bluuebunny/crossref_metadata_2025_split huggingface dataset:
Malignant mesothelioma of tunica vaginalis: Two extremely rare case reports
Authors: Karabacakoğlu Burak , Kısa Erdem , Özbilen Mert Hamza , Karademir Barış , Yardım Serdar , Çelik Orçun , Süelözgen Tufan , İlbey Yusuf Özlem 
Published: June 2021

Introduction: Malignant mesothelioma (MM) of tunica vaginalis is a very rare tumor and it has a poor prognosis. It is not easy to diagnose the disease preoperatively because there is a lack of comprehensive studies and information about the disease. We would like to present our two cases with severe scrotal edema and hydrocele, which were debrided perioperatively due to scrotal necrosis, followed by radical inguinal orchiectomy and subsequently diagnosed as MM of tunica vaginalis. Case 1: A 74-year-old male patient with bilateral scrotal swelling for 6 months. Right radical inguinal orchiectomy was performed. The pathology result of right radical inguinal orchiectomy material was compatible with malignant mesothelioma of tunica vaginalis. Case 2: A 90-year-old male patient with complaints of right scrotal swelling for 3 years. A right radical inguinal orchiectomy was performed. The pathology result of right radical inguinal orchiectomy material was compatible with malignant mesothelioma of tunica vaginalis. Conclusion and discussion: MM has a very poor prognosis therefore early treatment plan should be made. Surgery is the main treatment for malignant mesothelioma of the testis. Although chemotherapy and radiotherapy play an active role in the treatment of metastatic disease, surgery is the first-line therapy in the treatment of the tumor. Also; long-term hydrocele, recurrent epididymitis, scrotal edema can make it harder to detect the tumor diagnosis. MM should be considered in such patients. Necrosis and abscess appearance was not mentioned before in published case reports. In this respect, it should not be ignored the long-term hydrocele situation and the appearance of abscess-epididymitis that cannot be treated properly.
Hypercoagulability in Septic Shock Patients With Thrombocytopenia
Authors: Kim Sang-Min , Kim Sang-Il , Yu Gina , Kim June-Sung , Hong Seok In , Kim Won Young 
Published: June 2021

Background: Despite thrombocytopenia, patients with sepsis often experience hypercoagulability. However, limited information is available on the prevalence and effect of hypercoagulability in patients with sepsis-induced thrombocytopenia. Hence, we evaluated the prevalence of hypercoagulability and the association between hypercoagulability and clinical outcomes in septic shock patients with thrombocytopenia. Methods: Thromboelastography (TEG) was performed prospectively in 1294 patients with septic shock at the emergency department (ED) between January 2016 and December 2019. After excluding 405 patients who did not require resuscitation, refused enrollment, or developed septic shock after ED presentation, 889 patients were included. We defined thrombocytopenia as an admission platelet count lower than 150,000/µl according to SOFA score. We defined hypocoagulability and hypercoagulability as coagulation index (CI)< −3 and >3 on TEG, respectively. Results: Of the 889 septic shock patients (mean age 65.6 ± 12.7 years, 58.6% male), 473 (53.2%) had thrombocytopenia. Eighty-five (18.0%) patients showed hypercoagulable TEG and73 (15.4%) patients showed hypocoagulable TEG. The hypercoagulable TEG group had a significantly higher fibrinogen level and a lower 28-day mortality rate than the normal and hypocoagulable TEG groups (518 vs. 347 and 315 mg/dL; 7.1% vs. 21.1% and 36.8%, P < 0.01, respectively). In multivariate analysis, hypercoagulable TEG was associated with a decreased mortality rate (odds ratio: 0.395; 95% confidence interval, 0.162-0.965). Conclusions: In septic shock patients with thrombocytopenia, hypercoagulability was not uncommon. TEG can quickly distinguish the hypercoagulability and hypocoagulability states and serve as a valuable tool for evaluating the degree and risk in septic shock patients with thrombocytopenia.
Use of β-D-glucan in diagnosis of suspected Pneumocystis jirovecii pneumonia in adults with HIV infection
Authors: Juniper Thomas , Eades Chris P , Gil Eliza , Fodder Harriet , Quinn Killian , Morris-Jones Stephen , Gorton Rebecca L , Wey Emmanuel Q , Post Frank A , Miller Robert F 
Published: June 2021

