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Mechanical Thrombectomy of Carotid Terminus Occlusion Using Direct Aspiration Technique-Video Illustration: 2-Dimensional Operative Video.

Oper Neurosurg (Hagerstown) 2021 Jul 31. Epub 2021 Jul 31.

Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA.

Acute carotid terminus occlusion (CTO) is responsible for up to 5% of acute ischemic strokes secondary to emergent large vessel occlusion (ELVO) and up to 20% of acute internal carotid artery (ICA) occlusions.1 The term "CTO" has also been used to describe occlusions in the supra-clinoid segment or at the bifurcation of the ICA. Compared to other ELVOs, patients with CTO present with higher stroke severity and larger infarct volume, likely to be a result of disruption of direct Circle of Willis collaterals across the anterior communicating artery (AComA) and posterior communicating artery (PComA). Read More

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Characterization of a Portuguese family with Charcot-Marie-Tooth disease type 1E due to a novel point mutation in the PMP22 gene.

Clin Neurol Neurosurg 2021 Jul 21;208:106829. Epub 2021 Jul 21.

Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Rua da Junqueira 126, 1349-019 Lisbon, Portugal; CEDOC Chronic Diseases Research Centre, Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal.

Introduction: Point mutations in the Peripheral Myelin Protein 22 (PMP22) gene comprise less than 5% of the Charcot-Marie-Tooth (CMT) type 1 cases, and individualize either the CMT 1E subtype, or Hereditary Neuropathy with Liability to Pressure Palsy. The phenotype of CMT 1E presents with a severe early-onset polyneuropathy associated with deafness, although the clinical spectrum is broad.

Case Report: We describe a novel PMP22 gene point mutation (c. Read More

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Diabetic ketoacidosis and mortality in COVID-19 infection.

Diabetes Metab 2021 Jul 28:101267. Epub 2021 Jul 28.

Division of Endocrinology, Department of Medicine, Columbia University Irving Medical Center, New York, NY. Electronic address:

Aim: - Patients with diabetes have increased morbidity and mortality from COVID-19. Case reports describe patients with simultaneous COVID-19 and diabetic acidosis (DKA), however there is limited data on the prevalence, predictors and outcomes of DKA in these patients.

Methods: - Patients with COVID-19 were identified from the electronic medical record. Read More

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Development of a CNS-permeable reactivator for nerve agent exposure: an iterative, multi-disciplinary approach.

Sci Rep 2021 Jul 30;11(1):15567. Epub 2021 Jul 30.

Nuclear and Chemical Sciences Division, Lawrence Livermore National Laboratory, Livermore, CA, 94550, USA.

Nerve agents have experienced a resurgence in recent times with their use against civilian targets during the attacks in Syria (2012), the poisoning of Sergei and Yulia Skripal in the United Kingdom (2018) and Alexei Navalny in Russia (2020), strongly renewing the importance of antidote development against these lethal substances. The current standard treatment against their effects relies on the use of small molecule-based oximes that can efficiently restore acetylcholinesterase (AChE) activity. Despite their efficacy in reactivating AChE, the action of drugs like 2-pralidoxime (2-PAM) is primarily limited to the peripheral nervous system (PNS) and, thus, provides no significant protection to the central nervous system (CNS). Read More

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Gabapentin in Infants: Critical Evaluation of a Novel Sedative/Analgesic Medication.

Neonatal Netw 2021 Jul;40(4):267-272

Chronic pain and agitation can complicate the clinical course of critically ill infants. Randomized controlled trials of analgesia and sedation in neonatal intensive care have focused on relatively short durations of exposure. To date, clinicians have few options to treat chronic visceral pain and hyperalgesia. Read More

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Implementation of an older adult epilepsy clinic utilizing pharmacist services.

J Am Pharm Assoc (2003) 2021 Jul 10. Epub 2021 Jul 10.

Background: Antiseizure medications are commonly associated with adverse effects including behavioral and cognitive issues, drug interactions, idiosyncratic reactions, and long-term complications, which can lead to non-adherence. At the same time, there are limited reports describing multidisciplinary models of epilepsy care that include pharmacists.

Objective: To describe the pharmacist services in an epilepsy clinic for older adults and document the patient care delivered using this design. Read More

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Measuring hygiene competence: the picture-based situational judgement test HygiKo.

BMC Med Educ 2021 Jul 30;21(1):410. Epub 2021 Jul 30.

Klinikum rechts der Isar, TUM Medical Education Center, Fakultät für Medizin, TU München, Ismaninger Straße 22, D-81675, München, Germany.

Background: With the onset of the COVID-19 pandemic at the beginning of 2020, the crucial role of hygiene in healthcare settings has once again become very clear. For diagnostic and for didactic purposes, standardized and reliable tests suitable to assess the competencies involved in "working hygienically" are required. However, existing tests usually use self-report questionnaires, which are suboptimal for this purpose. Read More

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Primary synovial sarcoma of thyroid gland: A case report and review of literature.

