bluuebunny/crossref_metadata_2025_split huggingface dataset:
Influenza A Encephalitis in an Adult Patient
Authors: Gutman Michael Jason , Sharma Kumud , Basovic Lara , Shah Syed Omar 
Published: July 2020

Abstract
A 45-year-old woman presented with 7 days of worsening dyspnea, nonproductive cough, myalgias, and chills. The following day, the patient had acute respiratory failure, requiring mechanical ventilation, and eventually developed acute respiratory distress syndrome. Respiratory panel tested positive for influenza A. The patient's mental status progressively worsened to coma. Magnetic resonance imaging of the brain demonstrated relatively symmetrical bilateral T2 FLAIR abnormalities in the thalami, corpus callosum, pons, and cerebellum. Cerebrospinal fluid polymerase chain reaction was positive for influenza A. The patient was transitioned to high-dose oseltamivir and high-dose corticosteroids. Repeat magnetic resonance imaging demonstrated gross resolution of T2 FLAIR abnormalities. The patient's mental status continued to improve daily. At the time of discharge, 30 days after symptom onset, the patient was awake and following commands. Six months after hospitalization, the patient had successfully been able to return to her baseline function except for right homonymous quadrantanopia and some mild residual left upper extremity weakness.
Case Series of Staphylococcus aureus Bacteremia With Discordant Genotypic and Phenotypic Categorization of Methicillin Susceptibility
Authors: Gulliver Jessica , Jung-Hynes Brittney , Chen Derrick J. 
Published: July 2020

Background
Methicillin-susceptible/methicillin-resistant Staphylococcus aureus (MSSA/MRSA) can be directly identified from positive blood culture bottles using molecular methods, but discrepancies with phenotypic testing occasionally occur. We sought to determine the incidence and clinical impact of these discrepancies.

Methods
Positive blood culture bottles are routinely tested in the hospital laboratory for mecA via the Xpert MRSA/SA blood culture assay which uses real-time polymerase chain reaction (PCR), and antimicrobial susceptibility testing (AST) via MicroScan PC33 is performed on recovered S. aureus isolates; discrepancies between the Xpert MRSA/SA blood culture assay and AST are resolved by repeat and supplemental testing. A retrospective review of medical and laboratory data from January 2015 to June 2018 was performed on all patients that had discordant Xpert MRSA/SA blood culture assay and AST results.

Results
Approximately 1410 PCR assays were performed, and there were 6 (0.4%) cases with discordant AST results. Five cases were classified as MSSA by PCR but MRSA by AST, and 1 case was classified as MRSA by PCR but MSSA by AST. For the former group, antimicrobial therapy was changed in 3 patients to cover MRSA, whereas the remaining 2 patients were already being treated for MRSA; for the latter case, the patient was treated for MRSA during the initial hospitalization but was later readmitted with disseminated MSSA. Discrepancies were likely due to presence of an staphylococcal cassette chromosome mec variant (n = 2), borderline oxacillin resistance (n = 1), heterogeneous MRSA (n = 1), or undetermined (n = 2).

Conclusions
Rapid identification of MRSA bacteremia via PCR provides actionable information to direct empiric treatment. The PCR results are highly accurate, though are infrequently not corroborated by AST due to various reasons.
Effect of Intravitreal Antibiotic Injections on Culture-Negative Keratitis-Induced Endophthalmitis
Authors: Sim Ha Eun , Kang Min-Ji , Kim Jae-Suk , Hwang Je-Hyung 
Published: July 2020

BackgroundThis study aimed to evaluate treatment outcomes of culture-negative keratitis-induced endophthalmitis (CNKE).MethodsWe reviewed the medical records of 13 patients with CNKE, who underwent treatment from January 2011 to December 2017. All patients were referred from the emergency department or outpatient departments of local clinics. Outcome evaluation included the assessment of visual acuity and any need for evisceration/enucleation.ResultsThirteen eyes of 13 patients were included in this study. The mean age of the patients was 75.0 ± 13.3 years. All patients had used antibiotic eye drops before the initial visit. Visual acuity values at the initial visit ranged from no light perception to 2/100; final visual acuity values ranged from no light perception to 2/100. All patients underwent a vitreous tap and intravitreal ceftazidime/vancomycin injection. Two eyes underwent evisceration after intravitreal injection.ConclusionsIntravitreal antibiotic injections demonstrated favorable results for the treatment of patients with CNKE.
Role of gender in the survival outcome of acute phase of major trauma: A nationwide, population-based study
Authors: Lee Rong-Shou , Lin Wen-Chi , Harnod Dorji , Shih Hsin-Chin , Jeng Mei-Jy 
Published: July 2020

