bluuebunny/crossref_metadata_2025_split huggingface dataset:
Physician Fertility: A Call to Action
Authors: Marshall Ariela L. , Arora Vineet M. , Salles Arghavan 
Published: November 2019

Infertility is more prevalent in female physicians than in the U.S. general population. While pregnancy and its potential medical and career development consequences among physicians have been explored in the literature, infertility and its consequences remain understudied and unaddressed. Fertility issues are important for all physicians hoping to start families, including male physicians, transgender physicians, single physicians, and physicians with same-sex partners.
Infertility has numerous physical, emotional, and financial consequences and may have a negative impact on physician well-being. Options to preserve fertility (such as egg, embryo, and sperm cryopreservation) are available, yet physicians may not be aware of or have the financial ability to make use of such resources. Physician reproductive health, including the ability to build a family if and when a physician chooses, is a vital aspect of well-being. The risks and consequences of infertility and the management of fertility should be studied and addressed from policy and advocacy standpoints.
The authors, who have experienced and sought treatment for infertility, bring attention to the challenges around both physician infertility and preservation of fertility. They propose 3 strategies to address physician infertility: increasing fertility education and awareness starting at the undergraduate medical education level and continuing throughout training and practice, providing insurance coverage for and access to fertility assessment and management, and offering support for those undergoing fertility treatments. The authors believe that implementing these suggestions would make a significant positive impact on trainees and practicing physicians and help build a health care workforce that is healthy and well physically, emotionally, and financially.
Hormonal management of menopausal symptoms in women with a history of gynecologic malignancy
Authors: Harris Benjamin S. , Bishop Katherine C. , Kuller Jeffrey A. , Ford Anne C. , Muasher Lisa C. , Cantrell Sarah E. , Price Thomas M. 
Published: November 2019

Abstract

Objective:
The aim of the study was to review the role of hormone therapy in menopausal patients with breast cancer and gynecologic malignancies.

Methods:
We searched MEDLINE (via PubMed) using a combination of keywords and database-specific subject headings for the following concepts: menopause, hormone therapy, and cancer. Editorials, letters, case reports, and comments were excluded, as were non-English articles. Additional references were identified by hand-searching bibliographies of included articles. The searches yielded a total of 1,484 citations. All citations were imported into EndNote X9, where they were screened by the authors.

Results:
In breast cancer survivors, systemic hormone therapy is not recommended, whereas local low-dose estrogen therapy may be considered after discussion with the patient's oncologist. Among endometrial cancer survivors, hormone therapy is considered safe in low-risk cancers but should be avoided in high-risk subtypes. For survivors of epithelial ovarian cancer and cervical cancer, hormone therapy can be considered, but should be avoided in women with estrogen-sensitive histologic subtypes.

Conclusions:
The risks of hormone therapy should be assessed on an individual basis, with consideration of age, type of hormone therapy, dose, duration of use, regimen, route, and prior exposure. Systemic hormone therapy is not recommended in breast cancer survivors, whereas vaginal low-dose estrogen appears safe. Hormone therapy may be used by endometrial, cervical, and ovarian cancer survivors with low-risk, non-estrogen-receptor–positive subtypes.

Video Summary:
http://links.lww.com/MENO/A516.
Keratoconus Characteristics Used in Randomized Trials of Surgical Interventions—A Systematic Review
Authors: Baenninger Philipp B. , Bodmer Nicolas S. , Bachmann Lucas M. , Iselin Katja , Kaufmann Claude , Belin Michael W. , Thiel Michael A. 
Published: November 2019

Purpose:
To investigate descriptions and inclusion criteria of keratoconus used in randomized trials assessing the efficacy of surgical and nonsurgical interventions.

Methods:
Systematic review: we searched (Pre-)Medline and the Cochrane Library from inception until December 2018 and checked the reference lists of included articles and reviews. We included randomized trials assessing the efficacy of any kind of keratoconus treatment. No language restrictions were imposed. We assessed articles against the inclusion criteria, extracted relevant data including any kind of keratoconus description, and examined the methodological quality.

