bluuebunny/crossref_metadata_2025 huggingface dataset:
Quiet wakefulness: the influence of intraperitoneal and intranasal oxytocin on sleep–wake behavior and neurophysiology in rats
Authors: Raymond Joel S , Everett Nicholas A , Gururajan Anand , Bowen Michael T
Published: April 2023

Study Objectives

Exogenous administration of the neuropeptide oxytocin exerts diverse effects on various neurobehavioral processes, including sleep and wakefulness. Since oxytocin can enhance attention to social and fear-related environmental cues, it should promote arousal and wakefulness. However, as oxytocin can attenuate stress, reduce activity, and elicit anxiolysis, oxytocin might also prime the brain for rest, and promote sleep. At present, little research has comprehensively characterized the neuropsychopharmacology of oxytocin-induced effects on sleep–wake behavior and no reconciliation of these two competing hypotheses has been proposed.

Methods

This study explored the effects of oxytocin on sleep–wake outcomes using radiotelemetry-based polysomnography in adult male and female Wistar rats. Oxytocin was administered via intraperitoneal (i.p.; 0.1, 0.3 and 1 mg·kg−1) and intranasal (i.n.; 0.06, 1, 3 mg·kg−1) routes. Caffeine (i.p. and i.n.; 10 mg·kg−1) was administered as a wake-promoting positive control. To ascertain mechanism of action, pretreatment experiments with the oxytocin receptor (OXTR) antagonist L-368,899 (i.p.; 5 mg·kg−1) followed by oxytocin (i.p.; 1 mg·kg−1) were also conducted.

Results

In both male and female rats, i.p. oxytocin promoted quiet wakefulness at the cost of suppressing active wakefulness, non-rapid eye movement (NREM) and rapid eye movement (REM) sleep. Several i.p. oxytocin-induced sleep–wake effects were mediated by OXTR binding. In contrast, i.n. oxytocin did not alter most sleep–wake outcomes at any dose tested. Both i.p. and i.n. caffeine demonstrated wake-promoting effects.

Conclusions

These findings help reconcile competing hypotheses of oxytocin-induced effects on sleep–wake behavior: i.p. oxytocin promotes quiet wakefulness—a state of restful environmental awareness compatible with both oxytocin’s anxiolytic effects and its enhancement of processing complex stimuli.
Patterns of physical, chemical, and metabolic characteristics of sugar maple leaves with depth in the crown and in response to nitrogen and phosphorus addition
Authors: Young Alexander R , Minocha Rakesh , Long Stephanie , Drake John E , Yanai Ruth D
Published: April 2023

Few previous studies have described the patterns of leaf characteristics in response to nutrient availability and depth in the crown. Sugar maple has been studied for both sensitivity to light, as a shade-tolerant species, and sensitivity to soil nutrient availability, as a species in decline due to acid rain. To explore leaf characteristics from the top to bottom of the canopy, we collected leaves along a vertical gradient within mature sugar maple crowns in a full-factorial nitrogen (N) by phosphorus (P) addition experiment in three forest stands in central New Hampshire, USA. Thirty-two of the 44 leaf characteristics had significant relationships with depth in the crown, with the effect of depth in the crown strongest for leaf area, photosynthetic pigments and polyamines. Nitrogen addition had a strong impact on the concentration of foliar N, chlorophyll, carotenoids, alanine and glutamate. For several other elements and amino acids, N addition changed patterns with depth in the crown. Phosphorus addition increased foliar P and boron (B); it also caused a steeper increase of P and B with depth in the crown. Since most of these leaf characteristics play a direct or indirect role in photosynthesis, metabolic regulation or cell division, studies that ignore the vertical gradient may not accurately represent whole-canopy performance.
Less common than expected: late displacement after minimally displaced pediatric lateral condyle fractures of the elbow
Authors: Burkhart Robert J. , Kolin David A. , Fabricant Peter D. , Liu Raymond W. , Mistovich R. Justin
Published: April 2023

The incidence of late displacement among pediatric lateral condyle fractures has been described as 1.3–26%. However, prior studies are limited by small cohort sizes. The aim of this study was to determine the rate of late displacement and delayed union among lateral condyle fractures following immobilization in a large cohort and to establish additional radiographic criteria to help surgeons choose between immobilization and operative fixation for minimally displaced fractures. We performed a dual-center retrospective study of patients with lateral condyle fractures between 1999 and 2020. Patient demographics, injury mechanism, time to orthopedic presentation, duration of cast immobilization, and complications following casting were recorded. There were 290 patients with lateral condyle fractures included. The initial management in 61% of patients (178/290) was nonoperative, of which four had delayed displacement at follow-up and two developed delayed union requiring surgery (failure in 6/178, 3.4%). The mean displacement on the anteroposterior view was 1.3 ± 1.1 mm and the lateral view was 0.50 ± 1.0 mm in the nonoperative cohort. In the operative cohort, the mean displacement on AP was 6.6 ± 5.4 mm and the lateral view was 5.3 ± 4.1 mm. Our analysis found the rate of late displacement in patients treated with immobilization was lower than previously reported (2.5%; 4/178). The mean displacement on the lateral film in the cast immobilization cohort was 0.5 mm, suggesting that necessitating near anatomic alignment on the lateral film to consider nonoperative management may lead to a lower incidence of late displacement than previously reported. Level of evidence: Level III, retrospective comparative study.
Long-term Morbidity in Patients After Surgical Correction of Adult Spinal Deformity
Authors: Imbo Bailey , Williamson Tyler , Joujon-Roche Rachel , Krol Oscar , Tretiakov Peter , Ahmad Salman , Bennett-Caso Claudia , Schoenfeld Andrew J. , Dinizo Michael , De La Garza-Ramos Rafael , Janjua M. Burhan , Vira Shaleen , Ihejirika-Lomedico Rivka , Raman Tina , O’Connell Brooke , Maglaras Constance , Paulino Carl , Diebo Bassel , Lafage Renaud , Lafage Virginie , Passias Peter G.
Published: April 2023

Study Design.

