bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevention is better than healing. Clinical and economic implications of oral antiviral agents in COVID-19: a prospective study
Authors: Pietrantonio Filomena , Rosiello Francesco , Ruggeri Matteo , Cattaruzza Maria Sofia , Vinci Antonio , Lordi Margherita , Cipriano Enrica
Published: June 2024

COVID-19 represents a threat for frailty patients. This study compares molnupiravir and nirmatrelvir for fragile COVID- 19 patients' efficacy, safety, and cost. An observational, prospective study allowed us to evaluate molnupiravir’s efficacy and safety in real life, compare it to a subgroup of patients treated with nirmatrelvir-ritonavir, and analyze its cost-effectiveness. From January to December 2022, 435 patients (225 males, 220 females; median age 72 years), were enrolled; 24 patients were unvaccinated, and 280 patients had ≥2 risk factors. Molnupiravir performed better clinically and economically. Compared to literature data, in these patients, hospitalization was 2.5% vs. 6.8% (P<0.005), overall adverse effects 14,3% vs. 30.4% (P<0.0001), severe adverse effects 2.6 vs. 6.9% (P<0.001), thus involving potential total savings of about € 92.954 per patient (8% of standard of care cost). Early molnupiravir treatment helped fragile patients who partially responded to the vaccine, or with absolute contraindications to vaccination, to overcome COVID-19 without the need for hospitalization. In elderly patients with multiple pathologies and multiple drugs, molnupiravir prevents disease progression clinically and economically.
Detection method of potato leaf disease based on YOLOv5s
Authors: Li Jingtao , Chen Hao , Li Guisong , Liu Yueqi , Yang Yanli , Liu Xia , Wang Chang Yi
Published: June 2024

An improved leaf target detection method based on the YOLOv5s network is proposed to address the issues of low model detection accuracy and slow detection speed in potato leaf image target detection. Firstly, a deformable convolution replaces the standard convolution in YOLOv5s to ensure that the convolution region always covers the target region. Secondly, CBAM attention module is introduced into the convolutional module to enhance local feature extraction and fusion capability of the network, while WIoU_Loss serves as Bounding box loss function SRN-DeblurNet deblurnet is combined with YOLOv5s network to convert part of fuzzy images into clear ones before being integrated with multi-scale features for model prediction. To verify its effectiveness, we trained our model using Pytorch deep learning framework and achieved an accuracy rate of 90.3% and recall rate of 88%, which are respectively 8.6% and 8.9% higher than those obtained by YOLOv5s.
An Incidental Finding of Parathyroid Adenoma in a Patient Presenting with Brucella Endocarditis with Bicuspid Aortic Valve
Authors: Mashrani Ketan Suresh , Reddy Naveen Naveen
Published: June 2024

Endocarditis is a rare complication of brucellosis, but it is the main cause of the mortality in this disease. The accepted treatment for Brucella endocarditis (BE) is a combination of valve replacement and antibiotics. Conservative antibiotic treatment alone is not recommended by most of the authors as it is considered ineffective and increases the risk of fatality. In our literature search, we found 14 adult patients with BE treated only with antibiotics with a favorable outcome. Depending on the data from the growing literature and our patient we suggest that in selected patients with BE who do not have congestive heart failure, valvular destruction, abscess formation, or a prosthetic valve, conservative antibiotic treatment may be a valid alternative to surgery (Ann Thorac Cardiovasc Surg 2002;8:381-5).
Eosinopenia as a Diagnostic Marker of Enteric Fever: A 1-Year Observational Study
Authors: Gandhi Aashna , Darshan Arathi
Published: June 2024

Introduction:

Enteric fever is an acute febrile illness caused by Salmonella species. Its diagnosis is confirmed by culture. Absolute eosinopenia is a consistent finding seen with enteric fever; a high eosinophil count helps to rule out its diagnosis.

Materials and Methods:

Our aim was to prove that eosinopenia can be used as a marker for diagnosis. We performed a one-year observational study in Dr. KLEs Prabhakar Kore Hospital, India from January-December 2020 on 45 culture positive patients. Their hemograms and Widal titres were compared and statistical analysis was performed for the same.

Results:

Of the 45 patients, 38 had growth of Salmonella typhi on culture whereas 7 had growth of Salmonella paratyphi. 42 patients had absolute eosinopenia. Widal test had high titres in only 17 out of 45 patients.

Conclusions:

Absolute eosinopenia has a strong association with enteric fever as proved by this study. Moreover, a high eosinophil count maybe used by the clinician to rule out the diagnosis of enteric fever. Also, Widal test, which was used rampantly in the past, in our study, did not show a good correlation with a positive blood culture.
Association of Serum Ferritin and Gamma-glutamyl Transferase Levels with Metabolic Syndrome and Insulin Resistance
Authors: Rashmi B. M. , Pattanshetty Sunil , Bhagyajyoti  , Savadi Basavaraj V. , Prashanth G.
Published: June 2024

Background:

Metabolic syndrome (MetS) is a state of inflammatory condition carrying several risk factors that lead to insulin resistance (IR), atherosclerotic events, and related complications. Serum ferritin is an acute phase reactant. As an acute phase, serum ferritin increases inflammatory condition which can contribute for IR and MetS. Gamma-glutamyl transferase (GGT) is a pro-inflammatory marker, which participates in various pathophysiological processes such as oxidative stress and lipid peroxidation which are important in the pathogenesis of IR and MetS. This study was undertaken to understand the association of serum ferritin and GGT levels with IR and MetS.

