bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pneumosepsis survival in the setting of obesity leads to persistent steatohepatitis and metabolic dysfunction
Authors: Kumar Avnee J. , Parthasarathy Chitra , Prescott Hallie C. , Denstaedt Scott J. , Newstead Michael W. , Bridges Dave , Bustamante Angela , Singer Kanakadurga , Singer Benjamin H. 
Published: August 2023

Background:
As critical care practice evolves, the sepsis survivor population continues to expand, often with lingering inflammation in many organs, including the liver. Given the concurrently increasing population of patients with NAFLD, in this study, we aimed to understand the long-term effect of sepsis on pre-existing NAFLD and hyperglycemia.

Methods:
Male mice were randomized to a high-fat diet or a control diet (CD). After 24 weeks on diet, mice were inoculated with Klebsiella pneumoniae (Kpa). Serial glucose tolerance tests, and insulin and pyruvate challenge tests were performed 1 week before infection and at 2 and 6 weeks after infection. Whole tissue RNA sequencing and histological evaluation of the liver were performed. To test whether persistent inflammation could be reproduced in other abnormal liver environments, mice were also challenged with Kpa after exposure to a methionine-choline–deficient high-fat diet. Finally, a retrospective cohort of 65,139 patients was analyzed to evaluate whether obesity was associated with liver injury after sepsis.

Results:
After Kpa inoculation, high-fat diet mice had normalized fasting blood glucose without a change in insulin sensitivity but with a notable decrease in pyruvate utilization. Liver examination revealed focal macrophage collections and a unique inflammatory gene signature on RNA analysis. In the clinical cohort, preobesity, and class 1 and class 2 obesity were associated with increased odds of elevated aminotransferase levels 1–2 years after sepsis.

Conclusions:
The combination of diet-induced obesity and pneumosepsis survival in a murine model resulted in unique changes in gluconeogenesis and liver inflammation, consistent with the progression of benign steatosis to steatohepatitis. In a cohort study, obese patients had an increased risk of elevated aminotransferase levels 1–2 years following sepsis.
Posterior segment manifestations of ocular metastasis
Authors: Kongwattananon Wijak , Pothikamjorn Thananop , Somkijrungroj Thanapong 
Published: August 2023

Purpose of review
This article reviewed and summarized recent published data on ocular imaging findings and treatment of posterior segment manifestations of ocular metastasis.

Recent findings
Advanced ocular imaging can help differentiate ocular metastases from other mimicking lesions, including primary intraocular tumors or infections. Recently, case reports have demonstrated the successful use of targeted systemic therapy to achieve local control of vitreous and choroidal metastases.

Summary
Metastasis can lead to a wide variety of posterior segment ocular manifestations. The choroid is the most common metastatic site, whereas tumor metastasizing to the retina and optic disc are rare. Patients with possible metastatic eye disease are recommended to undergo extensive investigation to determine the underlying primary cancer and ongoing systemic metastases. Currently, there is no consensus on the treatment strategy. Treatment generally includes systemic chemotherapy in combination with local treatment, such as radiotherapy, laser therapy, or anti-vascular endothelial growth factor (anti-VEGF) treatment.
Predictors of Colonoscopy Use Among Asian Indians in New York City, 2003 to 2016
Authors: Nagpal Neha , McCready Taylor M. , Xia Yuhe , Lin Kevin , Glenn Matthew , Ng Sandy , Trinh-Shevrin Chau , Troxel Andrea B. , Kwon Simona C. , Liang Peter S. 
Published: August 2023

Background:
Asian Americans have the lowest colorectal cancer screening uptake of any racial and ethnic group in the United States. Asian Indians are among the most under-screened Asian American subgroups, but there is limited data for this population. We sought to characterize predictors of colonoscopy use among Asian Indians in New York City.

Methods:
Using 2003 to 2016 data from the New York City Community Health Survey, we identified all Asian Indian participants aged 50 years or older. We examined the association between sociodemographic and medical factors and up-to-date colonoscopy use (defined as colonoscopy within the last 10 y) using logistic regression over 4 time periods: 2003 to 2008, 2009 to 2012, 2013 to 2014, 2015 to 2016.

