bluuebunny/crossref_metadata_2025 huggingface dataset:
Outcomes of Accelerated 3-Year MD Graduates at NYU Grossman School of Medicine During Medical School and Early Residency
Authors: Satyamoorthi Nivedha , Marin Marina , Ludlow Peter , Triola Marc M. , Gillespie Colleen , Cohen Elisabeth , Abramson Steven , Cangiarella Joan
Published: October 2024

Purpose

For accelerated 3-year MD (3YMD) pathways to be fully adopted in medical education, a comprehensive analysis of outcome data is needed. This study includes 7 accelerated 3YMD graduating classes at NYU Grossman School of Medicine (NYUGSOM) and reports on outcomes from both medical school and internship compared with their 4-year MD (4YMD) counterparts.

Method

Outcomes across the undergraduate-graduate medical education continuum for the first 7 classes of NYUGSOM graduates (matriculated from 2013–2019) from the accelerated 3YMD (n = 136) and 4YMD pathways (n = 681) were compared. For the internship outcomes, 3YMD interns were compared with 4YMD interns who graduated from NYUGSOM and all 4YMD interns (4YMD graduates from NYUGSOM and any other medical school) at NYUGSOM residencies.

Results

Accelerated 3YMD students were approximately 5 months older at admission and had higher multiple mini-interview scores than 4YMD students. Overall, accelerated 3YMD students performed similarly to 4YMD students during medical school and internship. Significant differences included higher performance by 3YMD students on preclerkship exams and lower performance on Steps 1 and 2 (average: 5.6 and 5.4 fewer points, respectively) and the physical examination portion of the NYUGSOM Comprehensive Clinical Skills Exam. Internship data indicated comparable team assessments across all residencies, statistically significant higher performance on Step 3 when compared with all 4YMD interns, and, in internal medicine, comparable clinical reasoning between 3YMD and all 4YMD interns. When comparing 3YMD interns to all 4YMD interns in the internal medicine residency program, 3YMD interns had a statistically significantly higher performance on milestones.

Conclusions

The outcomes from 7 years of graduating accelerated 3YMD students at NYUGSOM show similar performance in medical school and early residency to 4YMD graduates. Long-term study of accelerated 3YMD students from NYUGSOM and other medical schools is needed to further validate the success of this innovative medical education pathway.
The Implications of Sacralized Transitional Vertebra on Spinal Alignment
Authors: Khalifé Marc , Vergari Claudio , Lafage Renaud , Elysée Jonathan , Finoco Mikael , Gille Olivier , Assi Ayman , Skalli Wafa , Lafage Virginie , Ferrero Emmanuelle
Published: October 2024

Study design:

Retrospective study of a multicentric prospective database.

Objective:

This study aimed to determine, in a cohort of healthy volunteers, the impact of sacralized lumbo-sacral transitional vertebra (LSTV) on spinal alignment according to its grade, particularly regarding lumbar lordosis magnitude and distribution, and the implications for spinopelvic parameters measurement.

Summary of Background Data:

There is little data regarding spinopelvic alignment assessment in LSTV patients.

Methods:

This study included healthy volunteers with full-body stereoradiographs in free-standing position aged over 18. Castellvi grade, pelvic parameters (measured on S1 and L5), L1-S1 lumbar lordosis (LL) and segmental lordosis for each disc and vertebral body, thoracic kyphosis, cervical lordosis, lower limb, and global alignment parameters were assessed. Castellvi I and II were considered as Low-grade and Castellvi III and IV as High-grade LSTV. Alignment parameters between No-LSTV, Low- and High-grade LSTV were compared. Propensity score matching was used to match PI in No-LSTV and Low-grades. Spinopelvic parameters measured on S1 in No-LSTV group and on L5 in High-grade were compared.

Results:

713 subjects were included, of whom 23 Low-grades and 27 High-grades. Mean pelvic incidence was 51.0±11.0° and mean age was 37.5±16.2 years. LL distribution was different between groups, with an apex and inflexion point significantly higher in High-grade (P<0.001). Kyphosis in the LSTV segment was compensated for by a steeper increase of LL above L5 in the High-grades. Low-grades and PI-matched No-LSTV presented similar alignment parameters. There were minor differences in parameters measured on S1 in No-LSTV and no L5 in High-grades.

Conclusion:

Subjects with low-grade LSTV present similar alignment as PI-matched No-LSTV subjects, and S1 should be taken as reference to measure spinopelvic parameters. High-grade LSTV subjects have kyphotic L5-S1 segment with more cranial lumbar apex and thoracolumbar inflexion point. In these subjects, spinopelvic parameters should be measured on L5.
Evaluation of the Efficacy and Safety of FFX Facet Cages Compared With Pedicle Screw Fixation in Patients With Lumbar Spinal Stenosis: A Long-Term Study
Authors: Houari Omar , Douanla Arnaud , Ben Ammar Mehdi , Benmekhbi Mustapha , Mortada Jihad , Lungu Gabriel , Magheru Cristian , Voirin Jimmy , Lebedinsky Pablo Ariel , Musacchio Mariano , Bolognini Federico , Srour Robin
Published: October 2024

Study Design:

Hybrid retrospective/prospective study.

Objective:

The study evaluated the long-term safety and efficacy of the FFX facet cage versus pedicle screw (PS) fixation in patients with lumbar spinal stenosis (LSS).

Summary of Background Data:

A previous single-arm study reported on the safety, fusion rate, and patient outcomes associated with the use of the FFX facet cage in patients with lumbar spinal stenosis. There are no long-term studies reporting outcomes with this device compared with the use of pedicle screw fixation.