Results:
Searches retrieved 459 nonduplicate records, and we included 57 randomized controlled trials investigating 9 different surgical interventions with the most used primary outcome measure being maximum keratometry. Only 15 (26.3%) described eligibility parameters regarding keratoconus staging/classification, of which 12 studies used the Amsler–Krumeich classification. Eleven studies were published before 1997 (before publication of the Consolidated Standards of Reporting Trials statement), and none of these described the use of a classification. From 1997 onward, 15 of 46 studies (32.6%) described the incorporation of a classification system (P = 0.051). The average methodological quality of included trails was modest.

Conclusions:
The evidence from randomized trials, even after introduction of the Consolidated Standards of Reporting Trials statement, remains ill-formed regarding a careful definition of keratoconus. This is unfortunate because imprecisions regarding the specification of included patients preclude clinicians to assess applicability, that is, the extent to which they can use inferences drawn from study participants regarding efficacy and adverse events in the care of individual patients.
Successful Descemet Membrane Endothelial Keratoplasty in Proven Herpetic Endothelial Decompensation Requires Intensive Antiviral Therapy
Authors: Friehmann Asaf , Myerscough James , Giannaccare Giuseppe , Mazzoni Maria , Bovone Cristina , Busin Massimo 
Published: November 2019

Purpose:
To report the outcomes of Descemet membrane endothelial keratoplasty (DMEK) with intensive antiviral therapy for corneal edema secondary to herpes simplex virus type 1 (HSV-1)-mediated endotheliitis.

Methods:
All eyes with polymerase chain reaction positive for HSV-1 undergoing DMEK for endothelial decompensation between January 2014 and January 2018 were followed up prospectively at our tertiary referral center. All eyes had been free of active inflammation for a minimum of 9 months and were treated prophylactically with high-dose systemic and topical antivirals, which were continued for a prolonged period of time. Primary outcomes were the occurrence of immunological rejection and/or recurrence of endotheliitis, eventually resulting in graft failure. Secondary outcomes were best spectacle-corrected visual acuity and endothelial cell loss.

Results:
Four consecutive eyes of 4 patients were included with a mean (±SD) patient age of 68.5 ± 15.1 years. The postoperative follow-up averaged 22 months. No eyes exhibited any signs of immunologic rejection, recurrence of endotheliitis, or graft failure. Mean (±SD) decimal best spectacle-corrected visual acuity improved from 0.2 ± 0.1 to 0.7 ± 0.2 (P = 0.007), whereas mean (±SD) endothelial cell loss was 56% ± 10.2% at the final postoperative follow-up.

Conclusions:
DMEK is an effective option to treat corneal edema secondary to HSV-1-related endotheliitis. Intensive antiviral prophylaxis may reduce the risk of recurrence and subsequent graft failure.
Molecular Characterization of Streptococcus pyogenes Causing Invasive Disease in Pediatric Population in Spain A 12-year Study
Authors: Sánchez-Encinales Viviana , Ludwig Guillermo , Tamayo Esther , García-Arenzana Jose Maria , Muñoz-Almagro Carmen , Montes Milagrosa 
Published: November 2019

Objectives:
To perform a comprehensive description of the epidemiology of Streptococcus pyogenes invasive disease in the pediatric population in 2 regions of Spain (Catalonia and Gipuzkoa) through 12 years.

Methods:
All S. pyogenes isolates causing invasive disease in pediatric patients between 2005 and 2016 were included. The emm-type and the presence of 13 exotoxin genes (speA, speB, speC, speF, speG, speH, speI, speJ, speK, speL, speM, smeZ, ssa and slo) were determined in all 93 available isolates and the Multi Locus Sequece Typing in 10% of isolates of each different emm-type.

