bluuebunny/crossref_metadata_2025 huggingface dataset:
Patch Testing in Toilet Seat Dermatitis: A Case Series of Six Patients with Paediatric Atopic Dermatitis
Authors: Begum Farheen , Asritha CVV , Panda Maitreyee , Agarwal Akash
Published: June 2024

Background:

Toilet seat dermatitis (TSD) is a localized form of dermatitis that commonly occurs in the buttocks and upper posterior aspect of the thigh in school-going children. Previously, it was mostly seen due to allergic contact dermatitis to wood, but recently, many other allergens in toilet seats along with the possibility of irritant contact dermatitis (ICD) to detergents were reported.

Materials and Methods:

Six cases diagnosed clinically as atopic dermatitis per Hanifin and Rajka criteria presented with posterior thigh dermatitis. Patch testing using the Indian Standard Series, toilet seat scrapings, and detergents was conducted.

Results:

Patch testing showed negative results at 48, 96, and 168 hours, including lesional site testing. Symptomatic management, including topical steroids and later tacrolimus, was administered, coupled with counselling on toilet seat cover use, with a follow-up after four weeks. Lesions showed resolution and reduced itching.

Limitation:

This study’s limitation lies in its small sample size from a single geographic area.

Conclusion:

Lesion resolution through topical treatment and toilet seat avoidance, support a diagnosis of contact dermatitis; however, the role of atopy remains crucial, suggesting a complex interplay. Larger studies are needed for a comprehensive understanding of this dermatological condition.
Diagnosis of primary immunodeficiency diseases by flow cytometry: Experience from Bangladesh
Authors: Sarker Avizit , Islam Mohammad Imnul , Nigar Ismet , Juyee Nusrat Akhtar , Ahmed S. M. Ali , Chakrobortty Tripty , Soma Susmita Karmakar , Ali Md. Eunus , Roy Chandan Kumar
Published: June 2024

BACKGROUND:

Primary immunodeficiency diseases (PIDDs) are clinically and immunologically diverse and require a wide array of clinical and laboratory modalities to make specific diagnosis. Serum immunoglobulin levels and T cell, B cell and NK (Natural killer) cell immunophenotyping are routine laboratory investigations advised to diagnose the PIDD cases in Bangladesh. Along with T-B-NK markers, use of Naïve (CD45RA+) and memory (CD45RO+) T cell, switched memory B cell (CD27+IgD-) markers, detection of intracellular BTK (Bruton’s tyrosine kinase), LRBA (Lipopolysaccharide-responsive beige-like anchor), DOCK8 (Dedicator of cytokinesis 8) protein expression and DHR123 (Dihydro-rhodamine 123) assay of neutrophil can increase the PIDD cases detection in Bangladesh.

METHODS:

The study was conducted in the Department of Microbiology and Immunology, Bangabandhu Sheikh Mujib Medical University (BSMMU) during the time period of March, 2021 to February, 2022. Seventy clinically suspected PIDD cases were enrolled in this study on the basis of clinical findings and peripheral venous blood was collected from all patients to perform immunophenotyping. Routine T-B-NK cell, naïve and memory T cell with switched memory B cell markers were detected by flow-cytometry. Serum immunoglobulins (IgG, IgM, IgA & IgE) were estimated by Nephelometry and by Chemiluminescence. Intracellular BTK, LRBA and DOCK8 protein expression was detected by flow-cytometry in suspected X-linked agammaglobulinemia (XLA), LRBA and DOCK8 deficiency patients respectively. DHR123 assay was performed in suspected Chronic granulomatous disease (CGD) patients.

RESULTS:

Among the 70 clinically suspected PIDD cases, 9 (12.9%) were diagnosed as patients of PIDDs on the basis of laboratory evidence. Five (55.55%) cases were diagnosed as predominantly antibody deficiencies (PADs), 3 (33.33%) were patients of combined immunodeficiency (CID) and 1 (11.11%) was CGD patient. Among the diagnosed PIDD cases, 2 (22.22%) were diagnosed by T-B-NK cell immunophenotyping with serum immunoglobulin levels and 7 (77.77%) cases were diagnosed by additional CD45RA+, CD45RO+, CD27+IgD- markers, BTK protein expression detection and DHR123 assay. LRBA and DOCK8 deficiency cases could not found in this study.

CONCLUSION:

The use of additional markers (CD45RA+, CD45RO+, CD27+IgD-) with BTK, LRBA, DOCK8 intracellular protein expression evaluation and DHR123 assay by flow-cytometry can increase rate of specific diagnosis of the PIDD cases in Bangladeshi paediatric population.
Serum ferritin levels in chronic spontaneous urticaria in association with autologous serum skin test: A cross-sectional study
Authors: Shaheema A. M. , Fernandes Michelle Serene
Published: June 2024

BACKGROUND:

Chronic spontaneous urticaria (CSU) is a common clinical condition presenting with wheals or along with angioedema. It has a complex pathogenesis having a considerable impact on quality of life. In patients with chronic spontaneous urticaria (CSU) exhibiting poor response to conventional treatments, the presence of hyposiderinemia suggests that oral iron therapy could potentially lead to resolution of the urticaria symptoms.

OBJECTIVES:

(1). To estimate serum ferritin levels in patients with CSU. (2) To assess the correlation between urticarial activity score, autologous serum skin test (ASST), and serum ferritin levels in CSU.

MATERIALS AND METHODS:

This prospective study enrolled 37 cases of clinically diagnosed CSU attending the dermatology outpatient department from December 2019 to November 2020 after Institutional Ethics Committee approval. ASST and serum ferritin level estimation were done on all patients. The severity of urticaria was calculated using the Urticaria Activity Score. Statistical analysis was done by frequency, standard deviation, and Chi-square test.