Methods:

Following a medical records review, subjects meeting the inclusion and exclusion criteria were consented to and enrolled in the prospective arm of the study. CT scans and dynamic X-rays were performed to assess fusion rates, range of motion, and translation. Adverse events during the 2-year post-index procedure were also analyzed. Preoperative and 2+ year Visual Analogue Scale (VAS) back and leg scores and Oswestry Disability Index (ODI) were also obtained.

Results:

A total of 112 subjects were enrolled with 56 patients included in the PS and FFX groups. Mean age was 63.1±11.2 and 67.1±10.9 years and the mean number of levels operated was 1.8±0.8 and 2.3±1.0, respectively, for the PS and FFX groups. There was no difference between the 2 groups for the primary composite fusion endpoint assessed with the FFX group achieving a 91% bony facet fusion rate. There was also no difference in postoperative complications or adverse events during the 2-year follow-up period. A higher percentage of patients in the PS group (10.7%) required reoperation compared with the FFX group (3.6%). Although both groups experienced significant improvements in VAS and ODI scores versus preoperative assessment, there was no difference between the 2 groups.

Conclusion:

The present study documents the long-term safety and efficacy of the FFX device in patients with LSS with a reduction in reoperation rate when compared with PS fixation.

Level of evidence:

Level III.
Angiotensin-II and Thromboembolic Events: A Systematic Review*
Authors: Caragata Rebecca , Johnston Samuel A. , Chan Jian Wen , Starkey Graham , Bellomo Rinaldo
Published: October 2024

OBJECTIVES:

To evaluate and synthesize the existing evidence for the association of angiotensin-II with thromboembolic events.

DATA SOURCES:

PubMed, Scopus, and CENTRAL databases.

STUDY SELECTION:

This systematic review included randomized trials and comparative observational studies that reported on the occurrence of venous and/or arterial thromboembolic events in adult patients receiving treatment for shock with angiotensin-II vs. a comparator.

DATA EXTRACTION:

A total of 1689 records were screened by two independent investigators. Seven studies were deemed eligible for inclusion, encompassing 1461 patients. This included two randomized controlled trials and five nonrandomized studies of intervention. Data were extracted independently and in duplicate. Risk of bias assessments were performed using the Risk of Bias 2 and Risk Of Bias In Nonrandomized Studies of Interventions tools.

DATA SYNTHESIS:

The included studies reported on a variety of individual and composite thromboembolic events as exploratory endpoints. Overall, they demonstrated an elevated risk of bias, predominantly related to confounding, measurement of outcomes and selection of reported results, which precluded quantitative synthesis. Within these limitations, we found that thromboembolic event rates were similar between the angiotensin-II and comparator groups. Venous thromboembolic events were described in 8.8% of patients receiving angiotensin-II and 9.4% of controls, while arterial thromboembolic events were reported in 11.3% and 12.7%, respectively. Total event rates were broadly comparable when utilizing data derived from the primary publications and when adjusted for the U.S. Food and Drug Administration account of trial data.

CONCLUSIONS:

Published evidence does not currently support or refute an association between angiotensin-II and an increased risk of venous or arterial thromboembolic events. Given the limited quality of available data, future studies should explicitly define diagnostic and reporting criteria for such events.
Low-Level Laser and LED Therapy in Alopecia: A Systematic Review and Meta-Analysis
Authors: Perez Sofia M. , Vattigunta Mounika , Kelly Colin , Eber Ariel
Published: October 2024

BACKGROUND

Low-level laser/LED therapy (LLLT) has been described as a treatment option for alopecia, but no study has comprehensively reviewed its efficacy in multiple alopecia types.

OBJECTIVE

To review and evaluate LLLT for various alopecia types.

MATERIALS AND METHODS

A systematic search of PubMed/MEDLINE, Embase, and CENTRAL was conducted to identify studies assessing the effect of LLLT on patients diagnosed with alopecia. Prespecified outcome measure was the change in hair density. Meta-analysis was performed to calculate the standardized mean difference in hair density before and after LLLT compared with placebo.

RESULTS

Thirty-eight studies were included that described 3,098 patients with androgenetic alopecia (2,930/3,098), scarring alopecia (49/3,098), alopecia areata (50/3,098), telogen effluvium (17/3,098), and chemotherapy-induced alopecia (32/3,098). The mean change in hair density increased significantly in androgenetic alopecia patients after LLLT for 4 to 26 weeks compared with placebo (<20 weeks: SMD = 1.14; 95% CI [0.51–1.78]; p = .000; I2 = 88.26%; >20 weeks: SMD = 1.44; 95% CI [0.97–1.91]; p = .000; I2 = 80.81%). Change in hair density was reported in 5 studies evaluating other alopecia types; however, statistical information was insufficient for meta-analysis.

CONCLUSION

LLLT is a promising treatment option for patients with androgenetic alopecia, but future studies are needed to better understand its efficacy in other alopecia types.
Breast Reconstruction Using Combined Unilateral Hemiabdominal DIEP Flap with Lipofilling from the Contralateral Abdomen
Authors: Noto Minami , Satake Toshihiko , Taki Kyona , Ikeda Tatsuya , Tsukura Kahori , Ikusaka Keisuke , Katsuragi Ryohei , Onoda Satoshi
Published: October 2024

