bluuebunny/crossref_metadata_2025_split huggingface dataset:
An Infectious Cause of Congenital Pupillary-Iris-Lens Membrane With Secondary Angle Closure Glaucoma in an Infant
Authors: Maheshwari Devendra , Rao Sanjana , Pawar Neelam , Kadar Mohideen A. , Ramakrishnan Rengappa 
Published: November 2020

Purpose:
The aim of the study was to report an infectious cause of congenital pupillary-iris-lens membrane with secondary angle closure glaucoma in an infant.

Design:
This was a case report.

Methods:
Institutional review board exemption for this report was obtained from the Institutional Ethics Committee, Aravind Eye Hospital, Tirunelveli. Informed consent was obtained.
A 3-month-old female infant presented to us with congenital pupillary-iris-lens membrane, iris bombe and raised intraocular pressure in the left eye. She underwent trabeculotomy and trabeculectomy along with membranectomy for the same. An aqueous tap performed a month later was suggestive of coexisting Toxoplasma gondii infection detected by polymerase chain reaction.

Result:
The study provides a description of the course of management of angle closure glaucoma secondary to congenital pupillary-iris-lens membrane with an associated infection. Intraocular pressure reduced from 40 to 20 mm Hg in the left eye.

Conclusion:
This condition is a rare entity of unknown etiology with an increased risk of glaucoma and visual loss. A multidisciplinary approach is needed for the management of these eyes. Infectious associations with these membranes should be ruled out by an aqueous tap with polymerase chain reaction and a close postoperative follow-up is mandatory.
Clinical Efficacy and Safety Outcomes of Micropulse Transscleral Diode Cyclophotocoagulation in Patients With Advanced Glaucoma
Authors: Lim Edward J.Y. , Cecilia Aquino M. , Lim Dawn K.A. , Sng Chelvin C.A. , Loon Seng Chee , Lun Katherine W.X. , Chew Paul T.K. , Koh Victor T.C. 
Published: November 2020

Precis:
Micropulse transscleral cyclophotocoagulation (MPTCP) is only moderately effective in lowering intraocular pressure (IOP) and is useful as an adjunct procedure to other glaucoma surgeries. There was a small risk of loss of vision, prolonged hypotony, and phthisis bulbi.

Aim:
The aim of this study was to determine the efficacy and safety of a single MPTCP treatment for an Asian population with advanced glaucoma.

Methods:
This is a retrospective single-center study of 207 eyes (207 patients) with advanced glaucoma which underwent first-time MPTCP between January 1, 2008, and March 31, 2018. Success was defined as IOP of 6 to 21 mm Hg or ≥20% reduction in IOP without an increase in glaucoma medication from baseline, and without glaucoma reoperation. The IOP, best-corrected visual acuity, and number of glaucoma medications were also analyzed.

Results:
The mean (SD) age was 64.9±16.9 years. The mean follow-up duration was 18.7±16.2 months. The rate of success at postoperative years 1 and 2 follow-up was 44.1% and 32.6%, respectively. The median survival time of MPTCP was 9.0 months and 85 (40.9%) eyes received reoperation. The mean IOP decreased from 31.5±12.0 mm Hg preoperatively to 22.1±10.3 and 23.8±11.8 mm Hg at postoperative years 1 and 2, respectively (P<0.0001). The mean number of glaucoma medications was reduced from 3.3±1.0 preoperatively to 2.6±1.1 and 2.4±1.1 at postoperative years 1 and 2, respectively (P<0.0001). Significant complications included prolonged hypotony [1 eye (0.5%)], phthisis bulbi [7 eyes (3.4%)], and best-corrected visual acuity reduction [29 eyes (13.9%)].

