bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Study on Variations in Size and Shape of Left Atrial Appendage from Formalin-fixed Cadavers
Authors: Sapna C. S. , Vellani Haridasan 
Published: April 2024

Introduction:
Atrial appendages were once considered vestigial structures with no significant role in atrial function. However, they are now recognized as significantly impacting various pathophysiological conditions, including cardiac thromboembolism and arrhythmias. The left atrial appendage (LAA), in particular, has been found to have significant variations in shape and size, and its relationship with nearby structures, such as the pulmonary veins (PVs), is crucial in planning interventional and surgical procedures in and around the LAA. Although most studies examining variations in the LAA are image-based, few have focused on anatomical studies.

Materials and Methods:
In this study, we examined heart specimens from 54 cadavers for anatomical dissection at a tertiary care teaching hospital. After removing the heart from the pericardial cavity, we opened the left atrium and examined its interior. Observations were made regarding the LAA orifice and PV orifices, and measurements were taken. Subsequently, we removed the LAA along with a portion of the left atrial wall, observed its shape and number of lobes, and took measurements. To classify the shape, we used a system proposed by Wang et
al. based on resemblance to familiar objects. Categorical variables were expressed as percentages and continuous as mean and standard deviation. The institutional research committee and the institutional ethics committee approved the study.

Results:
The most common shape variant observed was the Chicken Wing type, followed closely by the Windsock type. Specimens with Cauliflower or Cactus morphology were rare, with the Cactus variant being the least common. The LAA orifice was round or oval shaped in most cases. In most cases, the LAA orifice was at the same or lower level as the left superior PV orifice, with a prominent ridge between the two orifices in most patients. We observed most of the appendages to be trilobed, with considerable variations in length and diameter. We found two specimens with unusual morphologies but no specimens with accessory appendages.

Conclusions:
Based on our study, there are significant differences in findings compared to some of the previous studies reporting the shape variations of LAA. However, our findings are matching with those of some other earlier studies. The variations in the shape and size of LAA orifices and their relationship to PV orifices are similar to those reported in earlier studies. The distribution of variations in the size of LAA was also similar to those reported in earlier studies. Conducting larger studies to explore these variations could aid in designing and developing therapeutic interventions in the LAA.
Expression and clinical significance of pattern recognition receptor-associated genes in hand, foot and mouth disease
Authors: Wang Muqi , Deng Huiling , Chen Yuan , Wang Yikai , Zhang Yufeng , Liu Chenrui , Zhang Meng , Li Ting , Dang Shuangsuo , Li Yaping 
Published: April 2024

Objective:
To explore which pattern recognition receptors (PRRs) play a key role in the development of hand, foot, and mouth disease (HFMD) by analyzing PRR-associated genes.

Methods:
We conducted a comparative analysis of PRR-associated gene expression in human peripheral blood mononuclear cells (PBMCs) infected with enterovirus 71 (EV-A71) which were derived from patients with HFMD of different severities and at different stages. A total of 30 PRR-associated genes were identified as significantly upregulated both over time and across different EV-A71 isolates. Subsequently, ELISA was employed to quantify the expression of the six most prominent genes among these 30 identified genes, specifically, BST2, IRF7, 1FI16, TRIM21, MX1, and DDX58.

Results:
Compared with those at the recovery stage, the expression levels of BST2 (P=0.027), IFI16 (P=0.016), MX1 (P=0.046) and DDX58 (P=0.008) in the acute stage of infection were significantly upregulated, while no significant difference in the expression levels of IRF7 (P=0.495) and TRIM21 (P=0.071) was found between different stages of the disease. The expression levels of BST2, IRF7, IFI16 and MX1 were significantly higher in children infected with single pathogen than those infected with mixed pathogens, and BST2, IRF7, IFI16 and MX1 expression levels were significantly lower in coxsackie B virus (COXB) positive patients than the negative patients. Expression levels of one or more of BST2, IRF7, IFI16, TRIM21, MX1 and DDX58 genes were correlated with PCT levels, various white blood cell counts, and serum antibody levels that reflect disease course of HFMD. Aspartate aminotransferase was correlated with BST2, MX1 and DDX58 expression levels.