Results:
On multivariable analysis, language, age, income, recent exercise, body mass index, and influenza vaccination were associated with colonoscopy uptake in 1 time period. Compared with participants who preferred English, those who preferred an Indian language were less likely to have been up-to-date in 2013 to 2014 (odds ratio 0.12, 95% CI 0.02-0.66). Individuals older than 65 years were more likely than those aged 50 to 64 years to have received a colonoscopy in 2009 to 2012 (odds ratio 3.91, 95% CI 1.49-10.24), although the risk estimates were also consistently positive in the other 3 time periods.

Conclusions:
Among Asian Indians living in New York City, several demographic, socioeconomic, and health-related characteristics predict colonoscopy use. These findings highlight the importance of examining determinants of colonoscopy uptake in this understudied population to inform future public health interventions.
Chronically misdiagnosed Eagle’s syndrome, treated through transoral styloidectomy: a rare case report
Authors: Hamamin Omed Shafiq , Arif Ali Talib , Razha Ayoub Baqr , Abdul Aziz Jeza Muhamad , Rashid Muhammad Jabar , Rasheed Mariwan kadir , Abdullah Lanya Latif , Abdulrahman Mustafa Shakhawan , Ghafoor Raz Abdulkarim , Qutbadeen Nuha , Hamasharif Pshko Ahmad 
Published: August 2023

Introduction:
The stylohyoid ligament begins when the styloid process extends from the petrous temporal bone in a thin bony protrusion. Eagle’s syndrome (ES) is a condition related to either calcification of the calcifying the stylohyoid ligament or elongating styloid process The incidence of symptomatic ES is 0.16%, and it is more common in women. The reported study diagnosed ES and treated it surgically through transoral approach styloidectomy.

Case presentation:
A 39-year-old man who is a farmer and a driver was presented with complaints of ongoing, excruciating discomfort in the back of his left ear. Before the exam, he took a variety of drugs, various drugs 2 years without receiving a definitive diagnosis. Axial, coronal, and sagittal computed tomography scans of both petrous bones were analyzed, and the results showed aberrant styloid process elongation and calcification of the stylohyoid ligament

Discussion:
ES, shares many symptoms with other regional illnesses. Physicians frequently misdiagnose cases of ES and treat them without providing a conclusive diagnosis or treatment.

Conclusion:
ES diagnosis can be difficult for otolaryngologists and primary care providers due to its similarity with other regional illnesses. However, surgical intervention can result in consistent and significant symptomatic improvement when correctly diagnosed. The case presented in the report was successfully diagnosed as ES and treated surgically through transoral approach styloidectomy.
Direct oral anticoagulants vs. vitamin K antagonists in patients with antiphospholipid syndrome: a systematic review and meta-analysis
Authors: Shah Bidhan Bikram , Shankar Abhirami , Kumar Vinesh , Kumar Sumeet , Malik Umair Arshad , Majeed Abdul , Kumar Vijay , Berkha  , Suman  , Kumar Sumeet , Netha Aadarsh , Subedi Sonika , Ahmed Shoaib 
Published: August 2023

Background:
Optimal treatment regimen for patients with antiphospholipid syndrome (APS) remain unclear. Therefore, the authors sought to compare the outcomes of vitamin K antagonists (VKAs) vs. direct oral anticoagulants (DOACs) in patients with APS.

Methods:
MEDLINE, Embase, and Cochrane Central databases were searched for randomized controlled trials comparing efficacy and safety of VKAs and DOACs inhibitors in patients with APS. Recurrent thrombosis, all-cause mortality, stroke, adverse reactions, and bleeding were among outcomes of interest. Mantel–Haenszel weighted random-effects model was used to calculate relative risks (RRs) with 95% CIs.

Results:
The analysis included 625 patients from four randomized controlled trials and one post hoc analysis. Meta-analysis showed statistically non-significant difference between DOACs inhibitors and VKAs in the recurrent thrombosis risk (arterial or venous) [RR 2.77 (95%, CI 0.79, 9.65); P=0.11, I2=50%]. Consistent results were revealed among patients with the previous history of arterial thrombosis [RR 2.76 (95% CI 0.93, 8.16); P=0.75, I2=0%], venous thrombosis [RR 1.71 (95% CI 0.60, 4.84); P=0.31, I2=15%] and patients who were triple antiphospholipid positive [RR 4.12 (95% CI 0.46, 37.10); P=0.21, I2=58%]. DOACs inhibitors were significantly associated with increased risk of stroke [RR 8.51 (95% CI 2.35, 3.82); P=0.47, I2=0%].

