bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diagnostic accuracy of pediatric atypical appendicitis
Authors: Wang Zhi-hua , Ye Jing , Wang Yu-shui , Liu Yan 
Published: March 2019

Abstract

Rationale:
Acute appendicitis is one of the most common causes of acute abdomen in children, yet it is difficult to diagnose in young children because its clinical manifestations may be atypical. Here, 3 atypical clinical cases associated with appendicitis in children are reported.

Patient concern:
The 1st case corresponds to a 5-year-old male patient who presented with abdominal discomfort, intermittent fevers, and vomiting, have increased white blood cell (WBC) count and C-reactive protein (CRP). The second case is a 7-year-old male patient who began with intermittent fevers and lower quadrant abdominal pain, showing increased WBC count and CRP. The 3rd case corresponds to a 7-year-old female patient who presented with intermittent fevers, abdominal pain, and forebreast discomfort, demonstrating increased WBC count and CRP.

Diagnoses:
Abdominal computed tomography (CT) scan presented data suggestive of enlarged appendix in diameter, and stercolith, corroborated through surgery.

Intervention:
Two patients were treated by appendectomy, and 1 patient was treated conservatively with antibiotics.

Outcomes:
Three patients were treated successfully. At 3-month follow-up, the patients had no complaints of discomfort with no relapse of appendicitis.

Lessons:
Due to atypical symptoms of children, the diagnosis of appendicitis is often delayed, suggesting that the clinicians should be aware of this disease when encountering gastroenteritis patients with elevated WBC and CRP. Furthermore, abdominal CT scan should be taken into consideration when patients showed high level of WBC and CRP, whose appendix is not seen on ultrasound.
Adrenocortical hypofunction with simultaneous primary aldosteronism
Authors: Liang Kaiyong , Ou Xiaojuan , Huang Xukai , Lan Qunfang 
Published: March 2019

Abstract

Rationale:
Cases of adrenocortical hyperfunction combined with primary aldosteronism have been reported in the literature, and the underlying mechanism involves the secretion of aldosterone and glucocorticoids by a tumor or an adenoma. However, adrenocortical hypofunction and coexisting primary aldosteronism have not been reported until now. Herein, we report a case of adrenocortical hypofunction combined with primary aldosteronism.

Patient concerns:
A 66-year-old Chinese woman with rheumatoid arthritis who had been diagnosed with secondary adrenal insufficiency and was taking prednisone acetate tablets for replacement treatment presented to our department. She also had type 2 diabetes mellitus, osteoporosis, bilateral knee osteoarthritis, and lumbar vertebral compression fracture. She had previously developed tuberculosis, which had been cured.

Diagnosis:
The cortisol and adrenocorticotropic hormone rhythm indicated cortisol dysfunction in the patient. A 64-slice computed tomography and magnetic resonance imaging both showed bilateral adrenal hyperplasia. A postural stimulation test indicated a high level of aldosteronism and a high aldosterone-to-renin ratio (ARR, supine position: aldosterone 1788.73 pg/mL, ARR 146.62; upright position: aldosterone 2916.21 pg/mL, ARR 92.29). The captopril test showed the aldosterone level decreased by 364.70 pg/mL 1 hour after administration of captopril (from 2153.28 to 1788.58 pg/mL). The decline in aldosterone level was approximately 16.90% (i.e., <30%), and the ARR was still >40. Based on the above-mentioned findings, we diagnosed the patient with adrenocortical hypofunction with primary aldosteronism.

Interventions:
We administered spironolactone 20 mg twice daily and continued the glucocorticoid replacement therapy.

Outcomes:
One week after diagnosis, the patient had an aldosterone level of 2201.16 pg/mL, plasma renin activity of 3.88 ng/mL/h, and an ARR of 56.7 (upright position). Her blood pressure was maintained within the normal range.

Lessons:
Although adrenocortical hypofunction with primary aldosteronism is rare, cases of primary aldosteronism complicated with hypercortisolism are occasionally encountered. Hence, whenever possible, we recommend testing both aldosterone and cortisol levels in all patients with adrenal dysfunction.
Rapid resolution of reversible bronchiectasis after Mycoplasma pneumoniae pneumonia in an adult
Authors: Guo Qi , Li Hai-yan 
Published: March 2019

Abstract

Rationale:
Bronchiectasis results when inflammatory and infectious damage to the bronchial and bronchiolar walls leads to a vicious cycle of airway injury. On the basis of the classic characteristic, that is, permanent bronchial dilatation, bronchiectasis is generally considered irreversible in the adult population.

