bluuebunny/crossref_metadata_2025 huggingface dataset:
Improving the arthritis component of the SLEDAI-2K
Authors: Mahmoud Khaled , Md Yusof Md Yuzaiful , Teh Lee Suan , Khan Shah , Yee Chee-Seng , D’Cruz David , Isenberg David , Ciurtin Coziana , Conaghan Philip G , Emery Paul , Edwards Christopher J , Hensor Elizabeth M A , Vital Edward M
Published: December 2024

Objective

To propose a new definition for SLEDAI arthritis informed by imaging.

Methods

We performed a planned secondary analysis of observational data from a multicentre study evaluating SLE patients with inflammatory joint pain (swelling not required) using various clinical instruments, laboratory tests and ultrasound. For SLEDAI arthritis, assessors (blinded to ultrasound) were asked which of the glossary terms for arthritis in any version of the SLEDAI drove their decision to score for arthritis. These definitions were tested against ultrasound and other clinical variables. ROC analysis was used to test optimal joint count thresholds.

Results

A total of 78/133 patients had arthritis on SLEDAI-2K. In 21/78, clinician-observed swelling was not a reason for scoring (tenderness: 16/21; reported swelling between visits: 4/21; both of these: 1/21). No patient was scored for warmth or erythema alone. In total, 57 (73.1%) patients were scored for SLEDAI arthritis due to observed swelling, 90% had abnormal ultrasound (PPV = 90%, 95%CI: 79, 94). Of 21 patients with SLEDAI arthritis without observed swelling, 48% had abnormal ultrasound (PPV: 48%, 95%CI: 31, 67). Patients with SLEDAI arthritis with swelling had higher ESR, physician MSK-VAS, patient early morning stiffness (EMS)-VAS and IgG compared with other patients. Optimal sensitivity and specificity for ultrasound synovitis was 1 swollen joint using Youden’s criteria.

Conclusions

Our data suggest that the definition of arthritis in SLEDAI be modified to: ‘Inflammatory musculoskeletal pain (symmetrical small joint distribution), with one or more clinically swollen joints witnessed on examination, that is not explained by another arthropathy’.
Association of patient- and hospital-level predictors with patterns of initial treatment in patients with rheumatoid arthritis: findings from a national cohort study
Authors: Yang Zijing , Alveyn Edward , Russell Mark , Bechman Katie , Coalwood Callum , Price Elizabeth , Abhishek Abhishek , Norton Sam , Galloway James
Published: December 2024

Objectives

To update the first-line conventional synthetic DMARDs (csDMARDs) prescribing pattern, describe change and variation across demographical and geographical factors in the RA population, and identify individual and hospital factors associated with it.

Methods

This retrospective cohort study included newly diagnosed RA adult patients from 1 May 2018 to 1 April 2023 in the UK. We used adjusted multinomial logistic regression with random effect to explore associations with different first-line csDMRAD prescription and to account for hospital-level clustering.

Results

We identified 15 462 RA patients who received csDMARD treatment. Overall, 57% received MTX monotherapy and 14% received MTX combination therapy as first-line treatment. MTX is the most frequently medication, following by HCQ and SSZ. Compared with non-MTX prescription, prescription of MTX monotherapy [adjusted odds ratio (aOR) 1.25 95% CI (1.22–1.29)] and MTX combination therapy [aOR 1.45 (1.38–1.52)] was significantly higher in patients with higher DAS28, but lower in the non-White individuals with comorbidities: lung disease, cancer, fracture and heart attack. Among those who received MTX, monotherapy is more likely be prescribed in patients with higher DAS28 [aOR 1.08 (1.05–1.11)] and without lung disease [aOR 0.5 (0.44–0.56)], compared with combination therapy. Around 20% of the variability in first-line csDMARD prescribing was attributed to the hospital level.

Conclusion

In this cohort study of new-onset RA population, both individual- and institution-level variation in first-line csDMARD treatment strategy was evident. Gender, ethnicity, disease activity, and comorbidities, especially lung disease, were associated with disparities at the individual level.
Successful treatment of invasive Aspergillus rhinosinusitis and orbital aspergillosis with oral isavuconazole in a patient with contraindications to conventional first- and second-line therapy
Authors: Too Adriana , Sowerby Leigh , Bursztyn Lulu , Rahimi Reza
Published: December 2024

Objectives

Acute invasive fungal rhinosinusitis represents a severe, life-threatening condition that necessitates prompt diagnosis and intervention. In this case report, we discuss the use of isavuconazole, a novel, broad-spectrum triazole antifungal, approved for use in Canada in 2019 (Government of Canada. Summary Basis of Decision – Cresemba – Health Canada. Summary Basis of Decision. 2019. Accessed 6 June 2024. https://hpr-rps.hres.ca/reg-content/summary-basis-decision-detailTwo.php?linkID=SBD00424#:~:text=Summary%20Basis%20of%20Decision%20(SBD)%20for%20Cresemba&text=Summary%20Basis%20of%20Decision%20(SBD)%20documents%20provide%20information%20related%20to,original%20authorization%20of%20a%20product) that can be considered an alternative to voriconazole.

Methods

We present the case of a 78-year-old man with a unique case of invasive Aspergillus rhinosinusitis and orbital aspergillosis. He was admitted for urgent left maxillary antrostomy, left anterior and posterior ethmoidectomy, and left transorbital resection of lesion tissue with orbital decompression. His treatment course was complicated by a contraindication to voriconazole because of prolonged QTc interval and inability to tolerate IV amphotericin B.

