bluuebunny/crossref_metadata_2025 huggingface dataset:
A comparison of Atlas and Leo Baby stents-assisted coiling of intracranial aneurysms with small parent vessels
Authors: Tang Qing-wen , Feng Yu , Zhang Cheng-da , Zhang Ting-bao , Zhao Wen-yuan
Published: August 2023

Background:

Some studies have reported the efficacy and safety of the Atlas stent and the Leo Baby stent-assisted coiling (SAC) of intracranial aneurysms arising from small cerebral vessels. The authors aimed to compare the clinical performance of the Atlas and the Leo Baby stents in small parent arteries.

Methods and materials:

Between January 2019 and November 2022, 56 patients at our centre were treated using either Atlas or Leo Baby SAC of intracranial aneurysms arising from small parent vessels (<2 mm). The clinical and angiographic imaging data of the two cohorts were retrospectively collected and comparatively analyzed.

Results:

A total of 56 patients were included in this study. Thirty-two patients were treated with the Atlas SAC, and 24 patients were treated with the Leo Baby SAC. The mean age of the Atlas stent cohort was older, and the mean aneurysm size was smaller than the Leo Baby stent. The immediate complete occlusion rate was 68.6% in the Atlas stent cohort and 62.5% in the Leo Baby stent cohort. The mean angiographic follow-up time for Atlas stent cohort was 8.9±2.5 months, and the final aneurysm complete occlusion rate was 81.0%. The mean follow-up time for Leo Baby stent cohort was 18.9±6.0 months, and the final aneurysm complete occlusion rate was 83.3%.

Conclusions:

At the final follow-up, the Atlas or the Leo baby stent SAC of intracranial aneurysms with small parent vessels resulted in favourable angiographic results and clinical outcomes, with a low rate of associated complications.
Barriers and facilitators influencing access to and utilization of primary healthcare services in Kurdistan-region, Iraq: a cross-sectional study
Authors: Mahmood Kochr Ali , Saleh Abubakir Majeed
Published: August 2023

Background:

The primary healthcare (PHC) idea is intended to become the first line of interaction for members of the public with care needs, as well as a system that views health as a complete state of being rather than only a state of wellbeing. This study aimed to examine the barriers and facilitators influencing the access and utilization of PHC services in Erbil governorate, Kurdistan-region, Iraq, through assessing populations’ practice, and satisfaction. Also, explore the relationship between the socioeconomic, demographic, and cultural characteristics of the study population and utilization of PHC services.

Methods:

This was a cross-sectional study. A questionnaire-based survey was used for data collection. Totally, 2400 individuals have been selected in 6 different districts and the centre of Erbil through the multi-cluster random sampling method. The χ2 test was used for categorical variables, and a one-way ANOVA was used for numerical variables. A P value less than 0.05 was considered statistically significant.

Results:

The main reason for utilizing PHC centres was preventive purpose (68.1%), then poverty was the second reason (11.33%), and the participants reported that during the presence of urgent cases when they cannot use other health facilities, they use PHC centres (9%). In terms of barriers for utilizing and visiting PHC centres, the participated people stated that most of them, due to inadequate services, did not use and visit PHC centres (83.21%); the second reason was the presence of chronic diseases such as hypertension, which makes them visit private clinics (7.79%) and generally, (31.4%) of the participants were satisfied with the health services nearby.

Conclusion:

In conclusion, it appears that many people visit PHC facilities, but most of them only do so as a preventative measure, and very few go there to obtain basic medical treatment. Most patients go to private clinics and/or hospitals since those facilities have better access to specialists, better quality and quantity of medications, and laboratory testing. Additionally, combining and strengthening service quality aspects that prioritize a patient-centred environment and an effective service delivery system is a key strategy for the health sector to increase patient satisfaction.
The preparedness of preoperative anesthesia equipment’s and monitors for pediatric patients
Authors: Tegegne Biresaw Ayen , Lema Girmay Fitiwi , Fentie Demeke Yilkal , Bizuneh Yosef Belay
Published: August 2023

Background:

In resource-limited settings, providing anaesthesia services to paediatric patients at the operation theatre needs to be considered and optimal utilization of national resources available for the provision of services should be undertaken. Therefore, optimal perioperative care of infants and children requires the availability of monitors and contemporary equipment designed specifically for this purpose.

Objective:

This study aimed to determine the practice of preoperative anaesthesia equipment and monitor preparation for paediatric patients.

Method:

A cross-sectional study was employed among 150 consecutively selected paediatrics from April to June 2020. Data were collected by semi-structured questionnaire. Data entry and analysis were done using Epi Data and Stata version 14.0. Descriptive statistics were employed.

Result:

A total of 150 patients who undergo surgery under anaesthesia were observed in surgical and ophthalmic operation rooms. From those procedures, only stethoscope and small-sized syringes achieved 100% of the standards. But paediatric stylet, paediatric defibrillator and paediatric folly catheter had achieved 0%. The remaining were between 10 and 97% according to standards.

