bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Determination of the Efficacy of Neural Therapy in Conservative Treatment-resistant Patients with Chronic Low Back Pain
Authors: Yılmaz Ebru 
Published: December 2020

Study Design.A randomized clinical trial.Objective.The aim of this article is to determine the effectiveness of neural therapy (NT) in patients with chronic low back pain (LBP) who are resistant to medical and physical therapies.Summary of Background Data.Patients with LBP generally respond well to the treatment, whereas some cases do not improve via medical and physical therapies. Although trigger point injections (TPIs) may be an effective short-term treatment in selected patients with LBP, they are not recommended in patients with chronic LBP due to a long-lasting benefit not being demonstrated.Methods.Fifty patients, who had inadequate functional recovery and pain relief, with chronic LBP were randomly divided into two groups: Group 1, only single TPI; Group 2, NT. NT including local-segmental treatment (intradermal injections) on the lumbosacral region, 5 M injection (intradermal injections of the projection of the pelvic organs on the suprapubic region), pelvic plexus injection, i.v. injection (2 mL) for five sessions per a week. All patients in group 2 received the same kind of intervention every seance but interference field injections (injections into umbilicus for all patients and injections into scars resulting from vaccination and surgical operations such as cesarean section, if any) were also applied at the only first seance. The Visual Analog Scale (VAS) scores for current pain during activities and Roland Morris Disability Questionnaire (RMDQ) scores for disability were recorded at baseline and 1, 3, 6 months post-injection.Results.The VAS and RMDQ scores at 3 and 6 months were significantly lower in Group 2versusGroup 1 (P < 0.05).Conclusion.NT may be an alternative treatment option in patients with chronic LBP for pain relief and functional recovery in the long run.Level of Evidence:2
The Association of “U.S. News & World Report” Hospital Rankings and Outcomes Following Anterior Cervical Fusions
Authors: Malik Azeem Tariq , Xie Jack J. , Drain Joseph P. , Yu Elizabeth , Khan Safdar N. , Kim Jeffery 
Published: December 2020

Study Design.
Retrospective observational study.

Objective.
The aim of this study was to evaluate whether there are any differences in outcomes and costs for elective one- to three-level anterior cervical fusions (ACFs) performed at US News and World Report (USNWR) ranked and unranked hospitals.

Summary of Background Data.
Although the USNWR rankings are advertised by media and are routinely used by patients as a guide in seeking care, evidence regarding whether these rankings are reflective of actual clinical outcome remains limited.

Methods.
The 2010–2014 USNWR hospital rankings were used to identify ranked hospitals in “Neurosurgery” and “Orthopedics.” The 2010–2014 100% Medicare Standard Analytical Files (SAF100) were used to identify patients undergoing elective ACFs at ranked and unranked hospitals. Multivariable logistic regression and generalized linear regression analyses were used to assess for differences in 90-day outcomes and costs between ranked and unranked hospitals.

Results.
A total of 110,520 patients undergoing elective one- to three-level ACFs were included in the study, of which 10,289 (9.3%) underwent surgery in one of the 100 ranked hospitals. Following multivariate analysis, there were no significant differences between ranked versus unranked hospitals with regards to wound complications (1.2% vs. 1.1%; P = 0.907), cardiac complications (12.9% vs. 11.9%; P = 0.055), pulmonary complications (3.7% vs. 6.7%; P = 0.654), urinary tract infections (7.3% vs. 5.8%; P = 0.120), sepsis (9.3% vs. 7.9%; P = 0.847), deep venous thrombosis (1.9% vs. 1.3%; P = 0.077), revision surgery (0.3% vs. 0.3%; P = 0.617), and all-cause readmissions (4.7% vs. 4.4%; P = 0.266). Ranked hospitals, as compared to unranked hospitals, had a slightly lower odds of experiencing renal complications (7.0% vs. 4.9%; P = 0.047), but had significantly higher risk-adjusted 90-day charges (+$17,053; P < 0.001) and costs (+ $1695; P < 0.001).

