bluuebunny/crossref_metadata_2025 huggingface dataset:
Prognostics of Systemic Malignancy ICD-O Topography and Morphology Types on Brain Metastases
Authors: Alexopoulos Georgios , Zhang Justin , Karampelas Ioannis , Patel Mayur , Mercier Philippe
Published: August 2023

Background:

The primary site and histology of systemic malignancy are known predictors of progression to brain metastases (BM). We investigated the combinational interactions of International Classification of Diseases for Oncology (ICD-O) primary topography and morphology types on the survival of BM after adjusting for relevant clinical and demographic prognostic factors.

Methods:

The cohort included all adult patients with BM at diagnosis of an invasive malignancy in the National Cancer Database (2010 to 2018). The sample consisted of 180,150 entries out of 14,279,749 cancer patients screened. A survival analysis of the topography-specific and histology-specific time to death was performed. Multivariate Cox regression revealed violations of the proportional hazard assumption for multiple covariates. Parametric models using a log-logistic distribution best described the population survival pattern.

Results:

The primary topography “prostate” and morphology “choriocarcinoma” provided the strongest survival benefit among ICD-O types, whereas BM from prostate demonstrated a 14-month median overall increase in survival probability. Favorable prognostics were BM from breast, bone/joints, and testis; also, the morphologies of carcinoid tumor, mature B-cell lymphoma, and papillary adenocarcinoma. Poor prognostics were BM from gastrointestinal (liver, biliary tree, pancreas, and gallbladder) and gynecologic malignancies. All morphologies of spindle cell carcinoma, hemangiosarcoma, undifferentiated carcinoma, Ewing sarcoma, pseudosarcomatous carcinoma, renal cell carcinoma/sarcomatoid, signet ring cell carcinoma, spindle cell sarcoma, and squamous cell carcinoma/spindle cell were associated with poor survival.

Conclusions:

This is the largest cohort providing an unbiased estimate of the adjusted ICD-O topography and morphology effect sizes. The results can be summarized as a booklet for prognostic classification of disease in patients with BM secondary to systemic malignancy.
The effect of bedtime versus morning dosing of antihypertensive drugs on the cardiovascular outcomes: a systematic review and meta-analysis of randomized controlled trials
Authors: Abuelazm Mohamed , Saleh Othman , Albarakat Majd M. , Katamesh Basant , Abdalshafy Hassan , Mahmoud Abdelrahman , Abdelazeem Basel
Published: August 2023

Background and objective:

Antihypertensive drugs are one of the most effective strategies to prevent disability and mortality; however, there have been contradictory findings about the best dosing time for antihypertensive drugs. Therefore, we aim to evaluate the effect of bedtime versus morning dosing of antihypertensive drugs on cardiovascular outcomes.

Methods:

We synthesized randomized controlled studies (RCTs) from the Web of Science, SCOPUS, EMBASE, PubMed, and CENTRAL until 13 October 2022. The risk ratio (RR) for dichotomous outcomes with the corresponding 95% confidence interval (CI) was used. The study protocol was registered in PROSPERO with ID: CRD42022368612.

Results:

Five RCTs with 59 200 participants were included. Bedtime dosing was significantly associated with less incidence of myocardial infarction (MI) [RR: 0.80 with 95% CI (0.70–0.91), P = 0.0007] compared with morning dosing; however, there was no statistically significant difference between bedtime and morning dosing, regarding all-cause mortality [RR: 0.77 with 95% CI (0.51–1.16), P = 0.21], cardiovascular mortality [RR: 0.65 with 95% CI (0.35–1.21), P = 0.17], major adverse cardiac events (MACE) [RR: 0.79 with 95% CI (0.56–1.10), P = 0.16], heart failure [RR: 0.68 with 95% CI (0.42–1.09), P = 0.11], cerebrovascular accidents [RR: 0.80 with 95% CI (0.53–1.22), P = 0.30], coronary revascularization [RR: 0.79 with 95% CI (0.50–1.24), P = 0.30}, and angina [RR: 0.91 with 95% CI (0.55–1.50), P = 0.70].

Conclusion:

Evidence about the comparative efficacy of bedtime versus morning dosing of antihypertensives is still uncertain. However, bedtime dosing significantly reduced MI, which warrants more robust RCTs to validate.
Blood pressure control and antihypertensive medication use after discharge and prognosis of ischemic stroke
Authors: Shi Mengyao , Liu Yang , Wang Shuyao , Wang Ruirui , Yang Pinni , Peng Yanbo , Peng Hao , Wang Aili , Xu Tan , Chen Jing , Zhang Yonghong , He Jiang
Published: August 2023

Objective:

To investigate the effect of consistently blood pressure (BP) control status after discharge on adverse clinical outcomes among ischemic stroke (IS) patients.

Methods:

Three thousand, four hundred and six acute IS patients were included and followed up at 3 months, 12 months, and 24 months after stroke. Study outcomes were defined as death, vascular events and composite of death or vascular events. Cox proportional hazard models were used to estimate hazard ratios (HR) and 95% confident interval (CI) of death and the composite outcome of death or vascular events associated with BP control and antihypertensive medication use.

Results:

The multivariable adjusted HRs were 0.22 [95% confidence interval (CI): 0.09–0.57] for death and 0.60 (95% CI: 0.39–0.97) for the composite outcome of death or vascular events among participants with consistently controlled BP compared with those with consistently uncontrolled BP. The participants with both consistently controlled BP and regular use of antihypertensive medication had the lowest risks of death [hazard ratio (HR): 0.18, 95% CI: 0.04–0.75] and composite outcome of death or vascular events (HR: 0.54, 95% CI: 0.29–0.98) in comparison with those with both uncontrolled BP and irregular use of antihypertensive medication.

