bluuebunny/crossref_metadata_2025 huggingface dataset:
Do socio-cultural practices by elderly women influence obstetric complications? A study in Limpopo province
Authors: Makhado Langanani C. , Raliphaswa Ndidzulafhi S. , Maluleke Mary , Netshikweta Mutshinyalo L.
Published: December 2024

Background: Worldwide, women continue to die from obstetric-related complications, despite the global progress made to reduce maternal mortality. Elderly women play a key role in using their own socio-cultural practices during pregnancy and childbirth.Objectives: The study aimed to explore the practices based on the beliefs of elderly women in Limpopo province.Method: A qualitative approach using descriptive, explorative and contextual design was employed. Audio recording of unstructured focus group discussions was conducted of the elderly women who were purposively sampled. Data were analysed and coded using thematic analysis approach following Tesch’s method and co-coded to ensure trustworthiness. Ethical considerations were also adhered to.Results: The findings discuss practices based on beliefs of elderly women and the need for them to be trained to participate in maternal health practices.Conclusion: The study concluded that practices based on beliefs of elderly women lead to delays in seeking medical intervention. Therefore, elderly women need to be trained to reduce maternal mortality.Contribution: This study adds knowledge to the need for training and the importance of elderly women to be trained in order to reduce maternal mortality.
Comparative Efficacy of Iron Chelation Therapies on Cardiac and Liver Iron Levels in Thalassemia Patients: A Systematic Review and Network Meta-Analysis
Authors: Aleid Abdulsalam , Almu Dhiyaa , Almuwalad Nada , Alruwaili Muhannad , Alaryani Khalid , Alhaboob Zeyad , Alwabari Mohammed , Albenayyan Saja , AlHarbi Wahaj , Shamsan Abbas , Al Mutair Abbas
Published: December 2024

Beta-thalassemia major is a genetic disorder that causes hemolytic anemia and requires regular blood transfusions, leading to iron overload in organs such as the liver and heart. This iron accumulation can result in severe health issues, including cardiac complications and liver diseases. Although iron chelation therapy is vital for managing iron overload, the effectiveness of various chelation therapies remains to be investigated. A thorough literature search was conducted in January 2024 across databases, including PubMed, Web of Science, Cochrane Library, and Scopus. Data was analyzed using R software, employing packages for network meta-analysis (NMA). Continuous data was assessed using mean difference (MD) with 95% confidence interval (CI), with random-effect and fixed-effect models applied as appropriate. This network meta-analysis involved 17 studies. In cardiac MRI T2*, deferasirox (DFX) outperformed other therapies (MD = 1.75, 95%CI [0.34, 3.15]). The combination of DFX and deferiprone (DFP) had the greatest effect on ferritin levels DFP (MD = −1244.68, 95%CI [−2312.69, −176.68]). The NMA showed significant increase in liver MRI T2* achieved by DFO + DFP in comparison to DFO (MD = 2.19, 95%CI [0.42, 3.96]). By contrast, no significant differences were observed across treatments for liver iron concentration. This meta-analysis demonstrates that the effectiveness of iron chelation therapy for beta-thalassemia major varies, with DFX outperforming in cardiac MRI T2* improvement and a combination of DFO and DFP exhibiting a better result in liver MRI T2* increase. Future research should explore larger samples and diverse patient-reported outcomes to enhance understanding of the impact of these therapies on patient health and quality of life.
Evaluating the Accuracy of Psychiatric Diagnoses by Primary Health Physicians: A Retrospective Study at a Tertiary Medical Center
Authors: Alhamidy Farah K. , Alsubaie Ettab G. , Albadah Abdullah R. , Alharbi Abdulkareem H. , Alharbi Majed A.
Published: December 2024

Objectives:

Primary care physicians (PCPs) are often the first point of contact for patients presenting with psychiatric symptoms. This study aimed to evaluate the accuracy of psychiatric diagnoses made by PCPs in a tertiary center in Riyadh, Saudi Arabia.

Methods:

This cross-sectional study was conducted in the mental health department of a tertiary medical center in Riyadh. Data were collected for patients referred from primary healthcare (PHC) clinics to mental health (MH) clinics between September 1 and December 31, 2022. Diagnoses by PCPs were deemed accurate if they matched the final psychiatric diagnoses.

Results:

The study found that 73.1% of patients received correct diagnoses in PHC clinics, with a sensitivity of 71.6% and specificity of 73.4%. Citalopram was the most commonly prescribed medication in both PHC and MH clinics (38.2% and 32.3%, respectively). However, 64.9% of patients seen in PHC clinics received no medication.

Conclusion:

While PCPs accurately diagnosed most psychiatric cases, they often refrained from initiating treatment, opting instead to refer patients to MH clinics. These findings suggest that training for PCPs should emphasize the management of common psychiatric conditions, such as depression and anxiety, that can be effectively addressed in PHC settings.
Moringa oleifera: A Medicinal Herb
Authors: Zerwal Priyanka Dinkar , Patil Vishakha , Dodwad Vidya , Naorem Allen , Pharne Pooja
Published: December 2024

Moringa oleifera Lam., also referred to as munga, is one of the most important plants that are widely farmed in India. It belongs to the family Moringaceae. A popular nutritional supplement, Moringa oleifera Lam possesses a number of advantageous pharmacological qualities, such as anti-inflammatory, anti-diabetic, anti-microbial, anti-oxidant, anti-allergic, wound healing and analgesic. The most extensively grown species of the monogeneric Moringaceae family, which is native to south Asia, is Moringa oleifera.
Multiple [33] Impacted teeth with Bilateral Maxillary dentigerous cyst in cleidocranial dysplasia: A Rare Syndromic Finding
Authors: Shah Jigna S. , Suresh Nidhi Susan , Panchal Freni K.
Published: December 2024

