bluuebunny/crossref_metadata_2025 huggingface dataset:
I131 Accumulation in Hydrocele in the Setting of Metastatic Papillary Carcinoma Thyroid
Authors: Seetharam SJ , Rajaraman Vishnukumar , Pandit Nandini
Published: August 2023

131I is widely used for the treatment of goiter and residual and metastatic thyroid cancer. Uptake of 131I is mainly due to the expression of sodium-iodide symporter in the target tissues. Incidental third space accumulation in the pleural and pericardial cavity can be encountered due to passive diffusion of tracer into these cavities. We present an interesting finding of 131I accumulation in the scrotal hydrocele in a 70-year-old patient with a metastatic classical variant of papillary thyroid carcinoma, who was treated with 200 m Ci of 131I.
Utility of WhatsApp in emergency urological practice
Authors: Sharma Aditya Prakash , Singh Saket , Devana Sudheer Kumar , Chaudhary Kapil , Pareek Tarun , Singh Shrawan K.
Published: August 2023

Introduction:

The messaging application ‘WhatsApp’ is used in clinical practice, often for communication between a medical trainee and a consultant. We designed this study to find the interrater reliability of the data transmitted through this application and validating its use in urological practice.

Materials and Methods:

Clinical details and computerized tomographic (CT) images of 30 patients visiting the urology emergency were posted in a closed WhatsApp group involving three consultants (SKD, APS, and KC). The CT images were posted in the WhatsApp group as Whole Image (WI) and Image of Interest (IOI) format and rated on a scale of 1–5. The consultants formulated a provisional diagnosis and initial management strategy. The interrater reliability of these responses was analyzed in the study.

Results:

Mean WI rating ranged from 3.03 ± 0.61 to 3.73 ± 0.64 (Cronbach alfa [α]-0.494, P = 0.006). Mean IOI rating ranged from 3.4 ± 0.56 to 4.13 ± 0.73 (α-0.824, P < 0.0001). For diagnosis, the proportion of observed agreement (P0) was 83.3% for SKD and APS, 76.6% for SKD and KC, and 73.3% for APS and KC. For management, P0 was 86.6% for APS and KC, 86.6% for SKD and APS, and 80% for SKD and KC.

Conclusions:

WhatsApp Messenger serves to transmit good quality pictures of CT scan images. A reasonable diagnosis and management strategy can be formulated using this app with fair inter-rater reliability.
Primitive neuroectodermal tumor of the penile urethra
Authors: Asari Ashishkumar Narsinhbhai , Kulkarni Bijal , Yuvaraja T. B.
Published: August 2023

Primitive neuroectodermal tumor (PNET)/Ewing's sarcoma tumors are a group of highly malignant tumors composed of small, round cells showing neuroectodermal differentiation that commonly affects soft tissue and bone. PNET involving the genitourinary system is rare and PNET of the penile urethra is rarer still. It exhibits a highly aggressive biological behavior with poor prognosis. We report a case of a 27-year-old male presenting with penile swelling and difficulty in passing urine. Examination revealed a firm penile urethral mass. Pathological and immunohistochemical results of the specimen obtained from urethroscopic biopsy followed by total penectomy confirmed the diagnosis of PNET of the urethra. He received combination chemotherapy: ifosfamide and etoposide (IE) + vincristine, Adriamycin, and cyclophosphamide (VAC). In conclusion, PNET has to be considered in the differential diagnosis of a penile urethral mass in young patients.
Robot-assisted laparoscopic ureteral reimplant
Authors: Tyagi Vipin , Pahwa Mrinal , Lodha Praveen , Mistry Tejas , Chadha Sudhir
Published: August 2023

Introduction:

Open ureteral reimplant has been the gold standard for management of lower ureteric strictures. With the widespread acceptance of robotic surgery, robotic-assisted laparoscopic ureteral reimplant (RALUR) is becoming the preferred choice for performing ureteral reimplant. We present our single-institution and single-surgeon experience of performing RALUR.

Materials and Methods:

We performed a retrospective analysis of 40 patients who underwent RALUR at our institute in the last 5 years. Demographic data were recorded along with presenting complaint and diagnosis. Intraoperative variables included operative and docking time, blood loss, intraoperative complications, technique, and procedure performed. Postoperative data that were analyzed included complications, hospital stay, and outcomes. Patient satisfaction score was calculated using a numerical scale of points 1–6.

Results:

The mean age of patients was 31.5 ± 9.8 years (r = 4–45). Male: female ratio was 3:5. The most common presenting symptom was flank pain, and the most common etiology was iatrogenic strictures in adults and congenital vesicoureteral reflux in children. The mean operative time and blood loss were 135.3 ± 45.1 min (r = 84–221) and 67.7 ± 31.4 ml (r = 32–118), respectively. There were no intraoperative complications and nil conversion to open surgery. The mean length of hospital stay was 4.5 ± 2.3 days (r = 3–9). Radiographic success was achieved in 41 out of 44 ureters. Eighty-five percent of the patients were completely satisfied with robotic approach and its outcomes.

