bluuebunny/crossref_metadata_2025_split huggingface dataset:
P628 Risk Factors Associated with Extraintestinal Manifestations in Patients with Inflammatory Bowel Diseases
Authors: Liava C , Sinakos E , Dimitroulas T , Navrozidou C , Akriviadis E 
Published: May 2021

Abstract

Background
Risk factors associated with extraintestinal manifestations (EIMs) in patients with inflammatory bowel disease (IBD) have been evaluated mainly in retrospective studies. We aimed to determine risk factors associated with EIMs and to compare the frequency of EIMs between ulcerative colitis (UC) and Crohn’s disease (CD), based on retrospectively-prospectively collected data of a cohort of IBD patients followed in daily clinical practice.

Methods
Patients with biopsy-confirmed IBD aged 10–80 years old were included in the study. A comprehensive questionnaire was used to collect data on each site visit from July 2018 until March 2020. Logistic regression analysis and multivariable-adjusted models were used to examine risk factors associated with EIMs and chi-squared test was used to compare the frequency of EIMs between patients with UC and CD.

Results
300 patients with IBD (180 with CD, 113 with UC, and 7 with indeterminate colitis) were evaluated. EIMs were observed in 49% of patients, with a 2-fold increased risk in CD (OR 2.31; 95% CI:1.37–3.89; P&lt;.005). The musculoskeletal system was affected in 38% (43% in CD vs 29% in UC, OR 1.86; 95% CI:1.08–3.20; P&lt;.05) with peripheral arthropathy being the most common manifestation (33% in CD vs 23% in UC, P=.095), followed by dermatological manifestations (13%), with a 4-fold increased risk of erythema nodosum in CD (11% vs 3% in UC, OR 3.95; 95% CI:1.12–13.93; P&lt;.05). On univariate logistic regression analysis history of hospitalization for IBD, history of surgery for IBD, aphthous stomatitis, perianal disease, thyroiditis Hashimoto, age, use of thiopurines, and/or anti-TNF in the past were associated with increased risk of developing EIMs. A trend for increased risk of EIMs was found for family history of IBD in first-degree relatives (OR 2.47; 95% CI:0.91–6.74; P=.078) and fecal calprotectin above 250 μg/g (OR 2.22; 95% CI:0.90–5.47; P&lt;.084). On multivariate analysis only aphthous stomatitis (OR 4.60; 95% CI:2.32–9.13; P&lt;.001), perianal disease (OR 2.30; 95% CI:1.17–4.50; P&lt;.05), thyroiditis Hashimoto (OR 2.82; 95% CI:1.03–7.74; P&lt;.05) and age (2% increase in risk per year, OR 1.02; 95% CI:1.01–1.03; P&lt;.05) were significant for EIMs.

Conclusion
In this retrospective/prospective study 49% of IBD patients developed EIMs with a 2-fold increased risk in CD. Musculoskeletal and dermatological manifestations were the most frequent EIMs. Aphthous stomatitis, perianal disease, thyroiditis Hashimoto and age were associated with increased risk of EIMs.
P633 Clinical epidemiology of Inflammatory Bowel Disease in Lbanon
Authors: Abou Rached A , Saba J , Yared F , Saniour J , Abou Khalil M , Al Bacha R , Khalil P , Bou Jaoude J 
Published: May 2021

Abstract

Background
The worldwide epidemiology of Inflammatory Bowel Disease (IBD) is changing. Increasing Crohn’s disease (CD) and Ulcerative Colitis (UC) incidence and prevalence have been recorded. In Lebanon, the current status of IBD is not well known.

Methods
The aim is to report patients’ characteristics newly diagnosed with IBD in Lebanon based on Montreal classification and to report the prevalence and the incidence of IBD in the Lebanese population during a period of 20 years. This is a retrospective study conducted in collaboration with the National Institute of Pathology, from January 2001 till December 2020 were reviewed. Patients were characterized based on: sex, age at diagnosis, year of diagnosis, location and extension of the disease.

