bluuebunny/crossref_metadata_2025_split huggingface dataset:
Epidemiology, Etiology and Clinical Aspects of Childhood Acute Encephalitis in a Tertiary Pediatric Hospital in Costa Rica
Authors: Sevilla-Acosta Fabricio , Gutiérrez-Mata Alfonso , Yock-Corrales Adriana , Bogantes-Ledezma Sixto , Pérez-Corrales Cristian , Camacho-Badilla Kattia 
Published: October 2020

Background:
Limited data are available on childhood encephalitis in Latin America. Our study aimed to increase insight on clinical presentation, etiology and outcome of children with acute encephalitis in Costa Rica.

Methods:
We conducted a prospective, observational study during an 8-month period at the Hospital Nacional de Niños “Dr. Carlos Sáenz Herrera” in Costa Rica. Case definition was according to “International Encephalitis Consortium” in children <13 years. We analyzed demographic characteristics, clinical symptoms, neurologic imaging, etiology, treatment and mortality.

Results:
Forty patients were identified. Mean age was 5 years and 57.5% were male. Most frequently neurologic symptoms were altered mental status (100.0%), headache (57.5%) and seizures (52.5%). Etiology was determined in 52.5% of cases. Probable or confirmed viral etiology was identified in 6 cases (15.0%) and bacterial etiology in also 6 cases (15.0%). A possible etiology was identified in 7 cases (17.5%). Autoimmune encephalitis was diagnosed in 2 patients (5.0%). Enterovirus and Streptococcus pneumoniae were the most common confirmed agents. No cases of herpes simplex virus were found. Etiology of 19 cases (47.5%) remained unknown. Sequelae were reported in 45.0% of patients. Mortality rate was 15.0% (6 cases), 3 caused by virus (adenovirus, human herpesvirus 6, enterovirus), 2 by bacteria (S. pneumoniae, Haemophilus influenzae type b) and 1 of unknown etiology. Diffuse cerebral edema was the most important mortality predictor (P < 0.001).

Conclusions:
Acute encephalitis in our study was associated with significant morbidity and mortality. Early and aggressive antiviral, antibiotic and anticerebral edema treatment is necessary when acute encephalitis is suspected.
Optimal Initial Workup in Patients With Superficial Primary Gastric MALT Lymphoma
Authors: Na Hee Kyong , Won Sung Hyun , Lee Jeong Hoon , Kim Ga Hee , Jung Kee Wook , Ahn Ji Yong , Kim Do Hoon , Choi Kee Don , Song Ho June , Lee Gin Hyug , Jung Hwoon-Yong 
Published: October 2020

Background and Aims:
The prognosis of gastric mucosa-associated lymphoid tissue (MALT) lymphoma is favorable, especially in the absence of lymph node metastasis (LNM). We investigated LNM incidence and location in superficial type gastric MALT lymphoma.

Methods:
We performed a retrospective analysis of 450 patients newly diagnosed with gastric MALT lymphoma with tumor infiltration confined to the mucosa or submucosa as evidenced by endoscopic ultrasonography. LNM incidence and location were evaluated.

Results:
Of the 450 patients, most patients (434, 96.4%) were initially LNM negative as confirmed by computed tomography (CT) scanning. Sixteen patients (3.6%) were LNM positive. There was no difference in clinical characteristics between the 2 groups except for the extent of lymphoma involvement and endoscopic findings. Among 41 patients undergoing abdominal/pelvic CT (APCT) only, LNM was detected in 1 (2.4%). There were 8 LNM cases among 238 patients undergoing both APCT and chest CT (3.4%). Among 171 patients undergoing APCT, chest CT, and neck CT, 7 cases of LNM were detected (4.1%). The detection rates for each CT were as follows: abdominal CT, 13/450 (2.9%); chest CT, 6/408 (1.5%); and neck CT, 1/171 (0.6%). Among 6 patients with chest CT-positive findings, 3 showed no evidence of LNM on APCT.

Conclusion:
LNM was an infrequent finding in gastric MALT lymphoma patients with tumor infiltration confined to the mucosa or submucosa. Besides endoscopy and endoscopic ultrasonography, APCT and chest CT are considered as optimal initial workup modalities in patients with assumed primary superficial gastric MALT lymphoma.
Vitamin D in Children With Inflammatory Bowel Disease
Authors: El Amrousy Doaa , El Ashry Heba , Hodeib Hossam , Hassan Samir 
Published: October 2020

Background:
Vitamin D has anti-inflammatory and immune regulatory functions.

