bluuebunny/crossref_metadata_2025 huggingface dataset:
Blood pressure and cardiovascular risk in relation to birth weight and urinary sodium: an individual-participant meta-analysis of European family-based population studies
Authors: Yu Yu-Ling , Moliterno Paula , An De-Wei , Raaijmakers Anke , Martens Dries S. , Stolarz-Skrzypek Katarzyna , Tikhonoff Valérie , Malyutina Sofia , Casiglia Edoardo , Chori Babangida , Filipovský Jan , Rajzer Marek , Allegaert Karel , Kawecka-Jaszcz Kalina , Verhamme Peter , Nawrot Tim S. , Staessen Jan A. , Boggia José
Published: April 2023

Background:

Although the relation of salt intake with blood pressure (BP) is linear, it is U–shaped for mortality and cardiovascular disease (CVD). This individual-participant meta-analysis explored whether the relation of hypertension, death or CVD with 24-h urinary sodium excretion (UVNA) or sodium-to-potassium (UNAK) ratio was modified by birth weight.

Methods:

Families were randomly enrolled in the Flemish Study on Genes, Environment and Health Outcomes (1985–2004) and the European Project on Genes in Hypertension (1999–2001). Categories of birth weight, UVNA and UNAK (≤2500, >2500–4000, >4000 g; <2.3, 2.3–4.6 and >4.6 g; and <1, 1–2, >2, respectively) were coded using deviation-from-mean coding and analyzed by Kaplan–Meier survival functions and linear and Cox regression.

Results:

The study population was subdivided into the Outcome (n = 1945), Hypertension (n = 1460) and Blood Pressure cohorts (n = 1039) to analyze the incidence of mortality and cardiovascular endpoints, hypertension and BP changes as function of UVNA changes. The prevalence of low/medium/high birth weight in the Outcome cohort was 5.8/84.5/9.7%. Over 16.7 years (median), rates were 4.9, 8 and 27.1% for mortality, CVD and hypertension, respectively, but were not associated with birth weight. Multivariable-adjusted hazard ratios were not significant for any endpoint in any of the birth weight, UVNA and UNAK strata. Adult body weight tracked with birth weight (P < 0.0001). The partial r in the low-birth-weight group associating changes from baseline to follow-up in UVNA and SBP was 0.68 (P = 0.023) but not significant in other birth weight groups.

Conclusion:

This study did not substantiate its prior hypothesis but showed tracking of adult with birth weight and suggest that low birth weight increases salt sensitivity.
Transpulmonary thermodilution
Authors: Messina Antonio , Alicino Valeria , Cecconi Maurizio
Published: April 2023

Purpose of review

The purpose of this article is to systematically review and critically assess the existing data regarding the use of transpulmonary thermodilution (TPTD), by providing a detailed description of technical aspects of TPTD techniques, appraising the use of TPTD-derived parameters in specific clinical settings, and exploring the limits of this technique.

Recent findings

The aim of hemodynamic monitoring is to optimize cardiac output (CO) and therefore improve oxygen delivery to the tissues. Hemodynamic monitoring plays a fundamental role in the management of acutely ill patients. TPTD is a reliable, multiparametric, advanced cardiopulmonary monitoring technique providing not only hemodynamic parameters related to cardiac function, but also to the redistribution of the extravascular water in the thorax. The hemodynamic monitors available in the market usually couple the intermittent measurement of the CO by TPTD with the arterial pulse contour analysis, offering automatic calibration of continuous CO and an accurate assessment of cardiac preload and fluid responsiveness.

The TPTD is an invasive but well tolerated, multiparametric, advanced cardiopulmonary monitoring technique, allowing a comprehensive assessment of cardiopulmonary condition. Beyond the CO estimation, TPTD provides several indices that help answering questions that clinicians ask themselves during hemodynamic management. TPTD-guided algorithm obtained by pulse contour analysis may be useful to optimize fluid resuscitation by titrating fluid therapy according to functional hemodynamic monitoring and to define safety criteria to avoid fluid overload by following the changes in the extravascular lung water (EVLW) and pulmonary vascular permeability index (PVPI).
The clinical effects of Gyejibongnyeong-Hwan (Gui Zhi Fu Ling Wan) on patients with hyperlipidemia: A study protocol for a multicenter, double-blind, two-armed parallel, investigator-initiated, exploratory randomized controlled trial
Authors: Ko Mi Mi , Kim Pyung-Wha , Jung So Young , Kim Cheol-Hyun , Lee Byung-Cheol , Jung Jeeyoun
Published: April 2023

Background:

Hyperlipidemia, the most common form of dyslipidemia, is associated with an increased risk of atherosclerotic cardiovascular diseases. There is a constant demand for therapeutic agents with relatively few side effects that can be administered from the initial stage of hyperlipidemia, herbal medicines derived from natural products can be considered candidates for treating dyslipidemia. This study aims to explore the feasibility, preliminary effectiveness, and safety of Gyejibongnyeong-Hwan (GBH) in patients with hyperlipidemia.

Methods:

This was a 2-armed, parallel, multicenter, and exploratory randomized controlled trial on dyslipidemia. We will recruit 90 patients aged 20 to 65 years with hyperlipidemia between November 2021 and December 2022. Eligible participants will be randomly assigned to receive GBH or placebo granules for 8 weeks and followed up for 4 weeks after 4 weeks of lifestyle modification. The primary outcome is the percentage changes in low-density lipoprotein cholesterol from baseline to week 8. The secondary outcomes are percentage changes in other blood lipid parameters, blood glucose parameters, and blood stasis scores. As an exploratory outcome measure, metabolite analysis will be conducted to observe changes in metabolic patterns.