Discussion:

Continuous BP control and regular use of antihypertensive medications after discharge can decrease the risks of death and composite outcome of death or vascular events among IS patients, suggesting the importance of continuous BP control and regular use of antihypertensive medications after discharge for improving prognosis of IS.
Cultural Adaptation and Validation of the Barriers to HIV Testing Scale-Karolinska Version for Brazilian Men Who Have Sex With Men
Authors: Sousa Laelson Rochelle Milanês , de Mesquita Rafael Fernandes , Wiklander Maria , Eriksson Lars E. , Gir Elucir , Reis Renata Karina
Published: August 2023

The aim of this study was to perform the cultural adaptation and validation of the Barriers to HIV testing scale-Karolinska version for Brazilian men who have sex with men. A methodological study was conducted for cultural adaptation and validation of the scale. Reliability analyses, exploratory factor analysis, confirmatory factor analysis, and convergent and discriminant validity tests were performed. Four factors were extracted: F1, personal consequences; F2, structural barriers; F3, confidentiality; F4, economic consequences and individual concerns. Good fit indexes were obtained: (χ2)/GL (2.71); goodness of fit index (0.94); root-mean-square error of approximation (0.052; 90% CI [0.045–0.059]); Tucker–Lewis index (0.94); normed fit index (0.93); IFI (0.95); comparative fit index (0.95). Convergent validity results were greater than 0.7 for the four factors. The adapted version of the scale showed satisfactory reliability and validity for assessing barriers to HIV testing among men who have sex with men.
Understanding advanced practice registered nurse perspectives on providing care to people with a history of breast cancer
Authors: Anbari Allison B. , Sandheinrich Taryn , Hulett Jennifer , Salerno Elizabeth
Published: August 2023

Background:

People with a history of breast cancer (PHBC) face a lifelong risk of treatment-related sequelae affecting their quality of life. Stakeholders advocate for improving breast cancer survivorship outcomes by increasing clinicians' knowledge of cancer survivorship issues. In Missouri, advanced practice registered nurses (APRNs) in nononcology settings provide routine survivorship care to PHBC; however, little is known about how they approach survivorship care planning for PHBC.

Purpose:

Examine perspectives of Missouri APRNs practicing in nononcology settings about providing survivorship care to PHBC.

Methods:

A combination of grounded theory and thematic analysis techniques was used for focus groups and semistructured interviews. The interviews were audio-recorded, transcribed, and analyzed using grounded theory coding methods.

Results:

Nineteen nononcology Missouri-based APRNs (18 NPs, 1 CNS/DNP) shared their perspectives about managing care for PHBC. We identified four major themes. Our participants (1) attuned their baseline assessment techniques to a history of breast cancer; (2) were prepared to order additional evaluations; (3) were willing to proactively figure out next best steps for PHBC beyond theneed for breast cancer recurrence surveillance; and (4) suggest that streamlining cancer survivorship care resources would benefit both clinicians and PHBC.

Conclusions:

Our findings shed light on how APRNs approach care planning for PHBC and the needs of nononcology APRNs for managing PHBC.

Implications for Practice:

Advanced practice registered nurses are well-positioned to improve cancer survivorship care. Increasing knowledge of cancer survivorship care guidelines could improve long-term health outcomes of PHBC. Access to cancer survivorship resources or experts via telehealth/technology for both APRNs and patients could improve survivorship care and overall health of PHBC.
Acute complication posttransplant: primary allograft dysfunction
Authors: Brahmbhatt Darshan H. , Blitzer David , Billia Filio , Copeland Hannah
Published: August 2023

Purpose of review

Heart transplant is the gold standard treatment for patients with end-stage heart failure, improving both quality of life and survival. Despite advances in donor and recipient management, primary graft dysfunction (PGD) remains the most common cause of morbidity and mortality in the early posttransplant period. This review summarizes recent discoveries in the underlying pathophysiology, risk prediction and management of PGD.

Recent findings

The incidence of PGD appears to be rising and it is not clear whether this is due to better recognition or secular changes in transplant practice. The utilization of donation after circulatory death organs for transplant is a further consideration for the development of PGD. Organ transport systems and preservation techniques may help to prevent PGD. As some of the risk factors for developing PGD remain modifiable, we summarize the current evidence for prevention and management of PGD.

A better understanding will allow us to appropriately manage donors and recipients to reduce the complex interactions that lead to PGD. The development of an international consortium provides the opportunity for deep phenotyping and development of contemporary risk prediction models for PGD, which may reduce the incidence and consequent early mortality associated with heart transplantation.
A short communication of 2022 dengue outbreak in Bangladesh: a continuous public health threat
Authors: Islam Md. Aminul , Hemo Mizbahul k. , Marzan Abdullah Al , Arman Md. Sakil , Hasan Mohammad N. , Haque Md Azizul , Bhattacharya Prosun
Published: August 2023

Dengue virus infection, a highly prominent health concern, has caused many health complications, positive cases, and deaths in Bangladesh in previous years. However, the prevalence of this infection and fatality rates in 2022 has shattered all prior records. The dengue virus vector, mosquitoes, found a high prevalence of infection due to the weather’s favorable conditions for breeding in the months of June and July. While there is presently no particular vaccination for dengue infection, awareness of its epidemiology, pathogenesis, signs, and symptoms may aid in the development of improved diagnostic and treatment strategies. The government should also improve the infrastructure of cities to make prevent mosquito breeding and the spread of dengue infection.
Stroke patterns and outcomes during the second wave of COVID-19 pandemic: a cross-sectional study
Authors: Gajurel Bikram P. , Giri Subarna , Tamrakar Parishma , Pandeya Anupama , Gautam Niraj , Shrestha Aashish , Karn Ragesh , Rajbhandari Reema , Ojha Rajeev
Published: August 2023

Background:

The coronavirus disease 2019 (COVID-19) pandemic has affected the number of stroke activations, admission of patients with various types of strokes, the rate and timely administration of reperfusion therapy, and all types of time-based stroke-related quality assessment metrics. In this study, we describe the different types of strokes, different delays in seeking and completing treatment occurring during the second wave of the COVID-19 pandemic, and predictors of outcome at 3 months follow-up.

