bluuebunny/crossref_metadata_2025_split huggingface dataset:
Atrial Fibrillation and the Weekend Effect Regarding Cardioversion, Length of Stay, Readmission, and Mortality
Authors: Zaremski Lynn , Mazori Alon , Shulman Eric , Kargoli Faraj , Shah Tina , Chudow Jay Julius , Leiderman Ephraim , Di Biase Luigi , Fisher John , Ferrick Kevin , Krumerman Andrew 
Published: July 2018

Background:
The weekend effect is a phenomenon in which worse outcomes have been found to occur over the weekend. This has been investigated in the context of stroke, ST-elevation myocardial infarction, and pulmonary embolism among others. Atrial fibrillation (AF) is the most common sustained arrhythmia, and admissions for AF have been increasing. However, few studies exist investigating the existence of a weekend effect regarding AF. Previous studies have been limited by a pragmatic but unrealistic definition of the weekend starting at midnight on Friday and ending midnight on Sunday. In addition, the studies that exist have conflicting data regarding outcomes of mortality and length of stay (LOS).

Methods:
Over a 5-year period, 3233 patients with a primary diagnosis of AF were admitted to an academic center. A retrospective analysis was performed to determine rates of cardioversion, 30-day readmission, 30-day mortality, LOS, and time to cardioversion among patients admitted over the weekend compared with those admitted during the work week. Weekend was defined as the 48-hour period, including Saturday and Sunday.

Results:
Baseline demographics and common risk factors were found to be equivalent in weekend admissions compared with weekday admissions. These characteristics were found to be equivalent in those who underwent cardioversion and those who did not. There was no statistically significant difference between groups in odds of cardioversion, 30-day readmission, or 30-day mortality. Difference in mean LOS and mean time to cardioversion was not statistically significant between groups.

Conclusion:
In conclusion, a weekend effect was not identified regarding AF in an academic hospital.
Role of Hypertension and Other Clinical Variables in Prognostication of Patients Presenting to the Emergency Department With Major Bleeding Events
Authors: Conti Alberto , Molesti Daniele , Bianchi Simone , Catarzi Stefania , Mazzucchelli Mariuccia , Covelli Antonella , Tognarelli Andrea , Perrotta Mafalda Ester , Pampana Alessandro , Orlandi Giovanni , Dell’Amico Iginio , Baratta Alberto , Arena Giuseppe , Torri Tito 
Published: July 2018

Background:
Clinical variables including hypertension could be linked with major bleeding events and death beyond vitamin K antagonist (warfarin) or direct oral anti-coagulants (DOACs) treatment strategy.

Methods:
Subgroup analysis of major bleeding (primary endpoint) associated with clinical variables, site of bleeding, ongoing antithrombotics, reversal treatment or blood transfusion, outcomes (secondary endpoints) was performed in patients with bleeding events submitted to hard 5:1 propensity-score matching for hypertension.

Results:
Enrolled patients were 2,792 (mean age, 65.6 ± 19.9 years) during 2-year survey including 166,000 visits, of 200,000 inhabitants catchment area; 8,239 patients received warfarin and 3,797 DOACs. Hypertension account for 1,077 (39%) patients; major bleeding for 474 (17%); death for 29 (1%), and 72 (3%) on 1-month and 1-year, respectively. Hypertension, age, glucose, cancer, ischemic vascular disease, and CHA2D2VASc score were more likely to link with major bleeding. On multivariate analysis, only age (odds ratio [OR], 1.02; P < 0.001), CHA2DS2VASc score ≥ 2 (OR, 2.14; P = 0.001), and glucose (OR, 1.01; P = 0.005) were predictors of major bleeding. Kaplan–Meier analysis demonstrated patients with hypertension as compared with patients without showed 60% versus 20% death on 1-month (P < 0.001). Warfarin compared with DOACs was more likely to present with major bleeding (0.7% versus 0.2%; OR, 2.8; P = 0.005). Receiver operator characteristics analysis showed high value (0.61) of age and glucose over creatinine and systolic arterial pressure (P = NS).

