bluuebunny/crossref_metadata_2025_split huggingface dataset:
Polypharmacy Among Patients With Major Depressive Disorder and Co-occurring Substance Use Disorders in a Psychiatric Hospital Setting
Authors: Benz Madeline B. , Epstein-Lubow Gary , Weinstock Lauren M. , Gaudiano Brandon A. 
Published: April 2023

Abstract

Background
Major depressive disorder (MDD) is common among patients admitted to a psychiatric hospital who frequently present with comorbid conditions such as substance use disorders (up to 50%). Polypharmacy (ie, being prescribed 3 or more medications) may be relatively common in dual-diagnosis patients. This study sought to examine prevalence and risk factors associated with psychotropic polypharmacy in hospitalized patients with MDD and co-occurring SUDs.

Methods
An electronic chart review was conducted with 1315 individuals admitted to a psychiatric hospital; 505 (38.4%) were identified as having co-occurring MDD + SUD. We examined psychotropic polypharmacy and clinical severity to explore risk for concerning drug interactions.

Results
Potentially problematic polypharmacy patterns were identified among those with MDD + SUD and were related to negative clinical outcomes, particularly in terms of increased sedation potential for individuals with an opioid use disorder (OUD). Groups at the highest risk for polypharmacy included patients who were female, older in age, lower in functioning, and presenting with a co-occurring OUD. Having an OUD was associated with particularly risky polypharmacy combinations, while having a cannabis use disorder was associated with the least polypharmacy.

Conclusions
Results highlight a high prevalence of polypharmacy among a group that has an elevated risk for negative outcomes. There is a continued need to improve identification of complex patient presentations and adjust medications in a hospital setting to improve treatment outcomes and reduce future mortality.
Delays in Care During the COVID-19 Pandemic in the Veterans Health Administration
Authors: Mills Peter , Louis Robin Pendley , Yackel Edward 
Published: April 2023

ABSTRACT

Objectives:
The purpose of this study was to review patient safety reports in the Veterans Health Administration (VHA) related to delays during an 11-month period that included months of the COVID-19 pandemic.

Design:
A retrospective descriptive analysis of COVID-19 patient safety reports related to delays that were submitted in the Joint Patient Safety Event Reporting System database to the VHA National Center of Patient Safety from January 01, 2020 to November 15, 2020 was conducted. There were 897 COVID-19 patient safety events related to delays; 200 cases were randomly selected for analysis, with 148 meeting inclusion criteria.

Results:
The results showed delays in laboratory results, level of care, treatment and interventional procedures, specific aspects of care, radiology treatment, and diagnosis. Causes for delays included poor communication between staff, problems in getting laboratory results, confusion over policy, and misunderstanding of COVID-19–specific rules.

Conclusions:
Healthcare delays can be reduced during a pandemic by proactively standardizing medical processes/procedures when testing for infection, improving staff to staff communication teaching the SBAR (situation, background, assessment, and recommendations) communication model, and using simulation to identify latent safety issues and educating medical personnel on new protocols related to the pandemic. Simulation can be used to test new protocols developed during the pandemic.
The prognostic role of whole-body volumetric 68GA-DOTATATE PET/computed tomography parameters in patients with gastroenteropancreatic neuroendocrine tumor treated with 177LU-DOTATATE
Authors: Kepenek Ferat , Kömek Halil , Can Canan , Kaplan İhsan , Altindağ Serdar , Gündoğan Cihan 
Published: April 2023

Objective
The aim of this study is to evaluate the prognostic role of Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 and quantitative 68Ga-DOTATATE PET/computed tomography parameters such as maximum standardized uptake value (SUVmax), mean SUV (SUVmean), DOTATATE tumor volume (DTV), total lesion DOTATATE (TLD) in patients with gastroenteropancreatic neuroendocrine tumors (GEP-NETs) treated with 177Lu-DOTATATE.

Material and method
Our retrospective study included 21 patients with GEP-NETs treated with 177Lu-DOTATATE between January 2017 and January 2022. SUVmax, SUVmean, SUVmax/spleenSUVmax (SUVmax/Sx), DTV, TLD, SUVmean/spleenSUVmean (SUVmean/Sm), TLD/Sm values were calculated and recorded for all patients before and after 177Lu-DOTATATE treatment.