Discussion:

This is the first randomized controlled trial to explore the clinical effect and safety of GBH compared to placebo control in patients with hyperlipidemia, thereby potentially facilitating better management of hyperlipidemia. The results of this pilot study could form a foundation for future large-scale confirmatory clinical trials.

Ethics and dissemination:

This study was permitted by the Ministry of Food and Drug Safety on investigational new drug application on August 12, 2021 and approved by the Institutional Review Board of Kyung Hee University, Seoul, Republic of Korea (KOMCIRB202110012001) on November 26, 2021. The results will be published in a peer-reviewed journal and disseminated electronically and in print.
Pan-cancer analysis of aldolase B gene as a novel prognostic biomarker for human cancers
Authors: Zhao Nannan , Xu Haixu
Published: April 2023

Aldolase B (ALDOB) gene is essential for the process of glycolysis and differentially expressed in cancers. The aims of this study were to explore the potential role of ALDOB in pan-cancer, in order to deepen the research on the pathological mechanism of cancer. Hence, we used several online tools (TIMER2, GEPIA2, UALCAN, cBioPortal, and MXPRESS) and R language to identify the correlation between the ALDOB expression and survival analysis, genetic alteration, DNA methylation, and immune cell infiltration based on The Cancer Genome Atlas project. The results showed that ALDOB was lowly expressed in pan-cancer. Survival analysis revealed that low expression of ALDOB was markedly related with poor clinical prognosis, while the genetic alteration within ALDOB changed along with the difference of overall survival (OS) and disease-free survival (DFS) prognosis in several cancers. A possible relationship between DNA methylation and ALDOB expression for several tumors was found. Besides, ALDOB expression was confirmed to be associated with tumor immune cell infiltration, especially in breast invasive carcinoma (BRCA), esophageal carcinoma (ESCA), and testicular germ cell tumors (TGCT) cases. Further, the enrichment analysis demonstrated that metabolic pathway was closely related to ALDOB expression. Our results provide a comprehensive pan-cancer analysis and suggest ALDOB could act as a promising tumor predictive biomarker for human cancer.
Goblet cell adenocarcinoma of the anal canal with perianal Paget disease: A rare case report with literature review
Authors: Li Minhua , Yao Xiaofei
Published: April 2023

Introduction:

AS an uncommon neoplasm, goblet cell adenocarcinoma (GCA) is characterized by mixed endocrine-exocrine features. It is almost exclusively found in the appendix. Primary GCA of the anal canal is extremely rare.

Case presentation:

Herein we describe a novel rare case of 74-year-old Chinese female who is diagnosed with GCA in the anal canal with perianal Paget disease, including a brief review of the literature. In the lesion of anal canal, the tumor was composed of signet-ring-like cells on confluent growth model and copious mucin was produced as well. Simultaneously, the results of immunohistochemistry showed signet-ring-like cells were positive for CK20, CDX2, synaptophysin (Syn), CD56, carcinoembryonic antigen (CEA) and Villin. Meanwhile, the Ki67-labeling index reached 40%. In the lesion of perianal Paget disease, the small groups of atypical neoplastic cells were present in the epidermis. Immunohistochemically, the neoplastic cells were positive for CK20, CDX2 and epithelial membrane antigen, but negative for CK7, GCDFP15, S100, HMB45, and P63. The Ki67-labeling index reached 60% in the most concentrated spot.

Conclusions:

Extra-appendiceal GCA was rare and easily under-recognizable. The diagnosis of GCA was seldom made preoperatively. Occasionally, GCA could occur in the anal canal accompanied by perianal Paget disease. So careful rectal examination was important in the patient with perianal Paget disease for avoid missing diagnosis of GCA on anal canal. GCA may show aggressive clinical behavior compared with typical well-differentiated neuroendocrine tumors. Therefore, we should pay more attention on the recognization of this rare disease.
Efficacy and safety of vesatolimod in chronic hepatitis B: A systematic review and meta-analysis
Authors: Omer Ibrahim , Abuthiyab Noorah , Al-Omari Basil , Aletani Tala , Betar Manar , Alzaid Nura , Hakami Alqassem Y.
Published: April 2023

Background:

Vesatolimod is a toll-like receptor (TLR) agonist that is thought to suppress chronic hepatitis B (HBV) infection. This systematic review aimed to assess the safety and efficacy of vesatolimod in treating chronic hepatitis B.

Methods:

We included randomized clinical trials (RCTs) that assessed vesatolimod in patients with hepatitis B infection without hepatocellular carcinoma or liver transplantation and with reported levels of hepatitis B surface antigen (HBsAg) or liver transaminases post-intervention. We searched MEDLINE, SCOPUS, Springer, Google Scholar, ClinicalTrials.gov, and Cochrane Central Register of Clinical Trials for all related articles during May 2022. Two independent authors screened articles for inclusion, and discrepancies were resolved by consensus and a third reviewer. Two independent reviewers assessed studies included in this systematic review using the Critical Appraisal Skills Programme checklist for RCTs.