Methodology:

A comparative, descriptive cross-sectional study was conducted including 50 MetS cases and 50 matched healthy controls. Clinical examination was followed by laboratory investigations of GGT, ferritin, insulin, lipid profile, glycated hemoglobin (HbA1c), and IR were calculated by homeostasis model assessment-IR (HOMA-IR).

Results:

In the MetS patients’ group, IR (HOMA-IR) was found to have significant positive correlations with serum GGT, ferritin, insulin, and high-sensitivity C-reactive protein (HsCRP). It was also found that body mass index, fasting blood sugar, postprandial blood sugar, and HbA1c were significant risk factors of IR.

Conclusion:

The present study suggests that fasting insulin, HsCRP, GGT, and ferritin levels were found to be significantly associated with HOMA-IR. GGT and ferritin play a significant role toward the increasing oxidant stress and inflammatory load which predisposes to MetS. Hence, these parameters could be used as markers for the early diagnosis of MetS.
Role of Serum Uric Acid in Metabolic Syndrome: A Cross-sectional Study in Central Karnataka
Authors: Rashmi B. M. , Savadi Basavaraj V. , Bhagyajyoti  , Shrish Patil
Published: June 2024

Background:

Elevated levels of uric acid are the end product of purine metabolism. Uric acid levels are regulated by xanthine oxidase enzyme. Increased xanthine oxidase activity results in the generation of free radicals. Hence, elevated uric acid levels are the manifestations of oxidative stress. Meanwhile, raised uric acid can trigger release of inflammatory mediatory and create the inflammatory state. Thus, inflammation and oxidative stress are the important events in the pathogenesis of metabolic syndrome. This study aimed to find the association of uric acid levels with metabolic syndrome and the individual components of metabolic syndrome.

Methodology:

A comparative, descriptive, cross-sectional study was conducted among 50 metabolic syndrome cases and 50 controls. Clinical examination followed by laboratory investigations for the estimation of serum uric acid, fasting blood sugar, postprandial blood sugar, glycated hemoglobin, high sensitivity C-reactive protein (Hs-CRP), fasting insulin, and lipid profile. Insulin resistance (IR) was calculated by homeostatic model assessment-IR (HOMA-IR).

Results:

In the metabolic syndrome patients’ group, serum uric acid was found to have strong positive correlation with body mass index, blood pressure, glycemic indices, IR, lipid profile, and Hs-CRP. It was found that there was 2.5 times higher risk of development of metabolic syndrome with every unit increase in serum uric acid levels and this association was found to be statistically significant.

Conclusion:

Uric acid can be used as the marker for the early identification of metabolic syndrome or as a prognostic marker in the diagnosed cases of metabolic syndrome.
Knowledge and Comprehension about Health Risk and Safe Radiographic Techniques among the Dental Students of Vivekanandha Dental College for Women – A Cross-sectional Study
Authors: Rajan Jennifer Monisha , Kamaraj Kavya Ganesh , Shavi Girish R. , Shanmugam Shankar , Sennan Senthil Kumar , Gunasekaran Lalithambigai
Published: June 2024

Introduction:

Ionizing radiation has biological health hazards. Increased level of ionizing radiation has both stochastic and deterministic effect.

Aim:

The aim of the current study was to evaluate the knowledge, approach, and insight of the biological ill effects of dental X-ray and appropriate radiation safety measures among the female dental students from Tiruchengode and to compare it between the preclinical and clinical students.

Settings and Design:

This study was conducted at Vivekanandha Dental College for Women, Tiruchengode, a cross-sectional study.

Materials and Methods:

The current study was performed among 202 female dental students of Tiruchengode. The knowledge, approach, and insight about radiation safety were gathered by questionnaire survey. The questionnaire pertained to biological ill effects and radiation safety measures in the form of multiple choice was given to each subject through an online survey.

Statistical Analysis Used:

Descriptive analysis was performed. Mann–Whitney U-test was used to analyze the difference between the different answers of preclinical and clinical students.

Results:

The overall correct response was 39.14% and it was noted in descending order from clinical students to preclinical students.

Conclusions:

Thus, there is a vast difference in knowledge and awareness between the preclinical and clinical dental students. Moreover, this clearly shows that continuing education of radiology risk effects should be stressed, especially among female dental students, since they attain different milestones in their lives right from puberty.
Percutaneous tension band wiring in acute complete acromioclavicular joint dislocation
Authors: El-Shennawy Maged M.
Published: June 2024

Background

Dislocation of the acromioclavicular joint (ACJ) is a common orthopedic injury among athletes and victims of motor vehicle accidents, predominantly motorcycle crashes. There is a common view that early surgical management should be recommended for patients with Rockwood types IV-VI ACJ injuries, as it would prevent long-term sequelae, and also it is required for patients with grades III with heavy manual occupations, athletes, and so on. None of the body joints had been treated with such profuse different techniques in an attempt to properly restore its natural situation.

Patients and methods

The present study describes and evaluates a new technique of percutaneous application of temporarily dynamic compression design of tension band wiring in type III, IV, and V acute complete ACJ dislocations. Preserving the already injured ACJ capsule, ligaments, surrounding deltotrapezial fascia, and muscles from open surgical trauma is subsequently presumed to contribute in significant stability. All patients underwent surgical management by percutaneous tension band wiring. Patients were followed up from the viewpoint of functional and radiological results at 2, 6, 12, 18 weeks, and 1 year after surgery.

