bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clostridioides difficile Infection in Patients with Cirrhosis Treated for Hepatic Encephalopathy
Authors: Sehgal Kanika , Spiceland Clayton M. , Lennon Ryan J. , Pardi Darrell S. , Khanna Sahil 
Published: September 2023

Introduction Hospitalizations, proton-pump inhibitors (PPI), and systemic antibiotics increase the risk of Clostridioides difficile infection (CDI) in cirrhosis. We compare the risk of CDI with hepatic encephalopathy (HE) medications, hypothesizing that rifaximin may decrease CDI risk.
Materials and Methods A retrospective study of hospitalized HE patients treated with lactulose and/or rifaximin at Mayo Clinic Minnesota, Florida, and Arizona from 2008 to 2013 was conducted. Data on demographics, hospitalizations, antibiotics, and PPI use and CDI were gathered. Univariate and multivariable cox models were constructed.
Results We found 1,112 hospitalizations in 1,055 unique patients (55 had 1 subsequent readmission, 1 patient had 2); 428 (40.6%) patients were women (median age: 58 years [interquartile range: 52–65]). CDI developed after 66/1,112 (5.9%) hospitalizations within 12 months post-discharge. Lactulose was administered in 21 (31.8%), rifaximin in 5 (7.6%), both in 40 (60.6%) hospitalizations. Systemic antibiotics were used in 28 (42.4%) patients and PPIs in 60 (90.9%) patients.Univariate analysis using medication (with lactulose alone as the reference group) showed rifaximin was not significantly associated with CDI compared with lactulose (hazard ratio [HR]: 1.57, 95% confidence interval [CI]: 0.57–4.33, p = 0.39). Use of both medications was not significant compared with lactulose (HR: 1.41, 95% CI: 0.84–2.38, p = 0.19). Results were similar after controlling for confounders. Multivariable analysis based on length of stay, age, and gender showed no differences between rifaximin versus lactulose and both versus lactulose.
Conclusion There is no significant difference between lactulose and rifaximin on CDI development in HE patients. However, CDI should still be considered when managing diarrhea in HE patients.
Systematic Review and Meta-Analysis: Seroprevalence, Vaccination Rates, and Response for Hepatitis A in Inflammatory Bowel Disease
Authors: Jena Anuraag , Singh Anupam Kumar , Neelam Pardhu B. , Mohindra Ritin , Kumar-M Praveen , Mishra Shubhra , Patil Amol , Suri Vikas , Sharma Vishal 
Published: September 2023

Introduction Guidelines recommend hepatitis A virus (HAV) vaccination in individuals with inflammatory bowel disease (IBD). We performed a systematic review to inform the clinical practice regarding this guidance.
Methods After a PubMed and Embase search, duplicates were removed and the remaining titles screened for studies reporting relevant outcomes. Pooled seroprevalence rates for HAV, pooled vaccination rates, and pooled seroconversion rates were calculated. We also calculated pooled relative risk of seroprevalence for HAV among IBD and control population. Heterogeneity was investigated using subgroup analysis.
Results The pooled seroprevalence of HAV antibodies in patients with IBD (14 studies, 2,370 patients) was 0.36 (95% confidence interval [CI]: 0.22–0.53, I
2 = 95%). On comparing the seroprevalence of HAV in IBD with controls (4 studies), the pooled relative risk was not different between the two (0.94, 95% CI: 0.66–1.34, I
2 = 76%). The pooled seroconversion rate after two doses of HAV vaccination (5 studies, 221 patients) was 0.93 (95% CI: 0.88–0.96, I
2 = 0%). Three studies (104 patients) reported on the seroconversion after a single dose of HAV vaccination and the pooled seroconversion rate was 0.47 (95% CI: 0.35–0.59, I
2 = 20%). The pooled vaccination rate for hepatitis A among patients with IBD (18 studies, 9,521 patients) was 0.21 (95% CI: 0.14–0.30, I
2 = 99%).
Conclusion Hepatitis A vaccine has good immunogenicity in patients with IBD. The decision to routinely vaccinate IBD patients may be made in light of underlying seroprevalence of HAV.
The Relevance of Understanding Referencing Styles in the Era of Reference Managers
Authors: Goyal Mohit , Goyal Neha 
Published: September 2023

