bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence and risk factors for serositis in patients with systemic lupus erythematosus: A case-control study
Authors: Gimeno-Torres Laura , Carrión-Barberà Irene , Durán Xavier , Villegas Eduardo , Monfort Jordi , Salman-Monte Tarek Carlos 
Published: November 2021

Background Systemic lupus erythematosus (SLE) is an autoimmune multisystemic disease with a wide variety of clinical manifestations. One of its symptoms, associated to high morbidity, is serositis. Its prevalence ranges between 11% and 54%, and little is known about factors associated to this manifestation. The aim of this study is to determine the prevalence of serositis in SLE patients visited at the outpatient Lupus Unit of the Hospital del Mar and identify risk factors that can be used as predictors of this manifestation. Methods A retrospective case-control study was performed based on the review of 297 medical records of SLE patients. Twenty-eight patients were identified to have suffered serositis (cases) and were age- and sex-matched with 2 controls with SLE without serositis. Results The overall prevalence of serositis in our cohort was 9.42%, being higher in men than in women, 30% versus 7.9% ( p = 0.001, 95% CI: 1.7–42.4%). In 40.7%, it was the first manifestation of the disease. When looking for serositis-associated factors, an association was found with anti-dsDNA antibodies measured by the Crithidia method ( p = 0.016), and different measures of corticosteroids, where cases had required higher maximum doses and more pulses than controls throughout the disease, although this last correlation was lost when adjusting for confounding variables as nephritis and arthritis. Cases also received more mycophenolic acid ( p = 0.021) and, marginally, more belimumab ( p = 0.056). Conclusion The overall prevalence of serositis was 9.42%, being significantly higher in men (30%). Therefore, male gender constitutes a risk factor for serositis, and almost one third of men will develop this manifestation, so greater awareness is required in SLE men. CrithidiaDNA+ was also identified as a risk factor, and it should be determined in all SLE patients. Cases significantly received more corticosteroid pulses and higher maximum doses in relation to other SLE severe manifestations, which could imply a more aggressive form of SLE in patients with serositis.
Comparison of Clinical Outcomes Between Ceramic-Based Total Ankle Arthroplasty with Ceramic Total Talar Prosthesis and Ceramic-Based Total Ankle Arthroplasty
Authors: Yamamoto Tetsuya , Nagai Kanto , Kanzaki Noriyuki , Kataoka Kiminari , Nukuto Koji , Hoshino Yuichi , Matsushita Takehiko , Kuroda Ryosuke 
Published: November 2021

Background: Total ankle arthroplasty (TAA) has become one of the standard surgical treatments for patients with end-stage ankle osteoarthritis (OA). In recent years, TAA with total talar prosthesis (combined TAA) has been used for ankle OA patients with talar osteonecrosis, with severe talar collapse, or with subtalar joint OA. The purpose of this study was to investigate the functional and clinical outcomes of combined TAA, compared with conventional TAA. Methods: Forty-six ankles (44 patients, 32 women/12 men) that underwent conventional TAA with mean follow-up of 42 months, and 26 ankles (25 patients, 18 women/7 men) that underwent combined TAA with mean follow-up of 46 months were included. Clinical outcomes, which included ankle range of motion (ROM), the Japanese Society for Surgery of the Foot (JSSF) ankle-hindfoot scale, the Self-Administered Foot Evaluation Questionnaire (SAFE-Q), and complications were compared between the groups. Results: The preoperative ROM was significantly worse in combined TAA for both dorsiflexion and plantarflexion; however, in the final ROM, there was no significant difference between the groups. There was no significant difference in JSSF scale and SAFE-Q between the groups. Revision rate was 10.9% in conventional TAA and 0% in combined TAA. Conclusion: In this small series, at an average of 3.5 years, we found no significant difference in clinical results between conventional TAA and combined TAA; however, the revision rate was higher in conventional TAA. Level of Evidence: Level III, retrospective cohort study.
Relevance of Routine Abdominopelvic Ultrasound in Suspected Child Abuse in Children Under 2 years of Age: Review of 15 years of Experience
Authors: Martin-Champetier Antoine , Caujolle Anaïs , Bosdure Emmanuelle , Bresson Violaine , Aschero Audrey , Desvignes Catherine , Colavolpe Nathalie , Pico Harmony , Seiler Charlotte , Panuel Michel , Chaumoitre Kathia , Petit Philippe , Dabadie Alexia 
Published: November 2021