Conclusion:
DOACs exhibited increased risk of stroke among patients with APS. In addition, although not significant, the higher RRs among patients on DOACs may indicate higher risk of thrombotic events associated with DOACs.
A comparison of Atlas and Leo Baby stents-assisted coiling of intracranial aneurysms with small parent vessels
Authors: Tang Qing-wen , Feng Yu , Zhang Cheng-da , Zhang Ting-bao , Zhao Wen-yuan 
Published: August 2023

Background:
Some studies have reported the efficacy and safety of the Atlas stent and the Leo Baby stent-assisted coiling (SAC) of intracranial aneurysms arising from small cerebral vessels. The authors aimed to compare the clinical performance of the Atlas and the Leo Baby stents in small parent arteries.

Methods and materials:
Between January 2019 and November 2022, 56 patients at our centre were treated using either Atlas or Leo Baby SAC of intracranial aneurysms arising from small parent vessels (<2 mm). The clinical and angiographic imaging data of the two cohorts were retrospectively collected and comparatively analyzed.

Results:
A total of 56 patients were included in this study. Thirty-two patients were treated with the Atlas SAC, and 24 patients were treated with the Leo Baby SAC. The mean age of the Atlas stent cohort was older, and the mean aneurysm size was smaller than the Leo Baby stent. The immediate complete occlusion rate was 68.6% in the Atlas stent cohort and 62.5% in the Leo Baby stent cohort. The mean angiographic follow-up time for Atlas stent cohort was 8.9±2.5 months, and the final aneurysm complete occlusion rate was 81.0%. The mean follow-up time for Leo Baby stent cohort was 18.9±6.0 months, and the final aneurysm complete occlusion rate was 83.3%.

Conclusions:
At the final follow-up, the Atlas or the Leo baby stent SAC of intracranial aneurysms with small parent vessels resulted in favourable angiographic results and clinical outcomes, with a low rate of associated complications.
Barriers and facilitators influencing access to and utilization of primary healthcare services in Kurdistan-region, Iraq: a cross-sectional study
Authors: Mahmood Kochr Ali , Saleh Abubakir Majeed 
Published: August 2023

Background:
The primary healthcare (PHC) idea is intended to become the first line of interaction for members of the public with care needs, as well as a system that views health as a complete state of being rather than only a state of wellbeing. This study aimed to examine the barriers and facilitators influencing the access and utilization of PHC services in Erbil governorate, Kurdistan-region, Iraq, through assessing populations’ practice, and satisfaction. Also, explore the relationship between the socioeconomic, demographic, and cultural characteristics of the study population and utilization of PHC services.

Methods:
This was a cross-sectional study. A questionnaire-based survey was used for data collection. Totally, 2400 individuals have been selected in 6 different districts and the centre of Erbil through the multi-cluster random sampling method. The χ2 test was used for categorical variables, and a one-way ANOVA was used for numerical variables. A P value less than 0.05 was considered statistically significant.

Results:
The main reason for utilizing PHC centres was preventive purpose (68.1%), then poverty was the second reason (11.33%), and the participants reported that during the presence of urgent cases when they cannot use other health facilities, they use PHC centres (9%). In terms of barriers for utilizing and visiting PHC centres, the participated people stated that most of them, due to inadequate services, did not use and visit PHC centres (83.21%); the second reason was the presence of chronic diseases such as hypertension, which makes them visit private clinics (7.79%) and generally, (31.4%) of the participants were satisfied with the health services nearby.

Conclusion:
In conclusion, it appears that many people visit PHC facilities, but most of them only do so as a preventative measure, and very few go there to obtain basic medical treatment. Most patients go to private clinics and/or hospitals since those facilities have better access to specialists, better quality and quantity of medications, and laboratory testing. Additionally, combining and strengthening service quality aspects that prioritize a patient-centred environment and an effective service delivery system is a key strategy for the health sector to increase patient satisfaction.
The preparedness of preoperative anesthesia equipment’s and monitors for pediatric patients
Authors: Tegegne Biresaw Ayen , Lema Girmay Fitiwi , Fentie Demeke Yilkal , Bizuneh Yosef Belay 
Published: August 2023

Background:
In resource-limited settings, providing anaesthesia services to paediatric patients at the operation theatre needs to be considered and optimal utilization of national resources available for the provision of services should be undertaken. Therefore, optimal perioperative care of infants and children requires the availability of monitors and contemporary equipment designed specifically for this purpose.