The deep inferior epigastric perforator (DIEP) flap is the gold standard breast reconstruction procedure for patients with adequate lower abdominal tissue and is often elevated, including the unilateral DIEP. In patients with a lower midline abdominal surgical scar, the volume of the DIEP flap used for breast reconstruction may be limited because of the cessation of blood perfusion over the scar. Several options have been used for increasing the flap volume using bipedicled flaps; however, they are more invasive for the abdominal donor site and require longer operation time for complex vascular anastomoses. To overcome these disadvantages, we propose immediate breast reconstruction with simultaneous fat grafting combined with a DIEP flap, which can achieve an adequate breast volume. The patient was a 46-year-old woman with left-sided invasive ductal carcinoma. She underwent a left nipple-sparing mastectomy, sentinel lymph node biopsy, and one-stage immediate DIEP flap breast reconstruction. Indocyanine green angiography was used to evaluate the blood supply to the DIEP flap, and lipofilling was performed from the unstained flap area. The fat was injected into and under the pectoralis major muscle, and the total volume of the fat graft was 66 mL. The advantages of immediate lipofilling harvested from the unstained flap area include minimal sacrifice, the expectation of simultaneous restoration of the overall appearance of the breast with a minimal number of operations, the simplicity of the procedure, and the best use of viable tissues. Therefore, breast reconstruction combined with fat grafting is effective for volume augmentation.
INFLUENCE OF FOVEAL GLIAL TISSUE AFTER MACULAR HOLE SURGERY ON OUTER RETINAL RESTORATION AND VISUAL ACUITY
Authors: Iwasaki Masanori , Nakashizuka Hiroyuki , Tanaka Koji , Wakatsuki Yu , Onoe Hajime , Nakagawa Naoya , Fujimiya Taishi , Koutari Sawako , Sakakibara Takuya , Shoda Chiho , Hanaguri Junya , Yokota Harumasa , Takayuki Hattori , Mori Ryusaburo , Shimada Hiroyuki , Nagaoka Taiji , Yamagami Satoru
Published: October 2024

Purpose:

To investigate the impact of foveal glial tissue on the anatomical and functional results after macular hole (MH) surgery.

Methods:

This study included 141 consecutive eyes that underwent successful vitrectomy for full-thickness MH between January 2015 and December 2022. The best-corrected visual acuity and the length of outer retinal defects were evaluated preoperatively and at 6 months postoperatively. Macular hole with retinal detachment, recurrent MH, and traumatic MH were excluded. Multiple regression analyses were conducted on outer retinal restoration and visual acuity using foveal glial tissue size, surgical technique of internal limiting membrane peeling or inverted internal limiting membrane flap, and high myopia as explanatory variables.

Results:

Analyses revealed that the foveal glial tissue significantly limited the outer nuclear layer, external limiting membrane restoration, and ellipsoid zone restoration as well as best-corrected visual acuity improvement (r = −0.380, P < 0.001; r = −0.314, P = 0.035; r = −0.530, P = 0.015; r = −0.00027, P = 0.001; respectively). Meanwhile, the surgical technique and high myopia did not significantly affect the restoration of outer nuclear layer, external limiting membrane, ellipsoid zone, and best-corrected visual acuity after surgery.

Conclusion:

Foveal glial tissue after MH surgery attenuated outer nuclear layer, external limiting membrane, and ellipsoid zone restoration as well as best-corrected visual acuity improvement.
SUB–INTERNAL LIMITING MEMBRANE FOVEAL HEMORRHAGE UNDER TENSION
Authors: Miyamoto Shoto , Fukuyama Hisashi , Araki Takashi , Kimura Naoki , Gomi Fumi
Published: October 2024

Purpose:

To identify preoperative clinical characteristics of macular hole (MH) formation after vitrectomy for submacular hemorrhage because of ruptured retinal arterial macroaneurysm.

Methods:

The authors retrospectively analyzed eyes with submacular hemorrhage because of a ruptured retinal arterial macroaneurysm in patients who underwent vitrectomy and had more than 1 month of follow-up. Background factors and imaging findings were compared between groups classified by MH presence. The primary outcomes were best-corrected visual acuity, and fundus and optical coherence tomography findings.

Results:

Submacular hemorrhage because of a retinal arterial macroaneurysm rupture was identified in 48 eyes. Macular holes were identified in 8 eyes (16.3%): four intraoperatively and four postoperatively. Preoperative optical coherence tomography findings revealed that all MH cases exhibited the highest retinal thickness at the foveal lesion with sub–internal limiting membrane hemorrhage preoperatively. This finding was termed the “foveal mountain peak” sign, characterized by sub–internal limiting membrane hemorrhage where the peak of the retinal thickness coincides with the fovea. The incidence of foveal mountain peak sign (+) cases was significantly higher in the MH (+) group compared with the MH (−) group (100% vs. 47.5%, respectively; P = 0.006).

Conclusion:

The presence of the foveal mountain peak sign may indicate an increased risk of submacular hemorrhage–associated MH.
Exercise-Associated Muscle Cramps in Ironman-Distance Triathletes Over 3 Decades
Authors: Nilssen Paal K. , Johnson Kasey B. , Hiller W. Douglas B. , Miller Thomas K. , Connolly Christopher P.
Published: October 2024

Objective:

This study aimed to explore associations and trends for athletes experiencing exercise-associated muscle cramps (EAMC) in ultraendurance competitions.

Design:

Retrospective analysis of prospectively collected data.

Setting:

Medical tent data were collected from annual IRONMAN World Championship events.

Participants:

In total, 10 533 medical records were reviewed among 49 530 race participants from 1989 to 2019.

Assessment of Risk Factors:

Athlete demographics data, performance data, and additional medical conditions were examined.

Main Outcome Measures:

Primary outcome of interest was to compare triathletes with and without EAMC. Secondary outcome was to analyze triathletes with subsequent EAMC.