Results

A total of 30 adult patients were enrolled in the study; one male patient was lost to follow-up at the 12th week appointment (implant extraction); hence, he was excluded from the results. The mean age of the patients was 31.4 years. Overall, 28 were males and two females. Clinical outcomes were regarded as excellent in 25 cases, representing 86.2% (average score=92.65) and good in three cases (average score=85), including a re-wiring case. Two patients (6.8%) experienced partial reduction loss. However, there were no significant differences (P=0.236) between the right and left shoulders regarding coracoclavicular distance.

Conclusion

Percutaneous tension band wiring technique has shown to provide satisfactory clinical results and shoulder functions. It provides stable fixation, allows early motion exercise by minimizing surgical trauma to preinjured tissues, lowers the complications of rigid internal fixation, and reduces cosmetic problem in scar.
Evaluation and Comparison of Smear Layer Removal Potency of Three Different Irrigation Regimes – A Stereomicroscopic and Scanning Electron Microscopic Study
Authors: Patel Megha C. , Bhatt Roshni A. , Joshi Kaushal R. , Vaghela Lilavanti L.
Published: June 2024

Background:

Irrigation plays a pivotal role in pulp therapy owing to its flushing action and removal of the smear layer which if present prevents penetration of medicaments and sealers into the dentinal tubules.

Aim:

This study aims to evaluate and compare the smear layer removal potency of three commercial Irrigating agents.

Materials and Methods:

Single rooted 30 teeth were selected, decoronated, and randomly divided into three groups according to the irrigation regime to be used (Group I − 5% sodium hypochlorite [NaOCl] + ethylenediaminetetraacetic acid [EDTA], Group II – Chloraxid Gel + EDTA, Group III – Tween Kleen + 3% NaOCl). After recommended biomechanical preparation and irrigation, teeth were stained with 1% methylene blue dye for 24 h and sectioned in 2 halves. Stereomicroscopy was used to assess dye penetration and scanning electron microscope (SEM) analysis was done to detect dentinal surface changes. Data were analyzed using one-way ANOVA test and Tukey honestly significant difference test by statistical software SPSS version 20.0.

Results:

The highest dye penetration exhibiting smear layer removal for the apical third was seen in Group II (44.78) and for the middle third in Group I (64.73) which was statistically significant. SEM analysis showed maximum dentinal tubules visibility and patency in Group I and minimum in Group III.

Conclusion:

Newer irrigating materials (1-hydroxyethylidene-1, 1-bisphosphonate) exhibited weak potency for smear layer removal. The sequential use of gold standard NaOCl + EDTA gave satisfactory results, however, in apical third NaOCl Gel + EDTA was found to be more effective. Therefore, it can be prudent to use NaOCl Gels as a safer alternative to conventional means.
Laser Assisted Modified Lip Repositioning Surgery for the Treatment of Excessive Gingival Display Using Y V Plasty
Authors: Ghumman Simran , Kalsi Devinder Singh , Sharma Vikrant , Arora Khushboo , Jaiswal Ajit , Chaudhary Girish
Published: June 2024

Excessive gingival display is matter of concern for a lot of patients and affects their psychological well-being. Various methods have been employed to reduce excessive gingival display but with variable results. Modified Lip repositioning is a surgical way to correct gummy smile by limiting the retraction of the elevator smile muscles and yet preserve the labial frenum using Y-V plasty using a method that gives long term results along with being non-invasive and has high patient compliance. After thorough disinfection and achieving adequate anaesthesia, the strip of mucosa which had to ablated was marked with a laser, which was twice the amount of gingival display seen in the patient. After carrying out laser ablation of the marked tissue, and performing Y-V plasty, the surgical area was evaluated and the wound margins were approximated with multiple interrupted sutures. The patient was put on a regular follow-up. The results revealed a marked reduction in gingival display at the 3-month follow-up. Overall gingival display reduced from 6 mm to 2 mm.
The Mask
Authors: Gupta Nupur , Sharma Anuradha , Khan Shaiza
Published: June 2024

The legendary Greek philosopher, Aristotle once said that “Man is by nature a social animal.” Biological transmission of any disease is linked to the social contact of human beings. Respiratory infections are the best example of it. Pandemics of respiratory viral illnesses in history have taught a lesson of simple measures to protect ourselves by using face masks. Since the last nine centuries, scientists have struggled to come up with the masks giving 95%–99% of protection against respiratory pathogens. Through this article, we aim to review the evolution of the mask through times, with the objective of finding its effectiveness in preventing infections and also its role as a source of infection. Various online databases were searched to find articles that provided description of evolution of the mask.
Prosthodontic Rehabilitation
Authors: Banerjee Saurav , Biswas Debabrata
Published: June 2024

Amelogenesis imperfecta is a genetically determined inherited disorder characterized by abnormal formation of tooth enamel leading to esthetic, functional, and psychological impact on the patient. If teeth affected are not treated early; the existing condition will further deteriorate, leading to injury to the attachment apparatus complicating the proposed treatment plan and future prognosis. The definitive objectives of this rehabilitation were to eradicate tooth sensitivity while restoring masticatory function and enhancing esthetics. Treatment plan included root canal treatment of the decrepit teeth followed by porcelain fused to metal restoration. This case report highlight the prosthodontic management of a patient diagnosed with hypomaturation type amelogenesis imperfecta.
Association between Bilateral Sagittal Split Osteotomy Setback and Autorotation of the Mandible
Authors: Zahara Syeda Fathimuz , Shetty Nandish , Harish Pooja , Husain Akhter
Published: June 2024

Introduction:

The study aimed to evaluate the autorotation for Class III malocclusions after the bilateral sagittal split osteotomy (BSSO) setback procedure

. Methodology:

This retrospective study includes lateral cephalograms of eight males and three females total of 11 patients who had undergone BSSO, without any other additional surgeries. The Frankfurt-Horizontal (F-H) plane was used as a reference and manual superimposition was done. Considering stable mandibular landmarks, reference line perpendicular (RLp) and reference line (RL) were drawn as x and y coordinates, respectively. Pre- and postsurgical statistics were used to compare using paired t-test where P < 0.05 was set for statistical significance.

