bluuebunny/crossref_metadata_2025 huggingface dataset:
Combination Therapies in Iron Chelation
Authors: Origa Raffaella
Published: December 2021

The availability of oral iron chelators and new non-invasive methods for early detection and treatment of iron overload, have significantly improved the life expectancy and quality of life of patients with β thalassemia major. However, monotherapy is not effective in all patients for a variety of reasons. We analyzed the most relevant reports recently published on alternating or combined chelation therapies in thalassemia major with special attention to safety aspects and to their effects in terms of reduction of iron overload in different organs, improvement of complications, and survival. When adverse effects, such as gastrointestinal upset with deferasirox or infusional site reactions with deferoxamine are not tolerable and organ iron is in an acceptable range, alternating use of two chelators (drugs taken sequentially on different days, but not taken on the same day together) may be a winning choice. The association deferiprone and deferoxamine should be the first choice in case of heart failure and when dangerously high levels of cardiac iron exist. Further research regarding the safety and efficacy of the most appealing combination treatment, deferiprone and deferasirox, is needed before recommendations for routine clinical practice can be made.
Non-Transfusion Dependent Thalassemia: Translating Evidence to Guidelines
Authors: Harb Afif R. , Saliba Antoine N. , Taher Ali T.
Published: December 2021

The thalassemias are a group of inherited disorders of hemoglobin synthesis characterized by various degrees of defective production of the α- or β-globin chains of adult hemoglobin A. Non-transfusion- dependent thalassemia (NTDT) includes a group of thalassemia patients who do not require regular RBC transfusions for survival, but may require occasional transfusions due to infection or pregnancy or may require more regular transfusions later in life due to splenomegaly or other complications. Due to the rising phenomenon of global migration, this previously well-localized entity is currently spreading more and more worldwide reaching Northern America and Northern Europe. The clinical picture of NTDT is governed by the severity of the ineffective erythropoiesis and the chronic hemolytic anemia, which, in turn, lead to iron overload, hypercoagulability, and an array of clinical complications involving almost every organ system. Patients with NTDT suffer from complications that are distinct from those encountered in patients with transfusion- dependent thalassemia (TDT) in addition to the complications shared by both TDT and NTDT. As a consequence, patients with NTDT deserve a care specifically tailored to their needs. In the care of patients with NTDT, aiming at a standardized yet personalized care is not an easy task especially that NTDT patients lie on a heterogeneous spectrum with a wide variability in their clinical presentation and response to therapy. Therefore, guidelines emerge as a necessity to answer the specific needs of NTDT patients and the clinicians caring for them. In this article, we summarize the complications most commonly associated with NTDT and the recommendations of the guidelines for the management of patients with NTDT, based on the best available evidence.
Economic Recession and Health
Authors: Theocharous Eleni
Published: December 2021

The economic crisis, which struck in Europe since 2008, has raised concerns about the health of the less privileged, vulnerable and poor people of the continent - the ordinary people of Europe. There is currently sufficient evidence for the negative and, in certain countries, devastating effects of austerity policies on the financing of health and other services of general interest, essential to promote the proper functioning of our economies and the cohesion of our societies. This evidence proves that health and social services are seriously impaired.
Fertility and Pregnancy in Thalassaemia and Sickle Cell Disease. The UK Guidelines
Authors: Davis Bernard
Published: December 2021

Progressive improvements in the health and survival of patients with thalassaemia and sickle cell disease have increased the reproductive prospects of affected individuals. However, pregnancy in these disorders is associated with significant maternal and fetal risks and expert management is required to ensure good outcomes. In the United Kingdom, it is recognised that the patchy geographical distribution of these conditions poses challenges for access to specialist care, including specialist obstetric services. Guidelines on the pregnancy management of thalassaemia and sickle cell disease in the UK have been published by the Royal College of Obstetricians and Gynaecologists. These guidelines describe the preconceptual, antenatal, intrapartum and postpartum aspects of care. They highlight the high-risk status of pregnancy in these conditions and emphasise the vital importance of specialist multidisciplinary care to the achievement of favourable maternal and fetal outcomes. The guidelines are a valuable resource to healthcare professionals, especially those working in low prevalence areas.
Quality of Life of Patients with Haemoglobinopathies in Periods of Economic Austerity
Authors: Tsironi Maria
Published: December 2021

The concept of quality of life (QoL) encompasses a broad spectrum of meaning that is variously influenced by individual, natural and psychological conditions [...]
Quantification Method and Training Load Changes in High School Cross-Country Runners Across a Competitive Season
Authors: Garcia Micah C. , Pexa Brett S. , Ford Kevin R. , Rauh Mitchell J. , Bazett-Jones David M.
Published: December 2021

Context

Running programs traditionally monitor external loads (eg, time and distance). Recent efforts have encouraged a more comprehensive approach to also account for internal loads (eg, intensity, measured as the session rating of perceived exertion [sRPE]). The combination of external and internal loads accounts for the possible interaction between these loads. Although weekly changes in training loads have been reported between external loads and the combination of external and internal loads during 2- and 4-week training cycles, no authors have indicated whether these differences occur during an entire cross-country season in high school runners.

Objective

To compare changes in training loads, as measured by (1) external loads and (2) combined external and internal loads in high school runners during an interscholastic cross-country season.

Design

Case series.

Setting

Community-based setting with daily online surveys.

Patients or Other Participants

Twenty-four high school cross-country runners (females = 14, males = 10, age = 15.9 ± 1.1 years, running experience = 9.9 ± 3.2 years).