RESULTS:

Among ASST-positive patients, only 4 (19%) had low ferritin levels. No association was found between ASST and serum ferritin levels (P = 0.342). Mean serum ferritin levels in ASST-positive patients were high 91.34 ± 87.24 μg/L which was statistically significant compared to mean serum ferritin levels in ASST-negative patients 49.64 ± 46.91 μg/L. There was significant involvement of palms and soles in ASST-positive patients (P = 0.038).

CONCLUSION:

Although there was no significant correlation of serum ferritin levels with CSU, oral iron supplementation may be considered an add-on treatment in case of refractory urticaria.
Laparoscopic management of delayed traumatic left diaphragmatic hernia with intrathoracic kidney: A rare case report and technical aspects
Authors: Shenoy Ganesh K. , Thomas Marina , Shamburao Ramesh B. , Jan Nawab
Published: June 2024

Occult traumatic diaphragmatic hernias (DHs) are relatively rare and may present years after the trauma. Clinical presentations range from asymptomatic incidental findings on imaging to life-threatening incarceration of abdominal organs. Traumatic migration of the kidney into the thorax is a very uncommon event. We herein report a rare case of a 34-year-old male patient with a symptomatic DH secondary to a motor vehicle accident and a history of laparotomy for liver laceration 10 years back who underwent laparoscopic reduction and intraabdominal reposition of left kidney from thorax, suture repair of the defect with mesh reinforcement. Thoracoscopic visualization was performed to assess the efficiency and completeness of the repair and to rule out any iatrogenic pericardial injury after mesh fixation. The operative technique, difficulties encountered, and tips to overcome these challenges were discussed. With adequate expertise, reduction, and repositioning of migrated kidney, suture closure of the defect with mesh reinforcement is safe and feasible by laparoscopic approach.
Isolated Renal Mucormycosis by Apophysomyces in an Immunocompetent Adult
Authors: Sethi Jasmine , Shankar Gowri , Subramani Vignesh , Mete Uttam , Prabhakar Nidhi , Kaur Harsimran
Published: June 2024

ABSTRACT

Isolated renal mucormycosis (IRM) in an apparently healthy immunocompetent adult is a rare entity with most cases reported from India and China. Fever not responding to antibiotics, sterile pyuria, and characteristic imaging findings are strong pointers toward renal mucormycosis. We report a rare case of IRM due to Apophysomyces elegans in an apparently healthy young adult who underwent bilateral nephrectomy and ultimately succumbed to sepsis. Clinical indicators such as fever not responding to antibiotics, severe flank tenderness, sterile pyuria, and characteristic computed tomography findings (diffuse or patchy areas of absent contrast enhancement, perinephric fat stranding, and thickened Gerota’s fascia) are strong pointers toward renal mucormycosis. Aggressive surgical debridement and timely antifungal is imperative for favorable patient outcome in this aggressive infection.
Prevalence and Factors Predicting Nondiabetic Kidney Disease in Type 2 Diabetic Patients
Authors: Subramani Vignesh , Venkatasubramanian Vaishnavi , Sethi Jasmine , Sekar Aravind , Nada Ritambhra , Rathi Manish
Published: June 2024

ABSTRACT

Background:

Renal involvement in type 2 diabetes is mostly presumed to be due to diabetic nephropathy; however, a significant majority of diabetic patients can have pure nondiabetic kidney disease (NDKD) or NDKD superimposed on diabetic kidney disease (DKD). Kidney biopsy cannot be routinely performed for all diabetic patients, and hence, short of conclusive biomarkers, we need to explore various factors that can predict the occurrence of NDKD.

Methods:

We conducted a retrospective review of all native kidney biopsies conducted in patients with type 2 diabetes at our institute to identify the prevalence and factors that predict NDKD. The demographic data, clinical data, laboratory parameters, and histological results of the patients were obtained from their medical records. Binary logistic regression analysis was performed to evaluate the predictive factors for NDKD.

Results:

We analyzed a total of 69 patients. The mean (standard deviation) age of the cohort was 51.94 ± 12.7 years and males constituted the majority (68%). Patients with pure DKD, pure NDKD, and NDKD superimposed on DKD constituted 46.3%, 33.3%, and 20%, respectively, of the cohort. Around two-third of pure DKD patients in our cohort had diabetic retinopathy (DR), whereas only around one-fifth (26%) of pure NDKD patients had DR (P = 0.005). Membranous glomerulonephritis (MGN) was the most common histological lesion in the NDKD group (43%), followed by acute tubulointerstitial nephritis (ATIN) (17.3%). Among combined DKD and NDKD, the most common histological diagnosis was pyelonephritis (28.6%), followed by MGN and ATIN (14.3%). Independent factors predicting NDKD were shorter duration of diabetes (odds ratio [OR] = 0.74, confidence interval [CI] =0.59–0.94, P = 0.01) and absence of DR (OR = 0.15, 95% CI = 0.09–0.26, P = 0.01).

