bluuebunny/crossref_metadata_2025 huggingface dataset:
Metastatic Hidradenocarcinoma of Inguinal Region: A Cytological Diagnosis
Authors: Aden Durre , Singh Mukul , Ranga Sunil
Published: July 2024

Hidradenocarcinoma is an unusual malignant tumor of the sweat gland with a high local recurrence and lymph node metastasis. They are primarily located in the head and neck, and trunk. Here, we present a case of hidradenocarcinoma recurrence with metastasis to the right inguinal region, which is a rare occurrence. In cytology, dual population of cells, consisting of eosinophilic and clear cells, can be observed, which are arranged in clusters, tubules, and papillae showing pleomorphism, along with extracellular hyaline material and necrosis. Although excision biopsy is needed for diagnosis, fine needle aspiration can be a simple and minimally invasive method in preoperative diagnosis.
Quantitative Evaluation of Lymphoid Reaction and CD8+ T Lymphocyte Count in Colorectal Carcinoma (CRC) and Its Association with Grading and Staging of CRC
Authors: Lingutla Getha Rani , Arakeri Surekha Ulhas
Published: July 2024

Introduction:

Staging of colorectal carcinoma (CRC) is based on the depth of tumor invasion, presence or absence of regional lymph node involvement, distant metastases, and differentiation. It was observed in some studies that an increase in lymphocytic infiltrate in CRC is linked with better survival. Hence, the present study was undertaken for quantitative evaluation of lymphoid reaction and CD8+T lymphocyte count in CRC.

Aims and Objectives:

To evaluate the association between peritumoral lymphoid reaction (PTLR) and CD8+T lymphocyte infiltration with grading and staging of CRC.

Materials and Methods:

A cross-sectional, descriptive study on excised specimens of CRC received in the Department of Pathology from 2015 to 2020 was done. A total of 38 resected specimens of CRC diagnosed as adenocarcinoma on histopathology were evaluated for age, sex, tumor location, grading, and staging of the tumor. A quantitative evaluation of PTLR and CD8+ T lymphocyte marker score was done in all cases and was correlated with the grading and staging of CRC.

Results:

The mean age of patients in the present study was 52.8 years with male-to-female ratio of 1:1. The most common site was the proximal colon. The majority of the cases were moderately differentiated adenocarcinoma. Stage pT3 and pNo were the most common followed by stage pT2 and stage pN1. PTLR and CD8+ lymphocyte count were highest in well-differentiated adenocarcinoma, in stage pT1 and stage pN0.

Conclusions:

Significant association was noted between PTLR and CD8+T lymphocyte count with grading and staging, and hence these can be considered as prognostic markers in CRC.
Peripheral Neuropathy Resembling CIDP Following Exposure to Toxic Fumes in Shoe Factory: A Case Report
Authors: Mishra Ajit P. , Sahoo Srikanta K. , Sahoo Lulup K. , Pattaniak Srimant
Published: July 2024

Different types of solvents and adhesives are used in a shoe factory. The toxic chemicals can cause acute and chronic effects on the central and peripheral nervous system. Here, we report a case of a 25-year-old young man working as a coloring and gluing worker in a shoe factory, who presented with progressive quadriparesis following exposure of six months. Some of his coworkers also developed a similar illness. Nerve conduction velocity studies of the patient showed combined sensory and motor demyelinating and axonal polyneuropathy. Cerebrospinal fluid (CSF) analysis was normal. With conservative management and physiotherapy, there is a gradual improvement of the condition in the patient who can ambulate independently now.
T-Acute Lymphoblastic Leukemia
Authors: Fernandes Leena S. , Khajuria Atul
Published: July 2024

Acute lymphoblastic leukemia (ALL) is a condition in which immature white blood cells (WBCs) accumulate in the bone marrow, resulting in the crowding of normal WBCs and buildup in the liver, spleen, and lymph nodes. ALL is a malignancy of B or T lymphoblasts. B lymphocytes protect the body against bacteria and viruses through production of antibodies, which can directly destroy target cells or trigger others to do so. T lymphocytes directly destroy bacteria or cells infected with viruses. Approximately 20% of all ALL patients are categorized specifically to suffer from T-cell ALL (T-ALL), and it is seen to be more prevalent in the adult population in comparison with children, with incidences shown to diminish with age. Among T-ALL cases in the pediatric population, a median onset of age 9 has been identified and the disease is particularly prominent among adolescents. The disease stems from cytogenic and molecular abnormalities, resulting in disruption of developmental pathways controlling thymocyte development, tumor suppressor development, and alterations in control of cell growth and proliferation. Distinct from adult T-cell leukemia where T-cell lymphotropic virus type I causes malignant maturation of T cells, T-ALL is a precursor for lymphoid neoplasm. Its clinical presentation most commonly includes infiltration of the central nervous system and further identifies mediastinal mass presence originating from the thymus, along with extramedullary involvement of multiple organs including the lymph node as a result of hyperleukocytosis.
Pharmacognostical and Pharmaceutical Analysis of Sthaulyahara Ghana Vati: A Herbal Ayurveda Formulation for Obesity
Authors: Patir Nikita , Kori Virendra K. , Bhinde Sagar M. , Harisha Channappa Rudrappa , Shukla Vinay J.
Published: July 2024

Introduction:

Sthaulyahara Ghana Vati (SHGV) is a polyherbal formulation, which is indicated in Sthualya (obesity) in Vaidhyasara sangraha. There are few clinical works carried out on this medicine, but no any researchers had evaluated this formulation for its quality control (QC) parameters. Pharmacopeia standards for this formulation are also not available till date.