Int J Surg Case Rep 2021 Jul 26;85:106245. Epub 2021 Jul 26.

Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. Electronic address:

Introduction And Importance: Synovial cell sarcoma (SS) is an extremely rare mesenchymal malignancy, representing nearly 10% of all soft-tissue sarcomas. These high-grade soft tissue sarcomas commonly arise in the para-articular regions of lower extremities. However, 15% of Synovial sarcomas has been described at Unusual locations, including head, neck, and trunk. Read More

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DICER1-associated malignancies mimicking germ cell neoplasms: Report of two cases and review of the literature.

Pathol Res Pract 2021 Jul 16;225:153553. Epub 2021 Jul 16.

Pathology Unit, Department of Laboratories, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy 00165. Electronic address:

DICER1 syndrome is characterized by a unique combination of features and a growing list of associated rare tumors. Traditionally, gonadal or extra-gonadal teratomas have not been considered part of this spectrum, with only rare DICER1-related teratoid neoplasms recently reported. Besides, their methylation profiles remain elusive. Read More

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Robot-assisted exploration of somatic nerves in the pelvis and transection of the sacrospinous ligament for Alcock canal syndrome.

J Minim Invasive Gynecol 2021 Jul 27. Epub 2021 Jul 27.

Department of Obstetrics and Gynecology, Kurashiki Medical Center, Okayama, Japan. Electronic address:

Objective: Some articles have reported the surgical management of Alcock canal syndrome (ACS) using transperineal [1], transgluteal [2], or conventional laparoscopic approach [3, 4]. In 2015, Rey and Oderda reported the first robotic neurolysis of the pudendum, providing the advantages of robot-assisted surgery: magnified and 3-dimensional vision and greater precision of movements [5]. However, to our knowledge, there have been no reports of the use of a robotic platform for the treatment of ACS in the field of gynecology. Read More

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Inborn errors of metabolism and COVID-19: Evaluation of the metabolic outcome.

Pediatr Int 2021 Jul 30. Epub 2021 Jul 30.

Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Pediatrics, Division of Nutrition and Metabolism, Istanbul, Turkey.

Background: Infectious diseases can result a catabolic state and possibly trigger an acute metabolic decompensation in inborn errors of metabolism (IEM) that will even be life threatening. Studies regarding the course of SARS-CoV-2 infections in patients with IEM are generally limited to case reports. Here, we aimed to evaluate the clinical findings of COVID-19 and describe the impact of SARS-CoV-2 infections on metabolic outcome in IEM patients. Read More

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Variation in Hospital Performance Measures from the Turkey Ministry of Health.

Int J Qual Health Care 2021 Jul 30. Epub 2021 Jul 30.

Precision Vaccines Program, Department of Pediatrics, Harvard Medical School, Boston Children's Hospital, Boston, MA, USA.

Background: The Turkish healthcare system has seen broad population-based improvements in expanded health insurance coverage and access to healthcare services. Hospital performance in this national system is understudied. We aimed to identify trends in hospital performance over time following implementation of the Health Transformation Program and describe how regional outcomes correlate with regional vital statistics. Read More

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Prevalence and pain distribution of anterior knee pain in college basketball players.

J Athl Train 2021 Jul 30. Epub 2021 Jul 30.

1La Trobe Sport and Exercise Medicine Research Centre; College of Science, Health and Engineering; La Trobe University; Australia.

Context: Causes of anterior knee pain (AKP) in jumping athletes include patellofemoral pain and patellar tendinopathy. Differential diagnosis of AKP is challenging, with variation in clinical presentations. No previous research has used pain location to describe AKP in basketball athletes. Read More

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Pediatric ACL Revision Using Salvaged Iliotibial Band Autograft in a Physeal-Sparing Multiligamentous Knee Reconstruction: A Case Report.

JBJS Case Connect 2021 Jul 30;11(3). Epub 2021 Jul 30.

Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland.

Case: Iliotibial band (ITB) autograft is used for anterior cruciate ligament (ACL) reconstruction in prepubescent patients. No reports have described ITB salvage techniques for failed reconstruction. We describe a 13-year-old boy who sustained a multiligamentous knee injury, experienced a failed primary reconstruction, and required a revision ITB ACL, lateral collateral ligament, and posterior lateral corner reconstruction with reuse of his ITB autograft. Read More

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Low-level mosaicism in tuberous sclerosis complex in four unrelated patients: Comparison of clinical characteristics and diagnostic pathways.

Am J Med Genet A 2021 Jul 30. Epub 2021 Jul 30.

Institute of Human Genetics, Medical University of Innsbruck, Innsbruck, Austria.

