bluuebunny/crossref_metadata_2025 huggingface dataset:
Indocyanine green fluorescence imaging to localize insulinoma and provide three-dimensional demarcation for laparoscopic enucleation: a retrospective single-arm cohort study
Authors: Tao Haisu , Zeng Xiaojun , Lin Wenjun , Wang Zhuangxiong , Lin Jinyu , Li Jiang , Qian Yinling , Yang Jian , Fang Chihua
Published: April 2023

Background:

Indocyanine green (ICG) fluorescence imaging is a new technology that can improve the real-time location of tumor edges and small nodules during surgery. However, no study has investigated its application in laparoscopic insulinoma enucleation. This study aimed to evaluate the feasibility and accuracy of this method for intraoperative localization of insulinomas and margin assessment during laparoscopic insulinoma enucleation.

Materials and Methods:

Eight patients who underwent laparoscopic insulinoma enucleation from October 2016 to June 2022 were enrolled. Two methods of ICG administration, ICG dynamic perfusion and three-dimensional (3D) demarcation staining, were utilized in the laparoscopic insulinoma enucleation. Tumor-to-background ratio (TBR) and histopathologic analysis were used to evaluate the feasibility and accuracy of these novel navigation methods in laparoscopic insulinoma enucleation.

Results:

All eight enrolled patients underwent both ICG dynamic perfusion and 3D demarcation staining. ICG dynamic perfusion images were available for six of them, among which five tumors could be recognized by TBR (largest TBR in each case 4.42±2.76), while the other could be distinguished by the disordered blood vessels in the tumor area. Seven out of eight specimens had successful 3D demarcation staining (TBR 7.62±2.62). All wound bed margins had negative frozen sections and final histopathologic diagnoses.

Conclusions:

ICG dynamic perfusion may be helpful in observing the abnormal vascular perfusion of tumors, providing similar functionality to intraoperative real-time angiography. ICG injection under the tumor pseudocapsule may be a useful method for acquiring real-time, 3D demarcation for the resection of insulinoma.
Impact of HER2 on prognosis and benefit from adjuvant chemotherapy in stage II/III gastric cancer patients: a multicenter observational study
Authors: Gao Xianchun , Zhao Lulu , Zhang Nannan , Han Weili , Liu Kun , Yan Junya , Chen Ling , Pan Yan , Li Renlong , Li Wenjiao , Zhang Haohao , Li Hongwei , Wang Shibo , Gao Xiaoliang , Niu Penghui , Wang Wanqing , Ji Gang , Zhao Qingchuan , Lu Yuanyuan , Li Zengshan , Shang Lei , Liang Han , Wu Kaichun , Deng Jingyu , Chen Yingtai , Nie Yongzhan ,   for the MAGIS Study Group
Published: April 2023

Background:

Human epidermal growth factor receptor 2 (HER2) is a well-developed therapeutic target in breast and gastric cancer (GC). However, the impact of HER2 on survival and benefit from fluorouracil-based adjuvant chemotherapy remains unclear in patients with GC.

Materials and Methods:

This multicenter cohort study involved 5622 consecutive stage II/III GC patients. HER2 expression was assessed prospectively via immunohistochemistry (IHC). The staining intensity was graded on a scale of 0 to 3+. An IHC score of 2+or 3+was defined as high expression, and a score of 3+was defined as overexpression.

Results:

HER2 overexpression was independently associated with a lower 5-year overall survival (OS) in stage II [hazard ratio (HR), 2.10; 95% CI: 1.41–3.11], but not in stage III GC (HR, 1.00; 95% CI, 0.82–1.20). Further analysis revealed that stage II patients with high HER2 expression showed a poorer response to chemotherapy than stage II patients with low HER2 expression (P
interaction=0.024). The HRs for 5-year OS were 0.51 (95% CI, 0.38–0.70) for stage II patients with low HER2 expression, 0.58 (95% CI, 0.51–0.66) for stage III patients with low HER2 expression, 1.13 (95% CI, 0.61–2.09) for stage II patients with high HER2 expression, and 0.47 (95% CI, 0.36–0.61) for stage III patients with high HER2 expression.

Conclusions:

Fluorouracil-based adjuvant chemotherapy is insufficient for stage II GC patients with high HER2 expression, indicating that prospective trials are required to validate alternative HER2-targeted adjuvant therapies in the individuals above.
Use of Percutaneous Left Ventricular Assist Device Before Durable Device Implantation in Patients With Cardiac Cachexia: Case Series
Authors: Salas De Armas Ismael A. , Bergeron Amanda , Akkanti Bindu , Akay Mehmet H. , Scovell Alison , Patel Manish K. , Patel Jayeshkumar , Bhardwaj Anju , Al Rameni Dina , Marcano Juan , Nascimbene Angelo , Kar Biswajit , Gregoric Igor D.
Published: April 2023

