bluuebunny/crossref_metadata_2025 huggingface dataset:
Systemic lupus erythematosus disease activity and neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio: a cross-sectional case–control study
Authors: Abdalhadi Safaa , Khalayli Naram , Al-Ghotani Basel , Kudsi Maysoun
Published: April 2023

Background:

Systemic lupus erythematosus (SLE) is an autoimmune disease with unknown etiology. It involves multiple organs and presents as varying clinical manifestations such as renal involvement (nephritis) and hematological disorders.

Materials and Methods:

One hundred sixty people, divided equally into two groups: SLE patients, diagnosed according to the 2010 American College of Rheumatology/European League Against Rheumatism criteria, and healthy controls matched in age and gender, attending the University Hospitals between April 2019 and January 2021. White blood cells count, neutrophils count, lymphocytes count, platelet count, erythrocyte sedimentation rate, C-reactive protein, serum complements (C3 and C4), anti-double-stranded deoxyribonucleic acid, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and the SLE disease activity by using Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) was compared between the patient group and the control group. Demographic data were collected from all participants, and data on the disease, including disease durations and disease activity, were only collected from the patients.

Results:

The age of the patients was 30.49±10.979 years, while it was 34.54±13.710 years in the control group (P=0.249). In all, 90% were females and 10% were males in the patient’s group, while 85% were female and 15% were males in the control group. NLR and PLR were significantly higher in SLE patients compared to healthy control. A significant relation was found between SLEDAI and NLR and PLR.

Conclusion:

The NLR and PLR are correlated with disease activity while also being cost-effective.
Nephrotic syndrome presented as a portal vein thrombosis: a case report
Authors: Jeele Mohamed Osman Omar , Adan Abdisamad M.
Published: April 2023

Introduction:

Nephrotic syndrome (NS) is a clinical disorder characterized by significant proteinuria, hypoalbuminemia, hyperlipidemia, edema, and other complications. Urinary loss of clotting inhibitors, zymogens, and plasminogen; increased hepatic synthesis of fibrinogen and lipoproteins, and hemoconcentration due to fluid loss are some of the factors which predispose NS patients to hypercoagulable states like portal vein thrombosis.

Case presentation:

In the presenting case report, we described a 21-year-old woman with no history of NS and a hypercoagulable state who presented to our emergency department with severe generalized abdominal pain and lower limb edema. She was subsequently diagnosed with NS complicated with portal vein thrombosis and was admitted to our internal medicine unit. After 2 weeks of treatment, the patient was discharged in good health.

Conclusion:

Additional evaluation for newly onset NS with venous thrombosis should be needed in the presence of severe abdominal pain and lower limb edema even in a patient without a previous history of NS.
The challenging presentation of gastric cancer during pregnancy with krukenberg tumor: a case report
Authors: Chen Han-Ying , Lee Chien-Nan , Lin Shin-Yu
Published: April 2023

Introduction:

The incidence of ovarian tumors in pregnancy is around 0.05%. Primary ovarian cancer and metastatic malignancy are rare in pregnancy, and women often delayed in diagnosis.

Importance:

This is the first case ever reported on gastric cancer diagnosed during pregnancy presenting with a Krukenberg tumor and mimic ovarian tumor torsion, cholecystitis. By reporting this case, we could sensitize physicians to be more vigilance of abnormal abdominal pain in pregnant women.

Case presentation:

A 30-year-old female came to our hospital at the 30th week of gestational age due to preterm uterine contraction and worsening abdominal pain. A cesarean section was performed due to preterm uterine contraction and intolerable abdominal pain suspected to be ovarian torsion. Microscopic examination of the ovarian specimen showed signet-ring cells. The patient was diagnosed with gastric adenocarcinoma at stage IV after complete surveillance. Postpartum chemotherapy consisted of oxaliplatin and high-dose 5-fluorouracil. The patient died 4 months after delivery.

Clinical discussion:

Malignancies during pregnancy should be kept in mind while encountering atypical clinical presentations. Krukenburg tumor is rare in pregnancy and gastric cancer is the most common cause. Early diagnosis of the gastric cancer in the operable stage is the key to a better prognosis.

Conclusion:

Diagnostic examinations for gastric cancer in pregnancy could be performed after first trimester. Treatment should be introduced after balancing maternal-fetal risks. Early diagnosis and intervention are crucial to decrease the high mortality rate of gastric cancer in pregnancy.
Successful management of Herlyn–Werner–Wunderlich syndrome in a 17-year-old virgin girl in the challenging socio-cultural-logistic setting of Syria: a case report
Authors: Martini Nafiza , Alabdallah Ebaa , Al-Ghotani Basel , ALAWAD IEMAN , Tawashi Nazih
Published: April 2023

Introduction and Importance:

Herlyn–Werner–Wunderlich syndrome (HWWS) is a rare developmental anomaly of the female reproductive system caused by a failure of fusion during Mullerian duct development. The triad of uterus didelphys, obstructed hemivagina, and ipsilateral renal agenesis characterizes HWWS. The most common presenting symptoms are dysmenorrhoea, pelvic pain, primary infertility in later years, and an abdominal mass due to hematometrocolpos.

Case Presentation:

A 17-year-old girl presented to the authors’ department with recurrent low back pain, which was neither responsive to analgesics nor associated with urinary complaints, vomiting, or fever. Imaging techniques confirmed she had the triad of uterus didelphys, obstructed hemivagina, and right renal agenesis.

