bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluating stress in mothers of children with profound hearing impairment in Indian context
Authors: Puthiyadath Malavika , Nisha Kavassery Venkateswaran , Prabhu Prashanth
Published: August 2023

Purpose:

When a child is diagnosed with hearing impairment (HI), it will be stressful for the parents and other family members. They are more likely to experience an extensive range of emotions, which will affect the parent-child dynamics. To prevent or minimize its influence on the HI child, it is crucial to identify these stress factors at the earliest. The primary objective of the study is to use a close-ended questionnaire to assess the major stress factors experienced by Indian mothers of children with HI.

Materials and Methods:

The 21-item Caregiver Strain Questionnaire (CGSQ) was modified by replacing the emotional/behavioral domain with hearing problems. The CGSQ was administered to 100 caregivers of children with HI in the age range of 4–6 years. A 5-point Likert scale was used to measure the response ranging from “Not at all” to “Very much” a problem.

Results:

The item rated “Very much” a problem by most of the mothers was the sadness felt as a result of their child’s hearing problem. The second most reported stress mothers faced were related to the future of their child. Apart from the stress related to the personal domain, there was a considerable amount of stress related to the financial aspects.

Conclusions:

The findings from the study highlight the significant stress factors in mothers of HI children, which has important implications in counseling and family-based intervention.
The effects of Yoga on voice: A systematic review
Authors: Belpu Navya , Yeshoda Krishna
Published: August 2023

Yoga has long been seen as a multifaceted intervention. There are scientific data supporting the beneficial effects of Yoga on a person’s physical and mental wellness. Hence, this review aimed to look at the scope of applicability of these practices to target breathing, phonation, and posture for producing quality voice in normophonics and/or dysphonics. Boolean procedures were used to combine keywords, and databases such as PubMed, Google Scholar, Science Direct, Com-Disdome (ProQuest), J-Gate, and N-List were searched. Lists of references were searched manually for further relevant studies. The database searches turned up a total of 10,371 items. After removing 2072 duplicates, 8299 further articles were included in the title/abstract screening. Finally, four articles were selected for the full-length article screening. Three articles matched the inclusion criteria in the study. The review demonstrated that yogic practices, namely Pranayama, could be employed to see improvements in voice quality as the results were corroborated with scientific data and evidences.
Language disorders in children: Complementary role of child psychiatrists and speech-language pathologists
Authors: Manohar Harshini , Meera Shoba S , Nair Deepa B , Srinath Shoba
Published: August 2023

The high prevalence of developmental and psychiatric comorbidities in children and adolescents with language disorders calls for a multidisciplinary approach to assessment and management. More specifically, this study aimed to provide an overview of the complementary role of child psychiatrists in the assessment and management of children and adolescents with language disorders. Case vignette-based discussion has been chosen as a pedagogical methodology to highlight practical concerns during clinical practice. In language disorders, comorbidity is a rule rather than an exception. This diagnostic overlap is not limited to one-time point in development but is likely to occur across the lifespan. Understanding and teasing out complex relationships between language disorders, and neurodevelopmental and psychiatric comorbidities are an important step in assessment, diagnosis, and management. Language disorders may pose social disadvantages in developmental tasks such as peer relationships and learning difficulties. Children with language impairment may show considerable improvement with early intervention and may come in contact with the clinician later during childhood or adolescence, with concerns primarily related to comorbid disorders such as anxiety or depression and consequent decompensation in functionality. It would be prudent for clinicians to educate families about the longitudinal nature of language disorders and their cascading impact on overall developmental and mental health outcomes of the child. Professionals of various disciplines working with neurodevelopmental disorders, where the common interests related to the etiology and biological underpinnings of the interventions are the atypical development of the central nervous system, are best considered “clinical neuroscientists.” Consistent attempts over time and transcending interdisciplinary boundaries as a “clinical neuroscientist” will result in a coordinated team that places the best interest of the given child and the family as central.
Persons with auditory neuropathy spectrum disorder: A case study for disability certification
Authors: Shetty Hemanth N , Raghunathrao Rangasayee
Published: August 2023

Four clients had visited Tertiary clinic seeking a hearing disability certificate. All the clients reported reduced hearing sensitivity in both ears. Audiological evaluation and hearing aid trial were performed. In addition, the standardized hearing handicap checklist was administered on them. The audiological evaluation showed that two of them had bilateral symmetrical sensorineural hearing loss (SNHL) with moderate (pure-tone average [PTA]: R-42.5 and L-46.25) and moderately severe (PTA: R-61.5 and L-61.5) degree, respectively. The other two clients are diagnosed as bilateral symmetrical mild (PTA: R-38.25 and L-31.25) and moderately severe (PTA: R-61.25 and L-61.25) degree, respectively, with overlaid auditory neuropathy spectrum disorder (ANSD). The severity of hearing handicap was mild to moderate for SNHL clients and severe for ANSD clients. Further, hearing aid was found to be beneficial to the two clients with SNHL, but the two ANSD clients did not get benefit from hearing aid. Irrespective of the site of the lesion, the two clients who had moderately severe sensory neural hearing loss (HL) (≥60-dB HL) in both ears availed of concessions/benefits with the disability certificate issued to them under the guidelines of the RPD Act, 2016. Though the individual with ANSD had a mild degree of HL and experienced severe handicap due to severely impaired speech perception. The hearing aid was not beneficial for the purposes of speech perception. In spite of his severe speech perception problem, the client with ANSD with mild degree of HL was not eligible to avail of benefits from the hearing disability certificate as his HL did not reach the benchmark disability of 60-dB HL or 40% under the RPwD Act, 2016. The probable conflicts of thoughts on benchmark hearing disability are discussed in the present study.
Structural model of reading comprehension ability in English for children with English as second or subsequent language
Authors: Waknis Aarti Pushkar , Sone Piyush , Santhosh Arunima , Jose Anjali , Kaur Manpreet
Published: August 2023

Purpose:

Studies in India have examined the relation of rapid automatized naming (RAN), reading fluency (RF), phonological awareness (PA), spelling ability, and language ability with reading comprehension (RC) in English in children where English is taught for the purpose of education. However, the predictor variables of RC have not been explored.

