bluuebunny/crossref_metadata_2025_split huggingface dataset:
Gastric varices
Authors: Wang Thomas J. , Ryou Marvin 
Published: September 2023

Purpose of review
Gastric varices are a rare cause of gastrointestinal bleeding in patients with portal hypertension. There have been significantly advances within endoscopic ultrasound for treatment of gastric varices over the past 5 years in addition to the conventional endoscopic and endovascular therapies. In this review, we will review the latest literature on gastric varices with emphasis on changes to the conventional classification systems and comparisons among the different treatment options for gastric varices in terms of efficacy and safety.

Recent findings
There have been new guidelines proposed by the American Gastrointestinal Association on a simpler classification system compared to the conventional Sarin classification. In addition, endoscopic ultrasound guided coil embolization, a novel treatment pioneered over the past 5 years for gastric varices, has shown increased efficacy and reduced adverse event profile compared to cyanoacrylate glue, the more traditional therapy for gastric variceal bleeding. Options for endovascular therapy overall have not significantly changed over the recent years.

Summary
Based on our literature review, we recommend a step-up approach with initial medical and endoscopic management with consideration of endovascular therapies when initial therapies fail.
Gastroparesis: time for a paradigm change
Authors: Lacy Brian E. , Wise Journey L. , Cangemi David J. 
Published: September 2023

Purpose of review
Gastroparesis (GP) is a syndrome defined by symptoms and delayed gastric emptying in the absence of mechanical obstruction. Typical symptoms include nausea, vomiting, abdominal pain, and early satiety. Only one medication is currently FDA-approved for the treatment of GP. This review highlights recent research findings pertaining to GP and provides evidence to support a change in the current GP diagnostic and treatment paradigm.

Recent findings
An analysis of GP trials over the past four decades demonstrates the power of placebo and the need to perform longer studies with clearly defined patient populations. Two studies highlight the need to evaluate patients with suspected GP carefully and to perform gastric emptying studies properly. The misdiagnosis of GP symptoms is reviewed, preceded by a discussion of whether GP should be considered a disorder of gut-brain interaction. Finally, new data on therapies that target the pylorus are highlighted.

Summary
Gastroparesis is frequently over-diagnosed and incorrectly diagnosed. Performing a proper gastric emptying study which adheres to standard protocol, and accurately interpreting the results in the context of the individual patient, are critical to making an accurate diagnosis of GP. The treatment paradigm needs to shift from simply aiming to accelerate gastric emptying to treating global symptoms of a chronic syndrome that may represent gut-brain dysfunction in many patients.
Body Mass Index Affects Delayed Chemotherapy-induced Vomiting in Pediatric Malignancy Patients
Authors: Yu Luyan , Zhou Ying , Zhang Wenbo , Wu Qian , Chu Xiaoyi , Zhang Yiran , Lv Danni , Shen Zhipeng 
Published: September 2023

Background:
Delayed chemotherapy-induced vomiting (DCIV) is a problem for children undergoing chemotherapy for malignant tumors. The aim of this study was to investigate the association between body mass index (BMI) and DCIV in children.

Patients and Methods:
Clinical data were collected from patients with malignancies who underwent chemotherapy at our center. Independent risk factors for DCIV derived by logistic regression. The Youden Index, which calculates BMI, divides patients into a high-risk group and a low-risk group, and the difference in DCIV between the two groups was analyzed. The relationship between BMI and DCIV was assessed by calculating the frequency of vomiting episodes and the severity of vomiting.

Results:
A total of 283 patients were included in this cohort study. BMI (odds ratio [OR]: 0.811; 95% CI: 0.699-0.941), age (OR: 1.014; 95% CI: 1.006-1.021), and emetogenic grade (OR: 2.858, 95% CI: 1.749-4.671) were independent risk factors for the development of DCIV in children. Patients in the high-risk group experienced vomiting more frequently and with greater severity than those in the low-risk group (P < 0.05).

