bluuebunny/crossref_metadata_2025 huggingface dataset:
Late-week Multilevel Anterior Cervical Discectomy and Fusion Associated With Increased Length of Stay
Authors: Miller Evan M. , Polascik Bryce W. , Kitchen Spencer T. , Wahbeh Elias E. , Abouhaif Taylor M. , Contillo Nicholas J. , Elashker Adrianna L. , Hsia Michelle W. , Marsh Kathleen A. , Thometz Kyler J. , Yin Timothy C. , O’Gara Tadhg J.
Published: February 2024

Study Design:

Retrospective analysis of clinical data from a single institution.

Objective:

To assess the day of surgery during the week as a possible predictor of length of stay (LOS) following anterior cervical discectomy and fusion (ACDF).

Summary of Background Data:

Surgeries later in the week may result in longer LOS and higher costs for joint arthroplasty, yet this is unclear following spine surgery. Procedures performed later in the week may lead to weekend admissions when there are limited services that may contribute to an extended LOS. We attempt to identify associations between day of surgery and LOS, readmission, and complications following single- and multilevel ACDF.

Materials and Methods:

Patients at a single institution undergoing ACDF by 7 primary surgeons in both orthopedic and neurosurgery spine departments between 2015 and 2019 were retrospectively reviewed. Patients were stratified by surgery day at either the beginning (Monday/Tuesday) or end (Thursday/Friday) of the week and by single- or multilevel ACDF. Surgery for trauma, infections, adjacent level disease, or revision were excluded. Patient demographics, Charlson Comorbidity Index (CCI), LOS, postoperative complications, and readmission rates were assessed.

Results:

Six hundred fifty-two patients underwent ACDF. For single-level ACDF, 222 were reviewed, with 112 having surgery at the beginning and 110 at the end of the week. For multilevel ACDF, 431 were reviewed, with 192 having surgery at the beginning and 239 at the end of the week. No differences in pre- or postoperative variables were determined for single-level ACDF. Despite no differences in pre-operative variables, CCI, operative duration, or number of levels, late-week multilevel ACDF had longer average LOS (2.8±3.0 days) compared to early-week surgery (2.0±2.0 days) (P=0.018).

Conclusions:

Late-week multilevel ACDF was associated with an increased LOS, as it may prove beneficial to surgical planning. This conflicts with previous reports that day of week was not associated with LOS following ACDF.

Level of Evidence:

III
Pulmonary Artery Hypertension: Fifty Years Following Pneumonectomy in Infancy
Authors: Seplowe Matthew , Isath Ameesh , Michaud Liana , Frishman William H. , Levine Avi , Aronow Wilbert S. , Lanier Gregg M.
Published: February 2024

Pulmonary hypertension (PH) may be the result of many different pathological processes. PH is a rare but recognized vascular complication following major lung resection. We describe the diagnosis and management of moderate PH resulting more than 50 years in a patient who underwent a total unilateral pneumonectomy in infancy. Unfortunately, patients who undergo pneumonectomy will likely go on to develop PH and their functional status will be greatly impacted. In the case presented, we report on a patient whose PH and symptoms improved following off-label WHO group 1 treatment.
Hemorrhoidectomy: Does Age Make a Difference?
Authors: Capece Steven J. , Browning Charles J. , Barros de Sousa Cesar A. , Shaak Kyle , Yoon Justin Y. , Sangster William
Published: February 2024

BACKGROUND:

Grade II and III hemorrhoids often require a multimodal approach that may ultimately culminate to surgical resection. Age and overall medical conditioning around the time of diagnosis can often impact the decision.

OBJECTIVE:

The objective of this study was to evaluate patients with a diagnosis of symptomatic grade II or grade III hemorrhoids and determine progression to hemorrhoidectomy based on age and the time interval between diagnosis and surgical intervention.

DESIGN:

A retrospective cohort study.

SETTINGS:

Group practice at a single institution

PATIENTS:

Patients age 18-75 with grade II or grade III internal hemorrhoids between 2015 and 2020 were included. Patients with thrombosed hemorrhoids or surgical contraindications to hemorrhoidectomy were excluded. A total of 961 patients met inclusion criteria for Grade II (n = 442) and III (n = 519) hemorrhoids

INTERVENTION:

Treatments included hemorrhoidectomy, in-office procedures, and/or medical management.

MAIN OUTCOME MEASURES:

Baseline demographics, treatment choices and time to hemorrhoidectomy (if applicable) were stratified and analyzed based on hemorrhoid grade (grade II and III) and age groupings that were pre-determined by the authors (18-30, 31-50, and 51-75).

RESULTS:

Patients with Grade III vs Grade II hemorrhoids were more likely to choose hemorrhoidectomy as the initial treatment management (27.6% vs 4.1%). Patients in age groups 18-30 and 30-50 were more likely to choose hemorrhoidectomy as the initial treatment management compared to ages 51-75 years old (23.5% and 22% vs 12.8%). In patients who were initially treated with medical management or office-based procedures and then progressed to hemorrhoidectomy, no significant differences in length of time to hemorrhoidectomy were noted based on hemorrhoid grade or age.

LIMITATIONS:

Data only looks at age groups and their treatment selection. Personal biases of surgeon and patient may alter results.

