bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 60: Rickets in congenital bullous ichthyosiform erythroderma
Authors: Butukuri Likhitha
Published: August 2024

Introduction: Congenital ichthyosiform erythroderma (CIE), also known as bullous congenitalichthyosiform erythroderma is a rare type of the ichthyosis family of skin diseases which occurs in 1 in 200,000 to 300,000 births. CIE comes under the umbrella term autosomal recessive congenital ichthyosis (ARCI), which include non-syndromic congenital ichthyosis such as harlequinichthyosis and lamellar ichthyosis. Ichthyosiform erythroderma due to keratinizing disordersmaysuppress cutaneous vitamin D synthesis, leading to vitamin D deficiency and rickets.

Description: A 8 year 10 months old female child presented with poor height gain from 5 years and inward bending of knees from 5 years. h/o hyperpigmented hyperkeratotic scaly dry skinfrombirth. She was diagnosed with Bullous ichythosiform erythroderma and was prescribed emollients by a dermatologist. She is born out of non-consangienous marriage, second in birth order has an elder and youngersibling who are apparently normal. Ichythyosis present from birth more during winter season. h/o delayed dentition present. No h/o constipation or weight gain. h/o delayed motor milestones present. Language and social skills normal. o/e height is 78 cms @ < -10.8 SDS; height age <2 years weight 10 kg @ < - 6 SDS ; weight age < 2 years inward bending of knees + ; forward bending of tibia + ; ichthyosis over lower limbs, abdomen and upper limb. Her labs showed low Vit D levels of 8.7 ng/ml; calcium of 7.5 mg/dl (8- 10 mg/dl); phosphorus 2.6 mg/ml (2.5-4.8 mg/dl); elevated serum Alkaline phosphatase of 1450 IU/L; serum PTH of 181 pg/ml; normal thyroid and renal profile. She was started on oral vitamin D3 supplements and calcium supplements.

Discussion: Ichthyosiform erythroderma is of two types, one inherited as an autosomal dominant and the other as an autosomal recessive trait. The recessive form is nonbullous and is associated with growth retardation, oligophrenia, spastic paralysis, genital hypoplasia, hypotrichia and shortened life expectancy. In the autosomal dominant or bullous form, however, life expectancy is not shortened, and the associated symptoms include only seborrhoea of the head an probably polydipsia. Both types begin at birth and are localized mostly on the flexor surfaces. Nonbullous congenital ichthyosiform erythroderma is characterized by prominent erythroderma and fine white, superficial semiadherent scales. The majority of affected individuals are present at birth as collodion babies. Skin histology shows hyperkeratosis, an increase in stratum corneum thickness, a normal or prominent granular layer and increased mitoses. Development of skeletal features in this condition can be explained by the fact that the maintenance of healthy skeleton requires vitamin D, the main source of which is biosynthesis in the skin. Epidermal hyperproliferation disturbs this synthesis and results in rickets.
Abstract 71: Preserved beta cell function in long standing type 1 diabetes mellitus
Authors: Vivek K , Reddy D Sandeep , Sharmila P , Rao P Srinivas , Danda Vijay Sheker Reddy
Published: August 2024

Background: Maturity onset diabetes of young (MODY) may be misdiagnosed as type 1 or type 2 diabetes mellitus and there may be an overlap between MODY and type 1 diabetes. The presence of persistent endogenous insulin, after the “honey-moon period” has ended, should lead to evaluation of secondary causes of diabetes including MODY.

Aim: To identify subjects with preserved beta cell function; utilizing urinary C-peptide/creatinine ratio (UCPCR) in those, who have been diagnosed and treated as Type 1 diabetes mellitus.

Methodology: Hospital based cross sectional study, between February 2019 and February 2021 in 100 Subjects diagnosed as Type 1 DM for more than 3 years.

Results: Mean age and duration of DM 14.17 years and 5.3years respectively. Among 18 who had family history of D.M, 7 subjects had 3 generation involvement. GAD antibodies (68%) were more prevalent compared to IA 2 antibodies (56%). 49% had presence of both Anti GAD and IA2 auto antibodies. Mean UCPCR was 0.17. UCPCR >0.2 (suggestive of preserved endogenous insulin secretion) was present in 8 subjects among study population. Among these 8 subjects, 4 subjects had history of DKA episodes, 3 subjects had family history of D.M. 3 subjects did not have either of the auto antibodies. Compared to UCPCR <0.2, subjects with UCPCR >0.2 had statistically significant lower Hba1c (p=0.005), high UCPCR values (p=0.001), high MODY probability scores (p=0.004).

Conclusions: UCPCR can be used as a screening tool to identify cases who need further evaluation for secondary causes, including genetic testing for MODY.
Abstract 72: Prevalence, course, and predictive factors of water and electrolyte disturbances (WEDs) following transsphenoidal pituitary surgery (TSS) in patients with pituitary adenoma
Authors: Bhardwaj S , Jaiswal1 A K , Yadav S , Yadav2 R
Published: August 2024

Background: TSS is commonly associated with various WEDs in postoperative period, which can lead to prolonged hospital stay, readmission and rarely be life threatening. There is scarcity of prospective studies regarding various factors which could predict occurrence of these disturbances.

Aims and Objectives: To prospectively study the prevalence, presentation and clinical course of WEDs following TSS in patients with pituitary adenoma and assess potential risk factors for these disturbances.