Conclusions:
BMI in children with malignancy is associated with DCIV, and the incidence of DCIV decreases as BMI increases. Physicians may be able to arrange a more elaborate antiemetic prevention regimen based on the patient’s BMI.
Relationship between metalloproteinase-9 (MMP-9) expression and clinicopathology in colorectal cancer: a cross-sectional study
Authors: Mudatsir  , Labeda Ibrahim , Uwuratuw Julianus Aboyaman , Hendarto Joko , Warsinggih  , Lusikooy Ronald Erasio , Mappincara  , Sampetoding Samuel , Kusuma Muhammad Ihwan , Syarifuddin Erwin , Arsyad Arham , Faruk Muhammad 
Published: September 2023

Introduction:
According to the WHO’s GLOBOCAN database, ~1,931,590 new colorectal cancer (CRC) cases and 915,607 CRC-related deaths occurred in 2020. The incidence of CRC in Indonesia is 8.6%, making it the fourth most common cancer. With CRC, matrix metalloproteinase-9 (MMP-9) has a role in tumour development and progression, such that patients with a higher MMP-9 expression had poorer survival. This study aimed to analyze the relationship between MMP-9 expression and clinicopathology in CRC patients.

Methods:
This was an analytic observational study with a cross-sectional research design. It was conducted from November 2021 to June 2022 with 52 patient tissue samples: these were subjected to MMP-9 immunohistochemistry stain, with the GeneTex (Irvine) MMP-9 monoclonal antibody. Patient data were collected with clinical variables based on medical records and histopathological examination by anatomy pathologists.

Results:
Primary tumour location, cancer staging, and histopathology grading were associated with MMP-9 (P=0.016, P=0.001, P=0.049). The more proximal to the primary tumour, the higher the stage of cancer, and the higher the histopathological grade, thus the greater the expression of MMP-9.

Conclusion:
A significant relationship existed of primary tumour location, cancer staging, and histopathology grading with MMP-9 expression in CRC patients. MMP-9 expression could be a useful indicator for the clinical assessment of tumour biologic behaviour and prognosis in CRC patients.
Does ozaki procedure have a future as a new surgical approach for aortic valve replacement? a systematic review and meta-analysis
Authors: K. Awad Ahmed , Farahat Ramadan A. , Reda Gad Eman , Shaban Abdelgalil Mahmoud , Hassaballa Aly Sherif 
Published: September 2023

Background:
In 2014, Ozaki et al. introduced the neo-cuspidation (Ozaki procedure), a new valve from the pericardium, to reduce or even prevent the risk of chronic autoimmune inflammation and subsequent rejection or valve degeneration. Thus, the authors aimed to assess the safety and efficacy of the Ozaki technique in treating aortic valve diseases.

Materials and methods:
A comprehensive search was performed via PubMed, the Cochrane Library, Scopus, and the Web of Science up to 20 February 2022. Random-effects meta-analysis models were employed to estimate the pooled mean and SD or event to the total of the Ozaki procedure. Relevant records were retrieved and analyzed by OpenMeta analyst software.

Results:
A total of 2863 patients from 21 studies were finally included in our analysis. Ac. Ozaki technique showed statistical significance in terms of mean cardiopulmonary bypass time of 148 mins (95% CI 144–152.2, P<0.001), mean aortic cross-clamp time of 112.46 mins (95% CI 105.116, 119.823, P<0.001), reoperation with a low risk of 0.011 (95% CI 0.005, 0.016, P=0.047), conversion to aortic valve replacement with a low risk of 0.004 (95% CI −0.001, 0.008, P=0.392), finally ICU stay (days) and hospital length of stay (days) with a mean of 2.061 days (95% CI 1.535, 2.587, P<0.001) and 8.159 days (95% CI 7.183–9.855, P<0.001), respectively.

Conclusion:
The Ozaki procedure provides a safe surgical technique with low mean cardiopulmonary bypass time and aortic cross-clamp time; moreover, a mean of 2-day-postoperative hospital stay was observed with the Ozaki procedure with a low risk of conversion to aortic valve replacement, reoperation, ICU and hospital stay, and death.
Incidence and predictors of postoperative severe acute pain within 24 hours after cesarean section performed under spinal anesthesia at public hospitals in West Shoa, Ethiopia, 2022 prospective cohort study
Authors: Bekele Zenebe , Ayana Mulatu , Haile Merga , Tesfaye Adamu , Tasew Asaminew 
Published: September 2023

Background:
Acute postoperative pain is common after a caesarean section; the mother suffers severe pain in the first 24 h after the caesarean section compared to spontaneous birth. Failure to discover predictors of pain leads to maternal dissatisfaction, increased expenses, and restricted movement; it increases the risk of deep vein thrombosis, lengthens hospital stays, and decreases social intimacy.

