bluuebunny/crossref_metadata_2025_split huggingface dataset:
Increased Incidence of Ventilator-Acquired Pneumonia in Coronavirus Disease 2019 Patients: A Multicentric Cohort Study*
Authors: Vacheron Charles-Hervé , Lepape Alain , Savey Anne , Machut Anaïs , Timsit Jean Francois , Vanhems Philippe , Le Quoc Viet , Egbeola Julia , Martin Maelle , Maxime Virginie , Pugliesi Paul-Simon , Maucort-Boulch Delphine , Friggeri Arnaud ,   REA-REZO Study Group
Published: September 2021

OBJECTIVES:
Little is known about the epidemiology of ventilator-acquired pneumonia among coronavirus disease 2019 patients such as incidence or etiological agents. Some studies suggest a higher risk of ventilator-associated pneumonia in this specific population.

DESIGN:
Cohort exposed/nonexposed study among the REA-REZO surveillance network.

SETTING:
Multicentric; ICUs in France.

PATIENTS:
The coronavirus disease 2019 patients at admission were matched on the age, sex, center of inclusion, presence of antimicrobial therapy at admission, patient provenance, time from ICU admission to mechanical ventilation, and Simplified Acute Physiology Score II at admission to the patients included between 2016 and 2019 within the same surveillance network (1:1).

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
The overall incidence of ventilator-associated pneumonia, the cumulative incidence, and hazard rate of the first and the second ventilator-associated pneumonia were estimated. In addition, the ventilator-associated pneumonia microbiological ecology and specific resistant pattern in coronavirus disease 2019 exposed and nonexposed patients were compared. Medication data were not collected. A total of 1,879 patients were included in each group. The overall incidence of ventilator-associated pneumonia was higher among coronavirus disease 2019 exposed patients (25.5; 95% CI [23.7–27.45] vs 15.4; 95% CI [13.7–17.3] ventilator-associated pneumonia per 1,000 ventilation days). The cumulative incidence was higher for the first and the second ventilator-associated pneumonia among the coronavirus disease 2019 exposed patients (respective Gray test p < 0.0001 and 0.0167). The microbiological ecology and resistance were comparable between groups with a predominance of Enterobacterales and nonfermenting Gram-negative bacteria. The documented resistance pattern was similar between groups, except for a lower rate of methicillin-resistant Staphylococcus aureus in the coronavirus disease 2019 exposed patient (6% vs 23%; p = 0.013).

CONCLUSIONS:
There was a higher incidence of ventilator-associated pneumonia occurring among coronavirus disease 2019 patient compared with the general ICU population, with a similar microbiological ecology and resistance pattern.
IV Vitamin C in Critically Ill Patients: A Systematic Review and Meta-Analysis
Authors: Patel Jayshil J. , Ortiz-Reyes Alfonso , Dhaliwal Rupinder , Clarke John , Hill Aileen , Stoppe Christian , Lee Zheng-Yii , Heyland Daren K. 
Published: September 2021

OBJECTIVES:
To conduct a systematic review and meta-analysis to evaluate the impact of IV vitamin C on outcomes in critically ill patients.

DATA SOURCES:
Systematic search of MEDLINE, EMBASE, CINAHL, and the Cochrane Register of Controlled Trials.

STUDY SELECTION:
Randomized controlled trials testing IV vitamin C in critically ill patients.

Data Abstraction:
Two independent reviewers abstracted patient characteristics, treatment details, and clinical outcomes.

DATA SYNTHESIS:
Fifteen studies involving 2,490 patients were identified. Compared with placebo, IV vitamin C administration is associated with a trend toward reduced overall mortality (relative risk, 0.87; 95% CI, 0.75–1.00; p = 0.06; test for heterogeneity I
2 = 6%). High-dose IV vitamin C was associated with a significant reduction in overall mortality (relative risk, 0.70; 95% CI, 0.52–0.96; p = 0.03), whereas low-dose IV vitamin C had no effect (relative risk, 0.94; 95% CI, 0.79–1.07; p = 0.46; test for subgroup differences, p = 0.14). IV vitamin C monotherapy was associated with a significant reduction in overall mortality (relative risk, 0.64; 95% CI, 0.49–0.83; p = 0.006), whereas there was no effect with IV vitamin C combined therapy. No trial reported an increase in adverse events related to IV vitamin C.

