bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Case Study of Early Postpartum Excessive Breast Engorgement: Is it Related to Feedback Inhibition of Lactation?
Authors: Coban Asuman , Bayraktar Sema , Yıldız Nevin , Tunçel Duygu , Gökçay Gülbin , Ince Zeynep 
Published: October 2020

Introduction There is limited information about problems of feedback inhibition of lactation which should be considered as a rare cause of breast engorgement. We report the management of excessive breast engorgement in a mother with a presumptive diagnosis of a defect in the feedback inhibition of lactation. Main issue The participant, who had been discharged on postpartum Day 2 while breastfeeding her infant, was readmitted to the hospital the next day with engorgement of the breasts and cessation of milk flow. Pumping and application of cold dressings alone did not work effectively. The severity of the symptoms decreased only after the addition of an anti-inflammatory drug and a prolactin inhibitor. Management The participant received breastfeeding counseling, family-centered care, and support for pumping equipment. An anti-inflammatory drug was started and a low dose prolactin inhibitor was given. The difficulty was the management of extensive and painful breast engorgement and the re-establishment of milk flow. At postpartum Day 14, the participant and her infant were discharged with effective breastfeeding status. Conclusions The recognition of a problem in the feedback inhibition of lactation as a cause of breast engorgement is important because it may be unresponsive to classical treatment methods resulting in cessation of milk flow. With the cautious use of low-dose cabergoline, in addition to other treatment strategies, milk flow can be reduced in a controlled manner while ensuring the continuity of milk production. An early diagnosis, interdisciplinary approach, and a close follow-up of the mother–infant pair are essential for preserving lactation.
Mortality in patients with systemic lupus erythematosus and neuropsychiatric involvement: A retrospective analysis from a tertiary referral center in the Netherlands
Authors: Monahan Rory C , Fronczek Rolf , Eikenboom Jeroen , Middelkoop Huub A M , Beaart-van de Voorde Liesbeth J J , Terwindt Gisela M , van der Wee Nic J A , Rosendaal Frits R , Huizinga Tom W J , Kloppenburg Margreet , Steup-Beekman Gerda M 
Published: October 2020

Objective We aimed to evaluate all-cause and cause-specific mortality in patients with systemic lupus erythematosus (SLE) and neuropsychiatric (NP) symptoms in the Netherlands between 2007–2018. Methods Patients visiting the tertiary referral NPSLE clinic of the Leiden University Medical Center were included. NP symptoms were attributed to SLE requiring treatment (major NPSLE) or to other and mild causes (minor/non-NPSLE). Municipal registries were checked for current status (alive/deceased). Standardized mortality ratios (SMRs) and 95% confidence intervals (CI) were calculated using data from the Dutch population. Rate ratio (RR) and 95% CI were calculated using direct standardization to compare mortality between major NPSLE and minor/non-NPSLE. Results 351 patients were included and 149 patients were classified as major NPSLE (42.5%). Compared with the general population, mortality was increased in major NPSLE (SMR 5.0 (95% CI: 2.6–8.5)) and minor/non-NPSLE patients (SMR 3.7 (95% CI: 2.2–6.0)). Compared with minor/non-NPSLE, mortality was similar in major NPSLE patients (RR: 1.0 (95% CI: 0.5–2.0)). Cause-specific mortality rates demonstrated an increased risk of death due to infections in both groups, whereas death due to cardiovascular disease was only increased in minor/non-NPSLE patients. Conclusion Mortality was increased in both major NPSLE and minor/non-NPSLE patients in comparison with the general population. There was no difference in mortality between major NPSLE and minor/non-NPSLE patients.
Quantification of Severity of Unilateral Coronal Synostosis
Authors: Kronig Sophia A. J. , Kronig Otto D. M. , Vrooman Henri A. , Veenland Jifke F. , Van Adrichem Léon N. A. 
Published: October 2020

