bluuebunny/crossref_metadata_2025 huggingface dataset:
Association between Diabetes Mellitus and Immunity to Some Bacterial Infections
Authors: Al-Jamal Mustafa Hussam Abd Ali , Al-Khikani Falah Hasan Obayes
Published: May 2024

Background:

Diabetes mellitus (DM) is a major public health problem, affecting about 10% of the population, its pathogenesis and possible causes are still unclear. Helicobacter pylori (H. pylori) and Salmonella spp. are one of the most common human bacterial pathogens, and infection causes a wide array of systemic and gastric disorders. The aim of this study is to find a possible correlation between DM and immunity to some bacterial infections.

Materials and Methods:

A total of 100 serum specimens were collected from different groups, 34 patients with diabetes mellitus, 33 patients with prediabetic, and 33 persons as a control group. All these samples tested for random blood sugars (RBSs), immunoglobulin G (IgG) antibody to H. pylori, antibodies to Salmonella typhi and Salmonella paratyphi, serum urea, and serum creatinine.

Results:

The mean of RBS in diabetic patients was 297.44 ± 84.662, while for the control group, it was 93.44 ± 9.702, with a high significant difference (P = 0.000). The prevalence of S. typhi and S. paratyphi among diabetic, prediabetic, and control groups was 32.35%, 27.27%, and 48.48%, respectively. No significant differences in urea and creatinine between all groups at P = 0.67 and P = 0.23, respectively.

Conclusions:

Significant differences between diabetic and control groups regarding IgG antibodies to H. pylori have been observed (P = 0.04). Hence, these antibodies represent a risk factor in DM. In spite of the high percentage of positive results for S. typhi and S. paratyphi in the control groups 48.48% compared to the diabetic group 32.35%, it is still insignificant at P = 0.17. Hence, antibodies to Salmonella spp. may represent the protective factor.
A Study to Assess the Effectiveness of Audiovisual Education on Mirror Therapy Exercises among Hospitalized Stroke Patients at a Tertiary Care Hospital of South Indian Town
Authors: Ramaswamy Deepa , Parimala S.
Published: May 2024

Background:

Hemiplegia, which means paralysis of one side of the body, is one of the most common and debilitating effects of a stroke. Stroke is a leading cause of permanent disability in adults. It is estimated that there will be 23 million new cases of strokes and 8 million stroke deaths in 2030. Mirror therapy (MT), in addition to a traditional rehabilitation program, was found to be useful in terms of motor recovery and upper limb function.

Materials and Methods:

The current study aimed at assessing the effect of audiovisual education on MT exercises among the hospitalized stroke patients. A quasi-experimental design was adopted in this study, where the audiovisual education was given to the experimental group, whereas routine treatment was given to the control group.

Results:

The result shows that in the experimental group, the majority (40%; n = 6) of the patients belonged to the age group of 61–70 years, whereas in the control group, majority (33.3%; n = 5) of the patients belonged to the age group of 51–60 years and 61–70 years. Majority (60%) of the patients in this study were male.

Conclusion:

MT exercises were found to be an effective, low-cost, and nonpharmacological method of lowering pain in stroke patients in the hospital.
Study of Bone Marrow Iron Storage in Patients Presented with Pancytopenia
Authors: Bardapurkar Padmakar , Randive Ruchi Samir , Gurwale Sushama , Gore Charusheela Rajesh , Viswanathan Vidya
Published: May 2024

Introduction:

Bone marrow examination is a useful technique for the evaluation of both hematological and nonhematological diseases. Perls Prussian blue stain is the “gold standard” to demonstrate the iron content and hemosiderin in the sideroblasts and the bone marrow macrophages. In our study, we assess the grades of iron storage in the bone marrow, as seen in various diseases in pancytopenia patients.

Materials and Methods:

An evaluation of iron storage in bone marrow aspirate of 140 patients of pancytopenia in a tertiary care center in western India, using Perls’ stain and Gales’ system of grading.

Results:

Out of all pancytopenia cases, 60.71% of the cases had low iron stores, 30% had normal, and 9.29% of cases had high iron stores, using Gales’ system of iron stores grading. Dimorphic anemia was in the range of 0–3 iron store grade, with 72.4% having low iron stores, 24.6% having normal iron stores, and 2.8% having high iron stores. Megaloblastic anemia showed iron store grade in the range of 0–4, and iron-deficiency anemia showed decreased iron stores, along with multiple myeloma, acute lymphoblastic leukemia, and aplastic anemia.

Conclusion:

Gale’s method of grading is used universally to grade iron stores in bone marrow aspirate as it is highly convenient and result oriented and it helps clinicians to plan necessary treatment accordingly.
A Case Report on Smear-Positive Pulmonary Tuberculosis with Neurofibromatosis Type-1
Authors: Chavda Khushboo , Mistry Smit , Sajan Cyril
Published: May 2024

Neurofibromatosis (NF) is a group of disorders that is caused by a genetic mutation which is dominantly inherited neurogenetic disorder. They are of three types: NF1, NF2, and schwannomatosis. Out of these three, NF1 is the most common. NF1 mainly affects the skin, peripheral and central nervous system, bones, cardiovascular, and endocrine systems. Tuberculosis is a bacterial infection of the lung that is caused by Mycobacterium tuberculosis. It spreads by speaking, sneezing, and coughing in the air. Active pulmonary infections can spread to other people. Here, we represent a case of a 45-year-old male diagnosed with pulmonary tuberculosis (PTB) presenting with breathlessness, fever, loss of appetite, runny nose, nervousness, and dry cough. The patient had multiple swellings over the body with papules and nodules seen on different parts of the body. Cafe-au-lait macules were also present. After the all-over examination, the patient was diagnosed with smear-positive PTB with NF1.
Inconspicuous Suprascapular Arteriovenous Malformation Causing Suprascapular Nerve Entrapment: Unique Case Report
Authors: Nimje Varun Vasant , Bodhankar Shubham Baburao , Yadav Tushar Suresh
Published: May 2024

