bluuebunny/crossref_metadata_2025 huggingface dataset:
Resectable fusiform internal jugular vein aneurysm with vascular excision and bypass with an 8 mm Maquet graft: A case report
Authors: Gong Ting-Sheng , Li Tzong-Shiun
Published: April 2023

Rationale:

Venous aneurysm is a rare vascular disease. Studies reveal that patients with fusiform internal jugular vein aneurysms are not suitable for embolization.

Patient concerns:

Two treatment options are considered, either bypass the aneurysm via stenting or excision of the lesion site and anastomosis using an artificial graft. The advantages of excision bypass include the absence of endoleak and stent migration; however, a larger wound and longer operation time are required for it.

Diagnoses:

Physical examination revealed a swelling in the right neck area. Head and neck computed tomography was performed for the survey. It revealed a 27.22 × 25.07 × 58.17 mm internal jugular fusiform aneurysm.

Interventions:

Vein excision was performed while using hemoclamps to control inflow and outflow, and a graft was anastomosed for bypass using an 8 mm Maquet graft.

Outcomes:

The wound recovery was favorable, with no signs of infection, and the pain was under control.

Lessons:

The patient had a contrast-enhanced head and neck computed tomography, and the images efficiently diagnosed a venous aneurysm. This patient had refractory pain, which was a significant indication of the operation. We decided by ourselves on the duration of the interval of following up. We used excision and bypassing with graft, and the result was beneficial.
FAIM2 is correlated with metastasis of medulloblastoma through bioinformatics analysis
Authors: Zhou Xiaojun , Zhao Hao
Published: April 2023

Medulloblastoma (MB) is one of the most frequent malignant brain tumors in children. The metastasis of MB outside the nervous system is associated with a poor prognosis. Our study aimed to explore the genes correlated with metastasis in MB. Using the data downloaded from the gene expression omnibus database, the differentially expressed genes were identified between the metastatic and nonmetastatic samples in MB, which were undergone functional enrichment. Prognosis related genes were identified using univariate Cox regression analysis. The gene set enrichment analysis was conducted to find MB metastasis related pathways. A total of 196 differentially expressed genes were identified between metastatic and nonmetastatic samples in MB patients, and these genes were significantly enriched in 483 gene ontology terms and 29 Kyoto encyclopedia of genes and genomes pathways. In addition, univariate Cox regression analysis screened the top 10 genes (CEMIP, GLCE, ART3, GABRA5, COLEC12, LIN28B, ZNF521, IL17RB, Fas apoptotic inhibitory molecule 2 (FAIM2), RCBTB2) that were significantly associated with survival of MB, among which FAIM2 was prominently expressed in cerebral cortex, cerebellum and hippocampus. The expression of FAIM2 was decreased in metastatic MB samples, and FAIM2 harbored missense mutations, amplifications and deep deletions in metastatic samples of MB. Moreover, a total of 25 pathways were significantly activated and 41 pathways were significantly inhibited in FAIM2 high expression group compared to FAIM2 low expression group in MB patients. FAIM2 was tightly correlated with metastasis in MB patients, and the low expression of FAIM2 was associated with poor prognosis.
Copious vaginal discharge finally diagnosed as cervical adenocarcinoma: A case report
Authors: Mao Peiyu , Zhang Chen , Wang Xinyan , Yang Huadi
Published: April 2023

Rationale:

Copious vaginal discharge is a frequent manifestation of reproductive tract infections. However, when little effect can obtain treated as vaginitis, cervical disease should be highly suspected.

Patient concerns:

A 41-year-old woman had suffering from abnormally increased vaginal discharge without any other signs of discomfort for the past 4 years. A lot of medical examinations and treatment of vaginosis were administered, resulting in unclear diagnosis and little effect.

Diagnoses:

Cervical adenocarcinoma.

Interventions:

Gynecological examination, vaginal microbiome culture, and primary cervical cancer screening were negative, and a positron emission tomography revealed an increased 18F-fluorodeoxyglucose metabolism in the local cervix. After a thorough description, the patient demanded a hysterectomy and bilateral salpingo-oophorectomy.

Outcomes:

Histopathological evaluation confirmed adenocarcinoma in situ of the uterine cervix.

Lessons:

The correct diagnosis of symptomatic patients with increased vaginal discharge is challenging. Human papillomavirus-negative patients presenting profuse watery vaginal discharge with an abnormal signal of cervix lesion on positron emission tomography or magnetic resonance imaging should be alert to cervical adenocarcinoma. Deep-seated cervical biopsy, conization, or even hysterectomy is conducive to early diagnosis, treatment and improvement of prognosis.
Analysis of the influence of pyroptosis-related genes on molecular characteristics in patients with acute myocardial infarction
Authors: Wu Huan , Xiong Xiaoman , CUI Xueying , Xiong Jianlong , Zhang Yan , Xiang Liubo , Xu TAO
Published: April 2023