Methods and materials:
An institution-based prospective cohort study was conducted among 422 women who went to undergo caesarean sections under spinal anaesthesia at public hospitals in West Shoa from 30 July to 30 October. Participants were selected by systematic random sampling. Data were collected by a structured questionnaire, and the collected data were entered into SPSS version 20 and exported into STATA 64 for analysis. The results were presented in tables and figures. Risk factors were assessed by Poisson regression with a robust standard error.

Results:
The overall incidence of severe postoperative pain after a caesarean section performed under spinal anaesthesia within 24 h of follow-up was 50.4% [95% confidence interval (CI): 40.7, 60.1]. Preoperative anxiety risk ratio 1.7 (95% CI: 1.4–2.0), preoperative pain risk ratio 1.3 (95% CI: 1.0–1.48), type of incision risk ratio 11.3 (95% CI: 1.1–1.6), spinal anaesthesia without adjuvants risk ratio 4.1 (95% CI: 1.5–10.9), and duration of surgery risk ratio 1.5 (95% CI: 1.3–1.8) were found to be predictors for postoperative severe acute pain after caesarean section performed under spinal anaesthesia.

Conclusion:
In this study, the overall incidence of severe acute pain after a caesarean section under spinal anaesthesia was high. Preoperative fear, duration of the operation, preparatory pain, spinal anaesthesia without the use of adjuvants, and the type of incision were risk factors for severe acute postoperative pain after a caesarean section under spinal anaesthesia.
Association of urinary albumin-to-creatinine ratio with lipid abnormalities and glycemic control in patients with type 2 diabetes mellitus
Authors: Khadka Sitaram , Yadav Gopal K. , Subedi Prativa , Amgain Kapil , Sharma Arun , Joshi Rinku 
Published: September 2023

Introduction:
While proteinuria aggravates dyslipidemia in diabetic patients, dyslipidemia further worsens proteinuria via inflammatory cytokines-mediated glomerular damage. Urinary albumin creatinine ratio (ACR) is an easy and reliable method of detecting proteinuria. This study aims to determine the association of ACR with lipid abnormalities and glycemic control in the Nepalese population.

Methods:
This was a cross-sectional study conducted among 201 diabetes patients visiting the outpatient department of internal medicine. Based on ACR values, patients were categorized as nonalbuminuric (less than 300 μg/mg) or albuminuric (more than 300 μg/mg). An unpaired t-test was used to compare the mean of various lipoproteins in these two categories. Binary logistic regression was used to check the association of ACR with sociodemographic factors (age, sex, and education), hypertension, and glycated hemoglobin.

Results:
Albuminuric patients had higher mean cholesterol (192.8±53.5 vs. 184.2± 37.6; P=0.209), triglyceride (194.9±97.8 vs. 164.4±73.7; P=0.017) and low-density lipoprotein (99.9±38.4 vs. 90.0±27.4; P=0.034) but lower high-density lipoprotein (53.9±18.5 vs. 61.3±19.9; P=0.008) compared to nonalbuminuric patients. There was a significant difference in mean HbA1c values across albuminuria and nonalbuminuria groups (7.1±1.1 vs. 6.7±0.8; OR: 1.4, 95% CI=1.1–1.9, P=0.030).

Conclusions:
Urine ACR of more than 30 mg/gram was associated with higher triglyceride and low-density lipoprotein levels and lower high-density lipoprotein levels. The HbA1c level strongly correlates with the development of albuminuria.
Clinical manifestations and outcomes of COVID-19 in maintenance hemodialysis patients of a high infectious epidemic country: a prospective cross-sectional study
Authors: Mondal Mina , Islam Muhammad Nazrul , Ullah Ahsan , Haque Md Rezwanul , Rahman Motiur , Bosak Liza , Rahman Md. Foyzur , Zaman Shaikh Riaduz , Rahman Mohammad Meshbahur 
Published: September 2023

