bluuebunny/crossref_metadata_2025 huggingface dataset:
Seaweed consumption and the risk of prostate cancer: the Miyagi cohort study
Authors: Matsumoto Koichi , Sugawara Yumi , Sone Toshimasa , Kanemura Seiki , Fukao Akira , Tsuji Ichiro
Published: April 2023

Some laboratory studies have shown that fucoidan, which is contained in seaweed extract, has inhibitory effects on the invasion and angiogenesis of tumor cells; however, the association between seaweed consumption and prostate cancer incidence remains unclear. The purpose of the present study was to examine the association between seaweed consumption and the risk of prostate cancer incidence in the Japanese population. Data from 19 311 men in the Miyagi Cohort Study who were 40–64 years old at baseline in 1990 were examined. Seaweed consumption was assessed at baseline using a self-administered food frequency questionnaire. The participants were divided into three categories based on seaweed consumption at baseline. During 24.5 years of follow-up, we identified 815 incident cases of prostate cancer. Multivariate analysis showed that seaweed consumption was not associated with prostate cancer incidence. The multivariate hazard ratios and 95% confidence intervals for prostate cancer incidence in the highest tertile versus the other tertiles were 0.76 (0.60–0.96) and 0.78 (0.61–0.99) (P-trend = 0.15). Furthermore, the null association was independent of whether their clinical stage was localized or advanced. In this population-based prospective cohort study conducted in Japan, we found no significant association between seaweed consumption and the incidence of prostate cancer.
Computational pathology to improve biomarker testing in breast cancer: how close are we?
Authors: Sajjadi Elham , Frascarelli Chiara , Venetis Konstantinos , Bonizzi Giuseppina , Ivanova Mariia , Vago Gianluca , Guerini-Rocco Elena , Fusco Nicola
Published: April 2023

The recent advancements in breast cancer precision medicine have highlighted the urgency for the precise and reproducible characterization of clinically actionable biomarkers. Despite numerous standardization efforts, biomarker testing by conventional methodologies is challenged by several issues such as high inter-observer variabilities, the spatial heterogeneity of biomarkers expression, and technological heterogeneity. In this respect, artificial intelligence-based digital pathology approaches are being increasingly recognized as promising methods for biomarker testing and subsequently improved clinical management. Here, we provide an overview on the most recent advances for artificial intelligence-assisted biomarkers testing in breast cancer, with a particular focus on tumor-infiltrating lymphocytes, programmed death-ligand 1, phosphatidylinositol-3 kinase catalytic alpha, and estrogen receptor 1. Challenges and solutions for this integrative analysis in pathology laboratories are also provided.
Surgical outcomes following breast reconstruction in patients with and without a history of chest radiotherapy for Hodgkin lymphoma: a multicentre, matched cohort study
Authors: Harmeling J. Xavier , Woerdeman Leonie A.E. , Ozdemir Ezgi , Schaapveld Michael , Oldenburg Hester S.A. , Janus Cécile P.M. , Russell Nicola S. , Koppert Linetta B. , Krul Inge M. , van Leeuwen Flora E. , Mureau Marc A.M.
Published: April 2023

Background:

Breast cancer is the most common treatment-related second malignancy among women with previous chest radiotherapy for Hodgkin lymphoma (HL). Little is known about the effects of this kind of radiotherapy on the outcomes of postmastectomy breast reconstruction (BR). This study compared adverse outcomes of BR after HL-related chest radiotherapy to matched controls.

Methods:

The authors conducted a retrospective, matched cohort study in two expert cancer centres in the Netherlands. BRs after therapeutic or prophylactic mastectomy in HL survivors who received chest radiotherapy were matched with BRs in nonirradiated patients without HL on age at mastectomy date, date of BR, and type of BR. The primary outcome was complication-related BR failure or conversion and secondary outcomes were complication-related re-operation, capsular contracture, major donor-site complications, and complication-related ICU admission. The authors analyzed all outcomes univariably using Fisher’s exact tests and the authors assessed reconstruction failure, complication-related re-operation, and capsular contracture with multivariable Cox regression analysis adjusting for confounding and data clustering.

Results:

Seventy BRs in 41 patients who received chest radiotherapy for HL were matched to 121 BRs in 110 nonirradiated patients. Reconstruction failure did not differ between HL survivors (12.9%) and controls (12.4%). The comparison groups showed no differences in number of reoperations, major donor-site complications, or capsular contractures. BR in HL survivors more often let to ICU admission due to complications compared with controls (P=0.048).

Conclusions:

We observed no increased risk of adverse outcomes following BR after previous chest radiotherapy for HL. This is important information for counselling these patients and may improve shared decision-making.
Irradiation stent with 125I plus TACE versus sorafenib plus TACE for hepatocellular carcinoma with major portal vein tumor thrombosis: a multicenter randomized trial
Authors: Lu Jian , Guo Jin-He , Ji Jian-Song , Li Yu-Liang , Lv Wei-Fu , Zhu Hai-Dong , Sun Jun-Hui , Ren Wei-Xin , Zhang Fu-Jun , Wang Wei-Dong , Shao Hai-Bo , Cao Guang-Shao , Li Hai-Liang , Gao Kun , Yang Po , Yin Guo-Wen , Zhu Guang-Yu , Wu Fa-Zong , Wang Wu-Jie , Lu Dong , Chen Sheng-Qun , Min Jie , Zhao Yang , Li Rui , Lu Li-Gong , Lau Wan Yee , Teng Gao-Jun
Published: April 2023

Background and Aim:

Treatment strategy for hepatocellular carcinoma (HCC) and Vp4 [main trunk] portal vein tumor thrombosis (PVTT) remains limited due to posttreatment liver failure. We aimed to assess the efficacy of irradiation stent placement with 125I plus transcatheter arterial chemoembolization (TACE) (ISP-TACE) compared to sorafenib plus TACE (Sora-TACE) in these patients.