Conclusion:

Even though some paediatric anaesthesia equipments and monitoring preparation have fulfilled the standards, this study showed practice gaps in majority of cases in the preparation of appropriately sized paediatric equipments and monitors.
The need for neonatal jaundice screening awareness in the Pakistani population: short communication
Authors: Naeem Hafsa , Ullah Kaleem , Ochani Sidhant , Naeem Khadija , Ahmad Hafiz B. , Hasibuzzaman Md. Al
Published: August 2023

Neonatal jaundice is a common illness that affects around 80% of preterm and 50–60% of full-term newborn infants. It is one of the most common causes of neonatal death. Neonatal jaundice may be physiological or pathological. Physiologic jaundice is far more common than pathologic jaundice and accounts for most hyperbilirubinemia. Physiologic jaundice in neonates is due to greater hemoglobin breakdown compared to bilirubin clearance. While pathological jaundice occurs due to various infections, drug toxicity, inborn enzyme deficiencies, Rhesus fetal-maternal incompatibility, hypothyroidism, and congenital biliary duct obstruction diseases. In many parts of the world, midwives, and nurses perform spontaneous vaginal deliveries and they only rely on visual screening for neonatal jaundice. However, this is not reliable, especially for newborns having darker skin. Educating the mothers on screening for early detection of neonatal jaundice and seeking medical treatment in a country like Pakistan, which is considered a high-risk population, is crucial. Also, as most females give birth at home, hence, midwives’ knowledge about neonatal jaundice also needs to be improved.
Clinical outcome of established diagnostic and treatment modalities of COVID-19-associated myocarditis: a systematic review
Authors: Sai Santhosha Mrudula Alla , Agarwal Pahel , Vempati Roopeessh , Alla Deekshitha , Balusu Kavya , Tarannum Suha , Patel Krish , Devaragudi Sanjana , Patel Devkumar , sultana Qamar , Paudel Kusum
Published: August 2023

Background:

Despite the significant research and development of COVID-19 diagnostic and therapeutic approaches, the virus still poses a concern, particularly to groups that are already vulnerable. Several individuals experienced cardiac problems like myocardial infarction, arrhythmia, heart failure, cardiomyopathy, myocarditis, and pericarditis after they had recovered from the infection. Early diagnosis and timely management of sequelae are part of the therapy. However, there are gaps in the knowledge of the diagnostic and definitive treatment options for COVID-19 myocarditis. This review focuses on myocarditis associated with COVID-19.

Objective:

This systemic review provides the most recent overview of myocarditis caused by COVID-19, including clinical manifestations, diagnostic techniques, available treatments, and outcomes.

Methods:

The PubMed, Google Scholar, and ScienceDirect servers were used to conduct a systematic search in compliance with the PRISMA guidelines. Boolean search terms included “(COVID-19)” OR “(COVID19)” OR “(COVID-19 VIRUS INFECTION)” AND “(MYOCARDITIS)”. The results were tabulated and analyzed.

Results:

A total of 32 studies, including 26 case reports and 6 case series, were included in the final analysis, and 38 cases of COVID-19-associated myocarditis were analyzed. Middle-aged men constituted the most affected population (60.52%). Dyspnoea (63.15%), chest pain or discomfort (44.73%), and fever (42.10%) were the prevalent presentations. ST-segment abnormalities were reported in 48.38% of cases on electrocardiography testing. Leucocytic infiltration (60%) was the frequent finding obtained on endomyocardial biopsy. Cardiac magnetic resonance imaging yielded myocardial oedema (63.63%), and late gadolinium enhancement (54.54%) as the most common findings. Reduced ejection fraction (75%) was the frequent result obtained on echocardiography. Corticosteroids (76.31%) and immunomodulators (42.10%) were the well-established in-hospital medications. Veno-arterial extracorporeal membrane oxygenation (35%) was the most common intervention used to support the treatment. The frequent in-hospital complications were cardiogenic shock (30.76%), followed by pneumonia (23.07%). The mortality rate was 7.9%.

Conclusion:

Early detection and timely management of myocarditis are essential to reduce the risk of developing further complications. It is crucial to emphasize the need to evaluate COVID-19 as a possible cause of myocarditis in populations that are young and healthy to avoid fatal consequences.
Investigating the effect of sudden occlusion of the testicular vessels on the testicular tissue in rat models
Authors: Shojaeian Reza , Hiradfar Mehran , Bahrami Taqanaki Pegah , Khorsand Ahmadi Sarina , Jelveh Masouleh Yousef , Ameri Leila , Parvizi Mashhadi Mahdi
Published: August 2023

Background:

One of the ways to treat undescended testicles is to use orchiopexy surgery, which is modified into the two-stage Fowler–Stephens technique in cases of short or immobile testes. The disadvantage of using this technique is the probability of testicular ischaemia following the sudden closure of the testicular artery; although the collateral arteries prevent atrophy, the testis loses its germ cells during this stress and may no longer be functional. Therefore, this study aims to examine the changes in testicular tissue regarding necrosis and infarction after the occlusion of the vessels.

Methods and materials:

In this experimental study 15 male rats weighing 200–250 g were prepared and first, one of the rats was sacrificed and testicles on both sides were used for pathology control. After general anaesthesia vascular ligature was performed with the left testes undergoing both venous and arterial occlusion and the right testes only arterial occlusion. After 1 month, all specimens were killed and the testes were completely removed and sent for histopathological evaluation.

Results:

A total of 14 rats and 28 testes were studied in two equal groups of case and control. There was no significant difference between the case and control groups in terms of testicular volume, consistency, and viability. Microscopic findings revealed that necrosis, infarction, and state of inflammation were significantly higher in the case group than in the control group.

