bluuebunny/crossref_metadata_2025_split huggingface dataset:
Febrile convulsions during recovery after anesthesia in an infant with history of MMR vaccination
Authors: Lee Hyung Gon , Bae Hong-Beom , Choi Jeong Il , Pyeon Taehee , Kim Sungmin , Kim Joungmin 
Published: August 2019

Abstract

Rationale:
Seizures are rare during the perioperative period; in most cases, there is a previous history of epilepsy or surgery-associated seizures. Febrile convulsions may occur when the body temperature rises above 38°C; this is the most common cause of seizures in children. Febrile convulsions after general anesthesia in the postanesthetic care unit (PACU) without a past or family history are rare. Some reviews suggest that since anesthesia changes immunity, elective surgery should be postponed three weeks after live vaccination.

Patient:
A 12-month-old female with bilateral hearing loss underwent cochlear implantation under general anesthesia. She did not have any history of convulsions or developmental disorders. However, 1 week before surgery, measles-mumps-rubella (MMR) vaccination was given as a regular immunization.

Diagnoses:
Forty minutes after arrival at the PACU, sudden generalized tonic-clonic movement occurred during recovery and the patient's measured body temperature exceeded 38.0°C.

Interventions:
Thiopental sodium was administered intravenously as an anticonvulsant, and the tonic-clonic movement stopped immediately. Endotracheal intubation was performed to secure the airway, and tepid massage and diclofenac β-dimethylaminoethanol administration were performed to lower the patient's body temperature.

Outcomes:
There was no further fever and no seizures, and no other neurological deficits were observed until discharge.

Lessons:
The anesthesiologist should check the recent vaccination history even if the patient has not developed particular symptoms after vaccination. It is important to know that febrile convulsions may occur in patients who have recently received MMR vaccination.
The performance of M and XL probes of FibroScan for the diagnosis of steatosis and fibrosis on a Brazilian nonalcoholic fatty liver disease cohort
Authors: Cardoso Ana Carolina , Cravo Claudia , Calçado Fernanda Luiza , Rezende Guilherme , Campos Carlos Frederico F. , Neto João Marcello A. , Luz Rodrigo P. , Soares Jorge André S. , Moraes-Coelho Henrique Sergio , Leite Nathalie C. , Perez Renata M. , Villela-Nogueira Cristiane A. 
Published: August 2019

Objectives
Recently, controlled attenuation parameter (CAP) was incorporated for XL probe. However, its performance through M and XL probes has been scarcely evaluated in nonalcoholic fatty liver disease (NAFLD). The performance of probes regarding transient elastography by Fibroscan is still under debate.

Aim
Compare the performance of CAP and transient elastography in NAFLD patients obtained through XL with M probes using histological analysis as gold standard.

Methods
NAFLD patients underwent liver biopsy and FibroScan/CAP with M and XL probes the same day. C-statistic evaluated CAP performance in the identification of moderate/severe (≥33%) and severe (≥66%) steatosis by both probes and transient elastography performance for identification of significant fibrosis (≥F2).

Results
Eighty-one patients (74% female; age 54.2 ± 9.9 years; BMI 32.8 ± 5.2/ BMI ≥ 25 92.6%; 96% metabolic syndrome; 60% diabetes mellitus) were included. Mean CAP with M and XL probes was 314 ± 39 and 325 ± 47 dB/m, respectively. The areas under receiver operating characteristic curves (AUROCs) of the M and XL probes for steatosis detection ≥33% were 0.75 (0.64–0.84) and 0.76 (0.65–0.84) (P = 0.95) and for steatosis ≥66% 0.83 (0.73–0.90) and 0.82 (0.71–0.89) (P = 0.73), respectively, with similar performances for both degrees of steatosis. Regarding transient elastography, AUROCs of M and XL probes for ≥F2 were 0.82 (0.71–0.93) and 0.80 (0.69–0.92) (P = 0.66).

Conclusion
Performance of M and XL probes is similar for the diagnosis of moderate and severe steatosis and significant fibrosis even on a overweight population with NAFLD.
Performance of noninvasive scores for the diagnosis of advanced liver fibrosis in morbidly obese with nonalcoholic fatty liver disease
Authors: de Carli Maria AL , de Carli Luiz A. , Correa Marcos B. , Junqueira Gerson , Tovo Cristiane Valle , Coral Gabriela P. 
Published: August 2019

Objectives
Liver fibrosis is one of the most important predictors of mortality related to nonalcoholic fatty liver disease (NAFLD). The use of noninvasive markers has the advantage of a simple and low-cost evaluation. The aim of this study was to evaluate the performance of six noninvasive scores for the diagnosis of advanced liver fibrosis in morbidly obese patients.