Main Outcome Measure(s)

Week-to-week percentage changes in training load were measured by external loads (time, distance) and combined external and internal loads (time × sRPE [timeRPE] and distance × sRPE [distanceRPE]).

Results

Overall, the average weekly change was 7.1% greater for distanceRPE than for distance (P = .04, d = 0.18). When the weekly running duration decreased, we found the average weekly change was 5.2% greater for distanceRPE than for timeRPE (P = .03, d = 0.24). When the weekly running duration was maintained or increased, the average weekly change was 10% to 15% greater when external and internal loads were combined versus external loads alone, but these differences were nonsignificant (P = .11–.22, d = 0.19–0.34).

Conclusions

Progression in the training load may be underestimated when relying solely on external loads. The interaction between internal loads (sRPE) and external loads (distance or time) appears to provide a different measure of the training stresses experienced by runners than external loads alone.
Trends in Cardiac Care Utilization under Ayushman Bharat Pradhan Mantri Jan Arogya Yojana, India
Authors: Naib Parul , Kumar Pulkit , Chandrashekar Sudha , Smith Owen , Chhabra Sheena
Published: December 2021

Background:

Ayushman Bharat, the flagship scheme of the Government of India, was launched in September 2018 to achieve the vision of universal health coverage in India.

Objectives:

One of the important components of Ayushman Bharat is the Pradhan Mantri Jan Arogya Yojna (PM-JAY) that provides a benefit cover of INR 5 lakhs per family per year for secondary and tertiary care hospitalization.

Methods:

The present study explores key trends in the utilization of cardiac care packages under the Ayushman Bharat AB PM-JAY. This would have an implication in making cardiac care more accessible by bridging the existing gaps in cardiac care delivery under PM-JAY. All cardiac claims under PM-JAY were analyzed for a period of 17 months (from the inception of the scheme in September 2018 to February 2020).

Results:

The analysis shows that claims from cardiac (cardiology as well as cardiothoracic and vascular surgery) specialty accounted for 5% of the total PM-JAY claim volume, however, it shares in the total claim volume. It was significantly higher at 26% indicating that a very high proportion of the scheme was utilized to provide free cardiac care to beneficiaries coming from the poorest segment of the population.

Conclusion:

The analysis also indicates significant variation in the supply of the cardiac facilities and the need to further develop health infrastructure for cardiac care, particularly in certain states where the supply is found to be inadequate.
Total Laparoscopic Hysterectomy for Anterior Cervical Myoma
Authors: Ishidera Yumi , Furugori Megumi , Hirata Go , Wakabayashi Reina , Shigeta Hiroyuki , Yoshida Hiroshi
Published: December 2021

Hysterectomy for large uterine anterior cervical myoma is a challenging surgical procedure. We summarize our experience in the management of large uterine anterior cervical myoma. Three patients underwent hysterectomy for uterine anterior cervical myoma with similar sizes and different positions treated by laparoscopic surgery. Total laparoscopic hysterectomy (TLH) for cervical myoma is possible by performing ureterolysis and adopting retrograde hysterectomy. Because the position of myoma is important to determine the difficulty of TLH, we propose to measure the axis between the most caudal point of the myoma and external cervical os and pubococcygeal line as a possible useful method in objectively predicting the difficulty of TLH for large anterior cervical myoma.
A Case of Heterotopic Ovarian Pregnancy after in vitro Fertilization
Authors: Hong Yeon Hee , Kim Hyojin , Kim Seul Ki , Jee Byung Chul
Published: December 2021

Here, we reported the case of a 32-year-old pregnant woman who presented with sudden abdominal pain at 5 weeks of gestation and diagnosed as ruptured heterotopic ovarian pregnancy. She was conceived after in vitro fertilization. Right ovarian pregnancy was noticed, and we performed right ovarian wedge resection via single-port access laparoscopic surgery. Intrauterine pregnancy had remained intact, and she delivered a term baby. Rapid diagnosis in early gestation and minimally invasive laparoscopy resulted in a satisfactory pregnancy outcome without other complications. Single-port laparoscopic surgery can be feasible and appears to be a good first treatment option in a ruptured heterotopic ovarian pregnancy.
Vaginal-assisted Laparoscopic Sacrohysteropexy and Vaginal Hysterectomy with Vaginal Vault Suspension for Advanced Uterine Prolapse
Authors: Cengiz Huseyin , Yildiz Sukru , Alay Ismail , Kaya Cihan , Eren Ecem , Iliman Derya Ece
Published: December 2021

Objective:

Vaginal-assisted laparoscopic sacrohysteropexy (VALH) is a new modified form of uterine-sparing prolapse surgery using a combined vaginal and laparoscopic approach. We aimed to compare 1 year efficacy and safety of VALH and vaginal hysterectomy with vaginal vault suspension (VH + VVS) in the surgical treatment of apical pelvic organ prolapse (POP).

Materials and Methods:

Women who requested surgical treatment for stage 2–4 symptomatic uterine prolapse were recommended to participate in one year-long randomized study between July 2017 and January 2019. POP Quantification (POP-Q) examination and validated questionnaires such as International Consultation on Incontinence Questionnaire Vaginal Symptoms (IVIQ-VS) survey, Urogenital Distress Inventory (UDI-6), Incontinence Impact Questionnaire Short Form (IIQ-7), and Patient Global Impression of Improvement (PGI-I) were recorded at baseline and 12 months after surgery. The main primary outcome measure was apical prolapse recurrence. Secondary results were duration of surgery, pain score, blood loss, postoperative hospital stay, and quality of life scores related to prolapse.

