bluuebunny/crossref_metadata_2025_split huggingface dataset:
Giant cervical lymphangioma encompassing the neck great vessels (carotid artery and jugular vein): a case report
Authors: Hakimi Turyalai 
Published: April 2023

Introduction and importance:
Lymphangiomas are benign congenital defects affecting the lymphatic system. These lesions commonly involve the head and neck, predominantly the posterior cervical triangle. Lymphangiomas cause obstructive symptoms in the upper airway and pose an esthetic concern to the patient. Clinically, these lesions are seen as cervical swelling, and a definite diagnosis is made by ultrasonography, computerized tomography scanning, and histopathologic analysis. Herein, the author present an unusual case of an 18-month-old child presenting with a huge cervical swelling on the right side with extension to the carotid triangle (encompassing neck great vessels) as well as unilateral neck and fascial disfigurement. The patient was treated surgically with the complete excision of the mass and followed up with an excellent esthetic result.

Case presentation:
An 18-month-old child was brought to our teaching hospital’s pediatric surgery department with a huge cervical mass on the right side since birth. Following the completion of work-up with the laboratory and imaging (computerized tomography scan) diagnostic modalities, the patient was prepared for definite treatment. Our team approached the mass through a right neck hockey stick incision, and with the preservation of the neurovascular bundle, the mass was completely excised. The patient was followed up for 12 months on two occasions, with excellent esthetic results and no relapse.

Conclusion:
Lymphangiomas confined to the posterior cervical triangle are a common problem in children. Lesions extending to the anterior of the neck, especially those involving the neck neurovascular bundle, are uncommon entities. The decision to proceed with sclerotherapy or surgical excision should be justified, provided that, during the surgical procedure, the neurovascular bundle is preserved and none of the vital organs (neurovascular components) are compensated with the goal of a complete mass excision.
Hurthle cell carcinoma: a rare variant of thyroid malignancy – a case report
Authors: Adhikari Yuvraj , Marasini Anupama , Adhikari Nawaraj , Paneru Laxman D. , Upadhaya Regmi Binit , Raut Manita 
Published: April 2023

Introduction and importance:
Oncocytic/Hurthle cell neoplasm is a rare form of thyroid malignancies, derived from follicular epithelium, presenting with a wide variety having either presenting with features of thyrotoxicosis or no any associated symptoms.

Case presentation:
The authors present a case of a 49-year-old female with a known case of chronic obstructive pulmonary disease and hypertension who presented to our hospital with anterior neck swelling for 4 months that has gradually increased over the time. Physical examination, laboratory test, various radiological imaging, and cytological study led to the diagnosis of Hurthle cell neoplasm. With prompt diagnosis, she was admitted and surgery was done that include right hemithyroidectomy. Though it is a rare type of thyroid malignancy, early diagnosis and proper treatment has shown a very good prognosis.

Clinical discussion:
Hurthle cell carcinoma initially presents with a single, painless palpable mass in the thyroid with pressure symptoms in advanced cases including dysphagia, dyspnea, and hoarseness. Pain, rapid growth, or significant compressive symptoms are suggestive of an invasive one.

Conclusion:
This case highlights on rarity of disease, presentation, and availability of treatment modality.
Herpes simplex encephalitis in a patient abusing morphine: a case report from Nepal
Authors: KC Bijay , Bhattarai Himal B. , Shah Sangam , Bhattarai Madhur , Uprety Manish , Jha Abhishek , Rayamajhi Sushil , Pant Subhash , Limbu Chandra P. , Shrestha Babu R. 
Published: April 2023

Introduction:
Herpes simplex encephalitis results from either primary infection with the herpes simplex virus (HSV) or reactivation of latent HSV residing within the nuclei of sensory neurons. Opioid’s administration is known to reactivate HSV infection.

Case presentation:
We report a 46-year-old male who was in a rehabilitation center for 17 days for abusing morphine for 2 years.

Discussion:
Chronic morphine use weakens immune system thereby, making body prone for development of infection. Opioids may reactivate HSV infection because of their immunosuppressive function.

