bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of Sleep EEG Changes in Paediatric Patients with Language Dysfunction: A Follow Up Study
Authors: El-Rashidy Omnia Fathy , Ghandour Hassan Hosny , Mahsoub Abd-Elsalam Omnia Alaa , Hesham Zaitoun Raghda Mohamed
Published: July 2024

Background

Several case reports and studies have described an association between sleep epileptiform discharges and language dysfunctions. This has been partly confirmed in studies that have investigated the effect of this epileptiform discharges on neurocognitive function.

Objectives

To screen for sleep-potentiated epileptiform discharges in children with language dysfunction (language delay or regression) and to evaluate the effect of treatment of these epileptiform discharges on language dysfunction.

Methods

The study was conducted on 93 children with language delay or language regression. Patients were recruited from the pediatric neurology clinic, pediatric outpatient clinic, phoniatrics outpatient clinic and the inpatient neurology ward at the Ain Shams University Children’s hospital, Cairo, Egypt in the period between February 2020 and November 2021. A 90- minute sleep electroencephalography, intelligence quotient level and language age were done for all patients included in the study. Children who had an active electroencephalography with uncontrolled clinical seizures or persistently epileptogenic activity without clinical seizures received treatment according to type of activity then after 6 months they were subjected to follow up electroencephalographyand assessment of intelligence quotient level and language age.

Results

The enrolled patients were divided into two groups: Group (1) including 28 (30%) patients with either or both of epileptogenic activity and clinical seizures and group (2) including 65 (70%) patients without either epileptogenic activity or clinicalseizures. We found 24 (85.7 %) children in group 1 had clinical seizures with median age of onset 2.5 years (range from 1-8 years). Further in the first group, 21 (85.7 %) of children showed presence ofepileptogenic activity with 10 (47.6 %) of children showed spike and slow wave, 6 (28.6 %) showed sharp wave, 3 (14.3 %) showed continuous spike and wave during slow wave sleep (CSWS), 2 (9.5 %) children showed sharp and slow wave. In our study, levetiracetam was given as first line treatment in patients with active seizures. An add-on therapy was given in patients who were not controlled on one antiepileptic drug. A follow up 90 minutes sleep electroencephalography was done and showed a highly significant reduction in epileptogenic activity with a p value of < 0.001. A follow up language test and intelligence quotient level score were done and showed a highly significant improvement with p value of (0.001 and 0.009) respectively.

Conclusion

Epileptiform activities with or without epilepsy in children may alter normal language function. Treatment of these epileptogenic activity affect improvement of this language dysfunction.

Trial registration: ClinicalTrials.gov I.D: NCT05487521.
The Clinical Significance of the Platelet Membrane Glycoproteins in Children with Primary Immune Thrombocytopenia
Authors: Mokhtar Galila Mohamed , Elsayed Ebeid Fatma Soliman , Sayed Safa Matbouly , Abdelmaksoud Mariam Fathy , Fathy Shnouda Sara Adel
Published: July 2024

Background

Primary immune thrombocytopenia (ITP) is an acquired immune-mediated disorder characterized by isolated thrombocytopenia. Although decreased platelet count is believed to be the main cause of hemorrhage in ITP, it is a poor predictor of bleeding risk by itself.

Aim of the Work

to measure CD62p and CD42b level in the pediatric ITP patients by using flow cytometer, measurement of platelet parameters in the pediatric ITP patients and to study its correlations to bleeding score.

Patients and Methods

sixty children with ITP were recruited and assessed for eligibility at the out-patients Hematology clinic – Pediatric Hospital at Ain Shams University, and compared with age and sex matched thirty healthy subjects.

Results

Pediatric ITP patients had a significant increase in the mean platelet volume, platelet distribution width and a significant decrease in plateletcrit among the ITP patient group in comparison with the control group (P value<0.001). The chronic ITP subgroup had significant increase of platelet count and plateletcrit in comparison with the acute ITP subgroup (P value<0.001). Pediatric ITP patients had significant increase in CD42b and a significant decrease in CD62p among the ITP patient group in comparison with the control group (P value<0.001). No statistically significant difference found between the acute, persistent and chronic ITP subgroups regarding CD42b and CD62p (P value>0.05).

Conclusion

Platelet function, platelet parameters and platelet glycoprotein CD62p, CD42b expression can be used as a clinical biomarkers in pediatric ITP.
CD34+ Hematopoietic Stem Cell Count as a Novel Predictor of Vascular Event in Sickle Cell Disease Patients
Authors: Mohsen Ellaboudy Mohamed Abdel , Aly Nihal Hussien , Ismail Mona Ahmed , Ibrahim Badawi Rania Ahmed
Published: July 2024

Background

Sickle cell disease (SCD) is one of the most common genetic disorders, it not only has hematological pathophysiological consequences, but also has systemic pathological manifestations such as vascular events (VEs). Prior studies have described that VEs are associated with poor outcomes in the short term and decreased quality of life in patients over the long term. There is no standardized method for predicting vascular injury in Sickle cell disease patients.

Aim of the Work

Our aim is to evaluate circulating CD34 as a novel predictive marker of occurrence of vascular event in Children with Sickle Cell Disease in their steady state and relate levels to severity of VEs in the following 6 months.

Patient and Methods

This study was an exploratory study, conducted at Pediatrics Hematology- Oncology Unit at Ain Shams University Children’s Hospital, where 50 children with sickle cell disease were enrolled at their steady state (defined as 2 months free from any Vascular Event prior to the study), aged 6 months - 16 years. Flow cytometry was done for quantification of circulating CD34+ at inclusion and compared to age and sex matched control and patients were followed up for 6 months for vascular events.