Materials and methods:

This is a single-centered prospective cross-sectional study carried out from May 2021 to November 2021, enrolling patients with stroke. Data collected were demographic characteristics, stroke types and their outcomes, and different types of prehospital delays.

Results:

A total of 64 participants were included in the study with a mean age of 60.25±15.31 years. Ischemic stroke was more common than hemorrhagic stroke. The median time of arrival to the emergency room of our center was 24 h. The most common cause of prehospital delay was found to be delays in arranging vehicles. The median duration of hospital stays [odds ratio (OR)=0.72, P<0.05] and baseline NIHSS (National Institute of Health Stroke Scale) score (OR=0.72, P<0.05) were found to be a predictor of good outcomes at 3 months follow-up on binary logistic regression.

Conclusion:

The factors that cause the delayed transfer to the hospital and onset of treatment should be addressed. Patient counseling about the likely prognosis can be done after evaluating the probable outcome based on the NIHSS score and median duration of hospital stay. Nevertheless, mechanisms should be developed to reduce the prehospital delay at the ground level as well as at the policy level.
Breast cancer awareness among women in the Syrian Coast: a cross-sectional study
Authors: Abdul Rahman Seif-Aldin , Kherbek Haidara , Ismail Sawsan , Abdul Rahman Ali , Zahlout Jaafar , Abboud Ibrahem , Hraib Munawar , Jouni Sarah , Turk Tareq , Hleibieh Yana , Layka Khedr , Alaidi Sara , Skef Jana , Mansour Somar , Georgeos Michael , Taweel Ousama , Alshehabi Zuheir
Published: August 2023

Background:

Breast cancer is the most common malignancy in women and represents a leading cause of cancer-related mortalities. Females’ awareness toward breast cancer is essential for the early diagnosis and detection especially in low and middle-income countries. This study aims to assess the awareness of breast cancer risk factors among females in the Syrian Coast.

Methodology:

An online cross-sectional survey was conducted among Syrian females during the COVID-19 pandemic. The questionnaire used in the study was derived from the Cancer Research UK questionnaire and modified to fit the perspective of the study. Statistical Package for Social Sciences (SPSS) was used for data analysis. The independent samplest-test and the one-way analysis of variance (ANOVA) were applied to determine whether there is statistical evidence or any statistically significant differences between the variables.

Results:

A total of 1305 females participated in the study. The majority aged between 18 and 25, (28.8%) of the participants obtained their information related to breast cancer from internet, (36.7%) of were smokers and (82.8%) had a family member with breast cancer. These results suggested a significant correlation between smoking, family history of cancer, marital status, and breast cancer awareness.

Conclusion:

This study showed which factors are significantly related to women’s awareness of breast cancer risk factors. These results can contribute in the implementation of awareness programs and campaigns, thus raising the level of awareness among women.
Rectovaginal fistula surgery with horizontal mattress and running suture after unsuccessful first repair: a report of two cases
Authors: Handaya Adeodatus Y. , Andrew Joshua , Hanif Ahmad S. , Susilo Naufal C.J. , Subroto Polycarpus D. , Aditya Azriel F.K.
Published: August 2023

Introduction:

Rectovaginal fistula (RVF) repair after failed primary repair is uncommon. Patients with RVF experience physiological and sexual dysfunction with a significantly high risk of intravaginal infection and sepsis. There are many surgical procedures available for RVF repair. We performed an improvised transvaginal repair technique.

Methods:

We report two cases of recurring RVF after failed primary repair. Patient 1 developed RVF because of a failed vaginoplasty due to cosmetic reasons, while patient 2 developed RVF because of a fourth-degree perineal rupture repair post-delivery. We used a combination of horizontal mattress and running suture with the addition of diverting colostomy. Both surgeries went successfully and there were no complications.

Outcomes:

RVF repair using a combination of horizontal mattress and running suture went successfully and there were no complications. Both patients were able to be discharged after a short stay. Long-term evaluation was done by physical and supporting examinations for 2–3 months. Both patients showed excellent wound healing and physiological function.

Conclusions:

The combination of a transvaginal horizontal mattress and running suture in the posterior to anterior fashion with diverting colostomy is a safe and effective procedure for recurring RVF repair.
Analysis of natural resistance-associated macrophage protein-1 (NRAMP-1) level based on death, comorbidities and severity of COVID-19 patients: a cross-sectional study
Authors: Dwiyanti Ressy , Muthaher Annisa Anwar , Achmad Djumadi , Arsyadi Gunawan , Nelwan Berti J. , Cangara Muhammad Husni , Lawrence Gatot S. , Kaelan Cahyono , Dase Jerny , Mathius Denny , Indrayaty AR , Early Afriani , Junita Ade Rifka , Febrianti Andini , Sri Diana Eva , Fachri Muhammad , Syukri Ahmad , Primaguna Muhammad Reza , Azhar Azhar , Hatta Mochammad
Published: August 2023

Background:

An accurate diagnosis of COVID-19 is essential for pandemic control and for establishing adequate therapeutic strategies to reduce morbidity and mortality. COVID-19 infection replicates in macrophage cells and affects the immune system. Natural resistance-associated macrophage protein-1 (NRAMP-1) carries cation ions, such as Fe2+, Zn2+ and Mn2+, and plays an essential role in the immune system to infection with micro-organisms. In addition, the function of NRAMP-1 is to limit the replication of pathogens by changing the phagosomal environment. Levels of NRAMP-1 protein are based on death, comorbidities and clinical symptoms of COVID-19 patients and it is possible for the soluble protein NRAMP-1 level to be used as an additional biomarker for forensic and medicolegal related COVID-19 cases and prosecutions from patients and families.

