bluuebunny/crossref_metadata_2025 huggingface dataset:
Engagement with the HCV care cascade among high-risk groups: A population-based study
Authors: Erman Aysegul , Everett Karl , Wong William W.L. , Forouzannia Farinaz , Greenaway Christina , Janjua Naveed , Kwong Jeffrey C. , Sander Beate
Published: August 2023

Background:

HCV elimination requires a thorough understanding of the care cascade. A direct-acting antiviral (DAA)-era description of the care cascade has not been undertaken in Ontario, Canada’s most populous jurisdiction. Our primary objective was to describe the current population-level care cascade in the general Ontario population and among key risk groups ─ baby boomers, immigrants, and individuals experiencing residential instability. The secondary objective was to identify predictors of engagement.

Methods:

We conducted a population-based cohort study of Ontario residents undergoing HCV testing between January 1, 1999, and December 31, 2018, and mapped the care cascade [antibody-diagnosed, RNA tested, RNA positive, genotyped, treated, achieved sustained virologic response, reinfected/relapsed] as of December 31, 2018. The cascade was stratified by risk groups. Cause-specific hazard modeling was used to identify demographic, and socioeconomic predictors of engagement with key steps of the cascade.

Results:

Among 108,428 Ontario residents living with an HCV antibody diagnosis, 88% received confirmatory RNA testing; of these, 62% tested positive and 94% of positive tests were genotyped. Of those with confirmed viremia, 53% initiated treatment and 76% of treated individuals achieved sustained virologic response, while ~1% experienced reinfection or relapse. Males, older birth cohorts, long-term residents, those with a history of substance use disorder and social marginalization (eg, material deprivation, residential instability), and those initially diagnosed in the pre-DAA era exhibited lower rates of engagement with almost every step of HCV care.

Conclusions:

Despite DAA era improvements, treatment initiation remains a major gap. HCV screening and linkage-to-treatment, particularly for those with a history of substance use disorder and social marginalization, will be needed to equitably close gaps in HCV care in the province.
Tools for assessing labour pain: a comprehensive review of research literature
Authors: Zhang Erina W. , Jones Lester E. , Whitburn Laura Y.
Published: August 2023

The experience of pain associated with labour is complex and challenging to assess. A range of pain measurement tools are reported in the literature. This review aimed to identify current tools used in research to assess labour pain across the past decade and to evaluate their implementation and adequacy when used in the context of labour pain. A literature search was conducted in databases MEDLINE and Cumulative Index of Nursing and Allied Health Literature, using search terms relating to labour, pain, and measurement. A total of 363 articles were selected for inclusion. Most studies (89.9%) assessed pain as a unidimensional experience, with the most common tool being the Visual Analogue Scale, followed by the Numerical Rating Scale. Where studies assessed pain as a multidimensional experience, the most common measurement tool was the McGill Pain Questionnaire. Only 4 studies that used multidimensional tools selected a tool that was capable of capturing positive affective states. Numerous variations in the implementation of scales were noted. This included 35 variations found in the wording of the upper and lower anchors of the Visual Analogue Scale, some assessment tools not allowing an option for “no pain,” and instances where only sections of validated tools were used. It is clear that development of a standardised pain assessment strategy, which evaluates the multidimensions of labour pain efficiently and effectively and allows for both positive and negative experiences of pain to be reported, is needed.
Behavioral Sleep Interventions and Cardiovascular Risk Factors
Authors: McCarthy Christine Eileen , McAteer Claire A. , Murphy Robert , McDermott Clodagh , Costello Maria , O'Donnell Martin
Published: August 2023

Background/Objectives

Chronic sleep disturbance has been consistently associated with cardiovascular disease. We sought to determine whether behavioral interventions to improve sleep have been associated with improvements in 4 common cardiovascular disease risk factors: hypertension, diabetes mellitus (DM), obesity, and smoking.

Methods

Randomized controlled trials evaluating the prospective effect of behavioral sleep interventions on (a) blood pressure in participants with hypertension/prehypertension, (b) glycemic control in participants with DM/pre-DM, (c) anthropometrics in participants who were overweight/obese, and (d) smoking status in smokers were eligible. Where feasible, we undertook random-effects meta-analyses of standardized mean differences in cardiovascular disease risk factor change.

Results

Overall, 3 trials met the inclusion criteria for blood pressure, 4 for glycemic control, 9 for overweight/obesity, and 2 for smoking. On meta-analysis, interventions with sleep as the sole behavioral target were associated with a significant reduction in hemoglobin A1c% (−0.84; 95% confidence interval [CI], −1.34 to −0.34), but not a significant reduction in systolic blood pressure (−0.18; 95% CI, −0.55 to 0.20) versus controls. In addition, any interventions with sleep as a behavioral target were associated with significant reductions in hemoglobin A1c% (−0.71; 95% CI, −1.01 to −0.42) and weight (−0.78; 95% CI, −1.11 to −0.45), but not systolic blood pressure (−0.72; 95% CI, −1.82 to 0.37). Trials evaluating smoking status were not amenable to meta-analysis.

