bluuebunny/crossref_metadata_2025 huggingface dataset:
Colonoscopy-related injury among colonoscopists: an international survey
Authors: Al-Rifaie Ammar , Gariballa Mohammed , Ghodeif Alhassan , Hodge Stephen , Thoufeeq Mo , Donnelly Mark
Published: January 2021

Background and study aims Colonoscopy is physically demanding for endoscopists and patients. Repetitive movements during colonoscopy can lead to overuse injuries. We aimed to explore the prevalence and range of colonoscopy-related musculoskeletal injuries (CRIs) in endoscopists.

Methods A cross-sectional electronic survey of 1825 endoscopists was performed. The sample was composed of members of the British Society of Gastroenterology, European Society of Gastrointestinal Endoscopy, and National Nurse Endoscopy Group (UK). The survey comprised 20 questions. These included: endoscopists’ workload, level of experience, and their perceived CRIs. All endoscopists who perform colonoscopy independently were included in the analysis.

Results A total of 368 questionnaires were completed of 1825 surveyed (20.16 %). Of those, 319 participants (17.48 %) were fully independent in colonoscopy. Of 319 endoscopists, 254 (79.6 %) have experienced musculoskeletal injuries. These were reported as either possibly (n = 143, 56.3 %) or definitely (n = 90, 35.4 %) related to colonoscopy. Commonly injured areas were the lower back (n = 85, 36.5 %), neck (n = 82, 35.2 %) and left thumb (n = 79, 33.9 %). Of the injured endoscopists, 98 (30.7 %) made some modification to their practice, such as stretching exercises and ergonomic changes. Of the endoscopists, 134 (42.0 %) thought that repetitive limb strain was a likely causative mechanism. Around 40 % believed that torquing the scope and challenging body position were precipitating CRIs. Several treatment modalities were used to treat CRIs. These included; physiotherapy (n = 109), medications (n = 70), rest (n = 43), splinting (n = 31), steroid injections (n = 26) and surgery (n = 11).

Conclusions A significant proportion of colonoscopists experience CRIs. The majority of the suggested modifications to practice can be adopted by any endoscopist. These results highlight the need to recognise CRI as an important occupational health hazard and to adopt preventative strategies routinely in the future.
Clinical Relevance of Isolated Lupus Anticoagulant Positivity in Patients with Thrombotic Antiphospholipid Syndrome
Authors: Yin Dongmei , de Groot Philip G. , Ninivaggi Marisa , Devreese Katrien M. J. , de Laat Bas
Published: January 2021

Background Patients positive for all three types of antiphospholipid antibodies (aPLs; triple positivity) have been identified for having a high risk for thrombotic events. However, the clinical significance of isolated lupus anticoagulant (LAC) positivity is debated.

Objectives To investigate the clinical relevance of isolated LAC.

Methods A total of 456 patients were enrolled in this study; 66 antiphospholipid syndrome patients and 390 control patients. The control group consisted of autoimmune patients (n = 91), patients with thrombosis but without aPLs (n = 127), and normal controls (n = 172). LAC, anticardiolipin (anti-CL), and anti-β2 glycoprotein I (anti-β2GPI) immunoglobulin G (IgG) and immunoglobulin M (IgM) were determined according to the International Society on Thrombosis and Haemostasis (ISTH) guidelines. Anti-CL and anti-β2GPI were measured by four different solid-phase platforms to overcome variability between test systems. The noncriteria IgA anti-CL and anti-β2GPI, antidomain I of β2GPI IgG, and antiphosphatidylserine/prothrombin antibodies (anti-PS/PT) IgG and IgM were detected according to the ISTH guidelines for solid-phase assays.

Results In total, 70 patients were positive for LAC, of which 44 were negative for both anti-β2GPI and anti-CL antibodies. We found that isolated LAC proved to be strongly associated with vascular thrombosis (odds ratio [OR]: 7.3; 95% confidence interval [CI]: 3.3–16.1), even better than triple-positive samples (OR: 4.3; 95% CI: 1.6–12.2). The titers of the anti-PS/PT IgG and IgM were significantly higher in triple-positivity samples compared with samples with isolated LAC positivity. The majority of single LAC positives were anti-PS/PT-negative. We observed that LAC positivity was weaker in isolated LAC-positive patients compared with LAC activity in triple-positive patients.

Conclusion Isolated LAC was highly associated with thrombosis. The presence of anti-PS/PT antibodies could not explain LAC positivity in isolated LAC. Isolated LAC showed a weaker LAC activity compared with triple-positive patients.
Gain-of-Function Variant p.Pro2555Arg of von Willebrand Factor Increases Aggregate Size through Altering Stem Dynamics
Authors: Huck Volker , Chen Po-Chia , Xu Emma-Ruoqi , Tischer Alexander , Klemm Ulrike , Aponte-Santamaría Camilo , Mess Christian , Obser Tobias , Kutzki Fabian , König Gesa , Denis Cécile V. , Gräter Frauke , Wilmanns Matthias , Auton Matthew , Schneider Stefan W. , Schneppenheim Reinhard , Hennig Janosch , Brehm Maria A.
Published: January 2021

