bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of C-MACTM Videolaryngoscope with Macintosh Laryngoscope in Anticipated Difficult Airway
Authors: Ramamoorthy Srivats V , Paneerselvam Sakthirajan , Elakkumanan Lenin Babu , Rudingwa Priya , Govindaraj Kirthiha
Published: August 2023

Background:

Failure to intubate is one of the dreaded outcomes of airway management. Videolaryngoscopes have the potential to increase intubation success by overcoming the shortcomings of direct laryngoscopy. This study aimed to compare the first-attempt intubation success rate of the C-MACTM videolaryngoscope and Macintosh laryngoscope in patients with anticipated difficult airways.

Methods:

Eighty adult patients with multiple predictors of difficult airway scheduled for surgery under general anaesthesia were randomised either into Group C (first using the C-MACTM videolaryngoscope) or Group D (first using the Macintosh laryngoscope). Laryngoscopy was done sequentially with both laryngoscopes in a patient based on the randomisation. The primary outcome was the first-attempt intubation success rate. Intubation time, Cormack–Lehane view, use of airway adjuncts and the need for external laryngeal manipulations constituted the secondary outcomes.

Results:

The first-attempt intubation success rate was 100% in both groups with the P value 1.0 and the intubation time was 26 s in Group C and 24.4 s in Group D with P = 0.17. The C-MACTM videolaryngoscope provided better grades of laryngoscopic view than direct laryngoscopy (P = 0.02). Tracheal tube introducer-assisted intubation (P = 0.01) and requirement of laryngeal manipulation to aid intubation (P = 0.01) were higher with the Macintosh laryngoscope.

Conclusion:

The Macintosh laryngoscope was comparable to the C-MACTM videolaryngoscope in terms of intubation success, intubation time and complications. However, an increased requirement for external laryngeal manipulation, lifting force and the use of an introducer for intubation were noted in the Macintosh group.
Airway Management in Tracheal Resection and Anastomosis – Challenges and Novel Solutions!
Authors: Pavithran Priyanka , Sekhar Biju
Published: August 2023

Airway management in tracheal resection and anastomosis is very challenging. The technique of securing the airway depends on the degree and location of stenosis. Multidisciplinary planning and good communication are the keys to the successful management of these cases. The technique used to maintain the airway and ventilation may vary and needs to be chosen on a case-to-case basis.
Assessing the bleeding severity in patients with type I von Willebrand using the International Society on Thrombosis and Hemostasis-Bleeding Assessment Tool (ISTH-BAT) questionnaire
Authors: Hafez Rania , Hennes Shery N , Abdelaal Azza , Tawfik Nabawia M , Hussein Safinaz
Published: August 2023

Background

In the recent decade, bleeding evaluation methods have evolved to standardize the severity of bleeding symptoms in a uniform manner. In 2010, the International Society on Thrombosis and Hemostasis-Bleeding Assessment Tool (ISTH-BAT) was developed and validated.

Aim and objectives

The aim of the study was to evaluate bleeding score (BS) in Egyptian patients with von Willebrand disease (VWD) type I and correlate it with laboratory parameters.

Patients and methods

This cross-sectional cohort study was conducted at Assiut University Hospital. It included 100 participants that were divided into 49 patients with type I VWD and 51 healthy participants with no known problem with bleeding or bruising. The duration of the study was ~12 months.

Results

Study revealed that there was significant relation between BS severity and laboratory parameters such as level of von Willebrand factor: Ag (P=0.02) while there was no significant relation between BS and sex (P=0.390). By using receiver operating characteristic curve analysis, ISTH-BAT BS can detect type I VWD patients in total with excellent accuracy (98%), area under the curve was 0.989 with sensitivity and specificity of 96 and 100%, respectively (P<0.001).

Conclusion

The ISTH-BAT BS is designed to reflect the severity of bleeding. Our results demonstrate the inherent variability of this bleeding pattern. We also found that the ISTH-BAT BS has high sensitivity and specificity to detect type I VWD patients in total with excellent accuracy.
Predictive factors of response to eltrombopag and romiplostim in Egyptian immune thrombocytopenia patients: a single center experience
Authors: El Demerdash Doaa , Mohamady Nagham , Abdelghany Wafaa , Youssef Heba
Published: August 2023

Background

Thrombopoietin receptor agonists (TPO-RA) are a well-established treatment in patients with immune thrombocytopenia (ITP). Predictors of response to some lines of treatment in ITP have been reported; yet, to date there are no predictors of response to TPO-RA were identified. We aimed to identify predictive factors of response to TPO-RA in adult ITP patients to avoid unwanted adverse effects and to individualize the treatment.

Patients and methods

We investigated demographic features, clinical-laboratory data as well as previous lines of treatment in 48 adult ITP patients who received TPO-RA for at least 3 months duration to detect reliable predictive factors of response to TPO-RA, in addition, health-related quality of life and fatigue burden was assessed in all studied ITP patients using 2 questionnaires which are 36-item short-form health survey and functional assessment of chronic illness therapy.

Results

The percentage of platelet change from days 0 to 28 of initiation of romiplostim can be a predictive factor of response to treatment with romiplostim (P=0.008) but none of the other studied factors has influenced response to TPO-RA. Both 36-item short-form health survey domains, as well as functional assessment of chronic illness therapy questionnaires had no statistically significant difference between the romiplostim and eltrombopag groups.

