bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early versus late initiation of infliximab for refractory uveitis in a cohort of Egyptian BD patients
Authors: Fadel Mariam R. , AboulNaga Shereen H. , ElGhobashy Nehal , Mohamed Sally S. 
Published: July 2024

Introduction
Behçet’s syndrome is a multisystem inflammatory disease characterized by recurrent oral aphthous ulcers, genital ulcers, skin lesions, and uveitis. Ocular involvement, occurring roughly in 50% of patients, is one of the most feared complications of Behçet’s syndrome. Recurrent severe uveitis leads to irreversible severe vision loss.

Purpose
The main goals in the management of patients with Behçet’s uveitis are rapid resolution of intraocular inflammation, prevention of recurrent attacks, and achievement of complete remission and preservation of vision. Corticosteroids are generally used for the treatment of acute episodes of inflammation. According to the updated EULAR recommendations for the management of BS ‘any patient with BS and inflammatory eye disease affecting the posterior segment should be on a treatment regime such as azathioprine, cyclosporine-A, interferon alpha or monoclonal tumor necrosis factor alpha antagonists.

Methods
Infliximab has been increasingly used in the treatment of Behçet’s syndrome patients with uveitis when they are refractory to conventional immunosuppressive therapy. However, there is no consensus on the best time to start anti- tumor necrosis factor alpha therapy. In our study we evaluated the outcome of early initiation of infliximab for refractory uveitis in cohort of Egyptian Behçet’s syndrome patients.

Conclusion
Early administration of Intravenous Infliximab therapy for severe sight-threatening uveitis and chorioretinitis in Egyptian Behçet’s syndrome patients has a favorable value regarding BCVA. Multidisciplinary approach in managing Behçet’s uveitis is mandatory to reach better functional visual outcome.
Health-Promoting Lifestyle Factors Among Opioid-Dependent Patients: A Scoping Review
Authors: Negi Parvender Singh , Mathur Rahul , Sarkar Siddharth 
Published: July 2024

AbstractThe health deficits of individuals with opioid use disorders have received considerable attention, especially in the context of risky behaviors, injection drug use, and HIV infection. Health-promoting behaviors and lifestyles play an important role in influencing numerous diseases in today’s world, including substance use disorders. The present review aimed to report on the health-promoting lifestyle factors among patients with opioid dependence. A literature search was done from May to June 2023, covering 30 years, and focused on English-language peer-reviewed journals in PubMed, Google Scholar, PsycINFO, and Medknow. An electronic search was used for specific keywords related to opioids and health-promoting behaviors. Data extraction was done according to health-promoting lifestyle dimensions enunciated by Walker: Physical activity, nutrition, spiritual growth, stress management, health responsibility, and interpersonal relations.
Serotonin Syndrome in an Adolescent Following Overdose of Escitalopram and Lithium: A Case Report
Authors: Sharma Namita , Saini Yash , Grover Sandeep 
Published: July 2024

Abstract
In routine clinical practice, some patients consume overdose of more than one medication, that makes it difficult to identify the toxic syndrome. In this report, we present the case of a 16-year female who was brought to the emergency with an alleged account of an overdose of tablet lithium and tablet escitalopram. A 16-year female, suffering from depression for about 4-months, and was on treatment consumed approximately 3000 mg of lithium and 150 mg of escitalopram with the intention to die. At presentation (after 12 h of the overdose), her Glasgow Coma Scale score was E3V1M6, her blood pressure was 70/50 mm Hg, her pulse rate was 84 beats/min, her respiratory rate was 24 breaths/min, and she was afebrile. On physical examination, she was found to have diaphoresis, mydriasis, ocular clonus, patellar clonus, ankle clonus, hyperreflexia, rigidity, increased bowel sound, and whole-body tremulousness. On mental state examination she was found to be delirious to stuporous. In view of the toxicity, initially a diagnosis of serotonin syndrome and lithium toxicity was considered. Considering the availability of antidote, it was decided to manage the patient first in the line of serotonin syndrome. She should dramatic improvement with cyproheptadine and stabilized in 48 h. Her lithium levels also normalized with supportive management during the same time frame. The index case highlights the fact that when a patient presents with toxicity of more than one psychotropic, with antidepressants being one of them, SS should always be suspected and managed rapidly with the antidote.
Online Exposure and Response Prevention for Obsessive-Compulsive Disorder: A Case Report
Authors: Mishra Eepsita , Grover Sandeep 
Published: July 2024

