bluuebunny/crossref_metadata_2025_split huggingface dataset:
Strategies to communicate pregnancy complications: a systematic review and practical points for healthcare professionals
Authors: Karapanos Ioannis , Bolou Angeliki , Nazer Maya , Iliodromiti Stamatina , Greco Elena 
Published: August 2023

Purpose/methods
This systematic review aims to provide an overview of strategies available for healthcare professionals (HCPs) to effectively communicate unexpected news in pregnancy, specifically for the most common pregnancy complications. Three medical databases and grey literature were searched until March 2023 using subject headings and keywords. Snowball techniques were also used. The articles were reviewed at each stage of screening independently by two separate authors. Qualitative, quantitative and mixed methods studies were included.

Recent findings
Forty-three studies were included and grouped according to the gestational age of the pregnancy complication – miscarriage, increased risk screening, foetal conditions, stillbirth. The main key points for communication were outlined at each specific complication and eventually the six common themes that emerged from all the categories were included in the acronym PRICES (Preparation – Referral – Individualized care – Clarity – Empowerment – Sensitivity).

Summary
Given the negative impact of failed communications both in pregnancy outcomes and patients’ experience, we advocate that communication training for HCP providing pregnancy care should be mandatory, and skills should be updated at regular intervals. Tools like our acronym PRICES can be used during teaching HCPs how to communicate more effectively.
Weeks-Ahead Epidemiological Predictions of Varicella Cases From Univariate Time Series Data Applying Artificial Intelligence
Authors: Wood David A. 
Published: August 2023

Abstract

Background
“Chickenpox” is a highly infectious disease caused by the varicella-zoster virus, influenced by seasonal and spatial factors. Dealing with varicella-zoster epidemics can be a substantial drain on health-authority resources. Methods that improve the ability to locally predict case numbers from time-series data sets every week are therefore worth developing.

Methods
Simple-to-extract trend attributes from published univariate weekly case-number univariate data sets were used to generate multivariate data for Hungary covering 10 years. That attribute-enhanced data set was assessed by machine learning (ML) and deep learning (DL) models to generate weekly case forecasts from next week (t0) to 12 weeks forward (t+12). The ML and DL predictions were compared with those generated by multilinear regression and univariate prediction methods.

Results
Support vector regression generates the best predictions for weeks t0 and t+1, whereas extreme gradient boosting generates the best predictions for weeks t+3 to t+12. Long-short-term memory only provides comparable prediction accuracy to the ML models for week t+12. Multi–K-fold cross validation reveals that overall the lowest prediction uncertainty is associated with the tree-ensemble ML models.

Conclusion
The novel trend-attribute method offers the potential to reduce prediction errors and improve transparency for chickenpox time series.
Surgery for severe mitral regurgitation: The etiology matters
Authors: Tsai Yi-Lin , Lee Ching-Wei , Huang Wei-Ming , Cheng Hao-Min , Yu Wen-Chung , Chen Chen-Huan , Sung Shih-Hsien 
Published: August 2023

Background:
While surgery has been the standard treatment for patients with severe primary mitral regurgitation (PMR), the role of surgery for severe secondary mitral regurgitation (SMR) remained debated. We therefore investigated the prognostic differences of surgery for patients with either severe PMR or SMR.

Methods:
Subjects hospitalized for heart failure were enrolled from 2002 to 2012. The severity of MR was assessed by continuity equation, and an effective regurgitant orifice area of ≥40 mm2 was defined as severe. Long-term survival was then identified by the National Death Registry.

Results:
A total of 1143 subjects (66.4 ± 16.6 years, 65% men, and 59.7% PMR) with severe MR were analyzed. Compared with PMR, patients with SMR were older, had more comorbidities, greater left atrial and ventricular diameter, and less left ventricular ejection fraction (all p < 0.05). While 47.8% of PMR patients received mitral valve surgery, only 6.9% of SMR patients did. Surgical intervention crudely was associated with 54% reduction of all-cause mortality in PMR (hazard ratio, 0.46; 95% confident interval, 0.32-0.67), and 48% in the subpopulation with SMR (0.52, 0.30-0.91). Propensity score matching analysis demonstrated the survival benefits of mitral valve surgery was observed in patients with PMR (log rank p = 0.024), but not with SMR. Among the unoperated subjects, age, renal function, and right ventricular systolic pressure were common risk factors of mortality, regardless of MR etiology.

