bluuebunny/crossref_metadata_2025 huggingface dataset:
Activation of M2 macrophage autophagy by rapamycin increases the radiosensitivity of colorectal cancer xenografts
Authors: Shao Lening , Wu Yongyou , Cao Jianping , Zhong Fengyun , Yang Xiaodong , Xing Chungen
Published: April 2024

Background:

Tumor-associated macrophages (TAMs) are intimately involved in cancer radiochemotherapy resistance. However, the mechanism by which macrophages affect radiosensitivity through autophagy remains unclear. The purpose of our study was to investigate how activating autophagy in type-II macrophages (M2) by using rapamycin (RAP) would affect the radiosensitivity of colorectal cancer (CRC) xenografts.

Materials and Methods:

A nude mouse CRC model was established by injecting LoVo CRC cells. After tumor formation, supernatant from M2 cells (autophagy-unactivated), autophagy-activated M2 cells, or autophagy-downregulated M2 cells was injected peritumorally. All tumor-bearing mice were irradiated with 8-Gy X-rays twice, and the radiosensitivity of CRC xenografts was analyzed in each group.

Results:

The mass, volume, and microvessel density (MVD) of tumors in the autophagy-unactivated M2 group significantly increased; however, supernatant from M2 cells that were autophagy-activated by rapamycin significantly decreased tumor weight, volume, and MVD compared with negative control. Combining bafilomycin A1 (BAF-A1) with RAP treatment restored the ability of the M2 supernatant to increase tumor mass, volume, and MVD. Immunohistochemical and Western blot results showed that compared with the negative control group, supernatant from M2 cells that were not activated by autophagy downregulated the expression of Livin and Survivin in tumor tissues; activation of M2 autophagy further downregulated the protein levels.

Conclusions:

Therefore, autophagy-activated M2 supernatant can downregulate the expression of the antiapoptotic genes Livin and Survivin in CRC xenografts, improving the radiosensitivity of CRC by inducing apoptosis in combination with radiotherapy and inhibiting the growth of transplanted tumors.
Intracerebral Aneurysms in the Young: Institutional Series and Review of Literature
Authors: Menon Girish , Srinivasan Siddharth , Kanneganti Yasaswi , Nair Rajesh , Hegde Ajay
Published: April 2024

ABSTRACT

Introduction:

Intracranial (IC) aneurysms in the paediatric population are uncommon. The natural history, clinical presentation and clinical outcome of children with IC aneurysms are different from their adult counterparts. We analyse our hospital database for IC aneurysms in children <20 years and present our findings.

Materials and Methods:

A retrospective review of case records of patients less than 20 years admitted with IC aneurysm was conducted at our institute. Details of clinical presentation, treatment provided and outcome were obtained from the case records.

Results:

Ten children were admitted with IC aneurysms. The mean age of presentation was 16.5 ± 3.43 years (9–20 years). While 90% were spontaneous in presentation, one case was post-traumatic. Nine patients underwent treatment for their aneurysm in the form of microsurgical clipping. Subarachnoid haemorrhage with intracerebral haemorrhage was the most common mode of presentation. Outcome was good in 80% and poor in 20% of patients. One patient succumbed to the illness before treatment.

Conclusion:

IC aneurysms in the young are represent a small subset of patients with aneurysms. IC aneurysms in the young represent a small subset of patients with aneurysms predominantly located in the anterior circulation. Micro-surgical treatment provides excellent outcomes in these patients.
A Rare Case of Four Aneurysms Arising from Anterior Communicating Artery: Diagnostic Dilemma and Surgical Difficulties
Authors: Zeya Monirah , Singh Daljit , Aziz Ahmad Masood
Published: April 2024

ABSTRACT

Multiple aneurysms of the anterior communicating artery in a single patient occur rarely. The authors report a case of four aneurysms arising from Acom artery in a single patient, which is the highest number reported so far. Treatment for such aneurysms either by clipping or coiling, needs to be individualized. The radiological and surgical difficulties encountered intreating these complex and uncommon aneurysms are discussed.
Study of Microsurgical Anatomy of Middle Cerebral Artery in Human Cadaveric Brain
Authors: Gupta Vishnu , Jha Deepak Kumar , Gosal Jaskaran Singh , Dixit Shilpi Gupta , Nayyar Ashish Kumar , Ghatak Surajit
Published: April 2024

ABSTRACT

Background:

Micro-dissection of cadaver specimens is the base, on which our knowledge of the intricate anatomy of the human brain. Microsurgical anatomy of middle cerebral artery (MCA) is of particulate interest to neurosurgeons as it is the largest and most complex arterial system of the brain. Although various studies have been done on MCA, no such study has been done taking into consideration large sample size of the Indian population. This study will be advantageous in improving knowledge of MCA and its variations. This will prove useful for neurosurgeons in performing microsurgeries.

Objective:

A study of the microsurgical anatomy of the MCA in human cadaveric brain; comparison of the findings with the existing studies and implication of these finding in micro-neurosurgical procedures.

Materials and Methods:

Sixteen formalin-fixed cadaveric brains, that is, 32 vessels from its origin from the internal cerebral artery to M1 segment with respect to diameter, length and branching pattern were studied under high magnification (operating microscope) and the data compared with literature.

