bluuebunny/crossref_metadata_2025 huggingface dataset:
The Predictive Value of Serum IL-6 in Pediatric Critically Ill Patients with Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with COVID-19
Authors: Ibrahim Hanan M , Mansour Mervat GE , Rezk Ahmed R , Ahmed Hossam K
Published: August 2023

Background

Unexplained cases of fatal rapidly spreading viral pneumonia were reported in December 2019 in Wuhan, China. A novel type of coronavirus, SARS-COV-2, was isolated during the examination of patients' samples. By May 2019, the novel coronavirus has been responsible for more than 3 million infections worldwide with a case fatality rate up to 7%.

Aim of the Work

To evaluate the correlation between serum level of IL-6 and cases of COVID-19 and Multisystem inflammatory syndrome in children (MIS-C) progression and outcome.

Patients and Methods

This is a cohort study that was conducted at the Pediatric Intensive Care Unut, Ain Shams University. It included 53 patients whose median age was 6 years and ranged between 2-10 years. They were divided into 24 patients (45%) with COVID and 29 patients with MIS-C (55%). Laboratory work up done to both groups include : routine laboratory tests (CBC, CRP, ESR, serum ferritin) and measurement of serum IL-6 using ELISA (Normal values up to 7pg/ml).

Results

Median serum level of IL-6 was higher albeit insignificant in patients with MIS-C as compared to those with COVID (Median:72.7 pg/ml (range: 20.2-140.5 pg/ml) versus a median of 53 pg/ml (range:17.2-293.2) respectively. Serum IL 6 was significantly positively correlated with CRP, ESR and ferritin in both MIS-C and COVID patients groups (p < 0.05). Among MIS-C patients, the best cut off point of serum IL6 to predict severe course and mortality was >168.2 pg/ml, while among COVID patients, the best cut off level was slightly lower >146 pg/ml.

Conclusion

Systemic inflammation is a feature of COVID and MIS-C in part reflected by increased serum IL 6 and increased ESR, CRP and Ferritin. Increased serum IL 6 has excellent sensitivity to severe MIS-C and COVID with good specificity. It's low predictive value for mortality suggest it's limited value to predict the outcome in severe cases as indicated by the multiple factors interacting in the disease course.
The Role of Chitinase-3-Like Protein 1(YKL-40) as a Biomarker of Psoriatic Arthritis
Authors: Mohammed Rana S , Sebaie Mona A El , Awad Mohamed A , Salama Sherihan M
Published: August 2023

Background

Psoriatic arthritis (PsA) is a chronic multifaceted inflammatory seronegative arthritis. Plasma YKL-40 is an inflammatory biomarker.

Objective

To evaluate the role of Chitinase-3-like protein 1 (YKL-40) as a diagnostic biomarker in psoriatic arthritis (PsA) patients and determine its value in assessment of disease activity and severity in PsA patients.

Patients and Methods

This study included twenty five adult patients with clinical evidence of PsA and twenty five healthy matched age and sex as control group. All underwent history, laboratory investigation, clinical examination, assessment of disease activity using Disease Activity in PSoriatic Arthritis (DAPSA) Score and assessment of severity of PsA using Psoriasis Area and Severity Index (PASI), Nail Psoriasis Severity Index (NAPSI), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Leeds Enthesitis Index (LEI) and examination of dactylitis.

Results

The mean age of patients was 39.72 ± 11.94. Also, The mean age of healthy controls was 42.88 ± 12.11. There was highly statistically significant difference regarding the serum levels of YKL- 40 (P < 0.01) between the patients and the control groups (P < 0.01). The receiver operating characteristic curve (ROC) curve of YKL -40 showed that the sensitivity and the specificity of YKL- 40 in diagnosis of PsA were 96% and 92% respectively. There were statistically significant positive correlations between YKL- 40 levels (μl/mL) and each of PASI score (p = 0.005) (r = 0.539) and DAPSA score (p = 0.007) (r = 0.526).

Conclusion

YKL- 40 measurement may serve as a diagnostic biomarker for PsA, as it has the potential to contribute to the fundamental processes underlying the pathogenesis of PsA. So, the results of this study suggested that the addition of YKL- 40 as a serological marker has a valuable role in diagnosis of PsA and reflection of disease activity.
The Role of Transcranial Grayscale and Doppler Ultrasound Examination in Diagnosis of Neonatal Hypoxic-Ischemic Encephalopathy
Authors: Aly Zeinab A , Hemeda Yasmin H , Al-Ghannam Adel M
Published: August 2023

Objectives

To evaluate role of transcranial grayscale ultrasound (TC-GSUS) and transcranial color Doppler (TCD) in diagnosis of neonatal Hypoxic-ischemic encephalopathy (HIE).

Materials & Methods

26 neonates with suspected HIE underwent sonographic examinations using SonoScape SSI-6000 ultrasound device that is equipped by L743 linear array probe with frequency 5-10 MHz. TC-GSUS was performed at levels of anterior, mastoid and posterior fontanelles and at level of temporal window. TCD was performed using Color-coded Doppler study of the intracerebral vessels to assess brain perfusion and detect ischemic brain changes. Resistance index (RI) was considered abnormal in preterm neonates if it was <0.54 or > 0.86 and if it was <0.52 or > 0.8 for term neonates.