Results:

There were 15 women in VALH and 19 women in the VH + VVS group. ICIQ-VS score, ICIQ-QOL, UDI-6, and IIQ-7 scores were improved for both groups. According to the PGI-I scores, 80% of subjects in the VALH group, and 100% in the VH + VVS group, were “very much better” or “much better” with their prolapse symptoms at their 1-year follow-up. There was no reoperation or operation-related complication in both groups.

Conclusion:

VALH and VH + VVS have similar 1-year cure rates and patient satisfaction.
Postlaparoscopic Hysterectomy Discharge within 24 h in Hospital Putrajaya
Authors: Padzil Nurul Idayu Mohamad , D'silva Emily Christine , Safiee Anis Iryani , Ghazali Wan Ahmad Hazim Wan
Published: December 2021

Objective:

The study objective was to determine the feasibility and selection criteria for discharge within 24 h posttotal laparoscopic hysterectomy with or without bilateral salpingo-oophorectomy (TLH with or without BSO) in Hospital Putrajaya.

Materials and Methods:

A total of thirty patients among all gynecology inpatients who were planned for TLH with or without BSO with controlled medical diseases, normal preoperative investigations, and uncomplicated surgery were recruited from January 2014 to December 2016. Data were collected from electronic medical records. Postoperatively, patients who fulfilled the selection criteria were discharged within 24 h and were followed up at 6 weeks and 3 months postsurgery. The results were presented as frequency with percentage and mean standard deviation.

Results:

All patients who had uncomplicated surgery and blood loss <1 l with no early postoperative complications were discharged within 24 h. They had a pain score of < 3 and were able to ambulate and tolerated orally well. None of these patients who were discharged 24 h postsurgery required readmissions. During follow-up, there were no reported complications such as persistent pain, wound infection, or herniation.

Conclusion:

Twenty-four hours' discharge post-TLH with or without BSO is feasible and safe if the selection process is adhered to.
Does Uterine Manipulator Type Affect Surgical Outcomes of Laparoscopic Hysterectomy?
Authors: Yavuzcan Ali , Altıntaş Raşit , Yıldız Gazi , Başbuğ Alper , Baştan Merve , Çağlar Mete
Published: December 2021

Objectives:

Many surgeons use uterine manipulator (UM) during laparoscopic hysterectomy (LH). In this study, we aimed to compare the outcomes of LH operations performed by using partially reusable UM with the articulated system (artUM) and disposable (dUM) UM without articulation.

Materials and Methods:

A total of 99 patients underwent the LH operation. This study was carried out with 35 of those 99 Caucasian patients who met the inclusion criteria. Group 1 consisted for 7 LH operations using the articulated RUMI® II/KOH-Efficient™ (Cooper Surgical, Trumbull, CT, USA) system (artUM), while Group II consisted of 28 patients using old-type V Care®(ConMed Endosurgery, Utica, New York, USA) dUM as UM.

Results:

Mean operation time was found to be 157.1 ± 42.0 min. The operation time was found statistically longer in Group 1, consisted of artUM used patients (P = 0.006 and P < 0.05). No statistically significant difference was found between two groups in terms of surgical results such as, delta hemoglobin value (P = 0.483 and P < 0.05), length of hospital stay (P = 0.138 and P < 0.05), and postoperative maximum body temperature (P = 0.724 and P < 0.05).

Conclusion:

The UM type did not alter the surgical outcomes except the operating time in our study. According to our results, the surgical technique is a more significant variable than instruments used in LH for normal size uterus. Further prospective, large-scale studies comparing various UM systems are mandatory.
Surgical Trend and Volume Effect on the Choice of Hysterectomy Benign Gynecologic Conditions
Authors: Lin Chung-Hong , Long Cheng-Yu , Huang Kuan-Hui , Lo Tsia-Shu , Wu Ming-Ping
Published: December 2021

With the advance of minimally invasive surgery (MIS), the surgical trends of hysterectomy changed significantly during past 2 decades. Total number (age-standardized) of all types of hysterectomy decreased, which may be due to the availability of some other alternatives, e.g. hysteroscopy, laparoscopic myomectomy. However, laparoscopic hysterectomy (LH) still remains the mainstream of surgical treatment. LH significantly increases for benign gynecologic conditions in Taiwan and worldwide. The increase of LH was accompanied with decrease of TAH; VH kept stationary, and SAH increased slightly. The increase in popularity of LH and SAH; provides evidence of surgical trends and a paradigm shift for hysterectomy. This time-frame shift suggests LH has reached a u during the later years. Older patients tend to receive AH, while middle-aged women tend to receive LH. Oder surgeons tend to perform AH, while younger surgeons tend to perform LH. However, all type hysterectomy and LH were more commonly performed by older surgeons aged over 50 years. It means both patients and surgeons became older during the time-frames. The above phenomena may also happen due to less young surgeons entered in the gynecologic practice. Most of the LHs were performed by high-volume surgeons, however, there is a shift from high-volume, to medium- and low-volume surgeons. The above scenario may be due to the wide spread of LH techniques. Surgical volume has important impacts on both complications and costs. The high-volume surgeons have lower complications, which result in lower costs. In the future, how to increase the use of LH, to improve the training and monitoring system deserves more attentions.
Abnormal Urine Outflow from the Ureteral Orifice on Cystoscopy Following Vaginal Stump Suture in Total Laparoscopic Hysterectomy
Authors: Kobayashi Hiroharu , Iga Kentaro , Kato Keiichiro , Kato Airi , Otsuka Koji , Soga Eri , Konno Hiroko , Nakayama Satoru , Shiojima Satoshi
Published: December 2021

Objectives:

Ureteral injuries may occur subsequent to abdominal or laparoscopic hysterectomy. In total laparoscopic hysterectomy (TLH), we usually check for ureteral damage by confirming urinary outflow from the bilateral ureteral orifices by cystoscopy after vaginal stump suture. In this work, we investigated the causes of urine outflow disruption after TLH.