Key findings

The patient was treated with a 14-week course of isavuconazole as an alternative to voriconazole. At 3 months, there was no clinical evidence for infection, and the patient was sent for a computed tomography (CT) of the head and sinus to assess for evidence of active infection or bone destruction, which showed significant improvement in paranasal sinus inflammation and soft tissue infiltration. At his 6-month follow-up, his CT head showed regression in inflammatory change, with no deterioration in his sinusitis, and no further antifungal treatment was required.

Conclusions

Given the novelty of isavuconazole, there has been limited experience with its use in the setting of rhinosinusitis and orbital invasive aspergillosis. This case highlights isavuconazole as a reasonable alternative to voriconazole and other triazoles in patients that are intolerant or have contraindications related to QTc prolongation.
Religious Fundamentalism: A Conceptual and Empirical Study Among Muslims of Turkish Origin in Germany
Authors: Pollack Detlef , Müller Olaf , Demmrich Sarah
Published: December 2024

Muslims in Europe face reservations due to the association of Islam with fundamentalism and extremism. Our study aims to use a new concept of fundamentalism and new data to identify factors that correlate with fundamentalism, and to investigate how far these attitudes are associated with the acceptance of violence. Fundamentalism is defined as an attitude characterized by the claim to exclusive truth, to superiority over all other positions, to the universal validity of the exclusive truth, and to the transformation of the world according to the yardstick of this truth. Empirical analyses show that feelings of disadvantage and exclusion as well as traditional religious ties contribute to fundamentalism, while integration indicators play only a subordinate role. Additionally, social structure seems partially decoupled from feelings of disadvantage among Muslims scoring high on fundamentalism. Although correlated with fundamentalism, acceptance of violence could not be identified as an inherent component of fundamentalism.
Knowledge, attitudes and practices of the general population towards Marburg virus disease in sub-Saharan African countries: a cross-sectional study
Authors: Hussein Mohamed Fakhry , Gebreal Assem , Saleeb Marina , Tessema Eyerusalem Amossa , Okeh Debra , Gaitano Gori , Nathanson Marc , Tsoeu Nthabiseng , Gilbert Eshun , Ally Khadija Swalehe , Noureldin Ahmed Elsayed said , Hussein Mai , Ghazy Ramy Mohamed
Published: December 2024

Background

Marburg virus disease (MVD) is categorized among viral hemorrhagic fevers. MVD is associated with high rates of morbidity and mortality. This study aimed to identify factors affecting MVD knowledge, attitudes and practices in sub-Saharan African countries.

Methods

Using a validated questionnaire, a cross-sectional survey was conducted from 21 April to 23 May 2023 in eight English-speaking sub-Saharan African countries (Ethiopia, Ghana, Kenya, Lesotho, Nigeria, Senegal, South Africa and Tanzania).

Results

Of 3142 participants, 51% were males, 66.0% were aged 18–29 y, 74.4% were living in urban areas, 47.9% completed their university education and 21.7% were healthcare workers (HCWs). Tanzanians had the highest good knowledge (89%), while Kenyans had the lowest (26%). Tanzanians had the highest positive attitude (82%), while Nigerians had the highest negative attitude (95%). The best practices exhibited were by Ethiopians (70%), and the poorest practices exhibited were by Ghanaians (94%). The predictors of good knowledge were marital status (adjusted OR [aOR]=0.75; 95% CI 0.59 to 0.94; p=0.013), knowing the correct mode of transmission (aOR=18.31; 95% CI 13.31 to 25.66; p<0.001), whether the participant has heard before about MVD (aOR=2.24; 95% CI 1.82 to 2.75; p<0.001), whether they modified their working habits (aOR=2.79; 95% CI 2.12 to 3.67; p<0.001), nationality (p<0.001) and being a HCW (aOR=2.71; 95% CI 2.01 to 3.67; p<0.001). The predictors of good attitude were being female (aOR=0.71; 95% CI 0.60 to 0.85; p<0.001), age (aOR=0.99; 95% CI 0.98 to 0.99; p=0.01), place of residence (aOR=3.13; 95% CI 2.46 to 3.99; p<0.001), level of education (aOR=1.67; 95% CI 1.37 to 2.04; p<0.001), knowing the correct mode of transmission (aOR=1.59; 95% CI 1.28 to 1.98; p<0.001), modification of working habits (aOR=1.30; 95% CI 1.01 to 1.68; p=0.039) and nationality (p<0.001). The predictors of practice were being female (aOR=1.17; 95% CI 1.01 to 1.37; p=0.042), place of residence (aOR=1.23; 95% CI 1.02 to 1.48; p=0.033), marital status (aOR=0.65; 95% CI 0.55 to 0.78; p<0.001), knowing the correct mode of transmission (aOR=0.46; 95% CI 0.38 to 0.56; p<0.001), modification of working habits (aOR=0.40; 95% CI 0.32 to 0.49; p<0.001) and occupation (aOR=0.37; 95% CI 0.30 to 0.46; p<0.001).

