bluuebunny/crossref_metadata_2025 huggingface dataset:
Stress fracture in athletes after reconstruction of the anterior cruciate ligament of the knee – case reports and literature review
Authors: DE SOUZA PINTO MAIKON FELICETTI , DE PAIVA LUCIANO ALEXANDRE , DE ARAUJO MATHEUS AGUIAR , ALEIXO BRUNA ANDRADE , LUDERS VICTOR CANDIOTTO , PIETROBOM LEONARDO CAÇADOR
Published: November 2024

Objectives

We purpose to report two cases of stress fractures in amateur athletes after anterior cruciate ligament reconstruction (ACLR) and review literature data.

Methods

Case Presentation: The first case involved a 30-year-old male, who underwent ACLR with hamstring autograft. Post-surgery, he recovered well and returned to sports after 9 months. However, he later experienced pain, swelling, and reduced joint motion, revealing a low-risk, grade III stress fracture in the postero-medial region of the proximal tibia. The second case featured a 34-year-old male with ACL injury, successfully treated with ACLR using hamstring autograft. Despite a smooth recovery, he developed pain and swelling, uncovering a low-risk, grade III stress fracture in the postero-medial proximal tibia during follow-up examinations.

Results

Two rare stress fracture cases in the tibial plateau post-ACLR are reported in amateur athletes. Following initial recovery, both experienced pain, swelling, and reduced knee motion. MRI revealed low-risk stress fractures in the postero-medial proximal tibia (grade III). Management involved a two-phase protocol: pain control, activity modification, and physiotherapy (1); gradual return to sports with predisposing factor correction (2). The paper discusses the rarity of such fractures in healthy athletes, emphasizing tibial tunnel positioning and biomechanical factors. Genetic susceptibility to stress fractures is considered. Evaluation of acutely painful knees post-ACLR should include stress fracture assessment, emphasizing early MRI diagnosis and established management principles.

Conclusion

In conclusion, stress fractures in the proximal tibia following ACLR are infrequent, especially in athletic individuals, highlighting the need for continued research into contributing biomechanical factors, optimal tunnel positioning, and genetic influences. Management protocols involve early detection through MRI and a phased approach to rehabilitation, emphasizing the significance of individualized patient care.
The incidence of anterior cruciate ligament injury in youth and male soccer athletes: an evaluation of 17,108 players over two consecutive seasons with an age-based sub-analysis
Authors: DIEGO DA COSTA ASTUR , COHEN MOISES
Published: November 2024

Objectives

To evaluate the incidence of anterior cruciate ligament (ACL) injuries in male athletes from professional soccer clubs over two consecutive seasons (2018-2019) with a sub-analysis based on age category: under-13 (U-13), under-15 (U-15), under-17 (U-17), and under-20 (U-20) years.

Methods

A total of 17,108 young male soccer players were retrospectively reviewed from sixty-three professional clubs in the four highest Brazilian soccer divisions. Data regarding the number of athletes and the number of ACL injuries confirmed by magnetic resonance imaging (MRI) exams in the 2018 and 2019 seasons were collected. Incidence of ACL injury were compared by season, age category (under-13; under-15; under 17; and under-20), demographic region, and club division.

Results

Clubs from all regions of Brazil participated in the study. A total of 336 primary ACL injuries were diagnosed over the two seasons (8,167 athletes during the 2018 season and 8,941 athletes during the 2019 season) among all athletes, which corresponds to 2% of the included athletes. There were 11 cases (0.3%) in the under-13, 53 cases (1.3%) in the under-15, 107 cases (2.5%) in the under-17, and 165 cases (3.8%) in the under-20 age category. There was a higher incidence of ACL injury in the older age groups (p < 0.001).

Conclusion

A total of 336 ACL injuries were identified in 17,108 youth soccer players from 63 professional clubs with an overall incidence of 2% over 2 seasons of competition. ACL injury rate ranged from 0.3% to 3.8% and was higher in the older and more competitive club divisions.
Epidemiology of Knee injuries in São Paulo state's baseball athletes
Authors: Santos Netto AS , Arashiro VK , Aguilar KC , Xu T , Rabelo N , Cury RPL
Published: November 2024

Objectives

Identify the main knee complaints and injuries associated with baseball, and their prevalence in our state.

Methods

Epidemiological study developed through the analysis of data obtained from an online questionnaire, between 2019 and 2022, distributed among baseball athletes in the state of São Paulo.

Results

98 athletes participated in the study, with an average age of 24.3 years, 85.72% of whom were men. The most prevalent ethnicities are yellow (50%) and white (42.86%) and the majority of athletes have incomplete or complete higher education (75.5%). 88.77% have been training for more than a year and 40.82% work in more than one position. More than half simultaneously practice another sport. 66.32% of athletes present knee complaints or symptoms and 37.75% have suffered a knee injury associated with playing baseball through various mechanisms (contact with the ground, contact with another player, no contact). 59.45% of athletes needed to be removed from practice due to complaints, symptoms or injuries presented.

Conclusion

Of the athletes interviewed, 66.32% had a knee complaint and 37.75% had already had an injury diagnosed in this joint, the most prevalent being meniscal and ligament injuries. The injury rate was highest in the first year of practice.
The State of Academic Bullying Among Medical Students in Tanzania: Prevalence, Forms and Associated Factors. A Cross-Sectional Study
Authors: Mashauri Harold L. , Angolile Cornel M. , Max Baraka L. , Makule Angela O. , Peter Ashrak M. , Mhando Lisbeth , Sakita Francis
Published: November 2024

Introduction

Academic bullying is prevalent in medical schools due to their unique study settings. Globally, the prevalence of academic bullying is increasing markedly; it ranges from 27% to 99.1%. However, the extent, forms, and associated factors of academic bullying among medical students in Tanzania are unknown.

