bluuebunny/crossref_metadata_2025_split huggingface dataset:
Causes of Corneal Melt After the Boston Keratoprosthesis Type I: The Chinese People's Liberation Army General Hospital Experience
Authors: Yang Zhe , Wang Yu-Qi , Wang Qun , Xu Weiwei , Zhang Shifeng , Li Zhao , Huang Yulei , Huang Yi-Fei , Wang Li-Qiang 
Published: May 2024

Purpose:
The purpose of this study was to evaluate the long-term incidence, risk factors, and the management of corneal melt following Boston type I keratoprosthesis (B-KPro I) implantation.

Methods:
This is a retrospective observational case series. Data were collected regarding demographics, preoperative characteristics, incidence, and outcomes of corneal melt in 102 patients who underwent B-KPro I in the Chinese PLA General Hospital between 2011 and 2018, with a follow-up period ranging from 4 to 11 years.

Results:
Chemical burn was the most common indication for B-KPro I (n = 56; 53.8%), followed by ocular trauma (n = 26; 25.0%). During the follow-up period (107 ± 25.7 months), corneal melt occurred in 60 cases among 37 eyes (35.6%), with an incidence of 20.2% at 1 year after surgery. Fourteen cases presented with recurrent corneal melt. Patients with multiple corneal allograft failures had a higher risk of corneal melt. Thermal burns, compared with alkali burns, significantly elevated the odds ratio (OR) of corneal melt (OR, 5.11; 95% confidence interval, 1.05–24.86; P = 0.043).

Conclusions:
Corneal melt significantly reduced the retention time of KPro (P < 0.01), and its coexistence with other complications further shortened the retention time. A specific pattern of corneal melt occurrence was identified, with a peak incidence at 1 year postoperatively. Our findings suggest variations in the risk of corneal melt among different indications, with thermal burns carrying the highest OR. Moreover, each previous failed keratoplasty doubled the risk of corneal melt after B-KPro I.
Immunohistochemical findings of lens capsules obtained from patients with dead bag syndrome
Authors: Sumioka Takayoshi , Werner Liliana , Yasuda Shingo , Okada Yuka , Mamalis Nick , Ishikawa Nobuyuki , Saika Shizuya 
Published: May 2024

Purpose:
To investigate the extracellular matrix and cellular components in lens capsules extracted from patients with dead bag syndrome (DBS) through immunohistochemistry.

Setting:
Department of Ophthalmology, Wakayama Medical University School of Medicine, Wakayama, Japan, and Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah.

Design:
Immunohistochemical experimental study.

Methods:
9 capsular bag specimens from DBS cases, as well as 2 control specimens from late-postoperative in-the-bag intraocular lens dislocation cases related to previous vitrectomy, pseudoexfoliation, and blunt trauma were included. They were processed for histopathology; unstained sections were obtained from each one and analyzed by immunohistochemistry targeting collagen type IV, laminin, vimentin, collagen type I, and fibronectin.

Results:
Immunohistochemistry in DBS showed lens capsule stained for basement membrane components. The outer part of the anterior capsule that was split from the inner part was more markedly stained for type IV collagen as compared with the posterior part. Faint staining for fibrous posterior capsular opacification (PCO) components, for example, collagen type I and fibronectin, was detected in limited areas, but the major portion of the capsule was free from these components. Small spotty vimentin-positive materials, suggesting the presence of cell debris, were also detected in limited samples.

Conclusions:
Small amounts of fibrotic PCO components were detected in capsules extracted from patients with DBS, but their major parts were free from PCO components. Current findings suggest small amounts of lens epithelial cells were present after surgery and secreted fibrous components before undergoing cell death process.
Factor Xa inhibitors versus low-molecular-weight heparin for preventing coagulopathy following COVID-19: a systematic review and meta-analysis of randomized controlled trials
Authors: Amin Laraib , Qayyum Komal , Uzair Muhammad , Khan Fatima , Sethi Parkha , Hanif Laiba , Azhar Aima , Mazhar Saad , Ejaz Umer , Jawad Sayed 
Published: May 2024

Background:
Hospitalized patients with COVID-19 have shown a significant occurrence of thromboembolism and a heightened risk of death. It remains unclear whether factor Xa inhibitors are superior to enoxaparin in this context. Hence, there is a need for a direct comparison to assess the preventive effects and safety of factor Xa inhibitors versus enoxaparin in hospitalized COVID-19 patients.