Conclusions:
Four in 10 patients with major bleeding showed hypertension; of these 8 in 10 will die within 1 month. Warfarin compared with DOACs was more likely to present with major bleeding.
The Impact of Formal Training and Certification on the Relationship Between Volume and Outcomes in Percutaneous Coronary Interventions
Authors: Dakik Habib A. , Karowni Wassef , El-Sibai Katia , Kobrossi Semaan , Abdul-Ameer Karrar , Tamim Hani 
Published: July 2018

Background:
Little data are available on the impact of formal training and certification on the relationship between volumes and outcome in percutaneous coronary interventions (PCIs).The objective of this report is to study the relationship between PCI volume and outcome for a formally trained interventional cardiologist who is certified by the American Board on Internal Medicine – Interventional Cardiology subspecialty board.

Methods:
The operator witnessed 3 different PCI volumes/yr over a 15-year practice period (2000–2014): <50 PCI/yr (years 2000–2006; n = 179), 50–100 PCI/yr (years 2007–2010; n = 256), and >100 PCI/yr (years 2011–2014; n = 427). Angiographic and procedural success rates were compared between the 3 volume groups, as well as in-hospital cardiovascular events (death, recurrent myocardial infarction, repeat PCI, stroke, or coronary artery bypass surgery).

Results:
The in-hospital mortality rate throughout the study period was 0.8% and was not statistically significant among the 3 volume groups. There was also no significant difference among the 3 groups with respect to recurrent myocardial infarction or repeat PCI. There was a slightly higher rate of same-stay elective coronary artery bypass grafting in the early low-volume period compared with the other 2 groups (2.2% vs. 0.8% vs. 0.2%; P = 0.04). The overall angiographic and procedural success rates were 97.3% and 96.5%, and they were not significantly different among the 3 groups.

Conclusions:
Our study shows that the angiographic and procedural success rates of PCI, as well as the in-hospital mortality, do not seem to be dependent on the annual volume for formally trained and certified interventional cardiologists.
The Effectiveness of Virtual Reality Interventions for Improvement of Neurocognitive Performance After Traumatic Brain Injury: A Systematic Review
Authors: Manivannan Susruta , Al-Amri Mohammad , Postans Mark , Westacott Laura Jayne , Gray William , Zaben Malik 
Published: July 2018

Objective:
To evaluate current evidence for the effectiveness of virtual reality (VR) interventions in improving neurocognitive performance in individuals who have sustained a traumatic brain injury (TBI).

Methods:
A systematic literature search across multiple databases (PubMed, EMBASE, Web of Science) for articles of relevance. Studies were evaluated according to study design, patient cohort, VR intervention, neurocognitive parameters assessed, and outcome. VR interventions were evaluated qualitatively with respect to methodology and extent of immersion and quantitatively with respect to intervention duration.

Outcomes:
Our search yielded 324 articles, of which only 13 studies including 132 patients with TBI met inclusion criteria. A wide range of VR interventions and cognitive outcome measures is reported. Cognitive measures included learning and memory, attention, executive function, community skills, problem solving, route learning, and attitudes about driving. Several studies (n = 10) reported statistically significant improvements in outcome, and 2 studies demonstrated successful translation to real-life performance.

Conclusions:
VR interventions hold significant potential for improving neurocognitive performance in patients with TBI. While there is some evidence for translation of gains to activities of daily living, further studies are required to confirm the validity of cognitive measures and reliable translation to real-life performance.
MULTIMODAL IMAGING OF CHOROIDAL AND OPTIC DISK VESSELS NEAR OPTIC DISK PITS
Authors: Adams Matthew K. , Cohen Salomon-Yves , Souied Eric H. , Goldenberg Dafna , Loewenstein Anat , Olsen Timothy W. , Pulido Jose S. 
Published: July 2018

Purpose:
To describe modern multimodal imaging of the choroidal and optic disk vessels in optic disk pits.

Methods:
Case reports of four patients with optic disk pit who underwent multimodal imaging of the optic pit and surrounding structures. Patients included in this article were found to have optic disk pits and subsequently underwent multimodal imaging.

Results:
Cilioretinal arteries were present in two of the four cases (50%). SPECTRALIS optical coherence tomography showed intraretinal and subretinal fluid in all cases. Small vessels in the choroid and in the disk around the pit were also present in all cases through optical coherence tomographic angiography. Confocal fluorescein angiographic imaging in the first case showed leakage from the vessels adjacent to the optic disk pit.

