bluuebunny/crossref_metadata_2025_split huggingface dataset:
Vaginal Delivery After External Cephalic Version in Patients With a Previous Cesarean Delivery
Authors: Homafar Mona , Gerard Jessica , Turrentine Mark 
Published: October 2020

OBJECTIVE:
To estimate the rate of vaginal delivery after successful external cephalic version for breech presentation in women with compared with without a previous cesarean birth.

DATA SOURCES:
We searched MEDLINE, Scopus, EMBASE, CINAHL, ClinicalTrials.gov, and Cochrane Central Register of Controlled Trials for studies comparing the mode of delivery after successful external cephalic version in women with and without a previous cesarean birth.

METHODS OF STUDY SELECTION:
Two reviewers independently identified studies, extracted data, and evaluated study quality. The rate of vaginal delivery after successful external cephalic version in women with and without a previous cesarean birth was compared, and odds ratios (ORs) with 95% CIs were estimated.

TABULATION, INTEGRATION, AND RESULTS:
Six cohort studies and two case–control studies, reporting on 14,515 women were identified. The median point prevalence of a successful external cephalic version was 74% (interquartile range 63–81%) in women with a previous cesarean birth compared with 69% (interquartile range 64–83%) in women without a previous cesarean birth. The overall success rate of external cephalic version in women with a previous cesarean birth was similar compared with women without a previous cesarean birth (pooled OR 0.84, 95% CI 0.61–1.15). The median point prevalence of a vaginal delivery was 75% (interquartile range 61–84%) in women with a previous cesarean birth compared with 92% (interquartile range 85–95%) in women without a previous cesarean birth after a successful external cephalic version. The overall success rate of a vaginal delivery in women with a previous cesarean birth was less compared with women without a previous cesarean birth (pooled OR 0.26, 95% CI 0.14–0.50). A planned subgroup analysis on studies that included only multiparous women in the control group (parity one or greater) noted the overall success rate of external cephalic version in women with a previous cesarean birth 76% (853/1,123) was lower compared with multiparous women without a previous cesarean birth 84% (9,911/11,855) (pooled OR 0.70, 95% CI 0.54–0.89, I2 37%). The overall success rate of a vaginal delivery in women with a previous cesarean birth 83% (666/806) was less compared with women without a previous cesarean birth 97% (9,449/9,746) (pooled OR 0.21, 95% CI 0.12–0.39, I2 73%).

CONCLUSION:
Women with previous cesarean birth have similar rates of successful external cephalic version when compared with women without a cesarean birth. Although the rate of vaginal delivery is lower, the majority of patients have a successful vaginal birth after cesarean.

SYSTEMATIC REVIEW REGISTRATION:
PROSPERO, CRD42020160145.
Identification of Juvenile Cystic Adenomyoma Using High-Resolution Imaging
Authors: Wilcox Annemieke , Schmidt Megan , Luciano Danielle 
Published: October 2020

BACKGROUND:
Juvenile cystic adenomyoma is a rare condition that is often misdiagnosed as a noncommunicating uterine horn or adnexal mass during adolescence.

CASES:
We describe two patients who presented with dysmenorrhea unresponsive to standard management with oral contraceptives. Both patients were initially misdiagnosed as having endometriotic cysts. Juvenile cystic adenomyoma was suspected on standard pelvic ultrasound scan and subsequent high-resolution three-dimensional ultrasonography. The diagnosis was subsequently confirmed and the lesions successfully treated laparoscopically.

CONCLUSION:
Gynecologists should be aware of the possibility of juvenile cystic adenomyoma in adolescents with dysmenorrhea refractory to medical management. Three-dimensional ultrasonography may provide the resolution necessary to distinguish this rare condition.
Pain Control and Medication Use in Children Following Closed Reduction and Percutaneous Pinning of Supracondylar Humerus Fractures: Are We Still Overprescribing Opioids?
Authors: Stillwagon Matthew R. , Feinstein Shawn , Nichols Byrd , Andrews Paul N. , Vergun Anna D. 
Published: October 2020

Background:
The purpose of this 2-part study is to determine opioid prescribing patterns and characterize actual opioid use and postoperative pain control in children following discharge after closed reduction and percutaneous pinning of a supracondylar humerus fracture.

Methods:
A retrospective study was conducted from 2014 to 2016 to determine pain medication prescribing patterns at a single level 1 trauma center. Next, a prospective, observational study was conducted from 2017 to 2018 to determine actual pain medication use and pain scores in the acute postoperative period. Data were collected through telephone surveys performed on postoperative day 1, 3, and 5. Pain scores were collected using a parental proxy numerical rating scale (0 to 10) and opioid use was recorded as the number of doses taken.

