bluuebunny/crossref_metadata_2025_split huggingface dataset:
Subcutaneous Microabscesses and Myositis as Part of Immune Reconstitution Inflammatory Syndrome due to Chronic Disseminated Candidiasis in a Child With Acute Lymphoblastic Leukemia
Authors: Reddy Nalla A. , Addala Soundarya , S.S. Shyam , Lashkari Harsha P. 
Published: April 2023

Background:
Immune reconstitution inflammatory syndrome (IRIS) occurs when there is immune recovery after a prolonged period of leucopenia as a response to an underlying latent or chronic infection due to a proinflammatory cascade. It can occur in a child on chemotherapy for acute lymphoblastic leukemia (ALL) with underlying chronic disseminated candidiasis (CDC).

Observation:
We present a 7-year-old girl with pre-B ALL on chemotherapy who had prolonged febrile neutropenia and CDC with microabscesses in the liver, spleen, and kidney and a prolonged intensive care unit stay. Upon neutrophil recovery, she continued to have high-grade fever (blood and urine cultures negative). She also presented severe myositis of bilateral thigh muscles and developed unusual granulomas in the subcutaneous region of the lower back and right thigh. Although IRIS was suspected, she could not be initiated on steroids due to right upper lobe collapse consolidation due to multidrug-resistant Acinetobacter baumanni, which was treated with sensitive antibiotics. Treatment with steroids resolved her fever and normalized inflammatory markers. She is currently well on maintenance chemotherapy.

Conclusions:
IRIS can complicate the treatment of ALL in children. Diagnosing it while having a concurrent bacterial infection is challenging. Rarely CDC can present with subcutaneous granulomas. Treatment with steroids at the right time is very crucial.
Pulmonary embolism at CT pulmonary angiography in patients with COVID-19 at a tertiary care center in Nepal: a cross-sectional study
Authors: Amatya Isha , Regmi Pradeep R. , Adhikari Gauri , Pokhrel Bidushi , Baniya Anish , Dangol Anisha 
Published: April 2023

Introduction:
Coronavirus disease 2019 (COVID-19) began to spread in December 2019 and was declared a pandemic by WHO on 11 March 2020. Pulmonary embolism (PE) is a known sequel to COVID-19 infection. Many patients showed worsened symptoms of thrombotic events of pulmonary arteries during the second week of the disease for which computed tomography pulmonary angiography (CTPA) is recommended. The most frequent complications in critically ill patients are prothrombotic coagulation abnormalities and thromboembolism. So, this study aimed to assess the prevalence of PE in patients with COVID-19 infection and to evaluate the relation to disease severity on CTPA findings.

Methods:
This cross-sectional study was performed to evaluate the patients who tested positive for COVID-19 and underwent CTPA. COVID-19 infection in participants was confirmed by a PCR of nasopharyngeal or oropharyngeal swab samples. Frequencies of computed tomography severity scores and CTPA were calculated and compared with clinical and laboratory findings.

Results:
The study included 92 patients with COVID-19 infection. Positive PE was found in 18.5% of the patients. The mean age of the patients was 59.83±13.58 years with an age range of 30–86 years. Among the total participants, 27.2% underwent ventilation, 19.6% died during treatment, and 80.4% of them got discharged. PE was developed in patients who did not receive prophylactic anticoagulation, which is statistically significant (P≤0.001). There was also a significant relationship between mechanical ventilation and CTPA findings.

Conclusions:
The authors conclude from their study that PE is one of the complications of COVID-19 infection. Rising D-dimer during the second week of disease alerts clinicians to do CTPA to exclude or confirm PE. This will help in the early diagnosis and treatment of PE.
Evidence-based guideline on management of status epilepticus in adult intensive care unit in resource-limited settings: a review article
Authors: Besha Aschalew , Adamu Yayeh , Mulugeta Hailemariam , Zemedkun Abebayehu , Destaw Belete 
Published: April 2023

Background:
Status epilepticus (SE) is a life-threatening condition associated with at least 5 min of continuous seizures or repeated seizures without regaining consciousness between episodes. It is a medical emergency with significant morbidity and mortality. The most common causes of SE are previous seizures, stroke, trauma, metabolic disorders, and central nervous system tumor. The aim of this review was to systematically review articles and ultimately develop evidence-based guidelines for the management of SE in resource-limited settings.