Methods:

In this multicenter randomized controlled trial, participants with HCC and Vp4 PVTT without extrahepatic metastases were enrolled from November 2018 to July 2021 at 16 medical centers. The primary endpoint was overall survival (OS). The secondary endpoints were hepatic function, time to symptomatic progression, patency of portal vein, disease control rate, and treatment safety.

Results:

Of 105 randomized participants, 51 were assigned to the ISP-TACE group, and 54 were assigned to the Sora-TACE group. The median OS was 9.9 months versus 6.3 months (95% CI: 0.27–0.82; P=0.01). Incidence of acute hepatic decompensation was 16% (8 of 51) versus 33% (18 of 54) (P=0.036). The time to symptomatic progression was 6.6 months versus 4.2 months (95% CI: 0.38–0.93; P=0.037). The median stent patency was 7.2 months (interquartile range, 4.7–9.3) in the ISP-TACE group. The disease control rate was 86% (44 of 51) versus 67% (36 of 54) (P=0.018). Incidences of adverse events at least grade 3 were comparable between the safety populations of the two groups: 16 of 49 (33%) versus 18 of 50 (36%) (P=0.73).

Conclusion:

Irradiation stent placement plus TACE showed superior results compared with sorafenib plus TACE in prolonging OS in patients with HCC and Vp4 PVTT.
Macrophage morphology and distribution are strong predictors of prognosis in resected colorectal liver metastases: results from an external retrospective observational study
Authors: Costa Guido , Sposito Carlo , Soldani Cristiana , Polidoro Michela A. , Franceschini Barbara , Marchesi Federica , Nasir Faizan D. , Virdis Matteo , Vingiani Andrea , Leo Ana , Di Tommaso Luca , Kotha Soumya , Mantovani Alberto , Mazzaferro Vincenzo , Donadon Matteo , Torzilli Guido
Published: April 2023

Introduction:

Tumor-associated macrophages (TAMs) are key components of a tumoral microenvironment and have been shown to impact prognosis in different cancers. Previously reported data showed that TAM morphology correlates with prognosis in colorectal liver metastases (CLMs) after hepatectomy, with smaller TAMs (S-TAMs) conferring a more favorable prognosis than larger ones (L-TAMs). This study aims to externally validate this finding.

Material and methods:

The external cohort consisted of 84 formalin-fixed and paraffin-embedded surgical samples of CLMs and peritumoral tissue. Two-micrometer-section slides were obtained; the area and perimeter of 21 macrophages in each slide were recorded. The endpoints were TAMs morphometrics and their prognostic significance in relation to disease-free survival (DFS).

Results:

The average macrophage perimeter was 71.5±14.1 μm whilst the average area was 217.7±67.8 μm2. At univariate analysis, the TAM area demonstrated a statistically significant association with DFS (P=0.0006). Optimal area cutoff value was obtained, showing a sensitivity and specificity of 92 and 56%, respectively. S-TAMs and L-TAMs were associated with 3-year DFS rates of 60 and 8.5%, respectively (P<0.001). Multivariate analysis confirmed the predictive role of TAM area for DFS [hazard ratio (HR)=5.03; 95% CI=1.70–14.94; P=0.003]. Moreover, in a subset of patients (n=12) characterized by unfavorable (n=6, recurrence within 3 months) or favorable (n=6, no recurrence after 48 months) prognosis, TAMs showed a different distribution: L-TAMs were more abundant and closer to the tumor invasive margin in patients that encountered early recurrence and tended to cluster in foci significantly larger (P=0.02).

Conclusions:

This external validation confirms that morphometric characterization of TAMs can serve as a simple readout of their diversity and allows to reliably stratify patient outcomes and predict disease recurrence after hepatectomy for CLMs.
Minimally invasive nephrolithotomy versus retrograde intrarenal surgery in surgical management of Lower calyceal stones: a systematic review with meta-analysis
Authors: Liu Ming , Hou Jun , Xu FeiHong , Du HuiFang , Liu JingXuan , Li Ning
Published: April 2023

Objective:

The efficacy and safety of minimally invasive nephrolithotomy (MPCNL) versus retrograde intrarenal surgery (RIRS) was assessed for lower calyceal (LC) stones.

Methods:

Our team conducted a systematic literature search up to December, 2022, using PUBMED, EMBASE and the Cochrane Library. The study was registered in PROSPERO, CRD 42021247197. Randomized controlled trials evaluating the efficacy and safety of MPCNL versus RIRS for LC stones were collected. Heterogeneity among the studies was assessed using the χ2 test based on the Q and I
2 tests. Pooled effect sizes were calculated using a fixed model if I
2 is less than 50%; otherwise, a random-effects model was chosen. The primary outcomes were the 3-month stone-free rate (3SFR) and total complications, while the secondary outcomes were the operating time, hospital stay, haemoglobin reduction, bleeding, postoperative fever and complications with the Clavien–Dindo system. A subgroup analysis of 10–20 mm LC stones was also designed.