The multimeric plasma glycoprotein (GP) von Willebrand factor (VWF) is best known for recruiting platelets to sites of injury during primary hemostasis. Generally, mutations in the VWF gene lead to loss of hemostatic activity and thus the bleeding disorder von Willebrand disease. By employing cone and platelet aggregometry and microfluidic assays, we uncovered a platelet GPIIb/IIIa-dependent prothrombotic gain of function (GOF) for variant p.Pro2555Arg, located in the C4 domain, leading to an increase in platelet aggregate size. We performed complementary biophysical and structural investigations using circular dichroism spectra, small-angle X-ray scattering, nuclear magnetic resonance spectroscopy, molecular dynamics simulations on the single C4 domain, and dimeric wild-type and p.Pro2555Arg constructs. C4-p.Pro2555Arg retained the overall structural conformation with minor populations of alternative conformations exhibiting increased hinge flexibility and slow conformational exchange. The dimeric protein becomes disordered and more flexible. Our data suggest that the GOF does not affect the binding affinity of the C4 domain for GPIIb/IIIa. Instead, the increased VWF dimer flexibility enhances temporal accessibility of platelet-binding sites. Using an interdisciplinary approach, we revealed that p.Pro2555Arg is the first VWF variant, which increases platelet aggregate size and shows a shear-dependent function of the VWF stem region, which can become hyperactive through mutations. Prothrombotic GOF variants of VWF are a novel concept of a VWF-associated pathomechanism of thromboembolic events, which is of general interest to vascular health but not yet considered in diagnostics. Thus, awareness should be raised for the risk they pose. Furthermore, our data implicate the C4 domain as a novel antithrombotic drug target.
Medication Adherence and Its Determinants among Women of Cardiovascular Disease of Tertiary Care Hospital, Hyderabad
Authors: Arnipalli Haritha , Bala Sudha , Pandve Harshal
Published: January 2021

Background and Aim Adherence to long-term therapy for chronic illnesses in developed countries averages to 50%. In developing countries, the rates are even lower. Poor adherence to long-term therapies severely compromises the effectiveness of treatment making this a critical issue in population health both from the perspective of quality of life and of health economics. Cardiovascular diseases (CVDs) are the most common disorders affecting most of the productive age group. Therefore, an attempt has been made to determine medication adherence using the Morisky medication adherence scale-4 (MMAS-4) and its determinants in women patients with CVD.

Material and Methods A Hospital based cross-sectional study was conducted at outpatient block of General Medicine and Cardiology departments which included 175 women patients who were already diagnosed with CVD (with at least 3 months of medication) and those who were willing to give informed consent for participation. Semi structured questionnaire was used which consisted of sociodemographic variables, MMAS-4 to measure the level of adherence and various determinants such as socioeconomic, patient related, condition related, therapy related, and health system related.

Results Prevalence of medication adherence among women of CVDs using MMAS-4 was high, medium, and low among 39, 51, and 10%, respectively. Significant determinants found were socioeconomic, patient related, health system, and therapy related.

Conclusion Low-to-medium medication adherence was found to be high which needs to be addressed to reduce the morbidity and mortality associated with CVDs.
A Comparative In Vivo and In Vitro Study on the Effectiveness of Homoeopathic Medicines on Aquarium Zebrafish Infected with Vibrio parahaemolyticus
Authors: Aiswarya A.S. , Reshmy K.R. , Chandraja C.V. , Sisir P.R.
Published: January 2021

Background Human infections associated with Vibrio parahaemolyticus rank high among the pathogenic bacteria associated with fishes which causes septicaemia and gastroenteritis in humans. Humans acquire such infections by handling of infected fishes. Therefore, rather than curing the diseases in humans, it can be prevented in fishes by homoeopathic medicines.

Objectives The main objective of the study is to show the effectiveness of homoeopathic medicines in curing aquarium zebrafish infected with Vibrio parahaemolyticus.

Materials and Methods Fifteen pairs of healthy aquarium zebrafish were chosen for the study. They were inoculated with Vibrio parahaemolyticus after the acclimatisation period of 1 month. The signs were noted down in chronological order. homoeopathic medicines Sulphur 200, Arsenicum album 200 and Pyrogenium 200 was administered based on the totality obtained. An in vitro study was also done by the serial dilution of water from each tank and also by the serial dilution of the fish gut which was plated in thiosulphate-citrate-bile salts-sucrose (TCBS) agar media. A growth sensitivity study to show the growth inhibition was done on Muller Hinton agar media.

Results Although the incubation period of vibriosis was 4 days, the condition was completely cured within 10 days of administration of homoeopathic medicines. But in the case of tetracycline, the signs disappeared after 15 days. Sulphur being deep acting remedy showed cure in fishes as well as in the water. Arsenicum album showed therapeutic as well as prophylactic characters.

Conclusion From the study, it is proved that the Sulphur 200 was the most effective remedy. Homoeopathic medicines do not produce any resistant bacteria but improves the immunity of the living organism. Sulphur, the deep acting remedy ensures 100% cure, i.e., both the water and the fishes are cured of Vibrio parahaemolyticus.
Suboccipital Retrocondylar Approach for an Anterolateral Foramen Magnum Meningioma
Authors: Balașa Adrian , Gyorki Gabriel , Tamas Flaviu , Hurghis Corina , Chinezu Rares
Published: January 2021

Objectives This study was to demonstrate surgical technique for an anterolateral foramen magnum meningioma.

Design Present study is presented through an operative video.

