bluuebunny/crossref_metadata_2025_split huggingface dataset:
Literature review and case report of septic arthritis and purpura fulminans leading to a child limb amputation as chickenpox complications
Authors: Hijazi Bassel , Nairoukh Effat , Yahya Razan M. , Abunejma Fawzy M. 
Published: August 2024

Introduction and significance:
Chickenpox, induced by the varicella-zoster virus (VZV), generally presents with an itchy rash and fluid-filled blisters. While complications such as pneumonia and sepsis are well-documented, occurrences of septic arthritis and purpura fulminans are exceedingly rare. Septic arthritis following varicella infection is infrequently reported and often attributed to Staphylococcus aureus. Purpura fulminans encompasses disorders characterized by rapidly progressing purpuric lesions, often fatal and associated with consumptive coagulopathy.

Case presentation:
The authors present the case of an 8-year-old boy diagnosed with chickenpox who concurrently developed severe left knee pain, erythema, and swelling indicative of septic arthritis, along with a single pustular lesion on his right foot that progressed to purpura fulminans. Laboratory investigations revealed elevated inflammatory markers. Knee ultrasound findings were consistent with septic arthritis, corroborated by synovial fluid analysis. Immediate initiation of empiric antibiotics was undertaken. Further investigation disclosed unusual coagulation parameters, positive autoantibodies, and reduced protein S levels. Treatment included anticoagulation, immunomodulation, and ultimately, amputation.

Clinical discussion:
This rare case underscores the complexity of varicella-related complications, representing the first documented instance of simultaneous septic arthritis and purpura fulminans in a pediatric patient. It highlights the necessity of a multidisciplinary approach for accurate diagnosis and management, emphasizing the importance of recognizing rare complications to improve patient outcomes.

Conclusion:
This case exemplifies the complexity of varicella-associated complications, showcasing a rare simultaneous occurrence of septic arthritis and purpura fulminans in a pediatric patient. It underscores the importance of a thorough understanding and collaborative management approaches for timely intervention and enhanced clinical outcomes.
Rhino-orbital-cerebral mucormycosis with Klebsiella and MRSA co-infection in a diabetic patient: a case report
Authors: Subedi Ram Chandra , Adhikari Ayush , Gurung Shekhar , Jha Pinky , Acharya Subi , Shiwakoti Tibbin Kumar , Bhatta Bhuwan , Kharbuja Naresh , Lamichhane Barada , Paudel Raju , Jha Saroj Kumar 
Published: August 2024

Introduction and importance:
Rhino-orbital-cerebral mucormycosis is an opportunistic infection caused by fungus species Rhizopus and Mucor. Early recognition and aggressive management is crucial for favorable outcomes. A delay in diagnosis and treatment is fatal.

Case presentation:
A 32-year-old female presented with high-grade fever, right-sided facial deviation associated with facial swelling, and inability to move her left eye for 10 days. Biopsy from the left nasal cavity showed fibrinoid material, edema, and sheets of neutrophilic infiltrate while KOH preparation of nasal scrapping showed aseptate hyphae with obtuse-angled branching. Amphotericin B, oral posaconazole, and antibiotics were started with exploration and debridement of the affected tissue. The patient recovered well and was discharged.

Discussion:
Immunocompromised people are primarily affected by mucormycosis, a serious fungal illness. Inhaling fungal spores, especially those of the Rhizopus and Mucor species, is the usual cause. Rhinocerebral mucormycosis (ROCM), the most common type, increased during COVID-19 pandemic, frequently as a result of hyperglycemia brought on by steroids. Angioinvasion and tissue necrosis are pathogenesis-related processes that are made worse by diabetes and the overuse of glucocorticoids. Histopathology, culture, and imaging are used in the diagnosis. Surgery and antifungal drugs like Amphotericin B are used in treatment. Early intervention and interdisciplinary care, including hyperbaric oxygen therapy, are critical for survival. Results deteriorate with postponed therapy, underscoring the urgency of prompt action.

Conclusion:
Mucormycosis should be kept in mind while formulating differential diagnosis of infective pathology in immunocompromised patients. Early diagnosis and treatment are important in improving patient prognosis in rhino-orbital-cerebral mucormycosis.
Sigmoid colon cancer presenting as a large abdominal mass accompanied by abscess and rupture: a case report and literature review
Authors: Ding Haibo , Xu Baiying , Wang Yueming , Xu Bin , Qiu Wei , Zhang Wenzhong , Wang Yongbing , Li Gang 
Published: August 2024

Introduction and Importance:
Colon cancer presenting as a large abdominal mass accompanied by abscess and rupture is rare and prone to be misdiagnosed and delayed. In addition, the treatment plan is not clear when combined with abdominal wall metastasis.

