bluuebunny/crossref_metadata_2025 huggingface dataset:
Antinuclear antibodies positive acute nonfulminant hepatitis A associated with acute renal failure and hives: a case report
Authors: Kliea Marwa , Alsultan Mohammad , Basha Kassem
Published: April 2023

Introduction:

Acute hepatitis A (AHA) is a self-limited illness. While the prognosis for hepatitis A is generally good, complications with acute renal failure can have a negative impact.

Presentation of case:

A 60-year-old male was admitted due to fever and malaise for a week, accompanied by jaundice and reduced urine output over the past 3 days. The patient was exhausted with icteric skin and sclera, dark urine, bilateral pretibial grade II pitting edema, and a urinary output of nearly 1 l/day. Laboratory findings on admission showed acute liver injury and acute kidney injury with positive hepatitis A virus immunoglobulin M. Liver and kidney function tests were augmented gradually aligned with oliguria. Thereafter, the patient had an itchy rash on his back and abdomen. Screening for immune diseases came back negative except for positive antinuclear antibodies. The authors continued conservative management with dialysis, diuretics, and restricted hydration. After five hemodialysis sessions, urinary output improved and liver function tests were improved, however, kidney function tests were slowly improved. One month later, serum creatinine was reduced to 1.4 mg/dl, and 2 months later, it was 1.1 mg/dl.

Conclusion:

The authors experienced a rare case of nonfulminant AHA that resulted in severe acute renal failure and needed dialysis. Several hypotheses had been postulated for AHA-related nephropathy; however, hyperbilirubinemia-induced acute tubular necrosis was the most acceptable theory in the patient. Since AHA associated with antinuclear antibodies positive and hives rash could confuse the diagnosis, clinicians should consider extrahepatic manifestations associated with hepatitis A virus infection in such conditions after excluding immune disorders.
Primary anorectal melanoma mimicking polyp in a scleroderma patient: a case report
Authors: Alazki Osama , Othman Hasan , Mohammad Rita , Al-Dabbagh Jacob , Al-Soufi Lina , Alshehabi Zuheir , Kanaan Samir
Published: April 2023

Introduction:

Primary anorectal melanoma is an extremely rare malignancy of the gastrointestinal tract with a very poor prognosis. Due to the late presentation, most patients with primary anorectal melanoma are diagnosed at advanced stages. Scleroderma is an autoimmune disease characterized by fibrosis of the skin and visceral organs. There is an increased risk of developing cancer in scleroderma patients.

Case Presentation:

A 57-year-old Syrian female diagnosed with localized scleroderma complained of a sensation of a mass in her anal area. She was diagnosed with primary rectal melanoma and was put on neoadjuvant radiotherapy. Following the radiotherapy, the endoscopy revealed several black lesions in her anal canal, and thus abdominoperineal resection was conducted.

Discussion and Conclusion:

Malignant melanoma can occur in unsuspected locations such as the anal canal. Novel therapies like anti-CTLA4 drugs have proven efficient in controlling the disease. The lack of data in the literature on this malignancy and the absence of guidelines make it challenging for an optimal approach.
Acute limb ischemia from embolization of left ventricular pseudoaneurysm thrombus: a rare case report
Authors: Ismayl Mahmoud , Radaideh Qais , Abusnina Waiel , Aboeata Ahmed , Holmberg Jeffrey
Published: April 2023

Introduction and importance:

Myocardial infarction (MI) can lead to a wide spectrum of mechanical complications. Left ventricular pseudoaneurysm (LVP) is a rare but serious complication of MI.

Case presentation:

A 69-year-old woman with prior coronary artery bypass grafting and a remote history of inferolateral ST-elevation MI (STEMI) with failure to revascularize the left circumflex artery presented with gangrenous right toes that appeared 2 years after her STEMI. A computed tomography angiogram of the right lower extremity showed arterial occlusion and mild atherosclerotic disease. Echocardiography revealed a pseudoaneurysm with an adherent mural thrombus as the underlying cause of acute limb ischemia. The patient was started on heparin and cardiothoracic surgery was consulted but did not operate as the risk of surgery outweighed the benefit. On hospital day 3, the patient underwent amputation of her gangrenous toes as the tissue was nonviable. The patient remained stable during her hospital stay and was discharged on day 5 on long-term anticoagulation.

Clinical discussion:

LVPs have a wide spectrum of presentations, from asymptomatic or nonspecific symptoms to thromboembolism with end-organ damage, such as in our case. Therefore, early diagnosis and management are of paramount importance. Our patient’s prior coronary artery bypass grafting most likely helped in forming a fibrous pericardium that sealed the pseudoaneurysm and prevented its rupture.

Conclusions:

STEMI requires close follow-up, especially in cases where revascularization is not achievable, as the risk of mechanical complications and mortality is high. Physicians should have a high suspicion for LVP in patients with prior MI, given its wide spectrum of presentations.
Accidental gunshot injury with left-sided lung injury and D11 burst fracture: a case report
Authors: Chaudhary Aashutosh , Acharya Suyash , Pradhan Shiris K. , Gurung Kalpana , Karmacharya Robin Man , Vaidya Satish , Mahat Chadani , Kunwar Kajol , Bhatt Swechha
Published: April 2023

Introduction:

Penetrating chest injuries are mainly caused by gunshot trauma and stab injuries. These lead to damage to the vital structures, which requires a multidisciplinary approach for management.

