bluuebunny/crossref_metadata_2025_split huggingface dataset:
#54: Sensitivity and Specificity of Procalcitonin vs C Reactive Protein in Identifying Pediatric Bacterial infections
Authors: Kim Sara , Bhatt Avni , Carr Silvana , Saccoccio Frances , Lew Judy 
Published: June 2021

Abstract

Background
Procalcitonin (PCT) and c-reactive protein (CRP) have been utilized in children to assess risk for serious bacterial infections. However, there have been different cut-offs reported for PCT and CRP, which yield different sensitivity and specificity. This study aims to compare the sensitivity and specificity of PCT and CRP in detecting serious bacterial infections (SBIs), specifically urinary tract infections, bacteremia and meningitis.

Methods
In this retrospective, single center cohort study from January 2018 to June 2019, we analyzed children with a fever greater than 38C with both PCT and CRP value within 24 hours of admission. Each patient had a blood, urine and/or cerebrospinal fluid culture collected within 48 hours of admission. No antibiotics were administered from the admitting hospital prior to collection of the PCT or CRP. Our gold standard was a positive culture obtained from blood, cerebrospinal fluid, or urine. The statistical analysis included categorical variables as percentages and compared them using the Fisher exact test. The optimal cutoff values for PCT or CRP were based on ROC curve analysis and Youden Index. Sensitivity and specificity analysis were based on literature review cut offs and ROC curves cut offs.

Results
Among 202 children, we had 45 culture positive patients (11 urinary tract infections, 4 meningitis, and 32 bacteremia). The patients with culture positivity had higher PCT levels (7.9 ng/mL vs 2.5 ng/mL, P=0.0111), CRP levels (110.9 mg/L vs 49.6 mg/L, P&lt;0.0001) and temperature (39.2C vs 39C, P&lt;0.0052). The area under the curve (AUC) comparing culture positivity vs negativity for all culture types was 0.72 (p&lt;0.0001) for PCT and 0.66 (p=0.001) for CRP. In Figure 1, the AUC for culture positive bacteremia was 0.68 (p=0.0011) for PCT and 0.70 (p=0.0003). The AUC for culture positive urinary tract infections (UTI) only was 0.86 (p=0.0001) for PCT and 0.70 (p=0.3607). For the cut-off value for PCT at 0.5 ng/mL, the sensitivity and specificity was 64% (95% confidence interval [CI] 0.5–0.77) and 70% (95% CI 0.62–0.77) respectively in identifying children with bacterial infection. For the cut-off value for CRP at 20 mg/L, the sensitivity and specificity was 67% (95% CI 0.52–0.79) and 52% (95% CI 0.44–0.59) respectively in identifying children with bacterial infection.

Conclusion
In this study, PCT and CRP are nearly equivalent classifiers for detecting SBIs as a group and bacteremia, but PCT is statistically better for urinary tract infections; however, the clinical utility is unknown.
#7: Clinical Characteristics of Children with COVID-19: A Multicenter Study in the United Arab Emirates
Authors: Ennab Farah , ElSaban Mariam , Khalaf Eman , Tabatabaei Hanieh , Amar H K , Devi Bindu Radha , Hanif Kashif , Elhassan Hiba , Saravanan Ketharanathan , Cremonesini David , Popatia Rizwana , Malik Zainab A , Ho Samuel B , Abusamra Rania 
Published: June 2021

Abstract

Background
To date, coronavirus disease-2019 (COVID-19) has infected over 82 million people globally. The first confirmed case in the United Arab Emirates (UAE)was reported on 29th January 2020. Current data suggests that children with COVID-19 have a mild disease course. There is a lack of extensive published data about COVID-19 infection among children in the Arabian Gulf region.

Methods
This cross-sectional multicenter study included children with confirmed COVID-19 infection admitted between March 1st and June 15th, 2020 to three large hospitals in Dubai, UAE. Serial nasal swabs for COVID-19 polymerase chain reaction (PCR) testing were collected during hospitalization. We investigated patients’ demographics,clinical characteristics, radiological and laboratory investigations during their inpatient hospital course.

