bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efficacy and Safety of 5-Fluorouracil Tattooing to Repigment Idiopathic Guttate Hypomelanosis: A Split-Body Randomized Trial
Authors: Arbache Samir , Hirata Sergio Henrique 
Published: April 2023

BACKGROUD
Idiopathic guttate hypomelanosis (IGH) is a common skin disorder with no standard treatment.

OBJECTIVE
Assess the efficacy and safety of 5-fluorouracil (5FU) compared with saline, delivered using a tattoo machine, to repigment IGH lesions.

METHODS
This split-body randomized single-blinded trial recruited adults with symmetrical IGH lesions. A tattoo machine was used to deliver 5FU in IGH lesions of 1 limb and saline in the contralateral limb. Outcomes were the number of achromic lesions 30 days after treatment compared with baseline, patient satisfaction, and local or systemic adverse events.

RESULTS
Twenty-nine patients (28 women) were included. The median number of achromic lesions decreased significantly in 5FU-treated limbs (baseline: 32, interquartile range (IQR) 23–37 × post-treatment: 12, IQR 6–18, p = .000003) and saline-treated limbs (baseline: 31, IQR 24–43 × post-treatment: 21, IQR 16–31, p = .000006), but reduction was significantly more pronounced in 5FU-treated limbs (p = .00003). All participants were satisfied or very satisfied with results on 5FU-treated limbs. There were no adverse events.

CONCLUSION
5-fluorouracil delivery using a tattoo machine was more effective than saline to repigment IGH lesions, with high patient satisfaction and no adverse events.

Clinicaltrials.gov: NCT02904564.
Empowered But Isolated
Authors: Xu Mengqi , Ruan Tiantian , Luo Zhenlan , Sun Linfang , Zhu Lingyan , Hu Sanlian 
Published: April 2023

Background
Family caregivers play crucial roles in the self-management of patients with heart failure (HF). However, little is known about caregiving experiences of Chinese family caregivers during acute HF.

Objective
The aim of this study was to describe Chinese family caregivers' experiences in symptom management and care-seeking during acute HF.

Methods
This is an exploratory, qualitative study using the Consolidated Criteria for Reporting Qualitative Research guidelines. Data were collected through semistructured interviews and analyzed with thematic analysis.

Findings
A total of 21 family caregivers of patients with acute HF were enrolled in this study. “Empowered but isolated” was identified as the overarching theme during data analysis, including 3 themes and 6 subthemes: (1) “Responsible symptom managers: leading the home-based symptom management,” including 2 subthemes, “Proxy in symptom management” and “Only knowing the surface, instead of the truth”; (2) “Powerless anchors: care-seeking is a torturous journey,” including 2 subthemes, “Facing discrepancies in care-seeking” and “Seeing a doctor is the last choice”; (3) “Carrying the weight forward: responsibility combing with emotional burnout,” including 2 subthemes, “Living on tenterhooks” and “Submitting to fate.”

Conclusions
In this study, we described Chinese family caregivers' experiences in symptom management and care-seeking during acute HF. Although empowered as proxy, they were also isolated bearing a great burden, receiving insufficient support from patients, family, and the medical system.
Objective measurement of retention of laparoscopic skills: a prospective cohort study
Authors: Rahimi A. Masie , Hardon Sem F. , Scholten Samuel R. , Bonjer H. Jaap , Daams Freek 
Published: April 2023

Introduction:
There has been an overall growth of 462% in laparoscopic procedures performed by surgical residents between 2000 and 2018. Therefore, training courses in laparoscopic surgery are advocated in many postgraduate programs. While the immediate effect is determined in some cases, the retention of acquired skills is rarely investigated. The objective of this study was to objectively measure the retention of laparoscopic technical skills to offer a more personalized training program.

Methods:
First year general surgery residents performed two fundamental laparoscopic skills tasks (Post and Sleeve and the ZigZag loop) on the Lapron box trainer. Assessment was performed before, directly after, and 4 months after completing the basic laparoscopy course. Force, motion, and time were the measured variables.

Results:
A total of 29 participants were included from 12 Dutch training hospitals and 174 trials were analyzed. The 4 months assessment of the Post and Sleeve showed a significant improvement in force (P=0.004), motion (P≤0.001), and time (P≤0.001) compared to the baseline assessment. The same was true for the ZigZag loop: force (P≤0.001), motion (P=0.005), and time (P≤0.001).
Compared to the 4 months assessment, skill deterioration was present for the Post and Sleeve in the mean force (P=0.046), max impulse (P=0.12), and time (P=0.002). For the ZigZag loop, skill decay was observed for force (P=0.021), motion (P=0.015), and time (P≤0.001) parameters.