Results:

EAMC (N = 2863) occurred in 57.8 per 1000 participants (95% confidence interval = 55.7 to 60.0). The incidence of EAMC did not differ between athlete sex. Athletes with EAMC had greater weight loss but did not differ in serum sodium and serum potassium compared with those without EAMC. Further analysis with a logistic regression analysis revealed that dehydration, exhaustion, hypotension, abdominal pain, headaches, and a previous evaluation for cramping were strongly associated with muscle cramping. The most common treatment for EAMC was intravenous fluids.

Conclusions:

Findings from the current study support previous reports that electrolyte abnormalities are not associated with cramping. However, our finding that dehydration is associated with muscle cramping contradicts current literature.
Improving obstructive sleep apnea competency of primary care clinicians through online education
Authors: Hiebert Cayla
Published: October 2024

Background:

Obstructive sleep apnea (OSA) is an often overlooked, widespread disease and a public health concern. Evidence-based practice guidelines do not exist to guide primary care clinicians' OSA screening practices. Clinicians must be competent in OSA; however, clinicians lack competency about this disease.

Local problem:

Elevated rates of undiagnosed OSA potentially exist in two rural and one suburban counties in Kansas, as indicated by the increased weight and elevated chronic disease prevalence in these counties' populations.

Methods:

A one-cohort, pretest–posttest, quasi-experimental design was used for this quality-improvement project implemented over 11 weeks. Clinicians' competencies on OSA were measured before and after the intervention using the Obstructive Sleep Apnea Knowledge and Attitude Survey.

Intervention:

A brief educational video on OSA was developed for this project. Definition, risk factors and complications, screening methods, definitive diagnosis, and treatment options were covered in this video.

Results:

Participants (N = 14) showed improved OSA competency after watching the educational video. Participants improved OSA competency after watching the interventional video (M = 16.3, SE = 0.194) versus preintervention (M = 14.2, SE = 0.318). Participants also improved OSA attitude scores postintervention.

Conclusion:

Primary care clinician OSA competency scores improved after engaging in a brief educational video intervention when measured using the OSA knowledge and attitude survey. Practicing clinicians can benefit from participating in education about the disease.
GATA1 transcription factor targets the gene expression of B19 virus in HEK293 cell line
Authors: Atashi Amir , Jafaripour Leila , Froughi Kobra , Behzadifard Mahin
Published: October 2024

Background/Aim:

B19 virus (B19V) is a single-strand DNA virus that has specific tropism to erythroid progenitor cells (EPCs). The virus enters the cells via P antigen and coreceptors and induces infection and cell apoptosis. GATA1 has a high expression in EPC and is a critical transcription factor for the cells development and differentiation. As human EPCs are the main target of the virus infection that have high expression of GATA-1 as the critical transcription factor, the aim of this study was to investigate the effect of GATA1 cotransfection with B19V genome on the expression of the viral mRNAs in HEK293 as nonpermissive cell line to the virus that had no mRNA expression of GATA-1.

Methods:

HEK293 cells were transfected with pHI0 plasmid containing the B19V genome and the plasmid of the GATA1 genome. The quantity of B19V mRNAs (NS1, 7.5 kDa, and 11 kDa) expression was evaluated after 24 h of transfection.

Results:

The results showed a statistically significant increase in fold change expression of (NS1 ∽12.3, VP1 ∽27.6, 11kb protein ∽38) in cotransfected cells with GATA1 and B19 plasmids compare to control group (P<0.05).

Conclusion:

This research showed transfected cells with GATA1 had elevation in the expression of the B19V genes mRNAs in a nonpermissive cell. This result may show the role of GATA1 as a critical transcription factor in support of the virus infection in EPCs. This suggests that GATA1 may potentially sport B19V replication or gene expression.
Hemorrhagic hepatic infarction in a pregnant woman with severe pre-eclampsia: a case report
Authors: Onanga Antoine O. , Narayan Gaurang , Rusho Maher A. , Kalala Brigitte , Bwami Clovis A. , Karanga Edouard K. , Bulondo Daniel , Peter Uggh Innocent H. , Naaz Farheen , Suheb Mahammed K. , Tague Christian , Akilimali Aymar
Published: October 2024

Introduction and importance:

Severe pre-eclampsia is a medical condition that affects women during the last two trimesters of pregnancy. Hemorrhagic hepatic infarction is a hepatic complication and is rarely encountered in women with severe pre-eclampsia. This case report aims to present the characteristics of hemorrhagic hepatic infarction in a pregnant woman with severe pre-eclampsia.

Case presentation:

A 27-year-old pregnant woman with a 30-week gestation of amenorrhea was admitted with a blood pressure of 160/100 millimeters of Mercury (mmHg), headaches, dizziness, and oedema in the lower limbs.

Clinical discussion:

These complaints with clinical and paraclinical examinations led to the diagnosis of severe pre-eclampsia, and she underwent an emergency cesarean section, but 6 h later, she presented with hypovolemic shock, and this led to a new surgery. A surgery that made it possible to develop or discover a diffuse hepatic infarction with hemorrhagic infiltration of the gallbladder and the falciform ligament without active bleeding in the liver. Emergency management of pre-eclampsia was adopted, and the postoperative course was simple, with a good clinical outcome when the patient was discharged.

Conclusion:

Severe pre-eclampsia and hemorrhagic hepatic infarction are complications of pregnancy, which require emergency treatment, and above all, these medical conditions require the termination of the pregnancy.
Cross-sectional study exploring the prevalence and clinical manifestations of acute diarrhea among under-5 children in primary care hospital in Democratic Republic of the Congo
Authors: BAVURHE Rodrigue Fikiri , RUSHO Maher Ali , BALUME Alain , NAAZ Farheen , KIHANDUKA Elie , ALI Babar , FAREED Areeba , RHUGENDABANGA Francois , SUHEB Mahammed Khan , HANGI Samson , RUGENDABANGA Excellent , BYIRINGIRO Elysée , CAKIRWA Hugues , BALAGIZI Fabien , BANTURAKI Davis , MBABAZI Samuel A. , ODUOYE Malik Olatunde , ONESIME Jones , BANGA Styves , AKILIMALI Aymar ,   Medical Research Circle (MedReC) Collaborators
Published: October 2024

Background:

Acute diarrhea (AD), which is defined as frequent passing of liquid stools compared to normal, is a serious and worrying problem and remains a concern for healthcare systems because of its high mortality cause in children under 5 years old. The authors’ study aimed to present the prevalence and to describe the clinical manifestation of AD among under-5 children.

