bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nutritional Rickets Due to Severe Food Selectivity in Autism Spectrum Disorder
Authors: Hartman Jacob S. , Silver Alyssa H. 
Published: September 2020

ABSTRACT:

Objective:
Studies have detected differences in various measures of bone health between individuals with autism spectrum disorder (ASD) and their peers. However, these measures do not amount to direct clinical evidence of increased orthopedic pathology in this population. Some of the most compelling evidence to this effect comes from case reports of nutritional rickets in children with ASD. We report on 1 such case that, to our knowledge, is the first report of nutritional rickets in ASD necessitating corrective surgery.

Methods:
Case report, review of relevant literature, and implications for further research.

Results:
An 11-year-old girl with ASD was admitted for postoperative medical comanagement after successful repair of bilateral genu valgum (knock knees). On admission, the patient's mother reported that the patient was a “picky eater.” No cause had been determined preoperatively, although the deformity had developed at 10 years of age, thereby qualifying as pathologic. The medical team considered rickets because of the patient's limited diet. Subsequent laboratory work demonstrated hypocalcemia, vitamin D deficiency, and secondary hyperparathyroidism. The patient was diagnosed with nutritional rickets due to inadequate vitamin D intake, a consequence of severe food selectivity associated with ASD.

Conclusion:
This case exemplifies the extreme orthopedic and metabolic complications that can result from food selectivity in children with ASD, pointing to the need for further research into the prevalence and causes of orthopedic pathology and nutritional rickets in this population. The case also underscores the need for evidence-based guidelines to prevent orthopedic pathology in children with ASD.
Prolonged time to extubation after general anaesthesia is associated with early escalation of care
Authors: Vannucci Andrea , Riordan Isabella Rossi , Prifti Kevin , Sebastiani Anne , Helsten Daniel L. , Lander Daniel P. , Kallogjeri Dorina , Cavallone Laura 
Published: September 2020

BACKGROUND
Prolonged time to extubation after general anaesthesia has been defined as a time from the end of surgery to airway extubation of at least 15 min. This occurrence can result in ineffective utilisation of operating rooms and delays in patient care. It is unknown if unanticipated delayed extubation is associated with escalation of care.

OBJECTIVES
To assess the frequency of ‘prolonged extubation’ after general anaesthesia and its association with ‘escalation of care before discharge from the postanaesthesia care unit’, defined as administration of reversal agents for opioids and benzodiazepines, airway re-intubation and need for ventilatory support. In addition, we tried to identify independent factors associated with ‘prolonged extubation’.

DESIGN
Single-centre retrospective study of cases performed from 1 January 2010 to 31 December 2014.

SETTING
A large US tertiary academic medical centre.

PATIENTS
Adult general anaesthesia cases excluding cardiothoracic, otolaryngology and neurosurgery procedures, classified as: Group 1 – regular extubation (≤15 min); Group 2 – prolonged extubation (≥16 and ≤60 min); Group 3 – very prolonged extubation (≥61 min).

MAIN OUTCOME MEASURES
First, cases with prolonged time to extubation; second, instances of escalation of care per extubation group; third, independent factors associated with prolonged time to extubation.

RESULTS
A total of 86 123 cases were analysed. Prolonged extubation occurred in 8138 cases (9.5%) and very prolonged extubation in 357 cases (0.4%). In Groups 1, 2 and 3 respectively, naloxone was used in 0.4, 4.1 and 3.9% of cases, flumazenil in 0.03, 0.6 and 2% and respiratory support in 0.2, 0.7 and 2%, and immediate re-intubation occurred in 0.1, 0.3 and 2.8% of cases. Several patient-related, anaesthesia-related and procedure-related factors were independently associated with prolonged time to extubation.

