bluuebunny/crossref_metadata_2025 huggingface dataset:
Management of acute aortic services during the COVID-19 pandemic: a retrospective cohort study from the Middle East
Authors: Manla Yosef , Bhatnagar Gopal , Khan Naureen , Al Badarin Firas , AlJabery Yazan , Kakar Vivek , Aleinati Tareq , Bayrak Yusuf , AlMahmeed Wael , Sänger Stefan , Bafadel Ahmed , Göbölös Laszlo
Published: August 2023

Background:

COVID-19 created a challenging situation for cardiac surgery and associated acute care programs around the world. While non-urgent cases might be postponed, operating on life-threatening conditions, including type A aortic dissection (TAAD), must be sustained despite the ongoing pandemic. Therefore, the authors investigated the impact of the COVID-19 pandemic on their urgent aortic program.

Methods:

The authors included consecutive patients presenting with TAAD (n=36) in the years 2019 and 2020 [pre-pandemic period (2019; n=16) and the pandemic era (2020; n=20)] at a tertiary care centre. Patient characteristics, TAAD presenting symptoms, operative techniques, postoperative outcomes, and length of stay were determined retrospectively using chart review and were compared between both years.

Results:

An increase occurred in the absolute number of TAAD referrals during the pandemic era. Patients were featured by younger age of presentation (pre-pandemic group: 47.6±18.7, and the pandemic group: 50.6±16.2 years, P=0.6) in contrast to Western data but showed similar male predominance (4:1) in both groups. There was no statistical difference in baseline comorbidities between the groups. Length of hospital stay [20 (10.8–56) vs. 14.5 (8.5–53.3) days, P=0.5] and intensive care unit stay [5 (2.3–14.5) vs. 5 (3.3–9.3) days, P=0.4] were comparable between both groups. Low rates of postoperative complications were registered in both groups with no significant between-group difference. There was no significant difference in the rates of in-hospital mortality between both groups [12.5% (2) vs. 10% (2), P=0.93].

Conclusions:

Compared with the pre-pandemic era (2019), there was no difference in resource utilisation and clinical outcomes of patients presenting with TAAD during the first year of COVID-19 pandemic (2020). Structural departmental re-configuration and optimal personal protective equipment utilisation warrant maintained satisfactory outcomes in critical healthcare scenarios. Future studies are required to further investigate aortic care delivery during such challenging pandemics.
Safety and efficacy of pimecrolimus versus vehicle for the treatment of atopic dermatitis in adults and paediatric population: a systematic review and meta-analysis
Authors: Akhtar Sareema E. , Shakil Saad , Farooqui Sabeeh K. , Khedro Tarek , Alzufairi Ahmad L. , Niaz Muhammad A. , Syed Saifullah , Jiffry Riaz , Alsubai Abdulla K. , Almesri Abdullah , Ismail Hebatalla , Khan Kashif A. , Al-Hindawi Ahmed , Ali Hussein K. , Falodun Timothy , Tabassi Aysa , Tabassi Aylin , Almas Talal
Published: August 2023

Introduction:

Atopic dermatitis remains a widespread problem affecting various populations globally. While numerous treatment options have been employed, pimecrolimus remains a potent and viable option. Recently, there has been increasing interest in comparing the safety and efficacy of pimecrolimus with its vehicle.

Methods:

The authors conducted a comprehensive search of several databases, including PubMed, COCHRANE, MEDLINE, and Cochrane Central, from inception to May 2022, using a wide search strategy with Boolean operators. The authors also employed backward snowballing to identify any studies missed in the initial search. The authors included randomized controlled trials in our meta-analysis and extracted data from the identified studies. The authors used Review Manager (RevMan) Version 5.4 to analyze the data, selecting a random-effects model due to observed differences in study populations and settings. The authors considered a P-value of 0.05 or lower to be statistically significant.

Results:

The authors initially identified 211 studies, of which 13 randomized controlled trials involving 4180 participants were selected for analysis. Our pooled analysis revealed that pimecrolimus 1% was more effective at reducing the severity of atopic dermatitis than its vehicles. However, no significant difference was observed in adverse effects between pimecrolimus and vehicle, except for pyrexia, nasopharyngitis, and headache, which were increased with pimecrolimus.

Conclusion:

Our meta-analysis showed that pimecrolimus 1% is more effective than vehicle, although the safety profile remains inconclusive. Pimecrolimus reduced the Investigator’s Global Assessment score, Eczema Area and Severity Index score, and severity of pruritus when compared to its vehicle, indicating a higher efficacy profile. This is one of the first meta-analyses to assess the efficacy and safety profile of pimecrolimus 1% against a vehicle and may assist physicians in making informed decisions.
Looping a suture under the coracoid process using a modified pelvic suture needle in coracoclavicular stabilization
Authors: Asavanapakas Panpaporn , Klabklay Prapakorn , Maliwankul Korakot , Chuaychoosakoon Chaiwat
Published: August 2023

Introduction:

A distal clavicle fracture is a common shoulder injury. Coracoclavicular (CC) stabilization is a popular procedure for treating this injury. However, with this method, there is a technical difficulty in looping the suture under the coracoid base with instruments normally available in the operating room (OR). Herein, the authors describe modifying a pelvic suture needle to ease this process.

Case presentation:

An 18-year-old Thai female presented with left shoulder pain after a fall while cycling. The physical examination showed tenderness at the prominent distal clavicle. The radiograph of both clavicles showed a displaced distal clavicle fracture of the left shoulder. After discussing the treatment, she decided to have CC stabilization as the authors recommended.