Results:

The mean length of M1 was 24.1 ± 11 mm with the outer diameter of 3.1 ± 08 mm. An average number of perforators pre-bifurcation was 7 and post-bifurcation was 3. The pattern of branching of the main trunk was bifurcation (70%), trifurcation (20%) and tetrafurcation (10%), and amongst this, inferior trunk dominance was seen in 70%. An average number of early cortical branch was 3.

Conclusion:

The knowledge of anatomy of MCA and its variations is important for neurosurgical residents’ training and neurosurgeons dealing with MCA aneurysm management or bypass surgeries.
Nosocomial infections in patients admitted in medical intensive care units in a tertiary health center in Western part of India and their hematological correlation
Authors: Roychoudhury Arnav Kr. , Maheshwari Ujwala , Bansal Nidhi , Padhye Amruta
Published: April 2024

Background and Aim:

Acquired infections (AIs) in medical intensive care units (MICUs) have become serious threats with increasing mortality and morbidity more so in the developing countries. The most common reason is lack of efficient infection control protocols. The national nosocomial infections surveillance system defines a nosocomial infection as a localized or systemic condition that results from adverse reaction to the presence of infectious agents or their toxins that were not present or incubating at the time of admission to the hospital. Critically ill patients are at increased risk of acquiring nosocomial infections because of their lower immune status. These infections being opportunistic, microbes of low virulence cause also cause disease in hospital patients whose immune systems are impaired. This study was conducted to study the association of leukocytosis in relation to nosocomial infections in MICU.

Methods:

A retrospective study was conducted at the MICU under the Department of Anesthesiology in collaboration with the Department of Microbiology and Department of Pathology of Mahatma Gandhi Medical College and Hospital, Navi Mumbai over six months. All the patients who were admitted in MICU and stayed for more than 48 hours were included in the present study.

Results:

A total of 805 patients were admitted in the MICU from January 1st to June 30th, 2017, for a period of 6 months. Out of 805 cases, 27 patients developed nosocomial infections amounting to 3.3% with male-to-female ratio of 2.8:1. The age of the patient ranged from 15 to 85 years with the mean age of 50 years. Male predominance was seen with 74% cases with mean age of 48.5 years. Maximum cases were seen in the geriatric age group mainly 6th to 7th decade comprising of 40.7% of all cases. In our study, bloodstream infection was the most common finding constituting 100% of the cases, followed by urinary tract infections. All the cases of nosocomial infections showed polymorphonuclear leukocytosis with shift to left. In our study, diabetes mellitus followed by hypertension and chronic kidney disease was the major contributory comorbidities comprising of 29.6%, 29.6%, and 22.2%, respectively. In our study, the invasive devices contributed to the overall outcome of the patients. Urinary catheters (all cases) were the most prevalent invasive device followed closely by Ryle’s tube (90%) and endotracheal tube (60%).

Conclusions:

Intensive care units (ICUs) comprise of less than 10% of the total hospital beds but contribute >20% of all the nosocomial infections acquired in the hospital. World Health Organization (WHO) estimates the burden of nosocomial infections in hospitalized patients to be 7–12% globally, in contrast to the figures from India being alarmingly high varying from 11–83%.
The psychosocial impact on single mothers’ well-being - A literature review
Authors: Dharani M. K. , Balamurugan J.
Published: April 2024

In India, single-parent families are proliferating. In particular, women are taking the lead in assuming the role. They are the most vulnerable of all the disadvantaged groups. Due to an absence of financial and social support, single mothers endure a great deal of emotional strain. So, the aim of the study is to investigate the various psychosocial factors that influence the well-being of single mothers. Additionally, this research seeks to assess the coping strategies employed by single mothers. This article reviews 80 studies on psychosocial concerns faced by single mothers, focusing on mental health, challenges, and social support. It cites 71 publications from 80 sources from Google Scholar, Scopus, Web of Science, and PubMed, between 1980 and 2023. The study used keywords as a search strategy such as “single mother,” “mental health,” “challenges,” and “social support.” The results showed that the absence of financial resources, education, and social support had a negative impact on the emotional and social well-being of single mothers. Children of single mothers are more likely to struggle with addictions like alcoholism, tobacco use, delinquency, hazardous sexual behavior, and even suicidal thoughts due to dysfunctional parenting. As a result, single mothers use their religious convictions, support networks, and social networks as coping mechanisms. The study implies that premarital counseling and health education are essential for young couples to prevent family disintegration in the event of divorce and separation. To provide assistance and improve the overall quality of life for this vulnerable population, collaboration between government and nongovernment organizations is necessary.
Comparing Four Cephalometric Methods Used to Evaluate the Change in the Lower Incisor Inclination
Authors: Sood Shweta , Mittal Sanjay , Aggarwal Isha , Goyal Merry , Parveen Abida , Vishvkarma Pallavi
Published: April 2024

Aim:

The assessment of change in the lower incisor inclination using cephalometry during any orthodontic treatment is used to determine the treatment outcome. The inclination change is measured using the lower border of the mandible even though it is subjected to remodeling in growing children. We have used Bjork’s superimposition technique using “stable structures” to eliminate these growth changes. In this study, we have evaluated if there is any major difference between three routinely used methods to estimate the lower incisor inclination change influenced by orthodontic treatment (gonion-gnathion, gonion-menton, and tangent drawn to the lower border of the mandible) in contrast to Bjork’s superimposition technique.

