bluuebunny/crossref_metadata_2025_split huggingface dataset:
Influence of Gender on Outcomes and Palliative Care Utilization in Patients with Hodgkin's Lymphoma: A Retrospective Study Using the National Inpatient Sample Database
Authors: Shah Raj , Akkawi Abdul Rahman , Mukhtiar Vaibhavi P , Alqam Anas , Karam Wissam , Zakhour Joud 
Published: December 2024

KEYWORDS
Hodgkin's lymphoma, palliative care utilization

OBJECTIVE
To assess outcomes, mortality, and palliative care utilization in hospitalized patients.

DESIGN
Retrospective cross-sectional study

SETTING
National Inpatient Database 2019-2021 using ICD-10 codes
Introduction:
Managing Hodgkin's lymphoma patients in the hospital involves various risk factors along with comorbidities. Its clinical outcomes can vary by gender and other factors. The utilization of palliative care services has encouraged risk stratification of patients, which can be challenging. We aim to explore the actual utilization of palliative care services and outcomes of hospitalized Hodgkin lymphoma patients.
Method:
We analyzed data from the National Inpatient Sample to identify patients who were admitted with a diagnosis of Hodgkin's lymphoma from 2019-2021. Among this population, we looked for trends in the utilization of palliative care services and factors affecting outcomes in hospitalized patients. We investigated the role of gender and overall mortality in this cohort.
Results:
A total of 144,614 patients were admitted over 3 years with a diagnosis of Hodgkin's lymphoma. 53.5% were male and 46.5% were female. The in-hospital mortality was around 3.4%, with more deaths in males than females (4% vs. 3%). Gender did not affect the outcomes for respiratory failure. However, males had a higher incidence of Acute Kidney Injury(AKI) (21% vs. 14%), Gastrointestinal(GI) bleeds (5% vs. 4%), and they required more hemodialysis (1.2% vs. 0.8%). Palliative care utilization was 4.8% and was similar for both genders. The trends for utilizing palliative care services improved overall, with 4.2% in 2019, 4.6% in 2020, and 5.1% in 2021, which was statistically significant with a p-value of 0.02.
Conclusion: Our study's preliminary results indicate a higher incidence of AKI, GI bleeding, and the need for hemodialysis in hospitalized male patients. Considering the higher inpatient mortality in males, studies identifying risk factors might be beneficial. Palliative care services can play a crucial role in the overall management of the patient, and increasing utilization trends are encouraging. Considering the limited availability and higher need for palliative care services, studies on risk stratification will help in navigating care for these patients.
Rethinking Caseloads in Sickle Cell Disease Social Work
Authors: Moorman Spencer , Johnson Shirley , Smith Wally R 
Published: December 2024

Background
Sickle cell disease, a lifelong inherited condition affecting mostly African Americans, presents multilayered psychosocial challenges affiliated with systemic health inequities and social determinants of health.1 With the strata of psychological, social, and vocational issues that accompany this pain-filled illness, social workers at the National Alliance of Sickle Cell Centers (NASCC) 2022 meeting voiced their concern about administrative and physician lack of clarity regarding their role, varied licensures, expertise, and capacity to cover caseload expectations.2 To illustrate this misunderstanding in reality, a benchmark survey endorsed by the National Alliance of Sickle Cell Centers was distributed to psychosocial providers and social workers of differing qualifications to gather their reported caseloads per year.
Methodology
A NASCC-endorsed survey was distributed to psychosocial provider contacts in the organization's database. Providers of all sickle cell center sizes, from 100 to 800 + patients, were asked to indicate their role and caseload number. Free text boxes were provided for respondents to expand if necessary. Responses from social work and licensed clinical social work roles were filtered from the data using SPSS t-test statistical analysis.
Results
Of the forty social workers (MSW, CSW, LCSW, etc.) who responded to the survey, thirty-one gave a caseload number and nine either didn't answer or were unsure. The range of caseload numbers provided varied greatly (3 minimum to 600 maximum). The mean for nineteen master level social workers (MSW, MSSW, CSW, ASW, LSW, LBSW, LMSW) was 180 caseloads with a Standard Deviation of +/- 151. For the twelve licensed clinical social workers who responded, the mean was 194 with Standard Deviation of +/- 148.
Conclusion
These results are the first to represent perspectives of the social work workforce in the sickle cell space. No significant differentiation in caseload number exists across scope of practice and credentials. Lack of comprehension of the bandwidth needed across psychosocial roles to address the complex needs of patients with sickle cell disease is evident through the voices of those overworked in this field.
Hemophagocytic Histiocytosis in Acute Myeloid Leukemia: A Prospective Study Integrating Clinico-Laboratory and Flow Cytometry Findings
Authors: Paramasivam Sabitha , Sahoo Ranjit Kumar , Bakhshi Sameer , Mendiratta Mohini 
Published: December 2024

