bluuebunny/crossref_metadata_2025_split huggingface dataset:
Analysis of Residency Experience in Transfemoral Prosthetics
Authors: Hull Denise , Kenworthy Sally , Mullen Ashley 
Published: February 2025

Abstract

Introduction
As part of the requirements for certification in orthotics and prosthetics, a clinical residency must be completed. Currently, there has been minimal analysis of residency data that could demonstrate a presence or lack of consistency between each resident’s experiences. Analysis of data and the standardization of the residency experience may offer a pathway toward consistency in entry-level practice. Transfemoral prosthetic competency is one of the most difficult to achieve.

Objective
The objective of this study was to quantify the experience of residents with respect to transfemoral patient care.

Study Design
This study is a retrospective data analysis.

Methods
Data were collected from National Commission on Orthotics and Prosthetics Education (NCOPE) Tracker for residents who completed an integrated residency from the years 2018–2021. Patient appointment date, appointment type, patient age (years), gender (male/female), diagnosis (ICD-10 code with descriptor), device type, and resident engagement level (observer, assistant, independent) were analyzed to determine trends and variation.

Results
Residents saw a median of 112 (interquartile range [IQR] = 61) transfemoral patient encounters with a median of 17.8% (IQR = 17.2) logged as independent encounters. Results were similar across three cohorts of residents.

Conclusions
This study provides a baseline for developing transfemoral prosthetic competency during an integrated, combined O&P residency. Just under one tenth of cases logged involved transfemoral care. The majority of those cases were logged at the level of assistance, and the timing of transfemoral competency attainment did not affect subsequent case volume or resident engagement level. Comparison with the ABC Practice Analysis indicated potential differences in appointment types experienced during residency as compared with clinical practice. Further analysis is required to evaluate other residency models and other factors, which affect the attainment of clinical competence and development of skill in transfemoral prosthetic care.

Clinical Relevance
Documentation and comparison of the residency experience may offer a pathway toward developing consistency in residency training and continuation into entry-level practice.
Perceptions of the challenges facing nurse practitioners in providing care to children
Authors: Bowman Ashleigh F. , Gigli Kristin Hittle 
Published: February 2025

ABSTRACT

Background:
Pediatric nurse practitioners (NPs) play an essential role in achieving optimal child health. However, few studies have examined barriers to implementing pediatric NP roles.

Purpose:
The purpose of this study was to identify challenges in pediatric NPs' practice that limit their ability to provide care.

Methodology:
The authors conducted a secondary, qualitative analysis of survey data collected by the National Association of Pediatric Nurse Practitioners. The authors analyzed data from one open-ended question, “What is the biggest challenge to the pediatric-focused NP role?” An inductive thematic analysis resulted in discovery of 18 themes.

Results:
A total of 980 pediatric NPs responded, most (67.9%) were primary care pediatric NPs, and 15.2% were acute care pediatric NPs. Challenges aligned with four megathemes: who we are, what we can do, what we need, and what our patients need.

Conclusions:
Pediatric NPs identified barriers to role recognition that align with improving professional identity.

Implications:
Future research should address barriers to role recognition that can increase the ability of pediatric NPs to provide child health care.
The impact of the Naples prognostic score in long-term outcomes after percutaneous coronary intervention for chronic total occlusions
Authors: Dündar Cihan , Tanalp Ali Cevat , Yağmur Aysel , Karaaslan Muhammet Buğra 
Published: February 2025

Background
Chronic total occlusions (CTOs) of coronary arteries present a significant challenge in cardiology, with long-term outcomes following percutaneous coronary intervention (PCI) for CTOs remaining variable and unpredictable. The Naples prognostic score (NPS), which incorporates markers of nutritional status and systemic inflammation, has shown potential in predicting outcomes in various cardiovascular settings. This study evaluates the NPS as a predictor of long-term outcomes after PCI for CTOs.

Methods
A retrospective analysis was conducted on 287 patients who underwent coronary angiography. Patients were categorized into non-CTO-PCI and CTO-PCI groups. Patients were further stratified based on survival status. Cox regression and Kaplan–Meier survival analyses were used to evaluate the association between NPS and long-term outcomes.