Results:

A total of 7 peer-reviewed trials comprising 711 patients were identified. No statistical differences were observed in the heterogeneity results of the 3SFR or total complications (P>0.1, I
2 < 50%). Compared with RIRS, MPCNL had an unfavourable safety profile, resulting in total complications [odds ratio (OR): 1.87 (95% CI: 1.05, 3.33); P=0.03], haemoglobin reduction [OR: 0.81 (95% CI: 0.15, 1.47); P=0.02] and complications with Grade I [OR: 5.52 (95% CI: 1.34, 22.83); P=0.02] but an improved efficacy and 3SFR [OR: 2.43 (95% CI: 1.48, 3.97); P=0.0004]. As for the 10–20 mm LC stones, compared with RIRS, MPCNL also had an unfavourable safety profile, resulting in total complications [OR: 2.47 (95% CI: 1.20, 5.07); P=0.01], complications with Grade I [OR: 4.97 (95% CI: 0.99, 25.01); P=0.05] and an increased hospital stay [OR: 2.46 (95% CI: 2.26, 2.66); P=0.00001] but an improved efficacy and 3SFR {OR: 3.10 (95% CI: 1.61, 5.99); P=0.0008]. The efficacy effect of MPCNL and safety effect of RIRS were nearly equal for both stones sized less than 20 mm (number needed to treat = 17, number needed to harm = 20) and stones sized 10–20 mm (number needed to treat = 20, number needed to harm = 13). No statistical difference was found between the MPCNL and RIRS groups for the rest of outcomes.

Conclusion:

Both MPCNL and RIRS are safe and effective management methods. Moreover, compared with RIRS, MPCNL had an unfavourable safety profile but improved efficacy for LC stones of ≤20 mm or 10–20 mm, and the differences were statistically significant. The relative profit of efficacy of MPCNL was similar to the relative profit of safety of RIRS.
Inhaled Nitric Oxide Utilization in Congenital Diaphragmatic Hernia Treated With Extracorporeal Life Support: A Propensity Score Analysis
Authors: Gowda Sharada H. , Almaazmi Ahmed , Hagan Joseph , Niemyjski Emily , Vogel Adam M. , Jancelewicz Tim , Di Nardo Matteo , Harting Matthew T. , Fernandes Caraciolo J. , Nguyen Danh V. , Guner Yigit S.
Published: April 2023

Although used commonly, ability of inhaled nitric oxide (iNO) to improve outcomes in infants with congenital diaphragmatic hernia (CDH) who receive extracorporeal life support (ECLS) remains controversial. We sought to determine the association between pre-ECLS use of iNO and mortality in infants with CDH from the Extracorporeal Life Support Organization (ELSO) Registry. Neonates who underwent ECLS for CDH were identified from the ELSO Registry from 2009 to 2019. Patients were categorized into those treated with iNO versus not prior to initiating ECLS. Patients were then matched 1:1 for case-mix based on pre-ECLS covariates using the propensity score (PS) for iNO treatment. The matched groups were compared for mortality. The matched cohorts were also compared for ELSO-defined systems-based complications as secondary outcomes. There were a total of 3,041 infants with an overall mortality of 52.2% and a pre-ECLS iNO use rate of 84.8%. With 1:1 matching, there were 461 infants with iNO use and 461 without iNO use. Following matching, use of iNO was not associated with a difference in mortality (odds ratio [OR] = 0.805; 95% confidence interval [CI], 0.621–1.042; p = 0.114). Results were similar in unadjusted analyses, and after controlling for covariates in the full cohort of patients and in the 1:1 matched data. Patients receiving iNO had significantly higher odds of renal complications (OR = 1.516; 95% CI, 1.141–2.014; p = 0.004), but no other significant differences were observed among secondary outcomes. ECLS use of iNO in CDH patients was not associated with a difference in mortality. Future randomized controlled studies are needed to delineate the utility of iNO in CDH patients.
Extended Support With the Impella 5.5: Transplant, ECMO, and Complications
Authors: Cohen William G. , Rekhtman David , Iyengar Amit , Shin Max , Ibrahim Michael , Bermudez Christian , Cevasco Marisa , Wald Joyce
Published: April 2023

We report midterm results of Impella 5.5 use with focus placed on bridge-outcomes, venoarterial extracorporeal membrane oxygenation (VA-ECMO) transition, complications, and risk factors for mortality. A retrospective review of patients implanted with the Impella 5.5 at our medical center was conducted. Forty patients were included with varying bridge strategies. Sixteen (40%) patients were supported for <14 days, 13 (32.5%) for 14–30 days, and 11 (27.5%) for >30 days. Thirty day mortality was 22.5% (9/40). Twenty-five (62.5%) were successfully bridged to transplant or durable left ventricular assist device (LVAD), while four (10.0%) recovered without the need for any further cardiac support. Five of 11 (60%) patients initially supported with VA-ECMO were either transitioned to durable left ventricular assist device (dLVAD; n = 3, 27.3%), transplanted (n = 1, 9.1%), or recovered (n = 1, 9.1%). Of nine patients with >moderate right ventricle (RV) dysfunction, five (55.6%) were successfully bridged to transplant or LVAD. Five (12.5%) patients required interval cannulation to VA-ECMO, often in the setting of RV dysfunction, and all (100%) were successfully transplanted. Lower pulmonary artery (PA) systolic pressure (P = 0.029), among other factors, was associated with mortality. In summary, the Impella 5.5 may be able to effectively stabilize patients in refractory left ventricular predominant cardiogenic shock for extended durations, allowing time for mechanical circulatory support (MCS) and transplant evaluations.
Association between the amount of rehabilitation and the outcomes in patients with aspiration pneumonia
Authors: Kato Yuki , Hori Shinsuke , Ushida Kenta , Shimizu Miho , Shirai Yuka , Momosaki Ryo
Published: April 2023