Material and methods
A retrospective study validation included 323 morbidly obese patients undergoing bariatric surgery. Advance fibrosis was defined as stage 3 and 4 (septal fibrosis or cirrhosis). Accuracy, sensitivity, specificity, positive (PPV) or negative (NPV) predictive value, and positive (PLR) or negative (NLR) likelihood ratio test of the following noninvasive liver fibrosis scores were evaluated: aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio (AAR); AST to platelet ratio index (APRI); BARD; FIB4, NAFLD fibrosis score (NFS) and BAAT, which were compared with the histological findings of the intraoperative liver biopsy. The cutoff points established in the validation studies were used: AAR  >  1; APRL  >  0.98; BARD  ≥  2; FIB4  >  2.67; NFS  >  0.676 and BAAT  >  1.

Results
Twenty-nine patients (8.97%) presented advanced fibrosis. APRI presented the higher specificity (99.61%), PPV (85.71%), PLR (62.5) and accuracy (0.93). FIB4 was the second test in accuracy (0.9) and in PLR (10.53). BAAT presented the highest sensitivity (73.08%) and NPV (94.78%); NFS the lowest sensitivity (12,5%), and BARD the lowest accuracy (0.44).

Conclusion
APRI and FIB-4 were the tests with best performance to predict advanced fibrosis.
Safety of variceal band ligation in patients with cirrhosis and portal vein thrombosis treated with anticoagulant therapy: A retrospective study
Authors: Ponthus Simon , Spahr Laurent , Casini Alessandro , Berney Thierry , Frossard Jean-Louis , Majno Pietro , Elkrief Laure 
Published: August 2019

Background and aims
Anticoagulant therapy has been recommended in patients with cirrhosis and portal vein thrombosis especially in candidates for liver transplantation. These patients are also likely to need variceal band ligation. This study aimed to assess the incidence of upper gastrointestinal bleeding after elective variceal band ligation in patients with cirrhosis receiving anticoagulant therapy for portal vein thrombosis.

Methods
Patients with cirrhosis and nontumoral portal vein thrombosis treated with anticoagulant therapy undergoing elective variceal band ligation were retrospectively included. We recorded upper gastrointestinal bleeding events occurring within two weeks after variceal band ligation. Postvariceal band ligation bleeding was defined as active bleeding on at least one site of previous ligation at endoscopy.

Results
Between 2014 and 2017, 32 patients with cirrhosis had scheduled variceal band ligations while on anticoagulant therapy [men 75%; median age 59 years; aetiology of cirrhosis: alcohol (50%), viral (34%), alcohol and viral (16%); and Child-Pugh score: A (31%), B (44%), and C (25%)]. Three (9%) patients presented postvariceal band ligation bleeding during the follow-up. None of these events led to haemorrhagic shock or death. Factors associated with postvariceal band ligation bleeding included variceal band ligation performed as secondary prophylaxis (P = 0.05) and previous decompensation of cirrhosis (P = 0.03).

Conclusion
In this small group of patients under anticoagulation therapy undergoing variceal band ligation, only a minority presented postendoscopic bleeding of minor importance. Nevertheless, particular attention should be paid to patients with previous decompensation of cirrhosis.
The 7-day mortality associated with an early warning score varies between age groups in a cohort of adult Danish emergency department patients
Authors: Dynesen Jacob , Skov Maj J. , Mackenhauer Julie , Jessen Marie K. , Liesanth Janet Y. , Ebdrup Lotte , Kirkegaard Hans 
Published: August 2019

Introduction:
Early warning scores are designed for monitoring hospitalized patients and enable a timely response to deviating vital signs. The aim of this study was to examine whether 7-day mortality, associated with an initial early warning score, differs between age groups. Our hypothesis was that elderly patients are at greater risk of dying compared to a younger patient with a similar early warning score.

Methods:
This observational cohort study included adult emergency department patients from five hospitals in Denmark over three consecutive months in 2015. Logistic regression was used to examine the relationship between patients’ initial early warning scores category (0, 1–2, 3–4, 5–6, 7+) and 7-day mortality in different age groups (16–59 years, 60–79 years, 80+ years). Mortality rates in each early warning scores category are compared between the youngest patients (16–59 years, reference group) and the two older age groups (60–79 years and 80+ years).

