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Am J Case Rep 2021 Apr 17;22:e930902. Epub 2021 Apr 17.

Department of Pathology, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea.

BACKGROUND Osteoma is a benign bone tumor that typically arises in facial bones and less frequently in the long bones. It rarely occurs in the appendiceal skeleton. Pathologic findings are similar to those for parosteal osteosarcoma, periostitis ossificans, and osteoid osteoma. Read More

Int J Surg Case Rep 2021 Apr 6;82:105863. Epub 2021 Apr 6.

Department of Surgery, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia; King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.

Introduction: Non-operative management and minimally invasive surgery reduce the burden of negative laparotomies in patients with penetrating gunshot wounds (GSW). Careful patient selection is key. Although challenging, in experienced hands laparoscopic exploration of the retroperitoneal space can be carried out. Read More

Am Surg 2021 Apr 16:31348211011084. Epub 2021 Apr 16.

Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA.

Background: Management of hepatocellular adenoma (HA) is marked by a paucity of recent studies. Long-term follow-up data from an equal access health care system may facilitate our understanding of the natural disease course of HA and identify modifiable risk factors.

Methods: A multi-institutional, retrospective review of patients with HA from 2008-2017 was performed. Read More

N Engl J Med 2021 Apr 16. Epub 2021 Apr 16.

From the Department of Haematology, University College London Hospitals NHS Foundation Trust (M.S., M.L.), National Institute for Health Research University College London Hospitals Biomedical Research Centre (M.S., M.L.), Special Coagulation, Health Services Laboratories (D.S.), Great Ormond Street Institute of Child Health, University College London (D.G.), and National Institute for Health Research Great Ormond Street Biomedical Research Centre (D.G.), London, the Department of Haematology, University Hospital Southampton, Southampton (R.L.), National Health Service Blood and Transplant, Bristol (A.P.), National Institute for Health Research Health Protection Research Unit, University of Liverpool, Liverpool (T.S.), the Department of Haematology, Mid Essex Hospitals, Chelmsford (P.K.), the Department of Haematology, Addenbrookes Hospital, Cambridge (W.T.), and the Department of Haematology, University Hospitals Birmingham, and Institute of Cardiovascular Sciences, University of Birmingham, Birmingham (W.L.) - all in the United Kingdom; and the Department of Vascular Medicine, Amsterdam University Medical Center, Amsterdam (M.L.).

Background: The mainstay of control of the coronavirus disease 2019 (Covid-19) pandemic is vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Within a year, several vaccines have been developed and millions of doses delivered. Reporting of adverse events is a critical postmarketing activity. Read More

Ophthalmic Physiol Opt 2021 Apr 16. Epub 2021 Apr 16.

The University of New South Wales, Sydney, New South Wales, Australia.

Purpose: This study investigates how and in what circumstances a school-based eye health programme, the Refractive Errors Among CHildren (REACH) programme, achieved its desired outcomes: accessibility, standards of refractive care, fidelity and availability of comprehensive services, for over 2 million school children in six districts across India.

Methods: We conducted a realist evaluation to identify programme aspects and their causal relationships with outcomes. Deductive and inductive thematic analysis of qualitative data included three phases: 1. Read More

Clin Chem 2021 Apr 16. Epub 2021 Apr 16.

Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.

Methods: We conducted a multicenter, retrospective, observational, US-based study of COVID-19 patients undergoing hs-cTnT. Outcomes included short-term mortality (in-hospital and 30-days post-discharge) and a composite of major adverse events including respiratory failure requiring mechanical ventilation, cardiac arrest, and shock within the index presentation and/or mortality during the index hospitalization or within 30-days post-discharge.

Results: Among 367 COVID-19 patients undergoing hs-cTnT, myocardial injury was identified in 46%. Read More

Int Med Case Rep J 2021 9;14:233-236. Epub 2021 Apr 9.

Department of Surgery, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.

Background: Appendiceal agenesis is a rare intraoperative diagnosis which occurs in 0.001% of laparotomies done for presumed acute appendicitis. To our knowledge, this is the first report of appendiceal agenesis in our country and the second in Africa. Read More

Emerg Med J 2021 Apr 15. Epub 2021 Apr 15.

Department of Emergency Medicine, University of Pecs, Pécs, Baranya, Hungary.

