bluuebunny/crossref_metadata_2025_split huggingface dataset:
P061 Polymyalgia rheumatica following COVID-19 vaccination: presentation of four patients
Authors: Mohareb Marwa , Bharadwaj Anurag , Nandagudi Anupama 
Published: April 2022

Abstract

Background/Aims
Vaccination against coronavirus is a cornerstone in the fight against the COVID-19 pandemic. Although the safety and efficacy of vaccines was established prior to roll out, long-term data and reports of rare adverse reactions remain inadequate. Literature reviews revealed two cases of PMR-like syndrome, left elbow arthritis and a case of rheumatoid arthritis (RA) flare following COVID-19 vaccination. Additionally, a case of new onset RA and case of reactive arthritis was reported with COVID infection.

Methods
We present four patients with polymyalgia rheumatica (PMR) following COVID-19 vaccination. The clinical details of the four patients are outlined in the table:
Ultrasound (US) revealed typical finding of bilateral sub deltoid bursitis and biceps tendonitis in the first patient and there was severe right sub deltoid bursitis with biceps tendonitis in the second patient. None of the patients had features to suggest malignancy, giant cell arteritis, seronegative spondyloarthropathies or connective tissue disease.

Results
After exclusion of other inflammatory causes of shoulder pain, they were diagnosed with PMR based on clinical judgement and high inflammatory marker at time of presentations, ultrasound findings and significant improvement with prednisolone.

Conclusion
PMR following COVID-19 vaccination is exceptional and cannot be proven. In these patients post vaccination chronology of events favours this diagnosis. It is known that immunological illness may start after viral infection or vaccination (hapten or immune stimulation). The patients have responded well to the prednisolone similar to typical PMR cases. We need further studies to look at possible link between COVID-19 vaccination and PMR.

Disclosure
M. Mohareb: None. A. Bharadwaj: None. A. Nandagudi: None.
P188 Baricitinib effectiveness after a previous inadequate response to an alternative JAK inhibitor: results from the Swiss rheumatoid arthritis register
Authors: Gilbert Benoît T. P , Courvoisier Delphine S , Mongin Denis , Lauper Kim , Guimaraes Vanessa A , Mueller Ruediger B , Finckh Axel 
Published: April 2022

Abstract

Background/Aims
Previous research has suggested that switching between b/tsDMARDs with different mode of action may be more effective than switching agents within the same mechanism of action. Limited data exists about the impact of an inadequate response to a previous JAK-inhibitor (JAKi) on subsequent JAKi effectiveness.

Methods
This is a nested study within the Swiss Clinical Quality Management (SCQM) registry of RA patients. All patients initiating baricitinib treatment courses (BARI) between 01-09-2017 and 01-06-2020, with at least one follow-up visit, were included. We compared the time to treatment discontinuation, as a measure of drug effectiveness, of BARI with a previous history of an inadequate response (IR) to tofacitinib (“BARI-post-TOFA”) or without (“BARI-initial”). Tofacitinib IR was defined as previous tofacitinib treatment discontinuation for adverse events or for ineffectiveness. Baseline characteristics were compared using t-tests or χ2. We used Kaplan-Meier curve to display crude time to discontinuation and a Cox model to estimate adjusted hazard ratio (HR). Cox model was adjusted for potential confounding factors: age, BMI, concomitant csDMARD, concomitant steroid usage, baseline CDAI, disease duration, smoking status, line of therapy, gender and seropositivity to RF/ACPA.

Results
Of the 273 included BARI, 72 were initiated in patients with a history of a previous tofacitinib IR (Table 1). No differences were found between the “BARI-post-TOFA” and the “BARI-initial” groups in terms of time-to-discontinuation, as demonstrated by both the unadjusted Kaplan-Meier survival analysis (Log-rank p = 0.44) and the fully adjusted Cox analysis (Hazard Ratio BARI-post-TOFA vs BARI-initial = 0.76 (95% IC [0.42 - 1.34]; p = 0.34). Other covariates significantly associated with drug maintenance were active smoking (p = 0.03) and CDAI score (p &lt; 0.01).

Conclusion
In this preliminary analysis, a history of prior tofacitinib IR did not appear to significantly impact subsequent drug maintenance of baricitinib.