Objective

To determine the prevalence, forms, and factors associated with academic bullying among medical students in Tanzania.

Methodology

This was a cross-sectional study among medical students in 10 medical schools in Tanzania using an online structured questionnaire. Statistical analysis included the use of frequencies, percentages, chi-square and univariate logistic regression at 95% confidence intervals (CIs) and significance at p-value <0.05.

Results

The study included 427 medical students. Majority (71.7%) of the medical students were in their clinical years. Among the participants, 80.8% had heard of academic bullying in medical school. Prevalence of academic bullying was 34.7% while 28.7% had a secondary experience. It was more common in clinical rotation settings (65.4%). Verbal abuse was the most common form of bullying. Factors associated with academic bullying included age, sex, marital status, religion, class category, year of study, presence of mentorship programs, having a mentor or not, presence of bullying reporting system, friendliness of bullying reporting system and students perceived overall rating of the learning environment.

Conclusion

Despite being relatively low compared to most countries, the prevalence of academic bullying among medical students in Tanzania is potentially of both medical education, career prosperity and mental health concern especially among medical students. Collaborative efforts among national respective authorities, medical schools and students are crucial in prevention and control of academic bullying practice.
The international Hip Outcome Tool 12 questionnaire (iHOT-12): an Italian language cross-cultural adaptation and validation
Authors: Randelli Filippo , Fioruzzi Alberto , Clemente Alice , Radaelli Alessandra , Menon Alessandra , Di Via Danilo , Caria Clemente , Mazzoleni Manuel Giovanni , Buono Claudio , Di Benedetto Paolo , Paciotti Michele , Papalia Rocco , Fiorentino Gennaro , Collarile Marco , Panasci Manlio , Carulli Christian , Rosolani Marco , Rocca Federico Della , Cerulli Simona , Potestio Domenico , Conati Michele , Costantini Alberto , Bisciotti Gian Nicola , Aprato Alessandro , Perticarini Loris , Santori Nicola , Loppini Mattia , Solarino Giuseppe , Vicenti Giovanni , Pavone Vito , Di Martino Alberto , Rivera Fabrizio
Published: November 2024

Background

Patient-reported outcome (PRO) measures are essential for evaluating disease-related quality of life. The International Hip Outcome Tool 12 (iHOT12) assesses various aspects of hip-related symptoms, function, sports participation, and social limitations. This study aimed to adapt and validate an Italian version of the iHOT12 according to COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines.

Materials and methods

A multicenter observational cohort study was conducted to translate and validate the iHOT-12 into Italian (iHOT-12-ita) and assess its psychometric properties. Following international guidelines, we translated and culturally adapted the iHOT-12-ita. Patients with hip pain included in the study completed the iHOT-12-ita and mHHS-ita questionnaires at three timepoints: initial consultation (T0), 10–20 days later (T1), and at least 2 months after treatment (T2): hip injection, hip arthroscopy or total hip replacement. The evaluation of the iHOT-12-ita psychometric properties was conducted following the COSMIN checklist, assessing its reliability, responsiveness, interpretability, and acceptability.

Results

Between May 2019 to September 2022, 104 patients were included, from two tertiary hip surgery referral center clinics, they completed both questionnaires and were available for data analysis. The psychometric evaluations revealed robust test–retest reliability on 27 patients at T1, with a Lin coefficient of 0.709 [95% confidence interval (CI) 0.553–0.888] and a high Pearson correlation coefficient of 0.745. At T2 after treatment, there was significant responsiveness (p < 0.001, n = 72), with excellent correlation observed between the iHOT-12-Ita and mHHS-Ita questionnaires (pwcorr = 0.7971). All predefined hypotheses were confirmed.

Conclusions

The Italian iHOT-12-ita proved reliable, valid, and responsive in assessing hip disease-related quality of life. Its implementation in routine clinical practice and research can enhance patient care and research quality in hip preservation surgery for the Italian orthopedic community.

Level of evidence: II.
Enhanced prediction of hemolytic activity in antimicrobial peptides using deep learning-based sequence analysis
Authors: Abdelbaky Ibrahim , Elhakeem Mohamed , Tayara Hilal , Badr Elsayed , Abdul Salam Mustafa
Published: November 2024

Antimicrobial peptides (AMPs) are a promising class of antimicrobial drugs due to their broad-spectrum activity against microorganisms. However, their clinical application is limited by their potential to cause hemolysis, the destruction of red blood cells. To address this issue, we propose a deep learning model based on convolutional neural networks (CNNs) for predicting the hemolytic activity of AMPs. Peptide sequences are represented using one-hot encoding, and the CNN architecture consists of multiple convolutional and fully connected layers. The model was trained on six different datasets: HemoPI-1, HemoPI-2, HemoPI-3, RNN-Hem, Hlppredfuse, and AMP-Combined, achieving Matthew’s correlation coefficients of 0.9274, 0.5614, 0.6051, 0.6142, 0.8799, and 0.7484, respectively. Our model outperforms previously reported methods and can facilitate the development of novel AMPs with reduced hemolytic activity, which is crucial for their therapeutic use in treating bacterial infections.
Analysis of risk factors related to acute exacerbation in patients with chronic pancreatitis: a retrospective study of 313 cases from a single center in China
Authors: Liu Jiaming , Wang Cong , Chen Zhen , Dai Qili , Bai Jingrui , Cui Yun‑Feng
Published: November 2024

Background

Acute on chronic pancreatitis(ACP) is a common cause of treatment in patients with chronic pancreatitis(CP). However, as far as we know, research on ACP has been few, and the quality may vary. This study intended to explore the risk factors related to acute exacerbation in patients with chronic pancreatitis.

