bluuebunny/crossref_metadata_2025_split huggingface dataset:
Catastrophic antiphospholipid syndrome in lupus-associated immune thrombocytopenia treated with eltrombopag A case series and literature review
Authors: Garra Wakar , Carmi Or , Kivity Shaye , Levy Yair 
Published: February 2023

Background:
Eltrombopag, a thrombopoietin receptor (TPO-R) agonist, is considered a second-line treatment for patients with refractory immune thrombocytopenia (ITP). Systemic lupus erythematosus (SLE) is frequently associated with ITP. In some cases, thrombocytopenia in SLE patients is attributed to concurrent antiphospholipid antibodies (APLA). Currently, data regarding treatment with TPO-R agonists for ITP in SLE or APLA patients are limited. The incidence of SLE flare or antiphospholipid syndrome while on TPO-R agonists has not been well-studied.

Cases:
We report 2 cases of female patients with SLE and concurrent triple positive APLA, without thrombotic events in their medical history, in our rheumatology clinic, who were treated for refractory ITP with eltrombopag. Both developed catastrophic antiphospholipid syndrome a few weeks after beginning treatment with eltrombopag. They were admitted to the intensive care unit and treated with solumedrol, plasmapheresis, anticoagulation and rituximab.

Conclusions:
We describe a severe possible side-effect of eltrombopag as a trigger of catastrophic antiphospholipid syndrome, a rare initial manifestation of antiphospholipid syndrome, in SLE patients with APLA. We suggest that APLA should be tested before initiating eltrombopag in patients with SLE-associated ITP. The safety of this treatment should be considered in these cases.
Cross-sectional study examining the epidemiology of chronic pain in Nepal
Authors: Higgins Cassie , Sharma Saurab , Bimali Inosha , Hales Tim G. , Cameron Paul A. , Smith Blair H. , Colvin Lesley A. 
Published: February 2023

Abstract

Introduction:
The World Health Organization recognizes chronic pain as a global public health concern; however, there is a bias towards research conducted in relatively affluent nations. There is a dearth of large-scale epidemiological studies in Nepal using rigorously validated, cross-culturally adapted instruments.

Objectives:
The aim of this study was to examine the prevalence of both chronic pain and chronic pain of predominantly neuropathic origin and their associations with a range of sociodemographic and psychosocial characteristics.

Methods:
We conducted a cross-sectional study of adults (≥18 years) in all households in Ranipani, Baluwa Village Development Committee, Nepal. All adults (n = 887) were approached, and those consenting, who met the inclusion criteria (n = 520, 58.6%), participated. Questionnaires validated in Nepali were used to examine several constructs: demographics; chronic pain; neuropathic pain; pain catastrophizing; resilience, pain intensity; pain interference; sleep disturbance; and depression.

Results:
The point prevalence of chronic pain was 53.3% (n = 277). The point prevalence of chronic pain of predominantly neuropathic origin was 12.7% (n = 66). Chronic pain was associated with female gender, older age, and manual labour occupations. Using standardized scoring techniques, compared with available population estimates from other countries, those with chronic pain were associated with lower pain intensity and resilience scores and higher pain catastrophizing, pain interference, and depression scores.

Conclusion:
These findings are broadly comparable to epidemiological studies from other countries, and these indicate areas for targeting interventions (eg, occupational and mental health). For comparison, more data are needed, from larger population samples in this region.
High Deductibles are Associated With Severe Disease, Catastrophic Out-of-Pocket Payments for Emergency Surgical Conditions
Authors: Scott John W. , Neiman Pooja U. , Scott Kirstin W. , Ibrahim Andrew M. , Fan Zhaohui , Fendrick A. Mark , Dimick Justin B. 
Published: February 2023

Background:
Out-of-pocket spending has risen for individuals with private health insurance, yet little is known about the unintended consequences that high levels of cost-sharing may have on delayed clinical presentation and financial outcomes for common emergency surgical conditions.

