bluuebunny/crossref_metadata_2025 huggingface dataset:
DECAF score at admission as a tool to predict clinical outcome in acute exacerbation of COPD
Authors: Gogul Mathialagan M  , Jacinth Preethi J  , Manikandan V  , Vinoth R
Published: March 2024

Background: The Dyspnea, Eosinopenia, Consolidation, Acidemia, and Atrial Fibrillation (DECAF) score at presentation is designed to predict the risk of death in patients with chronic obstructive pulmonary disease (COPD).
Aims and Objectives: To study the DECAF score at admission to predict the clinical outcome of the patients during hospitalization for acute exacerbation of COPD (AE-COPD).
Materials and Methods: The study was conducted using a prospective cross-sectional observational study design in a tertiary care center in South India from April 2022 to March 2023. Patients were recruited based on specific inclusion and exclusion criteria. The data corresponding to the five variables of the DECAF score was obtained, and the relation to outcome measures such as survival, ventilation, and duration of stay was measured.
Results: Two hundred consecutive patients were assessed. Based on the DECAF score, 102 patients (51%) were classified as low-risk, and this group had no mortalities. In the intermediate-risk group, the mortality rate was 7.4%; in the high-risk group, the observed mortality rate was 38.6%. The differences noted were significant statistically. Higher dyspnea grade as measured by extended Modified Research Council criteria was related to DECAF score was significant and with the outcome.
Conclusion: Our study shows that the DECAF score at the initial presentation can be used as a reliable tool to predict the outcome of AE-COPD. Dyspnea grading can be used to predict mortality indirectly.
Role of predictors in acceptance of post-exposure prophylaxis with single-dose rifampicin among contacts of leprosy in rural area of Bankura: An explanatory mixed-method study
Authors: Prianka Mukhopadhyay  , Tanushree Karmakar  , Aditya Prasad Sarkar  , Sarkar Manisha
Published: March 2024

Background: India achieved the elimination of leprosy two decades ago although its sustenance continues to be threatened by ongoing active transmission in few remaining pockets. There is a paucity of data regarding the acceptance of single-dose rifampicin (SDR) prophylaxis among healthy contacts.
Aims and Objectives: The aims and objectives of the study are to assess the factors influencing the acceptability of SDR among contacts.
Materials and Methods: A community-based, sequential, explanatory mixed-method study was conducted over 6 months from September 2022 to February 2023 among 168 contacts of leprosy patients from two blocks in Bankura district, West Bengal. Quantitative analysis was done for SDR acceptance and its predictors among contacts using the Chi-square test, Mann–Whitney U test, and Logistic regression. This was followed by qualitative assessment using focus group discussions and in-depth interviews among contacts to explain the findings through a thematic approach.
Results: Household contacts (aOR=13.72, 95% CI=2.09–90.19), increasing knowledge score of contacts (aOR=3.18, 95% CI=1.88–5.38), counseling by health workers (aOR=11.98, 95% CI=2.20–65.15), trust in health workers (aOR=152.96, 95% CI=13.17–1776.09), and not taking other medicines for comorbidity (aOR=35.82, 95% CI=2.94–436.02) were associated with increased SDR uptake among leprosy contacts. Barriers and facilitators of post-exposure prophylaxis (PEP)-SDR were categorized as contact, health workers, and program-related factors.
Conclusion: SDR acceptability among contacts was 77.4%. Facilitators of SDR-PEP were awareness of side-effects, follow-up, prompt support by health workers, IEC, belief in National programs, etc. Lack of knowledge of PEP-SDR and contraindications, ineffective counseling by health workers, stigma of the disease, the increased workload of health workers, etc., were the barriers to SDR-PEP implementation.
Accessory cavitated uterine mass in a young female with chronic pelvic pain and dysmenorrhea
Authors: Naik Deepti
Published: March 2024

Accessory and cavitated uterine mass is a rare form of developmental Mullerian anomaly seen in young females, which presents as chronic recurrent pelvic pain and severe dysmenorrhea. Hysterosalpingography (HSG), ultrasonography, and magnetic resonance imaging (MRI) are the mainstay of diagnostic imaging. This entity is often underdiagnosed; therefore, a high index of suspicion combined with HSG and MRI imaging can help in making an accurate and timely diagnosis and thus prevent unnecessary interventions.
Association of inflammatory markers with clinical outcome in COVID-19 patients during the second wave in 100 bedded dedicated COVID MCH Hospital, Raigarh, Chhattisgarh State
Authors: Pankaj Madhukar Luka  , Ved Prakash Gilley  , Anmol Madhur Minz  , Harish Kumar  , Manoj Kumar Minj
Published: March 2024

Background: A novel coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) was the causative agent of coronavirus disease 2019 (COVID-19) pandemic 2019. SARS-CoV-2 affects respiratory tract and damages the tissue resulting in generation of inflammatory cells such as cytokines and chemokines such as IFN that damage the lung alveoli, causing severe acute respiratory syndrome.
Aims and Objectives: The aims and objectives of the study are to analyze the blood inflammatory markers of COVID-19 patients and association between clinical outcomes in COVID-19-positive patients with serum inflammatory markers during the second wave of COVID-19 pandemic in 100 bedded dedicated COVID MCH Raigarh CG.
Materials and Methods: In this hospital-based cross-sectional observational study, 90 patients with COVID-19 were enrolled and categorized into three groups: mild, moderate, and severe. Blood inflammatory markers such as C-reactive protein (CRP), lactate dehydrogenase (LDH), ferritin, CK-Nac as well as hemogram total leukocyte count (TLC), differential leukocyte count, and neutrophil: lymphocyte (N:L) were determined and analyzed.
Results: The results of the oxygen saturation (SpO2) severity strength of association with multiple variables taken in the study through logistic regression analysis of COVID-19 patient’s inflammatory markers serum levels of LDH (P<0.05, odds ratio [OR]=1.0146), ferritin (P<0.05, OR=0.9788), N:L (P<0.05, OR=4.1041), and other non-inflammatory parameters such as creatinine (P<0.05, OR=17.8039) were significant. SpO2 severity of COVID-19 patient’s with inflammatory markers LDH, ferritin, CK-Nac, and TLC associated with all severe, moderate, and mild groups. There was no significant association in the serum levels of CRP between the severe, moderate, and mild groups.
Conclusion: The findings of this study suggest that the levels of LDH, ferritin, CK-Nac, and TLC could be used to predict the severity of COVID-19 disease.
Evaluation of optimum dose of anti-snake venom required and its outcome based on severity of envenomation in snakebite case
Authors: Kavitha S  , Nalini GK  , Sahana GN
Published: March 2024