Methods

313 patients with CP were analyzed based on clinical data from 2014 to 2023 and categorized into ACP and non-ACP groups. Their data, assessed across eleven parameters, were used to study risk variables associated with acute exacerbation in patients with chronic pancreatitis.

Results

Of the 313 eligible patients, 163(52.1%) were ACP. Age > 50 years old (P = 0.049, OR = 0.614, 95%CI: 0.378–0.998), recurrent acute pancreatitis(RAP) history (P = 0.000, OR = 3.284, 95%CI: 1.972–5.467) and steatorrhea (P = 0.013, OR = 0.189, 95%CI: 0.051–0.704) were related factors for ACP.

Conclusion

The history of RAP was an independent risk factor for ACP. Age and steatosis were protective of the prevalence of ACP.
The COVID-19 experience among international migrant workers in the Republic of Korea: knowledge and awareness of treatment and immigration policies
Authors: Park Jayoung , Heo Jongho , Kim Woong-Han , Choi Sugy
Published: November 2024

Introduction

The COVID-19 pandemic has exposed various health risks and inequities experienced by international migrant workers. The number of migrant workers in the Republic of Korea (ROK) is rapidly growing and is expected to continue growing. Health related research on migrant workers in ROK is limited, especially among undocumented migrant workers who were more vulnerable to the pandemic. This study aims to examine the experiences of migrant workers and their knowledge and awareness of treatment and immigration policies during the pandemic.

Methods

We used data from the International Migrant Workers’ COVID-19 Health Literacy and Access to Medical Care project, a cross-sectional survey conducted with international migrant workers residing in ROK in 2021 (n = 537). Descriptive statistics and multivariable regression models were employed to understand different demographic, occupational, and immigration factors affecting migrant workers’ knowledge and awareness of treatment and immigration policies.

Results

Undocumented migrant workers had a longer length of residence in ROK and earned less compared to workers with work visa status. None of the undocumented migrant workers had access to health insurance since they were ineligible to enroll in the national health insurance scheme. In the early days of the pandemic, most undocumented migrant workers experienced a decrease in their average income. After adjusting for demographic differences and language proficiency, undocumented migrant workers (AOR: 0.41, 95% CI: 0.21, 0.78) were less likely to be aware of the policy allowing foreigners, including undocumented individuals, to access COVID-19 testing and treatment without the risk of deportation. Workers with a longer length of residence (AOR: 1.29, 95% CI: 1.09, 1.53) were more likely to be aware of this policy.

Conclusion

Undocumented migrant workers were often less informed about COVID-19 policies. While most of the survey respondents were knowledgeable about governmental policies regarding COVID-19 treatment and immigration, our results reveal multiple occupational and health insurance vulnerabilities of undocumented migrant workers living in ROK. More attention is needed to understand healthcare service barriers and how to provide adequate resources for this vulnerable population.
Multiple losses of aKRAB from PRDM9 coincide with a teleost-specific intron size distribution
Authors: Zinner Ann-Christin , Jakt Lars Martin
Published: November 2024

Background

Primary transcripts are largely comprised of intronic sequences that are excised and discarded shortly after synthesis. In vertebrates, the shape of the intron size distribution is largely constant; however, most teleost fish have a diverged log-bimodal ‘teleost distribution’ (TD) that is seen only in teleosts. How the TD evolved and to what extent this was affected by adaptative or non-adaptive mechanisms is unknown.

Results

Here, we show that the TD has evolved independently at least six times and that its appearance is linked to the loss of the aKRAB domain from PRDM9. We determined intron size distributions and identified PRDM9 orthologues from annotated genomes in addition to scanning 1193 teleost assemblies for the aKRAB domain. We show that a diverged form of PRDM9 ($$\beta$$
β
) is predominant in teleosts whereas the $$\alpha$$
α
version is absent from most species. Only a subset of PRDM9-$$\alpha$$
α
proteins contain aKRAB, and hence, it is present only in a small number of teleost lineages. Almost all lineages lacking aKRAB (but no species with) had TDs.

Conclusions

In mammals, PRDM9 defines the sites of meiotic recombination through a mechanism that increases structural variance and depends on aKRAB. The loss of aKRAB is likely to have shifted the locations of both recombination and structural variance hotspots. Our observations suggest that the TD evolved as a side-effect of these changes and link recombination to the evolution of intron size illustrating how genome architectures can evolve in the absence of selection.
Biostimulants for enhancing productivity, bioactive components, and the essential oils of garlic with the potential antifungal activity
Authors: Hassan Hanaa S. , Feleafel Mostafa N. , El-Lahot Mina S. R. Abd , EL-Hefny Mervat , Rahman Taghreed F. M. Abdel , Mohamed Abeer A. , Abd-Elkader Doaa Y. , Mahdy R. M.
Published: November 2024

