bluuebunny/crossref_metadata_2025_split huggingface dataset:
A case of Tocilizumab-induced thrombocytopenia in steroid-resistant Graves orbitopathy
Authors: Cuculescu Victoria , Vudu Stela , Rizov Cristina , Vudu Lorina 
Published: January 2023

Abstract

Introduction
Graves’ orbitopathy (GO) is the main extrathyroidal manifestation of Graves’ disease (GD). It is more common in women, but men have more severe evolution of the disease. GO appears in 25–70% of patients with GD and can have a severe evolution in 5% cases and even lead to sight loss. In mild forms local treatment is often sufficient to alleviate eye symptoms. However, in moderate-to-severe cases systemic glucocorticoids are used, combined or not with immunosuppressive drugs. In moderate-to-severe glucocorticoid-refractory cases, conventional and biological immunosuppressive drugs have been used, among which is treatment with Tocilizumab (TCZ) – a monoclonal antibody targeting the interleukin-6 receptor, involved in GO's pathogenesis.

Clinical Case
A 49 years old former smoking Caucasian man was admitted to the endocrinology unit with asymmetrical bilateral exophthalmos, spontaneous and movement induced retrobulbar pain, hyperlacrimation. He has been diagnosed with Graves disease 9 months prior to the admission to our clinic. At that time the patient was treated with antithyroid drugs and oral prednisolone. The clinical activity score – CAS 7/7 points confirmed an active form of GO. Laboratory findings revealed a suppressed TSH 0.01 UI/ml, increased freeT4 40,1 pmol/l, positive TR-Ab (30,04 IU/L). Treatment with high-dose regimen of i.v. methylprednisolone (Mt), cumulative dose 5.75 g in 12 weeks was applied. The patient was soon thereafter admitted repeatedly for evaluation: a non-response to Mt has been established, occurrence of diplopia, convergent strabismus, therefore a second-line treatment with tocilizumab (TCZ) was considered. His blood platelet count before TCZ was 158×10*9. The patient received the first 8 mg/kg dose of i.v. TCZ and showed an improvement in the CAS score (5/7 points), however 1 month later, the platelet count had decreased to 48×10*3 and further treatment with TCZ has been postponed until thrombocyte count increases above 100×10*9. His oral medicines were thiamazole and levothyroxine. Other causes of thrombocytopenia (HIV, Hepatitis C, Ebstein-Barr virus, Helicobacter pylori, liver disease) have been excluded. 7 weeks later thrombocyte count increased spontaneously to 102×10*3 and TCZ treatment has been resumed.
Discussion. The mechanism of thrombocytopenia induced by TCZ is dependent on its effect on IL-6 receptor, which stimulates thrombopoiesis through thrombopoietin induction. Clinical studies prove the effectiveness of TCZ in the treatment of GO, but side effects limit its use. Older age and low platelet count before TCZ treatment were associated with the development of thrombocytopenia after treatment.

Conclusion
Thrombocytopenia induced by tocilizumab is tolerable. However, in patients with known risk factors, close monitoring of platelet counts is recommended. An individual approach is appropriate, considering the high cost of the drug, side effects and comorbidities.
Ectopic lingual thyroid tissue diagnosed in an elderly patient
Authors: Avcı Merdin Fatma , Araz Mine , Büyükatalay Zahide Çiler , Faik Erdoğan Murat 
Published: January 2023

Abstract

Introduction
Lingual thyroid (LT) is a rare ectopy of the gland characterized by residual thyroid tissue remaining along the thyroglossal duct, due to inability of the gland to descend from the foramen cecum into the lower part of the neck.

