bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinicodemographic profile of orbital exenteration in a tertiary eye care center – A 20-year experience
Authors: Meel Rachna , Pushker Neelam , Kashyap Seema , Chaurasia Shweta , Rathod Aishwarya , Bajaj Mandeep Singh , Sen Seema , Agrawal Sahil
Published: March 2024

Purpose:

This study aimed to determine the clinical indications for orbital exenteration, demographic profile of these patients, and clinicopathologic correlations in the current times and to compare these results with previous published data.

Methods:

It was a retrospective study. All exenterations performed at a tertiary eye care center over a period of 20 years (from January 2001 to June 2020) were retrospectively evaluated. Patient records were reviewed to obtain demographic data, presenting symptoms and their duration, laterality, and clinical and histopathologic diagnosis.

Results:

A total of 352 cases (males:females = 222:130) who underwent exenteration were identified. Patients age ranged from 11 months to 87 years (mean: 43.86 years, median: 50 years). The most common indication for exenteration was found to be eyelid malignancy in 54.36%, followed by retinoblastoma in 18.75% and primary orbital tumors in 14.49%. Out of 156 cases of eyelid malignancies requiring exenteration, squamous cell carcinoma (SCC) was the most common histologic subtype (n = 94, 60.26%), followed by sebaceous gland carcinoma (n = 40, 25.64%) and basal cell carcinoma (n = 20, 12.82%). The most common primary orbital tumors requiring exenteration were adenocystic carcinoma of the lacrimal gland in adults and rhabdomyosarcoma in the pediatric age group. Benign conditions requiring exenteration included fulminant fungal orbital infections and lymphangioma among others.

Conclusion:

The number of exenterations performed have significantly increased in terms of absolute numbers. However, the ratio of exenteration to other tumor-related surgeries, mainly excision biopsy, has reduced compared to that reported from a previous study. The most common indication in our study remains eyelid malignancy followed by intraocular malignancy. However, SCC has emerged as the most common tumor histologic subtype requiring exenterations.
Outcomes of Ahmed glaucoma valve surgery performed by glaucoma fellows – A large retrospective study from Eastern India
Authors: Roy Avik K , Khan Sardar M , Rao Aparna
Published: March 2024

Purpose:

Teaching and training of glaucoma fellows on the technique of Ahmed glaucoma valve (AGV) implantation surgery is very important. The purpose of this study was to describe the clinical outcomes and complications of AGV surgery performed by glaucoma fellows of a tertiary eye center from eastern India.

Methods:

This was a retrospective study based on electronic medical records. Thirty-five eyes operated with AGV by five glaucoma fellows from January 2016 to November 2020 were included. Best-corrected visual acuity, intraocular pressure (IOP), and number of antiglaucoma medications (AGMs) were the study outcome measures.

Results:

The mean (±standard deviation) age of the patients was 40.5 (±19.7) years. The follow-up period was 24.37 (±13.01) months. Both complete success (IOP <21 mmHg without additional AGM) and qualified success (IOP <21 mmHg with an additional AGM) were achieved in eight eyes each (22.8%). Failure of the surgery was noted in 19 eyes (54.3%) as there was a need for repeat surgery for IOP control in 12 eyes and a persistent IOP spike (IOP >21 mmHg with AGM beyond 3 months) in seven eyes. Despite a high rate of failure of the primary surgery, with the consultants’ intervention, there was statistically significant improvement in vision and IOP in all patients (P < 0.01) at the last follow-up.

Conclusion:

AGV implantation is a challenging surgical skill to be acquired by the glaucoma fellows.
Comparative study of the three-dimensional perception of videos recorded on a “Do it yourself” three-dimensional recording assembly versus the conventional recording system
Authors: Aravind MJ , Sampangi Raju , Sud Rouli , Sheikh Rubina , Kaur Harpreet , Hemalatha BC , Khanduja Sumeet
Published: March 2024

Purpose:

To develop an indigenous “Do it yourself” (DIY) three-dimensional (3D) ophthalmic surgery recording system and validate the perception of stereopsis using it.

Methods:

A cross-sectional survey of practicing ophthalmologists with post-postgraduation experience of at least 5 years for perception of stereopsis for three different surgeries was performed; cataract, retinal detachment, and intravitreal drug injection were recorded on DIY assembly, viewed on VRBOX and using laptop videos and pseudo 3 d videos as control.

Results:

The laptop videos and 3D VR Box videos received higher ratings for stereopsis than the pseudo 3D videos. The parameters that received significantly higher ratings on the 3D VR Box viewing were instrument’s position relative to the ocular surface in cataract surgery, anterior chamber depth during capsular staining, ophthalmic visco-surgical device injection, capsulorhexis, phaco tunnel depth, movement of nuclear fragments in the anterior chamber, and intra-ocular lens tilt in the capsular bag during cataract surgery (P < 0.05). In scleral buckling surgery, the parameters that were significantly rated higher on VR Box were globe contour, separation of the scleral plane from muscle, and explant plane (P < 0.05). Furthermore, the depth of the needle in the vitreous cavity while administering intravitreal drug injection was also rated significantly higher on VR Box (P < 0.05). However, the ratings for the depth of corneal incision, depth of scleral incision, overall color, and overall quality were not different statistically when compared between laptop and VR Box viewing.

