bluuebunny/crossref_metadata_2025 huggingface dataset:
Association between Clinical Characteristics and Laboratory Findings of 102 Patients with COVID-19 in Iraq
Authors: Hussein Ghazwan Faisal , Al-Saadi Ali Hmood
Published: August 2023

Background:

The coronavirus epidemic (COVID-19) initially appeared in Wuhan, China in December, 2019 and then rapidly spread all over the world. The importance of information about the clinical and non-clinical characteristics of Iraqi COVID-19 patients was highlighted. The aim of this study was to investigate the demographic, clinical, and laboratory data of COVID-19 with assessed the influence of comorbidities on the severity of infections.

Materials and Methods:

We collected medical records of hospitalized 102 patients with COVID-19 at three hospitals from December 2021 to May 2022. Patients in the cohort study were diagnosed with positive COVID-19 by reverse transcription polymerase chain reaction according to nasopharyngeal samples. The cohort study was for separating two groups: non-severe and severe or critical groups.

Results:

The receiver operating characteristic (ROC) curve revealed that patients aged ≥ 48 years had higher levels of D-dimer, white blood cell (WBC) and neutrophils count (NUE), neutrophil-to-lymphocyte ratio (NLR), and platelets-to-lymphocyte ratio (PLR) when compared to non-severe patients. These parameters were used to predict high-risk patients with low lymphocyte counts. A logistic regression model generated results to include D-dimer, NUE, and lymphocytes count (LYM) were identified as independent risk factors for intensive care unit (ICU) patients of COVID-19 whereas WBC was a dependent factor with an odds ratio (8.330, 1.288, 0.225, and 1.534), respectively. Cut-off values by ROC curve for D-dimer, NUE, WBC, LYM, PLR, and NLR parameters were ≥ 0.780, ≥7.7, ≥10.5, ≥1.27, ≥200, and ≥5.4, respectively.

Conclusion:

In conclusion, this study demonstrated that COVID-19 severity can be predicted by analyzing clinical and laboratory data of patients. Comorbidities such as hypertension, diabetes mellitus, cardiac diseases, kidney diseases, malignancy, and hepatic diseases were identified as significant risk factors for COVID-19 severity and progression.
Evaluation of Imatinib Adherence in Chronic Myeloid Leukemia Patients in Babylon Province, Iraq
Authors: Gatea Athmar Kadhim , Al-Jabory Mohammed Ali , Baiee Noor Hasan
Published: August 2023

Background:

Chronic myeloid leukemia is a clonal myeloproliferative neoplasm that results in proliferation, mainly of granulocytic components. Resulting from t(9;22) with fusion oncogen BCR-ABL1 which has uninhibited tyrosine kinase activity. The introduction of tyrosine kinase inhibitors, such as Imatinib, has significantly altered the management and prognosis of this condition, but poor adherence is still a significant factor in therapy failure.

Objective:

To measure chronic myeloid leukemia (CML) patients’ adherence to Imatinib treatment and to analyze potential reasons for poor adherence.

Materials and Methods:

The study included 52 CML patients in the chronic phase treated with Imatinib for at least 12 months; 30 of them were women and 22 were men, with a median age of 45 years. Patient adherence to Imatinib was assessed using the Morisky Medication adherence scale. Response to treatment was assessed by the evaluation of the level of BCR-ABL1 mutation in peripheral blood.

Results:

Out of 52 patients, 17 were adherent to Imatinib while 35 of them were nonadherent. The patient’s adherence status to Imatinib was found to have a significant effect on the response to treatment. The most common cause of nonadherence was forgetfulness. Age, sex, occupation, educational level, marital status, residence, duration of treatment, relation to meal time, taking other medications, and drug side effects have no significant effect on adherence.

Conclusions:

Adherence to Imatinib was poor and this has a negative impact on patients’ response to therapy. Patients’ forgetfulness was the most frequent reason for nonadherence, followed by drug-related patient disturbance.
Immunological Study of Orthodontically Treated Patients Recovering from COVID-19 in Babylon Province, Iraq
Authors: Eidan Basma Abdel Khaleq , Al-Khafaji Thaer Jaber , Abbas Ahmed Mohammed
Published: August 2023

Background and Objectives:

This study aimed to examine the levels of the toll-like receptors TLR4 and TLR2 in the blood and saliva of patients with coronavirus disease-2019 (COVID-19) receiving orthodontic care in Babylon Province.

Materials and Methods:

Sixty serum and saliva samples were collected and divided into three groups of 20 patients: patients with COVID-19 who did not receive orthodontic treatment (group 1); patients with COVID-19 who received orthodontic treatment (group 2); and patients with COVID-19 who received orthodontic treatment and recovered (group 3). Thirty samples of serum and saliva from healthy outpatient clinics comprised the control group. Enzyme-linked immunosorbent assay was used to determine the result.

Results:

TLR4 levels in saliva increased in all experimental groups (1–3) as compared with the control group. However, only COVID-19 patients and orthodontic patients in group 2 had elevated blood levels of TLR4, whereas the levels were reduced in the other two groups (1 and 3). All experimental groups showed an increase in TLR2 levels in saliva relative to the control group. In the first and second experimental groups, serum TLR2 concentrations increased dramatically, whereas they declined in the third group. There was no correlation between TLR4 and TLR2 in either group of patients. The concentrations of TLR4 and TLR2 in saliva were higher in the experimental groups than in the control group.
Salivary Semaphorin 4D Level in Patients with Different Severities of Periodontitis (Observational Case–Control Study)
Authors: Alwan Zahraa M. , Mohammed Ayser N.
Published: August 2023

Background:

Periodontal diseases are progressive, destructive, and inflammatory conditions of the tissues that support the teeth. An immune response is triggered by microbial dysbiosis in the sub-gingival biofilm. Semaphorin 4D (Sema4D) is a glycoprotein expressed by osteoclasts, T-cells, and activated B-cells involved in both immune response and bone remolding.