Clinical Case
A 65-year-old female patient presented with a long-standing difficulty in swallowing and sensation of a foreign body in the throat. Oropharyngeal examination revealed a well-circumscribed submucosal mass at the base of the tongue. Neck MRI detected 28×25×30 mm, lesion, isointense on T1WI and T2WI, showing prominent and homogeneous contrast enhancement located at the base of tongue, midline at the level of the vallecula, and narrowing towards the oropharynx anteriorly. Since normal thyroid tissue was not observed in the thyroid bed, the mass was suspected to be an ectopic lingual thyroid tissue. Tc99m pertechnetate thyroid scintigraphy revealed focal involvement at the base of the tongue rather than its anatomical region, confirming the diagnosis of LT. Thyroid function tests showed; serum TSH level of 4.25 mU/L (normal range: 0.27–4.20), free T4 12.1 pmol/L (11–22), free T3 4.1 pmol/ L (3.1–6.8), Anti-TPO &lt;0.9 IU/ml, Anti-Tg: 14.9 IU/ml(0–115).Since the patient had difficulty swallowing, Levothyroxine was considered to be insufficient and time-consuming, surgical intervention was planned as a permanent solution. After surgical treatment, LT4 replacement was initiated, and the pathology confirmed normal thyroid tissue. The patient is being followed up with LT4 replacement therapy.
Lingual thyroid (LT) is the most frequent ectopic location of the thyroid gland, its prevalence ranges between 1/100000 and 1/300000 being seven times more common in women. While the ectopy is often diagnosed at an early age, it may present at any age from birth to senility. Patients with ectopic LT are usually asymptomatic, hypothyroidism has been reported in 33% to 62% of patients. In proportion to the size of the lingual thyroid tissue, it can also cause complaints such as dysphonia, dysphagia, respiratory distress, foreign body sensation in the throat. Diagnosed with ectopic LT tissue at an advanced age, our patient had complaints of long-standing difficulty in swallowing solid foods, but hypothyroidism was not detected. After ENT examination, the diagnosis was confirmed by technetium (Tc99m) pertechnetate thyroid scintigraphy. Treatment of ectopic LT is either surgical or medical, depending on the size of the mass and patient's signs and symptoms. Ectopic lingual thyroid gland should always be considered, for the midline lesions, especially at the base of the tongue. Detailed assessment should be conducted to conclusively rule out obstruction and malignancy where the surgery is indicated. Levothyroxine could be a good solution for smaller, well defined benign lesions, which may stay stable or reduce in size under treatment.
Severe thrombocytopenia in a patient with diffuse toxic goitre
Authors: Vudu Stela , Hinculov Cezara , Gonta Veronica , Vudu Lorina 
Published: January 2023

Abstract

Introduction
Diffuse toxic goitre is an autoimmune disorder with a marked prevalence in women. Thrombocytopenia may coexist with diffuse toxic goitre. Nevertheless, the mechanisms of decline in platelet count alongside with autoimmune thyroid disease have not been extensively investigated.

Clinical Case
A case of diffuse toxic goitre is reported in a 55-year-old man who has been receiving continuous treatment with methimazole for 7 years. The physical examination revealed an asthenic man, with an enlarged thyroid gland, inactive bilateral orbitopathy and multiple ecchymosis, but no lymphadenopathy or hepatosplenomegaly. Laboratory analysis revealed suppressed thyroid stimulating hormone (TSH) 0.01 mlU/ml, normal free T4 level 21.60 pmol/l, increased free T3 6.99 pmol/l and thyroid stimulating immunoglobulin (TSI) level of 23.60 IU/L. Complete blood count revealed severely decreased platelets 3×10^9 / l, decreased hemoglobin 110.00 g/l and hematocrit 21.90%, normal leucocytes 9.58×10^9/l, low prothrombin Index 11% and International normalized ratio (INR) 7.00. Additional serological investigations excluded HIV infection and C viral hepatitis. The bone marrow aspiration disclosed a rich cellular and polymorph marrow, an increased number of megakaryocytes suggesting that the thrombocytopenia is due to platelet destruction. The patient has recovered from viral pneumonia caused by SARS-COV-2, 1 month prior to the medical consultation. He received platelet transfusion and was started on 1 mg/kg oral prednisolone followed by a gradual taper and improvement of platelet count.
Thrombocytopenia observed in diffuse toxic goitre may be mediated by both metabolic and immunological phenomena. In our case, the following causes may be considered: (1) an overlapping autoimmune process; (2) methimazole creating destructive antibodies; (3) COVID-19 disease. An autoimmune process is capable of triggering both conditions by activation of the reticuloendothelial system by thyroid hormones along with a cross-reaction between thyroid antibodies and platelet epitopes. Methimazole generates a drug-dependent immune response against platelets, involving platelet endothelial cell adhesion molecules and thus provoking thrombocytopenia. SARS-CoV-2 can induce thrombocytopenia by increasing the number of autoantibodies and immune complexes that destroy platelets. Lung damage by decreasing pulmonary capillary bed and platelet aggregation in the lungs indirectly leads to a reduced number of circulatory platelets.