Arteriovenous malformations (AVMs) are congenital high-flow vascular malformations and are generally diagnosed when they cause localized swelling, pulsatility, or skin changes. AVMs only manifest themselves when they are sufficiently large. We present a case of a young woman presenting with nonspecific pain over the posterior aspect of the left shoulder that was found to be due to suprascapular nerve entrapment caused by an unremarkable AVM. Entrapment of the suprascapular nerve as a cause of shoulder pain is in itself unusual. That being said, AVM is even rarer and uncommon as a cause of suprascapular nerve entrapment.
Cytokines and Inflammatory Markers in Nonalcoholic Fatty Liver Disease: A Narrative Review
Authors: Patel Sujal , Bawankule Shilpa , Acharya Sourya , Kumar Sunil
Published: May 2024

Increased liver fat content is a hallmark of nonalcoholic fatty liver disease (NAFLD), a group of histological abnormalities. It has been proposed that these alterations in hepatic and systemic inflammation may be connected and that the presence of fat deposition in the liver is crucial for the diagnosis of NAFLD. Uncertainty surrounds whether each histological category reflects an unlike disease or merely various stages of the same disease may alter the pathogenesis and prognosis of NAFLD. A considerable activation of inflammatory cells and an increase of a variety of soluble inflammatory mediators are characteristics of nonalcoholic steatohepatitis. The most inflammatory NAFLD has a higher risk of developing into serious and chronic liver disease. Among other mediators, cytokines and chemokines may be important in NAFLD and are being researched as possible treatment targets. In this review, we will update our understanding of the potential impact that cytokines and chemokines may have in the emergence of NAFLD.
Management of Unilateral Temporomandibular Joint Ankylosis by Interpositional Arthroplasty and Bilateral Coronoidectomy
Authors: Malhotra Prachur , Venkatesh Rashmi , Shah Deep , Badi Kavita , Chandalia Saurabh
Published: May 2024

Ankylosis of the temporomandibular joint (TMJ) is an intracapsular union of the disc-condyle complex to the temporal articular surface that restricts mandibular movement, including the fibrous adhesions or bony fusion between condyle, disc, glenoid fossa, and articular eminence. It is more commonly associated with trauma, local or systemic infection, or systemic diseases. It is a serious and disabling condition that may cause problems in facial growth, mastication, swallowing, digestion, speech, appearance, and poor oral hygiene. The severity of ankylosis is diagnosed by evaluating the degree to which mouth opening is restricted. Conventional X-rays, computed tomography scans, or magnetic resonance imaging tests determine the abnormality in the bony or soft tissue formations in the joint area. The treatment of TMJ ankylosis poses a significant challenge because of the high incidence of recurrence. In this article, we report a case of a 27-year-old adult female who presented with left TMJ ankylosis and was treated with interpositional arthroplasty and bilateral coronoidectomy.
Comparing the Effectiveness of Ayurvedic, Homeopathic, and Conventional Dentifrice on Gingiva: A Double-Blind Randomized Controlled Trial
Authors: Kengadaran Shivashankar , Divvi Anusha , John Joseph
Published: May 2024

Background:

Dental diseases are a major public health problem worldwide. The World Health Organization reports a prevalence of over 60%–90% of dental caries and gingiva diseases among school children worldwide. Fluoridated dentifrices were considered to be the gold standard for the prevention of dental diseases. However, the side effects encountered with these dentifrices have led to the search for novel and safe alternatives.

Aim:

This study aims to compare the effectiveness of Ayurvedic, Homeopathic, and Conventional dentifrice on the gingiva.

Setting and Design:

Double-blinded, parallel-group, randomized clinical trial.

Materials and Methods:

The study was conducted among healthy adults. Subjects were randomly allocated to three groups (n = 54). Group I-Herbal dentifrice, Group II-Homeopathic dentifrice and Group III-Fluoride dentifrice. Plaque and gingival indices were recorded at baseline, 14th day, and 28th day of follow-up.

Statistical Analysis Used:

Paired t-test and One-way ANOVA.

Results:

The mean plaque and gingiva index scores were significantly reduced by all treatment groups at the 28th day follow-up. The mean gingival index scores were reduced among all three groups. However, Group I showed the highest reduction (Group I [0.46 ± 0.09] followed by Group II [0.50 ± 0.10] and Group III [0.50 ± 0.14]) at the 14th day and (Group I [0.45 ± 0.09] followed by Group II [0.49 ± 0.06] and Group III [0.44 ± 0.9]) at the 28th day, respectively. The reduction was found to be statistically significant.

Conclusion:

All three groups exhibited antiplaque activity by bringing about a significant reduction in mean plaque and gingival index at 14th day and 28th day. Among all the dentifrices, Group I (Herbal dentifrice) showed better results compared to other groups.
Comparison of Cytokeratin Expression Vis-à-Vis Bloom–Richardson Grading of Breast Carcinoma in Resource-limited Setup: A Cross-sectional Study
Authors: Mishra Preeti , Vagha Sunita , Shukla Samarth , Acharya Sourya , Jagtap Miheer Milind
Published: May 2024

Background:

Breast cancer is the most common malignant tumor and the leading cause of female mortality. Its incidence and prevalence are rapidly increasing worldwide. Age <35 years, multiple nodal involvements, ad increased size and grade are the bad prognostic factors indicating a higher risk of recurrence. Early diagnosis of breast cancer is one of the best approaches to prevent this disease.