Aim:

To evaluate SHGV through pharmacognostical, physiochemical parameters and high-performance thin-layer chromatography (HPTLC) fingerprinting.

Materials and Methods:

Preauthenticated raw drugs of SHGV were procured, and SHGV was prepared at pharmacy, Institute of Teaching and Research in Ayurveda (ITRA), Jamnagar. Organoleptic parameters and microscopic analysis of SHGV were carried out at the Pharmacognosy Department, ITRA, Jamnagar. Physiochemical analysis and HPTLC of SHGV were carried out at the Pharmaceutical Laboratory, ITRA, Jamnagar.

Result:

Microscopic features of SHGV were cross-checked with Ayurvedic pharmacopeia of India standards of individual ingredients, and it was found to have characteristics of all ingredients in it. In pharmaceutical parameters, pH value was 6.0, water-soluble extract was 16.2% w/w, methanol-soluble extract was 14.9% w/w, ash value was 11.8% w/w, and loss on drying was 3.9% w/w. HPTLC at 254 and 366 nm showed six and three spots, respectively.

Conclusion:

This study has generated preliminary data on pharmacognostical, pharmaceutical parameters, and HPTLC. This fingerprinting can be useful for future researchers to reproduce this formulation and to establish QC parameter of SHGV.
Pattern and Predictors of Thyroid Dysfunction among Pediatric Endocrine Referrals at the Tertiary Care Center of Northern India: A Longitudinal Study
Authors: Sood Mona , Bhat Moomin Hussain , Masoodi Shariq R. , Ahmad Peerzada O.
Published: July 2024

Postiodization era has experienced a change in pediatric thyroid disorders with autoimmune disorders and subclinical hypothyroidism (SCH) now more frequently diagnosed. The aims of this study were to evaluate the clinical spectrum of thyroid disorders among children referred to us, to ascertain characteristics that influence treatment, and to follow them for various outcome measures. An observational longitudinal study where all treatment-naïve children (<18 years) with suspected thyroid disorders were recruited. Data collected were anthropometry, serum TSH, TT4, TT3, antithyroid autoantibodies, family history, and clinical symptoms. The management was based on the clinical judgment of the endocrinologist with the first follow-up at six weeks and subsequent visits three monthly for one year. A total of 241 subjects aged 28 days to 17 years were included. Overall, SCH was the most common abnormality (39%) detected among subjects, followed by overt hypothyroidism (OH) (33%), congenital hypothyroidism (CH) (18%), and overt thyrotoxicosis (5%). A total of 85.5% (n = 204) of subjects were treated and in follow-up, 81% of them were found to be adequately managed. Comparative analysis of OH and SCH revealed pubertal age, female predominance, and the presence of autoimmunity (positive anti-TPO and anti-TG Ab) statically significant variables in the OH group. A major independent predictor of treatment in treated SCH (72/96) in comparison with nontreated SCH (24/96) was anti-TPO positivity (P = 0.029). Eight of 24 nontreated SCH were eventually treated in follow-up and positive family history was observed as a significant variable among them (P < 0.05). Subjects with CH presented at a mean age of 6 months (28 days to 2 years). However, guidelines for the management of SCH are still evolving, autoimmunity and positive family history should be considered as decisive factors while initializing treatment. Delayed presentation of CH in our study warrants active surveillance of children at birth for thyroid disorders for their mental well-being.
Revitalizing Bites – Formulation of Low-budget Nutri Crackle Rusk for Empowering Pediatric Oncology Warriors
Authors: Rajasekar Bavatharani , Kavya S , Preethi K , Manohar Shiny Lizia , Xavier Julius S. , Velraja Supriya
Published: July 2024

Background:

Nutri Crackle rusk, developed using an innovative pigmented variety of black rice flour, possesses a rich nutritional profile with essential amino acids, dietary fibers, and antioxidants, offering unique health benefits beyond traditional rice varieties. Establishing healthy eating habits during childhood cancer treatment is crucial for long-term well-being. Mindful consumption, incorporating Nutri Crackle rusk instead of empty-calorie snacks, can significantly improve the quality of life of childhood cancer survivors during their survivorship period.

Materials and Methods:

The novel Nutri Crackle rusk using black rice flour was developed under proper hygienic conditions. Semi-trained panel and consumer panel members evaluated the organoleptic properties of the developed product. Nutrient components of the formulated Nutri Crackle rusk were examined through an organoleptic assessment.

Results:

The nutrient composition of the formulated Nutri Crackle rusk was analyzed using a standard procedure. Sensory evaluation indicated positive feedback, with an overall acceptability score of 8.01. Nutrient analysis revealed a well-rounded profile, emphasizing energy provision (464.285 kcal), (11.97 g protein), (11.29 g fiber), and essential micronutrients (zinc, iron, and vitamins B1 and B2). Nutri Crackle rusk is a favorable and potentially beneficial snack for this vulnerable group.