Conclusion
Severe thrombocytopenia was detected in a patient with Grave's disease, in whom the number of platelets was 50 times below the lower limit of the reference range. Coexistence of thrombocytopenia may be explained by (1) an overlapping autoimmune process; (2) the effect of methimazole; (3) its occurrence or aggravation secondary to COVID-19.
Differentiating active from Inactive Sacroiliitis in ankylosing spondylitis by combination of DWI and Magnetization Transfer Imaging
Authors: Ning Qiuping , Fan Tiebing , Ren Hua , Ye Huiyi , Wang Wensheng 
Published: January 2023

Objectives: To evaluate lesions of sacroiliac joint (SIJ) by combination of diffusion-weighted imaging (DWI) and magnetization transfer (MT).
Methods: A retrospective study was used in this study. Forty-nine ankylosing spondylitis (AS) patients admitted to The China Academy of Chinese Medical Sciences Xiyuan Hospital from May 2020 to October 2020 were collected into active and inactive groups. Twenty-two healthy volunteers were recruited. Apparent diffusion coefficient (ADC) values for bone marrow edema (BME), sclerosis area, fat deposit area, and normal-appearing bone marrow (NABM) (both patients and healthy volunteers) and the magnetization transfer (MT) rate of the cartilage (MTRc) were analyzed in the groups. The above five parameters (ADC (NABM), ADC (BME) and ADC (fat deposit) and MTRc) between the active group and the inactive group were compared. The effectiveness of each parameter in diagnosing sacroiliac arthritis of ankylosing spondylitis were analyzed, and the predictive value of the parameters was compared.
Results: ADC(BME), ADC(NABM) and MTRc showed statistically significant differences between the active and inactive groups (P <0.05). ADC (BME) and ADC (NABM) could predict the activity of AS sacroiliac arthritis (P <0.01). ADC (NABM) and MTRc were significantly different between healthy volunteers and the active group (P <0.01). The areas under the ROC curve (AUCs) of ADC (BME)_ADC(NABM), ADC(NABM)_MTR, and ADC(BME)_MTRc were 0.885 (cut-off value=0.69), 0.849 (cut-off value=0.56) and 0.864 (cut-off value=0.60), respectively. The predictive ability of the combined index ADC (BME)_MTRc and ADC(NABM)_MTRc was increased.
Conclusion: The ability to diagnose and predict AS might be improved by the combination of diffusion-weighted imaging (DWI) and magnetization transfer (MT).
doi: https://doi.org/10.12669/pjms.39.2.6094
How to cite this: Ning Q, Fan T, Ren H, Ye H, Wang W. Differentiating active from Inactive Sacroiliitis in ankylosing spondylitis by combination of DWI and Magnetization Transfer Imaging. Pak J Med Sci. 2023;39(2):---------. doi: https://doi.org/10.12669/pjms.39.2.6094
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Complete Kawasaki disease after COVID-19 infection in an infant
Authors: Tahir Maliha , Mehmood Ramlah , Ahmad Mirza Sultan 
Published: January 2023

Kawasaki disease is a generalized systemic vasculitis that affects blood vessels throughout the body. The aetiology of Kawasaki disease is still unknown but is thought to be related to the combined effects of the immune response, genetic susceptibility, and infections including COVID-19. In this case report, we present a seven months old male infant who presented to us with fever, swollen lips, ulcers in the mouth, enlarged tonsils, strawberry tongue, conjunctivitis and generalised non-blanchable maculopapular rash. The detailed workup fulfilled the criteria of Kawasaki disease. The COVID-19 IgM antibodies were positive. The patient was treated with IV Immunoglobulins, IV methylprednisolone and Aspirin. The repeat echocardiography on six weeks follow-up turned out normal. In conclusion, there should be a high index of suspicion of Kawasaki disease while evaluating pediatric patients with COVID-19 infection so that timely intervention can be made to prevent complications. Prospective studies are needed to evaluate the relationship between Kawasaki Disease and COVID-19 infection.
doi: https://doi.org/10.12669/pjms.39.2.6359
How to cite this: Tahir M, Mehmood R, Ahmad MS. Complete Kawasaki disease after COVID-19 infection in an infant. Pak J Med Sci. 2023;39(2):---------. doi: https://doi.org/10.12669/pjms.39.2.6359
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Effects of Ranibizumab combined with laser photocoagulation on macular volume and best corrected visual acuity in patients with macular edema secondary to ischemic retinal vein occlusion
Authors: Liang Jing , Xiong Ting , Chen Huiqiong , Tao Ran , Cao Liping 
Published: January 2023

