bluuebunny/crossref_metadata_2025_split huggingface dataset:
Seasonal variation in ambulatory blood pressure control in patients on clinic blood pressure-guided antihypertensive treatment
Authors: Ye Xiao-Fei , Wang Wen-Yuan-Yue , Wang Xin-Yu , Huang Qi-Fang , Sheng Chang-Sheng , Li Yan , Wang Ji-Guang 
Published: January 2024

Background:
We investigated seasonal variation in ambulatory blood pressure control in hypertensive patients on clinic blood pressure-guided antihypertensive treatment.

Methods:
The study participants were hypertensive patients enrolled in an 8-week therapeutic study. Antihypertensive treatment was initiated with long-acting dihydropyridine calcium channel blockers amlodipine 5 mg/day or the gastrointestinal therapeutic system (GITS) formulation of nifedipine 30 mg/day, with the possible up-titration to amlodipine 10 mg/day or nifedipine-GITS 60 mg/day at 4 weeks of follow-up.

Results:
The proportion of up-titration to higher dosages of antihypertensive drugs at 4 weeks of follow-up was higher in patients who commenced treatment in autumn/winter (n = 302) than those who commenced treatment in spring/summer (n = 199, 24.5 vs. 12.0%, P < 0.001). The control rate of clinic blood pressure, however, was lower in autumn/winter than in spring/summer at 4 (56.7 vs. 70.7%, P = 0.003) and 8 weeks of follow-up (52.5 vs. 74.9%, P < 0.001). At 8 weeks, patients who commenced treatment in autumn/winter, compared with those who commenced treatment in spring/summer, had a significantly (P≤0.03) smaller daytime (mean between-season difference -3.2/-2.8 mmHg) but greater nighttime SBP/DBP reduction (3.6/1.6 mmHg). Accordingly, at 8 weeks, the prevalence of nondippers was significantly (P < 0.001) higher in spring/summer than in autumn/winter for both SBP (54.8 vs. 30.0%) and DBP (53.4 vs. 28.8%).

Conclusion:
Clinic blood pressure-guided antihypertensive treatment requires a higher dosage of medication in cold than warm seasons, which may have led to over- and under-treatment of nighttime blood pressure, respectively.
Blood pressure and variability responses to the down-titration of antihypertensive drugs
Authors: Kim Byung Sik , Lee Yonggu , Shin Jeong-Hun , Heo Ran , Kim Hyun-Jin , Shin Jinho 
Published: January 2024

Objectives:
Several recent guidelines have proposed the gradual reduction of antihypertensive drugs for patients with well controlled blood pressure (BP). However, no studies have examined alterations in BP variability (BPV) during the down-titration of antihypertensives. This study aims to investigate changes in home BPV during the down-titration of antihypertensives.

Methods:
We analyzed 83 hypertensive patients who underwent down-titration of antihypertensives and had available home BP data during the down-titration. Down-titration was performed when home SBP was less than 120 mmHg, regardless of the clinic SBP. Primary exposure variable was the standard deviation (SD) of home BP.

Results:
Among 83 patients (mean age 66.3 ± 11.9 years; 45.8% men), down-titration led to increase home SBP (from 110.5 to 118.7 mmHg; P < 0.001), and home DBP (from 68.8 to 72.8 mmHg; P = 0.001) significantly. There were no significant differences in SDs of SBP [from 6.02 ± 3.79 to 5.76 ± 3.09 in morning, P = 0.570; from 6.13 ± 3.32 to 6.63 ± 3.70 in evening, P = 0.077; and from 6.54 (4.80, 8.31) to 6.37 (4.65, 8.76) in home SBP, P = 0.464] and SDs of DBP during the down-titration of antihypertensive drugs.

Conclusion:
Down-titration of antihypertensive drugs did not have notable impact on clinic BP and home BPV, while significantly increasing home BP. These findings provide important insights indicating that the potential concern related to an increase in BPV in the planned strategy of reducing antihypertensive drugs is not substantial.
Soft Tissue Robotic Assisted Orbital Surgery Using da Vinci SP: A Cadaveric Experience
Authors: Faulkner Jack , Malik Mohsan , Daniel Claire , Uddin Jimmy , Arora Asit , Stein Hubert , Jeannon Jean-Pierre 
Published: January 2024

Purpose:
Robotic surgical techniques have transformed many surgical specialties however robotic techniques and applications have been much more limited in ophthalmology. This study aims to evaluate the feasibility of robotic assisted orbital surgery using a single-port novel robotic platform, the da Vinci SP.