Conclusion:

RALUR is a minimally invasive, safe, feasible, less morbid technique with good outcome.
Renal transplant in a patient of severe hemophilia
Authors: Malik Sandeep , Sadasukhi Nripesh , Sadasukhi T. C. , Gill Amrit Pal Singh
Published: August 2023

Hemophilia is a rare disorder that is difficult to diagnose and manage. The prevalence of end-stage renal disease is increasing in hemophilic patients because of improved life expectancy. Renal transplant surgery in such patients is often complicated by adverse hematological events such as bleeding and intravesical thrombosis, both with a risk of renal allograft rejection. We report a case of a 46-year-old hemophilia A patient on hemodialysis who underwent renal transplant and show that although challenging, renal transplant in hemophilic patients is possible.
Safety and feasibility of freehand transperineal prostate biopsy under local anesthesia
Authors: Sivaraman Ananthakrishnan , Ramasamy Vasantharaja , Aarthy P. , Sankar Vinoth , Sivaraman P. B.
Published: August 2023

Introduction:

With the emergence of multidrug-resistant organisms causing urosepsis after transrectal biopsy of prostate, the need for an alternative approach has increased. We assessed the safety and feasibility of transrectal ultrasound (TRUS) guided free-hand transperineal prostate biopsy under local anesthesia (LA) for suspected prostate cancer.

Materials and Methods:

This prospective study was conducted from July 2019 to December 2020 in which patients with elevated prostate-specific antigen (PSA) and/or abnormal digital rectal examination underwent magnetic resonance imaging-TRUS cognitive fusion transperineal prostate biopsy (target and systematic) using coaxial needle. Demographic, perioperative, and outcome data of 50 consecutive patients were analyzed.

Results:

The mean age of the patients was 69.6 ± 7.61 years, median PSA 13.55 ng/mL (4.17–672) and prostate size 45cc (16–520). Prostate Imaging–Reporting and Data System (PIRADS) 2, 3, 4, and 5 lesions were found in 2, 12, 12, and 24 patients, respectively. Average procedure duration was 20 min (15-40 min) and number of cores ranged from 12 to 38 (median 20). Forty out of fifty (40/50) patients experienced only mild pain with visual analog scale ≤2. Histopathological examination showed adenocarcinoma, benign prostatic hyperplasia, and chronic prostatitis in 41, 5, and 4 patients respectively with 82% cancer detection rate (CDR). Over 95% of cases showed clinically significant cancer (International Society of Urological Pathology class ≥ 2) and 91.7% of patients with PIRADS score 4/5 and 66.7% with PIRADS score 3 had malignancy. Three patients developed complications (two hematuria, one urinary retention), both were managed conservatively and none had urosepsis.

Conclusions:

Free-hand transperineal prostate biopsy by coaxial needle technique under LA is safe and feasible with good tolerability, high CDR, and minimal complications particularly reduced urosepsis.
Comparison of whole-body bone scintigraphy with axial skeleton magnetic resonance imaging in the skeletal evaluation of carcinoma prostate
Authors: Venkatachalapathy Vigneswara Srinivasan Sockkalingam , Rajeshkannan Ramiah , Sarma Manjit , Pooleri Ginil Kumar
Published: August 2023

Introduction:

Whole-body bone scintigraphy (WBBS) is considered to be the standard of care in the initial skeletal evaluation of patients with carcinoma prostate. Magnetic resonance imaging (MRI) is a potential alternative technique for detecting bone metastasis. The objective of this study was to compare the diagnostic performance of WBBS with a single-photon emission computed tomography–computed tomography (SPECT-CT) correlation of the suspicious WBBS lesions to the axial skeleton (AS)-MRI in diagnosing bone metastasis in patients with carcinoma prostate.

Methods:

WBBS and AS-MRI were both performed during the initial skeletal evaluation in 35 patients of carcinoma prostate with the prostate-specific antigen (PSA) in the range of 10–50 ng/ml. Suspicious lesions on the WBBS were correlated on SPECT CT. The presence or absence of metastasis was determined by best valuable comparator. The validity parameters of WBBS and AS-MRI were computed and compared.

Results:

The sensitivity, specificity, positive predictive value, and negative predictive value of WBBS and AS-MRI for detecting patients with bone metastasis were 55.6%, 88.5%, 62.5%, 85.2% and 100.0%, 96.2%, 90.0%, 100%, respectively. The kappa value and the accuracy of WBBS were 0.457 and 80.0%, respectively. The kappa value and accuracy of AS-MRI were 0.928 and 97.1%, respectively.

Conclusions:

The diagnostic performance of AS-MRI in detecting patients with bone metastasis due to carcinoma prostate is superior to that of WBBS with SPECT-CT correlation of the suspicious lesions in the PSA range of 10–50 ng/ml.
Drotaverine-induced priapism
Authors: Kanbur Ajay Shyam , Agarwal Abhishek , Rokade Muktachand L
Published: August 2023

Drug-induced priapism is well known and papaverine is the most common drug known to cause priapism. Drotaverine, an analog of papaverine, is used extensively to treat Colicky pain. We report the first case of drotaverine.induced priapism.
Unusual presentation of castrate-resistant prostate cancer with urethral and inguinal nodal metastasis
Authors: Jindal Tarun , Pawar Pravin , Subedi Neeraj
Published: August 2023

Metastatic involvement of the urethra is a rare finding in patients with carcinoma prostate. The signs and symptoms overlap with those of a primary urethral malignancy. The diagnosis is made following a biopsy of the suspected lesions. We describe the case of a 66-year-old patient with carcinoma prostate who presented with penile pain, 18 months after the treatment with androgen deprivation therapy. Ga-68 prostate-specific membrane antigen positron emission tomography/computed tomography helped in the identification of the urethral and inguinal nodal metastasis, which was confirmed histologically. We also discuss the management of this unusual clinical scenario.
The current role of cytoreductive nephrectomy for metastatic renal cell carcinoma
Authors: Umbreit Eric C. , McIntosh Andrew G. , Suk-Ouichai Chalairat , Karam Jose A. , Wood Christopher G.
Published: August 2023