Conclusion

Slow or minimal change of platelet count during the first month of therapy with romiplostim could be used as a predictive factor of no response to romiplostim in ITP patients; In addition, none of the demographic features, initial clinical-laboratory features, previous lines of treatment with splenectomy or rituximab, or even the number of previous lines of therapy have influenced response to TPO-RA.
Prognostic significance of activin A in adult Egyptian patients with acute lymphoblastic leukemia
Authors: Azzazi Mohamed O , Abd-Allah Hegab Hany M , El-Ghammaz Amro M S , Shawky Verna A R , Hafez Heba M S , Helal Reham A A
Published: August 2023

Background

Activin A belongs to the transforming growth factor-beta superfamily of cytokines that exert a plethora of biological functions, including developmental differentiation, sex determination, control of cellular proliferation, migration, and immune responses. Activins are dimeric glycoproteins that play a significant role in reproduction and in endocrine-active tumors, although inhibins and activins have primarily been described in human gonads and identified as modulators of follicle-stimulating hormone production of the pituitary gland, they have also been detected in several solid tumor types, including endocrine-responsive endometrial, ovarian, and breast carcinomas. Their differential expression has suggested their important role in malignant cell transformation, as well as possible roles in cancer differentiation, proliferation, and growth tumors.

Aim

The aim was to assess expression of activin A in the serum of adult patients with acute lymphoblastic leukemia (ALL) and its influence on remission and survival of ALL patients.

Patients and methods

Serum activin A was measured using enzyme-linked immunosorbent assay in 30 ALL patients recruited from Hematology and Bone Marrow Transplantation Unit, Ain Shams University Hospitals, and followed for 1 year in comparison with 15 healthy controls.

Results

Serum level of activin A was elevated in ALL patients in comparison with the control group with a statistically significant difference (P<0.001). A statistically significant negative correlation was detected between age of the patients and activing-A level (P=0.035). The comparison between different outcomes of the patients (remitted, relapsed, and died patients) above and below the mean level of activin A (265.667 ng/ml), was statistically significant (P<0.001). A statistically significant negative correlation was detected between activing-A level in ALL patients and overall survival (P<0.001), and by using the log-rank test, a statistically significant difference (P<0.001) was detected in ALL patients above and below the mean level of activin A. However, a statistically nonsignificant difference was detected between the mean activing-A level in Philadelphia chromosome-positive patients and Philadelphia chromosome-negative patients (P=0.839).

Conclusion

Activin A can be a useful poor prognostic biomarker in ALL patients, also, it can be used as a predictor for aggressiveness of the disease, resistance, and survival.
Characteristics of TP53 mutation in adult precursor B-cell acute lymphoblastic leukemia
Authors: Samy Heba , Fouad Dina A , Ali Basma S.M , Attia Hend
Published: August 2023

Objectives

TP53 is the most intensively studied gene in cancer. However, data on the frequency and prognostic significance of TP53 mutations in acute lymphoblastic leukemia (ALL) are still lacking. This study aimed to determine the characteristics of TP53 mutation, its correlation with clinical and laboratory parameters and other cytogenetic alterations, and their impact on patient outcome on day 21 after induction therapy.

Patients and methods

This is a prospective cohort clinical study that was conducted on 41 de-novo adult ALL patients, who presented to the Hematology/Oncology Unit of Ain-Shams University Hospitals, where all studied patients were subjected to the treatment regimen. TP53 mutation was investigated in 41 patient samples using the RT-PCR.

Results

TP53 mutation was detected in 19.5% of studied cases. A highly significant association was detected between 17P deletion and TP53 mutation (P<0.0001). A significant association was detected between TP53 mutation and abnormal karyotyping (P=0.032). The authors found a clear association between TP53 mutation and hypodiploidy (P=0.001) and MYC rearrangements (P=0.001). In contrast, TP53 mutation was clearly underrepresented in ALL patients with t(9;22)(q34;q11). A highly significant association between TP53 mutation and the poor outcome on day 21 (P=0.002) was observed. The patients with TP53 mutation revealed either failure of remission (50%) or incomplete remission (50%). Logistic regression analysis of factors influencing the patient outcome showed that advanced age (>34 years), high total leukocyte count (>40 × 109/l), and abnormal fluorescence in-situ hybridization and karyotyping results due to cytogenetic abnormalities are independent predictors of poor outcome with failure of induction of complete remission on day 21.

Conclusion

TP53 alterations strongly identify high-risk adult precursor B-ALL patients with poor outcome in this study; yet, this needs further investigation on a larger sample size with a longer follow-up. Investigations of TP53 mutation especially in adult B-cell ALL (accounting 75% of adult ALL) may help with the selection of patients in need of intensive therapeutic strategy or may help with designation of new innovative targeted therapies.
Nothing is impossible if you have the right tools and techniques to support
Authors: Paritekar Prajakta , Haldipurkar Suhas , Shetty Vijay
Published: August 2023

Background:

Zonular weakness is a known complication that a surgeon can encounter during cataract surgery.

Purpose:

The purpose of this video is to make surgeons aware about the different tools and techniques available to handle zonulopathy.

