bluuebunny/crossref_metadata_2025_split huggingface dataset:
Adrenal neurofibroma masquerading as phaeochromocytoma
Authors: Jha Vivek , Arjunan Durairaj , Shaharyar Amal , Das Liza , Bhadada Sanjay Kumar 
Published: November 2024

ABSTRACT
This study describes the case of a 48-year-old male who was incidentally found to have a left adrenal mass during routine imaging, despite having no significant medical history or symptoms. Initial laboratory tests revealed elevated plasma-free normetanephrines, leading to a preliminary diagnosis of pheochromocytoma (PCC). Imaging confirmed a left large adrenal mass, which suggested PCC. However, following laparoscopic surgical excision, histopathological examination identified the mass as a neurofibroma, an uncommon and benign tumor in the adrenal gland. Post-surgery, the patient’s biochemical markers normalized, and follow-up imaging showed no residual mass. This case underscores the importance of thorough evaluation and consideration of differential diagnoses in the management of adrenal incidentalomas.
Pediatric adrenocortical tumor manifesting as Cushing’s syndrome and virilization
Authors: Kumar Subhash , Bishnoi Avina , Manayankath Reshma , Chandrashekhar Supreeth , Kumar Ritesh , Agrawal Neeraj Kumar 
Published: November 2024

ABSTRACT
Pediatric Cushing’s syndrome is a rare entity. In younger children, adrenocortical tumors are the common cause of this syndrome. Although clinically it is difficult to differentiate benign adrenocortical adenoma from aggressive carcinoma, the categorization of the tumor by the Wieneke scoring system can assist in predicting the future outcomes. In this study, we report a case of a 2-year-old male child diagnosed with endogenous Cushing syndrome and virilization due to a right adrenocortical adenoma. After a successful right adrenalectomy, the child experienced clinical and biochemical improvement, including weight loss and resolution of cushingoid features, with normalization of blood pressure and hyperandrogenism.
“Caution with choroidals” - choose the right one at right time
Authors: Boral Subhendu K. , Mitra Santanu 
Published: November 2024

Background:
During the repair of rhegmatogenous retinal detachment (RRD), pre-existing or intraoperative sudden choroidal detachment (CD), often compromises the surgical outcome and visual prognosis.

Purpose:
To describe video-guided specific approaches for pre-existing or sudden intraoperative CDs during the repair of RRDs.

Synopsis:
Cannula-guided choroidal drainage is necessary to decrease the severity of pre-existing CDs. Complex RRD with massive hemorrhagic CD often warrants a similar approach. Intraoperative sudden CD can be due to sudden hypotony because of a disproportionate increase in outflow due to high suction or a decrease in inflow due to kinking or blockade of the infusion tube/tip by vitreous/detached retina. It may also be due to the leakage around the cannulas in the eyes with thin sclera. Rarely accidental air entry inside the suprachoroidal space due to inadvertent slippage of a non-sutured infusion cannula tip can precipitate sudden kissing CD. If the air infusion pressure is 40 mm Hg or more, this suprachoroidal air can cause a tear in the vortex vein ampullae, and air enters inside the vortex vein. Then, it may go via ophthalmic veins to the cavernous sinus or via pterygoid plexus to the internal jugular vein, superior vena cava, and the right atrium, and can cause pulmonary embolism or less likely occlude systemic arteries via the foramen ovale. This possible life-threatening Venous Air Embolism (VAE), occurring concurrently with Ocular Air Fluid Exchange (OAFE) during vitrectomy, is known as “PRESUMED AIR BY VITRECTOMY EMBOLISATION (PAVE)”. Immediate stoppage of the air infusion and removing it can prevent this accidental PAVE and eventual death. In this era of MIVS, this risk is likely to be higher than in previous decades, when infusion cannulas were used to be sutured to the sclera.

Highlights:
The video describes the strategies for treating pre-existing CD along with RRDs and managing sudden intra-operative CDs, sometimes to prevent PAVE in cases of suprachoroidal air entry.