Clinical discussion:

CC stabilization is one of the main surgical techniques used in treating an acute displaced distal clavicle fracture. The most important but difficult step of the CC stabilization is passing a suture under the coracoid base. To make this step easier, various commercial tools have been created, however, they are expensive ($1400–1500 per piece), and most operating rooms in resource-limited countries do not have them available. The authors modified a pelvic suture needle specifically for use in looping a suture under the coracoid process, which is hard to do with standard surgical tools.
A rare case of Guillain-Barrè syndrome with unilateral facial palsy and asymmetrical ascending weakness: a case report
Authors: Maharjan Suman , Bhattarai Birat , Basnet Sanjog , Pandey Suvekchya , Basnet Sarita , Shrestha Pawan , Thapa Kriti
Published: August 2023

Introduction and Importance:

Guillain-Barrè syndrome is a life threatening postinfectious disease causing acute paralytic neuropathy that rarely presents with asymmetrical limb weakness (1%) and unilateral facial nerve palsy (4.9%).

Case Presentation:

A 39-year-old male presented with pain and weakness in the right lower limb with right sided facial weakness. The cranial nerve examination revealed lower motor neuron type right facial palsy (Bell ’s palsy). On rest neurological examination, he had decreased power in the right lower limb with an absent knee and ankle reflex on presentation. Later, the weakness was symmetrical in both lower limbs.

Clinical Discussion:

Cerebrospinal fluid analysis showed albuminocytologic dissociation with no cells and an elevated protein of 203.2 mg/dl. The nerve conduction study was abnormal in bilateral lower limbs suggesting severe demyelinating motor neuropathy. Intravenous Immunoglobulin was started with the dose of 25 gm (0.4 mg/kg) once daily for 5 days, that is, five doses. The patient started showing signs of recovery with the initial dose of immunoglobulin.

Conclusion:

The course of the disease usually recovers spontaneously and completely; however, plasma exchange and immunomodulatory therapy have shown improvement in patient with rapidly deteriorating symptoms.
Influence of implant protrusion length and initial bone height on intrasinus bone gain in transalveolar sinus floor elevation without bone graft: a 2-year retrospective study
Authors: Albash Ziad , Khalil Ali , Sleman Nadim
Published: August 2023

Introduction:

A transalveolar sinus lift is a safe and predictable long-term surgical approach. Several factors affect clinical and radiographic outcomes. This study aimed to evaluate the correlation between intrasinus bone gain (IBG) with the implant protrusion length (IPL) and the initial bone height (IBH) in transalveolar sinus floor elevation (TSFE) without bone graft procedures.

Materials and methods:

This retrospective cohort study was carried out on patients who had reported to the department of oral and maxillofacial surgery at Tishreen University between January 2020 and September 2022. The sample consisted of patients who had a transalveolar sinus lift with simultaneous dental implants placement. TSFE was performed using motorized threaded bone expanders. The IBH, the IPL, and the IBG height were analyzed using CBCT scans that were taken preoperatively and 6 months postoperatively. Statistical analysis was performed to assess the relationship of the IBG with the IPL and the IBH. The P values < 0.05 were considered to be statistically significant.

Results:

A total of 34 implants were placed using motorized threaded bone expanders in 29 patients who were included in the study. Three membrane perforations were observed out of 34 procedures (8.82%). The survival rate for all implants was 100%. The mean IBH was 6.37±0.85 mm, the mean IPL was 2.01±0.55 mm, and the mean IBG was 1.69±0.44 mm. A strong positive correlation was found between bone gain and IPL. No correlation was found between bone gain and IBH.

Conclusions:

According to the result of this study, the IPL is a critical factor in TSFE and dental implant placement simultaneously without bone graft procedures.
Anti-acid treatment for ulcerated early gastric cancer may be a treatment option avoiding unnecessary gastrectomy: a cohort study
Authors: Suto Daisuke , Yoshida Masashi , Otake Takaaki , Osawa Yosuke , Sato Kiichi , Yamada Hidehiko , Akita Takayuki , Ohdaira Hironori , Suzuki Yutaka , Kohgo Yutaka
Published: August 2023

Background:

Diagnosing the invasion depth of ulcerated early gastric cancer is usually inaccurate, especially for endoscopists in primary care clinics who are often not experts in this area. In reality, many patients with open ulcers who can be treated with endoscopic submucosal dissection (ESD) are referred for surgery.

Materials and methods:

Twelve patients with ulcerated early gastric cancer who were treated with proton pump inhibitors, including vonoprazan, and underwent ESD were included in the study. Conventional endoscopic and narrow-band images were evaluated by five board-certified endoscopists (two physicians: A, B, and three gastrointestinal surgeons: C, D, and E). They assessed the invasion depth, and the results were compared with the pathologic diagnosis.

Results:

The accuracy of the invasion depth diagnosis was 38.3%. According to the pretreatment diagnosis of invasion depth, gastrectomy was recommended for 41.7% (5/12) of the cases. However, histological examination revealed that additional gastrectomy was required in only one case (8.3%). Thus, in four out of five patients unnecessary gastrectomy could be avoided. Post-ESD mild melena occurred in only one case, and there was no case of perforation.