Synopsis:

This video describes the various causes of zonular weakness and different tools available to manage zonular weakness intraoperatively. The surgical technique of using the tools is also demonstrated in the video.

Highlights:

Causes of zonular weakness and surgical techniques to handle it intraoperatively.

Video Link:
https://youtu.be/xoyOP6tiiZ4

Key words: Assi anchor, capsule hooks, CTR, CTS, zonular dialysis
An approach to reduce Descemet’s membrane scrolling: Relevance to Descemet’s membrane endothelial keratoplasty (DMEK)
Authors: Dua Harminder S , Freitas Rui , Sadek Youssef , Ting Darren SJ , Nubile Mario , Mohammed Imran , Said Dalia G
Published: August 2023

Purpose:

We aimed to determine whether Descemet’s membrane (DM) scrolling occurs primarily along the vertical or horizontal axis and establish whether oval trephination along the axis of least scrolling can reduce the grade of the scroll.

Methods:

The longest limbus-to-limbus axis on 28 sclerocorneal discs was taken as the horizontal axis. The horizontal (n = 7) or (right angles to it) vertical (n = 6) axis was marked on DM before peeling it off. The direction and grade of scrolling was observed. Narrow strips (3–4 mm wide) were then cut along the two axes (n = 4 each) and the scrolling pattern was observed. Ellipses (7 × 9 mm) of DM were punched along the two axes (n = 6 each) and the scrolls graded. Immunofluorescent staining for elastin on horizontal and vertical tissue sections from three DM samples was performed. The intensity and thickness of elastin staining were measured.

Results:

Twenty-four (85.72%) DM samples showed scrolling along the horizontal axis, none showed scrolling along the vertical axis, and four (14.28%) samples showed a spiral scroll, regardless of which axis was marked (grade 3.7 and 3.6). Vertically oval discs showed significantly reduced scrolling (grade 1.2) compared to horizontally oval discs (grade 3.5). Narrow strips of DM showed a similar scrolling pattern. Immunohistology showed no difference in any of the parameters examined along the two axes or from the center to the periphery.

Conclusion:

DM scrolls primarily along the horizontal axis. Vertically oval DM samples show minimal scrolling, which can be an advantage in DMEK. Differential scrolling is not determined by the distribution of elastin.
Prognostic factors for visual outcome after surgical repair of limbal corneal laceration at a tertiary eye care center in South India
Authors: Shetty Prerana A , Natarajan Ramya , Bhalerao Sushank A , Vuyyuru Sowjanya , Thigale Uma Yogesh , Tara Divya
Published: August 2023

Purpose:

To determine the factors affecting the visual outcome after surgical repair of limbal corneal lacerations at a tertiary eye care center in South India.

Methods:

A retrospective analysis of patients diagnosed with limbal tears between 2011 and 2021 was conducted. Demographic information such as age, gender, cause of injury, and size of the laceration was recorded. Comprehensive ocular examination was performed, including gentle B scan evaluation whenever not contraindicated for detailed posterior segment evaluation. Only those cases with a minimum follow-up of one year were included. Postoperative best-corrected visual acuity, intraocular pressure (IOP), cornea clarity, and integrity of the wound at last follow-up were noted.

Results:

Out of the 20 patients, 15 (75%) were males and 5 (25%) were females. The mean age was 42.6 ± 22.4 years. All 20 patients had a penetrating injury, with four (20%) injured by a stick, two (10%) by an iron rod, three (15%) due to road traffic accident (RTA), three (15%) by glass, and eight (40%) with other nonspecific objects [two (10%) with needle, two (10%) with elastic rope, two (10%) with bangle, and two (10%) with metal]. The average time between the injury and the surgery was 48 hours (2 days). Four (20%) patients underwent a second surgery within a week of repair. After limbal tear repair, at final follow-up at 3 years, 7 (35%) had VA worse than 20/800, 3 (15%) had VA between 20/100 and 20/800, and 10 (50%) achieved VA better than 20/80.

Conclusion:

Preoperative visual acuity (VA), mode of injury, and size of wound affect the final visual outcome after surgical repair of limbal corneal laceration. Preoperative VA and mode of injury were statistically significant even in the multivariate analysis.
Corrective and preventive actions (CAPAs) in eye bank
Authors: Garg Aastha , Nathawat Rakhi , Singh A K , Dixit Surender , Acharya Manisha
Published: August 2023

This case series highlights the challenges in eye banking and the importance of a quality assurance program. Three cases triggered corrective and preventive actions (CAPAs) to improve the processes. Case 1 emphasized training to prevent retrieval failures. Case 2 stressed the need for blood samples and comprehensive documentation. In Case 3, mishandling led to policy revisions and staff training. CAPA involved identifying concerns, root cause analysis, action plans, implementation, checks, and closure. Errors can occur in man, machinery, process, and policies. Continuous CAPA ensures continuous quality improvement and safe corneal tissue transplantation, benefiting patients in need.
Phacoemulsification, pinhole pupilloplasty, and pre-Descemet’s endothelial keratoplasty for keratoconus with Fuchs’ endothelial dystrophy
Authors: Kumar Dhivya Ashok , Jacob Soosan , Naveen Preethi , Sivagnanam Soundari , Agarwal Amar
Published: August 2023