Background: Snakebite is an important occupational hazard in India as it is always been a land of poisonous snakes. The isssue which the physician confronts while treating a snake bite patient is assesment of degree of envenomation and requirement of ASV dose.
Aims and Objectives: This study was taken to evaluate the optimum dose of anti-snake venom (ASV) required based on the severity of envenomation.
Materials and Methods: Patients with a history of snakebite brought to the Department of General Medicine, Hassan, were included in this study. The study was conducted during the period from December 2014 to June 2016. The sample size of 80 patients was included in the study after fulfilling the inclusion criteria.
Results: A total of 80 patients were included in the study. The majority of the victims were males (70%), age between 21 and 40 years (47.5%), and agriculture was the main occupation (67.3%). 51.25% did not identify the snake. The most poisonous were viper and cobra types which were 36.5% and 12.5%, respectively. A delay in lag time of 8.99±8.2 h was observed in severe envenomation. Overall, 51 cases (63.75%) had cellulitis, and 3 (3.75%) in the severe group required fasciotomy. Twenty percent had hematologic derangements. Ten percent of patients had developed renal failure and one required dialysis. 8.75% of patients developed respiratory failure and all required mechanical ventilation. The average dose of ASV vials used in mild, moderate, and severe envenomation was 9.04±3.51 vials, 18.5±5.27 vials, and 28.6±7.30 vials, respectively. The overall mortality rate was 5%.
Conclusions: The optimum dose of ASV required in mild, moderate, and severe envenomation is 9.04±3.51 vials, 18.5±5.27 vials, and 28.6±7.30 vials, respectively to neutralize the circulating venom and lower the risk of development of serious complications.
Littoral cell angioma: An incidental finding in a traumatic spleen
Authors: Madhurima Das  , Rupsha Dutta Pal  , Dwaipayan Samaddar  , Jaya Bagchi Samaddar  , Bidyut Krishna Goswami
Published: March 2024

Littoral cell angioma (LCA) of the spleen, a rare vascular tumor, is usually asymptomatic, often discovered incidentally and a majority of them are benign in nature. A 20-year-old boy with a history of blunt abdominal trauma, who underwent splenectomy showed the presence of a capsular tear and variegated outer surface on gross examination of the spleen. On the cut section, multiple nodular areas with areas of hemorrhage were noted. Microscopical examination revealed the proliferation of anastomosing, irregular, tortuous blood-filled channels with plenty of histiocytes in the splenic tissue and extensive areas of hemorrhage, inflammatory cell infiltration, and fibrinoid deposits. Immunohistochemistry revealed positivity for CD31 (endothelial differentiation), CD68, and lysozyme (histiocytic differentiation) but was negative for CD34. The final diagnosis was LCA in a case of ruptured spleen after ruling out angiosarcoma. The possibility of this benign entity to have contributed to the potentially fatal splenic injury cannot be overlooked.
Can concurrent use of king vision video laryngoscope and fiberoptic bronchoscope improve efficacy and safety of awake intubation in patients with limited mouth opening? - A case report
Authors: Gupta Sunana , Gupta Rahul , Mehta Nandita , Saini Heena
Published: March 2024

Securing the airway by endotracheal intubation in a patient with a restrictive mouth opening poses a challenge to anesthesiologists. Awake tracheal intubation using flexible fiberoptic bronchoscopy is the gold standard in the anesthetic management of patients with restricted mouth openings. Awake video laryngoscopy (VL) is being increasingly used for the management of the anticipated difficult airways. We report a case of temporomandibular joint ankylosis with restrictive mouth opening posted for laparoscopic nephrectomy managed by awake intubation with the combined use of king vision VL (KVVL) and fiberoptic bronchoscope (FOB). KVVL provided an improved and clear view of the airway structures and FOB helped in guiding and maneuvering the tube safely into the larynx. The combined use of KVVL and FOB enhanced the effectiveness and safety of the procedure.
Von Willebrand factor and gastric cancer – is there an association? – A pilot study from South India
Authors: S Karthikeyan , Niyas Ahamed  , Sastha A  , Villalan R  , Rajnihedan KG  , Padmanabhan S  , Govindan Ramajayam , Mahesh Kumar
Published: March 2024

