bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcomes of Pseudophakic, Phakic, and Triple DMEK
Authors: Moshiri Isabella , Karimi-Golkar Damian , Schrittenlocher Silvia , Cursiefen Claus , Bachmann Björn 
Published: April 2021

Purpose:
To evaluate the outcome of phakic and pseudophakic eyes treated by Descemet membrane endothelial keratoplasty (DMEK) versus DMEK combined with cataract surgery (triple DMEK).

Methods:
Retrospective cohort study based on the prospective Cologne DMEK data base. This study is a single-center analysis of 62 eyes undergoing phakic (age mean ± SD 52 ± 6.43), 518 eyes undergoing pseudophakic (73.5 ± 8.57), and 557 eyes undergoing triple DMEK (67.93 ± 8.57). Outcome measures were changes in best spectacle-corrected visual acuity (BSCVA), central corneal thickness, endothelial cell density (ECD), rebubbling rates within the first year after surgery, and the need for cataract surgery within the first 2 years after phakic DMEK.

Results:
The preoperative BSCVA (mean ± SD; logarithm of the minimum angle of resolution) was 0.30 ± 0.22 in the phakic, 0.63 ± 0.45 in the pseudophakic, and 0.44 ± 0.30 in the triple DMEK group (P < 0.001), which changed to 0.09 ± 0.12, 0.14 ± 0.1, and 0.1 ± 0.1 (P < 0.001) 1 year after surgery, respectively. There was no difference in central corneal thickness (P = 0.929) and endothelial cell density (P = 0.606) 1 year postoperatively. Rebubbling rates in DMEK using SF6 20% for anterior chamber tamponade were not significantly different (P = 0.839). After phakic DMEK, 40% of eyes underwent cataract surgery within the second year. However, there was a high loss to follow-up in this group.

Conclusions:
Phakic and triple DMEK procedures tend to have a better 1-year BSCVA than pseudophakic DMEK, with no differences in all other parameters analyzed. However, patients from the pseudophakic DMEK group were older and already had worse BSCVA before surgery.
One-Year Front Versus Central and Paracentral Corneal Changes After Bowman Layer Transplantation for Keratoconus
Authors: Tourkmani Abdo K. , Mohammad Tariq , McCance Eleanor , Potts James , Ford Richard , Anderson David F. 
Published: April 2021

Purpose:
To report the front corneal versus central and paracentral corneal changes after Bowman layer transplantation for keratoconus in a tertiary hospital in the United Kingdom.

Methods:
Five eyes of 5 patients receiving Bowman layer transplant for advanced keratoconus in Royal Gwent Hospital (Newport, United Kingdom) were included. Preoperative and postoperative visual acuity; Kmax; Kmean, and corneal cylinder in the front cornea, 4.5 mm central, and 6 mm central; and corneal thickness were analyzed.

Results:
Corneal flattening and reduction in corneal astigmatism was observed, more marked in the central and paracentral zone, allowing for improvement in best-corrected visual acuity with the aid of visual correction in 4 eyes.

Conclusions:
These results support previous data reporting Bowman layer transplantation as a useful strategy in the treatment of advanced keratoconus and suggest greater attention may be focused on central or paracentral corneal changes.
Bowman Layer Onlay Grafting: Proof-of-Concept of a New Technique to Flatten Corneal Curvature and Reduce Progression in Keratoconus
Authors: Dapena Isabel , van der Star Lydia , Groeneveld-van Beek Esther A. , Quilendrino Ruth , van Dijk Korine , Parker Jack S. , Oellerich Silke , Melles Gerrit R. J. 
Published: April 2021

Purpose:
The aim of this study was to describe a new surgical technique for flattening the corneal curvature and to reduce progression in eyes with advanced progressive keratoconus (KC) by using Bowman layer (BL) onlay grafting and to report on the preliminary outcomes of this procedure.

Methods:
In this prospective interventional case series, 5 patients with advanced progressive KC underwent BL onlay grafting. After removal of the epithelium, a BL graft was placed and “stretched” onto the stroma, and a bandage lens was placed to cover the BL graft. In 1 case, BL onlay grafting could be performed immediately after ultraviolet corneal crosslinking; all other eyes were ineligible for ultraviolet corneal crosslinking. Best spectacle- and/or best contact lens–corrected visual acuity, refraction, biomicroscopy, corneal tomography, anterior segment optical coherence tomography, and complications were recorded at 1 week and at 1, 3, 6, 9, and 12 to 15 months postoperatively.