Results:
From 2014 to 2016, there were 126 patients who were prescribed a mean of 47 doses of opioid medication at discharge. From 2017 to 2018, telephone questionnaires were completed in 63 patients. There was no significant difference (P>0.05) in pain ratings or opioid use by fracture type (Gartland), age, or sex. Children required a mean of 4 doses of oxycodone postoperatively. There were 18 (28%) patients who did not require any oxycodone. On average, pain scores were highest on postoperative day 1 (average 5/10) and decreased to clinically unimportant levels (<1) by postoperative day 5. Acetaminophen and ibuprofen were utilized as first-line pain medications in only 25% and 9% of patients, respectively. Two of 3 patients who used >15 oxycodone doses experienced a minor postoperative complication.

Conclusions:
Pediatric patients have been overprescribed opioids after operative treatment of supracondylar humerus fractures at our institution. Families who report pain scores >5 of 10 and/or persistent opioid use beyond postoperative day 5 warrant further clinical evaluation. Two of 3 pain outliers in this study experienced a minor postoperative complication. With appropriate parental counseling, satisfactory pain control can likely be achieved with acetaminophen and ibuprofen for most patients. If oxycodone is prescribed for breakthrough pain, then the authors recommend limiting to <6 doses.

Level of Evidence:
Level IV—observational, cohort study.
Cost-benefit relationship of keeping dantrolene stocks from the point of view of healthcare institutions
Authors: Rincón-Valenzuela David A. , Gómez-Ardila Ciro 
Published: October 2020

Introduction:
Malignant hyperthermia (MH) is an acute syndrome triggered by certain anesthetic medications. Dantrolene is the only specific treatment for MH crises. Without treatment, lethality may be as high as 80%. In Colombia, it is not mandatory to keep dantrolene supplies in stock.
Objective:

To establish the cost-benefit ratio, from the perspective of healthcare institutions, of keeping dantrolene supplies in stock in the operating theater.
Methods:

Using a decision tree, a Monte Carlo simulation was run with 10,000 scenarios to determine the median annual cost of keeping full or partial stocks (36 or 12 vials x 20 mg, respectively) of dantrolene. For the option of not keeping supplies in stock, the cost threshold was calculated where the expected value of both alternatives of the decision tree is equalized. Indifference curves were constructed for complete and partial supplies.
Results:

The median annual cost was estimated at 6.6 million Colombian pesos (COP) for full dantrolene supplies, and at COP 2.2 million for partial supplies. The median economic consequence threshold for 1 death due to the unavailability of dantrolene was estimated at COP 18.5 million for full supplies, and at COP 57.0 million for partial supplies.
Conclusion:

If, as a result of the unavailability of dantrolene, the economic consequences of a death due to MH exceed the threshold of COP 57.0 or COP 18.5 million, the purchase of full or partial stocks, respectively, is justified.
Clinical impacts of cerebral microbleeds in patients with established coronary artery disease
Authors: Uemura Yusuke , Shibata Rei , Imai Ryo , Ishikawa Shinji , Takemoto Kenji , Watarai Masato , Murohara Toyoaki 
Published: October 2020

Objective:
Although cerebral microbleeds predict the occurrence and recurrence of cerebrovascular events in stroke patients, their clinical impacts are unclear in coronary artery disease patients. We aimed to investigate the clinical effect of the presence of cerebral microbleeds in patients with coronary artery disease receiving antithrombotic treatment.

Methods:
We included 447 coronary artery disease patients taking at least one thrombotic agent who underwent brain MRI. The association between the presence of cerebral microbleeds and incidence of major adverse cardiac and cerebrovascular events was investigated.

Results:
Cerebral microbleeds were identified in 18.7% of patients. Median follow-up duration was 1055 (interquartile range, 781–1172) days. Kaplan–Meier survival analysis demonstrated that patients with cerebral microbleeds had a higher incidence of major adverse cardiac and cerebrovascular events than those without (log-rank P = 0.003). A multivariate Cox regression analysis revealed that the presence of cerebral microbleeds was independently correlated with the occurrence of major adverse cardiac and cerebrovascular events after adjusting for other classical risk factors of coronary artery disease (hazard ratio 1.965, 95% confidence interval 1.086–3.556, P = 0.026). Hypertension was associated with the presence of cerebral microbleeds. The cut-off values to maximize the predictive power of SBP and DBP were 132 and 74 mmHg, respectively (P < 0.001).