Conclusion:
Herpes simplex encephalitis is a potentially fatal condition but can be treated with early diagnosis and intervention.
A successful process of treatment with necrotizing fasciitis of upper extremities in patients with diabetes mellitus: a case report
Authors: Wang Tian-yuan , Jiang Dong , Wang Wei , Chen Yin-chen , Sun Jin-shan , Sun Bo , Wang Ai-ping , Chen Yue-dong 
Published: April 2023

Introduction and importance:
Necrotizing fasciitis (NF) represents a rapidly progressive, life-threatening infection involving the fascia and subcutaneous tissue. Early diagnosis and intervention are crucial to treat, especially in diabetic patients.

Case presentation:
This case report presents on a patient with diabetes mellitus rapidly developed a NF of the upper extremities following a minor trauma in the palmar of greater thenar. In the initial stages of her hospital admission, severe hand soft tissue infection, and systemic toxicity is the most prominent clinical manifestation. During her hospitalization, efficacious multidisciplinary treatment was carried out to avoid severe consequences.

Clinical discussion and conclusion:
The objective of this case report is to present a successful individual strategy in a complex case to standardize the treatment process. Accurate and standardized management can improve the prognosis of patients affected from upper extremities NF of diabetic avoiding and severe complications and saving lives.
A rare case report on neonatal complications from Nepal: solitary neonatal hepatic abscess
Authors: Yogi Barurendra R. , Basnet Bal M. , Thapa Sajina , Bohara Sujan 
Published: April 2023

Introduction and Importance:
Neonatal liver abscess is a rare condition with a high mortality rate. However, in a low-resource setting, high clinical vigilance and the use of readily accessible diagnostic modalities can help in early diagnosis and, along with appropriate medical management, prevent lethal complication.

Case presentation:
We present the case of a patient who presented with one day of sudden abdominal distension and two episodes of projectile nonbilious vomiting. A solitary liver abscess was diagnosed using ultrasonography and contrast-enhanced computed tomography findings, and the patient was treated conservatively with parenteral broad-spectrum antibiotics. Following the completion of the antibiotic dose, an ultrasound of the abdomen reveals that the size of the liver abscess has decreased.

Clinical discussion:
Neonatal liver abscess is a rare clinical condition that causes significant morbidity and mortality in premature and term babies. In a neonate with potential risk factors, a high index of suspicion is required to make the diagnosis. Baseline tests, as well as computed tomography with or without contrast, aid in the definitive diagnosis of a hepatic abscess. For management, a multidisciplinary approach should be considered, including correction of the predisposing factor as well as appropriate medical and/or surgical intervention.

Conclusion:
Neonatal liver abscess is frequently overlooked due to its rarity. Thus, whenever a neonate exhibits the aforementioned clinical spectrum, it should be considered in the differential diagnosis, and a diagnostic workup and treatment should be initiated as soon as possible to avoid debilitating complications.
Bridge of the left anterior descending artery revealed by syncope: a case report
Authors: Boutaybi Mohammed , Tahani Ikram , EL-Azrak Mohammed , Ismaili Nabila , EL Ouafi Noha 
Published: April 2023

The myocardial bridge is a congenital coronary anomaly defined as the presence of a region of myocardium overlying an epicardial coronary artery. This is a 51-year-old patient, diabetic for 4 years on oral hypoglycemic, has had stress angina for 4 years, neglected by the patient. The current history goes back to 2 months by the installation of an episode of syncope occurring with the effort, then of a second episode the day of its admission. Electrocardiogram on admission showed complete atrioventricular block with an heart rate of 32 beats per minute, the patient spontaneously recovered sinus rhythm with a heart rate of 88 beats per minute and a PR interval of 200 ms, coronary angiography was performed showing coronary arteries without stenosis with an intramyocardial bridge of the left anterior descending artery. During exercise and in the presence of a myocardial bridge on the left anterior descending artery, systolic compression leads to a decrease in flow to the septal branches, which is responsible for an alteration of the vascularization of the sub-nodal tissue with paroxysmal conduction disorders leading to syncope. Conduction disorders of ischemic origin are not always associated with atherosclerotic or thromboembolic lesions, but may also be secondary to myocardial bridges.
Anesthetic management of congenital epulis in a newborn: a case report
Authors: Dulal Aliza , Timilsina Bivek , Timilsina Pratikshya , Timalsina Binod , Ranjit Sangina , Dwa Manakamana , Chaudhary Aashutosh 
Published: April 2023

Introduction:
The epulis of the newborn is a granular cell tumor that originates from the mucosa of the gingiva.

