bluuebunny/crossref_metadata_2025_split huggingface dataset:
New ultrasound techniques for acute kidney injury diagnostics
Authors: McDonald Rory , Watchorn James , Hutchings Sam 
Published: November 2024

Purpose of review
Acute kidney injury (AKI) is common in critical illness and associated with adverse outcomes. Imaging, specifically ultrasound, is increasingly finding a role in AKI diagnostics. This includes the assessment of arterial and venous blood flow, tissue perfusion and the condition of the renal parenchyma. This review provides an update on ultrasound techniques and their application to AKI in critical care.

Recent findings
Advances have been made in arterial and venous Doppler, contrast enhanced ultrasound (CEUS) and shear wave elastography (SWE). Doppler and CEUS techniques offer benefit in terms of AKI diagnosis and in identifying patients at risk. In addition, through the demonstration of altered flow or impaired perfusion, these techniques provide information on the pathophysiology of AKI, offering potential for targeted intervention. Renal SWE, an emerging technique, assesses tissue stiffness potentially allowing exploration of the role of venous congestion in the pathogenesis of AKI.

Summary
Ultrasound continues to demonstrate great promise in the diagnosis and management of AKI, offering a noninvasive means to diagnose perfusion deficits and assess response to treatments. Further research, with standardization of techniques, may allow multifaceted renal ultrasound assessment in the critically ill for more accurate diagnosis and tailored intervention in AKI.
Erythromycin disrupts Acinetobacter baumannii biofilms through destruction of the quorum sensing system
Authors: Dong Hang , Sun Jianguo , Liu Yiling , Li Qin , Huang Jianglong , Xu Panfeng , Wang Yuanqing 
Published: November 2024

Background:
This study was conducted to explore the effects of erythromycin on biofilms comprising Acinetobacter baumannii (A baumannii).

Methods:
To clarify the effect of erythromycin on the biofilms of A baumannii, we collected pure Ab strains isolated and identified from a variety of sample types extracted from patients in the microbiological laboratory of our hospital from April to August 2023, and divided them into an experimental group (treated with erythromycin) and a control group (without erythromycin). The morphology and quantity of A baumannii biofilm were observed at 24h, 48h, 72h, and 5d post-treatment, respectively, and the expression of quorum sensing (QS) system gene (abaI, abaR) mRNA was detected by fluorescence quantitative PCR.

Results:
The results showed that A baumanniis are prone to form multiple drug-resistant (MDR) bacteria, against which the most commonly used clinical antibiotics are ineffective. Overall, we found that the number of bacteria, the number of bacteria in the biofilm, and the number of biofilms formed gradually increased over time, with a statistical difference (P < .05). After the addition of erythromycin, significant improvements in biofilm formation were achieved, indicating that erythromycin can destroy A baumannii biofilms, inhibiting bacterial growth to a certain extent. The expression levels of abaI and abaR gradually increased over time, indicating that the role of the QS system became more apparent over time. Biofilm formation is related to the QS system of A baumanniis. After erythromycin treatment, abaI and abaR mRNA expression was downregulated in the experimental group.

Conclusion:
Erythromycin disrupts A baumannii biofilms by destroying the quorum sensing system.
Autonomic dysfunction as manifestation of ICANS: A case report
Authors: Rochate Dina , González-García Antonio Manuel , Santos Marcos Carmen , Pérez-López Estefanía , Martín-López Ana-África , Alaña Mónica , Martín Martín Lourdes , López Parra Miriam , Sánchez Guijo Fermín , López Corral Lucía 
Published: November 2024

Rationale:
Anti-CD19 chimeric antigen receptor T-cell (CAR-T) therapy is a successful treatment for B-cell malignancies associated with cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). Cardiovascular toxicities have also been reported in this setting. However, there is scarce data regarding development of autonomic disorders after CAR-T cell therapy.

Patient concerns:
We report a case with a patient with non-Hodgkin B-cell lymphoma, refractory to 2 prior lines of immunochemotherapy, treated with CAR-T therapy.

Diagnoses:
Orthostatic hypotension secondary to autonomic dysfunction was diagnosed as manifestation of ICANS.

Interventions:
The patient received metilprednisolone 1000 mg IV daily for 3 days and anakinra 100 mg IV every 6h.

Outcomes:
The vast majority of autonomic symptoms ceased and 4 months after CAR-T therapy, autonomic dysfunction was resolved.

