bluuebunny/crossref_metadata_2025_split huggingface dataset:
851 Self-Medication with Caffeine for 31 Years: A Case of Undiagnosed Childhood Narcolepsy Type II
Authors: Seydou Moustapha Doulaye , Karime Christian , Wyrick Brenda , Khan Amir 
Published: May 2021

Abstract

Introduction
Narcolepsy represents a relatively rare chronic neurological sleep disorder. While peak incidence occurs in adolescence and early-adulthood, reports indicate a substantial number of children under 10 remain undiagnosed or are misdiagnosed. The present case describes a female with undiagnosed narcolepsy type II self-medicating with caffeinated beverages from the age of 7.

Report of case(s)
A 40-year-old female presented at our clinic with excessive daytime fatigue and hypersomnolence despite adequate sleep (Epworth sleepiness scale= 16/24). The patient denied snoring, sleep paralysis, catalepsy, and hypnagogic/hypnopompic hallucinations. Symptoms began at the age of 7 and steadily worsened, with teachers reporting significant concentration difficulties and multiple episodes of unintentional sleep onset in the classroom. The patient reported heavily relying on caffeinated beverages from the age of 7 to remain awake and focused on classroom activities. Starting at the age of 7, the patient consumed on average a caffeine-equivalent of 1 espresso shot/day (64mg caffeine/day). This increased to 4–6 espresso shots/day (256-384mg caffeine/day) by the age of 12 and 5–9 espresso shots/day (320-576mg caffeine/day) by the age of 18. At the age of 25, the patient developed severe anxiety with panic attacks and episodes of suicidal ideation. With multiple episodes of sleep onset while operating a motor vehicle, a near-accident prompted medical evaluation. Diagnosed with general anxiety disorder and idiopathic hypersomnolence, escitalopram and armodafinil were started with limited effect. The patient continued self-medicating with caffeinated beverages until age 38 when she was diagnosed with narcolepsy type II. Sodium oxybate was subsequently added to her treatment plan with initial sleep benefit and caffeine reduction. A repeat mean sleep latency test confirmed narcolepsy type II (mean sleep latency= 3 minutes, mean rapid eye movement [REM] sleep latency= 3 minutes). Polysomnography was later performed due to non-resolving symptoms, revealing mild obstructive sleep apnea (REM apnea-hypopnea index= 13.5/hour). Continuous positive airway pressure was added to the treatment regime with significant sleep benefit.

Conclusion
We describe a case of undiagnosed childhood narcolepsy type II necessitating significant caffeine consumptions in order to maintain classroom performance. With known anxiety-provoking effects of caffeine, the case highlights the importance of addressing childhood narcolepsy.
Support (if any):
857 Too sleepy: A pediatric case of Prader Willi Syndrome and Narcolepsy
Authors: Lam Elizabeth , Malhotra Sonal , Glaze Daniel 
Published: May 2021

Abstract

Introduction
Prader Willi syndrome (PWS) is a genetic disorder due to deletion of the paternal copies of genes within the chromosome region 15q11-q13. Individuals with PWS are commonly seen with obesity, sleep disordered breathing, and excessive daytime sleepiness (EDS). While the exact cause of EDS in individuals with PWS is not fully understood, there have been reports of PWS with narcolepsy-like syndrome. We report a case of a patient with PWS with findings suggesting the diagnosis of Narcolepsy Type 2.

Report of case(s)
Our patient is a 12-year-old male with PWS and 2nd degree heart block who was evaluated in our pediatric sleep center. He has a previous diagnosis of mild obstructive sleep apnea (OSA) with an apnea hypopnea index (oAHI) of 3.2. At 12 years of age, mother and patient reported that he had increased snoring, weight gain, EDS with a Pediatric Daytime Sleepiness Score (PDSS) of 10 and frequent refreshing naps during the daytime. Patient denied cataplexy during that visit. Subsequently, 2-week actigrapghy was performed which demonstrated an average total night sleep of 8 hours and 8 minutes. Overnight PSG with Multiple Sleep Latency Test (MSLT) demonstrated an oAHI of 4.8, total sleep time of 6.88 hours. During the MSLT, the mean sleep latency was 6.2 minutes and 5 sleep onset REM periods were observed over 5 nap opportunities. At his follow-up visit, methylphenidate was initiated after clearance by his cardiologist. Patient and mother opted for medical management of his mild OSA with Fluticisone and Montelukast. At his follow-up appointment, the patient had improvement in daytime sleepiness with a PDSS of 2 despite taking his Methylphenidate at night. Patient was instructed to switch to morning Methylphenidate dosing to optimize treatment of his EDS.