Conclusion:

The study signifies that the novel healthy Nutri Crackle rusk is rich in fiber, zinc, iron, protein, vitamin B1, and vitamin B2. Intake of the developed Nutri Crackle rusk could be a healthy alternative for pediatric cancer patients and cancer survivors.
Effectiveness of Adolescent Interactive Education Program on Knowledge About Child Sexual Abuse and Self-Protection Among Early Adolescent Girls from Selected Urban School of Bengaluru, Karnataka
Authors: Pame Annie , Govindan Radhakrishnan , Madegowda Rajendra Kiragasur
Published: July 2024

In India, child sexual abuse is a widespread, serious, and long-growing problem. Children are generally abused by the people known to them and less likely by strangers. A majority of people remain numb about the issues because of fear, denial from the community and social stigma and also result in less reported cases among the victims. Our aim was to assess early adolescent girl’s knowledge on child sexual abuse and self-protection and assess the effectiveness of interactive education programs. For the study, we adopted one group of pre-test and post-test designs. A total of 30 early adolescent girls from a selected school participated. The intervention consisted of interactive education program using role-play, discussion, storytelling, and audiovisual aids. Knowledge about CSA and self-protection was assessed pre- and post-intervention. There were significant changes in the knowledge score of pre-test from post-test (t = -7.632, P < 0.001) following interactive sessions. Also, the mean for self-protection was significantly lower than the post-test mean. After the intervention, there were significant changes in the knowledge score of pre-test from post-test (t = -5.722, P < 0.001). The results also show that the education of parents and monthly family income had significant association with the pre-intervention knowledge level. Interactive education program effectively increases the knowledge level on CSA and self-protection.
Qualitative Assessment for Milk Adulteration: Extent, Common Adulterants, and Utility of Rapid Tests
Authors: Garg Lakshya , Mulla Shakila
Published: July 2024

Background:

The adulteration of milk is an important issue that needs to be addressed because of its deleterious effects on health. Detection of adulterants in milk can be done in laboratories or by purchasing adulteration detection kits. There are few home-based rapid tests to detect common milk adulterants, which are less known by our community. Objectives of this study were to estimate the proportion of milk adulteration and to identify common adulterants, to determine the association of milk adulteration with gastrointestinal and renal diseases; and also to validate rapid home-based tests by comparing its result with standard milk adulteration detection kit.

Materials and Methods:

A community-based study was conducted on 330 medical and paramedical staff. Collected milk samples during family visits were tested by standard milk adulteration detection tests and rapid home-based tests.

Results:

Among 330 tested milk samples, 233 samples were adulterated with one or more than one adulterant. The most common adulteration observed was the addition of water to milk, followed by detergent, urea, and neutralizer. The specificity of the rapid tests was found to be almost 100% in the detection of water and detergent in milk and accuracy was above 80%; with “substantial agreement” (kappa = 0.7) between rapid tests and standard tests on kappa statistics.

Conclusion:

The present study has identified a large extent of milk adulteration and common adulterants, which may have harmful effects on health. The utility of home-based rapid tests is clearly proven to detect common adulterants.
Theoretical underpinnings of flow and its relation with academic engagement: A narrative review
Authors: Mazid Afrin , Samantaray Narendra Nath , Chaudhury Suprakash
Published: July 2024

In the age of digitization, the prevalence of distraction has grown significantly, particularly impacting the academic sphere and students’ overall well-being. Although previous research highlights the positive outcomes of achieving the state of flow in various contexts, its connection to academic engagement remains relatively less explored. This narrative review article seeks to bridge this gap by synthesizing existing literature to examine the conceptual overlaps and underlying principles between the state of flow and academic engagement. A total of 15 studies were included based on the following criteria: studies on flow and engagement published in English between 1973 and 2021 with a QualSyst score above 0.60. Drawing from the review, we present a conceptual framework delineating the probable conditions for achieving a state of flow to boost academic involvement, bolster student well-being, and foster academic success. It comprises factors such as having clear, well-defined goals and providing prompt feedback; each condition has a significant impact on students’ learning outcomes because of its direct effect on their sense of autonomy, control, and concentration. The implications and insights for educators in guiding students through challenging academic tasks to enhance engagement and well-being were discussed.
Migration and mental health problems of older adults: Challenges and proposed solutions
Authors: Anantapong Kanthee , Udomratn Pichet , Ventriglio Antonio , Pemberton Max , Poulter Daniel , Bhugra Dinesh
Published: July 2024

Due to several geopolitical factors, the number of older migrants increased worldwide with an estimated of 34.3 million in 2020. Older migrants are particularly vulnerable to mental health problems because of their physical health, reduced social networks, and lack of social support. This review aims to summarize current evidence on mental health issues of older persons related to migration and propose possible actions to promote mental health and prevent psychiatric illnesses of this vulnerable group. There are two types of migration in the elderly, for those with and without secured support. Not surprisingly, they have major differences in many characteristics. Common mental health problems in older migrants are depression, loneliness, anxiety, and other symptoms that become complicated with existing or new physical conditions. The links between migration, mental health, and older adults are explored in this paper. Suggested solutions for mental health practitioners and policymakers are proposed. In order to explore these challenges, further suggestions are offered to ensure that older adults’ mental health and wellbeing are looked after.
Geopsychiatry: Climate change, migration, and mental health
Authors: Anantapong Kanthee , Moura Helena Ferreira , Udomratn Pichet , Persaud Albert , Javed Afzal , Ramachandran Padmavati , Castaldelli-Maia João Mauricio , Torales Julio , Ventriglio Antonio , Bhugra Dinesh
Published: July 2024