Video Link:

https://youtu.be/fEstbqVkXH4
Observance of ethical codes of midwifery profession in students and graduates of department of midwifery and reproductive health, Isfahan University of Medical Sciences
Authors: Sohrabi Zahra , Savabi-Esfahani Mitra , Shahriari Mohsen , Salehi Kobra 
Published: November 2024

BACKGROUND:
Ethical performance is one of the main components of maternal and fetal care. Nurturing and training students who meet professional ethics in midwifery is of utmost importance. It is essential to assess the level of adherence of students and graduates to the codes of ethics in order to determine the extent of education needs in this regard. Therefore, the present research aims to draw a comparison between the level of adherence to codes of ethics between midwifery students and graduates in the fields of midwifery and reproductive health department at Isfahan University of Medical Sciences.

MATERIALS AND METHOD:
This descriptive cross-sectional study was conducted in 2021–2022 on 93 midwifery students and 107 graduate midwives of Isfahan University of Medical Sciences. It is crucial to note that the study included all-year midwifery students. The data collection tools included a demographic questionnaire and one more questionnaire to assess adherence to the codes of ethics, which were made available to participants through Google Forms. Data were analysed using SPSS software statistics version (SPSS, Chicago, IL, USA). A significance level of 0.05 was considered significant for all tests.

RESULTS:
The mean adherence to codes of ethics was 79.01 ± 14.80 for the students and 79.07 ± 14.55 for the graduate midwives. There was a significant difference in the overall mean score of adherence to the codes of ethics, professional commitments, and self-communication between the two groups of students and graduates (P < 0.05).

CONCLUSION:
Although ethics is addressed in midwifery education programs, it is required to put considerable emphasis on teaching codes of professional ethics to both the students and graduates. Additionally, an educational and clinical setting is required to identify errors and their causes so that it can help take steps towards adhering to codes of ethics.
The effects of synbiotic supplementation along with non-surgical periodontal therapy in improving the metabolic status and inflammatory markers in type 2 diabetes mellitus patients with periodontal disease: A double-blind randomized clinical trial
Authors: Yarahmadi Mohsen , Javid Ahmad Zare , Bazyar Hadi , Yousefimanesh Hojat Allah , Nejatian Touraj , Gravand Ehsan , Haghighizade Mohammad Hossein 
Published: November 2024

BACKGROUND:
Diabetes mellitus and periodontitis are two common chronic diseases with bidirectional relationship. Considering the role of oxidative stress in the pathogenesis of these two diseases, the use of nutritional supplements with antioxidant properties can be useful. The purpose of this study was to determine the effectiveness of daily synbiotic supplement in the management of patients with type 2 diabetes mellitus (T2DM) and periodontal disease (PD) under non-surgical periodontal therapy (NSPT).

MATERIALS AND METHODS:
In this randomized double-blind placebo controlled clinical trial, 50 patients suffering from T2DM and periodontal disease were recruited and randomly assigned to two groups: intervention group (n = 25), where one capsule of multi-species probiotic plus 100 mg fructo-oligosaccharide supplement (500 mg in each capsule) every day is given, and control group (n = 25), which received one placebo capsule containing 500 mg wheat flour for 8 weeks. At the beginning and end of the study, the serum levels of fasting blood glucose (FBG), glycosylated hemoglobin (HbA1c), the lipid profile including total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) and inflammatory markers such as tumor necrosis factor alpha (TNF-α), interleukin 6 (IL-6), and high-sensitivity C-reactive protein (hs-CRP) were measured. All subjects received NSPT including oral health education, scaling, and root planning at the beginning of study. One month after the intervention, the second NSPT was performed. The paired-sample test was used to identify within-group differences. The independent sample t-test (crude model) and the analysis of covariance or ANCOVA (adjusted model) were used to compare the results between the two groups.

RESULTS:
Synbiotic supplement with NSPT significantly decreased serum levels of FBG, HbA1c, TNF-α, and IL-6 compared with the baseline values (all P < 0.05). Furthermore, LDL-C levels significantly decreased compared with the baseline value in both groups (all P < 0.05). Also, the mean changes of IL-6 were significantly lower in the intervention group compared with the control group after the adjustment of confounding factors (P = 0.01).