Frailty and malnutrition in patients with heart failure are barriers to durable left ventricular assist device (D-LVAD) support and heart transplantation. Moreover, cachexia in patients with advanced heart failure carries a high mortality risk. There are no guidelines for these patients other than increased caloric intake and rehabilitation. Patients suffering from cardiac cachexia and heart failure may benefit from temporary, percutaneous assist device support to improve the underlying heart disease and reverse the catabolic state. We retrospectively reviewed patients from January 2017 to January 2022. All patients who received Impella support (5.0 or 5.5, Abiomed) before D-LVAD implantation were screened. Those who met the criteria for cardiac cachexia were included. Patient demographics, nutritional and biochemical markers, and survival data were collected. A total of 14 patients were included. The majority of patients were male (85.7%) with ischemic cardiomyopathy (64.3%). Caloric intake, physical strength, and ambulation improved. Prealbumin levels improved from a median of 13.7–18.0 mg/dl (p < 0.006) while on Impella 5.0 or 5.5 support. All patients survived to discharge and the 6 month follow-up. In conclusion, use of the Impella device improves cardiogenic shock symptoms and, consequently, may improve cachexia status prior to D-LVAD implantation.
Development and validation of machine learning-based models for prediction of adolescent idiopathic scoliosis: A retrospective study
Authors: Lv Zheng , Lv Wen , Wang Lei , Ou Jiayuan
Published: April 2023

Adolescent idiopathic scoliosis (AIS) can cause abnormal body posture, which has a negative impact on the overall posture. Therefore, timely prevention and early treatment are extremely important. The purpose of this study is to build an early warning model of AIS risk, so as to provide guidance for accurately identifying early high-risk AIS children and adolescents. We conducted a retrospective study of 1732 children and adolescents with or without AIS who underwent physical examination in Longgang District Central Hospital of Shenzhen (LDCHS queue) from January 2019 to October 2022 and 1581 children and adolescents with or without AIS in Shenzhen People Hospital (January 2018 to December 2022) as external validation queues (SPH queue). The random forest model (RFM), support vector machine model, artificial neural network model (ANNM), decision tree model (DTM), and generalized linear model (GLM) were used to build AIS model for children and adolescents. The predictive efficacy of 5 machine learning models was evaluated by receiver operating characteristic curve and decision curve analysis. For screening candidate predictors of AIS, the ratio of sitting height to standing height (ROSHTSH), angle of lumbar rotation, scapular tilt (ST), shoulder-height difference (SHD), lumbar concave (LC), pelvic tilt (PT) and angle of thoracolumbar rotation (AOTR) can be used as a potential predictor of AIS. The effectiveness of the prediction model constructed by the 5 machine learning algorithms was between (area under the curve [AUC]: 0.767, 95% confidence interval [CI]: 0.710–0.824) and (AUC: 0.899, 95% CI: 0.842–0.956) in the training set and internal verification set, respectively. Among them, the ANNM was equipped with the best prediction effectiveness (training set: AUC: 0.899, 95% CI: 0.842–0.956) and (internal verification set: AUC: 0.897, 95% CI: 0.842–0.952). The prediction model of AIS based on machine learning algorithm can achieve satisfactory prediction efficiency, among which ANNM is the best, which can be used to guide clinicians in diagnosis and treatment and improve the prognosis of AIS children and adolescents.
Morphometric features of gastric mucosa in atrophic gastritis: A different pattern between corpus and antrum
Authors: Lin Xue-Mei , Wang Li , Xi Chun-Hui , Wang Jun , Wang Xian-Fei , Wang Qiong , Yuan Cong
Published: April 2023

Atrophic gastritis can cause mucosa thinning, while detailed metrological evidence is lacking. We aimed to compare the morphological features of full-thickness gastric mucosa in antrum and corpus and evaluate the diagnostic performance for atrophy. Gastric cancer patients were prospectively enrolled (N = 401). Full-thickness gastric mucosa was obtained. Foveolar length, glandular length and musculus mucosae thickness were measured. Pathological assessment was conducted using the visual analogue scale of the updated Sydney system. Areas under the receiver operating characteristic curves (AUCs) were calculated for different atrophy degrees. In corpus mucosa, foveolar length and musculus mucosae thickness were positively correlated with the atrophy degree (spearman’s correlation coefficient [r
s] = 0.231 and 0.224, respectively, P < .05); glandular length and total mucosal thickness were negatively correlated (r
s = −0.399 and −0.114, respectively, P < .05). Total mucosal thickness did not correlate with antral atrophy degree (P = .107). The AUCs of total mucosal thickness for corpus and antral atrophy were 0.570 (P < .05) and 0.592 (P < .05), respectively. The AUCs for corpus atrophy, moderate and severe, and severe atrophy were 0.570 (P < .05), 0.571 (P = .003), and 0.584 (P = .006), respectively. The corresponding AUCs for antral atrophy were 0.592 (P = .010), 0.548 (P = .140), and 0.521 (P = .533), respectively. The tendency for mucosal thickness to thin with atrophy occurred in the corpus rather than in the antrum. The diagnostic performance of corpus and antral mucosal thickness was limited for atrophy.
Comparison of seven prehospital early warning scores to predict long-term mortality: a prospective, multicenter, ambulance-based study
Authors: Martín-Rodríguez Francisco , Enriquez de Salamanca Gambara Rodrigo , Sanz-García Ancor , Castro Villamor Miguel A. , del Pozo Vegas Carlos , Sánchez Soberón Irene , Delgado Benito Juan F. , Martín-Conty José L. , López-Izquierdo Raúl
Published: April 2023

Background The long-term predictive validity of early warning scores (EWS) has not been fully elucidated yet.

Objective The aim of the present study is to compare seven prehospital EWS to predict 1-year mortality.

Methods

A prospective, multicenter, ambulance-based study of adult patients with an acute illness involving six advanced life support units and 38 basic life support units, referring to five emergency departments in Spain.