Methods:
In this retrospective analysis of claims data from a large commercial insurer (2016–2019), we identified adult inpatient admissions following emergency department presentation for common emergency surgical conditions (eg, appendicitis, cholecystitis, diverticulitis, and intestinal obstruction). Primary exposure of interest was enrollment in a high-deductible health insurance plan (HDHP). Our primary outcome was disease severity at presentation—determined using ICD-10-CM diagnoses codes and based on validated measures of anatomic severity (eg, perforation, abscess, diffuse peritonitis). Our secondary outcome was catastrophic out-of-pocket spending, defined by the World Health Organization as out-of-pocket spending >10% of annual income.

Results:
Among 43,516 patients [mean age 48.4 (SD: 11.9) years; 51% female], 41% were enrolled HDHPs. Despite being younger, healthier, wealthier, and more educated, HDHP enrollees were more likely to present with more severe disease (28.5% vs 21.3%, P<0.001; odds ratio (OR): 1.34, 95% CI: 1.28–1.42]); even after adjusting for relevant demographics (adjusted OR: 1.23, 95% CI: 1.18–1.31). HDHP enrollees were also more likely to incur 30-day out-of-pocket spending that exceeded 10% of annual income (20.8% vs 6.4%, adjusted OR: 3.93, 95% CI: 3.65–4.24). Lower-income patients, Black patients, and Hispanic patients were at highest risk of financial strain.

Conclusions:
For privately insured patients presenting with common surgical emergencies, high-deductible health plans are associated with increased disease severity at admission and a greater financial burden after discharge—especially for vulnerable populations. Strategies are needed to improve financial risk protection for common surgical emergencies.
Barriers and Facilitators to Communication Accessibility as Perceived by People With Aphasia
Authors: Kim Esther S. , Mauriks Kira , Wilson Carlee , Auch Leah , Koo Herman , Swensrude Daralynn , Laccett Jessica , Ruelling Andrea 
Published: February 2023

Purpose:
Communication access is a human right, but many individuals with communication impairments face challenges accessing their environments. As part of a larger study investigating barriers and facilitators to communication access in the retail/service industry, the purpose of the present study was to investigate the experiences of people with aphasia (PWA) accessing goods and services in their communities.

Methods:
Nine PWA were interviewed about their experiences accessing retail businesses and services. Interviews were coded and thematically analyzed to identify key themes related to barriers and facilitators to communication during business interactions. Stakeholders on the research team included two PWA, who provided input throughout the research process.

Results:
Three main themes were found: supporting communication, aphasia awareness and education, and respect for PWA. Codes within each theme comprised facilitators that led to positive experiences and barriers that led to negative business interactions.

Discussion/Conclusions:
People with aphasia identified tangible ways that retail businesses can be made more communicatively accessible. Stakeholders with aphasia made meaningful contributions to the research process. Future work will investigate how these findings, integrated with business perspectives, can be used to support businesses in applying strategies to become more communicatively accessible.
Long-term Outcomes Associated With Post–kidney Donation Pregnancy Complications
Authors: Palzer Elise F. , Helgeson Erika S. , Evans Michael D. , Vock David M. , Matas Arthur J. 
Published: February 2023

Background.
Kidney donors have increased risk of postdonation gestational hypertension (gHTN) and preeclampsia. In the general population, pregnancy complications are associated with long-term maternal risk. However, little data exist on whether donors with postdonation pregnancy-related complications have similar increased long-term risks. We studied whether postdonation gHTN, preeclampsia/eclampsia, or gestational diabetes (gDM) was associated with increased risk of developing hypertension, DM, cardiovascular disease, or estimated glomerular filtration rate <45 mL/min/1.73 m2.

Methods.
Postdonation pregnancies with complications were matched to pregnancies without complications based on time from donation. Incidence of outcomes was compared using sequential Cox regression with robust standard errors. Donors with predonation pregnancy complications were excluded. Models were adjusted for age at pregnancy, gravidity, year of donation, and family history of hypertension, DM, and heart disease.

Results.
Of the 384 donors with postdonation pregnancies (median [quartiles] follow-up of 27.0 [14.2–36.2] y after donation), 39 experienced preeclampsia/eclampsia, 29 gHTN without preeclampsia, and 17 gDM. Median interval from donation to first pregnancy with preeclampsia was 5.1 (2.9–8.6) y; for gHTN, 3.7 (1.9–7.8) y; and for gDM, 7.3 (3.7–10.3) y. Preeclampsia/eclampsia (hazard ratio [HR] 2.70; 95% confidence interval [CI], 1.53-4.77) and gHTN (HR 2.39; 95% CI, 1.24-4.60) were associated with development of hypertension. Preeclampsia/eclampsia (HR 2.15; 95% CI, 1.11-4.16) and gDM (HR 5.60; 95% CI, 1.41-22.15) were associated with development of DM. Pregnancy-related complications were not associated with increased risk of cardiovascular disease or estimated glomerular filtration rate <45 mL/min/1.73 m2.