Results

There is statistically significant higher level of CD34+ among SCD patients compared to age and sex matched control with p value < 0.001.Circulating CD34+ showed significantly higher level in patients who developed systemic vascular events after 6 months of follow up with p value 0.022. There was no statistically significant correlation between circulating CD34+ and severity of peripheral vascular events (or any need for hospitalization) on follow up.

Conclusion

CD34+ cell count at steady state may be a promising biomarker of further vascular event in children with SCD.
Frequency of Non-Thyroidal Illness Syndrome in Pediatric Patients with Sepsis and Septic Shock
Authors: Abdelgawad Tarek Ahmed , Magdy Sondos Mohamed , Ahmed Mahmoud Rana Abdelhakaim , Abdelfatah Taha Sara Ibrahim , Elhameed Ali Safaa yossef Abd
Published: July 2024

Background

Non-Thyroidal Illness Syndrome (NTIS) is considered when patients demonstrate abnormal thyroid functions and levels decrease at onset of infection and keep decreasing with disease progression. Levels usually get normalized after the illness is cured. NTIS is not studied well in pediatric population.

Aim of the Work

Assess the hormonal changes of NTIS in sepsis and septic shock patients. Furthermore, Follow up the severity of NTIS and its effect on outcome.

Patients and Methods

This study (1st phase: Cross-sectional, 2nd phase: Prospective) included 40 critically ill children categorized into two groups: (i) Sepsis group : was defined according to standard international criteria using pediatric Sequential Organ Failure Assessment (p SOFA) score and sepsis was considered when p SOFA score > 2 (ii) Septic shock group: was defined by a vasopressor requirement to maintain a mean arterial pressure ≥ 65 mm Hg and having a serum lactate level > 2 mmol/L despite adequate fluid resuscitation (Singer et al., 2016), with 20 patients in each group. Patients were admitted to the pediatric intensive care unit (PICU). Thyroid hormone levels were assessed and compared in day 1 and day 5 in all patients and subgroups. All patients were followed up until discharge or death. ROC curve and Univariate and multivariate approaches were used to assess the link between thyroid hormones and prediction of mortality.

Results

NTIS was found in 47.5% of patients. NTIS was higher among septic shock group than sepsis 65.5% versus 30% (p value = 0.027). NTIS was associated with each of ventilation, catecholamines infusion and SOFA score (p value =0.044, 0,027 and 0.033) respectively. FT3 (Free triiodothyronine) levels were lower and rT3 (reverse T3) levels were higher in day 5 of illness than day 1 (p value =0.041and 0.000) respectively. Furthermore, FT3 levels in day 5 were lower, and rT3 levels in day 1 and day 5 were higher in non survivors than survivors (p value =.0.002, 0.015 and 0.003) respectively. ROC curve to assess thyroid hormone levels, SOFA score and CRP (C-reactive protein) as predictors of mortality revealed that FT3 levels in day 5 was the best in predicting PICU mortality (sensitivity 100%, and specificity 68.42%), Followed by SOFA score day 5 (sensitivity 100%, and specificity 57.89%). In the multivariate regression analysis, we discovered that high rT3 levels in day1 and CRP in day 5 were independently associated with PICU mortality.

Conclusion

NTIS is common among critically ill children and higher among septic shock group than sepsis. Also, Beside the SOFA score, FT3 measured in day5 of illness and rT3 measured in day1 of illness were the best predictors of PICU mortality.
Oral Ibuprofen versus Placebo for Management of Patent Ductus Arteriosus in Preterm infants: A Double Blinded, Randomized Controlled Trial
Authors: Sherif Dalia El , El-Raggal Nehal M , Mohamed Nada Hussein , Saleh Ghada Ahmad , Abd Elhady Marwa Waheed , Metwally Mohamed Hussein
Published: July 2024

Background

A consensus on the management of patent ductus arteriosus (PDA) in premature neonates remains indefinable. Conservative PDA treatment is based on the premise that in most preterms PDAs spontaneously close before discharge. Ibuprofen has been used for treating PDA, however, no clear guidelines for management have been suggested.

Aim of Work

The aim of this work is to compare the effect of oral ibuprofen versus placebo on PDA closure in preterm infants less than 34 weeks’ gestation.

Methodology

This study was conducted on 80 preterm neonates with gestational age ≤ 34 weeks with a hemodynamically significant PDA. They were randomized into a medical treatment group (n = 40) and a placebo group (n = 40). Both groups received conservative PDA therapy in the form of fluid restriction, positive end-expiratory pressure, and/or diuretics. The medical treatment group received oral ibuprofen (at an initial dose of 10 mg/kg/day, followed by 5 mg/kg/day for the next 2 days) and the placebo group received an oral placebo. The open-label option and an extended oral ibuprofen therapy (an offered or a repeated course with the same dose) were only offered if there are concerns over a poor patient condition that was attributed to persistent PDA and only after meeting certain criteria like signs of pulmonary hyperperfusion and/or systemic hypoperfusion. Echocardiography was done on day 1 of recruitment (48-72 hours of age) and was followed up till discharge. The patients were followed up for adverse effects of ibuprofen by serum creatinine and total serum bilirubin after the first course of treatment.

