bluuebunny/crossref_metadata_2025 huggingface dataset:
De novo Donor-specific Anti-human Leukocyte Antigen Antibody and Its Outcome in Pediatric Renal Transplant Recipients: A Single-center Experience in India
Authors: Saha Anshuman , Kapadia Shahenaz F. , Vala Kinnari B. , Trivedi Varsha B , Patel Himanshu V , Shah Pankaj R. , Kute Vivek B.
Published: December 2023

Development of de novo donor-specific anti-HLA antibody (dnDSA) is associated with poor graft survival in adults. However, there is a paucity of data about its prevalence and outcome in Indian children. We retrospectively assessed the proportion and spectrum of dnDSA and its outcome on antibody-mediated rejection (ABMR) and graft function. Children ≤18 years who were transplanted between November 2016 and October 2019 were included in this study. Pretransplant donor-specific antibody (DSA) was screened by complement-dependent cytotoxicity, flow cytometry crossmatch, and single antigen bead (SAB) class I and II by Luminex platform. Either antithymocyte globulin or basiliximab was used as induction. Tacrolimus, mycophenolate, and prednisolone were used for the maintenance of immunosuppression. SAB screening was done at 1, 3, 6 months, and yearly in seven children and at the time of acute graft dysfunction in eight. Mean fluorescence intensity ≥1000 was considered positive. Protocol biopsies were done at 3, 6, and 12 months and annually thereafter in seven children. Fifteen children, all males with a median age (interquartile range) of 13 years (11; 15.5) were analyzed. Only one child had pretransplant DSA who developed dnDSA posttransplant. Overall, 8 (53%) developed dnDSA over a median follow-up of 18 months. Seven (87%) had Class II, one Class I and 3 (37%) both Class I and II. Six had dQ and two had DR. All children with dnDSA had ABMR, of these two had subclinical rejection. DSAs persisted despite treatment, though graft function improved. Children with DSA and ABMR had lower graft function than those without DSA. The proportion of dnDSA was high in our study, majority against DQ. The detection of dnDSA prompted early diagnosis and treatment of ABMR.
Neurological manifestations of COVID-19 infection: A case series
Authors: Khan Ayimen Khalid , Khan Anam , Khan Ammar Khalid , Anwar Shayan Sirat Maheen
Published: December 2023

Neurological symptoms of COVID-19 infection can be lethal if optimum intervention is not provided at the right time. However, it is extremely important to distinguish the non-specific symptoms of COVID-19 according to its severity directly or indirectly caused by the coronavirus. Here, we present five radiological case studies of COVID-19 to highlight the wide array of neurological manifestations associated with COVID-19.
Myo-inositol versus metformin effects on clinical features, endocrine and metabolic profiles in infertile women with polycystic ovary syndrome: A randomized controlled trial
Authors: Le Nguyen Sa Viet , Le Minh Tam , Cao Thanh Ngoc
Published: December 2023

Objective:

To compare the effectiveness of inositol and metformin on the clinical characteristics, and endocrine and metabolic profiles of infertile polycystic ovarian syndrome (PCOS) women from Vietnam.

Methods:

From June 2018 to August 2022, a randomized trial was undertaken at the Hue Center for Endocrinology and Reproduction on infertile women aged 18 to 40 years with polycystic ovarian syndrome. The clinical, endocrine, and metabolic features of these individuals were assessed before and after 3 months of treatment with 2 g of inositol or 1700 mg of metformin per day. Natural pregnancy rates, adverse effects, and tolerance of inositol were recorded.

Results:

The study included 171 infertile PCOS women who were eligible to participate and took part in the baseline assessment, of whom 132 women participated in data analysis after 3 months. After metformin treatment, 42.1% of women with oligomenorrhea experienced regular menstruation. Metformin significantly lowered body mass index (BMI), waist circumference and testosterone levels, but had no effect on other clinical characteristics, endocrine profiles, or metabolic profiles. 29.2% Of women reported experiencing side effects. 21% Of them attained pregnancy, which resulted in 17.1% of live births. In the inositol group, the rate of regular cycle increased by 18.2% and the total testosterone concentration significantly decreased. In overweight/obese women with PCOS, inositol significantly decreased weight, BMI, waist and hip circumferences (P<0.05). 100% Of women tolerated inositol and continued treatment. 18.9% Of them became pregnant, leading to 17% of live births.

Conclusions:

Metformin and inositol can improve weight and waist circumference in overweight/obese infertile women with PCOS. Metformin is associated with a higher rate of regular menstruation, whereas inositol is associated with a lower rate of adverse effects. The spontaneous conception, clinical pregnancy, and live birth rates between two groups are comparable.
Expression of VEGF165 and VEGF165b during ovarian follicular development
Authors: Changsangfa Chinnarat , Turathum Bongkoch , Sroyraya Morakot , Grataitong Khwanthana
Published: December 2023

Objective:

To investigate the role of vascular endothelial growth factor (VEGF)165a, VEGF165b, and VEGF receptor (VEGFR) in the development of bovine follicles.

Methods:

We cultured follicular cells that were collected from small, medium, and large sized bovine follicles with estrogen and measured the expression of VEGF, VEGFR2 and VEGF165b by Western blot analysis and immunofluorescence.