Conclusion:

DIY 3D recording assembly offers a superior means of appreciating depth at various stages of cataract surgery, scleral buckling, and intravitreal drug injection when compared to laptop viewing and can serve as an effective tool for skill transfer.
Current understanding of acute zonal occult outer retinopathy (AZOOR)
Authors: Roy Rupak , Dutta Majumder Parthopratim
Published: March 2024

Acute Zonal Occult Outer Retinopathy (AZOOR) is characterized by sudden visual impairment, often presenting with scotoma and photopsia in young to middle-aged adults, showing a female predominance. This condition, distinct from genetic disorders like retinitis pigmentosa, lacks a hereditary basis and exhibits unique fundus changes and imaging features indicative of outer retinal dysfunction. Recent advancements have broadened our understanding, identifying variants like Acute Annular Outer Retinopathy (AAOR) and Multizonal outer retinopathy and retinal pigment epitheliopathy (MORR), each with specific clinical presentations and imaging characteristics. The diagnosis of AZOOR and its variants primarily relies on excluding other conditions through comprehensive evaluation, including imaging and serological testing. Treatment approaches, including the use of corticosteroids and immunosuppressives, remain debated, with some evidence suggesting benefits in the early stages. The prognosis of AZOOR varies, with most patients experiencing stabilization, although complications like choroidal neovascularization may occur, requiring targeted therapy. This manuscript elucidates the complexity of AZOOR, emphasizing the necessity of high clinical suspicion and the role of advanced imaging in diagnosis and management.
Navigating diagnostic and therapeutic challenges in ocular manifestations of Hansen’s disease and trachoma: A narrative review
Authors: Gurnani Bharat , Kaur Kirandeep , Savla Hritik R , Prajjwal Priyadarshi , Pentapati Siva Santosh Kumar , Kutikuppala L V Simhachalam
Published: March 2024

Neglected tropical diseases (NTDs) encompass a group of approximately 20 diseases prevalent in tropical and subtropical regions, closely associated with poverty, affecting over a billion people in low-income countries. This manuscript aims to explore the ocular manifestations and burden of two significant NTDs, namely Hansen’s disease and trachoma while addressing gaps in understanding and management. Hansen’s disease, caused by Mycobacterium leprae, has a long history and presents with diverse neurological and ocular manifestations. Despite the availability of treatment, ocular complications persist, leading to significant visual impairment in some cases. The manuscript emphasizes the importance of early diagnosis, regular ophthalmic examinations, and follow-ups to prevent and control ocular complications, reducing the burden of visual impairment and blindness. Trachoma, caused by Chlamydia trachomatis, remains the leading infectious cause of blindness in underdeveloped and remote areas. The manuscript highlights the clinical diagnosis and implementation of the World Health Organization’s (WHO’s) SAFE (surgery, antibiotics, facial hygiene, and environmental sanitation) strategy to prevent transmission and associated blindness. However, challenges in health surveillance tools and underreporting of trachoma cases are addressed, emphasizing the need for improved strategies to combat the disease effectively. Through a comprehensive review of the ocular manifestations and management of Hansen’s disease and trachoma, this manuscript contributes to the existing knowledge base and enhances a deeper understanding of these NTDs. Addressing gaps in understanding and management emphasizes the importance of implementing WHO’s strategies and collaborative efforts to achieve the global goal of reducing the burden of NTDs and improving community health and well-being. The manuscript underscores the significance of early intervention, preventive measures, and technological advancements, providing valuable insights for policymakers, healthcare professionals, and researchers working in the field of NTDs.
Safety evaluation of 5-hydroxytryptophan and S-(2-aminoethyl)isothiouronium bromide hydrobromide on rodent lungs
Authors: Thokchom Suresh Kumar , Indracanti Namita , Khanna Anoushka , Indraganti Prem Kumar
Published: March 2024

OBJECTIVES:

During the past few decades, various compounds have been researched for their potential as radioprotectants, and many of them were found to be safe and effective in several preclinical models. However, many of these compounds were found to have serious adverse effects when evaluated in clinical settings, thereby making them unsuitable for human applications. 5-hydroxytryptophan (5-HTP) and S-(2-aminoethyl) isothiouronium bromide hydrobromide (AET) act in a synergistic fashion to promote radioprotection. The present study primarily emphasizes the safety of fixed dose of 5-HTP + AET in the lungs of C57BL/6 mice, a well-known model used in drug safety studies.

MATERIALS AND METHODS:

Post-administration of the combination of HTP+AET at specific time points, blood and bronchoalveolar lavage fluid (BALF) were collected for the analysis of inflammatory and oxidative stress markers of the lungs. Thereafter, the mice were sacrificed and the lungs were dissected out, weighed, and fixed in formalin for histopathological studies.

RESULTS:

The inflammatory biomarkers: tumor necrosis factor-alpha and interleukin-10 and oxidative stress biomarkers: 8-isoprostane and 8-hydroxy-2′-deoxyguanosine were found to have normal levels in blood and BALF in both control and treatment groups, which was further supported by normal histological findings. In addition, other endpoints such as food and water intake were found to be within normal limits.