Tuberous sclerosis complex (TSC) is an autosomal dominant neurocutaneous syndrome caused by either TSC1 or TSC2 gene mutations. About 15% of TSC patients remain without genetic diagnosis by conventional analysis despite clinical evidence. It is important to identify somatic mosaics, as therapeutic options are now available in patients with TSC1 or TSC2 mutations. Read More

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An analysis of select swine feed ingredients and pork products imported into the US from African Swine Fever Virus (ASFV) Affected Countries.

Transbound Emerg Dis 2021 Jul 30. Epub 2021 Jul 30.

VetNOW, Canonsburg, PA.

The potential for feed ingredients to serve as a vehicle for African swine fever virus (ASFV) introduction to the US remains a significant concern. It is therefore imperative that channels through which high-risk livestock feeds and feed ingredients are imported into the US from ASFV positive countries are identified and considered into the USDA's ASF National Response Framework. The purpose of this study is to demonstrate the use of a novel analytical tool to categorically quantify pork products and potential high-risk feed ingredients that have entered the US from ASFV-positive countries over a five year period (2016-2020). Read More

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Multisystemic lymphoplasmacytic inflammation associated with PCV-3 in wasting pigs.

Transbound Emerg Dis 2021 Jul 30. Epub 2021 Jul 30.

Servei de Diagnòstic de Patologia Veterinària, Facultat de Veterinària, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, 08193, Spain.

Porcine circovirus 3 (PCV-3) has been detected in diseased and healthy pigs of different ages. Several reports have associated the agent with reproductive failure and mummified and stillborn piglets. One report from North America have proposed a consistent potential association with postweaning disorders. Read More

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Effects of Knockdown of XPO5 by siRNA on the Biological Behavior of Head and Neck Cancer Cells.

Laryngoscope 2021 Jul 30. Epub 2021 Jul 30.

Department of ENT, Adana City Training and Research Hospital, Health Science University, Adana, Turkey.

Objectives/hypothesis: Dysregulated expression of microRNAs (miRNAs) and dysregulation of the mechanisms that regulate them are associated with carcinogenesis. Exportin-5 (XPO5), a member of the Karyopherin family, is responsible for the transfer of pre-miRNAs from the nucleus to the cytoplasm. Despite the high oncogenic potential of XPO5 as a critical regulator of the biogenesis of miRNAs, its role in head and neck squamous cell carcinoma (HNSCC) biology has not been explained yet. Read More

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A novel technique for large lateral enterocutaneous fistula management after intestinal transplantation.

Pediatr Transplant 2021 Jul 30:e14105. Epub 2021 Jul 30.

Department Pediatric Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.

Background: Enterocutaneous fistula (ECF) is a serious and complex problem when affecting children, being responsible for a high morbidity burden, with an estimated mortality rate of 10 to 20%. There are many therapeutic options, including surgery and a wide variety of nonoperative strategies. Prognosis of ECF closure depends on the output and also on the patency of distal bowel. Read More

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A novel likely pathogenic heterozygous HECW2 missense variant in a family with variable expressivity of neurodevelopmental delay, hypotonia, and epileptiform EEG patterns.

Am J Med Genet A 2021 Jul 30. Epub 2021 Jul 30.

Department of Neurology, University Medical Center, Georg-August University, Göttingen, Germany.

Pathogenic variants in HECW2 are extremely rare. So far, only 19 cases have been reported. They were associated with epilepsy, intellectual disability, absent language, hypotonia, and autism. Read More

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PLXNA2 as a candidate gene in patients with intellectual disability.

Am J Med Genet A 2021 Jul 29. Epub 2021 Jul 29.

Department of Translational Genomics, Center for Genomic Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.

Intellectual disability (ID) is one of the most common disabilities in humans. In an effort to contribute to the expanding genetic landscape of ID, we describe a novel autosomal recessive ID candidate gene. Combined autozygome/exome analysis was performed in two unrelated consanguineous families with ID. Read More

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Long-Term Failure Rates of Interval Filshie Clips As a Method of Permanent Contraception.

Womens Health Rep (New Rochelle) 2021 27;2(1):279-284. Epub 2021 Jul 27.

Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah, USA.

In 1996, the U.S. Collaborative Review of Sterilization (CREST) reported permanent contraception failure rates by method, but did not include the Filshie clip. Read More

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Healthcare costs due to low back pain in the emergency department and inpatient setting in Sydney, Australia.

Lancet Reg Health West Pac 2021 Feb 29;7:100089. Epub 2021 Jan 29.

Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia.

Background: Low back pain is the leading cause of disability worldwide and a common presentation to emergency departments, often resulting in subsequent admissions to hospital. There have been several studies investigating the cost of low back pain to society, but few specific to the emergency department and inpatient setting, especially in Australia. The aim was to describe the cost of low back pain in Australian public hospital emergency departments, and inpatient settings, and explore healthcare costs associated with different care pathways. Read More

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February 2021

The impact of the rotavirus vaccine on diarrhoea, five years following national introduction in Fiji.