Objective: To investigate the effects of ranibizumab combined with laser photocoagulation on macular volume and best corrected visual acuity (BCVA) in patients with macular edema secondary to ischemic retinal vein occlusion.
Methods: The clinical data of 90 patients (90 eyes) with macular edema secondary to ischemic retinal vein occlusion treated in our hospital from June 2018 to December 2021 were retrospectively analyzed. Patients were divided into Groups-A, B, and C according to the type of treatment they received. The Group-A was treated with laser photocoagulation, the Group-B was intravitreally injected with ranibizumab, and the Group-C underwent ranibizumab combined with laser photocoagulation. The efficacy, intraocular pressure, BCVA, central macular thickness (CMT) and adverse reactions were compared among the three groups.
Results: The total efficacy of the Group-C was higher than that of the Group-A and B, with statistically significant differences (P< 0.05). Three months after treatment, BCVA was higher while CMT was reduced in the Group-C than those in the Group-A and B (P < 0.05). Six months after treatment, BCVA was higher while intraocular pressure was lower and CMT was thinner in the group C compared with the Group-A and B (P< 0.05).
Conclusions: Ranibizumab combined with laser photocoagulation in the treatment of macular edema secondary to ischemic retinal vein occlusion presents significant efficacy, and can effectively reduce macular volume, improve visual acuity and promote the recovery of retinal function.
doi: https://doi.org/10.12669/pjms.39.2.7040
How to cite this: Liang J, Xiong T, Chen H, Tao R, Cao L. Effects of Ranibizumab combined with laser photocoagulation on macular volume and best corrected visual acuity in patients with macular edema secondary to ischemic retinal vein occlusion. Pak J Med Sci. 2023;39(2):---------. doi: https://doi.org/10.12669/pjms.39.2.7040
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Maternal and perinatal outcome of Ramadan fasting in women with gestational diabetes
Authors: Abdullah Saba , Shumaila  , Mughal Saba , Samuel Mahwish , Hossain Nazli 
Published: January 2023

Objective: To compare maternal and perinatal outcome of Ramadan fasting during pregnancy in women with/without gestational diabetes.
Methods: This prospective case-control study was conducted at Department of Obstetrics & Gynecology Unit 1 Ruth PKM Civil Hospital & Dow Medical College and Holy Family Hospital, Karachi during 1st April to 31st July, 2022. In this study normoglycemic pregnant women and those identified as gestational diabetes(n=52) on oral glucose tolerance test, who fasted during Ramadan were included. Women, on diet control or diet plus metformin were included in the study. Study questionnaire included demographic details, days of fasting, self-reported hypoglycemic episodes. Maternal outcomes included preterm birth, pregnancy induced hypertension. Perinatal outcome included hyperbilirubinemia, hypoglycemia, weight of placenta, and apgar score.
Result: Eighty two women were included in the study, gestational diabetes (n=57) and normoglycemic (n=25). Average days of fasting were 16 ±9.0 days (range 5-30). Women with GDM were older (28.6 vs. 26.0 years, p-value=0.034), had raised levels of HbA1c (5.5 vs. 5.1, p-value=0.004), mean FBS (102.8 vs. 84.6 mg/dl, p-value <0.001), mean RBS (135.3 vs. 106.4 mg/dl, p-value <0.001) and had higher BMI at delivery (31.0 vs. 26.6 kg/m2, p-value=0.004). HbA1c (p-value=0.016) and head circumference of baby (p-value=0.038) were found lower in the group who fasted for more than 20 days among normoglycemic pregnant women. No other maternal and neonatal outcomes were found to be significantly affected by Ramadan fasting among pregnant women with/without GDM.
Conclusion: Gestational diabetes do not affect maternal and perinatal outcome among pregnant women.
doi: https://doi.org/10.12669/pjms.39.2.7332
How to cite this: Abdullah S, Shumaila, Mughal S, Samuel M, Hossain N. Maternal and perinatal outcome of Ramadan fasting in women with gestational diabetes. Pak J Med Sci. 2023;39(2):---------. doi: https://doi.org/10.12669/pjms.39.2.7332
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
AGE-RELATED FEATURES OF PORTAL HEMODYNAMICS IN RATS
Authors: Andreeva Irina V. , Telia Vladimir D. 
Published: January 2023