Conclusion

Behavioral interventions to improve sleep were associated with improved glycemic control in patients with DM. It is also possible that these interventions improve weight in individuals who were overweight/obese. A low number of trials and small sample sizes indicate that further large, well-designed randomized controlled trials of interventions are warranted.
Rapid-Response Electroencephalography in Seizure Diagnosis and Patient Care: Lessons From a Community Hospital
Authors: Eberhard Eleanor , Beckerman Samuel R.
Published: August 2023

BACKGROUND: Nonconvulsive seizures are a major source of in-hospital morbidity and a cause of unexplained encephalopathy in critically ill patients. Electroencephalography (EEG) is essential to confirm nonconvulsive seizures and can guide patient-specific workup, treatment, and prognostication. In a 208-bed community hospital, EEG services were limited to 1 part-time EEG technician and 1 EEG machine shared between inpatient and outpatient settings. Its use was restricted to typical business hours. A nursing-led quality improvement (QI) project endeavored to enhance access to EEG by introducing a point-of-care rapid-response EEG program. METHODS: For this project, a multidisciplinary protocol was developed to deploy a Food and Drug Administration–cleared, point-of-care rapid-response EEG platform (Ceribell Inc) in a community hospital's emergency department and inpatient units to streamline neurodiagnostic workups. This QI project compared EEG volume, study location, time-to-EEG, number of cases with seizures captured on EEG, and hospital-level financial metrics of diagnosis-related group reimbursements and length of stay for the 6 months before (pre-QI, using conventional EEG) and 6 months after implementing the rapid-response protocol (post-QI). RESULTS: Electroencephalography volume increased from 35 studies pre-QI to 115 post-QI (3.29-fold increase), whereas the median time from EEG order to EEG start decreased 7.6-fold (74 [34-187] minutes post-QI vs 562 [321-1034] minutes pre-QI). Point-of-care EEG was also associated with more confirmed seizure diagnoses compared with conventional EEG (27/115 post-QI vs 0/35 pre-QI). This resulted in additional diagnosis-related group reimbursements and hospital revenue. Availability of point-of-care EEG was also associated with a shorter median length of stay. CONCLUSION: A nurse-led, rapid-response EEG protocol at a community hospital resulted in significant improvements in EEG accessibility and seizure diagnosis with hospital-level financial benefits. By expanding access to EEG, confirming nonconvulsive seizures, and increasing care efficiency, rapid-response EEG protocols can enhance patient care.
Comparison of outcomes with stapler versus hand-sewn closure of the pancreatic stump following minimally invasive distal pancreatectomy: a retrospective cohort study
Authors: Qian Tao , Huang Kaiquan , Chen Wen , Bai Xueli , Gao Shunliang , Shen Yan , Zhang Min , Wu Jian , Yu Jun , Ma Tao , Liang Tingbo
Published: August 2023

Background:

Pancreatic fistula after distal pancreatectomy is a common and potentially lethal complication. The optimal closure method for the pancreatic remnant during minimally invasive distal pancreatectomy (MDP) remains unclear.

Methods:

Data of consecutive patients who underwent MDP in our institution between July 2018 and June 2021 were collected. The outcomes of MDP with stapler and hand-sewn closure were compared. The primary outcome was clinically relevant postoperative pancreatic fistula (CR-POPF) per the International Study Group of Pancreatic Surgery definition.

Results:

Of the 384 patients (stapler closure, 339; hand-sewn closure, 45) enrolled, 249 developed CR-POPF (grades B and C: 242 and 7 patients, respectively). The rates of grade B and grade C POPF in the stapler group were similar to the corresponding rates in the hand-sewn group (64.6% and 1.5% vs 51.1% and 4.4%, P = .078 and P = .223, respectively). No differences between the stapler and hand-sewn groups were observed regarding the median operation time (207 vs 222 minutes, P = .139), incidence of major complications (16.5% vs 20.0%, P = .559), and mortality (0.2% vs 0%, P = 1.000). The independent risk factors of CR-POPF were abdominal abscess, prolonged operation time, and transection site (P = .004, .006, and .001, respectively).

Conclusion:

The incidence and severity of CR-POPF by stapler closure of the pancreatic stump were comparable to those associated with hand-sewn closure in MDP in this retrospective cohort. Randomized controlled trials are needed to verify this finding.
Competency-based curriculum in nurse practitioner education
Authors: Arends Robin
Published: August 2023

Professional nursing standards and guidelines form the foundation for nurse practitioner curriculum. Nurse educators should understand the role these professional standards and guidelines have in the development of curriculum. Recently, nursing education has moved to a competency-based education with the release of the new American Association of Colleges of Nursing Essentials and the National Organization of Nurse Practitioner Faculties Nurse Practitioner Role Core Competencies. Competency-based curriculum allows for a common understanding of the knowledge, skills, and experiences nurse practitioner graduates require for entry to practice. Competency-based education also provides consistent and uniform expectations for novice nurse practitioners on entry to practice. With the change to a competency-based curriculum, nurse educators can review and revise curriculum through refinement of courses, student learning objectives, assignments, and evaluations. Nurse educators have a responsibility to critically analyze student assignments and evaluations to ensure competencies are met multiple times through a variety of methods. In addition, nurse educators have the opportunity to use assignments that meet multiple competencies to modernize student learning. Refinement and revision lead to enhanced student critical thinking and provide opportunities for real-world training to improve student outcomes.
Trends on Near-Infrared Spectroscopy Associated With Acute Brain Injury in Venoarterial Extracorporeal Membrane Oxygenation
Authors: Zhao David , Shou Benjamin L. , Caturegli Giorgio , Whitman Glenn J. R. , Kim Bo Soo , Cho Sung-Min ,   on behalf of Herald Investigators
Published: August 2023