Results:

Superimposed tracings showed no significant difference in pre- and postsurgical treatments. There was no statistically significant amount of autorotation after the BSSO setback procedure (P = 0.714).

Conclusion:

Hence, BSSO setback surgery will not cause any significant amount of autorotation of the mandible. If autorotation is required it must be incorporated into treatment planning.
Subcutaneous Emphysema of Dental Origin – Two Case Reports with a Comprehensive Review of Literature from 1965 to 2020, with an Emphasis on Timely Management
Authors: Melkote Deepti Rao , Rao Nageswar Ravella
Published: June 2024

Subcutaneous emphysema (SE) is a rare but possible complication of dental treatment resulting from the usage of high-speed air-driven instruments and introduction of irrigating solutions like hydrogen peroxide into soft tissues. Two case reports are described here, namely (a) drying of root canals using a three-way syringe by “Venturi” technique and (b) accidental injection of hydrogen peroxide instead of local anesthesia in an infiltration technique. A review of the literature is done wherein a search for terms such as pneumomediastinum, mediastinitis, embolism, or extensive SE (ESC) from 1965 to 2020 using the PubMed search engine was done and the results were tabulated. Since the number of cases and complications reported are on the rise, data regarding diagnosis, investigations, and a management protocol with an emphasis on prevention have been elaborated. Methods such as reductive manipulation or “counter incision,” as incited from medical literature, have been suggested to reduce morbidity and mortality. In both of the case reports, subcutaneous cervicofacial emphysema resolved briefly due to the effectual reduction maneuver implemented promptly.
Knowledge, Attitude, and Practice of Parents about Child’s Oral Health in Faridabad and its Correlation with Prevalence of Dental Caries in Children through a Questionnaire Survey
Authors: Singh Shivani , Saraf Bhavna Gupta , Sheoran Neha , Singh Ritu , Kapil Disha
Published: June 2024

Background:

An individual’s health and overall well-being are strongly correlated with their oral health. Parents’ knowledge, attitude, and practice have a great impact on the maintenance of child’s oral health.

Objective and Aim:

The aim of the study is to assess the knowledge, attitude, and practice of parents about child’s oral health in Faridabad and its correlation with prevalence of dental caries in children through a questionnaire survey in 3–6-year-old children.

Materials and Methods:

A cross-sectional study was conducted in Faridabad. The data were collected from the parents and their children 3–6 years old. A total sample of 400 parents and their children 3–6 years old residing in Faridabad was included. A questionnaire regarding knowledge, attitude, and practice about child’s oral health was given to the parents. The parents who volunteer to participate in the study their children were taken for the study examination.

Results:

Parental perception of early childhood oral health is critical for developing effective preventive measures. Parents play an important role in making decisions about their child’s oral health. The parents were given a self-administered questionnaire. The study included 400 parents and children aged 3–6 years. There was no significant difference in perception of their child’s oral health care between mothers and fathers. The majority of parents/caretakers had good knowledge about children’s oral hygiene, particularly fathers, but this knowledge did not appear to reflect in their attitude and practice.

Conclusion:

The current study concludes that parents are not well aware about dental disease prevention measures. As a result, it is the responsibility of the government and health-care providers to teach parents about oral health because they are role models for their children.
Knowledge, Attitude, and Practices of Parents on the Importance of Their Children's Oral Health in Greater Noida, India
Authors: Singh Sukhdeep , Awasthi Neha , Goel Dhirja , Khandelwal Deepak , Sachdeva Priyanka , Bakhtawar Rakshana
Published: June 2024

Background:

Parents and family members are considered the primary source for knowledge about child rearing and health habits for children. Young children's oral health maintenance and outcomes are influenced by their parent's knowledge and beliefs, which affect oral hygiene and healthy eating habits. Parental perception has a long-term influence in determining a child's oral health status.

Aim:

The aim of this study is to assess the oral health-related knowledge, attitude, and practices (KAP) of parents with children aged 3–5 years.

Materials and Methods:

A total of 500 parents of children aged 3 to 5 years were included in the study. A self-administered questionnaire, written both in English and local language (Hindi), validated through pre-tested survey, was given to the parents to assess the oral health related KAP. The results were calculated on the basis of frequency and percentages using the SPSS software.

Results:

Males comprised 49.8% and females comprised 50.2% of the respondents of questionnaire. Majority of fathers and mothers of the study population agreed for the importance of primary teeth. Almost all the participants in this study agreed that a child's teeth should be brushed/cleaned. A little less than half of study population considered 1 year as the suitable age for the child's first dental visit. A higher proportion of females as compared to males felt that night time bottle/breastfeeding leads to caries.

Conclusion:

Parental attitude, knowledge, and practices are responsible for their child's oral health. No statistical significance was seen between mothers and fathers on perception of their child's oral health care.
The Role of Decalcified Freeze-dried Bone Allografts in the Healing of Postoperative Osseous Defects Resulting from Cyst Enucleation
Authors: Joshi Tejashvini , Vyas Neha , Shah Nitu , Thaker Saket , Sanghvi Nesha
Published: June 2024

Background:

We performed this pilot study to evaluate the osteoinductive potential of decalcified freeze-dried bone allografts (DFDBA) in the healing of postsurgical osseous defects after cyst enucleation through radiographic bone density monitoring over a 6-month period.