Setting This study is conducted at the Department of Neurosurgery, Tîrgu Mureș, Romania.

Participants A 62-year-old female is the participant who was diagnosed with a foramen magnum meningioma.

Main Outcome Measures Complete surgical resection of the tumor with no postoperative deficits or complications.

Results A 62 years-old female was admitted for left hemilingual atrophia, dysphonia, right hemiparesis grade 2 of 5, right hemihypesthesia, and cervical pain. The magnetic resonance imaging (MRI) showed a right foramen magnum meningioma, sized approximately 2 cm in all planes (Fig. 1). This was classified with the Bernard system as an intradural foramen magnum meningioma with anterolateral insertion to the dura mater and below the vertebral artery. A suboccipital, retrocondylar, and c1 right hemilaminectomy approach was performed. Using microsurgical tumoral decompression techniques, ultrasonic aspiration, and following the natural cleavage planes, complete tumor removal was achieved (Fig. 2). The patient presented an uneventful postoperative course with no postoperative new neurological deficits and was discharged at home 7 days following surgery. Control MRI at 6 months (Fig. 1) and 2 years showed no tumor residue or recurrence. Neurologic status at 6 months was excellent, showing complete remission of symptoms.

Conclusion Retrocondylar suboccipital approach is a safe and feasible option for anterolateral foramen magnum meningiomas provided that natural corridors and dynamic retraction are used.

The link to the video can be found at: https://youtu.be/jpxMcjCpN6E.
Ozonum—The Global Impact
Authors: Gajdos Petr Simeon
Published: January 2021

The remedy Ozonum has become the highest-ranking prescription in my practice during the coronavirus pandemic. Respiratory tract illnesses represent a smaller percentage of cases that have responded well to the remedy. Most cases I have seen were predominantly affected by the indirect impact of the pandemic. I have noticed a similar increase in Ozonum prescriptions following former global events, for example, the terrorist attack on the Twin Towers on 11th September 2001 in New York, the 2004 Indian Ocean earthquake and tsunami, the 2010 eruption of Iceland's Eyjafjallajökull volcano which paralysed flights across Europe and the severe 2017 to 2018 flu season. Ozone is a gas, called 'activated oxygen', formed by three atoms of oxygen instead of the two that we normally breathe. We are familiar with the protective function of the ozone layer in the atmosphere. The life cycle of ozone and its connection to ocean and marine life, to trees, habitat, and life in general, is less commonly known. A dynamic constellation of the homeopathic remedy becomes clear once we understand the ozone life cycle and its ecosystem in its natural and disrupted form. Ozonum—the homeopathic remedy—was used by our forefathers but has almost been forgotten until Anne Schadde's proving in nineties of the last century. Ozonum as a remedy has a wide range of applications such as pandemics, mass casualties and disasters, as well as routine clinical uses. Within different levels of context, the main feeling of Ozonum dynamic is exemplified by the statement—'I can't breathe!' It may be considered a 'polychrest' of our time evidently resonating with contemporary climatic, medical, socio-political and economic global challenges. We need to adopt a global view to keep up with the times and perceive a link between individual and global health in a broader perspective.
Study of 20 Cases of Otitis Media Successfully Treated with Homoeopathic Medicines—A Case Series
Authors: Sharma Pawan , Aggarwal Tanya , Kar Shubhadeep
Published: January 2021

Background Otitis is a general term for inflammation or infection of the ear. Otitis media is the presence of inflammation or infection in the middle ear. Homoeopathy is the most popular treatment among the complementary and alternative medicine therapies sought for otitis media. Several studies revealed promising role of homoeopathic treatment in otitis media. The present study comprises the role of homoeopathic medicines in the treatment of 20 cases of otitis media.

Materials and Methods It is a case series of 20 cases of otitis media which is unicentric retrospective observational study. Data was collected after consecutive appointments of patients visiting one outpatient clinic of Regional Research Institute for Homoeopathy, Guwahati, during the 12 months, January 2019 to January 2020. Individualised homoeopathic medicines were administered according to the rules of homoeopathy. In this study, outcome related to impact on daily living scale was used to assess the patient's well-being. The outcome score recorded at the last follow-up appointment per case was thus the single value analysed.

Result Among the patients (n = 20) included in the study, the number of patients belonging to female category was 10, (50%) while 10 patients (50%) were male, with a ratio of 1:1. Several medicines (n = 8) were prescribed and administered as follows: Belladonna (n = 1, 5%), Chamomilla (n = 1, 5%), Kali muriaticum (n = 2, 10%), Kali sulphuricum (n = 4, 20%), Mercurius dulcis (n = 2, 10%), Mercurius solubilis (n = 7, 35%), Pulsatilla (n = 2, 10%), Silicea (n = 1, 5%). No patient required antibiotics. Out of 20 cases, only four patients needed second prescription. Change of prescription was done in only one case among them. Higher potency was administered for the other three cases. 16 patients followed-up and 4 patients were dropped out after first prescription. Of these 16 follow-ups, there was a positive outcome in 12 (60%), negative in 2 (10%) and no change in 2 (10%) patients. In our study, outcome did not depend on the age but on medicine. Correctly chosen remedy with strict homoeopathic principle shows maximum improvement. When duration of illness was analysed, it was found that cases with complaints of short duration improve early, whereas cases with long duration of illness took much time to recover or remained status quo.

