bluuebunny/crossref_metadata_2025 huggingface dataset:
Simulation-based perioperative anaesthesia information management practice: cross-sectional study
Authors: Admassie Belete Muluadam , Ferede Yonas Admasu , Mekonnen Zemenay Ayinie , Sisay Menarguachew Atanaw , Worku Misganaw Degu
Published: March 2024

Background:

Perioperative anaesthesia record completeness is very essential skill of the anaesthesia profession at the time of operation in the health setting. During perioperative, anaesthesia care sometimes there may be missing important information of the patient, medication taken or planned. This study aimed to improve perioperative anaesthesia information management practice.

Methodology:

Pre-interventional and post-interventional cross-sectional study was conducted from 21 June to 25 July 2022 on 164 anaesthesia record filled by 51 anaesthesia care provider in pre-interventional and post-interventional phase. Data were collected using a semi-structured questionnaire and the data entered by Epi-data software (version 4.6) and analyzed by using SPSS version 26. For all indicators, the projected completion rate was 100%. Indicators with completion rates of greater than 90% were classified as acceptable, while those with completion rates of 50% were seen as urgently needing improvement.

Results:

Pre-interventional result: among all indicators, none of the indicators had 100%, completeness rate. Postoperative nausea and vomiting management orders, the names of the surgeon and anaesthetist, the location of the intravenous cannula, the maintenance of anaesthesia, the total amount of fluid supplied, the content of the consent discussion, and null per ose status, age, and weight of the patient were some of the markers that were identified below average (50%) and in need of significant improvement. Post-interventional result: when compared with the pre-interventional result, their documentation skills were improving after discussions with stakeholders and the relevant bodies; however, none of the indicators attained 100% completion rate.

Conclusion and recommendation:

Even after the interventions, the desired completion rate was not attained. As a result, it requires ongoing instruction on perioperative anaesthesia information management according to the standard perspectives.
Utilization of the emergency department by kidney transplant recipients: a retrospective cohort study from a high-volume transplant center
Authors: Sabbah Belal Nedal , Alghafees Mohammad , Sabbah Ahmad Nedal , Arabi Tarek Ziad , Abdul Rab Saleha , Alaklabi Abdulaziz Mohammed , Abdalla Hytham Mubarak , Maklad Ahmed Essam , El Sarrag Mazin Ibrahim , Hawari Emad Sameer , Barbour Omar Hussien , Khedr Ahmed , Alrasheed Faisal , Alshalhoub Mohammed , Sayedahmed Ghali , Alshuwaier Khalid , Alkharashi Yasser , Albassam Abdulrahman , Bin Ofisan Salman , Altamimi Abdulrahman
Published: March 2024

Background:

This study aims to assess the trends of emergency department (ED) visits among kidney transplant recipients in a high-volume transplant centre.

Methods:

This retrospective cohort study targeted patients who underwent renal transplantation at a high-volume transplant centre from 2016 to 2020. The main outcomes of the study were ED visits within 30 days, 31–90 days, 91–180 days, and 181–365 days of transplantation.

Results:

This study included 348 patients. The median (interquartile range) age of patients was 45.0 years (30.8, 58.2). Over half of the patients were male (57.2%). There was a total of 743 ED visits during the first year after discharge. 19% (n=66) were considered high-frequency users. High-volume ED users tended to be admitted more frequently as compared to those with low frequencies of ED visits (65.2% vs. 31.2%, respectively, P<0.001).

Conclusion:

As evident by the large number of ED visits, suitable coordination of management through the ED remains a pivotal component of post-transplant care. Strategies addressing prevention of complications of surgical procedures or medical care and infection control are aspects with potential for enhancement.
Thrombocytopenia with absent radii syndrome with delayed presentation of thrombocytopenic episodes: a case report
Authors: Alassri Riffa , Martini Nafiza , Othman Razan , Kamil Hazem , Mahmoud Jaber
Published: March 2024

Background:

Bilateral radii aplasia with the presence of both thumbs and episodes of low platelets count are the main characteristics of thrombocytopenia with absent syndrome, which is an unusual birth disorder, with an incidence of 0.42\100 000 population.

Case presentation:

The authors reported a case of a 6-month-old baby girl who experienced thrombocytopenia at the age of 6 months for the first time, as a result of cow’s milk being introduced for 45 days with chronic diarrhea and growth failure. She had a deviation of the axis of the hand laterally, and a bilateral absent of radii with the presence of both thumbs. In addition, she had abnormal psychomotor development, marasmus case manifestations.

Conclusions:

Our aim in publishing the current case report is that clinicians caring for patients with thrombocytopenia with absent syndrome will be aware of the myriad of complications, which may occur in the other organ systems so that they can promptly diagnose and treat any associated abnormalities.
Impact of insufflator/aspirator versus exclusive insufflator during robotic radical prostatectomy: a comparative prospective cohort study
Authors: Otaola-Arca Hugo , Mejías Orlando , Bravo Juan Cristóbal , Pinochet Rodrigo , Bernier Pablo , Muñoz Lorena , Orvieto Marcelo
Published: March 2024

Background:

New generation devices that combine high-flow insufflation with smoke aspiration using continuous gas recirculation ]so-called Insufflator/aspirator systems (IAS)] have recently been developed to generate pneumoperitoneum. The use of an IAS could have an impact on surgical compared to conventional insufflation systems (CIS). The present study aimed to compare the clinical effectiveness/safety, healthorganizational, and pathological/oncological outcomes of the CIS versus IAS during robot-assisted radical prostatectomy (RARP).