Objectives:

This study attempted to assess the salivary levels of Sema4D in patients with different severities (stages I–IV) of periodontitis in comparison to healthy control.

Materials and Methods:

A total of 171 participants of both genders were included into this case–control study. From the dental centers in Al-Najaf city and the Department of Periodontics in the College of Dentistry, University of Kufa, five groups were established for them: clinically healthy periodontium control group (19 subjects), Stage I periodontitis group (38 subjects), Stage II periodontitis group (38 subjects), Stage III periodontitis group (38 subjects), and Stage IV periodontitis group (38 subjects). The clinical periodontal parameters were examined after collecting whole unstimulated salivary samples from all individuals. The levels of Sema4D in saliva samples were estimated utilizing the ELISA technique. Statistical analysis used: ANOVA test, Games-Howell test, and Pearson correlation (r) test.

Results:

The findings revealed that the mean level of salivary Sema4D was the highest in the stage IV periodontitis group (758.11 ± 139.119), followed by stage III periodontitis group (725.815 ± 127.055), stage II periodontitis group (679.169 ± 121.993), stage I periodontitis group (601.742 ± 145.459), and control group (366.515 ± 47.635) respectively with a significant difference (P ≤ 0.01).

Conclusions:

The periodontitis patients showed higher Sema4D levels in unstimulated saliva as compared to the control. Hence, this molecule may play an essential role in the pathogenesis of periodontitis.
Impacts of Valproic Acid on Systemic Bone Loss Associated with Experimental Model of Rheumatoid Arthritis in Rats
Authors: Ali Mohammed Shaema Mohammed , Al-Zubaidy Adeeb A.
Published: August 2023

Background:

Valproic acid (VA) is a compound used for many neurological disorders, which is also known as a histone deacetylase inhibitor. The impacts of VA on adjuvant-induced arthritis (AIA) in rats were investigated.

Objectives:

To investigate the possible osteoprotective and anti-inflammatory effects of VA in rheumatoid arthritis (RA).

Materials and Methods:

AIA was achieved through subdermal injection of complete Freund’s adjuvant (CFA) into the rat hindpaw. Forty Swiss albino rats were recruited in this study. These rats were divided into four groups: the normal control group received 0.1 mL phosphate buffer saline intraperitoneally each day, the positive control group received 0.75 mg/kg intraperitoneal once weekly dose of methotrexate, the AIA group received CFA without treatment, and the VA group received 300 mg/kg/day intraperitoneal dose of VA. Statistical analysis was done, and a P value of less than 0.05 was considered as statistically significant.

Results:

VA (300 mg/kg body weight) administered intraperitoneally could significantly reverse the effect of adjuvant arthritis on bone mineral density and bone mineral content in addition to an improvement in bone formation markers (osteoprotegerin, osteoprotegerin/RANKL ratio). Serum levels of tumor necrosis factor and interleukin 1b were significantly reduced by VA treatment. Reduced serum malondialdehyde with the elevated superoxide dismutase level was also achieved.

Conclusion:

These findings support the evidence that VA has a positive effect on bone anabolism and its anti-inflammatory properties could be considered as a bonus in inflammatory disorders induced bone loss such as RA.
The Effect of Silica Nano Particle Derived from Natural Rice on Surface Roughness and Wettability of High Impact Heat Cure Resin
Authors: Khairi Azza Walaaldeen , Naji Ghassan Abdul-Hamid
Published: August 2023

Background:

Poly (methyl-methacrylate) (PMMA) is considered the most popular current denture material; its principal material for the fabrication of denture base has relatively poor physical mechanical properties. Several nanofillers have been added to address this problem.

Objectives:

The aim of the current study was to investigate the incorporating of rice husk-derived silica particles into high impact heat cure acrylic resin to improve its physical properties.

Materials and Methods:

According to the results of the pilot study, high impact heat cure resin was mixed with 1% and 3% (by weight) of silica particles which derived from a natural rice husk source. The study’s samples were divided into two main groups (n = 10 samples for each group) based on the tests that were done. Each group was then divided into three smaller groups, (0% control, 1%, and 3%) depending on the amount of natural silica particles added (n = 10 samples for each subgroup).

Results:

The results showed that adding 3% silica particles derived from natural rice husk increased the roughness and wettability values significantly (P < 0.01), whereas adding 1% silica particles decreased the roughness and contact angle values significantly (P < 0.01) compared to the control group (0 wt.%).

Conclusion:

The incorporation of 1 wt.% and 3 wt.% silica nanoparticles derived from rice husk was found to enhance the surface roughness and wettability of high impact acrylic resin. With 1 wt.% and 3 wt.% rice husk derived silica produced the best outcomes.
Leptin and Ferritin as Indicators of Breast Cancer’S Severity in Overweight-Postmenopausal Women
Authors: Hamzah Sarah A. , Abd Basim A. , Mohammed Mushtaq Q.
Published: August 2023

Background:

Breast cancer–obesity association is a significant hazard that affects postmenopausal women in a special concern. The microenvironment created by adipose tissue appears to be the basis for the relation between obesity and breast cancer, and raised values of leptin and ferritin may be the risk for tumor development.