Results
A total of 3101 new IBD cases were identified (1504 UC, 1597 CD), mean age for UC and CD was 41.05 years and 36.5 years, respectively. sex ratio (M/F) of 1.15 and 1.29 in UC and CD, respectively.
In UC, the 3 age groups distribution, ≤ 16 years, 17–40 years and &gt; 40 years were 5.72%, 47.83% and 40.45%, respectively. Regarding the location distribution, E3 was the most prevalent (55.6%), followed by E1 (24.6%) and E2 (19.8%); with no difference between male and female. Similar pattern of location distribution was noted in the 3 age groups. There was no difference in age of diagnosis but a significant increase of E3 from 40% (2001–2010) to 60% (2011–2020) was noted.
In CD, 5.54%, 58.93% and 35.53% of patients were aged ≤ 16 years, 17–40 years and &gt; 40 years, respectively. L1, L2, L3 and L4 represented 57.8%, 16.72%, 23.42% and 1.88% of the location distribution, respectively; without difference between male and female. L1 is significantly higher in the young age groups (≤ 16 years: 68.75% and 17–40 years: 67.72%) compared to the older age group (&gt; 40 years: 39.06%) whereas L2 and L3 were higher in the older age group. When divided into two 10-year periods, there was a significant increase of L1 (63%) in the last 10 years (2010–2020) compared to the 10 years before (40%) and an increase of the disease incidence in the age group 17–40 years.
Based on all these data, we calculated the incidence of UC and CD and their progression during this period of 20 years. We noted a progressive increase of the incidence of IBD, especially for CD in the last 3 years. The cumulative incidence of UC and CD were 4.686 and 4.582, respectively. The prevalence of UC and CD were 69.9 par 100000 and 68.35 per 100000, respectively.

Conclusion
The mean age of IBD in Lebanon is higher than that described in Europe and North America. Pancolitis in UC and ileal involvement in CD remain the most common forms found. There was an increase of the incidence of IBD during the last 20 years and especially of CD during the last 3 years
Long-term changes of plumage between urban and rural populations of white-crowned sparrows (Zonotrichia leucophrys)
Authors: Smith Shawn H , Hessong-Brown Jesi , Lipshutz Sara E , Phillips Jennifer N , Rochefort Catherine , Derryberry Elizabeth P , Luther David A 
Published: May 2021

AbstractUrbanization is one of the most extreme forms of land transformation and results in changes to ecosystems and species compositions. As a result, there are strong directional selection pressures compared to nearby rural areas. Despite a surge in research on the different selection pressures on acoustic communication in urban and rural areas, there has been comparatively little investigation into traits involved with visual communication. We measured the plumage of museum specimens of white-crowned sparrows (Zonotrichia leucophrys) from urban and adjacent rural habitats in San Francisco, CA, to assess the effects of divergent habitats on plumage. We found significant differences in dorsal plumage, but not crown plumage, between urban and rural populations that have been diverging over the past 100 years. Urban birds have increasingly darker and duller dorsal plumage, whereas rural birds in adjacent areas have plumage with richer hues and more color complexity. Our findings suggest a newly observed adaptation to urban environments by native species and suggest that many traits, in addition to acoustic signals, may be changing in response to urban selection pressures. Additional collections in urban areas are needed to explore likely divergences in plumage coloration between urban and rural environments.
Challenges for Family Medicine Residents in Attaining the CanMEDS Professional Role: A Thematic Analysis of Preceptor Field Notes
Authors: Kazevman Gill , Ng Jessica C.Y. , Marshall Jessica L. , Slater Morgan , Leung Fok-Han , Guiang Charlie B. 
Published: May 2021

Purpose
Among the roles of the competent physician is that of a professional, according to the Canadian Medical Education Directives for Specialists (CanMEDS) framework, which describes the abilities physicians require to effectively meet the health care needs of the people they serve. Through examination of preceptor field notes on resident performance, the authors identified aspects of this role with which family medicine residents struggle.

Method
The authors used a structured thematic analysis in this qualitative study to explore the written feedback postgraduate medical learners receive at the University of Toronto Department of Family and Community Medicine. Seventy field notes written between 2015 and 2017 by clinical educators for residents who scored “below expectation” in the CanMEDS professional role were analyzed. From free-text comments, the authors derived inductive codes, amalgamated the codes into themes, and measured the frequency of the occurrence of the codes. The authors then mapped the themes to the key competencies of the CanMEDS professional role.

Results
From the field notes, 7 themes emerged that described reasons for poor performance. Lack of collegiality, failure to adhere to standards of practice or legal guidelines, and lack of reflection or self-learning were identified as major issues. Other themes were failure to maintain boundaries, taking actions that could have a negative impact on patient care, failure to maintain patient confidentiality, and failure to engage in self-care. When the themes were mapped to the key competencies in the CanMEDS professional role, most related to the competency “commitment to the profession.”