Methods:

Comparative retrospective cohort study including patients with non-metastatic prostate cancer treated with RARP by four expert surgeons at a robotic referral centre between January 2020 and December 2021. A CIS was used until 15 March 2021, and the IAS thereafter. Data were extracted from the Institutional Review Board-approved (#1064) retro and prospective institutional database.

Results:

The final analysis included 299 patients (143 CIS; 156 IAS). We found no statistically significant differences in demographic data and preoperative results, allowing adequate group comparison. The rate of complications of any degree (9.1% and 1.9%, P<0.05) and major complications (4.2% and 0.6%, P<0.05) were lower in the IAS group. Accordingly, the hospital stay was shorter in the IAS group (P<0.05); however, the small size of this statistically significant difference probably lacks clinical value (1.9±1.6 vs. 1.6±0.8 days). There was no significant difference in surgical time, bleeding, pathological findings, or oncological results.

Conclusions:

Data from this large group of patients showed that the rate of overall complications, the rate of major complications, and the length of stay were lower in the IAS group. Implementing the IAS in RARP patients increased the occurrence of SCE and affected our daily practice of transversus abdominis plane block. Interpretation of the results should be made with caution since the design of this study did not allow for the identification of a causal relationship.
Pulmonary embolism complicated by tamponade revealing metastatic lung cancer in a woman pregnant with twin: about a case report
Authors: El Rhalete Abdelilah , Rhazi Inas , Bkiyer Houssam , Housni Brahim
Published: March 2024

Introduction:

Lung cancer can be revealed by thromboembolic complications. Its association with pregnancy is becoming more frequent due to the increasing number of smoking women. The care of a pregnant woman with cancer is quite delicate because it requires finding a balance between the treatment of the mother and the potential foetal risk.

Case presentation:

The authors report the case of a 38-year-old patient, with a twin pregnancy of 16 weeks, complicated by proximal and distal peripheral venous thrombosis of the left lower limb under low molecular weight heparin therapy at a curative dose. A week later, the patient presented to the emergency room with respiratory distress associated with chest pain and low-abundance metrorrhagia. The obstetrical ultrasound performed confirmed the vitality of only one of the two foetuses. The transthoracic ultrasound objectified a very abundant pericardial effusion producing a tamponade, which was drained percutaneously and whose cytological study revealed a liquid rich in tumour cells. After the unfortunate death of the second twin and an endouterine evacuation, a chest computed tomography angiogram demonstrated a bilateral proximal pulmonary embolism associated with bilateral moderate pulmonary effusion as well as multiple thrombosis and secondary aspect liver lesions with a suspicious parenchymal lymph node of the upper lung lobe. A liver biopsy concluded to a secondary hepatic localization of a moderately differentiated adenocarcinoma whose immunohistochemical complement revealed a pulmonary origin. A multidisciplinary consultation meeting leaned towards treatment with neoadjuvant chemotherapy. The patient died 7 months later.

Discussion:

Venous thromboembolic disease is more common in pregnant women. Delayed diagnosis is common in these cases, resulting in a high rate of locally advanced or metastatic disease. Since the treatment of pregnancy-associated cancer does not rely on a standardized approach, the decision on how to proceed must be made by a multidisciplinary team.

Conclusion:

The cornerstone of management remains to find the balance between treating the mother as well as possible while preventing the foetus from the possible harm of cytotoxic drugs frequently used to treat lung cancer. Because of the delayed diagnosis, the maternal prognosis often remains poor.
Mpox vaccination in global perspective: priorities and challenges
Authors: Rana Jigyasa , Patel Shailesh Kumar , Agrawal Aditya , Channabasappa Nikhil K. , Niranjan Ankush K. , Chandra Das Bhabesh , Pandey Megha K. , Tiwari Sita Prasad , Gaihre Milan
Published: March 2024

After the global panic created by COVID-19, the monkeypox (Mpox) virus emerged as a new challenge for the world population. As of 19 January 2023, a total of 84,733 cases across 110 countries/territories including 80 deaths has been reported. The virus has been transmitted to nonendemic countries in a short span of 6 months warranting WHO to declare Mpox, a Public Health Emergency of International Concern on 23 July 2022. As the Mpox virus is crossing geographical boundaries without established transmission patterns, there is an urgent need for new scientific strategies from global researchers to contain it before turning into the next pandemic. The control of Mpox outbreaks primarily relies on various public health measures such as proper surveillance, contact tracing, rapid diagnosis, isolation and care of patients, and vaccination. At present, there are three vaccines viz. ACAM2000, MVABN, and LC16 are in consideration and have been approved in several jurisdictions for ongoing Mpox outbreak. Prioritization of individuals along with the production of specific Mpox vaccine is need of the hour to meet out the global demand of Mpox vaccination.
Rare diagnosis of coexistent antiphospholipid syndrome and systemic lupus erythematosus in a male patient with successful management: a case report
Authors: Shrateh Oadi N. , Jobran Afnan W.M. , Amoori Azeeza
Published: March 2024

Introduction:

Antiphospholipid syndrome (APS) and systemic lupus erythematosus (SLE) are two autoimmune disorders that can develop together or separately. Similarities in the pathogenesis have been discovered, including the production of autoantibodies that target subcellular antigens and shared elevated risk of cardiovascular morbidity, which may be caused by common pathologic pathways.

