bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessing serum C-reactive protein as a predictor of COVID-19 outcomes: a retrospective cross-sectional study
Authors: Abdullah Ardalan J. , Arif Ali T. , Rahman Hawre A. , Sofihussein Kadhim Q. , Hadi Jihad M. , Aziz Jeza M. Abdul , Tofiq Shko Sh. , Mustafa Ayman M. 
Published: August 2023

Background:
Despite being very infectious and fatal, the coronavirus disease 2019 (COVID-19) lacks a reliable and practical biomarker to assess how serious it will be.

Aim:
The current study aims to conclude the possibility of C-reactive protein (CRP) level serving as a biomarker for early prediction of COVID-19 infections.

Methods:
In this retrospective cross-sectional study, 88 people participated who were infected with COVID-19, aged from 25 to 79 years old. Compare the CRP test range of all samples from patients who visited the hospital between January and April 2022.

Results:
All participants were confirmed to have COVID-19 through nasopharyngeal swab analysis and real-time polymerase chain reaction real-time polymerase chain reaction testing. Results showed that the majority of infected individuals had elevated CRP levels. A P-value of less than 0.05 indicated a significant difference in CRP levels between alive and dead patients. No significant difference in CRP levels was found between male and female patients. The average CRP level of deceased patients was 137.79 mg/l, while the average CRP level of survivors was 14.37 mg/l. The median interquartile range of deceased patients was also found to be significantly higher compared to survivors.

Conclusion:
In conclusion, serum CRP levels potentially predict the severity and development of sickness in patients with COVID-19 infections.
Urinary bladder metastasis from primary lung cancer, a rare and challenging diagnosis: a case report
Authors: Irzi Mohamed , Miri Achraf , El Moudane Anouar , Ouraghi Abdelghani , Barki Ali 
Published: August 2023

Introduction and importance:
Bladder metastases are rare, representing only 2% of all bladder tumors, secondary bladder localization from a primary lung is exceptional.

Case presentation:
The authors describe the case followed for lung adenocarcinoma with an exceptional metastatic site, which is the bladder. A computed tomography scan showed a left suprahilar bronchial tumor with pleurisy (Fig. 1A), which biopsies concluded to a moderately differentiated adenocarcinoma. The patient is treated with palliative cisplatin-based chemotherapy. And died 11 months after diagnosis.

Clinical discussion:
Bladder metastases are rare, representing only 2% of all malignant bladder tumors. Metastatic lesions of the bladder are generally revealed by hematuria. Confirmation of bladder invasion is immunohistochemical, facilitated by knowledge of the primitive.

Conclusion:
In the presence of any adenocarcinoma of the bladder, a thoracic-abdominal-pelvic computed tomography scan must be requested in search of a primary extra-vesical cancer who can facilitate the diagnosis.
Infective endocarditis presenting as meningitis: a case report
Authors: Gautam Sudarshan , Sharma Nava R. , Kansakar Sajog , Lamichhane Saral , Pokhrel Madalasa , Basnet Arjun 
Published: August 2023

Introduction and importance:
Infective endocarditis (IE) primarily affects the endocardium of heart valves. Neurologic manifestations include strokes, intracerebral hemorrhages, meningitis, cerebral and spinal abscess, and mycotic aneurysms. Although rare, meningitis is a potentially life-threatening complication of IE, so physicians should be aware of this rare and fatal complication of IE.

Case presentation:
Here, the authors present a case of a 53-year-old male who presented with bacterial meningitis secondary to IE. His blood culture was positive for methicillin-sensitive staphylococcal aureus. Echocardiography findings were suggestive of endocarditis. Despite aggressive intensive care management, our patient did not survive.

Clinical discussion:
The isolation of Staphylococcus aureus in culture should raise a suspicion of foci being elsewhere outside the central nervous system. Treatment of complications like meningitis may require intrathecal antibiotics. The vegetation and neurological complications are often difficult to treat and require the participation of a multidisciplinary team.