Retrospective.

Objective.

The objective of this study is to describe the rate of postoperative morbidity before and after two-year (2Y) follow-up for patients undergoing surgical correction of adult spinal deformity (ASD).

Summary of Background Data.

Advances in modern surgical techniques for deformity surgery have shown promising short-term clinical results. However, the permanence of radiographic correction, mechanical complications, and revision surgery in ASD surgery remains a clinical challenge. Little information exists on the incidence of long-term morbidity beyond the acute postoperative window.

Methods.

ASD patients with complete baseline and five-year (5Y) health-related quality of life and radiographic data were included. The rates of adverse events, including proximal junctional kyphosis (PJK), proximal junctional failure (PJF), and reoperations up to 5Y were documented. Primary and revision surgeries were compared. We used logistic regression analysis to adjust for demographic and surgical confounders.

Results.

Of 118 patients eligible for 5Y follow-up, 99(83.9%) had complete follow-up data. The majority were female (83%), mean age 54.1 years and 10.4 levels fused and 14 undergoing three-column osteotomy. Thirty-three patients had a prior fusion and 66 were primary cases. By 5Y postop, the cohort had an adverse event rate of 70.7% with 25 (25.3%) sustaining a major complication and 26 (26.3%) receiving reoperation. Thirty-eight (38.4%) developed PJK by 5Y and 3 (4.0%) developed PJF. The cohort had a significantly higher rate of complications (63.6% vs. 19.2%), PJK (34.3% vs. 4.0%), and reoperations (21.2% vs. 5.1%) before 2Y, all P<0.01. The most common complications beyond 2Y were mechanical complications.

Conclusions.

Although the incidence of adverse events was high before 2Y, there was a substantial reduction in longer follow-up indicating complications after 2Y are less common. Complications beyond 2Y consisted mostly of mechanical issues.
Two is company, is three a crowd? Triplet therapy, novel molecular targets, and updates on the management of advanced renal cell carcinoma
Authors: Goodstein Taylor , Yang Yuanquan , Runcie Karie , Srinivasan Ramaprasad , Singer Eric A.
Published: April 2023

Purpose of review

The purpose of this review is to highlight the most recent changes in the management of advanced renal cell carcinoma, a complicated and ever-changing field of research.

Recent findings

A recent meta-analysis examining combination therapy favors nivolumab plus cabozantinib as the overall survival leader in doublet therapy. Initial results on the first ever trial of triplet therapy have demonstrated improved progression-free survival over current standard of care. The hypoxia-inducible factor-2α (HIF-2α) inhibitor belzutifan is FDA approved for patients with von Hippel-Lindau disease and is currently being investigated in patients with nonhereditary renal cell carcinoma. The new glutamate synthesis inhibitor, telaglenastat, perhaps confers synergistic benefit when combined with everolimus, but combination with cabozantinib was not so effective. Dual mammalian target of rapamycin (mTOR) inhibition with sapanisertib does not appear to be an effective therapeutic option. New biomarkers and targets are actively being investigated. Four recent trials examining alternative agents to pembrolizumab in the adjuvant setting did not demonstrate an improvement in recurrence-free survival. Cytoreductive nephrectomy in the combination therapy era is supported by retrospective data; clinical trials are recruiting patients.

The last year ushered in novel approaches of varying success for managing advanced renal cell carcinoma, including triplet therapy, HIF-2α inhibitors, metabolic pathway inhibitors, and dual mTOR inhibitors. Pembrolizumab remains the only modern therapy available in the adjuvant setting, and the waters surrounding cytoreductive nephrectomy are still murky.
What Is the Efficacy of Intra-articular Injections in the Treatment of Ankle Osteoarthritis? A Systematic Review
Authors: Paget Liam D. A. , Mokkenstorm Milo J. , Tol Johannes L. , Kerkhoffs Gino M. M. J. , Reurink Gustaaf
Published: April 2023

Background

Ankle osteoarthritis (OA) is painful and can impact a patient’s physical and mental quality of life. Although intra-articular injections are commonly used to alleviate symptoms, there is conflicting evidence concerning their efficacy. Therefore, an updated systematic review would be informative.

Question/purpose

In this systematic review, we asked: Are there clinically important benefits or harms associated with the use of intra-articular injections in the treatment of ankle OA?