Conclusion:
Single first-time MPTCP for advanced glaucoma eyes was moderately effective in lowering IOP but >50% failed by 1 year.
Methods to discriminate between mechanism-based categories of pain experienced in the musculoskeletal system: a systematic review
Authors: Shraim Muath A. , Massé-Alarie Hugo , Hodges Paul W. 
Published: November 2020

Abstract
Mechanism-based classification of pain has been advocated widely to aid tailoring of interventions for individuals experiencing persistent musculoskeletal pain. Three pain mechanism categories (PMCs) are defined by the International Association for the Study of Pain: nociceptive, neuropathic, and nociplastic pain. Discrimination between them remains challenging. This study aimed to build on a framework developed to converge the diverse literature of PMCs to systematically review methods purported to discriminate between them; synthesise and thematically analyse these methods to identify the convergence and divergence of opinion; and report validation, psychometric properties, and strengths/weaknesses of these methods. The search strategy identified articles discussing methods to discriminate between mechanism-based categories of pain experienced in the musculoskeletal system. Studies that assessed the validity of methods to discriminate between categories were assessed for quality. Extraction and thematic analysis were undertaken on 184 articles. Data synthesis identified 200 methods in 5 themes: clinical examination, quantitative sensory testing, imaging, diagnostic and laboratory testing, and pain-type questionnaires. Few methods have been validated for discrimination between PMCs. There was general convergence but some disagreement regarding findings that discriminate between PMCs. A combination of features and methods, rather than a single method, was generally recommended to discriminate between PMCs. Two major limitations were identified: an overlap of findings of methods between categories due to mixed presentations and many methods considered discrimination between 2 PMCs but not others. The results of this review provide a foundation to refine methods to differentiate mechanisms for musculoskeletal pain.
Frailty in Acute Care: Not Just Your Grandparents' Medical Condition
Authors: Exum Emelia 
Published: November 2020

Background and Purpose:
Frailty is defined as a clinically recognizable state of increased vulnerability resulting from aging-associated declines in reserve and function across multiple physiologic systems such that the ability to cope with everyday or acute stressors is comprised. Frailty assessment is commonly reserved for the geriatric population and the outpatient setting. The purpose of this review is to discuss the concept of frailty in the acute care setting and its relevance to those in the adult, nongeriatric population.

Description:
This review describes the characteristics of frailty in the acute care setting, the populations most likely to have non-age-related frailty, how current frailty outcome measures can be used in acute care, and the limitations of these assessments of frailty in the acute care setting.

Outcomes:
Frailty is associated with patients of all ages and is closely correlated with patients who have dysfunction of the heart, kidneys, liver, and lungs. Frailty is also associated with oncology-related diagnoses, critical care, multimorbidity, and obesity. Multiple assessments in the literature are aimed at assessing frailty but many are subjective and only valid with specific populations and criteria.

Discussion:
Frailty is a multidimentional clinical diagnosis that is not reserved solely to those older than 65 years. Many diagnoses have been closely linked to frailty. Clinicians across the spectrum need to recognize and assess for frailty, especially in acute care, as discharge planning is a key component in reducing readmissions. Creating and adapting a treatment plan that meets all the necessary domains of fitness, combined with the appropriate intensity and duration, will provide the greatest chance of reversing patients along the continuum from frail to prefrail to nonfrail.
A Method Model Presentation: Online Clinical Mentoring for Physical Therapists Experiencing Professional Isolation
Authors: Westervelt Karen C. , Kunker Katrina , Patel Radha , Smith Elizabeth , Wolitzer Kaylee 
Published: November 2020

Background and Purpose.
Clinical mentoring is essential for the professional development of physical therapists (PTs) and improves confidence and clinical decision making. Physical therapists working in professionally isolated settings with the lack of contact with professional peers face unique challenges, including lack of access to mentors, which can result in diminished job satisfaction, recruitment, and retention. The innovative use of technology, including videoconferencing, can help address the challenges faced by these health care providers by improving access to clinical mentoring. The purpose of this study was to examine the effects of an online model of clinical mentoring on PTs experiencing professional isolation in an outpatient musculoskeletal setting.

Method/Model Description and Evaluation.
Eight professionally isolated and 4 expert PTs were divided into 4 groups. Three 1-hour online case-based mentoring video sessions were held over the course of 5 weeks. Data were collected from pre and postparticipation surveys and postparticipation focus groups. A mixed-methods analysis was used to evaluate data.

Outcomes.
Qualitative results for the mentee group revealed 4 themes: perspective, reflection, perceived clinical benefits, and feasibility. Three themes emerged for the mentor group: accessible model, advancing the profession, and perspective. Quantitative analysis revealed significant improvement in 4 areas of confidence. All participants felt that the intervention supported professional attributes; 75% of participants reported the group size as ideal, and 75% of mentees felt that the program improved both confidence and clinical decision-making skills.