CONCLUSION:

The present safety study reflects that the combination has no adverse effects on the lungs of the experimental mouse. Further, evaluation in higher mammals including nonhuman primates is essential prior to validation of the safety of the combination in humans.
Cosmeceuticals: A transit state from synthetic to natural
Authors: Sathyaseelan Sathyabama , Rao Bhavana Hemantha , Anushmati S
Published: March 2024

Cosmeceuticals are topically applied cosmetic products containing a biologically active ingredient with a pharmaceutical effect that improves, nourishes, and treats the skin appearance. The trend of cosmeceuticals began during the mid-20th century due to its potent ingredients with therapeutic effects for various skin ailments. Even though there is a great advancement in cosmetics, which shows the risk of cosmetic linked melanoma, endocrine disorders, and birth defects which was one in 1500 people during 1935 have increased to one in 75 people in 2000. Hence, as a part of reducing the harmful effect, natural ingredients were added to the formulation to give the pharmaceutical effect. Thus, natural/herbal cosmeceuticals were introduced. Due to the awareness of the side effects such as photo-toxicity, mutagenicity, irritation by these synthetic products, people started preferring herbal/natural cosmetic products. Moreover, natural cosmeceuticals were proven to be effective against various dermatological conditions as well as have fewer side effects marked the natural/herbal cosmeceuticals in the market. Unlike a drug, cosmeceutical products undergo safety, toxicity, and efficacy tests, but these are not classified under Food and Drug Administration. This review will give an insight into different natural ingredients used in natural/herbal cosmeceutical formulation and their function challenges faced during formulation, advantages of natural cosmeceuticals over regular cosmeceuticals, and regulatory aspects in India.
Dolutegravir-induced hand–foot skin reaction in a seropositive male: A rare presentation
Authors: Gayen Tirthankar , Baisya Subhasmita , Sarawgi Devansi , Sen Sumit
Published: March 2024

Hand–foot skin reaction (HFSR) is a specific but uncommon cutaneous side effect mainly following chemotherapeutic drugs such as multitargeted kinase inhibitors. HFSR is reversible and non-life-threatening. HFSR, also known as palmoplantar erythrodysesthesia, presents with various degrees of erythema, edema, hyperkeratosis, blister, and sometimes with a fine white scale. Dolutegravir, a first next-generation integrase inhibitor, is used with other antiretroviral therapy (ART) to treat mainly HIV infections. HFSR is diagnosed depending on the suggestive association of drug intake and characteristic palmoplantar eruption. ART can cause several cutaneous adverse drug reactions though no case report of dolutegravir-induced HFSR has been reported till date in literature. Here, we present a case of HFSR in a seropositive male on ART.
Development of Alpha-Synuclein protein model against therapeutic aspects of Parkinson’s disease
Authors: Bhardwaj Kanika , Rajawat Neelu Kanwar , Mathur Nupur
Published: March 2024

JOURNAL/ijpha/04.03/01363791-202401000-00007/figure1/v/2024-07-09T132108Z/r/image-tiff

Parkinson’s disease (PD) is the most common neurodegenerative disease caused by the steady depletion of dopamine in the striatum due to the loss of dopaminergic neurons. Most of the current therapeutics work on rebuilding the striatal dopamine level through oral administration of levodopa which stops the symptoms of PD. But there is a long-term motor complication with these dopamine precursors. Moreover, no preventive treatment is available for PD. Thus, before finding a therapeutic treatment for PD, it is necessary to first understand the basic cause of PD. Moreover, alpha-synuclein oligomerization can be the major factor in PD. From the UniProt database, protein information was extracted, and the model was designed by homology modeling technique and validated by the model validation server. Hence, the designed model has 96.5% most favored region and 0% disallowed region. Therefore, the model is stable based on RC plot parameters.
The effective dose of remimazolam in adult gastroscopy
Authors: Zhang Rongyan , Zhao Gang , Yan Zhangjun , Xuan Hongmei , Chen Yan
Published: March 2024

OBJECTIVES:

The objectives of this study were to explore the median effective dose (ED50) and the dose required for successful anesthesia in 95% of the patients (ED95) of remimazolam for intravenous anesthesia in adult outpatients undergoing gastroscopy.

METHODS:

This pilot study was conducted in patients scheduled to undergo painless gastroscopy at the authors’ hospital between March 15, 2022 and March 25, 2022. The ED of remimazolam was determined using the modified Dixon sequential method, using an initial induction dose of 0.2 mg/kg. With successful or failed anesthesia, the remimazolam dose was decreased or increased by 0.05 mg/kg for the next patient, respectively.

RESULTS:

Twenty-two patients (43.6 ± 10.5 years of age) were enrolled. During gastroscopy, the remimazolam induction dose was 19.93 ± 2.96 mg (0.2–0.45 mg/kg). Eighteen patients could complete anesthesia with remimazolam alone, and four patients needed propofol to complete anesthesia. The induction time after the injection of remimazolam was 20.8 ± 8.4 s, the gastroscopy time was 5.1 ± 1.3 min, and the anesthesia recovery time was 17.5 ± 5.6 min. The ED50 and the ED95 of remimazolam were 0.362 mg/kg (95% confidence interval [CI]: 0.313–0.455 mg/kg) and 0.464 mg/kg (95% CI: 0.403–2.242 mg/kg), respectively. The vital signs of all patients remained within the predefined acceptable limits. No patients required antagonist rescue.

CONCLUSION:

The ED50 and ED95 of remimazolam for adult gastroscopy were 0.362 mg/kg and 0.464 mg/kg, respectively. Additional anesthetics might be required during gastroscopy in some patients.

TRIAL REGISTRATION:

The trial was registered. The number is ChiCTR2200057446.
Real-world safety and effectiveness of Pistacia lentiscus (mastic gum) in patients with diabetic gastroparesis: 24-week interim analysis postintervention
Authors: Kant Ravi , Singh Ajaypal , Raina Rohit , Dhingra Vandana , Bairwa Mukesh , Kanwar Varsha
Published: March 2024

INTRODUCTION:

Gastrointestinal neuropathies are frequently found in diabetic patients.

