bluuebunny/crossref_metadata_2025 huggingface dataset:
Nonalcoholic fatty liver disease in prediabetes – Predisposing and protective factors
Authors: Miranda Jennifer , Bhat Smitha
Published: August 2024

Introduction:

Nonalcoholic fatty liver disease (NAFLD) is increasing worldwide with a prevalence ranging from 5% to 28% in India. It is a common cause of chronic liver disease and can lead to complications including cirrhosis and portal hypertension. NAFLD and insulin-resistant states such as obesity, type 2 diabetes, and prediabetes are interlinked. We studied the role of diet, dyslipidemia, and glycemia in the genesis of NAFLD in patients with prediabetes.

Methods:

This case–control study was done in 86 prediabetic subjects availing the services of a medical college hospital. Cases of NAFLD were diagnosed and categorized by severity by ultrasonogram. Symptoms, demographic profile, dietary history by 24 h recall method, anthropometry, liver function tests, lipid profile, and blood glucose were recorded.

Results:

Cases of NAFLD were found to have higher fat consumption and lower carbohydrate and protein in their diet. Fatigue and right hypochondriac pain were common symptoms among the cases, and their mean body mass index (27.2 kg/m2) was higher. When compared with prediabetic controls, cases of NAFLD had higher mean systolic and diastolic blood pressures, as well as impaired lipid profile and postprandial hyperglycemia.

Conclusion:

Obesity, dyslipidemia, and specific dietary patterns predispose patients with prediabetes to develop NAFLD. Additionally, postprandial hyperglycemia is associated with NAFLD. Thus, targeting postprandial hyperglycemia in patients with prediabetes may retard the development of NAFLD.
Health-seeking behavior of patients with diabetes mellitus
Authors: Vaishnavi Balakrishnan , Mishra Amit Kumar
Published: August 2024

Introduction:

Health-seeking behavior is a complex outcome of many independent factors operating at individual, family, and community level. Studies have shown that there is an improvement in compliance to treatment and a decrease in the complications with an increase in patients' knowledge about the disease and its complications. The current study was done to explore the health-seeking behavior among patients diagnosed with diabetes mellitus (DM).

Materials and Methods:

A community-based cross-sectional descriptive study was conducted among patients diagnosed with DM in an urban area of Pondicherry. A simple random sampling method was used to recruit the study participants in the community. A predesigned structured questionnaire was used to collect information from the participants by conducting face-to-face interview. Data entry was done in EpiData and the analysis was done using the Statistical Package for the Social Sciences Version 21.

Results:

In the present study, 109 participants were included and interviewed. Majority of participants (29.4%) belonged to 61–70 years. Most of the respondents (56.8%) seek treatment from a private health facility. The most common comorbidity reported was hypertension (59.6%). Participants shared that unhealthy diet (55%), family history (25.7%), sedentary lifestyle (23.9%), and obesity (17.4%) were the risk factors of DM. Only 12.8% of participants were testing their blood glucose level at monthly intervals. Eight participants were on irregular medication, and among them, three participants told that they were irregular on treatment because their blood glucose levels were normal.

Conclusion:

The level of awareness on diabetes among the participants is not satisfactory though the overall treatment-seeking behavior is found to be satisfactory among the study participants. It is recommended to plan and implement various Information, Education and Communication (IEC) activities in the study area to increase the level awareness.
Skin staples
Authors: Ravi Swaminathan , Purushothaman Vijayan , Chase Suchita , Nayak Sukria
Published: August 2024

Background:

Inguinal hernia is a common condition in the general population requiring surgical treatment. The lifetime risk of developing an inguinal hernia is 27% for men and 3% for women. Lichtenstein et al. in 1989 introduced a tension-free repair technique using a polypropylene mesh to reinforce the posterior wall of the inguinal canal. The current practice world over is to secure the mesh in place using polypropylene sutures. The time taken from mesh preparation to skin closure may be significantly reduced if skin staples are used in place of polypropylene sutures. The use of skin staples may also lead to a reduced incidence of certain postoperative complications such as seroma formation, nerve impingement, and superficial surgical site infections owing to reduced tissue handling. The aim of this study was to evaluate the use of skin staples in place of polypropylene sutures for mesh fixation and wound closure in patients undergoing elective inguinal hernia repair.

Methodology:

A single-arm study was designed to observe the effects of skin staples for mesh fixation and wound closure in 50 consecutive cases of primary unilateral adult inguinal hernia open mesh repair from November 1, 2015, to July 31, 2017. The mesh fixation time was noted, and the incidence of postoperative complications was calculated. The data were compared with 50 retrospective controls for the postoperative complications who had undergone Lichtenstein’s hernioplasty with polypropylene sutures for mesh fixation.

Results:

The median mesh fixation time was noted to be 14.15 min with a range of 8:30–30:00 min. The median pain score measured by the Visual Analog Score was 7 on the day of the operation and 5 on the next day after operation. The median pain score was 2 on the 1st week after the operation, and then, it was 0. There was no statistically significant difference between the cases and the retrospective controls in terms of postoperative complications such as reexploration (P = 0.500), seroma formation (P = 0.951), surgical site infection (P = 0.282), and recurrence (P = 0.278).