Case presentation:
The authors report a case of a 4-day-old neonate with a large mass arising from the right upper gingival area and occupying most of the oral cavity who presented for surgery with a potentially difficult airway. Intubation was achieved uneventfully using a gaseous induction with an appropriate-size facemask and displacement of the epulis to allow cautious laryngoscopy.

Discussion:
General anesthesia offers good airway protection and also alleviates the stress and pain associated with the surgery.

Conclusion:
Congenital epulis is a relatively rare congenital tumor of a newborn, which is one of the causes of difficult airways in neonates and children. However, after slight manipulation of the tumor, endotracheal intubation for the administration of general anesthesia is attainable.
Role of multimodal imaging in differentiating unilateral APMPPE from unilateral Harada disease – a case report
Authors: Sharma Sadhana , Kharel Ranju , Parajuli Sanket , Karki Pratap , Joshi Sagun N. 
Published: April 2023

Introduction and importance:
Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) is classified as a part of the spectrum of the white dot syndromes affecting the inner choroid and the outer retina. It is usually bilateral and affects young patients between the second and fourth decades. The authors report an unusual case of unilateral APMPPE mimicking Vogt–Koyanagi–Harada (VKH) disease where the fundus fluorescein angiography was instrumental in confirming the diagnosis.

Case presentation:
A 35-year-old male presented with decreased visual acuity in the right eye for 3 days. Fundus examination revealed minimal vitritis, disc edema, and multifocal yellowish placoid lesions. Optical coherence tomography (OCT) showed the accumulation of subretinal fluid with subretinal septations closely mimicking VKH. Fundus fluorescein angiography depicted features of early hypofluorescence and late staining of the placoid lesions, suggesting APMPPE. Subretinal fluid partly resolved within a week, and visual acuity improved to 6/9(20/30) in the affected eye after the use of oral NSAIDS. Complete resolution of subretinal fluid was seen after 6 weeks.

Clinical discussion:
The most distinguishing feature in this case is the unilateral presentation and macular serous retinal detachment with subretinal septa on OCT imaging, which are not the typical features in APMPPE but quite similar to the characteristic features in acute VKH disease.

Conclusion:
APMPPE and acute VKH disease may share some overlapping clinical manifestations and imaging findings on OCT. APMPPE is a self-resolving disease, unlike VKH, and early diagnosis can avoid unnecessary administration of steroids and related side effects.
An invasive squamous cell carcinoma of the ankle: a case report
Authors: Sumulong Martin Carmelo , Coruña Juan Agustin , Liawrungrueang Wongthawat 
Published: April 2023

Introduction and importance:
One to ten percent of all squamous carcinomas are invasive squamous cell carcinomas (ISCC), a rare variation of the disease. According to a recent literature review, less than 25 cases have been reported in the foot and ankle, making it especially uncommon in those areas.

Case presentation:
The authors present the case of a male patient, 60 years old, who presented with a progressive mass on his left ankle for 2 years with a history of healed burns in that area. The ISCC was diagnosed using histopathology after which he underwent a marginal excision biopsy and split-thickness skin grafting. Wide-marginal excision and split-thickness skin grafting were done. It was noted that the graft had taken well and that there were clear tumour margins postoperatively. The skin graft was almost completely incorporated. No tumour cells were reported on the margins during the postoperative histopathology.

Clinical discussion:
This case highlights a successful outcome of the patient improved at the 12-month follow-up, and he expressed a high degree of satisfaction with the treatment.