Conclusions

Different modifiable and non-modifiable risk factors can be targeted to improve population perspectives towards MVD.
Endothelial‐specific CXCL12 regulates neovascularization during tissue repair and tumor progression
Authors: Hostler Andrew C. , Hahn William W. , Hu Michael S. , Rennert Robert , Fischer Katharina S. , Barrera Janos A. , Duscher Dominik , Januszyk Michael , Henn Dominic , Sivaraj Dharshan , Yasmeh Jonathan P. , Kussie Hudson C. , Granoski Maia B. , Padmanabhan Jagannath , Vial Ivan N. , Riegler Johannes , Wu Joseph C. , Longaker Michael T. , Chen Kellen , Maan Zeshaan N. , Gurtner Geoffrey C.
Published: December 2024

C‐X‐C motif chemokine ligand 12 (CXCL12; Stromal Cell‐Derived Factor 1 [SDF‐1]), most notably known for its role in embryogenesis and hematopoiesis, has been implicated in tumor pathophysiology and neovascularization. However, its cell‐specific role and mechanism of action have not been well characterized. Previous work by our group has demonstrated that hypoxia‐inducible factor (HIF)‐1 modulates downstream CXCL12 expression following ischemic tissue injury. By utilizing a conditional CXCL12 knockout murine model, we demonstrate that endothelial‐specific deletion of CXCL12 (eKO) modulates ischemic tissue survival, altering tissue repair and tumor progression without affecting embryogenesis and morphogenesis. Loss of endothelial‐specific CXCL12 disrupts critical endothelial–fibroblast crosstalk necessary for stromal growth and vascularization. Using murine parabiosis with novel transcriptomic technologies, we demonstrate that endothelial‐specific CXCL12 signaling results in downstream recruitment of non‐inflammatory circulating cells, defined by neovascularization modulating genes. These findings indicate an essential role for endothelial‐specific CXCL12 expression during the neovascular response in tissue injury and tumor progression.
Neddylation drives myofibrillogenesis in the developing heart
Authors: Littlejohn Rodney , Zambrano‐Carrasco Josue , Zou Jianqiu , Lu Yi , Liu Elise , Kim Il‐man , Jiao Kai , Weintraub Neal L. , Zhou Jiliang , Li Jie , Su Huabo
Published: December 2024

Neddylation is a highly conserved post‐translational modification that plays critical roles in various cellular processes through the modulation of cullins and non‐cullin substrates. While neddylation is known to be essential for embryonic development, tumor growth, and organogenesis of different tissues, its role in cardiogenesis remains unexplored. Here, we investigated the role of neddylation in early cardiac development by deleting the gene encoding a regulatory subunit of the NEDD8‐specific E1 activating enzyme, Nae1, globally and in a heart‐specific fashion via Nkx2‐5Cre. Global deletion of Nae1 in mice led to embryonic lethality before embryonic day (E) 8.5, whereas cardiac‐specific NAE1 knockout mice died at around E12.5 with pronounced cardiac effusion and peripheral hemorrhage, characteristic of cardiac failure. Histological analysis revealed significant thinning of the compact myocardium and reduced trabeculae in mutant hearts, which were accompanied by reduced cardiomyocyte proliferation. Unbiased transcriptomic analysis identified perturbations in cardiomyocyte proliferation and myofibril architecture in mutant hearts. Subsequent analysis showed that loss of NAE1 disrupted sarcomere assembly dysregulated the expression of several important contractile proteins, and impaired mitochondrial function in the developing heart, which was accompanied by downregulation of key cardiac transcription factors including NKX2‐5 and SRF. Collectively, our findings demonstrate the essential role of neddylation in cardiogenesis at least in part by driving cardiomyocyte proliferation and myofibrillogenesis.
The Next Era of Assessment: Can Ensuring High-Quality, Equitable Patient Care Be the Defining Characteristic?
Authors: Schumacher Daniel J. , Kinnear Benjamin , Burk-Rafel Jesse , Santen Sally A. , Bullock Justin L.
Published: December 2024

Previous eras of assessment in medical education have been defined by how assessment is done, from knowledge exams popularized in the 1960s to the emergence of work-based assessment in the 1990s to current efforts to integrate multiple types and sources of performance data through programmatic assessment. Each of these eras was a response to why assessment was performed (e.g., assessing medical knowledge with exams; assessing communication, professionalism, and systems competencies with work-based assessment). Despite the evolution of assessment eras, current evidence highlights the graduation of trainees with foundational gaps in the ability to provide high-quality care to patients presenting with common problems, and training program leaders report they graduate trainees they would not trust to care for themselves or their loved ones. In this article, the authors argue that the next era of assessment should be defined by why assessment is done: to ensure high-quality, equitable care. Assessment should place focus on demanding graduates possess the knowledge, skills, attitudes, and adaptive expertise to meet the needs of all patients and ensuring that graduates are able to do this in an equitable fashion. The authors explore 2 patient-focused assessment approaches that could help realize the promise of this envisioned era: entrustable professional activities (EPAs) and resident sensitive quality measures (RSQMs)/TRainee Attributable and Automatable Care Evaluations in Real-time (TRACERs). These examples illustrate how the envisioned next era of assessment can leverage existing and new data to provide precision education assessment that focuses on providing formative and summative feedback to trainees in a manner that seeks to ensure their learning outcomes prepare them to ensure high-quality, equitable patient outcomes.
A Theoretical Foundation to Inform the Implementation of Precision Education and Assessment
Authors: Drake Carolyn B. , Heery Lauren M. , Burk-Rafel Jesse , Triola Marc M. , Sartori Daniel J.
Published: December 2024

Precision education (PE) uses personalized educational interventions to empower trainees and improve learning outcomes. While PE has the potential to represent a paradigm shift in medical education, a theoretical foundation to guide the effective implementation of PE strategies has not yet been described. Here, the authors introduce a theoretical foundation for the implementation of PE, integrating key learning theories with the digital tools that allow them to be operationalized. Specifically, the authors describe how the master adaptive learner (MAL) model, transformative learning theory, and self-determination theory can be harnessed in conjunction with nudge strategies and audit and feedback dashboards to drive learning and meaningful behavior change. The authors also provide practical examples of these theories and tools in action by describing precision interventions already in use at one academic medical center, concretizing PE’s potential in the current clinical environment. These examples illustrate how a firm theoretical grounding allows educators to most effectively tailor PE interventions to fit individual learners’ needs and goals, facilitating efficient learning and ultimately improving patient and health system outcomes.
Sensor-Based Discovery of Search and Palpation Modes in the Clinical Breast Examination
Authors: Laufer Shlomi , Klatzky Roberta L. , Pugh Carla M.
Published: December 2024

Purpose

Successful implementation of precision education systems requires widespread adoption and seamless integration of new technologies with unique data streams that facilitate real-time performance feedback. This paper explores the use of sensor technology to quantify hands-on clinical skills. The goal is to shorten the learning curve through objective and actionable feedback.