Methods:
MEDLINE, Embase, and Cochrane Central databases were searched for randomized controlled trials (RCTs) or retrospective studies that compared the effectiveness or safety of factor Xa inhibitors and enoxaparin in preventing thromboembolism in hospitalized patients with COVID-19. Embolic incidence, incidence of bleeding, and all-cause mortality were among the outcomes of interest. Mantel–Haenszel weighted random-effects model was used to calculate relative risks (RRs) with 95 percent CIs.

Results:
The analysis included six RCTs and two retrospective studies containing 4048 patients. Meta-analysis showed a statistically significant reduction among patients on factor Xa inhibitors compared with low-molecular-weight heparin (LMWH) in the embolic incidence [risk ratio (RR) 0.64 (95%, CI 0.42, 0.98); P=0.04, I2=12%]. Upon subgroup analysis by type of study design, no significant reductions were noted in patients on factor Xa inhibitors in RCTs (RR: 0.62; 95% CI: 0.33–1.17; P=0.14) or observational studies (RR: 0.53; 95% CI: 0.23–1.26; P=0.15) when compared with enoxaparin Factor Xa inhibitors were not significantly associated with incidence of bleeding [RR 0.76 (95% CI 0.36, 1.61); P=0.47, I2=0%] or all-cause mortality (RR: 0.81; 95% CI: 0.48–1.36; P=0.43). Consistent results were obtained upon subgroup analysis by the type of study design.

Conclusion:
Factor Xa inhibitors are more effective than enoxaparin in preventing thromboembolism among patients with COVID-19 who are not acutely ill and are hospitalized. Additional rigorous RCTs comparing factor Xa inhibitors with enoxaparin are warranted.
Direct carotid cavernous fistula treated with transvenous approach: a case report
Authors: Phuyal Subash , Thapa Chhetri Suchit , Phuyal Prakash , Khanal Deepa , Paudel Sushanta 
Published: May 2024

Introduction:
Carotid cavernous fistulas are uncommon vascular abnormalities marked by anomalous connections between the carotid artery and the cavernous sinus. The authors present a case of a direct carotid cavernous fistula and its successful treatment in a 42-year-old female.

Case presentation:
A 42-year-old female presented with right eye painful swelling and visual disturbance. She had no known comorbidities or history of injury. Examination showed proptosis, chemosis, and orbital bruit. Carotid angiography confirmed a carotid cavernous fistula, which was managed endovascularly. The patient fully recovered after treatment.

Discussion:
Carotid cavernous fistula occurs spontaneously or as a result of trauma or other vascular abnormalities. Common clinical manifestations include proptosis, chemosis, and orbital bruit, with vision loss being a feared complication. Diagnosis is typically confirmed through angiography, with digital subtraction angiography being the gold standard. Endovascular treatment is usually effective, although surgical management may be necessary in certain cases.

Conclusion:
Carotid cavernous fistula is a rare but potentially sight-threatening neurological condition. Treatment with a transvenous approach is effective for the management of direct carotid cavernous fistula.
Orbital Mass Identified With Point-of-Care Ultrasound in a Child Presenting With Eyelid Swelling
Authors: Callegari Alison , Abulfaraj Maher M. 
Published: May 2024

Abstract
Point-of-care ultrasound was used in a child presenting to the emergency department with progressively worsening left eyelid swelling. The early use of ultrasound was helpful in detecting a soft tissue mass that is exhibiting pressure effect on the eyeball. Point-of-care ultrasound helped expedite advanced imaging and consultation with the specialist. The patient eventually had a biopsy and was diagnosed with idiopathic orbital inflammation.
Efficacy and Safety of Dexmedetomidine Compared to Other Needle-Free Pharmacological Sedation Methods in Pediatric Patients Undergoing Imaging Procedures
Authors: Alsabri Mohammed Alsabri Hussein , Abdelshafi Abdelrahman , Bostamy Elsnhory Ahmed , Selim Noha Samir , Elsnhory Alaa Bostamy , Albelal Douaa , Akram Fatima , Elshanbary Alaa Ahmed 
Published: May 2024

Background
Pediatric patients often require sedation during magnetic resonance imaging (MRI) and computed tomography (CT) to ensure stillness and minimize stress. This meta-analysis compared the effectiveness and safety of 3 sedative agents—dexmedetomidine, midazolam, and chloral hydrate—for pediatric MRI/CT sedation.