Patient concerns:
A 21-year-old woman presented to our hospital with a 9-day history of productive cough and fever.

Diagnosis:
Bronchiectasis after Mycoplasma pneumoniae pneumonia.

Interventions:
The patient was treated with azithromycin for 7 days.

Outcomes:
The bronchial dilatation resolved as evidenced by sequential chest high-resolution computed tomography 7 days and 1 month later, respectively.

Lessons:
Although complete disappearance is quite rare in adult, this case demonstrated that bronchial dilatation might resolve completely in such a fascinating short period of time if receiving adequate and timely regimens.
Primary antiphospholipid syndrome during aromatase inhibitors therapy
Authors: Tenti Sara , Giordano Nicola , Cutolo Maurizio , Giannini Fabio , Fioravanti Antonella 
Published: March 2019

Abstract

Rationale:
Aromatase inhibitors (AIs) are a class of drugs widely used in the treatment of estrogen sensitive breast and ovarian cancer which convert testosterone to estradiol and androstenedione to estrogen. The AIs of third generation, including anastrazole, letrozole and exemestane, have actually become the standard of care of estrogen-receptor-positive breast cancer in menopausal women and are recommended as adjuvant treatment after surgery in place of/or following tamoxifen. Their main side-effects include reduction in bone mineral density, occurrence of menopausal manifestations and development of musculoskeletal symptoms which are, usually, transient, but sometimes evolve into a typical form of arthritis, such as rheumatoid arthritis (RA). Recently, a pathogenic linkage with other autoimmunity diseases, such as Sjogren syndrome (SjS), anti-synthetase antibody syndrome (ASAS), systemic sclerosis (SS) and subacute cutaneous lupus erythematosus (SCLE), was also described.

Patient concerns:
Here, we report the first case of a patient with primary antiphospholipid syndrome (APS) developed during treatment with anastrazole.

Diagnosis:
The patient developed a sudden onset of speech disturbance and disorientation, due to ischemic lesions, after 6 months of AIs therapy and the laboratory examination showed the positivity of anti-Cardiolipin antibodies, anti-β2 Glycoprotein 1 antibodies and Lupus Anticoagulant, so a certain diagnosis of APS was achieved.

Interventions:
The patient was treated with warfarin associated to hydroxychloroquine and monthly cycles of low doses intravenous immunoglobulins.

Outcomes:
A good control of the disease was obtained despite the continuation of anastrazole; the patient's clinical and laboratory situation remained not modified after AIs withdrawal.

Lessons:
We discussed the possible role of anastrazole treatment in inducing APS in our patient, reporting the available literature data about the association between AIs treatment and autoimmune diseases. Furthermore, we analyzed the mechanism of action of estrogens in the pathophysiology of autoimmune rheumatic disorders.
Dietary ginger as a traditional therapy for blood sugar control in patients with type 2 diabetes mellitus
Authors: Huang Fang-yan , Deng Ting , Meng Lian-xin , Ma Xin-ling 
Published: March 2019

Abstract

Background:
Ancient medical practitioners used to encourage dietary supplements and herbal medicine for the treatment of type 2 diabetes mellitus (T2DM). Ginger (Zingiber officinale), is a nontoxic spice with negligible side effects, and is considered safe by the food and drug administration. In this analysis, we aimed to systematically compare fasting blood sugar (FBS) and glycated hemoglobin (HbA1c) at baseline versus at follow-up in T2DM patients who consumed and who did not consume ginger.

Methods:
A literature search was carried out through MEDLINE, Embase, the Cochrane Central, and www.ClinicalTrials.gov for English-published trials comparing glucose parameters in T2DM patients who were assigned to ginger consumption versus a control group. All the participants were patients with T2DM who were either assigned to ginger therapy (1600– 4000 mg daily) or to a control group. FBS and HbA1c were assessed in the ginger and control groups, respectively, from baseline to follow-up to observe any significant change. Weight mean difference (WMD) with 95% confidence intervals (CI) was calculated to represent the analysis which was carried out by the RevMan 5.3 software.