Objectives:

This study aimed to investigate whether elevated levels of leptin and ferritin are correlated to a more severe form of postmenopausal breast cancer.

Materials and Methods:

A cross-sectional study was conducted on 240 postmenopausal women diagnosed with breast cancer at Babylon Oncology Treatment Center in Merjan Medical City in Al-Hillah City, Babylon Governorate under the supervision of the Department of Medical physiology in Babylon Medical Faculty. The study extended from the start of September 2022 to the end of March 2023. The patients were divided into two groups according to the score of their body mass indexes (BMIs). The first group of patients (n = 138) included those with BMI > 30 kg/m2, whereas the second group (n = 102) included those with BMI < 30 kg/m2. The diagnosis of breast cancer and its pathologic subtypes were determined based on the results of tissue biopsy samples. Serum leptin and ferritin values were addressed using special biochemical kits.

Results:

Values of leptin and ferritin were higher in the first group of patients in comparison to the second group and statistically significant differences were present between the two groups regarding those parameters (P = 0.001 for leptin and 0.0001 for ferritin).

Conclusion:

Elevated values of leptin and ferritin are correlated to a more severe form of breast cancer in postmenopausal women having elevated levels of BMIs.
Tracheobronchial Foreign Body Inhalation
Authors: Al-Anbari Abbas Jaafar Khaleel
Published: August 2023

Background:

Foreign body aspiration (FBA) is not an uncommon entity in the population.

Objectives:

In the current study, we discuss our experience in the management of 234 case series with tracheobronchial foreign body removal using bronchoscopy.

Materials and Methods:

The bronchoscopy database (from 2021 to 2022) was reviewed for subjects with a history of FBA managed with bronchoscopy. Demographic, clinical, and bronchoscopy data were collected and analyzed.

Results:

A total of 234 bronchoscopies were carried out for FBA throughout the study period. FBA was more prevalent in children under the age of two (29%) and in patients over the age of ten (24%). In 205 patients, a foreign corpse was found (87.6%). The majority of organic foreign bodies were sunflower seeds (22.4%). Nonetheless, the metallic pins (25.3%) were the most frequent foreign body. The preferred location for the impaction was the right major bronchus (45.9%). Just 90.2% of these individuals had a foreign body. History had an 89.7% sensitivity and a 31% specificity for detecting FBA. Laryngeal edema, which afflicted 32 patients (13.7%), and recurrent chronic chest infection, which affected 13 patients (5.5%), were the most frequent bronchoscopy-related side effects.

Conclusions:

Foreign body inhalation most frequently impacted children aged 1–2 years. The history is a major element in the diagnosis, and bronchoscopy findings were strongly correlated with the patient’s history of the incident. The most frequent clinical symptom among individuals who had a proven foreign body but no history of inhalation was protracted pneumonia. The location of the most frequent foreign body lodgment in the tracheobronchial tree depends on the type of foreign body, with metallic pins occurring more commonly in the left main bronchus. Laryngeal edema, which occurred in 13.7% of bronchoscopy patients, was the most frequent complication.
Interleukin-8 and -17 Levels in the Sera of Vaccinated Subjects Receiving a Booster Dose of Measles Virus
Authors: Al-Kaif Laith A. I. K. , Al-Khafaji Younis A. K. , Shandaway Sarah K. , AL-Janabi Uday H. K. , Kadhim Kawther Jawad , Akkaif Mohammed Ahmed
Published: August 2023

Background:

Measles is a highly contagious viral infection that can lead to severe complications. Vaccination has successfully reduced measles cases; however, the immune response to booster doses of the measles vaccine is not fully understood. This follow-up study aimed to investigate the levels of interleukin-8 (IL-8) and IL-17 in the sera of vaccinated subjects after receiving a booster dose of the measles virus.

Objectives:

This follow-up study evaluated the levels of IL-8 and IL-17 in the sera of volunteers who received a second booster dose of the measles virus vaccine compared to a control group.

Materials and Methods:

Forty volunteers were included in the study, with 20 volunteers receiving a second booster dose of the vaccine and the remaining volunteers serving as the control group. The levels of IL-8 and IL-17 were measured using the enzyme-linked immunosorbent assay at various time intervals.

Results:

The results revealed significant differences in IL-8 levels, whereas IL-17 levels showed non-significant differences among the tested subjects at different time intervals (P ≤ 0.05). In the vaccinated group, the mean IL-8 level after one week was 192.04 ± 31.44 pg/mL, whereas it decreased to 30.89 ± 4.44 pg/mL after 7 weeks, showing a significant difference between these two periods. The control group had an IL-8 level of 367.95 ± 32.61 pg/mL. Regarding IL-17, there was no significant difference between the 3-week measurement (415.63 ± 61.12 pg/mL) and the 7-week measurement (848.61 ± 54.29 pg/mL) in the vaccinated group, as well as the control group (819.46 ± 75.33 pg/mL).

Conclusions:

The findings of this study suggest that the levels of IL-8 decreased, whereas there was variation in IL-17 levels after administering a second booster dose of the measles vaccine compared to normal subjects. These results contribute to our understanding of the immune response following a booster dose of the measles vaccine and highlight potential differences in the immune profile of vaccinated individuals compared to the control group.
The Risk Impact and Benefits of Ramadan Fasting on Patients with Type 2 Diabetes in a Sample of Iraqi Patients
Authors: Selman Nihad Abdallah , Albayati Ali Hussein Alwan , Alsaffar Yasameen , Farhan Adil Hamid
Published: August 2023

Background:

Ramadan fasting is one of the five pillars of Islam. In it, Muslims abstain from eating, drinking, and having sexual intercourse from dawn to sunset every day for the whole holy (Ramadan) month.