Objectives: An elevated serum (1-3)-β-D-glucan (BDG) concentration has high sensitivity for a diagnosis of Pneumocystis pneumonia (PCP) in people with HIV (PWH). At the current manufacturer-recommended positive threshold of 80 pg/mL (Fungitell), specificity for PCP is variable and other diagnostic tests are required. We evaluated the utility of serum BDG for diagnosis of suspected PCP in PWH at three inner-London hospitals to determine BDG concentrations for diagnosis and exclusion of PCP. Methods: From clinical case records, we abstracted demographic and clinical information and categorised patients as having confirmed or probable PCP, or an alternative diagnosis. We calculated sensitivity, specificity and positive predictive value (PPV) of serum BDG concentrations >400 pg/mL and negative predictive value (NPV) of BDG <80 pg/mL. Results: 76 patients were included; 29 had laboratory-confirmed PCP, 17 had probable PCP and 30 had an alternative diagnosis. Serum BDG >400 pg/mL had a sensitivity of 83%, specificity of 97% and PPV 97% for diagnosis of PCP; BDG <80 pg/mL had 100% NPV for exclusion of PCP. Conclusions: In PWH with suspected PCP, BDG <80 pg/mL excludes a diagnosis of PCP, whereas BDG concentrations >400 pg/mL effectively confirm the diagnosis. Values 80–400 pg/mL should prompt additional diagnostic tests.
Situating the Efficacy of Certificate Course in Social Work: A Case of First-Ever Course in Bhutan
Authors: Chhetri Ramesh K. , S Dorji , Dorji Tshering , Wangchuk Sangay 
Published: June 2021

Purpose: With the transition of political, economic, and social scenario in Bhutan, the civil society organizations (CSOs) have been expanding over the years. However, a paucity of trained social workers in Bhutan has compelled the CSOs to recruit employees with varying degrees. Considering such situation, this study was designed to understand the efficacy of Bhutan’s first-ever certificate course in social work offered by Samtse College of Education from the vantage point of the participants. Method: It adopted a convergent parallel mixed-method design, primarily employing questionnaires and semistructured individual interviews. Results: The study found the certificate course to be highly effective in enhancing the professional competence of the social workers in Bhutan. Discussion: The study supports the need to provide similar courses to hundreds of untrained social workers in Bhutan who are aspiring to upgrade their professional competence.
Factors Influencing the Vietnamese Older Persons in Choosing Healthcare Facilities
Authors: Nguyen Tuyet Anh , Giang Long Thanh 
Published: June 2021

Background: The rapidly growing aging population poses major challenges for health systems in Vietnam. This study was therefore aimed to examine factors influencing the choices of healthcare facilities among older patients in Vietnam, using a national survey on older people. Methods: We applied multinomial logistic regression models based on Andersen’s Behavioral Model with various predisposing factors, enabling factors and healthcare-needs factors associated with different types of healthcare facilities where older patients utilized services. Data: We used data from the Vietnam Aging Survey (VNAS) in 2011. This was the first-ever nationally representative survey on older persons in Vietnam. Results: Among those who used healthcare services, 15.1% visited central hospitals; 23.6% visited provincial hospitals; 28.0% visited district hospitals; 8.8% visited commune heath centres; 18.3% visited private hospitals/clinics; and 6.2% visited other facilities. The results showed that “having to pay cost” and “having sufficient income” were strong predictors for using commune health centres, district hospitals, and private facilities, while “having health insurance” was not a significant predictor for using these facilities. Also, we showed that apart from enabling factors (such as age, gender, educational levels, employment status, living regionand place of residence), predisposing factor (such as health insurance, perceived sufficient income, household wealth and having to pay medical cost) as well as need factors (such as self-rated health and chronic disease) were also associated with the choice of healthcare facilities. Conclusions: Based on the findings, we discussed the implications of the results for organizing healthcare finance and delivery to achieve efficiency and equity for older people in Vietnam.
Masses of the Sternoclavicular Area: Case Series and Review of the Literature
Authors: Oviedo Parisa , Bliss Morgan 
Published: June 2021

