bluuebunny/crossref_metadata_2025 huggingface dataset:
Robustness of Felsenstein’s Versus Transfer Bootstrap Supports With Respect to Taxon Sampling
Authors: Zaharias Paul , Lemoine Frédéric , Gascuel Olivier
Published: August 2023

The bootstrap method is based on resampling sequence alignments and re-estimating trees. Felsenstein’s bootstrap proportions (FBP) are the most common approach to assess the reliability and robustness of sequence-based phylogenies. However, when increasing taxon sampling (i.e., the number of sequences) to hundreds or thousands of taxa, FBP tend to return low support for deep branches. The transfer bootstrap expectation (TBE) has been recently suggested as an alternative to FBP. TBE is measured using a continuous transfer index in [0,1] for each bootstrap tree, instead of the binary {0,1} index used in FBP to measure the presence/absence of the branch of interest. TBE has been shown to yield higher and more informative supports while inducing a very low number of falsely supported branches. Nonetheless, it has been argued that TBE must be used with care due to sampling issues, especially in datasets with a high number of closely related taxa. In this study, we conduct multiple experiments by varying taxon sampling and comparing FBP and TBE support values on different phylogenetic depths, using empirical datasets. Our results show that the main critique of TBE stands in extreme cases with shallow branches and highly unbalanced sampling among clades, but that TBE is still robust in most cases, while FBP is inescapably negatively impacted by high taxon sampling. We suggest guidelines and good practices in TBE (and FBP) computing and interpretation.
Reasons for Optimism About Academic Medicine’s Actions Against Climate Change
Authors: Mallon William T. , Deas Deborah , Good Michael L.
Published: August 2023

Since the first mention of climate change in Academic Medicine in 2009, the pace of the climate crisis has accelerated, its impacts on every facet of planetary health have grown more severe, and the urgency for humans to act has become more dire. Medical schools, teaching hospitals and health systems, universities, affiliated organizations, and the millions of people who traverse the halls of these institutions as leaders, physicians, scientists, educators, learners, patients and families, and community members have an obligation to respond. In this commentary, the authors describe 3 reasons they are optimistic that academic medicine will continue to act against climate change. First, the mission of academic medicine, inherently aligned with climate action, propels teaching hospitals and health systems to address climate change to improve the health of patients, families, and communities. Second, younger generations of learners, faculty, and staff who populate the workforce increasingly desire, and often demand, to work at institutions that are aligned with their personal values for climate action. Third, broader forces are pushing academic medicine forward in action against climate change. Economic factors will continue to reduce the cost and increase the return on investment of climate-smart facilities, purchased goods and services, fuel, transportation, food systems, and waste management. The authors are optimistic but not complacent. Current levels of climate action in academic medicine are not nearly enough. Faculty, staff, learners, leaders, patients and families, and community partners can and must apply a “climate lens” to everything they do: weave climate solutions into education, patient care, research, community collaborations, operations, and supply chain and facility management; integrate climate actions into strategic thinking, planning, and doing; address health inequities and climate injustice; and leverage their trusted voices to press for climate action and climate justice in the health sector and in society.
The c.415C>T polymorphism in NUDT15 is more frequent than the polymorphisms in TPMT in Chilean patients who use thiopurine drugs
Authors: von Muhlenbrock Christian , Estay Camila , Covarrubias Natalia , Miranda Julio , Venegas Mauricio
Published: August 2023

Azathioprine (AZA) and 6-mercaptopurine (6-MP) are drugs widely used in the treatment of autoimmune diseases. Among the enzymes involved in the metabolism of AZA and 6-MP are thiopurine methyltransferase (TPMT) and nudix hydrolase 15 (NUDT15). The existence of single nucleotide polymorphisms in the genes that code for these enzymes could decreased enzymatic activity AND lead to severe myelosuppression. The most relevant polymorphism is NUDT15*3 (rs116855232), where the replacement of cytosine for thymine at position 415, which in turn leads to a loss of enzymatic activity. In a previous study, it was identified that together the polymorphisms in the TPMT gene reach an allelic frequency of 3.81%. There is no information regarding the rs116855232 polymorphism in the NUDT15 gene, so this corresponds to the objective of this report. Blood samples from Chilean adult patients with indications for the use of AZA or 6-MP for different pathologies and who had undergone a TPMT gene polymorphism study were retrospectively analyzed. A total of 253 blood samples were analyzed. Of the 253 patients, 47 presented the c.415C>T polymorphism in the NUDT15 gene, 3 being homozygous and 44 heterozygous. Four of the heterozygous patients for NUDT15 also had the *3A variant in the TPMT gene, also heterozygous. The allelic frequency of the minor T allele found (9.88%) was very similar to that found in patients of Asian origin, and much higher than that reported for the European Caucasian or Latin American population.
Strategies to communicate pregnancy complications: a systematic review and practical points for healthcare professionals
Authors: Karapanos Ioannis , Bolou Angeliki , Nazer Maya , Iliodromiti Stamatina , Greco Elena
Published: August 2023

Purpose/methods

This systematic review aims to provide an overview of strategies available for healthcare professionals (HCPs) to effectively communicate unexpected news in pregnancy, specifically for the most common pregnancy complications. Three medical databases and grey literature were searched until March 2023 using subject headings and keywords. Snowball techniques were also used. The articles were reviewed at each stage of screening independently by two separate authors. Qualitative, quantitative and mixed methods studies were included.