Abstract
Over the years, there has been an increase in the use of telepsychiatry services for the management of various psychiatric disorders. In terms of the management of obsessive-compulsive disorder (OCD), emerging data suggests that exposure and response prevention (ERP) can be done through telepsychiatry services. However, most of this data are in terms of short-term outcomes. In this case report, we present the information of two sisters, who presented with OCD and were managed with a combination of antiobessional agents and ERP for 2 years. For ERP, one of the two patients was managed with self-exposure, and at the same time acted as co-therapist for the second patient.
Some Hematological Indices as Predictors of Survival in Chronic Myeloid Leukemia Patients
Authors: Faraj Yusur Falah , Salih Khalid Mahdi , Khelif Abderrahim 
Published: July 2024

Abstract

Background:
Despite the promising of introduction of tyrosine kinase inhibitors (TKIs), chronic myeloid leukemia (CML) remains a significant cause of annual mortality. Red blood cell distribution width (RDW), neutrophil/lymphocyte ratio (NLR), and platelet/lymphocyte ratio (PLR) are parameters derived from a complete blood count (CBC) commonly used to diagnose anemia, autoimmune diseases, and inflammation. These parameters have been reported to have a strong association with various diseases, including hematologic malignancies.

Objectives:
The study aims to identify whether RDW, NLR, and PLR can act as predictors of survival in newly diagnosed and treated CML patients.

Materials and Methods:
The study involved 60 Iraqi patients (37 males, 23 females, aged 17–69 years) with CML at chronic phase, who were referred to the National Center of Hematology/Mustansiriyah University, Baghdad, from February 2022 to December 2022. Twenty were newly diagnosed (T0), and 40 were under TKI treatment (T+), with 20 on imatinib and 20 on nilotinib. Additionally, a control group of 20 age- and gender-matched healthy subjects was included. CBC assessed red blood cell (RBC) indices across all groups.

Results:
There was no significant difference in the age of CML patients at the onset of disease between males (34.5 ± 11.7 years) and females (34 ± 11.9 years). Likewise, there was no significant difference in the treatment of CML patients with imatinib or nilotinib between males (48% and 52%) and females (53.3% and 47.7%), respectively. Most RBC indices for patients and controls were within normal ranges without significant differences. However, RDW% in T0 was markedly elevated (20.4%), with about 80% showing anisocytosis, surpassing both T+ and controls, and exceeding the upper limit of normal. The total and differential white blood cell (WBC) counts were significantly higher in T0 compared to T+, exceeding their normal ranges. Additionally, the NLR was significantly higher in T0 (8.13) compared with T+ and controls (1.80 and 1.87, respectively). Platelet count, mean platelet volume, and platelet distribution width (PDW%) differed significantly among the three groups but remained within the normal range. However, PLR in T0 (31 ± 24) was significantly lower than those in T+ and controls (130 ± 43 and 102 ± 27, respectively).

Conclusion:
It can be concluded that the monitoring of some parameters in peripheral blood in CBC test (as a simple and inexpensive test) such as RDW%, NLR%, and PLR% during the therapy course of CML patients may act as predictive markers to evaluate the prognosis of disease in CML patients and the degree of response to certain TKI treatment.
Brain Natriuretic Peptide in Patients with Acromegaly: A Comparative Study between those with and without Obstructive Sleep Apnea
Authors: Hammood Shaymaa Dheyab , Ali Eham Amer , Rahmah Abbas Mahdi 
Published: July 2024

Abstract

Background:
Acromegaly is a rare endocrine disorder; it has an incidence of 4 per million annually and a prevalence of 40 per million. It is due to growth hormone-secreting pituitary adenoma. The objective of our study is to evaluate the levels of brain natriuretic peptide (BNP) in patients with acromegaly with and without obstructive sleep apnea (OSA).

Materials and Methods:
One hundred five registered patients with acromegaly in the National Diabetes Center-Mustansiriyah University were enrolled in the study. Out of 105 patients with acromegaly, 81 have OSA while the remaining 24 have no OSA. OSA affects 81.8% of males and 72% of females. All recruited patients have given oral consent to participate in the study which was conducted during the period from January to October 2023.