Lessons:
New-onset autonomic dysfunction can occur as manifestation of ICANS in patients who experience persistent neurologic and cardiovascular symptoms after resolution of acute neurotoxicity and should be early recognized. Differences in differential diagnosis, mechanisms and treatment approaches are discussed.
Cutaneous manifestations of infective endocarditis as presenting signs of left atrial myxoma in a patient with acute ischemic stroke: A case report
Authors: Shen Ying-Chi , Chang Kai-Chun , Su Jen-Jen 
Published: November 2024

Rationale:
Approximately one-fifth ischemic stroke are attributed to cardioembolism. Patients with cardioembolic stroke often develop a more severe disability and a higher risk of stroke recurrence. Cardiac myxoma, although uncommon, can serve as a potentially curable cause of acute embolic strokes.

Patient concerns:
A 55-year-old male patient presented to the emergency department with acute vertigo and unsteady gait, accompanied by left upper limb numbness. Concurrently, purple-like lesions on the left hand were noticed.

Diagnoses:
Brain magnetic resonance imaging showed multiple infarctions in the posterior circulation. Additionally, skin examination showed Janeway lesions, Osler nodes and splinter hemorrhages. There was no evidence of systemic infection. Subsequently, transthoracic echocardiogram revealed a left atrial myxoma.

Intervention:
Early surgical resection of cardiac myxoma was performed.

Outcomes:
The patient recovered well from the surgery. No recurrent embolic event was reported at 3-month postoperatively.

Lessons:
Clinicians should be vigilant for skin manifestations of cardiac embolism. In patients with acute ischemic strokes, the presence of cutaneous embolic phenomena could serve as a warning sign of cardioembolism.
The effect of dexmedetomidine on emergence delirium of postanesthesia events in pediatric department: A systematic review and meta-analysis of randomized controlled trials
Authors: Tang Sunyu , Liu Jikai , Ding Zheng , Shan Ting 
Published: November 2024

Background:
Emergence delirium (ED) is a common occurrence in pediatric postanesthesia events, leading to negative outcomes. Dexmedetomidine (DEX), as an anesthesia adjuvant, has shown promise in preventing ED in adult surgeries, and it has been increasingly used in pediatric surgical settings. However, its effectiveness in other postanesthesia events, such as MRI examinations and ambulatory surgery centers, remains unclear. This meta-analysis aims to assess the safety and efficacy of DEX in preventing ED in various pediatric postanesthesia events beyond surgery.

Methods:
Prospective randomized controlled trials were searched in Pubmed, Web of Science, and EBSCO until October 13, 2023. Comparisons were made between DEX and other sedatives or analgesics in different postanesthesia events (including surgery operations, the examination of MRI, day surgery, and invasive action). Subgroup analyses were conducted based on drug delivery methods, medication timing, DEX dosages, use of analgesics, event types, and recovery time.

Results:
A total of 33 trials involving 3395 patients were included. DEX significantly reduced the incidence of ED (odds ratios [OR] = 0.23, 95% confidence interval [CI]: 0.19–0.27, I2 = 37%, P < .00001). Intranasal delivery of DEX was the most effective (OR 0.18, 95% CI: 0.10–0.32, P < .00001, I2 = 0%). DEX also showed benefits in day surgery and mask insertion events (OR 0.30, 95% CI: 0.14–0.26, P = .001, I2 = 0%).

Conclusion:
DEX demonstrates superior efficacy in preventing ED in pediatric postanesthesia events compared to other sedatives and analgesics. Its use is recommended in various settings for its safety and effectiveness in managing ED.
Recent advances in Del Nido cardioplegia: A comprehensive analysis of randomized clinical trials in adult cardiac surgery
Authors: Ahmed Muhammad , Raja Adarsh , Virwani Vikash , Raja Sandesh , Hussain Syed Yawar , Moeed Abdul , Bai Shanta , Abbas Johar , Fadelallah Eljack Mohammed Mahmmoud , Asghar Muhammad Sohaib 
Published: November 2024

Background:
Del Nido cardioplegia (DNC) has extensively been used for pediatric population undergoing cardiac surgery. However, its use in adult cardiac surgeries have been limited thus, its benefits are not yet fully known. This analysis was performed to evaluate the impact of DNC versus any other type of cardioplegia in adult patients who are undergoing cardiac surgery.

