bluuebunny/crossref_metadata_2025_split huggingface dataset:
MNGA-07 CHARACTERISTICS AND OUTCOMES OF FOUR PARASAGITTAL TUMORS EXCISED AT PARIRENYATWA CENTRAL HOSPITAL, ZIMBABWE
Authors: Sanyamandwe Simbarashe , Kalangu Kazadi , Dzowa Maximilian , Zimani Nathaniel 
Published: October 2024

Abstract

OBJECTIVE
To investigate the clinical features and outcomes of patients undergoing excision of parasagittal tumors at Parirenyatwa Central Hospital, Zimbabwe over a six-month period between October 2023 to March 2024.

METHOD
The clinical and operation notes of patients with parasagittal tumors who underwent excision were retrieved from the hospital archives and used to populate a pre-developed tool.

RESULTS
Four cases were operated on with their ages ranging from 33 to 61 years. There were three males and one female with the average duration of presenting symptoms being 2 years 3 months from a range of 6 months to 4 years. Two of the tumors were located in the middle third of the superior sagittal sinus while there was 1 of each in the posterior and anterior third location. All of the masses were Sindou type I except for 1 case which was a type II Sindou classification. No preoperative embolization was done for all the patients and the masses were categorized as large with the masses measuring 6 x 7 x 9, 7 x 5 x 4.5, 7.3 x 5.6 x 7.4 and 7 x 8 x 9 centimeters. Intraoperatively 2 cases did not receive blood transfusion while one received 1 unit, and the Sindou type II patient received 2 units. The extent of resection was Simpson grade II for 3 cases and Simpson IV for the Sindou type II case. All the patients were discharged from in-hospital care. The immunohistopathology showed that the excised massed were 2 cases of type 1 meningiomas, a xanthomatous meningioma and a solitary fibrous tumor.

CONCLUSION
The parasaggital sinus tumors presenting at Parirenyatwa, Zimbabwe are large and outcomes of excision are generally good despite no preoperative embolization being undertaken.
OTHR-11 A CASE SERIES OF OUTER TABLE CALVARIAL DECORTICATION AS A VIABLE OPTION TO ACHIEVE SKULL COVER AFTER RESECTION OF LARGE SCALP TUMORS
Authors: Dzinotyiwei Daniel , Kalangu Kazadi , Zimani Nathaniel , Dzowa Maximilian 
Published: October 2024

Abstract
A showcase of a scalp cover technique that offers a simple solution to a unique challenge posed by excision of late presenting large scalp tumors in a third-world setting through a case series of 2 patients with extensive scalp malignancy requiring wide local excision with striping of the pericranium. Outer table skull drilling resulted in granulation tissue formation allowing for defect cover by wound contraction. Unique circumstances in a third-world setting compounded by the COVID-19 pandemic restrictions allowed for observation of the natural history of the progression of the scalp defect coverage by wound contraction over a decorticated granulation tissue bed. An adequate granulation bed can be achieved within 4-6 weeks. Closure of the defect by wound contraction over the granulation bed is possible, albeit over a protracted period of months. These two cases proved that outer table decortication offers a good option to cover denuded large scalp defects after the excision of scalp tumors. Although less than ideal, total defect closure can be achieved without subsequent grating.
PDOC-03 CASE SERIES ON PEDIATRIC PATIENTS WITH LEPTOMENINGEAL METASTASES FROM VARIOUS PRIMARY BRAIN TUMORS: FROM CLINICAL PRESENTATIONS TO OUTCOMES
Authors: Kwikima Ugumba , Kalinga Violeth , Mallango Atuganile 
Published: October 2024

