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Hematological Indices Predicting the Severity of Acute Pancreatitis Presenting to the Emergency Department: A Retrospective Analysis.

Cureus 2021 Jul 30;13(7):e16752. Epub 2021 Jul 30.

General Surgery, Civil Hospital Karachi, Karachi, PAK.

Introduction Acute pancreatitis is defined as inflammation of the pancreas. The body responds to inflammation by producing excessive neutrophils and causing programmed cell death of lymphocytes. This leads to immunological instability, which increases the severity of the disease and mortality rate. Read More

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Developmental dysplasia of the hip: Beyond the screening. Physical exam is our pending subject.

An Pediatr (Engl Ed) 2021 Sep 10. Epub 2021 Sep 10.

Hospital Universitario Río Hortega de Valladolid, Valladolid, Spain.

Introduction: Developmental dysplasia of the hip is a common cause of disability among children. Early detection leads to better prognosis. There are some risk factors that increase the possibility of developing a dysplasia. Read More

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September 2021

Phylogenetic analyses, protein modeling and active site prediction of two pathogenesis related (PR2 and PR3) genes from bread wheat.

PLoS One 2021 10;16(9):e0257392. Epub 2021 Sep 10.

Centre of Agricultural Biochemistry and Biotechnology (CABB), University of Agriculture, Faisalabad, Pakistan.

Wheat is a major staple food and has been extensively grown around the globe. Sessile nature of plants has exposed them to a lot of biotic and abiotic stresses including fungal pathogen attack. Puccinia graminis f. Read More

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September 2021

Deeper Sections: Its Frequency and Diagnostic Utility in Histopathology of Noncutaneous Small Biopsy Specimen in a Tertiary Hospital in Nepal.

Adv Med 2021 28;2021:5926047. Epub 2021 Aug 28.

Department of Pathology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal.

Background: Biopsy is an important tool for accurate diagnosis of disease in histopathology which can be examined at multiple levels during microscopic examination. The initial sections may not be representative of the entire biopsy, which leads to frequent request for deeper sections. This study assessed the frequency and diagnostic utility of deeper sections in noncutaneous small biopsy specimens at a tertiary hospital. Read More

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Integrated disease management interventions for patients with chronic obstructive pulmonary disease.

Cochrane Database Syst Rev 2021 Sep 8;9:CD009437. Epub 2021 Sep 8.

Department of Public Health and Primary Care, Leiden University Medical Center (LUMC), Leiden, Netherlands.

Background: People with chronic obstructive pulmonary disease (COPD) show considerable variation in symptoms, limitations, and well-being; this often complicates medical care. A multi-disciplinary and multi-component programme that addresses different elements of care could improve quality of life (QoL) and exercise tolerance, while reducing the number of exacerbations.

Objectives: To compare the effectiveness of integrated disease management (IDM) programmes versus usual care for people with chronic obstructive pulmonary disease (COPD) in terms of health-related quality of life (QoL), exercise tolerance, and exacerbation-related outcomes. Read More

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September 2021

Case Report: Hereditary Alpha Tryptasemia in Children: A Pediatric Case Series and a Brief Overview of Literature.

Front Pediatr 2021 20;9:716786. Epub 2021 Aug 20.

Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.

Hereditary alpha tryptasemia (HαT) is a recently described autosomal dominant genetic trait caused by an increased copy number of the TPSAB1 gene. It commonly leads to elevated basal serum tryptase levels, and it is associated with heterogeneous clinical manifestations. Some individuals report few to no symptoms, while others present with a spectrum of debilitating features. Read More

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Incremental biomarker and clinical outcomes after switch from enzyme therapy to eliglustat substrate reduction therapy in Gaucher disease.

Mol Genet Metab Rep 2021 Dec 28;29:100798. Epub 2021 Aug 28.

Yale Internal Medicine: Digestive Diseases, New Haven, CT, USA.