Methods
Six studies with a total of 633 patients were included in the analysis. Quality assessment revealed varying levels of bias risk. Dexmedetomidine exhibited a significantly higher successful sedation rate compared to midazolam (risk ratio [RR] = 0.43, 95% confidence interval [CI] [0.29–0.64]), but no statistically significant difference compared to chloral hydrate (RR = 0.94, 95% CI [0.60–1.45]). Chloral hydrate also showed a higher successful sedation rate compared to midazolam (RR = 0.46, 95% CI [0.25–0.83]). The onset of sedation time did not significantly differ between the 3 agents.

Results
The dexmedetomidine group had a significantly higher incidence of bradycardia compared to the chloral hydrate group (RR = 0.17, 95% CI [0.05–0.59]), but no significant difference compared to the midazolam group (RR = 0.29, 95% CI [0.06–1.26]). No statistically significant differences were observed in the incidence of nausea and vomiting between the 3 groups.

Conclusions
Dexmedetomidine demonstrates effectiveness in pediatric MRI/CT sedation, offering advantages over midazolam and similar efficacy to chloral hydrate. Careful cardiovascular monitoring is essential during administration, particularly in patients with congenital heart disease. Sublingual and intranasal administration of dexmedetomidine is a viable option with high bioavailability. This meta-analysis contributes valuable insights into refining sedation protocols for pediatric imaging procedures, emphasizing efficacy and safety considerations.
Volar Distal Radius Buckle Fractures
Authors: Nandigam Meghana , Chmil Margarita , Thompson Benjamin Patrick , Samora Julie Balch , Ruess Lynne 
Published: May 2024

Background
A removable brace with home management is widely accepted treatment for distal radius buckle fractures, which most commonly involve the dorsal cortex.

Purpose
The purpose of this study is to determine if a removable brace and home management treatment is safe for volar distal radius buckle fractures.

Materials and Methods
Isolated distal radius buckle fractures in children (3–16 years) diagnosed at an acute care visit (April 1, 2019 to May 31, 2022) were identified. Final diagnosis was confirmed using strict criteria including cortical buckling without cortical breach or physeal involvement. Cortical buckling was categorized as either dorsal or volar. Demographic data, mechanism of injury, treatment, and any complications were recorded and analyzed.

Results
Three hundred thirty-three fractures were either dorsal (254, 76%) or volar (79, 24%) buckle fractures. Mean age (SD) for volar fractures (9.3 [2.2 years]; range, 4–14 years) was significantly higher than for dorsal fractures (8.5 (3.0 years); range, 3–15 years; P = 0.012). More girls had volar fractures (48 [60%], P = 0.006). Most fractures occurred after a standing-height fall. Two hundred forty-four (96%) dorsal and 76 (96%) volar fractures were initially treated with a removable brace. Two hundred fourteen (84%) dorsal and 66 (84%) volar fractures had orthopedic follow-up. Brace treatment continued for 167 (167/204, 82%) dorsal and 56 (56/63, 89%) volar fractures. Treatment changed from initial brace to cast for 37 (37/204, 18%) dorsal fractures and 7 (7/63, 11%) volar fractures, influenced by caregiver preference and/or sport participation requirements. Only 1 (1/79, 1%) patient with a volar fracture returned for an additional visit for persistent pain.

Conclusions
When diagnosis of volar buckle fracture is made using the same strict criteria used for dorsal buckle fractures, removable brace and home management treatment is safe. Shared decision making with caregivers may alter buckle fracture treatment.
Efficacy and Safety of Intranasal Fentanyl in Pediatric Emergencies
Authors: Alsabri Mohammed , Hafez Abdelrahman H. , Singer Emad , Elhady Mahmoud M. , Waqar Muhammad , Gill Paviter 
Published: May 2024

Background
Intranasal fentanyl (INF) has gained popularity in pediatric emergency departments (EDs) as an effective alternative to intravenous morphine for treating acute moderate to severe pain. Intranasal fentanyl eliminates the need for invasive access, making it advantageous for patients with minor injuries. Our study aims to provide a comprehensive evaluation of the available evidence regarding the effectiveness and safety of INF administration in pediatric emergency wards, particularly compared with other treatment options described in the literature.