Results

According to cranial biometry, TC-GSUS has negative and positive rates for HIE of 7.7% and 92.3%, respectively. Using TC-GSUS periventricular leukomalacia, intraventricular hemorrhage, brain edema and hydrocephalus were detected in 17, 19, 14 and 16 patients, respectively. According to RI of intracranial vessels, TCD excluded HIE in 11 patients and assured diagnosis of HIE in 15 patients. TC-GSUS can diagnose HIE in neonates with sensitivity, specificity and accuracy rates of 87.5%, 30% and 65.4%, respectively. ROC curve analysis defined abnormally high RI of intracranial arteries as the significant specific predictor for the presence of NHIE and as the significant sensitive predictor for HIE severity grade. Regression analysis defined high RI of internal carotid artery (ICA) as the most specific predictor for presence of HIE, while high RI of anterior cerebral artery (ACA) was the most sensitive predictor for high grade HIE.

Conclusion

TCD can diagnose HIE in neonates with high sensitivity and specificity and abnormal RI of ICA and ACA could be used as accurate diagnostic tests. Whenever, TCD was unavailable, TC-GSUS could diagnose HIE with accuracy rate of 65.4% versus TCD.
Recent Advances of TIRADS Classification of Thyroid Nodules by Ultrasound
Authors: Ibrahim Ayman Mohammed , Shokry Wessam Sherin , Ebrahim Hanan Ebrahim Mousa
Published: August 2023

Background

Thyroid nodules are abnormal growths of thyroid tissue which commonly arise within an otherwise normal thyroid gland. They may be hyperplasia or a thyroid neoplasm, but only a small percentage of the latter are thyroid cancers. Small, asymptomatic nodules are common, and many people who have them are unaware of them. Thyroid nodules can be felt as a lump in the throat. When they are large, they can sometimes be seen as a lump in the front of the neck.

Objectives

The aim of this work was to improve the management of the patients and to reduce cost-effectiveness by decreasing number of unnecessary fine needle aspiration cytology (FNAC).

Patients and Methods

This study was conducted on 50 patients with thyroid nodules detected by clinical palpation or incidentally noted during neck imaging for other reasons. There were 33females (74%) and 17 males (26%). Their ages ranged from 41 to 50 years. All patients in the study were subjected to full history taking, thorough clinical examination. Gray scale Ultrasound and color Doppler examination were done to all patients. The nodules were classified into TIRADS categories and the risk of malignancy was calculated for each category.

Results

All the nodules with TIRADS 1 were benign. In TIRADS 2 there were 10 benign and 1 malignant nodules. In TIRADS 3 there were 4 benign and 1 malignant nodules. In TIRADS 4 there were 2 benign nodules and 4 benign nodules while in TIRADS 5 there were 2 benign and 4 malignant nodules. There was a statistically significant difference between the two groups. There was a statistically significant difference between the two groups with benign and malignant nodules regarding the texture of the nodules. Solid texture was higher in the malignant nodules and spongiform texture was common in the benign nodules while the cystic and mixed texture were comparable between the two groups. Hypoechoic nodules were higher in the malignant nodules, however, there was no statistically significant difference between the two groups with benign and malignant nodules regarding the echogenicity of the nodules. There was a statistically significant difference between the two groups with benign and malignant nodules regarding the echogenic foci.

Conclusion

The major ultrasound features seen associated with malignancy were microcalcifications, taller than wider shape of the nodule, hypoechoic and marked hypoechoic echopattern of the nodule, irregular borders and presence of suspicious cervical lymph nodes.
Role of MRCP in Patients with Jaundice When Biliary Tree Is Normal on Previous Imaging
Authors: Younan Kirolos Monir Barsoum , El Gaafary Sahar Mohamed , Madkour sherihan Said
Published: August 2023

Background

Obstructive jaundice is one of the most frequent and grave form of hepatobiliary disease. It is important for treatment planning to detect level and cause of obstruction.

Aim of the Work

To assess the role of MRCP in patients presented with jaundice, right hypochondrial pain with the absence of dilated biliary system by ultrasound.

Patients and Methods

This was cross sectional study that included 38 patients who presented with obstructive jaundice or right hypochondrial pain with normal biliary system by ultrasound referred to the Radio diagnosis Department for MRCP.

Results

MRCP has high sensitivity reaching 100% and high specificity reaching 93.33% in gall bladder pathology and high specificity 100% in biliary and pancreatic pathology in comparison to ultrasound.

Conclusion

if there is high clinical suspicion of ductal pathology when patient presented by jaundice or right hypochondrial pain with abnormal liver function tests despite normal biliary tree by ultrasound, an MRCP examination should be strongly considered as next imaging modality of choice
Bronchial Artery Einbolization for Treatment of Hemoptysis from Cavitary Lung Lesions
Authors: Mohamed Ahmed Mostafa , El Din Nourhan Mohammed Hossam , Abdelaziz Norhan Abozeid Ahmed , ElShimy Ahmed
Published: August 2023

Background

Treatment for liemoptysis is not limited to surgery, and among the various options, bronchial artery emboli/anon is regarded as an effective approach.

Aim of the Work

To evaluate the technique, efficacy, and safety of Bronchial Artery Embolization in patients with haemoptysis from cavitary lung lesions.

Patients and Methods

Our study was a reconstructive (retrospective and prospective) cohort study that was held during the period between March 2021 and September 2021. The study included 20 patients who presented with hacmoptysis due to cavitary lung lesions refractory to supportive treatment measures. Patients were referred from chest department to interventional Radiology Unit, Ain Shams University Hospitals.

Results

Massive hemoptysis was seen in 15 patients and recurrent mild-moderate in 5 patients. On imaging cavitary lesions were seen at left side in 8 patients, right side in 8 patients, and bilateral involvement in 4 patients. Bronchiectatic changes were the predominant pathology seen in 6 patients, immediate success was achieved in 20 patients, while recurrence within one month was noted at 4 patients. Minor complications such as chest pain were recorded in 13 patients yet no major complications such as spinal cord ischemic.

