bluuebunny/crossref_metadata_2025_split huggingface dataset:
Endotheliitis—A Presentation of Acanthamoeba Keratitis
Authors: Lakhani Bansri K. , Thajudeen Bushra , Jawaid Imran , Attzs Michelle S. , Maharajan Veerabahu S. 
Published: August 2020

Purpose:
To report endotheliitis as an early, key presenting sign of Acanthamoeba keratitis in patients who are soft contact lens wearers.

Methods:
We report 4 cases of patients presenting with pain, red eye, and reduction in vision in the context of soft contact lens wear. On examination, the predominant clinical finding was that of endotheliitis, localized fusiform stromal edema with corresponding keratic precipitates, anterior chamber inflammation, and minimal epithelial and anterior stromal signs. The classical signs of Acanthamoeba keratitis were not present.

Results:
All 4 cases were clinically diagnosed as Acanthamoeba endotheliitis; corneal scrapes were negative; case 1 was polymerase chain reaction positive, and case 3 underwent confocal microscopy that showed double-walled cysts, suggesting Acanthamoeba. All responded well to anti-Acanthamoeba medication alone with 3 cases achieving complete resolution with minimal anterior stromal scarring by 7 weeks. Case 1 had steroid treatment before being seen at our unit and had a prolonged course of treatment with complete resolution by 4 months.

Conclusions:
It is imperative to have a high index of suspicion for Acanthamoeba in patients presenting with pain and endotheliitis in the context of contact lens wear, even in the absence of classical signs.
Endosvascular Treatment of Mycotic Thoracic Aortic Pseudoaneurysm Secondary to Nontyphoidal Salmonella Infection
Authors: Ambroziak Agnieszka , Dobrowolski Sebastian , Hendiger Włodzimierz 
Published: August 2020

Abstract
Treatment of patients with infected aortic aneurysm remains a challenge for the vascular surgeon and carries a high risk of mortality. Here, we present a case of a patient with infected thoracic aneurysm treated successfully with endovascular technique. The female patient, age 57 years, was admitted to the hospital due to severe thoracic pain. The angiotomography revealed inflammation of the thoracic aorta along with the presence of air bubbles. Stool and blood cultures were positive for Salmonella ser. Enteritidis. Targeted antibiotics were given intravenously for 22 days followed by oral delivery for 6 months. After 14 weeks, angiotomography showed the presence of pseudoaneurysm of the descending thoracic aorta with a diameter of 87 mm, and a thoracic stent-graft was implanted. No endoleaks were detected at the 3-year follow-up. The presented patient with Salmonella-positive infected thoracic aneurysm was successfully treated with endovascular method but still needs lifelong follow-up.
Characteristics, Clinical Course, and Outcomes of Veterans Admitted With Covid-19 in Detroit, Michigan
Authors: Monday Lea M. , Abu-Heija Ahmad , Shatta Maya , Ilyas Sahrish , Bazzy Kareem , Natesan Suganthini Krishnan , Brown Patricia D. 
Published: August 2020

Background
The deaths due to coronavirus disease (Covid-19) in Michigan have been disproportionately centered in the city of Detroit. We sought to characterize hospitalized veterans with Covid-19 infection in Detroit, MI and compare them to inpatients previously reported.

Methods
A retrospective observational study of 79 veterans admitted to a veteran's hospital with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) between March 10, through April 6, 2020. Each patient had at least 30 days of follow-up.

Results
The median age of 79 enrolled patients was 69.0 years (interquartile range, 57.0–75.0 years) and 74 (94%) were men. Twenty-four (30%) had a recent emergency department visit. Respiratory symptoms were present in 67 (85%). Gastrointestinal symptoms were common (49 [62%]), including diarrhea (27 [34%]) and loss of appetite (31 [39%]). Only 30 (38%) patients had fever on admission. Comorbidities included hypertension (73 [92%]), diabetes (48 [61%]), obesity (42 [53%]), chronic obstructive pulmonary disease (30 [38%]), coronary disease (28 [35%]), and obstructive sleep apnea (25 [32%]). Nine patients were admitted to the intensive care unit, and 18 (26%) of 70 required intensive care unit transfer. Twenty-Four (30%) were intubated; of which 3 were extubated and 20 (83%) died. Of the 57 (72%) patients discharged alive, 22 (39%) required supplemental oxygen and 8 (14%) were readmitted within 30 days.

