bluuebunny/crossref_metadata_2025 huggingface dataset:
Synergistic Effects of 2-Deoxy-D-Glucose and Cinnamic Acid with Erlotinib on NSCLC Cell Line
Authors: Al-khfajy Wrood salim , Munaf Hashim Abdulrazzaq  , Al-Mashhadani Zakariya
Published: December 2023

Background: In spite of all efforts, Non-small cell lung cancer (NSCLC) is a fatal solid tumor with a poor prognosis as of its high metastasis and resistance to present treatments. Tyrosine kinase inhibitors (TKI) such as erlotinib are efficient in treating NSCLC but the emergence of chemoresistance and adverse effects substantially limits their single use. Objective: in this study, the combination treatments of either 2-deoxy-D-glucose (2DG) or cinnamic acid (CINN) with erlotinib (ERL) were tested for their possible synergistic effect on the proliferation and migration capacity of NSCLC cells. Methods: In this study, NSCLC model cell line A549 was used to investigate the effects of single compounds and their combination on cell growth inhibition, clonogenic potential, and migration capacity. Next, the Combination index (CI) and the Dose-Reduction Index (DRI) were determined to determine the nature of the drug’s combination and to measure how many folds the dose could be lowered for each drug in a synergistic combination. Results: the combination treatment demonstrated more significant inhibition of viability of A549 cells compared to individual therapy. Our data show that CINN augments the sensitivity to erlotinib in all doses tested. The combination of 2DG or CINN with erlotinib also reduced the clonogenicity of NSCLC cells up to 67% and 85%, respectively, as compared to the erlotinib single treatment. Furthermore, CINN +ERL decreased the migratory ability of A549 cells by 3-fold and further induced much more apoptotic cell death phenotypes. Conclusion: in summary, co-administration of 2DG or cinnamic acid with erlotinib increases the inhibitory effects of erlotinib on NSCLC cell tumorigenicity and migration.
Bilosomes as Soft Nanovesicular Carriers for Ropinirole Hydrochloride: Preparation and In- vitro Characterization
Authors: Ali Samer Khalid , Entidhar J. Al-Akkam
Published: December 2023

Bilosomes are nanovesicular carriers that contain bile salts and non-ionic surfactants in a bilayer with cholesterol. These are more ultra-deformable, elastic, and flexible than other nanovesicular carrier.Ropinirole hydrochloride (RH) is a non-ergot dopamine D2-agonist. It is used to manage Parkinson's disease and to minimize "on-off" variations in levodopa responsiveness. The oral bioavailability is about 50% due to it being extensively metabolized in the liver, with an elimination half-life of about 6 h.The aim of this study was to enhance oral drug delivery and provide the sustained release of RH by preparing it as soft nanovesicular carriers (bilosomes).Eight formulas of RH bilosomes were prepared by a reverse-phase evaporation method using mixed surfactant (span®60: tween®60 at 1:2 ratio), cholesterol and sodium deoxycholate as bile salt.All formulas were evaluated for their drug content, entrapment efficiency, vesicle size, polydispersity index, zeta potential, drug release, transmission electron microscopy and fourier transform infrared spectroscopy.Results showed all prepared RH bilosomes were in nano-range with vesicle size ranging (from 124.40±10.60 to 294.60±11.50) nm, Zeta potential ranged (from -16.955±7.372 to -23.22±0.880) mV and with entrapment efficiency % ranged (from 57.30±6.48% to 77.77±3.78%).

The best formula F5 showed vesicle size (160.60±15.82) nm, Zeta potential (-20.75±0.930) mV, and entrapment efficiency %(77.77±3.78%) with 84.39% in-vitro release of RH after 24 h.It is concluded that bilosomes are good nanovesicular carriers for enhancing oral drug delivery and providing the sustained release of RH and all that may enhance oral bioavailability for RH.
Serum Soluble Angiotensin-Converting Enzyme-2 Level and Its Potential Association With The Renin-Angiotensin-Aldosterone System in Non-Hypertensive Iraqi COVID-19 Patients: An Observational Study
Authors: Turki Mohammed A. , A. Kasim Ali
Published: December 2023

Background: The novel coronavirus disease (COVID-19) is caused by Severe acute respiratory syndrome coronavirus 2 (SARS-Cov2) which utilizes angiotensin converting enzyme2 (ACE2) to invade the host cells. This membrane-bound peptidase is widely distributed in the body; its activity antagonizes the renin-angiotensin-aldosterone system (RAAS). Once SARS-Cov2 enters the cell, it causes downregulation of ACE2, resulting in the unopposed activation of RAAS. The unregulated activity of the RAAS system can deteriorate the prognosis in COVID-19 patients. A soluble form of ACE2 (sACE2) was reported to have a role in the SARS-Cov2 invasion of the susceptible cells.

Aim of the study: This study aims to investigate the potential association of serum levels of sACE2 and RAAS components in severe COVID-19 patients compared to healthy individuals.

Methods: Eighty-five participants enrolled in the study were grouped into 45 non-hypertensive severe COVID-19 patients and 40 healthy individuals with comparable age and gender. Serum levels of sACE2, renin, angiotensin 2, and aldosterone by ELISA, and serum potassium level was measured by turbidimetric method.

Results: The results showed a significant difference in the serum levels of sACE2 (lower), renin, angiotensin 2, and aldosterone (higher) in COVID-19 patients compared to the control subjects (p-value <0.001; for all.