CONCLUSION:

Our study shows that the younger population tend to seek hemorrhoidectomy first over the older population. See Video Abstract.
Clinical Utility of Laser Speckle Contrast Imaging and Real-Time Quantification of Bowel Perfusion in Minimally Invasive Left-Sided Colorectal Resections
Authors: Skinner Garrett C. , Liu Yao Z. , Harzman Alan E , Husain Syed G. , Gasior Alessandra C , Cunningham Lisa A. , Traugott Amber L. , McCulloh Christopher J. , Kalady Matthew F. , Kim Peter C. , Huang Emily S.
Published: February 2024

BACKGROUND:

Left-sided colorectal surgery demonstrates high anastomotic leak rates, with tissue ischemia thought to influence outcomes. Indocyanine green is commonly used for perfusion assessment, but evidence remains mixed for whether it reduces colorectal anastomotic leaks. Laser speckle contrast imaging provides dye-free perfusion assessment in real-time through perfusion heatmaps and quantification.

OBJECTIVE:

This study investigates the efficacy of advanced visualization (indocyanine green versus laser speckle contrast imaging) perfusion assessment and utility of laser speckle perfusion quantification in determining ischemic margins.

DESIGN:

Prospective intervention group using advanced visualization with case-matched, retrospective control group.

SETTINGS:

Single academic medical center.

PATIENTS:

Forty adult patients undergoing elective, minimally invasive, left-sided colorectal surgery.

INTERVENTIONS:

Intraoperative perfusion assessment using white-light imaging and advanced visualization at three time points: T1 – proximal colon after devascularization, before transection; T2 – proximal/distal colon before anastomosis; and T3 – completed anastomosis.

MAIN OUTCOME MEASURES:

Intraoperative indication of ischemic line of demarcation before resection under each visualization method, surgical decision change using advanced visualization, post-hoc laser speckle perfusion quantification of colorectal tissue, and 30-day postoperative outcomes.

RESULTS:

Advanced visualization changed surgical decision making in 17.5% of cases. For cases in which surgeons changed a decision, the average discordance between line of demarcation in white-light imaging and advanced visualization was 3.7 cm, compared to 0.41 cm (p = 0.01) for cases without decision changes. There was no statistical difference between line of ischemic demarcation using laser speckle versus indocyanine green (p = 0.16). Laser speckle quantified lower perfusion values for tissues beyond the line of ischemic demarcation while suggesting an additional 1 cm of perfused tissue beyond this line. One (2.5%) anastomotic leak occurred in the intervention group.

LIMITATIONS:

This study was not powered to detect differences in anastomotic leak rates.

CONCLUSIONS:

Advanced visualization using laser speckle and indocyanine green provides valuable perfusion information that impacts surgical decision-making in minimally invasive left-sided colorectal surgeries. See Video Abstract.
Socioeconomic Disparities in Anal Cancer: Effect on Treatment Delay and Survival
Authors: Nepal Pramod , Zafar Muhammad , Liu Li C , Xu Ziqiao , Abdulhai Mohamad A. , Perez-Tamayo Alejandra M , Chaudhry Vivek , Mellgren Anders F , Gantt Gerald
Published: February 2024

BACKGROUND:

Socioeconomic inequities have implications in access to health care and may be associated with disparities in treatment and survival.

OBJECTIVE:

To investigate the impact of socioeconomic inequities on time to treatment and survival of anal squamous cell carcinoma.

DESIGN:

This is a retrospective study using a nationwide dataset.

SETTINGS:

The patients were selected from National Cancer Database enrolled from 2004 to 2016.

PATIENTS:

We identified patient with stage I-III squamous cell carcinoma of anus who were treated with chemoradiation.

MAIN OUTCOMES MEASURES:

Socioeconomic factors, including race, insurance status, median household income, and percentage of no high school degrees were included. The association of these factors with treatment delay and overall survival were investigated.

RESULTS:

A total of 24,143 patients who underwent treatment for Grade I-III squamous cell carcinoma of anus were identified. Median age was 60 years and 70% were female. The median time to initiation of treatment was 33 days. Patients from zip codes with lower median income, higher percentage of no high school degree, and patients with other government insurance followed by Medicaid insurance had treatment initiated after 60 days from diagnosis. Kaplan-Meier survival analysis showed that the late treatment group had worse overall survival compared to early treatment group (98 vs 125 months; p < 0.001).

LIMITATIONS:

No detailed information about chemoradiotherapy regimen, completion of treatment, recurrence, disease free survival and individual level socioeconomic condition and risk factors.

CONCLUSION:

Patients from communities with lower median income, level of education, and enrolled in public insurance had longer time to treatment. Lower socioeconomic status was also associated with poorer overall survival. These results warrant further analysis and measures to improve access to care to address this disparity. See Video Abstract.
Extravascular injection of neuromuscular blocking drugs
Authors: Nietvelt Frederik , Van Herreweghe Imré , Godschalx Vincent , Soetens Filiep
Published: February 2024