Materials and Methods:

Patients aged between 18 and 70 years of either gender with noninfected odontogenic or nonodontogenic cystic jaw lesions measuring 1–5 cm in size were enrolled and randomly assigned to study group or control group. The study group patients were filled with DFDBA graft in bony defects resulting from the enucleation of the cysts, whereas no filling material was used in the control group. Sutures were removed on the 7th postoperative day and healing was assessed. Further follow-up visits were done at 1, 3, and 6 months. Bone densities were recorded with grayscale histogram using Adobe Photoshop (version CS 5.1) and compared across all follow-ups.

Results:

A total of 20 patients were enrolled in the study. Both the groups were balanced in terms of the baseline (preoperative) characteristics. There was a significant increase in bone density in the study group as compared to the control group at months 1, 3, and 6 after the surgery. There was an overall percentage increase in bone density (postoperative density as reference) at months 1, 3, and 6 in the study and control groups. However, the increase was significantly greater in the study group as compared to the control group at month 3 and month 6, whereas there was no difference between both the groups at month 1.

Conclusion:

Our findings suggest the osteoinductive potential of DFDBA in the healing of osseous defects resulting from the enucleation of cysts.
Lymphoblastic lymphoma presenting as soft-tissue swelling – A single-center experience
Authors: Nair Pallavi , Thambi Sugeeth M. , Narayanan Geetha , Vasudevan Jayasudha A. , Pallath Ashwin Mohandas , Nair Sreejith G.
Published: June 2024

BACKGROUND:

Lymphoblastic lymphomas (LBL) are a rare, aggressive type of non-Hodgkin lymphomas and constitute 2% of all lymphomas. It is classified as T-lymphoblastic lymphoma (T-LBL) and B lymphoblastic lymphoma (B-LBL) and resembles acute lymphoblastic leukemia (ALL), with no or limited bone-marrow involvement. LBL rarely present as soft-tissue swellings. Soft-tissue involvement is more common in B-LBL than in T-LBL. They occur predominantly in adolescents and young adults and have a prognosis similar to ALL.

OBJECTIVE:

p>The aim was to study the clinical characteristics, treatment response, and survival of patients with lymphoblastic lymphoma presenting with soft-tissue swelling.

SETTINGS AND DESIGN:

This was a retrospective study of eight adolescent and adult patients with lymphoblastic lymphoma presenting with soft-tissue swelling conducted in the Department of Medical Oncology at a tertiary cancer center in India.

STATISTICAL ANALYSIS:

The baseline patient characteristics, treatment details, and response assessment were analyzed using descriptive statistics. Overall survival (OS) and progression-free survival were obtained by the Kaplan–Meier method, using the SPSS version. 11.

MATERIALS AND METHODS:

We present the clinical features, imaging, diagnosis, treatment, and outcome of eight cases of lymphoblastic lymphoma presenting with soft-tissue swellings. Patients above 14 years of age treated over 12 years were included in the study.

RESULTS:

There were five males and three females. The median age at diagnosis was 24 years. Common presenting complaints were swelling, pain, and paraparesis. The sites of involvement were the epidural mass, thigh, calf, breast, and anterior chest wall. The diagnosis was confirmed by immunohistochemistry. Seven patients were diagnosed with B-LBL and one with T-LBL. They were treated with intensive chemotherapy (six patients with Berlin–Frankfurt–Munster protocol and two with hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone). Three patients received consolidation radiotherapy and one received palliative radiotherapy. Seven patients attained remission after induction chemotherapy and four of them are currently alive at a median follow-up of 48 months. The 2-year OS was 71.4%.

CONCLUSION:

Even though rare, lymphoblastic lymphoma should be considered a differential diagnosis in patients presenting with soft-tissue swelling and should be managed with systemic chemotherapy similar to ALL.
Evaluation of busulfan, cyclophosphamide, and etoposide as a preparation regimen for autologous stem cell transplantation in Hodgkin’s lymphoma patients
Authors: Biçim Soykan , Erkurt Mehmet Ali , Kuku İrfan , Kaya Emin , Berber İlhami , Kaya Ahmet , Hidayet Emine , Uysal Ayşe , Sarıcı Ahmet , Özen İlknur Nizam
Published: June 2024

BACKGROUND:

Hodgkin’s lymphoma (HL) exhibits a cure rate of 90% in patients diagnosed at an early stage and a cure rate ranging from 70% to 90% in patients diagnosed at an advanced stage. In the case of patients with relapsed/refractory HL (r/rHL), it is recommended to provide salvage chemotherapy initially, followed by autologous stem cell transplantation (ASCT). The ideal conditioning regimen for the transplantation process is still being investigated.

OBJECTIVES:

For individuals with r/rHL, high-dose chemotherapy combined with ASCT (HD-ASCT) is thought to be the most effective method of treatment. The purpose of this research was to evaluate the effectiveness and safety of the busulfan, cyclophosphamide, and etoposide (BuCyE) preparation regimen in r/rHL patients.

MATERIALS AND METHODS:

Retrospective analysis was conducted on the data of 67 lymphoma patients older than 18 years who had HD-ASCT with the BuCyE conditioning regimen between September 2014 and November 2021 (86 months). The research consisted of 34 r/r HL patients among them. A parenteral regimen of 0.8 mg/kg of busulfan every 6 h from day −7 to day −5, 50 mg/kg of cyclophosphamide on days −3 and −2, and 400 mg/m2 of etoposide on days −5 and −4 comprised the patient preparation regimen before ASCT. All data were collected from inpatient files and the Inonu University Turgut Ozal Medical Center Hospital Information System.