Case presentation:

A 28-year-old male, referred to our hospital for the assessment of chest pain. Past medical history was significant for extensive deep venous thrombosis despite the appropriate management with a therapeutic dose of direct-acting oral anticoagulant. Prolonged partial thromboplastin time was not corrected by mixing study along with positive lupus anticoagulant, anticardiolipin, and B-2 glycoprotein antibodies. In addition, antinuclear antibodies, anti-DNA antibodies, and direct Coombs were positive with decreased levels of C3. The patient was diagnosed with SLE with brain, heart, and kidney involvement in the setting of antiphospholipid antibody syndrome. He was treated successfully with full recovery.

Discussion:

SLE and APS both have sneaky ways of manifestation. Ineffective diagnosis and therapy could cause irreversible organ damage. Clinicians should have a high index of suspicion for APS, particularly in young patients who approach with spontaneous or unprovoked thromboses or unexplained recurrent early or late pregnancy loss. Anticoagulation, modifying cardiovascular risk factors, and identifying and treating any underlying inflammatory diseases are all part of the multidisciplinary care that is needed for management.

Conclusion:

Although male affection is rare, SLE and APS should be considered in male patients as these conditions tend to be more aggressive than in the female.
Gut-brain axis: altered microbiome and depression – review
Authors: Mohan Anmol , Godugu Swathi , Joshi Saumya S. , Shah Kenisha B. , Vanka Srija C. , Shakil Hania , P Dhanush , Veliginti Swathi , Sure Prajwal S. , Goranti Jyothsna
Published: March 2024

The concept of a ‘gut-brain axis’ was recently developed when the complex communications between the brain and the gut became evident. The interaction may affect emotions, motivation, mood, and higher cognitive functions as well as gut homeostasis. Human microbe symbiosis’s merits are now acknowledged to transcend human mental health. Research has recently indicated that the gut-brain axis plays a vital role in brain health maintenance. The term ‘gut-brain axis’ can only partially capture the intricacy of these interactions. Dysbiosis of the gut commensals has been seen in patients with psychiatric diseases, such as depression. Major depressive disorder is caused by complicated interactions between the individual gene and the environment. In a forced swimming test, P. Zheng et al. discovered that germ-free mice with no gut microbiota had a shorter immobility duration than healthy mice. More radical effects were expressed on the use of probiotics rather than prebiotics and postbiotics in reducing the symptoms of depression in patients with major depressive disorder. One of prime importance can be given to exploring more microbiota to investigate the better therapeutic effects of probiotics, prebiotics, and postbiotics.
Surgical management of giant recurrent retroperitoneal liposarcoma: a case report and review of the literature
Authors: Ayoub Madani , Leila Bouzayan , Yassin Mabrouk , Achraf Miry , Rachid Jabi , Mohamed Pr Bouziane
Published: March 2024

Introduction:

Liposarcoma is a rare, primary, malignant mesenchymal tumor. It represents ∼7% of all mesenchymal sarcomas and 1% of all cancers. Their incidence does not exceed to 2.5 cases/million inhabitants/year. This tumor is locally invasive, diagnosed at a late stage, and can reach a significant size and weight, resulting in a locally advanced tumor.

Case presentation:

A 59-year-old female patient consulting for a large abdominal mass. The abdominal computed tomography showed three retroperitoneal masses, and the surgical exploration revealed a huge process in the retroperitoneal cavity, which takes the left renal compartment, and the left colon. The intervention consisted of a mono-bloc excision of the mass taking the spleen, the left renal compartment, and the left colon with colonic anastomosis. The histological examination concluded the existence of a well-differentiated myxoid liposarcoma of grade I, the postoperative follow-up was simple. One year later, she underwent an excision of a recurrence of the same retroperitoneal location, but of a pleomorphic cell histological type of grade II according to the FNCLCC classification. We review the literature, the pathological, therapeutic, and prognostic aspects of this tumor.

Discussion:

Retroperitoneal liposarcoma is a rare tumor. Its gravity is due to an often-late diagnosis, a complete imaging workup including ultrasound, computed tomography and often MRI is necessary preoperatively to determine the relationship with the different organs. The definitive diagnosis is histological, surgery is the most effective treatment and can be extended to neighboring organs. the frequency of recurrence requires particular surveillance.

Conclusions:

We highlight the importance of radical surgical excision to avoid retroperitoneal liposarcoma tumor complications and to minimize the recurrence risk.
Understanding correlates of infant mortality in Ethiopia using 2019 Ethiopian mini demographic and health survey data
Authors: Adebe Kebede Lulu , Wake Senahara Korsa , Yadata Sagni Daraje , Gondol Ketema Bedane , Mekebo Gizachew Gobebo , Wolde Temesgen Senbeto , Bechera Terefa , Regesa Belema Hailu , Galdassa Agassa , Yadata Kumera Dereje
Published: March 2024

Background:

Infant mortality is one of the most sensitive and commonly used indicators of the social and economic development of a nation. Ethiopia is among the African countries with high infant mortality rates. This study aimed to understand and identify correlates of infant mortality in Ethiopia.