Conclusion: Non-hypertensive severe COVID-19 patients have lower sACE2 and higher RAAS peptide levels, and they can serve as diagnostic markers of severe COVID-19 patients.

Recommendations: we recommend a future study with a larger sample size that enrolls COVID-19 patients with different severity levels.

Keywords: Aldosterone, Angiotensin, COVID-19, Renin, Soluble angiotensin converting enzyme 2
O uso não descrito em bula (off label) de medicamentos anti-histamínicos na pediatria
Authors: Morgana Gomes Candido Agnes , Silva dos Santos Breno , Eugenio da Silva Jefferson , Galuppi Auletta Lucas , Meneses Delfino Suellen , Dos Santos Pereira Thaynara , Bertoluci Raquel , Giorgetti Leandro
Published: December 2023

O pediatra necessita ter uma maior sensibilidade de uma visão integral da criança e do adolescente, dentro do contexto social em que estão inseridos, diante da segurança e eficácia dos medicamentos prescritos, as quais depende das concentrações do fármaco no organismo.

No que dizem respeito às formulações pediátricas, os principais fatores que desestimulam a indústria farmacêutica a desenvolver medicamentos para crianças, contemplam: o número pequeno de sujeitos disponíveis para participar destas pesquisas, os elevados custos marginais, o mercado reduzido e a complexidade ética desses estudos. Nesse sentido, médicos praticam o uso não descrito em bula (off label), o qual pode ser definido como o uso não aprovado de um medicamento pelo órgão sanitário local.

Devido ao seu efeito sedativo os anti-histamínicos H1 lideram as prescrições off-label na pediatria, os motivos para o seu uso são diversos, contudo podemos destacar: indução ao sono, tratamento de gripe e tosse, rinite, dermatite, asma, otite e urticária. Visto que muitos medicamentos utilizados no tratamento de doenças alérgicas não passaram por estudos para populações pediátricas, devido a certas barreiras éticas, a prescrição off-label destes produtos acaba sendo comum e geram uma preocupação a respeito de possíveis eventos adversos, mesmo com a crescente preocupação e esforços para melhorar os cuidados de saúde praticados em crianças, especificamente através da utilização de medicamentos seguros e efetivos.

Dessa forma, no período pós-comercialização de um produto farmacêutico, os profissionais farmacêuticos dentro da farmacovigilância, como papel de Detentoras de Registro de Medicamentos (DRM), monitoram informações de segurança e, a partir delas, realizam avaliações benefício-risco e estabelecem medidas de minimização de risco, além de ser um dever e compromisso ético do farmacêutico instruir os pais e responsáveis das crianças mesmo quando o uso dos medicamentos está fora dos rótulos.
Meningoencefalomielite por Cryptococcus spp. em felino
Authors: Caravalho Isabella Michels , Patella Lara Zanetti , Morgenstern Tiago Luís Morgenstern , Bastos Newton Rafael , Gorczak Rochelle
Published: December 2023

Cryptococcosis is a systemic mycosis caused by encapsulated yeasts from the gender Cryptococcus. It mainly affects the nasal cavity, adjacent tissue and lungs, and can spread to the central nervous system, eyes and skin, causing meningoencephalomyelitis. It can be noninfectious or infectious via yeasts and bacteria, and felines are the most prevalent when infected by the Feline Leukemia Virus (FeLV) or Feline Infectious Peritonits (FIP). The neurological signs of infection by criptococcus could be convulsion, depression, disorientation, ataxia, paralysis of the pelvic limbs, mydriasis and blindness. For diagnosis, the neurological exam is indispensable, and must be combined with the general full body physical exam, with the intention to find the injury. The aim of this study is to report the case of a cat, 10 months old, with meningoencephalomyelitis by Cryptococcus spp. The animal presented the clinical signs of abrupt change in behavior, excessive fear, lack of appetite and progressive weight loss. Methadone was administrated for the pain, used gabapentin that changed for pregabalin. Cerebrospinal fluid (CSF) analysis and MRI were performed to assist in the diagnosis. However, false negatives can occur, which may consequently hinder adequate treatment. In this report, diagnostic conclusion occurred post-mortem. Thus, the patient lacked the adequate treatment to stabilize in life.
Homeopathic treatment for aural hematoma in cat: Case report
Authors: Valle Ana Catarina Viana , Fernandes Filipa Neto , Carvalho Aloísio Cunha de
Published: December 2023

Aural hematoma is defined by the accumulation of serosanguineous fluid within the ear pinna in small animals, typically stemming from traumatic incidents. Inadequate treatment may lead to recurring episodes and structural deformities in the patient's ear. In veterinary clinical practice, this condition exhibits a high incidence among dogs, but is relatively rare in cats. Conventional treatments employed for the physiological and aesthetic restoration of the affected area are typically invasive and often entail significant costs. Therefore, this article aims to present a case study involving a 15-year-old female mixed-breed feline diagnosed with an aural hematoma. The patient had previously undergone various forms of conventional treatment, none of which proved successful. Thus, a complementary treatment approach utilizing oral homeopathy was selected, as it represented the sole available option at that particular juncture. The homeopathic medicines were selected according to the law of similars. The treatment consisted of the following medications: Arsenicum album 30CH; Bellis perennis 30CH and Rhus Toxicodendron 30CH. After 20 days of treatment, the animal exhibited an ear pinna devoid of fluid accumulation and recurrence. The ear pinna was in excellent condition, except for the presence of scars along the ear, resulting in a residual deformation. Hence, homeopathic therapy holds significant promise as a therapeutic modality for managing aural hematomas in cats, obviating the necessity for invasive procedures. Under this perspective, this article represents one of the initial reports documenting such a treatment approach in feline cases.
Broken Heart Syndrome: A Rare Case of Recurrent Reverse Takotsubo Cardiomyopathy Associated with Acute Respiratory Failure: Reverse Takotsubo Cardiomyopathy
Authors: Pattanshetty Deepak , Jabeen Samina
Published: December 2023