Results: Forty patients (median age 45.5 years, 60% male) harbored 25 clinically hormone inactive and 15 hormone secreting pituitary adenoma. Postoperative WEDs occurred in 45 % of the patients; in 22.5 % as transient diabetes insipidus (DI) %, in 5 % as biphasic response, in 5% as isolated SIADH, in 12.5% as persistent DI. Median day of onset of DI was day 2 and remission was day 4. Median day of onset of SIADH was day 5 and remission was day 9. Younger age and greater adenoma volume were associated with increased risk of DI.

Conclusion: WEDs are common following TSS. Diabetes insipidus was more common than SIADH.
D2 MTE3 Case 7: Localising parathyroid gland
Authors: Badgandi Mohan
Published: August 2024

A 56 year old lady walked into our clinic with history of bilateral renal calculi and generalised weakness of 6 months duration. She was known to have well- controlled hypertension on medications. Clinical examination did not reveal any positive findings. She had been seen by a visiting Endocrinologist in Maldives twice, administered calcium and vitamin D. She also underwent tests to rule out osteoporosis, (17/09/2019) PTH- 180 pg/mL [10.0-65.0] and Serum Calcium levels: Total-11.3 mg/dl [8.0-10.5], Ionised-6.12 mg/dl [4.40-5.30], Vitamin D: 38.6 ng/ml [30-80], renal function was normal. She underwent CT Contrast for Neck & Thorax for Parathyroid adenoma on 28/09/2019 which showed suspicious nodular enhancing lesion in the left lobe of the thyroid (7x4 mm in the trachea-oesophageal groove). In view of her raised PTH, Sestamibi scan done revealed no definite evidence but Methyl-Choline scan showed hypodense area in the left lobe of the thyroid. She therefore underwent surgical exploration of left minimally invasive Parathyroidectomy on 28/09/2019. Frozen section showed Parathyroid hyperplasia hence underwent 3 and a half parathyroid excision on 30/09/2019. HPE report did not reveal any parathyroid adenoma. Post-operatively, Serum PTH and Calcium levels remained high (229.5 and 11.5 mg/dl, Ionised-5.97 mg/dl). Patient later underwent excision of lymph node and left lobe of thyroid on 02/01/20 in view of persistent hyperparathyroidism. However, on biopsy it showed reactive nodes and thyroid tissue with colloid filled follicles. We still faced persistent elevation of Serum PTH and Calcium. Hence it was decided to start the patient on Cincalcet 30 mg daily after a joint meeting with surgical and nephrology consultants. Patient was not able to follow up due to the covid pandemic. Presently, her PTH -288.2, Serum Calcium-11, Vitamin D- 33.2, Phosphorus-2.9 (October 2021). This clearly shows the treatment has not been effective and we are dealing with persistent hypercalcaemia, hyperparathyroidism and no localisation. We are also faced with the problem of post-operative management of hypercalcaemia.

How to manage persistent hypercalcaemia and hyperparathyroidism?

How to proceed with localisation of the primary source of PTH?
Abstract 86: Pneumo-encephalus: A rare complication following pituitary surgery
Authors: Nikith Siddu
Published: August 2024

Background: Pneumo-encephalus is a rare complication of trans-nasal trans-sphenoidal pituitary surgery. Mostly it is asymptomatic, but can present with signs of raised intra-cranial tension (tension pneumo-encephalus). Tension pneumo-encephalus can lead to multiple cranial nerve palsies including vison loss, mass effect on brain parenchyma or meningitis, which can be life-threatening. Here, we present a case of Cushing's disease, who underwent adenoma resection, following which patient developed pneumo-encephalus along with cerebrospinal fluid (CSF) leak.

Case Presentation: A 58-year-old female, presented to Endocrinology out-patient services for management of diabetes mellitus, with history of weight gain. On examination, patient had Cushingoid facies, centripetal obesity and thin skin. Laboratory evaluation revealed ACTH-dependent endogenous hypercortisolism, and a pituitary microadenoma was detected on magnetic resonance imaging. Patient underwent trans-nasal trans-sphenoidal adenoma excision with a documented remission; she was started on replacement dose of glucocorticoids and discharged. One week later, she presented to Emergency Medicine Department with headache, watery discharge from nose suggestive of CSF rhinorrhoea, and altered sensorium. A computed tomography of the brain was performed that revealed multiple air filled pockets inside cranium and was diagnosed as having pneumo-encephalus. CSF leak was repaired by closing the leak with an omental patch and patient was discharged after symptomatic improvement.

Conclusion: Pneumo-encephalus is a rare complication which can occur in early post-operative period, following pituitary surgery. Early recognition and meticulous management of this condition is necessary, as it can be life-threatening.
Abstract 151: Association of vegetarian and non-vegetarian diet with inflammatory biomarkers in healthy North Indian population
Authors: Ashraf Hamid , Zehra Munis , Ganie Mohd Ashraf , Sahar Tajali , Rashid Aafia
Published: August 2024

Background: Low-grade chronic inflammation is a known risk factor for the development of age-related diseases such as CVD, diabetes and some cancers, these findings have stimulated research into the influence of nutrition and dietary patterns on inflammatory indices.

Aims and Objective: To assess the effect of plant based vs. animal origin diets on serum markers of inflammation in normal healthy individuals.

Results: 275 non-vegetarians and 353 vegetarians were included in the study. Weight and BMI was significantly higher in the vegetarians. Both fasting blood glucose and Insulin level were significantly higher in vegetarians, while total cholesterol, HDL, triglyceride and LDL was significantly higher in the non-vegetarians. Serum ALT and ALP was significantly higher and total protein and albumin was lower in vegetarian group. The serum level of IL-6, IL-1, resistin and CRP was significantly higher in vegetarian, while the levels of IL-10, adiponectin were significantly raised in non-vegetarian group. BMI had significant positive correlation with TNFα, IL-6, Resistin, hsCRP and IL-1 β, protein intake had significant negative correlation with TNFα, IL-6, and hsCRP.

