bluuebunny/crossref_metadata_2025_split huggingface dataset:
Stroke patterns and outcomes during the second wave of COVID-19 pandemic: a cross-sectional study
Authors: Gajurel Bikram P. , Giri Subarna , Tamrakar Parishma , Pandeya Anupama , Gautam Niraj , Shrestha Aashish , Karn Ragesh , Rajbhandari Reema , Ojha Rajeev 
Published: August 2023

Background:
The coronavirus disease 2019 (COVID-19) pandemic has affected the number of stroke activations, admission of patients with various types of strokes, the rate and timely administration of reperfusion therapy, and all types of time-based stroke-related quality assessment metrics. In this study, we describe the different types of strokes, different delays in seeking and completing treatment occurring during the second wave of the COVID-19 pandemic, and predictors of outcome at 3 months follow-up.

Materials and methods:
This is a single-centered prospective cross-sectional study carried out from May 2021 to November 2021, enrolling patients with stroke. Data collected were demographic characteristics, stroke types and their outcomes, and different types of prehospital delays.

Results:
A total of 64 participants were included in the study with a mean age of 60.25±15.31 years. Ischemic stroke was more common than hemorrhagic stroke. The median time of arrival to the emergency room of our center was 24 h. The most common cause of prehospital delay was found to be delays in arranging vehicles. The median duration of hospital stays [odds ratio (OR)=0.72, P<0.05] and baseline NIHSS (National Institute of Health Stroke Scale) score (OR=0.72, P<0.05) were found to be a predictor of good outcomes at 3 months follow-up on binary logistic regression.

Conclusion:
The factors that cause the delayed transfer to the hospital and onset of treatment should be addressed. Patient counseling about the likely prognosis can be done after evaluating the probable outcome based on the NIHSS score and median duration of hospital stay. Nevertheless, mechanisms should be developed to reduce the prehospital delay at the ground level as well as at the policy level.
Breast cancer awareness among women in the Syrian Coast: a cross-sectional study
Authors: Abdul Rahman Seif-Aldin , Kherbek Haidara , Ismail Sawsan , Abdul Rahman Ali , Zahlout Jaafar , Abboud Ibrahem , Hraib Munawar , Jouni Sarah , Turk Tareq , Hleibieh Yana , Layka Khedr , Alaidi Sara , Skef Jana , Mansour Somar , Georgeos Michael , Taweel Ousama , Alshehabi Zuheir 
Published: August 2023

Background:Breast cancer is the most common malignancy in women and represents a leading cause of cancer-related mortalities. Females’ awareness toward breast cancer is essential for the early diagnosis and detection especially in low and middle-income countries. This study aims to assess the awareness of breast cancer risk factors among females in the Syrian Coast.Methodology:An online cross-sectional survey was conducted among Syrian females during the COVID-19 pandemic. The questionnaire used in the study was derived from the Cancer Research UK questionnaire and modified to fit the perspective of the study. Statistical Package for Social Sciences (SPSS) was used for data analysis. The independent samplest-test and the one-way analysis of variance (ANOVA) were applied to determine whether there is statistical evidence or any statistically significant differences between the variables.Results:A total of 1305 females participated in the study. The majority aged between 18 and 25, (28.8%) of the participants obtained their information related to breast cancer from internet, (36.7%) of were smokers and (82.8%) had a family member with breast cancer. These results suggested a significant correlation between smoking, family history of cancer, marital status, and breast cancer awareness.Conclusion:This study showed which factors are significantly related to women’s awareness of breast cancer risk factors. These results can contribute in the implementation of awareness programs and campaigns, thus raising the level of awareness among women.
Rectovaginal fistula surgery with horizontal mattress and running suture after unsuccessful first repair: a report of two cases
Authors: Handaya Adeodatus Y. , Andrew Joshua , Hanif Ahmad S. , Susilo Naufal C.J. , Subroto Polycarpus D. , Aditya Azriel F.K. 
Published: August 2023

Introduction:
Rectovaginal fistula (RVF) repair after failed primary repair is uncommon. Patients with RVF experience physiological and sexual dysfunction with a significantly high risk of intravaginal infection and sepsis. There are many surgical procedures available for RVF repair. We performed an improvised transvaginal repair technique.

Methods:
We report two cases of recurring RVF after failed primary repair. Patient 1 developed RVF because of a failed vaginoplasty due to cosmetic reasons, while patient 2 developed RVF because of a fourth-degree perineal rupture repair post-delivery. We used a combination of horizontal mattress and running suture with the addition of diverting colostomy. Both surgeries went successfully and there were no complications.

