bluuebunny/crossref_metadata_2025_split huggingface dataset:
First documented case of Smith-Lemli-Opitz syndrome in Syria: clinical presentation, diagnosis, and experimental management with simvastatin
Authors: Aladia Alwa Hussien , Hamdan Samar , Alkheder Ahmad 
Published: November 2024

Abstract
Smith-Lemli-Opitz syndrome (SLOS) is a rare genetic disorder that affects cholesterol synthesis and causes various physical and mental abnormalities. The case is a 25-day-old male infant who presented with multiple congenital anomalies, such as microcephaly, facial dysmorphism, syndactyly, hypospadias, and other organ malformations. He also had severe vomiting, feeding difficulty, irritability, dehydration, and hyponatremia. Laboratory tests showed low serum cholesterol, in addition to genetic tests, confirming the diagnosis of SLOS. The infant was treated with simvastatin, which improved his irritability and was well tolerated. The paper discusses the clinical features, diagnosis, and management of SLOS, and highlights the importance of early recognition and intervention for this rare case. It is also considered the first documented case in Syria.
Rubella myopericarditis and cardiac tamponade: a case report
Authors: Ishibashi Yohei , Nojiri Yoshito , Takahashi Yosuke , Takahashi Shinya , Fukuda Nobuaki , Hiroi Shitoshi 
Published: November 2024

Abstract
A 20-year-old male patient with ulcerative proctitis presented with a fever and chest pain. He was diagnosed with rubella-associated myopericarditis due to pericardial rub, elevated troponin I, ST elevation, and positive rubella-immunoglobulin M. The patient subsequently developed cardiac tamponade but responded well to pericardial drainage and antiinflammatory therapy. Notably, he lacked the classic rubella rash and lymphadenopathy. This case highlights the rare but potential complication of rubella-induced myopericarditis with tamponade, and the importance of considering this diagnosis in the absence of typical rubella symptoms.
Patent ductus arteriosus with pulmonary endarteritis leading to pulmonary infarction in a 9-year-old boy: a case report
Authors: Shakya Amshu , Shakya Urmila , Shah Subash Chandra , Bhandari KC Vidhata , Khadka Devaki , Ghulu Urusha 
Published: November 2024

Abstract
Background: Pulmonary endarteritis secondary to Patent ductus arteriosus (PDA) can present even in silent PDAs. Pulmonary endarteritis is treated with prolonged duration of antibiotics followed by PDA closure. It can also cause septic pulmonary emboli requiring critical care if multi-organ dysfunction ensues. Case presentation: A 9-year-old boy had high grade fever for one week and few nonspecific complaints. Echocardiogram showed PDA with infective endarteritis. Child was admitted with IV antibiotics. CECT chest done for resurgence of fever and need for increased oxygen demand showed multiple septic pulmonary emboli with pulmonary infarction. Surgical closure of PDA prevented further clinical deterioration. Conclusion: This case highlights the poor medical scenario of rural communities of Nepal. Such life- threatening complication can be prevented by timely recognition of the condition which is only possible by implementation of standard, accessible and affordable health care system across the country.
A rare case of Behçet’s disease complicated by Budd-Chiari syndrome and perforated duodenal ulcers in a young male
Authors: Hroub Osama , Ibraheem Kareem , Herbawi Abdalrahman N , Hroub Mohammad , Smerat Mohammad I , Batran Ahmad 
Published: November 2024

Abstract
Behçet’s disease (BD) is characterized by skin lesions, uveitis, and recurrent oral and genital ulcers. Vascular problems, predominantly affecting veins, lead to thrombosis, increasing the risk of ruptured artery aneurysms and Budd-Chiari syndrome (BCS). Morbidity and mortality are significantly heightened by rare occurrences such as pulmonary artery aneurysms, cardiac involvement, and BCS. Prompt diagnosis and treatment are pivotal for prognosis improvement, particularly in males with early onset. We present a case of a 16-year-old male with BD history, who developed abdominal distension, pedal edema, and shortness of breath. Clinical examination and laboratory findings revealed thrombosis in the right popliteal vein and BCS. Despite the initiation of lifelong anticoagulation therapy, the patient later suffered a gastrointestinal bleed from perforated duodenal ulcers, necessitating emergency intervention. Given a high Model for End-Stage Liver Disease (MELD) score and associated mortality risk, the patient was promptly referred for liver transplantation.
Rupioid psoriasis, a unique presentation treated with Ustekinumab
Authors: Diab Sdrah , Al-janabi Moatasem Hussein , Diab Ibrahim , Hassan Fouz 
Published: November 2024