Conclusions:
The diagnosis of IE in patients presenting with neurologic deficits and fever should be considered. A physician should raise a suspicion of infective foci being elsewhere outside the central nervous system if the organism isolated in culture is Staphylococcus aureus.
Mad honey poisoning presenting with syncopal attack: a case report
Authors: Baniya Abinash , Duwadee Prabin , K.C. Sujata , Shahi Manoj , Shrestha Nabaraj , Bam Prabin K. , Gurung Bipana , Shrestha Roshan 
Published: August 2023

Introduction and importance:
Mad honey contains grayanotoxin, which is commonly derived from the nectar of a few Rhododendron species. It is commonly used by natives of the Himalayas in the belief of its medicinal use.

Case presentation:
The authors report a case of 62 years old male with mad honey poisoning who was presented to the emergency department with loss of consciousness and had bradycardia and hypotension on arrival. The patient received intravenous fluids, atropine, and vasopressor support and was closely monitored in the coronary care unit for 48 h.

Discussion:
Grayanotoxin I and II are believed to be primarily responsible for mad honey intoxication and act by persistent activation of voltage-gated sodium channels. Hypotension, dizziness, nausea, vomiting, and impaired consciousness are the common presentation of mad honey intoxication. Toxic effects are usually mild and close monitoring for 24–48 h is sufficient but life-threatening complications like cardiac asystole, convulsions, and myocardial infarction have also been reported.

Conclusion:
Most cases of mad honey intoxication only need symptomatic treatment and close observation but the potential for deterioration and life-threatening complications must also be considered.
Renal function impairment might be worsened by SARS-CoV-2 virus: a triple critical care disease causing hypoxemia
Authors: Bereda Gudisa 
Published: August 2023

Background and importance:
People who have underlying chronic renal disease may be more susceptible to the catastrophic disease caused by coronavirus disease 2019 (COVID-19), which is characterized by multisystem organ failure, thrombosis, and an aggravated inflammatory response.

Case presentation:
On 11 July 2022, a middle-aged black African male merchant, 57 was taken to the emergency room. The patient arrived at the emergency room with grade II pitting edema, weight loss, a cold intolerance, stress, a fever, a headache, dehydration, and shortness of breath that had persisted for 2 days. After 28 h, the results of the polymerase chain reaction test on a throat swab confirmed the presence of the severe acute respiratory syndrome coronavirus-2 virus. An auscultation of the chest revealed bilateral wheezing, crepitations in the right infrascapular region, and bilateral airspace consolidations, which were more pronounced on the left side and included practically all zones. He received 1000 ml of fluid resuscitation (0.9% normal saline) and insulin therapy through a drip as soon as he was admitted to an ICU. He received subcutaneous enoxaparin 80 mg once every 12 h as treatment for his confirmed COVID-19 and thromboprophylaxis.

Clinical discussion:
The COVID-19 infection can cause difficulties in infected individuals that can result in pneumonia, intubation, admission to an ICU, and even death. Common diseases, including diabetes mellitus and chronic renal disease, have a synergistic relationship with early death.

Conclusion:
The existence of prior chronic renal impairment may possibly be a factor in the increased prevalence of kidney involvement seen in hospitalized COVID-19 patients.
Assessment of rational use of antimicrobials: a cross-sectional study among people of Nepal
Authors: Khadka Sitaram , Khadka Sulochana , Yadav Gopal K. , Sharma Arun , Giri Santoshi , Joshi Rinku , Amgain Kapil 
Published: August 2023

Introduction:
Inappropriate antimicrobial use leading to antimicrobial resistance is a matter of public health concern globally. This research was conducted with the objective of preventing antimicrobial misuse across knowledge, behavior, and practice domains among the general people of Nepal.

Methods:
It was a cross-sectional survey conducted among 385 participants visiting tertiary care center from all over Nepal from February 2022 to May 2022. Modified Bloom’s cut-off point was utilized to categorize the participants’ overall knowledge, behavior, and practice. The chi-square (χ
2) test and odds ratio (OR) using binary logistic regression at 95% CI and Spearman’s rank correlation coefficient test (r) were calculated wherever appropriate.