Abstract
Leptomeningeal disease (LMD), also known as carcinomatous meningitis, is when cancer cells are found in the thin layers covering the brain and spinal cord, in the spaces between these layers, or in the fluid surrounding the brain and spinal cord. In children with brain tumors, LMD is rare, occurring in about 1% to 2% of cases. It’s most commonly seen in certain types of tumors like medulloblastoma and primary central nervous system lymphoma, but it can also occur in other types such as pineoblastoma, Atypical Teratoid Rhabdoid Tumor, and both low-grade and high-grade gliomas. Although pilocytic astrocytomas, a type of low-grade glioma, seldom spread, there have been a few reported cases of them spreading to the leptomeninges. The exact prevalence of LMD in pediatric brain tumors isn’t well-documented due to differences in how it’s screened for across different types of tumors and at different stages of the disease. Improved surgical methods and various treatments targeting specific areas or affecting the whole body have resulted in better survival rates for patients with LMD. Detecting LMD early is important for treatment options. It can be found either at the same time as the primary brain tumor, when the tumor comes back, or as LMD without an initial tumor. There’s concern that procedures to divert cerebrospinal fluid might spread cancer cells. MRI scans are important for diagnosing LMD, but it can still be challenging to diagnose based on these scans alone. Usually, confirmation is done by analyzing the fluid around the brain and spinal cord for cancer cells. Given that LMD is a complex and rare complication of pediatric brain tumors, more research is needed to improve diagnosis and treatment. In this article, we’ll discuss three cases of pediatric brain tumors with LMD, including how they were diagnosed, treated, and their clinical outcomes.
SPIN-01 PRIMARY MALIGNANT MELANOMA, AN ATYPICAL PRESENTATION IN THE CERVICAL SPINE: A CASE REPORT
Authors: Kamabu Larrey Kasereka , Kataka Louange Maha , Vivalya Bives Mutume Nzanzu , Sikakulya Franck Katembo , Lekuya Hervé Monka , Galukande Moses 
Published: October 2024

Abstract

BACKGROUND
Few studies have documented the occurrence of melanoma in the cervical spine. Of all malignant melanoma cases, 1% are primary melanoma of the central nervous system, which makes it extremely uncommon and nonspecific. We aim to report a case of the uncommon presentation of primary melanoma in the cervical spine. Case presentation: The patient was a 59-year-old Muganda male who presented with a 2-year history of anterior neck swelling as well as severe pain and a tingling sensation in the left shoulder and arm, which worsened in the recent 6 months. He developed weakness and paresthesia in the upper left arm and progressive gait disturbance of the left leg. A physical examination revealed masses in the left cervical and right submandibular region. Additionally, the upper and lower left extremities revealed hemiparesis and hemihypoesthesia. A magnetic resonance imaging scan showed a hyperintense lesion on TIWI and another hypointense lesion on T2WI, originating from the cervical spine and involving the vertebral bodies and paravertebral soft tissues. The patient underwent surgery, a black tumor was extracted, and histology revealed the tumor to be malignant melanoma. The patient died within 1 month after the diagnosis and surgery.

CONCLUSION
This case is presented to highlight the significance and challenges associated with making a pre- and postoperative diagnosis of primary cervical melanoma with atypical radiological characteristics. Patients with extradural lesions that show hyperintensity on T1-weighted images and hypointensity on T2-weighted images should have spinal melanoma examined as a possible differential diagnosis.
SPIN-03 PROFILE OF MALIGNANT SPINAL CORD COMPRESSION AMONG CHILDREN AT A SINGLE CENTRE IN JOHANNESBURG, SOUTH AFRICA
Authors: Mauree Angidi , Laher Anees , Goodwin Bernard , Geel Jennifer 
Published: October 2024

Abstract

OBJECTIVE
Malignant spinal cord compression (MSCC) in children can lead to permanent neurological deficits and therefore warrants urgent referral, prompt diagnosis and treatment. There is limited data on paediatric MSCC in Sub-Saharan Africa. The objective was to assess the characteristics, aetiology, clinical presentation, treatment and long-term outcomes of MSCC.

METHODS
Records of 23 patients with MSCC were retrospectively assessed over a 15-year period (2008-2023) at Charlotte Maxeke Johannesburg Academic Hospital in Johannesburg, South Africa.

RESULTS
The median age of MSCC diagnosis was four years (range: 5 months to 15 years). The median interval between symptom onset and confirmed diagnosis was three months (1 week to 20 months). MSCC’s leading causes were central nervous system tumours (30%), lymphomas (22%), sarcomas (17%), germ cell tumours (9%), teratoid tumours (9%), neuroblastomas (9%) and leukaemias (4%). Commonest presenting symptoms were motor deficits (96%), pain (35%) and sphincter dysfunction (22%). Magnetic resonance imaging (MRI) of the spine was diagnostic in all cases. The primary tumour was managed using a multimodality approach: 70% underwent neurosurgical intervention and 39% received radiotherapy. The median follow-up duration was two years (1 month to 15 years). There were six deaths (two cases of ependymoma and a case each of glioblastoma multiforme, alveolar rhabdomyosarcoma, acute lymphoblastic leukaemia and Burkitt lymphoma) at a median interval of 4.5 months from diagnosis (1 month to 2 years). The commonest long-term sequelae were motor deficits (52%) and sphincter dysfunction (26%) and 22% of patients were asymptomatic.

