bluuebunny/crossref_metadata_2025_split huggingface dataset:
Bilateral decompression retinopathy after deep sclerectomy with mitomycin C in a child with tubulointerstitial nephritis and uveitis syndrome
Authors: Muñoz-Negrete Francisco J , Díez-Álvarez Laura , Garcia Carlota Fuente , Rebolleda Gema 
Published: March 2019

Introduction: To report the first case of bilateral ocular decompression retinopathy after uneventful non-perforating deep sclerectomy with mitomycin C in a child with tubulointerstitial nephritis and uveitis syndrome. Case description: An 8-year-old girl affected by tubulointerstitial nephritis and uveitis syndrome developed ocular hypertension (45 mmHg in the right eye and 42 mmHg in the left eye) associated with recurrent episodes of uveitis and chronic use of steroids despite maximum hypotensive medical treatment. Bilateral non-perforating deep sclerectomy with mitomycin C (0.2 mg/mL, 1 min) was performed under general anesthesia without complications. The first postoperative day, the visual acuity was reduced to 0.6 in the right eye and 0.05 in the left eye and the intraocular pressure was 3 mmHg in both eyes. Fundoscopy revealed bilateral optic nerve swelling and diffuse retinal hemorrhages, some of them with scattered-white centers. About 2 months after surgery, the visual acuity was normal and the fundus examination showed complete resolution. Conclusion: The ocular decompression retinopathy is an uncommon complication after non-perforating deep sclerectomy. This is the first case of bilateral ocular decompression retinopathy reported after non-perforating deep sclerectomy in a child with ocular hypertension secondary to recurrent uveitis and chronic use of steroids associated with tubulointerstitial nephritis and uveitis syndrome.
Optic coherence tomography angiography follow-up in a case of Purtscher-like retinopathy due to atypical hemolytic uremic syndrome
Authors: Santamaría Álvarez Juan Francisco , Serret Camps Anna , Aguayo Alvarez Javier , García García Olga 
Published: March 2019

Purpose: To report a case of Purtscher-like retinopathy due to atypical hemolytic uremic syndrome and the changes seen in the optical coherence tomography angiography before and after treatment with eculizumab. Case description: A 22-year-old man with an unremarkable medical history presented with acute, bilateral blurred vision and headache of 1-week duration. Best corrected visual acuity of 20/50 and 20/40, respectively, in the patient’s right eye and left eye. Funduscopy revealed multiple cotton-wool spots associated with intrarretinal fluid. Swept source optical coherence tomography revealed multifocal retinal detachments with increased choroidal thickness. Optical coherence tomography angiography showed areas of ischemia in both capillary plexus. Due to concurrent symptoms and laboratory analysis, he was diagnosed with atypical hemolytic uremic syndrome and secondary Purtscher-like retinopathy; therefore, treatment with eculizumab was initiated. After 2 months revascularization of the previous ischemic areas was seen in the optical coherence tomography angiography that were correlated with best corrected visual acuity improvement. Conclusion: Our findings suggest that evaluation of the macular capillary plexus revascularization by optical coherence tomography angiography during the disease could help to predict an improvement of best corrected visual acuity in these patients and the measurement of choroidal thickness could give us information about the resolution of the pathologic process.
The Voice-Related Quality Of Life: A Study on the Reliability and Validity of the Tamil Version
Authors: Rangarajan Akshaya , Selvaraj Jasmine Lydia , Santhanam Divya Perumal 
Published: March 2019