Conclusion
EDS is a common complaint seen in patients with PWS, however the etiology of it is not entirely understood. It is thought to be centrally mediated with components of hypersomnia and narcolepsy like-symptoms. More research is needed to better understand, diagnose and adequately treat patients with PWS and EDS.
Support (if any):
Sleep deprivation impairs binding of information with its context
Authors: Kurinec Courtney A , Whitney Paul , Hinson John M , Hansen Devon A , Van Dongen Hans P A 
Published: May 2021

AbstractBinding information to its context in long-term memory is critical for many tasks, including memory tasks and decision making. Failure to associate information to its context could be an important aspect of sleep deprivation effects on cognition, but little is known about binding problems from being sleep-deprived at the time of encoding. We studied how sleep deprivation affects binding using a well-established paradigm testing the ability to remember auditorily presented words (items) and their speakers (source context). In a laboratory study, 68 healthy young adults were randomly assigned to total sleep deprivation or a well-rested control condition. Participants completed an affective item and source memory task twice: once after 7-hour awake during baseline and again 24 hours later, after nearly 31 hours awake in the total sleep deprivation condition or 7 hours awake in the control condition. Participants listened to negative, positive, and neutral words presented by a male or female speaker and were immediately tested for recognition of the words and their respective speakers. Recognition of items declined during sleep deprivation, but even when items were recognized accurately, recognition of their associated sources also declined. Negative items were less bound with their sources than positive or neutral items, but sleep deprivation did not significantly affect this pattern. Our findings indicate that learning while sleep-deprived disrupts the binding of information to its context independent of item valence. Such binding failures may contribute to sleep deprivation effects on tasks requiring the ability to bind new information together in memory.
High light-induced photoinhibition is not limiting seedling establishment at abrupt treeline ecotones in New Zealand
Authors: Döweler Fabian , Case Bradley S , Buckley Hannah L , Bader Martin K-F 
Published: May 2021

Abstract
Seedlings of New Zealand’s treeline-forming Fuscospora cliffortioides (Hook.f.) perform poorly beyond the established canopy, limiting treeline advance. To test the long-standing assumption that photoinhibition impairs regeneration in the subalpine belt of New Zealand’s Southern Alps, we assessed photosystem II (PSII) performance of seedling-sized individuals and microclimate variation. We performed diurnal, non-invasive chlorophyll-a-fluorescence measurements on exposed and canopy-sheltered individuals at two sites in New Zealand’s Southern Alps during summer and winter. Diurnal recordings of the effective (ΦPSII) and optimal (Fv/Fm) photosynthetic quantum yield were supplemented with light response curves and micro-temperature recordings. ΦPSII returned to near-optimal values around 0.8 after 30 min of shading, which rules out accumulative or long-term photoinhibition effects. The maximum electron transport rate derived from rapid light curves was significantly higher (+12%) in exposed compared with canopy-shaded individuals. Summer temperature fluctuated widely on the scree (−0.5 to 60.5 °C) and near seedlings (−2 to 26.5 °C). Our results revealed a remarkable level of light adaptation and contradict previous studies hinting at high light-induced photoinhibition as a treeline-limiting factor in the Southern Alps. By linking low ΦPSII on winter mornings, and large, sudden temperature drops in summer, we suspect that cold-induced photoinhibition might occur but the rapid recovery of ΦPSII seen across a wide temperature range makes lethal photo-oxidative damage rather unlikely. Given the demonstrably low summer frost tolerance of F. cliffortioides, cold-related damage resulting from frost events during the growing season or embolism induced by frost drought may offer more plausible explanations for the poor seedling establishment. Duration and frequency of these events could diminish with global warming, which may promote treeline advance.
Rotavirus Diarrhoea among Children Aged &lt;5 Years in Hospital Setting in Dar Es Salaam, Tanzania
Authors: Nalitolela Neema , Kisenge Rodrick , Mkopi Namala Patrick , Manji Karim 
Published: May 2021

