bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 61
Authors: Agarwal Khushboo , Jose Arun , Kapoor Nitin , Paul Thomas , Thomas Nihal , Jebasingh Felix , Cherian Kripa , Asha HS
Published: February 2023

Background: Some of the signs and symptoms of Cushing’s syndrome are non-specific and the diagnostic modalities are cumbersome or require hospital admission. Late-night salivary cortisol (LNSC) is an alternative to midnight serum cortisol sampling. But, most immunoassays have poor sensitivity and specificity at the low diagnostic cut-off, which is close to the lower limit of detection. Measurement of LNSC by liquid chromatography-mass spectrometry (LC-MS/MS) or highly sensitive electro-chemiluminescence assay (ECLIA) is an alternative.

Objectives: The primary objective was to assess the diagnostic utility of LNSC measured using LC-MS/MS for the diagnosis of Cushing’s syndrome and compare the values in obese and healthy controls. The secondary objective was to compare the diagnostic performance of LNSC measurements by LC-MS/MS with the Roche II ECLIA for the diagnosis of Cushing’s syndrome.

Methodology: It was a cross-sectional study. Three groups of subjects were studied: group 1 –subjects with Cushing’s syndrome diagnosed by two of the three screening tests being positive (midnight serum cortisol, 24 hr Urinary Cortisol and 1 mg overnight dexamethasone suppression test [ONDST]), group 2 –obese controls recruited from the Bariatric clinic, and group 3- normal weight controls recruited from the community. Patients with pre-existing psychiatric illnesses, chronic liver disease, and chronic kidney disease were excluded. After taking informed consent, thorough history including demography, previous illnesses, and drug history weretaken. All participants underwent routine anthropometric measurements and subjects in group 1 underwent biochemical evaluationfor Cushing’s syndrome. Obese controls were tested with 8am serum Cortisol and 1 mg ONDST to exclude Cushing’s syndrome. All subjects collected saliva at 11 PM on two consecutive nights using Salivette. Salivary cortisol was measured byLC-MS/MS and Roche II assay.

Results: The mean age of the subjects with Cushing’s syndrome was 32.25 ± 8.98 years. In group 2 and group 3, the mean age was 37.74 ± 11.80 years and 31.57 ± 7.04 years respectively. With a receiver operating characteristic (ROC) curve, an LNSC cut-off by LC-MS/MS of 0.054 mg/dl had a sensitivity of 88.4% and specificity of 70.6% for the diagnosis of Cushing’s syndrome; and Roche II assay LNSC cut-off of 0.135 mg/dl had asensitivity of 95.2% and specificity of 93.2%. There was no significant day-to-day variability between LNSC values assayed by Roche II ECLIA or LC- MS/MS methods in all the three groups.

Conclusion: We recommend measurement of LNSC by the Roche II ECLIA and suggest a cut-off of 0.135 mg /dl for the diagnosis of Cushing’s syndrome.
Abstract 63
Authors: Bhandiwad Chandrashekhar , Palle Sharmila , Paidipally Srinivasa Rao , Sheker Vijay , Danda Reddy
Published: February 2023

We present a case of 55 year old man, who had consulted us for recurrent hypoglycemia. Patient had no previous history of head trauma, tumor or radiation. Since last month he noticed post prandial excessive sweating, uneasiness and palpitations. On evaluation his plasma glucose 43 mg/dl. On examination, the patient was in good general health, with normal renal and hepatic function. During hospitalization, no hypoglycemic episodes were recorded during a 48-h fasting test. Biochemical data and abdominal computed tomography (CT) excluded insulinoma and tumor-induced hypoglycemia. The extended oral glucose tolerance test (OGTT) showed an impaired glucose tolerance with a tendency towards symptomatic hypoglycemia (plasma glucose at fasting-98 mg/dl, 2nd hours-151 mg/dl, 3rd hour- 61 mg/dl). Hormonal analysis showed low levels of GH (0.073 ng/ml) in the critical sample and low IGF-I (51 ng/ml); the response of GH to glucagon confirmed a severe GHD (GH peak 0.16 ng/ml). Other pituitary and counter-regulation hormones were within the normal range and magnetic resonance imaging (MRI) of the pituitary gland showed partial empty sella. Patient was started on replacement with a dose of 0.2 mg of recombinant human growth hormone (rhGH), which led to increase in IGF-I up to normal values with complete regression of hypoglycemic events. In conclusion, we report a case of adult-onset growth hormone deficiency and it’s association with post prandial hypoglycemia.
Abstract 67
Authors: Gupta Kashish , Mathur Sandeep Kumar , Sharma Balram , Saran Sanjay
Published: February 2023

Background: Klinefelter syndrome is the most common chromosomal disorder with karyotype XXY characterized by tall stature, male external genitalia with a small penis and testes, and infertility due to azoospermia. The association of Klinefelter with autoimmune conditions like Lupus is well known but the association with nephrotic syndrome and hypothyroidism has not been explored.

