bluuebunny/crossref_metadata_2025_split huggingface dataset:
Multisystem Inflammatory Syndrome in Children Presenting as Acute Appendicitis
Authors: Saritas Nakip Ozlem , Kesici Selman , Talay Mehmet Nur , Kangin Murat , Bayrakci Benan 
Published: December 2022

Background
The majority of multisystemic inflammatory syndrome in children (MIS-C) patients presented with gastrointestinal symptoms. To draw attention to association of MIS-C and acute appendicitis, we reported a number of patients presented with localized symptoms as appendicitis but later diagnosed as MIS-C. The main goal of this study was to point out that localized presentation of MIS-C, and the secondary outcome was to compare 2 different treatment modalities of MIS-C.

Methods
The patients admitted to intensive care units of 2 tertiary hospitals, with diagnosis of MIS-C and accompanying clinically or radiologically suspected or confirmed appendicitis, were included. Data were retrospectively analyzed. The patients were examined in 2 groups as intravenous immunoglobulin (IVIG)-only and combined therapy. The combined therapy was defined as at least 2 immunomodulatory treatments of which included IVIG, steroid, Anakinra, and plasmapheresis.

Results
Between June 2020 and December 2020, 9 patients were enrolled in the study. The mean age was 8.7 ± 3.4 years. All patients had delayed diagnosis because of investigations focusing on abdominal pathologies such as appendicitis. Four patients had typical ultrasonographic findings of appendicitis and 2 were complicated with perforation. All patients had cardiovascular compromise accompanying at least 1 more organ dysfunction. In the IVIG only group, the median lymphocyte count was 480 cells/mm3 and the median levels of ferritin, C-reactive protein (CRP), procalcitonin, and interleukin 6 were 955 pg/mL, 17.4 mg/dL, 33.9 ng/mL, and 136.3 pg/mL, respectively. In the combined therapy group, the median lymphocyte count was 1200 cells/mm3 and the median levels of ferritin, CRP, procalcitonin, and interleukin 6 were 1650 pg/mL, 28 mg/dL, 47.8 ng/mL, and 56.7 pg/mL, respectively. The median pediatric risk of mortality 3 and pediatric logistic organ dysfunction scores of the combined therapy group were higher than IVIG-only group. The IVIG-only patients were more lymphopenic at presentation (P = 0.014), while ferritin, CRP, and procalcitonin levels of combined therapy group were higher than IVIG-only group (P = 0.376, P = 0.181, and P = 0.346, respectively). The mean length of stay in pediatric intensive care unit of combined therapy group was shorter than IVIG-only group.

Conclusions
Multisystemic inflammatory syndrome in children should be kept in mind in the differential diagnosis of patients with localized gastrointestinal symptoms, such as acute appendicitis. Early diagnosis and proper treatment of MIS-C may have a critical role in the patient's outcome.
Circulation of SARS-CoV-2 Among Asylum Seekers: A Real-Life Experience to Address Health Equity in Piacenza, Italy
Authors: Colpani Agnese , Donisi Alessandra , De Vito Andrea , Zauli Beatrice , Fanelli Chiara , Fiore Vito , Babudieri Sergio , Madeddu Giordano 
Published: December 2022

Aim of the Study
We aimed to evaluate the virus spreading among a migrant population previously excluded by community surveillance programs.

Methods
We conducted a retrospective study, collecting data about people without SARS-CoV-2–related symptoms who attended the outpatient clinic for undocumented migrants from November 1, 2020, to April 30, 2021. Patients who performed a nasopharyngeal swab and serologic test to evaluate the presence of antibody anti–SARS-CoV-2 were enrolled.

Results
Overall, 240 people were included in our study. Of them, 15 (6.3%) were female, with a median age of 27.0 years (interquartile range [IQR], 24.3–32.1 years). Thirty-seven patients (15.4%) tested positive for SARS-CoV-2 at the nasopharyngeal swab during the study period. Of these, 16 had positive or low positive results for immunoglobulin G (IgG) and 3 tested positive for both IgG and IgM. Besides, 22 participants (9.2%) resulted positive to serological testing, but negative to polymerase chain reaction testing.
The median age of SARS-CoV-2 positive patients (n = 59) was significantly higher than negative (29.6 [IQR, 25.0–35.0] vs 26.8 [IQR, 24.2–31.5], P = 0.022). Among positive patients, the most frequent nationality was Bangladeshi, with 24 people (40.7%, P < 0.001). The highest percentage of positive was found among the same nationality (51.1% of Bangladeshi tested positive).