Cleidocranial dysplasia (CCD) is a rare autosomal disorder characterized by multiple impacted supernumerary teeth sometimes accompanied by follicular cysts. These patients may be first noticed by the dentist because of esthetic problems or delayed eruption of teeth. The aim of the study was to emphasize the importance of early diagnosis of CCD as multiple impacted teeth can give rise to dentigerous cyst in later stages. Two case reports describe the patients having typical features of CCD with impacted teeth and one of them was radiographically diagnosed with multiple dentigerous cysts. Early diagnosis of CCD and its management of impacted teeth with a multidisciplinary approach helps in avoiding the functional and pathological problems associated with it which include difficulty in mastication and poor patient self-esteem.
Keratosis Palmoplantar-periodontopathy Syndrome – A Clinical Diagnostic Dilemma
Authors: Joshi Manjiri Uttam , Vanjani Mukta Vijaykumar , Jagtap Manali
Published: December 2024

Papillon–Lefevre syndrome is an autosomal recessive disorder distinguished mainly by a triad of palmar-plantar hyperkeratosis, aggressive periodontitis involving both deciduous and permanent dentition and intracranial calcifications. Patients also exhibit increased susceptibility to bacterial infections. Most of the cases are reported on account of homozygous mutations affecting cathepsin C (CTSC) gene, as both the alleles of cathepsin C gene are mutated. Periodontal disease can, however, develop either as a principal manifestation or be fostered by the presence of local factors. This article presents such a rare case report along with dermatological manifestations and its clinical significance from dental perspective. This will aid in a proper multidisciplinary treatment approach.
Evaluating Oral Health Status, Oral Lesions Prevalence, and Oral Health Impact Profile-14 among Tobacco Industry Workers
Authors: Srujananjali Grandhi , Ramya K. , Karri Roja Lakshmi , Bonthagarla Krishna Sahi , Sree Akkineni Bhavya , Mounika Yannam
Published: December 2024

Background:

Maintaining optimal oral health is critical for general well-being, particularly in occupational settings where unique hazards may impact oral health. The purpose of the present study is to comprehensively examine the oral health implications among tobacco industry workers, considering demographic factors, deleterious habits, oral health measures, and quality of life indicators.

Materials and Methods:

The study comprised 180 participants employed in the tobacco industry were included in the study. Demographic data, tobacco-related habits, and oral health parameters including decayed, missing, filled teeth (DMFT), community periodontal index (CPI), loss of attachment (LOA), oral hygiene index-simplified (OHI-S), and oral health impact profile (OHIP-14) scores were assessed.

Results:

The study revealed a predominantly younger, lower-income demographic with significant tobacco use. Oral health assessment indicated moderate dental caries (DMFT: 8.65), low-to-moderate periodontal issues (CPI: 2.28, LOA: 1.49), and fair oral hygiene (OHI-S: 1). Notably, a moderate level of oral health impact was observed (OHIP-14: 10.51), with physical pain and disability having the highest impact. The prevalence of oral lesions, although relatively low (84.4% with no lesions), suggests the importance of tailored oral health management.

Conclusion:

These findings emphasize the importance of focused interventions and ongoing research to enhance overall oral health and quality of life among tobacco industry workers. Public health initiatives, educational programs, and tailored interventions are warranted to address the identified oral health challenges in this population.
Current Status, Challenges, and Solution for Heart Transplantation in Public Sector Hospital
Authors: Manek Pratik , Madkaiker Ashish , Gandhi Hemang , Trivedi Visharad , Prajapati Jayesh , Jain Anil , Patel Kartik , Ninama Sunil , Mukunda Venkata , Pandya Himani , Doshi Chirag
Published: December 2024

For patients with end-stage cardiac failure, heart transplantation is still a lifesaving surgery; however, access to this treatment in public institutions faces many obstacles. This review article examines the status of heart transplantation in public institutions, including its difficulties and possible remedies. This review also examines the various obstacles faced by public sector hospitals when performing heart transplant procedures, including financial aspects, infrastructure, legal procedures, trained personnel and transplant teams, and logistical difficulties related to organ procurement and distribution. In conclusion, even though heart transplantation in public hospitals has many difficulties, systematic efforts to remove obstacles and provide creative fixes have the potential to improve the results and accessibility for patients in need of this lifesaving procedure.
Complete Resolution of Hemodialysis-induced Pseudoporphyria after Renal Transplantation
Authors: Doley Prodip Kumar , Tamut Oyik , Sharma Manjuri , Pegu Gayatri
Published: December 2024

