bluuebunny/crossref_metadata_2025 huggingface dataset:
Viral intra-host evolutionary dynamics revealed via serial passage of Japanese encephalitis virus in vitro
Authors: Sun Bangyao , Ni Ming , Liu Haizhou , Liu Di
Published: March 2023

Analyses of viral inter- and intra-host mutations could better guide the prevention and control of infectious diseases. For a long time, studies on viral evolution have focused on viral inter-host variations. Next-generation sequencing has accelerated the investigations of viral intra-host diversity. However, the theoretical basis and dynamic characteristics of viral intra-host mutations remain unknown. Here, using serial passages of the SA14-14-2 vaccine strain of Japanese encephalitis virus (JEV) as the in vitro model, the distribution characteristics of 1,788 detected intra-host single-nucleotide variations (iSNVs) and their mutated frequencies from 477 deep-sequenced samples were analyzed. Our results revealed that in adaptive (baby hamster kidney (BHK)) cells, JEV is under a nearly neutral selection pressure, and both non-synonymous and synonymous mutations represent an S-shaped growth trend over time. A higher positive selection pressure was observed in the nonadaptive (C6/36) cells, and logarithmic growth in non-synonymous iSNVs and linear growth in synonymous iSNVs were observed over time. Moreover, the mutation rates of the NS4B protein and the untranslated region (UTR) of the JEV are significantly different between BHK and C6/36 cells, suggesting that viral selection pressure is regulated by different cellular environments. In addition, no significant difference was detected in the distribution of mutated frequencies of iSNVs between BHK and C6/36 cells.
Formation of Interpersonal Competencies Through Interprofessional Simulation
Authors: Rojas Reyes Jennifer , Macias Inzunza Lylian , Baeza Contreras Marcela , Arévalo Valenzuela Carolina , Munilla González Viviana
Published: March 2023

AIM

The aim of this study was to analyze the process of interpersonal competencies formation in nursing and medical students who participated in a standardized interprofessional clinical simulation.

BACKGROUND

Interprofessional education in health sciences has had an important impact on the development of relational qualities centered on the patient.

METHOD

The study followed a qualitative interpretive approach with students. Students who participated in clinical simulation activities were asked about their experiences and their learning process with respect to interpersonal competencies. A thematic analysis of the data was performed

RESULTS

Three themes emerged: 1) approaching the practice with uncertainty and fear of new relationships, 2) reflecting on decisions while recognizing distinctive roles, and 3) recognizing the human sense of practice while developing skills for caring and curing.

CONCLUSION

Students underwent this process and learned about empathy, communication, critical reflexive thinking, and teamwork.
Development of Cultural Competence: The Effects of a Virtual Exchange Between US and Omani Nursing Students
Authors: Emerson Christie , Keen Diane
Published: March 2023

Development of cultural competence is essential for nurses to meet the needs of patients, families, and communities. Immersion experiences abroad have been shown to facilitate the development of cultural competence in nursing students; not all students are able to participate in these experiences. Virtual exchange is an alternative type of immersion experience that requires no travel and few resources. The purpose of this study was to examine the effects of a virtual exchange between bachelor of science in nursing students in the United States and the Sultanate of Oman on the development of cultural competence.
Implementation of Lung-Protective Ventilation in Patients With Acute Respiratory Failure*
Authors: Grissom Colin K. , Lanspa Michael J. , Groat Danielle , Jacobs Jason R. , Carpenter Lori , Kuttler Kathryn G. , Leither Lindsay , Peltan Ithan D. , Brown Samuel M. , Srivastava Rajendu
Published: March 2023

OBJECTIVES:

We implemented a computerized protocol for low tidal volume ventilation (LTVV) to improve management and outcomes of mechanically ventilated patients with, and without, the acute respiratory distress syndrome (ARDS).

DESIGN:

Pragmatic, nonrandomized stepped wedge type II hybrid implementation/effectiveness trial.

SETTING:

Twelve hospitals in an integrated healthcare system over a 2-year period.

PATIENTS:

Patients greater than or equal to 18 years old who had initiation of mechanical ventilation in the emergency department or ICU. We excluded patients who died or transitioned to comfort care on the day of admission to the ICU. We defined a subgroup of patients with ARDS for analysis.

INTERVENTIONS:

Implementation of ventilator protocols for LTVV in the ICU.

MEASUREMENTS AND MAIN RESULTS:

Our primary clinical outcome was ventilator-free days (VFDs) to day 28. Our primary process outcome was median initial set tidal volume. We included 8,692 mechanically ventilated patients, 3,282 (38%) of whom had ARDS. After implementation, set tidal volume reported as mL/kg predicted body weight decreased from median 6.1 mL/kg (interquartile range [IQR], 6.0–6.8 mL/kg) to 6.0 mL/kg (IQR, 6.0–6.6 mL/kg) (p = 0.009). The percent of patients receiving LTVV (tidal volume ≤ 6.5 mL/kg) increased from 69.8% (n = 1,721) to 72.5% (n = 1,846) (p = 0.036) after implementation. The percent of patients receiving greater than 8 mL/kg initial set tidal volume was reduced from 9.0% (n = 222) to 6.7% (n = 174) (p = 0.005) after implementation. Among patients with ARDS, day 1 positive end-expiratory pressure increased from 6.7 to 8.0 cm H2O (p < 0.001). We observed no difference in VFD (adjusted odds ratio, 1.06; 95% CI, 0.91–1.24; p = 0.44), or in secondary outcomes of length of stay or mortality, either within the main cohort or the subgroup of patients with ARDS.

