bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical spectrum & changing presentation of celiac disease in Indian children
Authors: Lal Sadhna Bhasin , Venkatesh Vybhav , Aneja Aradhana , Seetharaman Keerthivasan , Kumar Yashwant , Prasad Kaushal Kishor , Rana Surinder Singh
Published: August 2023

Background & objectives:

Celiac disease (CD) is a genetic immune mediated disorder characterised by gluten intolerance. This single centre study, from north India was aimed to assess the clinical, serological and histological profile of CD in a large cohort of children and the changing trends in its presentation.

Methods:

A review of clinical details of CD children diagnosed between 2000 and 2019 and currently on follow up was performed. Information on demography, symptoms, associated conditions, serology, biopsy findings and gluten-free diet were analyzed.

Results:

The mean age (±standard deviation) of 891 children included in the study, at onset and at diagnosis was 4.0±2.7 and 6.2±3.1 yr, respectively. Growth faltering, abdominal pain, abdominal distension and diarrhoea were presenting symptoms in 70, 64.2, 61.2 and 58.2 per cent, respectively. A positive family history of CD was present in 14 per cent and autoimmune conditions in 12.3 per cent of children. Thyroid disorders were seen in 8.5 per cent of children and Type 1 diabetes mellitus (T1DM) in 5.7 per cent. The duration of breastfeeding had a weak positive correlation with age at onset and diagnosis of CD (P<0.001). Non-classical CD was significantly more common in children aged >10 yr and in those presenting after 2010 (P<0.01). T1DM and hypothyroidism occurred more frequently in non-compliant children.

Interpretation & conclusions:

This was the largest single centre study, pertaining to the presentation and follow up of CD in children. Infants and young children were more likely to present with classical symptoms of diarrhoea, abdominal distension and growth failure while older children presented with non-classical CD. There was a trend towards non-classical forms of CD in recent years.
SARS-CoV-2 Antibody Seroprevalence and Humoral Response to Vaccination in Patients Undergoing Maintenance Hemodialysis: A Prospective Cohort Study
Authors: Senthilkumaran Guhan , Rajarathinam Vaishanavi D. , Govindarajan Srinivasaraman , Jibia V. S. , Balasubramanian Chelvamalai M. , Devaraju Prem K. , Murugesan Vinoj , Shankar P , Lamech Tanuj M. , Arumugam Venkatesh , Gopalakrishnan Natarajan
Published: August 2023

Introduction:

COVID-19, caused by SARS-CoV-2, has resulted in significant mortality and morbidity worldwide. Patients of chronic kidney disease who are on maintenance hemodialysis represent a vulnerable population cohort that is susceptible to severe disease. Hence, it is of utmost importance to prioritize vaccination in this population and to assess their response to said vaccination.

Methods:

This prospective analytical study was conducted at the Institute of Nephrology, Madras Medical College, between August 2021 and February 2022. Patients of chronic kidney disease stage 5 dialysis (CKD5D) who were on maintenance hemodialysis and who consented to receive COVID-19 vaccine were studied. Serum samples were obtained before vaccination, ≥28 days after receiving the first dose of the vaccine, and ≥28 days after receiving the second dose. Antibody titers against the spike protein were estimated using the Roche chemiluminescent immunosorbent assay. Patients were grouped into non-responders/seronegative (<0.8 U/ml) and responders/seropositive (≥0.8 U/ml), with a value ≥250 U/ml considered as robust response.

Results:

A total of 96 patients were included. The mean age was 36.70 (±11.53) years and 77.1% of them were male. The median dialysis vintage was 2 (IQR: 0.95–5) years. Twelve patients (9.9%) had a prior COVID-19 infection. Sixty-seven (69.8%) patients had received Covaxin and 29 (30.2%) had received Covishield vaccines. Among the 17 patients who were seronegative at baseline, 4 (23.52%) became seropositive after the first dose of the vaccine, and 11 (64.7%) were seropositive after the second dose, with high titers (“robust response”) achieved in two patients (11.76%). No antibody response, despite two doses of the vaccine, was noted in six patients (35.29%).

Conclusion:

Our study showed a high baseline seropositivity rate, even prior to vaccination, which indicated a high rate of subclinical COVID infection. Among those who were seronegative at baseline, the seroconversion rate after two doses of Covaxin or Covishield was 64.70%.
A prospective study to assess the role of paraoxonase 1 genotype and phenotype on the lipid-lowering and antioxidant activity of statins
Authors: Godbole Charuta , Thaker Saket , Salagre Santosh , Shivane Vyankatesh , Gogtay Nithya , Thatte Urmila
Published: August 2023

