bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical trial design, endpoints and regulatory considerations in heart failure
Authors: Rosano Giuseppe M.C.
Published: March 2024

Following the withdrawal of flosequinan in the early 1990s due to heightened mortality and fatal arrhythmia risks, regulatory agencies have demanded evidence of the efficacy of novel treatments in managing heart failure, with mortality and morbidity endpoints becoming more stringent criteria for approval. In recent times, regulatory agencies have exhibited a greater willingness to permit the evaluation of functional capacity as an efficacy endpoint, albeit limited to specific patient groupings. Consequently, a novel therapeutic intervention for heart failure may be granted approval provided that it enhances survival rates, decreases length of hospital stays, and/or safely improves functional capacity. This article reviews clinical trial design, trial endpoints and regulatory issues in heart failure trials.
COVID-19 myocarditis
Authors: Bestetti Reinaldo B. , Furlan-Daniel Rosemary , Pereira Luciano P.
Published: March 2024

Background: Myocarditis can be observed in patients with COVID-19. Myocarditis can also be seen in patients vaccinated against SARS-CoV-2 infection, the etiological agent of this disease. Epidemiological, morphological, pathophysiological, clinical aspects, clinical course, and potential therapeutics for patients with COVID-19 myocarditis are not entirely clear.Methods: We perform a search in PubMed linking the terms “COVID-19 and myocarditis”, “SARS-CoV-2 and myocarditis”, and “vaccine and myocarditis and COVID-19”. A hand-search of references from retrieved papers has also been done. We selected papers dealing with the epidemiological, morphological, clinical aspects, and therapeutic regarding COVID-19 myocarditis.Results: Myocarditis can be clinically diagnosed in about 2% of patients with COVID-19 illness, but its prevalence is higher (up to 33%) in autopsied with this disease. At magnetic resonance imaging, myocarditis can be diagnosed in up to 60% patients in the short-term follow up after SARS-CoV-2 infection. A few ultrastructural studies have detected SARS-CoV-2 in endothelial cells, macrophages, neutrophils, fibroblasts, and inside cardiomyocytes. Shortness of breath, fever, cough, and precordial chest pain are the main clinical symptoms; in half patients, ground glass opacities in chest X-ray are also observed, although oxygen saturation may be normal. COVID-19 myocarditis may occur in a patient with no past cardiac history and may alternatively be a late phenomenon in the course of the disease. COVID-19 myocarditis can also affect children and adolescents; acute heart failure is the predominant clinical manifestation, including fulminant myocarditis, in this population. Elevated troponin blood levels are observed in the majority of patients. Abnormal electrocardiogram findings – usually ST-segment changes and inverted T waves – can be detected in at least 25% of cases. Abnormal echocardiography can be found in 3% of cases and left ventricular systolic dysfunction can be found in 67% of such cases. The clinical course of COVID-19 myocarditis is usually benign with most patients recovering from the myocardial insult. Non-steroidal anti-inflammatory drugs are the treatment for noncomplicated cases; colchicine is added in case of associated pericarditis. Corticosteroids have largely been used. Mechanical support is lifesaving in cases of cardiogenic shock. Post-vaccination myocarditis is very rare, and less frequently found than COVID-19 myocarditis.Conclusions: Although relative rare, myocarditis may be a serious complication of COVID-19 illness.
A Psycholexical Study of Personality Trait Structure of Hindi Speaking Indians
Authors: Singh Jitendra , Misra Girishwar
Published: March 2024

This study adopted a psycholexical approach to uncover the personality trait structure of Hindi speaking Indians. The endorsement for personality descriptive adjectives was obtained from young adults (n=240) using a Likert-type 5-point rating scale. The principal component analysis using varimax rotation revealed a six-factor structure comprised of (I) rajasic (passion and mobility), (II) sattvic (goodness and harmony), (III) tamasic (dullness and inertia), (IV) competence, (V) neuroticism, and (VI) extraversion. The six-factor structure of personality in Hindi language has broader psycholexical space than what is proposed in the “Big Five” personality theory.
Synergistic and antagonistic effects of vinegar and sodium bicarbonate on antibiotic-resistant Escherichia coli
Authors: Al-Khikani Falah Hasan Obayes , Fareeq Hassan Tahir , Mohammed Hassan Abbas , Jassem Baraa Waleed , Abdul-Hussein Baraa Wissam , Banay Aya Abdul-Kadhim , Jawad Baneen Abd-Ali , Hamza Tabarak Hakeem , Hilal Balqees Malik
Published: March 2024

Background:

Escherichia coli with antimicrobial resistance has become a frequent global problem in recent decades, which makes it challenging to treat with conventional medicines. This study aimed to evaluate different strategies for managing microbial resistance.