Materials and Methods:

We conducted a retrospective review of all TLHs performed for benign diseases at our hospital from February 2012 to March 2016. There were 11 cases with no or poor urine outflow from the ureteral orifice after vaginal stump suture. For these cases, we assessed the treatment to recover urine outflow and examined the cases with intraoperative manipulation. EZR version 1.25 was used for statistical analysis. Correlation coefficients were calculated with Spearman's rank correlation coefficient test.

Results:

The abnormality was on the right and left sides in seven and four cases, respectively. In all cases, apart from one, urine outflow was recovered by removing the sutures at the affected side, where the initial suture had included a small amount of the connective tissue near the urinary bladder. It was inferred that ureteral deviation due to vaginal stump sutures that picked up the connective tissue near the ureter caused ureteral peristaltic disorder and abnormal ureteral orifice outflow.

Conclusion:

TLH without ureter isolation requires sufficient separation of the bladder from the anterior vaginal wall and careful vaginal stump suture without involving the bladder-side tissue to avoid ureteral injury.
Assessing the Effectiveness of a Weight Reduction Program in Hospitalized Obese Patients Undergoing Laparoscopic Surgery
Authors: Imai Ken , Chikazawa Kenro , Ito Takaki , Kimura Azusa , Ko Hiroyoshi , Miho Yokota , Kuwata Tomoyuki , Konno Ryo
Published: December 2021

Investigate the efficacy of a hospitalized weight reduction program before laparoscopic surgery among high body mass index (BMI) patients with endometrial cancer. The patients were housed in a shared room, received exercise guidance, and restricted to a total caloric intake of 1200 kcal. A physiotherapist and a dietitian provided pedometer and nutritional guidance, respectively. The primary outcome was weight reduction. Among the 16 patients included, 12 (75%) had Stage I endometrial cancer and 10 (62.5%) underwent laparoscopic surgery. Weight and BMI at first consultation were 88.4±10.4 kg and 34.8±3.9 kg/m2, respectively. The rate of weight reduction was 6.5%±2.5%; on average, BMI decreased by 2.1±1.0 kg/m2. The duration from initial consultation to surgery was 39.1±11.4 days. Hospitalization duration until weight reduction was 20.8±8.0 days; there were no surgical complications. Our hospitalized weight reduction program may be effective for obese endometrial cancer patients.
Comparative clinical assessment of 5% minoxidil topical application with supplemental intradermal meso-solution administration for the management of androgenetic alopecia in men
Authors: Gupta Neha , Kohli Sarvraj
Published: December 2021

Objectives:

Androgenetic alopecia (AGA) is characterized by progressive patterned hair loss from the scalp affecting both men and women. The aim of this study was to evaluate the influence of intradermal administration of meso-solution (MS) along with topical application of 5% minoxidil lotion on hair re-growth.

Materials and Methods:

Sixty healthy adult men (32.6 ± 4.3 years of age) with a history of hair loss completed the 12-month study. They were equally randomized into two groups. Subjects enrolled in Group A (n
1 = 30) received once-daily topical application of 5% minoxidil lotion, whereas those in Group B (n
2 = 30) received additional intradermal injection of MS (Stem C’rum HL, Caregen Co. Ltd, Anyang-si, Gyeonggi-do, South Korea) using a mesogun every 15 days for 3 months and then once every month for 9 months. Hair re-growth was evaluated using a 7-point rating scale.

Results:

Data collected were subjected to chi-square test. Results indicate that there is a statistically significant (P < 0.05) increase in hair re-growth in individuals in Group B at 6 months. This progressed to a highly significant (P < 0.001) increase at 9 and 12 months.

Conclusion:

Intradermal administration of MS using a mesogun along with minoxidil yielded a statistically significant increase in hair re-growth as compared to only minoxidil application.
Effective Treatment Option for Lichen Planus
Authors: Parlapalli Neelima , Priscilla Tina
Published: December 2021

Background:

Data on safety and efficacy of low molecular weight heparin (LMWH) in lichen planus (LP) and comparison with oral corticosteroids (OCs) in Indian patients is limited.

Aims:

The aim of this article is to compare the clinical efficacy of LMWH and systemic corticosteroids in LP.

Materials and Methods:

This study was a single-center prospective comparative study. The patients received either LMWH subcutaneously (3 mg weekly for 6 weeks) or OC (20 mg/day for 6 weeks, tapered gradually).

Results:

Fifty patients were enrolled in the study, and 35 (70.0%) were females. Mean age of the study population was 35.46 years with age ranging between 21 and 40 years. Itching (92.0%) was a common symptom; generalized cutaneous lesions (90.0%) and involvement of mucous membrane were seen in 40%. Classical LP was common (56.0%). Early results were seen with OC (week 4) compared to LMWH (week 5); higher cure rate was seen with OC (89.47% vs. 76.0%) at week 6. There was no significant statistical difference (P > 0.05) in the therapeutic response between the study groups. No new lesions were noted in 23 and 13 patients treated with OC and LMWH, respectively. Relapse rate (33.33%) was higher in patients treated with LMWH (P < 0.05). Treatment with low-dose LMWH was associated with no side effects, whereas gastric irritation (42.1%) was the most common side effect followed by facial puffiness (31.57%) and acneiform eruptions (26.31%) with OC. The cost of treatment was more for LMWH compared with OC.

