the current status of the coronavirus disease 2019 in the severely ill patients during the active phase and postinflammatory phase.
Psychometric Properties of the Assessment of Perceived Access to Care (APAC) Instrument
Authors: Fortney John C. , Pyne Jeff M. , Hawrilenko Matt , Bechtel Jared M. , Moore Dana , Nolan John P. , Pfeiffer Paul , Shushan Stephanie , Shore Jay H. , Bowen Deb
Published: November 2020

Valid measures of perceived access are needed to measure whether health care systems are providing adequate access. This research reports on the psychometric properties of the Assessment of Perceived Access to Care (APAC), which was administered to 1004 Community Health Center patients screening positive for psychiatric disorders. Known-group validity was good, with 6 of the 8 hypothesized associations between social determinants of access and perceived access being significant (P < .01). Better access was significantly (P < .01) correlated with more outpatient mental health visits, indicating good convergent validity. The test-retest Pearson correlation coefficient (0.64) was statistically significant (P < .01). The APAC has acceptable psychometric properties.
Communicating a Complicated Medicaid Waiver Program to Enrollees in Iowa
Authors: Askelson Natoshia M. , Brady Patrick J. , Wright Brad , Ryan Grace , Momany Elizabeth , McInroy Brooke , Damiano Peter
Published: November 2020

Iowa expanded Medicaid eligibility with a waiver including a personal responsibility component. Early program evaluation revealed low compliance and awareness among members. There is little research on leveraging existing contact points in the health care system to effectively communicate with Medicaid enrollees. We interviewed outreach and enrollment staff at Federally Qualified Health Centers (FQHCs) to explore their work. We show that FQHCs use several strategies to enroll individuals in appropriate programs and support them in understanding and navigating their health insurance coverage. With increasingly complex Medicaid programs, this support will be more widely needed to prevent hardship and loss of coverage.
COVID-19 and Vaccine Hesitancy
Authors: Coustasse Alberto , Kimble Craig , Maxik Kenneth
Published: November 2020

A significant portion of the U.S. population may experience vaccine hesitancy of a new COVID-19 vaccine, which poses dangers to both the individual and their community, since exposure to a contagious disease places the person at risk, and individuals are far more likely to spread the disease to others if they do not get vaccinated. Many individuals are doubtful, and without the healthcare community, speaking with one voice has led to distrust. Experience from the influenza vaccines have shown vaccine acceptance has not been optimal, and this new vaccine, even though it is not approved, is already showing layperson skepticism compounded by political influences.
A Targeted “Top 100” High-Risk Care Management Program Improves Adherence to Best Practices
Authors: Conway Sarah J. , Singh Abhay , Peterson Cassy , Dunbar Linda , Himmelrich Sarah , Berkowitz Scott A.
Published: November 2020

Care management programs for high-risk patients have yielded inconsistent results in reducing health care expenditures. We reviewed the most successful programs and identified 5 best practice areas: (1) in-person patient meetings; (2) direct care manager/physician interaction; (3) provide transitional care services; (4) educate patients; and (5) provide medication review. We measured adherence to the best practices at baseline and at 6 and 9 months into the program for the highest-risk patients. The program increased adherence from baseline to each best practice area. Program enrollment increased at the 6-month follow-up but fell at the 9-month follow-up.
The Impact of COVID-19 on the Life Quality of Ambulatory Patients With Chronic Skin Conditions
Authors: Plachouri Kerasia-Maria , Georgiou Sophia
Published: November 2020

This article addresses the issue of the psychological distress of ambulatory dermatologic patients on the ground of cancelation of nonurgent dermatology visits during the SARS-CoV-2 pandemic, as well as the risk of underestimating the emotional suffering of patients with chronic skin diseases, which traditionally would not qualify as urgent cases.
Single-domain antibodies for radio nuclear imaging and therapy of esophageal squamous cell carcinoma: a narrative review
Authors: Liu Huifang , Nie Xu , Tian Zhenchao , Chen Dan , Chen Xueli , Zeng Qi , Xu Xinyi
Published: November 2020