Conclusion:

Kidney biopsy revealed NDKD in nearly half of type 2 diabetes mellitus (T2DM) patients, especially in those with short duration of diabetes and absence of DR. Kidney biopsy is strongly recommended for T2DM patients with atypical presentation and in the absence of DR.
Vesicoureteral Reflux Fixed; Kidneys Not Fixed! – A Case Series
Authors: Deshpande Pankaj Venkatrao
Published: June 2024

ABSTRACT

Surgery is advocated in high-grade vesicoureteral reflux (VUR) in children (grades 4 and 5) to prevent recurrent urinary tract infections (UTIs) and prevent kidney damage. Recent studies have shown that the risk of recurrent UTIs is minimal, even with conservative management. In the three cases presented here, reimplantation of the ureters was done to abolish high-grade VUR. Yet these children have abnormal kidney function and proteinuria on long-term follow-up (10 years and more), though kidney function was normal at the time of surgery. The surgical procedures to correct the high-grade VUR do not preclude the kidney damage entirely. These children often are born with dysplastic kidneys. The outcome in terms of kidney function depends on many factors, such as the degree of dysplasia that is present in the kidneys at birth, proteinuria, hypertension, bladder-bowel dysfunction, and recurrent UTI. Abolishing VUR by surgical means does not seem to change the outcome.
Intracranial Hypertension in a Person Infected with Influenza A: An Accidental Diagnosis
Authors: Augustine Jolsana , Paulson Caroline Theresa , Abdalla Khadiga , Ebied Ahmed Ahmed , Harriss Mohammed
Published: June 2024

Idiopathic intracranial hypertension (ICH) is a neurological syndrome determined by a rise in intracranial pressure without a specific cause. The exact pathophysiology of this disease is unknown. Intake of retinoids, steroid hormones, high body mass index, release of cytokines, and adipokine levels could be possible causal or associated factors. The association of influenza with ICH has been observed rarely in adults. The clinical symptoms can be headache, disturbance of vision, diplopia, and tinnitus, which can be very well missed during an acute flu attack as the symptoms overlap. Even though papilledema is considered the most specific sign, it is rarely found. Neuroradiological signs on magnetic resonance imaging may suggest the diagnosis of idiopathic ICH. Ophthalmological evaluation is mandatory to find out complications and sequelae in the form of visual loss. Lumbar puncture and cerebrospinal fluid opening pressure measurement are helpful in establishing a diagnosis as well as relieving pressures as part of the management. Influenza is a preventable disease with the administration of a yearly vaccine against specific strains of the virus for the year and region, as released by the Center for Disease Control.
Clinical Utility of Pulmonary Rehabilitation in Diffuse Parenchymal Lung Diseases
Authors: Joshi Ambarish , Sujatha Gorle , Gupta Nitesh , Kumar Rohit , Sen Manas Kamal , Ish Pranav , Rathi Vidushi , Popalwar Harshanand
Published: June 2024

Background:

Pulmonary rehabilitation (PR) can help in improving the exercise capacity and quality of life (QoL) in diffuse parenchymal lung diseases (DPLDs), even in end-stage lung diseases listed for lung transplant. With the paucity of literature from the Indian population, the current study assessed PR’s benefits on the respiratory functions and exercise capacity in DPLD.

Methods:

This prospective interventional study was conducted over 18 months in patients with diagnosed stable DPLD who were previously not involved in any PR program. All the enrolled patients underwent 12-week in-hospital, supervised PR program, which included exercise training with increasing load, endurance training, resistance training, flexibility training, and stretching. The patients were evaluated for the measures at baseline and after 12 weeks of a rehabilitation program.

Results:

There was a significant improvement in respiratory capacity forced expiratory volume in 1 s (FEV1), 6-min walk distance (6MWD), Modified Medical Research Council (MMRC), and total St. George’s Respiratory Questionnaire scores (P < 0.05) after the completion of the PR program. Among the outcome parameters, there were no significant differences in the PO2 and FEV1/forced vital capacity ratio (P > 0.05) etiologically; the improvement was significant for all outcome parameters except MMRC and symptom score in the idiopathic pulmonary fibrosis (IPF) group (P = 0.165). In the non-IPF group, the improvement was significant for all outcome parameters except PO2 (P = 0.9). On multivariate linear regression, age was the only independent factor for 6MWD (P = 0.0002; 95% confidence interval [CI]: −5.019–−1.665) and MMRC (P = 0.005; 95% CI: 0.007–0.037).

Conclusion:

This study reveals that PR is effective for people with DPLD in decreasing the symptoms and improving the exercise capacity and QoL. Clinical improvement is greater in those with non-IPF compared to IPF, but both groups as a whole achieved clinically significant improvements. An adaptation of the PR regimen as per age may be necessary for optimizing the clinical benefits.
Dietary Assessment of Tuberculosis Patients Receiving Treatment at a Tertiary Care Center in New Delhi
Authors: Nath Ravindra , Ahmad Aftab , Debnath Aninda , Rathi Vidushi , Ish Pranav
Published: June 2024

Introduction:

Undernutrition and tuberculosis (TB) are interrelated, with a bidirectional relationship. Despite its potential impact on nutritional status and TB patient outcomes, there is limited information available on the dietary patterns of TB patients in the Indian TB program. This study aims to address this knowledge gap by evaluating dietary patterns and factors associated with reduced dietary intake among TB patients in a tertiary care center.

Methodology:

This was a cross-sectional study conducted in a directly observed treatment short center working under the National Tuberculosis Elimination Program. A semi-structured, pretested interviewer-administered questionnaire was used to collect data related to the demographic profile and dietary patterns of 49 patients.

Results:

The mean calorie intake among the patients was 1525.2 (±897) kcal, whereas the required mean calorie intake was 2231.6 (±409.2) kcal. The mean protein requirement was 66.9 (±15.2) g, whereas the mean protein intake was only 39.2 (±15.4) g.