In Gaucher disease (GD), genetic deficiency of acid β-glucosidase leads to accumulation of its substrate glucosylceramide (GlcCer) and glucosylsphingosine (GlcSph). Lipid-laden cells, most prominently seen as macrophages engorged with GlcCer and GlcSph-laden lysosomes, trigger chronic metabolic inflammation and multisystemic phenotypes. Among the pleiotropic effects of inflammatory cascades, the induction of glucosylceramide synthase accentuates the primary metabolic defect. Read More

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December 2021

Current State of Stroke Care in the Philippines.

Front Neurol 2021 17;12:665086. Epub 2021 Aug 17.

Department of Neurosciences, College of Medicine, Philippine General Hospital, University of the Philippines, Manila, Philippines.

Stroke remains the leading cause of disability and death in the Philippines. Evaluating the current state of stroke care, the needed resources, and the gaps in health policies and programs is crucial to decrease stroke-related mortality and morbidity effectively. This paper aims to characterize the Philippines' stroke system of care and network using the World Health Organization health system building blocks framework. Read More

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Assessment of a widely applicable torso ECG in acute coronary syndrome.

Indian Heart J 2021 Jul-Aug;73(4):487-491. Epub 2021 Apr 6.

LTMG Hospital, Sion, Mumbai, India.

Introduction: The time from symptom onset to arrival at healthcare facility, and door to reperfusion time in treatment of acute coronary syndrome (ACS) can be improved significantly if the patient or the relatives can record a 12-lead ECG at home and transmit it to the physician for prompt interpretation. To make this widely applicable, the 12-lead ECG recording device has to be simple and user friendly. In this regard, torso ECG (T-ECG) electrode positions that are less cumbersome than the conventional ECG (C-ECG) electrode positions are an alternative worthy of consideration. Read More

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Medical Device-related Pressure Injuries Associated With Electroencephalogram Leads in a Tertiary Care Children's Hospital: A Retrospective Chart Review.

Wound Manag Prev 2021 Sep;67(9):25-32

Children's Wisconsin, Milwaukee, Wisconsin.

Background: Medical device-related pressure injuries (MDRPIs) present a substantial safety risk for children who are hospitalized.

Purpose: This study aimed to describe patient and clinical characteristics of children who develop MDRPIs related to electroencephalogram (EEG) leads, determine risk factors associated with their development, and determine if there are common risk factors that can lead to actionable strategies to reduce MDRPIs related to EEG leads.

Methods: A retrospective review was completed of the electronic health records of all 3136 children who had EEG lead placements between January 1, 2014, and April 16, 2018, at a large tertiary care children's hospital. Read More

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September 2021

Prevalence and predictors of non-alcoholic fatty liver disease in tertiary care hospital of Taif, Saudi Arabia: A retrospective study.

Saudi J Biol Sci 2021 Sep 1;28(9):4921-4925. Epub 2021 Jun 1.

Department of Pharmacy Practice, College of Pharmacy, AlMaarefa University, Dariyah, 13713 Riyadh, Saudi Arabia.

Background: The prevalence of nonalcoholic fatty liver disease (NAFLD) in Saudi Arabia is predicted to exceed 30% by 2030. NAFLD leads to liver fibrosis, thus increasing morbidity and health care burden. Obesity and diabetes have been strongly associated with NAFLD in different cities in Saudi Arabia. Read More

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September 2021

Does Operative Management of Epidural Abscesses Increase Healthcare Expenditures up to 1 Year After Treatment?

Clin Orthop Relat Res 2021 Aug 31. Epub 2021 Aug 31.

Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.

Background: The incidence of spinal epidural abscesses is increasing. What is more, they are associated with high rates of morbidity and mortality. Advances in diagnostic imaging and antibiotic therapies have made earlier diagnosis and nonoperative management feasible in appropriately selected patients. Read More

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Simulation Improves Internal Medicine Resident Confidence With Defibrillation, Cardioversion, and Transcutaneous Pacemaker Use.

Cureus 2021 Jul 26;13(7):e16648. Epub 2021 Jul 26.

Medical Simulation, OhioHealth, Columbus, USA.