We aimed to determine the association between cerebral regional oxygen saturation (rSO2) trends from cerebral near-infrared spectroscopy (cNIRS) and acute brain injury (ABI) in adult venoarterial extracorporeal membrane oxygenation (VA-ECMO) patients. ABI was defined as intracranial hemorrhage, ischemic stroke, hypoxic ischemic brain injury, or brain death during ECMO. rSO2 values were collected from left and right cerebral oximetry sensors every hour from ECMO cannulation. Cerebral desaturation was defined as consecutive hours of rSO2 < 40%. rSO2 asymmetry was determined by (a) averaging left/right rSO2 difference over the entire ECMO run; (b) consecutive hours of rSO2 asymmetry. Sixty-nine VA-ECMO patients (mean age 56 years, 65% male) underwent cNIRS. Eighteen (26%) experienced ABI. When the mean rSO2 asymmetry was >8% there was significantly increased odds of ABI (aOR = 39.4; 95% CI = 4.1–381.4). Concurrent rSO2 < 40% and rSO2 asymmetry >10% for >10 consecutive hours (asymmetric desaturation) was also significantly associated with ABI (aOR = 5.2; 95% CI = 1.2–22.2), but neither criterion alone were. Mean rSO2 asymmetry>8% exhibited 39% sensitivity and 98% specificity for detecting ABI, with an area under the curve (AUC) of 0.86, and asymmetric desaturation had 33% sensitivity and 88% specificity, with an AUC of 0.72. These trends on NIRS monitoring may help detect ABI in VA-ECMO patients.
Predictive factors for early requirement of respiratory support through phone call to Emergency Medical Call Centre for dyspnoea: a retrospective cohort study
Authors: Balen Frederic , Lamy Sebastien , Fraisse Sarah , Trinari Julie , Bounes Vincent , Dubucs Xavier , Charpentier Sandrine
Published: August 2023

Background

Acute dyspnoea is a common symptom in Emergency Medicine, and severity assessment is difficult during the first time the patient calls the Emergency Medical Call Centre.

Objective

To identify predictive factors regarding the need for early respiratory support in patients who call the Emergency Medical Call Centre for dyspnoea.

Design, settings and participants

This retrospective cohort study carried out in the Emergency Medical Call Centre of the University Hospital of Toulouse from 1 July to 31 December 2019. Patients over the age of 15 who call the Emergency Medical Call Centre regarding dyspnoea and who were registered at the University Hospital or died before admission were included in our study.

Outcome measure and analysis

The primary end-point was early requirement of respiratory support [including high-flow oxygen, non-invasive ventilation (NIV) or mechanical ventilation after intubation] that was initiated by the physicians staffed ambulance before admission to the hospital or within 3 h after being admitted. Associations with patients’ characteristics identified during Emergency Medical Call Centre calls were assessed with a backward stepwise logistic regression after multiple imputations for missing values.

Main results

During the 6-month inclusion period, 1425 patients called the Emergency Medical Call Centre for respiratory issues. After excluding 38 calls, 1387 were analyzed, including 208 (15%) patients requiring respiratory support. The most frequent respiratory support used was NIV (75%). Six independent predictive factors of requirement of respiratory support were identified: chronic β2-mimetics medication [odds ratio (OR) = 2.35, 95% confidence interval (CI) 1.61–3.44], polypnea (OR = 5.78, 95% CI 2.74–12.22), altered ability to speak (OR = 2.35, 95% CI 1.55–3.55), cyanosis (OR = 2.79, 95% CI 1.81–4.32), sweats (OR = 1.93, 95% CI 1.25–3) and altered consciousness (OR = 1.8, 95% CI 1.1–3.08).

Conclusion

During first calls for dyspnoea, six predictive factors are independently associated with the risk of early requirement of respiratory support.
Endemic statistical paradoxes in epidemiologic studies distort knowledge on prostate cancer: mitigation and caution of fallacies in prostate cancer causal epidemiological studies
Authors: Cussenot Olivier , Fromont Gaelle , Cancel-Tassin Géraldine , Hamdy Freddie C. , Martin Richard M.
Published: August 2023

Purpose of review

Many studies on epidemiology of prostate cancer (PCa) are based on a diagnosis of PCa using PSA (prostate-specific antigen) level. However, biases can distort the interpretation of the results, which in turn limits policy and decision making on public health prevention strategies or clinical guidelines. The main confusion is to interpret the posterior probability of the outcome following the exposure as a change in the prevalence of the disease outcome, whereas this change reflects only the predictive values of the PSA test induced by the exposure of interest.

Recent findings

Many studies report potential causal factors involved in PCa risk. However, the lack of integration of how physiological changes in PSA values are associated with the exposures being investigated, they explain in part contradictory and controversial results on PCa risk factors in the literature.

A strategy to perform case--control studies based on PSA stratification is suggested to avoid misinterpretation related to PSA misclassification. Real data are analysed, and we show that we can exploit the mechanism of selection biases using different modalities of controls recruitment based on biomarker stratification to distinguish real from false causal factors.
Ectopia cordis with multiple ventricular septal defect and sternal cleft in a newborn: a case report
Authors: Goli Rasoul , Majidi Balaneji Sahar , Hosseinpour Leila , Abbasi Mahdiyeh , Feizi Milad , Nafe Parihan , Faraji Navid , Heydari Bisafar Mojgan , Arad Mansour
Published: August 2023

Introduction and importance:

Ectopia cordis is a rare type of malformation where the heart is not located normally. It may be partially or completely located outside the thoracic cavity and can be associated with other congenital abnormalities.

Case presentation:

This case report is of a 34-week- and 6-day-old female fetus with a birth weight of 2040 g, a height of 41 cm, and a head circumference of 32 cm. The initial physical examination revealed a responsive newborn with an externalized heart outside the chest, with pericardium protection. In addition, a thoracic wall defect was detected suggesting incomplete formation of the septum bone. Moreover, in this case, the echocardiography report showed a multiple ventricular septal defect.