Conclusion:
Modern multimodal imaging shows that there are anomalous vessels in and around an optic pit. Whether these vessels affect the development of optic pit, maculopathy needs to be further evaluated.
“HOURGLASS COLOBOMA”: A CASE REPORT AND REVIEW OF ETIOPATHOGENESIS
Authors: Kumar Madhu , Shanmugam Mahesh , Sagar Pradeep , Kumar Dilip , Konana Vinaya Kumar 
Published: July 2018

Purpose:
To report a rare case of multiple fundal colobomata and to review the possible etiopathogenic factors involved in its genesis.

Method:
Case report.

Result:
A 21-year-old myopic lady was noted to have 2 fundal colobomata—one in the inferior and the other in superior hemisphere of globe in a mirror-image fashion resembling an “hourglass” in the right eye and a typical Type 3 coloboma in the left eye. The iris was normal in both the eye. Multiple fundal colobomata have not been described in the literature. The presence of “accessory embryonic fissure” in the developing eyeball is the only probable mechanism that can explain this presentation. This case is an evidence for the possibility of presence of accessory embryonic fissure in developing eyeball in human. The eponym “hourglass coloboma” or “mirror-image colobomata” best describes this condition.

Conclusion:
This report of multiple fundal colobomata is the first of its kind. This case is an evidence for possibility of presence of accessory embryonic fissure in developing eyeball in human.
Prevalence, Risk Factors, and Outcome of Chikungunya Encephalitis in Hospitalized Patients at a Tertiary Care Center in Gujarat, India, During the 2016 Outbreak
Authors: Gohel Swati , Modi Rohan , Patel Ketan K. , Kumar Ambuj , Patel Atul K. 
Published: July 2018

Background
India has experienced 2 major chikungunya viral (CHIKV) fever outbreaks over the last decade, with reportedly higher mortality during the 2006 outbreak.

Methods
This was a retrospective observational study conducted at a tertiary care center over a period of 4 months involving 110 hospitalized patients confirmed with CHIKV fever during the 2016 outbreak. Data on the proportion of patients with CHIK viral encephalitis (CHIK VE) and possible attributable risk factors were obtained from a retrospective chart review and data analysis using SPSS.

Results
Of 110 patients with confirmed CHIKV fever, 16 (14.6%) developed CHIK VE; 62.5% of the hospitalized patients with CHIK VE were older than 60 years. Patients with CHIK VE presented late to the hospital (4.9 ± 2.7 vs 2.9 ± 1.5, respectively, P = 0.00031) as opposed to those without encephalitis; 87.5% patients in the CHIK VE group required intensive care unit admission and had a prolonged hospital stay (9.2 ± 6.7 days vs 5.1 ± 4.2 days; odds ratio, 0.034; P = 0.001) compared with those in the nonencephalitis group. Patients in the extreme age groups were more vulnerable to CHIK VE compared with adults aged between 30 and 60 years, without a statistically significant difference. There was no statistically significant difference in the mean absolute lymphocyte count, globulin levels, total leukocyte counts, and underlying comorbidities between the 2 groups. Overall mortality with CHIK VE was 18.75%.

Conclusions
Large-scale studies are needed to validate the association of CHIK VE patients with probable risk factors, as it is associated with high mortality, based on the findings of the present study.
Autoimmune and Allergic Disorders are More Common in People With Celiac Disease or on a Gluten-free Diet in the United States
Authors: Kim Hyun-seok , Unalp-Arida Aynur , Ruhl Constance E. , Choung Rok Seon , Murray Joseph A. 
Published: July 2018

Goals:
We analyzed demographics, lifestyle patterns, and clinical characteristics of people with celiac disease (CD) and people without CD avoiding gluten (PWAG) to better understand associations with medical conditions and consumer behavior.

Background:
Clinical significance of CD and gluten avoidance in the general population is incompletely understood. Recently, a high incidence of CD in adolescents with susceptibility genotypes, similar to other autoimmune or allergic disorders, and regional differences in consumer practices of gluten avoidance were reported.

Methods:
Among 22,277 participants in the National Health and Nutrition Examination Survey 2009-2014, we identified persons with CD by testing CD serology or by both a health care provider diagnosis and adherence to a gluten-free diet. Similarly, PWAG were defined as adherent to a gluten-free diet without a CD diagnosis. Consumer behavior and characteristics of both groups, CD and PWAG were compared with those without these conditions, using survey-weighted generalized logistic regression.