Results:
All 5 surgeries could be performed successfully. Average maximum keratometry went from 75 diopters (D) preoperatively to 70 D at 1 year postoperatively. All eyes showed a completely reepithelialized and a well-integrated graft. Best spectacle-corrected visual acuity improved at least 2 Snellen lines (or more) in 3 of 5 cases and best contact lens–corrected visual acuity remained stable, improving by 3 Snellen lines in case 1 at 15 months postoperatively. Satisfaction was high, and all eyes again had full contact lens tolerance.

Conclusions:
BL onlay grafting may be a feasible surgical technique, providing up to −5 D of corneal flattening in eyes with advanced KC.
Granulicatella adiacens Infective Endocarditis Treated With Teicoplanin and Ceftriaxone: A Case Report
Authors: Tang Min , Zhou Hongji , Zhang Ju , Peng Fengying , Sumayyah Golamaully , Jia Bei 
Published: April 2021

Abstract
We describe a case of infective endocarditis (IE) caused by Granulicatella adiacens in a patient who had fever for 4 months before admission. He had a complex medical history of active hyperthyroidism and schizophrenia, which might have misled the clinician in ignoring the existence of a serious infection like IE. A history of splenectomy and the likelihood of congenital cardiac valve deficiency were the possible underlying risk factors. His persistent leukocytosis perplexed our judgement in terms of resolution of infection and treatment efficacy, which was probably due to his splenectomy. C-reactive protein was the alternative laboratory indicator. Clinical and Laboratory Standards Institute criteria have not been established for the fastidious G. adiacens. Therefore, we referred to the viridans group streptococci and literature to evaluate antimicrobial susceptibility testing. We suggest that teicoplanin combined with ceftriaxone could serve as an effective therapy for IE caused by G. adiacens.
Seizure in Children Under Five Presenting With Pneumonia in a Critical Care Ward in Bangladesh: Prevalence, Associated Factors, and Outcome
Authors: Chisti Mohammod Jobayer , Sarker Shafiqul Alam , Shahunja KM , Shahid Abu Sadat Mohammad Sayeem Bin , Sharifuzzaman  , Hasan Md Imran , Nuzhat Sharika , Kabir Md Farhad , Afroze Farzana , Alam Tahmina , Shahrin Lubaba , Ahmed Tahmeed 
Published: April 2021

Background:Pneumonia is the leading infectious cause of deaths in children under 5 for the last few decades. Development of seizure in those children is common and associated with increased risk of deaths. We therefore investigated the prevalence, associated factors and outcome of seizure in children hospitalized with pneumonia.Methods:We conducted a retrospective chart analysis in the intensive care unit of the Dhaka Hospital of icddr,b. Children under 5 with World Health Organization (WHO) classified clinical (excluding seizure as 1 of the clinical diagnostics) and radiologic pneumonia, admitted to the intensive care unit at Dhaka Hospital of icddr,b between August 2013 and December 2017 were analyzed. We initially identified the children with pneumonia who had seizure. For comparison, we have taken 2 folds randomly selected controls from rest of the children with pneumonia having no seizure. Prevalence and outcome of children with pneumonia and seizure were measured. Factors associated with seizure in children with pneumonia compared with those without seizure were also identified. Seizure was characterized by sudden, violent, involuntary, and abnormal repetitive movements with or without loss or impairment of consciousness confirmed by attending physician.Results:Among a total of 4101 children with pneumonia, 514 (12.5%) had seizure. Compared with children with pneumonia alone children having pneumonia and seizure more often developed respiratory failure (18% vs. 3%,P < 0.001) and died (13% vs. 3%,P < 0.001) during hospitalization. In logistic regression analysis hypoxemia (95% CI: 1.59–3.17,P < 0.001), severe pneumonia (95% CI: 2.13–6.52,P < 0.001), severe sepsis (95% CI: 1.30–2.88,P = 0.001), and hypernatremia (95% CI: 5.31–10.93,P < 0.001) were found to be independent risk factors for seizure. On the contrary, children with pneumonia having seizure were less likely to have severe acute malnutrition (95% CI: 0.26–0.50,P < 0.001).Conclusions:Early identification of risk factors for seizure in children with pneumonia may be helpful for clinicians to promptly treat them and therefore may have potential to reduce deaths in those children especially in resource limited settings.
A Case of Streptococcus intermedius Abscess Within a Malignant Neck Mass and Review of the Literature
Authors: Cummins Kaelyn C. , Lin Doris 
Published: April 2021