Objective:
This study aimed to determine the practice of preoperative anaesthesia equipment and monitor preparation for paediatric patients.

Method:
A cross-sectional study was employed among 150 consecutively selected paediatrics from April to June 2020. Data were collected by semi-structured questionnaire. Data entry and analysis were done using Epi Data and Stata version 14.0. Descriptive statistics were employed.

Result:
A total of 150 patients who undergo surgery under anaesthesia were observed in surgical and ophthalmic operation rooms. From those procedures, only stethoscope and small-sized syringes achieved 100% of the standards. But paediatric stylet, paediatric defibrillator and paediatric folly catheter had achieved 0%. The remaining were between 10 and 97% according to standards.

Conclusion:
Even though some paediatric anaesthesia equipments and monitoring preparation have fulfilled the standards, this study showed practice gaps in majority of cases in the preparation of appropriately sized paediatric equipments and monitors.
Clinical outcome of established diagnostic and treatment modalities of COVID-19-associated myocarditis: a systematic review
Authors: Sai Santhosha Mrudula Alla , Agarwal Pahel , Vempati Roopeessh , Alla Deekshitha , Balusu Kavya , Tarannum Suha , Patel Krish , Devaragudi Sanjana , Patel Devkumar , sultana Qamar , Paudel Kusum 
Published: August 2023

Background:Despite the significant research and development of COVID-19 diagnostic and therapeutic approaches, the virus still poses a concern, particularly to groups that are already vulnerable. Several individuals experienced cardiac problems like myocardial infarction, arrhythmia, heart failure, cardiomyopathy, myocarditis, and pericarditis after they had recovered from the infection. Early diagnosis and timely management of sequelae are part of the therapy. However, there are gaps in the knowledge of the diagnostic and definitive treatment options for COVID-19 myocarditis. This review focuses on myocarditis associated with COVID-19.Objective:This systemic review provides the most recent overview of myocarditis caused by COVID-19, including clinical manifestations, diagnostic techniques, available treatments, and outcomes.Methods:The PubMed, Google Scholar, and ScienceDirect servers were used to conduct a systematic search in compliance with the PRISMA guidelines. Boolean search terms included “(COVID-19)” OR “(COVID19)” OR “(COVID-19 VIRUS INFECTION)” AND “(MYOCARDITIS)”. The results were tabulated and analyzed.Results:A total of 32 studies, including 26 case reports and 6 case series, were included in the final analysis, and 38 cases of COVID-19-associated myocarditis were analyzed. Middle-aged men constituted the most affected population (60.52%). Dyspnoea (63.15%), chest pain or discomfort (44.73%), and fever (42.10%) were the prevalent presentations. ST-segment abnormalities were reported in 48.38% of cases on electrocardiography testing. Leucocytic infiltration (60%) was the frequent finding obtained on endomyocardial biopsy. Cardiac magnetic resonance imaging yielded myocardial oedema (63.63%), and late gadolinium enhancement (54.54%) as the most common findings. Reduced ejection fraction (75%) was the frequent result obtained on echocardiography. Corticosteroids (76.31%) and immunomodulators (42.10%) were the well-established in-hospital medications. Veno-arterial extracorporeal membrane oxygenation (35%) was the most common intervention used to support the treatment. The frequent in-hospital complications were cardiogenic shock (30.76%), followed by pneumonia (23.07%). The mortality rate was 7.9%.Conclusion:Early detection and timely management of myocarditis are essential to reduce the risk of developing further complications. It is crucial to emphasize the need to evaluate COVID-19 as a possible cause of myocarditis in populations that are young and healthy to avoid fatal consequences.
Investigating the effect of sudden occlusion of the testicular vessels on the testicular tissue in rat models
Authors: Shojaeian Reza , Hiradfar Mehran , Bahrami Taqanaki Pegah , Khorsand Ahmadi Sarina , Jelveh Masouleh Yousef , Ameri Leila , Parvizi Mashhadi Mahdi 
Published: August 2023

Background:
One of the ways to treat undescended testicles is to use orchiopexy surgery, which is modified into the two-stage Fowler–Stephens technique in cases of short or immobile testes. The disadvantage of using this technique is the probability of testicular ischaemia following the sudden closure of the testicular artery; although the collateral arteries prevent atrophy, the testis loses its germ cells during this stress and may no longer be functional. Therefore, this study aims to examine the changes in testicular tissue regarding necrosis and infarction after the occlusion of the vessels.

