bluuebunny/crossref_metadata_2025 huggingface dataset:
Fixation of Tibial Plateau Fractures Type 5,6 by Ilizarov Apparatus: A Systematic Review of Outcomes and Complications
Authors: AbouSeif Salah , Kotb Mohamed Ismail , Abass Ahmed Magdy Abdel Fattah
Published: November 2024

Background

Complex proximal tibial fractures especially tibial plateau are one of the most challenging problems in fracture surgery. Treatment of complex tibial plateau fractures remains difficult. The soft tissue component to the injury necessitates careful timing of surgical fixation in order to minimize wound complications.

Objective

To compare the 2 Methods of fixation in management of Tibial plateau fractures (Schatzker type V & VI) as regards many aspects including but not limited to; superficial infection, deep infection, osteoarthritis, Functional & Radiological outcome, compartemental syndrome& postoperative stiffness.

Patients and Methods

Search results was conducted to systematic review management software and manually screened for eligibility to be included. Comparing Ring fixator and ORIF in outcomes and complications for treatment of high-energy fractures (Schatzker type V&VI) of the proximal tibia.

Results

The results showed that Ilizarov had a higher proportion of cases with excellent functional results compared to ORIF (57.1% vs 24.3%). In addition, the proportion of cases with poor functional results was lower in the Ilizarov group compared to the ORIF group (6.1% vs 25.7%). This revealed a significant difference between the two surgical techniques (p-value = 0.001), indicating that Ilizarov was associated with better functional outcomes compared to ORIF. These findings suggest that Ilizarov may be a more effective surgical technique for achieving better functional outcomes in patients with limb injuries. However, it is important to note that the included studies had some limitations, such as small sample sizes and potential biases. Further studies with larger sample sizes and more rigorous methodologies are needed to confirm these findings and to provide more conclusive evidence on the comparative effectiveness of Ilizarov and ORIF.

Data Sources

Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal) and all materials available in the Internet till 2022.

Conclusion

This meta-analysis reviewed and compared the outcomes of two different surgical techniques, Ilizarov and ORIF, in treating limb injuries. The results showed that there was no statistically significant difference between the two techniques in terms of superficial infection, deep infection, osteoarthritis, compartmental syndrome, and stiffness. However, ORIF had a faster time to radiographic union compared to Ilizarov. In terms of functional outcomes, Ilizarov was associated with better outcomes compared to ORIF. These findings suggest that Ilizarov may be a more effective technique for achieving better functional outcomes in patients with limb injuries. Nonetheless, the limitations of the included studies need to be considered, and further research with more robust methodologies is necessary to confirm these findings.
Percutaneous Fixation of Scaphoid Fractures: A Systematic Review
Authors: Hussein Mohamed Hussein Mohamed , Hewaidy Ayman Ibrahim Fathy , Nabil Yasin Amr Mohamed
Published: November 2024

Background

percutaneous fixation of acute non-displaced or minimally displaced scaphoid fractures, especially in young active individuals in whom prolonged immobilization can be a significant burden, provides excellent results regarding functional outcome, earlier gain of motion of the wrist, earlier time to union, quicker return to activity of daily living, and a lower complication rate.

Aim of the Work

to assess the outcomes of acute, un-displaced scaphoid fractures managed with percutaneous or mini-open screw fixation in terms of time to return to work (RTW), time to union, morbidity, and functional evaluation of the outcome.

Materials and Methods

This is a systematic review done in percutaneous fixation of scaphoid fractures.

Results

One hundred and nine patients were included in this study who undergone percutaneous fixation of scaphoid fracture. The range of age was between 16-55 years old. There was male predominance with 79% compared to females. 60% of included patients was RT handed dominant. Regarding complications 15.6% of cases (total of 17 patients) were complicated. Complications were like screw protrusion, sympathetic dystrophy, non-union, wire breakage during fixation, breakage of screw driver, and superficial wound infection. The position of screws was central in most cases except four patients which had eccentric screw position but with good outcome in 3 of them. Regarding time to union, the average time to union was 5-18 weeks as proven by PXR and CT. Regarding return to work, the average recorded time to return to work was 2-12 weeks. Regarding range of motion 84.4% regained full range of motion as compared to the healthy side. Regarding pain assessment only 50% of patients were included in pain assessment, 51 patients had little or no pain at final follow-up. Regarding grip strength, 91 patients had the same grip strength compared to healthy side at final follow-up. The functional end result acc. to Mayo modified wrist score, 57 patients had excellent outcome. Four patients had good outcome. One patient had fair outcome. One patient had poor outcome. There were a number of different immobilization techniques and regimes used in the included studies. A clear benefit of surgical stabilization is that it reduces the requirement for post-operative immobilization, facilitating an accelerated return to work and sporting activities.