Introduction While many graduate medical education programs require residents to be certified in advanced cardiac life support, this does not cover all aspects of cardiac stabilization in patients with a pulse. Residents are often on the front lines of providing care to patients with life-threatening dysrhythmias. Our residents expressed a lack of confidence in their ability to provide this care. Read More

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Lost diagnoses in not otherwise specified headache in Emergency Department.

Acta Neurol Belg 2021 Aug 27. Epub 2021 Aug 27.

Clinical Unit of Neurology, Headache Centre, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste-ASUGI, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy.

 The diagnosis of Not Otherwise Specified (NOS) headaches in the Emergency Department (ED) is frequent despite many specialist visits performed. The aim of the study was to examine specialist visits carried out in the patients discharged from ED with diagnosis of NOS headache to evaluate discrepancies between specialist and ED diagnosis at discharge. We retrospectively (1. Read More

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A New Dioxazolone for the Synthesis of 1,2-Aminoalcohols via Iridium(III)-Catalyzed C(sp )-H Amidation.

Angew Chem Int Ed Engl 2021 Aug 24. Epub 2021 Aug 24.

University of Basel, Department of Chemistry, St. Johanns-Ring 19, 4056, Basel, Switzerland.

Vicinal aminoalcohols are widespread structural motifs in bioactive molecules. We report the development of a new dioxazolone reagent containing a p-nitrophenyldifluoromethyl group, which 1. displays a good safety profile; 2. Read More

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Meso-Rex bypass for the management of extrahepatic portal vein obstruction in adults (with video).

Hepatobiliary Pancreat Dis Int 2021 Aug 14. Epub 2021 Aug 14.

Service de Chirurgie et Transplantation Abdominale, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, 10 Avenue Hippocrate, Brussels 1200, Belgium; Pôle de Chirurgie Expérimentale et Transplantation, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium. Electronic address:

Background: Extrahepatic portal vein obstruction (EHPVO) results in severe portal hypertension (PHT) leading to severely compromised quality of life. Often, pharmacological and endoscopic management are unable to solve this problem. Restoring hepatic portal flow using meso-Rex bypass (MRB) may solve it. Read More

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X-Linked Hypophosphatemic Rickets: Multisystemic Disorder in Children Requiring Multidisciplinary Management.

Front Endocrinol (Lausanne) 2021 6;12:688309. Epub 2021 Aug 6.

Laboratory of Pediatric Endocrinology and Bone Densitometry Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.

X-linked hypophosphatemic rickets (XLH) is the commonest inherited form of rickets. It is caused by an impaired regulation of fibroblast growth factor 23 (FGF23) due to a PHEX gene mutation, which leads to reduced tubular reabsorption of phosphate and renal 1α-hydroxylase activity and increased renal 24-hydroxylase activity. Hypophosphatemia associated with renal phosphate wasting, normal serum levels of calcium, parathyroid hormone, and 25-hydroxyvitamin D represents the main biochemical sign in affected patients. Read More

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Partial EMT in Squamous Cell Carcinoma: A Snapshot.

Int J Biol Sci 2021 13;17(12):3036-3047. Epub 2021 Jul 13.

Department of Orthodontics II, Affiliated Stomatological Hospital of Zunyi Medical University, Zunyi 563000, China.

In the process of cancer EMT, some subgroups of cancer cells simultaneously exhibit both mesenchymal and epithelial characteristics, a phenomenon termed partial EMT (pEMT). pEMT is a plastic state in which cells coexpress epithelial and mesenchymal markers. In squamous cell carcinoma (SCC), pEMT is regulated, and the phenotype is maintained via the HIPPO pathway, NOTCH pathway and TGF-β pathways and by microRNAs, lncRNAs and the cancer microenvironment (CME); thus, SCC exhibits aggressive tumorigenic properties and high stemness, which leads collective migration and therapy resistance. Read More

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Korean physician prescription patterns for home oxygen therapy in chronic obstructive pulmonary disease patients.

Korean J Intern Med 2021 Aug 20. Epub 2021 Aug 20.