Aim:

The aim of this study is to develop an understanding of the relationship between cytokeratin (CK) 5/6 and CK 8/18 expression and the Bloom–Richardson (BR) grading of carcinoma breast.

Materials and Methods:

The present observational, analytical, and cross-sectional study investigated CK 5/6 and CK 8/18 expression in relation to the BR grade in 50 cases of infiltrating ductal carcinoma. Hematoxylin and eosin staining for BR grade and immunohistochemistry for CK 5/6 and CK 8/18 was carried out in the histopathology and immunohistochemistry sections of the Department of Pathology, Jawaharlal Nehru Medical College, Sawangi (M).

Results:

Out of 50 cases, CK 5/6 expression was observed in the majority of BR Grade III cases (87.50%) indicating a basal phenotype, and CK 8/18 expression was seen in the majority of BR Grade I cases (92.86%) signifying a luminal phenotype. The P value interpretation was found to be statistically significant (<0.05).

Conclusions:

CKs along with BR grading can be used as an alternative tool for predicting the endocrine status of carcinoma breast instead of employing an expensive panel of markers.
Aldehyde Dehydrogenase Isoform 1 as an Indicator in the Malignant Potential of Cutaneous Lichen Planus
Authors: Aliakbarpour Fatemeh , Alijanpour Robabeh , Ghorbani Raheb , Bisheh Saba Gilaki , Kashfi Arezoo , Sohanian* Shabnam
Published: May 2024

Introduction:

Hypertrophic variant of cutaneous lichen planus (CLP) is a chronic variant with controversial malignant association. Since aldehyde dehydrogenase isoform 1 (ALDH1) is considered as a prognostic marker in various cancers and its expression was significantly associated with malignant transformation in the oral type of lichen planus. So we decided to assess the ALDH1 expression in CLP in order to know the role of this biomarker in the CLP.

Materials and Methods:

Thirty blocks of CLP from the archive of Dermatology Department of Babol University of Medical Sciences and 30 blocks of normal skin as the control group were selected. Immunohistochemical staining for ALDH1 marker was performed. In terms of evaluation of the ALDH1 expression, the percentage of stained cells as well as the intensity of cytoplasmic staining was considered.

Results:

In this study, the percentage of stained cells, the intensity of staining the epidermal cells, and the final score of the ALDH-1 expression were significantly different between two groups (P < 0.001). There was no significant relationship between ALDH-1 expressions and sex (P = 0.0202), and also, lesion location and final score (P = 0.345). No correlation was found between age and ALDH-1 expression (P = 0.217, r = 0.232).

Conclusion:

To sum up, ALDH1 was significantly expressed in CLP; furthermore, the expression may be correlated with malignant transformation. Consequently, ALDH1 might be an independent prognostic indicator in CLP. However, further studies with larger patient samples are required to verify the findings of the current study.
Endoscopic Retrograde Cholangiopancreatography Findings in HIV Cholangiopathy Patients
Authors: Alsari Marwan Taher , Elfaghih Salah , Tumi Ali
Published: May 2024

HIV infection and its related opportunistic infections increasing the risk of having HIV-related cholangiopathy, especially those who had low CD4 counts. In this case series, we assessed the findings of endoscopic retrograde cholangiopancreatography and the interventions required in those patients who underwent this procedure at Tripoli Central Hospital between January 2007 and December 2020, comparing them with previous studies conducted in other centers. Our study concluded that common bile duct strictures are more frequent finding than papillary stenosis, and accordingly most of those patients managed by placing common bile duct stent rather than sphincterotomy only.
Morphometric Study of Lumbar Vertebral Pedicles by Using Computed Tomography among Adults in Kano, Nigeria
Authors: Lawal Yusuf , Ibrahim Mustapha U. , Saleh Mohammed K. , Adamu Mansur Y. , Hikima Mustapha Shu’aibu , Abubakar Musa
Published: May 2024

Context:

Precise anatomical knowledge of lumbar pedicle dimensions is necessary to make a clinical diagnosis of lower back pain, and any structural deviation of the pedicles may result in interference with the weight transmission mechanism and compression of neural structures.

Aim:

To evaluate the morphometric dimensions of lumbar vertebral pedicles among normal adults in Kano by using computerized tomography scan images.

Materials and Method:

This was a hospital-based cross-sectional study that was conducted in the radiology department of Aminu Kano Teaching Hospital (AKTH). This study was conducted over 1 year and included 110 adults aged 18–75 years involving both sexes in Kano, using their CT scan images from L1 to L5, following IRB ethics approval. Each vertebral pedicle was measured in transverse and sagittal planes. The measurements included the pedicle width (PW), sagittal pedicle height (SPH), and the pedicle chord length (PCL) of individual pedicles. The mean and standard deviations for each measurement parameter were determined, and parametric correlation tests were performed to determine the relationships between age, sex, and ethnicity.

Statistical Analysis Used:

Data analysis was performed using the statistical software package IBM SPSS Statistics version-23 for Windows. The significance level was considered at P < 0.05.

Results:

Mean PW size increased craniocaudally along the lumbar spine from L1 (7.49 ± 1.52 mm) to L5 (14.31 ± 1.93 mm). A gradual decrease in mean SPH sizes from L1 (14.53 ± 1.32 mm) to L5 (11.73 ± 1.38 mm) was noted, while mean PCL showed an irregular “U” pattern, with the smallest size at L4 (44.63 ± 3.42 mm) and highest at L2 (46.80 ± 3.85 mm). All measured dimensions were significantly higher in the right pedicles and among male subjects (P < 0.05). Age and ethnicity did not consistently affect pedicle dimensions (P > 0.05).