Results:
More than three-fifths of the participants (248, 64.42%) demonstrated good behavior, whereas less than half of the participants showed good knowledge (137, 35.58%) and practice (161, 41.82%) about rational use of antimicrobials. Health professionals had higher knowledge (OR: 1.07, 95% CI: 0.70–1.62) and good behavior (OR: 0.42, 95% CI: 0.27–0.64) than other professionals (P<0.05). Those with higher income [≥50 000 NRS (Nepalese rupees)] had good behavior (OR: 3.37, 95% CI: 1.65–6.87) and good practice (OR: 2.58, 95% CI: 1.47–4.50) scores than those with less monthly income (P<0.05). Similarly, higher educational degrees, viz. master’s and/or above, had good behavior (OR: 4.13, 95% CI: 2.62–6.49) and good practice scores (OR: 2.55, 95% CI: 1.68–3.87). Additionally, there were significant positive correlations between knowledge (K), behavior (B), and practice (P) scores (r=0.331 for K and B, r=0.259 for K and P, and r=0.618 for B and P, respectively; P<0.05).

Conclusions:
The findings imply the demand for effective legislature, strict enforcement of the drug act, and proper implementation of plans and policies to curb antimicrobials misuse. Lack of execution of existing laws and the unawareness of the public led to the extravagant use of antimicrobials.
Outcomes of viral myocarditis in patients with and without COVID-19: a nationwide analysis from the United States
Authors: Ismayl Mahmoud , Ahmed Hasaan , Hamadi Dana , Goldsweig Andrew M. , Aronow Herbert D. , Aboeata Ahmed 
Published: August 2023

Background:Cardiovascular complications contribute to 40% of coronavirus disease 2019 (COVID-19) related deaths. The viral myocarditis associated with COVID-19 accounts for significant morbidity and mortality. How COVID-19 myocarditis compares to other viral myocardites is unknown.Methods:The authors conducted a retrospective cohort study using the National Inpatient Sample database to identify adult patients hospitalized for viral myocarditis in 2020 and to compare outcomes between those with and without COVID-19. The primary study outcome was in-hospital mortality. Secondary outcomes included in-hospital complications, length of stay, and total costs.Results:The study population included 15 390 patients with viral myocarditis, of whom 5540 (36%) had COVID-19. After adjustment for baseline characteristics, patients with COVID-19 had higher odds of in-hospital mortality [adjusted odds ratio (aOR) 3.46, 95% CI 2.57–4.67], cardiovascular complications (aOR 1.46, 95% CI 1.14–1.87) including cardiac arrest (aOR 2.07, 95% CI 1.36–3.14), myocardial infarction (aOR 2.97, 95% CI 2.10–4.20), venous thromboembolism (aOR 2.01, 95% CI 1.25–3.22), neurologic complications (aOR 1.82, 95% CI 1.10–2.84), renal complications (aOR 1.72, 95% CI 1.38–2.13), and hematologic complications (aOR 1.32, 95% CI 1.10–1.74), but lower odds of acute heart failure (aOR 0.60, 95% CI 0.44–0.80). The odds of pericarditis, pericardial effusion/tamponade, cardiogenic shock, and the need for vasopressors or mechanical circulatory support were similar. Patients with COVID-19 had longer length of stay (7 days vs. 4 days,P<0.01) and higher total costs ($21,308 vs. $14,089,P<0.01).Conclusions:Among patients with viral myocarditis, COVID-19 is associated with higher in-hospital mortality and cardiovascular, neurologic, renal, and hematologic complications compared to non-COVID-19 viruses.
Clinical spectrum of ear, nose and throat foreign bodies at a tertiary hospital: a cross-sectional study
Authors: Abraham Zephania Saitabau , Kahinga Aveline Aloyce , Khamis Khamis Omar , Liyombo Edwin 
Published: August 2023

Background:
Presence of foreign bodies (FBs) in the ears and upper aerodigestive tract is a common encounter in children unlike adults in otorhinolaryngology practice. FBs form a major part of emergencies in otorhinolaryngology. Studies on ear, nose and throat FBs in Tanzania are scarce.

Objective:
To determine the clinical spectrum of ear, nose and throat FBs at the largest tertiary hospital.

Methods:
A descriptive hospital based cross-sectional study was conducted where 95 patients were recruited at the Hospital from December 2019 to May 2020. Data were collected using semi-structured questionnaires and analyzed using Statistical Package for the Social Sciences (SPSSs) version 24.

