bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ocular manifestations in COVID-19 infections: a case series
Authors: Khalayli Naram , Haider Ghina , Hodifa Yara , Kudsi Maysoun , Naman Nada 
Published: October 2023

Introduction:The prevalence of ocular abnormalities of COVID-19 is different according to different reports. However, currently available evidence on the presence of this virus in ocular secretions and its association with conjunctivitis is not well established.Objective:To reveal the ocular features among COVID-19 patients and to describe them with the findings of clinical data, inflammatory markers, and respiratory support therapy.Methods:Ocular symptoms were evaluated and recorded in 494 COV19 patients through questionnaire-style interviews, and an ophthalmologic examination. Data including age, sex, disease severity, and nasopharyngeal swab results were collected. Laboratory test values were reviewed. Patients with COVID-19 infections were classified into severe cases and mild cases.Results:The prevalence of ocular features was (2.83%). The most common features were conjunctival hyperaemia, epiphora, and foreign body sensation with itching. Patients with ocular manifestations on CPAP support therapy had higher rates of itching, lower rates of foreign body sensation. No differences were found in the levels of inflammatory marker. Meanwhile, patients used respiratory-aid therapy revealed higher values of white blood cells, platelet counts, erythrocyte sedimentation rate, C-reactive protein, ferritin, and lactate dehydrogenase.Discussion:Ocular involvement in COVID-19 and possibility of disease transmission through ocular tissues and secretions, has been registered in some reports, with a prevalence of 2–32%. The external and internal ocular parts are involved.Conclusion:Ocular features are not infrequent in COVID-19 patients.
The impacts of anxiety and depression on outcomes in orthopaedic trauma surgery: a narrative review
Authors: Weinerman Jonathan , Vazquez Arianna , Schurhoff Nicolette , Shatz Connor , Goldenberg Brandon , Constantinescu David , Hernandez Giselle M. 
Published: October 2023

Introduction:The impact of anxiety and depression on outcomes in orthopaedic trauma surgery is a topic of growing research interest.Patients and methods:Orthopaedic trauma patients often experience high rates of psychiatric disorders, with anxiety and depression being the most prevalent. Mental health disorders have been shown to increase the risk of negative surgical outcomes and morbidity. This narrative review seeks to summarize the current literature surrounding the impacts of anxiety and depression on orthopaedic trauma surgery outcomes.Discussion:There is a bidirectional relationship between chronic pain and mental health disorders, involving overlapping brain regions and neurotransmitter pathways. Anxiety and depression have been identified as predictors of negative surgical outcomes in orthopaedic trauma patients. Screening tools like the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder Screener-7 (GAD-7), and Medical Outcomes Study 36-item Short Form (SF-36) can assess mental health status and help tailor interventions. Psychological distress, chronic pain, and traumatic limb amputation are factors that contribute to adverse mental health outcomes in orthopaedic trauma patients. Opioid use for pain management is common in orthopaedic surgery, but it can worsen symptoms of depression and lead to dependency. Non-opioid pain management strategies may improve postoperative outcomes by reducing the impact of opioid-exacerbated depression.Conclusion:Mental health interventions, both preoperative and postoperative, are crucial in optimizing surgical outcomes and improving patient quality of life. Multidisciplinary approaches that address both physical and mental health are recommended for orthopaedic trauma patients. Further research is needed to develop effective interventions for improving mental health outcomes in this patient population.
Neutropenic enterocolitis in aplastic anemia – a case report from Nepal
Authors: Sharma Jagdish , Adhikari Anshumala , Basnet Ashik , Gelal Dharana , Singh Shivani , Mishra Aavash 
Published: October 2023

Introduction and importance:
Neutropenic enterocolitis (NE) is a life-threatening necrotizing enterocolitis, particularly in neutropenic patients.

Case presentation:
We are presenting a case of a 22-year-old male who presented chief complaints of abdominal pain, reddish black stool, abdominal distention, and low-grade fever with laboratory and bone marrow findings suggestive of aplastic anemia. Computed tomography scan of the abdomen and pelvis with contrast was used to establish the diagnosis of necrotizing enterocolitis. Nonsurgical management including broad-spectrum antimicrobials, bowel rest, nasogastric suction, fluid and nutritional support, and blood product support, helped this patient to recover.