Case Report: A 29-year-old female known case of hypertension and hypothyroidism presented with complaints of weight gain and primary amenorrhea for 2 yrs. On examination, patient had a BMI of 43.4 kg/m2 and was vitally stable. General physical examination revealed pallor, pedal oedema and facial puffiness. On pelvic examination, patient had an SMR of A -ve, P1, B5. On investigation, the patient had hypergonadotrophic hypogonadism; serum LH 31.1 mIU/mL; FSH 57; testosterone 1.25 ng/ml, ft3 101, ft4 7.49, TSH 8.7. Urea 59 mg/dl, creatinine 2.24 mg/dl, albumin 2.9 g/dl, 24 hr urinary protein 20 g/day. USG showed ascites with hepatomegaly. MRI revealed absence of uterus, ovaries and prostate. Right testis at right inguinal ring measuring 19 x 13 mm, left testis not visualized and scrotal sac not well developed. Renal biopsy showed nodular glomerulopathy; immunofluorescence markers were negative. Karyotyping revealed XXY chromosome. Based on these findings, she was diagnosed to have female phenotype Klinefelter syndrome with morbid obesity, nephrotic syndrome and hypothyroidism.

Conclusion: Klinefelter syndrome variant 47XXY can present in several forms, female phenotype being a rare entity. Further FISH analysis is required to look for presence of SRY gene on chromosome Y to explain the development of testes and absence of mullerian structures. The possibility of normal Y function with androgen insensitivity; CAIS, needs to be kept in mind which requires further AR gene analysis.
Abstract 7
Authors: Kar Anish , Saha Pradip , Mukhopadhyay Satinath
Published: February 2023

Background: Lithium is the gold standard for the treatment of bipolar affective disorder and is associated with a number of biochemical and hormonal changes with use. In the absence of sufficient data from this part of the country, this study was planned.

Objectives: Prevalence of biochemical (specially glycemic status and calcium) and hormonal (specially thyroid function) in patients on lithium.

Method: This was a cross sectional study planned on adult patients taking lithium for at least 6 months and were not on thiazides, bisphosphonates or had history of prior thyroid or parathyroid disease or surgery. A total of 40 patients were taken. Data was managed in Excel 2016 and exported to SPSS 25 software for statistical analysis. Level of significance was set at p < 0.05.

Result: Mean age of patients was 40 ± 13.9 yrs, with 30 females. Most patients were in age gr 30-40 yrs and hypertension present in 30%. Mean serum calcium was 8.6 mg/dl with a prevalence of thyroid dysfunction at 46%.

Discussion/Conclusions: Lithium use is associated with hypothyroidism predominantly.
Abstract 75
Authors: Behera Kishore Kumar , Sahoo Biswajit
Published: February 2023

Background: Thyroid-associated ophthalmopathy (TAO) is an array of symptoms caused by an autoimmune process involving the orbital tissue. Most TAO is reported in hyperthyroid Grave’s disease and in euthyroid and hypothyroid Graves’ patients with positive thyroid receptor antibodies. But TAO is rarely reported in Hashimoto’s thyroiditis (HT) and is a poorly understood entity. Here we report a unilateral TAO in a patient withhypothyroidHTwith negative TSH-R antibodyand high TPO antibody. Hewas treated with pulse methyl-prednisolone, levothyroxine, and artificial teardrops.

Case Report: A 43-year-old non-smoker, non-alcoholic male with a complaint of fatigue and lethargy with mild swelling of both legs. On evaluation, his TSH was 180 miu/ml in 2016, and levothyroxine 50 mcg was initiated, then gradually increased throughout three months to 150 mcg daily. He became euthyroid. In January 2021, he noticed pain and protrusion in the right eye, so he consulted an ophthalmologist. On investigation, his TSH was 70 miu/ml; on asking, he agreed that he was not consistently on thyroid hormone replacement. So, he restarted 100 mcg of LT4. In March 2021, he noticed further aggravation of eye symptoms despite taking LT4 replacement with TSH of 8 miu/l, so he consulted endocrinology. Details of hormonal test in table-1.

General physical and systemic examination was unremarkable. The degree of exophthalmos on the Hertelexophthalmometers was 18 mm for the left eye and 25 mm for the right eye. Intraocular pressure was normal in both eyes. The CAS SCORE was 4 in March 2021, then improved over six months to 2. Magnetic resonance imaging of orbits revealed unilateral right eye proptosis with a mild increase in bulk of inferior rectus (IR) (maximum thickness 6.5 mm) with sparing of the anterior part of tendons.

Treatment and follow-up: He hadbeen given pulse methyl-prednisolone 500 mg weekly for five weeks and advised to continue LT 150 mcg once daily. At the discharge, he was euthyroid biochemically, and there was an improvement in eye symptoms. He had followed up on Aug 20th; his CAS was 2 with stable eye disease and was euthyroid on LT150 mcg. CT orbit showed enlargement of IR and MR.

Discussion: Pathogenesis of TAO in Hashimoto thyroiditis is poorly understood. We have reported TAO in a patient with hypothyroidism and negative TRAb with a high anti-TPO antibody. HEwas managed with LT, and pulse methylprednisolone on March 2021, and subsequent follow-up showed stable unilateral eye disease.

Conclusion: Thyroid-associated ophthalmopathyisrarebut can sometimes occur in Hashimoto’s thyroiditis. Awareness of this atypical form is essential for appropriate treatment because prompt recognition and management can prevent corneal involvement and blindness due to optic nerve compression.
Abstract 76
Authors: Goel Pawan
Published: February 2023

Background: Graves’ disease most common cause of hyperthyroidism. Despite, presence of multiple treatment options namely thionamides, radioiodine therapy and surgeryneed for an effective and complication free option is still being explored. Different studies have found several clinical, biochemical, or demographic factors for prediction relapse after antithyroid therapy atbaseline and end of treatment. No previous studies have been conducted in Indian patients.