Conclusion:
Mitral valve surgery for patients with heart failure and severe MR was associated with better survival in patients with PMR, but not in those with SMR.
Assessing Adherence to Clozapine
Authors: Flanagan Robert J. , Hunter Samora , Obee Stephen J. 
Published: August 2023

Abstract

Background
The clinical assessment of adherence to clozapine may prove difficult.

Method
We studied the incidence of nonadherence (plasma clozapine <0.01 mg L−1) in samples submitted to a clozapine therapeutic drug monitoring (TDM) service, 1993–2017.

Results
Clozapine was not detected in 2865 samples from men (2214 patients, 1.1% of all samples from men) and 1068 samples from women (822 patients, 1.0% of all samples from women). Information on the prescribed dose was supplied for 1623 of these samples from men and 492 of these samples from women. Prescribed doses ranged up to 1200 mg d−1, although most were in the range 100 to 600 mg d−1. Norclozapine was detected in 260 (9.1%) and 67 (6.3%) of the samples from men and from women, respectively, that did not contain clozapine. While an assay was requested to confirm either a patient history of nonadherence, or to establish that clozapine had been cleared from the circulation after overdosage, for example, in at least 38 instances, in the vast majority of cases the absence of clozapine from the sample was unexpected.

Implications
While adherence to clozapine may be good in general, tolerance to its potentially fatal cardiovascular effects is easily lost. Moreover, in treatment-resistant schizophrenia, the risk of self-harm increases if the drug is not taken regularly. In addition to presently available TDM services, the advent of a clozapine immunoassay for laboratory use should make it easy to institute at least monthly clozapine TDM at minimal extra cost.
Two case reports of adult traumatic inferior hip dislocations following road traffic accidents without complications
Authors: Najafi Arvin , Shahbazi Parmida , Zargar Danoosh , Gholami Niloofar , Hadavi Dorsa , Mirhoseini Mohammad S. 
Published: August 2023

Introduction and Importance:
Inferior dislocation of the hip is the rarest type of hip dislocation, mainly occurring from high-energy incidents, mostly from road traffic accidents or sports. It is generally an injury among adults.

Case presentation:
A 17-year-old male sustained injuries as a pedestrian, and a 30-year-old male sustained a traffic accident as a motorcycle rider. Both patients complained of severe pain in the hip, decreasing range of motion, and the inability to weight bearing. In both, the affected hip joint was fixed in 90° flexion, abduction, and external rotation, and the leg was slightly shorter than the other limb. An X-ray showed the inferior dislocation of the right hip and left hip, respectively, without any sign of fracture. We reduced both dislocations closely after sedation without any complications during follow-ups.

Conclusion:
This injury should be treated as an emergency, and reduction performed as soon as possible, within 6 h. It can be managed usually with closed reduction under general anesthesia. Close follow-up is necessary to prevent its complications, including avascular necrosis, associated fractures, neurovascular compromise, and articular cartilage injuries.
Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes syndrome: a case report from Nepal
Authors: Subedi Ram C. , Paudel Raju , Paudel Sharma , Thapa Lekhjung , Phuyal Subash , kharbuja Naresh , Adhikari Ayush 
Published: August 2023

Introduction and importance:
Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like syndrome (MELAS) is a rare neurodegenerative inherited disorder that is characterized by stroke-like episodes, seizures, endocrine, and multiple system involvement. It is important to consider it as a differential diagnosis in a young patient with stroke-like episodes as it is progressive and has multiple complications.

Case presentation:
A 28-year-old male presented with slurring of speech and drowsiness for 7 h. He was a diagnosed case of type 2 diabetes mellitus, Wolf-Parkinson-White syndrome, and bilateral hearing loss.