Pyroptosis is a newly identified mode of programmed cell death, but the potential role in patients with acute myocardial infarction (AMI) remains unclear. In this study, bioinformatics methods were used to identify differentially expressed genes from peripheral blood transcriptome data between normal subjects and patients with AMI which were downloaded by the Gene Expression Omnibus database. Comparing Random Forest (RF) and Support Vector Machine (SVM) training algorithms were used to identify pyroptosis-related genes, predicting patients with AMI by nomogram based on informative genes. Moreover, clustering was used to amplify the feature of pyroptosis, in order to facilitate analysis distinct biological differences. Diversity analysis indicated that a majority of pyroptosis-related genes are expressed at higher levels in patients with AMI. The receiver operating characteristic curves show that the RF model is more responsive than the SVM machine learning model to the pyroptosis characteristics of these patients in vivo. We obtained a column line graph diagnostic model which was developed based on 19 genes established by the RF model. After the consensus clustering algorithm of single sample Gene Set Enrichment Analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) Enrichment Analysis, the results for them found that pyroptosis-related genes mediate the activation of multiple immune cells and many inflammatory pathways in the body. We used RF and SVM algorithms to determine 19 pyroptosis-related genes and evaluate their immunological effects in patients with AMI. We also constructed a series of by nomogram related to pyroptosis-related genes to predict the risk of developing AMI.
Educating health professionals in ultrasound guided peripheral intravenous cannulation: A systematic review of teaching methods, competence assessment, and patient outcomes
Authors: Hoskins Michael J. , Nolan Brieana C. , Evans Kiah L. , Phillips Bríd
Published: April 2023

Background:

Peripheral intravenous cannula insertion is the most common invasive healthcare procedure, however failure rates remain unacceptably high, particularly in patients with difficult intravascular access. This leads to treatment delays and increased complication risk, causing poorer outcomes among this patient subset. Ultrasonographic guidance reduces these risks and is therefore becoming a competency required of health professionals. However, there is no consensus on how to design teaching sessions to achieve this competency.

Methods:

Systematic review was conducted to identify characteristics of effective teaching sessions for current and training health professions to achieve ultrasound guided peripheral intravenous cannulation competency. Secondary outcomes included defining competency and to assess benefits to patients and healthcare systems. Eligibility for inclusion required description of teaching of ultrasound guided peripheral intravenous cannulation to qualified or training health professionals who went on to perform it in human patients or volunteers with reported outcomes or success rates. Studies were excluded if not accessible in full, not peer-reviewed or presented research that had been presented elsewhere previously. Of the 1085 records identified on review of 6 databases, 35 were included for final review based on eligibility criteria.

Results:

Almost all (97.1%) used mixed modality teaching comprising of didactic and simulation portions, although time allocated varied widely. A median of 5 proctored procedures was required for competency. Competency was independent of previous experience or staff seniority. Mean reported insertion attempts was 1.7, success rate was 82.5% and first-time success rate was 75.5%. All included studies described improvement in their participants or healthcare system including significantly reduced midline insertion rates, central venous catheter insertion rates and associated bacteremia and sepsis, self-reported cannulation difficulty, specialist input, therapy delays and premature catheter failure rates. Further, there was significantly improved procedural confidence, knowledge and competence.

Conclusion:

Simple teaching interventions can lead to competent ultrasound guided peripheral intravenous cannula insertion by novices, resulting in numerous positive outcomes for patients and healthcare systems.
Prevalence of Buprenorphine Providers Requiring Cash Payment From Insured Women Seeking Opioid Use Disorder Treatment
Authors: Richards Michael R. , Leech Ashley A. , Stein Bradley D. , Buntin Melinda B. , Patrick Stephen W.
Published: April 2023

Context:

Medications for opioid use disorder (OUD) are known to be effective, especially in reducing the risk of overdose death. Yet, many individuals suffering from OUD are not receiving treatment. One potential barrier can be the patient’s ability to access providers through their insurance plans.

Data and Methods:

We used an audit (simulated patient) study methodology to examine appointment-granting behavior by buprenorphine prescribers in 10 different US states. Trained callers posed as women with OUD and were randomly assigned Medicaid or private insurance status. Callers request an OUD treatment appointment and then asked whether they would be able to use their insurance to cover the cost of care, or alternatively, whether they would be required to pay fully out-of-pocket.

Findings:

We found that Medicaid and privately insured women were often asked to pay cash for OUD treatment––40% of the time over the full study sample. Such buprenorphine provider requests happened more than 60% of the time in some states. Areas with more providers or with more generous provider payments were not obviously more willing to accept the patient’s insurance benefits for OUD treatment. Rural providers were less likely to require payment in cash in order for the woman to receive care.

Conclusions:

State-to-state variation was the most striking pattern in our field experiment data. The wide variation suggests that women of reproductive age with OUD in certain states face even greater challenges to treatment access than perhaps previously thought; however, it also reveals that some states have found ways to curtail this problem. Our findings encourage greater attention to this public health challenge and possibly opportunities for shared learning across states.
Patient-Reported Outcome Measures That Describe the Feeding Skills Domain for Pediatric Feeding Disorder: A Clinimetric Review
Authors: Marshall Jeanne , Gosa Memorie M. , Dodrill Pamela
Published: April 2023

Objectives:

Pediatric feeding disorder (PFD) is defined as “impaired oral intake that is not age-appropriate, and is associated with medical, nutritional, feeding skill, and/or psychosocial dysfunction.” Patient-reported outcome measures (PROMs) are tools that complement clinical assessment, but many have limited clinimetric data. This review aimed to assess PROMs that reported on the feeding skills domain for PFD in children.