Conclusion:

The management of ectopia cordis is a challenge for any obstetrician and pediatric surgeon due to its rarity. It causes mental agony and anxiety to the parents. With an early diagnosis, termination of pregnancy can be one of the options. Once it is diagnosed late, it needs a multidisciplinary approach, and the services of a very experienced pediatric surgeon to improve the prognosis.
Dumble cystic lymphangioma as an underlying cause of vague abdominal complaints in a 2-year-old girl: case report
Authors: Atqiaee Khashayar , Samady Khanghah Ali , Mohajerzadeh Leily , Mardi Ali , Khayat Zahiri Farhad , Barin Sajjad
Published: August 2023

Introduction:

Lymphatic malformations (LM) refer to very rare hamartomatous benign lymphatic ectasias with an incidence of 1:250 000. They almost involve children more than adults, and among them, infants under one age are mostly affected. Macrocytic LM is found to be more than 2 cm in diameter or 2×2 cm2 in volume. The proper treatment for mesenteric LM is complete surgical excision unless there is vital structure involvement.

Case presentation:

The authors report a mesenteric macrocytic LM in a 2-year-old girl complaining of vague abdominal discomfort and persistent vomiting in which ultrasonography revealed a cystic masse with seromucous components. She then underwent exploratory laparotomy. The operation and the follow-up duration were uneventful.

Discussion:

LMs are rare benign lesions of vascular origin with lymphatic differentiation, according to the latest International Society for the Study of Vascular Anomalies (ISSVA 2018). Under light microscopy, these malformations are characterized by their thin-walled endothelium and lymphatic tissue.

These mobile lesions are incidentally found or appear with intestinal obstruction or acute abdomen scenarios.

Conclusion:

Although benign, the LMs have the potential for invasion and recurrence. Thus, the examiner physician must keep such intra-abdominal lesions in mind.
1 Year-follow-up of transforaminal surgical approach in the management of migrated disc herniation: a cross-sectional study
Authors: Do Hung Manh , Doan Ha Thi-Ngoc , Nguyen Long Hoang
Published: August 2023

Background:

Transforaminal percutaneous endoscopic lumbar discectomy (TPELD) recently confirms its superiority compared to typical open discectomy in the treatment of very high-grade migrated disk herniation. In Vietnam, this technique has been applied in recent years; however; lack of reports and evidence.

Objectives:

In this study, the authors would like to share their surgical experience and report the initial results in their center, after successfully performing TPELD for very high-grade migrated disk herniation in 40 patients.

Patients and methods:

Forty patients, who underwent TPELD to remove the nucleus of very high-grade migrated disk herniation, were enrolled in this study. The study was carried out from April 2019 to April 2021. Preoperative and postoperative MRI were compared to demonstrate the removed disk. Postoperative visual analog score, oswestry disability index, and modified Macnab criteria were obtained after 1 month, 6 months, and 1 year and were compared.

Results:

There were no major complications related directly to this technique. Seven patients were operated at L3-4, 28 patients at L4-5, and 5 patients at l5-S1. Mean visual analog score for leg pain improved from 7.36±0.64 preoperatively to 1.22±1.16 at 6 months postoperatively and 1.34±1.47 at 1 year postoperatively (P<0.01). The mean preoperative oswestry disability index improved from 67.1±8.79 preoperatively to 12.1±13.48 at 1 year postoperatively (P<0.01). Excellent or good global outcomes were obtained in 95%.

Conclusions:

TPELD is a minimally invasive treatment with effective and safe results of very high-grade migrated disk herniation. Improvement of several pain scores can be observed in the 12-month follow-up after surgery.
Assessing serum C-reactive protein as a predictor of COVID-19 outcomes: a retrospective cross-sectional study
Authors: Abdullah Ardalan J. , Arif Ali T. , Rahman Hawre A. , Sofihussein Kadhim Q. , Hadi Jihad M. , Aziz Jeza M. Abdul , Tofiq Shko Sh. , Mustafa Ayman M.
Published: August 2023

Background:

Despite being very infectious and fatal, the coronavirus disease 2019 (COVID-19) lacks a reliable and practical biomarker to assess how serious it will be.

Aim:

The current study aims to conclude the possibility of C-reactive protein (CRP) level serving as a biomarker for early prediction of COVID-19 infections.

Methods:

In this retrospective cross-sectional study, 88 people participated who were infected with COVID-19, aged from 25 to 79 years old. Compare the CRP test range of all samples from patients who visited the hospital between January and April 2022.

Results:

All participants were confirmed to have COVID-19 through nasopharyngeal swab analysis and real-time polymerase chain reaction real-time polymerase chain reaction testing. Results showed that the majority of infected individuals had elevated CRP levels. A P-value of less than 0.05 indicated a significant difference in CRP levels between alive and dead patients. No significant difference in CRP levels was found between male and female patients. The average CRP level of deceased patients was 137.79 mg/l, while the average CRP level of survivors was 14.37 mg/l. The median interquartile range of deceased patients was also found to be significantly higher compared to survivors.

Conclusion:

In conclusion, serum CRP levels potentially predict the severity and development of sickness in patients with COVID-19 infections.
Urinary bladder metastasis from primary lung cancer, a rare and challenging diagnosis: a case report
Authors: Irzi Mohamed , Miri Achraf , El Moudane Anouar , Ouraghi Abdelghani , Barki Ali
Published: August 2023

Introduction and importance:

Bladder metastases are rare, representing only 2% of all bladder tumors, secondary bladder localization from a primary lung is exceptional.

