bluuebunny/crossref_metadata_2025_split huggingface dataset:
Treatment options for multidrug-resistant Gram-negatives in urinary tract infections
Authors: Zollner-Schwetz Ines , König Elisabeth 
Published: March 2023

Purpose of review
Infections due to multidrug-resistant (MDR) Gram-negative bacteria are challenging to treat because of limited treatment options and potential side effects of less frequently used anti-infectives. In the past few years, several new antimicrobial agents effective against MDR Gram-negatives have become available. This review focuses on the treatment options for complicated urinary tract infections (cUTIs) caused by MDR Gram-negatives.

Recent findings
The novel combinations, betalactam or carbapenem and betalactamase inhibitor, ceftazidime/avibactam and meropenem/vaborbactam, are effective for infections caused by KPC-carbapenemase-producing pathogens. Imipenem/relebactam, another carbapenem/betalactamase inhibitor combination, has been approved for the treatment of cUTI. However, data on the efficacy of imipenem/relebactam against carbapenem-resistant pathogens is still limited. Ceftolozane/tazobactam is mainly used for the treatment of MDR Pseudomonas aeruginosa infections. For the treatment of cUTI caused by extended-spectrum betalactamases producing Enterobacterales aminoglycosides or intravenous fosfomycin should be considered.

Summary
To ensure prudent use and to avoid the development of resistance to novel anti-infective substances, an interdisciplinary approach, including urologists, microbiologists, and infectious disease physicians, is strongly advised.
Intra-articular platelet-rich plasma vs. corticosteroid injections efficacy in knee osteoarthritis treatment: a systematic review
Authors: Idres Fatima A. , Samaan Michel 
Published: March 2023

Background:Osteoarthritis (OA) affects the entire joint structure. The most injured joints are the hands, knees, and hips. OA is a common disease all over the world, and a cause of disability in the elderly; hence, medicine is facing a steady challenge to find effective therapeutics to relieve the pain, improving symptoms for a better quality of life for patients.Purpose:To compare the results, in the recent literature, of intra-articular injection of platelet-rich plasma (PRP) and corticosteroids (CSs) in osteoarthritic knees at early and mid-term postinjection.Methods:A PubMed and CENTRAL (Cochrane Central Register of Controlled Trials) database search was performed. Initial screening yielded 108 randomized controlled trials, 17 results, and 17 others were added after updates. The final review includes nine randomized control trials, with outcome evaluating of knee OA by Western Ontario and McMaster Universities Arthritis Osteoarthritis Index, Knee Injury and Osteoarthritis Outcome Scale Index, and Visual Analog Scale.Results:PRP and CS intra-articular injections both are safe and effective treatments in knee OA for alleviating pain, and improving symptoms. It seems that PRP injections have prolonged and shown better improvement in some studies. However, the results do not prefer one method over the other.Conclusion:Up till now, it is not easy to draw firm conclusions about prioritizing PRP or CS injections for knee OA treatment due to the limitation of this review.
Serum vitamin D and antinuclear antibody level in oral lichen planus patients: a cross-sectional study
Authors: Nosratzehi Tahereh 
Published: March 2023

Background:
Vitamin D is a secosteroid prohormone that regulates the immune system. Antinuclear antibody (ANA) is a protein antibody made against substances inside the nucleus of cells. Serum vitamin D and ANA levels progress to psoriasis and oral cancer. The present study aimed to measure the serum vitamin D and ANA levels in patients with oral lichen planus (OLP), an autoimmune and precancerous disease.

Methods:
We conducted this cross-sectional study on patients with OLP (n=50) and healthy individuals (n=50). We used the enzyme-linked immunosorbent assay method to measure serum vitamin D and ANA levels and Mann–Whitney U-test and t-test to analyze data.

Results:
The present study showed that 14 (28%) patients with OLP had vitamin D deficiency, and 18 (36%) had insufficient vitamin D. Further, 9 (18%) and 15 (30%) of the participants in the control group suffer from vitamin D deficiency and insufficient vitamin D level, respectively. Results showed a significant relationship between levels of serum vitamin D in both groups. The level of ANA positive in patients with OLP was 6 (12%). The results of the t-test showed no significant difference between the mean serum ANA levels in the two nodes with an 80% confidence interval (P=0.34).