Abstract

Background
Diarrhoea remains among the highest causes of death in children under 5 years of age in developing countries. Before the introduction of rotavirus vaccine in Tanzania, rotavirus infection was the leading cause of severe diarrhoea in children below the age of 5 years but there is a paucity of studies reporting the severity of this infection after the introduction of rotavirus vaccine. This hospital-based study reports the proportion of children with rotavirus-associated diarrhoea in Dar es Salaam, its severity and associated factors.

Methods
A hospital-based cross-sectional study was conducted at the inpatient and outpatient paediatrics departments of the selected health facilities from September 2018 to February 2019. A total of 314 children meeting inclusion criteria were enrolled into the study. A structured questionnaire was used to collect demographic and medical history, anthropometric measurements were taken and a stool sample was collected from each patient for rotavirus antigen detection using CTK Biotech Onsite rotavirus antigen rapid test

Results
A total of 314 children were included in the study with age range between 2 and 59 months. The median age was 12 months with an interquartile range of 8–19 months. Symptoms of rotavirus diarrhoea were vomiting (p-value = 0.018) and severe dehydration (p-value = 0.000). Independent associated factors of rotavirus diarrhoea included: age of mother between 35 and 49 years (AoR 4.1, 95% CI 1.0–17.1, p-value = 0.05), geographical distribution (Ilala District, AoR 4.0, 95% CI 1.1–10.4, p-value = 0.039), poor hand hygiene (AoR 8.5, 95% CI 2.6–28.1, p-value = 0.000) and drinking bottled/home-treated water (AoR 5.4, 95% CI 1.3–22.7, p-value = 0.02).

Conclusion
Rotavirus infection is still prevalent and severe among children with diarrhoea. The difference in prevalence among the districts is also of concern and hence larger community-based cohort studies are needed to assess the association of rotavirus diarrhoea with the geographical variation across districts and regions. Improving sanitation and hygiene through health education amongst households is crucial for disease prevention.
Mineralized-tissue histology reveals protracted life history in the Pliocene three-toed horse from Langebaanweg (South Africa)
Authors: Nacarino-Meneses Carmen , Chinsamy Anusuya 
Published: May 2021

Abstract
We studied the bone and dental histology of the tri-dactyl equid Eurygnathohippus hooijeri, one of the most iconic mammals found at the world-renowned Pliocene site of Langebaanweg, South Africa, to reconstruct important features of its life history. Our results show that key life-history events, such as weaning, skeletal maturity and reproductive maturity, occurred later in this African hipparionine compared with European three-toed equids and several extant Equus. Its late life-history schedule agrees with an ecological context of low adult extrinsic mortality and low juvenile survival rates. We also observed high rates of bone growth in Eu. hooijeri that were probably achieved through a high-quality diet and plentiful available water. Our research highlights the significance of combining bone and dental histology in the same taxon to obtain refined palaeobiological information about extinct vertebrates.
A Pilot Prospective Observational Study of Cerebral Autoregulation and 12-Month Outcomes in Children With Complex Mild Traumatic Brain Injury: The Argument for Sufficiency Conditions Affecting TBI Outcomes
Authors: Thamjamrassri Thanyalak , Watanitanon Arraya , Moore Anne , Chesnut Randall M. , Vavilala Monica S. , Lele Abhijit V. 
Published: May 2021

Background:
The relationship between cerebral autoregulation and outcomes in pediatric complex mild traumatic brain injury (TBI) is unknown, and explored in this study.