Extravascular injection of neuromuscular blocking drugs (NMBDs) can cause a neuromuscular block because of systemic absorption. Currently, there are no guidelines available on managing extravasation of NMBDs. This article reviews the available literature on extravasation of NMBDs. Medline and Embase databases were searched for studies concerning the paravenous or subcutaneous injection of NMBDs. Nine articles were included consisting of seven case reports, one case series and one clinical trial. Rocuronium was used as primary NMBD in nine cases, vecuronium in two cases and pancuronium in one case. Although there exists significant heterogeneity between the reported information in the included studies, the majority of the case reports describe a slower onset, with a median delay of 20 min and prolonged duration of the neuromuscular block. Nine patients had a residual neuromuscular block at the end of the surgery. Postoperative monitoring in the recovery room was prolonged (median time 4 h). Most studies suggest that the delay in NMBD onset and recovery is caused by the formation of a subcutaneous depot, from which the NMBD is slowly absorbed into the systemic circulation. According to the current literature, extravasation of NMBDs results in an unpredictable neuromuscular block. Strategies to prevent potentially harmful side effects, such as frequent train-of-four (TOF) monitoring, the use of NMBD reversal agents and prolonged length of stay in the postanaesthesia care unit (PACU), should be considered. This article suggests a clinical pathway that can be used after extravascular injection of NMBDs.
Alveolar Oral Layer Repair by Periosteal Grafts versus Maxillary Flaps and Gingivoperiosteoplasty: Techniques and Follow-up to Adolescence
Authors: El Danaf Ahmed A. , Al-Ahmady Hatem H. , Eldanaf Heba A. , Soliman Helmy A. , Elhelw Moustafa H. , Khalil Maurice F. , Rizk Ibrahim A. , Donia Mohamed S.
Published: February 2024

Background:

Alveolar periosteoplasty during primary repair of cleft lip is still a topic of debate due to the fear exacerbating maxillary retrusion. The authors present their experience with early closure of alveolar clefts. The study aims to analyze gingivoperiosteoplasty (GPP) by comparing the use of locoregional flaps versus distant grafts for reconstruction of the lower layer of the primary palate cleft.

Methods:

Seventeen infants underwent 22 alveolar cleft repairs. After nasal floor repair by nasal mucoperiosteum, the oral layer was repaired by maxillary or gingival periosteal flaps in seven patients with alveolar clefts less than or equal to 6 mm wide, and tibial or pericranial periosteal grafts in 10 patients with wider clefts. At teenage years, crossbites in three flap-GPP and three graft-GPP patients were compared with nine older adolescents without primary GPP.

Results:

Alveolar clefts were perfectly sealed. Radiographs during the early 3 postoperative years showed new bone formation more posteriorly extended in patients who underwent graft-GPP. Teeth eruption and alveolar rigidity at the mixed dentition age eliminated the need for secondary bone grafting. The anterior crossbites in adolescent patients ranged between −2 and −14 mm; crossing was relatively smaller in patients with a younger age and without cleft palate. The mean crossbite was 7.2 mm in the six teenagers and 9.6 mm in the control cases.

Conclusions:

Graft-GPP may be a good alternative to flap-GPP, particularly for wide alveolar cleft repair. Maxillary retrusion is aggravated in patients with cleft palate and older age at assessment. GPP may not increase crossbite.
Work Characteristics, Workplace Support, and Mental Ill-Health in a Canadian Cohort of Healthcare Workers During the COVID-19 Pandemic
Authors: Cherry Nicola , Adisesh Anil , Burstyn Igor , Durand-Moreau Quentin , Galarneau Jean-Michel , Labrèche France , Ruzycki Shannon , Zadunayski Tanis
Published: February 2024

Objective

The aim of the study was to identify determinants of mental health in healthcare workers (HCW) during the COVID-19 pandemic.

Methods

A cohort of Canadian HCW completed four questionnaires giving details of work with patients, ratings of workplace supports, a mental health questionnaire, and substance use. Principal components were extracted from 23 rating scales. Risk factors were examined by Poisson regression.

Results

A total of 4854 (97.8%) of 4964 participants completed ratings and mental health questionnaires. Healthcare workers working with patients with COVID-19 had high anxiety and depression scores. One of three extracted components, ‘poor support,’ was related to work with infected patients and to anxiety, depression, and substance use. Availability of online support was associated with feelings of better support and less mental ill-health.

Conclusions

Work with infected patients and perceived poor workplace support were related to anxiety and depression during the pandemic.
Work and Lifestyle Factors Influencing Job Satisfaction of Japanese Civil Servants
Authors: Nishioka Ryuichiro , Tatsuse Takashi , Sekine Michikazu , Yamada Masaaki
Published: February 2024

Objective

Although work, family, and lifestyle factors were associated with job satisfaction, prospective studies are lacking. This longitudinal study clarified the predisposing factors for job satisfaction.

Methods

Datasets were obtained from the Japanese Civil Servants Study and included 1429 participants. We assessed the relationship between job satisfaction and specific work and lifestyle factors. Logistic regression analyses evaluated the association between deteriorating job satisfaction and poor work and lifestyle factors at baseline and changes in these factors at follow-up.

Results

Poor sleep quality and limited job control at baseline were associated with deterioration in job satisfaction. Furthermore, deterioration in job control and work-to-family conflict at follow-up was associated with job dissatisfaction.