To feed the world’s growing population, the agriculture sector has recently had to strike a balance between reducing its detrimental effects on ecosystems and human health and boosting resource efficiency and production. In reality, pesticides and fertilizers are vital to agriculture and are useful instruments that farmers can employ to increase yield and guarantee steady productivity throughout the seasons under both favorable and unfavorable conditions. Therefore, in the present study, fertilizing with potassium citrate as a foliar spray and humic acid (HA) as a soil application allowed for the evaluation of vegetative growth parameters (plant height, number of leaves/plant), total phenolic content, total carbohydrate, antioxidant activity, the essential oil (EO) composition, and bulb yield of garlic (Allium sativum L.). These were carried out in two field experiments throughout the 2020–2021 and 2021–2022 growth seasons. A gas chromatography-mass spectroscopy (GC-MS) apparatus was performed to determine the chemical composition of the isolated EOs. The antifungal activity of the EOs was assessed against two fungi, Fusarium proliferatum and Macrophomina phaseolina, that cause geranium plants to wilt and decay. The findings indicated that applying HA at a rate of 2 g/L with potassium citrate at a rate of 5 or 10 mL/L produced garlic bulbs with the highest levels of productivity and diameter. The diverse treatments between HA with potassium citrate resulted in significant variations in the bioactive components, such as total phenol content, antioxidant activity, total carbohydrate, and sulfur content. The analysis of the EOs revealed the presence of dimethyl trisulfide, diallyl disulfide, methyl 2-propenyl trisulfide, allitridin, and methyl allyl disulfide and allyl tetrasulfide as main compounds. By gradually increasing the concentration of the garlic EO to 4000 µg/mL compared to the control, the inhibition percentage of fungal growth of F. proliferatum and M. phaseolina was increased. In conclusion, a high concentration of HA with potassium citrate (5 or 10 mL/L), may be suitable and highly appreciated as a fertilizer application to enhance the productivity and EOs content of garlic plants.
Engineered macrophages: an “Intelligent Repair” cellular machine for heart injury
Authors: Zhang Zhuo , Du Hetian , Gao Weijie , Zhang Donghui
Published: November 2024

Macrophages are crucial in the heart’s development, function, and injury. As part of the innate immune system, they act as the first line of defense during cardiac injury and repair. After events such as myocardial infarction or myocarditis, numerous macrophages are recruited to the affected areas of the heart to clear dead cells and facilitate tissue repair. This review summarizes the roles of resident and recruited macrophages in developing cardiovascular diseases. We also describe how macrophage phenotypes dynamically change within the cardiovascular disease microenvironment, exhibiting distinct pro-inflammatory and anti-inflammatory functions. Recent studies reveal the values of targeting macrophages in cardiovascular diseases treatment and the novel bioengineering technologies facilitate engineered macrophages as a promising therapeutic strategy. Engineered macrophages have strong natural tropism and infiltration for cardiovascular diseases aiming to reduce inflammatory response, inhibit excessive fibrosis, restore heart function and promote heart regeneration. We also discuss recent studies highlighting therapeutic strategies and new approaches targeting engineered macrophages, which can aid in heart injury recovery.
Contribution of aseismic slips to earthquake swarms at the Hakone volcano
Authors: Kawai Tetsuro , Yukutake Yohei , Doke Ryosuke , Honda Ryou
Published: November 2024

Recent studies have proposed the contribution of aseismic slip (AS) to earthquake swarms. We investigated the role of AS in earthquake swarms that occurred in 2009, 2015, and 2019 at the Hakone volcano, central Japan, through highly resolved hypocenter distribution analysis, geodetic observation analysis, and identification of similar earthquakes. We observed diffusion-like migration of hypocenters during these swarms. The hydraulic diffusivity varied among the swarms, indicating differing dynamics. The 2015 swarm exhibited rapid hypocenter migration and significant crustal deformation, as revealed by the temporal sequences of tiltmeters near the swarm region. Right-lateral shear dislocation on fault planes could explain the crustal deformation observed in 2015, indicating that AS released approximately 90% of the moment. However, the 2009 swarm lacked evidence of significant AS contribution, indicating that the primary mechanism was fluid pressure diffusion. The substantial contribution of AS to the 2015 swarm might be attributed to increased fluid pressure due to the intrusion of hydrothermal fluid into the shallow part beneath the volcano during volcanic unrest. Our findings imply that the temporal and spatial patterns of seismicity can provide valuable insights into the underlying mechanics of earthquake swarms.

Graphical abstract
The role of endoscopic ultrasound (EUS) in detecting common bile duct (CBD) stones missed post-endoscopic retrograde cholangiopancreatography (ERCP) in patients with calculous obstructive jaundice
Authors: Hassan Mohamed Badr , Hashim Ahmed Morad , Darwish Mahmoud Abd Elnabi Mohamed , Abdellatef Abeer
Published: November 2024

Background

Choledocholithiasis occurs in up to 20% of patients with gallstones. Diagnosing choledocholithiasis can be challenging. Previously, the gold standard for diagnosis was endoscopic retrograde cholangiopancreatography (ERCP). However, small stones often evade detection through ERCP and magnetic resonance cholangiopancreatography (MRCP). Endoscopic ultrasound (EUS) has proven effective in identifying common bile duct (CBD) stones that MRCP and ERCP might miss, particularly small stones or those lodged in the distal CBD or papillary region. The study aimed to evaluate the accuracy of EUS in detecting CBD stones missed by MRCP and ERCP.

Methods

A case–control study was conducted; we enrolled 30 patients who were presented with calculous obstructive jaundice and had undergone both ERCP and MRCP. A stent was inserted in these patients. Prior to stent removal, these patients underwent EUS to evaluate its effectiveness in detecting any remaining CBD stones post-ERCP. The sensitivity and specificity of EUS, ERCP, and MRCP were compared based on the presence, size, and number of detected stones.

Results

The mean age of involved patients was 50.3 ± 10.2 years. ERCP demonstrated a sensitivity of 44.4%, specificity of 100%, positive predictive value (PPV) of 100%, negative predictive value (NPV) of 16.6%, and an accuracy of 50%. MRCP showed a sensitivity of 81.5%, specificity of 100%, PPV of 100%, NPV of 37.5%, and an accuracy of 83.3% when compared with EUS results. The complication rate for EUS was significantly lower than that for diagnostic ERCP. Additionally, an EUS-based strategy was more cost-effective than diagnostic ERCP for patients with low, moderate, or high risk.