Objective: Voice serves as an identity and is one of the primary requisites of an individual, especially for singers who are extensive professional voice users with greater vulnerability to voice disorders. The aim of this study is to translate and validate the Tamil version of Voice-Related Quality of Life (T-VRQOL), a self-rating questionnaire that estimates the influence of voice disorders on quality of life. The study also intends to compare the T-VRQOL scores in singers (with and without voice complaint) and non-singers, and to correlate T-VRQOL and the Tamil Singing Voice Handicap Index-10 (TSVHI-10). Method: In this cross-sectional study, 120 native Tamil speakers (40 classically trained Carnatic singers without voice complaints, 40 Carnatic singers with voice complaints and 40 normal non-singers) in the age range of 20 to 50 years, filled in the T-VRQOL and the TSVHI-10 rating scales, along with a demographic questionnaire. Results: Reliability of T-VRQOL was established with Cronbach α coefficient (r = 0.9, P < .001) and good test-retest reliability (r = 0.98). The validity of T-VRQOL was confirmed by examining convergent and discriminant validity. T-VRQOL also demonstrated a good correlation with the TSVHI-10 (r = 0.838, P < .001). On comparing the T-VRQOL scores across the groups, singers (13.88 and 24.3) obtained higher values than the non-singers (11.63). Among the singers, those with voice complaints (24.3) scored higher than those without voice complaints (13.88) in the T-VRQOL. Conclusions: The Tamil version of Voice-Related Quality of Life (VRQOL) questionnaire correlates well with TSVHI-10. It proves to be an effective clinical tool in effectively evaluating the VRQOL among the Tamil-speaking population.
Predictive value of conventional MRI parameters in first spinal attacks of neuromyelitis optica spectrum disorder
Authors: Bonnan Mickael , Debeugny Stéphane , Mejdoubi Mehdi , Cabre Philippe 
Published: March 2019

Background: While spinal cord (SC) attacks of neuromyelitis optica spectrum disorder (NMOSD) are often devastating, signs predictive of their poor clinical outcome have been elusive until now, except for the delay in initiating plasma exchange (PE). Objective: We studied the correlation between conventional non-standardized magnetic resonance imaging (MRI) parameters, PE treatment, and clinical data obtained at nadir and recovery. Methods: Retrospective study of first SC attacks of NMOSD. Results: Sixty-nine Afro-Caribbean NMOSD patients were included (aquaporin-4 (AQP4) antibodies positive in 65%). Median nadir and residual expanded disability status score (EDSS) were, respectively, 7.5 and 4.0. In bivariate analysis, all conventional MRI parameters were correlated with nadir and residual EDSS. In multivariate analysis, nadir EDSS correlated with lesion length ( p = 0.022) and edema ( p = 0.019), whereas residual EDSS correlated with T1w (T1-weighted) hypointense signal ( p = 0.003). Gadolinium enhancement was not associated with outcome. Conclusion: A specific pattern of lesions in conventional MRI data is differentially associated with nadir and residual EDSS. Lesions associated with poor prognosis should prompt highly efficient treatment.
Automated classification of primary care patient safety incident report content and severity using supervised machine learning (ML) approaches
Authors: Evans Huw Prosser , Anastasiou Athanasios , Edwards Adrian , Hibbert Peter , Makeham Meredith , Luz Saturnino , Sheikh Aziz , Donaldson Liam , Carson-Stevens Andrew 
Published: March 2019

Learning from patient safety incident reports is a vital part of improving healthcare. However, the volume of reports and their largely free-text nature poses a major analytic challenge. The objective of this study was to test the capability of autonomous classifying of free text within patient safety incident reports to determine incident type and the severity of harm outcome. Primary care patient safety incident reports (n=31333) previously expert-categorised by clinicians (training data) were processed using J48, SVM and Naïve Bayes. The SVM classifier was the highest scoring classifier for incident type (AUROC, 0.891) and severity of harm (AUROC, 0.708). Incident reports containing deaths were most easily classified, correctly identifying 72.82% of reports. In conclusion, supervised ML can be used to classify patient safety incident report categories. The severity classifier, whilst not accurate enough to replace manual processing, could provide a valuable screening tool for this critical aspect of patient safety.
Parents’ and children’s perceptions of child maltreatment
Authors: Lev-Wiesel Rachel , Massrawa Nadia , Binson Bussakorn 
Published: March 2019