Objective: Masses of the sternoclavicular area are rare, and are not well described in the literature. We aim to present a series of patients with masses in this location and to review all reported English language cases of sternoclavicular masses in pediatric patients. Methods: This is a case series of pediatric patients with masses of the sternoclavicular area presenting to a tertiary care pediatric hospital from 2010 through 2017. Data was collected by using ICD-9 and ICD-10 codes to query the electronic medical record. Chart review included age at presentation, mass characteristics, medical and surgical interventions, and pathology results. A review of the literature was then performed. Results: Ten patients with masses overlying the sternoclavicular area were identified. Four patients presented with abscess and were treated with incision and drainage. Three of these patients were then treated with staged excision once infection cleared. Two additional patients were treated with primary excision. Four patients were treated with observation. The most common histopathologic finding was epidermoid. One patient was found to have a dermoid cyst, and 1 had a congenital cartilaginous rest. Conclusion: Epidermoids and dermoids are the most common masses overlying the sternoclavicular area. Controversy remains regarding the embryologic origin of sternoclavicular masses. The differential for masses in this area also includes branchial remnants, bronchogenic cysts, ganglion cysts, or septic arthritis.
A Single Center Study of ProGlide Used for Closure of Large-Bore Puncture Holes After EVAR for AAA
Authors: Mathisen Sven Ross , Nilsson Kristofer F. , Larzon Thomas 
Published: June 2021

Purpose: The objective of this study was to evaluate the primary and assisted secondary percutaneous and non-invasive technical success of the ProGlide device on all-comers in a consecutive case series of percutaneous endovascular aortic aneurysm repair (P-EVAR). Method: A single-center consecutive case series where 434 elective and acute P-EVAR procedures were registered prospectively between May 2011 and July 2017. The mean age was 74.5 years ± SD 11.4 years. 82.3% of the patients were male. All patients were pre-planned from CT angiography. Percutaneous access punctures, performed in local anesthesia in the common femoral artery, with a final introducer size between 12-22 Fr OD were included and stratified in 2 groups, 12-16 Fr and 17-22 Fr. Results: By screening 868 access groins 22 groins were excluded. Of the remaining 846 groins, intended to be treated with ProGlide, 9 groins were excluded peri-procedurally and treated with the Fascia Suture Technique or surgical cutdown. The remaining 837 groins had access closure with ProGlide, with a mean value of 2.15 devices per groin with a slight significant difference between the 2 stratification groups. Primary ProGlide technical success was achieved in 68.1% of the groins. Secondary percutaneous or non-invasive technical success was achieved in 96.9%. Here there was no statistically significant difference between the 2 stratification groups. Thirty-one (3.7%) groin complications were registered during 30-day follow-up and 17 required additional treatment. Total mortality was 2.8%. None of these deaths were related to the access site. Conclusion: ProGlide by itself has a significant failure rate in the closure of large-bore access holes on an unselected cohort of patients eligible for P-EVAR. However, together with adjunct percutaneous or non-invasive methods a success rate of 97% can be achieved. The access complication rate was lower than 4% at 30-day follow-up.
Percutaneous Fixation of Unstable Proximal Phalanx Fractures: A Biomechanical Study
Authors: Nikci Valdet , Effiong Linda , Freibott Christina E. , Gardner Thomas R. , Strauch Robert J. 
Published: June 2021