Conclusions
This study highlights aspects of professional conduct with which residents struggle and suggests that the way professionalism is taught in residency programs—and at all medical training levels—should be reassessed. Educational interventions that emphasize learners’ commitment to the profession could enhance the development of more practitioners who are consummate professionals.
Evaluation of the Parameters Affecting Respiratory Functions at Adolescent Idiopathic Scoliosis Patients
Authors: Çimen Osman , Öner Ali , Köksal Alper , Dirvar Ferdi , Mert Muhammed 
Published: May 2021

Study Design:
This was a retrospective observational study.

Objective:
The objective of the study was to evaluate the spinal and extraspinal factors responsible for pulmonary dysfunction in adolescent idiopathic scoliosis patients.

Summary of Background Data:
Development of thoracic deformity due to scoliosis results with the restrictive ventilatory pattern and the reduced pulmonary function. To prevent pulmonary function deterioration, it is imperative to understand which factors are causing the restrictive lung disease in adolescent idiopathic scoliosis patients.

Materials and Methods:
An online database search was conducted in a hospital computerized archive between 2008 and 2018 years. Cobb angle of >30 degrees, Lenke type 1 and 2 patients treated in a single spine unit were included. Coronal and sagittal Cobb angle, bending correction rate for evaluation of flexibility, Risser score, apical vertebra rotation (AVR), and pulmonary function test of patients were obtained.

Results:
There was a moderate negative correlation between forced expiratory volume in the first second, forced vital capacity, and AVR. There was no correlation between forced expiratory volume in the first second and forced vital capacity with age, sex, Cobb angle, Risser score, kyphosis, and bending correction rate.

Conclusions:
When considering the results of the current study and the other studies in the literature there is not any strong correlation between the features of scoliotic curvature and respiratory functions. In the current study, 52 (72.22%) of 72 patients with moderate to severe scoliosis had mild to severe respiratory dysfunction. Considering the age-related physiological respiratory loss, to evaluate the necessity of surgical treatment in patients with moderate and severe scoliosis, especially in patients with high AVR, the respiratory functions of the patient should also be evaluated.

Level of Evidence:
Level III.
A trauma-informed guide to caring for adolescents following sexual assault
Authors: Wiener Susan J. , Fitzgerald Susan , Einhorn Honora 
Published: May 2021

Purpose of review
Sexual assault is common among adolescents worldwide. Survivors of sexual assault may experience various immediate and long-term effects on their physical and mental health. It is important that pediatric healthcare providers (HCPs) are aware of the high prevalence of sexual assault and recognize the impact on their adolescent patients. The aim of this update is to discuss how pediatric HCPs can embody a trauma-informed approach when caring for survivors of sexual assault across various settings.

Recent findings
All adolescent patients should be screened for sexual assault during routine clinical visits; in responding to a disclosure, providers should exhibit compassion, express validation, and help connect the patient to resources to aid in healing. Caring for survivors of sexual assault should ideally be multidisciplinary, involving treatment of the medical complications (including the possibility of pregnancy or infection) and mental health sequelae (including increased likelihood of depression, posttraumatic symptoms, and suicidality).

Summary
A trauma-informed approach can be applied to all aspects of caring for survivors of sexual assault, from screening for sexual assault and responding to disclosure, to providing acute and longitudinal care following sexual assault.
Choice and duration of antifungal prophylaxis and treatment in high-risk haematology patients
Authors: Coussement Julien , Lindsay Julian , Teh Benjamin W. , Slavin Monica 
Published: May 2021

Purpose of review
This review aims to summarize available guidelines as well as the emerging evidence for the prevention and treatment of invasive fungal diseases in high-risk haematology patients.

Recent findings
Primary mould-active prophylaxis is the strategy used in many centres to manage the risk of invasive fungal disease in high-risk haematology patients, and posaconazole remains the antifungal of choice for most of these patients. Data on the use of other antifungals for primary prophylaxis, including isavuconazole, are limited. There is considerable interest in identifying a strategy that would limit the use of mould-active agents to the patients who are the most likely to benefit from them. In this regard, a recent trial demonstrated that the preemptive strategy is noninferior to the empiric strategy. For primary treatment of invasive aspergillosis, two randomized trials found isavuconazole and posaconazole to be noninferior to voriconazole. Isavuconazole does not appear to require therapeutic drug monitoring.