Case presentation:

The authors describe the case followed for lung adenocarcinoma with an exceptional metastatic site, which is the bladder. A computed tomography scan showed a left suprahilar bronchial tumor with pleurisy (Fig. 1A), which biopsies concluded to a moderately differentiated adenocarcinoma. The patient is treated with palliative cisplatin-based chemotherapy. And died 11 months after diagnosis.

Clinical discussion:

Bladder metastases are rare, representing only 2% of all malignant bladder tumors. Metastatic lesions of the bladder are generally revealed by hematuria. Confirmation of bladder invasion is immunohistochemical, facilitated by knowledge of the primitive.

Conclusion:

In the presence of any adenocarcinoma of the bladder, a thoracic-abdominal-pelvic computed tomography scan must be requested in search of a primary extra-vesical cancer who can facilitate the diagnosis.
Infective endocarditis presenting as meningitis: a case report
Authors: Gautam Sudarshan , Sharma Nava R. , Kansakar Sajog , Lamichhane Saral , Pokhrel Madalasa , Basnet Arjun
Published: August 2023

Introduction and importance:

Infective endocarditis (IE) primarily affects the endocardium of heart valves. Neurologic manifestations include strokes, intracerebral hemorrhages, meningitis, cerebral and spinal abscess, and mycotic aneurysms. Although rare, meningitis is a potentially life-threatening complication of IE, so physicians should be aware of this rare and fatal complication of IE.

Case presentation:

Here, the authors present a case of a 53-year-old male who presented with bacterial meningitis secondary to IE. His blood culture was positive for methicillin-sensitive staphylococcal aureus. Echocardiography findings were suggestive of endocarditis. Despite aggressive intensive care management, our patient did not survive.

Clinical discussion:

The isolation of Staphylococcus aureus in culture should raise a suspicion of foci being elsewhere outside the central nervous system. Treatment of complications like meningitis may require intrathecal antibiotics. The vegetation and neurological complications are often difficult to treat and require the participation of a multidisciplinary team.

Conclusions:

The diagnosis of IE in patients presenting with neurologic deficits and fever should be considered. A physician should raise a suspicion of infective foci being elsewhere outside the central nervous system if the organism isolated in culture is Staphylococcus aureus.
Mad honey poisoning presenting with syncopal attack: a case report
Authors: Baniya Abinash , Duwadee Prabin , K.C. Sujata , Shahi Manoj , Shrestha Nabaraj , Bam Prabin K. , Gurung Bipana , Shrestha Roshan
Published: August 2023

Introduction and importance:

Mad honey contains grayanotoxin, which is commonly derived from the nectar of a few Rhododendron species. It is commonly used by natives of the Himalayas in the belief of its medicinal use.

Case presentation:

The authors report a case of 62 years old male with mad honey poisoning who was presented to the emergency department with loss of consciousness and had bradycardia and hypotension on arrival. The patient received intravenous fluids, atropine, and vasopressor support and was closely monitored in the coronary care unit for 48 h.

Discussion:

Grayanotoxin I and II are believed to be primarily responsible for mad honey intoxication and act by persistent activation of voltage-gated sodium channels. Hypotension, dizziness, nausea, vomiting, and impaired consciousness are the common presentation of mad honey intoxication. Toxic effects are usually mild and close monitoring for 24–48 h is sufficient but life-threatening complications like cardiac asystole, convulsions, and myocardial infarction have also been reported.

Conclusion:

Most cases of mad honey intoxication only need symptomatic treatment and close observation but the potential for deterioration and life-threatening complications must also be considered.
Renal function impairment might be worsened by SARS-CoV-2 virus: a triple critical care disease causing hypoxemia
Authors: Bereda Gudisa
Published: August 2023

Background and importance:

People who have underlying chronic renal disease may be more susceptible to the catastrophic disease caused by coronavirus disease 2019 (COVID-19), which is characterized by multisystem organ failure, thrombosis, and an aggravated inflammatory response.

Case presentation:

On 11 July 2022, a middle-aged black African male merchant, 57 was taken to the emergency room. The patient arrived at the emergency room with grade II pitting edema, weight loss, a cold intolerance, stress, a fever, a headache, dehydration, and shortness of breath that had persisted for 2 days. After 28 h, the results of the polymerase chain reaction test on a throat swab confirmed the presence of the severe acute respiratory syndrome coronavirus-2 virus. An auscultation of the chest revealed bilateral wheezing, crepitations in the right infrascapular region, and bilateral airspace consolidations, which were more pronounced on the left side and included practically all zones. He received 1000 ml of fluid resuscitation (0.9% normal saline) and insulin therapy through a drip as soon as he was admitted to an ICU. He received subcutaneous enoxaparin 80 mg once every 12 h as treatment for his confirmed COVID-19 and thromboprophylaxis.

Clinical discussion:

The COVID-19 infection can cause difficulties in infected individuals that can result in pneumonia, intubation, admission to an ICU, and even death. Common diseases, including diabetes mellitus and chronic renal disease, have a synergistic relationship with early death.