Conclusion:

Antiacid treatment contributed to avoid unnecessary gastrectomy in four out of five patients for whom gastrectomy was indicated based on an inaccurate pretreatment diagnosis of the invasion depth.
Delayed enterocutaneous fistula after 17 years of gunshot wound injury: a case report
Authors: Nur Nuradin M. , Salad Najib M. , Ahmed Abdullahi A.
Published: August 2023

Introduction and importance:

Enterocutaneous fistula (ECF) is a common complication of abdominal surgery. Postoperatively, it may be the result of a small intestinal injury or an anastomosis leak, and it typically manifests days or weeks following surgery.

Case presentation:

A 56-year-old man with a history of a gunshot wound injury in the abdomen with colon injury managed for colocolic anastomosis 17 years earlier presented to our hospital’s general surgery clinic with the complaint of drainage at the scar area. It was discovered that he had an ECF. The patient underwent a laparotomy. Fistula tract excision and segmental colon resection with colocolic anastomosis were done.

Clinical discussion:

ECF formation after an extraordinarily long latency due to an anastomotic leak, which has not been previously documented in the literature, is a distinctive aspect of the case. As a result, surgeons should consider ECF in their differentials for patients with a history of abdominal operations.

Conclusion:

Surgical management is the definitive treatment of ECF after proper resuscitation and stabilization of the patient’s condition. Preoperative imaging is crucial for determining the anatomy of the fistula and any associated intra-abdominal pathology.
Chimeric antigen receptor T cell therapy for the treatment of systemic rheumatic diseases: a comprehensive review of recent literature
Authors: Bhandari Sambhawana , Bhandari Sadikshya , Bhandari Samikshya
Published: August 2023

Systemic rheumatoid diseases (SRDs) are autoimmune and inflammatory disorders that affect multiple organ systems, impacting patients’ quality of life, and survival rates. Standard treatment requires continuous drug therapy and immunosuppression. Chimeric antigen receptor (CAR) T cell therapy has the potential to target and eliminate pathologically activated immune cells and re-establish tolerance in organs affected by dysregulated immunity, making them a promising treatment option for autoimmune diseases. In autoimmune diseases, CAR T cells have the advantage of being able to kill B cells effectively without the need for an accessory cell type. Additionally, CAR T cells targeting CD19 have shown promise in comprehensive B cell aplasia, preserving pre-existing humoral immunity, and specifically eliminating pathogenic B cells. CAR T cell therapy’s limited use in SRDs is due to its inability to effectively target the various autoreactive lymphocytes present. Researchers are developing a universal CAR T cell therapy that detects and targets autoreactive lymphocytes using major epitope peptides, though further studies are required. Moreover, adoptive transfer of CAR-Tregs has shown promise for effectively reducing inflammation and treating autoimmunity. Through this exploration, the authors hope to provide a comprehensive understanding of the current state of research on this topic, identify areas for further study, and promote the advancement of CAR T cell therapy as a treatment option for SRDs.
Emphysematous pyelonephritis complicated by septic shock treated with antibiotic therapy alone: a case report
Authors: Merbouh Manal , El Aidouni Ghizlane , Bkiyar Houssam , Housni Brahim
Published: August 2023

Introduction and importance:

Emphysematous pyelonephritis (EPN) is a rare and serious complication of urinary tract infections that mainly occurs in diabetic patients. It results in the development of aerobic gas-forming bacteria1. Diagnosis is based mainly on a computed tomography scanner. Therapeutic management is based on the patient’s clinical condition and radiological classification.

Case presentation:

We present a case of a 64-year-old female patient with type 2 diabetes under insulin and hypertension under amlodipine, who was admitted to the intensive care unit for a state of septic shock on EPN. The patient received resuscitation measures and antibiotic therapy, and the evolution was favorable. The patient was transferred to the urology unit after 10 days of hospitalization in the intensive care unit.

Discussion:

EPN is frequently caused by gram-negative cocci and generally develops in diabetics. The clinical signs of EPN are not very specific and are essentially based on the signs of acute pyelonephritis, which responds badly to treatment.

Conclusions:

It is essential to take preventive measures in diabetic patients to avoid this complication. Early diagnosis allows for avoiding surgery by preserving the kidney.
Case of left atrial myxoid sarcoma with lung metastases presented as a cardiogenic shock: a case report and literature review
Authors: Khalil Omar R.S. , Omar Belal M.M. , Khalil Lamees , Tarabieh Doaa , Al-Karaja Layth , Alkhatib Hasan , Asad Diya
Published: August 2023

Introduction and importance:

Cardiac tumors are a rare condition that typically presents with nonspecific symptoms. Among the histologic patterns, myxoid sarcomas are rarely identified and may have a less favorable prognosis. Reporting a case of this type of cardiac tumor can increase awareness about this condition and aid in early diagnosis, potentially leading to better outcomes.

Case presentation:

We are presenting a case of a 41-year-old female with left atrial myxoid sarcoma, which was presented with a cardiogenic shock picture. She underwent surgical excision of the mass and was discharged in good condition. After discharge, she deteriorated and was found to have lung metastases.

Clinical discussion:

Primary cardiac sarcomas, due to their rarity and poor prognosis, are often diagnosed at an advanced stage of the disease and lack sufficient data to establish a standard course of treatment. The cornerstone of therapy is surgical resection. However, novel therapeutic approaches must be developed.