Method

A sensor-enabled clinical breast examination (CBE) simulator was used to capture force and video data from practicing clinicians (N = 152). Force-by-time markers from the sensor data and a machine learning algorithm were used to parse physicians’ CBE performance into periods of search and palpation and then these were used to investigate distinguishing characteristics of successful versus unsuccessful attempts to identify masses in CBEs.

Results

Mastery performance from successful physicians showed stable levels of speed and force across the entire CBE and a 15% increase in force when in palpation mode compared with search mode. Unsuccessful physicians failed to search with sufficient force to detect deep masses (F[5,146] = 4.24, P = .001). While similar proportions of male and female physicians reached the highest performance level, males used more force as noted by higher palpation to search force ratios (t[63] = 2.52, P = .014).

Conclusions

Sensor technology can serve as a useful pathway to assess hands-on clinical skills and provide data-driven feedback. When using a sensor-enabled simulator, the authors found specific haptic approaches that were associated with successful CBE outcomes. Given this study’s findings, continued exploration of sensor technology in support of precision education for hands-on clinical skills is warranted.
Ultrasound-guided Percutaneous Cryoneurolysis for the Treatment of Pain after Traumatic Rib Fracture: A Randomized, Active-controlled, Participant- and Observer-masked Study
Authors: Finneran John J. , Kobayashi Leslie , Costantini Todd W. , Weaver Jessica L. , Berndtson Allison E. , Haines Laura , Doucet Jay J. , Adams Laura , Santorelli Jarrett E. , Lee Jeanne , Trescot Andrea M. , Donohue Michael C. , Schaar Adam , Ilfeld Brian M.
Published: December 2024

Background:

Traumatic rib fractures are associated with pain lasting weeks to months and a decreased ability to inspire deeply or cough to clear secretions. Ultrasound-guided percutaneous cryoneurolysis involves reversibly ablating peripheral nerve(s) using exceptionally low temperature with a transdermal probe, resulting in a prolonged nerve block with a duration measured in months. The authors hypothesized that cryoneurolysis would improve analgesia and inspired volume after rib fracture.

Methods:

Adults with one to six traumatic rib fractures were randomized to either active cryoneurolysis and sham peripheral nerve block or sham cryoneurolysis and active peripheral nerve block in a participant/observer-masked fashion. The primary endpoint was the maximum inspired volume the day after the procedure as measured with an incentive spirometer.

Results:

The day after the procedure, the unadjusted median [interquartile range] maximum inspired volume for participants who received cryoneurolysis (n = 11) was 2,250 ml [1,500, 2,500 ml] versus 1,300 ml [750, 2,500 ml] for peripheral nerve block (n = 9, mean difference, 496; 95% CI, –428 to 1,420; t test P = 0.269). When adjusted for covariates (e.g., baseline lung volume), the cryoneurolysis group had an estimated 793 ml greater mean volume than peripheral nerve block (95% CI, 273 to 1,312 ml; analysis of covariance P = 0.005). Improvement from baseline in maximum inspired volume for cryoneurolysis was 1,000 ml [1,000, 1,375 ml] versus 300 ml [0, 1,000 ml] for peripheral nerve block (t test P = 0.002). This was equivalent to an improvement over baseline of 100% [90%, 188%] for cryoneurolysis versus 30% [0%, 50%] for peripheral nerve block (t test P = 0.003). Average daily pain scores were generally lower for the cryoneurolysis group throughout the first month. Total cumulative oxycodone equivalents were 5 mg [0, 13 mg] for cryoneurolysis versus 45 mg [43, 135 mg] for peripheral nerve block (t test P = 0.013).

Conclusions:

Ultrasound-guided percutaneous cryoneurolysis improves maximum inspired lung volume while concurrently decreasing pain and opioid consumption after traumatic rib fracture. These results should be considered preliminary, requiring confirmation with a trial including a larger sample size.
Amino Acid Infusion for Kidney Protection in Cardiac Surgery Patients with Chronic Kidney Disease: A Secondary Analysis of the PROTECTION Trial
Authors: Redaelli Martina Baiardo , Monaco Fabrizio , Bradic Nikola , Scandroglio Anna Mara , Ti Lian Kah , Belletti Alessandro , Viscido Cristina , Licheri Margherita , Guarracino Fabio , Pruna Alessandro , Pisano Antonio , Pontillo Domenico , Federici Francesco , Losiggio Rosario , Serena Giovanni , Tomasi Enrico , Silvetti Simona , Ranucci Marco , Brazzi Luca , Cortegiani Andrea , Landoni Giovanni , Mastroroberto Pasquale , Paternoster Gianluca , Gaudino Mario F.L. , Zangrillo Alberto , Bellomo Rinaldo ,   for the PROTECTION Study Group Collaborators
Published: December 2024

Background:

In the PROTECTION trial, intravenous amino acids (AA) decreased the occurrence of acute kidney injury (AKI) in cardiac surgery patients with cardiopulmonary bypass (CPB). Recruitment of renal functional reserve may be responsible for such protection. However, patients with chronic kidney disease (CKD) have diminished renal functional reserve, and AA may be less protective in such patients. Thus, a separate investigation of such patients is warranted.