Conclusion

Work and lifestyle characteristics were associated with job dissatisfaction. Employees with limited job control and high work-to-family conflict at baseline were more likely to develop job dissatisfaction.
A Solution for Distal Femoral Occlusion After Venoarterial Extracorporeal Membrane Oxygenation Decannulation: Distal Femoral Access and Thrombectomy
Authors: Bemtgen Xavier , von zur Mühlen Constantin , Westermann Dirk , Wengenmayer Tobias , Staudacher Dawid L.
Published: February 2024

For patients on venoarterial extracorporeal membrane oxygenation support where ready-to-wean criteria are met, complications during the decannulation are quite common. Management of these complications can be challenging as many of the remaining standard arterial access sites are in use or had prior closure by a closure device. In this case report of a 70-year-old patient, explantation of the arterial cannula with the help of a vascular closure device led to thrombotic occlusion of the distal femoral artery. Here, we describe a step-by-step guide outlining our approach on management of this complication. Most relevantly, a distal femoral access via the superficial femoral artery was used, and thrombus aspiration was done with the help of the AngioJet peripheral thrombectomy system.
Association of the interleukine-6 polymorphism with catheter-induced coronary artery spasm in Egyptians
Authors: Abdelaziz Tarek A. , Mohamed Randa H. , Dwedar Ashraf A. , Eldeeb Mohey Eldeen A. , Abdelfattah Abdelrahman A. , Saadawy Sara F.
Published: February 2024

Background

The role of coronary artery spasm (CAS) was extended beyond variant angina to ischemic heart disease in general, including effort angina, unstable angina, acute myocardial infarction (MI) and sudden death. It is difficult and cumbersome to examine CAS during coronary angiography. Risk factors for CAS include smoking and genetic polymorphisms.

Aim

We aimed to investigate the association of the interleukin-6 (IL-6) polymorphism with catheter-induced CAS in Egyptian patients who undergo coronary angiography.

Methods

This is a case–control study. Two hundred patients with chronic coronary artery disease who underwent elective coronary angiography were included in the study. Patients were divided into two groups: the non-CAS group (100 patients) and the CAS group (100 patients). The subjects were genotyped to the −572 C>G (rs 1800796) polymorphism of the IL-6 gene by PCR-restriction fragment length polymorphism.

Results

We found that patients with CAS have more risk factors for atherosclerosis compared to those without CAS. Smoking, the IL-6 GG genotype, and the G allele were independent risk factors for CAS.

Conclusion

We concluded that the GG genotype and G allele of the IL-6 gene are associated with CAS. Smoking, the GG genotype, and the G allele of the IL-6 gene are independent predictors of catheter-induced CAS.
Age shock index as an early predictor of cardiovascular death in acute coronary syndrome patients
Authors: Carvalho Pedro Rocha , Bernardo Marta Catarina , Carvalho Catarina Ribeiro , Moreira Isabel , Borges Sara , Guimarães José Pedro , Gonçalves Fernando Fonseca , Mateus Pedro , Fontes José Paulo , Moreira Ilídio ,   on Behalf of the ProACS Investigators
Published: February 2024

Background

The shock index (SI), reflecting heart rate (HR) to SBP ratio, is established for predicting adverse outcomes in acute coronary syndrome (ACS) patients. Exploring the age shock index (ASI), obtained by multiplying SI with age, could offer further insights into ACS prognosis.

Objectives

Assess ASI’s effectiveness in predicting in-hospital death in individuals with ACS.

Methods

This study encompassed patients with acute myocardial infarction, drawn from a national registry spanning October 2010 to January 2022. The optimal ASI threshold was established using receiver operating characteristic (ROC) curve analysis. The primary outcome was in-hospital mortality.

Results

A total of 27 312 patients were enrolled, exhibiting a mean age of 66 ± 13 years, with 72.3% being male and 47.5% having ST-elevation myocardial infarction. ROC analysis yielded an area under the curve (AUC) of 0.80, identifying the optimal ASI cutoff as 44. Multivariate regression analysis, adjusting for potential confounders, established ASI ≥ 44 as an independent predictor of in-hospital death [hazard ratio: 3.09, 95% confidence interval: 2.56–3.71, P < 0.001]. Furthermore, ASI emerged as a notably superior predictor of in-hospital death compared to the SI (AUCASI = 0.80 vs. AUCSI = 0.72, P < 0.0001), though it did not outperform the Global Registry of Acute Coronary Events (GRACE) score (AUCASI = 0.80 vs. AUCGRACE = 0.85, P < 0.001) or thrombolysis in myocardial infarction (TIMI) risk index (AUCASI = 0.80 vs. AUCTIMI = 0.84, P < 0.001).

Conclusion

The ASI offers an expedient mean to promptly identify ACS patients at elevated risk of in-hospital death. Its simplicity and effectiveness could render it a valuable tool for early risk stratification in this population.
Novel UBE3B mutations: report of eight patients with Kaufman oculocerebrofacial syndrome with additional clinical findings from a highly consanguineous population
Authors: Albakheet AlBandary , Almuallami Duaa , Almass Rawan , Qari Alya , Kenana Rosan , AlQudairy Hanan , Huma Rozeena , Binomar Hadeel , Wakil Salma Majid , Alowain Mohammad , Colak Dilek , Kaya Namik , AlSayed Moeenaldeen D.
Published: February 2024

Biallelic mutations in UBE3B cause Kaufman oculocerebrofacial syndrome (KOS; OMIM 244450) with a wide range of clinical manifestations. In this study, we employed genetic analyses including homozygosity mapping, candidate gene sequencing, whole exome sequencing, and confirmatory Sanger sequencing on eight patients from three unrelated consanguineous families. Our analysis yielded three different novel variants in UBE3B: a missense substitution [NM_130466.4: c.2975C>T; (p.Pro992Leu)] in the HECT domain in family 1, a 3-bp deletion within exon 14 [c.1692_1694delCTC; (p.Ser565del)] leading to removal of a serine residue in family 2, and a splice donor site variant in intron eight of UBE3B (c.630 + 1G>T) in family 3. Blepharophimosis, telecanthus, ptosis, intellectual disability and abnormal lipid profile were similar to those found in previously reported KOS patients. Longitudinal follow-up revealed rather marfanoid body habitus of the patients in family 1. This study reports eight patients from Saudi Arabia with novel deleterious variants in UBE3B and adds to the phenotypic spectrum of KOS.
Deep learning applications for kidney histology analysis
Authors: Pilva Pourya , Bülow Roman , Boor Peter
Published: February 2024