CONCLUSIONS:

We observed improved adherence to optimal ventilator management with implementation of a computerized protocol and reduction in the number of patients receiving tidal volumes greater than 8 mL/kg. We did not observe improvement in clinical outcomes.
Latest incidence and electrocardiographic predictors of atrial fibrillation: a prospective study from China
Authors: Wei Yong , Zhou Genqing , Wu Xiaoyu , Lu Xiaofeng , Wang Xingjie , Wang Bin , Wang Caihong , Shen Yahong , Peng Shi , Ding Yu , Xu Juan , Cai Lidong , Chen Songwen , Yang Wenyi , Liu Shaowen
Published: March 2023

Background:

China bears the biggest atrial fibrillation (AF) burden in the world. However, little is known about the incidence and predictors of AF. This study aimed to investigate the current incidence of AF and its electrocardiographic (ECG) predictors in general community individuals aged over 60 years in China.

Methods:

This was a prospective cohort study, recruiting subjects who were aged over 60 years and underwent annual health checkups from April to July 2015 in four community health centers in Songjiang District, Shanghai, China. The subjects were then followed up from 2015 to 2019 annually. Data on sociodemographic characteristics, medical history, and the resting 12-lead ECG were collected. Kaplan–Meier curve was used for showing the trends in AF incidence and calculating the predictors of AF. Associations of ECG abnormalities and AF incidence were examined using Cox proportional hazard models.

Results:

This study recruited 18,738 subjects, and 351 (1.87%) developed AF. The overall incidence rate of AF was 5.2/1000 person-years during an observation period of 67,704 person-years. Multivariable Cox regression analysis indicated age (hazard ratio [HR], 1.07; 95% confidence interval [CI]: 1.06–1.09; P < 0.001), male (HR, 1.30; 95% CI: 1.05–1.62; P = 0.018), a history of hypertension (HR, 1.55; 95% CI: 1.23–1.95; P < 0.001), a history of cardiac diseases (HR, 3.23; 95% CI: 2.34–4.45; P < 0.001), atrial premature complex (APC) (HR, 2.82; 95% CI: 2.17–3.68; P < 0.001), atrial flutter (HR, 18.68; 95% CI: 7.37–47.31; P < 0.001), junctional premature complex (JPC) (HR, 3.57; 95% CI: 1.59–8.02; P = 0.002), junctional rhythm (HR, 18.24; 95% CI: 5.83–57.07; P < 0.001), ventricular premature complex (VPC) (HR, 1.76; 95% CI: 1.13–2.75, P = 0.012), short PR interval (HR, 5.49; 95% CI: 1.36–22.19; P = 0.017), right atrial enlargement (HR, 6.22; 95% CI: 1.54–25.14; P = 0.010), and pacing rhythm (HR, 3.99; 95% CI: 1.57–10.14; P = 0.004) were independently associated with the incidence of AF.

Conclusions:

The present incidence of AF was 5.2/1000 person-years in the studied population aged over 60 years in China. Among various ECG abnormalities, only APC, atrial flutter, JPC, junctional rhythm, short PR interval, VPC, right atrial enlargement, and pacing rhythm were independently associated with AF incidence.
Detection of Speech-Language Delay in the Primary Care Setting: An Electronic Health Record Investigation
Authors: Frelinger Catherine , Gardner Rebecca M. , Huffman Lynne C. , Whitgob Emily E. , Feldman Heidi M. , Bannett Yair
Published: March 2023

Objective:

The purpose of this study is to determine the rate and age at first identification of speech-language delay in relation to child sociodemographic variables among a pediatric primary care network.

Methods:

We analyzed a deidentified data set of electronic health records of children aged 1- to 5-years-old seen between 2015 and 2019 at 10 practices of a community-based pediatric primary health care network. Primary outcomes were numbers (proportions) of patients with relevant ICD-10 visit-diagnosis codes and patient age (months) at first documentation of speech-language delay. Regression models estimated associations between outcomes and patient characteristics, adjusting for practice affiliation.

Results:

Of 14,559 included patients, 2063 (14.1%) had speech-language delay: 68.4% males, 74.4% with private insurance, and 96.1% with English as a primary household language. Most patients (60%) were first identified at the 18- or 24-month well-child visit. The mean age at first documentation was 25.4 months (SD = 9.3), which did not differ between practices reporting the use of standardized developmental screener and those using surveillance questionnaires. Regression models showed that males were more than twice as likely than females to be identified with speech-language delay (adjusted odds ratio [aOR] = 2.05, 95% CI: [1.86–2.25]); publicly insured were more likely than privately insured patients to be identified with speech-language delay (aOR = 1.48, 95% CI: [1.30–1.68]). Females were older than males at first identification (+1.2 months, 95% CI: [0.3–2.1]); privately insured were older than military insured patients (private +3.3 months, 95% CI: [2.2–4.4]).

Conclusion:

Pediatricians in this network identified speech-language delays at similar rates to national prevalence. Further investigation is needed to understand differences in speech-language delay detection across patient subgroups in practices that use developmental screening and/or surveillance.
ECHO (Extension for Community Healthcare Outcomes) Autism STAT: A Diagnostic Accuracy Study of Community-Based Primary Care Diagnosis of Autism Spectrum Disorder
Authors: Sohl Kristin , Levinstein Leeore , James Alexandra , Greer Sophia , Boles Katrina , Curran Alicia Brewer , Mahurin Melissa , Mazurek Micah O. , Nanclares Valeria
Published: March 2023

Objective:

Children can be reliably diagnosed with autism spectrum disorder (ASD) by a highly trained clinician as early as 12 to 24 months of age, but recent estimates indicate that the average age of diagnosis is 4.4 years. We hypothesized that trained primary care physicians and practitioners can reliably and accurately diagnose children 14 to 48 months with unambiguous symptoms of ASD.