Conclusion:

Both treatment modalities were comparable in efficacy and tolerated well. LMWH had no adverse effect but had a high relapse rate. Therapy with OC is cost-effective.
Lenalidomide in a case of thalidomide intolerant erythema nodosum leprosum
Authors: Chahar Shankar Lal , Mani Sidharth , Sridhar Jandhyala , Srinivasan Padmapriya
Published: December 2021

Lenalidomide is an immunomodulatory drug, which is considered to be a derivative of thalidomide. It has a more potent suppressive effect on tumor necrosis factor-α (TNF-α) production and has a more tolerable adverse effect profile as compared to its parent drug. It has been approved by FDA for use in multiple hematopoietic malignancies and myelodysplasia, but unlike thalidomide its use in erythema nodosum leprosum (ENL) has not been reported so far. Herein we report a case of 45-year-old man with Hansen’s disease (BL) on MDT for 4 months who presented with ENL and was managed with minimum dose of lenalidomide.
Morphometric analysis of itraconazole pellets of commonly available brands using dermoscopy
Authors: Pise Gajanan A. , Komala H. T. , Dastikop Shilpa V. , Manohar Naveen , Akshay L. M. , Sanagoudar Vinitha
Published: December 2021

Introduction:

Itraconazole (ITZ) is commonly used to treat cutaneous and systemic mycoses. The bioavailability of ITZ capsules varies between individuals; therefore, the quality of ITZ pellets is a major determinant of their absorption and therapeutic efficacy. Morphometric analysis is a surrogate method of evaluating the absorption and efficacy of ITZ capsules, and the number and size of pellets in each capsule are the most important morphometric parameters.

Aim:

To analyze the morphometric characteristics of commonly available brands of ITZ.

Materials and Methods:

Commonly available formulations of ITZ in the market were analyzed using a hand-held dermoscope. Morphometric characteristics of 30 and 10 brands of 100-mg and 200-mg formulations were analyzed, respectively. A dermoscope was used to determine the size and the number of pellets per capsule. Furthermore, variations in the size of pellets across brands were compared to that in the global innovator brand. Statistical analysis used was SPSS v. 21 (IBM Inc., Armonk, NY).

Results:

The capsules included 126–1010 pellets of 788–2343 µm, and dummy pellets and loose powder were found in some brands. Five brands that cost <20 Indian rupees (INR) per capsule included good pellet count, small pellet size, and low size variation. Two other brands included these qualities but were priced at INR 20–30 per capsule. The size variation was the minimum, and no dummy particles or loose powder were observed with the innovator brand; however, it was the costliest.

Conclusion:

The morphometric characteristics of ITZ formulations varied significantly between brands, which may significantly affect their efficacy.
Symptom-free status after prolonged suffering with refractory chronic migraine
Authors: Prakash Vaidya Balendu , Ramachandani G. D. , Prakash Vaidya Shikha , Sharma Shakshi , Tiwari Sneha
Published: December 2021

Migraine is ranked sixth among disability-causing diseases in the world. Patients with chronic migraine suffer from headaches 15 days or more in a month. Refractory migraine patients fail to respond to conventional treatments even after avoiding all migraine triggers. These patients continue to suffer in the absence of any established cause and cure. A patient suffering from chronic refractory migraine for about 37 years presented with daily headache associated with symptoms of nausea, vomiting, phonophobia, and photophobia. The patient underwent 9 months Ayurvedic treatment, including initial three weeks of residential treatment. The patient reported a considerable reduction in Visual Analog Scale score, Migraine-Induced Disability Assessment Score, duration/frequency of headache, consumption of analgesics, and improved general well-being indicating the therapeutic efficacy of Ayurvedic treatment.
Efficacy of Ayurveda modalities in the management Raktaja pravahika (ulcerative colitis)
Authors: Varsakiya Jitendrakumar Nathabhai , Goyal Mandip , Kathad Divyarani , Kumari Ritu
Published: December 2021

Ulcerative colitis is an idiopathic, chronic inflammatory disorder of the colonic mucosa that commonly involves the rectum and may extend in a proximal and continuous fashion to involve other parts of the colon. Cardinal symptoms of this disease are bloody diarrhoea with rectal urgency and tenesmus with or without mucus, and abdominal pain which alleviates after defecation. Raktaja pravahika described in Ayurvedic treatise bears symptomatic and etiological resemblance with ulcerative colitis. A 26-year-old female who was suffering with Atipravahana of Purisha (~repeated defecation), Udarashoola (~abdominal pain), Saphena and Raktayukta purisha (~blood mixed frothy stools) for eight months was treated with Ayurvedic medicaments. Pichcha basti was administered in this patient followed by oral medications including Sanjivani vati, Dadimastaka churna and Bilva churna along with Pathya-apathya. After treatment of 15 months, the condition was improved from grade four to grade one, which was assessed through colonoscopy. This case report illustrates the significance of Ayurvedic treatment modalities in the management of ulcerative colitis.
COVID-19-affected family treated at home through integrative approach
Authors: Rastogi Sanjeev
Published: December 2021

