bluuebunny/crossref_metadata_2025_split huggingface dataset:
Temporary Conjunctival Flap Plus Medical Treatment Versus Medical Treatment Only for High-Risk Fungal Keratitis: A Randomized Controlled Trial
Authors: Khalil Ahmad S. , Baioumy Shereen A. , Hegab Mohammed A. , Khairy Marwa A. , Ali Ali Goda 
Published: August 2024

Purpose:
The purpose of this study was to evaluate the efficacy of temporary conjunctival flap with topical natamycin and oral voriconazole compared with medical treatment only in reducing the rate of perforation in high-risk fungal keratitis.

Methods:
Sixty-two eyes of 62 patients with severe fungal keratitis were examined; only 54 patients were enrolled and divided randomly into 2 groups. The first group received medical treatment only in the form of topical natamycin 5% together with oral voriconazole 200 mg, while the second group received the same medical treatment plus a temporary conjunctival flap that was removed after 2 weeks. Five patients were lost during the follow-up, and only 49 patients were statistically analyzed. All patients were examined frequently until reepithelialization or the development of perforation.

Results:
Fifteen perforations were reported, with a higher rate among the medical group (48%) compared with the conjunctival flap group (12.5%), with P value <0.05. A significant delay was noted in reepithelialization time in the medical group compared with the conjunctival flap group (mean time was 21.69 ± 5.41 and 15.36 ± 2.2 days, respectively), with P value = 0.001. Significant improvement in visual acuity was reported over time when comparing baseline versus 3-month visual acuity in the same group using paired t sample test (P value was 0.003 and <0.001 in the first and second group, respectively).

Conclusions:
Temporary conjunctival flap is associated with a lower perforation rate compared with medical treatment only in severe fungal keratitis, which can provide a cheap and available alternative to therapeutic penetrating keratoplasty.
A Rare Case of Infective Endocarditis and Intracardiac Device Infection by Providencia stuartii With Review of the Literature
Authors: Tehaili Hussein , Saleh Ronny , Malviya Meenal 
Published: August 2024

AbstractProvidenciabacteremia is relatively uncommon but can be rapidly fatal and is often polymicrobial. It is usually associated with long-term indwelling catheter use. Infective endocarditis byProvidenciais seen even less frequently, and only 1 case was found on a PubMed database search and literature review ofProvidencia stuartiiinfective endocarditis, and another withProvidencia rettgeri. A 56-year-old African American man with long-standing lower extremity ulcers presented to the hospital for lower extremity weakness and pain. He had been discharged from the hospital 3 weeks prior for local debridement of lower extremity ulcerations with noted maggot infestation and hadP stuartiibacteremia at the time with associated wound culture positive for gram-negative bacilli. On repeat admission, blood cultures yieldedP stuartiiwith identical resistance patterns noted on susceptibilities. Transthoracic echocardiogram showed vegetations attached to the ICD lead and large tricuspid valve vegetation. A biopsy of the longstanding nonhealing lower extremity ulcer had findings consistent with pyoderma gangrenosum. The risk of cardiac device-related infection in patients with gram-negative bacteremia is lower than those with gram-positive bacteremia, and routine echocardiography is not recommended, especially when a known alternative source of bacteremia is available. This case highlights the importance of prudence when dealing with patients with cardiac devices, and with those who have a recurrence of bacteremia despite adequate treatment.
Determining the Relationship of Bacteria Associated With Dental Disease and Infective Endocarditis
Authors: Indermun Suvarna , Baswaraj Deepa , Regunath Hariharan , Kumar Senthil 
Published: August 2024

Objectives
Poor oral hygiene is a risk factor for bacteremia and infective endocarditis (IE). The purpose of this study was to determine the relationship of bacteria commonly associated with dental disease in native valve and prosthetic valve endocarditis patients at a tertiary center in Missouri.

Methods
This retrospective cross-sectional analysis reviewed the electronic medical records of patients diagnosed with definite IE, per the modified Duke criteria, at the University of Missouri Hospital between September 2015 and April 2019. Medical records were screened using International Classification of Diseases, Tenth Edition, code for IE (I 33) and further validated by screening echocardiography for intracardiac vegetations. Demographics, type of IE, echocardiographic findings, blood culture results, and relevant medical and dental data were recorded, and a descriptive analysis performed.