Conclusion:

The mean mesh fixation time calculated from this study can be used as a reference for future interventional trials. The incidence of postoperative complications was comparable with the standard procedures.
Anesthetic challenges in a case of Sheehan's syndrome posted for open reduction and internal fixation and nailing following fracture femur
Authors: Ramachandran Abinaya , Palanisamy Nagalakshmi , Johny Pradeesh T , Ranjan R V
Published: August 2024

Sheehan's syndrome is postpartum hypopituitarism caused by necrosis of the pituitary gland due to severe hypotension or shock caused by massive hemorrhage during or after delivery. Patients with Sheehan's syndrome have varying degrees of pituitary hormone deficiency. There is increased sensitivity to barbiturates and opiates in patients with Sheehan's syndrome. They are more prone to hypotension, hypoxia, and hypothermia which must be addressed intraoperatively. Herein, we report successful anesthetic management of a patient with Sheehan's syndrome with distal third femoral shaft fracture for fixation who had numerous hormonal and electrolyte abnormalities. This case report emphasizes the importance of meticulous preanesthetic assessment, optimization, and perioperative management of patients with Sheehan's syndrome for successful management of the case.
Vitamin D levels among adults in a tertiary care hospital in Wayanad
Authors: Raj Aiswarya , Cherian Shreya , Srinivasan Shuba
Published: August 2024

Background:

Vitamin D insufficiency affects nearly 50% of the population worldwide. Inadequate serum Vitamin D levels are associated with multiple conditions such as secondary hyperparathyroidism and increased fracture risk. Multiple studies carried out also showed a correlation between Vitamin D deficiency and occurrence of diabetes and hypertension (HTN) in these deficient individuals. This study aimed to determine the serum levels of Vitamin D among patients frequenting a tertiary care hospital in Wayanad and the associations with sunlight exposure, gender, dietary factors, and diabetes and HTN.

Settings and Design:

Cross-sectional study.

Materials and Methods:

Hundred patients were randomly selected from the outpatient department over 6 months and asked to fill up a questionnaire. Vitamin D analysis was done by Elecsys Vitamin D total assay. Statistical analysis used was IBM SPSS statistics for Windows, version 20.0: Association between continuous data was determined using t-test/Mann–Whitney test depending on normality of data and association between categorical variables was determined using Pearson's Chi-square test.

Results:

Fifty-seven percentage of patients had Vitamin D deficiency. Significantly lower values of Vitamin D were seen among women.

Conclusions:

The median Vitamin D levels in men were 22.785 ng/ml and 17.81 ng/ml in women. No association was established between >1 h of daily sunlight exposure, the prevalence of diabetes and HTN, and daily consumption of dairy products and Vitamin D deficiency.
Epidemiological characteristics of COVID-19-positive health-care personnel and their workplace contacts at a tertiary care hospital
Authors: Fazili Anjum B. , Qadri Shamila Hamid , Allaqband Uroosa Farooq , Shah Rohul jabeen , Shah Suhail Manzoor , Parray Javeed Ahmad
Published: August 2024

Background:

Health care personnel (HCP) are at risk for nosocomial acquisition of severe acute respiratory syndrome-COV 2 from the exposure to infected patients and co-workers.

Aim and Objective:

This study was done to assess the epidemiological characteristics of HCP with COVID-19 and their workplace contacts.

Methodology:

This is a cross-sectional study done from April to July 2020. Data were collected telephonically from the cases, whereas the data from contacts were collected by both face-to-face interview and telephonically. A total of 125 cases and their 552 workplace contacts were included in the study.

Results:

Majority of study participants were symptomatic, young males with majority reporting exposure within the health facility.

Conclusion:

Ensuring workplace safety and adequate availability of personal protective equipment and sanitizers are the responsibility which every HC facility has to take care of COVID-19, health-care.
Perioperative management of a rare case of severe polycythemia vera with gout coming for an emergency minor surgery – A concern for the anesthesiologists
Authors: Manujkumar Ganapathysubramanian , Kamalnath Amoolya , Ruthrendra Ethirajulu , Ranjan Venkatesh R.
Published: August 2024

Polycythaemia Vera is a chronic myeloproliferative neoplasm with an unknown etiology and is a rare occurrence. The erythrocytosis and thrombocytosis along with the hypercoagulable state as a direct result of surgery predispose these patients to thrombosis and hence haemorrhage. Here, we report the anaesthetic issues concerning an elderly male patient presenting with complaints of difficulty in passing stools, fever, and cough with mucoid sputum and diagnosed to be having low anal fistula and perianal abscess with presence of haemorrhoids along with polycythaemia and gout, who was not on any treatment, and posted for an emergency perianal abscess drainage and fistulectomy. With a hematocrit of 63.3% and normal arterial oxygen saturation, the anesthetic management included a thorough preoperative evaluation of associated comorbidities, proper positioning, conducting regional anesthesia meticulously and prevention of acute thrombotic or hemorrhagic episodes. The uneventful perioperative period resulted in the smooth recovery of the patient.
Comparative evaluation of accuracy of implants placed with thermoplastic and three-dimensional-printed surgical guides: A randomized controlled trial
Authors: Husain Firasat , Grover Vishakha , Bhaskar Nandini , Jain Ashish
Published: August 2024

Background:

The current study was planned to evaluate the accuracy of dental implant placement with two different types of surgical guides: Thermoplastic and three-dimensional (3D) printed.

Materials and Methods:

A total of 32 implants were placed in 20 healthy, partially dentate individuals with an isolated single missing tooth. The implant sites were randomly allocated into two treatment groups: Group A (thermoplastic implant surgical guide, n = 16 implants) and Group B (3D printed implant surgical guide, n = 16 implants). All the cases in both groups were digitally planned according to a defined protocol, and a comparison of the planned and actual implant positions was performed using the medical image analysis software. The differences in the outcome variables, i.e., angular deviation (AD), 3D error at the entry, 3D error at the apex (3D EA), vertical deviation (VD), and composite deviation, were statistically analyzed.