Summary
Prophylaxis and treatment of invasive fungal diseases in high-risk haematology patients is a rapidly evolving field. Critical clinical questions remain unanswered, especially regarding the management of suspected invasive fungal diseases breaking through mould-active prophylaxis, and the duration of antifungal therapy for invasive mould infections.
Military deployment’s impact on the surgeon’s practice
Authors: Hall Andrew , Qureshi Iram , Vasquez Matthew , Iverson Kyle , Tadlock Matthew D. , McClendon Hampton , Davis Elizabeth , Glaser Jacob , Hanson Matthew , Taylor Jonathan , Gurney Jennifer M. 
Published: May 2021

BACKGROUND
As the United States withdraws from overseas conflicts, general surgeons remain deployed in support of global operations. Surgeons and surgical teams are foundational to combat casualty care; however, currently, there are few casualty producing events. Low surgical volume and acuity can have detrimental effects on surgical readiness for those frequently deployed. The surgical team cycle of deployment involves predeployment training, drawdown of clinical practice, deployment, postdeployment reintegration, and rebuilding of a patient panel. This study aims to assess these effects on typical general surgeon practices. Quantifying the overall impact of deployment may help refine and implement measures to mitigate the effects on skill retention and patient care.

METHODS
Surgeon case logs of eligible surgeons deploying between January 1, 2017, and January 1, 2020, were included from participating military treatment facilities. Eligible surgeons were surgeons whose case logs were primarily at a single military treatment facility 26 weeks before and after deployment and whose deployment duration, location, and number of deployed cases were obtainable.

RESULTS
Starting 26 weeks prior to deployment, analyzing in 1-week intervals toward deployment time, case count decreased by 4.8% (p < 0.0001). With each 1-week interval, postdeployment up to the 26-week mark, case count increased by 6% (p < 0.0001). Cases volumes most prominently drop 3 weeks prior to deployment and do not reach normal levels until approximately 7 weeks postdeployment. Case volumes were similar across service branches.

CONCLUSION
There is a significant decrease in the number of cases performed before deployment and increase after return regardless of military branch. The perideployment surgical volume decline should be understood and mitigated appropriately; predeployment training, surgical skill retention, and measures to safely reintegrate surgeons back into their practice should be further developed and implemented.

LEVEL OF EVIDENCE
Economic/Decision, Level III.
Saving the brain after mild-to-moderate traumatic injury: A report on new insights of the physiology underlying adequate maintenance of cerebral perfusion
Authors: Convertino Victor A. , Cardin Sylvain , Cap Andre P. , Crowder Alicia T. , Stackle Mark E. , Talley Michael J. , Lurie Keith G. 
Published: May 2021

ABSTRACT
Traumatic brain injury (TBI) is associated with increased morbidity and mortality in civilian trauma and battlefield settings. It has been classified across a continuum of dysfunctions, with as much as 80% to 90% of cases diagnosed as mild to moderate in combat casualties. In this report, a framework is presented that focuses on the potential benefits for acute noninvasive treatment of reduced cerebral perfusion associated with mild TBI by harnessing the natural transfer of negative intrathoracic pressure during inspiration. This process is known as intrathoracic pressure regulation (IPR) therapy, which can be applied by having a patient breath against a small inspiratory resistance created by an impedance threshold device. Intrathoracic pressure regulation therapy leverages two fundamental principles for improving blood flow to the brain: (1) greater negative intrathoracic pressure enhances venous return, cardiac output, and arterial blood pressure; and (2) lowering of intracranial pressure provides less resistance to cerebral blood flow. These two effects work together to produce a greater pressure gradient that results in an improvement in cerebral perfusion pressure. In this way, IPR therapy has the potential to counter hypotension and hypoxia, potentially significant contributing factors to secondary brain injury, particularly in conditions of multiple injuries that include severe hemorrhage. By implementing IPR therapy in patients with mild-to-moderate TBI, a potential exists to provide early neuroprotection at the point of injury and a bridge to more definitive care, particularly in settings of prolonged delays in evacuation such as those anticipated in future multidomain operations.