In France, the current recommendation is to perform a routine abdominopelvic ultrasound in any child under 2 years of age who is suspected to have been abused. We retrospectively studied the relevance of this practice in our center over the past fifteen years. This was a descriptive, retrospective study of all children under 2 years of age who had been subject to suspected abuse. Abdominal images and reports were reviewed and cross-referenced with possible clinical and biological signs. Four hundred and five children were included between 2006 and 2020, of whom 296 underwent abdominal imaging (2 initial abdominopelvic CT scans, 4 ultrasounds followed by CT scans, and 290 ultrasounds alone). Four examinations revealed traumatic abnormalities related to abuse. These four children all had clinical or biological anomalies. In the absence of clinical or biological signs, no imagery showed any abnormality related to abuse.
Factors Associated With Psychosocial Illness Impact Among Black/African American and Hispanic Older Women Living With HIV
Authors: Iriarte Evelyn , Cianelli Rosina , Villegas Natalia , De Oliveira Giovanna , Toledo Christine , Smith Lindsay , Castro Jose Guillermo 
Published: November 2021

BACKGROUND: In 2018, one in six newly diagnosed individuals with HIV in the United States were adults aged 50 years and older, 24% were women, and 60% were Black/African American and Hispanic (42% and 18%, respectively). AIMS: This study aims to examine the factors associated with HIV psychosocial illness impact among Black/African American and Hispanic older women living with HIV. METHOD: Guided by the socioecological model, a secondary data analysis design with cross-sectional data that included 138 Black/African American and Hispanic women aged 50 years and older was conducted. RESULTS: Higher levels of avoidant coping, depressive symptoms, negative self-perception of health, and decreased social support were significant factors associated with HIV psychosocial illness impact among this sample. CONCLUSIONS: Findings from this study can contribute to identifying solutions to prevent and decrease these negative factors associated with HIV psychosocial illness impact among Black/African American and Hispanic older women.
Long-term outcomes following thrombolysis of arteriovenous grafts
Authors: Li Ben , Abdelmasih Monica , Eisenberg Naomi , Lok Charmaine , Roche-Nagle Graham 
Published: November 2021

Background: Thrombolysis for arteriovenous grafts (AVG) yields high technical success rates, however, long-term outcomes are unclear. We conducted a multicenter retrospective cohort study to analyze 5-year patency rates following AVG thrombolysis. Methods: All patients who underwent AVG thrombolysis between 2005 and 2015 at three academic hospitals were included. Prospectively maintained institutional nephrology and radiology databases were used to record demographic, clinical, and AVG characteristics. The primary outcome was primary patency, defined as AVG access survival without re-intervention including angioplasty ± stent with/without re-thrombolysis. Secondary outcomes were assisted primary patency and cumulative patency, defined as AVG access survival until re-thrombosis requiring re-thrombolysis or abandonment, respectively. Technical success was defined as restoration of flow with <30% residual stenosis. Patients were followed until 2017. Patency rates were assessed using Kaplan–Meier survival analysis and Cox proportional hazards were calculated to determine associations between covariates and patency loss. Results: Seventy-four patients underwent AVG thrombolysis during the study period with a median follow-up period of 21.4 (IQR 8.3–42.8) months. The average age was 58.6 years with a high rate of comorbidities, including hypertension (82.4%) and diabetes (54.1%). Thrombolysis technical success was 96%. There were 147 re-interventions in 46 patients, of which 98 were re-thrombolysis (mean re-intervention rate of 1.27/patient/year). Primary patency at 1, 3, and 5 years were 43.2%, 20.2%, and 7.7%. Assisted primary patency at 1, 3, and 5 years were 47.5%, 20.2%, and 7.7%. Cumulative patency at 1, 3, and 5 years were 75.0%, 38.8%, and 22.6%. Cox proportional hazards analysis demonstrated no associations between demographic, clinical, and procedural characteristics and patency rates. Conclusions: Despite a high technical success rate, thrombolysis for AVG dysfunction is associated with poor long-term patency. Future studies are needed to determine risk factors for re-thrombosis to identify patients who will benefit from AVG thrombolysis in the long-term.
Plasma Phospholipids: A Promising Simple Biochemical Parameter to Evaluate COVID-19 Infection Severity
Authors: Hussein Mohammed Abdalla , Ismail Noor Eldin Mohamed , Mohamed Ahmed H , Borik Rita M , Ali Ali Abdelaziz , Mosaad Yasser O 
Published: November 2021