Recent findings

Forty-three studies were included and grouped according to the gestational age of the pregnancy complication – miscarriage, increased risk screening, foetal conditions, stillbirth. The main key points for communication were outlined at each specific complication and eventually the six common themes that emerged from all the categories were included in the acronym PRICES (Preparation – Referral – Individualized care – Clarity – Empowerment – Sensitivity).

Given the negative impact of failed communications both in pregnancy outcomes and patients’ experience, we advocate that communication training for HCP providing pregnancy care should be mandatory, and skills should be updated at regular intervals. Tools like our acronym PRICES can be used during teaching HCPs how to communicate more effectively.
Distinct immune surveillance in primary biliary cholangitis and primary sclerosing cholangitis is linked with discrete cholangiocarcinoma risk
Authors: Nanjundappa Roopa H. , Christen Urs , Umeshappa Channakeshava S.
Published: August 2023

Primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC) are 2 major liver autoimmune diseases. PBC is common in women and primarily affects intrahepatic small bile duct epithelial cells, known as cholangiocytes. In contrast, PSC is dominant in men and primarily affects medium and big intrahepatic and extrahepatic bile duct epithelial cells. Cholangiocarcinoma (CCA) is a malignancy arising from cholangiocytes, and its incidence is increasing worldwide in both men and women. Numerous retrospective and clinical studies have suggested that PBC patients rarely develop CCA compared to PSC patients. CCA is accountable for the higher deaths in PSC patients due to ineffective therapies and our inability to diagnose the disease at an early stage. Therefore, it is paramount to understand the differences in immune surveillance mechanisms that render PBC patients more resistant while PSC patients are susceptible to CCA development. Here, we review several potential mechanisms contributing to differences in the susceptibility to CCA in PBC versus PSC patients.
Weeks-Ahead Epidemiological Predictions of Varicella Cases From Univariate Time Series Data Applying Artificial Intelligence
Authors: Wood David A.
Published: August 2023

Background

“Chickenpox” is a highly infectious disease caused by the varicella-zoster virus, influenced by seasonal and spatial factors. Dealing with varicella-zoster epidemics can be a substantial drain on health-authority resources. Methods that improve the ability to locally predict case numbers from time-series data sets every week are therefore worth developing.

Methods

Simple-to-extract trend attributes from published univariate weekly case-number univariate data sets were used to generate multivariate data for Hungary covering 10 years. That attribute-enhanced data set was assessed by machine learning (ML) and deep learning (DL) models to generate weekly case forecasts from next week (t0) to 12 weeks forward (t+12). The ML and DL predictions were compared with those generated by multilinear regression and univariate prediction methods.

Results

Support vector regression generates the best predictions for weeks t0 and t+1, whereas extreme gradient boosting generates the best predictions for weeks t+3 to t+12. Long-short-term memory only provides comparable prediction accuracy to the ML models for week t+12. Multi–K-fold cross validation reveals that overall the lowest prediction uncertainty is associated with the tree-ensemble ML models.

Conclusion

The novel trend-attribute method offers the potential to reduce prediction errors and improve transparency for chickenpox time series.
Surgery for severe mitral regurgitation: The etiology matters
Authors: Tsai Yi-Lin , Lee Ching-Wei , Huang Wei-Ming , Cheng Hao-Min , Yu Wen-Chung , Chen Chen-Huan , Sung Shih-Hsien
Published: August 2023

Background:

While surgery has been the standard treatment for patients with severe primary mitral regurgitation (PMR), the role of surgery for severe secondary mitral regurgitation (SMR) remained debated. We therefore investigated the prognostic differences of surgery for patients with either severe PMR or SMR.

Methods:

Subjects hospitalized for heart failure were enrolled from 2002 to 2012. The severity of MR was assessed by continuity equation, and an effective regurgitant orifice area of ≥40 mm2 was defined as severe. Long-term survival was then identified by the National Death Registry.

Results:

A total of 1143 subjects (66.4 ± 16.6 years, 65% men, and 59.7% PMR) with severe MR were analyzed. Compared with PMR, patients with SMR were older, had more comorbidities, greater left atrial and ventricular diameter, and less left ventricular ejection fraction (all p < 0.05). While 47.8% of PMR patients received mitral valve surgery, only 6.9% of SMR patients did. Surgical intervention crudely was associated with 54% reduction of all-cause mortality in PMR (hazard ratio, 0.46; 95% confident interval, 0.32-0.67), and 48% in the subpopulation with SMR (0.52, 0.30-0.91). Propensity score matching analysis demonstrated the survival benefits of mitral valve surgery was observed in patients with PMR (log rank p = 0.024), but not with SMR. Among the unoperated subjects, age, renal function, and right ventricular systolic pressure were common risk factors of mortality, regardless of MR etiology.

Conclusion:

Mitral valve surgery for patients with heart failure and severe MR was associated with better survival in patients with PMR, but not in those with SMR.
Assessing Adherence to Clozapine
Authors: Flanagan Robert J. , Hunter Samora , Obee Stephen J.
Published: August 2023

Background

The clinical assessment of adherence to clozapine may prove difficult.

Method

We studied the incidence of nonadherence (plasma clozapine <0.01 mg L−1) in samples submitted to a clozapine therapeutic drug monitoring (TDM) service, 1993–2017.