Methods:

We defined CKD as an estimated glomerular filtration rate (eGFR)<60 mL·min-1·1.73 m-2 and patients with eGFR≥60 mL·min-1·1.73 m-2 served as controls. The primary outcome was the occurrence of AKI. Secondary outcomes included severity of AKI, need for and duration of renal replacement therapy, and all-cause mortality.

Results:

Among CKD patients (n=812), compared with placebo, AA significantly decreased the rate of AKI (43.1% vs 50.3%; RR, 0.86; 95%CI, 0.74 to 0.99; p=0.041; number needed to treat [NNT]=14) with a median percentage increase in eGFR from baseline to postoperative day three of 12.7% vs. 6.5% (p=0.002). In eGFR-based CKD subgroups (30 to 39, 40 to 49, and 50 to 59 mL·min-1·1.73 m-2) the AA effect was similar (interaction p=0.50). Finally, AA infusion decreased the occurrence of severe (stage 3) AKI (2.7% vs. 5.6%; RR 0.48; 95%CI, 0.24 to 0.98; p=0.038).

Conclusions:

AA infusion protected CKD patients undergoing CPB from developing AKI, with an absolute risk reduction of 7% and a NNT of 14 in a cohort with a >45% rate of AKI. Moreover, it delivered a >50% relative risk reduction in severe AKI.
Maternal Morbidity and Medically Assisted Reproduction Treatment Types
Authors: Pelikh Alina , Smith Ken R. , Myrskylä Mikko , Debbink Michelle P. , Goisis Alice
Published: December 2024

OBJECTIVE:

To compare odds of maternal morbidity by mode of becoming pregnant and type of medically assisted reproduction treatments: fertility-enhancing drugs, intrauterine insemination (IUI), and assisted reproductive technology (ART) with autologous or donor oocytes.

METHODS:

Birth certificates were used to study maternal morbidity among the birthing population in Utah between 2009 and 2017 (N=469,919 deliveries); 22,543 pregnancies occurred through medically assisted reproduction (4.8%). Maternal morbidity was identified as a binary variable, indicating the presence of any of the following: blood transfusion, unplanned operating room procedure, admission to intensive care unit, eclampsia, unplanned hysterectomy, and ruptured uterus. Using logistic regression, we assessed maternal morbidity among medically assisted reproduction pregnancies (overall and by type of treatment) compared with unassisted pregnancies in the overall sample before and after adjustment for individual sociodemographics (age at birth, family structure, level of education, Hispanic origin, parity), and pre-existing comorbidities (ie, chronic hypertension, heart disease, asthma), multifetal gestation, and obstetric comorbidities (ie, placenta previa, placental abruption, cesarean delivery).

RESULTS:

Individuals becoming pregnant through medically assisted reproduction had higher risk of maternal morbidity, with odds ratios (ORs) increasing as medically assisted reproduction treatments become more invasive. Associations were largely attenuated when accounting for multifetal gestation and further reduced after controlling for obstetric comorbidities. However, ART with autologous oocytes (OR 1.46, 95% CI, 1.20–1.78) maintained higher coefficients compared with unassisted pregnancies. In models including only singletons, after controlling for obstetric comorbidities, the OR differences in maternal morbidity between all medically assisted reproduction groups and unassisted pregnancies were no longer statistically significant.

CONCLUSION:

More invasive medically assisted reproduction treatments (ART and IUI) are associated with higher odds of maternal morbidity, whereas less invasive treatments are not. This relationship is partially explained by higher prevalence of multifetal gestation and obstetric comorbidities in people undergoing more invasive treatment, but the persistent association suggests subfertility itself may contribute to maternal morbidity.
Mid-term Results Following Surgical Hip Dislocation for Residual Pediatric Deformities
Authors: Muffly Brian T. , Trotzky Zachary A. , Oettl Felix C. , Sink Ernest L.
Published: December 2024

Background:

Mid-term results following surgical hip dislocation (SHD) for healed slipped capital femoral epiphysis (SCFE) and Perthes-related deformities are limited. This study aimed to characterize patient-reported outcome measures [including rates of achieving the minimal clinically important difference (MCID) and patient-acceptable symptomatic state (PASS)], report survivorship free from conversion to arthroplasty, and identify risk factors associated with composite failure.

Methods:

Twenty-seven patients (n=13 SCFE, n=14 Perthes) with minimum 2-year follow-up (mean 5.7 y) who underwent primary SHD from 2011 to 2021 were retrospectively reviewed. Modified Harris Hip Score (mHHS) and International Hip Outcome Tool-12 (iHOT-12) were collected preoperatively and at the latest follow-up. Composite failure was defined as not meeting any MCID/PASS threshold or conversion to arthroplasty. Continuous variables were analyzed using independent-sample t tests or the Wilcoxon Mann-Whitney test, where appropriate. Categorical variables were analyzed using χ2 or Fisher exact test, as indicated. Kaplan-Meier survivorship was determined.