Purpose of review

Nephropathology is increasingly incorporating computational methods to enhance research and diagnostic accuracy. The widespread adoption of digital pathology, coupled with advancements in deep learning, will likely transform our pathology practices. Here, we discuss basic concepts of deep learning, recent applications in nephropathology, current challenges in implementation and future perspectives.

Recent findings

Deep learning models have been developed and tested in various areas of nephropathology, for example, predicting kidney disease progression or diagnosing diseases based on imaging and clinical data. Despite their promising potential, challenges remain that hinder a wider adoption, for example, the lack of prospective evidence and testing in real-world scenarios.

Deep learning offers great opportunities to improve quantitative and qualitative kidney histology analysis for research and clinical nephropathology diagnostics. Although exciting approaches already exist, the potential of deep learning in nephropathology is only at its beginning and we can expect much more to come.
Immunotherapy treatment for sarcomatoid renal cell carcinoma: case report and literature review
Authors: Su Hui , Yu Chao , Ma Xuezhen , Yu Xiao , Sun Guiming
Published: February 2024

Introduction:

Sarcomatoid renal cell carcinoma (SRCC) is clinically rare, accounting for ~1.0–1.5% of renal parenchymal tumors. Although the concept of SRCC was proposed in 1968, the molecular mechanisms and immunological characteristics of sarcomatoid changes remain unclear. In the era of targeted therapy, the overall survival (OS) of patients with SRCC is typically less than 12 months.

Case presentation:

This article reports a case of SRCC in an 81-year-old male. Progression-free survival (PFS) was as long as 25 months and OS was 30 months after immunotherapy and the effect was significant. This is the first report of successful use toripalimab in the treatment of SRCC.

Clinical discussion:

SRCC is a rare type of renal cancer with no obvious specific clinical manifestations or imaging findings, and the diagnosis of the disease is based on pathological examinations. SRCC has a high degree of malignancy, progresses rapidly, and has a poor prognosis. The effect of traditional treatment is limited, and immune checkpoint inhibitors may have therapeutic potential.

Conclusions:

Toripalimab may be effective and further exploration is anticipated to advance a new period of SRCC.
Septal atrial thrombosis as a primary presentation of antiphospholipid syndrome in a patient with ANA-negative systemic lupus erythematosus: a case report
Authors: Hamsho Suaad , Alaswad Mohammed , Makhlouf Zeina , Alcheikh Salwa
Published: February 2024

Introduction and importance:

Systemic lupus erythematosus (SLE) predominantly affects young women and is associated with an increased risk of thrombosis. Antiphospholipid antibody syndrome (APS) may complicate the clinical picture, often leading to recurrent arteriovenous thrombosis. This case report underscores the significance of two unique aspects: the rare occurrence of an atrial thrombus and the presence of antinuclear antibody (ANA)-negative SLE.

Case presentation:

A 32-year-old woman presented with a history of symmetric polyarticular joint pain, oral ulcers, significant weight loss, and a history of unprovoked popliteal thrombosis and two unexplained abortions. One week prior to admission, she experienced severe headaches and elevated blood pressure. Clinical evaluation revealed several abnormalities, including a systolic murmur, livedo reticularis, and a transthoracic echocardiogram showing severe mitral regurgitation and an atrial thrombus. A transesophageal echocardiogram confirmed the presence of a pedunculated lesion in the right atria, challenging differential diagnosis.

Clinical discussion:

ANA-negative SLE, though rare, was observed in this patient, highlighting diagnostic complexities. APS compounded the clinical presentation, emphasizing the importance of identifying specific autoantibodies and recurrent thrombotic events. In the case of atrial thrombus, differentiation from other cardiac conditions, such as myxoma or vegetation, is a key.

Conclusions:

This case underscores the critical importance of recognizing and managing atrial thrombus, a rare but life-threatening complication in patients with systemic lupus erythematosus and antiphospholipid syndrome. Additionally, the diagnostic challenge of ANA-negative SLE warrants careful consideration in patients presenting with characteristic features of the disease.
Energy drink consumption among medical students in Jordan – prevalence, attitudes, and associated factors: a cross-sectional study
Authors: Qasem Nuha W. , Al-omoush Omar M. , Al Ammouri Zaid M. , Alnobani Nour M. , Abdallah Mohamed M. , Khateeb Abdullah N. , Habash Michael H. , Hrout Ruba A.
Published: February 2024

Background:

Energy drinks (ED) are popular beverages that contain high levels of caffeine, sugar, and other supplements, such as vitamins, which are marketed to enhance mental alertness and physical performance. Studies have shown that energy drink consumption is prevalent among medical students. Therefore, this study aimed to assess the prevalence, attitudes, and factors associated with energy drink consumption among medical students in Jordan.

Materials and methods:

A cross-sectional study was conducted among medical students from six public universities in Jordan. A total of 307 students were included in the study, and data were collected using an expert-validated questionnaire. The collected data were analyzed using SPSS version 25.