Methods:

From June 2022 to May 2023, the authors conducted a retrospective, descriptive and cross-sectional study including all patients aged 0–5 years hospitalized for AD.

Results:

Out of 512 patients, only 197 (38.5%) children with AD were selected for our study. The average age is 25.5 months, and the sex ratio is 1.11. Some families (75.1%) have clean latrines, and 21.8% use water from the river. Inaccessibility to clean water and intolerance or food poisoning were the causes of acute diarrhea in children. Major signs and symptoms are fever, dehydration and vomiting. Weight loss and malnutrition are the major complications of AD in children. The treatment of AD is provided by oral rehydration solutions and antibiotics.

Conclusion:

The study highlights the significant prevalence of acute diarrhea among under-5 children underscores the importance of preventive measures and government intervention, such as the introduction of rotavirus vaccination. However, conclusions regarding prevalence rates should be interpreted with caution due to the lack of detailed population data.
Radio-protective effects of melatonin therapy against testicular oxidative stress: a systematic review and meta-analysis of rodent models
Authors: Dehdari Ebrahimi Niloofar , Sadeghi Alireza , Falamarzi Kimia , Shahlaee Mohammad Amin , Azarpira Negar
Published: October 2024

Background:

Radiation exposure is a concern in today’s world, given the widespread use of electronic devices and medical procedures involving ionizing and non-ionizing radiation. Radiations may cause male infertility by inducing oxidative stress in testicular tissue. Melatonin has antioxidant properties.

Methods:

The authors systematically reviewed the literature for the studies that have investigated the effects of melatonin therapy on radiation-induced oxidative stress in rodents’ testicular tissue. PubMed, Scopus, and Web of Science were searched for relevant animal trials. Standardized mean difference and 95% CIs were used to pool the data. Subgroup and sensitivity analyses were done. The risk of bias was assessed using SYRCLE tool.

Results:

Outcomes: histopathology and sperm analyses (testicular apoptotic cells, Johnsen’s testicular biopsy score, seminiferous epithelial height, tubular diameter, sperm motility, viability, count, and morphology, concentration of spermatid, spermatocyte, and spermatogonia), body and testes weights (absolute and relative body and testicular weights), reproductive hormones (serum prolactin, FSH, and testosterone), and oxidative stress tissue markers (TBARS, CAT, GSH, GSH-Px, MDA, SOD, and XO, and total antioxidant capacity). Rats and mice were exposed to electromagnetic radiations (gamma, roentgen, microwave, radiofrequency, and high-power line energy) and particle waves (radioiodine and carbon-ion). Melatonin therapy was significantly associated with improved male reproduction.

Conclusion:

Radiation exposure harms male fertility, but melatonin, as an antioxidant, is potentially associated with improved male reproductive function in rodents. Inconsistencies in research require further investigations.
Efficacy and safety of the FGF19 analog aldafermin for the treatment of nonalcoholic steatohepatitis: a GRADE assessed systematic review and meta-analysis
Authors: Ali Mohammad Haris , Rehman Obaid Ur , Talha Muhammad , Fatima Eeshal , Fatima Laveeza , Zain Ahmad , Haisbuzzaman Md Al
Published: October 2024

Background:

Nonalcoholic fatty liver disease (NAFLD) is increasingly concerning due to its rising prevalence. It encompasses conditions from simple steatosis to severe nonalcoholic steatohepatitis (NASH), posing risks such as fibrosis, cirrhosis, or hepatocellular carcinoma if untreated. This systematic review and meta-analysis aims to assess aldafermin, an FGF19 analog, for efficacy and safety in NASH patients.

Methods:

Eligible studies were identified by searching PubMed, Cochrane Library, and Google Scholar, resulting in 1115 studies. Three RCTs were included. The risk of bias was assessed using the Cochrane Risk of Bias tool, and data synthesis utilized Review Manager software. The certainty of evidence was evaluated with the GRADE approach.

Results:

In the 3 mg dose group, aldafermin significantly improved various parameters. The ELF score decreased notably (pooled MD: −0.46, 95% CI: −0.64 to −0.28; P<0.00001). Additionally, fibrosis improvement without NASH worsening showed a pooled MD of 8.15 (95% CI: −3.62 to 19.93; P<0.17), and fibrosis improvement with NASH resolution displayed a pooled MD of 10.16 (95% CI: 1.68–18.64; P=0.02). Furthermore, significant reductions were noted in absolute AST levels (pooled MD: −13.40, 95% CI: −18.66 to −8.14; P<0.00001) and absolute ALT levels (pooled MD: −19.92, 95% CI: −27.08 to −12.75; P<0.00001), suggesting improved liver function.