Aim:

To propose a structural model for RC in English in children with mother tongue Marathi studying in English medium schools.

Materials and Methods:

Participants included 80 children with mother tongue Marathi (Grades 1 and 2) in English medium schools. A battery of test for the assessment of language, RAN, PA, RF, spelling and RC in English was administered. Smart PLS 3.0 was used for the analysis of data.

Results:

The final model proposed had loadings > 0.708, composite reliabilities > 0.7, and AVE of all constructs > 0.5. Discriminant validity of the model was ascertained as the values were less than the heterotraitmonotrait (HTMT) criteria of 0.85 for all components. 86% of variance in RC was explained by language ability (β = 0.409, P < 0.001) and RF (β = 0.453, P < 0.001), when RF was mediated by RAN-letter (β = 0.348, P < 0.001), and PA (β = 0.384, P < 0.001).

Conclusion:

The structural model proposed in the study is reliable and valid. Language ability and RF have significant influence on RC, and RAN-letter and PA have a significant mediating role in the relationship between RF and RC. Thus, RC in English can be improved if language and RF are developed, and RF can be improved by enhancing RAN-letter speed, and PA skills in these children.
Preparation, standardization, and in vitro anti-inflammatory action of Navatchara aakiranam
Authors: Muniraj Pooja , Karthigaeyan Kirutisri , Rayma Kehren R. , Parveen Aaliya , Karthigaeyan Balagurusamy
Published: August 2023

Background:

Siddha system is a traditional system belonging to South India. An estimated 134 million Indians are thought to have chronic sinusitis, which can cause incapacitating headaches, fever, and nasal congestion and blockage, among other symptoms. Aakiranam is one among 32 types of external medicine that is therapeutically more effective due to its quicker mode of absorption. However, these traditional formulations are less validated scientifically.

Objective:

This study aims at the preparation, standardisation and evaluation of in vitro anti-inflammatory activity of Navatchara aakiranam (NA), a Siddha classical Herbomineral formulation.

Materials and Methods:

Physicochemical analysis, sophisticated instrumental analysis, such as Fourier transform infrared spectroscopy, scanning electron microscopy, energy dispersive x-ray analysis, and inductively coupled plasma- optical emission spectroscopy studies, and in vitro anti-inflammatory using bovine serum albumin study were conducted on NA.

Results:

The study drug NA selected from the Siddha classical text “Gunapadam - Thathu Jeeva Vagupu” by Dr. Thiyagarajan R.L.I.M is taken for the first preliminary study as it is a potential as snuff in the treatment of sinusitis.

Conclusion:

This study validates the standardization of NA through organoleptic, biochemical, physicochemical, microbial load, and instrumental analyses.
Effectiveness of Varmam integration on the quality of pain management
Authors: Kannaiyan Nandhagopal , Shanmugavelan Rajalakshmi , Krishna Arunachalam , Soundariya Radha , Karunanithi Samraj , Purushothaman Vinod Nalupalil
Published: August 2023

Varmam is one of the noninvasive therapeutic procedures in the Siddha system of medicine, majorly practiced in ortho- and neuromuscular diseases. This observational case study was used to evaluate the effectiveness of Varmam integration with non-steroidal anti-inflammatory drugs improving the quality of life by reducing the pain. Fifteen participants of both sexes on different characteristic of pain such as sharp, hot, cold, and throbbing were participated in this semiexperimental study. Precisely targeted and commonly used pain-reducing Varmam points were manipulated for the patients based on the “Guidelines for practice of Siddha Varmam Therapy”. The different aspects and types of pain that patients experienced were measured with the help of Pain Quality Assessment Scale (PQAS) used before and after the Varmam application. PQAS can help to measure the type of pain such as sharp, hot, cold, dull, aching, radiating, throbbing, heavy, shooting, tender, tingling, and unpleasant categories. Findings showed that the scores of pain, quality of pain, and depth of the pain were significantly decreased, and quality of life was significantly increased. Varmam manipulation significantly decreased the severity of pain, such as aching pain, sharp pain, radiating pain, unpleasant pain, and dull types of pain, when compared with the pain with nature of tingling and throbbing, hot and cold cramping, and dull, heavy, and numb types of pain. The unique Siddha therapeutic procedure Varmam holds a considerable position in the management of pain with or without other supportive medications. Further heightened research can prove the hypothesis.
An analytical feedback report of Siddha Yogam practice and integration perspective among the undergraduate female medical students of Tirupati
Authors: Shanmugavelan Rajalakshmi , Karunanithi Samraj , Kannaiyan Nandhagopal , Sudalaimani Radha , Krishnasamy Arunachalam , Nerella Sharvani , Kadarkarai Kanakavalli
Published: August 2023

Background:

The application of Siddha Yogam (SY) as a healing intervention, which began early in the ancient Indian history, which has various health benefits. This is the first preliminary study to evaluate the student interest toward SY and integration.