Disclosure
B.T.P. Gilbert: Other; Invited speaker for Lilly Symposium SGR Congress Lausanne (2021). D.S. Courvoisier: None. D. Mongin: None. K. Lauper: None. V.A. Guimaraes: Other; Clinical Research Scientist Immunology at Eli Lilly (Suisse) S.A. R.B. Mueller: None. A. Finckh: Grants/research support; Invited speaker and consultant for Eli Lilly. Has received research grant from Eli Lilly.
Between Aspirations and Law: Protection Consciousness among Congolese Forced Migrants in Rabat
Authors: Wissing Ruben 
Published: April 2022

Abstract
This article analyses forced migrants’ perceptions of “protection”, coined here as “protection consciousness”. The article is built around the voices and lived experiences of Congolese forced migrants in the Moroccan capital and asks: which aspirations mobilise them?; what does “protection” mean for them?; and do they find it in the law, or elsewhere? Fieldwork data was obtained through observations and 15 interviews with Congolese migrants with self-assessed protection needs in Rabat in 2019. A socio-legal analysis of the data leads to three main findings. First, once they are in Morocco, Congolese forced migrants aspire material subsistence and work rather than “protection”, and do so irrespective of the original reason that forced them to leave the DRC. Second, they understand and experience “protection” not as a strictly legal concept, but as physical safety, freedom of movement and spiritual and religious comfort. Third, they feel alienated from State law, conceive it as protection-inhibiting rather than protection-enhancing, and prefer to rely on more informal normative and social orders instead.
E-Cigarette (E-Cig) Liquid Composition and Operational Voltage Define the In Vitro Toxicity of Δ8Tetrahydrocannabinol/Vitamin E Acetate (Δ8THC/VEA) E-Cig Aerosols
Authors: Marrocco Antonella , Singh Dilpreet , Christiani David C , Demokritou Philip 
Published: April 2022

Abstract
The 2019 United States outbreak of E-cigarette (e-cig), or Vaping, Associated Acute Lung Injury (EVALI) has been linked to presence of vitamin E acetate (VEA) in Δ8tetrahydrocannabinol (Δ8THC)-containing e-liquids, as supported by VEA detection in patient biological samples. However, the pathogenesis of EVALI and the complex physicochemical properties of e-cig emissions remain unclear, raising concerns on health risks of vaping. This study investigates the effect of Δ8THC/VEA e-liquids and e-cig operational voltage on in vitro toxicity of e-cig aerosols. A novel E-cigExposure Generation System platform was used to generate and characterize e-cig aerosols from a panel of Δ8THC/VEA or nicotine-based e-liquids at 3.7 or 5 V. Human lung Calu-3 cells and THP-1 monocytes were exposed to cell culture media conditioned with collected e-cig aerosol condensate at doses of 85 and 257 puffs/m2 lung surface for 24 h, whereafter specific toxicological endpoints were assessed (including cytotoxicity, metabolic activity, reactive oxygen species generation, apoptosis, and inflammatory cytokines). Higher concentrations of gaseous volatile organic compounds were emitted from Δ8THC/VEA compared with nicotine-based e-liquids, especially at 5 V. Emitted PM2.5 concentrations in aerosol were higher for Δ8THC/VEA at 5 V and averagely for nicotine-based e-liquids at 3.7 V. Overall, aerosols from nicotine-based e-liquids showed higher bioactivity than Δ8THC/VEA aerosols in THP-1 cells, with no apparent differences in Calu-3 cells. Importantly, presence of VEA in Δ8THC and menthol flavoring in nicotine-based e-liquids increased cytotoxicity of aerosols across both cell lines, especially at 5 V. This study systematically investigates the physicochemical and toxicological properties of a model of Δ8THC/VEA and nicotine e-cigarette condensate exposure demonstrating that pyrolysis of these mixtures can generate hazardous toxicants whose synergistic actions potentially drive acute lung injury upon inhalation.
Two-stage Radiofrequency-assisted Lipoabdominoplasty
Authors: Stein Michael J. , Theodorou Spero , Chia Christopher T. 
Published: April 2022

Summary:
Decades of lipoabdominoplasty safety, reliability, and efficacy have permitted more aggressive contouring of the abdominoplasty flap without increased risk for wound healing complications. However, the recent introduction of unrestricted liposuction of all vascular zones and high-definition liposculpting continue to challenge the vascularity of the abdominoplasty flap, particularly in high-risk patients. The present study reviews the authors' approach to abdominal lipodystrophy, and introduces a technique which maximizes fat extraction and skin excision while reducing risk of complication (two-stage radiofrequency-assisted liposuction and abdominoplasty).
The Management of Postsurgical Pyoderma Gangrenosum following Breast Surgery
Authors: Edinger Kylie M. , Rao Venkat K. 
Published: April 2022

Background:
Postsurgical pyoderma gangrenosum is a rare condition characterized by ulcerative lesion development at surgical sites. It is frequently misdiagnosed as infection and mismanaged with surgical debridement, which only worsens the condition. Achieving the correct diagnosis is crucial to delivering the appropriate medical therapy. This article presents four clinical cases of postsurgical pyoderma gangrenosum in breast surgery patients, and proposes a work-up schematic to aid in its diagnosis based on literature review and author experience.