Discussion and Conclusion.
Online clinical mentoring can address several of the barriers faced by PTs who work in professional isolation and allows PTs who would not otherwise have access to postprofessional education to access a mentor remotely.
Effects of ambulatory blood pressure monitoring on sleep in healthy, normotensive men and women
Authors: Gaffey Allison E. , Schwartz Joseph E. , Harris Kristie M. , Hall Martica H. , Burg Matthew M. 
Published: November 2020

ObjectivesTo determine the effect of ambulatory blood pressure monitoring (ABPM) on sleep quality among healthy adults and to explore possible effect modification by demographics.MethodsWe examined data from 192 relatively healthy young (median age: 31; 33% men, 18% with clinic BP >130/80 mmHg) participants in an observational study of sleep and arterial stiffness. Demographic/health questionnaires were completed. A wrist-based accelerometer assessed sleep for seven nights, and sleep duration, wakefulness after sleep onset (WASO), fragmentation (physical restlessness), midpoint, and efficiency were estimated. ABPM was conducted for one 36-h period, including one actigraphy night.ResultsWithin-subject comparisons indicated that WASO and fragmentation were higher, midpoint was later, and efficiency was lower on the ABPM night (Ps < 0.001–0.038). Neither age nor sex moderated these associations. Among older adults, a later midpoint and worse fragmentation were observed with ABPM (Ps = 0.002–0.010). There was also a main effect of sex: men demonstrated shorter sleep duration, greater WASO and fragmentation, and less efficiency than women (Ps = 0.002–0.046). With ABPM, women had worse fragmentation and a later midpoint (Ps = 0.002–0.049); for men, WASO and fragmentation were worse (Ps = 0.003–0.023). Importantly, this study does not address whether the effect of wearing ABPM on sleep in turn affects BP during sleep.ConclusionsABPM appears to modestly disturb actigraphy-assessed sleep among healthy adults. Researchers and clinicians should consider the downstream effects of performing ABPM and whether these effects are more pronounced in those who typically experience sleep disturbance.
Does Ramadan fasting have effects on sleep, fatigue and blood pressure among patients with hypertension?
Authors: Bener Abdülbari , Al-Hamaq Abdulla O.A.A. , Öztürk Mustafa , Güllüoğlu Semih 
Published: November 2020

Aim
The aim of this study was to determine the effect of Ramadan fasting on blood pressure (BP), fatigue, sleeping and physical activity among hypertensive patients.

Subjects and methods
A cross-sectional study was conducted from April 2019 to July 2019. Of the total 1500 hypertensive patients approached, 1118 (74.5%) gave their consent. Data analysis included sociodemographics, lifestyle habits, anthropometric measurements and clinical biochemistry parameters at baseline, and after 3 months.

Results
Out of 1118 subjects, 593(47.6%) were male and 653(52.4%) were female. There were statistically significant differences between males and females regarding age groups in years, educational level, occupational status, income, smoking habits, physical exercise, sports activities and fatigue. There were statistically significant differences for the biochemistry parameters regarding vitamin D, blood glucose, HbA1c level, creatinine, bilirubin, albumin, total cholesterol, triglycerides, HDL-C, LDL-C, uric acid and SBP for both males and females after the holy month of Ramadan as compared to before Ramadan. Also, BMI was significantly lower during the after month of Ramadan as compared to before Ramadan (P < 0.001). Multiple linear regression analysis results revealed that less hours of sleeping (P < 0.001), SBP (mmHg) (P < 0.001), DBP (mmHg) (P < 0.001), family size (P = 0.002), obesity BMI (kg/m2) (P = 0.013), fatigue (P = 0.022) and smoking cigarette (P = 0.029) were identified as statistically significant predictors of hypertensive patients with Ramadan fasting as contributing at higher risk factors.

Conclusion
This study confirmed that fasting during Ramadan has no effect on the BP, blood glucose, HbA1C level, sleep quality, fatigue and BMI among hypertensive patients.
Role of ursodeoxycholic acid on maternal serum bile acids and perinatal outcomes in intrahepatic cholestasis of pregnancy
Authors: Roy Akash , Premkumar Madhumita , Mishra Saurabh , Mehtani Rohit , Suri Vanita , Aggarwal Neelam , Singh Surender , Dhiman Radha Krishna 
Published: November 2020

Aim
Intrahepatic cholestasis of pregnancy (ICP) is associated with safe maternal outcomes but perinatal outcomes have been variable. We assessed clinical factors and impact of bile acid levels on maternal and neonatal outcomes in ICP.