Abstract
Rupioid psoriasis is a rare subtype of psoriasis characterized by distinctive lesions resembling oyster shells, known as rupioid lesions. This subtype is particularly uncommon in the pediatric population and is often associated with poor treatment compliance. Ustekinumab, an IgG monoclonal antibody, targets IL-12 and IL-23, reducing the release of proinflammatory cytokines TNFα, IL-2, and IL-17α, which play vital roles in psoriasis pathophysiology. Approved for pediatric patients aged six years and older, ustekinumab provides a therapeutic option for moderate to severe psoriasis. We present the case of a 10-year-old girl diagnosed with psoriasis vulgaris at age two. She presented with rupioid lesions following a urinary tract infection that had been treated with oral cefixime (200 mg). After conducting appropriate tests, ustekinumab (45 mg subcutaneously) was administered, leading to significant improvements in the thickness of the lesions and overall appearance. This case demonstrates ustekinumab’s efficacy in treating this challenging form of psoriasis.
Proinflammatory diet is associated with higher pain, disease severity and biochemical parameters associated with inflammation in fibromyalgia
Authors: Ersoy Söke Nursena , İnceöz Hansa , Solmaz İlker , Yardımcı Hülya 
Published: November 2024

Abstract

Objective
Fibromyalgia, which is becoming increasingly common today, affects the quality of life of those affected. The aim of this study was to investigate the relationship between diet and pain, disease severity, and biochemical parameters in fibromyalgia.

Design
Cross-sectional design using validated questionnaires.

Setting
Fibroyalgia patients with Traditional and Complementary Medicine clinics.

Subject
In total, 84 patients with fibromyalgia (FM), which was diagnosed by a rheumatologist.

Methods
The cross-sectional study was conducted with 84 fibromyalgia patients in Turkey. The Dietary Inflammatory Index (DII) was calculated by a 24-hour diet recall. Self-reported pain levels and disease severity were evaluated by the Visual Analog Scale (VAS) and a Revised Fibromyalgia Impact Questionnaire (FIQR), respectively. Antropometric measures and biochemical parameters associated with inflammation were also evaluated.

Results
Linear regression analysis revealed that the VAS pain score [β (95% confidence interval [CI])=1.72 (0.90–2.55), P &lt; .001], FIQ-R [β (95% CI)=5.62 (0.14–11.09), P &lt; .001] and uric acid/creatinine ratio [β (95% CI)=0.21 (−0.10 to 0.52), P &lt; .001] were positively associated with the DII after adjustments for body mass index (BMI), body fat, fat free mass, cholesterol, fiber, caroten, iron, magnesium, vitamine C reported by the patients with FM.

Conclusions
A pro-inflammatory diet was associated with higher pain, disease severity and uric acid/creatinine ratio in patients with FM.
Sociogeographic determinants of rapid opioid reduction or discontinuation among patients on high-dose long-term opioid therapy in North Carolina, 2006–2018
Authors: Alam Ishrat Z , DiPrete Bethany L , Pence Brian W , Planey Arrianna Marie , Marshall Stephen W , Fulcher Naoko , Ranapurwala Shabbar I 
Published: November 2024

Abstract

Objective
Rapid opioid reduction or discontinuation among patients on high-dose long-term opioid therapy (HD-LTOT) is associated with increased risk of heroin use, overdose, opioid use disorder, and mental health crises. We examined the association of residential segregation and health care access with rapid opioid reduction or discontinuation among patients on HD-LTOT and examined effect measure modification of individual-level characteristics.

Methods
Using 2006–2018 North Carolina private insurance claims data, we conducted a retrospective cohort study of patients who were 18–64 years of age and on HD-LTOT (≥90 morphine milligram equivalents for 81 of 90 consecutive days), with 1-year follow-up. The outcome was rapid opioid reduction or discontinuation (versus maintenance, increase, or gradual reduction/discontinuation). Individual-level characteristics included age, sex, and clinical diagnoses (post-traumatic stress disorder [PTSD], depression, anxiety, and substance use disorder). Neighborhood-level characteristics included health care access (measured as geographic distance to health care facilities) and residential segregation (operationalized with the Index of Concentration at the Extremes). We conducted bivariate linear regression to estimate 1-year risk differences and 95% confidence intervals.