Introduction:
Hemophagocytic Histiocytosis (HLH), an acute immune activated state described as cytokine storm, diagnosed by both clinical and laboratory parameters in haematological diseases and as complications in cellular therapies and is uniformly related to inferior outcome in the early- as well as late-period. The incidence of HLH in patients of AML is not explored comprehensively in past. In countries with poor health care facilities, the AML-patients, present late and the overall outcome is poor despite younger age. We hypothesized HLH could be contributing to the inferior outcome. In this study, we prospectively looked for HLH in AML patients both clinically as well as by flow cytometry.
Methods:
We evaluated 34 AML patients prospectively in our institute, with the baseline symptoms (fever) with or without organomegaly, serum ferritin levels and flow cytometry (T-cell profiling) in AML patients (n=34). Clinical HLH in our study was defined as, high-grade unremitting fever with elevated ferritin (&gt; 1000 ng/ml). We performed flow cytometry on peripheral blood for the enumeration of T-lymphocytes and their subtypes and correlated with the clinical HLH.
Results:
Median age 35.5 years (range 15-66) with 70% male population. 58% were newly diagnosed and the rest were relapsed/refractory AML patients. Average baseline blast count of 56%, Hb of 8.9 g/dl, TLC of 18,214 /microlitre and serum ferritin of 1301 ng/ml. More commonly seen with NPM1(23%), RUNX1-RUNX1T1(23%) and IDH2R140Q (20%) mutated were in the group. Out of 34 patients, 27 developed clinical HLH during induction chemotherapy. Induction therapy used were 2+5+Ven (two days of daunorubicin, 5 days of ARA-C and 5 days of venetoclax) under a clinical study. Out of 34 patients, 29 exhibited enhanced expression of CD38 along with HLA-DR (70.22%; range: 33.51%-91.46%) on cytotoxic T-cells. In contrast 5 patients did not show a significant proportion of CD38 with HLA-DR (10.26%; range: 5.43%-14.61%). These findings suggest a potential correlation with HLH, as elevated CD38 expression on cytotoxic T cells has been associated with the hyperactivation and proliferative responses seen in HLH, reflecting a state of heightened immune activation and dysregulation. Notably, 1 patient displayed a dim expression of CD38 (98.83%) without HLA-DR. Clinical data with serum ferritin and fever were correlated with the flow cytometric analysis (correlation co-efficient 0.59, p&lt;0.01). In that out of 34 patients, 20 (58%) showed evidence of HLH by flow cytometry as well as clinical HLH.
Conclusion:
Flow cytometry could be useful in identifying HLH at baseline in patients of AML. Further data regarding early mortality, relapse, and survival will be presented in the conference
Bilateral improvement in age-related macular degeneration following unilateral Aflibercept injection
Authors: Karamat Muhammad Irfan , Saleem Hira , Khakwani Minahil , Ahmed Abdullah 
Published: December 2024

Abstract
Background
The "fellow-eye effect" in anti-vascular endothelial growth factor (anti-VEGF) therapy is a rare phenomenon, particularly with aflibercept. This case report documents the first instance of this effect in Pakistan, highlighting its significance in a resource-limited setting where recent regulatory changes have restricted treatment options for age-related macular degeneration (AMD).

Case presentation
A 62-year-old male presented with bilateral central vision loss due to neovascular AMD. Optical Coherence Tomography revealed serous subretinal fluid in both eyes. Due to financial constraints, only the right eye received a single 2 mg intravitreal aflibercept injection. Remarkably, at the four-week follow-up, both eyes showed significant improvement. Visual acuity improved from 6/12 to 6/9 in the treated right eye and from 6/15 to 6/12 in the untreated left eye. OCT scans demonstrated bilateral resorption of subretinal fluid. At three months, complete fluid resorption was observed in both eyes, with visual acuity improving to 6/6 bilaterally.