Conclusion

Percutaneous fixation of acute non-displaced or minimally displaced scaphoid fractures, especially in young active individuals in whom prolonged immobilization can be a significant burden, provides excellent results regarding functional outcome, earlier gain of motion of the wrist, earlier time to union, quicker return to activity of daily living, and a lower complication rate.
Immunohistochemical Expression of SATB2 and PAX8 in Differentiating Primary from Metastatic Ovarian Mucinous Neoplasms
Authors: Mostafa El Ghondakly Rana Ahmed , Haddad Salwa Ibrahim El , Salam Magda Mohamed Abdel , Nada Ola Hassan , Farid Rola Mohamed , Salah Eldin Farid Laila Magid
Published: November 2024

Background

Accurate stratification of an ovarian mucinous neoplasm as primary or secondary is always challenging. The ovary is a frequent metastatic site for primary gastrointestinal malignancies that shows overlapping histomorphological and immunohistochemical features with primary ovarian mucinous carcinomas. This study assessed the value of immunohistochemical expression of SATB2 and PAX8 in this diagnostic dilemma as single and combined panels.

Methods

Immunohistochemical staining for SATB2 and PAX8 was performed on 80 cases of mucinous ovarian neoplasms subdivided into 53 primary ovarian mucinous neoplasms (POMNs) and 27 secondary ovarian mucinous tumors of gastrointestinal (GI) origin (12 metastatic adenocarcinomas of colonic origin, 7 metastatic adenocarcinomas of appendiceal origin and 8 metastatic adenocarcinomas of gastric origin). Expression was correlated with different clinicopathologic parameters.

Results

PAX8 positive immunostaining was detected in 38/53 cases (71.69%) of POMNs with null positivity in the sub-group of secondary ovarian mucinous tumors of GI origin (0/27). On the other hand, SATB2 positive immunohistochemical staining was detected in 16/27 cases (59.26%) of the secondary ovarian mucinous tumors of GI origin. None of the studied POMNs showed any positive immunostaining for SATB2 (0/53).

Conclusion

A Profile of SATB2- /PAX8+ and SATB2+ / PAX8- can be used to differentiate POMCs from secondary ovarian mucinous tumors of GI origin, respectively, with a 100% specificity. This warrants the use of SATB2 and PAX8 in clinical practice for helping in the dilemma of diagnosing an ovarian mucinous neoplasm with higher precision. Moreover, PAX8 expression is associated with some clinico-pathologic parameters providing the basis for further studies for the possible usage of PAX8 as prognostic marker.
Effect of Vitamin A Supplement on Serotonin Level and Severity of Autistic symptoms in Autistic Children
Authors: Elhossiny Reham M , Nawar Hadear K , Abdelhamid Dalia H , AbdelAziz Asmaa W , Abdel Raouf Batoul M
Published: November 2024

Background

Autism spectrum disorder (ASD) is a neurodevelopmental disorder, becoming the most common condition among mental disabilities due to its recent increase in incidence. The serotonin system depends on vitamin A, which plays a crucial role in the nervous system. As a result, children's neurodevelopment and the emergence of ASD can be significantly impacted by vitamin A deficiency (VAD)

The Aim

We aimed in this study to evaluate vitamin A, and serotonin levels in a group of Egyptian ASD patients under the age of 8 years before and after vitamin A supplementation. In addition, we aimed to evaluate their association with ASD symptoms.

Material and Methods

The first part of this two-stage study is a controlled cross-sectional analysis, and the second stage is an interventional analysis that includes a clinical trial and an open-label design. Children Between the ages of 1 year and 8 years, with ASD diagnosis according to (DSM-V) criteria were included, as well as healthy controls.

Results

We included 30 ASD children and 30 normal children in the control group with a mean age and SD of 5.33±1.7 years. We observed that 33.3% of ASD patients had a family history of similar cases. According to Childhood Autism Rating Scale of the patients at baseline, 73.3% had mild to moderate ASD symptoms, while 26.7% had severe symptoms. Moreover, we observed a statistical decrease of Vitamin A level in the study group compared to the control group with a mean of 133.85 mmol/L, and 207.43 mmol/L, respectively. ASD patients with low vitamin A level had a mean and SD of 51.27±25 mmol/L. This was increased significantly after vitamin A supplementation to be 81.18±21.652 mmol/L with P Value = 0.04. Furthermore, serotonin level before supplementation in ASD patients was with a mean value of 590.59±163.32 ng/ml. This level was decreased Significantly after vitamin A supplementation to be with a mean value of 496.5±192.12 ng/ml with P Value = 0.015. subsequently, Autism Treatment Evaluation Chicklist (ATEC), which is used to assess the effect of the intervention on patients ASD symptoms, was decreased significantly with P Value of 0.001. The mean and SD of ATEC was 77.77±22.236 before vitamin A supplementation, while after Vitamin A supplementation was with a Mean and SD of 72.38±19.104. Furthermore, we found no statistically significant correlation between vitamin A and serotonin levels with different patients’ demographics, or anthropometric measures.

Conclusion and Implications

ASD children exhibited lower levels of vitamin A than normal children, even though vitamin A deficiency is common in Egypt. Children with ASD who had low serum vitamin A levels received vitamin A supplements, which not only helped lower the children's serotonin levels but also markedly reduced their autistic symptoms.
Pregnancy Outcome of SARS-Cov-2 Infection on Newborns and Infants – A Systematic Review and Meta-Analysis
Authors: Elsayed Solaf Mohamed , Gaafary Maha Mohamed El , Elhossiny Reham Mohammed , Abdel-Sattar Sara Adel
Published: November 2024

Background

The impact of coronavirus disease (COVID -19) on maternal and newborn health is unclear so there is a great need to understand the effects of maternal COVID-19 infection on birth outcomes.