Lung Research Institute of Hallym University College of Medicine, Chuncheon, Korea.

Background/aims: Hypoxemia in chronic obstructive pulmonary disease (COPD) leads to reduced ability to exercise, decreased quality of life, and, eventually, increased mortality. Home oxygen therapy in patients with severe COPD reduces distress symptoms and mortality rates. However, there have been few studies on physicians' prescription behavior toward home oxygen therapy. Read More

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Evaluation of ultrasound-guided bilateral low thoracic erector spinae plane block for postoperative analgesia in cesarean delivery patients: a prospective, randomized, controlled clinical trial.

Braz J Anesthesiol 2021 Aug 16. Epub 2021 Aug 16.

Maltepe University Faculty of Medicine, Department of Anesthesiology, Istanbul, Turkey.

Background: Erector spinae plane block (ESPB) is a recently described block. In many reports, ESPB has been reported to provide effective postoperative analgesia in patients undergoing cesarean delivery (CD). Herein, we compared the effectiveness of ESPB and control group in postoperative analgesia in patients undergoing CD under spinal anesthesia. Read More

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Protocol for a randomised controlled feasibility study of psychologically informed vestibular rehabilitation for people with persistent dizziness: INVEST trial.

Pilot Feasibility Stud 2021 Aug 16;7(1):156. Epub 2021 Aug 16.

Health Psychology Section, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK.

Background: Dizziness is a common complaint that often persists and leads to disability and distress. Several cognitive and behavioural responses may contribute to the neurobiological adaptations that maintain persistent vestibular symptoms. This paper will present the protocol of a two-arm parallel group feasibility randomised controlled trial designed to determine whether a fully powered efficacy trial is achievable by examining the feasibility of recruitment, acceptability and potential benefits of an integrated cognitive behavioural therapy and vestibular rehabilitation (CBT-VR) treatment for people with persistent dizziness. Read More

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Single-centre, open-label, randomised, trial to compare rapid molecular point-of-care streptococcal testing to standard laboratory-based testing for the management of streptococcal pharyngitis in children: study protocol.

BMJ Open 2021 08 11;11(8):e047271. Epub 2021 Aug 11.

Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.

Introduction: Streptococcal pharyngitis, which commonly occurs in children, should be treated with antibiotics. Clinical prediction rules to differentiate streptococcal pharyngitis from viral infection are not recommended in children. Rapid point-of-care (POC) antigen tests have limited sensitivity and so are not often used in Canadian paediatric emergency departments (EDs). Read More

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The aetiology of medical device-related pressure ulcers and how to prevent them.

Amit Gefen

Br J Nurs 2021 Aug;30(15):S24-S30

Professor of Biomedical Engineering, Herbert J Berman Chair in Vascular Bioengineering, Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Israel.

This article provides an introduction to the aetiology of medical device-related pressure ulcers (MDRPUs), describes the vicious cycle that leads to these injuries and highlights bioengineering methodologies and findings that connect the aetiology to the clinical practice of preventing MDRPUs. Specifically, the vicious cycle of MDRPUs is triggered by the sustained tissue deformations induced by a skin-contacting device. The primary, deformation-inflicted cell damage leads to a secondary inflammatory-oedema-related damage and then to tertiary ischaemic damage. Read More

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Mechanism Exploration of 3-Hinge Gyral Formation and Pattern Recognition.

Cereb Cortex Commun 2021 3;2(3):tgab044. Epub 2021 Jul 3.

School of Environmental, Civil, Agricultural, and Mechanical Engineering, College of Engineering, the University of Georgia, Athens, GA 30602, USA.

The 3-hinge gyral folding is the conjunction of gyrus crest lines from three different orientations. Previous studies have not explored the possible mechanisms of formation of such 3-hinge gyri, which are preserved across species in primate brains. We develop a biomechanical model to mimic the formation of 3-hinge patterns on a real brain and determine how special types of 3-hinge patterns form in certain areas of the model. Read More

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Incremental modification of robotic prostatectomy technique can lead to aggregated marginal gains to significantly improve functional outcomes without compromising oncological control.