Bullous dermatoses in end-stage renal disease are not an uncommon entity. A high index of clinical suspicion is essential for the proper diagnosis of rare dermatological diseases in chronic kidney disease patients. Pseudoporphyria (PP) should consider in differential diagnosis of bullous dermatoses in patients on Maintenance hemodialysis (MHD). PP is a photo-distributed bullous disorder with clinical and histologic features of porphyria cutanea tarda (PCT) but without accompanying biochemical porphyrin abnormalities. PP is a blistering disease with skin fragility and shallow scarring that clinically and histopathologically closely resembles PCT. The two conditions can be distinguished by porphyrin levels that typically are elevated in PCT, but not or only slightly in PP. PP can be induced by various medications (e.g. nonsteroidal anti-inflammatory drugs, antibiotics, diuretics, and retinoids), intense ultraviolet (A) exposure, or hemodialysis. Treatment of hemodialysis-associated PP is not yet standardized. Here, we report a case of pseudoporphyria in a patient on maintenance hemodialysis, refractory to the conventional treatment, and who subsequently underwent successful renal transplantation with full resolution of skin lesions within a month.
Bench Surgery for Urolithiasis in Renal Transplant: A Sensible Option!!
Authors: Jadaon Abhiyutthan Singh , Singh Chandra Pal
Published: December 2024

Introduction:

Renal transplantation is the wisest option for patients with end-stage renal disease. Due to less availability of organs for transplantation, professionals are compelled to use organs from expanded-criteria donors. Urolithiasis in the to be transplanted kidney of donor is considered a relative contraindication due to the complications from stone in recipients like infection leading to sepsis, urinary tract obstruction, and also loss of allograft function. Therefore management of stones is needed, prior to transplanting that kidney.

Material and Methods:

A retrospective study was undertaken to identify those living renal donors who underwent ex vivo stone removal on the bench before transplantation.

Results:

In the time period of 2021 and 2023, we carried out 208 living donor Renal transplants at different centers in Rajasthan, Delhi & Haryana, INDIA. Of these, 32(18.2%) donor kidneys had to undergo ex vivo bench surgery for the removal of the stones.

Discussion:

In our study none of the grafts undergoing stone surgery showed evidence of stone recurrence at the follow-up examination. In all recipients those underwent bench URS had kidney graft survival was 96.8% after long-term follow-up.

Conclusion:

To date, there are no definitive criteria for the surgical management of urolithiasis from living donors. In this study we report our surgical experience and long-term follow-up in a series of living kidney donors (LKD) with asymptomatic kidney stones, after ex vivo ureterorenoscopy (URS) for stone removal before kidney transplantation.
Sphingomonas paucimobilis Bloodstream Infection in a Post Liver Transplant Patient
Authors: Rajni Ekadashi , Jain Anand Kumar , Jorwal Ayushi , Mehta Naimish N.
Published: December 2024

The health-care sector has undergone remarkable progress along with experiencing challenges such as escalating antimicrobial resistance. Here, we report the successful management of Sphingomonas paucimobilis bloodstream infection in a postliver transplant patient. The objective of sharing this case report is to create the awareness regarding the possibility of this novel bug implicated in infections in the posttransplant setting. Further, it emphasizes on the utility of breakpoint to Minimum Inhibitory Concentration quotient in tailoring appropriate antibiotic therapy.
Clinical Characteristics and Outcome of Kidney Transplant Recipients Infected with COVID-19: A Retrospective Observational Study
Authors: Parry Manzoor Ahmad , Sheikh Rayees Yousuf , Qadri Raja Kaamil , Wani Muzafar Maqsood , Wani Imtiyaz , Bhat Mohammad Ashraf
Published: December 2024

Background:

This study investigated the clinical characteristics and outcomes of kidney transplant recipients (KTRs) who contracted COVID-19.

Methods:

In this retrospective study, we analyzed data from 122 KTRs confirmed to have COVID-19.

Results:

The mean age in patients with mild COVID-19 disease was 37.1 ± 9.1 years, whereas those with moderate and severe disease were 44.7 ± 13.7 and 48.1 ± 11.2 years, respectively (P = 0.02). The median neutrophil-to-lymphocyte ratio was 4.2 (interquartile range [IQR] 3.0–6.8) for mild cases, 6.5 (IQR: 5.0–10.8) for moderate cases, and 19 (IQR: 7.0–24.7) for severe cases (P = 0.008). The median C-reactive protein (CRP) levels (mg/L) were 19.5 (1QR: 5.0–156.3), 53.9 (1QR: 31.5–96.0), and 63.4 (1QR: 23.2–228) for mild, moderate, and severe cases, respectively (P = 0.006). Acute kidney injury occurred in 13.6%, 60%, and 81.57% of patients with mild, moderate, and severe cases, respectively (P = 0.004). Risk factors for a composite outcome of death and dialysis included age >50 years (odds ratio [OR]: 3.25, confidence interval [CI]: 1.25–7.7; P = 0.027), nonvaccinated status (OR 2.87, CI: 1.56–4.18; P = 0.008), graft dysfunction (OR: 2.1, CI: 1.2–5.9; P = 0.034), and CT severity index (CTSI) >13 (OR 3.3, CI: 1.5–5.9; P = 0.040).

