bluuebunny/crossref_metadata_2025_split huggingface dataset:
Acute respiratory distress syndrome in mechanically ventilated patients with community-acquired pneumonia
Authors: Cilloniz Catia , Ferrer Miquel , Liapikou Adamanthia , Garcia-Vidal Carolina , Gabarrus Albert , Ceccato Adrian , Puig de La Bellacasa Jorge , Blasi Francesco , Torres Antoni 
Published: March 2018

Our aim was to assess the incidence, characteristics, aetiology, risk factors and mortality of acute respiratory distress syndrome (ARDS) in intensive care unit (ICU) patients with community-acquired pneumonia (CAP) using the Berlin definition.We prospectively enrolled consecutive mechanically ventilated adult ICU patients with CAP over 20 years, and compared them with mechanically ventilated patients without ARDS. The main outcome was 30-day mortality.Among 5334 patients hospitalised with CAP, 930 (17%) were admitted to the ICU and 432 required mechanical ventilation; 125 (29%) cases met the Berlin ARDS criteria. ARDS was present in 2% of hospitalised patients and 13% of ICU patients. Based on the baseline arterial oxygen tension/inspiratory oxygen fraction ratio, 60 (48%), 49 (40%) and 15 (12%) patients had mild, moderate and severe ARDS, respectively.Streptococcus pneumoniaewas the most frequent pathogen, with no significant differences in aetiology between groups. Higher organ system dysfunction and previous antibiotic use were independent risk factors for ARDS in the multivariate analysis, while previous inhaled corticosteroids were independently associated with a lower risk. The 30-day mortality was similar between patients with and without ARDS (25%versus30%, p=0.25), confirmed by propensity-adjusted multivariate analysis.ARDS occurs as a complication of CAP in 29% of mechanically ventilated patients, but is not related to the aetiology or mortality.
Omalizumab effectiveness in patients with severe allergic asthma according to blood eosinophil count: the STELLAIR study
Authors: Humbert Marc , Taillé Camille , Mala Laurence , Le Gros Vincent , Just Jocelyne , Molimard Mathieu 
Published: March 2018

Omalizumab is a monoclonal anti-IgE antibody used to treat severe allergic asthma (SAA). The aim of the STELLAIR study was to determine the importance of pre-treatment blood eosinophil count as a predictive measure for response to omalizumab.This retrospective real-life study was conducted in France between December 2015 and September 2016 using medical records of SAA omalizumab-treated patients. Response to omalizumab was assessed by three criteria: physician evaluation, reduction of ≥40% in annual exacerbation rate and a combination of both. Response rate was calculated according to blood eosinophil count measured in the year prior to omalizumab initiation.872 SAA omalizumab-treated patients were included by 78 physicians (723 adults (age ≥18 years) and 149 minors (age 6–17 years)). Blood eosinophil count was ≥300 cells·µL−1in 52.1% of adults and 73.8% of minors. By physician evaluation, 67.2% of adults and 77.2% of minors were responders and 71.1% adults and 78.5% minors had a ≥40% reduction in the exacerbation rate. In adults, the response rate for combined criteria was 58.4% (95% CI 53.2–63.4%) for blood eosinophils ≥300 cells·µL−1(n=377) and 58.1% (95% CI 52.7–63.4%) for blood eosinophils <300 cells·µL−1(n=346).This study shows that a large proportion of patients with SAA have a blood eosinophil count ≥300 cells·µL−1, and suggests that omalizumab effectiveness is similar in “high” and “low” eosinophil subgroups.
Comprehensive Knowledge and Uptake of Cervical Cancer Screening Is Low Among Women Living With HIV/AIDS: The Case of Northwestern Ethiopia
Authors: Belachew Sewunet Admasu , Netere Adeladlew Kassie , Mersha Amanual Getnet , Abebe Sileshi Ayele , Mekuria Abebe Basazn , Erku Daniel Asafw 
Published: March 2018