Conclusion:

To strive toward the goal of TB elimination in India, the nutritional care of the patient cannot be undermined. The need of the hour is to enforce the nutritional supplementation as well as support program by the government at the national level.
Comparative Evaluation of Masseter and Buccinator Muscle Activity using Electromyography in Denture Wearer and Nondenture Wearer by Fabricating Dentures with Neutral Zone Technique – An In vivo Study
Authors: Dafade Anagha , Dhamande Mithilesh , Sathe Seema , Borle Anjali Bhoyar , Shinde Dipak , Balwani Tanvi
Published: June 2024

Introduction:

The objective of this study was to analyze buccinator and masseter muscle activity in previous denture wearer and nondenture wearer wherein dentures were constructed with neutral zone technique; however, complete dentures for patients with no history of previous dentures can be made with a neutral zone technique for improved stability.

Methodology:

A total of 50 patients were included in this study among which, Group A consisted of a total of 25 patients, who were old denture wearer and for whom a new denture was fabricated with the neutral zone technique. Group B consisted of 25 patients who were first-time denture wearer for whom a new denture was fabricated with a neutral zone technique.

Results:

The muscle activity does not significantly differ in previous denture and nondenture wearers. However, complete dentures for patient with no history of previous dentures can be made with a neutral zone technique for improved stability.

Conclusions:

Buccinator and masseter muscle activities significantly differ due to morphological changes that occurred in denture wearers and nondenture wearers.
Reproducibility of Sagittal Condylar Path Inclination Assessed by Protrusive Interocclusal Record with Two Different Techniques of Facebow Registration
Authors: Jain Ajay , Ugrappa Sridevi , Hui Ooi Jia , Jun Ooi Wan , Ting Pang Siao
Published: June 2024

Purpose:

The purpose is to validate whether the data obtained for sagittal condylar inclination are correctly reproduced on the semi-adjustable articulator using protrusive interocclusal records for conventional facebow registration method (orbitale (OR) as an anterior point of reference) and facebow registration using bubble leveler (BL) as an anterior point of reference and compared these values with the values obtained by lateral cephalogram (gold standard).

Materials and Methods:

In total, 30 individuals (20 males and 10 females) with proper teeth alignment, facebow registrations were recorded using OR as an anterior point of reference (Group A, conventional technique) and WBL as an anterior point of reference (Group B). The sagittal condylar path inclination was measured and compared using protrusive interocclusal records for both the groups. These values compared with the values for sagittal condylar path inclination obtained using lateral cephalogram (Group C) using one-way analysis of variance (P < 0.05).

Results:

There was no statistically significant differences observed in the values of sagittal condylar inclination for all three groups with P = 0.583.

Conclusion:

This study suggests that BL technique can be used for the orientation of maxillary cast on the semi-adjustable articulator as accurately as the conventional approach, for those practitioners who find difficulty in locating the OR for those patients with deformity in facial region. Lateral cephalogram provides almost the same measurements of sagittal condylar path inclination as obtained using protrusive interocclusal record on facebow registrations using OR and BL as an anterior point of references.
Impact of Quality of Life among Teachers after Nursing Strategy Intervention – A Quantitative Study
Authors: Cathrine R. Thephilah , Aruna S. , Vijayaragahavan R.
Published: June 2024

Introduction:

Teachers are one of the most significant human resources. The qualities and nature of any instructive framework depends generally on their teacher's work. It has been very much reported that educating is one of the most distressing professions in the world.

Aims:

The aims of this study were as follows: (i) to assess the level of quality of life (QOL) among teachers of private and fully aided schools in posttest for the experimental and control groups and (ii) to determine the effectiveness of nursing strategies on QOL among teachers of private and fully aided schools. Materials and methods: A quantitative research approach with true experimental design including experimental and control groups and pretest–posttest control group design, was adopted for this study. The study focused on the selected schools in Vellore district. Totally 28 participants were selected by consecutive sampling technique with the age of 25–60 years. Based on the inclusion criteria and availability of teachers, they were allocated into control group (n = 14) and experimental group (n = 14). A nursing strategy program by various modules (the nature of stress, cognitive skills, affect skills, and behavioral skills) once a week for 6 weeks was given. Results: We found that the median value in pretest is significantly different from median value in posttest (P = 0.001). This research suggests that nursing strategy interventions are effective and beneficial in all domains of QOL.

Conclusion:

More help ought to be offered to teachers to improve their QOL and prosperity.
Clinical Study of Age-Related Macular Degeneration-Incidence, Visual Acuity Assessment, and Risk Factors
Authors: Jaiswal Sapan , Raut Priyanka , Kamble Mala , Gadegone Aditi
Published: June 2024

Background:

Age-related macular degeneration (AMD) is an eye disease that can blur the sharp, central vision you need for activities like reading and driving. “Age-related” means that it often happens in older people. “Macular” means it affects a part of your eye called the macula.

Settings and Design:

AMD is a common condition – it's a leading cause of vision loss for people age 50 and older. AMD doesn't cause complete blindness, but losing your central vision can make it harder to see faces, drive, or do close up work like cooking or fixing things around the house.

Methods:

AMD happens very slowly in some people. Even if you have early AMD, you may not experience vision loss for a long time. For other people, AMD progresses faster and can lead to central vision loss in one eye or both eyes.

Conclusion:

The present article aims to summarize the current knowledge on AMD its incidence, visual acuity, and risk factors
Study of Electrocardiographic and Two-Dimensional Echocardiography Changes in Patients of Intracerebral Hemorrhage and its Outcome in Terms of Mortality
Authors: Narayankar Atul S. , Shivnitwar Sachin Kisan
Published: June 2024

Aims of the Study:

The aim was to study the electrocardiographic and two-dimensional echocardiography (2D ECHO) changes in patients of intracerebral hemorrhage and its outcome in terms of mortality.