Conclusion:
ISCC of the lower extremities is a rare disease that almost never affects the ankle and is frequently treated inappropriately since it mimics chronic wounds. It is important to have an index of suspicion in patients with a history of chronic irritation to the area of interest. Surgery is the primary option if ICCS is detected. Clear tumour margins are important, and, if done well, excision should be curative.
Revealing the relation between job satisfaction and workload: a cross-sectional study in the emergency department
Authors: Batarfi Rayan F. , Bakhsh Ahmad M.A. , Alghamdi Ibrahim D. , Alotaibi Faris A. 
Published: April 2023

Background:
Job satisfaction is recognized as an essential parameter that affects the performance and quality of medical services provided by emergency department (ED) health professionals. However, little is known about the status of job satisfaction related to workload among ED staff in Saudi Arabia. This study aimed to explore the current level of job satisfaction and to analyze the relationship between job satisfaction and the personal and professional characteristics of ED staff.

Methods:
A cross-sectional questionnaire-based study was conducted among ED staff, including various job positions, to assess job satisfaction. An online questionnaire was sent electronically to all ED staff. The structured online questionnaire collected information on sociodemographic factors, workload-related factors, and job satisfaction. The data was analyzed using SPSS version 26.

Results:
The questionnaire used to assess job satisfaction levels demonstrated high internal consistency and reliability using Cronbach’s α (0.85). Completed responses were obtained from 103 ED staff members; 58.25% were males, and most of the participants in the survey were either nurse (48.54%) or physicians (28.16%). Most of the respondents (61.16%) had a satisfaction score that was higher than half of the possible attainable score and showed a high level of satisfaction, although 38.84% fell below half of the possible attainable score on the satisfaction parameter and showed a lower level of satisfaction.

Conclusion:
It may be concluded that ED staff have a higher level of job satisfaction related to workload factors. The level of satisfaction did not change for different age groups, genders, levels of education, levels of experience, or jobs.
ERCP practice at a tertiary care hospital in Kashmir, North India: a large single-center cross-sectional study with focus on quality indicators, success rate, and indications
Authors: Parveen Shaheena , Shah Altaf H. , Gulzar Ghulam M. , Sodhi Jaswinder S. , Khan Mushtaq A. , Tiwari Avinash , Mir Tariq A. , Sharma Ankush , Ahmad Syed N. , Dar Nazir A. 
Published: April 2023

Introduction:
Endoscopic retrograde cholangiopancreatography (ERCP) is the most technically demanding endoscopic procedure with significant adverse events that mandate appropriate training, competence and careful decision-making. The American Society for Gastrointestinal Endoscopy (ASGE) and the European Society of Gastrointestinal Endoscopy (ESGE) updated a list of quality indicators and performance measures for pancreatobiliary endoscopy. Nevertheless, real-life data are scarce, especially from developing countries. The study aimed to assess overall quality, procedural success, and indications of ERCP at our center.

Methods:
An audit of our endoscopy center at the start of the study for quality and performance indicators and a retrospective analysis of the 4 years of the prospectively maintained data of patients who underwent ERCP regarding procedural success and indications was done.

Results:
The study showed that ERCP is performed by meeting good quality standards, but structured training, sedation practice, and microbiological surveillance are subpar. A total of 3544 procedures were carried out with successful cannulation of the naive papilla in 93%, with 60% of procedures carried out on females, 80.5% of procedures done for benign diseases, and 19.5% on suspected or proven malignancy (47% men and 53% women) with perihilar obstruction being commonest in both sexes (32–33%) followed by carcinoma gallbladder in women (21%) and distal cholangiocarcinoma in men (27%). Among benign diseases (2711), 12% had benign pancreatic diseases, and 64.8% had common bile duct (CBD) stones, with 31% of CBD stones requiring more than one session for clearance.