Results
A total of 319 metastases were detected in the patients included in the study, and a total of 68 target lesions were selected. In univariant Cox regression analysis, TLD/Sm percent change (∆TLD/Sm) was found to be statistically significant on overall survival (OS) (P = 0.044). The 3-year survival in nonresponders was 50% (P = 0.034) based on ∆SUVmax/Sx values, 50% (P = 0.002) based on RECIST values, 50% based on ∆TDTV + new lesion values (P = 0.033), and according to ∆TTLD + new lesion values, it was 66% (P = 0.030).

Conclusion
In our study, we showed that SUVmax/Sx, RECIST, ∆TDTV + new lesion, and ∆TTLD + new lesion parameters can predict OS in the evaluation of response to treatment.
Nontraumatic spontaneous bilateral intracerebral haemorrhage in a young patient: a rare case report
Authors: Yadav Pramodman Singh , Panthi Sagar , Neupane Aakash , Uprety Manish , Acharya Rochana , Shah Leeza , Ansari Ajmat , Basnet Ujjwal , Bhattarai Raksha , Khanal Bhawani 
Published: April 2023

Introduction and importance:
Spontaneous bilateral intracerebral haemorrhage is a rare surgical occurrence, especially in young populations with poor prognosis. Hypertension is the leading cause but vascular malformations, infections and rare genetic conditions are also responsible.

Case presentation:
Twenty-three-year-old male with no prior comorbidities presented to emergency with sudden onset loss of consciousness and 1 episode of seizure. No history of intoxication or trauma was given. Glasgow Coma Scale at presentation was E1V2M2. CT scan head revealed bilateral basal ganglia haematoma along intraventricular haemorrhage.

Clinical discussion:
The patient was managed conservatively in the Neurosurgical Intensive care unit. Supportive management was provided. The patient’s motor response was improving and a repeat CT scan showed a resolving haematoma. However, due to poor economic conditions, the patient party left against medical advice.

Conclusion:
Spontaneous bilateral basal ganglia haemorrhage is a rare surgical emergency with no clear consensus on a management approach. This case highlights the importance of undiagnosed hypertension in causing intracerebral haemorrhage in poor economic groups.
Intra thecal baclofen pump as an ad hoc measure for a case of severe tardive dystonia refractory to multiple lesioning
Authors: Kayastha Jessica , Shrestha Resha , Shrestha Bishal , Gurung Pritam , Dabadi Sambardhan , Dhungel Raju Raj , Pant Basant 
Published: April 2023

Introduction and Importance:
Tardive dystonia is an infrequent ailment in patient reliant with chronic antipsychotic medication. The front-line envoy in the treatment of this illness is set into motion with oral agents including baclofen, benzodiazepines, and other antispasmodics. Regardless of an extensive therapy, the patients are not able to control of their spasticity/ dystonia. The authors reported a case of severe tardive dystonia treated with baclofen therapy in a patient frigid to medical therapy and multiple lesioning.

Case Report:
A 31-year-old female, diagnosed as a case of depressive illness and being managed with neuroleptic medications, who went onto develop tardive dystonia progressively worsening over a 4-year duration. After a comprehensive and meticulous evaluation of her neurological and psychological stratum, globus pallidus interna lesioning was reputed as the best course of action. As intended, staged lesioning was executed bilaterally with a trivial resolution eventually succumbing into recurrence, compelling a repeat lesioning. It was inaptly discouraging to see her crippled with the plight. Determined, not to give upon her, a way out with a baclofen therapy was proposed. A test dose with a 100 mcg of baclofen with an increment up to 150 mcg over a 3-day period demonstrated a promising prospect. On that account, the insertion of the baclofen pump was performed with an outstanding aftermath in her neurological endeavor.