Materials and Methods:

This study was performed using the lateral cephalograms of total of 39 subjects undergoing orthodontic treatment using fixed appliances, aged 12–16 years at the beginning of the treatment. The pretreatment and mid-treatment cephalograms of these subjects were evaluated with a gap of at least 1 year between the two radiographs. Patients who had undergone lower incisor extractions were excluded from this study.

Results:

The ICC was calculated using Bjork’s superimposition technique as references and subsequently the other techniques were compared. The linear regression model showed good ICC between all methods, with ICC being 0.92 for Go-Me, 0.94 for Go tangent, and 0.88 for Go-Gn. All the three methods showed a significant correlation with Bjork’s method.

Conclusion:

The data in the current study showed that there was no significant difference in the findings obtained by Bjork’s superimposition method when compared to other techniques. Furthermore, remodeling of the lower border of the mandible showed no significant changes in the investigated time frame.
An enchiridion on the socket shield technique
Authors: Kshirsagar Jaishree Tukaram , Nithiyaraj S. , Monika A. , Akshaya M. N. , Sharma K. Shyam , Sathyasree S.
Published: April 2024

Socket shield technique is one of the recent innovative techniques of immediate implant placement. The importance of this technique is maintenance of both hard and soft tissues, especially in esthetically critical areas like maxillary anterior region. It involves preservation of a portion of root followed by immediate placement of implant. It has various advantages over other ridge preservation procedures like conventional immediate implant placement, socket preservation methods, and ridge augmentation procedures. This review briefly summarizes the classification, surgical technique, variations, and potential complications of this technique.
Ictal barking in frontal lobe epilepsy
Authors: Chaudhuri Titas , Samantray Swayanka , Raj Sanjay , Ravan Jayaprakash Russell , Pattnaik Jigyansa Ipsita , Panda Udit Kumar
Published: April 2024

Nonspeech vocalizations are usually seen in temporal or frontal lobe epileptic focus, especially in the dominant side of the brain. There can be screaming, hooting, barking, humming grunting, etc., Barking is most characteristic, which is commonly seen in mesial frontal lobe epilepsy. In this report, we describe a unique case of ictal barking with onset at 18 years of age mistaken for unspecified psychotic disorder, which was subsequently diagnosed as complex partial seizure following electroencephalogram findings and was maintained on valproate 1500 mg/day, and levetiracetam 1500 mg/day was added along with clobazam 10 mg/day. Ictal barking is mostly focal, similar to our case; however, there has been sparse evidence of ictal barking in generalized seizures as well.
Quality of obturation and the behavior of children treated under nitrous oxide conscious sedation: A double-blinded split-mouth randomized clinical trial
Authors: Madiajagane Nandini D , Govindaraju Lavanya
Published: April 2024

Aim:

Our aim is to assess the quality of obturation and behavior of the children treated with and without nitrous oxide sedation and also to investigate the association between the quality of obturation and the behavior of children.

Materials and Methods:

A double-blinded split-mouth randomized clinical trial was conducted in 60 teeth. A total of 30 children aged 4–8 years in need of pulpectomy in bilateral mandibular molars were selected. On the first appointment, the children were assigned to protocol A, where the pulpectomy was performed without nitrous oxide inhalation sedation (NOIS). In the second visit, the children were allocated to protocol B, where pulpectomy was done in the contralateral molar under NOIS. The obturation quality and behavior of the children were graded according Coll and Sadrian criteria and Ohio State University Behavior Rating Scale, respectively. The data were assessed with descriptive statistics, Chi-square test, and Wilcoxin signed-rank test.

Results:

The quality of obturation and the behavior of the children were significantly better under conscious sedation (P = 0.000). Also, there was a significant association noted between the behavior of the children and quality of obturation (P = 0.0.012). Children exhibiting quiet behavior favored optimal fill, while in children showing cry alone or struggle , it was more of under-fill. In children showing both struggle and cry, more of over-fill pattern of obturation was noticed.

Conclusion:

Nitrous oxide sedation enhances the obturation quality and children’s behavior. Furthermore, there is a clear association between children’s behavior and obturation quality, regardless of whether nitrous oxide sedation is used or not.
Anxiety associated painful temporomandibular disorders in Peruvian dental students during the major waves of COVID-19 infection: A cohort study
Authors: Angeles-García Karen , Ladera-Castañeda Marysela , Briceño-Vergel Gissela , Córdova-Limaylla Nancy , Huamani-Echaccaya José , Cervantes-Ganoza Luis , Cayo-Rojas César
Published: April 2024

Aim:

During the major waves of coronavirus disease 2019 (COVID-19) infection, Peru had the highest case fatality rate in the world. This situation may have caused psychological conditions with somatic consequences in students who were susceptible to infection due to exposure to infected patients. The present study was designed to investigate the association between anxiety levels and painful temporomandibular disorders in dental students from two Peruvian provinces during the major waves of COVID-19 infection.

Materials and Methods:

The study conducted was both longitudinal and analytical. The total population consisted of 558 dental students from Peru, with 314 from Chimbote and 244 from Trujillo. No sample size calculation was necessary as the entire student population was invited to participate. Of the 366 students who initially joined the closed cohort, only 204 remained at the end of the study. During the first and second waves of COVID-19 infections, the Zung anxiety diagnostic test and the diagnostic criteria for painful temporomandibular disorder (DC/TMD) triage questionnaire were used to assess anxiety levels. The study also evaluated variables such as sex, age, marital status, academic year of study, area of residence, housing type, and occupation. The study employed statistical analysis to determine the relative risk (RR) of painful TMD incidence during the first and second waves of COVID-19 infections. A logit model was also used to determine the presence of painful TMD, with odds ratio (OR) as the measure. The statistical significance level was set at P < 0.05.