Clinical Discussion:

The genital system is the same for males and females before 6 weeks of pregnancy. HWWS is a rare congenital disorder as a result of the failure of fusion during Mullerian duct development. It consists of a didelphic uterus, hemivaginal septum, and unilateral renal agenesis.

Conclusion:

Shame and social stigma associated with virginity continue to endanger the lives of many girls in Syria. To complicate matters further, the low resources in Syria produced by war pose a difficult challenge in managing many gynecological conditions, including HWWS, like this case, in which endoscopic technologies were not available, necessitating open surgery while keeping in mind preserving hymen intactness. So, the authors indicate that preserving virginity could be conducted even though the approach is open surgery by very careful intervention and experienced surgeons.
Pleuropulmonary blastoma type I presenting as a tension pneumothorax: a case report and review of the literature
Authors: AbuAyyash Rafat Ibrahim , Aqel Wafa , Bannoura Sami , Asbeh Yousef Abu
Published: April 2023

Pleuropulmonary blastoma (PPB) is a very rare, aggressive, embryonal pulmonary malignancy that mostly affects children under the age of 5 years. According to the histological features, three subtypes of PPB have been recognized: type I (purely cystic), type II (grossly visible cystic and solid elements), and type III (purely solid). The authors report a case of a 10-month-old male infant with type I PPB, who was clinically misdiagnosed with pneumothorax, that he presented complaining of shortening of breath, fever, and cough. Radiographs of the patient showed right pneumothorax, so he had managed accordingly in another centre without improvement. Then Computed Tomography showed a huge right upper lobe sepated pneumocyst, which was treated surgically and the diagnosis was confirmed by combining the imaging and the histopathological examination as PPB type I. PPB is a relatively rare tumour, and it is important to put PPB with their subtypes within the differential diagnoses of any pulmonary lesion in children below the age of 5 or 6 years, as the early diagnosis will help to give early management. Hence, the patient may have a better outcome.
Incidental finding of multiple diffuse large B-cell lymphomas masquerading as jejunojejunal intussusception with unexplained pleural effusion: a case report
Authors: Liu Kuang-Ting , Chang Yueh-Ching , Lin Yu-Chieh , Chang Junn-Liang
Published: April 2023

Introduction:

Primary non-Hodgkin’s lymphoma of the gastrointestinal (GI) tract is rare. It is aggressive and necessitates early diagnosis and management. Simultaneous primary GI lymphomas are unusual with rarely reported cases.

Case presentation:

This novel case report describes an 84-year-old man with multiple primary diffuse large B-cell lymphomas (DLBCLs) of the jejunum with disseminating pleural and multiple regional lymph nodes involvement presenting as intestinal obstruction and segments of jejunojejunal intussusception. The patient underwent surgical intervention and adjuvant chemotherapy. Unfortunately, the patient suffered from multiple organ failure and died 4 months after surgery.

Clinical discussion:

Obstruction and perforation are rare and life-threatening complications of GI lymphoma. Multiple DLBCLs of the jejunum are rare. Moreover, primary GI-DLBCL that initially presents with pleural effusion or with intestinal perforation is uncommon. This report aims to remind clinicians that lymphoma should be considered when assessing the cause of unexplained pleural effusion, especially when the available examination data cannot be confirmed by clinical manifestations.

Conclusion:

Through this case report, the authors learn that clinical manifestations, morphological characteristics, immunophenotypes, and molecular biological characteristics are vastly different and important. This poses the biggest challenge before surgery and should not be ignored.
Case report: utilization of Z-Point fixture “Trans-nasal” implants
Authors: Oh Simon , Zelig David , Aalam Alexandre Amir , Kurtzman Gregori M.
Published: April 2023

Background:

Severe bone loss in the anterior maxilla poses challenges to implant placement, especially when treating the entire arch. Utilization of zygomatic implants may not allow positioning of the implant platform anterior enough to properly support the full arch prosthesis, leaving an anterior cantilever in some clinical cases.

Importance:

Placement of implants into the trans-nasal bone between the pneumatized maxillary sinus and nasal fossa allows utilization of an extralong implant in this residual bone to augment zygomatic implants placed distal to this for better support of a full arch prosthesis.

Case presentation:

A typical case is presented with insufficient alveolar height for traditional implant placement in the anterior maxilla following extraction of the dentition related to bone loss resulting from periodontal disease. Review of the anatomy and technique for placement of implants into the Z-point area for trans-nasal implants.

Clinical discussion:

This article discusses the utilization of trans-nasal implants into the Z-point and the technique for placement in this residual bone with a case example.

Conclusions:

The Z-point implant aids in the elimination of the anterior cantilever that may be present due to the most anterior the platform for the zygomatic implant can be placed. Trans-nasal implants should be considered as part of the treatment plan in severely resorbed maxillary arches to allow better implant to spread and load management during functioning.
An interesting case of unintentional vitamin D toxicity in an infant due to erroneous supplement concentration: a case report
Authors: Kharal Nikita , Kadel Anuradha , Sapkota Srijana , Pokhrel Prakash , Baidya Sujata , Lamichhane Machhindra , Sharma Arun K. , Tuladhar Eans T. , Sharma Vijay K. , Niraula Apeksha
Published: April 2023

Introduction and importance:

Despite the rare occurrence of vitamin D toxicity in infants, increased use of vitamin D formulations as well as incorrect supplement concentration by manufacturing pharmaceutical companies, has contributed to an increased incidence of vitamin D toxicity. Over-the-counter vitamin D preparation constitutes variable concentrations that can render life-threatening consequences in children.

