bluuebunny/crossref_metadata_2025_split huggingface dataset:
Culture-proven Bloodstream Infections at a Specialist Pediatric Hospital
Authors: Al Yazidi Laila S. , Outhred Alexander C , Britton Philip N. , Kesson Alison 
Published: March 2020

Background:
Bloodstream infection (BSI) is one of the leading causes of morbidity and mortality in children. This study was done to assess the local epidemiology and outcome of BSIs managed at a large specialist pediatric hospital with a focus on community-onset BSI.

Methods:
We retrospectively reviewed laboratory-confirmed BSI in children (0–18 years) at The Children’s Hospital at Westmead over a 3-year period (2014–2016). Laboratory data and patient medical records were used to determine BSI rates, blood culture contamination rates, patient demographics, isolate profile, antimicrobial resistance and mortality rate in this cohort.

Results:
In total, 47,368 blood cultures were collected; 1027 (2.2%) grew probable contaminants and 991 (2.1%) grew clinically significant isolates. Clinically significant bacteremia accounted for 4.8 per 1000 admissions, with 391 children managed for 465 culture-proven BSI episodes. One hundred thirty-one (28.2%) episodes were community-onset community-associated, and 334 (71.8%) were either community-onset healthcare-associated (HCA) (187; 40.2 %) or hospital-onset (147; 31.6%). Of the significant isolates, 243 (52.3%) were Gram-positive bacteria, 198 (42.6%) were Gram-negative bacteria, 6 (1.3%) were polymicrobial infections and 18 (3.9%) were yeast. Staphylococcus aureus (115; 24.7%) and Escherichia coli (54; 11.6%) were the most common organisms identified. Osteoarticular infection (44; 33.6%) and urosepsis (23; 17.6%) were the most frequent sites of infection associated with non-HCA BSI. Mortality at 30 days was reported in 15 (3.3%) children, all whom had preexisting comorbidities.

Conclusions:
The majority of BSI episodes managed in our hospital were either community-onset HCA or hospital-onset infections. This highlights the considerable importance of infection control and central venous catheter device care initiatives. Among community-associated BSI, S. aureus in association with osteoarticular infection was predominant.
Clinical and Laboratory Characteristics of Herpes Zoster in Patients With HIV/AIDS and Those With Juvenile Systemic Lupus Erythematosus
Authors: Da Silva Adriana Maria Paixao De Sousa , De Moraes-Pinto Maria Isabel , Succi Regina Célia Menezes , Terreri Maria Teresa , Machado Daisy Maria 
Published: March 2020

Background:
HIV infection and juvenile systemic lupus erythematosus (jSLE) are risk factors for the development of herpes zoster (HZ) and its complications. Both diseases share similar immunologic aspects, such as immunodeficiency and immune activation. Therefore, our objective was to evaluate and compare the frequency and characteristics of HZ episodes in pediatric patients with HIV infection and jSLE.

Methods:
A retrospective cohort study was carried out with the evaluation of 2 pediatric cohorts: HIV patients who were followed from January 1987 to December 2014 and patients with jSLE followed up from January 1990 to December 2014 in outpatient clinics.

Results:
Of the 190 HIV patients, 48 had HZ (25.3%), with 67 episodes; of the 92 patients with jSLE, 27 had HZ (29.3%), totaling 28 episodes. The median age at the first episode of HZ was higher in the jSLE than in the HIV group (8.9 vs. 12.5 years, respectively) (P = 0.020). HIV patients were more likely to have recurrent HZ (P = 0.025). In addition, there was a tendency for HIV patients to present with disseminated HZ more frequently (P = 0.060). Although the hospitalization rate was similar between groups, patients with jSLE received intravenous acyclovir more frequently (P = 0.014). When HIV non-immune reconstitution syndrome patients were compared with jSLE group, recurrence of HZ in HIV was the only significant difference between groups (P = 0.017).