Case presentation:

We present a case of an accidental gunshot injury (GSI) to the chest resulting in left-sided hemopneumothorax, left lung contusion, and D11 burst fracture with spinal cord injury. The patient underwent thoracotomy to remove the bullet along with instrumentation and fixation of the D11 burst fracture.

Clinical discussion:

Penetrating trauma to the chest requires prompt resuscitation and stabilization with eventual definitive care. Most GSIs to the chest require chest tube insertion, which helps to create negative pressure in the chest cavity, allowing adequate time for the expansion of the lungs.

Conclusion:

GSIs to the chest could give rise to life-threatening conditions. However, the patient must be stabilized for at least 48 h before performing any surgical repair to ensure that there are fewer complications following surgery.
An interesting case of pulmonary hypertension in nephrotic syndrome due to amphetamine use for attention-deficit hyperactivity disorder
Authors: Khan Abat , Ubaid Aamer , Hanif Muhammad , Jaiswal Vikash , Gohar Ashraf , Mehta Aashna , Ramakrishnan Dushyant , Shrestha Abhigan Babu
Published: April 2023

Introduction and importance:

Pulmonary arterial hypertension (PAH) was first associated with stimulants use in the 1960s during an outbreak of amphetamine-like appetite suppressants (anorexigens). To date, various drugs and toxins have been correlated with PAH. Diagnosing PAH in nephrotic syndrome has always remained a challenge due to the overlap of signs and symptoms in clinical presentation between the two entities.

Case presentation:

In this report, the authors present an interesting case of a 43-year-old male, diagnosed with nephrotic syndrome secondary to minimal change disease, as well as currently presenting with PAH secondary to amphetamine.

Clinical discussion and conclusion:

Patients with nephrotic syndrome and end-stage renal disease should be regularly followed up and evaluated for comorbidities, complications, as well as adverse events from pharmacological intervention. In patients with end-stage renal disease hypertension control is key, stimulant use can precipitate poor blood pressure control especially in pulmonary arteries resulting in PAH. PAH can result in right ventricular dysfunction and heart failure that can further exacerbate renal dysfunction and vice-versa in a vicious cycle, deteriorating patient condition and quality of life.
Spontaneous facial hematoma induced by vitamin K antagonist therapy: a rare case report
Authors: Mrabet Asmae , Boulouiz Soumiya , Bilal Marwa , El Ouafi Nouha , Bazid Zakaria
Published: April 2023

Introduction and Importance:

The benefits of anti-vitamin K drugs have been demonstrated in several indications; however, it is always counterbalanced by an increased risk of bleeding, that can occur in different areas. Facial hematoma is a rare bleeding complication to our knowledge, this is the first report of a rapidly expanding atraumatic facial hematoma secondary to vitamin K antagonist over coagulation.

Case Presentation:

The authors report the case of an 80-year-old woman with a medical history of hypertension, and pulmonary embolism after 15 days of immobilization following a hip fracture treated surgically 3 years earlier, who has been on vitamin K antagonist therapy since then, without any follow-up, came into our emergency department complaining of a sudden onset of progressive left facial swelling for one day, and vision loss in her left eye. Her blood investigations revealed a high international normalized ratio of prothrombin up to 10. A computed tomography scan exposing face, orbit, and oromaxillofacial area objectived spontaneously hyperdense collection in the left masticator space suggestive of an hematoma. An intraoral incision was done by oromaxillar surgeons, and drainage were performed with a favorable evolution.

Clinical Discussion

In this mini review, the authors aim to describe this rare complication and to insist on the necessity of regular follow-up with international normalized ratio values and early warning signs of bleeding to prevent such fatal complications.

Conclusion:

Immediate recognition and management of such complication is very important to avoid complications.
The capillary-leakage syndrome caused by glyphosate poisoning: a case report
Authors: Ge Xiaogang , Yang Zhihui , Cai Qiqi
Published: April 2023

Background, introduction, and importance:

Glyphosate is widely used in agriculture even though it can cause self-poisoning, inducing gastrointestinal disturbance, acute respiratory distress syndrome, arrhythmia, renal failure, and even death.

Case presentation:

The authors present a case of glyphosate poisoning in a patient who developed capillary-leak syndrome, severe metabolic acidosis, and shock. After treatment with hemoperfusion and continuous renal replacement therapy, the patient was extubated after 7 days and transferred out of the intensive care unit after 10 days.

Clinical discussion:

Severe glyphosate poisoning can lead to multiple organ failure and systemic capillary leak syndrome. Clinical manifestations of systemic capillary leak syndrome included hemoconcentration, increased hematocrit, hypoalbuminemia, interstitial fluid accumulation, and refractory hypotension. Substantial improvement of capillary leakage was observed only gradually after initiation of early continuous renal replacement therapy, plasma infusion, and application of ulinastatin.

Conclusions:

This case report highlights the life-threatening nature of glyphosate poisoning. Aggressive treatment and careful monitoring of complications are required, particularly in patients at risk of capillary leakage syndrome.
Outcomes of pancreas transplantation in patients with underlying inflammatory bowel disease: a retrospective case series
Authors: Ray Samrat , Yousuf Anila , Dharia Atit , Ayoub Ghassan , Parmentier Catherine , Norgate Andrea , Schiff Jeffrey , Shwaartz Chaya , Selzner Markus , Reichman Trevor W.
Published: April 2023

Introduction:

Despite having emerged as a definitive treatment for diabetes mellitus (DM), pancreas transplantation remains a formidable surgical task owing to complications like graft pancreatitis, enteric leaks, and rejection. This becomes more challenging in the setting of underlying bowel pathology, such as inflammatory bowel disease (IBD), which has a strong immune-genomic association of co-existence with DM. Risk of anastomotic leaks, dose adjustments of immunosuppressants and biologicals, and management of IBD flares constitute some of the major perioperative challenges calling for a protocol-based, systematic, multidisciplinary approach.

