bluuebunny/crossref_metadata_2025_split huggingface dataset:
PCR performance for the diagnosis of cutaneous leishmaniasis caused by Leishmania viannia complex using biopsy samples, compared with exudate samples from skin lesions on filter paper
Authors: Apaza-Castillo Yahanda Gisela , Aguilar-Ancori Elsa Gladys , Quispe-Flórez Mercedes Maritza , Ramírez-Soto Max Carlos , Pacheco-Venero Rosa Luz 
Published: July 2020

Abstract

Background
Cutaneous leishmaniasis (CL) is generally diagnosed by molecular methods, including PCR, using biopsy samples, skin scrapings and clinical exudates. In this study, we assessed the PCR performance for diagnosis of CL using skin of biopsy samples vs PCR of skin lesion exudate samples on filter paper and compared the diagnostic concordance of PCR using both sampling methods.

Methods
We assessed the PCR performance using 80 skin biopsy samples and 80 filter paper samples containing exudates from skin lesions obtained from 74 patients with clinical suspicion of CL in Cusco, Peru.

Results
: PCR using skin biopsy samples had superior diagnostic accuracy compared with filter paper PCR (62.5% [50/80] vs 38.7% [31/80], respectively; p˂0.005) and the diagnostic concordance between both sampling methods was ‘moderate’ (kappa coefficient=0.50, 95% CI 0.98 to 1.0).

Conclusions
PCR using biopsy samples remains the standard for diagnosis of CL.
Latent tuberculosis infection prevalence in rural Madagascar
Authors: Sadananda Gouri , Knoblauch Astrid M , Andriamiadanarivo Andry , Razafindrina Kimmerling , Ambinintsoa Ideal , Rabetombosoa Roger Mario , Pando Christine E , Tsang Lai Yu , Small Peter M , Rakotosamimanana Niaina , Grandjean Lapierre Simon 
Published: July 2020

Abstract

Background
Understanding latent Mycobacterium tuberculosis infection (LTBI) prevalence is crucial for the design of TB control strategies. There are no data on LTBI in rural Madagascar.

Methods
Tuberculin skin tests were performed in 98 adults aged &gt;15 y in five rural villages in the Ifanadiana district, Madagascar.

Results
Of adults, 78.6% were positive for LTBI, ranging between 28.6% and 95.0% among villages. The majority (65.3%) showed an induration reaction of &gt;15 mm.

Conclusions
LTBI prevalence is high in rural Madagascar. Long-term TB control strategies including LTBI testing and treatment must account for high and heterogeneous prevalence in remote, underdeveloped areas.
Application of urine antigen assay to evaluate outcomes of praziquantel treatment and reinfection in opisthorchiasis in northeast Thailand
Authors: Worasith Chanika , Wangboon Chompunoot , Kopolrat Kulthida Y , Homwong Chutima , Sithithaworn Jiraporn , Techasen Anchalee , Thanan Raynoo , Khuntikeo Narong , Sithithaworn Paiboon 
Published: July 2020

Background
A urine antigen assay was applied to evaluate chemotherapeutic outcomes and reinfection patterns of opisthorchiasis in Thailand.

Methods
We used a prospective study design by following opisthorchiasis subjects at baseline and post-treatment using a urine antigen assay and faecal examination by the formalin–ethyl acetate concentration technique (FECT).

Results
The antigen of Opisthorchis viverrini in urine diminished within 4 weeks after praziquantel treatment. Concurrent faecal examinations by FECT showed that faecal eggs were negative at 4 weeks after treatment. In a subsequent study, reinfection rates and intensity patterns of O. viverrini were evaluated at 48 weeks after praziquantel treatment. Within a group of subjects with curative treatment (n=137), 16.8% became reinfected according to FECT and 27.7% according to the urine antigen assay (p&lt;0.05). There were significant correlations in intensity of infection between pretreatment and at 48 weeks post-treatment in both faecal egg counts and antigen levels in urine.