Methods:
Four patients who developed postsurgical pyoderma gangrenosum following breast surgery were identified by chart review at our institution.

Results:
The cases include two breast reduction patients, an abdominally based breast reconstruction patient, and a breast augmentation patient. The time to diagnosis and treatment varied greatly between the patients, with diagnosis achieved as early as 13 days postoperatively to as late as one year postoperatively. Two of the four patients were initially mismanaged with surgical debridement, and all patients were treated with at least one course of antibiotics for a misdiagnosis of surgical site infection before they were correctly diagnosed.

Conclusions:
Postsurgical pyoderma gangrenosum is a rare, ulcerative condition that is difficult to diagnose and often mismanaged with surgical debridement. Diagnosis requires a high clinical suspicion and should be considered in patients with ulcerative lesions resistant to antibiotic therapy, in patients who have bilateral lesions with NAC sparring, and in those with systemic inflammatory conditions. Diagnosis is usually delayed, so it is imperative that surgeons keep this diagnosis in mind when treating breast patients with postsurgical wounds.
Midline Mandibular Cleft Repair: A Case Report
Authors: Ismaiel Wael Fawzy , Abdelazim Mohamed Hussein , Younes Ahmed , Hadeya Abdelgawad M. , Amin Mahmoud Ahmed 
Published: April 2022

Summary:
Midline clefts of the lower lip and mandible are extremely uncommon. Couronne reported the first case in 1819, and fewer than 80 cases have been discovered in the literature to date. This case report describes a female infant who was born having a full midline cleft of the mandible and lower lip, as well as neck flexion contracture that extended from the lower lip to the manubrium sterni. A fenestrated type of acrylic splint was applied over the mandibular arch and fixed by circum-mandibular wiring. Fixation was done using a 0.5 interosseous wire passing through the prepared hole and tightened over a previously harvested rib bone graft.
The COVID-19 Pandemic Consequences on Microsurgical Reconstructions: A Single Center’s Shift of Indications
Authors: Zindrou Darco , Halle Martin , Jakobsson Stina 
Published: April 2022

Background:
Since its outbreak, the COVID-19-pandemic has had a tremendous impact on healthcare systems worldwide. We conducted a comparative study to analyze the pandemic’s consequence on microsurgical reconstructions at a reconstructive plastic surgery center in Sweden.

Method:
All free flaps performed at a single center between March 2019 and 2021 were analyzed. The patient cohort was divided into two groups, with a period of 1 year in each group: non-COVID-19 year and COVID-19 year. The periods were compared regarding the number and type of surgeries and patient characteristics.

Results:
In the year prior to the pandemic, 123 free flap surgeries were performed, compared with 103 surgeries during the COVID-19 year. There was a significant shift in the most common site for free flap reconstruction: from the breast [which decreased by 42% (66–38)] to head and neck [which increased by 22% (41–50); OR 0.53 (P = 0.02)]. This was also reflected by a significant increase in hospital stay for free flap patients during the COVID-19 year (P = 0.02).

Conclusions:
During the COVID-19 pandemic, a shift was seen from breast reconstructions toward head and neck reconstructions as the most common free flap procedure performed. An increasing backlog of elective breast reconstructions demands increased resources and tougher priorities, which challenge the healthcare system in the post-COVID-19 era.
Changes in Adenoma Detection Rate From Full-Spectrum Endoscopy to Standard Forward-Viewing Endoscopy
Authors: Chang Tyler L. , Lewis Blair , Deutsch Netanel , Nulsen Benjamin 
Published: April 2022

Goals:
The aim was to investigate the adenoma detection rate (ADR) of endoscopists who have used full-spectrum endoscopy (Fuse) for 3 years and revert back to traditional forward-viewing endoscopes (R-TFV) at an ambulatory surgical center.

Background:
Traditional forward viewing (TFV) endoscopes have 1 camera and provide an angle of view of 140 to 170 degrees, whereas Fuse provides a 330 degrees view through the addition of 2 side cameras. It has previously been reported that Fuse increased the ADR by 5.4% when compared with previous rates using TFV. Fuse is no longer commercially available. The ADR of endoscopists who revert back to TFV is unknown.

