bluuebunny/crossref_metadata_2025_split huggingface dataset:
Spectrum of adrenal disorders in a referral hospital of Bangladesh
Authors: Hossain Kazi Nazmul , Ashrafuzzaman SM , Pathan Md Faruque , Amin Md Feroz , Shefin Sultana Marufa , Afsana Faria , Rouf Rushda Sharmin Binte 
Published: April 2021

Background: Adrenal diseases are common and their presentations are variable. This study aimed to determine the frequency and presenting features of various adrenal diseases in a tertiary care hospital of Bangladesh.
Methods: This retrospective descriptive study was carried out in Endocrinology in-patient department of BIRDEM General Hospital, Dhaka, Bangladesh, from October 2017 to December 2018. During this time, total 745 patients were screened; out of whom 91 had adrenal diseases.
Results: Mean age of the study population was 39.6±11.5 years. Among them, 65.9% were male. Most (75.8%) cases had adrenal insufficiency, followed by endogenous Cushing’s syndrome (8.8%), Conn’s syndrome (6.6%), non-functioning adenoma (3.3%), congenital adrenal hyperplasia (CAH) (2.2%), pheochromocytoma (1%), myelolipoma (1%) and adrenal carcinoma (1%). According to functional status, most (75.8%) were hypofunctional. Of the patients with adrenal insufficiency, secondary adrenal insufficiency was the most common (78.3%). Among the secondary adrenal insufficiencies, 75.9% had iatrogenic adrenal insufficiency and 24.1% had pituitary diseases. Regarding the cases of primary adrenal insufficiency, 20% cases were due to adrenal tuberculosis, 6.6% were due to adrenal histoplasmosis and 73.3% were idiopathic. Most of the adrenal insufficiency patients presented with hypotension (66.7%), followed by gastrointestinal symptoms (76.8%), weight loss (55.1%), hyponatraemia (42%), pigmentation (13%) and hypoglycemia (10%). In this study, 9.9% patients had adrenal incidentaloma. Most of them (88.9%) were benign. Causes of Cushing’s syndrome among the study population were, iatrogenic (66.7%), adrenal (16.7%) and pituitary cause (16.7%). In this study, 16.5% patients had endocrine hypertension and the causes were endogenous Cushing’s syndrome (53.3%), Conn’s syndrome (40%) and pheochromocytoma (6.7%). Of the hypertensive patients, 60% had co-existing hypokalemia.
Conclusion: Adrenal insufficiency was the most common adrenal disorder followed by endogenous Cushing’s syndrome, Conn’s syndrome, non-functioning adenoma and other adrenal disorders. Presentations of adrenal disorders are variable. Among the cause of adrenal insufficiency iatrogenic adrenal insufficiency was the most common.
Birdem Med J 2021; 11(2): 103-107
Microbiological profile and treatment outcome of emphysematous pyelonephritis: experience from two teaching hospitals of Bangladesh
Authors: Chowdhury Juli , Biswas Nirmol Kumar , Kanta Shamima Sharmin , Rahim Muhammad Abdur , Haque Wasim Md Mohosin Ul , Iqbal Sarwar , Uddin Khawja Nazim 
Published: April 2021