Conclusions.
In our single-center study, postdonation preeclampsia, gHTN, or gDM was associated with long-term risk of hypertension or DM.
Current advances in endovascular treatment
Authors: Molad Jeremy , Honig Asaf 
Published: February 2023

Purpose of review
Endovascular thrombectomy (EVT) is the most beneficial reperfusion therapy for acute ischemic stroke. Currently, much effort is done to promote trials examining EVT efficacy and safety in various conditions not included in the main randomized controlled trials established the superiority of EVT. This review summarizes the current advances of EVT patients’ selection and periprocedural management.

Recent findings
Recent evidence points to beneficial effect of EVT among patients with relatively large ischemic core, premorbid independent nonagenarians and basilar artery occlusion, and suggest that intravenous thrombolysis bridging treatment is associated with better reperfusion rates. Ongoing trials currently examine EVT efficacy and safety in distal vessel occlusions and in large vessel occlusion with low NIHSS. Current evidence also support use of general anaesthesia and avoid postprocedural extremely low or high blood pressure as well as haemodynamic instability.

Summary
The field of EVT is rapidly evolving. The results of recent trials have dramatically increased the indications for EVT, with many ongoing trials examining further indications.
Pharmacological treatment for older adults with epilepsy and comorbid neurodegenerative disorders
Authors: O’Dwyer Rebecca , Foster Emma , Leppik Ilo , Kwan Patrick 
Published: February 2023

Purpose of review
An increased interest in epilepsy in older adults has emerged as the global population ages. The purpose of this article is to review the literature regarding the pharmacological treatment of epilepsy in older adults, highlighting issues specifically pertinent to those living with comorbid neurodegenerative disorders.

Recent findings
Although new original research remains sparse, in the last 5 years, there has been a growing number of studies addressing the relationship between epilepsy and neurodegenerative disorders. Accurate diagnosis is incredibly challenging with electroencephalogram findings often requiring circumspect interpretation. Older individuals are often excluded from or under-represented in clinical trials, and there are sparse guidelines offered on the management of these patients, with even less available in reference to those with neurodegenerative comorbidities.

Summary
We propose that seizures occurring earlier in the neurodegenerative process should be treated aggressively, with the goal to inhibit neuro-excitotoxicity and the associated neuronal loss. By strategically choosing newer antiseizure medications with less adverse effects and a holistic approach to treatment, a patient's time living independently can be conserved. In addition, we advocate for original, multinational collaborative research efforts.
Lessons from the coronavirus disease 2019 pandemic in schizophrenia: a review
Authors: Fond Guillaume , Boyer Laurent 
Published: February 2023

Purpose of review
Multiple countries have reported increased COVID-19 mortality in patients with schizophrenia. The purpose of this review was to synthetize the consequences of the pandemic on patients with schizophrenia including vaccination data.

Recent findings
We have synthetized data on the increased risk of infection and increased mortality, the impact of the pandemic and lockdowns on psychiatric care, vaccination policies, unwillingness to vaccine in patients and the rates of vaccination.

Summary
Schizophrenia has been confirmed at increased risk of both COVID-19 infection and developing a severe/lethal form of the infection. Patients with schizophrenia should, therefore, be prioritized for vaccination whenever possible and should be prioritized for psychiatric and somatic care access. Psychotic symptomatology may be a barrier to vaccination in some patients, and heterogenous vaccination rates were identified in national databases. The COVID-19 pandemic has been also a unique opportunity to develop telehealth. A mixed face-to-face and distance model should be encouraged, whenever possible, to improve the experience of patients, relatives and healthcare professionals. No major change of long-acting antipsychotics has been reported in most countries, and there was no consistent evidence for clozapine prescription to increase the risk of COVID-19 infection or severe outcomes.
Is climate change affecting mental health of urban populations?
Authors: Cianconi Paolo , Hanife Batul , Hirsch Daniele , Janiri Luigi 
Published: February 2023

