bluuebunny/crossref_metadata_2025_split huggingface dataset:
Frequency and Cause of Readmissions in Sepsis Patients Presenting to a Tertiary Care Hospital in a Low Middle Income Country
Authors: Arshad Ainan , Ayaz Ahmed , Haroon Mian Arsam , Jamil Bushra , Hussain Erfan 
Published: February 2020

Objectives:
Hospital readmissions are known to be common after sepsis but unfortunately, in a developing country like Pakistan, very little is known of the frequency or cause of these readmissions in sepsis patients and even less about how they can be prevented. To our knowledge, this is the first-ever long-term follow-up study in a developing country in which frequency and cause of readmissions are being evaluated in sepsis patients.

Design:
This retrospective study evaluated sepsis patients admitted at the Aga Khan University Hospital in 2017. Outcome measures included in-hospital mortality and readmission within 180 days.

Setting:
Aga Khan University Hospital, Karachi, Pakistan.

Subjects:
Four-hundred thirty-nine sepsis patients.

Interventions:
None.

Measurements and Main Results:
Respiratory infections were the most common cause of sepsis (172 [39%]) followed by urinary tract infections (86 [20%]). Mortality in sepsis was 42% (183/439) and associated risk factors included ICU admission (odds ratio, 1.57; 95% CI, 1.05–2.35; p = 0.027), malignancy(odds ratio, 3.50; 95% CI, 1.70–7.19; p = 0.001), acute kidney injury (odds ratio, 1.86; 95% CI, 1.25–2.77; p = 0.002), septic shock (odds ratio, 4.75; 95% CI, 3.04–7.35; p = 0.001), and serum lactate greater than or equal to 4 mmol (odds ratio, 5.11; 95% CI, 3.00–8.73; p = 0.001). Of the 256 patients that survived, 31% (79/256) were readmitted within 180 days. Infections accounted for 67% (53/79) of these readmissions. Half of these infections were new infections while an additional 26% were unclear since cultures were negative in at least one of the hospitalizations.

Conclusions:
We concluded that mortality rates in sepsis are alarmingly high and even those who manage to survive are still at a great risk of getting readmitted due to a new infection in the near future. Given the limited resources available in developing countries, prevention of these infections should be given utmost importance. Unfortunately, reliable interventions to identify high-risk patients for readmissions are still inadequately characterized. Hence, we hope this study becomes a platform for larger multicenter studies in developing countries for early prediction of potential readmissions and developing precise interventions to prevent them.
Comparison of cell salvage with one and two suction devices during cesarean section in patients with placenta previa and/or accrete: a randomized controlled trial
Authors: Chen Hong , Tan Hua , Luo Pei-Xin , Shen Yi-Fang , Lyu Chang-Cheng , Qian Xiao-Wei , Chen Xin-Zhong 
Published: February 2020

Abstract

Background
Cell salvage has recently been recommended for obstetric use in cases with a high risk of massive hemorrhage during cesarean section (CS). However, limited data are available to support the use of one suction device to collect lost blood. This study aimed to investigate the volume of red blood cells (RBCs) salvaged and the components of amniotic fluid (AF) in blood salvaged by one suction device or two devices during CS in patients with placenta previa and/or accrete.

Methods
Thirty patients with placenta previa and/or accrete undergoing elective CS in the Women's Hospital of Zhejiang University School of Medicine were recruited for the present study from November 1, 2017 to December 1, 2018. The patients were randomly assigned to one of the two groups according to an Excel-generated random number sheet: Group 1 (n = 15), in which only one suction device was used to aspirate all blood and AF, and Group 2 (n = 15), in which a second suction device was mainly used to aspirate AF before the delivery of the placenta. Three samples of blood per patient (pre-wash, post-wash, and post-filtration) were collected to measure AF components. The salvaged RBC volumes were recorded. Continuous data of pre-wash, post-wash, and post-filtration samples were analyzed by using one-way analysis of variance with Tukey's test for multiple comparisons, or Kruskal-Wallis test with Dunn test for multiple comparisons. Comparisons of continuous data between Group 1 and Group 2 were conducted using Student's t test or Mann-Whitney U test.