Results:
Participants with CD considered nutrition very important when grocery shopping and tended to have more constipation and thyroid disease. PWAG tended to spend more money on groceries, purchase organic foods, and check food labels more frequently during grocery shopping. They also reported having more food allergies, asthma, and thyroid disease.

Conclusions:
Our study confirms that CD and PWAG share comorbidities of autoimmune nature. PWAG had more autoimmune/allergy-related disorders that may be associated with non-celiac gluten sensitivity a self-justifiable reason to be on the diet.
Uterine Inversion: A Review of a Life-Threatening Obstetrical Emergency
Authors: Wendel Michael P. , Shnaekel Kelsey L. , Magann Everett F. 
Published: July 2018

Importance
Uterine inversion is frequently accompanied by postpartum hemorrhage and hypovolemic shock. Morbidity and mortality occur in as many as 41% of cases. Prompt recognition and management are of utmost importance.

Objective
The aim of this review is to describe risk factors, clinical and radiographic diagnostic criteria, and management of this rare but potentially life-threatening complication of pregnancy.

Evidence Acquisition
A PubMed, Web of Science, and CINAHL search was undertaken with no limitations on the number of years searched.

Results
There were 86 articles identified, with 25 being the basis of review. Multiple risk factors for a uterine inversion have been suggested including a morbidly adherent placenta, short umbilical cord, congenital weakness of the uterine wall or cervix, weakening of the uterine wall at the placental implantation site, fundal implantation of the placenta, uterine tumors, uterine atony, sudden uterine emptying, fetal macrosomia, manual removal of the placenta, inappropriate fundal pressure, excessive cord traction, and the use of uterotonic agents prior to placental removal. The diagnosis is almost exclusively clinical, and successful treatment depends on prompt recognition of the uterine inversion. Treatment options include manual and surgical replacement of the inverted uterus. There is no consensus regarding mode of delivery in subsequent pregnancies as reinversion in a subsequent pregnancy is unpredictable. However, if surgical replacement was required in the index pregnancy and involved an incision into the contractile portion of the uterus, cesarean delivery is a reasonable management option similar to that offered for a prior classic cesarean section.

Conclusions
Successful treatment is dependent on prompt recognition. Management should include resuscitation of maternal hypovolemic shock, as well as repositioning of the inverted uterine fundus.

Relevance
Uterine inversion is a rare but potentially life-threatening obstetrical emergency.

Target Audience
Obstetricians and gynecologists, family physicians.

Learning Objectives
After completing this activity, the learner should be better able to evaluate published literature regarding puerperal uterine inversion, assess its associated comorbidities and risk factors, define clinical and radiographic diagnostic criteria to assist in prompt recognition and management of this obstetrical emergency, and propose management options for future pregnancies.
Gonococcal Conjunctivitis in Adults: Case Report and Retrospective Review of Cases in Alberta, Canada, 2000–2016
Authors: Belga Sara , Gratrix Jennifer , Smyczek Petra , Bertholet Lindsay , Read Ron , Roelofs Kelsey , Singh Ameeta E. 
Published: July 2018

BackgroundA case of gonococcal conjunctivitis (GC) prompted us to review the reported cases and treatment regimens of GC in Alberta, Canada.MethodsGonococcal cases reported from 2000 to 2016 were extracted from the provincial sexually transmitted infection reporting database. The diagnosis of GC was based on a positive culture and/or nucleic acid amplification test from the eye.ResultsA total of 45 cases of GC were reported in adults. Three quarters (75.6%; n = 34) of the cases were diagnosed using culture, 57.8% (n = 26) of cases were among men, and 55.5% (n = 25) were diagnosed since 2014. Very few (13.3%; n = 6) of the cases were treated according to current Canadian Guidelines on Sexually Transmitted Infections, using 2 g of ceftriaxone in combination with azithromycin or doxycycline. Results of test of cures were available for 15.6% (n = 7) of the cases and occurred within 10 to 79 days (median = 26 days) after treatment; all were negative.ConclusionsGonococcal conjunctivitis was relatively uncommon in our region, but given its potential for severe manifestations and sequelae coupled with the rising rates of gonorrhea; it remains important to consider this diagnosis in sexually active individuals presenting with purulent conjunctivitis. Additional studies are needed to inform treatment recommendations and to evaluate outcomes of infection.
Failure-to-rescue in Patients Undergoing Pancreatectomy
Authors: El Amrani Mehdi , Clement Guillaume , Lenne Xavier , Farges Olivier , Delpero Jean-Robert , Theis Didier , Pruvot François-René , Truant Stéphanie 
Published: July 2018