Results
111 children were included in our study and represented 22 nationalities. Fifty-nine (53.2%) were boys. The mean age was 7 years (±5.3), and 15.3% of children were younger than 1 year. Only 4 (3.6%) children had pre-existing asthma, all of whom had an uneventful clinical course. At presentation 43 (38.7%) were asymptomatic, 68 (61.2%) had mild or moderate symptoms and none had severe illness requiring intensive care. Fever (20.7%), cough (19.8%) and rhinorrhea (15.3%) were the most common presenting symptoms, most of which resolved by day 5 of hospitalization. Most of our patients had a normal chest x-ray. The most common laboratory abnormalities on admission included variations in neutrophil count (24.7%), aspartate transaminase (22.5%), alkaline phosphatase (36.7%) and lactate dehydrogenase (42.5%). Children were infrequently prescribed targeted medications, with only 4 (3.6%) receiving antibiotics. None of the 52 patients tested for viral co-infections were positive. COVID-19 PCR turned negative at a median of 10 days [6–14 days] after the first positive test. Overall, there was no significant difference in time to negative PCR between symptomatic and asymptomatic children.

Conclusion
This pediatric study of COVID-19 presents a first look into the burden of COVID-19 infection among children in the UAE. Patients had various laboratory abnormalities despite clinical stability. We conclude that a large percentage of children with COVID-19 infection experience no symptoms, and severe disease is uncommon in the UAE. Ongoing surveillance, contact tracing and public health measures will be essential in containing future outbreaks.
#29: Analysis of Mortality Due to Infections in Pediatric Patients in the Oncology Unit of a Third Level Hospital in La Paz, Bolivia
Authors: Marisol Trujillo-Gutierrez , Pablo Rodriguez-Auad Juan 
Published: June 2021

Abstract

Background
In recent decades, advances in cancer treatment have made it possible to improve the prognosis of hemato-oncological patients, however, mortality is still high in developing countries. One of the most important causes of morbidity and mortality during the treatment of children with cancer is infectious complications, especially in the induction phase. The multiple interventions that are carried out during treatment, such as the use of catheters, increase the risk of developing these infections, which can be more frequent if the recommended strategies to prevent them are not applied. The objective of this study was to investigate what were the causes of death in children with cancer at our institution.

Methods
The medical records of deceased patients were analyzed in the onco-hematology unit of the Children′s Hospital “Dr. Ovidio Aliaga Uria” in the city of La Paz, Bolivia. The causes of mortality, the stage of chemotherapy in which the death occurred, its relationship with infections and the microorganism identified during 2020 were classified.

Results
During 2020, 19 deaths were found in cancer patients, the mean age was 8.5 years and of which 52% were male. Regarding the basic diagnosis, there was a higher proportion of hematological diseases 68% and solid tumors 32%. Among the causes of death, 58% were due to their underlying pathology where most of the patients were in palliative care or in relapse and 42% were due to infectious causes, of which 62% were in induction phase of chemotherapy. Among the 8 patients who died from infections, the following causes were found: 50% neutropenic colitis, 25% bacteremia and 25% necrotizing fasciitis; in 7 (87.5%) patients the microorganism was isolated in blood culture, these were E. coli 43%, Klebsiella spp 43% and Bacillus spp 14%. Gram negative bacilli (GNB) represented 86% of the isolates and 50% were producers of extended spectrum beta-lactamases (ESBL).

Conclusions
Considering that infections are preventable and are among the most important causes of mortality in children with cancer in our hospital, it is essential that infection control teams are developed that apply evidence-based strategies to prevent these infections and thus achieve a reduction in morbidity and mortality, applying programs with training of human resources and equipment to reduce these deaths.
#32: Single Center Experience with the Use of Convalescent Plasma Transfusion (CPT) for COVID-19 + Patients in Argentina
Authors: Gómez Sergio Miguel 
Published: June 2021

Abstract

Background
COVID-19 pandemic challenged health sanitary systems worldwide. 1.65 million cases have been reported in Argentina with 43.635 deaths. CPT emerged as a possible and feasible treatment. Transfusion cardiovascular overload (TACO), acute lung injury (TRALI) and anaphylactic reactions (AR) have raised safety concerns; in the other hand, it is still unknown its efficacy but preliminary reports have claimed that if it is delivered early, mortality or morbidity could be decreased. Pediatric use of CPT is emerging from adults’ studies.

Objective
To review clinical outcomes, laboratory parameters and side effects of CPT in a single center in Argentina and determine the mortality rate.