Results and conclusion:

Only 4 were considered eligible from 391 articles identified through our search. All eligible studies did not report any clinically significant outcomes following the use of vesatolimod, as evidenced by the persistence of HBsAg. However, vesatolimod was associated with induction of interferon-stimulated genes (ISGs) and only mild side effects, warranting further studies to evaluate its potential for future use as a safe, tolerable anti-HBV medication. No significant differences were noted amongst trials included in either of Vesatolimod doses (Vesatolimod 1 mg, RR = 0.99, 95% CI 0.76–1.30, P = .95, I
2 = 0%; Vesatolimod 2 mg, RR = 1.06, 95% CI 0.82–1.37, P = .66, I
2 = 0%; Vesatolimod 4 mg, RR = 1.06, 95% CI 0.82–1.37, P = .66, I
2 = 0%;), further suggesting its comparable safety in comparison to oral antiviral agents.
Bioinformatics analysis combined with molecular dynamics simulation validation to elucidate the potential molecular mechanisms of Jianshen Decoction for treatment of osteoporotic fracture
Authors: Liu Weinian , Chen Weijian , Hu Mengting , Wang Guangwei , Hu Yuanhao , He Qi , Xu Yidong , Tan Jun , Wang Haibin , Huo Liwei
Published: April 2023

Osteoporotic fracture (OPF) is a prevalent skeletal disease in the middle-aged and elderly. In clinical practice, Jianshen Decoction (JSD) has been used to treat OPFs. However, the specific effective components and mechanisms of JSD on OPF have not been explored. Therefore, this study used bioinformatics analysis combined with molecular dynamics simulation validation to explore the molecular mechanism of JSD treatment of OPF. Public databases (TCMSP, Batman TCM) were used to find the effective active components and corresponding target proteins of JSD (screening conditions: OB ≥ 30%, drug-likeness ≥ 0.18, half-life ≥ 4). Differentially expressed genes (DEGs) related to OPF lesions were obtained based on the gene expression omnibus database (screening conditions: adjustPvalue < .01, | log2FC | ≥ 1.0). The BisoGenet plug-in and the CytoNCA plug-in of Cytoscape were used to derive the potential core target proteins of JSD in the treatment of OPF. The JSD active ingredient target interaction network and the JSD-OPF target protein core network were constructed using the Cytoscape software. In addition, the R language Bioconductor package and clusterProfiler package were used to perform gene ontology (GO)/Kyoto Encylopedia Of Genes And Genome (KEGG) enrichment analysis on core genes to explain the biological functions and signal pathways of core proteins. Finally, molecular docking and molecular dynamics simulations were carried out through PyMOL, AutoDockTools 1.5.6, Vina, LeDock, Discovery Studio (DS) 2019, and other software to verify the binding ability of drug active ingredients and core target proteins. A total of 245 targets and 70 active components were identified. Through protein-protein interaction (PPI) network construction, 39 core targets were selected for further research. GO/KEGG enrichment analysis showed that the DNA-binding transcription factor binding, RNA polymerase II-specific DNA-binding transcription factor binding, MAPK signaling pathway, and ErbB signaling pathway were mainly involved. The results of molecular docking and molecular dynamics simulations supported the good interaction between MYC protein and Quercetin/Stigmasterol. In this study, bioinformatics, molecular docking, and molecular dynamics simulations were used for the first time to clarify the active components, molecular targets, and key biological pathways of JSD in the treatment of OPF, providing a theoretical basis for further research.
Clinical outcome measures reporting in randomized trials evaluating Tuina therapy for chronic nonspecific low back pain: A systematic review
Authors: Zhou Xuan , Ma Qingyu , Yang Juan , Mohabbat Arya B. , Croghan Ivana T. , Tan Celia la choo , Chen Jiaxu , Bauer Brent A.
Published: April 2023

Background:

Tuina has gained widespread attention and utilization for the management of chronic nonspecific low back pain (CNLBP). However, evidence-based guidance for choosing accurate and appropriate outcome measures of Tuina is lacking. The objective of this study is to systematically synthesize the existing outcome measures reported in randomized controlled trials (RCTs) evaluating Tuina therapy in CNLBP.

Methods:

Electronic literature searches were conducted in multiple English and Chinese databases from their inception to May 2022. RCTs were included if they involved clinical outcome measures in Tuina treatment for patients with CNLBP. Outcome instruments for each study were extracted and analyzed. Evidence from included studies were assessed using the Cochrane risk-of-bias tool.

Results:

Of the 735 identified articles, 17 articles with 1628 participants were included. Measurement domains in these RCTs were mainly reported in terms of pain (94%) and physical activity (71%), followed by safety (41%), Chinese medicine outcome (35%), and quality of life (12%). Moreover, several limitations with existing outcomes were reported, including lack of emphasis on the evaluation of quality of life, inadequate safety monitoring, as well as insufficient and vague Chinese medicine outcome measures. All trials were deemed to be of poor methodological quality.

Conclusion:

Pain and physical disability were the most frequently studied outcome domains in CNLBP treated by Tuina therapy. More rigorous and high-quality trials with appropriately selected outcome measures are needed in the future.
Effect of tracheal intubation on postoperative complications in patients with pulmonary hypertension combined with non-cardiothoracic, non-obstetric surgery
Authors: Sun Min , Gao Li-Jie , Zhang Yong , Jing Guang-Jian , Liu Jiu-Ling , Ye Ting , Zhang Quan-Yi
Published: April 2023