Conclusion

BAE is a safe and effective procedure with a negligible complication rate that can be performed routinely in patients presenting with heimoptysis,
Evaluation of the Relationship between Carotid Intima Media Thickness and Coronary Artery Disease in Patients Evaluated by CT Coronary Angiography
Authors: Ibrahim Ahmed Samir , Hassan Hend Galal Eldeen Mohamed Ali , Azziz Mohamed Samar Essam Abdul
Published: August 2023

Background

Coronary artery disease (CAD) is associated with high mortality around the world, hypertension, diabetes and smoking are common risk factors for CAD.

Aim of the Work

Our study aims to explore the relationship between CIMT and coronary artery disease (CAD) in patients evaluated by coronary angiography for suspected CAD.

Patients and Methods

This cross-sectional study was carried out in radiology department, Faculty of medicine, Ain Shams University. All patients gave their written informed consent for taking part in this study. The study was approved by Ethical Committee of Faculty of medicine, Ain Shams University. It included 30 patients that were referred for MDCTA for coronary arteries study and IMT measuring by ultrasonography, Patients were referred for coronary CTA because of known or suspected coronary artery disease (CAD).

Results

We conducted our study on 30 patients 80% were males and 20 % were females aged between 30-70 years by using ECG gated 128 MDCT then ultrasonography examination for CIMT evaluation, Patients were referred for coronary CTA because of known or suspected CAD. 60% of cases were smokers, 66.7% of cases had hypertension, 73.3% had DM and 63.3 % had hyperlipidemia. Both imaging modalities showed overall good agreement and the concordance was better for moderate and higher grades of atherosclerosis than for low grade.

Conclusion

Higher values of CIMT were found in patients with various coronary risk factors (DM, Hypertension and hyperlipidemia). Carotid duplex ultrasonography provides a simple, easy and non-invasive tool for detection of CAD. It can be used as a predictor for incidence of CAD. There was also a significant relation between CIMT and the extent of CAD, noted as increased number of coronary vessels affected. Finally we demonstrated the usefulness of carotid intima media thickness in predicting coronary artery disease.
Risk Factors and Predictors of Occlusion of Stent of Trans Jugular Intrahepatic Porto-Systemic Shunt (TIPSS) in Egyptian Patients with Primary Budd Chiari Syndrome: A Single Center Experience
Authors: El-Din Fatma Ahmed Ali , Elmaaty Mohamed El-Ghareeb Abo , Atteya Heba Rashad , Ibrahim Ibrahim Abd El-Hakim
Published: August 2023

Background

Budd–Chiari syndrome is a heterogeneous group of disorders characterized by hepatic venous outflow obstruction at the level of the hepatic venules, the large hepatic veins, the inferior vena cava till its junction with the right atrium. The classic triad of abdominal pain, ascites, and hepatomegaly is observed in the vast majority of patients with Budd-Chiari syndrome. The diagnosis of BCS is made by clinical presentation and confirmatory investigations. Standard laboratory investigations are rarely helpful in establishing the diagnosis, because abnormal liver function tests are not specific for BCS, real time Gray-scale sonography combined with colour flow is considered by some to be the initial imaging technique. The recommended stepwise therapeutic algorithm of BCS is mainly by medical treatment with anticoagulation, angioplasty with or without stenting, TIPS of surgical shunting and liver transplantation if indicated. TIPS is a common teqnique used in BCS and TIPS stent occlusion is major complication.

Objectives

To identify the possible risk factors and predictors of stent occlusion in primary BCS patients who underwent TIPSS.

Patients and Methods

The studied patients were selected from patients presented to Budd Chiari outpatient clinic. Tropical medicine department in Ain Shams University hospitals. total number of cases during the study period was 76 cases fulfilling the inclusion criteria, they were divided in 2 groups according to patency of TIPS stent and comparing both groups regarding their pre and post TIPS data.

Results

The mean age of the patients was (29.29 ± 7.92) with female predominance. FVLM (69.7%) & MTHFRD (67.1%) were the most common causes of BCS in the studied patients. positive and higher CRP results were found in the occluded stent patients than patent groups. also, higher TLC levels were found in the occluded TIPS stent patients.

Conclusion

Identifying these risk factors may help predict the outcome of TIPS stent patency.
Comparison between Levels of Vitamin D in Primary Mono-Symptomatic Nocturnal Enuresis and Non-Enuretic Children
Authors: Sayed Shaker Hasan , Abdelfattah Dyaa' Eddin , Badr Abdallah Mohamed Said Rashad
Published: August 2023

Background

Enuresis (synonymous with intermittent nocturnal incontinence) refers to discrete episodes of urinary incontinence during sleep in children 25 years of age. Enuresis can be divided into primary enuresis (PE) and secondary enuresis (SE). A child who has never been dry is considered to have PE; a child who has been continent for at least 6 months before the onset of the bedwetting is considered to have SE. The pathogenesis of PE is similar to that of SE.

Aim of the Study

To compare between the levels of Vitamin D - as an important factor in growth and development - in primary monosymptomatic enuretic and non-enuretic children.

Patients and Methods

This is a case control study was performed in Ain Shams University Hospitals, Damanhour National Medical Institute. The study started on February 2020. The study included 60 children with primary mono-symptomatic nocturnal enuresis selected randomly and 60 healthy children age and sex matched children as a control group.