Results:

All the outcome variables showed improvements, but statistically significant improvement was shown by AD (P = 0.005), 3D EA (P = 0.01), and VD (P = 0.007). The mean and standard deviation (SD) for AD, (3D EA), and VD were 5.58° ±1.93°, 0.96 ± 0.32 mm, and 0.58 ± 0.36 mm, respectively, for group A. The mean and SD for AD, (3D EA), and VD were 3.94° ± 0.64°, 0.64 ± 0.35 mm, and 0.29 ± 0.13 mm, respectively, for group B (P < 0.05).

Conclusion:

Within the limits of the study, dental implants placed using 3D-printed surgical guides were positioned clinically with greater accuracy, and fewer deviations were observed from their presurgical planned positions as compared to the thermoplastic surgical guides.
Applications of a minimally invasive roll flap technique in peri-implant soft-tissue augmentation – A case series
Authors: Kulkarni Mihir Raghavendra , Chhabariya Anjali Mahesh , Sinha Shiphalika , Sahana L. , Jain Anushtha
Published: August 2024

Deficiency of peri-implant tissue contours is commonly seen due to the process of alveolar ridge resorption after tooth loss. Minor deficiencies can be effectively managed by soft-tissue augmentation procedures to create a more biomimetic tissue contour. The minimally invasive roll technique is a modification of the palatal roll-flap technique and can be carried out at both stages of implant surgery. In this technique, the crestal keratinized tissue is marked and de-epithelialized using a circular partial-thickness incision. The crestal connective tissue is then reflected using a lingual full-thickness semi-circular incision, keeping the buccal attachment intact. This buccal attachment serves as the pedicle. The crestal connective tissue is then rolled into a pouch on the buccal aspect of the ridge to obtain soft-tissue augmentation. The present case study documents the clinical results of the minimally invasive roll flap technique (MIRT) in three clinical scenarios, namely single-stage implant surgery, second-stage implant surgery, and anterior esthetic soft-tissue contouring. In all the cases, excellent soft-tissue contour and thickness has been obtained around dental implants. The MIRT is a simple and efficient technique for areas that require minor soft-tissue augmentation. The technique can be used both in the maxilla and the mandible and facilitates a suture-free surgery.
Spontaneous postoperative bleeding after periodontal procedure: An alarming sign of bleeding disorder
Authors: Mishra Shivani , Ratre Madhu Singh , Jain Parul
Published: August 2024

The prevalence of inherited bleeding disorders (BDs) is low in the general population (10–20 per 100,000 individuals), particularly hemophilia B cases, which may remain undiagnosed for a very long time until exposed to some surgical procedure. The dental professional must be aware of the possibility that patients with no previous history of abnormal bleeding may manifest their first bleeding episode in the dental office. Particularly as periodontists, we often encounter patients with bleeding gums and severe bleeding complications may precipitate while performing routine periodontal procedures. Hence, we must have a thorough knowledge of BDs and their management in challenging hemorrhagic situations. Management of such patients necessitates a multidisciplinary approach by involving the patient’s hematologist and advanced laboratory facilities. The present case report is an attempt to discuss the diagnosis and management of a bleeding episode that occurred post periodontal flap surgery in an undiagnosed hemophilia B patient.
Quantification of Porphyromonas gingivalis using real-time polymerase chain reaction in subjects suffering from chronic periodontitis with and without rheumatoid arthritis
Authors: Bhatsange Anuradha , Rajput Ketan
Published: August 2024

Background:

Porphyromonas gingivalis, highly virulent bacteria, is said to play an important role in the pathogenesis of periodontal disease and rheumatoid arthritis (RA). Chronic periodontitis (CP) is a microbial-induced inflammatory disease leading to tooth loss if undetected and untreated. RA is a systemic inflammatory disease affecting the joints with subsequent morbidity and mortality. These two diseases share a common pathobiology. Although the presence of P. gingivalis has been investigated as a bridging link between these two diseases, its quantification has not been fully elicited. Hence, this case–control study primarily aimed at quantifying P. gingivalis using real-time quantitative polymerase chain reaction (qPCR) and secondarily assess the influence of age and gender on the clinical and biochemical parameters of these two diseases.

Materials and Methods:

The study population consisted of 51 patients divided into two age groups, i.e., 35–55 and 55–76 years. Twenty-five patients belonged to the test group (RA with CP) and 26 to the control group (CP without RA). Both the groups were analyzed for quantification of P. gingivalis using the qPCR technique along with periodontal and biochemical parameters. The study also analyzed the influence of age and gender on clinical characteristics.

Results:

P. gingivalis count was exponentially raised in younger females having CP with RA. Age had no effect on clinical variables in CP patients with and without RA. However, gender comparison revealed RA factor and erythrocyte sedimentation rate to be more sensitive for females with significant relationship.