The management of metastatic renal cell carcinoma (mRCC) continues to be a therapeutic challenge; however, the options for systemic therapy in this setting have exploded over the past 20 years. From the advent of toxic cytokine therapy to the subsequent discovery of targeted therapy (TT) and immune checkpoint inhibitors, the landscape of viable treatment options continues to progress. With the arrival of cytokine therapy, two randomized trials demonstrated a survival benefit for upfront cytoreductive nephrectomy (CN) plus interferon therapy and this approach became the standard for surgical candidates. However, it was difficult to establish the role and the timing of CN with the subsequent advent of TT, just a few years later. More recently, two randomized phase III studies completed in the TT era questioned the use of CN and brought to light the role of risk stratification while selecting patients for CN. Careful identification of the mRCC patients who are likely to have a rapid progression of the disease is essential, as these patients need prompt systemic therapy. With the continued advancement of systemic therapy using the immune checkpoint inhibitors as a first line therapy, the role of CN will continue to evolve.
Diagnostic accuracy of urinary aquaporin-1 as a biomarker for renal cell carcinoma
Authors: Cheriyan Abhilash , Nellickal Arun Jose , John Nirmal Thampi , Jeyaseelan Lakshmanan , Kumar Santosh , Devasia Antony , Kekre Nitin
Published: August 2023

Introduction:

Optimal patient selection plays a vital role in management of renal tumors with the introduction of nephron-sparing approaches and active surveillance. A reliable and accurate diagnostic biomarker will be a useful adjunct to decision-making. We studied the diagnostic accuracy of urinary aquaporin-1 (uAQP-1), an upcoming urinary biomarker, for renal cell carcinoma.

Materials and Methods:

In this prospective biomarker study, urine samples were obtained preoperatively from 36 patients with an imaged renal mass suggestive of RCC and 24 healthy age-matched controls, chosen from among voluntary kidney donors. uAQP-1 concentrations were estimated with a sensitive and specific enzyme-linked immunosorbent assay (ELISA) and normalized by estimation of urinary creatinine. The Mann–Whitney U-test was used to compare differences between any two groups. A receiver operator characteristic (ROC) curve was plotted to analyze the diagnostic accuracy of uAQP-1 for RCC.

Results:

The median uAQP-1 concentration among the cases and controls was 8.78 ng/mg creatinine (interquartile range [IQR]: 5.56–12.67) and 9.52 ng/mg creatinine (IQR: 5.55–12.45), respectively. There was no significant difference in uAQP-1 concentrations between the two groups. ROC analysis showed that, for a cutoff value of 8 ng/mg creatinine, the sensitivity and specificity of uAQP-1 as a diagnostic test were 47.2% and 66.7%, respectively, and area under the curve was 0.52 (95% confidence interval: 0.42–0.62).

Conclusions:

uAQP-1 concentrations did not discriminate between healthy individuals and patients with RCC. The results of this study suggest that uAQP-1 may not be a suitable diagnostic biomarker for RCC in the study population.
Use of posterior radial nephrotomy in laparoscopic enucleation of renal hilar tumors
Authors: Chiruvella Mallikarjuna , Ghouse Syed Mohammed , Adapala Rajesh Kumar Reddy
Published: August 2023

Centrally located completely endophytic renal hilar tumors pose a technical challenge, especially during a minimally invasive surgery. Relation of the tumor to the renal vasculature decides the approach. Tumors placed anterior to the vasculature can be approached in the anterior trans-hilar manner. However, tumors placed posterior to the vasculature need a posterior approach, which is quite a difficult maneuver during transperitoneal laparoscopy. Adequate exposure to access the resection plane is the key principle. We describe a laparoscopic technique for enucleation of such tumors, applying the surgical principle of radial nephrotomy in the intersegmental plane which is usually performed to remove renal stones.
Ultrasound-guided supine mini-percutaneous nephrolithotomy in ectopic pelvic kidney
Authors: Sharma Laxmi Kant , Venkatachalapathy Vigneswara Srinivasan Sockkalingam , Mishra Dilip Kumar , Agrawal Madhu Sudan
Published: August 2023

Management of urolithiasis in an ectopic pelvic kidney is challenging and laparoscopic pyelolithotomy and laparoscopy-guided percutaneous nephrolithotomy (PCNL) are commonly favored options. We report a case of ultrasound-guided supine mini-PCNL in ectopic pelvic kidney in an adolescent female. Complete stone clearance was achieved with an uneventful postoperative period. Ultrasound-guided supine mini-PCNL is safe and effective treatment option for the management of calculus in the ectopic pelvic kidney. The risk of injury to surrounding structures associated with ultrasound modality of access can be avoided with proper case selection and careful technique.
Retrograde intrarenal surgery for renal stones in children <5 years of age
Authors: Chandramohan Vaddi , Siddalingaswamy P. M. , Ramakrishna Paidakula , Soundarya Ganesan , Manas Babu , Hemnath Anandan
Published: August 2023

Introduction:

There are very few studies in the literature describing retrograde intrarenal surgery (RIRS) in preschool children. We have evaluated the feasibility, stone-free rate, and complications of RIRS in children <5 years of age.

Methods:

All children <5 years of age and stone size <2 cm (renal/proximal ureteric), who underwent RIRS at our hospital from February 2010 to May 2020 were included in this retrospective study. All children were prestented for the passive dilatation of ureter. A 7.5 Fr flexible ureterorenoscope was introduced over the ureteral access sheath (UAS) or over a guidewire. At 2 weeks, the stent was removed and at 2 months the child was evaluated for residual stones.

