bluuebunny/crossref_metadata_2025 huggingface dataset:
Role of Growth Hormone Therapy in Metabolic-Dysfunction-Associated Steatotic Liver Disease: A Systematic Review and Meta-Analysis
Authors: Dutta Deep , Nagendra Lakshmi , Mohindra Ritin , Bhattacharya Saptarshi , Joshi Ameya , Kamrul-Hasan ABM
Published: August 2024

Multiple observation studies and meta-analysis have linked growth hormone (GH) deficiency with metabolic-dysfunction-associated steatotic liver disease (MASLD). No meta-analysis has analysed the efficacy and safety of GH therapy on different aspects of MASLD. We undertook this meta-analysis to address this gap in knowledge. Electronic databases were searched for RCTs involving patients with MASLD receiving GH therapy. Primary outcome was to evaluate changes in radiologic measures of MASLD (magnetic resonance spectroscopy (MRS) and ultrasonography) and liver enzymes. Secondary outcomes were to evaluate alterations in body composition parameters [dual-energy X-ray absorptiometry (DXA)], lipids, glycaemia and side effects. From initially searched 1047 articles, data from three RCTs (120 patients) which fulfilled all criteria were analysed. After 6 months of GH therapy in MASLD, the per cent reduction in intrahepatic lipid (MRS) was significantly higher with GH as compared to placebo [MD -5.85% (95%CI:-11.41– -0.30); P = 0.04; I2 = 63%]. Visceral adipose tissue (VAT) area reduction (DXA) was significantly higher with GH [MD-9.94 cm2 (95%CI:-19.04– -0.84); P = 0.03; I2 = 0%]. Serum insulin-like growth factor-1 (IGF-1) was significantly raised in MASLD patients receiving GH as compared to placebo [MD +166.86 ng/ml (95%CI: 79.19–254.53); P < 0.0.001; I2 = 90%]. High-sensitivity C-reactive protein (hsCRP) was significantly lower in patients receiving GH [MD -0.89 mg/L (95%CI:-1.40–-0.38); P = 0.0.0006; I2 = 0%]. Patients receiving GH had similar changes in triglycerides [MD-1.06 mg/L (95%CI:-20.45–18.34); P = 0.91; I2 = 15%] and fasting glucose [MD -0.56 mg/L (95%CI:-4.67–3.55); P = 0.79; I2 = 39%]. Gamma-glutamyl transpeptidase was significantly lower in patients receiving GH [MD -7.86 U/L (95%CI:-12.46–-3.27); P = 0.0008; I2 = 0%]. No increase in new-onset hypothyroidism was noted [OR 5.49 (95%CI: 0.25–121.18); P = 0.28]. Short-term 6-month GH therapy in MASLD is associated with a significant reduction in intrahepatic lipid content, visceral adiposity, GGT and hsCRP without any increased occurrence of dysglycaemia or hypothyroidism.
Circulating C-Terminal Agrin Fragment
Authors: Racha Pranathi , Selvam Sumithra , Bose Beena , Bantwal Ganapathi , Sambashivaiah Sucharita
Published: August 2024

Background:

Undetected onset of sarcopenia among individuals with chronic diseases especially Type 2 Diabetes Mellitus (T2D) makes it important to be evaluated. The feasibility of diagnosing sarcopenia in a clinical setup might be a difficult task. Circulating markers including C-terminal agrin fragment (CAF) are emerging as an alternative. Hence, the objectives of the study were to compare circulating CAF levels between T2D, prediabetes (PD) and healthy controls and to study its association with sarcopenic index, muscle mass, strength and quality.

Methods:

Ninety-nine participants (n = 42, T2D; n = 33, PD; n = 24, healthy controls) aged 18 to 60 yrs were recruited. HOMA (homeostatic model assessment) indices were derived using plasma glucose and insulin. All participants underwent lipid profiling, muscle strength including quality (isokinetic dynamometer), body composition (Dual energy X-ray Absorptiometry (DXA)) and sarcopenic index (appendicular skeletal muscle mass/body weight) assessment. Serum samples were used to estimate CAF levelsusing enzyme-linked immunosorbent assay (ELISA).

Results:

Median CAF level was significantly higher among T2D group compared to PD and control groups (P < 0.0001). Circulating CAF levels correlated positively with age and glycated haemoglobin (HbA1c) (both, P < 0.001) and negatively with HOMA-B and muscle quality (both, P < 0.001), and sarcopenic index (P = 0.07). Multivariable analysis demonstrated that the odds of being in the highest tertile category was 7.67, 95% C.I. (2.10, 29.3) among T2D.

Conclusion:

Circulating CAF levels were significantly higher among T2D compared to PD and control study groups along with reduced skeletal muscle quality. This suggests that the circulating CAF level has the potential to be considered as a clinical marker to evaluate sarcopenia among T2D.
Prevalence and Clinical Course of Water and Electrolyte Disturbances Following Transsphenoidal Pituitary Adenoma Surgery in Immediate and Early Postoperative Period: A Prospective Observational Study
Authors: Bhardwaj Shivendu , Jaiswal Awadhesh K. , Yadav Subhash C. , Gupta Devendra , Yadav Rajanikant , Singh Alok P. , Bhatia Eesh
Published: August 2024

Introduction:

Transsphenoidal pituitary adenoma surgery (TSS) was commonly associated with water and electrolyte disturbances (WEDs) in the postoperative period, which could lead to prolonged hospital stay, readmission and is rarely life threatening. The present study aimed to investigate the prevalence and predictive factors of WEDs following TSS.

