bluuebunny/crossref_metadata_2025 huggingface dataset:
Cardiovascular Manifestations and Outcomes in Patients Admitted with Severe COVID-19
Authors: Alkindi Fahad , Alhashmi Khamis , Nadar Sunil , Alharthi Salma , Alsaidi Khalid , Alrashdi Tasneem , Alasmi Shabib , Khamis Feryal , Algafri Adil , Allawati Sultan , Alfarsi Muzna , Murthi Sathiya , Albusaidi Mujahid , Balkhair Abdullah , Alhadi Hafidh , Alrasadi Khalid , Alabri Maather , Alissai Maryam , Alkindi Shihab , Alsabti Hilal
Published: May 2024

Objectives:

Coronavirus disease-19 (COVID-19) is caused by severe acute respiratory distress syndrome-coronavirus-2 (SARS-CoV-2) -that can affect the cardiovascular system. The aim of our study was to assess the cardiovascular manifestations and its effect on the overall mortality among patients with severe COVID-19 who were admitted in the intensive care units (ICU).

Methods:

This is a retrospective, multicenter cohort study that included all adult patients admitted to the ICU with laboratory-confirmed COVID-19 in three major hospitals in Oman between March 1, 2020, and August 10, 2020.

Results:

A total of 541 patients (mean age of 50.57 ± 15.57 years; 401 [74.1%] male) were included in the study of which 452 (83.5%) were discharged and 89 (16.5%) died during hospitalization.

Evidence of cardiac involvement was found in 185 (34.2%) patients, which included raised troponin (31.6%), arrhythmias (4.3%), myocardial infarctions (2.6%), or drop in ejection fraction (0.9%). High troponin of >100 ng/l was associated with higher mortality (odds ratio [OR] = 7.98; 95% confidence interval [CI]: 4.20–15.15); P < 0.001). Patients with any cardiovascular involvement also had a high risk of dying (OR = 8.8; 95% CI: 4.6–16.5; P < 0.001).

Conclusion:

Almost a third of patients in our study had evidence of cardiovascular involvement which was mainly myocardial injury. This was associated with increased mortality.
Effectiveness of Scenario-based Roleplay as a Method of Teaching Soft Skills for Undergraduate Medical Students
Authors: Lavanya KM , Somu Lava Kumar , Mishra Sushant Kumar
Published: May 2024

Background:

Despite the widespread acknowledgment of the need and significance of soft skills (SKs) in health professions education, the subject is not emphasized enough in training students. These skills can be taught to undergraduates through roleplay. Communication skills and teamwork were taught by scenario-based roleplay and assessed in this study.

Objectives:

The study aimed to implement scenario-based roleplay as a method of teaching communication skills and teamwork to undergraduate medical students and to assess their perceptions.

Methodology:

A prospective study was conducted in the simulation/skills laboratory among 41 Phase I undergraduate medical students. The SKs taught during the sessions included communication skills, empathy, and teamwork.

Results:

The mean of the responses obtained from Gap Kalamazoo Communication Skills Checklist score in the first encounter was 27.0, 38.12 in the second encounter, and 41.24 in the third encounter. The mean scores showed a statistically significant difference between E1 and E2, E1 and E3, and E2 and E3. Posttest scores of students to self-efficacy questionnaire showed significant improvement compared to pre-test scores. Students in the present study opined that they could learn the aspects that could not have been learned in didactic lectures about communication skills and teamwork.

Conclusion:

Scenario-based roleplay can be used as an effective method for teaching SKs such as communication skills and teamwork for undergraduate medical students. Different scenarios which replicate the real-life situations can be incorporated to help students to learn and face the real-life encounters.
Peripheral Dentinogenic Ghost Cell Tumor- Diagnostic Challenge in a Gingival Epulis: Report of a Case with Update of all Dentinogenic Ghost Cell Cases Reported in English Literature
Authors: Nithya S. , Saxena Susmita , Kharbanda Jitin
Published: May 2024

Dentinogenic ghost cell tumor (DGCT), a variant of the calcifying odontogenic cyst, is considered to be a benign epithelial and mesenchymal neoplasm containing aberrant epithelial keratinization, ghost cells, and spherical calcifications. While there can be peripheral and central variants of this entity, the extraosseous type is rarer and usually innocuous in its clinical presentation. The aim of this article is to report a case of peripheral DGCT on the maxillary anterior region in a 14-year-old female evolving for 5 years and to emphasize the importance of histopathologic examination of gingival growths to avoid diagnostic pitfalls. A compilation of all reported cases in the English literature till date with details on the site, size, age sex, symptoms radiographic features, treatment follow-up, and recurrences has been attempted for better understanding of the biologic nature of this rare neoplasm.
Prevalence of Smartphone Addiction and its Relationship with Obesity among Young Adults: A Cross-sectional Study from Delhi, India
Authors: Das Priyosmita , Saraswathy Kallur Nava , Chaudhary Vineet
Published: May 2024