Objective:
To evaluate the influence of hospital volume on failure-to-rescue (FTR) after pancreatectomy in France.

Background:
There are growing evidences that FTR is an important source of postoperative mortality (POM) after pancreatectomy. However, few studies have analyzed the volume-FTR relationship following pancreatic surgery.

Methods:
All patients undergoing pancreatectomy between 2012 and 2015 were included. FTR is defined as the 90-day POM rate among patients with major complications. According to the spline model, the critical cutoff was 20 resections per year and hospitals were divided into low (<10 resections/an), intermediate (11–19 resections/yr), and high volume centers (≥20 resections/yr).

Results:
Overall, 12,333 patients who underwent pancreatectomy were identified. The POM was 6.9% and decreased significantly with increased hospital volume. The rate of FTR was 14.5% and varied significantly with hospital volume (18.3% in low hospital volume vs 11.9% in high hospital volume, P < 0.001), age (P < 0.001) and ChCl (CCl0-2: 11.5%, ChCl3: 13%, CCl ≥4:18.6%; P < 0.001). FTR for renal failure was the highest of all complications (40.2%), followed by postoperative shock (36.4%) and cardiac complications (35.1%). The FTR was significantly higher in low and intermediate compared with high volume hospitals for shock, digestive, and thromboembolic complications and reoperation. In multivariable analysis, intermediate (OR = 1.265, CI95%[1.103–1.701], P = 0.045) and low volume centers (OR = 1.536, CI95%[1.165–2.025], P = 0.002) were independently associated with increased FTR rates.

Conclusion:
FTR after pancreatectomy is high and directly correlated to hospital volume, highlighting variability in the management of postoperative complications. Measurement of the FTR rate should become a standard for quality improvement programs.
β-Blockade in Rectal Cancer Surgery
Authors: Ahl Rebecka , Matthiessen Peter , Fang Xin , Cao Yang , Sjolin Gabriel , Lindgren Rickard , Ljungqvist Olle , Mohseni Shahin 
Published: July 2018

Objective:
To ascertain whether regular β-blocker exposure can improve short- and long-term outcomes after rectal cancer surgery.

Background:
Surgery for rectal cancer is associated with substantial morbidity and mortality. There is increasing evidence to suggest that there is a survival benefit in patients exposed to β-blockers undergoing non-cardiac surgery. Studies investigating the effects on outcomes in patients subjected to surgery for rectal cancer are lacking.

Methods:
All adult patients undergoing elective abdominal resection for rectal cancer over a 10-year period were recruited from the prospectively collected Swedish Colorectal Cancer Registry. Patients were subdivided according to preoperative β-blocker exposure status. Outcomes of interest were 30-day complications, 30-day cause-specific mortality, and 1-year all-cause mortality. The association between β-blocker use and outcomes were analyzed using Poisson regression model with robust standard errors for 30-day complications and cause-specific mortality. One-year survival was assessed using Cox proportional hazards regression model.

Results:
A total of 11,966 patients were included in the current study, of whom 3513 (29.36%) were exposed to regular preoperative β-blockers. A significant decrease in 30-day mortality was detected (incidence rate ratio = 0.06, 95% confidence interval: 0.03–0.13, P < 0.001). Deaths of cardiovascular nature, respiratory origin, sepsis, and multiorgan failure were significantly lower in β-blocker users, as were the incidences in postoperative infection and anastomotic failure. The β-blocker positive group had significantly better survival up to 1 year postoperatively with a risk reduction of 57% (hazard ratio = 0.43, 95% confidence interval: 0.37–0.52, P < 0.001).

Conclusions:
Preoperative β-blocker use is strongly associated with improved survival and morbidity after abdominal resection for rectal cancer.