Endotracheal intubation can be associated with certain complications in certain group of patients. However, the relationship between endotracheal intubation and postoperative complications is unclear in patients with pulmonary hypertension (PHTN). This study evaluated the relationship between endotracheal intubation and postoperative complications in non-cardiothoracic and non-obstetric surgery patients with PHTN. A secondhand analysis of non-cardiothoracic, non-obstetric procedures was performed on patients with PHTN between 2007 and 2013 in a hospital at the University of Washington. Multivariable logistic regression analyses were used to calculate the adjusted odds ratios to estimate the association between anesthesia and 30-day postoperative complications. Interaction and stratified analyses were conducted according to the American Society of Anesthesiologists score (ASA), smoking, hypertension, and open surgical approach. A total of 573 patients were included in this study, and the mean age was 60.3; 54% were male. In a multivariate regression model for patients with non-cardiothoracic, non-obstetric surgery combined with PHTN, the risk of 30-day postoperative complications was higher in the tracheal intubation group than in patients with non-intubated anesthesia after adjusting for potential covariates (adjusted odds ratio = 2.47; 95% CI, 1.28–4.78). However, there was no significant difference in postoperative mortality between these groups. Statistical analysis showed no interaction between the variables of tracheal intubation and 30-day postoperative complications. In this study, we found that tracheal intubation anesthesia is associated with increased risk of 30-day postoperative complications in PHTN patients undergoing non-cardiothoracic, non-obstetric surgery. Further studies are needed to confirm our findings.
Dexmedetomidine improves lung compliance in patients undergoing lateral decubitus position of shoulder arthroscopy: A randomized controlled trial
Authors: Zhao Xiujie , Song Qianqian , Wang Yewen , Zhang Quanyi , Sun Chao
Published: April 2023

Background:

The improvement of oxygenation and pulmonary mechanics in patients under general anesthesia can be achieved by dexmedetomidine (DEX) infusion. However, its role in patients undergoing lateral supine shoulder arthroscopy has not been thoroughly studied. This study aimed to evaluate the effect of DEX on lung compliance in patients undergoing shoulder arthroscopic surgery in a lateral decubitus position.

Methods:

The patients who underwent lateral recumbent shoulder arthroscopy under general anesthesia were randomly divided into the DEX group (group D) and the control group (group N). At the start of the trial, group D was given 0.5 μg/kg/hours continuous pumping until 30 minutes before the end of anesthesia; Group N was injected with normal saline at the same volume. The patients were recorded at each time point after intubation: supine position for 5 minutes (T0), lateral position for 5 minutes (T1), lateral position for 1 hour (T2), lateral position for 2 hours (T3), airway peak pressure, platform pressure, dynamic lung compliance, and static lung compliance, etc.

Results:

At the end of the drug infusion, the DEX group showed significant improved pulmonary mechanics and higher lung compliance than the control group. Compared with group N, group D’s heart rate and mean arterial pressure were lower at all time points; there was no statistical difference in Tidal volume and Pressure end-tidal carbon dioxide data at each time point in Group D.

Conclusion:

DEX can improve lung compliance and reduce airway pressure and platform pressure of patients undergoing shoulder arthroscopy in the lateral position under general anesthesia.
Supernumerary digit of bilateral hands: a rare congenital anomaly presented as a case report
Authors: Raut Ujwal , Shah Sandesh , Shrestha Garima
Published: April 2023

Introduction:

Abnormalities in the development of hands and fingers are caused by faulty signaling centers, together with or without abnormal production of important regulatory proteins. One of those abnormalities is the supernumerary digit. Postaxial supernumerary digit can present as a functioning or a nonfunctional digit.

Case:

We describe a case of a 29-year-old male with a postaxial supernumerary digit of the ulnar aspect of the bilateral fifth digit.

Clinical Findings and Investigations:

The patient had a growth of 0.5 cm over the ulnar aspect of the proximal phalanx of the fifth digit of the right hand and 0.1 cm over the ulnar aspect of the proximal phalanx of the fifth digit of the left hand with a broad base. X-rays of bilateral hands were sent.

Intervention:

Suture ligation or surgical excision was recommended for the patient, but they were both rejected by the patient.

Conclusion:

Bilateral hands with supernumerary digits are a rare congenital defect. The differential diagnosis of digital fibrokeratoma should be used by doctors. Simple observation, suture ligation, or excision with skin sutures are examples of potential treatments.
Glioblastoma simulating an arteriovenous malformation: a case report
Authors: Faham Btissam , Nsengiyumva Emmanuel olave , Jamal Oufaa , Makhchoune Marouane , Naja Abdessamad , Lakhdar Abdelhakim
Published: April 2023

Introduction and importance:

Glioblastoma is the most common primary malignant brain tumor in adults. It is enhanced by the abnormal proliferation of central nervous system cells called astrocytes. Microvascular endothelial proliferation is one of the criteria for a histological diagnosis. Hypervascular glioblastoma simulating an arteriovenous malformation is an involuntary manifestation and constitutes a rare entity.

Case presentation:

The authors report a case of a 44-year-old patient with no history followed. Symptoms began 6 months ago with the gradual onset of headaches without vomiting or seizures associated with a drop in normal visual acuity without neurological deficit. Cerebral imaging including cerebral angiography concluding with a right parieto-occipital cerebral process probably associated with an arteriovenous malformation.

Clinical discussion:

The management was surgical by biopsy after a right parieto-occipital bone flap concluding in glioblastoma. The patient needs chemotherapy and radiotherapy sessions with good clinical evolution.

Conclusion:

The coexistence of an arteriovenous malformation and glioblastoma remains an association whose pathophysiology still remains to be explored.
Determinants of hyperphosphatemia and its relation with hemoglobin levels among hemodialysis patients in two hospitals from Syria: a prospective cross-sectional study
Authors: Alsultan Mohammad , Kliea Marwa , Anan Mohamed T. , Abdulkader Baraa , Kazkaz Reem , Al Sultan Abdullah , Al Masri Mohamad , Hassan Qussai , Basha Kassem
Published: April 2023

Introduction:

Hyperphosphatemia and anemia were both associated with several complications in chronic kidney disease (CKD) patients. This study aimed to determine the risk factors of hyperphosphatemia and its relation with anemia among hemodialysis (HD) patients. Secondly, it aimed to determine the prevalence of hyperphosphatemia and anemia.