Results

Clozapine was not detected in 2865 samples from men (2214 patients, 1.1% of all samples from men) and 1068 samples from women (822 patients, 1.0% of all samples from women). Information on the prescribed dose was supplied for 1623 of these samples from men and 492 of these samples from women. Prescribed doses ranged up to 1200 mg d−1, although most were in the range 100 to 600 mg d−1. Norclozapine was detected in 260 (9.1%) and 67 (6.3%) of the samples from men and from women, respectively, that did not contain clozapine. While an assay was requested to confirm either a patient history of nonadherence, or to establish that clozapine had been cleared from the circulation after overdosage, for example, in at least 38 instances, in the vast majority of cases the absence of clozapine from the sample was unexpected.

Implications

While adherence to clozapine may be good in general, tolerance to its potentially fatal cardiovascular effects is easily lost. Moreover, in treatment-resistant schizophrenia, the risk of self-harm increases if the drug is not taken regularly. In addition to presently available TDM services, the advent of a clozapine immunoassay for laboratory use should make it easy to institute at least monthly clozapine TDM at minimal extra cost.
Consensus of clinical diagnosis and treatment for non-functional pancreatic neuroendocrine neoplasms with diameter <2 cm
Authors: Wu Wenming , Cai Shouwang , Chen Rufu , Fu Deliang , Ge Chunlin , Hao Chunyi , Hao Jihui , Huang Heguang , Jian Zhixiang , Jin Gang , Li Fei , Li Haimin , Li Shengping , Li Weiqin , Li Yixiong , Liang Tingbo , Liu Xubao , Lou Wenhui , Miao Yi , Mou Yiping , Peng Chenghong , Qin Renyi , Shao Chenghao , Sun Bei , Tan Guang , Wang Huaizhi , Wang Lei , Wang Wei , Wang Weilin , Wei Junmin , Wu Heshui , Wu Zheng , Yan Changqing , Yang Yinmo , Yin Xiaoyu , Yu Xianjun , Yuan Chunhui , Zhao Yupei
Published: August 2023

In clinical practice, pancreatic neuroendocrine neoplasms (pNENs) with a diameter smaller than 2 cm are commonly referred to as small pNENs. Due to their generally favorable biological characteristics, the diagnosis and treatment of small pNENs differ from other pNENs and are somewhat controversial. In response to this, the Chinese Pancreatic Surgery Association, Chinese Society of Surgery, Chinese Medical Association have developed a consensus on the diagnosis and treatment of small pNENs, which is based on evidence-based medicine and expert opinions. This consensus covers various topics, including concepts, disease assessment, treatment selection, follow-up, and other relevant aspects.
Orthosurgical approach of a skeletal class III malocclusion with mandibular laterognathia: a case report
Authors: Yosra Tabchi , Abdoul Hafizou Rabe Ammani , Fatima Zaoui , Hicham Benyahia
Published: August 2023

Skeletal class III malocclusion is characterized by an evident disharmony and discrepancy between the maxilla and mandible, affecting facial appearance and masticatory function. Usually, the association of transversal and vertical anomalies along with the anteroposterior problem makes the orthodontist’s job perceived as a challenge. The ortho-surgical approach can be considered as an efficient alternative for the treatment of skeletal class III malocclusion, and it requires an interdisciplinary relationship between the orthodontist and a maxillofacial surgeon. This case report presents a 25-year-old female patient who consulted with a chief complaint of unsatisfactory facial esthetics. The clinical examination revealed a skeletal class III mainly due to maxilla hypoplasia accompanied with mandibular laterognathism, causing a unilateral posterior crossbite. The patient was treated with the ortho-surgical approach. The treatment objectives were achieved, providing a stable class I occlusion with an acceptable overjet and overbite, coordinated midlines, and a satisfactory facial profile with an excellent esthetic balance between the hard and soft tissue.
Two case reports of adult traumatic inferior hip dislocations following road traffic accidents without complications
Authors: Najafi Arvin , Shahbazi Parmida , Zargar Danoosh , Gholami Niloofar , Hadavi Dorsa , Mirhoseini Mohammad S.
Published: August 2023

Introduction and Importance:

Inferior dislocation of the hip is the rarest type of hip dislocation, mainly occurring from high-energy incidents, mostly from road traffic accidents or sports. It is generally an injury among adults.

Case presentation:

A 17-year-old male sustained injuries as a pedestrian, and a 30-year-old male sustained a traffic accident as a motorcycle rider. Both patients complained of severe pain in the hip, decreasing range of motion, and the inability to weight bearing. In both, the affected hip joint was fixed in 90° flexion, abduction, and external rotation, and the leg was slightly shorter than the other limb. An X-ray showed the inferior dislocation of the right hip and left hip, respectively, without any sign of fracture. We reduced both dislocations closely after sedation without any complications during follow-ups.

Conclusion:

This injury should be treated as an emergency, and reduction performed as soon as possible, within 6 h. It can be managed usually with closed reduction under general anesthesia. Close follow-up is necessary to prevent its complications, including avascular necrosis, associated fractures, neurovascular compromise, and articular cartilage injuries.
Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes syndrome: a case report from Nepal
Authors: Subedi Ram C. , Paudel Raju , Paudel Sharma , Thapa Lekhjung , Phuyal Subash , kharbuja Naresh , Adhikari Ayush
Published: August 2023

Introduction and importance:

Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like syndrome (MELAS) is a rare neurodegenerative inherited disorder that is characterized by stroke-like episodes, seizures, endocrine, and multiple system involvement. It is important to consider it as a differential diagnosis in a young patient with stroke-like episodes as it is progressive and has multiple complications.