Results
The mean age of the study population was 63.5 ± 10.6 years, with 28.6% being female. The NPS was significantly higher in the CTO-PCI group compared to the non-CTO-PCI group (P = 0.004) and was also elevated in the non-survival group (P = 0.004). Multivariable Cox regression analysis identified NPS as an independent predictor of mortality (P = 0.015). Kaplan–Meier analysis demonstrated significantly higher mortality in patients with an elevated NPS (P = 0.009).

Conclusion
The NPS is a valuable independent predictor of long-term mortality in patients undergoing CTO-PCI. Incorporating NPS into existing risk stratification models could improve predictive accuracy and guide individualized patient management. Further prospective studies are warranted to validate these findings and explore interventions targeting inflammation and nutrition in this high-risk population.
A Kikuchi-fujimoto Syndrome in the Pocket of a Non-hodking Lymphoma: Case Report With a Mini-review of the Literature
Authors: Bouchlarhem Saad , Amine Sbai Achraf , Drissia Benfadil , Azeddine Lachkar , Fahd El Ayoubi El Idrissi 
Published: February 2025

Introduction:
Kikuchi-Fujimoto disease is a rare, benign necrotizing lymphadenitis primarily affecting young women.

Case presentation:
We present the case of a 26-year-old female patient with no notable medical history, who developed a persistent right-sided lateral cervical lymphadenopathy over a two-month period. Following a comprehensive clinical, laboratory, radiological, and histopathological evaluation, a diagnosis of Kikuchi-Fujimoto disease was confirmed. Given the rarity of this condition, clinicians should maintain a high index of suspicion to avoid misdiagnosis or delayed recognition.

Clinical discussion:
Kikuchi-Fujimoto disease is a rare, It presents as febrile cervical lymphadenopathy and may be associated with systemic lupus erythematosus. Often mistaken for conditions such as non-Hodgkin lymphoma, its diagnosis relies on histopathological examination. Lymph node biopsy is crucial to prevent unnecessary investigations. The prognosis is generally favorable, with treatment commonly involving corticosteroids.

Conclusion:
While the prognosis for KFD is generally favorable, around 30% of sufferers may go on to develop systemic lupus erythematosus, underlining the need for ongoing monitoring of autoimmune markers
Ultrasound-guided bilateral Erector Spinae Plane Block (ESPB) for postoperative analgesia in laparoscopic cholecystectomy: a randomized controlled trial
Authors: Mandal Arun Kumar , Shrestha Bibek , Yadav Krishna Kumar , Dahal Suman , Yadav Pratibha , Yadav Prashant , Deo Sulav 
Published: February 2025

Background
Laparoscopic cholecystectomy is a commonly performed procedure with significant postoperative pain, leading to potential complications such as delayed recovery and opioid-related side effects. Regional anesthesia, particularly the Erector Spinae Plane Block (ESPB), has shown promise in improving postoperative analgesia. This study investigates the effectiveness of ultrasound-guided bilateral ESPB for pain management in LC, compared to standard multimodal analgesia.

Materials and methods
This double-blind randomized controlled trial included 48 patients undergoing LC at a tertiary hospital between June 2022 and June 2023. Patients were randomly assigned to two groups: 24 received ultrasound-guided bilateral ESPB with 0.25% ropivacaine, and 24 received standard multimodal analgesia. Statistical analysis was conducted using t-tests, ANOVA, and chi-square tests, with a p-value of less than 0.05 considered significant.

Results
The ESPB group experienced significantly prolonged analgesia, with a mean time to rescue analgesia of 11.2 hours compared to 0.5 hours in the control group (p < 0.001). Pain scores were consistently lower in the ESPB group for the first 6 hours postoperatively. Additionally, total tramadol consumption in the ESPB group was significantly reduced (172.92 mg vs. 245.83 mg, p < 0.001). Patient satisfaction was higher in the ESPB group.

Conclusion
Ultrasound-guided bilateral ESPB significantly enhances postoperative pain management in Laparoscopic Cholecystectomy, reducing both pain intensity and opioid consumption. It represents a safer alternative to opioid-based analgesia, improving recovery and patient outcomes.
Perioperative Management of a Pregnant Patient With a Mechanical Heart Valve Undergoing Appendectomy: a Case Report
Authors: Hassan Ibrahim Nagmeldin , Yaqub Siddig , Ibrahim Mohamed 
Published: February 2025

Introduction and importance:
Managing pregnant patients with mechanical heart valves who require non-cardiac surgery presents unique challenges, particularly in balancing anticoagulation to prevent thromboembolic complications while minimizing bleeding risks. This case report discusses the perioperative management of a pregnant patient with a mechanical mitral valve undergoing emergency appendectomy.