Results
One hundred twenty-seven patients with 134 episodes (mean = 51.1 years, SD ± 17.7 yrs; M: F = 1:1) satisfied the criteria. Of these, 19 (14.2%) episodes were identified to have blood culture results positive for bacteria associated with the oral cavity. Seventy-seven (57.5%) episodes were related to Staphylococcus aureus. Staphylococcus aureus is a constituent of normal oral flora and can contribute to oral disease and IE, but the connection between the 2 remains contentious in both medical and dental practice. Remarkably, 72 (53.8%) medical records lacked documentation of dental history and oral examination.

Conclusions
A significant proportion of IE cases are from bacteria associated with the oral cavity, advocating for routine dental evaluation and treatment as an essential component of care of patients with IE.
Unusual Presentations of the Usual Typhoid Fever
Authors: Doke Purwa , Diwan Arundhati , Makashir Prachee , Gaikwad Naineesh , Nadagoudar Meghana 
Published: August 2024

BackgroundMore than half of the global burden of typhoid fever occurred in India in 2017. [1] The incidence of this disease remains high in India as per a study done in 2023. [1] This is due to poor access to safe water and sanitation as well as inadequate vaccination coverage across the country. Typhoid fever can affect multiple organs.MethodsWe have presented 6 patients with atypical presentations seen between February 2020 to June 2022.ResultsThere were 3 males and 3 female patients. The youngest patient was 20 years and the oldest was 56 years old. Diagnosis of salmonellosis was based on cultures.ConclusionsAll patients made a complete recovery, and were stable at the time of discharge.
Long-term prognostic effect of serum albumin concentration in diabetic patients with stable coronary artery disease: A multicenter cohort study
Authors: Lu Ting-Wei , Chien Shih-Chieh , Leu Hsin-Bang , Yin Wei-Hsian , Tseng Wei-Kung , Wu Yen-Wen , Lin Tsung-Hsien , Chang Kuan-Cheng , Wang Ji-Hung , Wu Chau-Chung , Yeh Hung-I. , Chen Jaw-Wen 
Published: August 2024

Background:
Diabetes and insulin resistance alter the physiological state of serum albumin (SA), which is a prognostic marker for stable coronary artery disease (CAD). However, whether the SA concentration is associated with long-term cardiovascular (CV) outcomes in diabetic patients with stable CAD remains unclear.

Methods:
In total, 1148 patients were retrospectively identified from a nationwide multicenter cohort study on patients with stable CAD. They were categorized into four groups according to their diabetes mellitus (DM) status and SA concentration (cutoff: 4 g/dL).

Results:
The patients’ mean age was 62.5 years, and 83.5% were male. Of the total patients, 405 were included in group 1 (SA ≥4/non-DM), 322 in group 2 (SA <4/non-DM), 201 in group 3 (SA ≥4/DM), and 220 in group 4 (SA <4/DM). Group 4 had the oldest age and a higher prevalence of prior myocardial infarction and stroke. During the median 4.5-year follow-up (interquartile range: 1.5-6.7 years), the highest and lowest survival rates in terms of all-cause and CV mortality were found in groups 1 and 4, respectively. However, no prognostic differences were noted in nonfatal stroke and myocardial infarction among the groups. The data were consistent after covariate adjustment. Using group 1 as the reference, hazard ratio (HRs) (95% CIs) for all-cause mortality in groups 2, 3, and 4 were 3.64 (1.22-10.83), 3.26 (0.95-11.33), and 5.74 (1.92-16.95), respectively, and those for CV mortality were 2.8 (0.57-13.67), 2.62 (0.40-17.28), and 6.15 (1.32-28.58), respectively.

Conclusion:
In diabetic patients with stable CAD, a low SA concentration (<4 g/dL) was associated with increased long-term mortality regardless of all-cause or CV reasons but not nonfatal CV events.
Esketamine vs. placebo combined with erector spinae plane block vs. intercostal nerve block on quality of recovery following thoracoscopic lung resection: a randomized controlled factorial trial
Authors: Hu Jing-hui , Zhong Zhang-zhen , Shi Hai-jing , Wang Jie , Chen Shaomu , Shan Xi-sheng , Liu Hua-yue , Liu Hong , Meng Lingzhong , Ji Fu-hai , Peng Ke 
Published: August 2024

Background:
Multimodal analgesic strategy is pivotal for enhanced recovery after surgery. The objective of this trial was to assess the effect of subanesthetic esketamine vs. placebo combined with erector spinae plane block (ESPB) vs. intercostal nerve block (ICNB) on postoperative recovery following thoracoscopic lung resection.