The second wave of COVID-19 pandemic in India had been highly devastating to the family and community clusters. It has simultaneously affected many within a close community including the family and has posed unique issues related to health care. A pan India disruption in hospital-based health-care delivery during the second wave has increased the trouble manifolds in cases where many members of the family were simultaneously affected. Family physicians through online consultations have played crucially to navigate the family from this grim situation. During prevailing uncertainty of availability of dependable hospital-based care, most people remained bound to home care following the advice of their respective physicians. Ayurveda family physicians also have played decisively in this phase. This is observed that the families treated in an integrative mode utilizing the standard home care recommendations along with standard Ayurveda care as per the Ayurveda physicians' recommendations, got benefitted most. As is shown in the case under study, all patients in the family cluster suffering from SARS-CoV-2 infection, recovered completely in a short span and, despite brief episodes of lowered oxygen in between, did not require any hospitalization. This observation highlights the importance of Ayurveda family practice during the current pandemic and warrants more serious studies to define the role and impact of Ayurveda family practice during the pandemic.
A diagnostic dilemma
Authors: Leonido Finella Marie G. , Mendoza Maria Czarina V
Published: December 2021

A 24-year-old nulligravida who presented with seizures and behavioral changes with prodrome of flu-like symptoms was initially treated as a case of viral encephalitis. Neurologic diagnostic tests including electroencephalogram, cerebrospinal fluid analysis (CSF), and cranial magnetic resonance imaging were done and inconclusive. Patient's seizure attacks persisted and her neurologic status was deteriorating despite giving appropriate anti-epileptic medications, hence an autoimmune disease was highly considered. The CSF was positive for N-methyl-D-aspartate receptor antibodies. This prompted a search for an associated teratoma and revealed a diagnostic dilemma between presence of an ovarian new growth versus a normal enlarged ovary. Laparoscopy which is both diagnostic and therapeutic was utilized. This report highlights prompt recognition of a rare case and prevented its progression to a potentially fatal condition as resection of the tumor dramatically relieved the symptoms. The significance of minimally invasive surgery in managing this case, effect in fertility, and possible association with pelvic inflammatory disease are also discussed.
Delayed diagnosis and management of late second trimester intra-abdominal pregnancy
Authors: Vargas Ana Patricia C. , Magtibag Viktoria Ines P. , Festin-Dalawangbayan Maria Anna Luisa L.
Published: December 2021

Abdominal pregnancy resulting in lithopedion is a rare condition constituting only 0.0054% of all pregnancies. This is a case of a 48-year-old Gravida 6 Para 3 (3-0-2-2) who consulted at the emergency room for an ultrasound finding of abdominal pregnancy. The patient had previous imaging done which showed a live intrauterine pregnancy until her fourth ultrasound, showing fetal death in utero. After several months without passage of the products of conception, a repeat ultrasound showed an abdominal pregnancy. Diagnosis of abdominal pregnancies may be difficult, thus it is important to utilize other imaging modalities to confirm the diagnosis. The mainstay for treatment for abdominal pregnancies is laparotomy. However, due to the possible severe hemorrhage that may arise intraoperatively, preoperative and postoperative arterial embolization of feeding vessels may be performed, as was done in the case discussed.
Synchronous endometrioid endometrial and serous ovarian carcinoma
Authors: Crimen Ana Victoria C. , Martin Nora A. , Marinas Maria Kathrina S.
Published: December 2021

Synchronous malignant tumors are two primary tumors diagnosed at the same time during surgery. A postmenopausal, nulligravid, presented with vaginal bleeding. Ultrasound revealed an endometrial and right ovarian mass, both with nonbenign features. Cancer Antigen 125 and Human Epididymis Protein 4 were elevated. She underwent extrafascial hysterectomy with bilateral salpingo-oophorectomy with the frozen section of the endometrium and right ovary, followed by complete surgical staging. Histopathology report was endometrioid endometrial carcinoma and high-grade serous ovarian carcinoma. The endometrial and ovarian tissues tested positive for vimentin and Wilm's Tumor 1 (WT1), respectively, suggesting both are primary independent tumors. The pelvic lymph nodes and recto-sigmoid lymph nodes tested positive for vimentin and negative for WT1, suggesting endometrial tumor metastasis. The final diagnosis is synchronous endometrioid endometrial carcinoma Stage IIIC1 and high-grade serous ovarian carcinoma Stage IA, right ovary.
The association of advanced maternal age with maternal and neonatal outcomes of pregnancy in Filipino patients in a tertiary medical center
Authors: Gamboa-Chua Leolina Remeceta M , Soriano-Estrella Agnes L.
Published: December 2021

BACKGROUND:

For the past decade, advanced maternal age (AMA) became more common in developed and developing countries due to the postponement of pregnancy because of career goals, widespread use of family planning, and advances in assisted reproductive techniques. This increase bears an impact on maternal and perinatal outcomes. The link between AMA and adverse maternal, perinatal, and neonatal outcome showed contradicting results. This study was conducted to investigate the association between AMA and adverse outcomes among nulliparous, Filipino with singleton pregnancies who gave birth in a private tertiary hospital.

METHODOLOGY:

Medical records of patients admitted for delivery between January 2015 and December 2019 were reviewed retrospectively. The control (20–34 years), AMA 35–39 years, very AMA 40–44 years, and extremely advanced maternal age (EAMA) 45 years and above groups included 206, 111, 18, and 2, respectively.