AbstractWriting the references of a manuscript accurately requires a significant amount of time and effort. While it can be a daunting task for beginners, even experienced authors can find it time consuming. The advent of reference managers brought a ray of hope of an end to this tedious toil. While these managers have eased the authors' task to a great extent, they may not always be completely accurate in the reference output they generate. Errors, inaccuracies, omissions, and compatibility issues do occur at times with the best of reference managers. It is thus of paramount importance to be able to recognize these issues and address them before submitting the manuscript to the journal. Sound knowledge of referencing styles helps in quick recognition and redressal of such errors thus increasing accuracy, ensuring consistency of references, and saving the author's time.
Sociodemographic Profile, Genotype, and Response to Therapy in Hepatitis C Virus Infection: A Brief Report from Himachal Pradesh
Authors: Sharma Brij , Sharma Vineeta , Kumar Rajesh , Sharma Rajesh , Bodh Vishal , Chauhan Ashish , Sachdeva Amit , Majeed Tahir , Bilal Mir , Sharma Dikshant 
Published: September 2023

Introduction Hepatitis C virus (HCV) infection is a major cause of liver disease worldwide. There is no data on sociodemographic profile, risk factors, genotype, and response to therapy of HCV infection from Himachal Pradesh.
Methods In this single-center study, we retrospectively analyzed data from HCV-infected patients treated with new oral direct-acting antiviral drugs from September 2019 to March 2022. Data on the sociodemographic profile of HCV-infected patients, along with risk factors for its transmission, HCV genotype, and response to therapy, was analyzed.
Results A total of 189 patients were included, with a mean age of 30.9 ± 13.8 years. Most were males and were students. Predominant risk factor for HCV transmission was intravenous drug use (61.4%), tattooing (11.7%), and hemodialysis (11.1%). A majority of the patients were students (72%). The predominant genotype was GT 3. Most (95.2%) patients were without cirrhosis, so sofosbuvir plus daclatasvir for 12 weeks was the most common regimen used. Sustained virological response was achieved in 94.7% of patients.
Conclusion This study, alarmingly, shows that intravenous drug users and tattooing are important risk factors for HCV infection in Himachal Pradesh. Further, students were the most frequently infected group.
Systematic Review and Meta-Analysis: Safety and Efficacy of Saccharomyces boulardii for Prevention of Clostridioides difficile Infection
Authors: Tariq Raseen , Tahir Muhammad Waqas , Hayat Maham , Pardi Darrell S. , Khanna Sahil 
Published: September 2023

Background Clostridioides difficile infection (CDI) is associated with frequent recurrences. The role of probiotics in preventing CDI remains unclear despite patients frequently using them.
Methods We performed a systematic-review and meta-analysis to evaluate the role of Saccharomyces boulardii, a yeast probiotic, in preventing primary or recurrent CDI in patients on systemic antimicrobial therapy. We searched MEDLINE, Embase, and Web of Science up to December 2021 to identify studies (case-control, cohort, or clinical trial studies) reporting the use of systemic antimicrobials with or without S. boulardii and providing information on primary or recurrent CDI. Pooled odds ratios with 95% confidence intervals were calculated using a random effects model.
Results Eight studies (six randomized control trials and two cohort studies) were included. Six studies with 9,712 patients evaluated primary prevention. The rate of CDI in patients who received S. boulardii was 0.73% (44/5977) compared to 1.09% (41/3735) in the control group. Meta-analysis showed no difference in the risk of CDI among the two groups (odds ratio [OR], 0.71; 95%CI, 0.46–1.10; p = 0.124) with no significant heterogeneity (I2 = 0%). In two studies with 292 patients evaluating secondary prevention, the rate of recurrent CDI was 36.73% (54/147) on S. boulardii compared to 46.20% (67/145) in controls, with no significant difference (p = 0.19). Subgroup analysis of studies using S. boulardii (250 mg twice daily) showed no difference in the CDI risk with or without S. boulardii. No serious adverse events from S. boulardii were noted.
Conclusion The use of S. boulardii appears to have no benefit for preventing either primary or recurrent CDI in patients taking systemic antimicrobials.
Infections in Patients with Severe Alcoholic Hepatitis: A Retrospective Study
Authors: Jain Mayank 
Published: September 2023