Case presentation:

Here, we present a case of a 2.5-month-old infant presenting with failure to thrive. The clinical presentations were nasal blockage, noisy breathing, poor feeding, lethargy, dehydration, and fever for 3 days with decreased appetite. Her urine culture report showed a urinary tract infection. The biochemical evaluation demonstrated raised total serum calcium (6.0 mmol/l) and serum 25-hydroxy vitamin D (>160 ng/ml) with suppressed parathyroid hormone concentration (3.7 pg/ml), which was the major concern to the clinicians. On ultrasonographical examination, nephrocalcinosis was observed. Further evaluation unveiled that the vitamin D supplement administered to the infant constituted a deucedly high dose of 42 000 IU instead of the recommended dose of 0.5 ml of 800 IU.

Clinical discussion:

The patient developed vitamin D toxicity after consuming a mega dose of vitamin D supplements due to a manufacturer error.

Conclusions:

Hypervitaminosis D has severe life-threatening consequences like failure to thrive in otherwise healthy-born infants. Regular monitoring of vitamin D supplements administered in infants by medicinal practitioners and strict supervision of all stages of the production process by pharmaceutical companies is crucial to prevent complications from supplement overdose.
Surgical outcomes of premeatal and retromeatal cerebellopontine angle meningioma in Vietnam: a single-center prospective cross-sectional study
Authors: Pham Duy , Nguyen Anh Duc , Do Toan Thanh Thi , Kieu Hung Dinh
Published: April 2023

Background:

Cerebellopontine angle (CPA) meningiomas are the second most common tumor of the CPA. Depending on the site of dural attachment, the relationship between the tumor and critical neurovascular structures of the CPA is variable. This study aims to evaluate the influence of CPA meningioma location in relation to the internal auditory canal (IAC) on clinical symptoms, radiological presentations, and surgical treatments and outcomes which has been rarely reported in Vietnam.

Patients and methods:

A prospective study on 33 patients treated with microsurgery from August 2020 to May 2022 at the Neurosurgery Center, Viet Duc University Hospital.

Results:

The mean age of 27 females (85%) and 6 (15%) males was 54±12 years. Based on their location to the IAC, there were 16 premeatal cases (49%) (anterior to the IAC) and 17 retromeatal cases (15%) (posterior to the IAC). The time of diagnosis of the retromeatal group was later (16.5 vs. 9.7 months), the average tumor size of the 2 groups was not different, but when there was brainstem compression, the average tumor size of retromeatal group was larger (49 vs. 44 mm). The clinical presentations of the retromeatal group were related to the cerebellar symptoms, while trigeminal neuropathy symptoms all came from the premeatal group. Gross total resection of the premeatal group was 31% and of the retrometal group was 71%. The results of preserving the facial nerve function of the premeatal group were lower (44 vs. 82%). Postoperative Karnofsky score of the retromeatal group improved, while the premeatal group did not change.

Conclusions:

Classification of CPA meningiomas according to their location to the IAC plays an important role in diagnosis and treatment, affecting clinical symptoms, surgical strategy as well as surgical outcomes.
Diffuse large B-cell lymphoma in a patient treated with azathioprine for ulcerative colitis: a case report
Authors: Sedai Hari , Shrestha Suraj , Chand Vikash , Poddar Elisha , Acharya Suman , Koirala Dinesh
Published: April 2023

Introduction and importance:

Azathioprine (AZA) used as an immunomodulator agent in the management of inflammatory bowel disease (IBD) increases the risk of the development of lymphoma.

Case presentation:

We present a case of a 45-year-old female receiving AZA for severe ulcerative colitis for 4 years. She presented with the chief complaints of bloody stool and abdominal pain for 1 month. Through a series of investigations including colonoscopy, contrast-enhanced computed tomography scan of the abdomen and pelvis, and biopsy with immunohistochemistry; she was diagnosed to have diffuse large B-cell lymphoma of the rectum. She is currently on a chemotherapeutic regimen and is planned for surgical resection after the completion of neoadjuvant therapy.

Clinical discussion:

AZA is classified as a carcinogen by the International Agency for Research on Cancer. Prolonged exposure to higher doses of AZA increases the risk of developing lymphoma in IBD. Previous meta-analysis and research indicate that the risk of development of lymphoma after the use of AZA in IBD increases by about four- to six-fold, especially in older age groups.

Conclusions:

AZA may increase the susceptibility to developing lymphoma in IBD, but the benefit far outweighs the risk. Precautions must be taken in prescribing AZA in older individuals which mandates periodic screening.
Coexistence of multiple clear cell papillary renal cell carcinoma with renal oncocytoma: a case report
Authors: Hermi Amine , Saadi Ahmed , Mokadem Seif , Blel Ahlem , Chakroun Marouene , Ben Slama Mohamed Riadh
Published: April 2023

Introduction and importance:

Clear cell papillary renal cell carcinoma (CCPRCC) is a new entity, previously known as unclassified renal cell carcinoma, and initiallly identified in patients suffering of end-stage kidney failure. It is extremely rare to see this new entity associated with others renal malignant lesions.

Case presentation:

The authors report a case of a female 65-year-old suffering from end-stage kidney failure for 10 years, who presented with a double left renal tumor, composed by an oncocytoma associated to multiple CCPRCC, a very rare entity. A radical left nephrectomy was realized by lumbotomy, with an uneventful postoperative course. Histological examination was challenging. Immunohistological examination showed diffuse positivity of cytokertain 7. No local recurrence nor metastatic progression were found during the 12 months of follow-up.