Methods:

Through this diagnostic accuracy study, 20 patients diagnosed with ASD by clinicians trained through the ECHO (Extension for Community Healthcare Outcomes) Autism STAT program participated in an independent gold-standard evaluation at a regional autism center. Caregiver perceptions of the diagnostic process were also assessed.

Results:

Of the 20 patients who received a diagnosis of ASD by a trained clinician and completed the study, 19 diagnoses were confirmed by a gold-standard evaluation. Caregivers indicated that undergoing diagnosis in their local community rather than an autism specialty center was helpful (4.8/5 on a 5-point Likert scale, n = 19). Results of this study demonstrate that primary care clinicians can be trained to reliably diagnose ASD in children 14 to 48 months with unambiguous symptoms.

Conclusion:

Diagnosis in the primary care setting may lead to earlier diagnosis and quicker connection to evidence-based therapies and interventions. Given the potential impact of increasing access to high-quality diagnostic services, the role of primary care clinicians in the diagnosis of ASD should be further evaluated.
Use of a Three-dimensional Smartphone Scanner in the Quantitative Analysis of Repaired Unilateral Cleft Lip during the Coronavirus Disease Pandemic
Authors: Sari Kartika P. , Saputro Iswinarno D. , Hariani Lynda
Published: March 2023

Background:

Cleft lip, a major craniofacial abnormality, is highly prevalent among people with low socioeconomic status in Indonesia. Direct two-dimensional measurement of the affected region is the gold standard for surgical preparation; however, its compliance and usability are limited in pediatric patients. Modern smartphones, including iPhones, are equipped with high-resolution cameras, which can record images and videos of a face. Here, we investigated whether a three-dimensional (3D) smartphone scanner can be used for the facial measurements of patients with unilateral cleft lip.

Methods:

Twelve facial measurements were acquired after cleft lip surgery in three female and seven male patients (aged 11–29 months) with unilateral cleft lip using direct anthropometry and a 3D smartphone scanner. The accuracy and precision of the 3D smartphone scanner were assessed through comparative analyses (t test and Bland–Altman plot).

Results:

The anthropometric data obtained using the 3D smartphone scanner matched the direct measurement data. The linear measurements did not differ significantly between two-dimensional and 3D modalities (P > 0.05). The intraobserver reliabilities of the two-dimensional smartphone scanner of the first and second observers were high (intraclass correlation coefficient 0.876–0.993 and Cronbach alpha 0.920–0.998) and moderate to high (intraclass correlation coefficient 0.839–0.996 and Cronbach alpha 0.940–0.996), respectively. Inter-observer data showed an intraclass correlation coefficient of 0.876–0.981 and a Cronbach α of 0.960–0.997.

Conclusion:

The 3D smartphone scanner is effective, efficient, economical, quick, and feasible for facial measurements of patients with unilateral cleft lip and is a viable alternative to direct two-dimensional measurements.
Xenogeneic cross-circulation for physiological support and recovery of ex vivo human livers
Authors: Wu Wei Kelly , Ukita Rei , Patel Yatrik J. , Cortelli Michael , Trinh Vincent Q. , Ziogas Ioannis A. , Francois Sean A. , Mentz Meredith , Cardwell Nancy L. , Talackine Jennifer R. , Grogan William M. , Stokes John W. , Lee Youngmin A. , Kim Jinho , Alexopoulos Sophoclis P. , Bacchetta Matthew
Published: March 2023

Background and Aims:

The scarcity of suitable donor livers highlights a continuing need for innovation to recover organs with reversible injuries in liver transplantation.

Approach and Results:

Explanted human donor livers (n = 5) declined for transplantation were supported using xenogeneic cross-circulation of whole blood between livers and xeno-support swine. Livers and swine were assessed over 24 hours of xeno-support. Livers maintained normal global appearance, uniform perfusion, and preservation of histologic and subcellular architecture. Oxygen consumption increased by 75% (p = 0.16). Lactate clearance increased from −0.4 ± 15.5% to 31.4 ± 19.0% (p = 0.02). Blinded histopathologic assessment demonstrated improved injury scores at 24 hours compared with 12 hours. Vascular integrity and vasoconstrictive function were preserved. Bile volume and cholangiocellular viability markers improved for all livers. Biliary structural integrity was maintained.

Conclusions:

Xenogeneic cross-circulation provided multisystem physiological regulation of ex vivo human livers that enabled functional rehabilitation, histopathologic recovery, and improvement of viability markers. We envision xenogeneic cross-circulation as a complementary technique to other organ-preservation technologies in the recovery of marginal donor livers or as a research tool in the development of advanced bioengineering and pharmacologic strategies for organ recovery and rehabilitation.
REAL WORLD STUDY COMPARING PHAKIC VERSUS PSEUDOPHAKIC EYES IN DIABETIC MACULAR EDEMA TREATED WITH DEXAMETHASONE IMPLANT
Authors: Mathis Thibaud , Rezkallah Amina , Ricard Cécile , Vartin Cristina , Abukhashabah Amro , Devin François , Kodjikian Laurent
Published: March 2023

Purpose:

Dexamethasone implant (DEX-implant) is one treatment choice in diabetic macular edema. However, steroid-induced cataract is a common complication when treating a chronic disease and could lead to vision loss. Because of the lack of studies specifically focused on the functional outcomes according to the lens status, the authors therefore aim to analyze the effectiveness and safety of DEX-implant treatment for diabetic macular edema in phakic versus pseudophakic eyes.