Results
Of 13 375 patients on HD-LTOT, 48.6% experienced rapid opioid reduction or discontinuation during 1-year follow-up. Female patients and those diagnosed with PTSD who lived in areas of least racial and economic privilege had higher risks of rapid opioid reduction or discontinuation than did those living in areas with the most racial and economic privilege.

Conclusion
Health care providers need to address potential biases toward patients living in underserved and marginalized communities, as well as intersectionality with mental health stigma, by prioritizing training and education in delivering unbiased care during opioid tapering.
Identifying factors associated with persistent opioid use after total joint arthroplasty: a retrospective review
Authors: Quaye Aurora , DiPalazzo John , Kostka Kristin , Richard Janelle M , Beers-Mulroy Blaire , Peck Meredith , Krulee Robert , Zhang Yi 
Published: November 2024

Abstract

Objective
To identify predictors of persistent opioid use in opioid-naïve individuals undergoing total joint arthroplasty.

Design
Retrospective cohort study.

Setting
Maine Health System.

Subjects
Opioid-naïve patients who underwent at least one total joint arthroplasty (knee, hip, or shoulder) between 2015 and 2020.

Methods
Least Absolute Shrinkage and Selection Operator (LASSO) logistic regression was used to create a predictive model for persistent opioid use after surgery from a US Electronic Health Record dataset in the Observational Medical Outcomes Partnership Common Data Model format. 75% of the data was used to build the LASSO model using 10-fold cross-validation and 25% of the data was used to determine the optimal probability threshold for predicting the binary outcome.

Results
Out of 6432 patients, 12.3% (792) were identified as having persistent opioid use across combined total joint arthroplasties defined as at least one opioid prescription between 90 days and 1 year after surgery. Patients with persistent opioid use were more likely to be current smokers (OR 1.65), use antidepressants (OR 1.76), or have a diagnosis of post-traumatic stress disorder (OR 2.07) or a substance-related disorder (OR 1.69). Other factors associated with persistent opioid use included back pain (OR 1.43), dementia (OR 1.65), and body mass index over 40 (OR 2.50). The probability of persistent opioid use was not associated with age, sex, or ethnicity.

Conclusions
This predictive model for persistent opioid use after total joint arthroplasty shows promise as an evidence-based, validated, and standardized tool for identifying high-risk patients before surgery in order to target strategies and interventions to reduce the reliance on opioids for postoperative pain control.
Structure of the aminoterminal domain of the birnaviral multifunctional VP3 protein and its unexplored critical role
Authors: Ferrero Diego Sebastian , Gimenez María Cecilia , Sagar Amin , Rodríguez Javier María , Castón José R , Terebiznik Mauricio R , Bernadó Pau , Verdaguer Nuria 
Published: November 2024

Abstract
To overcome their limited genetic capacity, numerous viruses encode multifunctional proteins. The birnavirus VP3 protein plays key roles during infection, including scaffolding of the viral capsid during morphogenesis, recruitment, and regulation of the viral RNA polymerase, shielding of the double-stranded RNA genome and targeting of host endosomes for genome replication, and immune evasion. The dimeric form of VP3 is critical for these functions. In previous work, we determined the X-ray structure of the central domains (D2–D3) of VP3 from the infectious bursal disease virus (IBDV). However, the structure and function of the IBDV VP3 N-terminal domain (D1) could not be determined at that time. Using integrated structural biology approaches and functional cell assays, here we characterize the IBDV VP3 D1 domain, unveiling its unexplored roles in virion stability and infection. The X-ray structure of D1 shows that this domain folds in four α-helices arranged in parallel dimers, which are essential for maintaining the dimeric arrangement of the full-length protein. Combining small-angle X-ray scattering analyses with molecular dynamics simulations allowed us to build a structural model for the D1–D3 domains. This model consists of an elongated structure with high flexibility in the D2–D3 connection, keeping D1 as the only driver of VP3 dimerization. Using reverse genetics tools, we show that the obliteration of D1 domain prevents the VP3 scaffold function during capsid assembly and severely impacts IBDV infection. Altogether, our study elucidates the structure of the VP3 D1 domain and reveals its role in VP3 protein dimerization and IBDV infection.
Identifying brain targets for real-time fMRI neurofeedback in chronic pain: insights from functional neurosurgery
Authors: Liu Dan , Mi Yiqi , Li Menghan , Nigri Anna , Grisoli Marina , Kendrick Keith M , Becker Benjamin , Ferraro Stefania 
Published: November 2024

Abstract

Background
The lack of clearly defined neuromodulation targets has contributed to the inconsistent results of real-time fMRI-based neurofeedback (rt-fMRI-NF) for the treatment of chronic pain. Functional neurosurgery (funcSurg) approaches have shown more consistent effects in reducing pain in patients with severe chronic pain.