Smartphone addiction (SA) has emerged as an important health concern worldwide. Recent studies have recognized SA as one of the factors that promote sedentarism and can contribute to obesity. However, the relationship between SA and obesity among Indian young adults remains understudied. The present study aims to estimate the prevalence of SA and explore its association with general and central obesity among young adults in Delhi, India. This cross-sectional study was conducted among 246 young adults (aged 18–30 years) of either sex (60.16% females) from Delhi. Screening for SA was done using the Smartphone Addiction Scale–Short Version. Somatometric measurements (height, weight, waist circumference, and hip circumference) were taken to determine general and central obesity. SA was prevalent among 25.2% of the participants. The prevalence of SA was higher among males and undergraduate students than among females and postgraduate/MPhil/PhD students, respectively. Further, SA was not associated with any of the obesity variables. Interestingly, smartphone addicts were found to have a 2.5-fold increased risk of being underweight. Though SA was not associated with obesity, it was found to be associated with being underweight, indicating a relationship between smartphone use and nutritional status among young adults.
Advances in neuro-oncological imaging and their impact on patient management
Authors: Hakim Arsany , Wiest Roland
Published: May 2024

Neuroradiological imaging of gliomas has undergone many advances in the recent years. Visual assessment of structural image datasets is nowadays complemented by quantifiable imaging markers to detect tumor progression and correlations with molecular markers. Detailed information about the tumor-specific pathophysiology, reflected by alterations of hemodynamics and metabolism or about tumor microstructure and infiltration of neighboring structures, is nowadays accessible noninvasively through the magnetic resonance imaging (MRI). Some of these developments have been driven by the updates of the neuropathological classification of gliomas, which now ranks genotypic markers ahead of histomorphological criteria. Neuroimaging constitutes also a key element in the diagnostic support, therapy planning, and monitoring of disease progression under therapy. While computed tomography is still of importance in emergency situations to screen for neoplastic cerebral lesions or acute complications of therapy or tumor progression, as for example, hemorrhage or seizure generation, MRI is the fundamental technology for the differential diagnosis and localization of cerebral gliomas. This review aims at providing an introduction into the most frequent clinically employed advanced magnetic resonance methods for glioma imaging.
Orbital tumors
Authors: Dikshit Priyadarshi , Nandan Maruti , Balachandar D , Jaiswal Awadhesh K. , Behari Sanjay
Published: May 2024

Orbit can be home for a spectrum of tumors with almost every orbital structure having the potential to harbor a neoplastic process. Surgical exposure and resection of orbital tumors can often be tricky due to the intricate anatomy of the region, with an additional complexity caused by a tumor related distortion. The clinical presentation depends on the primary structure involved and the location of the tumor within the orbit, and so does the scheme of management. Modern diagnostic imaging modalities offer a crucial pre-operative understanding of the precise location of the tumor within the orbit; it also helps in defining the nature of the tumor. Both these aspects are required for planning the appropriate surgical approach. Often, orbital tumors extend beyond the confines of the orbit requiring the tailoring of the surgical procedure, which may necessitate the involvement of a multidisciplinary team. The contemporary neurosurgical practice is also witnessing a progressive inclination towards minimally invasive endoscopic approaches, which have shown equally good if not better results in properly selected cases. Furthermore, early promising results with attempts at performing multisession stereotactic radiosurgery on orbital tumors has rekindled interest in this modality, in line with the management of intra-cranial tumors having a similar pathology. This article aims to recapitulate relevant surgical anatomy and to elucidate the current practice in the management of common orbital tumors encountered by neurosurgeons.
Intraoperative electrophysiological principles in neurooncological practice
Authors: Kumar G. Krishna , Pradeep K. , Rajesh B. J. , Bhaire Vishwanath S. , Manohar Nitin , Balasubramaniam Anandh
Published: May 2024

Intraoperative neurophysiological monitoring (IOMN) is an important adjunct in modern day neurosurgical practice. There has been a paradigm shift from functional preservation to maximal safe or total excision of a tumor along with functional preservation, aiming for a better quality of life to the patients. In neurosurgery, like in any other specialty, we have two extremes of tumors, benign and malignant. In malignant tumors, the extent of resection, along with molecular genetics of the tumor, play an important role in the survival of patients. Thus, one should target for complete resection, whenever feasible, in these types of tumors. In benign tumors, such as World Health Organisation (WHO) grade 2 gliomas, a good chance of long-term survival exists. IOMN is a valuable adjunct in neurosurgical practice that guides the surgeon and warns him/her of the important neurological structures in the vicinity, during surgery. The IOMN procedures, however, have their own limitations that everyone should be aware of. The technique has been used along with other adjuncts like a preoperative MRI (including the functional magnetic resonance imaging [MRI], diffusion tensor imaging of long tracts and perfusion studies), neuronavigation and intraoperative imaging to maximize the chances of a better outcome in the form of onco-functional balance. In this review, an overview of IONM has been discussed.
Role of liquid biopsy in central nervous system tumors
Authors: Chakraborty Rituparna , Suri Vaishali , Dandapath Iman , Singh Jyotsna , Sharma MC , Sarkar Chitra
Published: May 2024

Challenges in obtaining tissue specimens and tumor heterogeneity are major limitations for accurate diagnosis, molecular characterization, risk stratification, and development of biomarker-driven therapies in central nervous system (CNS) tumors. The potential of assessment of CNS tumors through analysis of corporeal fluids (liquid biopsy) is being explored to document tumor-related genetic/epigenetic alterations and protein expression to identify prognostic and therapeutic biomarkers. The quantity of circulating tumor DNA isolated also appears to be directly associated with tumor progression and response to treatment. In this review, we provide synopsis of the recent studies which have provided crucial insights into analyzing circulating tumor cells, cell-free nucleic acids, and extracellular vesicles for directing long-term disease control. We have also highlighted the stumbling blocks and gaps in technology that need to be overcome to translate research findings into a tool in the clinical setting.
Diagnosis and management of central nervous system embryonal tumors in the molecular era
Authors: Santosh Vani , Rao Shilpa , Dasgupta Archya , Gupta Tejpal
Published: May 2024