Results:

A total of 62 children with 67 renal units met the inclusion criteria. The mean age was 42.11 months (4–60 months). Mean weight was 13.31 kg (6–16.3 kg). Mean stone size was 11.9 mm (7.3–18.2 mm). Majority of the stones were in pelvis (37.8%). UAS 9.5/11.5 Fr was placed in 40 (63.5%) children. Mean operative time was 55.2 min; mean hospitalization was 61 h. Four out of the 67 renal units (5.9%) required conversion to minipercutaneous nephrolithotomy in the same sitting, due to access failure. Two cases who developed post-operative fever required a change of antibiotics. Two cases required ureteroscopy for steinstrasse postoperatively. Stone-free rate at 2 months for stones size ≤2 mm was 76.3%.

Conclusion:

Pediatric RIRS is a promising option in young children as it offers acceptable stone-free rates and a low incidence of high-grade complications. However, it requires expertise and should be offered in tertiary care centres.
Teleconsultation for paraphimosis reduction in the geriatric population
Authors: Sharma Aditya Prakash , Tyagi Shantanu , Chaudhary Kapil , Singh Shrawan Kumar
Published: August 2023

The health-care sector has been drastically overwhelmed in the wake of prevailing COVID-19 pandemic, hampering elective and emergency medical services alike. The geriatric population is especially affected in this regard as they are the ones who need access to health care services the most, and unfortunately, they are the ones with the highest risk of cross infection and mortality with SARS-COV-2. Lockdown and public restrictions have made the accessibility even harder. Telemedicine has emerged as a useful tool that avoids the risk of cross infection during the face-to-face consultation. Numerous guidelines have been made regarding the implementation of teleconsultations during this pandemic. Through this report, we describe the “beyond guidelines” emergency management of paraphimosis in an aged, bedridden male with comorbidities, through teleconsultation amid the COVID-19 pandemic.
Right Ventricle Response to Major Lung Resection (the RIVER Study)
Authors: Giustiniano Enrico , Nisi Fulvio , Piccioni Federico , Gambino Francesco , Aceto Romina , Lungu Ramona , Carrara Alfonso , Neganov Maxim , Cecconi Maurizio
Published: August 2023

Backgrounds:

Major lung resection is associated with high postoperative morbidity and mortality, especially due to cardiorespiratory complications. Right ventricle (RV) ejection, pulmonary artery (PA) pressure, and tone are tightly coupled. Since the RV is exquisitely sensitive to changes in afterload, an acute increase in RV outflow resistance (i.e., acute pulmonary embolism [PE]) will cause acute RV dilatation and, a reduction of left ventricle compliance too, rapidly spiraling to acute cardiogenic shock and death. We investigated the changing in RV performance after major lung resection.

Materials and Methods:

We carried out transthoracic echocardiography (TTE) aiming at searching for the incidence of early RV systolic dysfunction (defined as tricuspid annulus plane systolic excursion [TAPSE] <17 cm, S’-tissue Doppler imaging <10 cm/s) and estimate the RV-PA coupling by the TAPSE/pulmonary artery pressures (PAPs) ratio after major lung resection. The TTE has been performed before and immediately after surgery.

Results:

After the end of the operation the echocardiographic parameters of the RV function worsened. TAPSE decreased from 24 (21 ÷ 28) to 18 (16 ÷ 22) mm (P = 0.015) and PAPs increased from 26 (25 ÷ 30) to 30 (25 ÷ 39) mmHg (P = 0.013). TAPSE/PAPs ratio decreased from 0.85 (0.80 ÷ 0.90) to 0.64 (0.54 ÷ 0.79) mm/mmHg (P = 0.002).

Conclusions:

In line with previous reports, after major lung resection the increase in afterload reduces the RV function, but the impairment remains clinically not relevant. The different clinical picture of an acute cor pulmonale due to PE implies that the pathogenesis of cardiac failure involves more pathways than the mere mechanic occlusion of the blood flow.
An Unusual Case of Ascending Aorta Dissection 4 Years after Perceval Sutureless Bioprosthesis Implantation: Easier Access to Diagnosis through the Right Parasternal Longitudinal Echocardiographic Window
Authors: Sonaglioni Andrea , Grasso Enzo , Nicolosi Gian Luigi , Trevisan Roberta , Martinelli Gian Luca , Lombardo Michele
Published: August 2023

Sutureless bioprostheses are more frequently used for the surgical treatment of elderly patients with high burden of comorbidity, who are candidates to aortic valve replacement (AVR). Among the sutureless bioprostheses, the Perceval valve has shown a good midterm durability, with very few reports of valve deterioration and low risk of complications. Herein, we present an unusual case of ascending aorta dissection which occurred 4 years after AVR with a Perceval sutureless pericardial bioprosthesis, likely related to the peculiar prosthetic design. A high right parasternal longitudinal view of the aorta in the right lateral decubitus allowed to suspect the acute aortic syndrome, thus accelerating the subsequent diagnostic and therapeutic iter.
A Rare Case of Intramyocardial Dissecting Hematoma following Acute Myocardial Infarction
Authors: Sarkar Shibsankar , Majumder Biswajit , Ghosh Ratul , Chakraborty Sougat
Published: August 2023

Intramyocardial dissecting hematoma (IDH) is a rare and very dangerous complication of myocardial infarction (MI) and percutaneous intervention. Hemorrhage inside the spiral fibers of the myocardium causes this type of dreaded complication. We have reported a case of IDH following acute anterior wall MI. The patient’s electrocardiogram showed ST elevation in precordial leads. The serum troponin level was elevated. IDH should be considered a rare complication after acute MI. The patient may present with features of cardiogenic shock. A two-dimensional echocardiography may demonstrate this type of complication.
Frequency and Clinical Significance of Atrial Cavities in situ Thrombosis: A Large-Scale Study and Literature Review
Authors: Cresti Alberto , Baratta Pasquale , Aloia Elio , Sensi Francesco De , Solari Marco , Limbruno Ugo
Published: August 2023

Background:

Atrial tachyarrhythmias are the main cause of atrial thrombosis, and are usually in the left appendage. The prevalence and causes of endocavitarian thrombosis have not been investigated in recent large-scale studies. Aim of our work was to describe the epidemiology, the clinical characteristics and predisposing factors of “extra-appendicular” atrial thrombosis and to report a systematic review of recent literature.