Methods

We used PubMed, Embase, and the Cochrane Library to search for randomized controlled trials on intra-articular injections for the treatment of ankle OA in June 2021, and updated the search in January 2022; eligible dates were from the date of inception of each database through January 2022. Reference lists of eligible studies and previous reviews were manually screened. Two reviewers independently assessed studies for eligibility. We included seven studies. Three compared hyaluronic acid (HA) with saline, one compared HA with exercise, one compared four different regimens of HA [34], one compared platelet-rich plasma (PRP) with saline, and one compared botulinum toxin Type A (BoNT-A) with HA. A total of 340 patients were included: 141 in the HA arms, 48 in the PRP arm, 38 in the BoNT-A arm, and 113 in the saline arms. Across all studies, the mean age was 52 ± 21 years, and 35% were women (119 of 340 patients). Methodologic quality was assessed using the Cochrane Risk of Bias 2.0 tool. Of the included studies, the risk of bias was low in two studies, presented some concerns in one study, and was high in four studies. According to the Grading of Recommendations Assessment, Development, and Evaluation methodology, the level of evidence was very low for HA, moderate for PRP, and very low for BoNT-A. The level of heterogeneity was high, and we opted to perform a systematic review rather than a meta-analysis. A clinically relevant difference was based on whether the between-group difference surpassed the cutoff point determined as the minimum clinically important difference.

Results

No clinically relevant differences were found among HA, PRP, and BoNT-A and their control groups at 3, 6, or 12 months. No studies reported any serious adverse events in any treatment group.

Conclusion

Given the lack of observed efficacy in this systematic review, these treatments should not be used in practice until or unless future high-quality studies find evidence of efficacy.

Level of Evidence

Level III, therapeutic study.
Embryonic arrest: causes and implications
Authors: Sahin Gizem N. , Yildirim Raziye M. , Seli Emre
Published: April 2023

Purpose of review

Embryonic arrest is a key determinant of the number of euploid blastocysts obtained after IVF. Here, we review factors that are implicated in the developmental arrest of preimplantation embryos and their relevance for assisted reproduction outcomes.

Recent findings

Among the treatment options available to infertile women, IVF is the one associated with most favorable outcomes. The cumulative pregnancy rates in women undergoing IVF are determined by aneuploidy rate (age), ovarian response to stimulation (ovarian reserve), and the rate of embryo developmental arrest. Mutations in maternal effect genes, especially those encoding for subcortical maternal complex, have been implicated in human embryo developmental arrest. In addition, perturbation of biological processes, such as mitochondrial unfolded protein response and long noncoding RNA regulatory pathways, may play a role. However, how each of these factors contributes to embryos’ arrest in different cohorts and age groups has not been determined.

Arrest of human embryos during preimplantation development is a common occurrence and is partly responsible for the limited number of euploid blastocysts obtained in assisted reproduction cycles. Although genetic and metabolic causes have been implicated, the mechanisms responsible for human embryo developmental arrest remain poorly characterized.
Polypharmacy Among Patients With Major Depressive Disorder and Co-occurring Substance Use Disorders in a Psychiatric Hospital Setting
Authors: Benz Madeline B. , Epstein-Lubow Gary , Weinstock Lauren M. , Gaudiano Brandon A.
Published: April 2023

Background

Major depressive disorder (MDD) is common among patients admitted to a psychiatric hospital who frequently present with comorbid conditions such as substance use disorders (up to 50%). Polypharmacy (ie, being prescribed 3 or more medications) may be relatively common in dual-diagnosis patients. This study sought to examine prevalence and risk factors associated with psychotropic polypharmacy in hospitalized patients with MDD and co-occurring SUDs.

Methods

An electronic chart review was conducted with 1315 individuals admitted to a psychiatric hospital; 505 (38.4%) were identified as having co-occurring MDD + SUD. We examined psychotropic polypharmacy and clinical severity to explore risk for concerning drug interactions.

Results

Potentially problematic polypharmacy patterns were identified among those with MDD + SUD and were related to negative clinical outcomes, particularly in terms of increased sedation potential for individuals with an opioid use disorder (OUD). Groups at the highest risk for polypharmacy included patients who were female, older in age, lower in functioning, and presenting with a co-occurring OUD. Having an OUD was associated with particularly risky polypharmacy combinations, while having a cannabis use disorder was associated with the least polypharmacy.

Conclusions

Results highlight a high prevalence of polypharmacy among a group that has an elevated risk for negative outcomes. There is a continued need to improve identification of complex patient presentations and adjust medications in a hospital setting to improve treatment outcomes and reduce future mortality.
Delays in Care During the COVID-19 Pandemic in the Veterans Health Administration
Authors: Mills Peter , Louis Robin Pendley , Yackel Edward
Published: April 2023

Objectives:

The purpose of this study was to review patient safety reports in the Veterans Health Administration (VHA) related to delays during an 11-month period that included months of the COVID-19 pandemic.

Design:

A retrospective descriptive analysis of COVID-19 patient safety reports related to delays that were submitted in the Joint Patient Safety Event Reporting System database to the VHA National Center of Patient Safety from January 01, 2020 to November 15, 2020 was conducted. There were 897 COVID-19 patient safety events related to delays; 200 cases were randomly selected for analysis, with 148 meeting inclusion criteria.

Results:

The results showed delays in laboratory results, level of care, treatment and interventional procedures, specific aspects of care, radiology treatment, and diagnosis. Causes for delays included poor communication between staff, problems in getting laboratory results, confusion over policy, and misunderstanding of COVID-19–specific rules.