Methods
This is a single-center single-arm exploratory-descriptive prospective study, starting on May 1, 2021 until October 31, 2021. A protocol developed for donation of CPT included those individuals with SARS-CoV-2 RT- PCR positive in respiratory secretions and SARS-CoV-2 antibody positive by immunochromatography o chemiluminescence, with a titer by ELISA (Covidar®) &gt; 1:400 and 200 – 250 mL were considered 1 Unit. Recipients weighing &lt;70 kg received 1 unit, and those recipients weighing &gt;70kg received 2 units. CPT was prescribed within 14 days of starting SARS-CoV-2 symptoms. All patients received dexamethasone and standard support measures. We used percentages and frequencies for reporting the results of this study. Categorical variables were compared with Chi2 and numeric Fisher/Mann Whitney. Time dependent survival variables were calculated with Kaplan Meier method. SPPS 20 software was used for data processing.

Results
The CPT recipients median age (IQR) was 47 years of age (range 43–59 years); 65.5 % were; 12,5% had either hypertension or obesity, 3.1% chronic obstructive lung disease; 30% had diabetes. The median temperature at diagnosed was (IQR) 37.7°C (range 36.6°C - 38.9°C). A total of 39 CPT units were infused in 32 patients. 25 patients (78%) received 1 unit, 6 patients (19%) received 2 units and 1 patient (3%) received 3 units (3%). Donor median (IQR), SARS-CoV-2 antibody titer was 1:400 (range 400–1600); median time (IQR) to transfusion was 1 day (range 1–4). Coverage was 100%.

Outcomes
29 patients (91%) survived and 3 (9%) died for COVID-19. Only 3 patients (8%) developed moderate/reversible side effects: allergic reaction (2 pts) and TRALI(1pt) At a median time of 100 days, the median survival was 85% (0.5) and the mortality rate was 19 % (0.6).
Laboratory features:

Conclusion
CPT was feasible to deliver and could be implemented in a less resourced country in a timely fashion. All our patients could afford plasma therapy. No severe adverse events were reported. Pediatric studies can be based on the results of this type of study. Research should focus now on a control case cohort study to determine efficacy of CPT.
Writing about Polyphony, Talking about Civilization: Charles Burney’s Musical ‘Corns and Acorns’
Authors: Semi Maria 
Published: June 2021

Abstract
In the eighteenth century polyphony—from simply being a term denoting a musical technique—became an evaluative-descriptive concept, following this path in association with the idea of civilization. Retracing Burney’s steps as a music historian and a music critic, the article shows how the Musical Doctor adopted a specific kind of narrative developed by Scottish conjectural historians that saw history as unfolding through several specific stages, progressively abandoning simplicity for the complexities of civilization. This seemingly linear narrative is complicated both by showing how making every music fit into this linear scheme was not easy, and by bringing forth the arguments developed especially by Scottish literati in order to explain why their native musical tradition could be considered equal or superior to Western art-music. The discourse, with Rousseauian echoes, that allowed the association between simplicity and positive values that were to be opposed to the excesses and depravity of civilized life, was articulated through the intellectual tools developed during the debate about luxury that raged through the eighteenth century. Nestled in the luxury debate, the non-literate music tradition that in non-Western locations had been considered as an instance of ‘barbarism’ now stood for a noble ‘simplicity’, whose value consequently reversed making artlessness a possible element of sublime beauty. The contradictions in Burney’s attitude towards non-Western musics and national European musics—on the one hand tirelessly collecting information about music-making from any corner of the world and on the other hand promoting only those values that made multi-part music the emblem of musical civilization—will serve to explain the interplay between ideas related to polyphony, civilization, and national musics in the eighteenth century.
The parental experience and perceptions of blenderized tube feeding for children with medical complexity
Authors: Soscia Joanna , Adams Sherri , Cohen Eyal , Moore Clara , Friedman Jeremy N , Gallagher Kelsey , Marcon Margaret , Nicholas David , Weiser Natalie , Orkin Julia 
Published: June 2021

Abstract

Objectives
Parents of children with medical complexity are often expected to implement complicated plans of care, such as enteral tube feeding, to support the health of their child. Enteral feeding can have psychosocial implications for the parent, child, and family. Blenderized tube feeding (BTF) refers to the administration of pureed food and drinks through a feeding tube. Little is known regarding parents’ experiences with BTF. Therefore, the purpose of this qualitative study was to understand the lived experience of BTF from the parent’s perspective.