Conclusion

Endoscopic ultrasound (EUS) is a promising, non-invasive, non-contrast technique that may serve as a superior diagnostic tool compared with MRCP and ERCP, particularly for detecting small stones or those impacted in the distal CBD or papillary region.
Policing Muslims under the Directory
Authors: Coller Ian
Published: November 2024

In early 1799 French authorities issued orders to identify and register Ottoman Muslims within the territory of the Republic, followed by orders to arrest Algerian subjects and sequester their property. The immediate context of the policing operation was France's unprovoked July 1798 invasion of Egypt, leading to the Ottoman declaration of war in September. But the aims of this botched and almost entirely fruitless operation are harder to discern. Presented as a way of ensuring the safety of French subjects who had been detained in Istanbul and Algiers, it only exacerbated tensions. It was less a proportionate diplomatic action than a Machiavellian tactic by the foreign minister, Talleyrand. In the interests of ending the Revolution in France, Talleyrand sought to aggravate the war and drive the Ottoman Empire into the arms of the anti-French coalition. The new anti-Muslim rhetoric that emerged in this process outlasted Talleyrand's ministry and contributed to the fragmentation of republican universalism in the lead-up to Napoleon Bonaparte's coup d’état at the end of 1799.
School Starting Age, Fertility, and Family Formation: Evidence From the School Entry Cutoff Using Exact Date of Birth
Authors: Beck Kathryn Christine , Hart Rannveig Kaldager , Flatø Martin
Published: November 2024

In the past 50 years, the age at first birth in Norway and other European countries has shifted, leading to concerns that individuals begin childbearing too late to reach their intended family size. This article analyzes the effect of school starting age on fertility and family formation by utilizing Norway's age-based school entry policy. Using individual-level register data and a regression discontinuity design, we find that being born after the age cutoff for school start results in an increased age at first birth of 2.9 months for women and 4.0 months for men, whereas completed cohort fertility was unchanged. Similarly, being born after the cutoff increased the age at first marriage by 4.7 months for women and 2.4 months for men, with no effect on the overall probability of having a partner. Results show that age at completed education and earnings development are important mechanisms in this fertility postponement. Additionally, we analyze detailed age- and parity-specific effects, providing important insights into how age at starting school affects fertility timing but not overall fertility.
Impactos da pandemia da covid-19 sobre a adaptação acadêmica, a saúde mental e o bem-estar de alunos universitários
Authors: Bandeira Andriola Wagner , Melo de Castro Nogueira Paulo Roberto , Melgaço da Silva Lucas
Published: November 2024

O texto apresenta resultados de uma pesquisa executada para averiguar os impactos da Covid-19 sobre aspectos da saúde mental dos alunos de cursos de graduação, a partir do desenvolvimento do Projeto “Pandemia da Covid-19 na Educação Superior: avaliação dos impactos sobre a saúde mental de discentes e servidores, bem como sobre o desempenho de Instituições de Ensino Superior (IES)", financiado pela Coordenação de Aperfeiçoamento de Pessoal de Ensino Superior (CAPES). A amostra contou com a participação de 5.954 alunos matriculados em cursos de graduação da Universidade Federal do Ceará (UFC) e do Centro Universitário Unichristus. Para o aspecto metodológico do estudo, adotou-se o método ex-post facto, com dados coletados por meio de formulário eletrônico disponibilizado via plataforma Google Forms. Os resultados revelaram os impactos da Covid-19 sobre a saúde mental dos alunos de graduação.
Post-traumatic extensive chronic osteomyelitis of skull vault: An illustrative case report
Authors: Reshtin Maksalmina , Faeez Ahmad , Qadri Haseeb Mehmood , Ghafoor Abdul , Khizar Ahtesham
Published: November 2024

Chronic osteomyelitis of the skull base is a commonly reported pathology in existing scientific literature, but chronic osteomyelitis of the skull vault (COSV) is a rarely documented disease. We report the case of a 38 years old Afghan male with a presenting complaint of irregular swelling on the skull vault for six months. The patient had a history of head trauma one year back with a compound depressed fracture which had been surgically managed then. Physical examination revealed a 15 x 15 cm hard, immobile swelling with an old scar mark over the scalp. Neuroimaging was consistent with diffuse, bilateral frontoparietal swelling of bony origin, sparing underlying brain parenchyma. Surgically excision of the lesion was done through a bicoronal skin flap and cranioplasty done at the same time. Histological findings of the specimen reported chronic osteomyelitis. However, microbiology revealed no growth in culture. Patient was discharged on the second postoperative day uneventfully. This case turns minds into keeping skull vault osteomyelitis as differential diagnosis besides other spontaneous bony lesions; e.g. fibrous dysplasia, osteoma and giant cell tumours.
Abbreviations: COSV: Chronic osteomyelitis of skull vault, CT: Computed Tomography, MRI: Magnetic Resonance Imaging, PMMA: Polymethylmethacrylate, SBO: Skull Base Osteomyelitis.
doi: https://doi.org/10.12669/pjms.40.12(PINS).10977
How to cite this: Reshtin M, Faeez A, Qadri HM, Ghafoor A, Khizar A. Post-traumatic extensive chronic osteomyelitis of skull vault: An illustrative case report. Pak J Med Sci. 2024;40(12):S75-S79. doi: https://doi.org/10.12669/pjms.40.12(PINS).10977
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Cerebellopontine angle paraganglioma masquerading as vestibular schwannoma
Authors: Najeeb Zia Ul Rehman , Ali Shafqat , Qadri Haseeb Mehmood , Shabbir Asif
Published: November 2024