Results:

During the initial wave of COVID-19 infections, 50% (95% CI: 43.1–56.9%) of the 204 students experienced anxiety, while 26.5% (95% CI: 20.4–32.6%) reported TMD. Furthermore, those who exhibited anxiety were eight times more likely to develop TMD (OR = 8.88, 95% CI: 3.95 - 19.97). In the second wave, 62.3% (95% CI: 55.6–69.0%) of students reported anxiety, and 86.3% (95% CI: 81.6–91.0%) reported TMD. Additionally, individuals with anxiety were found to have a significantly higher likelihood of developing painful TMD, with a nine-fold increase in risk (OR = 9.87, 95% CI: 5.08–19.19). The cohort of students exposed and not exposed to anxiety during the first and second waves of COVID-19 infection showed a 4.58 times higher risk (95% CI: 2.61–8.03) of developing painful TMD due to anxiety.

Conclusion:

Between the first and second waves of COVID-19 infection, the prevalence of anxiety and painful temporomandibular disorder (TMD) increased among dental students. This establishes anxiety as a significant predisposing factor for the development of painful TMD over time.
Fracture strength of fiber post with polyetheretherketone post: An In vitro comparative study
Authors: Deshpande Rohan , Kumar Sowmya M , Anoop Minu , Kapse Payal , Veena Korikkar Mahaling
Published: April 2024

Aim:

To assess and compare the fracture strength of polyetheretherketone (PEEK) post materials with fiber posts on endodontically treated maxillary central incisors.

Materials and Methods:

In this in vitro comparative study, two dental post materials were evaluated: fiber-reinforced post and PEEK post. Simple random sampling was done and 30 specimens were fabricated using extracted, decoronated, and endodontically treated maxillary central incisors (n = 15 for each group). Post-space preparation was done 5 mm short of the apex and restored with prefabricated fiber post (n = 15) and customized PEEK post (n = 15). Samples were mounted in a cold cure acrylic cylindrical block, at 45° angulation for testing the fracture strength using a universal testing machine. The data were analyzed and compared statistically, using an independent t test.

Results:

Mean fracture strength of the PEEK post was 65.79 kg and the fiber post was 59.32 kg with no statistically significant difference in the fracture strength between the two groups.

Conclusion:

Within the limitations of the study, it can be concluded that the PEEK post has similar mechanical properties to the fiber post and could be considered as an alternative to the fiber post having the advantages of being custom-made requiring conservative canal preparation with minimal dentin removal.
Remineralization potential of varying concentrations of two plant-based extracts of Cocos nucifera on white spot lesions using SEM and EDAX analysis: An in vitro study
Authors: Balakrishnan Nivethigaa , Subramanian Aravind Kumar , Eswaramoorthy Rajalakshmanan , Angappan Mahalakshmi
Published: April 2024

Abstract

Aim:

To evaluate the remineralization potential of varying concentrations of two plant-based extracts of Cocos nucifera on white spot lesions using SEM and EDAX in vitro testing methods.

Materials and Methods:

The pulp was freshly obtained from coconut and divided into two. Then, coconut milk was obtained by blending, while the next portion was freeze-dried and lyophilized. Third molar teeth were processed into tooth slabs (N = 40) and split equally into five groups by block randomization. After demineralization, one tooth slab was taken from each, and SEM analysis was done. Remineralization was then performed among the various groups that included Group 1, which acted as a control and consisted of the remineralization solution. Groups 2 and 3 comprised 1:1 and 2:1 concentrations of the coconut milk, whereas Groups 4 and 5 consisted of 1:1 and 2:1 concentrations of the lyophilized extract. SEM and EDAX testing were done post-remineralization. Ca and phosphate values were tabulated, and statistical significance was determined for the obtained values using ANOVA.

Results:

Among the control and treatment groups, surface remineralization was better observed in 1:1 coconut milk and 2:1 coconut milk than in the 2:1 lyophilized coconut, control, and 1:1 lyophilized coconut. Between the control and treatment groups, Ca and phosphate percentages (P < 0.001) showed statistical differences. The lowest value of 2.3% was noted in the 2:1 lyophilized coconut group.

Conclusion:

Coconut extracts exhibit remineralization potential on the artificial carious lesion. Coconut milk exhibited significant improvement in the surface properties than lyophilized coconut.
Current trends in placing posterior composite restorations: Perspectives from Palestinian general dentists: A questionnair study
Authors: Arandi Naji Ziad
Published: April 2024

Abstract

Aim:

The success of composite restorations relies on material selection and practitioner-related factors that shape the overall outcome. This study explores the practices of Palestinian general dental practitioners in placing posterior composites, examining the impact of work sector, experience, and gender on their choices.

Materials and Methods:

The study was conducted as an online cross-sectional questionnaire and involved 351 participants, with a response rate of 69.8%. The survey comprised 18 closed-ended questions covering demographics, material selection, and composite placement in special cases, techniques, and factors influencing the choices. Statistical analyses included descriptive statistics, chi-squared tests, and Fisher’s exact tests.