Background: Gastric adenocarcinoma in Indian patients’ is on the rise. A high level of plasma von Willebrand factor (vWF) is associated not only with the development of cancerassociated thrombosis but also with the degree of malignancy, the rate of metastasis, andcancer prognosis.
Aims and Objectives: The aim of this study was to study the association of vWF with tumor location, TNM staging, and grades of tumor differentiation in gastric adenocarcinoma and to assess the usefulness of circulating vWF levels as a potential biomarker for gastric adenocarcinoma.
Materials and Methods: This study is a prospective observational study done in the Department of Surgical Gastroenterology, Madurai Medical College, Madurai, over a period of 2 years between September 2020 and August 2022. Fifty cases of gastric cancer and 50 controls were recruited and vWF levels were analyzed.
Results: Among the 50 gastric cancer patients, 8% belonged to Stage II, 62% belonged to Stage III, and 30% belonged to Stage IV. vWF was elevated in Gastric Cancer patients compared to control group. Mean value of vWF in Cases and Control population was 3.68 ng/ml and 0.58 ng/ml respectively (p value 0.0005). Pertaining to Stage, the vWF value was, Stage II – 4.7, Stage III – 3.3, and Stage IV – 4.1 ng/mL. With respect to tumor differentiation, the vWF values were, poorly differentiated – 4.7, moderately differentiated – 3.0, and well differentiated – 3.9 ng/mL.
Conclusion: vWF values were significantly elevated in gastric cancer patients. Based on the results, vWF can be used as a surrogate marker to predict the tumor differentiation in patients, thereby prognosticating the disease. Stage-wise, there was no significantdifference in the vWF values.
Land Use Land Cover Change Detection in Churia of Bara District, Nepal by Using GIS and Remote Sensing
Authors: Manjan Shiv Kumar , Shrestha Sanjay Las
Published: March 2024

Land use land cover (LULC) is a dynamic process. It is derived by forces responsible for these changes. LULC changes has become a central component of current strategies in managing natural resources and monitoring environmental changes. Among them, Forest cover have been changes due to different activities like deforestation, encroachment infrastructure development etc. so, the study was carried out with integrated approach using Remote sensing and GIS techniques together with socio-economic data to examine the LULC change and its driving forces. Image processing was done through supervised classification in order to prepare LULC maps using Maximum Likelihood algorithm. Result showed that the forest cover as well as Rivers & Riverine area are decreasing by 0.39% and 1.06% per year respectively, contributing to increase Agricultural land and built-up area at the rate of 1.13% and 4.18% per year respectively in churia range of Bara, Nepal. Mostly, forest area has been converted to Built-up area between 1991 to 2018. Similarly, drivers found associated with forest cover decrease were illegal settlement & encroachment, high dependency on forest product, grazing & forest Fires, infrastructure development & urbanization, natural drivers, land fragmentation, environmental consequences and political instabilities.
Impulse Buying Intentions of Gen Z’s Consumers from Hedonic Shopping Perspective for Apparels
Authors: Agrawal Surabhi
Published: March 2024

Purpose: The purpose of the study is to explain the paths that lead to impulse buying intentions of Gen z’s consumer behaviour for apparels by hedonic shopping perspective.
Design/Methodology/Approach: Data were collected using a structured questionnaire from a sample of 257 consumers from north India aged 15 to 27 by using the simple random sampling. For testing the research hypotheses, regression analysis was employed using SPSS.
Findings: The results of the study reveal that all the five variables of hedonic shopping value is positive associated with Impulsive buying intentions of Gen z’s for apparels.
Research Limitations/Implications: The study assumes immense significance because it presents the insights regarding the behaviour of eastern Uttar Pradesh consumers and would be informative for consumer behaviour researchers, retailers and marketers. The study neglects demographic and socio-psychological factors which are the major factor that affects consumer’s purchase behavior.
Originality/Value: This research adds to the understanding of association between hedonic shopping and impulse purchase. In this regard, the study's findings of the study would contribute to scant empirical works of impulse buying behaviour of apparel purchasers which help marketers to improve their business strategy.
Journalism and the Search for the Strategy
Authors:   Academic Advisor and Senior Research Fellow, Immanuel Kant Baltic Federal University, Teslya Andrei A.
Published: March 2024

Suddenly, there is relative unity of both the government (to a lesser extent) and society: the desire for enlargement and expansion at a time when preservation is a matter of utmost importance.
One Hundred Years after Lenin: The Necessity for a Leninist Global Strategy
Authors:   Analyst, Ambassador Extraordinary and Plenipotentiary of the Democratic Socialist Republic of Sri Lanka (2018–2020), Jayatilleka Dayan
Published: March 2024

Brzezinski coined the concept of the ‘Crescent (or Arc) of Crisis’ to justify his successful strategy of provoking and entrapping the USSR in Afghanistan. To return the favor, this time around, a ‘Crescent of Crisis’ should face Russia’s main strategic adversary and that adversary’s brutal ally in the Middle East.
Probable – Unobvious
Authors:   Research Professor, Faculty of World Economy and International Affairs, National Research University– Higher School of Economics, Moscow, Russia, Lukyanov Fyodor A. ,   Editor-in-Chief, Russia in Global Affairs
Published: March 2024

Russia wants to change the world while changing itself. Or, probably vice versa―it wants to change itself by changing the world. This is a paradox that looks very much like Pushkin’s. And it is impossible to say which is more attainable.
منهج عمر فوتيوتال ومالك سه في مقاومة نموذج الحضارة الفرنسية البعثية mission civilisatrice في سنيغمبيا
Authors: Omar Jah
Published: March 2024

فإفريقية قارة الأزمات, ومن أزماتها هويتها والدفاع عن هذه الهوية , ومن أزمة هوية هذه القارة صعوبة  تحديد هذه الهوية بصفة عامة لأنها قارة مسلمة ومسيحية وديانات تقليدية في نفس الوقت, ولكل من هذه الأبعاد رجال دافعوا ويدافعون عنه وهناك أيضا من دافعوا عن بعد أفريقي مجرد دون اعتبارات دينية وهكذا نجد ان أدب المقاومة متأصّل في  إفريقية, فالبعد الذي يتناوله هذه الورقة بعد إسلامي صوفي ضد نموذج الحضارية الفرنسية البعثية : mission civilisatrice واخترنا من رجال إفريقيا عمر فوتيوتال ومالك سه اللذين عاشا في فترة ما بين 1927-1830م  ودافعا عن هذا البعد الاسلامي الصوفي الذي حاول الاستعمار طمسه.    