Conclusions:

COVID-19 infection in KTRs is linked to a high mortality rate. Advanced age, lymphopenia, elevated CRP levels, and acute graft dysfunction are associated with disease severity. Age >50 years, nonvaccinated status, graft dysfunction, and a CTSI >13 are risk factors for the composite outcome of death and dialysis.
Precision medicine in cancer treatment: Revolutionizing care through proteomics, genomics, and personalized therapies
Authors: Jawdekar Riddhi , Mishra Vaishnavi , Hatgoankar Kajal , Tiwade Yugeshwari R. , Bankar Nandkishor J.
Published: December 2024

Recent developments in biotechnology have allowed us to identify unique and complicated biological traits associated with cancer. Genomic profiling through next-generation sequencing (NGS) has revolutionized cancer therapy by evaluating hundreds of genes and biomarkers in a single assay. Proteomics offers blood-based biomarkers for cancer detection, categorization, and therapy monitoring. Immune oncology and chimeric antigen receptor (CAR-T cell) therapy use the immune system to combat cancer. Personalized cancer treatment is on the rise. Although precision medicine holds great promise, its widespread application faces obstacles such as lack of agreement on nomenclature, the difficulty of classifying patients into distinct groups, the difficulties of multimorbidity, magnitude, and the need for prompt intervention. This review studies advances in the era of precision medicine for cancer treatment; the application of genomic profiling techniques, NGS, proteomics, and targeted therapy; and the challenge in the application of precision medicine and the beneficial future it holds in cancer treatment.
Breast fine-needle aspiration cytology utilizing the International Academy of Cytology Yokohama System: One-year retrospective study in a tertiary care center in Himachal Pradesh
Authors: Sarohi Monica , Mardi Kavita , Dingyon Tenzin L.
Published: December 2024

Background:

In 2016, the International Academy of Cytology (IAC) established a reporting system for breast fine-needle aspiration (FNA) cytology. This system proposed five categories in its classification: category for insufficient; category 2 for benign; category 3 for atypical, probably benign; category 4 indicating suspicious for malignancy; and category 6 for malignant.

Aims and Objectives:

The aim of the present study was to review and categorize the breast FNA samples according to the new system of reporting, to assess the risk of malignancy (ROM) for each category, and to assess the diagnostic yield of breast FNA biopsy (FNAB).

Materials and Methods:

The present retrospective study was conducted in the department of pathology, IGMC, Shimla from January 2019 to December 2019. All the samples during this period were included in the study.

Results:

A total of 405 breast cytology cases were included in the present study. The FNA findings were correlated with histopathology in 82 cases. The ROM for each category was 16.6% for insufficient, 3.7% for benign, 0% for atypical for malignancy, 100% for suspicious for malignancy, and 92.3% for malignant category.

Conclusion:

The IAC Yokohama system for reporting breast FNA cytology helps in standardizing reports and easier communication of the pathologists with treating surgeons. It offers a ROM for each category which helps during follow-up of patients. Utilizing the system in day-to-day reporting will improve diagnostic clarity and management.
Comparison of prone versus supine position for whole breast radiotherapy following breast conservation: A dosimetric study
Authors: Gopikrishna MS , Babu Geethu , Raghavan Rajeev Kavalakara , Gopalakrishnan Zhenia , Menon Sharika V. , George Preethi Sara , Mathew Beela Sarah
Published: December 2024

Background:

Long-term morbidity of breast radiotherapy, particularly due to the dose received by the heart and lungs is a cause for concern. Prone positioning for treatment has reported benefits with regard to acute and late toxicities with no detrimental effect on efficacy, especially for patients with large and pendulous breasts. This dosimetric study was aimed at assessing the dose conformity and homogeneity to a defined breast PTV and doses received by structures such as the heart, lungs, and contralateral breast using 3DCRT plans generated in supine and prone positions. The study was approved by the Institutional Review Board.

Methods:

The computed tomography (CT) image data sets of 41 consecutive women with large breasts who had undergone breast conservation surgery for pT1/T2, N0 cancer, and underwent dual CT imaging (in supine and prone positions) for planning whole breast radiotherapy were used for this comparative analysis. The various dosimetric parameters were calculated for the target volumes and organs-at-risk (OARs) and compared for both positions.

Results:

Among the 41 patients, 32 had left-sided cancer. The mean of breast PTV dose and homogeneity index were better for the prone position. The mean conformity index was comparable for both positions. The PTV V95%, V98%, and V100% of the prescribed dose were significantly better in the supine position; however, the V107% was comparable for both positions. The mean dose, V20, V12, and V5 of the ipsilateral lung were better in the prone position. The mean heart dose was comparable for both supine and prone positions. The V5 (%) of the heart was significantly lower for the prone position. The mean contralateral breast dose and low-dose radiation to normal tissue were significantly worse for the prone position. Based on individual dosimetric parameters, 26 patients had superior plans in the prone position.

Conclusion:

Prone breast radiotherapy is capable of producing improved normal tissue sparing with no detriment to target volume coverage in appropriately selected patients with large/pendulous breasts. Strict standard operating procedures with regard to simulation, planning, and treatment execution should be in place to ensure accuracy and daily reproducibility to achieve maximum benefit from this labor-intensive process.
Application of 3D printing technology in brachytherapy
Authors: Natanasabapathi Gopishankar , Saini Surendra K. , Mittal Apoorva , Dhanabalan R , Subramani V , Sharma Daya Nand
Published: December 2024

Brachytherapy (BT) is an extensively used treatment modality for cancer in many sites in the body. In this treatment method, small radioactive sources are localized proximal to cancerous tumors. The commercially available applicators, templates, etc., used for tumor localization and targeting in BT have standard sizes and dimensions. Besides this, researchers are now focusing on achieving more accuracy in BT. This goal can be accomplished through 3D printing technology, also known as “additive manufacturing” (AM) or rapid prototyping, which has rapidly evolved in numerous applications. The 3D printing technology has enormous potential to perform personalized BT products and has enormous scope to improve clinical outcomes while lowering the risk of radiation-induced toxicity by growing recognition of precision medicine. In this review, the authors summarize the application of 3D printing in BT, and the challenges in developing a practical system are discussed.
Development of absolute dosimeter for standardization of low-energy synchrotron radiation and establishing of diagnostic X-ray beam qualities
Authors: Kumar Sudhir , Chaudhary Rahul Kumar , Sharma Sunil Dutt , Sapra Balvinder Kaur
Published: December 2024

Purpose:

Low energy X-rays from synchrotron radiation (SR) and X-ray generators are used for diagnostic imaging procedures. The dosimetry of low energy X-rays is challenging. For these types of radiations, the free-air ionization chamber (FAIC) is considered as the primary standard for absolute determination of air-kerma, which is an important quantity for the patient dose during diagnostic radiology investigation.