Geopsychiatry, a newly emerging discipline within psychiatry, examines the influence of geopolitical determinants on mental health and mental illness. Geopolitical determinants include conflict and wars, global austerity, climate change, public health crises (such as the coronavirus disease 2019 (COVID-19)), and migration. This study focuses on the two significant areas of climate change and migration. Climate change can affect mental health directly or indirectly in a variety of ways, including chronic (global warming) and acute (heat waves and environmental disasters) events. Certain groups of migrants, including migrating children, older migrants, refugees, and asylum seekers, are particularly vulnerable to developing psychiatric disorders. The convergence of climate change and migration is significantly complicating the already highly difficult situation for mental health services worldwide, particularly in low- and middle-income countries where access to care is limited. Despite this, the majority of studies examining mental health impacts of these events originate from high-income countries, and there is still a lack of effective preventive and treatment strategies. In 2023, the World Psychiatric Association (WPA) set up a Special Interest Group on Geopsychiatry with a clear and explicit aim to summarize current evidence and propose strategies to tackle geopolitical challenges on mental health. The Special Interest Group aims to support regional and local groups across all psychiatric disciplines and stakeholders dedicated to building local consensus, prioritizing research, crafting policies, and collating and sharing good clinical practices. With such significant effort, we can expand our understanding and collaboration on geopsychiatry and make changes to the care of people with geopolitical and mental health challenges around the globe.
Clinical Study on the Application of Ultrasound-guided Quadratus Lumborum Block Combined with Ilioinguinal/Iliohypogastric Nerve Block in Inguinal Surgery in the Elderly
Authors: Zhang Jian , Sun Guohai , Zhang Lei , Zhang Lihui
Published: July 2024

Background:

This study aimed to investigate the effects of combining an ilioinguinal/iliohypogastric nerve block with an ultrasound-guided quadratus lumborum block during inguinal surgery in older patients.

Methods:

Between December 2020 and June 2023, 300 elderly patients who underwent inguinal surgery at our institution were randomly divided into an observation group (n = 150) and a control group (n = 150). The observation group received ultrasound-guided quadratus lumborum block in addition to ilioinguinal/iliohypogastric nerve block, whereas the control group received only ultrasound-guided ilioinguinal/iliohypogastric nerve block. The postoperative conditions and anesthesia dose (propofol and remifentanil) during surgery were recorded. The average arterial pressure and heart rate of the two groups were compared 10 min before anesthesia, 10 min after anesthesia, and postoperatively. Pain intensity was measured during and 30 min after the procedure using the pain Visual Analog Scale (VAS). The levels of malondialdehyde (MDA), aldosterone (ALD), and total antioxidant capacity (TAC) were evaluated before surgery and 1 day later, and the incidence of postoperative complications was noted and compared between the two groups.

Results:

The propofol and remifentanil dosages in the observation group were much lower than those in the control group, and hospital stay and recovery times were significantly shorter (P < 0.05). Ten minutes before anesthesia, there was no significant difference in the mean arterial pressure and heart rate between the two groups, and no difference at any other time point in the observation group (P > 0.05). Ten minutes after anesthesia and postoperatively, the average arterial pressure and heart rate of the observation group were lower than those of the control group, whereas those of the control group were higher than those observed preanesthesia (P < 0.05). The postoperative MDA and ALD levels in the observation group were significantly higher than those in the control group (P < 0.05), and the postoperative TAC level in the observation group was significantly lower than that in the control group (P < 0.05). The VAS scores in the observation group were significantly lower than those in the control group. No discernible difference in the frequency of complications was observed between the two groups (P > 0.05).

Conclusion:

The combination of ilioinguinal/iliohypogastric nerve block with ultrasound-guided quadratus lumborum block can significantly minimize the amount of anesthesia used during surgery, exert a good analgesic effect, shorten hospitalization time, stabilize hemodynamics, and reduce stress response with high safety.
Anxiolytic effects of stem of Rubia cordifolia ethanol extract on anxiety models in Wistar albino rats
Authors: Yasar S Ahamed Shaheen , Kotekar Sridevi , Bhat Nagapati Prabhakar , Nayak Roopa P.
Published: July 2024

Background:

Anxiety is an emotional condition characterized by unease, discomfort, and worry or fear about certain known or unknown potential hazards in the future. Plants have served as a useful resource for the discovery of novel medications for therapeutic purposes. Since ancient times, Rubia cordifolia (manjistha) has been valued for its therapeutic qualities.

Objective:

The objective of the study was to assess in Wistar albino rats the anxiolytic potential of an ethanolic extract derived from the stem of R. cordifolia.

Subjects and Methods:

The models elevated plus maze (EPM) and light & dark arena (LDA) were utilized to assess the anxiolytic activity. There were four groups each containing six animals: distilled water (10 mg/kg po), diazepam (2 mg/kg po), extract test dose 1 (100 mg/kg po) and extract test dose 2 (200 mg/kg po).

Results:

The one-way ANOVA and Tukey–Kramer multiple comparison tests were used to assess the standard error mean results. The statistical program used for data analysis was GraphPad Prism 6.0. Rats treated with the extract dose of 200 mg/kg showed significant results with more time spent in the EPM open arms (50.5 ± 3.2) and higher entries into the light arena (24.8 ± 0.5) in comparison to the control group. The anxiolytic effect observed in this study was closely comparable to the standard anxiolytic drug, diazepam 2 mg/kg (EPM: 49.7 ± 1.7 and LDA: 25.6 ± 0.4).