Methods:

A search strategy across 4 databases was conducted (July 2022). PROMs were included in the review if they described elements of the feeding skills domain of PFD, had criterion/norm-referenced data and/or a standardized assessment procedure, description, or scoring system available, and were applicable to children ≥6 months. PROMs were mapped to the PFD diagnostic domains and aspects of the International Classification of Function (ICF) model. Quality assessment was completed using the COnsensus-based Standards to the selection of health Measurement Instruments methodology.

Results:

Overall, 14 PROMs across 22 papers met inclusion criteria. There was variable methodological quality across the tools, with those more recently developed often receiving better scores, particularly where a more rigorous process for tool development and content validity was reported. Most tools captured ICF aspects of impairment (n = 11, eg, biting/chewing) or activity (n = 13, eg, eating a meal), rather than social participation (n = 3, eg, going to a restaurant).

Conclusions:

Using PROMs with strong content validity, and including some measure of social participation, is recommended as part of an assessment battery for PFD. Consideration of the caregiver/child perspective is an essential component of family-centered care.
Comparison of low-dose (162 mg) and high-dose (650 mg) Aspirin prophylaxis following total joint arthroplasty: a prospective cohort study
Authors: Shafiei Seyyed Hossein , Rastegar Mohammad , Mirghaderi Peyman , Siavashi Babak , Mortazavi Seyed Mohammad Javad
Published: April 2023

Background:

Since Aspirin’s adverse effects are dose-dependent, and evidence supporting the use of low-dose (LD) Aspirin in preventing venous thromboembolism (VTE) after total hip arthroplasty (THA) is weak, the authors do not know what the minimal effective dosage of Aspirin is to prevent VTE. This study aimed to compare the rates of 90-day symptomatic VTE following THA and total knee arthroplasty in healthy patients taking LD Aspirin vs. high-dose (HD) Aspirin for 6 weeks postoperatively.

Materials and methods:

A prospective cohort of patients with THA and total knee arthroplasty was conducted at two tertiary centres. Symptomatic VTE within 90 days of index arthroplasty was the primary outcome; gastrointestinal bleeding (GIB) and mortality were secondary outcomes.

Results:

The final analysis included 312 consecutive patients: 158 in the LD group and 154 in the HD group. Two groups were similar regarding preoperative data, including sex, age, BMI, smoking, diabetes mellitus, Hgb and platelet count, and type of surgery. The LD group had one deep vein thrombosis (0.6%), and the HD group had two (1.3%) (P=0.62). Neither group had PTE. Therefore, VTE rates are the same as deep vein thrombosis rates and similar between the groups (0.6% vs. 1.3%, P=0.62)

Regarding GIB due to anticoagulant therapy, no patient in the LD group reported GIB, whereas two (1.3%) patients in the HD group reported GIB within 90 days of arthroplasty. GIB rates did not differ significantly between groups (P=0.24). Considering VTE + GIB combined, the HD groups showed a higher rate of complications (N=4, 2.6%) than the LD groups (N=1, 0.6%) but not statistically significant (P=0.21).

Conclusions:

Prophylactic administration of Aspirin with low doses (81 mg BID) and high doses (325 mg BID) for six weeks is equally effective at reducing VTE in total joint arthroplasty patients and had similar adverse effects.

Level of Evidence:

Therapeutic Level II
Plasmacytoid bladder cancer: a rare case report
Authors: Benabdallah Wajdi , Ben Othmane Mouna , Ouahchi Ines , Mestiri Sarra , Belkacem Oussama , Bouassida Khaireddine , Hmida Wissem , Jaidane Mehdi
Published: April 2023

Introduction and importance:

Plasmacytoid carcinoma of the bladder is a rare histological variant of urothelial carcinoma associated with late presentation. This pattern of disease may portend an extremely poor prognosis and significant challenges for treatment with curative intent.

Case presentation:

The authors report a case of a patient with locally advanced plasmacytoid urothelial carcinoma (PUC) of the bladder. A 71-year-old man with a history of chronic obstructive pulmonary disease presented with gross hematuria. The rectal examination revealed a fixed bladder base. A computed tomography scan showed a pedunculated lesion arising from the anterior and left lateral bladder wall and extended to the perivesical fat. The patient underwent transurethral resection of the tumor. The histologic examination revealed the presence of muscle-invasive PUC of the bladder. The decision of the multidisciplinary consultation meeting was to do palliative chemotherapy. Thus, the patient could not receive systemic chemotherapy and died 6 weeks after transurethral resection of the bladder tumor.

Clinical discussion:

A plasmacytoid variant of urothelial carcinoma is a rare subtype of urothelial carcinoma that has a poor prognosis with a high mortality rate. The disease is usually diagnosed at an advanced stage. Given the rarity of plasmacytoid bladder cancer, treatment guidelines are not clear; therefore, more aggressive treatment may be required.

Conclusion:

PUC of the bladder is characterized by high aggressiveness, an advanced stage at the time of diagnosis, and a poor prognosis.
Knowledge assessment of radiologists, radiology residents, and radiographers regarding contrast materials and management of adverse drug reactions occurring due to contrast materials: a cross-sectional study
Authors: Khan Faheemullah , Abbas Fakhar , Hilal Kiran , Samad Mehreen , Wahid Ghazala , Ali Iftikhar , Khan Adil , Sahito Abdul Moiz , Kumari Usha , Wasim Ezza , Iqbal Raheel , Mumtaz Hassan , Saeed Muhammad Arif
Published: April 2023

Purpose:

The purpose of this study was to assess the knowledge of the radiology personnel regarding contrast media used in radiology and the management of associated adverse drug reactions.