Background: Coronavirus-19 (COVID-19) pandemic is a worldwide public health problem that has been known in China since December 25, 2019. Phospholipids are structural components of the mammalian cytoskeleton and cell membranes. They suppress viral attachment to the plasma membrane and subsequent replication in lung cells. In the virus-infected lung, phospholipids are highly prone to oxidation by reactive oxygen species, leading to the production of oxidized phospholipids (OxPLs). Objective: This study was carried out to explain the correlation between the level of plasma phospholipids in patients with COVID-19 infection and the levels of cytokine storms to assess the severity of the disease. Methods: Plasma samples from 34 enrolled patients with mild, moderate, and severe COVID-19 infection were collected. Complete blood count (CBC), plasma levels of D-dimer, ferritin, C-reactive protein (CRP), cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), phospholipids, secretory phospholipase A2 (sPLA2)α2, and cytokine storms were estimated, and lung computed tomography (CT) imaging was detected. Results: The CBC picture showed the presence of leukopenia, lymphopenia, and eosinopenia in patients with COVID-19 infection. Furthermore, a significant increase was found in plasma levels of D-dimer, CRP, ferritin, tumor necrosis factor (TNF)-α, interleukin (IL)-1β, IL-6, and IL-13 as well as sPLA2α2 activity compared to normal persons. However, plasma levels of phospholipids decreased in patients with moderate and severe COVID-19 infection, as well as significantly decreased in levels of triacylglycerols and HDL-C in plasma from patients with severe infection only, compared to normal persons. Furthermore, a lung CT scan showed the presence of inflammation in a patient with mild, moderate, and severe COVID-19 infection. Conclusions: This study shows that there is a correlation between plasma phospholipid depletion and elevated cytokine storm in patients with COVID-19 infection. Depletion of plasma phospholipid levels in patients with COVID-19 infection is due to oxidative stress, induction of cytokine storm, and systemic inflammatory response after endothelial cell damage promote coagulation. According to current knowledge, patients with COVID-19 infection may need to administer surfactant replacement therapy and sPLA2 inhibitors to treat respiratory distress syndrome, which helps them to maintain the interconnected surfactant structures.
Prevalence and risk factors of moderate to severe hepatic steatosis in patients with rheumatoid arthritis: an ultrasonography cross-sectional case–control study
Authors: Erre Gian Luca , Castagna Floriana , Sauchella Assunta , Meloni Pierluigi , Mangoni Arduino Aleksander , Farina Giuseppina , Woodman Richard , Dore Maria Pina , Vidili Gianpaolo 
Published: November 2021

Background: The independent association between hepatic steatosis and rheumatoid arthritis is poorly defined. Methods: The presence of moderate to severe steatosis was assessed, using liver ultrasonography, in 364 consecutive non-diabetic subjects (223 patients with rheumatoid arthritis and 141 age- and sex-matched healthy controls). Adjusted multiple regression analysis was performed to explore the association between rheumatoid arthritis and moderate to severe steatosis in the overall sample and identify independent risk factors in the rheumatoid arthritis subgroup. Results: The prevalence of moderate to severe steatosis in the overall sample was 31.3%, with a significantly higher prevalence in patients with rheumatoid arthritis than healthy controls (38.7% versus 19.7%, p < 0.0001). After adjustment for sex, age, cholesterol, triglycerides, body mass index, waist, hypertension and smoke, rheumatoid arthritis remained significantly associated with moderate to severe steatosis [odds ratio (95% confidence interval) = 2.24 (1.31, 3.84); p = 0.003]. In the rheumatoid arthritis group, male sex, higher body mass index, higher triglycerides concentrations and higher cumulative dosage of methotrexate [odds ratio (95% confidence interval) = 1.11 (1.01, 1.23); p = 0.026] were significantly associated with moderate to severe steatosis, while systemic inflammation, disease activity, use of steroids and biologics were not. Conclusion: Rheumatoid arthritis is independently associated with moderate to severe steatosis, with male sex, higher body mass index and cumulative dose of methotrexate being predisposing factors. Further prospective studies are warranted to confirm our findings and to investigate the effect of steatosis on liver outcomes in the rheumatoid arthritis population.
The Children’s Hospital of the Future: A Vision That Meets All Needs
Authors: Więckowska Barbara , Byszek Katarzyna , Malenda Maciej 
Published: November 2021