Outcomes:
RVF repair using a combination of horizontal mattress and running suture went successfully and there were no complications. Both patients were able to be discharged after a short stay. Long-term evaluation was done by physical and supporting examinations for 2–3 months. Both patients showed excellent wound healing and physiological function.

Conclusions:
The combination of a transvaginal horizontal mattress and running suture in the posterior to anterior fashion with diverting colostomy is a safe and effective procedure for recurring RVF repair.
Analysis of natural resistance-associated macrophage protein-1 (NRAMP-1) level based on death, comorbidities and severity of COVID-19 patients: a cross-sectional study
Authors: Dwiyanti Ressy , Muthaher Annisa Anwar , Achmad Djumadi , Arsyadi Gunawan , Nelwan Berti J. , Cangara Muhammad Husni , Lawrence Gatot S. , Kaelan Cahyono , Dase Jerny , Mathius Denny , Indrayaty AR , Early Afriani , Junita Ade Rifka , Febrianti Andini , Sri Diana Eva , Fachri Muhammad , Syukri Ahmad , Primaguna Muhammad Reza , Azhar Azhar , Hatta Mochammad 
Published: August 2023

Background:
An accurate diagnosis of COVID-19 is essential for pandemic control and for establishing adequate therapeutic strategies to reduce morbidity and mortality. COVID-19 infection replicates in macrophage cells and affects the immune system. Natural resistance-associated macrophage protein-1 (NRAMP-1) carries cation ions, such as Fe2+, Zn2+ and Mn2+, and plays an essential role in the immune system to infection with micro-organisms. In addition, the function of NRAMP-1 is to limit the replication of pathogens by changing the phagosomal environment. Levels of NRAMP-1 protein are based on death, comorbidities and clinical symptoms of COVID-19 patients and it is possible for the soluble protein NRAMP-1 level to be used as an additional biomarker for forensic and medicolegal related COVID-19 cases and prosecutions from patients and families.

Methods:
Determination of NRAMP-1 protein levels using the enzyme link-immunosorbent assay technique in death, had comorbidities and severity of clinical symptoms of COVID-19 patients.

Results:
Of the 62 patients who received treatment, 10 patients died with an average NRAMP-1 level of 650 ng/ml and 52 patients who survive with an average NRAMP-1 level of 1065.26 ng/ml. The results of the study also found that 34 patients had comorbidities with an average NRAMP-1 level of 838.82 ng/ml and 28 patients without comorbidities with an average NRAMP-1 level of 1191.92 ng/ml. Based on the severity of clinical symptoms in survive patients, 10 patients with mild were found with an average NRAMP-1 level of 984.31 ng/ml, with moderate in 31 patients with an average NRAMP-1 level of 1104.71 ng/ml and severe in 11 patients with an average NRAMP-1 level of 1027.71 ng/ml.

Conclusions:
NRAMP-1 protein levels were significantly lower in COVID-19 patients who died and had comorbidities.
Nonhealing oesophageal ulcer: a case report
Authors: Gurung Ram Bdr , Sapkota Prakash , Sharma Pasand , Lamsal Anukram , Joshi Sahasra , Pandey Urmila , Panta Tanka Psd , Bhardwaj Sushant 
Published: August 2023

Introduction and importance:
Esophageal tuberculosis is a rare presentation of a common infectious disease. It may occur as a primary infection of the esophagus or as a secondary spread mostly from caseating mediastinal lymph nodes. The clinical diagnosis of the condition is presumed to be complex, owing to nonspecific biopsy findings, failure of isolation of bacilli, and a lack of predisposing conditions in patients. This study aims to present a rare condition of esophageal tuberculosis secondary to mediastinal lymphadenitis and highlights a unique modality of diagnosis of the condition, especially in a resource strained setting.

Case presentation:
This case report presents the case of a 50-year-old male with dysphagia and a burning sensation at the epigastrium. Endoscopy and histopathological examination showed ulceration at the esophagus and granulomatous inflammation, respectively. Computed tomography showed enlargement of the prevascular and paratracheal group of lymph nodes. However, the acid-fast bacilli stain at the ulcer site was negative. The diagnosis could be confirmed only after 2 months of the antitubercular treatment trial, which significantly potentiated ulcer healing.