Methods:
This review was presented under the Protocol for Systematic Reviews and Meta-Analyses (PRISMA). A literature search was performed in PubMed, Google Scholar, Cochrane, and Medline databases from 2007 to 2021. The keywords for the literature search were (SE or controlled clinical trial) AND (SE or randomized controlled trial), (SE or multicenter trial) AND (SE or meta-analysis) AND (SE or crossover study).

Conclusion:
SE is an urgent medical emergency that requires early recognition and aggressive treatment. Medical treatment is initiated when seizures continue for more than 5 min after all stabilization measures have been taken. Based on the available evidence, diazepam can be used as a substitute for lorazepam in the treatment of SE. Ketamine is effective when given before other anesthetics as a third-line treatment in refractory and very refractory epilepsy. Propofol reduced the number of days of mechanical ventilation in the treatment of SE and has better seizure control than thiopental. Music has been recommended as an adjunctive therapy for epilepsy medication.
Association of d-dimer levels with in-hospital outcomes among COVID-19 positive patients: a developing country multicenter retrospective cohort
Authors: Tahir Muhammad Junaid , Yasmin Farah , Naeem Unaiza , Najeeb Hala , Kumar Kamlesh , Arti  , Kumar Rahul Robaish , Robaish Kumar Rahul , Majeed Abdul , Kumar Rahul , Wali Agha , Sandhya  , Shahab Ramsha , Shahab Ramsha , Hegazi Moustafa , Ahmed Khabab Abbasher Hussien Mohamed , Asghar Muhammad Sohaib 
Published: April 2023

IntroductionD-dimer levels, which originate from the lysis of cross-linked fibrin, are serially measured during coronavirus disease 2019 illness to rule out hypercoagulability as well as a septic marker.MethodsThis multicenter retrospective study was carried out in two tertiary care hospitals in Karachi, Pakistan. The study included adult patients admitted with a laboratory-confirmed coronavirus disease 2019 infection, with at least one measured d-dimer within 24 h following admission. Discharged patients were compared with the mortality group for survival analysis.ResultsThe study population of 813 patients had 68.5% males, with a median age of 57.0 years and 14.0 days of illness. The largest d-dimer elevation was between 0.51–2.00 mcg/ml (tertile 2) observed in 332 patients (40.8%), followed by 236 patients (29.2%) having values greater than 5.00 mcg/ml (tertile 4). Within 45 days of hospital stay, 230 patients (28.3%) died, with the majority in the ICU (53.9%). On multivariable logistic regression between d-dimer and mortality, the unadjusted (Model 1) had a higher d-dimer category (tertile 3 and tertile 4) associated with a higher risk of death (OR: 2.15; 95% CI: 1.02–4.54,P=0.044) and (OR: 4.74; 95% CI: 2.38–9.46,P<0.001). Adjustment for age, sex, and BMI (Model 2) yields only tertile 4 being significant (OR: 4.27; 95% CI: 2.06–8.86,P<0.001).Conclusion:Higher d-dimer levels were independently associated with a high risk of mortality. The added value of d-dimer in risk stratifying patients for mortality was not affected by invasive ventilation, ICU stays, length of hospital stays, or comorbidities.
Learning curve of the 67 steps of conventional total knee replacement: an experimental study
Authors: Hafez Mahmoud A. , Nasser Eltayeb , Nabeel Ahmed 
Published: April 2023

Background:
The instrumentation system for total knee replacement (TKR) has been there since the 1970s. The many steps and instruments are the main features despite several modifications over the last 50 years. This may lead to the accumulation of errors as certain steps are dependent on others. This study aimed to identify the errors while performing TKR by three trainees at different levels of training.

Methods:
Three trainees with different expertise performed the steps of TKR on bone models. One senior supervisor recorded the outcomes, including operative time and errors made during the experiment. Errors were further categorized into correctable and uncorrectable ones.