CONCLUSION
Prolonged time to extubation occurred in nearly 10% of cases and was associated with an increased incidence of escalation of care. Many independent factors associated with ‘prolonged extubation’ were nonmodifiable by anaesthetic management.
Effects of high-flow nasal oxygen during prolonged deep sedation on postprocedural atelectasis
Authors: Shih Chung-Chih , Liang Po-Chin , Chuang Yueh-Hsun , Huang Yi-Ju , Lin Pei-Jing , Wu Chun-Yu 
Published: September 2020

BACKGROUND
Atelectasis is common in patients undergoing prolonged deep sedation outside the operating theatre. High-flow nasal oxygen (HFNO) produces positive airway pressure which, hypothetically, should improve lung atelectasis, but this has not been investigated.

OBJECTIVE
We investigated whether HFNO ameliorates postprocedural atelectasis and compared the influences of HFNO and facial oxygen by mask on postprocedural outcomes.

DESIGN
A single-blind, open-label single-institution randomised controlled trial.

SETTING
A single university hospital, from February 2017 to July 2019.

PATIENTS
A total of 59 patients undergoing computed tomography (CT)-guided hepatic tumour radiofrequency ablation were randomly allocated to two groups.

INTERVENTION
These patients randomly received HFNO (oxygen flow 10 l min−1 before sedation and 50 l min−1 during the procedure) or a conventional oxygen face mask (oxygen flow 10 l min−1) during the procedure.

MAIN OUTCOME MEASURES
Changes in the area of lung atelectasis calculated on the basis of chest CT images and also recovery profiles were compared between the two groups.

RESULTS
The two groups had comparable procedural profiles, but the HFNO group exhibited less postprocedural atelectasis than the face mask group (median [IQR] 7.4 [3.9 to 11.4%] vs. 10.5 [7.2 to 14.6%]; P = 0.0313). However, the numbers of patients requiring oxygen supplementation in the recovery room and during transport from the recovery room to the ward did not differ significantly between groups (24.1 vs. 50.0%; P = 0.0596).

CONCLUSION
Our results suggested that HFNO ameliorates lung atelectasis after prolonged deep sedation in patients receiving CT-guided hepatic tumour radiofrequency ablation.

TRIAL REGISTRATION
Clinicaltrials.gov Identifier: NCT03019354.
Effects of magnesium on the dose of rocuronium for deep neuromuscular blockade
Authors: Han Jiwon , Jeon Young-Tae , Ryu Jung-Hee , Koo Chang-Hoon , Nam Sun Woo , Cho Sang-Il , Oh Ah-Young 
Published: September 2020

BACKGROUND
Magnesium is known to enhance the effect of rocuronium, but the extent is not quantified.

OBJECTIVES
We aimed to quantify the effect of magnesium on the dose of rocuronium for deep neuromuscular blockade.

DESIGN
A randomised controlled study.

SETTING
A single tertiary care hospital.

PATIENTS
Seventy males scheduled to undergo robot-assisted laparoscopic prostatectomy, aged between 20 and 80 years with American Society of Anesthesiologists physical status classification 1 or 2, were enrolled.

INTERVENTIONS
Patients were randomised to either the magnesium group or control group. The magnesium group were infused with 50 mg kg−1 of magnesium, followed by a continuous intra-operative infusion at 15 mg kg−1 h−1 while the control group were infused with the same volumes of 0.9% saline. Deep neuromuscular blockade was maintained with a continuous infusion of rocuronium and was reversed using sugammadex.

MAIN OUTCOME MEASURES
The primary outcome was the dose of rocuronium administered to maintain deep neuromuscular blockade. The secondary outcomes were recovery time, defined as the time from the administration of sugammadex to train-of-four ratio 0.9, and the incidence of postoperative nausea and vomiting.

RESULTS
The dose of rocuronium administered to maintain deep neuromuscular blockade was significantly lower in the magnesium group (7.5 vs. 9.4 μg kg−1 min−1, P = 0.01). There was no difference in recovery time or the incidence of nausea and vomiting.

CONCLUSION
Magnesium reduced the dose of rocuronium required for deep neuromuscular blockade by approximately 20% without affecting the recovery time after administration of sugammadex.