Results

We found that 61.7% of cases in the NE group had low Vit.D level (<20ng/ml) compared with 40% in the control group and this difference is statistically significant

Conclusion

Our study indicates that there • is a significant relationship between primary monosymptomatic nocturnal enuresis and serum vitamin D deficiency.
Stone Heterogeneity Index as a New Parameter for Prediction of Shockwave Lithotripsy Outcomes
Authors: Aggour Abd El Fattah Mohammed , El Shawaf Hisham , Omar Kareem , Nasef Abd El RahmanHossam Mahmoud
Published: August 2023

Background

Renal stones are a major public health concern with continuously increasing prevalence. Extracorporeal shock wave lithotripsy (ESWL) which was introduced more than three decades ago as an authentic modality for the treatment of urinary stone disease is considered first choice of treatment for nearly all kind of urinary tract calculi. The outcome of ESWL for renal and ureteral stones depends on many factors, including stone size, Hounsfield Unit (HU), Skin Stone Distance (SSD) and Body Mass Index (BMI).

Objective

To introduce the concept of Stone Heterogeneity Index (SHI) as a single factor or in combination with other factors that predict the outcome of extracorporeal shock wave lithotripsy for adult patients with renal or ureteral stones.

Methods

This is a prospective study conducted on 60 Patients with renal and ureteral stones planned to have ESWL sessions attending urology outpatient clinic in Ain shams university and Misr University for Science and Technology hospitals.

Results

The radiologic heterogeneity of a urinary stone or SHI was independently associated with SWL success in patients with renal and ureteral calculi. SHI in the success group was 246.49 ± 82.13 while in the failure group was 159.20 ± 47.59 with Cutoff point < 183 predicting failure of ESWL outcome. SHI between success and failure groups was statistically significant being higher in success group. (p = 0.000).

Conclusion

SHI will play a promising role when determining a treatment modality in patients with a urinary stone, and especially when selecting the proper SWL candidates from the patients with a stone of large size or high Mean Stone Density (MSD).
Comparing the Efficacy and Safety of Treatment with Fixed Dose of Tadalafil Monotherapy versus Its Combination with Silodosin in Patients with Benign Prostatic Hyperplasia and Erectile Dysfunction
Authors: Mourad Mohamed Sherif , Omar Karim , El Masry Cherif Mohy
Published: August 2023

Background

Benign prostate hyperplasia (BPH) is a histological diagnosis which is identified by non-malignant hyperplasia of prostatic tissue due to smooth muscle and epithelial cell proliferation in the prostatic transition zone.

Aim of the Work

To assess the efficacy and safety of fixed-dose of Tadalafil monotherapy versus its combination with Silodosin in treatment of BPH patient and erectile dysfunction (ED) by comparing IPSS score, PVR, Q max and The international Index of Erectile Function (IIEF questionnaire).

Methodology

This prospective randomized control clinical study was conducted at tertiary care hospital at Ain Shams University hospitals from June 2021 till January 2022 and performed on total 60 men patients which were 45 years old or older with a history of LUTS secondary to BPH of at least 6 months.

Results

Our study results revealed that there was no statistically significant difference found between the studied groups regarding IPSS and Q-max at baseline while there was statistically significant difference found in IPSS and Q-max at 1 month, 2 months and 3 months, with statistically significant decrease in IPSS and significant increase in Q-max through follow-up from baseline in each group.

Conclusion

This analysis suggested that the combination-therapy of tadalafil and Silodosin was more effective than tadalafil alone in improving subjective LUTS, but there was no significant improvement in sexual function.
Role of Focal HIFU Prostate Ablation in the Management of Unilaterally Diagnosed Low and Intermediate Risk Prostate Cancer
Authors: Noureldin M , Zaher T , Ahmed H , Hindley R , Mourad S , Emara A
Published: August 2023

Objective

Focal therapy for prostate cancer is gaining a rising evidence about their comparative effectiveness in cancer control with fewer complications to the radical treatment options. The aim of this study is to highlight the effectiveness of the focal therapy treatment on the ISUP group 2 and 3 mainly.

Subjects/patients and methods

115 patients with localized prostate cancer who had HIFU in our centre over 10 years were included. PSA levels were recorded routinely follow up MRI and the results of the prostate biopsies after the treatment.

Results

Patients were followed up after the treatment for 34 months in average. The failure free survival rate was higher in ISUP 2 (85.9%) in comparison to ISUP 3 (82.6%). Different grades of histological recurrence were detected in 24% in these patients, and they were offered different treatments accordingly. The patients had good functional performance after the procedure with IPSS of average 8 in the follow up and about 20% of them having erectile dysfunction with good response on medical treatment.

Conclusion

HIFU is an eminent treatment for the localized prostate cancer with a comparative oncological to the radical treatment with low functional side effects especially in intermediate risk group.
Genderplay: Reclaiming and Reconfiguring Femininity through the Gendered Labor Practices of Transmasculine Sex Workers
Authors: Chudyk Elliot
Published: August 2023

This article explores the gendered labor of transmasculine sex workers as they navigate client requests for genderplay, an eroticized form of gender misrecognition. Drawing on in-depth interviews with transgender men and AFAB nonbinary sex workers, I conceptualize this specific form of gendered labor as reclaimed and reconfigured femininity, a skilled labor process that can produce unique pleasures and pains for this group of workers. Accomplishing reclaimed and reconfigured femininity requires negotiating the demands, anxieties, and erotic needs of clients, which can come into conflict with their identities as transmasculine people. Despite the potential costs of such investments of emotional labor, I find that this process can become a subversive practice of self-exploration and gender-making, as well as a source of pleasure for the workers themselves. The gendered consequences of paid genderplay are more complicated and even contradictory than they first appear. Although the process of reconfigured and reclaimed femininity described here is, in many ways, unique to sex work or to transmasculine experiences of work, it also offers fresh insight for sociological analysis of gender, labor, and pleasure.
Occurrence of Kawasaki disease and neoplasms in temporal proximity—single-center experience and systematic review of literature
Authors: Banday Aaqib Zaffar , Babbar Alisha , Patra Pratap Kumar , Jindal Ankur Kumar , Suri Deepti , Pandiarajan Vignesh , Rawat Amit , Gupta Anju , Singh Surjit
Published: August 2023