Conclusion.
Despite the higher charges and costs of care at ranked hospitals, these facilities appear to have similar outcomes as compared to unranked hospitals following elective ACFs.

Level of Evidence: 3
SEQUENTIAL RETINAL THICKNESS ANALYSIS SHOWS HYDROXYCHLOROQUINE DAMAGE BEFORE OTHER SCREENING TECHNIQUES
Authors: Marmor Michael F. , Durbin Mary , de Sisternes Luis , Pham Brandon H. 
Published: December 2020

Purpose:
We sought to determine the earliest diagnostic signs of hydroxychloroquine retinopathy up to the point of clinical recognition.

Methods:
Retrospective series of 6 patients (5 parafoveal disease; 1 pericentral disease) with at least 3 examinations over 3.5 years or more preceding diagnosis of HCQ retinopathy. Spectral domain optical coherence tomography (sdOCT) cross-sections, fundus autofluorescence (FAF) and visual fields were generated clinically. Stored sdOCT data were re-examined later to generate topographic ellipsoid zone (EZ) maps, minimum intensity (MI) analysis and sequential plots of regional retinal thickness. Retrospective series of six patients (5 parafoveal disease; one pericentral disease) with at least three examinations over 3.5 years or more preceding diagnosis of hydroxychloroquine retinopathy.

Results:
Spectral domain optical coherence tomography cross-sections and fields showed similar sensitivity; fundus autofluorescence was not helpful. In parafoveal cases, EZ topography and minimum intensity analysis were no more reliable. Sequential thickness plots from four parafoveal cases showed dramatic retinal thinning across the posterior pole beginning 4 years to 5 years before clinical diagnosis, with parafoveal regions thinning even faster. The pericentral case showed thinning only outside the central macula. Peripheral EZ loss was more dramatic with EZ topography than sdOCT cross-sections.

Conclusion:
Sequential retinal thickness plots reveal definitive thinning years before current diagnostic procedures. We hope that OCT manufacturers will develop software to display such measurements. Ellipsoid zone topography was not more sensitive than sdOCT cross-sections, but important for recognizing pericentral disease.
Prolonged Detection of SARS-CoV-2 in a Patient With the Development of New Clinical Symptoms
Authors: Awoniyi Amaka , Rohm Zachery , Paranjape Neha , Arinze Folasade 
Published: December 2020

Abstract
We present a case of a 65-year-old woman with a persistently positive nasopharyngeal swab for severe acute respiratory syndrome coronavirus 2 PCR who developed new complications of coronavirus disease 2019 (COVID-19) 63 days from illness onset. She presented with intermittent fevers, fluctuating disorientation, gait instability, diffuse corticospinal tract signs, and acute venous thromboembolism. No alternate diagnosis was identified. This case highlights the potential for prolonged SARS-CoV-2 PCR positivity and persistent multisystem complications (particularly neurological), even after several months of initial COVID-19 diagnosis.
Outcomes of Orthopedic Hardware-Related Infection Treated Via a Public Teaching Hospital Outpatient Parenteral Antimicrobial Therapy Program
Authors: Valinetz Ethan , Beeler Cole , Erdman Sharon M. 
Published: December 2020

Background
Orthopedic hardware-related infection (OHRI) is associated with high morbidity and cost with limited published data describing outpatient parenteral antimicrobial therapy (OPAT) for its treatment. This study was conducted to evaluate clinical outcomes, complications, and risk factors for treatment failure in OHRI patients treated with OPAT.

Methods
Electronic medical records of adults receiving OPAT for OHRI between July 1, 2009 and March 1, 2015 were retrospectively reviewed. Demographic, medical, infection-specific, and drug-specific data were collected for each patient. Patients were categorized as cure or failure using standardized definitions. Safety was evaluated through adverse drug event and line complication monitoring; readmission rates were recorded.