Objective:

This study was aimed to assess: (i) modern medical students’ awareness (ii) knowledge, benefits and (iii) interest of medical students toward integration of SY in clinical practice.

Materials and Methods:

SY training was conducted for the students of Sri Padmavathi Medical College for Women, Tirupati, Andhra Pradesh, India. A total of 38 students were participated in a SY session. The training was conducted for about 2 weeks daily for a duration of 45 minutes. Feedback questionnaires were used to collect student perceptions about SY.

Results:

The result shows that out of 38 students, 37 (97.4%) were already aware of the benefits of SY, 28 (73.7%) practiced daily, 31 (81.6%) participated in the SY session regularly, 38 (100%) want to continue session in future, 38 (100%) had an interest in attending session, 15 (39.5%) found difficulty in doing SY during Yogam session, and 36 (94.7%) said that they will suggest Siddha Yogam for the patient approaching them.

Conclusion:

From the feedback data collected, it is evident that the students are interested in SY, aware of the benefits of SY, and are looking forward to an opportunity for an integrative approach in treatment strategy.
Standardization of the traditional Pudam (calcination) process used for higher-order medicine preparation in the Siddha system of medicine
Authors: Pudhur Mahendramani Indhu , Soruban Thiruvancheeswaran , Arul Dhas Sherin Nisha , Shanthirappan Sivakkumar , Ramasamy Meenakumari
Published: August 2023

Introduction:

Higher-order Siddha medicines such as Parpam and Chenduram are mainly prepared by the Pudam (calcination) process. The Pudam process is measured by the number of cow dung cakes (Varatti) used for the calcination process. The commercially available cow dung cakes are in various sizes, shapes, and thicknesses. Hence to overcome these difficulties, an attempt has been made to standardize the cow dung cake used for the Pudam process.

Materials and Methods:

An aluminum ring-like mold was made with the dimensions of 30 cm diameter and 1.25 cm height as a mold for preparation of cow dung cakes. In this study, Kaadai Pudam, Kowthari Pudam, Kukkida Pudam, Varaga Pudam, Manal maraivu Pudam, and Gaja Pudam were done, and standardization of heat generation during the Pudam process is recorded by the digital thermo-sensor and validated for different types of Pudam processes by using standard size cow dung cakes. In addition, the time duration of the Pudam process, peak temperature, and the sustain of peak temperature was also noted.

Results:

The time duration of the entire Pudam process of the aforementioned pudam processes was noted as about 4 h 50 min, 6 h 20 min, 8 h 40 min, 9 h 55 min, 10 h 35 min, and 17 h 50 min, respectively.

Conclusion:

The obtained results of temperature and time duration for each variety of Pudam process may help to establish the modernized technology-based instruments to prepare higher-order Siddha calcination medicines, without compromising the standard and quality of medicines.
Drug standardization and in vitro wound healing potential of Siddha herbomineral formulation Kandhaga Ennai for diabetic ulcers
Authors: Rayma Kehren R. , Karthigeyan Kirutisri , Muniraj Pooja , Gladys Jeeva , Karthigaeyam Balagurusamy
Published: August 2023

Background:

A serious and often expensive consequence of diabetes mellitus and diabetic foot ulcers are a major global source of death and morbidity. A diabetic patient's lifetime risk of developing a foot ulcer has been estimated to be between 19 and 34%.

Objective:

The study drug Kandhaga Ennai (KE) selected from the Siddha classical text Rasavatha Manjari by P.M. Abdullah Saayabu is taken for preliminary assessing its wound healing potential of Ranamegangal (diabetic ulcers).

Materials and Methods:

The drug is prepared as per the method mentioned in the classic Siddha literature. KE is subjected to a sophisticated instrumental analysis such as Fourier transform infrared (FTIR) inductively coupled plasma optical emission spectrometry studies, a few physicochemical analytical parameters, and in vitro preclinical studies toward wound healing assays.

Results:

The study infers that all the toxic heavy metals are within range. KE has significant antioxidant activities reducing free radicals and effective antifungal property, and promotes migration and proliferation of fibroblasts. The results indicate that the herbomineral formulation may be useful in effective management of superficial wounds.

Conclusion:

This study validates the traditional claim of KE confirming the herbomineral formulation for anti-inflammatory, antioxidant, antimicrobial, and wound healing activities through in vitro methods. Additional experimental animal tests as well as clinical trials are required of this drug to treat diabetic ulcers.
Monostotic Fibrous Dysplasia Involving the Midface – A Case Report of Conservative Surgical Approach
Authors: Aslam A. Sachin , Ayisha M. K. , Roshni A. , Mathew P. C. , Akhila K.
Published: August 2023

Fibrous dysplasia (FD) is an idiopathic, non-hereditary abnormality of skeletal development. It is distinguished by the excessive growth of fibrous tissue in irregular bony trabeculae that replaces normal bone. The recommended method of management is surgery, with two alternatives available: radical excision and reconstruction or conservative bone shaving. When compared to polyostotic FD, monostotic FD (MFD) is four times more common. For individuals who go undiagnosed, the malignant potential is 0.4%–1%. We present a case of MFD of the midface, which causes facial asymmetry and was successfully treated with conservative surgery.
Non-surgical Management of a Large Periapical Lesion: A Case Report
Authors: Nadakkavil Salahudheen , Nair K. Radhakrishnan , Praveena G. , Surya K. R.
Published: August 2023

