bluuebunny/crossref_metadata_2025 huggingface dataset:
Physician visits for psoriasis and reduced risk of adverse pregnancy outcomes: A nationwide study in Taiwan
Authors: Kao Li-Ting , Yang Hui-Wen , Chang Yu-Tien , Li I-Hsun , Chen Liang-Hsuan , Hu Ya-Chiao , Chen Yi-Hsien
Published: July 2024

Background:

It is unclear whether women with psoriasis who receive adequate management or achieve better control of their psoriasis before and during pregnancy could eliminate the negative effects.

Objectives:

The objective of this study was to investigate the association between physician visits for psoriasis and adverse pregnancy outcomes.

Methods:

This study used the National Health Insurance database and Birth Certificate Application in Taiwan. This research further categorized the study subjects into mothers with mild/severe psoriasis who visited physicians for psoriasis before delivery, mothers with mild/severe psoriasis who did not visit a physician for psoriasis before delivery, and mothers without psoriasis. Logistic regression was used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) for the occurrence of adverse pregnancy outcomes, including maternal and neonatal outcomes.

Results:

3,339 mothers with severe psoriasis, 41,296 mothers with mild psoriasis, and 2,017,271 mothers without psoriasis were included in this study. The mothers with mild/severe psoriasis demonstrated a significantly higher risk of labor complications and maternal risk factors. After adjusting for confounders, mothers with severe psoriasis who did not visit a physician for psoriasis demonstrated significantly higher odds of labor complications (OR 1.217), maternal risk factors (OR 1.507), having low-birth weight infants (OR 1.236), etc., than mothers without psoriasis.

Conclusion:

This study demonstrated that mothers with psoriasis had a higher risk of adverse pregnancy outcomes. In addition, seeking medical care for psoriasis, particularly for women with severe psoriasis, appeared to exert a protective effect against adverse pregnancy outcomes.
A mysterious skin rash outbreak over Pescadores Islands in Taiwan Strait: An airborne contact dermatitis by Euproctis taiwana revealed by ultrastructure mapping
Authors: Lin I-Ming , Hsu Tsung-Jen , Su Hung , Lin Chia-Hua , Chiang Yeo-Wan , Shiea Jentaie , Liao Hung-Chang , Kuang Sheng-Chieh , Lan Jui , Lee Chih-Hung
Published: July 2024

Background:

A mysterious skin rash (papular lesions) outbreak broke out for unknown reasons in Taiwan’s Pescadores Islands in mid-autumn 2021, causing much anxiety in the population already nervous about the ongoing COVID-19 epidemic.

Objectives:

We conducted a field survey for possible culprit agents.

Methods:

Skin samples were taken with rapid-glue adhesives from the affected skin. Electron microscopy from the skin samples as well as caterpillar seta was performed. Additional neurotransmitter analysis by mass spectrometry (MS) was conducted on the skin samples.

Results:

A field survey found a large increase in caterpillars, Euproctis taiwana, in September 2021, the warmest September in recent years. Electron microscopy performed on superficial skin samples (3–6 cells thick) of affected and healthy skin (n = 5 and 3, respectively) and caterpillar setae revealed ultrastructural similarities between setae spurs (0.15–0.2 μm) and tiny pits (0.2 μm) on the affected skin as well as similar vegetative debris (0.75 μm) on both setae and affected skin. MS showed large increases in tyrosine, serine, and histamine, known mediators of arthropod insult.

Conclusion:

The co-occurrence of E. taiwana population growth, excessive warming, and strong monsoon winds may lead to this unusual autumn outbreak in late September. The lifting of COVID-19-related travel restrictions against earlier that month probably exacerbated it.
Cutaneous metaplastic synovial cyst in the buttock: A comprehensive analysis of etiologic, clinical, ultrasonic, and pathological aspects
Authors: Tsai Li-Cheng , Hsu Chih-Jung
Published: July 2024

Cutaneous metaplastic synovial cyst (CMSC) is a rare cutaneous cystic lesion, which frequently occurs subsequent to trauma or surgery, forming through the reparative and healing process. It is often misdiagnosed as foreign body granuloma or recurrent epidermoid cyst. Histologically, it is characterized by a cystic structure with multiple villous projections pointing toward the cystic space, lined by cells resembling hyperplastic synovium. To date, only 32 cases have been reported in the English literature. In this article, we present two cases of CMSC with distinctive clinical features and ultrasonic findings. Furthermore, we found only three case reports of CMSC in the gluteal region. All of these cases were elderly patients and developed CMSC at the medial aspect of the buttock. Based on their unique clinical and ultrasonic characteristics, we propose that CMSC in the buttock may be considered a distinct subgroup within CMSC, demonstrating a spectrum of degenerative diseases along with ischiogluteal bursitis.
Evaluation of ultrasound-guided suprazygomatic maxillary nerve block in functional endoscopic sinus surgery for postoperative pain relief: A randomised controlled trial
Authors: Neupane Adhip , Jain Divya , Arora Suman , Gandhi Komal , Singla Varun , Goel Nitika , Virk Ramandeep Singh , Mohindra Satyawati
Published: July 2024

Background and Aims:

Postoperative pain can impede functional recovery and delay hospital discharge after functional endoscopic sinus surgery (FESS). The study aimed to assess the efficacy of ultrasound (USG)-guided suprazygomatic maxillary nerve block (SZMNB) for postoperative pain in FESS.