Methods:
We conducted a prospective observational study of patients aged 0 to 18 years hospitalized with complex mild TBI (admission Glasgow Coma Scale score 13 to 15 with either abnormal computerized tomogram of the head or history of loss of consciousness). Cerebral autoregulation was tested using transcranial Doppler ultrasonography, and impaired autoregulation defined as autoregulation index<0.4. We collected Glasgow Outcome Scale Extended-Pediatrics score and health-related quality of life data at 3, 6, and 12 months after discharge.

Results:
Twenty-four patients aged 1.8 to 16.6 years (58.3% male) with complete 12-month outcome data were included in the analysis. Median admission Glasgow Coma Scale score was 15 (range: 13 to 15), median injury severity score was 12 (range: 4 to 29) and 23 patients (96%) had isolated TBI. Overall, 10 (41.7%) patients had impaired cerebral autoregulation. Complete recovery was observed in 6 of 21 (28.6%) children at 3 months, in 4 of 16 (25%) children at 6 months, and in 8 of 24 (33.3%) children at 12 months. There was no difference in median (interquartile range) Glasgow Outcome Scale Extended-Pediatrics score (2 [2.3] vs. 2 [interquartile range 1.3]) or health-related quality of life scores (91.5 [21.1] vs. 90.8 [21.6]) at 12 months between those with intact and impaired autoregulation, respectively. Age-adjusted hypotension occurred in 2/24 (8.3%) patients.

Conclusion:
Two-thirds of children with complex mild TBI experienced incomplete functional recovery at 1 year. The co-occurrence of hypotension and cerebral autoregulation may be a sufficiency condition needed to affect TBI outcomes.
Neurodevelopmental Outcomes Associated With Intravitreal Bevacizumab Injections for Retinopathy of Prematurity
Authors: Webb Alexandra R. 
Published: May 2021

Background:
Retinopathy of prematurity (ROP) is a common disorder among premature infants associated with significant morbidity. The current standard of care includes laser ablation therapy when needed. While intravitreal bevacizumab (IVB) injections have emerged as a new therapy for ROP, so have concerns about the systemic effects of the bevacizumab (Avastin), specifically on neurodevelopmental outcomes.

Purpose:
To review the current literature on the impact of IVB on neurodevelopmental outcomes in neonates with ROP to inform nurses' knowledge and practice.

Methods:
A literature search was performed in the PubMed, CINAHL, and Embase databases. Eleven primary studies examining neurodevelopmental outcomes related to IVB were identified and reviewed.

Results:
Limitations of current studies, including small sample sizes, retrospective analysis subject to selection bias, and confounding factors such as sedation/anesthesia exposure, prevent robust conclusions from being drawn. However, there is not currently any clear evidence of negative neurodevelopmental impacts associated with IVB despite a sound theoretical basis for concern.

Implications for Practice:
Nurses should include all known and potential risks and benefits when counseling families and developing individualized plans of care for their neonatal patients with ROP.

Implications for Research:
Well-designed, prospective studies examining neurodevelopmental outcomes at later time points are needed to conclusively support or disprove results of IVB therapy for ROP in the context of potential adverse effects.
Does a medial mini-incision decrease the risk of iatrogenic ulnar nerve injury in pediatric supracondylar humeral fractures treated with closed reduction and percutaneous pinning? A retrospective cohort study
Authors: Al Habsi Salim , Al Hamimi Suliman , Al Musawi Hashim , Rao Kaza S.V. , AL Ajemi Abdulla , Sharaby Mohamed M.F. 
Published: May 2021

Background:
The authors compared two techniques for safe medial pin placement during fixation of supracondylar humeral fractures, namely closed pinning and mini-open pinning of medial wire insertion, and their effectiveness in protection against iatrogenic ulnar nerve injury.

Methods:
One hundred and nineteen patients with type 2 and 3 Gartland supracondylar humeral fractures (AO Foundation/Orthopaedic Trauma Association [AO/OTA] 13-M/3.1 II, III and IV) were included in this study after applying the exclusion criteria. All patients were managed with cross pinning with identification of two groups. The first group was for percutaneous pinning (N=63), and the second group for patients with medial open incision during medial wire insertion (N=56). All patients were evaluated for the incidence of nerve injury after surgery.