Methods:

Fifty-eight patients with pituitary adenoma were prospectively studied for the occurrence of WEDs. Patients were checked at 6 weeks postoperatively for persistence of diabetes insipidus and new-onset hormone deficiencies or recovery. Multivariate regression was applied to determine predictive factors for the occurrence of WEDs.

Results:

A total of 58 patients underwent TSS (median age: 43 years, 66% male). In the immediate postoperative period, 16 (27.6%) had transient diabetes insipidus (DI), two (3%) had transient DI followed by syndrome of inappropriate antidiuretic hormone (SIADH), five (8.6%) had isolated SIADH, five (8.6%) had persistent DI and only one patient had a triple-phase response. At 6 weeks, five (11%) patients continued to have persistent DI. In multivariate analysis, apoplexy and duration of surgery were predictive of DI occurrence. Recovery rate at 6 weeks was 11.1%, 13% and 9.3% for cortisol, thyroid and gonad axis, respectively. New-onset hormone deficiencies at 6 weeks were 5.6%, 5.6% and 7.4% for cortisol, thyroid and gonad axis, respectively.

Conclusions:

WEDs remain an important concern post-TSS. Timely follow-up should always be integral part of postoperative care for early diagnosis of new hormone deficiencies and avoiding unnecessary treatment in those with recovered axis.
Trends in Presentation and Management of Endogenous Hyperinsulinaemic Hypoglycaemia Over the Last Three Decades at a Tertiary Care Centre (1992–2022)
Authors: Gupta Setu , Goyal Alpesh , Kandasamy Devasenathipathy , Agarwal Shipra , Damle Nishikant , Pal Sujoy , Tandon Nikhil , Jyotsna Viveka P.
Published: August 2024

Introduction:

Endogenous hyperinsulinaemic hypoglycaemia (EHH) is characterized by inappropriate insulin secretion from pancreatic beta cells despite low blood glucose concentrations. We aimed to evaluate the secular changes in presentation and management of EHH due to insulinoma/non-insulinoma pancreatogenous hypoglycaemia syndrome (NIPHS) at our centre.

Methods:

This was a single-centre ambispective study (2014–2022). The clinical, biochemical, hormonal and radiological parameters (n = 63) collected as part of this study were compared with our earlier studies (1992–2005, n = 31; and 2006–2013, n = 35) and with other centres across the world.

Results:

A total of 63 patients (39 males) with a preoperative diagnosis of EHH (insulinoma, n = 58; and NIPHS, n = 5) and a mean age of 40.7 years were studied. The mean lag time from the onset of symptoms to diagnosis decreased from 4.6 years during the first study period to 1.9 years during this study period. However, the majority presented with fasting hypoglycaemia of 98.4%, and both fasting and postprandial hypoglycaemia of 32%. Exclusive postprandial hypoglycaemia was present in 1.7% of insulinoma. A histopathological diagnosis of insulinoma was made in 52 patients and nesidioblastosis in two patients. Intraoperative ultrasonography (IOUS) and intraoperative palpation (IOP) yielded 100% sensitivity, while endoscopic ultrasonography (EUS) and 68Ga-DOTA-Exendin-4 positron emission tomography/computed tomography (PET/CT) yielded sensitivity of 86% and 85%, respectively, for localizing insulinoma. Resolution of hypoglycaemia was noted in 53 of 57 (93%) patients who underwent surgery with a preoperative diagnosis of insulinoma.

Conclusion:

We observed a trend towards earlier diagnosis of EHH, increased patient numbers and availability of nuclear imaging techniques for preoperative localization in the last decade compared to earlier.
Primary treatment failure in acute retinal necrosis – A comprehensive review
Authors: Kawali Ankush , Khanum Aayesha , Mishra Sai B , Sanjay Srinivasan , Mahendradas Padmamalini
Published: August 2024

Acute retinal necrosis (ARN) is a sight-threatening ophthalmic emergency that requires aggressive treatment to prevent irreversible vision loss. However, primary treatment failure (PTF), where the initial antiviral therapy is ineffective, is a common challenge in ARN management. This comprehensive review examines PTF in ARN, drawing insights from a systematic literature search spanning 1997 to 2022, which identified 35 relevant cases from 23 reports. The analysis focuses on drug resistance patterns, alternative antiviral agents, combination therapies, and emerging treatments. Potential causes of drug resistance, including host factors, viral mutations, and drug-related considerations, are elucidated. Alternative agents such as foscarnet, cidofovir, and brivudine, as well as combination approaches involving systemic and intravitreal administration, high-dose therapy, judicious use of steroids, and potential treatment-related complications, are discussed. The review also highlights emerging therapies, including vaccines, monoclonal antibodies, and natural compounds, offering insights into future directions for addressing this challenging condition.
Descemet’s membrane detachment: An updated comprehensive review of etiopathogenesis, diagnosis, and management
Authors: Beniwal Abhijeet , Vanathi Murugesan , Venugopal Anitha , Chaurasia Sunita , Tandon Radhika
Published: August 2024

The Descemet membrane (DM) is the basement membrane of corneal endothelial cells, which are responsible for maintaining corneal transparency. DM detachment (DMD) can occur due to various reasons, with the most common etiology being post-surgical. Older age, blunt instruments, and faulty surgical technique predispose to the intraoperative or postoperative occurrence of DMD, and one should have a high index of suspicion for DMD in cases with unexplained or an atypical pattern of corneal edema after surgery. Prompt intervention for DMD management is imperative to effect early visual rehabilitation, decrease corneal morbidity, and avoid permanent damage leading to scarring of the cornea. Various classifications of DMD and management protocols have been described. Anterior-segment optical coherence tomography (AS-OCT) imaging is the most effective imaging to detect DMD and quantify its extent. Desmetopexy with air/gas is the initial treatment of choice and could be aided by suture fixation. Non-responsive cases might need endothelial keratoplasty.
Comprehensive insights into heart failure with mildly reduced ejection fraction: A critical review
Authors: Ezhumalai Babu
Published: August 2024