Results:
Eight randomized trials consisting of a total number of 454 participants with T2DM were included in this analysis. At first, FBS was compared in patients with T2DM from baseline prior to ginger consumption until follow-up after ginger consumption. The results showed no significant difference in FBS (WMD: 1.38, 95% CI: [−0.53–3.30]; P = .16). For the T2DM patients who did not consume ginger, no significant difference in FBS was observed (WMD: −0.27, 95% CI: [−5.09–4.54]; P = .91). However, a significantly improved HbA1c from baseline to follow-up was observed in those participants with ginger consumption (WMD: 0.46, 95% CI: [0.09–0.84]; P = .02) whereas in the control group, no significant difference in HbA1c was observed (WMD: −0.23, 95% CI: [−0.60–0.14]; P = .22).

Conclusion:
This analysis involving patients with T2DM showed no significant difference in FBS with ginger consumption. However, dietary ginger significantly improved HbA1c from baseline to follow-up showing that this natural medicine might have an impact on glucose control over a longer period of time in patients with T2DM.
The prognostic value of left ventricular systolic function and cardiac biomarkers in pediatric severe sepsis
Authors: Li Juanzhen , Ning Botao , Wang Ying , Li Biru , Qian Juan , Ren Hong , Zhang Jian , Hu Xiaowei 
Published: March 2019

Abstract
Echocardiography and cardiac biomarkers, such as cardiac troponin I (cTnI) and N-terminal pro-B-type natriuretic peptide (NT-pro BNP) are useful tools to evaluate cardiac dysfunction. Left ventricular systolic dysfunction (LVSD) is common in pediatric severe sepsis. The aim of this study is to evaluate the prognostic value of LVSD, cTnI, and NT-pro BNP for pediatric severe sepsis.
A prospective, single center, observational study was conducted. Severe sepsis children were enrolled in the study from December 2015 to December 2016 in pediatric intensive care unit of Shanghai Children's Medical Center. Recorded general information, transthoracic echocardiography were performed at day 1, 2, 3, 7, and 10, using Simpson to measure left ventricular end-diastolic dimension and left ventricular end-systolic dimension, obtained echocardiography parameters: left ventricular ejection fraction (LVEF), left ventricular fractional shortening, left ventricular end-diastolic volume, left ventricular end- systolic volume, stroke volume, cardiac output. At the same time collecting the blood sample to measure cTnI, NT-pro BNP. The definition of LVSD was LVEF <50%. According to the prognosis of 28 days, children with severe sepsis were divided into survived group and nonsurvived group.
Total of 50 pediatric patients who were diagnosed with severe sepsis (including septic shock) were enrolled, the incidence of LVSD was 52%. The 28-day mortality rate of severe sepsis was 34%. Multivariate logistic regression analyses for predictors of death in pediatric severe sepsis revealed that the 28-day mortality of severe sepsis was associated with mechanical ventilation (MV) within the first 6 hours of admission (odds ratio [OR], 0.01; 95% confidence interval [CI], 0.00–0.07) and total MV time (OR, 0.81; 95% CI, 0.68–0.97). The receiver operating characteristic curves LVEF (area under curve = 0.526), cTnI (area under curve = 0.480), and NT-pro BNP (area under curve = 0.624) were used to predict the 28-day mortality in pediatric severe sepsis. Follow-up echocardiography parameters for survived group and nonsurvived group showed no significant changes in LVEF, LVFS, stroke volume index, cardiac index (CI), left ventricular end-diastolic volume index and left ventricular end-systolic volume index at day 1, 2, 3, 7, and 10, except for CI at day 1 and 2. Kaplan–Meier plot of 28-day mortality and LVSD in pediatric severe sepsis showed there were no statistical differences (χ
2 = 0.042, P = .837).
LVSD occurs frequently in pediatric with severe sepsis. The 28-day mortality rate of severe sepsis was also high. In this study, none of LVSD, cTnI, and NT-proBNP was associated with the prognosis of pediatric severe sepsis.
Robotic radical lymphadenectomy without touching the pancreas during gastrectomy for gastric cancer
Authors: Ojima Toshiyasu , Nakamura Masaki , Nakamori Mikihito , Hayata Keiji , Katsuda Masahiro , Maruoka Shimpei , Yamaue Hiroki 
Published: March 2019

