bluuebunny/crossref_metadata_2025_split huggingface dataset:
Typhoid ileal perforation in a semi-urban tertiary health institution in north-eastern Nigeria
Authors: Grema B. A. , Aliyu I. , Michael G. C. , Musa A. , Fikin A.G. , Abubakar B. M. , Olusegun S. 
Published: November 2022

Introduction: Typhoid ileal perforation is a very serious complication of typhoid fever and remains a significant surgical problem in developing countries like Nigeria, where it is associated with higher mortality and morbidity, due to lack of adequate clean drinking water, poor sanitation and lack of access to health facilities in remote areas and delays in hospital presentation.Materials and methods: This was a retrospective study; all patients treated for typhoid ileal perforation at the centre in the period from January to December 2016 were included.Results: There were 22 (59.5%) males and 15 (40.5%) females, with a male to female ratio of 1.5: 1. The ages ranged from 5 to 49 years with mean of 16.5± 9.2 years. The month of October recorded the highest cases of typhoid ileal perforation. Abdominal pain, anorexia, fever and abdominal swelling were the most common symptoms reported by the subjects. The number of ileal perforations was from 1 to 7 with mean of 2.0 ± 1.3; however, the majority had a single perforation. In addition, excision and simple closure was the most common surgery performed in these cases. Operation site infection was the most common complication in this study. Furthermore, the majority of cases were successfully discharged while eight deaths were recorded.Conclusion: Typhoid ileal perforation was most common among males; abdominal pain, swelling and fever were common findings; single site perforation was the most common intra-operative findings and excision and simple closure was the most common operative procedure. Therefore early presentation, adequate resuscitation and lower number of ileal perforations are associated with better prognosis.
Third-Order Effects and Maxillary Incisor Control in Lingual Orthodontics – A Finite Element Study of a Ribbon Arch and Edgewise Straight Wire System
Authors: Konwar Siddhartha Kaustav , Goswami Manjusha , Kalha Anmol S. , Singh Vishal 
Published: November 2022

Introduction:
The aim of the present study was to analyze the effects of retraction mechanics on torque control when retraction forces were applied on the maxillary anterior dentition in two distinct lingual appliance systems.

Materials and Methods:
A three-dimensional bilateral maxillary model was created where the first premolar extraction case was included. 150 g (1.47 N) of retraction force was applied on each side from canine (C) hook to molar for both edgewise straight wire system and ribbonarch appliances.

Results:
In the edgewise appliance, it was observed in the X-axis that there was less amount of tipping of the six anterior teeth of the canine and central incisor (CI) when compared with the lateral incisor (LI) at occlusal point. In the Y-axis, overall extrusion was observed. In the Z-axis, there was less lingual crown movement. In the ribbonarch appliance, it was observed in the X-axis that there was less tipping, prominently in the canine and CI than in the LI. In the Y-axis, overall extrusion was observed. In the Z-axis, there was less lingual crown movement, whereas the CI and canine showed less movement when compared with the LI.

Conclusions:
It was observed that there was greater torque loss and extrusion in the edgewise appliance along with greater maximum principal stress in the cervical half of the facial side in the periodontal ligament (PDL) and minimum principal stress on the cervical half of the palatal side in the PDL when compared with the ribbonarch appliance.
Impact of Conjugated Linoleic Acid on Obesity and Its Association with Macrophage Recruitment: Experimental and Immunohistochemical Study
Authors: Abdou Asmaa Gaber , Bendary Mohamed AbdElfattah , Abdou Sara E. , Amer Ghada S. 
Published: November 2022

Abstract

Background:
Conjugated linoleic acid (CLA) has been shown in humans and animals to have anti-adipose effects. The current study aims to assess the prophylactic and therapeutic impact of CLA and its effect on recruited macrophage type using immunohistochemistry against CD68 and CD 163.

Materials and Methods:
Forty adult male albino rats of local strain were included in the study and divided into control, CLA-supplemented, obese, CLA-prophylactic obese, and CLA-treated obese groups. Biopsies from visceral fat of the investigated groups were obtained and assessed for histopathological changes and immunohistochemical staining for CD68 and CD163.

Results:
Obese group showed hypertrophied adipocytes and infiltration by inflammatory cells compared to other groups. The obese group showed a marked increase in the CD68 positivity compared with that in the control and CLA-supplemented groups. CLA-prophylactic and CLA-treated groups showed mild immune reaction with a significant decrease in CD68 positivity compared to the obese group. The obese group showed a significant decrease in the CD163 positivity compared with that in the control and CLA-supplemented groups.