The comorbidity of keratoconus with Fuchs’ endothelial dystrophy with cataract is a rare clinical combination. We present an amalgamation of surgical techniques to manage the above clinical conditions and its complications in single setting. The modified triple procedure, namely, the phacoemulsification, pinhole pupilloplasty, and pre-Descemet’s endothelial keratoplasty (PDEK) in the order of description is followed in single sitting. Lens removal by phacoemulsification, correction of irregular astigmatism by pinhole pupilloplasty (pinhole optics), and exchanging the endothelial layer for PDEK forms the main segments of the triple procedure. This combination of techniques may decrease the risk of multiple surgeries and its related complications. Moreover, it will allow the patient for faster visual rehabilitation by improving the uncorrected visual acuity and visual quality.
The Ganesh–Grewal cystitome maker – A step in standardizing cataract surgery
Authors: Ganesh Sri , Sriganesh Sushmitha S , Brar Sheetal , Sriganesh Supriya S
Published: August 2023

A well-centered, adequately sized continuous curvilinear capsulorhexis (CCC) is a prerequisite for successful cataract surgery. A perfect capsulorhexis ensures safe and effective performance of various steps of surgery as well as a correctly positioned intraocular lens (IOL) with optimal rotational stability. Ganesh and Grewal (GG) cystitome maker is a step toward standardizing the creation of a cystitome to reduce variations and complications associated with the crucial step of CCC in cataract surgery. We conducted a study to measure the repeatability and precision of cystitomes made by the GG cystitome maker versus those made manually with a needle holder. The results showed that the cystitomes made with GG cystitome maker had a lesser degree of variation. This indicates a more repeatable cystitome, which will inadvertently help in reducing the error caused by the instrument in making a good CCC during cataract surgery.
Posterior capsular opacification and Nd:YAG capsulotomy rates in patients implanted with square-edged and non-square-edged intraocular lenses in manual small-incision cataract surgery: A randomized controlled study
Authors: Joshi Rajesh S , Rasal Ashwini V.
Published: August 2023

Purpose:

To study posterior capsular opacification (PCO) and neodymium-doped yttrium aluminum garnet (Nd:YAG) capsulotomy rates in patients implanted with square-edged and non-square-edged intraocular lenses (IOLs) in manual small-incision cataract surgery (MSICS).

Setting:

Tertiary eye care center.

Design:

Prospective, comparative, and randomized controlled study.

Methods:

This study included patients with senile cataracts scheduled for MSICS and IOL implantation. One eye of each patient was randomized to the implantation of square-edged (S group) or non-square-edged IOL (NSQ group). An independent observer analyzed PCO at 6, 12, 18, and 24 months under slit-lamp illumination.

Results:

A total of 104 eyes were included in this study. The mean age of the participants in the two groups was 63.2 (±8.2) years, and there were 65 (62.5%) men and 39 women (37.5%). The mean best-corrected visual acuity (BCVA) values at 6, 12, and 18 months were 0.157 (±0.10), 0.11 (±0.12), and 0.12 (±0.11), respectively, in the S group and 0.17 (±0.10), 0.17 (±0.12), and 0.20 (±0.17), respectively, in the NSQ group. At 12 (P = 0.03) and 18 months (P = 0.01) follow-up, the BCVA of the S group was significantly better than that of the NSQ group. Four eyes in the NSQ group and one eye in the S group required Nd: YAG.

Conclusion:

Evaluation of PCO and Nd:YAG capsulotomy rates showed that the 360° square of the posterior IOL edge plays a role in the prevention of PCO. Owing to the low cost of the material and the easy availability of IOLs manufactured from it, square-edged IOL has a definite role in the prevention of PCO in MSICS.
Serum Methamphetamine Positivity in Trauma Patients Undergoing Surgery Has No Negative Effect on Postoperative Morbidity and Mortality
Authors: Zhou James , Wu Adela , Miao Jingya , Singh Harminder
Published: August 2023

Introduction:

The link between methamphetamine (METH) use and mortality or morbidity, particularly perioperative complications, associated with trauma surgery are not well characterized. This study aims to address this by performing a comparison of surgical outcomes between METH-negative (METH−) and METH-positive (METH+) trauma patients.

Methods:

An Institutional Review Board-approved retrospective chart review was performed on all trauma patients admitted to our Level 1 trauma center who underwent surgical operations between 2015 and 2020. Patients were categorized into METH− and METH+ groups. Patient characteristics such as age, sex, race, Injury Severity Score (ISS), presence of peri-operative complications, and mortality, amongst others, were used to perform univariate comparisons. Additional multi-variate comparisons were performed across both the whole cohort and with age, sex, and ISS-matched groups.

Results:

Of 571 patients who met the final inclusion criteria, 421 were METH− and 150 METH+. The METH+ group also possessed a lower median ISS (P = 0.0478) and did not possess significantly different mortality or morbidity than their METH− counterparts in univariate analysis. Multivariate analysis in whole-group and matched-group cohorts indicated that METH was not a positive predictor of mortality or morbidity. Instead, ISS predicted mortality (P = 0.048) and morbidity (P < 0.001).