RESULTS:

Five-year total deliveries at a private tertiary hospital were 8495 with a prevalence of 38.9% (95% confidence interval CI: 33.6%–44.3%) for elderly Filipino primigravids. AMA is a risk factor for diabetes mellitus and small for gestational age newborn in all 3 advanced age groups. Pregnancy induced hypertension, having cesarean section, admission of newborn to neonatal intensive care unit, and administration of antibiotics were more common to AMA but same risk for EAMA. AMA predisposes to having oligohydramnios, placenta previa and preterm delivery but pregnancy at EAMA predisposes more complications in maternal and neonatal outcomes such as having polyhydramnios, abruptio placenta, postpartum hemorrhage, maternal and neonatal death, low Appearance Pulse Grimace Activity and Respiration score, and stillbirth. There is no noted association between AMA and large for gestational age newborn, having meconium staining and delivering by classical cesarean section.

CONCLUSION:

AMA in Filipino gravida patients is markedly linked with adverse obstetrical, perinatal, and neonatal outcomes. This study confirms the current trend among women over 45 years that leads to more significant obstetric complications and neonatal morbidities.
Sperm Motility is the Best Semen Parameter to Predict Sperm DNA Fragmentation
Authors: Huang Wei-Lun , Chang Yi-Kai , Tung Sheng-Yung , Peng Bo-Hua , Chang Hong-Chiang
Published: December 2021

Purpose:

Sperm DNA fragmentation (SDF) is associated with male infertility and abnormal semen parameters. However, the effect of SDF on each parameter may differ. In this study, we evaluated the correlation between different semen parameters and SDF to identify the most suitable predictor for abnormal SDF.

Materials and Methods:

We conducted a retrospective review from a prospective database. Enrollees who underwent conventional semen analysis and an SDF test for medical purposes or elective examinations were enrolled. SDF ≥20% was regarded as abnormal. Spearman correlation coefficient was used to determine the correlations. Area under the receiver operating characteristic curve area under the curve (AUC) was calculated to determine the predictive value. Youden index was used to determine the optimal cutoff value of conventional semen parameters to predict abnormal SDF.

Results:

In total, 90 men were enrolled, of whom 44 (48.89%) visited for infertility and 51 (56.67%) had abnormal semen analysis. Immotile sperm (IM) and nonprogressive sperm (NPS, NPS = nonprogressive motility + IM) were significantly correlated with SDF (r = 0.50, P< 0.001 for NPS; r = 0.49, P< 0.001 for IM) and were the most predictive for abnormal SDF (AUC = 0.77 for NPS; AUC = 0.78 for IM). By using Youden index, the cutoff values for the prediction of abnormal SDF were 66.37% for NPS and 48.73% for IM.

Conclusion:

Sperm motility is the most predictive and relevant parameter for the prediction of abnormal SDF. Suboptimal sperm motility should be considered an indication for SDF testing.
Mitochondrial Dysfunction in Patients with Urogenital Disease
Authors: Chuang Tzu-Yu , Chang Te-Wei , Chen Shiou-Sheng , Chang Chan-Chi , Cheng Wei-Ming , Wei Yau-Huei
Published: December 2021

Mitochondria are intracellular organelles responsible for the production of the majority of adenosine triphosphate (ATP). In addition to energy production, mitochondria also contribute to cellular apoptosis, the regulation of intracellular Ca2+ homeostasis, signaling through reactive oxygen species (ROS), and the coordination of the cell cycle. The prevalence rate of primary mitochondrial disease was estimated at nearly 1:5000. In this review, we have integrated recent evidence to discuss new insights into how mitochondrial dysregulation plays a role in bladder dysfunction, reproductive disorder and the correlation between mtDNA mutation and bladder cancer.
Measuring Individual Ureteral Length Using Computed Tomography Urography to Determine the Appropriate Lengths of Ureteral Stents
Authors: Tsai Cheng-Han , Huang I-Shen , Chen Wei-Jen , Cheng Wei-Ming , Chiang Cheng-Yen , Kao Wei-Tang , Huang Eric Yi-Hsiu , Huang William J.
Published: December 2021

Purpose:

The purpose of the study was to describe and validate a method for calculating ureteral length using computed tomography (CT) images acquired before ureteral stent placement and to evaluate the appropriateness of fit based on this calculation.

Materials and Methods:

We analyzed 57 patients who underwent computed tomography urography (CTU). The axial ureteral length (AUL) and coronal ureteral length (CUL) were derived from measurements made on the CTU images, and the length of each patient-specific ureteral stent was chosen based on the calculated ureteral length.

Results:

Overall, 105 ureters were measured: 54 (51.4%) right side and 51 (48.6%) left side ureters. The mean CUL and AUL of right ureters were 22.5 ± 2.3 cm and 22.5 ± 2.3 cm, respectively, whereas the mean CUL and AUL of left ureters were 23.6 ± 2.2 cm and 23.4 ± 2.1 cm, respectively. Pearson correlation analysis showed that body height was significantly correlated with ureteric length (right CUL and patient height: r =0.441, P= 0.001; right AUL and patient height: R = 0.445, P= 0.001; left CUL: R = 0.341, P= 0.029; left AUL: R = 0.339, P= 0.015). Thirteen of 57 patients underwent ureteral stent insertion; none experienced stent migration (upward or downward) before the removal of the ureteral stent. Comparison of proposed stent size with actual stent size in the 13 patients shows the percentage of size appropriateness (as defined by concordance between proposed and actual stent length) to be 76.9% (10/13).