Results:

The expression of VEGF165 increased in all follicle sizes and the expression of VEGF165b was increased in the small and large follicles after culturing in an estrogen containing medium. The expression of VEGFR2 was increased in the medium and large follicles after culturing with estrogen for 96 h. VEGF165 was activated at 100 ng/mL estrogen in the large follicles for 96 h. In addition, VEGFR2 was upregulated in the medium and large follicles after treated with 100 ng/mL estrogen for 96 h.

Conclusions:

This evidence suggests that the expression of VEGF165 and VEGFR is associated with estrogen stimulation during the development of bovine follicles and in an autocrine or paracrine manner. This reveals an advantage during oocyte maturation in vitro.
Study of Face Mask-associated Dry Eye among Medical Students
Authors: Gupta Priyanka , Bansal Aditi , Aggarwal Anupriya , Singla Ritesh
Published: December 2023

Purpose:

The purpose of this study was to evaluate face mask-associated factors causing dry eye among medical students.

Methodology:

This was a cross-sectional study conducted on undergraduate medical and dental students, of all phases, while they were attending offline classes and were required to wear face masks in accordance with the government regulations. Sociodemographic data, ocular and medical history, face mask-wearing practices, screen usage, and quantification of symptoms using the modified Ocular Surface Disease Index (OSDI) questionnaire were collected. Objective tests were conducted in students having dry eye. The association of quantitative variables was done using ANOVA, Mann–Whitney, and Kruskal–Wallis test, whereas the Chi-square test was done for qualitative variables. Multivariate logistic regression was used to identify the risk factors for varying severity of dry eye.

Results:

The mean age of the 410 students was 21 ± 1.6 years. According to the OSDI, 39.51% (162/410) of students had dry eyes, 23.41% (96/410) had mild dry eye, 8.78% (36/410) had moderate dry eye, and 7.32% (30/410) had severe dry eye. Face mask-associated factors which were significantly linked to dry eye were N95 masks, loose-fit masks, and 6–8 h of continuous mask use. The Schirmer’s test and tear film break-up time were performed on 29 and 20 students, respectively, mean values being 19.25 ± 5.29 mm and 10.15 ± 1.41 s for nonsevere and 6.53 ± 1.55 mm and 5.3 ± 0.98 s for severe dry eye, respectively.

Conclusion:

It is important to educate medical students and create awareness regarding “face mask-appropriate behavior” to reduce the chances of dry eye secondary to face masks use.
The effect of the social support perceived by the women receiving chemotherapy on functional and psychosocial conditions: A cross-sectional, descriptive and correlational study
Authors: Ataman Hacer , Tuna Rujnan
Published: December 2023

Background:

Today, cancer is one of the most important health problems with fatal results. Individuals with cancer have to cope with many functional and psychosocial problems in the course of the disease besides physical impairments. The effect of social support of women receiving chemotherapy on their functional and psychosocial conditions was determined.

Methods:

This study had a cross-sectional, descriptive, and correlational design. The study was conducted with 330 women patients in a state hospital located in Istanbul, Turkey, which has an outpatient chemotherapy unit and is one of the hospitals where outpatient chemotherapy is applied most.

Results:

In the study, it was determined that there was a very high positive correlation between the social support perceived by the women with cancer and self-esteem and a very high negative correlation of self-esteem with fatigue and depression (P < 0.001). In contrast, there was a very high negative correlation between social support and self-esteem with many of the functional symptoms and a very high positive correlation between social support and self-esteem with fatigue and depression (P < 0.001). Education, number of children, economic situation, family structure, self-esteem, fatigue, and depression variables explained 33% of cancer patients’ social support.

Conclusion:

The management of the functional and psychosocial symptoms of women with cancer is closely related to the perceived social support. In the management of the functional and psychosocial symptoms of women with cancer, it is important to provide and maintain psychological support by involving the patients’ families in the treatment process.
Reconstruction of Partial Glossectomy Defects in Patients with Squamous Cell Carcinoma of Oral Tongue: A Prospective Clinical Study on the Assessment and Comparison of Intraoperative and Postoperative Outcomes of Islanded Nasolabial Flap Tunneled Under the Mandible and Radial Forearm Free Flap
Authors: Kangloo Shubhanshi , Bhola Nitin , Agarwal Anchal , Chakraborty Raj Kumar , Mishra Priyatam , Pillai Saurabh
Published: December 2023

Background:

Reconstruction of the glossectomy defect following surgery plays a pivotal role in a patient’s quality of life. Reconstruction of surgical defects following glossectomy has evolved greatly from locoregional flaps such as nasolabial, submental, infrahyoid, and pectoralis major myocutaneous flaps to microvascular free flaps (radial forearm free flap [RAFF], anterolateral thigh flap). Due to certain drawbacks, microvascular-free flaps are avoided; instead, local/regional flaps are preferred. Islanded Nasolabial Flap Tunneled Under the Mandible (INFTUM) is a modification of the conventional nasolabial flap based on the facial artery. The flap is raised by dissecting to a certain length to adequately reach a significant distance for reconstruction of the glossectomy defects of mild-to-moderate size. This flap provides adequate bulk and pliable tissue to the remaining tongue, which aids in better functional outcomes.

Aim:

The aim is to assess and compare the intraoperative and postoperative outcomes of INFTUM and RAFF for the reconstruction of partial glossectomy defects in patients with squamous cell carcinoma of the oral tongue.