Conclusions
The results suggested that in addition to screening, the urine antigen assay is an efficient tool for monitoring outcomes of drug treatment and reinfection in opisthorchiasis. Due to the ease of urine sample collection and handling, the urine assay becomes an alternative method to faecal examination for diagnosis and monitoring of opisthorchiasis.
Emergence and evolution of highly pathogenic porcine epidemic diarrhea virus by natural recombination of a low pathogenic vaccine isolate and a highly pathogenic strain in the spike gene
Authors: Wang Huinan , Zhang Libo , Shang Yuanbin , Tan Rongrong , Ji Mingxiang , Yue Xinliang , Wang Nannan , Liu Jun , Wang Chunhua , Li Yonggang , Zhou Tiezhong 
Published: July 2020

AbstractOutbreaks of a new variant of porcine epidemic diarrhea virus (PEDV) at the end of 2010 have raised interest in the mutation and recombination of PEDV. A PEDV strain (CN/Liaoning25/2018) isolated from a clinical outbreak of piglet diarrhea contained a 49-bp deletion in the ORF3 gene. This deletion is considered a genetic characteristic of low pathogenic attenuated vaccine strains. However, CN/Liaoning25/2018 was highly pathogenic. Complete genome sequencing, identity analysis, phylogenetic tree construction, and recombination analysis showed that this virus was a recombinant strain containing the Spike (S) gene from the highly pathogenic CN/GDZQ/2014 strain and the remaining genomic regions from the low pathogenic vaccine isolate SQ2014. Histopathology and immunohistochemistry results confirmed that this strain was highly pathogenic and indicated that intestinal epithelial cell vacuolation was positively correlated with the intensity and density of PEDV antigens. A new natural recombination model for PEDV was identified. Our results suggest that new highly pathogenic recombinant strains in the field may be generated by recombination between low pathogenic attenuated live PEDV vaccines and pathogenic circulating PEDV strains. Our findings also highlight that the 49-bp deletion of the ORF3 gene in low pathogenic attenuated vaccine strains will no longer be a reliable standard to differentiate the classical vaccine attenuated from the field strains.
Prospective Randomized Controlled Trial of Video- Versus Recall-Assisted Reflection in Simulation-Based Teaching on Acquisition and Retention of Airway Skills Among Trainees Intubating Critically Ill Patients*
Authors: Prakash Shivesh , Bihari Shailesh , Laver Russell , Chandran Giresh , Kerr Lachlan , Schuwirth Lambert , Bersten Andrew 
Published: July 2020

Objectives:Conventionally, simulation-based teaching involves reflection on recalled events (recall-assisted reflection). Instead of recall, video-assisted reflection may reduce recall bias and improve skills retention by contributing to visual memory. Here, we test the hypothesis that when compared with recall, video-assisted reflection results in higher acquisition and retention of skills involved in airway management among junior critical care doctors.Design:Randomized control trial. Participants were randomized 1:1 to video-assisted reflection or recall-assisted reflection group.Setting:University-affiliated tertiary care center.Subjects:Junior critical care doctors.Intervention:Video-assisted reflection.Measurements and Main Results:All participants underwent simulation-based teaching of technical and nontechnical airway skills involved in managing a critically ill patient. These skills were assessed before, post-workshop, and in the following fourth week, by two independent blinded assessors using a validated scoring tool. Quality of debrief was assessed using a validated questionnaire. Repeated-measures analysis of variance was used to assess time and group interaction. Forty doctors were randomized. At baseline, the groups had similar airway experience (p= 0.34) and skill scores (p= 0.97). There was a significant interaction between study groups and changes over time for total skill scores (F[2, 37] = 4.06;p= 0.02). Although both the study groups had similar and significant improvement in total skills scores at the postworkshop assessment, the decline in total skills scores at delayed assessment (F[1, 38] = 5.64;p= 0.02) was significantly more in the recall-assisted reflection group when compared with the video-assisted reflection group. This resulted in lower mean skill scores in the recall-assisted reflection group when compared with the video-assisted reflection group in the delayed assessment (89.45 [19.32] vs 110.10 [19.54];p< 0.01). Better retention was predominantly in the nontechnical skills. The perceived quality of debrief was similar between the two groups.Conclusion:When compared with recall, video-assisted reflection resulted in similar improvement in airway skills, but better retention over time.
Intravascular Cutaneous Disorders. A Clinicopathologic Review
Authors: Vilas Boas Pedro , Cerroni Lorenzo , Requena Luis 
Published: July 2020