Background:

Takotsubo cardiomyopathy accounts for 1% of acute coronary syndrome presentations and has been increasingly recognized.1 Reverse Takotsubo cardiomyopathy, a variant form of Takotsubo cardiomyopathy has been described which presents with hyperdynamic function of the apical segments and hypokinesis of the basal or mid-ventricular segments, is the rarest type of acute stress cardiomyopathy, with mid-ventricular akinesia and preservation of apical and basal contractility.2

Case Report:

We report the rare case of an elderly lady admitted to our intensive care unit (ICU) with acute respiratory failure due to exacerbation of chronic obstructive lung disease and heart failure. Echocardiography revealed reverse Takotsubo cardiomyopathy. Cardiac catheterization showed nonobstructive coronary artery disease. The wall motion abnormalities resolved in 2 weeks. The case is unique in that she had an identical presentation one year earlier after she had entered the same dusty room! 

Conclusion:

This case demonstrates that reverse Takotsubo cardiomyopathy with identical wall motion abnormalities can recur in a patient when re-exposed to similar stressful situation. Early recognition and appropriate management can prevent catastrophic outcomes.
Evaluation of the prognostic value of monocyte to HDL ratio (MHR) in primary PCI STEMI patients
Authors: Sedigh Hamid , Separham Ahmad , Aslan-abadi Naser , Javan-ajdadi Reza , Mehravani Kazem
Published: December 2023

Background: The purpose of this study was to assess the prognostic value of the monocyte-to-high-density lipoprotein ratio (MHR) as a marker of inflammation in patients diagnosed with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI). Materials and Methods: This retrospective cross-sectional study was conducted on patients with a diagnosis of STEMI who underwent PCI between March 2021 and March 2022 at Madani Training and Research Hospital in Tabriz, Iran. Data regarding clinical and demographic properties, and laboratory parameters were obtained from medical records. Patients were categorized into two groups according to the median of admission MHR. Results: The study population consisted of 652 patients, 378 males (58%), and 275 females (42%), with a median age of 68 years (interquartile range: 57-77). Results showed that groups with higher MHR (>15.59) had higher rates of in-hospital mortality and higher major adverse cardiovascular events (MACEs) in comparison with the group featuring lower MHR (<15.59). Receiver operating characteristic (ROC) curves demonstrated that MHR could predict in-hospital mortality with a 75.7% sensitivity and 53.5% specificity, as well as predict MACE with 60.2% sensitivity and 59.7% specificity. Multivariate analyses indicated that MHR is an independent predictor of both in-hospital mortality (OR 1.05, 95% CI 1.02-1.08, P=0.002) and MACE (OR 1.05, 95% CI 1.02-1.08, P<0.001). Conclusion: This research indicated that the rise in MHR was independently associated with a higher risk of MACE and in-hospital mortality in STEMI patients undergoing primary PCI.
A Study to Assess the Effectiveness of Midwife-Led Psychoeducation on Childbirth Fear and Childbirth Efficiency in Primigravida Mothers of Selected Hospital of Navi Mumbai
Authors: Thomas Ann Maria , G. Solomon Smriti
Published: December 2023

Aim: This study examines the effects of midwife-led psychoeducation on delivery fear and efficiency in primigravida moms in Navi Mumbai hospitals. Method: The researcher used quantitative evaluator research. Aquasi-experimental research approach was chosen for the investigation. Sample size for the study is 300. For this study, simple random sampling was performed. Results were presented using descriptive and inferential statistics. Demographic data, childbirth fear categorization, and efficacy were presented as frequency and percentage. T-test was used to compare pre- and post-test delivery fear and efficacy levels. Childbirth fear and efficacy were correlated with demographic characteristics using Chi-square testing. Result: Pre-intervention primigravida mothers’ delivery fear scores in the experimental and control groups. The experimental group contained 89 (59%) respondents with severe fear and 10 (7%) with low fear. 79 (53%) of the control group indicated high dread, whereas 8 (5% expressed low fear. Pre-interventional delivery efficacy scores for experimental and control primigravida moms. In the experimental group, 78 (52%) had average birthing efficacy, 63 (42%) with poor, and 9 (6% with good). Most of 72 (48%) control group members had low birth effectiveness scores, followed by 60 (40%) average and 18 (12%) good. Conclusion: This study shows that midwife-led psychoeducation reduces primigravida moms’ delivery fear and efficacy. Primigravida mothers’ labor efficacy and fear scores improve.
Pediatric shunt failure: finding predictability in the sea of uncertainty
Authors: Nadeem Mohammed , Jirankali Vishal , Singha Souvik , Tyagi Gaurav , Uppar Alok Mohan , Beniwal Manish , Konar Subhas Kanti , Birua Gyani Jail Singh , Thyagatura Lingaraju , Shukla Dhaval , Srinivas Dwarakanath
Published: December 2023

OBJECTIVE

Shunt malfunction is a complication that can have devastating implications. In this study, the authors aimed to evaluate the rate of shunt revision in a single institution over 5 years and to determine the factors associated with shunt revision in the pediatric population.