Aims and Objectives: To study various clinical, biochemical and imaging features in newly diagnosedpatients with grave’s disease on antithyroid drugs at baseline. To predict potential factors of relapse after 1 year follow up.

Results: in this interim analysis a total of 96 patients have been recruited. Mean age of patients is 40 years with a female preponderance of 61% with history of smoking and biomass exposure in 12% and 20% respectively. Patients had a coexistent autoimmune disorder in 8% and family h/o thyroid disorder in 16% of the patients. Out of the 26 patients completing 12 months of ATD therapy 6 (21%) had gone into biochemical remission. This population does not differ from baseline parameters of age, goitre size, T4 levels andTRabs. However, all patients entering remission were females (100%) compared to 67% in baseline

Conclusions: Interim analysis shows that medical therapy leads to initial remission in about 21% of the patients at 12 months of therapy.
Abstract 79
Authors: Nautiyal Manishi , Bhagwat Nikhil
Published: February 2023

Objective: To study the impact of gender on clinical presentation and outcome in patients with Acromegaly.

Methods: A retrospective study of gender differences in patient with Acromegaly. Statistical analysis was done using SPSS version 26. Chi square test, MannWhitneyUtestand T test were applied to determine the correlation between different parameters under study.

Results: A total of 103 patients were included in our study (54 females, 49 males). Headache was more common in females (77% vs 55%; p = 0.02). Females had lower median IGF-1 levels than males (520, IQR: 330.3 vs 713, IQR: 500; p = 0.012). When stratified to age groups below and over 50 years, the gender difference in IGF-I median was significantonly among the younger patients (520 vs752.5; p = 0.017). Median basal and nadir GH levels were comparable between both genders in both age groups. Females had greaterremission rate (31% vs 12%; p = 0.05). Age at presentation and diagnostic delay were not statistically different in both genders. There was no significant difference in terms of prevalence of comorbidities. The tumorvolumeof males and females (both below and over 50 years) showed no statistically significant difference.

Conclusion: In our study, women < 50 years had significantly lower IGF-1 level compared with men in the same age group. More females achieved remission suggesting the role of gender in response to therapy although no difference was found in tumor volume andknosp grade.
Abstract 81
Authors: Dahiya Nisha , Biswas Krishna , Prakash Abhishek , Agarwal Purnima , Swarna  , Verma Himanshu
Published: February 2023

Background: The diagnosis of central Diabetes insipidus (DI) requires intact renal function to manifest polyuria. Therefore, it may not become evident in patients with oliguric or anuric renal failure such as in chronic kidney disease (CKD) or end stage renal disease (ESRD). This might get manifested after renal transplantation, however there are only 5 cases reported so far of Central DI post renal transplantation. Here we report a case of central DI that was unmasked in a patient with CKD after kidney transplantation leading to polyuria.

Case Report: RV, 26-year-old male had one episode of febrile illness with hematuria at age of 20 years and was diagnosed IgA nephropathy by renal biopsy following which he recovered completely. Hypertension was detected in Feb 2021, and he has been on Cilnidipine 10 mg OD, Clonidine 0.1 mg TDS, Metoprolol XL 40 mg OD. At age of 25 years, he had covid illness and his kidney function deteriorated to ESRD for which he was started on twice weekly hemodialysis for 8 months and then underwent live donor renal transplantation in October 2021. Two months later, he was admitted for polyuria, polydipsia, and nocturia. After renal transplantation, his urine volume increased to 9-10 L/ d, while it had been less than 500 mL/day before the transplantation. His serum creatinine level improved from 3.2 mg/dL prior to transplant to 0.8 mg/dL after transplant. He had not been diagnosed with diabetes before, and his blood glucose levels were within the normal range. He showed no symptoms of polyuria or polydipsia before transplantation and had no history of head trauma or neurosurgery. Diagnosed to have primary hypothyroidism in Feb 2021 during pre-transplant workup, for which he was started on levothyroxine 50 ug and was euthyroid. The patient received prednisolone, tacrolimus, mycophenolate mofetil, and sulfamethoxazole/trimethoprim after the transplantation. During evaluation for polyuria, urine volume was >100 ml/kg in 24 Hour. Serum osmolality of 295 mOsm/kg, urine osmolality of 101 mOsm/kg, and serum sodium of 138 mEq/L, RBS 86 mg/dl, Urea 24 mg/dl. Anterior pituitary hormone profile workup was normal. To evaluate the cause of polyuria, water deprivation test was performed which confirmed complete central diabetes insipidus. He was started on oral desmopressin 120 ug in divided doses. His urine output subsequently decreased to about 2.5 L/d with resolution of excessive thirst and nocturia. MRI sella revealed normal anterior pituitary, infundibulum and diminished posterior pituitary bright spot in the T1-weighted image. Patient is continued on desmopressin therapy at 6 months with marked improvement in symptoms.

Conclusion: In this case, the water deprivation test and diminished posterior pituitary bright spot-on MRI and the responsiveness to desmopressin therapy confirm the diagnosis of central DI. Hence, any case of polyuria after renal transplantation must be evaluated for Central Diabetes Insipidus.
Abstract 85
Authors: Lalwani S. R. , Shekhawat V. S. , Nachankar A. S. , Dwivedi A.
Published: February 2023

Introduction: Wolfram syndrome, named after the physician D J Wolfram is a rare inherited neurodegenerative disorder. It is characterised by diabetes insipidus, juvenile-onset insulin dependent diabetes mellitus, optic atrophy, and deafness, and hence is also known as DIDMOAD syndrome.

