bluuebunny/crossref_metadata_2025 huggingface dataset:
Jerky dystonic tremor
Authors: Barad Narendrakumar H.
Published: May 2024

Dystonia is a very complex movement disorder. Recently, the classification of dystonia has been updated by a group of experts to simplify the clinical approach to dystonia. As per this new classification, clinically we can divide dystonia into either isolated or combined dystonia. In the isolated group, dystonia is the only feature with or without tremor. In the isolated dystonia (DYT) group, DYT-TOR1A and DYT-THAP1 are the commoner entities worldwide. In DYT-THAP1 cases, apart from classic generalized dystonia phenotype, appendicular tremor has also been described. However, in some cases, it could be jerky and may create confusion with myoclonus. To prevent this confusion and subsequent investigations in the line of myoclonic dystonic syndromes, identification of this jerky tremor assumes great clinical significance. Hereby, we are describing a genetically confirmed DYT-THAP1 patient with a jerky dystonic tremor of upper limbs.
Hemifacial spasm responsive to single low-dose abobotulinumtoxin A in a patient with relapsing-remitting multiple sclerosis
Authors: Torres Julie Ann Kristy L. , de Leon Meliza Angelica J. , Rosales Raymond L.
Published: May 2024

Hemifacial spasm (HFS) is a movement disorder characterized by involuntary twitching of the facial muscles of one side of the face. Here, we report the case of a 31-year-old woman with relapsingremitting multiple sclerosis who presented with left-sided HFS while receiving interferon beta. Despite immunosuppressive medications and clonazepam, only a partial response was documented. Near complete resolution of HFS was achieved 6 months after a single low dose of abobotulinumtoxin A was injected into the left periocular muscles; no recurrence was observed after 4 years. Botulinum toxin injection for focal dystonia, such as HFS, may lead to long-term symptomatic benefit in patients with multiple sclerosis who have already received optimum medical treatment.
Comparison of yoga and physiotherapy on motor neuropsychiatric symptoms and quality of life in Parkinson’s disease
Authors: Thunga Akash V. , Karthikbabu Suruliraj , Prem Venkatesan
Published: May 2024

Background:

Motor and neuropsychiatric symptoms are the manifestations of Parkinson’s disease (PD), leading to poor quality of life of patients.

Aim:

This study aims to compare the benefits of yoga versus physiotherapy on motor and neuropsychiatric symptoms and health-related quality of life in patients with PD.

Materials and Methods:

Twenty-four patients with PD, Hoehn and Yahr disease severity rating scale of I–III, score of <3 on a pull test, and walking ability for 10 meters participated in this observer-blinded randomized clinical trial. The yoga group practiced asanas (postures), pranayama (breathing), and meditation. The comparator group underwent physiotherapy. All participants performed 60-minute training sessions a day, with two sessions per week for 12 weeks. The Parkinson’s Disease Questionnaire-39 (PDQ-39), Addenbrooke Cognitive Examination (ACE-R), Beck’s Depression Inventory (BDI), Unified Parkinson’s Disease Rating Scale (UPDRS) motor experiences, and Balance Evaluation System Test (BESTest) were the outcome measurements.

Results:

On comparing the groups using the Mann–Whitney U test, a statistical significance was observed in the overall quality of life (p = 0.008), emotional well-being (p = 0.008), and stigma (p = 0.048) domains of PDQ-39 and the memory (p = 0.025) and fluency (p = 0.003) domains of ACE-R, which were favorable for yoga. The BDI, UPDRS motor experiences, and BESTest measures were statistically significant (p < 0.05) for both the yoga and physiotherapy groups, only on within-group analysis.

Conclusion:

Psycho-spiritual yoga practice appears to promote emotional well-being and alleviate the stigma attached to PD; therefore, it improves the quality of life of PD patients compared to physical exercises. In addition, it is noted that patients taking antidepressants may experience less depressive symptoms, warranting a multi-arm parallel-group randomized trial. In conclusion, both yoga and physiotherapy appear to exhibit therapeutic potential in alleviating the motor and neuropsychiatric symptoms of PD and enhancing the balance performance in patients.
Automated analysis of pen-on-paper spirals for tremor detection, quantification, and differentiation
Authors: Rajan Roopa , Anandapadmanabhan Reghu , Nageswaran Sharmila , Radhakrishnan Vineeth , Saini Arti , Krishnan Syam , Gupta Anu , Vishnu Venugopalan Y. , Pandit Awadh K. , Kumar Singh Rajesh , Radhakrishnan Divya M , Bhushan Singh Mamta , Bhatia Rohit , Srivastava Achal , Kishore Asha , Padma Srivastava M V
Published: May 2024

Objective:

To develop an automated algorithm to detect, quantify, and differentiate between tremor using pen-on-paper spirals.

Methods:

Patients with essential tremor (n = 25), dystonic tremor (n = 25), Parkinson’s disease (n = 25), and healthy volunteers (HV, n = 25) drew free-hand spirals. The algorithm derived the mean deviation (MD) and tremor variability from scanned images. MD and tremor variability were compared with 1) the Bain and Findley scale, 2) the Fahn–Tolosa–Marin tremor rating scale (FTM–TRS), and 3) the peak power and total power of the accelerometer spectra. Inter and intra loop widths were computed to differentiate between the tremor.