Conclusion:
Researchers of the present study reported low serum vitamin D in many OLP patients. Due to the prevalence of vitamin D deficiency in society, we need to perform comprehensive studies to evaluate the deficiency’s effects on pathogenesis.
Evaluation of the coexistence of pilonidal sinus disease and hirsutism in female patients: a retrospective cross-sectional study
Authors: Akbulut Sami , Caliskan Alper , Yilmaz Davut , Atay Arif , Garzali Ibrahim Umar , Yagmur Yusuf 
Published: March 2023

Background:
This study aimed to investigate the coexistence of pilonidal sinus disease (PSD) and hirsutism in female patients.

Materials and methods:
The demographic and clinical data of 164 female patients who underwent surgery for PSD between January 2007 and May 2014 were evaluated for this retrospective cross-sectional study. Data collected for this study were age, BMI, the modified Ferriman and Gallwey scale (mFGS) for hirsutism, main symptoms, type of surgery, early postoperative complications (wound infection, wound dehiscence), recurrence, and follow-up. The independent variables are hirsutism (mFGS scores) and BMI. Dependent variables are early postoperative complications and recurrence.

Results:
The median age was 20 years (95% CI for median: 19–21 years). According to the BMI, 45.7, 50.6, and 3.7% of patients were considered normal, overweight, and obese, respectively. According to the mFGS, 11, 9.8, 52.4, and 26.8% of patients were considered to have none, mild, moderate, or severe hirsutism, respectively. Fourteen (8.5%) patients had developed recurrence. Recurrence developed in six patients with primary closure, five patients with Limberg flaps, two patients with Karydakis, and one with marsupialization. There was no statistical difference between recurrent and nonrecurrent patients in terms of BMI (P=0.054) and mFGS (P=0.921). On the other hand, BMI was statistically significantly higher in those who developed early postoperative complications than in those who did not (P<0.001).

Conclusion:
PSD is no longer a ‘men’s only disease’. BMI increases the risk of early postoperative complications, but this association was not found between BMI and recurrence. Prospective multicenter studies are needed on the relationship between PSD and hirsutism.
Computer-related ophthalmic syndrome in teachers of a University of the Province of Cañete
Authors: Uribe-Hernández Yrene C. , Ochoa-Paredes Fernando F. , Meneses-Claudio Brian A. , Tello-Aguilar Carmen P. , Buendía-Aparcana Roberto R. , Pacheco Alex 
Published: March 2023

Introduction and Importance:
Virtual education has impacted the vision of people during the coronavirus pandemic, as by spending more time on the computer, it compromises the eye health of the person causing long-term visual problems. So the objective of this investigation is to assess computer-related ophthalmic syndrome in teachers of a University of the Province of Cañete.

Methods:
This is a quantitative, nonexperimental, descriptive, cross-sectional study on a total population of 63 teachers, who answered a digital survey using the sociodemographic data and the Computer Vision Syndrome Questionnaire.

Clinical Discussion:
From the results it can be observed that the results of computer ophthalmic syndrome in the university teachers of the province of Cañete, where 51 (81%) of the teachers do not present the computer vision syndrome and 12 (19%) presented with the computer vision syndrome.

Conclusion:
The population conducting virtual education as well as the students should be educated on the measures to be taken to prevent computer ophthalmic syndrome and its consequences.
Recurrent acute pancreatitis in an adult female with sickle cell disease: A case report
Authors: Sharma Aayushi , Khadka Bibek , Sharma Anupam , Shah Kunda B. , Shrestha Amar N. 
Published: March 2023

Introduction and Importance:
Although risk factors such as cholelithiasis and vaso-occlusive crises exist in sickle cell disease, acute pancreatitis and its recurrence are considered rare complications manifesting as acute abdomen.

Case Presentation:
A 33-year-old female with sickle cell disease and established cholelithiasis presented to the center with acute abdomen. After examination, investigation, and contrast enhanced computed tomography, acute pancreatitis was diagnosed. Conservative management was done and cholecystectomy was planned but delayed due to low hemoglobin. In the interval she presented again with similar features and diagnosed with of recurrence. After conservative management and after optimization of patient’s hemodynamic status, laparoscopic cholecystectomy was finally performed. Postoperative period and follow-up visit after 2 months were uneventful.