Methods:

This multicenter, retrospective study conducted in France included eyes of consecutive patients who had received a DEX-implant for diabetic macular edema.

Results:

A total of 328 eyes were included: 158 eyes (48.2%) were phakic, 167 eyes (50.9%) were pseudophakic and three were unknown. According to the lens status, mean change in best-corrected visual acuity from baseline was never significantly different between phakic and pseudophakic eyes (likelihood ratio test, P = 0.09) nor in the change in central macular thickness (likelihood ratio test, P = 0.79) in multivariate analysis. Cataract surgery was performed in 63 phakic eyes (39.9%) during the study period with a mean delay of 8.1 months (CI95% [6.59–9.69]). The mean change in best-corrected visual acuity between phakic eyes who underwent cataract surgery and those who did not, was not significantly different during the follow-up at each visit. The risk of ocular hypertension was not statistically different between phakic and pseudophakic subsets (P = 0.9).

Conclusion:

The authors showed here that phakic eyes treated with DEX-implant for diabetic macular edema did not have a significant difference in visual gain in comparison to pseudophakic eyes, with a comparable safety profile.
WHEN THE PICTURE MASKS THE DIAGNOSIS - AN ATYPICAL AND SEVERE GIANT CELL ARTERITIS CASE REPORT
Authors: Moleiro Ana Filipa , Vilares-Morgado Rodrigo , Falcão-Reis Fernando , Torres-Costa Sónia
Published: March 2023

Purpose:

The purpose of this study was to describe an atypical and severe case of giant cell arteritis (GCA).

Methods:

This was a case report description.

Results:

The authors report the case of a 76-year-old man who presented with severe and progressive bilateral visual loss. On presentation at the ophthalmology emergency room, the patient's right eye (OD) displayed aqueous flare, hyphema, rubeosis iridis, and dense posterior capsular opacification. After YAG laser capsulotomy, vitreous densifications, intraretinal hemorrhages, cotton wool spots, retinal ischemia, and vasculitis were observed in the fundoscopy. The patient's left eye (OS) also presented intraretinal hemorrhages and cotton wool spots around the temporal arcades. The diagnostic workup excluded infectious diseases, demyelinating diseases, and ocular ischemic syndrome due to carotid obstruction. Proteinogram revealed a monoclonal gammopathy, suggesting a possible hematologic condition. High-dose corticotherapy was initiated, which improved the vitreous densifications and enabled the visualization of the pale optic disk. The remaining study did not confirm the diagnosis of hematologic disease. During follow-up, bilateral VA deteriorated, with the development of progressive pallor in the OS optic disk. Follow-up fluorescein angiography demonstrated progressive retinal and choroidal ischemia. Finally, owing to high clinical suspicion, temporal artery Doppler ultrasound was performed, confirming the diagnosis of GCA.

Conclusion:

GCA may present multiple ocular features. The knowledge of these different presentations, including retinal and choroidal ischemia or uveitis, is critical for timely diagnosis and treatment initiation. Since patients with GCA often present with vision loss, ophthalmologists may be the first medical doctors who contact with these patients, being on the frontline of GCA diagnosis.
CLINICAL CHARACTERISTICS AND MULTIMODAL IMAGING FINDINGS IN UNILATERAL FROSTED BRANCH ANGIITIS: A CASE REPORT
Authors: Lari Giorgio , Battista Marco , Marchese Alessandro , Bordato Alessandro , Lattanzio Rosangela , Querques Giuseppe , Modorati Giulio , Bandello Francesco , Miserocchi Elisabetta
Published: March 2023

Purpose:

Our aim was to report a comprehensive multimodal imaging case of unilateral frosted branch angiitis in a 40-year-old White woman.

Methods:

Case report involving clinical examination, ultra-wide field fundus photograph, ultra-wide field fluorescein angiography, optical coherence tomography (OCT) and OCT angiography.

Results:

A 40-year-old patient presented with unilateral acute vision loss. On fundus examination, extensive retinal veins sheathing, macular edema, and vascular congestion were observed while ultra-wide field fluorescein angiography revealed a hyperfluorescent “hot” optic disc and blood retinal barrier disruption. Optical coherence tomography angiography displayed foveal avascular zone enlargement and excluded papillary neovascularization. Extensive laboratory workup for infectious, autoimmune, and inflammatory disorders was negative; thus, a diagnose of acute idiopathic unilateral frosted branch angiitis was made. Intravitreal injection of dexamethasone implant was administered with a good clinical response.

Conclusion:

Multimodal imaging is crucial to correctly diagnose and treat frosted branch angiitis. To the best of our knowledge, the use of optical coherence tomography angiography as a complementary tool to the diagnostic process in frosted branch angiitis has been described in literature just once as a photographic essay of cytomegalovirus-related frosted branch angiitis1 and it might be of great value for better characterizing clinical features of this disorder and for following disease activity in a noninvasive fashion.
Occurrence of False-Positive Tests and Cross-reactions Between COVID-19 and Dengue With Implications During Diagnosis: A Mixed Evidence Synthesis
Authors: Digwo Daniel C. , Elebe Chidinma P. , Chigor Vincent N. , Madueke Stella N. , Ezeh Christian K. , Ike Anthony C.
Published: March 2023