Materials and Methods:

This prospective study was conducted on 20 patients equally divided into two groups, Group A – Islanded Nasolabial Flap Tunnelled Under the Mandible and Group B – RAFF conducted in SGM Cancer Hospital, Sawangi. Intraoperative and postoperative outcomes were evaluated, and statistical analysis was performed using independent sample t-test and Chi-square test where values less than P = 0.05 were found significant.

Results:

INFTUM flap displayed better intraoperative and postoperative outcomes, especially functional outcomes, in shorter duration as it is locally available with minimum cosmetic deformity to the donor site. In this study, the flap is done in a single stage by tunneling under the mandible. It has a good reach to any aspect of the oral cavity, including the contralateral side, if ipsilateral level Ib nodes are compromised.

Conclusion:

INFTUM is a simple, effective, and safe flap that can be used for the reconstruction of T2-T3 lesions or partial glossectomy defects. It provides better intraoperative and postoperative outcomes and comparable functional outcomes to RAFF, especially when patients have anesthesia risk for prolonged surgical procedures in a limited-resource setting. Furthermore, it has comparatively less postoperative complications as it has less learning curve.
Supraclavicular Artery Island Flap in Head-and-neck Reconstruction: Our Experience
Authors: Thaduri Abhinav , Jat Bhinyaram , Kumar Amit , Tyagi Amit Kumar , Singh Abhijeet , Kailey Vikramjit Singh , Maharaj Dileep Dungala , Usmani Shahab , Gupta Kartikesh
Published: December 2023

Background:

Reconstruction of head-and-neck cancer defects is a challenging task, keeping in mind the complexity of the defects. Locoregional pedicle flap reconstruction is not an inferior option. The supraclavicular flap gained popularity in 1997 to reconstruct mentosternal contractures in postburn patients. This is a perforator-based pedicled, axial, and fasciocutaneous flap based on the supraclavicular artery. This study aims to examine a series of cases with pedicled supraclavicular flap reconstruction in head-and-neck cancers.

Methods:

This study is a retrospective review of patient data from our institution from 2018 to 2020. A total of seven patients were included who underwent surgical resection for various head-and-neck cancers. Surgical defects were reconstructed with a supraclavicular islanded fasciocutaneous flap.

Results:

All patients underwent wide excision of the tumor following oncological principles, and four out of seven patients received postoperative adjuvant radiotherapy. Two patients with parotid tumors underwent facial skin excision along with total parotidectomy. Both cases were recurrent. One patient had partial necrosis of the distal part of the flap. Two patients required split-thickness skin graft for the closure of the donor site.

Conclusion:

Supraclavicular artery island flap (SCAIF) is one of the good reconstructive options for midline neck defects, simple oral cavity defects, and cheek skin defects. It is an excellent alternative to free tissue transfer with limited donor-site morbidity. Careful selection of patients is key to successful reconstruction using a SCAIF in the head-and-neck region.
Thyroid Papillary Microcarcinoma - Carcinoma with Clinically Benign Behaviour
Authors: Singhavi Hitesh R , Mair Manish , Qayyumi Burhanuddin , Singh Arjun , Chaturvedi Pankaj
Published: December 2023

Introduction:

The availability of sensitive diagnostic procedures has led to an increased incidence of micropapillary thyroid carcinoma (mPTC) globally. Moreover, there has been a paradigm shift in the treatment of these cancers from total thyroidectomy to lobectomy to active surveillance.

Methodology:

To identify manuscripts with latent mPTCs, the database was searched and relevant articles were included in the manuscript. We have looked at the probable incidence of mPTC based on the autopsy report and World Bank population. Furthermore, the clinical behavior of mPTC is elaborated with its psychological and financial impact on the patients.

Results:

Based on the published autopsy reports, we estimated that around 8.7 million people would suffer from thyroid papillary microcarcinoma in 2018. This hypothetical number will easily outnumber the required number of thyroid surgeons to operate these cases. This will cause significant psychological distress to the patient by the word “cancer.” In addition, the incidence of bankruptcy is also higher in these patients as they live longer.

Conclusion:

We postulate that labeling thyroid papillary microcarcinoma as “Carcinoma with clinically benign behavior” might reduce the associated psychological distress as well as financial burden.
Comparative Estimation of C-terminal Cross-linked Telopeptide of Type I Collagen Levels in Gingival Crevicular Fluid in Diabetic and Nondiabetic Patients with Chronic Periodontitis
Authors: Ningombam Anushree , Dhalla Nipun , Palwankar Pooja , Goyal Anjana , Pandey Ruchi
Published: December 2023

Aim:

To estimate C-terminal cross-linked telopeptide (CTx) levels in GCF, using ELISA in diabetic and nondiabetic patients with chronic periodontitis.

Materials and Methods:

A total of 42 patients were recruited: 21 type II diabetic patients with chronic periodontitis (group A) and 21 nondiabetic patients with chronic periodontitis (group B). Scaling and root planing (SRP) were done in groups, followed by collection of GCF samples and recording of clinical variables. Measurements for clinical indicators of periodontal health were taken on 0 day (baseline), first and after third month. The Ctx level of GCF was taken at baseline and after 3 months using enzyme-linked immunosorbent assay (ELISA). GPower software (version 3.0) was used. Paired t tests and Student's t tests as well as parametric tests were used to analyze the results. The threshold for significance was fixed at P < 0.05.