The appropriate amount of rehabilitation for aspiration pneumonia remains unknown. We conducted a historical cohort study to investigate the association between the amount of rehabilitation provided and the outcome of patients with aspiration pneumonia. A total of 4148 patients with aspiration pneumonia recruited from a database created by JMDC were categorized into three groups based on daily rehabilitation units: none or <1 unit (low-volume group), 1–2 units (medium-volume group), and more than 2 units (high-volume group). The main outcome measures were death in the hospital, discharge home, and length of hospital stay. The results showed that the middle-volume and high-volume groups had significantly fewer in-hospital deaths [middle-volume group, odds ratio (OR) 0.62; 95% confidence interval (CI), 0.46–0.83; high-volume group, OR 0.66; 95% CI, 0.45–0.97], more patients were discharged home (middle-volume group, OR 1.29; 95% CI, 1.03–1.62; high-volume group, OR 2.00; 95% CI, 1.48–2.71), and shorter hospital stay (middle-volume group, coefficient −3.30; 95% CI, −6.42 to −0.19; high-volume group, coefficient −4.54; 95% CI, −8.69 to −0.40) compared with the low-volume group. In conclusion, higher rehabilitation units per day provided to patients with aspiration pneumonia were associated with fewer deaths, more home discharges, and shorter hospital stays.
Prevalence and antimicrobial susceptibility of Acinetobacter spp. in a tertiary care hospital in Peshawar: a cross-sectional study
Authors: Ahmad Shahzad , Shakireen Najmush , Ali Khan Mohammad S. , Mumtaz Hassan , Ahmad Wiqar , Shah Mohammad H. , Ahmad Izaz , Khan Waqas , Khan Faheemullah , Nadeem Abdullah , Naqvi Nabiha , Khan Momina S.
Published: April 2023

Background:

Acinetobacter spp. have been a primary cause of nosocomial infections worldwide, causing significant morbidity and mortality, especially in Pakistan. The purpose of this study was to investigate the trend of antimicrobial resistance over a 5-year period in a tertiary care hospital in Pakistan.

Methods:

A retrospective cross-sectional study regarding the occurrence and antimicrobial resistance of Acinetobacter spp. recovered from clinical specimens that were referred to the Pathology Laboratory of Northwest General Hospital, Peshawar. The data from 2014 to 2019 was recorded and analyzed by the laboratory. Sociodemographic characteristics and laboratory record data was analyzed using SPSS, version 25. A chi-square test was applied to see the significance.

Results:

Of 59 483 clinical samples, Acinetobacter baumannii strains were detected in 114 of them. The majority of the clinical samples were from blood (89.5%) followed by sputum (7.9%), wound swab (1.8%), and bone marrow (0.9%). A. baumannii has been found in 52 men (67.53%) and 28 women (75.67%), with an overall risk of 0.669 times. In 76 men (98.70%), sensitivity for ertapenem (99.1), colistin (96.49), and tigecycline (78.9%) were also observed which indicated the potential viability of these drugs to treat multidrug-resistant (MDR) Acinetobacter infections. The male-to-female risk ratio was 0.98 for colistin and 0.71 for amikacin.

Conclusion:

Increased frequency of MDR supports the need for continuous surveillance to determine the prevalence and evolution of MDR Acinetobacter spp. in Pakistan. Colistin, tigecyclines, and ertapenem remain the possible line of drugs to treat MDR Acinetobacter.
Two plus one port laparoscopic assisted continuous ambulatory peritoneal dialysis insertion modified technique: a case series
Authors: Daniswara Nanda , Yudha Fajar G. P. , Santosa Ardy , Soedarso Moh A. , Nugroho Eriawan A. , Wibisono Dimas S. , Addin Sofyan R.
Published: April 2023

Background:

Continuous ambulatory peritoneal dialysis (CAPD) is one of the modalities for renal replacement therapy in patients with stage 5 chronic kidney disease. There are various techniques and modifications, but there is no main reference for laparoscopic catheter insertion. One common complication related to CAPD is the malposition of the Tenckhoff catheter. In this study, the authors present a modified laparoscopic technique for insertion that can prevent malposition of the Tenckhoff catheter by using two plus one port.

Material and method:

A retrospective case series from the medical records at Semarang Tertiary Hospital was identified between 2017 and 2021. Demographic, clinical, intraoperative, and postoperative complication data were collected with a 1-year follow-up after the CAPD procedure.

Results:

This study included 49 patients with a mean age of 43.2±13.6 years, and diabetes was the main cause (51.02%). This modified technique showed no complications intraoperatively. The postoperative complications were found to include one case of hematoma (2.04%), eight cases of omental adhesion (16.3%), seven cases of exit-site infection (14.28%), and two cases of peritonitis (4.08%). Malposition of the Tenckhoff catheter was not found 1-year after the procedure.

Conclusion:

The two plus one port modified laparoscopic assisted CAPD technique could prevent malposition of the Teckhoff catheter because it is already fixated in the pelvic. A long-term follow-up of 5 years is necessary to know the long-term survival of the Tenckhoff catheter in the next study.
Intensive care unit presentation of central corneal descemetocele secondary to Methicillin-Resistant staphylococcal infection superimposed by a hypopyon: a case report
Authors: Zhitny Vladislav P. , Tun Kyaw M. , Roma Katerina , Narra Gopi , Kilburn Jeremy P
Published: April 2023

Introduction:

A descemetocele is a rare type of keratopathy that occurs when an intact descemet’s membrane of the eye undergoes a herniation through an overlying stroma. Previous literature has documented corneal damage via bacterial enzymes, especially, Pseudomonas and Neisseria species. Most recent prospective interventional studies showed treatment of these infections.