Conclusions
This case underscores the potential of the "fellow-eye effect" in anti-VEGF therapy, particularly with aflibercept, in treating bilateral AMD. It highlights a possible strategy for optimizing treatment regimens and reducing costs in resource-limited settings. However, it also raises concerns about systemic absorption and potential risks. The findings emphasize the need for further research on the pharmacokinetics of anti-VEGF agents, personalized treatment plans, and alternative therapies. This case is particularly significant in the context of Pakistan's recent ban on bevacizumab, underscoring the urgent need for accessible and affordable AMD treatments in developing countries.
Changes in psychiatric disorder incidence patterns during the COVID-19 pandemic in Korea: a study using the nationwide universal health insurance data
Authors: Han Changwoo , Choi Juho , Jang Hoyeon , Lee Hwa-Young , Benmarhnia Tarik , Oh Juhwan 
Published: December 2024

Abstract
Background
Few studies have evaluated the incidence of various psychiatric disorders during the coronavirus disease (COVID-19) pandemic using hospital visit data for the entire population of a nation. We used Korea’s universal compulsory health insurance data to conduct a descriptive analysis to evaluate changes in psychiatric disorder incidence during the COVID-19 pandemic.

Methods
Hospital visit data related to psychiatric disorders were retrieved from the National Health Insurance Database. First-ever diagnosis for specific psychiatric disorders for each Korean was identified (from January 2015 to February 2023) and monthly age-standardized incidence rates were calculated. An interrupted time-series analysis was used to estimate counterfactual disease incidence rates and observed and counterfactual rates were compared using difference-in-difference framework.

Results
Compared to pre-pandemic period, there was a decrease in the incidence [percentage changes in monthly rate (95% confidence intervals)] of organic mental disorders [-14.6% (-18.4, -10.9)] and psychoactive substance related disorders [-12.9% (-17.5, -8.3)] during the pandemic. However, anxiety disorders [8.8% (3.1, 14.6)], behavioral syndromes associated with physiological disturbances [8.1% (4.2, 11.9)], mental retardation [8.6% (3.0, 14.2)], psychological developmental disorders [19.6% (11.5, 27.7)], childhood- and adolescent-onset behavioral and emotional disorders [45.1% (28.4, 61.8)], and unspecified mental diseases [51.8% (39.8, 63.8)] increased.

Conclusions
Psychological disease incidence patterns changed substantially during the pandemic in South Korea. Various pandemic-related stressors, such as disrupted lifestyles and hospital accessibility, may have influenced these changes. The causes and public health consequences of these changes require further evaluation.
Clinical research framework proposal for ketogenic metabolic therapy in glioblastoma
Authors: Duraj Tomás , Kalamian Miriam , Zuccoli Giulio , Maroon Joseph C. , D’Agostino Dominic P. , Scheck Adrienne C. , Poff Angela , Winter Sebastian F. , Hu Jethro , Klement Rainer J. , Hickson Alicia , Lee Derek C. , Cooper Isabella , Kofler Barbara , Schwartz Kenneth A. , Phillips Matthew C. L. , Champ Colin E. , Zupec-Kania Beth , Tan-Shalaby Jocelyn , Serfaty Fabiano M. , Omene Egiroh , Arismendi-Morillo Gabriel , Kiebish Michael , Cheng Richard , El-Sakka Ahmed M. , Pflueger Axel , Mathews Edward H. , Worden Donese , Shi Hanping , Cincione Raffaele Ivan , Spinosa Jean Pierre , Slocum Abdul Kadir , Iyikesici Mehmet Salih , Yanagisawa Atsuo , Pilkington Geoffrey J. , Chaffee Anthony , Abdel-Hadi Wafaa , Elsamman Amr K. , Klein Pavel , Hagihara Keisuke , Clemens Zsófia , Yu George W. , Evangeliou Athanasios E. , Nathan Janak K. , Smith Kris , Fortin David , Dietrich Jorg , Mukherjee Purna , Seyfried Thomas N. 
Published: December 2024