Results:
Males with OSA had a mean age of 52 years while those without OSA had a mean age of 46 years. Epworth Sleepiness Scale is higher among those with OSA. BNP is found to be higher in females with OSA (905.54 pg/ml) while in males with OSA, it drops down to 878.76 pg/ml. In no OSA group, the BNP level was 355.33 ± 30.1 pg/ml while in those with OSA, it jumped to 890.66 ± 205.63 pg/ml.

Conclusions:
The results showed that BNP was elevated in patients with acromegaly and OSA versus those without OSA, OSA is more common in males particularly when they get older.
The Impact of Psychological, Social, Societal, and Economic Factors Leading to Relapse in Patients Recovered from Addiction
Authors: Al-Musway Jasim Mohammed Hashim 
Published: July 2024

Abstract

Background:
The problem of using psychotropic substances and addiction has become one of the major problems in the world. Despite the significant increase in treatment programs of addiction, many studies indicate that the rate of relapse globally is very high, especially when treatment is limited to the medical side only.

Aims:
The study aims to determine the percentage of influence of psychological, societal, social, economic, and other factors that lead to relapse when recovering from addiction.

Methods:
This study conducted in two main hospitals for the treatment of substance use disorders in Baghdad (Ibn Rushud Teaching Hospital for Psychiatry and Al-Ataa Center for Addiction Treatment) through the period from January 10, 2023, to June 10, 2023. All (300 inpatient) who are suffering from relapse to addiction after recovery were included in the study. The scale was prepared for the psychological, social, therapeutic, environmental, and economic factors, which was used by a group of senior doctors working in the field of treatment of addiction and rehabilitation centers, who unanimously agreed with their expertise on these factors.

Results:
This study revealed that the most important factor for relapse is the availability of addictive substances (91%); other factors include psychological, social pressures that the addict is exposed to in his social environment, in addition to the loss of social support (76%). The pressure of friends or peers with a rate of (78%) and the weakness of family control (44%) in addition to the influence of other factors that were examined in this study.

Conclusion:
There are many factors affecting the return of those recovering from addiction to addiction again, and the most prominent of these factors is the abundance or ease of access to psychoactive substances in addition to other factors, which include (psychological, social, societal, and economic factors). Society must realize that the responsibility for preventing addiction should not be borne by the medical treatment alone, because it is a problem that must be dealt with collectively by all parties to enable recovered patients from addiction to build their lives with confidence.
The Influence of Autonomic Nervous System during Resting State on the Peripheral Pulse Wave Velocity in Young Adult Males
Authors: Al-Wahab Zainab Nazar , Saleem Ali Fouad , Al-Gailani Bassam Talib 
Published: July 2024

Abstract

Background:
The association between the activity of autonomic nervous systems (ANS) and pulse wave velocity (PWV) was commonly deduced after adjusting for confounding factors. The relationship between the ANS and PWV was either maintained, but attenuated, or no longer statistically connected after controlling for confounding variables. Research in young healthy individuals showed that the ANS does not control aortic stiffness (indexed by PWV) in a pressure-independent manner. Therefore, the role of the ANS in controlling PWV is debatable.

Objectives:
The objective of this study was to examine the possibility that ANS directly affects PWV independent of blood pressure (BP) and heart rate (HR).

Subjects and Methods:
Thirty-four healthy male volunteers (19 years old) were recruited. Stable brachial systolic BP (SBP)/diastolic BP (DBP) and HR were measured in semi-supine position after a 15-min rest. During the last 5 min, fingertip digital pulse wave (DPW) and lead II electrocardiogram (ECG) signals were recorded. The pulse transit time, and consequently PWV, was calculated by measuring the duration between the ECG R wave climax and a reference point on the DPW in the same cardiac cycle. The ANS activity was assessed by calculating the HR variability (HRV) indices obtained from the ECG record of 5-min R-R intervals (RRIs).

Results:
HRV indices low-frequency (LF)/high-frequency (HF) (LF band power measured in the 0.04–0.15 Hz)/the HF band power measured in the 0.15–0.4 Hz band) and SD2/SD1 ratios (SD1 and SD2 represent the dispersion along the minor and major axis of the fitted ellipse of the Poincaré plot) (sympathovagal balance) were significantly and positively correlated with PWV. In addition, the standard deviation of RRI, or normal-to-normal “NN” (SDNN) interval, after excluding ectopic beats, the square root of the mean squared differences of successive NN intervals (RMSSD) were significantly and negatively correlated with the PWV. No correlation was obtained between PWV and HR, SBP, or DBP.