Results:
Overall, 103 cases of S. pyogenes invasive infections were detected: 77 in Catalonia and 26 in Gipuzkoa, being 50.5% females. The incidence rate per 100,000 children was 2.5 for Gipuzkoa and 2.6 for Catalonia, with no significant temporal trends. The median age was 30 months. The most frequent clinical presentations were: pneumonia (26.2%), bacteremia/sepsis (23.3%), septic arthritis/osteomyelitis (22.3%), cellulitis/mastoiditis (12.6%) and meningitis (6.8%). Eight children developed streptococcal toxic shock syndrome. Nine cases were preceded by varicella infection. The associated mortality rate was 3.9%. Three isolates were resistant to erythromycin, being one of them also resistant to clindamycin and 4 isolates were resistant to levofloxacine. Forteen different emm-types were detected being emm1/ST28 (40.9%) the most frequent clone in both regions followed by emm12/ST36-ST242, emm6/ST382, emm3/ST15, emm75/ST150 and emm4/ST38-39. speA gene was only detected in emm1 and emm3 isolates. Eight exotoxins were enough to assign an emm-type with a very high degree of accuracy (95%). The 30-valent vaccine would include 96.8% of isolates.
Clinical Course and Management of Dengue in Children Admitted to Hospital
Authors: Karyanti Mulya Rahma , Uiterwaal Cuno S.P.M. , Hadinegoro Sri Rezeki , Jansen Maria A.C. , Heesterbeek J.A.P. Hans , Hoes Arno W. , Bruijning-Verhagen Patricia 
Published: November 2019

Background:
Dengue incidence is rising globally which was estimated 100 million per year, whereas in Indonesia was estimated 7.5 million per year. Dengue clinical course varies from mild dengue fever (DF) to dengue hemorrhagic fever (DHF) or dengue shock syndrome (DSS). Patients, clinicians and care facilities would benefit if reliable predictors can determine at admission which cases with clinically suspected dengue will progress to DHF or DSS.

Methods:
From 2009 through 2013, a cohort of 494 children admitted with clinically suspected dengue at a tertiary care hospital in Jakarta, Indonesia, was followed until discharge. We evaluated the clinical course and disease outcome of admitted patients and estimated the burden of dengue cases hospitalized over time.

Results:
Of all 494 children, 185 (37%) were classified at admission as DF, 158 (32%) as DHF and 151 (31%) as DSS. Of DF patients, 52 (28%) progressed to DHF or DSS, 10 (5%) had other viral diseases. Of DHF patients, 9(6%) progressed to DSS. Of 33 routinely collected parameters at admission, duration of fever ≤4 days was the only significant predictor of disease progression (P = 0.01). Five cases (3%) admitted with DSS died. Between 2009 and 2013, annual dengue admissions declined, while distribution of disease severity remained stable.

Conclusions:
Almost a third of children admitted to tertiary care with clinically suspected DF progress to DHF or DSS. Among routinely collected parameters at admission, only fever duration was significantly associated with clinical progression, emphasizing unpredictability of dengue disease course from parameters currently routinely collected.
Systematic Review on the Acute Cost-of-illness of Sepsis and Meningitis in Neonates and Infants
Authors: Salman Omar , Procter Simon R. , McGregor Callum , Paul Proma , Hutubessy Raymond , Lawn Joy E. , Jit Mark 
Published: November 2019

Background:
Sepsis and meningitis in neonates and infants are a source of substantial morbidity, mortality and economic loss. The objective of this review is to estimate the acute costs associated with treating sepsis, meningitis and meningococcal septicemia, in neonates and infants, worldwide.

Methods:
The electronic databases Medline, Embase and EconLit were searched and exported on November 24, 2018. Studies that reported an average hospitalization cost for confirmed cases of sepsis, meningitis or meningococcal septicemia were eligible for our review. Descriptive data were extracted and reported costs were inflated and converted. A narrative synthesis of the costs was conducted.

Results:
Our review identified 20 studies reporting costs of sepsis, meningitis and/or meningococcal septicemia. Costs ranged from $55 to $129,632 for sepsis and from $222 to $33,635 for meningitis (in 2017 US dollars). One study estimated the cost of meningococcal septicemia to be $56,286. All reported costs were estimated from the perspective of the healthcare provider or payer. Most studies were from the United States, which also had the highest costs. Only a few studies were identified for low- and middle-income countries, which reported lower costs than high-income countries for both sepsis and meningitis.

Conclusions:
Sepsis and meningitis in neonates and infants are associated with substantial costs to the healthcare system and showed a marked difference across global income groups. However, more research is needed to inform costs in low- and middle-income settings and to understand the economic costs borne by families and wider society.
Cytomegalovirus Seroprevalence and Birth Prevalence of Congenital CMV Infection in Bosnia and Herzegovina
Authors: Arapović Jurica , Rajič Borko , Pati Sunil , Brizić Ilija , Azinović Igor , Šušak Božo , Ostojić Maja , Tutiš Borka , Raguž Ana Boban , Tomić Vajdana , Jonjić Stipan , Boppana Suresh 
Published: November 2019

Background:
Congenital cytomegalovirus infection (cCMV) is a leading cause of sensorineural hearing loss (SNHL) and neurodevelopmental disabilities in developed countries. Although high cCMV rates have been reported in populations with high seroprevalence, the cCMV prevalence in low/middle-income countries in Europe has not been defined.