Conclusions:
Adipose tissue in obese is characterized by inflammation with more M1 than M2 macrophages. CLA could direct the recruited macrophages toward the anti-inflammatory subtype (M2) which encourages its beneficial effects in prophylaxis from obesity.
Dominance of Pro-Inflammatory Cytokines Over Anti-Inflammatory Ones in Placental Bed of Creta Cases
Authors: Abdel-Hamid Ahmed A. M. , Mesbah Yaser , Soliman Mona F. M. , Firgany Alaa El-Din L. 
Published: November 2022

Abstract

Objective:
The objective of the study is to investigate changes occurring in key inflammatory cytokines at molecular level (including genetic and protein) in placental bed of placenta creta compared to that of normal placenta and their correlation to interstitial extravillous trophoblasts (EVT) number.

Subjects and Methods:
Case–control study including placentas of patients with invasive placentation (creta placentas, n = 19) compared with those of normal placentation (n = 19). Besides routine histology and immunocytochemistry detection (cytokeratin-7 [CK-7]), addition to biochemical evaluation of expression of various cytokines including tumor necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1β), IL6, IL-1RA, IL-8, IL-10, and IL-13 was carried out.

Results:
Routine histological examination of placentas of creta cases revealed CK-7+ extravillous trophoblasts (EVT) penetrating deeply the myometrium with various histopathological arrangements and trophoblastic vascular invasion of the deep myometrial blood vessels. A significant increase (P < 0.05) in the mRNA expression of TNF-α, IL-1 β, and IL6 with an insignificant decrease in placental bed IL-1RA, IL-8, IL-10, and IL-13 was observed in creta cases compared to the control ones. A corresponding significant increase was detected in the protein levels of TNF-α, IL-1 β, and IL-6 as well as an insignificant decrease in placental bed IL-1RA, IL-8, IL-10, and IL-13 in creta cases compared to the normal ones. Moreover, we displayed a significant positive correlation (P < 0.05) between interstitial EVT number and mRNA expression of almost all pro-inflammatory cytokines with negative but insignificant correlation with anti-inflammatory cytokines in creta cases.

Conclusion:
The upregulated pro-inflammatory cytokines and the correlation of their expression with the increased interstitial EVT provide a supporting evidence of their potentially more relevant role in the development of placenta creta than the anti-inflammatory ones.
Prescribing patterns and pharmacoeconomic analysis of antihypertensive drugs in South Indian population: A cross-sectional study
Authors: Shanmugapriya S. , Thangavelu Saravanan , Shukkoor Aashiq Ahamed , Janani P. , Monisha R. , Scaria Varsha Elsa 
Published: November 2022

Background:
Global evidence-based recommendations for hypertension management are periodically updated, and ensuring adherence to the guidelines is imperative. Furthermore, the current high prevalence of hypertension effectuates a high health-care cost.

Purpose:
To evaluate the prescribing patterns of antihypertensive drugs and other factors affecting blood pressure (BP) with the objective of assessing the proportion of patients achieving the target BP and to perform a pharmacoeconomic analysis in a South Indian population.

Materials and Methods:
In a cross-sectional study, 650 patients previously diagnosed with hypertension and already on treatment with one or more drugs were included. A prospective interview of patients was done using a prevalidated questionnaire on various factors in BP control. Prescribing patterns and pharmacoeconomic analyses, namely, cost acquisition, cost of illness, and cost-effectiveness analyses were carried out.

Results:
Of 650 subjects, 257 (39.54%) achieved the target BP, while 393 (60.46%) did not. A significant association of age, occupational status, monthly family income, and area of residence in addition to physical activity and diet scores, with achieving target BP was noted. A significantly higher cost of anti-hypertensive drug treatment in achieving target BP (P = 0.02) was observed. Among patients who achieved target BP, 37.35% were on monotherapy and 48.25% on multiple drug therapy compared to 46.31% and 35.62%, respectively, in patients who did not. Average cost-effectiveness ratio were found to be Rs. 20.45 and Rs. 57.27, respectively, for single and multiple drug therapies, with incremental cost-effectiveness of Rs. 194.14 per additional patient treated with multiple free drug combinations.