Results:

Composite was the predominant choice for small-size (83.7%) and large-size posterior cavities (60.4%). Practitioners commonly opted for composite restorations in cases involving occlusal parafunctional activity (60%), poor oral hygiene (78%), and subgingival cavities (72.2%). Only 19.6% and 5.3% reported occlusal and gingival beveling, respectively. Rubber dams for isolation stood at 30%, one-step self-etch adhesives at 44.9%, and the oblique layering technique at 51%. Light-emitting diode curing units were popular (97.55%), but monitoring output with a radiometer was infrequent (93.5%). Tofflemire metal matrix usage was 46.1%, whereas a sectional matrix system was employed by 29.8%. A 2 mm layer exposure to light curing for 20 s was reported by 62%, and 27.75% utilized additional light-curing postmatrix band removal.

Conclusion:

The study highlights the need for Palestinian dental professionals to update their clinical approaches in placing composite restorations in posterior teeth. Gender, work sector, and experience influence practitioners’ choices, emphasizing the importance of tailored continuing education programs for improving clinical practices.
Shear bond strength between conventional composite resin and alkasite-based restoration used in sandwich technique: An in vitro study
Authors: Dawood Alaa E , Alkhalidi Emad F , Saeed Mohammad A
Published: April 2024

Abstract

Aim:

The success of layered restorations necessitates the utilization of an improved restorative material compatible with composite restorations. Therefore, in this line of research, the strength of adhesion of conventional resin-based dental composite to different filling materials was tested.

Materials and Methods:

Conventional composite resin was bonded to four restorative materials (Group I: conventional glass ionomer cement (GIC), Group II: resin-modified glass ionomer cement, Group III: flowable composite, and Group IV: Cention-N) received no surface treatment (Subgroup A: control), sandblasting using 50-µm aluminum oxide particles (Subgroup B), sandblasting and resin adhesive (Subgroup C), acid etch and resin adhesive (Subgroup D), or self-etch resin adhesive (Subgroup E). After 24 h, the strength of adhesion between the conventional composite resin and the other tested filling materials was estimated by using a universal testing machine and compared using one-factor analysis of variance and Tukey’s method.

Results:

The conventional GIC had the minimum values of adhesion strength while the flowable composite and Cention-N had the maximum values of adhesion strength (P < 0.05). The treatment of the used restorative materials with sandblasting and resin adhesive boosted the adhesion strength (P < 0.05). The surface treatment of GIC-based materials with either acid etch and resin bonding agent or self-etch resin bonding agent boosted the adhesion strength (P < 0.05).

Conclusion:

Cention-N sandblasted and coated with resin adhesive before the application of conventional composite resin in layered restorations is a potential alternative to GIC-based restorations and flowable composite.
Educators Who Do Not Use AI Will Be Replaced by Those Who Do: Disadvantages of Not Embracing AI in Medical Education
Authors: Giray Louie
Published: April 2024

Resistance among educators to using artificial intelligence (AI) may yield significant disadvantages. Without AI, educators risk a higher workload, inefficient use of time, limited personalization, lack of feedback, inability to adapt, reduced student engagement, fewer job opportunities, and limited professional development. However, AI is designed to empower educators, enhance instructional practices, and foster professional growth. In the field of medicine, reluctance to adopt AI could hinder students from being equipped with vital skills in tackling the modern health-care situation. By leveraging AI tools, educators can create dynamic learning environments, producing better-trained health-care professionals ready to tackle evolving challenges. AI integration enhances education quality and prepares students for technological advancements in their medical careers, ensuring they are equipped to navigate the complexities of modern health-care practice. Thus, AI adoption in education is essential for maintaining the competitiveness and relevance of curricula in the AI age.
Lean Metabolic Syndrome vis-à-vis Obese Metabolic Syndrome: Observations from an Eastern Indian Tertiary Set-up
Authors: Chatterjee Rupak , Mukherjee Shatavisa , Karmakar Partha Sarathi , Pramanik Netai
Published: April 2024

Background:

Metabolic syndrome (MetS) in obese is a fairly common entity. However, excluding the waist circumference (WC) criteria, other components of the MetS are also seen in lean or nonobese people. Our study aimed to determine the prevalence of lean MetS among newly diagnosed MetS cases and compare the biochemical parameters and insulin resistance in lean versus overweight/obese MetS.

Methods:

A cross-sectional, observational study was conducted over 12 months and included adult patients of either sex, newly diagnosed with MetS. Fever cases, infections such as tuberculosis/HIV/chronic infectious disease, chronic inflammatory diseases, those having endocrine causes of obesity such as Cushing syndrome, known cases of ischemic heart disease, and those on antiobesity medications were excluded. Diagnosed MetS patients were categorized as lean or obese based on the standard criteria. A convenient sample of 50 was considered for either group (lean MetS vs. obese MetS). Included patients were investigated for lipid, liver, glycemic, and insulin resistance profiles. Other parameters included serum uric acid, thyroid function, whole abdomen ultrasound, electrocardiography, two-dimensional echocardiography (ECHO), fibroscan, and polysomnography for obstructive sleep apnea (OSA).