METHODS

This retrospective report assimilated data from all patients ≤ 18 years old who underwent shunt surgery between January 2015 and April 2021 at the authors’ institute with a minimum of 3 months of follow-up. Patient data regarding demographic characteristics, indications, clinical status, point of entry, operative and CSF findings, revision interval, and cause of failure were collected.

RESULTS

Between January 2015 and April 2021, 1112 pediatric patients underwent initial shunt surgery at the authors’ institute, among whom 934 patients met the inclusion criteria. Ninety-five patients underwent revision (shunt revision rate 10.2%). The cohort comprised 562 male and 368 female patients (no sex was recorded in 4 cases), with infratentorial tumors (37.8%) being the most common indication for the shunt. Multivariate analyses revealed that younger patient age, right-sided shunt, single surgeon, and shunt placement done in the evening and night were significantly associated with shunt failure. Among all the factors analyzed, female sex had the greatest risk of early shunt failure (OR 2.90 [95% CI 1.09–8.16], p = 0.037). The presence of prior external ventricular drainage was associated with an increased risk of multiple revisions (OR 6.67 [95% CI 1.60–32.52], p = 0.012). The most common cause of failure was obstruction, usually at the cranial end. The most common cause of distal failure was malposition of the abdominal end.

CONCLUSIONS

This study identifies various factors associated with shunt failure. Various goal-directed strategies toward modifiable risk factors can significantly improve shunt survival.
Subdural hematoma, retinal hemorrhage, and fracture triad as a clinical predictor for the diagnosis of child abuse
Authors: Mamaril-Davis James C. , Riordan Katherine , Sumdani Hasan , Bowlby Paul , Emami Neyestanak Maryam , Simpson Lauren , Avellino Anthony M. , Tang Andrew , Weinand Martin E.
Published: December 2023

OBJECTIVE

Nonaccidental trauma (NAT) is a major cause of traumatic death during infancy and early childhood. Several findings are known to raise the index of clinical suspicion: subdural hematoma (SDH), retinal hemorrhage (RH), fracture, and external trauma. Combinations of certain injury types, determined via statistical frequency associations, may assist clinical diagnostic tools when child abuse is suspected. The present study sought to assess the statistical validity of the clinical triad (SDH + RH + fracture) in the diagnosis of child abuse and by extension pediatric NAT.

METHODS

A retrospective review of The University of Arizona Trauma Database was performed. All patients were evaluated for the presence or absence of the components of the clinical triad according to specific International Classification of Diseases (ICD)–10 codes. Injury type combinations included some variation of SDH, RH, all fractures, noncranial fracture, and cranial fracture. Each injury type was then correlated with the ICD-10 codes for child abuse or injury comment keywords. Statistical analysis via contingency tables was then conducted for test characteristics such as sensitivity, specificity, positive predictive value, and negative predictive value.

RESULTS

There were 3149 patients younger than 18 years of age included in the quantitative analysis, all of whom had at least one component of the clinical triad. From these, 372 patients (11.8%) had a diagnosis of child abuse. When compared to a single diagnosis of either SDH, RH, all fractures, noncranial fracture, or cranial fracture, the clinical triad had a significantly greater correlation with the diagnosis of child abuse (100% of cases) (p < 0.0001). The dyad of SDH + RH also had a significantly greater correlation with a child abuse diagnosis compared to single diagnoses (88.9%) (p < 0.0001). The clinical triad of SDH + RH + fracture had a sensitivity of 88.8% (95% CI 87.6%–89.9%), specificity of 100% (95% CI 83.9%–100%), and positive predictive value of 100% (95% CI 99.9%–100%). The dyad of SDH + RH had a sensitivity of 89.1% (95% CI 87.9%–90.1%), specificity of 88.9% (95% CI 74.7%–95.6%), and positive predictive value of 99.9% (95% CI 99.6%–100%). All patients with the clinical triad were younger than 3 years of age.

CONCLUSIONS

When SDH, RH, and fracture were present together, child abuse and by extension pediatric NAT were highly likely to have occurred.
Same-day discharge after craniotomy for brain tumor resection: enhancing patient selection through a prognostic scoring system
Authors: Levy Adam S. , Merenzon Martin A. , Bhatia Shovan , Costello Meredith C. , Di Long , Lu Victor M. , Morell Alexis A. , Daggubati Lekhaj , Shah Ashish H. , Komotar Ricardo J. , Ivan Michael E.
Published: December 2023

OBJECTIVE

Neurosurgery, among other surgical fields, is amid a shift in patient management with enhanced recovery and same-day discharge (SDD) protocols slowly becoming more popular and feasible. While such protocols reduce the risk of nosocomial complications and improve patient satisfaction, appropriate patient selection remains an area of debate. The authors aimed to better quantify selection criteria through a prospective follow-up study of patients undergoing brain tumor resection with SDD.

METHODS

Three arms of analysis were carried out. First, clinical data of SDD patients were prospectively collected between August 2021 and August 2022. In parallel, a retrospective analysis of patients who qualified for SDD but were excluded at surgeon clinical discretion over the same period was performed. Third, a comparative analysis of the pilot and follow-up studies was done from which a clinical scoring system for patient selection was derived.