AbstractGlioblastoma (GBM) is the most aggressive primary brain tumor in adults, with a universally lethal prognosis despite maximal standard therapies. Here, we present a consensus treatment protocol based on the metabolic requirements of GBM cells for the two major fermentable fuels: glucose and glutamine. Glucose is a source of carbon and ATP synthesis for tumor growth through glycolysis, while glutamine provides nitrogen, carbon, and ATP synthesis through glutaminolysis. As no tumor can grow without anabolic substrates or energy, the simultaneous targeting of glycolysis and glutaminolysis is expected to reduce the proliferation of most if not all GBM cells. Ketogenic metabolic therapy (KMT) leverages diet-drug combinations that inhibit glycolysis, glutaminolysis, and growth signaling while shifting energy metabolism to therapeutic ketosis. The glucose-ketone index (GKI) is a standardized biomarker for assessing biological compliance, ideally via real-time monitoring. KMT aims to increase substrate competition and normalize the tumor microenvironment through GKI-adjusted ketogenic diets, calorie restriction, and fasting, while also targeting glycolytic and glutaminolytic flux using specific metabolic inhibitors. Non-fermentable fuels, such as ketone bodies, fatty acids, or lactate, are comparatively less efficient in supporting the long-term bioenergetic and biosynthetic demands of cancer cell proliferation. The proposed strategy may be implemented as a synergistic metabolic priming baseline in GBM as well as other tumors driven by glycolysis and glutaminolysis, regardless of their residual mitochondrial function. Suggested best practices are provided to guide future KMT research in metabolic oncology, offering a shared, evidence-driven framework for observational and interventional studies.
Dry needling as an adjunct treatment to multimodal rehabilitation protocol following rotator cuff repair surgery: a preliminary, randomized sham-controlled trial
Authors: Naseri Faeze , Dadgoo Mehdi , Pourahmadi Mohammadreza , Amroodi Morteza Nakhaei , Azizi Shirin , Shamsi Amirhossein 
Published: December 2024

Abstract
Background
Rotator cuff repair (RCR) is one of the most prevalent procedures to manage rotator cuff tears (RCT). Postoperative shoulder pain is a common complication following RCR and may be aggravated by activation of myofascial trigger points (MTrP) associated with the injury to the soft tissues surrounding the surgical incision. This study aimed to describe a preliminary, randomized, sham-controlled trial to evaluate the effectiveness of implementing 4 sessions of myofascial trigger point dry needling (MTrP-DN) as a muscle treatment approach along with 10 sessions of multimodal rehabilitation protocol (MRh) consisting of therapeutic exercise, manual therapy, and electrotherapy on postoperative shoulder pain, range of motion (ROM), strength, and functional outcome scores for patients following RCR surgery.

Methods
Forty-six patients aged 40–75 following RCR surgery were recruited and randomly allocated into 2 groups: (1) MTrP-DN plus MRh (experimental group), and (2) sham dry needling (S-DN) plus MRh (control group). This trial had a 4-week intervention period. The primary outcome was the Numeric Pain Rating Scale (NPRS) for postoperative shoulder pain. Secondary outcomes were the Shoulder Pain and Disability Index (SPADI), ROM, and strength. The mentioned outcomes were measured at baseline and week 4. In the current study, adverse events were recorded as well.

Results
No statistically significant differences were observed between groups when adding MTrP-DN to MRh for postoperative shoulder pain after 4 weeks of intervention (mean difference 0.32, [95% CI -0.41,1.05], p = 0.37). However, this trial found a small effect size for postoperative shoulder pain. No significant between-group differences were detected in any of the secondary outcomes (p > 0.05) either. We found significant within-group changes in all studied outcome measures. (p < 0.001). This study also reported minor adverse events. following the needling approach.

Conclusion
The lack of statistically significant differences in the outcomes and small clinical significance in shoulder pain highlights the complexity of pain management, suggesting that alternative methodologies may be needed for meaningful clinical benefits. Future studies should consider different control groups, long-term follow ups, larger sample sizes, and more MTrP-DN sessions to better understand their potential impact.

Trial registration
This trial was registered at (https://www.irct.ir), (IRCT20211005052677N1) on 19/02/2022.
Real-World Survival Outcomes in Non–Small Cell Lung Cancer: The Impact of Genomic Testing and Targeted Therapies in a Latin American Middle-Income Country
Authors: Hernandez-Martinez Juan-Manuel , Guijosa Alberto , Flores‐Estrada Diana , Cruz-Rico Graciela , Turcott Jenny , Hernández-Pedro Norma , Caballé‐Perez Enrique , Cardona Andrés F. , Arrieta Oscar 
Published: December 2024

PURPOSE
Targeted therapies are indicated for patients with non–small cell lung cancer (NSCLC) and driver tumor mutations. However, real-world studies on the survival benefits of these agents are limited. This study aimed to evaluate the effect of targeted therapies matched to a genomic alteration on the survival of patients with NSCLC.