Case presentation:

A 28-year-old male presented with slurring of speech and drowsiness for 7 h. He was a diagnosed case of type 2 diabetes mellitus, Wolf-Parkinson-White syndrome, and bilateral hearing loss.

Clinical findings and investigations:

The patient had expressive aphasia with impaired fluency, repetition, and naming. After being discharged, he represented with loss of consciousness and involuntary movements of the whole body. MRI and MRS showed extension of hyperintense lesions to parieto-occipital regions from temporal regions not limited by vascular territories. MELAS was considered, which was confirmed by molecular genetic analysis. Coenzyme Q10 was used for MELAS. Insulin, Linagliptin, and levetiracetam were used for diabetes and seizures. Regular follow-up was advised to the patient.

MELAS is an important syndrome to consider in any young patient presenting with unexplained stroke disorders. A high index of suspicion is needed in an appropriate clinical setting to avoid misdiagnosis.
Cultural patterns and outcome of umbilical cord care among caregivers in Africa: a systematic review
Authors: Abua Monica Agianipe , Antor Odu Ndep , Madubuattah Louis Chinweike , Ogunkola Isaac Olushola
Published: August 2023

Background:

The third leading cause of death in infants under 1-month-old is neonatal sepsis. Following the severing of the umbilical cord, bacterial infection may result in newborn sepsis and mortality. The objective of this review on cultural patterns and umbilical cord-care outcomes is to evaluate present practices and create a case for developing and implementing novel cord-care regimens in Africa.

Materials and methods:

In order to find published studies on cultural patterns and outcomes of umbilical cord care among caregivers in Africa from January 2015 to December 2021, we conducted a systematic literature search across six computerized bibliographic databases: Google Scholar, POPLINE, PubMed, Web of Science, Science Direct, and Scopus. As a result, a narrative synthesis of quantitative and qualitative data was employed to summarize the data from the included research.

Results:

There were 17 studies included in this review with 16 out of the 17 studies having a total of 5757 participants. The odds of neonatal sepsis were 13 times higher among infants whose caregivers had improper hygiene compared with those who had proper hygiene. The outcome of cord management showed that the majority (75.1%) of the umbilical cords were infected. Majority of the included studies (n=13) show that the respondents (caregivers) had a low level of knowledge and practice.

Conclusion:

This systematic review reveals that unsafe umbilical cord-care practices remained prevalent in some African regions. Home delivery is still a prevalent practice in some communities and inappropriate umbilical cord cleaning practices were common findings.
Liver injury in COVID-19: prevalence and its associated factors in Nepal – A retrospective cross-sectional study
Authors: Rajbhandari Bibek , Pant Suman , Hamal Achyut B. , Thapa Ashish , Shrestha Apurba , Shrestha Saurav , Shrestha Anil , Panta Niranjan , Pandey Udesh , Nepal Mukul Upadhyay , Shilpakar Olita
Published: August 2023

Background:

Liver impairment has been reported as a common clinical manifestation in patients with Severe Acute Respiratory Syndrome Coronavirus 2 infection, with varying degrees of severity ranging from a mild elevation of liver enzymes to acute liver failure. However, the prevalence and clinical significance of liver injury in Coronavirus Disease 2019 (COVID-19) patients, particularly in low- and middle-income countries such as Nepal, remains poorly understood. To investigate the hepatic injury related to this disease and its clinical significance, the authors conducted a retrospective study that included adult patients with COVID-19 infection in security hospitals of Nepal.

Methodology:

The authors performed a retrospective chart review on 1007 COVID-19-positive patients who underwent a liver function test during their admission in two COVID-19 dedicated hospitals in Nepal from April 2021 to January 2022. The data were collected and entered into Microsoft Excel before being exported to SPSS version 24 for analysis. Univariate and multivariate logistic regression were used to determine factors associated with liver injury. We reported adjusted odds ratios (aOR) with 95% CI.

Results:

Of the total, 549 (54.5%) patients had an acute liver injury. Among 549 patients, 68.1% were mild, 27.9% were moderate, and 5.0% were severe. Out of 1007 patients, 1.4% had cholestatic liver injury. Most patients with mild, moderate, and severe liver injury had greater than or equal to 10 C-reactive proteins (CRP). In multivariate logistic regression, sex, and CRP were significantly associated with the presence of liver injury. Males had 1.78 times higher odds of having a liver injury compared to females (aOR:1.78; 95% CI: 1.37–2.30, P-value:<0.001). Similarly, patients who had CRP greater than 10 had higher odds of having liver injury compared to those who had CRP less than 10 (aOR: 1.84; 95% CI: 1.41–2.39; P-value: <0.001).

Conclusions:

The present study reveals that COVID-19 infection is commonly associated with mild increased liver enzymes. However, the likelihood of developing acute liver injury was found to be higher in patients with an inflammatory state indicated by CRP levels greater than 10. Furthermore, the study highlights the sex-based difference in the prevalence of liver injury, with males demonstrating a higher predisposition.
Lipectomy for madelung disease using tumescent technique: a cross-sectional study
Authors: Duc Nguyen Quang , Tien Nguyen Phuong , Tu Nguyen Thanh , Huynh Hoang Ngoc , Linh Le Diep
Published: August 2023

Background:

Madelung’s disease is a rare disfiguring disorder that affects both function and esthetic appearance in the head and/or shoulder, neck, and arms regions. Lipectomy is typically necessary but such treatment can encounter difficulties due to the large sizes of the tumors, interspersed with important organs in the surrounding region. In this report, the authors evaluate the effectiveness of using tumescent solution in lipectomy to provide a dual treatment of tissue removal for Madelung disease in the head-and-neck region.