Methods and Results:

5,862 consecutive adult patients referred to a transesophageal echocardiographic exam, were enrolled. A total of 175 subjects with Atrial Thrombosis were found with a prevalence of 2.98%; among those 22 was found in left (0.38%) and 2 in the right (0.03%) atrium. Among the 22 patients with left atrial thrombosis, 8 were associated with prosthetic valves, 4 with mitral stenosis and the remaining with hypercoagulative conditions (cancer, septic shock, eosinophilic pneumonia, cardiogenic shock and warfarin under-dosage in permanent atrial fibrillation and decompensated heart failure). Cancer was associated in one of the two patients with a right atrial clot. The review of the literature from 2000 to December 2019 revealed conflicting results of 48 case reports of atrial cavity thrombosis; pooling this data proved the rarity of extra-appendage thrombosis and confirmed its association with a valvular heart disease or a systemic hypercoagulable state.

Conclusions:

Atrial “extra-appendage” thrombosis is a rare condition usually associated to “valvular” atrial fibrillation (such as prosthetic valves and mitral stenosis). A minority, but significant, cases are secondary to a thrombophilic conditions. In absence of valvular heart disease an underlying condition should be sought.
The Influence of Special Military Training on Left Ventricular Adaptation to Exercise in Elite Air Force Soldiers
Authors: Junianto Iwan , Soesanto Amiliana Mardiani , Radi Basuni , Yonas Emir , Kuncoro Ario Soeryo , Atmadikoesoemah Celly Anantaria , Sakti Damba Dwisepto Aulia
Published: August 2023

Purpose:

The purpose of this study was to observe the influence of level physical training intensity on left ventricular (LV) adaptation in elite air force soldiers compared to regular basic military training.

Methods:

The LV adaptation of special military physical training for elite air force soldiers was compared with basic military training for regular troops. A group of the nonmilitary subject was also evaluated as a control group. The presence of LV adaptation was evaluated using some echocardiography parameters, including LV mass index (LVMI), LV ejection fraction (LVEF), global longitudinal strain (GLS), and myocardial work index. The parameters of the myocardial work index include global constructive work (GCW), global wasted work (GWW), global work index (GWI), and global work efficiency (GWE).

Results:

Forty-three elite air force soldiers underwent special military training, 43 regular troops underwent basic military training, and 23 nonmilitary subjects as a control group. Age, heart rate, blood pressure, and Cooper test results significantly differed among the three groups. Multivariate analysis among all groups showed that the level of physical training was associated with the LVMI (coefficient β = 6.061; 95% confidence interval [CI] = 1.91–10.22; P = 0.005), LVEF (coefficient β = −1.409; 95% CI = −2.41–[−0.41]; P = 0.006), LVGLS (coefficient β = 1.726; 95% CI = 1.20–2.25; P < 0.001), GWW (coefficient β = −13.875; 95% CI = −20.88–[−6.87]; P < 0.001), GWE (coefficient β = 0.954; 95% CI = 0.62–1.26; P < 0.001), GCW (coefficient β = 176.128; 95% CI = 121.16–231.10; P < 0.001), and GWI (coefficient β = 196.494; 95% CI = 144.61–248.38; P < 0.001).

Conclusions:

Higher intensity of physical training observed in a special military training is associated with higher LV GLS, GWE, GCW, GWI, and lower GWW value suggesting greater physiological adaptation than the lower intensity training.
Determining Association Between Cognitive Function and Oral Health Status among Rural Community Dwelling Geriatrics
Authors: Balasubramaniam Arthi , Diwakar Madan Kumar Parangimalai , Vaitheswaran Sridhar , Santhosh Kumar M P , Sushanthi S , Pandiyan Indumathy
Published: August 2023

Objective:

Numerous prospective studies worldwide investigated the association between oral health status and dementia or cognitive decline. No clear agreement has emerged on the association. This study aimed to determine the association of cognitive function and oral health status among community dwelling geriatrics in rural South India.

Materials and Methods:

A cross-sectional study was conducted among community dwelling geriatrics in rural South India by recruiting 211 individuals aged above 60 years. Their cognitive function was assessed using pre-validated community screening instrument for dementia (CSI-D) which has informant and cognitive scale. The data on cognitive function was collected by community health workers in electronic version (Web app). Their oral health status was assessed by World Health Organization (WHO) oral health assessment form in electronic version (Web app).

Results:

From the logistic regression analysis, it was observed that cognitive impairment showed an association with 1.6- and 1.9-times risk for root caries and a greater number of missing teeth (P ≤ 0.05). No association of other oral health parameters such as gingivitis, periodontitis, dental erosion, and dental trauma with cognitive impairment exhibited.