Conclusion:

P. gingivalis count increased exponentially in CP patients with RA compared to those without RA. Younger females harbored more P. gingivalis.
Effect of adjunctive photodynamic therapy on gingival crevicular fluid interleukin-1β in Stage III and IV periodontitis: A systematic review and meta-analysis
Authors: Karrabi Malihe , Baghani Zahra , Atarbashi-Moghadam Fazele
Published: August 2024

Interleukin-1β (IL-1β) is a main pro-inflammatory cytokine that is used for the assessment of treatment efficacy in periodontitis. This meta-analysis aimed to assess the effect of antimicrobial photodynamic therapy (aPDT) on Stage III–IV (severe) periodontitis-induced local IL-1β. This review study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement and registered in PROSPERO (CRD42024522546). Electronic and manual search of the literature was conducted in four databases for English articles from the first record up until June 30, 2022 comparing the effects of aPDT versus conventional scaling and root planing on IL-1β levels at different follow-up times. The mean gingival crevicular fluid level of IL-1β with 95% confidence interval (CI) was pooled using the random effect model. The I
2 statistics were applied to analyze the heterogeneity of the findings. The risk of bias (RoB) was analyzed using the revised Cochrane RoB. Analysis of 11 retrieved studies revealed that after the application of aPDT, a significant reduction in IL-1β level occurred at 1–2 (standardized mean difference [SMD]: 0.29, 95% CI: −0.57–1.15; P = 0.0002), 4–6 (SMD: 0.53; 95% CI: −0.36–1.42; P < 00001), and 12–13 (SMD: 1.04; 95% CI: −0.22–2.3; P < 0.00001) follow-up weeks. The application of aPDT can serve as an effective adjunctive therapy for the treatment of Stage III–IV periodontitis. Although the results of this meta-analysis showed that increasing the session frequency of aPDT had a higher effect size, further studies without the limitations of the existing studies are required to confirm the present results.
Comparative clinical evaluation of the stability of implants using double acid etching treatment with and without the addition of fluoride solution: A randomized clinical trial
Authors: Hoppe Fernando Luiz Kaesemodel , Formiga Márcio de Carvalho , Garcia Gislaine Fernandes Felipe , Manfro Rafael , Bortoluzzi Marcelo Carlos
Published: August 2024

Background:

Osseointegration depends on primary stability, and further, implant surface modifications may improve secondary stability. This randomized clinical trial evaluates whether adding a fluoride solution enhances the implant stability.

Materials and Methods:

Stability of dental implants with two different types of surface treatments was compared utilizing resonance frequency analysis (RFA). Twelve patients were recruited: eight females and four males with an average age of 58.3 years and they received either double acid etched implants (control: Porus Implant, Sistema Conexão) and double acid etched implants containing fluoride on their surfaces (test: Porus Nano Implant, Sistema Conexão). Each patient received one implant from the test category and another implant from the control category, resulting in 24 implants in this study. RFA, utilizing Osstell was used to assess the implant stability, immediately after the placement of implant and 15, 30 and 45 days post-implant placement.

Results:

At the initial time, there was no difference between the test and control groups regarding the ISQ. However, after 15, 30, and 45 days, ISQ values for the test group were significantly higher than the control group. When using implants without fluoride addition, it was observed that after 15 days, the ISQ values were lower than those found at the initial time, but after 30 days, values matched the initial. Concerning the test group results, the ISQ values from T0 (immediately after implant placement) to T3 (45 days after implant placement) always increased from every period of evaluation.

Conclusions:

It was concluded that double acid etched implants with surfaces containing fluoride solution increases the implant stability quotient, compared to implants with fluoride-free double acid etched surfaces.
Clinicopathological Features of Rare Bleeding Disorders in High Consanguinity Population; A Retrospective Analysis from Two Tertiary Hospitals in Saudi Arabia
Authors: Aljabry Mansour S , Alabbas Fahad , Elyamany Ghaleb , Sedick Qanita , Alsuhaibani Omar , Elfaraidi Huda , Alzahrani Azzah , Alotaibi Sultan , Alqahtani Mohammed S. , Alshahrani Ahmad M. , Alharbi Mohammed Abdulaziz , Abusabah Hassan S. , Alremali Lulwa , Alameen Abdulmohsen Abduaziz , Almohammadi Mohammed
Published: August 2024

BACKGROUND:

Rare bleeding disorder (RBDs) encompasses a deficiency of one or more of FXIII, FXI, FX, FVII, FV, FII, and FI clotting factors, leading to bleeding disorders with variable presentations and outcomes ranging from none or minimal to life-threatening events. RBDs are still underdiagnosed and underreported, especially in Saudi population with a high prevalence of consanguinity.

OBJECTIVES:

The study aimed to determine the frequency of RBDs, grading of their bleeding severity, and assessment of clinical manifestations and management of RBDs in tertiary Saudi Arabian hospitals.

DESIGN AND SETTINGS:

This retrospective study of RBDs describes the clinicopathological features of refereed cases to both Prince Sultan Military Medical City and King Khaled University Hospital in Riyadh, Saudi Arabia, from September 2018 to September 2021. Any patient who had already been diagnosed or suspected to have RBDs was enrolled in the study.

PATIENTS AND METHODS:

Patient's medical records were reviewed for demographic data, clinical presentations, bleeding and family history, consanguinity, treatment outcomes, and molecular testing. Samples were run in specialized coagulation laboratories. Patients with liver dysfunction or acquired factor deficiency were excluded. Patients were categorized into four groups according to the severity of bleeding episodes: asymptomatic, Grade I, Grade II, and Grade III.

RESULTS:

A total of 26 cases with RBDs were identified during the study period. Most of the included patients are males and pediatrics (<14 years) representing 15 (57.7%) and 14 (53.8%), respectively. FVII was the most common factor deficiency encountered in 9 (35%) patients, followed by FXIII in 5 (19%), FXI in 4 (15%), FX in 3 (11.5%), FV in 3 (11.5%), and combined factor deficiency in 2 (8%) patients. 17 (65.4%) RBD patients presented with bleeding manifestation either with Grade I (9%), Grade II (39%), or Grade III (15%), whereas 47% were asymptomatic.