Conclusion:

The results of this study show that abrupt closure of the testicular artery in rats is associated with necrosis and infarction, decreased spermatogenesis, and more inflammation. However, no significant differences were found in terms of macroscopic findings including volume, consistency, and viability.
Challenges with patient management of osteoarthritis during the COVID-19 pandemic: review
Authors: Patel Tarika Deepak , Coiado Olivia Campos
Published: August 2023

Osteoarthritis is a growing public health concern, affecting millions of people worldwide. With progressively worsening joint function and pain, management of osteoarthritis is important to ensure high quality of life for patients. Treatment includes a combination of pharmacologic agents and non-pharmacologic methods such as exercise and physical therapy. However, if multiple treatments fail to improve symptoms, joint replacement surgery is the final course of action. When the new coronavirus, SARS-CoV-2 (COVID-19), was declared a pandemic, all aspects of osteoarthritis treatment become affected. Due to increased public health measures, non-pharmacologic modalities and elective surgeries became limited in accessibility. Additionally, there were concerns about the interaction of current medications for osteoarthritis with the virus. As a result of limited options for treatment and quality of life of patients was negatively impacted, especially in those with severe osteoarthritis. Furthermore, a backlog of joint replacement surgeries was created which could take up to several months or years to address. In this review, we describe the impact COVID-19 had on osteoarthritis management as well as tactics to deal with the large caseload of surgeries as operative rooms begin to re-open for elective surgeries.
Assessment of the efficacy of auricular conchal cartilage graft in repairing orbital floor fractures and its effect on diplopia: a nonrandomized clinical trial
Authors: Deep Mohammad , Baroudi Ihsan , Assad Mounzer
Published: August 2023

Background:

Orbital fractures are a common sequela of maxillofacial zone trauma. Rapid assessment and management are essential for successful reconstruction. The selected treatment method depends on fracture types, accompanied injuries, and intervention time. Implantable grafts used to be from autologous materials. The study aimed to evaluate the effectiveness of using the auricular conchal cartilage taken from the ear to repair orbital floor fractures in cases of minimal bone loss, less than (2×2) cm.

Material and Methods:

A prospective single-arm, nonrandomised clinical trial was conducted during the past 4 years (from 2018 to 2022). A total of 15 cases, who had visited the department of oral and maxillofacial surgery department with orbital floor fractures, were enrolled. The participants underwent conchal cartilage grafting for orbital floor fracture reconstruction. The time factor to perform the surgery after trauma had been considered. Patients were closely monitored for the development of double vision (diplopia) at 15 days, 1 month, and 3 months postsurgery.

Results:

The results showed statistically significant differences during the follow-up period following the surgical procedure. They appeared to have complete restoration of eye movements, restoration of the normal positioning of the eyeball affected by the orbital floor fracture compared to the healthy eyeball, and regression of double vision (diplopia) throughout the follow-up period.

Conclusion:

Using the auricular conchal cartilage graft in repairing fractures of the orbital floor resulted in the improvement of the functional aspect of the eyeball and the restoration of the esthetic aspect.
Amputation of left foot macrodactyly improve quality of life for a toddler: a case report from Tigray, Northern Ethiopia
Authors: Haftu Hansa , Gebrekidan Atsede , Gebrehiwot Teklu , Gebre Niguse Tsegay , Mahtsun Gebreegziabher
Published: August 2023

Introduction and importance:

Macrodactyly is an uncommon, not inherited congenital malformation of the digit with unknown prevalence and path of pathogenesis. The condition was described in 1940 and since then 107 cases were reported. Manifestations may mislead the diagnosis of hemangiomas and lymphangiomatosis. There are different options for treatment without a clear consensus. The authors are presenting a macrodactyly case that improved the quality of his life after he underwent surgical amputation of the toes.

Case presentation:

The authors had a case of a 2-year and 4-month-old male child presented with progressive growth of the left foot toes; which started since birth in the 4th toe and then involved 3rd and 5th toe later; resulting in deformity and difficulty in wearing shoes. Physical examination; showed left foot enlargements of the 3rd–5th toes. X-ray of the left foot was done he was diagnosed to have macrodactyly. Under general anesthesia metatarsophalangeal joint of the 4th–5th toe and distal interphalangeal joint of the 3rd toe, disarticulation was done. The patient is doing okay on follow-up for the last year.

Clinical discussion:

Consistently with other case reports from Korea, Tanzania, and Congo our patient presented with a primary type of left foot macrodactyly in his early life, and he was successfully managed with amputation of the affected digits.

Conclusion:

This is one of the rare cases which needs a high index of suspicion to diagnose and treat early to improve quality of life. Amputation is the most important management in resources limited areas.
Serum procalcitonin as a tumor marker in lung adenocarcinoma with ovarian metastasis: a case report
Authors: Omari Mouhsine , Al Jarroudi Ouissam , Adil Zaimi , Jaouani Laila , El Attar Hicham , Afqir Said
Published: August 2023

Introduction and importance:

Primary lung cancer is the leading cause of mortality worldwide. The major sites of lung cancer metastasis are the bones, liver, brain, lung, and adrenal glands. However, secondary localizations in the genital tract are extremely rare.

Case presentation:

The authors report the case of a 36-year-old woman who consulted for a right scapular swelling evolving for 4 months associated with a chronic cough. Clinical examination showed a hard fixed right scapular mass with any inflammatory signs. The extension assessment followed by histological analysis concluded in a secondary ovarian location of a lung adenocarcinoma. A very high serum procalcitonin level unrelated to sepsis was detected in the patient along with a substantial hematological paraneoplastic disease. The patient died after 6 months of palliative chemotherapy.