Abstract

Streptococcus intermedius is an organism found commensally in various mucosal sites. Over the past couple decades, it has been recognized as a cause of severe pyogenic infections in sites including the brain, liver, lung, head and neck. Here, we describe an uncommon case of S. intermedius infection in a patient with tonsillar squamous cell carcinoma and a metastatic neck mass with overlying postradiation skin changes. We also review the literature on this pathogen in cancer patients because it remains understudied despite its pathogenicity.
Scrub Typhus With Secondary Hemophagocytic Lymphohistiocytosis
Authors: Jayachandran Akshaya , Sundaresan Durgadevi , Pannu Ashok Kumar , Ahluwalia Jasmina , Chinnadurai Krishna Kumar , Saroch Atul 
Published: April 2021

Abstract
Scrub typhus is a rickettsial disease transmitted to humans by arthropods, via the bite of larval mites (chiggers). A young man, aged 18 years admitted with the fever of 5 days and altered sensorium for 1 day. The patient was evaluated for tropical illness with encephalopathy and multiorgan dysfunction syndrome. Patient serology was positive for scrub typhus and fulfill requisite criteria (hemophagocytic lymphohistiocytosis [HLH]-2004) for secondary HLH. He was managed as scrub typhus with secondary HLH and was given dexamethasone 4 mg three times a day. Patient condition improved and discharged with normal vital.
An Unusual Malady of the Bladder
Authors: Carroll Maggie , Hum Jamie , Pereira Marcus , Miko Benjamin , Pagan Carlos , D'Ovidio Frank , Cooper Kimberly , Arcasoy Selim M. 
Published: April 2021

Abstract
Malakoplakia is a rare disease most commonly found in the immunocompromised host and is diagnosed via tissue sampling. Delayed diagnosis is often the result of its nonspecific presentation. The patient described presented with dysuria, urinary urgency, and frequency in the setting of recurrent urinary tract infections despite antimicrobial therapy. After further evaluation including direct visualization with cystoscopy and tissue sampling, the patient was diagnosed with Malakoplakia of the bladder. With reduction in immunosuppression and prolonged antimicrobial therapy, the patient improved.
Immune Reconstitution Inflammatory Syndrome Presenting as Mycobacterium avium Complex Cervical Lymphadenitis and Mycobacterium kansasii Pulmonary Disease in an HIV-Infected Patient
Authors: Martinez Oscar , Jarrin Claudia 
Published: April 2021

Abstract
Immune reconstitution syndrome (IRIS) is a known complication from antiretroviral therapy that can occur in response to a pathogen, host, and/or treatment factors. Its presentation is heterogeneous and can pose a significant treatment challenge. Opportunistic infections presenting as IRIS can occur under settings, such as immunosuppression secondary to tumor necrosis factor inhibitors, untreated HIV starting antiretroviral therapy, hematopoietic stem cell, and solid organ transplant once immunosuppression is removed (HIV AIDS (Auckl). 2015;7:49–64).
The most common nontuberculous mycobacteria (NTM) to cause disease in advanced HIV is Mycobacterium avium complex. This pathogen can manifest during IRIS-causing focal disease, presenting as localized lymphadenopathy, or disseminated disease, with constitutional symptoms (Clin Microbiol Rev. 1996;9(2):177–215). Mycobacterium kansasii is the second most common NTM, to affect the lungs, and can also cause disseminated disease. We present a case of IRIS in an HIV-1–infected patient with evidence of 2 NTM-causing diseases.
Why Is a Child Not a Miniadult for Infections?
Authors: Chappell M. Tresa , Kelly Carrie , Rosenthal Ken S. 
Published: April 2021

Abstract
The presentation of an infectious disease in a child is likely to differ from an adult and will differ at different ages of the child. In addition to differences in immune response, there are significant differences in anatomy, physiology, metabolism, and behavior that affect susceptibility, course of disease, severity, and treatment. This is the first of a series of reviews that examine differences in disease presentation for different demographics. This short review will look at some of the parameters that ask, “Why is a child not a miniadult for infections?”
Early Use of Remdesivir in Patients Hospitalized With COVID-19 Improves Clinical Outcomes
Authors: Paranjape Neha , Husain Mir , Priestley Jennifer , Koonjah Yashila , Watts Christopher , Havlik Joseph 
Published: April 2021

Background
Remdesivir treatment, like most antiviral drugs, is likely to be most effective when used early in the course of coronavirus disease 2019 (COVID-19). Optimal timing of remdesivir for the treatment of COVID-19 remains unclear.

Objectives
The aim of this study was to determine whether early treatment with remdesivir improves clinical outcomes: length of stay, need for mechanical ventilation, and death.