Methods:

The data, used in this study, were drawn from 2019 Ethiopian Demographic and Health Survey data. The multivariable Cox proportional hazard analysis was done to identify the correlates of infant mortality.

Results:

Infant mortality rate was high in the earlier age of months. Males, higher birth order and rural residences were at higher risk of dying before first birthday compared with respective reference groups whereas health facility deliveries, single births, rich wealth indices and older maternal age were at lower risk of dying before first birthday compared with respective reference groups.

Conclusion:

The study found that age of mother, place of residence, wealth index, birth order, type of birth, child sex and place of delivery were statistically significant in affecting the survival of the infants. Thus, health facility deliveries should be encouraged and multiple birth infants should be given special care. Furthermore, younger mothers should better care of their babies to improve the survival of infants in Ethiopia.
COVID-19 increases a person’s risk of cardiovascular problems: how common is chronic heart failure in SARS-CoV-2 patients? a case report
Authors: Bereda Gudisa
Published: March 2024

Background and importance:

The coronavirus disease of 2019 (COVID-19) infection typically affects the lungs but can also cause life-threatening heart issues. Heart failure is a common condition that can occur either with an existing heart condition or de novo as part of the clinical course of COVID-19.

Case presentation:

On 11 October 2022, a 60-year-old middle-aged black African woman widow was admitted with a history of muscular weakness for 2 days, a lack of appetite, and occasional vomiting for 1 day. She arrived at the emergency room after complaining for 2 days of peeing less than usual, a fast heartbeat, swelling in the feet, pink blood-tinged mucus, fever, headache, dehydration, a nonproductive cough, and shortness of breath. The left ventricular ejection fraction was 43% on the echocardiogram. Routine reverse transcription polymerase chain reaction testing was performed in the emergency room; she tested COVID-19 positive. To treat her proven COVID-19 infection, she received subcutaneous enoxaparin 80 mg every 12 h as prophylaxis for deep venous thromboembolism.

Clinical discussion:

A COVID-19 infection can induce cardiac failure and arrhythmias, as well as cause direct harm to the heart. This study explains how enoxaparin has dual benefits in this case report: it reduces the risk of venous thromboembolism in the COVID-19 hospitalized case and prevents death and cardiac ischemia in myocardial infarction.

Conclusion:

Higher mortality and more frequent acute decompensation may be caused by the capacity of severe acute respiratory syndrome associated coronavirus 2 to cause myocardial injury, as well as by patients with chronic heart failure’s lower baseline features, decreased cardiopulmonary reserve, and susceptibility for myocardial injury.
Standford type A aortic dissection in a patient with situs inversus totalis, with critical clinical presentation: a case report
Authors: De Masi De Luca Gabriele , Nicolardi Salvatore , Mangia Federica , Zaccaria Salvatore , Palamà Zefferino , Tridici Maurizio , Papadia Paola , De Masi De Luca Giuseppe , Accogli Michele
Published: March 2024

Introduction and importance:

The association of Standford type A acute aortic dissection with situs inversus totalis (SIT) is extremely rare and only a few cases are reported in the literature to date. Due to the particular rarity, this unusual condition, if not diagnosed quickly and correctly, can generate both clinical and surgical difficulties.

Case presentation:

We describe the case of a male Caucasian patient with SIT and aortic dissection type A, who occurred to our Emergency Department with a severe clinical condition of shock. Using the fast diagnostic approach with chest X-Ray and echocardiography followed by computed tomography investigation, a Standford type A acute aortic dissection and the presence of SIT were detected. The patient was subjected to surgical treatment with optimal results in a short time.

Clinical discussion and conclusion:

The event of aortic dissection is an extremely serious condition and the simultaneous presence of a critical clinical presentation with an unusual congenital anomaly could condition a correct and rapid diagnostic process. Only an accurate diagnostic investigation can give a quick diagnosis and useful elements for a correct therapeutic approach.
The influence of expanded carrier screening in assisted reproductive techniques: changed the ‘game’– review
Authors: Drettas Petros , Tatanis Vasileios , Spiliopoulou Chara , Adonakis Georgios , Liatsikos Evangelos
Published: March 2024

Expanded carrier screening constitutes a new scientific tool able to detect conditions that can be treated immediately after birth or during pregnancy. Its implementation could affect both the prenatal period and assisted reproductive techniques. It is strongly beneficial as it provides much useful information to future parents concerning the medical status of their offspring. In addition, the definition of ‘serious/severe’, regulating preimplantation diagnosis, donor insemination, and even the definitions of prerequisites for abortion diseases, should be reformed including all clinically severe diseases. On the other hand, controversies may arise especially regarding gamete donation. Future parents and offspring maybe informed regarding donors’ demographic and medical characteristics. This study aims to investigate the effects of the implementation of expanded carrier screening in the reformation of the definition of ‘severe/serious’ disease, the decision-making of future parents, gamete donation, and the possible new moral dilemmas that may arise.
Current status and future perspectives of wilms tumor treatment in Iran
Authors: Zahir Mazyar , Alidousti Arash , Kajbafzadeh Abdol-Mohammad , Arshadi Hamid , Kompani Farzad , Hajivalizadeh Sepideh , Zolbin Masoumeh Majidi , Ghohestani Seyed Mohammad , Amirzargar Hossein , Hekmati Pooya
Published: March 2024

Background:

Wilms tumor (WT) is among the most common pediatric malignancies. In this study, the authors tried to evaluate the adherence to internationally-approved WT treatment protocols in our tertiary medical center in Iran.