Summary Child maltreatment is under-reported despite its high prevalence. It ranges from one-third to one-half lifetime exposure to violence. This points out to the issue of laypersons’ perceptions of what is child maltreatment and at what severity should it be reported. The current study sought to examine children and youth versus parents’ perceptions of child maltreatment. Following ethical approval, 259 children and youth between the ages 9 and 14 and 229 parents were administered anonymous questionnaire that included demographics and The Perception of Child Maltreatment Severity Scale. Statistically significant differences between children and youth, and adults in perception of child maltreatment in general were observed. Findings Results indicated that the groups differ in the severity attributed to emotional abuse and sexual abuse. In addition, unlike parents, children and youth perceived exposure of embarrassing photos via Internet and silent treatment by peers to be severe whereas parents perceived sexual molestation to be most severe behavior. Applications The study findings were discussed in light of the cultural gap between children and parents. Practically, the gap between parents’ and children’s perceptions of child maltreatment indicates the need for parents and professionals to look beyond their own perceptions and be alert to experiences of victimization a young person may have. This might assist professionals in developing an intervention program to increase children’s awareness of violent behaviors and decrease the gap between generations in terms of the perceptions gap.
Delta Xtend reverse shoulder arthroplasty – Results at a minimum of five years
Authors: Ball Craig M 
Published: March 2019

Background Reverse shoulder arthroplasty provides predictable pain relief and improvements in function, but concerns remain regarding complication rates and there is little long-term outcome data. The aim of this study was to review the clinical and radiographic outcomes of the Delta Xtend reverse shoulder arthroplasty at a minimum of five years. Methods Ninety-six Delta Xtend reverse shoulder arthroplasty procedures were performed in 93 patients. There were 41 males and 52 females with an average age of 74.9 years. All available patients returned for clinical and radiographic analysis, including completion of patient reported outcome measures. Results The complication rate was 9.4%. There were three revisions (3.1%) and two other reoperations (2.1%). Fifty-nine shoulders were available for review at an average of 81 months. Average forward flexion was 142°. Average American Shoulder and Elbow Assessment Score improved from 27.6 to 78.5 (p<0.001). Radiolucent lines and/or proximal bone resorption was seen in 35.4%. Scapula notching was observed in 69.1%, with Grade III or IV notching in 20%. These findings had no effect on patient reported outcome measures. Discussion This study confirms the clinical benefits of reverse shoulder arthroplasty, with improvements maintained out to 10 years. The high rate of scapula notching remains a concern. Further study is needed to fully understand the clinical significance of notching, as well as the potential benefits of newer implant designs.
Assessment of literacy and numeracy skills related to non-steroidal anti-inflammatory drug labels
Authors: Jang Soo Min , Jiang Ruixin , Grabe Darren , Pai Amy Barton 
Published: March 2019

Background: Non-steroidal anti-inflammatory drugs are widely used and have a potential for over-the-counter misuse. Limited health literacy is associated with poor health outcomes. Identification of new strategies to assess literacy and numeracy could be useful in targeting effective education initiatives. Objective: To characterize numeracy and literacy skills related to non-steroidal anti-inflammatory drug labels in primary care patients. Methods: Patients were recruited and consented over an 8-month period after their regular primary care visit. Demographic information was collected and two instruments were administered to assess literacy and numeracy skills: (1) a medication label literacy instrument focused on non-steroidal anti-inflammatory drugs (MedLit-NSAID) and (2) a general healthy literacy-screening tool, the Newest Vital Sign. Two questions on the MedLit-NSAID instrument evaluated understanding of the Food and Drug Administration medication guide for non-steroidal anti-inflammatory drugs and the Food and Drug Administration approved over-the-counter label. Results: A total of 145 patients were enrolled. Mean MedLit-NSAID and Newest Vital Sign scores were 6.8 (scale range 0–8) and 4.2 (scale range 0–6), respectively. Higher education level was associated with higher scores for both tools (p ⩽ 0.05). Total MedLit-NSAID scores on average were higher in females compared with males (6.5 vs 6, p = 0.05). Patients with decreased kidney function (n = 18) had significantly lower MedLit-NSAID scores (p ⩽ 0.05). Test–retest scores were not significantly different for MedLit-NSAID (p = 0.32). The correlation between the tools was 0.54 and internal consistency MedLit-NSAID was 0.61. Conclusion: A medication information focused instrument provided specific information to assess health literacy related to non-steroidal anti-inflammatory drug labels. This information could be utilized to develop patient education initiatives for medication label comprehension.
The Bilateral Bidirectional Glenn Operation as a Risk Factor Prior to Fontan Completion in Complex Congenital Heart Disease Patients
Authors: Keizman Eitan , Tejman-Yarden Shai , Mishali David , Levine Shany , Borik Sharon , Pollak Uri , Katz Uriel , Serraf Alain E. 
Published: March 2019