RESULTS:

The median age of the patients was 43 years, and 67.6% were males. The most common type of HL was nodular sclerosis, which was followed by mixed cellularity. The median time for platelet and neutrophil engraftment was 14 and 11 days, respectively. 5.0 × 106/kg was the median transplanted dose of CD34+ cells (2.1–13.55). Liver toxicity was observed in 6 (17.6%) patients. Eight patients suffered from pulmonary side effects. The median number of previous chemotherapies was 2 (2–4). In all lymphoma patients, the complete response rate was 61.8% (n = 21), whereas the disease progression rate was 32.3% (n = 11). Transplantation-related mortality on the 100th day was 8.8% (n = 3). Three-year overall survival was 57.17%.

CONCLUSION:

When the literature was reviewed, the studies with the BuCyE preparation regimen in patients with r/rHL were limited. This conditioning regimen was found to have fewer side effects and a lower cost. It can be preferable when compared to carmustine (BCNU), etoposide, cytarabine (ARA-C), and melphalan (known as BEAM) in r/rHL.
Primary calvarial tubercular osteomyelitic abscess presenting as scalp swelling—a rare case
Authors: Bhatia Ankit , Joshi Sharad , Tayal Nitesh , Vaish Manish
Published: June 2024

Tuberculosis (TB) is a well-known endemic problem in India. Skeletal tuberculosis constitutes about 1% incidence of all cases of tuberculosis, however, tuberculosis involving the skull bones is very uncommon even in endemic areas like India. The frontal and the parietal bones are the most commonly involved bones. We, hereby, report a young male presenting to us with scalp swelling in the left temporal region after a small trauma. The radiology revealed an abscess within the left right temporal bone and an associated bony defect. A temporal craniotomy was done and Gene-Xpert as well as Mycobacterium culture confirmed tubercular pathology. There was no reoccurrence on antitubercular therapy.
Safety and efficacy of bronchoscopy with transbronchial lung biopsy in interstitial lung diseases: our experience
Authors: N Neenu , MK Kanmani , Utpat Ketaki , Desai Unnati
Published: June 2024

Background

Interstitial lung diseases (ILDs) are a heterogeneous group of disorders with wide spectrum whose accurate diagnosis and proper treatment pose a great challenge. Our study is focused on safety and efficacy of bronchoscopy with transbronchial lung biopsy (TBLB) in patients with ILD.

Methodology

A prospective observational study of 68 patients was conducted in our tertiary care center. Diagnostic role, yield, and safety of TBLB in ILD were studied by comparing with high-resolution computed tomography (HRCT) patterns and histopathology.

Results

A total of 136 cases of ILD were referred to us in the said period. Of these, 75 patients underwent bronchoscopy and 68 underwent bronchoscopy with TBLB. Among them, the most common HRCT pattern was chronic hypersensitivity pneumonitis (HP) 47.06%. ILDs were subdivided as, with known cause (13.24%), 64.71% granulomatous ILDs (17.65% sarcoidosis and 47.06% chronic HP) and 22.06% idiopathic interstitial pneumonitis IIP). Pathological diagnosis of ILD was obtained in 54.41%. Based on etiological classification, pathological diagnosis was obtained in 46.67% IIP, 11.11% ILD with known cause, and 65.9% granulomatous ILD. A total of 16.2% patients had complications with no mortality. Complications associated with TBLB in IIP with non-IIP cases as well as usual interstitial pneumonia (UIP) with non-UIP cases were statistically significant.

Conclusion

Bronchoscopy was safe and well tolerated. Most important limiting factor was awareness about bronchoscopy and unwillingness for the procedure on understanding the risks of the same in ILD. TBLB is a useful diagnostic procedure for our ILDs as a part of multidisciplinary approach with total yield of 54.41% and more yield in chronic HP and sarcoidosis. We experienced a low rate of complications.
Knowledge, attitude, and practices regarding COVID-19 among the postgraduate medical students of a government medical college in Gujarat (India)
Authors: Parekh Aneri , Dave Jigna , Singhal Sanjay , Deokar Kunal
Published: June 2024

Objective:

To assess postgraduate students’ knowledge, attitude, and practices regarding COVID-19.

Methods:

A self-designed online questionnaire was circulated to the postgraduate students. Mean knowledge, attitude, and practice scores were calculated and compared among different study groups with the ANOVA test.

Results:

Out of 254 postgraduate students approached, 220 responses were received, so the final sample size was 220. Out of 220 students enrolled, 159 (72.27%) students had good knowledge and 61 (27.73%) students had poor knowledge; 167 (75.90%) students had a positive attitude, 51 (23.18%) students had a neutral attitude, and only two (0.92%) students had a negative attitude; 196 (89.09%) students observed good practices whereas 24 (10.91%) students observed poor practices.