Methods:

Forty-eight adult patients between 18 and 65 years of age with American Society of Anesthesiologists physical status I and II and scheduled to undergo FESS were enroled in this randomised controlled study. Patients were randomly allocated to either receive USG-guided SZMNB with general anaesthesia (n = 24) or general anaesthesia alone (n = 24). The numerical rating scale (NRS) pain score in the immediate postoperative period was recorded as the primary outcome. A total of 24 h postoperative rescue analgesic consumption, surgeon satisfaction score, postoperative haemodynamics, and postoperative complications were noted as secondary outcomes.

Results:

The median (interquartile range) of the NRS pain score in the immediate postoperative period was 0 (0-0.25)[95% confidence interval (CI): 0, 0.08] in the block group compared to 2 (1.75-3) [95% CI: 1.60, 2.40] in the control group, P < 0.001]. Pain scores were significantly reduced at all time intervals till 24 h after surgery (P < 0.001). None of the patients required rescue analgesia in the block group. In contrast, eight patients required diclofenac 75 mg intravenous as rescue analgesia within 1 h of surgery and ten patients within 1–6 h of surgery in the control group. Other secondary outcomes were comparable between groups (P > 0.05).

Conclusion:

The USG-guided SZMNB provides excellent postoperative analgesia for patients undergoing FESS without significant side effects.
Assessing the appropriateness and completeness of ChatGPT-4’s AI-generated responses for queries related to diabetic retinopathy
Authors: Subramanian Brughanya , Rajalakshmi Ramachandran , Sivaprasad Sobha , Rao Chetan , Raman Rajiv
Published: July 2024

Objective:

To evaluate the appropriateness of responses generated by an online chat-based artificial intelligence (AI) model for diabetic retinopathy (DR) related questions.

Design:

Cross-sectional study.

Methods:

A set of 20 questions framed from the patient’s perspective addressing DR-related queries, such as the definition of disease, symptoms, prevention methods, treatment options, diagnostic methods, visual impact, and complications, were formulated for input into ChatGPT-4. Peer-reviewed, literature-based answers were collected from popular search engines for the selected questions and three retinal experts reviewed the responses. An inter-human agreement was analyzed for consensus expert responses and also between experts. The answers generated by the AI model were compared with those provided by the experts. The experts rated the response generated by ChatGPT-4 on a scale of 0–5 for appropriateness and completeness.

Results:

The answers provided by ChatGPT-4 were appropriate and complete for most of the DR-related questions. The response to questions on the adverse effects of laser photocoagulation therapy and compliance to treatment was not perfectly complete. The average rating given by the three retina expert evaluators was 4.84 for appropriateness and 4.38 for completeness of answers provided by the AI model. This corresponds to an overall 96.8% agreement among the experts for appropriateness and 87.6% for completeness regarding AI-generated answers.

Conclusion:

ChatGPT-4 exhibits a high level of accuracy in generating appropriate responses for a range of questions in DR. However, there is a need to improvise the model to generate complete answers for certain DR-related topics.
Kaplan’s Dislocation in a Child with Delayed Presentation: A Case Report
Authors: Keshkar Sanjay , Biswas Subhanwita
Published: July 2024

Kaplan’s dislocation is a rare occurrence, particularly in children. We encountered a case of Kaplan’s dislocation of the index finger in an 8-year-old child who presented 18 days post-injury. The child was managed through open reduction using a dorsal approach. At 7 months of follow-up, the patient exhibited a good functional outcome. This case is noteworthy not only for its rarity but also to highlight that it can occur in children and that even in cases with delayed presentation, open reduction (preferably via a dorsal approach) can yield favorable outcomes with proper follow-up.
Adductor Canal Block + Local Infiltration Versus Local Infiltration Alone in Post-Operative Pain Management in Total Knee Replacement
Authors: Venugopal Shyam Gopal , Mohan Vijaya , Abraham Aril , Antony Aleena
Published: July 2024

Background:

Adductor canal blocks (ACBs) are an emerging concept for post-operative pain management in total knee replacement (TKR). The present study was designed to evaluate the duration of analgesia, patient satisfaction, use of opioids, pain score, and ease of ambulation after ACB + intra-articular local infiltration for TKR surgery and compare it with local infiltration alone.

Materials and Methods:

This retrospective observational study included a total of 260 cases of TKR selected as per inclusion/exclusion criteria. All patients underwent surgery under spinal, epidural, or general anesthesia. For post-operative analgesia, intra-articular local infiltration of a cocktail [12.5 mL of 0.5% sensocaine + 2 mL ketorolac + 0.5 mg adrenaline + 95 mL normal saline] was administered to all patients, with some patients also receiving ACB (15 mL of 0.2% ropivacaine + 1 mcg/kg dexmedetomidine) by random selection. Thus, two groups of patients were formed: (i) those who received ACB and local infiltrative analgesia and (ii) those who received only local infiltrative analgesia. The two groups were matching in terms of demography, comorbidities, and complexity of osteoarthritis.

Variables were compared between these two groups by using outcome measures, including (i) time to attain SLR (straight leg raise), (ii) the total amount of opioid doses given in 24 h, (iii) the pain score by visual analogue score (VAS) at 24 h, (iv) success of early ambulation, and (v) complications.

Results:

Out of the 260 cases of TKR, 126 were of Group 1 and 134 were of Group 2. In the local infiltration alone group, the average VAS at 24 h was 3.8, the average amount of opioid doses given in 24 h was 1.54, the average time of ambulation was 3 h post-surgery, and the average time to attain SLR was 3 h post-surgery. In the adductor canal plus local infiltration group, the average VAS was 3.32, the average amount of opioid use was 0.9, the average time for ambulation was 3 h post-surgery, and the average time to attain SLR was 3 h post-surgery. No major complications were noted in either group.