Case Report: A 12-year-old female born of second-degree consanguineous marriage, Type 1 diabetic since four years of age, presented with pain abdomen and urinary retention, metabolic acidosis and progressive renal failure with increased urine output after catheterization. Patient was initially being treated for diabetic ketoacidosis and diabetic renal disease at a peripheral hospital. Radiological evaluation showed bilateral hydronephrosis as a cause of renal failure. On further questioning, patient had decreased visual acuity (VA) for 2 years which was implicated to poor glycemic control. However, eye examination revealed primary optic atrophy with VA 2/60 bilaterally. BERA revealed no hearing abnormality. A diagnosis of Wolfram’s syndrome was confirmed usinggenetic analysis, WFS1 gene positive on exon 8 was detected. The patient fulfilled two major and three minor criteria for diagnosis of Wolfram syndrome and was managed accordingly.

Conclusion: Renal and ophthalmic involvement in a case of juvenilleonset diabetes mellitus should be assessed for diagnosis other than diabetic complications and syndromic evaluation should be undertaken in suspicious cases.
Abstract 98
Authors: Prasad Trupti , Bhadada Rimesh Pal. Sanjay Kumar
Published: February 2023

Background: There is an increased risk of fragility fractures in patients with type 2 diabetes mellitus (T2DM). Bone mineral density (BMD) as measured by DEXAmay be increased despite poor quality of bone and thus FRAX may underestimate the risk of fractures in this population. HR-pQCT is a non-invasive imaging modality for assessment of volumetric BMD (vBMD) and microarchitecture of cancellous and cortical bones. Also the available data regarding the choice of anti-osteoporotic therapy in T2DM are based on either preclinical studies or posthoc/subgroup analysis of randomized controlled trials (RCTs) with no head-to-head comparison. We aim to compare the efficacy of the three most commonly used anti-osteoporotic medications, namely, teriparatide, zoledronate and denosumab, in a cohort of postmenopausal women with T2DM at a high risk of incident fragility fractures.

Methods: Here we present the interim analysis after 6 months of an open-labelled randomised control trial of 120 postmenopausal women with T2DM enrolled for 18 months follow-up. Patients were randomised into 4 groups in 1:1:1:1 ratio, with group Areceiving teriparatide, group B receiving zoledronate, Group C receiving denosumab each along with calcium and vitamin D supplements and group D receiving only calcium and vitamin D supplements. The objective was to determine the effects of the anti-osteoporotic drugs on HR-pQCT parameters at the end of 6 months compared to at the time of enrolment.

Results: 31 patients who completed their 6 months follow-up were included in the analysis, 8 in group A, 7 in group B and D and 9 in group C. There were no significant change in the vBMD amongst the groups at 6 months at both tibia (p = 0.075) and radius (p = 0.067). There was a decrease in the total vBMD in all the 4 groups at tibia. However at the radius, total vBMD increased in group B and decreased in the rest, however the intra-group changes were not significant. There was a statistically significant difference in trabecular spacing at tibia between group A (increased) and group C (decreased) (p = 0.031). There were no significant changes in other bone microarchitecture parameters.

Conclusion: At the end of 6 months, there were no significant changes in volumetric BMD and bone microarchitecture at both tibia and radius amongst the groups except for trabecular spacing. Larger number of patients with longer follow-up would help in further understanding.
Red Cell Distribution Width and the Severity of Acute Exacerbration of Chronic Obstructive Pulmonary Disease - A Hospital Based Case Control Study
Authors: Tundwal Vijay Kumar , Gaur Ravi , Ritumbhara  , Kumar Harish , Singh Saranshi , Tundwal Divyanshi
Published: February 2023

Background and Objective:

Acute exacerbation of chronic obstructive pulmonary disease (COPD) is one of the most common diseases in patients with having frequent hospitalization. The aim of this study is to find whether there is any relationship between red cell distribution width (RDW) with mortality in acute exacerbation of COPD.

Materials and Methods:

The hospital-based case–control study is conducted on hospitalized 50 patients with the diagnosis of acute exacerbation of COPD and 50 patients with stable period of COPD.

Results:

This was a hospital-based case–control study in the age group of above 30 years in hospitalized 50 patients with a primary and definite diagnosis of acute exacerbation of COPD and 50 participants in stable period of COPD conducted among admitted in the department of medicine. Maximum patients in both groups were found in the >60 years age group. The mean age in acute exacerbations of COPD group was 64.62 ± 8.24 years and in stable COPD were 63.22 ± 9.18 years. Both groups were comparable. Maximum patients in both groups were male. The mean RDW significantly higher in acute exacerbation of COPD (17.60% ±5.70%) as compared to stable COPD patients (13.80% ±3.33%). The difference in both groups was found statistically significant. The mean corpuscular volume was significantly lower in acute exacerbation of COPD (82.04 ± 1.49) as compared to stable COPD patients (86.50 ± 1.87). The difference in both groups was found statistically significant. RDW was significantly higher in those patients who were died (19.50% ±0.70%) as compared to survived patients (17.52% ±5.61%). The difference in both groups was found to be statistically significant. 4.00% hospital mortality in acute exacerbation of COPD group compared with stable COPD patients.