Conclusion:

The above study results suggest that the stem of R. cordifolia ethanol extract of dose 200 mg/kg possesses promising anxiolytic properties in Wistar albino rats. The aforementioned results of this study on antianxiety medications need to be confirmed by further clinical trials.
Evaluation of Serum Visfatin as a Biomarker of Lupus Nephritis in Egyptian Patients with Systemic Lupus Erythematosus
Authors: Shaker Amr , Fayed Ahmed , Morad Mohamed Abdelkader , Labib Safa , Elmessiery Riem M. , Salem Karem Mohamed , ElSheimy Hend A. , Hammad Hany , Fathy Ahmed
Published: July 2024

One of the most significant consequences of systemic lupus erythematosus (SLE) is lupus nephritis (LN). Visfatin, an adipokine that is significantly expressed in visceral fat and is a marker of endothelial dysfunction in chronic kidney disease, has multiple proinflammatory actions. We aimed to evaluate the state of serum visfatin in SLE patients and to detect its possible correlation with the disease's activity and effects on the kidney affection. Fifty patients with active LN, 50 patients with inactive lupus, and 50 healthy people had their serum visfatin levels tested. Chemical and immunological markers of SLE and LN were measured. The SLE Disease Activity Index (SLEDAI) was used to measure the disease's activity. Renal biopsies from the LN subgroup were collected and classified using the modified classification of the World Health Organization. The serum visfatin of patients with active LN was significantly greater than that of inactive lupus patients and the healthy controls (20.56 ± 1.07 ng/mL, 16.77 ± 1.02 ng/mL, and 9.96 ± 1.46 ng/mL, P <0.001). SLEDAI and serum visfatin levels were shown to be significantly correlated (P = 0.000057). Serum visfatin levels were likewise significantly correlated with the index of histological activity in the active group (P <0.00001). Serum visfatin was raised in individuals with active LN and was related to the SLEDAI and disease severity scores. Serum visfatin could be utilized as a noninvasive biomarker for evaluating the severity of LN and risk stratification of the risk.
Ambulatory Blood Pressure Monitoring versus Office Blood Pressure Monitoring to Identify the True Hypertension Status of Living Kidney Donors
Authors: Rather Jawad Iqbal , Sofi Khalid P. , Wani Muzamil Ahmad , Wani Muzafar Maqsood , Rasheed Rabiya , Bhat Mohammad Ashraf , Wani Imtiyaz Ahmad
Published: July 2024

Ambulatory blood pressure monitoring (ABPM) is a reliable modality and is preferred over office blood pressure monitoring (OBPM) for detecting hypertension. However, despite its advantages, the utilization of 24-h ABPM in evaluating living kidney donors has not been universally adopted by transplant centers, partly because of the lack of data about the utility of ABPM. This study aimed to identify patients with masked and white-coat hypertension, thereby ensuring appropriate identification of their true hypertension status and assessments of the risk to donors. This study included 73 potential living kidney donors. BP was measured in the office using a standardized protocol as well as by ABPM. Detailed clinical and biochemical parameters were assessed. Target organ damage was assessed in all the donors by assessing proteinuria, hypertensive retinopathy, and echocardiography. Out of the 73 donors, 64.4% were females and 35.6% were males. The average age of individuals in our donor population was 42.0 ± 11.28 years. In total, 31.5% were detected to be hypertensive by OBPM. With ABPM, only 21.9% of donors were hypertensive. The overall prevalence of white-coat hypertension was 30.4%; that of masked hypertension was 6.0%. In donors diagnosed as hypertensive by OBPM, three individuals were identified as having target organ damage. However, two additional donors who were initially missed as hypertensive using OBPM had target organ damage. OBPM overestimated the prevalence of hypertension compared with ABPM. ABPM is the better modality in terms of diagnosing white coats and masked hypertension. ABPM also more reliably correlates with target organ damage than OBPM.
A Case of Postcoronavirus Disease 2019 Antineutrophil Cytoplasmic Antibody-associated Vasculitis Successfully Treated with Rituximab
Authors: Mohamed Mahmoud M. , Ibrahim Atif , Razaq Zareen , Hassan Waleed
Published: July 2024

We report a case of a 69-year-old Caucasian male with a history of hypertension, Type 2 diabetes, and Stage IIIa chronic kidney disease (CKD), who presented to the emergency department with positional dizziness, generalized weakness, weight loss, and suppressed appetite. Two months earlier, the patient was diagnosed with coronavirus disease 2019 (COVID-19). The patient had non-oliguric acute kidney injury alongside preexisting CKD. The urinalysis showed hematuria and significant non-nephrotic proteinuria. His serological markers were positive for antineutrophil cytoplasmic antibodies with high titers. A kidney biopsy showed focal crescentic glomerulonephritis of the pauci-immune type. Initially, treatment with immunosuppressive medication was deferred because the biopsy findings suggested a poor renal outcome, as the cortical sample showed tubular atrophy and interstitial fibrosis of more than 50%. The patient was discharged but was later readmitted with worsening renal function, deep venous thrombosis in the lower extremities, and patchy lung consolidation suggesting possible pneumonia, which was ruled out. He required dialysis and brief empiric antibiotics for pneumonia, and anticoagulation for deep venous thrombosis, and was treated with intravenous (IV) pulsed steroids, followed by gradually tapering oral steroids and rituximab induction therapy. He continued dialysis three times a week. Three months after discharge, his renal function improved to near-baseline level, and he no longer required hemodialysis. He continues to be on maintenance IV rituximab therapy and low-dose oral steroids and is followed closely by a rheumatologist. Our case reflects the evolving state of understanding how COVID-19 impacts the immune system, its varying manifestations, and its management.
Adherence of Hemodialysis Patients to Fluid, Diet, Medications, and Hemodialysis Sessions, Makkah, Saudi Arabia
Authors: Al-Khattabi Ghanim Hamid
Published: July 2024