Conclusions:

Primary cardiac tumors should be suspected in adult patients with progressive dyspnea, and a biopsy should also be done to determine the histopathological pattern of the mass and estimate the overall prognosis and outcomes.
Immediate dental implantation after indirect sinus elevation using osseodensification concept: a case report
Authors: Mohrez Majd , Amam Mohey A. , Alnour Amirah , Abdoh Ealaf , Alnajjar Alaa , Beit Zavin K.
Published: August 2023

Introduction and importance:

Implantation in the posterior maxilla is more challenging due to the insufficient bone height after maxillary sinus pneumatization and the low bone density. Osseodensification (OD) is considered a novel, less invasive, and more effective indirect sinus floor elevation technique.

Case presentation:

A 52-year-old male presented to the oral and maxillofacial surgery department with a main complaint of chewing difficulties in the right posterior area maxilla (teeth numbers: 26 and 27). A cone-beam computed tomography (CBCT) imaging showed that the residual bone height ranged between 1 and 4 mm and the width ranged between 9 and 12 mm in the area of teeth numbers 16 and 17.

Intervention and outcome:

The treatment plan was to extract the teeth (numbers: 16 and 17) and conduct internal sinus lifting and bone grafting using the OD burs with immediate implantation.

Clinical discussion:

OD is proposed as an alternative procedure to the direct (lateral window) sinus floor elevation procedure. The amount of vertical bone gain obtained by this technique in transcrestal sinus lifting can be the same as external sinus lifting in this case.

Conclusion:

OD can be considered a promising technique for direct sinus floor elevation, considering the amount of vertical bone gain obtained by this technique.
Colonic pedunculated polypoid vascular ectasia mimicking ileocolic intussusception: a rare case report
Authors: Raut Ujwal , Thapa Santosh , Shrestha Garima , Shah Sandesh , Karki Utsav
Published: August 2023

Introduction and importance:

Vascular ectasias are characterized by abnormal blood vessel enlargement and presumed to be caused by degenerative processes. About 3% of lower gastrointestinal bleeding is caused by it. On endoscopy, colonic arteriovenous malformations are frequently solitary, sizable, flat, or raised red lesions. Conversely, colonic vascular ectasia that manifests as pedunculated polypoid lesions are rare.

Case presentation:

A 45-year-old woman presented with hematochezia and abdominal pain. Abdominal ultrasound and Contrast enhanced computed tomography abdomen, both showed features of ileocolic intussusception. Intraoperatively, an intraluminal pedunculated polypoid growth extending up to the hepatic flexure of the colon was discovered. A right hemicolectomy was performed, removing the polypoid growth as well. After histopathological evaluation, a final diagnosis of colonic polypoid vascular ectasia was made.

Clinical discussion:

Gastrointestinal bleeding is the common initial manifestation of vascular ectasia, while some individuals may continue to be asymptomatic. According to a study from July 2022, vascular ectasia that manifests as polypoid growth is an uncommon phenomenon that has only been documented in 17 other cases. An intussusception may have a polypoid vascular ectasia as its lead point. Conversely, a large polypoid vascular ectasia may have radiographic characteristics that resemble an intussusception.

Conclusion:

Large colonic vascular ectasia, which tends to enlarge over time, can occasionally be misinterpreted as an intussusception due to comparable radiological appearances. In the event that a polypoid colonic vascular ectasia is misidentified for intussusception, the surgical team must be ready to adjust the treatment protocol as needed.
Intussusception-induced acute abdomen caused by a giant lipoma in the transverse colon: a rare case report
Authors: Wardeh Abdulkareem Muhammad , Sattout Ghaith Izz Aldeen , Mansour Marah , Suliman Mahmoud , Alloush Ali Muhammad , Salloum Rabab
Published: August 2023

Introduction:

Intussusception is a common finding among children. Conversely, it is infrequent in adults. Colonic lipomas are generally clinically silent making them a very rare etiology of intussusception.

Presentation of case:

The authors present a case of a 48-year-old male who presented to the emergency department suffering from severe abdominal pain. Following examination and investigations, a giant lipoma (GL) in the transverse colon was identified via ultrasound which showed the classical “target sign”.

Clinical discussion:

Intussusception among adults is unusual as it accounts for only 1% of bowel obstruction cases. Being colo-colonic makes it even more unlikely since it occurs only in 17% of intestinal obstruction cases. GLs exceeding 5 cm in size can present with a variety of symptoms. Intussusception is an uncommon presentation of a GL. Preoperative diagnosis of GL-induced intussusception is highly improbable and surgical resection is the treatment of choice.

Conclusion:

Despite the dominance of the asymptomatic presentation of lipomas, considering its diagnosis in the case of an intussusception-induced acute abdomen should cross physicians’ minds.
Methodology to evaluate the effectiveness of instituting a modified preoperative time out on teamwork: a pilot study
Authors: Edelstein Robert A.
Published: August 2023

Objective:

To evaluate the effectiveness of modifying the preoperative surgical time out in increasing a validated measure of teamwork in the operating room.

Methods:

This study was conducted as a pre-intervention, post-intervention pilot study. A validated survey was used as an instrument to measure overall teamwork in the operating room. Data were obtained in two periods of time: In phase 1 (pre-intervention), the standard preoperative surgical time out was used. In phase 2 (post-intervention), a modification of the standard time out was employed, emphasizing the equality and importance to safety of listening to the opinions of all team members in the room.

Results:

The use of an enhanced surgical time out was shown to have a small, but measurable positive correlation with a validated measure of operating room teamwork. Mean survey Likert scores increased from 68.03 to 68.81 out of a total survey score of 90, with an appropriate control range shift. Although this small pilot study was insufficiently powered to evaluate subcategories of teamwork, such as clinical leadership, communication, coordination, and respect, we hope to address this in future larger studies.