Results:
In this study, there were more females, 56 (58.9%) than males, 39 (41.1%) with female to male ratio being 1.4:1. Children aged younger than 10 years predominated in this study, 69 (72.6%). The nose, 36 (37.9%) and ear, 29 (30.5%) were the commonest sites where FBs lodged followed by the pharynx, 22 (23.2%) and oesophagus, 10 (8.4%). Regarding types of FBs, inorganic types, 49 (51.6%) predominated and were mostly coins, 17 (17.9%). Majority of FBs were removed in less than 24 h (53.7%) and complications were found in 29 (30.5%) patients and being more pronounced with nasal FBs. Majority of those with complications presented to the hospital 24–72 h post lodging of FBs.

Conclusion:
FBs were encountered more commonly in children aged younger than 10 years. The nose was the commonly affected anatomical site followed by the ear, pharynx and oesophagus. The commonest FB was a coin. The inorganic FB type predominated and the most common inorganic type was a coin while the commonest organic type was a seed. Complications were encountered in those who presented between 24 and 72 h post FB lodgment.
Reverse takotsubo syndrome heralding as ventricular fibrillation: a case report
Authors: Basnet Arjun , Sharma Nava R. , Lamichhane Saral , Tiwari Kripa , Varghese Jeffy , Kansakar Sajog , Gautam Sudarshan 
Published: August 2023

Introduction and importance:
Reverse takotsubo syndrome, a variant of takotsubo cardiomyopathy, is an acute left ventricular failure characterized by the basal akinesis/hypokinesis associated with apical hyperkinesis. Its presentation is similar to that of the acute coronary syndrome.

Case presentation:
The authors present a case of a 49-year-old woman, a vice principal at a local school with a history of hypertension, who was brought to our center after she collapsed while giving a graduation speech. Reverse takotsubo was a presumed diagnosis after we ruled out other differentials.

Clinical discussion:
The pathophysiology of reverse takotsubo syndrome is poorly understood. It might be due to a different pattern of catecholamine-mediated myocardial dysfunction than classic takotsubo cardiomyopathy. It is often associated with physical and/or emotional stressors.

Conclusion:
Supportive treatment and identification and prevention of triggers can reduce the recurrence of reverse takotsubo cardiomyopathy. Physicians should be aware of various triggers for this condition.
The effect of cognitive-behavioral group therapy on reducing depression and anxiety in patients with mood disorders: experimental research
Authors: Nabian Pantea 
Published: August 2023

Introduction and importance:
Mood disorders are one of the most common psychiatric disorders that manifest as a low mood in depressed people or a high mood in manic people. The cognitive-behavioral therapy group is one of the most effective forms of intervention available for patients with mood disorders. This research aimed to evaluate the effect of cognitive-behavioral group therapy in reducing depression and anxiety in patients with mood disorders.

Case presentation:
The study was a semi-experimental study with a pretest-post-test design with a control group. The research subjects were 60 patients hospitalized in the psychiatric department of Razi Hospital in Tehran, who were randomly divided into two experimental (N:30) and control (N:30) groups. Both groups took medicine as usual. Before the therapeutic intervention, both groups were evaluated with Beck’s depression questionnaire and the Zung anxiety scale. In addition to drug therapy, the experimental group participated in ten sessions of the cognitive-behavioral therapy group, and in the control group, no psychological intervention was performed except for drug therapy. At the end of the nonpharmacological treatment intervention, both groups were evaluated again with the aforementioned tests. The obtained data were analyzed using independent and dependent t-tests.

Clinical discussion:
The research findings showed that the cognitive-behavioral therapy group was significantly (P<0.05) effective in reducing the depression of hospitalized patients with mood disorders, but this method did not have much effect in reducing the anxiety of the patients.

Conclusion:
Cognitive-behavioral group therapy can be effective in reducing depression in hospitalized patients with mood disorders.
The use of bovine-derived hydroxyapatite xenograft for defect filling in opening-wedge high tibial osteotomy
Authors: Santoso Asep , Utomo Pamudji , Mahyudin Ferdiansyah , Utomo Dwikora N. , Budhiparama Nicolaas C. , Anwar Iwan B. , Sibarani Tangkas , Warman Fanny I. 
Published: August 2023

Introduction:
High tibial osteotomy is a reliable procedure for the correction of knee varus deformity. An opening-wedge high tibial osteotomy (OW-HTO) is the most popular technique. The results of the bone defect after opening the wedge needed special treatment to ensure bone healing. This study aims to evaluate the use of bovine-derived hydroxyapatite graft for defect filling after OW-HTO.