Methods:

A questionnaire-based cross-sectional study was conducted from 21 February to 31 March 2019 in five major hospitals of Peshawar, Pakistan. A 30-item questionnaire was adopted from the existing literature containing both open and closed-ended questions and the authors conducted a pilot study among 25 participants to assess the face validity of the tool. A universal sampling technique was adopted. Descriptive statistics were used to summarize the findings of the study.

Results:

Less than half of the participants could correctly classify iodinated contrast media used in radiology on the basis of ionicity and osmolaity. Sixty-three percent chose severe contrast material-induced allergic reaction as type I hypersensitivity reaction while almost half of them correctly identified the features of iodinated contrast media associated with lesser side effects. Very few of them (6.7%) had read the ACR 2018 manual on contrast media. Regarding the risk factors for acute adverse reactions and signs/symptoms of anaphylaxis few could answer satisfactorily. Twenty-eight percent of participants correctly identified epinephrine as the initial medication in an anaphylactic reaction. Regarding the preferred route of administration, concentration and dose of epinephrine, the participants’ correct response was quite poor (43.8%, 6.7%, and 8.6%, respectively). More than 65% of participants could name a single intravenous corticosteroid and antihistamine.

Conclusion:

Radiology personnel’s knowledge regarding contrast material and management of severe contrast material-induced allergic reactions is unsatisfactory.
Depression, anxiety, and stress among undergraduate health sciences students during COVID-19 pandemic in a low resource setting: a cross-sectional survey from Nepal
Authors: Kalauni Bhoj Raj , Joshi Yadav Prasad , Paudel Kiran , Aryal Biplav , Karki Lava , Paudel Rajan
Published: April 2023

Background:

Mental health is an important issue for students during the time of the COVID-19 pandemic and uncertainty. Students suffer from mental health issues due to delayed academic years and prolong stay at home during the lockdown. This study aimed to identify factors associated with depression, anxiety, and stress among undergraduate health sciences students of different medical institutions in Nepal.

Materials and Methods:

A web-based cross-sectional survey was conducted among 493 health sciences students between 14 July and 16 August 2020. Depression, anxiety, and stress were measured using the Depression, Anxiety, Stress Scale-21 (DASS-21). Multivariable logistic regression analysis was performed to determine the risk factors of mental health outcomes.

Results:

Overall, 50.5, 52.5, and 44.6% of students had symptoms of depression, anxiety, and stress, respectively. Significantly higher odds of experiencing stress symptoms [adjusted odds ratio (AOR): 2.166; 95% CI: 1.075–4.363] were found with the participants whose relatives were infected with COVID-19. Participants with age less than or equal to 21 years among undergraduate health sciences students were significantly associated with higher odds of experiencing symptoms of stress (AOR: 1.626; 95% CI: 1.110–2.383) and anxiety (AOR: 1.6251; 95% CI: 1.110–2.379) in comparison with age above 21. Staying in quarantine was significantly associated with higher odds of experiencing depressive symptoms (AOR: 2.175; 95% CI: 1.142–4.143). Participants who had internet facilities at the residence had less likely to have depressive symptoms than those who are lacking internet services (AOR: 0.420; 95% CI: 0.195–0.905).

Conclusions:

Staying in quarantine had higher odds of having depression and students who had internet facilities had lower odds of having depression. While staying in quarantine or isolation, it would be better to provide things to engage like the internet. A focus on improving the mental well-being of health sciences students should be initiated immediately after such a pandemic and lockdown.
Rise of biologics in noninfectious uveitis: a retrospective cohort study from Nepal
Authors: Sharma Sadhana , Kharel Ranju , Parajuli Sanket , Jha Saket
Published: April 2023

Background:

Uveitis is a sight-threatening disease that poses a heavy burden on the quality of life. The treatment of uveitis has been revolutionized in the past two decades. Most remarkable among these is the emergence of biologics, which have shown to be effective and safer therapeutic option in noninfectious uveitis. Biologics are very useful when conventional immunomodulator therapy has failed or has been poorly tolerated. The most widely used biologics are tumor necrosis factor-α inhibitors (infliximab and adalimumab) with promising results. Other drugs include anti-CD20 inhibitors (rituximab), interleukin-6R-inhibitor (tocilizumab), interleukin-1R-inhibitor (anakinra), and Janus-associated kinase inhibitor (tofacitinib)

Methods:

A retrospective review of all cases of noninfectious uveitis and scleritis presenting to our center from July 2019 to January 2021 and had been treated with biological therapy were included.

Results:

We included 12 eyes of 10 patients. The mean age was 42.10±9.71 years. Anterior nongranulomatous uveitis comprised 70% of the cases and the most common etiology of anterior uveitis was spondyloarthritis (seven cases among which five cases were nonradiographic) axial spondyloarthritis (human leukocyte antigen B27 positive) followed by radiographic axial spondyloarthritis (two cases). The first line of treatment in all cases was conventional synthetic disease-modifying antirheumatic agents among which 50% (n=5) had received methotrexate (≥15 mg/week). As a second line of treatment, one or more biologics was used. Majority of the patients received oral tofacitinib 50% (n=5) followed by Inj adalimumab 30% (n=3). One case of Behcet’s disease required sequential biologics (Inj adalimumab followed by oral tofacitinib). All patients tolerated and responded well to the treatment and no recurrences were observed after discontinuation of biologics drugs during the follow-up period of 1 year.