Conclusion:

Our data from this pilot study suggest that giving each member of the surgical room team a position of equality in analyzing the operating room environment prior to commencing surgery led to a positive, measurable difference in an objective measure of teamwork. Increases in teamwork have been shown in the literature to lead to an overall safer surgical environment.
Neurological injury in primary Sjogren’s syndrome
Authors: Khalayli Naram , Bouri Mhd Fares , Wahbeh Molham , Drie Tasneem , Kudsi Maysoun
Published: August 2023

Introduction:

The incidence of neurological injury in primary Sjogren’s syndrome varies between 2.5 and 60%. The authors aimed to evaluate its prevalence and characteristics in patients with primary Sjogren’s syndrome in a sample of the Syrian population.

Patients and methods:

Forty-eight patients with primary Sjogren’s syndrome, attending outpatient clinics at Damascus Hospital between January 2020 and January 2022 in this cross-sectional study at the outpatient clinics, were interviewed and examined, and the necessary laboratory and radiological examinations were demanded. Information was collected on disease duration, onset time, and patterns of neurological symptoms.

Results:

Forty-eight patients, including 42 females, aged 56.1±10.3 years were enroled.

Central nervous system involvement was found in 34 patients. 85% of patients had generalized nerve manifestations, while local nerve manifestations were found in 77,5% of patients. The common neurological manifestation was headaches, then cognitive disorders, and the most common pattern of headache was migraine. Beck Depression Index showed a significant increase in the apathy evaluation scale.

The study of cognitive changes showed a significant increase in the Mini-Mental State Examination (MMSE) index.

Carotid Doppler showed the presence of injury in 42.4% of patients. The magnetic resonance imaging showed positive findings in 21 patients and positive evoked potentials in 52% of patients.

Discussion:

Studies showing the prevalence of Sjogren’s neurological injury patterns are insufficient, but this was changed when the criteria for diagnosing Sjogren’s syndrome was modified, and the definition of neurological traits in the context of the syndrome was expanded.

The presence of a high rate of headaches, cognitive changes, and fatigue confirms that generalized nervous system injuries are more common than local injuries. Migraine was the most common pattern of headache found in patients with the syndrome compared with other patterns such as tension headaches and headaches due to medications, especially analgesics.

This was associated with the presence of anti-SSA antibodies and Raynaud’s phenomenon, which suggest that the headache mechanism may be due to vascular endothelial dysfunction or an immune-mediated inflammation injury of the neurovascular system.

The changes that appeared on the MRI images suggested premotor cortex involvement rather than mesolimbic cortical impairment, and its presence was also associated with SSA antibody positivity, and it is caused by inflammation.

Conclusion:

Primary Sjogren’s syndrome should be considered as having any unspecified or specific neurological disorder.
Using the HEART score in patients with chest pain in the emergency department of Kosovo as an important triage criterion for treatment and hospitalization
Authors: Rashiti Premtim , Rashiti – Bytyçi Albiona , Haradinaj Kadri , Dermaku Erolind , Berisha Valdet , Bellanica Valon , Svarça Leonora , Haklaj Vjollca , Lahu Vendenis , Duraku Egzon , Shabani Afrim
Published: August 2023

Background:

Despite being a frequent presenting complaint in emergency rooms, chest pain’s clinical therapy varies greatly. Our objectives were to identify the traits of people who complain of chest pain and to analyze the value of the HEART (history, electrocardiogram, age, risk factors, and initial troponin) score index for risk assessment. Depending on how bad it is, each abnormality can be given a score of zero, one, or two points. These five factors add up to the HEART score.

Methods:

Clinical information on 269 individuals with chest pain admitted to the Emergency Room was reviewed: January 2022 until January 2023. A prospective registry was used to record information about patients with nontraumatic chest discomfort who were admitted from the emergency department.

Results:

Over a 12-month period, patients admitted in emergency department were classified through HEART score. From them 101 patients (37%) belong to the age group older than or equal to 65 years, 134 patients (50%) belong to the age group 45–65 years, and 34 patients (13%) belong to the age group younger than or equal to 45 years. Strong positive correlation between troponin level (HEART score) and hospitalization, also p value 0.043 is typically considered to be statistically significant. According to HEART score classification 43 cases (60%) from the group with 7–10 (high risk) were hospitalized. According to anamnesis (history) on cardiovascular disease in relation to hospitalization, then 48 cases hospitalized (67%) belong to the classification 1-moderately suspicious and 21 cases hospitalized (29%) belong to the classification 2-highly suspicious classification.

Conclusion:

The HEART score can be used for triage since it is a simple, rapid, and accurate predictor of outcome in patients with chest pain. A medium risk group included about half of the patients who reported chest pain to an emergency room. Hospitalization and troponin level had a strong positive link (HEART score), with a p value of 0.043.
Acute coronary syndromes in chronic hemodialysis patients: a series of 34 cases (case series)
Authors: Boutaybi Mohammed , Aloutmani Badia , El-Azrak Mohammed , Ismaili Nabila , El Ouafi Noha
Published: August 2023

Background:

Cardiovascular diseases, particularly acute coronary syndrome, are the leading cause of death in chronic hemodialysis patients. Our study aims to analyze the pathophysiological, clinical, angiographic, and therapeutic characteristics of coronary heart disease in hemodialysis patients.

Patients and Methods:

This single-centered retrospective descriptive study included 34 hemodialysis patients hospitalized in the cardiovascular ICU.

