bluuebunny/crossref_metadata_2025_split huggingface dataset:
Conjunctival Neuroma After Corneal Neurotization in a Patient With Neurotrophic Keratopathy
Authors: Camacho Alex de O. C. , Alzanki Sara , Al Enazi Mohammed , Cherifi Nora , Cayrol Romain , Rahal Akram , Hardy Isabelle , Brunette Isabelle , Mabon Michèle 
Published: December 2024

Purpose:
To report a rare case of conjunctival neuroma after a successful corneal neurotization surgery.

Methods:
The clinical file and histopathology slides of this patient who underwent surgical corneal neurotization for a neurotrophic keratopathy in the right eye were reviewed.

Results:
A 70-year-old man with a history of severe herpetic (varicella zoster) neurotrophic keratopathy and keratouveitis in the right eye developed a corneal perforation, which required tectonic keratoplasty (May 2020). Corneal neurotization was performed 1 year later without complication, using the ipsilateral supraorbital and supratrochlear nerves to reinnervate the right cornea (April 2021), followed by repeat penetrating keratoplasty (September 2021). Three months later, a superonasal conjunctival mass was observed with a contiguous corneal delle and melt at the corneal-host junction. In vivo confocal microscopy showed numerous nerve fibers within the conjunctival mass, suggesting a diagnosis of conjunctival neuroma. The mass was surgically debulked, and the diagnosis was confirmed by histopathology and immunohistochemistry. The delle and corneal melt were successfully treated with an amniotic membrane.

Conclusions:
To the best of our knowledge, this is the first case of confirmed conjunctival neuroma reported after corneal neurotization. Confocal microscopy, histopathology, and immunohistochemistry have proven to be highly useful tools for the prompt recognition and accurate diagnosis necessary for the proper management of this rare complication.
4-Factor prothrombin complex concentrates and factor VIII inhibitor bypass activity use in cardiac surgery
Authors: Budd Ashley N. , Parulkar Suraj D. , Carabini Louanne M. , McCarthy Robert J. 
Published: December 2024

Objectives
The objective of this study was to compare total thromboembolic complications between 4-factor prothrombin complex concentrate (4F-PCC) with factor VIII inhibitor bypassing activity (FEIBA) when utilized during cardiac surgery.

Design
A quasi-experimental analysis of retrospective data from consecutive patients.

Setting
A tertiary care university hospital.

Participants
Patients undergoing cardiac surgery with cardiopulmonary bypass.

Interventions
Patients received either 4F-PCC or FEIBA after discontinuation of cardiopulmonary bypass and reversal of heparin with protamine.

Measurements and main results
Medical records were reviewed for thromboembolic events (stroke, arterial or venous thrombosis, pulmonary embolism, myocardial infarction), acute kidney injury, ischemic bowel, death, duration of intensive care unit and hospital stay, clinical and surgical characteristics and blood product utilization. A comparison of the clinical and surgical variables demonstrated a mean effect size of 0.33 imbalance between groups that was reduced to 0.18 after propensity score weighting. The propensity scores weighted analysis found an incidence of composite thromboembolic events of 39% in the 4F-PCC (n = 90) and 47% in the FEIBA (n = 50) group, difference −8 (−24% to 12%), P = 0.13. Individual thromboembolic events, acute kidney injury, ischemic bowel, mortality, and length of intensive care unit or hospital stay was not different among groups. Patients who received FEIBA had greater chest tube drainage and received more cryoprecipitate intraoperatively. Patients who received 4F-PCC received more fresh frozen plasma transfusions postoperatively.

Conclusions
Among cardiac surgery patients, there was no difference in thromboembolic events between patients who received 4F-PCC or FEIBA when used as an adjunct to blood product administration.
Increase in prevalence and costs of cirrhosis in the Netherlands: a nationwide hospital diagnosis data analysis
Authors: de Wit Koos , van Doorn Diederick J. , Masclee Gwen M.C. , Coenraad Minneke J. , van Soest Hanneke , Cuperus Frans J.C. , Kramer Matthijs , Maan Raoel , Takkenberg R. Bart , Lantinga Marten A. ,   the Dutch Portal Hypertension Working Group
Published: December 2024

Introduction
Due to the rising incidence of patients with cirrhosis and its accompanied extensive management, there is an increasing burden of cirrhosis patients on healthcare resources and costs. However, exact data on Dutch cirrhosis epidemiology and associated costs are lacking.