Results:

Mean mHHS improved from 56.2 to 77.2 (P=0.003) and from 63.0 to 86.3 (P<0.001), while iHOT-12 improved from 36.1 to 64.7 (P=0.008) and 36.8 to 77.2 (P<0.001) in SCFE and Perthes cohorts, respectively. MCID achievement for mHHS and iHOT-12 were 85.7% and 75.0% among SCFE, compared with 83.3% and 81.8% in Perthes. The proportion meeting PASS for mHHS and iHOT-12 was 30% for both in SCFE, compared with 61.5% and 83.3% in Perthes. 5- and 10-year survivorship free of conversion to arthroplasty was 100% and 80%, as well as 93% and 77% in the SCFE and Perthes cohorts, respectively.

Conclusions:

At mid-term follow-up, patients undergoing SHD for residual deformities related to chronic SCFE and Perthes demonstrated significant improvements in mHHS and iHOT-12, as well as relatively high rates of meeting MCID. SHD is an effective approach providing pain and functional benefit. Preoperative expectations, though, should be tempered in these cohorts, as some pre-existing damage limits the ability to completely normalize anatomy.

Level of Evidence:

Level III, retrospective comparative study.
Association of remimazolam with delirium and cognitive function
Authors: Arias Jaime Andres , Wegner Gustavo Roberto Minetto , Wegner Bruno Francisco Minetto , Silva Larissa Santos , Bezerra Francisco José Lucena , Filardi Rafaela Goes Machado
Published: December 2024

BACKGROUND AND STUDY OBJECTIVE

Delirium is an organic mental syndrome significantly associated with long-term cognitive decline, increased hospital stays and higher mortality. This systematic review of randomised controlled trials (RCTs) with meta-analysis assesses the association of remimazolam with postoperative cognitive function and delirium compared with non-benzodiazepine hypnotics.

DESIGN

Systematic review of RCTs with meta-analysis.

DATA SOURCES

PubMed, Embase, Cochrane Library and Web of Science databases up to 27 April 2024.

ELIGIBILITY CRITERIA

Adult patients undergoing general anaesthesia or sedation procedures; use of remimazolam as the primary hypnotic or as an adjunct, administered via intermittent bolus or continuous infusion; comparison with other hypnotics or sedatives; evaluation of cognitive function or delirium.

MAIN RESULTS

Twenty-three RCTs with 3598 patients were included. The incidence of delirium was not significantly different between remimazolam and other sedatives in general anaesthesia and sedation procedures [n = 3261; odds ratio (OR) = 1.2, 95% confidence interval (CI), 0.76 to 1.91; P = 0.378843; I
2 = 17%]. Regarding cognitive function evaluation, remimazolam showed no difference compared with the control group in Mini-Mental State Examination (MMSE) scores on the first postoperative day (n = 263; mean difference = 0.60, 95% CI, −1.46 to 2.66; P = 0.5684; I
2 = 90%) or on the third postoperative day (n = 163; mean difference  = 1.33, 95% CI, −0.72 to 3.38; P = 0.2028; I
2 = 93%). Remimazolam exhibited superiority over the control group in MMSE scores on the seventh postoperative day (n = 247; mean difference = 0.53, 95% CI, 0.30 to 0.75; P < 0.0001; I
2 = 28%).

CONCLUSION

Remimazolam does not increase the incidence of delirium or cognitive impairments compared with non-benzodiazepine hypnotics. However, the analysis showed that the type of surgery significantly influenced the incidence of delirium. Additionally, remimazolam was associated with better short-term postoperative cognitive function.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42024532751.
Successful arm replantation using traditional surgical techniques: a case report from a low-resource country
Authors: Abubakir Malaka , Sabbagh Lana , Khalil Ghaiyath , Al Ali Shahama , Tfankji Salim , Alkanj Hussein
Published: December 2024

Introduction:

Upper limb replantation requires rapid intervention by a multidisciplinary team and appropriate equipment to rescue the limb. Note that the success of the operation and the decision to perform it depend on several factors. This case report presents an upper limb replantation performed using traditional surgical techniques.

Case presentation:

A 12-year-old boy presented to our hospital with a crushing injury to the right upper arm, which was amputated at the lower third of the humerus, with the biceps brachii tendon remaining intact. The first aid included resuscitation and intravenous fluid administration to maintain hemodynamic stability. The surgeons replanted the arm by immobilizing the fracture with Kirschner wires, performing several arterial and venous anastomoses, and suturing the damaged nerve and muscle aponeurosis in a 3-h operation. The patient was discharged after 5 days without any complications but was recommended to undergo physical therapy to regain his arm movement and is currently undergoing monthly follow-ups to ensure the required improvement.

Discussion:

Upper limb replantation is a complicated process that enables the conservation of arm function and appearance. This requires rapid intervention by a multidisciplinary team. Additionally, advanced equipment, such as microsurgical tools, provides greater success and ease of revascularization.

Conclusion:

To successfully re-implant an amputated limb, several factors must be considered: surgeon experience, availability of necessary equipment, and provision of post-operative care. Despite lacking advanced tools, surgeons can rely on their surgical skills to overcome this challenge.
Circular RNAs: history, metabolism, mechanisms of function, and regulatory roles at a glance
Authors: Karimi Roqaye , Javandoost Ehsan , Asadmasjedi Nooshin , Atashi Amir , Soleimani Alireza , Behzadifard Mahin
Published: December 2024