والمصادر أظهرت أن الرجلين اتفقا على اللإنتماء إلى غرب إفريقيا والدفاع عن الإسلام وعن البعد الصوفي في الإسلام ضد الحضارة الفرنسية البعثية, فإنهما اختلفا في المنهج والأسلوب المتبع في المقاومة .

 فبينما تبني عمرالفوتيو المواجهة العسكرية كأسلوب, اتبع مالك سه التثقيف والزراعة ونشرالعلم من خلال الشعر والنثر كأسلوب بديل. هذا وقد اخترنا فلسفة الرجلين ونقدمها لشباب اليوم كبديل لمظاهر الغلو والتشدد الديني وأراقة الدماء المتفجر والمنتشر في العالم الآن , وبما أن أدب المقاومة متعدد الأبعاد في إفريقيا, فإن الورقة تركز على غرب إفريقيا خلال التاريخ المذكورأعلاه:
The Mediating Role of Segmentation in Social Media Marketing and Brand Equity: A Study in Food and Beverage Industry
Authors: Abdul Ghani Azmi Ilhaamie
Published: March 2024

Food and beverage industry in Malaysia provides a significant GDP contribution. However, majority of firms are SMEs that face financial access as their main problem. Social media marketing is a novel trend in business nowadays due to technology intensification. This article investigates the link between social media marketing and brand equity whereby segmentation is the mediator variable in the SME food and beverage industry. By using questionnaires distributed systematically to consumers at shopping malls, about 329 usable responses were obtained. The results indicated no direct relationship between social media marketing and brand equity. A positive and significant relationship exists, however, between social media marketing and segmentation, segmentation and brand equity which indicates that segmentation is a partial mediator. The findings imply that SMEs especially in the food and beverage industry should carefully segment their market and at the same time, increase social media usage in marketing their products. This study is the first attempt to examine segmentation as mediating variable in the food and beverage industry.
External Debt Financing and Real Earnings Management: Evidence from Malaysian Family Group Affiliation
Authors: W Abdul Rahman Wan Nadiah , Mansor Noorhayati
Published: March 2024

The role of external debt in an emerging country with highly concentrated ownership is expected to raise the expropriation risk by the controlling shareholders as wider separation between cash flow and control rights might increase borrowing cost. This study investigates external debt financing role in exacerbating real earnings management (REM) in family group affiliation firms with complex pyramidal structure. A sample of 1,170 firm-year observations was collected covering 2006 until 2015. The Hausman test was used to determine the estimation method of fixed and random effects regression of each REM activity of the suspected firms towards short-term debt (STD) and long-term debt (LTD). We found a significant positive relationship between STD and REM. STD might motivate stringent monitoring by lenders and encourage family firms to manipulate earnings, possibly to avoid violating debt covenants and to portray healthy financial conditions to mask their entrenchment behavior. We have also found less manipulation of REM with LTD, as lack of tight monitoring by lenders might less likely trigger earnings manipulation. This study provides additional input to users of financial information in making informed decisions. This study, however, only documents the results in family group affiliation firms. Hence, causality of debt in non-family group affiliation firms also requires further theoretical and empirical examination. We argue that this is the first study to examine external debt financing effect on REM in family group affiliation firms in Malaysia.
Comparison between endovascular and surgical treatment of spinal dural arteriovenous fistulas: a single-center cohort and systematic review
Authors: Naamani Kareem El , Kaul Anand , Mouchtouris Nikolaos , Hunt Adam , Ahmed Meah T. , Sizdahkhani Saman , Majmundar Shyam , Ghanem Marc , Gooch M. Reid , Herial Nabeel A. , Jabbour Pascal , Rosenwasser Robert H. , Tjoumakaris Stavropoula I.
Published: March 2024

OBJECTIVE

With recent advancements in minimally invasive techniques, endovascular embolization has gained popularity as a first-line treatment option for spinal dural arteriovenous fistulas (sDAVFs). The authors present their institution’s case series of sDAVFs treated endovascularly and surgically, and they performed a systemic review to assess the outcomes of both modalities of treatment.

METHODS

The authors conducted a retrospective observational study of 24 consecutive patients with sDAVFs treated between 2013 and 2023. The primary outcome was the rate of occlusion, which was compared between the surgically and endovascularly treated sDAVFs. They also conducted a systemic review of all the literature comparing outcomes of endovascular and surgical treatment of sDAVFs.

RESULTS

A total of 24 patients with 24 sDAVFs were studied. The mean patient age was 63.8 ± 15.5 years, and the majority of patients were male (n = 19, 79.2%). Of the 24 patients, 8 (33.3%) received endovascular treatment, 15 (62.5%) received surgical treatment, and 1 (4.2%) patient received both. Complete occlusion at first follow-up was higher in the surgical cohort but did not achieve statistical significance (66.7% vs 25%, p = 0.52). Recurrence was higher in the endovascular cohort (37.5% vs 13.3%, p = 0.3), while the rate of postprocedural complications was higher in the surgical cohort (13.3% vs 0%, p = 0.52); however, neither of these differences was statistically significant.