Human paraoxonase 1 (PON1) enzyme protects against atherosclerosis by preventing low-density lipoprotein from oxidative modification. Upregulation of PON1 enzymatic activity is suggested to contribute to atheroprotective potential of statins. Glutamine (Q) to arginine (R) at site 192 and leucine (L) to methionine (M) substitution at site 55 polymorphisms influence the PON1 activity. The study assessed the role of PON1 polymorphisms on lipid-lowering and PON1-modulating activity of statins in a Western Indian cohort of patients with dyslipidemia. Lipid profile and PON1 activity were determined at baseline and 3 months after initiation of statin treatment. PON1 genotypes (QQ, QR, RR; LL, LM, and MM) were determined by PCR-RFLP. Paraoxon was used as a substrate for assessing PON1 activity by spectrophotometry. A total of 140 statin-naïve patients were enrolled; of them, 116 were available for final analysis. Fifty-seven (50%) had QQ, 39 (35%) had QR, and 17 (15%) had RR genotypes. Seventy-six (67%) patients had LL, 35 (31%) had LM, and 2 (2%) had MM genotypes. We observed no impact of PON1 polymorphisms on lipid parameters posttreatment. A significant increase was observed in the serum PON1 activity from a median (range) of 47.92 U/L (9.03–181.25) to 72.22 U/L (7.64–244.44) (P < 0.05) following statin treatment, which was independent from high-density lipoprotein (HDL) concentration. This increase was significantly greater in QQ compared to QR and RR genotypes (P = 0.01). To conclude, the important antioxidant properties of statins are exerted via the rise in serum PON1 activity, independent of HDL cholesterol concentrations. The increase was greater in individuals with QQ genotype. Future large-scale studies will validate the premise that QQ homozygotes see added benefits from statin treatment compared to R carriers. In the meantime, PON1 enzymatic activity remains an important marker to be measured while assessing pleotropic effects of statins in CAD.
Relationship between vancomycin-induced nephrotoxicity and vancomycin trough concentration in older adults
Authors: Dai Ning , Jiang Chunyan , Wang Yunchao
Published: August 2023

OBJECTIVES:

The objective of the study is to investigate the risk factors of vancomycin-induced renal toxicity in older adults, especially in those with chronic kidney disease (CKD) Stages 3–5.

METHODS:

In this retrospective observational study, serum vancomycin trough concentrations (VTCs) in patients aged g65 years treated with vancomycin were analyzed, and independent risk factors of vancomycin-induced nephrotoxicity (VIN) were determined by logistic regression analysis.

RESULTS:

In total, 321 patients were included in this study. Serum VTC was an independent risk factor for vancomycin-induced renal toxicity in total cohort (odds ratio [OR], 1.07; P = 0.004) as well as in the cohort with CKD Stages 3–5 (OR, 1.09; P = 0.010). A daily dose of vancomycin and Charlson comorbidity index was an independent risk factor for vancomycin-induced renal toxicity in total cohort (OR, 3.63; P = 0.006) and in the cohort with CKD Stage 3–5 (OR, 1.83; P = 0.002), respectively. In older adults with CKD Stages 3a and 3b-5, the VTCs associated with higher risk for vancomycin-induced renal toxicity were 21.5 mg/L and 16.5 mg/L, respectively.

CONCLUSIONS:

In older adults, serum VTC is an independent risk factor for VIN. VTCs over 21.5 mg/L and 16.5 mg/L are associated with increased risk of VIN in this population with CKD Stage 3a and 3b-5, respectively.
Safety signals of albumin-bound paclitaxel
Authors: Wang Yuwei , Liu Xiao
Published: August 2023

BACKGROUND:

With the extensive application of paclitaxel for injection (albumin-bound), its adverse reactions have also received increasing attention.

AIM:

This study aims to provide a reference for the safe use of albumin-bound paclitaxel in clinical practice; adverse drug events signals of albumin-bound paclitaxel were reviewed and identified by data mining of the Food and Drug Administration (FDA) adverse event reporting system (FAERS).

METHODS:

The reporting odds ratio method was used for the quantitative detection of signals from the data in the FDA public data program (OpenFDA) during 2004–2019 for the albumin-bound paclitaxel.

RESULTS:

According to the OpenFDA, 1659 adverse events (AEs) were identified for albumin-bound paclitaxel. AEs were mostly observed in females rather than males, aged 45–64 years. AEs involved 17 system organ classes, mainly blood and lymphatic, gastrointestinal, hepatobiliary, respiratory, thoracic, and mediastinal systems, and general AEs. Safety signals were found in 20 unexpected adverse drug reactions which are not listed on drug labels, mainly including macular edema and lymphopenia.

CONCLUSION:

Identifying and evaluating albumin-bound paclitaxel-associated AEs signals by mining FAERS may help evaluate the safety profiles of albumin-bound paclitaxel and reduce the risk of medical treatment. In the clinical application of albumin-bound paclitaxel in addition to the adverse reactions mentioned in the drug instructions, lymphocyte changes should be paid close attention to, and eye monitoring should be conducted regularly to avoid drug withdrawal or organ damage caused by adverse reactions.
Epidemiology and Clinical Pattern of Eczemas among Children and Adolescents – A Hospital-Based Cross-Sectional Study in the Desert Region of Western India
Authors: Sivasankari M , Arora Sandeep , Dharmesh  , Vishnuprasad R , Kumar Magesh
Published: August 2023

Introduction:

Eczemas in the pediatric age group are quite common. It has an impact not only on the child but also on the family. The chronicity and severity of these eczemas can affect the physical and mental growth of the child. Hence, the management includes medical treatment along with proper counseling of the patients and their family on the various precipitating/risk factors and their avoidance.

Objective:

The present study was conducted to evaluate the epidemiology and clinical pattern of various eczematous conditions occurring in children and adolescents in age group of 0–19 years in the dry desert areas of western India.

Materials and Methods:

A cross-sectional observational study was conducted in a hospital-based setting in a desert district of western India over 1 year from November 2018 to October 2019. A total of 362 children out of 1389 pediatric dermatoses had eczematous disorders during the study period. Their data were collected and analyzed.

Results:

Endogenous eczemas were common than exogenous eczemas. Atopic dermatitis (30.1%) was found to be the most common type of eczema in this desert region of India, followed by seborrheic dermatitis (21.5%) and pityriasis alba (15.5%).

