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BACKGROUND: Dealing with crises in the current era requires a fundamental change in science and technology, consumption patterns, and people’s relationship patterns, which demands new strategies, alternatives, and administrative methods to deal with different realities of life. Due to the severe outcome of the coronavirus disease 2019 (COVID-19) pandemic, governments had to intensify their efforts to deal with this disease and make decisions to manage the crisis and its extreme economic, health, and educational consequences. This qualitative study was conducted in 2023 and aimed to explain the healthcare executives’ decision-making structure in the COVID-19 crisis. METHODS: This qualitative study was conducted using content analysis method. 14 managers working in health and treatment sectors of Kurdistan University of Medical Sciences, Sanandaj, Iran were selected with purposeful sampling in 2023. A semi-structured interview was used to collect data. The conventional content analysis method was used to analyze the data. RESULTS: The results led to the extraction of 3 main categories, seven sub-categories, and 16 primary categories. The executives had made decisions, based on their point of view, to deal with COVID-19 in pre-crisis (including the sub-categories of crisis initiation signal recognition, preparing to resist the crisis, and preventing the geographical spread), during-crisis (preventing the crisis damage, limiting the crisis injuries), and post-crisis (including sub-categories of recovery of management and guidance systems and learning from the experiences) phases. CONCLUSION: Based on the results of this study, scientific management and the characteristic of leadership over people can be a way forward for healthcare managers to organize in crises.

Background: Despite the recommendations to follow guidelines for the prevention of COVID-19, different communities do not completely adhere to these guidelines. The aim of this study was to explore the barriers and facilitators of the adherence of the people of Sanandaj to the COVID-19 prevention guidelines. Materials & Methods: The present study was a qualitative content analysis study conducted in 2020. A purposive sampling method among the residents of Sanandaj, Iran was applied and continued until data saturation was achieved. Twenty semi-structured interviews were conducted with the participants. A verbatim transcription of interviews was analyzed through qualitative conventional content analysis. Results: Participants included 12 men and 8 women. Data analysis yielded 8 categories and 26 sub-categories regarding the barriers and facilitators of the participants’ adherence to the COVID-19 prevention guidelines. The barriers included myths, being under pressure, and letting and facilitators included awareness, fear, commitment, unity against the disease, and warnings. Conclusion: According to the findings, it is necessary to correct people’s beliefs, support them, and continue to make them informed about the disease. Increasing awareness and commitment, strengthening the spirit of unity among people, and increasing the level of warnings can be effective in increasing adherence of people to the COVID-19 prevention guidelines.

ObjectiveThe aim of this systematic review and meta-analysis study was to determine the pooled estimate of the effect of antenatal magnesium sulfate (MgSO4) on intraventricular hemorrhage (IVH) in premature infants. MethodsTwo review authors independently searched all randomized clinical trials from international databases, including Medline (PubMed), Web of Sciences, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), and Research Registers of ongoing trials (ClinicalTrials.gov), from January 1989 to August 2017. Two independent review authors were responsible for data collection. After extracting the necessary information from the evaluated articles, meta-analysis of the data was performed using Stata version 14. Also, sources of heterogeneity among studies were determined by Meta regression. ResultsIn this study, among 126 articles that were extracted from primary studies, 7 papers that evaluated the effect of MgSO4 on IVH were eligible for inclusion in the meta-analysis. The results of the meta-analysis showed that pooled relative risk (95% confidence interval [CI]) was 0.80 (95% CI, 0.63 to 1.03) for the effect of MgSO4 on IVH. ConclusionResults of this study showed that although MgSO4 had a protective effect on IVH in premature infants, this effect was not statistically significant. Further studies are needed to determine the best dosage, timing, and gestational age to achieve the optimum effect of MgSO4 on IVH. Systematic Review RegistrationInternational Prospective Register of Systematic Reviews (PROSPERO) Identifier: CRD42019119610

