bluuebunny/crossref_metadata_2025_split huggingface dataset:
Multiple Polymerase Chain Reaction for Direct Detection of Bloodstream Infection After Cardiac Surgery in a PICU
Authors: Checa Rosa María Calderón , Gijón Manuel , Hofheinz Sylvia Belda , Rojo Pablo 
Published: May 2022

OBJECTIVES:
Nosocomial infections are a prevalent cause of death and complications in critically ill children. Conventional cultures are able to detect only up to 25% of bacteremia. Several studies have suggested that molecular tests could be a faster and effective tool for detection of bacterial infections. The objective of this study is to compare molecular tests for bacterial detection in whole blood samples, with routine blood culture for the diagnosis of nosocomial bloodstream infections (BSIs).

DESIGN:
Prospective cohort study.

SETTING:
A PICU of a tertiary center, reference for congenital heart diseases.

PATIENTS:
Children, 0–16 years, admitted to PICU between August 2016 and December 2019 after cardiac surgery were prospectively recruited. Demographic, clinical, laboratory, and microbiologic data from patient’s medical records, and laboratory and microbiologic results were collected.

INTERVENTIONS:
In all patients, blood culture and multiple polymerase chain reaction (PCR) for bacterial detection in a whole blood sample were performed.

MEASUREMENTS AND MAIN RESULTS:
Fifty-seven cases (patients with suspected infection) and 36 controls (patients with no suspected infection) were recruited during this period; 51.6% were female. Median age was 6 months (interquartile range [IQR], 0–13 mo), and median weight was 5 kg (IQR, 3.5–9.5 kg).
From the cases, 33% (19/57) had a confirmed BSI with positive blood culture; 52% were Gram-negative bacilli, and 48% were Gram-positive cocci. Thirty-three percentage (19/57) had a positive PCR with only a 26% (five cases) of concordance between PCR result and blood culture (three bacteremias for Klebsiella pneumoniae, one for Serratia marcescens, and one for Pseudomonas).

CONCLUSIONS:
Multiple PCRs in whole blood samples did not appear to be more sensitive than blood cultures in this series. Better concordance was found with Gram-negative microorganisms.
Club Cell Secretory Protein–Derived Acute Respiratory Distress Syndrome Phenotypes Predict 90-Day Mortality: A Reanalysis of the Fluids and Catheter Treatment Trial
Authors: Chase Aaron , Almuntashiri Sultan , Sikora Andrea , Zhang Duo 
Published: May 2022

OBJECTIVES:
Club cell secretory protein (CC16) is a protein with potential utility as a lung-specific biomarker for acute respiratory distress syndrome. The purpose of this study was to characterize CC16 in plasma from patients enrolled in the Fluid and Catheter Treatment Trial (FACTT) to determine the prognostic value for patient outcomes in our subgroup of FACTT patients.

DESIGN:
A secondary biomarker analysis of a prospective randomized-controlled trial. The primary outcome was area under the receiver operating characteristic (AUROC) of CC16 for prediction of 90-day mortality. Secondary outcomes included differences in mortality, length of stay, and ventilator-free days (VFDs) between patients with high and low CC16. Statistical analyses were performed with IBM SPSS Statistics.

SETTING:
Single-center laboratory analysis.

SUBJECTS:
Plasma samples from 68 FACTT subjects and 20 healthy controls.

INTERVENTIONS:
CC16 was measured in patient plasma samples by enzyme-linked immunosorbent assay.

MEASUREMENTS AND MAIN RESULTS:
Subjects were an average of 48 years old (sd, 16.7 yr old) and 51.5% male. AUROC analysis of CC16 on day 1 showed an area under the ROC curve of 0.78 for prediction of mortality (odds ratio, 1.011; 95% CI, 1.003–1.021) with an optimal cutoff value of 45 ng/mL. Patients in the low CC16 group (<45 ng/mL) had lower mortality (7.5 vs 50.0%; p < 0.001) and similar VFD (11.9 vs 13.2; p = 0.638). When stratified by CC16 concentration, there was no difference between mortality in the fluid liberal (36.4 vs 58.8%; p = 0.256) or conservative (4.3 vs 11.8%; p = 0.366) groups.