The adherence of hemodialysis (HD) patients to medical instructions is considered crucial for a longer life expectancy and better quality of life. Despite its importance, there is a remarkable paucity in research dealing with the adherence of patients under HD in Saudi Arabia. The objective of this study was to identify the prevalence of adherence to fluid, diet, medications, and HD sessions among HD patients in Makkah. This was a cross-sectional study in which 361 HD patients were randomly selected from HD centers in three governmental hospitals in Makkah. Individuals were assessed for adherence using the End-Stage Renal Disease Adherence Questionnaire in addition to a clinical examination and laboratory investigations. These methods were used to identify the level of adherence to fluid, diet, medications, and HD sessions. The frequency of adherence of patients was found to be high for dietary guidelines (88.4%), fluid restriction (87.8%), and medications (88.0%), but it was relatively low for adherence to HD sessions (56.0%). The overall adherence rates in the current study population were thought to be within the range of most published international studies.
Successful Management of Pulmonary Mucormycosis Presenting as Round Pneumonia by Lung Resection in a Kidney Transplant Recipient
Authors: Hase Aniket , Dalal Alpa , Bhanushali Amol , Limaye Kashmira , Dutta Supriya , Davda Kanishka , Kulkarni Tarang , Jha Navin , Hase Niwrutti
Published: July 2024

Pulmonary mucormycosis is rare in kidney transplant recipients and has a high mortality rate. We report a case of pulmonary mucormycosis presenting as round pneumonia 1 year and 1 month after the transplant. The diagnosis was confirmed by a percutaneous lung biopsy. A complete resection of the lung mass, followed by intravenous liposomal amphotericin B therapy, saved the life of the patient. In conclusion, early and prompt diagnosis followed by complete resection of the lesion in pulmonary mucormycosis is lifesaving.
Integration of Urinary Neutrophil Gelatinase-associated Lipocalin with the Renal Angina Index to Predict Subsequent Severe Acute Kidney Injury in Critically Ill Children: A Diagnostic Accuracy Study
Authors: Sunya Ngilyang , Gupta Shalu , Saha Abhijeet
Published: July 2024

The primary objective of this study was to determine the performance of the renal angina index (RAI) in predicting subsequent severe acute kidney injury (AKI) on day 3 of admission and whether integrating urinary neutrophil gelatinase-associated lipocalin (NGAL) with RAI would lead to improved prediction of AKI. This was a prospective observational study conducted in the pediatric intensive care unit (PICU) of a tertiary care hospital involving 170 children meeting the inclusion criteria. The RAI was assessed within 24 h of admission to the PICU. Positivity for renal angina was considered RAI ≥8. Urine samples were collected for all enrolled patients within the first 24 h and on day 3 of the PICU stay. NGAL was assayed using human-specific enzyme-linked immunosorbent assay. The overall incidence of AKI was 18.2%. Out of 170 children, 31 (18.2%) were RAI-positive on day 0. A higher proportion of patients in the RAI-positive group developed AKI on day 3 compared with the RAI-negative group (83.9% vs. 3.6%, P <0.001). Those who were RAI-positive on day 0 had a sensitivity, specificity, positive predictive value (PPV), and negative predictive value of 83.8%, 96.4%, 83.8%, and 96.4%, respectively, for predicting severe AKI on day 3. Incorporating urinary NGAL improved the specificity and PPV to 97.8% and 85.7%, respectively. Assessing the RAI is simple and useful for predicting severe AKI in critically ill children. The addition of urinary NGAL to the RAI optimizes its use for identifying patients at risk of subsequent severe AKI.
Acetyl-11-Keto-β-Boswellic Acid and Incensole Acetate Attenuate Lipopolysaccharide-Induced Acute Kidney Injury by Inhibiting Inflammation and Oxidative Stress
Authors: Sharifi Mohammad Rahim , Hakimi Zhara , Ghalibaf Mohammad Hosein Eshaghi , Fazeli Elham , Behshti Farimah , Marefati Narges , Hosseini Mahmoud
Published: July 2024

Boswellia serratahas been used in traditional medicine to treat various inflammatory diseases. Acetyl-11-keto-β-boswellic acid (AKBA) and incensole acetate (IA) are two active ingredients ofB. serratathat possess anti-inflammatory and antioxidant activities. The present study aimed to investigate the protective effects of AKBA and IA against lipopolysaccharide (LPS)- induced acute kidney injury (AKI) in rats. Wistar rats were intraperitoneally pretreated with AKBA or IA for 2 weeks. After 30 min, an LPS injection was applied to induce AKI. Blood samples and kidney tissues were collected and used for biochemical assays. AKBA and IA not only significantly decreased interleukin-6 as a marker of renal inflammation but also attenuated the oxidative stress markers in kidney tissues. AKBA and IA also remarkably decreased serum creatinine and blood urea nitrogen. These results suggest that AKBA and IA have protective effects against AKI in rats through regulating inflammation and oxidative stress.
A Prospective Observational Study of Renal Involvement in Hematological Malignancies
Authors: Eshwarappa Mahesh , Rajashekar  , Siddaiah Gireesh Mathihally , Gurudev Konana Chennabasappa , Udupa Karteek , Yusuff Mohammad
Published: July 2024