Methods:

A prospective study and clinical descriptions were conducted on 17 patients undergoing 26 head-and-neck lipectomies. A tumescent solution was injected into the surgical region with a blunt-tip cannula 5–10 min before skin incision. The authors recorded systemic manifestations both during and after surgery; tumescent volume; surgical region; clarity of the operative field; weight of fat removed, and early complications. After surgery, the authors followed the patients from periods of 3 months to 4 years.

Results:

All 17 male patients had a history of alcoholism. In total, 12 lipectomies for the removal of anterior neck fatty masses and 14 lipectomies for the removal of posterior neck fatty masses were performed. The average amount of tumescent injected was 260.1 ml (range 140–550 ml). Surgery was reported as totally bloodless in 10 (38.5%) operative fields, with minimum bleeding in 12 (46.1%) operative fields, acceptable bleeding in four (15.4%) operative fields. The average surgical time was 175.6 min (range 135–250 min). The removed fatty masses weighed between 250 and 2150 g, with an average of 582.9 g. Early complications were seen in four patients, accounting for 15.4% (2 hematoma, 1 skin necrosis, and 1 seroma).

Conclusions:

Using tumescent solution in lipectomies to treat Madelung disease in the head and neck area is a simple, safe, and useful technique. The technique helps to create a clean operative field, reduces bleeding, and thereby assists surgeons during the operation.
The effectiveness of adolescent-oriented mindfulness training on academic burnout and social anxiety symptoms in students: experimental research
Authors: Abarkar Zabihullah , Ghasemi Mohammad , Mazhari Manesh Ebrahim , Mehdibeygi Sarvestani Maryam , Moghbeli Nina , Rostamipoor Narges , Seifi Zahra , Bakhshi Ardakani Maryam
Published: August 2023

The aim of this study was to investigate the effectiveness of adolescent-oriented mindfulness training on academic burnout and social anxiety symptoms in students. The current study was a semi-experimental type with a pretest–posttest design with a control group with the measurement at baseline after the intervention and a 3-month follow-up. The statistical population included all high school students with symptoms of social anxiety who were studying in Tehran in the academic year 2022. Among the students, 100 students were selected as a sample by purpose-based sampling and randomly assigned to two experimental and control groups (50 people). The tools of this research were a researcher-made demographic questionnaire, social anxiety questionnaire, academic burnout questionnaire, and adolescent-oriented mindfulness protocol. Data analysis was performed using analysis of variance with repeated measures. The results showed that adolescent-oriented mindfulness training had a significant effect on reducing academic burnout and social anxiety symptoms of students (P<0.001). Based on the findings of the research, it can be said that adolescent-oriented mindfulness training is effective in reducing academic burnout and social anxiety symptoms of students.
Taurine as a potential anti-ageing therapy: the key to reversing the ageing process? Short communication
Authors: Sheikh Ayesha , Iqbal Maham
Published: August 2023

Taurine supplementation may be a viable solution to the problem of our cells manufacturing potentially hazardous by-products known as ‘free radicals’. Some of these chemicals serve crucial biological activities, but excessive amounts can harm internal cell structures, reducing the cells’ capacity to operate. The regulatory systems that contribute to maintaining a healthy balance of reactive oxygen species in the body deteriorate with age. Thus, in this article, we examine how the amino acid taurine could be used in anti-ageing therapy, as well as its mechanism of action, consequences and suggestions.
Intraoperative endoscope view classification of neurovascular compression in hemifacial spasm condition: a single neurosurgeon prospective cross-sectional study
Authors: Pham Anh Hoang , Duong Ha Dai , Dong He Van , Chu Hung Thanh , Nguyen Linh Duy , Bryan Lieber
Published: August 2023

Introduction:

Hemifacial spasm is a neurological disorder that causes involuntary contractions of facial muscles on one side of the face. This study aims to analyze the intraoperative pattern of neurovascular compression (NVC) and discuss relevant decompression techniques for 29 patients with hemifacial spasm who underwent endoscopy-assisted microvascular decompression (EAMVD).

Patients and Methods:

This was a prospective, single center, single neurosurgeon, cross-sectional study conducted from November 2020 to August 2022. All patients received EAMVD, and the NVC culprit vessel, compression site, severity, and type were analyzed using a 30-degree endoscope.

Results:

All 29 patients had successful interposition EAMVD without postoperative symptoms. The most common NVC site was REX (18 in 29 cases), the most common vessel to compress the seventh nerve was AICA (23 in 29 cases), while the most common type of NVC was loop (22 in 29 cases). NVC severity: 17 cases of mild compression, 4 cases of moderate compression, and 8 cases of severe compression. Without an angled telescope, we will miss the NVC in 12 cases (41.3%).