Materials and Methods:

To fulfil above requirement, a miniature parallel-plate FAIC (FAICSR) and portable parallel-plate FAIC (FAICDIAG) were designed and fabricated as the absolute dosimeter for standardization of SR beams and for establishing diagnostic X-rays beam qualities, RQR series respectively. Experiments were performed in SR beams (8-25 keV) as well as in diagnostic X-ray beams of 40, 50, 60, 70, 81, 90, 100 KVp for evaluating the basic characteristics of these chambers.

Results:

The basic characteristics of these chambers were in conformity with International Atomic Energy Agency (IAEA) TRS-374 and International Electrotechnical Commission (IEC) 61674, 60731. Dosimetric beam quality parameters such as the first half-value layer and homogeneity coefficient of the RQR series, measured using FAICDIAG are within the acceptable limits specified by IEC 61267 and IAEA TRS-457. The RQR series (RQR 2 to RQR 8) are established as per IAEA TRS-457 specifications.

Conclusions:

The performance of the indegeneously developed FAICs was found satisfactory as per design and expectation and they qualify as absolute dosimeters for measurement of air-kerma of low energy regions and for direct calibration of field dosimeters and quality assurance test tools used for performance evaluation of diagnostic X-ray machines in the radiology department.
Isolated central nervous system blast transformation in chronic myeloid leukemia on first-line dasatinib
Authors: Kaur Harpreet , Singh Suvir , Goel Sahil , Jain Kunal , Narang Vikram , Puri Sandeep
Published: December 2024

Extramedullary blast proliferation is one of the qualifying criteria to diagnose blast phase chronic myeloid leukemia and is usually noted along with progressive disease in the marrow. Although the incidence of blast transformation has significantly reduced with better drug therapy, rare cases of isolated extramedullary blast transformation in the central nervous system have been reported in patients on imatinib, largely owing to reduced central nervous system (CNS) penetration of the drug. We present a rare patient with isolated blast transformation in the CNS on first-line dasatinib and provide a review of possible mechanisms and further therapy for the same.
A retrospective analysis of unusual metastasis from carcinoma oesophagus to subcutaneous tissue
Authors: Singhal Saloni , Kesharwani Pragati , Kumar Amresh , Lodi Ashar I. , Bhandari Virendra
Published: December 2024

Introduction:

Oesophageal carcinoma is the ninth most common cancer worldwide. Skin and subcutaneous soft tissue are rare sites of metastases, constituting only 1% of sites of distant metastases. The location of subcutaneous metastasis from oesophageal carcinoma is variable.

Material and Method:

This is a single-institutional retrospective study done over 10 years. 798 patients with carcinoma oesophagus reported to our department over 10 years and distance metastasis was seen in 32% of the total treated patients.

Results:

The incidence of subcutaneous metastasis of all treated cases in our institution over a decade is one case per 1,000 people year. The site of subcutaneous metastasis varied widely from common sites like the chest wall, back, and abdomen to rare sites like the nose, axillary region, scalp, and great toe. None of the patients survived more than a year after development of subcutaneous metastasis and the median overall survival recorded was five months.

Discussion:

In a large cohort of 838 patients with oesophageal cancer done by LE Quint et al., approximately 20% of the patients showed distant metastasis, with a significantly lower rate of 1% for metastatic lesions involving the skin and the liver and lungs being the most common. Since the incidence of subcutaneous metastasis in carcinoma oesophagus is rarely seen, and we got the incidence of 1% as well.

Conclusion:

Subcutaneously are most likely missed if the patient is not being examined thoroughly. Only after the histopathological or cytological confirmation was the diagnosis of subcutaneous metastasis in our patients made.
Hepatoid adenocarcinoma of gallbladder, an unusual presentation of a rare entity
Authors: Jain Niharika , Suman Swapnil , Goyal Surbhi , Singh Chandra B. , Sakhuja Puja
Published: December 2024

Hepatoid adenocarcinoma is an extrahepatic adenocarcinoma with morphological and/or functional evidence of hepatocellular differentiation. Hepatoid adenocarcinoma of the gallbladder is extremely rare with very few case reports in the literature. It is both challenging and crucial to differentiate hepatoid adenocarcinoma presenting with liver metastasis from hepatocellular carcinoma and hepatoid yolk sac tumor. We are reporting an unusual presentation of a huge alpha-fetoprotein producing hepatoid adenocarcinoma of 20 cm × 20 cm, confined within the gallbladder, which did not show any local invasion or nodal metastases, contrary to the previous reports. It is important to recognize this variant because of its aggressive behavior and propensity for early widespread metastasis. Accurate diagnosis is crucial for deciding adjuvant treatment options and predicting patient prognosis.
Isolated scapular metastasis of rectal cancer: Report of a case
Authors: Ozsoy Mehmet S. , Baysal Hakan , Beyazadam Damla , Eren Tunc , Ozkan Korhan , Alimoglu Orhan
Published: December 2024