Results:

The mean age of patients in our study was 64.4±11.3 years. The main cardiovascular risk factor found in our study was age, with a prevalence of 76.50%, followed by hypertension, with a prevalence of 67.60%. Diabetes was present in 55.90% of patients. The authors also found that 17.90% of patients were obese, and 29.40% had abdominal obesity. The main cause of renal disease in our study was diabetic nephropathy (52.90% of cases), followed by hypertensive nephropathy (23.50% of cases). ST segment elevation myocardial infarction was found in 14.70% of cases, and non-ST-segment elevation myocardial infarction in 85.30% of cases. Coronary angiography was performed in 76.40% of patients. Single-vessel coronary artery disease (CAD) was found in 20%, two-vessel CAD in 50%, and three-vessel CAD in 30% of the cases. Coronary artery calcifications were observed in 21.42% of cases. 38.23% had an angioplasty, and 20.58% were referred for a coronary artery bypass graft.

Conclusion:

Despite the high mortality rate after acute coronary syndrome, hemodialysis patients are less likely to undergo diagnostic angiography or coronary revascularization. Patients on hemodialysis tend to have multiple, diffuse, calcified CAD.
Predictors of all-cause mortality in hospitalized COVID-19 patients taking corticosteroids: a multicenter retrospective cross-sectional study
Authors: Mahmoud Viviane , Hatem Georges , Al-Saleh Amani , Ghanem Diana , Yassine Ahmad , Awada Sanaa
Published: August 2023

Introduction:

Despite the recommendations to avoid using corticosteroids systematically for hospitalized coronavirus disease of 2019 (COVID-19) patients, healthcare professionals used personalized treatments, including corticosteroids, as adjuncts to treat their patients due to their limited access to treatment options. This study aims to evaluate the use of corticosteroids among hospitalized COVID-19 patients with all-cause mortality as the primary outcome and to assess the predictors of all-cause mortality associated with the characteristics of the patients and the corticosteroid regimens adopted.

Methods:

A multicenter retrospective study was performed over three months targeting 422 COVID-19 patients from six hospitals in Lebanon. Data were collected from patients’ medical charts retrospectively and covered a period of one year (September 2020–August 2021).

Results:

The study sample included 422 patients, predominantly males, with 59% of cases classified as severe or critical cases. Dexamethasone and methylprednisolone were the most used corticosteroids. Around 22% of the patients died during hospitalization. After adjusting for covariates, performing a polymerase chain reaction before admission increased the mortality rate by 424% compared to doing it at hospital admission (aHR 4.24, 95% CI 1.35–13.3), with 18.11 times higher mortality rate among critical cases (aHR 18.11, 95% CI 9.63–31.05). Exposure to side effects from corticosteroids increased the mortality rate by 514% compared to others (aHR 5.14, 95% CI 1.28–8.58). In particular, the mortality rate among patients having hyperglycemia dropped by 73% compared to others (aHR 0.27, 95% CI 0.06–0.98).

Conclusion:

Corticosteroids are frequently used in treating hospitalized COVID-19 patients. The all-cause mortality rate was higher among older and critical cases and lower among smokers and those treated for more than 7 days. Research exploring the safety and efficacy of corticosteroids is required to allow better in-hospital management of COVID-19 cases.
Hypogonadism among patients with transfusion-dependent thalassemia: a cross-sectional study
Authors: Mahwi Taha O. , Rashid Zagros G. , Ahmed Shaho F.
Published: August 2023

Introduction:

Patients with thalassemia major are liable to have complications from blood transfusion and iron excess despite using iron-chelating agents. It is common to have endocrine complications in these patients. Hypogonadism is one of the most common complications in thalassemic patients. Early detection and treatment are essential to restore puberty and prevent complications from hypogonadism.

Patients and methods:

The authors conducted this cross-sectional study in the Kurdistan Region of Iraq, from 1 July 2022, to 1 December 2022. Eighty patients with β-thalassemia major who were referred to the endocrinology clinic were enrolled. The patients were evaluated sequentially, starting with a history, followed by a clinical examination and laboratory tests related to endocrine disease. Those who met the inclusion criteria were enrolled in the study, while the others were excluded.

Results:

Out of 80 patients with major thalassemia who were referred to the endocrinology clinic, 53 (66.3%) were female, and 27 (33.7%) were male, with a mean (SD) age of 24.86±7.66 (14–59) years. Fifty-five (68.75%) of them had hypogonadism, three patients (3.8%) had hypothyroidism, while two (2.5%) had hypoparathyroidism. Five patients (6.3%) had diabetes. None of the patients had adrenal insufficiency. The mean ferritin level in thalassemic patients with hypogonadism and thalassemic patients without hypogonadism was 2326±2625 ng/ml vs. 1220±2625 ng/ml.

Conclusion:

To minimize the risk of endocrinopathy in patients with thalassemia major, they should receive blood transfusions regularly and initiate chelating agents early, because the leading cause of endocrinopathy in thalassemic patients is related to the severity of anemia and iron overload.
Surgical characteristics of appendectomy in the eastern region of the democratic republic of congo: a cross-sectional study
Authors: Masimango Gaston , Cakwira Hugues , Oduoye Malik O. , Onesime Jones , Otobo Daniel D. , Kibukila Fabrice , Banga Styves , Akilimali Aymar , Suvvari Tarun K. , Kyaruzi Victor M. , Rehman Ibad ur , Bavurhe Rodrigue F. , Nyakio Olivier
Published: August 2023

Background:

Appendectomy is a surgical procedure performed on a patient with acute appendicitis and is often performed by surgery and performed in an emergency. The authors have carried out this study, which aims to describe the surgical characteristics of appendectomies.