Conclusion:

Biologics are a relatively safe and effective modality of treatment in refractory, recurrent noninfectious uveitis.
A review of current trends in HIV epidemiology, surveillance, and control in Nigeria
Authors: Bassey Archibong Edem , Miteu Goshen David
Published: April 2023

The HIV epidemic remains a public health challenge in Nigeria, with about 1.9 million people living with the virus in 2020. Despite progress in controlling the epidemic, challenges remain, including inadequate funding and limited access to prevention and treatment services for key populations. This article provides an overview of the HIV control system in Nigeria and the current state of the HIV control system in Nigeria. It provides recommendations for strengthening the response to the epidemic. Contributions of government agencies, international partners, and civil society organizations are required to reduce this epidemic. This article highlights the need to strengthen surveillance systems, increase access to testing and treatment, enhance prevention strategies, address stigma and discrimination, increase funding, and expand research and development. The impact of antiretroviral therapy on HIV management is also discussed. Over the last decade, Nigeria has made significant progress in controlling the HIV epidemic, with a decline in new infections and increased treatment coverage. However, more work is needed to achieve the 95-95-95 targets set by the joint united nations programme on HIV/acquired immunodeficiency syndrome for 2030, and a multi-pronged approach is required to address the social and structural determinants of health that drive the epidemic. By implementing the recommendations outlined in this article, Nigeria can make significant progress towards ending the HIV epidemic and improving the quality of life for those living with the virus.
Adult attention deficit hyperactivity disorder: a comprehensive review
Authors: Williams Ozge C. , Prasad Sakshi , McCrary Amanda , Jordan Erica , Sachdeva Vishi , Deva Sheryl , Kumar Harendra , Mehta Jayati , Neupane Purushottam , Gupta Aditi
Published: April 2023

Attention deficit hyperactivity disorder (ADHD) is a common childhood disorder, with only 2–3% prevalence into adulthood. The epidemiology and proposed causes of ADHD are multifactorial, including genetic, prenatal and environmental influences. The diagnosis of ADHD is often complicated by masking coping mechanisms, an overlap of symptoms with other, more commonly diagnosed disorders. Traditionally, it has been treated with stimulant medications. Non-stimulant options often target norepinephrine and dopamine regulation and are preferred in cases of comorbid substance use disorder, anxiety and other complicating factors, due to an improved side-effect profile and patient preference. They include atomoxetine and viloxazine. The latter, Viloxazine, in the form of extended-release capsules, is the first novel, non-stimulant option approved for adults with ADHD, in the past two decades. Its therapeutic effects are predominantly produced by its action as a norepinephrine reuptake inhibitor and may also modulate the serotonergic system. Viloxazine is relatively safe and effective in treating other disorders such as depression, anxiety, epilepsy and substance use disorder. Its pharmacokinetics includes metabolization by CYP enzymes. As antiepileptics inhibit CYP1A2, therefore, a special consideration would be needed, when co-administering with anti-epileptic drugs. Similarly, individuals with liver or cardiovascular disease and a personal or family history of bipolar disorder require close monitoring, while on this medication. A thorough review of the history, mechanism of action, pharmacokinetics and drug–drug interactions has been presented here, with special attention on treatment in adults with comorbid conditions. This study conducted an all-language literature search on Medline, Cochrane, Embase, and Google Scholar until December 2022. The following search strings and Medical Subject Headings (MeSH) terms were used: “Viloxazine,” “ADHD,” “Stimulants,” and “adult ADHD.” We explored the literature on the growing knowledge of Viloxazine. A thorough review of the history, mechanism of action, pharmacokinetics, and drug–drug interactions are reviewed here with special attention on treatment in adults with comorbid conditions.
Pre-clinical evaluation of the new veress needle+ mechanism on thiel-embalmed bodies: a controlled crossover study – Experimental research
Authors: Postema Roelf R. , Frederik Hardon Sem , Cefai David , Dankelman Jenny , Jansen Frank-Willem , Camenzuli Christian , Calleja-Agius Jean , Horeman-Franse Tim
Published: April 2023

Background:

Veress needles (VN) are commonly used in establishing pneumoperitoneum in laparoscopic surgery. Previously, a VN with a new safety mechanism ‘VeressPLUS’ needle (VN+) was developed to reduce the amount of overshoot.

Methods:

Eighteen participants (novices, intermediates, and experts) performed in total of 248 insertions in a systematic way on Thiel-embalmed bodies with wide and small bore versions of the conventional VN (VNc) and the VN+. Insertion depth was measured by recording the graduations on the needle under direct laparoscopic vision.

Results:

Participants graded the bodies and the procedures as lifelike. Overall, a significant reduction (P<0.001) in average insertion depth was found for the VN+ compared to the VNc of 26.0 SD16 mm versus 46.2 SD15 mm. The insertion depth difference in the novice group was higher compared to the intermediates and experts (P<0.001). The average insertion depth for both needle types was less (P<0.001) for female participants compared to male.