Conclusion:
Peripheral PWV during rest or inactivity is affected directly by the sympathovagal balance independent of BP.
Correlation of Grayscale Ultrasound and Doppler Evaluation with Histopathological Diagnosis in Cases of Tubercular Cervical Lymphadenitis
Authors: Lahel Ranjit S. , Mathur Smriti , Chail Amit , Tiwari Chandan 
Published: July 2024

ABSTRACT

Introduction:
Cervical lymphadenopathy is a relatively common clinical presentation that can have varied causes including reactive, inflammatory, tubercular, or neoplastic etiologies. Sonography is most often the first line of investigation used in clinical practice to characterize the enlarged nodes with respect to their location, number, size, and morphological imaging characteristics and determine the differential etiological possibilities.

Materials and Methods:
The present study was conducted involving 434 patients who presented over a period of 3 years to radiology departments of three multispecialty hospitals for the evaluation of cervical swellings. The study aimed to establish the correlation between the ultrasound and Doppler parameters used in clinical practice and the final histological diagnosis in cases of tubercular cervical lymphadenitis.

Results:
Overall, a female predisposition was observed in the proportion of patients who presented with cervical lymphadenopathy. A similar increased female percentage was also observed in cases finally detected to have tubercular pathology. The highest diagnostic indices were obtained for two ultrasound parameters of “matted nodes” and “caseous necrosis with posterior acoustic enhancement.” Although other features such as hypoechoic nodes, Doppler findings of peripheral vascularity, and high resistive index (RI)/pulsatility index (PI) values demonstrated high sensitivity, they showed poor specificity, positive predictive values, and low accuracy.

Conclusion:
In ultrasound scans for suspected cases of tubercular cervical lymphadenitis, the maximum weightage should be given to “matted nodes” and “caseous necrosis with posterior acoustic enhancement” parameters to differentiate the tubercular etiology from other potential causes. These parameters demonstrate high sensitivity, specificity, positive predictive value, and accuracy. Hence, they can be relied upon to start timely anti-tubercular treatment and follow-up with patients on a clinical-radiological basis. This can supplement waiting for suboptimal cytology reports that are difficult to arrive at, specifically in tubercular cervical lymphadenitis cases. The same applies as well to biopsy specimens that are hard to obtain from cervical nodes with associated potential grave complications.
LEDoxy-SL: A Placebo-Controlled, Double-Blind, Randomized, 24-Month Trial of Six Weeks of Daily Doxycycline Plus Hygiene-Based Essential Care for Reducing Progression of Filarial Lymphedema in Sri Lanka
Authors: Yahathugoda Thishan Channa , De Silva Nirmitha Lalindi , Ruben Janaka , Gunawardena Sharmini , Weerasooriya Mirani Vasanthamala , Horton John , Budge Philip , Ottesen Eric , Sullivan Sarah Mary , Stephens Mariana , Shen John , Klarmann-Schulz Ute , Hoerauf Achim , Shott Joseph Patrick , Mackenzie Charles 
Published: July 2024

ABSTRACT.
Morbidity management of filarial lymphedema remains a challenge even during the post-lymphatic filariasis elimination era in Sri Lanka despite provision of the predominantly hygiene-based WHO Essential Package of Care. Because prior studies have suggested that 6 weeks of doxycycline may reduce progression of limb lymphedema, we conducted a randomized, placebo-controlled, superiority study to evaluate this possibility in Sri Lanka. Patients aged 14 to 65 years with lymphedema in one or both legs received either 200 mg of doxycycline daily for 6 weeks or matching placebo. The primary efficacy endpoint was improvement or lack of progression in lymphedema stage at 24 months postenrollment. Secondary endpoints included change in lymphedema stage at 12 and 24 months, frequency of acute adenolymphangitis episodes, and perceived disability measured by the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0). Training and supplies for limb hygiene were provided throughout the study. Two hundred participants (100 in each arm) with lymphedema of Dreyer stages 1 to 3 were enrolled. By the end of the 2-year study, 29% of the doxycycline patients and 34% of those on placebo showed improvement (i.e., a decrease in lymphedema stage), whereas 11% and 15% of the two groups showed worsening of the lymphedema. Adenolymphangitis rates were comparable in the two groups (43 doxycycline and 38 placebo recipients), although attacks lasted slightly longer in placebo patients (6.5 days versus 5.2 days). In both groups, perceived disability improved initially, with partial rebound in the second year. Only 34 adverse events affecting 24 patients (11%) occurred during the 6-week treatment period. Although doxycycline did not significantly impact lymphedema progression in this study, the results clearly indicate that clinical and personal benefits can be obtained from intensive hygiene management alone.
Dermatoses vulvares: revisão de tema
Authors: Silva Luiza Santos Ribeiro da , Correia Letícia Paula , Tavares Juliana Cruz Carneiro , Araújo Iohanna Melo de , Holanda Gabriela Cristina Siqueira de 
Published: July 2024