Conclusion:

The meta-analysis indicates that aldafermin, particularly, the 3 mg dose, shows significant efficacy in improving liver histology and biochemical markers in NASH patients compared to placebo, along with a satisfactory safety profile.
Management of high-dose olanzapine poisoning in a young child under limited resource setting: a case report from Nepal
Authors: Yadav Pramodman Singh , Pokhrel Popular , Bhattarai Sashank , Adhikari Pratik , Dev Abinash , Upadhaya Aishworya , Chaudhary Shipra
Published: October 2024

Introduction:

Olanzapine, an atypical antipsychotic, is widely used for treating psychiatric conditions such as schizophrenia and bipolar disorder. Accidental overdose in children is rare but can lead to severe clinical effects. This case report discusses the management of a 5-year-old male who accidently ingested 180 mg of olanzapine, the highest reported dose in a child around 5 year.

Case presentation:

A 5-year-old boy accidentally ingested 180 mg of Olanzapine, resulting in loss of consciousness and central nervous system depression. He exhibited hyperglycemia, elevated lactate, and prolonged prothrombin time, but no significant cardiovascular issues. Following intubation and supportive care, including intravenous medications and mechanical ventilation, the child gradually improved. He was discharged in stable condition with follow-up instructions.

Discussion:

Olanzapine toxicity in children presents with a variety of symptoms, including somnolence, hypotension, and neurological impairments, which are dose-dependent. Even in case of an exceptionally high overdose, the absence of cardiovascular toxicity supports safety profile of olanzapine. Common laboratory findings include hyperglycemia, elevated liver enzymes, and metabolic disturbances. Management involves airway protection, supportive care, and monitoring, as no specific antidote exists. Prompt and appropriate care, even in severe cases under limited resource settings, can lead to favorable outcomes.

Conclusion:

In cases of high-dose accidental olanzapine poisoning in children, it is essential to begin quick intervention and comprehensive supportive care to achieve successful outcomes and can be managed even in limited resource settings. Preventive measures are crucial to avoid such incidents, and careful monitoring is essential in managing pediatric olanzapine overdose.
Two-stage surgical approach for type III odontoid fracture with C1–C2 fracture dislocation: a case report and management overview
Authors: Haq Khitamul , Akhter Saleem , Waqas Muhammad A. , Alao Adedoyin E. , Halder Abhik , Chaurasia Bipin
Published: October 2024

Introduction and importance:

Odontoid fractures of the second cervical vertebra (C2) are categorized into three types, with type III extending into the body of the axis. These fractures, often resulting from high-energy trauma, can cause significant instability and neurological issues. This case report discusses a 43-year-old male with a type III odontoid fracture and C1–C2 fracture dislocation, demonstrating the effectiveness of traditional neurosurgical techniques in managing such complex injuries.

Case presentation:

A 43-year-old male presented with upper cervical pain and right upper limb weakness following a road traffic accident. Imaging revealed a type III odontoid fracture with posterior displacement and atlanto-axial (C1–C2) joint dislocation. The patient underwent a two-stage surgical procedure. The first stage involved transoral decompression to address the retropulsed odontoid fragment and relieve spinal cord compression. The second stage involved posterior craniocervical fixation using an autologous iliac bone graft for stabilization. The patient showed postoperative improvement and was discharged on the third day, with a stable condition at a one-month follow-up.

Clinical discussion:

Managing type III odontoid fractures with C1–C2 dislocation is challenging, requiring a strategic approach to ensure spinal stability and neurological recovery. Transoral decompression provides direct access for effective decompression, while posterior fixation ensures robust stabilization. The use of an autologous iliac bone graft enhances fusion and long-term stability. This case illustrates the successful integration of traditional neurosurgical techniques with modern surgical principles.

Conclusion:

This case underscores the importance of traditional neurosurgical techniques in managing complex odontoid fractures. The two-stage approach of transoral decompression followed by posterior craniocervical fixation proved effective, highlighting the relevance of these techniques in achieving positive outcomes in contemporary neurosurgical practice.
Cardioprotective strategies in the management of chemotherapy-induced cardiotoxicity: current approaches and future directions
Authors: Al-Hasnawi Zeineb , Hasan Hawraa Mohammed , Abdul Azeez Jaafar Mohammed , Kadhim Naam , Shimal Aya Ahmed , Sadeq Maryam Hussein , Mahood Noor Al-Huda Ali Motashar , Al-Qara Ghuli Abdulmelik A. N. , Hussein Ahmed Safaa , Prajjwal Priyadarshi , Jain Hritvik , Goyal Aman , Amir Omniat
Published: October 2024

Background:

Chemotherapy-induced cardiotoxicity (CIC) is a significant challenge in cancer treatment, leading to heart failure and myocardial infarction. With rising cancer survival rates, the long-term cardiovascular health of survivors has gained importance. While several cardioprotective medications have been studied to mitigate chemotherapy’s harmful effects on the heart, more research is needed to confirm their effectiveness and optimal use.

Methodology:

This review synthesizes evidence on cardioprotective drugs in managing CIC. The authors conducted a comprehensive literature search of peer-reviewed articles, clinical trials, and meta-analyses published between January 2000 and May 2024. Studies were selected based on relevance, quality, and focus on mechanisms, efficacy, and clinical outcomes of cardioprotective agents such as beta-blockers, ACE inhibitors, ARBs, statins, and dexrazoxane.

Results and discussion:

Cardioprotective medications show potential in alleviating the impact of chemotherapy on heart function. Beta-blockers and ACE inhibitors effectively reduce heart failure incidence and improve cardiac outcomes. Statins, with their anti-inflammatory and antioxidative properties, and dexrazoxane, which reduces anthracycline-induced cardiotoxicity, also show promise. However, variability in study designs, patient groups, and chemotherapy treatments complicates the establishment of standardized treatment protocols.