Results

The primary outcome was long-term mortality with a 1-year follow-up. The compared scores included: National Early Warning Score 2, VitalPAC early warning score, modified rapid emergency medicine score (MREMS), Sepsis-related Organ Failure Assessment, Cardiac Arrest Risk Triage Score, Rapid Acute Physiology Score, and Triage Early Warning Score. Discriminative power [area under the receiver operating characteristic curve (AUC)] and decision curve analysis (DCA) were used to compare the scores. Additionally, a Cox regression and Kaplan–Meier method were used. Between 8 October 2019, and 31 July 2021, a total of 2674 patients were selected. The MREMS presented the highest AUC of 0.77 (95% confidence interval, 0.75–0.79), significantly higher than those of the other EWS. It also exhibited the best performance in the DCA and the highest hazard ratio for 1-year mortality [3.56 (2.94–4.31) for MREMS between 9 and 18 points, and 11.71 (7.21–19.02) for MREMS > 18].

Conclusion

Among seven tested EWS, the use of the MREMS presented better characteristics to predict 1-year mortality; however, all these scores present moderate performances.
Association between out-of-hospital cardiac arrest and survival in paediatric traumatic population: results from the French national registry
Authors: Lockhart-Bouron Marguerite , Baert Valentine , Leteurtre Stéphane , Hubert Hervé , Recher Morgan
Published: April 2023

Background and importance

Trauma is an important cause of paediatric out-of-hospital cardiac arrest (OHCA) with a high mortality rate.

Objectives

The first aim of this study was to compare the survival rate at day 30 and at hospital discharge following paediatric traumatic and medical OHCA. The second aim was to compare the rates of return of spontaneous circulation and survival rates at hospital admission (Day 0).

Setting and participants

This multicentre comparative post-hoc study was conducted between July 2011 and February 2022 based on the French National Cardiac Arrest Registry data. All patients aged <18 years with OHCA were included in the study.

Outcome measures and analysis

Patients with traumatic aetiology were matched with those with medical aetiology using propensity score matching. Endpoint was the survival rate at day 30.

Main results

There were 398 traumatic and 1061 medical OHCAs. Matching yielded 227 pairs. In non-adjusted comparisons, days 0 and 30 survival rates were lower in the traumatic aetiology group than in the medical aetiology group [19.1% vs. 24.0%, odds ratio (OR) 0.75, 95% confidence interval (CI) 0.56–0.99, and 2.0% vs. 4.5%, OR 0.43, 95% CI, 0.20–0.92, respectively]. In adjusted comparisons, day 30 survival rate was lower in the traumatic aetiology group than in the medical aetiology group (2.2% vs. 6.2%, OR 0.36, 95% CI, 0.13–0.99).

Conclusion

In this post-hoc analysis, paediatric traumatic OHCA was associated with a lower survival rate than medical cardiac arrest.
Prognostic value of initial [18F]FDG PET/computed tomography volumetric and texture analysis-based parameters in patients with head and neck squamous cell carcinoma
Authors: Elahmadawy Mai Amr , Ashraf Aya , Moustafa Hosna , Kotb Magdy , Abd El-Gaid Salwa
Published: April 2023

Aim of work

To determine the predictive value of initial [18F]FDG PET/computed tomography (CT) volumetric and radiomics-derived analyses in patients with head and neck squamous cell carcinoma (HNSCC).

Methods

Forty-six adult patients had pathologically proven HNSCC and underwent pretherapy [18F]FDG PET/CT were enrolled. Semi-quantitative PET-derived volumetric [(maximum standardized uptake value (SUVmax) and mean SUV (SUVmean), total lesion glycolysis (TLG) and metabolic tumor volume (MTV)] and radiomics analyses using LIFEx 6.73.3 software were performed.

Results

In the current study group, the receiver operating characteristic curve marked a cutoff point of 21.105 for primary MTV with area under the curve (AUC) of 0.727, sensitivity of 62.5%, and specificity of 86.8% (P value 0.041) to distinguish responders from non-responders, while no statistically significant primary SUVmean or max or primary TLG cut off points could be determined. It also marked the cutoff point for survival prediction of 10.845 for primary MTV with AUC 0.728, sensitivity of 80%, and specificity of 77.8% (P value 0.026). A test of the synergistic performance of PET-derived volumetric and textural features significant parameters was conducted in an attempt to develop the most accurate and stable prediction model. Therefore, multivariate logistic regression analysis was performed to detect independent predictors of mortality. With a high specificity of 97.1% and an overall accuracy of 89.1%, the combination of primary tumor MTV and the textural feature gray-level co-occurrence matrix correlation provided the most accurate prediction of mortality (P value < 0.001).

Conclusion

Textural feature indices are a noninvasive method for capturing intra-tumoral heterogeneity. In our study, a PET-derived prediction model was successfully generated with high specificity and accuracy.
A dosimetric comparison of systemic peptide receptor radionuclide therapy and intra-arterial peptide receptor radionuclide therapy in patients with liver dominant gastroenteropancreatic neuroendocrine tumours
Authors: Nautiyal Amit , Jha Ashish K , Konuparamban Acsah , Mithun Sneha , Srichandan Tusharkanta , Puranik Ameya , Gala Kunal , Shetty Nithin , Kulkarni Suyash , Rangarajan Venkatesh
Published: April 2023

Objectives

Intra-arterial radionuclide therapy (IART) treatment allows direct delivery of 177Lu-DOTATATE to the overexpressed somatostatin-positive neuroendocrine liver metastases, which led to higher tumour concentration compared with systemic radionuclide therapy (SRT). The aim was to evaluate and compare the absorbed doses of both IART and SRT to organs and hepatic metastatic sites.