Background: Based on the 2018 update of the Surviving Sepsis Campaign, the Committee for Quality Improvement of the NHSs of England recommended the instigation of the elements of the 'Sepsis-6 bundle' within 1 hour to adult patients screened positive for sepsis. This bundle includes a bolus infusion of 30 mL/kg crystalloids in the ED. Besides the UK, both in the USA and Australia, compliance with similar 1-hour targets became an important quality indicator. Read More

Emerg Med J 2021 Apr 15. Epub 2021 Apr 15.

Paediatric Emergency Department, Bristol Royal Hospital for Children, Bristol, UK.

Background: Tonsillopharyngitis is a common presentation to paediatric emergency departments (PEDs). FeverPAIN (FP) and Centor scoring systems are recommended in the UK to help delineate bacterial aetiology, despite being primarily evidenced in adult populations. We investigate how the use of FP or Centor compares to actual clinician practice in guiding antibiotic prescription rates in PED. Read More

Clin Genitourin Cancer 2021 Mar 19. Epub 2021 Mar 19.

Department of Radiation Oncology, University of Utah, Salt Lake City, UT. Electronic address:

Introduction: Adrenocortical carcinoma (ACC) is a rare cancer with few well-powered studies regarding epidemiology or outcomes and even fewer studies to guide an evidence-based management approach. The effect of radiation therapy (RT) is particularly understudied and remains unclear, outside of general oncologic principles. We sought to describe current care patterns in the management of ACC and how these practices affect survival outcomes using the Surveillance, Epidemiology, and End Results (SEER) database. Read More

J Cardiothorac Surg 2021 Apr 15;16(1):85. Epub 2021 Apr 15.

Semmelweis University, Heart and Vascular Center, Varosmajor 68, Budapest, H-1122, Hungary.

Background: Behçet's disease is an auto-inflammatory disorder categorized as a primer systemic vasculitis of unknown aetiology. Genetic factors, infectious agents and the irregularity of T-cell homeostasis are presumed to be responsible for the emergence of Behçet's disease. Characteristic symptoms are multisystemic. Read More

BMC Endocr Disord 2021 Apr 15;21(1):71. Epub 2021 Apr 15.

Department of Human and Medical Genetics, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.

Background: Acrodysostosis is a rare hereditary disorder described as a primary bone dysplasia with or without hormonal resistance. Pathogenic variants in the PRKAR1A and PDE4D genes are known genetic causes of this condition. The latter gene variants are more frequently identified in patients with midfacial and nasal hypoplasia and neurological involvement. Read More

BMC Pediatr 2021 Apr 15;21(1):175. Epub 2021 Apr 15.

Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: Glycogen storage disease (GSD) type IXb is one of the rare variants of GSDs. It is a genetically heterogeneous metabolic disorder due to deficient hepatic phosphorylase kinase activity. Diagnosis of GSD can be difficult because of overlapping manifestations. Read More

Mult Scler Relat Disord 2021 Apr 7;51:102937. Epub 2021 Apr 7.

Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

Background: The onset and presentation of primary progressive multiple sclerosis (PPMS) like any other autoimmune diseases can be triggered by unexpected lifetime stressful events, which require to be assessed in order to minimize our exposure to such events as much as possible.

Objective: The aim of the present study was to determine the possible role of socioeconomic status (SES) and stressful events in PPMS development METHODS: The present population-based case-control study recruited PPMS cases and healthy controls from the general population during 2019-2020 in Tehran, Iran. Clinical diagnosis of cases was based on the 2017 McDonald criteria and confirmed by a neurologist. Read More

Urology 2021 Apr 12. Epub 2021 Apr 12.

Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, MA USA.

Objective: To characterize the presentation, patterns of care, and outcomes of radiation-associated muscle-invasive bladder cancer (RA-MIBC) compared to primary (non-radiation associated) MIBC. RA-MIBC has been suggested to represent a more aggressive disease variant and be more difficult to treat compared to primary (non-radiation associated) MIBC.

Methods: We identified 60,090 patients diagnosed with MIBC between 1988-2015 using the Surveillance, Epidemiology, and End Results database and stratified patients based on whether radiation had been administered to a prior pelvic primary cancer. Read More

J Pediatr 2021 Apr 12. Epub 2021 Apr 12.