Patients and methods:

This was a retrospective case series of patients between January 1996 and July 2021, with all patients being followed up until December 2021. All consecutive patients with end-stage DM who underwent pancreas transplantation (alone, simultaneous with kidney transplantation or after kidney transplantation) and had pre-existing IBD were included in the study. A Comparison of 1-, 5-, 10-year survival was done with pancreas transplant recipients without underlying IBD using Kaplan–Meir curves.

Results:

Of the total 630 pancreas transplants performed between 1996 and 2021, eight patients had IBD, mostly Crohn’s disease. Following pancreas transplantation, two of the eight patients had duodenal leaks, with one a requiring graft pancreatectomy. The 5-year graft survival rate for the cohort was 75% compared to 81.6% for the overall cohort of patients undergoing pancreas transplantation (P=0.48) with a median graft survival of 48.4 months compared to 68.1 months in the latter (P=0.56).

Conclusion:

The findings of the series provide a snapshot of the outcome of pancreas transplantation in the background of IBD, suggesting a graft and overall patient survival rates comparable with pancreas transplantation in patients without underlying IBD, with further validation of the findings required in a larger cohort of patients in the future.
Evaluation of human growth hormone (somatropin) in socket healing: a split-mouth randomized controlled trial
Authors: Sleman Nadim , Khalil Ali
Published: April 2023

Purpose:

Techniques for preserving alveolar bone after tooth extraction are becoming a part of the usual clinical practice of clinicians. These techniques aim at minimizing postextraction bony resorption, hence, minimizing subsequent follow-up for implant insertion. This randomized clinical study aimed to measure and compare alveolar bone and soft tissue healing between extraction sockets treated with somatropin to untreated sockets.

Methods:

The study is designed as a split-mouth randomized clinical trial. The selected patients were indicated for bilateral symmetrical tooth extraction, where each patient had an indication to extract two symmetrical teeth in anatomy and number of roots. Somatropin was applied to the tooth socket of the randomly selected side after tooth extraction by gel foam, and the control side was filled with gel foam only. A clinical follow-up of the soft tissue was done 7 days after tooth extraction to evaluate clinical aspects of the healing process. Radiographic follow-up was performed using a cone-beam computed tomography scan to assess volumetric changes of alveolar bone in the extraction area prior to and 3 months after the surgical procedure.

Results:

A total of 23 patients (aged 29.1±9.5 years) participated. The results showed a statistically significant association between somatropin application and better preservation of the bony dimensions of the alveolar ridge. Bone loss was −0.691±0.628 mm for the buccal plate on the study side compared to −2.008±1.175 mm on the control side. The level of the lingual/palatal plate bone loss was −1.052±0.855 mm on the study side compared to −2.695±1.878 mm on the control side. The bone loss of alveolar width was −1.626±1.061 mm on the study side compared to −3.247±1.543 mm on the control side. The results also showed better healing of covering soft tissues (P<0.05), as well as bone density in the socket where somatropin was applied, which has been statistically significant.

Conclusion:

The data from this study demonstrated that the application of somatropin in tooth sockets postextraction showed an effective contribution to reducing alveolar bone resorption and improving bone density following extraction, in addition to better healing of covering soft tissue.
Immunohistochemical study of insulin-like growth factor 1 in calcifying epithelial odontogenic tumor and ameloblastoma: experimental research
Authors: Alkutaifan Haya , Alnour Amirah , Almohareb Mumdouh
Published: April 2023

Background and aim of the study:

Several studies have indicated that increased levels of insulin-like growth factor 1 (IGF-I) or altered levels of its binding proteins are associated with an increased risk of the most common cancers, including cancers of the colorectal, lung, breast and prostate. The aim of this study is to investigate the expression of IGF-1 in both calcifying epithelial odontogenic tumor (CEOT) and ameloblastoma.

Materials and methods:

The research sample consisted of 23 paraffin block from Oral Pathology Department, Faculty of Dentistry, Damascus University, including six biopsies of CEOT, two biopsies of the plexiform ameloblastoma and 14 biopsies of the follicular ameloblastoma. All specimen were prepared and immunostained with rabbit polyclonal antibody to IGF-1. Immunostaining was assessed according to German-semiquantitative scoring system, and then the results were aggregated and statistically analyzed using SPSS version 13.0 (Student’s test for two independent samples, one-way analysis of variance, Kruskal–Wallis test and Mann–Whitney U-test), the significance level P value less than 0.05 was considered statistically significant.

Results:

All CEOT and ameloblastoma samples were positive for IGF-1 staining, except one sample of ameloblastoma, which was negative. The results showed that there were no statistically significant differences between CEOT and ameloblastoma in the values of IGF-1 expression (P=0.993) and IGF-1 expression rates (P=0.874) and in the frequency of IGF-1 expression (P=0.761) and IGF-1 staining intensity score (P=0.731).