Colorectal cancer is estimated to be the third most diagnosed cancer and the second most common cause of cancer death worldwide. Although the liver and lungs are the most common sites of metastatic spread of colorectal carcinoma, other locations of metastasis have been reported, such as the skin, bone, muscle, brain, and thyroid gland. We aimed to present a 54-year-old woman diagnosed with isolated scapula metastasis of rectal cancer who received multidisciplinary treatment.
Coinfection of Hepatitis B and C Viruses and Risk of Hepatocellular Carcinoma: Systematic Review and Meta-analysis
Authors: Awadh Abdullah A. , Alharthi Abdulrahman A. , Alghamdi Basil A. , Alghamdi Seraj T. , Baqays Mohammed K. , Binrabaa Ibrahim S. , Malli Israa A.
Published: December 2024

Introduction:

Hepatitis B and C are viral infections causing chronic liver inflammation and, when left untreated, lead to cirrhosis and a risk for hepatocellular carcinoma, the most common type of primary liver cancer with high mortality. The hepatitis B virus-hepatitis C virus (HBV-HCV) coinfection leads to a faster progression to advanced liver diseases and higher hepatocellular carcinoma (HCC) risk than monoinfection. Unlike the relative risk for HCC due to either HBV or HCV, no recent analysis of the risk for HBV-HCV coinfection exists.

Methods:

Based on PRISMA recommendations and guidelines, we developed a search strategy by combining the keywords (“hepatitis B”) and (“hepatitis C”) and (“hepatocellular carcinoma” or “liver cancer”). First, we performed a title and abstract screening and, later, a full-text screening. We extracted the demographic characteristics, such as gender, age, study design, sample size, country, and biomarkers of hepatitis B surface antigen (HBsAg), HBV DNA, HBeAg, anti-HCV, and HCV RNA. The data were assessed for quality, and the Review Manager software was used for the meta-analysis.

Results:

We included 63 studies. The pooled analysis showed that the risk of HCC was significantly higher in the case-cohort who were positive for HBsAg (odds ratio [OR] = 9.70 [3.75, 25.12], P = 0.0001), HBV DNA or HBeAg (OR = 22.77 [10.00, 51.88], P = 0.0001), HBV and HCV coinfection (OR = 46.07 [26.33, 80.60], P = 0.0001) than the control cohort.

Conclusion:

Chronic HBV and HCV infections are major risk factors for HCC, and their coinfection was significantly associated with an increased risk of HCC than monoinfection.
IgM against Merozoite Surface Protein 1-Block 2 Haplotypes as New Tools for Plasmodium vivax Infections
Authors: Batalha Fernanda de Almeida , da Silva Elizangela Farias , Serra Paula Taquita , dos Santos Rafaella Oliveira , Salimo Zeca Manuel , Chaves Yury de Oliveira , Fagundes Mirian Ívens , Feuser Paulo Emílio , de Souza Victor Costa , Naveca Felipe Gomes , de Ávila Ricardo A. Machado , Nogueira Paulo Afonso
Published: December 2024

Introduction:

The tools to distinguish relapse from reinfection are needed in malaria-endemic areas. We evaluated seroprevalence against sets of specific peptides to the block 2 region of Plasmodium vivax-merozoite surface protein-1 (PvMSP1) to detect parasite clones.

Methods:

We applied amplicon deep sequencing (ADS) of block 2 region of the MSP-1 gene (pvmsp1) to determine cocirculating parasite clones within eight P. vivax-infected individuals. Based on this, a seroprevalence of IgM and IgG antibodies against sets of peptides of different block-2 haplotypes was validated. After, we evaluated the seroprevalence in plasma of 72 pregnant women, from which 31 had recurrent P. vivax infections.

Results:

ADS revealed one block 2 haplotype clone infecting five of eight P. vivax-infected individuals. In all, IgM antibodies, not IgG, recognized only a set of peptides specific to the block 2 haplotype determined by ADS. In the other three patients, ADS determined three concurrent block 2 haplotype clones, among whom there was always one haplotype that predominated with more than 95% of high-quality reads and two other smaller haplotypes with up to 5% and the least was <1%. We observed higher IgM levels against haplotype-specific peptides corresponding to the predominant clone. The seroprevalence of pregnant women showed that anti-haplotype-specific IgM detected coinfection with parasite clones per pregnant woman and we also observed levels of anti-haplotype-specific IgM in primary infection increased in some recurrent episodes.

Conclusion:

IgM against sets of peptides specific to different pvmsp1 haplotypes may be employed as a serological marker for parasite clones in vivax malaria.
Nocardiosis in Renal Allograft Recipients
Authors: Rajesh Chilaka , Thomas Athul , Eapen Jeethu Joseph , Yusuf Sabina , John Elenjickal Elias , Valson Anna T. , Alexander Suceena , David Vinoi George , Michael Joy Sarojini , Varughese Santosh
Published: December 2024

Introduction:

The aim of the study was to study the clinical profile and outcomes of nocardiosis in renal allograft recipients.

Methods:

This was a retrospective study of clinical outcomes in consecutive renal allograft recipients with Nocardia infection over a 22-year period (2000–2022) from a tertiary care center in Southern India. The clinical data were obtained from electronic medical records and patient files.