RESULTS

Over the duration of the study, 31 of 334 patients were selected for SDD while 59 qualified for SDD by previously defined criteria but were not selected at the surgeon’s discretion. There was no difference in outcomes between the two groups, and there were no postoperative complications among the SDD group within 30 days of surgery. Preoperative clinical characteristics found to be significantly different between the two cohorts (left-sided lesion, extra-axial pathology, prior treatment of brain tumor, and tumor volume ≤ 11.75 cm3) were included in a predictive scoring system for successful SDD. The scoring system was found to significantly predict high or low likelihood for successful SDD when tested on the mixed prospective cohort.

CONCLUSIONS

This study provides a straightforward clinical scoring system for appropriate selection of candidates for SDD after craniotomy for brain tumor resection. This clinical tool aims to aid clinicians in appropriate admission course selection and builds on the growing literature surrounding same-day and outpatient cranial neurosurgery.
The Enhanced Recovery After Surgery protocol for the perioperative management of pituitary neuroendocrine tumors/pituitary adenomas
Authors: Cossu Giulia , Belouaer Amani , Kloeckner Julie , Caliman Catalina , Agri Fabio , Daniel Roy Thomas , Gaudet John G. , Papadakis Georgios E. , Messerer Mahmoud
Published: December 2023

OBJECTIVE

Enhanced Recovery After Surgery (ERAS) is a multimodal perioperative care pathway that has radically modified the management of patients in multiple surgical specialties. Until now, no ERAS Society guidelines have been formulated for the management of cranial pathologies. During the process of ERAS certification for their neurosurgical department, the authors formulated an ERAS protocol for the perioperative care of patients with pituitary neuroendocrine tumors (PitNET), along with a compliance checklist to monitor the adherence to it and its feasibility. The authors describe the protocol and checklist and report the results, including a cost-minimization analysis, with the application of the ERAS philosophy.

METHODS

The steps that led to the development of this ERAS protocol, including items concerning the preoperative, intraoperative, and postoperative period, are detailed. The authors report their preliminary results through the comparison of the care practice of a historical cohort with a consecutive surgical cohort of patients with PitNET who underwent operation after the implementation of this ERAS protocol. A compliance checklist with key performance indicators was useful to monitor the adherence to the protocol and the changes in the perioperative management.

RESULTS

Following the introduction of this ERAS protocol, the authors significantly shortened the duration of the antibiotic therapy (p < 0.00001) and increased the use of mechanical (p < 0.00001) and pharmacological measures to prevent deep venous thrombosis (p = 0.002). The median length of hospital stay was significantly shorter for the ERAS group (p = 0.00014), and there was no increase in readmission rate or postoperative complications. The documentation and data tracking strongly improved in the ERAS cohort and the authors were more attentive in pain evaluation (p = 0.001), postoperative hormonal supplementation (p = 0.001) and early feeding and mobilization (p = 0.0008 and p < 0.00001, respectively). More patients were discharged on day 3 after surgery in the ERAS group (p < 0.00001). The compliance to the whole process increased from 64.2% to 89.5% (p = 0.016), and the compliance per patient was also found to have significantly increased (p < 0.00001).

CONCLUSIONS

The introduction of a standardized ERAS protocol for the perioperative management of patients with PitNET allowed the authors to improve the multidisciplinary management of these patients. With the application of simple cost-effective interventions and with the avoidance of unnecessary measures, gains were made in terms of early mobilization and feeding, thereby resulting in a shorter in-hospital stay.
The Enhanced Recovery After Surgery protocol for the surgical management of craniosynostosis: Lausanne experience
Authors: Belouaer Amani , Cossu Giulia , Al-Tayyari Soulayma , Bubenikova Adela , Caliman Catalina , Agri Fabio , Perez Maria-Helena , Chanez Vivianne , Boegli Yann , Mury Caroline , Daniel Roy Thomas , Messerer Mahmoud
Published: December 2023

OBJECTIVE

Over the past decade, the Enhanced Recovery After Surgery (ERAS) program has demonstrated its effectiveness and efficiency in improving postoperative care and enhancing recovery across various surgical fields. Preliminary results of ERAS protocol implementation in craniosynostosis surgery are presented.

METHODS

An ERAS protocol was developed and implemented for cranial pediatric neurosurgery, focusing on craniosynostosis repair. The study incorporated a pre-ERAS group consisting of a consecutive series of patients who underwent craniosynostosis repair surgery prior to the implementation of the ERAS protocol; the results were compared with a consecutive group of patients who had been prospectively collected since the introduction of the ERAS for craniosynostosis protocol. The safety, feasibility, and efficiency of the ERAS protocol in pediatric neurosurgery was evaluated, through the collection of clinical data from the pre-, intra-, and postoperative phase. Surgery-related complications were evaluated according to the Clavien-Dindo classification. Costs of the stays were obtained using a microcosting approach.

RESULTS

A total of 35 pre-ERAS patients and 10 ERAS patients were included. Scaphocephaly was the most common pathology in both groups. The overall compliance with the pre-, intra-, and postoperative criteria significantly increased—from 35.5%, 64.4%, and 54.7%, respectively, in each phase to 94%, 90%, and 84% (p < 0.001). The authors noticed a reduction in the average opioid dose used per patient in the ERAS group (p = 0.004), and they observed a trend toward a decreased mean length of stay from 5.2 days in the pre-ERAS group to 4.6 days in the ERAS group, without an increase of the rate of readmission within 30 days of surgery. The rate of complications decreased but this difference was not statistically significant. The hospital costs lowered significantly: from 21,958 Confederatio Helvetica Francs (CHF) in the pre-ERAS group to 18,936 CHF in the ERAS group (p = 0.02).