AIM:

The aim of this study was to find out the safety, adverse reactions, and long-term effectiveness of Pistacia lentiscus plant extract (mastic gum) in diabetic gastroparesis (DG) with respect to sustainable improvement in gastroparesis symptoms (Gastrointestinal Cardinal Symptom Index [GCSI] score) by observational follow-up study of a single-centric double-blind noninferiority randomized control trial.

MATERIALS AND METHODS:

Thirty-eight individuals were recruited and equally randomized in two study groups based on GCSI score and TC99 radionuclide gastric emptying scintigraphy (GES), i.e. the mastic gum group and the levosulpiride group. After 24 weeks, the GCSI score was recalculated in both the groups, and patients were evaluated for the safety, adverse reactions, and long-term effectiveness of mastic gum and the standard drug levosulpiride.

RESULTS:

In the extended study, mean GCSI score changes at 24 weeks were statistically significant (P < 0.001) (t-test) between the two groups. In the mastic gum arm, the change in mean GCSI score at 24 weeks was statistically nonsignificant mean ± (standard deviation [SD]) 16.7± (3.81) compared to the GCSI score at 2-month postintervention mean (SD) 16.35± (2.27) (intragroup P = 0.89) (repeated measures ANOVA). It strongly indicates that mastic gum provided a sustainable improvement in DG symptoms in comparison to levosulpiride, with excellent subjective well-being postintervention, without any obvious significant adverse effects.

CONCLUSION:

Six-month (24-week) interim analysis of patients suggests that mastic gum gives a sustainable improvement in DG symptoms without any obvious adverse effects as compared to levosulpiride.
Amelioration by Withania somnifera of neurobehavioural and immunological markers in time dependent sensitization induced post traumatic stress disorder in rats
Authors: Rehman Sana , Faizan Mohammad , Ali Nafaa Hasan , Gulati Kavita , Ray Arunabha
Published: March 2024

AIMS AND OBJECTIVES:

Posttraumatic stress disorder (PTSD) is a complex neuropsychiatric pathophysiology with an unmet need for safe, effective, and sustainable therapeutic modalities. Thus, the present study evaluated the effects of Withania
somnifera (WS, Ashwagandha) on an experimental model of PTSD in rats.

MATERIALS AND METHODS:

Wistar rats (200–250 g) were used and time-dependent sensitization (TDS) was used as the experimental model of PTSD. Standardized WS root extract (100 and 300 mg/kg, p.o. for 15 days) was administered with TDS and their effects were observed on neurobehavioral (anxiety) and brain cytokines, corticosterone, and oxidative stress markers.

RESULTS:

Exposure to TDS resulted in anxiogenic behavior in the elevated plus maze (EPM) test, i.e., reductions in open arm entries and open arm time, as compared to the control group. Pretreatment with WS extract (100 and 300 mg/kg × 14 days) attenuated the TDS-induced anxiogenic activity in a dose-related manner, and these WS effects were comparable to those seen after the comparator drug fluoxetine (10 mg/kg). Assay of brain homogenates showed that TDS also resulted in elevations in brain interleukin-6 and reduction in corticosterone levels in both the hippocampus and prefrontal cortex (PFC), which were reversed after WS pretreatments. Further, WS pretreatment also reversed the TDS-induced changes in brain oxidative stress markers, namely elevated malondialdehyde and reduced glutathione levels in both the hippocampus and PFC.

CONCLUSION:

These results suggest that WS could have potential as a therapeutic agent for treating PTSD by attenuating anxiogenesis, neuroimmune axis activation, and oxidative stress.
Topical antibiotics in the prevention of port-site infection after elective day care laparoscopic cholecystectomy
Authors: Sharma Nipun , Kaman Lileswar , Khare Siddhant , Dahiya Divya , Gupta Ashish , Thakur Uttam Kumar , Sethi Sameer
Published: March 2024

BACKGROUND:

Wound-related infections and complications are rare after day care laparoscopic cholecystectomy (LC). They can have a significant adverse impact on the postoperative course after an uneventful elective LC. The use of topical antibiotics over the port site may prevent such complications.

MATERIALS AND METHODS:

This trial was conducted from January 2018 to June 2019. Two hundred and fifty patients who met the inclusion and exclusion criteria were included in the study. They were randomized into the topical antibiotic group (Group A, n = 125) and control group (Group B, n = 125). All patients underwent four-port LC. Mupirocin 2% topical antibiotic ointment was applied to all four-port sites in Group A, whereas no topical antibiotic was used in Group B. One dose of prophylactic systemic antibiotics was given to all patients in both groups.

RESULTS:

The mean age was 43.22 ± 12.7 years in Group A and 43.44 ± 12.5 years in Group B. The comorbidities and the other variables were comparable between the two groups. The port-site infection (PSI) was observed in one patient in Group A and three patients in Group B, which was statistically nonsignificant (P = 0.622). The mean time of detection of infection was 4.75 ± 1.7 days. All the infections were superficial surgical site infections. Microbiological swabs culture of the infected wounds yielded no growth of bacteria.