Conclusion:

Cardioprotective drugs hold significant promise in managing CIC and improving cardiac outcomes for cancer patients. Current evidence supports the efficacy of beta-blockers, ACE inhibitors, statins, and dexrazoxane. Further research is needed to establish standardized protocols, evaluate long-term safety, and optimize treatment timing. Integrating cardioprotective strategies into oncological care can enhance the quality of life and prognosis for cancer survivors.
Prevalence of bacteriuria and treatment outcomes in patients with symptomatic benign prostatic hyperplasia: a prospective observational study
Authors: Ramdam Niroj , Upadhya Pawan Sapkota , Luitel Prajjwol , Thapaliya Ishwor , Paudel Sujan , Kashyap Shiwangi , Karkee Rikesh Jung , Gupta Rakesh Kumar
Published: October 2024

Introduction:

The global incidence of benign prostatic hyperplasia (BPH) is rising, with bacterial causes of lower urinary tract symptoms (LUTS) being a common factor contributing to complications in these patients.

Aim:

To identify the prevalence of bacteriuria and treatment response in patients with symptomatic BPH.

Materials and methods:

This 1-year prospective study included all patients presenting with LUTS due to BPH who met the inclusion criteria. Urine samples were collected and analyzed for microscopy, culture, and sensitivity following standard protocols. Bacterial growth in urine specimens and International Prostate Symptom Score (IPSS) of LUTS were recorded before and after antibiotic therapy.

Results:

A total of 131 patients with symptomatic BPH were studied. Escherichia coli (47.6%) was the most commonly isolated bacteria, followed by Klebsiella pneumoniae and Pseudomonas species. E. coli and Klebsiella showed the highest sensitivity to nitrofurantoin. After 1 week of antibiotic therapy, 69% of patients had sterile urine cultures, while 31% remained E. coli positive. Significant improvement in IPSS scores was observed after 1 week of therapy (P<0.05), and there was no significant change in urine culture (P=0.854).

Conclusion:

Bacteriuria is a common finding in patients with symptomatic BPH in our setting. Escherichia coli and Klebsiella pneumoniae were the most frequently isolated organisms, with sensitivity to nitrofurantoin and cefixime. A week of antibiotic therapy significantly reduced IPSS scores but did not reduce bacteriuria.
The Impact of Allyship on Minoritized Patients and Providers in Palliative Practice
Authors: Terrance Rosa , Lastimoso Charmaine
Published: October 2024

Many minoritized patients experience discrimination in health care. The same is true for minoritized health care clinicians, including the advanced practice registered nurse (APRN). Specifically, Black Americans have historically and disproportionally been privy to both structural racism and interpersonal racial discrimination (J Subst Abuse Treat 2022;133:108551). For patients, such exposure is associated with physical and mental health consequences, including hypertension, obesity, depression, anxiety, psychological distress, and mortality (Health Serv Res 2019;54 suppl 2(suppl 2):1399–1408). For minoritized clinicians, the subsequent result of discrimination additionally includes poor job satisfaction, decreased productivity, and high turnover (JAMA Health Forum 2023;4(12):e235249). Allyship, the act of supporting minoritized individuals while not being a member of that group, is potentially useful in improving the practice experience of minoritized APRNs, as well as positively impacting minoritized patients’ outcomes. This article aims to provide actionable and practical skills for the APRN to create safe spaces for minoritized patients and partners in palliative practice. Explicitly, the role of the palliative care APRN as an ally will be reviewed as well as guidance on how to implement changes that will affect the health care experience for both patients and clinicians.
Imaging the translocator protein 18 kDa within cognitive control and declarative memory circuits in virally suppressed people with HIV
Authors: Rubin Leah H. , Maki Pauline M. , Du Yong , Sweeney Shannon Eileen , O’Toole Riley , Nam Hwanhee , Lee Hannah , Soule Ana R. , Rowe Steven P. , Lesniak Wojciech G. , Minn Il , Dastgheyb Raha , Shorer Eran F. , Wugalter Katrina A. , Severson Joan , Wu Yunkou , Hall Andrew W. , Mathews William B. , Kassiou Michael , Dannals Robert F. , Kassaye Seble G. , Brown Todd T. , Bakker Arnold , Pomper Martin G. , Coughlin Jennifer M.
Published: October 2024

Objectives:

Virally suppressed people with HIV (VS-PWH) show heterogeneity in patterns of cognitive dysfunction. To better understand the relationship between the neuroimmune response and cognition, we used PET to image the translocator protein 18 kDa (TSPO). The study examined HIV-serostatus differences in TSPO as well as associations between regional TSPO and select cognitive processes defined using the Research Domain Criteria (RDoC) framework.

Design:

Cross-sectional investigation in VS-PWH (n = 25) versus HIV-uninfected individuals (n = 18) of cognitive control and declarative memory, as well as [11C]DPA-713 PET measures of TSPO within cognitive control and declarative memory regions of interest (ROI).

Methods:

Group differences in [11C]DPA-713 binding (V
T) in cognitive control or declarative memory regions were examined using linear mixed models. Tests of associations between factor-derived cognitive system measures and PET measures were performed, controlling for TSPO genotype.

Results:

There were no group differences in any of the four factor-derived cognitive system measures. VS-PWH had higher log [11C]DPA-713 V
T across cognitive control regions [unstandardized beta coefficient reflecting mean difference [B] = 0.23, SE = 0.11, 95% confidence interval (CI) 0.01–0.45, P = 0.04] and declarative memory regions (B 
= 0.24, SE = 0.11, 95% CI 0.02–0.45, P = 0.03). Higher log [11C]DPA-713 V
T in cognitive control regions related to poorer cognitive control in each group, and to worse self-reported cognitive performance in VS-PWH. Log [11C]DPA-713 V
T in each declarative memory region did not associate with measured declarative memory.