Conclusion: Vegetarian diet in Indians is associated with higher BMI, blood glucose and insulin level. Non-vegetarian diet is associated with a more favorable inflammatory cytokine profile.
Abstract 152: Impaired quality of life and psychological well-being in polycystic ovary syndrome
Authors: Nabi Tauseef , Rafiq Nadeema
Published: August 2024

Background: Health-related quality of life (HRQoL) is an important issue in women with PCOS.

Aim and Objectives: Aim of the study was to compare the HRQoL between women with PCOS and its phenotypes and controls.

Methods: This case-control study was done on 100 females with PCOS diagnosed as per Rotterdam's criteria and 150 controls. Patients were studied for clinical characteristics, biochemical and hormonal investigations and ultrasound scans. Women underwent completed health questionnaires, including the Short Form-12v2.

Results: The mean age of the subjects with PCOS and controls was comparable 26.8±10.6 and 27.6±9.2 years, respectively. The phenotype D of PCOS was predominant form 47%, followed by phenotype C, A and B in 31%, 15% and 7%, respectively. The prevalence of impaired HRQoL was significantly higher in females with PCOS than controls (p=0.002). All women with PCOS presented lower scores in PCS compared to controls [mean (95%CI): 52.6 (51.2–54.7) vs. 55.6 (54.1–57.2); p=0.031], as well as lower scores for three out of the eight scales (p-values <0.05). Significant difference was observed for the MCS between PCOS and controls, but no correlation with PCOS phenotypes.

Conclusion: We recommend that all females with PCOS should be screened for physical and mental well-being. HRQoL was significantly decreased in women with PCOS.
Family History of Stuttering among Kurdish Children Who Stutter Near the Age of Onset
Authors: Mohammadi Hiwa , Bakhtiary Parya
Published: August 2024

Background:

The family history of stuttering is one of the most important factors for the prediction of recovery from stuttering. There is a high controversy about the rate of positive family history of stuttering among people who stutter (PWS). In the present study, the family history of stuttering in the first-, second-, and third-degree relatives was investigated among a group of Kurdish children who stuttered (CWS) close to the onset of the disorder.

Materials and Methods:

One hundred and seventy-two CWS, including 46 females (24.60%) aged 2–5 years (mean age: 3.71 years, SD = 0.75) were consecutively recruited. They were first examined close to the onset of the stuttering. Data about current and former stuttering among first-, second-, and third-degree relatives were collected using interviews with both parents. Data was described and analyzed by independent sample t test or Chi-square.

Results:

Among 172 CWS (mean age: 3.71 years, SD = 0.75), 119 (69.20%) reported a family history of stuttering. According to the result, the most family history of stuttering was reported among third-degree relatives (32.60%). Sixty-five participants (37.80%) reported just one relative with stuttering. CWS with a positive family history of stuttering had no significant difference with CWS without a positive family history of stuttering in sex (P = 0.48) and age of stuttering onset (P = 0.96).

Conclusion:

The rate of positive family history of stuttering among Kurdish CWS is similar to previously reported data in the same age group. There was no significant association of family history of stuttering with sex and age on the onset of the disorder.
A risk prediction model for vasovagal reactions in whole blood donors including the physical and psychological factors: Results from a case–control study done in a regional blood transfusion center
Authors: Shaiji P. S. , Indu Pillaveetil Sathyadas , Meena D. , Surendran Anish Thekkumkara
Published: August 2024

BACKGROUND AND OBJECTIVES:

Blood centers strive to maintain a safe and adequate supply of blood products from healthy volunteer donors. Primary responsibility of a medical officer is to assess donor risk for vasovagal reaction (VVR) and alert the phlebotomist. The study attempts to identify the significant risk factors of VVR which may help in decision-making.

METHODS:

This was a case–control study including blood donors donating 350 ml Whole blood in Department of Transfusion Medicine, Medical College, Thiruvananthapuram from December 19, 2017 to June 31, 2018. Donors who suffered VVRs during or after blood donation were considered as cases and compared with controls. The prevalence of risk factors such as age, sex, number of previous donations, body mass index (BMI), blood volume, sleep duration, food intake, fear and anxiety, and pain perception was compared between the groups.

RESULTS:

174 cases and 348 controls were studied. Most of the donors were < 35 years of age (63.2%) younger age groups (18–25 year) had a higher odds of VVR (5.54 with 95% confidence interval [CI] 2.4–12.5). First time donations carried an increased risk of VVR with an ODDs ratio of 5.8 (3.81–9.131) compared to repeat donors. Around 45% of cases were first timers whereas only 12% of controls were first time donors. There was a significantly higher rate of reactions in donors who had episodes of VVRs in the previous donations. Odds 1.99 (CI 1.09–3.74) other risk factors identified were female gender (6.3, 95% CI 2–20), lack of sleep at previous night (32.9; CI 16.17–67.18), and high BMI > 27.5/m2 with odds ratio 2.5 (1.4–4.3). Having an estimated blood volume < 3500 ml also was associated with higher odds of VVRs.