Various factors (e.g., infections) have been postulated to trigger Kawasaki disease (KD) in genetically predisposed individuals. Whether neoplasms can trigger KD is largely unknown due to paucity of data. Herein, we provide a detailed account of KD occurring in temporal proximity (within 6 months) to neoplasms (‘neoplasm-KD’). Patients with ‘neoplasm-KD’ diagnosed/treated at our center from January 1994 to May 2021 were included. Additionally, we performed a systematic literature review (as per PRISMA 2020 guidelines) utilizing PubMed, Web of Science and Scopus databases to retrieve details of all patients with ‘neoplasm-KD’ reported till June 2021. Patients with multisystem inflammatory syndrome in children were excluded. As all reports pertained to case description(s), risk of bias assessment was not performed. The details of patients with ‘neoplasm-KD’ were analyzed using SPSS software. Primary and secondary outcomes were occurrence of coronary artery abnormalities (CAAs) and clinical characteristics of ‘neoplasm-KD’, respectively. A total of 25 patients (data from 18 reports) were included in the ‘neoplasm-KD’ dataset. The most frequently diagnosed neoplasm was acute lymphoblastic leukemia followed by neuroblastoma and acute myeloblastic leukemia. Overall, CAAs were noted in 48% of patients. Interval between diagnoses of KD and neoplasm was shorter in patients with CAAs as compared to patients with normal coronary arteries (p-value = 0.03). Besides providing a comprehensive description of ‘neoplasm-KD’, this study raises a possibility that neoplasms might trigger KD. Also, ‘neoplasm-KD’ may be associated with a higher risk of development of CAAs. However, the small size of ‘neoplasm-KD’ dataset precludes definitive conclusions regarding this association. Funding: nil. Registration: PROSPERO (CRD42021270458).
Phencyclidine Positivity on Urine Drug Screening in Patients Treated for Alcohol Withdrawal on a Dual-diagnosis Medically Assisted Withdrawal Unit
Authors: Wang Philip R. , Dore Samyukta , Weleff Jeremy , Butler Robert S. , Barnett Brian S.
Published: August 2023

Objectives

Little contemporary research has explored phencyclidine (PCP) use in people with alcohol use disorder. Therefore, we sought to determine the prevalence of PCP positivity on urine toxicology screening among patients admitted for alcohol withdrawal, identify correlates of PCP positivity, and investigate PCP positivity's relationship to length of stay (LOS) and risk of facility readmission.

Methods

This was a retrospective study of patients admitted to a dual-diagnosis medically assisted withdrawal unit for alcohol withdrawal from 2014 to 2019. Univariate tests and logistic regression were used to investigate potential correlates of PCP positivity on admission toxicology screening (primary outcome). Multivariable linear regression models and survival analyses analyzing LOS and risk of readmission (secondary outcomes) were also developed.

Results

Ninety of 3731 patients (2.4%) screened positive for PCP. There were significant associations on univariate testing between PCP positivity and age, race, homeless status, and urine toxicology positivity for amphetamines, benzodiazepines, barbiturates, cocaine, tetrahydrocannabinol, and oxycodone. On multivariate logistic regression, only tetrahydrocannabinol, barbiturates, and cocaine positivity were associated with PCP positivity. Multivariate logistic regression and survival analysis found no statistically significant associations between PCP positivity and LOS or risk of readmission.

Conclusions

This study provides rare analysis of contemporary data on PCP use among patients undergoing medically assisted alcohol withdrawal. Phencyclidine positivity was uncommon, but use appears considerably higher among this patient population than the general population. There was no significant association between PCP positivity and LOS or readmission risk.
Use of Socioeconomic Demographic Data in Studies on Pediatric Unilateral Hearing Loss: A Scoping Review
Authors: Zhang Amy L. , Kosoko-Thoroddsen Tinna-Sólveig F. , Thomas Deborah A. , Lieu Judith E. C.
Published: August 2023

Objectives:

Social determinants of health (SDOH) (healthcare access and quality, education access and quality, socioeconomic status, social and cultural context, neighborhood and built environment) (Healthy People 2030) have been shown to impact a wide range of health-related outcomes and access to care. Given the medical and nonmedical costs associated with children with unilateral hearing loss (UHL), the varied insurance coverage for hearing healthcare services, and the differences in hearing aid utilization rates between children of different sociodemographic classes, the sociodemographic information of children with UHL enrolled in research studies should be collected to ensure the generalizability of hearing healthcare interventions. Therefore, the objective of this scoping review is to assess the reporting of SDOH data for participants in studies of pediatric UHL and its comparison to population trends.

Design:

Two searches of published literature were conducted by a qualified medical librarian. Two reviewers then evaluated all candidate articles. Study inclusion parameters were from 2010 to present, peer-reviewed studies with prospective study design, and participant population including children (age 0 to 18 years old) with UHL.

Results:

Two literature searches using PubMed Medline and Embase found 442 and 3058 studies each for review. After abstract and paper review, 87 studies were included in final qualitative review, with 22 of these studies reporting race distribution of participants, 15 reporting insurance status or family income, and 12 reporting the maternal education level.