Single-domain antibodies have the characteristics of small molecular weight, strong tissue penetration, and high affinity, and are widely used to construct molecular probes for disease diagnosis and treatment. This article reviews molecular imaging studies including positron emission tomography (PET), single-photon emission computed tomography/computed tomography (CT), PET/CT, and fluorescent imaging of molecular probes composed of single-domain antibodies against eight esophageal squamous cell carcinoma biological targets. These 8 targets are highly expressed on the membrane of esophageal squamous cell carcinoma cells and include epidermal growth factor receptor, human epidermal growth factor receptor 2, human epidermal growth factor receptor 3, hepatocyte growth factor receptor, vascular endothelial growth factor receptor 2, chemokine receptor 4, chemokine receptor 7, and carcinoembryonic antigen. The current problems and solutions are also discussed to provide a reference for future design of molecular imaging probes targeting esophageal squamous cell carcinoma.
Real-World Compliance With Follow-up in 2,554 Cochlear Implant Recipients: An Analysis of the HERMES Database
Authors: Shapiro Scott B. , Lipschitz Noga , Kemper Nathan , Abdelrehim Lamiaa , Hammer Theresa , Wenstrup Lisa , Breen Joseph T. , Grisel Jedidiah J. , Samy Ravi N.
Published: November 2020

Background:

Traditional paradigms of care recommend close audiology follow-up and regular speech perception outcomes assessment indefinitely for cochlear implant (CI) recipients after device activation. However, there is scant published data on actual compliance with this paradigm in clinical practice.

Methods:

A multi-center cochlear implant database was queried to identify follow-up rates after cochlear implantation. Follow-up rates where speech perception outcomes assessment occurred at 1-, 3-, 6-, 12-, 18-, and 24-months post-activation were determined by tabulating observed follow-up divided by expected follow-up (O/E ratio) expressed as a percentage. To determine all-cause audiology follow-up rates (with or without testing speech perception outcomes assessment), the database patients from two participating centers (one private practice and one academic center) were similarly analyzed using electronic health record (EHR) data to calculate O/E rates where audiology follow-up occurred for any reason.

Results:

O/E follow-up rates where speech perception outcomes assessment occurred was 42, 40, 31, 29, 5, and 22% for 1-, 3-, 6-, 12-, 18-, and 24-months post-activation, respectively (n = 2,554). All-cause audiology follow-up rates (with or without speech perception outcomes assessment) using EHR-confirmed data from two individual centers were 97, 94, 81, 66, 41, and 35% at 1-, 3-, 6-, 12-, 18-, and 24-months post-activation visits, respectively (n = 118).

Conclusions:

Compliance with audiology follow-up and speech perception outcomes assessment is generally low and decreases significantly as time post-activation increases. Future paradigms of care for CI should be designed recognizing the significant attrition that occurs with CI follow-up.
Systematic Review of Endoscopic Ear Surgery Outcomes for Pediatric Cholesteatoma
Authors: Basonbul Razan A. , Ronner Evette A. , Kozin Elliott D. , Lee Daniel J. , Cohen Michael S.
Published: November 2020

Objective:

Endoscopic ear surgery (EES) has been increasingly adopted to enhance visualization during otologic surgery including pediatric cholesteatoma resection. The purpose of this study is to systematically review the current literature reporting rates of residual cholesteatoma to evaluate outcomes of EES in the pediatric population.

Data Sources:

PubMed, Embase, Cochrane.

Study Selection:

Using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis recommendations (PRISMA), we systematically reviewed studies that reported outcomes for cholesteatoma surgery in children using the endoscope. Studies were included if they described the use of the endoscope for middle ear surgery and measured outcomes following cholesteatoma resection in pediatric patients.

Data Extraction:

Identified articles were assessed for study design, sample size, inclusion of pediatric population, the presence of a comparison group, outcomes measured such as: residual disease rate, recurrent cholesteatoma, audiologic outcome, quality of life measures, and complications.

Data Synthesis:

Fourteen articles in the literature discussed cholesteatoma outcomes in children when the endoscope was employed. Residual disease rate ranged from 0 to 22% when endoscope was used for dissection compared with 11 to 55% when endoscope was used for inspection or not at all. A meta-analysis was conducted on 11 studies. There was a significant risk reduction in residual disease rates for endoscopic dissection when compared with microscope (RR = 0.48, 95% CI = 0.37–0.63, p < 0.001).

Conclusion:

Among the studies included in this review, EES was associated with lower rates of residual cholesteatoma compared with traditional microscopic techniques. Additional prospective studies are needed to further assess these findings.