Conclusions:

Healthcare delays can be reduced during a pandemic by proactively standardizing medical processes/procedures when testing for infection, improving staff to staff communication teaching the SBAR (situation, background, assessment, and recommendations) communication model, and using simulation to identify latent safety issues and educating medical personnel on new protocols related to the pandemic. Simulation can be used to test new protocols developed during the pandemic.
The prognostic role of whole-body volumetric 68GA-DOTATATE PET/computed tomography parameters in patients with gastroenteropancreatic neuroendocrine tumor treated with 177LU-DOTATATE
Authors: Kepenek Ferat , Kömek Halil , Can Canan , Kaplan İhsan , Altindağ Serdar , Gündoğan Cihan
Published: April 2023

Objective

The aim of this study is to evaluate the prognostic role of Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 and quantitative 68Ga-DOTATATE PET/computed tomography parameters such as maximum standardized uptake value (SUVmax), mean SUV (SUVmean), DOTATATE tumor volume (DTV), total lesion DOTATATE (TLD) in patients with gastroenteropancreatic neuroendocrine tumors (GEP-NETs) treated with 177Lu-DOTATATE.

Material and method

Our retrospective study included 21 patients with GEP-NETs treated with 177Lu-DOTATATE between January 2017 and January 2022. SUVmax, SUVmean, SUVmax/spleenSUVmax (SUVmax/Sx), DTV, TLD, SUVmean/spleenSUVmean (SUVmean/Sm), TLD/Sm values were calculated and recorded for all patients before and after 177Lu-DOTATATE treatment.

Results

A total of 319 metastases were detected in the patients included in the study, and a total of 68 target lesions were selected. In univariant Cox regression analysis, TLD/Sm percent change (∆TLD/Sm) was found to be statistically significant on overall survival (OS) (P = 0.044). The 3-year survival in nonresponders was 50% (P = 0.034) based on ∆SUVmax/Sx values, 50% (P = 0.002) based on RECIST values, 50% based on ∆TDTV + new lesion values (P = 0.033), and according to ∆TTLD + new lesion values, it was 66% (P = 0.030).

Conclusion

In our study, we showed that SUVmax/Sx, RECIST, ∆TDTV + new lesion, and ∆TTLD + new lesion parameters can predict OS in the evaluation of response to treatment.
Nontraumatic spontaneous bilateral intracerebral haemorrhage in a young patient: a rare case report
Authors: Yadav Pramodman Singh , Panthi Sagar , Neupane Aakash , Uprety Manish , Acharya Rochana , Shah Leeza , Ansari Ajmat , Basnet Ujjwal , Bhattarai Raksha , Khanal Bhawani
Published: April 2023

Introduction and importance:

Spontaneous bilateral intracerebral haemorrhage is a rare surgical occurrence, especially in young populations with poor prognosis. Hypertension is the leading cause but vascular malformations, infections and rare genetic conditions are also responsible.

Case presentation:

Twenty-three-year-old male with no prior comorbidities presented to emergency with sudden onset loss of consciousness and 1 episode of seizure. No history of intoxication or trauma was given. Glasgow Coma Scale at presentation was E1V2M2. CT scan head revealed bilateral basal ganglia haematoma along intraventricular haemorrhage.

Clinical discussion:

The patient was managed conservatively in the Neurosurgical Intensive care unit. Supportive management was provided. The patient’s motor response was improving and a repeat CT scan showed a resolving haematoma. However, due to poor economic conditions, the patient party left against medical advice.

Conclusion:

Spontaneous bilateral basal ganglia haemorrhage is a rare surgical emergency with no clear consensus on a management approach. This case highlights the importance of undiagnosed hypertension in causing intracerebral haemorrhage in poor economic groups.
Intra thecal baclofen pump as an ad hoc measure for a case of severe tardive dystonia refractory to multiple lesioning
Authors: Kayastha Jessica , Shrestha Resha , Shrestha Bishal , Gurung Pritam , Dabadi Sambardhan , Dhungel Raju Raj , Pant Basant
Published: April 2023

Introduction and Importance:

Tardive dystonia is an infrequent ailment in patient reliant with chronic antipsychotic medication. The front-line envoy in the treatment of this illness is set into motion with oral agents including baclofen, benzodiazepines, and other antispasmodics. Regardless of an extensive therapy, the patients are not able to control of their spasticity/ dystonia. The authors reported a case of severe tardive dystonia treated with baclofen therapy in a patient frigid to medical therapy and multiple lesioning.

Case Report:

A 31-year-old female, diagnosed as a case of depressive illness and being managed with neuroleptic medications, who went onto develop tardive dystonia progressively worsening over a 4-year duration. After a comprehensive and meticulous evaluation of her neurological and psychological stratum, globus pallidus interna lesioning was reputed as the best course of action. As intended, staged lesioning was executed bilaterally with a trivial resolution eventually succumbing into recurrence, compelling a repeat lesioning. It was inaptly discouraging to see her crippled with the plight. Determined, not to give upon her, a way out with a baclofen therapy was proposed. A test dose with a 100 mcg of baclofen with an increment up to 150 mcg over a 3-day period demonstrated a promising prospect. On that account, the insertion of the baclofen pump was performed with an outstanding aftermath in her neurological endeavor.

Clinical Discussion:

Tardive dystonia is believed to be caused by striatal dopamine receptor super-sensitivity persuaded by the dopamine-antagonizing action of antipsychotic drugs. The first line of treatment being oral agents including oral baclofen, benzodiazepines, and antispasmodics. If the patient suffers from an early-onset primary generalized dystonia, then treatment with deep brain stimulation of the globus pallidus interna is the approved and preferred treatment approach. Recurrence of the symptoms despite of multiple lesioning can be overcome by intrathecal baclofen pump infusion as stated by many research. It is not uncommon to face complications in such a procedure, but the benefits outreach the risk, which makes it a choice of treatment.