Results:
Most of the errors were made by the trainee with the least experience during the stages of femoral cutting, sizing, and rotation. The first-year resident has taken 1.25 times longer than the fellow in preparing the femur and 1.11 times in preparing the tibia. The recorded mistakes were 28, 8, and 3 for the first-year resident, the second-year resident, and the fellow surgeon, respectively. Fifteen of the mistakes were uncorrectable, and none of them were from the senior surgeon.

Conclusion:
The results of this study highlight the type of errors made by different trainees. This shows the steep learning curve of conventional instrumentation systems for trainees. Increasing cognitive skills and applying computer-assisted technologies may help trainees overcome this steep learning curve.
How is ischemic stroke linked to a COVID-19-infected patient different from other cardiovascular risk factors? a case report
Authors: Bereda Gudisa 
Published: April 2023

Background:
Ischemic stroke is a recognized neurological consequence of an acute coronavirus disease 2019 (COVID-19) infection. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) directly infects endothelial cells, generating widespread endothelial inflammation. This may be the mechanism leading to an ischemic stroke. Infection with SARS-CoV-2 and inflammatory responses cause vascular damage, hypercoagulability, thrombin activation, platelet aggregation, and plaque shedding as a result of hemodynamic alterations, which increase the risk of ischemic stroke.

Case presentation:
On 19 September 2022, 3 h after the commencement of the right-sided weakness, a 61-year-old black African male farmer was sent to transported to the emergency room. When an radiography of the chest was performed, it showed diffuse bilateral infiltrates, coarse, slightly bilateral crepitation, and scattered reticulations. Cardiovascular testing of the patient turned up nothing unexpected. The eye-opening reaction was 1/4 (no eye opening) on the Glasgow Coma Scale, the motor response was 3/6 (abnormal flexion), and the verbal response was 3/5 (inappropriate words). When his breathing became difficult, he needed five intranasal doses of oxygen every minute to maintain saturation. He started taking low-dose aspirin daily for a month at 81 mg. He took consumed 75 mg of clopidogrel once a day for a month.

Clinical discussion:
Stroke was associated with in-hospital death among hospitalized patients with the COVID-19 infection. In patients who have risk factors for stroke, such as high blood pressure, obesity, and diabetes, COVID-19 increases the risk of stroke. The risk of stroke was highest in older people within the first few days after receiving a COVID-19 diagnosis.

Conclusion:
Patients with COVID-19 are more likely to get an ischemic stroke from large infarctions, mostly as a result of major artery thrombosis. From the start of COVID-19 signs, neurological problems can appear anywhere between 3 and 14 days later. Due to severe inflammation, immobility, hypoxia, and diffuse intravascular coagulation, SARS-CoV-2 also possesses neurological invasive capabilities and may migrate from the respiratory system to the central nervous system
Systematic extended right posterior sectionectomy (SERPS), a single center serial cases for secondary liver tumors
Authors: Tendean Michael , Mambu Toar D.B. , Tjandra Ferdinand , Panelewen Jimmy 
Published: April 2023

Introduction and importance:Liver resection in secondary liver tumors may associated with the consequences of posthepatectomy liver failure (PHLF). Systematic extended right posterior sectionectomy (SERPS) is offered as an alternative to resect secondary liver tumors in segment 6–7 with vascular invasion of right hepatic vein, with less risk of PHLF compared to right hepatectomy. This case series is important to demonstrate the effectivity and safety of SERPS procedure performed in developing country.Cases presentation:The authors reported the case of four patients that underwent SERPS procedure due to metachronous and synchronous liver metastases caused by gastric gastrointestinal stromal tumor and colorectal cancer. Thulium doped fiber laser and harmonic scalpel were used as an energy device. Intra and postoperative parameters were evaluated. SERPS data was collected in 2020–2021 at Prof. dr. R.D. Kandou General Hospital. There were no postoperative complications and no tumor recurrences were found in all four patients in two years surveillance.Clinical discussion:Liver resection poses a relatively moderate risk of mortality and morbidity. Nowadays, parenchyma-sparing liver surgery is the procedure of choice compared to major liver resection whenever feasible. SERPS was first developed to minimize the need for major resection. SERPS may serve as a first-choice procedure due to its superior safety and comparable effectivity compared to major hepatectomy.Conclusion:SERPS is a safe and promising alternative for secondary liver tumors at segments 6–7 and right hepatic vein vascular invasion, compared to right hepatectomy. Thus, minimizing the risk of PHLF by saving a larger volume of future liver remnant.
Association Between Low-Density Lipoprotein-Cholesterol Level and Risk of Intracranial Atherosclerotic Stenosis
Authors: Shen Yuan , Wang Jing , Wang Anxin , Zhao Xingquan 
Published: April 2023