Conclusion:

The existence of prior chronic renal impairment may possibly be a factor in the increased prevalence of kidney involvement seen in hospitalized COVID-19 patients.
Unravelling COVID-19 vaccination attributes worldwide: an extensive review regarding uptake, hesitancy, and future implication
Authors: Ali Hossam T. , Ashour Yara , Rais Mohammed A. , Barakat Mostafa , Rezeq Tasnim A. , Sharkawy Mohamed M. , Lapic Mina , Soliman Ziad A. , Abdullah Ahmed , Allahham Abdulrahman , Abdelaal Abdelaziz , Amer Samar A. , Rohilla Ranjana , Mohanty Aroop , Sah Ranjit
Published: August 2023

Since the declaration of the coronavirus disease 2019 pandemic, all efforts were directed towards limiting the transfer of the disease and preventing severe disease forms from occurring. In this regard, numerous vaccines were quickly developed to limit the associated morbidity and mortality of the disease and to reduce the burden on healthcare systems worldwide. However, to date, vaccine hesitancy remains a major limitation to vaccine distribution, with varying degrees in different countries. Therefore, the authors conducted this literature review to highlight the magnitude of this issue throughout the globe and summarize some of its major causes (i.e. governmental, healthcare system-related, population-related, and vaccine-related) and contributing factors (i.e. knowledge/awareness, social media, etc.). In addition, the authors highlighted some of the main motivating factors that can minimize the burden of vaccine hesitancy at the population, governmental, and worldwide levels. These include structural (i.e. government, country), extrinsic (i.e. family, friends), intrinsic (i.e. self-perception), and other factors (financial and nonfinancial). Finally, the authors proposed some implications for future research to ease the vaccination process and hopefully, put an end to this problem.
Assessment of rational use of antimicrobials: a cross-sectional study among people of Nepal
Authors: Khadka Sitaram , Khadka Sulochana , Yadav Gopal K. , Sharma Arun , Giri Santoshi , Joshi Rinku , Amgain Kapil
Published: August 2023

Introduction:

Inappropriate antimicrobial use leading to antimicrobial resistance is a matter of public health concern globally. This research was conducted with the objective of preventing antimicrobial misuse across knowledge, behavior, and practice domains among the general people of Nepal.

Methods:

It was a cross-sectional survey conducted among 385 participants visiting tertiary care center from all over Nepal from February 2022 to May 2022. Modified Bloom’s cut-off point was utilized to categorize the participants’ overall knowledge, behavior, and practice. The chi-square (χ
2) test and odds ratio (OR) using binary logistic regression at 95% CI and Spearman’s rank correlation coefficient test (r) were calculated wherever appropriate.

Results:

More than three-fifths of the participants (248, 64.42%) demonstrated good behavior, whereas less than half of the participants showed good knowledge (137, 35.58%) and practice (161, 41.82%) about rational use of antimicrobials. Health professionals had higher knowledge (OR: 1.07, 95% CI: 0.70–1.62) and good behavior (OR: 0.42, 95% CI: 0.27–0.64) than other professionals (P<0.05). Those with higher income [≥50 000 NRS (Nepalese rupees)] had good behavior (OR: 3.37, 95% CI: 1.65–6.87) and good practice (OR: 2.58, 95% CI: 1.47–4.50) scores than those with less monthly income (P<0.05). Similarly, higher educational degrees, viz. master’s and/or above, had good behavior (OR: 4.13, 95% CI: 2.62–6.49) and good practice scores (OR: 2.55, 95% CI: 1.68–3.87). Additionally, there were significant positive correlations between knowledge (K), behavior (B), and practice (P) scores (r=0.331 for K and B, r=0.259 for K and P, and r=0.618 for B and P, respectively; P<0.05).

Conclusions:

The findings imply the demand for effective legislature, strict enforcement of the drug act, and proper implementation of plans and policies to curb antimicrobials misuse. Lack of execution of existing laws and the unawareness of the public led to the extravagant use of antimicrobials.
Outcomes of viral myocarditis in patients with and without COVID-19: a nationwide analysis from the United States
Authors: Ismayl Mahmoud , Ahmed Hasaan , Hamadi Dana , Goldsweig Andrew M. , Aronow Herbert D. , Aboeata Ahmed
Published: August 2023

Background:

Cardiovascular complications contribute to 40% of coronavirus disease 2019 (COVID-19) related deaths. The viral myocarditis associated with COVID-19 accounts for significant morbidity and mortality. How COVID-19 myocarditis compares to other viral myocardites is unknown.

Methods:

The authors conducted a retrospective cohort study using the National Inpatient Sample database to identify adult patients hospitalized for viral myocarditis in 2020 and to compare outcomes between those with and without COVID-19. The primary study outcome was in-hospital mortality. Secondary outcomes included in-hospital complications, length of stay, and total costs.

Results:

The study population included 15 390 patients with viral myocarditis, of whom 5540 (36%) had COVID-19. After adjustment for baseline characteristics, patients with COVID-19 had higher odds of in-hospital mortality [adjusted odds ratio (aOR) 3.46, 95% CI 2.57–4.67], cardiovascular complications (aOR 1.46, 95% CI 1.14–1.87) including cardiac arrest (aOR 2.07, 95% CI 1.36–3.14), myocardial infarction (aOR 2.97, 95% CI 2.10–4.20), venous thromboembolism (aOR 2.01, 95% CI 1.25–3.22), neurologic complications (aOR 1.82, 95% CI 1.10–2.84), renal complications (aOR 1.72, 95% CI 1.38–2.13), and hematologic complications (aOR 1.32, 95% CI 1.10–1.74), but lower odds of acute heart failure (aOR 0.60, 95% CI 0.44–0.80). The odds of pericarditis, pericardial effusion/tamponade, cardiogenic shock, and the need for vasopressors or mechanical circulatory support were similar. Patients with COVID-19 had longer length of stay (7 days vs. 4 days,P<0.01) and higher total costs ($21,308 vs. $14,089,P<0.01).