Conclusion:

According to our study, ACB is certainly a useful tool in reducing the post-operative pain and increasing ambulation and patient satisfaction. However, a larger study is required to establish its effectiveness conclusively.
Pathology of Spinal Tumours
Authors: Nath Chinmay , Chatterjee Sankha
Published: July 2024

Spinal tumours are uncommon lesions, but they may cause significant morbidity and mortality. Majority of the spinal tumours are metastatic, that is, spread from tumours in other organs, which are mostly seen in older patients. Primary sarcomas involving the spinal column are rare. Benign tumours and tumour-like lesions of the musculoskeletal system are mostly seen in young patients. Spinal tumours can be subdivided into primary tumours, which are rare, and secondary tumours or metastases, which are much common. Primary vertebral tumours may be benign or malignant. Common benign spinal tumours include osteoid osteoma, osteoblastoma, osteochondroma, aneurysmal bone cyst and giant cell tumour. There are many malignant primary spinal tumours such as- osteosarcoma, chondrosarcoma, and chordoma, Ewing’s sarcoma, plasmacytoma and multiple myeloma. However, all of them, except multiple myeloma, are rare. Intraspinal tumours may be extradural or intradural. Common intradural extramedullary tumours include meningioma, schwannoma and intradural neurofibroma, whereas astrocytoma, ependymoma and haemangioblastoma are a few examples of intradural intramedullary tumours.
A case report on locally advanced squamous cell carcinoma in permanent perineal urethrostomy: A surgical conundrum!!
Authors: Paighan Nitin Madanrao , Goel Hemant Kumar , Makkar Arun
Published: July 2024

Primary urethral cancer is a rare condition often manifesting in the sixth decade of life and is typically associated with urethral stricture disease. A 65-year-old male, a known case of stricture urethra, underwent perineal urethrostomy 10 years back. He presented with a growth at the urethrostomy site and the biopsy revealed squamous cell carcinoma. Magnetic resonance imaging of the pelvis revealed that the lesion extended into the penile and prostatic urethra with possible involvement of the corpus spongiosum, bulbospongiosus, and the bladder neck. Radical cystectomy, penectomy, scrotectomy, and bilateral orchiectomy with ileal conduit were performed. At 18-months of follow-up, the patient is recurrence-free.
Change of the suprapubic catheter: Not always safe!
Authors: Kanbur Ajay S. , Pushkar Shrivastava , Maheshwari Pankaj N.
Published: July 2024

Suprapubic catheterization (SPC) is a commonly used technique for urinary bladder drainage. As an SPC may be needed for long term, the catheter needs to be changed every 2–6 weeks. Change of SPC is a simple and a safe outpatient procedure. Presented here are three unusual complications that occurred when changing the SPC catheter such as catheter getting misplaced up the ureter, balloon extruding outside the urethra and one case of bowel perforation. It is possible that greater awareness of risks and use of a proper technique could have prevented all three complications.
Descriptive epidemiology of prostate cancer in India, 2012–2019: Insights from the National Cancer Registry Programme
Authors: Sankarapillai Jayasankar , Krishnan Sathishkumar , Ramamoorthy Thilagavathi , Sudarshan Kondalli Lakshminarayana , Mathur Prashant
Published: July 2024

Purpose:

This study describes the epidemiology, clinical extent at diagnosis, and treatment modalities for prostate cancer in India.

Methodology:

This study is a secondary analysis of primary prostate cancer data sourced from the National Cancer Registry Programme. Data from population-based cancer registry for the period 2012–2016 were used to estimate the incidence rates, including crude incidence rate (CR), age-adjusted incidence rate (AAR), age-specific rate, and cumulative risk. Trends in the AAR were assessed using join-point regression. Hospital-Based Cancer Registry data from 2012 to 2019 were used to describe the clinical extent of the cancer at diagnosis and the treatment modalities.

Results:

The incidence of prostate cancers was higher in urban registries such as Delhi, Kamrup Urban, and Mumbai (AAR of 11.8 per 100,000, 10.9 per 100,000, and 9.7 per 100,000, respectively). Prostate cancer incidence showed a rise after the age of 50, with a notable acceleration after age 64. The overall annual percentage change for prostate cancer incidence from 1982 to 2016 was 2.6. Around 43.0% of all prostate cancers were diagnosed at the distant metastatic stage. Surgery and radiotherapy, either as standalone treatments or in combination with other modalities, contributed to the treatment of 78.5% of localized cancer, 74.2% of locoregional cancer, and 57.2% of distant metastatic stage of prostate cancer.

Conclusion:

There is heterogeneity in the incidence of prostate cancer, as evidenced by urban registries. Additionally, there is a need for downstaging the disease, without risking overdiagnosis.
The cost-effectiveness of reusable flexible ureteroscopes: An institutional audit
Authors: Khedekar Pranalee G. , Viswaroop S. Bobby , Arul M. , Gopalakrishnan Ganesh , Kandasami S. V.
Published: July 2024

Introduction:

A flexible ureteroscope (FU) is an important tool in the urologist’s armamentarium. This study aims to check the durability and cost-effectiveness of conventional FU.