Results:

MD was higher in the tremor group (48.9 ± 26.3) than in HV (26.4 ± 5.3; p < 0.001). The cut-off value of 30.3 had 80.9% sensitivity and 76.0% specificity for the detection of the tremor [area under the curve: 0.83; 95% confidence index (CI): 0.75, 0.91, p < 0.001]. MD correlated with the Bain and Findley ratings (rho = 0.491, p = 0 < 0.001), FTM–TRS part B (rho = 0.260, p = 0.032) and accelerometric measures of postural tremor (total power, rho = 0.366, p < 0.001; peak power, rho = 0.402, p < 0.001). Minimum Detectable Change was 19.9%. Inter loop width distinguished Parkinson’s disease spirals from dystonic tremor (p < 0.001, 95% CI: 54.6, 211.1), essential tremor (p = 0.003, 95% CI: 28.5, 184.9), or HV (p = 0.036, 95% CI: -160.4, -3.9).

Conclusion:

The automated analysis of pen-on-paper spirals generated robust variables to quantify the tremor and putative variables to distinguish them from each other.

Significance:

This technique maybe useful for epidemiological surveys and follow-up studies on tremor.
Geste antagoniste in dystonia
Authors: Prasad Shweta , Holla Vikram V. , Kumar Sahoo Lulup , Batra Dhruv , Stezin Albert , Mahale Rohan R , Kamble Nitish L. , Yadav Ravi , Pal Pramod K.
Published: May 2024

Sensory tricks, also known as “geste antagoniste” or “alleviating maneuvers,” refer to specific maneuvers that temporarily improve dystonic postures; this is often considered to be a hallmark of primary dystonia. Although classically described to be simple activities such as a gentle touch, they can be complex and multisensory, including tactile, proprioceptive, visual, auditory, and thermal stimuli or even imaginary tricks. To date, there is no concrete concept to explain the mechanisms by which geste antagoniste alleviate dystonia. The suggested mechanisms imply an increase in intracortical facilitation in dystonia, and balance between facilitation and inhibition is restored by the geste. This narrative review aims to provide a brief overview of geste antagoniste, covering the historical aspects, types of geste, known mechanisms, and implications.
A Clinical Approach to the Patients with Combination of Dystonia and Myoclonus
Authors: Chouksey Anjali , Pandey Sanjay
Published: May 2024

Myoclonus–dystonia syndrome is one of the well-defined “combined dystonia” syndromes, now observed in many conditions, including genetic and acquired. With widespread access to next-generation sequencing techniques, the list of genetic diseases manifesting as combined dystonia with myoclonus continues to expand. In this article, we aim to review different etiologies of combined dystonia with myoclonus. We searched databases such as PubMed, OMIM, and Gene Review using the keywords “dystonia and myoclonus” and “myoclonus–dystonia” to identify such disorders. We identified different acquired and genetic disorders manifesting with the combination of dystonia and myoclonus, with or without other movement disorders, irrespective of the predominant movement disorder. In addition, we propose the diagnostic algorithms for children and adults with myoclonus and dystonia, based on clinical manifestations to guide diagnostic procedures and further management.
Tourette syndrome in Duchenne muscular dystrophy
Authors: Jadhav Nikhil , Sharma Agrata , Rai Nirendra , Dubey Ayush , Kohat Abhijeet K.
Published: May 2024

Duchenne Muscular Dystrophy (DMD) is an X-linked recessive muscular dystrophy that presents in the first decade of life. Neurodevelopmental disorders are increasingly recognized features in DMD including autistic spectrum disorder, attention-deficit– hyperactivity disorder, and obsessive-compulsive disorder. The presence of Gilles De La Tourette Syndrome (GTS) in DMD patients is extremely rare. GTS in DMD patients supports the hypothesis that disruption of different dystrophin isoforms may play a role in brain development and function.
Assessment of Maxillary Canine Impaction and Severity in Young Patients
Authors: Patel Shubham , Sharma Tarun , Prasad Narayana , Gupta Ritika , Rawat Anupa
Published: May 2024

Introduction:

The most common form of tooth impaction is maxillary permanent canines, third molars being an exception to this rule. Ericson and Kurol estimated that impactions are twice as common in females (1.17%) as in males (0.51%). It is estimated that of all patients with maxillary impacted canines, 8% are bilateral impaction. The purpose of this study is an assessment of maxillary canine impaction and severity in young patients based on angular and linear measurements on panoramic radiographs.

Materials and Methods:

The retrospective study with 150 males and females, panoramic radiographs were taken between the age group of 14 and 20 years. Out of 150, in 25 Orthopantograms (OPGs), maxillary canine impaction was found. The samples were further classified into two groups involving unilateral and bilateral canine impaction. Angular and linear measurements were performed, and the linear distance between the cusp tip and apex of the cuspid was measured perpendicular to the occlusal plane or midline.

Results:

Statistical analysis was performed using an unpaired t-test. The equality of means t-test shows that the distance measured from the canine cusp tip to the central incisor was highly significant (P < 0.05 and angular measurements were highly insignificant. The severity of bilateral impaction was found to be higher in females than males.

Conclusion:

The incidence and severity of bilateral maxillary canine impaction were significant in females compared to males.
Angular Photogrammetric Analysis for a Young Adult Garhwali Population
Authors: Srivastava Neelesh Kumar , Sharma Tarun , Prasad P. Narayana , Rawat Anupa , Joshi Sumit
Published: May 2024

Objectives:

The aim of this study is to quantify the average parameters that define the soft-tissue facial profile of a young adult Garhwali population of age 18–21 by means of angular measurement on standardized photographs.