Conclusion:
This study identified the anti-hypertensive prescribing pattern and provided insight into the various pharmacoeconomic factors that play a significant role in attaining target BP in the treated population.
Public disclosure of clinical trial results at Clinical Trial Registry of India- Need for transparency in research!
Authors: Munshi Renuka , Pilliwar Chaitali , Maurya Miteshkumar Rajaram 
Published: November 2022

Introduction:
Since June 15, 2009, clinical trial registration in the Clinical Trial Registry-India (CTRI) has been made mandatory by the Drugs Controller General of India to improve transparency, accountability, conform to accepted ethical standards and reporting of all relevant results of registered trials. In this study, we planned to evaluate the compliance of Indian and global sponsors with clinical trials conducted in India in terms of reporting of clinical trial results at the CTRI.

Methods:
We included trials registered in the CTRI between January 2018 and January 2020. The CTRI and ClinicalTrials.gov registry was thoroughly searched for all completed interventional studies. A year-wise comparative analysis was performed to evaluate the number of clinical trials reporting results in both the registry.

Results:
The reporting of completed interventional clinical trial results was 25/112 (22.32%) in year 2018, y, 8/105 (7.6%) in year 2019 and 17/140 (12.14%) in year 2020. There was significantly less reporting of results of Pharmaceutical company sponsored Interventional Studies-Indian at CTRI when compared with ClinicalTrials.gov registry for the year 2019 (odds ratio [OR]-0.17 (95% confidence interval [CI]: 0.08–0.36) and P < 0.0001) and year 2020 (OR-0.45 [95% CI: 0.24–0.82] and P < 0.01). The difference in results reported at CTRI was significantly low for Pharmaceutical company sponsored Interventional Studies-Global only for year 2019 (OR-0.09 [95% CI: 0.005–1.45] and P = 0.04) compared with ClinicalTrials.gov.

Conclusion:
There is a need to develop the culture of reporting clinical trial results in CTRI to strengthen the transparency in the research for overall benefit of public, health care professionals, and research community.
The CONUT score is prognostic in esophageal cancer treated with chemoradiotherapy
Authors: Demir Metin , Demircan Nazım Can 
Published: November 2022

Background:
Malnutrition is a frequent issue in esophageal cancer (EC). The Controlling Nutritional Status (CONUT) Score has been established as a prognostic indicator in EC patients who underwent surgery. We aimed to investigate the role of the CONUT Score in EC patients treated with chemoradiotherapy (CRT).

Methods:
The trial included 101 non-metastatic EC patients. Receiver operating characteristic (ROC) curve analyses were used to determine cut-off values for the CONUT Score and other indices. Cox regression analyses were performed to determine prognostic markers.

Results:
Of 101 patients, 59.4% (n = 60) and 40.6% (n = 41) of patients were treated with CRT alone and CRT plus surgery, respectively. ROC curve analyses determined an optimal cut-off for CONUT Score in overall survival (OS), which was 3.5 (AUC = 0.63, CI 95%: 0.51-0.76, P = 0.05). The sensitivity and specificity of CONUT were 66% and 61%, respectively. Low CONUT (≤3.5) patients had significantly longer median OS than high CONUT (>3.5) patients (57.1 vs. 23 months; P = 0.009). Multivariate regression analysis revealed a CONUT Score hazard ratio (HR) of 1.96 for OS (CI 95%: 1.03-3.75, P = 0.04).

Conclusion:
The CONUT Score might be a useful prognostic tool in EC patients treated with CRT. Appropriate nutritional support might provide a better prognosis, which underlines the importance of multidisciplinary assessment of malnutrition in EC patients.
Pattern of structural magnetic resonance imaging lesions in the patients with progressive cognitive decline
Authors: Ezeala-Adikaibe Birinus Adikaibe , Oti B. Bibiana , Ohaegbulam Samuel C , Ndubuisi Chika Anele , Okwudili Okwuonodulu 
Published: November 2022

Objectives:
The aim of the index study was to describe the pattern and frequency of structural brain lesions in magnetic resonance imaging (MRI) of patients with dementia.

Methods:
This was a retrospective, descriptive study carried out in Memfys Hospital in Enugu, South East Nigeria, to review all MRIs of patients who presented with progressive cognitive decline.