CONCLUSION:

The study emphasizes on importance of establishing a national registry of RBDs in Saudi Arabia and the need for further genetic studies to clarify the genotype/phenotype relationships.
Approaches to Multiple Myeloma Management in Gulf Countries
Authors: Al Sharif Fahad Z. , Alhuraiji Ahmad , Alam Arif , Alhejazi Ayman , Osman Hani , El Sabah Hesham , Khan Faraz , Alahmadi Majed , Alzahrani Musa , Siddiqi Mustaqeem A , Abdeljalil Omar Zeid , Hesham Ahmed , Rabea Magdy , Hannout Waleed , Marashi Mahmoud
Published: August 2024

Multiple myeloma (MM) is neoplasm of the plasma cells derived from the postgerminal B-cell lineage and it ranges from premalignant conditions like monoclonal gammopathy of unknown significance and smoldering MM (SMM) to malignant diseases such as overt MM. With advances in science and technology, the understanding of the disease has increased paving the way for advanced therapeutic options and better patient outcomes. Thus, this article is a narrative review summarizing the recent advances in the epidemiology, clinical presentation, risk stratification, and MM patient populations treatment and to provide insights by the authors who are experts in the field of MM management who are considered as Gulf Myeloma Working Group and who were the members of 'Approaches to MM Management' Advisory Board meeting held on October 29, 2021. The expert panel provided several recommendations and drawn consensus statements pertaining to MM management in the Gulf countries.
A Comparative Study on Determination of Erythrocyte Sedimentation Rate by Two Automated Erythrocyte Sedimentation Rate Analysis Techniques-Ves Matic Cube 30 and Mixrate X20 in Comparison to Modified Manual Westergren Method
Authors: Itty Seena Susan , Priya P. V. , Anju C. K. , Sankar S.
Published: August 2024

BACKGROUND:

Erythrocyte sedimentation rate (ESR) is a widely used simple and cost-efficient lab test for the diagnosis and follow-up of many diseases. Even though the Westergren method is considered as gold standard, it has many drawbacks such as long test time duration, infection risk to technician, and need of citrated blood sample and to overcome these limitations, automated ESR analysis techniques have been introduced. This study aimed to compare and assess the agreement as well as to analyze the correlation between the ESR values obtained by two automated ESR analysis techniques– Ves Matic Cube 30 and Mixrate-X20 against the gold standard–Modified Manual Westergren method.

MATERIALS AND METHODS:

Four milliliter blood samples were collected from 1174 patients who came to the Central laboratory with complete blood count and ESR test request forms, after taking informed consent. Each of these samples was subjected to ESR test in both Mixrate X20 and Ves Matic Cube 30, followed by ESR analysis through the modified manual Westergren method. All values obtained were recorded and analyzed using SPSS software. Mean, standard deviation, Bland–Altman agreement analysis, Linear regression, and Pearson's correlation coefficient analysis was done.

RESULTS:

Of 1174 study samples, 588 were male and 586 were female and major proportion of the study sample was in the age group of 50–59 years. Bland–Altman agreement analysis of manual ESR Vs Ves Matic cube 30, showed a mean difference of −2.44 ± 13.01 with 95% limit of agreement (LOA) between −27.93 and 23.05 whereas it was 0.05 ± 1.68 with 95% LOA between −3.24 and 3.34 for manual ESR vs Mixrate X20. Pearson's correlation coefficient for manual ESR Vs Ves Matic Cube 30 was r = 0.891 whereas r = 0.998 for manual ESR Vs Mixrate X20, indicating a strong positive correlation between ESR values obtained through manual method and both automated ESR analyzers.

CONCLUSION:

ESR results from both automated analyzers are agreeable to the reference method with no proportional bias statistically. However, the results from Mixrate X20 ESR analyzer correlate very well with the manual ESR, with close readings that do not affect the clinical interpretation and so can be used in clinical laboratories to optimize workflow and use of human resources.
Primary Myelofibrosis with Extramedullary Hematopoiesis – A Case Report with a Review of Literature
Authors: Mehta Gaurav , Rathod Vaishnavi M , Patel Tejasvi M
Published: August 2024

Primary myelofibrosis (PMF) is the least common of all myeloproliferative neoplasms (MPNs), characterized by a neoplastic transformation of early hematopoietic stem cells, predominantly megakaryocytes and granulocytes. The disease shows gradual evolution from an initial prefibrotic stage to an overt fibrotic stage. Janus kinase (JAK) 2, CALR, and MPL mutations are most common in nonchronic myeloid leukemia MPNs but are not always present. Ineffective marrow hematopoiesis leads to extramedullary hematopoiesis and associated symptoms such as splenomegaly, hepatomegaly, anemia, and pro-inflammatory cytokines-induced constitutional symptoms. The WHO criteria, 2016, consider the combination of clinical, morphological, and molecular genetics features for the diagnosis of the condition. Currently, Dynamic International Prognostic Scoring System is most widely used to predict the prognosis. Here, we report the case of a 63-year-old male diagnosed with the rare disease PMF with extramedullary hematopoiesis and bleeding gastric varices. PMF was diagnosed by bone marrow biopsy showing diffuse fibrosis, positive JAK2-V617F mutation in genetic analysis, negative Philadelphia chromosome, pancytopenia, splenomegaly, and raised leukocyte dehydrogenase.
A Bibliometric Analysis of Anemia Research in Children or Adolescents in the Last 10 Years
Authors: Flores-Briones Keyla , Rios-Lopez Sebastian , Mayta-Tovalino Frank
Published: August 2024

INTRODUCTION:

Both nationally and internationally, anemia is one of the greatest public health challenges. It mainly affects children, adolescents, and women of reproductive age and manifests itself in different etiological forms. To examine the worldwide scientific production on anemia in children and adolescents focusing on the Scopus database, in a period between 2011 and 2020, the present bibliometric study is proposed.