Objectives:

This study was conducted to assess the risk impact and benefits of Ramadan fasting on patients with diabetes in a sample of Iraqi patients.

Materials and Methods:

This is a cross-sectional prospective study involving 106 patients with type 2 diabetes who decide to fast Ramadan enrolled in this study and parameters gathered before and after Ramadan to identify anthropometric and biochemical changes that develop throughout the whole month.

Results:

More than 96% of patients fasted for more than 25 days of Ramadan. Hypoglycemia developed in 17% of patients. It occurred significantly in those with a history of mild and severe hypoglycemia and hyperglycemia >300 mg/dL in the preceding 3 months before Ramadan and those with comorbidities especially, stroke, chronic kidney disease (CKD), and hypertension. Following Ramadan, there was a significant reduction in HbA1c, systolic and diastolic blood pressure, and significant weight reduction.

Conclusion:

Most patients with diabetes can fast for more than 25 days during the whole Ramadan month. Ramadan fasting can be considered as safe in patients with type 2 diabetes without comorbidities (like CKD, stroke). Ramadan fasting reduces the glycated hemoglobin, reduces body weight, and reduces blood pressure in patients with diabetes.
Assessment of Tumor Necrosis Factor-α, Interleukin-17, and Vitamin D3 Levels on a Group of Gastrointestinal Tumor Patients in Babylon Provence, Iraq
Authors: Al-Shimmery Ali Husain Shilib , Al-Alwany Marwan Hamed Obaid , Chabuck Zainab Adil Ghani , Al-Mammori Raheem Tuama Obayes , Mokif Thanaa Abdulmahdi , Mahdi Zena Abdul-Ameer , Al-Dahmoshi Hussein O. M. , Al-Khafaji Noor S. K. , Makki Al-Hindy Hayder Abdul-Amir , Abed Suhad Y. , Abdulabbas Hadi Sajid
Published: August 2023

Background:

Gastrointestinal (GIT) tumors refer to collection of tumor including colorectal, gastric, liver, and pancreatic tumors and other.

Objective:

The current study aims to measure the serum level of tumor necrosis factor-α (TNF-α), interleukin-17 (IL-17), and vitamin D3 among GIT tumor patients comparing with irritable bowel disease (IBD) patients and healthy control.

Materials and Methods:

Serum samples were taken from 88 participants (42 from malignant GIT tumor, 29 from benign GIT tumor, 10 from IBD (as positive control), and 7 from health individual (as negative control)). All patients admitted in GIT center of Babylon in Merjan Medical city at April up to December 2020. The TNF-α, IL-17, and vitamin D3 level were measured by Enzyme-Linked Immunoassay (ELISA.

Results:

The result showed younger men are more prevalent with malignant GIT tumor with mean age (53.39 years) than benign GIT tumor as well as IBD. There is an significant increase in TNF-α (Least Significant Difference (LSD = 1.79) levels of malignant GIT tumor when compared with other groups (mean ± Standard Deviation (SD) = 23.7 ± 8.1, 20.4 ± 2.8, 18.9 ± 2.66, and 18.1 ± 2.78 pg/mL for malignant GIT, benign GIT, IBD, and healthy persons respectively). Results of IL-17 level also reveal a significant increase (LSD = 13.2) of malignant GIT tumor when compared with other groups (mean ± SD = 222.2 ± 73.5, 128.2 ± 35.5, 201.5 ± 39.4, and 164.2 ± 44.1 pg/mL for malignant GIT, benign GIT, IBD, and healthy persons, respectively). Inverse results were documented for vitamin D3 level, in which a significant decrease (LSD = 23.45) in the levels of malignant GIT tumor was observed when compared with other groups (mean ± SD = 204.2 ± 24.3, 306.1 ± 97.2, 453.2 ± 78.2, 368 ± 78.0 pg/mL for malignant GIT, benign GIT, IBD, and healthy persons, respectively).

Conclusion:

The current study concluded that early age men get affected with malignant GIT tumor in Iraqi population giving a hint to that the population at high risk to involved with such tumor as well as other tumor types with elevated level of TNF-α and IL-17 and decreased level of vitamin D3. More and more studies with large number of patients should be recommended to exclude the factors in which that may lead to such conditions.
Novel SARS-COV-2 virus (COVID-19)
Authors: Sharma Ridhima , Choudhary Ripon , Gupta Nishkarsh , Gupta Anju
Published: August 2023

The COVID-19 is an ongoing global crisis. To deal with it efficiently, health-care system has to gear up to the increasing burden by judicious use of workforce and resources. In the perioperative setting, adequate preventive measures are of prime importance to prevent infection spread among health-care workers. The knowledge regarding the disease is still evolving. In this article, we have outlined the basic epidemiology, pathology, presentation, and diagnosis of COVID-19 along with the considerations for operating room preparedness, personal protective equipment required, airway management, anesthesia conduct, and perioperative concerns when managing positive or suspected COVID-19 pediatric patients and have suggested ways to overcome potential hindrances based on available literature. We have also deliberated upon the specific considerations for a COVID child undergoing regional anesthesia and critically ill COVID-19 pediatric patients. Careful adaptation of working principles based on local needs can help in the prevention of disease spread when optimizing care to the patients.
An encounter with Nager's syndrome
Authors: Kadni Reena Ravindra , Varghese Zachariah K. , Maganthi Madhuri , Shyamsundar L G
Published: August 2023