Methods

A total of 48 patients received SRT and IART. In SRT, activity was administered intravenously, whereas in IART, activity was administered directly into hepatic arteries. The sequential whole-body images were acquired at 2, 4, 24, 72 and 160 h. The reconstructed whole-body planar and single-photon emission computed tomography-computed tomography images were processed using the Dosimetry Toolkit for the estimation of normalized cumulated activity in the organs and tumour lesions. The absorbed dose was computed using OLINDA EXM 2.0 software.

Results

The median absorbed dose (mGy/MBq) of kidneys and spleen in IART was compared with SRT and found to be decreased by 30.7% (P = 0.03) and 37.5% (P = 0.08), whereas it was found to be increased by 40% (P = 0.26) and 8.1% (P = 0.28) in the liver and lungs. The median dose (mGy/MBq) of tumours determined in IART was found to be increased by 62.2% (P = 0.04).

Conclusion

IART with 177Lu-DOTATATE significantly increases tumour dose while reducing overall systemic toxicity in comparison to SRT treatment. After considering the maximum tolerance limit of kidneys in peptide receptor radionuclide therapy, the number of treatment cycles and injected activity can be optimized further with IART for better response and survival.
Transplant oncology: multivisceral transplantation for neuroendocrine tumor and liver metastasis
Authors: Nagai Shunji
Published: April 2023

Purpose of review

Neuroendocrine tumor (NET) liver metastatic lesions are often multiple and found to be unresectable. Rationale of multivisceral transplantation (MVT: liver–pancreas–intestine transplantation) include radical and complete resection of primary, visible and invisible metastatic tumors by removing all abdominal organs and the lymphatic system. This review aims to describe the concept of MVT for NET and neuroendocrine liver metastasis (NELM), patient selection, timing of MVT, and posttransplant outcomes and management.

Recent findings

Although indication criteria of MVT for NET vary between transplant centers, the Milan-NET criteria for liver transplant are often applied to MVT candidates. Extra-abdominal tumors such as lung and/or bone lesions should be ruled out prior to MVT. Histology should be confirmed as low-grade (G1/G2). Ki-67 should be also checked to confirm biologic features. Timing of MVT remains controversial, whereas many experts recommend 6 months of disease stability prior to MVT.

Although MVT would not be a standard therapy because of limited access to MVT centers, benefit of MVT should be recognized, which includes its potential ability to better achieve curative resection of disseminated tumors in the abdominal cavity. Early referral of difficult cases to MVT centers should be considered before palliative best supportive cares.
Clofarabine for Lymphodepletion Before CAR-T-Cell Infusion: A Brief Case Report
Authors: Foti Alycia , Stein Dylan , Seidel Drew , Levine Jennifer , Hijiya Nobuko , Williams Olatundun , George Diane , Bhatia Monica , Satwani Prakash
Published: April 2023

Given the shortage of fludarabine, alternative preparative lymphodepleting regimens for CAR-T-cell therapy need to be identified. We present a case of relapsed/refractory B-cell acute lymphoblastic leukemia requiring multiple lines of salvage therapy with persistent extensive disease, who underwent lymphodepletion with clofarabine and cyclophosphamide before tisagenlecleucel CD19+ CAR-T-cell infusion with eventual remission. We offer evidence of clofarabine’s activity against B-cell acute lymphoblastic leukemia in combination with tisagenlecleucel therapy. In this patient, clofarabine did not decrease CAR-T-cell effectiveness, supported by presence of cytokine release syndrome and ultimate minimal residual disease negativity both on flow cytometry and next-generation sequencing.
Effects of a treatment program based on constraint-induced movement therapy for the lower extremities on gait and balance in chronic stroke: a 6-month follow-up pilot study
Authors: Kobari Tomoyoshi , Murayama Takashi , Matsuzawa Kazuhiro , Sakai Katsuya
Published: April 2023

Constraint-induced movement therapy (CIMT) for the lower extremities CIMT (LE-CIMT) has been shown feasible and promising but the long-term outcomes remain uncertain. In this pilot study, we recruited eight participants with chronic stroke from our facility for persons with disabilities to determine changes in gait and balance throughout an extended treatment program based on the principles of LE-CIMT. The program consisted of a run-in phase (3 weeks), LE-CIMT phase (3 weeks), and maintenance phase (6 months). In the LE-CIMT phase (3.5 h/day, 5 days/week, 3 weeks), the participants received task-oriented training (3 h) and transfer package training (30 min). The maintenance phase (30 min/day, 2–3 times/week, 6 months) included a transfer package and conventional training. The assessments were performed in the beginning and after each phase using the Fugl–Meyer Assessment, 6-min walk test (6MWT), Berg Balance Scale (BBS), and 10-m walk test from which walking speed, cadence, and stride length were derived. Overall, 6MWT, BBS, walking speed, and cadence improved significantly over time (analysis of varianceP < 0.001). When comparing the results from before to after the LE-CIMT phase, 6MWT, BBS, walking speed, and cadence improved significantly (P = 0.002 to 0.022). At the end of the 6-month maintenance phase, further improvements relative to the after LE-CIMT phase were found for 6MWT, walking speed, and cadence (P = 0.002 to 0.034). These pilot results suggest that an extended treatment program based on the principles of LE-CIMT can improve balance and more so walking in the chronic phase of stroke.
A simple smartphone-aided program to support meaningful occupation in people with severe neuro-motor and speech disabilities
Authors: D’Amico Fiora , Lancioni Giulio E. , De Marinis Flavio , Abbinante Fabiana , Taurisano Paolo , Abbatantuono Chiara , Alberti Gloria
Published: April 2023