Conclusion:

IGF-1 plays an important role in the growth of odontogenic tumors and there are no differences in IGF-1 expression between CEOT and ameloblastoma.
Levels of SARS-COV-2 anti-spike protein receptor-binding domain (S-RBD) IgG in Indonesian-vaccinated healthcare workers: experimental research
Authors: Tambunan Betty A. , Ugrasena I. Dewa G. , Nugraha Jusak , Fitriah Munawaroh , Permatasari Cynthia A. , Moses Emmanuel J. , Yusoff Narazah M. , Aryati
Published: April 2023

Introduction:

Studies evaluating the levels of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) anti-spike protein receptor-binding domain (S-RBD) immunoglobulin G (IgG) antibodies in vaccinated healthcare workers in Indonesia are limited.

Objectives:

Evaluating time-dependent levels of anti-IgG S-RBD antibodies and monitoring the response of healthcare workers in a tertiary hospital in Indonesia after vaccination.

Materials and methods:

This prospective cohort observational study was conducted from January to December 2021. A total of 50 healthcare workers participated in the study. Blood samples were collected at five time points. Antibody levels were measured using a CL 1000i analyzer (Mindray Bio-Medical Electronics Co., Ltd., Shenzhen, China). Antibody levels between groups were analyzed using the Wilcoxon signed-rank test with P less than 0.05.

Results:

The median levels of SARS-CoV-2 anti-S-RBD IgG antibody on days 14, 28, 90, and 180 were significantly higher than the levels on day 0 (P<0.001). After the second dose, peak levels were observed on day 14; the levels decreased gradually after day 28. Despite receiving two doses of the vaccine, 10 out of 50 participants (20%) were infected with COVID-19 (coronavirus disease 2019). However, symptoms were mild, and antibody levels were significantly higher than in noninfected participants (P<0.001).

Conclusion:

SARS-CoV-2 anti-S-RBD IgG antibody levels increased significantly until day 14 after the second dose; the levels decreased gradually after day 28. Ten participants (20%) were infected with SARS-CoV-2, with mild symptoms.
Differences in BMI obesity measures in a workers compensation population: a cross-sectional study
Authors: Hyman Mark H. , Peled Tamra J. , Hyman Noah M. , Tan Jingyi , Guo Xiuqing , Rotter Jerome I.
Published: April 2023

Objective:

To assess the accuracy of BMI compared to directly measured dual-energy X-ray absorptiometry percent body fat (DEXA %BF) among a worker compensation population.

Methods:

The agreement between BMI and DEXA %BF was assessed by the Pearson correlation coefficient among 1394 evaluable patients over a 5-year period. Sensitivity and specificity were calculated to measure how well BMI can identify true obese and nonobese individuals.

Results:

Using at least 30kg/m2 to identify obesity, BNI had a specificity of 0.658 and a sensitivity of 0.735. The correlation was better in females at 0.66, compared to males at 0.55, and weaker in older age groups at 0.42, as compared to the youngest age group at 0.59. Overall, 29.8% of the population was reclassified based on their DEXA %BF measures.

Conclusions:

In a 5-year cohort worker compensation population, BMI was an inaccurate measure of true obesity.
Knowledge and attitude toward COVID-19 booster dose among health care professionals in Nepal: a cross-sectional study
Authors: Paudel Kiran , Shah Sangam , Bhusal Sandesh , Dahal Krishna , Bhatta Nikita , Pokhrel Saurav , Dahal Suman , Gaihre Milan , Mudvari Anish , Gyanwali Pradip
Published: April 2023

Introduction:

Vaccination has become the most effective way to combat the coronavirus disease 2019 (COVID-19) pandemic. As there have been reports of a gradual decline in the protection it offers, many countries have decided to administer booster doses of the COVID-19 vaccine. In Nepal, booster doses have been introduced to frontline health workers as a priority group. Therefore, this study aims to assess the knowledge and attitude of health care professionals toward booster doses of COVID-19 vaccines in Nepal.

Methods:

A cross-sectional study was conducted from December 2021 to January 2022 among health care professionals working at public health facilities in Nepal. Multivariable logistic regression was performed to identify predictors that correlate with knowledge and attitude toward COVID-19 booster dose. P value less than 0.05 was considered statistically significant.

Results:

A total of 300 participants were included in the final analysis. Among the study participants, 68.0% and 78.6% had good knowledge and favorable attitude toward COVID-19 booster dose, respectively. Female health care workers and those who had received a single dose of COVID-19 vaccine had significantly lower odds of having good knowledge of COVID-19 booster dose. Similarly, participants with lower educational levels and those who had received a single dose of COVID-19 vaccination had an unfavorable attitude toward COVID-19 booster dose.

Conclusion:

This study showed a satisfactory level of knowledge and attitude of health care professionals toward COVID-19 booster dose in Nepal. Health care professionals’ positive attitude toward COVID-19 booster dose vaccine is key to the patient and community safety. Personalized education and risk communication can aid in improving overall awareness and attitudes toward COVID-19 booster dose in such populations.
Perioperative mortality and its predictors among patients undergoing emergency laparotomy at selected southern Ethiopian governmental hospitals, 2022: a multicenter prospective cohort study
Authors: Hailu Seyoum , Ayinie Animut , Amsalu Hunde , Hailu Sileshi , Tadesse Muhiddin , Mamo Temesgen , Sagni Yonas , Mekonen Semagn , Jemal Bedru
Published: April 2023

Background:

Globally, emergency laparotomy is a frequently performed type of surgery with high morbidity and mortality rates, even in the best healthcare systems. There is limited knowledge regarding the outcome of emergency laparotomy performed in Ethiopia.