Results

There was no significant difference in PDA closure rate following the first ibuprofen course (62.5% in the ibuprofen treated group vs 65% in the placebo group, p > 0.05). At discharge time (mean 13.5 days in the ibuprofen group, 14 days in the placebo group), a closure rate of 75% was achieved in both groups, respectively. There was no significant difference in initial serum creatinine levels between the two groups either on day 1 of recruitment or after the first course of the intervention, p > 0.05, respectively. Meanwhile, serum creatinine significantly decreased in both groups after treatment (p-value <0.001, respectively). Also, there was no difference between the two groups in serum bilirubin either on day 1 of recruitment or after the first course of treatment, p > 0.05, respectively.

Conclusion

Conservative treatment is not inferior to oral ibuprofen therapy in the management of PDA. Oral ibuprofen does not elevate serum creatinine levels or cause hyperbilirubinemia.
Comparative Study between Platelet-Rich Plasma, Corticosteroids and Perineural Dextrose local Injections for Treatment of Carpal Tunnel Syndrome
Authors: Magdy Sarah , Mohamed Abbas , El-Sebaie Mona Abdullah , Amin Irene Raouf , Nassif Mary Atef
Published: July 2024

Background

Carpal tunnel syndrome (CTS), one of the most common entrapment neuropathies, is considered as a socio- economic issue that reduces work productivity and increases disability.

Aim of the Work

to compare the effect of Platelet- Rich Plasma (PRP), corticosteroids (CS) and perineural Dextrose 5 % in water (D5W) local injections for the treatment of idiopathic mild and moderate CTS.

Patients and Methods

A prospective study was performed on 60 median nerves of 60 patients. They were diagnosed as idiopathic CTS and classified randomly into 3 groups (each contains 20 patients) according to the treatment program received: group I (ultrasound guided CS injection), group II (ultrasound guided perineural Dextrose 5% injection) and group III (ultrasound guided PRP injection).

Results

Ultrasound guided local injection using single doses of CS, D5W, and PRP were very efficient as regards symptomatic and functional improvement, reducing distal motor latency (DML) and Peak sensory latency ( PSL) of median nerve, as well as decreased Cross Section Area (CSA) of Median nerve (MN) and improving median nerve mobility for idiopathic mild to moderate CTS. For symptom and functional improvement, single injection of CS was more effective than that of PRP and D5W within 3 months post-injection. Moreover, PRP was slightly better than D5W. For reducing DML and PSL, CS was the most effective followed by PRP and then D5W at 3 months post injection. For reducing CSA, CS was the most effective followed by PRP and then D5W at 3 months post injection. For improving mobility of median nerve, D5W was the most effective at 3 months post injection followed by CS and PRP.

Conclusion

Injection of CS, D5W and PRP had resulted in significant Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) score reduction at 3 months post-injection in comparison to the BCTQ score at the baseline evaluation. All of the three studied groups (Corticosteroids, dextrose 5 % and PRP) have shown a great result regarding improving in clinical examination, clinical assessment scales, nerve conduction studies and improving in Neuromuscular Ultrasound results with favorable results of Corticosteroids group over Perineural dextrose 5 % group and PRP group.
Significance of Inflammatory Markers in Primary Fibromyalgia Syndrome and Their Relation in Assessing the Disease Severity
Authors: Mohamed El-sawy Esraa Ayman , Abdul Hakim Mervat Mohamed , Kadry El-Zohiery Abeer Ahmed , Salama Sherihan Mahdy
Published: July 2024

Background

Fibromyalgia syndrome (FMS) is a musculoskeletal disorder characterized by diffuse chronic musculoskeletal pain associated with various other symptoms. Although the etiology and pathogenesis of FMS are still unclear, it was reported to have possible inflammatory basis. No laboratory marker is currently available to diagnose the disease.

Aim of the Work

to assess the serum levels of ESR, CRP, NLR, MPV and PDW in primary Fibromyalgia syndrome patients and their relation with the disease severity and depression scores.

Patients and Methods

The study included 30 FMS patients, diagnosed according to the 2010 ACR (American Colleague of Rheumatology) criteria who presented to Ain Shams University Physical Medicine and Rehabilitation clinic as well as 30 healthy volunteers who served as a control group. The following laboratory tests were assessed among both groups: Erythrocyte Sedimentation Rate (ESR), C-reactive protein (CRP), Neutrophil Lymphocyte Ratio (NLR), Mean Platelet Volume (MPV) and Platelet Distribution Width (PDW). FMS patients filled out The Revised Fibromyalgia Impact Questionnaire (FIQR) and Montgomery Asberg Deprssion Score (MADRS) as well.

Results

MPV, NLR, ESR and CRP values were significantly higher among the patients’ group (p < 0.05). Statistically positive correlation was found between FIQR and each of CRP (p = 0.021) and ESR (p = 0.027) levels. Another statistically significant positive correlation was found between MADRS and CRP (p = 0.01). The NLR showed marginal positive significance with FIQR.

Conclusion

In the light of these previous results, we can state that the serum levels of the tested inflammatory markers being mainly the acute phase reactants, have a positive relation with disease severity and depression scores, which in turn affect the quality of daily living. Accordingly, we arise the possibility of using those markers as good indicators of ongoing inflammatory process among FMS patients reflecting the severity of the disease.
Study of the Influencing Factors and their Predictive Value of Skin Graft Take in Early Excision and Grafting in Severe Burns: A Prospective Study
Authors: Mohamed Mostafa Mohamed , Mohammed Salah Nasser , Abd El Salam Ahmed Mohamed , Amin Abdel Gawad Ebrahim Mohamed
Published: July 2024

Background

Burn injury is one of the most life-threatening traumas worldwide especially in developing countries. After severe burns, the patients suffer from loss of multiple functions of skin, such as fluid loss, and high infection rate with burn sepsis and septic shock.