Abstract
Laparoscopic lymph node dissection around the peripancreatic area for gastric cancer (GC) remains challenging because of drawbacks in laparoscopic surgery including the limited range of movement, amplification of hand tremors, and inconvenient surgical positioning. In some cases of laparoscopic gastrectomy (LG), therefore, postoperative pancreatic fistula (POPF) occurs. Robotic surgery, on the other hand, plays an essential role in ergonomics and offers advantages, such as motion scaling, less fatigue, tremor filtering, 7 degrees of motion in the robotic instruments assisted by the wrist-like instruments tips, and three-dimensional vision. Robotic gastrectomy (RG) may enable surgeons to overcome the drawbacks associated with laparoscopic surgery. This study compares the safety and feasibility of short-term surgical outcomes of RG and LG for patients with GC.
This was a single-center retrospective study of 659 consecutive patients with GC who received minimally invasive surgery. LG (n = 639) was performed between 2013 and 2017 and RG (n = 20) was performed in 2017. Lymphadenectomy without touching the pancreas was basically performed during RG using assisting articulating forceps.
Overall incidence of postoperative complications higher than Clavien–Dindo grade 2 was not significantly different (LG group 5.9%, RG group 5.0%). In RG group, POPF, intra-abdominal abscess, and anastomotic leakage were not found, but postoperative bleeding requiring interventional catheter embolization occurred in 1 patient. In LG, POPF was found in 4.7%. Amylase levels in drainage fluid on postoperative day 1 were significantly lower in the RG group (238.5 IU/L) than in the LG group (884.5 IU/L) (P = .028).
Regarding short-term surgical outcomes, RG is feasible, safe, and ideal treatment procedure for GC. Our robotic procedure without touching the pancreas may be associated with decreased incidence of POPF.
Incontinence in Phelan‐McDermid Syndrome
Authors: Witmer Claire , Mattingly Aviva , D'Souza Precilla , Thurm Audrey , Hadigan Colleen 
Published: March 2019

ABSTRACTObjective:The aim of the study was to evaluate gastrointestinal symptoms and continence in the context of Phelan‐McDermid Syndrome (PMS).Methods:A prospective evaluation of children with PMS (n = 17) at the National Institutes of Health.Results:Parent‐reported history of symptoms were common: constipation (65%), reflux (59%), choking/gagging (41%), and more than half received gastrointestinal specialty care. No aspiration was noted in 11/11 participants who completed modified barium swallows. Four participants met criteria for functional constipation, 2 of whom had abnormal colonic transit studies. Stool incontinence was highly prevalent (13/17) with nonretentive features present in 12/17. Participants who were continent had significantly smaller genetic deletions (P = 0.01) and higher nonverbal mental age (P = 0.03) compared with incontinent participants.Conclusions:Incontinence is common in PMS and associated with intellectual functioning and gene deletion size. Management strategies may differ based on the presence of nonretentive fecal incontinence, functional constipation, and degree of intellectual disability for children with PMS.
Pediatric Celiac Disease and Eosinophilic Esophagitis
Authors: Patton Tiffany , Chugh Ankur , Padhye Leena , DeGeeter Catherine , Guandalini Stefano 
Published: March 2019

ABSTRACTObjective:The coexistence of celiac disease (CeD) and eosinophilic esophagitis (EoE) in pediatric patients has been increasingly recognized. In the current study, we have aimed to assess the outcomes of therapeutic dietary interventions in a cohort of pediatric patients with CeD and EoE.Methods:Pediatric patient records obtained from the University of Chicago Celiac Center Database from August 2008 to July 2013 were reviewed. Information was collected on patients with concomitant CeD and EoE regarding age, sex, dates of diagnoses, presenting symptoms, length of symptoms before diagnosis, familial and personal atopic history, dietary therapy, and esophageal histologic response to dietary therapy.Results:A total of 350 records of patients with CeD were reviewed. Twenty‐two (6.3%) had a confirmed diagnosis of CeD and EoE, 17 had repeat biopsies. Four of 17 (23.5%) had resolution of esophageal eosinophilia on an exclusive gluten‐free diet, 10 of 17 (59%) required additional eliminations to show histologic resolution, 1 of 17 (6%) had not reached histological remission, and 2 of 17 (12%) were lost to follow‐up. Success rates of single food reintroductions were: soy 5 of 5 (100%), eggs 3 of 5 (60%), dairy 3 of 7 (43%), nuts 2 of 4 (50%), and fish 2 of 4 (50%).Conclusions:To our knowledge, this is the largest pediatric study to assess the histologic outcome of EoE‐associated esophageal eosinophilia in response to dietary management of pediatric patients with concomitant CeD and EoE. We demonstrate that soy is well tolerated in this cohort, and suggest that reintroducing this food first, or trialing a soy‐inclusive elimination diet is a viable strategy.
Neurocognitive Impairment Risk Among Individuals With Multiple Drug–Resistant Tuberculosis and Human Immunodeficiency Virus Coinfection
Authors: Tomita Andrew , Ramlall Suvira , Naidu Thirusha , Mthembu Sbusisiwe Sandra , Padayatchi Nesri , Burns Jonathan K. 
Published: March 2019

