bluuebunny/crossref_metadata_2025_split huggingface dataset:
Scrotal trichilemmal cysts: a case report
Authors: Sahito Abdul M. , Sehar Alina , Kumari Usha , Daggula Nikhil R. , Kumari Sanjana , Khoshbakht Freshta 
Published: April 2023

Introduction and importance:
Trichilemmal cyst (TC), commonly known as the pilar cyst of the scrotum wall, is an uncommon disease. It is a type of epidermoid cyst (EC) with a benign course, and malignant change is quite rare. This disease is unusual in the scrotum; therefore, multiple cysts in the scrotum are much more unusual. There have been reports of TCs in other parts of the body, but this is the first instance of scrotal TCs in Pakistan.

Case presentation:
We discuss the case of a 60-year-old male patient who presented to the clinic with a right-sided scrotal swelling, which was identified as a right-sided inguinal hernia on examination, and multiple small swellings on the scrotal skin identified as TCs. The patient had scrotoplasty after hernia surgery to remove the cysts and reconstruct the excised scrotum. Following scrotoplasty, the patient’s discomfort was resolved, and cosmetic satisfaction was achieved.

Clinical discussion:
Excision is required if TCs become infected or for esthetic reasons. In the event of big cysts, full scrotal wall resection followed by scrotoplasty is necessary. The thigh fasciocutaneous flap is used to cover the denuded testes after scrotoplasty. The procedure’s advantages include a good outcome, low morbidity, early discharge, and great esthetic outcomes.

Conclusion:
We present a literature review about multiple TCs in the scrotum and their surgical management. This case will guide surgeons and future researchers in dealing with similar cases in the future.
Demographical, clinical, and complication differences between vaccinated and unvaccinated hospitalized children with measles in mogadishu somalia: a hospital-based retrospective cohort study
Authors: Mohamud Abdirahman Khalif , Ahmed Omar Abdullahi , Ali Ikran Abdulkadir , Dirie Najib Isse 
Published: April 2023

Background:
Measles is endemic in Somalia; recurrent outbreaks are reported annually. Under-five children are the most affected due to low immunization coverage, vitamin A deficiency, and malnutrition. The study aims to evaluate the demographical, clinical, and complication variations between vaccinated and unvaccinated hospitalized children with measles in the study hospital.

Method:
A hospital-based retrospective cohort study was implemented between 10 October and 10 November 2022 by reviewing case record files following a well-structured checklist of admitted clinical features, demographic characteristics, history of measles immunization, and measles complication status. Descriptive statistics were used by presenting frequency and percentage for categorical and the mean score for continuous variables. χ2 and Fisher’s exact test at P =0.05 were used to identify the proportions differences between vaccinated and unvaccinated cases.

Result:
A total of 93 hospitalized measles children participated in the study. Over half were boys, the mean age in months was 20.9 (SD±7.28), and over two-thirds of the mothers/caregivers did not have formal education. Almost 9.7% of hospitalized measles children had one dose of the measles-containing vaccine, while none had two doses. The vaccinated cases had fewer ill with fewer complications than the unvaccinated cases. Fever, cough, rash, and Koplik’s spots were clinical features associated with measles immunization status.

Conclusion:
Around one in ten hospitalized children had one dose of the measles vaccine. Vaccinated cases had fewer illnesses with few complications than unvaccinated cases. The paper highly emphasizes providing booster doses, improving vaccine logistics and storage, and following immunization schedules. In addition, conducting further multicentral high sample-size studies is highly required to identify whether vaccine inadequacy was due to host-related or vaccine-related factors.
Severe hyponatremia as an atypical manifestation of pituitary macroadenoma: a case report
Authors: Yadav Alisha , Kharel Sanjeev , Shah Bikash K. , Parajuli Naresh 
Published: April 2023

Introduction and importance:
Pituitary macroadenoma most commonly presents with visual disturbances, headache, and other symptoms secondary to adeno hypophyseal hormonal deficiencies and usually alleviates after tumor resection. Pituitary adenomas may be the cause of the syndrome of inappropriate antidiuretic hormone secretion (SIADH) causing hyponatremia, although so far, there have only been a few documented cases. Here, we present a case of pituitary macroadenoma with SIADH and hyponatremia. This case has been reported in line with CARE (CAse REport) criteria.