Abstract 1 Purpose In Ethiopia, cervical cancer is the second most common type of cancer in women, and is approximately 8 times more common in HIV-infected women; however, data on the knowledge of HIV-infected women of cervical cancer and the acceptability of screening is scarce in Ethiopia. The current study aimed to assess the level of knowledge of cervical cancer and the uptake of screening among HIV-infected women in Gondar in northwestern Ethiopia. Methods A cross-sectional, questionnaire-based survey was conducted in 302 HIV-infected women who attended the outpatient clinic of the University of Gondar referral and teaching hospital from March 1, 2017, to March 30, 2017. Descriptive statistics and univariable and multivariable logistic regression analyses were also performed to examine factors that are associated with the uptake of cervical cancer screening service. Results Overall, only 64 respondents (21.2%) were knowledgeable about cervical cancer and screening, and only 71 respondents (23.5%) underwent screening in their lifetimes. Age between 21 years and 29 years (adjusted odds ratio [AOR], 2.78; 95% CI, 1.71 to 7.29), perceived susceptibility to the development of cervical cancer (AOR, 2.85; 95% CI, 1.89 to 6.16), and comprehensive knowledge of cervical cancer (AOR, 3.02; 95% CI, 2.31 to 7.15) were found to be strong predictors of cervical cancer screening service uptake. Conclusion Knowledge and uptake of cervical cancer screening among HIV-infected women was found to be poor. Taking into consideration the heightened importance of comprehensive knowledge for increasing the number of participants in cervical cancer screening services, different stakeholders working on cancer and HIV/AIDS should provide a customized health promotion intervention for, and create awareness among, HIV-infected women, as well as improve the accessibility of cervical cancer screening services in rural areas. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST No COIs from the authors.
Measuring Knowledge Change and Skills Improvement in Participants of a Comprehensive Cervical Cancer Prevention Training Program in Low-Resource Areas in Texas and Mozambique
Authors: Lopez Melissa S. , Parra Sonia , Salcedo Mila , Baker Ellen , Milbourne Andrea , Lorenzoni Cesaltina , Luis Elvira , Mabota Flora , Fontes-Cintra Georgia , Moretti-Marques Renato , Ogburn Anthony , Gowen Rose , Robles Eduardo , Tavares Jose H. , Schmeler Kathleen 
Published: March 2018

Abstract 5 Purpose There are more than 530,000 new cases of cervical cancer and 275,000 related deaths annually worldwide. More than 85% of cases and deaths occur in low- and middle-income countries and some areas of the United States. There is a shortage of medical specialists to provide prevention, screening, and treatment services in these regions. Needed are programs that are focused on increasing the clinical capacity to improve cancer prevention services via innovative, locally held, hands-on training courses in conjunction with regular telementoring. Locally held, hands-on training courses for colposcopy, cervical biopsy, and loop electrosurgical excisional procedures using innovative training models and theoretical practical lectures were held in conjunction with telementoring using Project ECHO (Extension for Community Health Outcomes). Methods We initiated a cervical cancer prevention education program with two complementary components: locally held, hands-on training courses using innovative teaching aids that were developed by Rice University, and Project ECHO telementoring using regularly held videoconferences to ensure regular mentoring. These innovative training models are low cost (< $80 USD) and allow course participants to simulate different cervical cancer screening and early treatment techniques, including VIA, colposcopy, cervical biopsies, cryotherapy, and loop electrosurgical excisional procedures. Results To date, four hands-on training programs have been held in Mozambique (n = 2) and underserved areas of Texas, including the Rio Grande Valley (n = 1) and Laredo (n = 1). In addition, since 2014, 99 ECHO telementoring sessions have been held with providers in the Rio Grande Valley and Laredo (average, n = 23 providers) as well as Mozambique (average, n = 11 providers). Conclusion Through this cervical cancer prevention education program, we have found that locally held, hands-on training courses using innovative models, complemented with Project ECHO telementoring, is an innovative way to improve cervical cancer screening and prevention efforts in low-resource settings. Evaluation is ongoing to determine the efficacy of these programs compared with traditional training methods. Funding: The Cancer Prevention Research Institute of Texas, The University of Texas MD Anderson Sister Institution Network Fund, The University of Texas MD Anderson Cancer Center Moon Shots program, and The Prevent Cancer Foundation. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST No COIs from the authors.
Cervical Cancer Screening in Transgender Men in El Salvador: A Pilot Study
Authors: Meléndez Mario , Herrera Alejandra , Hernández Xavier , Rodríguez Bryam , Soler Montserrat , Alfaro Karla , Masch Rachel , Cremer Miriam , Maza Mauricio 
Published: March 2018

