bluuebunny/crossref_metadata_2025_split huggingface dataset:
Influence of implant protrusion length and initial bone height on intrasinus bone gain in transalveolar sinus floor elevation without bone graft: a 2-year retrospective study
Authors: Albash Ziad , Khalil Ali , Sleman Nadim 
Published: August 2023

Introduction:
A transalveolar sinus lift is a safe and predictable long-term surgical approach. Several factors affect clinical and radiographic outcomes. This study aimed to evaluate the correlation between intrasinus bone gain (IBG) with the implant protrusion length (IPL) and the initial bone height (IBH) in transalveolar sinus floor elevation (TSFE) without bone graft procedures.

Materials and methods:
This retrospective cohort study was carried out on patients who had reported to the department of oral and maxillofacial surgery at Tishreen University between January 2020 and September 2022. The sample consisted of patients who had a transalveolar sinus lift with simultaneous dental implants placement. TSFE was performed using motorized threaded bone expanders. The IBH, the IPL, and the IBG height were analyzed using CBCT scans that were taken preoperatively and 6 months postoperatively. Statistical analysis was performed to assess the relationship of the IBG with the IPL and the IBH. The P values < 0.05 were considered to be statistically significant.

Results:
A total of 34 implants were placed using motorized threaded bone expanders in 29 patients who were included in the study. Three membrane perforations were observed out of 34 procedures (8.82%). The survival rate for all implants was 100%. The mean IBH was 6.37±0.85 mm, the mean IPL was 2.01±0.55 mm, and the mean IBG was 1.69±0.44 mm. A strong positive correlation was found between bone gain and IPL. No correlation was found between bone gain and IBH.

Conclusions:
According to the result of this study, the IPL is a critical factor in TSFE and dental implant placement simultaneously without bone graft procedures.
Anti-acid treatment for ulcerated early gastric cancer may be a treatment option avoiding unnecessary gastrectomy: a cohort study
Authors: Suto Daisuke , Yoshida Masashi , Otake Takaaki , Osawa Yosuke , Sato Kiichi , Yamada Hidehiko , Akita Takayuki , Ohdaira Hironori , Suzuki Yutaka , Kohgo Yutaka 
Published: August 2023

Background:
Diagnosing the invasion depth of ulcerated early gastric cancer is usually inaccurate, especially for endoscopists in primary care clinics who are often not experts in this area. In reality, many patients with open ulcers who can be treated with endoscopic submucosal dissection (ESD) are referred for surgery.

Materials and methods:
Twelve patients with ulcerated early gastric cancer who were treated with proton pump inhibitors, including vonoprazan, and underwent ESD were included in the study. Conventional endoscopic and narrow-band images were evaluated by five board-certified endoscopists (two physicians: A, B, and three gastrointestinal surgeons: C, D, and E). They assessed the invasion depth, and the results were compared with the pathologic diagnosis.

Results:
The accuracy of the invasion depth diagnosis was 38.3%. According to the pretreatment diagnosis of invasion depth, gastrectomy was recommended for 41.7% (5/12) of the cases. However, histological examination revealed that additional gastrectomy was required in only one case (8.3%). Thus, in four out of five patients unnecessary gastrectomy could be avoided. Post-ESD mild melena occurred in only one case, and there was no case of perforation.

Conclusion:
Antiacid treatment contributed to avoid unnecessary gastrectomy in four out of five patients for whom gastrectomy was indicated based on an inaccurate pretreatment diagnosis of the invasion depth.
Delayed enterocutaneous fistula after 17 years of gunshot wound injury: a case report
Authors: Nur Nuradin M. , Salad Najib M. , Ahmed Abdullahi A. 
Published: August 2023

Introduction and importance:
Enterocutaneous fistula (ECF) is a common complication of abdominal surgery. Postoperatively, it may be the result of a small intestinal injury or an anastomosis leak, and it typically manifests days or weeks following surgery.

Case presentation:
A 56-year-old man with a history of a gunshot wound injury in the abdomen with colon injury managed for colocolic anastomosis 17 years earlier presented to our hospital’s general surgery clinic with the complaint of drainage at the scar area. It was discovered that he had an ECF. The patient underwent a laparotomy. Fistula tract excision and segmental colon resection with colocolic anastomosis were done.