Background:
It is unknown whether plasma low-density lipoprotein-cholesterol level (LDL-C) can predict the occurrence of intracranial atherosclerotic stenosis (ICAS), especially asymptomatic (A)ICAS. This study investigated whether LDL-C level is independently associated with AICAS.

Methods:
The Asymptomatic Polyvascular Abnormalities Community study is an ongoing community-based, prospective, long-term follow-up observational study with 3387 participants. AICAS was diagnosed by transcranial Doppler ultrasonography. The participants were divided into 3 groups based on LDL-C level. Cox regression was used to evaluate the association between LDL-C level and incidence of AICAS.

Results:
During 2 years of follow-up, 9.98% of participants were diagnosed with AICAS. The incidence of AICAS (person-years with 95% CI) was 4.99% (4.48%-5.50%). AICAS incidence did not increase with increasing LDL-C level. Compared with the <2.6 mmol/l subgroup, the incidence of asymptomatic ICAS was not significantly higher in the 2.6 to 3.4 and >3.4 mmol/l subgroups after adjusting for confounding factors (hazard ratio=0.95, 95% CI: 0.86-1.03 and hazard ratio=0.96, 95% CI: 0.84-1.10, respectively).

Conclusions:
LDL-C is not an independent predictor of AICAS incidence in the Chinese population.
ASSESSMENT OF THE IMPLEMENTATION OF ELECTRONIC RECORDS MANAGEMENT SYSTEM IN BAYELSA STATE
Authors: Abaya Samuel Terungwa , Orga Chris , Raimi Aziba-anyam Gift , Raimi Morufu Olalekan , Kakwi Daniel Josephine 
Published: April 2023

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<p>The information quality that medical practitioners have access to when providing care to patients affects the outcome of service delivery. Health information technology has been proven to enhance patient safety and treatment quality in the healthcare industry. This study's goal is to pinpoint the enablers and impediments to NDUTH, Okolobiri's adoption of an electronic records management system. The descriptive cross-sectional research design was adopted for this investigation. The sample was drawn using stratified random sampling from the 204 staff members that took part in the survey at NDUTH Okolobiri. A small number of hospital employees who had implemented the electronic records system were also subjected to phone interviews. The results show that the majority of participants (51.0%) were female, and that their average age was 37(SD+9.0) years. The overall knowledge of electronic records management system among the respondents was 45.9%. The overall level of implementation was 22.8%. The facilitators in the study were of support from leadership and availability of ICT equipment’s while the barriers were funding, lack of power supply, inadequate ICT infrastructures, administrative challenge, poor staff compliance, lack of government support, poor maintenance of software and ICT equipment’s. The findings show that there is a need for government and private organizations to invest more in healthcare delivery through electronic records management system. This is very important because the effectiveness of health services delivery is influenced by the quality of information that medical professionals have access to when caring for patients. It is also found to ensure efficient management of health facilities.</p>
Primary Neuroblastoma of the Thymus
Authors: Chaurasiya Kailash , Kireeva Elena , Shamanskaya Tatyana , Kachanov Denis , Likar Yury 
Published: April 2023

Abstract
Primary neuroblastoma is the most common extracranial solid tumor in children and may occur anywhere along the sympathetic chain, but most commonly occur in abdominal/retroperitoneal region including the adrenal glands, followed by the thorax. In children, the most primary neuroblastomas in the thorax are in the posterior mediastinum. We present herein an extremely rare case of primary neuroblastoma of thymus in pediatric patient.
Mast Cells in Kidney Transplant Biopsies With Borderline T Cell-mediated Rejection and Their Relation to Chronicity
Authors: Varol Hilal , van der Elst Guus , Baan Carla C. , van Baardwijk Myrthe , Hesselink Dennis A. , Duong van Huyen Jean-Paul , Kramann Rafael , Rabant Marion , van den Bosch Thierry P.P. , Clahsen-van Groningen Marian C. 
Published: April 2023

Background.
Mast cells are potential contributors to chronic changes in kidney transplants (KTx). Here, the role of mast cells (MCs) in KTx is investigated in patients with minimal inflammatory lesions.