Abstract 27 Purpose Transgender persons are particularly vulnerable to a lack of adequate health care, particularly with regard to sexual and reproductive health. In El Salvador, where cervical cancer is a leading cause of cancer death, transgender men are at high risk of developing this disease. Whereas the Papanicolaou test is the most widely used screening method for cervical cancer, there are reports of high numbers of unsatisfactory results among transgender men compared with nontransgender persons. Human papillomavirus (HPV) testing may be a more viable screening option in this population. In this pilot study, we assessed the feasibility of cervical cancer screening among transgender men using a self-sampling HPV test as an alternative to the Papanicolaou test. Methods Participants were transgender men of the Organización Generación Hombres Trans El Salvador (Trans Men Generation Organization of El Salvador) between age 19 and 55 years. After obtaining informed consent, a questionnaire was administered to 24 participants to collect sociodemographic, lifestyle, and sexual behavior data, and to assess knowledge about cervical cancer prevention. Participants then performed a vaginal, self-sampling HPV test. Participants who received a positive HPV result were offered a colposcopy evaluation. Results Almost all participants—23 of 24—agreed to conduct vaginal self-sampling. Of these, three (13%) of 23 participants tested positive, with the remainder obtaining a negative result. Colposcopies and biopsies were accepted by all three participants who tested positive. One participant was diagnosed with CIN3, whereas two2 were diagnosed with CIN1. Conclusion There is limited information on cervical cancer prevention among transgender men, particularly in low and middle-income countries. Use of HPV self-sampling tests is a viable method that can significantly improve participation in and acceptance of screening in this vulnerable population. HPV testing may reduce the number of unsatisfactory results generated when using Papanicolaou tests as a screening method. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST No COIs from the authors.
High Acceptability of Human Papillomavirus Self-Sampling Among Nonattenders of a Public Cervical Cancer Screening Program in El Salvador
Authors: Maza Mauricio , Melendez Mario , Cremer Miriam , Masch Rachel , Alonzo Todd , Castle Philip , Alfaro K. , Soler Montserrat , Conzuelo Gabriel , Gage Julia 
Published: March 2018

Abstract 29 Purpose In high-income countries, human papillomavirus (HPV) self-sampling has been demonstrated to increase adherence to cervical cancer prevention initiatives in underscreened women. El Salvador recently completed the Cervical Cancer Prevention in El Salvador (CAPE) program using a high-risk HPV test as the screening method. Although successful, 12% of targeted women did not attend their screening appointments. HPV self-sampling may offer the opportunity to reach these nonattending women. In the current study, we evaluated HPV self-sampling as a way to increase screening among CAPE nonattenders and to report factors that impact self-sampling acceptability in a low- to middle-income country. Methods Nonattending and underscreened women age 30 to 59 years from the Paracentral region of El Salvador were invited to participate (N = 2,019). Women were visited at home and offered self-sampling with an HPV test. Women who provided consent also received a series of questionnaires to collect demographic and test acceptability data. After tests were analyzed, women were provided with results during another home visit. HPV-positive women were asked to make an appointment at a local clinic to undergo colposcopy, biopsy, and, if eligible, cryotherapy treatment. Women with contraindications for cryotherapy were referred to appropriate treatment or follow-up. Results Of 1,989 eligible women, 94% accepted the HPV self-sampled test. Of these, 11.8% (n = 221) tested positive. All but 13 women attended the colposcopy appointment, and 190 women received cryotherapy. Biopsy results revealed low-grade precancer in 6.3% of women, whereas 12.6% received diagnoses of high-grade precancer. Reasons for not attending the original CAPE appointment included logistic concerns, but also discomfort with male providers, confidentiality fears, and misconceptions regarding HPV, cervical cancer, and the screening procedure. Conclusion HPV self-sampling was shown to be overwhelmingly acceptable to nonattending and underscreened rural women in El Salvador. This method may be a feasible alternative that circumvents barriers to cervical cancer screening in low- to middle-income countries. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST No COIs from the authors
Pattern of Chemotherapy-Related Adverse Effects Among Adult Patients With Cancer Treated at Gondar University Referral Hospital, Ethiopia: A Cross-Sectional Study
Authors: Belachew Sewunet Admasu , Erku Daniel Asfaw , Mekuria Abebe Basazn , Gebresillassie Begashaw Melaku 
Published: March 2018