Case presentation:

This report presents the first instance of a methicillin-resistant Staphylococcus aureus descemetocele presentation in a 51-year-old African American male, with co-presenting hypopyon sequelae successfully managed conservatively in an intensive care unit setting.

Clinical discussion:

An instance of a methicillin-resistant Staphylococcus aureus has not yet been documented in the literature. Likewise, a co-presentation with a hypopyon, which is known as a formation of inflammatory debris rich in white blood cells has not been studied.

Conclusion:

The presence of a hypopyon in the instances of bacterial descemetocele herniation should be further evaluated to see if there are associations with conservative, nonsurgical intervention outcomes.
Kikuchi–Fujimoto disease in a 20-year-old female: a case report
Authors: Gurung Shekhar , Pariyar Ribek Sunam , Karki Saurab , Gautam Anu , Sapkota Hari
Published: April 2023

Introduction:

Kikuchi disease is an uncommon, self-limited disease that mimics malignant lymphoma in presentation but with an excellent prognosis. The study highlights the importance of diagnosis of Kikuchi disease and modalities to reach it.

Case presentation:

The authors present a case of a 20-year-old Asian female who had complaints of swelling at the angle of the mandible along with fever. There was bilateral cervical lymphadenopathy. Ultrasonography of the neck showed features of tubercular lymphadenitis whereas cell and tissue study revealed the diagnosis of Kikuchi disease. She was managed conservatively and her lesions subsided.

Discussion:

Kikuchi disease is a rare but self-limiting disease characterized by lymphadenopathy. It has similarities with other etiologies especially malignancy and tubercular lymphadenitis which leads to misdiagnosis. Hence, knowledge about incidence, and clinicopathological features helps to reach proper diagnosis prompting effective management.

Conclusion:

Kikuchi disease, being a benign disease needs to be kept in mind to avoid overtreatment in the line of malignancy or tubercular lymphadenitis.
Giant cervical lymphangioma encompassing the neck great vessels (carotid artery and jugular vein): a case report
Authors: Hakimi Turyalai
Published: April 2023

Introduction and importance:

Lymphangiomas are benign congenital defects affecting the lymphatic system. These lesions commonly involve the head and neck, predominantly the posterior cervical triangle. Lymphangiomas cause obstructive symptoms in the upper airway and pose an esthetic concern to the patient. Clinically, these lesions are seen as cervical swelling, and a definite diagnosis is made by ultrasonography, computerized tomography scanning, and histopathologic analysis. Herein, the author present an unusual case of an 18-month-old child presenting with a huge cervical swelling on the right side with extension to the carotid triangle (encompassing neck great vessels) as well as unilateral neck and fascial disfigurement. The patient was treated surgically with the complete excision of the mass and followed up with an excellent esthetic result.

Case presentation:

An 18-month-old child was brought to our teaching hospital’s pediatric surgery department with a huge cervical mass on the right side since birth. Following the completion of work-up with the laboratory and imaging (computerized tomography scan) diagnostic modalities, the patient was prepared for definite treatment. Our team approached the mass through a right neck hockey stick incision, and with the preservation of the neurovascular bundle, the mass was completely excised. The patient was followed up for 12 months on two occasions, with excellent esthetic results and no relapse.

Conclusion:

Lymphangiomas confined to the posterior cervical triangle are a common problem in children. Lesions extending to the anterior of the neck, especially those involving the neck neurovascular bundle, are uncommon entities. The decision to proceed with sclerotherapy or surgical excision should be justified, provided that, during the surgical procedure, the neurovascular bundle is preserved and none of the vital organs (neurovascular components) are compensated with the goal of a complete mass excision.
Hurthle cell carcinoma: a rare variant of thyroid malignancy – a case report
Authors: Adhikari Yuvraj , Marasini Anupama , Adhikari Nawaraj , Paneru Laxman D. , Upadhaya Regmi Binit , Raut Manita
Published: April 2023

Introduction and importance:

Oncocytic/Hurthle cell neoplasm is a rare form of thyroid malignancies, derived from follicular epithelium, presenting with a wide variety having either presenting with features of thyrotoxicosis or no any associated symptoms.

Case presentation:

The authors present a case of a 49-year-old female with a known case of chronic obstructive pulmonary disease and hypertension who presented to our hospital with anterior neck swelling for 4 months that has gradually increased over the time. Physical examination, laboratory test, various radiological imaging, and cytological study led to the diagnosis of Hurthle cell neoplasm. With prompt diagnosis, she was admitted and surgery was done that include right hemithyroidectomy. Though it is a rare type of thyroid malignancy, early diagnosis and proper treatment has shown a very good prognosis.

Clinical discussion:

Hurthle cell carcinoma initially presents with a single, painless palpable mass in the thyroid with pressure symptoms in advanced cases including dysphagia, dyspnea, and hoarseness. Pain, rapid growth, or significant compressive symptoms are suggestive of an invasive one.

Conclusion:

This case highlights on rarity of disease, presentation, and availability of treatment modality.
Herpes simplex encephalitis in a patient abusing morphine: a case report from Nepal
Authors: KC Bijay , Bhattarai Himal B. , Shah Sangam , Bhattarai Madhur , Uprety Manish , Jha Abhishek , Rayamajhi Sushil , Pant Subhash , Limbu Chandra P. , Shrestha Babu R.
Published: April 2023

Introduction:

Herpes simplex encephalitis results from either primary infection with the herpes simplex virus (HSV) or reactivation of latent HSV residing within the nuclei of sensory neurons. Opioid’s administration is known to reactivate HSV infection.