Methods:
A series of orbital procedures were performed in cadaveric specimens utilizing the da Vinci SP robotic system. The procedures performed included lacrimal gland dissection and biopsy, medial and lateral orbital wall dissections, enucleation, and lid-sparing orbital exenteration. Successful completion of each procedure was defined by the operating surgeon and was considered the primary outcome and marker of feasibility.

Results:
Seven cadaveric procedures were performed in 3 cadaveric specimens. All 7 procedures were completed successfully without complication. Setup optimization occurred throughout the study and setup and operative times were acceptable. Three instrument arms and 1 endoscope were utilized throughout the study allowing 3 arm operating and dynamic retraction. Instrument size was found to limit surgical access and precision particular at the orbital apex.

Conclusions:
This preclinical study demonstrates that the da Vinci SP can be utilized within the orbit and is feasible for several applications. Robotic surgical systems offer significant advantages over conventional techniques and should be embraced. However, current commercially available robotic platforms are not optimized for the orbit and have their limitations although they may be suitable for some clinical applications.
Pneumococcal Aortitis
Authors: Shah Ali , Myers Joseph P. 
Published: January 2024

Abstract
Infectious aortitis, often leading to mycotic aortic aneurysm, is an uncommon disease. It is usually caused by either Staphylococcus aureus or Salmonella species. Streptococcus pneumoniae is rarely reported as a cause of aortitis. We report a patient with infectious aortitis in which S. pneumoniae was isolated in blood and tissue cultures from emergent open surgical intervention. A review of the literature suggests that pneumococcal aortitis is an emerging infectious disease with many more cases reported during the last 2 decades than in the previous 50 years. Of the cases reported since 2008, only 9 of 28 patients had an associated source for pneumococcal disease (pneumonia, meningitis, or endocarditis). Physicians should include infectious aortitis in the differential diagnosis of patients with primary pneumococcal bacteremia (no initial defined source).
Pharmacoepidemiology and Clinical Correlates of Lithium Treatment for Bipolar Disorder in Asia
Authors: Shuy Yao Kang , Santharan Sanjana , Chew Qian Hui , Lin Shih-Ku , Ouyang Wen-Chen , Chen Chih-Ken , Park Seon-Cheol , Jang Ok-Jin , Park Jun Hyuk , Chee Kok-Yoon , Ding Kwong Sen , Chong Jamaline , Zhang Ling , Li Keqing , Zhu Xiaomin , Jatchavala Chonnakarn , Pariwatcharakul Pornjira , Kallivayalil Roy A. , Grover Sandeep , Avasthi Ajit , Ansari Moin , Maramis Margarita M. , Aung Paing Phyo , Tan Chay Hoon , Xiang Yu-Tao , Chong Mian-Yoon , Park Yong Chon , Kato Takahiro A. , Shinfuku Naotaka , Baldessarini Ross J. , Sim Kang 
Published: January 2024

Abstract

Background
As clinical practices with lithium salts for patients diagnosed with bipolar disorder (BD) are poorly documented in Asia, we studied the prevalence and clinical correlates of lithium use there to support international comparisons.

Methods
We conducted a cross-sectional study of use and dosing of lithium salts for BD patients across 13 Asian sites and evaluated bivariate relationships of lithium treatment with clinical correlates followed by multivariate logistic regression modeling.

Results
In a total of 2139 BD participants (52.3% women) of mean age 42.4 years, lithium salts were prescribed in 27.3% of cases overall, varying among regions from 3.20% to 59.5%. Associated with lithium treatment were male sex, presence of euthymia or mild depression, and a history of seasonal mood change. Other mood stabilizers usually were given with lithium, often at relatively high doses. Lithium use was associated with newly emerging and dose-dependent risk of tremors as well as risk of hypothyroidism. We found no significant differences in rates of clinical remission or of suicidal behavior if treatment included lithium or not.

