bluuebunny/crossref_metadata_2025_split huggingface dataset:
Disseminated adrenal histoplasmosis in an immunocompetent adult from Nepal: a case report
Authors: Oli Aadhar , Poudel Shila , Ranabhat Abirodh 
Published: September 2023

Introduction:
Histoplasmosis is caused by the environmental fungus Histoplasma capsulatum. In immunocompromised patients, histoplasmosis can present as a disseminated infection that can involve the liver, lymph nodes, lungs, and adrenal glands. Disseminated histoplasmosis affecting the adrenal glands in an immunocompetent individual is a rare infection.

Case presentation:
A 53-year-old male without HIV complained of weight loss of 15 kg in 6 months. Computed tomography (CT) scan of the abdomen was done, which showed bilateral adrenal gland hyperplasia with hepatosplenomegaly. Endoscopic ultrasound fine needle aspiration of the adrenal gland revealed numerous budding yeast forms of Histoplasma intracellularly within the macrophages. A diagnosis of disseminated adrenal histoplasmosis was made. Liposomal amphotericin B and itraconazole therapy was started.

Discussion:
Disseminated histoplasmosis is commonly present in immunocompromised individuals. Immunocompetent individuals may also present with the disseminated form of the disease, which typically involves the adrenal glands. CT scan of the abdomen shows bulky adrenal glands with normal configuration, peripheral enhancement, and central hypodensities due to necrosis and/or hemorrhage. This might be a common presentation in other disseminated infections. Therefore, a definitive visualization of H. capsulatum in tissue specimens is the best method to confirm the diagnosis in a patient.

Conclusion:
Physicians must be suspicious of disseminated adrenal histoplasmosis in patients presenting with enlarged adrenal glands, even in immunocompetent individuals who are from endemic regions. Histopathological or cytological evaluation is the best method to establish a diagnosis.
Characteristics and factors associated with hypertensive crisis: a cross-sectional study in patients with hypertension receiving care in a tertiary hospital
Authors: Chootong Rattanaporn , Pethyabarn Wasuntaraporn , Sono Supinya , Choosong Thitiworn , Choomalee Kittisakdi , Ayae Maimoonah , Wisan Punnisa , Kantalak Phappim 
Published: September 2023

Background:
The hypertensive crisis is characterized by poorly controlled hypertension, which can lead to unfavorable outcomes and high utilization. The purpose of this study was to examine the prevalence, clinical characteristics, and factors associated with hypertensive emergency.

Material and Methods:
This cross-sectional study collected data from the hospital information system that included patients greater than or equal to 18 years who were diagnosed with hypertensive crisis (blood pressure ≥180 and/or 120 mmHg) and receiving care from the primary care unit and emergency department from 2020 to 2022. The prevalence and clinical characteristics of these patients were examined. Multiple logistic regression analysis was used to analyze factors associated with hypertensive emergency.

Results:
Among 3329 patients with hypertension, 17.33% had a hypertensive crisis (16.64 vs. 0.69%, urgency and emergency types). Most patients were female (63.6%), with a median age of 66 years. Almost half the patients (42.2%) with hypertensive crisis presented without specific symptoms, and the most common presenting symptom was vertigo/dizziness (27.7%). The initial and after treatment blood pressures were 203/98 and 174/91 mmHg. In the hypertensive emergency, the most common end-organ damage was ischemic stroke (33.3%), hemorrhagic stroke (25%), and acute heart failure (20.8%). An oral angiotensin-converting enzyme (57.5%) was the most commonly administered medication. Multiple logistic regression was performed but did not reveal any statistically significant.

Conclusion:
Our result revealed a high prevalence of hypertensive crises; most were of hypertensive urgency. The most common presenting symptom was vertigo/dizziness. There was no factor significantly associated with the hypertensive emergency in this study. Further studies should explore the cause of the hypertensive crisis to improve care delivery to patients with hypertension.
Short-term recurrence rate of male urethral stricture and its predictors after treatment with optical internal urethrotomy: Prospective Cohort Study at a tertiary center in Ethiopia
Authors: Issack Feysel H. , Hassen Seid M. , Tefera Alemayehu T. , Teshome Henok , Gebreselassie Kaleab H. , Mummed Ferid O. 
Published: September 2023

Abstract

Background:
Although optical internal urethrotomy is popular among the urologists due to its simplicity and safety, urethroplasty is considered the gold standard treatment for urethral strictures. This study aims to determine the 1-year recurrence rate of urethral strictures after optical urethrotomy and identify predictors of recurrence in a tertiary center in Ethiopia.