Methods
Patients with ICP (defined as pruritus with serum bile acids ≥ 10 mmol/l) were included prospectively with an assessment of risk factors, modes of delivery as well as maternal and neonatal outcomes. Mild and severe ICP were diagnosed when serum bile acid was always <40 mmol/l and ≥40 mmol/l, respectively. Patients with gestational pruritus served as controls.

Results
Out of 643 patients, 375 patients (mean age 29 ± 7.6 years, 45.8% primigravida) met inclusion criteria. Pregnancy-induced hypertension [PIH: 10.5%; odds ratio (OR): 4.8; 95% confidence interval (CI): 2.4–8.5; P = 0.0014], gestational diabetes (GDM: 12.5%; OR: 2.6; 95% CI: 2.3–4.1; P = 0.045) and spontaneous preterm labor (15.1%; OR: 2.5; 95% CI: 1.2–3.5; P = 0.040) were higher in patients with ICP. Ursodeoxycholic acid (UDCA) (median dose 900 mg; 600–1800 mg) ameliorated symptoms of cholestasis, bile acid levels and liver aminotransferases in 79% cases. When compared with patients with mild ICP, patients with severe ICP presented at a lower gestational period (26 vs. 32 weeks, P = 0.036), required frequent induction (12.5%; OR: 3.2; 95% CI: 2.1–5.6; P = 0.045) and had increased fetal distress (15%; OR: 1.9; 95% CI: 1.3–4.9; P = 0.048).Overall eight stillbirths were recorded.

Conclusion
Severe ICP is associated with a higher incidence of GDM and PIH, risk of pre-term labor, elective induction and stillbirths. UDCA remains a first-line agent in treating ICP.
Patient-reported experience measure in pancreatobiliary endoscopy: a systematic review to highlight areas for improvement
Authors: Apadula Laura , Capurso Gabriele , Arcidiacono Paolo Giorgio 
Published: November 2020

Objective
Increasing attention is paid to measure patient’s experience using specific patient-reported experience measures (PREMs) as tool to assess the overall quality of care provided. The European Society of Gastrointestinal Endoscopy and the United European Gastroenterology have recognized the measure of quality of endoscopy facilities as a priority to provide an adequate service. However, although some studies included patient satisfaction measurement, specific PREMs for gastrointestinal endoscopy are limited, especially in the field of pancreatobiliary endoscopy, with heterogeneous methods and results. This study is aimed at systematically reviewing the literature to summarize the available PREMs for pancreatobiliary endoscopy and to highlight areas of implementation.

Methods
PubMed, Embase and Scopus were searched until February 2020.

Results
The search initially retrieved 1064 articles, but only six were includable. The identified studies employed several methods to measure patient’s experience, with the most frequently used questionnaires being Gastrointestinal Endoscopy Satisfaction Questionnaire and Group Health Association of America-9. The following areas that need implementation were identified: (a) evaluation of pain is one of the most investigated areas but seems marginal, as most pancreatobiliary endoscopic procedures are performed under deep sedation; (b) endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography are considered as a whole, but they have very different indication and contexts (e.g. inpatients or outpatients); (c) ‘experience’ and ‘satisfaction’ are wrongly considered as synonyms; (d) the optimal modality and timing of questionnaire administration are unclear.

Conclusion
There are few tools to measure PREMS in pancreatobiliary endoscopy with several limitations. We have, therefore, started the process of building a specific PREM tool for pancreatobiliary EUS.
Anxiety and depression in patients with Barrett’s esophagus: estimates of disorder rates and associations with symptom load and treatment-seeking
Authors: Treml Julia , Kreuser Nicole , Gockel Ines , Kersting Anette 
Published: November 2020

Background
Patients with Barrett’s esophagus (BE) may experience psychological burden from living with a chronic medical condition, which has been identified as the most important risk factor for esophageal adenocarcinoma. The aim of this study was to estimate rates of depression and anxiety in a large sample of patients with BE.