Conclusion:
The presence of cerebral microbleeds predicts major adverse cardiac and cerebrovascular events in coronary artery disease patients receiving antithrombotic treatment. Evaluation of cerebral microbleeds and hypertension treatment complying with the established guidelines may be beneficial in the management of coronary artery disease patients.
Additive effect of hypertension on left ventricular structure and function in patients with asymptomatic type 2 diabetes mellitus
Authors: Jiang Li , Ren Yan , Yu Hong , Guo Ying-kun , Liu Xi , Deng Ming-yan , Xie Lin-jun , Gao Yue , Shen Meng-ting , Han Pei-lun , Yang Zhi-gang 
Published: October 2020

Objective:
We aimed to comprehensively determine the effects of hypertension on left ventricular (LV) structure, microcirculation, tissue characteristics, and deformation in type 2 diabetes mellitus (T2DM) using multiparametric cardiac magnetic resonance (CMR) imaging.

Methods:
We prospectively enrolled 138 asymptomatic patients with T2DM (80 normotensive and 58 hypertensive individuals) and 42 normal glucose-tolerant and normotensive controls and performed multiparametric CMR examination to assess cardiac geometry, microvascular perfusion, extracellular volume (ECV), and strain. Univariable and multivariable linear analysis was performed to analyze the effect of hypertension on LV deformation in patients with T2DM.

Results:
Compared with controls, patients with T2DM exhibited decreased strain, decreased microvascular perfusion, increased LV remodeling index, and increased ECV. Hypertension lead to greater deterioration of LV strain (peak strain-radial, P = 0.002; peak strain-longitudinal, P = 0.006) and LV remodeling index (P = 0.005) in patients with T2DM after adjustment for covariates; however, it did not affect microvascular perfusion (perfusion index, P = 0.469) and ECV (P = 0.375). In multivariable analysis, hypertension and diabetes were independent predictors of reduced LV strain, whereas hypertension is associated with greater impairment of diastolic function (P = 0.009) but not systolic function (P = 0.125) in the context of diabetes, independent of clinical factors and myocardial disorder.

Conclusion:
Hypertension in the context of diabetes is significantly associated with LV diastolic function and concentric remodeling; however, it has little effect on systolic function, myocardial microcirculation, or fibrosis independent of covariates, which provide clinical evidence for understanding the pathogenesis of comorbidities and explaining the development of distinct heart failure phenotypes.
Knowledge, perception and practice of health professionals regarding blood pressure measurement methods: a scoping review
Authors: Todkar Shweta , Padwal Raj , Michaud André , Cloutier Lyne 
Published: October 2020

Objective:
Guideline-concordant performance of accurate blood pressure measurement (BPM), whether the modality is home (HBPM), ambulatory (ABPM), automated (AOBP) or office (OBPM), is dependent on proper technique. Knowledge, perception and practice of health professionals for BPM is crucial and has been partly studied, but a thorough review has never been reported. A scoping review of global studies was conducted to synthesize published data on this topic.

Methods:
An Arksey and O‘Malley methodological framework was used. Keywords were identified and extraction was completed to April 2019 using CINAHL and MEDLINE. Studies were classified as positive for knowledge, perception and practice if the majority (>50%) of reported responses were favourable, and negative otherwise. If specific results were not reported, the author's conclusions were used to classified.

Results:
Seventy-two studies were identified: 25 HBPM, 14 ABPM, two AOBP, 40 OBPM. For knowledge, the percentage of negative studies were higher for HBPM (40%) and OBPM (68%) and lower for ABPM (14%) regarding BPM techniques. For perception, the number of negative studies were lower for HBPM (20%) and ABPM (7%) regarding usefulness of BPM methods in hypertension management. For practice, the number of negative studies were higher for HBPM (48%), ABPM (71%), OBPM (73%) and AOBP (50%) regarding implementation of hypertension guidelines.

Conclusion:
The results of this scoping review demonstrate adequate perception of BPM but suboptimal knowledge and practice. Education is still needed to improve knowledge and practice. Future efforts should focus on improving what we know and what we do when measuring BP.
Angiotensin II Administration in Patients With COVID-19 Shock
Authors: Ofosu-Barko Kwadwo , Liu Yi , Alkhatib Tamimi Faisal , Al Husami Wael , Ganatra Sarju , Resnic Frederic , Shah Sachin P. 
Published: October 2020

Purpose:
To understand the hemodynamic effect of angiotensin II as a vasopressor in patients with shock secondary to COVID-19 infection.