Methods:

Determination of NRAMP-1 protein levels using the enzyme link-immunosorbent assay technique in death, had comorbidities and severity of clinical symptoms of COVID-19 patients.

Results:

Of the 62 patients who received treatment, 10 patients died with an average NRAMP-1 level of 650 ng/ml and 52 patients who survive with an average NRAMP-1 level of 1065.26 ng/ml. The results of the study also found that 34 patients had comorbidities with an average NRAMP-1 level of 838.82 ng/ml and 28 patients without comorbidities with an average NRAMP-1 level of 1191.92 ng/ml. Based on the severity of clinical symptoms in survive patients, 10 patients with mild were found with an average NRAMP-1 level of 984.31 ng/ml, with moderate in 31 patients with an average NRAMP-1 level of 1104.71 ng/ml and severe in 11 patients with an average NRAMP-1 level of 1027.71 ng/ml.

Conclusions:

NRAMP-1 protein levels were significantly lower in COVID-19 patients who died and had comorbidities.
Nonhealing oesophageal ulcer: a case report
Authors: Gurung Ram Bdr , Sapkota Prakash , Sharma Pasand , Lamsal Anukram , Joshi Sahasra , Pandey Urmila , Panta Tanka Psd , Bhardwaj Sushant
Published: August 2023

Introduction and importance:

Esophageal tuberculosis is a rare presentation of a common infectious disease. It may occur as a primary infection of the esophagus or as a secondary spread mostly from caseating mediastinal lymph nodes. The clinical diagnosis of the condition is presumed to be complex, owing to nonspecific biopsy findings, failure of isolation of bacilli, and a lack of predisposing conditions in patients. This study aims to present a rare condition of esophageal tuberculosis secondary to mediastinal lymphadenitis and highlights a unique modality of diagnosis of the condition, especially in a resource strained setting.

Case presentation:

This case report presents the case of a 50-year-old male with dysphagia and a burning sensation at the epigastrium. Endoscopy and histopathological examination showed ulceration at the esophagus and granulomatous inflammation, respectively. Computed tomography showed enlargement of the prevascular and paratracheal group of lymph nodes. However, the acid-fast bacilli stain at the ulcer site was negative. The diagnosis could be confirmed only after 2 months of the antitubercular treatment trial, which significantly potentiated ulcer healing.

Clinical discussion:

Esophageal tuberculosis may result from a secondary infection caused by systemic dissemination following a pulmonary disease or as a primary infection. In this case, it likely resulted from lymphatic dissemination via prevascular and paratracheal lymph nodes manifested mainly as dysphagia.

Conclusion:

Tuberculosis should be considered as one of the differential diagnoses in areas of limited resources. Clinicians may have to rely on clinical judgement and/or the patient’s response to standard antitubercular treatment to make a definitive diagnosis.
Determinants of infant mortality in Oromia region, Ethiopia
Authors: Irana Tariku , Mekebo Gizachew Gobebo , Diriba Gezahagn , Sisay Assefa Legesse , Woldeyohannes Birhanu , Yohannes Zemene
Published: August 2023

Introduction:

Infant mortality is one of the commonest health-related indicators used to assess the health status of the community. Children born in Sub-Saharan Africa are at highest risk of infancy death in the world. Ethiopia, in Sub-Saharan Africa, is a country with high infant mortality. Oromia region is among the regions with high infant mortality rate in Ethiopia. Therefore, this study aimed to identify determinants of infant mortality in Oromia region, Ethiopia.

Methods:

The source of data for this study was 2019 Ethiopian Mini Demographic and Health Survey. Multivariable logistic regression model was employed to identify the determinants the infant mortality. An adjusted odds ratio (OR) with a 95% CI was used examine the determinants of infant mortality.

Results:

A total of 719 live births born 5 years preceding the survey were included. The infant mortality rate in the study area was 54 deaths per 1000 live births. The risk of dying in infancy was lower for females [adjusted OR (AOR): 0.518, 95% CI: 0.284, 0.945], health deliveries (AOR: 0.429, 95% CI: 0.235, 0.783), infants born to mothers attended ANC during pregnancy (AOR: 0.603, 95% CI: 0.489, 0.744), infants from families with wealth indices of medium (AOR: 0.715, 95% CI: 0.580, 0.882) and rich (AOR: 0.638, 95% CI: 0.425, 0.958) compared with the respective reference categories while it was higher for infants of multiple births (AOR: 2.241, 95% CI: 1.768, 2.841) compared with singletons.