Materials and Methods:
This randomized, controlled, 2×2 factorial trial was conducted at a university hospital in Suzhou, China. One hundred adult patients undergoing thoracoscopic lung surgery were randomized to one of four groups (esketamine-ESPB, esketamine-ICNB, placebo-ESPB, and placebo-ICNB) to receive i.v. esketamine 0.3 mg/kg or normal saline placebo combined with ESPB or ICNB using 0.375% ropivacaine 20 ml. All patients received flurbiprofen axetil and patient-controlled fentanyl. The primary outcome was quality of recovery (QoR) at 24 h postoperatively, assessed using the QoR-15 scale, with a minimal clinically important difference of 6.0.

Results:
The median age was 57 years and 52% were female. No significant interaction effect was found between esketamine and regional blocks on QoR (P=0.215). The QoR-15 score at 24 h was 111.5±5.8 in the esketamine group vs. 105.4±4.5 in the placebo group (difference=6.1, 95% CI: 4.0–8.1; P<0.001); 109.7±6.2 in the ESPB group vs. 107.2±5.6 in the ICNB group (difference=2.5, 95% CI: 0.2–4.9; P=0.033; not statistically significant after Bonferroni correction). Additionally, esketamine resulted in higher QoR-15 scores at 48 h (difference=4.6) and hospital discharge (difference=1.6), while ESPB led to a higher QoR-15 score at 48 h (difference=3.0).

Conclusions:
For patients undergoing thoracoscopic lung resection, subanesthetic esketamine improved QoR after surgery, while ICNB can be used interchangeably with ESPB as a component of multimodal analgesia.
Effects of supplementing extracorporeal shockwave therapy to hyaluronic acid injection among patients with rotator cuff lesions without complete tear: a prospective double-blinded randomized study
Authors: Ko Jih-Yang , Huang Chung-Cheng , Huang Po-Hua , Chen Jeng-Wei , Liao Chin-Yi , Kuo Shu-Jui 
Published: August 2024

Background:
The study investigates the combined efficacy of subacromial hyaluronic acid (HA) injections and extracorporeal shockwave therapy (ESWT) in managing rotator cuff lesions without complete tears.

Materials and methods:
Eligible patients were randomized into three groups: three HA injections combined with two sham ESWT (HA), three HA injections combined with one ESWT and one sham ESWT (HA + 1 ESWT), or three HA injections combined with two ESWT (HA + 2 ESWT) with an allocation ratio of 1:1:1. Visual Analogue Scale (VAS), Constant–Murley Score (CMS), range of motion (ROM), and muscle power of shoulder abduction (MP) were assessed preintervention and at 1, 3, 6, and 12 months postinitial HA injection. Shoulder MRI was conducted before and 12 months after the intervention.

Results:
All pertinent parameters showed no significant between-group differences at baseline but demonstrated significant within-group improvement throughout the study. The HA + 1 ESWT group demonstrated superior improvements in MP (P=0.011) and CMS (P=0.018) at 1 month, and in MP (P=0.014) and CMS (P=0.005) at 6 months, compared to the HA group. The HA + 2 ESWT group showed greater improvements in FF (P=0.027), IR (P=0.019), and SROM (P=0.025) at 1 month, and in ABD (P=0.022) at 6 months, compared to the HA group. Notably, the HA + 2 ESWT group exhibited greater improvements in FF (P=0.013), IR (P=0.019), and SROM (P=0.025) at 1 month, and in FF (P=0.007) at 3 months, than the HA + 1 ESWT group. Moreover, no deterioration in tendinopathy grading or tear status occurred in the HA + 1 ESWT group on MRI scans.