Material and methods:

A prospective cross-sectional study was conducted among 146 HD patients from two HD centers in Syria, between June 2021 and March 2022. All patients at least 18 years old on maintenance HD were enrolled. The threshold of phosphorus (phos) level was divided by the upper normal range among HD patients (5.5 mg/dl). We used parametric and nonparametric statistics, the Pearson and Spearman correlations with simple and multiple linear regressions between study variables.

Results:

36.9% of patients had a serum phos level of 5.5 or less (norm phos group), and 63.1% of patients had a serum phos level higher than 5.5 (high phos group). Also, 60.9% of patients had hemoglobin (Hb) less than 10 g/dl, and 40.4% of patients had Hb at least 10 g/dl. Age, type of HD access, phos binders (P-binders), parathyroid hormone (PTH), and calcium (Ca) showed significant effects on phos levels. Most patients were using arteriovenous fistula (AVF) (89.7%) as a HD access, and the meantime on HD was higher in the norm phos group compared to the high phos group. In a multivariate and univariate logistic regression analysis, hyperphosphatemia increased with increasing urea (Ur) and creatinine (Cr) levels, while the odds declined with increasing time on HD. Hb did not show a significant relation with phos by using several statistical methods.

Discussion/Conclusion:

A high prevalence of hyperphosphatemia and anemia was encountered among this sample of HD patients from Syria. There was no correlation between phos and Hb levels in contrast to previous conflicting studies, which mandates future studies to evaluate this correlation and further efforts to determine the range of phos that could have a benefit on anemia with respect to other comorbidities.
Mortality predictive value of APACHE II Scores in COVID-19 patients in the intensive care unit: a cross-sectional study
Authors: Mehryar Hamid Reza , Yarahmadi Poya , Anzali Babak C.
Published: April 2023

Introduction:

The Acute Physiology and Chronic Health Evaluation II (APACHE II) scoring system was developed to predict hospital mortality, which can be used as a predictor of final hospital outcome in coronavirus disease 2019 (COVID-19) patients. Therefore, the present study was designed and conducted with the aim of determining the average APACHE II score in patients with COVID-19 patients.

Methods:

In this cross-sectional study, patients with COVID-19 infection confirmed by PCR test were enrolled in the ICU of Imam Khomeini Hospital in Urmia city during 2020–2022. The laboratory, radiological, and clinical findings of the patients were collected and evaluated. The APACHE II scores of the patients were also calculated by the specialists of ICU and Infectious Diseases Department for each patient and recorded in the checklist.

Results:

A total of 150 patients were examined in this study. The mean age of the patients was 53.71±16.02 years; 82 patients, or 54.7%, were male, and 68 patients, or 45.3%, were female. The mean APACHE II score was 10.12±6.3; 105 patients (0.70%) were discharged, and 45 patients (0.30%) died. The mean APACHE II score was significantly higher in patients with cough (P=0.001), shortness of breath (P=0.002), hemoptysis (P>0.001), gastrointestinal hemorrhage (P=0.002), and renal failure (P=0.001). In addition, there was a significant direct relationship between age and APACHE II score, such that APACHE II score increased significantly with age (r=0.53,P>0.001). The mean APACHE II score in men was 10.04±5.8 and in women was 10.20±6.9, and according to the results of the independentt-test, there was no statistically significant difference between the two sexes (0.88). The mean APACHE II score was lower in patients with a history of dialysis (P=0.01), thyroid disease (P>0.001), hypertension (P>0.001), ischemic heart disease (P=0.04), and diabetes (P=0.02) were significantly higher.

Conclusion:

Patients with gastrointestinal bleeding, cough, shortness of breath, hemoptysis, and renal failure after COVID-19 infection, with a history of dialysis, thyroid disease, hypertension, and diabetes, and intubated patients had a significantly higher APACHE II score. A significant relationship was found between patients’ age and the APACHE II score. However, this index was not a suitable criterion for predicting death in COVID-19 patients.
Bilateral hydatid cyst of the breast: a case report and review of the literature
Authors: Al Sharei Aiman , Abu-Jeyyab Mohammad , Al-Khalaileh Maysaa , Al-Awabdeh Michleen , Al-Asbahi Hanan , Al-Dwairy Salem , Al-Share Mohammad
Published: April 2023

Hydatid cyst disease is a parasitic infestation caused by the tapeworm Echinococcus granulosus. The incidence of the disease is 1–200 cases per 100 000. The usual presentation is the formation of fluid-filled cysts in the liver or lungs and, less commonly, in the brain. The breast is a rare site of presentation for this disease. An isolated hydatid cyst in the breast is very rare, even in endemic regions, occurring in only 0.27% of all hydatid cases. Although these cases are very rare, they should be considered severe. A hydatid breast cyst may mimic a fibroadenoma, phyllodes tumor, chronic abscess, or even carcinoma. Therefore, a high incidence of misdiagnosis may occur. Preoperative diagnosis can be made using needle aspiration and imaging facilities such as breast ultrasonography, mammograms, and computerized topographic images. Nevertheless, in most cases, the final diagnosis cannot be made until the pathological report is obtained postsurgery. This paper reports the first case of a bilateral hydatid cyst of the breast that was diagnosed preoperatively by radiological facilities. We present the patient history, physical examination, and investigations, discuss the risk factors, and present our treatment plan.
A comparison of the outcomes of a novel technique of Mini-Incision and Self-Express (MISE) for breast abscess with the conventional techniques: a retrospective comparative cohort study
Authors: Chan Xiang Ting , Allen John Carson , Gudi Mihir , Lim Geok Hoon
Published: April 2023

Background:

Conventional techniques for treatment of breast abscess, such as incision and drainage (I&D) and needle aspiration, have disadvantages. The authors aimed to compare the outcomes of a novel technique of bedside mini-incision and self-express (MISE) for breast abscess with the conventional techniques.