Clinical Discussion:
Tardive dystonia is believed to be caused by striatal dopamine receptor super-sensitivity persuaded by the dopamine-antagonizing action of antipsychotic drugs. The first line of treatment being oral agents including oral baclofen, benzodiazepines, and antispasmodics. If the patient suffers from an early-onset primary generalized dystonia, then treatment with deep brain stimulation of the globus pallidus interna is the approved and preferred treatment approach. Recurrence of the symptoms despite of multiple lesioning can be overcome by intrathecal baclofen pump infusion as stated by many research. It is not uncommon to face complications in such a procedure, but the benefits outreach the risk, which makes it a choice of treatment.

Conclusion:
The use of a continuous intrathecal baclofen pump for cases with tardive dystonia refractory to conventional therapy, it has been approved as one of the safest and capable procedures.
Ectopic liver tissue adherent to the gallbladder serosa: two cases report from Syria
Authors: Hussein Al-janabi Moatasem , Kenaan Nour Ibrahim , Sulaiman Sara Houssam , Ibrahim Jana Ahmad , Saoud Nour abd allatif , Kannan Samir , Issa Younes , Ahmad Issa , Salloum Rabab 
Published: April 2023

Introduction and importance:
Ectopic liver tissue is an exceedingly rare anomaly in which the hepatic tissue is present extrahepatic site and has no connection to the true liver. Most cases of ectopic liver tissue were asymptomatic and discovered by an accident during abdominal surgery or autopsy.

Case presentation:
Case 1 involved a 52-year-old man who was admitted to the hospital due to an abdominal grip in the right hypochondrium and epigastrium for 1 month. The patient underwent laparoscopic cholecystectomy. During the gross examination, a well-circumscribed brownish nodule with a smooth outer surface, located at the fundus region was found. Case 2 involved a 40-year-old man with 2 months history of epigastric pain radiating to the right shoulder. Calculus chronic cholecystitis was diagnosed by ultrasound. The patient undergoes elective laparoscopic cholecystectomy. A gross inspection showed a small nodule attached to the serosa of the gallbladder. Microscopically, both cases revealed ectopic liver tissue.

Clinical discussion:
Ectopic liver tissue is an uncommon entity that occurs during the embryological development of the liver and can be found below and above the diaphragm, especially the gallbladder. Histologically, it usually has the normal architecture of the liver. Although ectopic liver tissue is an exceptional finding, pathologists should be aware of it because it has a high risk of transformation into malignancy.

Conclusion:
Hepatic choristoma is a rare failure of embryological liver development. It should be removed when recognized and examined histologically to rule out malignancy.
Novel guanidinoacetate methyltransferase (GAMT) mutation associated with cerebral creatine deficiency syndrome in a Syrian child: a case report
Authors: Alhomsi Dima , Abdalsalam Dania , Sulaiman Rama , Bakleh Sameer , Alasmar Diana 
Published: April 2023

Introduction:
Guanidinoacetate methyltransferase (GAMT) deficiency, also known as cerebral creatine deficiency syndrome type 2 (CCDS2), is an uncommon disease caused by an innate genetic defect in the metabolic pathway of creatine inherited in an autosomal recessive manner. It is a rare cause of neurological regression and epilepsy. In this report, we present the first GAMT deficiency case in Syria related to a novel variant.

Case Presentation:
A 2.5-year-old boy presented to the paediatric neurology clinic with evidence of neurodevelopmental delays and intellectual disabilities. Recurrent eye blinking, generalized non-motor (absence) seizures, hyperactivity, and poor eye contact were revealed in the neurological examination. Some athetoid and dystonic movements were noticed. His electroencephalography (EEG) was very disturbed because of generalized spike-wave and slow-wave discharges. Based on these findings antiepileptic drugs were administered. His seizures slightly improved, but then relapsed with myoclonic and drop attacks. After 6 years of unbeneficial treatment, a genetic test was required. Whole-exome sequencing was conducted and identified a novel homozygous GAMT variant (NM_138924.2:c.391+5G>C). Treatment with oral creatine supplementation, ornithine, and sodium benzoate was administered. After 1.7 years of follow-up, the child was almost seizure-free with a remarkable reduction of epileptic activity on EEG. He demonstrated good—but not complete—behavioural and motor improvement due to delayed diagnosis and treatment.