CONCLUSIONS

Endovascular embolization in the management of sDAVFs is an alternative treatment to surgery, whose long-term efficacy is still under investigation. These findings suggest overall comparable outcomes between endovascular and open surgical treatment of sDAVFs. Future studies are needed to determine the role of endovascular embolization in the overall management of sDAVFs.
Comparison of the transarterial, transvenous, and superior ophthalmic vein approaches in the treatment of indirect carotid-cavernous fistulas
Authors: El Naamani Kareem , Mouchtouris Nikolaos , Majmundar Shyam , Sah Eric , Kaul Anand , Sizdahkhani Saman , Momin Arbaz A. , Ghanem Marc , Al Saiegh Fadi , Gooch M. Reid , Herial Nabeel A. , Rosenwasser Robert H. , Tjoumakaris Stavropoula I. , Bilyk Jurij R. , Jabbour Pascal
Published: March 2024

OBJECTIVE

Indirect carotid-cavernous fistulas (CCFs) are abnormal arteriovenous shunting lesions with a highly variable clinical presentation that depends on the drainage pattern. Based on venous drainage, treatment can be either transarterial (TA) or transvenous (TV). The aim of this study was to compare the outcomes of indirect CCF embolization via the TA, TV, and direct superior ophthalmic vein (SOV) approaches.

METHODS

The authors conducted a retrospective analysis of 74 patients admitted to their institution from 2010 to 2023 with the diagnosis of 77 indirect CCFs as confirmed on digital subtraction angiography.

RESULTS

A total of 74 patients with 77 indirect CCFs were included in this study. Embolization was performed via the TA approach in 4 cases, the TV approach in 50 cases, and the SOV in 23 cases. At the end of the procedure, complete occlusion was achieved in 76 (98.7%) cases. The rate of complete occlusion at the end of the procedure and at last radiological follow-up was significantly higher in the SOV and TV cohorts than in the TA cohort. The rate of recurrence was highest in the TA cohort (25% for TA vs 5.3% for TV vs 0% for SOV, p = 0.68).

CONCLUSIONS

The rate of immediate complete occlusion was higher in the TV and SOV cohorts than in the TA cohort while the rate of complete occlusion at final follow-up was highest in the SOV cohort. The SOV approach was significantly associated with higher rates of postoperative complications. Indirect CCFs require careful examination of the fistulous point and the venous drainage to provide the most effective patient-tailored approach.
Long-term outcome of endovascular treatment for indirect carotid-cavernous fistulas
Authors: Baharvahdat Humain , Qoorchi Moheb Seraj Farid , Al-Raaisi Amira , Blanc Raphael , Najafi Sajjad , Mirbolouk Mohammad Hossein , Redjem Hocine , Ebrahimnia Feizollah , Escalard Simon , Zabihyan Samira , Desilles Jean-Philipe , Mowla Ashkan , Boisseau Willian , Mazighi Mikael , Smajda Stanislas , Piotin Michel
Published: March 2024

OBJECTIVE

Endovascular treatment (EVT) is the primary approach used to treat indirect carotid-cavernous fistulas (CCFs). In this study, the authors evaluated the immediate and long-term efficacy and safety of different endovascular techniques for indirect CCFs.

METHODS

The databases of two endovascular centers were retrospectively reviewed to collect the patients with indirect CCFs treated using endovascular techniques between 2013 and 2023. Demographics, clinical presentation, CCF features, EVT characteristics, and clinical and radiological outcomes were evaluated and analyzed. The analysis was performed to compare the clinical and radiological data between different endovascular approaches and different embolic materials.

RESULTS

Ninety-eight patients were included in the study. EVT was successful in 95 patients (96.9%). Immediate complete obliteration of the CCF was achieved in 93.9% of patients, with 98% undergoing embolization with liquid embolic agents (LEAs) and 95.6% undergoing coiling alone. Complete CCF obliteration was higher in the transvenous than in the transarterial approach (94.3% vs 75%, p = 0.010). At ≥ 6 months follow-up, complete CCF obliteration was achieved in all patients (100%). The rate of procedure-related complications was higher following LEAs than with coiling alone (32.0% vs 15.6%). New cranial nerve (CN) palsy was diagnosed in 26.0% and 2.2% after embolization with LEAs and coiling alone, respectively (p = 0.001), with complete CN palsy recovery in 78.6%. Procedure-related intracranial hemorrhage occurred in 3 patients (3.1%). Two patients experienced an ischemic stroke following Onyx migration into the internal carotid artery. Ocular symptoms improved in 93% (83/89) of the patients who were followed.

CONCLUSIONS

In this study, complete obliteration of an indirect CCF was achieved in more than 90% of patients. Despite the occurrence of some new postprocedural ocular CN palsy, ocular symptoms improved in most patients in long-term follow-up. The transvenous approach was the most effective method for treating the indirect CCF. Coiling was safer than LEAs for the embolization of the indirect CCF.
Stereotactic radiosurgery with versus without embolization for intracranial dural arteriovenous fistulas: a systematic review and meta-analysis
Authors: Maroufi Seyed Farzad , Fallahi Mohammad Sadegh , Ghasemi Moein , Sheehan Jason P.
Published: March 2024

OBJECTIVE

Stereotactic radiosurgery (SRS) has been established as a safe and alternative treatment for dural arteriovenous fistulas (dAVFs). While embolization alone is the most commonly used modality for the treatment of dAVFs, the adjunctive use of embolization with SRS, with the growing use of SRS, has gained increasing interest in the past few years. However, the relative efficacy and safety of SRS combined with embolization versus SRS alone for dAVFs remains uncertain. Hence, this systematic review aimed to evaluate the efficacy of SRS with adjunctive embolization for intracranial dAVFs.

METHODS

A systematic review and meta-analysis was conducted by searching electronic databases, including PubMed, Embase, and the Cochrane Library, up to August 2023. All studies evaluating the utilization of adjunctive embolization and SRS for dAVFs were included. Risk of bias was assessed using the Newcastle-Ottawa Scale. A meta-analysis was conducted on the suitable outcomes.