Clinical discussion:

Ovarian localization is found in only 0.4% of metastatic ovarian tumors, which is extremely low, the differentiation between primary and secondary ovarian adenocarcinoma is fundamental since the treatment and prognosis are very different. The serum procalcitonin can be elevated in lung adenocarcinoma.

Conclusion:

This case report highlights the interest to encourage doctors to look for ovarian metastasis during the clinical course of lung cancer, and explain the elevation of serum procalcitonin during lung adenocarcinoma.
Giant parathyroid adenoma causing severe hypercalcemia; a case report from Duhok
Authors: Musa Dildar Haji , Sgery Azri Salih Haji , Omar Asaad Shareef , Keorges Gina James , Ibrahim Nashwan MR
Published: August 2023

Introduction and importance:

Nephrolithiasis, a common urological disease, could indicate a more ominous pathology beyond the kidneys. Patients who present with renal stones must be investigated for serum calcium and subsequently parathyroid hormones, if indicated, as one of the clinical presentations of primary hyperparathyroidism is renal stones.

Case presentation:

A 48-year-old married female with a past medical history significant for renal stones presented to the clinic chiefly complaining of muscle pain, joint pain, and fatigue. After thorough investigations, she was diagnosed with a case of primary hyperparathyroidism due to parathyroid adenoma and was managed surgically according to guidelines.

Clinical discussion:

Hypercalcemia, serum calcium of greater than 2 standard deviations above the reference value, is commonly seen to be associated with parathyroid mass therefore, assessment of serum calcium is a necessary step toward the diagnosis of parathyroid adenoma in cases with recurrent renal stones.

Conclusion:

Recurrent nephrolithiasis requires more thorough investigation for the possible underlying cause. Primary hyperparathyroidism due to parathyroid adenoma can present with recurrent renal stones and some vague symptoms.
Diesel siphoning induced chemical pneumonitis: a case report
Authors: Pandey Pratik , G.C. Shasan , Bhujel Shishir , Karki Shailendra , Acharya Surya Kiran , K.C. Pooja , Shrestha Abhigan Babu
Published: August 2023

Introduction and importance:

Diesel fuel aspiration can occasionally result in an uncommon but potentially deadly condition called chemical pneumonitis.

Case presentation:

In this case study, a 16-year-old boy gave a history of diesel fuel siphoning from a motor vehicle tank, which brought him to our emergency room. He complained of coughing, breathing difficulties, and chest discomfort upon admission to the hospital. Patchy bilateral parenchymal lung opacities consistent with acute chemical pneumonitis were seen in radiological imaging tests. Treatment included supportive care, oxygen supplementation, and intravenous antibiotics. The patient’s symptoms improved gradually throughout his hospitalization, and he was eventually discharged home with a good prognosis.

Clinical discussion:

Siphoning is a common practice in developing countries like Bangladesh. Workers at automobile transfer hydrocarbon products from one vehicle to other. However, its aspiration can cause a pneumonia like features and may wrongly misdiagnose. Diagnosis is made mainly on history taking.

Conclusion:

Physicians ought to know that patients exposed to diesel fuel may develop chemical pneumonitis, and they should consider this for an early diagnosis and effective treatment that can lead to favourable outcomes.
Remitting seronegative symmetrical synovitis with pitting edema syndrome postsecond COVID-19 vaccination: a case report
Authors: Hodifa Yara , Khalayli Naram , Hodaifa Amr , Kudsi Maysoun
Published: August 2023

Introduction and importance:

Coronavirus disease 19 (COVID-19) has become the most serious public health crisis of our generation, and vaccines are effective in preventing its infection. Remitting seronegative symmetrical synovitis with pitting edema is an idiopathic rare benign syndrome, but it could be secondary to aautoimmune diseases. Here, the authors reported the first case of this syndrome’s development after COVID-19 vaccination.

Case presentation:

A 52-year-old woman presented with hand edema, arthralgia, and morning stiffness, after receiving the second dose of m RNA COVID-19 vaccination. Examination revealed edema in the dorsum of both hands and symmetrical tenderness of the shoulders, elbows, wrists, knees, and ankles. Blood test results were normal except for elevated levels of C-reactive protein. The immune profile and the tuberculin test were also negative. A hand radiograph showed soft tissue edema. Ultrasonography of the extremities has shown tenosynovitis. Remitting seronegative symmetrical synovitis with pitting edema syndrome was diagnosed according to the diagnostic criteria. She was treated with 30 mg/day prednisolone, with a complete disappearance of edema and arthralgia after 10 days, and the C-reactive protein level was decreased.

Clinical discussion:

Vaccines are still the most effective and protective method against COVID-19 infection, but it may trigger an immunological response. Remitting seronegative symmetrical synovitis with pitting edema (or sometimes RS 3 PE) is a rare nonunderstood syndrome identified by symmetric polyarthritis, synovitis, acute pitting edema of hands and/or feet, and a negative serum rheumatoid factor, with an excellent prognosis to treatment with steroid. Usually occurred in the old aged population, young patients’ cases were mentioned. As the authors did not find any data about our subject, this is the first case of this syndrome development after the second dose of COVID-19 vaccination.