CONCLUSIONS:
Synbiotic supplementation with NSPT may be beneficial in improving glycemic control and inflammation and decreasing LDL-C in patients with T2DM and PD.
Medical student perception of force application: An accuracy assessment and pilot training program
Authors: Becker Heather , Duncan Riley , Newsome D’Angeleau , Zaremski Kenneth A. , Beutel Bryan G. 
Published: November 2024

BACKGROUND:
It is unclear how accurately students can reproduce specific forces that are often required for physical examination maneuvers. This study aimed to determine the baseline accuracy of force application for preclinical medical students, evaluate the effectiveness of a quantitative visual feedback intervention, and investigate whether certain demographics influence accuracy.

MATERIALS AND METHODS:
First- and second-year medical students were enrolled and demographic data were collected. Students blindly applied their estimation of 15 lbs (6.8 kg), 3 lbs (1.4 kg), 10 lbs (4.5 kg), 1.5 lbs (0.7 kg), and 6 lbs (2.7 kg) of force on a scale. Visual feedback training was then performed wherein students applied a series of additional forces unblinded five times, and then blindly administered the same five initial forces 12 minutes and one week later. Accuracy was compared at each time point and a regression analysis was evaluated for predictors of accuracy.

RESULTS:
Thirty-three students participated. The mean baseline accuracy was 38.3%, 41.1% immediately following intervention, and 35.6% one week later (P = 0.66). Accuracy was significantly higher at higher intended forces compared to lower forces (P < 0.05). The number of prior occupations was a positive independent predictor (P = 0.04), and the number of sports played was noted to be a negative predictor (P = 0.01), of baseline accuracy.

CONCLUSIONS:
Medical students’ ability to accurately reproduce clinically relevant forces is poor. There is a clear need to implement a robust training program in medical education, and students may need multiple training sessions to refine this skill.
Stress level and coping strategies among intensive care nurses: A cross-sectional study
Authors: Babkair Lisa A. , Alaamri Marym , Tunsi Afnan , Alhofaian Aisha , Alsulami Nada Manea , Hakami Maryam Y. , Alshehri Norah A. , Alsulami Wed M. 
Published: November 2024

BACKGROUND:
Intensive care units (ICUs) are high-stress environments, particularly for nurses, who face numerous stressors that can negatively impact their well-being. This study aimed to examine stress levels and stressors among ICU nurses, investigate their stress coping strategies, and explore the primary stressors in this demanding work environment.

MATERIALS AND METHODS:
Employing a cross-sectional design, this study assessed the stress levels of ICU nurses by using the Perceived Stress Scale and their coping strategies through the Brief-COPE scale, from March 15, 2021, to April 14, 2021. In addition, semi-structured interviews were conducted to gain deeper insights into the main stressors. The study also used critical appraisal tools to ensure quality and rigor.

RESULTS:
Among 103 participants, moderate stress levels were predominant. The most common coping strategies identified were religious activities, approach coping, humor coping, and avoidant coping. Interviews with three participants revealed two main themes: “It is an overwhelming job” and “Just stay strong.” The primary stressors reported were dealing with critically ill patients and nurse shortages, exacerbated by the pandemic crisis.

CONCLUSION:
ICU nurses experience moderate stress levels, primarily due to the challenges of working with critically ill patients and facing multiple stressors. The study highlights the need for future research to test the effectiveness of stress management programs and to further investigate common stressors among Saudi ICU nurses. Health policymakers are urged to provide more support to nurses through appropriate education, protection, and compensation, aiming to reduce work-related stressors and enhance their overall well-being.
Jejunal flap interposition after total gastrectomy in managing patients with familial adenomatous polyposis: A report on the experience of a single centre
Authors: Barbosa José , Lopes Vítor , Sousa Fabiana , Baptista Manuela , Barbosa José Pedro , Barbosa Elisabete 
Published: November 2024

Abstract

Introduction:
Patients with familial adenomatous polyposis (FAP) are characterised by the appearance of colorectal cancer if the disease is left to follow its natural course, which means they frequently undergo prophylactic colectomy at a young age. In these patients, duodenal cancer becomes the leading cause of death, which deems surveillance necessary. Gastric cancer, although rare, can also occur in these patients, and total gastrectomy is the usual treatment option.