Goals:
The authors investigated the effect of vitamin D supplementation in children with inflammatory bowel disease (IBD) and hypovitaminosis D on disease activity, quality of life (QOL), inflammatory markers, and cytokines.

Study:
This randomized double-blinded controlled clinical trial included 120 children with IBD and hypovitaminosis D; 22 of them were excluded later. Patients were randomized to receive either oral vitamin D3 in a dose of 2000 IU/day or placebo for 6 months. The primary outcome was to evaluate the effect of vitamin D supplementation on the IBD activity score. The secondary outcomes were to assess the QOL, inflammatory markers, cytokines, the safety of vitamin D, and to correlate serum vitamin D level with various clinical and laboratory variables.

Results:
Vitamin D supplementation significantly decreased the IBD activity score in the vitamin D group compared with the placebo group. Moreover, QOL significantly improved after vitamin D supplementation. Inflammatory markers, for example, erythrocyte sedimentation rate, C-reactive protein, and fecal calprotectin and interleukin-2 IL-12, IL-17, IL-23, and tumor necrosis factor-alpha significantly decreased in the vitamin D group. However, IL-10 significantly increased after vitamin D supplementation. Vitamin D was significantly inversely correlated with the activity score, QOL score, levels of all inflammatory markers, the frequency of hospitalization, and emergency department visits.

Conclusion:
Vitamin D supplementation may have a beneficial effect in children with IBD.
Efficacy and Safety of Modified Dual Therapy as the First-line Regimen for the Treatment of Helicobacter pylori Infection
Authors: Huang Qiuyue , Shi Zongming , Cheng Hong , Ye Hui , Zhang Xuezhi 
Published: October 2020

Background:
In an era of antibiotic resistance, modified dual therapy has been paid much attention because of simple drug composition and low resistance of amoxicillin. However, its eradication rate as a first-line regimen remains controversial. This study is to evaluate the efficacy and safety of modified dual therapy for the initial treatment of Helicobacter pylori (H. pylori) infection compared with mainstream first-line therapies.

Methods:
PubMed, the Cochrane Library, and Embase were searched for randomized clinical trials evaluating the efficacy and safety of modified dual therapy as the initial treatment for H. pylori eradication compared with guideline-recommended first-line therapies. A meta-analysis was conducted using Review Manager 5.3 and dichotomous data were estimated by the risk ratio (RR) with the 95% confidence interval (CI). We also performed subgroup analysis according to control groups and studies with antibiotic susceptibility tests.

Results:
Eight studies including 1672 patients with H. pylori infection met the selection criteria and were assessed. The meta-analysis demonstrated that modified dual therapy achieved similar efficacy [85.83% vs. 86.77%, RR 0.99 (95% CI, 0.95-1.03), intention-to-treat analysis; 89.53% vs. 90.45%, RR 0.99 (95% CI, 0.96-1.02), per-protocol analysis] and compliance [95.77% vs. 95.56%, RR 1.00 (95% CI, 0.98-1.02)] compared with recommended first-line regimens. In addition, there were no significant differences in comparing the eradication rate of modified dual therapy with clarithromycin triple therapy, bismuth quadruple therapy, and concomitant therapy, respectively. Subgroup analysis based on the studies with antibiotic susceptibility tests also confirmed a similar efficacy. However, modified dual therapy showed fewer adverse effects [8.70% vs. 22.38%, RR 0.39 (95% CI, 0.28-0.54)], with a significant difference (P<0.00001).

Conclusion:
Modified dual therapy achieved equal efficacy and compliance compared with recommended first-line regimens for H. pylori infection, and generally modified dual therapy showed fewer side effects.
Dietary protein interventions to improve nutritional status in end-stage renal disease patients undergoing hemodialysis
Authors: Hendriks Floris K. , Kooman Jeroen P. , van Loon Luc J.C. 
Published: October 2020

Purpose of review
Poor nutritional status is prevalent among end-stage renal disease patients undergoing hemodialysis. Chronic hemodialysis patients show an accelerated decline in skeletal muscle mass and strength, which is associated with higher mortality rates and a reduced quality of life. The current review aims to summarize recent advances regarding underlying causes of muscle loss and interventions that support muscle mass maintenance in patients with chronic hemodialysis.

Recent findings
Muscle maintenance in chronic hemodialysis patients is compromised by low dietary protein intake levels, anabolic resistance of skeletal muscle tissue, sedentary behavior, and amino acid removal during hemodialysis. Studies assessing the effect of increased protein intake on nutritional status generally show beneficial results, especially in hypoalbuminemic chronic hemodialysis patients. The muscle protein synthetic response following protein ingestion in chronic hemodialysis patients may be enhanced through incorporation of structured physical activity and/or concurrent ketoacid ingestion.