Results:

The prevalence of lean MetS was 9.87%. Variables such as body mass index, WC, low-density lipoprotein, and systolic blood pressure were significantly higher in the obese MetS in comparison to the lean MetS group. Fasting insulin was also significantly higher in the obese MetS compared to lean MetS. Biochemical measures such as aspartate aminotransferase and alanine transferase were significantly higher for the obese MetS, while the change was nonsignificant for other biochemical measures. Except for complications such as polycystic ovary syndrome, acanthoses nigricans, and gallstones which were significantly higher in the obese MetS group, the rest of the complications were similar in both groups.

Conclusion:

MetS among nonobese or lean subjects differs in certain aspects from those with obesity. As lean MetS is an emerging entity, clinicians must be aware of it to avoid morbidity.
Cardiac Amyloidosis: Approach to Diagnosis
Authors: Chopra Neha , Arava Sudheer Kumar , Patel Chetan , Kumar Sanjeev , Seth Sandeep
Published: April 2024

Amyloid is an amorphous, fibrillar material formed from various abnormally folded proteins that deposits locally or systemically. Over 95% of cases have been attributed to light chain deposition (AL) or transthyretin deposition (ATTR) amyloidosis. The basic investigations in the evaluation of cardiac amyloidosis include the electrocardiogram, echocardiography and cardiac biomarkers. Echocardiography in a patient with cardiac amyloidosis shows biatrial enlargement, biventricular hypertrophy, diastolic dysfunction, interatrial septal thickening, valvular thickening, a glistening appearance of the interventricular septum, and pericardial effusion. Magnetic resonance imaging can help distinguish amyloidosis from other causes of infiltrative/restrictive cardiomyopathy, from example, sarcoidosis, hemochromatosis, and Fabry disease based on characteristic enhancement patterns in these diseases. The latest Expert Consensus recommends that serum/urine immunofixation electrophoresis along with a serum free light chain assay must be done in all the cases of suspected cardiac amyloidosis. If the light chain assays are positive, we proceed with tissue diagnosis for confirmation of AL amyloidosis. If the screening assays are negative for monoclonal gammopathy, the next step is to obtain cardiac scintigraphy. If the nuclear scan is negative, but the index of suspicion remains high, an endomyocardial biopsy can be done. Once amyloid is demonstrated in histopathologic specimens, it must be typed to distinguish between AL and ATTR. The ideal method for this is tandem mass spectrometry, although this may not be widely available. It has a sensitivity of 88% and specificity of 96% higher than other techniques 23. In resource-poor settings, immunohistochemistry or immunoelectron microscopy can allow this distinction, although with lesser sensitivity.
Zero-contrast Multivessel Percutaneous Coronary Intervention with Intravascular Ultrasound Guidance in a Patient with Acute-on-chronic Kidney Disease: Turn Hopeless into Hopeful
Authors: Sharma Sanjay Kumar
Published: April 2024

Contrast-induced nephropathy is one of the serious complications in patients with renal dysfunction who underwent administration of intravascular contrast media. To overcome this, an approach of drastic reductions in contrast volume and the use of intravascular ultrasound has been adopted in some clinical cases. This report emphasizes the potential benefits of zero-contrast multivessel percutaneous coronary intervention in a patient presenting with acute-on-chronic kidney disease.
Recurrent Transient Ischemic Attack in the Elderly due to Asymptomatic Atrial Septal Defect: An Unusual Scenario
Authors: Reddy K. Harshitha , Kumar Sunil , Malali Suprit , Pantbalekundri Nikhil , Acharya Sourya , Suryadevara Manasa
Published: April 2024

Atrial septal defects (ASD) are congenital cardiac anomalies, characterized by abnormal communication between the atria. These are commonly diagnosed in childhood and occasionally remain asymptomatic and undetected until the later stages of life. In ASD, there is communication between atria. Until the 4th decade of life, the majority of ASD are asymptomatic. Some exhibit the signs of exhaustion, syncope, exercise intolerance, and dyspnea with effort. Eisenmenger syndrome, paradoxical embolism, and atrial arrhythmias are among the problems that some people may later on develop. We describe a particular case of a 70-year-old male who arrived with a transient ischemic attack where he had left-sided upper limb weakness due to a paradoxical embolism due to ASD.
Managing risk of infectious disease transmission at religious mass gatherings: Insights from survey, COVID-19 PCR, and antibody tests from Arbaeen walkers in 2020
Authors: Al-Ansari Farah , Al-Ansari Basma , Abdulzahra Mohammed S. , Rashid Harunor , Hill-Cawthorne Grant A. , Al-Ansari Mohammad B. , Al-Fatlaw Sabah M. , Mawash Mohammad , Al Ansari Mustafa , Conigrave Katherine M.
Published: April 2024

Background:

Arbaeen in Iraq has been one of the largest mass gatherings during the COVID-19 pandemic with 14.5 million attendees in 2020. We set out to assess the prevalence of current or past COVID-19 among 2020 Arbaeen participants, and establish associations between COVID-19 test results, symptoms, and known recent exposure.

Methods:

This was a cross-sectional study involving participants who joined Arbaeen walk in Iraq in October 2020. COVID-19 PCR and/or rapid antibody test were conducted among consented participants. A short questionnaire was administered. Rapid antibody testing was done onsite. Nasal and throat swab samples were transferred to the laboratory for PCR testing.