Conclusion:

EAMVD using an angled endoscope is a promising technique for treating hemifacial spasm. Intraoperative analysis of NVC can lead to a better understanding of the patterns of compression and may help in selecting appropriate decompression techniques.
Hinge abduction hip dysplasia in (morquio a syndrome) treated by proximal femoral valgization osteotomy: a rare case report
Authors: Alkhateeb Ameen , Aboujaib Muhammed Fayez
Published: August 2023

Introduction and importance:

Morquio A syndrome or mucopolysaccharidosis type IVA (MPS IVA) is an autosomal recessive and is a result of the abnormal metabolism of glycosaminoglycan, which manifests with normal intelligence, a cloudy cornea, dysfunction of endochondral ossification of epiphyseal cartilage, severe hip dysplasia, pain, impaired mobility, severe genuvalgum, thoracic kyphosis, and C1–C2 instability. An important manifestation is hinge abduction hip as an abnormal movement of the hip, which occurs when a deformed femoral head (often with a large uncovered anterolateral segment) impinges on the lateral lip of the acetabulum. Clinically appears as a restriction of movements, pain, and an unpleasant clunking sensation.

Case presentation:

A 10-year-old girl suffering from MPS IVA with many signs of orthopedic manifestations. When concentrating on the hip joint, she had acetabulofemoral dysplasia and hinge abduction hip with the aid of plain radiographs and arthrography with dynamic testing. A valgization osteotomy of the proximal femur in combination with a shelf acetabuloplasty was performed bilaterally.

Clinical discussion:

There is no documented case of valgus osteotomy of the proximal femur in MPS IVA patients. Furthermore, preoperative arthrographies are not described as a routine diagnostic tool, because the routine surgical procedure was to do varus osteotomy with a high rate of failure.

Conclusion:

In our opinion, understanding of the dynamic function of the hip is essential for the surgical decision-making process. Our successful case with an 8-year follow-up illustrates that the well-known and widely performed valgus osteotomy in cases of hinge abduction in MPS IVA is an alternative, which should be considered preoperatively.
Vitamin D and polycystic ovary syndrome (PCOS): a review
Authors: Mohan Anmol , Haider Ramsha , Fakhor Hajar , Hina Fnu , Kumar Vikash , Jawed Aleeza , Majumder Koushik , Ayaz Aliza , Lal Priyanka Mohan , Tejwaney Usha , Ram Nanik , Kazeem Saka
Published: August 2023

A common health problem known as polycystic ovarian syndrome (PCOS), is characterized by irregular periods, an excess of androgen production, and polycystic ovaries. It is one of the most prevalent endocrine disorders in women of reproductive age, affecting 4–20% of women worldwide. Numerous studies have found a connection between the onset and symptoms of PCOS and Vitamin D insufficiency. Vitamin D insufficiency causes calcium dysregulation and follicular arrest in women with PCOS, which is connected to menstrual irregularities and fertility issues. Studies have connected PCOS metabolic alterations to VDR polymorphisms such as iApa-I, Taq-I, Cdx2, and Fok-I. Insulin resistance is directly related to Vitamin D, is one of the most distinctive characteristics of the PCOS phenotype. Thus, it is suggested that Vitamin D therapy may help PCOS patients with their insulin sensitivity. In addition to insulin resistance, cardiovascular issues are a second metabolic disturbance that PCOS patients with low Vitamin D levels experience. Dyslipidemia is not linked to an increased risk of cardiovascular disease in PCOS-affected women. Vitamin D dramatically improves glucose metabolism by increasing insulin production, insulin receptor expression and reducing pro-inflammatory cytokines. The effect of Vitamin D on the metabolic and reproductive dysfunctions associated with PCOS may be mediated by an overall impact on insulin resistance. Vitamin D supplementation improved menstrual periods, increased folliculogenesis, and decreased blood testosterone levels in PCOS patients, all of which had a significant impact on the ability to procreate. As a result, it might be a cutting-edge therapeutic strategy for treating PCOS concurrently.
Fatal rhabdomyolysis caused by COVID-19 infection: a case report
Authors: Khalayli Naram , Ibrahim Raghad , Ibrahim Rahaf , Kudsi Maysoun
Published: August 2023

Introduction and importance:

COVID-19 is a systemic viral disease complicated with medical conditions. Severe rhabdomyolysis during the COVID-19 course is not until now well known.

Case presentation:

The authors presented a 48-year-old female with fatal rhabdomyolysis caused by COVID-19 infection. She was referred to us with cough, generalized myalgia and arthralgia, and fever during the last week. Laboratory results showed an elevated erythrocyte sedimentation rate, elevated C-reactive protein level, and elevated creatine kinase. The nasopharyngeal swab confirmed the diagnosis of coronavirus 2 RNA infection. She was managed initially in the COVID-19 isolation department. Three days later, she was transferred to the intensive care unit and mechanically ventilated. Laboratory results were consistent with rhabdomyolysis. She died because of cardiac arrest due to continuous hemodynamic deterioration.

Clinical discussion:

Rhabdomyolysis is a serious condition that can be fatal or cause disability. Rhabdomyolysis cases have been reported in COVID-19 patients.

Conclusion:

Rhabdomyolysis cases have been reported in COV19 patients. Further studies are needed to understand the mechanism and to optimize the treatment.
Primary melanoma of the rectum: a case report of a rare tumor
Authors: Tran Thang , Pham Phuong Thanh , Nguyen Hoa Thi , Hoang Cuc Thi
Published: August 2023

Introduction and importance:

Malignant melanoma has a generally poor prognosis and occurs primarily on the skin but may rarely be found in internal organs such as the small intestine, colon, or rectum.