Methods:

The institution registry of damaged FU over the last 7 years was reviewed. A total of 17 flexible scopes were used. The data of 13 scopes (11 Storz fiberoptic and 2 Seesheen digital) are included in this study. A total of 1905 cases were performed. The cost of scope, duration of use, number of cases done by each scope, and nature of damage were evaluated. We compared the cost-effectiveness of conventional scopes with published costs on disposable scopes.

Results:

The mean number of cases done by fiberoptic scope was 159 (range 25–334). The total cases done by 2 digital scopes were 135 and 25. The mean life of fiberoptic and digital scopes was 17 (range 4–31) and 8 months, respectively. The mean cost of fiberoptic scope was Indian Rupee (INR) 338,951 ($4082.7221) and INR 525,000 ($6323.7138) for digital scope. The cost per case for reusable scope is calculated by dividing the mean cost of FU by the mean number of cases done. The reprocessing cost of INR 527 was then added. Thus, the average cost per procedure for fiberoptic and digital FU was INR 2658.76 and INR 7089.50, respectively. We compared this cost with a projected cost of disposable FUbased on today’s market data, which ranged from INR 60,000 to 107,427.

Conclusions:

The reusable scopes are durable, cost-effective, and an excellent option for high case-load institutions.
Intravesical bupivacaine in reducing catheter-related bladder discomfort and lower urinary tract symptoms after transurethral surgery: A randomized controlled trial
Authors: Purushothaman Jithesh , Kalra Sidhartha , Dorairajan Lalgudi Narayanan , Selvarajan Sandhiya , Sreerag K. S. , Aggarwal Deepanshu
Published: July 2024

Introduction:

The objectives of this study were to investigate the efficacy and safety of intravesical bupivacaine instillation in reducing catheter-related bladder discomfort (CRBD) and lower urinary tract symptoms (LUTS) after transurethral surgery.

Methods:

The study enrolled 100 American Society of Anesthesiologists (ASA) grade I–III patients aged ≥18 years undergoing transurethral resection of the prostate or transurethral resection of the bladder tumor, randomly assigned to Group B (intravesical bupivacaine) or Group S (saline). Double blinding was employed. Independent variables included demographics, surgery type, ASA grade, and intervention details. Dependent variables comprised CRBD severity, Patient Perception of Bladder Condition (PPBC), Pelvic Pain Urgency Frequency (PUF), Visual Analog Scale (VAS) for pain, need for additional analgesics, and International Prostate Symptom Score (IPSS). SPSS version 19 was used for analysis with a significance level of P < 0.05. Side effects such as hematuria were also recorded.

Results:

Group B reported significantly lower “moderate” CRBD immediately (2% vs. 40%, P < 0.001) and at 12 h (0% vs. 18%, P = 0.003) post-instillation compared to Group S and also required fewer additional analgesics (4% vs. 46%). The PPBC at catheter removal also favored Group B (P = 0.003) and day 1 (P < 0.001). The PUF scores were also significantly lower in Group B at catheter removal (P = 0.001) and at day 1 (P = 0.028). The IPSS was also significantly lower in the Group B on day 1 (P = 0.003) and 7 (P = 0.001). The VAS scores also favored the Group B consistently and although the side effects were higher in Group B but this was not statistically significant.

Conclusion:

Intravesical bupivacaine administration has the potential to alleviate CRBD and postoperative LUTS following lower urinary tract transurethral electrosurgery. The study’s findings underscore the importance of personalized pain management strategies in optimizing the patient comfort during the postoperative recovery.
The impact of sestamibi scan on clinical decision-making for renal masses: An observational single-center study
Authors: Yong Courtney , Tong Yan , Tann Mark , Sundaram Chandru P.
Published: July 2024

Introduction:

We aimed to determine whether sestamibi scan changes management of renal masses.

Methods:

All patients undergoing sestamibi scan for renal masses between 2008 and 2022 at a single center were retrospectively reviewed. Data were gathered on patient demographics, pre- and postoperative creatinine, sestamibi scan parameters, and cross-sectional imaging characteristics. Outcomes included whether the patient underwent renal mass biopsy or surgical resection and the final pathological diagnosis if tissue was obtained from biopsy or resection. Data regarding postbiopsy as well as postoperative complications were also collected. The odds ratio (OR) for surgery or biopsy based on sestamibi result was calculated.

Results:

Forty-three patients underwent sestamibi scan from 2008 to 2022, with 10 scans consistent with oncocytoma and 33 with nononcocytoma. The mean tumor size at initial presentation was 4.0 ± 1.8 cm with a median RENAL score of 7 (range: 4–11). For patients with sestamibi scans negative for oncocytoma, the OR for surgery was 12.5 (95% confidence interval [CI]: 2.1–71.2, P = 0.005), and the OR for biopsy was 0.04 (95% CI: 0.005–0.39, P = 0.005). Conversely, for patients with sestamibi scans positive for oncocytoma, the OR for surgery was 0.28 (95% CI: 0.03–2.4, P = 0.24) and the OR for biopsy was 24.0 (95% CI: 2.6–222.7, P = 0.005). Creatinine at the last follow-up was similar between patients with positive and negative sestamibi scans. No patients experienced complications from surgery or biopsy. The median follow-up was 19 months (range: 2–163).

Conclusions:

A sestamibi scan positive for oncocytoma led to increased use of renal mass biopsy for confirmation. Sestamibi scans that were negative for oncocytoma were more likely to result in surgical resection without biopsy.
Comparison of Optical Biometry and Scheimpflug Device Keratometric Readings Accuracy in Predicting Intraocular Lens Power in Cataract Surgery
Authors: Khorsheed Mehtab Ameer , Tawfeeq Firas Nazar , Issa Ammar Fouad
Published: July 2024

Background:

A correct preoperative intraocular lens (IOL) power measurement in cataract surgery depends on accurate assessment of axial length (AL), anterior segment parameters, and using the suitable formula for the calculation of the power.