Clinical discussion:
NE is a life-threatening inflammatory condition of the small and large intestines. Typical symptoms of NE include diffuse abdominal pain, fever, and watery or bloody diarrhea. Diagnosis of NE is done by clinical and imaging findings. Management of the primary disease is important to improve the ultimate survival of the disease.

Conclusion:
Early identification and management of neutropenic enterocolitis help to reduce mortality.
Acalvaria: the first case report from Nepal
Authors: K.C. Kusha , Baral Abal 
Published: October 2023

Introduction and importance:
Acalvaria is a rare congenital malformation in which the flat bones of the cranial vault, dura mater, and associated muscles are absent while the central nervous system usually remains unaffected. It is an extremely rare congenital anomaly with only a handful of cases being reported in literature.

Case presentation:
The authors report a case of a 2-month-old male infant with acalvaria who was delivered at home and brought to our centre with the complaint of an abnormally soft skull. He was evaluated in a primary centre in rural Nepal. Parietal bones were missing bilaterally but no other abnormalities were found during the physical examination and investigations. Major differential diagnoses like anencephaly, cephalocele, osteogenesis imperfecta type II, and hypophosphatasia were ruled out with the help of history, physical examination, and available investigations and the case was diagnosed as acalvaria.

Clinical discussion:
Acalvaria is a post-neurulation defect which is associated with anomalies of various organ systems. Radiological diagnosis, with supportive laboratory investigations, is the most reliable method of antenatal diagnosis.

Conclusion:
Acalvaria is known to have a dismal prognosis and all the living cases with long-term follow-up are mentally retarded and physically disabled. Early and reliable antenatal diagnosis can reduce the economic, physical, and psychological burden associated with this fatal disease, especially in low-income countries.
Recurrent paradoxical cerebral embolism caused by a thrombus entrapped in a patent foramen ovale: a case report
Authors: Do Anh Phuong , Nguyen Hung Minh , Thi Thu Nguyen Hoai , Ta Cuong Manh , Bui Son Tran Thanh , Pham Hung Manh 
Published: October 2023

Introduction:
A thrombus straddling the patent foramen ovale (PFO) is a very rare clinical entity. Optimal management remains unclear due to the availability of various therapeutic options; thus, an individualized approach is recommended.

Case presentation:
The authors describe a case presenting with recurrent cerebral embolism and a large and mobile thrombus straddled in the PFO. Historically, cardiac surgery, thrombolysis or anticoagulation were possible management options for this patient. However, there are no guidelines on what the optimal treatment is. Our patient was a poor surgical candidate because of advanced age and multiple comorbidities. Furthermore, she had a recent ischaemic stroke which was a relative contraindication to thrombolysis. After consulting the Heart Team, medical treatment alone with systemic anticoagulation was administered. Subsequent transthoracic echocardiography (TTE) after 1 week showed complete thrombus resolution. After 4 months, the PFO was successfully occluded with an Amplatzer device. The patient received rehabilitation therapy and had good functional recovery.

Clinical discussion:
Anticoagulant therapy alone was chosen because of high risk for surgery. Complete thrombus resolution was achieved after 1 week although the initial thrombus size was quite large. Nevertheless, this approach may not be applicable to every patient. In addition to TTE, multimodality imaging using transesophageal echocardiography and cardiac magnetic resonance is helpful to identify the mechanism of stroke, which in our case is a thrombus-straddled PFO, and to make early treatment decisions. Serial TTEs help assess the response to anticoagulation. An individualized approach should be made with a multidisciplinary Heart Team.