Conclusions
Study findings clarify current prevalence, dosing, and clinical correlates of lithium treatment for BD in Asia. This information should support clinical decision-making regarding treatment of BD patients and international comparisons of therapeutic practices.
Dyskeratosis congenita: beyond the triad and beyond the cause
Authors: Konda Deepthi , Mathurthi Gopi Krishna , Madhavarapu Praneeth Sai Santosh , Sakthivadivel Varatharajan , Kolavali Raghavendra Rao , Morya Arvind 
Published: January 2024

Introduction:
Dyskeratosis congenita (DC) is a rare genodermatosis caused by mutations in various genes encoding the proteins responsible for maintaining the telomere length. It is defined by the presence of three clinical features: nail dystrophy, abnormal skin pigmentation, and oral leukoplakia.
We herein report a typical case of DC with all three classical features along with pancytopenia, osteopenia, and epiphora but with no identifiable pathogenic mutations of DC-associated genes.

Case presentation:
Cutaneous examination revealed areas of hypopigmented and hyperpigmented macules forming a reticular pattern all over the body but mainly over the neck and upper chest, with relative sparing of the face. Skin atrophy with hypopigmentation was observed on the knuckles. The nails showed dystrophy in the form of pterygium, anonychia, and brittleness. The palms showed mild wrinkling with hypopigmented macules. Examination of the oral cavity revealed a white non-removable coating over the tongue and bilateral buccal mucosae (oral leukoplakia); the teeth were normal. Syringing of both eyes was performed by an ophthalmologist, and the patient was diagnosed with punctual stenosis (occlusion of the opening of the lacrimal canaliculus).

Discussion:
DC is a genodermatosis caused by germline mutations in genes encoding telomerase-associated components, shelterin proteins, and other regulators of telomere length and replication. Depending upon the gene involved, the mode of inheritance can be X-linked autosomal dominant or autosomal recessive. DC is characterized by the clinical triad of abnormal skin pigmentation, dystrophic nails, and oral leukoplakia. Patients with DC are also known to develop other rare clinical features at later stages, including epiphora, early graying of the hair, premature tooth loss, enteropathy with malabsorption, immune deficiency, esophageal stricture, cardiomyopathy, liver cirrhosis, osteoporosis and avascular necrosis of the bone. Patients with DC are predisposed to the development of malignancies, especially hematological malignancies and head/neck cancer. Management of DC involves a multidisciplinary approach and includes genetic counseling of family members at risk, regular surveillance of the patient for bone marrow failure and malignancies, and treatment of the associated features and any complications.

Conclusion:
Dyskeratosis congenita (DC) is a rare genodermatosis caused by mutations in various genes encoding telomerase complex. We present a typical case of DC with all three classical features but with no pathogenic mutations of existing DC-associated genes thus raising the possibility of new unidentified genes in the pathogenesis of DC.
Extra-axial cerebellopontine angle nodular medulloblastoma mimicking meningioma: a case report with literature review
Authors: Mehta Aanand , Yadav Manish , Shilpakar Sushil K. , Bohara Sandip , Yadav Digraj 
Published: January 2024

Introduction:
Medulloblastoma, a highly malignant embryonal tumor predominantly found in the pediatric population, typically arises within the cerebellum. This case report holds particular importance due to the rarity of medulloblastoma within the cerebellopontine angle (CPA). The distinct anatomical challenge posed by the CPA complex neurovascular structures, along with the absence of pathognomonic clinical or radiographic features, highlights the unique diagnostic and management challenge of this case.

Case presentation:
A 5-year-old boy presented with mild, progressively worsening headaches on CT/MRI imaging, which revealed a solid mass in the left CPA. Radiologically, the lesion closely resembled a CPA meningioma. The patient underwent a left retrosigmoid suboccipital craniectomy, utilizing a modified park bench position and careful burrhole creation. Intraoperatively, the tumor exhibited well-defined margins, firm adherence to cranial nerves, and complex tissue characteristics. Postoperatively, histopathological analysis identified nodular medulloblastoma, WHO grade IV, with immunohistochemical markers confirming its subtype.

Discussion:
This case highlights the critical role of surgical intervention in addressing rare tumors, emphasizing the need for multidisciplinary collaboration in both diagnosis and management to achieve a favorable outcome. Uncommon tumor locations, such as the CPA, require tailored approaches, and the utilization of advanced diagnostic techniques, including immunohistochemistry, aids in accurate subtype classification.