Conclusion:
GAMT deficiency should be considered in differential diagnoses in children with neurodevelopmental regression along with drug-refractory epilepsy. A special concern is needed in Syria for such genetic disorders; regarding the high prevalence of consanguinity. Whole-exome sequencing and genetic analysis can be used to diagnose this disorder. We reported a novel GAMT variant to extend its mutation spectrum and provide an additional molecular marker for the definitive diagnosis of GAMT deficiency patients and prenatal diagnosis in the affected families.
The influence of physical activity, social relationships, and diet intake on depression: a case-series study
Authors: Nabdi Samira , Boujraf Said , Benzagmout Mohammed 
Published: April 2023

Introduction:
This paper aims to investigate the three areas [diet, physical activity (PA), and social relationship] and their relationship with depressive disorders in the North African population.

Study design:
This is an observational cross-sectional study of 654 participants residing in the urban commune of Fez (n=326) and the rural commune of Loulja (n=328) in the province of Taounate. Participants were categorized into two groups: G1 without a current depressive episode and G2 with a current depressive episode. Risk factors, including locality, gender, marital status, age, parental status, employment status, tobacco use, alcohol consumption, social habits, and dietary patterns, were assessed. A multinomial probit model in Stata software was used to identify factors associated with depression occurrence in the population.

Results:
A total of 94.52% of the participants who engaged in PA did not experience a depressive episode (P=0.001). Additionally, 45.39% of the participants in our series were on a processed diet and presented with a depressive disorder (P=0.0001), the social contact (time spent with friends >1.5 h) remained strongly associated with reduced depressive symptoms when comparing the two groups (P=0.001). The results showed that being rural, a smoker, an alcohol user, and having no spouse significantly increased depression in participants. The coefficient of age was negatively related to the probability of the occurrence of age-related depression; however, this factor was not significant in the model. Thus, having a spouse and/or children and spending time with friends on a healthy diet significantly decreased depression in our population.

Discussion:
The converging evidence suggests that physical exercise, a stable social relationship, a healthy diet, and the use of PA can alleviate depression symptoms, but limited understanding and few studies have attempted to characterize or identify the neural mechanisms of these effects.

Conclusion:
Nonpharmaceutical interventions such as PA and dietary changes have proven to be effective treatments for depression, while maintaining positive social relationships can act as a protective factor, serving a prophylactic role in the prevention of depression.
A technique for esophagojejunostomy following robot-assisted gastrectomy: a liner stapler and barbed suture device-based technique: a case series
Authors: Ohdaira Hironori , Kamada Teppei , Takahashi Junji , Nakashima Keigo , Nakaseko Yuichi , Ishigaki Takayuki , Suzuki Norihiko , Yoshida Masashi , Yamanouchi Eigoro , Suzuki Yutaka 
Published: April 2023

Background:
Intracorporeal esophagojejunostomy after total or proximal robot-assisted gastrectomy is technically more demanding than gastroduodenostomy and gastrojejunostomy for distal gastrectomy, as well as laparoscopic surgery. We have established a safe and simple esophagojejunostomy procedure using a liner stapler attached to the Da Vinci Surgical System and a barbed suture device.

Patients and methods:
For esophagojejunostomy after total gastrectomy or proximal gastrectomy with double-tract reconstruction, we choose the “overlap method,” in which entry holes were made at the left of the esophageal stump and at 5 cm of the anal side in antimesentric area of the jejunum, followed by anastomosis on the left of the esophagus using SureForm (blue 45 mm) and hand-sewing closure of the common entry hole with V-Loc. We analyzed the short-term surgical outcomes of all patients.

Results:
23 patients underwent this reconstruction technique. None of the patients required any further open surgeries. The mean time to perform anastomosis was 24.7±2.8 min. The postoperative course was uneventful in 22 patients; a single patient developed minor anastomotic leakage (Clavien–Dindo grade 3), which was treated with conservative therapy employing a drainage tube.