Introduction: The Glenn procedure is generally performed as a second-stage palliative procedure toward the completion of Fontan circulation in patients with a functionally univentricular heart. Safe Fontan completion requires normal ventricular function, competent atrioventricular valves, normal pulmonary arteries anatomy, and low pulmonary vascular resistances (PVRs), which is merely an estimation that considers both lungs as a single unit. Clinical observations revealed that patients who previously underwent bilateral bidirectional cavopulmonary anastomosis (b-BCPA) had a stormier postoperative course in respect to other patients with previous unilateral BCPA (u-BCPA) postoperatively after Fontan completion. This retrospective study was designed to compare and analyze the outcomes of patients following Fontan completion with previous u-BCPA versus b-BCPA. Patients and Methods: A total of 98 patients were divided into two groups based on the presence or absence of bilateral superior vena cava (SVC). Group 1 included 80 patients with unilateral SVC, and group 2 included 18 patients with bilateral SVC. Univariate and multivariate (SPSS) analyses were performed with regard to mortality and failure. P value of <.05 was considered as significant. Results: Prior to the total cavopulmonary anastomosis operation, the G1 and G2 had similar demographic and physiological findings, ages and weights were 4.3 ± 1.72 years and 15.0 ± 3.71 kg in G1 and 4.8 ± 3.21 years and 17.5 ± 9.76 kg in G2. Mean end-diastolic ventricular pressures (in mm Hg) were 10.50 ± 2.86 in G1 and 10.28 ± 3.07 in G2 and the mean PVRs (in Woods units) were 1.66 ± 1.29 in G1 and 1.49 ± 0.82 in G2. The Stormy postoperative course, Fontan failure, and early mortality were all significantly higher in G2 in respect to G1 ( P value <.05). G1 mortality rate was 3.7%, 3 patients of 80, while in G2, the mortality rate was 22%, 4 patients of 18. Late Fontan failure rates were 6% for G1 patients where two patients developed pulmonary hypertension, two patients developed heart failure, and one patient had protein losing enteropathy (PLE), and 22% for the G2 patients of which two patients developed heart failure, one patient had PLE, and one patient had persistent low systemic venous saturation. Conclusions: Our results have demonstrated that patients after b-BCPA might have a tendency for worse outcomes upon Fontan completion. The b-BCPA is associated with pulmonary artery bifurcation stenosis and presents multiple sources of pulmonary blood flow where conventional PVR calculation might be imprecise and misleading since it considers the lungs as a single unit. Therefore, b-BCPA engenders correction of the conventional PVR calculation to consider each lung separately. Furthermore, the surgical approach for patients with persistent left SVC and univentricular heart should be modified.
Porcine Versus Pericardial Pulmonary Valve Replacement in Adults With Prior Congenital Cardiac Surgery: Midterm Outcomes
Authors: Yuen Chi Sum , Lee Kwok Fai Lucius , Bhatia Inderjeet , Yam Nicholson , Rocha Barnabe Antonio , Yung Tak-cheung , Chow Pak-cheong , Au Wing-Kuk Timmy 
Published: March 2019