Conclusion:

We have concluded that the mean RDW on the day of presenting the illness was significantly higher in acute exacerbation of COPD as compared to stable COPD. Those patients who had a high RDW during admission were associated with poor prognoses.
Awareness of Periconceptional Folic Acid in Parents of Children Affected by Spina Bifida – A Pilot Study
Authors: Vashisht Rohan Giridhar , Dasaratha Vinupriya , Santahanakrishna Ramesh
Published: February 2023

Background:

Spina bifida is a congenital malformation involving an open vertebral column resulting from failure in neural tube closure. It is among the most frequently occurring birth defects, observed in 1-3 cases per 1,000 live births worldwide. Conventionally requiring surgical repair, it can cause severe neurologic and musculoskeletal complications. However, consumption of prophylactic folic acid in mothers, at least 3 months before to 12 weeks after conception (periconceptional) has been shown to reduce the incidence of spina bifida by approximately 75%. This makes ascertaining parental understanding of such benefits critical. Therefore, this study provides baseline information on the awareness of periconceptional folic acid among parents whose children previously underwent surgical repair of spina bifida defects.

Materials and Methods:

The study subjects constituted 80 parents whose biological children had undergone surgical repair of spina bifida defects from 2014 to 2021 at a large paediatric tertiary care centre in South India. Upon providing informed consent, the subjects answered a cross-sectional telephonic survey containing 21 questions aimed at exposing their understanding of folic acid and its association with spina bifida.

Results:

None of the mothers had consumed folic acid before conception. However, 75% of them had consumed it as prescribed by their obstetrician during the first trimester of pregnancy. Finally, only 35% of them were aware of its role in preventing spina bifida.

Conclusion:

The awareness of periconceptional folic acid and its preventive role in spina bifida was low amongst parents whose children were once treated for same congenital abnormality.
Inflammatory Myofibroblastic Tumour in Children
Authors: Sreepriya P. P. , Ali Md Mokarram , Rashi Rashi , Kumar Amit , Sinha Amit Kumar , Raj Surabhi , Kumar Bindey
Published: February 2023

Inflammatory myofibroblastic tumour in paediatric patients present with a diagnostic dilemma because of its clinical, radiological and histopathological features overlapping with other mesenchymal tumours common in this age. Because of its rarity, the exact features are still unclear. Here, we are reporting clinical, radiological and histopathological appearances of two such cases. In both cases, the exact diagnosis was confirmed only after immunohistochemistry. There is a need for further detailed study to exactly determine the natural course and prognosis of these tumours.
A Rare Case of Paramedian Cleft Palate
Authors: Ameer Khyrat Al , Andrews Sherry , Eapen Brigit Varghese
Published: February 2023

We present a case report of a 15-month-old baby with an isolated unilateral paramedian cleft palate. A cleft palate is usually seen in children born to their parents through consanguineous marriage. However, a paramedian cleft palate is a very rare finding and very few cases have been reported in the world and none have been published, hence our initiative to present this case report and a modified technique for closure of the same. Along with the conventional von Langenbeck technique, a modification using a rotational flap from the retromolar fossa was done to close the oral mucosal layer.
The Outcomes of Modified Millard Technique Versus Tennison-Randall Technique in Unilateral Cleft Lip Repair
Authors: Abdullateef Khaled Salah , Nagaty Mohamed A. M. , Fathy Mohamed , Elmenawi Khaled Abdelmoneim , Aboalazayem Abeer , Abouelfadl Mohamed H.
Published: February 2023

Purpose:

This study aimed to use anthropometric measurements taken pre- and post-operation to evaluate quantitative assessment of modified Millard technique compared with Tennison-Randall technique in unilateral cleft lip (UCL) repair.

Patients and Methods:

Prospective randomised controlled study recruited infants scheduled for UCL repair. Infants aged 2–6 months, either complete or incomplete deformity. A total of 68 patients were randomised in 1:1 ratio to undergo either modified Millard technique (Group I) or Tennison-Randall technique (Group II).

Results:

Group I had significantly longer operative time than Group II (85.7 ± 7.4 vs. 68.7 ± 8.8 min, respectively; P < 0.001). Group I has less post-operative wound infection, wound dehiscence and wound scarring than Group II, but Group II has less post-operative lip notch. In Group I, greater increases in post-operative horizontal lip length and vertical lip height were observed, compared to Group II, without statistically significant difference. Group I showed a greater reduction in nasal width and total nasal width than Group II, without statistically significance. Group II had a greater increase in philtral height. However, only post-operative Cupid’s-bow width was significantly different between two groups (P = 0.041).