LEVEL OF EVIDENCE
Report.
Trends in prehospital pain management following the introduction of new clinical practice guidelines
Authors: Vysokovsky Moshe , Avital Guy , Betelman-Mahalo Yaar , Gelikas Shaul , Fridrich Lidar , Radomislensky Irina , Tsur Avishai M. , Glassberg Elon , Benov Avi 
Published: May 2021

BACKGROUND
Early pain treatment following injury has been shown to improve long-term outcomes, while untreated pain can facilitate higher posttraumatic stress disorder rates and worsen outcomes. Nonetheless, trauma casualties frequently receive inadequate analgesia. In June 2013, a new clinical practice guideline (CPG) regarding pain management was introduced in the Israel Defense Forces (IDF) Medical Corps, recommending oral transmucosal fentanyl citrate (OTFC) and low-dose intravenous (IV)/intramuscular ketamine. The purpose of this study was to examine trends in prehospital pain management in the IDF.

METHODS
All cases documented in the IDF trauma registry between 2008 and 2020 were examined. This study compared casualty parameters before and after the introduction of analgesia CPG in 2013. Parameters compared included demographics, injury parameters, treatment modalities, and types of analgesia provided.

RESULT
Overall, 5,653 casualties were included in our study. During the 6 years before the introduction of the CPG, 289 (26.7%) of 1,084 casualties received an analgesic treatment, compared with 1,578 (34.5%) of 4,569 casualties during the 7 years following (p < 0.001). Since its introduction, OTFC was administered to 41.8% of all casualties who received analgesia and became the most used analgesic drug in 2020 (61.1% of casualties receiving analgesia). The rate of IV morphine significantly decreased after 2013 (22.6–16%, p < 0.001).

CONCLUSION
Pain management has become more common in trauma patients’ prehospital care in the IDF in recent years. There has been a significant increase in analgesia administration, with the increased use of OTFC, along with a significant reduction in the use of IV morphine. These results may be attributed to introducing a pain management CPG and implementing OTFC among medical teams. The perception of OTFC as a safe user-friendly analgesic may have contributed to its use by medical providers, increasing analgesia rates overall.

LEVEL OF EVIDENCE
Therapeutic/care management, level III.
Don’t mess with the pancreas! A multicenter analysis of the management of low-grade pancreatic injuries
Authors: Biffl Walter L. , Ball Chad G. , Moore Ernest E. , Lees Jason , Todd S. Rob , Wydo Salina , Privette Alicia , Weaver Jessica L. , Koenig Samantha M. , Meagher Ashley , Dultz Linda , Udekwu Pascal (Osi) , Harrell Kevin , Chen Allen K. , Callcut Rachael , Kornblith Lucy , Jurkovich Gregory J. , Castelo Matthew , Schaffer Kathryn B. ,   the WTA Multicenter Trials Group on Pancreatic Injuries
Published: May 2021

INTRODUCTION
Current guidelines recommend nonoperative management (NOM) of low-grade (American Association for the Surgery of Trauma-Organ Injury Scale Grade I–II) pancreatic injuries (LGPIs), and drainage rather than resection for those undergoing operative management, but they are based on low-quality evidence. The purpose of this study was to review the contemporary management and outcomes of LGPIs and identify risk factors for morbidity.

METHODS
Multicenter retrospective review of diagnosis, management, and outcomes of adult pancreatic injuries from 2010 to 2018. The primary outcome was pancreas-related complications (PRCs). Predictors of PRCs were analyzed using multivariate logistic regression.

RESULTS
Twenty-nine centers submitted data on 728 patients with LGPI (76% men; mean age, 38 years; 37% penetrating; 51% Grade I; median Injury Severity Score, 24). Among 24-hour survivors, definitive management was NOM in 31%, surgical drainage alone in 54%, resection in 10%, and pancreatic debridement or suturing in 5%. The incidence of PRCs was 21% overall and was 42% after resection, 26% after drainage, and 4% after NOM. On multivariate analysis, independent risk factors for PRC were other intra-abdominal injury (odds ratio [OR], 2.30; 95% confidence interval [95% CI], 1.16–15.28), low volume (OR, 2.88; 1.65, 5.06), and penetrating injury (OR, 3.42; 95% CI, 1.80–6.58). Resection was very close to significance (OR, 2.06; 95% CI, 0.97–4.34) (p = 0.0584).

CONCLUSION
The incidence of PRCs is significant after LGPIs. Patients who undergo pancreatic resection have PRC rates equivalent to patients resected for high-grade pancreatic injuries. Those who underwent surgical drainage had slightly lower PRC rate, but only 4% of those who underwent NOM had PRCs. In patients with LGPIs, resection should be avoided. The NOM strategy should be used whenever possible and studied prospectively, particularly in penetrating trauma.

LEVEL OF EVIDENCE
Therapeutic Study, level IV.