Conclusion:

The occurrence of acute symmetrical seronegative polysynovitis with extremities edema, in the elderly, should guide toward the diagnosis of this syndrome.
Unusually aggressive primary testicular diffuse large B-cell lymphoma initially presenting as systemic disseminating metastases in older adult men: a case report
Authors: Liu Kuang-Ting , Chang Yueh-Ching , Lin Yu-Chieh , Chang Junn-Liang
Published: August 2023

Introduction:

Primary testicular lymphoma (PTL) accounts for 1–2% of all nonHodgkin lymphomas (NHL), 4% of extranodal nonHodgkin lymphomas, and ~9% of testicular malignancies. A rare subtype of PTL is primary testicular diffuse large B-cell lymphoma (PT-DLBCL), which may initially present as disseminating metastasis in older adult males and has a poor prognosis.

Case presentation:

Herein, the authors describe the case of a 64-year-old man with the chief complaint of a painless unilateral scrotal mass. Computed tomography scans of the abdomen and a pelvic examination demonstrated a left testicular tumor with multiple lymphadenopathies partially aggregated in the para-aortic area and disseminated to multiple soft tissues and organs. Subsequently, the patient underwent a left radical orchiectomy. Pathological and immunohistochemical examinations confirmed the diagnosis of left PT-DLBCL with systemic disseminating metastases.

Clinical discussion:

PTL often aggressively spreads to other extranodal organs, such as the contralateral testis, central nervous system, lung, pleura, Waldeyer’s ring, and soft tissues. In men over 60 years of age, PT-DLBCL is the most common testicular malignancy. However, extensive systemic metastasis as the initial presentation is extremely rare. PT-DLBCL has a dismal prognosis and requires radical orchiectomy followed by multimodal therapy and central nervous system prophylaxis or systemic intervention to improve survival.

Conclusion:

The diagnosis of PT-DLBCL through preoperative and imaging examinations is often challenging. Thus, histopathology and immunohistochemical markers play a crucial and valuable role in the definite diagnosis and differential diagnosis of PTLs.
Stem cell-based combinatorial therapies for spinal cord injury: a narrative review of current research and future directions
Authors: Aderinto Nicholas , Abdulbasit Muili Opeyemi , Olatunji Deji
Published: August 2023

Spinal cord injury (SCI) is a devastating condition that can result in lifelong disability. Despite significant progress in SCI research, current treatments only offer limited functional recovery. Stem cell-based combinatorial therapies have emerged promising to enhance neural repair and regeneration after SCI. Combining stem cells with growth factors, biomaterials, and other therapeutic agents can improve outcomes by providing a multifaceted approach to neural repair. However, several challenges must be addressed before these therapies can be widely adopted in clinical practice. Standardisation of stem cell isolation, characterisation, and production protocols ensures consistency and safety in clinical trials. Developing appropriate animal models that accurately mimic human SCI is crucial for successfully translating these therapies. Additionally, optimal delivery methods and biomaterials that support the survival and integration of stem cells into injured tissue must be identified. Despite these challenges, stem cell-based combinatorial therapies for SCI hold great promise. Innovative approaches such as gene editing and the use of neural tissue engineering may further enhance the efficacy of these therapies. Further research and development in this area are critical to advancing the field and providing effective therapies for SCI patients. This paper discusses the current evidence and challenges from the literature on the potential of stem cell-based combinatorial therapies for SCI.
Neonatal giant mastauxe: a case report
Authors: Pant Ved Prakash , Mishra Deepak
Published: August 2023

Introduction and importance:

Giant mastauxe is an uncomplicated physiological enlargement of the breasts in newborns, characterized by a breast bud diameter greater than 3 cm. While most newborns have some degree of breast enlargement, giant mastauxe is rare, which may be unnecessarily intervened upon.

Case presentation:

A 13-day-term male neonate presented with bilateral breast enlargement and milky nipple discharge, which worsened upon breast massage. The mother had an uneventful pregnancy, and neither the mother nor the baby had a history of drug intake. The examination revealed soft, non-tender, non-erythematous bilateral breast swellings measuring 3.6×3.8 cm on the right side and 3.2×3.4 cm on the left side. Ultrasonography confirmed their hypoechoic nature with minimum vascularization. The white blood cell count, C-reactive protein levels, and culture of nipple discharge yielded normal results. The baby was discharged, and upon follow-up after 2 weeks, it was observed that breast swellings had spontaneously reduced in size.

Discussion:

Neonatal breast enlargement can occur as a result of either the transplacental transfer of maternal estrogens or declining levels of estrogens toward the end of pregnancy, leading to hyperprolactinemia. However, the exact reasons behind the occurrence of giant mastauxe in some newborns remain incompletely understood. It may be due to increased sensitivity of the breast tissue to estrogens.

Conclusion:

Proper clinical examination, along with the use of ultrasonography and/or laboratory investigations if required, is essential to differentiate giant mastauxe from neonatal mastitis or breast abscess. Treatment primarily involves observation and providing reassurance to parents.
High mortality diphtheritic myocarditis with conduction disturbance, case series, and review of literature
Authors: Poudel Binod , Lamsal Aastha , Poudel Chandra M.
Published: August 2023

Introduction:

Diphtheria cases are still being reported in various parts of the globe. Although complete heart block resulting from diphtheric myocarditis is infrequent, it can lead to fatality. Awareness and recognition of this help strengthen the importance of vaccines and their proper management.