Background: Emphysematous pyelonephritis (EPN) is a rare severe necrotizing infection of the renal parenchyma, collecting system and/or perirenal tissues. Patients with diabetes mellitus, renal stones and renal tract obstruction are at risk for development of EPN. Escherichia coli is the most common aetiological agent and treatment is aimed at infection control and interventions in appropriate cases. This study aimed to identify the aetiological agents responsible for EPN and the outcome of such cases.
Methods: This observational study was done in BIRDEM General Hospital and Bangabandhu Sheikh Mujib Medical University over a period of three years (2011-2013). Twenty adult EPN cases were included in this study.
Results: The mean age of the study participants was 59.2 years with female predominance (80%). Risk factors included diabetes mellitus (90%), renal stones (5%) and kidney transplant recipient (5%). Fever, loin pain and dysuria were common. Six patients had class 1 EPN, seven had class 2 disease, five had class 3 and two patients had class 4 EPN. Aetiological agents were cultured in 19 cases; E. coli in 12 (68%), Klebsiella in three (16%), Pseudomonus in two (11%) and Proteus and Enterococcus, one each (5% each). Carbapenems appeared as the most sensitive antibiotic. Along with antibiotic, half of the patients required interventions; percutaneous drainage in two, open drainage in two and six patients required nephrectomy. Regarding outcome, five patients died, 10 patients recovered completely and five patients recovered with residual renal dysfunction.
Conclusion: E. coli was the most common causative agent in present EPN cohort. Outcome was poor. With improved management strategy, combining nephrologists, intervention radiologists and urologists – all together, a good outcome is expected.
Birdem Med J 2021; 11(2): 108-111
Serum complement levels as prognostic marker for monitoring treatment response in lupus nephritis
Authors: Khan Saiful Bahar , Islam Rafi Nazrul , Mizan Md Saif Bin , Rahman AKM Shahidur , Hossain Shah Md Zakir , Mullah Shahida , Md Ershad Sk , Rahman Tanvir , Rahman Md Mustafizur , Feroz Salahuddin , Mohammad Kaiser Amir 
Published: April 2021

Background: Lupus nephritis (LN) is one of the most common and serious manifestations of systemic lupus erythematosus (SLE) that causes significant morbidity and mortality. Certain biomarkers for LN are sometimes able to assess treatment response in lupus nephritis. This study aimed to compare serum complement levels (C3 and C4) as markers of treatment response of LN and their relation to the LN class in renal biopsy.
Methods: This prospective observational study was conducted in the Department of Nephrology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from July 2018 to August 2019. Twenty seven patients who were diagnosed with LN after kidney biopsy were included in this study. Serum complement levels (C3 and C4), 24 hours urinary total protein (24-hr UTP) and anti-double-stranded DNA (anti-ds DNA) were measured in all patients at baseline, 3 months and 6 months after treatment initiation. These biomarker values before and after treatment were compared between the proliferative and non-proliferative LN patients.
Results: Serum C3 levels were significantly different between patients with proliferative LN (Class III and Class IV) and non-proliferative LN (Class V) at baseline (0.47 ± 0.32 g/l versus 0.89 ± 0.43 g/l, p=0.009) and levels changed significantly 6 months after treatment initiation (p<0.001) and likewise for serum C4 levels (0.10 ± 0.06 g/l versus 0.24 ± 0.26 g/l, p=0.040). The values of 24-hr UTP and anti-ds-DNA were significantly different 6 months after treatment with p value <0.05 in both groups but C3 (p<0.001) and renal Systemic Lupus Erythematosus Disease Activity Index (rSLEDAI) (p<0.001) were only significant in the proliferative group. On the other hand, after 6 months treatment, C4 levels became relatively higher but that was not significant in both groups (p>0.05).
Conclusion: After 6 months of treatment, serum C3 and C4 levels increased towards normal in both LN groups. Serum C3 and C4 levels in patients with LN correlate with disease activity. Therefore, serum complement (C3 and C4) levels may be utilized as serological biomarkers for treatment response of LN.
Birdem Med J 2021; 11(2): 97-102
Primary intraosseous meningioma: a case report
Authors: Taher MA , Mohammad Behnom Ishtiaque , Saha Mohua , Sultana Jafreen , Hossain Tasneem 
Published: April 2021

Primary intraosseous meningioma (PIM) is a rare form of meningioma, a benign lesion of the meninges. Imaging evaluation of a patient with frontoparietal scalp swelling revealed an osteoblastic intracalvarial lesion. Following surgical resection, the histological examination revealed an intra-osseous meningioma.
Birdem Med J 2021; 11(2): 133-136
Nintedanib in the management of pulmonary fibrosis after COVID-19: a case report
Authors: Chakrabortty Rajashish , Rahman Samia , Jahan Rawnak , Dip Abir Hasan , Rahman Mohammed Mirazur 
Published: April 2021