Objectives: Severity of unilateral coronal synostosis (UCS) can vary. Quantification is important for treatment, expectations of treatment and natural outcome, and education of the patient and parents. Design: Retrospective study. Setting: Primary craniofacial center. Patients, Participants: Twenty-three preoperative patients with unilateral coronal craniosynostosis (age < 2 years). Intervention: Utrecht Cranial Shape Quantifier (UCSQ) was used to quantify severity using the variables: asymmetry ratio of frontal peak and ratio of frontal peak gradient. Main Outcome Measures(s): The UCSQ variables were combined and related to visual score using Pearson correlation coefficient; UCSQ and visual score were additionally compared to Di Rocco classification by one-way analysis of variance or Kruskal-Wallis test. All measurements were made on computed tomography scans. Results: Good correlation between UCSQ and visual score was found ( r = 0.67). No statistically significant differences were found between group means of UCSQ in the 3 categories of Di Rocco classification ( F 2,20 = 0.047; P > .05). Kruskal-Wallis test showed no significant differences between group means of visual score in the 3 categories of Di Rocco classification (Kruskal-Wallis H (2) = 0.871; P > .05). Conclusions: Using UCSQ, we can quantify UCS according to severity using characteristics, it outperforms traditional methods and captures the whole skull shape. In future research, we can apply UCSQ to 3D-photogrammetry due to the utilization of external landmarks.
Direct Oral Anticoagulant Use in Chronic Kidney Disease and Dialysis Patients With Venous Thromboembolism: A Systematic Review of Thrombosis and Bleeding Outcomes
Authors: Cheung Catherine Y. S. , Parikh Jash , Farrell Ashley , Lefebvre Melissa , Summa-Sorgini Claudia , Battistella Marisa 
Published: October 2020

Objective: To evaluate how treatment with DOACs for VTE affects thrombosis and bleeding outcomes compared to warfarin in CKD and dialysis patients. Data Sources: A literature search was conducted for studies evaluating VTE and bleeding outcomes with DOAC use in CKD and dialysis patients. Searches conducted through EMBASE, MEDLINE/PubMed, Scopus, and Cochrane Central Register of Controlled Trials, from inception to September 22, 2020. Study Selection and Data Extraction: Randomized controlled trials, cohort studies, and case series with ≥10 patients included. Data Synthesis: From 7286 studies, nine studies met inclusion criteria. There was no significant difference between DOACs (dabigatran, rivaroxaban, apixaban) and warfarin for reducing recurrent VTE and bleeding events in moderate CKD patients. The risk of overall major bleeding increased when the degree of kidney impairment increased. There was no significant difference between apixaban and warfarin for VTE outcomes in dialysis patients. Relevance to Patient Care and Clinical Practice: There continues to be a controversial debate whether it may be more beneficial to use DOACs versus warfarin in CKD/dialysis patients with venous thromboembolism (VTE). The risk vs benefit of using DOACs in the CKD/ESKD population should continue to be evaluated for each individual patient. Conclusion: Apixaban may be used cautiously as an alternative in acute VTE treatment in severe CKD patients. Insufficient evidence is available to suggest the use of dabigatran and rivaroxaban in this patient population. The benefit of using DOACs in this population for VTE treatment should be weighed against the potential bleeding risk in patients with CKD.
Direct Oral Anticoagulants in the Treatment of Left Ventricular Thrombus: A Retrospective, Multicenter Study and Meta-Analysis of Existing Data
Authors: Cochran John M. , Jia Xiaoming , Kaczmarek Jessica , Staggers Kristen A. , Rifai Mahmoud Al , Hamzeh Ihab R. , Birnbaum Yochai 
Published: October 2020

Aim: To compare the safety and efficacy of direct oral anticoagulants (DOAC) relative to vitamin K antagonists (VKA) for the treatment of left ventricular thrombus (LVT). Methods: This retrospective study enrolled patients diagnosed with LVT from 2014-2017. Patient characteristics and outcomes within 12 months of LVT diagnosis were recorded and analyzed. A meta-analysis was also performed by pooling our results with existing data in literature. Results: 14 DOAC and 59 VKA patients were included. Baseline demographic and clinical characteristics were similar except for age. Although more strokes within 12 months occurred in VKA (15%) than in DOAC (0%) patients, this was not statistically significant ( P = 0.189). There were no significant differences in outcomes between patients on DOAC and VKA for acute coronary syndrome (ACS) (7%, vs 3.4%, P = .477), LVT resolution (86% vs 76%, P = .499) or bleeding (14% vs 14%, P = 1) within 12 months. The meta-analysis included 6 studies (n = 408 for DOACs; n = 1207 for VKA). There were no significant differences between DOACs versus VKAs with respect to odds for unresolved thrombus (OR 0.61, 95% CI 0.26,1.41), embolic events (OR 1.24, 95% CI 0.90,1.69), embolic events and death (OR 1.10, 95% CI 0.84,1.45) or bleeding events (OR 1.13, 95% CI 0.74,1.72). Conclusions: Our study and meta-analysis suggest similar efficacy and safety of DOACs in the treatment of LVT compared to VKA. These findings underscore the need for a randomized controlled trial.
Testing the Effects of Hookah Tobacco Social Media Risk Communication Messages Among Young Adults
Authors: Johnson Andrea C. , Mays Darren 
Published: October 2020