Aim of the Work

This study aimed to provide evidence using a systematic review and meta-analysis on the impact COVID-19 during pregnancy on neonates and infants.

Patients and Methods

The study included published case-control studies, case report studies, and retrospective case follow-up evaluating the COVID-19 infection in pregnancy and its effect on newborns and infants. A total of 429 studies were evaluated and only 61 met the eligibility criteria for data extraction and data analysis. Of these, 30 studies were used in meta-analysis and underwent quality assessment and bias evaluation.

Results

Fourteen studies were included detecting preterm labor event among cases with and without COVID-19 and showed significantly higher preterm labour among pregnant women with COVID-19 than without with p-value at < 0.0001. Eleven studies were included detecting NICU admission event among cases with and without COVID-19 which showed significantly higher NICU admission among pregnant women with COVID-19 than without with p-value at < 0.0001 while 4 studies were included detecting stillbirth admission event among cases with and without COVID-19 which showed insignificant differences of still births between the two groups with p-value at 0.6786, and 8 studies were included detecting Intrauterine growth retardation (IUGR)\ low birth weight admission event among cases with and without COVID-19 that showed insignificant differences of IUGR/ low birth weight between the two groups at p-value 0.1822.

Conclusion

COVID-19 infection in pregnant women has an impact on several neonatal outcomes, such as, preterm delivery, oxygen therapy, intubation, and NICU admission, but it does not significantly affect low birth weight, neonatal mortality, IUFD and stillbirth.
Predictive Factors for Hepatic Decompensation after Transarterial Chemoembolization for Hepatocellular Carcinoma
Authors: Katry Abanoub Samuel Asaad , Abdelhamid Hetta Osama Mohamed , Ashraf Okba Ahmed
Published: November 2024

Background

Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide, and has a poor prognosis unless treated. Transarterial chemoembolization (TACE) of HCC lesions is a promising treatment option for patients who are not eligible for surgery. There are various risk factors that can contribute to the development of hepatic decompensation such as liver function status, HCC morphology and patient’s comorbidities.

Aim of the Work

to analyse the different predictive parameters for hepatic decompensation after transarterial chemoembolisation (TACE) for hepatocellular carcinoma (HCC).

Patients and Methods

Our study included 50 patients who underwent TACE for HCC, mostly males (72%) with HCV being the most common cause (86%) of HCC in our sample.

Results

The results showed that 44% of patients developed hepatic decompensation after TACE. Comparison was done between the compensated and decompensated patients as regards different epidemiologic, laboratory and tumor morphology variables. Regarding the pre-TACE laboratory data, the decompensated group had significantly lower levels of albumin and higher levels of bilirubin, ALT, AST and INR. There was no statistically significant difference in the levels of AFP and creatinine between the two groups. Regarding the tumor characteristics in our study groups, the size and number of nodules were significantly higher in the decompensated group. However, the location and the distribution of the tumor between the two groups were not statistically significant. Multivariate analysis revealed that serum bilirubin level (p = 0.007 at 95% CI), MELD score (p value=0.011 at 95% CI) and ALBI score (p = 0.021 at 95% CI) were the statistically significant independent factors predictive of decompensation after TACE.

Conclusion

There is significant hepatic decompensation after TACE for patients with HCC. Serum bilirubin level with the ALBI and MELD scores were the independent predictors of decompensation after TACE. Patients should be cautiously selected for TACE and prioritized in post-operative management to early identify the signs of hepatic decompensation. This would allow prioritized treatment and improve the chances of survival.
Role of Trans perineal Ultrasound in Inflammatory Bowel Disease
Authors: Ouf Merihan Ali Mostafa , Abd El Khalek Yasser Ibrahim , Abdulhafiz Essam Mohamed , Elessawy Hagar Ahmed Ahmed
Published: November 2024

Background

Inflammatory Bowel Disease (IBD) is a medical terminology for a group of diseases that cause chronic intestinal inflammation. It is categorized into two subtypes: Ulcerative colitis and Crohn’s disease. Fistulae are frequently seen manifestations of perianal IBD, and their clinical course these consists of flare-ups with bouts of active drainage, followed by intervals of clinical remission. Improved prognosis, treatment, and assessments of perianal disease activity may all contribute to a better patient quality of life.

Aim of the Work

to explore the role of trans perineal ultrasound in assessment of disease activity and/or complications in patients with inflammatory bowel disease.

Patients and Methods

The Diagnostic Radiology Unit; Radiology Department, Ain Shams University Hospitals. For 6 months. We studied the relevance of 23 different ultrasound parameters and 6 indices in conjunction with clinical, endoscopic based scores. Sample size of at least 30 patients with IBD with affection of anal or perianal area were sufficient to achieve study objective.

Results

Rectal wall thickness and submucosal band thickness could be used as indicators for presence of disease in ulcerative colitis patients. TPUS could be used to assess the internal sphincter thickness, external sphincter integrity in Crohn’s disease. Partial Mayo clinical score showed significant correlation with Mayo endoscopic score; however, it couldn’t predict degree of severity. Internal sphincter thickening increased anal canal vascularity and perianal fistula is more common in Crohn’s disease than ulcerative colitis.