Aims and methods
We aimed to determine the year-prevalence of adults (aged ≥18 years) with cirrhosis registered as active patients in Dutch hospitals (2017–2021) using the Dutch hospital claims database. Next, we assessed average reimbursed annual healthcare costs.

Results
The prevalence of patients with cirrhosis registered as an active patient in Dutch hospitals increased by 54% from 48.7 patients per 100 000 in 2017 to 75.2 per 100 000 in 2021. There were regional differences and prevalence for cirrhosis was at highest of 105.6 patients per 100 000. The yearly incidence of patients for which hospitals requested claims was n = 3725 in 2018, n = 3840 in 2019 (+3%), n = 3749 in 2020 (−2%), and n = 3695 in 2021 (−1%). Total number of hospital admissions increased by 19% from 2443 in 2017 to 2899 in 2021. The annual reported costs for patients with cirrhosis increased by 120% from €35 million in 2017 to €78 million in 2021. Adjusted for inflation this increase was 143% to €85 million.

Conclusion
The prevalence of patients with cirrhosis registered as a patient in Dutch hospitals increased by more than 50 percent from 2017 to 2021, with regional differences. Consequently, total healthcare costs for Dutch patients with cirrhosis more than doubled in less than 5 years.
Rectal bleeding due to cavernous hemangioma in Klippel–Trenuany syndrome: a rare presentation and review of management
Authors: Usman Omer , Tariq Maham , Khan Muhammad W. , Shahbaz Muhammad U. , Mujahid Rehaab , Ijaz Osama , Hassan Muhammad A. 
Published: December 2024

Introduction and importance:
Klippel–Trenaunay syndrome (KTS) is a rare congenital disorder with an incidence of about 2–5:100 000. It is characterized by the triad of cutaneous hemangiomas, soft tissue or bone hypertrophy, and venous malformations. Gastrointestinal (GI) involvement in KTS, although uncommon, can lead to severe complications such as profuse GI bleeding. Our case highlights the challenges and management strategies of a patient with KTS.

Case presentation:
A 5-year-old child presented with rectal bleeding since birth, accompanied by swelling and bluish discoloration on left flank, and multiple varicose veins on left leg. Examination revealed small hemangiomatous lesions scattered along the torso and trunk. Barium enema showed diffuse mucosal irregularity with polypoidal filling defects in the rectum and sigmoid colon. Doppler ultrasound revealed slow-flow vascular lesions in the left flank and leg without arteriovenous communication. Computed tomography (CT) scan showed diffuse cavernous hemangiomas in the descending colon, sigmoid colon, and rectum. Histopathology demonstrated numerous dilated, irregular vascular channels with calcification and hemosiderin-laden macrophages.

Clinical discussion:
GI tract cavernous hemangiomas can cause chronic bleeding and anemia, necessitating careful evaluation. Imaging modalities like CT and Doppler ultrasound are crucial for assessing vascular lesions. Surgical interventions, including partial proctocolectomy and colorectal anastomosis, effectively control bleeding and improve outcomes. A multidisciplinary approach is essential for managing such cases.

Conclusion:
This case underscores the importance of multidisciplinary management in KTS with GI bleeding. Effective diagnostic imaging and surgical treatment are key to managing severe complications and achieving successful outcomes. Long-term follow-up is crucial to monitor for recurrence and residual lesions.
HLA B*15:02 and carbamazepine-induced Stevens-Johnson syndrome and toxic epidermal necrolysis: first case report from Nepal with genetic analysis
Authors: Joshi Mandeep D. , Acharya Bimarsh , Sapkota Surendra , Khati Karuna , Randuwini Dissanayake Dissanayake M. L. , Shah Sachin , Jawarchan Jayanti 
Published: December 2024

Introduction and importance:
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are the severe adverse drug reactions following drugs like carbamazepine, allopurinol, and infections. Here we present A 32-year-old woman developed SJS/TEN after 7 days of carbamazepine therapy, highlighting the importance of recognizing this risk, particularly in HLA-B*1502 allele carriers.

Case presentation:
A 32-year-old female developed fever, vomiting, and mucocutaneous blisters 7 days after starting carbamazepine. Lesions spread from the face to the chest, abdomen, and extremities, with throat discomfort and eye discharge. History included prior dizziness episodes.

Examination revealed denuded skin, positive Nikolsky’s sign, and HLA-B*1502 allele positivity. Treatment comprised ceasing carbamazepine, fluid administration, and steroids.