This review explores the enigmatic heart failure (HF) subtype known as HF with mildly reduced ejection fraction (HFmrEF), which constitutes a significant percentage of HF cases yet remains inadequately understood. Characterized by an ejection fraction (EF) between 41% and 49%, HFmrEF poses unique challenges in diagnosis and treatment due to its intermediary nature between HF with reduced EF (HFrEF) and HF with preserved EF (HFpEF). Epidemiological data reveal variable prevalence rates influenced by demographic and regional factors, with a higher incidence associated with aging and cardiovascular comorbidities such as hypertension and diabetes. Pathophysiological insights suggest a blend of systolic and diastolic dysfunction, myocardial fibrosis, and inflammatory processes that differentiate HFmrEF from other HF categories. Diagnostic approaches currently rely on echocardiography and biomarkers such as N-terminal pro-brain natriuretic peptide, but there is a need for more precise tools. Treatment largely extrapolates from HFrEF and HFpEF protocols, yet specific evidence for HFmrEF is sparse, underscoring the necessity for targeted clinical trials. Patient outcomes, falling between those of HFrEF and HFpEF, further highlight the need for individualized management strategies. This review underscores the urgency of dedicated research to refine diagnostic criteria, optimize therapeutic regimens, and ultimately improve patient care for those with HFmrEF. Future research must focus on tailored treatments, pathophysiological clarity, and identifying specific biomarkers to advance our understanding and management of this complex condition.
Management of high thrombus burden during primary percutaneous coronary intervention
Authors: Kumar Akhilesh , Bhandari Suman
Published: August 2024

Managing high thrombus burden during primary percutaneous coronary intervention (PCI) poses significant challenges and is associated with increased procedural complications and adverse clinical outcomes. This abstract reviews current strategies and controversies surrounding the treatment of high thrombus burden in patients undergoing PCI. It discusses pharmacological approaches such as potent antiplatelet agents, glycoprotein IIb/IIIa inhibitors, and novel antithrombotic therapies, alongside mechanical strategies including thrombus aspiration and balloon angioplasty. The importance of individualized treatment based on clinical presentation, thrombus characteristics, and procedural factors is emphasized. Clinical trials and guidelines are reviewed to provide evidence-based recommendations for optimizing outcomes in this complex patient population. Future directions in research and technology aimed at further refining management strategies are also explored.
Simultaneous alcohol septal ablation and intravascular imaging-guided percutaneous transluminal coronary angioplasty – An effective approach in patients with hypertrophic obstructive cardiomyopathy and critical coronary artery disease
Authors: Mastebhakti Bhavana , Mustaqueem Arif , Bhandari Suman
Published: August 2024

We report a case of symptomatic hypertrophic obstructive cardiomyopathy refractory to medical management with a left ventricular outflow tract pressure gradient (LVOTPG) of 160 mmHg associated with a significant calcific coronary artery disease treated using simultaneous percutaneous transluminal septal myocardial ablation (PTSMA) and an intravascular imaging-guided percutaneous transluminal coronary angioplasty. The left anterior descending artery stenosis distal to the third septal perforator was stented using a drug-eluting stent under optical coherence tomography guidance. Subsequently, the LVOTPG was addressed using PTMSA. Following the procedure, the patient had an uncomplicated recovery. A follow-up echo revealed an LVOTPG of 15 mmHg 4 weeks later.
Primary aldosteronism: An underdiagnosed clinical entity
Authors: Jain Peeyush , Kaushik Atul , Dey Nilashish , Mehta Ashwani , Kapoor Shaloo , Agrawal Chhavi
Published: August 2024

Primary aldosteronism (PA) is a group of disorders characterized by excessive and autonomous aldosterone secretion by one or both adrenal glands leading to hypertension. Thought to be rare, 5%–13% of the hypertensive patients are found to have PA by systematic screening. There is also a long delay in diagnosis, which may account for high rates of the long-term complications. PA is most commonly caused by bilateral adrenal hyperplasia, followed by an aldosterone-producing adrenal adenoma. Aldosterone-producing adrenal cortical lesions are due to the mutations in various genes encoding membrane-bound ion channels. Some forms of the familial hyperaldosteronism have also been linked to germline mutations. Inappropriate secretion of aldosterone results in hypertension, hypokalemia, and metabolic alkalosis. Hypokalemia is not a must for considering the diagnosis. It is important to detect PA because not only it is a potentially curable cause of hypertension but also patients with PA have a higher prevalence of cardiovascular morbidity and mortality compared with essential hypertension. This article is an account of screening, confirmation, and management strategies of this underdiagnosed clinical entity for the practicing clinicians.
Primary transitional cell carcinoma of the endometrium: Case report of a rare tumor
Authors: Khan Adil A. , Behera Rakesh , Ahuja Sana , Ahluwalia Charanjeet
Published: August 2024