Conclusion The study reflected the importance of homoeopathic prescribing in the treatment of otitis following strict homoeopathic principles.
Entrapment of the Greater Occipital Nerve with Chronic Migraine and Severe Facial Pain: A Case Report
Authors: Son Byung-chul
Published: January 2021

Migraine is thought to be a primary neurovascular headache due to brain dysfunction and is known to involve peripheral and central sensitization. A female patient with chronic migraine symptoms for 30 years reported severe pain in the deep ear and face. This headache always showed the same pattern and temporal progression. The sudden onset of ache and throbbing pain in the right temporo-occipital area extended to the left temporo-occipital areas. She felt sick as if the head would burst, and nausea and vomiting occurred. During the last 3 years, the patient endured sharp pain in bilateral deep ears and severe pain in the face as if all the facial bones were broken, and tears flowed. Chronic disabling headache and facial pain improved with the decompression of the greater occipital nerve. This case suggests that peripheral sensitization may be related to the pathophysiology of migraine, especially in the migraine without aura.
ACDF plus Uncovertebrectomy versus ACDF alone for the Treatment of Cervical Spondylotic Radiculopathy: Minimum 5-Year Follow-Up
Authors: Cui Yaqing , Zhou Yongchun , Liu Jun , Duan Dapeng , Gong Liqun , Li Weiwei
Published: January 2021

Objective The surgical approach for cervical spondylotic radiculopathy (CSR) is controversial. This study aims to investigate the effectiveness of the combined anterior cervical diskectomy and fusion (ACDF) and uncovertebrectomy for treatment of CSR.

Methods This is a retrospective case control study. One hundred and forty-six patients with CSR who underwent two different procedures (ACDF alone [group A]) and a combination of ACDF and uncovertebrectomy [group B]) from March 2008 to April 2013 were included. The operation time, blood loss, Visual Analog Scale scores of the neck (VAS-neck) and arm (VAS-arm), Neck Disability Index (NDI) score, 36-Item Short Form Health Survey (SF-36) score, fusion segment curvature, global cervical curvature, and the rate of surgical complication were evaluated.

Results There were no significant differences in the basic demographic and clinical characteristics between the two groups (p > 0.05). No significant differences were noticed in the fusion segment curvature and global cervical curvature between the two groups (p > 0.05). Whereas the operation time and blood loss in group B were greater than those in group A (p < 0.05), the VAS-neck, VAS-arm, NDI, and SF-36 scores were better in group B (p < 0.05). The surgical complication rate between the two groups was not significantly different (p > 0.05).

Conclusions Clinical efficacy of ACDF plus uncovertebrectomy for the treatment of patients with CSR may be better than that of ACDF alone, but at the expense of more operation time and blood loss.
Accuracy of Intraoperative Computed Tomography Assisted Dorsal Instrumentation in Spinal Revision Surgery
Authors: Bertram Ulf , Clusmann Hans , Geiger Matthias Florian , Riabikin Alexander , Mueller Christian-Andreas , Blume Christian
Published: January 2021

Purpose Instrumentation in spinal revision surgery is considered challenging. Altered or missing anatomical landmarks hinder the surgeons' intraoperative orientation. In recent history, the importance of navigated approaches to spinal screw placement is constantly increasing. A growing number of medical centers have introduced intraoperative CT (iCT) navigation as a new clinical standard. In this study, we compare the accuracy of dorsal iCT-navigated instrumentation in revision surgery versus primary interventions.

Methods Between September 2017 and January 2019, we prospectively analyzed a consecutive series of dorsal instrumentation using iCT. Patients with previous operative interventions in the relevant spinal segments were included in the revision group and compared with a previously assessed group of primary interventions (nonrevision group). Each screw was assessed individually by an independent observer, making use of a modified Gertzbein and Robbins classification.

Results In this period, 39 patients were treated in the revision group with a total amount of 269 implanted screws. We achieved an overall accuracy of 95.91% compared with 95.12% in the nonrevision group (46 patients, 287 screws). We found no significant difference in accuracy between the two groups or any anatomical region of the spine.

Conclusion In summary, iCT-navigated screw placement yields a good accuracy in spinal revision surgery, without significant difference to primary interventions.
Perception and Practices of Colonoscopy Procedure: A Nationwide Survey of Indian Gastroenterologists
Authors: Jha Jitendra Mohan , Babu Sethu
Published: January 2021

Introduction There is a lack of data and consensus about the practices and policies regarding performing colonoscopy in India. We surveyed gastroenterologists to assess their practices and policies of performing colonoscopy.

Methodology A questionnaire was presented to gastroenterologists all over India regarding their preference of bowel preparation and method of sedation, completeness of cecal and ileal intubation rates, preferences for inflation, use of carbon dioxide and nitrous oxide, and complications faced.

Results Of the 350 surveys, 307 had completely responded (88%). Only 18% of the centers were conducting more than 100 colonoscopies a month and 46% denied following a colon cancer screening policy. Two bottles of liquid polyethylene glycol were the most preferred preparation. A total of 21% did not prefer any sedation at all. Nitrous oxide was used by only 5.6% of doctors. Ileal intubation rate was >96% in 34% of centers and cecal intubation rate >96% in 58% of centers. Air was used for inflation by 58%, while 39% used CO2. A total of 40% of the respondents believe CO2 inflation would improve cecal intubation rate, while 9.4% believed otherwise. While one third found CO2 inflation unnecessary and 14% not cost-effective, three fourths were still interested in setting up a CO2 facility. Reasons for not using nitrous oxide were practical/administrative difficulty (46.6%), side effects (20%), and cost (16%). Still more than half surveyed would consider using Entonox in future. Perforation was the most noted complication faced by respondents.