Conclusions:

Atopic dermatitis and seborrheic dermatitis were the most commonly observed eczemas among children and adolescents in a desert region of India.
A Case Report of Xanthoma in a Child: A Sign of Systemic Disease
Authors: Katakam Bhumesh Kumar , Sunki Karthik , Netha G Narsimha Rao , Rani Sudha
Published: August 2023

Xanthomas are localized lipid deposits within an organ system. They are often an important sign of systemic disease. An 11-year-old boy came with complaints of multiple asymptomatic raised lesions over elbows, hands, and knees for 1 year. Lipid profile showed increased levels (total serum cholesterol of 622.2 mg%). Biopsy was suggestive of tuberous xanthoma. His parent’s cholesterol levels were also elevated. Familial hypercholesterolemia (FH) is a common genetic disease in which high low-density lipoprotein cholesterol levels are seen from the birth, and patients are at high risk for cardiovascular disease, cerebrovascular accidents, metabolic syndrome, and premature coronary death. Early detection of FH and early treatment is imperative to reduce morbidity and mortality.
Familial Reactive Perforating Collagenosis: Clinical, Dermoscopy, and Histopathological Features in Two Siblings
Authors: Albadri Warood , Uttmani Bhargavi M. , Inamadar Arun C.
Published: August 2023

Transepidermal elimination disorders include reactive perforating collagenosis (RPC), perforating folliculitis, elastosis perforans serpiginosa, and Kyrle’s disease. RPC is a rare transepidermal elimination disorder wherein altered collagen is extruded through the epidermis. It has two types: rare inherited form and relatively common acquired form. Most inherited cases present during infancy or early childhood with papules on extensor surface of hands, elbows, knees preceded by superficial trauma. We report two female siblings of 11 and 10 years with multiple, symmetrically distributed, hyperpigmented papules with central keratotic plug, predominantly over extensor aspects of extremities with no aggravating and relieving factors. Clinical diagnosis of familial RPC was confirmed by consistent dermoscopic and histopathological findings. Both children were started on oral isotretinoin 10 mg/day with topical 12% ammonium lactate.
Hereditary Sensory and Autonomic Neuropathy Type II in Two Brothers, a Close Differential of Leprosy
Authors: Sachan Sonal , Verma Nishant , Verma Parul , Suvirya Swastika , Shukla Prakriti
Published: August 2023

Hereditary sensory autonomic neuropathy (HSAN) falls under heritable neuropathies and is often misdiagnosed as leprosy leading to physical, emotional and financial burden to patients and their families. It presents as sensory and autonomic dysfunction leading to recurrent skin ulcers, scars, deformities of anaesthetic areas, Charcot joints, and decreased sweating. We report similar findings in an 11-year-old boy and his 10-year-old brother, in the form of ulcer, multiple healed scars and amputation of toes with reduced perception of touch, pain, temperature and vibration. No peripheral nerves were thickened, motor examination was within normal limits along with negative slit skin smear. Nerve conduction study revealed sensory polyneuropathy. X-ray of ankle joint showed degenerative changes. A diagnosis of HSAN type II with Charcot joint was made highlighting the importance of clinical history taking and physical examination. Parents were counselled regarding the management.
Piebaldism with Neurofibromatosis-1 with Skeletal Anomalies in Two Successive Generations
Authors: Mehra Sonam , Kumar Shailesh , Meena Manish Kumar
Published: August 2023

Piebaldism is a rare autosomal dominant disorder characterized by the congenital absence of melanocytes in affected areas of the skin and hair due to mutations of the c-KIT gene on chromosome 4q12. Neurofibromatosis type 1 (NF1) is an autosomal dominant neurocutaneous disorder. We present a case report of three siblings with piebaldism with neurofibromatosis-1. They presented with depigmented lesions over the abdomen and knees since birth. Two of them had white forelock of hair. The oldest sibling had gait abnormality, scoliosis, and reported repigmentation over the forehead lesion. Along with that, multiple café-au-lait macules were present in all the three siblings of size more than 5 mm in diameter and more than 6 in number. Their father had a history of similar depigmented macules over both shins and he also developed freckles over the axilla, palms, and feet. Diagnosis of piebaldism and NF1 was based on clinical features, and the National Institute of Health Consensus Conference in 1987 has given seven diagnostic criteria.
Evaluating the Body Mass Index, Blood Glucose, and Serum Insulin in Adolescent Acne
Authors: Saha Barnita , Mendiratta Vibhu
Published: August 2023

Background:

Acne is one of the most common skin diseases affecting the pilosebaceous unit that is seen in adolescents mainly. The pathogenesis is multifactorial. High glycemic food, milk and dairy products, and sedentary lifestyle lead to high body mass index (BMI) and high serum insulin levels. These ultimately converge on mammalian target of rapamycin complex 1 activation, leading to acne genesis. There are few studies correlating the acne with BMI, serum insulin, and fasting blood glucose.

Aim:

To evaluate the BMI, fasting blood glucose, and serum insulin levels of adolescent acne vulgaris patients and compare it with controls.

Materials and Methods:

One hundred cases of acne vulgaris and age- and sex-matched controls were included in the study. Their BMI was calculated and fasting blood glucose and serum insulin levels were measured.

Results:

Mean BMI, fasting blood glucose, and serum insulin were higher among cases than controls. All the outcomes were statistically significant.