RESULTS

Eighteen studies involving 715 patients were included. The mean age of the participants in the study was 64.30 years in the adjunctive embolization group and 60.51 years in the SRS-alone group. In the adjunctive embolization group 41.3% of patients were female, compared with 47.1% in the SRS-only group. The dAVF obliteration rates were 64.7% and 65.7% in the adjunctive embolization and SRS-alone groups, respectively. These obliteration rates were comparable between the two groups (p = 0.96), as were the symptom improvement rates (p = 0.35). Adverse events were rare, and were more commonly associated with the adjunctive embolization procedure, although further causal analysis was not possible.

CONCLUSIONS

This study provides evidence that adjunctive embolization plus SRS provides similar obliteration and symptom improvement rates compared with SRS alone, with both having very limited SRS-related adverse events. Considering the added burden and adverse events of additional endovascular treatment, the authors recommend embolization be reserved for more complex dAVFs or when embolization can potentially be curative alone or provide more rapid symptomatic relief or protection during the radiosurgical latency period.
Intracranial dural arteriovenous fistulas: association with cerebral venous thrombosis, baseline aggressiveness, and clinical outcomes. A retrospective multicenter study on 263 consecutive patients and literature review
Authors: Cohen Clara , Lenck Stéphanie , Talbi Atika , Ifergan Héloïse , Premat Kévin , Boulouis Grégoire , Janot Kévin , Boch Anne-Laure , Magni Christophe , Herbreteau Denis , Sourour Nader , Shotar Eimad , Barrot Valère , Clarençon Frédéric
Published: March 2024

OBJECTIVE

The pathogenesis of intracranial dural arteriovenous fistulas (icDAVFs) is controversial. Cerebral vein thrombosis (CVT) and venous hypertension are recognized predisposing factors. This study aimed to evaluate the incidence of association between icDAVF and CVT and describe baseline aggressiveness and clinical outcomes for icDAVFs associated with CVT. The authors also performed a literature review of studies reporting icDAVF associated with CVT.

METHODS

Two hundred sixty-three consecutive patients in two university hospitals with confirmed icDAVFs were included. A double-blind imaging review was performed to determine the presence or absence of CVT close or distant to the icDAVF. Location, type (using the Cognard classification), aggressiveness of the icDAVF, clinical presentation, treatment modality, and clinical and/or angiographic outcomes at 6 months were also collected. All prior brain imaging was analyzed to determine the natural history of onset of the icDAVF.

RESULTS

Among the 263 included patients, 75 (28.5%) presented with a CVT concomitant to their icDAVF. For 18 (78.3%) of 23 patients with previous brain imaging available, CVT preceding the icDAVF was proven (6.8% of the overall population). Former/active smoking (OR 2.0, 95% CI 1.079–3.682, p = 0.022) and prothrombogenic status (active inflammation or cancer/coagulation trouble) were risk factors for CVT associated with icDAVF (OR 3.135, 95% CI 1.391–7.108, p = 0.003). One hundred eighty-seven patients (71.1%) had a baseline aggressive icDAVF, not linked to the presence of a CVT (p = 0.546). Of the overall population, 11 patients (4.2%) presented with spontaneous occlusion of their icDAVF at follow-up. Seven patients (2.7%) died during the follow-up period. Intracranial DAVF + CVT was not associated with a worse prognosis (modified Rankin Scale score at 3–6 months: 0 [interquartile range {IQR} 0–1] for icDAVF + CVT vs 0 [IQR 0–0] for icDAVF alone; p = 0.055).

CONCLUSIONS

This was one of the largest studies focused on the incidence of CVT associated with icDAVF. For 6.8% of the patients, a natural history of CVT leading to icDAVF was proven, corresponding to 78.3% of patients with previous imaging available. This work offers further insights into icDAVF pathophysiology, aiding in identifying high-risk CVT patients for long-term follow-up imaging. Annual imaging follow-up using noninvasive vascular imaging (CT or MR angiography) for a minimum of 3 years after the diagnosis of CVT should be considered in high-risk patients, i.e., smokers and those with prothrombogenic status.
Induction of Labour in a District Hospital of Rural Nepal: A Descriptive Cross-sectional Study
Authors: Chapagain Raju , Basnet Roshan , Rai Sandesh , Chaudhary Diwakar , Thapa Isha
Published: March 2024

Introduction: Induction of labour, a medical intervention before spontaneous onset, is employed when the risk of continuing pregnancy is elevated. Common indications include intrauterine growth restriction, preeclampsia, gestational diabetes, placental abnormalities, prelabor rupture of membranes, post-term pregnancy, and intrauterine foetal demise. The objective of this study was to find out the prevalence of induction of labour in a rural setting in Nepal.Methods: We conducted a descriptive cross-sectional study in the District Hospital Tehrathum using patients’ record files from 14 January 2021 to 14 January 2023. Ethical approval was obtained from Nepal Health Research Council. Demographic variables were collected along with maternal outcomes which include indication of induction of labour, mode of delivery, indication of lower segment caesarean section and foetal outcomes include APGAR score at one and five minutes, birthweight and liquor colour. A total population sampling method was used in the study and 95% confidence Interval was used to calculate the point estimate. Results: Among 640 deliveries during the study period 118 (18.43%) (15.43- 21.43, 95% Confidence Interval) underwent induction of labour. Sixty-three (53.4%) of the 118 patients who underwent induction of labour were primigravida.Conclusions: The prevalence of induction of labour was comparable with previous studies. Neonatal outcome, rate of vaginal and lower segment C-section deliveries after induction of labour using misoprostol is comparable with other studies.
Elderly Patients at Risk of Malnutrition Presenting to a Tertiary Hospital in Nepal: A Descriptive Cross-sectional Study
Authors: Karki Sabita , Dahal Akriti Shree , Chaulagain Ramila , Sapkota Sabitra , Chaudhary Suman
Published: March 2024