Methods:
We systematically searched PubMed, Cochrane Library, and Scopus from database inception till March 2023, and moderate to high-quality randomized controlled trials were included which compared DNC to other cardioplegia. The primary outcome was postoperative stroke and/or transient ischemic attack (TIA). Secondary outcomes included spontaneous rhythm return, postoperative myocardial infarction, all-cause mortality, postoperative atrial fibrillation, defibrillation after coronary reperfusion, postoperative intra-aortic balloon pump, postoperative kidney injury, postoperative low cardiac output syndrome, inotropic support, cardiopulmonary bypass time, cross-clamp time, blood transfusion, cardioplegia volume, hospital stay, intensive care unit stay, mechanical ventilation stay, postoperative left ventricular ejection fraction, and cardiac markers.

Results:
In this meta-analysis, 13 studies were included with a patient population of 2207. Stroke and/or TIA studies (risk ratio [RR]: 0.54, 95% CI [0.29, 1.00]) and all-cause mortality studies (RR: 1.30, 95% CI [0.66, 2.56]) were insignificant. From the secondary outcomes, spontaneous rhythm return (RR: 1.58, 95% CI [1.02, 2.45]), defibrillation after coronary reperfusion (RR: 0.49, 95% CI [0.30, 0.79]), inotropic support (RR: 0.70, 95% CI [0.57, 0.85]), composite risk of stroke and/or TIA and/or acute kidney injury and mortality (RR: 0.72, 95% CI [0.53, 0.99]), cross-clamp time (mean difference [MD]: −6.01, 95% CI [−11.14, −0.89]), blood transfusion (RR: 0.73, 95% CI [0.60, 0.90]), cardioplegia volume (MD: −537.17, 95% CI [−758.89, −315.45]), troponin T (MD: −1.71, 95% CI [−2.11, −1.32]), creatine phosphokinase-MB (MD: −2.96, 95% CI [−5.84, −0.07]) were significant. Whereas all other secondary outcomes were found to be insignificant.

Conclusion:
No significant difference was observed between patients undergoing Del Nido administration in comparison to other cardioplegia solutions for the primary outcome, stroke or/and TIA.
Non-alcoholic fatty liver disease is associated with coronary flow reserve impairment: A pilot meta-analysis
Authors: Jain Hritvik , Pervez Neha , Dey Debankur , Raza Fatima Ali , Jain Jyoti , Ahmed Mushood , Goyal Aman , Odat Ramez M. , Jha Mayank , Tariq Muhammad Daoud , Fox Sebastian , Yadav Rukesh , Ahmed Raheel 
Published: November 2024

Background:
Non-alcoholic fatty liver disease (NAFLD) is estimated to affect approximately 25% of the global population. Both, coronary artery disease and NAFLD are linked to underlying insulin resistance and inflammation as drivers of the disease. Coronary flow reserve parameters, including coronary flow reserve velocity (CFRV), baseline diastolic peak flow velocity (DPFV), and hyperemic DPFV, are noninvasive markers of coronary microvascular circulation. The existing literature contains conflicting findings regarding these parameters in NAFLD patients.

Methods:
A comprehensive systematic search was conducted on major electronic databases from inception until May 8, 2024, to identify relevant studies. We pooled the standardized mean differences (SMD) with 95% confidence intervals (CI) using the inverse-variance random-effects model. Statistical significance was set at P < .05.

Results:
Four studies with 1139 participants (226 with NAFLD and 913 as controls) were included. NAFLD was associated with a significantly lower CFRV (SMD: −0.77; 95% CI: −1.19, −0.36; P < .0002) and hyperemic DPFV (SMD: −0.73; 95% CI: −1.03, −0.44; P < .00001) than the controls. NAFLD demonstrated a statistically insignificant trend toward a reduction in baseline DPFV (SMD: −0.09; 95% CI: −0.38, 0.19; P = .52) compared to healthy controls.

Conclusion:
Patients with NAFLD are at a higher risk of coronary microvascular dysfunction, as demonstrated by reduced CFRV and hyperemic DPFV. The presence of abnormal coronary flow reserve in patients with NAFLD provides insights into the higher rates of cardiovascular disease in these patients. Early aggressive targeted interventions for impaired coronary flow reserve in subjects with NAFLD may lead to improvement in clinical outcomes.
COVID-19 positive woman presented with major fetal congenital anomalies: A case report with literature review
Authors: Erciyestepe Sezgi Güllü , Pata Özlem 
Published: November 2024

Rationale:
Pregnancy is a special term in life with physiological changes in both cardiorespiratory and immune systems; that is why severe acute respiratory syndrome coronavirus 2 infection in pregnancy may result in an altered response. With this, we present a case report of a young pregnant lady who was exposed to severe acute respiratory syndrome coronavirus 2 infection just before pregnancy and ended up with an affected fetus. The impact of coronavirus disease 2019 (COVID-19) exposure on neonatal outcomes has not yet been fully evaluated; by this article, we aim to find if COVID-19 exposure is linked to congenital anomalies.