Methods:

In this retrospective study, the medical records of 72 pathologically confirmed WT patients who underwent treatment from April 2014 to February 2020 were evaluated. Demographic characteristics, histologic features of the tumors and metastases, utilized treatments, and survival rates were subsequently investigated.

Results:

From the total of 72 patients, 31 (43.1%) and 41 (56.9%) were males and females, respectively. The median age at the time of diagnosis was 44.0 (interquartile range: 18.5, 72.0) months. Among the patients, favorable histology was observed in 68 (94.6%) patients, while 4 (5.4%) patients had unfavorable histology. Regarding chemotherapy, 34/56 (60.7%), 4/56 (7.1%), and 18/56 (32.2%) received adjuvant, neoadjuvant, and combined chemotherapy, respectively. The mean numbers of neoadjuvant and adjuvant chemotherapy sessions were 9.4±5.6 and 14.5±11.1, respectively. 32/72 (44.4%) of the patients received adjuvant radiotherapy with a mean number of 7.3±3.6 sessions. Overall survival rates were 86% at 1-year, 74% at 3-year, and 62% at 5-year.

Conclusion:

Our results suggested that while the demographic characteristics of WT patients in Iran resemble those in other countries, abidance to internationally recommended protocols is relatively low. Moreover, survival rates were rather dismal in our study compared to those from other developing countries, further signifying the need for the development of a nation-specific treatment protocol for WT.
Autoimmune hemolytic anemia, a rare disease in newborns: a case report
Authors: Kukreja Sandhaya , Baker Saadia Abu , Ochani Sidhant , Lohana Sapna , Kalwar Asifa , Memon Kainat , Kumari Sadhna , Faraz Muhammad , Hasibuzzaman Md. Al
Published: March 2024

Introduction and importance:

Autoimmune hemolytic anemia (AIHA) is a type of hemolytic anemia in which autoantibodies attack the membrane antigens of red blood cells, causing cell rupture (lysis). Hemolysis stimulates compensatory RBC production by boosting erythropoietin levels; however, this response is often insufficient to restore normal hemoglobin blood levels, resulting in anemia. It is a rare disease, with an annual incidence of one case in every 80 000 live births. Infants of any age can be affected, though neonatal incidence is unusual. Here, the authors report a rare case of AIHA in the neonatal period with concomitant atrial septal defect, ventricular septal defect, and patent ductus arteriosus.

Case presentation:

A one-hour-old male neonate weighing 3 kg who was born at 38 weeks of gestation presented to the pediatric department with the complaint of respiratory distress. Examination revealed obvious respiratory distress with subcostal and intercostal recessions and a continuous grade 2 murmur at the left upper chest; the liver was palpable 1 cm below the right subcostal margin with a palpable splenic tip. Laboratory investigations were ordered, which showed hemoglobin was decreasing continuously and bilirubin was raised, suspecting AIHA. A positive blood culture, tachycardia, tachypnea, and a raised leukocyte count showed that the baby was in sepsis. The baby improved clinically, and the complete blood count showed improved Hb. Cardiac examination findings and a second-grade continuous murmur at the left upper chest were further investigated through echocardiography, which showed a grade 2 atrial septal defect, a muscular ventricular septal defect, and a patent ductus arteriosus.

Clinical discussion:

Childhood AIHA is a rare and underrated disease that differs from the adult form. The disease’s initial manifestation and subsequent course are both poorly understood. It affects mostly young children, and a high prevalence (21%) is found in infants. In some patients, there is a genetic predisposition to the development of this disease, and there is underlying immune deregulation in more than half of the cases, necessitating long-term homogeneous multidisciplinary follow-up. It is of two types, primary and secondary, and according to the study conducted in France, AIHA is associated not only with other autoimmune diseases but with some systemic diseases as well, like neurological, digestive, chromosomal abnormalities, and cardiac diseases, as in our case.

Conclusion:

There is a scarcity of data on clinical management and treatment strategies. More research should be done to know the environmental factors that can trigger the immune response against red blood cells. Moreover, a therapeutic trial is essential for a better outcome and helps prevent serious complications.
Drug reaction with eosinophilia and systemic symptoms syndrome secondary to isoniazid and ethambutol: a case report and literature review
Authors: Adhikari Yagya Raj , Bhattarai Madhur , Baral Bikash , Jha Supriya , Subedi Prativa , Karki Ruchi , Baral Amrita , Sharma Prakash , Kharel Arun , Paudel Basanta Sharma
Published: March 2024

Introduction:

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe, potentially life-threatening condition precipitated by reaction of therapeutic drugs. The prevalence of potential antitubercular therapy (ATT)-induced DRESS is 1.2%.

Case presentation:

A 71-year-old female patient after 5 weeks of starting ATT complaints of fever, vomiting, dizziness, and generalized itchy maculopapular rash over the body. It was associated with marked eosinophilia (absolute eosinophil count 3094 cell/mm3, 36% in peripheral blood smear).