Conclusion:

Most students had good knowledge, a positive attitude, and good practices.
Isolated hemorrhagic pleural effusion due to sarcoidosis in a patient with primary Sjogren syndrome
Authors: Abdulla Mansoor C.
Published: June 2024

Sarcoidosis is a multisystem disease which rarely involves pleura resulting in various manifestations including pleural effusion, pneumothorax, pleural thickening, hydropneumothorax, trapped lung, hemothorax, or chylothorax. Hemorrhagic Pleural effusion secondary to sarcoidosis is extremely rare. Sarcoidosis is considered to be exclusion criteria for diagnosis of sjogrens syndrome (SS). But there are reports showing coexistence of these two disorders in the past. We present a patient with SS who presented with isolated hemorrhagic pleural effusion due to sarcoidosis.
Echocardiographic Evolution of PosteroLateral Left Ventricular Aneurysm with Normal Coronary Arteries in Patient Recently COVID-19 Vaccinated
Authors: Ceresa Fabrizio , Micari Antonio , Trifirò Maria Paola , Costa Francesco , Vizzari Giampiero , Giuseppe Alessio Vite , Patanè Francesco
Published: June 2024

A 72-year-old woman, recently COVID-19 vaccinated with a third dose, was referred to our center for acute chest pain and dyspnea. On admission, the electrocardiography showed a STEMI on inferior derivations and the dyskinesia of the inferior wall was found at the first transthoracic echocardiogram. The coronary angiography did not show coronary artery disease. After 1 week, a huge posterolateral left ventricular (LV) aneurysm with initial signs of rupture was found and the patient underwent a Dor's procedure to exclude the LV aneurysm. As far as we know, this is the first reported case of Takotsubo following the COVID-19 vaccination requiring cardiac surgery.
Impact of Coronary Microvascular Dysfunction on Myocardial Strain in Patients with Heart Failure and Preserved Ejection Fraction
Authors: Yahia Mohamed , Emara Ahmed , Abdou Waleed , Ewis Mohamed Fouad
Published: June 2024

Background:

This research aimed to evaluate the role of coronary microvascular dysfunction in alteration of left ventricular (LV) myocardial deformation.

Materials and Methods:

This observational study involved 50 patients with LV ejection fraction (LVEF) >50% and coronary microvascular dysfunction (diagnosed by coronary angiography). TIMI frame count (TFC) was calculated for each patient. They were classified into 2 groups: 30 patients with heart failure and preserved ejection fraction (HFpEF) (cases group) and 20 patients without HF (control group). Speckle tracking echocardiography was used to evaluate LV deformation.

Results:

The mean age of the studied patients was 58.8 ± 8 years. The frequency of diabetes mellitus, hypertension, and dyslipidemia were significantly higher in cases than controls. Cases had significant higher BMI (30 ± 4.48 vs. 27.3 ± 3.94 kg/m2, P=0.029). The total TFC in cases was 97.1 ± 22.9 and in controls was 79 ± 18.5, and this difference was statistically significant (P=0.005). Significantly decreased LV global strain was observed in HFpEF cases than in controls (−17.6 ± 2.14 % versus −19.5 ± 1.98%, P < 0.001). In cases with a higher TFC, the LV global strain decrease was more pronounced. There was a significant correlation between the LV global strain and total TFC (r=-0.470 and P=0.009).

Conclusion:

Patients with HFpEF exhibited higher total TFC reflecting more affected coronary microvasculature. Those patients had reduced LV global strain. Coronary microvascular dysfunction probably leads to alteration of myocardial performance.
Chest Shape Influences Ventricular-Arterial Coupling Parameters in Infants with Pectus Excavatum
Authors: Sonaglioni Andrea , Nicolosi Gian Luigi , Braga Marta , Villa Maria Cristina , Migliori Claudio , Lombardo Michele
Published: June 2024

Background:

The present study was designed to investigate the possible influence of chest shape, noninvasively assessed by modified Haller index (MHI), on ventricular-arterial coupling (VAC) parameters in a population of term infants with pectus excavatum (PE).

Methods:

Sixteen consecutive PE infants (MHI >2.5) and 44 infants with normal chest shape (MHI ≤2.5) were prospectively analyzed. All infants underwent evaluation by a neonatologist, transthoracic echocardiography, and MHI assessment (ratio of chest transverse diameter over the distance between sternum and spine) within 3 days of life. Arterial elastance index (EaI) was determined as end-systolic pressure (ESP)/stroke volume index, whereas end-systolic elastance index (EesI) was measured as ESP/left ventricular end-systolic volume index. Finally, VAC was derived by the Ea/Ees ratio.

Results:

At 2.1 ± 1 days after birth, compared to controls (MHI = 2.01 ± 0.2), PE infants (MHI = 2.76 ± 0.2) were diagnosed with significantly smaller size of all cardiac chambers. Biventricular systolic function, left ventricular filling pressures, and pulmonary hemodynamics were similar in both the groups of infants. Both EaI (4.4 ± 1.0 mmHg/ml/m2 vs. 3.4 ± 0.6 mmHg/ml/m2, P < 0.001) and EesI (15.1 ± 3.0 mmHg/ml/m2 vs. 12.7 ± 2.5 mmHg/ml/m2, P = 0.003) were significantly increased in PE infants than controls. The resultant VAC (0.30 ± 0.10 vs. 0.30 ± 0.08, P > 0.99) was similar in both the groups of infants. Both EaI (r = 0.93) and EesI (r = 0.87) were linearly correlated with MHI in PE infants, but not in controls. On the other hand, no correlation was found between MHI and VAC in both the groups of infants.