Clinical discussion:
Esophageal tuberculosis may result from a secondary infection caused by systemic dissemination following a pulmonary disease or as a primary infection. In this case, it likely resulted from lymphatic dissemination via prevascular and paratracheal lymph nodes manifested mainly as dysphagia.

Conclusion:
Tuberculosis should be considered as one of the differential diagnoses in areas of limited resources. Clinicians may have to rely on clinical judgement and/or the patient’s response to standard antitubercular treatment to make a definitive diagnosis.
Determinants of infant mortality in Oromia region, Ethiopia
Authors: Irana Tariku , Mekebo Gizachew Gobebo , Diriba Gezahagn , Sisay Assefa Legesse , Woldeyohannes Birhanu , Yohannes Zemene 
Published: August 2023

Introduction:
Infant mortality is one of the commonest health-related indicators used to assess the health status of the community. Children born in Sub-Saharan Africa are at highest risk of infancy death in the world. Ethiopia, in Sub-Saharan Africa, is a country with high infant mortality. Oromia region is among the regions with high infant mortality rate in Ethiopia. Therefore, this study aimed to identify determinants of infant mortality in Oromia region, Ethiopia.

Methods:
The source of data for this study was 2019 Ethiopian Mini Demographic and Health Survey. Multivariable logistic regression model was employed to identify the determinants the infant mortality. An adjusted odds ratio (OR) with a 95% CI was used examine the determinants of infant mortality.

Results:
A total of 719 live births born 5 years preceding the survey were included. The infant mortality rate in the study area was 54 deaths per 1000 live births. The risk of dying in infancy was lower for females [adjusted OR (AOR): 0.518, 95% CI: 0.284, 0.945], health deliveries (AOR: 0.429, 95% CI: 0.235, 0.783), infants born to mothers attended ANC during pregnancy (AOR: 0.603, 95% CI: 0.489, 0.744), infants from families with wealth indices of medium (AOR: 0.715, 95% CI: 0.580, 0.882) and rich (AOR: 0.638, 95% CI: 0.425, 0.958) compared with the respective reference categories while it was higher for infants of multiple births (AOR: 2.241, 95% CI: 1.768, 2.841) compared with singletons.

Conclusions:
Infant mortality rate in the study area, Oromia region, is higher than the national figure. The study found that sex of child, birth type, antenatal care (ANC), place of delivery and wealth index of household were significant determinants of infant mortality. Therefore, concerned bodies should make awareness creation to mothers regarding ANC and encourage them to have ANC follow-up during pregnancy and deliver at health institution to improve the infant survival in the region.
Radiological identification of neuromyelitis optica in a patient presented with unexplained weight loss and generalized weakness: a case report and literature review
Authors: Shrateh Oadi N. , Jobran Afnan W.M. , Khaled Zaina , Zaid Momen A. , Dallashi Ahmad A. 
Published: August 2023

Introduction and importance:
Central nervous system (CNS) inflammatory demyelinating disease known as neuromyelitis optica spectrum disorder (NMOSD) is characterized by recurrent inflammatory events that primarily affect the optic nerves and spinal cord; it may also affect the hypothalamus, area postrema, and periaqueductal gray matter. The NMOSD-specific aquaporin-4 antibody (AQP4-IgG) is available. Myelin oligodendrocyte glycoprotein antibodies (MOG-IgG) have recently been discovered in a group of patients who do not have AQP4-IgG.

Case presentation:
A 29-year-old female presented to the hospital with the complaint of blurry vision in her right eye and left eye ptosis for 2 days. Two months ago, the patient had a history of generalized fatigue with continuous documented fever with an average of 38.5°C, which was relieved by acetaminophen and ibuprofen. She also complained of continuous hiccups that increased at night and interfered with her sleep pattern and breathing; they lasted for 3 weeks and disappeared suddenly. She had also developed episodes of vomiting and could not tolerate food intake due to which she lost 6 kg within 3 weeks. She was later diagnosed with neuromyelitis optica (NMO) using radiological neuroimaging.

Clinical discussion:
Early and correct diagnosis, followed by urgent treatment for acute exacerbations and the prevention of further relapses, are essential for treating NMO spectrum illnesses since they entail significant morbidity and, occasionally, fatality.