Discussion:

Fever, rash, lymphadenopathy, and internal organ involvement with marked eosinophilia constitute the major clinical manifestations of DRESS. RegiSCAR scoring system is usually used to diagnose DRESS. Identification of the culprit drug is based on the temporal correlation of symptoms with drug exposure and rechallenge test, patch test and lymphocytic transformation tests may be valuable adjunctive tools. Treatment includes withdrawal of offending agent and use of topical or systemic corticosteroids, antihistamines, cyclosporin or JAK inhibitor with clinical judgement.

Conclusion:

Clinicians from the tuberculosis burden region must be aware of DRESS associated with ATT and they must counsel the patient properly before prescription and manage them without delay if DRESS ensues.
Prospective, multicenter study of antimicrobial-coated, noncrosslinked, acellular porcine dermal matrix (XenMatrix™ AB Surgical Graft) for hernia repair in all centers for disease control and prevention wound classes: 24-month follow-up cohort
Authors: IIahi Obeid N. , Velmahos George , Janis Jeffrey E. , Kovach Stephen J. , McLean Susan F. , Askari Reza , Sommer Courtney A. , Agarwal Suresh , Srinivasan Jahnavi , Wong Alex K. , Pakula Andrea , Miranda Edward P. , Breen Kerry , Shapiro Mark , Deeken Corey R. , Stringer R. Cody , McGraw J. Reed , Bascone Corey , Martindale Robert G.
Published: March 2024

Background:

Prospective, multicenter, single-arm study of antimicrobial-coated, noncrosslinked, acellular porcine dermal matrix (AC-PDM) in a cohort involving all centers for disease control and prevention wound classes in ventral/incisional midline hernia repair (VIHR).

Materials and methods:

Seventy-five patients (mean age 58.6±12.7 years; BMI 31.3±4.9 kg/m2) underwent ventral/incisional midline hernia repair with AC-PDM. Surgical site occurrence (SSO) was assessed in the first 45 days post-implantation. Length of stay, return to work, hernia recurrence, reoperation, quality of life, and SSO were assessed at 1, 3, 6, 12, 18, and 24 months.

Results:

14.7% of patients experienced SSO requiring intervention within 45 days post-implantation, and 20.0% thereafter (>45 d post-implantation). Recurrence (5.8%), definitely device-related adverse events (4.0%), and reoperation (10.7%) were low at 24 months; all quality-of-life indicators were significantly improved compared to baseline.

Conclusion:

AC-PDM exhibited favourable results, including infrequent hernia recurrence and definitely device-related adverse events, with reoperation and SSO comparable to other studies, and significantly improved quality of life.
Tackling sickle cell crisis in Nigeria: the need for newer therapeutic solutions in sickle cell crisis management – short communication
Authors: Mary Nnagha Ekene , Kayode Ademola Matthew , Ann Izevbizua Eghosa , Uwishema Olivier , Nazir Abubakar , Wellington Jack
Published: March 2024

Sickle cell disease (SCD) is a group of inherited haematological disorders, which affects the shape of the oxygen-carrying haemoglobin component of erythrocytes, giving it an abnormal sickle-shaped appearance. This disease is one of the most common haematological disorders in Nigeria and is generally characterized by anaemia, painful crises, and multi-organ dysfunction. Recurrent episodes of painful crises account for most of the morbidities and mortalities observed in SCD, particularly sickle cell anaemia. This has been a critical concern in the field of haematology and molecular genetics as several therapeutic solutions have been explored over the past few years to treat symptoms of this disease and alleviate painful crises. However, most of these treatment options are not readily available and affordable to affected patients in lower socioeconomic settings in Nigeria, causing a wider range of complications and end-stage organ failure. To address this issue, this article explores an overview of SCD, management alternatives and the need for newer therapeutic solutions to cover the gaps or inadequacies of effective sickle cell crisis management.
Conservative therapy of severe acute pancreatitis is a safe option – results of a 15-year long-term follow-up cohort study
Authors: Alsfasser Guido , Klar Ernst , Feitl Judith , Schafmayer Clemens
Published: March 2024

Background:

Treatment of severe acute pancreatitis can be challenging with high mortality. In 2012 we reported a significantly reduced in-hospital mortality if these patients are treated conservatively for at least the first 3 weeks in the course of the disease as compared to early necrosectomy. We performed a long-term follow-up and compared the outcome of these two study groups (group 1 – early necrosectomy, n=20 versus group 2 – primary conservative treatment, n=24).

Materials and methods:

Follow-up of the study patients by personal contact, phone survey, or data from primary care physician. Median follow-up was 15 years (range 10–22 years). This trial is registered at: Research Registry UIN researchregistry8697.

Results:

Eleven survivors of group 1 and 22 survivors of group 2 were discharged after initial treatment. Ten of 11 surviving patients of group 1 (90.9%) and 20 of 22 surviving patients of group 2 (90.9%) were included in this study. Between groups, there were no statistical differences in the rate of resubmission (P=0.23), development of diabetes (P=0.78), or development of exocrine insufficiency (P=1.0). However, long-term survival in group 2 was significantly better than that of group 1 (P=0.049).

Conclusion:

Primary conservative treatment of severe acute pancreatitis without early necrosectomy does not lead to early complications and even shows an advantage in long-term survival. Therefore conservative treatment of severe acute pancreatitis is safe and there is no absolute need for necrosectomy in severe acute pancreatitis.
Accuracy prediction of Goodsall’s rule for anal fistulas of crypotogladular origin, is still standing?
Authors: Bakir Qais Khadim , Noori Ibrahim Falih , Noori Ahmed Falih
Published: March 2024

Background:

Treatment of anal fistulas is still a challenging task because of high recurrence and risk of incontinence. Identification of internal fistula opening is paramount for successful treatment. Goodsall’s rule is commonly used to predict the course of fistula and internal opening. However, its accuracy has been questioned by many investigators and its role became a controversial topic.