Paragangliomas are slow-growing, extra-adrenal neuroendocrine tumors with rare intracranial presentation. Although benign, they can be locally aggressive tumors causing bone destruction and compression related symptoms. We report the case of a 19 years old, normotensive female who presented with headache and vertigo for the past six months. Her examination showed right-sided conductive hearing loss and signs of cranial nerve X, vagus nerve palsy. Neuroimaging revealed a lobulated, extra-axial mass measuring 5.4 x 4.2 x 6.8 cm in right cerebellopontine angle (CPA). Subtotal surgical resection was achievable. Histopathology was suggestive of benign, non-secretory paraganglioma. The diagnosis of primary CPA was reached after ruling out other sources of paraganglioma in abdomen, pelvis and thorax. Radiotherapy was advised on follow up visit with no new post-operative deficits seen. Primary CPA paraganglioma should be included in the list of differentials of CPA lesions. Surgical excision in the absence of preoperative embolization of paraganglioma can be successful.
doi: https://doi.org/10.12669/pjms.40.12(PINS).10978
How to cite this: Najeeb ZR, Ali S, Qadri HM, Shabbir A. Cerebellopontine angle paraganglioma masquerading as vestibular schwannoma. Pak J Med Sci. 2024;40(12):S99-S102. doi: https://doi.org/10.12669/pjms.40.12(PINS).10978
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Primary Aneurysmal Bone Cyst of Sacrum: A Case Report of a 12 years old boy from Pakistan
Authors: Qadri Haseeb Mehmood , Khawaja Arham Amir , Bashir Raahim , Bashir Asif
Published: November 2024

Aneurysmal bone cysts are locally invasive, benign lesions usually found in the spine or metaphysis of long bones. They can be primary (idiopathic) or secondary to other bone pathologies. Primary aneurysmal bone cyst usually occurs in the first two decades of life.
We report a 12 years old male, a known case of Type-1 diabetes mellitus, with lower back pain radiating to the right lower limb for the past two months following a fall. There were no neurological deficits, although straight leg raises and Faber’s tests were positive. Neuroimaging suggested an enhancing 7 x 8 mm lesion involving the lamina of the first sacral vertebra with protrusion into the spinal canal. Bone scan ruled out metastatic pathology. Excision of the lesion with laminectomy and foraminotomy was done. Histopathology was suggestive of aneurysmal bone cyst. The patient is living a healthy life. Upfront surgical excision without preoperative embolization and expensive medical therapies can be an option in resource-limited settings.
doi: https://doi.org/10.12669/pjms.40.12(PINS).10988
How to cite this: Qadri HM, Khawaja AA, Bashir R, Bashir A. Primary Aneurysmal Bone Cyst of Sacrum: A Case Report of a 12 years old boy from Pakistan. Pak J Med Sci. 2024;40(12):S95-S98. doi: https://doi.org/10.12669/pjms.40.12(PINS).10988
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Multiple primary brain abscesses in a 14 years old immunocompetent boy: A tale of Proteus mirabilis infestation from Pakistan
Authors: Khokhar Tariq Imran , Qadri Haseeb Mehmood , Fatima Ibreeza , Ghafoor Abdul , Bilal Muhammad Talha
Published: November 2024

Brain abscess (BA) formation that may be due to due to Gram-positive bacteria commonly and less commonly due Gram-negative bacteria affects pediatric population. Most cases are secondary to the involvement of ear, nose, throat and sinuses (ENTS). We describe a rare case of a 14 year old patient presenting with generalized tonic clonic seizures for the last six months associated with fever, vomiting and headache. ENTS examination was normal. Neuroimaging was suggestive of multiple left fronto-pariettal space occupying lesions. Modified pterional craniotomy was done to excise the multiloculated, encapsulated lesion with yellow-green pus. Culture sensitivity yielded Proteus mirabilis. Patient was discharged from the hospital uneventfully. The diagnosis of multiple primary brain abscesses secondary to Proteus mirabilis is very rare and it should be considered in the list of differentials of multiple brain abscesses when the systematic examination is normal. Early surgical excision is the key to a successful outcome.
doi: https://doi.org/10.12669/pjms.40.12(PINS).11033
How to cite this: Khokhar TI, Qadri HM, Fatima I, Ghafoor A, Bilal MT. Multiple primary brain abscesses in a 14 years old immunocompetent boy: A tale of Proteus mirabilis infestation from Pakistan. Pak J Med Sci. 2024;40(12):S87-S89. doi: https://doi.org/10.12669/pjms.40.12(PINS).11033
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Neurosurgical residency: A lost cause or a last resort? Decoding the dilemma
Authors: Kiran Arooj , Ameer Sidra
Published: November 2024

doi: https://doi.org/10.12669/pjms.40.12(PINS).11103
How to cite this: Kiran A, Ameer S. Neurosurgical residency: A lost cause or a last resort? Decoding the dilemma. Pak J Med Sci. 2024;40(12):S126-S127. doi: https://doi.org/10.12669/pjms.40.12(PINS).11103
Revolutionizing neurosurgical care: Cost-effective follow-up with social media applications
Authors: Shahid Raana , Safdar Zainab
Published: November 2024

doi: https://doi.org/10.12669/pjms.40.12(PINS).11104
How to cite this: Shahid R, Safdar Z. Revolutionizing neurosurgical care: Cost-effective follow-up with social media applications. Pak J Med Sci. 2024;40(12):S128-S129.  doi: https://doi.org/10.12669/pjms.40.12(PINS).11104
Outcomes of Fenestration of Lamina Terminalis for Hydrocephalus following Clipping of Ruptured Aneurysms of Anterior Circulation
Authors: Iqbal Ismaeel Khalid , Ansari Nasruddin , Subhan Muhammad , Sheikh Faiq , Wadd Ejaz Hussain , Majid Hafiz Abdul
Published: November 2024