Conclusion:
Echocardiography plays an important role in the diagnosis and treatment evaluation for patients with a thrombus straddling a PFO. An individualized approach to manage the patient should be made with a multidisciplinary Heart Team.
The top 100 most-cited studies on monkeypox: a brief bibliometric analysis
Authors: Zheng Li , Yuan Yuan , Zhang Kaihua , Wang Yan , Min Xianjun 
Published: October 2023

Background:
A plethora of monkeypox papers have been published; however, pinpointing key and pivotal studies can be challenging amongst the ever-expanding literature. Bibliometric analyses are helpful in identifying the most influential articles and their impact pertinent to this field, which has helped mould the recognition and management of monkeypox.

Methods:
The Web of Science Core Collection (WoSCC) was searched on 27 October 2022. The top 100 most-cited articles on monkeypox were identified and evaluated by author, country, institution, type of articles, theme, journal of publication, keywords, and citations.

Results:
The top 100 most-cited studies were published between 1997 and 2022, and the 5-year period with the largest number of articles was 2007–2011. The median number of citations among the top 100 most-cited articles was 78.23. Of the top 100 most-cited studies, 91 were original articles, and nine were reviews, the median of annual citations was significantly higher in the review group than the original group, 7.86 (4.20–13.80) versus 4.50 (3.07–7.59; P=0.023). The 100 articles were classified into different research theme, with the top three being Immunology (31%), Infectious Diseases (30%), and Virology (26%), respectively. The keywords with the highest co-occurrence frequency were “monkeypox”, “smallpox,” and “smallpox virus.” The largest number of articles in the top 100 were published in Emerging Infectious Diseases (n=13), followed by Journal of Virology (n=11), Journal of Infectious Diseases (n=5), and PLoS One (n=5). The authors identified 711 different authors from 195 institutions and 28 countries in the top 100 most-cited articles, with the majority based in the USA.

Conclusion:
The top 100 most-cited studies provide an important insight into the historical developments of monkeypox. The authors should strengthen the recognition and management of monkeypox worldwide and strengthen research cooperation among scholars in order to better respond to the ongoing or future outbreak.
Effect of Guided Imagery on Patient Comfort, Vital Signs, Pain, Anxiety, and Satisfaction in Cancer Patients Undergoing Port Catheterization With Local Anesthesia
Authors: Acar Kadriye , Ersöz Hasan 
Published: October 2023

Background
Port catheter placement is usually an operation performed under local anesthesia. Being conscious during the interventions performed with local anesthesia can lead to anxiety and stress.

Objective
The aim of this study was to determine the effect of guided imagery performed before and during the procedure on vital signs and comfort, pain, anxiety, and satisfaction levels in patients with cancer undergoing port catheterization with local anesthesia.

Methods
A total of 80 patients were included in the study. Patients in the intervention group received standard treatment and nursing care, as well as a guided imagery intervention once before and once during the procedure. Patients in the control group received only standard treatment and nursing care.

Results
Patients in the guided imagery group reported lower pain and anxiety scores, higher patient satisfaction, and increased comfort compared with patients in the control group. Patients in the guided imagery group showed significantly lower respiratory rate and heart rate than the control group by the end of the procedure. There was no significant difference in blood pressure.

Conclusion
Practicing guided imagery before and during a procedure performed under local anesthesia reduced cancer patients’ pain, increased patient satisfaction and comfort, and had a positive effect on their respiratory and heart rates.

Implications for Practice
We recommend guided imagery as a practical, low-cost complementary therapy for patients receiving local anesthesia.
Patient-Reported Outcomes Measurement Information System Pediatric Symptom Profiles of Children With Cancer in China
Authors: Liu Yanyan , Li Danyu , Shen Nanping , Zhang Wen , Zhou Fen , Yuan Changrong 
Published: October 2023

Background
Unpleasant symptoms are common in children with cancer. However, research identifying subgroups of children with cancer who experience similar levels of self-reported symptoms in China is limited.

Objectives
This study aimed to classify the symptom profiles of children with cancer and detect the possible predictors of the profiles and their effect on children’s quality of life (QoL).