Central nervous system (CNS) embryonal tumors exhibit significant biological heterogeneity and pose challenges in diagnosis and clinical management. Among these, medulloblastoma is the most common and extensively studied tumor. Advances in understanding the molecular alterations of these tumors, using genomic and epigenomic platforms, have led to refinement in their diagnosis, classification, and guiding clinical management. This review discusses the current understanding of the molecular underpinnings of CNS embryonal tumors and details their clinical presentation, histopathological, and molecular features. Based on the recent discoveries, the current state of management of medulloblastoma and other embryonal tumors, including the recent biomarker-based clinical trials, is reviewed.
Advances in radiation therapy in malignant brain tumors
Authors: Jalali Rakesh , Sudarsan Rishan Thimma
Published: May 2024

Radiation therapy (RT) plays a key role in the optimal management of a range of primary and secondary brain tumors. RT has evolved from conventional radiotherapy to three-dimensional (3D) conformal, intensity-modulated radiotherapy (IMRT), volumetric modulated arc therapy (VMAT), stereotactic techniques such as stereotactic radiosurgery or fractionated stereotactic radiotherapy to particle beam therapies such as the proton beam therapy (PBT) and carbon ion therapy. Further, there is increased evidence of molecular-based approach in the treatment of malignant brain tumors. Tumors such as the high-grade gliomas tend to have inferior outcomes as compared to the low-grade gliomas. Pediatric brain tumors tend to do better, in terms of local control, progression-free survival, and overall survival. In such scenarios, sparing of critical structures is essential as it tends to reduce the dose to the normal brain tissue, thereby improving neurocognitive outcomes, reduces hormonal impairment and risk of secondary malignant neoplasms. Modern techniques such as the IMRT, VMAT, and PBT, especially image-guided intensity-modulated proton therapy, spare the critical structures to bare minimum, which in turn leads to superior dose distribution without any low dose spillage to the nearby areas. These advanced techniques not only behave therapeutically but are also cost-effective, resulting in improved quality of life.
Metabolic memory and diabetic retinopathy: Legacy of glycemia and possible steps into future
Authors: Sheemar Abhishek , Bellala Keerthi , Sharma Sumant Vinayak , Sharma Sarmeela , Kaur Inderjeet , Rani Padmaja , Sivaprasad Sobha , Narayan KM Venkat , Das Taraprasad , Takkar Brijesh
Published: May 2024

The response of retinal pathology to interventions in diabetic retinopathy (DR) is often independent of the glycated hemoglobin (HbA1c) values at the point of care. This is despite glucose control being one of the strongest risk factors for the development and progression of DR. Previous preclinical and clinical research has indicated metabolic memory, whereby past cumulative glucose exposure may continue to impact DR for a prolonged period. Preclinical studies have evaluated punitive metabolic memory through poor initial control of DM, whereas clinical studies have evaluated protective metabolic memory through good initial control of DM. In this narrative review, we evaluate the preclinical and clinical evidence regarding metabolic memory and discuss how this may form the basis of preventive care for DR by inducing “metabolic amnesia” in people with a history of uncontrolled diabetes in the past. While our review suggested mitochondrial biology may be one such target, research is still far from a possible clinical trial. We discuss the challenges in such research.
Unmasking of Churg–Strauss Syndrome in an Asthmatic
Authors: Navya K K , Ramakrishnan Gayathri Anur
Published: May 2024

Churg–Strauss syndrome, also known as eosinophilic granulomatosis, is one of the antineutrophilic cytoplasmic antibody (ANCA)-associated vasculitis associated with asthma and peripheral eosinophilia. Here, we present a case of a 50-year-old male, known asthmatic presenting with cough, dyspnea, fever, and lower limb purpura. On evaluation found to have perinuclear ANCA positivity; a nerve conduction study showed mononeuritis multiplex, and he was diagnosed with Churg–Straus syndrome.
Ultrasonographic Analysis of Biparietal Diameter as an Indicator of Gestational Age in North Indian Fetuses
Authors: Singh Archana , Gupta Rakesh , Singh Arun
Published: May 2024

Background:

Clinical data such as menstrual cycle or uterine size often are not reliable parameter for pregnancy dating. Sonographic measurements of the fetus provide information about gestational age, growth and expected date of delivery. Aims: To develop a reference chart to estimate gestational age by ultrasonographic measurement of fetal bi-parietal diameter (BPD) and to find out correlation between two variables.

Material and Methods:

Cross sectional study was conducted on among 750 pregnant women of gestational age of 14-40 weeks, attending the Obstetrics and Gynaecology out-Patient department during one year period. Each fetus was ultrasonographically measured for BPD, the mean was used in subsequent statistical analysis.

Statistical Analysis:

It was done by the software SPSS version 21.0. A p-value < 0.05 considered to be significant. The previously published nomograms were compared by using unpaired t-test. Correlation & regression analysis has been done for BPD and GA. Results: Out of total 750 participants, 97.6% females confirmed their pregnancy by urine pregnancy test, 22.9% had dating scan, mean height was 163.004 cm. On ultrasound examination 78% participants had vertex, 7.6% had breech and 14.4% had variable presentation of fetus.Mean BPD increases 3.07 mm per week from 14to30 weeks and 1.93 mm per week from 31 to 40 weeks. For establishing a relationship between two variables GA & BPD, the correlation & regression analysis has been done.Sigmoid regression equation was the best for this study.