Objectives: The objective of this article is twofold. First, to present a comprehensive internal assessment of the hospital by different groups of stakeholders and, second, to determine whether there are common needs and wishes that, if incorporated in the hospital vision, will enable future development. Background: The Children’s Memorial Health Center is the largest children’s hospital in Poland. The hospital began operations in 1977 with a vision to be a modern healthcare facility that provides comprehensive care for children. That vision has not changed over time but everything else did. Methods: Six design thinking sessions were conducted with 83 employees and 40 respondents who used health services in the hospital in the past, along with in-depth interviews with 25 representatives of management to gather data for the hospital assessment. Results: Sixty-three features influencing future development were identified. Seven groups of features were classified to be either transformation drivers (four groups) or enablers (three groups). We focused on features that were indicated by all groups of respondents to define a common vision for future development. Conclusions: Depending on the respondent’s role in the healthcare ecosystem, the list of variables within each of seven groups defining the “hospital of the future” was different while evaluating the healthcare services. Therefore, all stakeholders must be engaged in the ideation process to create a strategy for a future care model driven by innovation.
Cardiovascular health and risk of hospitalization with COVID-19: A Mendelian Randomization study
Authors: Cecelja Marina , Lewis Cathryn M. , Shah Ajay M. , Chowienczyk Phil 
Published: November 2021

Background Susceptibility to and severity of COVID-19 is associated with risk factors for and presence of cardiovascular disease. Methods We performed a 2-sample Mendelian randomization to determine whether blood pressure (BP), body mass index (BMI), presence of type 2 diabetes (T2DM) and coronary artery disease (CAD) are causally related to presentation with severe COVID-19. Variant-exposure instrumental variable associations were determined from most recently published genome-wide association and meta-analysis studies (GWAS) with publicly available summary-level GWAS data. Variant-outcome associations were obtained from a recent GWAS meta-analysis of laboratory confirmed diagnosis of COVID-19 with severity determined according to need for hospitalization/death. We also examined reverse causality using exposure as diagnosis of severe COVID-19 causing cardiovascular disease. Results We found no evidence for a causal association of cardiovascular risk factors/disease with severe COVID-19 (compared to population controls), nor evidence of reverse causality. Causal odds ratios (OR, by inverse variance weighted regression) for BP (OR for COVID-19 diagnosis 1.00 [95% confidence interval (CI): 0.99–1.01, P = 0.604] per genetically predicted increase in BP) and T2DM (OR for COVID-19 diagnosis to that of genetically predicted T2DM 1.02 [95% CI: 0.9–1.05, P = 0.927], in particular, were close to unity with relatively narrow confidence intervals. Conclusion The association between cardiovascular risk factors/disease with that of hospitalization with COVID-19 reported in observational studies could be due to residual confounding by socioeconomic factors and /or those that influence the indication for hospital admission.
The Ratio of Stress to Nonstress Anterior Talofibular Ligament Length on Ultrasonography: Normative Values
Authors: Yokoe Takuji , Tajima Takuya , Kawagoe Shuichi , Yamaguchi Nami , Morita Yudai , Chosa Etsuo 
Published: November 2021