Nager acrofacial dysostosis is a rare genetic syndrome. It has a potential threat of obstructed airway from birth. Associated with severe micrognathia, it poses a difficult airway challenge to the anesthesiologist. Tracheostomy may be required for the survival of these patients. We report a case of a 2½-month-old infant with Nager's syndrome for lip reconstruction and club foot management.
Anesthetic management of a parturient with Wernicke's encephalopathy secondary to hyperemesis gravidarum for cesarean section
Authors: Gahlot Divya , Agarwal Munisha , Budoo Mohd Shoaib , Prasad Neelam , Singh Kuldeep
Published: August 2023

Wernicke's encephalopathy (WE) secondary to hyperemesis gravidarum (HG) is a rare but a known complication. A delay in diagnosis and treatment often results in long-term neurological sequelae. Critical care management of these patients is reported in the literature, but their anesthetic management for cesarean section is lacking. We report the case of a 28-year-old parturient who presented with HG in the first trimester of pregnancy and was managed conservatively. She later developed nystagmus, weakness, and cognitive dysfunction, and a diagnosis of WE secondary to HG was established. The patient was later posted for cesarean section in view of persistent quadriparesis and cognitive impairment at term gestation. General anesthesia was the preferred anesthesia technique of choice. Obstetric patients with preexisting neurological disease for cesarean section become a special subpopulation for anesthesiologists with their unique anesthetic challenges.
Comparison of ultrasound-guided transversus abdominis plane block and quadratus lumborum block for postoperative analgesia following laparoscopic living donor nephrectomy
Authors: Sengupta Kaushik , Ladhania Jitendra , Kundu Amit , Mitra Titisa Sarkar , Mistry Tuhin
Published: August 2023

Background and Aims:

The application of ultrasound (USG)-guided interfascial plane blocks in transplant anesthesia is expanding. This study evaluates and compares the postoperative analgesic efficacy of USG-guided transversus abdominis plane block (TAPB) and quadratus lumborum block (QLB) in adult individuals undergoing laparoscopic living donor nephrectomy (LLDN).

Materials and Methods:

A hundred donors of either sex, aged 30–60 years, scheduled to undergo LLDN were randomly allocated into two groups. After completion of the LLDN, USG-guided unilateral TAPB and QLB were performed in lateral position in Groups A (n = 48) and B (n = 48), respectively. A volume of 20 ml of 0.375% ropivacaine was administered in both groups. Postextubation donors were shifted to the postanesthesia care unit (PACU). Heart rate, systolic blood pressure, diastolic blood pressure, and numeric rating scale (NRS) scores were recorded on arrival at PACU at the time of discharge from PACU. Subsequently, the donor was shifted to the intensive care unit, and the vitals and NRS scores (static and dynamic) were monitored postoperatively on the 2nd, 6th, 12th, 18th, and 24th h. Duration of analgesia and the number of donors who needed rescue analgesia were also noted. All the donors were observed for any side effects and complications. P <0.05 was considered statistically significant.

Results:

The NRS score was significantly lower in Group B (QLB) than in Group A (TAPB). Duration of analgesia was significantly prolonged in Group B (11.34 ± 1.53 h) compared to Group A (9.05 ± 1.58 min). (P < 0.001)

Conclusion:

The QLB effectively prolonged the duration of analgesia, lowers pain scores, and decreases the requirement of rescue analgesia compared to the TAPB. Hence, the donors remain comfortable in the postoperative period without any potential side effects.
Comparative evaluation of intubating laryngeal mask airway with fiberoptic bronchoscopic intubation in anticipated difficult airway
Authors: Koul Neelakshi , Dhir Vinod Bala , Choudhary Nitin , Singh Jyoti , Nohwar Deepak Kumar , Kaur Mohandeep
Published: August 2023

Background:

Management of difficult airway remains a cornerstone of anesthesiology requiring constant probe into newer devices challenging set gold standards. Hence, we compared the effectiveness of intubating laryngeal mask airway (ILMA) with flexible fiberoptic bronchoscope (FOB) in anticipated difficult airway.

Aims:

The aim of this study was to compare and evaluate ILMA and FOB for tracheal intubation in patients with anticipated difficult airway.

Settings and Design:

The study design involves comparative randomized study.

Materials and Methods:

Fifty patients undergoing elective surgery under general anesthesia with anticipated difficult airway (Modified Mallampati Class III/Wilson's Score 6-7) were divided into Group I (ILMA) and Group F (FOB). Primary outcomes, i.e., ease of intubation (number and duration of attempts) and success rate; and secondary outcomes, i.e., hemodynamic parameters and adverse events were noted.

Results:

Both the groups were comparable in age, gender distribution, body mass index, and type of surgery. The number of attempts required and hemodynamics changes were similar in both groups. ILMA required lesser time, i.e., 59.76 s versus FOB, i.e., 109.88 s in the first attempt (DA1) and 62.67 s for Group I versus 120.86 s for Group F in the second attempt (DA2), being statistically significant. ILMA showed higher adverse event rate versus FOB; however, the difference was statistically insignificant.

Conclusions:

ILMA is an effective alternative to FOB in patients with anticipated difficult airway with respect to ease of intubation, with similar hemodynamic stability, success rate, and adverse events.
A Randomized comparative study to observe the safety and efficacy of I gel and blockbuster laryngeal mask airway used in patients undergoing short surgical procedure under general anesthesia
Authors: Khare Arvind , Awana Poonam , Thada Beena , Mathur Veena , Kumar Pradeep
Published: August 2023

Background and Aims:

Blockbuster laryngeal mask airway (LMA), a newer supraglottic airway device, provides a quick and reliable seal of the airway, making it useful for positive pressure ventilation. This randomized comparative study was undertaken to compare the safety and efficacy of I-gel and Blockbuster LMA used in short surgical procedures under general anesthesia.

