bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lessons From an Outbreak of Varicella Infection in Pediatric Hemato-oncology Patients
Authors: Manistarski Michal , Levin Dror , Dvir Rina , Berger-Achituv Sivan , Rosenfeld Keidar Hila , Grisaru-Soen Galia , Carmeli Yehuda , Elhasid Ronit 
Published: January 2018

Background:
Immunocompromised patients exposed to varicella may experience significant morbidity and a 7% mortality rate. Management and outcome of an outbreak of varicella infection among hospitalized pediatric hemato-oncology patients using the guidelines of the American Academy of Pediatrics Committee on Infectious Diseases are presented.

Methods:
This retrospective study describes an outbreak of varicella infection between February 2011 and June 2011. Data were retrieved from the patients’ files. Positive polymerase chain reaction results for varicella zoster virus from vesicular skin lesions were used for the diagnosis of varicella infection.

Results:
Twelve pediatric hemato-oncology patients experienced 13 episodes of varicella infection, 11 underwent 1 episode each and 1 patient had 2 episodes. All exposed patients without immunity received varicella zoster immune globulins or intravenous immunoglobulin and were isolated as recommended by the guidelines. Infected patients received intravenous acyclovir. One patient with acute lymphoblastic leukemia at induction chemotherapy died. All the other patients survived.

Conclusions:
Our experience in the management of hospitalized immunocompromised patients exposed to varicella was that a positive IgG serology did not confer protection after exposure to varicella infection and thus can not serve as a marker for immunity. Unlike the isolation period sufficient for immunocompetent patients, crusted lesions can be contagious and thus require extended isolation for immunocompromised patients. Patients receiving rituximab are at greater risk of having persistent or recurrent disease. Studies with a larger sample size should be performed to better assess the management of immunocompromized patients exposed to varicella.
Idiopathic Canalicular Inflammatory Disease: New Disease Description of Clinical Patterns, Investigations, Management, and Outcomes
Authors: Ali Mohammad Javed 
Published: January 2018

Purpose:
The objective of this perspective is to present a separate disease description of “idiopathic canalicular inflammatory disease” and outline the diagnostic criteria and early experiences with its investigations and management.

Methods:
Retrospective case series of 44 canaliculi of 22 eyes of 11 patients presenting at a tertiary care Dacryology service over a period of 2 years with typical clinical patterns of inflammatory canaliculitis and its outcomes were studied. All the patients underwent microbiological work-up with culture and sensitivity, dacryoendoscopy imaging, serial Fourier domain ocular coherence tomography, and collagen vascular profiles. Stages in the evolution of the disease were studied. All patients were treated initially with topical steroids followed by punctal dilatation and placement of mini-monoka stents. Five patients in addition had a small biopsy from the inflamed portion of the vertical canaliculus. Stents were extubated at 6 weeks.

Results:
Forty-four canaliculi were diagnosed to have idiopathic canalicular inflammatory disease during the study period. There was a female preponderance (81.8%, 9/11) and the mean age at presentation was 57 years. All patients presented with unilateral epiphora without any discharge, pain, or swelling. Collagen vascular profiles and screening for autoimmune diseases were negative. Clinical picture ranged from stages 1 to 5, consisting of edema, progressive centripetal vascularization, pouting of vascularized mucosa, membrane formation, and progressive scarring. The presentation begins in 1 eye and usually involves the other eye at a mean of 6 months. Ocular coherence tomography and dacryoendoscopy were of adjunctive value in the diagnosis. Histopathological examination was suggestive of a chronic inflammation. All patients had relentless progression to end-stage disease, although delayed significantly by steroids and monoka intubation.

Conclusion:
Idiopathic canalicular inflammatory disease has a distinct and typical clinical behavior and the current study proposed diagnostic features and disease staging. The use of topical and systemic immunosuppressive agents needs to be explored to formulate effective protocols for its management.
Interlamellar Autogenous Tarsal Graft for the Correction of Lower Eyelid Trichiasis Associated With Eyelid Margin Thinning
Authors: Cruz Antonio A. V. , Garcez Cecilia , Duarte Ana , Akaishi Patricia M. S. 
Published: January 2018

Purpose:
To evaluate the use of autogenous tarsal graft for surgical correction of lower eyelid trichiasis associated with eyelid thinning.