Abstract
Introduction Severe alcoholic hepatitis (SAH) is the severest type of alcohol-related liver disease and is fraught with risk of infectious complications. The present study was done to determine the frequency and types of infections noted in patients with SAH at baseline evaluation.
Methods This is a retrospective analysis of patients with alcoholic hepatitis treated at our center between 2019 and 2022. Details of age, gender, baseline laboratory parameters, and clinical presentation were noted. All patients were screened for infections to ascertain the suitability for steroid use as per protocol. Diagnosis of infections was done as per the North American Consortium for the Study of End Stage Liver Disease (NACSELD) criteria. In culture-positive infections, the details of the microorganisms that were isolated and antibiotic susceptibility patterns were recorded.
Results A total of 66 patients with SAH formed the study cohort (median age: 42 years; 100% males). The majority of them had underlying cirrhosis (33 [50%]) and 26 had acute-on-chronic liver failure. Twenty-eight (42.4%) cases had bacterial infections. Spontaneous bacterial peritonitis (10 [35.7%]) was the commonest infection, followed by urinary tract infection (8 [28.5%]), lower respiratory infections (7 [25%]), and skin infections (3 [10.7%]). Culture positivity was noted in 12 cases (42.9%). The commonest organism cultured was Escherichia coli (6 cases), followed by Klebsiella pneumoniae (cases). Multidrug-resistant (MDR) infections were noted in nine (13.6%) cases. Two patients had tuberculosis.
Conclusion In all, 42.4% of patients with SAH had bacterial infections at baseline evaluation. Spontaneous bacterial peritonitis was the commonest infection. MDR bacterial infections were noted in nine cases (13.6%).
Systematic Review and Meta-Analysis: Risk of Post-ERCP Cholangitis with Air or CO2 versus Contrast Cholangiography in Perihilar Malignant Biliary Obstruction
Authors: Giri Suprabhat , Harindranath Sidharth , Anirvan Prajna , Kumar Lohith , Sundaram Sridhar 
Published: September 2023

Background Endoscopic retrograde cholangiopancreatography (ERCP) may be associated with a risk of postprocedural cholangitis in case of failed drainage of the injected contrast. The present meta-analysis was conducted to assess whether air cholangiography reduces the risk of post-ERCP cholangitis compared with contrast injection.
Methods A comprehensive search of MEDLINE, EMBASE, and Science Direct from inception to September 2022 was done for studies comparing air or CO2 and contrast agent for cholangiography during ERCP, with the last search on September 31, 2022. Dichotomous outcomes were analyzed using risk ratios (RRs) with 95% confidence intervals (CIs).
Results A total of seven studies were included in the final analysis. Among these, there were three randomized trials and four retrospective studies. The included studies had moderate to high risk of bias. There was no difference in the clinical success rate (RR: 1.02, 95% CI: 0.94–1.09; I
2 = 0%), but a lower risk of all-cause adverse events (AEs) (RR: 0.21, 95% CI: 0.12–0.36; I
2 = 0%) with air cholangiography, compared with contrast cholangiography. Concerning individual AEs, this difference was seen only for cholangitis (RR: 0.51, 95% CI: 0.37–0.69; I
2 = 0%) but not for post-ERCP pancreatitis, perforation, and bleeding. Reintervention and 30-day mortality remained comparable between groups. The certainty of evidence remained low to very low.
Conclusion Air or CO2 cholangiography reduces the risk of overall AE, especially post-ERCP cholangitis, compared with contrast cholangiography. Further trials are required to validate the findings of the study.
Melioidosis Presenting as Splenic Abscess: A Case Report
Authors: Kumar Pranav S. , Birda Chhagan Lal , Chand Yadav Suresh , Yadav Taruna , Agarwal Ashish 
Published: September 2023

AbstractMelioidosis is an infectious disease caused by Gram-negative bacilli Burkholderia pseudomallei. Infection is acquired by direct exposure through broken skin, inhalation, or ingestion of the bacterium. Melioidosis has a wide variety of clinical presentations, ranging from an asymptomatic infection or localized cutaneous manifestations at the site of the entry, deep-seated abscess, to multiple organ involvement with sepsis leading to death. Although not uncommon, there is a lack of awareness of its variable presentation leading to a delay in the diagnosis and thus treatment. The diagnosis of melioidosis rests on the culture of the organism from biological samples. Presentation as a splenic abscess is rather rare and a high index of suspicion is needed for the diagnosis. In this article, we report an interesting case of recurrent splenic abscess which was eventually diagnosed to be due to melioidosis.
Enhancing Logistic Support During Chemotherapy to Nonlocal Children with Cancer and Their Families through Home Away from Home Program
Authors: K. Vasudeva Bhat , Venkatagiri Archana Melavarige , Venkatesh Vinay Munikoty , S. Ashwini , Nair Girish , Dave Ankeet , Rao Krithika Shantanu , Salins Naveen , Rao Sharath Kumar 
Published: September 2023