Conclusion:

Our results suggest that METH use does not exert a positive effect on mortality or morbidity in the acute trauma surgery setting and that ISS may be a more significant contributor, suggesting severity, and etiology of injury are also important considerations for trauma surgery evaluation.
Evaluation of serum selenium levels in patients with multiple warts
Authors: Alizadeh Narges , Rafiei Rana , Darjani Abbas , Eftekhari Hojat , Nejad Kaveh Gharaei , Rafiei Elahe , Nasiri Meghdad
Published: August 2023

Background

Some micronutrients including selenium (Se) have immunoregulatory effects in the body. Our hypothesis was that decreased serum Se levels could be associated with some degree of immunodeficiency and increased chance of multiple cutaneous warts.

Objective

To measure serum Se levels in patients with multiple cutaneous warts and healthy participants to verify its inhibitory role in cutaneous warts.

Patients and methods

A case–control study was conducted on 136 participants: 68 cases with multiple cutaneous warts and 68 age-matched and sex-matched healthy controls. Collected data were age, sex, number, duration, and clinical type of the warts. Blood samples were taken from all participants for the evaluation of serum Se level. Se level was measured with atomic absorption method.

Results

Median of the Se level was significantly lower in patients with multiple warts compared with healthy controls (P<0.05), but the frequency of Se deficiency was not significantly different in the two groups. There was not any association between Se level and number of warts, but it was significantly lower in palmoplantar warts compared with genital warts.

Conclusion

A significant decrease in median Se level in patients with multiple warts even without Se deficiency may cause some decline in immune system against papillomaviruses. Lack of Se deficiency in the north of Iran may have led to nonsignificant differences in the frequency of Se deficiency in the two groups.
Conventional and molecular diagnostics for detection of causative fungi in clinical samples of human dermatomycosis
Authors: Tawfik Khaled M. , Mohammed Refaat R. , Sobhy Ali , Shaltout Asmaa S.
Published: August 2023

Background

Dermatomycosis affects millions of people worldwide; the availability of data on the prevalence of superficial fungal infections and some associated epidemiological factors in our region is little.

Objective

To compare conventional and molecular methods to characterize some fungal species causing human mycotic infection.

Patients and methods

The present cross-sectional study of fungal skin diseases was done on 100 patients. Skin scrapings and nail cuttings were subjected to direct microscopic examination using potassium hydroxide and lactophenol cotton blue, followed by culturing on Sabouraud’ dextrose agar. HiCrome agar was used for characterization of Candida species. Molecular diagnosis of some fungal isolates was performed by sequencing the ribosomal DNA internal transcribed spacer region.

Results

Tinea capitis was the commonest clinical presentation in 48% of cases, followed by tinea corporis 20% and tinea faciei 13%. Fungi were demonstrated in 88% of cases by direct microscopy and/or culture. Direct microscopy was positive in 51% of cases. A higher percentage of positivity 77% was obtained from samples cultured on Sabouraud’ dextrose agar. Dermatophytes were isolated from patients who complained of tinea capitis and tinea corporis (75 and 70%, respectively). Comparing molecular with conventional results, it was found that molecular identification was confirmatory to conventional results, except in two isolates: Chrysosporium lobatum was previously diagnosed as Chrysosporium tropicum and Trichophyton interdigitale was previously diagnosed as Trichophyton mentagrophytes by conventional methods.

Conclusion

Trichophyton violaceum and Microsporum
canis were the main etiologic agents of tinea capitis (45.8 and 27%, respectively). Epidermophyton floccosum was only isolated from four cases of tinea corporis and one of the tinea cruris. Candida species were the main causal agents of onychomycosis. Acremonium spinosum and C. lobatum appeared in this study as new etiologic agents of nail infections. Molecular identification is confirmatory to conventional results, but it is expensive and faces some difficulties, in our country, its use is encouraged to identify dermatophytes in atypical isolates.
Acne on pigmented skin
Authors: Veraldi Stefano , Faraci Andrea G. , Nazzaro Gianluca , Barbareschi Mauro
Published: August 2023

Acne occurs in all races and ethnicities. In patients with pigmented skin, acne is very common. As far as the morphology of acne lesions is concerned, no significant differences exist between Caucasian and non-Caucasian skin; however, nodular acne is likely less frequent in patients with pigmented skin. The anatomic distribution of the lesions is similar in all races and ethnicities. Pomade acne is caused by the chronic application of oily products that are used to smooth the hair. It is characterized by more or less numerous closed comedones, with some papules and rare pustules, located on the forehead and temples. A very common and important complication of acne in patients with pigmented skin is postinflammatory hyperpigmentation. It is characterized by brown-to-black macules, of different morphology and size, located mainly on the face. Additional complications of acne in patients with pigmented skin are scars and keloids. The treatment of acne is superimposable in all phototypes. In order to improve tolerability and compliance of topical anti-acne therapy in patients with pigmented skin, it is helpful to begin the treatment with the lowest concentration of the drug, to use a cream or an aqueous gel as vehicle, to apply the drug every other day, with gradual increase to daily use, and to apply frequently a moisturizer. Furthermore, photoprotection is very important.
Subjective versus objective recognition of facial vitiligo lesions
Authors: Anbar Tag S. , Atwa Mona A. , Abdel-Aziz Rasha T. , Hegazy Rehab A. , Ibrahim Sarah I. , El Genedy Rabab M. , Afify Ahmed A. , Anbar Mohammed T. , Farid Carmen I.
Published: August 2023

Background

Visual recognition of alteration in the skin color depends upon the contrast between altered areas and their surrounding background color. The maximum contrast in vitiligo exists in dark-complexioned patients between depigmented white patches and unaffected background dark skin. On the other hand, hypopigmented and even depigmented lesions may not be easily recognizable in fair skin due to less contrast. Wood's light examination becomes essential in such cases for better recognition and definition of the lesions. Despite its established role, the exact added value of using Wood's light in recognition of vitiligo lesions has not been previously studied.