CONCLUSIONS:
CC16 demonstrated an acceptable AUROC for prediction of patient mortality with a cut point of 45 ng/mL. Patients with high CC16 on day 1 had worse outcomes compared with those with low CC16, suggesting a prognostic role for this lung-specific biomarker.
Raising the Question: Medication Mix-Up or Diversion
Authors: Reilly Marie , McGivney Christine , Christiansen Audrey , Augustyn Marilyn 
Published: May 2022

CASE:
Max is an 8-year-old boy with autism spectrum disorder and long-standing challenges with sleep maintenance, the latter of which persist despite behavioral intervention and environmental modification. When Max wakes in the early morning hours, he tends to wander the house, which causes his mother to be awake to monitor his safety. Given the impact of Max's fragmented sleep on his functioning and that of his family, you begin a trial of gabapentin liquid to promote sleep maintenance. Soon after, Max's mother reports that he is sleeping through the night, for the first time in his life.
Two months later, you receive a message from Max's mother requesting an early refill of his 90-day supply because of having spilled the bottle. You provide a new prescription, and Max's insurance company allows the early refill. Six weeks after that, Max's mother calls to say that she needs another gabapentin prescription because Max has run out. You confirm that she is giving the prescribed dose but are unsure as to why Max is out of medication weeks early. Given these events, you begin to question whether Max's gabapentin prescription is being diverted. What would you do next?
Changing the trajectory of clinical precepting for nurse practitioner students with the development of a preceptor resource network
Authors: Videtich Kayla , Moran Katherine , Zajac Lisa , Myers Richard 
Published: May 2022

ABSTRACT
Preceptors of nurse practitioner students can be difficult to recruit and retain. Schools of nursing have deployed incentives that aim to support preceptors; however, these incentives, such as conferences, webinars, and workshops, do not always entice preceptors. The purpose of this project was to enhance the overall clinical experience for both the preceptor and the Doctor of Nursing Practice primary care nurse practitioner students through the development of an innovative preceptor resource network (PRN). The PRN was designed and developed to support preceptors in rural and/or underserved areas. The network consists of informal monthly meetings with rotating content as well as an online repository that houses resources. More than half of the invited preceptors attend the meetings each month. Preceptors' feedback indicated that the meetings assist them in their precepting and/or clinical practice, and the discussions were engaging and interesting. Schools of nursing need to deploy creative, relationship-based strategies to recruit and retain preceptors for nurse practitioner students. The development of a PRN, which facilitates discussions from a preceptor-driven agenda, rather than a top-down educational method, is an innovative approach that is worthy of further exploration and replication. The PRN is a sustainable model for preceptor support that could be used by universities across the United States and abroad.
T staging with functional and radiomics parameters of computed tomography in colorectal cancer patients
Authors: Dou Yafang , Liu Yingying , Kong Xiancheng , Yang Shangying 
Published: May 2022

Abstract
Preoperative T staging is closely related to operation planning and prognosis of colorectal cancer (CRC). This study aimed to re-investigate the value of computed tomography (CT) in T stage evaluation of CRC patients with both functional and radiomics parameters.
The functional and radiomics parameters of CT images and the clinical information were collected from 32 CRC patients. The radiomics parameters were measured based on manually labelled 5-mm circles using software Syngo. The radiomics parameters were computed based on labelled tumor regions using Python software package.
A total of 125 parameters were collected and analyzed by using decision tree analysis. The decision tree analysis identified 6 rules. Based on the rules, the shape elongation, flow extraction of nodule and blood volume of tumor region were found to be of significance and could define a high-risk group and a low-risk group.
This study shows the combination of functional parameters and radiomics parameters of CT is helpful for the diagnosis and T staging of CRC.
Difference in the prevalence of advanced colon adenoma between patients with gastric neoplasm and healthy people
Authors: Koh Myeongseok , Kim Min-Chan , Jang Jin Seok 
Published: May 2022