Methods
We conducted a retrospective observational study of patients hospitalized with COVID-19 who received remdesivir therapy within 10 days of symptom onset at a large health system in Georgia, United States.

Results
We identified a total of 475 patients. Initiation of therapy 3 days or less from first positive SARS-CoV-2 improved length of stay (15.7 days) compared with those started on therapy more than 3 days after a positive test (19.3 days) (P = 0.03). In the ≤3 day group, further reduction in length of stay was seen in those with lower oxygen requirement at baseline (P < 0.0001). Length of stay was lower in the ≤3 day group both with and without the use of corticosteroids (P = 0.0003). The odds of requiring mechanical ventilation were higher for the >3 day group compared with the ≤3 day group (odds ratio, 1.5; 95% confidence interval, 0.8–2.7), and the odds of death were higher for the >3 day group versus the ≤3 day group (odds ratio, 1.74; 95% confidence interval, 0.9–3.2).

Conclusions
Our data show that early treatment with remdesivir in patients hospitalized with COVID-19 shortened length of stay.
Research approaches for evaluating opioid sparing in clinical trials of acute and chronic pain treatments: Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials recommendations
Authors: Gewandter Jennifer S. , Smith Shannon M. , Dworkin Robert H. , Turk Dennis C. , Gan Tong J. , Gilron Ian , Hertz Sharon , Katz Nathaniel P. , Markman John D. , Raja Srinivasa N. , Rowbotham Michael C. , Stacey Brett R. , Strain Eric C. , Ward Denham S. , Farrar John T. , Kroenke Kurt , Rathmell James P. , Rauck Richard , Brown Colville , Cowan Penney , Edwards Robert R. , Eisenach James C. , Ferguson McKenzie , Freeman Roy , Gray Roy , Giblin Kathryn , Grol-Prokopczyk Hanna , Haythornthwaite Jennifer , Jamison Robert N. , Martel Marc , McNicol Ewan , L. Oshinsky Michael , Sandbrink Friedhelm , Scholz Joachim , Scranton Richard , Simon Lee S. , Steiner Deborah , Verburg Kenneth , Wasan Ajay D. , Wentworth Kerry 
Published: April 2021

Abstract
Randomized clinical trials have demonstrated the efficacy of opioid analgesics for the treatment of acute and chronic pain conditions, and for some patients, these medications may be the only effective treatment available. Unfortunately, opioid analgesics are also associated with major risks (eg, opioid use disorder) and adverse outcomes (eg, respiratory depression and falls). The risks and adverse outcomes associated with opioid analgesics have prompted efforts to reduce their use in the treatment of both acute and chronic pain. This article presents Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) consensus recommendations for the design of opioid-sparing clinical trials. The recommendations presented in this article are based on the following definition of an opioid-sparing intervention: any intervention that (1) prevents the initiation of treatment with opioid analgesics, (2) decreases the duration of such treatment, (3) reduces the total dosages of opioids that are prescribed for or used by patients, or (4) reduces opioid-related adverse outcomes (without increasing opioid dosages), all without causing an unacceptable increase in pain. These recommendations are based on the results of a background review, presentations and discussions at an IMMPACT consensus meeting, and iterative drafts of this article modified to accommodate input from the co-authors. We discuss opioid sparing definitions, study objectives, outcome measures, the assessment of opioid-related adverse events, incorporation of adequate pain control in trial design, interpretation of research findings, and future research priorities to inform opioid-sparing trial methods. The considerations and recommendations presented in this article are meant to help guide the design, conduct, analysis, and interpretation of future trials.
Classification of chronic pain for the International Classification of Diseases (ICD-11): results of the 2017 international World Health Organization field testing
Authors: Barke Antonia , Korwisi Beatrice , Jakob Robert , Konstanjsek Nenad , Rief Winfried , Treede Rolf-Detlef 
Published: April 2021