Clinical discussion:

CCPRCC, is a new entity, previously known as the unclassified rena cell carcinoma, is a malignant renal tumor, initially reported in patients at end-stage kidney failure. Oncocytoma is a well-known rare benign renal tumor. The association of both is rare, and should be kept in mind, especially when scanoguided diagnosis biopsy is realized. Histopathological confirmation may be challenging, given the recent identification of CCPRCC. The nuclei disposal toward the luminal surface is a characteristic pathological landmark of CCPRCC. Immunohistopathological examination is of great help, showing a distinctive profile: diffuse staining for cytokertain 7 and carbonic anhydrase IX.

Conclusion:

CCPRCC is a new malignant pathological entity in renal tumors. It can be associated with other benign renal lesions. This should be taken into consideration while histopathological examination, mainly of scanoguided biopsy cores.
Willingness to accept COVID-19 vaccine and associated factors among adult household members: a short communication
Authors: Bekele Firomsa , Tafese Lalise
Published: April 2023

Even though COVID-19 vaccinations must be effective and safe to stop the pandemic, vaccine skepticism is growing everywhere. One of the challenges to world health today is vaccine hesitancy, which results from peoples’ refusal to accept the vaccine. The author found that the estimated willingness to accept COVID-19 vaccine was 28.4%. Globally, a people’s perceptions and beliefs may have an impact on how well they accept the COVID-19 vaccine. Peoples who have a negative attitude toward vaccinations may be reluctant to get vaccinated. The author recommends the increasing awareness level of the COVID-19 vaccine to increase the vaccine acceptance rate. Therefore, healthcare workers should provide continuous and updated information on the COVID-19 vaccine to increase the awareness level of the communities.
Challenges in diagnosing vaginal mass in a pregnant woman with an underlying duplex collecting system disease: a case report
Authors: Baroudi Ihsan , Mourad Danya , Salman Adnan
Published: April 2023

Introduction and importance:

Congenital renal anomalies are a sequence of defective renal parenchymal or collecting system development and migration that may be discovered during the prenatal period or incidentally among adults. Duplex collecting system diagnosing in adults represents a challenge to physicians. Long-term history of urinary tract infections besides vaginal mass in pregnant women should raise the suspicion of underlying urinary tract malformation.

Case presentation:

In this case, a 23-year-old pregnant woman at 32 weeks came to the clinic for a routine check-up. A vaginal mass had been noticed during the examination and was punctured, revealing unknown fluid. Further investigations revealed left duplex collecting system consisted of an upper moiety opening with a ureterocele in the anterior wall of the vagina and a lower moiety ending with an ectopic orifice near the right ureter orifice. Therefore, the modified Lich–Gregoir procedure was done to reimplant the ureter of the upper renal moiety. Postoperative following-up investigations affirmed improvement without complications.

Clinical discussion:

The duplex collecting system disease may remain asymptomatic until adulthood or present with unexpected symptoms. The subsequent workup in the duplex kidney disease depends on the moieties’ function and the ureter orifice opening site. Although the Weigert–Meyer rule is usually used to describe the typical pattern of duplex collecting system ureters opening sites, it has many expectations in the literature.

Conclusion:

This case shows how some common symptoms may lead to finding an unexpected urinary tract abnormality.
Management of blunt renal trauma on pre-existing diseased kidneys: a cross-sectional study
Authors: Saadi Ahmed , Maatougui Jasser , Hermi Amine , Mokadem Seif , Boussaffa Hamza , Zaghbib Selim , Bellali Mohamed , Allouche Mohamed , Jrad Mariem , Ayed Haroun , Bouzouita Abderrazak , Derouiche Amine , Chakroun Marouene , Ben Slama Mohamed R.
Published: April 2023

Introduction:

Pathological kidney trauma is a special entity. Congenital or acquired lesions may interfere with clinical presentation, radiological imaging, and the therapeutic approach.

Objective:

Our objective was to determine the clinical, radiological, and therapeutic features of this entity.

Materials and methods:

The medical records of 37 observations were retrospectively collected from January 1992 to February 2022. All cases were explored by a kidney ultrasound and/or a computed tomography scan, and classified according to the American Association of Surgery of Trauma. Pre-existing renal abnormalities were found in 37 patients among 203 (18.2%). The most common underlying lesion were urolithiasis (37.8%) followed by pyelo-ureteral junction syndrome (32.4%). Surgical abstention was decided in 11 cases, four nephrectomies were performed as a matter of urgency, and seven nephrectomies were performed remotely. The cure of uropathy was performed after an average delay of 3 months.

Conclusion:

Kidneys with underlying pathology are habitually more susceptible to trauma. Contusions are often benign contrasting with a high nephrectomy rate.
Combination of Cattell-Braasch and Kocher maneuver in laparotomy for diverticular resection in the third part of the duodenum: a case report
Authors: Handaya Adeodatus Y. , Utomo Bambang P. , Andrew Joshua , Hanif Ahmad S. , Tjendra Kevin R. , Subroto Polycarpus D. , Susilo Naufal C.J. , Aditya Azriel F.K.
Published: April 2023

Introduction:

A duodenal diverticulum is an outpouching of all or partial layers of the duodenal wall. Duodenal diverticulum complications such as bleeding, diverticulitis, pancreatitis, choledochal occlusion, and perforation can develop. Localization of the diverticulum in the third part of the duodenum is rare. Surgical intervention with a combination of Cattell-Braasch and Kocher maneuvers in laparotomy is currently emerging as a viable option.