Background Hookah tobacco is commonly used among young adults, and use is driven in part by widespread misperceptions about risks. Social media use, particularly Instagram, is prominent in this population and exposure to commercial and user-generated content promoting hookah commonly occurs. Aims This study tested the effects of hookah tobacco risk messaging for delivery via Instagram as a strategy to offset exposure to content promoting hookah use among young adults. Method Young adult hookah smokers were recruited online for a 2 × 3 between-subjects experiment ( n = 601). Participants completed preexposure measures and were randomized to view hookah tobacco Instagram ads (commercial or user generated) with risk messages (none, risk education, or graphic risk). Stimuli were presented as a simulated Instagram feed. After viewing the stimuli, participants completed postexposure outcome measures. Results There was a statistically significant main effect of risk message type but no significant main effect of Instagram ad type or risk message type by ad type interactions. Exposure to the graphic risk and risk education messages were associated with lower intentions to engage with hookah tobacco ads on Instagram. Graphic risk and risk education messages produced greater negative emotional response and the graphic messages increased motivation to quit compared with Instagram ads alone. Discussion Findings provide preliminary evidence that hookah tobacco risk messages delivered via Instagram can offset the influence of content promoting the use of hookah tobacco. Conclusion This study represents an example of risk message testing and the results suggest the messages warrant further testing via social media delivery.
Complications associated with a flash glucose monitoring system in diabetic cats
Authors: Shoelson Adam M , Mahony Orla M , Pavlick Michelle 
Published: October 2020

Objectives Glucose monitoring is an integral part of diabetes management. Interstitial glucose monitoring systems are increasingly commonly being used for this purpose in dogs and cats, including the use of a flash glucose monitoring system (FGMS). The aim of this study was to describe the incidence and nature of complications associated with the use of an FGMS in diabetic cats. Methods The medical records of all cats that had placement of a 14-day FGMS during a 1-year period were retrospectively reviewed. Data retrieved included the number of days the sensor remained attached and functional, location of sensor placement and complications associated with the sensor. Complications were defined as early sensor detachment, sensor failure prior to the end of the 14-day monitoring period and dermatologic changes at the sensor site. Descriptive statistics were used to characterize the data. Results Twenty cats had a total of 33 FGMSs placed. The majority (30/33 [91%]) of sensors were placed over the dorsolateral aspect of the thorax just caudal to the scapula. Twenty (61%) FGMSs remained attached and functional for the full 14 days. The overall incidence of complications associated with FGMS use was 10/33 (30%). The most frequent complication was early sensor detachment (n = 5/33 [15%]). Mild dermatologic changes (erythema, crusts) were noted with 4/33 (12%) FGMSs. More serious complications (skin erosions, abscess formation) were noted with 2/33 (6%) FGMSs. Conclusions and relevance The use of the FGMS is relatively safe in cats, although there are potential complications that owners should be made aware of.
Visual loss after long-haul flight
Authors: Abdul Ghani Nurliyana Ain , Mohd Abdullah Azlindarita Aisyah Binti , Abdul Hamid Shamsiah , Yuhana Muhamad Yazli , Ramli Norlina 
Published: October 2020