Conclusion:

The use of a continuous intrathecal baclofen pump for cases with tardive dystonia refractory to conventional therapy, it has been approved as one of the safest and capable procedures.
Ectopic liver tissue adherent to the gallbladder serosa: two cases report from Syria
Authors: Hussein Al-janabi Moatasem , Kenaan Nour Ibrahim , Sulaiman Sara Houssam , Ibrahim Jana Ahmad , Saoud Nour abd allatif , Kannan Samir , Issa Younes , Ahmad Issa , Salloum Rabab
Published: April 2023

Introduction and importance:

Ectopic liver tissue is an exceedingly rare anomaly in which the hepatic tissue is present extrahepatic site and has no connection to the true liver. Most cases of ectopic liver tissue were asymptomatic and discovered by an accident during abdominal surgery or autopsy.

Case presentation:

Case 1 involved a 52-year-old man who was admitted to the hospital due to an abdominal grip in the right hypochondrium and epigastrium for 1 month. The patient underwent laparoscopic cholecystectomy. During the gross examination, a well-circumscribed brownish nodule with a smooth outer surface, located at the fundus region was found. Case 2 involved a 40-year-old man with 2 months history of epigastric pain radiating to the right shoulder. Calculus chronic cholecystitis was diagnosed by ultrasound. The patient undergoes elective laparoscopic cholecystectomy. A gross inspection showed a small nodule attached to the serosa of the gallbladder. Microscopically, both cases revealed ectopic liver tissue.

Clinical discussion:

Ectopic liver tissue is an uncommon entity that occurs during the embryological development of the liver and can be found below and above the diaphragm, especially the gallbladder. Histologically, it usually has the normal architecture of the liver. Although ectopic liver tissue is an exceptional finding, pathologists should be aware of it because it has a high risk of transformation into malignancy.

Conclusion:

Hepatic choristoma is a rare failure of embryological liver development. It should be removed when recognized and examined histologically to rule out malignancy.
Novel guanidinoacetate methyltransferase (GAMT) mutation associated with cerebral creatine deficiency syndrome in a Syrian child: a case report
Authors: Alhomsi Dima , Abdalsalam Dania , Sulaiman Rama , Bakleh Sameer , Alasmar Diana
Published: April 2023

Introduction:

Guanidinoacetate methyltransferase (GAMT) deficiency, also known as cerebral creatine deficiency syndrome type 2 (CCDS2), is an uncommon disease caused by an innate genetic defect in the metabolic pathway of creatine inherited in an autosomal recessive manner. It is a rare cause of neurological regression and epilepsy. In this report, we present the first GAMT deficiency case in Syria related to a novel variant.

Case Presentation:

A 2.5-year-old boy presented to the paediatric neurology clinic with evidence of neurodevelopmental delays and intellectual disabilities. Recurrent eye blinking, generalized non-motor (absence) seizures, hyperactivity, and poor eye contact were revealed in the neurological examination. Some athetoid and dystonic movements were noticed. His electroencephalography (EEG) was very disturbed because of generalized spike-wave and slow-wave discharges. Based on these findings antiepileptic drugs were administered. His seizures slightly improved, but then relapsed with myoclonic and drop attacks. After 6 years of unbeneficial treatment, a genetic test was required. Whole-exome sequencing was conducted and identified a novel homozygous GAMT variant (NM_138924.2:c.391+5G>C). Treatment with oral creatine supplementation, ornithine, and sodium benzoate was administered. After 1.7 years of follow-up, the child was almost seizure-free with a remarkable reduction of epileptic activity on EEG. He demonstrated good—but not complete—behavioural and motor improvement due to delayed diagnosis and treatment.

Conclusion:

GAMT deficiency should be considered in differential diagnoses in children with neurodevelopmental regression along with drug-refractory epilepsy. A special concern is needed in Syria for such genetic disorders; regarding the high prevalence of consanguinity. Whole-exome sequencing and genetic analysis can be used to diagnose this disorder. We reported a novel GAMT variant to extend its mutation spectrum and provide an additional molecular marker for the definitive diagnosis of GAMT deficiency patients and prenatal diagnosis in the affected families.
The influence of physical activity, social relationships, and diet intake on depression: a case-series study
Authors: Nabdi Samira , Boujraf Said , Benzagmout Mohammed
Published: April 2023

Introduction:

This paper aims to investigate the three areas [diet, physical activity (PA), and social relationship] and their relationship with depressive disorders in the North African population.

Study design:

This is an observational cross-sectional study of 654 participants residing in the urban commune of Fez (n=326) and the rural commune of Loulja (n=328) in the province of Taounate. Participants were categorized into two groups: G1 without a current depressive episode and G2 with a current depressive episode. Risk factors, including locality, gender, marital status, age, parental status, employment status, tobacco use, alcohol consumption, social habits, and dietary patterns, were assessed. A multinomial probit model in Stata software was used to identify factors associated with depression occurrence in the population.

Results:

A total of 94.52% of the participants who engaged in PA did not experience a depressive episode (P=0.001). Additionally, 45.39% of the participants in our series were on a processed diet and presented with a depressive disorder (P=0.0001), the social contact (time spent with friends >1.5 h) remained strongly associated with reduced depressive symptoms when comparing the two groups (P=0.001). The results showed that being rural, a smoker, an alcohol user, and having no spouse significantly increased depression in participants. The coefficient of age was negatively related to the probability of the occurrence of age-related depression; however, this factor was not significant in the model. Thus, having a spouse and/or children and spending time with friends on a healthy diet significantly decreased depression in our population.