Conclusion:
The patient mentioned here represents a typical example of NMO disease. This case emphasizes the presence of this disease in our environment and the importance of accurately diagnosing this ailment, even in a context with minimal resources, to prevent disability.
Obstructed hemivagina and ipsilateral renal agenesis: magnetic resonance imaging findings in young Nepali females – a report of four cases
Authors: Paudel Sharma , Katwal Shailendra , Kayastha Prakash , Shrestha Suraj , Regmi Pradeep R. 
Published: August 2023

Introduction and importance:
Obstructed hemivagina and ipsilateral renal agenesis (OHVIRA) syndrome also known as the Herlyn-Werner-Wunderlich Syndrome is a rare embryological disorder associated with Mullerian and mesonephric duct abnormality.

Case presentation:
The cases presented describe the imaging (ultrasound and MRI) findings of four young females who presented with dysmenorrhea and urinary complaints. All of them had solitary kidneys with a didelphic uterus and unilateral hematometrocolpos. A proximally blind-ending ureter with distal ectopic insertion, transverse vaginal septum, and left-sided endometrioma was seen.

Clinical discussion:
OHVIRA syndrome is associated with duplicated uterovaginal structure with OHVIRA. Ultrasound is the first line of investigation; however, MRI better delineates the anatomy and assists in preoperative planning.

Conclusion:
This report highlights that earlier clinical suspicion and imaging diagnosis of OHVIRA is crucial to prevent adverse outcomes and treating complications.
Efficacy of cryotherapy on chemotherapy-induced peripheral neuropathy in patients with breast cancer: a propensity score-matched study
Authors: Xu Min , Wang Fan , Zhu Xiaoli , Hao Zhaohua 
Published: August 2023

Background:
Chemotherapy-induced peripheral neuropathy (CIPN) is one of the most frequent unfavorable side effects. CIPN refers to the loss of peripheral nerve function that certain types of chemotherapy can cause.

Objective:
This study investigated the effectiveness of cryotherapy in preventing CIPN and its effect on the quality of life (QoL) during chemotherapy.

Methods:
Eligible participants are cancer patients who began therapy with carboplatin, docetaxel, or paclitaxel in the Breast Oncology Unit between May 2022 and October 2022. Patients were distributed into intervention groups that utilized cryotherapy with ice gloves and ice boots and control groups that did not receive cryotherapy. Patient self-report questionnaires were used to quantify patients’ symptoms and QoL after treatment.

Results:
The intervention group exhibited significantly less cold sensitivity, hand and foot numbness, and hand tingling than the control group. Daily CIPN symptoms were substantially milder in the intervention group. Before and after treatment, nerve pain, balance, and muscle and joint discomfort were similar. Intervention and control groups have varied neurotoxicity adverse reaction scores. 2.4% of controls had grade 4 motor neurotoxicity impairment. Physical function and QoL improved in the intervention group.

Conclusions:
Cryotherapy relieves CIPN symptoms in breast cancer patients receiving carboplatin and paclitaxel chemotherapy. More thorough trials should be carried out to determine the best time limit and duration of cryotherapy.
Timely initiation of breastfeeding and its factors among women delivered via cesarean section under spinal anesthesia at the University of Gondar Comprehensive Specialized Hospital, north-west Ethiopia, 2021: a hospital-based cross-sectional study
Authors: Ibrahim Amelmasin Faris , Melkie Tadesse Belayneh , Filatie Tesera Dereje , Tegegne Biresaw Ayen 
Published: August 2023

Background:
The mode of delivery influences breastfeeding practice. Moreover, cesarean deliveries under anesthesia-related risk factors affect the timing of breastfeeding initiation compared to vaginal deliveries. In addition, high rates of cesarean section (CS) deliveries and low breastfeeding rates are important public health concerns for all developing countries.

Objective:
This study aimed to determine the timely initiation of breastfeeding and its factors among women delivered via CS under spinal anesthesia.

Methods:
Institutional-based cross-sectional study was employed among 422 systematically selected mothers from April to June 2021. Data were collected by a structured questionnaire. Data entry and analysis were done using Epi Data and Stata version 14.0. Binary logistic regressions were computed to identify factors. An adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to declare statistical significance.

Results:
Delayed initiation of breastfeeding (DIBF) was 41.8%. Mothers who had an emergency CS (AOR =2.13, 95% CI [1.21–3.75]), had less than four antenatal care (ANC) follow-ups (AOR=1.77, 95% CI [1.02–3.13]), had moderate to severe pain during the perioperative period (AOR=2.65, 95% CI [1.24–5.54]), primipara (AOR=1.89; 95% CI [1.20–3.25]), used intraoperative opioid medications (AOR=1.86; 95% CI [1.01–3.30]), and had no skin-to-skin contact (AOR=2.1, 95% CI [1.27–3.51]) were associated with DIBF.