Case presentation:

The authors report a case of a 68-year-old male with chief complaints of black stool and recurring epigastric pain. Barium follow-through showed diverticulum at the third part of the duodenum. Surgery with a combination of Cattell-Braasch and Kocher’s maneuvers using a linear stapler was successful, and there were no intraoperative or postoperative complications. Postoperative barium follow-through showed no diverticulum residue. The patient had no more complaints of black stools nor epigastric pain.

Clinical discussion:

Symptomatic duodenal diverticulum is a rare case with a very small chance of complications. Due to its lack of specific symptoms, imaging examinations play a better role in diagnosis. Surgical intervention is also rarely performed due to the small chance of complications. Diverticulectomy with the use of Cattell-Braasch and the extended Kocher maneuver results in better duodenum exposure, and the usage of a linear stapler also made the surgery safer and quicker to perform.

Conclusion:

The authors propose that a diverticulectomy of the third part of the duodenum performed with a combination of the Cattell-Braasch and Kocher maneuvers with the use of a linear stapler as a safe procedure.
Diagnostic accuracy of two-dimensional and three-dimensional transesophageal echocardiography in detecting pannus and thrombus in left mechanical valve obstruction
Authors: Pham Thao Thi Thanh , Kirkpatrick James N. , Duong Hung Duc , Pham Hung Manh , Vu Thom Thi , Giap Nguyet Thi Minh , Trinh Ha Viet , Nguyen Yen Thi Hai , Hoang Mai Thi Ngoc , Nguyen Hoai Thi Thu
Published: April 2023

Aims:

The aim of this study was to determine the accuracy of two-dimensional and three-dimensional transesophageal echocardiography (TEE) in the detection of pannus and thrombus in left mechanical valve obstruction (LMVO) compared with surgical and histopathology findings.

Materials and methods:

Patients with suspected LMVO on transthoracic echocardiography were enrolled consecutively. All patients underwent two-dimensional and three-dimensional TEE, and open-heart surgery to replace obstructed valves. Macroscopic and microscopic analysis of the excised masses was used as the gold standard for the diagnosis of thrombus and/or pannus.

Results:

Forty-eight patients [34 women (70.8%), age 49±13 years, New York Heart Association II: 68.8%, New York Heart Association III: 31.2%] were enrolled. In the diagnostic of thrombus, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of three-dimensional TEE were 89.2, 72.7, 85.4, 91.7, and 66.7%, respectively, compared with those of two-dimensional TEE (42.2, 66.7, 43.8, 95, and 7.1%, respectively). In the diagnosis of pannus, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of three-dimensional TEE were 53.3, 100, 85.4, 100, and 82.5%, respectively; compared with those of two-dimensional TEE (7.4, 90.5, 43.8, 50, and 43.2%, respectively). Receiver operating characteristic curves depict that the area under the curves of three-dimensional TEE was higher than the area under the curves of two-dimensional TEE in both diagnoses of thrombus and pannus (0.8560 vs. 0.7330, P=0.0427 and 0.8077 vs. 0.5484, P=0.005, respectively).

Conclusions:

This study indicated that three-dimensional TEE had a higher diagnostic value than two-dimensional TEE in the detection of thrombus and pannus in patients with LMVO, and can be a reliable imaging modality to identify the causes of LMVO.
Perceived caregiver’s burden among children with autism spectrum disorder in central Nepal: a cross-sectional study
Authors: Shrestha Manju , Shrestha Navina , Khand Yugant , Sherpa Lhamu
Published: April 2023

Introduction:

Autism spectrum disorder (ASD) is the most common childhood neurodevelopmental disorder characterized by an atypical social and communicative functioning and restricted, repetitive patterns of behaviour activities. Caring for children with ASD is challenging for both parents and their caregivers. This study aims to explore the psychosocial burden of the caregivers of children with ASD.

Materials and methodology:

An analytical cross-sectional study was performed in Centre for Autism in Kathmandu, Nepal. The enrolment occurred between January 2022 and July 2022 among the caregivers of children with ASD. One hundred twenty caregivers in contact with the centre was evaluated using the Zarit Burden Interview-22 during the study period meeting inclusion criteria.

Results:

Our study showed that majority of caregivers among child with ASD were mothers 65 (54.16%, n=65) followed by grandparents 35 (29.16%, n=35) and father 13 (10.8%), respectively. Among them, most of the caregivers perceived moderate to severe burden 57 (47.5%) followed by mild to moderate burden 45 (37.5%) and only 7 (5.8%) of the caregivers perceived severe burden during the study which was found to be statistically significant.

Conclusions:

This study highlighted the fact that although most of the caregivers perceived moderate to severe burden while caring a child with ASD. The degree of burden significantly correlated with the level of ASD in the child.
Prevalence and difference of COVID-19 symptoms, post-COVID conditions and duration of illness among the vaccinated and unvaccinated population: a cross-sectional study in Peshawar
Authors: Rahman Asad , Ikram Muhammad T. , Arif Amina , Khan Bakht D. , Azam Kamal U. , Fida Muhammad Sanaan , Rahim Adam K. , Khan Muhammad S. , Mushtaq Muhammad H. , Fida Raiyan , Yunus Hamza , Khan Mohammad D.
Published: April 2023

Background:

Studies on coronavirus disease 2019 (COVID-19) symptoms, post-coronavirus disease (COVID) conditions, and vaccination outcomes in Pakistan are limited and inconsistent. The study investigated differences in symptoms and post-COVID conditions between vaccinated and unvaccinated individuals and the impact of vaccination on illness duration based on existing literature.