Results:

A total of 1970 patients underwent renal transplantation at Christian Medical College, Vellore, India, between January 1, 2000, and December 31, 2022. During this period, 26 patients were diagnosed to have Nocardia infection. Half (50%) of the patients had fever and cough as their initial presentation, 7 (26.9%) patients presented with cutaneous abscesses, 2 (7.6%) patients were incidentally detected to have lung nodules during routine follow-up, 2 (7.6%) patients presented with headache accompanied by fever, and 3.8% had graft abscess. The diagnosis was made by isolating the organism in culture from one or more of the following samples: sputum, blood, pus, or lung biopsy (either computed tomography [CT]-guided or bronchoscopic aspirate culture). Eight patients required bronchoscopy and two patients required CT-guided biopsy for obtaining samples for diagnosis. All patients were similarly managed initially with a reduction of immunosuppression and appropriate antibiotics as per culture sensitivity. All 26 patients responded to induction treatment with meropenem (or imipenem) and trimethoprim–sulfamethoxazole (co-trimoxazole) followed by maintenance treatment with co-trimoxazole. Five (19.2%) out of 26 patients received Minocycline in induction and maintenance treatment regimens as in four patients isolates were resistant and one patient had allergic reaction to Cotrimoxazole. All patients had stable graft function. Two patients succumbed after 2 months of diagnosis with Gram-negative sepsis.

Conclusions:

At present, there exists no single serological test to diagnose Nocardia infection in patients. Multiple initially obtained cultures may be negative because of the slow growth of the organism and variable colony morphology. Hence, infected specimens should be obtained by aggressive approaches if the index of suspicion is high. Procedures such as bronchoscopic lavage and aspiration of abscess are invaluable toward making a diagnosis. In our study, eight patients required invasive diagnostic procedures such as bronchoalveolar lavage and CT-guided lung biopsy since initial Gram stain and sputum culture were negative. In conclusion, it is crucial to maintain a high level of suspicion and conduct thorough investigations among post renal transplant recipients. This approach facilitates early diagnosis, prompt initiation of appropriate treatment which helps prevent the spread of disease.
Feeding Outcomes in Tracheostomy-Dependent Children with Bronchopulmonary Dysplasia
Authors: Sher Ada C. , Shamim Humra , Stack Jacob T. , Maynard Jemma , Kistler Isaac , McNutt Megan , Afreen Hajera , Manning Amy , Hanin Melissa , Kielt Matthew J. , Miller Audrey , Pattisapu Prasanth , Chiang Tendy
Published: December 2024

Objective(s):

Bronchopulmonary dysplasia (BPD) is a chronic lung disease affecting premature infants. Tracheostomy is performed in infants with BPD who are unable to wean from ventilator support. Prior studies have highlighted delayed oral feeding in BPD but have excluded patients with tracheostomy. This study aims to characterize long-term feeding outcomes in this group of patients.

Materials and Methods:

This is a single-institution retrospective cohort study of infants diagnosed with BPD who underwent tracheostomy during their birth hospitalization admission between January 2016 and December 2022. Surviving patients were followed-up for at least 2 years. Data were obtained from hospital, clinic, and feeding therapy encounters.

Results:

A total of 71 patients were included in this study, and tracheostomy was performed at a median age of 55.6 weeks post-menstrual age (PMA). The overall mortality was 31% (n = 22); 25% of which occurred prior to discharge (n = 18/71). The first oral feed occurred at a median 66 weeks PMA, and 31% of patients achieved full oral feeds at a median age of 3.2 years PMA. Successful achievement of full oral feeds was associated with younger age at tracheostomy/gastrostomy placement and less severe BPD.

Conclusions:

Patients with BPD and tracheostomy have multiple risk factors for poor feeding progression. When compared to data on feeding in BPD or tracheostomy infants alone, oral feeding milestones were found to be delayed. Future studies are needed to understand the optimal timing of tracheostomy in infants with BPD. Providers should manage family expectations of oral feeding progression following tracheostomy.

Level of Evidence:

3.
Neutrophil-to-Lymphocyte Ratio as a Predictor of Outcome in Pediatric Traumatic Brain Injury: A Systematic Review
Authors: Chanchlani Roshan , Sharma Pramod K. , Sukumar Mondithoka , Ahmad Reyaz , Thanneeru Suresh K. , Sahoo Anjan K. , Rajavadivel K.R. , Agrawal Amit
Published: December 2024