Conclusion:
This case highlights the critical role of surgical intervention in addressing rare tumors, emphasizing the need for multidisciplinary collaboration in both diagnosis and management to achieve a favorable outcome.
A survival case of high-dose amlodipine intoxication with non-cardiogenic pulmonary edema: a case report
Authors: Pant Pankaj , Shah Sangam , Bhattarai Ganesh , Dahal Krishna , Bista Navindra Raj , Bade Sahil , Chapagain Kshitij , Bade Sohail , Pant Sagar 
Published: January 2024

Introduction:
Dihydropyridines calcium channel blockers at high dose can have conduction abnormalities, reduced inotropism, and non-cardiogenic pulmonary oedema (NCPE) which otherwise, at standard dosage have only vascular selectivity. They remain one of the commonly used anti-hypertensive exhibiting very lethal outcomes (50% mortality rates) in its overdose.

Case presentation:
The authors present a case of a 21-year-old male with amlodipine intoxication with 43 tabs of 10 mg (total of 430 mg) ingestion manifested by loss of consciousness, hypotension, tachycardia, and respiratory distress.

Discussion:
An amlodipine overdose causes refractory hypotension due to vasodilation and impaired cardiac metabolism and contractility. Further amlodipine toxicity can result in NCPE that manifests clinically as respiratory distress and low oxygen levels due to lung injury caused by inflammation and increased vascular permeability.

Conclusion:
This case report emphasizes the significance of early recognition and prompt treatment of amlodipine intoxication, which can result in serious complications like fluid overload and respiratory distress.
Emergency laparoscopy in underserved settings: optimizing diagnosis and management of appendicitis with ruptured hemorrhagic ovarian cyst
Authors: Abdallah Sary , Tarchichi Jana , Alabidin Ammasri Hussein Z. , Tarchichi Alaa , Moufawad Graziella 
Published: January 2024

Introduction and importance:
Laparoscopy is an established widely available technique for diagnosis and management. However, due to its high maintenance and expensive use, it is not readily available in emergency settings especially in underserved area hospitals. The coincidence of gynecologic and nongynecologic surgical emergencies incurs a diagnostic dilemma especially in women of reproductive age presenting with acute abdominal pain.

Case presentation:
This article is a case report about a woman presenting with acute abdominal pain in an underserved area and diagnosed as appendicitis.

Clinical discussion:
Emergency laparoscopy is so rare in underserved areas due to its high maintenance costs as well as the lack of availability of well-trained surgeons and personnel. The exceptional availability of emergency laparoscopy in her case has allowed the codiagnosis of a ruptured hemorrhagic ovarian cyst with the optimal surgical management preventing the complications that could have occurred from misdiagnosing the coincident ruptured hemorrhagic cyst.

Conclusion:
Emergency laparoscopy is not always available in such clinical settings and has, in our case, optimized the management and prevented an undiagnosed ruptured hemorrhagic cyst together with its complications.
A rare case of schwannomatosis with meningioma: a case report
Authors: Neupane Saurav , Kashyap Ashutosh , Paudel Shreeram , Bhattarai Ganesh , Kharel Santosh K. , Adhikari Asim , Ghimire Ashim , Pokharel Simankan , Yadav Pratibha , Yadav Krishna K. 
Published: January 2024

Introduction:
Schwannomatosis is characterized by multiple schwannomas without vestibular schwannomas or any other stigmata of neurofibromatosis type 2 (NF2). Schwannomatosis is a rare disorder, with a reported incidence ranging from 1 in 40 000 to 1 in 1.7 million. Meningioma is also associated with schwannomatosis in around 5% of cases.

Case presentation:
We describe a case of a 20-year-old female presenting with progressive weakness of the right lower limb for 7 months with a tingling sensation and numbness of the same limb for 6 months and was found to have schwannomatosis with multiple spinal and right cerebellopontine angle (CPA) (9th/10th cranial nerve) schwannomas and left anterior cranial fossa meningioma.

Discussion:
Schwannomas in schwannomatosis are seen along the cranial, spinal, and peripheral nerves but not along the vestibular nerve, as is characteristically seen in NF2. The occurrence of meningiomas is about 5% in individuals with schwannomatosis, and the patient in our case also had an associated meningioma. The tumor was confirmed to be a schwannoma based on features on an MRI examination and histological examination.