Case presentation:

The authors report two young patients who presented in the interval of a month, to the emergency department with signs and symptoms of diphtheria. Both developed diphtheric myocarditis with complete heart block and severe left ventricular systolic dysfunction, which did not respond to temporary pacing.

Discussion:

Diphtheria remains rare but few cases continue to emerge, especially in developing countries. Those who develop it have high mortality, particularly from cardiomyopathy, airway compromise, and organ failure. Conduction abnormalities are diagnostic of diphtheric myocarditis and have a grim prognosis and treatment options are limited.

Conclusion:

Diphtheric myocarditis has a poor prognosis and is an independent predictor of mortality. Since aggressive invasive treatment has not been shown to improve survival, early recognition along with antitoxin at the earliest suspicion and proper supportive care are the current best available options.
Diagnostic criteria for myocarditis on cardiac magnetic resonance imaging: an educational review
Authors: Joudar Imane , Aichouni Narjisse , Nasri Siham , Kamaoui Imane , Skiker Imane
Published: August 2023

Acute myocarditis represents one of the most mysterious acute cardiovascular diseases due to the great diversity of its clinical presentation, ranging from simple symptoms such as flu-like syndrome to lethal conditions such as cardiogenic shock or sudden cardiac death. The diagnosis will be suspicious in the presence of chest pain in a subject with risk factors, and guided mainly by the ECG, biological markers, trans-thoracic echocardiography, and the cardiac MRI. In this sense, and returning to the pathophysiological bases of this condition, the positive diagnosis will rely mainly on the detection of tissue abnormalities secondary to the myocardial inflammatory storm. Cardiac MRI represents a diagnostic pillar, given the information it can provide, both in analyzing the morphology, and the myocardial function but also tissue abnormalities that represent the main element of the diagnostic criteria of Lake Louisse.
Empathy levels among undergraduate medical students in Karachi, Pakistan: a cross-sectional study
Authors: Naseem Masooma , Tahir Burhanuddin , Salman Afia , Qadir Sara , Farhan Rida , Ali Sajjad , Naseem Zehra , Ahmed Warda , Anan Mahfuza
Published: August 2023

Background:

Empathy is a concept native to the field of medicine. However, over the course of medical school, empathy levels are expected to decline. The aim of this study was to assess the empathy levels among medical students in relation to their year of study and specialties of choice in the future.

Materials and methods:

A cross-sectional study was conducted to assess empathy levels among students from medical colleges in Karachi, Pakistan, using an online survey. The total duration of the study was 2 months. The authors analyzed the data using SPSS version 20.

Results:

A total of 463 undergraduate medical students participated in this survey. The overall mean empathy score was 101.9±16.3 with 104.6±14.1 for females, which was significantly higher than the male participants. The highest empathy levels were demonstrated in fourth-year medical students with a mean empathy score of 104.1±16.3, whereas, the lowest empathy levels were found in second-year medical students with a mean empathy score of 99.8±9.4. Study participants considering emergency medicine, neurology, obstetrics/gynecology, and oncology as their specialty of choice demonstrated the highest empathy levels followed by pediatrics and internal medicine.

Conclusion:

On average, there was a female preponderance in empathy levels among undergraduate medical students. Empathy levels among fourth-year students involved in clinical practice were greater as compared to students in their initial years of study. Further investigations are required to validate the findings of this study.
Emerging zoonotic diseases and COVID-19 pandemic: global Perspective and Indian Scenario
Authors: Bardhan Mainak , Ray Ishita , Roy Shubhajeet , Bhatt Parjanya , Patel Suyog , Asri Sucharu , Shariff Sanobar , Shree Anagha , Mitra Saloni , Roy Priyanka , Anand Ayush
Published: August 2023

The current coronavirus disease 2019 (COVID-19) pandemic is one example of the scores of zoonotic diseases responsible for various outbreaks resulting in the deaths of millions of people for centuries. The COVID-19 pandemic has broken the age-old healthcare infrastructure and led to utter chaos. In the shadow of this pandemic, other zoonotic infections like the nipah virus, monkeypox, and langya virus, to name a few, have been neglected. Hence, outbreaks caused by such zoonotic viruses are rising in their endemic areas, like the Indian subcontinent. The mortality and morbidity due to such zoonoses are greater than usual due to the shortage of healthcare professionals caused by the COVID-19 crisis. Due to the lack of vaccines and therapeutics directed against this viral infection, treatment of patients is limited to supportive management and prevention, making preparedness for these potential zoonotic viral outbreaks essential. This paper highlights some of these zoonotic infections, which perpetuated and wreaked havoc while the world was occupied with containing the COVID-19 pandemic.
Circulating miR-221/222 expression as microRNA biomarker predicting tamoxifen treatment outcome: a case–control study
Authors: Patellongi Ilhamjaya , Amiruddin Alfiah , Massi Muhammad N. , Islam Andi A. , Pratama Muhammad Y. , Sutandyo Noorwati , Latar Nani H.M. , Faruk Muhammad
Published: August 2023

Introduction:

The high mortality rate in breast cancer (BC) patients is generally due to metastases resistant to systemic therapy. Two causes of systemic therapy resistance in BC patients are circulating miRNAs-221 and miR-222, leading to improved BC cell proliferation, survival, and reduced cell apoptosis. This study investigated the miRNA expression changes associated with cancer cell resistance to tamoxifen therapy and is expected to be clinically meaningful before providing endocrine therapy to luminal-type BC patients who express them.