Methods
A total of 794 patients with endoscopically and histologically confirmed diagnosis of BE completed validated screening instruments for depression (Patient Health Questionnaire-9) and anxiety (Generalized Anxiety Disorder-7). Screening rates in the study sample were compared to general population estimates. Multivariable regression analyses were used to model associations between outcome variables and respondents’ sociodemographic characteristics, BE-related symptom load and incidence of inpatient treatment due to BE in the last 12 months.

Results
Rates of positive screens were 14.2% for depression and 9.9% for anxiety. For several age by sex subgroups, rates of depression and anxiety were about three to five times higher in the study sample than in the general population. BE-related reflux and pain symptoms showed strong associations with higher levels of depressive and anxiety symptoms, while the effect of treatment was small.

Conclusion
Study results indicate that a relevant proportion of patients with BE is at an increased risk for depression and anxiety, compared to general population controls. Lacking information on patients’ disease characteristics limited generalizability of results.
The prevalence of nodular regenerative hyperplasia of the liver in long-term thiopurine-treated inflammatory bowel disease patients
Authors: Gilissen Lennard P.L. , Tajzai Rudaba , Romberg Marielle , Pierik Marieke , Stronkhorst Arnold , Steenhuisen Karin , Van Bodegraven Ad , Daniels Alette , Wong Dennis 
Published: November 2020

Introduction
Nodular regenerative hyperplasia (NRH) has been associated with thiopurine therapy in patients with inflammatory bowel disease (IBD), but prevalence and prognosis of NRH remain unclear. This study is a cross-sectional search for NRH in IBD patients with long-term azathioprine or 6-mercaptopurine treatment.

Material and methods
Thirty-three IBD patients with continuous azathioprine/6-mercaptopurine treatment for at least 5 years were included. Laboratory tests, thiopurine metabolite levels, liver histology, MRI were examined for NRH and signs of portal hypertension.

Results
NRH was not observed in this cohort of 33 patients. Nevertheless, some possibly related signs of vascular changes were found by MRI in three patients. Also, splenomegaly, which may be associated with portal hypertension, was found in one patient. No high thiopurine dose neither high metabolite levels were found in these patients.

Conclusion
No NRH was found in this group of IBD patients with long-term azathioprine/6-mercaptopurine treatment. Larger multicenter studies are needed to determine the prevalence of NRH in thiopurine-treated IBD patients.
Endoscopic full thickness resection in the colo-rectum: outcomes from the UK Registry
Authors: Boger Philip , Rahman Imdadur , Hu Maxworth , Ayaru Laksh , Bhandari Pradeep , Chedgy Fergus , Green Susi , Hayat Mumtaz , Hopper Andrew D. , Ishaq Sauid , Martin John , McCallum Iain , Phull Perminder , Pugh Stirling , Russo Evangelos , Suzuki Noriko , Thomas-Gibson Siwan , Zeino Zeino , Patel Praful 
Published: November 2020

Background
Endoscopic full-thickness resection (eFTR) of the colon using the full-thickness resection device (FTRD) is a novel method for removing lesions involving, or tethered to, deeper layers of the colonic wall. The UK FTRD Registry collected data from multiple centres performing this procedure. We describe the technical feasibility, safety and early outcomes of this technique in the UK.

Methods
Data were collected and analysed on 68 patients who underwent eFTR at 11 UK centres from April 2015 to June 2019. Outcome measures were technical success, procedural time, specimen size, R0 resection, endoscopic clearance, and adverse events. Reported technical difficulties were collated.

Results
Indications for eFTR included non-lifting polyps (29 cases), T1 tumour resection (13), subepithelial tumour (9), and polyps at the appendix base or diverticulum (17). Target lesion resection was achieved in 60/68 (88.2%). Median specimen size was 21.7 mm (10–35 mm). Histologically confirmed R0 resection was achieved in 43/56 (76.8%) with full-thickness resection in 52/56 (92.9%). Technical difficulties occurred in 17/68 (25%) and complications in 3/68 (5.9%) patients.

Conclusion
eFTR is a useful technique with a high success rate in treating lesions not previously amenable to endoscopic therapy. Whilst technical difficulties may arise, complication rates are low and outcomes are acceptable, making eFTR a viable alternative to surgery for some specific lesions.