Abstract
We compared the prevalence of adenoma and cancerous colon polyps in patients undergoing endoscopic removal or gastric surgery for gastric adenoma or gastric cancer and in healthy individuals.
The medical records of 707 patients with gastric neoplasm and 798 age- and sex-matched healthy subjects were retrospectively analyzed between January 2010 and July 2018. The clinicopathological characteristics, prevalence of colorectal neoplasm diagnosed by colonoscopy, and risk factors for colorectal polyps were also investigated.
When comparing the two groups, the prevalence of overall colorectal polyps and its distribution was not different between the two groups (54.0% vs.49.5%, P = .079), whereas, the number of colon polyps (1.20 ± 1.71 vs 0.99 ± 1.54, P = .015) and the maximal size (3.53 ± 6.14 vs 2.08 ± 2.88, P < .001) were significantly larger in the gastric neoplasm group. The prevalence of advanced colon adenoma was significantly higher in the gastric neoplasm group (10.7% vs 3.8%, P < .001). Risk factors such as elevated glucose levels and the presence of gastric neoplasm were related to the prevalence of all colon polyps. The presence of gastric neoplasm is an important risk factor for advanced colon polyps.
Patients with gastric neoplasms had a significantly higher prevalence of advanced colon adenoma. Advanced colon adenoma is associated with the chain from benign adenomas through malignant altered adenomas to advanced colon cancer. Thus, patients with gastric neoplasm are regarded as a high-risk group for colorectal cancer and are recommended for screening colonoscopy at the time of diagnosis.
Primary ovarian abscess in virginal young woman with huge endometriosis cyst
Authors: Liu Wenhua , Zhang Zhifen , Li Dinghen 
Published: May 2022

Abstract

Rationale:
Primary ovarian abscess which develops as an isolated lesion without simultaneous tubal infection is a rare entity. Ovarian abscess (OA) is a serious complication of pelvic inflammatory disease (PID) rarely seen in virginal girls. Early diagnosis and treatment are essential to prevent further sequela including infertility, ectopic pregnancy, and chronic pelvic pain.

Patient concerns:
A 19-year-old virginal girl who presented with abdominal pain and pelvic mass with no risk factors.

Diagnoses:
Laparoscopic surgery was performed to confirm a primary ovarian abscess in the adolescent virginal female with a huge endometriosis cyst.

Intervention:
Ovarian abscess with extensive intestinal adhesions was determined during the laparoscopic operation. Abscess drainage and postoperative antibiotic therapy cured the patient.

Outcome:
After the surgery, the CRP level on the day of discharge was 3.18 mg/d. The histological findings revealed a cystic tissue sample with the fibrous wall infiltrated by neutrophilic granulocytes, and ectopic endometrium, suggesting abscess formation in the ovary and endometriosis cyst.

Lessons:
Although primary ovarian abscess in an adolescent virginal female is rare, given the severity of outcomes following ovarian abscess, this pathology should be considered in the differential diagnosis of virginal adolescents with fever and abdominal pain.
Peritonsillar abscess caused by Prevotella bivia during home quarantine for coronavirus disease 2019
Authors: Yamagishi Toshinobu , Arakawa Naoki , Toyoguchi Sho , Mizuno Koshi , Asami Yusuke , Yamanaka Yurika , Yamamoto Hiroki , Tsuboi Ken 
Published: May 2022

Abstract

Rationale:
Since late 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had rapidly spread worldwide, resulting in a pandemic. Patients with coronavirus disease 2019 (COVID-19) have difficulty in visiting clinics in person during pandemic because they might be encouraged to quarantine at home with supportive care. Peritonsillar abscess rarely coexists with COVID-19; however, patients with SARS-CoV-2 infection could get co-infections or become superinfected with other microorganisms which could cause peritonsillar abscess. We herein describe a case of peritonsillar abscess caused by Prevotella bivia that occurred as a co-infection with COVID-19 during home quarantine.

Patient concerns:
A 32-year-old Asian woman who was diagnosed with COVID-19 was instructed to stay home for quarantine. Her pharyngeal discomfort worsened, and she experienced trismus and dysphagia. An emergent visiting doctor referred her to our hospital. Contrast-enhanced computed tomography showed peritonsillar abscess findings, following which we referred her to an ear, nose, throat specialist. Prevotella bivia was identified on needle aspiration pus culture; however, two sets of blood and throat cultures were negative.

Diagnosis:
A definitive diagnosis of acute COVID-19 and peritonsillar abscess due to Prevotella bivia was made.

Interventions:
An antibiotic drug, antiviral drug, and adjunctive steroid were administered intravenously.

Outcomes:
Her symptoms improved without the need for incision and drainage, and she was discharged on day 7.