Results
The salvaged RBC volume was significantly higher in Group 1 than that in Group 2 (401.6 ± 77.2 mL vs. 330.1 ± 53.3 mL, t = 4.175, P < 0.001). In both groups, squamous cells, lamellar bodies, and fat were significantly reduced by washing (all P<0.001) and squamous cells were further reduced by filtering (P < 0.001). Squamous cells were found in six post-filtration samples (three from each group). Lamellar bodies and fat were completely removed by filtering. Insulin-like growth factor binding protein 1, alpha-fetoprotein, albumin, lactate dehydrogenase, and potassium were significantly reduced post-wash (all P < 0.05), with no further significant reduction after filtration in either group (all P > 0.05). The mean percentage of fetal RBCs post-filtration was (1.8 ± 0.8)% with a range of 1.0% to 3.5% and (1.9 ± 0.9)% with a range of 0.7% to 4.0% in Groups 1 and 2, respectively, showing no significant difference between the two groups (U = 188.5, P = 0.651).

Conclusion
Cell salvage performed by one suction device could result in higher volume of salvaged RBCs and can be used safely for CS in patients with placenta previa and/or accrete when massive hemorrhage occurs.

Trial registration number
ChiCTR-INR-17012926, http://www.chictr.org.cn/ Chinese Clinical Trial Registry.
Nipple-sparing Mastectomy and Ptosis: Using a Free Nipple Graft with Tissue Expander Reconstruction
Authors: Ghidei Luwam , Bansil Hannah A. , Stuckey Ashley , Pandya Sonali , Edmonson David , Michaud Pierre , Gass Jennifer 
Published: February 2020

Background:
Nipple-sparing mastectomies are increasingly offered to women with breast cancer given the evidence for oncologic safety and improved cosmetic outcomes. Women with significant ptosis are often excluded due to potential nipple malposition and increased risk of nipple ischemia. The use of a harvested free nipple graft may allow women with ptosis to conserve their nipple -areolar complex.

Methods:
This is an IRB approved retrospective study of breast cancer patients at an academic center with ptosis who underwent free-nipple graft mastectomies with a single plastic surgeon and 5 dedicated breast surgeons from 2014-2017. The primary outcomes were free nipple graft viability and the need for revision. Secondary outcomes included post-operative complications.

Results:
Fourteen women with ptosis underwent skin and nipple-sparing mastectomy with breast reconstruction involving use of harvested free-nipple graft. More than half of the women were diagnosed with early-stage invasive breast cancer (42% stage 1, 14% stage 2). Four women underwent mastectomy for prophylaxis or other benign reasons. All of the women had significant ptosis during the pre-operative evaluation (57% grade 2 ptosis, 36% grade 3 ptosis, and 7% uncategorized), with an average BMI of 30. None were active smokers. In the postoperative period, one had partial nipple necrosis in combination with skin flap necrosis and positive margin (7%). Other complications included infection (14%) and hypopigmentation (14%). All nipples lost sensation and full projection.

Conclusions:
This is a novel approach using a free nipple graft with a skin envelope reducing mastectomy and immediate expander-based reconstruction. This successful approach allows women with ptosis to undergo nipple-sparing mastectomy with preservation of the nipple -areolar complex.
Impact of Immediate Surgical Reconstruction Following Wide Local Excision of Malignant Head and Neck Melanoma
Authors: Hu Allison C. , Lee Seung Ah , Clark Emily G. , Yamamoto Maki , Jakowatz James G. , Evans Gregory R. D. 
Published: February 2020

Background:
The role of surgical reconstruction following melanoma extirpation is well recognized. Although technical considerations depend on patient anatomy and surgeon preference, the optimal timing of reconstruction remains unclear. This study aims to evaluate clinical and oncologic outcomes in melanoma extirpation followed by immediate reconstruction.

Methods:
We retrospectively identified patients who underwent immediate reconstruction following head and neck melanoma excision at our institution between January 2013 and December 2016. Demographic and clinical characteristics, operative variables, and outcome data were extracted.

Results:
Overall, 197 patients (male 70.6%) underwent excision followed by immediate reconstruction. Of the 70 patients with a history of cutaneous malignancy, 46 (65.7%) had a prior melanoma and 26 (37.1%) had 2 or more types of skin cancers. Of the 202 lesions resected, 138 (68.3%) were invasive, whereas 64 (31.7%) were in situ. The most frequent anatomic location involved was the cheek (34.2%), followed by scalp (31.2%). Reconstruction technique varied, with 116 (57.4%) lesions repaired by adjacent tissue transfer, 24 (11.9%) by full-thickness skin graft, 23 (11.4%) by complex primary closure, 17 (8.4%) by split-thickness skin graft, and 22 (10.9%) by more than 1 technique. On postoperative pathologic assessment, 2 patients had positive margins and 5 experienced local recurrence (mean follow-up: 2.3 years). In an unadjusted bivariate analysis, history of melanoma (P = 0.015) was significantly associated with local recurrence.