Conclusions:

Infant mortality rate in the study area, Oromia region, is higher than the national figure. The study found that sex of child, birth type, antenatal care (ANC), place of delivery and wealth index of household were significant determinants of infant mortality. Therefore, concerned bodies should make awareness creation to mothers regarding ANC and encourage them to have ANC follow-up during pregnancy and deliver at health institution to improve the infant survival in the region.
Nasal spray (Zavegepant) for migraines: a mini-review
Authors: Larik Muhammad Omar , Iftekhar Muhammad Ashhal , Syed Bilal Ulhassan , Ansari Omema , Ansari Mozaena
Published: August 2023

Neurological disorders, especially migraines, pose a significant global burden. This has driven the recent innovative research being conducted in the field of anti-migraine therapies, including the discovery of Zavegepant for the treatment of acute migraine attacks. Zavegepant is a novel, first-in-class, intranasally administered calcitonin gene-related peptide (CGRP) receptor antagonist that has recently been approved for use in acute migraine attacks. Recent randomized controlled trials comparing Zavegepant with a placebo have demonstrated favorable results with respect to primary endpoints, as well as a desirable safety profile. The current first-line therapy consists of oral triptans, which are associated with lower efficacy, weaker safety profile, and an unsatisfactory preference rate among patients. Moreover, the intranasal method of administration is a characteristic advantage of Zavegepant, as patients suffering from acute migraine attacks cannot easily ingest oral medication, due to severe nausea and vomiting. In this mini-review, the efficacy and safety of Zavegepant will be compared with those of alternative treatments available for migraines, including oral triptans, intranasal triptans, and other CGRP antagonists currently available in the market. With currently available research, Zavegepant holds superiority over other forms of treatment and can be included in the current treatment guidelines for migraine attacks. However, further research is necessary to effectively assess Zavegepant’s long-term efficacy, safety, tolerability, and drug–drug interactions.
Takayasu arteritis in a young male patient: a case report and review of literature
Authors: Poudel Saroj , Sharma Suraj , Gurung Praful , Kandel Kamal , Aryal Sajiva , Maharjan Sobilal
Published: August 2023

Takayasu arteritis is a systemic inflammatory disorder that causes harm to the large and medium arteries and their branches. It is primarily prevalent in Asia, Africa, and Latin America, with the incidence rate in Asia being reported to be 100 times higher than in Europe and North America. Females in their second or third decades of life are most commonly affected by this condition. In our case, a 26-year-old male patient was diagnosed with Takayasu arteritis after he experienced a headache and left upper limb weakness. The initial presentation of Takayasu arteritis includes nonspecific constitutional symptoms like fever, malaise, weight loss, and anorexia. Unfortunately, due to the delayed diagnosis of the disease, patients often experience claudication, absence of pulses, hypertension, myocardial infarction, and cerebrovascular accidents. An early and accurate diagnosis of Takayasu arteritis is vital to reduce the economic, social, and psychological burdens associated with the disease.
Radiological identification of neuromyelitis optica in a patient presented with unexplained weight loss and generalized weakness: a case report and literature review
Authors: Shrateh Oadi N. , Jobran Afnan W.M. , Khaled Zaina , Zaid Momen A. , Dallashi Ahmad A.
Published: August 2023

Introduction and importance:

Central nervous system (CNS) inflammatory demyelinating disease known as neuromyelitis optica spectrum disorder (NMOSD) is characterized by recurrent inflammatory events that primarily affect the optic nerves and spinal cord; it may also affect the hypothalamus, area postrema, and periaqueductal gray matter. The NMOSD-specific aquaporin-4 antibody (AQP4-IgG) is available. Myelin oligodendrocyte glycoprotein antibodies (MOG-IgG) have recently been discovered in a group of patients who do not have AQP4-IgG.

Case presentation:

A 29-year-old female presented to the hospital with the complaint of blurry vision in her right eye and left eye ptosis for 2 days. Two months ago, the patient had a history of generalized fatigue with continuous documented fever with an average of 38.5°C, which was relieved by acetaminophen and ibuprofen. She also complained of continuous hiccups that increased at night and interfered with her sleep pattern and breathing; they lasted for 3 weeks and disappeared suddenly. She had also developed episodes of vomiting and could not tolerate food intake due to which she lost 6 kg within 3 weeks. She was later diagnosed with neuromyelitis optica (NMO) using radiological neuroimaging.

Clinical discussion:

Early and correct diagnosis, followed by urgent treatment for acute exacerbations and the prevention of further relapses, are essential for treating NMO spectrum illnesses since they entail significant morbidity and, occasionally, fatality.

Conclusion:

The patient mentioned here represents a typical example of NMO disease. This case emphasizes the presence of this disease in our environment and the importance of accurately diagnosing this ailment, even in a context with minimal resources, to prevent disability.
Comprehensive review of diabetic ketoacidosis: an update
Authors: Elendu Chukwuka , David Johnson A. , Udoyen Abasi-O. , Egbunu Emmanuel O. , Ogbuiyi-Chima Ifeanyichukwu C. , Unakalamba Lilian O. , Temitope Awotoye I. , Ibhiedu Jennifer O. , Ibhiedu Amos O. , Nwosu Promise U. , Koroyin Mercy O. , Eze Chimuanya , Boluwatife Adeyemo I. , Alabi Omotayo , Okabekwa Olisa S. , Fatoye John O. , Ramon-Yusuf Habiba I.
Published: August 2023