Conclusion:

Overall results demonstrate no significant differences between modified Millard technique and Tennison-Randall technique.
Effects of Tai Chi and Qigong on fatigue and quality of life in patients with breast cancer: A narrative review of systematic reviews and meta-analyses
Authors: Gholamalishahi Shima , Okechukwu Chidiebere Emmanuel , La Torre Giuseppe , Mannocci Alice
Published: February 2023

Tai Chi is a slow-moving exercise that incorporates deep and steady breathing. Qigong is a self-guided workout that involves breathing exercises and meditation. Tai Chi, as it is practiced today, incorporates Qigong. The objective of this review was to evaluate the efficacy of Tai Chi and Qigong in improving the quality of life and reducing fatigue among patients with breast cancer. Three electronic medical databases (PubMed, Scopus, and Web of Science) were searched from their inception up to July 2021. Nine systematic reviews and meta-analyses were included in this narrative review. Quality assessment was independently conducted by the first two authors (SG and CEO) using a measurement tool to assess systematic reviews. Three systematic reviews and meta-analyses reported the effects of Tai Chi and Qigong on cancer-related fatigue and four reported their effects on the quality of life of patients with breast cancer. Tai Chi and Qigong are beneficial, safe, low-impact, and low-intensity therapeutic exercises for patients with breast cancer that can improve their quality of life and psychological health and can be utilized as adjunctive therapies for the management of fatigue, if appropriately recommended. The evidence that Tai Chi and Qigong reduce fatigue and improve health-related quality of life among patients with breast cancer is moderate.
Bendamustine in the third line or beyond in metastatic, recurrent, or relapsed head-and-neck cancers: A retrospective observational study
Authors: Patil Vijay , Adak Supriya , Noronha Vanita , Menon Nandini , Singh Gunjesh Kumar , Prabhash Kumar
Published: February 2023

Background:

Head-and-neck squamous cell carcinoma (HNSCC) is one of the most aggressive malignant tumors and is commonly diagnosed at an advanced stage. In the palliative setting, there are very limited options available for patients unfit to receive immunotherapy. Bendamustine has shown promising results in solid tumors, both alone and in combination with other treatment modalities.

Objectives:

We aimed to explore the role of bendamustine as palliative chemotherapy in patients with metastatic, recurrent, or relapsed HNSCC.

Materials and Methods:

We included patients with advanced HNSCC that was refractory to multiple lines of palliative intent therapy, and who were treated with bendamustine between October 2020 and January 2021 in the Department of Medical Oncology at the Tata Memorial Hospital, Mumbai, India. We evaluated the efficacy and safety parameters of the drug.

Results:

The study cohort included a total of 25 patients with a median age of 47 (range, 29-58) years; 21 (84%) were men. The primary tumor sites were buccal mucosa and oral tongue in 12 (48%) and 6 (24%) patients, respectively. The patients had received a median of 2 (range, 2-5) prior lines of treatment including platinum-taxane combination in 19 (76%), oral metronomic chemotherapy in 8 (32%), and immunotherapy in 4 (16%). Bendamustine resulted in a median progression-free survival of 1.3 months (95% CI, 0.9-2.0) and a median overall survival of 2.2 months (95% CI, 1.6-3.6). The common toxicities reported were constipation (7, 28%), neuropathy (5, 20%), and fatigue in 4 (16%) patients.

Conclusion:

Bendamustine is a promising and well-tolerated alternative drug for patients with metastatic, recurrent, or relapsed refractory HNSCC.
Paclitaxel with Mycidac-C in the second line and beyond in advanced head-and-neck cancer: A retrospective analysis from a tertiary cancer center
Authors: Sarma Rup J. , Patil Vijay M. , Shetty Alok , Menon Nandini , Noronha Vanita , Prabhash Kumar
Published: February 2023

Background:

Head-and-neck squamous cell cancers (HNSCC) are common in India. Recurrent and metastatic HNSCC carry a poor prognosis. The chemotherapy options are limited, and the median survival is measured in months. The addition of targeted antibodies and immunotherapy improves overall survival (OS). In resource-limited settings, chemotherapy remains the only option in advanced HNSCC.

Objectives:

We aimed to assess the efficacy and safety of the combination of paclitaxel and Mycidac-C (heat-killed Mycobacterium w) in the palliative setting for advanced HNSCC.

Materials and Methods:

This was a retrospective study conducted in the Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India in patients with relapsed/refractory or metastatic HNSCC who received the combination of paclitaxel and Mycidac-C between August 2019 and May 2020. Patients were treated until progression or unacceptable toxicity. The study was approved by the Institutional Ethics Committee, and the requirement for written informed consent was waived.

Results:

We included 28 patients in the study. Most of the patients (22, 78.6%) had oral cavity cancers and had platinum-refractory disease (25 patients, 96.4%). The median age was 51 years (range, 31-70), 26 (92.9%) patients were male, and 25 (89.3%) had a performance status of 0-1. At least two lines of previous therapies had been administered to 23 (82.1%) patients. The median duration of follow-up was 3.4 months (range, 0.2-18.1). The median numbers of cycles of paclitaxel and Mycidac-C administered were 3 (range, 1-6) and 2.5 (range, 1-6), respectively. The median progression-free survival (PFS) and OS were 2.9 months (95% confidence interval [CI], 2.36-3.48) and 4.9 months (95% CI, 3.78-5.99), respectively. The most common adverse effects were anemia in 26 (93.9%) patients and increased alanine aminotransferase and aspartate aminotransferase levels in five (17.9%) and four (14.3%) patients, respectively. Four (14.3%) patients developed neutropenia, two (7.1%) developed diarrhea, and two (7.1%) developed peripheral neuropathy.