Objective:

To assess perioperative mortality and its predictors among patients undergoing emergency laparotomy at selected southern Ethiopian governmental hospitals.

Methods:

A multicenter prospective cohort study was conducted, and data were collected at selected hospitals after obtaining ethical approval from the Institutional Review Board. Data were analyzed using SPSS version 26.

Results:

The rate of postoperative complications after emergency laparotomy surgery was 39.3%, with an in-hospital mortality rate of 8.4% and a length of hospital stay of 9±6.5 days. The predictors of postoperative mortality were the age of the patient greater than 65 [adjusted odds ratio (AOR)=8.46, 95% CI=1.3–57.1], presence of intraoperative complications (AOR=7.26, 95% CI=1.3–41.3), and postoperative ICU admission (AOR=8.5, 95% CI=1.5–49.6).

Conclusion:

Our study revealed a significant level of postoperative complications and in-hospital mortality. The identified predictors should be sorted and applied to the preoperative optimization, risk assessment, and standardization of effective postoperative care following emergency laparotomy.
Health-related quality of life measured by SF-36 among postdelivery mothers attending maternal and child health clinic in Eastern Nepal: a cross-sectional study
Authors: Chapagain Pratiksha , Pyakurel Prajjwal , Anand Ayush , Gupta Ashwini , Subedi Durga
Published: April 2023

Objectives:

Assessing health-related quality of life (HRQoL) and its associated factors is essential for providing adequate healthcare and developing necessary interventions in women postdelivery. This study intended to find out the HRQoL score and related factors among women postdelivery in Nepal.

Methodology:

This was a cross-sectional study using nonprobability sampling conducted at a Maternal and Child Health (MCH) Clinic in Nepal. The study participants were 129 women postdelivery to 12 months who visited the MCH Clinic from 2 September 2018 to 28 September 2018. Outcome measures were sociodemographic, clinical indicators, obstetric indicators, and their relation with the overall HRQoL score of postdelivery mothers using the Short Form Health Survey (SF-36) Version 1.

Results:

Of 129 respondents, 68.22% were in the 21–30 age group, 36.43% were upper caste, 88.37% were Hindu, 87.60% were literate, 81.39% were homemakers, 53.49% with income less than 12 months, 88.37% had family support, and 50.39% with vaginal deliveries. HRQoL was significantly more in employed women (P=0.037), those with family support (P=0.003), and those who had a cesarean section (P=0.02) and wanted pregnancy (P=0.040).

Conclusion:

HRQoL in women postdelivery can be influenced by employment status, family support, type of delivery, and desirability of pregnancy.
Paratesticular rhabdomyosarcoma: a rare case report from Syria
Authors: Sabbagh Aziz , Hamza Amr , Sukkari Mohamad Walid , Fattal Abdualh , Chammout Anwar , Ayoub Kusay , AL-Hadid Ibrahim
Published: April 2023

Introduction:

Paratesticular rhabdomyosarcoma (RMS) is a rare aggressive tumor manifesting in children and young adults. This tumor derives from mesenchymal elements of the Tunica vaginalis, epididymis, and spermatic cord. It is a very metastatic lesion that can spread by lymphatics to the iliac, para-aortic nodes, lung, and bone.

Case presentation:

In this paper, the authors report a case of a 6-year-old child who presented to the clinic with a painless mass in the right side of the scrotum. The mass was misdiagnosed and had evolved rapidly over 2 weeks. The mass measured 16×32 mm on ultrasound, and therefore, an orchiectomy was performed. The histological examination of the excised tissue confirmed the diagnosis of paratesticular RMS.

Discussion:

Paratesticular RMS mainly presented as a painless mass in the scrotum. It was a very metastatic lesion that required an immediate management. However, a lot of cases of paratesticular RMS misdiagnosed at first time, which worsens the overall prognosis.

Conclusion:

Eventually, paratesticular RMS should be always taken into consideration when a scrotal mass is suspected. Due to its extremely serious metastatic potential, this condition requires early diagnosis and management. The treatment is currently well codified combining surgery, chemotherapy, and radiotherapy.
Exophthalmos and hemiheadache caused by osteoma in the greater wing of sphenoid bone: an extremely rare case report
Authors: Tawashi Yamama , Tawashi Kenana , Beski Tasneem , Alhakeem Khaleel
Published: April 2023

Introduction and importance:

Osteoma is the most common benign tumor of the nose and paranasal sinuses. It is usually asymptomatic and diagnosed accidentally. In our case, the tumor formed in an unusual location and led to unexpected symptoms, which created a big challenge in diagnosis and treatment.

Case presentation:

A 53-year-old woman complained of hemiheadache, exophthalmos in the right eye, and limitation in lateral eye movements progressing to diplopia in the past 2 months. The physical examination of the rest systems was unremarkable. The radiological investigations revealed a hyperdense lesion arising from the right greater wing of the sphenoid bone and compressed on the orbit’s components and eye muscles, which caused proptosis. The radiological findings suggested osteoma and the tumor was excised by craniotomy. The patient gets rid of the symptoms and the follow-up for 6 months was uneventful.