Conclusion:

From the results, it can be concluded that cognitive impairment has an association with root caries and number of missing teeth which increases the risk for the same and vice versa.
C-reactive protein and its association with COVID-19
Authors: Devi Yumlembam Bishwabati , Presanambika Hari , Kongbrailatpam Bidyarani , Singh Ksh. Birendra , Chongtham Dhanaraj , Devi Khuraijam Ranjana
Published: August 2023

Background:

COVID-19 is the third serious Coronavirus outbreak after severe acute respiratory syndrome (2002–2003) and Middle East respiratory syndrome (2012). There is an increasing need for a credible marker to triage patients and for telescoping the prognosis of COVID-19 more so in resource-constrained settings. COVID-19 patients were found to have a significant increase of C-reactive protein (CRP) levels (20–50 mg/L). Severe COVID-19 patients were noted to have up to 86% elevated CRP. 10-fold higher CRP was found in patients who died from COVID-19 than the recovered cases.

Objectives:

To demonstrate the association of CRP levels with COVID-19 infected patients and to assess the findings in accordance with different variables.

Materials and Methods:

Thirty-three nonconsecutive COVID-19 tested positive patients whose blood samples were sent for CRP testing were included for a retrospective study conducted between August 2020 and February 2021.

Results:

This study revealed elevation in CRP levels in patients belonging to severe cases (median = 46.71 mg/L) followed by moderate (median = 21.61 mg/L) and mild cases (median = 8.572 mg/L). Patients with comorbidities were noted to have higher median CRP (37.86 mg/L) compared to those without comorbidities (median = 20.3 mg/L). This study also detected increased CRP levels (median = 43.732 mg/L) in morbid cases compared to recovered cases (median = 20.3 mg/L).

Conclusion:

In a hospital with limited resources, this study successfully demonstrated the significant role of CRP in COVID-19 outcome elucidating the importance of CRP levels when used for triaging patients and monitoring disease progression.
Doctors with skin injuries due to personal protective equipment in a dedicated COVID-19 hospital
Authors: Gupta Vikas , Nayyer Prem Singh , Gupta Vinita , Ranjan Rajesh
Published: August 2023

Background:

With the emergence of highly infectious epidemics/pandemics, such as Ebola virus diseases, severe acute respiratory syndrome, and coronavirus disease-2019 (COVID-19), doctors are at much greater risk of infection due to the exposure to the highly infectious bodily fluids and droplet nuclei. Hence, treating and caring for patients need the use of personal protective equipment (PPE) to reduce the transmission risk.

Objectives: The present study was conducted to estimate the prevalence of skin injury and its type due to PPE usage, to find the association of related factors with the skin injuries among doctors.

Materials and Methods:

This descriptive cross-sectional study was conducted after obtaining the institutional ethical approval in dedicated COVID-19 hospital for a period of 4 months among 132 doctors wearing grades 2 and 3 PPE kit using a questionnaire collecting the details regarding baseline, duty, skin injury characterization. During analysis of data, an association between variables was significant for P < 0.05.

Results:

It was observed that 17.1% of doctors were wearing the PPE kit for 5 or more hours/and 13.0% of subjects reported absenteeism from duty hours due to PPE-induced skin injuries. 76.4% of subjects have suffered from skin injury after PPE usage. The most common symptoms/signs for the skin injury occurred was indentation and pain on back of ears (61.0%).

Conclusion: The skin injuries of PPE among the doctors may result in reduced morale for overloaded work and made them anxious. Hence, an appropriate monitoring of these adverse effects should be done and effective preventive measures should be adopted.
Simulated patients in the training of medical students
Authors: Shrivastava Saurabh RamBihariLal , Shrivastava Prateek Saurabh
Published: August 2023

During the phase of medical training, patients are considered as the best teachers and it is strongly believed that exposure to patients helps medical students in both learning and practicing medicine. Nevertheless, the changing health dynamics has significantly affected the availability of patients in hospitals. This has led to the introduction of simulated patients in the delivery of medical education, initially for facilitating the acquisition of clinical skills and subsequently for the sake of assessment, including giving feedback to the learners. Any medical college, which is planning to initiate such curricular reforms within their setup, has to be aware of the standard practices to be adopted for recruitment, screening, and retention. In conclusion, the use of simulated patients in teaching and assessment in medical training has immense potential to improve the skills of medical students. It is the need of the hour for every medical college to explore their dynamics and then plan for the introduction of simulated patients within their setup and thereby improve multiple skills of future doctors.
Maternal deaths
Authors: Singh Khangembam Pradipkumar , Keisham Supriya , Chetri Deepen , Wanio Sungoh James Da O. , Zohlupuii Lynda B. , Meera Th. Devi
Published: August 2023

Background:

Maternal death is the death of a woman while pregnant or within 42 days of termination of pregnancy. This can be due to direct causes or indirect unrelated causes. It is an important indicator of health-care services. Autopsy, which is an important tool of investigation, provides valuable input regarding the sequence of events leading to maternal death.

Objectives:

The objective of this study is to determine factors causing maternal deaths and to discuss the utility of medicolegal knowledge in ascertaining the causes of maternal deaths.

Materials and Methods:

This was a retrospective study where individual records of all maternal deaths brought for autopsy in the hospital mortuary during the past 10 years from January 2011 to December 2020 were studied. The cause of death and the factors which led to death in each individual case were analyzed.

Results:

A total of 15 maternal deaths were brought during the study period. Most maternal deaths (40%) occurred in the age group of 31-40 years. Maximum of the cases 11 of 15 were able to reach a health-care center before delivery. Direct causes accounted for 86.67% of maternal deaths. Hemorrhage and shock (38.46%) were the major direct cause of maternal deaths. The majority of the deaths occurred during the postnatal period (53.33%). Regarding the pregnancy outcome, 8 (53.33%) mothers were able to deliver live-born babies, of which 5 (62.5%) were delivered by lower segment cesarean sections and 3 (37.5%) by normal vaginal deliveries.