Pulmonary fibrosis is becoming a recognized complication of coronavirus disease 2019 (COVID-19). Patients with pulmonary fibrosis may present with dry cough, shortness of breath, nail clubbing, low oxygen saturation. We report a case of a 40-year-old male patient with pulmonary fibrosis due to COVID- 19. Clinical examination showed that the patient was dyspneic with low oxygen saturation and there was bilateral inspiratory crepitation in the lower part of his chest. High resolution computed tomography showed bilateral multifocal patchy ground-glass opacities, consolidation with peripheral and basal distribution, sub-pleural fibrotic bands and vascular thickening (almost 40-45% of parenchymal involvement). We prescribed him an antifibrotic drug, nintedanib and there was a significant clinical and radiological improvement after 15 days of treatment. Nintedanib may have novel therapeutic role in preventing COVID-19 associated fibrosis.
Birdem Med J 2021; 11(2): 148-152
Cirurgia e Traumatologia Bucomaxilofacial em tempos de pandemia de COVID-19: Gestão, riscos e perspectivas
Authors: Santos Daniela Meneses , Oliveira Mirlany Mendes Maciel , Lauand Gustavo Amaral , Silva Cláudia Jordão , Silva Marcelo Caetano Parreira da , Batista Jonas Dantas 
Published: April 2021

A síndrome respiratória aguda grave (SARS-CoV-2) é uma doença respiratória infecciosa com taxas de morbidade e mortalidade significativas evoluindo no ano de 2020 como uma Pandemia. A odontologia é classificada na categoria de alto risco devido a maioria dos procedimentos gerarem aerossóis e a Cirurgia oral e maxilofacial é a especialidade odontológica que desempenhando funções tanto no âmbito hospitalar quanto no âmbito ambulatorial. O objetivo do presente trabalho é fazer um análise da gestão, riscos e perspectivas da cirurgia oral e oral e cirurgia maxilofacial em tempos de pandemia de COVID-19, visto que as cirurgias eletivas devem ser suspensas e as urgências priorizadas com o principal objetivo do gerenciamento dos risco para evitar o contágio em cuidado de emergência porém, quanto as pespectivas futuras é imprescindivel a adaptação desses profissionais a nova realidade de atendimento em virtude de diversas procedimentos realizados serem de caracter de urgência e emergência.
Mucociliary Clearance Scans Show Infants Undergoing Congenital Cardiac Surgery Have Poor Airway Clearance Function
Authors: Adams Phillip S. , Corcoran Timothy E. , Lin Jiuann-Huey , Weiner Daniel J. , Sanchez-de-Toledo Joan , Lo Cecilia W. 
Published: April 2021