Clinical Discussion:
As the features of pancreatitis and vaso-occlusive crisis are similar, the former should be considered as a differential diagnosis of acute abdomen in sickle cell patients. Laparoscopic cholecystectomy is the treatment of choice for symptomatic cholelithiasis in these patients. However, some issues related to management such as preoperative transfusion and prophylactic cholecystectomy are still debated. This uncertainty caused delay in surgery which may have contributed to the recurrence of pancreatitis in our patient. As the risk of recurrence is possible after the first attack, standard guidelines are required for the definite management of the cause.

Conclusion:
This case report adds to the limited literature on recurrent acute pancreatitis in sickle cell patients and points out the need for studies on developing management guidelines in such patients and need for prophylactic treatment.
Diffusely infiltrative squamous cell carcinoma of the esophagus resembling scirrhous gastric cancer: a case report
Authors: Aoki Hikaru , Kawada Hironori , Hanabata Yusuke , Shinkura Akina , Matsui Jun , Izumi Ai , Yamashita Tokuyuki , Kurimoto Makoto , Tamura Jun 
Published: March 2023

Introduction and Importance:
Diffusely infiltrative squamous cell carcinoma of the esophagus is rare and difficult to diagnose.

Case presentation:
The patient was a 75-year-old woman whose chief complaints were dysphagia and upper abdominal pain. Esophagogastroduodenoscopy and biopsy revealed squamous cell carcinoma at the abdominal esophagus. After neoadjuvant chemotherapy, esophagogastroduodenoscopy showed diffuse thickening and poor distensibility of the stomach wall. We suspected scirrhous gastric cancer and performed multiple biopsies, which revealed no evidence of malignancy. We then performed staging laparoscopy. There were no apparent changes in the serous membrane of the stomach, but peritoneal lavage cytology revealed squamous cell carcinoma. Thus, we made a diagnosis of squamous cell carcinoma of the esophagus with diffuse invasion of the stomach. Intraoperative pathological diagnosis revealed that there was greater diffuse submucosal invasion of the oral esophagus than we expected, and we had to resect the esophagus at the level of the middle thoracic esophagus. Despite multidisciplinary treatment (surgery, chemotherapy, and radiotherapy), the patient died 20 months after the initial diagnosis.

Clinical discussion:
In this case, although biopsy did not lead to a diagnosis, peritoneal lavage cytology led to the correct diagnosis. Moreover, it was impossible to preoperatively predict the exact extent of the expansion because of diffuse submucosal invasion.

Conclusion:
When diffusely infiltrative squamous cell carcinoma of the esophagus is suspected, peritoneal lavage cytology may be useful for confirming the diagnosis; however, it should be assumed that accurate preoperative evaluation of the range of diffusely infiltrative squamous cell carcinoma is difficult.
Isolated diffuse intestinal ganglioneuromatosis presented as a redundant sigmoid colon: a case report
Authors: Al Samaan Fadi , Alhimyar Maryam , Alhalbouni Mohammad , Aldirani Alaa , Assad Lina 
Published: March 2023

Introduction and Importance:
Diffuse intestinal ganglioneuromtosis is a benign tumor of the enteric nervous system, that almost always occurs in children with systemic syndromes. Whereas isolated cases in adults are exceedingly rare.

Case Presentation:
A 38-year-old man presented with refractory chronic constipation. An abdominal computed tomography scan revealed a redundant sigmoid colon, then he underwent a sigmoid colectomy. Histopathologic examination showed diffuse ganglioneuromatosis. However, the patient was in good health 18 months after surgery.

Clinical Discussion:
Intestinal ganglioneuromas commonly occur in children with systemic syndromes such as multiple endocrine neoplasia type 2B and neurofibromatosis type 1. The most frequent symptoms are abdominal discomfort, constipation, ileus, weight loss, appendicitis, and obstruction in more severe cases. surgical resection is the standard management in diffuse ganglioneuromatosis.