Summary
A coordinated program that combines nutritional and physical activity interventions is likely required to attenuate the decline in muscle mass and strength of chronic hemodialysis patients. Nephrologists, dieticians, and exercise specialists should collaborate closely to establish guidelines regarding the appropriate quantity and timing of protein ingestion. In addition, they should provide tailored nutritional and physical activity interventions for chronic hemodialysis patients (see video, Supplemental Digital Content 1, Video abstract, http://links.lww.com/COCN/A14).
Noninvasive strategies for colorectal cancer screening: opportunities and limitations
Authors: Lou Susan , Shaukat Aasma 
Published: October 2020

Purpose of review
In the United States, only 67% of patients are up to date with colorectal cancer (CRC) screening. While colonoscopy is highly sensitive and specific for CRC and precursor lesion detection and removal, it is invasive, expensive and resource heavy. Hence, there is an unfulfilled need for multiple modality CRC screening that can improve current CRC screening rates and may be resource effective strategies when used in conjunction with a colonoscopy program. Our review highlights the complementary, often underutilized, noninvasive CRC screening methods with a focus on performance, risks, benefits, and recent updates.

Recent findings
Studies demonstrate that fecal immunochemical testing (FIT) is superior to guaiac-based fecal occult blood tests for CRC screening. Studies show superiority of multitarget stool DNA test to FIT in sensitivity, though with concern for decreased specificity in setting of one-time tests. Technical advances continue to improve accuracy of colon capsule endoscopy. There are ongoing studies to characterize often difficult-to-detect high-risk lesions in computed tomography colonography. Septin 9 continues to have suboptimal accuracy for CRC screening, but has been shown to be associated with more advanced, invasive CRC stages.

Summary
There are ongoing advances in noninvasive screening modalities for CRC; these should be considered as alternatives to colonoscopy in specific patient populations.
Solitary rectal ulcer syndrome
Authors: Felt-Bersma Richelle J.F. 
Published: October 2020

Purpose of review
Solitary rectal ulcer syndrome (SRUS) is a rare disease which can puzzle the gastroenterologist. A review of the syndrome and new treatment options are discussed.

Recent findings
Its association with dyssynergia in general supports an important role for pelvic floor biofeedback, which can be successful in patients with SRUS. No other novel.

Summary
Awareness of this benign syndrome is important; endoscopic diagnosis and histological confirmation opens the way to a guided lifestyle therapy with regulation of defecation and pelvic floor biofeedback. A reluctance to proceed to surgery seems warranted.

Video abstract

http://links.lww.com/COG/A34
Posterior glottic stenosis: management and outcomes
Authors: DeHart Austin N. , Richter Gresham T. 
Published: October 2020

Purpose of review
Pediatric posterior glottic stenosis (PGS) is a challenging clinical entity with multiple treatment options. This review describes the evaluation of patients with PGS and discusses existing surgical techniques.

Recent findings
PGS secondary to a distinct scar band between the vocal folds can often be effectively managed with endoscopic division and surveillance. More advanced glottic scarring that also involves the interarytenoid mucosa, cricoarytenoid joints, or subglottis merits a more thorough investigation and repair. A postcricoid mucosal advancement flap can be employed in select adolescent or adult PGS, but long-term cricoarytenoid joint mobility is difficult to restore once it has been fixed. Younger pediatric patients have smaller airways and frequent concurrent subglottic stenosis which is better addressed with cartilage grafting.

Summary
Surgical success in pediatric PGS depends on careful preoperative airway assessment and the accurate characterization of airway stenosis. A surgical technique should be chosen based on the severity and extent of stenosis.
Knowledge of Endometrial Cancer Risk Factors in a General Gynecologic Population
Authors: Washington Christina R. , Haggerty Ashley , Ronner Wanda , Neff Pamela M. , Ko Emily M. 
Published: October 2020

(Abstracted from Gynecol Oncol 2020;158:137–142)
Obesity is a preventable condition that is associated with heart disease, diabetes, certain types of cancer, and innumerable other conditions causing significant morbidity and mortality in the United States. Despite that type 1 endometrial cancer (EC) was the first cancer to be associated with obesity, many women are unaware of the evidence-based association between obesity and EC.
In Vitro Fertilization and Risk for Hypertensive Disorders of Pregnancy: Associations With Treatment Parameters
Authors: Luke Barbara , Brown Morton B. , Eisenberg Michael L. , Callan Caitriona , Botting Beverley J. , Pacey Allan , Sutcliffe Alastair G. , Baker Valerie L. 
Published: October 2020