Case presentation:

This report presents a case of a 78-year-old male patient with stage IV gastrointestinal melanoma, which is a rare form of melanoma. The patient received first-line pembrolizumab with a complete response.

Clinical discussion:

Surgery plays a crucial role in local and regional control for patients with localized stages. Immune checkpoint inhibitor therapy, including nivolumab or pembrolizumab, is a well-studied and proven effective treatment option for patients with advanced skin melanoma. In this case report, the patient with gastrointestinal melanoma also had a very good response to immunotherapy.

Conclusions:

Understanding gastrointestinal melanoma is still limited due to the rarity of this clinical entity. Currently, there are no standard treatment guidelines for this rare group of patients. Immune checkpoint inhibitors could be the preferred first-line therapy for patients with distant metastases.
Decreasing mRNA HMGB1 expression in Klebsiella pneumoniae infection treated by Miana (Coleus scutellarioides (L.) Benth): a cohort experimental study
Authors: Akaputra Risky , Hatta Mochammad , Massi Muhammad N. , Djaharuddin Irawati , Bukhari Agussalim , Aminuddin Aminuddin , Santoso Arif , Natzir Rosdiana , Bahar Burhanudin , Fachri Muhammad , Farsida Farsida , Fathimah Agus , Ubaidah Firda M. , Sridiana Eva , Dwiyanti Ressy , Syukri Ahmad , Junita Ade R. , Febrianti Andini , Primaguna Muhammad R. , Azhar Azhar
Published: August 2023

Background:

Pneumonia is one of the most common infections caused by the bacterium Klebsiella pneumoniae. During the initiation of an infection, the immune system recognizes the pathogen through the release of high mobility group box 1 (HMGB1), thereby triggering the inflammation process. Miana has demonstrated potent inhibitory effects on the inflammatory process during infection in animal models. The aim of this study was to determine the effect of Miana leaf extract on mRNA HMGB1 expression in Balb/c mice infected with K. pneumoniae.

Methods:

This study comprised a cohort experiment using 20 Balb/c mice divided into four groups. Balb/c mice in each group were intraperitoneally injected with K. pneumoniae. Group 1 was given a placebo; Group 2 was given Miana; Group 3 was given levofloxacin; and Group 4 was given both levofloxacin and Miana. The levels of mRNA HMGB1 expression were measured using real-time PCR before, during, and after the infection as well as after the treatments.

Results:

The initial examination results showed that the average level of mRNA HMGB1 expression was 5.51 fc. The mRNA HMGB1 expression in mice after being challenged with K. pneumoniae was 9.64 fc. Group 1 that was given a placebo had a mean mRNA HMGB1 expression level of 14.99 fc. Group 2 that was given Miana had a mean mRNA HMGB1 expression level of 13.95 fc. Group 3 that was given levofloxacin had an average mRNA HMGB1 expression level of 6.45 fc, and Group 4 that was given levofloxacin and Miana together had an average mRNA HMGB1 expression level of 5.59 fc.

Conclusion:

Miana (Coleus scutellarioides (L.) Benth) increased mRNA HMGB1 expression at the initial administration via regulation of the immune system. Administration of Miana following K. pneumoniae infection inhibited the increase in mRNA HMGB1 expression. Treatment with levofloxacin reduced the level of mRNA HMGB1 expression, and the effect was optimized by the administration of Miana leaf extract as a supplement.
Digestive hemorrhage and fever as a result of a double secondary aortoenteric fistula following the repair of a juxtarenal abdominal aortic aneurysm and an infection of the aortobifemoral bypass graft: a case report
Authors: Abu Jheasha Amal A. , Ashhab Moutasem , Dukmak Osama N. , Maraqa Mohamed , Emar Mohammad , Jubran Fahmi , Alhusseini Rajai
Published: August 2023

Introduction:

A double secondary aortoenteric fistula (AEF) occurs in a patient who has had significant aortic surgery and is characterized by a direct connection between the gastrointestinal (GI) tract and the aorta at two separate sites.

Importance:

During aortoc reconstructive surgery, the patient may present with a variety of unusual complaints, including fever and GI bleeding. These symptoms are indicative of problems, including the development of an aortoentric fistula, particularly when there is a double secondary fistula.

Case presentation:

The patient was admitted to the hospital due to hematemesis, melena, and high-grade fever after undergoing synthetic grafting aortobifemoral bypass (anatomical reconstruction) and partial resection of the juxtarenal abdominal aortic aneurysm. Pus discharge and a double aortoenteric fistula in unusual sites such as the second-third portion of the duodenum and caecum are visible in upper GI endoscopy and computed tomography angiography. The patient underwent a two-stage open surgery, the first stage involving aortic limb graft exclusion and extra anatomical reconstruction, and the second stage involving graft removal, fistula management, and bowel repair. Then the patient spent a few days in the surgical intensive care unit before being discharged.

Clinical discussion:

Primary and secondary AEF are the two categories of AEF. In patients who underwent aortic reconstruction surgery, the frequency of secondary AEF ranges from 0.36 to 1.6%. Due to the 8:1 injury ratio in the secondery AEF, men suffer more injuries than women.There are two types of fistula depending on whether or not the suture line is involved. The first form is graft enteric erosion, which excludes the suture line, while the second type is entric graft fistula, where the suture line is included. Most common site fistula is third and fourth part of duodenum and least common site is fistula formation in large bowel.