Clinical findings and investigations:
The patient had expressive aphasia with impaired fluency, repetition, and naming. After being discharged, he represented with loss of consciousness and involuntary movements of the whole body. MRI and MRS showed extension of hyperintense lesions to parieto-occipital regions from temporal regions not limited by vascular territories. MELAS was considered, which was confirmed by molecular genetic analysis. Coenzyme Q10 was used for MELAS. Insulin, Linagliptin, and levetiracetam were used for diabetes and seizures. Regular follow-up was advised to the patient.
MELAS is an important syndrome to consider in any young patient presenting with unexplained stroke disorders. A high index of suspicion is needed in an appropriate clinical setting to avoid misdiagnosis.
Cultural patterns and outcome of umbilical cord care among caregivers in Africa: a systematic review
Authors: Abua Monica Agianipe , Antor Odu Ndep , Madubuattah Louis Chinweike , Ogunkola Isaac Olushola 
Published: August 2023

Background:
The third leading cause of death in infants under 1-month-old is neonatal sepsis. Following the severing of the umbilical cord, bacterial infection may result in newborn sepsis and mortality. The objective of this review on cultural patterns and umbilical cord-care outcomes is to evaluate present practices and create a case for developing and implementing novel cord-care regimens in Africa.

Materials and methods:
In order to find published studies on cultural patterns and outcomes of umbilical cord care among caregivers in Africa from January 2015 to December 2021, we conducted a systematic literature search across six computerized bibliographic databases: Google Scholar, POPLINE, PubMed, Web of Science, Science Direct, and Scopus. As a result, a narrative synthesis of quantitative and qualitative data was employed to summarize the data from the included research.

Results:
There were 17 studies included in this review with 16 out of the 17 studies having a total of 5757 participants. The odds of neonatal sepsis were 13 times higher among infants whose caregivers had improper hygiene compared with those who had proper hygiene. The outcome of cord management showed that the majority (75.1%) of the umbilical cords were infected. Majority of the included studies (n=13) show that the respondents (caregivers) had a low level of knowledge and practice.

Conclusion:
This systematic review reveals that unsafe umbilical cord-care practices remained prevalent in some African regions. Home delivery is still a prevalent practice in some communities and inappropriate umbilical cord cleaning practices were common findings.
Liver injury in COVID-19: prevalence and its associated factors in Nepal – A retrospective cross-sectional study
Authors: Rajbhandari Bibek , Pant Suman , Hamal Achyut B. , Thapa Ashish , Shrestha Apurba , Shrestha Saurav , Shrestha Anil , Panta Niranjan , Pandey Udesh , Nepal Mukul Upadhyay , Shilpakar Olita 
Published: August 2023

Background:
Liver impairment has been reported as a common clinical manifestation in patients with Severe Acute Respiratory Syndrome Coronavirus 2 infection, with varying degrees of severity ranging from a mild elevation of liver enzymes to acute liver failure. However, the prevalence and clinical significance of liver injury in Coronavirus Disease 2019 (COVID-19) patients, particularly in low- and middle-income countries such as Nepal, remains poorly understood. To investigate the hepatic injury related to this disease and its clinical significance, the authors conducted a retrospective study that included adult patients with COVID-19 infection in security hospitals of Nepal.

Methodology:
The authors performed a retrospective chart review on 1007 COVID-19-positive patients who underwent a liver function test during their admission in two COVID-19 dedicated hospitals in Nepal from April 2021 to January 2022. The data were collected and entered into Microsoft Excel before being exported to SPSS version 24 for analysis. Univariate and multivariate logistic regression were used to determine factors associated with liver injury. We reported adjusted odds ratios (aOR) with 95% CI.

Results:
Of the total, 549 (54.5%) patients had an acute liver injury. Among 549 patients, 68.1% were mild, 27.9% were moderate, and 5.0% were severe. Out of 1007 patients, 1.4% had cholestatic liver injury. Most patients with mild, moderate, and severe liver injury had greater than or equal to 10 C-reactive proteins (CRP). In multivariate logistic regression, sex, and CRP were significantly associated with the presence of liver injury. Males had 1.78 times higher odds of having a liver injury compared to females (aOR:1.78; 95% CI: 1.37–2.30, P-value:<0.001). Similarly, patients who had CRP greater than 10 had higher odds of having liver injury compared to those who had CRP less than 10 (aOR: 1.84; 95% CI: 1.41–2.39; P-value: <0.001).