Results:

The study found that 50% of the sample had consumed ED, half of them started consuming them at the age of 16–18, and learned about them from friends. The primary reasons for consuming ED were to stay awake at night and the majority of them increase their consumption during exams to increase alertness. Regular energy drink consumption was significantly associated with being a student at the university located in the south governorate of Jordan (P=0.021), living alone (P=0.000), drinking alcohol (P=0.049), drinking coffee daily (P=0.043), and consuming more than 10 cans of soft drinks weekly (P=0.001). However, sex, age, academic achievement, and smoking status had no significant association with regular energy drink consumption. Students with regular energy drink consumption experienced daytime sleepiness, decreased concentration, fatigue, and reduced performance more than students with no regular energy drink consumption.

Conclusion:

The prevalence of energy drink consumption among medical students in Jordan is high, with factors such as social influences, lifestyle behaviors, and academic pressure being significant contributors. This study highlights the need for interventions to promote healthy behaviors and raise awareness about the potential harms of ED among medical students.
A rare case of descending colonic volvulus presenting as large bowel obstruction 19 years after sigmoidectomy and descending colorectal anastomosis
Authors: Abebe Temesgen Agegnehu , Berhe Yophtahe Woldegerima , Seid Oumer Ahmed , Sefefe Worku Mekonnen , Lake Leaynadis Kassa
Published: February 2024

Introduction and importance:

Large bowel obstruction is a common surgical emergency worldwide. Large bowel obstruction secondary to descending colonic volvulus is an extremely rare condition with only few reported cases worldwide. Its extreme rarity is due to its retroperitoneal location and lack of mesentery.

Case presentation:

A 75-year-old male patient with a history of sigmoidectomy and end-to-end descending colorectal anastomosis 19 years previously, presented with failure to pass faeces and flatus of 1 day duration with associated colicky abdominal pain, distension and vomiting. The abdomen was distended but soft and non-tender. Digital rectal examination showed an empty and ballooned rectum. The intraoperative finding was of a 360° counter-clockwise rotated descending colon. Detorsion and extraperitonealization of the descending colon was performed and the patient was successfully discharged.

Clinical discussion:

Volvulus is a twisting of a segment of bowel along its own mesentery. Sigmoid volvulus and caecal volvulus accounts for up to 90% and less than 20% of cases, respectively. Descending colonic volvulus is described in very few case reports. Diagnosis is clinical and confirmed by imaging.

Conclusion:

Descending colonic volvulus is a surgical emergency and an extremely rare cause of large bowel obstruction. Surgical management options include extraperitonealization of the descending colon, diversion colostomy or resection and primary end-to-end anastomosis.
Equipment preparedness for neonatal resuscitation in neonatal intensive care unit in resource limited setting: cross-sectional study
Authors: Hassen Alemayehu Eshetu , Agegnehu Abatneh Feleke , Temesgen Mamaru Mollalign , Admassie Belete Muluadam , Abebe Temesgen Agegnehu , Admass Biruk Adie
Published: February 2024

Background:

Adverse healthcare’s events are a critical issue worldwide, neonatal intensive care unit adverse events are a considerable issue. It is important that we recognize the basic equipment needed to address these circumstances. The aim of this study is to asses’ equipment preparedness for neonatal resuscitation in the neonatal intensive care unit.

Method:

A hospital-based, cross-sectional study was conducted on 210 neonates admitted to neonatal intensive care unit at comprehensive specialized hospital from 26/03/2022 to 26/05/2022. The data were collected using Checklist prepared from Neonatal resuscitation: current evidence and guidelines. The data obtained were summed up and presented as descriptive statistics using the Microsoft Excel and were analyzed using SPSS version 25. The result reported in text and table form.

Result:

In this study there was 12.72% complete equipment preparation (without defect) in 210 cases. From the total, there was minor defect in 52.8% cases, and 34.45% cases had serious defect. Serious defects were more frequently detected in the equipment preparation (42.46%), resuscitation medications (12.5%), and radiant warmer set-up (40%).

Conclusion and recommendation:

Overall equipment preparation for neonatal resuscitation was insufficient, and quality of equipment preparation for neonatal resuscitation and stabilization needs to be improved. To enhance equipment preparedness in the neonatal intensive care unit staff should establish uniform guidelines.
Single breath count test and its applications in clinical practice: A systematic review
Authors: Bhandari Samikchhya Keshary , Bist Anil , Ghimire Anup
Published: February 2024

Background:

Single breath count test (SBCT) may be a reproducible, rapid, easy to perform and easy to interpret substitute to spirometry especially in low resource settings for certain conditions. Its interest has been rekindled with the recent COVID-19 pandemic and it can be done as a part of tele-medicine as well.

Objectives:

The Objective of this review was to summarize the evidence of single breath count test in clinical practice.

Methods:

We searched EMBASE, PubMed and Google Scholar for all the relevant articles as per exclusion and inclusion criteria. Two authors independently screened all the studies. Newcastle Ottawa Scale was used to assess the quality of the studies. The systematic review was carried following the PRISMA guidelines.

Results:

After the rigorous process of screening, a total of 13 articles qualified for the systematic review. Single breath count test (SBCT) >25 had sensitivity of >80% in diagnosing Myasthenia Gravis exacerbation and SBCT <=5 predicted the need for mechanical ventilation in Guillain–Barre syndrome (GBS) patients with 95.2% specificity. Also, Single breath count correlated significantly with Forced Expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) in children with pulmonary pathology and in patients with COVID 19 it was used to rule out the need for Noninvasive Respiratory Support.