Result:

Following SRP, there was a significant reduction in Ctx levelsand an improvement in clinical parameters in both groups. There is a negative correlation uniting CTx quantity with an improvement in periodontal conditions in both diabetic and nondiabetic patients.

Conclusion:

CTx levels in both diabetic and nondiabetic candidates with chronic periodontitis infection were reduced after nonsurgical periodontal therapy.
Effect of Nonsurgical Periodontal Therapy in Pre and Postmenopausal Women with Periodontitis
Authors: Mayta-Tovalino Frank , Quispe-Vicuña Carlos , Cabanillas-Lazo Miguel , Benites-Zapata Vicente A.
Published: December 2023

Aim:

The aim of this systematic review is to provide a comprehensive summary of the current evidence regarding the efficacy and safety of nonsurgical periodontal therapy (NSPT) in pre- and postmenopausal women.

Materials and Methods:

We performed a systematic search of five databases until May 2022 with no language or date restrictions. We included experimental or quasi-experimental clinical studies in pre- or postmenopausal female patients (≥40 years). We considered NSPT as scaling and root planning (SRP). The primary outcomes were: periodontal index (PRI) by Russell, plaque index (PI) by Löe and Silness or O'Leary and adverse events. A secondary outcome was a change in the bone mineral densitometry T-score.

Results:

We included three studies but did not meta-analyze the studies due to high heterogeneity. Two studies were pre–post trials, and one was a nonrandomized controlled trial. One trial included both pre- and postmenopausal women and two studies only evaluated postmenopausal women. The studies that compared the effect of SRP in pre- and postmenopausal women found a statistically significant reduction in PRI and PI according to Löe and Silness, and O'Leary. Another study found that SRP plus vitamin D and calcium supplementation decreased PI values. No study reported adverse events. The nonrandomized controlled trial reported a high risk of bias, and the two quasi-experimental studies showed high quality.

Conclusion:

All the studies included in the analysis demonstrated the effectiveness of Non-Surgical Periodontal Therapy (NSPT) in both pre- and postmenopausal patients with periodontitis. However, future studies with higher methodological quality and larger sample sizes are necessary.
Safety of E-Cigarettes and its Effectiveness in Smoking Cessation
Authors: Shete Anagha V. , Hajarnavis Arti M. , Shete Mrinal V. , Nerkar-Rajbhoj Ashwini A. , Sande Abhijeet , Channe Pallavi P.
Published: December 2023

Aim:

Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria, the main goal of our study is to analyze the safety of e-cigarettes and their relationship to quitting smoking.

Materials and Methods:

From January 2011 to December 2022, a thorough search of the Cochrane Library, PubMed, Scopus, Web of Science, and Scopus databases was carried out. Using PRISMA criteria, we evaluated 25 review papers, three randomized controlled trials, and three cross-sectional studies in this review, which analyzed 12,210 study participants. Although language did not restrict search results, all discovered studies were in English. The threat of bias and level of evidence were determined for each selected study.

Results:

Our systematic review showed a bigger rate of smoking cessation, i.e., 20%, with the use of E-cigarettes, suggestive of their contribution to smoking cessation. We found a correlation between cessation of smoking and E-cigarettes with nicotine, which suggests that they may prove as an effective alternative smoking cessation aid. The count of cigarettes used per day is lessened, so they may be used to reduce the harm caused by tobacco.

Conclusion:

Although not formally monitored, E-cigarettes can help smokers unable or unwilling to quit to remain abstinent or reduce their cigarette consumption. The toxic substances and chemicals within E-cigarettes are not clearly labeled, and hence, their safety is not guaranteed.
Palatogingival Groove
Authors: Demore Fernanda Paludo , Cecília Mauricio Santa , Souza Alessandra Areas , Zuza Elizangela Partata
Published: December 2023

Aim:

Palatogingival groove (PGG) is a morphological defect that usually affects maxillary incisors and may be related to periodontal and endodontic disease. The aim of this study was to evaluate the prevalence, characteristics, and clinical implications of the PGG in a Brazilian population.

Materials and Methods:

A convenience sample with 169 consecutive participants was evaluated in a cross-sectional study from September 2021 to May 2022. Upper anterior teeth were evaluated by a single examiner considering the presence of PGG, its characteristics and the presence of caries, periodontal and endodontic disease. Chi-square test and logistic regression were applied and P value was set at 5%.

Results:

PGG prevalence was 21.67% in individuals and 5.9% in teeth. A logistic regression did not reveal significant differences between sex [female: odds radio (OR) 1 and male: OR 0.53] and race (white: OR 1; black: OR 0.81; brown: OR 0.70). The highest prevalence was found in the upper lateral incisors (68.6%), in the cingulum (80.39%), with greater occurrence in the mid-palatal face of the tooth (39.21%). A high prevalence of bleeding on probing (83.8%) and caries (37.8%) was found in teeth with PGG, but no pulp alterations were found.