Conclusions: Data showing that North Indian fetuses are smaller than European fetuses after 22 weeks gestation.
Investigation of Bone Biomechanics in Rats with Traumatic Kidney Injury
Authors: Nalbant Asrin , Saygin Duygu Akin , Aydin Arif , Kabakçi Anil Didem Aydin
Published: May 2024

Objective:

Mineral metabolism disorders are common in chronic kidney disease (CKD) and increase the risk of fractures. It has been confirmed by animal models that these changes in bone also cause negative results in the mechanical properties of bone. Although there are many available methods for diagnosing metabolic bone disorders and estimating fracture risk, it has been suggested that biomechanical tests that provide information about bone’s structural and material properties are most appropriate, particularly in small rodents with CKD. Therefore, this study aimed to investigate the effects of trauma-induced kidney damage on bone biomechanical properties.

Materials and Methods:

In this study, we used 16 adult Wistar Albino rats, 200–300 g, 4–5 months old. The animals were examined under two groups: kidney control (n = 9) and healty kidney control group and kidney damage group (n = 7). In the control group, the rats were fixed by laparotomy, and the kidneys were closed without suturing. However, the kidney damage group was approached by suturing.

Results:

When the bone biomechanical properties of the control and kidney-damaged groups were compared, a statistically significant difference was found between the displacement at maximum load, duration, and young’s modulus groups (P < 0.005).

Conclusion:

The study showed that the bone biomechanical properties of rats with trauma-induced kidney damage changed, and there was an increased fracture risk.
Immuno Histological Evidence of Ormocarpum Sennoides DC Extract in the Expression of Bax and Bcl2 in Wister Rats with Glucocorticoid induced Osteoporosis
Authors: Srinivasan Bhuvaneswari C. , Krishnan Radhika
Published: May 2024

Introduction:

Glucocorticoid therapy is the most common cause for secondary osteoporosis leading to a resurgence of interest in traditional medicine that could have bone sparing effects by naturally occurring bioactive molecules. Therefore, this study was done to evaluate the effect of Ormocarpum sennoides DC through immunohistological evidence in the expression of Bax and Bcl2 in glucocorticoid-induced Osteoporosis in Wister albino rats.

Materials and Methods:

Rats were divided into five groups (Control, MPA (Osteoporosis), Alendronate (2 mg/kg), 100 mg (EOS), and 200 mg (EOS). The treatment was conducted for 45 days the Bax and Bcl2 expressions were evaluated in osteoclast of distal femur diaphysis.

Results:

When compared the MPA to control group (P < 0.05) Bax increased and Bcl2 reduced, when compared with MPA (P < 0.05) Alendronate, EOS 100 mg and EOS 200 mg increased the Bcl2 expressions, Alendronate, EOS 100 mg, and EOS 200 mg reduced the Bax expression.

Discussion and Conclusion:

EOS 100 mg and EOS 200 mg increased Bcl2 expression and reduced the Bax expression Ormocarpum sennoides prevents glucocorticoid-induced Apoptosis of preosteoblast; therefore, Bcl2 may be an important regulator of bone growth thus reporting antiapoptotic property of Ormocarpum sennoides DC.
To Estimate Age- and Gender-Related Morphometric Change in Cella Media Index of the Lateral Ventricles by Computed Tomography Scan in Adult Human Population of North India
Authors: Sharma Jyoti , Singh Pradeep , Gupta Anjali , Gupta Anshu
Published: May 2024

Background and Aim:

Several histopathological and gross changes are seen in human brain as age increases, causing enlargement of the lateral ventricles. Morphometric measurement and size of the lateral ventricle of the brain are of great importance to identify certain changes and correlate it with clinical significance. This study was designed to provide a normal data of the cella media index (CMI) measurements of the lateral ventricle of the brain and its association between both the genders and its correlation with different age groups of North Indian Population, which will be helpful for diagnosis of cerebral atrophy.

Subjects and Methods:

This study was carried out in the Department of Anatomy and Department of Radiodiagnosis, S. N. Medical College, Agra, Uttar Pradesh. In the present prospective study, computed tomography scans of 200 patients between the age of 18 and 75 years (126 males and 74 females) were done, and measurements of the lateral ventricle of the brain were analyzed statistically.

Results:

In our study, the overall mean CMI was 4.62 ± 0.5 (CMI in male was 4.53 ± 0.41 and mean CMI in female was 4.42 ± 0.28), difference being statistically significant between both genders as P = 0.04 (P ≤ 0.05). In our finding, r = −0.13, indicating a mild positive correlation between age and transverse diameter of CMI of the lateral ventricle in North Indian population.

Conclusion:

This study concludes that with increase in age, there is a decrease of cella media ratio/Schiersmann’s Index, which is helpful in diagnosis of neurological conditions (e.g. schizophrenia, bipolar disorder, and Alzheimer’s disease).
Spondylodiscitis: Understanding pathophysiology, surgical strategies, and postoperative management – A single-center study
Authors: Encarnación-Santos Daniel , Valerievich Kim-A , Scalia Gianluca , Shestov Eugeny , Pachev Murat , Wellington Jack , Bozkurt Ismail , Rubenovich-Chikara Dmitriy , Kirilin Igor , Chmutin Gennady , Tapia Ariel , Ekhsan Naim , Chaurasia Bipin
Published: May 2024

Background:

Spondylodiscitis (SD) is an inflammatory condition affecting the intervertebral discs and adjacent structures, often leading to serious complications, including epidural abscesses. This study aimed to differentiate postoperative SD from spontaneous cases caused by osteoporotic defects and associated pathologies, evaluating the frequency of SD in spinal diseases at a single center.

