bluuebunny/crossref_metadata_2025_split huggingface dataset:
Camel-Related Deaths—A Forensic Overview
Authors: Gilbert John D. , Byard Roger W. 
Published: September 2020

Abstract
Camels are ungulates of the genus Camelus and have been used for centuries in parts of Asia and Africa for transport and sustenance. Handling of camels is not without its dangers, and 4 cases from South Australia are reported with a review of lethal camel-related issues. Case 1 is a 56-year-old man who died of multiple blunt force injuries after he had attempted to move a 7-year-old female dromedary (Camelus dromedarius). Case 2 is a 65-year-old woman who was crushed by 1 or more camels that she had been training. Case 3 is a 1-year-old girl who died of blunt craniocerebral trauma after the car in which she was traveling rolled when the driver swerved to avoid a herd of camels that had strayed onto the road. Case 4 is a 66-year-old woman who died of ischemic and hypertensive cardiac disease exacerbated by physical activity while rounding up camels. Deaths associated with camels involve kicking, stomping, kneeling or sitting on a victim, or biting and shaking and throwing. Lethal mechanisms include hemorrhage from vascular injuries and internal organ disruption, crush asphyxia, and blunt craniospinal injuries. Death may also follow falls from camels or vehicle collisions. Camels also carry a wide range of zoonotic diseases, the most significant of which is Middle Eastern respiratory syndrome. Handling of camels may also exacerbate underlying organic illnesses such as cardiac disease. Those working with camels should be aware that the size, strength, and temperament of these animals may make them dangerous and that they also carry potentially lethal zoonotic diseases.
Histopathological Differentiation of Antemortem and Postmortem Electrical Burn Mark Produced by Low Voltage
Authors: Behera Chittaranjan , Sikary Asit Kumar , Kumar Vivek , Mridha Asit Ranjan 
Published: September 2020

Abstract
The study was undertaken to differentiate antemortem electrical (AME) and postmortem electrical (PME) burn marks with the help of histopathology. The electrical burn mark was produced on 25 dead bodies. Alongside 25 cases of electrocution deaths were included for comparison. Slides were prepared and stained with hematoxylin-eosin stains. Intraepidermal and subepidermal separation; coagulative necrosis of the epidermis; nuclear elongation and hyperchromasia of epidermal cells; homogenization of the dermis; nuclear elongation and hyperchromasia of hair follicles, sweat glands, sebaceous glands, and blood vessel endothelium were studied for histopathological changes and graded. The findings of the study suggest that the histopathological changes in electrical burn marks are due to the physical effect of heat produced by the electric current. The classical histopathological features of electrical burn mark cannot differentiate between AME and PME burn marks. However, careful evaluation of grading of the dermal changes can be helpful in differentiating AME and PME burn marks. Highest grade of dermal thickness homogenization and highest grade of nuclear elongation of dermal appendages were significantly more in the antemortem electrical burn marks than PME burn marks.
Embolism of Cerebral Tissue to the Lung After Head Trauma
Authors: Bugra Aytul , Das Taner 
Published: September 2020

AbstractEmbolism of cerebral tissue to pulmonary circulation is a rare entity. It can be occur because of penetrating or closed head trauma at any age or during difficult vaginal deliveries at any age. We present a case of cerebral tissue pulmonary embolization after severe head trauma in a male adult. The autopsy revealed multiple skull fractures, subdural hematoma, subarachnoid hemorrhages, and contusions. Microscopically, we observed cerebral tissue inside the branches of the pulmonary arteries. Embolism of cerebral tissue to the pulmonary circulation is a rare condition. It should always be kept in mind in sudden unexpected deaths during delivery and head trauma cases at any age.
Death by Copper Ammonium Complex–Containing Fungicide
Authors: Otter Jenna , Cantrell F Lee 
Published: September 2020