Methods:

This case–control research included individuals with the luminal subtype of BC who had received tamoxifen medication for around one year. Furthermore, the case group contained 15 individuals with local recurrence or metastases, while the control group comprised 19 patients without local recurrence or metastases. Plasma miR-221/222 quantification was performed with real-time PCR using transcript-specific primers.

Results:

A significant difference was found in circulating miR-221 expression between cases and controls (P=0.005) but not in miR-222 expression (P=0.070). There were no significant differences between miR-221/222 expression, progesterone receptor, Ki67 protein levels, lymphovascular invasion, and stage. However, receiver operator characteristic curve analyses showed miR-221/222 expressions predictive of tamoxifen resistance (P=0.030) with a sensitivity of 60.00 and a specificity of 83.33%.

Conclusion:

The use of circulating miR-221/222 expression can predict relapse as well as resistance to tamoxifen treatment in BC patients, and their testing is recommended for luminal subtype BC patients who will undergo tamoxifen therapy to determine their risk of tamoxifen resistance early, increasing treatment effectiveness.
Anatomical variations of cystic artery, cystic duct, and gall bladder and their associated intraoperative and postoperative complications: an observational study
Authors: Gupta Rohit , Kumar Anil , Hariprasad Chinniahnapalaya P. , Kumar Manoj
Published: August 2023

Background:

Anatomical variations in the calots triangle encountered during laparoscopic cholecystectomy are not uncommon. Misidentification and misperception of these structures are the major cause of vasculobiliary injuries. This study was conducted to estimate the prevalence of anatomical variations of the cystic artery, cystic duct (CD), and gall bladder. This is the first study in India to access the rate of intraoperative and postoperative complications in anatomical variants compared to normal individuals.

Patients and methods:

It was a prospective observational study on patients undergoing laparoscopic cholecystectomy in the department of General Surgery at the tertiary center of India. The calculated sample size was 298. Variations of the cystic artery, CD, and gall bladder along with intraoperative and postoperative complications were noted. The comparative analysis of intraoperative and postoperative complications and a subgroup analysis between anatomical variants and normal patients were performed.

Results:

The most common variations were found in cystic arteries (16.8%). CD anomalies were present in 11.4% of patients, and gall bladder anomalies were the least common of all (5.4%). Intraoperative and postoperative complications were compared between patients with anatomical variations and normal anatomy. Intraoperative complications in patients with anatomical variations were significantly higher. Bile leak (15.7% vs. 6.4%) (P=0.01), haemorrhage (16.8% vs. 1.9%) (P-value <0.001), conversion to open (3 vs. 0 patients) (P-value =0.03). Subgroup analysis revealed a strong association between intraoperative haemorrhage and bile leak with cystic artery and CD anomalies, respectively.

Conclusion:

Cystic artery anomalies are the most common variations. Patients with anatomical variations had significant intraoperative and postoperative complications compared to patients with normal anatomy.
Long-term persistence of transcriptionally-active “defective” HIV-1 proviruses: Implications for persistent immune activation during antiretroviral therapy
Authors: Singh Kanal , Natarajan Ven , Dewar Robin , Rupert Adam , Badralmaa Yuden , Zhai Tracey , Winchester Nicole , Scrimieri Francesca , Smith Mindy , Davis Ivery , Lallemand Perrine , Giglietti Aude , Hensien Jack , Buerkert Thomas , Goshu Bruktawit , Rehm Catherine A. , Hu Zonghui , Lane H. Clifford , Imamichi Hiromi
Published: August 2023

Objectives:

People with HIV-1 (PWH) on effective antiretroviral therapy (ART) continue to exhibit chronic systemic inflammation, immune activation, and persistent elevations in markers of HIV-1 infection (including HIV-DNA, cell-associated (CA) HIV-RNA, and antibodies to HIV-1 proteins) despite prolonged suppression of plasma HIV-RNA levels <50 copies/mL. Here, we investigated the hypothesis that non-replicating but transcriptionally- and translationally-competent “defective” HIV-1 proviruses may be one of drivers of these phenomena.

Design:

A combined cohort of 23 viremic and virologically suppressed individuals on ART were studied.

Methods:

HIV-DNA, CA HIV-RNA, western blot (WB) score (measure of anti-HIV-1 antibodies as a surrogate for viral protein expression in vivo), and key biomarkers of inflammation and coagulation (IL-6, hsCRP, TNF-alpha, tissue factor, and D-dimer) were measured in peripheral blood and analyzed using a combined cross-sectional and longitudinal approaches. Sequences of HIV-DNA and CA HIV-RNA obtained via 5’LTR-to-3’LTR PCR and single-genome sequencing were also analyzed.

Results:

We observed similar long-term persistence of multiple, unique, transcriptionally-active “defective” HIV-1 provirus clones (average: 11 yrs., range: 4–20 yrs.) and antibody responses against HIV-1 viral proteins among all ART-treated participants evaluated. A direct correlation was observed between the magnitude of HIV-1 WB score and the levels of transcription of “defective” HIV-1 proviruses (r = 0.73, p < 0.01). Additional correlations were noted between total CD8+ T cell counts and HIV-DNA (r = 0.52, p = 0.01) or CA HIV-RNA (r = 0.65, p < 0.01).