Conclusions:
Patients with HIV had more recurrent HZ than patients with jSLE.
Population Pharmacokinetics of Cefoxitin Administered for Pediatric Cardiac Surgery Prophylaxis
Authors: Ricci Zaccaria , Benegni Simona , Cies Jeffrey J. , Marinari Eleonora , Haiberger Roberta , Garisto Cristiana , Rizza Alessandra , Giorni Chiara , Di Chiara Luca , Arpicco Silvia , Muntoni Elisabetta , Ferrari Fiorenza , Milla Paola 
Published: March 2020

Background:
Available data about pharmacokinetics (PK) of antimicrobials administered as surgical prophylaxis to children undergoing cardiac surgery with cardiopulmonary bypass (CPB) showed that drug concentrations during CPB may be supra or subtherapeutic. The aim of this study was to determine the population PK and pharmacodynamic target attainment (PTA) of cefoxitin during pediatric CPB surgery.

Methods:
A prospective interventional study was conducted. Cefoxitin (40 mg/kg, up to max 1000 mg) was administered before skin incision. Blood samples were obtained in the operatory room throughout surgery. Population PK, PTA, and safety of cefoxitin were evaluated in neonates, infants, children <10 and >10 years old.

Results:
Forty patients were enrolled. Cefoxitin levels correlated with time from bolus administration (r = −0.6, P = 0.0001) and, after 240 minutes from bolus, drug values below the target (8 mg/L) were shown. Cefoxitin concentrations were best described by a one-compartment model with first order elimination. A significant relationship was identified between body weight, age, body mass index, and serum creatinine on drug clearance and age, body weight, and body mass index on cefoxitin volume of distribution. The PTA for free drug concentration being above the minimum inhibitory concentration of 8 mg/L for at least 240 minutes was >90% in all age groups except in patients >10 years of age (PTA = 62%).

Conclusions:
Cefoxitin PK appears to be significantly influenced by CPB with generally reduced drug clearance. The PTA was adequately achieved in the majority of patients except in patients >10 years old or longer surgeries.
Viral Etiology of Acute Lower Respiratory Tract Infections in Hospitalized Children in Nagasaki, a Regional City of Japan in 2013–2015
Authors: Hasuwa Tomoyuki , Kinoshita Fumiko , Harada Sadatomo , Nakashima Kazuhisa , Yoshihara Keisuke , Toku Yuichirou , Moriuchi Hiroyuki , Yoshida Lay Myint 
Published: March 2020

Background:
Acute lower respiratory tract infections (ALRIs) are the most common disease for hospitalized children in Japan. The aim of this study was to identify viruses in children hospitalized for ALRIs and to demonstrate epidemiologic and clinical characteristics in Japan.

Methods:
During a 2-year period from February 2013 to January 2015, we collected nasopharyngeal swab specimens from almost all hospitalized children with ALRIs in Nagasaki, a regional city of Japan, and its environs. Viruses were detected by multiplex polymerase chain reaction from these samples.

Results:
We detected one or more viruses from 259 (69%) of 374 patients, 227 of whom were infected with a single virus, 30 with 2, and 2 with 3 viruses. Detected viruses in this study were rhinovirus (46.4%), respiratory syncytial virus (29.7%), human metapneumovirus (6.8%), parainfluenza virus (5.5%), enterovirus D68 (3.4%), influenza virus (2.7%), adenovirus (2.4%), bocavirus (2.0%) and Coxsackie virus (1.0%). We detected a seasonal shift in respiratory syncytial virus outbreaks from the 2013–2014 to the 2014–2015 seasons. There was no significant difference in clinical course and severity among those viruses. Patients with a history of asthma or underlying diseases were older and more frequently required oxygen therapy than previously healthy patients.

Conclusions:
Viral etiology in hospitalized children with ALRIs in Nagasaki, Japan, was similar to that in many other countries. Enterovirus D68, which was recently recognized as a causative agent of severe ALRIs, was also identified in this study area. Severity of ALRIs may depend on underlying disease rather than type of etiologic virus.
Photochemical Collagen Cross-Linking Reverses Elastase-Induced Mechanical Degradation of Upper Eyelid Tarsus
Authors: Ugradar Shoaib , Karlin Justin , Le Alan , Park Joseph , Goldberg Robert A. 
Published: March 2020

Introduction:
The floppy eyelid syndrome describes an eyelid disorder characterized by floppy tarsal plates that may be caused by a loss of elastin. The authors attempted to create floppy eyelids by digesting elastin from cadaveric tarsus and then treated them with cross-linking using ultraviolet A and riboflavin.