Conclusions:

PGG prevalence is high when the number of individuals is considered, and the tooth more frequently affected by PGG is the upper lateral incisor, with greater occurrence in the mid-palatal and cingulum face. In addition to incisors, canines also can be affected by PGG. Teeth with PGG may present high rates of biofilm accumulation, periodontal inflammation, and caries.
Herbal Combination ‘HAGE-101912’ Ameliorates Gastroesophageal Reflux Disease in Rats
Authors: Azeemuddin Mohammed M , Narendra Madan M. , Mallappa Onkaramurthy , Anturlikar Suryakanth D. , Baig Mirza R. , Rafiq Mohamed
Published: December 2023

Background:

Gastroesophageal reflux disease (GERD) is a chronic, relapsing disorder. In this era of modern and fast-track lifestyle and food habits, the incidence of GERD is rapidly increasing. Currently, proton pump inhibitors (PPIs) are the primary choice of treatment. However, the associated side effects and a high relapse rate give rise to the need to explore alternative therapies.

Objective:

The study aimed to evaluate HAGE-101912, an herbal combination, in different experimental models of GERD.

Methods:

Antacid activity was assessed based on H+/K+ATPase inhibitory activity of parietal cells using artificial gastric juice. Tonic contraction of the lower esophageal sphincter (LES) was evaluated using an AD Instrument. A GERD model of the pylorus and fundus ligation (preventive and curative models) in rats was selected to assess the efficacy of HAGE-101912 at a dose of 250 mg/kg body weight, and various parameters such as the gastric pH, gastric volume, total acidity, gross esophageal ulcer index, and histopathological changes were evaluated. The prokinetic activity was assessed using the phenol red method.

Results:

HAGE-101912 increased the acid-neutralizing capacity (P < 0.001), decreased H+/K+ATPase activity (P < 0.01), and increased the contraction of the LES. In the preventive model, HAGE-101912 significantly reduced the gastric acid volume (P < 0.01), total acidity (P < 0.001), and gross esophageal ulcer index (P < 0.01); increased the gastric acid pH (P < 0.01); and protected the esophageal epithelium. In addition, HAGE-101912 increased gastric emptying and gastrointestinal transit through its prokinetic activity (P < 0.05).

Conclusion:

HAGE-101912 has a beneficial effect in GERD as it effectively inhibits the H+/K+ATPase, increases the gastric pH, restores the LES function, protects the esophageal epithelium, and increases gastric emptying and transit.
Presentation, clinical outcome, and quality of life of patients treated for head and neck skin cancer at the University College Hospital, Ibadan
Authors: Michael Afieharo I. , Ugwu Ebere O. , Olawoye Olayinka A. , Ademola Samuel A. , Oluwatosin Odunayo M.
Published: December 2023

Introduction:

Patients with head and neck skin cancer experience adverse functional, psychosocial, and financial impacts as a result of the disease and/or its treatment. This study aimed at evaluating the pattern of presentation, clinical outcomes, and quality of life of patients with head and neck skin cancer.

Materials and Methods:

A retrospective cross-sectional study of patients with head and neck skin cancer presenting to the Department of Plastic, Reconstructive & Aesthetic Surgery of the University College Hospital, Ibadan, from January 2017 to December 2021. Data obtained from the clinical records included sociodemographic characteristics, clinical and surgical details, as well as clinical outcomes. Quality of life was assessed using EORTC QLQ-C30 questionnaires. Data were summarized using descriptive statistics.

Results:

Nineteen patients were reviewed with a median age of 38 years (ranging from 18 to 85 years) and a male-to-female ratio of 1:1.4. Eight (42.1%) of the patients were albinos. Squamous cell carcinoma was the predominant histologic type (63.2%), while the scalp was the commonest location (42.1%). Only one patient (5.3%) presented with metastatic disease. A greater percentage of treated patients, eight (61.5%), had surgery as the only treatment modality. After a mean follow-up period of 33 months, a recurrence rate of 10.5% (two patients) and a mortality rate of 15.8% (three patients) were recorded. Quality of life assessment revealed an adverse financial impact of the disease on our patients.

Conclusion:

Although albinism is a recognized risk factor for skin cancers, head and neck skin cancers can occur in the dark-skinned.
Thermographic mapping of arterial perforators in the leg
Authors: Obadan Izegaegbe O. , Michael Afieharo I. , Iyun Ayodele O. , Ademola Samuel A. , Olawoye Olayinka A. , Aderibigbe Rotimi O. , Oluwatosin Odunayo M.
Published: December 2023

Background:

Preoperative localisation of perforators aids in easy intraoperative dissection. Infrared thermography is a simple, safe, and effective tool with a short learning curve that is useful in identifying perforators. It has been found to have a high concordance rate when compared with computed tomography angiography and is useful in identifying arterial perforators in the leg.

Objectives:

To create a thermographic map of arterial perforators in the leg and to determine the correlation between the number of perforators identified and the length of the leg.

Materials and Methods:

This was a cross-sectional study. The length of the leg was measured and the location of perforators corresponding to the distribution of the anterior tibial, posterior tibial, and peroneal arteries was identified using thermography. The mean number of perforators corresponding to the different surfaces of the leg was noted, this was then correlated with the length of the leg using the Pearson correlation coefficient.

Results:

Using thermography, perforators were identified along a line drawn from the medial malleolus to the medial tibia plateau and from the lateral malleolus to the head of the fibula and within 2 cm of these lines. More perforators were found in the middle third of the leg and there was no significant correlation between the number of perforators and the length of the leg.