Results
Fifty patients with OHRI (mean age, 51.5 ± 12.6 years; 56% male) received OPAT for a mean duration of 41.4 ± 6.9 days. Thirty-one patients received OPAT in the presence of retained hardware—15 (48%) achieved clinical cure and 16 (52%) experienced failure; 3 patients (10%) experienced early (within 4 weeks) failure requiring unanticipated surgery. Twenty-four patients with retained hardware received oral suppressive antibiotics after OPAT until hardware removal; 3 nonadherent patients experienced failure. Nineteen patients received OPAT after hardware removal—14 (74%) achieved clinical cure and 5 (26%) experienced failure. Five patients (10%) experienced adverse drug event and 4 patients (8%) developed line complications resulting in readmission for 3 patients (6%) and alternate therapy for 4 patients (8%).

Conclusions
Outpatient parenteral antimicrobial therapy is safe and effective for OHRI, especially after hardware removal. Retention of hardware and nonadherence to oral suppression were associated with failure.
Fitness to Administer Influenza Vaccine by Pharmacists in the UAE
Authors: Abdalla Amal , Thomas Dixon , McKeirnan Kimberly , Khalifa Sherief 
Published: December 2020

Backgrounds
The new United Arab Emirates (UAE) drug law permits pharmacists to administer medicines, including vaccines, after proper training. Pharmacists in many other countries have been successfully administering vaccinations for many years but not in the UAE. The objective of this study is to assess the competence of pharmacists who participated in one of the first influenza vaccination training programs in the UAE.

Methods
A pre-post interventional quasi-experimental study was designed to measure the beliefs and knowledge of pharmacists before and after participating in the influenza vaccination training. Skills were measured only after the training. The training included 2 lectures followed by hands-on skills-based vaccine administration training. The pharmacists' intramuscular injection skills were assessed using Objective Structured Clinical Examination stations. The Student t test and analysis of variance statistical tests were conducted using SPSS software version 26 to determine the difference in knowledge, skill, and beliefs.

Results
Of 26 enrolled candidates, 16 have participated and completed the program, all the final participants achieved the passing score on the posttest and their scores were higher compared with the pretest. Participants' beliefs of knowledge and the knowledge itself improved significantly after the training. Scores of Objective Structured Clinical Examination stations were consistently high for all the participants.

Conclusions
A comprehensive training with achievement of learning outcomes is a proof of fitness to practice influenza vaccination, an important new skill for pharmacists in the UAE. All the study participants successfully completed the training program, achieved the passing score and showed a fitness to administer flu vaccine.
Pneumococcal Mastitis With Septicemia in a Pregnant Woman With Systemic Lupus Erythematosus
Authors: Kano Yasuhiro , Takamatsu Akane , Honda Nanase , Miike Satoshi , Honda Hitoshi 
Published: December 2020

Abstract
Purulent mastitis due to Streptococcus pneumoniae is extremely rare and is thought to be transmitted to the mother from the respiratory tract of the child during breastfeeding. We report herein a case of a 37-year-old, pregnant, Japanese patient in her third trimester with systemic lupus erythematosus (SLE) who presented with bacteremic pneumococcal mastitis despite the absence of lactation. Previous studies suggested that a marked susceptibility to S. pneumoniae among patients with SLE may play an important role in the development of severe infections due to this organism. Clinicians should be aware of this susceptibility and the importance of pneumococcal vaccination for patients with SLE.
Cytomegalovirus Reactivation After Bendamustine-Based Chemotherapy
Authors: Aggarwal Abhimanyu , Cretara Anthony , Ford Katya , Steingart Richard , Walker Durane 
Published: December 2020

Abstract
Cytomegalovirus (CMV) is a DNA hepadnavirus, commonly implicated in reactivation disease after immunosuppression, especially in solid-organ and stem cell transplant patients. Bendamustine is an alkylating chemotherapeutic agent introduced into the management of hematological malignancies within the last decade. Few reports have raised potential concern for CMV reactivation disease after bendamustine therapy involving, but not limited to, the gastrointestinal tract, lungs, retina, and viremia. Cytomegalovirus reactivation in such instances should be added to the differential diagnoses for febrile nonneutropenic immunocompromised patients. Here, we report a case of an elderly gentleman recently diagnosed with mantle cell lymphoma who was started on chemotherapy with rituximab, bendamustine, and dexamethasone and developed CMV colitis and viremia after just 2 cycles of chemotherapy.
Capnocytophaga canimorsus Meningitis Complicating a Remote Dog Bite
Authors: Kusulja Marija , Atelj Anita , Butić Iva , Krajinović Vladimir , Vukelić Dalibor 
Published: December 2020