Background: Infants undergoing congenital cardiac surgery with cardiopulmonary bypass are at high risk for respiratory complications. As impaired airway mucociliary clearance (MCC) can potentially contribute to pulmonary morbidity, our study objective was to measure airway clearance in infants undergoing congenital cardiac surgery and examine correlation with clinical covariables that may impair airway clearance function.Materials and Methods: Airway clearance in infants was measured over 30 min using inhaled nebulized Technetium 99m sulfur colloid administered either via a nasal cannula or the endotracheal tube in intubated infants. This was conducted bedside with a portable gamma camera. No difficulty was encountered in positioning the gamma camera over the patient, and neither the camera nor the MCC scan interfered with routine medical care or caused any adverse events. Patient and perioperative variables were examined relative to the MCC measurements.Results: We prospectively enrolled 57 infants undergoing congenital cardiac surgery and conducted a single MCC scan per patient. MCC data from 42 patients were analyzable, including five pre-operative, 15 (40.5%) in the immediate post-operative period (days 1–2), and 22 (59.5%) were later post-operative (≥3 days). Pre-operative MCC was inversely proportional to days requiring post-operative mechanical ventilation (p = 0.006) and non-invasive positive pressure ventilation (p = 0.017). MCC was higher at later post-operative days (p = 0.002) with immediate post-operative MCC being lower (3%; 0–13%) than either pre-operative (21%; 4–25%) (p = 0.091) or later post-operative MCC (18%; 0–29%) (p = 0.054). Among the infants with low post-operative MCC, significantly more were pre-mature [5/19 (26%) vs. 0/18 (0%); p = 0.046], were intubated [14/19 (75%) vs. only 7/18 (39%); p = 0.033] and were receiving higher FiO2 (40%, 27–47% vs. 26%, 21–37%; p = 0.015).Conclusions: This is the first study to show that infants undergoing congenital cardiac surgery have impaired MCC. MCC appeared lowest in the immediate post-operative period. Worse MCC was associated with pre-maturity, mechanical ventilation, or receiving higher FiO2. These findings suggest MCC scans should be further explored for informing clinical decision making to improve post-surgical respiratory outcomes. The possible therapeutic benefit of airway clearance maneuvers for infants with poor MCC function should also be investigated.
Single Hormone Receptor-Positive Metaplastic Breast Cancer: Similar Outcome as Triple-Negative Subtype
Authors: Mao Jinqian , Hu Jin , Zhang Yanting , Shen Jian , Dong Fang , Zhang Ximeng , Ming Jie , Huang Tao , Run Xiaoqin 
Published: April 2021

BackgroundMetaplastic breast cancer (MBC) is a rare and aggressive subtype of the breast. To understand the characteristics and prognosis of single hormone receptor-positive (HR+) MBC (estrogen receptor-positive [ER+]/progesterone receptor-negative [PR-] and ER-/PR+), we compared these tumors to double HR+ tumors as well as HR- tumors.Patients and MethodsThe Surveillance, Epidemiology, and End Results database was used to analyze MBC between 1975 and 2016. The effect of HR status was evaluated using a multivariate Cox regression model.ResultsWe included 3369 patients with a median follow-up time of 42 months (range 0-322 months). In this study, 280 (8.3%) cases were double HR+ tumors, 2597 (77.1%) were double HR- tumors, and 492 (14.6%) cases were single HR+ tumors, of which 159 (4.7%) cases were ER-/PR+ tumors and 333 (9.9%) were ER+/PR- tumors. On multivariate Cox analysis, the prognosis was related to age, race/ethnicity, tumor grade, TNM stage, and surgery. HR status remained no impact on breast cancer-specific survival (BCSS). In the Kaplan-Meier curve, HR status was not associated with better BCSS or overall survival (OS). In patients without HER2 overexpression, the BCSS and OS of ER+/PR- and ER-/PR+ tumors were not significantly different from that of ER-/PR- and ER+/PR+ tumors. The difference remains no significant in patients with HER2 overexpression.ConclusionsIn comparison with both ER-/PR- and ER+/PR+ tumors, we have identified clinically and biologically distinct features of single HR+ tumors. In patients with or without HER2 overexpression, the prognosis of single HR+ tumors was similar to ER-/PR- and ER+/PR+ tumors.
Influence of High Pass Filter Settings on Motor Evoked Potentials
Authors: Nikolov Petyo , Hassan Shady S. , Schnitzler Alfons , Groiss Stefan J. 
Published: April 2021