Conclusions:
Reconstruction at time of excision is an oncologically safe approach for the management of patients with malignant melanoma. A prior history of melanoma may be associated with local recurrence.
The brave new world of genetic testing in the management of the dyslipidaemias
Authors: Nawawi Hapizah Md , Chua Yung-An , Watts Gerald F. 
Published: February 2020

Purpose of review
With the exception of familial hypercholesterolaemia, the value of genetic testing for managing dyslipidaemias is not established. We review the genetics of major dyslipidaemias in context of clinical practice.

Recent findings
Genetic testing for familial hypercholesterolaemia is valuable to enhance diagnostic precision, cascade testing, risk prediction and the use of new medications. Hypertriglyceridaemia may be caused by rare recessive monogenic, or by polygenic, gene variants; genetic testing may be useful in the former, for which antisense therapy targeting apoC-III has been approved. Familial high-density lipoprotein deficiency is caused by specific genetic mutations, but there is no effective therapy. Familial combined hyperlipidaemia (FCHL) is caused by polygenic variants for which there is no specific gene testing panel. Familial dysbetalipoproteinaemia is less frequent and commonly caused by APOE ε2ε2 homozygosity; as with FCHL, it is responsive to lifestyle modifications and statins or/and fibrates. Elevated lipoprotein(a) is a quantitative genetic trait whose value in risk prediction over-rides genetic testing; treatment relies on RNA therapeutics.

Summary
Genetic testing is not at present commonly available for managing dyslipidaemias. Rapidly advancing technology may presage wider use, but its worth will require demonstration of cost-effectiveness and a healthcare workforce trained in genomic medicine.
Atrial fibrillation in patients with heart failure with preserved ejection fraction
Authors: Aldaas Omar M. , Malladi Chaitanya L. , Hsu Jonathan C. 
Published: February 2020

Purpose of reviewTo review the shared pathology of atrial fibrillation and heart failure with preserved ejection fraction (HFpEF) and the prognostic, diagnostic, and treatment challenges incurred by the co-occurrence of these increasingly prevalent diseases.Recent findingsMultiple risk factors and mechanisms have been proposed as potentially linking atrial fibrillation and HFpEF, with systemic inflammation more recently being invoked. Nonvitamin K oral anticoagulants, left atrial appendage occlusion devices, and catheter ablation have emerged as alternative treatment options. Other novel pharmacological agents, such as neprilysin inhibitors, need to be studied further in this patient population.SummaryAtrial fibrillation and HFpEF commonly co-occur because of their shared risk factors and pathophysiology and incur increased morbidity and mortality relative to either condition alone. Although the presence of both diseases can often make each diagnosis difficult, it is important to do so early in the disease course as there are now a variety of treatment options aimed at improving symptoms and quality of life, slowing disease progression, and improving prognosis. However, more research needs to be performed on the role of catheter ablation in this population. Novel pharmacologic and procedural treatment options appear promising and may further improve the treatment options available to this growing population.
Treating Uncomfortable Contact Lens Wear With Orthokeratology
Authors: Duong Kim , McGwin Gerald , Franklin Quentin X. , Cox Jared , Pucker Andrew D. 
Published: February 2020

Objectives:
Many contact lens (CL) users permanently discontinue wear because of ocular dryness and discomfort. This study aimed to determine whether refitting symptomatic soft CL wearers in to orthokeratology could improve ocular symptoms and signs.

Methods:
This was a prospective, 3-month, open-label study of symptomatic (Contact Lens Dry Eye Questionnaire [CLDEQ-8] ≥12) soft CL wearers who were between the ages of 18 and 45 years. All subjects were refit into orthokeratology CLs (Emerald, Euclid Systems). The following tests were completed: CL history, Standardized Patient Evaluation of Eye Dryness (SPEED) questionnaire, CLDEQ-8, CLDEQ-4, logarithm of the minimum angle of resolution visual acuity, pupil size, refractive error, slit-lamp biomicroscopy, noninvasive tear break-up time, tear meniscus height, phenol red thread, conjunctival staining, corneal aesthesiometry, and corneal topography.