Discussion:

The converging evidence suggests that physical exercise, a stable social relationship, a healthy diet, and the use of PA can alleviate depression symptoms, but limited understanding and few studies have attempted to characterize or identify the neural mechanisms of these effects.

Conclusion:

Nonpharmaceutical interventions such as PA and dietary changes have proven to be effective treatments for depression, while maintaining positive social relationships can act as a protective factor, serving a prophylactic role in the prevention of depression.
A technique for esophagojejunostomy following robot-assisted gastrectomy: a liner stapler and barbed suture device-based technique: a case series
Authors: Ohdaira Hironori , Kamada Teppei , Takahashi Junji , Nakashima Keigo , Nakaseko Yuichi , Ishigaki Takayuki , Suzuki Norihiko , Yoshida Masashi , Yamanouchi Eigoro , Suzuki Yutaka
Published: April 2023

Background:

Intracorporeal esophagojejunostomy after total or proximal robot-assisted gastrectomy is technically more demanding than gastroduodenostomy and gastrojejunostomy for distal gastrectomy, as well as laparoscopic surgery. We have established a safe and simple esophagojejunostomy procedure using a liner stapler attached to the Da Vinci Surgical System and a barbed suture device.

Patients and methods:

For esophagojejunostomy after total gastrectomy or proximal gastrectomy with double-tract reconstruction, we choose the “overlap method,” in which entry holes were made at the left of the esophageal stump and at 5 cm of the anal side in antimesentric area of the jejunum, followed by anastomosis on the left of the esophagus using SureForm (blue 45 mm) and hand-sewing closure of the common entry hole with V-Loc. We analyzed the short-term surgical outcomes of all patients.

Results:

23 patients underwent this reconstruction technique. None of the patients required any further open surgeries. The mean time to perform anastomosis was 24.7±2.8 min. The postoperative course was uneventful in 22 patients; a single patient developed minor anastomotic leakage (Clavien–Dindo grade 3), which was treated with conservative therapy employing a drainage tube.

Conclusion:

Our esophagojejunostomy method following robot-assisted gastrectomy is simple and feasible, with acceptable short-term outcomes, and could represent the procedure of choice for esophagojejunostomy.
Comparison between single-dose oral prednisolone and oral dexamethasone in the treatment of croup: a randomized-controlled trial
Authors: Asif Alvina , Tayyab Asma , Qazi Shaista , Zulfqar Rubina , Hussain Irshad , Mumtaz Hassan
Published: April 2023

Introduction:

Croup is a common respiratory illness in children, accounting for 15% of annual clinic and emergency department visits for pediatric respiratory tract infections. We aimed to compare single-dose oral prednisolone with single-dose oral dexamethasone in the treatment of croup in terms of mean change in the Westley Croup Score.

Setting:

Emergency Department of Children Hospital.

Duration:

Six months from December 2017 to June 2022.

Design:

Randomized-controlled trial.

Subjects and methods:

A total of 226 children with Westley Croup Score 2 or more were included in this study. Patients were randomized into two groups, 113 patients received a single dose of 0.15 mg/kg of oral dexamethasone, while 113 patients received a single dose of 1 mg/kg of oral prednisolone. Croup score and other clinical observations were repeated at 4 h and recorded in the questionnaire.

Results:

The average age of the patients was 2.88±1.17 years. There were 129 (57.1%) males and 97 (42.9%) females. At 4 h, a significant reduction in mean Westley Croup Score was observed in group dexamethasone as compared with group prednisolone (P=0.0005).

Conclusions:

Our trial demonstrated that oral dexamethasone at a dose of 0.15 mg/kg is effective in reducing the total croup score but there were no statistical differences in respiratory rate, pulse rate, and oxygen saturation between groups. Future studies are required to determine if these treatments differ in efficacy for severe croup and whether there is a role for multiple-dose corticosteroid therapy in some patients.
The relationship of serum amylase levels in acute organophosphorus poisoning with its clinical severity and outcome: a cross-sectional study
Authors: Subedi Basudev , Yadav Gopal Kumar , Raut Amar , Joshi Nisha , Subedi Bal Krishna , Joshi Nimesh , Neupane Ram Prasad , Bhandari Ved , Maharjan Ramesh Kumar , Acharya Ramesh Prasad
Published: April 2023

Background:

There are limited literatures studying the pancreatic involvement in organophosphate (OP) poisoning using biochemical means. This study focused on assessing the type of OP poisoning and determining the association of serum amylase levels with the patient’s presentation and outcome.

Materials and methods:

A cross-sectional study was carried out in the Maharajgunj Medical Campus, Tribhuwan University Teaching Hospital, Kathmandu, Nepal, after ethical approval [Ref: IRB/308 (6-11-E)]. We collected data from 172 participants with OP poisoning over the period of 2 years using nonprobability purposive sampling method. All patients with age group 16–75 years having a history of OP poisoning within the previous 24 h with clinical features and physical evidence of poisoning were included in the study. Those participants with indications of exposure to an entirely different poisons, poisoning with multiple poisons, OP poisoning along with alcohol, chronic alcoholics, comorbid conditions, taking drugs that could affect serum amylase levels (azathioprine, thiazides, furosemide, etc.), and/or treated in other hospitals after poisoning were excluded from the study. Appropriate statistical calculations were made using the statistical package for social sciences (SPSS), version 21. The P-value of less than 0.05 was considered statistically significant.