Results:
Nerve injury occurred in 12 of 119 patients. The estimated duration of follow-up was 43.6±10.2 wk. The results revealed nine patients who had ulnar nerve injury among both groups (group 1, N=8, group 2, N=1), with statistically better results in group 2 (P=0.02). The incidence of nerve injury was not found to be correlated with other variables, which included age, gender, type of fracture, number of Kirschner wires that were inserted, and the level of the surgeon.

Conclusions:
A medial mini-open incision decreased the risk of ulnar nerve injury during cross pin fixation in the treatment of displaced supracondylar humeral fractures, without additional morbidity.

Level of Evidence:
Level III.
Spinal versus general anesthesia during retrograde intra-renal surgery: A propensity score matching analysis
Authors: Olivero Alberto , Ball Lorenzo , Fontaneto Carlotta , Mantica Guglielmo , Bottino Paolo , Pelosi Paolo , Terrone Carlo 
Published: May 2021

Abstract

Background:
The indications for retrograde intra-renal surgery (RIRS) have greatly increased, however, there is still no consensus on the use of spinal anesthesia (SA) during this procedure. The aim of this study was to evaluate the comparability of surgical conditions and outcomes with RIRS performed under SA versus general anesthesia (GA) for renal stones.

Materials and methods:
This was a prospective, observational study in patients scheduled for RIRS in a single teaching hospital in Italy. Inclusion criteria were age >18 years and the presence of single or multiple renal stones. We recorded information concerning the site of lithiasis, the number of calculi, total stone burden, and the presence of concomitant ureteral stones or hydronephrosis. A propensity score-matched analysis was performed to evaluate the results in terms of surgical outcome, intraoperative and postoperative complications, and analgesia demand balanced for confounding factors. Patients were followed-up until day 90 from discharge.

Results:
We included 120 patients, the propensity score-matched cohort included 40 patients in the SA and 40 in the GA groups. The stone-free rate was 67.5% in the GA group and 70.0% in the SA group (p = 0.81). The use of auxiliary procedures within 90 days did not differ between groups (25.0% vs. 22.5%, p = 0.79). No cases of conversion from SA to GA were recorded. We did not find any differences in intraoperative bleedings, perforations, and abortions. Complication rates were similar in the 2 groups (10.0% in GA vs. 5.0% in SA, p = 0.64).

Conclusions:
In our cohort, RIRS performed under SA and GA was equivalent in terms of surgical results and complications.
Effects of Hot Nights on Mortality in Southern Europe
Authors: Royé Dominic , Sera Francesco , Tobías Aurelio , Lowe Rachel , Gasparrini Antonio , Pascal Mathilde , de’Donato Francesca , Nunes Baltazar , Teixeira Joao Paulo 
Published: May 2021

Background:There is strong evidence concerning the impact of heat stress on mortality, particularly from high temperatures. However, few studies to our knowledge emphasize the importance of hot nights, which may prevent necessary nocturnal rest.Objectives:In this study, we use hot-night duration and excess to predict daily cause-specific mortality in summer, using multiple cities across Southern Europe.Methods:We fitted time series regression models to summer cause-specific mortality, including natural, respiratory, and cardiovascular causes, in 11 cities across four countries. We included a distributed lag nonlinear model with lags up to 7 days for hot night duration and excess adjusted by daily mean temperature. We summarized city-specific associations as overall-cumulative exposure–response curves at the country level using meta-analysis.Results:We found positive but generally nonlinear associations between relative risk (RR) of cause-specific mortality and duration and excess of hot nights. RR of duration associated with nonaccidental mortality in Portugal was 1.29 (95% confidence interval [CI] = 1.07, 1.54); other associations were imprecise, but we also found positive city-specific estimates for Rome and Madrid. Risk of hot-night excess ranged from 1.12 (95% CI = 1.05, 1.20) for France to 1.37 (95% CI = 1.26, 1.48) for Portugal. Risk estimates for excess were consistently higher than for duration.Conclusions:This study provides new evidence that, over a wider range of locations, hot night indices are strongly associated with cause-specific deaths. Modeling the impact of thermal characteristics during summer nights on mortality could improve decisionmaking for preventive public health strategies.