We assessed a simple smartphone-aided program to help three participants with severe neuro-motor and speech disabilities access preferred songs, call or send messages to distant partners, and call the caregiver. The program relied on the use of a smartphone, five cards with identification tags, and a mini speaker. The participants could select one of the cards (engagement options) by touching it with the smartphone. Using the program, all participants managed to access songs, reach partners, and call the caregiver independently and engaged in the related forms of leisure and communication/interaction throughout the 10-min sessions available. The results suggest that the program might be a valuable aid for people with severe neuro-motor and speech disabilities.
Tetraparesis as an initial manifestation of biotinidase deficiency: a case report
Authors: Badour Maysaa , Hammed Ali , Baqla Sameer , Amer Fatema
Published: April 2023

Introduction and importance:

Biotinidase deficiency (BTD) is an autosomal recessive disorder and causes the deficiency of four biotin-containing carboxylases. The prevalence is estimated at 1 in 60 000 births. BTD is associated with a wide spectrum of clinical manifestations, including abnormalities of the neurological, dermatological, immunological, and ophthalmological systems. Spinal cord demyelination as a manifestation of BTD has been infrequently described.

Case presentation:

The authors present a case of 2.5-year-old boy complained of progressive weakness in all four limbs, with difficulties in breathing.

Clinical discussion:

Abdominal examination revealed hepatomegaly and splenomegaly. Also, her parents were first-degree cousins. Therefore, tandem mass spectroscopy and urine organic acid analysis were planned to exclude metabolic disorders. Urinary organic acid analysis revealed elevated levels of methylmalonic acid and 3-hydroxyisovaleric acid. Serum biotinidase activity was found to be 3.9 nmol/min/ml. Oral biotin at a dose of 1 mg/kg daily was initiated. A marked improvement of his neurological deficit was noted over a period of 15 days after treatment and cutaneous manifestations resolved within 3 weeks.

Conclusion:

Myelopathy due to BTD is a challenging diagnosis. Spinal cord impairment is a rare complication of this disease and is frequently unrecognized. BTD should be included in the differential diagnosis of children presenting with demyelinating spinal cord disease.
Year-round dengue fever in Pakistan, highlighting the surge amidst ongoing flood havoc and the COVID-19 pandemic: a comprehensive review
Authors: Tabassum Shehroze , Naeem Aroma , Nazir Abubakar , Naeem Farhan , Gill Saima , Tabassum Shehram
Published: April 2023

Dengue fever (DF) is an arthropod-borne viral infection caused by four serotypes of dengue virus (DENV 1–4) transmitted to the host by the vector mosquito Aedes, which causes fever, vomiting, headache, joint pain, muscle pain, and a distinctive itching and skin rash, ultimately leading to dengue hemorrhagic fever and dengue shock syndrome. The first case of DF in Pakistan was documented in 1994, but outbreak patterns began in 2005. As of 20 August 2022, Pakistan has 875 confirmed cases, raising alarming concerns. Misdiagnosis due to mutual symptoms, lack of an effective vaccine, the weakened and overburdened health system of Pakistan, irrational urbanization, climate change in Pakistan, insufficient waste management system, and a lack of awareness are the significant challenges Pakistan faces and result in recurrent dengue outbreaks every year. The recent flood in Pakistan has caused massive destruction, and stagnant dirty water has facilitated mosquito breeding. Sanitization and spraying, proper waste management, an adequate and advanced diagnostic system, control of population size, public awareness, and promotion of medical research and global collaboration, especially amidst flood devastation, are recommended to combat this deadly infection in Pakistan. This article aims to comprehensively review the year-round DF in Pakistan, highlighting the surge amidst ongoing flood havoc and the coronavirus disease 2019 pandemic.
Correlation between caloric test results and VHIT VOR gains in unilateral horizontal canal deficits: a cross-sectional study
Authors: El Bouhmadi Khadija , Loudghiri Myriam , Oukessou Youssef , Rouadi Sami , Abada Redallah , Roubal Mohamed , Mahtar Mohamed
Published: April 2023

The purpose of the study is to evaluate the correlation between caloric test results and video head impulse test (VHIT) vestibulo-ocular reflex (VOR) gains in unilateral horizontal canal deficits in order to define a possible threshold value above which caloric deficits should be associated with predictable low VHIT VOR gains. Caloric test and VHIT were realised in 105 patients presenting with symptoms of rotational vertigo occurring within the last 2 weeks. The authors defined the cutoff value for a caloric abnormality as more than 15% of canal deficit, which allowed us to divide our patients on groups based on the severity of their caloric asymmetry. Then, the authors performed the VHIT considering abnormal horizontal gain as less than 0.8 with catch-up saccades. The authors evaluated the prevalence of results dissociation between the two tests and the correlation between the caloric asymmetry and the horizontal VHIT VOR gains in each group according to the severity of canal deficit. The correlation was considered statistically significant if P less than 0.05 (Fisher’s exact test). The caloric test revealed a significant unilateral deficit in 50 patients (47.6%). The interval of deficit between 21 and 40% included 25 patients, 18 (72%) presenting with normal VHIT VOR gains versus 7. On the other hand, for the 12 patients in the intervals of 81–100% of deficit, the VHIT VOR gain was highly abnormal in all cases. In comparison with the normal caloric test group, a correlation between each interval of caloric deficits and VHIT VOR gains has been assessed. This correlation was significant in the interval of 41–60% (P=0.04 <0,05) and in the interval of 81–99% next to patients with a total deficit of 100% (P=0.006 <0.05 for each). It appears that simultaneous affection of high vestibular frequencies evaluated on VHIT may be more likely and predictable above a minimal threshold of 40% caloric asymmetry, with better discrimination between normal and abnormal VHIT above 80%. Thus, they are two complementary tests to use as a couple rather than a replacement one for the other.
Bouveret Syndrome simultaneous with an incidental solitary Gastric Neuroendocrine Tumor in a 44-year-old female - A Case Report
Authors: Shaheen Jack , Al Laham Omar , Ibrahim Basha Zein , Atia Fareed , Sharaf Aldeen Rahaf , Isaac Michel , Alhanwt Alaa
Published: April 2023