Conclusion:

Dermatologists should also focus on improving the dietary and lifestyle in their acne patients, rather than just treating the disease per
se.
Hair Transplantation by Follicular Unit Extraction in Cicatricial Alopecia in Children
Authors: Buch Jeta , Chouhan Kavish
Published: August 2023

Cicatricial alopecias in children do not contribute to substantial pediatric consultations as they are relatively uncommon. Cicatricial alopecias are often missed in pediatric population as it is diagnostically and therapeutically challenging. No single treatment is usually effective and hence several off label treatments are used in children and adolescents with unknown safety and efficacy. Hair loss due to scarring may thus have a significant impact on the emotional well-being of young patients and diminishes the quality of life which often requires additional treatment. Traditional surgical treatments for cicatricial alopecia include excision, scar reduction, tissue expansion, scalp flap, and follicular unit transplantation. However, these procedures often result in unsightly scarring or unfavorable hair growth direction. Recently, hair grafting by follicular unit extraction (FUE) has now replaced the strip technique as it is minimally invasive, well-tolerated, and effective treatment for use in children and adolescents. However, use of this technique is limited in young patients. The article presents a comprehensive review of an effective surgical technique, i.e., FUE for the management of burnt-out inactive cicatricial alopecia in pediatric population. For the purpose of review, a PubMed search was done using keywords, “cicatricial alopecia,” “hair transplantation,” and “children.” All the articles were retrieved, and the final data were then analyzed and presented in a narrative fashion.
Abdominal Aplasia Cutis Congenita with Fetus Papyraceus: Frieden’s Class V
Authors: Solanki Avanita Deepak , Saxena Sonali R , Patel Neela M , Rangnani Twinkle C
Published: August 2023

Aplasia cutis congenita (ACC) is a rare congenital disorder, characterized by the absence of the skin and adjacent tissue, usually affecting the scalp but can affect any part of the body. It may present as an isolated defect, accompanied by other developmental anomalies or syndrome. The present report describes the case of a 1-day-old full-term male child born with the absence of the skin over the abdomen which is a rare site for developmental defect in this disease. Antenatal ultrasonography findings in mother were suggestive of a twin pregnancy with one of the fetus presenting as fetus papyraceus (FP) classifying the present case under Frieden class V. Although there are many surgical techniques to manage ACC, the present case was managed conservatively and responded well. Type V ACC is unique in that the lesions are symmetric and distributed primarily on trunk. The involvement of upper and lower extremities may or may not be there. Although there is no well-defined therapeutic protocol from the available literature, conservative management is usually recommended. Early surgical intervention does not hold any added benefit.
Relationship of personality, psychological distress, and substance use with social network characteristics of college going young adults
Authors: Kumar P C Pradeep , Antony Sojan , Murthy Pratima , Thirumoorthy Ammapattian , Philip Mariamma
Published: August 2023

Background:

Causes of substance use are multifactorial. Factors such as personality, psychological distress, and the person’s social ties contribute to the understanding of substance use problems of college students.

Aim:

The current study aimed to investigate the association between personality traits and psychological distress with ego-centric social networks of substance-using and non-using college students.

Method:

This cross-sectional descriptive study involved 902 undergraduate students from the government (n = 2) and government-aided (n = 9) colleges. The socio-demographic data sheet, Big Five Personality Inventory, Depression Anxiety and Stress Scale, and the semi-structured Ego-centric Social Network Questionnaire were used to collect data.

Results:

Of 902 participants, 26.9% of participants used substances. The mean score of anxiety (P < 0.002) and depression (P < 0.002) was significantly higher among the substance users compared with non-users. Agreeableness (P < 0.001) and conscientiousness (P < 0.001) scores were significantly higher among non-users. Depression (P < 0.01), anxiety (P < 0.01), and stress (P < 0.01) correlated positively with the total number of substance users in the network. Agreeableness (P < 0.01) and conscientiousness (P < 0.01) were positively correlated with parents and siblings in the network. Stress emerged as a predictor (OR 1.61, CI 1.09-3.04, P < 0.001) for considering substance users to the social network.

Conclusion:

Personality and psychological distress are associated with an individual’s social network and significantly contribute to student substance use problems.
Surgical treatment methods in the course of psychiatric disorders: Deep brain stimulation—Novel insights and indications
Authors: Giordano Ugo , Mizera Jakub , Żak Elżbieta , Pilch Justyna , Tomecka Paulina , Dudzik Tomasz , Palczewski Mikołaj , Biziorek Weronika , Piotrowski Patryk
Published: August 2023

Deep brain stimulation (DBS) is a relatively dated treatment procedure that emerged in the late 1980s. Nonetheless, numerous studies are being carried out to examine its influence on the human brain and develop new treatment indications. This systematic review aims to summarize the current state of knowledge referring to DBS, investigate novel insights into its indications, and discuss the technical aspects and rationale behind DBS application. In particular, we sought to subject to scrutiny the application of DBS specifically in anorexia nervosa (AN), various addiction types, depression, and obsessive–compulsive disorders (OCDs). The method is supposed to offer promising results, especially in pharmacologically resistant forms of the upper-mentioned psychiatric disorders. Moreover, further insight has been provided into the historical notions of the method and differences in the surgical approach in specific disease entities. Furthermore, we mark the possible influence of comorbidities on treatment results. Our review consists of articles and studies found on PubMed, Google Scholar, Cochrane, and Scopus, which were then analyzed with scrutiny in the identification process, including the most resourceful ones. After methodological quality and risk of bias assessment, a total of 53 studies were included. To this date, DBS’s usefulness in the treatment of AN, OCDs, depression, and addictions has been proven, despite an ongoing debate concerning the technical aspects and parameters when applying DBS. To the best of our knowledge, we have not found any paper that would recapitulate the current state of DBS in the context of psychiatric disorders with an addition of technical insights.
Manipal model of telepsychiatry
Authors: Munoli Ravindra N. , Bhandary P Rajeshkrishna , Sharma Podila Sathya Venkata Narasimha
Published: August 2023