CONCLUSION:

In spite of having a strict criteria for donor deferral based on risk factors, vasovagal reactions still occur and risk factors are prevalent in blood donor population. Special attention should be given to donors having one more of such risk factors and attempts should be made to avert VVRs.
“When less is more and more is less” red cell alloimmunization in multitransfused patients attending a medical institution with a newly developed blood center in North India: A multifactorial study
Authors: Mukherjee Ranjan , Negi Gita , Kaur Daljit , Nath Uttam Kumar , Chaturvedi Yatendra , Bava Davood
Published: August 2024

INTRODUCTION:

Multiple blood transfusions with one or more nonself, genetically mismatched donor red blood cells (RBCs) may result in the production of alloantibodies, complicating future transfusions and increasing patient morbidity. This could be averted if adequate prophylactic measures are implemented in the vulnerable group. Due to the paucity of data in our region, we planned this study to identify the alloimmunization pattern in relation to clinical and demographic patient factors.

MATERIALS AND METHODS:

A prospective observational study was carried out in a newly developed Medical Institution of National importance in Northern India, for 1 year. The red cell antibody screening and identification were done for 770 patients receiving two or more transfusions. The patient and transfusion-related factors were statistically compared between alloimmunized and nonalloimmunized cases.

RESULTS:

The overall seroprevalence of RBC alloimmunization among the multi-transfused patients was 4.02% (31/770). Thirty-six alloantibodies were identified in the 31 alloimmunized patients, which comprised 13 different alloantibody specificities. Most of them belonged to the Rh system (38.8%), followed by MNS (25%) and Lewis (27.7%) blood group systems. On Multivariate logistic regression analysis, the highest risk was found to be associated with recipients having more than three transfusions with an odds ratio of 8.4.

CONCLUSIONS:

The highest alloimmunization risk was found in multi-transfused patients receiving more than three transfusions and with female gender. Rh blood group system was found to be predominating the alloantibody specificity pattern. This highlights the need for the provision of extended Rh (DCcEe) matched packed red cells for susceptible patients.
Therapeutic plasma exchange for COVID-19 acute respiratory distress syndrome complicated by myasthenia gravis
Authors: Krishna Aparna , Pandey Hem Chandra , Coshic Poonam , Nair Parvathy Ramachandran , Haritha Damarla , Rajan Roopa , Mehta Vikas
Published: August 2024

The role and safety of therapeutic plasma exchange (TPE) in COVID-19-induced severe acute respiratory distress remains unclear, especially in the wake that a specific and effective treatment modality has not been discovered for the treatment of COVID-19. Here, we report a case where a patient presenting with severe COVID-19 acute respiratory distress syndromes (ARDS) complicated by myasthenia gravis showed significant improvement after the third session of TPE and was subsequently weaned off from the ventilator and shifted to the ward from intensive care unit. TPE can be considered an efficient and safe treatment modality in severe COVID-19 ARDS.
Multifaceted approach to successful management of pediatric acute liver failure: High-volume plasma exchange as a pivotal intervention
Authors: Yadav Anshika , Sharma Ravi , Gupta Supriya , Vaishnav Sandeep , Bansal Rajiv , Gupta Gajendra Nath
Published: August 2024

Pediatric acute liver failure (pALF) poses a formidable clinical challenge characterized by rapid hepatocyte necrosis and pro-inflammatory events. The urgency of pALF necessitates advanced therapeutic modalities, prompting the exploration of high-volume plasma exchange (HVPE) as a sophisticated intervention. This case report delves into the intricate management of a 16-year-old female with hyperacute liver failure secondary to hepatitis A, highlighting the critical need for nuanced and multidisciplinary approaches. The case unfolds through a detailed description of symptoms, clinical decision-making, and the therapeutic journey. The management includes a calculated deferral of liver transplantation in favor of HVPE, with a focus on the rationale for choosing HVPE over continuous renal replacement therapy. Technical aspects of the procedure, such as blood volume calculations and procedural details, are meticulously outlined. Laboratory investigations track the patient’s progress, showcasing the profound impact of HVPE on clinical and laboratory recovery. The patient’s response to HVPE is evident in the comprehensive clinical and laboratory recovery observed after the intervention. The resolution of encephalopathy, successful extubation, and eventual discharge highlight the positive outcomes achieved through the judicious application of HVPE. However, the procedure is not without challenges, as the emergence of hypertension during the second and third cycles and a lone episode of seizure require swift and careful management. The management of pALF demands a sophisticated and multidimensional approach, especially when liver transplantation is not immediately feasible. This case report underscores the nuanced decision-making involved in selecting extracorporeal therapies, with a focus on the successful application of HVPE. HVPE, as recommended by the American Society for Apheresis, emerges as a promising intervention in the context of pALF, offering a viable option when liver transplantation is deferred due to advanced encephalopathy. The favorable outcomes and considerations of cost-effectiveness and procedural simplicity further accentuate the potential of HVPE as a cornerstone in the critical care of pediatric patients with acute liver failure.
Red cell serological characterization of autoimmune hemolytic anemia in systemic lupus erythematosus patients
Authors: Chinnapureddy Vinay Kumar , Bonagiri Shanthi
Published: August 2024

INTRODUCTION:

Autoimmune hemolytic anemia (AIHA) is a clinical condition with increased red cell destruction or decreased red cell survival due to autoantibodies against self-antigens on red blood cells. AIHA may be primary or secondary to other underlying illness. Systemic lupus erythematosus (SLE) is the most common secondary cause of AIHA. Although the incidence of AIHA in SLE patients is low (5%–10%), sometimes, it causes severe anemia which requires blood transfusion. Characterization of these autoantibodies in AIHA is very important, because the clinical condition and treatment of the patient depend on the optimal temperature reactivity, class, and subclass of immunoglobulin responsible.