Results:
Out of a total of 147 (86.5%) scan reviewed, 6 (6.8%) had normal brain scan, while 95 (64.6%) had brain atrophy, followed by white matter lesions 78 (49.7%). Strokes, including lacunar stroke, were seen in 44 (29.9%). Hydrocephalus (14.3%) and brain tumors (11.6%) were the most common surgical lesion found. Patients with atrophy (P < 0.01) and white matter lesions (P < 0.01) were significantly older compared to the average age of the cohort, while patients with normal brain scans and brain tumors were younger P < 0.01 and P = 0.02, respectively.

Conclusion:
Brain atrophy and white matter lesions were the most common MRI findings in patients presenting with cognitive decline in Enugu, South East Nigeria. Such patients also tended to be older than those with normal brain scans or brain tumors.
Size and shape of sella turcica among Down syndrome individuals in a Nigerian population
Authors: Aghimien Osaronse Anthony 
Published: November 2022

Background/Aims:
This study was conducted to determine the size and shape of sella turcica (ST) among Down syndrome (DS).

Materials and Methods:
The size of the ST was determined among 29 DS (mean age 13.76 ± 2.41 years), while the shape of the ST was among 25 DS individuals (mean of 13.84 ± 2.41 years) who met the inclusion criteria. Statistical significance of linear measurement in relation to gender was evaluated using an independent t-test, while Chi-square test was used to analyze the occurrence and significance of the shape. A statistically significant level was set at P < 0.05.

Results:
ST length (STL), depth (STD), and anterior–posterior diameter (STAPD) were 9.00 ± 3.23 mm, 7.61 ± 1.51 mm, and 10.45 ± 2.79 mm, respectively. Female DS had a larger value for STD and STAPD than males (P > 0.05). The pyramidal shape of the dorsum sella accounted for the largest deviation (28.3%) in shape. A change in shape of the ST tend to affect the depth (F = 1.669, P = 0.204) and diameter (F = 1.425, P = 0.263) than its effects the length.

Conclusion:
The depth and diameter of ST were observed to be larger than normal individuals within the same age range documented in the literature. Abnormal deviation in the shape of sell turcica may have contributed to the variation in the length, depth, and diameter. A deviation in the size and shape of ST could be considered etiological factor in the development of malocclusion among Down syndrome individuals.
Validity of sonographic prediction of birth weight
Authors: Eze Cletus Uche , Cosmas Kingsley Chibuike , Nwamba Joshua Ifeanyichukwu , Upeh Ernest Ruto 
Published: November 2022

Background:
Accurate estimation of fetal birth weight is critical in determining the delivery route and management of the neonate.

Purpose of Study:
The purpose is to determine the accuracy of Hadlock IV, Campbell, and Shepard's algorithm as predictors of birth weight in a cohort of fetuses of Yoruba descent.

Materials and Methods:
Fetal weight (FW) was estimated in a sample of 384 fetuses using Hadlock IV, Campbell, and Shepard's algorithm while actual birth weight (ABW) was measured. Receiver operating characteristic curves were plotted and used to determine the accuracy and sensitivity of each algorithm.

Results:
Most babies (84.6%) had normal estimated fetal weight (EFW) and ABW; mean FW = 3.2 ± 0.5 kg); 10% had low weight while 5.5% were macrosomic. While EFW correlated positively and strongly with ABW, the Hadlock IV algorithm had the strongest correlation (r = 0.978). The Hadlock IV, Campbell, and Shepard's algorithms had 92%, 72%, and 56% accuracy within the tenth centile, respectively. At 95% confidence interval, Hadlock IV was the most accurate predictor of normal birth and low birth weight (area under the curve [AUC] =0.91 and 0.94, respectively). Campbell was the most accurate predictor of macrosomia (AUC = 0.89).

Conclusion:
While Hadlock IV and Campbell algorithm are valid predictors, the Shepard model is a doubtful birth weight predictor among fetuses of Yoruba origin. When there is a need for absolute birth weight values, the Hadlock IV algorithm is preferred for suspected normal and low-weight babies while the Campbell model is preferred for fetuses weighing >4 kg among Yoruba fetuses.
Leptospirosis: Epidemiological and Clinical Characteristics at the National Reference Hospital in Panama
Authors: Vazquez Guillamet Laia J. , Arauz Ana Belen , Suárez Jose A. , González Emma , Domingo de Obaldía Jose , Moreno Dianik , Henostroza German , Armién Blas 
Published: November 2022