Methods:
A retrospective study was performed on all patients who received OW-HTO at Prof. Dr R. Soeharso Orthopaedic Hospital from November 2019 to December 2022. A total of 21 patients (24 knees) were included in this study. Clinical dan radiological evaluation was performed on all patients preoperative and postoperatively. The mean of the follow-up period was 12.6 months with a minimum of 4 months follow-up.

Results:
Primary medial uni-compartment knee osteoarthritis was the most common diagnosis, with 17 of 24 cases (70.8%). Mechanical axis deviation was changed from 31 mm medial deviation (range: 8–52 mm) to 0.45 mm medial deviation (range: 13 - (-8) mm). The anatomic tibiofemoral angle was corrected from a preoperative mean of 4.7° of varus to a mean of 5.8° of valgus postoperatively. Bone defect height was mean 15.9 mm with a range of 10–23 mm. Bone defect width was mean 46.7 mm (range: 34–60 mm). Hydroxyapatite graft integration with the host bone was found in all patients during the final follow-up period.

Conclusions:
Bovine-derived hydroxyapatite graft is a safe and effective material for bone defect filling in OW-HTO procedures with a high bone union rate.
Osmotic demyelination syndrome with transient diabetes insipidus in postpartum female: a case report
Authors: Yadav Alisha , Sherpali Aakash , Bashyal Bibhav , Kala Kharel Kirti , Parajuli Naresh 
Published: August 2023

Introduction and importance:
Osmotic demyelination syndrome (ODS) is a neurological disorder usually after rapid correction of hyponatremia. Only few cases of ODS with hypernatremia and diabetes insipidus (DI) in postpartum state is reported. Postpartum hypernatremia is described as severe hypernatremia in postpartum period and presents as an encephalopathy with rhabdomyolysis with diffuse white matter hyperintensities suggestive of osmotic demyelination.

Case presentation:
The authors present a case of 29-year-old female who presented with chief complaint of altered sensorium and quadriparesis. Two days prior to onset of symptoms, she underwent caesarean section, was kept on nil per oral and free fluid restriction, after which she had confusion, altered sensorium, and weakness in all four limbs. Sodium level was 170 mEq/l. Urine osmolality and plasma osmolality was 150 and 410 mOsm/kg of water, respectively. MRI showed high signal intensity lesion in pons suggestive of demyelination. She was diagnosed ODS with transient DI and quadriparesis, in postpartum period due to further rise in sodium after free fluid restriction and nil per oral. She was treated with desmopressin, 5% dextrose and 0.9% normal saline, her quadriparesis recovered and desmopressin was tapered and stopped over 45 days and discharged at stable state.

Clinical discussion:
ODS can rarely be associated with hypernatremia in postpartum female presenting as quadriparesis and altered sensorium.

Conclusion:
Clinicians should be familiar of ODS with hypernatremia with transient DI in postpartum period, which is reversible and can be managed by desmopressin and fluid replacement.
Breakage of an orogastric tube in a critically Ill patient: a case report
Authors: Khanal Surendra , Shrestha Suraj , Khadayat Ramesh , Adhikari Aayush , Poddar Elisha , Kharel Sanjeev , Regmi Pradeep Raj 
Published: August 2023

Introduction and importance:
Orogastric and nasogastric tubes are common methods of enteral feeding. Although the methods of tube feeding are simple, these methods are not free of complications.

Case presentation:
This case report describes a 58-year-old patient with the diagnosis of stroke, in whom there was breakage of an orogastric tube during a prolonged ICU stay.

Clinical discussion:
Early enteral feeding in patients without any contraindications is associated with improved organ survival and recovery, and decreased incidence of infections, which decreases the ICU stay and improves the overall outcome. Nasogastric and orogastric tubes are the most commonly inserted feeding tubes. Breakage of an orogastric tube is a rare complication that can occur due to manufacturing defects, exposure to a harsh acidic environment, and forceful flushing of an obstructed tube.

Conclusions:
Timely identification of the broken feeding tube can help the treating clinicians retrieve it easily even with the help of a laryngoscope in selected patients.