Methods
A total of 272 children aged 8 to 17 years completed the Chinese version of the Pediatric Patient-Reported Outcomes Measurement Information System short form measures, the Pediatric QOL Inventory general core and cancer modules. Latent profile analysis was used to identify symptom profiles, and ordinal logistic regression and analysis of variance were used to examine predictors of symptom profile membership and profile differences on QoL.

Results
The best fit was a 3-profile model: low, moderate, and severe symptom distress. Children who had been inpatients in the past 7 days and were currently under treatment are more likely to have severe symptoms. Participants in the low symptom distress profile reported significantly greater QoL than those in the other profiles.

Conclusions
Children with cancer are heterogeneous in their experience of symptoms. Children’s characteristics, such as inpatient history and treatment status, are predictors of profiles; different symptom profiles are associated with QoL.

Implications for Practice
This study identified distinct groups of patients who predictably experience higher symptoms and their predictors, which could help to place children within a profile and perhaps allow nurses to provide targeted supportive care to match children’s specific symptom profile.
Mpox
Authors: Jafari Kaileen , Woodward George A. 
Published: October 2023

Abstract
Human mpox (formerly known as monkeypox) is a zoonotic disease that causes a smallpox-like infection in humans. The mpox virus, the causative agent of mpox, was first reported to cause human disease in a 9-month-old infant in the Democratic Republic of the Congo in 1970. Since that time, periodic outbreaks in primarily endemic regions have occurred, typically secondary to transmission from wildlife reservoirs. However, in May 2022, after a rapid rise in worldwide cases in largely nonendemic countries, the World Health Organization declared mpox a Public Health Emergency of International Concern. As of January 2022, more than 80,000 cases of mpox in nonendemic countries have occurred, and more than 25,000 cases in the United States alone. Most of these cases occurred in adults, with the highest frequency among men who had sex with men. Children and adolescents represented only 0.3% of US cases as of September 2022, with most infections in young children the result of direct contact with an infected household member. Although infection remains uncommon in US children and teens, pediatric emergency and urgent care providers should be aware of the clinical features, treatment, and prophylaxis of this important emerging infectious disease.
A Pilot, Single-Blind, Randomized Controlled Study Evaluating the Use of Platelet-Rich Plasma for Hand Skin Rejuvenation
Authors: Pincelli Thais , Zawawi Suha , Shapiro Shane , Heckman Michael G. , Hochwald Alexander P. , Desmond Cheryl , Arthurs Jennifer , Tolaymat Leila , Forte Antonio , Bruce Alison 
Published: October 2023

Background:
The presence of various growth factors in platelets makes platelet-rich plasma (PRP) a powerful tool in the stimulation of collagen regeneration in aging skin. The main objective of this study was to determine efficacy and safety of PRP compared with saline solution in women with aging skin of the hands.

Methods:
In this prospective, randomized clinical trial, 18 women with hand aging received PRP injections every 4 weeks into the unilateral dorsal hand for 12 weeks total; with saline injections into the contralateral hand in a randomized, controlled, single-blind fashion. Physician assessment, photographs, and quality-of-life questionnaires were used for assessment at baseline and at 12-week and 24-week follow-up.

Results:
The majority of patients reported pain and discomfort along with a burning/stinging sensation in both PRP- and saline-treated hands, with no significant differences noted in any patient outcome measures between the 2 treatments (all P ≥ 0.25). No differences were reliably detected between the treatment hands by a blinded investigator comparing before-and-after clinical photographs of the hands.

Conclusions:
Three injections of PRP spaced 4 weeks apart did not appear to be effective for treatment of aging skin of the hands in women, with no noted difference as compared with baseline, or saline injection. Although age older than 45 years may be a factor accounting for nonresponse (ie, subtle skin changes are difficult to appreciate, and possible limited platelet regenerative capacity in advanced age), it appears that PRP is not a reliable cosmetic option for management of hand aging.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, II.
Overactive Bladder in Late Pregnancy to 1 Year After First Vaginal Delivery
Authors: Hendrickson Whitney K. , Allshouse Amanda A. , Nygaard Ingrid E. , Swenson Carolyn W. 
Published: October 2023