Conclusions
Detroit veterans were primarily older African American men with more comorbidities than inpatients previously described. Gastrointestinal symptoms were twice as common as fever. Rates of mortality and readmission were higher than those previously reported in populations with shorter follow up.
A Singular Petechial Plantar Rash in a Patient With a Confirmed COVID-19
Authors: De la Torre Gomar Francisco J. , Saenz Aguirre Amaia , Rosés-Gibert Pau , Gimeno Castillo Javier , Martínez-González Maria Isabel , González-Pérez Ricardo 
Published: August 2020

Abstract
Several singular cutaneous manifestations have been recently reported in patients with confirmed or suspected coronavirus disease 2019 (COVID-19). Acral chilblain-like lesions, as well as purpuric macules, have already been characterized. We illustrate a case of a 100-year-old man who was diagnosed with COVID-19 and presented an acral petechial rash some weeks after his respiratory infection. We suggest that it could represent a novel variant of cutaneous manifestations associated to this viral infection, possibly related to a delayed immunological reaction.
Glucocorticoids Improve 30-day Survival Probability in Critical Coronavirus Disease 2019 Patients
Authors: Wang Tao , Guerra Alfonso Llosa 
Published: August 2020

Background
The optimal approach to manage Coronavirus Disease 2019 (COVID-19) patient is still uncertain, especially for critical ill patients, high mortality has been observed since the outbreak of the crisis. Glucocorticoid use has been in debate for treating COVID-19–infected patient.

Methods
Twenty-nine critically ill patients with COVID-19 in this report are defined as patients are intubated and admitted to intensive care unit (ICU). Chart review was conducted on those patients, their demographic characteristics, baseline comorbidities, hospital course, clinical management, and laboratory/imagine reports were summarized. Thirty-day survival probability after ICU admission was analyzed for comparing the steroid group and nonsteroid group. Survival curve and analysis were performed by Kaplan-Meier survival analysis. P value less than 0.05 is defined as significant different.

Results
Among the 29 critical COVID-19 cases, 12 are survived beyond day 30 of ICU admission, 9 of the 12 are successfully extubated and discharged home, 3 remained on ventilator support in ICU after 30 days. In the 12 survived patients, 10 (83%) received glucocorticoid treatment, whereas in the 17 patients who died, only 8 (44%) were treated with steroid. The baseline characteristics between the steroid and nonsteroid group are similar. The 30-day survival rate is lower in the steroid group comparing to the nonsteroid group (P = 0.0405).

Conclusions
Proper use of glucocorticoids offers considerable mortality benefit to the outcome of critical ill COVID-19 patient. This observational descriptive study might be helpful to other similar small community hospital facing a surge of COVID-19 patients, when other clinical trials or supports are hardly available.
Pudendal Nerve Injuries in Sports and Exercise: A Case Series of Pudendal Neuropathies From Squats
Authors: Kasitinon Donald , Kelly Brian , Price Taylor L. , Chhabra Avneesh , Scott Kelly M. 
Published: August 2020

Background:
Pudendal neuropathy is an underrecognized cause of pelvic pain that can be difficult to diagnose and treat. Cycling has been the traditional etiology associated with exercise-induced pudendal neuropathy, but with changing aesthetic and societal norms emphasizing a strong physique, there has been increasing anecdotal evidence of squat-based exercises causing the condition.

Study Design:
Case series. A retrospective medical record review was performed to look at all patients with pudendal nerve injuries who presented to a physical medicine and rehabilitation pelvic floor rehabilitation clinic over a 1-year period.

Case Description:
There were 15 cases of pudendal neuropathy thought to be due to squat-based exercises. Here, we present 4 of these patients (1 male and 3 females) who had good follow-up and compliance with treatment recommendations, along with their respective outcomes.

Outcomes:
This is the first case series to present a number of patients with pelvic pain due to pudendal neuropathies presumably derived from squat-related exercise. All 4 of these patients had good outcomes utilizing a multidisciplinary approach to management.

Discussion:
It is important for both physicians and physical therapists to learn to recognize pudendal neuropathy as a cause of pelvic pain and to counsel patients effectively to help them avoid pudendal nerve injury during exercise.
Association Between Helicobacter pylori Colonization and Inflammatory Bowel Disease
Authors: Shirzad-Aski Hesamaddin , Besharat Sima , Kienesberger Sabine , Sohrabi Ahmad , Roshandel Gholamreza , Amiriani Taghi , Norouzi Alireza , Keshtkar Aabbas 
Published: August 2020

Background:
Various observational studies have examined a potential relationship between Helicobacter pylori colonization and inflammatory bowel diseases (IBDs); however, results are inconclusive. This systematic review evaluates articles reporting an association between human H. pylori colonization and IBD.