Materials and Methods:

Hundred patients of either sex aged between 18 and 60 years belonging to the American Society of Anesthesiologist physical Status I and II undergoing general anesthesia were randomized into two groups of 50 patients each, using either I-gel (Group IG) or Blockbuster LMA (Group BB). After standard monitoring and induction of anesthesia, LMA was inserted according to their randomized groups and adequate ventilation was achieved. The primary objectives were grading of ease of insertion and time taken for successful insertion of device, while number of attempts for insertion, oropharyngeal seal pressure (OSP), hemodynamic changes, and adverse effects such as blood staining of device, injury of lips, tongue and teeth, postoperative hoarseness of voice and sore throat were secondary objectives. Data were analyzed using SPSS version 3.0.0.34.

Results:

The ease of insertion was graded as very easy in 46 patients in Group BB and 26 patients in Group IG (P < 0.001). The mean time for insertion was less with Group BB (24.30 ± 3.91 s) as compared to Group IG (29.50 ± 12.5 s) (P < 0.0001). 48 patients in Group BB while 37 patients in Group IG (P = 0.008) were required one attempt for insertion. The average OSP was 22.59 ± 1.44 cmH2O in Group BB as compared to 20.88 ± 2.22 cmH2O in Group IG (P < 0.0001). Hemodynamic changes were comparable at different time intervals. Complications such as blood stain of device and sore throat were more with I-gel.

Conclusions:

The Blockbuster LMA is an effective alternative to I-gel with faster, easier insertion, required a smaller number of attempts, high airway sealing pressure with stable hemodynamic, and less incidence of blood staining and postoperative sore throat.
Prediction of endotracheal tube size for pediatric patients from the length of the middle finger in comparison with standard age-based formula in South Indian population
Authors: Krishna Bhat Rama Rani , Kamlekar Ramya Lakshmi , Kulkarni Malavika
Published: August 2023

Background:

Determining the appropriate size of an endotracheal tube (ETT) in infants and children remains a challenge for anesthesiologists. We conducted this study to assess the accuracy of middle finger length (MFL) in predicting the appropriate ETT size for pediatric patients in comparison with the age-based estimation and derive a formula based on MFL for the estimation of ETT size.

Materials and Methods:

In the study, South Indian children 1–10 years of age, requiring general anesthesia were intubated by consultant anesthesiologists based on their discretion with an appropriately sized ETT. Subsequently, the MFL of the children was measured and tracheal tube size calculated from the age-based formula was also noted. The actual size of the ETT inserted was compared with the MFL and age-based formula using Pearson's correlation.

Results:

In children between 1 and 10 years of age, the age-based formulae (ABF) was found to correlate with ETT estimated with the correlation coefficient (r = 0.885; P < 0.001) and MFL (r = 0.783 and P < 0.001). ABF showed a stronger correlation with the ETT inserted compared to the MFL, nevertheless, we were able to arrive at a formula to predict tracheal tube size based on MFL: ETT ID (mm) =1.1+ (0.7 × MFL [cm]).

Conclusion:

Although age-based Cole's and Motoyama's formulae are better predictors of pediatric ETT size, MFL can still be used to predict the tube size in cases when age and weight are unknown.
Demographic profile and clinical characteristics of surgical patients operated in COVID-19 operation theater in a tertiary care hospital
Authors: Bathla Sapna , Mehta Mahak , Das Akshaya Kumar , Mullick Parul , Meena Dharam Singh , Ganapathy Usha
Published: August 2023

Background and Aim:

Surgical procedures in patients with COVID-19 disease are associated with increased perioperative morbidity and mortality. A retrospective study was conducted to evaluate the demographic and clinical data of surgical patients with suspected or confirmed COVID-19 disease.

Methods:

After taking hospital ethics committee approval, medical records of surgical patients operated during the period from May 2020 to November 2020 in a COVID-19-designated tertiary care hospital of northern India were assessed. The demographic data such as age, gender, associated comorbidities, type of surgery, intraoperative complications, and data on the postoperative status of the patients were collected and analyzed.

Results:

Ninety-four patients underwent surgical procedures during the study period. Out of all patients, 87.2% were females. The median age of patients was 28 years (range: 1 month–59 years). The emergency cesarean section was the most common surgery performed. The subarachnoid block was the most commonly used anesthesia technique. Out of 94 patients, 70 patients were confirmed COVID-19 positive, and 24 were suspected cases. Most of the patients were American Society of Anesthesiologists II (83%) and 43.6% of patients had comorbidities.

Conclusion:

The cesarean section was the most commonly performed surgical procedure. The most common anesthesia technique used was the subarachnoid block. The patients operated under subarachnoid block had a better prognosis and did not require intensive care unit stays in the postoperative period.
Study of platelet-derived growth factor receptor beta in bone marrow biopsy samples of patients with multiple myeloma
Authors: Musallam Ghada S.K.A. , Elkholy Rasha A. , Elgamal Basma M. , Ahmed Aisha A.A.
Published: August 2023

Background

Multiple myeloma (MM) is a malignant neoplastic disease manifested by uncontrolled proliferation of plasma cells in the bone marrow, production of monoclonal immunoglobulins, and associated organ dysfunction. Platelet-derived growth factor receptor beta (PDGFR-β) has demonstrated an important role in angiogenesis and neoplastic diseases.