Patient concerns:
A 25-year-old woman who has no history of genetic or chronic diseases applied to our clinic for routine control of pregnancy. She does not have a consanguineous marriage or any other potential risk factors for pregnancy.

Diagnoses and interventions:
She had a history of COVID-19 polymerase chain reaction positivity 2 days before the first day of the last menstruation period and hospitalization for 7 days. After 7 days of treatment with favipiravir and levofloxacin, enoxaparin sodium, famotidine, paracetamol, budesonide, dornaz alfa, and vitamin C; her general situation gets better, and discharged from the hospital on the seventh day of hospitalization without any further treatment prescription.

Outcomes:
During her routine controls for pregnancy at first-trimester evaluation ultrasonography; there was right forearm aplasia and deformities at both feet and legs.

Lessons:
In the literature, there is conflicting evidence about the impact of COVID-19 in pregnancy especially if the patient is confronted with the virus in the first trimester. Despite the increasing number of published studies on COVID-19 in pregnancy, there are insufficient good quality unbiased studies about the issue. Risk factors for COVID-19 overlap with the risk factors for pregnancy complications and the risk factors of the treatment prescribed. The impact of COVID-19 exposure on neonatal outcomes has not yet been fully evaluated; in this article, we aim to find if COVID-19 exposure is linked to congenital anomalies. Further research is needed to ascertain neonatal outcomes.
Influence of clinical experience in detecting calcifications of the head and neck region on panoramic radiographs: an app-based evaluation
Authors: Schneider Benedikt , Grün Pascal , Degel Ulli , Ströbele Dragan , Bandura Patrick , Pfaffeneder-Mantai Florian , von See Constantin , Turhani Dritan 
Published: November 2024

Introduction:
Digital panoramic radiographs (DPRs) are used in dental practice as the first diagnostic tool for the initial detection of head and neck regions soft-tissue calcifications. The aim of this study was to use a self-developed application (App) to evaluate the ability of dental students at different levels of training to examine known DPRs with different soft-tissue calcification.

Methods:
A total of known 100 DPRs with (n=50) and without (n=50) calcification were independently evaluated by four groups: preclinical, first clinical and last clinical dental students, and dentists with less than or equal to 1 year of professional experience in the same time (15 min) and examination conditions. Unity software was used to develop the examination App, which allowed to mark areas with calcifications on the DPRs. The data were statistically analyzed between the groups (significance level: P<0.05) for every location, and the detection rate was calculated as a percentage of detected calcifications.

Results:
Results revealed that the overall detection rate of calcifications in all groups was 29.17%. Dentists exhibited the highest detection rate (36.46%), followed by the last- (29.69%), first- (32.29%), and preclinical (15.10%) students.

Conclusion:
These findings suggest that clinical experience plays a role in the correct detection of soft-tissue calcifications in DPRs. However, deficiencies in radiological training during dental education may contribute to diagnostic errors. As these can become life-threatening risks, the results highlight the need for early training in the dental curriculum to improve diagnostic performance and minimize possible diagnostic errors.
Management of recurrent end-stage achalasia with robotic-assisted esophagectomy: a case report and literature review
Authors: Khalid Faizan , Augustine Sana W. , Singh Satvir , Sohail Rohab , Hashmi Tooba , Younus Shaik Mahboob , Asfeen Ummul , Zahdeh Tamer , Mahmood Khan Aadil , Singh Mansi 
Published: November 2024

Introduction and Importance:
Achalasia, an uncommon esophageal motility disorder, presents therapeutic challenges, especially in refractory cases with a history of multiple surgeries. Here, we present a complex case illustrating the dilemmas and multidisciplinary approach required in managing such patients. This case underscores the relevance of newer techniques like robotic-assisted esophagectomy in refractory achalasia management.