Conclusion:

This study observed right pedicle dimensions and male subjects as having significantly larger pedicle diameters, with age and ethnicity not having a significant effect on pedicle sizes across all vertebral levels.
Pedicled Anterolateral Thigh Flap
Authors: Elnahas Mohamed Abdalla
Published: May 2024

Background:

Once it has been first described by Song et al., in 1984, anterolateral thigh (ALT) flap gains wide popularity as a free flap with only a few reports in the literature regarding its application as a pedicled flap in regional soft-tissue reconstruction in pediatric patients.

Materials and Methods:

The author describes his experience about the role of pedicled ALT flap in reconstruction of different local defects in pediatric patients. Representative cases are presented for illustration.

Results:

Nine patients with ischial, trochanteric, and groin defects have been reconstructed by pedicled ALT flap between January 2018 and January 2019. The patients were between 7- and 15-year-old. The size of the flaps measured from 4 cm × 6 cm to 19 cm × 17 cm. The type of the flap was myocutaneous flaps in six cases and as perforator flaps in three cases. Primary closure of the donor site has been done in seven cases while split-thickness skin grafts were done in two cases. Eight flaps have been totally survived while partial necrosis has been occurred in the distal end of one case.

Conclusion:

Pedicled ALT flap provide a reliable and versatile option for plastic surgeons in reconstruction of difficult regional soft-tissue defects in pediatric patients especially when bulkiness and resistance of infection is indicated, with accepted functional and cosmetic results.
Polymethylmethacrylate Bone Cement Utilization for Hemostasis in an Intraosseous Arteriovenous Malformation
Authors: Dadaci Mehmet , Kendir Munur Selcuk , Baycar Zikrullah , Ince Bilsev
Published: May 2024

A 15-year-old girl applied to the outpatient clinic with an arteriovenous malformation, measuring approximately 20 cm × 10 cm, on the anterior aspect of the right knee. She was admitted to operation because of the failure of the previous embolization attempts. Intraoperatively, there was uncontrolled bleeding from the nidus which is located at the medulla of the tibia. After the failure of initial efforts, hemostasis could be achieved using polymethylmethacrylate cement. Arteriovenous malformations (AVMs) may cause life-threatening bleeding. In uncontrolled intraosseous bleeding, bone cement could be used for hemostasis. In this study, we present an AVM case and our experience about its management.
Freestyle Anterolateral Thigh Flap and Perforator Variations
Authors: Gur Ersin
Published: May 2024

Introduction:

Anterolateral thigh (ALT) flap has become an increasingly popular reconstructive option, especially for head-and-neck and extremity defects. In addition to the many advantages of the ALT flap, there are also some disadvantages such as individual variations in the number and location of cutaneous perforators. Doppler ultrasonography (USG) is one of the most frequently used methods to overcome variations in perforator anatomy. However, the Doppler device may obtain false results so some clinics use the “freestyle” harvesting technique for ALT flap. The aim of the study is to examine experience with freestyle ALT flap harvesting and to evaluate the perforator variations.

Materials and Methods:

Between 2018 and 2021, 59 ALT flaps were harvested by the same microsurgical team for head-and-neck reconstructions. Of 59 patients, 23 were female and 36 were male. Cases were performed without using preoperative or peroperative imaging techniques.

Results:

In 2 (3%) of 59 patients, different septocutaneous flap options were used because suitable perforators could not be found in both thigh regions. For 57 ALT flaps, the rate of descending branch of lateral circumflex femoral artery (LCFA) perforators was 73%, transverse/ascending branch was 17%, aberrant perforators other than classical branches of LCFA was 7%, and the perforator from medial circumflex femoral artery was 1%. Partial necrosis due to perfusion problem was experienced in one flap and total necrosis was in two flaps.

Conclusion:

The advantages of the freestyle technique, such as allowing the evaluation of all perforators and designing flaps according to the appropriate perforator, provide great flexibility and convenience to the surgeon. With this, surgical problems caused by inaccurate results obtained by devices such as Doppler USG are excluded.
In-Depth Survey of Demographic, Clinical, and Operative Measures in Cleft Lip and Palate Patients in Northwestern Turkey
Authors: Karadag Sari E. Cigdem , Yasar Emrah Kagan , Eren Guler Gamze , Altinkaya Altug , Agir Hakan
Published: May 2024

Background:

Orofacial clefts are the most common congenital craniofacial anomalies, globally. However, few reports describe cleft demographic, clinical, and surgical information in a Turkish population.

Aims and Objectives:

The aim of this study is to investigate the demographic, clinical, surgical information and outcomes of cleft lip and/or palate (CL/P) patients in Northwestern Turkey.

Materials and Methods:

We assessed demographic, clinical, operative characteristics, and postoperative complications data in this retrospective review of electronic medical records at a tertiary referral center from 2005 to 2015.

Results:

Our study included 150 CL/P patients (88 men, 62 women). Cleft lip and palate (CLP) was the most prevalent type of cleft (60%), followed by isolated cleft palate (31.3%) and isolated cleft lip (8.7%). The rates of maternal folic acid use, smoking, alcohol intake, and consanguinity were 83.3%, 5.3%, 1.3%, and 3.3%, respectively. Nasoalveolar molding was applied mostly in bilateral—not unilateral—CLP patients. The modified, extended Mohler technique was common for cleft lip repairs. Most cleft palate repairs used Bardach's two-flap palatoplasty combined with radical intravelar veloplasty. Most cases required grommet insertion. For cleft palate patients, myringotomy or paracentesis was performed in 12.8% of repairs, and acellular dermal matrix was used in 28.5% of repairs.