AbstractChildhood cancers have excellent outcomes in terms of cure rates and survival if they are diagnosed early and treated appropriately. However, there is a huge disparity in outcomes between high- and low-middle income country(ies) due to out-of-pocket expenditure, therapy abandonment, and severe infections. To bridge these gaps in outcomes, a partnership between a private medical institute and a nongovernmental organization was fostered to develop a long-stay facility for children with cancer and their families while receiving disease-directed therapies. This report aims to expound the story of development of the “Home Away from Home” program and its transformative potential and societal impact.
Subthalamic Deep Brain Stimulation in Parkinson's Disease: A Boon or Bane – A Single Centre Retrospective Observational Study from India
Authors: Hazra Darpanarayan , Chandy Gina Maryann , Ghosh Amit 
Published: September 2023

Abstract
Background Subthalamic deep brain stimulation (STN-DBS) for refractory Parkinson's disease (PD) is more of a modality of treatment that is empirical, for which a physiological explanation is being sought. This study was done to determine the outcome and complications of patients undergoing STN-DBS for PD.
Methods This retrospective observational cohort study was conducted in an advanced neuromedicine facility in eastern India for 9 years (August 2013–August 2022), which included all patients undergoing STN-DBS.
Results A total of 53 patients were operated on during the study period. The mean age group of the study population was 60.5 (standard deviation [SD]: 8.2) years with a male (33 [62.3%]) predominance. The most common presenting complaints included rigidity and hypokinesia (27), severe dyskinesia (21), and tremors (17). During the postoperative period, rigidity and hypokinesia (21), severe dyskinesia (16), and tremors (12) improved significantly in a subset of the patients. The majority (45 [84.9%]) of these cases received bilateral monopolar simulation, whereas three patients (5.7%) had bilateral bipolar stimulation. Unilateral bipolar stimulation was used in five (9.4%) patients. In the immediate postoperative period, they were initiated on limb, speech, and swallowing therapy as indicated. Surgery-related complications were seen in five (9.4%) cases. At 6 months of follow-up, a significant improvement in the Unified PD rating scale component (mainly motor examination and complication of PD therapy) was noted in the majority (36 [67.9%]) of patients. One patient developed neuroleptic malignant syndrome and succumbed to his illness on the fourth postoperative day.
Conclusion Given these findings, STN-DBS appears to be a good, safe, and effective treatment for a subset of medically refractory PD with an overall improvement in two-thirds of the study cohort and less than 10% risk of complications.
Intracranial Interdural and Extradural Cerebellar Convexity Dermoid Cyst: A Case Report of Rare Tumor at the Rarest Location
Authors: Mishra Manish Kumar , Yadav Vikrant , Pradhan Ravi Shekhar , Prasad Ravi Shankar 
Published: September 2023

AbstractIntracranial dermoid cysts are rare dysembryonic tumors of benign nature. These are uncommon in adults. If present, they are usually located in the midline or along the lines of embryonic fusion. The posterior fossa region is an infrequent site. Extradural or interdural locations are even more rare. In this case report, the authors report a laterally located large posterior fossa right cerebellar convexity interdural and extradural dermoid cyst over the sigmoid sinus. It was managed by totally extradural maximum possible safe decompression with microneurosurgical technique. The authors share their experience of addressing this rare pathology at the rarest location with unusual imaging findings.
Simplifying the Technique of Awake Brain Surgery in a Condition of Less Equipped Neurosurgical Institution in Uzbekistan
Authors: Mamadaliev Dilshod Mukhammadvalievich , Kariev Gayrat Maratovich , Asadullaev Ulugbek Maksudovich , Yakubov Jakhongir Bakhodirovich , Zokirov Kamoliddin Sodikjonovich , Khasanov Khabibullo Abdukholikovich , Akhmediev Tokhir Makhmudovich , Korotkov Dmitriy Sergeyevich 
Published: September 2023