Study:
We conducted a retrospective analysis of data examining the ADR from average risk screening colonoscopies at a 5-room ambulatory surgical center where endoscopists transitioned from TFV to Fuse in April 2014 and then reverted back to TFV in 2016. The primary outcome was ADR. Secondary outcomes were ADR for advanced and right-sided adenomas.

Results:
A total of 6110 procedures were reviewed. The ADR was 23.70% for TFV, 29.02% for Fuse and 28.88% for R-TFV. The ADR for advanced adenomas was 3.8% for TFV, 6.0% for Fuse and 7.3% for R-TFV. The ADR for right-sided adenomas was 13.0% for TFV, 16.7% for Fuse and 16.0% for R-TFV. The results for all 3 categories showed a statistical difference between TFV and Fuse as well as between TFV and R-TFV. There were no statistical differences between the ADR of Fuse compared with R-TFV.

Conclusions:
During R-TFV, endoscopists are able to maintain their increased ability to detect adenomas. This would suggest that there was a change in behavior in endoscopists using Fuse that was durable.
Network Meta-analysis Comparing Vonoprazan and Proton Pump Inhibitors for Heartburn Symptoms in Erosive Esophagitis
Authors: Oshima Tadayuki , Igarashi Ataru , Nakano Hiroya , Deguchi Hisato , Fujimori Ikuo , Fernandez Jovelle 
Published: April 2022

Goals:
This systematic review and network meta-analysis aimed to assess the relative efficacy of vonoprazan and proton pump inhibitors (PPIs) on early heartburn symptom resolution in patients with erosive esophagitis.

Background:
Limited available data directly compare the efficacy of vonoprazan, a first-in-class potassium-competitive acid blocker, with PPIs in erosive esophagitis.

Study:
We conducted a systematic literature review (in MEDLINE and CENTRAL) and subsequent network meta-analysis according to Cochrane and PRISMA guidelines. Double-blind, randomized controlled trials in adults with erosive esophagitis treated with vonoprazan or a PPI were included in the analysis. Primary outcomes were heartburn symptom resolution rate on Day 1 and Day 7. The study was performed with all available data, using a random effects model within a Bayesian framework.

Results:
Overall, 10 randomized controlled trials were included in the network meta-analysis. For heartburn resolution rate on Day 1 (9 of 10 trials), vonoprazan 20 mg once daily (QD) was superior to placebo (median odds ratio=16.75, 95% credible interval: 2.16–207.80). Point estimates numerically favored vonoprazan 20 mg QD over other comparators. For heartburn resolution rate on Day 7 (10 of 10 trials), vonoprazan 20 mg QD was superior to placebo and other comparators except rabeprazole 20 mg QD. Point estimates numerically favored vonoprazan 20 mg QD over rabeprazole 20 mg QD.

Conclusions:
In this study, vonoprazan 20 mg QD was equally effective in heartburn resolution on Day 1, and equally or more effective on Day 7 versus PPIs in adults with erosive esophagitis.
Comparison of the Pharmacokinetics of CT-P13 Between Crohn’s Disease and Ulcerative Colitis
Authors: Kim Eun Soo , Kim Sung Kook , Park Dong Il , Kim Hyo Jong , Lee Yoo Jin , Koo Ja Seol , Kim Eun Sun , Yoon Hyuk , Lee Ji Hyun , Kim Ji Won , Shin Sung Jae , Kim Hyung Wook , Kim Hyun-Soo , Park Young Sook , Kim You Sun , Kim Tae Oh , Lee Jun , Choi Chang Hwan , Han Dong Soo , Chun Jaeyoung , Kim Hyun Soo ,   on behalf of the IBD Research Group in the Korean Association for the Study of Intestinal Diseases
Published: April 2022

Background:
We aimed to compare trough infliximab levels and the development of antidrug antibody (ADA) for 1 year between Crohn’s disease (CD) and ulcerative colitis (UC) patients who were biologic-naive, and to evaluate their impact on clinical outcomes.

Methods:
This was a prospective, multicenter, observational study. Biologic-naive patients with moderate to severe CD or UC who started CT-P13, an infliximab biosimilar, therapy were enrolled. Trough drug and ADA levels were measured periodically for 1 year after CT-P13 initiation.