Periapical lesions develop as a sequela to pulpal diseases. The majority of inflammatory periapical lesions are initially treated with conservative non-surgical procedures. The success of root canal treatment is based on thorough cleaning, shaping and obturation of the root canal system. Calcium hydroxide and triple antibiotic paste (TAP) are recommended as intracanal medicaments due to its antibacterial properties. This case report describes the non-surgical management of a large cyst-like periapical lesion in relation to the maxillary lateral incisor of a 19-year-old male with the chief complaint of periodic swelling and pus drainage from the palatine region with a history of a traumatic accident in the same area. The present case highlights the use of calcium hydroxide and TAP as an interappointment endodontic dressing for non-surgical management of large periapical radiolucency, which resulted in favourable clinical and radiographic outcomes.
Minimally Invasive Aesthetic Management of Dental Fluorosis
Authors: Khadeeja M. , Rakhi P. V. , Praveena G. , Nair K. Radhakrishnan , Santhosh Midhuna
Published: August 2023

Dental fluorosis is a developmental disturbance of enamel caused by the intake of excessive fluoride, which leads to pathological changes to ameloblasts that interfere with the formation of normal hydroxyapatite crystals. The resultant appearance ranges from white opaque to dark brown colour and pitting and chipping of teeth which affects the aesthetic characteristics and self-confidence of the patients. The treatment methods to improve the appearance of dental fluorosis include microabrasion, bleaching, resin infiltration, composite restoration, placement of veneers or full crowns and a combination of the above. This case report describes minimally invasive aesthetic management in a 22-year-old female patient with moderate dental fluorosis. The treatment plan included enamel microabrasion followed by in-office bleaching. After 16 months of follow-up, an evaluation of the patient’s aesthetics revealed that teeth affected by dental fluorosis could be successfully treated with a minimally invasive technique involving micro-abrasion and in-office bleaching.
Endodontic Management of Four-Rooted Maxillary Second Molar with Large Periapical Lesion: A Case Report
Authors: Noufal M. V. , Nair K. Radhakrishnan , Praveena G. , Surabhi R.
Published: August 2023

Successful endodontic therapy requires a thorough understanding of root canal morphology and its variations. Commonly encountered morphological variations include the presence of extra roots, additional canals, lateral canals and deltas. The presence of periapical lesions in morphologically varied teeth may pose an additional clinical challenge affecting the long-term outcome of endodontic treatment. This case report demonstrates the successful endodontic treatment of four-rooted maxillary second molar with a large periapical lesion. Tooth #17 had a unique anatomy with two widely separated palatal roots, with two separate canals having different portals of exit. Successful healing of the periapical lesions was observed in an 8-month review.
Fragmented Glass Foreign Body in the Pre-auricular Region: Computer-assisted Radio Monitoring-guided Retrieval in a 3-year-old Child
Authors: Aslam A. Sachin , Manju S. , Roshni A. , Mathew P. C. , Hamza P. Shameem
Published: August 2023

Craniomaxillofacial region represents a complex region with anatomical boundaries that has difficult accessibility and slippage of foreign bodies into deeper planes challenging the surgical retrieval. Removal of embedded foreign bodies from the craniofacial region poses an additional risk of facial scars, particularly in the aesthetic zones. Most often for easy localisation and retrieval of these foreign bodies, an additional incision might be required over the site where it is embedded. Here, we report a case where a fragmented glass foreign body was localised and retrieved from the pre-auricular region of a 3-year-old child precisely using an intraoperative computer-assisted radio monitoring (C-arm) technique without additional incisions. We made use of an existing facial wound which was away from the actual location of the foreign body. Image-guided surgery is a technical refinement towards surgical exploration in anatomically complex regions. C-arm can be used routinely to aid surgical procedures as it is easy to use in operating rooms, technique friendly as well as cost-effective.
Siblings with Scheie syndrome
Authors: Anna Varghese Meenu , Kuncheria Jo Martin , Poornima K. N , Peter Anu Marie
Published: August 2023

Mucopolysaccharidoses (MPS) are a group of inherited lysosomal storage disorders. Mucopolysaccharidosis type 1 (MPS-1) results from mutation of the IUA gene on chromosome 4p encoding alpha-L-iduronidase. Clinical features vary from severe Hurler-to-mild Scheie syndrome. A 10-year- and 10-month-old boy, born as the third child of nonconsanguineous marriage presented with opacity of bilateral cornea as well as restricted movements and progressive deformity of the spine, bilateral upper limb and lower limb since birth. History of right inguinal hernia repair at 1 year, B/L carpel tunnel surgery at 8 years, and right lamellar keratoplasty at 9 years. H/o repeated upper respiratory infection present. History of fever triggered seizures at 1.6 years and 2 years. Gives h/o delay in attainment of motor milestones. Presently he has poor scholastic performance with difficulties in writing, learning and performing mathematical calculations. Hearing assessment done was normal. Right eye near vision was 20/100 distance equivalent. The left eye showed light perception only. His 13-year-old sibling who has similar complaints since birth. General examination shows coarse facies with corneal clouding, contracture, and deformity of multiple joints. Anthropometry shows underweight and short stature. Hepatosplenomegaly was present. Routine blood investigations were within normal limits. He had a urine MPS screening done at 3 years of age which was positive for MPS-1 and the diagnosis was confirmed based on nucleic acid isolation later at 6.6 years of age. Echocardiogram done was normal. The child was diagnosed to have MPS-1. He was managed by multidisciplinary approach including Recombinant enzyme replacement therapy and medical and surgical treatment for his disabilities.
A portrait of COVID-19 pandemic among pediatric patients in South India
Authors: Kumaran Keerthi , Gireeshan V. K. , Sreeraj R. , Vijayakumar M. , Babu F. C. A.
Published: August 2023