Results:
Twenty-nine of 40 qualifying subjects (age=24.43±4.62 years) completed the study. No significant differences were detected between completed and noncomplete subjects. Completed subjects had significantly better CLDEQ-8, CLDEQ-4, and SPEED scores at 3 months compared with baseline. Completed subjects had significantly better conjunctival staining scores and flatter keratometry values at 1 month compared with baseline.

Conclusions:
Although not all symptomatic soft CL wearers were able to be refit into orthokeratology, subjects who were wearing orthokeratology at 3 months had a significant and clinically meaningful improvement in ocular symptoms. Additional work is needed to determine the mechanism leading to improved comfort because few clinical signs were changed after switching to orthokeratology.
The Antimicrobial Activity of Multipurpose Disinfecting Solutions in the Presence of Different Organic Soils
Authors: Yamasaki Katsuhide , Mizuno Yohei , Kitamura Yoshiyuki , Willcox Mark 
Published: February 2020

Objective:
During use, contact lens disinfecting solutions are exposed to tears and clinical microbial isolates. The current study was designed to test the performance of several disinfecting solution in the presence of organic soils or clinical isolates.

Methods:
Standard and clinical isolates were exposed to the disinfecting solutions in the presence or absence of different organic soils. The number of microbial cells killed during disinfection was established by growing cells after disinfection on agar plates.

Results:
The disinfecting activity of the povidone-iodine or hydrogen peroxide solutions was not affected by the organic soils or clinical isolates. The presence of yeast organic soil did not affect the performance of the disinfecting solutions when tested with standard microbial strains, but the addition of a model tear organic soil significantly reduced the disinfecting activity of the solutions containing various combinations of polyhexamethylene biguanide, polyquaternium-1, alexidine, and myristamindopropyl dimethylamine especially when tested against the standard fungal strains (reducing the effectiveness by between 0.5–4 log10) or the clinical bacterial isolates (reducing the effectiveness by between 0.5–3.5 log10). One disinfecting solution that contained polyquaternium-1 and myristamindopropyl dimethylamine had very poor activity against the clinical bacterial isolates in the absence or presence of either organic soil.

Conclusions:
Povidone-iodine or hydrogen peroxide disinfecting solutions are not affected by organic soils and are very active against clinical bacterial isolates. Disinfecting solutions containing combinations of polyhexamethylene biguanide, polyquaternium-1, alexidine, and myristamindopropyl dimethylamine are affected by model tear organic soil and may have poor activity against clinical isolates.
Central Retinal Vessel Trunk Caliber Changes After Short-term Intraocular Pressure Elevation
Authors: Zhang Qi , Lin Cai Xia , Yang Hongli , Chen Jian Dong , Jonas Jost B. , Wang Ya Xing 
Published: February 2020

Precis:
After a short-term intraocular pressure (IOP) elevation, the central retinal vein caliber may be widened at lower IOP rise levels, while be compressed at higher IOP rise values.

Purpose:
The purpose of this study was to investigate changes in the calibers of the central retinal vein trunk (CRVT) and central retinal artery trunk (CRAT) trunk during a short-term elevation of IOP.

Methods:
A prospective observational study. Acute primary angle-closure suspects underwent a dark room prone provocative test (DRPPT) for 2 hours. Before and at the end of the test, tonometry, swept-source optical coherence tomography, and nonmydriatic fundus photography were performed. The calibers of the CRVT and CRAT were measured on the fundus photos taken at baseline and at the end of the DRPPT.

Results:
The study included 101 eyes (61 individuals; mean age: 54.8±9.3 y; range: 30 to 70 y) which showed an increase in IOP by 9.6±9.0 mm Hg (range: 2.3 to 46.7 mm Hg). From baseline to the end of the DRPPT, the mean CRVT caliber increased from 101.8±25.9 to 107.7±26.6 μm (P<0.001), while the CRAT caliber did not differ significantly (110.3±24.2 vs. 109.7±21.5 μm; P=0.54) during the test. The CRVT widening was larger in the subgroup with IOP rise of <6 mm Hg than in the subgroup with an IOP rise of 6 to 15 mm Hg, while in the subgroup with an IOP rise of >15 mm Hg the CRVT caliber did not change significantly (P=0.20) during the test.