CONCLUSIONS

The ERAS protocol represents a safe and cost-effective tool for the perioperative management of craniosynostosis. It showed its positive impact on the analgesia provided and on the reduction of in-hospital costs for these patients. ERAS protocols may thus be interesting options in the pediatric neurosurgical field.
Long-term tumor control in Koos grade IV vestibular schwannomas without the need for gross-total resection
Authors: Roethlisberger Michel , Moffa Giusi , Rychen Jonathan , Saemann Attill , Straumann Sven , Taub Ethan , Zumofen Daniel W. , Neddersen Heike , Westermann Birgit , Bodmer Daniel , Mariani Luigi
Published: December 2023

OBJECTIVE

The modern management of patients with Koos grade IV vestibular schwannomas (VSs) aims at functional preservation and long-term tumor control. Gross-total resection (GTR) leads to optimal tumor control but frequently also results in permanent facial nerve (FN) palsy. Subtotal resection (STR) or near-total resection (NTR) followed by a wait-and-scan protocol and second-line radiation therapy (RT) in case of progressive residuals yields excellent tumor control rates with less permanent morbidity.

METHODS

The authors present the results of their prospective cohort of Koos grade IV VS patients who underwent less-than-total resection followed by a wait-and-scan protocol between January 2009 and December 2019 and discuss the latest evidence on this controversial subject. The cohort was followed up with annual clinical and volumetric outcome analyses after standardized MRI.

RESULTS

Forty-eight patients were included in the analysis. The mean extent of resection was 87% (median 91%, range 45%–100%), best fitting into the definition of STR rather than NTR. In 2 cases, the proximal portion of the FN at the brainstem could not be reliably identified and monitored during the initial operation, and a second-stage resection was necessary. At 4.4 years after surgery, 81% (39/48) of the tumor residuals regressed or were stable in size. The percentage of regressive tumor residuals increased over time. Nineteen percent (9/48) of the tumor residuals displayed volumetric progression within a mean time of 35 months (median 36 months, range 14–72 months), resulting in a Kaplan-Meier estimate for progression-free survival of 79% after 4 years; higher postoperative volume showed a linear correlation with higher volumetric progression (factor 1.96, 95% CI 1.67–2.30; p < 0.001). Thirty-four of the 48 (71%) patients continue to undergo a wait-and-scan protocol. Second-line RT was performed in 14 patients (29%) within a mean time of 25 months (median 23 months, range 5–54 months), 12 (86%) of whom responded with post-RT pseudoprogression, resulting in an overall tumor control rate of 96%. At the 4.4-year follow-up from the initial resection, 92% of the patients had a good facial outcome (House-Brackmann [HB] grade I or II), 6% had a fair facial outcome (HB grade III), and 2% had a poor facial outcome (HB grades IV–VI). So far, there has been no need for salvage surgery after RT.

CONCLUSIONS

STR followed by observation and second-line RT in cases of progression leads to good facial outcome and an excellent tumor control rate in the longer term.
Management and outcomes of pediatric traumatic brain injury in Africa: a systematic review
Authors: Gupta Nithin , Kasula Varun , Waguia Kouam Romaric , Seas Andreas , Esene Ignatius , Malomo Adefolarin O. , Shokunbi Matthew T. , Haglund Michael M. , Fuller Anthony T. , Ukachukwu Alvan-Emeka K.
Published: December 2023

OBJECTIVE

Traumatic brain injury (TBI) carries a major global burden of disease; however, it is well established that patients in low- and middle-income countries, such as those in Africa, have higher mortality rates. Pediatric TBI, specifically, is a documented cause for concern as injuries to the developing brain have been shown to lead to cognitive, psychosocial, and motor problems in adulthood. The purpose of this study was to investigate the reported demographics, causes, management, and outcomes of pediatric TBI in Africa.

METHODS

A literature search was conducted using PubMed, Global Index Medicus, Embase, Scopus, Google Scholar, African Journals Online, and Web of Science. Various combinations of "traumatic brain injury," "head injury," "p(a)ediatric," "Africa," and country names were used. Relevant primary data published in the English language were included and subjected to a risk of bias analysis. Variables included age, sex, TBI severity, TBI cause, imaging findings, treatment, complications, and outcome.

RESULTS

After screening, 45 articles comprising 11,635 patients were included. The mean patient age was 6.48 ± 2.13 years, and 66.3% of patients were male. Of patients with reported data, mild, moderate, and severe TBIs were reported in 57.6%, 14.5%, and 27.9% of patients, respectively. Road traffic accidents were the most reported cause of pediatric TBI (50.53%) followed by falls (25.18%). Skull fractures and intracerebral contusions were the most reported imaging findings (28.32% and 16.77%, respectively). The most reported symptoms included loss of consciousness (24.4%) and motor deficits (17.1%). Surgical management was reported in 28.66% of patients, with craniotomy being the most commonly reported procedure (15.04%). Good recovery (Glasgow Outcome Scale score 5, Glasgow Outcome Scale–Extended score 7–8) was reported in 47.17% of patients. Examination of the period post-2015 demonstrated increased spread in the literature regarding pediatric TBI in Africa.