Conclusion:

Knowledge of CL/P characteristics is crucial for treatment planning and satisfactory health care. To our knowledge, this is the first study to assess CLP data in a Turkish population.
Is percutaneous nephrolithotomy safe in chronic kidney disease patients!!!
Authors: Adiga Pramod , Pudakalkatti Sanjay Ramachandra , Shivakumar V. , Jain Mayank , Sreenidhi R. Navaneeth , Manohar C. S. , Jayaram Sreenivas , Nagabhushan M. , Keshavamurthy Ramaiah
Published: May 2024

Introduction:

Management of renal calculus in a patient of chronic kidney disease (CKD) is always challenging. Treatment options include extracorporeal shock wave lithotripsy, retrograde intrarenal surgery, and percutaneous nephrolithotomy (PCNL). With PCNL being gold standard for renal calculus ≥1.5 cm in normal kidneys, we aimed to analyze the safety and efficacy of PCNL in CKD patients with calculus ≥1.5 cm.

Materials and Methods:

Sixty patients of CKD with renal calculus were included in the study: Group A with glomerular filtration rate (GFR) ≤30 ml/min/m2 and Group B with GFR >30 <60 ml/min/m2. The estimated GFR (eGFR) pre-PCNL, peak eGFR on follow-up, and eGFR at last follow-up, stone free rates, and complications were recorded. The CKD stage before and after PCNL were also compared at the last follow-up.

Results:

The mean age of patients was 52 years. A mean of 1.14sittings per renal unit was required for PCNL. Complete clearance was 94% after all auxiliary procedures. The mean prePCNL eGFR was 26.5 ± 4.01 and 43.6 ± 9l. 14 ml/min/1.73 m2 in Groups A and B, respectively. The mean post-PCNL eGFR was 32 ± 9.94 and 51 ± 8.85 ml/minute/1.73 m2, respectively, in Groups A and B. At a mean follow-up of 180 days, deterioration with the migration of CKD stage was seen in 13 patients (21.6%) out of which 10 patients were of Groups A and 3 in Group B. Six patients (10%) required maintenance hemodialysis. Postoperative bleeding complication requiring blood transfusions was seen in 12 (20%) and 3 (5%) required intensive care unit care postoperatively. No mortality was observed in our study.

Conclusion:

PCNL is an effective management strategy for renal calculus in patients with CKD with an acceptable stone clearance rates and manageable complications. Peak eGFR <30 ml/min/m2 and postprocedure complications predict deterioration and need for RRT.
Surgical technique of laparoscopic ureterocalicostomy using the VIO soft-coagulation system
Authors: Yagihashi Yusuke , Toyosato Tomotsune , Shimabukuro Shuichi
Published: May 2024

One of the most crucial issues while performing ureterocalicostomy (UC) in patients with well-functioning thick renal parenchyma is controlling bleeding from the anastomotic site. In general, renorrhaphy is necessary for hemostasis because conventional coagulation remains unreliable in cases of an incised thick renal parenchyma. Instead of the parenchymal renorrhaphy, the VIO soft-coagulation system is used for hemostasis. Sutureless hemostasis using soft coagulation is a safe, feasible, and minimally invasive technique for laparoscopic UC.
Epidemiology and composition of nephrolithiasis in a Lebanese tertiary care center
Authors: Degheili Jad A. , Heidar Nassib Abou , Yacoubian Aline , Moussawy Mouhamad , Bachir Bassel G.
Published: May 2024

Introduction:

Nephrolithiasis is a common affliction with a prevalence of 12% in men and 7% in women. The incidence rate diverges with geographic location. Arab countries report high nephrolithiasis prevalence rates, with Saudi Arabia being the highest (20.1%). To date, there is little knowledge about the demographics and composition of stones in Lebanon.

Methods:

A retrospective chart review was performed on stone composition at the American University of Beirut Medical Center, between 2005 and 2018. Patients’ demographics and stone characteristics were obtained from electronic medical records. Analysis of frequencies and Chi-square test were adopted for potential risk factor correlations by the Statistical Package for the Social Sciences (SPSS).

Results:

A total of 626 stone analyses were performed. Male patients predominated (69%). The mean age was 46.58 ± 16.5 years, and mean body mass index was 28.63 ± 5.6, for both sexes. Calcium oxalate was the most predominant stone in both sexes (70%). Uric acid stones followed (~16%), and calcium oxalate phosphate stones were the third most common (5%). Incidence of kidney stones peaks in the summer, with 11.86% presenting in July. Around 60% presented with flank pain to the Emergency Department, and 32% ended up with spontaneous passage of stones by medical expulsive therapies alone, with no further surgical intervention. Diabetes and hypertension were significantly correlated with stone recurrence in our cohort.

Conclusion:

There is a significant gender disparity in stone prevalence in Lebanon. Calcium oxalate is the most common type in both sexes. Future investigations of dietary and environmental factors are recommended from our region.
Stuttering priapism in a pediatric patient with pheochromocytoma-induced thrombocytosis
Authors: Boonchai Sarayuth , Sangkhathat Surasak , Laochareonsuk Wison , Attawettayanon Worapat
Published: May 2024

Priapism is an erection of more than 4 h without sexual stimulation. Ischemic priapism may lead to irreversible erectile dysfunction after a long-lasting period. Stuttering priapism is characterized by a pattern of recurrence that may progress to an unrelenting ischemic crisis, which is a urological emergency. Few reports have revealed that priapism is associated with essential thrombocythemia. The reactive thrombocytosis is uncommonly manifested by pheochromocytoma and rarely causes thrombotic events even if the platelet count is extremely high. We presented priapism related to reactive severe thrombocytosis in a 12-year-old male with pheochromocytoma. The cornerstone of care was prompt medical and surgical intervention by a multidisciplinary team approach to save life and preserve erectile function.
Factors affecting use of flexible ureteroscope in large renal stones; stone size or stone composition
Authors: Elbakary Mohamed Rady
Published: May 2024

Introduction:

After advances in flexible ureteroscopes’ design, accessories, and lithotripters, flexible ureteroscope has been used widely for the treatment of large renal calculi >2 cm.