Methods:
A total of 23 eyelids of 19 consecutive patients with trichiasis were operated with a variant of the Van Millingen procedure. The surgery consisted of interposing a 3-mm high fragment of autogenous ipsilateral upper eyelid tarsus corresponding to the trichiasis segment between the pretarsal anterior lamella and the lower tarsal plate. Preoperative assessment included quantification of eyelid thickness on the midpoint of the segment with trichiasis, biomicroscopy of the eyelid margin and location of the trichiasis. All patients were examined at 1, 3, 6, and 12 months after surgery. Eyelid thickness was measured at 1 month and 12 months of follow up.

Results:
Preoperatively the mean thickness of the eyelid margin was 0.99 mm ± 0.06 standard error. One month postoperatively eyelid thickness increased to 2.08 ± 0.28 standard error, decreasing over time to reach 1. 48 mm ± 0.18 standard error 1 year after surgery, a value that did not differ from that of the control group. Small granulomas were diagnosed only in the early phases of the postoperative period. Trichiasis recurrence was seen in just 1 eyelid. Isolated abnormal lashes lateral or medial to the graft were present in 5 eyelids at the end of the study.

Conclusions:
Autogenous tarsal grafts placed parallel to the lower tarsus are a good option both to correct misdirected eyelashes and to restore normal lower eyelid thickness.
Yield and Costs of Evaluating Children With Cyclic Vomiting Syndrome
Authors: Lucia‐Casadonte Chantal J. , Whaley Kaitlin G. , Chogle Ashish S. 
Published: January 2018

ABSTRACTBackground and Objectives:Cyclic vomiting syndrome (CVS) clinical guidelines recommend an algorithm of basic testing for standard patients, and more targeted testing, including laboratory and imaging studies, in the presence of specific red flags. The cost‐effectiveness of this screening of children with suspected CVS is lacking. The objectives of this study are to determine whether screening studies in CVS patients results in diagnostic change and to estimate their healthcare cost.Method:Charts of patients (1–18 years) with suspected CVS were retrospectively reviewed at a single center. Results and cost of laboratory and imaging studies were analyzed.Results:A total of 503 charts were reviewed from electronic medical records with the International Classification of Diseases‐9 (ICD‐9) code 536.2 or search terms “CVS, cyclic vomiting, persistent emesis/vomiting, hyperemesis, or intractable/ periodic vomiting.” Of these, 165 (33%) had a diagnosis of CVS and 135 (82%) children (mean age 7.7 ± 4.3; 73 (54%) girls) met CVS criteria based on North American Society for Pediatric Gastroenterology, Hepatology and Nutrition diagnostic criteria. Of those meeting CVS criteria, 6 (4%) had a change in management based on the CVS screening evaluation. The mean cost of screening per patient that met CVS criteria was $6125.02 and the estimated total cost for all patients who met CVS criteria was $826,877.88.Conclusions:The screening metabolic laboratory results, pelvic ultrasound, magnetic resonance imaging, and upper endoscopy resulted in a diagnosis change in few patients screened for CVS. Most children who met criteria for CVS did not benefit from screening evaluation as results did not change clinical diagnosis or management, and were associated with higher cost.
Impact of Thyroid Autoimmunity on Thyroid Function in 12‐year‐old Children With Celiac Disease
Authors: Norström Fredrik , van der Pals Maria , Myléus Anna , Hammarroth Solveig , Högberg Lotta , Isaksson Anders , Ivarsson Anneli , Carlsson Annelie 
Published: January 2018