Telepsychiatry can be understood as an interactive mental health service providing mode using information and communication technology. In recent decades, services provided under the umbrella term of telepsychiatry expanded to cater clinical services, diagnostic services, interventions, therapies, education, and research. Since telepsychiatry has been practiced in India for two decades, various models have emerged to meet the country’s demands and the logistics that are available. Both synchronous and asynchronous modes of telepsychiatry had been in practice in India depending on the availability of logistics. Most of the telepsychiatry services in India had focused on providing clinical care to reach the unreached population. Furthermore, telepsychiatry had been used to train mental health professionals and healthcare workers from other disciplines. However, not many models had incorporated the idea of hands-on training of the postgraduates/trainees of psychiatric social work (PSW) in telepsychiatry under supervision. This was addressed in the Manipal model of telepsychiatry. Manipal model of telepsychiatry has begun in 2016 with a novel idea to train mental health profession trainees in addition to cover other clinical services, research, and education. In the last eight years, four centers of Karnataka state have been covered under this model with progressive growth in a number of patients and this acted as a hands-on training model for the postgraduate trainees in starting telepsychiatry services independently. Furthermore, it provided an opportunity to develop the organization skills of trainees, improved their oratory skills, and improved their expertise in using information technology for mental healthcare delivery.
Novel intervention of high-frequency repetitive transcranial magnetic stimulation in patients with somatic symptom disorder and its safety and outcome
Authors: Kumar Nand , Singal Prakamya , Chakladar Abhishek
Published: August 2023

Somatic Symptom disorders (SSDs) are characterised by the presence of persistent somatic symptoms associated with excessive thoughts, feelings and behaviours related to the symptoms. However, current treatment modalities are non-specific with modest effects. We aim to explore the safety and outcome of high-frequency transcranial magnetic stimulation at medial Prefrontal Cortex in ten such patients. Patient Health Questionnaire-15, Hamilton Rating Scale for Depression and Hamilton Anxiety Rating Scale were applied to ten patients with Somatic Symptom Disorder. 15 sessions of 15Hz TMS using a double cone coil with 2500 pulses/session were administered. All patients completed their sessions except one. Eight of the nine patients reported significant improvement with a reduction of 33%-80% from their baseline PHQ-15 scores. One patient reported significant adverse effects. Double cone coil TMS at medial Prefrontal Cortex appears to be a safe therapeutic intervention with potentially good outcomes in SSDs.
An Adult Case of Pharyngeal Injury Caused by Toothbrush
Authors: Nakamura Satoshi , Katsura Yuki , Fujiwara Takashi , Ikegami Tetsunori
Published: August 2023

Most toothbrush-induced oral injuries occur in children and are relatively shallow, involving the oral mucous membranes and musculature, but rarely deeper layers. Here, the management of an adult case of pharyngeal injury caused by a toothbrush is discussed. A man fell while brushing his teeth, and his toothbrush stuck in his throat. Contrast-enhanced computed tomography showed a toothbrush stuck in the left parapharyngeal space, reaching the subcutaneous tissue of the posterior neck. The toothbrush was surgically removed because blind removal could damage major cervical arterioles and nerves. In intraoral injuries caused by deep penetrating toothbrushes, there is a risk that the injury extends to the major arterioles and nerves of the neck. The need for imaging studies, methods of removal, and possible complications should all be considered before taking an appropriate removal action.
Revisiting the Role of Amniotic Membrane Dressing in Acute Large Traumatic Wounds: A Randomized Feasibility Study at a Level 1 Trauma Centre
Authors: Choudhary Narendra , Kumar Abhinav , Priyadarshini Pratyusha , Bagaria Dinesh , Alam Junaid , Soni Kapil Dev , Kumar Vivek , Sagar Sushma , Gupta Amit , Kumar Subodh , Mohanty Sujata
Published: August 2023

Introduction:

Acute large traumatic wounds require temporary dressing prior to the definitive soft tissue reconstruction, as the physiological derangement during the immediate postinjury period delays the definitive surgical intervention. Selecting an ideal dressing material from numerous available synthetic dressings and skin substitutes poses a challenge. Although amniotic membrane (AM) scaffold has a definitive role in promoting wound healing in burns and chronic wounds, however, its efficacy in acute large traumatic wound is lacking. The present trial aimed to evaluate the safety and efficacy of AM in wound bed preparation before the definitive soft-tissue reconstruction in acute large traumatic wounds.

Methods:

Sixty patients with acute large traumatic wounds (>10 cm × 10 cm) were divided into two groups (conventional dressing and AM dressing) using simple mixed block randomization. Wounds were assessed using the Bates Jensen Score at various timelines for the signs of early wound healing. The primary outcome was to evaluate the time taken for the wound bed preparation for definitive soft-tissue reconstruction. The secondary outcome was the pain assessment and complications, if any.