Case presentation:
A 28-year-old pregnant woman at 22 weeks gestation with a history of rheumatic heart disease and a mechanical mitral valve presented with acute appendicitis. Anticoagulation therapy was shifted from warfarin to low-molecular-weight heparin (LMWH) to mitigate the risks of bleeding and teratogenicity. Intravenous unfractionated heparin (UFH) was used perioperatively to maintain adequate anticoagulation. A multidisciplinary team guided the patient’s care, and she underwent a successful laparoscopic appendectomy with stable maternal and fetal outcomes.

Clinical discussion:
Perioperative anticoagulation in pregnant women with mechanical heart valves is critical to avoiding valve thrombosis while minimizing the risk of bleeding. In this case, using LMWH as a bridging therapy and UFH during surgery proved effective in balancing these risks. The case underscores the importance of a coordinated multidisciplinary approach to optimize maternal and fetal outcomes during emergency surgery.

Conclusion:
This case highlights the complexities of managing anticoagulation in pregnant patients with mechanical valves requiring non-cardiac surgery. With appropriate anticoagulation adjustment, multidisciplinary planning, and vigilant perioperative monitoring, both maternal and fetal outcomes can be favorable in such high-risk situations.
Incidence and risk factors of ocular complications among patients with homocystinuria in Saudi Arabia: a cross-sectional study
Authors: Alzwaihri Abubakr Salem , Almasoudi EidAyed , Hadrawi Manal Taha , Danish Enam Y , Alasmari Faisal Fahad , Ahmed Hassan Arafah 
Published: February 2025

Background:
Cysteine beta-synthase deficiency, often known as classic homocystinuria, is an uncommon inborn mistake in methionine metabolism. Developmental delay, intellectual incapacity, skeletal and vascular symptoms, and ocular abnormalities are possible main clinical characteristics.

Objective:
This study sought to describe the ocular anomalies that King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia, homocystinuria patients presented with between 2018 and 2022.

Methods:
This retrospective research included 6 homocystinuria patients. Demographic and clinical characteristics of patients as age, gender, comorbidities were collected. Relevant clinical and ophthalmic assessments, like visual acuity, fundus examination findings, complications and type of surgery were also reported.

Results:
Six patients with homocystinuria (12 eyes) were included. Associated diseases were mostly mental retardation (100%), epilepsy (66.7%), developmental delay (50.0%), scoliosis (33.3%), bronchiectasis (16.7%), thrombophilia (16.7%), metabolic disorders (16.7%) and deep venous thrombosis (16.7%). All patients had ectopia lentis (100%), while one patient (16.7%) had eye ectropion, one patient (16.7%) had anterior uveitis and one patient (16.7%) had scleromalacia. Surgery type was mostly Lensectomy and vitrectomy (83.3%) then scleral fixation (16.7%), and Grice green procedure (16.7%). There were insignificant differences between first and last Autoref readings in spherical, cylinder and axis errors of right and left eyes

Conclusions:
Late-diagnosed homocystinuria patients frequently have abnormalities of the eyes. Ectopia lentis should always raise the possibility that homocystinuria is the cause of the condition.
Spectrum of Parathyroid Disorders in Pakistan: a Review Article
Authors: Wasim Umaima , Waseem Maria , Kumari Usha , Kumari Varsha , Sahito Abdul Moiz , Shanzay Zahid , Afzal Ifrah , Shaikh Somina , Alam Shaheer , Kumar Danish , Khan Aarash 
Published: February 2025

Parathyroid abnormalities and gland diseases are classified as hyperparathyroidism and hypoparathyroidism. These conditions are often discovered incidentally during screenings for abnormal serum calcium levels, typically conducted for renal or bone diseases and other disorders. Parathyroid hormone (PTH) plays a crucial biological role in maintaining ionized calcium and phosphate levels within the normal range by activating specific receptor-mediated cell responses throughout the body.
Compared to the Western world, Pakistan has significantly fewer publications on parathyroid diseases. Most available research comprises case reports, small case series, or retrospective studies, often including approximately 100 studies. In this article, we describe the demographics and varied clinical presentations of parathyroid gland disorders in the Pakistani population. Additionally, we provide a summary of biochemical parameters and localization strategies used in these cases. A compiled record of parathyroid gland disorders in Pakistan is currently lacking, and this article aims to bridge that gap by presenting a comprehensive review of all reported cases.