J Robot Surg 2021 Aug 9. Epub 2021 Aug 9.

Department of Urology, Cambridge University Hospitals, Hills Road, Cambridge, CB2 0QQ, UK.

Introduction And Objectives: Surgeons should aim for continuous quality improvement. The aim of this study was to evaluate the impact of incremental changes to Robot Assisted Radical Prostatectomy (RARP) technique on intra-operative and early post-operative outcomes.

Patients And Methods: All cases of RARP performed by a single surgeon in a tertiary institution over a 2-year period were included in this evaluation. Read More

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Paricalcitol versus Calcitriol + Cinacalcet for the Treatment of Secondary Hyperparathyroidism in Chronic Kidney Disease in China: A Cost-Effectiveness Analysis.

Front Public Health 2021 21;9:712027. Epub 2021 Jul 21.

Department of Clinical Pharmacy, School of Pharmacy, Nanjing Medical University, Nanjing, China.

Chronic Kidney Disease (CKD) is a global chronic disease with increasing prevalence in recent years, particularly CKD accompanied by Secondary Hyperparathyroidism (SHPT) leads to reduced quality of life, increased mortality, a considerable economic burden for patients and society. The aim of this study was to investigate the cost-effectiveness analysis of paricalcitol vs. calcitriol + cinacalcet for CKD patients with SHPT in China in 2020. Read More

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Elevated serum lactate as a predictor of outcomes in patients following major abdominal surgery at a tertiary hospital in Uganda.

BMC Surg 2021 Aug 7;21(1):319. Epub 2021 Aug 7.

Department of Surgery, College of Health Sciences, Makerere University, Kampala, Uganda.

Introduction: Major abdominal surgery is still a great contributor to postoperative morbidity and mortality in developing countries. Major abdominal surgery leads to hypoperfusion, which has an impact on postoperative morbidity and mortality. Lactate, a biomarker for hypoperfusion is under utilized in Uganda. Read More

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The Role of Dendritic Cells during Physiological and Pathological Dentinogenesis.

J Clin Med 2021 Jul 29;10(15). Epub 2021 Jul 29.

Department of Tissue Regeneration and Reconstruction, Division of Anatomy and Cell Biology of the Hard Tissue, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8514, Japan.

The dental pulp is a soft connective tissue of ectomesenchymal origin that harbors distinct cell populations, capable of interacting with each other to maintain the vitality of the tooth. After tooth injuries, a sequence of complex biological events takes place in the pulpal tissue to restore its homeostasis. The pulpal response begins with establishing an inflammatory reaction that leads to the formation of a matrix of reactionary or reparative dentin, according to the nature of the exogenous stimuli. Read More

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Strengthening sepsis care at a tertiary care teaching hospital in New Delhi, India.

BMJ Open Qual 2021 07;10(Suppl 1)

Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India.

Introduction: Failure of early identification of sepsis in the emergency department (ED) leads to significant delays in antibiotic administration which adversely affects patient outcomes.

Aim: The primary objective of our Quality Improvement (QI) project was to reduce the door-to-antibiotic time (DTAT) by 30% from the preintervention in patients with suspected sepsis. Secondary objectives were to increase the blood culture collection rate by 30% from preintervention, investigate the predictors of improving DTAT and study the effect of these interventions on 24-hour in-hospital mortality. Read More

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Antibiotic stewardship in a tertiary care NICU of northern India: a quality improvement initiative.

BMJ Open Qual 2021 07;10(Suppl 1)

Deparment of Neonatology, Neoclinic, Jaipur, Rajasthan, India.

Background: The overuse of antibiotics in newborns leads to increased mortality and morbidities. Implementation of a successful antibiotic stewardship programme (ASP) is necessary to decrease inappropriate use of antibiotics and its adverse effects.

Problem: Our neonatal intensive care unit (NICU) is a tertiary referral centre of north India, consisting of all outborn babies mostly with sepsis caused by high rate of multidrug-resistant organisms (MDROs). Read More

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