Conclusion

Trans perineal ultrasound is considered as a good tool that is noninvasive, cost effective and convenient and shows a potential in the assessment of disease activity and complications in inflammatory bowel disease.
Role of PET/CT in Evaluation of Locally Managed Hepatocellular Carcinoma with Negative CT/MRI Findings
Authors: Ramadan Elkholy Mohammed , Fattah Mousa Waleed Abdel , El Monem Saad Moaaz Nabil Abd
Published: November 2024

Background

Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related death worldwide (HCC). It is the most common primary liver cancer. Loco-regional management is important for patient survival. Post-therapeutic follow-up and early detection of recurrent HCC are crucial in the management plan.

Aim of the Work

To highlight the role of PET/CT in evaluation of post therapeutic hepatocellular carcinoma in comparison to traditional cross-sectional imaging (CT/MRI)

Patients and Methods

Type of Study: retrospective and prospective studies. Study Setting: The study was conducted in a private radiology center. Study Period: from March 2019 to March 2023. Study Population: This study enrolled 50 patients who had previously undergone local management, such as trans-arterial chemoembolization, radiofrequency ablation, a combination of these (trans-arterial chemoembolization and radiofrequency ablation), and surgical resection.

Results

In the current study, 18F FDG PET/CT showed 95.6% sensitivity, 75 % specificity, 97.8% positive predictive value, 60% negative predictive value, and 94% accuracy.

Conclusion

18F-FDG PET/CT is a valuable imaging tool to investigate the patients who have rising serum AFP level after HCC loco-regional treatment. It can accurately detect intrahepatic tumor recurrence as well as extrahepatic spread of HCC and can differentiate between benign and malignant portal vein thrombosis.
Enhancing Gout Diagnosis with Deep Learning in Dual-energy Computed Tomography: A Retrospective Analysis of Crystal and Artifact Differentiation
Authors: Choi Yunjung , Castro-Zunti Riel , Lee Daewoo , Yun Jae Sung , Choi Younhee , Ko Seok-bum , Choi Eun Jung , Jin Gong Yong , Yoo Wan-Hee , Park Eun Hae
Published: November 2024

Objectives

To evaluate whether the application of deep learning (DL) could achieve high diagnostic accuracy in differentiating between green colour coding, indicative of tophi, and clumpy artifacts observed in dual-energy computed tomography (DECT) scans.

Methods

A comprehensive analysis of 18 704 regions of interest (ROIs) extracted from green foci in DECT scans obtained from 47 patients with gout and 27 gout-free controls was performed. The ROIs were categorized into three size groups: small, medium, and large. Convolutional neural network (CNN) analysis on a per-lesion basis and support vector machine (SVM) analysis on a per-patient basis were performed. The area under the receiver operating characteristic curve, sensitivity, specificity, positive predictive value, and negative predictive value of the models were compared.

Results

For small ROIs, the sensitivity and specificity of the CNN model were 81.5% and 96.1%, respectively; for medium ROIs, 82.7% and 96.1%, respectively; for large ROIs, 91.8% and 86.9%, respectively. Additionally, the DL algorithm exhibited accuracies of 88.5%, 88.6%, and 91.0% for small, medium, and large ROIs, respectively. In the per-patient analysis, the SVM approach demonstrated a sensitivity of 87.2%, a specificity of 100%, and an accuracy of 91.8% in distinguishing between patients with gout and gout-free controls.

Conclusion

Our study demonstrates the effectiveness of the DL algorithm in differentiating between green colour coding indicative of crystal deposition and clumpy artifacts in DECT scans. With high sensitivity, specificity, and accuracy, the utilization of DL in DECT for diagnosing gout enables precise lesion classification, facilitating early-stage diagnosis and promoting timely intervention approaches.
A bonanza of Cretaceous fossils provides insights into the evolution of antennal protection in clown beetles (Coleoptera: Histeridae)
Authors: Simon-Pražák Jan , Yamamoto Shûhei , Lackner Tomáš , Fikáček Martin , Prokop Jakub , Caterino Michael S
Published: November 2024