Materials and Methods:

Patients admitted to medicine ward and intensive care unit selected for the study. Their electrocardiography (ECG), 2D ECHO, and outcome noted.

Results:

Mortality was higher in patients of intracerebral bleed having ECG and 2D ECHO changes than those with normal ECGs and 2D ECHO.

Conclusion:

ECG and 2D ECHO abnormalities are common in patients of intracerebral hemorrhage, and these have prognostic significance in predicting mortality in patients of intracerebral hemorrhage. Thus, every patient of intracerebral hemorrhage should undergo ECG and 2D ECHO examination for the evaluation of cardiac dysfunction occurring in these patients.
Ropivacaine with Dexmedetomidine versus Ropivacaine Alone in Ultrasonography-Guided Supraclavicular Brachial Plexus Block
Authors: Dash L. K. , Raghu K. , Rajaram G.
Published: June 2024

Context:

Supraclavicular brachial plexus block is the most flavored technique for upper limb surgeries in the day-to-day anesthetic practice. Adjuvants are commonly used along with local anesthetics to improve the overall quality of block. Dexmedetomidine is a α2 adrenoceptor agonist, nowadays gaining popularity due to its favorable outcomes.

Aims:

The aim of this study is to compare the block characteristics of 0.5% 30 ml ropivacaine alone with 0.5% 30 ml ropivacaine combined with 50 mcg of dexmedetomidine.

Settings and Design:

This was a prospective randomized controlled study.

Materials and Methods:

One hundred patients in the age group of 20–60 years, of American Society of Anesthesiologists Grade I and II, scheduled for elective upper limb surgeries were included in this study. Patients were divided into two groups of 50 each to receive either ropivacaine alone (Group A) or ropivacaine-dexmedetomidine combination (Group B). Onset and duration of sensory and motor blockade were assessed.

Statistical Analysis Used:

Standard qualitative and quantitative tests were used to compare data. P < 0.05 was considered statistically significant.

Results:

The onset of sensory and motor blockade was faster in Group B when compared to Group A (17.32 ± 2.05 min, 24.23 ± 5.83 min vs. 22.58 ± 1.75 min, 28.61 ± 2.78 min), the duration of sensory and motor blockade was longer in Group B when compared to Group A (635.0 ± 27.12 min, 513.21 ± 26.14 min vs. 501.1 ± 33.14 min, 402.17 ± 18.16 min), and the duration of analgesia was also longer in Group B compared to Group A (338.16 ± 10 min vs. 247.20 ± 12 min).

Conclusion:

Dexmedetomidine as an adjuvant to ropivacaine fastened the onset of block, prolonged the duration of block, and prolonged the duration of analgesia.
Comparison between two-hole-assisted phaco-chop and stop-and-chop techniques for nuclear disassembly in residents’ cataract surgery
Authors: Naqaish Rehan , Alrawashdeh Hamzeh M. , Sabih Rayyan , Naqvi Syed A. H. , Osama Muhammad , Sohail Salman , Niazi Manahil
Published: June 2024

PURPOSE:

The purpose of this study was to evaluate the safety of the novel two-hole-assisted phaco-chop technique as a transition between stop-and-chop and direct-chop techniques and to compare its phacoemulsification parameters with the stop-and-chop technique.

METHODS:

A prospective quasi-experimental study was conducted at Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan. One hundred and three patients (103 eyes), aged 18 years and above, with nuclear sclerosis (NS)+2, NS +3, +4, cortical, and posterior subcapsular cataracts (WHO Cataract Grading Group) were included, whereas patients with uveitis, glaucoma, traumatic cataracts, small pupils, zonular weakness, lens subluxation, small palpebral fissures, soft cataracts (NS + 1), and posterior polar cataracts were excluded from the study. The stop-and-chop technique was performed in 58 (56.3%) patients, whereas the two-hole-assisted chop technique in the rest. Ultrasound time (UST), total surgical time, and volume of balanced salt solution (BSS) delivered were recorded.

RESULTS:

The mean age of the participants was 65.12 ± 8.85 years. The comparison of the two techniques revealed no statistically significant difference in the UST (P = 0.723), volume of BSS used (P = 0.102), and total surgery time (P = 0.517). However, a significant positive correlation between cataract grade and UST (Spearman’s r = 0.888, P < 0.001), BSS volume delivered (Spearman’s r = 0.831, P < 0.001), and surgery time (Spearman’s r = 0.846, P < 0.001) was observed. Moreover, the UST comparison between cataract grades revealed a significant difference between the three groups (F = 185.09 P < 0.001). P < 0.05 was considered statistically significant.

CONCLUSION:

The two-hole-assisted phaco chop is a safe and efficient transitional technique between stop-and-chop and direct-chop techniques for nuclear disassembly in cataract surgery performed by resident surgeons. In addition, the phacoemulsification parameters of the two-hole-assisted chop technique are comparable with the stop-and-chop technique.
Sociodemography, diabetes mellitus clinical parameters, and retinal morphology as predictors of neurodegeneration in preclinical diabetic retinopathy
Authors: Sooryanarayana Sathiya P. , Hairol M. Izzuddin
Published: June 2024

PURPOSE:

The current prediction of preclinical diabetic retinopathy (DR) in asymptomatic patients with diabetes mellitus (DM) is limited due to a lack of suitable indicators. This study aimed to identify the predictors of neurodegenerative changes in type 2 DM patients during the preclinical stage of DR using sociodemographic and DM clinical parameters and retinal morphology.