CONCLUSION:

The PSI after LC is very less. The use of topical antibiotics to prevent PSIs after LC could not be established.
Fixed drug combination (levosulpiride and rabeprazole)-induced atypical Parkinsonian’s disorders with associated anxiety and low-lying depression
Authors: Tandon Vishal R. , Ismail Sheikh Hanan , Singh Amarjeet
Published: March 2024

We hereby describe a rare case of levosulpiride-induced atypical parkinsonism presenting with sluggish movements, atypical kinetic tremors (tremors with voluntary movement), periorbital tremors, dystonia, difficulty in speech and coordination, postural imbalance, with additional features of difficulty in swallowing and drooling with associated recent onset psychiatric disturbances such as anxiety and low-lying depression. The dechallenge of levosulpiride and medications for associated anxiety and low-lying depression caused a complete remission of the disease within 2 ½ months.
A study on patients who have undergone prosthodontic procedures using digital impressions and traditional impressions to evaluate their comfort levels and preferences
Authors: Sinha Manish , Agarwal Manisha , Shah Sanket S. , Goyal Varun , Patel Deven , Patel Rahulkumar Ratilal
Published: March 2024

Background:

Prosthodontic procedures involving dental impressions play a critical role in restorative dentistry. The advent of digital impression technologies offers an alternative to traditional methods, potentially influencing patient experiences. This study systematically explores and compares patient experiences with digital impressions and traditional impressions, aiming to provide insights into comfort levels, overall satisfaction, and preferences.

Materials and Methods:

Participants: A sample of 500 individuals who underwent prosthodontic procedures (250 with digital impressions and 250 with traditional impressions). Data collection: A structured questionnaire addressing demographic information, comfort levels during the procedure, overall satisfaction, and preferences for impression methods.

Results:

The digital impressions group demonstrated higher overall satisfaction scores than the traditional impressions group (P < 0.001). Preference for impressions: a majority of patients expressed a preference for digital impressions (78%) over traditional impressions (22%) (P = 0.002).

Conclusion:

This study indicates that patients undergoing digital impressions in prosthodontic procedures reported higher comfort levels, greater overall satisfaction, and a preference for digital impressions. The findings emphasize the potential benefits of incorporating digital technologies into prosthodontic practice to enhance patient-centered care.
Analysis of the quality of information provided by “Dr. YouTube™” on premature ejaculation
Authors: Singh Swarndeep , Neupane Bastabika , Dhungel Omkar , Sharma Pawan
Published: March 2024

Background:

YouTube™ is an important online resource to access health-related online information by the public worldwide. However, the quality of information available on it has not been adequately characterized.

Aim:

To assess the quality and reliability of information available on the treatment of premature ejaculation (PME) on YouTube™ in the Hindi and English language videos.

Materials and Methods:

A total of 151 (Hindi: 109, English: 42) YouTube videos were selected for assessment. The quality was evaluated using structured tools: Patient Education Materials Assessment Tool (PEMAT); and a 5-point modified DISCERN questionnaire (Range: 1-serious shortcomings; 5-minimal shortcomings). PEMAT assesses the understandability and actionability of video as separate percentages.

Results:

Three most common treatments suggested for PME were Kegel exercise (22.5%), start–stop technique (21.9%), and antidepressant medications (20.5%). Antidepressant medications, stop-squeeze techniques, and psychotherapy were more frequently suggested in English videos, whereas ayurvedic or herbal medicines were more frequently suggested in Hindi videos. About two-thirds of videos presented information in an easy-to-understand and actionable manner (PEMAT scores ≥70%). Only 6% of videos had a DISCERN score of ≥4, indicating good overall quality of information presented in them.

Conclusion:

People likely to encounter poor-quality information when seeking information for PME treatment on YouTube. A large number of videos suggested ineffective or unproven treatment strategies for PME. Healthcare professionals need to be mindful of this while counselling patients, and guide them regarding useful and reliable sources of health information available online.
Socio-demographic correlates of autism spectrum disorder: A study in Odisha
Authors: Nayak Asmita , Khuntia Rooplekha
Published: March 2024

Background:

There is very little data available on socio-demographic factors associated with the early detection of autism spectrum disorder (ASD).

Aim:

This study sought to investigate the socio-demographic correlates of ASD.

Materials and Methods:

A cross-sectional study of 201 first-time reported cases of ASD using a semi-structured socio-demographic datasheet was conducted to understand the socio-demographic correlates. The Statistical Package for the Social Sciences (SPSS) software (version 26) was used to calculate frequencies, percentages, and Chi-square values.

Results:

Descriptive analysis revealed an upward trend in the number of reported cases among both genders. Most cases were five years old or above, from middle socioeconomic background, with parents who had studied above matriculation, and lived in an urban area. Chi-square test results revealed a significant relationship between the number of first-time reported cases of ASD and that of parental education, socioeconomic status (SES), and living conditions.

Conclusion:

A prominent finding of this study was parents’ lack of awareness regarding their child’s condition. Measures for awareness and early detection have been recommended.
Severity of Exacerbation in Pneumococcal Vaccinated versus Unvaccinated Patients with Exacerbation of Chronic Obstructive Pulmonary Disease: A Post hoc Analysis of Presentation Status of the Subjects of HOPE Chronic Obstructive Pulmonary Disease Study
Authors: Venkitakrishnan Rajesh , Vijay Anand , Ramachandran Divya , Cleetus Melcy , Nirmal Aparna Soman , John Susan
Published: March 2024

Background:

Acute exacerbations occur with varying frequency and severity and impact the natural course of chronic obstructive pulmonary disease (COPD) patients. Pneumococcal vaccination has been shown to decrease the incidence of community-acquired pneumonia and exacerbation rate in COPD patients. There is a paucity of data on the influence of pneumococcal conjugate vaccination on the severity of COPD exacerbations.