Species in the beetle family Histeridae exhibit numerous defensive adaptations, from a generally compact and spheroid body shape to retractable tarsi, legs, heads, and antennae. Modes of antennal concealment are particularly variable, underscoring the importance of protecting these essential sensory structures. Understanding the evolution of these morphological features has been hindered by a weak understanding of the family’s basal phylogeny, and corresponding patterns of niche-use and morphological evolution. Cretaceous amber fossils have been proliferating, filling in important morphological gaps right around the time of the family’s explosive radiation. Here we describe 10 new species from Cretaceous Burmese ambers, six of them representing new genera: Palaeabraeus glabrus gen. nov. et sp. nov. (Abraeinae); Pseudacritus extinctus gen. nov. et sp. nov. (Abraeinae); Miculissima excavata gen. nov. et sp. nov. (unplaced to subfamily); Placatister cascus gen. nov. et sp. nov. (unplaced to subfamily); Cretomalus tibiodentatus gen. nov. et sp. nov. (Dendrophilinae: Paromalini); Prodigister tricostatus gen. nov. et sp. nov. (unplaced to subfamily); Anapleus punctulatus sp. nov. (Dendrophilinae: Anapleini); Pantostictus hirsutus sp. nov. (Abraeinae: Pantostictini); Phasmister kraliceki sp. nov. (Onthophilinae); and Phasmister planatus sp. nov. (Onthophilinae). A revised phylogenetic analysis that includes these taxa supports previous hints that inquilinous forms were prevalent and diverse during the Cretaceous. These results also support the contention that pressures in these environments to protect the critically important sensory apparatus, the antenna, were strong, driving multiple origins of two of the more protective configurations among extant taxa. Some of the new genera remain unplaced to subfamily, underscoring the gaps that still remain in the early fossil record for the family, and the continued need for more comprehensive analyses of combined data from extant taxa, along with additional extinct forms that we may assume will continue to be discovered.
METTL3 and IGF2BP2 coordinately regulate FOSL1 mRNA via m6A modification, suppressing trophoblast invasion and contributing to fetal growth restriction
Authors: Chen Ruixin , Wang Tingting , Tong Hai , Zhang Xue , Ruan Jie , Qi Hongbo , Liu Xinghui , He Guolin
Published: November 2024

Fetal growth restriction (FGR) increases the risk of short‐term and long‐term complications. Widespread N6‐methyladenosine (m6A) modifications on mRNAs have been found to be involved in various biological processes. However, the role of m6A modification in the pathogenesis of FGR remains elusive. Here, we report that elevated levels of METTL3 and m6A modification were detected in FGR placentae. Functionally, cell migration, invasion, and proliferation abilities were suppressed after METTL3 overexpression in HTR8/SVneo cells. Subsequently, methylated RNA immunoprecipitation sequencing (MeRIP‐seq) and RNA sequencing (RNA‐seq) of METTL3‐knockdown HTR8/SVneo cells were utilized together to identify FOSL1 as the downstream target genes of METTL3. Furthermore, we illustrated that METTL3‐mediated m6A modification enhanced the expression of FOSL1 in a IGF2BP2 dependent manner. FOSL1 inhibited trophoblast invasion and migration. Importantly, STM2457, a novel METTL3 catalytic inhibitor, was intravenously administered to FGR mice models, which restore fetal and placental weights in vivo. In vitro STM2457 regulated trophoblast proliferation, invasion, and migration in a dose‐dependent manner. In summary, this study reveals that METTL3 and IGF2BP2 increase FOSL1 expression in an m6A‐dependent manner. The increase of FOSL1disrupts normal trophoblast invasion, which results in the progression of FGR. METTL3 can serve as a potential target for FGR therapy.
Nurse Faculty Perceptions of Anxiety in Nursing Students
Authors: Tansey Cristina Andraca , Carroll Lisa Falgiatore
Published: November 2024

Anxiety in nursing students can interfere with the development of the knowledge, skills, and clinical judgment necessary to practice in a complex health care environment. Thirteen faculty from nursing programs across one state were interviewed to explore faculty perceptions of anxiety among prelicensure baccalaureate nursing students. Data analysis from this qualitative study showed that faculty recognized anxiety in students and its contributing factors. Findings also revealed that participants were unsure of the levels of anxiety that hinder or promote student learning but believed faculty are in a position to help students manage these feelings.
A Mental Health Objective Structured Clinical Examination to Evaluate Undergraduate Nursing Students’ Clinical Competence
Authors: Stockmann Cherrill , Adelman-Mullally Theresa , Willett Joanna
Published: November 2024

The purpose of this study was to establish the psychometrics of a 12-station mental health Objective Structured Clinical Examination (OSCE) to evaluate the clinical competence of undergraduate nursing students. A convenience sample of 65 first-semester senior-level undergraduate students participated. Content validities for the OSCE checklist and stations were established. Interrater reliability was statistically significant. Correlations between the OSCE and final course exam and grade were not statistically significant. Students described the OSCE as a beneficial learning experience but felt unprepared. This OSCE was initially established as a reliable, valid tool to objectively assess nursing competence.
To Lecture or Not Lecture: A Correlational Nursing Education Research Study
Authors: Catala-Beauchamp Aixa I. , Alava Stephanie , Callender Lynelle , Clark Jennifer , de la Osa Ada , Rollins Ebony , Johnson Arlene
Published: November 2024

Lecturing has been a primary method for delivering knowledge and information to nursing students from the early days of nursing education. Recent literature on the effectiveness of lecturing is based on literature published more than 10 years ago; current data on the influence of lecturing on learning outcomes are sparse. Our graduate nursing faculty program conducted a retrospective correlational study to evaluate if the addition of lectures influenced graduate students’ learning outcomes.
Fungal Osteomyelitis of a Diabetic Foot Infection Caused by Trichosporon asahii: A Case Report
Authors: Frost Livia , Xu Ya , Fukuta Yuriko
Published: November 2024