Conclusions This survey of real-world clinical practices will help to formulate practice guideline regarding colonoscopy in India.
Pilot Implementation of Clinical Genomic Data into the Native Electronic Health Record: Challenges of Scalability
Authors: Walton Nephi A. , Johnson Darren K. , Person Thomas N. , Reynolds Jonathon C. , Williams Marc S.
Published: January 2021

Background Recently, electronic health record (EHR) vendors have allowed for the storage of discrete genomic data within the EHR. With this new capability there remain many challenges related to adoption and implementation. Geisinger has genomic data available for approximately 145,000 patients. With the goal of integrating genetic data into the EHR for the entire sequenced population, we performed a pilot study on a subpopulation to assess the plausibility of large-scale deployment.

Objectives

Methods Discrete genomic variants were imported into the EHR. Maintenance guidelines and information resources were developed for each genetic condition and best practice alerts were built for pharmacogenomic variants. Weekly calls were held to address barriers to implementation. A list of challenges was maintained throughout the process. Solutions were proposed and categorized into short-term and long-term solutions.

Results Challenges were identified and solutions proposed for five discrete areas:

Conclusion Scaling the use of genomic data in the EHR requires the engagement of hospitals, open standards communities, laboratories, EHR vendors, and genomic information resources.
Endoscopic Management of Obstructive Jaundice in Pregnancy Due to Hepatic Hydatid Disease
Authors: Singh Aniruddha Pratap , Asif Shujaath , Lakhtakia Sundeep , Reddy D. Nageshwar
Published: January 2021

Liver is one of the most common site of hydatid infection. Intra-biliary rupture of the hydatid cyst is a common and serious complication that can occur during course of pregnancy. Early diagnosis and treatment as mortality is high due to cholangitis. Surgical treatment is the definitive option, however but in the presence of cholangitis and pregnancy, ERCP with biliary drainage is the preferred management option.
Midface Reconstruction: Planning and Outcome
Authors: Biswas Gautam
Published: January 2021

Reconstruction of the complex anatomy and aesthetics of the midface is often a challenge. A careful understanding of this three-dimensional (3D) structure is necessary. Anticipating the extent of excision and its planning following oncological resections is critical.

In the past over two decades, with the advances in microsurgical procedures, contributions toward the reconstruction of this area have generated interest. Planning using digital imaging, 3D printed models, osseointegrated implants, and low-profile plates, has favorably impacted the outcome. However, there are still controversies in the management: to use single composite tissues versus multiple tissues; implants versus autografts; vascularized versus nonvascularized bone; prosthesis versus reconstruction.

This article explores the present available options in maxillary reconstruction and outlines the approach in the management garnered from past publications and experiences.
Role of Teledentistry in COVID-19 Pandemic: A Nationwide Comparative Analysis among Dental Professionals
Authors: Abbas Beenish , Wajahat Mehreen , Saleem Zakia , Imran Eisha , Sajjad Mehvish , Khurshid Zohaib
Published: January 2021

Objectives To assess knowledge, awareness, and practice of health care workers about the role of teledentistry in coronavirus disease 2019 (COVID-19).

Materials and Methods A prevalidated structured questionnaire was used to evaluate awareness of general dentists, postgraduate dental students, dental educators, and consultants with postgraduation degrees toward teledentistry. The acceptability, reliability, and language clarity were also pretested. A total of 510 dental professionals contributed to this study.

Statistical Analysis A statistical analysis using SPSS (version 20.0) was performed. Responses were noted as yes or no. A p-value of ≤ 0.05 was considered to be significant. Frequencies described data. Chi-square test was performed for intergroup comparison to evaluate if the knowledge and attitude diverge with the increase in the level of seniority in the profession.

Results Awareness regarding teledentistry is high among general dentists with bachelor of dental surgery qualification in comparison to final-year students and postgraduate dental students. The majority of participants agreed with improvement in health care (88.20%), access to rural areas (82.90%), and general practicing dentist agreed with statistically significant difference (0.00) on saving time by teledentistry.

Conclusion General practicing dentist was observed with high awareness of teledentistry as compared with postgraduate and undergraduate dental students.
Association of Lymphatic Abnormalities with Early Complications after Fontan Operation
Authors: Dittrich Sven , Weise Anja , Cesnjevar Robert , Rompel Oliver , Rüffer André , Schöber Martin , Moosmann Julia , Glöckler Martin
Published: January 2021

Background Increased central venous pressure is inherent in Fontan circulation but not strongly related to Fontan complication. Abnormalities of the lymphatic circulation may play a crucial role in early Fontan complications.

Methods This was a retrospective, single-center study of patients undergoing Fontan operation from 2008 to 2015. The primary outcome was significant early Fontan complication defined as secondary in-hospital treatment due to peripheral edema, ascites, pleural effusions, protein-losing enteropathy, or plastic bronchitis. All patients received T2-weighted magnetic resonance images to assess abdominal and thoracic lymphatic perfusion pattern 6 months after Fontan completion with respect to localization, distribution, and extension of lymphatic perfusion pattern (type 1–4) and with application of an area score (0–12 points).