ImportanceUnderstanding overactive bladder (OAB) during pregnancy and postpartum may increase our knowledge of pathophysiology.ObjectivesThe purpose of this study was to understand the prevalence and severity of OAB during pregnancy through 1 year postpartum as well as the associated factors.Study DesignThis is a secondary analysis of a prospective cohort study evaluating primiparous women with a singleton term vaginal delivery assessed at the third trimester, 8 weeks postpartum, and 1 year postpartum. Overactive bladder was defined as urinary urgency plus nocturia or frequency, or urgency urinary incontinence (UUI). Overactive bladder severity was defined using average visual analog scores (0–100) from OAB symptoms on the Epidemiology of Prolapse and Incontinence Questionnaire. We evaluated associations with OAB at each time point using logistic regression.ResultsAmong 579 participants, mean age was 29 years. Overactive bladder prevalence was higher at 8 weeks postpartum (23%) than at the third trimester (18%,P= 0.03) and 1 year postpartum (19%,P= 0.03). Overactive bladder severity was higher at the third trimester (42.2) than at 8 weeks postpartum (23.3,P= 0.008), but not at 1 year postpartum (29.1,P= 0.1). In those with OAB, UUI severity was higher at 1 year postpartum compared with that at the third trimester (P= 0.02). Younger age was associated with third trimester OAB. At 8 weeks postpartum, OAB was associated with older age, urinary tract infection after delivery, birth weight ≥3,500 g, and third trimester OAB. At 1 year postpartum, OAB was associated with birth weight ≥3,500 g and third trimester OAB.ConclusionsOveractive bladder affects 1 in 5 primiparous women during pregnancy or after vaginal delivery. The increased severity of UUI postpartum and the association between higher birth weight and OAB postpartum suggest an effect of delivery.
Impact of Pretransplant Diabetes on Outcomes After Liver Transplantation: An Updated Meta-analysis With Systematic Review
Authors: Tang Ansel Shao Pin , Tan Caitlyn , Lim Wen Hui , Ng Cheng Han , Tan Darren Jun Hao , Zeng Rebecca , Xiao Jieling , Ong Elden Yen Hng , Cho Elina , Chung Charlotte , Lim Wei Shyann , Chee Douglas , Nah Benjamin , Tseng Michael , Syn Nicholas , Bonney Glenn , Liu Ken , Huang Daniel Q. , Muthiah Mark , Siddiqui Mohammad Shadab , Tan Eunice XX 
Published: October 2023

Background.
Preliver transplant diabetes mellitus (pre-LT DM) is a common comorbidity in LT recipients associated with poorer post-transplant survival. However, its relationship with other important outcomes, including cardiovascular and renal outcomes, remains unclear. This meta-analysis aims to provide an updated analysis of the impact of pre-LT DM on key post-LT outcomes.

Methods.
A search was conducted in Medline and Embase databases for articles comparing the post-transplant outcomes between patients with and without pre-LT DM. Pairwise analysis using random effects with hazard ratios (HRs) was used to assess the longitudinal post-LT impacts of pre-LT DM. In the absence of HR, pooled odds ratios analysis was conducted for secondary outcomes.

Results.
Forty-two studies involving 77,615 LT recipients were included in this analysis. The pooled prevalence of pre-LT DM amongst LT recipients was 24.79%. Pre-LT DM was associated with significantly lower overall survival (HR, 0.65; 95% confidence interval, 0.52-0.81; P<0.01) and significantly increased cardiovascular disease-related mortality (HR, 1.78; 95% confidence interval, 1.11-2.85; P=0.03). Meta-regression of other patient characteristics identified Asian ethnicity and hypertension to be significant predictors of worse overall survival, whereas African-American ethnicity was associated with significantly improved overall survival in patients with pre-LT DM. Further analysis of secondary outcomes revealed pre-LT DM to be a significant predictor of post-LT cardiovascular events and end-stage renal disease.

Conclusions.
The present study illustrates the impact of pre-LT DM on post-LT survival, and cardiovascular and renal outcomes and provides a sound basis for revision of preoperative management of pre-LT DM.