ObjectiveMotor evoked potentials (MEP), obtained by transcranial magnetic stimulation (TMS) are a common tool in clinical research and diagnostic. Nevertheless, reports regarding the influence of filter settings on MEP are sparse. Here, we compared MEP amplitudes and signal to noise ratio (SNR) using multiple high pass filter (HPF) and notch filter settings.Materials and MethodsTwenty healthy subjects were enrolled in the study. Recruitment curves were obtained with HPF settings varied at 10, 20, 50, and 100 Hz. The four HPF settings were tested both with and without 50 Hz active notch filter. Low pass filter was kept constant at 5 kHz.ResultsMEP amplitudes with HPF at 10 and 20 Hz were significantly higher than at 100 Hz, regardless of the notch filter. However, SNR did not differ among HPF settings. An active notch filter significantly improved SNR.ConclusionThe reduction in MEP amplitudes with HPF above 20 Hz may be due to noise reduction, since the different HPF conditions did not alter SNR. Thus, higher HPF above 50 Hz may be an option to reduce noise, the use of a notch filter may even improve SNR.SignificanceOur findings are relevant for the selection of filter settings and might be of importance to any researcher who utilizes TMS-MEP.
Step-by-Step Cadaver Dissection and Surgical Technique for Compartmental Tongue and Floor of Mouth Resection
Authors: Grammatica Alberto , Piazza Cesare , Ferrari Marco , Verzeletti Vincenzo , Paderno Alberto , Mattavelli Davide , Schreiber Alberto , Lombardi Davide , Fazio Enrico , Gazzini Luca , Giorgetti Giovanni , Buffoli Barbara , Rodella Luigi Fabrizio , Nicolai Piero , Calabrese Luca 
Published: April 2021

BackgroundThe aim of oral cancer surgery is tumor removal within clear margins of healthy tissue: the latter definition in the literature, however, may vary between 1 and 2 cm, and should be intended in the three dimensions, which further complicates its precise measurement. Moreover, the biological behavior of tongue and floor of mouth cancer can be unpredictable and often eludes the previously mentioned safe surgical margins concept due to the complexity of tongue anatomy, the intricated arrangements of its intrinsic and extrinsic muscle fibers, and the presence of rich neurovascular and lymphatic networks within it. These structures may act as specific pathways of loco-regional tumor spread, allowing the neoplasm to escape beyond its visible macroscopic boundaries. Based on this concept, in the past two decades, compartmental surgery (CS) for treatment of oral tongue and floor of mouth cancer was proposed as an alternative to more traditional transoral resections.MethodsThe authors performed three anatomical dissections on fresh-frozen cadaver heads that were injected with red and blue-stained silicon. All procedures were documented by photographs taken with a professional reflex digital camera.ResultsOne of these step-by-step cadaver dissections is herein reported, detailing the pivotal points of CS with the aim to share this procedure at benefit of the youngest surgeons.ConclusionsWe herein present the CS step-by-step technique to highlight its potential in improving loco-regional control by checking all possible routes of tumor spread. Correct identification of the anatomical space between tumor and nodes (T-N tract), spatial relationships of extrinsic tongue muscles, as well as neurovascular bundles of the floor of mouth, are depicted to improve knowledge of this complex anatomical area.
A Non-Invasive Scoring System to Differential Diagnosis of Clear Cell Renal Cell Carcinoma (ccRCC) From Renal Angiomyolipoma Without Visible Fat (RAML-wvf) Based on CT Features
Authors: Wang Xiao-Jie , Qu Bai-Qiang , Zhou Jia-Ping , Zhou Qiao-Mei , Lu Yuan-Fei , Pan Yao , Xu Jian-Xia , Miu You-You , Wang Hong-Qing , Yu Ri-Sheng 
Published: April 2021