Conclusions:
The present study reveals that COVID-19 infection is commonly associated with mild increased liver enzymes. However, the likelihood of developing acute liver injury was found to be higher in patients with an inflammatory state indicated by CRP levels greater than 10. Furthermore, the study highlights the sex-based difference in the prevalence of liver injury, with males demonstrating a higher predisposition.
Lipectomy for madelung disease using tumescent technique: a cross-sectional study
Authors: Duc Nguyen Quang , Tien Nguyen Phuong , Tu Nguyen Thanh , Huynh Hoang Ngoc , Linh Le Diep 
Published: August 2023

Background:
Madelung’s disease is a rare disfiguring disorder that affects both function and esthetic appearance in the head and/or shoulder, neck, and arms regions. Lipectomy is typically necessary but such treatment can encounter difficulties due to the large sizes of the tumors, interspersed with important organs in the surrounding region. In this report, the authors evaluate the effectiveness of using tumescent solution in lipectomy to provide a dual treatment of tissue removal for Madelung disease in the head-and-neck region.

Methods:
A prospective study and clinical descriptions were conducted on 17 patients undergoing 26 head-and-neck lipectomies. A tumescent solution was injected into the surgical region with a blunt-tip cannula 5–10 min before skin incision. The authors recorded systemic manifestations both during and after surgery; tumescent volume; surgical region; clarity of the operative field; weight of fat removed, and early complications. After surgery, the authors followed the patients from periods of 3 months to 4 years.

Results:
All 17 male patients had a history of alcoholism. In total, 12 lipectomies for the removal of anterior neck fatty masses and 14 lipectomies for the removal of posterior neck fatty masses were performed. The average amount of tumescent injected was 260.1 ml (range 140–550 ml). Surgery was reported as totally bloodless in 10 (38.5%) operative fields, with minimum bleeding in 12 (46.1%) operative fields, acceptable bleeding in four (15.4%) operative fields. The average surgical time was 175.6 min (range 135–250 min). The removed fatty masses weighed between 250 and 2150 g, with an average of 582.9 g. Early complications were seen in four patients, accounting for 15.4% (2 hematoma, 1 skin necrosis, and 1 seroma).

Conclusions:
Using tumescent solution in lipectomies to treat Madelung disease in the head and neck area is a simple, safe, and useful technique. The technique helps to create a clean operative field, reduces bleeding, and thereby assists surgeons during the operation.
Intraoperative endoscope view classification of neurovascular compression in hemifacial spasm condition: a single neurosurgeon prospective cross-sectional study
Authors: Pham Anh Hoang , Duong Ha Dai , Dong He Van , Chu Hung Thanh , Nguyen Linh Duy , Bryan Lieber 
Published: August 2023

Introduction:
Hemifacial spasm is a neurological disorder that causes involuntary contractions of facial muscles on one side of the face. This study aims to analyze the intraoperative pattern of neurovascular compression (NVC) and discuss relevant decompression techniques for 29 patients with hemifacial spasm who underwent endoscopy-assisted microvascular decompression (EAMVD).

Patients and Methods:
This was a prospective, single center, single neurosurgeon, cross-sectional study conducted from November 2020 to August 2022. All patients received EAMVD, and the NVC culprit vessel, compression site, severity, and type were analyzed using a 30-degree endoscope.

Results:
All 29 patients had successful interposition EAMVD without postoperative symptoms. The most common NVC site was REX (18 in 29 cases), the most common vessel to compress the seventh nerve was AICA (23 in 29 cases), while the most common type of NVC was loop (22 in 29 cases). NVC severity: 17 cases of mild compression, 4 cases of moderate compression, and 8 cases of severe compression. Without an angled telescope, we will miss the NVC in 12 cases (41.3%).