Objective:
To determine cytomegalovirus (CMV) seroprevalence and the cCMV prevalence in Bosnia and Herzegovina.

Methods:
Between March 2010 and February 2019, 5222 sera samples from patients seen at the University Clinical Hospital Mostar were tested for CMV IgG. The cord blood samples collected from 2091 infants between July 2011 and January 2013 were analyzed for CMV IgG and CMV DNA. The cCMV prevalence was determined by testing saliva swabs from 1293 infants between November 2015 and October 2016.

Results:
The overall CMV IgG prevalence was 81.4% (95% confidence interval: 0.8–0.82). Significantly higher prevalence was observed among females (84.9%) than in males (77.0%), and the rate increased from 50.8% in the 1 to 5 years group to 97.7% in the group > 65 years old. Most cord blood samples (2091/1925, 92.1%) were CMV IgG positive, and 2 (0.1%) were CMV DNA positive. Of the 1293 saliva swabs, 8 (0.62%; 95% confidence interval: 0.3–1.2) were CMV positive. All 8 infected infants had asymptomatic cCMV, and none had SNHL at 18 months of age.

Conclusions:
In a highly CMV seropositive population, the prevalence of cCMV was lower compared with that reported from other low/middle-income countries populations. None of the infected infants had symptomatic infection or SNHL at 18 months.
Complications of Otitis Media and Sinusitis Caused by Streptococcus anginosus Group Organisms in Children
Authors: McNeil J. Chase , Dunn James J. , Kaplan Sheldon L. , Vallejo Jesus G. 
Published: November 2019

Background:
The Streptococcus anginosus group (SAG, S. anginosus, S. intermedius and S. constellatus) are often associated with severe disease and abscess formation. In our institution, we observed an apparent increase in frequency of intraorbital and intracranial infections resulting from SAG at Texas Children’s Hospital. We undertook a retrospective review to describe the frequency and clinical features of these infections.

Methods:
We reviewed the database of the microbiology laboratory at Texas Children’s Hospital from 2011 to 2018 for SAG-positive cultures. Cases included were those associated with (1) either otitis media or sinusitis and (2) Pott’s puffy tumor, orbital abscesses, mastoiditis, epidural abscesses, subdural empyema, brain parenchymal abscesses or dural enhancement by imaging. The number of overall diagnoses were determined using diagnostic codes and used to estimate the proportion of disease caused by SAG.

Results:
Ninety-five cases were identified meeting inclusion criteria. The median age of patients was 11.4 years, and 75.8% were previously healthy. S. intermedius was most commonly isolated (80%) followed by S. constellatus (12.6%) and S. anginosus (7.4%); 50.5% of cases were polymicrobial. Among polymicrobial cases, Staphylococcus aureus was most frequently isolated. All patients underwent surgical intervention. 8.4% of patients experienced persistent neurologic deficits. We observed a significant increase in disease incidence during the study period; in addition, the overall proportion of all intracranial infections caused by SAG increased.

Conclusions:
Complications of otitis media and sinusitis caused by SAG are associated with substantial morbidity. These infections are becoming increasingly common at our center although the precise reason for this temporal trend is unclear.
Meta-analysis of the Clinical Efficacy and Safety of High- and Low-dose Methylprednisolone in the Treatment of Children With Severe Mycoplasma Pneumoniae Pneumonia
Authors: Sun Lin-Li , Ye Chao , Zhou Yu-Lu , Zuo Shan-Ru , Deng Zhen-Zhen , Wang Chun-Jiang 
Published: November 2019

Background:

Mycoplasma pneumoniae pneumonia is generally a self-limiting disease, but it can develop into severe Mycoplasma pneumoniae pneumonia (SMPP). Immunologic mechanisms are thought to play an important role in the pathogenesis of SMPP. Therefore, the use of systemic glucocorticoids may have beneficial effects. However, to date, the use of glucocorticoid therapy in SMPP is limited to small case series, and the glucocorticoid dosage for children with SMPP has not been established.