CONCLUSION
We documented longer diagnostic delays than published in the literature and recommend increased awareness and rapid referral to decrease permanent sequelae. Patients presenting with new-onset neurological deficits suggestive of MSCC should have urgent radiological imaging; preferably MRI, followed by prompt referral to a specialised centre with an experienced multidisciplinary team.
SPIN-05 A CASE PRESENTATION ON ASTROCYTOMA
Authors: Girisa Peres , Michelle Obat , Sarah Muma , Musau Helena 
Published: October 2024

Abstract
Patient initially presented to our facility with a 3 year history of limb weakness. The limb weakness started mainly with the right upper limb associated with pains that were radiating to the neck region. They had visited several local hospitals for treatment but had no improvement. One year later he developed low limb weakness, was on physiotherapy for a long time with no improvement, until 1/12 ago when he developed complete paralysis of both low limbs making him bound to use of wheelchair. He had an accompanied history of cervical and thoracic spine pains that were radiating to the chest. No history of trauma. MRI showed an expansile intramedullary cystic lesion seen throughout the length of the spinal cord with inhomogeneous post contrast enhancement, highly suggestive of astrocytoma. Ddx: Hemangioblastoma. On examination, he was not pale, no jaundice no edema, wheelchair bound, with Scoliosis. Vitals were within normal limit, with muscle atrophy and muscle power- RUL ⅗. LUL ⅘, RLL ⅗. LLB ⅖, with bilateral knee hyperreflexia with significant disuse atrophy. Pain scale 6/10. He was a secondary school student. His parents do menial jobs to support their family and would delay clinic reviews due to lack of finances.
TRLR-01 THE PROGNOSTIC UTILITY OF TEMPORALIS MUSCLE THICKNESS MEASURED ON MAGNETIC RESONANCE SCANS IN PATIENTS WITH INTRA-AXIAL MALIGNANT BRAIN TUMOURS: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Daniel Jeremiah , Osunronbi Temidayo , Olukoya Olatomiwa , Jesuyajolu Damilola , Thorne Lewis 
Published: October 2024

Abstract

OBJECTIVE
Sarcopenia is associated with worsened outcomes in solid cancers. Temporalis muscle thickness (TMT) has emerged as a measure of sarcopenia. Hence, this study aims to evaluate the relationship between TMT and outcome measures in patients with malignant intra-axial neoplasms.

METHODS
Following the PRISMA guidelines, we systematically searched PubMed, Embase, Scopus, and Cochrane databases for relevant studies from inception until June 17, 2022. Event ratios with 95% confidence intervals (CI) were analyzed using the RevMan 5.4 software. Where meta-analysis was impossible, vote counting was used to determine the effect of TMT on outcomes. The GRADE framework was used to determine the certainty of the evidence.

RESULTS
Four outcomes were reported for three conditions across 17 studies involving 4430 patients. Glioblastoma: thicker TMT was protective for overall survival (OS) (HR 0.59; 95% CI 0.46–0.76) (GRADE low), progression-free survival (PFS) (HR 0.40; 95% CI 0.26–0.62) (GRADE high), and early discontinuation of treatment (OR 0.408; 95% CI 0.168–0.989) (GRADE high); no association with complications (HR 0.82; 95% CI 0.60–1.10) (GRADE low). Brain Metastases: thicker TMT was protective for OS (HR 0.73; 95% CI 0.67–0.78) (GRADE moderate); no association with PFS (GRADE low). Primary CNS Lymphoma: TMT was protective for overall survival (HR 0.34; 95% CI 0.19–0.60) (GRADE moderate) and progression-free survival (HR 0.23; 95% CI 0.09–0.56) (GRADE high).