Objective

To investigate the various factors that affect the survival rate of skin grafts in early excision and grafting procedures (from 3rd to 7th day after burn) in patients with severe burns.

Patients and Methods

This Prospective cohort study was done in Ain Shams University Burn Center attached to Plastic, burn and maxillofacial department during the period from May 2021 to May 2022.

Results

Analysis was performed on 75 individuals who had early burnt skin excised and early skin graft coverage. Two patient groups were analyzed, in the form of good skin graft take >70% in 45 patients, and poor skin graft take < 70% in 30 cases, based on the survival rate of the skin graft post operatively.

Conclusion

The univariate analysis and repeated measurement showed that burn intensity, the post-operative sepsis, the neutrophil lymphocytic ratio on day 3 (NLR3) in the poor skin graft take group were significantly higher than those in the good skin graft take group, while the estimated albumin levels in perioperative period and the estimated pre-albumin levels in perioperative period were higher in the good skin graft take group. Receiver operating characteristic curve showed that NLR3, the estimated albumin levels and pre-albumin levels in perioperative period had a good predictive value for the survival of skin grafts. The estimated albumin levels ≤3.18 gm/dl, estimated pre-albumin ≤23.9 mg/dl, and NLR3 ≥ 12 were independent risk factors for graft take in perioperative period.
Assessment of Patient Handover Process from Operating Room to Intensive Care Unit at Cardiovascular Surgery Hospital of Ain Shams University
Authors: Al-Motar Shaymaa Shawki , Yosef Mostafa , Alansary Adel Mohamad , Fotouh Aisha Aboul
Published: July 2024

Background

Handovers of post-anesthesia patients to the intensive care unit are commonly unstructured and performed under time pressure. The cardiovascular patients are transferred directly to intensive care unit after the operation, as these vulnerable patients need more and faster care. Therefore, the handover processes are more susceptible to poor communication, loss of information and potential patient harm.

Objective

To identify the frequency of defects of current practice of healthcare providers during handover process from operating room to ICU after cardiovascular surgery and to determine the contributing factors that affect the transition of care process.

Methods

This descriptive Cross-sectional study was conducted after cardiovascular surgery the intensive care unit of Cardiovascular Surgery Hospital, one of Ain Shams University Hospitals between December 2021 to March 2022. A checklist was used to assess the performance of handover processes of 120 adult patients after cardiovascular operation, which included 8 main areas (Contributing factor, Pre-handover, Equipment and technology handover, Patient specific information, Anesthesia information, Surgical information, Duration of handover process, Distraction)

Results

The mean age of patients was 56.03 ± 10.77 years and most of them 85 (70.8%) were males. The median number of errors in pre-handover process was 0(0), patient specific information 3(1), anesthesia information 3(0), surgical information 4.5(2) and equipment handover 3(0). The mean duration of handover processes in minutes was 15.09 ± 5.69 (range 8–35) and 76 (63.3%) of the processes had distractions. There was no significant correlation between age, duration of surgery, duration of handover and number of errors regarding (pre- handover, patient information, anesthesia information, surgical information and equipment handover).The important items were not handed over at all(name of the patient, allergies to medication, estimated blood loss, medications given during surgery which need to be restarted)

Conclusions and Recommendations

The overall omission is low in spite of the expected to be zero, taking into consideration the type of procedures and the patient condition, so the critical situation need every elements must be fulfilled for patient safety and to avoid complications that may threat the patient life.
Role of CT Scan in Preoperative Evaluation of Bone Loss in Anterior Shoulder Instability Using the On Track and Off Track Concept
Authors: Aziz Mohamed Abdel , Niazy Gamal , Ibrahim Hazem , Sayed El Shoubky Nourhan Mohamed Amin
Published: July 2024

Purpose

The purpose of this study was to assess the role of CT scan in preoperative evaluation of glenoid and humeral head bone loss in cases of recurrent anterior shoulder joint dislocation using on track and off track concept and whether it can be used to predict engagement during arthroscopy.

Patients and Methods

In the period from June 2019 to October 2022, this study was conducted in Ain Shams University hospitals including 40 cases with recurrent anterior shoulder dislocation. CT scan with 3D reconstruction was done to calculate the width of the glenoid track using the best fit circle method as well as the Hill Sachs interval. We used the on-track off-track method to predict engagement and these results were compared with the findings related to engagement seen during arthroscopy

Results

Using the on-track /off-track technique on CT images, 22 of the 25 engaging (off-track) lesions was predicted correctly (sensitivity, 88%).While 13 of the 15 cases that did not engage (on-track) was correctly predicted (specificity, 86.7%). Overall, the accuracy of the on-track off-track method was 87.5% with a positive predictive value (PPV) of 91.7% and negative predictive value (NPV) of 81.3%. The on-track /off-track method was found to be a significant predictor of engagement as there is no statistically significant difference (p = 0.18) between this method and arthroscopic findings.

Conclusion

Our study showed that using the on-track off-track method by CT scan can accurately assess the glenoid and humeral head bone losses seen in patients with anterior shoulder instability for predicting the presence of engagement, or off-track, lesions. This technique can be used for preoperative evaluation to help in deciding the type of surgical procedure performed on patients with anterior shoulder instability.
Evaluation of Achilles Tendon in Type 2 Diabetes Mellitus Patients Using Sonoelastography
Authors: Sakr Hossam Moussa , Al Diasty Shaimaa Al Metwally , Badr Gomaa Nada Osama Nasreldeen
Published: July 2024

Background

Diabetes mellitus is an endocrine disease associated with several metabolic disorders and long-term complications. Achilles tendon is the largest and strongest tendon in the human body playing a crucial role in foot biomechanics. Hyperglycaemia in Diabetes Mellitus aids the deposition of glycosylated end products in most tissues including the Achilles tendon, which in turn alters its structure and function.