This review includes a summary of 54 studies, comprising retrospective studies and case reports, highlighting the clinical variability of parathyroid (PTH) disorders in Pakistan. According to the literature, 0.5% of patients were asymptomatic, while the mean duration of symptoms among symptomatic patients was 3.03 years. Unlike Western populations, laboratory findings from Pakistani patients show elevated levels of serum calcium, serum parathyroid hormone, and serum alkaline phosphate. Common clinical features included abdominal pain, dysphagia, and vitamin D deficiency, along with constitutional symptoms such as arthralgias, myalgias, fatigue, and headache. Psychiatric complications, particularly clinical depression, and pathological fractures emerged as the most frequent complications associated with PTH disorders in Pakistan.
Evaluating subclinical atherosclerosis, arterial stiffness, and lipid profile in patients with anti neutrophilic cytoplasmic antibodies associated vasculitis: a systematic review and meta-analysis
Authors: Yadav Rukesh , Mishra Ashish , Mandal Prince , Karki Susmin , Pokhrel Saurav , Neupane Narayan Prasad 
Published: February 2025

Abstract
Cardiovascular diseases (CVD) account for a significant portion of deaths in anti- neutrophilic cytoplasmic antibodies associated vasculitis (AAV). Previous studies have shown the presence of accelerated subclinical atherosclerosis and arterial stiffness in AAV patients that is not solely explained by conventional cardiovascular risk factors. Moreover, lipid profile may be deranged in such patients. The evidence of subclinical atherosclerosis, arterial stiffness, and lipid profile have not been analyzed in AAV patients.

Methods:
PubMed, Google Scholar and Embase databases were searched from inception till January 2024 for studies that measured parameters of arterial structure and function ((carotid intimal media thickness (CIMT), flow mediated dilation (FMD), pulse wave velocity (PWV)) and lipid profile of adult patients with AAV and matched healthy controls. Outcomes included standardized mean difference (SMD) with 95% confidence interval (CI) of CIMT, FMD, PWV and lipid profile between AAV patients and healthy controls. The analysis was done via Revman 5.1.

Results:
Ten studies comprising 360 AAV patients and 487 healthy controls were included in this analysis. CIMT value was significantly higher in AAV patients as compared to healthy controls [SMD = 0.34, CI = 0.09-0.59, P = 0.008, I2 = 56%]. Moreover, PWV was significantly higher in AAV patients [SMD = 0.53, CI = 0.26-0.79, P <0.001, I2 = 0%] as compared to healthy controls. The lipid profile was not significantly different among the AAV patients and the healthy controls except the total triglycerides level.

Conclusion:
This review validates the occurrence of subclinical atherosclerosis and arterial stiffness in AAV patients. Regular assessment using surrogate markers is warranted with aim to reduce CVD in such patients.
Cerebral venous sinus thrombosis in a postpartum woman: a case report on early diagnosis and management
Authors: Ali Masab , Ahmad Muhammad Husnain , Babar Ilsa , Javeriya Sana , Ochani Teesha , Katyara Sakshi , Hassan Muhammad , Saeed Humza 
Published: February 2025

Introduction and importance
Cerebral venous sinus thrombosis (CVST) is a rare but serious condition that can cause permanent neurological impairments if not promptly diagnosed and treated. Its nonspecific presentation, such as headache and altered awareness, often delays diagnosis. Postpartum women are at heightened risk for CVST, necessitating vigilance.

Case presentation
We describe a 25-year-old woman diagnosed with CVST two weeks postpartum. She presented with fever, severe headache, impaired vision, expressive dysphasia, and disturbed mental status. Magnetic resonance imaging and magnetic resonance venography confirmed multiple thrombosed cerebral sinuses. The patient was treated with low-molecular-weight heparin (LMWH), followed by rivaroxaban, and demonstrated significant clinical improvement. She was subsequently discharged on oral anticoagulation therapy.