Discussion:
SJS/TEN manifest with distinct symptoms and often emerge within weeks of drug exposure. Carbamazepine, a frequent trigger, poses higher risks for HLA-B1502 allele carriers. Timely identification and intervention are essential to reduce mortality rates (10-40%). Treatment involves corticosteroids and supportive measures, with pre-carbamazepine HLA-B1502 screening advised, despite potential accessibility constraints.

Conclusion:
This case underscores the necessity of recognizing carbamazepine-induced SJS/TEN risk, particularly in HLA-B*1502 carriers. Despite screening challenges, early intervention involving multidisciplinary specialists is essential for favorable outcomes. Increased awareness and proactive measures are vital in preventing and managing these severe reactions.
Acute urinary retention in an adolescent female with Herlyn–Werner–Wunderlich syndrome
Authors: Shrestha Pradeep , Shrestha Bibek , Mishra Amit K. , Katuwal Neeta 
Published: December 2024

Introduction and importance:
Herlyn–Werner–Wunderlich syndrome (HWWS) is a rare congenital anomaly characterized by the triad of uterus didelphys, unilateral obstructed hemivagina, and ipsilateral renal agenesis. However, atypical presentations such as acute urinary retention are uncommon and pose diagnostic challenges. Early identification and treatment are crucial to prevent long-term complications like endometriosis and infertility.

Case presentation:
A 12-year-old female presented with the unusual symptom of acute urinary retention, which was likely caused by compression of the bladder neck due to hematocolpos. Imaging via ultrasound and MRI confirmed the presence of uterus didelphys, obstructed hemivagina, and ipsilateral renal agenesis, consistent with HWWS. Surgical excision of the vaginal septum was performed to relieve the hematocolpos, with the patient experiencing a full recovery.

Clinical discussion:
Congenital abnormalities of Mullerian Duct are rare, and atypical presentations such as acute urinary retention, vaginal discharge, and even pyocolpos or hematosalpinx have been reported. MRI played a crucial role in confirming the diagnosis and guiding treatment. The importance of early detection and long-term monitoring is highlighted, though limitations exist due to the inability to assess future reproductive outcomes.

Conclusion:
This case emphasizes the importance of recognizing atypical presentations of HWWS, such as acute urinary retention. Timely diagnosis and appropriate surgical intervention are critical for preventing complications and restoring normal function. Early recognition of this rare syndrome, especially in patients with unusual symptoms such as urine retention, is essential for ensuring optimal clinical outcomes.
Evaluating high-sensitivity cardiac troponin I for early detection of treatment-related cardiotoxicity in HER2-positive breast cancer patients
Authors: Ahmed Nadeem A. , Redwan Faisal N. , Jahjah Akram S. , Al-Shehabi Zuhair A. 
Published: December 2024

Background:
Trastuzumab-related cardiotoxicity is a common adverse effect of HER2-positive breast cancer treatment, especially when combined with anthracyclines. However, to date, no definitive prognostic markers have been found to predict trastuzumab-related cardiotoxicity.

Methods:
Patients diagnosed with HER2-positive breast cancer, scheduled to receive anthracyclines followed by 12 months of trastuzumab or with pertuzumab, were prospectively followed up for 27 months. Measurements of left ventricular ejection fraction LVEF, high-sesitivity troponin I hs-Tn I, and a full cardiac examination were performed at baseline, after anthracycline treatment, and after four cycles of anti-HER2 agents. Subsequently, LVEF measurement and full cardiac examination were conducted every 3 months until the end of the follow-up. Cardiotoxicity was defined as an absolute decrease in LVEF of ≥15%, or a drop in LVEF of ≥10% from the baseline to <50%.

Results:
Among 78 patients, cardiotoxicity occurred in 13 (16.7%). A higher risk of cardiotoxicity was linked to hs-Tn I measured after four cycles of anti-HER2 agents (P < 0.001), with a significant cutoff of >84 ng/L. No short-term effects of the anthracycline agents (doxorubicin or epirubicin), were found. However, there was a slightly higher tendency to develop cardiotoxicity (P = 0.046) in patients treated with trastuzumab plus pertuzumab.