METHODOLOGY:

The Scopus database was used as the main data source to collect relevant manuscripts on anemia in children and adolescents from 2011 to 2020. The CSV data were exported to SciVal for analysis of most published topics, collaborations, most published institutions, productivity by journal category, most published journals, most published medical specialties, and most published authors.

RESULTS:

Of the 1784 manuscripts reported, it was shown that the year 2020 had the highest number of publications with 33, 19, 13, and 15 articles in the Q1 (top 25%), Q2 (top 26%–50%), Q3 (top 51%–75%), and Q4 quartiles (76%–100%), respectively. The University of Pennsylvania (USA), Johns Hopkins University (USA), and Baylor College of Medicine (USA) were the top three institutions with the highest article production. The top three places were for Pediatric Blood and Cancer, Public Health Nutrition, and Journal of Pediatric Hematology/Oncology with 20, 12, and 11 publications, respectively.

CONCLUSIONS:

In recent years, there has been evidence of an increase in the number of publications referring to anemia in children and adolescents, experiencing a notorious increase from 2015. In terms of scientific production, the United States, Egypt, and Canada are positioned as the leading countries in this field.
Serum Erythropoietin in the Evaluation of Erythrocytosis
Authors: Gupta Ruchi , Singh Manish Kumar , Chandra Dinesh , Rahman Khaliqur , Maddheshia Ashwani , Sharma Akhilesh , Yadav Sanjeev , Kashyap Rajesh
Published: August 2024

INTRODUCTION:

Serum erythropoietin (S. EPO) continues to be a minor diagnostic criterion for discriminating polycythemia vera (PV) from other causes of erythrocytosis. However, in the current era of Janus kinase 2 (JAK2) mutation testing, its relevance for establishing the diagnosis of PV is controversial.

AIMS AND OBJECTIVES:

The study aimed to assess the utility of S. EPO in patients with absolute erythrocytosis and ascertain its sensitivity and specificity for establishing the diagnosis of PV. Further, the clinicopathological features of PV and JAK2-EPOlow erythrocytosis were compared to discriminate the two disease states.

MATERIALS AND METHODS:

A total of 286 samples had undergone concomitant testing for S. EPO levels and JAK2V617F mutation for various indications over a period of 60 months (January 2017–December 2021). Clinical details and laboratory parameters were retrieved from the electronic medical records.

RESULTS:

Among 203/286 (70%) patients with erythrocytosis, JAK2 positivity was noted in 49 (24.1%) patients. A subnormal S. EPO level (<3.2 mIU/mL) was noted in only 27/43 (62.7%) cases of de novo PV, while the postphlebotomy PV patients (n = 6) had normal S. EPO levels. The sensitivity and specificity of low S. EPO for establishing the diagnosis of PV were 62.7% and 77.4%, respectively, while the sensitivity and specificity of high Hb levels (>16.5 g/dL) with low S. EPO and for diagnosing PV was 62.7% and 79.0%, respectively, while the sensitivity of high Hb levels with JAK2 positivity was 89.7%. In addition, 14.7% (30/203) of cases of high Hb/hematocrit (median: 18 g/dL and range: 16.3–23.8 g/dL) belonged to the JAK2-EPOlow subgroup. The median age of these patients, red blood cell count, total leukocyte count, and platelet count were, however, significantly lower as compared to the PV (P < 0.05).

CONCLUSION:

Overall, a low sensitivity and specificity of S. EPO were observed for diagnosing PV as an isolated investigation, thus questioning its diagnostic utility, though high levels had an excellent negative predictive value. However, this simple and inexpensive test remains an important screening tool for evaluating patients with absolute erythrocytosis.
Perioperative Anaesthetic Management of a Large Paraganglioma Compressing Abdominal Aorta and Inferior Vena Cava: A Case Report
Authors: Khandelwal Ayushee , Das Sambhunath , Rajmohan S. , Ishory Bhusal , Cyril Joseph , Anushna Babu S. , Rakesh Kumar
Published: August 2024

Paragangliomas (PGs) are rare neuroendocrine tumors that originate in the autonomic nervous system. Functionally, they are highly vascular and may be parasympathetic or sympathetic. Parasympathetic tumors are usually asymptomatic and inactive, located mostly in the skull base in the distribution of IX and X cranial nerves. In contrast, sympathetic tumors are highly active (secretes norepinephrine) and symptomatic and mainly located in the abdomen and pelvic regions. Surgical removal of these tumors is curative and key to favorable outcomes. Some of these tumors have malignant potential as well. Meticulous preoperative preparation is needed but many patients may still land up in hypertensive crises intraoperatively which should be managed promptly and cautiously by the anesthesia team to reduce morbidity and mortality during surgery. Here, we describe the successful anesthetic management of a patient diagnosed with large aortocaval PG abutting the aorta and compressing the inferior vena cava and bilateral renal veins.
Cardiovascular Risk Assessment Scores: A Narrative Review
Authors: Jain Dhriti , Acharya Sourya , Shukla Samarth , Kaushik Nikhil
Published: August 2024