Purpose of reviewIn this article, we outline an up-to-date overview of the climate change impact on mental health of urban population, conducted by searching the PubMed database for relevant studies published in the past 12–18 months, in English.Recent findingsClimate change is part of a larger systemic ecological problem in which human demands are exceeding the regenerative capacity of the biosphere. We are witnessing a ‘climate chaos’, a phase of instability and transformation, which is leading humans into a psychological condition of ‘systemic insecurity’ and a shared feeling of uncertainty. Currently, one of the places where our species is particularly exposed to climate change are cities, due to build-up in urban infrastructure, rapid and chaotic urbanization, high densities and recent rapid growth, social inequality, and ‘heat island effect’.The impact of climate change on cities exposes vulnerable groups to the worse mental health consequences. These groups include the homelessness, slum dwellers for whom the ‘neighbourhood effects’ are being discussed, climate refugees and migrants, young people, and finally those who assist these people.SummaryIn order to realize broader mental health prevention in cities exposed to climate change phenomena, public health approaches are needed. Institutions must avoid reinforcing inequalities among the more vulnerable groups or create new inequalities.
Sex-dependent Clinical Presentation, Body Image, and Endocrine Status in Long-term Remitted Anorexia Nervosa
Authors: Schloesser Louisa , Lotter Leon D. , Offermann Jan , Borucki Katrin , Biemann Ronald , Seitz Jochen , Konrad Kerstin , Herpertz-Dahlmann Beate 
Published: February 2023

AbstractObjectiveAlthough anorexia nervosa (AN) in males has recently gained attention, knowledge of its psychological and physiological outcomes is still scarce. We explore sex-specific characteristics of long-term remitted AN with respect to residual eating disorder psychopathology, body image, and endocrinology.MethodWe recruited 33 patients with AN in remission for at least 18 months (24 women, 9 men) and 36 matched healthy controls (HCs). Eating disorder psychopathology and body image ideals were assessed via clinical interviews, questionnaires, and an interactive 3D body morphing tool. Plasma levels of leptin, free triiodothyronine, cortisol, and sex hormones were quantified. Univariate models controlled for age and weight were used to test for the effects of diagnosis and sex.ResultsBoth patient groups showed residual eating disorder psychopathology but normal weight and hormone levels relative to HCs. Male remitted patients demonstrated significantly stronger muscularity-focused body image ideals, evident in interviews, self-reports, and behavioural data, than both female patients and HCs.ConclusionsSex-specific body image characteristics in patients with remitted AN point towards the need to adjust test instruments and diagnostic criteria to male-specific psychopathology. In the future, sufficiently powered studies should evaluate the risk of men with AN developing muscle dysmorphia in the long term.HighlightsGender-specific residual symptoms have been identified in long-term remitted AN patients, particularly regarding body image disturbance.The drive for muscularity in male remitted patients suggest a possible risk of transition from male AN to muscle dysmorphic disorder.Gender-specific criteria, especially muscle-oriented behaviour, need to be included in the description of diagnoses and symptoms in male patients.
Circulating Extracellular Vesicles in Human Cardiorenal Syndrome Promote Renal Injury
Authors: Chatterjee Emeli , Rodosthenous Rodosthenis S. , Kujala Ville , Karalis Katia , Spanos Michail , Lehmann Helge Immo , de Oliveira Getulio Pereira , Shi Mingjian , Miller-Fleming Tyne W , Li Guoping , Gokulnath Priyanka , Ghiran Ionita Calin , Lindenfeld JoAnn , Mosley Jonathan D , Sheng Quanhu , Shah Ravi , Das Saumya 
Published: February 2023