Methods:
A retrospective analysis was performed on all patients at a single center with COVID-19 infection and shock who were treated with angiotensin II. The hemodynamic response to angiotensin II was estimated by recording the mean arterial pressure, norepinephrine equivalent dose (NED) and urine output.

Results:
Ten patients with COVID-19 related shock were treated with angiotensin II. Over the initial 6 hours, the average the NED decreased by 30.4% (from 64.6 to 44 µg/min) without a significant change in the mean arterial pressure (0.7% decrease). Six patients experienced at least a 25% reduction in NED by 6 hours, and 2 experienced at least a 50% reduction.

Conclusions:
On average, the hemodynamic response to angiotensin II in COVID-19 related shock was favorable. Two patients had a marked rapid improvement. Given the relationship of SARS-CoV-2 with the renin-angiotensin-aldosterone system, further evaluation of angiotensin II for the treatment of COVID-19 related shock is warranted.
ACUTE EXUDATIVE POLYMORPHOUS VITELLIFORM MACULOPATHY ASSOCIATED WITH PRIMARY EPSTEIN–BARR VIRUS INFECTION
Authors: Lentzsch Anna M. , Dooling Vivienne , Wegner Ina , Di Cristanziano Veronica , Sadda Srinivas R. , Freund K. Bailey , Liakopoulos Sandra 
Published: October 2020

Purpose:
To report a case of acute exudative polymorphous vitelliform maculopathy associated with primary Epstein–Barr virus infection.

Methods:
Multimodal imaging including color fundus photography, spectral-domain optical coherence tomography, blue-light fundus autofluorescence, fluorescein angiography, and indocyanine green angiography.

Results:
A 24-year-old otherwise healthy woman presented with an acute bilateral visual disturbance associated with cervical lymphadenopathy. Spectral-domain optical coherence tomography showed bilateral foveal serous retinal detachment (SRD) with thickening of the ellipsoid zone throughout the posterior pole corresponding to hyperautofluorescence on fundus autofluorescence, faint diffuse hyperfluorescence on fluorescein angiography without leakage, and mild late hyperfluorescence on indocyanine green angiography. Systemic workup revealed an acute Epstein–Barr virus infection. Within several weeks, multifocal SRDs developed in the macula and paramacula. The SRDs then became increasingly hyperautofluorescent with spectral-domain optical coherence tomography showing subretinal hyperreflective material. This vitelliform material then slowly resolved while the thickness of the surrounding ellipsoid zone normalized. The fluorescein angiography and indocyanine green angiography appeared normal at Month 8. Visual acuity was 20/20 in both eyes at all times. No treatment was initiated.

Conclusion:
Acute exudative polymorphous vitelliform maculopathy may be associated with an acute Epstein–Barr virus infection. Acutely, multimodal imaging revealed findings consistent with RPE dysfunction and reduced photopigment density. Subsequent accumulation of vitelliform material gradually resolved over an 8-month follow-up.
The Effect of Continuity of Care and Provider Volume on Late Presentation of Glaucoma: A Nested Case-Control Study
Authors: Lu Yu-Chin , Pu Christy , Hou Chiun-Ho 
Published: October 2020

Précis:
Glaucoma late presentation is not associated with continuity of care. However, it is associated with frequency of physician visits and physician volume.

Purpose:
Late presentation of glaucoma often causes blindness. Continuity of care (COC) has been the central element in primary care. We investigated whether COC, frequency of visits to ophthalmology departments, and provider experience can reduce late presentation.

Methods:
We conducted a nested case-control study on patients aged above 20 years with confirmed glaucoma diagnosis. Claims data from the Taiwan’s National Health Insurance Research Database during 2007 to 2016 were linked to the Disability Registry (n=231,330) to identify patients with glaucoma late presentation. Physician experience was proxied using service volume. Logistic regression was estimated using matched samples.

Results:
A total of 111 patients satisfied the definition of late presentation. Patients with a low frequency of visits had lower odds of being in the late-presentation group (odds ratio=0.39, 95% confidence interval=0.18-0.81). COC index did not statistically affect late presentation. Old age and lower socioeconomic status were significantly associated with higher odds of late presentation. A statistically significant negative association was observed between physician volume and odds of late presentation.

Conclusion:
Late presentation for glaucoma can be reduced by promoting more frequent physician visits. However, enhancement from the provider-side, such as spreading awareness and offering routine tests, also play essential role in reducing late presentation.
Comparison of Gonioscopy-assisted Transluminal Trabeculotomy Versus Trabeculectomy With Mitomycin C in Patients With Open-angle Glaucoma
Authors: Fontana Luigi , De Maria Michele , Caristia Alice , Mastrofilippo Valentina , Braglia Luca , Iannetta Danilo , Scarale Giuliano Pio 
Published: October 2020

Précis:
Trabeculectomy (TRAB) lowers the intraocular pressure (IOP) more than gonioscopy-assisted transluminal trabeculotomy (GATT) at 18 months, with a reduction in IOP of 30% or more and a significant reduction in the number of glaucoma medications compared with baseline.