Patients with hematological malignancies (HMs) are at high risk of infections and comorbidities that substantially increase the occurrence of renal failure. Thus, the management of renal dysfunction in patients with HMs is crucial. The current study aimed to determine the incidence of renal involvement in patients with HMs and analyze their clinical profile in the context of renal disorders. A prospective observational study was conducted on 200 patients suffering from various HMs. Renal involvement was determined through blood and urine analyses. The mean age of the patients was 51.84 ± 17.47 years, with the male-to-female ratio being 1.5:1. Multiple myeloma (MM) (30.5%) and non-Hodgkin's lymphoma (NHL) (30.5%) were the most commonly observed types of HM, whereas plasmacytoma (1%) was the least observed. Moreover, 39.5% and 16.5% of patients were diagnosed with moderate and severe anemia, respectively. Mean calcium, creatinine, and blood urea nitrogen levels were 8.97 ± 1.19 mg/dL, 1.41 ± 1.37 mg/dL, and 16.83 ± 14.50 mg/dL, respectively. Mean sodium, potassium, and uric acid levels were 135.49 ± 6.79 mEq/L, 4.157 ± 0.65 mEq/L, and 5.81 ± 2.82 mg/dL, respectively. Twelve percent of the patients (24 out of 200) presented with renal insufficiency and nephrotic syndrome. Ten patients were diagnosed with NHL, 10 patients with MM, two with chronic myeloid leukemia, and two with acute myeloid leukemia. The causes of renal impairment in most cases were patchy interstitial lymphoid infiltrates, cast nephropathy, acute tubular necrosis, and minimal change disease.
Correlation of Urinary Neutrophil Gelatinase with the Histopathological Extent of Kidney Damage in Patients with Diabetic Nephropathy
Authors: Garg Priya , Shetty Manjunath , Krishnamurthy Vani
Published: July 2024

Diabetic nephropathy (DN), a leading cause of chronic kidney disease, is known to develop in around 40% of patients with diabetes. NGAL, a biomarker expressed by the tubular epithelium, has been evaluated in both acute and chronic kidney injury. However, kidney damage revealed by the histology of renal tissue core biopsies has not been quantified by morphometry and its correlation with urinary NGAL (uNGAL) has not been studied. Our objective was to compare levels of uNGAL with the extent of kidney damage in the histopathological results of morphometry in patients with DN. This prospective analytical study was conducted in a tertiary hospital. Urine samples of 42 patients were collected and freeze-dried. uNGAL was estimated through a chemiluminescent microparticle immunoassay. Pearson's correlation coefficients between kidney damage quantified by morphometry and NGAL values were examined. The correlation of uNGAL with the percentage of acute tubular injury assessed by morphometry in the renal core was 7.35% (P = 0.64). uNGAL had the highest correlation with inflammation (r = 54.2%; P = 0.002). Another parameter with a significant correlation was glomerular sclerosis with r = 35.6% (95% confidence interval: 10%–60%) and an associated P = 0.02. UNGAL was strongly correlated with inflammatory kidney damage in patients with DN.
A surge in fulminant idiopathic intracranial hypertension cases within 1 year from the coronavirus disease 2019 pandemic lockdown: A case series
Authors: Aldhahwani Bashaer , Gupta Arnav , Badeeb Nooran , Jordan David , Albreiki Danah
Published: July 2024

PURPOSE:

A surge in the number of cases of fulminant idiopathic intracranial hypertension (IIH) was observed within 1 year of the lockdown due to coronavirus disease 2019 (COVID-19) in March 2020. This study aims to describe the characteristics, outline of management, and final visual outcome for six cases diagnosed with fulminant IIH.

METHODS:

We reviewed the medical records of six adult patients diagnosed with fulminant IIH, between May and November 2021, based on their presentation at the University of Ottawa, Eye Institute.

RESULTS:

All six patients were diagnosed with fulminant IIH (five females and one male). Five out of six patients were obese and one patient was overweight. Medical treatment included the administration of acetazolamide (2–4 g/day) to all patients and intravenous methylprednisolone in four patients. Surgical treatment (optic nerve sheath fenestration) was performed for all patients. Visual function improved for three out of the six patients, two patients remained stable, and one patient got worse.

CONCLUSION:

There has been a recent surge in the number of cases of fulminant IIH in the COVID-19 lockdown period. The negative impact of COVID-19 on health led to an increase in weight, which is thought to have played a role in this recent increase in fulminant IIH cases. Urgent surgery, coupled with acetazolamide administration, is recommended for such patients. Patient compliance and close follow-up are recommended for early detection of relapse.
Prognostic Evaluation and Survival Prediction for Combined Hepatocellular-Cholangiocarcinoma Following Hepatectomy
Authors: Chun Seok-Joo , Jung Yu Jung , Choi YoungRok , Yi Nam-Joon , Lee Kwang-Woong , Suh Kyung-Suk , Lee Kyoung Bun , Kang Hyun-Cheol , Chie Eui Kyu , Kim Kyung Su
Published: July 2024