TRIAL REGISTRATION
ClinicalTrials.gov identifier: NCT04013243.
Platelet Apoptotic Response May Be Associated With the Capacity of Aspirin to Inhibit Platelets
Authors: Zamorano-León José J. , Gascón Martin , Martínez Carlos H. , Freixer Gala , Guerra Redy , Zekri-Nechar Khaoula , Bernardo Esther , Serna-Soto Mariano de la , Segura Antonio , Giner Manel , García-Fernández Miguel A. , Macaya Carlos , López-Farré Antonio J. 
Published: September 2020

Abstract:
An inadequate platelet response to aspirin (ASA) has been identified in some patients under chronic ASA treatment. The aim of this study was to analyze if ASA-sensitive and ASA-resistant platelets have differences in their apoptotic capability. Clinically stable ischemic coronary patients who had been taking ASA (100 mg/d) for at least 9 months before inclusion were divided into ASA-resistant (n = 11) and ASA-sensitive (n = 13) groups as defined by the PFA-100 test. Platelets from ASA-sensitive patients showed higher expression of the proapoptotic proteins Bak and Bax than those from ASA-resistant patients, although only Bak protein remained different when the results were adjusted by age. In resting platelets, neither caspase-3 activity nor cytosolic cytochrome C levels were different between both experimental groups. Stimulation of platelets with calcium ionophore (10 nmol/L, A23187) increased caspase-3 activity (1.91-fold higher; P < 0.05) and cytosolic cytochrome C levels (1.84-fold higher; P < 0.05) to a higher degree in ASA-sensitive than in ASA-resistant platelets. In conclusion, ASA-sensitive platelets seem to be better prepared to undergo apoptosis during robust platelet activation.
In-Hospital Management and Outcomes of Acute Myocardial Infarction Before and During the Coronavirus Disease 2019 Pandemic
Authors: Huang Bing , Xu Changwu , Liu Huafen , Deng Wei , Yang Zheng , Wan Jun , Yan Hui , Cao Guiqiu , Chen Jing , Jiang Hong 
Published: September 2020

Abstract:
The outbreak of coronavirus disease 2019 (COVID-19) has rapidly spread worldwide. This study sought to share our experiences with in-hospital management and outcomes of acute myocardial infarction (AMI) during the COVID-19 pandemic. We retrospectively analyzed consecutive AMI patients, including those with ST-elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI), from February 1, 2020, to April 15, 2020 (during the COVID-19 pandemic), and from January 1, 2019, to December 31, 2019 (before the COVID-19 pandemic), respectively. Fifty-three AMI patients (31 STEMI, 22 NSTEMI) during the COVID-19 pandemic were matched to 53 AMI patients before the pandemic. Baseline characteristics were comparable between the matched patients. STEMI patients during the COVID-19 pandemic had a longer delay time, less primary or remedial PCI and more emergency thrombolysis than those before the pandemic. Less coronary angiography and stenting were performed in AMI patients during the COVID-19 pandemic than before the pandemic. There were no statistically significant differences in the clinical outcomes between the matched patients. However, STEMI patients during the COVID-19 pandemic had a 4-fold (12.9% vs. 3.2%) increase in all-cause mortality rate compared with those before the pandemic. AMI combined with COVID-19 infection was associated with higher rates of mortality than AMI alone. This study demonstrates that the COVID-19 pandemic results in significant reperfusion delays in STEMI patients and has a marked impact on the treatment options selection in AMI patients. The mortality rate of STEMI patients exhibits an increasing trend during the pandemic of COVID-19.
Impact of RAAS Blockers on Contrast-Induced Nephropathy in Patients With Renal Insufficiency: A Meta-Analysis
Authors: Huang Yiquan , Zhang Shaozhao , Liu Menghui , Zhong Xiangbin , Lin Yifen , Xiong Zhenyu , Fan Yongqiang , Zhou Huimin , Sun Xiuting , Guo Yue , Xu Xingfeng , Li Yuqi , Yang Daya , Zhuang Xiaodong , Liao Xinxue 
Published: September 2020