Objectives

The study aims to investigate the differences in Achilles tendon thickness and stiffness in people with and without type 2 diabetes mellitus.

Patients and Methods

This is a case control study, where the Achilles tendons of 20 type 2 DM patients and 21 non-diabetic controls were examined for the thickness and stiffness. Achilles tendon thickness was measured using B-mode ultrasonography while its stiffness was evaluated by compression elastography.

Results

This study included 20 type 2 DM patients (40 Achilles tendons), and 21 non-diabetic controls (42 Achilles tendons). The Achilles tendon thickness was significantly higher in the diabetic group with a mean thickness of 4.23 ± 0.95 mm, compared to 3.06 ± 0.83 mm in the control group (p < 0.01). A statistically significant difference of the Achilles tendon stiffness was also established. The diabetic group showed a greater percentage of soft tendons (47.5%) compared to the control group (16.7%). The diabetic group also showed a smaller percentage of hard tendons (52.5%) compared to the control group (83.3%) (p < 0.05).

Conclusion

Achilles tendons of type 2 DM patients are both thicker and softer than their non-diabetic counterparts.
Uterine Artery Doppler in the Second Trimester as a Predictor of Preeclampsia in High Risk Pregnancy
Authors: Azab Enas Ahmed , Tantawy Salma Hassan , Refaat Kotb Sally Ahmed , El-Hamalawy Alaa Nasir El-Din Ali
Published: July 2024

Background

Preeclampsia is a multisystem disorder of pregnancy which is a major cause of maternal and fetal morbidity and mortality worldwide. The cardinal clinical features of the condition are hypertension and proteinuria occurring after 20 weeks gestation in women who were not previously known to be hypertensive.

Aim of the Work

The aim of the work was to evaluate the role of uterine artery Doppler in the second trimester as a predictor of preeclampsia in high risk pregnancy.

Patients and Methods

We included 80 pregnant females in the second trimester at high risk pregnancy in our study, uterine artery Doppler ultrasound was done in the second trimester and the patients were followed up in the third trimester for blood pressure measurement and diagnosis of PE.

Results

Our results revealed correlation between high indices of uterine arteries and development of PE.

Conclusion

Our study revealed that we can use uterine artery Doppler as a reliable method to predict preeclampsia.
MRI in Postero-Lateral Corner Injuries of the Knee Joint: Clinical-Radiological Correlation
Authors: Alkassar Nagwan Sadeq , Sakr Hossam , Salah Hesham
Published: July 2024

Background

The posterolateral corner (PLC) was once regarded as the “dark side of the knee” owing to the complex and variable anatomy superimposed on the inconsistent terminology used in the literature to describe the structures in this region.

Aim of the Work

To describe the role of MRI in assessment of posteriolateral corner injury of knee joint.

Patients and Methods

This cross sectional study was conducted in department of Radiology in Ain Shams University, the data collected from database to reach sample size number and enrolled data of 20 patients in period was 18-24 months.

Results

We were able to show that the MRI procedure we gave accurately visualises the majority of the complex individual components of the posterolateral knee, as well as damage to these structures, in this investigation. When the diagnosis of grade III injuries to the posterolateral knee is in doubt, we believe that MRI of the posterolateral knee is a useful complement to the surgeon. In our capacity to correctly diagnose damaged structures on MRI, there were no clear differences between acute and chronic knee injuries. On MRI, avulsions or tears of the direct arm or anterior arm insertion off the fibular styloid show focal discontinuity, nonvisualization, increased signal intensity, or proximal retraction, often with a contemporaneous bone avulsion. The damage pattern can also be seen in axial and sagittal views.

Conclusion

When posterolateral rotatory instability is suspected, the MRI approaches that described for visualizing particular injuries to the posterolateral knee will almost always reveal the bulk of the affected structures. When a posterolateral knee injury is assessed on MRI, using a special MRI protocol that covers the full fibular head and styloid on all imaging sequences will help in identifying these structures.
Jenna’s Project: Preventing Overdose and Improving Recovery Outcomes for Women Leaving Incarcerated Settings During Pregnancy and Postpartum Periods
Authors: Hairston Essence , Jones Hendrée E. , Johnson Elisabeth , Alexander James , Andringa Kimberly R. , O’Grady Kevin E. , Knittel Andrea K.
Published: July 2024

Objectives

For people with opioid use disorder (OUD), transitioning from pregnancy to postpartum and from incarceration to the community is a time of increased risk for opioid overdose. This prospective project evaluated the extent of Jenna’s Project’s success in preventing overdoses and improving recovery outcomes by coordinating postrelease care in incarcerated OUD perinatal patients.

Methods

Participants (N = 132) were pregnant or postpartum (1 year postdelivery) with OUD during incarceration and self-referred for postrelease services. From March 2020 to October 2021, participants could receive up to 6 months of postincarceration care coordination services (eg, regular communication, transportation, emergency housing, SUD treatment), medication to treat OUD (MOUD) and other treatment services. Outcomes included verified overdose (fatal), self-reported nonfatal overdose, reincarceration, active Medicaid, receipt of MOUD, presence of children living with participants, open Child Protective Services cases, and number of referrals for services.