Results:
A total of 19 123 emergency patients were included. The senior age groups (60–79 years and 80+ years) both displayed significantly higher 7-day mortality, in all early warning score categories, when compared to the youngest patients (16–59 years). The mortality difference between the youngest (16–59 years) and oldest age group (80+ years) remained significant in all early warning scores categories after adjusting for comorbidity.

Conclusion:
Our findings show that the oldest emergency department patients (80+ years) have a higher 7-day mortality compared to young patients (16–59 years) with a similar initial early warning score.
Persistently elevated early warning scores and lactate identifies patients at high risk of mortality in suspected sepsis
Authors: Hargreaves Duncan Sebastian , de Carvalho Joshua Lucas Jarman , Smith Laura , Picton Graham , Venn Richard , Hodgson Luke Eliot 
Published: August 2019

Objective
In the UK, the National Early Warning Score (NEWS) is recommended as part of screening for suspicion of sepsis. Is a change in NEWS a better predictor of mortality than an isolated score when screening for suspicion of sepsis?.

Methods
A prospectively gathered cohort of 1233 adults brought in by ambulance to two UK nonspecialist hospitals, with suspicion of sepsis at emergency department (ED) triage (2015–2017) was analysed. Associations with 30-day mortality and ICU admission rate were compared between groups with an isolated NEWS ≥5 points prehospital and those with persistently elevated NEWS prehospital, in ED and at ward admission. The effect of adding the ED (venous or arterial) lactate was also assessed.

Results
Mortality increased if the NEWS persisted ≥5 at ED arrival 22.1% vs. 10.2% [odds ratio (OR) 2.5 (1.6–4.0); P < 0.001]. Adding an ED lactate ≥2 mmol/L was associated with an increase in mortality greater than for NEWS alone [32.2% vs. 13.3%, OR 3.1 (2.2–4.1); P < 0.001], and increased ICU admission [13.9% vs. 3.7%, OR 3.1 (2.2–4.3); P < 0.001]. If NEWS remained ≥5 at ward admission (predominantly within 4 h of ED arrival), mortality was 32.1% vs. 14.3%, [OR 2.8 (2.1–3.9); P < 0.001] and still higher if accompanied by an elevated ED lactate [42.1% vs. 16.4%, OR 3.7 (2.6–5.3); P < 0.001].

Conclusion
Persistently elevated NEWS, from prehospital through the ED to the time of ward admission, combined with an elevated ED lactate identifies patients with suspicion of sepsis at highest risk of in-hospital mortality.
New immunodeficiency syndromes that help us understand the IFN-mediated antiviral immune response
Authors: Jing Huie , Su Helen C. 
Published: August 2019

Purpose of review
Studying primary immunodeficiencies (PIDs) provides insights into human antiviral immunity in the natural infectious environment. This review describes new PIDs with genetic defects that impair innate antiviral responses.

Recent findings
New genetic defects in the interferon (IFN) signaling pathway include IFNAR1 deficiency, which causes uncontrolled infections with measles-mumps-rubella or yellow fever vaccines, and possibly also cytomegalovirus (CMV); and IRF9 deficiency, which results in influenza virus susceptibility. Genetic defects in several pattern recognition receptors include MDA5 deficiency, which impairs viral RNA sensing and confers human rhinovirus susceptibility; RNA polymerase III haploinsufficiency, which impairs sensing of A:T-rich virus DNA and confers VZV susceptibility; and TLR3 deficiency, which causes HSV-1 encephalitis (HSE) or influenza virus pneumonitis. Defects in RNA metabolism, such as that caused by Debranching enzyme 1 deficiency, can cause virus meningoencephalitis. Finally, defects in host restriction factors for virus replication, such as in CIB1 deficiency, contribute to uncontrolled β-HPV infections.

Summary
Several new PIDs highlight the role of type I/III IFN signaling pathway, virus sensors, and host virus restriction factors in human antiviral immunity.
Improving Lower Extremity Bypass Patient Outcomes
Authors: Guthrie Meredith P. , Xhaja Anisa , Beck Adam W. 
Published: August 2019

Background:
Care variation is associated with poor quality outcomes. Clinical practice guideline implementation is one method to decrease care variation and improve outcomes. Enhanced Recovery After Surgery (ERAS) is a clinical pathway encompassing best practices across the surgical patient care continuum.