Purpose. To determine the indicators of portal hemodynamics in laboratory rats of different genders and ages based on the features of ultrasound scanning of the portal vein.
Materials and methods. The study was conducted on 60 mongrel rats of both sexes weighing 120-270 g. The first group included 20 rats aged 1 month, the second – 20 rats aged 6-12 months and the third – 20 rats aged more than 18-24 months. The study of qualitative and quantitative indicators of portal hemodynamics was performed using ultrasound scanners with zoletil-xylazine anesthesia. Statistical analysis was performed using the application package Statistica 13.0 (StatSoft, USA).
Results. The spectrum of blood flow in the portal vein of rats was unidirectional (monophasic), located above or below the isoline, with oscillations of the curve having a relationship with respiration. A clear dependence of blood flow fluctuations in the portal vein on cardiac activity has not been established. The diameter (by 15.4%, R= 0.64), the cross-sectional area (by 40%, R=0.68) and the maximum linear velocity of blood flow (by 1.2%, R=-0.09) in the portal vein increased with an increase in the age of the animals. The minimum linear velocity of blood flow decreased (by 32.2%, R =-0.05), which indicated an increase in the systolic-diastolic coefficient (an increase in the pulsativity of the flow). The indicator of the volumetric blood flow rate in the portal vein increased by 11.1% (R=0.06), and in relation to body weight decreased in elderly animals (by 11.5%, R=-0.05).
Conclusion. A moderate increase in volumetric blood flow in the portal vein (by 11.1%) with a pronounced increase in body weight (by 34.9%) was found with an increase in the age of animals. The perspective of further research is to study the functional reserve of the liver in the age aspect.
REGULARITIES ANALYSIS OF THE LINEAR EROSION DEVELOPMENT IN RIVER BASINS IN THE SOUTH OF THE CENTRAL RUSSIAN HILL WITH THE USE OF GIS
Authors: Pavlyuk Yaroslava V. , Sablina Olga M. , Smirnova Stanislava B. , Gladkaya Kristina A. 
Published: January 2023

Significant areas of the country’s territories are suffering erosion processes due to the increased anthropogenic load. Belgorod region territories are included. This fact makes the reason to the present study for the spatial and temporal patterns analysis of the linear erosion development. The analysis is needed to access the potential territory resistance to the erosion processes within the framework of the basin concept in the South of the Central Russian Upland. The spatial distribution analysis of erosional forms in the study area makes it possible to identify patterns of distribution and assess the possible development of erosion processes. Geoinformation modeling is used to maintain the study in conjunction with natural methods for studying the linear development of the erosion network.
During the research, the methods of thematic processing of space images, geospatial analysis, GIS modeling, comparative geographic, the method of analogies, landscape planning, as well as methods of statistical and mathematical data processing were used.
The study has revealed the fact, that territories with a high erosion density and a low share of the river density is characterized with the high ravine network density with a low density of ravines. Though, territories with low erosion density and a more developed river network are characterized by a decrease in the ravine network density; territories with a high erosion density are characterized with a weak development of upper link and the predominance of lower link of watercourses in the river network structure. Then, most basins with low ravine network density are significantly dissected in the upper and middle links of the river network. Establishing the regularity of the erosion forms distribution made it possible to assess the territory resistance of the erosion processes, as well as predict and analyze the need for anti-erosion measures.