Conclusion:
ESWT provides additional benefits when combined with HA injections for patients with rotator cuff lesions lacking complete tears.
The Clinical, Morphologic, and Molecular Spectrum of BRAF Fusion Spitz Tumors
Authors: Sharma Natasha , Patel Pragi , Chen Alice , Zhang Yongzhan , Fumero-Velázquez Mónica , Olivares Shantel , Nosek Daniel , Waldenbäck Pia , Kazakov Dmitry , Gerami Pedram 
Published: August 2024

BRAF fusion Spitz neoplasms along with MAP3K8 fusions are among the subtypes of Spitz most likely to be diagnosed as Spitz melanoma. However, the current literature has only limited amounts of clinical follow-up on these cases. In this study, we share our experience with 39 BRAF fusion Spitz neoplasms and provide the greatest number of cases with available clinical follow-up. Among 24 patients with clinical follow-up (mean duration of 26.1 mo), none developed metastatic disease. Detailed biomarker assessment with FISH studies, TERT promoter mutational analysis, PRAME and p16 IHC also strongly favored a benign process. Only 2 of 17 cases were positive by FISH, 37 of 38 were negative for TERT promoter mutations, 24 of 24 were negative for PRAME and 16 of 21 had retained staining with p16. In addition, we identify and describe several distinct morphologic patterns, some of which are highly spitzoid in cytomorphology while others lack convincingly spitzoid cytomorphology. We address classification of those cases with less than classic spitzoid cytomorphology with a nonsupervised PCA plot which shows that independent of how spitzoid the cytomorphology is, BRAF fusions strongly cluster with other subtypes of Spitz neoplasms. In conclusion, we show with clinical follow-up, a meta-analysis of the current literature, and our biomarker analysis, that most BRAF fusion Spitz neoplasms have an indolent course and should be considered either benign or of intermediate grade. Further, our morphologic assessment and PCA plot suggest the morphologic spectrum of Spitz neoplasms may need to be expanded.
Are We Imaging Gently in Indiana? A System-Wide Population-Based Study of Chest CT Use in the Pediatric Trauma Population
Authors: Mannava Sindhu , Collings Amelia , Colgate Cameron , Timsina Lava , Landman Matthew 
Published: August 2024

Objectives
Over the past decade, there has been a significant effort to decrease radiation exposure in pediatric trauma patients. The objective of this study was to determine if trauma centers (TCs) and nontrauma centers (non-TCs) are practicing in line with this effort. We hypothesized that TCs would demonstrate a significant decrease in the use of chest computed tomography (CT) during the study period, whereas non-TC would show no change in chest CT use.

Methods
We queried a state-wide database from 2010 to 2020 for pediatric trauma encounters at TCs and non-TCs within a single large health system. All transfer encounters were excluded. Chest CTs and chest radiographs (CXRs) were performed, and injury diagnosis codes were extracted for each encounter. Chest CT use and incidence of thoracic injuries were compared between TCs and non-TCs.

Results
A total of 13,014 encounters were included, of which 85.8% occurred at TCs and 14.2% occurred at non-TCs. There were significant differences between TC and non-TC encounter demographics. During the study period, the percentage of trauma encounters in which chest CT was obtained increased yearly at both TCs and non-TCs. Among encounters where both modalities were performed in the first 24 hours, chest CT was performed before CXR in 0.4% of TC and 0.1% of non-TC encounters (P = 0.086). Among encounters without thoracic injury, chest CT was performed in 5.2% of cases at non-TCs and 4.5% of cases at TCs (P < 0.001).

Conclusions
In the trauma encounters studied, chest CT was performed prior to CXR more frequently at TCs compared to non-TCs. These data may reflect regional trauma triage protocols, availability of chest CT, or differences in education between institutions. Whereas TCs may see more severely injured patients more frequently, education regarding conservative CT imaging principles should be reinforced through multidisciplinary efforts.
Bridges to care: A collaborative, community-based model of rehabilitation in Dominican Republic using the World Health Organization’s framework of community engagement
Authors: Pullen Sara , Bretón Oscar , Damas Tiernan , Rodriguez Vargas Lucia 
Published: August 2024

Background:
The most recent national population survey of the Dominican Republic (DR) estimated that ∼12.4% of all people in the country live with a disability. Ischemic heart disease is the number one cause of death in the DR, followed by stroke and road accidents, all of which, if survived, can cause significant suffering, disability, and need for rehabilitation.

Methods:
This study describes a sustainable, culturally responsive collaboration between the local health systems of the DR and the Rehabilitation Department of a U.S. medical school.

Results:
Over a period of 7 years, 855 patients were seen around 10 locations within a regional health area in teh DR. The majority of patients reported musculoskeletal pain, which reflects global health trends.