Conclusion:

There is scope for improvement as a large proportion of the observed deaths are preventable. Improving the rural health centers, upgrading the referral centers with round-the-clock functioning blood banks is the need of the hour.
An unusual case of coronavirus disease 2019 associated with chronic myeloid leukemia in a young male presenting with priapism
Authors: Iqbal Banyameen , Mishra Prtyush , Kumar Rakesh
Published: August 2023

Patients with chronic myeloid leukemia (CML) usually present in the elderly age and rarely in the adolescents and young adults (AYA) groups. In this case report, we describe a case of a 28-year-old male who presented to the hospital with priapism and pain abdomen along with a positive history of coronavirus disease 2019 (COVID-19) disease. The patient was diagnosed as CML based on his peripheral blood smear and bone marrow aspiration findings. These findings were confirmed by fluorescence in situ hybridization (FISH) which showed the presence of breakpoint cluster region/ABL1 fusion gene. The patient was treated with tyrosine kinase inhibitor along with surgical shunt for priapism which showed clinical improvement. There is a very limited understanding of disease management and survival outcomes in this group of patients; therefore, the aim of this case report is to understand the association of COVID-19 infection in patients of AYA group suffering from CML.
Evaluation of the efficacy of various dry powder inhalation devices in the treatment of bronchial asthma patients
Authors: Kumar Subodh , Pandey Anuj Kumar , Verma Ajay Kumar , Singh R. P. , Chaudhri Sudhir , Kant Surya , Katiyar S. K.
Published: August 2023

Introduction:

In the current study, we aimed to evaluate the efficacy in terms of clinical effectiveness and patients’ acceptability regarding the use of dry powder inhaler devices in asthmatic patients.

Materials and Methods:

Patients with mild-to-moderate asthma were recruited from Ganesh Shankar Vidyarthi Memorial Medical College, Kanpur, India. A total number of patients were divided into three groups and were given different dry powder inhalation devices, randomly Group one-Rotahaler; Group Two-Diskhaler; and Group Three-Transhaler. Spirometry was performed, and the inhalation technique was checked in each follow-up visit.

Results:

Patients with asthma in all three studied groups improved from the prescribed inhaled steroids, irrespective of the inhalational device. Min Max % as a marker for peak expiratory flow rate variability, improved in all three groups without any significant difference. Predicted forced expiratory volume in the first second percent considered as a marker of asthma severity improved significantly in all patients, but without any significant difference between groups.

Conclusion:

We conclude that these inhalers, particularly in mild-to-moderate asthma, have comparable efficacy; however, we carried out intensive monitoring and teaching of inhalational technique, which could be the reason behind insignificant difference.
The management of fatal hyperhemolysis in a sickle cell anemia patient transfused in a remote Island in North Andaman
Authors: Abdul Shahid .P.P , Shaiji P. S. , Hameed Yameena
Published: August 2023

Hyperhemolysis following red cell transfusion is a potentially fatal complication in sickle cell disease patients. Red cell alloimmunization can lead to a delayed hemolytic reaction further leading to hyperhemolysis resulting in the destruction of patients’ own red blood cells. The chances of alloimmunization increases when there are ethnic differences between the donor and recipients. We report the case of a 25-year-old female with sickle cell anemia, treated with packed red cells in a remote island of North Andaman, India, who suffered from hemolytic transfusion reaction and hyperhemolysis yet could be successfully treated to recovery with the available resources. She had a severe hemolysis, anemia with the hemoglobin levels than pretransfusion hemoglobin, jaundice, acute kidney failure, and deranged liver function tests. Multiple alloantibodies “anti-C and anti-E” were found in her serum which were potentially hemolytic. She was treated with forced diuresis, steroids, and hemodialysis and recovered in a span of 10–14 days.
Dietary practices and physical activity among the school-going adolescents of Bishnupur district, Manipur
Authors: Sanjana Laishram , Konjengbam Shantibala , Christina Soubam
Published: August 2023

Background:

Adolescence is a period during which maximum physical, psychological, and behavioral changes take place. Dietary habits and lifestyle during adolescence are risk factors for several nutrition-related non-communicable diseases in adulthood.

Objective:

The objective is to assess the dietary practices and physical activity among the school-going adolescents of Bishnupur district.

Materials and Methods:

A cross-sectional study was conducted among the school students of standard VIII to X of Bishnupur District. A total of 840 students were selected using a multistage stratified cluster random sampling technique. A self-administered questionnaire was used to collect data. The Chi-square test was used for the comparison of categorical variables. Student’s t-test was used to compare the mean intakes of energy, protein, and fat. A P < 0.05 was taken as statistically significant.

Results:

Overall, the adolescents reported poor dietary intakes; around half (47.7%) of the students reported consumption of fast food on the previous day. Almost half (51.8%) of them had fast foods/junk foods 1–3 times a week. The study also found that 369 (43.9%) participants performed moderate to vigorous physical activity daily.