Methods:

E. coli was isolated from wounds and the urinary tract infections and then cultured on blood agar, MacConkey agar and EMB media. The well diffusion method was used to evaluate the activity of vinegar (5%) alone and combined with three concentrations (5%, 10%, and 20%) of sodium bicarbonate (SBC). The diameter of the zone of inhibition was measured in millimeters. Statistical analyses were performed using Excel and the SPSS 26 software.

Results:

Of the 24 E. coli isolates, approximately 66.6% were sensitive to vinegar combined with 5% SBC compared to 75% sensitivity to vinegar alone. Furthermore, 41.66% of the bacteria were sensitive to vinegar combined with 10% SBC. This study showed that 33.33% of the bacteria were sensitive to vinegar combined with 20% SBC. Comparison of the mean of the inhibition zone for vinegar 13 ± 6.04 mm alone with 20% SBC plus vinegar 7.83 ± 5.56 mm was significant (P = 0.01). Vinegar combined with 10% SBC had an inhibitory effect (antagonism) on the antibacterial activity of vinegar (P = 0.02).

Conclusion:

The antibacterial efficacy of vinegar with SBC decreased with increasing SBC concentrations, demonstrating an antagonistic effect owing to sodium acetate formation.
Hydropneumothorax as a rare manifestation of primary pulmonary hydatid disease
Authors: Ali Mamoun Mohamed Ahmed , Gupta Rajesh , Mustafa Mohamed , Hamad Imad El-din Ahmed , Nayak Devdutt , Omar Alhaitham , El-Barkouky Ahmed
Published: March 2024

Echinococcosis, alternatively referred to as hydatid disease, is caused by the larvae of the tapeworm Echinococcus. The primary agents of human infections are Echinococcus granulosus and Echinococcus multilocularis. The present case report pertains to an individual who relocated from an endemic region to the United Arab Emirates and subsequently manifested symptoms of hydropneumothorax. The 44-year-old male patient presented with a 4-day fever and right-sided chest pain, accompanied by cough and breathlessness for 2 weeks. Computed tomography (CT) of the chest revealed right hydropneumothorax and a ruptured hydatid cyst with consolidation. The patient was diagnosed with a ruptured pulmonary hydatid cyst based on a strongly positive hydatid serology and the presence of hydatid tissue on histopathological examination. The patient underwent surgical decortication with cyst removal and received medical treatment with ceftriaxone and albendazole. He was discharged in good condition after a 10-day hospitalisation period. Echinococcosis is a parasitic disease that most often affects the liver and lungs. Although more than half of the patients do not show any symptoms, the main symptoms observed during presentation include dry cough, haemoptysis, and chest pain. Plain radiographs or chest CT scans are used for diagnosis. Surgery is considered the primary treatment for pulmonary hydatid cysts and medical treatment with benzimidazoles (albendazole and mebendazole) is recommended. Complicated pulmonary hydatid disease can manifest in various ways, including hydropneumothorax, as observed in the present case. Early diagnosis, surgical intervention combined with medical treatment, and multidisciplinary teamwork can significantly improve patient outcomes.
Fast Track versus Conventional Perioperative Care Protocols in Paediatric Intestinal Stoma Closure [FIGURE DASH] A Randomised Study
Authors: Farhad Tanzil , Sarwar Md. Khurshid Alam , Chowdhury Mohammad Zonaid , Walid Adnan , Sadia Ayesha , Chowdhury Tanvir Kabir
Published: March 2024

Context:

It is still unclear to what extent fast-track (FT) surgery is applicable in paediatric surgery.

Aims:

The aim of the study was to compare the outcome between FT and conventional perioperative care protocols in paediatric intestinal stoma closure to assess the safety for future application.

Settings and Design:

This study was a prospective randomised study.

Subjects and Methods:

Twenty-six paediatric patients who underwent intestinal stoma closure from December 2019 to March 2021 were divided into two groups: group A, conventional methods and Group B FT protocol. The FT protocol included minimal pre-operative fasting, no pre-operative bowel preparation, no routine intraoperative use of nasogastric tube, drain tube, urinary catheter, early post-operative enteral feeding, early mobilisation, non-opioid analgesics and prophylactic use of anti-emetic. Total length of post-operative hospital stays and complications between these two groups were compared.

Statistical Analysis Used:

t, Mann[FIGURE DASH]Whitney U, Chi-square and Fisher’s exact test were used.