AbstractCurrently, awake craniotomy (AC) is one of the most often employed procedures to map and resect tumors in eloquent brain areas, avoiding the use of general anesthesia (GA) and thereby reducing anesthesia-related complications and cost of surgery. Resource limitations are one of the basic reasons for avoiding AC in low- and middle-income countries (LMICs). The aim of this study is to describe the simplified protocol of awake brain surgery that can be implemented in a limited financial setting in LMICs and to share our first experience. Twenty-five patients diagnosed with tumor of the left frontotemporal lobes, all involving Broca's and Wernicke's areas, were operated on using AC. Brain mapping was executed using mono- and bipolar direct electrical stimulation including cortical and subcortical (axonal) mapping profiles, investigating basically cortical language centers. Neither neuronavigation nor intraoperative magnetic resonance imaging (MRI) was utilized due to financial constraints. AC was performed successfully in 23 of 25 patients, achieving a near-total resection in 16 (69.5%) patients, subtotal resection in 4 patients (17.39%) patients, and partial resection in 3 (13.04%) patients. In two patients, due to psychological instability—agitation and fear during the awake phase—speech test was not technically possible, so they were reintubated by giving them GA. There was no mortality in the early or postoperative period. In spite of the absence of advanced pre- and intraoperative technologies such as intraoperative MRI and navigation systems, AC can be safely performed in LMICs. These tools along with intraoperative cortical mapping and language testing can guarantee better surgical outcomes and quality of life. However, our study confirms that omitting these tools does not make a huge difference in getting good results with AC and that AC is not absolutely impossible. AC can be performed successfully, preserving eloquent brain areas, with minimum and basic set of the armamentarium like system for cortical and subcortical intraoperative neurostimulation which provides cortical/subcortical brain mapping.
Questionnaire for Dental Practitioners to Screen for Trigeminal Neuralgia
Authors: Komatsu Fuminari , Sasaki Kento , Tanaka Riki , Miyatani Kyosuke , Yamada Yasuhiro , Kato Yoko , Hirose Yuichi 
Published: September 2023

Abstract
Objective Trigeminal neuralgia (TN) is a neurological disorder that often presents as severe toothache. The majority of TN patients visit dental clinics first, so TN represents a potential pitfall for dental practitioners. This report describes the development of a trigeminal neuralgia questionnaire (TNQ), assessing 10 characteristics of TN, to assist dentists in screening for TN in dental clinics, and evaluates the effectiveness of TNQ.
Materials and Methods Fifty-three patients who visited the TN outpatient department in our institute and completed the TNQ were included in this study. All patients were examined by two neurosurgeons and neuroimaging was performed.
Statistical Analysis Patients were classified into a TN group and a non-TN group. TNQ score was retrospectively compared between groups. Furthermore, history and characteristics of TN were investigated in the TN group to clarify the status of the reference situation.
Results Thirty-seven cases were assigned to the TN group, and 16 cases to the non-TN group. Mean TNQ score was 8.3 in the TN group and 6.6 in the non-TN group. Setting a TNQ cutoff score of 7 offered 91% sensitivity and 56% specificity for TN. Investigation of the history of the present illness indicated that 39.2% of TN cases were improperly triaged and referred from initial dental clinics, and interdisciplinary practice was insufficient.
Conclusion TNQ offers a reliable, convenient method to triage TN patients, and may assist dentists in screening for TN. Multidisciplinary practice is necessary for total management of TN and the TNQ is expected to connect dentists and TN specialists.
A 10-Year Survival-Trend Analysis of Low-Grade Glioma and Treatment Patterns from an LMIC
Authors: Bajwa Mohammad Hamza , Anis Saad Bin , Yousaf Irfan , Shah Mashal 
Published: September 2023

Abstract
Objectives The 2021 WHO Classification of Central Nervous System Tumors taxonomy laid further stress on molecular classification and prognostication of glial tumors in comparison to histopathological grading. Research shows that low-grade gliomas (LGGs) can go through malignant differentiation and lead to severe disability and death. Data from various populations will be necessary to ascertain the exact interplay between genotypic predictors of LGG and outcomes.
Materials and Methods To assess the molecular pathology for glial tumors in the Pakistani population, the Shaukat Khanum Memorial Cancer Hospital carried out a retrospective chart review of electronic health records from 2008 to 2018, with immunohistochemistry analysis findings from 2010 to 2018. Patients with a pathological diagnosis of a glioma were included.
Statistical Analysis Analysis was performed using IBM SPSS Statistics Version 23 and STATA Version 16. A p-value of less than 0.05 was considered statistically significant with 95% confidence intervals reported.
Results In all, 281 operable tumors were recorded. The most common procedure was a subtotal resection, and astrocytomas (64.77%) were the most common tumors. Radiation therapy and PCV (procarbazine, CCNU, and vincristine) was received by 85 patients, while radiation therapy and temozolomide were administered to 15 patients.
Conclusions Isocitrate dehydrogenase (IDH) wild-type LGG had a lower survival time, while improved survival times were seen for alpha-thalassemia X-linked intellectual disability syndrome (ATRX) retained and 1p19q co-deleted LGGs. Further studies are required to gain a better understanding of lower-grade glial tumor treatment and survival in Pakistan.