Conclusion:
Hs-Tn I measured after four cycles of trastuzumab in HER2-positive breast cancer patients could be an important predictor of cardiotoxicity induced by chemotherapy followed by anti-HER2 agents, particularly in the first year post-treatment, with a different cutoff value than that used in other cardiac conditions.
Brain tumors and induced pluripotent stem cell technology: a systematic review of the literature
Authors: Shayestehfar Monir , Taherkhani Tina , Jahandideh Pardis , Hamidieh Amir A. , Faramarzpour Mahsa , Memari Amirhossein 
Published: December 2024

Background:
Induced pluripotent stem cells (iPSCs) provide a novel approach to studying the pathophysiology of brain tumors and assessing various therapeutic techniques with greater precision. This study aims to systematically review the existing literature to critically analyze and synthesize current research findings. The objective is to evaluate the role of iPSCs in understanding brain tumors and in the development of innovative treatment strategies.

Methods:
We systematically reviewed existing articles that utilized iPSC technology to assess either the pathophysiology of brain tumors or therapeutic techniques, following the standards of Preferred Reporting Items for Systematic review and Meta-Analysis guidelines. Key terms were comprehensively searched in electronic databases, including PubMed, EMBASE, and Scopus. Articles were screened based on specific inclusion and exclusion criteria. Ultimately, 22 relevant articles were chosen, and their data were extracted.

Results:
The summary of findings for each selected article was organized into two general categories: “Methods of Generating iPSCs” and “Applications of iPSCs.” The methods of iPSC generation, including transfection and transduction, as well as the types of viral or non-viral vectors used, were extracted and reported for each study. Additionally, the main aims of the selected studies, whether modeling or therapeutic approaches, were gathered and reported in the results section.

Conclusion:
iPSC technology is a novel vehicle that brings new solutions to overcome difficulties in brain tumor studies. In vivo and in vitro models generated from iPSCs provide suitable platforms to investigate the pathophysiology of brain tumors more precisely. Also, iPSCs have been utilized in various studies to examine how different antitumor agents may affect the target cells.
Microsurgical resection of a perimedullary conus medullaris arteriovenous fistula type IVa: a case report
Authors: Makhambetov Yerbol , Aiman Maidan , Okon Inibehe Ime , Kerimbayev Talgat , Kunakbayev Baurzhan , Shah Keyur , Abishev Nurzhan , Uteuova Saule , Chaurasia Bipin 
Published: December 2024

Introduction and importance:
Conus medullaris arteriovenous fistulas (AVFs) are rare among spinal vascular malformations. This case report highlights the presentation, diagnostic work-up, and management of a patient with a perimedullary conus medullaris AVF type IVa.

Case presentation:
A 29-year-old male presented with progressive weakness and numbness in the left leg. Thoracic magnetic resonance imaging (MRI) showed increased arterial supply in the dural membrane and large, smoldering, twisting spaces from T8 to L1 with a central point from which many abnormal vessels radiated. Angiographic findings showed an enlarged fistula fed by a radiculomedullary artery around the T10 level and draining through a medullary vein, draining into an aberrantly placed radicular vein at the posterior spinal venous plexus. The vein was mimicking nidus.

Clinical discussion:
The microsurgical resection with intraoperative indocyanine green angiography and neuromonitoring was successful. A follow-up MRI showed postoperative resolution of the malformation, and clinically, the patient experienced gradual improvement of his symptoms confirming the surgical success with complete AVF obliteration on postoperative angiography.

Conclusion:
Accurate detection and precise treatment are essential for managing conus medullaris AVFs. These complex lesions can be effectively addressed through both microsurgical and endovascular techniques. A successful treatment strategy necessitates thorough preoperative planning and a collaborative, multidisciplinary approach.
Hashimoto’s encephalopathy: a rare case report of Hashimoto’s thyroiditis with seizure
Authors: Hidig Mohamed Farah Osman , Bashir Ahmed Muhammad , Hassan Mohamed Sheikh , Adam Bakar Ali , Jeele Mohamed Osman Omar 
Published: December 2024

Introduction and importance:
Hashimoto’s thyroiditis (HT) is a common autoimmune condition that causes hypothyroidism. It is characterized by a wide range of symptoms, from conventional ones to rare and severe neurological manifestations. Seizures are a very uncommon symptom of HT, requiring a deep understanding and careful management owing to the challenges involved in diagnosing and the severe implications.

Case presentation:
A 19-year-old female with a medical history of untreated hypothyroidism caused by HT presented with a seizure characterized by generalized tonic-clonic movements. She displayed symptoms of fatigue, confusion, and swelling in the extremities. The laboratory results indicated a significant case of autoimmune hypothyroidism. The results of the brain imaging and EEG tests were within the expected range and did not show any abnormalities. The treatment regimen consisted of levothyroxine, levetiracetam, and methyl-prednisolone, which led to the cessation of seizures and the patient’s recovery from the postictal state.