AIM AND OBJECTIVES:

The aim and objective of this study are to perform detailed characterization of red cell autoantibodies for accurate diagnosis of AIHA in SLE patients, to find out specific class (immunoglobulin G [IgG]/IgM/IgA) of immunoglobulin and/or complement (C3c/C3d) responsible for AIHA, and their association with severity of hemolysis.

MATERIALS AND METHODS:

This was a prospective analytical study, done at a tertiary care hospital in Hyderabad, conducted between February 2021 and May 2022. SLE patients with AIHA were included in the study. Monospecific direct antiglobulin test (DAT) was performed to identify the specificity of autoantibody or complement. Based on hematological laboratory values, the study population was divided into three groups, i.e., mild, moderate, and severe hemolysis. DAT strength, hemolytic parameters, and severity of hemolysis were compared between different types of AIHA in SLE patients. Correlation statistics were used to know the association of severe hemolysis with DAT strength and different combinations of autoantibodies.

RESULTS:

Among 150 patients enrolled, 16 (10.6%) patients had severe hemolysis, 51 (34%) patients had moderate hemolysis, and 83 (55.3%) patients had mild hemolysis. Only IgG was positive in 109 (72.6%) patients, both IgG and C3d were positive in 37 (24.6%) patients, C3d was positive in 4 patients, and IgM was positive in 19 patients. High DAT reaction strength (3+–4+) and presence of C3d or IgM along with IgG were moderately correlated with severe hemolysis.

CONCLUSION:

Warm AIHA is the most common type of AIHA in SLE patients mediated by IgG. Mild and moderate hemolysis was seen in most cases. Severe hemolysis was moderately correlated with the presence of C3d or IgM. Further studies are warranted to find the predisposing factors leading to severe hemolysis.
A 10/14 French silicone urinary catheter with inflatable balloon used as novel expansion device in lid reconstruction surgery
Authors: Mandal Salil K , Honavar Santosh G , Mukhopadhyay Asrik , Maitra Anwesha , Sarkar Oishik , Gayen Mausree , Mallick Nazibul H
Published: August 2024

Purpose:

To describe the surgical technique using a 10/14 French silicone urinary catheter as a novel tissue expander for repair of defects after removal of eyelid tumors. This device recruits additional tissue by tissue expansion for repair of large eyelid defects.

Methods:

A prospective noncomparative, interventional case study was conducted over a period of 3 years in which 30 patients were enrolled. All the 30 patients were selected for upper or lower lid Tenzel rotational flap after removal of large malignant tumor, using the tissue expander.

Results:

A 10/14-French silicone urinary catheter was placed in the periocular region and expanded by graded inflation with normal saline to a total volume of 10 or 14 ml, respectively, over a period of 3 days. On the fourth day before the planned surgery, the catheter balloon was deflated and a modified Tenzel rotational flap was performed to close the defect. Postoperative blink reflex was preserved. There were no cases of wound dehiscence. There was a significant reduction of incision length in upper and lower lid reconstruction with modified Tenzel flap reconstruction.

Conclusion:

This approach allows for temporary tissue expansion, permitting the closure of large eyelid defects, typically not possible with a conventional Tenzel flap. This also provides excellent functional outcomes without closing patients’ eyelids (which limits vision for weeks to months) as is typical of other reconstructive modalities (e.g. Cutler Beard procedure). The device is cost-effective and readily available. The authors believe it is an excellent alternative in the developing world where access to more expensive options is limited.
Scleral imbrication with vitreoretinal surgery as a primary procedure for retinal detachment in pathological myopia
Authors: Sood Gitanjli , Mahajan Sandeep
Published: August 2024

A 45-year-old male presented with diminution of vision in the right eye (RE) for the past 2 weeks. He underwent sequential bilateral cataract surgery 25 years ago, with an intraocular lens in RE, which was his better eye. The left eye was aphakic with a thick fibrous membrane at the pupillary plane. Visual acuity was hand movement in the RE with the iris claw lens and total bullous retinal detachment (RD). The axial length with RD was 28.6 mm in RE and 29 mm in the left eye (LE). We did a vitrectomy with scleral imbrication, endolaser, fluid gas exchange, and tamponade in the RE. The LE developed RD subsequently, and he underwent similar surgical procedures in his LE. The best corrected visual acuity in his RE was 20/80, and that in the LE was 20/120 on follow-up. RD with staphyloma is a surgical challenge as the thin atrophic retina at the posterior pole fails to conform to the concavity of staphyloma. Vitrectomy with tamponade alone does not take care of staphyloma and has more chances of recurrent detachment or persistent fluid at the posterior pole. Scleral imbrication shallows the staphyloma cavity and shortens the axial length, thereby giving a good surgical outcome.
Clinical application and outcome of Tenon’s patch graft: A comprehensive review
Authors: Kusumesh Rakhi , Kishore Alisha , Venugopal Anitha , Shah Sushmita G , Vanathi Murugesan
Published: August 2024