Diabetic foot bacterial osteomyelitis is a serious infection that can lead to major amputations. However, fungal osteomyelitis in a diabetic foot ulcer is uncommon and has been underrecognized. It typically occurs in patients with underlying immunocompromised status and is associated with poor outcomes. Fungal osteomyelitis might be overlooked or diagnosed late because of underrecognition and the inability to differentiate it from bacterial osteomyelitis without specific laboratory testing, such as fungal culture of bone and histopathology including fungal stain. Treating fungal osteomyelitis involves a long course of antifungal treatment, along with surgical management and intensive wound care. In this report, the authors describe the case of a 78-year-old woman with peripheral arterial disease and diabetes who developed dry gangrene complicated by osteomyelitis due to the fungus Trichosporon asahii in the distal phalange of her right hallux. Initially, her pain and erythema around the gangrene improved with voriconazole; however, her gangrene worsened, likely because of nonadherence to wound care and offloading, and her comorbidities. Ultimately, she underwent a right foot guillotine transmetatarsal amputation. The authors also review the literature on fungal osteomyelitis, particularly in the context of diabetic foot infections and Trichosporon asahii infections.
Comparison of Coconut and Sunflower Seed Oils in Improving the Skin Integrity and Weight Gain of Infants in the Neonatal ICU
Authors: Tiryaki Öznur , Zengin Hamide , Çınar Nursan , Karabay Meltem , Caner İbrahim , Güçlü Ertuğrul
Published: November 2024

OBJECTIVE

To determine the effects of sunflower seed oil and coconut oil on the skin integrity and weight gain of preterm infants in the neonatal ICU.

METHODS

In this randomized controlled trial, 66 preterm neonates (34–37 weeks’ gestation) in the neonatal ICU of a training and research hospital were equally divided into three groups: sunflower seed oil, coconut oil, and control. The weights of neonates in all three groups were measured at admission to the neonatal ICU, at discharge, and at 1 month postdischarge. Their skin conditions were evaluated using the Neonatal Skin Condition Score and the Revised Northampton Neonatal Skin Assessment Tool at the same three time points.

RESULTS

At 1 month postdischarge, neonates in the sunflower seed oil and coconut oil groups weighed significantly more than those in the control group (P = .004). Mean Neonatal Skin Condition Score scores were significantly higher in the control group at 1 month postdischarge than in the sunflower seed oil and coconut oil groups (P = .000).

CONCLUSIONS

Skin care with coconut oil and sunflower seed oil was effective in maintaining the skin integrity and weight of neonates at 1 month postdischarge. The authors recommend that randomized controlled trials on skin care in preterm infants using sunflower, coconut, and other oils be conducted with larger sample sizes.
SUBRETINAL PIGMENT EPITHELIUM OPTICALLY EMPTY STRUCTURES IN POLYPOIDAL CHOROIDAL VASCULOPATHY
Authors: Teo Kelvin Yi Chong , Chong Yu Jeat , Cheung Chui Ming Gemmy
Published: November 2024

Purpose:

To describe the appearance of a novel optical coherence tomography (OCT) feature in polypoidal choroidal vasculopathy and report its prevalence in a clinical cohort.

Methods:

We retrospectively analyzed the OCT and indocyanine green angiography images of eyes with polypoidal choroidal vasculopathy. Main outcome measures included the appearance, prevalence, and longitudinal changes of “optically empty subretinal pigment epithelium (RPE) structures” on OCT and correlate them with indocyanine green angiography and OCT angiography.

Results:

We evaluated OCT of 55 patients. Each patient had monthly OCT from baseline to month 12. Presence of sub-RPE optically empty structures at any visit was detected in 10 eyes (7 at baseline, three during follow-up). These lesions are located under the RPE and are characterized by homogenously hyporeflective content similar to the vitreous cavity, which appear optically empty. Additional features include hypertransmission tail into choroid, round/polygonal in shape surrounded by thin wall and fuzzy overlying RPE. When compared with indocyanine green angiography, these structures can be colocalized to the area of pooling associated with polypoidal lesions but can persist after polyp regression. No flow signal was detected within the center of these optically empty structures.

Conclusion:

Sub-RPE optically empty structures likely represent spaces not filled with blood and are distinct from the lumen of a polypoidal lesion.
Clinical pearls from glaucoma clinical trials: a case-based approach
Authors: Barna Laura E. , Chung In Young , Shen Lucy Q.
Published: November 2024

Purpose of review

The purpose of this review is to summarize past and present findings of established clinical trials in glaucoma with a case-based approach. We provide a general overview of each major trial and provide recommendations for their implementation in clinical practice.

Recent findings

There have been several large glaucoma clinical trials performed over the last three decades. These trials have guided clinical decision making by helping risk stratify patients and guide medical and surgical management.
Reducing Wait Times in Child and Adolescent Ambulatory Mental Health
Authors: Murphy James , Banks Tiffany
Published: November 2024

Suicide remains a leading cause of death for youth nationally, with access to mental health care continuing to be an emergent care imperative for health care organizations that are struggling to triage and provide critically needed mental health services to the communities they serve. Administrative inefficiencies present a potentially life-threatening delay in access to children seeking mental health care. Health care organizations have successfully used evidence-based process improvement methodologies to improve efficiency and reduce waste, including the Lean Six Sigma methodology. This study highlights the successful use of Lean Six Sigma to create an ambulatory scheduling process that significantly reduced waitlist times and increased timeliness of access to mental health care in a large pediatric hospital.
Measuring Improvement Capabilities in a Health System: Findings From a Content Validity Study
Authors: Meurer Steve , Escalante Suzy
Published: November 2024