Conclusion:

A localized neuroimmune response marked by high TSPO in brain regions that subserve cognitive control may contribute to poorer cognitive control in VS-PWH.
Pre-expanded Local Flaps: Optimal Choice for Repairing Defects Following Extensive Benign Tumor Resection in the Head and Face
Authors: Cui Jiangbo , Zhang Yu , Tang Yinke , Chu Feifei , Liu Wei , Bai Ruoxue , Li Yang , Ma Xianjie
Published: October 2024

Background:

Treating extensive benign tumors of the head and face presents a longstanding challenge, necessitating efficacy at the lesion site, and postoperative esthetic considerations for the donor area.

Objective:

This study aims to explore the clinical outcomes of pre-expanded local flap reconstruction for extensive benign tumors of the head and face post resection.

Method:

From March 2018 to March 2023, a total of 18 patients with extensive benign tumors of the head and face were admitted, including 13 cases of nevus, 2 cases of hemangioma, 2 cases of neurofibroma, and 1 case of verruca. Based on the location and size of the lesions, suitable local areas were selected for tissue expansion, and expanders were implanted for regular saline injections over 8 to 16 weeks. After reaching the desired expansion, resection of the head and facial tumors and local flap reconstruction were performed. Postoperatively, data on patients’ information, tumor types, tumor area, expansion volume, postexpander complications, vascular condition after flap transfer, and donor site condition were collected.

Result:

In this series of 18 patients, benign tumors of the head and face were completely repaired through 1 to 2 stages of tissue expansion surgeries. Postimplantation complications included hematoma in 1 case and infections in 2 cases, with one instance of expander infection leading to surgical failure. However, all other patients achieved adequate expansion, successful flap survival post-transfer, and experienced no other complications. Follow-up over 6 to 24 months showed no recurrence at the lesion sites, with flaps maintaining consistent color, texture, and thickness matching surrounding skin tissue. In addition, donor site healing was excellent, with no obvious surgical scars.

Conclusions:

Pre-expanded local flap reconstruction is an ideal method for repairing extensive benign tumors of the head and face postresection.
Surgical Reconstruction of the Congenital Absent Earlobe
Authors: Guillen-Martinez Edgar Alan , Davila-Diaz Rodrigo , Barlandas-Quintana Erika , Marquez-Espriella Cuahutemoc , Garcia-Corral Jesus Ricardo , Barbosa-Villarreal Fernando
Published: October 2024

Introduction:

A simple technique for earlobe reconstruction in a single stage, with satisfactory esthetic results and minimal morbidity.

Cases:

Two patients with congenital absent earlobe are presented. In both cases, a bilobed flap comprising skin, subcutaneous tissue, and fat was used to reconstruct the lower border of the earlobe.

Discussion:

Different techniques for earlobe reconstruction are discussed, including flap overlap, the use of skin and cartilage grafts, and double-bilobed flaps.

Conclusion:

The procedure described in this article is based on a modification of Gavello’s surgical technique, supplying a simple and effective approach for earlobe reconstruction in a single procedure.
Investigation of the Effects of Ozon and Propolis on the Healing of Bone Defects: An Experimental Study
Authors: Durmuş Halil İbrahim , Gunes Nedim
Published: October 2024

Background/aim:

This study explores the effects of ozone and propolis on the healing of critically sized bone defects at both the histologic and molecular levels, and the locations and concentrations of osteopontin and osteonectin during healing; both proteins play roles during bone healing.

Materials and methods:

This study used 56 adult male Sprague-Dawley rats of an average weight of 350 g, divided into four groups of 14: a control group, a topical ozone group (O), a topical ozone + systemic propolis (O + PO) group, and a systemic propolis group (PO). Seven rats from each group were sacrificed at the end of week 4 and the other seven at the end of week 6. Tissues were subjected to histologic and immunohistochemical examinations in a fixative solution. The results were analyzed using the statistical software package SPSS 23 (Statistical Package for the Social Sciences—IBM). Results were considered significant at the 95% confidence level (P<0.05).

Results:

Graft sections were immunostained for osteonectin. Staining was low in the control group but moderate in the other three groups; the differences were significant. The three experimental groups did not differ significantly. Graft sections were also immunostained for osteonectin. At 4 weeks, staining was low in the control group but moderate in the other 3 groups. At 6 weeks, stronger staining was apparent in the 3 experimental groups. At both 4 and 6 weeks, the differences between the control and experimental groups were significantly different, but the differences among the experimental groups were not.

Conclusion:

The authors' results are compatible with the literature. Ozone and propolis, given separately or together, improved bone healing, increased bone formation, and reduced bone destruction. However, further research is required.
Pseudoaneurysm of the Lingual Artery in a Patient With Facial Trauma From Gunshot Wounds
Authors: Buxo Zachary , Rexroth Jonathan , Johnson Benjamin S. , Fessler Richard D. , Carron Michael
Published: October 2024

A pseudoaneurysm is an abnormal dilatation within the wall of a blood vessel due to the formation of a hematoma in the vessel wall after vessel injury. Because of the protective nature of the facial skeleton and the deep location of the lingual artery, the lingual artery pseudoaneurysm is rare. The authors report a case of a 20-year-old male who suffered multiple gunshot wounds, including to the mouth, presenting with immediate life-threatening injuries. On hospital day 1, otolaryngology performed debridement of the mandible, retrieval and removal of bullet fragments, intermaxillary fixation, external fixation of the mandible, intra-oral laceration repair, repair of tongue laceration, and tracheotomy revision. On postoperative day 15, the otolaryngology service was called for the abrupt onset of major oral cavity bleeding. computed tomography-angiogram detected a pseudoaneurysm of the lingual artery and was successfully treated with endovascular coil embolization.