Aim

The aim of this work was to calculate the expression of PDGFR-β in bone marrow trephine biopsy samples of newly diagnosed patients with MM and its clinical significance.

Patients and methods

A total of 20 newly diagnosed patients with MM were enrolled in this study. The expression of PDGFR-β on plasma cells in bone marrow trephine biopsy samples was assessed by immunohistochemical staining.

Results

Our results showed a statistically significant increase in lactate dehydrogenase, beta 2 microglobulin, and clonal plasma cell percentage in bone marrow of patients with high PDGFR-β expression in comparison with patients with negative and intermediate PDGFR-β expression and statistical significant decrease in albumin and prognostic-free survival in patients with high PDGFR-β expression in comparison with patients with negative and intermediate PDGFR-β expression.

Conclusion

Patients with MM with high PDGFR-β expression had unfavorable prognosis in terms of prognostic-free survival and advanced disease stage compared with intermediate and low PDGFR-β expressions.
Palpebral fissure changes following horizontal recti muscles surgery
Authors: El Zahar Wafaa S. , Shafik Heba M. , Awara Amr M. , El Desouky Mohamed A.
Published: August 2023

Background

Strabismus surgery is a 1-day operation. It can result in aligned eyes or nearly so (orthophoria) or overcorrection or undercorrection that may require further treatment or another surgery.

Aim

To assess alterations in vertical palpebral fissure height following horizontal recti muscle surgery (recession or resection) for the treatment of horizontal strabismus (esotropia or exotropia).

Patients and methods

A prospective interventional case series was carried out on 68 eyes of 41 patients with horizontal strabismus (exotropia or esotropia), comitant or incomitant (paralytic), who underwent surgical correction. Patients were subdivided into three groups: group I (n=50) underwent recession only, group II (n=10) underwent resection only, and group III (n=8) underwent recession and resection. All patients were subjected to preoperative, operative, and postoperative evaluations (palpebral fissure height and width measurement).

Results

Distant angle of exotropia was considerably lower in group I than group III (P2<0.019) but were insignificantly different between groups I and II and between groups II and III. Palpebral fissure at 6 months was considerably lower in group II than groups I and III (P=0.013 and 0.019, respectively).

Conclusion

Horizontal rectus muscles recession for horizontal strabismus causes vertical widening of palpebral fissure height, and also resection results in narrowing of vertical palpebral fissure height. The combination of horizontal rectus muscle recession and resection for horizontal strabismus results in vertical palpebral fissure height widening in half of eyes and vertical palpebral fissure height narrowing in a quarter of the eyes.
Effect of intraoperative single dose of dexamethasone on posttonsillectomy pain in children: a systematic review and meta-analysis
Authors: Sakr Mohamed A. , El-Guindy Ahmed S. , Khalefa Mohamed A. , Mandour Mahmoud F.
Published: August 2023

Background

Tonsillectomy is one of the commonest operative techniques done universally. In spite of developments in anesthetic and operative procedures, posttonsillectomy pain remains a vital clinical problem. Posttonsillectomy pain is perhaps the consequence of muscle spasm caused by inflammation and irritation of the pharyngeal muscular structure. Postoperatively cases frequently have significant odynophagia, alteration of diet, and reduced activity. The recovery interval of kids frequently continues from 4 to 7 days, whereas adults might continue being symptomatic up to 2 weeks. The odynophagia may be sufficiently severe to control oral intakes, which in occasional cases can lead to dehydration needing admittance for intravenous fluids.

Aim

This work aimed to evaluate the consequence of intraoperative single dosage of dexamethasone on posttonsillectomy pains in kids and to verify its significance.

Patients and methods

A systematic review of presently accessible randomized controlled trials via a one-dose, intravenous corticoid throughout pediatric tonsillectomy has been done. Visual analog pain score information was obtained with reviewers blinded to findings.

Results

Seven randomized trials have been involved in posttonsillectomy pain analysis. A significant decrease in pain as determined by visual analog pain score on the first-day postoperatively was found.

Conclusions

A single, intraoperative dosage of dexamethasone can decrease posttonsillectomy pain on the first day postoperatively by a factor of 1 on a 10-point pain scale. As the adverse effects and price of dexamethasone dosage seem negligible, considerations of routine usage appear acceptable.
Robotic-Assisted Laparoscopic Sigmoidectomy with Transrectal Specimen Extraction for Recurrent Diverticulitis
Authors: Judge Carolyn G. , Wisbach Gordon G.
Published: August 2023

Natural orifice specimen extraction is a surgical technique that is defined as the removal of a surgical specimen from a natural orifice with intracorporeal anastomosis. Natural orifice specimen extraction is defined by the site of extraction and has been performed via the vagina, anal canal, rectum, colon, and mouth. The primary benefit of this technique is reduced trauma at the access point due to avoidance of mini laparotomy, used to facilitate specimen extraction in conventional laparoscopy. This technique has been associated with less postoperative pain, lower analgesic requirement, faster return of bowel function, and fewer incisional hernias, as well as an improved cosmetic result. Use of the robotic platform allows for deep pelvic dissection, which is challenging to impossible with laparoscopic instruments. Here, we report a case of recurrent diverticulitis in the setting of complex abdominal surgical history managed by robotic-assisted laparoscopic sigmoidectomy with transrectal specimen extraction.
Solitary Fibrous Tumor Arising from the Colonic Wall
Authors: Mc Garry Jennifer L. , Ryan Fintan R. , Ng Zi Q.
Published: August 2023