Method:

This is a case series prospective study in which 320 consecutive patients with anal fistula with Mean age 48.9± 6 years ages (ranges from 16 to 64 years) and mean body mass index 24.8± 5.5 average 18.5–30.6) were enroled. Goodsall’s rule was applied to all fistulas according to the site of external fistula opening. Location of internal fistula opening as suggested by Goodsall’s rule then compared to the exact location of internal opening identified by perineal or pelvic MRI and intraoperative findings. to assess the accuracy and positive predictive value of the Goodsall’s rule in predicting the internal opening of the tract.

Results:

The overall accuracy rate, positive predictive value (PPV), sensitivity and specificity of Goodsall’s rule in this study were 74.75%, 77.1, 74.5, and 72.05, respectively. The accuracy in predicting the internal fistula opening was 52.4% in anterior tracts and 73% in posterior tracts. Goodsall’s rule was found to be more accurate in posterior fistulas than anterior fistulas and in short superficial fistulas rather than in long and high fistulas.

Conclusion:

Goodsall’s rule was accurate in 74.75% of anal fistulas. It was more accurate for posterior long fistulas and anterior short and superficial fistulas. Patients with long (>3 cm) anterior fistulas defied Goodsall’s rule when they found to have fistulas tracking to a midline anterior origin. Further, short posterior fistulas were found to open more commonly in a direct radial course rather to midline posteriorly.
Medical malpractice and epidural hematomas: a retrospective analysis of 101 cases in the United States
Authors: Pecorari Isabella L. , Agarwal Vijay
Published: March 2024

Background:

Neurosurgeons face particularly high rates of litigation compared to physicians in other fields. Malpractice claims are commonly seen after mismanagement of life-threatening medical emergencies, such as epidural hematomas. Due to the lack of legal analysis pertaining to this condition, the aim of this study is to identify risk factors associated with litigation in cases relating to the diagnosis and treatment of epidural hematomas.

Materials and Methods:

Westlaw Edge, an online database, was used to analyze malpractice cases related to epidural hematomas between 1986 to 2022. Information regarding plaintiff demographics, defendant specialty, reason for litigation, trial outcomes, and payouts for verdicts and settlements were recorded. Comparative analysis between cases that returned a jury verdict in favor of the plaintiff versus defendant was completed.

Results:

A total of 101 cases were included in the analysis. Failure to diagnose was the most common reason for litigation (n = 64, 63.4%), followed by negligent care resulting in an epidural hematoma (n = 44, 43.6%). Spine surgery (n = 29, 28.7%), trauma (n = 28, 27.7%), and epidural injection/catheter/electrode placement (n = 21, 20.8%) were the primary causes of hematomas. Neurosurgeons (n = 18, 17.8%) and anesthesiologists (n = 17, 16.8%) were the two most common physician specialties cited as defendants. Most cases resulted in a jury verdict in favor of the defense (n = 54, 53.5%). For cases ending in plaintiff verdicts, the average payout was $3,621,590.45, while the average payment for settlements was $2,432,272.73.

Conclusion:

Failure to diagnose epidural hematomas is the most common reason for malpractice litigation, with neurosurgeons and anesthesiologists being the most common physician specialties to be named as defendants. More than half of all cases returned a jury verdict in favor of the defense and, on average, settlements proved to be more cost-effective than plaintiff verdicts.
Knowledge, attitudes, and perceptions of physical therapists towards conventional physical therapy-across-sectional study
Authors: Albishi Alaa. M.
Published: March 2024

Background:

Conventional physical therapy (CPT) is widely used in clinical practice and known to contribute beneficially to patient’s health conditions but remains loosely defined. Research has shown inconsistency in the definition and utilization of CPT among physical therapists in clinical and research settings, limiting its generalisability and reproducibility. Therefore, this study evaluates physical therapists’ knowledge, attitudes, and perceptions toward CPT.

Methods:

A cross-sectional study using a self-administered questionnaire containing 36 questions was distributed among 238 licensed physical therapists. Descriptive and inferential statistics were used to measure the physical therapists’ knowledge, attitudes, and perceptions towards CPT.

Results:

Physical therapists showed limited knowledge of CPT in rehabilitation (4.09±1.698, 51%). However, the knowledge scores were significantly associated with age (P=0.002), educational levels (P=0.006), and years of work experience (P=0.001). Nevertheless, physical therapists showed an overall positive attitude towards CPT and perceived it as essential to rehabilitation.