Introdução: Dermatoses vulvares compreendem uma variedade de condições cutâneas que afetam a vulva. Estas podem ser inflamatórias e não infecciosas, englobando diversas doenças como dermatite de contato, liquen escleroso, dentre outras. O entendimento dessas dermatoses é essencial devido à sua prevalência e complexidade clínica. O presente estudo objetiva uma revisão abrangente das dermatoses vulvares, explorando sua etiologia, manifestações clínicas, opções diagnósticas e terapêuticas disponíveis. Materiais, sujeitos e métodos: A metodologia adotada incluiu uma busca sistemática em bases de dados como PubMed, Scopus e Google Scholar, priorizando estudos publicados entres os anos de 2018 a 2023 relevantes para a temática. A análise crítica dos artigos selecionados considerou a qualidade metodológica e consistência dos resultados. Resultados e discussão: Identificou-se uma diversidade de dermatoses vulvares, desde dermatite de contato até candidíase vulvovaginal, cada uma apresentando características clínicas distintas que variam desde prurido e dor até alterações visíveis na pele. O diagnóstico diferencial é crucial para determinar a etiologia e orientar o tratamento adequado, que pode incluir medidas tópicas como corticosteroides e antifúngicos, bem como intervenções não farmacológicas como modificações nos hábitos de higiene e escolha de roupas íntimas apropriadas. Conclusão: Portanto, destaca-se a importância da familiaridade com as dermatoses vulvares na prática clínica e a necessidade de uma abordagem multidisciplinar para um manejo eficaz. O reconhecimento precoce dos sinais e sintomas, juntamente com uma avaliação minuciosa, são fundamentais para evitar atrasos no diagnóstico e tratamento. São necessárias mais pesquisas para aprimorar a compreensão fisiopatológica dessas condições e desenvolver estratégias terapêuticas mais eficazes.
Esclerose múltipla no Brasil: uma revisão sistemática dos anos de 2010-2023
Authors: Menezes Joaquim Paranhos Borges de , Peres Luis Felipe Araújo , Bernardes Ana Paula Lazarin , Mendes Isabela Simões , Peixoto Mariana Cunha 
Published: July 2024

Introdução: Esclerose Múltipla (EM) é uma doença do Sistema Nervoso Central, de caráter desmielinizante, que afeta de maneira auto-imune e inflamatória a bainha de mielina dos neurônios, a substância branca do sistema nervoso. Epidemiologicamente, há um predomínio de acometimento em jovens, entre 20 e 40 anos, com prevalência aumentada no sexo feminino. Objetivo: Este artigo tem por objetivo realizar uma revisão da literatura sobre uma doença com demasiado impacto na vida do paciente. Materiais/sujeitos e métodos: Para a escrita do artigo, foram realizadas pesquisas nas plataformas Scielo, Scholar Google e Pubmed, analisando a literatura científica dos anos de 2010 a 2023. Resultados e discussão: Uma doença que afeta uma parcela da população jovem, com importante impacto na vida dos pacientes, porém, apresentando avanços consideráveis tanto no diagnóstico, quanto no tratamento, mais eficazes e instituídos de forma mais precoce. Considerações finais: Existem espectros variados de acometimentos e, a depender da forma clínica que afetar o paciente, poderá haver maior ou menor comprometimento neurológico. Existem sinais e sintomas consideravelmente incapacitantes, que, com a instituição de terapias precoces, além da reabilitação eficaz, podem trazer melhor qualidade de vida ao paciente.