Introduction and importance:

Bouveret Syndrome (BS) is a rare type of gallstone ileus, where a gallstone passes via a cholecystoduodenal fistula and causes gastric outlet obstruction. It comprises 0.3–0.5% of cholelithiasis complications. It primarily affects females with an average incidence age of 74 years. Gastric Neuroendocrine Tumors (G-NETs) make up merely 2% of all forms of gastric neoplasia and are known to be an extremely rare occurrence. Their annual incidence is estimated to be one to two per 1 million individuals, and they comprise 8.7% of all known neuroendocrine neoplasia of the gastrointestinal system.

Case presentation:

We present the case of a 44-year-old Middle Eastern female who presented to the clinic due to multiple episodes of food containing biliary nonprojectile emesis accompanied by epigastric pain. Preoperative radiological workup revealed a Bezoar blocking the gastric outlet and a G-NET in the mucosal layer of the stomach.

Clinical discussion:

Surgical intervention consisted of excising the impacted calculus to relieve the existing gastric outlet obstruction simultaneous to performing an uncut Roux-en-Y to treat the G-NET condition. The patient underwent complete recovery.

Conclusion:

BS is an extremely rare form of gallstone ileus and gastric outlet obstruction. Its clinical presentation is nonspecific and results in misdiagnosis. Additionally, it is rare to occur in our patient’s age group. NETs are also profoundly rare forms of neoplasia. To the best of our knowledge, no previous cases of simultaneous BS and G-NET have been documented. Therefore, clinical awareness should be raised to timely implement the necessary therapeutic interventions.
Kawasaki disease − often a diagnostic dilemma in pediatric population: a case report
Authors: Subedi Subash , Shrestha Swikriti , Khatri Chhetri Sujata , Lamichhane Sandesh , Dhakal Swastika , Dahal Pravakar , Baniya Shubha , Pokhrel Santosh
Published: April 2023

Introduction:

Kawasaki disease (KD) is the most common cause of childhood vasculitis affecting small- and medium-sized arteries. The cause of this disease is unknown with an overall prevalence of 0.10% making this a rare entity.

Case presentation:

Here the authors present an index case of a 2-year-old child presenting with a persistent high-grade fever of more than 5 days and a 3-day history of bilateral swelling of hands and feet along with cervical lymphadenopathy. On the subsequent day of admission, the child developed mucocutaneous symptoms and cervical lymphadenopathy. The diagnosis of KD was made, and it was successfully treated with intravenous immunoglobulin and aspirin.

Clinical discussion:

Timely diagnosis and early treatment of KD are challenging due to the lack of definitive diagnostic tests. Watchful waiting for symptoms may be necessary before a diagnosis can be made because not all clinical symptoms are present simultaneously as in the index case.

Conclusions:

This case highlights considering KD as a differential diagnosis of nonresolving fever in children with mucocutaneous findings. Intravenous immunoglobulin along with aspirin is the mainstay of therapy and should be started as early as possible to prevent detrimental cardiac complications. There is a high tendency of diagnostic dilemmas due to a wide array of nonspecific presentations thus healthcare providers must be more vigilant of this entity.
A rare case of pediatric orbital rhabdomyosarcoma in Nepal: a case report
Authors: Shrestha Tina , Mainali Sumina , Poudel Sandhya , K.C Narendra , Dulal Aliza
Published: April 2023

Introduction and Importance:

Orbital rhabdomyosarcoma (RMS) is a highly malignant, mesenchymal orbital tumor of childhood with a predilection in children less than 20 years of age. It presents as a space-occupying lesion in the orbit, most commonly over the superior nasal quadrant of the orbit. The patient usually presents with rapid onset unilateral proptosis and eyelid edema.

Case Ppresentation:

In this article, a 14-year-old male presented with rapidly progressive swelling of the right orbit. On ocular examination, there was nonaxial inferolateral proptosis of the right eye. Computed tomography revealed a large soft tissue density tissue lesion in the right nasal cavity and meati measuring at least 3.2×2.7×5.4 cm in size with the erosion of the right orbit along with extension of the lesion in the extraconal compartment of the orbit. An MRI of the brain with contrast showed a heterogeneously enhancing altered signal intensity lesion. Debulking was planned, and a biopsy of the mass was sent that gave an impression of alveolar RMS. He also received radiotherapy and chemotherapy at one of the cancer hospitals in Nepal. Postsurgical follow-up showed gradual improvement in the visual acuity of the right eye. No evidence of metastasis and recurrence was found upon subsequent follow-up.