CONCLUSION
TMT has significant prognostic potential in intra-axial malignant neoplasms, showing a moderate to high certainty for its association with outcomes following GRADE evaluation. This will enable shared decision-making between patients and clinicians.
Implementing the Infectious Diseases Society of America Antimicrobial Stewardship Core Curriculum: Survey Results and Real-World Strategies to Guide Fellowship Programs
Authors: Hojat Leila S , Patel Payal K , Ince Dilek , Kang Amy Y , Fong Gary , Cherabuddi Kartik , Nori Priya , Al Lawati Hawra , Stohs Erica J , Beeler Cole , Van Schooneveld Trevor C , Lee Matthew S , Hamilton Keith W , Justo Julie Ann , Spicer Jennifer O , Logan Ashleigh , Bennani Kenza , Williams Rostam , Shnekendorf Rachel , Bryson-Cahn Chloe , Willis Zachary I , Moenster Ryan P , Brennan-Krohn Thea , Paras Molly L , Holubar Marisa , Gaston David C , Advani Sonali D , Luther Vera P 
Published: October 2024

Abstract

Background
The Infectious Diseases Society of America (IDSA) developed the Core Antimicrobial Stewardship (AS) Curriculum to meet the increasing demand for infectious diseases (ID) providers with AS expertise. Notable diversity in implementation approaches has been observed among ID fellowship programs using the curriculum. We sought to describe individual approaches and develop a curriculum implementation roadmap.

Methods
We surveyed ID fellowship programs that had previously implemented the IDSA Core AS curriculum. The survey included questions regarding program characteristics, curriculum participants and presentation format, resources and barriers, and implementation strategies. Commonly reported program features were summarized in the context of the self-reported implementation strategies. Implementation guides were developed based on the most common characteristics observed.

Results
Of 159 programs that had purchased the curriculum, 37 responded, and 34 (21%) were included in the analysis. The curriculum was primarily taught by AS physicians (85%) and AS pharmacists (47%). The most common conference structure was a longitudinal conference series (32%), and eLearning was the most common presentation format. Limited AS faculty time (76%) and limited first-year fellow availability (62%) were frequently reported as barriers, and dedicated AS curricular time was a resource available to most programs (67%); implementation guides were created for these 3 program features.

Conclusions
Programs reported a variety of implementation barriers and resources, with several common themes emerging, allowing for the development of tailored curriculum planners for 3 commonly observed program characteristics. This work will equip fellowship programs with curriculum implementation strategies and guide future enhancements of the IDSA Core and Advanced AS curricula.
Developing and Validating a Multimodal Dataset for Neonatal Pain Assessment to Improve AI Algorithms With Clinical Data
Authors: Yang Nannan , Zhuang Ying , Jiang Huiping , Fang Yuanyuan , Li Jing , Zhu Li , Zhao Wanyuan , Shi Tingqi 
Published: October 2024

Background:
Using Artificial Intelligence (AI) for neonatal pain assessment has great potential, but its effectiveness depends on accurate data labeling. Therefore, precise and reliable neonatal pain datasets are essential for managing neonatal pain.

Purpose:
To develop and validate a comprehensive multimodal dataset with accurately labeled clinical data, enhancing AI algorithms for neonatal pain assessment

Methods:
An assessment team randomly selected healthy neonates for assessment using the Neonatal Pain, Agitation, and Sedation Scale. During painful procedures, 2 cameras recorded neonates’ pain reactions on site. After 2 weeks, assessors labeled the processed pain data on the EasyDL platform in a single-anonymized setting. The pain scores from the 4 single-modal data types were compared to the total pain scores derived from multimodal data. The On-Site Neonatal Pain Assessment completed using paper quality scales is referred to as OS-NPA, while the modality-data neonatal pain labeling performed using labeling software is MD-NPL.

Results:
The intraclass correlation coefficient among the 4 single-modal groups ranged from 0.938 to 0.969. The overall pain intraclass correlation coefficient score was 0.99, with a Kappa statistic for pain grade agreement of 0.899. The goodness-of-fit for the linear regression models comparing the OS-NPA and MD-NPL for each assessor was greater than 0.96.

Implications for Practice and Research:
MD-NPL represents a productive alternative to OS-NPA for neonatal pain assessment, and the validity of the data labels within the Multimodality Dataset for Neonatal Acute Pain has been validating. These findings offer reliable validation for algorithms designed to assess neonatal pain.
Therapeutic Indices of Topical Antiseptics in Wound Care: A Systematic Review
Authors: Geng Ryan S. Q. , Sibbald R. Gary , Slomovic Jacqueline , Toksarka Olivia , Schultz Gregory 
Published: October 2024

ABSTRACT

GENERAL PURPOSE
To review the therapeutic indices of topical antiseptics for bacterial species commonly isolated from chronic wounds.