INTRODUCTION:

In a report from Kerala, 7% of coronavirus disease (COVID)-positive patients were constituted by children less than 10 years old. This observational study gives a glimpse to the pattern of COVID-19 disease among the pediatric age group during the first wave of the pandemic.

MATERIALS AND METHODS:

This observational study was conducted in a COVID hospital in Malappuram from July 2020 to March 2021. Children under 12 years old admitted to the hospital with confirmed COVID-19 infection were included in the study. The study included main symptoms, duration of symptoms, laboratory analysis and relations with severity of disease, interventions required, and follow-up details. All these details were collected using a proforma.

RESULTS:

Four hundred ninety-two patients were included in the study. A total of 51.4% of these patients were asymptomatic. Only 1.8% of children had severe disease. The mean duration for which the symptoms lasted in each child was 1.9 ± 2.8 days (P = 0.00). There was a significant association between the severity of disease and presence of comorbidities, neutrophil-to-lymphocyte ratio (NLR), C-reactive protein (CRP), liver enzymes, serum ferritin, and X-ray findings (P < 0.05). Some skin lesions were noted in a group of children during the 3 months of follow-up (2%).

CONCLUSIONS:

During the first wave of COVID-19 pandemic, most of the children had asymptomatic disease. Severe disease was more common in children with chronic comorbidities. NLR, CRP, liver enzymes, serum ferritin, and chest X-ray findings can point toward the severity of the disease. Most of the children improved without any specific treatment. Some skin lesions such as urticaria were noted in the post-COVID period.
An antenatally missed case of harlequin ichthyosis
Authors: Balakrishnan Padmapriya , Arun Babu Thirunavukkarasu , Vijayan Sharmila
Published: August 2023

Newborns are particularly susceptible to severe illnesses during the early neonatal period due to various causes. To anticipate congenital diseases in babies before birth and ensure prompt management, it is crucial to gather a detailed medical history, conduct a thorough clinical examination, and perform antenatal ultrasound examinations of the mother. However, certain rare genetic disorders such as harlequin ichthyosis, characterized by thick generalized hyperkeratotic scaling and deep fissuring of the skin, cannot be detected through routine antenatal investigations. This condition often leads to neonatal death in the early days of life and poses significant emotional distress for the parents. We present a case of a newborn displaying symptoms of harlequin ichthyosis who passed away shortly after birth to emphasize the importance of recognizing this condition during the antenatal period, even when routine investigations do not reveal its presence.
Applied genetics in pediatric practice
Authors: Shagufa M. , Remesh Preetha , Anand M. R. , Vishnu Mohan P. T. , Pachat Divya
Published: August 2023

Systemic pseudohypoaldosteronism (PHA) type I is a rare genetic disorder resulting from mutations in the subunits of the epithelial sodium channel that manifests as severe salt wasting, hyperkalemia, and metabolic acidosis in infancy. In this article, we report two cases with systemic PHA presented as a shock in the early neonatal period. They were found to have a known mutation in the SCNN1A gene and subsequently required long-term treatment with high-dose fludrocortisone, antihyperkalemic measures, and added salt in diet. In any neonate who presents with hyponatremia, hyperkalemia, metabolic acidosis, dehydration, shock, and failure to thrive, pediatricians should consider the possibility of PHA as it could be potentially lethal if the diagnosis is delayed. It is also important to differentiate such cases from congenital adrenal hyperplasia.
Imaging clues for an early diagnosis of Nipah encephalitis, a new epidemic alert—2021
Authors: Mohanlal Smilu , Janardhanan Sujith , Kumar Satish , Anand Manjula , Suresh Kumar E. K. , Ramakrishnan K. G.
Published: August 2023

We report an interesting case of viral encephalitis where neuroimaging and a careful clinicoepidemiologic correlation led to the diagnosis, and we could alert the public health facilities to take measures to contain the spread. A 12-year-old boy presented with fever, headache, photophobia, seizures, and altered sensorium. Magnetic resonance imaging brain revealed T2 FLAIR hyperintensities in bilateral cerebral hemispheres. The differential diagnoses considered were viral/bacterial/rickettsia encephalitis/vasculitis. He also had myocarditis and acute respiratory distress syndrome (ARDS). On careful observation of this triad of encephalitis, myocarditis, ARDS, and previous experience of Nipah encephalitis in North Kerala (Kozhikode), cerebrospinal fluid for Nipah virus isolation was sent and that was positive. Though the boy succumbed to ARDS, health authorities took measures such as quarantine measures, careful disposal of the body, and lockdown measures in the locality to curb the spread. This case report highlights the importance of careful clinicoradiologic epidemiologic correlation in unexplained encephalitis.
A case of a 45,X,46,X+mar male phenotype mosaic Turner syndrome with a mixed gonadal germ cell tumor
Authors: Lagarteja Regrine Bolando , Bautista-Zamora Brenda Bernadette , Canoy Christian A.
Published: August 2023