BackgroundRenal angiomyolipoma without visible fat (RAML-wvf) and clear cell renal cell carcinoma (ccRCC) have many overlapping features on imaging, which poses a challenge to radiologists. This study aimed to create a scoring system to distinguish ccRCC from RAML-wvf using computed tomography imaging.MethodsA total of 202 patients from 2011 to 2019 that were confirmed by pathology with ccRCC (n=123) or RAML (n=79) were retrospectively analyzed by dividing them randomly into a training cohort (n=142) and a validation cohort (n=60). A model was established using logistic regression and weighted to be a scoring system. ROC, AUC, cut-off point, and calibration analyses were performed. The scoring system was divided into three ranges for convenience in clinical evaluations, and the diagnostic probability of ccRCC was calculated.ResultsFour independent risk factors are included in the system: 1) presence of a pseudocapsule, 2) a heterogeneous tumor parenchyma in pre-enhancement scanning, 3) a non-high CT attenuation in pre-enhancement scanning, and 4) a heterogeneous enhancement in CMP. The prediction accuracy had an ROC of 0.978 (95% CI, 0.956–0.999; P=0.011), similar to the primary model (ROC, 0.977; 95% CI, 0.954–1.000; P=0.012). A sensitivity of 91.4% and a specificity of 93.9% were achieved using 4.5 points as the cutoff value. Validation showed a good result (ROC, 0.922; 95% CI, 0.854–0.991, P=0.035). The number of patients with ccRCC in the three ranges (0 to &lt;2 points; 2–4 points; &gt;4 to ≤11 points) significantly increased with increasing scores.ConclusionThis scoring system is convenient for distinguishing between ccRCC and RAML-wvf using four computed tomography features.
The Heterogeneous Metabolic Patterns of Ganglia in 68Ga-PSMA, 11C-choline, and 18F-FDG PET/CT in Prostate Cancer Patients
Authors: Shi Yiping , Wu Jian Guo , Xu Lian , Zhu Yinjie , Wang Yining , Huang Gan , Liu Jianjun , Chen Ruohua 
Published: April 2021

PurposeStudies have indicated that PSMA-positive ganglia represent a diagnostic pitfall for nuclear medicine physicians. No studies have described choline and FDG uptake in ganglia, which may be a source of misdiagnosis. Herein, we described the percentage and uptake pattern of 68Ga-PSMA, 11C-choline and 18F-FDG PET/CT in ganglia and evaluated the heterogeneous metabolic patterns of ganglia to differentiate from lymph node metastases (LNM).MethodsThirty-nine patients who underwent 11C-choline PET/CT and 120 patients who underwent 68Ga-PSMA PET/CT and 18F-FDG PET/CT were retrospectively analyzed. The prevalence of PSMA-positive, choline-positive and FDG-positive ganglia was determined, the SUVmax of ganglia in different locations were measured, and the configuration was described. The SUVmax cutoff of PSMA-PET, choline-PET and FDG-PET was determined by ROC curve analysis to differentiate ganglia from LNM.Results329 PSMA-positive ganglia were identified in 120 patients, 95 choline-positive ganglia were identified in 39 patients, and 39 FDG-positive ganglia were identified in 34 patients. PSMA-positive uptake was observed in 98.3%, 95.8%, and 80.0% of cervical, coeliac, and sacral ganglia, respectively. Choline-positive uptake was observed in 84.6%, 97.4%, and 61.5% of cervical, coeliac, and sacral ganglia, respectively. FDG-positive uptake was observed in 16.7%, 13.3%, and 2.5% of cervical, coeliac, and sacral ganglia, respectively. Cervical and coeliac ganglia had a higher rate of PSMA-positive uptake than sacral ganglia. Choline uptake was highest in coeliac ganglia followed by cervical and sacral ganglia. PSMA, choline or FDG uptake in LNM was all significantly higher than ganglia. ROC curve analysis revealed that at a 4.1 SUVmax cutoff of PSMA-PET, the sensitivity, specificity and accuracy of LNM identification was 88.4%, 97.9% and 96.2%, respectively. ROC curve analysis revealed that at a 2.35 SUVmax cutoff for choline-PET, the sensitivity, specificity, and accuracy of LNM identification was 95.0%, 92.6% and 93.0%, respectively. ROC curve analysis revealed that at a 2.55 SUVmax cutoff for FDG-PET, the sensitivity, specificity, and accuracy of LNM identification was 77.3%, 87.2%, and 81.9%, respectively. PSMA-, Choline- and FDG-positive ganglia are mainly band-shaped; most LNMs exhibited nodular and teardrop-shaped configuration.Conclusion68Ga-PSMA and 11C-choline uptake in ganglia was common, and FDG-positive ganglia were observed at lower frequency. Using 68Ga-PSMA, 11C-choline and 18F-FDG uptake and anatomic location and configuration, the differentiation of ganglia from adjacent LNM is feasible.