Local Problem:
The lower extremity bypass (LEB) population had high length of stay (LOS), readmissions, and surgical site infections.

Methods:
A comprehensive and systematic project management process was utilized to implement the ERAS pathway in the LEB population with the help of an interdisciplinary team.

Interventions:
Clinical practice guidelines were created to integrate ERAS elements into the LEB population care continuum. Patient education was revised or created to ensure standardized information was communicated to patients from consultation through discharge and early follow-up.

Results:
Preliminary data show 4.57 mean LOS (n = 21) compared with the prior year's mean of 6.81 (n = 53).

Conclusion:
ERAS pathway introduction to the LEB population is suggestive of improved outcomes based on preliminary data.
Reducing Missed Appointments for Patients With HIV
Authors: Adams Judith Ann , Whiteman Kimberly , McGraw Samantha 
Published: August 2019

Background:
High rates of missed appointments for routine HIV care are associated with unsuppressed viremia, increasing morbidity.

Local Problem:
The Clinic no-show rate ranged between 30% and 35%, and only 69% of patients were considered retained in care within a 24-month time frame.

Methods:
The Woodward Risk Prediction Tool was completed on all patients to stratify patient risk for missing the next appointment.

Interventions:
All patients were offered text message along with standard phone message appointment reminders, and patients who missed appointments were called within 24 hours to reschedule. Medium-risk patients received a previsit planning call to remove barriers to appointment attendance, and high-risk patients received a home visit from the peer navigator.

Results:
The project resulted in a 3.8% reduction rate in the overall no-show rate in the first 5 months of implementation. Using risk stratification and targeted interventions allowed valuable resources to be allocated where they were needed.
Maximizing the Benefit of Quality Improvement Activities
Authors: Wolak Erica , Overman Angela , Willis Beth , Hedges Christine , Spivak Glen F. 
Published: August 2019

Background:
Many organizations struggle to efficiently and effectively spread improvement activities. This article presents findings from a model developed to standardize the sharing of innovative ideas within nursing at an academic medical center.

Problem:
Quality improvement activities were occurring in many nursing units but often did not spread beyond the originating unit. Challenges included variability in operationalizing initiatives, inconsistent understanding of project goals, and the lack of a dissemination process.

Approach:
The Spread of Innovations Model was developed to ensure structure and resources are in place to spread successful initiatives. The model uses Lean problem-solving and engages frontline nurses with senior leadership when spreading internally developed best practices.

Outcomes:
The model was piloted by spreading a catheter-associated urinary tract infection (CAUTI) prevention project throughout nursing. Using the model led to significantly decreased CAUTIs.

Conclusions:
Improvement efforts without a process for spreading can lead to inefficiencies and variable outcomes.
Modern-Day Relics of Psychiatry
Authors: Tripathi Samidha , Messias Erick , Spollen John , Salomon Ronald M. 
Published: August 2019

Abstract
Constantly shifting cultural views influence public perceptions of psychiatric diagnoses, sometimes accommodated by changes in diagnostic terminology. Evolving scientific knowledge of the era is at times used to justify and support mental illnesses. Too often, however, remasked nomenclatures fail to alter social stigma, in part because political arguments are used. Scientific validations of variant behaviors as symptoms with a pathologic status are unfortunately overshadowed. Examples of cultural bias effects on recurring diagnostic challenges illustrate a need for scientific validation. Renaming fails to improve stigma or diagnostic clarity. For example, neurasthenia, or nervous exhaustion, was attributed to fast-paced urban life through the late 1970s. Its symptoms are now largely, to no real advantage, retitled as chronic fatigue syndrome. Diagnoses like “hysteria” have evolved into histrionic personality disorder and somatoform spectrum disorders, although less as a result of demonic possession or a “wandering uterus.” Decriminalized and depathologized homosexuality remains a political football, where religious “sin” conceptualizations have not been displaced by studies documenting healthy adjustments among groups with diverse sexual orientations and preferences. Each of these remains severely socially stigmatized. The pseudoscience of “drapetomania,” once used to rationalize and pathologize a slave's freedom, is perceived now as psychiatric incarcerations of mentally healthy individuals, more commonly in totalitarian regimes—a politicization of stigma. Research reviews and funding efforts need to emphasize a sound basis for individuals caught in perpetuated diagnostic challenges, not remedied by simple shifts in nomenclature.
Determinants of Acquisition and Clearance of Human Papillomavirus Infection in Previously Unexposed Young Women
Authors: El-Zein Mariam , Ramanakumar Agnihotram V. , Naud Paulo , Roteli-Martins Cecilia M. , de Carvalho Newton S. , Colares de Borba Paola , Teixeira Julio C. , Moscicki Anna-Barbara , Harper Diane M. , Tyring Stephen K. , Ramjattan Brian , Dubin Gary , Franco Eduardo L. 
Published: August 2019