Results:

There was significant reduction in the wound exudate as well as peripheral tissue edema in the intervention group (P = 0.01). AM dressing was significantly less painful (P = 0.01). The incidence of wound infection and need for debridement was decreased in the intervention group. However, the time interval to definitive soft-tissue coverage was statistically insignificant and comparable in both the groups. No adverse reactions were seen in either group.

Conclusion:

AM dressings are safe and efficacious with significant reduction in wound exudates and peripheral edema. However, these dressings do not hasten the wound maturation as compared to conventional dressings. AM dressings can be used as a less painful alternative to conventional dressing in the management of large acute posttraumatic wounds.
Geriatric Intertrochanteric Fractures – A Challenge to Manage
Authors: Madhuchandra P. , Pawankumar K. M. , Manish K , Raju K. P.
Published: August 2023

Background:

Intertrochanteric fractures are among the frequently seen fractures in the elderly population. Treating these fractures is very challenging considering the fact that the quality of bone is poor and highly osteoporotic. The high failure rates with dynamic hip screw (DHS) especially in unstable fractures lead to the development of intramedullary devices such as proximal femoral nail (PFN) which has got multiple advantages over DHS.

Materials and Methods:

This prospective study included 30 patients above the age group of 60 years with unstable intertrochanteric fractures conducted in a tertiary institute between February 2021 and June 2022. Results were analyzed clinically and radiologically using the Modified Harris hip score.

Results:

Patients' age group was 61–85 years with a mean age of 69 years, comprising 63% female and 37% male. The average Harris hip score was 83.76 at 24 weeks' follow-up with 33.33% excellent, 56.66% good, 3.33% fair, and 6.67% poor. Postoperative complications included revision surgery in two patients, superficial infection in one patient, Z effect in one patient, peri-implant fracture in one patient.

Conclusion:

Treatment with PFN for unstable intertrochanteric fracture has the advantages of closed reduction, less tissue damage, early rehabilitation, and return to work. Osteosynthesis with short PFN resulted in good-to-excellent functional and radiological outcomes.
Frailty as a Predictor of Outcome in Heart Failure in the Elderly
Authors: Kumar Pratap , Dhar Minakshi , Kumar Barun , Jain Vikram
Published: August 2023

Introduction:

Heart failure is the leading contributor to global morbidity and mortality. Frailty is an emerging prognostic factor in heart failure. There is little data on the prognostic role of frailty in patients admitted for acute heart failure as most studies have been done on stable heart failure patients.

Methodology:

The study included elderly (age ≥60 years) patients admitted with acute heart failure at a tertiary care center in India. Patients with dementia, cognitive impairment, and documented terminal illness were excluded. The sample size was 85 patients. Frailty assessment was done using short performance physical battery (SPPB) and Fried phenotype scales and follow-up data was collected at 3 months postdischarge telephonically. The primary objective of the study was to determine the proportion of frailty in elderly in-hospital heart failure patients. The secondary objectives were to see the agreement between the frailty assessment tools used (SPPB and Fried phenotype).

Results:

Eighty seven patients were included in the study. The majority were male (n = 45) and had heart failure with reduced ejection fraction (n = 56). Coronary artery disease (CAD) (n = 60) was the most common cause of heart failure. Eighty-two patients had at least one comorbidity. The proportion of frailty as per the SPPB was 43.67%, and as per the Fried phenotype was 68.9%. A total of 4 deaths and 15 re-admissions occurred during the follow-up period of 3 months. The majority belonged to the frail category as per both the frailty scales (P < 0.001 for SPPB, P = 0.087 for Fried phenotype). Fleiss's kappa coefficient for agreement between the scales was 0.373 (SE = 0.106, P < 0.001), which signifies that there was a fair agreement between the two scales. The Spearman Rank correlation coefficient was −0.691 (P < 0.01) between the two scales. Hence, the SPPB score inversely correlated with the Fried phenotype.

Conclusion:

Frailty is largely prevalent in elderly heart failure patients. It can be used to predict poor outcomes in these patients. Clinicians should identify these high-risk patients at the time of discharge from their facility and consider interventions (tailored rehabilitation programs) to minimize the adverse outcomes.
Repigmentation of Gray Hair
Authors: Jerath Vinod Parkash , Nischal Richa , Jerath Aditya
Published: August 2023

A case of gray hair nearly 99% was seen to be converted to more than 99% of the pigmented hair, after using full sleeves shirts for 2 years, with 1-year follow-up, with the same results, and on screening the literature, we find it first such case in the world literature of almost complete repigmentation of both the forearms after using full sleeves shirts for 2 years and a follow-up of 1 year.
Factors Predicting Mortality in Elderly Patients Hospitalized for Congestive Heart Failure
Authors: Sharda Meenaxi , Vijay Ankit , Gandhi Nikhil , Aggarwal Meghna
Published: August 2023

Background:

Heart failure (HF) is a complex clinical syndrome that results from any structural or functional impairment of ventricular filling or ejection of blood. There are range of factors that predict the mortality, morbidity, and outcome in congestive HF (CHF) patients.

Objectives:

The objective was to study the clinico-epidemiological characteristics and predictors of inhospital mortality of elderly patients ≥60 years hospitalized for HF.

Subjects and Methods:

A complete medical history of enrolled patients and physical examination inclusive of etiology, New York Heart Association (NYHA) grade, heart rate (HR), and systolic blood pressure (SBP) were noted. Complete blood count, blood urea, serum creatinine, serum sodium, serum potassium, 12-lead electrocardiogram, X-ray of the chest, and echo were obtained in all patients. Outcomes were analyzed till the study endpoints.