Primary transitional cell carcinoma of endometrium or an endometrial carcinoma with an extensive transitional cell differentiation is an extremely rare entity and always poses a diagnostic and therapeutic challenge to clinicians and pathologists. We present a 70-year-old lady who presented with postmenopausal bleeding. Grossly, a gray white tumor was identified in the fundus region of the uterus and was invading >50% into the myometrium. Histopathological sections examined from the tumor showed a highly cellular tumor arranged in nests and tightly packed papillary structures with thin fibrovascular cores covered by multilayered polygonal cells. On immunohistochemistry, the tumor cells were positive for CK7, ER, vimentin, and focally positive for p16. The present case was reported to emphasize its clinical and histological features which will broaden the morphological spectrum of epithelial neoplasms of endometrium.
Can dysphagia aspiration related structures (DARS) be spared in patients with oropharyngeal cancers? Dosimetric evaluation in a prospective study of DARS optimized intensity modulated radiation therapy
Authors: Calcuttawala Adnan , Shinghal Abhishek , Budrukkar Ashwini N. , Swain Monali , Murthy Vedang , Laskar Sarbani G. , Gupta Tejpal , Upereti Rituraj , Kale Shrikant , Agarwal Jai Prakash
Published: August 2024

Purpose:

To evaluate the feasibility of sparing the dysphagia-aspiration-related structures (DARS) in various head and neck cancer sites treated with definitive DARS-optimized intensity modulated radiation therapy (IMRT) and concurrent chemotherapy.

Materials and Methods:

Target volumes, organs at risk, and in addition, individual DARS were delineated, including the superior, middle, and inferior pharyngeal constrictor muscles, supraglottic and glottic larynx, the base of the tongue, esophageal inlet muscles and cervical esophagus in 35 patients with head and neck squamous cell carcinoma. Volume-based dose constraints were applied to the DARS outside the planning target volume (PTV). An IMRT plan was then generated to limit doses to DARS without compromising PTV dose coverage.

Results:

Twelve (34.3%) patients had an oropharyngeal primary (OPX), 18 (51.4%) had a laryngeal, and 5 (14.3%) patients had hypopharyngeal primary. The mean dose to the DARS was 47.93 Gy for the entire group, while it was 54.6 Gy in oropharyngeal primaries and 44.4 Gy in laryngopharyngeal primaries. DARS mean dose of ≤45 Gy could be achieved in a significantly lesser number of patients with oropharyngeal primaries (P < 0.02). Similarly, DARS mean dose was 42.25 Gy in patients with N0 disease, 49.6 Gy with ipsilateral involved nodes, and 55 Gy with bilateral disease. Sparing of DARS was feasible when the volume of PTV was ≤150 cc (P < 0.025).

Conclusion:

Sparing of DARS structures appears to be challenging in patients with oropharyngeal cancers without compromising the dose to the PTVs while it is feasible in laryngopharyngeal cancers. DARS sparing is feasible when the PTV volume is < 150 cc and in patients with negative or unilateral nodal disease.
Comparison of magnetic seed and RFID methods in the localization of non-palpable breast lesions
Authors: Sanli Ahmet Necati , Tekcan Sanli Deniz E. , Golshan Mehra , Sezgin Efe , Celik Varol , Aydogan Fatih
Published: August 2024

Background:

Many methods have been developed for localizing non-palpable breast lesions. This study investigated the success rate and surgical results of the magnetic seed (Magseed) and radiofrequency identification (RFID) method, which are relatively new compared to standard wire-guided localizations.

Materials and Methods:

20 simulation (10 Magseed, 10 RFID) models were created using turkey breasts and raisins. Raisins containing magnetic seed and RFID tags were placed on the turkey breast. Sentimag® probe was used for the Magseed group, and Faxitron LOCalizer™ System device was used in the RFID group. Both methods were evaluated in terms of accuracy in detecting breast lesion localization, operation times, excised tissue weights, total resection volume, surgical margin negativity, and re-excision rates.

Results:

Lesion localization success in both techniques was 100%. While procedure times were statistically significantly shorter in the Magseed group, incision lengths were shorter in the RFID group (P = 0.013, P = 0.007, respectively). No statistically significant difference was found between the groups for the weight of the removed parts, total resection volume, and surgical margin distance (P > 0.05).

Conclusion:

In this feasibility study, it was concluded that neither the RFID nor Magseed methods had a significant advantage over each other, in terms of localization detection and surgical margin negativity, and both methods could be used successfully for localization.
Adenomatoid tumor uterus coexisting with high grade serous carcinoma ovary: An incidental finding with literature review
Authors: Kumar Rabish , Mandal Shramana , Mallya Varuna , Mala Y. M.
Published: August 2024

Adenomatoid tumor is a benign neoplasm of mesothelial origin encountered most often in the male and female genital tracts. These are generally small, benign lesions and are mostly incidental findings. Here we present a case of adenomatoid tumor uterus incidentally detected in a 39-year-old female who was operated for cystic lesion in the ovary.
An unusual presentation of oral metastasis of mucinous colorectal adenocarcinoma: A rare clinical entity and diagnostic challenge
Authors: Aggarwal Dipanshu , Shetty Devi C. , Gupta Amit , Saluja Meenakshi
Published: August 2024

Mucinous colorectal adenocarcinoma represents a distinctive variant of colorectal carcinoma (CRC), which is typified by copious amounts of extracellular mucin. This subtype of CRC is distinguished by the presence of mucin, which constitutes at least 50% of the tumor volume, thus serving as a defining histologic feature of this malignancy. Colorectal carcinoma patients may develop lymphocytic and hematogenous metastases. While surgery is the only curative treatment option available, the use of chemotherapy, radiation therapy, or a combination of both can help improve the prognosis. However, the risk of recurrence remains substantial, in terms of both locoregional and distant spread. This article reports a gingival metastatic carcinoma of colorectal mucinous adenocarcinoma in a 24-year-old woman. Microscopically, architectural and cellular features resulted in ruling out differentials. Oral metastases are an infrequent phenomenon that can arise within either the soft tissues or the osseous structures of the oral cavity. This metastasis can exhibit clinical and radiographic features that are reminiscent of clear cell lesions localized in the head and neck region.
Total skin radiation therapy with low-dose helical tomotherapy for a patient with mycosis fungoides
Authors: Katano Atsuto , Yamashita Hideomi
Published: August 2024