Conclusion:
The described collaborative work fosters a bidirectional partnership as well as enhanced rehabilitation access in a global context.
Reliability of a 2D-Panoramic Ultrasound System for the Determination of Muscle Volume in Older Hospitalized Patients
Authors: Boureau Anne Sophie , Anger Sylvain , Cornu Christophe , Mathieu Marie , Berrut Gilles , Nordez Antoine 
Published: August 2024

Abstract
Reliability of muscle thickness assessed in B-mode ultrasound has been confirmed in adults but remains a less direct assessment of muscle mass than muscle volume (MV). The aim of this prospective monocentric study was to assess the interday reliability of MV determined by the 2D-panoramic ultrasound in older hospitalized patients.
Ten participants hospitalized in geriatric ward (mean age = 84) underwent 2 sessions of panoramic ultrasound scanning 1 week apart for MV assessment and DXA for leg lean mass (LLM) assessment when it was possible. The interday reliability of MV assessed using the intraclass correlation coefficient (ICC) was excellent, whatever was the muscle analyzed: ICC = 0.99 for tibialis anterior; ICC = 0.99 for vastus lateralis; ICC = 1 for rectus femoris. The pilot analysis of its association with leg lean mass revealed a good association between the vastus lateralis MV and LLM, but this needs to be confirmed on a larger number of participants (Pearson correlation coefficient = 0.91, P = 0.03).
The 2D-panoramic ultrasound system for the determination of MV was reliable in older hospitalized patients with measurements performed on the patient's bed. MV seemed to be more correlated to LLM than muscle thickness. Future research will need to reduce the data processing time maybe with automation of data measurement.
Clinical Presentations and Surgical Outcomes in Traumatic Iris and Lens-Related Injuries Due to Blunt Trauma
Authors: Özer Ömer , Güçlü Emin S. 
Published: August 2024

Purpose:
The aim of this study was to evaluate the clinical presentation, treatment options, and surgical outcomes of patients admitted with traumatic iris and lens-related injuries due to blunt trauma.

Methods:
This retrospective study included 43 eyes of 43 patients who presented with traumatic iris and lens injuries between September 01, 2022 and July 01, 2023.

Results:
The mean age was 46.1±14.6 years and the mean ocular trauma score was 74.7±9.9. According to the cause of injury, the most common cause in males is assault, and the most common cause in females is fall. Nine (20.9%) patients underwent pars plana vitrectomy. Six (14%) patients underwent cataract surgery with phacoemulsification and intraocular lens implantation into “the bag.”

Conclusions:
In conclusion, other concomitant pathologies may make these surgeries difficult to perform. Early evaluation and timely management are essential to achieve the best possible outcomes in patients with traumatic iris and lens-related injuries.
Effect of Nasal Septoplasty on Fibrinogen/HDL Ratio in Patients With Nasal Septal Deviation
Authors: Bayram Ali , Şahin Mustafa , Alici Sert Gökçen 
Published: August 2024

Objective:
The present study aimed to investigate the plasma fibrinogen/high-density lipoprotein (HDL) ratio in patients with marked nasal septal deviation (NSD) and to evaluate the effect of septoplasty on this ratio.

Methods:
The present prospective study included 56 patients who had a septoplasty due to a marked NSD (NSD group) in an academic tertiary hospital and 40 age-matched and sex-matched healthy volunteers (control group) between April 2019 and December 2021. The diagnosis of marked NSD was performed via a detailed otorhinolaryngological examination, nasal endoscopy, and computed tomography finding. All patients in the NSD group were evaluated for plasma fibrinogen, HDL, mean platelet volume (MPV), platelet distribution width (PDW), and fibrinogen/HDL values before and 3 months after surgery, and preoperative values were compared with the control group. Preoperative and postoperative fibrinogen, HDL, MPV, PDW, and fibrinogen/HDL values were also compared in the NSD group.

Results:
There was no significant difference between the NSD and control groups regarding age, sex, fibrinogen, HDL, MPV, PDW, and fibrinogen/HDL values. Fibrinogen, MPV, and fibrinogen/HDL values were significantly decreased, whereas HDL levels significantly increased after septoplasty in the NSD group. There was no significant difference in terms of preoperative and postoperative PDW values.

Conclusion:
To the best of our knowledge, this is the first study investigating the fibrinogen/HDL ratio and the effect of septoplasty on this ratio in NSD in the literature. In the present study, the fibrinogen/HDL ratio was significantly decreased after septoplasty in patients with NSD, which may be attributed to the therapeutic effect of nasal septoplasty on the restoration of hypercoagulopathy provoked by chronic hypoxia.