Background: Stress ultrasonography (US) has been shown to be a valid procedure for evaluating chronic anterior talofibular ligament (ATFL) injury. The ratio of stress/nonstress ATFL length (ATFL ratio) as measured on US is clinically useful; however, there are no published normative data concerning this ratio. Purpose: To report a normative value of the ATFL ratio on US and evaluate the relationships between sex, generalized joint laxity (GJL), and the grade of anterior drawer test (ADT). Study Design: Cross-sectional study; Level of evidence, 3. Methods: The ATFL lengths were prospectively measured in the stress and nonstress positions (manual maximal anterior drawer position) for participants with noninjured ankles from March 2020 to March 2021. GJL was defined as a Beighton score ≥4. A manual ADT was also performed. The ATFL ratio was calculated, and the relationships between sex, GJL, and ADT grade were evaluated. Results: A total of 333 ankles in 184 participants (mean age, 24.5 ± 2.7 years; range, 20-33 years) were eligible for the analysis. GJL was found in 69 ankles (20.7%). The mean ATFL ratio was 1.08 ± 0.04 (95% CI, 1.08-1.09; range, 1.01-1.24), and there was a significant difference between male (1.07 ± 0.04; 95% CI, 1.07-1.08; range, 1.02-1.23) and female (1.09 ± 0.04; 95% CI, 1.08-1.10; range, 1.01-1.24) ankles ( P = .001). In male ankles, the ATFL ratio was significantly greater in participants with GJL (1.11 ± 0.06 vs 1.07 ± 0.03; P = .02) or a higher grade of ADT (grade 2 vs grade 1: 1.11 ± 0.06 vs 1.07 ± 0.03, P = .002). These findings were not observed in female ankles. Conclusion: The normative value of the ATFL ratio on stress US was 1.07 ± 0.04 in men and 1.09 ± 0.04 in women. The ATFL ratio was affected by the presence of GJL in men but not in women. These findings will be useful for future studies seeking to establish the cutoff value of the ATFL ratio for diagnosing chronic lateral ankle stability on stress US.
Effect and implementation experience of intensive adherence counseling in a public HIV care center in Uganda: a mixed-methods study
Authors: Lukyamuzi Zubair , Etajak Samuel , Katairo Thomas , Mukunya David , Tetui Moses , Ssenyonjo Aloysius , Wanyenze Rhoda K. 
Published: November 2021

Abstract
Background
Intensive adherence counseling (IAC) is an intervention recommended by the World Health Organization to improve anti-retroviral therapy (ART) adherence among people living with HIV on ART with unsuppressed viral load; and in 2016, the intervention was implemented in Uganda. This study evaluated the effect and experiences of providing IAC in an urban HIV care center in Kampala, Uganda.

Methods
This was a sequential explanatory mixed-method study that compared viral load suppression during IAC implementation (intervention) to the period before IAC at Kisenyi Health centre IV. Data were abstracted from patient files and viral load register. The effect of IAC on viral load suppression and associated factors were analyzed using modified Poisson regression with robust standard errors. Using in-depth interviews and an inductive analysis approach in Atlas-ti 8. We also explored experiences of providing IAC among healthcare workers.

Results
A total of 500 records were sampled: 249 (49.8%) in the intervention period and 251 (51.2%) in the pre-intervention period. The mean age was lower during the intervention period 33.1 (± 12.0) than 36.5 (± 13.4) in the pre- intervention period, p = 0.002. More clients were currently on Protease-based regimen in the pre-intervention period 179 (71.3%) than 135 (54.2%) in the intervention period, p ≤ 0.001. In the intervention period, all eligible clients received IAC [249/249 (100.0%)]. Overall, 325 (65.0%) received IAC and of these, 143 (44.1%) achieved viral load suppression compared to 46 (26.3%) who received regular counseling. Receiving IAC significantly increased viral load suppression by 22% (aPR 1.22, 95% CI 1.01–1.47). Clients on Protease-based regimen were less likely to suppress than those on Efavirenz or Nevirapine-based regimens (aPR 0.11, 95% CI 0.08–0.15). All the interviewed healthcare workers lauded IAC for improving ART adherence. However, patient and health care system related factors hindered adherence during IAC.

Conclusions
The full potential of IAC in achieving viral load suppression in this setting has not been reached due to a combination of the patient and health care system related factors. Provision of adequate IAC necessities and use of patient centered approach should be emphasized to obtain the maximum benefit of the intervention.