Abstract

Capnocytophaga canimorsus is a rare cause of disease in humans. This article reports a case of C. canimorsus meningitis in an adult previously immunocompetent woman but with concurrent influenza A infection. The diagnosis was made from a blood and cerebrospinal fluid culture using DNA sequencing, and the patient recovered well after a 21-day course of ceftriaxone. Based on our case report and other available literature on the subject, implications of exposure history, empirical bacterial meningitis treatment, and dog bite prevention are discussed.
Acute severe respiratory syndrome coronavirus-2 treatment overview for pediatrics
Authors: Murphy Mark E. , Clay Gwendolyn , Danziger-Isakov Lara , Schulert Grant , Paulsen Grant C. 
Published: December 2020

Purpose of review
The novel severe respiratory syndrome coronavirus-2 (SARS-CoV-2) virus has caused a world-wide pandemic with devastating effects. Fortunately, most children display only mild-to-moderate symptoms, but there are a subset that will have severe symptoms warranting treatment. This review evaluates the current evidence for antiviral and anti-inflammatory treatment of acute SARS-COV-2 infections, including coronavirus disease 2019 in pediatrics.

Recent findings
Treatment recommendations continue to evolve with emerging results from clinical trials. Initial therapies were tailored to repurposed medications, and have now transitioned toward more specific antiviral therapy. In addition to specific antiviral therapy, there is also support to modulate the immune system and reduce inflammatory damage seen in coronavirus disease 2019. Much of the data result from adult studies with subsequent extrapolation to pediatrics.

Summary
Recommended therapy will continue to adapt as results return from clinical trials. A continued commitment from the National Institutes of Health and research community to assist in determining optimal therapies for pediatric patients is essential. Until then, most recommendations will likely be informed from the results seen in adult populations.
Visual Function in Eyes with Intermediate AMD with and without Retinal Pigment Abnormalities
Authors: Schneck Marilyn E. , Lott Lori A. , Haegerstrom-Portnoy Gunilla , Hewlett Susan , Gauer Bonnie M. , Zaidi Ali 
Published: December 2020

SIGNIFICANCE
In intermediate AMD, a simple, clinically feasible vision test of sensitivity to radial deformation is significantly more impaired in eyes with hyperpigmentation than in eyes with large drusen but normal retinal pigmentation, consistent with the former's increased risk of progression to advanced AMD. This ongoing longitudinal study will determine whether this vision measure is predictive of progression to advanced AMD.

PURPOSE
This study aimed to determine whether simple, clinically feasible psychophysical measures distinguish between two levels of intermediate AMD that differ in their risk of progression to advanced AMD: eyes with large macular drusen and retinal pigment abnormalities versus eyes with large macular drusen without pigment abnormalities. Abnormal pigmentation in the presence of large drusen is associated with a higher risk of development of advanced AMD.

METHODS
Each eye of 39 individuals with the same form of intermediate AMD in both eyes was tested monocularly on a battery of vision tests. The measures (photopic optotype contrast sensitivity, discrimination of desaturated colors, and sensitivity to radial deformation [shape discrimination hyperacuity]) were compared for both dominant and nondominant eyes. ANOVA with eye (dominant or nondominant) as a within-subject factor and retinal status (pigmentary abnormalities present or absent from the macula) as a between-subject factor was used to determine statistical significance.

RESULTS
Sensitivity to radial deformation was significantly reduced in eyes with large drusen and pigment changes compared with eyes with large drusen and normal retinal pigmentation (−0.40 ± 0.04 vs. −0.61 ± 0.02, respectively; F = 13.31, P = .001).