Methods:

The study was a 3-month cross-sectional study conducted in Peshawar, Pakistan. It targeted individuals aged 16 and above who had contracted COVID-19 at least once during the recent pandemic, regardless of gender, and confirmed through reverse transcriptase polymerase chain reaction testing. The sample size was 250, determined using the WHO sample size calculator. Data were collected through questionnaires after obtaining verbal consent and analyzed using IBM SPSS version 26, taking into account their vaccination status along with other important variables.

Results:

Among the 250 respondents, 143 (57.2%) were unvaccinated, while 107 (42.8%) were vaccinated at the time of contracting COVID-19. Unvaccinated subjects developed a greater variety of symptoms that lasted for longer durations (P<0.001) with symptoms like dyspnea [55 (38.5%,P=0.011)], anosmia [76 (53.1%,P=0.001)], and chest pain [24 (16.8%,P=0.029)] occurring at greater percentages. Sixty-one (42.7%) unvaccinated subjects reported post-COVID conditions as opposed to 29 (27.1%) among the vaccinated group [P=0.011; odds ratio (OR)=0.5; 95% CI=0.29–0.86].

Conclusion:

The study found that COVID-19 vaccination can reduce the duration and frequency of symptoms, as well as post-COVID conditions. This is the first research of its kind conducted in Peshawar, Pakistan, and may serve as a foundation for future research in this demographic.
Factors associated with anemia among pregnant women attended antenatal care: a health facility-based cross-sectional study
Authors: Balcha Wondu F. , Eteffa Tola , Tesfu Azimeraw A. , Alemayehu Bezawit A. , Chekole Fentahun A. , Ayenew Asteray A. , Gessesse Nigusu A. , Getu Alemwork A. , Kassahun Eden A. , Gezahegn Tigist W. , Adugna Kebede F. , Nega Amanuel T.
Published: April 2023

Introduction:

Anemia is characterized by a decline in the number or size of red blood cells and Hb concentration, which results in impairment capacity to transport oxygen. It is a major cause of indirect maternal mortality. Anemia is largely preventable and easily treatable, if detected in time; however, it remains one of the leading causes of maternal morbidity and mortality, especially in developing countries. This study aimed to assess factors associated with anemia among pregnant women who attended antenatal care.

Methods:

A health facility-based cross-sectional study was conducted from 1 February 2020 to 2 March 2020 among 420 pregnant women. The data were collected by systematic random sampling technique, entered into a computer using EpiData 3.5, and analyzed using the Statistical Package of Social Sciences 23.0 version. Bivariate and multivariable logistic regression analyses were done to estimate the crude and adjusted odds ratio with a CI of 95% and aP-value of less than 0.05 considered statistically significant. Frequency tables, figures, and descriptive summaries were used to describe the study variables.

Results:

The overall prevalence of anemia was 32.9% (95% CI: 28.6–37.4), and it was higher in rural than urban pregnant women (45 vs. 23%), respectively. In multivariable analysis women who are found in the age group of greater than or equal to 30 years (AOR=3.45, 95% CI=1.22–9.78), rural residency (AOR=3.51, 95% CI=1.92–6.42), low family income (AOR=3.10, 95% CI=1.19–8.08), multiparty (AOR=2.91, 95% CI=1.33–6.38), a short interpregnancy gap (AOR 3.32, 95% CI=1.69–6.53), not taking iron and folate (AOR=4.83, 95% CI=2.62–9.90), third trimester of pregnancy (AOR=3.21, 95% CI=1.25–8.25), poor minimum dietary diversity score (AOR=3.54, 95% CI=1.58–7.95), undernourished (AOR=4.9, 95% CI=2.19–7.64), poor knowledge of anemia (AOR=3.19, 95% CI=1.72–5.93), consumption of coffee always after meal per day (AOR=3.24, 95% CI=1.42–7.42), having a history of irregular menstruation, and antepartum hemorrhage were significantly associated with anemia in pregnant women.

Conclusion:

This study showed that the prevalence of anemia in pregnant women in this study area was a moderate public health problem. The author suggest emphasizing the education and counseling of women on the advantage of taking the supplemented iron and folic acid. Health care providers should have to advise women to stay for at least 2 years before the next pregnancy to reduce the risk of adverse maternal and infant outcomes. Awareness creation in the community on the utilization of insecticide-treated bed nets is also needed.
High-dose intravenous versus low-dose oral vitamin C in burn care: potential protective effects in the severely burned: a retrospective cohort study
Authors: Malkoc Aldin , Jong Seungwon , Fine Kerry , Wong David T.
Published: April 2023

Background:

Antioxidant therapies, such as ascorbic acid may have an important role during the acute phase of burn management. However, there are mixed results on the most effective dose and method of administration of ascorbic acid in burn patients. In this study, we compared the efficacy of intravenously and orally administered ascorbic acid in second-degree burns greater than 20% total-body-surface-area.

Materials and methods:

The hospital burn database was used to obtain data on all patients with second-degree or deeper burns of 20% total-body-surface-area or greater. Fourteen patients were selected at random to receive a scheduled dose of 1250 mg intravenous ascorbic acid every 6 h for 72 h. This was considered the high-dose group. During same period, 40 patients received scheduled 500 mg oral ascorbic acid every 6 h for 72 h and this was considered the low-dose group. We gathered sociodemographic and clinical variables associated with ascorbic acid dosing.