METHODS:

Fifty-six adult DM participants (mean age: 40.41 ± 7.281 years) were classified into three groups: DM without DR, DM with mild nonproliferative DR (NPDR), and DM with moderate-to-severe NPDR. Demographic data, including age, gender, race, DM duration, glycated hemoglobin levels, household income, comorbidities, and insulin dependency, were collected. Retinal morphology, including macular retinal layer thickness, peripapillary retinal nerve fiber layer, and vascular caliber, were analyzed. Multinomial logistic regression models explored these factors’ influence on NPDR prediction.

RESULTS:

Participants with moderate-to-severe NPDR were less likely to have DM without comorbidities (odds ratio [OR]: 0.048, 95% confidence interval [CI]: 0.003–0.823, P = 0.036). Those with longer DM duration were 27% more likely to develop moderate-to-severe NPDR (OR: 1.272, 95% CI: 1.035–1.564, P = 0.022). Retinal morphology parameters did not predict NPDR risk and severity levels in DM patients, except for mild NPDR, which had a 1.05 times higher risk of wider central retinal arteriolar equivalent (CRAE) (OR: 1.052, 95% CI: 1.002–1.105, P = 0.043).

CONCLUSION:

DM duration, comorbidity presence, and widened CRAE are critical parameters for assessing neurodegenerative changes in preclinical DR. These parameters could be incorporated into DR screening programs to mitigate NPDR progression and enhance long-term visual outcomes of DM patients.
A study to evaluate and compare Parker Flex-Tip tube and polyvinyl chloride endotracheal tube for hemodynamic response during intubation
Authors: Bansal Teena , Singhal Suresh , Aggarwal Ajay
Published: June 2024

Background and Aims:

Both laryngoscopy and endotracheal intubation individually contribute to hemodynamic pressor response following endotracheal intubation. Parker Flex-Tip tracheal tube has a flexible, curved, smooth, centered, and tapered distal tip that is designed to facilitate rapid, easy, and nontraumatic intubation. The present study was conducted to compare Parker Flex-Tip and polyvinyl chloride (PVC) endotracheal tube (ETT) for hemodynamic response during intubation.

Materials and Methods:

Sixty patients of either sex of age 18–50 years, belonging to the American Society of Anesthesiologists (ASA) physical Status I or II scheduled for elective surgery under general anesthesia requiring endotracheal intubation were included. In Group I (n = 30), Parker Flex-Tip tube was used and in Group II (n = 30), PVC ETT was used. Heart rate (HR), systolic blood pressure, diastolic blood pressure (DBP), and mean arterial pressure were compared at various time intervals. Quantitative variables were compared using unpaired t-test and qualitative variables were compared using Chi-square test. P ≤0.05 was considered statistically significant.

Results:

The mean basal value of HR was 81.33 ± 13.78 beats/min in Group I and 87.36 ± 13.34 beats/min in Group II (P = 0.09). The difference between both the groups was found to be comparable at baseline, prelaryngoscopy, and just after laryngoscopy (AL) but this difference was found to be statistically significant just after intubation (AI) and at 1 min AI. In both groups, DBP started increasing just AL but the difference was not significant. This difference between the two groups was observed to be statistically significant at 1 min AI (81.73 ± 13.29 in Group I vs. 88.96 ± 10.27 in Group II, [P = 0.02]).

Conclusion:

Parker Flex-Tip tube is beneficial in controlling the hemodynamic response during laryngoscopy and intubation. This effect is significantly evident in HR and DBP.
Effect of oral clonidine premedication on perioperative hemodynamics and postoperative analgesia in patients undergoing laparoscopic cholecystectomy: A prospective randomized double-blind placebo-controlled clinical trial
Authors: Meena Khemraj , Verma Reena , Sharma Sandeep , Choudhary Santosh , Kumar Yogesh , Thomas Chanchel Mary
Published: June 2024

Background:

Laryngoscopy, endotracheal intubation, and creation of pneumoperitoneum during laparoscopic cholecystectomy cause sympathetic stimulation manifesting as hypertension, tachycardia, arrhythmia, and myocardial ischemia.

Methods:

We undertook this study to determine the effect of oral clonidine premedication on perioperative hemodynamics, postoperative pain, and sedation for patients undergoing laparoscopic cholecystectomy. In this double-blinded randomized controlled trial, 100 American Society of Anesthesiologists Grades I and II patients scheduled for laparoscopic cholecystectomy were randomized into 2 groups to receive 100 μg tablet clonidine in Group I and ranitidine 150 mg tablet in Group II (control group) 90 min before induction of general endotracheal anesthesia. Effect on hemodynamic parameters, duration of analgesia, requirement of rescue analgesic, and sedation score was assessed. Data were expressed as mean ± standard deviation or number (proportion). Unpaired t-test and Chi-square test were applied wherever indicated. P < 0.05 was considered statistically significant.

Results:

Patients in the clonidine group had lower systolic blood pressure, diastolic blood pressure, mean arterial pressure, and heart rate values as compared to control group at all measured time intervals (P < 0.05). The duration of analgesia was prolonged in the clonidine group (256.6 ± 34.97 min vs. 103.4 ± 10.94 min, P = 0.000). Total amount (88.50 ± 29.11 mg vs. 165.00 ± 30.31 mg, P = 0.000) and number of doses (1.18 ± 0.39 vs. 2.20 ± 0.40, P = 0.000) of rescue analgesic requirement in 1st 24 h postoperative period were also lesser in clonidine group. The sedation score was higher in clonidine group just after extubation (2.24 ± 0.43) as compared to the placebo group (1.92 ± 0.40, P = 0.000) at 1 h of postoperative period.