Background Unstable extra-articular proximal phalanx fractures are common injuries to the hand that are often treated by closed reduction and percutaneous pinning. Fracture-induced shortening of the proximal phalanx leads to an extensor lag at the proximal interphalangeal joint. We describe a biomechanical study in cadaver hands to compare the ability of each of three different pin configurations to resist shortening in unstable fractures. Methods Seventeen fresh frozen hands were disarticulated at the proximal ends of the metacarpals. The second, third, and fourth proximal phalanges were tested. A 5-mm section of bone was resected from the mid-shaft of proximal phalanx to simulate an unstable fracture. Three techniques were employed and randomized for each finger: transmetacarpophalangeal joint pinning using 1 or 2 Kirschner wires (K-wires) and periarticular cross pinning using 2 K-wires. Compressive axial loads and energy at 1 mm, 2 mm, 3 mm, 4 mm, and 5 mm of subsidence were examined. Results The forces and energy required to shorten the finger for each amount of subsidence were similar for all 3 pinning techniques and for all 3 finger types. Greater amounts of shortening were found to require larger forces. Conclusion Closed reduction and percutaneous pinning using any of the presented techniques is an adequate method of treatment for unstable proximal phalanx fractures. All of the techniques were equivalent in their ability to resist axial loading, regardless of the complexity of technique, the number of pins used, or finger that was pinned.
Our clinical experiences of vascular injuries due to lumbar disc surgeries
Authors: Kaygin Mehmet Ali , Halici Umit 
Published: June 2021

Objectives We aimed to evaluate emergency vascular complications of the lumbar disc reconstructive surgery in this study. Method Between March 2006 and February 2020, nine patients (six males and three females; mean age: 53.4 ± 9.6 years; range: 38–64 years) who underwent emergent vascular intervention during lumbar spinal disc reconstructive surgery in our clinic were included in this retrospective study. Result The left common iliac artery injury, the left common iliac artery and left common iliac vein injuries, bilateral common iliac artery and abdominal aortic injuries, and vena cava inferior injury with left common iliac vein and right common iliac vein injuries were detected in two, three, two, and two patients, respectively. In addition, 16 mm Dacron tube graft interposition and graft patch plasty were performed in one and two patients who had an abdominal aortic injury, respectively. Also, 8 mm polytetrafluoroethylene straight graft interposition was performed in two patients with left common iliac artery injury, and lateral wall repair was performed in other patients. Graft patch plasty and 8 mm polytetrafluoroethylene graft interposition were performed in one patient with vena cava inferior injury and left common iliac vein injury, respectively. Also, lateral wall repair was performed in other patients with venous injuries. Deep venous thrombosis had developed in three patients, and one patient of these had a pulmonary embolism. Conclusion The incidence of vascular injury after the lumbar disc surgery is relatively low; however, the emergency vascular operation should be performed as soon as possible.
Reemployment Needs and Barriers of Users of Workforce Development Programs: A Mixed-Methods Study
Authors: Madigan Dana , Bonney Tessa 
Published: June 2021

Background: Employment is an important social determinant of health, and supporting individuals’ return to the workforce is likely to have robust impacts on their health and well-being. The aim of this study was to identify (a) the self-perceived employment needs and expectations of users of community employment services; (b) the assets, needs, and barriers to reemployment among users of community employment services; and (c) areas of priority for programmatic development, including implications for patient–worker needs assessment and care coordination in clinical settings. Methods: We conducted structured interviews with 71 adults recruited from three workforce development programs located in the Chicago metropolitan area serving vulnerable workers. Topics of discussion included job histories, financial and social assets, and the respondents’ motivation and expectations for their return to the workforce. We used descriptive statistics to analyze quantitative responses and performed content analysis for qualitative data. Findings: Users reported discrimination, legal barriers, family responsibilities, physical or mental health concerns, and needs related to transportation and housing as common challenges to reemployment. Concerns regarding navigating complex social support programs to meet individual and family needs, as well as uncertainty regarding what would qualify as sufficient employment in order to not be reliant on these programs in the future, were expressed. Conclusion/Application to practice: Health care providers have opportunities to identify those that may benefit from comprehensive referrals to reemployment programs and social services. Occupational health providers are also in a unique position to enhance workforce development programs through collaborations to better educate and support workers.
Smoking is associated with prolonged time of the return to daily and sport activities and decreased knee function after meniscus repair with outside-in technique: Retrospective cohort study
Authors: Domzalski Marcin , Muszynski Krystian , Mostowy Marcin , Wojtowicz Julia , Garlinska Anna 
Published: June 2021