Abstract:Intravascular proliferations of the skin are clinically heterogeneous and may present with a wide range of clinical features, including violaceous papules, nodules, plaques, or other unspecific cutaneous lesions. Histopathologically, these conditions are characterized by proliferation of different cell types within the lumina of dermal vessels and endothelial cell hyperplasia. Immunohistochemistry is the best tool to identify the nature of the intravascular proliferating cells and the type of involved vessel. In this review, we analyzed the clinicopathologic and immunohistochemical characteristics of intravascular large cell lymphoma, T-cell and natural killer-cell intravascular large cell lymphoma, intralymphatic variant of CD30+cutaneous lymphoproliferative disorders, benign atypical intralymphatic CD30+T-cell proliferation, reactive angioendotheliomatosis, intralymphatic histiocytosis, papillary intralymphatic angioendothelioma or Dabska tumor, glomeruloid hemangioma, papillary hemangioma, intravascular papillary endothelial hyperplasia or Masson phenomenon, and the intralymphatic involvement of Merkel cell carcinoma, cutaneous metastases, and cutaneous angiosarcoma.
Psoriasis With Eczematous Features: A Retrospective Clinicopathologic Study
Authors: Noorily Ariella R. , Criscito Maressa C. , Cohen Jeffrey M. , Brinster Nooshin K. 
Published: July 2020

Background:Dermatopathologists sometimes encounter patients with features of psoriasis vulgaris and additional changes of eczematous dermatoses. These cases are challenging to diagnose, and the clinical implications are unclear. In the age of targeted therapy, it is important to improve our understanding of these findings so that patients are managed appropriately.Objective:To characterize the clinical characteristics, histopathological features, diagnostic workup, successful treatment, and outcomes of patients with overlapping histopathologic features of psoriasis vulgaris and eczema.Methods:We conducted a retrospective chart review of 20 patients who had received the histopathologic diagnosis of psoriasis vulgaris with eczematous changes noted on skin biopsy. A database that included information about clinical characteristics, comorbidities, histopathological features, diagnostic workup, treatment modalities, and outcomes was created and analyzed.Results:Twenty patients were included in this study, with an average age of 57.3 years. After clinicopathologic correlation, most patients were diagnosed with psoriasis (85%), and the remainder were determined to have an eczematous dermatitis. Thirty-five percent of patients were diagnosed with allergic contact dermatitis, either in combination with psoriasis (6 patients) or alone (1 patient). Topical glucocorticoids were the most common effective therapy used, and systemic therapies were required in nearly half of patients for successful treatment.Conclusion:This study offers insights into the clinically and histopathologically challenging diagnosis of psoriasis vulgaris with eczematous changes and offers the diagnostic term “eczematized psoriasis” to describe these patients. The presence of allergic contact dermatitis should be considered in these patients.
Expression of androgen receptors in the structures of vulvovaginal tissue
Authors: Palacios Santiago 
Published: July 2020

Abstract

Importance and Objective:
Little is known about the role of androgens in the female genital tract, specifically in the vulvovaginal area. The abundance of androgen receptors in this area could help us to explain their role. The main objective of the present article is to review current data on androgen receptors in the different structures of vulvovaginal tissues.

Methods:
A review of the literature using data from PubMed was carried out on androgen receptors in the vulva, labia majora and minora, vestibule, clitoris, and vagina. The effects of androgens and regulation of androgen receptors both in the embryo and in premenopausal and postmenopausal women were also reviewed. Given the characteristics of this review, we also analyzed animal studies and animal models of human disease. There were no filters or restrictions with respect to the date of publication.

Discussion:
Androgen receptors have been detected throughout the genitourinary tract by means of Western blot, immunohistochemistry, ligand binding, and gene expression. They are present in the labia majora and minora, the clitoris, the vestibule, and in the three layers of the vaginal mucosa (epithelium, lamina propria, and muscularis). More specifically, studies on the labia majora have shown that androgen receptors seem to be particularly abundant in epidermal keratinocytes and in dermal fibroblasts. Androgen receptors are also abundant in the epidermis, especially in the keratinocytes, and in the dermis of the labia minora and vestibule, where they are more numerous than in the vagina. Androgen receptors have also been found in the Bartholin glands.