Patients and Methods:
We used a pedicled isoperistaltic jejunal flap interposition technique to reconstruct the digestive tract after a total gastrectomy so that duodenal surveillance could be maintained in patients followed in outpatient consultation for genetic diseases. We also describe how this technique was performed fully through laparoscopy in two of these cases.

Results:
We identified four patients with FAP who developed malignant or extensive pre-malignant gastric lesions which were not endoscopically resectable. Two patients were submitted to open surgery and the remaining two underwent laparoscopic surgery. There was no perioperative or post-operative morbidity, and all four patients are alive at the time of writing, with a minimum follow-up of 12 months. They were not diagnosed with major nutritional imbalances and were routinely submitted to endoscopic duodenal surveillance, sometimes including polypectomy, with ease.

Conclusion:
In our experience, this surgical technique has good results, and all surgical steps can be done entirely through laparoscopy, with every advantage this approach entails.
Retrospective Evaluation of Sedation Techniques for Tooth Extraction in Paediatric Patients
Authors: Sharma Mridul , Sahu Amit K. , Kaila Puja , Hassan Ali Abdel H. A. A. , Mansy Mohamed , Thakur Raksha , Homeida Husham E. 
Published: November 2024

ABSTRACT

Background:
Dental procedures often require local anesthesia, but managing fearful patients, especially children, can be challenging, potentially leading to dental phobia development. Sedation methods such as conscious sedation, deep sedation, or general anesthesia can aid in managing these patients.

Material and Method:
This study focuses on evaluating various sedation techniques used in an Oral and Maxillofacial Surgery Clinic for adults with special needs requiring dental treatments under sedation or general anesthesia. A retrospective analysis was conducted on 250 adult patients with special needs who underwent dental procedures between January 2019 and December 2023. Data on demographic characteristics, types of procedures, sedation techniques used, dosages, and complications were collected from medical records. Sedation techniques included midazolam-sufentanil, ketamine-midazolam, oral midazolam, chloral hydrate, ketamine, and propofol.

Results:
The midazolam-sufentanil combination was the most commonly used sedation technique (27.2%), followed by ketamine-midazolam (21.6%). Complications such as respiratory issues (2.9%), cardiovascular events (1.5%), nausea/vomiting (4.4%), and prolonged recovery time (2.9%) were observed.

Conclusion:
Overall, the incidence of complications was relatively low, indicating the safety and efficacy of the sedation techniques. Sedation techniques, particularly the midazolam-sufentanil and ketamine-midazolam combinations, were found to be effective and safe for managing dental procedures in adults with special needs. Personalized sedation approaches based on individual patient factors are essential for optimizing outcomes. Further research is needed to explore long-term effects and patient satisfaction.
Atomic Force Microscopic Evaluation of Surface Topographies of Various Rotary Files in Root Canal Preparation in Molar Teeth
Authors: Swathika B , Nagareddy Bharath , Vijith V , Alghamdi Nuha , Samson Angel 
Published: November 2024

ABSTRACT

Background:
The efficiency and safety of root canal preparation are significantly influenced by the surface topographies of rotary files. Atomic force microscopy (AFM) provides high-resolution imaging that can reveal detailed surface characteristics of these instruments.

Materials and Methods:
In this study, three types of rotary files (File A, File B, and File C) were used to prepare the root canals of extracted human molar teeth. A total of 30 molar teeth were divided into three groups (n = 10) and prepared using one of the three rotary files. After preparation, the rotary files were analyzed using AFM to measure surface roughness parameters including average roughness (Ra), root mean square roughness (Rq), and maximum peak height (Rp). Statistical analysis was performed using ANOVA and post
hoc tests to compare the differences between the groups.