Results Nine out of 42 patients developed early Fontan complication. Patients with complication had longer chest tube drainage (mean 28 [interquartile range [IQR]: 13–60] vs. 13 [IQR: 2–22] days, p = 0.01) and more often obstructions in the Fontan circuit 6 months after surgery (56 vs. 15%, p = 0.02). Twelve patients showed little or no abnormalities of lymphatic perfusion (lymphatic perfusion pattern type 1). Most frequently magnetic resonance imaging showed lymphatic congestion in the supraclavicular region (24/42 patients). Paramesenteric lymphatic congestion was observed in eight patients. Patients with early Fontan complications presented with higher lymphatic area score (6 [min–max: 2–10] vs. 2 [min–max: 0–8]), p = 0.001) and greater distribution and extension of thoracic lymphatic congestion (type 3–4: n = 5/9 vs. n = 1/33, p = 0.001).

Conclusion Early Fontan complication is related to hemodynamic factors such as circuit obstruction and to the occurrence and extent of lymphatic congestion.
Spontaneous Intracranial Hypotension Complicated by Subdural Effusions Treated by Surgical Relief of Cranial Venous Outflow Obstruction
Authors: Higgins J Nicholas , Axon Patrick R. , Macfarlane Robert
Published: January 2021

Spontaneous intracranial hypotension describes the clinical syndrome brought on by a cerebrospinal fluid (CSF) leak. Orthostatic headache is the key symptom, but others include nausea, vomiting, and dizziness, as well as cognitive and mood disturbance. In severe cases, the brain slumps inside the cranium and subdural collections develop to replace lost CSF volume. Initial treatment is by bed rest, but when conservative measures fail, attention is focused on finding and plugging the leak, although this can be very difficult and some patients remain bedbound for months or years. Recently, we have proposed an alternative approach in which obstruction to cranial venous outflow would be regarded as the driving force behind a chronic elevation of CSF pressure, which eventually causes dural rupture. Instead of focusing on the site of rupture, therefore, investigation and treatment can be directed at locating and relieving the obstructing venous lesion, allowing intracranial pressure to fall, and the dural defect to heal. The case we describe illustrates this idea. Moreover, since there was a graded clinical response to successive interventions relieving venous obstruction, and eventual complete resolution, it also provides an opportunity to consider particular symptoms in relation to cerebral venous insufficiency in its own right.
EUS-guided Gastroenterostomy: Assessing the Competence of the Endoscopist
Authors: Jena Anuraag , Rana Surinder Singh
Published: January 2021

Assessing competence is of utmost importance for complex EUS procedures like EUS-guided gastroenterostomy (EUS-GE) that are associated with higher risk of procedural complications. It is a matter of intense debate on what is the training needed to carry out these interventions, how to judge for competence, and who can perform these newer interventions. The procedure has several variations including the methods to identify the jejunal loops on EUS like direct puncture, balloon-assisted, and hybrid rendezvous with ultrathin endoscope. Therefore, there is lack of clarity on the role and ways of assessing the learning curve for EUS-GE. In this news and views, we are discussing two studies that assessed the learning curve for EUS-GE.
Clinical Impact of Universal Screening for COVID-19 before Therapeutic Endoscopy
Authors: Jagtap Nitin , Singh Aniruddha Pratap , Inavolu Pradev , Tandan Manu , Lakhtakia Sundeep , Reddy D Nageshwar
Published: January 2021

Introduction The Coronavirus pandemic (COVID-19) has led to drastic change in gastrointestinal (GI) endoscopy practice. Endoscopy is an aerosol-generating procedure. COVID-19 testing prior to endoscopy can reduce transmission by delaying non-emergency endoscopies in positive patients. There is scarcity of literature to support such protocols. We aimed to study the clinical impact of universal testing for COVID-19 before therapeutic endoscopy.

Methods This is retrospective analysis of prospectively maintained data. All patients requiring therapeutic endoscopy were enrolled between June 15 to July 15, 2020. Clinical profile, indication, endoscopic intervention, and outcome of patients tested positive for COVID-19 real-time polymerase chain reaction (RT PCR) or CT chest suggestive of CO-RADS 3 or more were included for analysis.

Results Out of 772 patients scheduled for endoscopic interventions, 26 (3.34%) patients had COVID-19 infection with mean age (range) of 48.19 (3–75) years. Eight (30.8%) were females. Of them, seven (26.9%) patients underwent emergency endoscopy, and another seven (26.9%) patients underwent endoscopy after minimum of 2 weeks waiting period. Two deaths were seen in patients who underwent emergency interventions which were unrelated to endoscopy. One patient, who was planned for endoscopic ultrasound (EUS) for choledocholithiasis, developed acute biliary pancreatitis in the waiting period.

Conclusion We suggest use of universal testing for COVID-19 by RT-PCR before endoscopic intervention. Endoscopy can be postponed for 2 weeks with marginal risk of adverse events during the waiting period in nonemergency indications. However, this approach needs to be tailored as per local needs, resources availability, and indication of endoscopy.
How Risky are Elective Endoscopic Procedures during the COVID-19 Normalization Process?
Authors: Bayram Mehmet , Yildirim Ozgur
Published: January 2021

Objective In this study, we aimed to investigate the incidence of COVID-19 after endoscopic procedures were performed with elective indications during the normalization process of the COVID-19 pandemic. We also aimed to investigate safety of these procedures.