Background:
Animal models of trauma have shown that females have better posttraumatic survival; however, results of previous studies on the influence of gender on major trauma patients have been controversial. This study aimed to evaluate the association between gender and survival in major trauma patients.

Methods:
We retrospectively analyzed patients registered in Taiwan’s National Health Insurance Research Database between 2008 and 2012 with the diagnosis codes 800-939 and 950-957 (International Classification of Diseases, ninth revision, clinical modification). Data on gender, age, catastrophic illness, and new injury severity score (NISS) ≥16 were collected for comparing patients’ mortality after trauma. Propensity score matching (PSM) was performed to eliminate dissimilarities in age, comorbidities, NISS, and primary traumatic regions between the genders.

Results:
Among 10 012 major trauma patients included in the study cohort, 28.8% (n = 2880) were women. The PSM patient group consisted of 50% (2876 of 5752) women. Women had a higher 30-day (15.4% of women vs 13.8% of men; p < 0.05) and hospital (16.1% of women vs 14.5% of men; p < 0.05) mortality and lower incidence rates of acute respiratory dysfunction (62.5% of women vs 65.9% of men; p < 0.005) and acute hepatic dysfunction (0.8% of women vs 2.1% of men; p < 0.001). However, the analysis of PSM patient groups showed lower mortality rates in women with moderate trauma (NISS 16–24) in the acute phase within three days (1.4% of women vs 2.7% of men, p = 0.03). Analysis of patients with an NISS of 16–24 who died within three days showed a higher NISS in women than in men (19.7 ± 2.3 vs 18.0 ±1.9, respectively, p <0.05).

Conclusion:
There is no gender difference in 30-day or hospital mortality among major trauma patients. However, women admitted for moderate major trauma had higher survival within three days of major trauma.
The relationship between coronary artery disease and clinical outcomes in COVID-19: a single-center retrospective analysis
Authors: Peterson Eric , Lo Kevin Bryan , DeJoy Robert , Salacup Grace , Pelayo Jerald , Bhargav Ruchika , Gul Fahad , Albano Jeri , Azmaiparashvili Zurab , Amanullah Aman , Patarroyo-Aponte Gabriel 
Published: July 2020

Introduction
Recent studies have reported evidence that coronavirus disease 2019 (COVID-19) has disproportionately affected patients with underlying comorbidities. Our study aims to evaluate the impact of both cardiac and noncardiac comorbidities on a high-risk population with COVID-19 infection and coronary artery disease (CAD) compared to those without CAD.

Methods
This is a retrospective study of patients who tested COVID-19 positive via reverse transcriptase-PCR (RT-PCR) assay. We compared the characteristics and outcomes of patients with and without CAD. Population demographics, comorbidities and clinical outcomes were collected and analyzed. Multivariate logistic regression analysis was used to identify factors associated with inpatient mortality.

Results
A final sample population of 355 patients was identified, 77 of which had a known diagnosis of coronary artery disease. Our study population had a higher proportion of females, and those with CAD were significantly older. The rates of cardiovascular risk factors including hypertension, diabetes mellitus and chronic kidney disease, as well as heart failure and chronic obstructive pulmonary disease were significantly higher in the CAD population. Lactate dehydrogenase was the only inflammatory marker significantly lower in the CAD group, while troponin and brain natriuretic peptide were significantly higher in this population. Patients with CAD also had significantly higher inpatient mortality (31% vs 20%, P = 0.046) and need for renal replacement therapy (33% vs 11%, P < 0.0001) compared to the non-CAD group. However, only age [odds ratio 1.041 (1.017–1.066), P = 0.001] was significantly associated with mortality in the overall population after adjusting for demographics and comorbidities, while the presence of CAD was not independently associated with mortality.