Background & Aim: Nowadays, organ transplantation is the final treatment for the patients with end-stage organ dysfunction. Considering the importance of the organ donation and the important role of nurses in increasing the number of organ donations, the present study aimed to determine the knowledge and attitudes of nurses in Sanandaj hospitals toward organ donation. Materials & Methods: This study was descriptive-analytic (cross-sectional). 250 nurses working in hospitals in Sanandaj city were selected by stratified sampling method in 2017 and completed the questionnaire on knowledge and attitude towards organ donation. Data were analyzed by SPSS software version 20, using independent t-test and ANOVA. Results: The results showed that the mean score of knowledge was 13/2 ± 04/ 57 and the mean score of attitude was 44.7 ± 82.75 and 207 (82.2%) did not have a donation card, while 146 nurses (58.4%) tended to receive a donation card. The mean score of nurses' knowledge about donation was 13.2 ± 26/49 and the mean score of their attitude was 13.2 ± 07. 91. There was also a significant correlation between attitude and level of education (p=0/045). Conclusion: According to the results, the knowledge and attitude of the majority of nurses were moderate and most of them did not have a donation card. Considering the importance of this effective group in increasing the culture of the community toward organ donation, education and preparing appropriate background for receiving, and increasing knowledge and attitudes toward organ donation for the nurses is necessary.

Background Organ donation requires management to promote awareness and create the proper culture in all societies. Awareness and attitude of students and nursing staff can affect the process of donating organs. Objectives The aim of this study was to determine the effect of blended education on the awareness and attitude of nursing students towards organ donation. Methods In this clinical trial study, which used a Solomon four-group design, 94 undergraduate nursing students from Azad University of Sanandaj in 2016 were selected by the census method and randomly assigned to four groups. The data collection tool included demographic data and the Organ Donation Awareness and Attitude Questionnaire blended education was provided to students through a one-day interactive workshop and social networks for 2 weeks. Before and after the intervention, students’ awareness and attitude were evaluated. The collected data were analyzed by SPSS 16 using Fisher, Wilcoxon, Mann-Whitney, and Kruskal-Wallis tests. Results The comparison of the awareness level after the intervention in the four groups showed statistically significant differences (P = 0.0001). Moreover, there was a significant difference in the attitude level after the intervention between the four groups (P = 0.02). Conclusions Blended education increases the awareness and attitude of nursing students. Thus, trainers and educators are suggested using blended education to train students regarding donation. Moreover, it is recommended to include the topic of donation in the nurse’s curriculum.

Osteomyelitis is commonly caused by pathogens like Staphylococcus aureus , but rare organisms such as Corynebacterium minutissimum , typically associated with superficial skin infections, can also be implicated. Recognizing these atypical pathogens presents diagnostic and therapeutic challenges, especially in the presence of orthopedic hardware. We conducted a literature review yielding 25 studies and encompassing 797 patient cases, which highlights the emerging role of Corynebacterium species in osteomyelitis, particularly following trauma or surgical interventions. A 72-year-old man with a history of chronic right tibia and fibula fractures from a motor vehicle accident presented with progressively worsening leg pain over six months. Imaging revealed hardware failure and new fractures. Surgical intervention involved hardware removal, osteotomy, and placement of an external fixator. Intraoperative cultures eventually grew C. minutissimum which was resistant to ceftriaxone but sensitive to doxycycline. His antibiotic regimen was switched from intravenous cefazolin to oral doxycycline, leading to gradual pain improvement and stable clinical status. This case adds to the growing body of literature on C. minutissimum as a rare but significant cause of osteomyelitis, particularly in patients with orthopedic hardware. Our literature review emphasizes the need for clinicians to be vigilant for Corynebacterium species in cases of osteomyelitis unresponsive to standard treatments. Early recognition and targeted antimicrobial therapy guided by susceptibility testing are crucial for successful outcomes in managing atypical bone infections., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Ansari et al.)

Background: Lateral epicondylitis impacts 1-3% of the population. It affects nearly half of all tennis players, primarily due to repetitive forearm muscle use leading to pain at the lateral elbow, particularly at the extensor carpi radialis brevis tendon. While conservative treatments resolve most cases, 4-11% of patients with persistent pain require surgery. Tenotomy is the gold standard for repair, but the research comparing the benefits of specific types of tenotomies (open, arthroscopic, percutaneous, ultrasonically assisted, and Tenex forms) is lacking. Methods: PubMed and Embase searches were conducted for articles focused on four tenotomy techniques. The inclusion criteria allowed for the use of randomized controlled trials (RCTs), prospective cohort studies, and comparative observational studies, while the exclusion criteria excluded meta-analyses. Following the PRISMA guidelines, the initial search resulted in 2327 articles. Once the inclusion and exclusion criteria were applied, 1702 articles underwent abstract screening. Finally, 232 articles proceeded to full-text screening, resulting in 37 articles undergoing data extraction. Results: The primary outcomes included functional improvement, pain relief, overall performance, and postoperative disability. The secondary outcomes included patient-reported satisfaction, return-to-work timeframes, and procedural complications. Conclusions: The tenotomy outcomes were similar, regardless of the method, indicating that discussions with patients about their specific outcome preferences may help guide tenotomy method selection.