Abstract:
The effect of renin-angiotensin-aldosterone system (RAAS) blockers [angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers] on Contrast-induced nephropathy (CIN) is unclear in patients with renal insufficiency. Thus, we conduct a meta-analysis to evaluate the association between the administration of RAAS blockers and CIN in patients with renal insufficiency. We searched PubMed, EMBASE, and Cochrane Library for relevant studies published before September 2019. The primary outcome was the incidence of CIN, and the secondary outcome was the changes in serum creatinine (SCr) from baseline to postprocedure (ΔSCr). Pooled odds ratio (OR) or weighted mean difference (WMD) with their 95% confidence interval (CIs) for the CIN incidence, ΔSCr were used to calculate original data. A total of 8 studies were included in the meta-analysis. Compared with controls, ACEI/angiotensin receptor blocker increased the risk of CIN (OR = 1.61, 95% CI 1.14–2.28, I2 = 30%; P = 0.007), whereas this association was not significant in Chinese patients (OR = 1.07, 95% CI 0.65–1.77, I2 = 19%, P = 0.79). The total weighted mean differences of the ΔSCr were 0.06 mg/dL (95% CI: 0.01–0.11, I2 = 82%; P = 0.03). Administration of RAAS blockers in patients with renal insufficiency was associated with a significantly higher incidence of CIN, whereas it did not show a significant effect on Chinese patients.
Efficacy and Safety of Non-Vitamin K Antagonist Oral Anticoagulants in Patients With Atrial Fibrillation and Chronic Kidney Disease Stage G4: A Single-Center Experience
Authors: Heleniak Zbigniew , Papuga-Szela Elżbieta , Krzysztof Plens , Anetta Undas 
Published: September 2020

Abstract:
Atrial fibrillation (AF) is associated with increased stroke and bleeding risk in patients with chronic kidney disease (CKD). Little is known about the real-life use of non-vitamin K antagonist oral anticoagulants (NOACs) in CKD stage G4. In a retrospective cohort study, we enrolled 182 consecutive AF patients with CKD stage G4 including 90 (49%) subjects on NOAC, ie, 61 on apixaban 2.5 mg bid and 29 on rivaroxaban 15 mg qd, and 92 (51%) subjects on warfarin. Thromboembolic and bleeding events were recorded during a mean follow-up of 26.3 months. There were no differences in demographic, clinical, and laboratory variables at baseline between the 2 treatment groups. During follow-up, arterial thromboembolic events occurred in 11 (12.22%) subjects on NOAC and 7 (7.61%) on warfarin, (hazard ratio [HR] 1.70; 95% CI, 0.65–4.42), with similar risk of ischemic stroke (9 [10%] vs. 7 [7.61%], P = 0.56, respectively). Major bleedings or clinically relevant nonmajor bleeding occurred in 14 (15.56%) on NOAC and 13 (14.13%) on warfarin, (HR 1.12; 95% CI, 0.53–2.39), with similar risk of gastrointestinal bleeding (HR 0.70; 95% CI, 0.20–2.47). We observed no difference in all-cause mortality related to the type of anticoagulants, but it tended to be lower in the apixaban group compared with rivaroxaban group (14.7% vs. 31%, P = 0.07), without any differences in thromboembolic and bleeding events. The study suggests that AF patients with CKD stage G4 receiving reduced-dose NOAC or warfarin have similar risk of thromboembolism and bleeding in everyday practice of a tertiary anticoagulation center.
Impact of ABCB1 Polymorphism on Levetiracetam Serum Concentrations in Epileptic Uygur Children in China
Authors: Zhao Ting , Yu Jing , Wang Ting-Ting , Feng Jie , Zhao Wen-Bo , Sun Li , Yu Lu-Hai , Li Hong-Jian , Sun Yan 
Published: September 2020

Background:
Interindividual variations in the efficacy of antiseizure medications make epilepsy treatment challenging. This is due to genetic factors such as gene polymorphisms in Adenosine-triphosphate (ATP)-binding cassette sub-family B member 1 (ABCB1). In this article, the impact of polymorphisms in the P-glycoprotein-encoding gene, ABCB1 (C1236T, G2677T/A, and C3435T), on levetiracetam disposition was evaluated in Uygur Chinese children with epilepsy.