Conclusion:

In resource-limited settings, the combination of paclitaxel and Mycidac-C can be considered a therapeutic option for patients with advanced relapsed/metastatic HNSCC.
Do you have a standard way of interpreting the standard deviation? A narrative review
Authors: Darling H. S.
Published: February 2023

Data presented in a paper have the limitation of summarizing the individual findings into statistical inferences. The standard deviation allows the reader to understand the spread of the data or the measurement of variation in a dataset that follows a normal distribution. The correct calculation and presentation of data along with measures of central tendency allow the comparison of data in systematic reviews and meta-analyses. A medical literature database search was performed in PubMed, Embase, and Cochrane using the keywords, “standard deviation”, “biostatistics”, and “clinical studies,” followed by abstract screening, and full paper evaluation to gather the desired information. This review highlights the importance of the standard deviation, its uses, interpretation, and fallacies.
Fam-trastuzumab deruxtecan-nxki (Enhertu®): A narrative drug review
Authors: Varghese Ryan , Soman Niraja , Karsiya Jainam , Bafna Nimesh , Nag Shona
Published: February 2023

Human epidermal growth factor receptor 2 (HER2) is a subset of the epidermal growth factor receptor family that expresses tyrosine kinase activity. Dimerization of the receptor initiates various cellular signaling pathways, ultimately leading to the proliferation and division of cancer cells. The HER2 receptors are expressed in a multitude of cancers, such as metastatic breast cancer, gastric cancer, gastroesophageal adenocarcinoma, and non-small-cell lung cancer. Owing to its expression in several cancers, precision medicine products such as antibodies can be conjugated with conventional drugs to form antibody-drug conjugates (ADCs). These ADCs, like fam-trastuzumab deruxtecan-nxki, could be employed against these cancers, especially when previous lines of therapy have failed. This drug review aims to explore the pharmacodynamics, pharmacokinetics, clinical indications, contraindications, dosing regimen, dose modifications, adverse drug events, and the storage and administration of fam-trastuzumab deruxtecan-nxki. We screened all previous trials and tabulated the results to provide a bird’s eye view of the clinical outcomes. This review was prepared after an exhaustive literature search in PubMed, ScienceDirect, Google Scholar, Dimensions, and EBSCO Host, as well as by searching the websites of the United States Food and Drug Administration (US FDA), drug manuals, and conference presentations, using terms such as “fam-trastuzumab deruxtecan-nxki”, “Enhertu” and “HER2”. Of a total of 755 publications, 29 were found pertinent, and after rigorous scrutiny, 13 were included for curating this drug review. Supporting data were obtained from various abstracts and conference proceedings.
COVID-19-associated pathological changes in placentae of third-trimester pregnant women
Authors: Abdelwahab Mai M. , Tash Rehab M.E. , Shazly Sherin A. , Elbasateeny Samah S.
Published: February 2023

Background and aim

Recently, many instances of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [coronavirus disease 2019 (COVID-19)] placental invasion in late pregnancy have been reported, and this is still not completely clear. Controversy data are sequentially published, so more studies are needed to investigate placental pathology as it gives vital information on placental changes, mechanisms of maternal–fetal infection transmission, and viral effects on the placenta as inflammatory or vascular changes. We aimed to find out the placental pathological changes in term placentae and to detect SARS-CoV-2 RNA in specimens fixed in formalin and embedded in paraffin.

Patients and methods

A total of 30 placentae were obtained from COVID-19-infected pregnant women. They were examined for pathological changes by histopathology; immunohistochemistry for CD3, CD20, CD15, CD68, angiotensin-converting enzyme 2, cytokeratin, and PDL-1; and reverse transcription-PCR to recognize viral RNA.

Results

According to the COVID-19 status at the delivery time, four groups were identified. Group 1 (12 patients with COVID-19 at the delivery time) showed chronic villitis and placental maternal and fetal malperfusion. Group 2 (seven cases that turned negative by PCR of the nasopharyngeal swab prior to delivery by 5–8 days) showed maternal malperfusion but no villitis. Both groups were SARS-CoV-2 RNA positive by PCR of the nasopharyngeal swab. Group 3 (five cases that turned negative 1 day before delivery) showed maternal–fetal malperfusion and mild chronic subchorionitis and deciduitis. Only three had SARS-CoV RNA. Group 4 (six cases with a persistent negative swab for 20 days before delivery) showed focal villitis (much less than other groups) and maternal malperfusion. Only two had SARS-CoV-2 RNA. Immunophenotyping of cases in the four groups detected mixed inflammatory infiltrate with variable diffuse angiotensin-converting enzyme 2 immunostaining of villus and extravillous trophoblasts. Cytokeratin staining detected thinning and discontinuity of syncytiotrophoblast and strong PD-L1 expression was seen in villitis areas.

Conclusion

SARS-CoV-2-positive women exhibited a diverse range of results; thus, pregnant women should not be considered a homogeneous group as outcomes are dependent on a multitude of interdependent circumstances.
Aldehyde dehydrogenase 1 expression in invasive breast carcinoma and its correlation with other clinicopathological parameters
Authors: Farrag Mayada S. , Elmetwally Mohamed , Farrag Nesrine S. , Ibrahiem Afaf T
Published: February 2023

Background

Breast cancer is the main reason for mortality due to cancer among women worldwide. Activity of aldehyde dehydrogenase 1 (ALDH1) is known worldwide as a signature of breast malignancy stem cells. In this research, we tried to discover the variable expression of ALDH1 in diverse molecular categories of invasive breast duct carcinoma and its relation to other clinical and pathological parameters and to patient outcomes.

Study design

This is a retrospective study carried out on 118 samples of invasive breast duct carcinoma retrieved from the archives of Pathology Laboratory Department of Oncology Center, Mansoura University, Egypt.