CONCLUSIONS:
IV vitamin C administration appears safe and may be associated with a trend toward reduction in overall mortality. High-dose IV vitamin C monotherapy may be associated with improved overall mortality, and further randomized controlled trials are warranted.
Sepsis Among Medicare Beneficiaries: 4. Precoronavirus Disease 2019 Update January 2012–February 2020
Authors: Frank Charles E. , Buchman Timothy G. , Simpson Steven Q. , Sciarretta Kimberly L. , Plopper George E. , Finne Kristen P. , Sowers Nicole , Collier Michael , Chavan Saurabh , Lin Cheng , Oke Ibijoke , Rhodes Kiersten E. , Santhosh Aathira , Chu Steve , MaCurdy Thomas E. , Patel Sandeep A. , Disbrow Gary L. , Kelman Jeffrey A. 
Published: September 2021

OBJECTIVES:
To provide updated information on the burdens of sepsis during acute inpatient admissions for Medicare beneficiaries.

DESIGN:
Analysis of paid Medicare claims via the Centers for Medicare and Medicaid Services DataLink Project.

SETTING:
All U.S. acute-care hospitals, excluding federally operated hospitals (Veterans Administration and Defense Health Agency).

Patients:
All Medicare beneficiaries, January 2012—February 2020, with an explicit sepsis diagnostic code assigned during an inpatient admission.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
The count of Medicare Part A/B (fee-for-service) plus Medicare Advantage inpatient sepsis admissions rose from 981,027 (CY2012) to 1,700,433 (CY 2019). The proportion of total admissions with sepsis in the Medicare Advantage population rose from 21.43% to 35.39%, reflecting the increasing beneficiary proportion enrolled in Medicare Advantage. In CY2019, 6-month mortality rates in Medicare fee-for-service beneficiaries for sepsis continued to decline, but remained high: 59.9% for septic shock, 35.5% for severe sepsis, 30.8% for sepsis attributed to a specific organism, and 26.5% for unspecified sepsis. Total fee-for-service-only inpatient hospital costs rose from $17.79B (CY2012) to $22.98B (CY2019). We estimated that the aggregate cost of sepsis hospital care for the entire U.S. population was at least $57.47B in 2019. Inclusion of 14 months’ (January 2019—February 2020) newer data exposed new trends: the cost per patient, number of admissions, and fraction of patients with sepsis labeled as present on admission inflected around November 2015, coincident with the change to International Classification of Diseases, 10th Edition, and introduction of the Severe Sepsis and Septic Shock Management Bundle (SEP-1) metric.

CONCLUSIONS:
Sepsis among Medicare beneficiaries precoronavirus disease 2019 imposed immense burdens upon patients, their families, and the taxpayers.
Peculiar Histopathologic Feature of an Erythematous/Morbilliform Eruption in a COVID-19–Positive Patient
Authors: Caputo Valentina , Metze Dieter , Bonoldi Emanuela , Merli Marco , Rongioletti Franco 
Published: September 2021

Abstract:
One of the most common patterns of presentations that have been described in COVID-19 patients includes the erythematous/papular/morbilliform eruptions. However, actually, the diffuse exanthems containing macules and papules were not specific to COVID-19, and even histopathology does not show any specific signs that could help to differentiate COVID‐19 skin lesions from non–COVID‐19 causes such as drugs or other viral infections. We present the case of a COVID-19–positive woman with a morbilliform rash, whose skin biopsy showed the presence of some peculiar cytopathic epidermal changes that could represent a possible distinctive histopathological feature related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection The presence of viral particles in the keratinocytes with additional positivity of endothelial cells and eccrine glands by immunohistochemistry using an anti-SARS‐CoV‐2 Spike S1 antibodies supports a causal relation of the lesions with SARS‐CoV‐2 infection.
Podophyllotoxin Cytological Effects on the Epidermis in Condyloma Acuminatum
Authors: Leung Bonnie , Enos Tyler , Vandergriff Travis 
Published: September 2021