Conclusion and recommendation:
DIBF after cesarean delivery was high. Emergency CS, less than four ANC visits, immediate postoperative pain, and lack of skin-to-skin contact were factors associated with delayed breastfeeding. Health care providers, especially anesthetists, in the operation theater, should implement multimodal analgesics and minimize opioid consumption. Moreover, they should keep the newborn in skin-to-skin contact to initiate breastfeeding in the operation theater soon after birth.
Use of the Superthin Superficial Circumflex Iliac Artery Perforator Flap for Reconstruction of Lower Lip Defects
Authors: Park Se Yeon , Lee Kyeong-Tae 
Published: August 2023

Summary:
Wide local excision remains the main treatment modality for primary lip cancer, which often results in considerable deficits of lip tissue and requires reconstruction using free tissue transfer. Although diverse free flaps, such as radial forearm flap or anterolateral thigh flap, have been used, their application is often limited by their inherent limitations, including donor-site morbidity and flap bulkiness. This report details the authors’ experience of lower lip reconstruction using a superthin superficial circumflex iliac artery perforator (SCIP) free flap. Two patients with primary squamous cell carcinoma spanning their lower lip underwent wide local excision with an 8-mm lateral excision margin and superficial layer of orbicularis oris muscle. To cover the shallow but extensive lower lip defects, a superthin SCIP flap elevating along the intraadipose tissue layer and a pure-skin perforator SCIP flap elevating along the subdermal layer were harvested. The thickness of the harvested SCIP flap was 3 mm in both cases. The microvascular anastomoses of pedicles were conducted using the inferior labial artery and adjacent subcutaneous vein as recipient vessels, and the flaps were inset. The flaps survived completely without any perfusion-related complications. The patients were discharged uneventfully. Postoperatively, both patients displayed complete functional recovery with good lip competence and aesthetically pleasing results, without requiring secondary debulking operations. The authors’ results suggest that the superthin or pure-skin perforator SCIP flap might be considered as an effective method for covering shallow and wide lower lip defect.
Radiographic Evidence of Dental Complications after Mandibular Distraction Osteogenesis: Inverted-L versus Oblique Osteotomy
Authors: Barrero Carlos E. , Ryan Isabel A. , Salinero Lauren , McGraw J. Reed , Pontell Matthew E. , Bartlett Scott P. , Napoli Joseph A. , Swanson Jordan W. , Nah Hyun-Duck , Taylor Jesse A. 
Published: August 2023

Background:
Patients with micrognathia undergoing mandibular distraction osteogenesis (MDO) for functional and aesthetic improvement are at significant risk for dental complications. The authors investigated the association of 2 osteotomy patterns—oblique and inverted-L—with risk to developing dentition.

Methods:
A senior orthodontist (H.D.N.) performed a retrospective review of dental radiographs of patients undergoing MDO with confirmed oblique or inverted-L osteotomies between 2012 and 2022. Images were assessed for evidence of missing, damaged, or displaced teeth, and proportion of affected hemimandibles by injury type and median number of affected teeth per hemimandible were compared between groups using appropriate statistical methodology.

Results:
Analysis included 44 patients (23 oblique, 21 inverted-L) and 85 hemimandibles (45 oblique, 40 inverted-L). Mean age at surgery was 3.1 ± 4.6 years, and mean time to imaging was 4.9 ± 4.1 years; there was no difference between groups (P = 0.23, P = 0.34, respectively). Oblique osteotomy was associated with greater odds of missing teeth (odds ratio [OR], 13.3, P < 0.001), damaged teeth (OR, 3.2; P = 0.02), and any dental injury (OR, 39.9; P < 0.001) compared with inverted-L, as well as greater number of missing teeth (β = 0.6; P < 0.01), damaged teeth (β = 0.3; P = 0.02), and total number of affected teeth (β = 0.9; P < 0.001). There was no difference in incidence (P = 0.5) or number (P = 0.4) of displaced teeth between groups.

Conclusions:
Inverted-L osteotomies were associated with fewer dental complications compared with oblique osteotomy at all ages studied. Although longer-term follow-up and prospective data are needed before definitive recommendations can be made, these data are helpful to surgeons as they plan MDO.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.