Clinical discussion:
ECF formation after an extraordinarily long latency due to an anastomotic leak, which has not been previously documented in the literature, is a distinctive aspect of the case. As a result, surgeons should consider ECF in their differentials for patients with a history of abdominal operations.

Conclusion:
Surgical management is the definitive treatment of ECF after proper resuscitation and stabilization of the patient’s condition. Preoperative imaging is crucial for determining the anatomy of the fistula and any associated intra-abdominal pathology.
Emphysematous pyelonephritis complicated by septic shock treated with antibiotic therapy alone: a case report
Authors: Merbouh Manal , El Aidouni Ghizlane , Bkiyar Houssam , Housni Brahim 
Published: August 2023

Introduction and importance:
Emphysematous pyelonephritis (EPN) is a rare and serious complication of urinary tract infections that mainly occurs in diabetic patients. It results in the development of aerobic gas-forming bacteria1. Diagnosis is based mainly on a computed tomography scanner. Therapeutic management is based on the patient’s clinical condition and radiological classification.

Case presentation:
We present a case of a 64-year-old female patient with type 2 diabetes under insulin and hypertension under amlodipine, who was admitted to the intensive care unit for a state of septic shock on EPN. The patient received resuscitation measures and antibiotic therapy, and the evolution was favorable. The patient was transferred to the urology unit after 10 days of hospitalization in the intensive care unit.

Discussion:
EPN is frequently caused by gram-negative cocci and generally develops in diabetics. The clinical signs of EPN are not very specific and are essentially based on the signs of acute pyelonephritis, which responds badly to treatment.

Conclusions:
It is essential to take preventive measures in diabetic patients to avoid this complication. Early diagnosis allows for avoiding surgery by preserving the kidney.
Case of left atrial myxoid sarcoma with lung metastases presented as a cardiogenic shock: a case report and literature review
Authors: Khalil Omar R.S. , Omar Belal M.M. , Khalil Lamees , Tarabieh Doaa , Al-Karaja Layth , Alkhatib Hasan , Asad Diya 
Published: August 2023

Introduction and importance:
Cardiac tumors are a rare condition that typically presents with nonspecific symptoms. Among the histologic patterns, myxoid sarcomas are rarely identified and may have a less favorable prognosis. Reporting a case of this type of cardiac tumor can increase awareness about this condition and aid in early diagnosis, potentially leading to better outcomes.

Case presentation:
We are presenting a case of a 41-year-old female with left atrial myxoid sarcoma, which was presented with a cardiogenic shock picture. She underwent surgical excision of the mass and was discharged in good condition. After discharge, she deteriorated and was found to have lung metastases.

Clinical discussion:
Primary cardiac sarcomas, due to their rarity and poor prognosis, are often diagnosed at an advanced stage of the disease and lack sufficient data to establish a standard course of treatment. The cornerstone of therapy is surgical resection. However, novel therapeutic approaches must be developed.

Conclusions:
Primary cardiac tumors should be suspected in adult patients with progressive dyspnea, and a biopsy should also be done to determine the histopathological pattern of the mass and estimate the overall prognosis and outcomes.
Immediate dental implantation after indirect sinus elevation using osseodensification concept: a case report
Authors: Mohrez Majd , Amam Mohey A. , Alnour Amirah , Abdoh Ealaf , Alnajjar Alaa , Beit Zavin K. 
Published: August 2023

Introduction and importance:
Implantation in the posterior maxilla is more challenging due to the insufficient bone height after maxillary sinus pneumatization and the low bone density. Osseodensification (OD) is considered a novel, less invasive, and more effective indirect sinus floor elevation technique.

Case presentation:
A 52-year-old male presented to the oral and maxillofacial surgery department with a main complaint of chewing difficulties in the right posterior area maxilla (teeth numbers: 26 and 27). A cone-beam computed tomography (CBCT) imaging showed that the residual bone height ranged between 1 and 4 mm and the width ranged between 9 and 12 mm in the area of teeth numbers 16 and 17.

Intervention and outcome:
The treatment plan was to extract the teeth (numbers: 16 and 17) and conduct internal sinus lifting and bone grafting using the OD burs with immediate implantation.

Clinical discussion:
OD is proposed as an alternative procedure to the direct (lateral window) sinus floor elevation procedure. The amount of vertical bone gain obtained by this technique in transcrestal sinus lifting can be the same as external sinus lifting in this case.