This review aimed to assess the occurrence of false-positive serological reaction between dengue and coronavirus disease 2019 (COVID-19) and its implications for diagnosis. Evidence syntheses were conducted by systematically reviewing available literature using multiple databases, including Web of Science, PubMed, Google Scholar and medRxiv. Among a total of 16 presented cases from clinical settings, cross-reaction to COVID-19 serological tests was observed in two (12.5%) dengue-positive patients, while 14 patients (87.5%) confirmed positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) showed a cross-reaction with dengue serological tests, leading to misdiagnosis and mismanagement by attending clinicians. Of 1789 SARS-CoV-2-positive sera, cross-reaction to dengue serological tests was observed in 180 sera (10%), which is higher than the cross-reaction observed for SARS-CoV-2 in archived pre-COVID-19 sera positive for a dengue infection (75 of 811, 9.2%, P = 0.674). Clinicians in tropical regions are therefore advised to interpret serological tests with caution and use a more pragmatic approach to triage these infections.
Immunoprofile of adenosquamous carcinoma in gastric cancer
Authors: Wu Cheng-Han , Lai Cheng-Lun , Teng Chieh-Lin Jerry , Fang Wen-Liang , Huang Kuo-Hung , Fen-Yau Li Anna , Yu Hung-Yuan , Chiang Nai-Jung , Chao Yee , Hung Yi-Ping , Chen Ming-Huang
Published: March 2023

Background:

Gastric adenosquamous carcinoma (GASC) is a rare subtype of gastric cancer. Research on GASC treatment is limited, and its outcome is usually poor. We investigated the clinical features, immunoprofile of GASC, and determined the optimal treatment modality for these patients.

Methods:

Patients with GASC from Taipei Veterans General Hospital were retrospectively reviewed. Clinical features and treatment outcomes were evaluated. Adequate samples were examined for surrogate biomarkers for immunotherapy by IHC staining.

Results:

Total 14 (0.35%) GASC patients were found among 4034 gastric cancer patients. The median tumor size was 6.8 cm in 10 patients with stage III GASC, and all these patients underwent radical gastrectomy followed by adjuvant therapy. The median progression-free survival (PFS) and overall survival (OS) were 6.0 and 11.5 months, respectively. Two patients with stage IV GASC received frontline immunotherapy. Their median PFS and OS were 9.0 and 12.5 months. In immunoprofiling, 25.0% (n = 3), 75.0% (n = 9), and 33.3% (n = 4) of the samples had deficient mismatch repair (dMMR) protein, combined positive score (CPS) of ≥1, and CPS of ≥10, respectively. The univariate analysis revealed that programmed death-ligand 1 ≥5% (HR: 0.12; 95% CI: 0.01-0.97; p = 0.047) was significant associated with superior OS. One stage IV patient with CPS ≥10 and dMMR proteins received nivolumab monotherapy as frontline treatment that resulted 14-month PFS.

Conclusion:

Patients with GASC are more likely to yield positive results for CPS and dMMR. Biomarkers should be examined, and immunotherapy can be considered as frontline systemic treatment.
A 5-year-old Syrian female was born with Oguchi disease: a rare case report
Authors: Habeeb Rasha , Baba Marwa , Bazkke Bashar , Zazo Aya , Marashi Ameen
Published: March 2023

Introduction:

Oguchi disease is a rare autosomal recessive disease that causes congenital stationary blindness, which is distinguished by the Mizuo–Nakamura phenomenon and caused by mutations of rhodopsin kinase gene or the arrestin gene.

Case presentation:

A 5-year-old Syrian female complains of stationary night blindness, investigated by fundus photo and optical coherence photograph and diagnosed as Oguchi disease.

Discussion:

Oguchi disease is an autosomal recessive retinal disorder causing stationary nyctalopia. It is characterized by Mizuo–Nakamura phenomenon, which is the alteration of fundus reflex color from golden-yellow to normal with dark adaptation. Literature reports suggest that mutations in rhodopsin kinase or arrestin genes may cause Oguchi’s disease.

Conclusions:

Optical coherence tomography is of great importance in Oguchi’s disease. Optical coherence tomography usually shows an absence of the inner and outer segments line in the extrafoveal area during a partly dark-adaptation phase.
A critical appraisal on the treatment of acute appendicitis in pediatric population during the COVID-19 pandemic
Authors: Awuah Wireko A. , Ng Jyi C. , Mehta Aashna , Huang Helen , Abdul-Rahman Toufik , Kalmanovich Jacob , Nansubuga Esther P. , Candelario Katherine , Hasan Mohammad M. , Isik Arda
Published: March 2023

Acute appendicitis is one of the most common causes of abdominal pain in children. During the coronavirus disease 2019 (COVID-19) pandemic, a delay in presentation to the emergency department and a higher rate of complicated appendicitis were observed. Traditionally, operative management (laparoscopic or open appendectomy) was thought to be the best treatment strategy for acute appendicitis. However, nonoperative management with antibiotics has gained popularity in managing pediatric appendicitis during the COVID-19 era. The pandemic has posed significant challenges in the management of acute appendicitis. Cancellation of elective appendectomies, delay in seeking care due to fear of contracting COVID-19 infection, and impact of COVID-19 infection in the pediatric population have resulted in higher rates of complications. Furthermore, multiple studies have reported multisystem inflammatory syndrome in children mimicking acute appendicitis, subjecting patients to unnecessary surgery. Therefore, it is imperative to update the treatment guidelines for the management of acute appendicitis in the pediatric population during and after COVID-19 times.
The relationship between knowledge, attitude, and practice of plasma donation with age and gender as moderators: a cross-sectional survey
Authors: Tousif Kashif , Saeed Sajeel , Hamid Sidra , Haider Tehseen , Basit Jawad , Rauf Khalid Abdul , Ali Muaz , Dhillon Rubaid Azhar , Ur Rehman Mohammad Ebad , Farhan Muhammad
Published: March 2023

Introduction:

Convalescent plasma therapy has gained worldwide notoriety since its inception as a form of soul treatment for terminally ill patients. This study investigates the link between knowledge, attitude, and practice of plasma donation while simultaneously probing the moderative role of age and gender in this context.