Results

There were 0 nonfatal and 0 fatal overdoses at both 1 and 6 months postrelease, and 3 of 132 (2%) returned to incarceration. Significantly fewer participants had Medicaid at release (36%) and at 6 months postrelease (60%) than before incarceration (87%) (P < 0.001 for all 3 pairwise comparisons). At 6 months postrelease, significantly more participants reported MOUD receipt (51%) compared with before incarceration (39%) (P < 0.001). There was no significant change in the number of open Child Protective Services cases. Referrals for childcare or parenting services were the most common referrals provided.

Conclusion

Immediate postrelease care coordination for pregnant and postpartum women with OUD was feasible and effective in preventing overdose, reincarceration, and promoting recovery outcomes.
Deep Learning–Based Real-Time Ureter Identification in Laparoscopic Colorectal Surgery
Authors: Narihiro Satoshi , Kitaguchi Daichi , Hasegawa Hiro , Takeshita Nobuyoshi , Ito Masaaki
Published: July 2024

BACKGROUND:

Iatrogenic ureteral injury is a serious complication of abdominopelvic surgery. Identifying the ureters intraoperatively is essential to avoid iatrogenic ureteral injury. We developed a model that may minimize this complication.

IMPACT OF INNOVATION:

We applied a deep learning–based semantic segmentation algorithm to the ureter recognition task and developed a deep learning model called UreterNet. This study aimed to verify whether the ureters could be identified in videos of laparoscopic colorectal surgery.

TECHNOLOGY, MATERIALS, AND METHODS:

Semantic segmentation of the ureter area was performed using a convolutional neural network–based approach. Feature Pyramid Networks were used as the convolutional neural network architecture for semantic segmentation. Precision, recall, and the Dice coefficient were used as the evaluation metrics in this study.

PRELIMINARY RESULTS:

We created 14,069 annotated images from 304 videos, with 9537, 2266, and 2266 images in the training, validation, and test data sets, respectively. Concerning ureter recognition performance, the precision, recall, and Dice coefficient for the test data were 0.712, 0.722, and 0.716, respectively. Regarding the real-time performance on recorded videos, it took 71 milliseconds for UreterNet to infer all pixels corresponding to the ureter from a single still image and 143 milliseconds to output and display the inferred results as a segmentation mask on the laparoscopic monitor.

CONCLUSIONS:

UreterNet is a noninvasive method for identifying the ureter in videos of laparoscopic colorectal surgery and can potentially improve surgical safety.

FUTURE DIRECTIONS:

Although this deep learning model could lead to the development of an image-navigated surgical system, it is necessary to verify whether UreterNet reduces the occurrence of iatrogenic ureteral injury.
Global Surgery: The Challenges and Strategies to Win a War That Must Be Won
Authors: Nthumba Peter M.
Published: July 2024

Background:

Modern science has conquered seas, land, and space. Although great strides have been made in technology and infectious diseases, global surgery, which was reborn in 2015, has not made much progress. The burden of surgical disease in low- and middle-income countries remains seemingly unconquerable, and its growth unstoppable. The myriad challenges in meeting the surgical needs of 5 billion people has intrigued the author.

Methods:

The author collected the views of plastic surgeons on sources and impediments to the scale-up of plastic surgery in low- and middle-income countries, as well as potential strategies for overcoming these obstacles. The author then performed a literature search reviewing the topics that arose from those discussions. The author proposes a strategy using plastic surgery as a model surgical discipline.

Results:

A root-cause analysis suggests that the Alma Ata Declaration, with its focus on primary healthcare, is the probable genesis of global surgery (GS) woes. The absence of a clear GS community leader and the fragmented nature of GS advocates who operate in multiple silos, without a clear unified goal, are the primary reasons GS advocates have achieved so little on the ground.

Conclusions:

Global surgery requires a business model to sustainably meet the surgical needs of the 5 billion people globally. The proposed and implemented strategies must meet rigorous criteria to ensure sustainability, as quick-fix solutions are counterproductive. The development of centers of excellence offers a viable solution to problems that must be addressed successfully.
Nd:YAG laser capsulotomy vs needle aspiration in intumescent cataracts: comparative study of complications and outcomes
Authors: Ceylan Ali , Aydin Fahri Onur , Karapapak Murat , Aydın Seyfi , Ozal Sadık Altan , Yildirim Yusuf
Published: July 2024

Purpose:

To compare the complications and postoperative outcomes of Nd:YAG laser anterior capsulotomy vs a needle aspiration approach for capsulorhexis in patients with intumescent cataracts.

Setting:

University of Health Sciences, Basaksehir Cam and Sakura City Hospital Department of Ophthalmology, Istanbul, Turkey.

Design:

Retrospective, cross-sectional study.

Methods:

Patients with intumescent cataract were divided into 2 groups. Group 1 (37 eyes) underwent Nd:YAG laser capsulotomy preoperatively, which reduced lens pressure. In Group 2 (31 eyes), the capsulorhexis was completed by reducing the intralenticular pressure by needle aspiration and then gradually expanding the capsule. Demographics, pre/postoperative parameters, complications, and surgical times were analyzed.

Results:

68 eyes of 68 patients were evaluated. Age and sex exhibited no significant differences between groups. Group 2 had more complications than Group 1 (P = .041). Specifically, no capsular tear extensions were seen in Group 1 while 4 patients in Group 2 had tears extending to the lens periphery. Group 1 showed a significant decrease in surgical maneuvers and time (P = .028) while no significant difference was found in effective phacoemulsification time (P = .076).