Conclusions:

Sociodemographic data are not commonly reported in research studies of children with UHL. In reported samples, research participants are more likely to have private insurance and higher family income compared with overall population distribution. These demographic biases may affect the generalizability of study results to all children with UHL. Further evaluation is warranted to evaluate whether participant recruitment affects outcomes that reflect the overall population.
Factors influencing outcomes of pelvic osteotomy for residual acetabular dysplasia following closed reduction in patients with developmental dysplasia of the hip
Authors: Li YiQiang , Liu Hang , Guo YueMing , Chen ShunYou , Canavese Federico , Liu YanHan , Li JingChun , Xu HongWen , Xia HuiMin ,   Chinese Multicenter Pediatric Orthopaedic Study Group (CMPOS)
Published: August 2023

To investigate the factors influencing outcome of pelvic osteotomy (PO) for residual acetabular dysplasia (RAD) following closed reduction (CR) in patients with developmental dysplasia of the hip (DDH). We retrospectively reviewed 91 patients (95 hips) with DDH who underwent PO for RAD. Tönnis grade, Acetabular index, Center Edge Angle, Reimer’s Index (RI), and avascular necrosis of the femoral head (AVN) were assessed. Hips were divided into satisfactory (Severin I/II) and unsatisfactory group (Severin III/IV). Finally, 87 hips (91.5%) had satisfactory and 8 (8.5%) unsatisfactory outcomes. The RI before PO was significantly higher in unsatisfactory (49.6 ± 9%) than in satisfactory group (30.6%±11.8%). All patients without AVN had satisfactory outcome, while it was 78.9% of patients with AVN. Logistic regression analysis showed that higher AVN grade and RI before PO were risk factors for unsatisfactory outcome. Satisfactory outcome was obtained in all hips with RI < 33% before PO, while it was 79.5% if RI > 33% before PO (79.5%). There was no difference in the satisfactory rate between patients undergoing open reduction (66.7%) and those not undergoing (83.3%). The rate of satisfactory outcome in patients undergoing femoral osteotomy (63.6%) was lower than those without it (100%). In patients with RAD following CR, good outcome can be expected after PO alone. AVN and preoperative RI > 33% are risk factors for poor outcome. Additional open reduction and femoral osteotomy do not significantly improve outcome of PO in patients with preoperative RI > 33%.
Evaluating Natural Language Processing Packages for Predicting Hospital-Acquired Pressure Injuries From Clinical Notes
Authors: Gu Siyi , Lee Eric W. , Zhang Wenhui , Simpson Roy L. , Hertzberg Vicki Stover , Ho Joyce C.
Published: August 2023

Incidence of hospital-acquired pressure injury, a key indicator of nursing quality, is directly proportional to adverse outcomes, increased hospital stays, and economic burdens on patients, caregivers, and society. Thus, predicting hospital-acquired pressure injury is important. Prediction models use structured data more often than unstructured notes, although the latter often contain useful patient information. We hypothesize that unstructured notes, such as nursing notes, can predict hospital-acquired pressure injury. We evaluate the impact of using various natural language processing packages to identify salient patient information from unstructured text. We use named entity recognition to identify keywords, which comprise the feature space of our classifier for hospital-acquired pressure injury prediction. We compare scispaCy and Stanza, two different named entity recognition models, using unstructured notes in Medical Information Mart for Intensive Care III, a publicly available ICU data set. To assess the impact of vocabulary size reduction, we compare the use of all clinical notes with only nursing notes. Our results suggest that named entity recognition extraction using nursing notes can yield accurate models. Moreover, the extracted keywords play a significant role in the prediction of hospital-acquired pressure injury.
Guillain–Barré Syndrome and COVID-19 Vaccine: A Multicenter Retrospective Study of 46 Cases
Authors: Castiglione Juan Ignacio , Crespo José Manuel , Bendersky Mariana , Silveira Facundo Oscar , Lecchini Lucila , Luis María Belén , Zambrano Francisco Caiza , Cotti Norberto , Simison Conrado J. , Aguirre Florencia , Piedrabuena María Agustina , Alonso Ricardo Nicolás , Azcona Carolina Laura , Sosa Pablo Sebastian , Maldonado Evangelina , Varela Francisco , Bettini Mariela , Rey Roberto D. , Cejas Luciana León , Rugiero Marcelo , Reisin Ricardo , Barroso Fabio
Published: August 2023

In the context of the global vaccination campaign against COVID-19, several cases of postvaccinal Guillain–Barré syndrome (GBS) were reported. Whether a causal relationship exists between these events has yet to be established. We investigated the clinical and electromyographic characteristics of patients who developed GBS after COVID-19 vaccination and compare these with findings in patients with GBS, without a history of recent vaccination. We included 91 cases between March 2020 and March 2022, treated at 10 referral hospitals of Buenos Aires, Argentina. Of these, 46 had received vaccination against COVID-19 within the previous month. Although Medical Research Council sum-scores were similar in both groups (median 52 vs. 50; P = 0.4), cranial nerve involvement was significantly more frequent in the postvaccination group (59% vs. 38%; P = 0.02), as was bilateral facial paralysis (57% vs. 24%; P = 0.002). No differences were found in clinical or neurophysiological phenotypes, although 17 subjects presented the variant of bilateral facial palsy with paresthesias (11 vs. 6; P = 0.1); nor were significant differences observed in length of hospital stay or mortality rates. Future vaccine safety monitoring and epidemiology studies are essential to demonstrate any potential causal relationship between these events.
Cytokines Single Nucleotide Polymorphisms (SNPs) Association With Myasthenia Gravis (MG) In Algerian Patients: A Case–Control Study On A Small Group
Authors: Bouchtout Mohamed Nadji , Meçabih Fethi , Boukadir Chahrazad , Attal Elias , Daoudi Smail , Benkortbi Halla , Touil-Boukoffa Chafia , Raache Rachida , Attal Nabila
Published: August 2023