Results:

No significant differences were found between the two groups regarding anastomotic leak (nil in both groups), wound infection (7.7% in Group A vs. 0% in Group B; P = 1.0) and wound dehiscence (7.7% in Group A vs. 0% in Group B; P = 1.0). No significant differences were found in post-operative length of stay (median 5, interquartile range [IQR] 4–9 in Group A and median 6, IQR 4–7 in Group B, P = 0.549) and time to appearance of bowel function (passage of stool) (median 2 days in both groups; P = 0.978).

Conclusions:

FT surgery was comparable to the conventional method in terms of complication and thus can reduce unnecessary interventions.
Rehabilitation Using Hybrid Technique for Feeding Plate Fabrication in a 3-Month-Old Infant with Cleft Palate Defect Utilising Digital and Conventional Method
Authors: Rathee Manu , Chahal Sujata , Jain Prachi , Alam Maqbul , Divakar S , Singh Sandeep
Published: March 2024

Cleft palate leads to difficulty in suckling, speech abnormalities, dental problems, hearing loss and middle ear infections. Feeding plate acts as a barrier between the oral and nasal cavities allowing the normal development of jaws and enhanced nutritional supply to the patient. Fabrication of the feeding plate using digital means provide better adaptability due to the engagement of all the possible favourable anatomic undercuts, thereby, providing better retention. This case report discusses the hybrid technique including both the digital and conventional means for fabrication of a feeding plate to obturate the defect between the oral and nasal cavity.
Neonatal Paratesticular Scrotal Mass
Authors: Srivastava Saurav , Chaubey Digamber , Rahul Sandip Kumar , Thakur Vinit Kumar , Ranjana Rashmi
Published: March 2024

Atypical neurofibromatous neoplasm with uncertain biologic potential presenting as a paratesticular scrotal mass in a neonate with congenital giant melanocytic nevus is rare. Only one such case of neonatal scrotal neurofibroma has been reported earlier. We report an additional case and its management.
An isolated case of pseudothrombocytopenia due to platelet satellitism with the review of literature
Authors: Suri Meenakshi
Published: March 2024

Platelet interaction with neutrophil polymorphs happens rarely, forming platelet aggregates like rosettes/beads around neutrophils, an uncommon phenomenon called ‘platelet satellitism’ (PS). It has been observed in peripheral blood smears prepared from blood samples anticoagulated with ethylene diamine tetra-acetic acid, but not in blood samples treated with heparin or sodium citrate. Automated hematology analyzers in present times have increased the reproducibility and accuracy of platelet counts, they may not completely resolve pseudothrombocytopenia. Being a rare cause of spurious thrombocytopenia, it might mislead the clinician into unnecessary investigations and treatment. To avoid false reporting of low platelet count, the peripheral blood smear examination should be performed in all patients with thrombocytopenia. PS usually occurs around neutrophil granulocytes and only in extremely rare cases are platelets phagocytosed by neutrophils, forming rosettes around lymphocytes and monocytes as observed only in patients with neoplastic lymphocytes. This study presents an isolated case of spurious thrombocytopenia due to PS around neutrophils, with platelet phagocytosis.
A brief review of the neuroimaging modalities in schizophrenia and their scope
Authors: Ray Sagarika , Pal Amit Kumar , Kundu Partha Sarathi
Published: March 2024

Schizophrenia is a serious mental disorder characterized by diverse symptoms, including hallucinations, delusions, and disorders in thinking, behavior and cognition. Its etiology is multifactorial involving genetic, environmental, developmental, and neurobiological factors. Neuroimaging studies have significantly contributed to understanding the underlying neural abnormalities associated with this disorder. Reduced brain volume was observed in frontal and temporal lobes in most studies using structural imaging techniques. Hypofrontality was observed in functional studies. Neuroimaging also aids in differentiating structural lesions causing symptoms mimicking schizophrenia. However, challenges persist due to variables such as age, gender, comorbidities, therapy history, substance use, and coexisting psychiatric conditions, which are often insufficiently controlled for, in the literature. This review article comprehensively consolidates the diagnostic and prognostic potential of various neuroimaging techniques in schizophrenia.
Development of Mysore Tridosha scale – A short report
Authors: Datar Shilpa , Murthy C. G. Venkatesha
Published: March 2024

The authors have developed the Mysore Tridosha psychological personality assessment scale and published it in 2011. This scale is being used to assess and understand personality in different aspects. Since it is long, and is online, there was a need to develop a shorter version of the scale and for application in research areas where online use may not be possible. Hence, a shorter version of the original scale was developed and this article describes the methodology and the results of the same.
Application of noninvasive neuromodulation and light therapy in post-stroke depression: a narrow review
Authors: Chen Xiaowei , Xu Yao , Dong Lianxi , Liu Xuncan , Zhang Jingjing , Tang Li , Jing Yuling , Yu Guan , Li Zhenlan
Published: March 2024