Abstract

Traumatic brain injury (TBI) is a significant concern in children, with various prognostic methods used, including the neutrophil-to-lymphocyte ratio (NLR). While studies in adults show the usefulness of NLR, limited data exists for children. Physiological differences in pediatric TBI may render adult criteria inapplicable. This systematic review aims to collect evidence from articles on NLR use in pediatric TBI, addressing knowledge gaps and providing insights specific to children. To gather and synthesize information on the use of NLR in prognosticating pediatric brain injuries. Following PRISMA guidelines, we conducted a systematic literature search across PubMed, SCOPUS, Cochrane Library, and ScienceDirect to identify relevant studies on the NLR in pediatric TBI for prognostication. Inclusion criteria comprised randomized controlled trials, prospective, and retrospective studies, while exclusion criteria ruled out case series, reports, editorials, comments, animal studies, and non-English literature. Extracted details included study characteristics, NLR measurement methods, inclusion/exclusion criteria, outcomes, and correlations. Bias was assessed using the revised JBI critical appraisal tool in alignment with study characteristics. This systematic review initially included 20 studies, narrowed down to 7 for qualitative synthesis. Spanning from 2020 to 2023, these studies involved 1462 pediatric patients under 18 years. NLR measurements and outcomes varied across the studies (e.g., GOS, GOS-E peds, GCS, PTA, CT, and PCPCS). Due to variability in reporting and NLR collection times, meta-analysis was not feasible. Individual studies demonstrated NLR correlations with diverse outcomes, and all seven studies had a low risk of bias in quality assessment. NLR shows promise as a predictive marker for pediatric TBI outcomes, but the limited literature with methodological variations underscores the need for prospective studies with standardized protocols. Caution is advised in interpreting NLR values until validated through rigorous research methodologies.
Radiological characterization of water of rivers and lakes in the Mounana region in South-Eastern Gabon
Authors: Mouandza Sylvere Yannick Loemba , Meye Philippe Ondo , Ndong Wilfried , Ndjembidouma Beaud Conrad Mabika , Mombo Evaldie-Dominique Durastanti-Rabenga , Ekogo Thierry Blanchard , Ben-Bolie Germain Hubert
Published: December 2024

The aim of this study, which is one of the few studies undertaken in this region in Gabon, was to determine the radioactivity levels in various lakes and rivers in the Mounana region by measuring the activity concentrations of alpha- and beta-emitter radionuclides. For this purpose, gross alpha (α)-beta (β) counting was carried out using a Canberra Tenelec Gas flow counter detector. From the samples collected, about 18% and 36% contained higher grossα-activity and higher grossβ-activity compared to the World Health Organization (WHO) guideline limits of 0.5 Bq l−1and 1 Bq l−1, respectively. It was also observed that 18% of the samples collected contained both gross α-and β-activities higher than the WHO guideline limits. The gross α-activity concentrations measured ranged between 0.026 ± 0.003 Bq l−1 and 1.602 ± 0.012 Bq l−1 while the gross β-activity concentrations measured ranged between 0.15 ± 0.01 Bq l−1 and 3.00 ± 0.04 Bq l−1. Given that these waters are used by the population living in Mounana for the domestic purposes, a few may be exposed to the low levels of internal radiation but below the permissible levels of 1 mSv per annum.
Probable maximum precipitation for a coastal site of Tarapur, Maharashtra, India, using intensity–duration–frequency curves
Authors: Kumar D. Satish , Behera Manasa Ranjan , Nadella Saikrishna , Kumar A. Vinod
Published: December 2024

Probable maximum precipitation (PMP) for Tarapur, a coastal industrial area, has been assessed by developing intensity–duration–frequency (IDF) curves using Atomic Energy Regulatory Board recommended probabilistic methods. The analysis identified Fréchet distribution as the best fit according to goodness of fit tests; however, its heavy-tailed nature led to implausible PMP estimates when compared with similar studies. Consequently, the Gumbel distribution, with parameters estimated using the least squares method, was selected as a more appropriate model for extreme rainfall events. The study also identified the most optimal plotting position formulations (PPFs) for the considered meterorological parameter. The Hazen PPF was identified to be better, for the considered rainfall data and was used to determine the PMP estimates for different storm durations. The distribution parameters were applied to yield the PMP estimates for 100, 1000, and 10000-year return period across all durations. The PMP presented as IDF charts prepared for this site, will be useful for modeling runoff characteristics and determining maximum water levels.
Evaluation and assessments of efficiency calibration and resolution of an alpha spectrometry system using standard sources
Authors: Bramha Satyanarayan , Chandrasekaran S.
Published: December 2024

Studies and evaluations of the detector characteristics of a high-resolution multichamber alpha spectrometer and its calibration using certified mixed standard sources of 239Pu, 241Am, and 244Cm for measuring alpha-emitting radionuclides dedicated to environmental samples. The efficiency and resolution were evaluated for each potential distance between the source and the detector across all four solid-state ORTEC-ULTRA AS detectors. The results obtained from the characteristics performance of the alpha from the standard alpha sources are described in detail in the paper, and also a case study for the environmental application shows very good recovery using the alpha spectrometer.
Role of self-efficacy in dealing with patients with alcohol dependence syndrome
Authors: Nongtdu Treiadalang , Elukapally Omesh Kumar , Rao Sireesha Srinivas , Usha L.V.R. , Boosa Raghuveer Raju
Published: December 2024

Background:

Self-efficacy plays a very important role in maintaining abstinence as well as predicting response to treatment in patients with alcohol dependence syndrome.

Aims:

The aim of the study was to assess and compare the level of self-efficacy among relapsed and abstinent patients with alcohol dependence syndrome.

Materials and Methods:

A cross-sectional study was conducted on patients with alcohol dependence syndrome recruited from the deaddiction ward of a tertiary care hospital who had relapsed (n = 50) and compared with abstinent (n = 50) on treatment with anticraving agents. All study subjects of both groups were assessed for self-efficacy using the Alcohol Abstinence Self-Efficacy Scale (AASES) – Confidence not to drink and AASES – Temptation to drink subscales.

Results:

Mean total scores of confidences not to drink subscale of the self-efficacy scale were higher in the abstinence group (43.86) than relapse group (37.24) (P = 0.01). In the temptation to drink subscale, mean total scores were higher for the relapse group (41.08) than the abstinent group (36.7) (P = 0.09).

Conclusion:

These findings indicate that self-efficacy had a significant effect on abstinence in persons with alcohol dependence syndrome.