Conclusion:
Our esophagojejunostomy method following robot-assisted gastrectomy is simple and feasible, with acceptable short-term outcomes, and could represent the procedure of choice for esophagojejunostomy.
Comparison between single-dose oral prednisolone and oral dexamethasone in the treatment of croup: a randomized-controlled trial
Authors: Asif Alvina , Tayyab Asma , Qazi Shaista , Zulfqar Rubina , Hussain Irshad , Mumtaz Hassan 
Published: April 2023

Introduction:
Croup is a common respiratory illness in children, accounting for 15% of annual clinic and emergency department visits for pediatric respiratory tract infections. We aimed to compare single-dose oral prednisolone with single-dose oral dexamethasone in the treatment of croup in terms of mean change in the Westley Croup Score.

Setting:
Emergency Department of Children Hospital.

Duration:
Six months from December 2017 to June 2022.

Design:
Randomized-controlled trial.

Subjects and methods:
A total of 226 children with Westley Croup Score 2 or more were included in this study. Patients were randomized into two groups, 113 patients received a single dose of 0.15 mg/kg of oral dexamethasone, while 113 patients received a single dose of 1 mg/kg of oral prednisolone. Croup score and other clinical observations were repeated at 4 h and recorded in the questionnaire.

Results:
The average age of the patients was 2.88±1.17 years. There were 129 (57.1%) males and 97 (42.9%) females. At 4 h, a significant reduction in mean Westley Croup Score was observed in group dexamethasone as compared with group prednisolone (P=0.0005).

Conclusions:
Our trial demonstrated that oral dexamethasone at a dose of 0.15 mg/kg is effective in reducing the total croup score but there were no statistical differences in respiratory rate, pulse rate, and oxygen saturation between groups. Future studies are required to determine if these treatments differ in efficacy for severe croup and whether there is a role for multiple-dose corticosteroid therapy in some patients.
The relationship of serum amylase levels in acute organophosphorus poisoning with its clinical severity and outcome: a cross-sectional study
Authors: Subedi Basudev , Yadav Gopal Kumar , Raut Amar , Joshi Nisha , Subedi Bal Krishna , Joshi Nimesh , Neupane Ram Prasad , Bhandari Ved , Maharjan Ramesh Kumar , Acharya Ramesh Prasad 
Published: April 2023

Background:
There are limited literatures studying the pancreatic involvement in organophosphate (OP) poisoning using biochemical means. This study focused on assessing the type of OP poisoning and determining the association of serum amylase levels with the patient’s presentation and outcome.

Materials and methods:
A cross-sectional study was carried out in the Maharajgunj Medical Campus, Tribhuwan University Teaching Hospital, Kathmandu, Nepal, after ethical approval [Ref: IRB/308 (6-11-E)]. We collected data from 172 participants with OP poisoning over the period of 2 years using nonprobability purposive sampling method. All patients with age group 16–75 years having a history of OP poisoning within the previous 24 h with clinical features and physical evidence of poisoning were included in the study. Those participants with indications of exposure to an entirely different poisons, poisoning with multiple poisons, OP poisoning along with alcohol, chronic alcoholics, comorbid conditions, taking drugs that could affect serum amylase levels (azathioprine, thiazides, furosemide, etc.), and/or treated in other hospitals after poisoning were excluded from the study. Appropriate statistical calculations were made using the statistical package for social sciences (SPSS), version 21. The P-value of less than 0.05 was considered statistically significant.

Results:
Metacid (53.5%, 92) was the most common OP poison. There were significantly higher mean values of serum amylase levels either within 12 h of exposure (468.60 vs. 135.4 IU/ml, P<0.001) or after 12 h of exposure (152.0 vs. 58.9 IU/ml, P<0.001) in dead participants than alive ones. The participants with initial and after 12 h of exposure-serum amylase level 100 or more IU/ml had more than two-fold and 18-fold higher odds of severe/life-threatening severity (odds ratio=2.40, 95% CI: 1.28–4.52, P=0.007 and odds ratio=18.67, 95% CI: 8.02–43.47, P<0.001) respectively than those with less than 100 IU/ml.

Conclusions:
The clinical severity of OP poisoning is directly related to serum amylase levels. Importantly, higher mean values of serum amylase levels were depicted in those participants with OP poisoning culminating to death. Thus, serum amylase level could be one of the easy measurable prognostic marker of OP poisonings.