Post-stroke depression is closely related to the poor prognosis of stroke, resulting in prolonged hospital stay, neurological dysfunction, and increased mortality. Post-stroke depression has a complex pathogenesis, and cannot be explained by a single pathophysiological mechanism; therefore, no treatment is definitely effective. Currently, the commonly used treatment methods include drug therapy, psychotherapy and noninvasive neuromodulation therapy, such as repetitive transcranial magnetic stimulation, and transcranial direct current stimulation. However, simple drugs have poor efficacy and are often accompanied by side effects. Although repetitive transcranial magnetic stimulation and transcranial direct current stimulation combined with drug therapy enhance drug efficacy, their application is limited in some cases. Light therapy can regulate the central nervous system through the light-sensitive retinal nerve pathway, which has been proven to have therapeutic effects in patients with depression. Light therapy has the advantages of no obvious side effects and a wider range of adaptation. This review summarizes the current research status of noninvasive neuromodulation and light therapy in post-stroke depression and explores the possibility of widespread application of physical factors modulation for post-stroke depression.
Unusual Artifacts Encountered during Routine Studies on Positron Emission Tomography-Computed Tomography and Gamma Camera
Authors: Rajai Prathamesh , Singh Natasha , Shivdasani Divya , Pereira Melvika
Published: March 2024

Artifacts in nuclear medicine imaging are not uncommon. We are aware of some of these, for which we follow necessary protocols to avoid them. However, there are some unusual and unavoidable artifacts that we come across in daily imaging, which may be of concern and need to be detected and corrected on time. Hence, sharing a few such unusual artifacts we encountered while performing routine studies on positron emission tomography-computed tomography and gamma cameras, evaluating the cause and possible precautions.
Role of 2-(fluorine-18) Fluoro-2-deoxy-D-glucose Positron Emission Tomography/Computed Tomography in Initial Staging and Bone Marrow Involvement Prediction in Patients with Newly Diagnosed Lymphoma in Correlation with Bone Marrow Study
Authors: Krishna Sarin , Ravina Mudalsha , Nanda Siddhartha , Lukose Tinu Thadiyananickal , Moideen Amal , Bansal Himanshu , Dasgupta Subhajit , Kote Rutuja
Published: March 2024

Background:

Lymphoma is a common malignant proliferative disease in which bone marrow infiltration will upstage the disease and thus affect prognosis of the disease. As of now bone marrow biopsy is considered as a reference standard to find out bone marrow involvement in lymphoma. Performing an invasive and painful intervention in all newly diagnosed lymphoma patients is controversial. PET-CT is a non-invasive technique that gives functional information about the cells using the glucose metabolism. It can detect early bone marrow and extra medullary organ involvement which can lead to restaging of the disease. These advantages make PET-CT a valuable adjunct in diagnosis of lymphoma. Aims and Objectives: Our study aims to evaluate the usefulness of 18 F-FDG PET-CT, a non-invasive, semi quantitative whole body imaging technique for detection of early bone marrow and extra medullary organ involvement in lymphoma patients which in turn can obviate the need for bone marrow study (BMS). The primary objective of study is to categorise FDG uptake in bone marrow as diffuse /unifocal /multifocal / no uptake and to correlate pattern of FDG uptake to bone marrow study. Our study also assesses the role of FDG PET/CT in staging of lymphoma.

Materials and Methods:

Thirty patients with newly diagnosed lymphoma in the age group 18 to 75 years of both sexes within 3 months of diagnosis and who have not been started on any treatment was included in the study. Marrow uptake on FDG PET/CT has been categorized as diffuse, unifocal, multifocal and no uptake. Agreement between bone marrow study and FDG PET/CT has been assessed by reliability analysis using Cohen’s kappa. Sensitivity, specificity, PPV, NPV of PET/CT in detecting marrow involvement have been calculated.

Results:

The sensitivity, specificity, PPV, NPV and accuracy of 18 F-FDG PET-CT in detecting marrow involvement of lymphoma cases are 86.6%, 77.7%, 68.4%, 91.3% and 80.9% respectively. 18 F-FDG PET-CT detected bone marrow involvement in 86.6% (13 out of 15 total positive cases) cases of lymphoma which included both HL and NHL. Reliability analysis using Cohen’s kappa is used to test the agreement between bone marrow study and 18F-FDG PET/CT. k value of 0.6 was obtained which showed a moderate agreement between bone marrow study and 18F-FDG PET/CT in marrow assessment.