Background: Esophageal neoplasms rank as the 7th most common cancers in the world. Squamous cell carcinomas of esophagus (SCCE) are the predominant subset, linked to a number of genetic alterations. Gene-driven tumour pathways are being increasingly identified with the emerging role of next-generation sequencing., Case Presentation: We report a case of an 82-year-old male patient who was diagnosed with SCCE involving the cervical region. He received definitive concurrent chemoradiotherapy with Carboplatin and Paclitaxel. To trace the family history of malignancy, a genetic test was carried out which turned out to be a pathogenic BRCA1 variant., Conclusion: SCCE arising in the context of known BRCA1 mutation has been rarely reported to date. Testing for these mutations should be considered in patients who present with esophageal cancer, especially in the backdrop of familial neoplasms., Competing Interests: The authors declare that they have no competing interests., (© the authors; licensee ecancermedicalscience.)

Bevacizumab and atezolizumab combination is one of the preferred combinations for managing advanced hepatocellular carcinoma (HCC), while the evidence on monotherapy with either agent is not convincing. We present a case of a man in his 50s diagnosed with HCC with spinal metastases who showed a good response to combination therapy. However, he developed severe proteinuria and hypertension secondary to bevacizumab, which had to be discontinued after 18 cycles. After an informed decision, atezolizumab was continued and the patient showed a sustained response. Till date, he has received 16 additional cycles of atezolizumab monotherapy after discontinuation of bevacizumab and continues to show a persistent response, with a progression-free survival of over 30 months now. It needs to be prospectively evaluated if atezolizumab's effectiveness as monotherapy for extended periods, as in our report, is a residual effect of initial combination therapy or if HCC is intrinsically responsive to immunotherapy alone., How to Cite This Article: Naviwala MSS, Shoaib D, Khan WA, et al. Complete Response with Immunotherapy Alone after Discontinuing VEGF Inhibitor in Advanced Hepatocellular Carcinoma: A Case Report. Euroasian J Hepato-Gastroenterol 2024;14(2):246-250., Competing Interests: Source of support: Nil Conflict of interest: None Patient consent statement: The author(s) have obtained written informed consent from the patient for publication of the case report details and related images.Conflict of interest: None, (Copyright © 2024; The Author(s).)

Hemophagocytic Lymphohistiocytosis is an inflammatory condition which results in over activation of the immune system. It could be either sporadic or familial. The familial subtype is linked with various genetic mutations and is commonly a disease of the young. Here we report a case of HLH in an adult, occurring in the background of a successfully treated hematological malignancy. Upon workup, he was also found to have pathogenic STXBP2 mutation, suggesting HLH of familial origin. To date, only few cases of adult-onset familial HLH have been brought to light., Competing Interests: No conflict of interest exists., (© 2023 The Authors. Published by Elsevier Ltd.)

Background: Squamous cell carcinoma of the head and neck have been characterized using various prognostic parameters. These include advanced age, lifestyle habits such as smoking, higher tumor stage at presentation & presence of metastasis. Many patients are diagnosed with head and neck cancers annually in Pakistan, but limited data is available for the prognosis of these patients. This study aims to investigate a new biomarker by estimating the mean level of pretreatment neutrophil to lymphocyte ratio (NLR) in patients with Squamous cell carcinoma of the head & neck., Methods: We conducted a cross-sectional study using non-probability consecutive sampling techniques for 222 biopsy-proven cases of head & neck squamous cell carcinoma. Clinical & pathological variables were analyzed, including the patient's profile and tumor characteristics. The NLR of each patient before treatment was calculated using the absolute neutrophil count divided by the absolute lymphocyte count in preoperative blood samples. An independent sample t -test was used to assess the mean difference. A p-value less than or equal to 0.05 was taken as statistically significant., Results: Of 222 patients, a male predominance was seen in the entire cohort. A median pretreatment NLR of 3.19 (2.47-4.97) was identified, and patients were classified into high and low NLRs based on this value. Data analysis revealed a statistically significant increase in NLR among patients with nodal metastasis. In addition, patients with NLR above the median cutoff value of 3.19 demonstrated that there was a significant increase in NLR values with high tumor (T) and nodal (N) classifications with a p-value of 0.001 and 0.003, respectively., Conclusion: Pretreatment neutrophil to lymphocyte ratio may be associated with increased nodal involvement. It may serve as a useful prognostic predictor for patients with squamous cell carcinomas of the head and neck. Identifying high-risk patients in the pretreatment phase with the help of such biomarkers will also facilitate early inclusion in clinical trials., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 Published by Elsevier Ltd.)