Objectives:

To determine the accuracy of IOL power calculations using keratometric measurements of the IOL Master compared to the Pentacam and to determine whether the results obtained can be used interchangeably in clinical practice in calculating IOL power in routine cataract surgery.

Patients and Methods:

In this prospective study, the biometric data including AL, keratometric readings, and anterior chamber depth (ACD) were obtained by both the IOL Master 500 and Pentacam Scheimpflug devices added to these measures the white-to-white (WTW) distance by IOL Master and central corneal thickness by Pentacam and calculation of the IOL power using SRK/T formula for the enrolled patients who undergone uneventful cataract surgery with IOL implantation. Postoperatively, spherical equivalent refraction was measured and the mean arithmetic error and the mean absolute error (MAE) for both keratometric readings were calculated to compare the accuracy between them in calculating the IOL power.

Results:

The study evaluated 57 eyes of 57 patient, the mean K value for the IOL Master was 43.92 (D) ± 1.5 (standard deviation [SD]) and the mean K value for the Pentacam was 43.77 (D) ± 1.7 (SD) (P = 0.62), ACD values between the two groups, was 3.19 ± 0.44 mm measure by IOL Master compared to 3.22 ± 0.48 mm in Pentacam (P = 0.769), with a very strong positive correlation between the two values (r = 0.995, P < 0.001). MAE for the IOL Master was 0.230 (D) ± 0.187 (SD), while for the Pentacam was 0.255 (D) ± 0.204 (SD), with no statistically significant differences between two devices’ values (P = 0.54).

Conclusions:

Pentacam Scheimpflug measured keratometric and ACD data had good correlation with IOL Master data with good interchangeability between two devices readings in measuring the IOL power in routine cases of cataract surgeries.
Nonadherence to Drug Therapy among Pregnant Women in Baghdad/Al-Karkh Directorate (2022)
Authors: Wasif Mais Waleed , Abdul-Sahib Hanadi Muhammad
Published: July 2024

Objectives:

This aim of the study was to estimate the prevalence of noncompliance to medication in pregnant women in Al-Karkh directorate and to address its most common causes.

Methods:

A cross-sectional study was conducted at a number of primary health-care centers located in Baghdad/Al-Karkh directorate including pregnant women in their second and third trimesters through a self-filled questionnaire; data were later analyzed.

Results:

The results obtained from the present study revealed that 185 out of 306 participants (60%) of pregnant women were noncompliant or inadequately compliant with their medication, whereas the remaining 121 (40%) were properly compliant. The most common reasons for noncompliance included wrong use of drugs (38.4%), not understanding or knowing the benefits of drugs (30.3%), forgetting to take drugs (29.7%), or thinking that they were unsafe for the fetus (25.9%).

Conclusions:

Appropriate health education and enhancing doctor–patient relationship and communication during antenatal care visits are crucial to achieve better compliance.
Knowledge and Attitude of Attention-deficit Hyperactivity Disorder among Parents Attending Primary Health-care Centers in Al-Karkh/Baghdad City, 2023
Authors: Jabar Ayat Haider , Saleh Amal Abdulkadir , Akmoosh Sura Ibrahim
Published: July 2024

Background:

Attention-deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in children. Knowledge and attitude of parents about the disorder influence the diagnosis, treatment, and future of the child as an individual and as a part of the community.

Objectives:

The objective of this study was to assess the knowledge and attitude of parents about ADHD in Alkarkh, Baghdad, Iraq, 2023.

Methods:

A cross-sectional study was conducted between February and July 2023, at 12 primary health centers in Al-Karkh Health Directorate in Baghdad City, and a convenient sample of 300 parents was involved. Data were collected using a direct interviewing questionnaire.

Results:

According to age, 196 (65.3%) of the sample fell in the age group of 31–40 years, the mothers-to-fathers ratio was 5:1, 76.3% of participants had higher education, 206 (68.7%) were employed, 134 (44.7%) participants had fair knowledge, and only 8 (2.7%) had good knowledge. More than two-thirds of parents, 214 (71.5%), had good knowledge about the treatment of ADHD, and 164 (54.8%) had symptoms of the disorder, while they had less knowledge about the nature of ADHD and its risk factors. There was a statistically significant association (P < 0.05) between knowledge level and parent’s education, occupation, and residency. About 252 (84%) parents had positive attitude toward ADHD. The positive attitude was significantly associated with the age, education, occupation, and residency of the participants.

Conclusions:

Less than half of the study samples had fair knowledge, and the majority had a good attitude regarding ADHD.
Knowledge, Attitude, and Practice toward Epilepsy among Primary School Teachers in Al-Rusafa/Baghdad 2022
Authors: Jasim Muna Saleh , Hussein Wijdan Akram
Published: July 2024

Background:

Epilepsy is one of the most widespread neurological illnesses in the world with a prevalence rate of 2.8–19.5 per 1000 of the general population, and it is more prevalent in childhood. The understanding of the teachers about epilepsy has a significant impact on the academic performance and social skills of schoolchildren with epilepsy.

Aim of Study:

This study aimed to assess teachers’ knowledge, attitude, and practice regarding epilepsy in schoolchildren and the association of certain studied variables with the level of schoolteachers’ knowledge, attitude, and practice.