Case presentation:
We present a case of a 45-year-old woman who presented with symptoms of lethargy, vomiting, altered sensorium, and seizure. Her initial sodium level was 107 mEq/l, plasma and urinary osmolality were 250 and 455 mOsm/kg, respectively, and her urine sodium level was 141 mEq/day, suggestive of hyponatremia due to SIADH. MRI scan of the brain revealed approximately 14×13×11 mm pituitary mass. Prolactin and cortisol levels were 41.1 ng/ml and 5.65 μg/dl, respectively.

Clinical discussion:
Hyponatremia can result from various diseases, making it hard to identify the cause. A pituitary adenoma is a rare cause of hyponatremia due to SIADH.

Conclusion:
Pituitary adenoma rarely might be the cause of SIADH presenting as severe hyponatremia. So, in case of hyponatremia due to SIADH, clinicians should keep pituitary adenoma as well in their differential diagnoses.
Mutation in PYCR2 gene and hypomyelinating leukodystrophy in children: a case report study
Authors: Hosseini Seyed Ahmad , Ghelichi-Ghojogh Mousa 
Published: April 2023

Introduction and importance:
Hypomyelinating leukodystrophies are a heterogeneous group of inherited white matter disorders characterized by a predominant absence of myelin deposits in the central nervous system.

Case presentation:
The patient was a one-year-old girl child. She at the age of 6 months was hospitalized due to loose, muscle weakness, and an upward gaze for 7–8 min with complaints of fever and convulsions.

Clinical discussion:
Using the test of whole exome sequencing, a nonsense homozygous mutation was found in the PYCR2 gene, which a mutation in the PYCR2 gene causes hypomyelinating leukodystrophy type 10 disease.

Conclusion:
Advances in the field of genetics, increased awareness, and the increasing availability of genetic testing in small cities in developing countries are helping to better assess complex neurological disorders and establish a complete diagnosis.
The prevalence, angiographic profile and clinical features, management, and outcomes of coronary artery perforation secondary to percutaneous coronary interventions in Pakistan: a retrospective cohort study
Authors: Khan Aiman , Kumar Rohan , Ali Rubia , Fatima Kiran , Abid Marvi , Ali Rumaisa , Meheshwari Govinda , Amin Rafiya , Hasan Mohammad , Ud Din Kasi Arbab Furquan 
Published: April 2023

Introduction:
Coronary artery perforation (CAP) is a rare entity that is often fatal. The mortality rates reported as high as up to 21% hence prompt diagnosis, intervention, and treatment are paramount to survival for such patients. Several factors may predispose a patient to coronary artery intervention including chronic total occlusion, severe calcification and tortuosity, aggressive use of oversized balloons and stents, and use of athero-ablative devices. Therefore, it is significant to have an insight related to it as despite being rare, it is one of the most feared complications of percutaneous coronary intervention (PCI).

Method:
We conducted a retrospective study of the patients who have undergone PCI at our institution from January 2015 to December 2021. During this duration, all the patients who had developed CAP based on angiographic review during the PCI were selected. The demographic, clinical, angiographic, procedure-related features, management of the CAP, and in-hospital and follow-up outcomes were gathered.

Result:
Thirty-five thousand fifty-nine patients underwent PCI among which, only 93 (0.26%) patients were complicated with (CAP. Fifty-eight (62.4%) patients were in the 50–70 years age range. The most common vessel involved was the left anterior descending (36.5%) followed by the right coronary artery (32.3%). The angiographic calcification was present in 51.6% of patients, significant tortuosity greater than 90° was seen in 48.4% of patients, chronic total occlusion was observed in 42% of patients and In-stent restenosis was found in 8.6% patients. The highest mortality of four patients was seen in the CAP involving the right coronary artery.

Conclusion:
Mostly the CAP involves large vessel perforations however both, the distal and large vessel perforations are related to the increased incidence of adverse clinical results which indicates the significance of the prevention and early identification and treatment of the perforation.
Delirium and Previous Psychiatric History Independently Predict Poststroke Posttraumatic Stress Disorder
Authors: Griffin Tian T. , Bhave Varun , McNulty Jack , Christophe Brandon R. , Garton Andrew L.A. , Sander Connolly Edward 
Published: April 2023

Objectives:
Delirium is an acute brain dysfunction that has been correlated with adverse mental health outcomes, such as depression and posttraumatic stress disorder (PTSD). However, delirium has not been studied in relation to mental health outcomes after cerebrovascular events. This study aimed to examine the incidence of PTSD after nontraumatic intracerebral hemorrhage (ICH) and identify new predictors of poststroke PTSD symptoms.