Methods and materials:
In this experimental study 15 male rats weighing 200–250 g were prepared and first, one of the rats was sacrificed and testicles on both sides were used for pathology control. After general anaesthesia vascular ligature was performed with the left testes undergoing both venous and arterial occlusion and the right testes only arterial occlusion. After 1 month, all specimens were killed and the testes were completely removed and sent for histopathological evaluation.

Results:
A total of 14 rats and 28 testes were studied in two equal groups of case and control. There was no significant difference between the case and control groups in terms of testicular volume, consistency, and viability. Microscopic findings revealed that necrosis, infarction, and state of inflammation were significantly higher in the case group than in the control group.

Conclusion:
The results of this study show that abrupt closure of the testicular artery in rats is associated with necrosis and infarction, decreased spermatogenesis, and more inflammation. However, no significant differences were found in terms of macroscopic findings including volume, consistency, and viability.
Assessment of the efficacy of auricular conchal cartilage graft in repairing orbital floor fractures and its effect on diplopia: a nonrandomized clinical trial
Authors: Deep Mohammad , Baroudi Ihsan , Assad Mounzer 
Published: August 2023

Background:
Orbital fractures are a common sequela of maxillofacial zone trauma. Rapid assessment and management are essential for successful reconstruction. The selected treatment method depends on fracture types, accompanied injuries, and intervention time. Implantable grafts used to be from autologous materials. The study aimed to evaluate the effectiveness of using the auricular conchal cartilage taken from the ear to repair orbital floor fractures in cases of minimal bone loss, less than (2×2) cm.

Material and Methods:
A prospective single-arm, nonrandomised clinical trial was conducted during the past 4 years (from 2018 to 2022). A total of 15 cases, who had visited the department of oral and maxillofacial surgery department with orbital floor fractures, were enrolled. The participants underwent conchal cartilage grafting for orbital floor fracture reconstruction. The time factor to perform the surgery after trauma had been considered. Patients were closely monitored for the development of double vision (diplopia) at 15 days, 1 month, and 3 months postsurgery.

Results:
The results showed statistically significant differences during the follow-up period following the surgical procedure. They appeared to have complete restoration of eye movements, restoration of the normal positioning of the eyeball affected by the orbital floor fracture compared to the healthy eyeball, and regression of double vision (diplopia) throughout the follow-up period.

Conclusion:
Using the auricular conchal cartilage graft in repairing fractures of the orbital floor resulted in the improvement of the functional aspect of the eyeball and the restoration of the esthetic aspect.
Amputation of left foot macrodactyly improve quality of life for a toddler: a case report from Tigray, Northern Ethiopia
Authors: Haftu Hansa , Gebrekidan Atsede , Gebrehiwot Teklu , Gebre Niguse Tsegay , Mahtsun Gebreegziabher 
Published: August 2023

Introduction and importance:
Macrodactyly is an uncommon, not inherited congenital malformation of the digit with unknown prevalence and path of pathogenesis. The condition was described in 1940 and since then 107 cases were reported. Manifestations may mislead the diagnosis of hemangiomas and lymphangiomatosis. There are different options for treatment without a clear consensus. The authors are presenting a macrodactyly case that improved the quality of his life after he underwent surgical amputation of the toes.

Case presentation:
The authors had a case of a 2-year and 4-month-old male child presented with progressive growth of the left foot toes; which started since birth in the 4th toe and then involved 3rd and 5th toe later; resulting in deformity and difficulty in wearing shoes. Physical examination; showed left foot enlargements of the 3rd–5th toes. X-ray of the left foot was done he was diagnosed to have macrodactyly. Under general anesthesia metatarsophalangeal joint of the 4th–5th toe and distal interphalangeal joint of the 3rd toe, disarticulation was done. The patient is doing okay on follow-up for the last year.

Clinical discussion:
Consistently with other case reports from Korea, Tanzania, and Congo our patient presented with a primary type of left foot macrodactyly in his early life, and he was successfully managed with amputation of the affected digits.

Conclusion:
This is one of the rare cases which needs a high index of suspicion to diagnose and treat early to improve quality of life. Amputation is the most important management in resources limited areas.