Measurable improvements in the American Healthcare System have been elusive. To understand why, a survey measuring improvement capabilities in a health system was developed from a 2002 tool that measured an outdated quality improvement methodology. That survey was tested for content validity and achieved an overall representativeness content validity index of 87.5%. From the responses and discussions with the subject matter experts, 3 reasons emerged as to why a lack of improvement occurs in key metrics on a balanced scorecard. These 3 were the decentralization of improvement efforts, waning leadership attention, and presenting information rather than insights.
Sport-Related Cutaneous Infections: A Narrative Review
Authors: Santoso Breanna N. , Korman Abraham M. , Bechtel Mark A. , Baria Michael R.
Published: November 2024

Bacterial and viral cutaneous infections pose a great risk of serious complications in combat athletes and contribute to a significant amount of time lost in practice and competition. Although these infections can be treated with standard antimicrobials, the rise in resistance of Staphylococcus aureus and dermatophytes calls for updated treatment recommendations. Methicillin-resistant S. aureus (MRSA) is becoming a highly prevalent culprit of impetigo, folliculitis, and cellulitis and must be managed correctly to eradicate infection effectively. In addition, the increased prevalence of tinea incognito and terbinafine-resistant Trichophyton tonsurans makes dermatophyte infections difficult to handle. Limited studies provide evidence for a nuanced approach when treating athletes who engage in weight cycling or rapid weight loss, but adjusted dosing and treatment guidelines remain important.
Participant-Level Analysis of Complications From the Prostate Biopsy Efficacy and Complications Randomized Study of Transrectal and Transperineal Prostate Biopsy
Authors: Aziz Asef , Fisher Hugh A. G. , Kaufman Ronald P. , Bernstein Adrien , Mian Badar M.
Published: November 2024

Purpose:

The Prostate Biopsy Efficacy and Complications (ProBE-PC) study reported composite end points for noninfectious and infectious complications after transrectal (TR-Bx) and transperineal (TP-Bx) prostate biopsies. However, the clinical relevance of component events within the composite can be quite variable. We aimed to evaluate participant-level details on the severity and management of each complication to provide clinically useful context to practitioners.

Materials and Methods:

Of the 763 randomized participants, 718 underwent either TR-Bx or TP-Bx. Data collection to identify complications included follow-up at 2 weeks and 30 days and review of all outside records to identify fever, genitourinary infections, prescriptions, laboratory test results, microbiology, and clinic or hospital visits.

Results:

Overall, fever was the most frequently reported event in 12 participants (1.7%), with 6 each in the TR-Bx and TP-Bx groups. Of the 11 participants (1.5%) receiving additional antibiotics for suspected infection, only 5 had a fever, and clear indication could not be ascertained in 5 participants. A combination of fever, antibiotic prescription, and/or emergency department/urgent care visits was noted in 0.9% and 0.6% after TR-Bx and TP-Bx, respectively. Overnight observation was required in 3 cases (2 in TR-Bx and 1 in TP-Bx). Hematuria prompting health care utilization occurred in 0.7%, but none required active intervention. Nearly one quarter of the complications occurred after 7 days.

Conclusions:

The composite end point can potentially overestimate the total event rate while clinically important infectious and noninfectious component events after prostate biopsy were infrequent and minor. The management seemed inconsistent, especially the use of empiric antibiotics for unconfirmed postbiopsy infection.
Impact of occupational exposures in patients with chronic obstructive pulmonary disease: current understanding and knowledge gaps
Authors: Bongers Quinn , Comellas Alejandro P.
Published: November 2024

Purpose of review

Chronic obstructive pulmonary disease (COPD) is thought of as a disease caused by tobacco exposure, but numerous occupational exposures have been identified as risk factors for development of disease and exacerbations, although these remain underappreciated and underdiagnosed. We highlight evidence of occupational exposures and how they relate to COPD, while also looking at gaps in how the changing workplace might affect the occupational COPD landscape.

Recent findings

Historical exposures linked to COPD included inorganic dusts like coal and silica and organic dusts like cotton and wood. Other data associated agricultural exposures, cleaning agents, air pollution, and construction work with COPD. As the workplace has evolved to include more work from home and growing industries like ridesharing and delivery, items like radon and indoor and outdoor air quality must be factored into the equation as occupational exposures with the potential to cause COPD and increase its morbidity. Despite this, causal conclusions with many risk factors are challenging due to the complex interaction between patient susceptibilities and environmental factors, both occupation-related and nonoccupation related.

Additional studies are needed, not only to better evaluate occupational exposures and COPD pathogenesis, but also to look at more solution-oriented areas like precision medicine and interventions targeting a healthier workplace.
Precision medicine in diabetes care
Authors: Tan Si Hua Clara , Loh Wann Jia , Lim Su Chi
Published: November 2024

Purpose of review

This review highlights emerging evidence supporting the premise of precision diabetes care including but not limited to monogenic diabetes and discuss potential opportunities, challenges, and limitations for clinical adoption.