Materials and Methods:

A retrospective observational study involving 25 patients was conducted, analyzing variations between postoperative revisions in SD patients and spontaneous SD due to concurrent pathology and osteoporotic defects. The effects of postoperative wound healing following transforaminal lumbar interbody fusion and decompressive hemilaminectomy with pedicle screws were also investigated. Ethical guidelines were strictly followed during the study, conducted from January 2023 to September 2023 at Moscow City Clinical Hospital No. 68, Demikhova V.P.

Results:

Among the 25 patients with spontaneous SD, 15 females and 10 males were included, with only two undergoing surgical revision. Predominant purulent inflammatory foci were observed at specific spinal levels, and demographics revealed prevalent comorbidities such as arterial hypertension (80%) and type 2 diabetes mellitus (60%). Postoperative complications included paravertebral abscesses and wound-related issues. Structural observations indicated vertebral destruction, joint gaps, and localized spinal canal narrowing, revealing complexities in SD cases.

Conclusion:

Surgical intervention remains crucial for addressing SD-related vertebral complications, while antimicrobial therapy tailored to specific pathogens is pivotal. Concurrent conditions necessitate comprehensive management, often involving cardiological interventions. Postoperatively, a combined approach of conservative therapy and calcium phosphate adjuncts is recommended, especially considering the observed low bone density, aiming to optimize patient recovery and spinal stability.
Enhancing palliative care in vulnerable patients: Robot-assisted radiofrequency ablation for multiple spinal metastases – Technical insights and preliminary outcomes
Authors: Ricciardo Giuseppe , Garufi Giada , Scalia Gianluca , Cacciola Fabio , Collufio Domenicantonio , Conti Alfredo , Cardali Salvatore Massimiliano
Published: May 2024

Background:

Radiofrequency thermal ablation (RFA) coupled with vertebroplasty or kyphoplasty offers a minimally invasive, safe, and efficacious approach to palliate polymetastatic spine disease, particularly in medically fragile individuals. However, the application of robotic assistance to RFA for spinal metastases remains unexplored. This study elucidates the technical viability of robot-assisted RFA combined with vertebroplasty in patients afflicted by multiple spinal metastases and presents preliminary outcomes. An illustrative case was also presented.

Materials and Methods:

Ten patients aged over 65 years with multiple vertebral metastases were enrolled in this study. Preoperatively, patients exhibited a median Visual Analog Scale (VAS) pain score of 6 and a Median Oswestry Disability Index (ODI) score of 58%. From February 2021 to April 2022, all patients underwent RFA, followed by vertebroplasty for spinal metastases. Surgical procedures were executed using the ExcelsiusGPS® robotic platform.

Results:

Patients experienced substantial pain relief, with a median VAS score of 2.5 at 24 h postoperatively (Δ −−3.5; P < 0.001) and a median VAS score of 2 at 1 month postoperatively (Δ −4; P < 0.001). All patients were discharged on the first postoperative day and continued their oncological treatments. In addition, the median ODI score at 1 month postoperatively was 34% (Δ −−24%; P = 0.006), indicating an enhanced quality of life and a satisfactory impact on daily activities. No procedural or postoperative complications were documented.

Conclusions:

This case series represents the inaugural successful application of robot-assisted RFA in conjunction with concurrent vertebroplasty/kyphoplasty. Our preliminary experience demonstrates that patients with oligo- and polymetastatic conditions can derive benefits from this minimally invasive intervention, characterized by rapid postoperative recovery and effective short- to medium-term pain management, without encountering complications.
Atlantoaxial subluxation and Down syndrome: A cross-sectional analysis
Authors: Merckling Matthew , Vazquez Sima , Nolan Bridget , Subah Galadu , Fortunato Michael , Stein Alan , Patel Harsdadkumar , Asprinio David , Wainwright John , Kinon Merritt , Gandhi Chirag , Al-Mufti Fawaz
Published: May 2024

Background:

Atlantoaxial subluxation (AAS) is a diagnosis describing misalignment of the C1 vertebra relative to C2. Excessive translation of this joint, located adjacent to the medullary brain stem, can lead to devastating neurological consequences. A higher prevalence of AAS within the Down syndrome (DS) population has been well-established. This study aims to establish a prevalence rate of DS in patients hospitalized for AAS and compare outcomes between AAS patients with and without DS.

Methods:

This study utilized the National Inpatient Sample (NIS) provided by the Healthcare Cost and Utilization Project (HCUP). In accordance with HCUP 2023 Clinical Classifications Software Refined files, data were queried using the International Classification of Diseases 10th Edition codes for DS and AAS. Demographics, comorbidities, hospital course, and outcomes were examined and compared using binary and linear multivariate regression. IBM SPSS software was used for data analysis.