Lancet Reg Health West Pac 2021 Jan 25;6:100053. Epub 2020 Nov 25.

Infection and Immunity, Murdoch Children's Research Institute, Parkville, VIC, Australia.

Background: In 2012, Fiji became the first independent Pacific island country to introduce rotavirus vaccine. We describe the impact of rotavirus vaccine on all-cause diarrhoea admissions in all ages, and rotavirus diarrhoea in children <5 years of age.

Methods: An observational study was conducted retrospectively on all admissions to the public tertiary hospitals in Fiji (2007-2018) and prospectively on all rotavirus-positive diarrhoea admissions in children <5 years at two hospital sites (2006-2018, and 2010-2015), along with rotavirus diarrhoea outpatient presentations at one secondary public hospital (2010-2015). Read More

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January 2021

Recurrent Acute Kidney Injury with Severe Loin Pain and Patchy Renal Ischaemia after Anaerobic Exercise without Renal Hypouricaemia in a New Zealand European Male.

Case Rep Nephrol Dial 2021 May-Aug;11(2):176-182. Epub 2021 Jul 5.

Adult Emergency Department, Auckland District Health Board, Auckland, New Zealand.

Acute kidney injury with severe loin pain and patchy renal ischaemia after anaerobic exercise (ALPE) is a rare clinical syndrome. ALPE has predominantly been described in Japanese and Korean populations to date. Many cases and most recurrent examples are associated with renal hypouricaemia. Read More

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Patiromer in a Patient with Severe Hyperkalemia on Incremental Hemodialysis with 1 Session per Week: A Case Report and Literature Review.

Case Rep Nephrol Dial 2021 May-Aug;11(2):158-166. Epub 2021 Jun 28.

Department of Nephrology, Central Defense Gomez Ulla Hospital, Madrid, Spain.

Hyperkalemia is common in patients with ESRD, undergoing hemodialysis (HD), and is associated with an increase in hospitalization and mortality. Residual kidney function in long-term dialysis patients is associated with lower morbidity and mortality in HD patients. Although the 2015 National Kidney Foundation-Kidney Disease Outcomes Quality Initiate (NKD-KDOQI) guidelines allow the reduction in the weekly HD dose for patients with a residual kidney urea clearance (Kur) >3 mL/min/1. Read More

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Acute Septic Carpal Tunnel Syndrome in a Rock Climber.

J Orthop Case Rep 2021 Apr;11(4):100-103

Rothman Orthopaedic Institute, New York, United States.

Introduction: Rock climbing is an increasingly popular sport in the United States. Acute and chronic upper extremity injuries related to rock climbing are frequently reported and include flexor pulley ruptures and hamate stress fractures. Deep space hand infections after indoor rock climbing are a sport-related pathology that has yet to be reported. Read More

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Holistic Approach in the Management of Skeletal Deformity in a Case of Homocystinuria.

J Orthop Case Rep 2021 Apr;11(4):1-5

Orthopaedic Research Group, Coimbatore, Tamil Nadu, India.

Introduction: Homocystinuria has a wide range of clinical presentations ranging from near normal intelligence and appearance with just lens dislocation and minimal skeletal deformities to severe mental retardation with gross skeletal deformities. In this background, we describe one such case with skeletal deformity managed comprehensively.

Case Report: A 17-year-old boy presented with complaints of deformity of the left lower limb since childhood more evident for the past 5 years along with a history of blurring of vision. Read More

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Healed Varicella Pneumonia: A Case of Diffuse Pulmonary Microcalcifications.

Cureus 2021 Jun 24;13(6):e15890. Epub 2021 Jun 24.

Internal Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, USA.

Varicella pneumonia is a potentially fatal complication of the Varicella-zoster virus (VZV), which causes the well-known chickenpox disease of childhood. Identifying this type of pneumonia by characteristic features is important for radiologists and radiology residents. Typical manifestations of active Varicella pneumonia include diffuse pulmonary nodules, which may mimic other diseases. Read More

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An Extremely Rare Case of Birk-Barel Syndrome With Severe Central Apneas.

Cureus 2021 Jun 23;13(6):e15862. Epub 2021 Jun 23.

Pediatrics, Ponce Health Sciences University, Ponce, PRI.

Birk-Barel syndrome, alternatively known as KCNK9 imprinting syndrome, is caused by a missense mutation in the potassium two pore domain channel subfamily K member 9 (KCNK9) gene on chromosome 8q24.3. This syndrome demonstrates dominant inheritance and is imprinted with paternal silencing, where the paternally inherited allele is silenced, and the maternally inherited allele is active. Read More

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