Methods:
Here, we used a meta-analysis method to collect data from randomized control trials of different doses of methylprednisolone in SMPP to assess the safety and efficacy of treatment with low- versus high-dose methylprednisolone in children with SMPP.

Results:
We included 13 Chinese randomized control trials that included 1049 children. The high- and low-dose groups were comprised of 524 and 525 children, respectively. The high-dose group was significantly more effective than the low-dose group in clinical efficacy [risk ratio = 1.30, 95% confidence interval (CI) (1.23, 1.38), P < 0.05]. In addition, compared with low-dose methylprednisolone, high-dose methylprednisolone significantly shortened hospital stays and antipyretic therapy, pulmonary rales disappearance, cough disappearance and pulmonary shadow absorption times. There was no significant difference in adverse events between the high- and low-dose groups: risk ratio= 0.85, 95% CI (0.53, 1.36), P > 0.05.

Conclusions:
We conclude that high-dose methylprednisolone is effective in the treatment of SMPP without increasing the incidence of adverse reactions.
Epidemiology and Microbiology of Bacterial Bloodstream Infection in a Tertiary Hospital in Nigeria
Authors: Iliyasu Garba , Dayyab Farouq Muhammad , Aminu Aliyu , Halilu Sadiq , Abubakar Salisu , Inuwa Salisu , Habib Abdulrazaq Garba 
Published: November 2019

Background
Bacterial bloodstream infections (BSIs) are a significant cause of morbidity and mortality among hospitalized patients, and data in resource-limited countries are sparse.

Methods
A hospital-wide retrospective analysis of microbiologically proven bacteremia was conducted. Sociodemographic data, comorbidities, bacterial isolates, and their antimicrobial susceptibility pattern were recorded.

Results
Of the 276 episodes of bacteremia studied, 130 (47.1%) occurred in females. The overall mean age was 15.29 ± 23.22 years. Community-acquired BSI was seen in 179 (65.0%) of the patients, whereas 97 (35%) was hospital-acquired BSI. Gram-negative bacteria 158 (57.2%) were the leading cause of BSI. More than 60% of the isolates were resistant to commonly prescribed antibiotics, especially trimethoprim-sulfamethoxazole, ampicillin, and amoxicillin–clavulanic acid.

Conclusions
Gram-negative bacteria are the leading cause of bacteremia with resistance to commonly prescribed antibiotics.
A Case of Sphingobacterium spiritivorum Bacteremia and Literature Review
Authors: Sahar Najmus , Shahid Mohammad , Ali Asghar 
Published: November 2019

Abstract
High sphingophospholipids in the cell membrane characterize the genus Sphingobacterium. Sphingobacterium spiritivorum is a gram-negative, non–spore-forming, nonmotile bacterium that is ubiquitous in nature and rarely involved in human disease. It is intrinsically resistant to many antimicrobials, which if underrecognized can be potentially life-threatening. We present a case of a 72-year-old white man who presented with cellulitis and sepsis secondary to S. spiritivorum.
Previously Unreported Presentation of Anaplasmosis in an Endemic Area
Authors: Saha Biplab K. , Chieng Hau , Itty Ria , Bonnier Alyssa , Shkolnik Boris , Beegle Scott 
Published: November 2019

Abstract
Human granulocytic anaplasmosis or anaplasmosis is a zoonotic disease that is endemic to certain geographic areas of the United States. Anaplasmosis is caused by Anaplasma phagocytophilum, an intracellular bacterium that is transmitted to humans by deer ticks. The clinical presentation can vary from a subclinical infection to fulminant disease resulting in multiorgan failure and death. Patients commonly present with fever, malaise, myalgia, headache, nausea, vomiting, arthralgia, and cough. Central nervous system involvement has also been reported. Here, we present 2 cases that presented with significant diagnostic challenge being the first reported cases of pleuropericarditis (case 1) and autoimmune hemolytic anemia due to cold agglutinin disease (case 2) secondary to anaplasmosis. Knowledge of these complications from human granulocytic anaplasmosis will help clinicians to make an early diagnosis and institute appropriate treatment, especially in an endemic setting.