Method:

A cross-sectional study was undertaken in Rawalpindi, Pakistan, on COVID-19-recovered patients (coronavirus disease 2019). In all, 383 persons were chosen using simple random sampling. A prestructured questionnaire was first validated and then used as a tool for data collection. jMetrik version 4.1.1 and SPSS version 26 were used to enter and analyze the data. Reliability analysis, hierarchal regression, and logistic regression analysis were applied.

Results:

A total of 85.1% and 58.2% of 383 individuals had a favorable attitude and sufficient knowledge toward plasma donation, respectively. Plasma donation was observed in 109 (28.5%) of the individuals. Plasma donation practice was shown to be strongly related to plasma donation attitude [adjusted odds ratio (AOR)=4.48; P<0.05] and knowledge (AOR=3.78; P<0.001). Females who had more plasma donation knowledge and attitude tend to donate more compared to males. However, no interactional effect of gender×knowledge and attitude, and age×knowledge and attitude was found with plasma donation practice.

Conclusion:

Plasma donation was uncommon, even though the majority of individuals had a good mindset and were well-informed. Fear of getting a health problem was linked to the decreased practice.
Superior mesenteric artery syndrome mimicking gastric outlet obstruction: a case report and a literature review
Authors: Khanal Bhawani , Panthi Sagar , Bhattarai Raksha , Khatiwada Pradeep , Acharya Rochana , Neupane Durga , Yadav Padmini , Sharma Ananta , Pokharel Lenish , Basnet Ujwal
Published: March 2023

Introduction:

Superior mesenteric artery (SMA) syndrome, an uncommon cause of intestinal obstruction, may present with clinical features mimicking gastric outlet obstruction.

Case presentation:

The authors present a case of a 65-year-old gentleman who presented to our institute with complaints of sudden onset abdominal distension and multiple episodes of bilious vomiting for 4 days. On examination, he was cachexic and dehydrated and was diagnosed later with SMA syndrome based on contrast-enhanced computed tomography abdomen findings.

Discussion:

After the diagnosis of SMA syndrome was made, the patient was planned for the operation. On exploration, a hugely distended stomach dilated first and the second part of the duodenum with SMA compressing the third part of the duodenum was found for which duodenojejunostomy was done.

Conclusion:

The high degree of suspicion is necessary for cachectic patients presenting with features of gastric outlet obstruction to diagnose SMA syndrome. Physical examination supported by radiological investigations can diagnose SMA syndrome to some extent. Treatment should be focused on relieving obstruction along with fluid and electrolyte resuscitation and nutritional supplementation. Some cases may require surgical correction.
Nerve sheath myxoma masqueraded as intramuscular myxoma: an extremely rare tumor with unusual location – a case report and literature review
Authors: Tos Salem M. , Radaydeh Afnan , Giacaman Narmeen , Ibdah Mohammad G. , Ass’ad Omar M. , Ibaidi Nouraldin M.M. , Abuaita Mahmoud A.A. , Abu Rub Saifeddin
Published: March 2023

Background:

Nerve sheath myxoma (NSM) is a very rare benign nerve sheath tumor that mostly affects young adults, with a peak incidence in the 30s. Patients usually present with an asymptomatic swelling commonly affecting the dermis and subcutaneous tissues of the head, neck, and upper extremities. Lower extremities are a much rarer location, and when this occurs, the knee/pretibial region is the most common location. NSM has not been reported within the anterior tibialis muscle.

Case Presentation:

The authors present the first reported case of NSM in the anterior tibialis muscle in a 39-year-old man presented as deep swelling in the left leg.

Discussion:

NSM is difficult to diagnose clinically or using standard imaging techniques; MRI and ultrasonography cannot differentiate it from other anomalies. Histopathology alone is not enough to distinguish NSM from neurothekeomas, which were considered synonymous in the past. They can be distinguished by using immunohistochemical markers.

Conclusion:

Soft tissue tumors in lower extremity muscles are somewhat difficult to diagnose. Excision of the tumor by a specialized orthopedic surgeon and histopathological/immunohistochemical analysis were the only avenues to correctly diagnose the NSM.
Golimumab therapy-induced isolated myelitis in a Behcet’s disease patient: a case report
Authors: Kudsi Maysoun , Shahada Zienab , Haidar Ghina , Safiah Mhd Homam , Khalayli Naram
Published: March 2023

Introduction:

Although central nervous system demyelinating lesions as a side effect of tumor necrosis factor (TNF)-alpha inhibitors have been reported, this treatment is still used in some autoimmune diseases.

Case Presentation:

A 34-year-old Syrian male presented with difficulty walking and tingling, and numbness on the left side of his body over the next 4 days, during golimumab treatment. Over the past 2 months, fatigue, recurrent calf spasms, and extremity numbness were found. Sense disturbance and hyper-reflexes of the lower extremities were found on neurological examination. MRI demonstrated variant demyelinating lesions. Steroid therapy was initiated, and golimumab was discontinued, with good outcomes as the symptoms have disappeared.