Circular RNAs (circRNAs) are non-coding RNA (ncRNA) molecules that, due to their covalent ring structure and lack of free ends, have a very high intracellular stability compared to their linear counterparts. In general, circRNAs are expressed in mammalian cells and exhibit tissue/cell-specific expression patterns. Mounting evidence is indicative that circRNAs regulate a variety of cellular processes by acting as miRNA sponges, transcriptional regulators, protein sponges, molecular scaffolds, and protein/peptide translators. The emergence of the biological functions of circRNAs has brought a novel outlook to our better understanding of cellular physiology and disease pathogenesis. CircRNAs have also been shown to play a critical role in the occurrence, development and progression of cancers. Their participation in the pathophysiology of various diseases including cardiovascular diseases, diabetes and neurological disorders is very important. Such characteristics have led to more studies investigating circRNAs as promising tools in molecular medicine and targeted therapy.
Acute ischemic stroke revealing an internal carotid artery dissection in a 12-year-old child: case report and literature review
Authors: Chahboun Bouchra , Mekkaoui Ikram , Kaba Ousmane , Zoubaa Yassmine , Laaribi Ilias , Bkiyar Houssam , Housni Brahim
Published: December 2024

Introduction and importance:

Internal carotid artery (ICA) dissection is a known cause of stroke but is often underdiagnosed in pediatric patients. Pediatric ischemic stroke significantly contributes to juvenile brain injury. Currently, there are no universally accepted guidelines for managing stroke in children.

Case Presentation:

We report the case of a 12-year-old girl who was admitted with sudden left hemiplegia and aphasia. Imaging revealed right carotid artery dissection and ischemic stroke in the right middle cerebral artery territory. She was managed with aspirin (75 mg/day) and enoxaparin (3000 IU/12 h) and remains under observation with persistent symptoms.

Clinical discussion:

This case highlights the difficulty in diagnosing ICA dissections in pediatric patients and the lack of clear guidelines for their management. The use of aspirin and enoxaparin represents an empirically-based therapeutic approach, underscoring the urgent need for further research to better understand the risk factors and pathogenic mechanisms of this condition. The persistence of symptoms in our patient also emphasizes the importance of close monitoring and individualized management.

Conclusion:

ICA dissection in pediatric stroke is hard to diagnose and treat. Research, empirically-based treatments, and personalized monitoring are crucial for better management and outcomes.
Febrile neutropenia in an immunocompetent patient with brucellosis: a case report and literature review
Authors: Khan Fasih Mand , Khan Ariba , Raja Sandesh , Raja Adarsh , Qammar Asfia , Chaulagain Aayush
Published: December 2024

Introduction and importance:

Brucellosis is a zoonotic disease that can affect various organs, with symptoms like fever, lymphadenopathy, and arthritis. Hematologic complications, including febrile neutropenia, are rare. This report highlights the diagnostic and therapeutic challenges of brucellosis with febrile neutropenia.

Case presentation:

A 36-year-old man presented with a 3-week history of fever, polyarthralgia, and night sweats. Examination showed febrile symptoms, joint swelling, and cervical lymphadenopathy. Laboratory tests revealed neutropenia and elevated inflammatory markers. Imaging was unremarkable, and blood cultures were negative, but brucellosis was confirmed by serology. Treatment with doxycycline and rifampicin led to clinical improvement.

Clinical discussion:

Brucellosis diagnosis can be challenging due to nonspecific symptoms and requires high suspicion, especially in non-endemic areas. In this case, early identification and targeted therapy led to symptom resolution. This case underlines the importance of considering zoonotic diseases in febrile neutropenia with inconclusive initial findings.

Conclusion:

Brucellosis with febrile neutropenia is rare but manageable with timely diagnosis and treatment, leading to favorable outcomes.
Connecting consultants with primary healthcare doctors in remote areas, mountains, and islands through available technology
Authors: Moshi Jobran M. , Jarabi Yahya Ali , Moafa Hassan N. , Bajobier Amal Mohammed Ahmed , Gadri Mouafeq Abdullah Yehya , Aldarwish Mohamad Saria , Salhabi Yahya Ahmed , Alkhairat Nabeel Mohammed , Heanbass Sameer Nasser
Published: December 2024

Telehealth has emerged as a pivotal tool in bridging the gap between consultants and primary healthcare physicians, particularly in remote, mountainous, and island regions. This paper discusses the innovative NARAKOM project, which leverages available technology to facilitate this connection. The project aims to enhance healthcare service delivery, ensure general practitioners’ continuous education, and improve patient outcomes in underserved areas. The project provides the confidentiality and effectiveness of medical consultations by employing mobile phones, phone calls, and the WhatsApp social networking program. Initial implementation in the Jazan region has shown promising results, and the project is poised for expansion across Saudi Arabia.
Transient olfactory hallucinations after insular glioma surgery: a case report
Authors: Mamadaliev Dilshod , Kariev Gayrat , Asadullaev Ulugbek , Yakubov Jakhongir , Khodjimetov D.N. , Chaurasia Bipin
Published: December 2024

Introduction and importance:

There are various types of hallucinations reported in the literature (auditory, visual, tactile, gustatory, or olfactory), and most of them are related to psychiatric (schizophrenia) disorders. Olfactory hallucinations related to neurosurgical disorders are uncommon. The authors present a case of a patient with a left insular glioma who developed transient olfactory hallucinations after microsurgical resection of the tumor.

Our Objective is to share a rare case of postoperative complication—olfactory hallucination following insular glioma surgery—which can potentially raise awareness among practicing neurosurgeons.

Case presentation:

A 32-year-old male patient underwent left insular glioma resection at our institution in 2024. He developed transient olfactory hallucinations after microsurgical resection of the tumor, which resolved within a month postoperatively.

Clinical discussion:

Insular gliomas often grow to a considerable size before becoming symptomatic in many patients. The insular region is regarded as one of the brain’s most sophisticated areas, with lesions manifesting in a wide range of symptoms and syndromes including olfactory hallucinations.