Conclusion:
Although diffuse ganglioneuromatosis is uncommon, it should be considered in patients with refractory constipation.
Phenotypes of a female patient with novel de novo frameshift ARX variant identified by whole-exome sequencing: a case report
Authors: Iskandar Kristy , Herini Elisabeth S. , Triono Agung , Hadiyanto Marissa L. , Nugrahanto Andika P. , Gunadi  
Published: March 2023

Introduction and importance:
Variants in the aristaless-related homeobox (ARX) gene cause a diverse spectrum of phenotypes of neurodevelopmental disorders (NDD) in male patients. This article describes the role of genetic testing using whole-exome sequencing (WES) in detecting a novel de novo frameshift variant in the ARX gene in a female patient with autism, seizure, and global developmental delay.

Case presentation:
A 2-year-old girl with frequent seizures, global developmental delay, and autistic features was referred to our hospital. She was the second child of consanguineous non-affected parents. She had a high forehead, mildly prominent ears, and prominent nasal root. A generalized epileptiform discharge was noted in her electroencephalography. Brain MRI revealed corpus callosum agenesis, cerebral atrophy, and a left parafalcine cyst. The WES result showed a likely pathogenic variant identified as a novel de novo deletion in exon 4 of the ARX gene, which creates a frameshift variant. The patient is on dual therapy of antiepilepsy drugs, physiotherapy, speech therapy, occupational therapy, and oral motor exercises.

Clinical discussion:
Variants in the ARX gene can result in various phenotypes in males transmitted from asymptomatic carrier females. However, several reports showed that the ARX variants might cause phenotypes in females with milder symptoms than affected males.

Conclusion:
We report a novel de novo ARX variant in an affected female with a NDD. Our study confirms that the ARX variant might cause remarkable pleiotropy phenotypes in females. Moreover, WES could help to identify the pathogenic variant in NDD patients with diverse phenotypes.
A rare occurrence of an incidental primary intra-abdominal Cystic Lymphangioma in a Middle Eastern adult female: A case report
Authors: Al Laham Omar , Abdul Khalek Gheed , Almaydaani Mohamad , Abazid Eias , Abazeed Omar , Alshalabi Abdulghani 
Published: March 2023

Introduction and Importance:
Cystic Lymphangiomas (CLs) are rare vascular anomalies of benign nature. The etiology remains a subject of controversy, but they are considered to arise due to anomalies that occur during the normal embryogenic developmental process of lymphatic vessels. They have an estimated incidence rate of merely 1 in every 20,000–250,000 individuals. Since they are mainly known as a disease of the pediatric population, accurate epidemiological rates of CLs, especially in adults, are still unidentified due to the scarcity of published data. Documentation is pivotal to collect further information about them to establish timely diagnoses and minimize the potentially high patient morbidity.

Case Presentation:
The authors hereby demonstrate the case of a 46-year-old lady who presented to the outpatient general surgery clinic at our university hospital complaining of chronic right hypochondriac abdominal pain. Investigative radiological imaging marked a cystic formation with well-defined borders and homogenous content extending from the lower pole of the right kidney to the lower hepatic border.

Clinical Discussion:
Surgical intervention was performed by completely resecting the lesion in question. Directly afterward, histopathological analysis was achieved and established the diagnosis of a CL.
Conclusion:
CL is a rare neoplasm with ill-defined symptoms and ambiguous clinical presentations. They remain poorly studied due to their rarity and lack of sufficient data in the published literature. This magnifies the importance of clinical awareness and time-efficient surgical intervention. Documenting these cases aids in identifying their subsequent etiological origins, disease-specific risk factors, clinical course, and yields proposals of novel therapeutic approaches.
Neuropathology of 30 deceased patients with COVID-19: a case series in Tehran, Iran
Authors: Nouri Majid , Soleiman-Meigooni Saeed , Mohammadi Shadi , Sakhabakhsh Mehdi , Yaghmayee Ramin , Fotoohi Mahtab 
Published: March 2023

Introduction:
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can affect the nervous system and result in neurological symptoms. The most common feature of central nervous system involvement is hypoxia and congestion. This study aimed to evaluate the histopathology of cerebral tissue in deceased patients with coronavirus disease 2019 (COVID-19).