Conclusions:
Estrogens play a major role in the maintenance of vaginal physiology. Although little is known about the role of androgens in the genital apparatus of women, specifically in the vulvovaginal area, the abundance of androgen receptors could enable us to explain their role. Androgens and estrogens play a major role in the maintenance of vaginal physiology. Better knowledge of the role of androgens and their receptors in vulvovaginal tissue would make it possible to discern their effects on female genitalia and help us to understand new therapeutic strategies.
PARACENTRAL ACUTE MIDDLE MACULOPATHY AS A PRESENTING SIGN OF CENTRAL RETINAL ARTERY OCCLUSION IN SICKLE CELL DISEASE TREATED WITH TISSUE PLASMINOGEN ACTIVATOR
Authors: Chua Michael R. , Giovinazzo Jerome V. , Kaplan Richard I. , Connor Thomas , Kellner Christopher , Barash Alexander , Rosen Richard B. 
Published: July 2020

Purpose:
We report the case of a 27-year-old monocular woman with a history of sickle cell disease who received intra-arterial tissue plasminogen activator (tPA) after presenting with acute painless vision loss secondary to incomplete central retinal artery occlusion presenting as paracentral acute middle maculopathy in her left eye.

Methods:
Ultrawidefield fundus photography, ultrawidefield fluorescein angiography, en face optical coherence tomography (OCT), and optical coherence tomography angiography (OCTA) were obtained and reviewed, followed by cerebral angiography and infusion of intra-arterial tissue plasminogen activator.

Results:
A patient with a history of sickle cell disease presented with a new onset of a dense central scotoma, and the visual acuity diminished to 20 of 200 from baseline 20 of 20 in her left eye. Fluorescein angiogram was nondiagnostic. Optical coherence tomography revealed perifoveal hyper-reflective bands in the inner nuclear layer in a pattern characteristic of paracentral acute middle maculopathy. The patient received intra-arterial tissue plasminogen activator through her left ophthalmic artery shortly after presentation, resulting in a gradual restoration of the visual acuity to 20 of 20 in the three months after the procedure.

Conclusion:
This is the first report describing the use of intra-arterial tissue plasminogen activator to treat incomplete central retinal artery occlusion presenting as a paracentral acute middle maculopathy lesion in a patient with sickle cell disease.
SURGICAL REMOVAL AFTER IATROGENIC SUBRETINAL INJECTION OF AN INTRAVITREAL DEXAMETHASONE IMPLANT
Authors: da Cruz Natasha F. S. , Kawamuro Mariana , Hilgert Gabriel R. , Pipolo Gabriel S. R. , Maia Mauricio 
Published: July 2020

Purpose:
To report a rare case of subretinal migration of an intravitreal dexamethasone implant to treat macular edema secondary to diabetic retinopathy in a vitrectomized eye and the surgical outcome.

Observations:
A pars plana vitrectomy and a retinotomy were performed to remove the implant and restore vision.

Conclusion and Importance:
Subretinal dislodgement of intravitreal implants is a rare and preventable complication. In the current case, we speculated that this complication might have been related to the injection technique, a possible unrecognized retinal perforation before the injection of the implant, or delayed treatment with the implant. Because a retinal detachment and vitreoretinal proliferation were observed, surgical management was required. Increasing widespread application of any technology may lead to a more significant risk of complications, and ophthalmologists should be aware of this potential risk.
Challenges of Implementing the Choosing Wisely Guideline to Promote Sleep and Rest at Night for Hospitalized Patients
Authors: Graham Kimberly , Ogbuji Grace , Williams Zainab , Crain Maria , Rolin Barbara , Juala Jeremy , Larbi Ida , Bernard Noreen , Oster Cynthia A. , Baird Marianne , Gullatte Mary Magee 
Published: July 2020

Background:
Evidence suggests that a lack of sleep among patients during hospitalization can impact their health and well-being.

Local Problem:
On inpatient units, patients experience lack of sleep due to noise and multiple interruptions at night.

Methods:
A pilot intervention to support the initiative, “Don't wake the patient for routine care unless the patient's condition or care specifically requires it,” was implemented on 3 units in 3 hospitals. All the 3 units had experienced patient concerns about lack of sleep at night.

Interventions:
Nurses implemented the project using a purposeful strategy of sleep masks, earplugs, noise detectors, and bundling care.

Results:
Positive experiences of those patients who participated in the sleep intervention.