Objectives: To evaluate the Outcomes of Fenestration of Lamina Terminalis for Hydrocephalus following Clipping of Ruptured Aneurysms of Anterior Circulation.
Methods: A retrospective case series study was conducted at the Punjab Institute of Neurosciences, Lahore from August 2022 to July 2023. Seventy seven patients meeting the inclusion criteria of age group 20-65 years, ruptured saccular aneurysm of anterior circulation with or without lamina terminalis fenestration during clipping, were enrolled through non-probability convenience sampling. Data was collected on all patients concerning postoperative hydrocephalus and the measures to mitigate its adverse effects. SPSS version 21 was utilized for data analysis.
Results: The average age of the patients was 46, and 60% were female. In the Lamina terminalis fenestrated group (n=40), the percentage of shunt-dependent hydrocephalus cases following aneurysm clipping was 4% for low Fisher grade and 13% for high Fisher grade. In contrast, in the non-fenestrated group of (n=37) patients, the percentage was 10% for the low Fisher grade and 37% for the high Fisher grade.
Conclusion: Reducing the likelihood of shunt-dependent hydrocephalus after ruptured aneurysm clipping can be achieved using lamina terminalis fenestration, regardless of fisher grade. It assists in preventing excessive brain retraction, decreasing intracranial pressure, raising brain perfusion, cisternal blood cleansing, and lowering the need for a ventriculoperitoneal shunt in cases of persistent hydrocephalus. Consequently, to reduce the incidence of shunt-dependent hydrocephalus, we recommend routine lamina terminalis fenestration following anterior circulation aneurysm clipping.
doi: https://doi.org/10.12669/pjms.40.12(PINS).11122
How to cite this: Iqbal IK, Ansari N, Subhan M, Sheikh F, Wadd IH, Majid HA. Outcomes of Fenestration of Lamina Terminalis for Hydrocephalus following Clipping of Ruptured Aneurysms of Anterior Circulation. Pak J Med Sci. 2024;40(12):S37-S40.  doi: https://doi.org/10.12669/pjms.40.12(PINS).11122
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Surgical outcomes of delayed clipping in ruptured intracranial aneurysms of anterior circulation: Experience from a low-middle-income country
Authors: Khokhar Tariq Imran , Cheema Zulqarnain Akram , Fatima Ibreeza , Riaz Maimoona , Qadri Haseeb Mehmood , Bashir Asif
Published: November 2024

Objective: To evaluate the surgical outcomes of delayed microsurgical clipping for ruptured intracranial aneurysms (RICAs) of anterior circulation.
Methods: This retrospective, cross-sectional study assessed the surgical outcomes of 50 patients who underwent surgical clipping for “ruptured aneurysms” with subarachnoid haemorrhage after the 21st post-bleed day, from May 01, 2022, till May 01, 2023, at the Department of Neurosurgery, Punjab Institute of Neurosciences, Lahore, Pakistan.
Results: The mean age of patients was 49.66 ± 6.231 years with a female preponderance of 54%. Out of 50 cases, 21 were midline aneurysms (42%), followed by left-sided laterality in 16 cases (32%). Aneurysm of the anterior communicating artery was the most common accounting for 42% of the patients. Forty-nine patients returned home after first postoperative week without deficits, with a success rate of 98%. Seizures, surgical site infection and cerebrospinal fluid leak were noted in 6%, 4% and 2% patients, respectively.
Conclusion: Delayed clipping in RICAs after the 21st post-bleed day is advocated, especially in resource-constrained settings. Meticulous surgical technique and asepsis are responsible for great postoperative outcomes.
doi: https://doi.org/10.12669/pjms.40.12(PINS).11273
How to cite this: Khokar TI, Cheema ZA, Fatima I, Riaz M, Qadri HM, Bashir A. Surgical outcomes of delayed clipping in ruptured intracranial aneurysms of anterior circulation: Experience from a low-middle-income country. Pak J Med Sci. 2024;40(12):S41-S46.  doi: https://doi.org/10.12669/pjms.40.12(PINS).11273
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Takotsubo Cardiomyopathy in Epilepsy: A Systematic insight into the Existing Literature from 2000-2023
Authors: Qadri Haseeb Mehmood , Ismail Fiza , Khawaja Momina , Sohail Amna , Bukhari Seeneen , Bashir Asif
Published: November 2024