Introduction: The nutritional status of elderly people is crucial for healthy aging, enabling them to maintain productive lives and reduce the progression of chronic diseases. Given that the quality of life tends to decline with age, it becomes particularly crucial for elderly individuals. Therefore, this study was aimed to find out the prevalence of elderly patients at risk of malnutrition in a tertiary hospital. Methods: This descriptive cross-sectional study was conducted among 281 elderly patients in a tertiary hospital from 2 January 2023 to 10 February 2023 after obtaining ethical approval. Non-probability purposive sampling technique was used. A face-to-face interview was conducted using a structured interview schedule with the elderly in the absence of their caregiver using a standard Mini-Nutritional Assessment tool for nutritional status, and WHOQOL_OLD quality of life for the elderly to assess the quality of life. Point estimate at 95% Confidence Interval was calculated.Results: Out of 281 elderly patients enrolled in our study, 164 (58.36%) (52.64-64.16, 95% Confidence Interval) were at risk of malnutrition.
Conclusions: The study concluded that older people could be at risk of malnutrition, which could impair their quality of life.
Infantile Subglottic Hemangioma: A Case ReportInfantile Subglottic Hemangioma: A Case Report
Authors: Baniya Richa , Chaudhary Ashlesha , Poudel Upadhyaya Ashram , Rijal Prashant
Published: March 2024

Subglottic hemangiomas are rare benign vascular tumors of infancy which involve the airway. It isa subtype of infantile hemangiomas and is a potentially life-threatening condition with a mortalityrate of 50% if left untreated. Hence, early intervention in this condition is essential. Here we presenta case of a 4-month-old infant, a male infant with a history of cough and noisy breathing requiringmultiple hospital visits before eventually being diagnosed with subglottic hemangioma. Due to itssimilar presentation with other more common respiratory illnesses, the diagnosis can be missed.Oral propranolol is the first-line therapy, which was used successfully in our case.
Herlyn Werner Wunderlich Syndrome with Hydrocolpos: A Case Report
Authors: Oli Saurav Sen , Sapkota Shova , Bajagain Rupa , Saha Rachana , Paudel Suman
Published: March 2024

Herlyn-Werner-Wunderlich Syndrome is a very rare congenital malformation of the urogenitaltract involving both the Mullerian and Wolffian ducts characterized by the triad uterine diadelphys,obstructed vagina, and unilateral renal agenesis. If not diagnosed on time it may progress to adversegynecological complications making timely diagnosis and treatment crucial. We hereby present a14-year girl with right flank pain diagnosed as Herlyn-Werner-Wunderlich Syndrome by ultrasoundscan which was managed surgically with drainage of hydrocolpos and marsupialization of vaginalseptum. On two weeks follow up patient had symptomatic improvement with no any complications.
THE INFLUENCE OF CHITOSANES ON THE DYNAMICS OF THE CONTENT OF PHENOLIC COMPOUNDS IN TOMATO LEAVES
Authors: Bohoslavets V.
Published: March 2024

The aim of this work was to study the influence of chitosans of different molecular weight on the dynamics of the content of phenolic compounds in tomato plants of the 'Zagadka' variety. In the experiment, tomato plants treated with chitosan with a molecular weight of 50-190 kDa and 310-375 kDa were studied. Using the method of high-performance thin-layer chromatography (HPTLC), biochemical profiling of the extracts of the studied plants was performed. Differences in the primary reactions of plants to chitosans of different molecular weights were revealed. Low molecular chitosan caused a significant increase in the content of phenols and, accordingly, increased the antioxidant potential of leaf tissues. The increase in the content of phenols in response to the action of low-molecular-weight chitosan occurs due to the activation of phenylpropanoid synthesis and an increase in the total antioxidant potential, which indicates the mobilization of the plant organism against a potential pathogen. Thus, an hour after the treatment of plants with a solution of low molecular weight chitosan, the content of rutin in the leaves was 3.36 mg/g, and after 18 hours - 5.56 mg/g. The content of chlorogenic and caffeic acids in the leaves increased in 12 hours. In 18 hours, the content of chlorogenic acid was 1.64 mg/g, and caffeic acid was 0.18 mg/g. This may be due to the gradual decomposition of chlorogenic acid into its constituent components under the influence of low molecular weight chitosan, which is accompanied by the release of caffeic acid. A positive correlation was established between the pool of chlorogenic and caffeic acid (r = 0.995; p < 0.06). Therefore, depending on the molecular weight, chitosan causes significant changes in the synthesis of phenylpropanoids and biochemical transformation of complex and simple esters of hydroxycinnamic acids in tomato plants.
The high-molecular chitosan solution caused a decrease in the number of compounds with high antioxidant potential in tomato leaves, which indicates the activation of another plant defense system. The content of rutin in leaves treated with high-molecular-weight chitosan after 18 hours was 1.32 mg/g, which is four times less compared to the treatment of plants with low-molecular-weight chitosan. At the same time, in response to treatment with high molecular weight chitosan, the content of caffeic acid in the leaves increased significantly. The decrease in the content of phenols is associated with the isolation of tissues from a potential threat, which is aimed at its neutralization. The result of such a reaction is the oxidation of phenolic compounds, additional lignification and suberinization of cell walls. The activation of various induced immunity reactions in the plant organism already in the first hours after eating low-molecular or high-molecular chitosan indicates the existence of a system of differential recognition of complex bipolymers by plants.
What Threshold of Amyloid Reduction Is Necessary to Meaningfully Improve Cognitive Function in Transgenic Alzheimer’s Disease Mice?
Authors: Singh Anita , Maker Matthew , Prakash Jayant , Tandon Raghav , Mitchell Cassie S.
Published: March 2024

Background:

Amyloid-β plaques (Aβ) are associated with Alzheimer’s disease (AD). Pooled assessment of amyloid reduction in transgenic AD mice is critical for expediting anti-amyloid AD therapeutic research.