Objectives:

The objectives of this study were to evaluate the severity of exacerbation in pneumococcal vaccinated (vaccinated with 13-valent conjugate vaccine) versus unvaccinated COPD subjects hospitalized with acute exacerbation.

Materials and Methods:

This was a post hoc analysis of the severity of exacerbation in the subjects of HOPE COPD study. This involved the collection of clinical, radiological, and laboratory data of 120 COPD patients who were hospitalized with an acute exacerbation, 60 of whom had prior pneumococcal vaccination and 60 were unvaccinated. Data of COPD patients at the time of presentation with acute exacerbation were analyzed. Comparison was made between severity parameters such as presence of fever, leukocytosis, respiratory failure, multilobar consolidation, hypotension needing inotropic support, and presence of sepsis between pneumococcal vaccinated and unvaccinated subjects.

Results:

The occurrence of multilobar consolidation was substantially less in the vaccinated group (60% vs. 6.7%; P = 0.0001). The incidence of fever, leukocytosis, and elevated C-reactive protein was significantly higher in the unvaccinated group. Need for intensive care unit care was higher in the unvaccinated group (58.3% vs. 30% with P = 0.019). The occurrence of new-onset respiratory failure was similar in both the groups although type 2 failure with respiratory acidosis was more in the unvaccinated group. Patients in the unvaccinated group had a higher incidence of sepsis and need for inotropic support as well as assisted ventilation.

Conclusions:

Prior immunization with 13-valent pneumococcal conjugate vaccine ameliorates the severity of exacerbation in COPD patients needing hospitalization. Pneumococcal vaccination may be recommended for all patients with COPD who are at risk of hospitalization with acute exacerbation.
The Use of Neuraminidase Inhibitors in Teenagers May Not Increase the Risk of Neuropsychiatric Adverse Events: A Nationwide Population-based Retrospective Study
Authors: Chang Chao-Feng , Chung Chi-Hsiang , Lin Hsuan-Hwai , Chiu Chun-Hsiang , Chien Wu-Chien , Chen Tien-Yu
Published: March 2024

Background:

Pandemic influenza virus is a public health issue, and the neuraminidase inhibitors (NIs) “Oseltamivir” and “Zanamivir” are effective treatments. While teenagers use NIs, there are concerns regarding neuropsychiatric adverse events (NPAEs).

Aim:

We aimed to use the Taiwan National Health Insurance Research Database to identify the correlation between NPAEs and NIs use in teenagers aged 13–19 years.

Methods:

The final population between 2000 and 2015 included in this study was 3698 individuals, with 2287 individuals having received “Oseltamivir” and “Zanamivir” (study cohort group) and 9148 individuals not receiving “Oseltamivir” and “Zanamivir” (comparison cohort group). We initially used a multivariate Cox regression analysis during the tracking period to determine the cumulative incidence of NPAEs.

Results:

Our findings revealed no significant increase in the likelihood of developing NPAEs in the study group. The Kaplan–Meier survival curve demonstrated that individuals who received “Oseltamivir” and “Zanamivir” were not associated with statistically significantly increased NPAEs compared with controls (log-rank test, P = 0.724).

Conclusion:

No more risk in comparison of the normal population in our study, and the safety of “Oseltamivir” and “Zanamivir” is established treatments for influenza.
A Case of True Allergy to Amide Local Anesthetics in a Parturient
Authors: Vijayan Vijayanthi , Gunasekaran Adethen , Paneerselvam Sakthirajan , Govindaraj Kirthiha
Published: March 2024

IgE-mediated hypersensitivity reactions to amide local anesthetics (LAs) are very rare events in anesthesia practice. When such a reaction occurs, anesthesiologists are often left with numerous confounding causes of adverse e after LA administration. Most times, such reactions result from systemic toxicity or non-hypersensitivity reactions. In the event of a true allergy to LA molecules, subsequent administration of the same drug can lead to life-threatening complications. Herewith, we report the successful diagnosis of LA allergy in a parturient who had a history of anaphylaxis following the administration of subarachnoid block with an unknown drug elsewhere. She presented to our institute for her second cesarean section. Skin prick testing was done after a dermatology consultation, which revealed a positive response to lignocaine, bupivacaine, and ropivacaine (preservative-free). She was taken up for elective cesarean section under general anesthesia with complete avoidance of LAs. Postoperative analgesia was instituted with intravenous patient-controlled fentanyl administration. The procedure and recovery were uneventful and both mother and baby were discharged without any issues.
Practice of Enhanced Recovery after Caesarean Delivery: A Randomised Controlled Clinical Trial in a Tertiary Hospital in Yaoundé-Cameroon
Authors: Emelinda Berinyuy Nyuydzefon , Amengle Ludovic Albert , Bengono Roddy Stephan Bengono , Arlette Metogo Mbengono Junette , Ngongheh Brian Ajong , Gouag  , Minkande Jaqueline Ze
Published: March 2024

Background:

Enhanced recovery after surgery (ERAS) is a new and evolving concept whereby strategies are put in place in the perioperative period to ensure better and accelerated patient recovery with fewer complications. Being a new protocol in our milieu, the need for pre-implementation trials motivated our study in elective caesarean section (CS) in the Yaoundé Gyneco-Obstetric and Pediatric Hospital (YGOPH).