Conclusion:

Premedication with 100 μg clonidine provides stable hemodynamics against stress response triggered by the creation of pneumoperitoneum, laryngoscopy, and endotracheal intubation in patients undergoing laparoscopic cholecystectomy and also prolongs the duration of postoperative analgesia with reduced requirement of rescue analgesics without causing prolonged postoperative sedation.
A prospective randomized double-blind clinical study to compare the effect of nalbuphine versus fentanyl on attenuation of pressor response during endotracheal intubation and analgesic potential on patients under general anesthesia
Authors: Singh Maina , Ali Naazneen , Patodi Veena , Kumar Pradeep , Mathur Veena , Khare Arvind
Published: June 2024

Background:

Laryngoscopy and orotracheal intubation often trigger a hemodynamic response, increasing catecholamines and potentially leading to higher morbidity. Fentanyl, with a high safety margin and rapid onset, and Nalbuphine, a µ receptor antagonist and k receptor agonist with minimal respiratory depression and a “ceiling effect,” are commonly used to mitigate this response.

Aim:

This study compares the efficacy of Fentanyl and Nalbuphine in reducing the pressor response during laryngoscopy and intubation in patients under general anesthesia, monitored by Bispectral Index (BIS). It also evaluates total analgesic requirements, time to first rescue analgesic post-extubation (VAS score), and associated complications.

Method:

The study was a hospital-based, prospective, double-blind, randomized interventional trial registered under the Clinical Trials Registry - India (CTRI/2022/05/042731). The sample size of 70 patients (35 in each group) was calculated based on alpha error, study power, and the minimum clinically significant difference for MAP after induction. Patients aged 18-65 years with ASA grade I and II and body weight between 40-70 kg were included. Group A received Fentanyl, and Group B received Nalbuphine. Vital parameters were monitored during the surgery, and additional doses of the study drug were administered if the BIS score exceeded 60. Postoperative analgesic effect was evaluated by a blinded anesthesiologist.

Results:

The demographic characteristics of the study population were similar between the Fentanyl and Nalbuphine groups, as indicated by age, weight, sex, and ASA physical status, there was a statistically significant difference in systolic blood pressure, diastolic blood pressure, mean arterial pressure and heart rate post-intubation, with the Nalbuphine group demonstrating a greater increase compared to the Fentanyl group, which was significant at all time intervals.
Comparative study between retrograde intrarenal surgery and ultrasound- guided shock wave lithotripsy for treatment of 1 to 2 cm radiolucent lower calyceal stones
Authors: Elal Ashraf M Abd , Shaher Hussein , El-Barky Ehab , Ali Saad , Omar Rabea Gomaa
Published: June 2024

Objectives:

The objective is to compare the safety and efficacy of retrograde intrarenal surgery (RIRS) and ultrasound-guided (US-guided) shock wave lithotripsy (SWL) for the treatment of radiolucent lower pole calculi of 1–2 cm.

Materials and Methods:

This prospective randomized study was performed at our tertiary care urology institute of Benha University Hospitals; cases were randomized either to undergo RIRS (Group A) or US-guided SWL with a triple focus system (Group B). The safety and effectiveness of both therapies were compared using new criteria for stone-free rate (SFR): Grade A (absolutely stone free), Grade B (≤2 mm fragments), and Grade C (>2 mm up to 4 mm fragments), fluoroscopy time, operative time, auxiliary procedures, retreatment, and complications.

Results:

Out of 100 patients, 92 were eligible for this study. RIRS had a higher SFR of 88.9% compared to SWL, 72.3% (P = 0.045). Furthermore, stone-free classification significantly differed between the studied groups (P < 0.001), with Grade A being significantly higher in Group A. Conversely, Grades B and C were lower in Group A. On the other hand, operative and fluoroscopy times were significantly reduced with SWL (P = 0.004 and < 0.001, respectively). While complications did not significantly differ between the two groups (P = 0.340), a significant distinction was observed in terms of the Clavien–Dindo classification.

Conclusions:

RIRS is an effective and safe option for treating radiolucent lower calyceal stones of ≤2 cm, with a greater SFR and lower need for auxiliary operations. However, Sono SWL is a cost-effective alternative that can achieve a comparable success rate after retreatment sessions.
Characteristics and management of iatrogenic urinary tract injuries in teaching hospital: A single-centered study
Authors: Warli Syah Mirsya , Ramon Ryan , Nasution Ramlan , Kadar Dhirajaya Dharma , Adhyatma Kharisma Prasetya , Tala Mohd. Rhiza Z.
Published: June 2024

Context and Aims:

Despite its rarity, iatrogenic urinary tract injury can cause severe morbidity and mortality. The purpose of this study was to determine the frequency of urinary tract injuries caused by medical treatment in a hospital in Medan, Indonesia.

Settings and Design:

This retrospective descriptive study was conducted at H. Adam Malik General Hospital and Universitas Sumatera Utara Hospital in Medan from March to August 2022.

Subjects and Methods:

Medical data of individuals who had iatrogenic urinary tract injuries in a Medan teaching hospital from 2018 to 2022 were obtained using total sampling. SPSS version 25 was utilized to analyze patient characteristics, the type of surgery, urinary tract injuries, and urologic procedures.