Objectives:

The objective was to evaluate the role of flexible ureteroscopy with laser lithotripsy in the treatment of large renal calculi >2 cm and find out which factor can affect the results.

Patients and Methods:

Prospectively, we have studied 47 patients who have passed through flexible ureteroscopy with laser lithotripsy for renal calculi >2 cm. Preoperative, operative, and postoperative data were recorded. Results and complications were recorded, too.

Results:

In 47 patients, the mean stone size is 26.2 ± 4.1 cm and the total stone-free rate (SFR) is 89.4%, while in stone size ≤3 cm, the SFR is 90.7%, and for stone size >3 cm, the SFR is 75%. Overall stone density is 1020 ± 286 HU. The SFR is 95.5% in stones ≤1000 HU and 84% in stones >1000 HU. The mean operative time is 99.2 ± 29.3 min. The intraoperative complications are 17%, while postoperative complications are 36% and all complications are mild.

Conclusion:

Flexible ureterorenoscopy (FURS) is safe and effective for the treatment of large renal calculi >2 cm. Stones >3 cm may have lower results even after staged therapy.
Stent diameter and stent-related symptoms, does size matter? A systematic review and meta-analysis
Authors: Ehsanullah Syed Ali , Bruce Angus , Juman Charlotte , Krishan Anil , Krishan Alisha , Higginbottom Jake , Khashaba Shehab , Alnaib Ziad
Published: May 2024

The ureteral insertion of a silicone tube was first performed in 1967. A validated ureteral stent symptom questionnaire (USSQ) is used for an objective assessment of patient-reported stent-related symptoms. As the impact of stent diameter on the incidence of stent-related symptoms is unclear, we aimed to perform a systematic review and meta-analysis comparing USSQ reported outcomes when using a 6 Fr diameter ureteric stent, versus smaller diameter stents (4.7–5 Fr) when inserted for ureteric stones. All randomized control trials and comparative studies of 6 Fr versus 4.7–5 Fr ureteric stents were reviewed. The USSQ outcomes were considered as the primary outcome measures while stent migration was considered as a secondary outcome measure. A total of 61 articles were identified of which four studies met the eligibility criteria. There was a statistically significant association between the use of wider (6 Fr) diameter stents and the incidence of urinary symptoms as measured by the urinary index score. Larger stent diameters were associated with a statistically significant increase in the pain index score. There was no statistically significant difference in the scores between the compared stent diameters with regard to work performance score, general health index score, additional problems index score, and stent migration. There were insufficient reported outcomes to perform a meta-analysis of sexual matters index score. Our meta-analysis shows that using smaller diameter ureteric stents is associated with reduced urinary symptoms and patient-reported pain. Other USSQ parameter outcomes are statistically similar in the 6 Fr ureteric stent cohort versus the 4.7–5 Fr ureteric stent cohort. Our meta-analysis was limited due to the limited number of studies and gross heterogeneity of reporting parameters in various studies. We hope a large-scale homogeneous randomized control trial will further shed more insight into the stent symptoms response to stent diameter.
Testicular torsion as the initial presentation of testicular tuberculosis
Authors: Almesned Razan Khalid , Alseini Dania A. , Bedaiwi Khaled K.
Published: May 2024

Testicular tuberculosis (TB) is a rare disease, and it tends to mimic other testicular diseases which are more common. We highlight the case of a 37-year-old male who presented to the emergency department with testicular torsion. Further investigations revealed evidence of TB.
Safety and efficacy of en bloc renal hilum control during laparoscopic nephrectomy and nephroureterectomy
Authors: Alsunbul Abdulrahman , Alakrash Hamad , AlMuaiqel Muaiqel , Aldughiman Abdullah W. , Albalawi Abdulaziz , Al-Gadheeb Abdullah S. , El-Tholoth Hossam S. , Alzahrani Tarek , Alzahrani Ahmed
Published: May 2024

Objective:

The objective of the study is to evaluate the safety, efficacy, and long-term outcome of en bloc renal pedicle control during laparoscopic nephrectomy and nephroureterectomy.

Patients and Methods:

A total of 126 nephrectomies and nephroureterectomies that underwent en bloc renal pedicle control using the endovascular stapler (45 or 60 mm vascular reload) were retrospectively analyzed. Perioperative outcomes, including the risk of arteriovenous fistula (AVF), hospital stay, and estimated blood loss, were recorded. Complications were reported using Clavien classification.

Results:

En bloc pedicle control was employed in 126 laparoscopic nephrectomies and nephroureterectomies on 126 patients with a mean age of 55.7 years (range: 18–94) and a mean body mass index of 29.2 kg/m2 (range: 17–42). All laparoscopic nephrectomies were performed or supervised by one of three minimally invasive surgeons using identical surgical techniques, even in cases of multiple hilar vessels. During follow-up with a mean 23.3 months (range: 12–48), no patients presented with radiological or clinical signs of AVF (91 patients where followed up with either Doppler ultrasound, computed tomography with contrast, or magnetic resonance imaging for different indications). The mean operative time was 91.8 min (range: 45–215). Intraoperative blood transfusion was required in two cases. Diaphragmatic injury occurred in one case but was repaired laparoscopically. Open conversion occurred in two cases with severe colonic adhesions and injury, with one requiring primary repair, and the other managed with a colostomy. One patient developed fever; two patients developed paralytic ileus. Hospital stay mode was 5 days, ranging from 3 to 10 days.