Conclusion:

A useful surface marking to aid the identification of perforators in the leg using infrared thermography was found. There was no significant correlation between the length of the leg and the number of perforators.
Analysis, treatment modality and demographic characteristics of urolithiasis patients visiting Korle-Bu Teaching Hospital in Ghana
Authors: Akpakli Evans Ametefe , Asante Emmanuel , Kyei Matthew Yamoah , Klufio Kenneth , Toboh Bernard , Mensah James Edward
Published: December 2023

Background:

Globally urolithiasis is on the rise and gradually becoming a public health concern due to the associated complications. This study reviewed the demographic characteristics, the chemical composition of stones, treatment modality and duration of hospitalisation of urolithiasis patients at Korle-Bu Teaching Hospital, Accra, Ghana.

Materials and Methods:

This was a retrospective study conducted between March 2019 and April 2022. Data from consecutive patients treated for urolithiasis were used for this study. Data on demographic characteristics, stones chemical composition, urine factors, urolithiasis treatment modality and duration of hospital stay after therapy were collated and analysed using descriptive and inferential approaches.

Results:

The age of the patients ranged from 2 to 75 years with a mean of 45 (±13.4). The predominant age group for stone formation was 30–39 years – 52(26.3%). Urolithiasis was common among patients in the formal employment sector: 81(40.9%). All stones had two or more chemical compositions, with the combination of calcium oxalate monohydrate, calcium oxalate dihydrate and uric acid being the predominant stone type: 88(57.5%). Ureteroscopy with semi-rigid and Percutaneous nephrolithotomy were the predominant treatment modalities: 105(53.0%) and 74(37.4%), respectively. Escherichia coli was responsible for most urinary tract infections in urolithiasis patients 8(4.0%) and the least duration of hospital stay after the procedure was associated with the use of semi-rigid ureteroscope as the treatment modality with a median duration of 2 days (1–2 days) with P < 0.0001.

Conclusions:

Urolithiasis was predominant among professionals in the formal sector. All stones were mixed with Calcium oxalate monohydrate, calcium oxalate dihydrate, and uric acid combination being the majority. Ureteroscopy with semi-rigid and percutaneous nephrolithotomy were the common treatment modality.
Prevention of equinus deformity after external fixation for open tibia fractures: A comparison between plaster of Paris backslab and passive ankle physiotherapy
Authors: Lartey Samuel Quarshie , Holdbrook-Smith Henry , Baddoo Daniel Tettey , Ocloo Agbeko , Gudugbe Senyo
Published: December 2023

Background:

Ankle equinus deformity is a common complication of prolonged external fixator use in tibia fractures with an incidence of 15%–16%. It affects gait and may lead to foot, leg, and back problems. Treatment of equinus deformity increases the cost of treatment of open tibia fractures and increases the time spent off work. Several preventive modalities have been suggested in literature with variable success, but no standard protocol exists.

Objectives:

The aim of this study was to determine the most appropriate method of preventing equinus deformity of the ankle joint during the management of open tibia fractures with unilateral uniplanar external fixators by comparing plaster of paris (POP) backslab application with passive ankle physiotherapy using strips of car tyre inner tubing.

Materials and Methods:

The study was a prospective randomised study involving patients with open tibia fractures who were managed with external fixators at the Korle Bu Teaching Hospital between April 2020 and February 2021. Patients were randomised into two groups; one group had below knee POP backslab and the other group did passive ankle physiotherapy using a strip of car tyre inner tubing. The passive ankle range of motion was measured at the beginning and after 6 weeks using a goniometer.

Results:

Fifty-six participants were recruited with 29 in the POP backslab group and 27 in the ankle physiotherapy group. The median age was 35.0 years. Male-to-female ratio was 4.6:1. Motor vehicle crash contributed to over 90% with 42.9% being motorbike riders. Initial and final mean ankle measurements for the POP backslab group were 6.79° and 10.14° for dorsiflexion and 29.93° and 34.52° for plantarflexion, respectively. The ankle physiotherapy group had initial and final dorsiflexion of 7.19° and 12.85° and plantarflexion of 30.44° and 34.52°, respectively. The ankle physiotherapy group had a better range of motion (47.37°) than the POP group (40.66°) with a P value of 0.008. One participant (3.7%) from the ankle physiotherapy group had equinus deformity compared with seven (24%) from the POP backslab group, a difference which gives a P value of 0.029.

Conclusions:

Passive ankle physiotherapy with car tyre inner tube is a better and cheaper modality of preventing ankle equinus deformity and maintaining ankle range of motion.
A rare case of hematometrocolpos due to transverse vaginal septum along with distal vaginal atresia in an adolescent girl
Authors: Pipal Vibha Rani , Seth Shikha , Pipal Dharmendra Kumar
Published: December 2023

Primary amenorrhoea due to Müllerian malformations is rare, with 1 in 4500 cases and 2%–8% of cases presenting as infertility. Obstructive Müllerian anomalies present as hematometra and hematocolpos during puberty. Timely surgical intervention is required to relieve acute pelvic pain and restore functional anatomy. A 15-year-old girl presented to OPD with complaints of severe pain in her lower abdomen and lower back for the last 2–3 weeks, not relieving on medication. She has not attained menarche and has been having cyclical pain and low backache for 7–8 days every month for the last year. Physical examination showed a suprapubic lump with vaginal agenesis. Magnetic resonance imaging revealed hematometrocolpos due to transverse vaginal septum and distal vaginal atresia. Pull-through vaginoplasty along with complete excision of transverse vaginal septum was performed. Vaginal dilator therapy was done after the healing of the sutures. In follow-up, the patient attained menstruation with a patent vagina. Obstructive Müllerian anomalies should be identified early by detailed clinical examination and targeted investigations to prevent long-term morbidity and infertility.
Unilateral keratoconus associated with iridocorneal endothelial syndrome: Case report
Authors: Kalantan Hatem A.
Published: December 2023