(Abstracted from Am J Obstet Gynecol 2020;222:350.e1–350.e13)
With an increasing proportion of pregnancies being conceived using assisted-reproductive technology, important changes to in vitro fertilization (IVF) such as the use of cryopreserved oocytes or embryos have been made. It is now established that adverse maternal and infant perinatal outcomes are associated with both assisted reproductive technologies and subfertility.
Skull Fracture Patterns and Morphologies Among Fatal Motorcycle Traffic Accident Victims in Vietnam
Authors: Anh Nguyen Tuan , Hung Luu Sy , Xuan Nguyen Thanh , Lap Phan Duc , Tuan Dinh Thanh , Kien Vu Duy 
Published: October 2020

Abstract
We aim to describe morphological structures of skull fractures and relevant factors in motorcycle accident victims in Vietnam. This work represents a retrospective cross-sectional study based on forensic reports of fatal motorcycle accident victims. Between January 2013 and August 2019, a total of 226 fatal motorcycle accident patients with skull fracture diagnoses were enrolled. Linear and depressed fractures were the common patterns (46.0% and 37.2% of cases, respectively), whereas stellate (11.5%) fractures were rare. Fractures of the temporal bone (68.6% of cases) and basilar skull (60.6%) were the most common, whereas fractures of the parietal bone were the least common (9.7%). Two or more patterns of skull fracture were recorded in 25.5% of cases, and 2 or more fracture locations were recorded in 76.6% of cases. Fractures of the parietal bone were associated with victims not wearing a helmet. In addition, fractures of the basilar skull were more likely to occur among victims with alcohol consumption. We found the common pattern of skull fractures was linear and depressed fractures, and the common location of skull fractures was temporal and basilar bone. Further studies that include larger sample sizes and collect more information should be conducted to better understand relationships between skull fractures and related factors.
Point-of-Care Ultrasound for Central Venous Assessment in the Emergency Department
Authors: Pandya Lori , Cooper Michael , Patel Nishit , Leonard David , Fernandes Neil , Spear Dave , Nesiama Jo-Ann 
Published: October 2020

Objectives
The objective of this study was to estimate the width, height, and depth of the femoral vein (FV) and internal jugular vein (IJV), both sites of potential central line placement in children, using point-of-care ultrasound.

Methods
This was a prospective observational study. Point-of-care ultrasound was used to measure the width, height, and depth of the right FV and IJV in 100 children. The primary outcome was a comparison of the widths of the FV and the IJV in the same child. Our primary hypothesis was that the IJV would be wider than the FV. Secondary outcome measures included comparison of the heights and depths the FV and IJV and description of vessel overlap frequency between the 2 sites.

Results
A total of 106 children were enrolled, with 6 subjects excluded, and equally divided into 5 age groups (0–30 days, 1–24 months, 2–5 years, 6–11 years, and 12–17 years). The FV/IJV width ratios (95% confidence interval) by age were 0.58 (0.49–0.68), 0.53 (0.43–0.66), 0.57 (0.49–0.67), 0.68 (0.55–0.85), and 0.73 (0.62–0.85), all P < 0.002. The FV/IJV height ratios were <1 in all age groups, with P < 0.003 in the 4 youngest age groups. The FV/IJV depth ratios were >1 in 6 to 11 years (P = 0.018) and 12 to 17 years (P < 0.001).

Conclusions
The IJV was significantly wider and taller than the FV in the same child in all age groups. The FV was significantly deeper than the IJV in children 6 years and older. This supports the use of the IJV as a potential site when placing ultrasound-guided central lines in children.
Schistosoma mansoni Infection Is Associated With a Higher Probability of Tuberculosis Disease in HIV-Infected Adults in Kenya
Authors: McLaughlin Taryn A. , Nizam Azhar , Hayara Felix Odhiambo , Ouma Gregory Sadat , Campbell Angela , Khayumbi Jeremiah , Ongalo Joshua , Ouma Samuel Gurrion , Shah N. Sarita , Altman John D. , Kaushal Deepak , Rengarajan Jyothi , Ernst Joel D. , Blumberg Henry M. , Waller Lance A. , Gandhi Neel R. , Day Cheryl L. , Benkeser David 
Published: October 2020