Results:

Of the 213,095 patients in the NIS database admitted between 2016 and 2020 with AAS as their primary diagnosis, 7.2% were DS patients. DS patients were significantly younger (26.56 ± 20.81 vs. 49.39 ± 27.63, P < 0.01), less likely to be female (33.30% vs. 52.10%), and had fewer comorbidities (diabetes mellitus, hypertension, and hyperlipidemia) than non-DS patients. There was no significant difference in likelihood to undergo surgical fusion between DS patients and non-DS patients with AAS.

Conclusion:

This large-scale study using NIS data determined that 7.2% of all patients admitted to hospitals for AAS are DS patients. The analysis of demographics, hospital course, and outcomes can influence the development of treatment protocols for AAS in the DS population.
Full endoscopic percutaneous stenoscopic lumbar decompression and discectomy: An outcome and efficacy analysis on 606 lumbar stenosis patients
Authors: Victorio  , Shen Robert , Nasution Mahdian Nur , Mahadewa Tjokorda Gde Bagus
Published: May 2024

Introduction:

Laminectomy has long been a “gold standard” to treat symptomatic lumbar spinal stenosis (LSS). Minimal invasive spine surgery (MISS) is widely developed to overcome the limitations of conventional laminectomy to achieve a better outcome with minimal complications. Full endoscopic percutaneous stenoscopic lumbar decompression (FE-PSLD) is the newest MISS technique for spinal canal decompression. We aimed to evaluate and analyze the significance of FE-PSLD in reducing pain and its association with age, duration of symptoms, stenosis level, and operative time (OT).

Materials and Methods:

A longitudinal cross-sectional study was conducted on 606 LSS patients who underwent FE-PSLD and enrolled from 2020 to 2022. Three-month evaluation of the Visual Analog Scale (VAS) and the modified MacNab criteria were assessed. The significance of changes was analyzed using the Wilcoxon signed-ranks test. Spearman’s correlation test was performed to evaluate the significant correlation of several variables (pre-PSLD-VAS, age, symptoms duration, OT, and level of LSS) to post-PSLD-VAS, and multiple regression analysis was conducted.

Results:

The reduction of VAS was statistically significant (P ≤ 0.005) with an average pre-PSLD-VAS of 6.75 ± 0.63 and post-PSLD-VAS of 2.24 ± 1.04. Pre-PSLD-VAS, age, and stenosis level have a statistically significant correlation with post-PSLD-VAS, while the duration of the symptoms and OT have an insignificant correlation. Multiple regression showed the effect of pre-PSLD-VAS (β =0.4033, P = 0.000) and stenosis level (β =0.0951, P = 0.021) are statistically significant with a positive coefficient.

Conclusions:

FE-PSLD is an efficacious strategy with favorable outcomes for managing LSS, shown by a significant reduction of pain level with a relatively short follow-up time after the procedure. Preoperative pain level, age, and stenosis level are significantly correlated with postoperative pain level. Based on this experimental study, PSLD can be considered a good strategy for treating lumbar canal stenosis in all age groups and all LSS levels.
Disseminated Intravascular Coagulation during a Course of Miliary Tuberculosis with Acute Respiratory Distress Syndrome
Authors: Sharma Kapil , Jaryal Ajay , Sharma Sumita , Rana Lokesh
Published: May 2024

Miliary tuberculosis (TB) can occasionally lead to acute respiratory distress syndrome (ARDS) and disseminated intravascular coagulation (DIC). In this case report, we present the case of an 18-year-old male who was diagnosed with miliary TB based on miliary shadows on X-ray and computed tomography of the chest, as well as positivity for mycobacterium TB in endotracheal aspirate by cartridge-based nucleic acid amplification. The patient’s hospital stay was complicated by ARDS and DIC, which was successfully managed with ventilatory support, administration of antitubercular treatment, systemic corticosteroids, and blood products.
Evaluation of Interstitial Cells of Cajal-Like Cells at the Pelviureteric Junction in Children with Pelviureteric Junction Obstruction
Authors: Nandan Ruchira , Jain Vishesh , Agarwala Sandeep , Das Prasenjit , Goel Prabudh , Kalaivani Mani , Yadav Devendra Kumar
Published: May 2024

Introduction:

The etiopathogenesis of pelviureteric junction obstruction (PUJO) has been debated. Recently, the role of interstitial cells of Cajal-like cells (ICC-LC)has been studied and reported to be the cause of this functional obstruction. We studied the histopathology and ICC-LC density at PUJ and compared it with that of PUJ of the control group and distal ureteric margin of the study group.

Methods:

A prospective study was conducted which included PUJO patients in the study group and the renal tumor patients in the control group. Histopathological examination (muscle hypertrophy and fibrosis) and immunohistochemistry (ICC-LC density) were done. The muscle hypertrophy, fibrosis, and ICC-LC density at the PUJ in both the groups were compared. A similar comparison was performed between the findings at the PUJ and the distal margin in the study group.

Results:

The study and control groups included 37 PUJO patients and 13 Wilms tumor patients. The ICC-LC density at PUJ in the study group was significantly lower than that in the control group (P < 0.001) and that at the distal resected margin of the study group (P < 0.001). Significantly increased muscle hypertrophy (P < 0.001) and fibrosis (P = 0.002) were seen at PUJ in the study group compared to the control group. No significant association was noted between the ICC-LC density and muscle hypertrophy at PUJ and the distal resected margin in the study group.