Conclusions:

These findings suggest a novel interplay between transcription and translation of “defective” HIV-1 proviruses and the persistent immune activation seen in the setting of treated chronic HIV-1 infection.
Pan American League of Associations for Rheumatology Guidelines for the Treatment of Takayasu Arteritis
Authors: de Souza Alexandre Wagner S. , Sato Emilia I. , Brance Maria Lorena , Fernández-Ávila Daniel G. , Scolnik Marina , Magri Sebastián Juan , Ugarte-Gil Manuel Francisco , Flores-Suárez Luis Felipe , Saldarriaga-Rivera Lina María , Babini Alejandra , Zamora Natalia V. , Acosta Felquer María Laura , Vergara Facundo , Carlevaris Leandro , Scarafia Santiago , Soriano Guppy Enrique Roberto , Unizony Sebastian
Published: August 2023

Objective

To develop the first evidence-based Pan American League of Associations for Rheumatology (PANLAR) guidelines for the treatment of Takayasu arteritis (TAK).

Methods

A panel of vasculitis experts developed a series of clinically meaningful questions addressing the treatment of TAK patients in the PICO (population/intervention/comparator/outcome) format. A systematic literature review was performed by a team of methodologists. The evidence quality was assessed according to the GRADE (Grading of Recommendations/Assessment/Development/Evaluation) methodology. The panel of vasculitis experts voted each PICO question and made recommendations, which required ≥70% agreement among the voting members.

Results

Eleven recommendations were developed. Oral glucocorticoids are conditionally recommended for newly diagnosed and relapsing TAK patients. The addition of nontargeted synthetic immunosuppressants (e.g., methotrexate, leflunomide, azathioprine, or mycophenolate mofetil) is recommended for patients with newly diagnosed or relapsing disease that is not organ- or life-threatening. For organ- or life-threatening disease, we conditionally recommend tumor necrosis factor inhibitors (e.g., infliximab or adalimumab) or tocilizumab with consideration for short courses of cyclophosphamide as an alternative in case of restricted access to biologics. For patients relapsing despite nontargeted synthetic immunosuppressants, we conditionally recommend to switch from one nontargeted synthetic immunosuppressant to another or to add tumor necrosis factor inhibitors or tocilizumab. We conditionally recommend low-dose aspirin for patients with involvement of cranial or coronary arteries to prevent ischemic complications. We strongly recommend performing surgical vascular interventions during periods of remission whenever possible.

Conclusion

The first PANLAR treatment guidelines for TAK provide evidence-based guidance for the treatment of TAK patients in Latin American countries.
Complication Rates in Therapeutic Versus Prophylactic Bilateral Mastectomies
Authors: Shaheen Mohammed S. , Wan Derrick , Momeni Arash
Published: August 2023

Background

The “Jolie effect” and other media focus on prophylactic treatments have resulted in unilateral breast cancer patients increasingly undergoing contralateral prophylactic mastectomy. Little is known, however, regarding outcomes following therapeutic versus prophylactic mastectomy. In this study, we compared complication rates of unilateral breast cancer patients undergoing contralateral prophylactic mastectomy (BM-TP) to patients undergoing bilateral prophylactic mastectomy (BM-P).

Methods

The BM-TP and BM-P patients from 2015 to 2019 were identified in Optum Clinformatics DataMart. Six-month outcomes were assessed and included wound complications, infection, hematoma/seroma, breast pain, fat necrosis, flap failure, implant failure/removal, other flap/implant complications, and other complications. Multivariable regression models adjusted for age, residence, insurance, race, and Charlson Comorbidity Index score.

Results

Of 9319 women, 7114 (76.3%) underwent BM-TP, and 2205 (23.7%) underwent BM-P. In multivariable analysis, BM-TP had higher odds of overall complications (adjusted odds ratio [aOR], 1.35; P < 0.0001), but no difference was observed among patients who had autologous (P = 0.1448) or no breast reconstruction (P = 0.1530). Higher odds of overall complications persisted even after controlling for radiation therapy (aOR, 1.25; P = 0.0048) and chemotherapy (aOR, 1.28; P = 0.0047), but not after controlling for lymph node surgery (P = 0.7765).

Conclusion

The BM-TP (vs BM-P) patients face higher odds of overall complications but without any difference in certain reconstructive modalities or after controlling for lymph node surgery.
Maternal provisioning interacts with incubation temperature to affect hatchling mercury exposure in an oviparous reptile
Authors: Johnson Josiah M. , Smaga Christopher R. , Bock Samantha L. , Parrott Benjamin B.
Published: August 2023

The thermal environment experienced by developing embryos can influence the utilization of maternally provisioned resources. Despite being particularly consequential for oviparous ectotherms, these dynamics are largely unexplored within ecotoxicological frameworks. Here, we test if incubation temperature interacts with maternally transferred mercury to affect subsequent body burdens and tissue distributions of mercury in hatchling American alligators (
Alligator mississippiensis
). Nine clutches of alligator eggs were collected from a mercury-contaminated reservoir and incubated at either female- or male-promoting temperatures. Total mercury (THg) concentration was measured in egg yolk collected during incubation and in a suite of tissues collected from hatchlings. THg concentrations in residual yolk and blood were higher in hatchlings incubated at cooler, female-promoting temperatures compared to the warmer, male-promoting temperatures. THg concentrations in most tissues were positively correlated with THg concentrations in blood and dermis, and egg yolk THg concentration was the best predictor of THg concentration in many resultant tissues. Our results highlight a hereto unknown role of the developmental environment in mediating tissue specific uptake of contaminants in an oviparous reptile.