Methods.
Fourty-seven KTx biopsies (2009–2018) with borderline pathological evidence for T cell-mediated rejection according to the Banff’17 Update were retrospectively included and corresponding clinical data was collected. Immunohistochemistry for tryptase was performed on formalin-fixed paraffin-embedded sections. Cortical MCs were counted and corrected for area (MC/mm²). Interstitial fibrosis was assessed by Sirius Red staining and quantified using digital image analysis (QuPath).

Results.
Increased MC number was correlated to donor age (spearman’s r = 0.35, P = 0.022), deceased donor kidneys (mean difference = 0.74, t [32.5] = 2.21, P = 0.035), and delayed graft function (MD = 0.78, t [33.9] = 2.43, P = 0.020). Increased MC number was also correlated to the amount of interstitial fibrosis (r = 0.42, P = 0.003) but did not correlate with transplant function over time (r = −0.14, P = 0.36). Additionally, transplant survival 2 y post-biopsy was not correlated to MC number (mean difference = −0.02, t [15.36] = −0.06, P = 0.96).

Conclusions.
MC number in suspicious (borderline) for acute T cell-mediated rejection is correlated to interstitial fibrosis and time post-transplantation, suggesting MCs to be a marker for cumulative burden of tissue injury. There was no association between MCs and transplant function over time or transplant survival 2 y post-biopsy. It remains unclear whether MCs are just a bystander or have pro-inflammatory or anti-inflammatory effects in the KTx with minimal lesions.
No immunological interference or safety concerns when adjuvanted recombinant zoster vaccine is coadministered with a COVID-19 mRNA-1273 booster vaccine in adults aged 50 years and older: A randomized trial
Authors: Naficy Abdi , Kuxhausen Adrienne , Pirrotta Paola , Leav Brett , Miller Jacqueline , Anteyi Kate , Adams Mark S , Danier Jasur , Breuer Thomas , Mwakingwe-Omari Agnes 
Published: April 2023

ABSTRACTBackgroundThere is growing consensus that COVID-19 booster vaccines may be coadministered with other age-appropriate vaccines. Adding to the limited available data supporting coadministration, especially with adjuvanted vaccines, could enhance vaccine coverage in adults.MethodsIn this phase 3, randomized, open-label study, eligible adults aged ≥50 years were randomly assigned (1:1) to receive mRNA-1273 (50µg) booster vaccination and a first dose of recombinant zoster vaccine (RZV1) 2 weeks apart (Seq group) or concomitantly (Coad group). The second RZV dose (RZV2) was administered 2 months post- RZV1 in both groups. Primary objectives were noninferiority of anti-glycoprotein E and anti-Spike protein antibody responses in the Coad group compared to the Seq group. Safety and further immunogenicity assessments were secondary objectives.Results273 participants were randomized to the Seq group, 272 to the Coad group. Protocol-specified non-inferiority criteria were met. The adjusted geometric mean concentration ratio (Seq/Coad) was 1.01 (95% confidence interval [CI], 0.89–1.13) for anti- gE antibodies 1-month post-RZV2, and 1.09 (95% CI 0.90–1.32) for anti-Spike antibodies 1- month post-mRNA-1273 booster. No clinically relevant differences were observed in overall frequency, intensity, or duration of adverse events between the 2 study groups. Most solicited adverse events were mild/moderate in intensity, each with median duration ≤2.5 days.Administration site pain and myalgia were the most frequently reported in both groups.ConclusionsCoadministration of mRNA-1273 booster vaccine with RZV in adults aged ≥50 years was immunologically noninferior to sequential administration and had a safety and reactogenicity profile consistent with both vaccines administered sequentially (clinicaltrials.govNCT05047770).Visual abstract