Conclusion:

Olfactory hallucinations following left insular glioma resection can potentially raise awareness among practicing neurosurgeons regarding this rare postoperative complication. These types of postoperative complications may resolve in a short period if no serious vascular injury has been encountered.
Mycetoma in Somalia: an updated literature review
Authors: Mohamed Ahmed Farah , Saeed Ali Awadallah , Mohamoud Mohamed Ali , Jama Abdisamad Ahmed , Fahal Ahmed Hassan
Published: December 2024

Introduction:

Mycetoma is a chronic disabling inflammatory disease characterized by the formation of granulomatous masses in subcutaneous tissue extending to the skin, deep tissues, and bones.

Findings:

An exhaustive and detailed exploration of medical literature unveiled only 11 published articles addressing mycetoma in Somalia since 1927. Among these, six were case reports involving 12 patients, and three were case series encompassing 163 patients, resulting in a total of 175 reported cases. Notably, two articles in French lacking abstracts were excluded from the review. Considering Somalia shares geographical and environmental traits with other mycetoma-endemic regions, a heightened prevalence of the disease is anticipated in the country. It is essential to recognize, however, that mycetoma is not a notifiable disease, and the accuracy of disease reporting in Somalia is compromised due to various factors and consequently, the actual number of mycetoma cases in Somalia is likely to surpass the figures presented in this report.

Conclusion:

Ongoing research, international collaboration, and efforts to improve healthcare accessibility and awareness are essential. Encourage country to make mycetoma a notifiable disease with the integration of data collection in the national health information system. Addressing the environmental determinants, describe true burden, disability, impact of quality life, and implementing preventive measures can contribute to mitigating the impact of mycetoma in Somalia.
Advances in diabetic cardiomyopathy: current and potential management strategies and emerging biomarkers
Authors: Hassooni Furqan Ridha Hassooni , Aljubori Eathar , Abbas Ghadeer Mohammed Abbas , Dheyab Athraa Yaseen Dheyab , Abdulatif Mohammed Qutaiba Abdulatif , Sadeq Sadeq Maram A. , Budair Ahmed , Alturshan Ali , Enad Ayat Hussein , Mohammed Asmaa Jasim , Hassan Ghadeer Ali , Yaqoob Zinah Qasim Yaqoob , Prajjwal Priyadarshi , Jain Hritvik , Goyal Aman , Amir Omniat
Published: December 2024

Background:

Diabetic cardiomyopathy (DCM) is a significant complication of diabetes mellitus (DM) and a major contributor to heart failure (HF). Despite its prevalence and impact, there is a notable lack of targeted therapies, highlighting the need for ongoing research into novel treatment strategies. Current management primarily involves blood sugar control, lifestyle modifications, and addressing risk factors. Conventional treatments, including Renin-angiotensin-aldosterone system (RAAS) inhibitors, angiotensin receptor/neprilysin inhibitor, beta-blockers, ivabradine, and vericiguat, are also employed.

Methodology:

A comprehensive search was made using PubMed, Scopus, and Google Scholar for studies published. The search focused on DCM, therapeutic strategies, and emerging biomarkers. Articles were selected based on relevance, study quality, and inclusion criteria, which emphasized peer-reviewed studies on DCM management and biomarker identification.

Results and discussion:

Our review reveals that targeting oxidative stress through these antioxidant therapies offers a promising approach for limiting DCM progression. Clinical trials provide evidence supporting the efficacy of these agents in reducing oxidative damage and improving cardiac function in diabetes-induced cardiomyopathy.

Conclusion:

The current landscape of DCM management highlights the need for novel therapeutic strategies and early detection methods. Antioxidant therapies show potential for addressing the oxidative stress that underlies DCM, and ongoing research into emerging biomarkers may offer new avenues for early diagnosis and treatment.
Diagnostic challenges and management of kikuchi-fujimoto disease: a rare case report
Authors: Motwani Jatin , Kumar Ameet , Azhar Laiba , Qureshi Ayaan Ahmed , Fatima Zukhruf , Khalid Saif , Kumari Verkha , Mahmud Nishat Syeed
Published: December 2024

Introduction:

Kikuchi-Fujimoto disease, otherwise referred to as histiocytic necrotizing lymphadenitis, is a rare and self-limiting disorder characterized by fever, lymphadenopathy, and upper respiratory symptoms. The main target of the illness is young Asian adults and is more prevalent in females. This disease probably has viral triggering or autoimmune responses, and diagnosis depends on histopathological examination.

Case Presentation:

We present a case of an 18-month history of recurrent high-grade fever with marked weight loss and an enlarged occipital lymph node in a 42-year-old diabetic male from Karachi, Pakistan. The patient’s symptoms did not subside despite being hospitalized several times and receiving multiple courses of antibiotics. Physical examination revealed a firm, non-tender occipital lymph node. Laboratory studies showed mild anemia and leukopenia, raised inflammatory markers, but unremarkable imaging studies and autoimmune tests. An excisional biopsy of the lymph node confirmed KFD with necrotizing lymphadenitis showing characteristic karyorrhectic debris.

Discussion:

This case epitomizes the diagnostic challenges of KFD, which can mimic a host of conditions like tuberculosis and lymphoma. The recurrent fevers in the presence of significant weight loss and failure to respond to the usual treatments raised suspicion for further detailed investigation. Excisional biopsy established the diagnosis and differentiated it from other conditions. The patient’s rapid improvement with corticosteroid therapy aligns with established treatment protocols for KFD, thus proving its efficacy.

Conclusion:

KFD should be included in the differential diagnosis of fever of unknown origin. Diagnosis and management of KFD can avoid misdiagnosis and hence improve patient outcomes.