Abstract
Although neurocognitive impairment (NCI) is a well-recognized challenge in human immunodeficiency virus (HIV), there is little evidence regarding it among individuals with multiple drug–resistant tuberculosis (MDR-TB) within HIV endemic sub-Saharan Africa. The extent of NCI risk, particularly HIV-associated neurocognitive disorders (HAND) risk, was investigated in 200 microbiologically confirmed inpatients with MDR-TB at a TB-specialist hospital in KwaZulu-Natal Province, South Africa. Within this population, the prevalence of HIV coinfection, major depressive episode, and substance use disorder was 89.50%, 10.50%, and 7.00%, respectively. After excluding individuals with major depressive episode/substance use disorder and monoinfection (i.e., MDR-TB without HIV), the prevalence of HAND risk was 43.5%. Older and low-income individuals had significantly greater odds of HAND risk, whereas those with family members/relatives who work(ed) in the health services had lower odds. The role of timely linkage to and retention of care in TB/HIV treatment to offset cognitive decline in MDR-TB/HIV coinfected individuals needs to be investigated further.
Shared Obsessive-Compulsive Disorder
Authors: Benatti Beatrice , Arici Chiara , Altamura A. Carlo , Dell'Osso Bernardo 
Published: March 2019

Abstract
Shared obsessive-compulsive disorder (S-OCD) has seldom been reported in the literature, whereas shared psychotic disorder has been described since the end of 19th century. The aim of this report was to describe a case of S-OCD in a married couple. A 38-year-old OCD patient, after several pharmacological trials, eventually improved when a combination of escitalopram and risperidone was prescribed. During his symptoms' remission, his wife started developing the same OCD symptoms. She was prescribed escitalopram, but, given her inconsistent compliance, it was difficult to obtain full effectiveness of the pharmacological treatment. The case showed several common features with S-OCD. Obsessions and delusions could be considered as extremes of the same spectrum—an option recognized by the Diagnostic and statistical manual of mental disorders, fifth edition within the “OCD with poor insight” category—and S-OCD could represent the continuum between OCD and psychotic conditions. Additional investigation is required to better understand psychotic and nonpsychotic shared disorders.
Parental Engagement and Early Interactions With Preterm Infants Reduce Risk of Late Postpartum Depression
Authors: Xie Jun , Zhu Lihong , Zhu Tingli , Jian Ying , Ding Ye , Zhou Min , Feng Xiaoyan 
Published: March 2019

Abstract
Recent studies have shown that preterm delivery is a risk factor for the development of postpartum depression, which not only impairs maternal-infant interactions, leading to infant developmental delay and social interaction difficulties in affected children, but also increases the risk of depression in the mother. Hence, this article aims to study the effects of parental engagement and early interactions with preterm infants on subsequent infant development and behavior, maternal adjustment, and mother-infant relationship. A total of 151 infants/mothers were enrolled in our study. Infants were randomized either to receive early parent interaction or standard care. The early parent interaction program was performed in addition to routine standard of care, Kangaroo Mother Care, during the neonatal intensive care unit stay based on PremieStart Protocol. The behavioral competencies of preterm infants were assessed, as were their mothers' adjustment (depression and coping) and competencies (knowledge of child development). At 12 months of postnatal age, child competencies (development and behavior) were assessed, together with maternal adjustment (parenting stress and depression). Mother-infant interaction was also observed. Early parent interaction did not alter early or later infant development. Furthermore, early parent interaction did not alter early maternal adjustment or late mother-infant relationship, but it reduced the risk of late postpartum depression. Taken together, these studies provide a strong basis for interventions that support parents in the parenting role and guide parents in developmentally appropriate interactions with their preterm babies. These interventions have the potential to lessen the adverse impact of preterm birth on babies and mothers. In addition, the positive benefits of reduced stress can improve parent mental health outcomes and ultimately may further improve parents' relationships with their babies.