Conclusion:
OD can be considered a promising technique for direct sinus floor elevation, considering the amount of vertical bone gain obtained by this technique.
Colonic pedunculated polypoid vascular ectasia mimicking ileocolic intussusception: a rare case report
Authors: Raut Ujwal , Thapa Santosh , Shrestha Garima , Shah Sandesh , Karki Utsav 
Published: August 2023

Introduction and importance:
Vascular ectasias are characterized by abnormal blood vessel enlargement and presumed to be caused by degenerative processes. About 3% of lower gastrointestinal bleeding is caused by it. On endoscopy, colonic arteriovenous malformations are frequently solitary, sizable, flat, or raised red lesions. Conversely, colonic vascular ectasia that manifests as pedunculated polypoid lesions are rare.

Case presentation:
A 45-year-old woman presented with hematochezia and abdominal pain. Abdominal ultrasound and Contrast enhanced computed tomography abdomen, both showed features of ileocolic intussusception. Intraoperatively, an intraluminal pedunculated polypoid growth extending up to the hepatic flexure of the colon was discovered. A right hemicolectomy was performed, removing the polypoid growth as well. After histopathological evaluation, a final diagnosis of colonic polypoid vascular ectasia was made.

Clinical discussion:
Gastrointestinal bleeding is the common initial manifestation of vascular ectasia, while some individuals may continue to be asymptomatic. According to a study from July 2022, vascular ectasia that manifests as polypoid growth is an uncommon phenomenon that has only been documented in 17 other cases. An intussusception may have a polypoid vascular ectasia as its lead point. Conversely, a large polypoid vascular ectasia may have radiographic characteristics that resemble an intussusception.

Conclusion:
Large colonic vascular ectasia, which tends to enlarge over time, can occasionally be misinterpreted as an intussusception due to comparable radiological appearances. In the event that a polypoid colonic vascular ectasia is misidentified for intussusception, the surgical team must be ready to adjust the treatment protocol as needed.
Intussusception-induced acute abdomen caused by a giant lipoma in the transverse colon: a rare case report
Authors: Wardeh Abdulkareem Muhammad , Sattout Ghaith Izz Aldeen , Mansour Marah , Suliman Mahmoud , Alloush Ali Muhammad , Salloum Rabab 
Published: August 2023

Introduction:Intussusception is a common finding among children. Conversely, it is infrequent in adults. Colonic lipomas are generally clinically silent making them a very rare etiology of intussusception.Presentation of case:The authors present a case of a 48-year-old male who presented to the emergency department suffering from severe abdominal pain. Following examination and investigations, a giant lipoma (GL) in the transverse colon was identified via ultrasound which showed the classical “target sign”.Clinical discussion:Intussusception among adults is unusual as it accounts for only 1% of bowel obstruction cases. Being colo-colonic makes it even more unlikely since it occurs only in 17% of intestinal obstruction cases. GLs exceeding 5 cm in size can present with a variety of symptoms. Intussusception is an uncommon presentation of a GL. Preoperative diagnosis of GL-induced intussusception is highly improbable and surgical resection is the treatment of choice.Conclusion:Despite the dominance of the asymptomatic presentation of lipomas, considering its diagnosis in the case of an intussusception-induced acute abdomen should cross physicians’ minds.
Methodology to evaluate the effectiveness of instituting a modified preoperative time out on teamwork: a pilot study
Authors: Edelstein Robert A. 
Published: August 2023

Objective:
To evaluate the effectiveness of modifying the preoperative surgical time out in increasing a validated measure of teamwork in the operating room.

Methods:
This study was conducted as a pre-intervention, post-intervention pilot study. A validated survey was used as an instrument to measure overall teamwork in the operating room. Data were obtained in two periods of time: In phase 1 (pre-intervention), the standard preoperative surgical time out was used. In phase 2 (post-intervention), a modification of the standard time out was employed, emphasizing the equality and importance to safety of listening to the opinions of all team members in the room.

Results:
The use of an enhanced surgical time out was shown to have a small, but measurable positive correlation with a validated measure of operating room teamwork. Mean survey Likert scores increased from 68.03 to 68.81 out of a total survey score of 90, with an appropriate control range shift. Although this small pilot study was insufficiently powered to evaluate subcategories of teamwork, such as clinical leadership, communication, coordination, and respect, we hope to address this in future larger studies.