Materials and Methods:

A sample of 50 Garhwali individuals (25 males and 25 females) between 18 and 21 years of age was obtained with a class I dental relationship. The photographic set-up consisted of a tripod that held a digital SLR camera. The photographic records of the subjects were taken in natural head posture. The obtained records were digitized and analyzed using the Digimizer software program. Twelve measurements were digitally analyzed on each photograph. For statistical evaluation, Student’s-t-test was performed and reliability of the method was analyzed. The results were compared with established soft-tissue profile photogrammetric norms.

Results:

The Student’s t-test was applied to all variables to determine the influence of sex in the measurements. Two of the angles showed sexual differences: nasofrontal (G–N–Prn, P = 0.001) and mentolabial angle (Li–Sm–Pg, P = 0.002). Nasofrontal angle was found wider in the females while mentolabial angle was found be wider in the males.

Conclusion:

Orthodontist has the ability to alter facial features and must analyze the soft-tissue facial profile and compare it with standard measurements of the soft- tissue facial profile. The sample’s mean values can be compared against records of participants using the same photogrammetric technique and sharing the same attributes. The results showed sexual differences in two of the measurements: the nasofrontal and mentolabial angle.
Oral Manifestations in COVID-19-positive Patients: A Clinical Case Series
Authors: Kumar Srishti , Saluja Pulin , Dave Aparna
Published: May 2024

The development of oral lesions in COVID-19 patients can be attributed to a variety of factors. High viral load in saliva, the virus directly targeting the mucosa, association with dermal manifestations, use of corticosteroids, long hospital stay, intubation, and hospital-acquired infections are few possible causes. Evidence suggests that ACE2 receptors in salivary ducts, tongue, and other oral tissues have a high affinity for SARS-CoV-2. Therefore, it is important for clinicians to understand the different lesions that are most frequently seen in COVID-19 patients for proper management. In the present study, eight cases of oral manifestations in COVID-19 patients have been discussed along with their management. Tongue was found to be one of the most common sites due to the abundance of ACE2 receptors. Pigmentation, depapillation, hyperplastic papillae, benign migratory glossitis, and fungal overgrowth were noted on the tongue. Xerostomia, pigmentation, and fungal infection of oral mucosal surfaces, as well as oral ulceration, were other lesions.
Evaluation of Effectiveness of Three Different Behavioral Modification Techniques among 4–8-year-old Children
Authors: Kaur Savreen
Published: May 2024

Background:

Dental anxiety being attributed by many as a major cause to avoid seeking dental care by children, so several communicative, advanced, and pharmacological interventions have been developed to manage children’s anxious and cooperative behaviors.

Aim:

To evaluate the effectiveness of tell–show–do (TSD), tell–play–do (TPD), and ask–tell–ask (ATA) behavioral modification techniques among 4–8 years old coming for a restorative treatment.

Materials and Methods:

Thirty children aged 4–8 years were enrolled in the study and randomly allocated to three groups, 10 children in each group. Group A: Those to receive restorative treatment by the behavior modification technique (BMT) of TSD; Group B: Those to receive restorative treatment by BMT of TPD; and Group C: Those to receive restorative treatment by BMT of ATA.

Evaluation:

Each child’s heart rate was monitored before, during, and after the entire treatment with a pulse oximeter. The oximeter was clipped to the thumb of the child’s left hand. Furthermore, Frankel Behavioral Rating Scale was to be monitored before, during, and after the procedure.

Results:

TPD technique is more efficient than TSD and ATA to control 4–8-year-old children’s anxiety and achieve cooperative behavior during dental treatment.

Conclusion:

TPD is a technique worth practicing in pediatric dentistry. The dentist should consider the cognitive development of the patient to communicate effectively for developing sound rapport and trust. Each dental visit should be designed to receive proper behavioral guidance techniques such as TPD, TSD, and modeling; these can help the child to develop a positive attitude toward oral health.
Comparative Determination of Working Length by Electronic Apex Locator, Digital Radiography, and Cone-beam Computed Tomography: An In vitro Study
Authors: Bansal Rajinder , Bansal Manu , Singh Devinder , Singla Priya
Published: May 2024

Purpose:

The aim of the present in vitro study is to evaluate and compare the working length determination by electronic apex locator, digital radiography radio visio graphy (RVG), and cone-beam computed tomography (CBCT).

Materials and Methods:

Sixty extracted teeth were collected, cleaned, and stored. Preoperative digital radiograph and CBCT scans of all the samples were taken. K-file was placed into root canal after access cavity preparation. According to the method used, different groups were made to determine the working length. Group I: Actual working length of each tooth was determined and kept as a control group. Group II: Each tooth working length was measured by electronic apex locator. Group III: Each tooth working length was measured by digital radiography (RVG). Group IV: Each tooth working length was measured by CBCT.

Results:

When compared with the actual working length by means of analysis of variance, the difference in mean working length calculated by electronic apex locator, RVG, and CBCT was found to be statistically significant (P = 0.001).