Case Presentation:
A 79-year-old woman presented with a large abdominal mass accompanied by abscess and rupture. It was misdiagnosed as a soft tissue infection in a local hospital, and after a comprehensive examination, it was diagnosed as sigmoid colon cancer with abdominal wall metastasis and abscess formation. The patient underwent a one-stage surgery, including en bloc resection of the tumor and invaded abdominal wall, as well as autologous tissue abdominal wall reconstruction, with a good clinical prognosis.

Clinical Discussion:
For the diagnosis of large abdominal masses, abdominal CT, and pus culture are more valuable than ultrasound. For colon cancer with abdominal wall metastasis, one-stage surgery to completely remove the tumor and full-thickness of the abdominal wall, and the use of autologous tissue abdominal wall reconstruction technology to repair defects is feasible.

Conclusion:
This case highlights the importance of using colon cancer as one of the differential diagnoses for the diagnosis for large abdominal mass accompanied by abscess and rupture in elderly patients, as well as the possibility of one-stage surgical resection of the tumor and invasion of the abdominal wall and reconstruction of the abdominal wall with autologous tissue when there is abdominal wall metastasis.
Further Refinements in Otoplasty Surgery: A Modified Approach to Prevent Suture Extrusion in Cartilage-Suturing Otoplasty Using a Postauricular Dermofascial Flap
Authors: Bulstrode Neil W. , Ronde Elsa M. , Mazeed Ahmed S. 
Published: August 2024

Background:
Suture extrusion has been reported to be the most common complication after cartilage-sparing otoplasty. Several studies have described various designs of postauricular flaps to cover the cartilage sutures and reduce the incidence of suture extrusion.

Methods:
A total of 100 consecutive patients with prominent ears were operated on between January of 2018 and February of 2023 using a deepithelialized postauricular dermofascial flap that is performed as an adjunct to the authors’ cartilage-sparing otoplasty technique, which is essentially a combined modified Mustardé and Furnas technique. The flap is used to cover the cartilage-holding sutures with an extra layer of vascularized tissue to avoid the scar being directly over these sutures.

Results:
The median age of patients was 12 years (interquartile range, 9 to 15). One out of the 100 patients (1%) developed a postauricular skin infection requiring surgical removal of sutures. Primary suture extrusion did not occur; in an earlier study of cartilage-sparing technique without the postauricular flap, 17 out of 200 patients had suture extrusion (P = 0.001). No hematoma occurred that necessitated return to the theater. Skin necrosis and wound dehiscence did not occur in any case. No patient developed cartilage deformities or relapse requiring surgical correction.

Conclusions:
Combining cartilage-sparing otoplasty using sutures and the described postauricular dermofascial flap is simple to perform and has significantly reduced the complication rate and improved the outcome compared with cartilage-sparing otoplasty alone. This flap is recommended for both primary and revisional otoplasty.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Breast-Conserving Therapy Preserves Sexual Well-Being More than Postmastectomy Breast Reconstruction: Trends, Factors, and Interventions
Authors: Stern Carrie S. , Kim Minji , Smith Montes Elizabeth , Boe Lillian A. , Zhang Kevin , Vingan Perri , Carter Jeanne , Mehrara Babak J. , Tadros Audree B. , Allen Robert J. , Nelson Jonas A. 
Published: August 2024

Background:
Up to 85% of patients with breast cancer report sexual health concerns, but their concerns are not adequately addressed by providers. Sexual dysfunction among patients with breast cancer remains understudied. The authors aimed to investigate the impact of breast-conserving therapy (BCT) and postmastectomy breast reconstruction (PMBR) on the sexual health of patients with breast cancer and the frequency of sexual medicine consultation in postoperative care.

Methods:
The authors conducted a retrospective analysis of patients who underwent BCT or PMBR and completed the Sexual Well-Being section of the BREAST-Q BCT and Reconstruction modules from January of 2010 through October of 2022. They compared Sexual Well-Being scores between patients who received BCT or PMBR over time up to 5 years after surgery, delineated associated demographic and clinical factors with Sexual Well-Being scores, and evaluated the frequency of sexual medicine consultations.