Results:

There were 11 ureteral injuries and 23 bladder injuries in 32 iatrogenic urinary tract injuries. The average age of the patients was 40.5 ± 13.3. Patients who received obstetrical care had the highest rate of iatrogenic urinary tract injury (56.3%), followed by patients who received gynecological care (21.9%) and surgical care (21.9%). The procedure most likely to cause iatrogenic urinary tract injury was hysterectomy (40.6%). Bladder rupture (65.5%) and ureteral transection (28.1%) were common types of iatrogenic bladder and ureteral injuries. Majority of iatrogenic urinary tract injuries were treated with bladder repair (68.8%).

Conclusions:

Obstetrical and gynecologic procedures, especially hysterectomy, were the most common causes of iatrogenic urinary tract injury; bladder repair was the most common treatment. Iatrogenic urinary tract injury is best managed by knowing the anatomical position of the urinary tract inside the operative field.
Dimers on Riemann surfaces I: Temperleyan forests
Authors: Berestycki Nathanaël , Laslier Benoit , Ray Gourab
Published: June 2024

This is the first article in a series of two papers in which we study the Temperleyan dimer model on an arbitrary bounded Riemann surface of finite topological type. The end goal of both papers is to prove the convergence of height fluctuations to a universal and conformally invariant scaling limit. In this part, we show that the dimer model on the Temperleyan superposition of a graph embedded on the surface and its dual is well posed, provided that we remove an appropriate number of punctures. We further show that the resulting dimer configuration is in bijection with an object which we call Temperleyan forest, whose law is characterised in terms of a certain topological condition. Finally, we discuss the relation between height differences and Temperleyan forest and prove that the convergence of the latter (which is the subject of the second paper in this series) implies the existence of a conformally invariant scaling limit of height fluctuations.
Flat morphisms with regular fibers do not preserve $F$-rationality
Authors: Quinlan-Gallego Eamon , Simpson Austyn , Singh Anurag K.
Published: June 2024

For each prime integer

p>0

, we construct a standard graded

F

-rational ring

R

, over a field

K

of characteristic

p

, such that

R\otimes_{K}\overline{K}

is not

F

-rational. By localizing, we obtain a flat local homomorphism

(R, \mathfrak{m}) \to (S, \mathfrak{n})

such that

R

is

F

-rational,

S/\mathfrak{m}S

is regular (in fact, a field), but

S

is not

F

-rational. In the process, we also obtain standard graded

F

-rational rings

R

for which

R\otimes_{K} R

is not

F

-rational.
Procesamiento de información y automatización de procesos en restaurantes de consumo masivo. Un enfoque a través de la investigación mixta
Authors: Alania Atoc Noemi Rosario , Orosco-Fabian Jhon Richard
Published: June 2024

La investigación tuvo como objetivo optimizar la cadena de valor con el uso de TIC en pollerías de la provincia de Tarma. El estudio se enmarca en el enfoque mixto (desde el uso de los métodos), de diseño explicativo secuencial. La muestra de investigación fue mixta, siendo para el estudio cuantitativo 14 pollerías de la provincia de Tarma a través de sus dueños, gerentes o directivos, y para el estudio cualitativo se seleccionaros dos pollerías en quienes se implementó la propuesta del software Sistema de Ventas para Pollerías – Versión 1.0. Para el recojo de información se utilizó el cuestionario para recoger datos cuantitativos y la guía de entrevista para el recojo de datos cualitativos. Los resultados y hallazgos del estudio permiten concluir que el uso de TIC optimiza el proceso de la cadena de valor de las pollerías de la provincia de Tarma, sin embargo, es indispensable que la empresa a implementar esté dispuesta a invertir en capacitaciones y en adquisición de equipos. Además, las TIC no intervienen en el 100% de la cadena de valor, sino permite brindar herramientas para el tratamiento de información y automatización de algunos procesos. Es decir, las TIC serán eficientes siempre y cuando los datos almacenados y los equipos a utilizar sean utilizados adecuadamente.
Review of local autonomy and autonomous police status
Authors:   National Public Law Review, Kim Won-Jung
Published: June 2024

At the present time, when the autonomous police system is being implemented, it is necessary to review the meaning of the autonomous police system and whether it is in line with the purpose of the local autonomy system through its actual situation. The purpose of the autonomous police system is to establish regional security through a police system that matches the local circumstances. The autonomous police system must be institutionalized to meet the needs of regional security and suit the characteristics of each region. However, it is questionable whether the autonomous police system currently in effect is structured and operated to suit the characteristics of the region. The constitutional purpose of local autonomy is to implement self-governance to improve the welfare of residents. When approaching local autonomy from the perspective of promoting the welfare of residents, it is necessary to reexamine the extent to which the autonomous police system is contributing to improving the welfare of residents.
The autonomous police system must be organized and operated to reflect the opinions of residents. However, the current police law has limitations in that it does not provide an opportunity for the autonomous police committee, which is an autonomous police agency, to reflect the opinions of residents. According to the current law, the Autonomous Police Committee directs and supervises the city/provincial police chiefs regarding autonomous police affairs. However, it cannot be said that these autonomous police committees have a status that allows them to actually perform their functions in command and supervision of city/provincial police chiefs. The Autonomous Police Committee is granted the status of a consensus-based administrative agency for autonomous police affairs, but exercises command and supervision rights through deliberation and voting rights only on simple administrative affairs, not direct autonomous police affairs.
Therefore, in this study, we analyzed the current state of the law and presented improvement measures to meet the purpose of local autonomy, which is to promote the welfare of residents in order to achieve institutional guarantee of local autonomy. However, the limitations of this study are that the analysis of the actual situation was conducted through a literature review, and it was limited to the actual state of the legislation and the actual state of the system.