Total body skin irradiation with electron beams has been used for patients with mycosis fungoides (MF). Recently, helical tomotherapy was considered available for total body irradiation, although severe myelosuppression was frequently observed as an adverse event. We report the first case of low-dose helical tomotherapy in a patient with MF. An 87-year-old Asian male with an 18-year medical history of MF was referred to our department due to a rapidly growing skin lesion during systemic therapy. He decided to undergo low-dose total skin radiotherapy with helical tomotherapy. The total skin was treated by dividing into three parts (trunk, head, and lower extremities). Each part was treated with helical radiotherapy consisting of 10 Gy in 5 fractions, with the administration of 5 fractions per week. Once the skin lesion clearly disappeared after total skin radiotherapy, recurrence was detected in the lower abdominal wall in the radiation-treated field. Insufficient doses of radiation therapy cause early relapse. There is still no optimized dose for total skin irradiation in helical tomotherapy. Further radiation therapy dose trials are required to optimize the treatment schedule.
Impact of two intervention packages on the health and fitness of ante - and post-natal women attending in a teaching hospital
Authors: Sarkar Pradip Kumar , Singh Paramvir , Dhillon Mandeep Singh , Singh Amarjeet , Bhattacharya Sudip
Published: August 2024

Introduction:

Pregnancy brings about many changes in mothers’ body which continue even after the baby is born. After a vaginal delivery, taking good care of the mother is an essential part of postpartum care and to maintain overall fitness.

Objective:

The purpose of this research was to evaluate the effect of a physiotherapeutic intervention to improve the maternity fitness of Indian women.

Methodology:

It was a three-group RCT (randomized controlled trial). The target population consisted of women in ante and postnatal stage, 50 participants (58 were included in the end) in each group, randomly selected from Obstetrics and Gynecology OPD of a tertiary care hospital in North India. The study was carried out in the department of PRM (Physiotherapy). A total of 174 participants was included in the study and was divided into three groups, two intervention groups, and one control group. The target population consisted of women in ante and postnatal stage, randomly selected from ANC (Antenatal clinic) and PNC (Post-natal clinic). The study was conducted over a period of 4 years (2014–2018). They were advised to do exercise, postural correction, regular walking, and electrotherapy modalities and six follow-ups throughout their pregnancy. Outcome measures like (Visual Analogue Scale = VAS): Low and upper back pain relief (n = 158), Leg cramps (n = 41), Coccyx pain (n = 36), Sacro-iliac joint pain (n = 26) was considered.

Results:

The impact of the intervention package on both ante-natal and post-natal women with fitness-related health problems showed significant improvement.

Conclusion:

Pain, leg cramp and heaviness in the lower limb, coccyx pain, etc., during pregnancy are common complaints that start early in pregnancy and may persist throughout life if treatment does not start early in the pregnancy.
Fungal Pneumonia in a Diabetic Female Masquerading as Primary Lung Cancer
Authors: Mangal Vishal , Adhikari Sudipt , Garg Yadvir , Vasudev Anil
Published: August 2024

Aspergillus is a ubiquitous saprophytic mold that humans and animals constantly inhale. In health, the conidia are eliminated by the innate immune system. However, a subset of individuals with risk factors such as neutropenia, receiving high doses of glucocorticoids or certain biologicals, and recipients of hematopoietic or solid-organ transplants develop invasive aspergillosis. The mortality associated with invasive aspergillosis is 42%–64%. The early diagnosis of invasive pulmonary aspergillosis in patients without classical risk factors remains challenging. We present a case of an elderly female with uncontrolled diabetes mellitus who presented with acute-onset chest pain, breathlessness, and cough without expectoration. On evaluation, her chest radiograph showed a mass lesion in the right upper zone. 18Fluorodeoxyglucose (FDG)-positron emission tomography-computed tomography showed two FDG-avid lesions in the apical and medial segment of the right upper lobe. The lung biopsy was negative for malignancy; however, she was diagnosed with invasive pulmonary aspergillosis based on serum and bronchoalveolar fluid galactomannan positivity. She was managed with voriconazole with complete resolution of the lesion.
Evaluation of Cardiovascular Risk Profile and Risk Scores of Antiretroviral Therapy-naïve HIV Patients in Eastern India
Authors: Chaubey Manaswi , Chakravarty Jaya , Gupta Rishabh , Jethwani Parth , Puri Rahul , Sundar Shyam
Published: August 2024

Introduction:

People living with human immunodeficiency virus (PLHIV) are known to have an increased prevalence of traditional cardiovascular risk factors and are at a higher risk of cardiovascular disease (CVD). This study was done to assess the CVD risk factors in treatment naïve PLHIV in a center of the national program.

Methods:

In this cross-sectional explorative study, traditional CVD risk factors were assessed, and 10-year Framingham and atherosclerotic cardiovascular disease (ASCVD) risk score were calculated in treatment naïve PLHIV attending the antiretroviral therapy (ART) center, IMS, BHU.