Conclusions:

Electronic apex locator is the most precise (96%) method for working length determination, followed by CBCT (94%). RVG was found to be a less accurate (93%) method in this study.
Giant genital wart during pregnancy: A challenging case
Authors: Awad Sherif S. , ELGelany Saad , Abdel-Raouf Hamza , Abdel-Aziz Rasha T.A. , Maalom Rokia , Qandeel Aya A. A. , Mohammed Sahar S.
Published: May 2024

Genital warts, commonly known as condyloma acuminate (CA), caused by the proliferation of squamous epithelial cells in the presence of sexually transmission of human papilloma virus (HPV) infection. There are several modalities of treatment options available for genital warts, medical and/or surgical. We present a case of 23-year-old primigravida who presented with giant extensive genital warts. Lesions were treated using; cryotherapy, sub-lesional vitamin D3, acyclovir, and Trichloro-acetic acid 50% (TCA).
Cannula-based versus common needle-based subcision in combination with fractional CO2 laser in the treatment of post-traumatic atrophic facial scars: A clinical trial
Authors: Makki Mahmoud Abdel Sabour , Abdel-Aleem Hazem L. , Mohamed Marwa
Published: May 2024

Background

Despite the presence of many treatment options for management of atrophic post-traumatic scar, it is still a challenging problem. Different modalities have been used and have shown some degree of success in the improvement of scars.

Objective

To evaluate and compare the effectiveness of the subcision technique by two different modalities (cannula based versus common needle) with fractional CO2 laser for the management of post-traumatic atrophic facial scars.

Patients and methods

This study was performed on 50 patients with post-traumatic facial scar were treated three times at a 4-week interval with a follow-up visit. Each scar were divided into two equal halves; cannula subcision technique was done for an upper and right half, while the lower left half-treated with common needle based one, followed by application of fractional CO2 laser to whole scar. The effectiveness of these two techniques of subcision was evaluated using Vancouver Scar Scale (VSS), along with patient and doctor’s satisfaction measures; in addition to the late adverse effects 3 months postsubcision.

Results

The study group included 50 patients, their ages ranged from 20 to 60 years old with mean (28.4±8.1). The mean total VSS score improved significantly from 5.65±1.61 to 3.64±1.33 and 4.78±1.34 to 3.16±1.42 with cannula-based subcision and common needle-based one, respectively (P < 0.001). However, the mean cannula was significantly superior to common needles (P = 0.001), as regard Vancouver score parameters (pigmentation, pliability, and height), such as the pigmentation, pliability, and height of the mean difference values of Vancouver score (2.1±1.18) and (1.57±1.07) P < 0.05 and a significant difference in Vancouver score parameters, such as the pigmentation, pliability, and height in both methods with fewer adverse effects and more satisfaction by both patient and physician in subcision technique using blunt cannula versus common needle one.

Conclusion

Cannula-based subcision is more preferred than common needle one in the treatment of post-traumatic atrophic facial scars because it is safer, more practical and with lesser side effects.
Factors associated with the occurrence of adult acne in African tropical environment
Authors: Kouassi Yao Isidore , Kouamé Menan Gerad , Gbandama Koffi Kouame Pacome , Touré Mariam , Allou Ange Sylvain , Kouassi Kouame Alexandre , Kourouma Hamdan Sarah , Kouamé Kanga , Kaloga Mamadou , Ahogo Kouadio Celestin , Ecra Elidje Joseph , Sangaré Abdoulaye
Published: May 2024

Aim

To identify the risk factors associated with the occurrence of adult acne in tropical Africa.

Materials and methods

This was a matched case-control study at the Dermatology-Venerology Department of the Treichville University Hospital from January 5 to September 24, 2021. Cases were patients aged 25 years and older seen in consultation for recent acne. Controls were patients consulting in the same department without acne. We recruited two controls for one case by matching them on sex and age. SAS software version 9.4 was used for statistical analyses.

Results

We interviewed 1089 patients, of whom 144 were men and 945 were women. The cases consisted of 48 men and 315 women. The acne patients had a professional activity that exposed them to the sun most frequently (73%) and were mostly single (70%). The median age of the patients was 29.64 years, the median body mass index was 24.03 kg/m2. The median number of lesions was 10 (forehead), 15 (right cheek), 15 (left cheek), 10 (chin) and 8 (lower lip). After adjustment, variables associated with acne were sun exposure (OR = 2.19), low seafood consumption (OR = 6.74), family stress (OR = 2.53) and skin depigmentation (OR = 14.17).

Conclusion

The factors associated with adult acne in tropical environments are numerous. In our study, seafood seems to have protective effects against acne.
Burden of multiple genital warts on male sexual function
Authors: Khaled Hesham N. , Ali Hend N. , Arafat Eman S.
Published: May 2024

Background

Anogenital warts are one of the many clinical symptoms of human papillomavirus (HPV), which is a highly contagious sexually transmitted virus. Every year, genital warts (GWs) are detected in an estimated 3–4 million males across the world. Patients with GWs have been observed to experience elevated degrees of worry, sadness, and sexual dysfunction.

Aims

The goal of the current study was to assess the influence of numerous GWs on the erectile function of male patients.

Patient and methods

Forty male patients with numerous GWs and 40 age and sex-matched healthy controls participated in this case-control research. Each patient had their history taken and was given a physical examination. Blood samples were taken from the veins. Enzyme-linked immunosorbent assay was utilized to assess testosterone and HbA1c concentrations in the serum (ELISA).