Conclusions:
A physiological short-term IOP rise at lower levels of IOP elevation led to a widening of the CRVT, while at higher IOP values, the further IOP-rise may have compressed the retinal vein. Because of higher intraluminal pressure values, the retinal artery diameters were not affected by the IOP-rise.
Pericardium Patch Graft (Tutoplast) for Bleb Repair and Bleb Remodelling After Nonpenetrating Filtering Surgery: 6-Month Outcomes
Authors: Niegowski Laëtitia J. , Bravetti Giorgio E. , Gillmann Kevin , Mansouri Kaweh , Mermoud André 
Published: February 2020

Purpose:
The purpose of this study was to evaluate the outcome of pericardium patch graft (Tutoplast) as an adjuvant to either bleb repair or bleb reduction after nonpenetrating filtering surgery.

Methods:
Retrospective study, at a tertiary glaucoma center. Bleb revision with Tutoplast positioning was performed either for bleb repair to treat early leaks or hypotony with maculopathy, either for bleb reduction to improve ocular pain, discomfort, burning, foreign body sensation, tearing, and fluctuations of visual acuity. Intraocular pressure (IOP), best corrected visual acuity, number of antiglaucoma medications, and postoperative complications were analyzed postoperatively at 1 week, 1, 3, 6 months, and compared with the preoperative baseline. Surgical success was defined as achieving an IOP between 8 and 16 mm Hg.

Results:
Six-month data were available from 15 eyes of 15 patients; mean patient age was 69.6±11.7 (66.7% male). Bleb revision was necessary for 10 patients due to bleb dysesthesia (bleb reduction), and in 5 patients due to leaking filtering bleb (bleb repair). The success rate was 73.3% at 6 months, with a significant IOP increase from 4.9±2.2 mm Hg preoperatively to 12.7±3.5 mm Hg at 6 months (P=0.0001), and a concomitant rise of best corrected visual acuity from 0.5±0.3 to 0.6±0.3 (P=0.2871). To control IOP, antiglaucoma medications were needed for 3 patients (20%) at 6 months. Overall, 3 patients (20%) required additional bleb revision for persistent hypotony, and 1 patient underwent a subsequent glaucoma surgery (transscleral cyclodestruction).

Conclusion:
Pericardium patch graft (Tutoplast) is a safe and effective adjuvant for bleb revision due to bleb dysesthesia of leaking filtering bleb after nonpenetrating filtering surgery.
Trabeculectomy With Extended Subscleral Tunnel Versus Conventional Trabeculectomy in the Management of POAG: A 1-Year Randomized-controlled Trial
Authors: Allam Riham S.H.M. , Raafat Karim A. , Abdel-Hamid Rehab M. 
Published: February 2020

Precis:
This clinical trial compares a modified trabeculectomy technique [extended subscleral tunnel (ESST)] with conventional trabeculectomy [subscleral trabeculectomy (SST)] in terms of success rate and bleb morphology. ESST showed comparable results, with lower incidence of bleb-related complications and need for postoperative antiglaucoma medications.

Background:
To evaluate the outcome of modified trabeculectomy with extended subscleral tunnel “ESST” versus conventional subscleral trabeculectomy “SST” in the management of uncontrolled primary open-angle glaucoma.

Participants and Methods:
This is a randomized clinical trial of 40 eyes (40 patients) divided into 2 equal groups. In the first group, a conventional SST with adjuvant 0.3% mitomycin-C was performed. In the second group, the ESST group, an additional 1.00 mm wide longitudinal scleral groove was dissected and excised in the center of the deep scleral bed extending 1.00 mm beyond the posterior margin of the flap. Patients were examined on days 1, 7, 14, 30, 90, 180, and at 1 year, with a special focus on intraocular pressure and bleb morphology. Postoperative ultrasound biomicroscopy was performed to evaluate the surgical area.

Results:
Both groups showed a significant reduction in intraocular pressure, with the ESST group showing significantly lower values on days 7, 14, 30, 90, and 180 (P=0.001, 0.004, 0.026, 0.001, and 0.048), but no significant differences on day 1 and at 1 year (P=0.06 and 0.07). The need for postoperative antiglaucoma medications was significantly lower in the ESST group (P=0.043). Visually significant cataract and bleb related complications were more in the SST group (P=0.044 and <0.001). Significantly more eyes in the ESST group showed normal bleb vascularity and wider extent.

Conclusions:
ESST offers a guarded posterior flow with a success rate comparable to that of conventional SST. ESST could minimize bleb-related complications and bleb-dysesthesia with better long-term bleb morphology and vascularity. It could also minimize the need for further adjuvant postoperative antiglaucoma medications.