Methods:
A systematic search of studies was conducted to evaluate a possible relationship between H. pylori colonization and IBD. Seven databases and different types of gray literature were searched. After screening for relevant articles, selection and data extraction were done. After that, the data were analyzed, and pooled odds ratios (ORs) were calculated, using meta-analysis. Heterogeneity, sensitivity, and subgroups analyses were conducted. Funnel plots followed by Begg and Egger tests were done to assess the publication bias.

Results:
Among 58 studies, including 13,549 patients with IBD and 506,554 controls, the prevalence of H. pylori colonization was 22.74% and 36.30%, respectively. A significant negative association was observed between H. pylori colonization and IBD (pooled OR: 0.45, 95% confidence interval 0.39-0.53, P≤0.001). The random-effect model showed significant statistical heterogeneity in the included studies (I
2=79%). No publication bias was observed. Among subgroups, ORs were notably different when the data were stratified by the age difference between patient and control group, and by study regions and/or continent. Finally, the meta-regression analysis showed significant results, in terms of the age difference and region variables.

Conclusions:
In this meta-analysis, all statistical data support the theory that H. pylori has a protective role in IBD. However, more primary studies using proper methodology are needed to confirm this association.
Lifestyle interventions affecting hepatic fatty acid metabolism
Authors: Parry Sion A. , Turner Mark C. , Hodson Leanne 
Published: August 2020

Purpose of review
Prevalence of metabolic-associated fatty liver disease (MAFLD) is increasing, and as pharmacological treatment does not exist, lifestyle interventions (i.e. diet and exercise) represent the cornerstone management and treatment strategy. Although the available data clearly demonstrate that changes in lifestyle influence intrahepatic triglyceride (IHTG) content, the mechanisms through which this is achieved are seldom investigated. Here, we review recent evidence demonstrating the influence of lifestyle interventions on hepatic fatty acid metabolism and IHTG content.

Recent findings
Diet and exercise influence IHTG content through various, and often interrelated factors. These include alterations in whole-body and tissue-specific insulin sensitivity, which may influence the flux of fatty acid and lipogenic substrates to the liver, and changes in intrahepatic fatty acid synthesis and partitioning. Notably, there are only a few studies that have investigated intrahepatic fatty acid metabolism in vivo in humans before and after an intervention.

Summary
Lifestyle interventions represent an effective means of influencing hepatic fatty acid metabolism. IHTG content is decreased without weight-loss either through exercise or by changing the macronutrient composition of the diet, although what the optimal macronutrient composition is to achieve this has yet to be defined.
Can a carnivore diet provide all essential nutrients?
Authors: O’Hearn Amber 
Published: August 2020

Purpose of review
The aim of this study was to summarize current contributions affecting knowledge and predictions about the nutritional adequacy of plant-free diets, contextualized by historical accounts.

Recent findings
As demonstrated in recent experiments, nutrient interactions and metabolic effects of ketogenic diets can impact nutritional needs, sometimes resulting in nutrient-sparing effects. Other studies highlight conflicting hypotheses about the expected effect on metabolic acidosis, and therefore mineral status, of adding alkaline mineral-rich vegetables.

Summary
A carnivore diet is a newly popular, but as yet sparsely studied form of ketogenic diet in which plant foods are eliminated such that all, or almost all, nutrition derives from animal sourced foods. Ketogenic diets are already nutritionally controversial due to their near-complete absence of carbohydrate and high dietary fat content, but most ketogenic diet advocates emphasize the inclusion of plant foods. In this review, we discuss the implications of relying solely on animal sourced foods in terms of essential nutrient status.
Racial Differences in the Effectiveness of a Multifactorial Telehealth Intervention to Slow Diabetic Kidney Disease
Authors: Kobe Elizabeth A. , Diamantidis Clarissa J. , Bosworth Hayden B. , Davenport Clemontina A. , Oakes Megan , Alexopoulos Anastasia-Stefania , Pendergast Jane , Patel Uptal D. , Crowley Matthew J. 
Published: August 2020

Background:
African Americans are significantly more likely than non-African Americans to have diabetes, chronic kidney disease, and uncontrolled hypertension, increasing their risk for kidney function decline.