Background and Aim: Diffuse large B-cell lymphoma (DLBCL) has been classified using various parameters, including the site of origin. Studies have reported conflicting outcomes when DLBLC patients were stratified according to the site of origin. This study aimed to investigate the response rate and survival outcomes in nodal versus extranodal DLBCL and compare the results to a region-matched study covering the 1988 - 2005 period., Methods: A single-center retrospective cohort study was conducted on all patients diagnosed with DLBCL and treated in a tertiary care hospital in Pakistan during 2014 - 2019. We calculated the mean and median for continuous variables and frequency and percentages for all categorical variables. Progression-free survival (PFS) and overall survival (OS) were calculated using Kaplan-Meier survival curves. A Cox proportional hazards model was used to determine the hazard ratio (HR) for OS., Results: Of the 118 patients, 49 patients (41.5%) had nodal disease and 69 patients (58.5%) were diagnosed with extranodal DLBCL. The majority of patients in the nodal and extranodal cohorts presented with Stages III and IV disease (73.4% and 62.3%, respectively). A complete response to (immuno) chemotherapy was achieved in 71.4% of nodal DLBCL patients and 65.2% of extranodal DLBCL patients. The 5-year PFS and median PFS in the entire cohort were 0.8% and 17 m, respectively. The PFS and median PFS in the nodal and extranodal DLBCL cohort were 0% and 1.4%, respectively, and 15 m and 19 m, respectively. The 5-year OS and median OS in the entire cohort were 16.1% and 19 m, respectively. The OS and median OS in the nodal and extranodal DLBCL cohort were 8.2% and 21.7%, respectively, and 19 m and 21 m, respectively. Multivariable linear regression revealed that the ABC phenotype (nodal, HR = 1.37, 95% CI = 1.37 - 3.20; extranodal, HR = 1.65, 95% CI = 1.46 - 3.17; GBC as reference) and double and triple hit DLBCL (nodal, HR = 1.29, 95% CI = 1.19 - 2.81; extranodal, HR = 1.87, 95% CI = 1.28 - 2.43; and non-expressors as reference) are independent negative predictors of OS., Conclusions: DLBCL incidence in the Karachi region has remained comparable but patient composition in the extranodal DLBCL cohort has shifted to predominantly advanced stage. Nodal and extranodal DLBCL were associated with similar PFS and OS profiles and first- and second-line treatment responses. Cell of origin and antigen expression status was independent negative predictors of OS, disfavoring the ABC phenotype and lesions with c-MYC and BCL2 and/or BCL6 overexpression., Relevance for Patients: DLBCL is an aggressive type of non-Hodgkin's lymphoma, however; patients respond well to standard systemic chemotherapy. Extranodal type of DLBCL patients tend to have more residual disease after first-line systemic chemotherapy, but physicians should keep in mind that the subsequent line treatment mitigates its negative impact on survival., Competing Interests: The authors declare that they have no competing interests., (Copyright: © 2022 Author(s).)