Objective

To verify the differential perception of vitiligo lesions between the patient and the dermatologist compared with the gold-standard detection by Wood's lamp.

Patients and methods

This multicenter cross-sectional study included 200 vitiligo patients. The distribution and surface area of their facial lesions were delineated and measured as perceived by the patient, and by the dermatologist in standardized regular light and using Wood's lamp.

Results

Lesional surface area as perceived by the patient and the dermatologist in regular light did not differ significantly (P=0.137), while lesions delineated under Wood's lamp were significantly larger than both (P<0.001 in both instances), due to the detection of new clinically invisible lesions and/or invisible extensions to clinically visible lesions. The presence of these subclinical lesions was not related to Fitzpatrick's skin phototype, vitiligo clinical type, duration, or activity score.

Conclusion

Subclinical lesions represent a new addition to the current spectrum of vitiligo presentations. Their detection in the current study depended solely on Wood's light examination; hence, its use should be integral to vitiligo patient assessment. Pointing out these lesions to the patient is essential for proper application of local medications.
Outpatient therapeutic program
Authors: Amin Ulfat , Rasool Insha , Manzoor Foziya , Jan Rohi
Published: August 2023

One strategy for treating acute malnutrition in the community is the outpatient therapeutic program (OTP), which involves the community involvement, providing children with good appetites and management of uncomplicated severe acute malnutrition among children of 6–59 months old by providing them ready-to-use therapeutic food at home along with standard medical care. Approximately 85%–90% of kids with severe acute malnutrition are effectively treated at home in OTP by coming in frequently till they become well. With OTP, severe acute malnutrition management services are offered closer to the community at primary healthcare institutions, where children with simple severe acute malnutrition get varying amounts of ready-to-use therapeutic food such as Plumpy’ Nut sachets depending on their body weight. OTP are a vital component of the global effort to address malnutrition in children. These programs typically involve providing nutrient-dense therapeutic foods to children, along with regular medical checkups and counseling for caregivers on feeding practices and nutrition. Studies have shown that OTPs can lead to significant improvements in weight gain, recovery rates, and reduction in mortality among children with severe acute malnutrition. OTPs have also been found to be cost-effective and can be scaled up to reach a large number of children. OTPs can provide life-saving treatment to children suffering from SAM and help prevent the long-term consequences of malnutrition.
Mandatory COVID-19 vaccination: A controversial but necessary tool for public health
Authors: Panda Paramjot
Published: August 2023

BACKGROUND:

The COVID-19 pandemic has caused a global health crisis, with over 6 million deaths and over 500 million cases reported as of February 2023. Vaccination is a critical tool for preventing the spread of COVID-19 and protecting people from severe illness, hospitalization, and death.

MATERIALS AND METHODS:

This paper reviews the evidence on the safety, appropriateness, and effectiveness of mandatory COVID-19 vaccination. The paper also discusses the ethical and legal considerations of mandatory vaccination.

RESULTS:

The available evidence suggests that COVID-19 vaccines are safe and effective. The vaccines have been rigorously tested and have been shown to be safe for most people. The vaccines are also highly effective at preventing severe illness, hospitalization, and death from COVID-19. Mandatory vaccination is a controversial issue, but it may be an appropriate tool for protecting public health during a pandemic. Mandatory vaccination can help to ensure that everyone is vaccinated, which can help to stop the spread of disease and protect the most vulnerable members of society.

CONCLUSION:

The evidence suggests that mandatory COVID-19 vaccination is safe, appropriate, and effective. Mandatory vaccination may be an important tool for protecting public health during the COVID-19 pandemic.
Perceptions of the undergraduate medical students about roleplay, a teaching/learning and training tool: A descriptive cross-sectional study
Authors: Piryani Rano Mal , Piryani Suneel , Zeba Nudrat
Published: August 2023

BACKGROUND:

Roleplay is not commonly used as a tool for teaching/learning and training in the majority of medical schools in Pakistan. Bilawal Medical College, the newly established constituent college of Liaquat University of Medical and Health Sciences Jamshoro, Sindh, Pakistan, organized roleplay sessions for second-year undergraduate medical students and took feedback from them. The objective of this study was to assess the perceptions of students about roleplay as a teaching-learning/learning and training tool.

MATERIALS AND METHODS:

This descriptive cross-sectional study was conducted on June 2022 with a purposive sampling technique. The questionnaire comprised 10 closed-ended questions on a Likert scale of 1–5 (5=strongly agree, 4=agree, 3=to-some-extent agree, 2=disagree, and 1=strongly disagree) besides age and comments as open-ended questions. The validity was checked with pilot testing. The data were entered in Microsoft Excel and analysis was done in SPSS version 23. The frequency with the percentage of each item and median with interquartile range were calculated. The reliability of the questionnaire was calculated using Cronbach α.