Results:

Compared to normal comparators, a higher mortality was observed in patients with age >75 years (33.3%), HR >100 beats per min (27.14%), SBP <80 mmHg (60%), NYHA IV HF (37.1%), hemoglobin (Hb) <12 mg/dl (31.25%), blood urea ≥40 mg/dl (26.39%), serum creatinine >1.30 mg/dl (29.17%), serum sodium <135 meq/L (26.69%), and ejection fraction (EF) <50% (26.39%).

Conclusion:

Increasing age, prior history of CHF on admission, higher NYHA grade on admission, higher HR, lower SBP, lower EF, low Hb, higher blood urea, serum creatinine, and low serum sodium levels are statistically significant predictors of inhospital mortality of elderly CHF patients.
Thymoma
Authors: Jha Dipesh , Tendulkar Prakash , Dhar Minakshi , Shah Bishal Pratap , Bisht Khusbhoo
Published: August 2023

Recurrent pericardial effusion is always complicated for the primary care physician to diagnose, and it often goes undiagnosed. Thymoma is rare cancer, but it is the most common tumor in the anterior mediastinum. It can present in a variety of ways; it can be asymptomatic for an extended period of time and only rarely as pericardial effusion. A 68-year-old male presented to us with two episodes of pericardial effusion in the previous 2 years and was later diagnosed with thymoma.
Angiolymphoid Hyperplasia with Eosinophilia
Authors: Aggarwal Anushruti , Gupta Sharang , Chopra Dimple , Arora Raina
Published: August 2023

Angiolymphoid hyperplasia with eosinophilia (ALHE) is an uncommon benign proliferation of blood vessels of uncertain etiology. It primarily affects the head-and-neck region. Histologically, it is characterized by the prominent proliferation of plump endothelial cells, and accompanying eosinophilic and lymphocytic infiltration. Herein, we report the case of ALHE in a 65-year-old male.
Anemia in Elderly Patients ≥65 Years of Age
Authors: Kadhiravan E. , Devi Agalya , Mohan Reenaa , Sindhuri R. , Abdula Shiek , Devi D. S. Karthika
Published: August 2023

Introduction:

Anemia in elderly patients of any degree contributes significantly to morbidity and mortality and has a significant effect on the quality of life. Despite of high prevalence, very few studies have examined the effect of anemia in elderly patients in India. Hence, this study is undertaken to know the prevalence and clinicopathological pattern of anemia in elderly patients.

Objectives:

1. To estimate the prevalence of anemia in the elderly aged 65 years and above. 2. To determine the severity, clinicohematological patterns, and causes of anemia in the elderly aged 65 years and above.

Materials and Methods:

A hospital-based descriptive cross-sectional study was done

.

The study was conducted for 1 year; during this period, elderly patients aged 65 years and above admitted for other medical conditions were recruited in the study using consecutive sampling technique until the desired sample size of 236 was achieved and they were evaluated for anemia. Among them with hemoglobin cutoff value <13 g% for men, <12 g% for women were further evaluated to known the cause of anemia and its clinicohematological pattern. Ethical committee approval was obtained. Data were analyzed using SPSS Software version 23.0.

Results:

The mean age of the participants was 73.9 ± 7.4 (standard deviation [SD]) years. Majority, 53.8%, of the participants were males. Among the 236 elderly patients, recruited in the study 65.3% were anemic and among them 44.2 had mild anemia and 37% had moderate anemia. Mean hemoglobin value of the participants was 10.7 ± 2.83 SD and it ranged from 3 to 16.3 g/dl. There was no significant difference in the hematological parameters between male and female elderly patients in the study. The main cause of anemia was found to be due to chronic diseases followed by iron-deficiency anemia.

Conclusion:

This study concludes that anemia was highly prevalent among elderly patients and most of them had identifiable and treatable etiology. Hence, all elderly patients with anemia should be evaluated properly for underlying etiology and treated accordingly to reduce the mortality and morbidity in elderly patients with multiple comorbidities.
Psychiatric Presentations and Factors Associated with Suspected Organicity in Elderly Attending a Tertiary Care Facility in South India
Authors: Srisudha B. , Nandyal Munaf Babajan , Kolloju Naveen , Joseph Rachna George , Karuppusami Reka , Kurian Suja
Published: August 2023

Objectives:

The objectives were to determine the proportion of elderly among the new psychiatry outpatient attendees, identify their sociodemographic profile and clinical presentations, and determine risk factors associated with suspected organic conditions in patients presenting with acute onset and chronic presentations.

Methodology:

This retrospective cross-sectional study focused on the elderly presenting with psychiatric symptoms to a psychiatric setting. The onset of symptoms at presentation was divided into acute and chronic conditions. Clinical symptom clusters and the risk factors associated with organic conditions were identified. The Chi-square and Fisher's exact test were used to find an association between factors and outcome (organic/functional).

Results:

Elderly seeking consultation constituted < 10% of total new case registration. Acute onset was seen in one-third and chronic presentation constituted nearly two-thirds of the group. The common clinical presentations with acute onset were acute psychosis, altered sensorium, and psychosis due to an organic etiology. The most common clinical presentation with chronic course was chronic psychosis. Nearly 40% had suspected organicity. Increasing age, structural abnormality in brain imaging, and the presence of stressors were risk factors for the onset of psychiatric presentation in the elderly (P = 0.001).