Conclusion:

Thus, early diagnosis and prompt treatment is most for a favorable prognosis in the case of RMS. The main aim of this article was to briefly overview a rare case of RMS, its clinical presentation, diagnosis, treatment modalities, and its prognosis.
The outcome of spine metastatic after surgery: a case series
Authors: Azharuddin  , Kamarlis Reno Keumalazia , Akbar Fikri
Published: April 2023

Introduction:

Spine metastases occur because of the spread of the primary tumour that causes back pain and neurological deficits in the sufferer and has a high risk for surgery.

Case presentation:

In this case series, all three patients had the same initial symptoms; back pain and lower limb weakness and had a history of previous primary tumours that metastasized to the spine. The MRI showed a tumour mass on T11 accompanied by a burst fracture in the first patient, L4 in the second patient, and T3 in the third case accompanied by a dislocated fracture. The three reported patients underwent a posterior decompression procedure, and a histopathological examination showed a metastatic adenocarcinoma.

Outcomes:

Postoperatively the patient underwent physiotherapy and showed a change in the Frankel grade condition. However, in the second case, the patient had complications such as a pathological fracture that made the patient undergo further surgery for this. Still, after the operation, the patient died due to hemodynamic instability due to heavy blood loss. In this report, the indication for surgery is because the three patients complained of pain and neurological deficits resulting in the patient having limited motor movement in the lower limbs.

Conclusion:

Surgery is one of the things that can improve spine metastatic patients’ activities of daily living and quality of life even though it is a high-risk procedure; The surgeon must carefully assess the patient’s condition in determining the classification, evaluation, and scoring system to provide the necessary therapy.
Diffuse large B-cell lymphoma presenting as sternal mass in a patient with ankylosing spondylitis: a case report study
Authors: Borhani Ali , Daskareh Mahyar , Gilanchi Samira , Vakilpour Azin , Poursharif Maryam , Vojdanian Mehdi
Published: April 2023

Introduction and importance:

Primary bone lymphoma is a rare entity that constitutes less than 1% of all non-Hodgkin lymphomas and 3–5% of malignant bone tumors. Chronic immune and inflammatory diseases carry a level of risk for the development of malignancies that is correlated with the disease severity. There is conflicting evidence regarding the risk of lymphoma in spondyloarthritis.

Case presentation:

The authors present a rare case of primary diffuse large B-cell lymphoma of the sternum in a 41-year-old Iranian woman with ankylosing spondylitis (AS). Physical examination revealed a 7×7.5 cm firm swelling of the anterior midline chest wall above the breasts, and MRI showed a lesion within the sternal marrow with an associated soft-tissue mass in the anterior aspect of the sternum. Following core-needle biopsy under ultrasound guidance, a histopathological study demonstrated diffuse sheets of large noncleaved atypical cells with large multilobated prominent nuclei and fine chromatin compatible with diffuse large B-cell lymphoma.

Clinical discussion:

Primary and exclusive involvement of the sternum is an uncommon presentation of lymphoma. Radiological, histological, and clinical characteristics of primary bone lymphoma can resemble those of other medical disorders. Although infrequent, existing evidence shows that AS seems to be associated with a small but significant risk for malignancy.

Conclusion:

Even though inflammatory involvement of the anterior chest wall could be a common clinical finding in patients with AS, it is recommended that anterior chest wall pain or any mass almost always needs comprehensive assessment and imaging evaluation in such patients to avoid any delayed diagnosis, misdiagnosis, and ensuing morbidity or mortality.
Marked reduction in the hospital admission rate of a man with nonislet cell tumor hypoglycemia after starting steroids: a case report
Authors: Elsdai Ibrahim , Elsdai Taher
Published: April 2023

Introduction and importance:

Nonislet cell tumor hypoglycemia (NICTH) is a rare cause of hypoglycemia. It results from the secretion of insulin-like growth factor 2 from various tumors, which acts on insulin receptors, increasing glucose utilization by the tumor. Among the treatment options for patients with NICTH, steroids have the best palliative effects.

Case presentation:

The authors present the case of a man with metastatic lung cancer who had multiple hospitalizations for hypoglycemia and associated anorexia, weight loss, and depression. After receiving steroids, the patient’s hospital admission rate due to hypoglycemia reduced, depression improved, and weight loss reversed.

Clinical discussion:

Steroids, diazoxide, octreotide, glucagon infusion, and recombinant growth hormone have shown good results in treating NICTH. Steroids have many advantages: they are easy to administer and relatively inexpensive. In our patient, steroids had the added benefit of improving the appetite with subsequent weight gain and controlling depression. They also significantly reduced the readmission rate.

Conclusion:

NICTH is a rare cause of hypoglycemia. Glucocorticoids show better palliative effects than other medical treatments. In our patient, steroids dramatically reduced the number of hospitalizations due to hypoglycemia while improving the appetite, weight, and depression.
Transit analysis of thyroid antibodies in graves’ disease following painless thyroiditis: a case report
Authors: Suto Daisuke , Ebihara Ken , Ishikawa San-e
Published: April 2023