ABSTRACTObjectives:Celiac disease (CD) is associated with thyroid autoimmunity and other autoimmune diseases. Data are, however, lacking regarding the relationship between thyroid autoimmunity and thyroid function, especially in regard to CD. Our aim was to investigate the impact of thyroid autoimmunity on thyroid function in 12‐year‐old children with CD compared to their healthy peers.Methods:A case‐referent study was conducted as part of a CD screening of 12‐year‐olds. Our study included 335 children with CD and 1695 randomly selected referents. Thyroid autoimmunity was assessed with antibodies against thyroid peroxidase (TPOAb). Thyroid function was assessed with thyroid‐stimulating hormone and free thyroxine.Results:TPOAb positivity significantly increased the risk of developing hypothyroidism in all children. The odds ratios (with 95% confidence intervals) were 5.3 (2.7–11) in healthy 12‐year‐olds, 10 (3.2–32) in screening‐detected CD cases, 19 (2.6–135) in previously diagnosed CD cases, and 12 (4.4–32) in all CD cases together. Among children with TPOAb positivity, hypothyroidism was significantly more common (odds ratio 3.1; 95% CI 1.03–9.6) in children with CD (10/19) than in children without CD (12/46).Conclusions:The risk of thyroid dysfunction due to thyroid autoimmunity is larger for those with CD than their healthy peers. Our study indicates that a gluten‐free diet does not reduce the risk of thyroid dysfunction. Further studies are required for improved understanding of the role of the gluten‐free diet for the risk of autoimmune diseases in children with CD.
Integrated HIV-Care Into Primary Health Care Clinics and the Influence on Diabetes and Hypertension Care: An Interrupted Time Series Analysis in Free State, South Africa Over 4 Years
Authors: Rawat Angeli , Uebel Kerry , Moore David , Yassi Annalee 
Published: January 2018

Background:
Noncommunicable diseases (NCDs), specifically diabetes and hypertension, are rising in high HIV-burdened countries such as South Africa. How integrated HIV care into primary health care (PHC) influences NCD care is unknown. We aimed to understand whether differences existed in NCD care (pre- versus post-integration) and how changes may relate to HIV patient numbers.

Setting:
Public sector PHC clinics in Free State, South Africa.

Methods:
Using a quasiexperimental design, we analyzed monthly administrative data on 4 indicators for diabetes and hypertension (clinic and population levels) during 4 years as HIV integration was implemented in PHC. Data represented 131 PHC clinics with a catchment population of 1.5 million. We used interrupted time series analysis at ±18 and ±30 months from HIV integration in each clinic to identify changes in trends postintegration compared with those in preintegration. We used linear mixed-effect models to study relationships between HIV and NCD indicators.

Results:
Patients receiving antiretroviral therapy in the 131 PHC clinics studied increased from 1614 (April 2009) to 57, 958 (April 2013). Trends in new diabetes patients on treatment remained unchanged. However, population-level new hypertensives on treatment decreased at ±30 months from integration by 6/100, 000 (SE = 3, P < 0.02) and was associated with the number of new patients with HIV on treatment at the clinics.

Conclusions:
Our findings suggest that during the implementation of integrated HIV care into PHC clinics, care for hypertensive patients could be compromised. Further research is needed to understand determinants of NCD care in South Africa and other high HIV-burdened settings to ensure patient-centered PHC.
Leveraging Quick Response Code Technology to Facilitate Simulation-Based Leaderboard Competition
Authors: Chang Todd P. , Doughty Cara B. , Mitchell Diana , Rutledge Chrystal , Auerbach Marc A. , Frisell Karin , Jani Priti , Kessler David O. , Wolfe Heather , MacKinnon Ralph J. , Dewan Maya , Pirie Jonathan , Lemke Daniel , Khattab Mona , Tofil Nancy , Nagamuthu Chenthila , Walsh Catharine M. 
Published: January 2018

Introduction
Leaderboards provide feedback on relative performance and a competitive atmosphere for both self-guided improvement and social comparison. Because simulation can provide substantial quantitative participant feedback, leaderboards can be used, not only locally but also in a multidepartment, multicenter fashion. Quick Response (QR) codes can be integrated to allow participants to access and upload data. We present the development, implementation, and initial evaluation of an online leaderboard employing principles of gamification using points, badges, and leaderboards designed to enhance competition among healthcare providers.

Method
This article details the fundamentals behind the development and implementation of a user-friendly, online, multinational leaderboard that employs principles of gamification to enhance competition and integrates a QR code system to promote both self-reporting of performance data and data integrity. An open-ended survey was administered to capture perceptions of leaderboard implementation.

Results
Conceptual step-by-step instructions detailing how to apply the QR code system to any leaderboard using simulated or real performance metrics are outlined using an illustrative example of a leaderboard that employed simulated cardiopulmonary resuscitation performance scores to compare participants across 17 hospitals in 4 countries for 16 months. The following three major descriptive categories that captured perceptions of leaderboard implementation emerged from initial evaluation data from 10 sites: (1) competition, (2) longevity, and (3) perceived deficits.