Conclusions:

Nd:YAG laser capsulotomy effectively prevented capsular extensions and reduced surgical time in intumescent cataracts. This technique provides a safe alternative to traditional methods, potentially reducing intraoperative risks and improving surgical efficiency. The findings support Nd:YAG laser anterior capsulotomy as a viable approach for capsulorhexis in intumescent cataracts, emphasizing its potential benefits in reducing complications and enhancing surgical outcomes.
Mental Health Disorders, Organizational Stigma, and Health Service Utilization Among US Fire Investigators
Authors: Testoff Addison C. , Pauley Jeffrey L. , Brewer Michael , Weidlich Christopher P. , Koru-Sengul Tulay , Solle Natasha Schaefer , Caban-Martinez Alberto J.
Published: July 2024

Objective

The aim of the study is to estimate in a sample of US fire investigators the (1) prevalence of generalized anxiety disorder (GAD), depression, posttraumatic stress disorder (PTSD) risk, and mental health services use and (2) association between organizational stigma and mental health disorders.

Methods

This is a cross-sectional study design used to administer between November 2023 and January 2024, a 35-item behavioral/mental health survey.

Results

Approximately 18.0% of fire investigators had GAD, 22.8% depression, and 18.2% PTSD risk. Organizational stigma about mental health disorders was reported by 53.3% of fire investigators. The most frequently used behavioral/mental health services were cognitive behavioral therapy (40.1%) and medication management (36.1%). Organizational stigma around reporting mental health disorders was significantly associated with PTSD risk (adjusted odds ratio = 5.25 [2.41–11.43]).

Conclusions

Mental health disorders are present in the fire investigator workforce, and organizational stigma is associated with limited report of PTSD risk.
Odds of Developing Cancer Among Male and Female Volunteer Firefighters in Florida
Authors: Caban-Martinez Alberto J. , Koru-Sengul Tulay , McClure Laura A. , Pinheiro Paulo S. , Hernandez Monique N. , Kobetz Erin N. , Lee David J.
Published: July 2024

Objective

Determine whether volunteer firefighters in Florida are at increased odds of developing cancer compared with nonfirefighters.

Methods

A case-control study design was implemented to assess the odds of developing cancer among male and female volunteer firefighters in Florida. Gender-specific age and calendar year-adjusted odds ratios and 95% confidence intervals were estimated.

Results

Male volunteer firefighters were at increased odds for developing prostate (aOR = 1.26; 95%CI;[1.10–1.44]) and male genital cancers combined (1.22;[1.07–1.39]), while reduced odds for endocrine cancer (0.41;[0.17–1.00]), and all leukemias (0.55;[0.35–0.86]), including lymphocytic (0.48;[0.24–0.97]); and chronic lymphocytic (0.40;[0.17–0.97]) leukemias. Female volunteer firefighters were at increased odds of developing of kidney cancer (2.51;[1.29–4.91]).

Conclusions

Male volunteer firefighters are at increased odds for prostate and overall male genital cancers, while female volunteers are increased odds of kidney cancer.
Effect of Side Jobs and Psychological Distress on Employee Turnover in Japanese Employees
Authors: Hara Tatsuhiko , Mori Takahiro , Nagata Tomohisa , Odagami Kiminori , Adi Nuri Purwito , Nagata Masako , Mori Koji ,   for the W2S-Ohpm Study
Published: July 2024

Objectives

We investigated the impact of engaging in side jobs on turnover and its interaction with psychological distress among Japanese employees.

Methods

A prospective cohort study was conducted using a questionnaire-based survey. We investigated 2783 full-time employees in companies permitting side jobs. Multiple logistic regression analyses were used to examine the relationship between side jobs and turnover, and its relationship stratified by psychological distress.

Results

Employees engaging in side jobs had higher odds ratios (ORs) for turnover after adjusting for covariates, including psychological distress (OR, 1.54; 95% confidence interval, 1.22 to 1.93). Among those under psychological distress, ORs for turnover were significantly higher (OR, 1.96; 95% confidence interval, 1.39 to 2.76). Conversely, in employees without distress, no significant difference was observed.

Conclusions

Side job engagement correlates with higher turnover, particularly among employees under psychological distress.
Predicting COVID-19 Cases in Nursing Homes of California and Ohio
Authors: Roy Soumyadipta , Collins Jamie E. , Boden Leslie I. , Katz Jeffrey N. , Wagner Gregory R. , Sorensen Glorian , Williams Jessica A.R.
Published: July 2024

Objective

The cross-sectional study evaluates if the prepandemic work environments in nursing homes predict coronavirus disease 2019 (COVID-19) cases among residents and staff, accounting for other factors.

Method

Leveraging data from a survey of California and Ohio nursing homes (n = 340), we examined if Workplace Integrated Safety and Health domains — Leadership, Participation, and Comprehensive and Collaborative Strategies predicted cumulative COVID-19 cases among nursing home residents and staff.

Results

In Ohio, a 1-unit increase in Leadership score was associated with 2 fewer staff cases and 4 fewer resident cases. A 1-unit increase in Comprehensive and Collaborative Strategies score in California showed an average marginal effect of approximately 1 less staff case and 2 fewer resident cases.