Abstract
Because chronic pain has been poorly represented in the International Statistical Classification of Diseases and Related Health Problems (ICD) despite its significant contribution to the burden of disease worldwide, the International Association for the Study of Pain (IASP) developed a classification of chronic pain that was included in the ICD-11 version as “MG30” and approved by the World Health Assembly in 2019. The objective of this field test was to determine how well the classification of chronic pain works in the context of the ICD-11. A web-based survey using the WHO-FiT platform recruited 177 healthcare professionals from all WHO regions. After a training on coding chronic pain hosted by the IASP Web site, participants evaluated 18 diagnostic codes (lines) of the 2017 frozen version of the ICD-11 and 12 vignettes (cases) describing chronic pain conditions. Correctness, ambiguity, and perceived difficulty of the coding were compared between the ICD-11 and the ICD-10 and the applicability of the morbidity rules for the ICD-11 verified. In the line coding, 43.0% of correct chronic pain diagnoses assigned with the ICD-10 contrasted with 63.2% with the ICD-11. Especially in cases in which the chronic pain is regarded as the symptom of an underlying disease, the ICD-11 (63.5%) commanded more correct diagnoses than the ICD-10 (26.8%). The case coding was on average 83.9% accurate, only in 1.6% of cases any difficulty was perceived. The morbidity rules were applied correctly in 74.1% of cases. From a coding perspective, the ICD-11 is superior to the ICD-10 in every respect, offering better accuracy, difficulty, and ambiguity in coding chronic pain conditions.
Effect of intraoperative methadone vs other opioids on postoperative outcomes: a meta-analysis of randomized controlled studies
Authors: Cheriyan Thomas , Gaber Mohamed , Glenn Taylor , Latremouille John , Loy Kayla L. , Cheriyan Jerry , Dua Anterpeet , Singh Paramvir , Kumar Vikas , Omran Mohamed Ben 
Published: April 2021

Abstract
Recent randomized controlled trials comparing the efficacy between intraoperative methadone and other opioids on postoperative outcomes have been limited by their small sample sizes and conflicting results. We performed a meta-analysis on randomized controlled trials which investigated outcomes between methadone and an opioid control group. Primary outcome data included postoperative opioid consumption, number of patients who received postoperative opioids, time to first analgesic, and pain scores. Secondary outcomes included time to extubation and incidence of nausea, vomiting, and respiratory depression. Statistical analysis was performed using RevMan. A P < 0.05 was considered statistically significant. Nine studies comprising 632 patients were included. There was no statistically significant reduction in opioid consumption postoperatively between the groups. Forty-seven percentage of patients in the methadone group received a dose of opioid postoperatively compared with 55% in the other opioids control group, which was not statistically significant. (P = 0.25) There was no difference in average time to receiving first postoperative analgesic among the groups. Pain scores within 24 hours were significantly lower in the methadone group when compared with other opioids (8 studies, n = 622, −0.49 [−0.74, −0.23], P = 0.002). However, there was no difference between 24 and 72 hours. There was no difference among the groups with respect to extubation time, nausea, vomiting, or respiratory depression. This meta-analysis concludes that there is currently insufficient evidence for the use of intraoperative methadone, when compared with other opioids. Although there was a decrease in average pain scores with methadone when compared with controls at 24 hours, there was no difference between 24 and 72 hours.
Clinical and economic burden of prescribing tramadol and other opioids for patients with osteoarthritis in a commercially insured population in the United States
Authors: Silverman Stuart , Rice J. Bradford , White Alan G. , Beck Craig G. , Robinson Rebecca L. , Fernan Catherine , Schepman Patricia 
Published: April 2021

Abstract
In 2019, the American College of Rheumatology conditionally recommended tramadol and conditionally recommended against nontramadol opioids for patients with hip and knee osteoarthritis. Although tramadol is known to be less prone to opioid use disorders, little is known about the differing magnitude of negative clinical outcomes, health care resource utilization, and costs of tramadol relative to nontramadol opioids. Administrative claims records for commercially insured patients with osteoarthritis who were prescribed opioids were used to compare clinical and cost outcomes during a 3-year follow-up period by conducting a pre–post analysis and a matched case–cohort analysis. Data for 14,491 patients were analyzed: 4048 (28%) were initiated on tramadol, and 10,443 (72%) were initiated on nontramadol opioids. After matching, 4048 patients per cohort were analyzed. In each empirical analysis, tramadol patients did develop opioid use disorders; however, opioid use disorder rates were 3.5-fold higher in the nontramadol cohort (1.2% vs 4.2%). In addition, rates of other opioid-related clinical outcomes (falls, fractures, nausea, fatigue, and constipation) were also directionally lower among the tramadol cohort, although quantitatively similar (<5% difference) to the nontramadol cohort. Finally, in both analyses, the nontramadol cohort incurred higher levels of inpatient and emergency department visits and all-cause costs during the 3-year follow-up period. However, tramadol patients incur a higher incremental change (+$24,013) in costs relative to their pretreatment baseline compared with nontramadol (+$18,191). These real-world findings demonstrated lower risks with tramadol relative to other opioids, albeit risks and increased health care costs were present with tramadol, highlighting the need for further strategies to improve outcomes.