Graves’ disease and painless thyroiditis induce hyperthyroidism and are manifestations of an immunological disorder; however, their clinical entities differ. This case report illustrates a possible interrelation between the pathogenesis of these two disorders. A 34-year-old woman presented with palpitations, fatigue, and shortness of breath and was initially diagnosed with painless thyroiditis, which spontaneously normalized within 2 months. Within the euthyroid state, there were atypical alterations in thyroid autoantibodies, namely, activation of the thyroid stimulating hormone receptor antibody and inactivation of thyroid peroxidase and thyroglobulin antibodies. Ten months later, her hyperthyroidism recurred, with this second incidence deemed to be related to Graves’ disease. Our patient had two types of painless thyroiditis with no successive hyperthyroidism, followed by Graves’ disease, with her clinical manifestation transitioning from painless thyroiditis to Graves’ disease over a 20-month period. Future studies are needed to elucidate the mechanisms and relationship between painless thyroiditis and Graves’ disease.
Obturator hernia (the little old lady’s hernia) diagnosed via computed tomography: a case report
Authors: Bohara Sujan , Karki Samikshya , Gautam Anu , Regmi Binit U. , Rimal Sabin , Khadka Laxman , Pokharel Anuj , Gurung Bibek , Rawal Sushil B.
Published: April 2023

Introduction and importance:

Obturator hernia is an infrequent clinical entity of abdominal wall hernia, accounting for an incidence rate ranging from 0.073 to 2.2% of all hernias and being responsible for 0.2–1.6% of all cases of mechanical intestinal obstruction. The computed tomography (CT) scan, as an imaging modality, is critical in improving the diagnostic rate of obturator hernia.

Case presentation:

The authors herein report an 87-year-old thin male patient with a known history of chronic obstructive pulmonary disease who presenting with complaints of abdominal pain for 3 days and constipation for 2 days, as well as one episode of vomiting without any features of peritoneal irritation, which was diagnosed early as a right-sided obturator hernia via CT and managed with exploratory laparotomy with hernia reduction and polypropylene mesh repair.

Discussion:

Obturator hernia is a rare surgical phenomenon with a varied clinical spectrum, ranging from asymptomatic to presenting as intestinal obstruction. The CT scan plays a critical role in the detection of obturator hernias, which ameliorates the possible significant postoperative morbidity and mortality.

Conclusion:

This report demonstrates that a high index of suspicion combined with CT imaging aids in early diagnosis and management, thus overcoming the reluctant morbidity.
Affective Temperaments Misdiagnosed as Adult Attention Deficit Disorder
Authors: Mauer Sivan , Ghazarian Garo , Ghaemi S. Nassir
Published: April 2023

Adult attention-deficit disorder (ADD) is a common diagnosis, and amphetamine medications are increasingly used. Recent reports suggest high prevalence of affective temperaments, such as cyclothymia, in adult ADD. This study reexamines prevalence rates as reflecting misdiagnosis and reports for the first time on the effects of amphetamine medications on mood/anxiety and cognition in relation to affective temperaments. Among outpatients treated at the Tufts Medical Center Mood Disorders Program (2008–2017), 87 cases treated with amphetamines were identified, versus 163 non–amphetamine-treated control subjects. Using the Temperament Scale of Memphis, Pisa, Paris and San Diego–Autoquestionnaire, 62% had an affective temperament, most commonly cyclothymia (42%). In amphetamine-treated cases, mood/anxiety symptoms worsened notably in 27% (vs. 4% in the control group, risk ratio [RR] 6.2, confidence interval [CI], 2.8–13.8), whereas 24% had moderate improvement in cognition (vs. 6% in the control group; RR, 3.93; CI, 1.9–8.0). Affective temperaments, especially cyclothymia, are present in persons about one-half of persons diagnosed with adult ADD and/or treated with amphetamines.
The Case Against “Excited Delirium”
Authors: Weiss Kenneth J. , Lanzillotta Cristina
Published: April 2023

Citizens' deaths in police custody are sometimes attributed to “excited delirium syndrome” (ExDS). This terminology is rejected by the American Medical Association and the American Psychiatric Association. ExDS has no demonstrable pathology but has been proposed as predisposing to sudden death, thus exonerating police. Ketamine use during arrests complicates manner of death. ExDS deaths trigger lawsuits claiming police misconduct and excessive force. Defendant officers and municipalities have used ExDS to distance themselves from liability, using expert testimony from nonpsychiatrists. This argument is expressed despite lack of autopsy findings, the false idea that mental illness itself can lead to sudden death, and the absence of consistent diagnostic criteria. This article traces the history of ExDS and reviews the arguments for and against its use in psychiatry and law enforcement. The authors conclude that the label is medically unreliable, has eroded confidence in police-citizen interactions, and obscures dynamics of deaths in custody.
Psychiatric Comorbidities and Risk of Somatic Symptom Disorders in Posttraumatic Stress Disorder
Authors: Sejdiu Albulena , Jaka Sanobar , Younis Hadia , Kidambi Neil S. , Faruki Farzana , Patel Rikinkumar S. , Gunturu Sasidhar
Published: April 2023

Nearly 90% of Americans are exposed to a traumatic event at some point in their lives, and over 8% of those individuals will develop posttraumatic stress disorder (PTSD). Our study examined the demographic differences and psychiatric comorbidities in inpatients with PTSD with and without somatic symptom disorders (SSDs), using data from the Nationwide Inpatient Sample for 2018 and 2019. Our sample included 12,760 adult patients with a primary diagnosis of PTSD, which was further subdivided based on a codiagnosis of SSD. We used a logistic regression model to determine the odds ratio (OR) of association for SSD and identify demographic predictors and comorbid risk factors in inpatients with PTSD. The prevalence of SSD in inpatients with PTSD was 0.43%, and it was more commonly seen in women and Caucasians. Personality disorders (OR, 5.55; p < 0.001) and anxiety disorders (OR, 1.93; p = 0.018) were found to increase the likelihood of codiagnoses of SSD in inpatients with PTSD. These findings support the need for a systematic, modular approach that includes evidence-based interventions to treat at-risk populations.