Conclusion:
Acquired laparoscopic technical skills decreased 4 months after the basic laparoscopy course. Compared to baseline performance, participants showed significant improvement, however deterioration was observed compared to postcourse measurements. To preserve acquired laparoscopic skills, it is recommended to incorporate maintenance training, preferably with objective parameters, in training curricula.
Prevalence and etiology of Helicobacter pylori infection in dyspepsia patients: a hospital-based cross-sectional study
Authors: Sardar Maryam , Kumar Deepak , Aakash FNU , Partab FNU , Kumar Sunny , Barkha FNU , Danesh FNU , Berza Qammer , Shaikh Bisma , Sangam FNU , Hasan Mohammad , Erum Sheeza , Mumtaz Hassan 
Published: April 2023

Background:

Helicobacter pylori infection is seropositive in ~50% of people globally. Therefore, this study was conducted to evaluate its prevalence in dyspepsia patients.

Methods:
A cross-sectional study was conducted at Jinnah Postgraduate Medical Centre (JPMC) from January to June 2022 to find out the prevalence and risk factors of H. pylori in dyspepsia patients. A prevalidated questionnaire was used to collect the data from 180 patients. This study adheres to the principles outlined in the Helsinki Declaration. The χ
2-test was applied, and the odds ratio and 95% CI were calculated to find the association of H. pylori with the risk factors.

Results:
A total of 180 patients were enrolled in this study, of whom, 73 (40.6%) patients were male and 107 (59.4%) were female. In seropositive H. pylori patients, 80 (60.6%) patients had nausea or vomiting, 110 (83.3%) patients were found to have flatulence, 128 (97.7%) patients were experiencing frequent burping, and 114 (86.4%) patients were having epigastric pain. The household member greater than 4, smoking, rural area residence, NSAIDs consumption, BMI greater than 25, O+ blood group, and Rhesus positive status were significantly associated with H. pylori with a P value of less than 0.05.

Conclusion:
This study concludes that the prevalence of H. pylori in our population is high, and the risk factors identified are lower class, BMI greater than 25, smoking, O+ blood group, NSAID consumption, rural area residence, household member greater than 4, Rhesus positive status, and the symptoms of nausea or vomiting, frequent burping, epigastric pain, and flatulence. Patients with an increased number of risk factors should be taken into consideration for an appropriate checkup.
Parasitological and histopathological features of appendectomy specimens in Fars Province, southern Iran: a retrospective study
Authors: Mohtasebi Sina , Shokripour Mansoureh , Vahid Parisa , Mikaeili Fattaneh , Abbaszadeh Afshar Mohammad Javad , Alimi Rasoul , Goudarzi Fatemeh , Teimouri Aref 
Published: April 2023

Background:
Although the appendix is the most commonly resected and examined intra-abdominal organ, the pathogenesis and etiology of acute nonspecific appendicitis remain enigmatic. This retrospective study aimed to assess the prevalence of parasitic infection in surgically removed appendices and to evaluate the probable associations between the presence of parasites and the occurrence of appendicitis through parasitological and histopathological examinations of the appendectomy specimens.

Materials and methods:
This retrospective study was carried out from April 2016 to March 2021 among all patients referred to hospitals affiliated with Shiraz University of Medical Sciences, Fars Province, Iran, for appendectomy. Patient information, including age, sex, year of appendectomy, and type of appendicitis, was collected from the available data in the hospital information system database. In positive cases, all pathology reports were retrospectively evaluated for the presence of the parasite and its type, and analytical and descriptive statistics were carried out using SPSS software version 22.

Results:
A total of 7628 appendectomy materials were evaluated in the present study. Of the total participants, 4528 (59.4%, 95% CI: 58.2–60.5) were males, and 3100 (40.6%, 95% CI: 39.5–41.8) were females. The mean age of participants was 23.87±14.28 years. Overall, Enterobius vermicularis was observed in 20 appendectomy specimens. Fourteen of these patients (70%) were less than 20 years old.