Methods:

Patients with a pathologically confirmed breast abscess were retrospectively identified. Patients with mastitis, granulomatous mastitis, breast fillers with infection, ruptured abscess prior to intervention, other interventions or bilateral breast infection were excluded. Data collected included patient demographics, radiological features such as size and number of abscess, treatment modality, microbiological results and clinical outcomes. These outcomes were then compared between the patients with MISE, I&D and needle aspiration.

Results:

Twenty-one patients were included. The mean age was 31.5 years old (range: 18–48). Mean abscess size was 57.4 mm (range: 24–126). 5 (23.8%), 11 (52.4%) and 5 (23.8%) had MISE, needle aspiration and I&D, respectively. Average duration of antibiotics was 1.8, 3.9 and 2.6 weeks for MISE, needle aspiration and I&D groups, respectively, which was statistically significant after adjusting for confounders (P=0.024). Mean duration of recovery was 2.8, 7.8 and 6.2 weeks for the MISE, needle aspiration and I&D groups, respectively (P=0.027), after adjusting for confounders.

Conclusion:

MISE, in suitable patients, results in shorter recovery time and lesser antibiotics usage, compared with the conventional techniques.
Scrotal trichilemmal cysts: a case report
Authors: Sahito Abdul M. , Sehar Alina , Kumari Usha , Daggula Nikhil R. , Kumari Sanjana , Khoshbakht Freshta
Published: April 2023

Introduction and importance:

Trichilemmal cyst (TC), commonly known as the pilar cyst of the scrotum wall, is an uncommon disease. It is a type of epidermoid cyst (EC) with a benign course, and malignant change is quite rare. This disease is unusual in the scrotum; therefore, multiple cysts in the scrotum are much more unusual. There have been reports of TCs in other parts of the body, but this is the first instance of scrotal TCs in Pakistan.

Case presentation:

We discuss the case of a 60-year-old male patient who presented to the clinic with a right-sided scrotal swelling, which was identified as a right-sided inguinal hernia on examination, and multiple small swellings on the scrotal skin identified as TCs. The patient had scrotoplasty after hernia surgery to remove the cysts and reconstruct the excised scrotum. Following scrotoplasty, the patient’s discomfort was resolved, and cosmetic satisfaction was achieved.

Clinical discussion:

Excision is required if TCs become infected or for esthetic reasons. In the event of big cysts, full scrotal wall resection followed by scrotoplasty is necessary. The thigh fasciocutaneous flap is used to cover the denuded testes after scrotoplasty. The procedure’s advantages include a good outcome, low morbidity, early discharge, and great esthetic outcomes.

Conclusion:

We present a literature review about multiple TCs in the scrotum and their surgical management. This case will guide surgeons and future researchers in dealing with similar cases in the future.
Demographical, clinical, and complication differences between vaccinated and unvaccinated hospitalized children with measles in mogadishu somalia: a hospital-based retrospective cohort study
Authors: Mohamud Abdirahman Khalif , Ahmed Omar Abdullahi , Ali Ikran Abdulkadir , Dirie Najib Isse
Published: April 2023

Background:

Measles is endemic in Somalia; recurrent outbreaks are reported annually. Under-five children are the most affected due to low immunization coverage, vitamin A deficiency, and malnutrition. The study aims to evaluate the demographical, clinical, and complication variations between vaccinated and unvaccinated hospitalized children with measles in the study hospital.

Method:

A hospital-based retrospective cohort study was implemented between 10 October and 10 November 2022 by reviewing case record files following a well-structured checklist of admitted clinical features, demographic characteristics, history of measles immunization, and measles complication status. Descriptive statistics were used by presenting frequency and percentage for categorical and the mean score for continuous variables. χ2 and Fisher’s exact test at P =0.05 were used to identify the proportions differences between vaccinated and unvaccinated cases.

Result:

A total of 93 hospitalized measles children participated in the study. Over half were boys, the mean age in months was 20.9 (SD±7.28), and over two-thirds of the mothers/caregivers did not have formal education. Almost 9.7% of hospitalized measles children had one dose of the measles-containing vaccine, while none had two doses. The vaccinated cases had fewer ill with fewer complications than the unvaccinated cases. Fever, cough, rash, and Koplik’s spots were clinical features associated with measles immunization status.

Conclusion:

Around one in ten hospitalized children had one dose of the measles vaccine. Vaccinated cases had fewer illnesses with few complications than unvaccinated cases. The paper highly emphasizes providing booster doses, improving vaccine logistics and storage, and following immunization schedules. In addition, conducting further multicentral high sample-size studies is highly required to identify whether vaccine inadequacy was due to host-related or vaccine-related factors.
Severe hyponatremia as an atypical manifestation of pituitary macroadenoma: a case report
Authors: Yadav Alisha , Kharel Sanjeev , Shah Bikash K. , Parajuli Naresh
Published: April 2023

Introduction and importance:

Pituitary macroadenoma most commonly presents with visual disturbances, headache, and other symptoms secondary to adeno hypophyseal hormonal deficiencies and usually alleviates after tumor resection. Pituitary adenomas may be the cause of the syndrome of inappropriate antidiuretic hormone secretion (SIADH) causing hyponatremia, although so far, there have only been a few documented cases. Here, we present a case of pituitary macroadenoma with SIADH and hyponatremia. This case has been reported in line with CARE (CAse REport) criteria.