Aims:

To analyse the benefits of the enhanced recovery after caesarean section program (ERAS) over standard care in women undergoing elective caesarean section in the Yaoundé Gyneco – Obstetric and Paediatric Hospital.

Materials and Methods:

A single-blinded randomized controlled trial, in the ratio 1:1, from December 2020 to August 2021, compared the ERAS in caesarean section (ERAS-CS) treatment package, with our standard care package (Non-ERAS group). The ERAS-CS package included pre-operative counselling, reduced pre-operative fast, warming of fluids intraoperatively, use of Dexamethasone and Ondansetron (to prevent post-operative nausea and vomiting) and early oral feeding as well as early mobilisation. Satisfaction 24 hours after surgery as well as complications were evaluated in both groups. Data analysis was with STATA.

Results:

We enrolled 42 women, 21 in each arm. Average age of participants was 31.9 years. A body temperature drop of 0.6 degree Celsius in the ERAS group versus 1.7 degree Celsius in N-ERAS group, p=0.001 was noted. Intraoperative nausea and vomiting (IONV) was significantly decreased in the ERAS group (p=0.038) as well as per-operative hunger and cold. ERAS patients felt significantly more capable of looking after their personal toileting and hygiene, and in control with a greater feeling of well-being than those in the N-ERAS group, 24 hours after surgery.

Conclusion:

The ERAS-CS program led to fewer per and post-operative complications, and faster recovery of patients.
Successful Resuscitation of a Young Maternal Cardiac Arrest with Twin Pregnancy: A Case Report
Authors: Barman Lisa , Bhardwaj Mamta , Chugh Ritika
Published: March 2024

Cardiopulmonary arrest in pregnancy is one of the most dreadful situations for clinicians. Along with physiological changes in pregnancy, the time constraint to save both lives makes this situation impeccably difficult to manage. Here, we present a case of successful resuscitation of a young mother with twin pregnancies who was diagnosed with pre-eclampsia and was under antihypertensive therapy for 4 days. Evidently, a multidisciplinary approach, rapid response and timely intervention can alleviate both the maternal and neonatal mortality rate in pregnancies landing up on cardiopulmonary resuscitation (CPR).
Word of Caution for Anesthetist with Intrauterine Vasopressin during Myomectomy: A Report of Two Cases
Authors: Gupta Deepika , Mitra Sukanya , Jindal Swati , Saxena Puja
Published: March 2024

Blood loss is one of the major complications in myomectomy. There are several methods to reduce blood loss, one of which that is commonly being used is intramyometrial injection of vasopressin, but there are many adverse events reported with its use. We hereby report two such cases of myomectomy in which patients had bradycardia and cardiac standstill following the use of vasopressin. We hereby discuss the anesthetic concerns and the safe limit of vasopressin for its use in myomectomy.
Prophylactic, Manually Titrable Variable Rate Norepinephrine Infusion for Prevention of Hypotension during Spinal Anesthesia for Cesarean Section: A Randomized, Double Blind, Controlled Study
Authors: Bedi Vikram , Thomas Chanchel Mary , Goyet Suman , Choudhary Santosh , Batcha Riyaz Ahamed Kader , Verma Reena
Published: March 2024

Background and Aims:

Norepinephrine is recently being investigated for mitigation of spinal-induced hypotension. Our study aimed at evaluating the role of manually titrated infusion of norepinephrine in preventing hypotension in patients undergoing lower segment cesarean section (LSCS) under subarachnoid block (SAB).

Subjects and Methods:

This prospective, randomized, double-blind, placebo-controlled trial was conducted in 140 parturients undergoing LSCS under SAB. Patients were randomly allocated to two groups: group A received an infusion of 5 µg/mL norepinephrine started at 30 mL/h (2.5 µg/min) immediately after SAB and manually adjusted within the range 0–60 mL/h (0–5 µg/min), according to the values of systolic blood pressure (SBP) until delivery; in group B, no prophylactic vasopressor was given, and bolus 1 mL norepinephrine (5 µg) was given whenever the SBP decreased to <80% of the baseline value. Groups were compared with regard to the incidence of hypotension, hemodynamic parameters, and norepinephrine consumption. Categorical data were presented as number and compared using the Chi-square test. Continuous variables were presented as mean ± standard deviation (SD) and compared using t-test. P <0.05 was considered statistically significant.

Results:

Cumulative episodes of hypotension were significantly lesser in group A (eight) than group B (29) (P < 0.001). Mean time of onset of hypotension was significantly higher in group A (19.75 ± 8.24 min) compared to group B (4.36 ± 0.77 min) (P < 0.001). Mean SBP, diastolic blood pressure (DBP), and mean arterial pressure (MAP) were significantly higher in group A compared to group B intraoperatively (P < 0.001). Mean heart rate (HR) was significantly lower in group A compared to group B (P < 0.05). Neonatal outcomes were comparable between both the groups.