Methods:
A prospective observational cohort study was conducted on 80 male patients who underwent optical urethrotomy from November 2019 to August 2020 in a tertiary center in Ethiopia. Logistic regression was used to analyze the association between dependent and independent variables, with a P-value of <0.05 considered statistically significant.

Results:
The mean and median age (±SD) of patients at the time of the procedure were 54.76 (±14.74) and 58 years with a range [20–78], respectively. Urethral discharge was the most common etiology identified in 39 (48.75%) of patients. Eleven (13.75%) patients had no identifiable etiology for their urethral stricture disease.
The majority of patients presented with at least one voiding lower urinary tract symptoms.
Sixty-eight (85%) patients out of the total had a single stricture and 12 (15%) had multiple strictures. The location of the stricture was in the bulbar urethra on cystourethrography in 83% of the patients. The 1-year recurrence rate of urethral stricture after optical urethrotomy was 35% in our study.
The number of strictures and the presence of hypertension were independent predictors of recurrence of urethral stricture within 1-year after treatment with optical urethrotomy (AOR=15.35, 95% CI: 2.92–80.61, P=0.00; AOR=19.47, 95% CI: 2.11–178.98, P=0.01, respectively).

Conclusions:
Our study identified that multiple strictures, and the presence of hypertension are associated with an increased recurrence rate in the first postoperative year.
Posterior reversible encephalopathy syndrome in a child following hypovolemic shock: a case report
Authors: Adhikari Yuvraj , Bista Satkirti , Karmacharya Sammridhi , Upadhaya Regmi Binit , Marasini Anupama , Basukala Anisha , Bhandari Shakar , Ghimire Krishna , Subedi Ram Chandra 
Published: September 2023

Introduction and importance:
Posterior reversible encephalopathy syndrome (PRES) is a condition that causes a wide range of clinical neurological manifestations like headache, seizures, visual changes, and altered mental sensations. It is diagnosed with the help of sequential neuroimaging findings. Manifestations may occur a few hours to months after the initial precipitating cause. In the pediatric population, the most common cause is hypertension caused by renal disease or different drugs.

Case presentation:
Here, the authors present the case of a 4-year-old boy with a significant medical history of acute gastroenteritis following hypovolemic shock that later developed white matter edema of the brain on T2-weighted MRI scans along with symptoms such as headache and vomiting. Here, the patient was managed symptomatically with antiepileptic medication as prophylaxis.

Clinical discussion:
PRES is a rare neurological diagnosis made in the child that presents with headache, vomiting, blurring of vision, and abnormal body movements, which have several etiology like hypertension, glomerulonephritis, organ transplant, drugs, and very rarely with hypovolemic shock. It is an acute reversible condition in which a person presents with visual disturbances, headaches, and seizures. Seizures present as a life-threatening situation, so antiepileptic drugs are used as early prophylaxis.

Conclusion:
PRES is a reversible neurological condition, and prognosis is typically favorable if recognized and treated early, with symptom improvement or resolution in a few days to several weeks. Complications of PRES develop if the disease is not treated promptly. Complications include focal neurologic deficits from ischemic injury and epilepsy.
Plasma cell leukemia in a 34-year-old male: rare scenario case report
Authors: Issa Muhsen , Hannouneh Zein Alabdin , Alabbas Zeina , Hussein Firas , Issa Rana 
Published: September 2023

Introduction:
Plasma cell leukaemia is an uncommon plasma cell dyscrasia with a very poor prognosis. It is more common among males and usually presents between 55 and 65 years of age.