Results:

The study included 337 ART naïve patients. The prevalence of CVD risk factors in treatment naïve PLHIV - were low high-density lipoprotein cholesterol levels (81.4%), high triglyceride levels (32.7%), smoking (32.3%), obesity (13.6%), hypertension (5%), diabetes (2.7%), and high low-density lipoprotein cholesterol levels (2.1%). Moderate-to-high 10-year Framingham Risk Score and American Heart Association/American College of Cardiology 10-year ASCVD risk score were 10.8% and 8.9%, respectively. In Framingham Risk Score, age ≥40 years (odds ratio [OR] - 131) (95% confidence interval [CI] - 6.5–1043) alcohol intake (OR - 5.14 [95% CI - 1.82–14.46] and presence of tuberculosis (OR - 4.78) (95% CI - 1.48-15.40), while in ASCVD risk score history of alcohol intake (OR - 26.20 [95% CI - 3.1-216.8] were at higher risk of CVD in multivariate variate analysis.

Conclusion:

CVD risk factors were common among ART naïve patient. Thus, screening, education, and treatment of CVD risk factors should be done in these patients at initiation of care.
Surgical Evaluation of Autologous Platelet-rich Fibrin Membrane as a Coverage Layer in Repair of Urethrocutaneous Fistula after Hypospadias Surgeries: A Randomized Controlled Trial
Authors: Wishahy Ahmed Mohamed Kadry , Abdullateef Khaled Salah Ahmed , Kaddah Sherif Nabhan , Mohamed Alaa Ali , Mohamed Mahmoud Tarek
Published: August 2024

ABSTRACT

Purpose:

It has recently been reported that the use of platelet-rich fibrin (PRF) as an extralayer over the urethroplasty has been related to a considerable reduction in fistula rates. Due to the lack of evidence supporting the usage of PRF in urethrocutaneous fistula (UCF) repair, we conducted this study to evaluate the efficacy of PRF in patients with UCF.

Materials and Methods:

We conducted a randomized controlled study on patients with distal fistula after hypospadias repair. Patients were randomized into two groups, one with local dartos coverage and the other with PRF coverage layer.

Results:

In the present study, we included 37 patients; 20 patients underwent local dartos coverage, and 17 patients underwent PRF. The mean age was 22.45 ± 4545 ± 4515 ± ±15.35 (range 11–56) months for the study group and 20.6 ± 66 ± 614 ± ±14.5 (range 6–45) months for the control group. The incidence of recurrent UCF was 11.8% in the treatment group (two patients), whereas the incidence was 30% (six patients) in the control group (P = 0.246).

Conclusion:

UCF surgery may benefit from the use of PRF as a supportive tissue that promotes wound healing, angiogenesis, and tissue restoration. We believe that the use of PRF as a new approach for UCF repair should be investigated further through clinical studies.
Giant Mesenteric Lipoblastoma in an Infant: Case Report and Review of Literature
Authors: Sundar Haarini , Hegde Priyanka , Loganathan Arun Kumar
Published: August 2024

ABSTRACT

Abdominal lipoblastoma is a rare tumor composed of embryonic fat. Mesenteric involvement is rarer, with only five cases reported in infants. We report a case of a 10-month-old infant with a lipomatous tumor arising from the ileal mesentery. Primary resection was done, and histopathology was suggestive of a lipoblastoma. The child is well in follow-up with no evidence of recurrence.
Microbial Colonization Pattern of Indwelling Double J Stents in Children
Authors: Nishanth Sandeep , Babu Ramesh , Arunaa Sathyamurthy , Prasad D. Arun , Shanthi M. , Sekar Uma
Published: August 2024

ABSTRACT

Background:

Indwelling double-J-stent (DJ stent) kept post-urological procedures may cause urinary tract infections (UTIs) due to polymicrobial biofilm formation and colonisation.

Aims:

To determine the incidence and microbiological characteristics of DJ stent related UTIs in a paediatric population.

Methods and Material:

Patients under the age of 18 admitted for DJ stent removal following pediatric urological procedures were enrolled into the study. Prior to surgical removal of the DJ stent, a urine sample was collected and the stent was cystoscopically removed under anesthesia. The ends of the stent were inoculated into culture media and incubated up to 48 hours. When growth was observed, an antibiogram was obtained using a panel of anti-microbial agents.

Results:

The study group consisted of 27 patients (M:F = 23:4) with a mean age of 4.3 years (1 month – 13 years). The commonest indication for stent placement was Pyeloplasty, 19 (70%). Stent colonisation was found in 8 out of 27 patients (29.6%; CI 12-51%) and E.Coli (33%) was the commonest organism. Polymicrobial growth was noted in 4 patients. Organisms were sensitive to Cephaerazone/ Sulbactam and Amikacin, and resistant to other Cephalosporins. All 8 culture positive patients were asymptomatic and a repeat urine culture revealed no growth. Colonisation did not lead to active UTI and post stent removal the urine became sterile.

Conclusions:

Microbial colonisation was noted in 30% of patients with indwelling DJ stents. Prior knowledge of culture & sensitivity pattern helps to cover the patients with appropriate antibiotic on the day of stent removal.
An Unusual Association of Trichobezoar with Refeeding Syndrome and Subacute Intestinal Obstruction in Postoperative Period
Authors: Kapoor Rohit , Prakash Divya , Singh Sunita , Shukla Amit , Dixit Rini
Published: August 2024

ABSTRACT

Trichobezoar with Rapunzel syndrome is a rare condition seen in young females. Refeeding syndrome is a rare phenomenon that can occur in any chronically malnourished person after starting feeds. We discuss and review available literature of extremely rare cases of 11-year-old girl, with trichobezoar with refeeding syndrome with subacute intestinal obstruction in the postoperative period.
Survival Rate of Self-Adhesive Resin Cement on Various Crown Materials: A Scoping Review
Authors: Larasati Annisa Fildzah , Takarini Veni , Novianti Vita Mulya Passa
Published: August 2024

Aim:

The use of crowns made of all-ceramic, metal-ceramic, or porcelain fused to metal (PFM) with a self-adhesive resin cement as an indirect restorative process is a method of indirect restorative. The cement is anticipated to improve survival rates due to its many benefits. Thus, this research aimed to ascertain how long self-adhesive resin cement will last when applied to different types of crown materials.