Conclusion:

This study indicated that the VN+ significantly reduced the insertion depth in all tested conditions. Whether the difference between female and male performance can be linked to differences in muscle control or arm mass should be further investigated. Useful technical information was gathered from this study to further improve the VN+.
Liver injury at admission and outcomes in patients with COVID-19 disease: a prospective cohort study
Authors: Poudel Shekhar , Mishra Aakash , Poudel Sujan C. , Baskota Arati , Bhattarai Mahesh , Aryal Ananta , Kunwar Asma
Published: April 2023

Background:

The liver is one of the common extrapulmonary organs involved in the coronavirus disease 2019 (COVID-19) infection. We aimed to find the prevalence of liver injury at hospital admission and its effects on outcomes.

Methods:

This is a single-center prospective observational study. All consecutive patients with COVID-19 admitted during the months of May to August 2021 were included in the study. Liver injury was defined as at least 2 times elevation of aspartate transaminase, alanine transaminase, alkaline phosphatase, and bilirubin above the upper limits on normal. The predictive efficacy of liver injury was measured as its effects on outcome variables, that is duration of hospital stay, requirement of ICU admission, mechanical ventilation, and mortality. Presence of liver injury compared with existing biomarkers markers of severe disease, that is lactate dehydrogenase, D-dimer, and C-reactive protein.

Results:

A total of 245 consecutive adult patients with COVID-19 infection were included in the study. Liver injury was present in 102 (41.63%) of patients. There was a significant association between the presence of liver injury and duration of hospital stay (10.74 vs. 8.9 days; P=0.013), the requirement of ICU admission (12.7 vs. 10.2%; P=0.018), mechanical ventilation (10.6% vs. 6.5%; P=0.003), and mortality (13.1% vs. 6.1%; P<0.001). Liver injury was significantly associated (P<0.001) with the corresponding elevation of serum biomarkers of severity.

Conclusion:

The presence of liver injury in patients with COVID-19 infection at the time of hospital admission is the independent predictor of poor outcomes and can also be used as the marker of disease severity.
Etiological associations of cerebral venous sinus thrombosis among adult sudanese patients: a multicenter cross-sectional study
Authors: Malekaldar Mohamed , Ahmed Khabab Abbasher Hussien Mohamed , Abdalla Yassin , Omer Mohammed Eltahier Abdalla , Siddig Amira , Mohammed Khalid , Hassan Haroun Mazin S. , Hussien Abbasher , Eljack Mohammed Mahmmoud Fadelallah
Published: April 2023

Background:

Cerebral venous sinus thrombosis (CVST) is a common condition that, if not detected and treated promptly, carries a high risk of morbidity and mortality. CVST’s most common aetiological associations are post-partum, pregnancy, and oral contraceptive pills. The purpose of this study was to look into the aetiology of CVST in Sudanese patients in neurological centres in Khartoum state.

Methodology:

This was a cross-sectional hospital bases study conducted on CVST patients at four neurological centres in Khartoum state in the period from March to October 2020. Patients were studied for the aetiological association of CVST using a standardized questionnaire including medical history, clinical examination, investigation, and treatment.

Results:

The study included about 60 patients, 50 of whom were female (83.3%) and 10 of whom were male (16.7%). In terms of clinical presentation, almost all patients had headache, followed by visual disturbances in 49 (81.7%), seizures in 46 (76%), disturbed consciousness in 12 (20%), and weakness in 12 (20%). The most common sign was abnormal speech, which was found in eight patients (13.3%), memory disturbances in eight patients (13.3%), evidence of CN VI lesion in three (5%), papilledema in 49 (81.7%), and hemiparesis in 46 (76.7%), while abnormal sensory signs were found in only one patient. The most common aetiological association were pregnancy in 15 (25%), oral contraceptive pills in 11(18.3%), and being in the post-partum period in 23(38.3%). All of the patients’ magnetic resonant imaging/magnetic resonant venography results were abnormal. Six patients had extensive sinus involvement, 35 had superior sagittal sinus involvement, and 19 had transverse sinus involvement. After treatment, 45 patients (75%) fully recovered, 11 (18.3%) partially recovered, and 4 (6.7%) died.

Conclusion:

Post-partum, pregnancy, and oral contraceptive pills were the most common aetiological associations of CVST compared with other populations.
How is Guillain-Barre syndrome associated with COVID-19 infection differentiated from hypokalemic periodic paralysis? a case report
Authors: Bereda Gudisa
Published: April 2023

Background and importance:

Patients with coronavirus disease 2019 (COVID-19)-associated Guillain-Barre syndrome (GBS) exhibit a range of clinical symptoms, such as cranial nerve paralysis and axonal or motor-sensory electrophysiological signals.

Case presentation

A 61-year-old retired black African female was brought into the emergency room on 13 May 2022, with a 4-day history of shortness of breath and high-grade fever and a 1-day history of global body weakness (bilateral paralysis of the upper and lower extremities). Motor examination indicated reduced muscular strength in all limbs, with a Medical Research Council score of 2/5 in the right arm of the upper extremities, 1/5 in the right leg of the lower extremities, 1/5 in the left leg of the lower extremities, and 2/5 in the left arm of the upper extremities. Her electrocardiogram revealed ST depression in the anterior-lateral leads and sinus tachycardia. For the COVID-related infection, azithromycin 500 mg per day for 5 days was begun. After cerebrospinal fluid findings supported the diagnosis of GBS, she underwent intravenous immunoglobulin 400 mg/kg every day for 5 days.