Introduction and Importance: Myoepithelial carcinomas are a diverse group of tumors exhibiting myoepithelial differentiation. There have been increasing reports of extra-salivary sites of origin for myoepithelial carcinomas such as soft tissues, bone and visceral areas. Due to this entity's rarity, definite diagnostic and treatment parameters are somewhat limited. We present the case of a myoepithelial carcinoma arising from the abdominal wall, a rare site of origin of an uncommon tumor., Case Presentation: A 37-year-old gentleman presented to our institution in Oct 2018 with a recurrent abdominal mass for which he underwent wide local excision after completing the workup, which included systemic scans and relevant blood investigations. The histopathology report was consistent with malignant abdominal myoepithelial carcinoma. However, subsequent follow-up scans in May 2019 showed disease progression with the appearance of multiple lung metastases. After a detailed discussion, he was started on Pazopanib 800 mg orally once a day, on which he remained stable till May 2022. It was then when he experienced clinical disease progression confirmed on systemic scans, so he was offered palliative systemic chemotherapy., Clinical Discussion: Abdominal malignant myoepithelial carcinomas are an infrequent entity. However, this case highlights its critical diagnostic markers and primary and recurrent abdominal myoepithelial carcinoma management., Conclusion: Abdominal myoepithelial carcinomas, although rare, are also under-recognized. Thus, keeping an index of high suspicion for these tumors and being armed with knowledge regarding the heterogeneity of its features would lead to better diagnostic awareness and documentation, paving the way for better evidence-based treatments., Competing Interests: Declaration of competing interest Authors have no conflict of interest., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Schwannoma is a rare tumor that arises from the Schwann cells, which are specialized, myelin-producing cells of the peripheral nerve sheaths. As anatomic logic would dictate, these masses commonly occur in the skull base, cerebellopontine angle, and posterior spinal roots. Of this already rare entity, rarer still are the pleural schwannomas, representing approximately 1-2% of thoracic tumors. These tumors commonly affect adults with a propensity for the third and sixth decades of life and a comparative male predilection. Schwannomas are benign, indolent, and follow an asymptomatic course. As such, they often come to light incidentally. Here we report a case of primary pleural schwannomas in a 68-year-old female, found incidentally on a CT scan of the chest. To the best of our knowledge and literature review, no other similar case has been reported in our country, Pakistan. Around three weeks before her presentation, she was diagnosed with COVID-19. Her infection had run a mild course with quick recovery without the need for any hospitalization. Therefore, the manifestation of shortness of breath after resolution of all other symptoms prompted a further workup. Radiographic chest x-ray revealed an incidental finding of a large right upper lobe lung mass, slightly impinging on the trachea. This was followed by a chest CT scan at our radiological imaging facility, which showed a large, well-encapsulated, right upper lobe lung mass in the paraspinal apical location. She then underwent an image-guided biopsy of the aforementioned mass, pathological analysis of which was suggestive of a benign peripheral nerve sheath tumor (PNST) arising from the pleura (pleural schwannoma). She underwent right posterolateral thoracotomy with uneventful complete surgical removal of the pleural-based lung mass. Postoperative investigations included a chest x-ray that showed interval complete resection of the mass. Currently, she is asymptomatic and her clinical condition has improved with the successful resumption of her daily routine. Physicians thus need to keep pleural schwannomas in mind as a probable diagnosis of intrathoracic tumors. Indolent and asymptomatic, they are very amenable to surgical resection with little to no chances of recurrence in the long term. However, these patients should be closely followed with repeat imaging studies when symptomatic., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Shoaib et al.)

Protein components of the invertebrate occluding junction-known as the septate junction (SJ)-are required for morphogenetic developmental events during embryogenesis in Drosophila melanogaster. In order to determine whether SJ proteins are similarly required for morphogenesis during other developmental stages, we investigated the localization and requirement of four representative SJ proteins during oogenesis: Contactin, Macroglobulin complement-related, Neurexin IV, and Coracle. A number of morphogenetic processes occur during oogenesis, including egg elongation, formation of dorsal appendages, and border cell (BC) migration. We found that all four SJ proteins are expressed in egg chambers throughout oogenesis, with the highest and the most sustained levels in the follicular epithelium (FE). In the FE, SJ proteins localize along the lateral membrane during early and mid-oogenesis, but become enriched in an apical-lateral domain (the presumptive SJ) by stage 11. SJ protein relocalization requires the expression of other SJ proteins, as well as Rab5 and Rab11 like SJ biogenesis in the embryo. Knocking down the expression of these SJ proteins in follicle cells throughout oogenesis results in egg elongation defects and abnormal dorsal appendages. Similarly, reducing the expression of SJ genes in the BC cluster results in BC migration defects. Together, these results demonstrate an essential requirement for SJ genes in morphogenesis during oogenesis, and suggest that SJ proteins may have conserved functions in epithelial morphogenesis across developmental stages., (© The Author(s) 2021. Published by Oxford University Press on behalf of Genetics Society of America.)