Results:

A total of 835 (88.3% male; 11.7% female) participants were recruited. The most common symptom overall was cough (9.6%) followed by sore throat, fever, and loss of taste/smell (6.6%, 5.5%, and 5.0%, respectively). One in five (20.3%) participants reported close contact with a confirmed COVID-19 case in the past 14 days. Of the 237 participants with a PCR test, 18 (7.6%) were positive. Of the 765 participants with rapid antibody test, 19.3% tested positive for IgM, 39.3% for IgG, and 16.4% for both. Approximately 40% of the participants had evidence of current or past COVID-19 infection based on antibody and PCR.

Conclusions:

The almost 1 in 10 COVID-19 cases within such a multimillion person gathering, illustrates the difficulty in limiting the participation of infectious individuals in religious mass gatherings. There is a pressing need to explore measures to reduce the risk of transmission of infectious diseases at major mass gathering events.
Preference and Disclosure of Fetal Gender to Pregnant Women during Prenatal Ultrasonography in South South Nigeria
Authors: Maduka NR , Nnoli US
Published: April 2024

ABSTRACT

Background:

Ultrasound scan (USS) in pregnancy has become a common diagnostic tool used in the assessment of pregnancy in recent time. In the course of routine pregnancy assessment using USS, some pregnant women will request to know the sex of their unborn babies. Their reasons for wanting to know the gender of their baby could be either for social reason like planning for an unborn child or their desire for a preferred gender.

Aim:

The aim of the study was to evaluate gender preferences and disclosure of foetal sex at prenatal USS.

Methods:

This was a cross-sectional study conducted at the antenatal clinic of Central Hospital Agbor, Delta State, Nigeria. A total of 235 consecutive consenting women who came for antenatal care (ANC) registration were recruited for the study after obtaining their informed written consent. Questionnaire was used to seek for their sociodemographic characteristics, preference and desires for foetal gender disclosure, reasons for gender disclosure, and awareness of USS accuracy for gender determination.

Results:

The desire to know the sex of baby was high (99.6%). The major reason for wanting to know the sex of baby was to plan for the unborn child (47.7%) and maternal curiosity (37.0%). Majority of the women (57.4%) had no gender preference. Sixty percent (60%) were not aware that USS sex diagnosis could be wrong.

Conclusion:

There is a strong desire by pregnant women to know the sex of their babies at routine USS. Considering the fact that many of the women were not aware that there could be wrong diagnosis at prenatal ultrasound, it is suggested that adequate counselling be given before fetal sex disclosure.
Comparison of vision screening results between trained teachers and general practitioners among elementary school students in rural Bali: A cross-sectional study
Authors: Tania  , Monica Mattarungan , Cisca Kuswidyati
Published: April 2024

Context: Visual impairment is a major healthcare burden worldwide. The vision screening program was supposed to be conducted routinely; however, the shortage of healthcare personnel posed a significant challenge. Aims: This study was conducted to compare the visual acuity examination results of elementary school students when examined by trained teachers as lay screeners and general practitioners (GPs). Settings and Design: This was a cross-sectional study involving 2056 students from 19 elementary schools under one primary healthcare center in Gianyar. Materials and Methods: All students included in the study underwent a basic visual acuity test using the Snellen’s Chart at a distance of 6 m. The test was performed two times, once by teachers and once by GPs. Statistical Analysis Used: Data analysis was performed using Cohen’s Kappa interrater reliability. Results: The total number of study participants was 2056 students. The mean age of the screened students was 9.43 ± 1.69 years, and most of them were male (52.4%). The estimated number of children needing further eye examination and referred to the ophthalmologist was 253 (12.31%). The agreement between visual acuity examinations conducted by teachers and GP was found to be almost perfect, as indicated by Kappa values of 0.859 for the right eye, 0.856 for the left eye, and 0.878 for both eyes, and these were statistically significant (P < 0.001). Conclusions: The high agreement value of visual acuity examination between teachers and GP shows the feasibility of involving teachers as lay vision screeners, which can elevate the number of children screened.
Amlodipine-induced gingival overgrowth in a patient with hypertension
Authors: Mahajan Anushi , Kaur Prabhjot , Badyal Dinesh
Published: April 2024

Amlodipine-induced gingival overgrowth (AIGO) is characterized by an increase in the volume of connective tissue matrix in the gingiva. Amlodipine is one of the commonly prescribed antihypertensive drugs, and gingival hyperplasia is one overlooked side effect in patients taking amlodipine. Many factors can contribute to the development of gingival overgrowth, including: plaque control; periodontal variables; medications and their relative dose; age; sex; and, genetic factors. Currently, more than 20 prescription medications are associated with gingival enlargement. Drugs associated with gingival overgrowth can be broadly divided into three categories: Anticonvulsants, calcium channel blockers, and immunosuppressant. In the present case, a 66 year old male patient who presented with gingival overgrowth and was found taking Amlodipine for 20 year.
Antitubercular treatment-induced chronic progressive sensory-motor polyneuropathy with optic neuropathy
Authors: Makwana Mitul Jagdishbhai , Rana Devang A. , Panchal Krisha , Gupta Sapna D.
Published: April 2024