Results:

In our study, statistically significant variables were fluid requirements (p<0.001), hospital stay (p=0.011), length of time intubated on ventilator (p<0.001), colloids used (p=0.002), and total procedures required (p=0.014). Despite higher modified Baux predicted mortality in the high-dose group (10 patients vs. 24 patients, p=0.026) there was no noted significant association in days until the first infection and mortality rate (p=0.451 and 0.326, respectively).

Conclusions:

The calculated modified Baux predicted a higher mortality rate with the higher dosing group, yet this study did not find a mortality difference between the groups. We speculate that high-dose intravenous ascorbic acid may have protective effects in burn resuscitation. This finding may support some previous studies that found that high-dose ascorbic acid may improve clinical outcomes.
Risk factors associated with the reported scores on the symptoms severity and functional limitations scales of the Boston Carpal Tunnel Questionnaire: a cross-sectional study
Authors: Al-Jasim Ameer , Sarhan Fajr M.A. , Al-Abbasi Ghaith , Ali Ali B. , Alaraj Rami S.N. , Yasin Diana , Macciacchera Matthew , Bouchard Marc , Ibrahim Ibrahim K.
Published: April 2023

Background:

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. It presents with numbness, paresthesias, and pain. Multiple risk factors are associated with CTS, such as pregnancy, oral contraceptive use, rheumatoid arthritis (RA), and diabetes mellitus (DM). The Boston Carpal Tunnel Questionnaire (BCTQ) is a self-administered questionnaire for assessing the severity of symptoms and functional status of those previously diagnosed with CTS. We aim to identify risk factors associated with higher scores of CTS symptoms severity and functional limitations scales on the BCTQ.

Materials and methods:

This cross-sectional study was conducted among 366 female participants. The data was mainly collected using the BCTQ. Demographics and risk factors of CTS were added to the study’s complete questionnaire; risk factors included RA, DM, hypothyroidism, number of pregnancies, usage of oral contraceptive pills (OCPs), use of smartphones and keyboards. A P value of less than 0.05 was considered statistically significant.

Results:

Most participants were in their 30s (44%) and housewives. RA, DM, hypothyroidism, and pregnancy were associated with reporting symptoms and functional limitations on BCTQ. OCPs and smartphone use were associated with functional limitations only.

Conclusion:

Different risk factors are associated with reporting symptoms and functional limitations of CTS on the BCTQ. For example, RA, DM, hypothyroidism, pregnancy, OCPs, and smartphone use have all been found to statistically affect the outcome of the BCTQ in this study. Therefore, clinical confirmation of the CTS diagnosis is required in future studies to ensure that these symptoms and functional limitations are associated with the CTS pathology rather than other risk factors and pathologies for proper targeted treatment plans and outcomes.
Effects of the Mandibular Functional Units and Soft Tissue on Facial Asymmetry
Authors: Jo Hyunmi , Park Jaehan , Park Jin Hoo , Kim Jun-Young , Jung Young-Soo , Jung Hwi-Dong
Published: April 2023

Mandibular asymmetry has a variety of patterns because they are affected the position and the shape of mandible in addition to the overlying soft tissue. This study aimed to assess the factor in mandibular asymmetry, focusing on each mandibular functional units and the soft tissue thickness in the mandibular angle area. Forty patients who were diagnosed with facial asymmetry and undergone the orthognathic surgery without genioplasty were enrolled in this study. The skeletal patterns of the patients were analyzed by using cone-beam computed tomography data and 3D virtual images divided into 2 categories; the mandibular functional unit length and the soft tissue depth. All difference in bilateral mandibular functional unit lengths had a statistically significant with chin top deviation (P<0.05). The greatest correlation was the condylar unit length compared with other functional units. The soft tissue thickness in the mandibular angle area was not statistically related to chin top deviation (P>0.05), and the soft tissue did not change remarkably after orthognathic surgery (P>0.05). This study suggests that the considerations of a surgical plan for treatment based on the mandibular asymmetry.
Recent advances in artificial intelligence applications for supportive and palliative care in cancer patients
Authors: Reddy Varun , Nafees Abdulwadud , Raman Srinivas
Published: April 2023

Purpose of Review

Artificial intelligence (AI) is a transformative technology that has the potential to improve and augment the clinical workflow in supportive and palliative care (SPC). The objective of this study was to provide an overview of the recent studies applying AI to SPC in cancer patients.

Recent Findings

Between 2020 and 2022, 29 relevant studies were identified and categorized into two applications: predictive modeling and text screening. Predictive modeling uses machine learning and/or deep learning algorithms to make predictions regarding clinical outcomes. Most studies focused on predicting short-term mortality risk or survival within 6 months, while others used models to predict complications in patients receiving treatment and forecast the need for SPC services. Text screening typically uses natural language processing (NLP) to identify specific keywords, phrases, or documents from patient notes. Various applications of NLP were found, including the classification of symptom severity, identifying patients without documentation related to advance care planning, and monitoring online support group chat data.