Conclusion:

The patient's height was found to correlate significantly with CT-derived measurements of ureteral length. Accordingly, the choice of ureteral stent length can be reliably decided from CT measurements.
Mortality of Eucalyptus pilularis progenies and provenances after frost
Authors: Baroni Gabriel de Resende , Campoe Otávio Camargo , Dobner Júnior Mário , Topanotti Larissa Regina , Silva Paulo Henrique Muller da
Published: December 2021

We aimed to quantify frost tolerance and damage on Eucalyptus pilularis provenances and progenies in Curitibanos, Santa Catarina State, Brazil. Mortality and severity of damage were assessed before frost at 7 months old and at 14 and 19 months old after frost events. Frost resulted in plant mortalityof 55.7%, with no difference among progenies and provenances. The tolerance of 5.3% may have occurred due to specific local conditions (escape). We concluded that the species does not have tolerance to frost in subtropical environment, with daily thermal range from - 5 °C to 28 °C.
AVALIAÇÃO DE OCORRÊNCIA DE MANIFESTAÇÕES PATOLÓGICAS EM SISTEMAS PREDIAIS HIDROSSANITÁRIOS NOS PRIMEIROS ANOS DE USO E OPERAÇÃO
Authors: Salomão Rael de Morais Lucas , Martins de Paula Heber , Prado Abreu Reis Ricardo
Published: December 2021

RESUMO: Considerando que as ações de avaliação de desempenho de edificações e de manutenção predial vêm ganhando ênfase nos últimos anos, a identificação de patologias nos sistemas prediais e a sua detecção precoce estão sendo tratadas mais a sério.   Destaca-se o grande número de registros de patologias nos sistemas prediais hidrossanitários (SPHS), devido suas características de heterogeneidade de seus elementos e o elevado grau de interação com os usuários. Este artigo tem o objetivo de avaliar a ocorrência de manifestações patológicas em edifícios públicos nos seus primeiros anos de uso e operação através da avaliação de relatórios de ordens de serviço de manutenção predial da Universidade Federal de Goiás durante o período de 2012 a 2019. A partir dessas informações, foi avaliada a participação das edificações com pouca idade na manutenção predial da instituição e identificar quais foram os tipos de manifestações patológicas relatadas nesses edifícios. Observou-se participação significativa de edifícios com menos de 5 anos nas requisições de manutenção dos SPHS. A ocorrência de manifestações patológicas foi relacionada ao uso de materiais de baixa qualidade e deficiências nas etapas de projeto, execução e fiscalização da obra.
MÉTODO DE VERIFICAÇÃO EM CAMPO DE PRESSÕES DINÂMICAS EM PONTOS DE CONSUMO DE SISTEMAS PREDIAIS DE ÁGUA FRIA E QUENTE
Authors: Furtado Yamada Marco Antonio , Oliveira Lúcia Helena de
Published: December 2021

RESUMO: O comissionamento é uma inovação que requer alteração no processo de projeto. Além disso, devido a revisão e integração das normas técnicas NBR 5626 (ABNT, 1998) e NBR 7198 (ABNT, 1993) no ano de 2020, diversos requisitos foram atualizados e novos foram estabelecidos. A soma desses fatores criou a necessidade de pesquisas devido à dificuldade em integrar o comissionamento no processo de projeto dos sistemas prediais. Dentre as dificuldades encontradas, a etapa de verificação em campo da conformidade dos requisitos e critérios de desempenho é um dos pontos que precisa ser abordado. Parte dessa dificuldade ocorre devido à falta de métodos de verificação claramente definidos. Desse modo, este artigo propõe um método de verificação dos critérios de desempenho da distribuição de água do sistema predial de água fria e quente. O método foi desenvolvido com base em uma pesquisa exploratória sobre os temas relacionados, além de uma etapa em campo, onde o método e a instrumentação para a verificação foram empregados. Os resultados indicam que o método é capaz de verificar os critérios estabelecidos, porém a instrumentação precisa ser melhorada para verificar outros critérios que podem ser estabelecidos pelo Proprietário do Projeto.
Analisis Tingkat Pelayanan Jalan Dan Evaluasi Struktur Perkerasan Jalan Pada Jalan Semeru, Jalan Pancasila Dan Jalan Kolonel Sudiarto
Authors: Mirajhusnita Isradias , Ayu Nisya’ul Fitri Ros , Yusuf Muhammad , Yunus Muhamad
Published: December 2021

Tegal city station which is in the center of Tegal city. Activities in and out of station visitors lead to a density of road capacity. As well as the smoothness of traffic also depends on the condition of the road pavement. This study aims to determine the level of road service and evaluation of road pavement thickness as well as to provide alternative ways of handling road problems on Jalan Semeru, Jalan Pancasila and Jalan Kolonel Sudiarto which are influenced by road users around the Kota Tegal station. The benefits of the research provide material for consideration of regional structuring policies and input data on road improvement planning for related agencies. The research method is qualitative, namely analyzing the level of road service with LOS calculations according to the 1997 Indonesian Road Capacity Manual and evaluating pavement thickness with CESA calculations according to the 2013 Road Pavement Design Manual. Data analysis was obtained from field measurements and traffic volume calculations. The results of the calculation of the analysis of the level of road service on Jalan Semeru, Jalan Pancasila and Jalan Kolonel Sudiarto are at service level C, namely stable current conditions with an average speed of 30 km / h due to side obstacles so that the driver has limitations in choosing speed, it is recommended to add and traffic sign confirmation. Evaluation of the structure of the pavement layer on Jalan Pancasila is adequate for the next 20 years of planning life. Meanwhile, Jalan Semeru with a length of 610 meters and a width of 550 meters as well as Jalan Kolonel Sudiarto with a length of 845 meters and a width of 700 meters need to be thickened with a layer of wear layer (AC-WC) with a thickness of 4 cm at a cost of Rp. 1,256,137,000.