Background: Deep cerebral venous sinus thrombosis is a reversible yet potentially serious thromboembolic event. A number of reports suggest a relationship between long-haul flights and thromboembolic events, mainly deep venous thrombosis (DVT) and pulmonary embolism (PE). It is rarely reported to cause deep cerebral venous sinus thrombosis. We report a case of a bilateral papilledema after long-haul flight secondary to deep cerebral venous sinus thrombosis with subsequent complete recovery post corticosteroid and anticoagulant therapy. Case: A case of a 21-year-old woman with no known medical illness who presented with gradual painless bilateral visual loss is described. She had a history of travelling on a long-haul flight 3 weeks prior to presentation. Examination showed presence of bilateral papilloedema, no vitritis, choroiditis and retinitis. Blood investigations showed raised international normalised ratio (INR). Otherwise, workup for infectious causes of optic disc swelling, connective tissue disease screening were normal. Magnetic resonance imaging (MRI) and magnetic resonance venography (MRV) of the brain showed loss of flow signal in the right transverse sinus and the left sigmoid sinus. Blood workup for preexisting hypercoagulable state was normal. She was diagnosed with deep cerebral venous sinus thrombosis and showed complete recovery with oral corticosteroid and anticoagulant therapy. Conclusion: Deep cerebral venous sinus thrombosis is a potentially serious consequence of long-haul flights. A high index of suspicion along with radiological techniques is needed for early detection and initiation of anticoagulation for this reversible condition.
Should we employ preoperative templating in hip hemiarthroplasty after femoral neck fracture? A nested case-control study
Authors: Pujol Oriol , Carrasco María G , Vicente Matías , Mimendia Iñaki , García Yaiza , Selga Jordi , Barro Víctor 
Published: October 2020

Introduction: Dislocation following hip hemiarthroplasty is a serious complication. It remains unclear if acetabular morphology is associated with a higher risk of dislocation. The aim of our study was to investigate whether there are differences in hip morphology radiological parameters between patients who have suffered a dislocation episode, and those who have not suffered a dislocation. Material and methods: Between January 2015 and December 2018, a nested case-control study was performed. From 707 patients who underwent hip hemiarthroplasty because of femoral neck fracture, 50 patients (50 hips) suffered an episode of dislocation. They were randomly matched with 94 patients (100 hips) without dislocation (ratio 1:2). Clinical data regarding demographics, medical comorbidities and surgical and radiological parameters were studied. Results: Statistically significantly smaller lateral centre-edge angle (LCEA) and femoral offset (FO) and greater Tönnis angle were found in the dislocation group. No differences in acetabular angle were seen. Neurological impairment prevalence was statistically significantly higher in patients who suffered a dislocation (60% vs. 44%, p = 0.011). Conclusions: The current study suggests that a smaller LCEA and FO, a greater TA, and neurological impairment could be related to a higher risk of hip hemiarthroplasty dislocation after femoral neck fracture in the elderly. We consider that preoperative templating could be helpful in identifying abnormal parameters and carefully planning surgery could lead to changes in treatment strategy, such as choosing a dual-mobility total hip arthroplasty.
Long peripheral catheters and midline catheters: Insights from a survey of vascular access specialists
Authors: Qin Kirby R , Pittiruti Mauro , Nataraja Ramesh M , Pacilli Maurizio 
Published: October 2020

Background: Peripheral intravenous access is no longer limited to the standard intravenous catheter (cannula). Devices varying in length, material and insertion technique, are increasingly accessible. There is substantial variability surrounding the nomenclature and use of these devices in the literature. We wished to understand the attitude of vascular access specialists towards the nomenclature and use of peripheral intravenous catheters (PIVCs), long peripheral catheters (LPCs) and midline catheters (MCs). Methods: A 15-question electronic survey was sent to members of the Association of Vascular Access (AVA) regarding the nomenclature and use of PIVCs, LPCs and MCs. Results: A total of 228 participants completed the survey. Approximately two-thirds of respondents use LPCs (65.8%) and MCs (71.9%) in their clinical practice. The most common indication for LPCs was difficult venous access (56.5%), while the most common indication for MCs was medium-term (1–4 weeks) intravenous therapy (62.7%). The majority of participants (57.9%) agreed with the following classification of peripheral intravenous devices: PIVCs: 2 to 6 cm in length, terminating distal to the axilla; LPCs: 6 to 15 cm in length, terminating distal to the axilla; MCs: 15–25 cm in length, terminating in the axilla. Participants suggested that the length of the catheter should be considered a general recommendation, as LPCs and MCs should be primarily differentiated by tip location. Conclusions: The majority of vascular access specialists from AVA have incorporated LPCs and MCs into their repertoire of peripheral venous access tools. We envisage that their use will increase as the clinical community becomes more familiar with these devices.
A telemedicine strategy to reduce waiting lists and time to specialist care: A retrospective cohort study
Authors: Pfeil Juliana N , Rados Dimitris V , Roman Rudi , Katz Natan , Nunes Luciana N , Vigo Álvaro , Harzheim Erno 
Published: October 2020