Results:
Of 15,857 patients, 8510 (53.7%) underwent BCT and 7347 (46.3%) underwent PMBR. Patients who underwent PMBR had significantly lower Sexual Well-Being scores than patients who underwent BCT from preoperatively to 5 years postoperatively. Regression analyses showed that patients who underwent PMBR scored 7.6 points lower at 1 year than patients who underwent BCT. Separated marital status, higher body mass index, cardiovascular disease, hyperlipidemia, psychiatric diagnosis, and neoadjuvant chemotherapy were associated with significantly lower Sexual Well-Being scores. A total of 299 patients (3.5%) who underwent BCT and 400 patients (5.4%) who underwent PMBR received sexual medicine consultations.

Conclusions:
Sexual health concerns must be considered in breast cancer care, particularly among patients who undergo PMBR. Although many patients experience sexual dysfunction, most do not receive a sexual medicine consultation, suggesting an opportunity for providers to improve the sexual health of patients with breast cancer.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Cost Comparison of Digital Nerve Repair Techniques
Authors: Hu Kevin , Williams Mica C. G. , Kammien Alexander J. , Canner Joseph , Mukherjee Thayer , Hill Elspeth , Colen David 
Published: August 2024

Background:
Direct cost comparisons of nerve allograft with other techniques for repairing short digital nerve gaps are lacking. This study compares the costs of various techniques for digital nerve repair, anticipating significant cost increases for allograft implants.

Methods:
The State Ambulatory Surgery and Services Databases for Florida, New York, and Wisconsin from 2015 through 2020 were used. Patients with primary repair, short autograft, conduit, and allograft were compared along total, surgical supply, operating room, and anesthesia charges.

Results:
Among 5009 patients, there were 2967 primary nerve repairs (59.2%), 77 autografts (1.5%), 1647 conduits (32.9%), and 318 allografts (6.3%). A total of 2886 patients were male (57.6%), and the mean patient age was 40.4 ± 16.3 years. Over the study period, primary repairs decreased (from 63.9% in 2015 to 56.3% in 2020), whereas allografts increased significantly (from 8.8% in 2018 to 12.6% in 2020). Median total charges varied significantly across procedures, with the most expensive being allograft ($35,295), followed by conduit ($25,717), autograft ($24,749), and primary repair ($18,767). On multivariable regression, allografts were significantly more expensive than autografts in total charges of $11,224 (95% CI, $4196 to $18,252) and supply charges of $10,484 (95% CI, $6073 to $14,896), but not in operating room or anesthesia charges. Flexor tendon repair was associated with greater total, operating room, and anesthesia charges, but had similar supply charges.

Conclusions:
Nerve allografting is the most expensive digital nerve repair technique, most likely due to the cost of the implant. To minimize health care expenditure and ensure equitable patient access, surgeons should consider this cost along with clinical factors when choosing digital nerve repair techniques.
True and False Positive HIV Point of Care Test Results in a Prospective Multinational Study of At-Risk African Women: Implications for Large-Scale Repeat HIV Testing in HIV Prevention Programs
Authors: Morrison Susan , Batting Joanne , Wanga Valentine , Beesham Ivana , Deese Jennifer , Hofmeyr G. Justus , Kasaro Margaret P. , Louw Cheryl , Morrison Charles , Mugo Nelly R. , Palanee-Phillips Thesla , Pleaner Melanie , Reddy Krishnaveni , Scoville Caitlin W. , Smit Jenni , Stringer Jeffrey S.A. , Ahmed Khatija , Bukusi Elizabeth , Kotze Philip , Baeten Jared M. ,   for the ECHO Trial Team
Published: August 2024

Background:
Accurate HIV point of care testing is the cornerstone of prevention and treatment efforts globally, although false (both negative and positive) results are expected to occur.

Setting:
We assessed the spectrum of true and false positive HIV results in a large prospective study of HIV incidence in African women using 3 contraceptive methods tested longitudinally in Eswatini, Kenya, South Africa, and Zambia.

Methods:
HIV serologic testing was conducted quarterly using 2 parallel rapid HIV tests. When one or both tests were positive, additional confirmatory testing was conducted, including HIV enzyme immunoassay (EIA) and RNA.

Results:
A total of 7730 women contributed 48,234 visits: true positive results occurred at 412 visits (0.9%) and false positives at 96 visits (0.2%). Of 412 women with HIV seroconversion, 10 had discordant (ie, 1 negative and 1 positive) rapid tests and 13 had undetectable HIV RNA levels. Of 62 women with false positive rapid HIV results, most had discordant rapid testing, but 6 (9.7%) had dually positive rapid results, and 4 (6.5%) had false positive or indeterminate EIA results. The positive predictive value of dual positive rapid results was 98.3%.