Myasthenia gravis (MG) is an autoimmune disease of multifactorial etiology in which genetic factors and cytokines seem to play an important role. The aim of this study was to investigate potential associations of cytokines single nucleotide polymorphisms (SNPs) and MG in Algerian patients. We performed a case–control study that included 27 patients and 74 healthy subjects. Cytokines SNPs genotyping was performed by the polymerase chain reaction sequence–specific primers (PCR-SSP) method. Our results showed that the TNF-α −308G/A (P < 0.005) and TGF-β1 +869T/T (P < 0.05) genotypes were more frequent among patients with MG compared with healthy individuals, whereas TNF-α −308G/G (P < 0.0001), TGF-β1 +869T/C (P < 0.05), and IFN-γ +874A/A (P < 0.05) were less frequent. Our results also showed that IL-10 and IL-6 SNPs did not show any significant difference in distribution between MG patients and healthy individuals. Our observations support the hypothesis that implicates genetic variants of certain cytokines in MG. However, ours results should be replicated with a larger sample size. In addition, the precise underlying processes remain to be clarified.

Highlights

TNF-α −308G/A and TGF-β1 +869T/C genotypes predispose to MG.

IFN-γ +874A/A genotype protects against MG.

IL-6 −174C/G SNP is not associated with MG.
Congenital Myasthenic Syndrome Caused by DOK7 Mutation in a Quinquagenarian Male with Calf Hypertrophy
Authors: Gomathy Saranya B. , Das Animesh , Garg Ajay , Srivastava Achal Kumar
Published: August 2023

Congenital myasthenic syndromes (CMS) are relatively rare neurologic syndromes of defective neuromuscular transmission that stem from mutations in various proteins at the myoneural junction. Classically, the patients present within the first 2 years of life; however, the disease can also have onset in the second or third decade of life. The disease characteristically involves the skeletal muscles and spares smooth and cardiac muscles. The patients present with weakness involving ocular, limb, axial, or bulbar muscles. The specific diagnosis in most cases is clinched by genetic testing. We report a 59-year-old man presenting with neuromuscular weakness for 3 years and calf hypertrophy. He had myopathic features on electrophysiologic studies with a decremental response on repetitive nerve stimulation. Genetic testing confirmed a diagnosis of DOK7 CMS. He was managed with salbutamol and showed significant improvement.
Juvenile Dermatomyositis Without Skin Lesions in an Antinuclear Matrix Protein 2 Antibody Seropositive Pediatric Case
Authors: Kamoun Fatma , Laroussi Sirine , Mellouli Azza , Jallouli Olfa , Feki Sawsan , Ben Sassi Samia , Charfi Triki Chahnez
Published: August 2023

We report a 5-year-old boy who presented with progressive weakness in 4 limbs and gait disorders over 7 months. No skin rash was observed on admission. A symmetrical proximodistal weakness was found. The creatine kinase level was normal with a slightly elevated lactate dehydrogenase level. Biopsy specimens showed infiltration of mononuclear cells, few necrotic fibers, and perifascicular atrophy. Screening for myositis-specific antibodies was positive for the antinuclear matrix protein 2 antibody, which is mainly associated with dermatomyositis. Symptoms improved on receiving corticosteroids. Our findings suggest that in cases where inflammatory muscle disease is suspected, antinuclear matrix protein 2 antibody analyses should be considered for precise diagnosis, even with the absence of dermatological symptoms. The case suggests consideration of juvenile dermatomyositis in children with no associated skin manifestations or elevated creatine kinase levels and highlights the importance of screening for myositis-specific antibodies in helping with the diagnosis, given the possible heterogeneity of its clinical presentations.
Genetic polymorphisms effect on cyclophosphamide’s tolerability and clinical efficacy in Egyptian patients with lupus nephritis
Authors: Abuelsoud Nermeen N. , EL Khateeb Engy M.
Published: August 2023

Objectives

Many studies were conducted to determine the association between genetic polymorphisms in CYP2B6 c.516G>T and cyclophosphamide (CYC) efficacy or toxicity, no studies were focused on both clinical efficacy and toxicity of CYC. This study aimed to investigate the relationship between the CYP2B6 c.516G>T polymorphism (rs 3745274) and 17 different parameters related to CYC efficacy and tolerability in Egyptian patients with lupus nephritis (LN).

Methods

A prospective cohort study on 142 LN patients with a mean age of 36.26 was conducted at Kasr Al Ainy School of Medicine, Cairo University, Egypt after the exclusion of 14 patients due to receiving an interacting medication with CYC. All clinical parameters related to CYC efficacy or toxicity were recorded and compared between the different genotypes.

Results

There was a statistically significant difference between different genotypes in 11 out of 13 of the studied efficacy-related parameters. Many of the studied clinical parameters revealed that CYC’s efficacy was associated with the presence of the T allele. There was a statistically significant difference between different genotypes in hepatotoxicity, diarrhea, and blood-related toxicities.