Methods
This qualitative study was a grounded theory analysis utilizing semi-structured interviews of parents who provided at least 50% of their child’s diet through BTF. Participants were recruited using purposive sampling from the Complex Care Program at a tertiary care paediatric centre. Interviews were conducted until thematic saturation was achieved. Themes were identified using constant comparative analysis of transcribed interviews.

Results
Parents (n=10) felt that BTF positively affected the experience of tube feeding and enhanced their child’s health and wellbeing. Parents described BTF as a means of self-empowerment and a mechanism to normalize feeding and care for the entire family. Despite reporting BTF as more time consuming than formula feeding, all parents were satisfied with having made the change, and planned on continuing the diet.

Conclusion
BTFs can improve the experience of tube feeding and positively address some of the negative psychosocial implications of enteral tube feeding, providing a sense of normalcy and control for parents caring for a child with medical complexity.
Deformation effect on nuclear density profile and radius enhancement in light- and medium-mass neutron-rich nuclei
Authors: Horiuchi Wataru , Inakura Tsunenori 
Published: June 2021

Abstract
The mass number dependence of nuclear radii is closely related to the properties of nuclear matter. It is known that most nuclei exhibit some deformation. We discuss how the nuclear density profile is modified by nuclear deformation to elucidate the enhancement mechanism of nuclear radii through a systematic investigation of neutron-rich Ne, Mg, Si, S, Ar, Ti, Cr, and Fe isotopes. Skyrme–Hartree–Fock calculations are performed in a 3D Cartesian grid to describe the nuclear deformation in a non-empirical way. The role of nuclear deformation in nuclear density profiles is explored in comparison to calculations with a spherical limit. We find correlations between nuclear deformation and the internal nuclear density. The evolution of nuclear radii appears to follow the core swelling mechanism recently proposed in spherical nuclei [W. Horiuchi and T. Inakura, Phys. Rev. C 101, 061301(R) (2020)], and the radius is further enhanced by nuclear deformation. This study demands further theoretical and experimental investigations for the internal density.
WALANT Hand Surgery Does Not Require Postoperative Opioid Pain Management
Authors: Dar Qurratul-Ain , Avoricani Alba , Rompala Alexander , Levy Kenneth H. , Shah Neil V. , Choueka David , White Colin M. , Koehler Steven M. 
Published: June 2021

Background:
Currently, opioids are the standard of care for postoperative pain management. Avoiding unnecessary opioid exposure in patients is of current interest because of widespread abuse.

Methods:
This is a prospective cohort study in which wide-awake, local anesthesia, no-tourniquet (WALANT) technique was used for 94 hand/upper extremity surgical patients and compared to patient cohorts undergoing similar procedures under monitored anesthesia care. Patients were not prescribed opioids postoperatively but were instead directed to use over-the-counter pain relievers. Pain scores on a visual analogue scale were collected from patients preoperatively, and on postoperative days 1 and 14. WALANT visual analogue scale scores were compared to those of the two patient cohorts who either did or did not receive postoperative opioids after undergoing similar procedures under monitored anesthesia care. Electronic medical records and New York State’s prescription monitoring program, Internet System for Tracking Over-Prescribing, were used to assess prescription opioid-seeking. Information on sex, age, comorbidity burden, previous opioid exposure, and insurance coverage was also collected.

Results:
Decreased pain was reported by WALANT patients 14 days postoperatively compared to preoperatively and 1 day postoperatively, with a total group mean pain score of 0.37. This is lower than mean scores of monitored anesthesia care patients with and without postoperative opioids. Only two WALANT patients (2.1 percent) sought opioid prescriptions from outside providers. There was little evidence suggesting factors including sex, age, comorbidity burden, previous opioid exposure, or insurance status alter these results.

Conclusion:
WALANT may be a beneficial technique hand surgeons may adopt to mitigate use of postoperative opioids and reduce risk of abuse in patients.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, II.
Usefulness of Model-Based Iterative Reconstruction in Brain CT as Compared With Hybrid Iterative Reconstruction
Authors: Sekino Hirofumi , Ishii Shiro , Kuroiwa Daichi , Fujimaki Hideki , Sugawara Shigeyasu , Suenaga Hiroki , Hakozaki Motoharu , Yamakuni Ryo , Watanabe Hirotake , Hasegawa Osamu , Ito Hiroshi 
Published: June 2021

Objective
The aim of this study was to compare the contrast of gray to white matter between forward-projected model-based iterative reconstruction solution (FIRST) and hybrid iterative reconstruction (IR) by measuring computed tomography value of brain parenchyma.