Conclusions:

An uncommon complication is double secondary AEF following aortic reconstruction surgery. Since one of the most significant presentations an AEF patient can present with is major GI bleeding and sepsis, A delay in seeking immediate medical treatment could result in the patient’s death. It should be emphasized that one of the mechanisms for AEF formation and a frequent cause of sepsis in patients is recurrent aortic graft infection following aortic reconstruction surgery.
Case report for a patient with an inguinal hernia diagnosed with an Amyand’s hernia during surgery
Authors: AlKwider Hussam A. , Froh Mamon
Published: August 2023

Introduction and importance:

Amyand’s hernia is rare, occurs when the appendix is located within the hernial sac, is difficult to diagnose prior to surgery, and is considered to be discovered during surgery.

Case presentation:

A 4-year-old child was brought to the medical clinic by her mother with a swelling complaint in the right inguinal region. Following clinical diagnosis and imaging tests, an indirect inguinal hernia was found to be present. It was decided to perform surgery on the child, and he was taken to the operating room and given general anesthesia. An incision was made on the right inguinal side, reaching the spermatic cord and the ostium internum, where a hernia sac was found containing the inflamed appendix. The appendix was removed from the edges of the hernia sac, tied off at its base, and cut. Finally, the hernia sac was closed without the use of a mesh, the surgical incision was closed, and the wound was dressed.

Clinical discussion:

The diagnosis of inguinal hernia is initially made based on the symptoms presented by the patient, as well as through ultrasound imaging. For surgical management, there is a classification called Losanoff and Basson, which discusses the surgical treatment options necessary for different types of Amyand hernias. The hernia is classified into four types based on the clinical presentation of the patient and the condition of the appendix, and each type has its own treatment.

Conclusion:

Amyand’s hernia is an uncommon condition diagnosed during surgery.
Esophageal cancer operation in the COVID-19 era: are the outcomes different from its past in an observational cohort study?
Authors: Shirkhoda Mohammad , Basravi Monem , Jalaeefar Amirmohsen , Farhangian Mehdi , Memari Fereydoun , Meidani Mohsen
Published: August 2023

Background:

COVID-19 spread rapidly and potentially affected every medical profession, including surgery. This study aims to compare the postoperative outcomes of oesophageal cancer surgeries in COVID-19 age and a year before.

Methods:

This retrospective cohort study was performed as a single-centred study from March 2019 to March 2022 at Cancer institute, Tehran, Iran. Demographic data, cancer type, surgical procedures, and postoperative outcomes and complications were compared between the two groups pre-COVID-19 and during the COVID-19 pandemic.

Results:

Totally, 120 patients enroled in the study, of which 57 underwent surgery before the COVID-19 pandemic, and 63 during the COVID-19 pandemic. The mean age in these groups was 56.9 (±12.49) and 58.11 (±11.43), respectively. Females included 50.9% and 43.5% of individuals who underwent surgery before and during the COVID-19 pandemic. The interval between admission and surgery was significantly shorter in patients underwent surgery during the COVID-19 pandemic (5.17 vs. 7.05; P=0.013). However, there was no significant difference between time interval between surgery and discharge [11.68 (7.81) vs. 12 (6.92); P=0.689]. Aspiration pneumonia was the most common complication in both groups. There was no significant difference between postoperative complications in both groups.

Conclusion:

Outcomes of oesophageal cancer surgeries in COVID-19 age in our institution were comparable with the year before the pandemic. The decrease in the time interval between surgery and discharge did not lead to an increase in postoperative complications and could be noted for post-COVID-19 era policymaking, too. This study suggests not postponing any of the surgical treatments for oesophageal cancer in the COVID-19 era.
Cerebellopontine angle meningioma in a patient presented as acute cerebrovascular accident
Authors: Hassan Mohamed Sheikh , Köksal Ayhan
Published: August 2023

Introduction and importance:

Cerebellopontine angle (CPA) meningioma is a slowly growing benign tumor of the brain that may compress adjacent neural structures. It has variable clinical presentations that progress very slowly depending on its growth pattern and associated mass effect. A sudden onset clinical presentation is unusual and should prompt consideration of other potential etiologies.

Case presentation:

Here, the authors present a 66-year-old male patient with diabetes, hypertension, and hyperlipidemia who presented to the emergency department of our hospital with sudden onset walking difficulty (ataxia). On examination, the patient was fully conscious. There was no associated cranial nerve deficit, hearing loss, or focal/lateralizing weakness. All sensory modalities were intact. However, the patient had a gait impairment. Romberg and tandem gait tests were positive with the tendency to sway to the left. The patient was admitted with suspicion of acute cerebrovascular disease. The initial noncontrast brain computed tomography and subsequent diffusion MRI were inconclusive. A later brain MRI with contrast revealed a homogeneously contrast enhancing meningioma in the left CPA.

Clinical discussion:

The differential diagnosis of sudden onset ataxia is broad and should include the assessment of a possible CPA lesion. Sudden onset ataxia by a CPA meningioma is very rare as meningiomas grow very slowly. A brain MRI with contrast is essential for its diagnosis.

Conclusion:

Although stroke is the main cause of sudden onset ataxia in a patient with cerebrovascular risk factors, yet other less common causes may be found as in this case of CPA meningioma.