Conclusions
Our data underline the significantly higher prevalence of SARS-CoV-2 infection in the undocumented migrant population in respect of the general population of Piacenza province in the same period (15.4% vs 5.9%, P < 0.001). The extension of surveillance programs to the whole population, thus including undocumented people, is crucial to curb the spreading of the virus.
Does COVID-19 Vaccine Impact the Soul? A Pre-post Vaccination Comparison of Health Care Workers’ Infection Control Practices and Perspectives
Authors: Khalid Imran , Akhtar Muhammad Ali , Imran Manahil , Imran Maryam , Mujalli Musaab Ahmed , Qashqari Moayad Sami , Alshukairi Abeer N , Nisar Amina , Khalid Tabindeh Jabeen 
Published: December 2022

Background
It is unclear how COVID-19 vaccines have impacted the behavioral and physical infection control practices of health care workers (HCWs), both in the hospital and community. We conducted our study to explore this issue.

Methods
A comprehensive survey of 4 sections and 40 questions was administered to 146 HCWs 6 months apart, before and after COVID-19 vaccination. Besides demographics, the 4 sections evaluated the “behavioral” and “physical” infection control practices of HCWs in the hospital, infection control precautions in the community and their emotional stress. Each question was scored on a 4-point scale from 0 to 3.

Results
One hundred four of the HCWs (71%) completed both surveys. Respondents were mostly female, middle-aged nurses. Only 21% were confident that vaccine would prevent them from hospitalization or death. Despite some statistical improvement in some of the perspectives and practices, the intensity scores remained moderate-to-high for majority of the questions after vaccination. The HCWs remained worried about contracting COVID-19 infection in hospital and community, continued zealous precautionary measures, maintained social distancing both inside and outside of the hospital, avoided touching surfaces, and minimized contact with COVID-19 patients (P ≥ 0.08). Their emotional stress also did not improve after vaccination (P > 0.24).

Conclusions
COVID-19 vaccines have only a modest impact on the physical and behavioral infection control practices and emotional stress of HCWs. Additional measures are needed to influence HCW “souls” so they can reclaim their life of normalcy.
Extrapulmonary Pneumocystis jirovecii Infection in an Immunocompromised Patient With Concomitant Cytomegalovirus Reactivation: A Case Report and Literature Review
Authors: Fabiani Silvia , Amadori Francesco , Tiseo Giusy , Del Bono Laura , Moneta Sara , Pisano Roberta , Borrelli Valerio , Guadagni Simone , Ciancia Eugenio Mario , Ferranti Simone , Falcone Marco 
Published: December 2022

Abstract

Pneumocystis jirovecii is commonly associated with a potentially fatal pneumonia in acquired immune deficiency syndrome patients, but its spread outside lungs is uncommon and poses a diagnostic challenge. Clinical awareness is therefore needed to start promptly adequate therapy.
In this review, we report the case of an acquired immune deficiency syndrome patient with rapidly progressive disseminated pneumocystosis and subsequently analyze 189 other cases of extrapulmonary pneumocystosis described in literature.
The most common extrapulmonary sites of Pneumocystosis jirovecii infection were spleen, lymph nodes, liver, kidneys, and eyes; clinical manifestations, which may occur either with or without lung involvement, ranged from asymptomatic incidental findings to a multifaceted disease with multisystem involvement.
Human immunodeficiency virus (HIV) infection was documented in the majority of cases (91.6%), and concurrent or subsequent immunodeficiency-related conditions other than Pneumocystosis jirovecii were reported in 63.4% of patients, with cytomegalovirus (CMV) infection as the most common.
In conclusion, disseminated pneumocystosis is a rare, little-known, but life-threatening opportunistic infection that must be taken into account, together with other immunodeficiency-related conditions such as Cytomegalovirus infection, to draw up an adequate diagnostic algorithm, establish a timely diagnosis, and ensure proper treatment.
Hospitalizations for or Complicated by Syphilis at an Urban, Single-Institution Center
Authors: Hunt Travis J. , DePaola Rosalie V. , Ferranti Mary E. , Ahmed Maliha , Weber Devin M. 
Published: December 2022

Background
In recent years, the number of cases of syphilis has been increasing at both local and global levels. In this study, we sought to profile how this increase in cases has translated to the inpatient setting by examining inpatient admissions due to or complicated by syphilis at any stage.