Materials and Methods The study included 351 patients who underwent an endoscopic procedure for elective indications in the endoscopy unit of the gastroenterology department of the İstanbul Kanuni Sultan Süleyman Training and Research Hospital and whose risk assessment for COVID-19 was low before the procedure. All patients were followed-up within 14 days after the procedure in terms of getting a COVID-19 PCR test and its results and also assessing development of any symptoms such as fever, cough, and shortness of breath associated with COVID-19.

Results A total of 351 patients were included in the study. A total of 445 procedures were performed: upper gastrointestinal (GI) system endoscopy in 180 patients, colonoscopy in 74 patients, double procedure (upper GI endoscopy + colonoscopy) in 94 patients, and percutaneous endoscopic gastrostomy (PEG) in three patients. It was found that at least one of the symptoms including cough, shortness of breath, and fever developed in 33 (9.4%) of these 351 patients within 14 days. It was observed that 20(5.6‰)of these 33 patients were tested for COVID-19 and the test results were reported as positive in two(5.6‰)patients.

Conclusion In the normalization process of COVID-19, elective endoscopic procedures can be performed in patients, who are shown to be low risk, by paying attention to the consummate use of the personal protective equipment (PPE).
New Modalities of Treatment for Coronary Calcific Lesions
Authors: Padmanabhan TNC , Azam Mohammed Sadiq
Published: January 2021

Since the publication of the previous article on the same topic in the journal, as a result of the better understanding in intravascular imaging (intravascular ultrasound [IVUS] and optical coherence tomography [OCT]) and introduction of intravascular lithotripsy (IVL) into clinical practice, the outcomes in patients with calcified coronary lesions have become more predictable and safe with lesser complication rates.
Expert’s Opinion–Challenging ECG
Authors: Kale Seema
Published: January 2021

Varying kinds of AV blocks can occur in the setting of myocardial ischaemia or due to degeneration of conduction system. Wenckebach AV block can present with typical Wenckebach periodicity or atypical periodicity. A variant of atypical Wenckebach periodicity may present like Mobitz II AV block. This is called Pseudo Mobitz II AV block. As we are aware that Mobitz II AV block is more dangerous and can suddenly convert into complete heart block, it is essential that we should try to differentiate between Mobitz and Pseudo Mobitz II blocks. Infact atypical Wenckebach cycles are quite common at both AV node and his Purkinje system.
Aortic Aneurysm and Dissection in Pregnancy: Report of a Rare Case in a Marfan with Bicuspid Aortic Valve
Authors: Masiello Paolo , Leone Rocco , Benvenga Rossella Maria , Iesu Severino
Published: January 2021

Background Type A aortic dissection is an emergency with high morbidity and mortality when surgery is not performed. Few cases are described in the literature about aortic dissection during pregnancy. A correlation between pregnancy and aortic dissection is mainly reported in patients with family history and connective tissue disorders, such as Marfan’s syndrome (MS), Loeys–Dietz’s syndrome, and Ehlers–Danlos’s syndromes, and patients with bicuspid aortic valve (BAV); exceptional cases are also described in patients without risk factors.

Case presentation A 22-year-old young woman with MS, ascending aorta dilation, and BAV became pregnant. During labor, she experienced a short-term chest pain with spontaneous resolution. The electrocardiogram (ECG) and cardiac biomarkers were negative for acute coronary artery disease, but no transthoracic echocardiogram (TTE) was performed. A caesarean section was performed without complications. After 1 month, a routine TTE showed a chronic ascending aortic dissection involving the aortic arch and supra-aortic vessels. Due to a normally functioning aortic valve, the David operation was performed (sparing aortic valve) with the replacement of the aortic arch and supra-aortic vessels.

Conclusions Aortic dissection is a rare cardiovascular complication that can occur during pregnancy and is associated with very high-risk mortality. We have reported a rare case of undiagnosed type A aortic dissection involving the aortic arch during unplanned pregnancy in patients with BAV and MS, subsequently treated with the David surgery and replacement of ascending aortic arch and supra-aortic vessels. A closer clinical and instrumental follow-up is necessary in this particular group of patients at risk. Awareness of all physicians involved is mandatory.
Canada’s nuclear future brightens
Authors: Kramer David
Published: January 2021

Although the Canadian and US nuclear industries have shared origins in World War II, their paths soon diverged.
A field guide to angle-independent structural color
Authors: Manoharan Vinothan N. , Stephenson Anna B.
Published: January 2021

The hues of blue birds come from constructive interference, but scattering and refraction also matter.
Spinning tops and magnetic orbits
Authors: Novikov S. P.
Published: January 2021

A number of directions were initiated by the author and his students in their papers of 1981–1982. However, one of them, concerning the properties of closed orbits on the sphere

and in the groups

and

, has not been sufficiently developed. This paper revives the discussion of these questions, states unsolved problems, and explains what was regarded as fallacies in old papers. In general, magnetic orbits have been poorly discussed in the literature on dynamical systems and theoretical mechanics, but Grinevich has pointed out that in theoretical physics one encounters similar situations in the theory related to particle accelerators such as proton cyclotrons. It is interesting to look at Chap. III of Landau and Lifshitz’s Theoretical physics, vol. 2, Field theory (Translated into English as The classical theory of fields [12]. where mathematical relatives of our situations occur, but the physics is completely different and there are actual strong magnetic fields.