Conclusion:
Patients with suspected peritonsillar abscess should be triaged and referred to ear, nose, throat specialists appropriately. Scoring systems, such as modified Liverpool peritonsillar abscess score or the guidelines criteria might be useful tools to triage patients. During the early phase of SARS-CoV-2 infection, administration of corticosteroids is not recommended. When adjunctive steroids are considered for peritonsillar abscess, prior to or simultaneous use of the antiviral agent remdesivir for COVID-19 might be recommended.
The transformation of isolated gastric myeloid sarcoma into acute myeloid leukemia presenting with a complex karyotype and TLS-ERG gene fusion
Authors: Gao Lu , Xu Yan , Tian Zuguo , Xia Junxiu , Yuan Zhong , Chen Di , Ren Mingqiang 
Published: May 2022

Abstract

Rationale:
Isolated myeloid sarcoma (MS) is characterized by the rapid proliferation of myeloblasts of acute myeloid leukemia (AML), without any blood or bone marrow involvement. This disease can manifest with extramedullary organ involvement, such as the skin, lymph nodes, bone, brain, breast cervix, and visceral organs, while the occurrence of myeloid sarcomas in the stomach is rare. Isolated MS has been associated with acute myeloid leukemia (AML), but the rapid progression of MS to acute myeloid leukemia with a complex karyotype and TLS-ERG fusion gene is even rarer.

Patient concerns:
A 33-year-old woman suffered from persistent epigastric pain accompanied by two months of anorexia and nausea, as well as 1-week of melena.

Diagnosis:
This patient was initially diagnosed with gastric MS that eventually transformed into AML with a complex karyotype and TLS-ERG fusion gene, 4 months later.

Interventions:
Only palliative care, including nutrition support, antacids, blood transfusion, anti-infection methods were used on this patient to determine the cachexia status and the family's requirement.

Outcomes:
Routine follow-up results demonstrated this patient had died due to cerebral hemorrhage five months after the diagnosis of MS.

Lessons:
Comprehensive integration of patient history, imaging features, mass and bone marrow biopsy, and molecular cytogenetic may provide insights that could help us avoid the misdiagnosis of gastric MS. Isolated gastric MS can rapidly progress to AML with a poor prognosis if the patient does not receive appropriate treatment.
Adrenal insufficiency and pregnancy
Authors: Alexandraki Krystallenia I. , Kaltsas Gregory A. 
Published: May 2022

Introduction
Adrenal insufficiency is a disorder characterized by the failure of adrenocortical function because of distorted function of hypothalamic–pituitary– adrenal (HPA) axis. Pregnancy is a state of a physiological glucocorticoid excess as the HPA axis is functioning at a higher level.

Purpose of review
The aim of the present review was to shed light on current evidence of adrenal insufficiency management during pregnancy, along with maternal and neonatal outcomes.

Recent findings
A recent multicenter study under the auspices of the European Network for the Study of Adrenal Tumours (ENSAT) presented real-life data of pregnant women with adrenal insufficiency documenting an increased use of hydrocortisone (or mineralocorticoids when needed according to the level of disorder) replacement treatment, increased rates of caesarean section, preterm delivery and adrenal crises along with peripartum and postpartum complications but no maternal or neonatal fatality. These data were in agreement with those obtained from previously published studies.

Conclusion
The limited published evidence is in line with the present guidelines as real-life data did not document any increased fatality among pregnant women or newborns. Prospective data with prolonged follow-up are needed to shed more light on appropriate dose adjustments to avoid the risks of under-replacement or over-replacement of glucocorticoid and/or mineralocorticoid drugs and their sequelae.

Summary
A recent multicenter study by ENSAT presented real-life data of pregnant women with adrenal insufficiency documenting an increased use of hydrocortisone as replacement treatment during pregnancy, along with an increased rate of caesarean section and preterm delivery, adrenal crises, peripartum and postpartum complications but no maternal or neonatal fatality. These data are in agreement with those of a previously published study and also confirm the statements made by the recent guidelines. Prospective data are needed aiming to develop precise therapeutic protocols during each trimester of pregnancy according to the different causes of adrenal insufficiency.
Burnout in emergency medicine professionals after 2 years of the COVID-19 pandemic: a threat to the healthcare system?
Authors: Petrino Roberta , Riesgo Luis Garcia-Castrillo , Yilmaz Basak 
Published: May 2022

Background
Burnout is a common problem among healthcare professionals (HCPs), in particular young doctors and nurses working in emergency medical services. The coronavirus disease 2019 (COVID-19) pandemic has generated a substantial increase in the workload of those working in front-line services, and there is evidence of physical and mental distress among professionals that may have caused an increase in burnout.

Objective
The objective of the study was to evaluate the level of burnout in the different professionals of emergency medical services.