Conclusion:

Single breath count test will undoubtedly be an asset in low resource settings and in telemedicine to assess the prognosis and guide management of different respiratory and neuromuscular diseases.
A case report of coexisting breast cancer with peritoneal, cutaneous tuberculosis, and potential Pott’s disease: therapeutic and diagnostic challenges
Authors: Hassan Bassam , Alshehabi Zuheir
Published: February 2024

Introduction:

Breast cancer affects one in eight women during their lifetime; it may coincide with other diseases due to its high prevalence. Different pathologies that occur simultaneously with breast cancer, or later during its course, lead to multiple interactions with cancer and have a significant impact on its management.

Presentation of case:

A 58-year-old Syrian female was admitted to our hospital for compliant of abdominal distension. Following complete examination, obtained biopsies confirmed the diagnosis of peritoneal tuberculosis. At a subsequent time, she suffered back pain and the computed tomography showed vertebral lesion with breast mass that was diagnosed as invasive lobular carcinoma (ILC) of the left breast. Vertebral lesion that appeared on radiologic assessment was diagnosed as cancer metastasis. However, the interaction of this metastasis with the proposed management diverted the attention towards its non-cancerous entity. Five months after completing the chemotherapy, biopsies revealed the recurrence of triple-negative (ER−, PR−, HER2− neu−) ILC of the breast. Ultimately, the patient was followed up for an overall duration of 4 years.

Discussion:

Latent tuberculosis infections may be activated by chemotherapy regimens that suppress immunity. Therefore, initial management of tuberculous infection is preferred when it coexists with cancer.

Conclusion:

Breast cancer is common and may co-present with other diseases, which, in some cases, produce mimicking lesions that alter its diagnosis. Pott’s disease, albeit a rare entity, has shown a resurgence in developed countries and should be considered in the differential diagnosis of vertebral lesions in patients with breast cancer.
Pilot Application of SEM/EDX Analysis on Suspected Cigarette Burns in a Forensic Autopsy Case of Child Abuse
Authors: Tambuzzi Stefano , Gentile Guendalina , Primavera Riccardo , Muccino Enrico , Zoja Riccardo
Published: February 2024

Cigarette burn lesions present forensic scenarios that are often difficult to investigate, both from a morphological diagnostic point of view and with regard to the mode of infliction, especially if the victim is unable to speak or has died. Although there may be the suspicion for a lesion to be produced by a lit cigarette, to date one can only rely on the morphological aspects that characterize it, and there is a lack of tools to reach the most evidence-based diagnosis possible. This limitation arose when managing a forensic autopsy case of possible child abuse that resulted in the death of the child, characterized by the presence of 3 suspicious cigarette burn lesions. We therefore decided to perform scanning electron microscopy/energy-dispersive x-ray (SEM/EDX) spectrometry analysis on these lesions and on the cigarette butt found at the crime scene. At the same time, SEM/EDX was applied to the analysis of an unlit cigarette in its entirety (obtained from the same source package as the cigarette butt), a positive control skin sample with an iatrogenic cigarette burn injury, and a negative control skin sample. Among the various compounds highlighted on compositional analysis, only sulfuric anhydride (SO3) and phosphoric anhydride (P2O5) showed a highly significant distribution pattern by being found in the autopsy samples, the cigarette butt, the tobacco of the unlit cigarette, and the positive skin control. Considering this, cigarette burns appear to follow Locard's principle as well, and similarly to other lesions, SEM/EDX allowed the diagnosis of cigarette burn lesions, already suspected morphologically, to be corroborated. Therefore, SEM/EDX is confirmed as a helpful tool in forensic pathology investigations.
Long-Acting Reversible Contraception Knowledge Among Female Adolescents Presenting to a Pediatric Emergency Department
Authors: Bowling Morgan S. , Yao Meizhen , Mazzaferro Natale , Greenberg Patricia , George Ellen , Sivitz Adam , Tejani Cena
Published: February 2024

Objectives

The objective of this study was to assess awareness and use of long-acting reversible contraception (LARC) among female adolescents presenting to a pediatric emergency department (PED).

Study Design

During routine presentation to an urban PED in New Jersey, female adolescents, aged 15–19 years, were asked to voluntarily complete an electronic survey about sexual practices and contraception. The PED is in an urban teaching hospital, treating 35,000 children annually. Patients could schedule a follow-up appointment at the hospital's obstetrics/gynecology clinic. Data were collected over 13 months, and follow-up was monitored to determine if they attended an outpatient appointment, and if so, what the outcome was.

Results

Data for 199 participants were analyzed. The median age of participants was 18 years, whereas 79% self-identified as Black, and 17.6% self-identified as Latina. Twenty-one percent of participants used a form of birth control during their first sexual encounter, the largest percentage being condoms (77.8%). Forty percent of participants reported some prior knowledge about contraceptive implants, and 20% had knowledge about intrauterine devices, whereas only 3 (1.5%) intrauterine devices and 2 (1%) arm implants had been previously used. Of the 78 participants that requested a follow-up, 14 (17.9%) completed their appointment. Of those, 2 (14%) were prescribed contraception (Depo-Provera shot and oral contraceptive pills).