The most frequent hyperglycemic emergency and the leading cause of death in people with diabetes mellitus is diabetic ketoacidosis (DKA). DKA is common in people with type 1 diabetes, while type 2 diabetes accounts for roughly one-third of occurrences. Although DKA mortality rates have generally decreased to low levels, they are still significant in many underdeveloped nations. In industrialized countries, its mortality rate ranges from 2 to 5%, but in underdeveloped nations, it ranges from 6 to 24%. Therefore, it is always lethal if misdiagnosed or improperly treated. According to specific research, DKA can be present at the time of type 1 diabetes onset in 25 to 30% of cases and in 4 to 29% of young people with type 2 diabetes mellitus, and its features include hyperglycemia, metabolic acidosis, and ketosis with its triggering factors commonly being infections, newly discovered diabetes, and failure to start insulin therapy. Less than 20% of DKA patients present comatose, and patients with different levels of consciousness can present at other times. A close association between abnormalities found during a mental status evaluation and osmolality seems to exist. Hospital admission is necessary for vigorous intravenous fluid therapy, insulin therapy, electrolyte replacement, diagnosis and treatment of the underlying triggers, and routine monitoring of the patient’s clinical and laboratory conditions to manage DKA properly. Appropriate discharge plans should include actions to prevent a DKA recurrence and the proper selection and administration of insulin regimens.
Obstructed hemivagina and ipsilateral renal agenesis: magnetic resonance imaging findings in young Nepali females – a report of four cases
Authors: Paudel Sharma , Katwal Shailendra , Kayastha Prakash , Shrestha Suraj , Regmi Pradeep R.
Published: August 2023

Introduction and importance:

Obstructed hemivagina and ipsilateral renal agenesis (OHVIRA) syndrome also known as the Herlyn-Werner-Wunderlich Syndrome is a rare embryological disorder associated with Mullerian and mesonephric duct abnormality.

Case presentation:

The cases presented describe the imaging (ultrasound and MRI) findings of four young females who presented with dysmenorrhea and urinary complaints. All of them had solitary kidneys with a didelphic uterus and unilateral hematometrocolpos. A proximally blind-ending ureter with distal ectopic insertion, transverse vaginal septum, and left-sided endometrioma was seen.

Clinical discussion:

OHVIRA syndrome is associated with duplicated uterovaginal structure with OHVIRA. Ultrasound is the first line of investigation; however, MRI better delineates the anatomy and assists in preoperative planning.

Conclusion:

This report highlights that earlier clinical suspicion and imaging diagnosis of OHVIRA is crucial to prevent adverse outcomes and treating complications.
Efficacy of cryotherapy on chemotherapy-induced peripheral neuropathy in patients with breast cancer: a propensity score-matched study
Authors: Xu Min , Wang Fan , Zhu Xiaoli , Hao Zhaohua
Published: August 2023

Background:

Chemotherapy-induced peripheral neuropathy (CIPN) is one of the most frequent unfavorable side effects. CIPN refers to the loss of peripheral nerve function that certain types of chemotherapy can cause.

Objective:

This study investigated the effectiveness of cryotherapy in preventing CIPN and its effect on the quality of life (QoL) during chemotherapy.

Methods:

Eligible participants are cancer patients who began therapy with carboplatin, docetaxel, or paclitaxel in the Breast Oncology Unit between May 2022 and October 2022. Patients were distributed into intervention groups that utilized cryotherapy with ice gloves and ice boots and control groups that did not receive cryotherapy. Patient self-report questionnaires were used to quantify patients’ symptoms and QoL after treatment.

Results:

The intervention group exhibited significantly less cold sensitivity, hand and foot numbness, and hand tingling than the control group. Daily CIPN symptoms were substantially milder in the intervention group. Before and after treatment, nerve pain, balance, and muscle and joint discomfort were similar. Intervention and control groups have varied neurotoxicity adverse reaction scores. 2.4% of controls had grade 4 motor neurotoxicity impairment. Physical function and QoL improved in the intervention group.

Conclusions:

Cryotherapy relieves CIPN symptoms in breast cancer patients receiving carboplatin and paclitaxel chemotherapy. More thorough trials should be carried out to determine the best time limit and duration of cryotherapy.
Timely initiation of breastfeeding and its factors among women delivered via cesarean section under spinal anesthesia at the University of Gondar Comprehensive Specialized Hospital, north-west Ethiopia, 2021: a hospital-based cross-sectional study
Authors: Ibrahim Amelmasin Faris , Melkie Tadesse Belayneh , Filatie Tesera Dereje , Tegegne Biresaw Ayen
Published: August 2023

Background:

The mode of delivery influences breastfeeding practice. Moreover, cesarean deliveries under anesthesia-related risk factors affect the timing of breastfeeding initiation compared to vaginal deliveries. In addition, high rates of cesarean section (CS) deliveries and low breastfeeding rates are important public health concerns for all developing countries.

Objective:

This study aimed to determine the timely initiation of breastfeeding and its factors among women delivered via CS under spinal anesthesia.

Methods:

Institutional-based cross-sectional study was employed among 422 systematically selected mothers from April to June 2021. Data were collected by a structured questionnaire. Data entry and analysis were done using Epi Data and Stata version 14.0. Binary logistic regressions were computed to identify factors. An adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to declare statistical significance.

Results:

Delayed initiation of breastfeeding (DIBF) was 41.8%. Mothers who had an emergency CS (AOR =2.13, 95% CI [1.21–3.75]), had less than four antenatal care (ANC) follow-ups (AOR=1.77, 95% CI [1.02–3.13]), had moderate to severe pain during the perioperative period (AOR=2.65, 95% CI [1.24–5.54]), primipara (AOR=1.89; 95% CI [1.20–3.25]), used intraoperative opioid medications (AOR=1.86; 95% CI [1.01–3.30]), and had no skin-to-skin contact (AOR=2.1, 95% CI [1.27–3.51]) were associated with DIBF.