Results:
A total of 267 patients who received CT-P13 treatment were included (CD 168, UC 99). The rates of clinical remission (72% vs. 32.3%, P<0.001) at week 54 were significantly higher in CD than in UC. The median trough drug level (μg/mL) was significantly higher in CD than in UC up to week 14 (week 2, 18.7 vs. 14.7, P<0.001; week 6, 12.5 vs. 8.6, P<0.001; week 14, 3.4 vs. 2.5, P=0.001). The median ADA level (AU/mL) was significantly lower in CD than in UC at week 2 (6.3 vs. 6.5, P=0.046), week 30 (7.9 vs. 11.8, P=0.007), and week 54 (9.3 vs. 12.3, P=0.032). Development of ADA at week 2 [adjusted odds ratio (aOR)=0.15, P=0.026], initial C-reactive protein level (aOR=0.87, P=0.032), and CD over UC (aOR=1.92, P<0.001) were independent predictors of clinical remission at week 54.

Conclusion:
Infliximab shows more favorable pharmacokinetics, including high drug trough and low ADA levels, in CD than in UC, which might result in better clinical outcomes for 1-year infliximab treatment in CD patients.
The 2022 ANCC Institute for Credentialing Research and Quality Management Priorities
Authors: Cámpoli Marcela , Mulvey Tanya 
Published: April 2022

ABSTRACT
It is imperative that we listen to our nation's nurses, who have a unique vantage point from their clinical environments. Clinical research nurses have greatly contributed to studying the delivery of care over the years; however, since 2020, COVID-19 has brought unprecedented changes within the nursing profession. Each wave of the pandemic has created a worrisome landscape where nurse researchers face multiple challenges in implementing and funding practice-based nursing-led research projects. To raise nurses' voices and promote nurse-led research, the American Nurses Credentialing Center (ANCC) Research Council 2022 Research Priorities include the dissemination of a research agenda for practice-based research, promoting interprofessional research, and encouraging equitable and inclusive participation on research teams.
Do Nurse Managers Feel Competent in the Financial and Business Aspects of Their Roles?
Authors: Welch Teresa D. 
Published: April 2022

OBJECTIVE
The aim of this study was to assess the influence of 3 variables on unit-based nurse managers' self-perception of business and financial competence in patient care: 1) educational degree; 2) participation in leadership development continuing education; and 3) prior nursing management experience.

BACKGROUND
Nurse managers must develop business acumen to support patient care and the nurses who provide care. Successful managers must become fluent in the language of finance and must understand how to use it. Their ability to promote continuous quality improvement (QI) in a cost-effective, resource-conscious manner is the foundation of economic viability.

METHODS
A feasibility study was conducted using Facebook to recruit nurse managers nationally and to distribute an electronic survey designed to assess the unit-based managers' self-perceptions of business and financial competence in patient care.

RESULTS
The strongest predictors of self-perceived business and financial competence were continuing education and MSN degree. Years of experience in a leadership role did not predict self-reported levels of business or financial competence in patient care.

CONCLUSION
Findings suggest that nursing leadership competency in the area of finance is developed through continuing education. Healthcare organizations should implement comprehensive nursing leadership mentoring and orientation programs for nurse managers to improve their self-perceptions of business and financial competencies.
Use of Outpatient Opioids Prescribed From a Pediatric Acute Care Setting
Authors: DePhillips Michelle , Watts Jennifer , Sample Jennifer , Dowd Mary Denise 
Published: April 2022

Objectives
Deaths due to prescription opioid overdoses are at record high levels. Limiting the amount of opioid prescribed has been suggested as a prevention strategy, but little is known about how much is needed to adequately treat acutely painful conditions for outpatients. The purpose of this study was to quantify the usage of opioids prescribed from the pediatric emergency departments of a Midwestern tertiary care children’s hospital system.

Methods
This was a prospective descriptive study in which patients aged 0 to 17 years seen in 2 pediatric emergency departments who received a prescription for an outpatient opioid were enrolled. The main outcome was opioid doses used at home, which was obtained via phone follow-up. Additional information, including patient demographics, location, prescriber specialty, diagnosis, and opioid name and amount prescribed, was obtained via chart review.

Results
A total of 295 patients were enrolled, with 281 completing the study (95%). The median numbers of opioid doses prescribed and used were 12 and 2 doses, respectively, with 9 doses in excess. Patients with lower extremity fractures used more opioids than other diagnoses, with a median of 8 doses. The majority of families reported keeping extra doses at home.

Conclusions
Prescribed opioid doses exceeded used doses by a factor of 6. Lower extremity fractures required more doses than other acutely painful conditions. We should consider limiting doses prescribed to decrease excess opioids available for misuse and abuse.