Patients and methods

Immunostaining for ALDH1was done in addition to ER, PR, Her2, Ki67, EGFR, and CK5/6.

Results

We found that ALDH1 overexpression was found in 89% of cases. ALDH1 overexpression was considerably related to increased TNM staging (P=0.001). Moreover, disease-free survival was lesser in patients with ALDH1 overexpression than in patients with low ALDH1 expression.

Conclusions

Elevated ALDH1 expression is associated with aggressive traits as well as advanced TNM stage of breast cancer. Importantly, these discoveries may pave the way for novel cancer therapeutics based on ALDH1 inhibitors or antibodies.
Effects of ketamine or dexmedetomidine on postoperative cognitive dysfunction after cataract surgery: A randomized controlled trial
Authors: Oriby Mohamed E , Elrashidy Ayman A , Elsharkawy Ahmed , Ahmed Sameh A
Published: February 2023

Background and Aims:

Ketamine and dexmedet omidine have neuroprotective effects that may reduce the occurrence of postoperative cognitive dysfunction (POCD) when they are used by intravenous infusion in geriatric patients scheduled for cataract extraction.

Methods:

Ninety patients aged 65-85 years old, ASA physical status II and III, and scheduled for cataract extraction under peribulbar block were randomly distributed equally among three groups: control group, in which patients received normal saline; ketamine group, in which patients received 0.3 mg/kg/h of ketamine; and dexmedetomidine group, in which patients received 0.5 µg/kg/h of dexmedetomidine. Medications were administrated by intravenous infusion and started 10 min before the surgery and continued throughout the duration of surgery. The analysed parameters included the incidence of POCD (primary outcome) through composite score of neuropsychological testing at one week and 3 months after surgery, postoperative pain score, postoperative sedation score, changes in haemodynamic parameters, changes in intraocular pressure, and incidence of complications.

Results:

In comparison with control group, ketamine and dexmedetomidine groups exhibited a significant decline in number of patients who developed POCD (P < 0.0001), a decrease in the postoperative pain score 4 h after surgery (P = 0.038), and an increase in the postoperative Ramsay sedation Score (P = 0.0002, 0.0003, and 0.011), without significant changes in the vital parameters, intraocular tension, or incidence of complications. Ketamine and dexmedetomidine groups were comparable.

Conclusion:

Intravenous administration of ketamine or dexmedetomidine in elderly patients undergoing cataract surgery under peribulbar anesthesia significantly decreases the incidence of POCD.
Comparison of retrograde transillumination and conventional technique for flexible videoscopy by novice anaesthesia residents: A randomised controlled trial
Authors: Gopalakrishnan Sri Showmiya , Rudingwa Priya , Kuberan Aswini , Mishra Sandeep Kumar , Panneerselvam Sakthirajan , Jha Ajay Kumar
Published: February 2023

Background and Aims:

Retrograde transillumination technique has been found helpful for performing direct and video laryngoscopy by better identification of glottis. The usefulness of this technique during flexible videoscopy by novices has not been evaluated. So, we aimed to compare the retrograde transillumination and conventional technique of flexible videoscopy by novices. The primary outcomes were the time required to visualise the glottis from the point of insertion of the scope into the nostril (T1) and the time needed to see tracheal rings after glottis visualisation (T2). The secondary outcomes were incidence of desaturation with peripheral oxygen saturation (SpO2) <92% and the ease of performance of flexible videoscopy using retrograde transillumination.

Methods:

A total of 92 surgical patients who are undergoing general anaesthesia with normal airway parameters were randomised into two groups, Group C (Conventional flexible videoscopy- Ambu® aScope™ 3 Broncho Slim) and Group R (Flexible videoscopy aided by retrograde transillumination through the cricothyroid space using an OTICA LED vein finder).

Results:

The time to visualise glottis from scope insertion into the nose (T1) (median [interquartile range]) in group C and group R was (19.23 [13.6-30.5] versus 22.50 [17.8-25.5] seconds; P value = 0.417) and time to visualise the tracheal rings (T2) was (13.07 [9.1-20.00] versus 12.13 [9.0-19.1] seconds; P value = 0.714) were comparable in both the groups. 61% of residents found the retrograde transillumination to be very helpful. No incidence of desaturation was noted in either group.

Conclusion:

Retrograde transillumination-aided flexible videoscopy does not shorten the time but facilitates glottis and tracheal rings visualisation among novice anaesthesia residents.
Isolated Spinal Intramedullary Neurocysticercosis
Authors: Vijayan Selvin P. , Gerber Christopher , Basu Anindya , Mhatre Radhika
Published: February 2023

Cysticercosis is the most common parasitic disease of the central nervous system but an isolated spinal intramedullary involvement is very rare. We present one such case of a 68-year-old female who had spastic paraplegia with bladder involvement. Magnetic resonance imaging (MRI) revealed D3 intramedullary space-occupying lesion. She was treated with surgical excision and her diagnosis was confirmed to be cysticercosis by histopathological examination. With appropriate post-operative rehabilitation and medical management, she was found to have significant recovery. At final follow-up, she was walking with aid and regained her bladder control. A high index of suspicion is required in endemic zones, like India, when the MRI shows an unusual picture of space-occupying intramedullary lesions. With early diagnosis and initiation of treatment, neurocysticercosis (NCC) shows better prognosis than what was previously known.