Conclusions:
There was multidisciplinary support to promote a better patient experience of nighttime sleep. The experiences across the 3 hospital units were positive for providers, patients, and patients' families.
Early comprehensive testing for COVID-19 is essential to protect trauma centers
Authors: Hu Parker , Jansen Jan O. , Uhlich Rindi , Black Jonathan , Pierce Virginia , Hwang James , Northern David , Stephens Shannon W. , Lee Rachael A. , Gelbard Rondi B. , Holcomb John B. , Kerby Jeffrey , Cox Daniel ,   UAB Acute Care Surgery COVID-19 Consortium
Published: July 2020

BACKGROUND
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic presents a threat to health care systems worldwide. Trauma centers may be uniquely impacted, given the need for rapid invasive interventions in severely injured and the growing incidence of community infection. We discuss the impact that SARS-CoV-2 has had in our trauma center and our steps to limit the potential exposures.

METHODS
We performed a retrospective evaluation of the trauma service, from March 16 to 30, following the appearance of SARS-CoV-2 in our state. We recorded the daily number of trauma patients diagnosed with SARS-CoV-2 infection, the presence of clinical symptoms or radiological signs of COVID-19, and the results of verbal symptom screen (for new admissions). The number of trauma activations, admissions, and census, as well as staff exposures and infections, was recorded daily.

RESULTS
Over the 14-day evaluation period, we tested 85 trauma patients for SARS-CoV-2 infection, and 21 (25%) were found to be positive. Sixty percent of the patients in the trauma/burn intensive care unit were infected with SARS-CoV-2. Positive verbal screen results, presence of ground glass opacities on admission chest CT, and presence of clinical symptoms were not significantly different in patients with or without SARS-CoV-2 infection (p > 0.05). Many infected patients were without clinical symptoms (9/21, 43%) or radiological signs on admission (18/21, 86%) of COVID-19.

CONCLUSION
Forty-five percent of trauma patients are asymptomatic at the time of SARS-CoV-2 diagnosis. Respiratory symptoms, as well as verbal screening (recent fevers, shortness of breath, cough, international travel, and close contact with known SARS-CoV-2 carriers), are inaccurate in the trauma population. These findings demonstrate the need for comprehensive rapid testing of all trauma patients upon presentation to the trauma bay.

LEVEL OF EVIDENCE
Diagnostic tests or criteria, level III, Therapeutic/care management, level IV.
Lessons Learned About Peristomal Skin Complications
Authors: Salvadalena Ginger , Colwell Janice C. , Skountrianos George , Pittman Joyce 
Published: July 2020

PURPOSE:
The aims of this study were to (1) describe the demographic and clinical characteristics of the individuals with peristomal skin complications (PSCs); (2) describe the PSCs; (3) examine the relationship of PSC occurrence and severity with possible risk factors, and (4) describe how PSCs were managed clinically.

DESIGN:
Secondary analysis of data from randomized controlled study, the ADVOCATE trial.

SUBJECTS AND SETTING:
Study participants (n = 153) were divided into 2 groups: those who did not experience a PSC (n = 80) and those who did (n = 73). A participant was considered to have sustained a PSC during the original study if his or her Discoloration, Erosion, and Tissue score increased above the baseline score.

METHODS:
Demographic and pertinent characteristics of participants with and without PSCs were compared. In addition, data from the 73 participants who sustained PSCs were further analyzed to characterize and describe the PSCs, to investigate potential risk factors associated with the occurrence and severity of a PSC, and for clinical management. Group comparisons were made via t tests for continuous variables, χ2 test or Fisher exact test for categorical variables, and generalized linear models for identification of risk factors.

RESULTS:
The majority of the PSCs were mild or moderate in nature, and they were most commonly categorized by the investigators as irritant dermatitis. Two risk factors were associated with an increased likelihood of experiencing a PSC: stoma duration and peristomal skinfold or creases. Within the study period, the odds of sustaining a PSC increased over time and the presence of skinfolds or creases increased the likelihood of PSCs. Peristomal skin complication severity was likely to be worse with an ileostomy and less severe as stoma duration increased. Products used to manage PSCs consisted of barrier rings/seals, skin barrier powder, and paste or paste strips.

CONCLUSIONS:
Ileostomy is associated with higher risk of a severe PSC and peristomal skin creases or folds. Patient follow-up should be on a structured schedule beyond the first few weeks after surgery because the likelihood of getting a PSC increases over time. This approach may help improve outcomes, particularly for those with an ileostomy and challenging skin contours.