Department of Neonatology and Pediatrics; Haifa, Israel; Technion, Israel Institute of Technology; Haifa, Israel.

Objective: To evaluate the recommendations based on the early-onset sepsis (EOS) calculator in the first two years of its implementation in Israel.

Study Design: Prospective two-year surveillance of a cohort of infants born at gestational age (GA) ≥34 weeks in Bnai Zion Medical Center, who were evaluated using the EOS calculator because of peripartum risk factors.

Results: 1146 newborns with peripartum risk factors were evaluated using the EOS calculator. Read More

PLoS One 2021 15;16(4):e0246980. Epub 2021 Apr 15.

Louisiana State University Health Sciences Center, Baton Rouge, Louisiana, United States of America.

Sepsis must be diagnosed quickly to avoid morbidity and mortality. However, the clinical manifestations of sepsis are highly variable and emergency department (ED) clinicians often must make rapid, impactful decisions before laboratory results are known. We previously developed a technique that allows the measurement of the biophysical properties of white blood cells as they are stretched through a microfluidic channel. Read More

Eur J Pediatr 2021 Apr 15. Epub 2021 Apr 15.

Department of Paediatrics, Willem Alexander Children's Hospital, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.

The aim of this study was (1) to prospectively evaluate the nationwide implementation of the ESPGHAN-guidelines for the diagnosis of celiac disease (CD), (2) to investigate the incidence and clinical presentation of diagnosed childhood CD (0-14 years) in the Netherlands, and (3) to compare the findings with national survey data from 1975 to 1990 and 1993 to 2000 using the same approach. From 2010 to 2013, all practicing paediatricians were invited to report new celiac diagnoses to the Dutch Pediatric Surveillance Unit. Data were collected via questionnaires. Read More

West J Emerg Med 2021 Feb 15;22(2):319-325. Epub 2021 Feb 15.

Vanderbilt University Medical Center, Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Center for Clinical Quality and Implementation Research, Nashville, Tennessee.

Introduction: Despite large-scale quality improvement initiatives, substantial proportions of patients with ST-elevation myocardial infarction (STEMI) transferred to percutaneous coronary intervention centers do not receive percutaneous coronary intervention within the recommended 120 minutes. We sought to examine the contributory role of emergency medical services (EMS) activation relative to percutaneous coronary intervention center activation in the timeliness of care for patients transferred with STEMI.

Methods: We conducted a retrospective analysis of interfacility transfers from emergency departments (ED) to a single percutaneous coronary intervention center between 2011-2014. Read More

West J Emerg Med 2021 Jan 29;22(2):170-176. Epub 2021 Jan 29.

The Ohio State University Wexner Medical Center, Department of Emergency Medicine, Columbus, Ohio.

Objective: Dyspnea is the second most common symptom experienced by the approximately 4.5 million patients with cancer presenting to emergency departments (ED) each year. Distinguishing pneumonia, the most common reason for presentation, from other causes of dyspnea is challenging. Read More

Open Forum Infect Dis 2021 Apr 8;8(4):ofaa622. Epub 2021 Apr 8.

Baylor College of Medicine, Houston, Texas, USA.

Background: Long regarded as the second most common cause of community-acquired pneumonia (CAP), has recently been identified with almost equal frequency as pneumococcus in patients hospitalized for CAP. The literature lacks a detailed description of the presentation, clinical features, laboratory and radiologic findings, and outcomes in pneumonia.

Methods: During 2 prospective studies of patients hospitalized for CAP, we identified 33 patients with pneumonia. Read More

Front Med (Lausanne) 2021 29;8:653294. Epub 2021 Mar 29.

State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The Department of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, School of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China.

Pulmonary infections remain a significant cause of morbidity and mortality in immunocompromised patients. The pathogens spectrum of pulmonary infection that can affect patients with human immunodeficiency virus (HIV) is wide such as bacterial, fungal, viral, parasitic organisms, and so on. The risk of multi-pathogenic pneumonia is higher in HIV-infected patients. Read More

BMC Vet Res 2021 Apr 14;17(1):163. Epub 2021 Apr 14.

Carlson College of Veterinary Medicine, Oregon State University, Corvallis, OR, USA.