Case Presentation:
A 53-year-old male with recurrent achalasia endured persistent dysphagia, reflux, and esophageal spasms despite undergoing Heller myotomies, fundoplications, and hiatal hernia repairs. Imaging revealed severe esophageal dilation and anatomical alterations post-surgeries. Opting for a robotic-assisted thoracoabdominal esophagectomy due to relentless symptoms, the patient faced technical hurdles due to adhesions and a dilated esophagus. Post-surgery, complications like thoracic duct injury, milky pleural effusion, atrial fibrillation, and limb ischemia arose, necessitating multidisciplinary intervention.

Clinical discussion:
Managing refractory achalasia poses significant challenges, particularly in extensively operated patients. Despite aggressive surgeries, debilitating symptoms persisted, emphasizing the need for a multidisciplinary approach. Complications like thoracic duct injury and atrial fibrillation further complicate management, highlighting the intricacies of such cases. Careful consideration of surgical options and the potential of newer techniques like POEM are crucial in navigating such complexities.

Conclusion:
Managing refractory achalasia, especially in patients with extensive surgical histories, requires a multidisciplinary approach and careful consideration of treatment options. This case underscores the evolving landscape of achalasia management and emphasizes the potential benefits of newer techniques like POEM in select cases.
Tuberculous meningitis leading to stroke: a case report
Authors: Aryal Egesh , Adhikari Aayam , Adhikari Alisha , Bhattarai Dikshita , Shakya Subij , Paudel Amita , Dhonju Kiran , Ranjini Nived J. , Sharma Aditi , Dahal Mohit R. 
Published: November 2024

Introduction:
Tuberculosis is a major public health issue in developing countries. Vasculitis, resulting from tubercular meningitis, can lead to stroke.

Case presentation:
A 33-year-old male presented to the Emergency Department with relapsing-remitting fever with an evening rise in temperature for 1 month, personality changes (aggression and mutism) for 2 weeks, followed by difficulty in moving his lower limbs, and bowel and bladder incontinence. Neck rigidity, a positive Kernig’s sign, bilateral mute plantar responses, and 0/5 power in bilateral lower limbs were noted on examinations. MRI of the brain was suggestive of tubercular meningitis and showed an infarct with hemorrhagic transformation in the relatively uncommon, right basifrontal lobe. Gene Xpert test done on cerebrospinal fluid confirmed the diagnosis.

Discussion:
Tuberculous meningitis leading to infarct is a challenging diagnosis due to nonspecific symptoms and variable cerebrospinal fluid AFB staining results. Radiological imaging with MRI helps in suggesting the diagnosis and Gene Xpert confirms the diagnosis. Antitubercular therapy, steroids, physiotherapy, and supportive care are part of management.

Conclusion:
This case highlights the importance of considering tubercular meningitis-related cerebral infarction despite initial negative CSF AFB stain. Radiological investigation may help in guiding the clinician towards a diagnosis of tuberculous meningitis with vasculitis.
Time to successful outcome vs. treatment duration in cranial remolding orthosis treatment
Authors: Petz Alyssa M. , Vallery Claire E. , Richards Chelsea J. , Gensch Hannah T. , Yosef Matheos , Khalatbari Shokoufeh H. , Frank Christopher J. , Richards Jennifer A. 
Published: November 2024

Background:
Cranial remolding orthoses are an effective treatment of deformational plagiocephaly. Typical treatment durations are well documented. However, treatment duration can be affected by multiple factors and may not be a true representation of the time necessary to achieve a successful clinical outcome.

Objective:
This study compared the time to achieve a successful clinical outcome against the total treatment duration for cranial remolding orthosis therapy in infants with deformational plagiocephaly.

Study design:
This is a retrospective study of infants treated for deformational plagiocephaly with a cranial remolding orthosis.

Methods:
A total of 300 infants with deformational plagiocephaly who were treated with a cranial remolding orthosis were grouped by corrected age at initiation of treatment and by severity of deformity. A successful outcome was defined as achieving a final cranial vault asymmetry of 5 mm or less. For the 226 infants who achieved a successful outcome, time to successful outcome and treatment duration were compared between the groups.

Results:
The time to successful outcome depended on severity but not on age at initiation. The median time to successful outcome ranged from 6 weeks to 17.5 weeks, depending on the severity of the deformity. Time to successful outcome was significantly shorter than treatment duration for infants with an initial cranial vault asymmetry of less than 17 mm.

Conclusion:
Current treatment durations for infants with moderate plagiocephaly may be longer than necessary. Estimated treatment time lines should be based on the initial severity of the infant's deformity.