Background: Arthroscopic repair of post-traumatic meniscal lesion is one of the most common procedures in the orthopedics. Although algorithm of the treatment of meniscal lesion, this procedure is rarely discussed in combination with smoking as a risk factor for the meniscal healing. Purpose: The aim of this study was to assess the knee function, and the amount of time needed to return to daily and sport activities after the non-bucket-handle meniscal outside-in repair depending on Tobacco use. Methods: Retrospective chart review identified 99 patients after isolated outside-in meniscal repair within a series of 292 consecutive patients who underwent meniscus repair during a 3 years period. Ninety-two patients were available for follow-up and were divided into smokers and non-smokers group. Demographic data were collected from their medical records which included: age and body mass index, gender, side of index knee, duration of symptoms prior to surgery, meniscal involvement. At the time of the minimum 2 years follow-up examination: KOOS, time of the return to daily activities, time of the return to sport activities, and Tegner scale were collected. Results: The smoking and non-smoking groups were similar in age, sex, BMI, side, meniscus involved, Tegner scale, and duration of symptoms. Smokers population was 3.5 years older on average. The knee function was significantly better in non-smokers group with average KOOS score 80.2 vs 67.4 in smokers group. In smokers population delayed time of return to daily activities (5.4 vs 4.2 months) and prolonged time of the return to sport activities (9.4 vs 7.6 months) were observed. Conclusions: Smoking is associated with significantly prolonged time of the return to daily and sport activities and decreased knee function after meniscus repair with outside-in technique. Level of evidence: III
Tolerating subretinal fluid in the treatment of neovascular age-related macular degeneration with intravitreal aflibercept
Authors: Yildiz Dilan , Cakir Akin , Erden Burak , Bolukbasi Selim , Erdenöz Serkan , Elcioglu Mustafa Nuri 
Published: June 2021

Objective: To compare the anatomical and functional outcomes of intensive and relaxed intravitreal aflibercept regimen in the management of neovascular age-related macular degeneration. Methods: The medical records of 50 eyes of 50 patients with treatment-naive neovascular age-related macular degeneration, who underwent intravitreal aflibercept therapy in the Retinal Department of University of Health Sciences Okmeydanı Training and Research Hospital (Istanbul, Turkey), were retrospectively reviewed. The demographic features and best-corrected visual acuities at baseline and at 1st-, 2nd-, 3rd-, 4th-, 6th-, 10th- and 12th- months, optical coherence tomography measurements, presence of intraretinal fluid, subretinal fluid and intraocular pressure values were studied. The patients were divided into two groups: intensive (subretinal fluid intolerant) and relaxed (<200 microns subretinal fluid tolerated) intravitreal aflibercept regimens. Results: The change in the mean best-corrected visual acuities from baseline to 12th month was 13.72 ± 33.97 letters in the intensive treatment group and 8.68 ± 27.22 in the relaxed group. There was no statistically significant difference between the groups ( p = 0.566). Similar proportions of both groups achieved ⩾10 letters gain (%48 vs. %40, respectively; p = 0.755) and ⩾10 letters loss (%20 vs. %24, respectively; p = 0.755). The mean central subfield thickness values decreased statistically significantly in both groups ( p < 0.001). There was no statistically significant difference between the groups (442.40 ± 161.32 to 318.0 ± 63.10 vs. 431.64 ± 151.52 to 303.08 ± 140.91, respectively; p = 0.724). The mean total injection numbers were significantly lower in the relaxed group (6.4 ± 1.65 vs. 4.8 ± 1.45, respectively; p = 0.01). Conclusion: Relaxed intravitreal aflibercept regimen has comparable efficiency and safety outcomes at 12 months with intensive intravitreal aflibercept regimen with fewer injections in the management of neovascular age-related macular degeneration.