Results:

Metacid (53.5%, 92) was the most common OP poison. There were significantly higher mean values of serum amylase levels either within 12 h of exposure (468.60 vs. 135.4 IU/ml, P<0.001) or after 12 h of exposure (152.0 vs. 58.9 IU/ml, P<0.001) in dead participants than alive ones. The participants with initial and after 12 h of exposure-serum amylase level 100 or more IU/ml had more than two-fold and 18-fold higher odds of severe/life-threatening severity (odds ratio=2.40, 95% CI: 1.28–4.52, P=0.007 and odds ratio=18.67, 95% CI: 8.02–43.47, P<0.001) respectively than those with less than 100 IU/ml.

Conclusions:

The clinical severity of OP poisoning is directly related to serum amylase levels. Importantly, higher mean values of serum amylase levels were depicted in those participants with OP poisoning culminating to death. Thus, serum amylase level could be one of the easy measurable prognostic marker of OP poisonings.
Thoracic spinal tuberculosis in a 2.5-year-old child treated by surgical procedure with a transthoracic approach: a case report
Authors: Kitaz Mohammad N. , Alosman Majd A. , Jawish Abdelrazzak , Alothman Fadi , Alali Kutaiba , Wereekia Mahmoud , Abbas Walaa , Kadi Mohamad , Morjan Mohamad
Published: April 2023

Introduction and importance:

Pott’s disease is a form of extrapulmonary tuberculosis (TB) and has a global increase in incidence. The diagnosis should be made early to avoid neurological deficiency or deformity of the spine.

Case presentation:

A 2-year-old and 6-month-old boy was admitted with fever and unspecific generalized pain, the examination revealed mild hyperreflexia in the lower extremities, isotope scan showed increased uptake in the T8 vertebra. MRI demonstrated destruction in the T8 vertebra with kyphotic deformity and abscess anterior to T7, T8, and T9 levels with an epidural abscess at the T8 level extending to the spinal canal and compressing the spinal cord. The patient underwent a surgical procedure with a transthoracic approach, the decompression of the spinal canal was performed through T8 corpectomy, the reduction of kyphosis was performed and the internal fixation with a dynamic cylinder and lateral titanium plate was carried out. Microbiologic examination suggests Mycobacterium tuberculosis.

Clinical discussion:

Pott’s disease (spinal TB) is extremely rare in the young children population, and surgical treatment is reported only in a few reports, and it is considered a technical challenge. There are several surgical approaches during childhood, for upper thoracic spinal TB, the posterior approach is easy, minimally invasive, safe, reliable, and effective. But it had the worst outcomes. In contrast, the anterior approach provides direct access to the lesions.

Conclusion:

More research are needed to detect the best choice in the management of thoracic spinal TB in children.
Adrenocortical carcinoma in a 10-month-old infant: A literature review and a rare case report
Authors: Al-Ghotani Basel , Alabdallah Ebaa , Shaaban Venus , Nemer Farah , Alsneeh Amal , Sharif Fawaz AL , Dalati Husam , Mansour Marah
Published: April 2023

Introduction and importance:

Adrenocortical carcinoma (ACC) in children is a rare condition. The annual incidence of ACC is extremely low, with only 0.2–0.3 cases per million children. The clinical presentations of ACC are numerous, such as terminal hair appearance, pubertal progress, hypercortisolism, enlarged clitoris, acne, systemic arterial hypertension, weight gain, and voice change.

Case presentation:

A 10-month-old female infant presented by her parents to the Department of Endocrinology with a mass on the right adrenal gland and Cushing’s syndrome symptoms. Surgery was performed. The death occurred after two times resuscitation due to sudden cardiac arrest.

Clinical discussion:

The adrenal gland consists of two distinct parts. Different types of tumors arise from each part of the adrenal gland. The most common tumor in adrenomedullary tumors was neuroblastoma which accounted for 60.4% of adrenal tumors. ACC in children is a rare condition. The etiology of ACTs is unclear.

Conclusion:

This case emphasizes that early diagnosis has a considerable role in preventing major complications. Also to advise considering ACC as a differential diagnosis when similar symptoms are found in an infant.
Severe hepatitis E infection in pregnancy: a case report
Authors: Jha Kritika , Tandukar Alina , Aryal Roshan , Shrestha Prezma , Bajracharya Sunita , Bista Kesang D.
Published: April 2023

Introduction and importance:

Hepatitis E virus causes self limiting hepatitis most of the times but, during pregnancy it can lead to severe hepatitis along with various complications thereby increasing the mortality.

Case presentation:

A 27-year-old woman gravida two, para one at 38 weeks and 6 days of gestation presented with multiple episodes of nonbilious vomiting, severe dehydration, and later developed right upper quadrant abdominal pain. The patient had a positive serological test for the hepatitis E virus, and liver enzymes were severely elevated. Under supportive treatment she delivered a healthy baby, and her liver enzymes returned to normal levels after 2 weeks of delivery.

Clinical discussion:

Although the hepatitis E virus usually causes self-limiting hepatitis, it can quickly progress to severe hepatitis, liver failure, and even death during pregnancy. Immunological change with a Th2 biased response and increased hormonal levels during pregnancy could possibly facilitate the development of severe liver damage. No particular drug has been approved for the treatment of hepatitis E viral infection in pregnant women, and the commonly used drugs are contraindicated due to the risk of teratogenicity. Supportive therapy and intensive monitoring are the core management techniques for hepatitis E virus infection in pregnant women.