Clinical discussion:

In the majority of COVID-19-related GBS cases, areflexic quadriparesis developed suddenly. A COVID-19 infection related to a GBS case was the only one that had preceding signs, including ageusia and hyposmia. By testing serum potassium levels, this study determined that there is no connection between GBS and hypokalemia, which can lead to diagnostic and therapeutic conundrums by evaluating serum potassium levels, which showed a normal value.

Conclusion:

One of the neurological symptoms of the COVID-19 infection is GBS. Several weeks after a COVID-19 acute infection, GBS is frequently observed.
FRAX calculation with and without bone mineral density for assessment of osteoporotic fracture risk in patients of rheumatic disease: a cross-sectional study
Authors: ur Rehman Obaid , Sharif Muhammd , khan Muhammad Sufyan , Tahir Saira , Zammurrad Shazia , Shabbir Khurram , Mumtaz Hassan , Kumar Danisha , Nusrat Butool
Published: April 2023

Aim:

To compare fracture risk assessment (FRAX) calculation with and without bone mineral density (BMD) in predicting 10-year probability of hip and major osteoporotic fracture in patients of rheumatic diseases.

Methodology:

A cross-sectional was conducted at outpatient Department of Rheumatology. Eighty-one Patients of more than 40 years of age having either sex. Diagnosed case of Rheumatic diseases were according to American College of Rheumatology (ACR) /European Alliance of Associations for Rheumatology (EULAR) criteria were included in our study. FRAX score without BMD was calculated and information was recorded in proforma. These patients were advised dual energy X-ray absorptiometry Scan and after that FRAX with BMD was calculated, after which comparison between result of two scores was made. The data were analyzed by SPSS software version 24. Effect modifiers were controlled by stratification. Post-stratification χ2 test were applied. P value less than 0.05 was considered as significant

Results:

This study consisted of 63 participants, who were assessed for osteoporotic risk fracture, with and without BMD. Data analysis revealed a significant association between the type of fracture and age (p value=0.009), previous fracture (p value=0.25), parent fractured hip (p values) and treatment with bone mineral dismissal. There was no statistically significant association seen of fractures with bone deterioration with sex, weight, height, or current smoking.

Conclusion:

FRAX may be crucial in rural areas where dual energy X-ray absorptiometry scanning is not available since it is a readily available instrument. FRAX is a useful substitute for estimating osteoporosis risk when funds are scarce. Given the possible effect it will have on healthcare costs, this is extremely pertinent.
Usefulness of electrocardiography QT interval for prediction of left ventricular diastolic dysfunction: a cross-sectional study
Authors: Abid Seemab , Mustafa Zaidi Syed Haris , Hunde Meklit Zenbabaw , Bai Jharna , Batool Arifa , Zeeshan Muhammad , Mumtaz Hassan , Ahad Syed Abdul , Eqbal Farea , Anees Muhammad , Rehan Romaisa
Published: April 2023

Introduction:

Heart failure (HF) is a leading cause of morbidity and mortality worldwide, with projections showing a further rise in incidence, impacting a decline in quality of life and the costs incurred in its diagnosis and treatment. The authors aim to establish the correlation between the prediction of left ventricular diastolic dysfunction based on a change in QT wave intervals.

Methods:

A cross-sectional at Holy-family Hospital, Rawalpindi Medical University, Pakistan. One thousand five hundred patients were referred for electrocardiography (ECG) for clinical suspicion of HF between May and July 2022. Ejection fraction (EF), lateral mitral annulus velocity (e’), mitral inflow early (E) and late (A) velocities, left ventricular filling pressure (E/e’ ratio), and QT interval (QTc) was calculated. Odds ratios with a 95% CI (odds) were obtained by comparing QTc with all variables.

Results:

The patients were mostly middle-aged adults with a mean age of 30.27 (±7.64). Male to female ratio was nearly balanced, with 771 (51.4%) males included in the clinical survey. The ECG parameters were; QT interval—494.07 (±63.61), EF—57.11 (±11.96), early to atrial filling velocity ratio—0.71 (±0.20), and lateral mitral annulus velocity—8.29 (±1.64).

Conclusion:

The promising results for correlation between QT interval and ECG parameters, particularly EF and lateral mitral annulus velocity, should not be considered as the alternative in diagnosing left ventricular diastolic dysfunction thus far. Prolonged electrocardiographic QTc interval in patients with HF is useful in predicting diastolic dysfunction.
Blood flow restricted walking in patients suffering from intermittent claudication: a case series feasibility and safety study
Authors: Bentzen Andreas , Nisgaard Line B. , Mikkelsen Rikke B.L. , Høgh Annette , Mechlenburg Inger , Jørgensen Stian L.
Published: April 2023

Objectives:

To examine the feasibility and safety of blood flow restricted walking (BFR-W) in patients with intermittent claudication (IC). Moreover, to evaluate changes in objective performance-based and self-reported functioning following 12 weeks of BFR-W.