Subjects and Methods:

This was a cross-sectional study that included 402 participants and was conducted in Al-Rusafa/Baghdad during the period from November 1, 2021, to January 31, 2022. A self-administered questionnaire was used for data collection method.

Results:

Most of the studied sample demonstrated fair knowledge (52%), attitudes (55%), and practices (55%). A significant association was detected between knowledge, attitude, practices, and each of marital status, specialty, and academic qualification (P < 0.05).

Conclusion:

There was a Fair level of knowledge, attitude, and practice of teachers regarding students with epilepsy. Being single unmarried, of university degree and with a scientific specialty were considered as a predictor factors of good knowledge, attitude, and practice. While age, gender, and years of experience were not associated with any of the knowledge, attitude, and practice parameters. Multiple sources considered a major source of information.
The Heart Team during the Pandemic: A Case Report of Bio-Prosthesis Degeneration Treated with Valve in Valve Implantation
Authors: Manes Maria Teresa , Ritacco Anna Rita , Cassano Susanna , Ferrò Maria Teresa , Manduca Bruno , Spaccarotella Carmen , Musacchio Domenico
Published: July 2024

The pandemic changed the type of patients. The concept of “patient at the center” became concrete. The execution of simple consultancy was overcome to create effective collaboration and fruitful exchanges between specialists. The “Heart Team” model is on increasing affirmation. The TEAM-BASED approach in the cardiology field is successfully used in patients suffering from ischemic heart disease and valvulopathies for the choice of possible treatments. Degenerative type Sao is the most frequent valvulopathy among the valvulopathies in Western countries and its incidence is correlated with age. In high-risk patients, percutaneous valve replacement (transcatheter aortic valve implantation) is the most valid therapeutic option. The implantation of biological prostheses raises the problem of both degeneration and dysfunction of the prosthesis itself over time in subjects of advanced age and with comorbidities. In this scenario, valve-in-valve (VinV) is a valid therapeutic alternative in high-risk patients. A clinical case of aortic prosthetic degeneration, as an outcome of endocarditis, treated with VinV is presented. The therapeutic decision was made by an “Electronic Heart Team” which represents a further evolution of the treatment pathways and reduces the distance between the specialists in “Hub” Centers and the “Spoke” center.

The advent of the pandemic caused active collaboration and fruitful discussions among medical specialists. As a matter of fact, a shift from a simple consultation to the establishment of a proper “Heart Team” model occurred and the concept of “patient at the center” arose. TEAM-BASED approaches in cardiology are being successfully used as possible treatments in patients suffering from ischemic heart disease and valvulopathies. Degenerative type Sao is the most frequent valvulopathy in Western countries and its incidence is correlated with age. In high-risk patients, percutaneous valve replacement (TAVI) is the most viable treatment option. However, in subjects of advanced age, with comorbidities, the implantation of biological prostheses is associated with the degeneration and dysfunction of the prosthesis itself over time. In this scenario, Valve-in-valve (VinV) is a viable therapeutic alternative in high-risk patients. A clinical case of aortic prosthetic degeneration, as an outcome of endocarditis, that was treated with VinV is presented. The decision on VinV was made by an “Electronic Heart Team” which represents a further evolution of care pathways to reduce the distance between the “Hub” Centers and the specialist at the “Spoke” center.
How Right is the Right Ventricle in Predicting Cardiac Mortality in Cardiac Failure: A 6-year Prospective Cohort Study
Authors: Sljivic Aleksandra , Kleut Milena Pavlovic , Celic Vera , Neskovic Aleksandar N. , Nesic Ivan , Gazibara Tatjana
Published: July 2024

Aim:

Two-dimensional speckle tracking echocardiography (2D-STE) and three-dimensional echocardiography (3DE) may overcome many limitations of the conventional 2D echocardiography (2DE) in assessing right ventricular (RV) function. We sought to determine whether characteristics of the right atrium and right ventricle as measured by 2D-STE and 3DE are associated with cardiac mortality in patients with ischemic heart failure, over a 6-year follow-up.

Materials and Methods:

The inclusion criteria were ischemic cardiomyopathy with left ventricular ejection fraction of <40% diagnosed using standard 2DE, 2D-STE, and 3DE examination. Patients were followed for 6 years, and cardiac mortality was recorded.

Results:

The study sample comprised a total of 54 participants. During the period of follow-up, 24% (13/54) died. The 2DE models showed that being older, having a higher body mass index (BMI), having higher systolic pulmonary artery pressure (SPAP), and a lower RV global longitudinal strain were associated with cardiac mortality in our cohort after 6-year follow-up. Finally, the 3DE models showed that in addition to being older, having higher BMI, having a higher SPAP baseline, lower baseline 3DE RV stroke volume, and larger 3DE RV end-diastolic volume and 3DE RV end-systolic volume were associated with cardiac mortality over 6-year follow-up.

Conclusion:

This study provides evidence that RV dysfunction as seen on 2D-STE and 3DE could be associated with increased risk of cardiac-related mortality in patients with heart failure over 6 years.
Echocardiographic Assessment of Recovered Patients with Mild COVID-19 Infection: A Case–Control Study
Authors: Alimi Hedieh , Bigdelu Leila , Poorzand Hoorak , Ghaderi Fereshteh , Emadzadeh Maryam , Yadollahi Asal , Izadi-Moud Azadeh , Fazlinezhad Afsoon , Danesh Maedeh Rezaei
Published: July 2024

Context:

Coronavirus disease 2019 (COVID-19) has been revealed as a severe illness with a wide-ranging cardiac manifestation and has a worldwide burden on the health-care system.