Conclusions:
PRR-associated genes likely initiate the immune response in patients at the acute stage of HFMD.
A comparative study between magnesium sulfate and dexmedetomidine as adjuvants to bupivacaine using ultrasound-guided lumbar-plexus block in lower abdominal surgeries
Authors: AbdAlsalam Mahmoud A. , Mohamed Nayera A. 
Published: April 2024

Background and aim
Pain international association of described pain as an unpleasant sensory and emotional practice accompanied with actual or potential tissue injuries. Opioid administrations remain the cornerstone of postoperative pain relief, but it may cause significant side effects, including sedations, nausea, vomiting, and urinary retention. We aimed to compare the efficacy of ultrasound-guided lumbar-plexus block through adding magnesium sulfate and dexmedetomidine (DEX) to bupivacaine on postoperative analgesia and thereafter surgical operation.

Patients and methods
This prospective, randomized, double-blinded, controlled research was performed on Al-Azhar University Hospitals. A total of 75 cases of both sexes, age between 21 and 65 years, American Society of Anesthesiologists class I– II, were listed for elective lower-abdomen surgical operation underneath general anesthesia.

Results
Pain scores were decreased significantly in the study groups for 12 and 18 h in BM and BD, respectively, also, there was a significant decrease at 2, 4, 6, 8, and 12 h in the BD group lesser than the BM group postoperatively. The time to the initial analgesic appeal was significantly extended in the BD group (11.9±1 h) than the BM group (10.6±0.7 h).

Conclusion
Posterior lumbar-plexus block utilizing 22 ml of bupivacaine 0.5% with DEX 1 μg/kg decreases pain score, opioid consumption, prolongs duration of analgesia, better hemodynamics stability, and perfect outcome of cases’ satisfaction postoperatively compared with posterior lumbar-plexus block using 22 ml of bupivacaine 0.5% with magnesium sulfate 150 mg. DEX provides faster onset time and longer periods of MB and extended period of analgesia with smaller consumptions of postoperative rescue analgesia.
Audiovestibular performance in patients with low bone mineral density
Authors: Elwan Mohamed , Elmoursy Mohamed M. , Ibrahim Metwaly Ahmed M. , Ryan Mohamed M. 
Published: April 2024

Background and aim
Audiovestibular dysfunctions have been previously linked to osteoporosis (OP) with controversies about the mutual relationship. In this study, we aimed to assess the audiovestibular functions in patients with OP and osteopenia and to study their association with vitamin D deficiency.

Patients and methods
Of 60 patients enrolled in this study, 30 had low bone mineral density (BMD) (group I) and 30 had normal BMD (group II). After clinical examination and evaluation of serum vitamin D and calcium levels, the participants then were referred for audiovestibular assessments, which included basic audiological evaluation by pure tone audiometry and speech audiometry, tympanometry, acoustic reflex, video-nystagmoscopy tests, and vestibular-evoked myogenic potential (VEMP) to assess saccular function. Both participants and audiologist were blinded regarding the BMD results.

Results
There was a significant difference between patients and controls regarding the level of calcium (P=0.002) and vitamin D (P=0.001). There was a significant difference in the normal hearing threshold between both groups (P=0.005). There was no significant difference in VEMP testing (VEMP P1; P=0.489, amplitude; P=0.898). Benign paroxysmal positional vertigo was the most common finding in group I, among the females, where they had vitamin D deficiency (16.67±4.16) and OP (mean T score=−2.73±0.06).

Conclusions
Patients with low BMD showed a greater degree of audiovestibular dysfunction, which should be considered among the associating risk factors and comorbidities. Assessment of the audiovestibular functions should be recommended for patients with low BMD in the management guidelines.
Evaluation of serum presepsin concentrations as a biomarker of sepsis in high-risk neonates
Authors: El-Masry Hosny M.A. , Hassan Alaa-Eldin A. , Amin Hesham H. , Abd Elmoaty Mohamed A. 
Published: April 2024

Background
Sepsis is a common cause of morbidity and mortality among neonates. The clinical usefulness of assessment of presepsin concentration was studied and compared with other laboratory parameters in a prospective case–control study.

Patients and methods
A prospective case–control study was carried out in the neonatal intensive care unit of Al-Azhar University Hospital (Assiut, Egypt) from July 2016 to July 2018. The authors enrolled 80 newborns: 40 at high risk of neonatal sepsis (group A), 20 septic (group B) according to Tollner clinical sepsis score greater than 2 and/or positive blood culture, and 20 controls (group C). Full medical history, clinical examination, estimation of gestational age by new Ballard score, and laboratory investigations were done. Presepsin, C-reactive protein (CRP), complete blood count, and blood culture were done during first day (D1) of admission for all neonates. Additional measurements of presepsin and CRP were done at D3 for group A, and another measurement at D5 for neonates who have increased CRP and/or appearance of signs of sepsis (group A) at D3.