Results

There was a highly significant difference between cases and control regarding libido, it was present only in 62.5% of cases while was present in all controls (P value 0.001). There was a highly significant difference among patients and control regarding the presence of orgasm and ejaculation, it was present in 75% of cases but present in all controls (P value 0.001). Mean depression and anxiety score was significantly higher in cases than controls12.0±5.15 vs. 6.15±3.66 and 10.5±5.18 vs. 5.80±2.20, respectively (P value 0.001). 52.5% of cases had depression compared with only 10% in controls and 40% of cases had anxiety compared with only 2.5% of controls (P value 0.001). There was a significant relation between the Dermatology life quality index (DLQI) score and number of warts, patients with more than 3 warts had an extreme effect on their quality of life (QOL) (P value 0.032). There was a significant relation between Dermatology life quality index score and size of warts, patients with large warts greater than or equal to 3 cm had an extreme effect on their quality of life (P value 0.038).

Conclusions

Multiple genital warts might hinder a person’s normal activities. As the condition progressed and recurrences occurred, the quantity and size of genital warts became increasingly significant. More often than not, males with genital warts experience erectile dysfunction. When comparing cases to controls, there was also a statistically significant decline in desire, orgasm, and ejaculation.
Efficacy of autologous adipose-derived stem cells and fractional carbon dioxide laser in the treatment of atrophic linear scars
Authors: Alashry Shereen E. , Fouad Sara H. , Fayed Hassan A. , El-Chennawi Farha A. , El-kamel Mohammed F. , El-Dessouki Ibrahim F. , Shaat Reham M.
Published: May 2024

Background

Atrophic linear scars are scars that exhibit indentation or depression in the skin below the level of the surrounding tissues. Hyperpigmentation or hypopigmentation may be present. They are often caused by surgery, burns, and trauma.

Objective

To evaluate the efficacy of autologous adipose-derived stem cells (ADSCs) combined with fractional carbon dioxide (CO2) laser in the treatment of atrophic linear scars.

Patients and methods

This randomized, controlled preliminary study included 20 patients aged 20–45 years of both sexes with facial atrophic linear scars. The patients were randomized systematically into two groups: group A (combined ADSCs and fractional CO2 laser procedure) and group B (fractional CO2 laser only) of 10 patients each. The scar was evaluated using the Vancouver scar scale, along with a subjective satisfaction questionnaire, and ultrasound skin analysis at baseline and 1 month after the third treatment session.

Results

All participants completed the study. The mean Vancouver scar scale score improved significantly from 3.60±0.69 to 1.20±0.79 and from 2.20±1.03 to 1.60±0.52 with fractional CO2 laser plus ADSCs and CO2 laser procedure, respectively (P<0.001). However, CO2 laser plus ADSCs was significantly superior. Ultrasound skin examination showed a statistically significant increase in dermal collagen density (thickness) in both groups.

Conclusion

Our study shows that treatment with CO2 laser exposure plus ADSCs is safe and more effective for atrophic linear scar management than CO2 laser exposure alone.
Extraintestinal manifestation of Crohn’s disease in an 11-year-old girl: a rare case report with review
Authors: Gupta Sunil K. , Khalid Ayesha
Published: May 2024

Crohn’s disease (CD) is an inflammatory condition of the gastrointestinal tract with extraintestinal manifestations. Of all the patients affected by CD 40% experience at least one extraintestinal manifestation of the disease, the skin being the most common site of extraintestinal involvement. We are reporting a case of 11-year-old female child presented to us in the Dermatology OPD with redness and swelling of both upper and lower lip for a duration of 1 year, with swelling of right labia major for 3 months. Skin biopsy showed keratotic plugging, follicular plugging, and loss of rete ridges. Entire dermis and subcutis shows noncaseating granulomas without any giant cells with lymphohistiocytic cuffing around it. The patient was treated with prednisolone followed by methotrexate and supportive measures. There was a decrease in the swelling of face and vulva after a period of 1 month on the treatment. We report this case to draw the attention over the rare cutaneous manifestation of CD.
Clinical efficiency of narrowband–ultraviolet B phototherapy and methotrexate therapy and their effects on serum tumor necrosis factor-alpha in patients with cutaneous lichen planus
Authors: Hegazy Eisa M. , Mohammed Abdallah E. , Ahmad Marwa R. , El-Hamd Mohammed A. , Younis Ali M. , Ibrahim Hasan M.
Published: May 2024

Objective

This study aimed to assess the clinical efficiency of narrowband–ultraviolet B (NB–UVB) phototherapy and methotrexate (MTX) therapy and their effects on serum tumor necrosis factor-alpha (TNF-α) in patients with cutaneous lichen planus (CLP).

Patients and methods

The present prospective cohort study was carried out on 60 patients with CLP. The included patients were indiscriminately classified into two treatment groups: group A (30 patients) received NB–UVB phototherapy for three months and group B (30 patients) received MTX therapy for 3 months. All the patients were assessed clinically and TNF-α before and after treatments.

Results

There were no statistically significant differences between the two groups of treatment with regard to clinical improvement after treatment (P=0.149). Regarding the levels of TNF-α, there was a statistically significant difference between the two treatment groups after treatment (P=0.024). There was a statistically significant reduction in TNF-α level after treatment in the MTX group.