Conclusion:
This study indicated that E. vermicularis is one of the common infectious agents that could be found in the appendix and may increase the risk of appendicitis. Therefore, in terms of appendicitis, clinicians, and pathologists must be aware of the possible presence of parasitic agents, especially E. vermicularis, to treat and manage the patients sufficiently.
Normal preoperative levels of gamma-glutamyltransferase predict the absence of common bile duct stones in patients scheduled for laparoscopic cholecystectomy: a retrospective cohort study
Authors: Khan Noman Ahmed , Siraj Muhammad Imran , Rajput Iqra Anees , Memon Zahid Ali , Ali Rehan Ramzan , Ursani Asna , Anees Muhammad Muthar , Kumar Karan , Naina  , Kumar Rahul Robaish , Kumar Rahul , Shahab Ramsha , Asghar Muhammad Sohaib 
Published: April 2023

Objective:Laparoscopic cholecystectomy, nowadays, is considered the gold standard option for management in patients diagnosed with symptomatic cholelithiasis. Nevertheless, some patients may have coexisting choledocholithiasis, which manifests later in life with grave complications such as cholangitis and pancreatitis. The objective of this study is to evaluate the role of preoperative gamma-glutamyltransferase (GGT) in predicting choledocholithiasis in patients undergoing laparoscopic cholecystectomy.Method:A total of 360 patients with symptomatic cholelithiasis based on diagnosis aided with abdominal ultrasound were included in the study. The study design was a retrospective cohort. Patients were evaluated based on a comparison between findings of per-operative cholangiogram and laboratory measure of GGT.Result:The mean age of study participants was 47.22 (±28.41) years. Mean GGT levels were 121.54 (±87.91) U/l. One hundred (27.7%) participants had raised GGT. But only 19.4% had been diagnosed with filling defect positive on cholangiogram. The predictability of GGT for positive cholangiogram is statistically significant at less than 0.001 with an area under the curve of 0.922 (0.887–0.957), sensitivity of 95.7%, specificity of 88.6%, and accuracy of 90%. The standard error reported (0.018) was found to be relatively low.Conclusion:Based on the provided information, it is concluded that GGT plays an important role in predicting the coexistence of choledocholithiasis in symptomatic cholelithiasis and can be used in the setting where the facility of per-operative cholangiogram is not available.
Pubertal extravaginal nontraumatic spontaneous testicular torsion: a case report
Authors: Basukala Sunil , Rayamajhi Bikash Bikram , Karki Sabin , Shrestha Melina , Banmala Sabin , Maharjan Suman 
Published: April 2023

Introduction and Importance:
Testicular torsion (TT) is the most common urosurgical emergency in the case of acute scrotal pain. Early diagnosis, both clinically with imaging and emergent surgical exploration, is the key step in the salvage of testis and its management.

Case Presentation:
A 12-year-old male with no known comorbidities came to the emergency department of our center with complaints of left scrotal region pain and swelling for 10 h.

Clinical Findings and Investigation:
Left testicular tenderness and swelling with Phren’s sign negative, Deming’s sign positive, and absent cremasteric reflex. Ultrasonography showed coarse echotexture with a lack of obvious vascularity in the left testicle suggestive of TT and bulky left epididymis with bilateral hydrocele; left side greater than right.

Intervention and Outcome:
The patient underwent emergency left orchidectomy with right orchidopexy. Following this, he was symptomatically better, and the excruciating testicular pain and swelling subsided.

Conclusion:
Extravaginal TT is a rare presentation in pubertal age groups; however, whatever may be the types and causes, TT is a urological emergency that may lead to permanent ischemic necrosis. Delays in diagnosis should be avoided as this is directly related to the percentage of testicular salvage or loss. Prompt emergent surgical exploration is the cardinal point in management.
L-2-hydroxyglutaric aciduria – review of literature and case series
Authors: Ahmed Sibtain , Siddiqui Ayra , DeBerardinis Ralph J. , Ni Min , Gu Lai Wen , Cai Feng , Vu Hieu S. , Afroze Bushra 
Published: April 2023

Background:
L-2-hydroxyglutaric aciduria (L2HGA) is an autosomal recessive, slowly progressive neurodegenerative disease characterized by psychomotor delay and cerebellar dysfunction. The biochemical hallmark is increased concentrations of L2HG in body fluids. Brain MRI exhibits characteristic centripetal extension of the white matter involvement that differentiates it from other leukodystrophies. The authors report two sisters from Pakistan with L2HGA with 4 years of follow-up. The authors have also compared the clinical outcome of our patients with 45 previously reported patients with L2HGA for whom treatment and clinical outcome was reported.