Abstract 32 Purpose Adverse drug reactions (ADRs) are a global problem and constitute a major clinical problem in terms of human suffering. The high toxicity and narrow therapeutic index of chemotherapeutic agents makes oncology pharmacovigilance essential. The objective of the current study was to assess the pattern of ADRs that occur in patients with cancer who were treated with chemotherapy in a tertiary care teaching hospital in Ethiopia. Methods A cross-sectional study over a 2-year period from September 2013 to August 2015 was conducted in patients with cancer who underwent chemotherapy at Gondar University Referral Hospital Oncology Center. Data were collected directly from patients and their medical case files. Reported ADRs were assessed for causality using the WHO causality assessment scale and Naranjo’s algorithm. Severities of the reported reactions were also assessed using National Cancer Institute Common Terminology Criteria for Adverse Events (version 4.0). Pearson’s χ2 test was used to examine the association between two categorical variables. Results A total of 815 ADRs were identified from 203 patients who were included in the study. The most commonly occurring ADRs were nausea and vomiting (18.9%), infections (16.7%), neutropenia (14.7%), fever and/or chills (11.3%), and anemia (9.3%). Platinum compounds (31.4%) were the most common group of drugs that caused ADRs. Of reported ADRs, 65.8% were grades 3 to 4 (severe level), 29.9% were grades 1 to 2 (mild level), and 4.3% were grade 5 (toxic level). Significant association was found between age, number of chemotherapeutic agents, and dose of chemotherapy with the occurrence of grades 3 to 5 toxicity. Conclusion The high incidence of chemotherapy-related ADRs among patients with cancer is of concern. Establishing an effective ADR monitoring and reporting system—oncopharmacovigilance—and creating awareness among health care professionals of the importance of ADR reporting may help prevent the problem. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST No COIs from the authors.
Intrathecal Drug Delivery Systems for Refractory Pancreatic Cancer Pain: Observational Follow-up Study Over an 11-Year Period in a Comprehensive Cancer Center
Authors: Carvajal Gabriel , Dupoiron Denis , Seegers Valerie , Lebrec Nathalie , Boré François , Dubois Pierre-Yves , Leblanc Damien , Delorme Thierry , Jubier-Hamon Sabrina 
Published: March 2018

BACKGROUND:
Pancreatic cancer is the fourth leading cause of cancer-related death in Europe and the United States. Studies have demonstrated that patients with pancreatic cancer have a high prevalence of pain, with rates varying from 47% to 82%. Analgesia using intrathecal drug delivery systems (IDDS) has been poorly studied specifically in this population.

METHODS:
The IDDS for pancreatic cancer pain was a follow-up observational study designed to evaluate 11-year results of IDDS for refractory pancreatic cancer pain at the Institut de Cancérologie de L’Ouest, Paul Papin in France. Patients were followed from March 2006 to April 2017. Patients were selected for IDDS based on multidisciplinary meeting discussion. All IDDS-treated patients were prescribed a combined intrathecal analgesics regimen through a catheter placed according to painful metameric level. Postimplant assessment of pain was determined using a numerical rating scale (NRS). Patients were followed via day-hospital visits and telephone calls at least monthly until death. Pain scores were compared using the Wilcoxon signed rank test. Overall survival (OS) was estimated using the Kaplan–Meier method and compared between groups by log rank tests.

RESULTS:
Ninety-three patients received IDDS, and total therapy duration accounts for 10,300 IDDS days. Implanted patients suffered from severe pain before implantation (median presurgical NRS, 8 [interquartile range, 7–9]) despite a median 360 mg (260–600) oral morphine equivalent daily dose. Median OS in the whole cohort after intrathecal treatment start was 82 days (95% confidence interval, 59–95). Median OS after surgery for implantable pump was 91 days (83–111) and for external pump 27 days (20–49; P < .0001). IDDS was associated with pain relief with a significant statistical difference between preimplantation NRS pain score and 1 week (median, −6 [−7 to −4]; P < .001), 1 month (median, −5 [−6 to −3]; P < .001), and 3 months (median, −6 [−7 to −4]; P < .001). Severe pain (NRS score, ≥7) decreased from 89.2% before surgery to 4.5% after 1 week, 6.7% after 1 month, and 10.3% after 3 months of IDDS implant (P < .01). Global complications rate was low, consistent with published literature.