Methods:

This retrospective, descriptive, and documentary cross-sectional study was conducted from October 2021 to October 2022. Within this time ~591 acute abdominal surgical procedures were performed, including 196 appendectomies performed in the general surgery department.

Results:

This study focused on 196 appendectomies performed out of a total of 591 surgeries performed, with an incidence of 34.2%. 51 cases (26%) for the age group between 15 and 20 years, 129 cases (65.8%) of women participated in the appendectomy. 133 (67.8%) acute appendicitis, 48 (24.5%) appendicular abscess and 15 (7.7%) appendicular peritonitis were indications for appendectomies. For the American Society of Anesthesiologists (ASA) score: for the ASA I, 112 (57.1%) of the patients had no conditions other than those requiring surgery (appendectomy). For the Altemeier classification, the authors recorded 133 (67.9%) own surgeries. 56 (28.6%) surgical site infections followed by 39 (19.8%) inflammation (swelling and redness), 37 (18.8%) pain, 24 (12.4%) purulent peritonitis, 21 (10, 7%) postoperative hemorrhage and 19 (9.7%) paralytic ileus and 157 (80.1%) patients benefited from medical treatment.

Conclusion:

The low incidence of complications related to laparotomy appendectomy has been reduced to a minimum thanks to the respect of sanitary measures and the quality of the technique.
Chronic contained ruptured abdominal aortic aneurysm with a rare presentation of lower limb neuropathic claudication: a report of two cases
Authors: Hariri Omar , Al Laham Omar , Mohammad Ammar
Published: August 2023

Introduction and importance:

A vertebral body erosion that takes place due to a chronic contained rupture of an abdominal aortic aneurysm is an especially rare vascular pathology that comprises less than 5% of all causes of vertebral body erosion. Chronic contained rupture of an abdominal aortic aneurysms are primarily observed in hemodynamically stable patients whose chief complaint is lower limb neuropathic pain. This entity is extremely misleading and this results in delayed management of those patients increasing the morbidity and mortality rates.

Case presentation:

We present the two cases of 62-year-old and 65-year-old males. Preoperative radiology for each patient showed an infrarenal aortic aneurysm with a retroperitoneal hematoma in contact with the lumbar vertebral bodies and psoas muscle. The draped aorta sign was evident in both cases.

Clinical discussion:

A curative surgical intervention was accomplished for both patients, respectively. This was achieved through the removal of the existing hematomas that were compressing the vertebrae in addition to the complete isolation and resection of the respective abdominal aortic aneurysms along with thorough reconstruction of the aortoiliac spindles with patent synthetic grafts to ensure the patency of the preexisting vascular axis.

Conclusion:

A contained rupture of an abdominal aortic aneurysm is a rare occurring vascular pathology that manifests with nonspecific symptoms, such as femoral neuropathy and lower back pain proportionate to the degree of the level of erosion of the affected lumbar vertebrae. This will increase the possibility of misdiagnosis and delays in treatment. Such a life-threatening vascular emergency should be timely detected and treated to avoid its complications and patient mortality.
Dynamic interaction of obesity, age, MCP-1 Level, and ACE-1 gene with the severity of knee osteoarthritis: a cross-sectional study
Authors: Mustari M. Nasser , Massi Muh. Nasrum , Usman Muhammad A. , Fikry Achmad , Bukhari Agussalim , Idris Irfan , Zainuddin Andi A. , Adnan Endy , Bakri Syakib , Hatta Mizwar
Published: August 2023

Introduction:

The risk factors most strongly associated with knee osteoarthritis (OA) are old age and obesity. However, few studies have evaluated the interaction between aging and obesity in conjunction with inflammatory markers and knee OA severity as part of a complete assessment of knee OA management. Therefore, this study aims to evaluate the interaction between obesity, age, inflammation [including the I/D polymorphism of angiotensin converting enzyme-1 (ACE-1)], and the severity of knee OA.

Methods:

A total of 80 knee OA patients were included in this cross-sectional study. The severity of knee OA was determined based on the Kellgren–Lawrence system. All patients underwent physical and radiological examination; monocyte chemoattractant protein 1 (MCP-1) markers were measured. The parameters of the ACE-1 gene were examined with sequencing DNA.

Results:

There was a significant relationship between age and severity of knee OA (P=0.007), with subjects aged greater than or equal to 65 having a 3.56-fold higher risk of developing moderate to severe OA than subjects aged less than 65. There was a significant difference between body weight and knee OA severity (P=0.026), in which subjects weighing greater than or equal to 60 kg had 3.14 times the risk of experiencing severe knee OA. Multivariate regression analysis indicated that age was the strongest independent variable for knee OA severity compared with body weight. MCP-1 levels were significantly higher in mild knee OA than in moderate to severe knee OA. The DD genotype of the ACE-1 gene increases the risk of severe knee OA by four times in subjects aged greater than or equal to 65 compared to subjects aged less than 65. However, the DD genotype of the ACE-1 gene does not increase the risk of severe knee OA in subjects weighing greater than or equal to 60 kg.