Objective
This study aims to redefine rt-fMRI-NF targets for chronic pain management informed by funcSurg studies.

Methods
Based on independent systematic reviews, we identified the neuromodulation targets of the rt-fMRI-NF (in acute and chronic pain) and funcSurg (in chronic pain) studies. We then characterized the underlying functional networks using a subsample of the 7 T resting-state fMRI dataset from the Human Connectome Project. Principal component analyses (PCA) were used to identify dominant patterns (accounting for a cumulative explained variance &gt;80%) within the obtained functional maps, and the overlap between these PCA maps and canonical intrinsic brain networks (default, salience, and sensorimotor) was calculated using a null map approach.

Results
The anatomical targets used in rt-fMRI-NF and funcSurg approaches are largely distinct, with the middle cingulate cortex as a common target. Within the investigated canonical rs-fMRI networks, these approaches exhibit both divergent and overlapping functional connectivity patterns. Specifically, rt-fMRI-NF approaches primarily target the default mode network (P value range 0.001–0.002) and the salience network (P = 0.002), whereas funcSurg approaches predominantly target the salience network (P = 0.001) and the sensorimotor network (P value range 0.001–0.023).

Conclusion
Key hubs of the salience and sensorimotor networks may represent promising targets for the therapeutic application of rt-fMRI-NF in chronic pain.
Comparison between Anterior Approach and Posterior Approach of Suprascapular Nerve Block for Postoperative Analgesia in Shoulder Arthroscopy
Authors: Ahmed Doaa Ramadan , ElZahaby Hany Mohamed , Hazem Ashraf mahmoud , Hassan Ramy Mohammed 
Published: November 2024

Abstract

Background
Severe intraoperative and postoperative pain associated with arthroscopic shoulder surgery has high incidence reaching up to 45%, it is often significant enough to interfere with initial recovery and rehabilitation. This pain is difficult to manage without large-dose opioids.

Aim of the Work
compare between anterior approach and posterior approach of suprascapular nerve block for postoperative analgesia in shoulder arthroscopy.

Patients and Methods
The study was conducted in Ain Shams University Eldemerdash Hospitals after approval from the ethics committee of anesthesia, intensive care and pain management department and written patients‟ consent. It included a total of 72 adult patients aged 18-60 years, Scheduled for shoulder arthroscopic surgeries. Patients were randomly divided into two equal groups, 36 each, according to the inclusion and exclusion criteria.

Results
no statistically significant differences in pain scores at 6, 12, and 24 hours postoperatively between the anterior SSNB and posterior SSNB groups. Postoperative First analgesia request time/hour early in posterior approach comparing to anterior approach (6.03±0.74, 5.64±0.68).opioid requirements were statistically different between the two groups, with a benefit in favour of the anterior route in the recovery area and during the first 24 postoperative hours.

Conclusion
the main finding is the anterior approach of SSNB provided superior analgesia compared with posterior approach of SSNB in postoperative opioid consumption.
Comparison between Preoperative Ultrasound Guided TAP Block and Caudal Block in Inguinal Hernia Repair in Paediatrics for Intraoperative and Postoperative Analgesia
Authors: Ahmed Hebatalla Maged Badrawy , Nabil el-shafeey Mohammed , Mohammed Abdelal Wael Ahmed , Elshaer Anesthesia Eman Mohamed 
Published: November 2024

Abstract

Background
Inguinal hernia repair is the most common scheduled sub-umbilical surgery done in day case paediatric surgical units. Using optimal analgesic regimens is essential to provide safe and effective analgesia, reduce postoperative stress response and accelerate recovery from surgery. Regional anaesthetic techniques are commonly used to facilitate pain control in paediatric surgical procedures.

Aim of the Work
To compare the effectiveness and safety of US guided TAP versus caudal block for postoperative analgesia in paediatric patients undergoing Unilateral Inguinal hernia repair.