This literature review indicates that AI tools can be used to support SPC clinicians in decision-making and reduce manual workload, leading to potentially improved care and outcomes for cancer patients. Emerging data from prospective studies supports the clinical benefit of these tools; however, more rigorous clinical validation is required before AI is routinely adopted in the SPC clinical workflow.
Current practices in managing end-of-life existential suffering
Authors: Di Risio Michelle , Thompson Alison
Published: April 2023

Purpose of the review

Within the context of palliative care, existential suffering (ES) can be an exclusive source of suffering or intertwined with physical pain and/or psychological and spiritual suffering. With newly emerging modalities for addressing this phenomenon and its increasing salience given that many patients cite ES as a significant contributing factor to requests for hastened death, a review of recent interventions for addressing ES at the end of life is timely.

Recent findings

This review of newer approaches to dealing with ES in the palliative context suggests some promising new modalities and pharmacological interventions, such as brain stimulation and the use of psychedelics. The use of other pharmacological interventions, such as palliative sedation and lethal injections, solely for the alleviation of existential distress remains ethically controversial and difficult to disentangle from other forms of suffering, not least because a clear clinical definition of ES has yet to emerge in the literature.

The evaluation of end-of-life (EOL) ES mitigating tools should also consider how broader contexts, such as institutional arrangements and barriers, and cultural factors may influence the optimal management of dying persons’ ES in the palliative care setting.
Rethinking protocolized completion angiography following extremity vascular trauma: A prospective observational multicenter trial
Authors: Niziolek Grace M. , Keating Jane , Bailey Joanelle , Klingensmith Nathan J. , Moren Alexis M. , Skarupa David J. , Loria Anthony , Vella Michael A. , Maher Zoe , Moore Sarah Ann , Smith Michael C. , Leung Amanda , Shuster Kevin M. , Seamon Mark J.
Published: April 2023

BACKGROUND

Completion angiography (CA) is commonly used following repair of extremity vascular injury and is recommended by the Eastern Association for the Surgery of Trauma practice management guidelines for extremity trauma. However, it remains unclear which patients benefit from CA because only level 3 evidence exists.

METHODS

This prospective observational multicenter (18LI, 2LII) analysis included patients 15 years or older with extremity vascular injuries requiring operative management. Clinical variables and outcomes were analyzed with respect to with our primary study endpoint, which is need for secondary vascular intervention.

RESULTS

Of 438 patients, 296 patients required arterial repair, and 90 patients (30.4%) underwent CA following arterial repair. Institutional protocol (70.9%) was cited as the most common reason to perform CA compared with concern for inadequate repair (29.1%). No patients required a redo extremity vascular surgery if a CA was performed per institutional protocol; however, 26.7% required redo vascular surgery if the CA was performed because of a concern for inadequate repair. No differences were observed in hospital mortality, length of stay, extremity ischemia, or need for amputation between those who did and did not undergo CA.

CONCLUSION

Completion angiogram following major extremity injury should be considered in a case-by-case basis. Limiting completion angiograms to those patients with concern for an inadequate vascular repair may limit unnecessary surgery and morbidity.

LEVEL OF EVIDENCE

Therapeutic/Care Management; Level III.
Automated partial resuscitative endovascular balloon occlusion of the aorta reduces blood loss and hypotension in a highly lethal porcine liver injury model
Authors: Cambronero Gabriel E. , Sanin Gloria D. , Patel Nathan T.P. , Ganapathy Aravindh S. , Lane Magan R. , Patterson James W. , Niebler Jacob A.P. , Johnson M. Austin , Rahbar Elaheh , Jordan James E. , Neff Lucas P. , Williams Timothy K.
Published: April 2023

BACKGROUND

Partial and intermittent resuscitative endovascular balloon occlusion of the aorta (pREBOA and iREBOA, respectively) are lifesaving techniques designed to extend therapeutic duration, mitigate ischemia, and bridge patients to definitive hemorrhage control. We hypothesized that automated pREBOA balloon titration compared with automated iREBOA would reduce blood loss and hypotensive episodes over a 90-minute intervention phase compared with iREBOA in an uncontrolled liver hemorrhage swine model.

METHODS

Twenty-four pigs underwent an uncontrolled hemorrhage by liver transection and were randomized to automated pREBOA (n = 8), iREBOA (n = 8), or control (n = 8). Once hemorrhagic shock criteria were met, controls had the REBOA catheter removed and received transfusions only for hypotension. The REBOA groups received 90 minutes of either iREBOA or pREBOA therapy. Surgical hemostasis was obtained, hemorrhage volume was quantified, and animals were transfused to euvolemia and then underwent 1.5 hours of automated critical care.

RESULTS

The control group had significantly higher mortality rate (5 of 8) compared with no deaths in both REBOA groups, demonstrating that the liver injury is highly lethal (p = 0.03). During the intervention phase, animals in the iREBOA group spent a greater proportion of time in hypotension than the pREBOA group (20.7% [16.2–24.8%] vs. 0.76% [0.43–1.14%]; p < 0.001). The iREBOA group required significantly more transfusions than pREBOA (21.0 [20.0–24.9] mL/kg vs. 12.1 [9.5–13.9] mL/kg; p = 0.01). At surgical hemostasis, iREBOA had significantly higher hemorrhage volumes compared with pREBOA (39.2 [29.7–44.95] mL/kg vs. 24.7 [21.6–30.8] mL/kg; p = 0.04).

CONCLUSION

Partial REBOA animals spent significantly less time at hypotension and had decreased transfusions and blood loss. Both pREBOA and iREBOA prevented immediate death compared with controls. Further refinement of automated pREBOA is necessary, and controller algorithms may serve as vital control inputs for automated transfusion.

LEVEL OF EVIDENCE

Therapeutic/Care Management; Level III.