Case presentation:

We present a case of a 45-year-old woman who presented with symptoms of lethargy, vomiting, altered sensorium, and seizure. Her initial sodium level was 107 mEq/l, plasma and urinary osmolality were 250 and 455 mOsm/kg, respectively, and her urine sodium level was 141 mEq/day, suggestive of hyponatremia due to SIADH. MRI scan of the brain revealed approximately 14×13×11 mm pituitary mass. Prolactin and cortisol levels were 41.1 ng/ml and 5.65 μg/dl, respectively.

Clinical discussion:

Hyponatremia can result from various diseases, making it hard to identify the cause. A pituitary adenoma is a rare cause of hyponatremia due to SIADH.

Conclusion:

Pituitary adenoma rarely might be the cause of SIADH presenting as severe hyponatremia. So, in case of hyponatremia due to SIADH, clinicians should keep pituitary adenoma as well in their differential diagnoses.
Mutation in PYCR2 gene and hypomyelinating leukodystrophy in children: a case report study
Authors: Hosseini Seyed Ahmad , Ghelichi-Ghojogh Mousa
Published: April 2023

Introduction and importance:

Hypomyelinating leukodystrophies are a heterogeneous group of inherited white matter disorders characterized by a predominant absence of myelin deposits in the central nervous system.

Case presentation:

The patient was a one-year-old girl child. She at the age of 6 months was hospitalized due to loose, muscle weakness, and an upward gaze for 7–8 min with complaints of fever and convulsions.

Clinical discussion:

Using the test of whole exome sequencing, a nonsense homozygous mutation was found in the PYCR2 gene, which a mutation in the PYCR2 gene causes hypomyelinating leukodystrophy type 10 disease.

Conclusion:

Advances in the field of genetics, increased awareness, and the increasing availability of genetic testing in small cities in developing countries are helping to better assess complex neurological disorders and establish a complete diagnosis.
The prevalence, angiographic profile and clinical features, management, and outcomes of coronary artery perforation secondary to percutaneous coronary interventions in Pakistan: a retrospective cohort study
Authors: Khan Aiman , Kumar Rohan , Ali Rubia , Fatima Kiran , Abid Marvi , Ali Rumaisa , Meheshwari Govinda , Amin Rafiya , Hasan Mohammad , Ud Din Kasi Arbab Furquan
Published: April 2023

Introduction:

Coronary artery perforation (CAP) is a rare entity that is often fatal. The mortality rates reported as high as up to 21% hence prompt diagnosis, intervention, and treatment are paramount to survival for such patients. Several factors may predispose a patient to coronary artery intervention including chronic total occlusion, severe calcification and tortuosity, aggressive use of oversized balloons and stents, and use of athero-ablative devices. Therefore, it is significant to have an insight related to it as despite being rare, it is one of the most feared complications of percutaneous coronary intervention (PCI).

Method:

We conducted a retrospective study of the patients who have undergone PCI at our institution from January 2015 to December 2021. During this duration, all the patients who had developed CAP based on angiographic review during the PCI were selected. The demographic, clinical, angiographic, procedure-related features, management of the CAP, and in-hospital and follow-up outcomes were gathered.

Result:

Thirty-five thousand fifty-nine patients underwent PCI among which, only 93 (0.26%) patients were complicated with (CAP. Fifty-eight (62.4%) patients were in the 50–70 years age range. The most common vessel involved was the left anterior descending (36.5%) followed by the right coronary artery (32.3%). The angiographic calcification was present in 51.6% of patients, significant tortuosity greater than 90° was seen in 48.4% of patients, chronic total occlusion was observed in 42% of patients and In-stent restenosis was found in 8.6% patients. The highest mortality of four patients was seen in the CAP involving the right coronary artery.

Conclusion:

Mostly the CAP involves large vessel perforations however both, the distal and large vessel perforations are related to the increased incidence of adverse clinical results which indicates the significance of the prevention and early identification and treatment of the perforation.
Delirium and Previous Psychiatric History Independently Predict Poststroke Posttraumatic Stress Disorder
Authors: Griffin Tian T. , Bhave Varun , McNulty Jack , Christophe Brandon R. , Garton Andrew L.A. , Sander Connolly Edward
Published: April 2023

Objectives:

Delirium is an acute brain dysfunction that has been correlated with adverse mental health outcomes, such as depression and posttraumatic stress disorder (PTSD). However, delirium has not been studied in relation to mental health outcomes after cerebrovascular events. This study aimed to examine the incidence of PTSD after nontraumatic intracerebral hemorrhage (ICH) and identify new predictors of poststroke PTSD symptoms.

Methods:

Clinical data were collected from 205 patients diagnosed with nontraumatic ICH. Demographics and hospital course data were examined. Univariate and multivariable correlational analyses were performed to determine predictors of PTSD symptoms. PTSD symptoms were assessed using PTSD checklist—civilian version (PCL-C) scores.