Conclusion
Patients with CAD and COVID-19 have higher rates of comorbidities, inpatient mortality and need for renal replacement therapy compared to their non-CAD counterparts. However, CAD in itself was not associated with mortality after adjusting for other covariates, suggesting that other factors may play a larger role in the increased mortality and poor outcomes in these patients.
Study of serology and genetics of celiac disease in patients with juvenile systemic lupus erythematosus ‘celiac in juvenile systemic lupus’
Authors: Shamseya Ayman M. , Elsayed Eman H. , Donia Hanaa M. 
Published: July 2020

Introduction
Several case reports and case series have suggested a possible association between celiac disease (CD) and systemic lupus erythematosus (SLE). Patients with CD developing SLE and vice versa have been reported, highlighting a possible association. Up to 23% of patients with CD have raised anti-double-stranded DNA and likewise 5–22% of SLE patients are seropositive for CD.

Objective
Aim was to screen for CD in the serum of patients suffering from juvenile SLE (JSLE).

Methods
One hundred JSLE patients and 40 (age- and sex-matched) healthy subjects were subjected to laboratory screening for CD, endoscopic examination and histopathological examination of the duodenal biopsies to confirm CD diagnosis (in seropositive cases only).

Results
tTG Ab tested positive in 10% and negative in 90% of patients. tTG Ab correlated significantly with Systemic Lupus Erythematosus Disease Activity Index score (P < 0.001) and insignificantly with hemoglobin and C-reactive protein. Esophago-gastro-duodenoscopy was done to all 10 patients with positive serology for CD revealing six patients with manifest celiac (positive serology and positive endoscopy/biopsy) and four cases of latent celiac (positive serology and negative endoscopy/biopsy).

Conclusion
Most CD patients with articular symptoms remain undiagnosed, which makes screening justified in high-risk patients with autoimmune diseases. This study highlights the strong relationship between JSLE and CD and the need to screen JSLE patients and also other auto-immune rheumatic diseases for the concomitant existence of CD.
Coverage for Adults With Chronic Disease Under the First 5 Years of the Affordable Care Act
Authors: Myerson Rebecca , Crawford Samuel 
Published: July 2020

Background:
A key goal of the Patient Protection and Affordable Care Act (ACA) was to increase health insurance coverage for people with chronic disease. Little is known about progress toward this goal over the first 5 years of ACA implementation.

Objective:
The objective of this study was to assess changes in coverage for nonelderly adults with and without chronic disease over the first 5 years of ACA implementation, and the effects of state-level Medicaid eligibility expansions on coverage for these populations.

Research Design:
Multivariable and difference-in-differences regression models.

Participants:
A total of 2,007,271 adults aged 18–64 years in the nationally representative Behavioral Risk Factor Surveillance System 2011–2018 data.

Measures:
Self-reported insurance coverage.

Results:
Over the first 5 years of ACA implementation, coverage increased among nonelderly adults with versus without chronic disease by 6.9 versus 5.4 percentage points, respectively (95% confidence interval: 6.1–7.6, P<0.001, and 4.4–6.3, P<0.001, respectively). State-level Medicaid eligibility expansions were associated with a coverage increase among people with chronic disease of 2.8 percentage points (95% confidence interval: 1.7–3.8, P<0.001). After ACA implementation diminished in 2017, coverage gains for people with chronic disease declined by 0.9 percentage points (P<0.001).

Conclusions:
Coverage significantly improved for people with chronic disease during the first 5 years of ACA implementation, with ACA Medicaid expansions increasing coverage further. After ACA implementation diminished in 2017, coverage gains decreased.
Rethinking strategies for blood transfusion in hip fracture patients
Authors: D’Amore Taylor , Loewen Michael , Gorczyca Michael T. , Judd Kyle , Ketz John P. , Soles Gillian , Gorczyca John T. 
Published: July 2020

Abstract

Objectives:
Most patients can tolerate a hemoglobin (Hgb) > 8 g per deciliter. In some cases, however, transfusion will delay physical therapy and hospital discharge. This study aims to review Hgb and transfusion data for a large volume of recent hip fracture patients in order to identify new opportunities for decreasing the length of hospital stay. Our hypotheses are that in some cases, earlier transfusion of more blood will be associated with shorter hospital stays, and that Hgb levels consistently decrease for more than 3 days postoperatively.