Methods:
MDR1 C3435T polymorphism was analyzed by polymerase chain reaction–fluorescence staining in situ hybridization. The χ2 test and Fisher exact test were used to analyze the allelic and genotypic distribution of ABCB1, C1236T, G2677T, and C3435T between the drug-resistant and drug-responsive groups. Differences in steady-state and dose-corrected levetiracetam serum concentrations between the different genotypes were analyzed using 1-way analysis of variance and Mann–Whitney test.

Results:
Total 245 Uygur children with epilepsy were analyzed [drug-resistant, n = 117 (males:females = 53:64) and drug-responsive, n = 128 (males:females = 76:52)]. The frequency of ABCB1 C1236T, G2677T/A, and ABCB1 C3435T genotypes, alleles, haplotypes, or diplotypes did not differ significantly between the 2 groups (P > 0.05). Significantly higher levetiracetam concentrations and serum concentration/body mass dose were seen in ABCB1 2677-GT, TT, GA, and AT genotypes and 3435-TT carriers compared with GG and CC carriers (P = 0.021 and P = 0.002 versus P = 0.001 and P = 0.000, respectively).

Conclusions:

ABCB1 G2677T/A and C3435T may affect levetiracetam disposition and therapeutic efficacy in Uygur children with epilepsy. Genetic analysis could be a valuable tool for predicting the response to antiseizure medications before the start of treatment and could contribute to personalized medicine for Uygur children with epilepsy.
A lasting impression: telemedicine in urogynecology during the coronavirus disease 2019 pandemic
Authors: Serna-Gallegos Tasha , Ninivaggio Cara S. 
Published: September 2020

Purpose of review
Amidst the worldwide coronavirus disease 2019 pandemic, a new medical landscape revolving around telemedicine has arisen. The purpose of this review is to describe and analyze current urogynecologic guidelines for optimizing usage of telemedicine when treating women with pelvic floor disorders.

Recent findings
Women managed by urogynecologists are on average older, and hence more likely to have comorbidities that make them susceptible to developing coronavirus disease 2019 with severe symptoms. Telemedicine is key in minimizing exposure without sacrificing treatments and quality of life. Recent studies published prior to the pandemic helped set the stage for successful components of virtual care. Nonsurgical options are crucial to beginning a treatment plan while elective surgeries are still restricted in many hospitals. Medication management and innovative technology, such as smart telephone applications, play a prominent role. The comprehensive literature review discussed here describes the degree of evidence supporting each management option, while also noting the limitations of telemedicine.

Summary
Telemedicine has opened a new door for the field of urogynecology allowing for continued safe, evidence-based care. The pandemic culture has tipped the balance away from surgery and toward nonsurgical treatments while attempting not to sacrifice outcomes or quality of care.
Management of bothersome bleeding associated with progestin-based long-acting reversible contraception: a review
Authors: Henkel Andrea , Goldthwaite Lisa M. 
Published: September 2020

Purpose of review
To describe common bleeding patterns and treatment strategies to minimize bothersome bleeding in users of progestin-based long-acting reversible contraception (LARC).

Recent findings
Most levonorgestrel intrauterine device users will establish a favorable bleeding pattern within a year; NSAIDs are the most effective bridge to help with bothersome bleeding during that time period. Early follicular phase insertion and fundal placement are associated with more favorable early bleeding profiles. Recent studies exploring tranexamic acid, mifepristone, and tamoxifen's adjunct role show modest or no benefit. The progestin implant is associated with more persistent unpredictable bleeding disproportionately affecting women with higher etonogestrel serum levels; recent studies indicate that oral contraceptives, ulipristal acetate, and tamoxifen may all provide temporary relief.