Aims:

Our aim in this study is to assess the impact of mild COVID-19 infection on cardiac function in patients without previous structural heart disease.

Settings and Design:

We evaluated 100 outpatients with a history of mild COVID-19 infection without needing hospitalization within 3 weeks to 3 months after recovery from the acute phase of the illness between August 2020 and July 2021.

Subjects and Methods:

The patients were compared with 105 healthy participants without a history of COVID-19 as the control group. All participants underwent comprehensive transthoracic echocardiography.

Statistical Analysis Used:

Data were analyzed using IBM SPSS statistics 23. For all tests, P < 0.05 was defined as statistically significant.

Results:

COVID-19 patients had higher global longitudinal strain (P = 0.001), systolic pulmonary artery pressure (P = 0.008), RV E’ (P = 0.049), and RV A’ (P = 0.003), while had lower septal tissue velocities (P = 0.01) and left ventricular ejection fraction (EF) (LVEF) (P = 0.03). Abnormal EF (LVEF <55%) was noted in 19% of the COVID-19 patients and 8.6% of the control group (P = 0.03). Moderate or more diastolic dysfunction was noted in 10 COVID-19 patients but only in one participant in the control group (P = 0.005).

Conclusions:

Mild COVID-19 infection can result in cardiac functional and structural changes, even in patients without known previous structural heart disease. Echocardiography can be a useful modality for risk assessment and follow-up in patients with COVID-19.
Estimation of the Proton Resonance Frequency Coefficient in Agar-based Phantoms
Authors: Filippou Antria , Evripidou Nikolas , Georgiou Andreas , Nikolaou Anastasia , Damianou Christakis
Published: July 2024

Aim:

Agar-based phantoms are popular in high intensity focused ultrasound (HIFU) studies, with magnetic resonance imaging (MRI) preferred for guidance since it provides temperature monitoring by proton resonance frequency (PRF) shift magnetic resonance (MR) thermometry. MR thermometry monitoring depends on several factors, thus, herein, the PRF coefficient of agar phantoms was estimated.

Materials and Methods:

Seven phantoms were developed with varied agar (2, 4, or 6% w/v) or constant agar (6% w/v) and varied silica concentrations (2, 4, 6, or 8% w/v) to assess the effect of the concentration on the PRF coefficient. Each phantom was sonicated using varied acoustical power for a 30 s duration in both a laboratory setting and inside a 3T MRI scanner. PRF coefficients were estimated through linear trends between phase shift acquired using gradient sequences and thermocouple-based temperatures changes.

Results:

Linear regression (R
2 = 0.9707–0.9991) demonstrated a proportional dependency of phase shift with temperature change, resulting in PRF coefficients between −0.00336 ± 0.00029 and −0.00934 ± 0.00050 ppm/°C for the various phantom recipes. Weak negative linear correlations of the PRF coefficient were observed with increased agar. With silica concentrations, the negative linear correlation was strong. For all phantoms, calibrated PRF coefficients resulted in 1.01–3.01-fold higher temperature changes compared to the values calculated using a literature PRF coefficient.

Conclusions:

Phantoms developed with a 6% w/v agar concentration and doped with 0%–8% w/v silica best resemble tissue PRF coefficients and should be preferred in HIFU studies. The estimated PRF coefficients can result in enhanced MR thermometry monitoring and evaluation of HIFU protocols.
Estimation of Proton Stopping Power Ratio and Mean Excitation Energy Using Electron Density and Its Applications via Machine Learning Approach
Authors: Chika Charles Ekene
Published: July 2024

Purpose:

The purpose of this study was to develop a simple flexible method for accurate estimation of stopping power ratio (SPR) and mean excitation energy (I) using relative electron density (ρ
e).

Materials and Methods:

The model was formulated using empirical relationships between SPR, mean excitation energy I, and relative electron density. Some examples were implemented, and a comparison was carried out using other existing methods. The needed coefficients in the model were estimated using optimization tools. Basis vector method (BVM) and Hunemohr and Saito (H-S) method were applied to estimate the ρ
e used in the application section. 80 kVp and 150 kVpSn were used as low and high energy, respectively, for the implementation of dual-energy methods.

Results:

All the examples of the proposed method considered have modeling error that is ≤0.32% and testing root mean square error (RMSE) ≤0.92% for SPR with a mean error close to 0.00%. The method was able to achieve modeling RMSE of 2.12% for mean excitation energy with room for improvement. Similar or better results were achieved in application to BVM.

Conclusion:

The method showed robustness in application by achieving lower testing error than other presented methods in most cases. It achieved accurate estimation which can be improved using the machine learning algorithm since it is flexible to implement in terms of the function (model) degree and tissue classification.
Assessing Heterogeneity Effects on Points A, B, and Organs at Risk Doses in High-dose-Rate Brachytherapy for Cervical Cancer – A Comparison of 192Ir and 60Co Sources Using Monte Carlo N-Particle 5
Authors: Sadeghi Mohammad Hossein , Sina Sedigheh , Meigooni Ali Soleimani
Published: July 2024

Purpose:

The present article deals with investigating the effects of tissue heterogeneity consideration on the dose distribution of 192Ir and 60Co sources in high-dose-rate brachytherapy (HDR-BT).