Conclusion:
EAMVD using an angled endoscope is a promising technique for treating hemifacial spasm. Intraoperative analysis of NVC can lead to a better understanding of the patterns of compression and may help in selecting appropriate decompression techniques.
Hinge abduction hip dysplasia in (morquio a syndrome) treated by proximal femoral valgization osteotomy: a rare case report
Authors: Alkhateeb Ameen , Aboujaib Muhammed Fayez 
Published: August 2023

Introduction and importance:
Morquio A syndrome or mucopolysaccharidosis type IVA (MPS IVA) is an autosomal recessive and is a result of the abnormal metabolism of glycosaminoglycan, which manifests with normal intelligence, a cloudy cornea, dysfunction of endochondral ossification of epiphyseal cartilage, severe hip dysplasia, pain, impaired mobility, severe genuvalgum, thoracic kyphosis, and C1–C2 instability. An important manifestation is hinge abduction hip as an abnormal movement of the hip, which occurs when a deformed femoral head (often with a large uncovered anterolateral segment) impinges on the lateral lip of the acetabulum. Clinically appears as a restriction of movements, pain, and an unpleasant clunking sensation.

Case presentation:
A 10-year-old girl suffering from MPS IVA with many signs of orthopedic manifestations. When concentrating on the hip joint, she had acetabulofemoral dysplasia and hinge abduction hip with the aid of plain radiographs and arthrography with dynamic testing. A valgization osteotomy of the proximal femur in combination with a shelf acetabuloplasty was performed bilaterally.

Clinical discussion:
There is no documented case of valgus osteotomy of the proximal femur in MPS IVA patients. Furthermore, preoperative arthrographies are not described as a routine diagnostic tool, because the routine surgical procedure was to do varus osteotomy with a high rate of failure.

Conclusion:
In our opinion, understanding of the dynamic function of the hip is essential for the surgical decision-making process. Our successful case with an 8-year follow-up illustrates that the well-known and widely performed valgus osteotomy in cases of hinge abduction in MPS IVA is an alternative, which should be considered preoperatively.
Fatal rhabdomyolysis caused by COVID-19 infection: a case report
Authors: Khalayli Naram , Ibrahim Raghad , Ibrahim Rahaf , Kudsi Maysoun 
Published: August 2023

Introduction and importance:
COVID-19 is a systemic viral disease complicated with medical conditions. Severe rhabdomyolysis during the COVID-19 course is not until now well known.

Case presentation:
The authors presented a 48-year-old female with fatal rhabdomyolysis caused by COVID-19 infection. She was referred to us with cough, generalized myalgia and arthralgia, and fever during the last week. Laboratory results showed an elevated erythrocyte sedimentation rate, elevated C-reactive protein level, and elevated creatine kinase. The nasopharyngeal swab confirmed the diagnosis of coronavirus 2 RNA infection. She was managed initially in the COVID-19 isolation department. Three days later, she was transferred to the intensive care unit and mechanically ventilated. Laboratory results were consistent with rhabdomyolysis. She died because of cardiac arrest due to continuous hemodynamic deterioration.

Clinical discussion:
Rhabdomyolysis is a serious condition that can be fatal or cause disability. Rhabdomyolysis cases have been reported in COVID-19 patients.

Conclusion:
Rhabdomyolysis cases have been reported in COV19 patients. Further studies are needed to understand the mechanism and to optimize the treatment.
Primary melanoma of the rectum: a case report of a rare tumor
Authors: Tran Thang , Pham Phuong Thanh , Nguyen Hoa Thi , Hoang Cuc Thi 
Published: August 2023

Introduction and importance:
Malignant melanoma has a generally poor prognosis and occurs primarily on the skin but may rarely be found in internal organs such as the small intestine, colon, or rectum.

Case presentation:
This report presents a case of a 78-year-old male patient with stage IV gastrointestinal melanoma, which is a rare form of melanoma. The patient received first-line pembrolizumab with a complete response.

Clinical discussion:
Surgery plays a crucial role in local and regional control for patients with localized stages. Immune checkpoint inhibitor therapy, including nivolumab or pembrolizumab, is a well-studied and proven effective treatment option for patients with advanced skin melanoma. In this case report, the patient with gastrointestinal melanoma also had a very good response to immunotherapy.

Conclusions:
Understanding gastrointestinal melanoma is still limited due to the rarity of this clinical entity. Currently, there are no standard treatment guidelines for this rare group of patients. Immune checkpoint inhibitors could be the preferred first-line therapy for patients with distant metastases.