Abstract:
Podophyllotoxin (PPT) is used to treat condylomata acuminata and works by destabilizing microtubules within epithelial cells, leading to mitotic arrest in metaphase. PPT-induced changes to the epidermis can cause histological findings mimicking dysplasia. Here, we present a case of vulvar condyloma acuminatum treated with PPT, showing ballooning degeneration, necrotic keratinocytes, and mitotic figures. PPT-treated skin may resemble dysplasia or squamous cell carcinoma in situ due to dyskeratosis and frequent mitoses; however, the synchronicity of mitotic figures in early phases of mitosis, as well as the absence of cellular pleomorphism and atypical mitotic figures, allows for distinction from malignancy. This case demonstrates the importance of understanding the histological changes caused by PPT to prevent misdiagnosis and potential overtreatment.
Plasma Cell-Predominant Lichen Planopilaris
Authors: Frew Derek , Oaxaca Gabriel , Habermehl Gabriel , Unwala Rashmi , Bergfeld Wilma 
Published: September 2021

Abstract:
Lichen planopilaris (LPP) is a scarring alopecia that is characterized by a lichenoid interface infiltrate with follicular extension. We present a case of LPP composed predominantly of plasma cells in a 52-year-old man. The patient was originally diagnosed with scalp psoriasis 30 years before presentation. Punch biopsies performed at an outside institution 2 years before presentation revealed lymphocyte-predominant LPP. After referral to the senior author's institution due to inadequate response to therapy, biopsies demonstrated a robust, superficial, and deep lichenoid interface dermatitis composed predominantly of plasma cells. Immunohistochemical and special staining for CD138, MUM-1, kappa and lambda light chains, immunoglobulin G4, CD3, CD20, PAX5, CD5, CD7, CD4, CD8, CD43, CD123, Gram, Grocott's methenamine silver stain, treponemal antibody, colloidal iron, and Movat showed a scarring alopecia and were not supportive of a hematolymphoid, infectious, or autoimmune etiology. B-cell clonality studies were below the threshold needed for definitive diagnosis of a clonal process. Doxycycline and hydroxychloroquine were subsequently added to the patient's treatment regimen, leading to an improvement of symptoms. We present this case to bring awareness to this unusual feature and discuss its differential diagnosis.
Telangiectasia Macularis Eruptiva Perstans of the Scalp Mimicking Angiosarcoma
Authors: Lawrence Marc , Sampson James , Oliver Fergus , Restall Paul , Mackenzie Monique 
Published: September 2021

Abstract:
We present a case of a 74-year-old man with marked photodamage who was ultimately diagnosed with telangiectasia macularis eruptiva perstans (TMEP) of the scalp. The diagnosis was made more difficult because of the clinical and histological similarity of this case with an early angiosarcoma. TMEP is a benign and indolent rare subtype of cutaneous mastocytosis presenting clinically with red–brown telangiectatic macules, usually symmetrically distributed over the trunk and extremities. Although most cases are limited to the skin, systemic involvement can occur, and this can be a potentially life-threatening disease. Although also rare, in contrast to TMEP, cutaneous angiosarcoma is a highly malignant vascular tumor with a poor prognosis. This case highlights the importance of including TMEP on the differential diagnosis where vascular lesions of the scalp are observed.
Menopausal hormone therapy and risk of incident hypertension: role of the route of estrogen administration and progestogens in the E3N cohort
Authors: Madika Anne-Laure , MacDonald Conor James , Fournier Agnès , Mounier-Vehier Claire , Béraud Guillaume , Boutron-Ruault Marie-Christine 
Published: September 2021

Abstract

Objectives:
Although menopausal hormone therapy (MHT) remains the most effective treatment for vasomotor symptoms of menopause, its association with the development of arterial hypertension remains unclear. We sought to explore associations between different formulations of MHT and incident hypertension among menopausal women in a prospective cohort study.

Methods:
We used the Etude Epidémiologique de femmes de la Mutuelle Générale de l’Education (E3N) cohort, a French prospective population-based study initiated in 1990 on 98,995 women. Out of these, 49,905 menopausal women with complete information on the use of MHT, and without prevalent hypertension at inclusion were included.