Methods:
Clinical data were collected from 205 patients diagnosed with nontraumatic ICH. Demographics and hospital course data were examined. Univariate and multivariable correlational analyses were performed to determine predictors of PTSD symptoms. PTSD symptoms were assessed using PTSD checklist—civilian version (PCL-C) scores.

Results:
Diagnostic criteria for a positive PTSD screen (PCL-C score ≥44) were met by 13.7%, 20.2%, and 11.6% of nontraumatic patients with ICH at 3, 6, and 12 months, respectively. On univariate analysis, younger age, female sex, unemployed, and in-hospital delirium were correlated with higher PCL-C scores. In multivariable models, younger age, female sex, unemployed, in-hospital delirium, and a previous anxiety or depression diagnosis were associated with higher PCL-C scores at different follow-up times. Modified Rankin Scale scores were also positively correlated with PCL-C scores at each time point.

Conclusions:
Delirium, previous psychiatric history, younger age, female sex, and unemployment status were found to be associated with a greater degree of posthemorrhagic stroke PTSD symptoms. More significant PTSD symptoms were also correlated with greater functional impairment. A better understanding of patient susceptibility to PTSD symptoms may help providers coordinate earlier interventions.
Developing Gender-Affirming Surgery Curricula for Plastic Surgery Residency and Fellowship via Delphi Consensus
Authors: Song Siyou , Park Keon Min , Parmeshwar Nisha , Dugi Daniel , Schechter Loren , Berli Jens Urs , Kim Esther A. ,   Group GAS Research
Published: April 2023

Background:
Gender-affirming surgery (GAS) is a rapidly growing field within plastic surgery, and it is crucial that residents and fellows receive appropriate training. However, there are no standardized surgical training curricula. Our objective was to identify core curricula within the field of GAS.

Methods:
Four GAS surgeons from different academic institutions identified initial curricular statements within six categories: (1) comprehensive GAS care, (2) gender-affirming facial surgery, (3) masculinizing chest surgery, (4) feminizing breast augmentation, (5) masculinizing genital GAS, and (6) feminizing genital GAS. Expert panelists consisting of plastic surgery residency program directors (PRS-PDs) and GAS surgeons were recruited for three rounds of the Delphi-consensus process. The panelists decided if each curriculum statement was appropriate for residency, fellowship, or neither. A statement was included in the final curriculum when Cronbach’s alpha value was ≥ 0.8 meaning that ≥ 80% of the panel agreed on inclusion.

Results:
34 panelists (14 PRS-PDs and 20 GAS surgeons representing 28 U.S. institutions) participated. The response rate was 85% for the first round, 94% for the second, and 100% for the third. Out of 124 initial curriculum statements, 84 reached consensus for the final GAS curricula, 51 for residency and 31 for fellowship.

Conclusions:
A national consensus on core GAS curriculum for plastic surgery residency and GAS fellowship was achieved via a modified Delphi method. Implementation of this curriculum will ensure that trainees in plastic surgery are adequately prepared in the field of GAS.
Evaluating Outcomes and Time Delays of a Non-Trainee-Driven Hospitalist Procedure Service
Authors: Orewa Gregory N. , Feldman Sue S. , Redmond Nicole , Hall Allyson G. , Kennedy Kierstin Cates 
Published: April 2023

Background and Objectives:
Ultrasound guidance has become standard of care in hospital medicine for invasive bedside procedures, especially central venous catheter placement. Despite ultrasound-guided bedside procedures having a high degree of success, only a few hospitalists perform them. This is because these are usually performed by radiologists or in the setting of trainee-run procedure teams. We sought to determine the impact of a non-trainee driven, hospitalist-run procedure service relative to time from consult to procedure.

Methods:
The University of Alabama at Birmingham Hospital (UAB), Department of Hospital Medicine, trained 8 non-trainee hospitalist physicians (from existing staff) to implement the ultrasound-guided procedure service. This study examines consult to procedure completion time since the implementation of the procedure service (2014 to 2020). Univariate analyses are used to analyze pre-implementation (2012-2014), pilot (2014-2016), and post-implementation data (2016-2018 initial, and 2018-2020 sustained).

Results:
Results suggest a 50% reduction in time from consult to procedure completion when compared with the period before implementation of the nontrainee hospitalist procedure service.