Conclusions
A well-designed leaderboard should be user-friendly and encompass best practices in gamification principles while collecting and storing data for research analyses. Easy storage and export of data allow for longitudinal record keeping that can be leveraged both to track compliance and to enable social competition.
Sarcopenia and Postoperative Complication Risk in Gastrointestinal Surgical Oncology
Authors: Simonsen Casper , de Heer Pieter , Bjerre Eik D. , Suetta Charlotte , Hojman Pernille , Pedersen Bente K. , Svendsen Lars B. , Christensen Jesper F. 
Published: January 2018

Objective:
The aim of the study was to evaluate sarcopenia as a predictor of postoperative risk of major and total complications after surgery for gastrointestinal cancer.

Background:
Sarcopenia is associated with poor survival in gastrointestinal cancer patients, but the role of sarcopenia as prognostic tool in surgical oncology has not been established, and no consensus exists regarding assessment and management of sarcopenic patients.

Methods:
We performed a systematic search for citations in EMBASE, Web of Science, and PubMed from 2004 to January 31, 2017. Random effects meta-analyses were used to estimate the pooled risk ratio for postoperative complications by Clavien-Dindo grade (total complications: grade ≥2; major complications: grade ≥3) in patients with sarcopenia versus patients without sarcopenia. Stratified analyses were performed by sarcopenia criteria, cutoff level, assessment methods, study quality, cancer diagnosis, and “Enhanced Recovery After Surgery” care.

Results:
Twenty-nine studies (n = 7176) were included with sarcopenia prevalence ranging between 12% and 78%. Preoperative incidence of sarcopenia was associated with increased risk of major complications (risk ratio 1.40; 95% confidence interval, 1.20–1.64; P < 0.001; I
2 = 52%) and total complications (risk ratio 1.35; 95% confidence interval, 1.12–1.61; P = 0.001; I
2 = 60%). Moderate heterogeneity was found for both meta-analyses. Subgroup analyses showed that sarcopenia remained a consistent risk factor across stratification by sarcopenia criteria, assessment methods, study quality, and diagnoses.

Conclusions:
Sarcopenia was associated with an increased risk of complications after gastrointestinal tumor resection, but lack of methodological consensus hampers the interpretation and clinical utilization of these findings. Combining assessment of muscle mass with measures of physical function may increase the prognostic value and accuracy in preoperative risk stratification.
Adenosine 2A Receptor Activation Attenuates Ischemia Reperfusion Injury During Extracorporeal Cardiopulmonary Resuscitation
Authors: Mehaffey James H. , Money Dustin , Charles Eric J. , Schubert Sarah , Piñeros Angela Fernandez , Wu Di , Bontha Sai Vineela , Hawkins Robert , Teman Nicholas R. , Laubach Victor E. , Mas Valeria R. , Tribble Curtis G. , Maluf Daniel G. , Sharma Ashish K. , Yang Zequan , Kron Irving L. , Roeser Mark E. 
Published: January 2018

Objective:
We tested the hypothesis that systemic administration of an A2AR agonist will reduce multiorgan IRI in a porcine model of ECPR.

Summary Background Data:
Advances in ECPR have decreased mortality after cardiac arrest; however, subsequent IRI contributes to late multisystem organ failure. Attenuation of IRI has been reported with the use of an A2AR agonist.

Methods:
Adult swine underwent 20 minutes of circulatory arrest, induced by ventricular fibrillation, followed by 6 hours of reperfusion with ECPR. Animals were randomized to vehicle control, low-dose A2AR agonist, or high-dose A2AR agonist. A perfusion specialist using a goal-directed resuscitation protocol managed all the animals during the reperfusion period. Hourly blood, urine, and tissue samples were collected. Biochemical and microarray analyses were performed to identify differential inflammatory markers and gene expression between groups.

Results:
Both the treatment groups demonstrated significantly higher percent reduction from peak lactate after reperfusion compared with vehicle controls. Control animals required significantly more fluid, epinephrine, and higher final pump flow while having lower urine output than both the treatment groups. The treatment groups had lower urine NGAL, an early marker of kidney injury (P = 0.01), lower plasma aspartate aminotransferase, and reduced rate of troponin rise (P = 0.01). Pro-inflammatory cytokines were lower while anti-inflammatory cytokines were significantly higher in the treatment groups.