Results:
The mean age of the population at baseline was 54.2 ± 4.3 years, and 32,183 (64.5%) reported ever using MHT. Among these women, 10,173 cases of incident hypertension were identified over an average follow-up time of 10.6 years. Compared with women who never used MHT, those who ever used it had an increased risk of incident hypertension (adjusted HR 1.07, 95% CI 1.02-1.12) after adjustment for body mass index and other potential confounders. Oral but not transdermal estrogen use was associated with an increased risk of hypertension (adjusted HR = 1.09; 95% CI: 1.04-1.14 and HR = 1.03; 95% CI: 0.99-1.07, respectively). However, the HRs associated with oral and transdermal estrogens did not differ significantly (P-homogeneity = 0.09). Regarding the role of concomitant progestogens, pregnane and norpregnane derivatives were significantly associated with hypertension risk (HR = 1.12; 95% CI: 1.06-1.19 and HR = 1.06; 95% CI: 1.01-1.13, respectively).

Conclusions:
MHT was associated with a modest but significant increased risk of incident hypertension, especially when using oral estrogen in combination with a progestogen such as pregnane and norpregnane derivatives. Surveillance of blood pressure should be added to the medical surveillance of MHT users.

Video Summary:

http://links.lww.com/MENO/A802.
Staying Close to Home: The Effects of COVID-19 on the Plastic Surgery Residency Match
Authors: Hollins Andrew W. , Zhang Gloria X. , Stoehr Jenna R. , Atia Andrew , Sergesketter Amanda R. , Wickenheisser Victoria A. , Ko Jason H. , Phillips Brett T. 
Published: September 2021

Background:
The 2019 novel coronavirus created unique challenges for the integrated plastic surgery match. The goal of this study was to evaluate the trends of the 2020 and 2021 integrated plastic surgery match specifically related to the 2019 novel coronavirus.

Methods:
Three separate individual surveys were designed for integrated plastic surgery program directors and applicants from the 2021 to 2020 match. The surveys were distributed to the email addresses of applicants that applied to our institution’s integrated residency program. Information of current interns and newly matched applicants from program websites and certified social media accounts were recorded.

Results:
We received completed surveys from 19 of the 69 program directors for a response rate of 27.5%. The survey for the 2020 and 2021 match applicants was completed by 25 and 68 applicants, respectively, for a response rate of 6.1% and 21.9%. There was a significant difference in the average number of completed virtual subinternships between applicants that did and did not successfully match into plastic surgery (1.48 versus 0.36, P = 0.01). The rate of students matching at their home institution was the highest in 2021 at 26% compared to 2020 (18%) and 2019 (15%).

Conclusions:
The results of this study demonstrate that applicants were more likely to match at programs with which they had established previous connections, including home institutions. Applicants also had a higher likelihood to match if they completed a virtual subinternship during the 2021 match. Learning points can be applied to the upcoming application cycle to improve the overall experience.
Comparison of the Effects of Temperature and Dehydration Mode on Glycerin-Based Approaches to SMILE-Derived Lenticule Preservation
Authors: Xia Fei , Zhao Jing , Fu Dan , Qin Bing , Chen Zhi , Zhao Yu , Shen Yang , Hou Jiayun , Zhou Xingtao 
Published: September 2021

Purpose:
The aim of this study was to explore the optimal method of small-incision lenticule extraction (SMILE)-derived lenticules, subjected to long-term preservation using glycerol, under a range of temperatures, and using an array of dehydration agents.

Methods:
In total, 108 myopic lenticules were collected from patients undergoing the SMILE procedure. Fresh lenticules served as a control group for this study, whereas all other lenticules were separated into 8 groups, which were preserved at 4 different temperatures (room temperature [RT], 4, −20, and −80°C) with or without silica gel in anhydrous glycerol. Evaluated parameters included thickness, transmittance, hematoxylin and eosin staining, transmission electron microscopy, and immunohistochemistry analyses.

Results:
After a 3-month preservation period, lenticular thickness in these different groups was significantly increased, particularly for samples stored at RT. The mean percentage transmittance of lenticules stored at −80°C with or without silica gel was closest to that of fresh lenticules. Hematoxylin and eosin staining revealed sparsely arranged collagen fibers that were more scattered in preserved lenticules relative to fresh lenticules, particularly in RT samples. Transmission electron microscopy revealed that the fibril bundles densities in lenticules stored at RT were significantly less than those stored at other temperatures. Immunohistochemistry analyses revealed reductions in or loss of CD45 and human leukocyte antigens in all preserved lenticules relative to control samples.