Conclusion:

The study found that a considerable proportion of adolescents was adopting unhealthy dietary practices and more than half of them were not engaged in physical activity daily. Hence, it is recommended that addressing these risk factors should be given the highest priority and various strategies of primordial, primary, and secondary prevention should be applied.
An investigation into the use of an extended lipid panel in the screening of cardiovascular events
Authors: Jaishankar Thirunavukkarasu , Shivasekar Meera , Vinodhini V. M.
Published: August 2023

Introduction:

Low-density lipoprotein (LDL) is classified into many subclasses based on its atherogenic propensity, with small dense (sd) LDL being a highly important risk biomarker for early coronary heart disease (CHD). Nonhigh-density lipoprotein cholesterol (non-HDLc) is made up of all atherogenic apolipoprotein B-containing lipoproteins, including low-density lipoprotein cholesterol, very-low-density lipoprotein-C, intermediate-density lipoprotein-C, lipoprotein (a), chylomicrons, and chylomicron remnants. Apolipoproteins, which include apolipoprotein B and apolipoprotein A1, are cholesterol transporters that play a key role in lipid metabolism. Furthermore, Apo-B and Apo-A1 indicate total atherogenic and nonatherogenic particles, respectively.

Materials and Methods:

This case–control research was done on participants visiting the cardiology and medicine OP in SRM Medical College Hospital and Research Center. The research included 546 people ranging in age from 30 to 55 years. After an overnight fast, blood samples were obtained for the measurement of apolipoprotein-B and apolipoprotein-A1 using the enzyme-linked immunosorbent assay technique. The calculation was used to determine the sd-LDL, non-HDL, and Apo-B/Apo-A1 ratios.

Results:

When compared to controls, the CHD group had significantly higher levels of sd-LDL, non-HDL, apolipoproteins, and the Apo-B/Apo-A1 ratio. In contrast, the mean level of LDL in CHD was higher and statistically significant (P < 0.001) when compared to normal healthy controls.

Conclusion:

The study shows that there is a high correlation between sd-LDL, nonHDL-C, apolipoproteins, and their Apo-B/Apo-A1 ratio. When compared to standard lipid indicators, the estimate of all of these parameters appears to be a better marker in predicting the early risk of cardiovascular disease in both diabetic and nondiabetic CHD participants and might be utilized successfully in clinical practice.
Framed motivic $\Gamma$-spaces
Authors: Garkusha Grigory Anatolevich , Panin Ivan Alexandrovich , Ostvaer Paul Arne
Published: August 2023

We combine several mini miracles to achieve an elementary understanding
of infinite loop spaces and very effective spectra in the algebro-geometric
setting of motivic homotopy theory. Our approach combines $\Gamma$-spaces
and Voevodsky's framed correspondences into the concept of framed motivic
$\Gamma$-spaces; these are continuous or enriched functors of two variables
that take values in framed motivic spaces. We craft proofs of our main
results by imposing further axioms on framed motivic $\Gamma$-spaces
such as a Segal condition for simplicial Nisnevich sheaves, cancellation,
$\mathbb{A}^1$- and $\sigma$-invariance, Nisnevich excision,
Suslin contractibility, and grouplikeness.
This adds to the discussion in the literature on coexisting points
of view on the $\mathbb{A}^1$-homotopy theory of algebraic varieties.
Deterministic and random attractors for a wave equation with sign changing damping
Authors: Chang Qingquan , Li Dandan , Sun Chunyou , Zelik Sergey Vital'evich
Published: August 2023

The paper gives a detailed study of long-time dynamics generated by
weakly damped wave equations in bounded 3D domains where the damping
coefficient depends explicitly on time and may change sign. It is shown that
in the case, where the non-linearity is superlinear, the considered equation
remains dissipative if the weighted mean value of the dissipation rate
remains positive and that the conditions of this type are not sufficient in
the linear case. Two principally different cases are considered. In the
case when this mean is uniform (which corresponds to deterministic
dissipation rate), it is shown that the considered system possesses smooth
uniform attractors as well as non-autonomous exponential attractors. In the
case where the mean is not uniform (which corresponds to the random
dissipation rate, for instance, when this dissipation rate is generated by
the Bernoulli process), the tempered random attractor is constructed. In
contrast to the usual situation, this random attractor is expected to have
infinite Hausdorff and fractal dimensions. The simplified model example
demonstrating infinite-dimensionality of the random attractor is also
presented.
A new class of fractional differential hemivariational inequalities
with application to an incompressible Navier-Stokes system coupled with
a fractional diffusion equation
Authors: Zeng Shengda , Migórski Stanislaw , Han Weimin
Published: August 2023

This paper is devoted to the study of a new and complicated dynamical system,
called a fractional differential hemivariational inequality, which consists
of a quasilinear evolution equation involving the fractional Caputo derivative
operator and a coupled generalized parabolic hemivariational inequality.
Under
certain general assumptions, existence and regularity of a mild solution to
the dynamical system are established by employing a surjectivity result for
weakly-weakly upper semicontinuous multivalued mappings, and a feedback
iterative technique together with a temporally semi-discrete approach through
the backward Euler difference scheme with quasi-uniform time-steps. To
illustrate the applicability of the abstract results, we consider a nonstationary
and incompressible Navier-Stokes system supplemented by a fractional
reaction-diffusion equation, which is studied as a fractional hemivariational
inequality.
The nonarithmeticity of the predicate logic
of primitive recursive realizability
Authors: Plisko Valerii Egorovich
Published: August 2023

The notion of primitive recursive realizability was introduced
by S. Salehi as a kind of semantics for the language of basic arithmetic
using primitive recursive functions. It is of interest to study
the corresponding predicate logic. D. A. Viter proved that the predicate
logic of primitive recursive realizability by Salehi is not arithmetical.
The technically complex proof combines the methods used by the author
of this article in the study of predicate logics of constructive arithmetic
theories and the results of M. Ardeshir on the translation of
the intuitionistic predicate logic into the basic predicate logic.
The purpose of this article is to present another proof of Viter's result
by directly transferring the methods used earlier in proving
the nonarithmeticity of the predicate logic of recursive realizability.