Methods:
In a case series study, we took cerebral samples of 30 deceased patients with COVID-19 through supraorbital bone from January to May 2021. The samples were fixed in a formalin solution, stained with haematoxylin–eosin dyes and studied by two expert pathologists. The Ethics Committee of AJA University of Medical Sciences approved this study with code IR.AJAUMS.REC.1399.030.

Results:
The mean age of the patients was 73.8 years, and the most common underlying disease was hypertension. Cerebral tissue samples showed hypoxic–ischaemic changes in 28 (93.3%), microhaemorrhage in six (20%), lymphocytic infiltration in five (16.7%) and thrombosis in three samples (10%).

Conclusion:
Hypoxic–ischaemic change was the most common neuropathology in our patient. Our study showed that many patients with severe COVID-19 may develop central nervous system involvement.
Sacral chordoma: an unusual cause of neurogenic bladder – a case report
Authors: Jelleli Nejmeddine , Mnasser Aymen , Sakly Aymen , Slama Meriem , Fouli Sarra , Chouaya Ines , Jellali Bilel , Chouaya Sabrine , Binous Mohamed Y. 
Published: March 2023

Introduction and Importance:
Sacral chordoma is a rare tumor arising from notochord remnants. Sacral pain is the most common sign. The authors report the case of a sacral chordoma diagnosed in a urology department. It was a rare cause of erectile dysfunction and it was unusually revealed by lower urinary tract symptoms (LUTSs).

Case Presentation:
A 67-year-old man had severe dysuria associated with erectile dysfunction. On digital rectal examination, we palpated a mass protruding through the posterior wall of the rectum. The gluteal region is infiltrated by a firm mass. MRI revealed an osteolytic sacral tumor. A percutaneous biopsy of the tumor was performed. A pathological examination confirmed the diagnosis of sacral chordoma. The patient had palliative radiotherapy. One year after radiotherapy, he had rectal stenosis associated with severe constipation.

Clinical Discussion:
Sacral chordoma is a rare malignant tumor. Sacralgia is the most common sign. LUTS and erectile dysfunction were rarely reported in patients affected by this bone tumor. MRI is very suggestive of this pathology. Diagnostic confirmation requires pathological examination. The curative management consists of a large resection of the tumor. For inextricable tumors, palliative radiotherapy can be carried out. The prognosis of sacral chordoma is defined by a high recurrence potential and a low metastatic risk.

Conclusions:
Sacral chordoma is a rare bone tumor. It is an unusual cause for LUTS and erectile dysfunction. Complete tumor excision is the only curative treatment. Recurrence after treatment is the main challenge for surgeons.
Evisceration of intestines with diaphragmatic laceration and gastric perforation secondary to trauma by rhinoceros attack and its management: a case report
Authors: Karki Sabin , Shrestha Melina , Basukala Sunil , Maharjan Suman , Banmala Sabin , Hona Anil , Thapa Narayan , Thapa Bikash B. 
Published: March 2023

Introduction and Importance:
Injuries from animal attack are one of the major public health problems at present scenario globally. Proper documentation is required for the study of different types of injuries caused by animal attacks so that early intervention can be done during life-threatening conditions.

Case Presentation:
A 36-year-old male presented with an alleged history of attack by two rhinoceros sustaining injuries over the abdomen, chest, shoulder and thigh.

Clinical Findings and Investigations:
There was a lacerated abdomen with evisceration of the stomach, small intestine, transverse colon and omentum and a lacerated wound over the left lateral thigh and left buttock along with the right shoulder. Extended Focused Assessment with Sonography in Trauma ultrasound showed minimal free fluid in the pelvis. Blood profile revealed reduced haemoglobin and deranged prothrombin time/international normalized ratio.

Interventions and Outcome:
Patient underwent exploratory laparotomy twice with repair of diaphragmatic injury, excision of avulsed greater omentum in the first setting and repair of gastric perforation in the second setting with stable haemodynamic status.

Conclusion:
Abdominal evisceration injury by rhinoceros attack is life threatening though rare. Its management should consist of assessing for and controlling associated haemorrhage, assessing for bowel content leakage, covering the eviscerated abdominal contents and early reduction of viscera if there is no active bleeding.