TARGET AUDIENCE
This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and registered nurses with an interest in skin and wound care.

LEARNING OBJECTIVES/OUTCOMES
After participating in this educational activity, the participant will:
1. Explain the mechanisms underlying chronic wound physiology and their implications for effective wound healing and management.
2. Evaluate the role of therapeutic index values for topical antiseptics in chronic wound management.
3. Apply evidence-based treatment strategies for chronic wound management.

BACKGROUND
Chronic wounds place a heavy burden on healthcare systems and reduce patients’ activities of daily living. Increased bacterial bioburden (local infection, covert infection) impairs wound healing. With increased antimicrobial resistance, alternative antimicrobial strategies are important.

OBJECTIVE
To determine the topical antiseptic therapeutic index values for common wound bacterial species. The therapeutic index is a ratio comparing lowest concentration that causes mammalian cell cytotoxicity to the minimum bactericidal concentration; higher values indicate greater safety / clinical benefit.

DATA SOURCES
MEDLINE and EMBASE databases were searched from conception to June 2023. Common wound bacterial species and their in-vitro minimum bactericidal concentrations were compared to the minimum mammalian cell cytotoxicity concentration.

STUDY SELECTION
The authors identified 37 qualifying articles.

DATA EXTRACTION
Antiseptic, bacterial organism, mammalian cell type, minimum bactericidal concentration, and mammalian cell cytotoxicity concentration values.

DATA SYNTHESIS
The therapeutic indices for the topical antiseptics were generally low, with most ranging between 0.5 and 3.0. The highest therapeutic index values for Escherichia coli (5.49), Staphylococcus aureus (6.31) and Pseudomonas aeruginosa (8.81) were achieved by hypochlorous acid. The highest therapeutic index value for methicillin resistant S aureus (12.1) was achieved by polyhexamethylene biguanide.

CONCLUSIONS
Antibiotic stewardship principles need to be applied to topical antiseptics due to some isolated topical antiseptic resistance and cross-resistance to oral antimicrobials. The choice of antiseptic should not be made solely based on therapeutic index values but individualized with the wound healing condition including covert infection.
Toward Analytical Performance Specifications for Immunosuppressive Drug Quantification in Transplantation: An Opinion Article
Authors: Shipkova Maria , Wieland Eberhard , Schütz Ekkerhard 
Published: October 2024

Background:
Analytical methods require performance that meets the clinical needs. Different approaches for setting up permissible analytical imprecision goals (pCVA%) for drug analyses have been reported. The aim of this study was to calculate the pCVA% for cyclosporine, tacrolimus, everolimus, sirolimus, and mycophenolic acid using 4 alternative approaches, to compare the results and to critically discuss advantages and disadvantages of each model.

Methods:
The approaches to evaluate pCVA% were (A) based on biological variation observed in routine measurement results between 2022 and 2023 in the authors' laboratory, (B) derived from the terminal elimination half-life and dosing interval of the drugs, and (C and D) explored from the width of the therapeutic ranges (TR) by the 2 methods. For approach A, routine measurement data for cyclosporine and tacrolimus, obtained through liquid chromatography–tandem mass spectrometry and electrochemiluminescence immunoassays, were evaluated separately.

Results:
The 4 alternative approaches for deriving pCVA% yielded similar results, for cyclosporine and tacrolimus in an analytical method dependent manner. The average pCVA% was 5.2%, 5.6%, 5.1%, 4.8%, and 7.7% for cyclosporine, tacrolimus, everolimus, sirolimus, and mycophenolic acid, respectively. The most challenging goals were those using TR-related approaches, while those using the biological variation approach were most easily achievable. Approach B resulted in more stringent goals for drugs with longer elimination half-lives (eg, everolimus and sirolimus).

Conclusions:
There is no single ideal approach for setting goals of drug analysis. However, the pCVA% values derived from the various approaches are similar and confirm that a <6% target proposed by the International Association of Therapeutic Drug Monitoring and Clinical Toxicology is adequate and realistic in combination with state-of-the-art measurement technologies. In the authors' opinion, approaches based on the width of the TR are preferable, as they represent a common basis for clinical decisions and reflect elements of biological variation and analytics used to establish the TR.