Abstract
There is a paucity of published reports of copper ammonium complex ingestion, as most published data describe overdoses of copper sulfate formulations. We report a case of suicide by ingestion of copper ammonium complex–containing fungicide with an elevated postmortem copper level. A 77-year-old woman was found dead at home by her relative after ingesting a fungicide containing 8% copper ammonium complex solution. Turquoise emesis was found at the scene, and on autopsy, turquoise material was found throughout the gastrointestinal tract. Postmortem central blood copper level was 500 μg/dL. Cause of death was determined to be acute copper toxicity.
Arrhythmogenic Right Ventricular Cardiomyopathy in a Young Athlete
Authors: Rich Lucas , Rarick Joshua , Prahlow Joseph 
Published: September 2020

Abstract
Sudden death in young athletes is rare, with an incidence of 0.61/100,000 person-years in the United States (Circulation. 2009;119(8):1085–1092). Etiologies may be divided into cardiac and noncardiac. We present a case of arrhythmogenic right ventricular cardiomyopathy (ARVC) resulting in sudden death in a high school athlete.
A 17-year-old adolescent boy with an unremarkable medical history suddenly collapsed while running. Autopsy revealed a 510-g heart with a markedly dilated right ventricle and multifocal areas of wall thinning and apparent fatty infiltration. The left ventricle demonstrated concentric hypertrophy. Coronary arteries were unremarkable, as were the cardiac valves. Microscopic examination revealed right ventricular myocyte loss with replacement by fibrofatty tissue. Remainder of the autopsy was negative except for mild chronic asthmatic changes. Serum and urine drug screens were negative. The cause of death was ARVC. The manner of death was natural.
Arrhythmogenic right ventricular cardiomyopathy is an inherited cardiomyopathy with variable expressivity and incomplete penetrance often resulting in heart failure or sudden cardiac death. It is characterized by segmental and multifocal fibro-fatty replacement of the right ventricle free wall. Arrhythmogenic right ventricular cardiomyopathy accounts for 2.1% to 4.0% of total sudden deaths in young athletes and thus should be considered in similar cases (J Am Coll Cardiol. 2018;72(7):784–804).
The Impact of the Novel Coronavirus on Brazilian PICUs
Authors: Araujo Orlei Ribeiro de , Almeida Carlos Gustavo de , Lima-Setta Fernanda , Prata-Barbosa Arnaldo , Colleti Junior José 
Published: September 2020

Objectives:
To study the impact of the coronavirus disease 2019 pandemic, considering the physical distancing and schools closing, on the characteristics of admission and epidemiology on Brazilian PICUs.

Design:
Observational, multicenter, time series analysis, of electronic medical records from 15 PICU in Brazil. Data consisted of all March, April, and May PICU admissions from 2017 to 2020.

Setting:
Fifteen private PICUs in Brazil.

Patients:
Pediatric patients admitted to the PICU from March to May since 2017.

Interventions:
None.

Measurements and Main Results:
The period from March 11, 2020, to March 17, 2020, was considered the “intervention point” studied, corresponding to the suspension of school activities and the beginning of physical distancing in Brazil. During the pandemic period studied, there were 28 cases of coronavirus disease 2019 (one death). The mean age was higher (p = 0.000), the length of stay was shorter (p = 0.000), but mortality rates were similar among the periods (p = 0.36). The model estimated a reduction of 1,483 PICU admissions from March 2020 to May 2020. At the end of May, there was an estimated drop of –146.6 bronchiolitis admissions (95% CI, –242.8 to –50.3; p = 0.016); –71 asthma admissions (95% CI, –93.6 to –48.63; p = 0.000); and –59 community-acquired pneumonia admissions (95% CI, –74.7 to –43.3; p = 0.000) per period. The model showed no effect of the “intervention” (physical distancing) on hospitalization rates for epilepsy, diarrhea, sepsis, bacterial meningitis, or surgery when analyzed individually. When assessed together, the model estimated a reduction of 73.6 admissions (95% IC, –132 to –15.2; p = 0.43).