RESULTS:

The reliability of the questionnaire was confirmed by Cronbach’s α, which was 0.75 falls within the acceptable level. The mean age of students was 20.057 ± 1.027 years. The perceptions of students are notable; the median value on nine statements (items) is 4 and one is 5, whereas the interquartile range of eight statements is 4–5 and 2 statements 3–5.

CONCLUSION:

The perceptions of medical students were positive regarding the role of roleplay in teaching/learning and training learners. A remarkable percentage of students strongly agreed to agree on all 10 items related to the cognitive, skills, and attitude domain of learning.
Synoptic review on Amavatari Rasa
Authors: Bhinde Sonam S. , Patgiri Biswajyoti J.
Published: August 2023

Amavatari Rasa (AR) is a well-known Kharaliya Rasayana that is frequently used in various diseases including Amavata (rheumatoid arthritis). AR has not been mentioned in Bruhattrayi and described by Rasendra Chintamani by Dhundhukanatha in 15th century for the first time, and amended for many times till today. Because of its efficacy and demand in clinical settings, many pharmaceutical companies are preparing this formulation and easily available in the market. But it is important to know details of the medicines one using in their clinical practice. This study was planned to get thorough idea related to its composition, method of preparation, therapeutic uses, organoleptic and physico-chemical parameters through various REFERENCES. Various Rasa classics having same ingredients of AR or having name as Vatari Rasa or AR with different ingredients were reviewed. Rasapanchaka (Ayurveda principles of drug action) and Dosha Karma (therapeutic action) of ingredients were compiled from Bhavaprakash Nighantu. Available published articles were searched through Research gate, J-gate, Google scholar, Dhara and Pubmed for its organoleptic and analytical parameters. It was found that AR has been described in 12 classical texts. Among these texts, AR has been mentioned by different names and ingredients in nine texts. Dose for AR is given as 6 Gunja (750 mg), whereas Vatari Rasa is given as 1 Karsha (12 g). Difference in Anupana (liquid to be taken along with medicine) was also found in Vatari Rasa and AR. Screening through various texts revealed that REFERENCES related to AR are available in 12 texts with few modifications inferring its efficacy in mentioned diseases since many years. This work may prove a torch bearer for future research works on Amavatari Rasa.
Randomized controlled clinical study to evaluate the efficacy of Pama-Dadru-Vicharchikahar Lepa topically in the management of Vicharchika (eczema)
Authors: Mungale Amol V. , Jaiswal Suryaprakash K. , Tikhat Kirti B.
Published: August 2023

Background:

The worldwide prevalence of eczema ranges from 15% to 20%. The exact cause of eczema is unknown. The modern dermatology employs systemic and local administration of steroid for the management of eczema. Despite an initial response, maintenance therapies with the small dose of systemic and topical glucocorticoid usually produce hazardous ill effect. This study evaluates and compares the effect of both the systems of medicine to get safe and cost-effective treatment.

Aim:

The purpose of this study was to compare the therapeutic efficacy of Pama-Dadru-Vicharchikahar Lepa (PDVL) to mometasone furoate 0.1% in the treatment of Vicharchika.

Materials and Methods:

Patients who arrived to the OPD and IPD of the Department of Kayachikita, DMM Ayurved College, Yavatmal, possess Vicharchika's classical signs and symptoms. In this study, 60 patients enrolled in two groups: 30 patients of group A treated with the local application of PDVL and similarly 30 patients of group B treated with the local application of mometasone furoate 0.1% ointment for 45 days with follow-up of 45 days. The data were compared: Wilcoxon signed rank test was used within each group, whereas the Mann–Whitney test was used between groups.

Result:

After 90 days of treatment with follow-up, it was found that in the trial group, PDVL, average % relief was 83.86%. In the control group, mometasone furoate 0.1%, average % relief was 79.69%. PDVL was found effective on % relief, safe, easy to administer, and cost-effective.

Conclusion:

The local application of PDVL is effective than mometasone furoate 0.1% in the management of Vicharchika to reduce Shyava Varna, whereas the local application of PDVL is not effective than mometasone furoate 0.1% topically in the management of Vicharchika to reduce Kandu, Pidika, Rukshata, Strava, Rajyo, Lohit Varna, Ruja, and Eczema Area And Severity Index score.

CTRI Number:

CTRI/2020/06/025982
Potential of Guduchi-Tinospora cordifolia (Willd.) Miers. (.) in the management of lifestyle disorders
Authors: Joglekar Aishwarya A. , Vyas Mahesh K. , Bhojani Meera K.
Published: August 2023

Introduction:

Lifestyle disorders such as dyslipidemia, hypertension, diabetes mellitus, chronic obstructive pulmonary disorders (COPD), stroke, and cancer pose a great risk to mankind aggravating cardiovascular manifestations leading to increased morbidity and mortality in population. The major causes of such disorders include faulty lifestyle comprising of a variety of factors including smoking, alcohol consumption, use of tobacco and other narcotic substances, sedentary lifestyle, and stress. Ayurveda promotes the use of potent herbs or herbal combination for the mitigation of various disorders. Guduchi (Tinospora cordifolia Willd. Miers. (.)) is one such herb widely used in Ayurveda in the preventive and treatment process of almost all the diseases. It is therefore also indicated for the purpose of prevention, management of lifestyle disorders, and the complications of the same.