Conclusions

Knowledge about LARC remains low in our PED, despite it being the most effective method of contraception. Even when interventions were made to link interested respondents to outpatient women's health services, follow-up attendance was poor, and no patients obtained LARC. There is a significant discrepancy between the consensus standard of contraception care across all relevant medical specialties and current utilization by high-risk populations. Future efforts must focus on how to close this gap, and the ED could be pivotal for improving both reproductive health education and intervention among adolescent patients.
68Ga-PSMA Uptake in the Testis
Authors: Calderon Tobar Merve Nida , Önner Hasan
Published: February 2024

Although abnormal 68Ga-PSMA uptake in the prostate and its metastases can be seen in a variety of diseases, it is rare to see in the testis. In these 2 cases, 68Ga-PSMA PET/CT revealed unilateral 68Ga-PSMA uptake in the testis of 2 patients. One of these patients was diagnosed with testis metastases from prostate cancer after an orchiectomy. The other patient was diagnosed with an orchitis. 68Ga-PSMA uptake should be considered as an infection, as well as a malignancy in the initial differential diagnosis.
Clinical Feasibility of Deep Learning–Based Attenuation Correction Models for Tl-201 Myocardial Perfusion SPECT
Authors: Lim Sungjoo , Park Yong-Jin , Lee Su Jin , An Young-Sil , Yoon Joon-Kee
Published: February 2024

Purpose

We aimed to develop deep learning (DL)–based attenuation correction models for Tl-201 myocardial perfusion SPECT (MPS) images and evaluate their clinical feasibility.

Patients and Methods

We conducted a retrospective study of patients with suspected or known coronary artery disease. We proposed a DL-based image-to-image translation technique to transform non–attenuation-corrected images into CT-based attenuation-corrected (CTAC) images. The model was trained using a modified U-Net with structural similarity index (SSIM) loss and mean squared error (MSE) loss and compared with other models. Segment-wise analysis using a polar map and visual assessment for the generated attenuation-corrected (GENAC) images were also performed to evaluate clinical feasibility.

Results

This study comprised 657 men and 328 women (age, 65 ± 11 years). Among the various models, the modified U-Net achieved the highest performance with an average mean absolute error of 0.003, an SSIM of 0.990, and a peak signal-to-noise ratio of 33.658. The performance of the model was not different between the stress and rest datasets. In the segment-wise analysis, the myocardial perfusion of the inferior wall was significantly higher in GENAC images than in the non–attenuation-corrected images in both the rest and stress test sets (P < 0.05). In the visual assessment of patients with diaphragmatic attenuation, scores of 4 (similar to CTAC images) or 5 (indistinguishable from CTAC images) were assigned to most GENAC images (65/68).

Conclusions

Our clinically feasible DL-based attenuation correction models can replace the CT-based method in Tl-201 MPS, and it would be useful in case SPECT/CT is unavailable for MPS.
Dual 177Lu–Prostate-Specific Membrane Antigen and 177Lu-DOTATATE Therapy in Metastatic Castration-Resistant Prostate Cancer With Neuroendocrine Differentiation
Authors: Beyhan Ediz , Erol Fenercioğlu Özge , Şahin Rahime , Çermik Tevfik Fikret , Ergül Nurhan
Published: February 2024

We present an 87-year-old man diagnosed with prostate cancer and neuroendocrine differentiation, posttherapy results to consecutive 177Lu–prostate-specific membrane antigen and 177Lu-DOTATATE. Despite hormonal therapy and chemoradiotherapy, the patient progressed rapidly, and multiple liver and bone metastases showed regression after 177Lu–prostate-specific membrane antigen and 177Lu-DOTATATE treatment. Prostate cancer with neuroendocrine differentiation is resistant to treatments; however, treatment with the combination of 177Lu-DOTATATE therapy may be promising.
Rare Presentations of Differentiated Thyroid Cancer Exposing Dr Jekyll and Mr Hyde Nature of an Otherwise Indolent Disease
Authors: Verma Priyanka , Malhotra Gaurav , Rao Ramesh D. , Sonavane Sunita , Agrawal Ritesh
Published: February 2024

Differentiated thyroid carcinoma (DTC) usually manifests as an indolent cancer with good prognosis. However, rarely uncommon sites of metastatic involvement can worsen the prognosis and require aggressive therapeutic approach. Here in, we describe 5 patients (3 women and 2 men) harboring rare sites of metastatic involvement from DTC including the adrenals, colon, kidneys, urinary bladder, brachial plexus, and superior vena cava with contiguous right atrial involvement. The awareness of such rare sites of involvement from DTC is imperative for treating clinicians to plan individualistic approach in management including multiprong therapies for better patient care.
18F-FDG PET/CT in Synovial Anaplastic Large Cell Lymphoma
Authors: Chiu Ka Lun , Chow Tsz Kit , Ma Wai Han , Ma Kwok Man
Published: February 2024

Anaplastic large cell lymphoma is an uncommon and aggressive form of peripheral T-cell lymphoma. Synovial anaplastic large cell lymphoma is very rare. We present PET/CT findings in a patient with synovial anaplastic large cell lymphoma. Intense FDG accumulation was found in irregular synovial thickening of the right knee. Biopsy of the synovium was performed and revealed anaplastic large cell lymphoma. This case demonstrates that anaplastic large cell lymphoma should be included as one of the differential diagnoses of FDG-avid synovial lesions.