Materials and Methods:

The study used a scoping review methodology that followed a Population, Concept, and Context framework. The articles included were published from January 1, 2013, to May 24, 2023, full-text, full-access, written in English, original article study design (clinical studies, observational studies, follow-up case reports, and comparative studies), and in vivo method. Boolean operators were applied to search across the databases Science Direct, PubMed, and EBSCOhost with the corresponding keywords “((survival rate) OR (success rate) AND (adhesive resin cement) AND (crown)).” Since Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) was implemented as the study design, it did not include randomization or statistical analysis. However, we added bias-risk information.

Results:

There were 104 studies in total. After the duplication checking and abstract screening processes, 23 articles were provided. A full-text assessment was done, and seven articles were extracted. Additionally, information about the author, publication year, study design, research methodology, self-adhesive resin cement brand, crown material, research duration, and outcomes was gathered.

Conclusions:

The results concluded that the self-adhesive resin cement survival rate on various crown materials, both all-ceramic and PFM, within 6 years is excellent. Due to the minimal number of articles that met the inclusion criteria, additional research is required.
Postoperative Pain of Endodontic Re-treatment in Single and Multiple Visits: A Systematic Review and Meta-Analysis of Randomized Clinical Trials
Authors: Swapna Sannapureddy , Niharika Mungara , Chinni Suneelkumar , Kiranmayi Govula , Pavankumar Yendluri , Anumula Lavanya
Published: August 2024

Aim:

This systematic review aimed to evaluate the influence of single-visit and multi-visit non-surgical endodontic re-treatments on the incidence, intensity, and duration of postoperative pain and adverse effects.

Materials and Methods:

A search of the literature was conducted after registration of the study protocols in PROSPERO to find randomized clinical studies assessing postoperative pain in non-surgical endodontic re-treatment conducted during one or more visits in PubMed, Cochrane library, and Scopus databases and EBSCO using a definitive search strategy based on inclusion and exclusion criteria. Using the Cochrane risk of bias method, two independent reviewers determined the studies that were eligible for inclusion, extracted data, and evaluated the quality. Meta-analysis was carried out at wherever appropriate.

Results:

A total of 827 citations were found by the database search and 16 citations from other sources. Eleven full-text articles were obtained after duplicates were eliminated. Three clinical trials were deemed eligible for inclusion; on qualitative evaluation, two studies showed an unclear risk and one was graded as having a significant high risk of bias. The sample size was significant in only one study, and the other two studies had a smaller sample size. Meta-analysis was performed at 24 h, 48 h, and 7 days. The random-effects model at 24 and 48 h and fixed-effects model after 7 days indicated that there is no significant difference in pain intensity between single-visit and multi-visit re-treatments.

Conclusion:

The significance of the number of visits on the subsequent pain following the re-treatment procedure was underlined by this current systematic review and meta-analysis. The single visit re-treatment caused less postoperative pain and can be considered based on the clinical scenario.
Bibliometric Analysis of 100 Most Cited Articles in Middle East and North Africa (MENA) Region on Implant Prosthodontics
Authors: Chitumalla Raj Kiran , Jamjoom Faris Z. , Haq Ikram Ul , Gopinathan Pillai Arun , Khan Sulthan Raja , Munaga Swapna
Published: August 2024

Abstract

Aim:

This study aims to conduct a comprehensive analysis and scientometric evaluation of the top 100 most cited publications in the field of implant prosthodontics, authored by individuals affiliated with nations of the Middle East and North Africa (MENA) region.

Materials and Methods:

In October 2023, the 100 most cited articles were gathered from the Web of Science database using the bibliometric research technique. The analysis was conducted on bibliometric indicators, including the distribution of articles over time, authorship, design of study, field of study, nature of research, contribution from various countries in MENA, international research collaboration, and most frequently used keywords by authors. Chi-square and one-way analysis of variance were used for statistical analysis. VOSviewer software was used to analyze the bibliometric network for co-occurrence among countries, coauthors, and common keywords.

Results:

The results revealed that the top 100 most cited articles from MENA countries on the topic of implant prosthodontics, published between 1995 and 2020, had received an average of 73.31 citations each. About one-third of the papers were published in the top 4 journals. The journal with the most published articles was Clinical Oral Implant Research, followed by the International Journal of Oral & Maxillofacial Implants, the International Journal of Prosthodontics, and the Journal of Oral and Maxillofacial Surgery. Saudi Arabia had the distinction of producing the greatest number of highly cited papers. The co-occurrence network analysis using VOSviewer software identified 10–15 related clusters. Research studies with multiple authors received significantly more citations (P < 0.05). Significant relationships were observed between the number of citations and journal type (open access vs. non-open access; P < 0.05), and also articles published in dental journals received the most citations and were statistically significant (P = 0.001).