Conclusions:
A hospitalist procedure service, which does not include trainees, results in less time lag from consult to procedure completion time, which could increase patient satisfaction and improve throughput. As such, this study has wide generalizability to community hospitals and other nonacademic medical centers that may not have trainees.
Hepatic Superscan in Methotrexate-Associated Lymphoproliferative Disorder
Authors: Chow Tsz-Kit 
Published: April 2023

Abstract
A 60-year-old man on methotrexate for treatment of adult-onset Still disease presented with acute onset of fever, pancytopenia, and deranged liver function. Besides FDG-avid lesions in spleen and skeleton, his 18F-FDG PET/CT study showed diffuse and intense uptake in the liver with significantly suppressed heart and brain activity (reminiscent of a hepatic superscan). Subsequent biopsy confirmed the diagnosis of methotrexate-associated lymphoproliferative disorder.
Incidental Finding of Intervertebral Disc Herniation With Increased 18F-FAPI-04 Uptake in a Healthy Volunteer
Authors: Yuan Hui , Liu Entao , Li Zhenxiang , Zhang Qing , Jiang Lei 
Published: April 2023

Abstract
A 44-year-old healthy volunteer received an 18F-FAPI-04 scan for a normal biodistribution and dosimetry study. An incidental finding of an increased uptake of the radiotracer at the L4/5 subarticular disc herniation was noted, and a subsequent MRI scan confirmed the degenerative nature of the lesion.
Factors Affecting Postoperative Complications of Suction-Curettage by Arthroscopic Shaver for Bromhidrosis
Authors: Chen Kun-Han , Changchien Chih-Hsuan , Fang Chien-Liang , Yang Cheng-San , Tsai Chong-Bin , Chen Ming-Shan , Yang Hsin-Yi 
Published: April 2023

Background
Suction-curettage by arthroscopic shaver is the most effective treatment for bromhidrosis; however, postoperative complications require wound management and exhibit a high risk of hypertrophic scarring. We investigated factors affecting postoperative complications.

Methods
We retrospectively evaluated data for 215 patients (430 axillae) with bromhidrosis treated with suction-curettage by arthroscopic shaver between 2011 and 2019. Cases followed for less than 1 year were excluded. Complications of hematoma or seroma, epidermis decortication, skin necrosis, and infection were recorded. Multinomial logistic analysis was used to calculate odds ratios and corresponding 95% confidence intervals for the complication of the surgery, adjusting for relevant statistically significant variables.

Results
Complications occurred in 52 axillae (12.1%). Epidermis decortication occurred in 24 axillae (5.6%), with a significant difference for age (P < 0.001). Hematoma occurred in 10 axillae (2.3%) with a significant difference in tumescent infiltration use (P = 0.039). Skin necrosis occurred in 16 axillae (3.7%) with a significant difference for age (P = 0.001). Infection occurred in 2 axillae (0.5%). Severe scarring occurred in 15 axillae (3.5%), with complications related to more severe skin scarring (P < 0.05).

Conclusion
Older age was a risk factor for complications. Use of tumescent infiltration resulted in good postoperative pain control and less hematoma. Patients with complications presented with more severe skin scarring, but none experienced limited range of motion after massage.
Cognitive Impairment in Liver Transplant Recipients With a History of Cirrhosis: A Systematic Review
Authors: Siddiqui Osama M. , Baskaran Archit B. , Lin Katherine A. , Najam Naela , Shah Tahir , Beestrum Molly L. , Thuluvath Avesh , Bonakdarpour Borna , Kim Minjee , Dietch Zachary , Wolf Michael , Ladner Daniela P. 
Published: April 2023

Background.
Cognitive impairment is common among patients with cirrhosis and may persist post-transplantation. This systematic review seeks to (1) describe the prevalence of cognitive impairment in liver transplant (LT) recipients with a history of cirrhosis, (2) describe risk factors for this population, and (3) describe associations between post-transplant cognitive impairment and quality outcome measures.

Methods.
Studies in PubMed, Embase, Scopus, PsychINFO, and the Cochrane Database of Controlled Trials were included through May 2022. Inclusion criteria included (1) population – LT recipient, age ≥18 y, (2) exposure – history of cirrhosis before transplant, and (3) outcome – cognitive impairment after transplant (per validated cognitive testing). Exclusion criteria included (1) wrong study type, (2) abstract-only publication, (3) full-text unavailable, (4) wrong population, (5) wrong exposure, and (6) wrong outcome. The risk of bias was assessed using the Newcastle-Ottawa Scale and the Appraisal tool for Cross-Sectional Studies. The Grading of Recommendations, Assessment, Development, and Evaluations system was used to assess evidence certainty. Data from individual tests were categorized into six cognitive domains: attention, executive function, working memory, long-term memory, visuospatial, and language.