Materials and Methods:

This review tries to focus on the applications of this multidimensional herb in the management of lifestyle disorders such as diabetes mellitus, obesity, cardiovascular disorders, COPD, and cancer. The relevant research by the contemporary sciences on the subject along with classical Ayurveda text-based REFERENCES and indications of Guduchi in related conditions according to Ayurveda is discussed in the article.

Discussion:

The literary review suggests that many research works have been conducted in this arena to prove the efficacy of this wonder herb, and its constituents are also mentioned to underline the evidences. The REFERENCES from the Ayurveda texts also underline the multidimensional activity of Guduchi on different body Strotasa.

Conclusion:

The ancient treasure of knowledge coupled with the scientific validation supports the multidimensional activity of Guduchi.
Effect of Vamana Karma (therapeutic emesis) in Mukhadushika (acne vulgaris)—A case study
Authors: Shende Harshali A. , Bhatted Santosh K.
Published: August 2023

Acne vulgaris is a chronic skin disease that comes about mostly in adolescent. It is identified by both inflammatory (papules, pustules, and nodules) and noninflammatory (comedones, open and closed) lesions. In the Ayurvedic classics, Mukhadushika is mentioned under Kshudra Rogas, which is declared that it transpires in young age, and its signs and symptoms are similar to those of acne vulgaris. In the Ayurvedic classics, Mukhadushika is mentioned under Kshudra Rogas, which is stated that it occurs in young age and its manifestations are similar to those of acne vulgaris. In Ayurveda, it is mentioned that Mukhadushika occurs due to the vitiation of Vata, Kapha, and Rakta having the Shalmali thorn like thick or hard painful eruptions, which are impregnated with Meda. Vamana karma is indicated for the treatment of Mukhadushika. This is a single case study on the effective management of Mukhadushika. Treatments included are Deepana, Pachana with Chitrakadi Vati and Musta Choorna, Shodhananga Snehapana with Tiktak Ghrita and Vamana Karma (therapeutic emesis) with Madanphala Yoga. After the completion of Vamana Karma (therapeutic emesis), a significant relief in signs and symptoms of Mukhadushika was observed. On the account of result acquired, it can be deduced that Vamana Karma (therapeutic emesis) with Madanphala Yoga can be used as an effective treatment for Mukhadushika and improve the quality of life in the patients of Mukhadushika.
Indigestion-induced hyperacidity (Vidagdhajirna) treated with Ayurveda therapy
Authors: Patil Sunny C. , Baghel Arjun S. , Kamble Shubhangi B.
Published: August 2023

Ayurveda, the ancient traditional system of medicine, believes that a majority of the diseases in humans arise due to hypofunctioning of Agni (~digestive fire). Disturbed function of Agni causing indigestion of food is termed as Ajirna (~indigestion) in Ayurveda. Vidagdhajirna is one of the types of Ajirna having Pitta predominance in its manifestation. Vidagdhajirna can be compared with indigestion-induced hyperacidity because of the resemblance in signs and symptoms observed in both the conditions. In this report, we are presenting a case of a 32-year-old female patient diagnosed with Vidagdhajirna. This case was treated with Ayurveda Shamana therapy prescribed at a specific drug administration time along with cessation of known etiological factors. Therapeutic assessment was done by using Reflux Disease Questionnaire (RDQ) scale. Significant improvement was noted in clinical parameters as well as on the standard RDQ scale without reported relapse of previous symptoms on follow-up visit. Also, there were no adverse events recorded during the treatment and follow-up period.
Therapeutic indications of formulations of Kapardika Bhasma (Cowrie calx) described in bharat bhaishajya ratnakar
Authors: Dukare Pranjali , Rathi Bharat Jagdishaji , Wanjari Anita , Khan Mujahid
Published: August 2023

Introduction:

Kapardika (Cypraeamoneta) is one of the animal origin drug mentioned in Rasashastra. According to different texts Kapardika (Cypraeamoneta) is classified under two categories they are Sudha Varga (Calcium component drugs) and Sadharana Rasa Varga (Herbal origin drug) Its medicinal usage is known since Vedic era and was used to treat various ailments effectively.

Aim and Objective:

Aim of the present study is to collect the formulations containing Kapardika Bhasma (Cypraeamoneta Powder) described in the text Bharat Bhaishajya Ratnakar and find out its therapeutic efficacy.

Materials and Methods:

All the formulations containing Kapardika bhasma (Cypraeamoneta Powder) are reviewed from all the five volumes of Bharat Bheshaja Ratnakar and again categorized according to its dosage forms.

Observation and Results:

Total 42 formulations containing Kapardika Bhasma (Cypraeamoneta Powder) have been reviewed which are indicated in Agnimandya (Loss of appetite), Parinamshula (Duodenal ulcer), Grahani (Malabsorption syndrome), Rajaykshma (Tuberculosis), Karnasrava (Ottorhoea), Netraroga (Diseases of the eye), and Sukraksaya (Oligospermia). These formulations are advised to be taken in different dosage forms such as Anjana (Collyrium) Vati (Tablets), Pottali (Bundle) etc.

Conclusion:

The present work will be valuable in recognition of newer formulations of Kapardika Bhasma (Cypraeamoneta Powder) and their therapeutic applications in various ailments.