Conclusions:

In patients undergoing SAB for LSCS, a manually titrated infusion of 5 µg/mL of norepinephrine was effective for maintaining BP and decreasing the incidence of hypotension, with no detectable detrimental effect on neonatal outcome.
Cesarean Section in a Patient with Severe Preeclampsia and Vertebral Artery Aneurysm, Secondary to Neurofibromatosis—A Rare Case
Authors: Jain Ruchi , Madireddy Sushmita , Magar Jyoti
Published: March 2024

Neurofibromatosis (NF1) is a relatively common multi-system genetic disorder. NF1 increases the risk of hypertension, and vasculopathy is a common finding. Extracranial vertebral artery aneurysm, though rare, can rupture and cause fatal hemorrhage. Pregnancy in NF1 is known to be associated with hypertension, preeclampsia, Hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome. We report anesthesia management of a primigravida with 30 weeks of gestation with neurofibromatosis presenting with severe preeclampsia and acute onset vertebral artery aneurysm, who underwent urgent cesarean section. We opted for general anesthesia over regional due to the risk of aneurysm rupture and technical difficulty with vigilant hemodynamic control. Postoperative course was complicated with HELLP and sepsis but was successfully managed. Knowledge, careful preoperative evaluation, appropriate technique, and management of anesthesia, and close postoperative monitoring are of utmost importance.
Comparison of Epidural, Combined Spinal Epidural, and Dural Puncture Epidural Techniques for Labor Analgesia
Authors: Khetarpal Ranjana , Chatrath Veena , Grover Suparna , Kaur Puneetpal , Taneja Ankita , Madaan Aishwarya
Published: March 2024

Background:

Lumbar epidural analgesia is a safe, effective, and beneficial technique for both the parturient and the fetus. Dural puncture epidural has been claimed to be better than combined spinal epidural and epidural techniques by many. We undertook this study to compare the three techniques regarding duration, quality of analgesia, and side effects. Debate regarding the best neuraxial technique for labor analgesia continues.

Materials and Methods:

The parturients of ASA grade I and II of age group 20–35 years were randomly divided into three groups of 20 each. Group E (epidural group) received 15 ml of 0.125% isobaric levobupivacaine with 30 µg fentanyl in the epidural space. Group CSE (combined spinal epidural group) received 2.5 mg of intrathecal isobaric levobupivacaine with 25 µg fentanyl and epidural top up of 15 ml of 0.125% levobupivacaine with 30 µg fentanyl. Group DPE (dural puncture epidural group) received 15 ml of 0.125% isobaric levobupivacaine with 30 µg fentanyl in epidural space; intrathecal medication was withheld. Epidural top-up doses were given as per Visual Analog Scale (VAS). Analgesic efficacy, extent of sensory and motor block, maternal and fetal outcome, duration of analgesia, and maternal satisfaction score were compared among three groups and analyzed statistically.

Results:

The onset and symmetry of sensory blockade and VAS score were better in CSE group. DPE group had better sacral coverage and less asymmetric blockade. Groups CSE and DPE had superior maternal and surgeon satisfaction scores in comparison to group E. Both groups E and DPE provided analgesia with minimal motor blockade and ambulation.
Distinguishing Between Preeclampsia and Dural Puncture Headaches in a Postpartum Patient: A Challenging Diagnosis
Authors: Sassi Kaissar , Boileau Béatrice Guyard , Olivot Jean Marc , Bonneville Fabrice , Rubin Amelie , Tardif Elsa , Minville Vincent , Guerby Paul
Published: March 2024

This case report highlights the diagnostic challenges in distinguishing between postpartum headaches caused by preeclampsia and those caused by a suspected dural puncture in a patient with both conditions. The patient had a history of preeclampsia, was well-controlled with labetalol, and received epidural anesthesia using the Tuohy needle during labor. Six hours after delivery, she reported postural headaches, neck tension, and tinnitus, typical symptoms of dural puncture headaches. However, the patient eventually experienced a generalized tonic-clonic seizure and was diagnosed with posterior reversible encephalopathy syndrome and intracranial hypotension. This case highlights the importance of considering multiple underlying factors when analyzing postpartum headaches and the need for prompt and appropriate management to prevent potentially life-threatening complications.
Primary Ileopsoas Abscess in Neonate
Authors: Pattanshetti Swapnil Annasaheb , Bagalkotkar Apoorva Gopal , Ruge Abhinandan , Mudakanagoudar Mahantesh Shivangouda , Metgud Tanmaya S.
Published: March 2024

We report the case of a 22-day-old boy baby, and he was brought to us with fever and vague rapidly growing mass in the lower abdomen eventually diagnosed as iliopsoas abscess (IPA). Ultrasonography (USG) and computed tomography were of help in making diagnosis. USG-guided aspiration failed; hence, the baby was treated by extraperitoneal drainage. IPA in neonates is uncommon. This rare disease presentation with confined review of literature is set out in this case report.
Hemangiomatous Ameloblastoma: A Case Report with a Review of Literature
Authors: Trimukhe Akshay Chandrakant , Bhavthankar Jyoti D. , Mandale Mandakini Subhash , Humbe Jayanti Govind , Nandkhedkar Vaishali Anil , Wagh Savita P.
Published: March 2024

Ameloblastoma, a benign epithelial odontogenic tumor, has an intriguing feature by virtue of its diverse histopathologic variants. One such variant that is not yet acclimatized in the literature due to the paucity of cases is “hemangiomatous ameloblastoma” (HA). HA exhibits the histology of conventional ameloblastoma with marked vascularity, which resembles the enamel organ and dental sac. Herein, we present the case of a 33-year-old male patient with swelling of the lower left back region of the jaw for 6 months, which on imaging presented multilocular radiolucency. Incisional biopsy was suggestive of ameloblastoma, and an excisional procedure showed odontogenic epithelial islands with marked vascular proliferation, based on which the diagnosis of HA was rendered. The rarity of this histologic variant and lack of long-term follow-up records in the literature challenges the clinician to predict its biological behavior. Hence, further research is required to understand the same.