Methods
Computed tomography values of the gray and white matter in 15 areas of 21 patients (7 males, 14 females; average age, 49.5 ± 10.7 years) were measured and compared between FIRST and hybrid IR with filtered back projection (FBP) using 2 different reconstruction kernels FC21 and FC26.

Results
The ratio of gray to white matter obtained using FIRST (1.25 ± 0.08) was significantly higher than that obtained using FBP with both kernel FC21 (1.13 ± 0.03) and kernel FC26 (1.22 ± 0.06).

Conclusions
FIRST increases the contrast between the gray and white matter, and decreases noise in brain computed tomography compared with FBP with hybrid IR.
The Effects of the Fat Distribution of Body, Skeletal Muscle Mass and Muscle Quality on Acute Pancreatitis Severity: A Retrospective Cross-Sectional Study
Authors: Akturk Yeliz , Ozbal Gunes Serra , Hekimoglu Baki 
Published: June 2021

Objective
We aim to investigate a possible relationship between acute pancreatitis (AP) and body fat and muscle parameters in computed tomography (CT).

Methods
Computed tomography images of 107 patients with AP were scored in terms of AP severity using the modified CT severity index. Muscle mass, muscle mass index, visceral and subcutaneous adipose tissue area, multifidus muscle/fat attenuation ratio, total psoas index (TPI) and Hounsfield units average calculation (HUAC) values were performed.

Results
Total psoas index and HUAC of mild AP cases were significantly higher than those with moderate and severe AP. The TPI of patients with severe pancreatic necrosis were found to be significantly lower than those without necrosis. Hounsfield units average calculation of cases without necrosis were significantly higher than those with severe necrosis in the pancreas.

Conclusions
Our study indicated that lower volume and density of psoas muscle associated with worse CT severity score and larger pancreatic necrosis in patients with AP.
Thirty-Day Hospital Readmissions for Acute Gout in the United States
Authors: Kichloo Asim , Edigin Ehizogie , Jamal Shakeel , El-amir Zain , Aucar Maria Isabel , Wani Farah , Eseaton Precious O. , Annapureddy Narender , Cabling Marven G. , Manadan Augustine M. 
Published: June 2021

Background/Objective
The aims of this study were to describe the rates and characteristics of nonelective 30-day readmission among adult patients hospitalized for acute gout and to assess predictors of readmission.

Methods
We analyzed the 2017 Nationwide Readmission Database. Gout hospitalizations were identified using the International Classification of Diseases, Tenth Revision, Clinical Modification code. Hospitalizations for adult patients were included. We excluded planned or elective readmissions. We utilized χ2 tests to compare baseline characteristics between readmissions and index hospitalizations. We used multivariate Cox regression to identify independent predictors of readmissions.

Results
A total of 11,727 index adult hospitalizations with acute gout listed as the principal diagnosis were discharged alive and included. One thousand five hundred ninety-four (13.6%) readmissions occurred within 30 days. Acute gout was the most common reason for readmission. Readmissions had higher inpatient mortality (2.4% vs 0.1%, p < 0.0001), greater mean age (68.1 vs 67.0 years, p = 0.021), and longer hospital length of stay (5.9 vs 3.8 days, p < 0.0001) compared with index hospitalizations. Charlson Comorbidity Index scores of ≥2 (score 2: adjusted hazards ratio [AHR], 1.67; p = 0.001; score ≥3: AHR, 2.08; p < 0.0001), APR-DRG (All Patients Refined Diagnosis Related Groups) severity levels ≥2 (level 2: AHR, 1.43; p = 0.044; level 3: AHR, 1.83; p = 0.002; level 4: AHR, 2.38; p = 0.002), admission to metropolitan hospital (AHR, 1.83; p = 0.012), atrial fibrillation (AHR, 1.31; p = 0.004), and anemia (AHR, 1.30; p = 0.001) were significantly associated with 30-day readmissions.

Conclusions
Acute gout readmissions were associated with worse outcomes compared with index hospitalizations. Charlson Comorbidity Index scores ≥2, APR-DRG severity levels ≥2, admission to metropolitan hospital, atrial fibrillation, and anemia were significant predictors of readmission.