Corneal perforations are potentially sight-threatening conditions if not promptly treated. Management depends on the size, location, cause, and severity of the perforation. Various methods, including tissue adhesives, amniotic membrane grafting (AMG), and keratoplasty, are available. However, the limited availability of donor tissue in emergencies poses a significant challenge. Recently, Tenon’s patch grafting (TPG) has emerged as a promising treatment option due to its autologous nature, availability, and lack of immunogenicity. This review provides a comprehensive overview of various aspects of TPG, along with relevant images. A literature search using keywords such as “Tenon’s patch graft,” “Tenon’s capsule,” “corneal patch graft,” “amniotic membrane,” and “corneal perforations” yielded 37 articles, included in this review. TPG is suitable for cases involving corneal tissue degradation leading to perforation, impending perforation, or descemetocele, with lesion sizes ranging from 2 to 6 mm. For larger perforations, the procedure may be modified by combining it with AMG or tissue adhesives. Postoperatively, the graft undergoes characteristic changes, including epithelialization and collagen deposition, resulting in the formation of a thick scar. Complications such as delayed epithelialization, wound leaks, and graft dehiscence can occur. High success rates have been reported, ranging from 74% to 87%. However, TPG may result in suboptimal visual outcomes, particularly when the graft is centrally located, necessitating future keratoplasty for visual rehabilitation. Overall, TPG is a safe and cost-effective technique for restoring structural integrity in corneal thinning disorders and perforations, especially in emergency settings when donor tissue is unavailable.
Peripartum cardiomyopathy revisited: Current concepts
Authors: Muduli Subrat Kumar
Published: August 2024

Peripartum Cardiomyopathy (PPCM) is an idiopathic cardiomyopathy condition characterised by LV systolic dysfunction with LVEF < 45% occurring during last months of pregnancy to early postpartum phase. After initial case description by Demakis et al understanding of PPCM pathophysiology, it’s genetic determinants and management approaches have undergone major changes. A vasculo-hormonal model has been proposed to explain the cardiomyocyte damage caused by modified maternal prolactin hormone. Though rapid recovery of LV function is common, in a minority of cases it can result in refractory heart failure and cardiogenic shock. Recently described ESC EORP PPCM recovery score is quite useful in predicting LV function recovery. Oral bromocriptine therapy is a disease modifying therapy for PPCM that improves LV function by suppressing prolactin levels. Its role is being tested in larger clinical trials. Recently proposed BOARD scheme advocates use of multimodal treatment to reduce cardiovascular outcomes in patients with severe LV dysfunction. Vaginal delivery and breast feeding are to be encouraged to improve feto-maternal outcomes. LV function recovery during index PPCM case is the single most important factor that determines recurrence and outcome of PPCM in subsequent pregnancies.
Cardiac amyloidosis in India: Experience from a single tertiary care center
Authors: Vivek B.S , Patel Rohan , Jain Ashish Kumar , Sawhney J.P.S. , Jain Rajneesh , Passey Rajiv , Mehta Ashwani
Published: August 2024

PURPOSE:

Cardiac amyloidosis (CA) is perceived as a rare disease. Identifying certain red flag signs in patients helps in early diagnosis of CA. Epidemiology of CA in India is not well known. We performed this study to determine various demographic, clinical, and imaging parameters of patients diagnosed with CA in a tertiary care center in India.

METHODS:

We prospectively screened 48 patients between January 2021 and December 2023 with one or more red flags signs of CA. Their demographic, clinical, and imaging parameters were analyzed.

RESULTS:

Among 48 patients with one or more red flag signs, CA was diagnosed in 23 patients (47.91%). Seventeen patients were found to have AL CA and 6 had ATTR CA. The mean age of patients was 62.2 years with slight male preponderance (n = 13, 56.5%). All the patients presented with heart failure with the majority in New York Heart Association Class III (n = 11, 47.8%). The most common electrocardiogram abnormality was low-voltage QRS complexes in limb leads (56.5% of patients). Common echocardiographic abnormalities were left ventricular hypertrophy (100%), biatrial enlargement (100%), and reduced global longitudinal strain with relative apical sparing (cherry on top appearance) (74%). Tc99-PYP bone scintigraphy was done in 16 patients. It showed grade 2 uptake in all ATTR CA patients and 6 out of 11 in AL CA patients.Cardiovascular magnetic resonance was done in 5 AL CA patients. The most typical finding was diffuse subendocardial late gadolinium enhancement.

CONCLUSIONS:

There are significant lacunae in epidemiologic, diagnostic, and prognostic data of CA, especially in India. CA is not as uncommon, as it was perceived earlier. High index of suspicion with the use of novel echocardiographic parameters can identify patients who require further testing to confirm CA. Early diagnosis of CA helps in the early initiation of disease-modifying therapy which improves survival.
Detection of transcriptionally active high-risk human papillomavirus in patients with oesophageal carcinoma by real-time PCR
Authors: Kotian Shravya , Ramesh Pushkal S. , Shetty Jayaprakash , Laxminarayana Kishan Prasad Hosapatna , Shetty Veena , Devegowda Devanand
Published: August 2024

Background:

Oesophageal malignancies (OC) are the sixth most common cause of cancer-related mortality worldwide. Traditional risk factors for OC include smoking, alcohol consumption, and poorly controlled acid reflux; however, the trends in the last decade have pointed out the potential carcinogenic roles of infectious agents, especially Human Papillomavirus (HPV), in the development of OC. The prevalence of HPV infection in OC varies greatly worldwide, mainly due to the inconsistencies of the detection assays employed. This study attempted to establish the association between high-risk HPV and oesophageal malignancies by detecting the transcriptionally active HPV mRNA.

Materials and Methods:

In this cross-sectional study, 30 malignant oesophageal samples were subjected to real-time PCR to detect high-risk HPV-16 and 18 by targeting transcriptionally active E6/E7 genes. The positive samples were further subjected to viral load assessment.

Results:

Histopathological analysis of the patients showed that a moderately differentiated squamous cell carcinoma was seen in 56.2% of the cases. Of the 30 samples, 4 (13.3%) showed positive for HPV-16 E6/E7, and none showed positive for HPV-18 E6/E7. The viral load of HPV-16 E6/E7 in the positive samples was lesser than the copies present in the well-established cell line, SiHa.