Case presentation:
The authors report two sisters with L2HGA from Pakistan born to consanguineous parents. The 15- and 17-year-old girls presented with psychomotor delay, seizures, ataxia, intentional tremors, and dysarthria. Both had normal anthropometric measurements for age. Exaggerated tendon reflexes and bilateral sustained ankle clonus were observed in addition to cerebellar signs. Urine organic acids analysis showed marked excretion of 2-hydroxyglutaric acid, chiral differentiation of 2-hydroxyglutaric acid showed it to be L2HGA. Brain MRI of the 15-year-old showed diffuse subcortical white matter changes evident by T2/FLAIR hyperintense signals bilaterally, particularly in the frontal region in the centripetal distribution with some diffusion restriction along involvement of globus pallidus. The characteristic MRI pattern raised the suspicion of L2HGA. Targeted L2HGDH sequencing identified a homozygous pathogenic variant, c.829C>T (p.Arg227*) in L2HGDH gene in both girls. Both parents were heterozygous carriers of the familial variant.

Conclusion:
Neuroradiological features of centripetal subcortical leukoencephalopathy with basal ganglia and dentate nuclei involvement are rather specific to L2HGA and should lead to further biochemical investigations to look for L2HGA and L2HGDH gene sequencing.
Cyclosporine treatment for steroid-resistant nephrosis complicated with acquired hemophilia A: a case report
Authors: Alsultan Mohammad , Jomaa Hiba , Shukri Arwa , Hajij Fatima , Hassan Qussai 
Published: April 2023

Introduction:
Acquired hemophilia refers to the development of a clotting factor deficiency typically, when autoantibodies are produced against coagulation factor and tend to be in the elderly and rare in children.

Case report:
A 12-year-old girl with steroid-resistant nephrosis (SRN) was admitted complaining of pain in her right leg and an ultrasound showed a hematoma in her right calf. The coagulation profile revealed partial thromboplastin time prolongation and high titers (156 BU) of anti-factor VIII inhibitors were observed. Where half of the patients with antifactor VIII inhibitors were associated with underlying disorders, additional tests were performed that rule out secondary causes. This patient with long-standing SRN, who was on a maintenance dose of prednisone for six years, was complicated with acquired hemophilia A (AHA). In different to the last recommendations of AHA treatment, we preferred using cyclosporine; which is considered the initial second-line therapy for children with SRN. Complete remission was achieved of both disorders after a month with no recurrence of nephrosis or bleeding events.

Conclusion:
To our knowledge, nephrotic syndrome with AHA was reported in only three patients, two cases after remission and one during a relapse but no one were treated with cyclosporine. The authors encountered the first case of cyclosporine treatment for AHA in a patient with SRN. This study supports the use of cyclosporine to treat AHA, especially with nephrosis.
Effects of heated tobacco products and conventional cigarettes on dental implant wound healing: experimental research
Authors: Morishita Yoshihisa , Hasegawa Shogo , Koie Shin , Nakaya Sanako , Goto Mitsuo , Miyachi Hitoshi , Naruse Keiko , Nakamura Nobuhisa , Hayashi Tatsuhide , Kawai Tatsushi , Nagao Toru 
Published: April 2023

Background:
Smoking affects wound healing and is associated with dental implant failure. Heated tobacco products (HTPs) appear to be less harmful than conventional cigarettes (CCs); however, there is limited analytical data to support this claim. This study aimed to compare HTPs and CCs for their impact on wound healing using L929 mouse fibroblast cells and evaluate whether HTPs also lead to failure in implant therapy.

Materials and methods:
Cigarette smoke extract (CSE) was obtained from CCs (Marlboro, Philip Morris) and HTPs (Marlboro Heat Sticks Regular for IQOS, Philip Morris) and initiated a wound-healing assay with a cell-free area created in the centre of a titanium plate by sticking a 2-mm-width line tape. The L929 mouse fibroblast cells were exposed with 2.5 and 5% CSE from HTPs and CCs and then seeded in the titanium plate. A scratch wound-healing assay was initiated when all samples were at 80% confluence. The number of cells migrating to the wound site was counted after 12, 24, and 48 h.

Results:
Cell migration decreased after CSE exposure from both CCs and HTPs. At each time-point with 2.5% CSE, cell migration in the HTP group was less than that of the CC group. There were significant differences between the 2.5% CC and 2.5% HTP groups and the 5% CC and 5% HTP groups after 24 h. HTPs and CCs had similar effects in the wound-healing assay.