Conclusion:

Due to the high mortality risk, pregnant women should try to avoid possible exposure to the hepatitis E virus, but once infected, symptomatic therapy is the mainstay.
Post-traumatic lateral abdominal wall hernia: a case report
Authors: Abdelali Mabrouk , Chaouch Mohamed Ali , Ben Jabra Sadok , Saad Jamal , Ben Mansour Maha , Chakroun Sawsen , Khouni Yasmine , Aguir Fadwa , Achour Asma , Zrig Ahmed , Noomane Faouzi , Maatouk Mezri
Published: April 2023

Introduction and importance:

Traumatic abdominal wall hernia (TAWH) also known as blunt abdominal TAWH is uncommon. The clinical diagnosis is difficult. The authors present a case report of posthigh-energy abdominal blunt trauma causing a TAWH.

Case presentation:

A 36-year-women, with unremarkable past medical history, was presented to the Emergency Department after a stuck in high-speed two automobiles. She was hemodynamic, respiratory, and neurologically stable. The BMI was 36 kg/m². The abdomen was not distended with an ecchymotic lesion on the right flank. The thoracic abdominal and pelvic computed tomography (CT) scan revealed a rupture in the lateral abdominal wall muscles with a TAWH in the location of the skin ecchymoses. There was no visceral lesion or intraperitoneal fluid. A conservative treatment was indicated. The follow-up was uneventful, with hematoma resorption and no cellulitis or abscess. The patient was discharged after 1 week. An abdominal repair will be planned using a mesh.

Clinical discussion:

TAWH is a rare entity. The best imaging modality for diagnosis is the CT scan allowing classification of the hernia and a screen for other injuries. The presence of an isolated TAWH must lower the threshold to closely monitor or to operatively explore, given the high rate of false-negative findings at imaging features.

Conclusion:

TAWH should be suspected behind any blunt abdominal trauma with high energy. CT scan and ultrasound were helpful for diagnosis and the only curative treatment is surgery to avoid complications.
Small bowel intussusception in an adult secondary to gastrointestinal stromal tumor: a rare case report
Authors: Basukala Sunil , Karki Sabin , Maharjan Suman , Banmala Sabin , Shrestha Melina , Jayswal Mukesh , Shrestha Kala
Published: April 2023

Introduction and Importance:

Intussusception is a rare surgical condition in adults less commonly confined to small bowel. Adult intussusception is an indication of surgical resection due to possibility of ischemia and malignant pathological cause like gastrointestinal stromal tumor (GIST) as in this case.

Case presentation:

A 32-year-old male presented with abdominal pain and vomiting for 3 days. Vitals parameters and abdominal examinations were normal. Abdominal ultrasonography revealed target sign suggesting ileoileal intussusception in right lower quadrant. Abdominal contrast-enhanced computed tomography of abdomen showed features suggestive of ileoileal intussusception. Diagnostic laparoscopy was done which was later turned to laparotomy for segmental resection and anastomosis of ileum for ileoileal intussusception. Polypoidal growth noted in the resected section of ileum was found to be GIST (CD117 and DOG-1 positive) which was considered to be the lead point. Patient recovered well during postoperative period and later referred to oncology clinic for chemotherapy.

Clinical discussion:

Intussusception and subsequent obstruction are very uncommon presentation in a patient with GIST because of their tendency to grow in an extraluminal fashion. As intussusception is rare in adult, high level of suspicion and proper imaging technique plays important role in diagnosing the condition.

Conclusion:

Ileoileal intussusceptions due to GIST are a rare clinical entity in adult intussusceptions and generally have a vague variable clinical presentation thus requiring high index of clinical judgement and suspicion with judicious use of imaging.
Alagille syndrome: an orphan disease in Colombia and summary of recent advances in treatment and survival – a case report
Authors: Echeverri-Mejía Camila , Ríos-Orozco Sergio U. , Lozada-Martínez Ivan D. , Narvaez-Rojas Alexis R.
Published: April 2023

Introduction:

Alagille syndrome has been described as a multisystemic clinical spectrum caused by an autosomal dominant genetic disorder. Although it is estimated that there is 1 case per 100 000 live births, the prognosis for survival and quality of life for these patients is varied but tends to be negative. In Colombia, this condition is considered an orphan disease with difficult management due to the lack of specialized centers that have all the medical specialties and subspecialties. Some reports state that no more than 30 cases have been published in this country.

Materials and methods:

The authors report a case of a male baby who, at 8 days old, he was taken to the general practitioner’s outpatient clinic for persistent jaundice. At 3 months of age, he was reviewed by the pediatric gastroenterology department, which requested liver and biliary tract scintigraphy, showing atresia of the biliary tract, hepatomegaly, and the absence of a gallbladder.

Results:

Liver transplantation is the definitive solution. However, in low- and middle-income countries, where there are no well-established organ transplantation programs, the prognosis for these patients is presumed to be worse.

Conclusion:

Alagille syndrome is a rare disease that requires an accurate and early diagnosis and timely multidisciplinary management to reduce the impact of multisystemic complications. It is necessary to advance in transplant programs in low- and middle-income countries, to provide a solution to cases where there are no other therapeutic alternatives, and to contribute to the quality of life of the affected patient.