Conclusion:

Over the last decade, there has been a significant surge in research related to implant prosthodontics. Among the countries in the MENA region, Saudi Arabia has distinguished itself by leading in terms of overall research output. This resource would benefit academicians, clinicians, and researchers in prosthodontics, oral surgery, and periodontic specialties of dentistry.
Uterine Arteriovenous Malformations
Authors: Bartolone Martina , Saluzzi Enrica , Mazzeo Allegra , D’Ambrosio Valentina , Corno Sara , Mascio Daniele Di , Manganaro Lucia , Giancotti Antonella
Published: August 2024

Uterine arteriovenous malformations (AVMs) are an abnormal presence of shunts between myometrial arteries and veins within the myometrium that usually occurs after a traumatic event on the uterus and it is often diagnosed after a miscarriage. In this case report, we propone the case of a woman, gravida 3 para 2, admitted at the emergency department presenting deep vaginal bleeding and suspicion of incomplete miscarriage at 11 weeks of pregnancy. The suspect of AVM was made with noninvasive procedure; transvaginal ultrasound examination with the advantage of color Doppler showed a myometrial hypervascular lesion of the posterior wall. Pulsed Doppler permitted the waveform analysis of uterine arteries and three-dimensional sonography with color Doppler and reconstructions clearly showed dilated ad tortuous blood vessels within the contest of the myometrium. Magnetic resonance angiography showed multiple tubular structures with tortuous appearance that confirmed the suspicion of AVM. Uterine artery embolization was performed of the right uterine artery. One month after uterine embolization, the ultrasound control confirmed the complete resolution of the AVM.
Detecting Advanced Esophageal Cancer by Point of Care Ultrasonography
Authors: Chen Chia-Ching
Published: August 2024

Esophageal cancer (EC) is the 8th-most common cancer and the 6th-most common cause of death worldwide in 2020. Patients with EC might present with a variety of symptoms, such as chest tightness, retrosternal pain, acid regurgitation, heartburn sensation, dyspnea, cough, recurrent pneumonia, hoarseness, dysphagia, and weight loss, which make early diagnosing EC extremely difficult. Currently, the golden diagnostic tool of EC remains endoscopic biopsy. However, in patient suspected advanced EC, point-of-care ultrasonography (POCUS) could be a first-line screening tool. By three zones of esophageal sonography including esophageal inlet, middle third segment of esophagus just beneath the cardiac chambers, and esophagogastric junction, we could be able to detect sonographic evidence of advanced EC including heterogeneous hyperechoic esophageal mass, loss of normal wall differentiation, and mass effect to adjacent structure such as left atrium. For patients with chest pain, POCUS should be focused on cardiac, adjust mediastinum and lung survey. Here, we present a 73-year-old male presented to the emergency department with retrosternal chest pain for 3 months. POCUS revealed esophageal mass which is also proved by computer tomography and endoscopic biopsy on the same day.
Impact of Adding Urethral Sonography with Retrograde Urethrography in Preoperative Assessment of Anterior Urethral Stricture
Authors: Sehgal Nidhi , Priyadarshi Vinod
Published: August 2024

Background:

Even with underlying risk factors and limitations, retrograde urethrography (RGU) is the most popular imaging modality in the assessment of anterior urethral stricture. Urethral sonography (SUG) is an able imaging modality in use for the last few years which evaluates anterior urethral stricture without these risks, though it is still not much popular due to its complexity. This prospective study was designed to compare the assessment made on SUG with the results of RGU and to analyze its impact on surgical decision-making when the results of SUG were taken into consideration with RGU.

Methods:

Thirty patients with anterior urethral stricture were assessed for stricture location, length, and associated urethral pathologies with RGU and surgery planned accordingly. Later, all were reevaluated with SUG, results compared with that of RGU and surgery replanned, considering both RGU and SUG findings. All results were compared with operative findings.

Results:

The mean stricture lengths on SUG, RGU, and surgery were 20.45 mm, 17.15 mm, and 20.38 mm, respectively. Overall sensitivity and specificity of SUG in actual stricture length prediction were 92.3% and 96.1%, whereas these were 78.9% and 85.1%, respectively, on RGU. Spongiofibrosis was assessed only with SUG, that too, with 85%–90% accuracy. Surgical plan was changed in 31% of cases when SUG findings were taken into account along with RGU findings.

Conclusion:

SUG was found more precise modality in the measurement of stricture length and more informative and elaborative in providing added knowledge of degree of spongiofibrosis and associated pathologies of diseased urethra and periurethral tissue. For better preoperative planning of anterior urethral strictures, SUG should be added to work-up along with RGU.
A narrative review of gas separation and conservation technologies during xenon anesthesia
Authors: McGuigan Steven , Abrahams Brendan F. , Scott David A.
Published: August 2024

Xenon gas has significant advantages over conventional general anesthetic agents but its use has been limited by the cost associated with its production. Xenon also has significant potential for medical use in the treatment of acquired brain injuries and for mental health disorders. As the demand for xenon gas from other industries increases, the costs associated with its medical use are only likely to increase. One solution to mitigate the significant cost of xenon use in research or medical care is the conservation of xenon gas. During delivery of xenon anesthesia, this can be achieved either by separating xenon from the other gases within the anesthetic circuit, conserving xenon and allowing other gases to be excluded from the circuit, or by selectively recapturing xenon utilized during the anesthetic episode at the conclusion of the case. Several technologies, including the pressurization and cooling of gas mixtures, the utilization of gas selective membranes and the utilization of gas selective adsorbents have been described in the literature for this purpose. These techniques are described in this narrative review along with important clinical context that informs how these technologies might be best applied. Whilst these technologies are discussed in the context of xenon general anesthesia, they could be applied in the delivery of xenon gas inhalation for other therapeutic purposes.