CONCLUSIONS:
Despite our study’s limitations, results suggest that long-term IDDS for refractory malignant pain due to pancreatic cancer was both efficacious and safe in pancreatic cancer pain. We have demonstrated, in the largest series of IDDS for pancreatic cancer pain reported yet, a clinically and statistically significant pain reduction in patients receiving IDDS.
Anesthesia for Percutaneous Pulmonary Valve Implantation: A Case Series
Authors: Arboleda Salazar Rafael , Heggie Jane , Wolski Piotr , Horlick Eric , Osten Mark , Meineri Massimiliano 
Published: March 2018

BACKGROUND:
Twenty percent of patients born with congenital heart disease present with right ventricular outflow tract abnormalities. These patients require multiple surgical procedures in their lifetime. Transcatheter pulmonary valve replacement (TPVR) has become a viable alternative to conventional pulmonary valve and right ventricular outflow tract surgery in pediatric and adult populations. In this retrospective review, we analyze the perioperative management of adult patients who underwent TPVR in our center.

METHODS:
The study consisted of a chart review of patients who underwent TPVR at Toronto General Hospital between 2006 and 2015. Information about preoperative assessment, intraoperative anesthetic management, and intra- and postprocedural complications was collected. Two types of percutaneous valves have been used for a conduit or valve size between 16 and 28 mm. These procedures are done via the femoral, jugular, or subclavian vein under general anesthesia.

RESULTS:
Seventy-nine adults (17–68 years of age) who underwent elective TPVR procedures were included. General anesthesia was used in all cases. Defibrillation was necessary in 1 case, and bradycardia was spontaneously resolved in another 1. Eighty-five percent were successfully extubated at the end of the procedure. Five patients required intraoperative inotropic support. Three patients presented self-resolved hemoptysis. Mechanical ventilation for >24 hours was necessary in 3 cases, 2 of which also required concomitant inotropic support. Four failed deployments and 1 case of persistent conduit stenosis were reported. Three patients required reintubation. All patients were discharged home.

CONCLUSIONS:
Patients undergoing TPVR represent a complex and heterogeneous population. General anesthesia with endotracheal intubation is preferred. Setup for urgent lung isolation and cardiac defibrillation should be considered. Postoperative monitoring and intensive care setting are required. Anesthesiologists with cardiac anesthesia training are probably better suited to manage these patients.
Welche medizinischen Thrombose-prophylaxestrümpfe - knielang oder oberschenkellang - sind effektiver?
Authors: Marshall M. , Wienert V. 
Published: March 2018

ZusammenfassungEs sollte der präventive Effekt knielanger (Wadenstrumpf) und oberschenkellanger (Schenkelstrumpf) medizinischer Thromboseprophylaxestrümpfe (MTPS) evaluiert werden.In den Datenbanken Pubmed, Cochrane Library, HTA-Berichte wurde nach den Stichwörtern „Thromboseprävention” und „Thromboseprophylaxestrümpfe” gesucht, und zwar in systematischen Reviews, Metaanalysen und Leitlinien.Es finden sich zwei ergiebige Leitlinien und zwei sehr umfangreiche systematische Reviews, alle im Zeitraum von 2010 bis 2015 publiziert.Die NICE-Leitlinie und die SIGN-Leitlinie empfehlen knielange oder oberschenkellange MTPS, vier Reviews dagegen zeigen keine eindeutigen Ergebnisse in der Prävention von Thrombosen.Der präventive Effekt beider MTPS ist nicht deutlich unterschiedlich:- Die Berechnung des präventiven Effekts beider MTPS ist nicht möglich, da die Studien signifikant heterogen sind.- Der präventive Effekt des oberschenkellangen MTPS, kombiniert mit der Pharmakotherapie, zeigt einen nicht signifikanten positiven Trend.- Der präventive Effekt eines oberschenkellangen MTPS plus Pharmakotherapie ist effektiver als der eines knielangen MTPS plus Pharmakotherapie.