Case presentation:

We report a 46-year-old male who was in a rehabilitation center for 17 days for abusing morphine for 2 years.

Discussion:

Chronic morphine use weakens immune system thereby, making body prone for development of infection. Opioids may reactivate HSV infection because of their immunosuppressive function.

Conclusion:

Herpes simplex encephalitis is a potentially fatal condition but can be treated with early diagnosis and intervention.
A successful process of treatment with necrotizing fasciitis of upper extremities in patients with diabetes mellitus: a case report
Authors: Wang Tian-yuan , Jiang Dong , Wang Wei , Chen Yin-chen , Sun Jin-shan , Sun Bo , Wang Ai-ping , Chen Yue-dong
Published: April 2023

Introduction and importance:

Necrotizing fasciitis (NF) represents a rapidly progressive, life-threatening infection involving the fascia and subcutaneous tissue. Early diagnosis and intervention are crucial to treat, especially in diabetic patients.

Case presentation:

This case report presents on a patient with diabetes mellitus rapidly developed a NF of the upper extremities following a minor trauma in the palmar of greater thenar. In the initial stages of her hospital admission, severe hand soft tissue infection, and systemic toxicity is the most prominent clinical manifestation. During her hospitalization, efficacious multidisciplinary treatment was carried out to avoid severe consequences.

Clinical discussion and conclusion:

The objective of this case report is to present a successful individual strategy in a complex case to standardize the treatment process. Accurate and standardized management can improve the prognosis of patients affected from upper extremities NF of diabetic avoiding and severe complications and saving lives.
A rare case report on neonatal complications from Nepal: solitary neonatal hepatic abscess
Authors: Yogi Barurendra R. , Basnet Bal M. , Thapa Sajina , Bohara Sujan
Published: April 2023

Introduction and Importance:

Neonatal liver abscess is a rare condition with a high mortality rate. However, in a low-resource setting, high clinical vigilance and the use of readily accessible diagnostic modalities can help in early diagnosis and, along with appropriate medical management, prevent lethal complication.

Case presentation:

We present the case of a patient who presented with one day of sudden abdominal distension and two episodes of projectile nonbilious vomiting. A solitary liver abscess was diagnosed using ultrasonography and contrast-enhanced computed tomography findings, and the patient was treated conservatively with parenteral broad-spectrum antibiotics. Following the completion of the antibiotic dose, an ultrasound of the abdomen reveals that the size of the liver abscess has decreased.

Clinical discussion:

Neonatal liver abscess is a rare clinical condition that causes significant morbidity and mortality in premature and term babies. In a neonate with potential risk factors, a high index of suspicion is required to make the diagnosis. Baseline tests, as well as computed tomography with or without contrast, aid in the definitive diagnosis of a hepatic abscess. For management, a multidisciplinary approach should be considered, including correction of the predisposing factor as well as appropriate medical and/or surgical intervention.

Conclusion:

Neonatal liver abscess is frequently overlooked due to its rarity. Thus, whenever a neonate exhibits the aforementioned clinical spectrum, it should be considered in the differential diagnosis, and a diagnostic workup and treatment should be initiated as soon as possible to avoid debilitating complications.
Bone remodeling of the sinus floor observed 19 years after third molar transplantation to close a maxillary defect: a case report
Authors: Grün Pascal , Pfaffeneder-Mantai Florian , Bandura Patrick , Schneider Benedikt , Degel Ulli , Grün Ann-Sophie , Turhani Dritan
Published: April 2023

Autologous tooth transplantation is the transplantation of an erupted, partially erupted, or unerupted tooth from one site to another in an individual. This is expected to maintain alveolar bone volume through physiological stimulation of the periodontal ligament (PDL). Tooth transplantation can be used for the closure of oroantral communication. As a simple, useful, and minimally invasive method, it should be considered a surgical option when a donor tooth is available in indicated cases. Herein, the authors report the case of a 20-year-old female patient whose left permanent maxillary first molar had to be extracted due to a longitudinal fracture and radicular cyst in the maxillary sinus floor. After the extraction, tooth 28 was exposed through an osteotomy and positioned in the gap. Nineteen years later, the autologous grafted tooth 28 could no longer be retained due to massive external resorption and was replaced by an implant. Human PDL stem cells can differentiate into bone-, fiber-, and cementum-forming cells and have the potential to build a PDL complex. Therefore, care must be taken to avoid damaging the PDL of the donor tooth during extraction. Autotransplanted teeth are expected to retain the alveolar bone volume. This case demonstrates the use of a transplanted tooth 28 for the treatment of a maxillary defect caused by the extraction of tooth 26 and removal of a radicular cyst. External resorption and regeneration of the bone of the maxillary sinus floor around the transplanted tooth occurred after 19 years.
Bridge of the left anterior descending artery revealed by syncope: a case report
Authors: Boutaybi Mohammed , Tahani Ikram , EL-Azrak Mohammed , Ismaili Nabila , EL Ouafi Noha
Published: April 2023