Conclusion:

En bloc renal pedicle control during laparoscopic nephrectomies is safe with reasonable operative time, and there were no indications of AVF with this technique over the long term.
Robotic surgery in pediatric urology
Authors: Salkini Mohamad Waseem
Published: May 2024

Robotic surgery revolutionized minimally invasive surgery. Urology is the widest surgical field in implementing robotic technology. Pediatric urology followed the footsteps of adult urology in utilizing da Vinci™ surgical system for urinary tract reconstruction. Indeed, day after day robotics is gaining more applications and popularity in pediatric urology due to the need for less invasive approach to reconstruct the urinary tract in pediatric population. In this manuscript, we reviewed in this article the steps of evolution of robotic pediatric urology.
Saudi Urological Association consensus guidelines on the use of robotic surgery in urology
Authors: Azhar Raed A. , Rabah Danny , Alenizi Abdullah M. , Alammari Adel , Alasker Ahmed , Alqahtani Ali A. , Alsaikhan Bader H. , Alyami Fahad A. , Alzahrani Hassan M. , Alothman Khalid I. , Moazin Maher S. , Alhgbani Mofarej , Baghdadi Mohammed , Alotaibi Mohammed F.
Published: May 2024

Over the past three decades, minimally invasive robotic technology has evolved substantially in urological practice, replacing many open procedures and becoming part of routine clinical practice. The Health Sector Transformation Program for the Kingdom’s Vision 2030 aims to restructure the health sector and optimize its status and prospects as an effective and integrated ecosystem centered on the patient’s health. Therefore, this consensus seeks to endorse the clinical practice guidelines for robotic surgery (RS) in the KSA, highlighting its effectiveness, safety, and favorable outcomes compared to open and laparoscopic surgeries in certain procedures when used by trained surgeons in well-structured RS programs.
A case series of inferior vena cava filter implantation in three COVID-19 patients with deep venous thrombosis
Authors: Cai Chuanqi , Guo Yi , You Yun , Cai Fei , Xie Mingxing , Li Yiqing , Wang Weici
Published: May 2024

The coronavirus disease 2019 (COVID-19) can cause venous thromboembolism, including deep venous thrombosis (DVT) and pulmonary embolism (PE), but there has been little research on the implantation of an inferior vena cava filter (IVCF) to prevent lethal PE complications. The purpose of this study is to determine the feasibility and effectiveness of IVCF implantation in DVT-COVID-19 patients through the aid of X-ray and bedside color ultrasound (US) techniques. We present three COVID-19 cases that were simultaneously confirmed as acute DVT. The first DVT-COVID-19 patient suffered from unexpected hemiplegia in the right limb. Due to the possibility of a cerebral hemorrhage, we performed X-ray-guided IVCF insertion to prevent PE occurrence. The second patient was diagnosed as having right limb gangrene. Due to the severe infection, we performed one bedside US-guided IVCF implantation before his acute right thigh amputation on the same day. The third patient complained of a feeling of paralysis in his left lower extremity. The X-ray radiograph determined thoracic and lumbar vertebra fractures. We also performed one bedside US-guided IVCF implantation before his vertebra internal fixation surgery. After the standard treatments, the first and third patients were discharged, while the second patient died due to an unexpected acute cardiovascular disease event in the intensive care unit. US-guided IVCF implantation is an effective method that can be considered as a precautionary strategy for preventing lethal PE occurrence, especially for critical DVT-COVID-19 patients who are not suitable to be transferred to a routine X-ray operation room.
construcción identitaria de las juventudes LGBTIQA+ en las redes sociodigitales: prácticas performativas reivindicativas.
Authors: Cervantes Hernández Rubén , Chaparro Medina Paola Margarita
Published: May 2024

Introducción: En la actualidad, las redes sociodigitales son un medio importante para la configuración identitaria sexual y de género en las juventudes LGBTIQA+. A través de dichas redes se desarrolla la capacidad de agencia de las personas; particularmente de jóvenes cuya orientación sexual e identidad de género se encuentran en los lindes de la matriz heteronormativa. En esta investigación de corte cualitativo, el objetivo es indagar en las manifestaciones de la capacidad de agencia en jóvenes de la diversidad sexo-genérica a través del uso de las redes sociodigitales (RSD) en el proceso de construcción y expresión de sus identidades de género y orientación sexual, considerando las prácticas en línea y sus posibilidades para disentir de la matriz heteronormativa. Metodología: Se realizó un estudio con 68 jóvenes de Zacatecas de entre 18 a 24 años que se reconocen como parte de la población LGBTIQA+ explorando sus experiencias en relación con sus prácticas en línea y su capacidad de agencia al disidir de la matriz heteronormativa. Resultados: Los datos se interpretaron a través de seis categorías emanadas de la teoría de la performatividad de género de Judith Butler. Se encontró que, en efecto, las RSD posibilitan interacciones individuales y con otros que permiten construir o reafirmar su propia identidad de género y orientación sexual. Discusión y conclusión: Por tanto, podríamos afirmar que estos espacios permiten el desenvolvimiento de experiencias en línea, prácticas socioculturales de interacción, diálogo, conocimiento y encuentro, generando así procesos de significación que construyen o refuerzan identidades que se enriquecen en las posibilidades de la diversidad sexo-genérica.
Neoadjuvant treatment of pancreatic ductal adenocarcinoma: Whom, when and how
Authors: Manojlovic Nebojsa , Savic Goran , Manojlovic Stevan
Published: May 2024