Methods
At a single-center, multisite health institution, charts for patients older than 18 years admitted between April 2017 and October 2020 with a diagnosis of syphilis were reviewed. Cases were characterized into stages of primary, secondary, latent, tertiary, and neuro/ocular syphilis, with all neuro/ocular cases categorized together despite the potential for neuro/ocular syphilis at any stage. Medical history, laboratory data, hospital course, and treatment outcomes were recorded.

Results
Eighty-one charts met inclusion, with a mean age of 49 years. Seventy-two percent were cisgender men, 42% were documented as men who have sex with men, and 49% were of Black race. Thirty-three percent had been previously diagnosed with syphilis, and 70% of that group had previously received treatment. Forty-one percent were HIV+. Fifty-one percent were cases of neurosyphilis, and 42% were latent. The mean LOS was 10 days, with 11% readmitted within 30 days.

Conclusions
These results formulate a profile for the outlook and course of hospitalizations for or complicated by syphilis in an urban setting. In light of these findings, and given the rising incidence of syphilis in the world, opportunities for further investigation into prevention, impact, and outcome quality are more necessary than ever.
Assessing the Efficacy of Telemedicine in High-Risk Populations by Evaluating Emergency Department Visits and Hospitalizations
Authors: Pappan Nikos , Austin Scarlett , Bosah Arinze , Wedgeworth Patrick , Venkat Divya 
Published: December 2022

Introduction
Advances in telemedicine have allowed physicians to provide quality care to high-risk patients with multiple comorbidities who would otherwise be unable to attend an in-person visit. Barriers to the routine use of telemedicine include access to the appropriate devices and understanding how to use applications or software. We hypothesize that patients who were contacted and seen via telemedicine did not have more emergency department visits or hospitalizations compared with patients who had office visits.

Methods
We conducted an observational quality improvement study with retrospective administrative data collection and analysis. This study took place in an inner-city internal medicine residency primary care clinic. The patient population was defined as those patients 65 years and older with predetermined chronic medical conditions or patients younger than 65 years with chronic health conditions who had not yet had an office, telephone, or video visit within 6 months of March 23, 2020.

Results
A total of 1340 high-risk individuals were considered for analysis. There were a total of 441 emergency department visits and 254 inpatient hospital admissions within this group. We did not detect a statistically significant difference between emergency department visits or inpatient hospital admissions between telephone, video, or office visits.

Conclusions
Providing patients with an alternative to an in-office visit may prevent exposures to high-risk patients during the pandemic and provide alternative healthcare access to patients who may struggle with attending their primary care in-office visits.
Genetic Sequencing of Breakthrough Severe Acute Respiratory Syndrome Coronavirus 2 Infections in Fully Vaccinated Healthcare Workers
Authors: Haddad Sara , Zurlo John , Wang Zi-Xuan , Richards Bonnie , Badjatia Nitika , Coppock Dagan 
Published: December 2022

Abstract

Introduction
Since the identification of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), several efforts have been made to prevent infection, culminating in the development of highly effective vaccines. However, as genetic variants of the virus have emerged, concerns have arisen regarding potential limitations of available vaccines.

Methods
In this article, we evaluated SARS-CoV-2 breakthrough infections among 520 healthcare workers in a 950-bed hospital from March 1, 2021, to October 31, 2021, and stratified them according to the type of vaccine received. We tested for associations between Alpha and Delta strains of SARS-CoV-2 and clinical characteristics.

Results
During the study period, only 0.85% of the patients with breakthrough infection vaccinated with messenger RNA (mRNA)-1273 required hospitalization, whereas none of patients vaccinated with BNT162b2 required admission. No association was noted between the variant isolated and the type of vaccination (P = 0.474). The cycle threshold was significantly lower for Delta strain infections compared with Alpha strain infections (P = 0.0144 for gene N1 and P = 0.0271 for gene N2), reflecting a significantly higher viral burden at the time of diagnosis of Delta strain infection. We observed that, at the time of diagnosis, almost all vaccinated patients had developed antispike antibodies, whereas slightly more than half had anti-N antibodies.