Result
Initial levels of serum presepsin in 80 neonates ranged from 293 to 1648 pg/ml. Presepsin had a significant difference between groups A and B (692.9±79.49 and 1327.3±208.41 pg/ml, respectively; P<0.001***). In group A, neonates who developed clinical signs of sepsis, presepsin levels had significant difference between D1, D3, and D5 (P<0.001***). Presepsin had a significant difference between full-term and preterm neonates (P<0.001***). There was a positive correlation of presepsin with CRP and white blood cells (r=0.580 and 0.546, respectively). Coagulase-negative staphylococci were the most isolated organism. The receiver operating characteristic curve of presepsin at enrollment shows an area under the curve of 0.99. The best calculated cutoff value was greater than or equal to 722 pg/ml, with 100% sensitivity and 97.5% specificity.

Conclusion
Presepsin level changes early in the disease course, so it can be used as a reliable biomarker for early diagnosis of neonatal sepsis, and it is a promising marker for detection of improvement.
Assessment of thyroid function in patients with chronic hepatitis C virus infection before and after treatment with oral direct-antiviral drugs
Authors: Abdelrazik Fathy Ghamry , Hussein Mohammed Salah Ali , Shady Zakarya Mohammed Zakarya , Khorshid Mohammed Assem , Elsherif Abdelhalim A. , Al Dahshan Tarek Abd El-Kareem 
Published: April 2024

Background
There are laboratory and clinical associations between liver and thyroid diseases. Hepatitis C virus is known to be responsible for both hepatic and extrahepatic diseases. Direct-acting antivirals (DAAs) provide high sustained viral response rates and much reduced adverse effects and impaired health-related quality of life during treatment.

Aim
To assess thyroid function in patients with chronic hepatitis C (CHC) receiving DAAs before start treatment and after achieving of SVR.

Patients and methods
A prospective study was conducted on 300 patients with CHC infection who were recruited for the study after obtaining written informed consent. Full history was taken, as well as routine examination and special investigations were done for all patients before the start of the remedy and by the end of treatment with DAAs.

Results
PCR results revealed a statistically significant difference, as SVR was evident in 98% of patients. Analysis of thyroid function assessments in the present study showed that 277 (92.3%) patients were euthyroid and 23 (7.7%) patients had thyroid disorders, comprising seven (2.3%) patients with subclinical hypothyroidism, 14 (4.66%) patients with overt hypothyroidism, and two (0.7%) patients with subclinical hyperthyroidism.

Conclusion
Thyroid function in patients with CHC infections was not damaged with treatment with DAAs for hepatitis C virus treatment. Hypothyroidism is prevalent in patients with CHC, and after treatment with DAAs, thyroid dysfunction slightly improved, especially subclinical, after achievement of SVR.
Comparative study between intramyometrial oxytocin and oxytocin analogue (carbetocin) in prevention of postpartum hemorrhage following cesarean section
Authors: Kassab Farid A. , Sedek Abd E.A. 
Published: April 2024

Background and aim
This is a prospective randomized single-center study aimed to assess the efficacy of carbetocin versus intramyometrial oxytocin in the prevention of atonic postpartum hemorrhage following Cesarean section in high-risk women.

Patients and methods
A total of 160 women with gestational age more than 38 weeks at high risk for primary atonic postpartum hemorrhage undergoing elective or urgent cesarean section under regional or general anesthesia were randomly divided into two equal groups: group A included 80 patients, and they received oxytocin 20 IU intramyometrially. Group B included 80 patients, and they received carbetocin, 100 μg intravenously.

Results
There was no significant difference in the mean values of hematocrit before and 24 h after delivery (P>0.05). Similarly, there was no significant difference in the estimated blood loss calculated by hematocrit values (P>0.05). Moreover, it was shown that 17.5% of women in the carbetocin group needed additional uterotonics versus 25% of women in the oxytocin group. Therefore, there was no significant difference between both groups regarding needing additional uterotonics. There were eight cases that needed more surgical intervention.