Turner syndrome is a congenital condition affecting 1 in every 2500 female live births. This condition is characterized by complete or partial loss of the X chromosome. They commonly present with normal female external and internal genitalia and may develop hypogonadism and streak ovaries later in life. We describe an unusual presentation of a case of Turner syndrome – a 31-year-old Filipino with male phenotype mosaic Turner syndrome, with 46,X,+mar[46]/45,X[4] chromosome, presenting with ambiguous genitalia and a pelvoabdominal mass. The patient underwent exploratory laparotomy, peritoneal fluid cytology, adhesiolysis, tumor debulking (gonadectomy) appendectomy, omentectomy, identification and inspection of bilateral ureters and bladder, gonioscopy and biopsy of the urogenital cavity (bladder vs. vagina). Histopathology revealed a mixed gonadal tumor, consisting of 70% yolk sac tumor, and 30% dysgerminoma. The patient eventually succumbed to postoperative complications. Postmortem fluorescence-in situ hybridization revealed a 46,X,+mar[46]/45,X,[4].ish der (Y) (DYZ3+), a marker of chromosome Y origin, consistent with a mosaic type Turner syndrome, associated with increased risk for gonadal malignancy.
Comparison between gynecologic oncology ultrasound and magnetic resonance imaging in the assessment of early-stage cervical cancer: A local experience in cancer imaging
Authors: Parroco Martha Isabel Junio , Amparo Genalin F. , Coloma Leilani C.
Published: August 2023

OBJECTIVE:

This study aimed to compare the diagnostic accuracy of gynecologic oncology ultrasound and magnetic resonance imaging (MRI) in the assessment of early-stage cervical cancer.

METHODOLOGY:

This was a prospective, cross-sectional study of patients with early-stage cervical cancer eligible for radical hysterectomy in a tertiary government institution from November 25, 2020, to August 2, 2022. Preoperative gynecologic oncology (transabdominal/transvaginal/transrectal) ultrasound and MRI measurements were obtained and compared with histopathologic findings. Sensitivity, specificity, positive predictive value, negative predictive value, and positive likelihood ratio were used to check for the diagnostic accuracy of each modality.

RESULTS:

A total of 27 patients were enrolled in the study. Four were stage IB1 (14.81%), 10 were stage IB2 (37.03%), nine were stage IB3 (33.33%), two were stage IIA1 (7.40%), and two were stage IIA2 (7.40%). Ultrasound has a comparable diagnostic accuracy with MRI to assess tumor size length, width, and height with an area under the curve of 0.789, 0.753, and 0.806, respectively. Both modalities can predict the absence of parametrial invasion and nodal involvement with a specificity of 100% and a negative predictive value of 88.89% and 81.48%, respectively. The results of the gynecologic oncology ultrasound showed good agreement with MRI.

CONCLUSION:

Ultrasound has comparable diagnostic accuracy with MRI in assessing tumor size, parametrial invasion, and nodal involvement in patients with early-stage cervical cancer. It is a good alternative imaging modality to MRI in staging cervical cancer, especially in low- to middle-income countries.
Myoinositol supplementation in the prevention of gestational diabetes mellitus among high-risk pregnant women: A meta-analysis
Authors: Ong Ava Katrina Pacleb , Pacquing-Songco Debby F.
Published: August 2023

OBJECTIVE:

The objective of the study was to determine the effectiveness of myoinositol (MI) supplementation in the prevention of gestational diabetes mellitus (GDM) among high-risk patients.

MATERIALS AND METHODS:

Comprehensive and systemic online searches were performed on PubMed, MEDLINE, Ovid, and Cochrane. Cross-referencing from related articles was also done. Only studies published in English were included in the study. We selected all randomized controlled trials on MI and singleton pregnant women with high risk for GDM.

DATA COLLECTION AND ANALYSIS:

Five randomized controlled trials were evaluated by two independent reviewers. For each comparison, the quality of evidence was assessed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Cochrane Collaboration tool. Review Manager 5.3 was used to generate the risk of bias evaluation and the analysis of the results.

MAIN RESULTS:

The present study identified five randomized controlled trials involving 871 participants. The comparison of the studies showed a statistically significant reduction in the incidence of GDM in MI supplementation versus the control group (odds ratio [OR] = 0.32, 95% confidence interval [CI] = 0.19–0.53,P= 0.0001,Z= 4.36) by 68%. Similarly, there is a greater reduction in the incidence of fetal macrosomia among patients in the MI group than the controlled group (OR = 0.24, 95% CI = 0.07–0.78;P= 0.02,Z= 2.36) by 78%. However, there was no difference in terms of incidence of gestational hypertension (OR = 0.61, 95% CI = 0.19–2.01;P= 0.42,Z= −0.81), cesarean section (OR = 0.89, 95% CI = 0.65–1.22;P= 0.47,Z= 0.72), and neonatal hypoglycemia (OR = 0.35, 95% CI = 0.01–8.80;P= 0.53,Z= 0.63) outcomes.