The myocardial bridge is a congenital coronary anomaly defined as the presence of a region of myocardium overlying an epicardial coronary artery. This is a 51-year-old patient, diabetic for 4 years on oral hypoglycemic, has had stress angina for 4 years, neglected by the patient. The current history goes back to 2 months by the installation of an episode of syncope occurring with the effort, then of a second episode the day of its admission. Electrocardiogram on admission showed complete atrioventricular block with an heart rate of 32 beats per minute, the patient spontaneously recovered sinus rhythm with a heart rate of 88 beats per minute and a PR interval of 200 ms, coronary angiography was performed showing coronary arteries without stenosis with an intramyocardial bridge of the left anterior descending artery. During exercise and in the presence of a myocardial bridge on the left anterior descending artery, systolic compression leads to a decrease in flow to the septal branches, which is responsible for an alteration of the vascularization of the sub-nodal tissue with paroxysmal conduction disorders leading to syncope. Conduction disorders of ischemic origin are not always associated with atherosclerotic or thromboembolic lesions, but may also be secondary to myocardial bridges.
Anesthetic management of congenital epulis in a newborn: a case report
Authors: Dulal Aliza , Timilsina Bivek , Timilsina Pratikshya , Timalsina Binod , Ranjit Sangina , Dwa Manakamana , Chaudhary Aashutosh
Published: April 2023

Introduction:

The epulis of the newborn is a granular cell tumor that originates from the mucosa of the gingiva.

Case presentation:

The authors report a case of a 4-day-old neonate with a large mass arising from the right upper gingival area and occupying most of the oral cavity who presented for surgery with a potentially difficult airway. Intubation was achieved uneventfully using a gaseous induction with an appropriate-size facemask and displacement of the epulis to allow cautious laryngoscopy.

Discussion:

General anesthesia offers good airway protection and also alleviates the stress and pain associated with the surgery.

Conclusion:

Congenital epulis is a relatively rare congenital tumor of a newborn, which is one of the causes of difficult airways in neonates and children. However, after slight manipulation of the tumor, endotracheal intubation for the administration of general anesthesia is attainable.
Role of multimodal imaging in differentiating unilateral APMPPE from unilateral Harada disease – a case report
Authors: Sharma Sadhana , Kharel Ranju , Parajuli Sanket , Karki Pratap , Joshi Sagun N.
Published: April 2023

Introduction and importance:

Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) is classified as a part of the spectrum of the white dot syndromes affecting the inner choroid and the outer retina. It is usually bilateral and affects young patients between the second and fourth decades. The authors report an unusual case of unilateral APMPPE mimicking Vogt–Koyanagi–Harada (VKH) disease where the fundus fluorescein angiography was instrumental in confirming the diagnosis.

Case presentation:

A 35-year-old male presented with decreased visual acuity in the right eye for 3 days. Fundus examination revealed minimal vitritis, disc edema, and multifocal yellowish placoid lesions. Optical coherence tomography (OCT) showed the accumulation of subretinal fluid with subretinal septations closely mimicking VKH. Fundus fluorescein angiography depicted features of early hypofluorescence and late staining of the placoid lesions, suggesting APMPPE. Subretinal fluid partly resolved within a week, and visual acuity improved to 6/9(20/30) in the affected eye after the use of oral NSAIDS. Complete resolution of subretinal fluid was seen after 6 weeks.

Clinical discussion:

The most distinguishing feature in this case is the unilateral presentation and macular serous retinal detachment with subretinal septa on OCT imaging, which are not the typical features in APMPPE but quite similar to the characteristic features in acute VKH disease.

Conclusion:

APMPPE and acute VKH disease may share some overlapping clinical manifestations and imaging findings on OCT. APMPPE is a self-resolving disease, unlike VKH, and early diagnosis can avoid unnecessary administration of steroids and related side effects.
An invasive squamous cell carcinoma of the ankle: a case report
Authors: Sumulong Martin Carmelo , Coruña Juan Agustin , Liawrungrueang Wongthawat
Published: April 2023

Introduction and importance:

One to ten percent of all squamous carcinomas are invasive squamous cell carcinomas (ISCC), a rare variation of the disease. According to a recent literature review, less than 25 cases have been reported in the foot and ankle, making it especially uncommon in those areas.

Case presentation:

The authors present the case of a male patient, 60 years old, who presented with a progressive mass on his left ankle for 2 years with a history of healed burns in that area. The ISCC was diagnosed using histopathology after which he underwent a marginal excision biopsy and split-thickness skin grafting. Wide-marginal excision and split-thickness skin grafting were done. It was noted that the graft had taken well and that there were clear tumour margins postoperatively. The skin graft was almost completely incorporated. No tumour cells were reported on the margins during the postoperative histopathology.

Clinical discussion:

This case highlights a successful outcome of the patient improved at the 12-month follow-up, and he expressed a high degree of satisfaction with the treatment.

Conclusion:

ISCC of the lower extremities is a rare disease that almost never affects the ankle and is frequently treated inappropriately since it mimics chronic wounds. It is important to have an index of suspicion in patients with a history of chronic irritation to the area of interest. Surgery is the primary option if ICCS is detected. Clear tumour margins are important, and, if done well, excision should be curative.
Revealing the relation between job satisfaction and workload: a cross-sectional study in the emergency department
Authors: Batarfi Rayan F. , Bakhsh Ahmad M.A. , Alghamdi Ibrahim D. , Alotaibi Faris A.
Published: April 2023

Background:

Job satisfaction is recognized as an essential parameter that affects the performance and quality of medical services provided by emergency department (ED) health professionals. However, little is known about the status of job satisfaction related to workload among ED staff in Saudi Arabia. This study aimed to explore the current level of job satisfaction and to analyze the relationship between job satisfaction and the personal and professional characteristics of ED staff.