Polyneuropathy is a major complication in tuberculosis (TB) patients associated with various causes, including comorbid conditions and antitubercular medications, particularly involving drugs such as isoniazid (INH) and ethambutol. INH interferes with pyridoxine synthesis, leading to sensory peripheral neuropathy, and presents with symptoms such as tingling, burning, numbness, and difficulty in walking. Ethambutol, on the other hand, is associated with optic neuropathy, presenting as bilateral and symmetrical visual field abnormalities. We report a case of a 39-year-old male with TB undergoing antitubercular treatment for 4 months, experiencing weakness in all four limbs and blurred vision. The patient developed chronic progressive sensory-motor polyneuropathy with optic neuropathy. Prevention strategies, routine screening, and prompt management are crucial in mitigating the impact of this condition. The article emphasizes the importance of early identification, withdrawal of offending agents, and management strategies, such as vitamin supplementation and physical therapy, to prevent permanent disability.
Aneurysm Wrapping as an Adjunct of Clipping of a Premature Rupture of the Middle Cerebral Artery Aneurysm
Authors: Marleen  , Niryana I Wayan , Putra Made Bhuwana , Tiffany  , Kusuma Yosi Wanda
Published: April 2024

Aneurysms, abnormal dilatations on cerebral arterial walls, pose a significant health concern due to the morbidity and mortality associated with ruptures causing subarachnoid hemorrhage. The risk of rupture is influenced by aneurysm size and location. Surgical clipping is the preferred treatment, especially for middle cerebral artery (MCA) aneurysms, despite recent endovascular advancements. Intraoperative premature rupture poses a critical challenge, requiring swift decision-making and efficient management techniques. We describe a case of an intraoperative premature aneurysm rupture managed with muscular wrapping as an adjunct to microsurgical clipping. The patient, with a history of spontaneous intracerebral hematoma, underwent urgent microsurgical clipping for a left MCA aneurysm. Premature rupture occurred during clipping, necessitating the use of a muscle patch and fibrin glue for wrapping. The wrapping technique, originally developed for unruptured aneurysms, induces fibrotic scar formation, enhancing vascular stability. Cotton, a common wrapping material, elicits chronic inflammation. Autologous tissues and synthetic materials, like muscle, offer alternatives with potential benefits. Factors associated with increased rupture risk include aneurysm location, irregular shape, and prior rupture. Vigilance and preparedness are crucial, especially for high-risk cases. As the availability of computed tomography scans increases, more aneurysm cases are diagnosed, requiring comprehensive patient assessments before interventions. The presented case demonstrates the effectiveness of on-site wrapping in controlling premature rupture. The combined use of muscle patch and fibrin glue postaneurysmal clipping may assist in preventing rebleeding events. Intraoperative ruptures demand careful consideration, and the described wrapping technique provides a valuable option for managing such complications.
Orbital compartment syndrome after pterional craniotomy for arachnoid cyst resection
Authors: Santana Bruno Silveira , Schmidt Luiz Paulo Bastos
Published: April 2024

Orbital Compartment Syndrome (OCS) represents a critical medical emergency characterized by heightened orbital pressure, jeopardizing blood flow and posing a risk to the optic nerve. Often stemming from surgical procedures such as craniotomies for arachnoid cyst resection, OCS necessitates swift diagnosis and intervention. We report the case of a 77-year-old female in São Paulo, Brazil, who underwent left pterional craniotomy for arachnoid cyst resection. Postoperatively, she manifested reduced visual acuity in the left eye, restricted ocular movement, and peripalpebral hematoma indicative of orbital compression syndrome. Computed tomography scans confirmed pneumocephalus and pneumo-orbital complications, prompting an immediate diagnosis of OCS. Immediate interventions, including lateral canthotomy and cantholysis, were employed, resulting in successful decompression and substantial symptom improvement within a 10-day period. This case underscores the significance of preoperative imaging, prompt diagnostic measures, and collaborative postoperative care in managing orbital complications following neurosurgery.
Bilateral Pulmonary Sequestration – A Rare Entity
Authors: Joseph Bindhu , Akshaya K. T. , Nair Reshmi S. , Raju Reyma Sara , Mini J. , Ravi Ajay
Published: April 2024

Bronchopulmonary sequestration (BPS) is a congenital anomaly within the spectrum of abnormalities that can affect the normal development of airways, lung parenchyma, and vasculature. It accounts for up to 6.4% of all congenital pulmonary malformations. Sequestrated lung is a nonfunctioning mass of lung tissue that lacks communication with the tracheobronchial tree and is supplied by systemic arterial circulation. Pulmonary sequestration is usually a unilateral disease, bilateral pulmonary sequestration is a rare entity. Herein we present the case of a 26year old female, evaluated for cough with expectoration, hemoptysis and loss of weight, whose radiology suggestive of bilateral bronchopulmonary sequestration.
Wojna i konflikt w cyberprzestrzeni. Piąty teatr wojny
Authors: Heromiński Maciej
Published: April 2024

The aim of this article is to present the genesis and typology of cyberspace and the threats that result from activities carried out in this area by state and non-state entities. The basic concepts, especially cyberspace, which is treated as a potential new theater of war, have been systematized. It was also presented the characteristics of the studied phenomenon from the point of view of using it to carry out destructive activities in the digital space and in the real world. Cyberspace is becoming an area for carrying out effective activities that serve to neutralize the enemy in a short time and with little effort. To prove his theses, the author uses numerous examples from the actual international relations, such as: the cyberwarfare in Estonia, the Israeli-American operations against Iranian ICT systems and the cyber-clashes between the United States of America and China.