Conclusion:

While obesity and age were found to be associated with the severity of knee OA, age emerged as the independent risk factor for knee OA severity. Furthermore, MCP-1 levels were significantly higher in cases of mild knee OA compared to severe knee OA. It was observed that the DD genotype of the ACE-1 gene increases the risk of severe knee OA in individuals aged 65 years or older.
Chikungunya outbreak in Africa: a review of the literature
Authors: Chinedu Eneh Stanley , Uwishema Olivier , Nazir Abubakar , El Jurdi Elissa , Faith Olanrewaju Omotayo , Abbass Zahraa , Mustapha Jolayemi Mubarak , Mina Nour , kseiry lea , Onyeaka Helen
Published: August 2023

Introduction:

The Chikungunya virus (CHIKV), transmitted via mosquitoes, exhibits clinical manifestations ranging from headaches, myalgia and arthralgia to debilitating systemic malfunctions. Endemic to Africa, CHIKV has seen an increase in cases since it was first recorded in 1950. There has recently been an outbreak in numerous African nations. The authors aim to review the history and epidemiology of CHIKV in Africa, current outbreaks, strategies adopted by governments and/or international organisations to mitigate such an outbreak, and future recommendations that can be employed.

Methodology:

Data were collected from medical journals published on Pubmed and Google Scholar, and from the official World Health Organisation, African and United States of America’s Centres for Disease Control and Prevention websites. All articles considering CHIKV in Africa, including epidemiology, aetiology, prevention and management, were sought after.

Results:

Since 2015, the number of Chikungunya cases in Africa has increased, reaching the highest values ever recorded, especially in 2018 and 2019. Even though numerous vaccination and therapeutic intervention trials are still ongoing, no advancement has been made so far, including drug approval. Current management is supportive, with preventative measures, such as insecticides, repellents, mosquito nets and habitat avoidance, paramount to halting disease spread.

Conclusion:

In light of the recent CHIKV outbreak in Africa, local and global attempts are re-emerging to mitigate the eruption of the case of the lack of vaccines and antivirals, controlling the virus may be an arduous feat. Improving risk assessment, laboratory detection and research facilities should be a priority.
Evaluation of the efficacy of horizontal distraction osteogenesis using expansion screws in the repair of the acquired jaw bone defects
Authors: Haddad Ibrahim , Khalil Ali
Published: August 2023

Background:

Restoration of the segmental defects of the maxilla presents a reconstructive dare to obtain a perfect osseous form and height. A variety of prosthetic and surgical bone grafts exists, that produces less than optimal results. Bone transport distraction is a dependable procedure in several maxillofacial bone defects reconstruction techniques. This study aimed to evaluate the effectiveness of horizontal distraction osteogenesis (DO) using expansion screws for the treatment of atrophic and deficient bone, which is caused by acquired malformations.

Material and methods:

A total of eight patients ( age 17–36 years) who came with atrophy of the maxilla were treated by horizontal DO. The used device consisted of two parts: one was an orthodontic expander and the other was a screw-ring. The expansion screws were set on the transport bone, which was osteotomized and fixed to the segments using microscrews. Radiographical documentation of the patients was obtained with cone beam computed tomography prior to the surgery and after 4 months of the distraction phase.

Results:

The average of the actual bone gain at the end of the consolidation period was 7 mm (range 5–9 mm). Intraoral DO failed in one patient. The average bone density in the distraction gap after 4 months of the DO was 460.40. The average bone density of the bone defect region after 4 months of the DO was 487.90

Conclusion:

Our results confirm that horizontal DO using expansion screws is a predictable and effective regenerative procedure for patients with acquired bone defects in the jaw.
Endoscopic septoplasty versus conventional septoplasty for nasal septum deviation: a systematic review and meta-analysis of randomized clinical trials
Authors: Besharah Bayan O. , Alharbi Hussain A. , Abu Suliman Omar A. , Althobaiti Hazem K. , Mogharbel Ahmed M. , Muathen Sumaiya H.
Published: August 2023

Background:

Although conventional septoplasty is widely used to treat nasal septum deviation, it increases morbidity due to poor visualization, poor illumination, the need for nasal packing, and difficulty in evaluating of the exact pathology. These drawbacks are also encountered in endoscopic septoplasty. Our study aimed to compare the treatment and complication outcomes of conventional and endoscopic septoplasty.

Methods:

The authors searched five electronic databases for relevant clinical trials. The records were screened for eligibility. Data were extracted from the included studies. Outcomes were pooled as risk ratios (RR) or mean differences with 95% CIs using RevMan ver.5.4.

Results:

Our study included 13 randomized clinical trials with 735 patients. Our analysis revealed that endoscopic septoplasty was significantly (P<0.05) superior to conventional septoplasty for postoperative nasal obstruction relief, intraoperative and postoperative hemorrhage, and mucosal adhesion and synechiae across both long-term and short-term follow-ups. The following pooled RR values were found in short-term follow-up periods: [RR=1.20, 95% CI:=(1.09,1.32)]; [RR=0.27, 95% CI=(0.14,0.54)]; and [RR=0.16, 95% CI=(0.08,0.32)], respectively. Regarding persistent septal deviation and septal tear, endoscopic septoplasty had the upper hand only in short-term follow-up periods [RR=0.30, 95% CI=(0.17,0.53)] and [RR=0.26, 95% CI=(0.15,0.46)], respectively.

Conclusion:

Our analysis revealed that endoscopic septoplasty was significantly superior to conventional septoplasty in postoperative nasal obstruction relief rate and reducing the risk of intraoperative and postoperative hemorrhage, mucosal adhesion and synechiae, persistent septal deviation, septal tear, and surgery duration.