Conclusion:
Our data from this pilot study suggest that giving each member of the surgical room team a position of equality in analyzing the operating room environment prior to commencing surgery led to a positive, measurable difference in an objective measure of teamwork. Increases in teamwork have been shown in the literature to lead to an overall safer surgical environment.
Neurological injury in primary Sjogren’s syndrome
Authors: Khalayli Naram , Bouri Mhd Fares , Wahbeh Molham , Drie Tasneem , Kudsi Maysoun 
Published: August 2023

Introduction:
The incidence of neurological injury in primary Sjogren’s syndrome varies between 2.5 and 60%. The authors aimed to evaluate its prevalence and characteristics in patients with primary Sjogren’s syndrome in a sample of the Syrian population.

Patients and methods:
Forty-eight patients with primary Sjogren’s syndrome, attending outpatient clinics at Damascus Hospital between January 2020 and January 2022 in this cross-sectional study at the outpatient clinics, were interviewed and examined, and the necessary laboratory and radiological examinations were demanded. Information was collected on disease duration, onset time, and patterns of neurological symptoms.

Results:
Forty-eight patients, including 42 females, aged 56.1±10.3 years were enroled.
Central nervous system involvement was found in 34 patients. 85% of patients had generalized nerve manifestations, while local nerve manifestations were found in 77,5% of patients. The common neurological manifestation was headaches, then cognitive disorders, and the most common pattern of headache was migraine. Beck Depression Index showed a significant increase in the apathy evaluation scale.
The study of cognitive changes showed a significant increase in the Mini-Mental State Examination (MMSE) index.
Carotid Doppler showed the presence of injury in 42.4% of patients. The magnetic resonance imaging showed positive findings in 21 patients and positive evoked potentials in 52% of patients.

Discussion:
Studies showing the prevalence of Sjogren’s neurological injury patterns are insufficient, but this was changed when the criteria for diagnosing Sjogren’s syndrome was modified, and the definition of neurological traits in the context of the syndrome was expanded.
The presence of a high rate of headaches, cognitive changes, and fatigue confirms that generalized nervous system injuries are more common than local injuries. Migraine was the most common pattern of headache found in patients with the syndrome compared with other patterns such as tension headaches and headaches due to medications, especially analgesics.
This was associated with the presence of anti-SSA antibodies and Raynaud’s phenomenon, which suggest that the headache mechanism may be due to vascular endothelial dysfunction or an immune-mediated inflammation injury of the neurovascular system.
The changes that appeared on the MRI images suggested premotor cortex involvement rather than mesolimbic cortical impairment, and its presence was also associated with SSA antibody positivity, and it is caused by inflammation.

Conclusion:
Primary Sjogren’s syndrome should be considered as having any unspecified or specific neurological disorder.
Using the HEART score in patients with chest pain in the emergency department of Kosovo as an important triage criterion for treatment and hospitalization
Authors: Rashiti Premtim , Rashiti – Bytyçi Albiona , Haradinaj Kadri , Dermaku Erolind , Berisha Valdet , Bellanica Valon , Svarça Leonora , Haklaj Vjollca , Lahu Vendenis , Duraku Egzon , Shabani Afrim 
Published: August 2023

Background:
Despite being a frequent presenting complaint in emergency rooms, chest pain’s clinical therapy varies greatly. Our objectives were to identify the traits of people who complain of chest pain and to analyze the value of the HEART (history, electrocardiogram, age, risk factors, and initial troponin) score index for risk assessment. Depending on how bad it is, each abnormality can be given a score of zero, one, or two points. These five factors add up to the HEART score.

Methods:
Clinical information on 269 individuals with chest pain admitted to the Emergency Room was reviewed: January 2022 until January 2023. A prospective registry was used to record information about patients with nontraumatic chest discomfort who were admitted from the emergency department.

Results:
Over a 12-month period, patients admitted in emergency department were classified through HEART score. From them 101 patients (37%) belong to the age group older than or equal to 65 years, 134 patients (50%) belong to the age group 45–65 years, and 34 patients (13%) belong to the age group younger than or equal to 45 years. Strong positive correlation between troponin level (HEART score) and hospitalization, also p value 0.043 is typically considered to be statistically significant. According to HEART score classification 43 cases (60%) from the group with 7–10 (high risk) were hospitalized. According to anamnesis (history) on cardiovascular disease in relation to hospitalization, then 48 cases hospitalized (67%) belong to the classification 1-moderately suspicious and 21 cases hospitalized (29%) belong to the classification 2-highly suspicious classification.