Background:Helminth infections can modulate immunity toMycobacterium tuberculosis(Mtb). However, the effect of helminths, includingSchistosoma mansoni(SM),on Mtb infection outcomes is less clear. Furthermore, HIV is a known risk factor for tuberculosis (TB) disease and has been implicated in SM pathogenesis. Therefore, it is important to evaluate whether HIV modifies the association between SM and Mtb infection.Setting:HIV-infected and HIV-uninfected adults were enrolled in Kisumu County, Kenya, between 2014 and 2017 and categorized into 3 groups based on Mtb infection status: Mtb-uninfected healthy controls, latent TB infection (LTBI), and active TB disease. Participants were subsequently evaluated for infection with SM.Methods:We used targeted minimum loss estimation and super learning to estimate a covariate-adjusted association between SM and Mtb infection outcomes, defined as the probability of being Mtb-uninfected healthy controls, LTBI, or TB. HIV status was evaluated as an effect modifier of this association.Results:SM was not associated with differences in baseline demographic or clinical features of participants in this study, nor with additional parasitic infections. Covariate-adjusted analyses indicated that infection with SM was associated with a 4% higher estimated proportion of active TB cases in HIV-uninfected individuals and a 14% higher estimated proportion of active TB cases in HIV-infected individuals. There were no differences in estimated proportions of LTBI cases.Conclusions:We provide evidence that SM infection is associated with a higher probability of active TB disease, particularly in HIV-infected individuals.
Cardiovascular Risk Factors and Coronary Calcification in a Middle-aged Dutch Population
Authors: Xia Congying , Vonder Marleen , Sidorenkov Grigory , Den Dekker Martijn , Oudkerk Matthijs , van Bolhuis Jurjen N. , Pelgrim Gert J. , Rook Mieneke , de Bock Geertruida H. , van der Harst Pim , Vliegenthart Rozemarijn 
Published: October 2020

Purpose:
To assess the presence of coronary artery calcium (CAC) and its association with cardiovascular risk factors and Systematic COronary Risk Evaluation (SCORE) risk in a middle-aged Dutch population.

Methods:
Classic cardiovascular risk factors and CAC were analyzed in 4083 participants aged 45 to 60 years (57.9% women) from the population-based ImaLife study. CAC scores were quantified on noncontrast cardiac CT scans. Age-specific and sex-specific distribution of CAC categories (0, 1 to 99, 100 to 299, ≥300) and percentiles were determined. SCORE risk categories (<1%, ≥1% to 5%, and ≥5%) were compared with CAC distribution. Population attributable fractions (PAFs) of classic risk factors for CAC were estimated.

Results:
CAC was present in 54.5% male and 26.5% female participants. The percentage of individuals with CAC increased with increasing age. Mean SCORE was 2.0% in men and 0.7% in women. In SCORE <1%, 32.7% of men and 17.1% of women had CAC. In men with SCORE ≥5%, 26.9% had no CAC. Only 0.1% of women had SCORE ≥5%. PAF of classic risk factors for CAC was 18.5% in men and 31.4% in women. PAF was highest for hypertension (in men 8.0%, 95% confidence interval, 4.2%-11.8%; in women 13.1%, 95% confidence interval, 7.9%-18.2%) followed by hypercholesterolemia and obesity.

Conclusion:
In this middle-aged cohort, more than half of the men and a quarter of the women had CAC. One out of 4 men at high risk (SCORE ≥5%) could be placed into a lower risk category owing to absence of CAC. Thus, adding CAC scoring to SCORE could have considerable effect on cardiovascular risk classification. Elimination of exposure to classic risk factors could reduce limited proportion of CAC in a middle-aged population.
Treatment Strategies of Complications of Breast Implants Associated With Ventriculoperitoneal Shunts
Authors: Orfahli Lynn M. , Alleyne Brendan J. , Patel Anooj , Isakov Raymond , Papay Francis A. , Gurunian Raffi 
Published: October 2020

AbstractBreast augmentation is among the most commonly performed cosmetic procedures in the United States. As these patients age or develop comorbidities, surgeons across many other disciplines will inevitably encounter these patients in their own practices. Consequently, surgeons must be aware of the potential interactions between breast implants and devices commonly used in their fields. This case, the second of its kind encountered by our own department, describes a woman who suffered one such interaction: migration and coiling of a ventriculoperitoneal shunt around her breast implant. A systematic review was conducted to characterize breast-related ventriculoperitoneal shunt complications reported in the literature and generate an algorithm for management of the most commonly reported scenarios. Recognition of potential complications will aid surgeons in appropriate operative planning and prevention of these adverse events.