Conclusion:

The role of HPV in the etiopathogenesis of oesophageal malignancies is unclear. Based on this study and the supporting data presented, it can be said that the association of high-risk HPV infection in oesophageal cancers does exist, but whether it is clinically and etiologically significant is the question that needs to be answered. Multicenter studies from different geographical locations, employing multiple molecular methods with a larger sample size, could aid in a better understanding of the etiopathogenesis of HPV in OC.
Can physical parameters from radiation simulation scan with deep inspiratory breath hold predict magnitude of heart dose reduction?
Authors: Kannan Venkatesan , Deshpande Sudesh , Anand Vivek , Naidu Suresh , Chauhan Kamalnayan , Chougle Nazneen , Hinduja Ritika Harjani
Published: August 2024

Introduction:

Deep inspiratory breath hold is one of the techniques for reducing the heart doses for left breast cancers. This study was conducted to confirm use of physical parameters from DIBH simulation CT scan like DIBH amplitude alongside several novel parameters to predict the heart dose reduction.

Materials and Methods:

Segmentation and planning of radiation to the left breast on the free breathing (FB) and DIBH simulation scan was performed for 50 left-sided breast cancer patients treated with DIBH technique. Physical parameters, namely DIBH amplitude, anterior sternal displacement, diaphragmatic excursion, ratio of lung volume (cc) in DIBH scan to lung volume in FB scan (cc), and delta heart volume in field (DHVIF), were extracted and were compared with magnitude of heart dose reduction (mean heart dose, V30Gy, and D5%).

Results:

Forty-eight (96%) patients achieved reduction in the mean heart dose with DIBH technique, while all patients had reduction in V30Gy. The median reduction was 41%, 89.7%, and 63% in the mean dose, V30Gy, and D5%, respectively. While DIBH did not correlate with heart dose reduction, ratio of lung volumes and DHVIF showed a strong positive correlation with heart dose reduction (P < 0.05). Sternal displacement correlated weakly with heart dose reduction but strongly with DHVIF, demonstrating to be an indirect predictor.

Conclusions:

Physical parameters like anterior sternal displacement, ratio of lung volumes of DIBH to FB, and possibly diaphragmatic movement can predict the dose reduction before the dose calculations by the physicist. These parameters can be used to construct a model to predict heart dose reduction.
Expression of Regulatory T Cell and Related Interleukins in Gingivitis Versus Stage 3, Grade B Generalized Periodontitis: Synergy or Cacophony—A Cross-Sectional Study
Authors: Kamel Asem M. , Badr Bahaa M. , Ali Abdullah I. , El-dydamoni Omnia A. , Gaber Ahmed H. , El-Hagrasy Hanan A.
Published: August 2024

Aim:

To raise “personalized periodontal diagnosis and prognosis” knowledge, Tregs, pro/anti-inflammatory interleukins (ILs) beside vitamin D-binding protein (VDBP) in serum and gingival cervical exudate of periodontally healthy individuals, plaque-induced gingivitis, and stage 3, grade B periodontitis patients were evaluated.

Materials and Methods:

An observational trial of different periodontal statuses according to 2018 periodontal classification was established from 60 subjects segregated into three equivalent groups (control periodontally healthy, gingivitis, and stage 3, grade B periodontitis). Peripheral blood and gingival crevicular fluid (GCF) were collected, to get GCF samples, inserted paper point in the pocket of the patient's teeth then the samples were placed with phosphate-buffered saline in Eppendorf. The peripheral blood was collected in ethylenediaminetetraacetic acid-coated vacutainer tubes. Frequency of CD4+ CD25+High Tregs was detected using flow cytometry. Cytokines were measured using an enzyme-linked immunosorbent assay. Mann–Whitney U test analysis was manipulated to distinguish the statistical discrepancies. Pearson’s correlation coefficient test was utilized to tie in the studied parameters.

Result:

Frequency of CD4+ CD25+High T cells were significantly ascendant in periodontitis than gingivitis and healthy (P ≤ 0.01; P = 0.04) and significantly superior in gingivitis than healthy (P = 0.01). There was no interdependence between systemic IL-21, IL-33, IL-22, IL-35, and the periodontal conditions except systemic VDBP, which significantly increased with the progression of the periodontal tissue inflammation. GCF compartments of IL-21, IL-33, and VDBP significantly increased with progression inflammation and GCF compartments of IL-22 and IL-35 significantly decreased with periodontal breakdown.

Conclusion:

Local increase of Treg is positively associated with increased local pro-inflammatory cytokines. This increment is more aggravated in periodontitis. Therefore, Tregs may have synergistic effects with periodontal disease progression.
Determining the Effect of Different Ferrule Designs on Fracture Resistance of Endodontically Treated Mandibular Premolars Restored with Fiber Posts: An In Vitro Study
Authors: Pidaparthi Aditya , Dhanak Nupur , Disodia Nitika , Vala Keyur , Kanodia Shikha
Published: August 2024

Aim:

This study aims to evaluate the effect of different crown ferrule designs on fracture resistance of endodontically treated mandibular premolars restored with glass fiber post, composite core, and metal crown.