Introduction:The outbreak of COVID-19 poses great challenges for patients on maintenance haemodialysis. Here, we reported the clinical characteristics and laboratory features of maintenance haemodialysis (MHD) patients with COVID-19 in Bangladesh.Methods:Altogether, 67 MHD patients were enroled in the study from two dedicated tertiary-level hospitals for COVID-19 after the prospective cross-sectional execution of selection criteria. Data were collected from medical records and interviews. Different statistical analysis was carried out in the data analysis.Results:The mean age was 55.0±9.9 years, with 40 males (59.7%). The mean dialysis duration was 23.4±11.5 months. The most common symptoms were fever (82.1%), cough (53.7%), and shortness of breath (55.2%), while the common comorbid condition was hypertension (98.5%), followed by diabetes (56.7%). Among MHD patients, 52.2% to 79.1% suffered from severe to critical COVID-19, 48 patients (71.6%) had 26-75% lung involvement on high resolution computed tomography of the chest, 23 patients (34.3%) did not survive, 20 patients (29.9%) were admitted to ICU, and nine patients (13.4%) needed mechanical ventilation. Patients who did not survive were significantly older (mean age: 63.0 vs. 50.86 years,P=0.0001), had significantly higher cardiovascular risk factors (69.6% vs. 43.2%,P=0.04), severe shortness of breath (82.6% vs. 40.9%,P=0.0001), and longer hospital stays (mean days: 17.9 vs. 13.0,P=0,0001) compared to the survivor group. The white blood cell count, C-reactive protein, lactate dehydrogenase, pro-calcitonin, and thrombocytopenia were significantly (P<0.0001) higher, while the albumin level was significantly lower (P=0.0001) in non-survivor compared to patients who survived.Conclusion:Maintenance haemodialysis patients had severe to critical COVID-19 and had a higher risk of non-survival if they were older and had comorbidities such as hypertension and diabetes. Therefore, MHD patients with COVID-19 need close monitoring to improve their outcomes.
Esophageal squamous cell carcinoma metastasizing to the oral cavity: a case report and literature review
Authors: Sittitrai Pichit , Ruenmarkkaew Donyarat , Lekawanvijit Suree 
Published: September 2023

Introduction and Importance:
Metastatic esophageal carcinoma to the oral cavity has been rarely reported, and most cases were adenocarcinoma metastasizing to the mandible. This first report of a case of metastatic esophageal squamous cell carcinoma to the floor of the mouth is crucial due to its rarity and difficulties in diagnosing and managing this condition.

Case Presentation:
A 53-year-old male had a painful submucosal mass on the left side of the floor of the mouth for 2 months. A biopsy indicated a moderately differentiated squamous cell carcinoma. Six months before the intraoral mass appeared, the patient had a moderately differentiated squamous cell carcinoma of the thoracic esophagus and was treated with concurrent chemoradiotherapy. With the previous history and pathological review, the diagnosis of metastatic esophageal squamous cell carcinoma to the floor of the mouth was made. Panendoscopy and an 18F-fluorodeoxyglucose positron emission tomography-computed tomography scan revealed no other abnormality or other distant metastasis. The patient underwent surgical resection with postoperative chemoradiotherapy. He was able to take a regular diet and had good speech function. Ten months after treatment completion, he has had recurrent disease at the floor of the mouth with lung metastasis.

Conclusions:
Oral metastasis from esophageal squamous cell carcinoma is very rare and should be differentiated from primary oral cancer using clinical and pathological features. 18F-fluorodeoxyglucose positron emission tomography-computed tomography scanning is the preferred imaging method to exclude primary tumor persistence and other metastases. Treatment is usually palliative; however, function-preserving surgery may be an option for a patient with limited disease in the oral cavity.
Non-adherence to anti-hypertensive medications in a low-resource country Nepal: a systematic review and meta-analysis
Authors: Pokharel Pashupati , Jha Saroj Kumar , Adhikari Alisha , Katwal Srijana , Ghimire Sagun , Shrestha Abhigan Babu , Poudel Nahakul 
Published: September 2023

Background:
Nepal is a low resource country with cardiovascular diseases being the number one cause of mortality. Despite hypertension being the single most important risk factor for cardiovascular diseases, non-adherence to anti-hypertensive medications has not been assessed systematically. So, this systematic review and meta-analysis aims to analyze the prevalence of non-adherence to anti-hypertensive medications in Nepal.

Methodology:
This systematic review and meta-analysis was piloted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Electronic databases of Embase, PubMed, Scopus, Web of Science, Cochrane Library, Cinhal Plus, and Google Scholar were searched from inception till 1 February 2023. The random-effects model with 95% confidence interval (CI) was used to calculate the non-adherence rate.