Results.
Twenty-four studies were included covering 847 patients. Follow-up ranged from 1 mo to 1.8 y after LT. Studies had a median of 30 (interquartile range 21.5–50.5) patients. The prevalence of cognitive impairment after LT ranged from 0% to 36%. Forty-three unique cognitive tests were used, the most common being the Psychometric Hepatic Encephalopathy Score. The most frequently assessed cognitive domains were attention (10 studies) and executive function (10 studies).

Conclusions.
The prevalence of cognitive impairment after LT varied across studies depending on cognitive tests utilized and follow-up duration. Attention and executive function were most impacted. Generalizability is limited due to small sample size and heterogeneous methodology. Further studies are needed to examine differences in the prevalence of post-LT cognitive impairment by etiology, risk factors, and ideal cognitive measures.
Bivalent mRNA-1273.214 vaccine effectiveness against SARS-CoV-2 omicron XBB* infections
Authors: Chemaitelly Hiam , Ayoub Houssein H. , AlMukdad Sawsan , Faust Jeremy Samuel , Tang Patrick , Coyle Peter , Yassine Hadi M. , Thani Asmaa A. Al , Al-Khatib Hebah A. , Hasan Mohammad R. , Al-Kanaani Zaina , Al-Kuwari Einas , Jeremijenko Andrew , Kaleeckal Anvar H. , Latif Ali N. , Shaik Riyazuddin M. , Abdul-Rahim Hanan F. , Nasrallah Gheyath K. , Al-Kuwari Mohamed G. , Butt Adeel A. , Al-Romaihi Hamad E. , Al-Thani Mohamed H. , Al-Khal Abdullatif , Bertollini Roberto , Abu-Raddad Laith J. 
Published: April 2023

AbstractQatar introduced COVID-19 bivalent vaccination for persons ≥12 years old using the 50-μg mRNA-1273.214 vaccine combining SARS-CoV-2 ancestral and omicron BA.1 strains. We estimated effectiveness of this bivalent vaccine against SARS-CoV-2 infection using a matched, retrospective, cohort study. Matched cohorts included 11,482 persons in the bivalent cohort and 56,806 persons in the no-recent-vaccination cohort. During follow-up, 65 infections were recorded in the bivalent cohort and 406 were recorded in the no-recent-vaccination cohort. None progressed to severe, critical, or fatal COVID-19. Cumulative incidence of infection was 0.80% (95% CI: 0.61-1.07%) in the bivalent cohort and 1.00% (95% CI: 0.89-1.11%) in the no-recent- vaccination cohort, 150 days after the start of follow-up. Incidence during follow-up was dominated by omicron XBB* subvariants including XBB, XBB.1, XBB.1.5, XBB.1.9.1, XBB.1.9.2, XBB.1.16, and XBB.2.3. The adjusted hazard ratio comparing incidence of infection in the bivalent cohort to that in the no-recent-vaccination cohort was 0.75 (95% CI: 0.57-0.97). Bivalent vaccine effectiveness against infection was 25.2% (95% CI: 2.6-42.6%). Effectiveness was 21.5% (95% CI: -8.2-43.5%) among persons with no prior infection and 33.3% (95% CI: - 4.6-57.6%) among persons with prior infection. mRNA-1273.214 reduced incidence of SARS- CoV-2 infection, but the protection was modest at only 25%. The modest protection may have risen because of XBB* immune evasion or immune imprinting effects, or combination of both.
Metabolic complexity increases adaptability
Authors: Fritzemeier Claus Jonathan , Ghaffarinasab Sajjad , Lieder Felix , Szappanos Balázs , Jarre Florian , Papp Balázs , Pál Csaba , Lercher Martin J. 
Published: April 2023

AbstractBacteria show a striking ability to adapt to new environments through horizontal gene transfer. Anecdotal evidence suggests that some bacteria are more adaptable than others:e.g., intestinalE. colifrequently spin off pathogenic strains adapted to other human tissues, while gastricHelicobacter pylorido not. However, it is unclear what determines the ability of individual strains or species to adapt to new environments. Here, we use pan-genome scale modeling to explore the ability of 102 different unicellular organisms to adapt to each of 5000+ diverse nutritional environments. While the small metabolic systems of specialized endosymbionts typically require 50+ additional metabolic reactions to adapt to new environments, different strains of the generalistE. colirequire on average less than 5 new reactions. Thus, there is a positive feedback between metabolic complexity and adaptability, contrary to speculations that complex systems are generally less adaptable.