Conclusion

To our knowledge, this study is the first study that focused on studying 17 different parameters related to CYC efficacy and tolerability. Our findings paint a picture of the function that CYP2B6 polymorphisms play in Egyptian LN patients. Pre-treatment evaluation of CYP2B6 rs 3745274 may account for some individual differences in treatment response.
Perioperative hormone treatment of endometriosis
Authors: Farkas William , Lazaridis Alexandros , Odejinmi Funlayo , Hirsch Martin
Published: August 2023

Purpose of review

The use of hormonally suppressive medication to reduce levels of reproductive hormones around the time of surgery is widely used in the management of endometriosis. This review summarizes the current evidence concerning the perioperative use of hormonal treatment in the management of endometriosis.

Recent findings

European Society of Human Reproduction and Embryology (ESHRE) guidance

Surgical Outcomes and Complications of Laparoscopic Hysterectomy for Endometriosis: A Multicentre Cohort Study

Pre and postsurgical medical therapy for endometriosis surgery. Cochrane 2020

Postoperative hormonal treatment for prevention of endometrioma recurrence after ovarian cystectomy: a systematic review and network meta-analysis. BJOG 2021

The literature highlights the importance of hormonal treatment for symptom relief, reduced surgical complications and postoperative benefits, including a reduction in pain, disease recurrence and improved pregnancy rates. The treatment of endometriosis can be broadly categorized into medical, commonly using hormonal suppression medications and surgical, in which endometriosis tissue is excised or ablated. This review aims to outline current management strategies and examines the relationship between the two treatment modalities.
Mid-face Massive Loss Reconstruction: Free Latissimus Dorsi Used as Both a Donor and Recipient for Two Subsequent Temporoparietal Flaps
Authors: El Danaf Ahmed A.
Published: August 2023

After a camel bite, a man lost much of his mid-face tissues, including right eye, nose, cheeks, upper lip, and palate. A free latissimus dorsi flap was used to simultaneously fill and cover the huge gap and to rebuild the new mouth roof. A few weeks later, it could also offer local hinged flaps working as raw beds to receive a converse scalping flap, and extended temporoparietal flaps were used for reconstruction of the nose and hairy upper lip, respectively. After 6 years, the face maintained height and width, and showed a marked sagittal shrinkage, obviously due to the absence of the vomero-maxillo-palatine skeletal axis. Despite this particular long-term inadequacy and flap insensitivity and inactivity, the new arrangement helped the patient to more easily socially integrate and to better eat, drink, and speak. This article highlights the consistency of free flaps to give and receive local and regional flaps.
Dual elastography to discriminate adjacent stages of fibrosis and inflammation in chronic hepatitis B: A prospective multicenter study
Authors: Jianping Dou , Xi Chen , Guangwen Cheng , Fankun Meng , Ying Zheng , Bulin Zhang , Wei Zhang , Yao Zhang , Zhiyong Yin , Hong Yang , Peng Lin , Jiaping Li , Zheng Chen , Shujing Wei , Xiting Xu , Chengcai Chen , Biwu Chen , Xuning Huang , Huiwen Fan , Jing Wu , Jiabao Zhu , Yuhuan Xie , Jingxin Lu , Hong Ding , Ping Liang , Jie Yu
Published: August 2023

Background and Aims:

To evaluate the diagnostic performance of dual elastography (dual-elasto) in continuous differentiation of liver fibrosis and inflammation in a large prospective cohort of patients with chronic HBV.

Approach and Results:

Adults with positive HBsAg for at least 6 months were recruited from 12 medical centers. Participants underwent dual-elasto evaluations. Biopsy was performed 3 days after dual-elasto examination. Four logistic regression models were trained and strung together into series models. Decision trees based on the series models were performed to achieve continuous differentiation of liver fibrosis and inflammation. The influence of inflammation on the fibrosis stage was also evaluated. A total of 560 patients were included in the training set and 240 in the validation set. Areas under the receiver operating characteristic curve of the series model were 0.82, 0.86, 0.93, and 0.96 to predict ≥F1, ≥F2, ≥F3, and F4 in the validation set, which were significantly higher than those of serum markers and shear wave elastography (all p < 0.05), except for the ≥ F1 levels (p = 0.09). The AUCs of the series model were 0.93, 0.86, 0.95, and 0.84 to predict inflammation stages ≥G1, ≥G2, ≥G3, and G4, respectively. Decision trees realized 5 continuous classifications of fibrosis and inflammation. Inflammation could enhance the mild fibrosis stage classification while showing limited influences on severe fibrosis or cirrhosis diagnosis.

Conclusions:

Dual-elasto demonstrated high performance in the continuous discrimination of fibrosis and inflammation in patients with HBV and could be used to diagnose mild fibrosis without the influence of inflammation.
Emerging and potential use of CRISPR in human liver disease
Authors: Adlat Salah , Vázquez Salgado Alexandra M. , Lee Markcus , Yin Dingzi , Wangensteen Kirk J.
Published: August 2023

CRISPR is a gene editing tool adapted from naturally occurring defense systems from bacteria. It is a technology that is revolutionizing the interrogation of gene functions in driving liver disease, especially through genetic screens and by facilitating animal knockout and knockin models. It is being used in models of liver disease to identify which genes are critical for liver pathology, especially in genetic liver disease, hepatitis, and in cancer initiation and progression. It holds tremendous promise in treating human diseases directly by editing DNA. It could disable gene function in the case of expression of a maladaptive protein, such as blocking transthyretin as a therapy for amyloidosis, or to correct gene defects, such as restoring the normal functions of liver enzymes fumarylacetoacetate hydrolase or alpha-1 antitrypsin. It is also being studied for treatment of hepatitis B infection. CRISPR is an exciting, evolving technology that is facilitating gene characterization and discovery in liver disease and holds the potential to treat liver diseases safely and permanently.