Conclusion

This study concluded that NB–UVB phototherapy and MTX therapy were clinically effective in the treatment of patients with CLP. MTX therapy was more efficient in the reduction of TNF-α level than NB–UVB phototherapy in patients with CLP.
Glutathione S-transferase M1 and T1 gene polymorphisms in psoriasis patients: a pilot case-control study
Authors: Tawfik Noha Z. , Abdallah Hoda Y. , Abdullah Mona E. , Alshaarawy Hagar F. , Atwa Mona A.
Published: May 2024

Background

The exact etiology of psoriasis remains unknown; nevertheless, it has been found that oxidative stress plays a vital role. Among the multiple antioxidant enzymes, genetic polymorphisms in the Glutathione S-Transferases (GSTs) led to an imbalance in the antioxidant system, resulting in increased levels of reactive oxygen species. Accordingly, the polymorphism in these genes could increase the susceptibility to psoriasis.

Objectives

To assess the association between Glutathione S-Transferase M1 (GSTM1) and Glutathione S Transferase Theta-1 (GSTT1) gene polymorphisms in psoriasis patients compared to healthy controls.

Methods

A total of 200 participants, 100 psoriasis cases who were assessed by the Psoriasis Area and Severity Index (PASI), and 100 healthy controls were included. DNA extraction was done followed by multiplex PCR to detect genetic polymorphism in the GSTM1 and GSTT1 genes, Finally, the relation between the presence of polymorphism and the severity of psoriasis was estimated.

Results

The null genotype frequency of GSTM1 and GSTT1 was 76.0% and 58.0%, respectively among psoriasis patients, while it was 58.0% and 55.0%, respectively among healthy controls. There was a significantly higher risk for psoriasis in patients with the null genotype GSTM1 (OR=2.293) as compared to controls. On the other hand, there was no statistically significant relation between their polymorphisms and family history, psoriasis severity, and PASI score.

Conclusion

The null genotype GSTM1 could increase the risk of psoriasis susceptibility especially among males.
Treatment outcome of the tyrosine kinase inhibitor (bosutinib) in previously treated chronic myeloid leukemia patients (sample of Iraqi patients)
Authors: Ahmed Anfal Mumtaz , Matti Bassam Francis
Published: May 2024

BACKGROUND:

Chronic myeloid leukemia (CML) is a type of myeloproliferative neoplasm characterized by the excessive accumulation of malignant myeloid cells in the bone marrow and peripheral blood. This condition is primarily triggered by a specific chromosomal translocation known as t(9;22) (q34.13;q11.23), which leads to the formation of the BCR-ABL fusion gene. The treatment landscape for CML has undergone significant changes with the approval of tyrosine kinase inhibitors (TKIs) targeting the BCR-ABL1 kinase activity. One such inhibitor is bosutinib, which has been available for several years to treat patients with chronic, accelerated, and blast-phase CML who have shown resistance or intolerance to previous therapies.

OBJECTIVES:

The aim of this study was to assess efficacy and safety of Bosutinib as a 2nd line therapy in CML patients, in addition to effect of adherence to treatment on patients response.

PATIENTS AND METHODS:

Eighty-five patients with CML were enrolled in a prospective cohort study from October 2021 to October 2022 at Hematology Center in Medical City Complex – Baghdad. All patients failed to at least one TKI, and all of them started escalated dose of bosutinib. The patients were followed-up by assessing molecular and cytogenetic response at 3 and 6 months and monitored carefully for adverse events (AEs) which were graded by common terminology IX criteria for AEs version 5. Adherence to bosutinib was also monitored by a specific adherence scale to optimize the response rate to treatment.

RESULTS:

The mean age of patients was 47.3 ± 14.9 (range: 18–77), with male:female ratio 1.4:1. Status of CML patients showed that 89.4% were in the chronic phase, 5.8% in accelerated phase, and 4.7% in blast phase. Regarding the number of previous TKIs before bosutinib, 72.9% of patients failed to prior one TKI (imatinib). At 6 months (72.3%), patients achieve optimal response according to European Leukemia Net criteria 2013. Gastrointestinal symptoms and dermatological manifestations were the most common nonhematological AEs of bosutinib. According to 9-item Morisky Medication Adherence Scale, 42% of patients were adherent to medication which showed a significant association with a higher number of optimal response (P = 0.0001).

CONCLUSION:

Bosutinib is effective with a high and promising response as a subsequent line treatment in CML patients, and it is generally safe and associated with mild-to-moderate tolerable and manageable AEs. Adherence to the drug plays a significant role in optimal response to bosutinib.
Correlation between the International Prostate Symptom Score and sonographic parameters in patients with symptomatic benign prostate enlargement
Authors: Apata Kehinde Omotola , Jeje Emmanuel Ajibola , Tijani Kehinde H. , Ogunjimi Adebisi M. , Ojewola Rufus Wale , Adeyomoye A Adekunle
Published: May 2024

Background:

Benign prostate enlargement is a common urological condition in the aging male that causes lower urinary tract symptoms (LUTS). The study was aimed at determining the correlation between International Prostate Symptom Score (IPSS) and sonographic parameters in a cohort of men attending the outpatient urology clinic of our teaching hospital.