Purpose This study aimed to assess prognostic factors associated with combined hepatocellular-cholangiocarcinoma (cHCC-CCA) and to predict 5-year survival based on these factors.Materials and Methods Patients who underwent definitive hepatectomy from 2006 to 2022 at a single institution was retrospectively analyzed. Inclusion criteria involved a pathologically confirmed diagnosis of cHCC-CCA.Results A total of 80 patients with diagnosed cHCC-CCA were included in the analysis. The median progression-free survival was 15.6 months, while distant metastasis-free survival (DMFS), hepatic progression-free survival, and overall survival (OS) were 50.8, 21.5, and 85.1 months, respectively. In 52 cases of recurrence, intrahepatic recurrence was the most common initial recurrence (34/52), with distant metastasis in 17 cases. Factors associated with poor DMFS included tumor necrosis, lymphovascular invasion (LVI), perineural invasion, and histologic compact type. Postoperative carbohydrate antigen 19-9, tumor necrosis, LVI, and close/positive margin were associated with poor OS. LVI emerged as a key factor affecting both DMFS and OS, with a 5-year OS of 93.3% for patients without LVI compared to 35.8% with LVI. Based on these factors, a nomogram predicting 3-year and 5-year DMFS and OS was developed, demonstrating high concordance with actual survival in the cohort (Harrell C-index 0.809 for OS, 0.801 for DMFS, respectively).Conclusion The prognosis of cHCC-CCA is notably poor when combined with LVI. Given the significant impact of adverse features, accurate outcome prediction is crucial. Moreover, consideration of adjuvant therapy may be warranted for patients exhibiting poor survival and increased risk of local recurrence or distant metastasis.
Upfront Stereotactic Radiosurgery or Fractionated Stereotactic Radiotherapy in Elderly Patients with Brain Metastases from Non–Small Cell Lung Cancer: A Retrospective Analysis of a 10-Year Bi-institutional Experience
Authors: Kim Myungsoo , Cha Jihye , Kim Hun Jung , Kim Woo Chul , Lee Jeongshim
Published: July 2024

Purpose Stereotactic radiosurgery (SRS) or fractionated stereotactic radiotherapy (FSRT) are increasingly used as initial therapies for brain metastases (BM). We aimed to assess the outcomes of SRS/FSRT in patients aged ≥ 65 years who had 1-10 BM from non–small cell lung cancer (NSCLC).Materials and Methods We retrospectively reviewed 91 elderly NSCLC patients with 222 BM who were treated with SRS/FSRT at two institutions between 2010 and 2020. The primary endpoint was overall survival (OS) after SRS/FSRT. In addition, in-field local control (IFLC) within the treated field was evaluated. Statistical analysis was performed to identify the prognostic factors affecting OS and IFLC.Results During a median follow-up of 18 months, the median OS was 32 months. The 1- and 2-year survival rates were 69.8% and 56.1%, respectively. In multivariate analysis, the NSCLC-specific graded prognostic assessment (GPA) score (p=0.007) and administration of systemic therapy (p=0.039) were defined as prognosticators affecting OS. The median IFLC period was 31 months, and the 1- and 2-year IFLC rates were 75.9% and 57.6%, respectively. The total BM volume (p=0.042) significantly affected IFLC. No severe adverse events were reported after SRS/FSRT.Conclusion SRS/FSRT is an effective upfront treatment option for BM arising from NSCLC in elderly patients, with a good OS without severe side effects. Higher GPA score and active systemic treatment were associated with improved OS, indicating that elderly patients are significant candidates for SRS/FSRT.
Linear and nonlinear transport equations with coordinate-wise increasing velocity fields
Authors: Lions Pierre-Louis , Seeger Benjamin
Published: July 2024

We consider linear and nonlinear transport equations with irregular velocity fields, motivated by models coming from mean field games. The velocity fields are assumed to increase in each coordinate, and the divergence therefore fails to be absolutely continuous with respect to the Lebesgue measure in general. For such velocity fields, the well-posedness of first- and second-order linear transport equations in Lebesgue spaces is established, as well as the existence and uniqueness of regular ODE and SDE Lagrangian flows. These results are then applied to the study of certain nonconservative, nonlinear systems of transport type, which are used to model mean field games in a finite state space. A notion of weak solution is identified for which unique minimal and maximal solutions exist, which do not coincide in general. A selection-by-noise result is established for a relevant example to demonstrate that different types of noise can select any of the admissible solutions in the vanishing noise limit.
Un principe d’Ax–Kochen–Ershov imaginaire
Authors: Hils Martin , Rideau-Kikuchi Silvain
Published: July 2024

We study interpretable sets in henselian and

\sigma

-henselian valued fields with value group elementarily equivalent to

\mathbb{Q}

or

\mathbb{Z}

. Our first result is an Ax–Kochen–Ershov type principle for weak elimination of imaginaries in finitely ramified characteristic zero henselian fields – relative to value group imaginaries and residual linear imaginaries. We extend this result to the valued difference context and show, in particular, that existentially closed equicharacteristic zero multiplicative difference valued fields eliminate imaginaries in the geometric sorts; the

\omega

-increasing case corresponds to the theory of the non-standard Frobenius automorphism acting on an algebraically closed valued field. On the way, we establish some auxiliary results on separated pairs of characteristic zero henselian fields and on imaginaries in linear structures, which are also of independent interest.
Universal inequalities for Dirichlet eigenvalues on discrete groups
Authors: Hua Bobo , Yadin Ariel
Published: July 2024

We prove universal inequalities for Laplacian eigenvalues with Dirichlet boundary condition on subsets of certain discrete groups. The study of universal inequalities on Riemannian manifolds was initiated by Weyl, Pólya, Yau, and others. Here we focus on a version by Cheng and Yang. Specifically, we prove Yang-type universal inequalities for Cayley graphs of finitely generated amenable groups, as well as for the

d

-regular tree (simple random walk on the free group).