Methods:
Nine right and 9 left upper eyelids were excised from cadavers. Four vertical strips of central tarsus were removed from each eyelid. One strip of tarsus from each eyelid was treated with 10 units/ml of elastase for 2 hours. Another tarsal strip from each eyelid was immersed in normal saline for 2 hours (control). A third strip from the same eyelid was cross-linked using ultraviolet A at 6 mW/cm2 for 18 minutes. Finally, a fourth strip of tarsus was cross-linked in the same manner following treatment with elastase for 2 hours. A microtensile load cell was used to measure the Young modulus (stiffness) of each tissue.

Results:
Mean (standard deviation) Young modulus for controls (18.9 ± 3.6 MPa) was significantly higher than samples treated with elastase alone (6.6 ± 3.8 MPa, p <0.01). Samples that were treated with cross-linking after elastase had a mean (standard deviation) Young modulus of 26 ± 2.3 MPa, while those treated with cross-linking alone had a mean (standard deviation) Young modulus of 34 ± 0.15 MPa. The differences in stiffness between all groups were significant (p <0.01).

Discussion:
Treatment with elastase significantly reduces the stiffness of tarsal plates. This effect is reversed by cross-linking, raising the possibility of using this modality for the treatment of FES.
A matched case–control study of the clinical, economic, and patient-reported outcomes of cystoid macular edema complicating phacoemulsification surgery
Authors: Sanders Francis W.B. , Lowin Peta , Gupta Nitin , Roberts Harry W. 
Published: March 2020

Purpose:
To assess the visual outcomes of pseudophakic cystoid macular edema (CME) as compared with age- and copathology-matched control subjects, the costs of treatment and follow-up, and the patient-reported outcomes using the new Cat-patient-reported outcome measures (PROM) 5 questionnaire.

Setting:
West Suffolk Hospital NHS Foundation Trust, United Kingdom.

Design:
Matched case–control study.

Methods:
Fifty-two eyes of 49 patients developed CME over an 18-month period. Age- and copathology-matched patients were identified from clinical records over the same time period in a 2:1 ratio (90 eyes). Postoperative clinical outcomes were recorded including treatments received, costs of treatments, and patient-reported outcome measures using the Cat-PROM5.

Results:
Patients with CME reported a significantly worse outcome from surgery than control subjects. Furthermore, patients with CME had significantly worse visual acuity postoperatively than control subjects (CME: logarithm of the minimum angle of resolution 0.40 ± 0.33, n = 37; control subjects: 0.30 ± 0.33; P < .05) despite there being no difference in preoperative visual acuity. In patients with epiretinal membrane (ERM), notably those with CME had worse patient-reported outcomes than control subjects with ERM, and only 18% received prophylactic corticosteroid injection at surgery compared with 63.6% of control subjects. CME resulted in an excess of 266 outpatient appointments, with 388 weeks of topical therapy, 18 orbital floor injections, 6 intravitreal steroid injections, 5 intravitreal antivascular endothelial growth factor injections, and 1 intravitreal dexamethasone implant with an excess expenditure of £216.81 per case.

Conclusions:
Patients developing CME after cataract surgery had reduced visual acuity at 4 to 6 weeks, patient-reported visual outcomes, and increased number of hospital appointments, treatments, and costs.
Effect of intracameral phenylephrine 1.0%–ketorolac 0.3% on postoperative cystoid macular edema, iritis, pain, and photophobia after cataract surgery
Authors: Visco Denise M. , Bedi Raman 
Published: March 2020

Purpose:
To assess the effectiveness of intracameral phenylephrine–ketorolac during cataract surgery compared with postoperative topical steroids in reducing the incidence of postoperative clinical cystoid macular edema (CME) confirmed via optical coherence tomography (OCT), breakthrough iritis, pain, and photophobia.

Setting:
Ambulatory surgical center/clinical practice.

Design:
Retrospective 2-cohort study.

Methods:
This study of cataract surgery patients compared the incidence of postoperative CME, breakthrough iritis, pain, and photophobia between patients receiving either intracameral phenylephrine 1.0%–ketorolac 0.3% during surgery or topical loteprednol 0.5% 2 days preoperatively, tapered postoperatively. Patients with prior CME or at high risk for postoperative CME, combined cataract/glaucoma surgery, and medication protocols different from those studied here were excluded. All eyes received bromfenac 2 days preoperatively and 10 weeks postoperatively.