Methods:

One hundred and fifty consecutive patients who met the inclusion criteria were enrolled into the study. The severity of LUTS was assessed using the IPSS questionnaire. Prostate volume (PV), bladder wall thickness (BWT), and postvoid residual (PVR) were determined via transabdominal ultrasound using Toshiba Nemino XG (Osaka Japan) with probe frequency 3.5MHz. The data were collected into a pro forma and analyzed using SPSS version 22 (IBM SPSS, Chicago, IL, USA). The data were subjected to Pearson's correlation and P < 0.05 was considered statistically significant.

Results:

The 150 patients who were enrolled had an age range of 46–85 years, while the mean age was 63.37 ± 9.45 years. The mean total IPSS was 17.58 ± 7.69. The PV, BWT, and PVR had a mean of 71.96 ± 48.75 ml, 4.63 ± 1.99 mm, and 48.01 ± 59.17, respectively. There was a weak correlation between the total IPSS and PV (r = 0.118; P = 0.149), BWT (r = 0.174; P = 0.03), and PVR (r = 0.118; P = 0.151). Correlating voiding and storage symptoms with PV showed a poor correlation. There was a statistically significant correlation between voiding symptoms and BWT (r = 0.255; P = 0.002).

Conclusion:

There was no correlation between total IPSS and PV with PVR. Total IPSS and voiding symptom scores had a statistically significant positive correlation with BWT.
Predictors of depression and malnutrition among older persons attending primary healthcare centres in South Western Nigeria
Authors: Akodu Babatunde , Akinwunmi Samuel , Ladi-Akinyemi Temitope , Baiyeroju Ibukunoluwa , Onajole Adebayo
Published: May 2024

Background:

Malnutrition and depression have been found to be prevalent in the older persons and often lead to preventable adverse complications. Depression has been shown to be associated with malnutrition. This study was aimed at determining the predictors of depression and malnutrition among older persons attending selected primary health-care centers (PHC) in Kosofe local government area in Lagos, Nigeria.

Methods:

This was a descriptive cross-sectional study carried out among older persons attending PHC in Kosofe local government, Lagos. A multi-stage random technique was used to select the 219 participants from the PHC centers. Data were collected using a structured interviewer-administered questionnaire and analyzed using Epi Info 7.1. Chi-square was used to test the association between Socio-demographic characteristics and nutritional status, body mass index and depression, and one-way ANOVA was used to test for the association between anthropometric parameters and malnutrition. Associations were statistically significant if P < 0.05.

Results:

It was found that 57.9% were malnourished or at risk of malnutrition. The study showed that 47.1% of the participants were depressed. There was a significant association (<0.001) between the malnutrition and the level of depression. There was a statistically significant association between family support (P ≤ 0.001), malnutrition (P ≤ 0.001), and depression. There was statistically significant association between the height (P = 0.009), weight (P = 0.001), waist–hip ratio (P = 0.036), and the malnutrition. Remarkably, there was statistically significant association between the waist (P = 0.023) and hip circumference (P = 0.047) and their level of depression.

Conclusion:

The results from this study revealed a high prevalence of malnutrition and depression among older persons. Therefore, health providers working in PHC centers should have a high index of suspicion for depression among older persons with malnutrition.
Telemedicine system for the diagnosis and management of invasive fungal infections in Nigeria
Authors: Nwaneri Solomon , Oladele Rita
Published: May 2024

Background:

Invasive fungal infections are not usually suspected by clinicians in our setting resulting in avoidable deaths, morbidity, and irrational/misuse of antibiotics. Unfortunately, there are few specialists of Medical Mycology in Nigeria working in very few centers where fungal infections can effectively be managed. This article describes a telemedicine system designed to provide an electronic consultation platform for the diagnosis and management of invasive fungal infections in Nigeria.

Methods:

The telemedicine center was designed and implemented using state-of-the-art technologies comprising hardware and software components. The center includes a high-resolution 60-inch liquid-crystal display smart television, an Intel Core i3 Desktop Computer, webcam system, a broadband Internet connection, and a backup electricity supply. The system currently uses the Zoom platform to establish virtual connections with collaborators as well as patients.

Results:

Since its inception, the center has managed 34 serious patients whose managing clinicians have called in for consultation. The establishment of the center has led to increased collaboration with other specialists in clinical mycology across Africa and Europe. Patient outcome has also been impacted positively because of consultation provided on diagnosis and antifungal therapy. The center has further accelerated the exchange of knowledge and ideas between health-care practitioners in Africa on the management of invasive fungal infections.

Conclusions:

Therefore, telemedicine center has been immensely beneficial for the management of patients suffering from invasive fungal infections in Nigeria.
Comparison of human cadaver and blue phantom for teaching ultrasound-guided regional anesthesia to novice postgraduate students of anesthesiology: A randomized controlled trial
Authors: Dang Deepanshu , Kamal Manoj , Kumar Mritunjay , Paliwal Bharat , Nayyar Ashish , Bhatia Pradeep , Singariya Geeta
Published: May 2024

Background and Aims:

Simulation is increasingly used in medical teaching. Various studies have evaluated different simulation models for training of regional anesthesia (RA). We compared the use of human cadaver and blue phantom models for training of regional anesthesia to novice postgraduate students of anesthesiology.