CONCLUSION:

MI supplementation taken at 4 g daily would decrease the incidence of GDM and fetal macrosomia. There was no statistically significant reduction in the risk of gestational hypertension, cesarean section, and neonatal hypoglycemia in the supplementation of MI.
Determining the risk of gestational hypertension, preeclampsia, and adverse perinatal outcomes in patients with antenatal lower threshold blood pressure elevations: A retrospective cohort study
Authors: Acosta Abigail Sandra Yao , Zamora Brenda Bernadette B.
Published: August 2023

BACKGROUND:

Diagnosing hypertensive disorders in pregnancy utilizes systolic blood pressure (BP) of >140 mmHg and/or diastolic of >90 mmHg. However, since 2017, the American College of Cardiology and the American Heart Association (ACC/AHA) have been endorsing lower BP thresholds for diagnosing hypertension.

OBJECTIVES:

This study determines if antenatal lower threshold BP elevations under elevated BP and Stage 1 hypertension from ACC/AHA show an increased risk of gestational hypertension, preeclampsia, and adverse perinatal outcomes.

MATERIALS AND METHODS:

This retrospective cohort study included service patients with prenatal consultations and deliveries at a private tertiary-level hospital from February 2016 to 2020. Antenatal BP measurements, categorized into “normal,” “elevated BP,” and “Stage 1 hypertension” under ACC/AHA classifications, had crude and adjusted relative risks (aRRs) and 95% confidence intervals (CIs) estimated to determine their associations with hypertensive disorders of pregnancy.

RESULTS:

Stage 1 hypertension was twice more likely to develop gestational hypertension (aRR: 2.314, 95% CI: 1.08–4.98) and thrice more likely to develop preeclampsia (aRR: 3.673, 95% CI: 2.30–5.86), whether without (aRR: 3.520, 95% CI: 1.33–9.29) or with severe features (aRR: 3.717, 95% CI: 2.16–6.41). There was a slightly increased risk for adverse perinatal outcomes from Stage 1 hypertension, as well as all outcomes from elevated BP, but was not statistically significant. Majority of BP elevations were during the third trimester.

CONCLUSION:

Lower threshold Stage 1 hypertension showed an increased risk of developing hypertensive disorders of pregnancy, with a three-fold increased risk for preeclampsia. There may be advantages in its application for diagnosing preeclampsia or having increased monitoring for these patients.
Survival rate, recurrence rate, and complications of routine appendectomy for patients with borderline and malignant mucinous ovarian tumor: A systematic review and meta-analysis
Authors: Manuel Applenette April San Jose , Co-Hidalgo Maribel Emma
Published: August 2023

OBJECTIVE:

The objective of the study is to determine the survival rate, recurrence rate, and complication rate among patients diagnosed with borderline and malignant mucinous ovarian tumor (MOT) who underwent complete surgical staging with appendectomy.

METHODOLOGY:

Eligibility criteria – A search of published literature was conducted in the electronic databases of MEDLINE (PubMed), Cochrane, and Google Scholar through 2000–2022, using a search strategy based on the PIO framework. Information of sources – The citations were identified with the use of a combination of the following text words: “mucinous ovarian tumors,” “MOT,” “appendectomy,” and “pseudomyxoma peritonei.” All retrospective studies with histopathologic diagnosis of borderline or malignant MOTs with patients who underwent appendectomy during primary surgery, including encompassing data on survival rate, recurrence rate, and/or incidence of complications (postoperative infections, appendectomy site leakage, hemorrhage, abscess, peritonitis, bowel perforation, and intestinal obstruction) that matched the terms set by the researchers were retrieved. Risk of bias – For the methodological quality of the individual clinical trials, the Jadad scale was used, which is based on the three following subscales: randomization (2, 1, or 0), blinding (2, 1, or 0), and dropouts/withdrawals (1 or 0). Guidelines for Cochrane collaboration were used to assess the risk bias. Synthesis of results – Review Manager version 5.3 (RevMan 5.4.1) was used by the researcher to perform the systematic review and meta-analysis of included studies.

RESULTS:

There were eight retrospective studies included in this study. The random interval for survival rate is 64.9%–99.7% with a P < 0.1. The prediction interval for recurrence rate is 0%–100% with 95% confidence interval. The odds of complications occurring are <0.69–2.99 times with 95% confidence interval, with mean effect size is 0.083, and with a 95% confidence interval is 0.027–0.23.

CONCLUSION:

The mean prevalence of abnormal histology of the appendix in patients diagnosed with borderline and malignant MOTs and underwent appendectomy during primary surgery is 3%–13%. There is no statistically significant difference in survival rate of patients who were diagnosed with borderline and malignant MOTs with or without appendectomy during primary surgery. The prediction interval for recurrence rate is 0%–100% with 95% confidence interval. There is no significant difference between the rate of complications in patients who underwent appendectomy and those without.
Assessing the diagnostic performance of four ovarian malignancy prediction risk models in differentiating benign and malignant ovarian masses in a tertiary hospital
Authors: Sarmiento-Babiera Mea Janelle F. , Llamas-Clark Erlidia F.
Published: August 2023

INTRODUCTION:

Ovarian cancer is considered the most lethal gynecologic malignancy because it is difficult to diagnose in its early stages. Ovarian malignancy prediction models may be useful in discriminating between benign and malignant masses, allowing for accurate and timely referral as well as proper therapeutic care.

OBJECTIVE:

To evaluate the diagnostic performance of the four ovarian prediction models: Risk of Malignancy Index-4 (RMI-4), Risk of Ovarian Malignancy Algorithm (ROMA), Copenhagen Index (CPH-I), and International Ovarian Tumor Analysis (IOTA)-Assessment of Different NEoplasias in the AdneXa (ADNEX) in identifying malignant and benign ovarian masses.