Discussion
We noted that vaccination remains an important preventive measure to protect patients from severe SARS-CoV-2 infection. The mRNA-1273 and BNT162b2 mRNA vaccines seem equally effective in minimizing the severity of breakthrough infections. Serologic patterns suggest that antispike antibodies may be more critical for protection than antinucleocapsid antibodies.
Adenovirus Enterocolitis in Hematopoietic Stem Cell Transplant Patients
Authors: LeMay Daniel , Handley Guy , Baluch Aliyah , Greene John N. 
Published: December 2022

Abstract
Adenovirus is a major pathogen implicated in infections among the immunocompromised, particularly patients who have undergone hematopoietic stem cell transplantation (HSCT). These infections may be life-threatening in patients with altered immune status, and recognition of the presence of adenovirus is crucial for patient management. Adenoviruses can infect many organ systems common to other pathogens and may even present similarly to noninfectious causes of disease in immunosuppressed groups, such as graft-versus-host disease. Understanding the prevalence, risk factors, presentations, diagnostic methods, and treatment options for adenovirus should guide clinicians toward recognition and, when necessary, treatment. In this article, we will review the literature on adenovirus infections with an emphasis on gastrointestinal infections in the setting of HSCT, as well as present 2 cases seen at our cancer center.
Intussception in Patients With Leukemia
Authors: Senapati Sidhartha Gautam , Greene John N. 
Published: December 2022

Abstract
Intussusception is a very rare complication of typhlitis in the setting of neutropenia. We present a case of intussception with typhlitis, associated with extended-spectrum β-lactamase Escherichia coli bacteremia in the setting of neutropenia in a patient with acute leukemia. The causative organisms, infectious pathogenesis, complications of neutropenic enterocolitis, and different diagnostic modalities for investigating one of its rare complications, intussusception, is emphasized in the case study.
Nurse Students' Knowledge and Skills in Respiratory Care During COVD-19 Pandemic
Authors: Benedetti Tiziana , Gasperini Beatrice , Sarti Donatella , Saudelli Sara , Silvestrini Antonella , Nicoletti Stefania , Riminucci Franca , Cesaretti Matteo , Prospero Emilia 
Published: December 2022

Abstract

Background
SARS-CoV-2 pandemic forced final-year nurse students to start working to reinforce the healthcare system in caring of COVID-19 patients.

Methods
This study aimed to assess the self-perception of third-year nurse students about the knowledge and skills acquired during their study course that were most useful for them when working with COVID-19 patients and which were the topics that they would improve, before and after they started to work. An online questionnaire was administered to third-year nurse students of nursing degree course, Polytechnic University of Marche, in March 2020. The questionnaire was sent again after they started to work, in May 2020. Pareto charts were used to prioritize the main useful knowledge and skills acquired and needed topics that they would improve when they were students and workers.

Results
Response rate was 100% in March and 70.8% in May. Nurses showed more interest in improving their basic knowledge on personal protective equipment management and disposal when they were students, whereas they were more interested in COVID-19 patient's management, in particular, in respiratory care (ventilation techniques, emergencies management, rhinopharyngeal swab execution, and pneumology) after they started to work.

Conclusions
The self-perception of the most useful knowledge and skills and the educational needs changed significantly after starting to work for nurse students. The nurse curriculum should take in account the weaknesses in education as perceived from students and workers.
Case Series: Avoidable Blindness after Inappropriate Ophthalmic Self-medication in Ghana
Authors: Aboagye-MacCarthy Asantewaa , Abraham Carl Halladay 
Published: December 2022

SIGNIFICANCE
Inappropriate ophthalmic self-medication continues to plague Sub-Saharan Africa because of lack of public health education and inaccessibility to eye care services. This case series describes three cases of blindness (two monocular, one binocular) in Ghana, because of self-treatment of ocular conditions using improper drugs or homemade herbal mixtures. The article highlights the consequences of misinterpretation of symptoms and use of traditional home remedies, leading to delayed professional eye care and avoidable blindness.