Conclusion and recommendation:

DIBF after cesarean delivery was high. Emergency CS, less than four ANC visits, immediate postoperative pain, and lack of skin-to-skin contact were factors associated with delayed breastfeeding. Health care providers, especially anesthetists, in the operation theater, should implement multimodal analgesics and minimize opioid consumption. Moreover, they should keep the newborn in skin-to-skin contact to initiate breastfeeding in the operation theater soon after birth.
Association of multiple sclerosis with chronic fatigue syndrome, restless legs syndrome, and various sleep disorders, along with the recent updates
Authors: Prajjwal Priyadarshi , Kalluru Pavan K.R. , Marsool Mohammed Dheyaa , Inban Pugazhendi , Gadam Srikanth , Al-ezzi Saud M.S. , Marsool Ali Dheyaa , Al-Ibraheem Abdullah M.T. , Al-Tuaama Abdullah Z.H. , Amir Omniat , Arunachalam Shivaram P.
Published: August 2023

Multiple sclerosis (MS) and myalgic encephalomyelitis (ME)/chronic fatigue syndrome (CFS) share the symptom of fatigue, and might even coexist together. Specifically focusing on genetics, pathophysiology, and neuroimaging data, the authors discuss an overview of the parallels, correlation, and differences in fatigue between MS and ME/CFS along with ME/CFS presence in MS. Studies have revealed that the prefrontal cortex and basal ganglia regions, which are involved in fatigue regulation, have similar neuroimaging findings in the brains of people with both MS and ME/CFS. Additionally, in both conditions, genetic factors have been implicated, with particular genes known to enhance susceptibility to MS and CFS. Management approaches for fatigue in MS and ME/CFS differ based on the underlying factors contributing to fatigue. The authors also focus on the recent updates and the relationship between MS and sleep disorders, including restless legs syndrome, focusing on pathophysiology and therapeutic approaches. Latest therapeutic approaches like supervised physical activity and moderate-intensity exercises have shown better outcomes.
Use of the Superthin Superficial Circumflex Iliac Artery Perforator Flap for Reconstruction of Lower Lip Defects
Authors: Park Se Yeon , Lee Kyeong-Tae
Published: August 2023

Wide local excision remains the main treatment modality for primary lip cancer, which often results in considerable deficits of lip tissue and requires reconstruction using free tissue transfer. Although diverse free flaps, such as radial forearm flap or anterolateral thigh flap, have been used, their application is often limited by their inherent limitations, including donor-site morbidity and flap bulkiness. This report details the authors’ experience of lower lip reconstruction using a superthin superficial circumflex iliac artery perforator (SCIP) free flap. Two patients with primary squamous cell carcinoma spanning their lower lip underwent wide local excision with an 8-mm lateral excision margin and superficial layer of orbicularis oris muscle. To cover the shallow but extensive lower lip defects, a superthin SCIP flap elevating along the intraadipose tissue layer and a pure-skin perforator SCIP flap elevating along the subdermal layer were harvested. The thickness of the harvested SCIP flap was 3 mm in both cases. The microvascular anastomoses of pedicles were conducted using the inferior labial artery and adjacent subcutaneous vein as recipient vessels, and the flaps were inset. The flaps survived completely without any perfusion-related complications. The patients were discharged uneventfully. Postoperatively, both patients displayed complete functional recovery with good lip competence and aesthetically pleasing results, without requiring secondary debulking operations. The authors’ results suggest that the superthin or pure-skin perforator SCIP flap might be considered as an effective method for covering shallow and wide lower lip defect.
Radiographic Evidence of Dental Complications after Mandibular Distraction Osteogenesis: Inverted-L versus Oblique Osteotomy
Authors: Barrero Carlos E. , Ryan Isabel A. , Salinero Lauren , McGraw J. Reed , Pontell Matthew E. , Bartlett Scott P. , Napoli Joseph A. , Swanson Jordan W. , Nah Hyun-Duck , Taylor Jesse A.
Published: August 2023

Background:

Patients with micrognathia undergoing mandibular distraction osteogenesis (MDO) for functional and aesthetic improvement are at significant risk for dental complications. The authors investigated the association of 2 osteotomy patterns—oblique and inverted-L—with risk to developing dentition.

Methods:

A senior orthodontist (H.D.N.) performed a retrospective review of dental radiographs of patients undergoing MDO with confirmed oblique or inverted-L osteotomies between 2012 and 2022. Images were assessed for evidence of missing, damaged, or displaced teeth, and proportion of affected hemimandibles by injury type and median number of affected teeth per hemimandible were compared between groups using appropriate statistical methodology.

Results:

Analysis included 44 patients (23 oblique, 21 inverted-L) and 85 hemimandibles (45 oblique, 40 inverted-L). Mean age at surgery was 3.1 ± 4.6 years, and mean time to imaging was 4.9 ± 4.1 years; there was no difference between groups (P = 0.23, P = 0.34, respectively). Oblique osteotomy was associated with greater odds of missing teeth (odds ratio [OR], 13.3, P < 0.001), damaged teeth (OR, 3.2; P = 0.02), and any dental injury (OR, 39.9; P < 0.001) compared with inverted-L, as well as greater number of missing teeth (β = 0.6; P < 0.01), damaged teeth (β = 0.3; P = 0.02), and total number of affected teeth (β = 0.9; P < 0.001). There was no difference in incidence (P = 0.5) or number (P = 0.4) of displaced teeth between groups.

Conclusions:

Inverted-L osteotomies were associated with fewer dental complications compared with oblique osteotomy at all ages studied. Although longer-term follow-up and prospective data are needed before definitive recommendations can be made, these data are helpful to surgeons as they plan MDO.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Intravoxel Incoherent Motion and Dynamic Contrast-Enhanced Magnetic Resonance Imaging Can Differentiate Between Atypical Cartilaginous Tumors and High-Grade Chondrosarcoma: Correlation With Histological Vessel Characteristics
Authors: Jin Bo , Yang Jie , Zhen Junping , Xu Yang , Wang Chen , Jing Qing , Shang Yangwei
Published: August 2023

Objective

To differentiate between atypical cartilaginous tumors and high-grade chondrosarcoma of the major long bones using intravoxel incoherent motion (IVIM) and Dynamic Contrast-Enhanced magnetic resonance imaging (DCE-MRI), and explore the correlation of quantitative parameters with hypoxia inducible factor-1α (HIF-1α), vascular endothelial growth factor (VEGF) and microvessel density (MVD).