Clinical discussion:

Even hemiheadache, exophthalmos, limitation in eye movements, and diplopia are unfamiliar findings in osteoma, they may be its manifestations. Also, MRI is used as a diagnostic method with computed tomography scan in intracranial osteoma. These cases are treated by craniotomy.

Conclusions:

Even though osteoma is a benign tumor, it may form in unusual locations and cause unexpected symptoms. So, it should be a differential diagnosis in skull bony tumors. Also, it should be treated when exists in sensitive places to avoid irreversible outcomes.
Assessment of routine medical checkups for common noncommunicable diseases and associated factors among healthcare professionals in Addis Ababa, Ethiopia, in 2022 a cross-sectional study
Authors: Getahun Genanew Kassie , Arega Meron , Keleb Gebretsadik , Shiferaw Addis , Bezabih Dawit
Published: April 2023

Background:

Routine medical checkups are one strategy for detecting and treating noncommunicable diseases early. Despite the effort to prevent and control noncommunicable diseases in Ethiopia, the prevalence of the problem is significantly increasing. The aim of this study was to assess the uptake of routine medical checkups for common noncommunicable diseases and associated factors among healthcare professionals in Addis Ababa, Ethiopia, in 2022.

Methods:

A facility-based cross-sectional study was conducted, enroling 422 healthcare providers in Addis Ababa. A simple random sampling method was used to select study participants. Data entry was made using Epi-data and exported to STATA for further analysis. A binary logistic regression model was used to determine predictors of routine medical checkups. In the multivariable analysis, the adjusted odds ratio along with a 95% confidence interval were determined. Explanatory variables whose p value less than 0.05 were selected as significant factors.

Results:

The overall uptake of routine medical checkups for common noncommunicable disease was 35.3% (95% CI: 32.34–38.26). Moreover, being married [adjusted odds ratio (AOR)=2.60, 95% CI=1.42–4.76], income level less than 7071 (AOR=3.05, 95% CI=1.23–10.05), absence of chronic medical disease (AOR=0.40, 95% CI=0.18–0.88), good provider commitment (AOR=4.80, 95% CI=1.63–14.05), drinking alcohol (AOR=0.35, 95% CI=0.19–0.65), and poor perception of health status (AOR=2.1, 95% CI=1.01–4.44) were the significant factors.

Conclusion:

The uptake of routine medical checkups was found to be low, owing to marital status, level of income, perception of health status, drinking alcohol, the absence of chronic medical conditions, and the availability of committed providers, which needs intervention. We recommend using committed providers for noncommunicable diseases and considering fee waivers for healthcare professionals to increase uptake of routine medical checkups.
Endovascular management of RCC in one-kidney patient: a case report study
Authors: Ghareeb Amjad , Salameh Bairak , Halaweh Malaz , Al-Tawil Muhamad , Nahas Mohammed Ali
Published: April 2023

Introduction and importance:

Renal cell carcinoma is considered one of the most common and deadly cancers, which remain asymptomatic until the late stage, needing total nephrectomy when it is detected. In mono-kidney patients this will lead to hemodialysis and later a kidney transplant.

Case presentation:

This case represents our center’s experience and strategy in managing renal cell carcinoma in a one-kidney patient by endovascular management first followed by partial nephrectomy.

Clinical discussion:

The patient’s postoperative follow-up has a good quality of life with no signs of tumor recurrence or metastasis in addition to normal kidney functions tests.

Conclusion:

Preoperative endovascular intervention can represent a good and accepted solution for a partial nephrectomy preserving not only a normal renal function, without the need for kidney transplantation, but also a good quality of life.
Creating a Learning Plan for Prelicensure Students in Primary Care Clinical Experiences
Authors: Nielsen Ann , Taylor Cynthia , Claudson Robin , Keller Ginger , Barfield Patricia
Published: April 2023

Background:

Registered nurses (RNs) working to the full scope of licensed practice can expand the capacity of the health care system and influence patient care quality. However, preparation of prelicensure nursing students to practice in primary care is particularly challenging due to curricular and practice site barriers.

Approach:

As part of a federally funded project to expand the primary care RN workforce, learning activities to teach key concepts of primary care nursing were designed and implemented. Students studied the concepts while placed in a primary care clinical setting and debriefed in a topical, instructor-facilitated, seminar. Current and best practices in primary care were explored, compared, and contrasted.

Outcomes:

Pre- and postsurveys revealed significant student learning related to selected primary care nursing concepts. Overall knowledge, skills, and attitudes increased significantly pre- to post-term.

Conclusion:

Concept-based learning activities can effectively support specialty nursing education in primary and ambulatory care settings.
CATCH IT: The Effect of Bladder Ultrasound in Decreasing the Time to Collect a Clean-Catch Urine Sample in the Nontoilet-Trained Child
Authors: Lennon Richard , Krishnamohan Anirudh , Fitzpatrick Lesley , Gillett Mark
Published: April 2023

Objectives

Clean-catch urine is essential in the investigation of an unwell child but can unfortunately be difficult to obtain in nontoilet-trained children. To this end, we compared the difference in time taken to collect clean-catch urine in nontoilet-trained children via the use of point-of-care ultrasound and traditional methods.

Methods

A single-center randomized controlled trial was conducted at an urban pediatric emergency department, recruiting 80 patients, of which 73 underwent data analyses. Participants were randomized to either the control arm, which consisted of the traditional “watch and wait” method of collecting a clean-catch sample, or to the intervention arm, which used point-of-care ultrasound to assess bladder volume and to stimulate the micturition reflex. The primary outcome measured was the mean time taken to collect a clean-catch urine sample.