Conclusion
Both drugs are equally effective in prevention of atonic postpartum hemorrhage. There is no significant difference between single injection of carbetocin and intramyometrial 20 IU oxytocin in reducing the use of additional oxytocic agents.
Human epidermal growth factor receptor 2 neu and E-cadherin expression in primary astrocytic brain tumors as prognostic biomarkers
Authors: Ali Mohamed Y. , El Kholy Marwa A. 
Published: April 2024

Background
The primary brain tumors including astrocytic tumors, ranging from circumscribed into diffuse and glioblastoma (GBM), which is considered as a highly malignant neoplasm of the central nervous system. They share common molecular and biological abnormalities. This study was aiming to illustrate the role of c-erbB-2 protein [human epidermal growth factor receptor 2 (HER2 neu)] and E-cadherin expression in varied groups of astrocytic tumors.

Patients and methods
The material of this work consisted of 50 cases with histopathological diagnosis of astrocytoma and GBM. The patients were classified histopathologically into four grades based on the WHO 2007 criteria: pilocytic astrocytoma (G1), diffuse astrocytoma (G2), anaplastic astrocytoma (G3), and GBMs (G4). C-erbB-2 protein and E-cadherin expressions were estimated semiquantitatively on immunohistochemically tissue sections stained with antibodies against c-erbB-2 protein and E-cadherin.

Results
Checking HER2 scores, 29 (58%) cases were HER2 neu positive. Comparing the percentage of all cases of astrocytic tumors, it was found that the most obvious positive staining was observed predominantly in anaplastic astrocytoma and GBM cases. Regarding E-cadherin, 19/50 (38%) cases were E-cadherin positive with variable expressions moderate to strong immunostaining, but was typically higher in low-grade astrocytoma than in higher grades.

Conclusions
Taken together from our and other data, HER2 overexpression may be considered a poor prognostic marker in patients with astrocytic tumors of the brain especially GBM and cadherin cell–cell contacts in astrocytoma cells may decrease its invasion, and they could become a new potential therapeutic strategy for astrocytoma's treatment.
Comparison between video head impulse and videonystagmography in patients with vertiginous migraine
Authors: Mohamed Waleed M.N. , Elzaree Gehan A. , Hassan Mahmoud M. , Mohamed Ahmed M. 
Published: April 2024

Background and aim
In addition to the classic migraine symptoms of vertigo, dizziness, and imbalance, vestibular migraine causes vertigo, dizziness, and imbalance. The video head impulse test (VHIT) is a novel approach for determining the function of each semicircular canal. Although videonystagmography (VNG) is an effective tool for identifying peripheral vertigo, not all patients with central vertigo can be easily detected. The goal of this research is to confirm the findings of the functional outcome of VHIT versus VNG in patients with vertiginous migraine.

Patients and methods
We selected 40 patients (both sexes) with vestibular migraine and 25 normal individuals as control. Both groups were subjected to complete clinical examination after thorough history taking, laboratory investigations, VHIT, and VNG.

Results
VNG had excellent predictive value in the patients’ group (95% confidence interval=0.891–0.998, P=0.0001) with a 96.6% sensitivity and 86.2% specificity, while VHIT had poor predictive value with a sensitivity of 100% and specificity of 48.1% (95% confidence interval=0.523–0.779, P=0.099).

Conclusion
VNG has a specificity and sensitivity for the prognosis of vestibular migraine that is virtually identical to VHIT.
Serum miR-155, miR-21, and CA 15.3 for diagnosis and monitoring therapy of breast cancer in females
Authors: El Khateeb Khalid O. , Abonar Abdelraouf A. , Ibrahim Mosaad M. , Shalamesh Mohamed I. 
Published: April 2024

Background and Aim
Carbohydrate antigen 15.3 (CA 15.3) is the most frequently used tumor marker in breast cancer (BC). MicroRNAs (miRs) can be used to screen, diagnose, evaluate, and follow-up on some cancers. Our research aimed to explore the value of circulating miR-155 and miR-21 for diagnosis and monitoring therapy of BC compared with CA 15.3.

Patients and Methods
Our study included four groups: 25 women who were completely healthy, 20 women suffering from benign breast diseases, 20 patients suffering from BC after complete therapy, and 25 patients with BC before undergoing any therapy. CA 15.3, MiR-155, and miR-21 were measured for all participants.

Results
MiR-155, miR-21, and CA 15.3 levels in the four groups showed significant differences. MiR-21 is the most sensitive, followed by miR-155 and CA 15.3.