Clinical discussion
This case emphasizes the significance of maintaining a high level of suspicion for CVST in postpartum women who exhibit neurological symptoms. Early detection and intervention are essential to stop the disease’s course and reduce its long-term effects. The use of anticoagulation medication, commencing with LMWH followed by oral anticoagulants like Rivaroxaban, was beneficial in this patient, illustrating the typical approach to CVST management.

Conclusion
CVST in postpartum women requires prompt diagnosis and anticoagulation therapy to prevent severe complications. High clinical suspicion and early intervention can mitigate long-term neurological sequelae. Further research is needed to explore intensive treatment strategies for high-risk populations.
Mavorixafor; CXCR4 antagonist a novel treatment for whim syndrome, first FDA approval 2024 (Editorial)
Authors: Waheed Aiman , Gul Muhammad Hamza , Ilmaguook Badr , Wardak Abdul Baseer , Ahmad Sadeed , Hussaini Helai , Ahmad Sarah 
Published: February 2025

WHIM syndrome is a rare autosomal dominant disorder characterized by gain-of-function mutations in the Chemokine receptor type-4 (CXCR4 receptor). The acronym WHIM stands for Warts, Hypogammaglobulinemia, recurrent bacterial Infections, and Myelokathexis. Traditionally, WHIM syndrome has been managed with intravenous immunoglobulin (IVIG) and filgrastim (Granulocyte Colony-Stimulating Factor, G-CSF). IVIG is used to provide passive immunity to counteract hypogammaglobulinemia, while filgrastim stimulates the production and release of neutrophils from the bone marrow to address neutropenia. However, these treatments have limited efficacy, require frequent administration, and involve significant costs and patient burden. The recent Food and Drug Administration (FDA) approval of Mavorixafor, a small molecule CXCR4 antagonist, marks a significant advancement in the management of WHIM syndrome. Mavorixafor enhances white blood cell mobilization from the bone marrow, directly targeting the underlying cause of the disease. In a pivotal Phase-3 trial conducted by Badalato R et al. (2024), involving 30 participants randomized to receive Mavorixafor 400 mg daily or placebo for 52 weeks, Mavorixafor demonstrated a statistically significant increase in absolute neutrophil count (ANC) (p<0.01) and a notable reduction in annual infection frequency compared to placebo. Additionally, a Phase-2 study reported a 75% reduction in cutaneous warts and an annual infection rate of 2.27 occurrences with adequate dosing. Mavorixafor maintained a favorable safety profile and required fewer administration complexities than IVIG and filgrastim, with 78% of patients achieving an overall response compared to 10% in the placebo group. These findings underscore the potential of Mavorixafor to significantly improve clinical outcomes for patients with WHIM syndrome, offering a more effective and targeted treatment option. The approval of Mavorixafor not only enhances current therapeutic strategies but also paves the way for future research into CXCR4 antagonists, potentially revolutionizing the management of WHIM syndrome and similar immunodeficiencies.
Moral competence and conflict management styles in emergency nurses: a cross-sectional study
Authors: Amirkhanlou Zeinab , Esmaeili Ravanbakhsh , Zeydi AmirEmami , Khademlu Mohammad , Ghorbani Vajargah Pooyan , Karkhah Samad , Jafari Hedayat 
Published: February 2025

Background:
This study aimed to evaluate the moral competence and conflict management styles in emergency nurses

Materials and methods:
This cross-sectional study was conducted among emergency department nurses. Convenience sampling was employed. The data collection tools comprised a demographic-occupational questionnaire, a questionnaire assessing the moral competence of clinical nurses, and another questionnaire focused on exploring conflict management styles.

Results:
190 emergency department nurses were involved in this study. The study revealed that emergency department nurses’ average moral competence score was 159.81 (SD = 13.00), ranging from 121 to 184 points. Among emergency department nurses, the average score for conflict management styles stood at 105.61 (SD = 10.67), ranging from 41 to 132 points. The study findings revealed statistically significant associations between several factors and nurses’ overall moral competence score; age group (P = 0.004) and type of employment (P = 0.035) showed substantial relationships. Significant associations emerged between the overall conflict management score, job position (P = 0.021), and age group (P = 0.044).

Conclusion:
Emergency nurses demonstrated a commendable average score in moral competence and predominantly utilized conflict management styles over participation styles when handling conflicts. A robust and direct correlation between ethical competence and conflict management was also observed.