Solitary fibrous tumors (SFTs) are defined as fibroblast mesenchymal neoplasms. They occur in 0.35 per 100,000 individuals and most commonly occur in the pleura. Surgical resection is the mainstay of treatment. Our case aims to highlight the presentation, imaging findings, and management of colonic SFTs. We describe the case of a 48-year-old woman presenting with back pain and constipation. Computed tomography of the abdomen/pelvis revealed a large mass encompassing the terminal ileum and right hemi colon, suggesting gastrointestinal stromal tumor. Colonoscopy did not reveal any intraluminal lesion. Intraoperative findings revealed a right abdominal mass adherent to the cecum and terminal ileum without liver or peritoneal disease. The patient underwent a standard oncological right hemicolectomy. Histopathology revealed spindle cell neoplasm with foci of prominent vasculature and a positive signal transducer and activator of transcription 6 stain, supporting a diagnosis of SFT. Colonic SFTs are rare and usually benign in nature. To date, guidance with respect to treatment is dependent on case reports and case series.
A Randomized Controlled Trial of Negative Pressure Wound Therapy to Reduce Colorectal Surgical Site Infection
Authors: Groot Gary , Dattani Sheev , Mondal Prosanta , Darbyshire Rhonda , Morin Carolyn , Ginther David N. , Pham Hong , Gill Jivanjot
Published: August 2023

Background:

The rate of surgical site infection (SSI) in clean-contaminated wounds resulting from elective colorectal procedures ranges from 15 to 30%. Within the region considered in the study, the SSI rate is 20% despite the adoption of preventative measures.

Objective:

The objective of this study was to determine the effectiveness of prophylactic negative pressure wound therapy (NPWT) in reducing superficial SSIs in clean-contaminated wounds resulting from elective colorectal surgery to below 10%.

Design:

An unblinded randomized controlled trial was conducted.

Settings:

The study was conducted at two Canadian tertiary academic hospitals.

Patients and Methods:

Patients undergoing elective, non-emergent, clean-contaminated colorectal resection by both laparoscopic and open procedures were included. Participants were randomized to either standard surgical dressing (SSD) or NPWT over a closed incision.

Main Outcome Measures:

Incidence of superficial SSI on postoperative day 30.

Results:

The study closed early due to lack of accrual. From the planned group of 398 patients, 126 were randomly assigned to SSD (n = 61) or NPWT (n = 61). The analysis included 55 patients from the SSD group and 47 from the NPWT group. The mean age for the groups was 64.9 years (SSD) and 65.1 years (NPWT) with males comprising 52.7% (n = 29) and 44.7% (n = 21) of the populations, respectively. The results showed a clinically important but statistically non-significant difference between the two groups. The overall rate of SSI in the as-treated analysis was 14.7%, while it was slightly lower at 13.5% in the intent-to-treat (ITT) analysis. In both cases, there was a trend toward higher rates of SSI in the SSD, with the ITT analysis showing somewhat larger differences; however, in both the logistic regression models, the trends were non-significant.

Conclusion:

We present a randomized controlled trial of prophylactic NPWT following elective colorectal resection. The results indicated a clinically important reduction in the superficial SSI rate compared with standard surgical dressing. A more extensive randomized study is needed to clarify the effectiveness of NPWT to reduce wound infections in this patient population.

Limitations:

Neither patients nor clinicians were blinded to the treatment. The lack of recruitment introduced a type two statistical error, which led to a non-significant difference between the cases and controls.

Conflict of Interest:

None.
Prognostic Role of the Lymph Node Ratio in Colorectal Cancer
Authors: Derici Serhat Tolga , Ergenç Muhammer , Sücüllü İlker , Akin Mehmet Levhi
Published: August 2023

Background:

Studies have been conducted to investigate more practical and useful parameters in determining the prognosis of patients with colorectal cancer (CRC), and some suggest that the lymph node ratio (LNR) may be useful in doing so, especially in patients with inadequate lymph node dissection.

Objectives:

We aimed to evaluate the effect of LNR (number of metastatic lymph nodes/number of total lymph nodes excised) on disease-free survival and overall survival rates in CRC.

Design:

A single-center retrospective cohort study.

Setting:

Tertiary care hospital.

Patients and Methods:

The clinical and pathological features of the patients were analyzed by dividing them into groups according to tumor localization; tumor, node, metastasis staging; and LNR. The Kaplan–Meier method and the log-rank test were used for survival analysis.

Sample Size:

A total of 479 patients with CRC who were operated on between September 1991 and December 2011 were included in this study. The LNR of 439 patients could be calculated, and analyses were according to these patient groups.

Main Outcome Measures:

The primary objective of this study was to determine the effect of LNR on disease-free survival and overall survival in CRC.

Results:

A total of 121 right-sided colon cancers, 202 left-sided colon cancers, and 156 rectal cancers were analyzed. The age of the patients ranged from 20 to 93 years, and the mean age was 66.8 (13.5) years. The cumulative 5-year survival rate was 48.5% in our patients with CRC. When analyzing the tumor, node, metastasis stages of the groups according to their LNRs, the results showed that as the rate of lymph node metastasis increases, so does the tumor stage parameter (P < 0.001). The overall survival and disease-free survival rates significantly decreased as LNR increased (P < 0.001).

Conclusion:

This study showed that LNR correlates well with the disease-free and overall survival rates. A higher LNR could indicate the aggressiveness of the tumor; therefore, LNR may be a predictor of the poor prognosis of CRC.

Limitations:

Some patients could not be followed-up and we could not evaluate complications because not all patients had data on postoperative complications. As a result, our study results may have been affected.

Conflict of Interest:

The authors have no conflict of interest to declare.