AbstractBackgroundCardiorenal syndrome (CRS)—renal injury during heart failure (HF)—is linked to higher morbidity. Whether circulating extracellular vesicles (EVs) and their RNA cargo directly impact its pathogenesis remains unclear.MethodsUsing a microfluidic kidney chip model (KC), we investigated transcriptional effects of circulating EVs from patients with CRS on renal epithelial/endothelial cells. We used small RNA-seq on circulating EVs and regression to prioritize subsets of EV miRNAs associated with serum creatinine, a biomarker of renal function.In silicopathway analysis, human genetics, and interrogation of expression of miRNA target genes in the KC model and in a separate cohort of individuals post-renal transplant with microarray-based gene expression was performed for validation.ResultsRenal epithelial and endothelial cells in the KC model exhibited uptake of EVs. EVs from patients with CRS led to higher expression of renal injury markers (IL18,NGAL,KIM1) a greater cystatin C secretion relative to non-CRS EVs. Small RNA-seq and regression identified 15 miRNAs related to creatinine, targeting 1143 gene targets specifying pathways relevant to renal injury, including TGF-b and AMPK signaling. We observed directionally consistent changes in expression of TGF-b pathway members (BMP6, FST, TIMP3) in KC model exposed to CRS EVs, as well as in renal tissue after transplant rejection. Mendelian randomization suggested a role for FST in renal function.ConclusionEVs from patients with CRS directly elicit adverse transcriptional and phenotypic responses in a KC model by regulating biologically relevant pathways, suggesting a novel role for EVs in CRS.Trial RegistrationClinicalTrials.govNCT 03345446.FundingAHA (SFRN16SFRN31280008), NHLBI (1R35HL150807-01) and NCATS (UH3 TR002878).
Impact of intraoperative use of venovenous extracorporeal membrane oxygenation on the status of von Willebrand factor large multimers during single lung transplantation
Authors: Oishi Hisashi , Okada Yoshinori , Suzuki Yamato , Hirama Takashi , Ejima Yutaka , Fujimaki Shin-ichi , Sugawara Shingo , Okubo Noriyuki , Horiuchi Hisanori 
Published: February 2023

AbstractPurposevon Willebrand factors (vWFs), hemostatic factors, are produced as large multimers and are shear stress-dependently cleaved to become the appropriate size. A reduction in vWF large multimers develops in various conditions including the use of extracorporeal life support, which can cause excessive-high shear stress in the blood flow and result in hemostatic disorders. The objective of this prospective study was to investigate the impact of venovenous extracorporeal membrane oxygenation (VV ECMO) use on the status of vWF large multimers and hemostatic disorders during single lung transplantation (SLT).MethodsWe prospectively enrolled 12 patients who underwent SLT at our center. Among them, seven patients were supported by VV ECMO intraoperatively (ECMO group) and the remaining five patients underwent SLT without ECMO support (control group). The vWF large multimer index (%) was defined as the ratio of the large multimer proportion in total vWF (vWF large multimer ratio) derived from a patient’s plasma to that from the standard human plasma.ResultsThe vWF large multimer index at the end of the surgery was significantly lower in the ECMO group than in the control group (112.6% vs. 75.8%, respectively;p< 0.05). The intraoperative blood loss and the amounts of intraoperative transfusion products in the ECMO group tended to be greater than those in the control group; however, the differences were not significant.ConclusionDuring SLT, the intraoperative use of VV ECMO caused a decrease in the vWF large multimer index. However, the vWF large multimer index was maintained at > 75% in average at the end of SLT, which did not affect the bleeding complications.
Resilience and social support improve mental health and quality of life in patients with post-COVID-19 syndrome
Authors: Galanis Petros , Katsiroumpa Aglaia , Vraka Irene , Kosiara Katerina , Siskou Olga , Konstantakopoulou Olympia , Katsoulas Theodoros , Gallos Parisis , Kaitelidou Daphne 
Published: February 2023

AbstractThe effects of post-COVID-19 syndrome on patients’ life are significant. As there is no prior study available, we investigated the impact of resilience and social support on anxiety, depression, and quality of life among patients with post-COVID-19 syndrome. We conducted a cross-sectional study with a convenience sample. The measures included demographic and clinical characteristics of patients, the Brief Resilience Scale, the Multidimensional Scale of Perceived Social Support, the Patient Health Questionnaire-4, and the EuroQol-5D-3L. Multivariable analysis identified that resilience and social support reduced anxiety and depression among our patients. Also, we found a significant positive relationship between resilience and social support, and quality of life. In conclusion, our findings suggest that resilience and social support can be protective by reducing anxiety and depression, and improving quality of life among patients with post-COVID-19 syndrome. Policy makers should develop and implement healthcare management programs to provide psychological support to these patients.