Conclusion:
The HEART score can be used for triage since it is a simple, rapid, and accurate predictor of outcome in patients with chest pain. A medium risk group included about half of the patients who reported chest pain to an emergency room. Hospitalization and troponin level had a strong positive link (HEART score), with a p value of 0.043.
Acute coronary syndromes in chronic hemodialysis patients: a series of 34 cases (case series)
Authors: Boutaybi Mohammed , Aloutmani Badia , El-Azrak Mohammed , Ismaili Nabila , El Ouafi Noha 
Published: August 2023

Background:
Cardiovascular diseases, particularly acute coronary syndrome, are the leading cause of death in chronic hemodialysis patients. Our study aims to analyze the pathophysiological, clinical, angiographic, and therapeutic characteristics of coronary heart disease in hemodialysis patients.

Patients and Methods:
This single-centered retrospective descriptive study included 34 hemodialysis patients hospitalized in the cardiovascular ICU.

Results:
The mean age of patients in our study was 64.4±11.3 years. The main cardiovascular risk factor found in our study was age, with a prevalence of 76.50%, followed by hypertension, with a prevalence of 67.60%. Diabetes was present in 55.90% of patients. The authors also found that 17.90% of patients were obese, and 29.40% had abdominal obesity. The main cause of renal disease in our study was diabetic nephropathy (52.90% of cases), followed by hypertensive nephropathy (23.50% of cases). ST segment elevation myocardial infarction was found in 14.70% of cases, and non-ST-segment elevation myocardial infarction in 85.30% of cases. Coronary angiography was performed in 76.40% of patients. Single-vessel coronary artery disease (CAD) was found in 20%, two-vessel CAD in 50%, and three-vessel CAD in 30% of the cases. Coronary artery calcifications were observed in 21.42% of cases. 38.23% had an angioplasty, and 20.58% were referred for a coronary artery bypass graft.

Conclusion:
Despite the high mortality rate after acute coronary syndrome, hemodialysis patients are less likely to undergo diagnostic angiography or coronary revascularization. Patients on hemodialysis tend to have multiple, diffuse, calcified CAD.
Predictors of all-cause mortality in hospitalized COVID-19 patients taking corticosteroids: a multicenter retrospective cross-sectional study
Authors: Mahmoud Viviane , Hatem Georges , Al-Saleh Amani , Ghanem Diana , Yassine Ahmad , Awada Sanaa 
Published: August 2023

Introduction:
Despite the recommendations to avoid using corticosteroids systematically for hospitalized coronavirus disease of 2019 (COVID-19) patients, healthcare professionals used personalized treatments, including corticosteroids, as adjuncts to treat their patients due to their limited access to treatment options. This study aims to evaluate the use of corticosteroids among hospitalized COVID-19 patients with all-cause mortality as the primary outcome and to assess the predictors of all-cause mortality associated with the characteristics of the patients and the corticosteroid regimens adopted.

Methods:
A multicenter retrospective study was performed over three months targeting 422 COVID-19 patients from six hospitals in Lebanon. Data were collected from patients’ medical charts retrospectively and covered a period of one year (September 2020–August 2021).

Results:
The study sample included 422 patients, predominantly males, with 59% of cases classified as severe or critical cases. Dexamethasone and methylprednisolone were the most used corticosteroids. Around 22% of the patients died during hospitalization. After adjusting for covariates, performing a polymerase chain reaction before admission increased the mortality rate by 424% compared to doing it at hospital admission (aHR 4.24, 95% CI 1.35–13.3), with 18.11 times higher mortality rate among critical cases (aHR 18.11, 95% CI 9.63–31.05). Exposure to side effects from corticosteroids increased the mortality rate by 514% compared to others (aHR 5.14, 95% CI 1.28–8.58). In particular, the mortality rate among patients having hyperglycemia dropped by 73% compared to others (aHR 0.27, 95% CI 0.06–0.98).

Conclusion:
Corticosteroids are frequently used in treating hospitalized COVID-19 patients. The all-cause mortality rate was higher among older and critical cases and lower among smokers and those treated for more than 7 days. Research exploring the safety and efficacy of corticosteroids is required to allow better in-hospital management of COVID-19 cases.