Conclusions:
The coronavirus disease 2019 pandemic strongly affected Brazilian PICUs, reducing admissions, length of stay, and the epidemiological profile. The measures to oppose the coronavirus disease 2019 pandemic may have prevented thousands of PICU hospitalizations across the country.
Crohn Disease Presenting as the Cutaneous Rash of Pyoderma Gangrenosum
Authors: Harris Corrie Ann , Lehto Elizabeth M. , Laneiwcz Megan Bryce 
Published: September 2020

Abstract
Pyoderma gangrenosum (PG) is a rare pediatric diagnosis, occurring in 3 to 10 patients per million per year, and most commonly seen in individuals between ages 20 and 50 years. This severe ulcerating skin rash is typically associated with an underlying systemic inflammatory condition. The appearance of PG often coincides with exacerbation of the underlying disease. In the absence of systemic symptoms, misdiagnosis of PG can occur, resulting in delay of appropriate treatment. The disease's visual similarity to soft tissue infections, which have dramatically increased in recent years (Ann Emerg Med. 2008;51,3:291–98), makes isolated dermatologic presentations particularly problematic. We present a case of Crohn disease presenting as the inflammatory rash of PG in the absence of significant bowel symptoms. This case highlights the importance of keeping PG in the differential for inflammatory lesions presenting to the emergency department.
Radiation-Free Diagnosis of Pediatric Appendicitis
Authors: Davis Joshua , Chima Melissa , Kasmire Kathryn 
Published: September 2020

Introduction
Appendicitis is a common pediatric surgical emergency, and it can often be difficult to diagnose. Computed tomography is commonly used as a diagnostic criterion standard, but herein, we describe the accuracy of a “radiation-free” diagnostic algorithm using point-of-care ultrasonography (POCUS) and magnetic resonance imaging (MRI) to diagnose pediatric appendicitis.

Methods
This was a retrospective chart review of all patients who had a POCUS ordered for evaluation of pediatric appendicitis. Results of POCUS and MRI were classified as positive, negative, or equivocal using previously described cutoffs and criterion standard of surgery/pathology or clinical follow-up. Diagnostic accuracy was calculated using traditional methods.

Results
We identified 209 patients for inclusion. The sensitivity and specificity of POCUS were 100% and 95.2%, respectively, in addition to 86 equivocal examinations, 6 of which had appendicitis. The sensitivity and specificity of MRI were 94.4% and 96.5%, respectively, in addition to 27 equivocal examinations, 2 of which had appendicitis.

Conclusions
Using POCUS and MRI for the diagnosis of pediatric appendicitis is a highly accurate way to avoid ionizing radiation in children. In our study, POCUS is as accurate as MRI, although this is limited by being mostly done by a single provider and a high number of equivocal examinations.
Seated Position Does Not Change Lumbar Dimensions Compared With Lateral Position
Authors: Long Michael T. , Del Re Angelo M. , Uya Atim , Kanegaye John T. , Nguyen Margaret B. 
Published: September 2020

Objective
The infant lumbar puncture (LP) can be a technically challenging procedure. Understanding the anatomical lumbar dimensions may optimize LP conditions. Data from preterm neonates, older children, and adults indicate measurements of the lumbar spine in the seated LP position may be superior when compared with the lateral position. We use point-of-care ultrasound (US) to determine if the seated position, when compared with the lateral decubitus position, significantly affected the lumbar dimensions of infants 12 months or younger presenting to the pediatric emergency department.

Methods
We conducted a prospective observational study of a convenience sample of patients 12 months or younger. We used US to obtain 3 still images oriented longitudinally in the midline over the L3 to L4 interspace in the lateral decubitus and seated positions. A US fellowship-trained emergency physician, blinded to patient position, measured interspinous space, subarachnoid space width, and spinal canal depth. We then compared the means of all 3 dimensions in the lateral and seated positions.

Results
From 50 subjects, 49 subjects provided 46 evaluable sets of images for each measure. Interspinous space, spinal canal depth, and subarachnoid space width did not differ significantly between positions. Mean differences did not exceed 0.02 cm for any of the measured dimensions. We report no significant differences in the 3 lumbar dimensions at the seated position when compared with the lateral decubitus position.