Conclusion:

A significant decrease in the density of ICC-LC and increased fibrosis and muscle hypertrophy at PUJ in children with PUJO play a role in the etiopathogenesis of the disease.
Looking Beyond Toxicities
Authors: Sehgal Mehak , Jain Vishesh , Agarwala Sandeep , Dhua Anjan , Goel Prabudh , Yadav Devendra Kumar , Bakhshi Sameer , Kalaivani Mani
Published: May 2024

Aim:

In addition to the well-known toxicities of treatment, survivors of pediatric solid tumors can also develop other health-related conditions. They may either be an indirect consequence of therapy or could be unrelated to their prior history of malignancy. We aim to evaluate the nontoxicity related health conditions in survivors of pediatric solid tumors.

Materials and Methods:

The study included a cohort of hepatoblastoma (HB), Wilm's tumor (WT), and malignant germ cell tumors (MGCT) survivors registered at pediatric surgical-oncology clinic from 1994 to 2016. Follow-up was done according to standard protocols and children were evaluated at each visit for any health-related conditions.

Results:

Of the survivors, 318 survivors, comprising of 48, 81, and 189 survivors of HB, MGCT, and WT, respectively, were included in the analysis. We found 20.8% of patients with HB, 11.1% of patients with MGCT, and 16.4% of patients with WT to report nontoxicity-related health issues. A high prevalence of surgical conditions (3.4%), secondary malignancies (1.2%), gynecological conditions in girls (16.9%), tuberculosis (1.2%), gallstone disease (0.9%), pelvi-ureteral junction obstruction (0.9%), and neurological issues (0.9%) was noted. Two presumed survivors had died, one due to a late recurrence and the other due to a secondary malignancy.

Conclusions:

A high prevalence of medically or surgically manageable conditions makes it imperative to keep these children under follow-up to address any health-related conditions they may subsequently develop.
A New Score for the Diagnosis of Complicated Appendicitis in Children - Complicated Appendicitis Pediatric Score
Authors: Tzortzopoulou Adelais K. , Tsolia Mariza , Spyridis Nicolaos , Giamarelou Panagiota , Sfakiotaki Rodanthi , Passalides Alexander , Zavras Nicolaos
Published: May 2024

Aim:

This study aims to construct and validate a new score for diagnosis of complicated appendicitis in children, complicated appendicitis pediatric score (CoAPS), to guide residents’ clinical decision-making on choosing the correct patients for immediate surgery, reducing the emergency negative surgeries.

Methods:

This prospective observational study enrolled two cohorts of patients 5–15 years old. Four hundred and seven consecutive patients were enrolled for the derivation cohort. Demographic data, clinical features, and histopathology data were collected. The outcome measure was the histological diagnosis of gangrenous appendicitis with or without perforation. The score was next validated in a separate cohort of 312 consecutive patients who were classified according to their risk of complicated appendicitis. The diagnostic performance of the score and the potential for the risk stratification to select patients for diagnostic imaging, emergency operative management, and reduce emergency negative operation rates were quantified.

Results:

A positive “jumping up” test, vomiting, white blood cell >13.5 × 10^3/ml, lymphocytes <18%, and C-reactive protein >50 mg/dl were independent predictors for complicated appendicitis. The final prediction model exhibited an area under the curve of 0.890 (95% confidence interval: 0.859–0.922). The low-risk group demonstrated high sensitivity (90.4%) for complicated appendicitis, while scores 6 or more were very specific (95%) for the disorder. Describing the potential utility of the score, emergency ultrasound imaging would have been postponed in 14.5% of patients (P = 0.0016), and emergency negative explorations would have been cut by 87%.

Conclusion:

The CoAPS score could guide residents in emergency management of children with complicated appendicitis reducing hospitalizations and urgent surgeries.
Bardet–Biedl Syndrome with Choledochal Cyst
Authors: Kumar Saket , Harisankar A. G. , Singh Nidhi , Singh Rakesh Kumar , Mayank Nilay
Published: May 2024

Bardet–Biedl syndrome is an autosomal-recessive ciliopathic disorder affecting multiple organ systems. Characteristic features include progressive retinal dystrophy, obesity, polydactyly hypogonadism, mental retardation, and renal disorders. Other manifestations include congenital heart diseases, hepatic fibrosis, ataxia, and diabetes. Approximately 30% of patients with Biedl–Bardet syndrome (BBS) have hepatobiliary disorders such as periportal fibrosis, nonalcoholic fatty liver disease, and cystic dilation of the bile ducts. The association of BBS with choledochal cysts (CDC) is extremely rare. Here, we report a case of a 14-year-old boy with a novel variant of BBS and associated type IV CDC. The patient was managed surgically with CDC excision and Roux-en-Y hepaticojejunostomy.
Bronchial Carcinoid Tumor in an Adolescent Female
Authors: Kapoor Rohit , Mandelia Ankur , Farzana Nayab , Nigam Neha , Dabadghao Preeti , Sharma Shyamendra Pratap , Kanneganti Pujana , Pande Shantanu
Published: May 2024

Bronchial carcinoid is the most common primary malignant lung tumor in children; however, it remains a very rare diagnosis due to the overall low incidence of childhood lung malignancies. We report a case of a 17-year-old girl with respiratory symptoms who was initially misdiagnosed as a case of COVID pneumonia. She was later detected to have a right mainstem bronchial carcinoid which was managed successfully by a multi-disciplinary team.
Persistent urogenital sinus with ambiguous genitalia and urethral duplication in a pubertal female
Authors: Kumar Sunil , Ghorai Rudra Prasad , Navriya Shivcharan , Usha Preeti , Ranjan Satish Kumar
Published: May 2024