Discussion:

The incidence of demyelination following anti-TNF therapy is uncommon. Most studies have reported that the average time between the anti-TNFα inhibitor treatment and the demyelinating lesion presence is from 5 months to 4 years, and these lesions may appear even after the cessation of the anti-TNFα inhibitor; meanwhile, a total cure of the symptoms after treatment cessation happened in our case, which suggests a causal relation, although a temporal relationship, in this case, cannot be established. The authors believe that golimumab plays a role in the demyelinating lesions development, although it may be a clinical manifestation during the course of Behcet’s disease.

Conclusion:

Caution should be taken for the side effects of Golimumab treatment, such as demyelinating lesions, and long-term monitoring of patients with Bechet disease is required.
Massive bone defects due to infection at the surgical site associated with a distal humeral fracture that was treated using fibula autograft: a case report
Authors: Fouladpour Amin , Asadi Kamran , Aris Arash , Mollaei Amirabbas , Vajargah Pooyan Ghorbani , Karkhah Samad , Salari Amir
Published: March 2023

Introduction and importance:

Distal humerus fractures comprise between 2 and 5% of all fractures, and approximately one-third of all humerus fractures are of this type. In the present report, the authors described the massive bone defects due to infection at the surgical site associated with a distal humeral fracture that was treated using fibula autograft.

Case presentation:

A 28-year-old female patient experienced a fall from a height of 4 m and was referred to Poursina Educational and Medical Center. Clinical examinations and radiological imaging showed an open fracture of the right distal humerus. In the postoperative 50-day follow-up, the complication of infection at the surgical site causes bone loss of up to 8 cm. The posterior triceps-split approach (Campbell) to the distal humerus was used in this surgery. To evaluate the quality of surgery, standard radiographs of anteroposterior and lateral of the elbow joint and humeral shaft were performed after surgery.

Clinical discussion:

At 5 months postoperatively, the patient’s initial results are good, and the range of motion of the elbow joint is ~10–120°.

Conclusion:

Based on the results of the present study, fibular transplantation in distal humerus fractures is considered one of the bone treatment options for repair.
Association of subclinical hypothyroidism with metabolic syndrome components in a group of apparently healthy Syrians: a retrospective cross-sectional study
Authors: Alourfi Zaynab , Hijazi Nermeen , Alsultan Mohammad
Published: March 2023

Background:

Thyroid disorders were reported to be associated with various diseases, particularly dyslipidemia. This study aimed to assess the prevalence of thyroid disorders in a group of apparently healthy Syrians and investigate the relationship between subclinical hypothyroidism and metabolic syndrome (MetS).

Methods:

A retrospective, cross-sectional study was performed at Al-Assad University Hospital. Participants were healthy individuals aged 18 years and older. Data about their biochemical tests, weight, height, BMI, and blood pressure were collected and analyzed. Participants were categorized according to their thyroid tests into euthyroid, subclinical hypothyroid, subclinical hyperthyroid, and according to their BMI into normal, overweight, and obese, and according to the International Diabetes Foundation into normal and having MetS.

Results:

A total of 1111 participants were involved in this study. Subclinical hypothyroidism and subclinical hyperthyroidism were found in 4.4 and 1.2% of participants, respectively. The incidence of subclinical hypothyroidism was significantly increased in females and in the presence of positive antithyroid peroxidase. Subclinical hypothyroidism was significantly associated with MetS, a higher waist circumference, central obesity, and triglycerides; however, there was no correlation with high-density lipoprotein.

Conclusion:

The prevalence of thyroid disorders among Syrians was consistent with the results of other studies. These disorders were significantly more common in females compared to males. Add to that, subclinical hypothyroidism was significantly associated with MetS. Since MetS is a known factor for morbidity and mortality, this may raise the attention needed to perform future prospective trials to evaluate the possible benefits of subclinical hypothyroidism treatment with a low dose of thyroxin.
Exertional rhabdomyolysis with acute kidney injury resulting from lower extremity training: a case report
Authors: Hashi Mohamed Abdulrashid , Abdikadir Osman Abdirahman , Abdullahi Adani Abdulkamil , Muse Osman Marian
Published: March 2023

Introduction:

Acute kidney injury (AKI) is a severe complication of rhabdomyolysis, a clinical syndrome characterized by the damage of skeletal muscle and the subsequent release of its breakdown products into the bloodstream.

Case Presentation:

A 32-year-old previously healthy male who had generalized body pain, dark-colored urine, nausea, and vomiting for 2 days, presented to the hospital after he performed a vigorous gym workout. Blood results revealed creatine kinase of 39 483 U/l (normal range: 1–171 U/l), myoglobin 224.9 ng/ml (normal range: 0–80 ng/ml), serum creatinine 4.34 mg/dl (normal range: 0.6–1.35 mg/dl), and serum urea 62 mg/dl (normal range: 10–45 mg/dl). Based on clinical and laboratory findings, he was diagnosed with exercise-induced rhabdomyolysis with AKI; he was successfully treated with isotonic fluid therapy and titrated accordingly without requiring renal replacement therapy. After 2 weeks of follow-up, a full recovery was seen.

Clinical Discussion:

Between 10 and 30% of people with exercise-induced rhabdomyolysis are thought to develop AKI. Exercise-induced rhabdomyolysis is typically characterized by symptoms such as muscle discomfort, weakness, fatigue, and black urine. An initial diagnosis is often made when creatine kinase levels are more than five times the upper limit, and there has been a recent history of intense physical activity.