Method

Between September 2016 and March 2022, 35 patients (17 atypical cartilaginous tumors, 18 high-grade chondrosarcoma) underwent MRI examination and pathological confirmation at our hospital. First, IVIM-derived parameters (D, D*, and f), and DCE-MRI parameters (K
trans, K
ep, and Ve
) were measured, and intraclass correlation efficient (ICC) and Mann-Whitney U test were performed. Second, receiver-operating characteristic curve analysis was performed to evaluate the diagnostic performance. Finally, Spearman's correlation analysis was performed between the quantitative parameters of IVIM-DWI and DCE-MRI and the immunohistochemical factors HIF-1α, VEGF, and MVD in chondrosarcoma tissue.

Results

D in atypical cartilaginous tumors was significantly higher than that in high-grade chondrosarcoma (P = 0.003), whereas D*, K
trans, and Kep
in atypical cartilaginous tumors were significantly lower than those in high-grade chondrosarcoma (all P < 0.001). K
trans demonstrated the highest area under the curve (AUC) of 0.979. The D*, K
trans, and Kep
were positively correlated with HIF-1α, VEGF, and MVD (all P < 0.001), whereas D had no correlation with HIF-1α, VEGF, and MVD (P = 0.113, 0.077, 0.058, respectively).

Conclusion

The IVIM-DWI quantitative parameters (D, D*) and DCE-MRI quantitative parameters (K
trans, K
ep) are helpful to differentiate between atypical cartilaginous tumors and high-grade chondrosarcoma and could be imaging biomarkers to reflect the expressions of HIF-1α, VEGF, and angiogenesis of chondrosarcoma.
Patient Positioning Assistive Technology Applicable to the Existing Computed Tomography System: Estimation by Pixel Value of Scout Image
Authors: Urikura Atsushi , Miyauchi Yosuke , Yoshida Tsukasa , Ishita Yuya , Takiguchi Keisuke , Aramaki Takeshi
Published: August 2023

This study aimed to propose a patient positioning assistive technique using computed tomography (CT) scout images. A total of 210 patients who underwent CT scans in a single center, including on the upper abdomen, were divided into a study set of 127 patients for regression and 83 patients for verification. Linear regression analysis was performed to determine the R
2 coefficient and the linear equation related to the mean pixel value of the scout image and ideal table height (THideal). The average pixel values of the scout image were substituted into the regression equation to estimate the THideal. To verify the accuracy of this method, the distance between the estimated table height (THest) and THideal was measured. The medians of age (in years), gender (male/female), height (in centimeters), and body weight (in kilograms) for the regression and verification groups were 68 versus 70, 85/42 versus 55/28, 163.8 versus 163.0, and 59.9 versus 61.9, respectively. Linear regression analysis indicated a high coefficient of determination (R
2 = 0.91) between the mean pixel value of the scout image and THideal. The correlation coefficient between THideal and THest was 0.95 (95% confidence interval, 0.92–0.97; P < 0.0001), systematic bias was 0.2 mm, and the limits of agreement were −5.4 to 5.9 (P = 0.78). The offset of the table height with THest was 2.8 ± 2.1 mm. The proposed estimation method using scout images could improve the automatic optimization of table height in CT, and it can be used as a general-purpose automatic positioning technique.
Comparison of Diatrizoate and Iohexol for Patient Acceptance and Fecal-Tagging Performance in Noncathartic CT Colonography
Authors: Chen Yanshan , Feng Lijuan , Huang Zixuan , Zou Wenbin , Luo Guibo , Dai Guochao , Zhao Weidong , Cai Wenli , Luo Mingyue
Published: August 2023

Objective

The aim of this study was to compare diatrizoate and iohexol regarding patient acceptance and fecal-tagging performance in noncathartic computed tomography colonography.

Methods

This study enrolled 284 volunteers with fecal tagging by either diatrizoate or iohexol at an iodine concentration of 13.33 mg/mL and an iodine load of 24 g. Patient acceptance was rated on a 4-point scale of gastrointestinal discomfort. Two gastrointestinal radiologists jointly analyzed image quality, fecal-tagging density and homogeneity, and residual contrast agent in the small intestine. The results were compared by the generalized estimating equation method.

Results

Patient acceptance was comparable between the 2 groups (3.95 ± 0.22 vs 3.96 ± 0.20, P = 0.777). The diatrizoate group had less residual fluid and stool than the iohexol group (P = 0.019, P = 0.004, respectively). There was no significant difference in colorectal distention, residual fluid, and stool tagging quality between the 2 groups (all P's > 0.05). The mean 2-dimensional image quality score was 4.59 ± 0.68 with diatrizoate and 3.60 ± 1.14 with iohexol (P < 0.001). The attenuation of tagged feces was 581 ± 66 HU with diatrizoate and 1038 ± 117 HU with iohexol (P < 0.001). Residual contrast agent in the small intestine was assessed at 55.3% and 62.3% for the diatrizoate group and iohexol group, respectively (P = 0.003).

Conclusions

Compared with iohexol, diatrizoate had better image quality, proper fecal-tagging density, and more homogeneous tagging along with comparable excellent patient acceptance, and might be more suitable for fecal tagging in noncathartic computed tomography colonography.