Cardiovascular disease (CVD) is considered to be one of the major groups of diseases which is preventable. The prevalence of such conditions is increasing due to the various lifestyle habits. In the majority of the cases, the disease remains asymptomatic. These CVDs can be prevented by early lifestyle modifications and treatment. CVDs are considered to be one of the major causes of death worldwide. Various risk assessment tools are used to identify patients with high risks, such as high blood pressure, cholesterol levels, age, obesity, and atherosclerosis. These tools are used for calculating the risk of beginning a CVD from various risk factors of the patient obtained from history, physical and general examination along with investigations. The risk assessment tools play an important role in preoperative period for better decision-making and planning for the treatment. The objective is to locate, evaluate, and synthesize current systematic reviews that discuss the role of risk assessment tools in primary CVD prevention. This review article comprises the various risk assessment tools or scores that can be used to calculate the cardiovascular risk in an individual and also the scores relevant in India. They are the Framingham risk score, systemic coronary risk evaluation, Reynolds risk score, JBS3 risk calculator, and many more.
Cardiology Update 2024
Authors: Kumar Devesh , Yadav Satyavir
Published: August 2024

Contemporary practice of cardiology is inspired by epistemological principles of Evidence Based Medicine. With rapidly evolving scientific data, it is imperative that clinicians are updated with the most recent evidence. We intend to review some of the most recent trials that may in the future impact our clinical practice. Here we discuss some practice changing trials in Coronary artery disease, heart failure and preventive cardiology.
Aortopulmonary Window Device Closure
Authors: Chavan Chandrakant , Trivedi Ashish , Badani Rajesh
Published: August 2024

Aortopulmonary window (APW) is an uncommon congenital cardiac defect. Most infants presenting with APW will undergo conventional surgical repair. Experience with transcatheter closure of APW is limited. We report the case of a 5-year-old boy with APW, in whom transcatheter closure was performed successfully using Amplatzer ductal occluder device.
Mobile Clot Inside the Left Ventricle: A Ticking Time Bomb
Authors: Ananthanarayanan Chandrasekaran , Singh Rahul , Patel Kartik , Patel Archit , Doshi Chirag , Wadhawa Vivek , Patel Ramesh , Sheth Megha , Shah Pratik
Published: August 2024

Thrombus formation inside the left ventricle (LV) is a dreaded complication following myocardial infarction. Depending on their anatomical characteristics, they pose a significant risk of embolism, specifically stroke. Cardiac surgery in a patient with acute cerebral infarction is a tough predicament for the treating surgeon. Mobile clots carry higher risk than mural clots and need urgent thrombectomy. We present a case of massive LV clot in a young man leading to multiple acute embolic infarcts who was successfully treated by LV thrombectomy.
Anaesthetic challenges of carinal resection and reconstruction: A case report
Authors: Arumugam C Ganapathy , Sekar Kavitha , Sridhar R , Narasimhan Ajay , Narasimhan R
Published: August 2024

Carinal resection of tumour involving trachea and carina remains as a challenge for thoracic surgeons and anaesthesiologists. Resection is technically demanding and can be associated with significant morbidity and mortality. In this case report, we describe the successful management of carinal tumour with carinal resection in a 45-year-old female. The tumour was involving lowermost trachea, carina and bilateral primary bronchi causing 60% narrowing of the lower trachea just before carina, more than 90% narrowing of right main bronchus and 50% luminal narrowing of left main bronchus. Carinal resection and reconstruction were successfully performed under general anaesthesia. Patient was managed with conventional orotracheal intubation with Micro laryngeal endotracheal tube and positioned in left principal bronchus railroaded over a paediatric bronchoscope for lung isolation. After thoracotomy, the left main bronchus was intubated directly across the operative field with a sterile flexometallic endotracheal tube. With intermittent ventilation, anastomosis was completed. During anastomosis Micro laryngeal endotracheal tube cuff was damaged twice and we had to reintubate the patient twice in lateral position itself. At the end of anastomoses, flexometallic tube was removed and wound repaired. After confirming no leakage at anastomotic site, Micro laryngeal endotracheal tube was removed and Laryngeal Mask Airway was inserted and bronchial toileting done with adult bronchoscope. Meticulous planning and communication between the anaesthesia and surgical teams are mandatory for the safe and successful anaesthetic management of carinal resection surgeries.
The minimal important difference of one-minute-sit-to-stand test in subjects with chronic pulmonary aspergillosis
Authors: Sehgal Inderpaul Singh , Dhooria Sahajal , Muthu Valliappan , Prasad Kuruswamy Thurai , Soundappan Kathirvel , Aggarwal Ashutosh Nath , Chakrabarti Arunaloke , Rudramurthy Shivaprakash Mandya , Agarwal Ritesh
Published: August 2024

Background and objective:

There is a need for simple functional test to assess treatment response in chronic pulmonary aspergillosis (CPA) in resource-constrained settings. The one-minute-sit-to-stand test (1-min-STS) is one such test. However, the minimal important difference (MID) for 1-min-STS in subjects with CPA remains unknown. Herein, we estimate the MID for 1-min-STS for CPA subjects.

Materials and Methods:

We retrospectively reviewed the clinical details of CPA subjects treated with oral azoles for 6 months. We included only subjects who completed the 1-min-STS test at baseline and 6 months. We used the change in VAS (visual analogue scale, for overall improvement) as an external anchor. We used the anchor and the distribution (standard deviation-based) methods to determine the MID estimates. We used the anchor-based method only if there was correlation of 0.3 with the 1-min-STS test.

Results:

One hundred-eight subjects completed the 1-min-STS test at baseline and 6 months. We did not find significant correlation between the change in VAS for overall improvement (r2 = 0.024, P value = 0.809) and the 1-min-STS test. The MID for the 1-min-STS test was 2 repetitions (range, 1.5–2.8 repetitions).