ABSTRACT.
Leptospirosis represents a public health problem in Panama, with an incidence rate of 1 in 100,000 inhabitants in 2014. Despite active surveillance and reports of outbreaks in the news, publications about human leptospirosis in Panama are scarce. The objective of this study was to describe the epidemiological and clinical features of leptospirosis in a cohort of patients admitted to the national reference hospital from January 2013 to December 2018. A total of 188 patients with suspected leptospirosis were identified, but only 56.9% (107 of 188) of the medical records could be retrieved. Microagglutination assays were completed in 45% (48 of 107) of the patients, confirming leptospirosis in 29.2% (14 of 48) of the patients. The most prevalent serogroup identified was Leptospira interrogans icterohemorrhagiae (4 of 14, 28.6%). The majority of patients with confirmed disease were middle-aged (36.4 ± 15.7 years), male (11 of 14, 78.6%), and symptomatic for 6.8 ± 0.7 days before admission. The predominant clinical presentation was fever (13 of 14, 92.9%), abdominal pain (7 of 14, 50%), and jaundice (8 of 14, 57.1%). Respiratory failure (8 of 14, 57.1%), elevated creatinine levels on admission (8 of 14, 57.1%), transfusion of blood-derived products (6 of 14, 42.9%), and required use of vasopressors (4 of 14, 28.6%) were common complications. Mortality was 28.6% (4 of 14). Empiric antibiotic therapy was initiated in almost all patients (10 of 12, 83.3%), and was appropriate in 90% (9 of 10) of them. Our study highlights the high prevalence of severe disease and reveals the diagnostic challenges concealing the true burden of leptospirosis in Panama. However, the small number of confirmed patients limits the generalization of these findings.
Case Report: Extensive Gangrene: A Rare Presentation of Multisystem Inflammatory Syndrome in Children
Authors: Banothu Kiran Kumar , Dekate Parag Shankarrao , Gupta Priyanka , Reddy Avinash , Immaneni Satish Rao 
Published: November 2022

ABSTRACT.
A wide spectrum of cutaneous manifestations are reported in multisystem inflammatory syndrome in children (MIS-C). However, gangrenous changes are less frequently reported. A 3-year old boy, with a known case of unoperated tetralogy of Fallot, presented with a short history of fever, rash, and melena. The rash was black and diffuse, with a rapid progression. The patient was stable hemodynamically at admission, with pallor, grade II clubbing, edema, and oral ulcers. Inflammatory markers were raised. He developed gangrenous changes over the ears and acral areas. He had very high levels of antibodies to severe acute respiratory syndrome coronavirus2 (SARS-CoV-2) infection and was diagnosed as having MIS-C. Skin biopsy revealed near total epidermal necrosis with dermal vascular thrombi and negative immunofluorescence. Skin biopsy was positive for IgG antibodies to SARS-CoV-2. He was treated with antibiotics, immunomodulation with steroids, intravenous immunoglobulin, and plasmapheresis. He had features of both micro- and macroangiopathy. Gradually the child improved, with residual deformity.
Case Report: Visceral Leishmaniasis-associated Hemophagocytic Lymphohistiocytosis in Adults: A Case Series and Literature Review
Authors: Qin Yao , Lv Xiaoju , Zheng Qin , Wu Qian , Zheng Linmao , Kang Mei , Liu Ting , He Fang 
Published: November 2022

ABSTRACT.
Hemophagocytic lymphohistiocytosis (HLH) is a rare and fatal complication of visceral leishmaniasis (VL). To provide a basis for early and correct diagnosis and to improve prognosis in the future, we describe a case series of VL-associated HLH in adults in our center in the past decade after review of all reported cases of adult VL-associated HLH in English through May 2022. In our case series, a total of 111 patients were diagnosed with VL. Among these patients, only six cases were diagnosed with VL-associated HLH. All patients tested positive for serology. Leishmania was detected for the first time by bone marrow aspiration (BMA) in three of the six patients and in the other three patients after three or four BMAs. It took more than 1 month from onset to diagnosis of VL for all the six cases, and the longest time was 6 months. Five of the six patients recovered after receiving sodium stibogluconate. VL-associated HLH is rare but potentially life-threatening in adults and predisposes to early delays in diagnosis. However, diagnostic techniques are not complicated or difficult, so it is more important to consider that it is not recognized by physicians. Although guidelines recommend liposomal amphotericin B as the most effective therapy, our experience suggests that sodium stibogluconate can be an alternative option when liposomal amphotericin B is unavailable or unaffordable.