Conclusions:
Of the tested approaches, the preservation of SMILE-derived lenticules over a 3-month period was optimal at −80°C with or without silica gel in anhydrous glycerol.
Bloodstream Infections at Two Neonatal Intensive Care Units in Ghana
Authors: Labi Appiah-Korang , Enweronu-Laryea Christabel C. , Nartey Edmund T. , Bjerrum Stephanie , Ayibor Prosper K. , Andersen Leif P. , Newman Mercy J. , Kurtzhals Jorgen A. L. 
Published: September 2021

Background:
Bloodstream infections (BSIs) are a major cause of morbidity and mortality in hospitalized neonates. Data on antibiotic resistance in neonatal BSIs and their impact on clinical outcomes in Africa are limited.

Methods:
We conducted a prospective cohort study at 2 tertiary level neonatal intensive care units (NICUs) in Ghana. All neonates admitted to the NICUs were included from October 2017 to September 2019. We monitored BSI rates and analyzed the effect of BSI and antibiotic resistance on mortality and duration of hospitalization.

Results:
Of 5433 neonates included, 3514 had at least one blood culture performed and 355 had growth of a total of 368 pathogenic microorganisms. Overall incidence of BSI was 1.0 (0.9–1.1) per 100 person days. The predominant organisms were Klebsiella pneumoniae 49.7% (183/368) and Streptococcus spp. 10.6% (39/368). In addition, 512 coagulase negative Staphylococci were isolated but considered probable contaminants. Among K. pneumoniae, resistance to gentamicin and amikacin was 91.8% and 16.4%, respectively, while carbapenem resistance was 4.4%. All-cause mortality among enrolled neonates was 19.7% (1066/5416). The mortality rate was significantly higher in neonates with BSI compared with culture-negative neonates in univariate analysis (27.9%, n = 99/355 vs. 16.5%, n = 520/3148; hazard ratio 1.4, 95% confidence interval 1.07–1.70) but not in multivariate analysis.

Conclusion:
The diversity of etiologic agents and the high-risk of antibiotic resistance suggest that standard empirical treatment is unlikely to improve the outcome of BSIs in low and middle income. Such improvements will depend on access to reliable clinical microbiologic services.
Exercise combined with Acceptance and Commitment Therapy compared with a standalone supervised exercise programme for adults with chronic pain: a randomised controlled trial
Authors: Casey Máire-Bríd , Smart Keith M. , Segurado Ricardo , Hearty Conor , Gopal Hari , Lowry Damien , Flanagan Dearbhail , McCracken Lance , Doody Catherine 
Published: September 2021

Abstract
A prospective, 2-armed, parallel group randomised controlled trial (RCT) was conducted to compare the effectiveness of Acceptance and Commitment Therapy (ACT) combined with a supervised exercise programme with a supervised exercise programme alone for adults with chronic pain. One hundred seventy-five participants were individually randomised to receive either the combined Exercise and ACT (ExACT) intervention or supervised exercise alone. Those allocated to the ExACT group attended 8 weekly sessions with a psychologist based on the ACT approach, in addition to supervised exercise classes led by a physiotherapist. The control group attended weekly supervised exercise classes but did not take part in an ACT programme. Both groups were followed up postintervention and again after 12 weeks. The primary outcome was pain interference at 12-week follow-up. Estimates of treatment effects at follow-up were based on intention-to-treat analyses, implemented using a linear mixed-effects model. The findings of this RCT showed no difference in the effectiveness of ExACT, compared with a supervised exercise programme alone for the primary outcome pain interference at 12-week follow-up (mean difference −0.18, 95% confidence interval −0.84 to 0.48, P = 0.59, d = 0.11). ExACT group participants reported superior outcomes for pain self-efficacy, pain catastrophising, and committed action, compared with the control group, but there were no differences between the groups for other secondary outcomes or treatment process measures. Higher levels of treatment satisfaction and global impression of change were reported by ExACT group participants. Exercise combined with Acceptance and Commitment Therapy was not superior to a standalone supervised exercise programme for reducing pain interference in adults with chronic pain.