Objective:

The mean threshold of Aβ reduction necessary to achieve cognitive improvement was measured via pooled assessment ( n = 594 mice) of Morris water maze (MWM) escape latency of transgenic AD mice treated with substances intended to reduce Aβ via reduction of beta-secretase cleaving enzyme (BACE).

Methods:

Machine learning and statistical methods identified necessary amyloid reduction levels using mouse data (e.g., APP/PS1, LPS, Tg2576, 3xTg-AD, control, wild type, treated, untreated) curated from 22 published studies.

Results:

K-means clustering identified 4 clusters that primarily corresponded with level of Aβ: untreated transgenic AD control mice, wild type mice, and two clusters of transgenic AD mice treated with BACE inhibitors that had either an average 25% “medium reduction” of Aβ or 50% “high reduction” of Aβ compared to untreated control. A 25% Aβ reduction achieved a 28% cognitive improvement, and a 50% Aβ reduction resulted in a significant 32% improvement compared to untreated transgenic mice ( p < 0.05). Comparatively, wild type mice had a mean 41% MWM latency improvement over untreated transgenic mice ( p < 0.05). BACE reduction had a lesser impact on the ratio of Aβ42 to Aβ40. Supervised learning with an 80% –20% train-test split confirmed Aβ reduction was a key feature for predicting MWM escape latency (R2 = 0.8 to 0.95).

Conclusions:

Results suggest a 25% reduction in Aβ as a meaningful treatment threshold for improving transgenic AD mouse cognition.
Predictors of response in PROMIS-global in a chronic low back pain specialty clinic: STarTBack and chronic overlapping pain conditions
Authors: Zheng Patricia , Ewing Susan , Tang Angelina , Black Dennis , Hue Trisha , Lotz Jeffrey , Peterson Thomas , Torres-Espin Abel , O’Neill Conor
Published: March 2024

BACKGROUND: Tools, such as the STarTBack Screening Tool (SBT), have been developed to identify risks of progressing to chronic disability in low back pain (LBP) patients in the primary care population. However, less is known about predictors of change in function after treatment in the specialty care population. OBJECTIVE: We pursued a retrospective observational cohort study involving LBP patients seen in a multidisciplinary specialty clinic to assess which features can predict change in function at follow-up. METHODS: The SBT was administered at initial visit, and a variety of patient characteristics were available in the chart including the presence of chronic overlapping pain conditions (COPCs). Patient Reported Outcomes Measurement Information System-10 (PROMIS-10) global physical health (PH) and global mental health (MH) were measured at baseline and at pragmatic time points during follow-up. Linear regression was used to estimate adjusted associations between available features and changes in PROMIS scores. RESULTS: 241 patients were followed for a mean of 17.0 ± 7.5 months. Mean baseline pain was 6.7 (SD 2.1), PROMIS-10 global MH score was 44.8 (SD 9.3), and PH score was 39.4 (SD 8.6). 29.7% were low-risk on the SBT, 41.8% were medium-risk, and 28.5% were high-risk. Mean change in MH and PH scores from baseline to the follow-up questionnaire were 0.86 (SD 8.11) and 2.39 (SD 7.52), respectively. Compared to low-risk patients, high-risk patients had a mean 4.35 points greater improvement in their MH score (p= 0.004) and a mean 3.54 points greater improvement in PH score (p= 0.006). Fewer COPCs also predicted greater improvement in MH and PH. CONCLUSIONS: SBT and the presence of COPC, which can be assessed at initial presentation to a specialty clinic, can predict change in PROMIS following treatment. Effort is needed to identify other factors that can help predict change in function after treatment in the specialty care setting.
Effects of transcutaneous radiofrequency diathermy versus ultrasound on latent myofascial trigger points in the upper trapezius: A randomized crossover trial
Authors: Jiménez-Sánchez Carolina , Cordova-Alegre Paula , Carpallo-Porcar Beatriz , Burgos-Bragado Jose Manuel , Sanjuan-Sánchez Daniel , Brandín-de la Cruz Natalia
Published: March 2024

BACKGROUND: Currently, the use of radiofrequency diathermy for the treatment of neck pain is booming. OBJECTIVE: This study aimed to evaluate the clinical efficacy of Digital Capacitive Diathermy (DCD®) on stiffness, pain, cervical range of motion, and cervical disability and to compare it with ultrasound (US) in patients with latent myofascial trigger point (MTrP) in the upper trapezius. METHODS: Nineteen participants with latent MTrPs in the upper trapezius were included in the assessor-masked, randomized, clinical crossover trial. Subjects were exposed to both interventions: US and DCD® and treatment effectiveness was measured by myotonometric variables, pressure pain threshold (PPT), visual analog scale (VAS), cervical side-bending flexion ranges, and the neck disability index scale (NDI). RESULTS: There were no significant differences between US and DCD® interventions regarding changes in outcome measures. The US group achieved a statistically significant difference of 2.16 to 1.13 points (p= 0.005; r= 0.646) for the VAS. The DCD® intervention showed a statistically significant improvement of 1.11 points for the NDI at 1-week following intervention (95% CI 0.14–2.07; p= 0.27; d= 0.217). CONCLUSION: Our findings suggest that DCD® and US can both be considered effective modalities for the treatment of latent MTrPs, having a longer duration of action with DCD® therapy.