CONCLUSIONS
In the presence of large macular drusen, performance on a shape discrimination task is related to the presence versus absence of abnormal retinal pigmentation, being poorer in the higher-risk group, supportive of the measure's potential to predict progression to advanced AMD.
A Comparison of Foveal and Peripheral Contour Interaction and Crowding
Authors: Marten-Ellis Stephanie M. , Bedell Harold E. 
Published: December 2020

SIGNIFICANCE
Performance on clinical tests of visual acuity can be influenced by the presence of nearby targets. This study compared the influence of neighboring flanking bars and letters on foveal and peripheral letter identification.

PURPOSE
Contour interaction and crowding refer to an impairment of visual resolution or discrimination produced by different types of flanking stimuli. This study compared the impairment of percent correct letter identification that is produced in normal observers when a target letter is surrounded by an array of four flanking bars (contour interaction) or four flanking letters (crowding).

METHODS
Performance was measured at the fovea and at eccentricities of 1.25, 2.5, and 5° for photopic (200 cd/m2) and mesopic stimuli (0.5 cd/m2) and a range of target-to-flanker separations.

RESULTS
Consistent with previous reports, foveal contour interaction and crowding were more pronounced for photopic than mesopic targets. However, no statistically significant difference existed between foveal contour-interaction and crowding functions at either luminance level. On the other hand, flanking bars produced much less impairment of letter identification than letter flankers at all three peripheral locations, indicating that crowding is more severe than contour interaction in peripheral vision. In contrast to the fovea, peripheral crowding and contour-interaction functions did not differ systematically for targets of photopic and mesopic luminance.

CONCLUSION
The similarity between foveal contour interaction and crowding and the dissimilarity between peripheral contour interaction and crowding suggest the involvement of different mechanisms at different retinal locations.
Negative Fusional Vergence Is Abnormal in Children with Symptomatic Convergence Insufficiency
Authors: Scheiman Mitchell M. , Alvarez Tara L. , Cotter Susan A. , Kulp Marjean T. , Sinnott Loraine T. , Plaumann Maureen D. , Jhajj Jasleen ,   the Convergence Insufficiency Treatment Trial Investigator Group
Published: December 2020

SIGNIFICANCE
Deficits of disparity divergence found with objective eye movement recordings may not be apparent with standard clinical measures of negative fusional vergence (NFV) in children with symptomatic convergence insufficiency.

PURPOSE
This study aimed to determine whether NFV is normal in untreated children with symptomatic convergence insufficiency and whether NFV improves after vergence/accommodative therapy.

METHODS
This secondary analysis of NFV measures before and after office-based vergence/accommodative therapy reports changes in (1) objective eye movement recording responses to 4° disparity divergence step stimuli from 12 children with symptomatic convergence insufficiency compared with 10 children with normal binocular vision (NBV) and (2) clinical NFV measures in 580 children successfully treated in three Convergence Insufficiency Treatment Trial studies.

RESULTS
At baseline, the Convergence Insufficiency Treatment Trial cohort's mean NFV break (14.6 ± 4.8Δ) and recovery (10.6 ± 4.2Δ) values were significantly greater (P < .001) than normative values. The post-therapy mean improvements for blur, break, and recovery of 5.2, 7.2, and 1.3Δ, respectively, were statistically significant (P < .0001). Mean pre-therapy responses to 4° disparity divergence step stimuli were worse in the convergence insufficiency group compared with the NBV group for peak velocity (P < .001), time to peak velocity (P = .01), and response amplitude (P < .001). After therapy, the convergence insufficiency group showed statistically significant improvements in mean peak velocity (11.63°/s; 95% confidence interval [CI], 6.6 to 16.62°/s), time to peak velocity (−0.12 seconds; 95% CI, −0.19 to −0.05 seconds), and response amplitude (1.47°; 95% CI, 0.83 to 2.11°), with measures no longer statistically different from the NBV cohort (P > .05).

CONCLUSIONS
Despite clinical NFV measurements that seem greater than normal, children with symptomatic convergence insufficiency may have deficient NFV when measured with objective eye movement recordings. Both objective and clinical measures of NFV can be improved with vergence/accommodative therapy.