Results:
Altogether, 14 studies with a total of 3276 hypertensive patients were included in the meta-analysis. The pooled prevalence of non-adherence to anti-hypertensive medications was 49% (95% CI: 0.37–0.62, I
2=98.41%, P<0.001). The non-adherence rate using Morisky Medication Adherence Scale (MMAS) was 55% (95% CI: 0.34–0.76, I
2=99.14%, P<0.001), and using Hill–Bone Compliance Scale, the non-adherence rate was 45% (95% CI: 0.37–0.54, I
2=84.36%, P<0.001). In subgroup analysis, the non-adherence was higher in rural areas 56% (95% CI: 0.51–0.61, I
2=0.0%, P=0.46) compared to urban areas 42% (95% CI: 0.31–0.54, I
2=96.90%, P<0.001). The trend of non-adherence was increasing after 2020. Additionally, forgetfulness, carelessness, cost of medications, number of comorbidities, and using an alternate form of medication were common factors associated with non-adherence.

Conclusions:
This meta-analysis showed that half of the hypertensive population of Nepal are non-adherent to their anti-hypertensive medications, thereby posing a significant long-term cardiovascular consequence among Nepali population.
A diagnostic challenge: misdiagnosing Blau syndrome as juvenile dermatomyositis in a pediatric patient
Authors: Deek Soud M.S. , Shubietah Abdalhakim R.M. , Atatri Yazid , Najjar Mohab , Zakaria Zaid , Abu Tayyem Nours , Habayeb Lanah , Maree Mosab , AbuMohsen Haytham 
Published: September 2023

Introduction:
Blau syndrome (BS) and juvenile dermatomyositis (JDM) are distinct conditions with different pathophysiological mechanisms. Accurate diagnosis of BS can be challenging due to overlapping clinical features with other inflammatory conditions. This case is being reported to highlight a pediatric case initially diagnosed with JDM, and subsequently found to have BS through genetic testing.

Case Presentation:
We present the case of a 4-year-old Arab male initially diagnosed with JDM based on skin manifestations, negative histology for another disease, and no other clinical features suggestive of an alternate diagnosis. However, subsequent symptoms suggestive of BS emerged, leading to genetic testing confirmation of BS, marking the second reported case in the region. This unique clinical scenario highlights the challenges in diagnosing BS and the potential for misinterpretation of the skin rash as JDM. Accurate differentiation between these conditions is crucial to guide appropriate management and prevent delays in treatment.

Discussion:
The diagnostic process for JDM involves clinical evaluation, laboratory investigations, imaging, and biopsy findings. However, muscle biopsy may yield false-negative results. BS has been misdiagnosed as other conditions, such as Kawasaki disease and juvenile idiopathic arthritis, due to overlapping clinical features. This case highlights the significance of a thorough diagnostic strategy for BS that takes into account any potentially negative histopathology findings. A precise diagnosis is essential since misdiagnosis can result in inadequate or delayed therapy.

Conclusion:
The diverse presentation of the skin rash in BS can pose difficulties for physicians in distinguishing it from other pediatric rheumatological conditions, such as JDM.
Explaining the barriers to donor participation in the field of health: a qualitative study
Authors: Mirzadeh Koohshahi Masoud 
Published: September 2023

Background:Iran’s health system is facing increasing costs and a lack of resources. Developing the financial participation of donors is one of the ways to strengthen the financial health system.Objective:This research was done to explain the barriers to donors’ participation in the field of health.Method:This qualitative study was conducted in 2022 using semi-structured interviews with 22 experts, health donors, policymakers, and managers in Iran. The conventional content analysis method was also used for data analysis.Results:The review and classification of the interviews showed that the participation of donors in the health system includes four main issues: the incompleteness of legal processes, the lack of continuous communication with the charity, management, and resources problems, and the insufficient awareness of the donors about the problems and needs of the health system and 18 subtopics.Conclusions:Donors play an important role in financing, developing resources, providing health services, and financially supporting patients in Iran’s health system. Therefore, by recognizing and removing obstacles to the participation of donors, policymakers and managers of the health system should target the participation of donors with proper planning, organization, guidance, and supervision, and avoid parallel work and waste of resources.