Conclusion:
Therefore, HTP use may be a risk factor for poor dental implant healing.
Collodion baby with ectropion in a Syrian newborn: a case report study
Authors: Soqia Jameel , Mohamad Lama , Aloqla Nizaar Adnan , Al Mouallem MHD Moamen , EID Mohammed Nader 
Published: April 2023

Introduction and importance:
Collodion baby is a rare congenital disorder and a very intense disorder in which the baby suffers from several complications, such as trans-epidermal water loss. Only ∼270 cases of collodion babies have been reported in the literature since 1892. This disease may later develop one of a spectrum of diseases including lamellar ichthyosis, which the patient may had Congenital lamellar ichthyosis with ectropion, which was clinically distinguished by the collodion baby phenotype at birth.

Case presentation:
The authors are reporting the first case in Syria, a 20-day-old white Syrian male newborn, vaginally delivered at 38 weeks of pregnancy, with normal conditions, and congenital lamellar ichthyosis was shown by physical examination, as parchment-like scales were covering the newborn’s skin, which was starting to detach and showing the “collodion baby” appearance. Ophthalmologic examination revealed a bilateral ectropion of the upper eyelids with tarsal eversion. A treatment of Tobramycin 0.3% eye ointment was prescribed four times a day, with a viscotears liquid gel eye drops 4 times a day, and vaseline petroleum jelly to be applied three times daily. At 2-month follow-up, a significant improvement was noted.

Conclusion:
Ichthyosis have a wide range of disorders that involve the skin and have inherited and acquired forms. As a result, keratolytic and systemic retinoids can have significant benefits in restoring skin function.
The rate and management of prosthetic joint infection in the low-income setting: a cross-sectional study
Authors: Hafez Mahmoud A. , Zamel Fouad , El-Khadrawi Tarek , El Ganzoury Ibrahim , Lotfy Abdel M. , Fansa Maher , Makram Abdelrahman M. 
Published: April 2023

Introduction:
Although the rate of prosthetic joint infection (PJI) after total hip and knee arthroplasties (THA and TKA, respectively) is well documented in developed countries, there is a paucity of information in the literature on infection rates in low-and-middle-income countries. This study aims to review the PJI rate and management based on the Egyptian Community Arthroplasty Registry (ECAR) and six arthroplasty surgeons.

Methods:
Using data from the ECAR, for over 10 years, and surveying six high-volume arthroplasty surgeons, we reviewed the infection rate, common organisms, antibiotics used, and how the revision surgeries were done. The total number of patients included in this study was 210 infection cases out of 5216 THA and TKA.

Results:
Out of the 5216 joint replacement surgeries, the rate of all infections in THA and TKA was 4.03% (4.73 and 2.94%, respectively). The rate of infections requiring staged revision surgeries was 2.24 and 1.71% (2.03% in total) in the THA and TKA groups, respectively. The most encountered organism was Staphylococcus aureus. The common antibiotics used were vancomycin and a combination of cefoperazone and sulbactam.

Conclusion:
From this study, we conclude that THA was associated with a higher rate of PJI, surgeons’ use of antibiotics for a relatively long period, and the rate of PJI in our setting is relatively higher than what is reported in developed countries but lower in other low-income settings. We believe that with improved operating theater design and infection control education, infection rates will decrease significantly. Finally, we acknowledge the need for a national arthroplasty registry that can help in documentation and improving patient outcomes.
Metallic foreign bodies ingestion by schizophrenic patient: a case report
Authors: Jin Shengjian , Horiguchi Taigo , Ma Xiaolong , Yuan Shichao , Liu Qingguo 
Published: April 2023

Introduction and Importance:
The ingestion of foreign objects is a widespread health issue, with a higher occurrence in adults with psychosis.

Case Presentation:
The authors present the case of a 39-year-old man who arrived at the hospital with symptoms of abdominal distension and occasional black stools for a week. The patient was known to have schizophrenia but had not received regular hospital follow-up or treatment for the past 5 years. He had a history of exogenous stimulation, which led him to surreptitiously swallow metallic objects. Upon physical examination, he displayed abdominal distension and mild tenderness in the upper abdomen. Radiographs revealed multiple foreign objects in his stomach, leading to the decision for laparotomy, gastric opening, and removal of the foreign objects under general anesthesia.

Clinical Discussion:
Mental illnesses, including schizophrenia, bipolar disorder, major depression, and multiple substance abuse, are recognized as being significant risk factors for ingesting foreign bodies. In such cases, it is crucial to intervene quickly. For patients presenting with psychiatric symptoms, the involvement of family caregivers is of even greater importance than endoscopic or surgical treatments.

Conclusion:
Foreign body ingestion is more prevalent in individuals with psychosis, highlighting the importance of ongoing care and follow-up for patients with mental illness.