Conclusions:

Among patients with viral myocarditis, COVID-19 is associated with higher in-hospital mortality and cardiovascular, neurologic, renal, and hematologic complications compared to non-COVID-19 viruses.
Coronary allograft vasculopathy in post-heart transplant patients: pathogenesis and role of cardiac computed tomography in diagnosis—a comprehensive review
Authors: Sharma Vagisha , Agarwal Siddharth , Grover Tanvi , Malhotra Anureet , Kumar Harendra , Gowda Diksha M. , Agarwal Yash , Bhatia Hitesh , Koirala Samrat Babu , Singh Satinder P.
Published: August 2023

Coronary allograft vasculopathy, often known as cardiac allograft vasculopathy (CAV), is a substantial source of morbidity and mortality in people who have had heart transplants. Early detection and monitoring of CAV are crucial for improving outcomes in this population. Although cardiac computed tomography (CT) has emerged as a possible method for finding and evaluating CAV, invasive coronary angiography has long been thought of as the gold standard for recognizing CAV. This study focuses on the utility of cardiac CT for CAV diagnosis and treatment in the post-heart transplant population. It provides an overview of recent studies on the application of cardiac CT in CAV and highlights the advantages and disadvantages of this imaging modality. The potential application of cardiac CT for CAV risk assessment and care is also examined in the study. Overall, the data point to a potential role for cardiac CT in the detection and treatment of CAV in post-heart transplant patients. It enables evaluation of the whole coronary tree and low-radiation, high-resolution imaging of the coronary arteries. Hence, further study is required to determine how best to employ cardiac CT in treating CAV in this group.
Clinical spectrum of ear, nose and throat foreign bodies at a tertiary hospital: a cross-sectional study
Authors: Abraham Zephania Saitabau , Kahinga Aveline Aloyce , Khamis Khamis Omar , Liyombo Edwin
Published: August 2023

Background:

Presence of foreign bodies (FBs) in the ears and upper aerodigestive tract is a common encounter in children unlike adults in otorhinolaryngology practice. FBs form a major part of emergencies in otorhinolaryngology. Studies on ear, nose and throat FBs in Tanzania are scarce.

Objective:

To determine the clinical spectrum of ear, nose and throat FBs at the largest tertiary hospital.

Methods:

A descriptive hospital based cross-sectional study was conducted where 95 patients were recruited at the Hospital from December 2019 to May 2020. Data were collected using semi-structured questionnaires and analyzed using Statistical Package for the Social Sciences (SPSSs) version 24.

Results:

In this study, there were more females, 56 (58.9%) than males, 39 (41.1%) with female to male ratio being 1.4:1. Children aged younger than 10 years predominated in this study, 69 (72.6%). The nose, 36 (37.9%) and ear, 29 (30.5%) were the commonest sites where FBs lodged followed by the pharynx, 22 (23.2%) and oesophagus, 10 (8.4%). Regarding types of FBs, inorganic types, 49 (51.6%) predominated and were mostly coins, 17 (17.9%). Majority of FBs were removed in less than 24 h (53.7%) and complications were found in 29 (30.5%) patients and being more pronounced with nasal FBs. Majority of those with complications presented to the hospital 24–72 h post lodging of FBs.

Conclusion:

FBs were encountered more commonly in children aged younger than 10 years. The nose was the commonly affected anatomical site followed by the ear, pharynx and oesophagus. The commonest FB was a coin. The inorganic FB type predominated and the most common inorganic type was a coin while the commonest organic type was a seed. Complications were encountered in those who presented between 24 and 72 h post FB lodgment.
Reverse takotsubo syndrome heralding as ventricular fibrillation: a case report
Authors: Basnet Arjun , Sharma Nava R. , Lamichhane Saral , Tiwari Kripa , Varghese Jeffy , Kansakar Sajog , Gautam Sudarshan
Published: August 2023

Introduction and importance:

Reverse takotsubo syndrome, a variant of takotsubo cardiomyopathy, is an acute left ventricular failure characterized by the basal akinesis/hypokinesis associated with apical hyperkinesis. Its presentation is similar to that of the acute coronary syndrome.

Case presentation:

The authors present a case of a 49-year-old woman, a vice principal at a local school with a history of hypertension, who was brought to our center after she collapsed while giving a graduation speech. Reverse takotsubo was a presumed diagnosis after we ruled out other differentials.

Clinical discussion:

The pathophysiology of reverse takotsubo syndrome is poorly understood. It might be due to a different pattern of catecholamine-mediated myocardial dysfunction than classic takotsubo cardiomyopathy. It is often associated with physical and/or emotional stressors.

Conclusion:

Supportive treatment and identification and prevention of triggers can reduce the recurrence of reverse takotsubo cardiomyopathy. Physicians should be aware of various triggers for this condition.
The effect of cognitive-behavioral group therapy on reducing depression and anxiety in patients with mood disorders: experimental research
Authors: Nabian Pantea
Published: August 2023

Introduction and importance:

Mood disorders are one of the most common psychiatric disorders that manifest as a low mood in depressed people or a high mood in manic people. The cognitive-behavioral therapy group is one of the most effective forms of intervention available for patients with mood disorders. This research aimed to evaluate the effect of cognitive-behavioral group therapy in reducing depression and anxiety in patients with mood disorders.