Background
Global variation in human papillomavirus (HPV) prevalence and persistence may be explained by differences in risk factors, such as sexual activity, oral contraceptive use, and behavioral factors. We evaluated determinants of acquisition and clearance of HPV infection among young women previously unexposed to HPV.

Methods
Five hundred thirty-four women aged 15 to 25 years who were cytology and HPV DNA negative, and seronegative for anti-HPV-16/18 antibodies, were recruited (July 2000–September 2001) from study centers in Brazil, the United States, and Canada (NCT00689741/NCT00120848). They were followed up for 76 months. Cervical samples were HPV genotyped via polymerase chain reaction. We used multivariable (forward stepwise, P = 0.15) Cox proportional hazards regression to estimate rate ratios (RR) and 95% confidence intervals (CI), separately according to length of follow-up time.

Results
On short-term follow-up (0–27 months), 257 (48%; 8535.80 person-months; incidence rate = 30.11; 95% CI, 26.64–34.02) incident HPV infections were detected. Marital status, lifetime number of sex partners, history of any sexually transmitted disease, and occasional use of oral contraceptives were strongly associated with acquisition of any HPV. Having 2 or more lifetime sex partners (RR, 2.03; 95% CI, 1.37–3.02) and a history of any sexually transmitted disease (RR, 1.98; 95% CI, 1.19–3.29) were the most important determinants of high-risk HPV (hrHPV) incidence. During the entire follow-up (0–76 months), an increased hrHPV clearance was found among women in North America (RR, 1.38; 95% CI, 1.08–1.78) and black women (RR, 1.64; 95% CI, 1.04–2.60). Greater number of lifetime partners was associated with reduced clearance rates for any HPV (RR, 0.65; 95% CI, 0.43–0.98).

Conclusions
We identified variation in risk of HPV acquisition and clearance among women unexposed to HPV at baseline.
Pediatric Exposures Reported to the Toxicology Investigators Consortium, 2010–2015
Authors: Desai Neil M. , Mistry Rakesh D. , Brou Lina , Boehnke Maren E. , Lee Jeffrey S. , Wang George S. ,   on behalf of the Toxicology Investigators Consortium
Published: August 2019

Background and Objective
Poisoning is the leading cause of injury death in pediatric patients. Hospital and provider readiness, including pharmacy stocking, depends on reliable surveillance data describing local patterns of age-specific clinically significant exposures and the therapeutic modalities employed in their treatment. We aimed to characterize trends in clinically significant toxic exposures and their management.

Methods
We performed a retrospective review of patients 18 years or younger in the American College of Medical Toxicology's Toxicology Investigators Consortium (ToxIC) Registry, a self-reporting database completed by bedside consulting medical toxicologists. We reviewed cases from January 1, 2010, through December 31, 2015. In 2015, ToxIC included 101 health care facilities. Data collected included demographics, geographic region, encounter and exposure details, survival, and therapeutic modalities employed, including antidotes, antivenoms, gastric decontamination, enhanced elimination, hyperbaric oxygen therapy, and extracorporeal membrane oxygenation.

Results
From 2010 to 2015, 11,616 consults were recorded in ToxIC. Pediatric consultations increased from 934 (23.7%) in 2010 to 2425 (29.9%) in 2015 (P < 0.001). Exposures were most commonly reported in females (57.8%) and adolescents (59.4%). Intentional ingestions (55.5%) comprised the majority of cases. The most frequent agents of exposure were analgesics (21.0%). There were 38 deaths reported (0.9%). The antidote used most commonly was N-acetylcysteine (11.0%). Geographic variation was demonstrated in prevalence of envenomations and heavy metal exposures, their respective treatments, and overall use of decontamination.

Conclusions
Toxicology consultations for pediatric exposures increased from 2010 to 2015. Understanding which pediatric exposures require toxicologist management, the therapies most frequently employed, and geographical patterns is paramount to facility-level planning, pharmacy stocking, and provider education.