Conclusion:

Most physical therapists have low knowledge about CPT but positive attitudes and perceptions. Therefore, customized medical education is necessary to incorporate CPT theories and applications into physical therapists’ rehabilitation programs.
Characterization of BCL-XL, MCL-1, and BAX Protein Expression in Response to Neoadjuvant Chemotherapy in Breast Cancer
Authors: Saleh Tareq , Al Shboul Sofian , Awad Heyam , El-Sadoni Mohammed , Alhesa Ahmad , Alsharaiah Elham , Abu Shahin Nisreen , Alotaibi Moureq R. , Battah AbdelKader , Azab Bilal
Published: March 2024

The use of chemotherapy has improved the overall treatment of breast cancer, which is frequently administered in the form of neoadjuvant chemotherapy (NAC). Apoptosis is an established cell stress response to NAC in preclinical models; however, there is limited understanding of its role in clinical cancer, specifically, its contribution to favorable pathologic responses in breast cancer therapy. Here, we aimed to characterize the change in protein expression of 3 apoptosis-associated biomarkers, namely, BCL-XL, MCL-1, and BAX in breast cancer in response to NAC. For this, we utilized a set of 68 matched invasive breast cancer FFPE samples that were collected before (pre) and after (post) the exposure to NAC therapy that were characterized by incomplete pathologic response. Immunohistochemistry (IHC) analysis suggested that most of the samples show a decrease in the protein expression of all 3 markers following exposure to NAC as 90%, 69%, and 76% of the matched samples exhibited a decrease in expression for BCL-XL, MCL-1, and BAX, respectively. The median H-score of BCL-XL post-NAC was 150/300 compared with 225/300 pre-NAC (P value <0.0001). The median H-score of MCL-1 declined from 200 pre-NAC to 160 post-NAC (P value <0.0001). The median H-score of BAX protein expression decreased from 260 pre-NAC to 190 post-NAC (P value <0.0001). There was no statistically significant association between the expression of these markers and stage, grade, and hormone receptor profiling (luminal status). Collectively, our data indicate that the expression of apoptosis regulatory proteins changes following exposure to NAC in breast cancer tissue, developing a partial pathologic response.
Nationwide Longitudinal Annual Survey of HIV/AIDS Referral Hospitals in Japan From 1999 to 2021: Trend in Non–AIDS-defining Cancers Among Individuals Infected With HIV-1
Authors: Tanaka Takeshi , Oshima Kazuhiro , Kawano Kei , Tashiro Masato , Kakiuchi Satoshi , Tanaka Akitaka , Fujita Ayumi , Ashizawa Nobuyuki , Tsukamoto Misuzu , Yasuoka Akira , Teruya Katsuji , Izumikawa Koichi
Published: March 2024

Background:

Non–AIDS-defining cancers (NADCs) in patients infected with HIV have recently attracted attention because of the improved survival of this patient population. To obtain accurate data, a longitudinal study is warranted for the nationwide surveillance of the current status and national trend of NADCs in patients infected with HIV in Japan.

Setting:

An annual nationwide surveillance of NADCs in patients infected with HIV-1 in Japan from 1999 to 2021.

Methods:

An annual questionnaire was sent to 378 HIV/AIDS referral hospitals across Japan to collect data (clusters of differentiation 4-positive lymphocytes, time of onset, outcomes, and antiretroviral therapy status) of patients diagnosed with any of the NADCs between 1999 and 2021.

Results:

The response and case-capture rates for the questionnaires in 2021 were 37.8% and 81.2%, respectively. The number of reported NADC cases subsequently increased since the beginning of this study. Evaluation of the case counts of NADCs demonstrated a high incidence of lung, colorectal, gastric, and liver cancers as the top 4 cancers. Pancreatic cancer (0.63), lung cancer (0.49), and leukemia (0.49) had the highest mortality rates among the NADCs. Trends of NADCs regarding transmission routes were maintained over the years in male individuals who have sex with male individuals compared with heterosexual male individuals and female individuals.

Conclusions:

We demonstrated an increasing trend in the incidence of NADCs over a period of 23 years in Japan. The current data highlighted the importance of raising awareness regarding cancer management for patients infected with HIV in Japan.
Experimentally evolved Staphylococcus aureus shows increased survival in the presence of Pseudomonas aeruginosa by acquiring mutations in the amino acid transporter, GltT
Authors: Alexander Ashley M. , Luu Justin M. , Raghuram Vishnu , Bottacin Giulia , van Vliet Simon , Read Timothy D. , Goldberg Joanna B.
Published: March 2024

When cultured together under standard laboratory conditions Pseudomonas aeruginosa has been shown to be an effective inhibitor of Staphylococcus aureus. However, P. aeruginosa and S. aureus are commonly observed in coinfections of individuals with cystic fibrosis (CF) and in chronic wounds. Previous work from our group revealed that S. aureus isolates from CF infections are able to persist in the presence of P. aeruginosa strain PAO1 with a range of tolerances with some isolates being eliminated entirely and others maintaining large populations. In this study, we designed a serial transfer, evolution experiment to identify mutations that allow S. aureus to survive in the presence of P. aeruginosa. Using S. aureus USA300 JE2 as our ancestral strain, populations of S. aureus were repeatedly cocultured with fresh P. aeruginosa PAO1. After eight coculture periods, S. aureus populations that survived better in the presence of PAO1 were observed. We found two independent mutations in the highly conserved S. aureus aspartate transporter, gltT, that were unique to evolved P. aeruginosa-tolerant isolates. Subsequent phenotypic testing demonstrated that gltT mutants have reduced uptake of glutamate and outcompeted wild-type S. aureus when glutamate was absent from chemically defined media. These findings together demonstrate that the presence of P. aeruginosa exerts selective pressure on S. aureus to alter its uptake and metabolism of key amino acids when the two are cultured together.