Conclusions

These findings suggest that leadership commitment and interdepartment collaboration to prioritize worker safety may have protected against COVID-19 cases in nursing homes.
An examination of nurse practitioner students' perceptions of knowledge, confidence, and experiences related to caring for lesbian, gay, bisexual, transgender, and queer or questioning patients: A national perspective
Authors: Smith Kathy , Cooper Stacy D.
Published: July 2024

Background:

Lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ+) individuals are significantly less likely to have a primary health care provider, and are more likely to be uninsured, and postpone medical care. A health care provider's lack of knowledge in LGBTQ+ health needs, low confidence in discussing sexuality, and bias can result in LGBTQ+ patients choosing to delay or avoid seeking care. These are missed opportunities for health care providers to recognize their unique needs, provide education and preventive screenings and care, and manage chronic conditions.

Purpose:

The aim of this study was to examine nurse practitioner students' perceptions of knowledge, confidence, and experiences related to caring for LGBTQ+ patients.

Methodology:

Using a descriptive, cross-sectional survey research design, a 29-item online survey was distributed through email to nurse practitioner students (n = 419) across the United States.

Results:

Overall, nurse practitioners (NP) students demonstrated infrequent questioning related to gender preferences, sexual terms, and clarification of relationships. Results showed that 77.9% of NP students within two terms of graduation had not received any LGBTQ+-specific training. Almost 75% of the NP students reported not routinely asking about sexuality, and 82% reported infrequently or never asking gender identity. Furthermore, 93.1% of respondents reported providers infrequently or never ask about preferred gender or pronouns, and 86% reported providers infrequently inquire about sexual identity in primary care visits.

Conclusions:

Study findings demonstrate the uniqueness of managing care for LGBTQ+ patients and importance for more detailed LGBTQ+ health training in curricula in NP programs.

Implications:

Closing the gap in health care for LGBTQ+ patients is paramount in addressing global health disparities and population care.
Charcot–Marie–Tooth Disease and Hearing Loss: A Systematic Review With Meta-Analysis
Authors: Mills John F. , Heiland Luke D. , Nguyen Shaun A. , Close Michaela F. , Meyer Ted A.
Published: July 2024

Objective

To characterize the pattern of hearing loss in Charcot–Marie–Tooth (CMT) disease to help guide clinical management.

Databases Reviewed

CINAHL, PubMed, and Scopus.

Methods

Two independent investigators selected studies on CMT patients with pure-tone average (PTA) and auditory brainstem response (ABR) data. Case reports, case series <5 patients, and data that overlapped with another study were excluded. Investigators performed data extraction, quality rating, and risk-of-bias assessment using the Newcastle–Ottawa Scale. Meta-analysis of mean difference using fixed/random effects models was used. Also, data were analyzed using a weighted one-way analysis of variance, with post-hoc Tukey's test for comparison.

Results

Ultimately, 6 prospective studies (N = 197) were included. The most common demyelinating subtype (CMT1A) had significantly prolonged ABR latency values across wave III (0.20 ms, 95% confidence interval [CI]: 0.05–0.35), wave V (0.20 ms, 95% CI: 0.01–0.39), waves I–III (0.20 ms, 95% CI: 0.01–0.39), and waves I–V (0.20 ms, 95% CI: 0.01–0.39) when compared to matched controls. The autosomal recessive demyelinating subtype (CMT4C) had significantly worse PTA when compared to the most common subtype (CMT1A) (Δ 28.93 dB, 95% CI 18.34–39.52) and nondemyelinating subtype (CMT2A) (Δ 28.3 dB, 95% CI: 15.98–40.62).

Conclusions

Patients with CMT can present with a variety of phenotypes depending on the causative mutation. The ABR interpeak latency values for the most common demyelinating form of CMT are delayed when compared to matched controls. Most subtypes have normal hearing thresholds, apart from CMT4C, which presents with mild hearing loss on average.
Endoscopic-Assisted Presigmoid Approach to the Internal Auditory Canal. A Feasibility Study
Authors: Irwin Lindsay A. , Lee Lawrance , Mitchell Joshua , Corwin Frank D. , Coelho Daniel H. , Manzoor Nauman F.
Published: July 2024

Hypothesis

The retrolabyrinthine (presigmoid) approach has been utilized in various skull base surgeries but has not been fully utilized in the management of internal auditory canal (IAC) lesions, such as vestibular schwannoma (VS). Microsurgical retrolabyrinthine approach provides limited visualization of the IAC, while endoscopic-assisted techniques allow for further lateral exposure with labyrinthine preservation.

Background

Traditional approaches to the IAC have the disadvantage of hearing sacrifice or retraction of brain tissue. With the introduction of endoscopic techniques and enhanced visualization, access to this region of complex anatomy is possible.

Methods

Radiomorphometric and anatomical dissection was performed on two cadaveric temporal bones. High-resolution computed tomography was used to segment and delineate the volume of the IAC. Projected accessible IAC was compared to actual postdissection data with preservation of the posterior semicircular canal (PSCC) via the retrolabyrinthine corridor.

Results

While preserving the PSCC, the 0° and 30° endoscopes visualized 57.1% and 78.6% of the IAC for cadaver 1, and 64.0% and 76.0% of the IAC for cadaver 2, respectively. Sacrificing the PSCC, the 0° and 30° endoscopes provided visualization of 78.6% 85.7% of the IAC for cadaver 1, and 88.0% and 95.1% of the IAC for cadaver 2, respectively.

Conclusions

Retrolabyrinthine approach to resection of VS is a potentially viable hearing-preserving alternative to traditional approaches. This approach provides access to the majority of the IAC, while angled endoscopes or sacrifice of the PSCC can provide additional access toward the fundus. Further studies are needed to determine the clinical feasibility of this approach.