Case presentation:

The study was a semi-experimental study with a pretest-post-test design with a control group. The research subjects were 60 patients hospitalized in the psychiatric department of Razi Hospital in Tehran, who were randomly divided into two experimental (N:30) and control (N:30) groups. Both groups took medicine as usual. Before the therapeutic intervention, both groups were evaluated with Beck’s depression questionnaire and the Zung anxiety scale. In addition to drug therapy, the experimental group participated in ten sessions of the cognitive-behavioral therapy group, and in the control group, no psychological intervention was performed except for drug therapy. At the end of the nonpharmacological treatment intervention, both groups were evaluated again with the aforementioned tests. The obtained data were analyzed using independent and dependent t-tests.

Clinical discussion:

The research findings showed that the cognitive-behavioral therapy group was significantly (P<0.05) effective in reducing the depression of hospitalized patients with mood disorders, but this method did not have much effect in reducing the anxiety of the patients.

Conclusion:

Cognitive-behavioral group therapy can be effective in reducing depression in hospitalized patients with mood disorders.
The use of bovine-derived hydroxyapatite xenograft for defect filling in opening-wedge high tibial osteotomy
Authors: Santoso Asep , Utomo Pamudji , Mahyudin Ferdiansyah , Utomo Dwikora N. , Budhiparama Nicolaas C. , Anwar Iwan B. , Sibarani Tangkas , Warman Fanny I.
Published: August 2023

Introduction:

High tibial osteotomy is a reliable procedure for the correction of knee varus deformity. An opening-wedge high tibial osteotomy (OW-HTO) is the most popular technique. The results of the bone defect after opening the wedge needed special treatment to ensure bone healing. This study aims to evaluate the use of bovine-derived hydroxyapatite graft for defect filling after OW-HTO.

Methods:

A retrospective study was performed on all patients who received OW-HTO at Prof. Dr R. Soeharso Orthopaedic Hospital from November 2019 to December 2022. A total of 21 patients (24 knees) were included in this study. Clinical dan radiological evaluation was performed on all patients preoperative and postoperatively. The mean of the follow-up period was 12.6 months with a minimum of 4 months follow-up.

Results:

Primary medial uni-compartment knee osteoarthritis was the most common diagnosis, with 17 of 24 cases (70.8%). Mechanical axis deviation was changed from 31 mm medial deviation (range: 8–52 mm) to 0.45 mm medial deviation (range: 13 - (-8) mm). The anatomic tibiofemoral angle was corrected from a preoperative mean of 4.7° of varus to a mean of 5.8° of valgus postoperatively. Bone defect height was mean 15.9 mm with a range of 10–23 mm. Bone defect width was mean 46.7 mm (range: 34–60 mm). Hydroxyapatite graft integration with the host bone was found in all patients during the final follow-up period.

Conclusions:

Bovine-derived hydroxyapatite graft is a safe and effective material for bone defect filling in OW-HTO procedures with a high bone union rate.
Osmotic demyelination syndrome with transient diabetes insipidus in postpartum female: a case report
Authors: Yadav Alisha , Sherpali Aakash , Bashyal Bibhav , Kala Kharel Kirti , Parajuli Naresh
Published: August 2023

Introduction and importance:

Osmotic demyelination syndrome (ODS) is a neurological disorder usually after rapid correction of hyponatremia. Only few cases of ODS with hypernatremia and diabetes insipidus (DI) in postpartum state is reported. Postpartum hypernatremia is described as severe hypernatremia in postpartum period and presents as an encephalopathy with rhabdomyolysis with diffuse white matter hyperintensities suggestive of osmotic demyelination.

Case presentation:

The authors present a case of 29-year-old female who presented with chief complaint of altered sensorium and quadriparesis. Two days prior to onset of symptoms, she underwent caesarean section, was kept on nil per oral and free fluid restriction, after which she had confusion, altered sensorium, and weakness in all four limbs. Sodium level was 170 mEq/l. Urine osmolality and plasma osmolality was 150 and 410 mOsm/kg of water, respectively. MRI showed high signal intensity lesion in pons suggestive of demyelination. She was diagnosed ODS with transient DI and quadriparesis, in postpartum period due to further rise in sodium after free fluid restriction and nil per oral. She was treated with desmopressin, 5% dextrose and 0.9% normal saline, her quadriparesis recovered and desmopressin was tapered and stopped over 45 days and discharged at stable state.

Clinical discussion:

ODS can rarely be associated with hypernatremia in postpartum female presenting as quadriparesis and altered sensorium.

Conclusion:

Clinicians should be familiar of ODS with hypernatremia with transient DI in postpartum period, which is reversible and can be managed by desmopressin and fluid replacement.
Breakage of an orogastric tube in a critically Ill patient: a case report
Authors: Khanal Surendra , Shrestha Suraj , Khadayat Ramesh , Adhikari Aayush , Poddar Elisha , Kharel Sanjeev , Regmi Pradeep Raj
Published: August 2023

Introduction and importance:

Orogastric and nasogastric tubes are common methods of enteral feeding. Although the methods of tube feeding are simple, these methods are not free of complications.

Case presentation:

This case report describes a 58-year-old patient with the diagnosis of stroke, in whom there was breakage of an orogastric tube during a prolonged ICU stay.

Clinical discussion:

Early enteral feeding in patients without any contraindications is associated with improved organ survival and recovery, and decreased incidence of infections, which decreases the ICU stay and improves the overall outcome. Nasogastric and orogastric tubes are the most commonly inserted feeding tubes. Breakage of an orogastric tube is a rare complication that can occur due to manufacturing defects, exposure to a harsh acidic environment, and forceful flushing of an obstructed tube.

Conclusions:

Timely identification of the broken feeding tube can help the treating clinicians retrieve it easily even with the help of a laryngoscope in selected patients.