Results:
The AFM analysis revealed significant differences in the surface topographies of the rotary files. File A exhibited a Ra of 150 nm, a root mean Rq of 180 nm, and a maximum peak height Rp of 300 nm. File B showed an average roughness (Ra) of 200 nm, a root mean Rq of 230 nm, and a maximum peak height (Rp) of 350 nm. File C had an average roughness (Ra) of 170 nm, a root mean Rq of 210 nm, and a maximum Rp of 320 nm. Statistical analysis indicated that File B had significantly higher roughness parameters compared to File A and File C (P < 0.05).

Conclusion:
The surface topographies of rotary files vary significantly, which may impact their performance in root canal preparation. File B, with the highest roughness parameters, may pose a greater risk of canal wall damage and debris retention. These findings underscore the importance of selecting appropriate rotary files to optimize endodontic treatment outcomes.
Efficacy, safety and treatment satisfaction of transition to a regimen of insulin degludec/aspart: A pilot study
Authors: Yang Na , Lv Lu , Han Shu-Meng , He Li-Yun , Li Zi-Yi , Yang Yu-Cheng , Ping Fan , Xu Ling-Ling , Li Wei , Zhang Hua-Bing , Li Yu-Xiu 
Published: November 2024

BACKGROUND
There is a lack of clinical evidence on the efficacy and safety of transitioning from a thrice-daily pre-mixed insulin or basal-prandial regimen to insulin deglu-dec/aspart (IDegAsp) therapy, with insufficient data from the Chinese popu-lation.
AIM
To demonstrate the efficacy, safety, and treatment satisfaction associated with the transition to IDegAsp in type 2 diabetes mellitus (T2DM).
METHODS
In this 12-week open-label, non-randomized, single-center, pilot study, patients with T2DM receiving thrice-daily insulin or intensive insulin treatment were transitioned to twice-daily injections of insulin IDegAsp. Insulin doses, hemoglobin A1c (HbA1c) levels, fasting blood glucose (FBG), hypoglycemic events, a Diabetes Treatment Satisfaction Questionnaire, and other parameters were assessed at baseline and 12-weeks.
RESULTS
This study included 21 participants. A marked enhancement was observed in the FBG level (P = 0.02), daily total insulin dose (P = 0.03), and overall diabetes treatment satisfaction (P < 0.01) in the participants who switched to IDegAsp. There was a decrease in HbA1c levels (7.6 ± 1.1 vs 7.4 ± 0.9, P = 0.31) and the frequency of hypoglycemic events of those who switched to IDegAsp decreased, however, there was no statistically significant difference.
CONCLUSION
The present findings suggest that treatment with IDegAsp enhances clinical outcomes, particularly FBG levels, daily cumulative insulin dose, and overall satisfaction with diabetes treatment.
Diabetes-inducing effects of bronchial asthma
Authors: Al-Beltagi Mohammed , Bediwy Adel Salah , Saeed Nermin Kamal , Bediwy Hosameldin A , Elbeltagi Reem 
Published: November 2024

BACKGROUND
The relationship between diabetes mellitus (DM) and asthma is complex and can impact disease trajectories.
AIM
To explore the bidirectional influences between the two conditions on clinical outcomes and disease control.
METHODS
We systematically reviewed the literature on the relationship between DM and asthma, focusing on their impacts, mechanisms, and therapeutic implications. Various studies were assessed, which investigated the effect of glycemic control on asthma outcomes, lung function, and exacerbations. The study highlighted the role of specific diabetes medications in managing asthma.
RESULTS
The results showed that poor glycemic control in diabetes can exacerbate asthma, increase hospitalizations, and reduce lung function. Conversely, severe asthma, especially in obese individuals, can complicate diabetes management and make glycemic control more difficult. The diabetes-associated mechanisms, such as inflammation, microangiopathy, and oxidative stress, can exacerbate asthma and decrease lung function. Some diabetes medications exhibit anti-inflammatory effects that show promise in mitigating asthma exacerbations.
CONCLUSION
The complex interrelationship between diabetes and asthma suggests bidirectional influences that affect disease course and outcomes. Inflammation and microvascular complications associated with diabetes may worsen asthma outcomes, while asthma severity, especially in obese individuals, complicates diabetes control. However, the current research has limitations, and more diverse longitudinal studies are required to establish causal relationships and identify effective treatment strategies for individuals with both conditions.