CONCLUSIONS

This study provides a comprehensive overview of the literature regarding pediatric TBI in Africa and how it has evolved alongside global neurosurgical efforts. Although there has been increased involvement from various African countries in the neurosurgical literature, there remains a relative paucity of data on this subject. Standardized reporting protocols for patient care may aid in future studies seeking to synthesize data. Finally, further studies should seek to correlate the trends seen in this study, with primary epidemiological data to gain deeper insight into the disease burden of pediatric TBI in Africa.
Sarcopenia in paraspinal muscle as a risk factor of proximal junctional kyphosis and proximal junctional failure after adult spinal deformity surgery
Authors: Park Jin Seong , Cho Kyu Jung , Kim Jeong Seok , Park Sung Jun , Baek Hyeon
Published: December 2023

OBJECTIVE

The aim of this study was to identify the risk factors for proximal junctional kyphosis (PJK) and proximal junctional failure (PJF), including paraspinal muscle atrophy.

METHODS

Fifty-seven consecutive patients who underwent a long-instrumented fusion for adult spinal deformity (ASD) with a minimum follow-up of 2 years were included in the study. Patient, surgical, and radiological factors were evaluated. Muscle volume was measured using the muscle/vertebra ratio of the multifidus, erector spinae (ES), and psoas muscles, and muscle function was evaluated using the degree of fat infiltration at the L4–5 level.

RESULTS

The study included 57 consecutive patients: 25 patients in the combined PJK/PJF group (13 with PJK and 12 with PJF) and 32 in the control group (without PJK or PJF). The mean time to onset of PJK and PJF was 15.7 and 1.7 months, respectively. Multivariate analysis showed that greater pre- and postoperative sagittal vertical axis was associated with the occurrence of PJK/PJF. ES muscle atrophy was more significant in the PJK/PJF group than in the control group, and more severe in the PJF than in the PJK group.

CONCLUSIONS

This study showed that PJF occurred much earlier than PJK after ASD surgery. Paraspinal muscle atrophy was identified as a significant risk factor for PJK and PJF, especially PJF. The possibility of PJK and PJF development should be considered when long-segment fusion is planned for patients with paraspinal muscle atrophy.
Ocular Trauma among Patients Visiting the Outpatient Department of Ophthalmology in a Tertiary Care Centre
Authors: Basnet Anjila , Dhakal Grish , Ghising Kiran , Pathak Samyam Bickram , Shrestha Trishna
Published: December 2023

Introduction: Ocular trauma is an important cause of blindness and ocular morbidity worldwide. Knowledge of the cause of eye injuries can guide preventive strategies and optimize management capacity. The aim of the study was to find out the prevalence of ocular trauma among patients visiting the outpatient Department of Ophthalmology in a tertiary care centre.
Methods: A descriptive cross-sectional study was conducted among patients with ocular trauma from 10 January 2023 to 5 July 2023 after obtaining ethical approval from the Institutional Review Committee. A convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval.
Results: Among 4,959 patients, 107 (2.16%) (1.76-2.56, 95% Confidence Interval) had ocular trauma. Among them, 24 (22.43%) had occular trauma due to fall injuries. Ocular trauma was observed in 82 (76.64%) males and the common agent was blunt objects seen in 56 (52.34%).
Conclusions: The prevalence of ocular trauma among patients was lower than in other studies done in similar settings.
Good Quality of Life among People Living with Diabetes Mellitus Visiting the Outpatient Department of Endocrinology in a Tertiary Care Centre
Authors: Aryal Sumitra , Bhandari Roshan , Paudel Sabina , Khadka Radhika , Adhikari Sita , Kaphle Maheshor
Published: December 2023

Introduction: Assessing the quality of life of individuals living with diabetes is crucial for ensuring optimal care and effective management of complications related to their condition. Diabetes is one of the leading causes of preventable mortality and morbidity among non-communicable diseases. The study aims to find out the prevalence of the good quality of life of people living with Diabetes mellitus visiting a tertiary care centre.
Methods: A descriptive cross-sectional study was conducted among type 2 diabetic patients visiting the Outpatient Department of Endocrinology in a tertiary care centre from 30 June 2022 to 20 July 2022. Ethical approval was obtained from the Institutional Review Committee. A systematic random sampling technique was used. D-39 questionnaires were administered via face-to-face interviews. Point estimate was calculated at 95% Confidence Interval.
Results: Among 118 patients living with diabetes, good quality of life was seen in 97 (82.20%) (75.30-89.10, 95% Confidence Interval). This study found that the energy and mobility domain has the highest mean score of 26.7±7.8.
Conclusions: The prevalence of good quality life of people living with Diabetes mellitus was found to be higher than other similar studies done in similar settings.
Herlyn-Werner-Wunderlich Syndrome: A Case Report
Authors: Lamichhane Deepak , Sutihar Anshu , Janakyraman Gubeanthrey , Jaz Shrestha Rudish , Rahman Razeeb Mahbubur
Published: December 2023

Herlyn-Werner-Wunderlich syndrome is a rare congenital malformation of the Mullerian ducts characterized by uterine didelphys with obstructed hemivagina and ipsilateral renal agenesis. Commonly, such patients present with pelvic pain, dysmenorrhea following menarche, and an abdominal mass secondary to hematometrocolpos. In this report, a case of a 14-year-old female presented with abdominal pain, back pain and acute urinary retention. She attained menarche at the age of 10 years; however, symptoms of dysmenorrhea only appeared 4 years later. She was eventually diagnosed with the help of ultrasound and computed tomography urogram. She was managed conservatively with an incision and drainage procedure and was also advised for resection of vaginal septum. The nonspecific nature of symptoms such as regular menstruation with cyclical abdominal pain impedes the diagnosis which can lead to an array of complications. Awareness of this syndrome can help avoid misdiagnosis and allow for early surgical intervention.
An overview of Maritime English teaching and its principles, with a focus on practical applications and best practices online
Authors: Yurzhenko Alona , Diahyleva Olena , Kononova Olena
Published: December 2023