Objective:
The objective of this study was to compare how African Americans and non-African Americans with diabetes responded to a multifactorial telehealth intervention designed to slow kidney function decline.

Research Design:
Secondary analysis of a randomized trial. Primary care patients (N=281, 56% African American) were allocated to either: (1) a multifactorial, pharmacist-delivered phone-based telehealth intervention focused on behavioral and medication management of diabetic kidney disease; or (2) an education control.

Measures:
The primary study outcome was change in estimated glomerular filtration rate (eGFR). Linear mixed models were used to explore the moderating effect of race on the relationship between study arm and eGFR decline over time; the mean annual rate of eGFR decline was estimated by race and study arm.

Results:
Findings demonstrated a differential intervention effect on kidney function over time by race (P
interaction=0.005). Among African Americans, the intervention arm had significantly greater preservation of eGFR over time than the control arm (difference in the annual rate of eGFR decline=1.5 mL/min/1.73 m2; 95% confidence interval: 0.04, 3.02). For non-African Americans, the intervention arm had a faster decline in eGFR over time than the control arm (difference in the annual rate of eGFR decline=−1.7 mL/min/1.73 m2; 95% confidence interval: −3.3, −0.02).

Conclusion:
A multifactorial, pharmacist-delivered telehealth intervention for diabetic kidney disease may be more effective for slowing eGFR decline among African Americans than non-African Americans.
Learning and the “Early Joiner” Effect for Medical Conditions in Medicare’s Bundled Payments for Care Improvement Program
Authors: Joynt Maddox Karen E. , Orav E. John , Zheng Jie , Epstein Arnold M. 
Published: August 2020

Background:
Studies of medical conditions in the Bundled Payments for Care Improvement (BPCI) initiative did not show reductions in Medicare payments for the majority of conditions, but this could mask heterogeneity.

Objective:
To determine whether earlier enrollment and/or longer participation in BPCI were associated with performance.

Design:
We divided BPCI hospitals into wave 1 (joined 10/1/13, 1/1/14, or 4/1/14), wave 2 (joined 7/1/14, 10/1/14, 1/1/15, or 4/1/15), and wave 3 (joined 7/1/15, 10/1/15, or 1/1/16) and compared changes in Medicare payments for acute myocardial infarction, heart failure, pneumonia, sepsis, and chronic obstructive pulmonary disease between BPCI and matched controls in 6-month increments.

Subjects:
US hospitals.

Measures:
Medicare payments.

Results:
There were 120 hospital-condition pairs in wave 1, 264 in wave 2, and 300 in wave 3. Wave 1 hospitals had similar savings to controls early in the program (0–6 mo difference in differences −$10, P=0.976; 6–12 mo +$295, P=0.441; 12–18 mo −$540, P=0.218; 18–24 mo −$485, P=0.259) but had greater savings than controls at 24–30 months (difference in differences −$663, P=0.035). Wave 2 (0–6 mo +$193, P=0.524; 6–12 mo −$183, P=0.489; 12–18 mo −$162, P=0.618) and wave 3 hospitals (0–6 mo +$79, P=0.753; 6–12 mo −$32, P=0.876) did not achieve significant savings at any time interval. There were no differential changes in patient outcomes over time.

Conclusions:
Hospitals that joined BPCI earliest began to achieve savings at roughly 2 years of participation. These findings have implications for this and other alternative payment models.
Associations of 4 Nurse Staffing Practices With Hospital Mortality
Authors: Rochefort Christian M. , Beauchamp Marie-Eve , Audet Li-Anne , Abrahamowicz Michal , Bourgault Patricia 
Published: August 2020