Case presentation:
A 34-year-old male presented to Al-Assad hospital with unremitting back pain. He was given analgesics but his pain was unresponsive to treatment, and due to the COVID-19 pandemic, he refused a computed tomography scan in the hospital. Later that year, he presented again with weight loss, nausea, abdominal pain, melena, and ascites. He was pale with a moderately distended abdomen. Laboratory tests revealed anaemia, thrombocytopenia, hypercalcemia, increased total proteins, and elevated lactate dehydrogenase. Flow cytometry findings of the bone marrow aspirate showed the presence of 30% of plasma cells, positive for CD38, CD56, and kappa light chains. He was diagnosed with secondary plasma cell leukaemia and started on chemotherapy; however, he could not continue his treatment due to myeloid inhibition. He passed away 5 months later.

Clinical discussion:
Multiple myeloma was not suspected in the patient due to his young age. The diagnosis was delayed even further due to the COVID-19 pandemic. His multiple myeloma progressed into secondary plasma cell leukaemia and had uncommon features like small intestinal polyps. Even though there has been groundbreaking advancements in chemotherapy, plasma cell leukaemia still possesses a fatal prognosis.

Conclusion:
This report showcases a rare age presentation with unique manifestations of secondary plasma cell leukaemia. Multiple myeloma should be a differential diagnosis for cases with unexplained back pain despite an unclassical age.
2 days versus 5 days of Postoperative Antibiotics for Complex Appendicitis
Authors: de Wijkerslooth Elisabeth M.L. , Boerma Evert-Jan G. , van Rossem Charles C. , Koopmanschap Marc A. , Baeten Coen I.M. , Beverdam Frédérique H. , Bosmans Joanna W.A.M. , Consten Esther C.J. , Dekker Jan Willem T. , Emous Marloes , van Geloven Anna A.W. , Gijsen Anton F. , Heijnen Luc A. , Jairam An P. , van der Ploeg Augustinus P.T. , Steenvoorde Pascal , Toorenvliet Boudewijn R. , Vermaas Maarten , Wiering Bas , Wijnhoven Bas P.L. , van den Boom Anne Loes ,   for the APPIC Study Group
Published: September 2023

Objective:
To compare costs for 2 days versus 5 days of postoperative antibiotics within the Antibiotics following aPPendectomy In Complex appendicitis (APPIC) trial.
Summary Background Data:
Recent studies suggest that restrictive antibiotic use leads to a significant reduction in hospital stay without compromising patient safety. Its potential effect on societal costs remains underexplored.

Methods:
This was a pragmatic, open-label, multicenter clinical trial powered for non-inferiority. Patients with complex appendicitis (age ≥ 8 y) were randomly allocated to 2 days or 5 days of intravenous antibiotics after appendectomy. Patient inclusion lasted from June 2017 to June 2021 in 15 Dutch hospitals. Final follow-up was on September 1, 2021. The primary trial endpoint was a composite endpoint of infectious complications and mortality within 90 days. In the present study, main outcome measures were overall societal costs (comprising direct healthcare costs and costs related to productivity loss) and cost-effectiveness. Direct healthcare costs were recorded based on data in the electronic patient files, complemented by a telephone follow-up at 90 days. In addition, data on loss of productivity were acquired through the validated Productivity-Cost-Questionnaire at four weeks after surgery. Cost estimates were based on prices for the year 2019.

Results:
In total, 1005 patients were evaluated in the Intention-to-Treat analysis: 502 patients allocated to the 2-day group and 503 to the 5-day group. The mean difference in overall societal costs was – € 625 (95% confidence interval – € 958 to – € 278) to the advantage of the 2-day group. This difference was largely explained by reduced hospital stay. Productivity losses were similar between the study groups. Restricting postoperative antibiotics to two days was cost-effective, with estimated cost savings of € 31,117 per additional infectious complication.

Conclusions:
2 days of postoperative antibiotics for complex appendicitis results in a statistically significant and relevant cost reduction, as compared with 5 days. Findings apply to laparoscopic appendectomy in a well-resourced healthcare setting.