Design:
Retrospective chart review.

Setting:
Two academic medical centers with Geriatric Fracture Programs.

Patients:
Data was collected from patients 50 years and older with hip fractures April 2015 and October 2017.

Intervention:
Operative stabilization of the hip fractures according to standard of care for the fracture type and patient characteristics. Transfusion according to established standards.

Main Outcome Measurements:
Electronic records were retrospectively reviewed for demographic information, Hgb levels, and transfusion events.

Results:
One thousand fifteen patients with femoral neck or intertrochanteric hip fractures were identified. Eight hundred sixty met the inclusion criteria. The average length of hospital stay was 6.7 days. The mean patient age was 82 years. The average American Society of Anesthesiologists score was 2.9. The average Hgb level consistently decreased for 5 days postoperatively before beginning to increase on day 6. There was poor consistency between intraoperative Hgb levels and preoperative or postoperative Hgb levels. Three hundred sixty-eight (42.8%) patients were transfused an average of 1.9 (range 1–6) units. One hundred five patients required a transfusion on postoperative day (POD) 1: 72 received only 1 unit of blood: 36 (50%) of the 72 required a second transfusion in the following days, compared to 9 of 33 (27%) who received 2 units on POD 1 (χ2 = 3.8898; P < .05). Patients who received transfusions on POD 3 or later had an average length of stay >2.5 days longer than those who received a transfusion earlier (P = 0.005).

Conclusions:
Our findings do not support earlier transfusion of more blood. Although in some cases, there is an association between earlier transfusion of more blood and shorter hospital stay, routine transfusion of more blood would incur higher transfusion risks in some patients who would not otherwise meet criteria for transfusion. After hip fracture surgery, the Hgb usually decreases for 5 days and does not begin to increase until POD 6. This information will provide utility in the population health management of hip fracture patients.

Level of Evidence:
Level III, Retrospective Cohort Study
Sudden Unexpected Death in MELAS Syndrome Due to Diabetic Ketoacidosis
Authors: Reed Erica M. , Swanson Amy A. , Roden Anja C. , Lin Peter T. 
Published: July 2020

Abstract
We present a case report of a 25 year-old man with MELAS (Mitochondrial Encephalopathy, Lactic Acidosis, and Stroke-like episodes) syndrome, who died suddenly and unexpectedly from diabetic ketoacidosis. This case report illustrates why it is important for medical examiners to be familiar with the clinical and autopsy features of MELAS syndrome and to be aware of the common complications, which may lead to sudden unexpected death.
Reclaiming the Autopsy as the Practice of Medicine
Authors: Weedn Victor W. , Menendez M.J. 
Published: July 2020

Abstract
The historically constricted forensic pathology workforce pipeline is facing an existential crisis. Pathology residents are exposed to forensic pathology through the American Council of Graduate Medical Education autopsy requirement. In 1950, autopsies were conducted in one half of the patients dying in American hospitals and 90% in teaching hospitals, but they have dwindled to fewer than 5%. Elimination of funding for autopsies is a major contributor to the lack of support for autopsies in departments of pathology. Funding may require reclaiming the autopsy as the practice of medicine. Funding of autopsies would rekindle interest in hospital autopsies and strengthen the forensic pathology workforce pipeline.
A Reevaluation of the Death of Vincent van Gogh
Authors: Arenberg I. Kaufman , Di Maio Vincent J.M. , Baden Michael M. 
Published: July 2020