Background & Objective: Takotsubo cardiomyopathy (TCM), manifests as left ventricular dysfunction triggered by physical or emotional stress. It leads to higher morbidity in epileptic patients and can progress to complications. To find out the correlation between Takotsubo cardiomyopathy and epilepsy and to investigate pathophysiology and associated types of epilepsy.
Methodology: This systematic review adhered to PRISMA guidelines and was sourced from the PubMed Central database. Search terms were pertinent to cardiomyopathy and epilepsy. Sixteen studies, comprising case reports and a case series were selected from 2000 to 2023 for data extraction. The quality evaluation was executed via the Joanna Briggs Institute Critical Appraisal checklist.
Results: The review included 18 female patients with a mean age of 57.22 years. Predominant symptoms included tonic-clonic seizures (66.66%). Seizure-induced TCM pathophysiology implicates catecholamine surge, precipitating myocardial stunting and characteristic apical ballooning. Most patients had a history of epilepsy (38.88%). ECG findings showed tachycardia (38.88%) and ST-segment elevation (38.88%). Elevated troponin levels were noted in 83.33% of patients. Echocardiography showed reduced ejection fraction (72.22%), hypokinesia (38.88%) and akinesis (27.77%). Treatment involved Benzodiazepines (50%), Beta-blockers (61.11%) and Phenytoin (38.88%). The majority of patients showed improvement in echocardiography findings (55.55%) and ECG findings (11.11%).
Conclusion: TCM in epilepsy patients evinces significant female predominance, with pathophysiology rooted in seizure-induced catecholamine surge. Early recognition in high-risk patients is essential in preventing complications.
doi: https://doi.org/10.12669/pjms.40.12(PINS).11274
How to cite this: Qadri HM, Ismail F, Khawaja M, Sohail A, Bukhari S, Bashir A. Takotsubo Cardiomyopathy in Epilepsy: A Systematic insight into the Existing Literature from 2000-2023. Pak J Med Sci. 2024;40(12):S114-S125. doi: https://doi.org/10.12669/pjms.40.12(PINS).11274
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
PINS’s Commitment to Research and Academic Excellence
Authors: Bashir Asif
Published: November 2024

doi: https://doi.org/10.12669/pjms.40.12(PINS).11413
How to cite this: Bashir A. PINS’s Commitment to Research and Academic Excellence. Pak J Med Sci. 2024;40(12):S3.  doi: https://doi.org/10.12669/pjms.40.12(PINS).11413
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Research and Innovations in Neurosciences
Authors: Jawaid Shaukat Ali
Published: November 2024

doi: https://doi.org/10.12669/pjms.40.12(PINS).11419
How to cite this: Jawaid SA. Research and Innovations in Neurosciences. Pak J Med Sci. 2024;40(12):S1-S2. doi: https://doi.org/10.12669/pjms.40.12(PINS).11419
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Αγγειακή προσπέλαση
Authors: Μπαλτά Λαμπρινή
Published: November 2024

Σκοπός: Η αξιολόγηση της ασφάλειας και της αποτελεσματικότητας της δημιουργίας διαδερμικής αρτηριοφλεβικής επικοινωνίας (pAVF) με το σύστημα WavelinQ 4-F EndoAVF. Υλικά και Μέθοδοι: Από τον Φεβρουάριο του 2018 έως τον Ιούνιο του 2020 δημιουργήθηκαν 30 pAVFs σε 30 διαδοχικούς ασθενείς (άνδρες, ηλικία, 55,3 ετών ± 13,6). Από τους 30 ασθενείς οι 21 (70%) ήταν ήδη σε αιμοκάθαρση χρησιμοποιώντας κεντρικό φλεβικό καθετήρα. Τα κύρια μέτρα έκβασης ήταν η τεχνική επιτυχία, οι επιπλοκές και ο ρυθμός παρακέντησης. Τα δευτερεύοντα μέτρα έκβασης περιλάμβαναν τον αριθμό των δευτερευουσών διαδικασιών που απαιτούνται για τη παρακέντηση, τον χρόνο συντήρησης έως τη παρακέντηση και την επιβίωση του pAVF. Αποτελέσματα: Η τεχνική επιτυχία ήταν 100%. Το ποσοστό ανεπιθύμητων ενεργειών ήταν 6,7% (2/30), συμπεριλαμβανομένου ενός ψευδοανευρύσματος της βραχιόνιας αρτηρίας, που αναπτύχθηκε αμέσως μετά την αφαίρεση του θηκαριού, και ενός ανευρύσματος της αναστόμωσης 17 ημέρες μετά τη διαδικασία, το οποίο αντιμετωπίστηκε με κεκαλυμμένο στεντ τοποθετημένο στην αρτηριακή πλευρά . Η μέση παρακολούθηση ήταν 547 ημέρες ± 315,7 (εύρος, 14–1.071 ημέρες). Το ποσοστό παρακεντήσεων ήταν 86,7% (26/30). Ο μέσος χρόνος για τη παρακέντηση ήταν 61,3 ημέρες ± 32,5 (εύρος, 15–135 ημέρες). Η μέση παρακολούθηση μετά τη παρακέντηση ήταν 566,2 ημέρες ± 252,7 (εύρος, 35–1.041 ημέρες). 4 pAVF θρομβώθηκαν μετά τη παρακέντηση, με 2 από αυτές να θρομβολυθούν με επιτυχία. Χρειάστηκαν 16 παρεμβάσεις για να επιτευχθεί η παρακέντηση σε 15 ασθενείς (συνολικά 0,53 επεμβάσεις/ασθενή). Πραγματοποιήθηκαν 7 ενδοαγγειακές παρεμβάσεις συντήρησης (μετά τη παρακέντηση) κατά τη διάρκεια της περιόδου παρακολούθησης σε 6 ασθενείς (συνολικά, 0,27 επεμβάσεις/ασθενή, 0,17 επεμβάσεις/ασθενή/έτη). Για τα pAVF που παρακεντήθηκαν η βατότητα ήταν 96% στο 1 έτος και 82% στα 2 και 3 έτη, σύμφωνα με την ανάλυση επιβίωσης Kaplan-Meier. Συμπεράσματα: Αυτή η αρχική εμπειρία υποδηλώνει ότι η δημιουργία της pAVF είναι ασφαλής και μπορεί να πραγματοποιηθεί με επιτυχία με υψηλά ποσοστά ωρίμανσης και μακροπρόθεσμα ποσοστά βατότητας. Απαιτούνται προοπτικές μελέτες μεγαλύτερης κλίμακας για την επικύρωση των αποτελεσμάτων.