PURPOSE
This case series aims to report three separate cases of avoidable blindness after inappropriate ophthalmic self-medication to draw attention to the need for intense public health education in Ghana.

CASE REPORTS
Three men aged 25, 79, and 35 years, respectively, reported severe reduction in visual acuity in one eye for two cases and both eyes for one case. All patients reported ophthalmic self-medication either with an inappropriate drug bought from the drug store or a homemade herbal mixture made from leaves assumed to treat eye infections. Professional care did not yield any improvement in visual acuity because their corneas were already decompensated at the onset of management. The eye of one patient had to be enucleated.

CONCLUSIONS
These cases highlight the importance of eye health promotion and education. It is recommended that intense sensitization is carried out at all levels.
Anemia and Erythrocyte Indices Are Associated With Neurocognitive Performance Across Multiple Ability Domains in Adults With HIV
Authors: Okwuegbuna Oluwakemi K. , Kaur Harpreet , Jennifer Iudicello , Bush William S. , Bharti Ajay , Umlauf Anya , Ellis Ronald J. , Franklin Donald R. , Heaton Robert K. , McCutchan J. Allen , Kallianpur Asha R. , Letendre Scott L. 
Published: December 2022

Background:
Anemia is linked to neurocognitive impairment (NCI) in people with HIV (PWH), but its impact within specific ability domains, and in diverse populations with HIV, is uncertain.

Methods:
Participants included 1339 PWH enrolled in observational HIV cohort studies with a mean of 3 comprehensive neurocognitive assessments over 30 months. Global and domain-specific neurocognitive function were assessed by the global deficit score and domain deficit score (GDS and DDS, respectively) or as GDS-defined or DDS-defined NCI (GDS ≥ 0.5, DDS > 0.5). Time-dependent associations of anemia or red-cell indices with neurocognitive function were evaluated by multivariable regression.

Results:
The mean age at entry was 43.6 years (85% male, 23.9% Hispanic, 16.7% African ancestry by self-report, and 69.8% virally suppressed). Anemia occurred at entry in 297 (22.2%) and developed subsequently in another 129 (9.6%). Anemia (present in 26.8% of cognitively impaired PWH at entry) and lower hemoglobin were associated with higher (worse) GDS values; the association for anemia persisted after multivariable adjustment and in virally suppressed persons (P < 0.0001). Anemia was also associated with reduced processing speed, motor function, learning, delayed recall, working memory (all P < 0.01), executive function (P = 0.021), and verbal fluency (P = 0.035), and these findings persisted in longitudinal analyses (adjusted P < 0.01 for all domains, except verbal fluency). Higher mean corpuscular volume and mean corpuscular hemoglobin were associated with less impairment in learning and recall (all P < 0.05).

Conclusions:
Anemia in diverse and virally suppressed PWH associates with reduced neurocognitive performance in multiple domains, cross-sectionally and over time. The impact of identifying and treating anemia to prevent or slow neurocognitive decline in PWH should be prospectively evaluated.
Order of Occurrence of COVID-19 Symptoms
Authors: Wojtusiak Janusz , Bagais Wejdan , Vang Jee , Roess Amira , Alemi Farrokh 
Published: December 2022

Background and Objectives:
COVID-19 symptoms change after onset—some show early, others later. This article examines whether the order of occurrence of symptoms can improve diagnosis of COVID-19 before test results are available.

Methods:
In total, 483 individuals who completed a COVID-19 test were recruited through Listservs. Participants then completed an online survey regarding their symptoms and test results. The order of symptoms was set according to (a) whether the participant had a “history of the symptom” due to a prior condition; and (b) whether the symptom “occurred first,” or prior to, other symptoms of COVID-19. Two LASSO (Least Absolute Shrinkage and Selection Operator) regression models were developed. The first model, referred to as “time-invariant,” used demographics and symptoms but not the order of symptom occurrence. The second model, referred to as “time-sensitive,” used the same data set but included the order of symptom occurrence.

Results:
The average cross-validated area under the receiver operating characteristic (AROC) curve for the time-invariant model was 0.784. The time-sensitive model had an AROC curve of 0.799. The difference between the 2 accuracy levels was statistically significant (α < .05).

Conclusion:
The order of symptom occurrence made a statistically significant, but small, improvement in the accuracy of the diagnosis of COVID-19.