Conclusions:
Using a novel and clinically relevant porcine model of circulatory arrest and ECPR, we demonstrated that a selective A2AR agonist significantly attenuated systemic IRI and warrants clinical investigation.
A Nationwide, Systematic, and Comprehensive Assessment of Surgical Capacity in Lebanon
Authors: Kaafarani Haytham M. A. , Khalifeh Jawad M. , Ramly Elie P. , Simon David , Safa Rawan , Khalil Lana , Raad Randa , Hoballah Jamal J. 
Published: January 2018

Objective:
We sought to perform a systematic, comprehensive, and nationwide cross-sectional analysis of surgical capacity in Lebanon.

Background:
Providing surgical care in refugee areas is increasingly recognized as a global health priority. The surgical capacity of Lebanon where at least 1 in 6 inhabitants is currently a refugee remains unknown.

Methods:
The Surgical Capacity in Areas with Refugees cross-sectional study included 3 steps: (1) geographically mapping all hospitals providing surgical care in Lebanon, (2) systematically assessing each hospital's surgical capacity, and (3) identifying surgical care gaps/disparities. First, a list of hospitals in Lebanon and their locations was generated combining data from the Lebanese Ministry of Health and Syndicate of Hospitals. Specialty, rehabilitation, and maternity facilities were excluded. Second, the validated 5 domain Personnel, Infrastructure, Procedures, Equipment, and Supplies (PIPES) tool was administered in each hospital through a face-to-face or phone interview. Hospitals’ PIPES indices were computed; data were aggregated and analyzed for geographic and private/public disparities.

Results:
A total of 129 hospitals were geographically mapped; 20% were public. The PIPES tool was administered in all hospitals (100%). The mean PIPES index was 10.98 (Personnel = 14.91, Infrastructure = 15.36, Procedures = 37.47, Equipment = 21.63, Supplies = 24.78). The number of hospital beds, operating rooms, surgeons, and anesthesiologists per 100,000 people were 217, 8, 16, and 9, respectively. Deficiencies in infrastructure were significant, whereby 62%, 36%, 16%, and 5% of hospitals lack incinerators, pretested blood, intensive care units, and computed tomography, respectively. Continuous external electricity was lacking in 16 hospitals (12%). Compared to private hospitals, public hospitals had a lower PIPES index (10.48 vs 11.1, P = 0.022), including lower Personnel and Infrastructure scores (12.31 vs 15.57, P = 0.03; 14.04 vs 15.7, P = 0.003, respectively). Geographically, the administrative governorates with highest refugee concentrations had the lowest PIPES indices.

Conclusions:
Evaluating surgical capacity in Lebanon reveals significant deficiencies, most pronounced in public hospitals in which refugee care is provided and in areas with the highest refugee concentration.
Human posterior insula to posterior cingulate functional connectivity is related to the subjective intensity of acute pain
Authors: Becker Christopher J. , Vogt Keith M. , Ibinson James W. 
Published: January 2018

AbstractBackgroundSeveral studies have shown that, in the context of chronic pain, alterations in functional connectivity between the insula and default mode network (DMN) are correlated with pain intensity. However, it is unknown whether a similar relationship between insula-to-DMN connectivity and pain intensity exists in the absence of chronic pain. Our aims were 1) to assess whether insula-to-DMN connectivity changes are correlated to the intensity of ongoing acute pain in healthy subjects, and 2) provide an initial assessment of the capacity of pIns-to-PCC connectivity to differentiate between painful and non-painful states. 3T BOLD functional imaging data were obtained from 13 healthy human subjects in three conditions: rest, non-painful tactile stimulation, and capsaicin-induced pain.ResultsPosterior insula to posterior cingulate (pIns-to-PCC) connectivity was significantly correlated with pain intensity. Additionally, we found that discrimination between painful and non-painful states could be achieved based on pIns-to-PCC connectivity.ConclusionsFunctional connectivity alterations in healthy subjects experiencing acute ongoing pain are similar to those observed in chronic pain patients, and can be used to classify pain state. This suggests that the inclusion of the pIns and PCC regions in future fcMRI-based methods to detect ongoing pain is warranted.