Introduction The demand for specialty care is rising worldwide. In the state of Rio Grande do Sul, Brazil, more than 150,000 people were waiting for specialist consultations in 2013. A telemedicine programme (RegulaSUS) developed referral protocols, audited waitlisted cases, authorised/prioritised referrals by risk and discuss deferred cases primary-care physician. This study assesses the effectiveness of RegulaSUS. Methods A retrospective cohort analysis with contemporaneous controls was performed from June 2014 to June 2016. Six medical specialties included in RegulaSUS (50,185 patients) were compared to 50,124 control patients waitlisted according to the usual routine (scheduled for specialty consultation at the next available date). The groups were matched (1:1) by semester and year of waitlisting and by the specialty demand-to-supply ratio. Primary outcomes were referral-to-consultation time and number of waitlisted patients. Results The mean referral-to-consultation time was 584.8 days in the intervention group and 607.0 days in controls ( p<0.001). For specialties regulated by RegulaSUS, the mean referral-to-consultation time was 237.6 days for higher-risk patients. At the end of the observation, 26,708 control patients had been unlisted compared to 31,050 patients in the intervention group (reduction of 53.5% vs. 61.9%, respectively; p<0.001). The number of cancelled referrals was lower in the control group ( n=14,403; 28.7%) than in the intervention group ( n=16,387; 32.7%; p<0.001). Discussion Telemedicine support for primary care effectively decreased the time to specialty consultation, reduced the number of waitlisted patients and allowed sicker patients to reach a specialist faster.
Teledentistry: Increasing utilisation of oral-health services for children in rural areas
Authors: Surdu Simona , Langelier Margaret 
Published: October 2020

Introduction The objective of this study was to evaluate factors influencing utilisation of follow-up oral-health services in general dentistry clinics among children subsequent to a teledentistry consultation and treatment with a paediatric dental specialist. Methods Conducted in 2017, the study included 144 children living in rural upstate New York who experienced a teledentistry consultation in 2015–2016 at one of several local general dentistry clinics. A remotely located paediatric dental specialist provided consultation services in the teledentistry visit and treatment services in the specialty dental clinic. Associations between follow-up services at the general dentistry clinics and patients’ characteristics, specialty treatment recommendations, case-management services, timeliness of treatments and travel distances were evaluated. Results The study results indicated that most children completed a treatment plan (97.2%) at the specialty clinic and subsequently accessed follow-up oral-health services at one of the local general dentistry clinics (77.1%) where teledentistry services were provided. Children’s utilisation of follow-up services in general dentistry clinics was associated with a shorter time to specialty treatment ( p = 0.013) and fewer case-management contacts ( p = 0.004). Children who had a longer time to treatment initiation ( p < 0.001) or completion ( p = 0.043) required significantly more case-management services than other children. Discussion The study found that case severity and compliance with treatment were predictors of utilisation of oral-health services in general dentistry clinics. An additional finding was that case-management interventions were important in facilitating specialty dental care.
A randomized controlled trial of cognitive behavioral therapy compared with diabetes education for diabetic peripheral neuropathic pain
Authors: Higgins Diana M , Heapy Alicia A , Buta Eugenia , LaChappelle Kathryn M , Serowik Kristin L , Czlapinski Rebecca , Kerns Robert D 
Published: October 2020

A randomized controlled trial compared cognitive behavioral therapy (CBT) and diabetes education (ED) as an adjunctive treatment for diabetic peripheral neuropathic pain (DPNP). We examined change from baseline to 12- and 36-week follow-up in overall pain intensity (NRS), neuropathic pain intensity/quality, pain interference, and mental health functioning, among others. Although CBT participants demonstrated improvement in pain intensity NRS, there were no between-condition differences at either follow-up. CBT reduced neuropathic pain intensity at 12-weeks more than ED. At 36-weeks, CBT was superior to ED for improving pain interference and mental health functioning. Results provide evidence of benefit of CBT for DPNP. ClinicalTrials.gov Identifier: NCT00830011