Patients and Methods
The study was conducted on 40 randomly chosen patients in Ain Shams University Hospitals after approval of the medical ethical committee. Patients were divided randomly into two groups, each group consisted of 20 patients. After preoperative assessment and obtaining baseline vital data, all patients received general anaesthesia followed by the block at the beginning of the operation.

Results
the study revealed that US guided TAP block provided significantly prolonged postoperative analgesia and reduced the postoperative analgesic requirements as compared with caudal block in paediatric patients and also demonstrated that both analgesic techniques are safe.

Conclusion
From our study we can conclude that Ultrasound-guided transversus abdominis plane block and caudal epidural block are effective analgesics in children undergoing inguinal hernia repair surgery, with transversus plane block providing longer analgesic effect and decreased pain scores.
Subcostal TAP Block Versus Lateral TAP Block for Postoperative Analgesia in Patients Undergoing Total Abdominal Hysterectomy
Authors: Saba Tomas Michael Naser , Taha Abdallah El-Safty Omar Mohamed , Shoukry Mohamed Randa Ali , Mahmoud Khamis Ahmad Mohamed , Attia Samy Engy Samy 
Published: November 2024

Abstract

Background
Total abdominal hysterectomy surgeries are associated with severe postoperative pain. Effective pain management reduces the incidence of postoperative cardiac and pulmonary complications, decreases risk of postoperative deep venous thrombosis through early mobilization, provides patient satisfaction and reduces cost of hospital stay. A number of analgesic strategies have been adopted to minimize postoperative pain after abdominal surgeries. Studies suggest that abdominal wall blocks provide effective pain relief and faster postoperative rehabilitation than systemic analgesia.

Objective
To compare the effectiveness of subcostal versus lateral TAP blocks for post- operative pain management in patients undergoing total abdominal hysterectomy.

Patients and Methods
This study was a prospective randomised clinical study conducted in Ain Shams University Hospitals from October 2021 till October 2022 with a sample size of 100 patients undergoing total abdominal hysterectomy under general anaesthesia, divided into 2 groups, 50 patients each: Group A: Subcostal TAP Block group, Group B: lateral TAP Block group.

Results
These results demonstrated that performing postoperative bilateral subcostal TAP block in group (A) was associated with significant increase in heart rate, mean arterial blood pressure, pain scores and pethidine requirements postoperatively in comparison to bilateral lateral TAP block in group (B) which provided more effective analgesia than subcostal approach.

Conclusion
The quality of postoperative analgesia was more effective in patients received lateral TAP block than those received subcostal TAP block regarding hemodynamic changes, pain scores, doses of pethidine required for pain relief and postoperative mobilization.
Ultrasound Guided Suprascapular Nerve Block Combined with Intra-Articular Injection of Bupivacaine versus Ultrasound-Guided Interscalene Nerve Block in Shoulder Arthroscopy
Authors: Elsayed Abdullatif Ayman Ahmed , Hussein Mostafa Mansour , Mohamed Mohamed Abdelwareth , Mohamed Ezzat Shahrour Mohamed Tarek 
Published: November 2024

Abstract

Background
Severe intraoperative and postoperative pain associated with arthroscopic shoulder surgery has a high incidence reaching up to 45%; it is often significant enough to interfere with initial recovery and rehabilitation. This pain is difficult to manage without large doses of opioids.

Objective
To compare Interscalene nerve block ISNB with the suprascapular nerve and Intra- articular injection (SSNB+IAI) for postoperative analgesia after shoulder arthroscopic surgery guided with ultrasound.

Patients and Methods
This is a prospective, randomized, double-blinded study, that was carried out in Ain Shams University Educational Hospitals, through a period of six months.

Results
The ISNB and SSNB+IAI have the same efficacy for postoperative analgesia after shoulder arthroscopy done for different purposes. A non-significant difference in patient satisfaction assessed 24-hour post-operative, with p-value 0.054. There is a significant difference between the two groups regarding the reported complications, with a p-value of 0.017. Highly significant difference between the two groups regarding phrenic nerve paresis which is assessed using diaphragmatic ultrasound, with a p-value of 0.000. Based on our results we recommend further studies on larger patients and longer periods of follow-up to emphasize our conclusion.

Conclusion
ISNB and SSNB+IAI provided similar postoperative analgesia and patient satisfaction, but the higher rate of complications in ISNB made the SSNB+IAI superior for use in arthroscopic shoulder surgery.