Conclusion
Serum miR-155 and Serum miR-21 could be useful tests like CA 15.3 for differentiation between women suffering from BC, women suffering from benign breast diseases, and completely healthy women.
Vitamin D assessment in patients with benign paroxysmal positional vertigo
Authors: Kasem Mohamed M. Elmoursy 
Published: April 2024

Background
Benign paroxysmal positional vertigo (BPPV) is the most common type of peripheral vestibular disorder. Several studies have correlated between vitamin D deficiency and the development of BPPV.

Objectives
The aim of the study was to measure the serum levels of vitamin D and serum calcium in patients with BPPV and if vitamin D deficiencies have a role in the development of BPPV.

Patients and methods
The study included 50 patients with first attack of BPPV based on characteristic nystagmus on Dix-Hallpike's and Supine-Roll's tests, where serum levels of 25-hydroxyvitamin D and calcium, including both total and ionized forms, were measured and compared with control group of 25 apparently healthy individual.

Results
The mean vitamin D level in patients with BPPV and control groups was 22.80±11.26 and 29.30±10.62 ng/ml, respectively. There was a statistically significant difference regarding vitamin D levels in BPPV group in comparison with the control group (P=0.019). Moreover, there was a statistically significant difference regarding vitamin D deficiency in patients with BPPV in comparison with the control group (P=0.046).

Conclusion
Vitamin D deficiency contributes to the development of BPPV through abnormal calcium metabolism in the inner ear.
Extended pterional approach with orbital flattening for suprasellar and parasellar lesions
Authors: Al-Shyal Gasser H.R. 
Published: April 2024

Background and aim
The aim of this study was to investigate the advantages of the extended pterional approach and compare it with more invasive and less-invasive similar approaches.

Patients and method
s This study is an observational retrospective case-series study and descriptive statistics was used. Twelve patients with suprasellar and parasellar lesions were managed in the period between January 2016 and January 2019. Preoperative and postoperative clinical and radiological assessment were done for each patient.

Results
Twelve cases were done via this approach. There were nine females and three males. Age ranges from 2 to 55 years with a mean of 31.7 years. Regarding pathology, eight (67%) cases were meningiomas, three (25%) cases were craniopharyngiomas, while one (8.3%) case was pituitary adenoma. Most of the cases (91.7%) were presented with visual affection. The lesion was excised totally (gross total resection) in seven (58.3%) out of the 12 cases. Visual affection improved in seven (63.6%) out of 11 cases. Regarding complications, one case experienced permanent hemiparesis. One patient had deep-vein thrombosis that had been treated. One case had seizures. Approach-related complications: two cases had periorbital edema that disappeared within 1 week. One case had a rim of subdural hematoma. Frontalis nerve injury occurred in two cases, one of them improved within 6 months. We do not have a permanent cosmetic deformity with this approach.

Conclusion
The extended pterional approach has less functional and cosmetic complications and it can be done in lesser time than frontotemporal–orbitozygomatic approach. The exposure is much larger than conventional pterional approach.
Effect of corticosteroid therapy in patients with an acute exacerbation of chronic obstructive pulmonary disease receiving ventilatory support
Authors: Abdalah Hamdy Miligi , Sayed Wageeh Hassan , El-Monim Essam Abd 
Published: April 2024

Background
Chronic obstructive pulmonary disease (COPD) is a common, preventable, and treatable disease characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities, usually caused by significant exposure to noxious particles or gases. The chronic airflow limitation that characterizes COPD is caused by a mixture of small airway disease (e.g. obstructive bronchiolitis) and parenchymal destruction (emphysema), the relative contributions of which vary from person to person.

Aim
The aim of the study was to determine the effect of systemic corticosteroids in patients with severe acute exacerbations of COPD admitted to the ICU receiving ventilatory support.

Patients and methods
A total of 100 patients with acute exacerbations of COPD leading to hypoxemia and respiratory acidosis with pH less than 7.35 and PaCO2 more than 45 mmHg admitted to the ICU who were receiving ventilator support (invasive or noninvasive mechanical ventilation) were included.

Results
It was noticed that steroid group had significantly lower duration of mechanical ventilation (4.67±2.76 vs. 2.76±1.11 days; P=0.01), ICU stay (5.33±2.87 vs. 7.89±3.36 days; P=0.04), and hospital stay (11.65±3.89 vs. 16.67±4.44 days; P=0.03).

Conclusion
Corticosteroid therapy was associated with significantly lower duration of mechanical ventilation, ICU stay, and hospital stay.