Methods
A thorough search strategy identified randomized controlled trials assessing INF in the pediatric emergency ward. Eligible studies were independently screened, and relevant data were extracted. The analysis used pooled risk ratio (RR) for dichotomous outcomes and the standardized mean difference (SMD) for continuous ones. Randomized controlled trials' quality was assessed using the Cochrane Risk of Bias Assessment Tool 2.

Results
In our study, 8 randomized controlled trials involving 806 patients, INF demonstrated superior effectiveness in reducing pain compared with other comparators at the 15- to 20-minute mark (SMD, −0.23; 95% confidence interval, −0.37 to −0.08; P = 0.002). However, no significant differences were found at the 30- and 60-minute time points (SMDs, −0.16; 95% CI, −0.50, 0.19; P = 0.37; and −0.16; 95% CI, −0.50 to 0.19; P = 0.78) except when excluding one study to resolve heterogeneity at the 30-minute mark (RR, −0.02; 95% CI, −0.24 to 0.20; P = 0.87). Intranasal fentanyl also exhibited a better adverse outcome profile, with a lower risk of total adverse events and nausea/vomiting (RR, 0.66; 95% CI, 0.48–0.91; P = 0.01; and RR, 0.43; 95% CI, 0.30–0.63; P > 0.001) compared with other analgesics. However, no significant differences were observed for dizziness and hallucination (RR, 0.43; 95% CI, 0.30–0.63; P = 0.68; and RR, 0.43; 95% CI, 0.30–0.63; P = 0.35).

Conclusions
Our study assessed the effectiveness of INF compared with other analgesics in pain reduction. Intranasal fentanyl demonstrated superior pain reduction at the 15- to 20-minute point but showed no significant differences at 30 and 60 minutes. Intranasal fentanyl also had a more favorable adverse event profile, with a lower risk of nausea and vomiting than other analgesics. However, no significant differences were observed in dizziness and hallucination between the groups.
Lactate Levels as a Predictor of Emergency Department Revisits in Infants With Acute Bronchiolitis
Authors: Kim Gihyeon , Han Sangsoo , Bae Seong Phil , Lee Jungwon , Heo Nam Hun , Lee Dongwook , Kim Hyun Joon 
Published: May 2024

Objective
This study aimed to identify predictive biomarkers for unscheduled emergency department (ED) revisits within 24 hours of discharge in infants diagnosed with acute bronchiolitis (AB).

Methods
A retrospective observational study was conducted on infants diagnosed with AB who visited 3 emergency medical centers between January 2020 and December 2022. The study excluded infants with comorbidities, congenital diseases, and prematurity and infants who revisited the ED after 24 hours of discharge. Demographic data, vital signs, and laboratory results were collected from the medical records. Univariable and multivariable logistic regression analyses were performed on factors with P of less than 0.1 in univariable analysis. Receiver operator curve analysis was used to assess the accuracy of lactate measurements in predicting ED revisits within 24 hours of discharge.

Results
Out of 172 participants, 100 were in the revisit group and 72 in the discharge group. The revisit group was significantly younger and exhibited higher lactate levels, lower pH values, and higher pCO2 levels compared to the discharge group. Univariable logistic regression identified several factors associated with revisits. Multivariable analysis found that only lactate was a variable correlated with predicting ED revisits (odds ratio, 18.020; 95% confidence interval [CI], 5.764–56.334). The receiver operator curve analysis showed an area under the curve of 0.856, with an optimal lactate cutoff value of 2.15.