Background: Renal lymphoma in dogs is rare and has a poor prognosis. Granular lymphocyte morphology is rarely reported in canine renal lymphoma. Mild to moderate polycythemia is reported in a number of canine renal lymphoma cases. Read More

Epidemiol Mikrobiol Imunol 2021 ;70(1):72-75

Acute abdominal clinical presentations as initial manifestation of meningococcal infection are uncommon and frequently provoked by hyperinvasive isolates of meningococci. 10% of patients infected by the meningococcal strain, that is on the rise in Europe, suffer from abdominal pain. We hereby report the first laboratory confirmed fatal case of an otherwise healthy adult male presented with acute abdominal pain during first 24-48 hours, masking Neisseria meningitidis (N. Read More

J Patient Saf 2021 Apr 14. Epub 2021 Apr 14.

From the Yale School of Medicine Yale New Haven Health, New Haven, Connecticut.

Background: The presentation of critically ill patients to emergency departments often necessitates interhospital transfer (IHT) to a tertiary care center for specialized neurocritical care. Patients with nontraumatic intracranial hemorrhage represent a critically ill population subject to high rates of IHT and who is thus an important target for research and quality improvement of IHT. We describe the use of an innovative simulation methodology engaging transfer staff, clinicians, and stakeholders to refine and facilitate the adoption of a standardized IHT protocol for transferring patients with neurovascular emergencies. Read More

Ann R Coll Surg Engl 2021 Apr 14. Epub 2021 Apr 14.

Cambridge University Hospitals NHS Foundation Trust, UK.

Introduction: Diverticular disease is one of the most frequent reasons for attending emergency departments and surgical causes of hospital admission. In the past decade, many surgical and gastroenterological societies have published guidelines for the management of diverticular disease. The aim of the present study was to appraise the methodological quality of these guidelines using the Appraisal of Guidelines Research and Evaluation II (AGREE II) tool. Read More

Surg Case Rep 2021 Apr 13;7(1):91. Epub 2021 Apr 13.

Hepatic Biliary and Pancreatic Cancer Center, Chongqing University Cancer Hospital, No. 181 Hanyu Road, Shapingba, Chongqing, 400030, People's Republic of China.

Background: The majority of ingested foreign bodies pass through the gastrointestinal tract smoothly, with less than 1% requiring surgery. Fish bone could perforate through the wall of stomach or duodenum and then migrate to other surrounding organs, like the pancreas and liver.

Case Presentation: We report herein the case of a 67-year-old male who presented with sustained mild epigastric pain. Read More

Ann Hematol 2021 Apr 13. Epub 2021 Apr 13.

Internal Medicine and Hematology, Mustafa Kemal University Faculty of Medicine, Hatay, Turkey.

Thalassemia is a common genetic disorder. We aimed to present thalassemia mutation data that covers a period of 7 years from the Mediterranean region of Turkey by comparing with hemoglobin indices and to contribute to prenatal diagnosis and genetic counseling studies which should be decided very quickly. In this study, in which a retrospective archive was scanned, the cases were first grouped as α and β thalassemia, and then β thalassemia mutations were examined in a total of 5 groups as UTR-Pro, Codon, IVS, β, and β. Read More

Transl Androl Urol 2021 Mar;10(3):1342-1346

Department of Urology, University of Arizona College of Medicine, Tucson, AZ, USA.

Leiomyosarcoma (LMS) is one of the most common forms of soft tissue sarcoma with approximately 2,500 cases per year in the United States. The symptoms LMS vary depending upon the location, size, and spread of the tumor. In early stages, it may not be associated with any obvious symptoms so diagnosis and treatment may be delayed. Read More

Cureus 2021 Mar 10;13(3):e13814. Epub 2021 Mar 10.

Emergency Medicine, Stanford University, Stanford, USA.

Congenital lobar emphysema (CLE) and congenital pulmonary lymphangiectasis (CPL) are rare conditions that are most often identified with prenatal ultrasonography. Occasionally, this disease process is first identified in the emergency department (ED), where the physician should avoid common pitfalls in order to prevent acute decompensation. To the best of our knowledge, there are no prior reports in the emergency medicine literature of CLE or CPL presenting to the ED as undifferentiated respiratory distress in an infant. Read More