Results

Eighty patients (ultrasound, n = 41; standard care, n = 39) underwent randomization using a random number generator. Seven patients were removed from final analysis due to loss to follow-up for various reasons. Seventy-three patients (ultrasound, n = 37; standard care, n = 36) underwent statistical analysis. The ultrasound group had a median time to clean-catch urine of 40 minutes (interquartile range, 52) and mean time of 52 minutes (standard deviation, 42), and the control group had a median time of 55 minutes (interquartile range, 81), and mean time of 82 minutes (standard deviation, 90). This reached statistical significance (1-tail t test, P = 0.033). The baseline characteristics were similar between both groups for sex and age distribution; however, the mean ages were significantly different (2-tail t test, P = 0.049) with 8.4 months in the control group, and 12.3 months in the ultrasound group.

Conclusions

We found that there was a statistically and clinically significant reduction in mean time taken to collect clean-catch urine in nontoilet-trained children using point-of-care ultrasound compared with the traditional watch and wait method.
Introduction of the L-PAP Flap: Bipedicled, Conjoined, and Stacked Thigh-Based Flaps for Autologous Breast Reconstruction
Authors: Chu Carrie K. , Largo Rene D. , Lee Z-Hye , Adelman David M. , Egro Francesco , Winocour Sebastian , Reece Edward M. , Selber Jesse C. , Butler Charles E.
Published: April 2023

Thigh based-flaps are increasingly popular options for autologous breast reconstruction in the setting of abdominal donor site inadequacy, previous surgery, or patient preference, but the volume and skin associated with these flaps are often lacking relative to the abdomen. An individualized, shared-decision making approach to donor site selection was adopted based on body shape, surgical history, lifestyle, reconstructive needs, and patient expectations. Different thigh-based flaps combined in stacked, bipedicled, and/or conjoined configurations were selected to maximize efficient use of available soft tissue skin and volume while optimizing donor site aesthetics. A total of 23 thigh-based stacked, bipedicled, and/or conjoined profunda artery perforator (PAP), lateral thigh perforator (LTP), and/or gracilis musculocutaneous flap components were used in six patients. Configurations included bilateral stacked PAP and LTP flaps, bipedicled posterolateral thigh flaps based on the LTP and PAP perforators (L-PAP flaps), and bipedicled thigh flaps based on the gracilis and PAP pedicles. Most anastomoses were performed to the antegrade and retrograde internal mammary vessels, while intra-flap anastomoses were performed in one case. There were no partial or total flap losses. There was one donor site seroma. Design of stacked, bipedicled, and conjoined thigh-based flaps using multiple conventional flap components allows for tailored approaches to donor site utilization based on individual body shape in selected patients. Bipedicled design with the L-PAP flap represents one strategy in appropriate patients to overcome skin and volume deficiencies while facilitating coning and projection.
“Close the GAPS: A Standardized Perioperative Protocol Reduces Breast Reconstruction Implant Infections”
Authors: Brown Owen H. , Danko Dora , Muret-Wagstaff Sharon L. , Emefiele Jesse , Argüello-Angarita Marvin , Baker Nusaiba F. , Losken Albert , Carlson Grant , Cheng Angela , Walsh Mark , J. Muralidharan Vignesh , Thompson Peter W.
Published: April 2023

Background:

Implant-based breast reconstruction (IBBR) is a complex process with significant practice variability. Infections after IBBR are associated with higher rates of readmission, reoperation, and reconstructive failure. To reduce process variability and postoperative infections, we implemented an evidence-based, standardized protocol for IBBR.

Methods:

The protocol was applied to all patients undergoing IBBR at a single institution from 12/2019 to 02/2021. Intraoperative protocol adherence was recorded, and infection events were considered minor (managed with outpatient antibiotics) or major (managed with readmission or reoperation). A historic control group was retrospectively analyzed for comparison.

Results:

Sixty-nine patients (120 breasts) in the protocol group were compared to 159 (269 breasts) in the retrospective group. No differences were found in demographics, comorbidities, or type of reconstruction (expander vs. implant). Intraoperative protocol adherence was 80.5% (STD=13.9%). Overall infection rate was significantly lower in the protocol group vs. controls (8.7% vs 17.0%, p < 0.05). When dichotomized, protocol patients had a lower rate of both minor (2.9% vs. 5.7%, p=0.99) and major (5.8% vs 11.3%, p=0.09) infections, though this was not statistically significant. Rate of reconstructive failure secondary to infection was significantly lower in the protocol group (4.4% vs. 8.8%, p<0.05). Among protocol patients, those without infection had higher protocol adherence (81.5% vs 72.2%, p < 0.06) that neared statistical significance.

Conclusions:

A standardized peri-operative protocol for IBBR reduces process variability and significantly decreases rate of overall infections and reconstructive failure secondary to infection.
Assessing the efficacy of the S-PECS block in breast augmentation surgery – a randomised double-blind control trial
Authors: Sforza Marcos , Saghir Reyan , Saghir Norman , Husein Rodwan , Okhiria Renee , Okhiria Terrell , Sidhu Manu , Poojary Manoj
Published: April 2023

Introduction:

Postoperative acute and chronic pain following breast surgery is a common complication which needs resolving to allow for improved patient outcomes. Previously thoracic epidurals and paravertebral blocks (PVB) have been the gold standard administered intra-operatively. However, more recently the introduction of the Pectoral nerve block (PECS and PECS-2 blocks) has looked promising to control the pain more effectively, but further robust analysis is required to prove its efficacy.