Bibliography: 12 titles.
Investigation on nanosecond surface sliding discharge in a supersonic airflow with oblique shock wave
Authors: Mursenkova I , Ivanov I , Ulanov P , Liao Yu , Sazonov A
Published: January 2021

We report investigations of the nanosecond surface sliding discharge in supersonic airflows with the oblique shock wave at Mach numbers of the flow 1.30-1.60 in shock tube. We show that the surface sliding discharge developed in flows as a single channel located near a zone of interaction of the oblique shock with the boundary layer on the wall of the channel. A pulse voltage of 25 kV powered the discharge; the electric current was of 1 kA. The electron concentration in the localized discharge channel was (0.7-1.4).1015 cm-3 and the electron energy was of 1.8-2.2 eV from the analysis the emission spectra. High-speed flow field shadowgraphy after the surface sliding discharge showed that the localized discharge channel generates a strong shock wave, leading to restructuring the shock-wave structure of the flow within ∼100 μs and subsequent relaxation to a stationary configuration.
Nanosecond discharges in a non-stationary flow around an obstacle
Authors: Znamenskaya I. , Tatarenkova D. , Kuli-zade T. , Ivanov I.
Published: January 2021

The purpose of the work is to study the effect of a pulsed surface discharge (plasma sheet) on the transverse flow upon its initiation in an unsteady gas-dynamic flow in a channel with an obstacle on the wall. Also a comparison with the effect of a pulsed volume discharge under similar conditions was studied. The dynamics of the blast waves propagating from the separation zone behind the obstacle after self-localization of the discharge plasma there is investigated.
Space potential and charged particles density variation in a glow discharge plasma during shock wave propagation
Authors: Basargin I V , Bezverhniy N O , Bobashev S V , Monakhov N A , Sakharov V A
Published: January 2021

The plasma parameters in a glow discharge plasma near the front of shock wave moving perpendicularly to the discharge axis has been investigated using a double electrical probe. It has been discovered that the shock wave propagation is accompanied by an increase in the potential of discharge plasma. A relatively small change in the potential is observed before the shock wave arrival and a significant one behind shock wave front. The varying potential in the glow discharge plasma distorts the current of the double probe. A method of its correction is proposed, which consists in the joint processing of two signals obtained in separate experiments with different surface areas of the negative probe electrode. The method allows us determine the ionic current and the change in the potential of space. The magnitude of ion current corresponding to the charged particles concentration remains unperturbed before the shock wave arrival to the measurement point. A gradual increase in the ionic current is observed behind the shock wave front in contrast with the abrupt change in gas-dynamic parameters on the shock wave front.
Redistribution of energy in a viscous heat-conductive medium during the interaction of a shock wave with a temperature layered plasma region
Authors: Azarova O A , Krasnobaev K V , Kravchenko O V , Lapushkina T A , Erofeev A V
Published: January 2021

Experimental data on the creation of ionization unstable gas discharge plasma with large-scaled and small-scaled ionisation strata are presented. The redistribution of kinetic and internal energy between a stratified energy source and the area behind a shock wave is numerically studied on the base of the system of Navier-Stokes equations. Generation of the Richtmyer-Meshkov instabilities at many points is obtained which bend the shock wave front and, in some cases, completely destroy it (in density fields). The influence of heat conductivity on the obtained flow structures has been studied. For viscous heat conducting medium it was established the possibility to obtain local high energy zones behind the shock wave with values of energies several times higher than those for a non-stratified energy source with the same total energy. The values of energies in these zones were shown to be possibly controlled via the rarefaction parameter/temperature of a gas in the layers of a stratified energy source or by its geometry.
Investigation of Pulsed Electric Discharge in Hypersonic Air Flow and in Magnetic Field
Authors: Fomichev V P , Yadrenkin M A
Published: January 2021

The problem of local braking of a high-speed air flow (M = 6) using an electric discharge plasma in a magnetic field has been considered. The studies were carried out on an experimental MHD test rig based on a shock tube, at the end of the low pressure channel of which a Laval nozzle was placed with gas flowing into the Eiffel chamber. The discharge was initiated across the flow, between narrow electrodes, and across the magnetic field. It was shown that with increasing of the magnetic field the discharge is localized between the electrodes and then moved toward the flow as a result of strong MHD-interaction. At the same time the bow shock in front of MHD-interaction zone is observed. A comparison of the shock wave structures during the flow around the discharge on free electrodes, near the plate and in front of the blunt body has been shown.
Spectroscopic determination of the composition and spatial distribution of active particles in a plasma jet of helium and argon being blown out into atmospheric air
Authors: Akishev Yu S , Karalnik V B , Petryakov A V , Trushkin N I
Published: January 2021

Optical emission spectroscopy was used to determine the composition and spatial distribution of reactive species along a non-thermal plasma jet in a stream of argon and helium, expanding in the ambient air. It was shown that the composition and spatial distribution of reactive species in argon and helium plasma jets differ significantly. The geometric dimensions of the Ar and He plasma jets are also noticeably different. The features of the observed patterns of the composition and spatial distribution of active particles are discussed.