Conclusions:
Although most rapid test results were accurate, false positive results were expected and occurred in this population of initially HIV seronegative individuals tested repeatedly and prospectively. When HIV infection occurred, not all cases had textbook laboratory results. Our findings highlight the importance of confirmatory testing, particularly for individuals undergoing repeat testing and in settings where the point prevalence is expected to be low.

Trial registration:

ClinicalTrials.gov number NCT02550067.
Follow-Up Outcomes of Children, Adolescents, and Young People on Darunavir-Based Third-Line Antiretroviral Therapy: Observational Cohort From 9 African Countries
Authors: Tukei Vincent J. , Machekano Rhoderick , Tchounga Boris K. , Khumalo Philisiwe Ntombenhle , Tumwebaze Rachel , Murandu Mildrate , Viana Shannon , Masaba Rose Otieno , Mokone-Mwape Majoalane , Chirwa Lameck , Mashizwa Simba , Rakhmanina Natella , Tiam Appolinaire ,   The New Horizon's Study Team
Published: August 2024

Background:
We assessed clinical outcomes among children, adolescents, and people younger than 25 years on darunavir-based antiretroviral therapy (ART) in 9 sub-Saharan African countries.

Setting:
Third-line ART centers in Cameroon, Eswatini, Kenya, Lesotho, Nigeria, Rwanda, Uganda, Zambia, and Zimbabwe.

Methods:
From January 2019 to December 2022, we collected data from a cohort of children, adolescents, and young people receiving third-line ART from 9 sub-Saharan African countries. Data on treatment continuity, viral suppression, death, and clinic transfers were extracted from medical records and summarized. Cox proportional hazards models were used to identify factors independently associated with retention in care.

Results:
Of 871 participants enrolled, the median age was 14.8 (range: 0.2–24.7) years and 488 (56.0%) were male; 809 (92.9%) [median duration of follow-up of 28.3 months (interquartile range: 17.5–45.2)] had final outcomes after initiating third-line ART. Of these, 711 (87.9%) were alive and in care at the end of study follow-up, 29 (3.6%) died, 30 (3.7%) were transferred to other facilities, and 39 (4.8%) were lost to follow-up. Retention in care was less likely among male patients compared with female patients [aHR: 0.85, 95% confidence interval: 0.72 to 1.0] and in 10–14-year-old children compared with younger children. Adolescents (15–19 years old) had higher mortality compared with children younger than 10 years (aSHR: 4.20, 95% confidence interval: 1.37 to 12.87). Viral suppression was seen in 345/433 (79.7%), 249/320 (77.8%), and 546/674 (81.0%) patients with results at 6 months, 12 months, and study end, respectively.

Conclusions:
A high proportion of children and young people receiving third-line ART in sub-Saharan Africa remain in care and attain viral suppression during follow-up.
Performance and Interpretation of Lung Scintigraphy
Authors: Le Pennec Romain , Schaefer Wolfgang , Tulchinsky Mark , Lamoureux François , Roach Paul , Rischpler Christoph , Zukotynski Katherine , O’Brien Christopher , Murphy Declan , Pascal Pierre , Le Gal Grégoire , Salaun Pierre-Yves , Le Roux Pierre-Yves 
Published: August 2024

Purpose
Although ventilation/perfusion (V/Q) scintigraphy is a widely used imaging test, different options are possible for the acquisition and interpretation of the scan. The aim of this study was to assess current practices regarding the use and interpretation of lung scintigraphy in various clinical indications.

Patients and Methods
An online survey comprising 25 questions was sent to nuclear medicine departments in Australia, Canada, France, Germany, and United States between 2022 and 2023. A single response per department was consolidated.

Results
Four hundred nineteen responses were collected (Australia: 32, Canada: 58, France: 149, Germany: 92, and United States: 88). For acute pulmonary embolism (PE) diagnosis, 82.8% of centers reported using SPECT acquisitions (Australia: 93.3%, Canada: 91.8%, France: 99.2%, Germany: 96.2%, and United States: 32.1%). Among them, SPECT images were combined with a CT scan in 70.5% of centers. A total of 10.6% of centers reported not using ventilation for acute PE diagnosis. SPECT acquisition was used in 97.8% of centers using 99mTc carbon particles, 97.1% 81mKr gas, 58.7% 99mTc-DTPA, and 19.4% 133Xe gas, respectively. For V/Q SPECT interpretation, the EANM criteria were used in 65.0% of departments. A very wide variety of practices were observed in pregnant women and in COVID-19 patients. SPECT acquisition was widely used in the follow-up of PE and for the screening of chronic thromboembolic pulmonary hypertension (>90% of centers), with inconsistency regarding the interpretation of matched perfusion defects in this setting.