Results:
The study enrolled 2218 eyes (n = 1402). The phenylephrine/ketorolac treatment group included 1334 eyes (n = 830) and the topical loteprednol control group included 884 eyes (n = 572). The groups were comparable in age, race, gender, and perioperative characteristics. Clinical CME incidence was significantly lower in the phenylephrine–ketorolac group (0.52% vs 1.47%, P = .021). The phenylephrine–ketorolac group also had significantly lower breakthrough iritis (1.72% vs 4.86%, P < .001) and pain (1.27% vs 4.19%, P < .001) than the topical loteprednol group. The incidence of photophobia trended lower for the phenylephrine/ketorolac group relative to the topical loteprednol group (0.90% vs 1.13%, respectively, P = .590) but was not statistically significant.

Conclusions:
Intracameral phenylephrine/ketorolac and topical nonsteroidal antiinflammatory drugs (NSAIDs) without postoperative topical steroids significantly reduced postoperative clinical CME, breakthrough iritis, and pain after cataract surgery when compared with conventional perioperative topical steroids and NSAIDs.
Supporting the Health and Well-being of Caregivers
Authors: Bouchard Karen , Brownrigg Jane , Quinlan Bonnie , Bilodeau Jean , Higdon Gloria , Tulloch Heather 
Published: March 2020

Background
Caregivers contribute substantially to patients' management of and recovery from cardiovascular disease (CVD). Yet, the distress that many caregivers experience in this role continues to be underresearched and their needs undersupported.

Purpose
Situated within a patient engagement framework and adapted from experience-based co-design guidelines, the process of developing a comprehensive caregiver support resource with joint contributions from caregivers and healthcare providers representing multiple disciplines is described. A discussion of the challenges encountered during the development of the caregiver support resource and recommendations for future sites embarking on co-design work are noted.

Conclusion
Developing feasible and relevant approaches, such as informational support instruments, to meet the needs of the growing population of CVD caregivers is essential.

Clinical Implications
Although co-design processes are often complex, take more time and resources to implement, and involve multiple levels of an organization and community than traditional practices, these efforts may help to improve healthcare quality to stem the burden of CVD.
Associations Between Bioaerosol Exposures and Lung Function Changes Among Dairy Workers in Colorado
Authors: Martenies Sheena E. , Schaeffer Joshua W. , Erlandson Grant , Bradford Mary , Poole Jill A. , Wilson Ander , Weller Zachary , Reynolds Stephen J. , Magzamen Sheryl 
Published: March 2020

Objective:
Limited studies have examined effects of bioaerosols on the respiratory health of dairy workers; previous findings have been inconsistent across populations.

Methods:
Using a repeated measures design, exposures to dust, bioaerosols, and ozone were assessed and pre- and post-shift spirometry was performed for dairy workers (n = 36). Workers completed 1 to 8 visits. Linear mixed effect models estimated associations between air pollutant constituents and changes in spirometry.

Results:
There was an association between higher dust exposures and increased peak expiratory flow rate. However, for all other outcomes there was no association with the exposures considered.

Conclusions:
Relationships between bioaerosol exposures and respiratory health in dairy workers remain unclear. Future studies should increase sample sizes, include repeated measures designs, vary the timing of spirometry measurements, and include markers for Gram positive bacteria such as muramic acid or peptidoglycan.
Changes in Wide-band Tympanometry Absorbance Following Cochlear Implantation
Authors: Saoji Aniket A. , Shapiro Scott B. , Finley Charles C. , Koka Kanthaiah , Cassis Adam M. 
Published: March 2020

Objective:
Determine if changes in middle ear absorbance measured with wide-band tympanometry (WBT) occur following hearing-preservation cochlear implantation (CI). Such measures may provide insight into the mechanisms of acoustic hearing loss postimplantation.

Study Design:
Clinical capsule report.

Setting:
Tertiary academic referral center.

Design:
WBT absorbance was measured bilaterally during pre- and postoperative clinical office visits in five unilaterally-implanted cochlear implant recipients. Pre- and postoperative WBT measures were compared within each subject in the implanted and contralateral, unimplanted ears.