Trial Registration:
Trialregister.nl number NL5946.
Neopolyploidy increases stress tolerance and reduces fitness plasticity across multiple urban pollutants: support for the ‘general purpose’ genotype hypothesis
Authors: Turcotte Martin M. , Kaufmann Nancy , Wagner Katie L. , Zallek Taylor A. , Ashman Tia-Lynn 
Published: September 2023

ABSTRACTWhole genome duplication is a common macromutation with extensive impacts from gene expression, to cellular function, and whole organism phenotype. As a result, it has been proposed that polyploids have ‘general purpose’ genotypes that perform better than their diploid progenitors under stressful conditions. Here we test this hypothesis in the context of stresses presented by anthropogenic pollutants. Specifically, we tested how multiple neotetraploid genetic lineages of the Greater Duckweed (Spirodela polyrhiza) perform across a favorable control environment and five urban pollutants (iron, salt, manganese, copper, and aluminum). By quantifying the population growth rate of duckweed over multiple generations we found that across most pollutants, but not all, polyploidy decreased the growth rate of actively growing propagules but increased that of dormant ones. Yet, when considering total propagule production, polyploidy increased tolerance to most pollutants and polyploids maintained population-level fitness across pollutants better than diploids. Furthermore, broad-sense genetic correlations in growth rate among pollutants were all positive in neopolyploids but not so for diploids. Our results provide a rare test and support for the hypotheses that polyploids are more tolerant of stressful conditions and can maintain fitness better than diploids across heterogenous stresses. These results may help predict the distribution of polyploids across stress gradients such as those caused by urbanization and other human activities.
Differential outcomes of infection by wild-type SARS-CoV-2 and the B.1.617.2 and B.1.1.529 variants of concern in K18-hACE2 transgenic mice
Authors: He Yicheng , Henley Jill , Sell Philip , Comai Lucio 
Published: September 2023

AbstractBackgroundSARS-CoV-2 is a respiratory virus with neurological complications including loss of smell and taste, headache, and confusion that can persist for months or longer. Severe neuronal cell damage has also been reported in some cases. The objective of this study was to compare the infectivity of Wild-type virus, Delta and Omicron variants in transgenic mice that express the human angiotensin-converting enzyme 2 (hACE2) receptor under the control of the keratin 18 promoter (K18) and characterize the progression of infection and inflammatory response in the lung, brain medulla oblongata and olfactory bulbs of these animals. We hypothesized that Wild-type, Delta and Omicron differentially infect K18-hACE2 mice, thereby inducing distinct cellular responses.MethodsK18-hACE2 female mice were intranasally infected with Wild-type, Delta, or Omicron variants and euthanized either at 3 days post-infection (dpi) or at the humane endpoint. None of the animals infected with the Omicron variant reached the humane endpoint and were euthanized at day 8 dpi. Virological and immunological analyses were performed in the lungs, olfactory bulbs, medulla oblongata, and brains.ResultsMice infected with Wild-type and Delta display higher levels of viral RNA in the lungs than mice infected with Omicron at 3dpi. Viral RNA levels in the brains of mice infected with the Wild-type virus were however significantly lower than those observed in mice infected with either Delta or Omicron at 3dpi. Viral RNA was also detected in the medulla oblongata of mice infected by all these virus strains at 3dpi. At this time point, mice infected with the Delta virus display a marked upregulation of inflammatory makers both in the lungs and brains. Upregulation of inflammatory markers was also observed in the brains of mice infected with Omicron but not in mice infected with the Wild-type virus, suggesting that during the initial phase of the infection only the Delta and Omicron variants induce strong inflammatory response in the brain. At the humane endpoint/8dpi, mice infected by any of these strains display elevated levels of viral RNA and upregulation of a subset of inflammatory markers in the lungs. There was also a significant increase in viral RNA in the brains of mice infected with Wild-type and Delta, as compared to 3dpi. This was accompanied by an increase in the expression of most cytokines and chemokines. In contrast, mice infected with the Omicron variant showed low levels of viral RNA and downregulation of cytokines and chemokines expression at 8dpi, suggesting that brain inflammation by this variant is attenuated. Reduced RNA levels and downregulation of inflammatory markers was also observed in the medulla oblongata and olfactory bulbs of mice infected with Omicron, while infection by Wild-type and Delta resulted in high levels of viral RNA and increased expression of inflammatory makers in these organs.
Multiplexed single-cell lineage tracing of mitotic kinesin inhibitor resistance in glioblastoma
Authors: Cheng Yim Ling , Banu Matei A. , Zhao Wenting , Rosenfeld Steven S. , Canoll Peter , Sims Peter A. 
Published: September 2023