Conclusion:
It is of great significance to identify the entire spectrum of the disease in a patient with schwannomatosis, and to differentiate it from related conditions in order to track and surgically manage the patient appropriately based on symptomatology and imaging findings.
Severity and associated factors of postoperative pain in paediatric surgical patients aged 2 months–7 years at selected Addis Ababa Public Hospitals: a multicenter prospective longitudinal study
Authors: Rede Fassil Mihretu , Goshu Eyayalem Melese , muzien Sulaiman Jemal 
Published: January 2024

Background:
Postoperative pain is a common and distressing consequence of surgery in children. It can lead to suffering, prolonged recovery, impaired physical functioning, and even chronic pain. Effective postoperative pain management is crucial for improving patient outcomes. However, several factors hinder the accurate assessment and management of pain in children, particularly in low-income countries. This study aims to evaluate the severity of postoperative pain in paediatric patients and identify its predictors.

Materials and methods:
A longitudinal study was conducted on 235 paediatric surgical patients aged 2 months–7 years in Public Hospitals of Addis Ababa from January to April 2023. The primary outcome, pain severity, was assessed at three different times using a pain assessment tool. Cochran’s q-test was used to compare postoperative pain incidences. The Generalized Estimating Equation was used to determine predictor variables’ effects on pain severity over time. The study demonstrated the direction of association and significance using an AOR with a 95% CI at a P value of 0.05.

Result:
The incidence of moderate to severe postoperative pain was 36.6% at 12 h, 20% at 24 h, and 10% at 36 h. Patients with preoperative pain and preoperative anxiety were more likely to experience moderate to severe postoperative pain [adjusted odds ratio (AOR)=3.41, CI=1.15, 10.00 and AOR=2.28, CI=1.219, 4.277, respectively). Intraoperative predictors of postoperative pain severity included longer duration of surgery (AOR=6.62, CI=1.90, 23.00) and major surgery (AOR=5.2, CI=2.11, 12.88). Postoperative pain severity was reduced in patients receiving multimodal analgesia (AOR=0.24; CI=0.091, 0.652) and in patients assessed frequently in the postoperative period (AOR=0.09; CI=0.022, 0.393).

Conclusion:
A significant portion of paediatric surgical patients in this study experienced high levels of postoperative pain, particularly within the first 24 h. The most influential factors affecting pain severity were postoperative pain management strategies and assessment practices.
The Effect of Psychoeducational Interventions on Cancer-Related Fatigue
Authors: Karakuş Zeynep , Yangöz Şefika Tuğba , Özer Zeynep 
Published: January 2024

BackgroundCancer-related fatigue is one of the most common symptoms of cancer patients. Psychoeducation is often used in the management of cancer-related fatigue.ObjectiveThe aim of this study was to synthesize the effects of psychoeducational interventions on cancer-related fatigue.MethodsThis article is a systematic review and meta-analysis of randomized controlled studies. The 11 electronic databases were searched, and studies using psychoeducational interventions to manage cancer-related fatigue were included. Data synthesis was performed using Comprehensive Meta-Analysis software version 3.0. The random-effects model was used to pool the effect size for intervention. The subgroup analysis was conducted to investigate the effect of the characteristics of psychoeducational interventions. This study was reported according to the Cochrane Handbook for Systematic Reviews of Intervention version 6.3 and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines.ResultsThis analysis included 10 studies with a total of 1369 participants. Most of the included studies compared the psychoeducational intervention group with the passive control group. Our meta-analysis revealed that psychoeducational intervention has a positive medium effect on improving cancer-related fatigue with a low quality of evidence. Subgroup analyses indicated no difference between group and individual interventions, between face-to-face and digital interventions, or between ≤3 and >3 sessions.ConclusionsPsychoeducational interventions can improve cancer-related fatigue. Additional well-designed randomized controlled studies are needed to upgrade the quality of evidence for psychoeducational interventions on cancer-related fatigue.Implications for PracticeNurses may practice psychoeducational interventions to manage cancer-related fatigue and may use this study design for randomized controlled studies for psychoeducational interventions on cancer-related fatigue.