Conclusions:

Chest deformity strongly influences both Ea and Ees in PE infants, due to extrinsic cardiac compression, in the absence of any intrinsic cardiovascular dysfunction.
Approach to the Patient with Acute Aortic Syndromes in Light of the New Consensus Statement on Multimodality Imaging in Thoracic Aortic Diseases
Authors: Muratori Manuela , Mancini Maria Elisabetta , Tamborini Gloria , Mushtaq Saima , Annoni Andrea , Fusini Laura , Celeste Fabrizio , Baggiano Andrea , Fazzari Fabio , Mantegazza Valentina , Pontone Gianluca , Pepi Mauro
Published: June 2024

Acute aortic syndromes comprise a range of interrelated conditions including aortic dissection, intramural hematoma, penetrating atherosclerotic ulcer, and contained or not contained aortic aneurysm rupture. These syndromes are potentially life threatening; therefore, a rapid and accurate diagnosis is crucial. A new Clinical Consensus Statement on Aortic and Peripheral Vascular Disease has recently been published, and we will try to highlight the main innovations in the document.
A Case of Dyspnea in a Patient with a Previous Coronavirus Disease Infection
Authors: Tripodi Vincenzo Francesco , Bellieni Luca , Scigliano Fabio , Rossi Michele , Fratto Pasquale , Benedetto Frank Antonio , Mazzeo AnnaTeresa
Published: June 2024

Myxoma is the most common benign primary tumor of the heart. Diagnosis of cardiac myxoma is difficult as it presents itself with varying nonspecific symptoms, and an echocardiography can easily diagnose it. Sometimes, it can cause cardiac syncope and thromboembolic events. A woman with a recent infection by severe acute respiratory syndrome coronavirus-2 was admitted to our hospital with respiratory symptoms: dyspnea and tachypnea; cardiac symptoms: atrial fibrillation; and neurological symptoms: syncope. Initially, she performed brain computed tomography (CT) and CT angiography value. Transthoracic echocardiogram and transesophageal echocardiogram showed an atrial mobile mass. Chest X-ray did not show any interstitial lesions. Therefore, urgent cardiac surgery was performed to remove the mass. The histological examination confirmed the presence of a cardiac myxoma. Our experience could show the importance of early diagnosis and prompt surgical treatment to prevent stroke.
Unveiling the Hidden Chamber: Exploring the Importance of Left Atrial Function and Filling Pressure in Cardiovascular Health
Authors: Pergola Valeria , D’Andrea Antonello , Galzerano Domenico , Mantovani Francesca , Rizzo Massimiliano , Giannuario Giovanna Di , Khoury Georgette , Polizzi Vincenzo , Rabia Granit , Gimelli Alessia , Campana Marco
Published: June 2024

The left atrium (LA) is a vital component of the cardiovascular system, playing a crucial role in cardiac function. It acts as a reservoir, conduit, and contractile chamber, contributing to optimal left ventricle (LV) filling and cardiac output. Abnormalities in LA function have been associated with various cardiovascular conditions, including heart failure, atrial fibrillation, valvular heart disease, and hypertension. Elevated left ventricular filling pressures resulting from impaired LA function can lead to diastolic dysfunction and increase the risk of adverse cardiovascular events. Understanding the relationship between LA function and LV filling pressures is crucial for comprehending the pathophysiology of cardiovascular diseases and guiding clinical management strategies. This article provides an overview of the anatomy and physiology of the LA, discusses the role of LA mechanics in maintaining normal cardiac function, highlights the clinical implications of elevated filling pressures, and explores diagnostic methods for assessing LA function and filling pressures. Furthermore, it discusses the prognostic implications and potential therapeutic approaches for managing patients with abnormal LA function and elevated filling pressure. Continued research and clinical focus on left atrial function are necessary to improve diagnostic accuracy, prognostic assessment, and treatment strategies in cardiovascular diseases. It will explore the importance of assessing LA function as a marker of cardiac performance and evaluate its implications for clinical practice. In accordance with rigorous scientific methodology, our search encompassed PubMed database. We selected articles deemed pertinent to our subject matter. Subsequently, we extracted and synthesized the salient contents, capturing the essence of each selected article.
Isolated Tricuspid Regurgitation Alternans in Acute Myocardial Infarction
Authors: Agarwal Rakesh
Published: June 2024

Pulsus alternans is characterized by alternating strong and weak beats, and occurs with failing hearts. Left ventricular pulsus alternans is known to occur with ischemic heart disease, valvular heart disease, and outflow tract obstructions. Isolated right ventricular (RV) pulsus alternans is a rare entity. We report the case of a 51-year-old male patient who presented with inferior wall myocardial infarction and cardiogenic shock. He was diagnosed to have an isolated tricuspid regurgitation alternans signifying severe RV dysfunction. The patient was resuscitated and treated with primary percutaneous intervention to the right coronary artery. We also review the literature associated with RV pulsus alternans and its mechanisms.
Sensitivity and Reproducibility of Inferior Vena Cava Diameter and Superior Vena Cava Flow Velocity Measurements to Changes in Cardiac Preload in Subjects with Hypertension
Authors: Mcnally Ryan John , Farukh Bushra , Chowienczyk Phil J. , Faconti Luca
Published: June 2024

Objectives:

We investigated the sensitivity and reproducibility of inferior vena cava (IVC) diameters and superior vena cava (SVC) flow velocities in detecting changes in cardiac preload in clinically euvolemic subjects with hypertension.

Methods:

Measurements were obtained during passive leg raising (PLR) and lower limb venous occlusion (LVO), interventions which respectively transiently increase and decrease cardiac preload. Measurements were made in 36 subjects and repeated on two separate occasions to examine reproducibility.

Results:

During PLR, there was no significant change in IVC diameters, but peak flow velocity of the SVC S wave increased by 6.5 (95% confidence interval 1.6–11.3) cm/s (P = 0.01). During LVO, IVC diameter in expiration decreased by 3.2 (1.7–4.7) mm and the SVC S wave decreased by 9.7 (4.4–14.7) cm/s (P < 0.001). Venae cavae-derived indices can be used to assess changes in preload within the physiological range in euvolemia.

Conclusions:

Despite suboptimal reproducibility of baseline measurements, high agreeability between the changes in IVC diameter and SVC flow after LVO suggests that these indices can be used to monitor changes in cardiac preload.