Conclusion:
ERCP at our center is performed by meeting quality standards and by competent endoscopists with good procedural success. Improving sedation strategies, microbiological surveillance, and training programs remains an unmet need.
The Relationship Between Social Anxiety Disorder and Psychological Symptoms in University Students
Authors: Künkül Feyza , Bal Fatih 
Published: April 2023

Abstract
The aim of this study was to examine the relationship between social anxiety disorder and psychological symptoms in university students. It was also aimed to reveal the relationship between the dependent variables of the research and sociodemographic variables. The research is of the relational type, and the survey method was used to collect the relevant data. The research data were obtained from a total of 300 university students, 150 women and 150 men. According to the findings of the study, a low-, medium-, and high-strength linear relationship was found between social anxiety disorder and the Symptom Checklist-90 (SCL-90) general and its subdimensions. Scores on SCL-90 general and its subdimension increased as social anxiety disorder increased in the university student participants. It is recommended to give awareness education under the name of “general awareness-raising” about the concepts of social anxiety disorder and psychological symptoms in university students.
Responders and nonresponders to topical capsaicin display distinct temporal summation of pain profiles
Authors: Wong Felyx , Reddy Aditi , Rho Yeanuk , Vollert Jan , Strutton Paul H. , Hughes Sam W. 
Published: April 2023

Abstract

Introduction:
Topical application of capsaicin can produce an ongoing pain state in healthy participants. However, approximately one-third report no pain response (ie, nonresponders), and the reasons for this are poorly understood.

Objectives:
In this study, we investigated temporal summation of pain (TSP) profiles, pain ratings and secondary hyperalgesia responses in responders and nonresponders to 1% topical capsaicin cream.

Methods:
Assessments were made at baseline and then during an early (ie, 15 minutes) and late (ie, 45 minutes) time points post-capsaicin in 37 healthy participants.

Results:
Participants reporting a visual analogue scale (VAS) rating of >50 were defined as responders (n = 24) and those with <50 VAS rating were defined as nonresponders (n = 13). There was a facilitation of TSP during the transition from an early to the late time point post-capsaicin (P<0.001) and the development of secondary hyperalgesia (P<0.05) in the responder group. Nonresponders showed no changes in TSP or secondary hyperalgesia during the early and late time points. There was an association between baseline TSP scores and the later development of a responder or nonresponder phenotype (r = 0.36; P = 0.03). Receiver operating characteristic analysis revealed that baseline TSP works as a good response predictor at an individual level (area under the curve = 0.75).

Conclusion:
These data suggest that responders and nonresponders have different facilitatory pain mechanisms. The assessment of TSP may help to identify participants with stronger endogenous pain facilitation who may be more likely to respond to topical capsaicin.
The Superficial Musculo-Aponeurotic System (SMAS): Does it Really Exist as an Anatomic Entity?
Authors: Minelli Lennert , van der Lei Berend , Mendelson Bryan C. 
Published: April 2023

INTRODUCTION:
The exact anatomic entity behind the term superficial musculoaponeurotic system (SMAS) remains poorly understood. The different interpretations of the term SMAS by anatomists, surgeons and histologists have caused confusion. This study aims to provide clarity regarding this term and the relevant anatomy.

MATERIALS & METHODS:
A literature review was conducted to uncover the variety of descriptions of the term SMAS. A feasibility study, followed by a conclusive series of standardized layered dissections, complemented by histology and sheet plastination was performed on fifty cadaver heads (16 embalmed, 34 fresh, mean age 75 years).

RESULTS:
Most literature considers the SMAS as layer 3, i.e., a musculoaponeurotic layer that separates the subcutaneous fat of the superficial fascia from the deep fat of the deep fascia. Our dissections, histology and sheet plastination demonstrated that a layer 3 is present only where there are flat mimetic muscles and platysma-auricular fascia over the posterior part of the parotid gland as the evolutionary remnant of the platysma, but not between the flat mimetic muscles. Here, the subcutaneous fat is in direct contact with the deep fat without the interposition of a musculo-aponeurotic layer 3.

CONCLUSION:
Due to the absence of a distinct and complete layer 3 connecting the flat mimetic muscles, we conclude that the SMAS as originally concepted does not exist as a specific anatomical entity. In retrospect, the surgically created compound layered flap composed of a variable thickness of subcutaneous fat, mimetic muscles (platysma, orbicularis oculi, …), and a thin layer of deep fascia, is what is known as the “SMAS”.

Level of Evidence:
No level of evidence is needed for Cadaver Study Articles.