Methods:

A cross-sectional questionnaire-based study was conducted among ED staff, including various job positions, to assess job satisfaction. An online questionnaire was sent electronically to all ED staff. The structured online questionnaire collected information on sociodemographic factors, workload-related factors, and job satisfaction. The data was analyzed using SPSS version 26.

Results:

The questionnaire used to assess job satisfaction levels demonstrated high internal consistency and reliability using Cronbach’s α (0.85). Completed responses were obtained from 103 ED staff members; 58.25% were males, and most of the participants in the survey were either nurse (48.54%) or physicians (28.16%). Most of the respondents (61.16%) had a satisfaction score that was higher than half of the possible attainable score and showed a high level of satisfaction, although 38.84% fell below half of the possible attainable score on the satisfaction parameter and showed a lower level of satisfaction.

Conclusion:

It may be concluded that ED staff have a higher level of job satisfaction related to workload factors. The level of satisfaction did not change for different age groups, genders, levels of education, levels of experience, or jobs.
ERCP practice at a tertiary care hospital in Kashmir, North India: a large single-center cross-sectional study with focus on quality indicators, success rate, and indications
Authors: Parveen Shaheena , Shah Altaf H. , Gulzar Ghulam M. , Sodhi Jaswinder S. , Khan Mushtaq A. , Tiwari Avinash , Mir Tariq A. , Sharma Ankush , Ahmad Syed N. , Dar Nazir A.
Published: April 2023

Introduction:

Endoscopic retrograde cholangiopancreatography (ERCP) is the most technically demanding endoscopic procedure with significant adverse events that mandate appropriate training, competence and careful decision-making. The American Society for Gastrointestinal Endoscopy (ASGE) and the European Society of Gastrointestinal Endoscopy (ESGE) updated a list of quality indicators and performance measures for pancreatobiliary endoscopy. Nevertheless, real-life data are scarce, especially from developing countries. The study aimed to assess overall quality, procedural success, and indications of ERCP at our center.

Methods:

An audit of our endoscopy center at the start of the study for quality and performance indicators and a retrospective analysis of the 4 years of the prospectively maintained data of patients who underwent ERCP regarding procedural success and indications was done.

Results:

The study showed that ERCP is performed by meeting good quality standards, but structured training, sedation practice, and microbiological surveillance are subpar. A total of 3544 procedures were carried out with successful cannulation of the naive papilla in 93%, with 60% of procedures carried out on females, 80.5% of procedures done for benign diseases, and 19.5% on suspected or proven malignancy (47% men and 53% women) with perihilar obstruction being commonest in both sexes (32–33%) followed by carcinoma gallbladder in women (21%) and distal cholangiocarcinoma in men (27%). Among benign diseases (2711), 12% had benign pancreatic diseases, and 64.8% had common bile duct (CBD) stones, with 31% of CBD stones requiring more than one session for clearance.

Conclusion:

ERCP at our center is performed by meeting quality standards and by competent endoscopists with good procedural success. Improving sedation strategies, microbiological surveillance, and training programs remains an unmet need.
The Relationship Between Social Anxiety Disorder and Psychological Symptoms in University Students
Authors: Künkül Feyza , Bal Fatih
Published: April 2023

The aim of this study was to examine the relationship between social anxiety disorder and psychological symptoms in university students. It was also aimed to reveal the relationship between the dependent variables of the research and sociodemographic variables. The research is of the relational type, and the survey method was used to collect the relevant data. The research data were obtained from a total of 300 university students, 150 women and 150 men. According to the findings of the study, a low-, medium-, and high-strength linear relationship was found between social anxiety disorder and the Symptom Checklist-90 (SCL-90) general and its subdimensions. Scores on SCL-90 general and its subdimension increased as social anxiety disorder increased in the university student participants. It is recommended to give awareness education under the name of “general awareness-raising” about the concepts of social anxiety disorder and psychological symptoms in university students.
Responders and nonresponders to topical capsaicin display distinct temporal summation of pain profiles
Authors: Wong Felyx , Reddy Aditi , Rho Yeanuk , Vollert Jan , Strutton Paul H. , Hughes Sam W.
Published: April 2023

Introduction:

Topical application of capsaicin can produce an ongoing pain state in healthy participants. However, approximately one-third report no pain response (ie, nonresponders), and the reasons for this are poorly understood.

Objectives:

In this study, we investigated temporal summation of pain (TSP) profiles, pain ratings and secondary hyperalgesia responses in responders and nonresponders to 1% topical capsaicin cream.

Methods:

Assessments were made at baseline and then during an early (ie, 15 minutes) and late (ie, 45 minutes) time points post-capsaicin in 37 healthy participants.

Results:

Participants reporting a visual analogue scale (VAS) rating of >50 were defined as responders (n = 24) and those with <50 VAS rating were defined as nonresponders (n = 13). There was a facilitation of TSP during the transition from an early to the late time point post-capsaicin (P<0.001) and the development of secondary hyperalgesia (P<0.05) in the responder group. Nonresponders showed no changes in TSP or secondary hyperalgesia during the early and late time points. There was an association between baseline TSP scores and the later development of a responder or nonresponder phenotype (r = 0.36; P = 0.03). Receiver operating characteristic analysis revealed that baseline TSP works as a good response predictor at an individual level (area under the curve = 0.75).

Conclusion:

These data suggest that responders and nonresponders have different facilitatory pain mechanisms. The assessment of TSP may help to identify participants with stronger endogenous pain facilitation who may be more likely to respond to topical capsaicin.