Background:Cross-sectional studies of hospital-level administrative data have suggested that 4 nurse staffing practices—using adequate staffing levels, higher proportions of registered nurses (RNs) (skill mix), and more educated and experienced RNs—are each associated with reduced hospital mortality. To increase the validity of this evidence, patient-level longitudinal studies assessing the simultaneous associations of these staffing practices with mortality are required.Methods:A dynamic cohort of 146,349 adult medical, surgical, and intensive care patients admitted to a Canadian University Health Center was followed for 7 years (2010–2017). We used a multivariable Cox proportional hazards model to estimate the associations between patients’ time-varying cumulative exposure to measures of RN understaffing, skill mix, education, and experience, each relative to nursing unit and shift means, and the hazard of in-hospital mortality, while adjusting for patient and nursing unit characteristics, and modeling the current nursing unit of hospitalization as a random effect.Results:Overall, 4854 in-hospital deaths occurred during 3,478,603 patient-shifts of follow-up (13.95 deaths/10,000 patient-shifts). In multivariable analyses, every 5% increase in the cumulative proportion of understaffed shifts was associated with a 1.0% increase in mortality (hazard ratio: 1.010; 95% confidence interval: 1.002–1.017;P=0.009). Moreover, every 5% increase in the cumulative proportion of worked hours by baccalaureate-prepared RNs was associated with a 2.0% reduction of mortality (hazard ratio: 0.980; 95% confidence interval: 0.965–0.995,P=0.008). RN experience and skill mix were not significantly associated with mortality.Conclusion:Reducing the frequency of understaffed shifts and increasing the proportion of baccalaureate-prepared RNs are associated with reduced hospital mortality.
Electronic Measurement of a Clinical Quality Measure for Inpatient Hypoglycemic Events
Authors: Santos Carlos A.Q. , Conover Craig , Shehab Nadine , Geller Andrew I. , Guerra Yannis S. , Kramer Holly , Kosacz Nicole M. , Zhang Huiyuan , Budnitz Daniel S. , Trick William E. 
Published: August 2020

Background:
Hypoglycemia related to antidiabetic drugs (ADDs) is important iatrogenic harm in hospitalized patients. Electronic identification of ADD-related hypoglycemia may be an efficient, reliable method to inform quality improvement.

Objective:
Develop electronic queries of electronic health records for facility-wide and unit-specific inpatient hypoglycemia event rates and validate query findings with manual chart review.

Methods:
Electronic queries were created to associate blood glucose (BG) values with ADD administration and inpatient location in 3 tertiary care hospitals with Patient-Centered Outcomes Research Network (PCORnet) databases. Queries were based on National Quality Forum criteria with hypoglycemia thresholds <40 and <54 mg/dL, and validated using a stratified random sample of 321 BG events. Sensitivity and specificity were calculated with manual chart review as the reference standard.

Results:
The sensitivity and specificity of queries for hypoglycemia events were 97.3% [95% confidence interval (CI), 90.5%–99.7%] and 100.0% (95% CI, 92.6%–100.0%), respectively for BG <40 mg/dL, and 97.7% (95% CI, 93.3%–99.5%) and 100.0% (95% CI, 95.3%–100.0%), respectively for <54 mg/dL. The sensitivity and specificity of the query for identifying ADD days were 91.8% (95% CI, 89.2%–94.0%) and 99.0% (95% CI, 97.5%–99.7%). Of 48 events missed by the queries, 37 (77.1%) were due to incomplete identification of insulin administered by infusion. Facility-wide hypoglycemia rates were 0.4%–0.8% (BG <40 mg/dL) and 1.9%–3.0% (BG <54 mg/dL); rates varied by patient care unit.

Conclusions:
Electronic queries can accurately identify inpatient hypoglycemia. Implementation in non–PCORnet-participating facilities should be assessed, with particular attention to patient location and insulin infusions.
Current imaging tools for vestibular schwannoma
Authors: Dang Linh , Tu Nathan Chin-yau , Chan Eleanor Y. 
Published: August 2020

Purpose of review
Of the tumors found in the cerebellopontine angle (CPA), vestibular schwannomas are by far the most common. Modern diagnostic imaging enables excellent visualization of the CPA and detection of very small tumors while optimizing patient comfort and time. This review addresses the current imaging tools available for diagnosis of vestibular schwannomas.

Recent findings
The current gold-standard imaging study for vestibular schwannomas is a gadolinium-enhanced T1-weighted MRI. The yield of this expensive study is only about 3–4% given the low incidence of vestibular schwannomas, thus there is utility in screening with noncontrast T2-weighted MRI, which is a quicker and more economical study.

Summary
Vestibular schwannomas are best evaluated with gadolinium-enhanced T1-weighted MRI, which can detect tumors as small as 2–3 mm. Recent studies have found that the reported sensitivity and specificity of noncontrast MRI is almost equivalent to that of gadolinium-enhanced T1-weighted MRI. As such, this modality is increasingly being adopted by institutions for both diagnosis and surveillance of vestibular schwannomas and shows promise for broader implementation. Newer protocols, such as FLAIR and DTI may provide additional information and further aid preoperative counseling and surgical planning in the future.