Conclusion:

The MID for the 1-min-STS test in subjects with CPA was 2 repetitions. Future studies using a global rating of change scale as an anchor must confirm our findings.
Effect of long-term inhaled corticosteroids therapy on cognitive function in patients with bronchial asthma and chronic obstructive pulmonary disease
Authors: Sharma Suikriti , Karki Deepika , Julitta Kanivi
Published: August 2024

Background:

Inhaled corticosteroids (ICS) are prominent therapies for managing both asthma and chronic obstructive pulmonary disease (COPD). It has been noted that cognitive impairment is usually linked to high levels of corticosteroids in the blood.

Objective:

This investigation aims to ascertain how long-term inhaled corticosteroid treatment affects individuals with bronchial asthma and COPD’s cognitive performance.

Methodology:

A total of 139 inpatients diagnosed with COPD and bronchial asthma were enrolled in the study of which 43 were newly diagnosed (group 1), 34 were taking ICS for 0.5-1 year (group 2) and 62 were on long-term ICS, that is, for >2 years (group 3). Patients with a score of at least 24 were considered to have normal cognitive function as prescribed by the Montreal Cognitive Assessment scale.

Result:

It was observed that 56 patients (90.3%) were on long-term ICS treatment, 25 patients (73.5%) were on intermediate therapy and 27 patients (62.7%) who were newly diagnosed had cognitive impairment.

Conclusion:

In conclusion, the duration of ICS therapy was significantly associated with a decline in cognitive function.
Pediatric Lumbosacral Spondylolisthesis: Overcoming the Disability!
Authors: Mehrotra Anant , Pandey Satya D. , Singh Suyash , Kanjilal Soumen , Gajbhiye Sanjog , Dikshit Priyadarshi , Kumar Ashutosh , Verma Pawan K. , Maurya Ved P. , Bhaisora Kamlesh S. , Das Kuntal K. , Srivastava Arun K. , Jaiswal Awadhesh K. , Kumar Raj
Published: August 2024

Background:

Congenital spondylolisthesis is characterized by dysplasia of the facet joint or congenital defect in the pars.

Objective:

Our study highlights the clinical and radiological profile, various treatment options, and outcomes in patients with pediatric congenital lumbar and lumbosacral spondylolisthesis.

Methods:

A retrospective analysis and follow-up of 22 patients were conducted presented with radiological diagnosis of congenital lumbar/lumbosacral spondylolisthesis (2018–2021).

Results:

Twenty patients (91%) had L5-S1 listhesis and two patients (9%) had L4-L5 listhesis. Six (27.3%) patients had low-grade listhesis (grades 1–2), 16 (72.7%) had high-grade listhesis (grades 3–5). Seventeen (77.3%) had S1, three (13.6%) had L5, and two (9%) had both L4-L5 radiculopathy. All patients had neurogenic claudication. One had an associated spina bifida occulta. Six (27.3%) patients underwent two-level fixation, and 16 (72.7%) underwent three-level fixation. Minimally Invasive Transforaminal Lumbar Interbody Fusion (MIS TLIF) was done in two patients. Revision of at least one screw was done in three patients. After one year of follow-up, all the patients had 75–100% relief in radicular pain and neurogenic claudication. The Oswestry Disability Index (ODI) score in preop for all patients was 41–60% and postoperatively they showed an improvement in ODI score (0–20). The postoperative low back pain score on the Numeric Rating Scale was 0–1 for all patients.

Conclusion:

Congenital lumbar spondylolisthesis usually presents with high-grade listhesis. Management of such cases is a surgical challenge but posterior decompression resulted in relief of pain in all patients. However, in situ fixation without reduction is also effective in selective cases where attempts to reduce the listhesis result in a decline in intraoperative neuromonitoring parameters.
The Clinicopathological Features of the Solitary Subependymal Giant Cell Astrocytoma: A Systematic Review
Authors: Piña-Ballantyne Steven Andrés , Espinosa-Aguilar Eunice Jazmín , Calderón-Garcidueñas Ana Laura
Published: August 2024

Subependymal giant cell astrocytoma (SEGA), a circumscribed grade I glioma, is typically associated with tuberous sclerosis complex (TSC). However, “solitary SEGA” has been described. We performed a systematic review of available case reports and case series of solitary SEGA. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was used with the following MeSH terms: “Subependymal giant cell astrocytoma,” “Sporadic,” “Absence,” “Non-associated,” “Solitary,” and “Tuberous Sclerosis.” Data sources included PubMed, Google Scholar, Web of Science, and Cochrane from 1979 to June 29, 2023. Of the 546 studies, 20 met the inclusion criteria. Fifty-nine cases were analyzed. The mean age was 19 years (range 4–75), with 29 women (49.1%). Tumor ranged in size from 0.8 to 5.8 cm. Headache was the most frequent initial symptom (75.6%). The lateral ventricles near the foramen of Monro were the most common location (66.10%). Tumors expressed neuroglial (n = 19) or only glial (n = 20) markers. In nine of 59 cases, genetic studies ruled out germinal TSC1/2 mutations; in 13 cases (22.03%), somatic mutations in those genes were identified. “Solitary SEGAs” included tumors with neuroglial profile and classic morphological pattern, and tumors with only glial markers. It is necessary to confirm in SEGA-like tumors, the dual nature with at least glial fibrillary acidic protein (GFAP), neurofilaments, and synaptophysin antibodies. Screening for TSC1/2 mutations, and probably of the NF type 1 gene, is recommended for both germline and somatic mutations. Long-term clinical follow-up is necessary to analyze biological behavior and compare it with genetic and molecular profiles.