Materials and methods:

Sixteen patients with IC were recruited from two departments of vascular surgery. The BFR-W programme implied the application of a pneumatic cuff around the proximal part of the affected limb at 60% limb occlusion pressure in five intervals of 2 min, four times per week for 12 weeks. Feasibility was evaluated by adherence and completion rates of the BFR-W programme. Safety was evaluated by adverse events, ankle-brachial index (ABI) at baseline and follow-up, and pain on a numerical rating scale (NRS pain) before and 2 min after training sessions. Furthermore, changes in performance between baseline and follow-up were evaluated with the 30 seconds sit-to-stand test (30STS), the 6-minute walk test (6MWT) and the IC questionnaire (ICQ).

Results:

Fifteen out of 16 patients completed the 12-week BFR-W programme and adherence was 92.8% (95% CI: 83.4; 100%). One adverse event unrelated to the intervention was reported causing one patient to terminate the programme 2 weeks prematurely. Mean NRS pain 2 min following BFR-W was 1.8 (95% CI [1.7–2]). ABI, 30STS, 6MWT and ICQ score were improved at follow-up.

Conclusions:

BFR-W is feasible and appears to be safe in terms of completion rate, adherence to the training protocol, and adverse events in patients with IC. Further investigation of the effectiveness and safety of BFR-W compared to regular walking exercise is needed.
Intestinal intussusception in a child with Peutz–Jeghers syndrome: case report
Authors: Ovechkin Denys , Awuah Wireko Andrew , Wellington Jack , Adebusoye Favour Tope , Moskalenko Roman , Dmytruk Serhii , Abdul-Rahman Toufik , Ovechkina Yaryna
Published: April 2023

Introduction and importance:

Peutz–Jeghers syndrome (PJS), an uncommon inherited autosomal dominant disorder, is distinguished by mucocutaneous pigmentations, many gastrointestinal hamartomatous polyps, and a higher incidence of gastrointestinal tract, genitourinary, and extracolonic malignancies. Recurrent acute intestinal obstruction, in particular intussusception in the young, is a serious sequalae of PJS.

Case presentation:

A clinical observation of a 5-year-old patient with a complicated course of PJS is presented. Emphasis on recurring episodes of acute abdomen, clinical diagnosis including polyp histopathology, and surgical management is emphasised.

Clinical findings and investigations:

While an inpatient, bloodwork demonstrated severe iron deficiency anaemia (haemoglobin 72 g/l, red blood cell 3.1×1012/l) and multiple melanin pigmentations measuring 2–4 mm in size on the lip mucosa during a physical examination. Erosive duodenopathy and polyposis of the stomach were discovered via fibroesophagogastroduodenoscopy (multiple gastric polyps 5–10 mm in size). Acute intussusception of the intestine was discovered by ultrasonography.

Interventions and outcome:

A mid-median laparotomy was performed alongside manual disinvagination with gut viability intact. Histopathology of excised polyps revealed smooth muscle hyperplasia and Ki67 protein (MIB-1) positivity with small intestinal hamartomatous polyps seen macroscopically. Conservative management was initiated for standard postoperative care and intestinal motility. Patient was discharged 9 days postoperatively.

Relevance and impact:

Based on literature data, modern ideas concerning aetiology, diagnosis, and management of patients with PJS are considered. Attention is focused on the high risk of developing cancer of various localisation in PJS, recommendations are given for cancer screening and clinical observation of patients with hereditary gastrointestinal syndromes in childhood.
Identification of KRAS mutation and HER2 expression in Indonesian colorectal cancer population: a cross-sectional study
Authors: Rudiman Reno , Wijaya Alma , Sribudiani Yunia , Soedjana Hardi Siswo , Wiraswati Hesti Lina , Primastari Etis , Nugraha Prapanca , Lukman Kiki
Published: April 2023

Background:

In Indonesia, colorectal cancer is the third most common type. In 2008, Indonesia ranked fourth in the Association of Southeast Asian Nations (ASEAN) countries, with an incidence rate of 17.2 per 100 000 population. This figure is predicted to continue to increase from year to year. In 30% of colorectal cancer patients diagnosed after metastases, some patients will develop metastases after undergoing surgical resection of the primary tumor. The survival of metastatic colorectal cancer patients has improved significantly in the last 20 years with the introduction of target-oriented drugs, anti–epidermal growth factor receptor (EGFR), and anti–human epidermal growth factor receptor-2 (HER2). This study aims to assess the relationship between Kirsten rat sarcoma viral oncogene homolog (KRAS) mutation and HER2 expression for targeted therapy implementation.

Patients and methods:

This research is a cross-sectional study. The research subjects in this study were colorectal cancer patients in the digestive surgery division. There were 58 study subjects. Examination of KRAS mutations was carried out by PCR on fresh tumor tissue obtained from surgery or colonoscopy. Meanwhile, the HER2 examination used the immunohistochemistry method of paraffin blocks for anatomical pathology examination.

Results:

Examination of KRAS mutations showed 28/58 (43.8%) patients with colorectal cancer, while HER2 overexpression was found in 6/58 (10.3%) patients with colorectal cancer. Univariate analysis of KRAS mutations and HER2 expression showed that four subjects with KRAS mutations had excess HER2 expression (P=0.341).

Conclusion:

There is no association between KRAS mutations and HER2 overexpression in colorectal cancer patients.