Conclusion
Lactate value in infants diagnosed with AB were identified as a potential indicator of predicting unscheduled ED revisits within 24 hours of discharge. The predictive potential of lactate levels holds promise for enhancing prognosis prediction, reducing health care costs, and alleviating ED overcrowding. However, given the study's limitations, a more comprehensive prospective investigation is recommended to validate these findings.
Risk scores and coronary artery disease in patients with suspected acute coronary syndrome and intermediate cardiac troponin concentrations
Authors: Perez-Vicencio Daniel , Thurston Alexander JF , Doudesis Dimitrios , O’Brien Rachel , Ferry Amy V. , Fujisawa Takeshi , Williams Michelle C. , Gray Alasdair J. , Mills Nicholas L , Lee Kuan Ken 
Published: May 2024

AbstractBackgroundGuidelines recommend the use of risk scores to select patients for further investigation after myocardial infarction has been ruled out but their utility to identify those with coronary artery disease is uncertain.MethodsIn a prospective cohort study, patients with intermediate high-sensitivity cardiac troponin I concentrations (5 ng/L to sex-specific 99thpercentile) in whom myocardial infarction was ruled out were enrolled and underwent coronary computed tomography angiography (CCTA) after hospital discharge. HEART, EDACS, GRACE, TIMI, SCORE2 and PCE risk scores were calculated and the odds ratio (OR) and diagnostic performance for obstructive coronary artery disease determined using established thresholds.ResultsIn 167 patients enrolled (64±12 years, 28% female), 29.9% (50/167) had obstructive coronary artery disease. The odds of having obstructive disease was increased for all scores with the lowest and highest increase observed for an EDACS score ≥16 (OR 2.2 [1.1-4.6]) and a TIMI risk score ≥1 (OR 12.9 [3.0-56.0]), respectively. The positive predictive value (PPV) was low for all scores but was highest for a GRACE score >88 identifying 39% as high-risk for a PPV of 41.9% (30.4-54.2%). The negative predictive value (NPV) varied from 77.3% to 95.2% but was highest for a TIMI score of 0 identifying 26% as low-risk for a NPV of 95.2% (87.2-100%).ConclusionsIn patients with intermediate cardiac troponin concentrations in whom myocardial infarction has been ruled out, clinical risk scores can help identify patients with and without coronary artery disease, but the performance of established risk thresholds requires optimisation for this purpose.Clinical Trial Registrationhttps://clinicaltrials.gov/study/NCT04549805
Investigating the prevalence of tuberculosis and associated risk factors among prisoners at Peter Singogo Prison in Ndola: a retrospective cross-sectional study
Authors: Manda Chipo , Chisompola Namaunga Kasumu 
Published: May 2024

AbstractBackgroundTuberculosis primarily affects the lungs and is influenced by risk factors such as diabetes, HIV/AIDS, substance abuse, and crowded living conditions. Prisons can be high-risk environments for tuberculosis transmission due to overcrowding, poor ventilation, and limited access to medical care. Substance misuse and HIV infection are common among prisoners, increasing the risk of tuberculosis. The Peter Singogo Prison in Ndola, Zambia was studied to determine the prevalence of tuberculosis and its associated risk factors.MethodsTo ascertain the prevalence of Tuberculosis and related risk factors among inmates at Peter Singogo Prison, a retrospective cross-sectional study was done. Out of the 450 prisoners who passed screening, 220 prisoners were chosen using a purposive sampling strategy after Tuberculosis records were reviewed, considering known risk factors, Tuberculosis symptoms, and Sputum microbiology laboratory results. The collected results were then examined using Statistical Package for the Social Sciences Version 23; statistical significance was recognized for a P value of less than or equal to 0.05.ResultsTwo hundred and twenty prisoners had Tuberculosis symptoms. From these, a total of 51 prisoners (23%) had a Tuberculosis diagnoses with only 18 prisoners (35%) having a bacteriological confirmation of Tuberculosis, while 33 prisoners (65%) had a clinical diagnosis. In cases with bacteriological confirmation, the smear was positive. Human Immunodeficiency Virus positive inmates had a much greater frequency of Tuberculosis than Human Immunodeficiency Virus negative inmates (80% vs. 20%).ConclusionA significant prevalence of Tuberculosis at Peter Singogo prison was identified, with the majority of cases occurring in inmates who were Human Immunodeficiency Virus positive. The high prevalence found in this study may help to explain how Tuberculosis spreads within the prison, amongst inmates, and among different communities. Therefore, it is important to pay attention to prison environments to stop the spread of Tuberculosis to both convicts and the wider public.