Clinical discussion:
While managing HT itself is well-defined, tackling the neurologic complexities of Hashimoto’s encephalopathy (HE) takes a multifaceted approach.

Conclusion:
This case highlights the intricate nature of diagnosing and managing neurological symptoms caused by HT, namely seizures. Patients presenting with unexplained seizures and autoimmune thyroid illness should be mindful of the possibility of HE, an uncommon condition. Management includes the attainment of normal thyroid function and the consideration of immunosuppressive therapy for severe instances of HE.
Beyond blood transfusions: exploring iron chelation therapies in transfusion-dependent beta-thalassemia
Authors: Talha Muhammad , Ali Mohammad Haris , Hurjkaliani Sonia , Rahmat Zainab Syyeda , Sadia Haleema , Hasibuzzaman Md. Al , Uzair Ahsan Ul Qayyum 
Published: December 2024

Introduction:
Abnormal hemoglobin, or hemoglobinopathy, affects about 7% of the global population. Major hemoglobinopathies like beta-thalassemia and sickle cell disease require regular blood transfusions, leading to chronic iron overload. This review examines the efficacy and safety of deferiprone, an oral iron chelator, in managing iron overload in pediatric patients with transfusion-dependent conditions.

Methods:
Data were sourced from PubMed, Google Scholar, and relevant articles, focusing on randomized controlled trials (RCTs) published between 2010 and 2023. The search terms included “deferiprone,” “iron chelation,” “transfusion,” “iron overload,” “hemoglobinopathies,” and “thalassemia.” Three RCTs met the inclusion criteria, involving 521 pediatric patients.

Results:
The START trial demonstrated that early-start deferiprone significantly reduced iron load compared to placebo, with no severe adverse events. The DEEP-2 study found deferiprone non-inferior to deferasirox in terms of efficacy and safety. Another trial highlighted the benefits of early deferiprone therapy in delaying iron overload symptoms without serious side effects. Common adverse effects included pyrexia, nasopharyngitis, and decreased neutrophil count, but no significant differences in growth parameters, creatinine, or prolactin levels were observed.

Conclusion:
Deferiprone shows significant promise in managing iron overload in pediatric patients, with comparable effectiveness to existing therapies and a favorable safety profile. Its oral administration is advantageous for young children. However, long-term studies are needed to fully understand its safety and efficacy. Addressing challenges such as patient compliance and adverse effects through education, personalized medicine, and advanced monitoring techniques can further improve treatment outcomes for beta-thalassemia patients.
Effect of topical treatment with urea in ichthyosis, atopic dermatitis, psoriasis, and other skin conditions—a systematic review
Authors: Jawed Inshal , Umair Abdul Qadir Muhammad , Farwa Umm E. , Alam Farah , Bakhtawar Fatima Fasiha , Khan Hina , Kumar Karmani Vikash , Javaid Maham , Raja Sandesh , Khuzzaim Khan Muhammad , Raja Adarsh , Khanal Anuva 
Published: December 2024

Introduction:
The urea composition has a profound effect on skin disorders, specifically xerosis, desquamation, and scaling, which are some of the main concerns of the current health industry. The application of urea is relatable and more bioactive than alternate treatments. The objective of this systematic review was to evaluate the effectiveness of topically applied urea in the treatment of ichthyosis, psoriasis, and other dermatologic conditions.

Data and sources:
Research articles were retrieved through electronic databases, including Google Scholar, PubMed, EMBASE, Elsevier, and Sage, selected based on the provision of online free literature from its inception till November 2023. The significant findings were skin dryness, transepidermal water loss (TEWL), and eczema.

Study selection:
A total of 1826 studies have been found, of which 31 were selected based on inclusion criteria. The primary reason for the exclusion of the studies was the application of urea as a control. All in vivo studies disclosed the effectiveness of urea treatment separately or in addition to another compound on skin conditions. The selected studies have reported findings related to the improvement in xerosis, erythema, scaling, and reduction in TEWL.

Conclusion:
According to the in-depth review of the research articles, the application of urea has a tremendous effect on different skin diseases. Still, its role as monotherapy is overlooked due to the presence of more susceptible alternate products that need to be addressed. However, in the future, the evaluation of the effects of treatment containing urea with antibiotics on skin diseases would be more beneficial for practical knowledge.