Materials and Methods:

A Monte Carlo N-Particle 5 (MCNP5) code was developed for the simulation of the dose distribution in homogeneous and heterogeneous phantoms for cervical cancer patients. The phantoms represented water-equivalent and human body-equivalent tissues. Treatment data for a patient undergoing HDR-BT with a 192Ir source were used as a reference for validation, and for 60Co, AAPM Task Group 43 methodology was also applied. The dose values were calculated for both source types in the phantoms.

Results:

The results showed a good agreement between the calculated dose in the homogeneous phantom and the real patient’s treatment data, with a relative difference of less than 5% for both sources. However, when comparing the absorbed doses at critical points such as Point A right, Point A left, Point B right, Point B left, bladder International Commission on Radiation Units and Measurement (ICRU) point, and recto-vaginal ICRU point, the study revealed significant percentage differences (approximately 5.85% to 12.02%) between the homogeneous and heterogeneous setups for both 192Ir and 60Co sources. The analysis of dose–volume histograms (DVH) indicated that organs at risk, notably the rectum and bladder, still received doses within recommended limits.

Conclusions:

The study concludes that 60Co and 192Ir sources can be effectively used in HDR-BT, provided that careful consideration is given to tissue heterogeneity effects during treatment planning to ensure optimal therapeutic outcomes.
Performance Evaluation of Deformable Image Registration Systems – SmartAdapt® and Velocity™
Authors: Kumar M. Anil , Hajare Raghavendra , Nath Bhakti Dev , Lakshmi K. K. Sree , Mahantshetty Umesh M.
Published: July 2024

Aim:

To commission and validate commercial deformable image registration (DIR) systems (SmartAdapt® and Velocity™) using task group 132 (TG-132) digital phantom datasets. Additionally, the study compares and verifies the DIR algorithms of the two systems.

Materials and Methods:

TG-132 digital phantoms were obtained from the American Association of Physicists in Medicine website and imported into SmartAdapt® and Velocity™ systems for commissioning and validation. The registration results were compared with known shifts using rigid registrations and deformable registrations. Virtual head and neck phantoms obtained online (DIR Evaluation Project) and some selected clinical data sets from the department were imported into the two DIR systems. For both of these datasets, DIR was carried out between the source and target images, and the contours were then propagated from the source to the target image data set. The dice similarity coefficient (DSC), mean distance to agreement (MDA), and Jacobian determinant measures were utilised to evaluate the registration results.

Results:

The recommended criteria for commissioning and validation of DIR system from TG-132 was error <0.5*voxel dimension (vd). Translation only registration: Both systems met TG-132 recommendations except computed tomography (CT)-positron emission tomography registration in both systems (Velocity ~1.1*vd, SmartAdapt ~1.6*vd). Translational and rotational registration: Both systems failed the criteria for all modalities (For velocity, error ranged from 0.6*vd [CT-CT registration] to 3.4*vd [CT-cone-beam CT (CBCT) registration]. For SmartAdapt® the range was 0.6*vd [CT-CBCT] to 3.6*vd [CT-CT]). Mean ± standard deviation for DSC, MDA and Jacobian metrics were used to compare the DIR results between SmartAdapt® and Velocity™.

Conclusion:

The DIR algorithms of SmartAdapt® and Velocity™ were commissioned and their deformation results were compared. Both systems can be used for clinical purpose. While there were only minimal differences between the two systems, Velocity™ provided lower values for parotids, bladder, rectum, and prostate (soft tissue) compared to SmartAdapt. However, for mandible, spinal cord, and femoral heads (rigid structures), both systems showed nearly identical results.
Commissioning of the First MRlinac in Latin America
Authors: Alejandro Rojas-López José , Alexis Cabrera-Santiago , Xesús González Souto
Published: July 2024

Purpose:

To show the workflow for the commissioning of a MRlinac, and some proposed tests; off-axis targets, output factors for small fields, dose in inhomogeneities, and multileaf collimator quality assurance (MLC QA).

Methods:

The tests were performed based on TG-142, TG-119, ICRU 97, TRS-398, and TRS-483 recommendations as well as national regulations for radiation protection and safety.

Results:

The imaging tests are in agreement with the protocols. The radiation isocenter was 0.34 mm, and for off-axis targets location was up to 0.88 mm. The dose profiles measured and calculated in treatment planning system (TPS) passed in all cases the gamma analysis of 2%/2 mm (global dose differences). The output factors of fields larger than 2 cm × 2 cm are in agreement with the model of the MRlinac in the TPS. However, for smaller fields, their differences are higher than 10%. Picket fence test for different gantry angles showed a maximum leaf deviation up to 0.2 mm. Displacements observed in treatment couch adding weight (50 kg) are lower than 1 mm. Cryostat, bridge, and couch attenuation was up to 1.2%, 10%, and 24%, respectively.

Conclusion:

The implemented tests confirm that the studied MRlinac agrees with the standards reported in the literature and that the strict tolerances established as a baseline should allow a smoother implementation of stereotactic treatments in this machine.
Minimally Invasive Access Cavity Designs: A Review
Authors: Rane Sushmita , Pandit Varsha , Gaikwad Ashwini , Chavan Shivani , Patil Rajlaxmi , Shinde Mrunal
Published: July 2024

ABSTRACT

Access cavity preparation, chemo-mechanical preparation, and obturation make up the majority of the endodontic triad. Every action should be carefully observed by the clinician. In the last two decades, endodontics has seen advancements in both technology and materials. Given the technical advancements in applied sciences, magnification, and imaging techniques, minimally invasive therapies are currently used in the medical and dentistry industries. This review article will describe minimally invasive Access cavity designs and their advantages and disadvantages in Endodontic treatment.