Purpose:
To compare the IOP-lowering efficacy of GATT with mitomycin-C augmented TRAB in patients with uncontrolled open-angle glaucoma.

Methods:
Single-center, retrospective, comparative cohort study. One hundred ten consecutive patients (110 eyes) underwent GATT (n=61) or TRAB (n=49). The primary outcome measure was IOP reduction, defined as a percentage decrease ≥30% and absolute IOP≤18 mm Hg at 18 months with (qualified) or without (complete) medications. Secondary outcomes were visual field change, number of glaucoma medications, complications, and reintervention.

Results:
The mean±SD baseline IOP was 30.04±7.5 and 27.59±4.70 (P=0.072) with the mean number of medications of 3.08±0.73 and 2.92±0.91 (P=0.310) in TRAB and GATT, respectively. At 18 months, the mean±SD IOP was 15.26±3.47 mm Hg and 12.48±4.58 mm Hg after GATT and TRAB, respectively (P=0.002). The percentage of IOP lowering from baseline was 56.05±17.72 after TRAB and 42.04±15.56 after GATT (P<0.001). Percentages of complete and qualified success were 59% and 27% after TRAB and 46% and 31% after GATT (P=0.353). No change in visual field loss was observed in both groups. The mean reduction in medications was 2.3±1.4 and 2.1±1.5 in TRAB and GATT, respectively (P=0.493). The most frequent complication after TRAB was hypotony and after GATT hyphema. Reintervention occurred in 8.2% of cases after TRAB and in 14.8% after GATT (P=0.341).

Conclusions:
IOP lowering was greater after TRAB than after GATT at 18 months with a significant reduction in the number of medications after both procedures. Complications and reintervention occurred equally in both groups but differed in type.
The Direct and Indirect Impact of SARS-CoV-2 Infections on Neonates
Authors: Saha Senjuti , Ahmed ASM Nawshad Uddin , Sarkar Probir Kumar , Bipul Mohammed Rizwanul Ahsan , Ghosh Kinkar , Rahman Sheikh Wasik , Rahman Hafizur , Hooda Yogesh , Ahsan Nafiz , Malaker Roly , Sajib Mohammad Saiful Islam , Islam Mohammad Shahidul , Anik Ataul Mustufa , Saha Sudipta , Kanon Naito , Islam Maksuda , Hamer Davidson H. , Amin Ruhul , Shahidullah Mohammod , Saha Samir K. 
Published: October 2020

Background:
The impact of SARS-CoV-2 on neonates remains largely unknown in low- and middle-income countries (LMICs). We provide an epidemiologic and clinical report of SARS-CoV-2 infections in neonates hospitalized in Bangladesh.

Methods:
Outborn neonates admitted to Dhaka Shishu Hospital, a tertiary-care referral hospital, between 29 March and 1 July were screened for SARS-CoV-2. We reviewed clinical data, including chest radiograph and laboratory reports, and conducted SARS-CoV-2 genome sequencing. Patients were followed-up for 27–75 days. A subset of caregivers was also tested.

Results:
Of 83 neonates tested, 26 were positive (median age 8 days). Most neonates were admitted with diagnosis unrelated to SARS-CoV-2: 11 presented with serious non-communicable diseases, 7 with early-onset sepsis, 5 with late-onset sepsis and 2 with pneumonia. In 3 of 5 chest radiograph, infiltrates and ground-glass or patchy opacities were noted. Two neonates developed metabolic acidosis, one developed disseminated intravascular coagulation. Most SARS-CoV-2 positive neonates were referred to government-designated COVID-19 hospitals, leading to gaps in treatment. Twenty-three neonates could be followed-up: 12 were healthy, 8 died and 3 were still seeking medical care. Of 9 caregivers tested, 8 were positive.

Conclusions:
SARS-CoV-2 may have serious adverse effects on children born in LMICs. The virus likely contributed directly to two deaths, but the remaining 6 neonates who died had serious comorbidities. Positive SARS-CoV-2 test results led to gaps in immediate clinical care for other morbidities, which likely contributed to adverse outcomes. This case series emphasizes the need to understand COVID-19 in neonates in LMICs and its indirect impacts.