Pancreatic ductal adenocarcinoma (PDAC), which is notorious for its aggressiveness and poor prognosis, remains an area of great unmet medical need, with a 5-year survival rate of 10% - the lowest of all solid tumours. At diagnosis, only 20% of patients have resectable pancreatic cancer (RPC) or borderline RPC (BRPC) disease, while 80% of patients have unresectable tumours that are locally advanced pancreatic cancer (LAPC) or have distant metastases. Nearly 60% of patients who undergo upfront surgery for RPC are unable to receive adequate adjuvant chemotherapy (CHT) because of postoperative complications and early cancer recurrence. An important paradigm shift to achieve better outcomes has been the sequence of therapy, with neoadjuvant CHT preceding surgery. Three surgical stages have emerged for the preoperative assessment of nonmetastatic pancreatic cancers: RPC, BRPC, and LAPC. The main goal of neoadjuvant treatment (NAT) is to improve postoperative outcomes through enhanced selection of candidates for curative-intent surgery by identifying patients with aggressive or metastatic disease during initial CHT, reducing tumour volume before surgery to improve the rate of margin-negative resection (R0 resection, a microscopic margin-negative resection), reducing the rate of positive lymph node occurrence at surgery, providing early treatment of occult micrometastatic disease, and assessing tumour chemosensitivity and tolerance to treatment as potential surgical criteria. In this editorial, we summarize evidence concerning NAT of PDAC, providing insights into future practice and study design. Future research is needed to establish predictive biomarkers, measures of therapeutic response, and multidisciplinary strategies to improve patient-centered outcomes.
Clinical characteristics and risk factors of post-operative intestinal flora disorder following laparoscopic colonic surgery: A propensity-score-matching analysis
Authors: Li Gan-Bin , Wang Chen-Tong , Zhang Xiao , Qiu Xiao-Yuan , Chen Wei-Jie , Lu Jun-Yang , Xu Lai , Wu Bin , Xiao Yi , Lin Guo-Le
Published: May 2024

BACKGROUND

Intestinal flora disorder (IFD) poses a significant challenge after laparoscopic colonic surgery, and no standard criteria exists for its diagnosis and treatment.

AIM

To analyze the clinical features and risk factors of IFD.

METHODS

Patients with colon cancer receiving laparoscopic surgery were included using propensity-score-matching (PSM) methods. Based on the occurrence of IFD, patients were categorized into IFD and non-IFD groups. The clinical characteristics and treatment approaches for patients with IFD were analyzed. Multivariate regression analysis was performed to identify the risk factors of IFD.

RESULTS

The IFD incidence after laparoscopic surgery was 9.0% (97 of 1073 patients). After PSM, 97 and 194 patients were identified in the IFD and non-IFD groups, respectively. The most common symptoms of IFD were diarrhea and abdominal, typically occurring on post-operative days 3 and 4. All patients were managed conservatively, including modulation of the intestinal flora (90.7%), oral/intravenous application of vancomycin (74.2%), and insertion of a gastric/ileus tube for decompression (23.7%). Multivariate regression analysis identified that pre-operative intestinal obstruction [odds ratio (OR) = 2.79, 95%CI: 1.04–7.47, P = 0.041] and post-operative antibiotics (OR = 8.57, 95%CI: 3.31–23.49, P < 0.001) were independent risk factors for IFD, whereas pre-operative parenteral nutrition (OR = 0.12, 95%CI: 0.06–0.26, P < 0.001) emerged as a protective factor.

CONCLUSION

A stepwise approach of probiotics, vancomycin, and decompression could be an alternative treatment for IFD. Special attention is warranted post-operatively for patients with pre-operative obstruction or early use of antibiotics.
Comparing short-term outcomes of robot-assisted and conventional laparoscopic total mesorectal excision surgery for rectal cancer in elderly patients
Authors: Yang Hao , Yang Gang , Wu Wen-Ya , Wang Fang , Yao Xue-Quan , Wu Xiao-Yu
Published: May 2024

BACKGROUND

Da Vinci Robotics-assisted total mesorectal excision (TME) surgery for rectal cancer is becoming more widely used. There is no strong evidence that robotic-assisted surgery and laparoscopic surgery have similar outcomes in elderly patients with TME for rectal cancer.

AIM

To determine the improved oncological outcomes and short-term efficacy of robot-assisted surgery in elderly patients undergoing TME surgery.

METHODS

A retrospective study of the clinical pathology and follow-up of elderly patients who underwent TME surgery at the Department of Gastrointestinal Oncology at the Affiliated Hospital of Nanjing University of Chinese Medicine was conducted from March 2020 through September 2023. The patients were divided into a robot-assisted group (the R-TME group) and a laparoscopic group (the L-TME group), and the short-term efficacy of the two groups was compared.

RESULTS

There were 45 elderly patients (≥ 60 years) in the R-TME group and 50 elderly patients (≥ 60 years) in the L-TME group. There were no differences in demographics, conversion rates, or postoperative complication rates. The L-TME group had a longer surgical time than the R-TME group [145 (125, 187.5) vs 180 (148.75, 206.25) min, P = 0.005), and the first postoperative meal time in the L-TME group was longer than that in the R-TME (4 vs 3 d, P = 0.048). Among the sex and body mass index (BMI) subgroups, the R-TME group had better outcomes than did the L-TME group in terms of operation time (P = 0.042) and intraoperative assessment of bleeding (P = 0.042). In the high BMI group, catheter removal occurred earlier in the R-TME group than in the L-TME group (3 vs 4 d, P = 0.001), and autonomous voiding function was restored.

CONCLUSION

The curative effect and short-term efficacy of robot-assisted TME surgery for elderly patients with rectal cancer are similar to those of laparoscopic TME surgery; however, robotic-assisted surgery has better short-term outcomes for individuals with risk factors such as obesity and pelvic stenosis. Optimizing the learning curve can shorten the operation time, reduce the recovery time of gastrointestinal function, and improve the prognosis.