Results:

Diagnostic criteria for a positive PTSD screen (PCL-C score ≥44) were met by 13.7%, 20.2%, and 11.6% of nontraumatic patients with ICH at 3, 6, and 12 months, respectively. On univariate analysis, younger age, female sex, unemployed, and in-hospital delirium were correlated with higher PCL-C scores. In multivariable models, younger age, female sex, unemployed, in-hospital delirium, and a previous anxiety or depression diagnosis were associated with higher PCL-C scores at different follow-up times. Modified Rankin Scale scores were also positively correlated with PCL-C scores at each time point.

Conclusions:

Delirium, previous psychiatric history, younger age, female sex, and unemployment status were found to be associated with a greater degree of posthemorrhagic stroke PTSD symptoms. More significant PTSD symptoms were also correlated with greater functional impairment. A better understanding of patient susceptibility to PTSD symptoms may help providers coordinate earlier interventions.
Developing Gender-Affirming Surgery Curricula for Plastic Surgery Residency and Fellowship via Delphi Consensus
Authors: Song Siyou , Park Keon Min , Parmeshwar Nisha , Dugi Daniel , Schechter Loren , Berli Jens Urs , Kim Esther A. ,   Group GAS Research
Published: April 2023

Background:

Gender-affirming surgery (GAS) is a rapidly growing field within plastic surgery, and it is crucial that residents and fellows receive appropriate training. However, there are no standardized surgical training curricula. Our objective was to identify core curricula within the field of GAS.

Methods:

Four GAS surgeons from different academic institutions identified initial curricular statements within six categories: (1) comprehensive GAS care, (2) gender-affirming facial surgery, (3) masculinizing chest surgery, (4) feminizing breast augmentation, (5) masculinizing genital GAS, and (6) feminizing genital GAS. Expert panelists consisting of plastic surgery residency program directors (PRS-PDs) and GAS surgeons were recruited for three rounds of the Delphi-consensus process. The panelists decided if each curriculum statement was appropriate for residency, fellowship, or neither. A statement was included in the final curriculum when Cronbach’s alpha value was ≥ 0.8 meaning that ≥ 80% of the panel agreed on inclusion.

Results:

34 panelists (14 PRS-PDs and 20 GAS surgeons representing 28 U.S. institutions) participated. The response rate was 85% for the first round, 94% for the second, and 100% for the third. Out of 124 initial curriculum statements, 84 reached consensus for the final GAS curricula, 51 for residency and 31 for fellowship.

Conclusions:

A national consensus on core GAS curriculum for plastic surgery residency and GAS fellowship was achieved via a modified Delphi method. Implementation of this curriculum will ensure that trainees in plastic surgery are adequately prepared in the field of GAS.
Evaluating Outcomes and Time Delays of a Non-Trainee-Driven Hospitalist Procedure Service
Authors: Orewa Gregory N. , Feldman Sue S. , Redmond Nicole , Hall Allyson G. , Kennedy Kierstin Cates
Published: April 2023

Background and Objectives:

Ultrasound guidance has become standard of care in hospital medicine for invasive bedside procedures, especially central venous catheter placement. Despite ultrasound-guided bedside procedures having a high degree of success, only a few hospitalists perform them. This is because these are usually performed by radiologists or in the setting of trainee-run procedure teams. We sought to determine the impact of a non-trainee driven, hospitalist-run procedure service relative to time from consult to procedure.

Methods:

The University of Alabama at Birmingham Hospital (UAB), Department of Hospital Medicine, trained 8 non-trainee hospitalist physicians (from existing staff) to implement the ultrasound-guided procedure service. This study examines consult to procedure completion time since the implementation of the procedure service (2014 to 2020). Univariate analyses are used to analyze pre-implementation (2012-2014), pilot (2014-2016), and post-implementation data (2016-2018 initial, and 2018-2020 sustained).

Results:

Results suggest a 50% reduction in time from consult to procedure completion when compared with the period before implementation of the nontrainee hospitalist procedure service.

Conclusions:

A hospitalist procedure service, which does not include trainees, results in less time lag from consult to procedure completion time, which could increase patient satisfaction and improve throughput. As such, this study has wide generalizability to community hospitals and other nonacademic medical centers that may not have trainees.
Roles of protein tyrosine phosphatases in reproduction and related diseases
Authors: Du Ruo-Heng , Chen Huai-Yan , Gao Lu
Published: April 2023

Protein tyrosine phosphatases (PTPs) remove phosphate groups from protein tyrosine residues to regulate various cell signaling processes, subsequently affecting the growth, metabolism, differentiation, immune response, and other cellular processes. Several studies have investigated the functions of PTPs in tumor and organism immunity. However, only a few studies have focused on their roles in reproductive disorders. Therefore, in this review, we summarize the roles and underlying molecular mechanisms of PTPs in infertility, spontaneous abortion, pregnancy-induced hypertension, gestational diabetes mellitus, early embryonic developmental abnormalities, and preterm birth. This review can contribute to future research on PTPs and their potential applications as targets in the treatment of reproductive diseases.
Hepatic Superscan in Methotrexate-Associated Lymphoproliferative Disorder
Authors: Chow Tsz-Kit
Published: April 2023

A 60-year-old man on methotrexate for treatment of adult-onset Still disease presented with acute onset of fever, pancytopenia, and deranged liver function. Besides FDG-avid lesions in spleen and skeleton, his 18F-FDG PET/CT study showed diffuse and intense uptake in the liver with significantly suppressed heart and brain activity (reminiscent of a hepatic superscan). Subsequent biopsy confirmed the diagnosis of methotrexate-associated lymphoproliferative disorder.