METHODS
This retrospective study included 446 patients with advanced NSCLC who underwent next-generation sequencing between 2016 and 2023 at the Instituto Nacional de Cancerología in Mexico. The primary outcomes were progression-free survival (PFS) and overall survival (OS).

RESULTS

For the entire cohort, the PFS and OS were 10.71 months (95% CI, 9.35 to 12.06) and 47.77 months (95% CI, 29.67 to 65.86). PFS was significantly longer in patients with actionable mutations treated with targeted therapies (19.41 months [95% CI, 14.27 to 24.55];
P
< .001) than in patients without actionable mutations (6.4 months [95% CI, 4.4 to 8.4]) or not treated with targeted therapies (6.6 months [95% CI, 5.3 to 7.89]). Similarly, OS was significantly longer in patients with actionable mutations treated with targeted therapies (89.69 months [95% CI, 45.54 to 133.84];
P
< .001) than in patients without actionable mutations (17.11 months [95% CI, 8.65 to 25.57]) or not treated with targeted therapies (22.3 months [95% CI, 12.48 to 32.1]). Survival gains were driven by significant improvements in PFS and OS in patients with
EGFR
and
ALK
mutations.

CONCLUSION
This real-world data analysis demonstrated that targeted therapies improve the survival of patients with NSCLC with actionable mutations, which supports a recommendation for widening access to broad-based genomic testing and targeted therapies.
Gemcitabine Cisplatin and Durvalumab Experience in Advanced Biliary Tract Cancers: A Real-World, Multicentric Data From India
Authors: Muddu Vamshi Krishna , Shah Anjali , John Anupa , Raj Abhishek , Bahl Ankur , Rajappa Senthil J. , Raja Thirumalairaj , Ghosh Joydeep , Lavingia Viraj , Vora Amish , Bhargava Prabhat , Ramaswamy Anant , Khan Arif , Sharma Atul , Trikha Mehak , Dhanawat Aditya , Bonda Avinash , Siripurapu Indraja , Mahajan Manoj , Rohatgi Nitesh , Chandrakant Mosale Venkatesha , Gujarathi Himanshu , Vora Manan , Ankathi Sumankumar , Ostwal Vikas S. 
Published: December 2024

PURPOSE
Biliary tract cancers (BTCs) are usually diagnosed in advanced stages, where treatment options are either palliative chemotherapy and/or best supportive care. The breakthrough results of the TOPAZ-1 trial demonstrated a 24% decrease in risk of death at 2 years with the addition of durvalumab to chemotherapy.

MATERIALS AND METHODS
This was a multicenter retrospective cohort study conducted across 14 institutions in India. All the patients were diagnosed with advanced BTCs. The primary objective was to assess median overall survival (mOS) with the use of durvalumab in combination with chemotherapy backbone. The patient details, treatment details, laboratory results, and outcome parameters were recorded from the prospectively collected databases.

RESULTS

A total of 148 patients were included with a median age of 57.5 years; 36 (24.3%) patients had borderline Eastern Cooperative Oncology Group performance status ≥2. The most common subtype was gall bladder cancer (GBC), seen in 94 patients (63.5%); 126 (85.1%) patients presented with de novo metastases. At a median follow-up of 6.8 months (95% CI, 5.9 to 7.8), the estimated mOS for the entire cohort was 12 months (95% CI, 7.8 to 16.3) and median progression-free survival was 8.2 months (95% CI, 7.1 to 9.4) with objective response achieved in 44 (29.7%) patients, and the estimated 2-year OS being 25%. Immune-related grade 3/4 adverse events were reported in 11 (7.4%) patients. In multivariate analysis, age <60 years (
P
= .001) and standard dose of durvalumab (
P
< .001) were found to have improved OS compared with age >60 years and low dose of durvalumab.

CONCLUSION
To our knowledge, these real-world data provide the first evidence in Indian context of the efficacy and safety of durvalumab plus chemotherapy in patients with advanced/metastatic BTCs especially in GBC.