Objectives:

The authors aim to study the efficacy of a new block S-PECS that combines a serratus anterior and a PECS-2 block.

Methods:

In this study we performed a prospective, single-centre randomised controlled double-blind group trial in 30 female patients undergoing breast augmentation surgery with silicone breast implants and the S-PECS block. Divided into groups of 15, the PECS group received local anaesthetics with the no-PECS control group receiving a saline injection. All participants were followed up at recovery (REC), 4, 6 and 12 (4H, 6H and 12H) hourly postoperatively.

Results:

Our results showed that the pain score in the PECS group was significantly less than the no-PECS group across all time points REC, 4H, 6H and 12H. Furthermore, the patients that received the S-PEC block were 74% less likely to request pain medications compared to the no-PECS group (p<0.05).

Conclusion:

Overall, the modified S-PECS block is an effective, efficient and safe method of controlling pain in patients undergoing breast augmentation surgery with additional applications yet to be explored.
The Volumetric effect of Botulinum Toxin Type A Injection on Parotid Gland: A Prospective Randomized Controlled Trial
Authors: Jeong Woo Shik , Hong Dae Won , Ahn Tae Joo , Han Hyun Ho
Published: April 2023

Backgrounds:

Botulinum neurotoxin type A (BTX-A) to masseter muscle is a useful tool for the aesthetic narrowing the width of the lower face. The administration of BTX-A to visible parotid glands is also effective to reduce lower facial width. However, no studies quantitatively analyzed the effect of BTX-A on the parotid glands.

Methods:

The purpose of this study is to confirm the impact of BTX-A injection on the parotid gland and to suggest the effective dosage of BTX-A in facial slimming. This study was conducted by selecting patients that desired facial slimming from among patients that required surgery for a facial bone fracture. Patients undergoing BTX-A injection were prospectively randomized to high-dose, low-dose, and placebo groups, and different doses of BTX-A for each group were injected into both parotid glands during facial bone surgery.

Results:

A total of thirty patients were enrolled in this study. Ten patients in the high-dose, eight in the low-dose group, and nine in the control group completed the clinical trial. There were significant changes in each high and low dose groups compared to the control group (p < 0.001, p < 0.001), and in interaction of time and group (p < 0.001). The volume recovery after three months was found with 7.6% in the high-dose group and 4.8% in the low-dose group.

Conclusion:

BTX-A injection into parotid glands can be an effective treatment option in managing salivary gland enlargement for lower face contouring.
Open Science in Health Psychology and Behavioral Medicine: A Statement From the Behavioral Medicine Research Council
Authors: Segerstrom Suzanne C. , Diefenbach Michael A. , Hamilton Kyra , O’Connor Daryl B. , Tomiyama A. Janet ,   with the Behavioral Medicine Research Council
Published: April 2023

Open Science practices include some combination of registering and publishing study protocols (including hypotheses, primary and secondary outcome variables, and analysis plans) and making available preprints of manuscripts, study materials, de-identified data sets, and analytic codes. This statement from the Behavioral Medicine Research Council (BMRC) provides an overview of these methods, including preregistration; registered reports; preprints; and open research. We focus on rationales for engaging in Open Science and how to address shortcomings and possible objections. Additional resources for researchers are provided. Research on Open Science largely supports positive consequences for the reproducibility and reliability of empirical science. There is no solution that will encompass all Open Science needs in health psychology and behavioral medicine’s diverse research products and outlets, but the BMRC supports increased use of Open Science practices where possible.
A Network Analysis of Cardiovascular Risk Factors in Patients With Heart Disease: The Role of Socioeconomic Status and Sex
Authors: van den Houdt Sophie C.M. , Mommersteeg Paula M.C. , Widdershoven Jos , Kupper Nina
Published: April 2023

Objective

Diverse risk factors influence the development and prognosis of coronary heart disease (CHD) independently and mutually. Low socioeconomic status (SES) seems to exacerbate these risk factors’ influences. In addition, sex differences have been identified for individual risk factors. Network analysis could provide in-depth insight into the interrelatedness of the risk factors, their predictability, and the moderating role of sex, to ultimately contribute to more refinement in prevention and cardiac rehabilitation.

Methods

A total of 1682 participants (78% male; mean [standard deviation] age = 69.2 [10.6] years) with CHD completed questionnaires on psychosocial factors and health behaviors. Cardiometabolic data were retrieved through medical records. An SES index was created based on self-reported occupation, education, and area (i.e., postal code)-based median family income. Using R, we conducted a mixed graphical model network analysis on all risk factors combined with and without the moderating role of sex.

Results

SES belonged to the more influential risk factors with moderate to high levels of expected influence and degree centrality, indicating that it plays a considerable role in the risk factor network. When considering the moderating role of sex, relationships between SES and most risk factors were found to be stronger for women (b = 0.06–0.48).

Conclusions

The current study provided an insight into an interrelated network of psychosocial and medical risk factors among CHD patients. With SES belonging to the more influential risk factors and female sex influencing the strength of all the SES–risk factor relationships, cardiac rehabilitation and prevention techniques could be more refined by accounting for both influences.