Conclusions
This survey shows the strong adoption of SPECT in the various clinical indications of lung scintigraphy, except in the United States, where planar imaging is still mostly used. The survey also shows variability in interpretation criteria both for PE diagnosis and screening for chronic thromboembolic pulmonary hypertension, highlighting the need for further standardizations of practices.
Early major fracture care in polytrauma—priorities in the context of concomitant injuries: A Delphi consensus process and systematic review
Authors: Pfeifer Roman , Klingebiel Felix Karl-Ludwig , Balogh Zsolt J. , Beeres Frank J.P. , Coimbra Raul , Fang Christian , Giannoudis Peter V. , Hietbrink Falco , Hildebrand Frank , Kurihara Hayato , Lustenberger Thomas , Marzi Ingo , Oertel Markus F. , Peralta Ruben , Rajasekaran Shanmuganathan , Schemitsch Emil H. , Vallier Heather A. , Zelle Boris A. , Kalbas Yannik , Pape Hans-Christoph ,   for the IMPACT group—International MultidisciPlinAry Consensus Panel on PolyTrauma
Published: August 2024

BACKGROUND
The timing of major fracture care in polytrauma patients has a relevant impact on outcomes. Yet, standardized treatment strategies with respect to concomitant injuries are rare. This study aims to provide expert recommendations regarding the timing of major fracture care in the presence of concomitant injuries to the brain, thorax, abdomen, spine/spinal cord, and vasculature, as well as multiple fractures.

METHODS
This study used the Delphi method supported by a systematic review. The review was conducted in the Medline and EMBASE databases to identify relevant literature on the timing of fracture care for patients with the aforementioned injury patterns. Then, consensus statements were developed by 17 international multidisciplinary experts based on the available evidence. The statements underwent repeated adjustments in online- and in-person meetings and were finally voted on. An agreement of ≥75% was set as the threshold for consensus. The level of evidence of the identified publications was rated using the GRADE approach.

RESULTS
A total of 12,476 publications were identified, and 73 were included. The majority of publications recommended early surgery (47/73). The threshold for early surgery was set within 24 hours in 45 publications. The expert panel developed 20 consensus statements and consensus >90% was achieved for all, with 15 reaching 100%. These statements define conditions and exceptions for early definitive fracture care in the presence of traumatic brain injury (n = 5), abdominal trauma (n = 4), thoracic trauma (n = 3), multiple extremity fractures (n = 3), spinal (cord) injuries (n = 3), and vascular injuries (n = 2).

CONCLUSION
A total of 20 statements were developed on the timing of fracture fixation in patients with associated injuries. All statements agree that major fracture care should be initiated within 24 hours of admission and completed within that timeframe unless the clinical status or severe associated issues prevent the patient from going to the operating room.

LEVEL OF EVIDENCE
Systematic Review/Meta-Analysis; Level IV.
Gender Representation in the ECT Workforce in the United States From 2013 to 2021
Authors: Luccarelli James , Hart Kamber L. , McCoy Thomas H. 
Published: August 2024

Objectives
Electroconvulsive therapy (ECT) is an effective treatment for a range of psychiatric disorders. Although much research has examined what patients receive ECT, there is less research describing those physicians who provide ECT services. This study examines the ECT workforce in the United States by analyzing publicly available Medicare billing records.

Methods
Data regarding the providers performing ECT were accessed from the Medicare Physician and Other Supplier Data for the years 2013 through 2021 based on those physicians who billed the ECT procedural code 90870.

Results
During the study period, 1402 physicians performed ECT in at least 1 calendar year on a minimum of 11 Medicare beneficiaries, representing 3.9% of the 36,116 psychiatrists who billed Medicare during this period. Female physicians made up 39% of psychiatrists overall who bill Medicare, but 23% of psychiatrists billing for ECT. Fifty percent of billed ECT treatments were performed by 12% of ECT doctors; among these high-volume ECT providers, 16% were female.

Conclusions
Only a small subset of psychiatrists who bill Medicare provide ECT services, and female physicians are under-represented in the ECT workforce and among high-volume ECT providers. Improving workforce equity and with it access to ECT requires further study of psychiatric training and practice environment that may impose barriers on female participation as ECT providers.