Summary
Women's healthcare providers can offer patients adjunct medical therapies to minimize bothersome bleeding associated with progestin LARC use, which may result in increased satisfaction and continuation rates of these effective forms of contraception.
DIABETIC MACULAR EDEMA AND CATARACT SURGERY
Authors: Furino Claudio , Boscia Francesco , Niro Alfredo , D'Addario Maria , Grassi Maria O. , Saglimbene Valeria , Reibaldi Michele , Alessio Giovanni 
Published: September 2020

Purpose:
To compare functional and anatomical results of combined phacoemulsification and dexamethasone intravitreal implant (Ozurdex; DEX-I) with standard phacoemulsification in diabetic patients with cataract.

Methods:
Retrospective, comparative, cohort study. Patients with nonproliferative diabetic retinopathy, macular edema, and cataract, treated routinely at the Eye Clinic, Azienda Ospedaliero Universitaria Policlinico, Bari, Italy with phacoemulsification associated with DEX-I (n = 23; Phaco-Dex) or standard phacoemulsification (n = 23; Phaco-alone). Best-correct visual acuity, central subfield thickness, and intraocular pressure were assessed at baseline and monthly for 3 months after surgery, and t-test was used to assess change from baseline. A multilevel regression model with an unstructured correlation-type matrix to account for repeated data measures was used for statistical analysis in and between groups.

Results:
With Phaco-Dex, best-correct visual acuity increased significantly from the first month (P = 0.0005 vs. baseline) and remained stable at the following visits; central subfield thickness decreased significantly from Month 2 (P = 0.049 and P = 0.04 vs. baseline, respectively); at each timepoint, central subfield thickness was significantly lower in the Phaco-Dex group versus Phaco-alone. Intraocular pressure increased significantly during follow-up (P = 0.001 at Month 3 vs. baseline) but remained within the normal range. In the Phaco-alone group, best-correct visual acuity, and intraocular pressure did not show any significant changes after surgery, whereas central subfield thickness increased from Month 2 (P = 0.05 vs. baseline).

Conclusion:
In diabetic patients with macular edema and visually significant cataract, combined treatment with phacoemulsification and DEX-I seemed to be effective, safe, and superior to standard phacoemulsification considering both functional and tomographic parameters.
Detection of Coronavirus in Tear Samples of Hospitalized Patients With Confirmed SARS-CoV-2 From Oropharyngeal Swabs
Authors: Dutescu R. Michael , Banasik Peter , Schildgen Oliver , Schrage Norbert , Uthoff Daniel 
Published: September 2020

Purpose:
This study was designed to detect CoV-RNA in the tears of polymerase chain reaction (PCR)-confirmed SARS-CoV-2 positive patients.

Methods:
We performed a prospective case series study of hospitalized patients who have been confirmed SARS-CoV-2 positive by oropharyngeal swab within the previous 5 days. Tear samples obtained with a laboratory capillary and oropharyngeal swabs were analyzed by real-time PCR using the Altona SARS-CoV-2 Assay or the Roche SARS-CoV-2 LightMix PCR, depending on the availability. Patient history was documented, and ophthalmoscopy was used to assess for ocular surface disease.

Results:
Of all 18 patients recruited in April 2020, 5 suffered from respiratory failure and were submitted to an intensive care unit. None of our patients had signs of viral conjunctivitis although all patients in intensive care showed chemosis and conjunctival hyperemia because of third-spacing or fluid overload. The presence of coronavirus RNA was confirmed by PCR in 5 of 18 patients (28%) in tears and 72% for oropharyngeal swabs.

Conclusions:
Using a tear fluid sampling technique similar to oropharyngeal lavage presents a higher percentage of SARS-CoV-2 positive tears in contrast to earlier reports that used a conjunctival swab. This does not automatically indicate viral shedding in ocular tissue or contagiousness of tear fluid.