SUMMARYGlioblastoma (GBM) is a deadly brain tumor, and the kinesin motor KIF11 is an attractive therapeutic target because of its dual roles in proliferation and invasion. The clinical utility of KIF11 inhibitors has been limited by drug resistance, which has mainly been studied in animal models. We used multiplexed lineage tracing barcodes and scRNA-seq to analyze drug resistance time courses for patient-derived GBM neurospheres treated with ispinesib, a potent KIF11 inhibitor. Similar to GBM progression in patients, untreated cells lost their neural lineage identity and transitioned to a mesenchymal phenotype, which is associated with poor prognosis. In contrast, cells subjected to long-term ispinesib treatment exhibited a proneural phenotype. We generated patient-derived xenografts to show that ispinesib-resistant cells form less aggressive tumorsin vivo, even in the absence of drug. Finally, we used lineage barcodes to nominate drug combination targets by retrospective analysis of ispinesib-resistant clones in the drug-naïve setting and identified drugs that are synergistic with ispinesib.
Automated Identification of Heart Failure with Reduced Ejection Fraction using Deep Learning-based Natural Language Processing
Authors: Nargesi Arash A. , Adejumo Philip , Dhingra Lovedeep , Rosand Benjamin , Hengartner Astrid , Coppi Andreas , Benigeri Simon , Sen Sounok , Ahmad Tariq , Nadkarni Girish N , Lin Zhenqiu , Ahmad Faraz S. , Krumholz Harlan M , Khera Rohan 
Published: September 2023

ABSTRACTBackgroundThe lack of automated tools for measuring care quality has limited the implementation of a national program to assess and improve guideline-directed care in heart failure with reduced ejection fraction (HFrEF). A key challenge for constructing such a tool has been an accurate, accessible approach for identifying patients with HFrEF at hospital discharge, an opportunity to evaluate and improve the quality of care.MethodsWe developed a novel deep learning-based language model for identifying patients with HFrEF from discharge summaries using a semi-supervised learning framework. For this purpose, hospitalizations with heart failure at Yale New Haven Hospital (YNHH) between 2015 to 2019 were labeled as HFrEF if the left ventricular ejection fraction was under 40% on antecedent echocardiography. The model was internally validated with model-based net reclassification improvement (NRI) assessed against chart-based diagnosis codes. We externally validated the model on discharge summaries from hospitalizations with heart failure at Northwestern Medicine, community hospitals of Yale New Haven Health in Connecticut and Rhode Island, and the publicly accessible MIMIC-III database, confirmed with chart abstraction.ResultsA total of 13,251 notes from 5,392 unique individuals (mean age 73 ± 14 years, 48% female), including 2,487 patients with HFrEF (46.1%), were used for model development (train/held-out test: 70/30%). The deep learning model achieved an area under receiving operating characteristic (AUROC) of 0.97 and an area under precision- recall curve (AUPRC) of 0.97 in detecting HFrEF on the held-out set. In external validation, the model had high performance in identifying HFrEF from discharge summaries with AUROC 0.94 and AUPRC 0.91 on 19,242 notes from Northwestern Medicine, AUROC 0.95 and AUPRC 0.96 on 139 manually abstracted notes from Yale community hospitals, and AUROC 0.91 and AUPRC 0.92 on 146 manually reviewed notes at MIMIC-III. Model-based prediction of HFrEF corresponded to an overall NRI of 60.2 ± 1.9% compared with the chart diagnosis codes (p-value < 0.001) and an increase in AUROC from 0.61 [95% CI: 060-0.63] to 0.91 [95% CI 0.90-0.92].ConclusionsWe developed and externally validated a deep learning language model that automatically identifies HFrEF from clinical notes with high precision and accuracy, representing a key element in automating quality assessment and improvement for individuals with HFrEF.