Abstract
Vincent van Gogh died on July 29, 1890, from an apparent gunshot wound to the belly sustained approximately 30 hours earlier on July 27. Although little is known how Vincent sustained his mortal wound, art historians have long believed that the death was the result of a suicide, a widely accepted “truth” for the mysterious death of the then unknown and now iconic artist. The basis and validity of this suicide narrative is still very hotly debated among van Gogh scholars to this day. We dug deeper into all the circumstantial evidence and testimonies to arrive at a comprehensive overview of the probability that it was likely impossible for Vincent to self-inflict his mortal wound.
We used all the available circumstantial evidence related to the day Vincent van Gogh was wounded to present the information and conclusions as if we were before a judge as expert witnesses to answer the question: suicide or murder? If Vincent did not shoot himself in the belly (a red flag in and of itself), whoever inflicted that penetrating wound into his abdomen murdered him. In our study, results from firing the same model revolver that allegedly killed Vincent from various ranges (direct contact, intermediate, and distant) demonstrated within a reasonable degree of medical probability (greater than 50%) that it was not probable for Vincent van Gogh to shoot himself without a described powder burn.
With little forensic evidence to rely on 130 years after the suspicious event, many have suggested a respectful exhumation and graveside autopsy utilizing 21st century techniques to bring resolve to this 19th century cold case. This crime, whether suicide or murder, has generated renewed interest and numerous questions surrounding the suspicious death of the most iconic artist of the 19th century. These missing forensic facts will remain buried with all the secrets Vincent took with him to his grave, unless a definitive autopsy is performed. What an autopsy could add to our forensic fact basis and understanding of this intriguing cold case is enormous and further delineated as the next step to answer these difficult, otherwise unanswerable questions and allow us to finally sign off on his death certificate with certainty.
It is clearly impossible to definitively prove suicide or murder, but it is also impossible to disprove murder given the data and arguments offered in this analysis. A physician's opinion is based on the material available to him, and in this case, “our opinion as to the cause and manner of death is based on the limited amount of forensic information available. It is, therefore, our opinion, based on that limited information that in all medical probability, the cause of death is not a self-inflicted wound by Vincent van Gogh, and, thus, in all medical probability, a homicide.”
Methadone-based Multimodal Analgesia Provides the Best-in-class Acute Surgical Pain Control and Functional Outcomes With Lower Opioid Use Following Major Posterior Fusion Surgery in Adolescents With Idiopathic Scoliosis
Authors: Ye Jian , Myung Karen , Packiasabapathy Senthil , Yu Jeffrey S. , Jacobson Joseph E. , Whittaker Stephanie C. , Castelluccio Peter , Drayton Jackson Meghan , Sadhasivam Senthilkumar 
Published: July 2020

Introduction:
Posterior spinal fusion for idiopathic scoliosis is extremely painful, with no superior single analgesic modality. We introduced a methadone-based multimodal analgesia protocol, aiming to decrease the length of hospital stay (LOS), improve pain control, and decrease the need for additional opioids.

Methods:
We analyzed 122 idiopathic scoliosis patients with posterior instrumented spinal fusion. They were matched by age, sex, surgeon, and the number of levels fused before and after the implementation of the new protocol. This analysis included 61 controls (intrathecal morphine, gabapentin, intravenous opioids, and adjuncts) and 61 patients on the new protocol (scheduled methadone, methocarbamol, ketorolac/ibuprofen, acetaminophen, and oxycodone with intravenous opioids as needed). The primary outcome was LOS. Secondary outcomes included pain scores, total opioid use (morphine milligram equivalents), time to a first bowel movement, and postdischarge phone calls.

Results:
New protocol patients were discharged earlier (median LOS, 2 days) compared with control patients (3 days; P < 0.001). Total inpatient morphine consumption was lower in the protocol group (P < 0.001). Pain scores were higher in the protocol group on the day of surgery, similar on postoperative day (POD) 1, and lower by POD 2 (P = 0.01). The new protocol also reduced the median time to first bowel movement (P < 0.001), and the number of postdischarge pain-related phone calls (P < 0.006).

Conclusion:
Methadone-based multimodal analgesia resulted in significantly lower LOS compared with the conventional regimen. It also provided improved pain control, reduced total opioid consumption, and early bowel movement compared with the control group.