Urogenital sinus (UGS) and cloacal malformations are the spectra of disease affecting mainly females, resulting in an unusual confluence of the genital and urinary tract with or without the involvement of the gastrointestinal tract. Successful reconstruction of these anomalies depends on the accurate preoperative delineation of abnormal anatomy with the help of cross-sectional and other contrast studies like genitourogram along with cystourethroscopy wherever indicated. We hereby report a case of a 14-year-old female who presented with irregular cyclical hematuria and was diagnosed with persistent UGS with urethral duplication. After a thorough evaluation, the patient was successfully managed with surgical reconstruction, described in this study. Persistent UGS is a complex developmental anomaly. Complete characterization of anomaly requires a thorough evaluation such as hormonal assessment, endoscopy, cross-sectional, and radiological contrast study. Surgical reconstruction needs individualization and may need clitoroplasty, labioplasty, and urethral and vaginal mobilization. Morphological and functional outcome is satisfactory in a well-planned surgical reconstruction.
A Rare Case of Extragonadal Mixed Germ Cell Tumor of the Sacrococcygeal Region with Mature Thymic Tissue in the Teratoma Component
Authors: Chaturvedi Anubhuti , Tomar Reena , Balhara Kirti , Khurana Nita , Ratan Simmi K. , Mitra Aparajita
Published: May 2024

A rare extragonadal mixed germ cell tumor of the sacrococcygeal area presenting with mature thymic tissue in the teratomatous component, a rare finding and the first reported case of such an association.
Correlation of plasma renin activity values and resistive index on ultrasound doppler with findings of renal dynamic scan in patients with the society of fetal ultrasound grades 3 and 4 unilateral hydronephrosis
Authors: Zulpi Prashant K. , Sarin Yogesh Kumar
Published: May 2024

Background

Renal dynamic scans (RDS) despite being considered the gold standard for the diagnosis of pelvic ureteric junction obstruction (PUJO), fail to help resolve the dilemma about management issues in many patients. Multiple invasive and noninvasive methods are being studied to help the decision-making in these patients. We did this study to find correlation of plasma renin activity (PRA) values and resistive index (RI) on Doppler ultrasound with findings of RDS in patients with the Society for Fetal Urology (SFU) Grades 3 and 4 unilateral hydronephrosis (HDN) and also to determine the cut-off values of PRA and RI that could categorically acknowledge the success of pyeloplasty.

Methodology:

Twenty patients with SFU Grades 3 and 4 unilateral HDN due to PUJO were enrolled. Demographic details were recorded. All underwent Anderson-Hynes dismembered pyeloplasty. Based on the follow-up RDS scans, these patients could fall into one of three categories- improved (successful), status quo, or deteriorated (unsuccessful). Outcomes were compared based on RDS (split renal function [SRF]), ultrasonography, and Doppler findings were done at 3 months of postoperative period.

Results:

Follow up period was 3 months after Pyeloplasty. Seventeen patients had successful outcomes based on RDS findings, 12 had improvement in SRF (>5%), and 6 had normal drainage curves (t-t1/2<10 min). Three patients had indeterminate curves (t-t1/2between 10 to 20 min). Four had improvement on both the criteria, i.e., SRF and drainage curves. Among the three patients who showed no improvement in RDS, two were in “status quo” category and one patient showed deterioration. Seventeen patients also showed improvement in PRA and RI. No significant correlation between PRA and RI with SRF could be established. However, PRA was found to have good concordance with RDS (90%).

Conclusion:

No significant correlation could be demonstrated between SRF and the respective values of PRA and RI. However, PRA could act as an adjunct to predict the early success of pyeloplasty in view of good concordance with RDS. A larger trial with bigger cohort of patients is required to confirm our contention.
Probiotics as prophylaxis for postoperative infections of under-five children following gastrointestinal surgery
Authors: Sabbir Enayet Sheikh Mohammad , Hasina Kaniz , Tablu Abdul H
Published: May 2024

Purpose

Evaluation of the efficacy of use of probiotics as prophylaxis for postoperative wound infection in under-five children following gastrointestinal surgery.

Materials and Methods:

This randomized control trial was conducted over a period of 2 years in the pediatric surgery units of a tertiary level hospital in Dhaka, Bangladesh. A total of 60 patients undergoing gastrointestinal surgery under the age of 5 years were included in the study and randomly assigned to two groups – probiotics group (n = 30) and nonprobiotics group (n = 30). Patients in the probiotics group received probiotics in the preoperative (3 days) and postoperative period (7 days) along with traditional gut preparation (antibiotics and mechanical bowel wash). Patients in the nonprobiotic group got only antibiotics and traditional gut preparation. Outcome variables were surgical site infection, fever, c-reactive protein (CRP), total white blood cell (WBC) count, and neutrophil count.

Results:

Postoperative wound infection was less in the probiotic group (n = 2) compared to the nonprobiotic group (n = 3), but the difference was not statistically significant (P = 0.640). Postoperative CRP level was significantly lower in the probiotics group (P = 0.020). There was more decline in total count of WBCs in postoperative period in the probiotic group. No statistical difference was seen between the groups in postoperative pyrexia, the total count of WBC, and neutrophil count.

Conclusion:

Use of probiotics along with traditional gut preparation as prophylaxis for postoperative infection in children showed no added benefit in comparison to the use of traditional gut preparation only.