Design and participants
In January and February 2022, we conducted an online survey based on the Abbreviate Maslach inventory with the addition of three questions focused on possible modifying factors. The survey was disseminated to HCP via the list of European Society for Emergency Medicine contacts.

Outcome measures
The analysis was based on two of the three elements of the Maslach burnout concept, ‘depersonalisation’, ‘emotional exhaustion’, and ‘personal accomplishment’. Overall burnout was defined when at least one of the two elements ‘depersonalisation’ or ‘emotional exhaustion’ reached the level of high burnout.

Results
The number of responders was 1925, 84% of which were physicians, 12% nurses, and 2% paramedics. Burnout was present in 62% of all responders. A high burnout level was reported for depersonalisation, emotional exhaustion, and personal accomplishment in 47%, 46%, and 48% of responders, respectively. Females reported a higher proportion of burnout compared with males 64% vs. 59%, difference −6% [95% confidence interval CI, −8 to −1.9], and nurses higher than physicians, 73% vs. 60%, difference −13 (95% CI, −18.8 to −6). Less experienced professionals reported higher levels of burnout: those with less than 5 years of experience the burnout level was 74% compared with the group with more than 10 years, 60%, difference −26% (95% CI, −32 to −19.5). Reported frequent understaffing situations were associated with a higher risk of burnout: 70% vs. 37%, difference −33% (95% CI, −41 to −25). Burnout was associated with a higher risk of desire to change the workplace: 87% vs. 40%, difference −47% (95% CI, −52 to −42). Survey responders reported having access to support programmes in 41% of cases.

Conclusion
In this study, there is a high reported level of burnout among emergency HCPs. Several risk factors were identified such as being understaffed, female, or having less experience. HCPs with burnout thought more frequently about leaving the workplace, posing a threat to healthcare systems.
Brief Report: Impact of Antiretroviral Regimen on Pregnancy and Infant Outcomes in Women With HIV/ HBV Coinfection
Authors: Kiweewa Flavia Matovu , Tierney Camlin , Butler Kevin , Peters Marion G. , Vhembo Tichaona , Moodley Dhayendre , Govender Vani , Mohtashemi Neaka , Ship Hannah , Musoke Philippa , Dula Dingase , George Kathy , Chakhtoura Nahida , Fowler Mary G. , Currier Judith S. , Bhattacharya Debika 
Published: May 2022

Background:
There are limited data on the impact of antenatal antiretroviral regimens (ARV) on pregnancy and infant outcomes in HIV/HBV coinfection. We compared outcomes among 3 antenatal antiretroviral regimens for pregnant women with HIV/HBV.

Methods:
The PROMISE study enrolled ARV-naive pregnant women with HIV. Women with HBV were randomized to (no anti-HBV)-zidovudine (ZDV) + intrapartum nevirapine and 1 week of tenofovir disoproxil fumarate and emtricitabine (TDF-FTC); (3TC)-3TC + ZDV + LPV/r; or (FTC-TDF)-FTC + TDF + LPV/r. Pairwise group comparisons were performed with Fisher exact, t, or log rank tests. Adverse pregnancy outcome (APO) was a composite of low birth weight, preterm delivery, spontaneous abortion, stillbirth, or congenital anomaly.

Results:
Of 138 women with HIV/HBV, 42, 48, and 48 were analyzed in the no anti-HBV, 3TC, and FTC-TDF arms. Median age was 27 years. APOs trended lower in the no anti-HBV (26%) vs 3TC (38%), and FTC-TDF arms (35%), P ≥ 0.25). More infant deaths occurred among the FTC-TDF [6 (13%)] vs no anti-HBV [2 (5%)] and 3TC [3 (7%)] arms. There were no differences in time-to-death, HIV-free survival, birth or one-year WHO Z-score length-for-age, and head circumference. Hepatitis B e antigen (HBeAg) was associated with an increased risk of APO, 48% vs 27% (odds ratio 2.79, 95% confidence interval: 1.19 to 6.67, post hoc).

Conclusion:
With HBV/HIV coinfection, the risk of an APO was increased with maternal ARV compared with ZDV alone, although the differences were not statistically significant. Maternal HBeAg was associated with a significantly increased risk of APO. Infant mortality was highest with FTC + TDF + LPV/r. Early assessment of HBeAg could assist in identifying high-risk pregnancies for close monitoring.