Conclusion:

This case highlighted the potentially life-threatening risks associated with unexpected physical activity and underlined the critical preventative steps to lower the likelihood of experiencing exercise-induced rhabdomyolysis.
Laubry–Pezzi syndrome: three case reports and review of the literature
Authors: Charfo Mahamadou B. , Ettagmouti Yacine , Mahoungou Mackonia Noel M. , Arouss Salim , Drighil Abdel N.
Published: March 2023

Introduction and importance:

Laubry–Pezzi syndrome is a rare congenital heart disease characterized by the association of ventricular defect septal to aortic cusp prolapse responsible for aortic regurgitation (AR).

Case presentation:

We reported three cases of Laubry–Pezzi syndrome diagnosed in our department of cardiology on a cohort of more than 3000 cases of congenital heart disease. A 13-year-old patient presented a Laubry–Pezzi syndrome with severe AR and significant volumetric left ventricle overload and was operated on in time to allow a good evolution of his condition. A 43-year-old patient, followed for congenital cardiac pathology, presented with severe dyspnea. The echocardiogram found global dysfunction of the left ventricle with an ejection fraction of 35%, a perimembranous ventricular septal defect (VSD) almost completely closed by the prolapse of the noncoronary cusp, and severe eccentric aortic insufficiency due to the prolapse of the noncoronary cusp. Aortic valve replacement and VSD closure were indicated. The third patient is a 21-year-old patient with Down syndrome, in whom a grade 2/6 systolic murmur was detected. Transthoracic echocardiography revealed a perimembranous VSD measuring 4 mm without any hemodynamic repercussions and a moderate aortic insufficiency due to the prolapse of the noncoronary cusp. Clinical and echocardiographic monitoring with Osler prevention was indicated as a modality of management.

Clinical discussion:

The pathophysiology is explained by the Venturi effect, the restrictive shunt of the VSD creates an area of low pressure that sucks the adjacent cusp resulting in aortic prolapse and regurgitation. The diagnosis is essentially based on transthoracic echocardiography; it must be conducted before the emergence of AR. The management of this rare syndrome still remains nonconsensual, whether it is through timing or operative techniques.

Conclusion:

Management must be early by closing the VSD with or without aortic valve intervention to prevent the onset or worsening of AR.
APACHE scoring as an indicator of mortality rate in ICU patients: a cohort study
Authors: Mumtaz Hassan , Ejaz Muhammad K. , Tayyab Muhammad , Vohra Laiba I. , Sapkota Shova , Hasan Mohammad , Saqib Muhammad
Published: March 2023

Introduction:

Predictive scoring systems are tools that assess the magnitude of a patient’s illness and forecast disease prognosis, usually in the form of mortality, in the ICU. We aimed to determine the mortality rate among patients admitted to ICU using the Acute Physiology and Chronic Health Evaluation II (APACHE II) scoring system correlating with lengths of stay in the ICU.

Methodology:

A cohort study using team approach to care was conducted from July 2021 through July 2022 at KRL Hospital. Five hundred fifty-two patients aged 18–40 years, admitted for medical or surgical reasons (other than cardiac) who stayed in the ICU for more than 24 h were included. The APACHE II score was determined using 12 physiological variables at the end of the first 24 h of ICU admission. Data were analyzed using IBM Corp. released in 2015 (IBM SPSS Statistics for Windows, Version 23.0, Armonk, New York).

Results:

The average age of study participants was 36.34±2.77, ranging from 18 to 40 years. Three hundred fifteen participants were males and 237 were females. Patients were categorized into four separate groups as per their respective APACHE II scores. Patients with an APACHE II score of 31–40 were assigned to group 1. Patients with an APACHE II score of 21–30 were assigned to group 2. Patients with an APACHE II score of 11–20 were assigned to group 3. Lastly, patients with an APACHE II score of 3–10 were assigned to group 4. All patients in group 1 and group 2 died and none survived. Groups 1 and 2 contained a sum of 228 patients. A total of 123 patients were assigned to group 3, out of which 88 patients (71.54%) survived and 35 patients (28.45%) died. From these observations, it is evident that a higher APACHE II score is correlated with increased mortality.

Conclusion:

APACHE II scoring serves as an early warning indication of death and prompts clinicians to upgrade their treatment protocol. This makes it a useful tool for the clinical prediction of ICU mortality.
Basic life support knowledge among healthcare providers in Afghanistan: a cross-sectional study of current competencies and areas for improvement
Authors: Nemat Arash , Nedaie Mohammad Hamid , Essar Mohammad Yasir , Ashworth Henry , Aminpoor Hasibullah , Sediqi Abdul Wahed , Mowlabaccus Wafaa Binti , Ahmad Shoaib
Published: March 2023

Basic life support (BLS) is a type of emergency care provided by healthcare workers and public safety professionals to individuals experiencing cardiac arrest, respiratory distress, or other cardiopulmonary emergencies. Despite having a high burden of cardiovascular disease and trauma from conflict in Afghanistan, little is known about the level of BLS knowledge Afghani healthcare workers have. A cross-sectional study was conducted in Kabul, Afghanistan, to assess healthcare workers’ training and knowledge of BLS. The study, which took place from March to June 2022 across multiple public and private hospitals, was approved by the institutional ethics committee of Ariana Medical Complex. The sample size was calculated using a nonprobability convenience sampling method, and the study population consisted of healthcare workers actively working in a health center who were willing to complete a questionnaire. The results of the study showed that most participants (71.3%) were in the 21–30-year-old age range, and a third (32.3%) were doctors. 95.3% of participants had poor knowledge of BLS, with a mean score of 4.47±1.58 out of 13. Additionally, it was evident from questionnaire responses that providers are not adequately performing BLS. These findings suggest that further work, including regular BLS courses, is necessary to improve the knowledge and practice of BLS by healthcare workers in Afghanistan.