Material and Methods:

Fifty students were taught knobology of the ultrasonography (USG) machine. They were divided into two equal groups by computer-generated random number table, and the groups assigned were kept in sealed envelopes. In group BP, students were trained on a blue phantom model, and in group HC, students were trained on human cadaver. After training, a didactic video of sonoanatomy of the supraclavicular block was shown to all participants. The block performance was then judged on patients requiring supraclavicular block. The primary objective of the study was to compare the block performance time, and secondary objectives were the quality of image acquired, orientation of transducer to the target, identification of ultrasound artifacts, errors committed, complications, and success rate.

Results:

The mean block performance time was shorter in group HC compared to group BP (451.96 ± 50.25 and 526.48 ± 43.486 s, respectively; P < 0.001). The image quality score, transducer orientation to the target, and identification of USG artifacts were better in group HC compared to group BP, with lesser number of needle passes.

Conclusion:

Cadaver-based training produced better results compared to blue phantom simulator model for teaching of ultrasound-guided RA to novice postgraduate trainees of anesthesiology.
Post-operative vomiting after pediatric strabismus surgery: A comparison of propofol versus sevoflurane anaesthesia
Authors: Subramanian Shalini , Shetty Deepa , Shivanna Poornima , Das Priyanka , Phadke Medha
Published: May 2024

Background and Aims:

Squint surgery is a risk factor for postoperative vomiting (POV) in children. This study was designed to compare the incidence of POV in children undergoing strabismus surgery under balanced anesthesia with sevoflurane versus intravenous anesthesia with propofol.

Material and Methods:

In this prospective randomized controlled study conducted in a tertiary care ophthalmology hospital, 70 ASA I-II children aged 1-12 years undergoing strabismus surgery were randomized to two groups –Group S (sevoflurane-based anesthesia) and Group P (propofol-based anesthesia) for maintenance. The surgical details, intraoperative hemodynamic parameters, recovery characteristics, and emergence delirium were recorded. Any episode of postoperative vomiting in the 0-2 hours, 2-6 hours, and 6-24 hours period was noted. Rescue antiemetic was administered if there was more than one episode of vomiting.

Results:

Both the groups were similar with respect to demographic and surgical details. The average duration of surgery was 118.2 ± 41.88 min in group S and 137.32 ± 39.09 min in group P (P = .05). Four children in group S (11.4%) and one child in group P (2.9%) had POV in the first 24 hours but this was not statistically significant (P = .36). The median time to discharge from post anesthesia care unit was significantly less (P = .02) in the P group (50 min) than in the S group (60 min).

Conclusion:

Propofol-based anesthesia does not offer advantage over sevoflurane, in reducing POV after squint surgery, when dual prophylaxis with dexamethasone and ondansetron is administered. It, however, reduces the duration of stay in the post anesthesia care unit.
Evaluation of qCON and qNOX indices in pediatric surgery under general anesthesia
Authors: Praveen M , Kumar Alok , Parikh Badal , Sikdar Indranill
Published: May 2024

Background and Aims:

The objective of the study was to evaluate the performances of qCON and qNOX indices in pediatric populations undergoing surgery under general anesthesia (GA), focusing on the induction and recovery periods. Both the indices are derived from electroencephalogram (EEG) and implemented in the CONOX monitor (Fresenius Kabi, Germany).

Material and Methods:

After approval of the institutional ethics committee, this prospective observational study was conducted in pediatric patients of either sex in the age group of 1–12 years belonging to the American Society of Anesthesiology (ASA) grade I and II undergoing elective surgery under GA. Anesthetic technique was GA with or without regional analgesia (RA). All patients underwent inhalation induction and maintenance using sevoflurane. Patients were monitored with the use of a CONOX monitoring system (Fresenius Kabi, Germany), connected via a set of electrodes placed over the forehead. qCON and qNOX scores were recorded during awake (on operating table premedicated with oral midazolam 0.5 mg/kg), at induction, at loss of eyelash reflex, intubation/laryngeal mask airway (LMA) insertion, before and after regional anesthesia, surgical incision, at cessation of anesthesia, emergence, extubation, and eye-opening. Registered results were also analyzed compared with the minimum alveolar concentration of sevoflurane (MAC).

Results:

A total of 46 pediatric patients were enrolled in the study with a mean age of 5.6 years. All the patients were either ASA I or II. There was a simultaneous fall and rise of qCON and qNOX upon induction and recovery, respectively. There was a rise in qNOX with surgical incision irrespective of RA. However, there was a greater rise in qNOX following surgical incision in those who did not receive RA (P = 0.33) Also both qCON (P = 0.06) and qNOX (P = 0.41) were poorly correlated with MAC values of sevoflurane during GA in the pediatric population.

Conclusions:

Both qCON and qNOX values change predictably with changes in the conscious level and with different noxious stimuli. Further studies are required to confirm the findings taking into account the postoperative assessment of delirium and recall of intraoperative events.
Regional Odontodysplasia: Report of a Case
Authors: Goswami Suchetana
Published: May 2024

Regional odontodysplasia (RO) is a rare developmental anomaly affecting the enamel as well as dentin of teeth. The anomaly is more common in females than in males and observed in both dentitions. The maxilla is more commonly affected than the mandible, and the condition is, in most of the cases, limited to a quadrant only. Clinically affected teeth show yellowish-brown discoloration and pitted appearance. On radiograph, the teeth affected by RO look like “ghost teeth” due to reduced thickness of enamel and dentin. In this article, an 8-year-old female patient with clinical and radiographic features of RO was described.