Background: Postcongenital heart surgery pulmonary regurgitation requires subsequent pulmonary valve replacement. We sought to compare the outcomes of pulmonary valve replacement after using bioprosthetic valves, porcine versus pericardial bioprosthesis. Method: Retrospective single-center study of consecutive pulmonary valve replacement in patients with pulmonary regurgitation following initial congenital cardiac surgery. From 2004 to 2016, 82 adult patients (53 males, 29 females) underwent pulmonary valve replacement at a mean age of 28.7 ± 8 years (range 18-52 years) with a mean time to pulmonary valve replacement of 24 ± 7 years (range 13-43 years). Porcine bioprosthetic valves (group 1, n = 32) and pericardial valves (group 2, n = 50) were used. Cardiac magnetic resonance imaging was performed (n = 54) at a mean of 18 ± 13 months before and 24 ± 21 months after pulmonary valve replacement. Results: No significant difference was seen between the groups except that the mean follow-up was longer for group 1 (5.02 ± 2.06 vs 4.08 ± 3.21 years). In-hospital mortality was 1.1%. Follow-up completeness was 100% with no late death. Mean right ventricular end-systolic and end-diastolic volumes reduced significantly in both the groups ( P < .001), whereas right ventricular ejection fraction remained unchanged (group 1, P = .129; group 2, P = .675) . Only the left ventricular end-diastolic volume increased in both the groups, but the increase was significant for group 2 only (group 1, P = .070; group 2, P = .015), whereas the left ventricular end-systolic and ejection fraction remained unchanged in both the groups. There was no reoperation for pulmonary valve replacement. Freedom from intervention was 93.8% (group 1) and 100% (group 2) at eight years after pulmonary valve replacement ( P = .407). Conclusion: Midterm outcomes of pulmonary valve replacement in our adult cohort were satisfactory. Both types of bioprosthetic valves performed comparably for eight years and were a good option in adults.
Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease: the GOLD science committee report 2019
Authors: Singh Dave , Agusti Alvar , Anzueto Antonio , Barnes Peter J. , Bourbeau Jean , Celli Bartolome R. , Criner Gerard J. , Frith Peter , Halpin David M.G. , Han Meilan , López Varela M. Victorina , Martinez Fernando , Montes de Oca Maria , Papi Alberto , Pavord Ian D. , Roche Nicolas , Sin Donald D. , Stockley Robert , Vestbo Jørgen , Wedzicha Jadwiga A. , Vogelmeier Claus 
Published: March 2019

Precision medicine is a patient-specific approach that integrates all relevant clinical, genetic and biological information in order to optimise the therapeutic benefit relative to the possibility of side-effects for each individual. Recent clinical trials have shown that higher blood eosinophil counts are associated with a greater efficacy of inhaled corticosteroids (ICSs) in chronic obstructive pulmonary disease (COPD) patients. Blood eosinophil counts are a biomarker with potential to be used in clinical practice, to help target ICS treatment with more precision in COPD patients with a history of exacerbations despite appropriate bronchodilator treatment.The Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017 pharmacological treatment algorithms, based on the ABCD assessment, can be applied relatively easily to treatment-naive individuals at initial presentation. However, their use is more problematic during follow-up in patients who are already on maintenance treatment. There is a need for a different system to guide COPD pharmacological management during follow-up.Recent large randomised controlled trials have provided important new information concerning the therapeutic effects of ICSs and long-acting bronchodilators on exacerbations. The new evidence regarding blood eosinophils and inhaled treatments, and the need to distinguish between initial and follow-up pharmacological management, led to changes in the GOLD pharmacological treatment recommendations. This article explains the evidence and rationale for the GOLD 2019 pharmacological treatment recommendations.
Effects of exercise and airway clearance (positive expiratory pressure) on mucus clearance in cystic fibrosis: a randomised crossover trial
Authors: Dwyer Tiffany J. , Daviskas Evangelia , Zainuldin Rahizan , Verschuer Jordan , Eberl Stefan , Bye Peter T.P. , Alison Jennifer A. 
Published: March 2019

Exercise improves mucus clearance in people without lung disease and those with chronic bronchitis. No study has investigated exercise alone for mucus clearance in cystic fibrosis (CF). The aim of this study was to compare the effects of treadmill exercise to resting breathing and airway clearance with positive expiratory pressure (PEP) therapy on mucus clearance in adults with CF.This 3-day randomised, controlled, crossover trial included 14 adults with mild to severe CF lung disease (forced expiratory volume in 1 s % predicted 31–113%). Interventions were 20 min of resting breathing (control), treadmill exercise at 60% of the participant's peak oxygen consumption or PEP therapy (including huffing and coughing). Mucus clearance was measured using the radioaerosol technique and gamma camera imaging.Treadmill exercise improved whole lung mucus clearance compared to resting breathing (mean difference 3%, 95% CI 2–4); however, exercise alone was less effective than PEP therapy (mean difference −7%, 95% CI −6– −8). When comparing treadmill exercise to PEP therapy, there were no significant differences in mucus clearance from the intermediate and peripheral lung regions, but significantly less clearance from the central lung region (likely reflecting the huffing and coughing that was only in PEP therapy).It is recommended that huffing and coughing are included to maximise mucus clearance with exercise.