The paper is devoted to using innovative technologies in the professional training of future ship engineers. It highlights the need for tutors to make lessons interesting and exciting and to create a situation where every cadet can be active. The research emphasises that the main target of maritime education today is not just to accumulate knowledge and skills but to prepare cadets as independent subjects of educational activity who can learn and upgrade their knowledge. The article describes the benefits of digital technologies for online maritime education and training, including various videoconference services. It also discusses the psychological theory of learning based on the psychology of human relationships, which is crucial to interactive learning technologies. The paper concludes by describing various technologies for information visualisation, such as cloud technologies and gamification, and recommends tools like Mentimeter, Aha Slides, and Poll Everywhere for collaborative work and knowledge exchange. The research also suggests that using whiteboard resources during Maritime English lessons can serve cadets as a visual platform for displaying essential Maritime English vocabulary, supporting interactive discussions, conducting simulated exercises and role-playing scenarios.
Kindergarten in the Digital Era: Developing Engaging Android-Based Educational Tools for Letters and Numbers
Authors: Hapsari Estuning Dewi , Kurniawati Inung Diah , Setiawan Kodrat Eko Putro , Mahendra Muhammad Isya Noor
Published: December 2023

Technological developments have had a huge impact on the world of education. One of them is learning media. The development of computer technology has been able to display information in various forms including multimedia. Learning media is very important in helping students understand the material provided. With the development of learning media it is hoped that kindergarten children can easily understand letters and numbers. The purpose of this research is to develop interactive learning media to recognize letters and numbers based on Android for Kindergarten. This research was conducted at Cahaya Wonoasri Kindergarten Madiun. This research is development research with ADDIE model. Data collection techniques used in the form of observation interviews and questionnaires. Questionnaires are used to collect expert validation data. The results of the development of this learning media are in the form of applications that can be run on Android cellphones. Learning media is made in such a way that it is attractive to children. The results of the study showed that the results of the validity test of the content expert on learning media received good qualifications. The findings from the results of the validity test of the learning design expert got a good qualification. While the results of the validity test of learning media experts obtained very good qualifications and the results of individual trials received good qualifications
Evaluating the Effectiveness of Poster & Picture Card Media in Teaching the Water Cycle to Elementary Students
Authors: Nikmah Fitria Surya
Published: December 2023

This study explores the validity, practicality, and effectiveness of Postcard learning media in the classroom. Employing a Research and Development approach, the study utilized the ADDIE model, encompassing Analysis, Design, Development, Implementation, and Evaluation stages. The research was conducted with 17 fifth-grade students at SDN 1 Watudandang. The study involved quantitative analysis to assess the Postcard learning method's implementation, employing a variety of data collection techniques. These included validity questionnaires from media and material experts, teacher and student response questionnaires, and pretest-posttest scores. Validity testing revealed that the Postcard learning media were rated as "very valid" by experts, with scores of 91% from material experts and 84% from media experts. Practicality assessment, based on teacher and student response questionnaires, yielded scores of 91% and 88% respectively, placing it in the "very practical" category. The effectiveness of the media was demonstrated through significant differences in student learning outcomes, as evidenced by pretest and posttest scores. The Paired Samples T Test indicated a t-count greater than the t-table, with a significance value of 0.000. Furthermore, the N-Gain score of 0.75 fell into the "high" category, suggesting that the media were "effective enough". In conclusion, the Postcard learning media proved to be both valid and practical, and sufficiently effective for educational use in teaching fifth graders, notably in enhancing their understanding of the subject matter.
Design of Crop Irrigation Decision-Making System Based on ZigBee Technology
Authors: Sheng Qiang , Li Xinyu , Han Yuxiao , Li Han , Zhang Man
Published: December 2023

Abstract: To promote the high-quality development of agriculture, meet the needs of agricultural products grown in greenhouses, and achieve precise monitoring of greenhouse plants, a small greenhouse micro-environment multi-parameter monitoring system was designed and implemented. The system consists of three parts: a monitoring node, a gateway node, and a remote management platform. The monitoring node used the ESP32 microcontroller as the main control chip, combined ZigBee technology, and embedded different sensors to complete the collection and transmission of environmental parameters. In the gateway node, the 4G Data Transfer Unit module was used as the carrier, and the communication protocol was used to realize data communication between the monitoring terminal and the gateway. The remote management platform was based on the PyCharm development platform. It used the PyQt5 graphical user interface (GUI) toolkit to complete the design of the host computer monitoring platform, establish a database, and realize the storage and analysis of environmental parameters. The remote management platform embedded the crop reference evapotranspiration, online calculation model, to provide irrigation decisions for greenhouse crop management and improve the applicability and accuracy of irrigation decisions. After the experimental test platform was built to test the system communication distance, communication reliability, control reliability, and data reliability, the small greenhouse micro-environment multi-parameter monitoring system designed in this paper can operate stably for a long time. Its functions meet the expected requirements and are in line with modern requirements for multi-parameter monitoring of smart greenhouses.