Recent findings

Driven by a single gene mutation, monogenic diabetes remains the best use-case for precision diabetes care. However, the increasing prevalence of diabetes among adolescents and young adults in an obesogenic environment makes triaging potential patients for genetic screening clinically challenging. High-dimensional molecular biomarkers (i.e., multiomics) can improve the risk prediction for incident type 2 diabetes (T2D), over and above a well established prediction model based on clinical variables alone. Machine learning approaches using clinical variable-based clustering methods have generated novel and reproducible T2D subgroups with distinct phenotypic and omics characteristics that are associated with differential long-term outcomes. This stratification-strategy may inform clinical decisions. However, on-going discussion and research will be needed to understand the clinical utility of sub-phenotyping T2D for precision care.

Precision diabetes care has extended from uncommon monogenic diabetes to T2D which will need more complex approaches like multiomics and machine-learning methods. The successful clinical translation will require cumulative evidence and close collaboration among the stake holders.
Cerebral Venous Sinus Thrombosis as a Unique Initial Presentation of Thyroid Storm
Authors: Algahtani Hussein , Shirah Bader , Alameen Mohamed Najm Aldeen , Bin Saeed Abdulrahman
Published: November 2024

Introduction:

Thyrotoxicosis is associated with a hypercoagulable state, increasing the risk of thrombotic events like CVST. Literature review reveals thyroid hormone’s role in promoting prothrombotic abnormalities, impacting coagulation factors and platelet function.

Case Report:

This study explores the rare occurrence of thyroid storm complicated by deep cerebral venous sinus thrombosis (CVST) in a young male with no prior history of thyroid disease. Our case emphasizes the importance of considering thyroid disease, including thyroid storm, in patients who present with acute neurological symptoms and signs of hyperthyroidism.

Conclusions:

Multidisciplinary management is crucial for optimizing outcomes in both thyroid storm and neurological complications, with collaborative efforts from emergency physicians, endocrinologists, neurologists, and critical care specialists. This study underscores the need for increased awareness and timely intervention in complex presentations of thyroid dysfunction, urging further investigation into underlying mechanisms and therapeutic strategies to enhance patient care and prognosis in such critical scenarios.
Determining Outcomes in Patients With Large Vessel Occlusion and Mild Stroke Who Did or Did Not Receive Thrombolytics and/or Thrombectomy
Authors: Reyes Cleo Zarina A. , Castro-Apolo Ramiro Gabriel , Kincaid Hope , Tabibzadeh Navid , Yacoub Hussam A.
Published: November 2024

Objectives:

The utility of thrombolysis and/or thrombectomy in patients with mild stroke and large vessel occlusion (LVO) remains inconclusive. This retrospective study compared short-term and long-term outcomes in patients treated with best medical therapy (BMT group) versus with intravenous thrombolytics and/or endovascular thrombectomy (intervention group).

Methods:

Patients with acute ischemic stroke (AIS), LVO, and National Institutes of Health Stroke Score (NIHSS) ≤5 were included. Data collected includes demographics; hospital length of stay (LOS); modified Rankin scale (mRS) at admission, discharge, and follow-up; hemorrhagic conversion; and disposition. Bivariate analyses were conducted to compare outcomes between groups.

Results:

Of the 29 patients, 15 were treated with BMT and 14 underwent intervention. Median hospital LOS was slightly longer in the intervention group (6.5 [IQR=4 to 12] vs. 5 [IQR=3 to 5] d, P=0.070). Everyone in the BMT group had a favorable outcome (mRS 0 to 2) at discharge and follow-up, unlike the intervention group’s rate at discharge (100% vs. 71.4%, P=0.042), This gap was closed at follow-up between BMT group (median=33 d, IQR=28 to 48) and intervention group (median=44.5 days, IQR=30 to 48) (100% vs. 85.7%, P=0.224). Hemorrhagic conversion rates were similar between groups. More patients in the BMT group were discharged home (80% vs. 42.9%, P=0.079).

Conclusions:

Patients with AIS, low NIHSS, and LVO, who received thrombolytics and/or thrombectomy had longer hospital LOS, higher mRS at discharge and follow-up, and were less likely to be discharged home, though these trends were not statistically significant. Our study is limited by a small sample size and these findings should be further explored in larger studies.
Who, what, where, when, and how: IPOS legacy and future directions
Authors: Goldzweig Gil , Andersen Barbara L.
Published: November 2024

The International Psycho-Oncology Society (IPOS) has played a pivotal role in the integration and advancement of psychosocial care within oncology. Cancer diagnosis is just one of many stressors for patients, but those with mental health disorders, especially depression or anxiety, struggle disproportionately. Despite evidence for empirically supported psychological treatments and supportive care initiatives, the global visibility of psychosocial oncology is low in countries having the greatest need. Forecasts of cancer incidence and mortality suggest that more than two-thirds of the world's cancers will occur in low-income and middle-income/resource countries (LMRCs) within the next 15 years. Having multiple economic, institutional, and governmental/political barriers, LMRCs have not benefited from extensive research and psychosocial care integration seen in higher resource countries. But importantly, IPOS can leverage its global position and network to lead and support the inclusion of psychosocial care into national LMRC cancer plans and facilitate within-country research development and mentorship. The future requires awareness and leadership to build a global psychosocial infrastructure to improve quality of life for all affected individuals.