Conclusion:

Early detection of the clinical syndrome, identification of organic conditions, and appropriate and prompt referral to the general physician should be the rule for the care of the elderly presenting to a psychiatric facility.
Prognostic Value of Serum Albumin and C-reactive Protein Levels in the Elderly for Assessing Morbidity and Mortality in a Tertiary Care Center
Authors: John Sanjo K. , Padmaja N. , Rao I. V. Ramachandra , Priya Subalin , John Centina Rose , James Tittu Thomas
Published: August 2023

Introduction:

There is an increased population of elderly globally due to advancement of technology in health care. Elderly individuals are susceptible to various diseases, owing to deficits in nutrition or healthy lifestyle. Serum albumin and C-reactive protein (CRP) are found to be sensitive to nutritional status as well as inflammation. This study is an attempt to analyze the prognostic value of CRP and serum albumin and analyze its usefulness as a prognostic marker in assessing morbidity and mortality in elderly patients.

Methodology:

One hundred patients above the age of 65 years and were admitted to the emergency care facilities of our tertiary care center were recruited for the study. Serum albumin and CRP estimation was done on the day of admission along with Charlson Comorbidity Index (CCI), and was follow-up till discharge. Statistical analysis was performed to evaluate relationship between the serum values and CCI scores.

Results:

It was observed that 83.3% (10/12) of deaths occurred in those with low serum albumin levels, and 91.6% (11/12) with high CRP levels. The hazard ratio shows a 6% increased probability of death with one unit increase in CRP, whereas a one unit increase in serum albumin value decrease the probability of death.

Conclusion:

The present study concludes that low serum albumin and high CRP levels at the time of admission in the elderly population are associated with high CCI scores, longer hospital stay, and increased risk of mortality, demanding their estimation in the elderly in emergency and acute care facilities.
Strengths, Weaknesses, Opportunities, and Threats Analysis of the National Program for Health Care of the Elderly
Authors: Joshi Nitin Kumar , Joshi Vibha , Bajaj Komal
Published: August 2023

Background:

The National Program for the HealthCare of the Elderly (NPHCE) was adopted by the Ministry of Health and Family Welfare in 2010 to provide promotional, preventive, curative, and rehabilitative health-care services for the fast-growing older population in India. As literature about the assessment of NPHCE is lacking, the present study was conducted to perform a strengths, weaknesses, opportunities, and threats (SWOT) analysis of the program.

Methods:

The SWOT of the NPHCE program is analyzed using available literature and relevant documents.

Results:

Although this program embraces strategies to provide specialized training and services at primary health center, community health center, and district levels, including dedicated bedded wards, equipment, consumables, and pharmaceuticals but home-based care for the elderly, and the role of caregivers is overlooked in this program. NPHCE program can utilize the framework and take support of various ongoing healthy aging initiatives of international agencies to augment the health-care strategies for the elderly in India. Integrating schemes developed by the government for the upliftment of the elderly and the inclusion of traditional medicine systems in the program can serve as an opportunity for meeting unmet needs and improving the quality of life and well-being of the elderly. However, the growing elderly population, rise in nuclear families, and dual disease burden are significant threats to the program's implementation.

Conclusion:

This program can be more effective in providing comprehensive health care to the elderly if more emphasis is given to community participation, home-based care, and integrating digital health technologies and other existing welfare schemes.
Nuclear aberrations in the gingival epithelium of patients with chronic periodontitis
Authors: Serikova Olga Vasil’evna , Shumilovich Bogdan Romanovich , Filippova Zoya Alexandrovna , Kalaev Vladislav Nikolaevich , Kalaeva Elena Anatol’evna , Larina Anna Viktorovna
Published: August 2023

Context:

Periodontitis characterized by mild symptoms in the early stages, which makes diagnostics problematic. The gingival epithelium can be used for micronucleus assay since gums are the area affected by the disease.

Aims:

The aim of the study was to study the frequency of occurrence and the range of nuclear anomalies in gingival epithelium of healthy people and people with periodontitis.

Settings and Design:

Scrapings of the gingival epithelium were made next to the central incisors (1.1) and molar teeth (1.7) in control and experimental groups (ten healthy males 35–50 years old and 10 males with periodontitis).

Materials and Methods:

The preparations were stained by Romanowsky–Giemsa. The frequency of nuclear aberrations (‰), the accumulation index, and the repair index were determined.

Statistical Analysis Used:

The differences in the medians of nuclear aberrations were determined using Wilcoxon and the Van-der-Waerden tests. The pathology proportions were compared using the Z-test. To determine the predictors of periodontitis, receiver operator characteristic analysis was used. For multiple comparisons, the Bonferroni correction was used.

Results:

In the experimental group, the range of nuclear aberrations was wider, the ratio of karyolysis in the unaffected area was higher, than that in control; perinuclear vacuoles were fewer and macronuclei were more in the affected area. The frequency of cells with micronuclei over 1.33‰ in the affected area is the periodontitis marker.

Conclusions:

Gingival epithelium can be used in micronucleus assay. Micronucleus test revealed a wider range of nuclear aberrations in the cells of the gingival epithelium and a higher frequency of occurrence of micronuclei in patients with periodontal disease compared to healthy subjects. Therefore, cytological signs of the inflammation appear earlier than the clinical ones and are verified more clearly. The markers of apoptosis and destruction of nuclei, and low repair index indicate normal elimination of damaged cells. An increased accumulation index in people with periodontitis may indicate the risk of malignant tumors.