Materials and Methods:

A total of 150 mandibular premolar teeth underwent endodontic treatment, and based on ferrule design, the teeth were divided into five groups (n = 30 each). Group 1—2 mm circumferential ferrule; group 2—2 mm buccal + lingual ferrule; Group 3—2 mm buccal ferrule; group 4—2 mm lingual ferrule; and group 5—no ferrule. Each tooth was restored using a glass fiber post, composite core, and metal crown, and then loaded at 160° on the lingual slope of the buccal cusp in a universal testing machine until fracture. Fracture values were recorded in Newtons. Data were analyzed using the Kruskal–Wallis test, and post hoc analysis was conducted with the Mann–Whitney U test (P = 0.05).

Results:

The highest load to fracture was seen in group 1 (1027.35 ± 164.68 N), followed by group 2 (922.42 ± 49.14 N), group 3 (916.06 ± 64.79 N), group 4 (888.91 ± 47.36 N), and group 5 (801.55 ± 52.45 N), respectively. There was a statistically significant difference in fracture resistance among different groups.

Conclusions:

While a tooth with an incomplete ferrule was less resistant to fracture than one with a complete ferrule, it was still more resistant to fracture than one with no ferrule. Thus, increasing the number of ferrule walls improves the fracture resistance of endodontically treated teeth.
Evaluation of Antimicrobial Efficiency, Shear Bond Strength, and Adhesive Remnant Index of TiO2 Infiltrated Orthodontic Adhesive - An In Vitro Study
Authors: Harsha L. , Subramanian Aravind Kumar , Pugalmani S.
Published: August 2024

Abstract

Background:

Enamel demineralization is an unavoidable adverse effect encountered with bonding brackets in orthodontic therapy. Introducing nanoparticles into the composite adhesive paste can prevent enamel demineralization. Titanium dioxide (TiO2) is known to exhibit direct antimicrobial efficiency. This study aimed to assess the antibacterial efficiency and shear bond strength (SBS) of an orthodontic bonding composite infiltrated with TiO2 nanoparticles.

Materials and Methods:

This in vitro study evaluated the efficiency of TiO2 nanoparticle–incorporated light-curing orthodontic composite paste (ENLIGHT, ORMCO). Twenty extracted premolars were randomly and equally allocated to the two study groups, N = 10. While a conventional composite was utilized for the bonding brackets in Group I, a TiO2-incorporated composite was used in Group 2. The adhesive remnant index (ARI) scores given by Artun and Bergland et al. and SBS were determined. Furthermore, the antimicrobial efficiency was estimated using the minimum inhibitory concentration (MIC)/minimum bactericidal concentration (MBC) and agar well diffusion assay for six composite disc specimens. The results were statistically analyzed using the chi-square test and Student’s t test, at P < 0.05.

Results:

After 24 h of curing, no statistical mean difference was observed between the two groups in terms of ARI or SBS scores (P > 0.05). However, there was a significant increase in the antimicrobial efficiency of Group II when compared with Group I (P < 0.05).

Conclusion:

TiO2 nanoparticle–incorporated orthodontic composites improve the antimicrobial efficiency with no significant change in the SBS. The ARI scores indicate the presence of 50% remnant orthodontic composite on the tooth enamel surface post debonding.
Indian Dental Malpractice Claims and Lawsuits: A Medico-Legal Analysis
Authors: Vadde Sunil Venkata Naga , Reddy Madhusudan , Jois Harshavardhan , Koneru Mrunalini , Vedati Prathima
Published: August 2024

Abstract

Background and Aim:

The law of the land assumes that a dentist will always use credible skill, care, and caution in the care of patients. Failing to do something that one is supposed to do (act of omission) or doing something that one is not supposed to do (act of commission) falls under the purview of medical jurisprudence. Each patient is legally entitled to get quality medical care from a physician; failure to such trust is an actionable offense and grievances can be challenged in consumer redressal forums. This analytical study was aimed to study the reasons for dental negligence cases that sought judicial assistance in consumer courts in terms of monetary benefits and also to study the delay in settlements.

Materials and Methods:

Archival data of final court-pronounced judgment cases on dental negligence between 2018 and 2022 (i.e., 5 years) were gathered from customer forum websites (https://confonet.nic.in, http://indiankanoon.org/doc, and www.casemine.com). A total of 56 proven dental allegation cases were retrieved. In each verdict case, the allegation against dentist by the plaintiff was recorded, and the response to the complaint by the defendant was studied and analyzed. The year of filing the case and date of judgment, basis of compensation awarded, delay in judgment and role of expert evidence appointed by the court assessed.

Results:

Misdemeanor by serious negligence: 3, slight negligence: 8, negligent injuries: 35, felony of injuries by serious negligence: 10.

Conclusion:

Because dentistry involves making decisions in unclear scenarios that affect patient care, there is an inherent danger of malpractice litigation. Awareness of medico-legal issues and professional indemnity insurance coverage for the dentist to safeguard himself from negligence, continuous medico-legal training and documentation of records, and adherence to clinical standards for procedures should be emphasized as prior motives to enhance the standard of care, and a basic awareness of how Indian courts resolve disputes would help dentists plan their professional indemnity insurance and operate their profession properly.
Megacystis-microcolon-intestinal Hypoperistalsis Syndrome: Four Consecutive Pregnancies with Megacystis
Authors: Saraiva Susana , Solinho M. , Lourenço C. , Brito C.
Published: August 2024

Megacystis-microcolon-intestinal hypoperistalsis syndrome is a rare congenital disease with a poor prognosis and life expectancy. We present the prenatal diagnosis of four consecutive cases in the same woman. After medical genetics consultation, the couple was advised to resort to medically assisted reproduction techniques with oocyte donation. This case report demonstrates the recurrence of a rare disease in four consecutive pregnancies and how prenatal diagnosis assumed a preponderant role in parental counseling.