We report a rare association of unilateral keratoconus (KC) and iridocorneal endothelial syndrome in a 34-year-old female. Slit-lamp examination showed advanced KC with faint apical scarring in her right eye. The pupil was superiorly displaced with superior peripheral anterior synechia. Specular microscopy showed abnormal endothelium with low endothelial cell count in the right eye. Corneal topography confirmed the unilateral KC diagnosis. As the patient did not tolerate hard contact lens, penetrating keratoplasty with pupilloplasty was performed with excellent outcome.
Correlation of serum 1,25-dihydroxycholecalciferol with the incidence of primary open-angle glaucoma: A cross-sectional study on patients with chronic illnesses
Authors: Abass Ibrahim A. , Saleh Ahmed T. , Badi Athmar D. , Mohammad Bassim I. , Hamied Furkaan M. , Al-Aubaidy Hayder A.
Published: December 2023

PURPOSE:

Primary open-angle glaucoma (POAG) is a clinical progressive neuropathy which can lead to irreversible blindness if left untreated. A low level of serum Vitamin D3 is a major risk factor for glaucoma, and hence, represents a second target for glaucoma therapy following intraocular pressure (IOP). However, there is still controversy about whether there is a direct correlation between Vitamin D3 deficiency and the risk of increased IOP. This study aims to investigate the correlation between low serum levels of 1,24-dihydroxycholecalciferol and the development of open-angle glaucoma.

METHODS:

The study included a total of forty-one patients with POAG. Patients were classified into whether they have chronic illnesses such as type 2 diabetes and hypertension. Matching control subjects of 20 healthy controls were also included in the study. Anthropometric measures and venous blood samples were taken from all participants for serum analysis of various biochemical markers including serum 1,25-dihydroxycholecalciferol (1,25(OH)2D) levels.

RESULTS:

Overall, serum Vitamin D3 levels were 15% significantly lower in the patient’s cohort with open-angle glaucoma as compared to the healthy participants (P < 0.05). Among those, 63% of type 2 diabetic participants had significantly low levels of Vitamin D3 (P < 0.01). There was also a significant 70% reduction in serum Vitamin D3 levels among the hypertensive participants, (P < 0.001).

CONCLUSION:

We concluded that lower serum 1,25(OH) 2D levels were significantly associated with an increased risk of open-angle glaucoma in patients with chronic illnesses.
“Cornflake nevoid” lesions, mimicking choroidal lesions of neurofibromatosis 1, in the absence of neurofibromatosis 1: An imaging-based hypothesis
Authors: Papasavvas Ioannis , Herbort Carl P.
Published: December 2023

Whitish hypermelanocytic flake-like lesions on scanning laser ophthalmoscopy (SLO) multicolor posterior pole imaging (PPI) can correspond to several conditions, including simple nevi or shallow choroidal melanomas, paraneoplastic fundus lesions like bilateral diffuse uveal melanocytic proliferation, or choroidal melanocytic lesions found in neurofibromatosis type 1 (NF1). We report three cases with unilateral flake-shaped choroidal lesions on SLO multicolor PPI, similar to choroidal NF1 lesions, monitored their evolution and analyzed their potential nature using multimodal imaging including SLO multicolor and classical PPI, infrared autofluorescence (IRAF), spectral-domain-optical coherence tomography (SD-OCT), enhanced-depth imaging-OCT (EDI-OCT), OCT-angiography as well as fluorescein angiography, and indocyanine green angiography (ICGA). Two oncologic patients and one healthy patient presented unilateral whitish cornflake-shaped lesions on SLO multicolor and IRAF PPI, faintly or not visible on fundus photography, hypofluorescent on the intermediate-phase ICGA, but isofluorescent on the late-phase ICGA corresponding to hyperreflective areas in the choroid immediately under the retinal pigment epithelium on SD-OCT. The lesions were nonevolutive. Multimodal imaging determined that these “nevoid” lesions were melanocytic but could not be assimilated to classical nevi, having a looser structure that allowed some indocyanine green impregnation explaining the isofluorescence on the late-phase ICGA. The lesions were similar to those described in NF1 cases and were unrelated to the oncologic status.
Cosmetic outcomes of epicanthoplasty for epicanthus tarsalis
Authors: Fatani Dalal R. , Alsuhaibani Omar S. , Alsuhaibani Adel H.
Published: December 2023

PURPOSE:

Epicanthus is a term that refers to the semilunar eyelid skin fold over the medial aspect covering the medial canthal angle. Epicanthus tarsalis is the most common type and is most evident in the Asian population with a prevalence of 40% as opposed to 2%–5% in the non-Asian population. Epicanthoplasty has not been studied in patients of a population of heavier skin pigmentation.

METHODS:

A retrospective review of patients that underwent Park’s modified Z-epicanthoplasty from January 2018 to August 2020. They were categorized based on their Fitzpatrick skin type. Their preoperative and postoperative pictures were analyzed for epicanthal fold correction with focus on scar visibility, pigmentation, and elevation. The patients were contacted over the phone for a questionnaire about their subjective scar assessment and satisfaction rate.