Conclusions
For infants younger than 12 months, sonographic measurements of lumbar dimensions did not differ between the positions commonly used for LP.
Characteristics of Upper Limb Osteoarticular Infections at the Emergency Department of a Tertiary University Hospital in Spain
Authors: Martín Espín Irene , Murias Loza Sara , Lacasta Plasin Clara , Niño Saco María Dolores , Alcolea Sánchez Alida , de Ceano-Vivas la Calle María 
Published: September 2020

Objectives
Osteoarticular infections are infrequent in pediatric patients, although their incidence seems to be increasing. They usually affect children younger than 5 years and tend to localize in the lower limbs. Because of their nonspecific symptoms, especially at onset, a timely diagnosis is difficult to achieve, with the subsequent risk of a delay in treatment. We hereby report the management of osteoarticular infections in our pediatric emergency department.

Methods
This is a retrospective descriptive study of patients diagnosed with osteoarticular upper limb infection in the pediatric emergency department of a tertiary hospital from January 2011 to December 2016.

Results
From an initial global sample of 170 patients diagnosed with osteomyelitis or septic arthritis at any location at the pediatric emergency department, 32 children (18.82%) with upper limb involvement were included in the study. Of them, 22 were male and the mean age at diagnosis was 14.5 months (interquartile range, 2–106). Eighteen patients (56%) were diagnosed with septic arthritis, and 14 (44%) had a diagnosis of osteomyelitis.
The most frequent symptom was pain (50%). More than one third of patients (11) had received a different diagnosis in a previous hospital visit. A traumatic etiology was suspected in 7 cases (21%).
Regarding acute phase reactants, the mean value for C-reactive protein was 21.3 mg/L, and erythrocyte sedimentation rate was elevated in 27 cases (84%). In 28 patients, blood cultures were obtained, 24 of which came back negative. All children received antibiotic treatment and achieved a full recovery.

Conclusions
One third of patients were misdiagnosed at the first consultation, which stresses the importance of a high clinical suspicion to avoid delays in diagnosis and treatment of osteoarticular infections. This study also shows a lower mean age of children with upper limb infection as compared with those with lower limb infection. All patients recovered fully with oral antibiotics.
Which Clinical Features of Children on Initial Presentation to the Emergency Department With Head Injury Are Associated With Clinically Important Traumatic Brain Injury, Classification as Abuse, and Poor Prognosis?
Authors: Burns James , Rohl Stephen , Marth Daniel , Proctor Drexel , Amin Raid , Sekhon Carol 
Published: September 2020

Background
Pediatric traumatic brain injury (TBI) and abusive head trauma (AHT) are leading causes of morbidity and mortality. Clinicians may not be aware of AHT at presentation to the emergency department (ED).

Objective
The objective of this study was to determine which clinical features associated with head injury in children on initial presentation to the ED trauma bay predict 3 outcomes including clinically important TBI (CiTBI), classification as confirmed abuse by Child Protection Team (CPT), and poor neurologic status on hospital discharge.

Participants and Setting
Inclusion for this study were children 3 years or younger, presenting to the ED with significant TBI. In addition, presentations where the mechanism of injury was not verifiable such as with falls, being struck by object, or no mechanism of injury reported by caregiver were included.

Methods
Researchers used 3 sources of information for this analysis: a regional trauma registry, hospital records, and the CPT database. Clinical features included demographics, mechanisms of injury, physical, radiological findings, and CPT classification.

Results
On pairwise analysis, seizures, apnea, and no mechanism of injury reported by caregiver were the only clinical features related to all 3 outcomes (P < 0.001). Rib fractures (relative risk [RR], 3.3; P < 0.001), long bone fractures (RR, 3.1; P < 0.001), retinal hemorrhages (RR, 3.0; P < 0.001), seizures (RR, 3.6; P < 0.001), apnea (RR, 4.4; P < 0.001), and younger than 6 months (RR, 1.8; P < 0.001) were related to AHT. On multivariable logistic regression, no mechanism of injury reported by caregiver and seizures remained significantly related to CiTBI; seizures and retinal hemorrhage remained significantly related to classification as abuse by CPT, and no mechanism of injury by the caregiver, apnea, and seizures were significantly related to poor outcome on hospital discharge.