Results:
In general, WBT absorbance measurements show a broad spectral pattern including two or three distinct peaks measured over a frequency range of 226 to 8000 Hz. Grand average and linear mixed model comparisons between the pre- and postoperative WBT patterns show significantly reduced (p < 0.05) low-frequency absorbance in the implanted ears in the frequency region over 0.6 to 1.1 kHz, but not in the unimplanted ears. The maximum effect occurred at 1 kHz with absorbance decreasing from ∼0.8 to ∼0.5 after implantation. The limited data are consistent with expected relationships between WBT absorbance and air- and bone-conduction thresholds, assuming an increased air-bone gap reflects conductive hearing loss.

Conclusion:
Cochlear implantation can result in reduction of low-frequency acoustic absorbance as measured by WBT. WBT may be a useful and sensitive tool for monitoring the mechanical status of the middle and inner ears following cochlear implantation.
Unusual Locations of Benign Paroxysmal Positional Vertigo: Rare Entity or Regular Occurrence?
Authors: Fath Léa , Vuong-Chaney Hella , Rohmer Dominique , Lamy Michael , Baumgartner Daniel , Simon François , Debry Christian , Charpiot Anne 
Published: March 2020

Introduction:
According to the literature and our recent experience, even if patients present with symptoms strongly suggestive of benign paroxysmal positional vertigo (BPPV), the observed positional nystagmus does not always correspond to any previously described typical location. The aim of this multicentric study was to evaluate the frequency of both typical and less common forms of BPPV.

Material and Methods:
All consecutive patients presenting with BPPV in two hospitals between November 2016 and October 2017 were included. For each subject, answers to a standardized evaluation form and a recorded videonystagmoscopy were obtained by two otorhinolaryngologists. Appropriate diagnostic and therapeutic maneuvers were performed.

Results:
A total of 532 patients were studied and 491 cases of typical BPPV were found: 370 cases of canalolithiasis of the posterior semicircular canal (SCC), 3 cases of canalolithiasis of the anterior SCC, 107 cases of canalolithiasis of the lateral SCC, and 11 cases of cupulolithiasis of the lateral SCC. Fourty one patients reported symptoms suggestive of BPPV with positional nystagmus that could correspond to unusual locations of otoconia in the SCC: 18 cases of canalolithiasis in the anterior ampulla of the lateral SCC, 16 cases of posterior short arm canalolithiasis, four cases of pseudo-spontaneous nystagmus in canalolithiasis of the lateral SCC, and three cases of canalolithiasis of the posterior third of SCC.

Discussion:
Unusual BPPV accounted for almost 8% of BPPV treated in our clinics; it is paramount to know how to diagnose them, to carry out the appropriate therapeutic maneuvers and relieve these patients.
Congenital External Auditory Canal Cholesteatoma Resected by a Transcanal Endoscopic Approach
Authors: Ohki Masafumi , Kikuchi Shigeru 
Published: March 2020

Objective:
To describe the first case of congenital external auditory canal cholesteatoma resected via a transcanal endoscopic approach and describe the possible pathologenesis of cholesteatoma.

Patient:
A 2-year-old female patient presented with a cholesteatoma that extended from the floor of the external auditory bony canal to the inferior quadrant of her right tympanic membrane.

Intervention:
Otological examinations and computed tomography were performed. The cholesteatoma was resected using a transcanal endoscopic approach.

Results:
Pathologic examination confirmed the diagnosis of external auditory canal cholesteatoma. The patient's postoperative hearing was observed to be normal. Cholesteatoma did not recur during the 2-year follow-up period. Computed tomography scan revealed an isodense mass, partly surrounded by bony tissue, on the floor of the external auditory canal, outside of the inferior quadrant of an intact tympanic membrane. A minor malformation of the bony tissue, covering the inferiolateral surface of the cholesteatoma, was observed. The proposed mechanisms of pathogenesis are: 1) the embryonic developmental deficits of the meatal plug, during its differentiation into squamous epithelium, cause the arrest of ectodermal tissues, 2) a remnant of the squamous epithelium becomes trapped in the niche of the foramen tympanicum.

Conclusion:
A rare case of congenital external auditory canal cholesteatoma, located on the inferior external auditory canal, was diagnosed and resected using a transcanal endoscopic approach. It was possibly caused by a minor anomaly of the first branchial cleft or by a remnant of the squamous epithelium trapped in the foramen tympanicum.