RESULTS:

A total of 35 patients with mild epicanthus tarsalis were included in this study. Twenty-two patients had Fitzpatrick skin type 3, seven patients had type 4, and six had type 5. Normal postoperative scar pigmentation was reported 37.1% (n = 13) of patients. Scar hypopigmentation was reported in 28.6% (n = 10) and scar hyperpigmentation was reported in 34.3% (n = 12). The final cosmetic satisfaction rate score was a median of 9/10 on the 1–10 scale with 40% recording 10/10 satisfaction. On the scar visibility scale, the median was 3/10. About 82.9% (n = 29) had no scar elevation or hypertrophy. Only one patient had scar hypertrophy and elevation and three patients had a vertical depression scar. No clinical or statistical significance was found when correlating scar visibility and pigmentation with Fitzpatrick skin type.

CONCLUSION:

Epicanthoplasty is a commonly performed surgery, especially in China and South Korea. In our population, Z-epicanthoplasty has proven to be effective in epicanthus tarsalis with high cosmetic satisfaction rate, low scar visibility, and acceptable scar pigmentation.
Detection of graft failure in post-keratoplasty patients by automated deep learning
Authors: Mangana Carlos Méndez , Barraquer Anton , Ferragut-Alegre Álvaro , Santolaria Gil , Olivera Maximiliano , Barraquer Rafael
Published: December 2023

PURPOSE:

Detection of graft failure of post-penetrating keratoplasty (PKP) patients from the proprietary dataset using algorithms trained in Automated Deep Learning (AutoML).

METHODS:

This was an observational cross-sectional study, for which AutoML algorithms were trained following the success/failure labeling strategy based on clinical notes, on a cohort corresponding to 220 images of post-keratoplasty anterior pole eyes. Once the image quality criteria were analyzed and the dataset was pseudo-anonymized, it was transferred to the Google Cloud Platform, where using the Vertex AI-AutoML API, cloud- and edge-based algorithms were trained, following expert recommendations on dataset splitting (80% training, 10% test, and 10% validation).

RESULTS:

The metrics obtained in the cloud-based and edge-based models have been similar, but we chose to analyze the edge model as it is an exportable model, lighter and cheaper to train. The initial results of the model presented an accuracy of 95.83%, with a specificity of 91.67% and a sensitivity of 100%, obtaining an F1SCORE of 95.996% and a precision of 92.30%. Other metrics, such as the area under the curve, confusion matrix, and activation map development, were contemplated.

CONCLUSION:

Initial results indicate the possibility of training algorithms in an automated fashion for the detection of graft failure in patients who underwent PKP. These algorithms are very lightweight tools easily integrated into mobile or desktop applications, potentially allowing every corneal transplant patient to have access to the best knowledge to enable the correct and timely diagnosis and treatment of graft failure. Although the results were good, because of the relatively small dataset, it is possible the data have some tendency to overfitting. AutoML opens the possibility of working in the field of artificial intelligence by computer vision to professionals with little experience and knowledge of programming.
Blended Learning for Machine Learning-based Image Classification
Authors: Ye Shengpei
Published: December 2023

The paper commences with an introduction to blended learning, an educational approach that amalgamates traditional face-to-face instruction with online learning, aiming to capitalize on the advantages of conventional classroom instruction and digital resources in order to enhance the overall learning experience. The incorporation of diverse technologies facilitates a personalized learning experience that caters to the needs and learning styles of individual students. Image classification entails training machine learning models to categorize or label images into predetermined classes or categories, empowering machines to recognize and comprehend crucial components of visual information, emulating humans' classification of objects in the real world. The crux of image classification relies on extracting meaningful features from images and distinguishing different categories by associating specific features with distinct classes through iterative optimization learning. Machine learning significantly aids image classification by endowing automated systems with the capability to discern patterns, features, and distinctions within datasets, ultimately achieving accurate image classification. The integration of hybrid learning methods can augment the training process for machine learning models used in image classification by providing a flexible and adaptive learning environment.
Case Report: Melioidosis-Related Severe Cutaneous Features of Erythema Nodosum in a Thai Child
Authors: Tantawarak Nattakarn , Techasatian Leelawadee , Ungarreevittaya Piti , Kosalaraksa Pope , Lumbiganon Pagakrong
Published: December 2023

Erythema nodosum (EN) is characterized by rapidly developing, painful, erythematous subcutaneous nodules, most of which are located in the pretibial areas. This cutaneous finding can be caused by a variety of conditions, however Burkholderia pseudomallei is rarely the cause. This particular patient presented with a high-grade fever with characteristic EN on both pretibial areas. All of the typical EN causes were investigated, but the findings were all negative. The lesions progressed to severe hemorrhagic bleb features, and because the patient resided in Northeast Thailand, a melioidosis-endemic region, testing for B. pseudomallei was performed. Because a high level of melioidosis serology of more than 1:10,240 was detected, melioidosis therapy was started. At the 12-week follow-up after melioidosis therapy, the titer had declined to 1:1,280, indicating that melioidosis-related severe, cutaneous EN symptoms were the most likely diagnosis in this patient. We discovered a case of EN with severe hemorrhagic bleb features as a unique clinical manifestation of melioidosis. When a patient resides in an endemic area, B. pseudomallei should always be considered as a possible causative organism.