Conclusions
No mechanism of injury reported by the caregiver, seizures, and apnea at the time of presentation to the ED are important features associated with CiTBI, classification as AHT, and poor prognosis. In addition, younger age, retinal hemorrhage, rib, and long bone fractures were found to be important clinical features associated with AHT.
Lung Point-of-Care Ultrasound in Pediatric COVID-19
Authors: Kennedy Thomas M. , Malia Laurie , Dessie Almaz , Kessler David O. , Ng Lorraine , Chiang Elaine L. , Rabiner Joni E. 
Published: September 2020

Abstract
Lung point-of-care ultrasound (POCUS) has been shown to be useful for identifying pulmonary pathology in adult patients with coronavirus disease 2019 (COVID-19). However, pediatric literature for POCUS in COVID-19 is limited. The objective of this case series was to describe lung POCUS findings in pediatric patients with COVID-19. Three patients with COVID-19 who had lung POCUS performed in a pediatric emergency department were included. Point-of-care ultrasound revealed bilateral abnormalities in all patients, including pleural line irregularities, scattered and coalescing B-lines, consolidations, and pleural effusions. Additional pediatric studies are necessary to gain a broader understanding of COVID-19's sonographic appearance in this age group and to determine whether POCUS may be helpful to facilitate diagnosis and expedite management decisions.
COVID-19
Authors: Isba Rachel , Edge Rhiannon , Auerbach Marc , Cicero Mark X. , Jenner Rachel , Setzer Erika , Broughton Emily , Keegan Thomas 
Published: September 2020

Introduction
This cross-sectional study looked at the impact of the SARS-CoV-2/COVID-19 pandemic on pediatric emergency department (PED) attendances and admissions (as a proxy for severity of illness) in the United States and United Kingdom.

Methods
Data were extracted for children and adolescents, younger than 16 years, attending Royal Manchester Children's Hospital (RMCH, United Kingdom), and Yale New Haven Children's Hospital (YNHCH, United States). Attendances for weeks 1 to 20 of 2020 and 2019 were compared, and likelihood of admission was assessed via calculation of odds ratios, using week 13 (lockdown) as a cutoff.

Results
Attendance numbers for each PED decreased in 2020 compared with 2019 (RMCH, 29.2%; YNHCH, 24.8%). Odds of admission were significantly higher after lockdown than in 2019—RMCH (odds ratio, 1.26; 95% confidence interval, 1.08–1.46) and YNHCH (odds ratio, 1.60; 95% confidence interval, 1.31–1.98).

Conclusions
Although the absolute numbers of children and adolescents attending the PED and being admitted decreased after lockdown, the acuity of illness of those attending appears to be higher.
A Cadaveric Study of the Buccal Fat Pad: Implications for Closure of Palatal Fistulae and Donor-Site Morbidity
Authors: Echlin Kezia , Whitehouse Harry , Schwaiger Michael , Nicholas Rebecca , Fallico Nefer , Atherton Duncan D. 
Published: September 2020

Background:
For the cleft surgeon, palatal fistulae after cleft palate repair remain a difficult problem, with a paucity of local tissue options to aid closure. Small clinical series have described the use of the buccal fat pad flap to repair palatal fistulae; however, there is no literature detailing the anatomical coverage of the flap. This study delineates the anatomy of the buccal fat pad flap to guide surgeons in patient selection and examines the residual buccal fat after flap harvest to provide new information with regard to possible effects on the donor site.

Methods:
Buccal fat pad flaps were raised in 30 hemicadavers. The reach of the flap across the midline, anteriorly and posteriorly, was recorded. In 18 hemicadavers, the entire buccal fat pad was then exposed to determine the effects of flap harvest on movement and volume of the residual fat.

Results:
All buccal fat pad flaps provided coverage from the soft palate to the posterior third of the hard palate and all across the midline. Approximately three-fourths of flaps would cover the mid hard palate. The flap constitutes 36 percent of the total buccal fat pad on average, and a series of retaining ligaments were identified that may prevent overresection.

Conclusions:
The buccal fat pad flap is a useful tool for coverage of fistulae in the soft palate to the posterior third of the hard palate. In most cases, it will also reach the middle third; however, it is not suitable for more anterior defects. On average, two-thirds of the buccal fat pad remains within the cheek after flap harvest, which may protect against unwanted alteration in aesthetics.