MATERIALS AND METHODS:

This was a retrospective, cross-sectional, analytical diagnostic study in a tertiary hospital between January 2017 and December 2020. Receiver operating characteristic (ROC) curves, area under the curves (AUCs), sensitivities, specificities, positive and negative predictive values, and positive and negative likelihood ratios were used to assess the diagnostic performance of the prediction models.

RESULTS:

We analyzed a total of 248 patients. One hundred and sixty-one (65%) had benign tumors, 28 (11%) had borderline, and 59 (24%) had malignant tumors. The AUCs of all models were all above 90%, but when compared to the other models, CPH-I had the best estimate. RMI-4 had the highest sensitivity (98.3%) in diagnosing malignancy. For appropriately diagnosing benign disease, the IOTA-ADNEX model exhibited the highest specificity (92.1%). Overall, RMI-4 had the lowest diagnostic accuracy (74.6%), whereas IOTA-ADNEX had the greatest (93.2%).

CONCLUSION:

The four malignancy prediction models in this study were all useful tools in discriminating between benign and malignant ovarian tumors. IOTA-ADNEX, CPH-I, and ROMA all demonstrated overlapping diagnostic performances indicating that they are equal in that regard. In terms of sensitivity in predicting malignancy, RMI-4 was the most sensitive. CPH-I is the predictor with the best overall estimate. Lastly, IOTA-ADNEX was the most specific, and displayed highest diagnostic accuracy among the four.
Prevalence and determinants of long-acting reversible contraception initiation among teenage mothers in a tertiary hospital
Authors: Santiago Ma. Shenny Joy A. , Pastrana Mona Liza B.
Published: August 2023

BACKGROUND:

According to the WHO, about 16 million girls at the age of 15–19 years give birth each year. In the Philippines, 600 live births a day are registered under teenage mothers. At Mariano Marcos Memorial Hospital and Medical Center, 12% of all obstetric admissions yearly are teenagers. The American College of Obstetricians and Gynecologists recommends long-acting reversible contraception (LARCs), in the form of intrauterine device and progestin subdermal implant as pregnancy prevention options for young mothers. The objective of the study was to identify the prevalence and determinants of long-acting reversible contraception (LARC) initiation among teenage mothers in Mariano Marcos Memorial Hospital and Medical Center.

METHODOLOGY:

Prospective observational study: A self-administered questionnaire was given to the respondents wherein they ranked determinants involved in their selection of a contraceptive method on a scale of 1–4 (1 being the most important, and 4, the least important).

RESULTS:

A total of 162 teenage mothers participated in the study. Majority of the respondents were 17–18 years old, enrolled up to high school, single, unemployed, and primiparas. Eighty-seven percentage of all teenage mothers admitted at Mariano Marcos Memorial Hospital and Medical Center from December 2020 to December 2021 used long-active reversible contraception. Ranked from most (1) to least (4) important, the respondents considered: (1) Effectivity, (2) Long duration, (3) Family influence, and (4) Peer influence as their determinants for initiating LARC method. The high effectiveness and long duration of LARC were the primary reasons for initiation, while the least factors they considered were that of peer and family influence.
Dilemmas and management of a pregnant 10-year-old sexual assault victim
Authors: Valera-Defensor Pamela Grace V. , Martinez-Bucu Mikaela Erlinda G.
Published: August 2023

There has been a dramatic increase in very young adolescent pregnancies in recent years, with pregnancies documented in children as young as 10 years old, likely from sexual abuse. This article presents a 10-year-old female who initially consulted at the emergency room in her 27th week of pregnancy as a result of recurrent sexual abuse. Prompt assessment, diagnosis, and appropriate referrals to Obstetrics, Pediatric Adolescent Clinic, Psychiatry, and Child Protection Unit rendered optimal management for the patient. Dilemmas encountered in managing the case included preterm labor, large-for-gestational-age baby, immature pelvis, and approach to the appropriate mode of delivery compounded with management of trauma from sexual abuse. A multidisciplinary approach in managing these dilemmas achieved optimal outcomes with the patient delivering a live baby boy, appropriate for gestational age via cesarean section at term.
Double Trouble
Authors: Balicanta Christopher John Jericho A. , Toral Jean Anne B.
Published: August 2023

A 55-year-old, Gravida 2 Para 2 (2002), presented with postmenopausal vaginal bleeding. Workups pointed toward ovarian malignancy with distant metastasis (pleural effusion). Exploratory laparotomy, bilateral salpingo-oophorectomy, surgical staging, and appendectomy were performed. On histopathological examination, synchronous high-grade serous carcinoma of the right fallopian tube and borderline mucinous tumor of the left ovary were diagnosed. Primary fallopian tube carcinomas are very uncommon, while synchronous tumors of the female genital tract are extremely rare. Furthermore, there is a paucity of literature discussing the occurrence of synchronous primary malignancies arising from the fallopian tube and the ovary. It is crucial to differentiate primary malignancies from metastatic cancers to determine accurate staging and prognosis, as well as to assign appropriate treatment strategies. Immunohistochemistry and molecular testing play vital roles as adjunctive diagnostic tools to histologic examination in determining the origins of these tumors and distinguishing primary tumors from metastasis.