Conclusion:

18F‐FDG PET/CT is a highly sensitive imaging modality which can pick up extra‐nodal organ and BMI in patients with lymphoma and can upstage the disease and alter treatment strategies. PET‐CT cannot completely replace the bone marrow study. However, being an invasive painful procedure, BMB can be avoided in cases with unifocal or multifocal marrow involvement on PET‐CT.
Primary Leiomyosarcoma of Suprahepatic Inferior Vena Cava with Metastases
Authors: Mandava Anitha , Koppula Veeraiah , Kandati Meghana , Reddy Arvind Kumar , Abubacker Zakir Ali
Published: March 2024

A 67-year-old female presented with shortness of breath, weight loss, abdomen, and back pain for 2 months. Ultrasound of the abdomen revealed multiple focal liver lesions. 18F-Fluorodeoxyglucose whole-body positron emission tomography/computed tomography revealed a hypermetabolic lesion in the suprahepatic inferior vena cava extending into the right atrium. Multiple hypermetabolic lesions were seen in liver, bones, and abdominal lymph nodes, suggestive of metastases. Histopathology and immunohistochemistry of the lesions revealed it to be metastatic leiomyosarcoma.
“Bilateral Hot Forearm Sign”: Ingeminating the Pattern of Physiological Uptake of 18F-Fludeoxyglucose
Authors: Kumar Srinivas Ananth , Mittal Bhagwant Rai , Sindhu Tanigassalam , Kumar Rajender
Published: March 2024

Exertion and exercise increase glucose metabolism within the skeletal muscles causing increased fludeoxyglucose (FDG) uptake on 18F-FDG positron emission tomography/computed tomography (PET/CT). Here, we present findings of 18F-FDG PET/CT in a patient with acute viral hepatitis A-induced liver failure with multiple foci of pyoderma and incessant itching resulting in increased FDG uptake in the muscles of the bilateral forearm, producing the “bilateral hot forearm sign.”
Prostate-Specific Membrane Antigen (PSMA) Uptake in the Scrotum and Epididymis on PET-CT: When is it Pathological?
Authors: Singh Dalveer , Badya Rohitha , Drew Zachary
Published: March 2024

Prostate cancer is the most common solid organ tumor in men and has been reported to metastasize to unusual sites such as the epididymis. The clinical standard for detecting recurrent disease is through positive emission tomography/computed tomography with the radiotracer 18F-DCFPyL binding prostate-specific membrane antigen (PSMA) expressed by cancerous cells. Although PSMA can also be expressed physiologically, metastases are more likely to be intensely PSMA expressing and in a typical distribution depending on the extent of disease burden in the individual patient. A MEDLINE search revealed only three other case reports of isolated epididymal metastases from prostate cancer diagnosed with prostate-specific membrane antigen positron emission tomography–computed tomography. This case series comprising both metastatic and physiological PSMA expression in the epididymis provides a useful framework for the interpreting physician when the possibility of this rare but important finding is encountered in prostate cancer imaging.
Assessment of Small-bowel and Colonic Transit on Routine Gastric Emptying Scintigraphy: Establishment of Reference Values
Authors: Kumar Sonu , Chanu Asem Rangita , Jaleel Jasim , Gupta Priyanka , Khangembam Bangkim Chandra , Patel Chetan , Kumar Rakesh
Published: March 2024

Purpose of the Study:

The primary objective was to establish the reference values for small-bowel and colonic transit within the context of the routine standard solid meal gastric emptying scintigraphy (GES). The secondary objective was to compare the small-bowel and colonic transit between the anterior view and geometric mean methods.

Materials and Methods:

Twenty-nine healthy controls underwent routine GES, with additional imaging at 24 h if feasible. Small-bowel transit was assessed using the index of small-bowel transit (ISBT), calculated as the ratio of terminal ileal reservoir counts to total abdominal counts at 4 h. Colonic transit was evaluated using the colonic geometric center (CGC) by dividing the large bowel into four segments, with an additional fifth segment accounting for the eliminated counts. Reference values were established based on the fifth percentile or mean ± 1.96 standard deviations. Rapid small-bowel transit was visually determined. Paired Samples t-test or Wilcoxon signed-rank test, as applicable, was used to compare the small-bowel and colonic transit between the anterior view and geometric mean methods. For comparing small-bowel and colonic transit between females and males, the Independent samples t-test or Mann–Whitney U-test was applied, as appropriate. The correlation between age and small-bowel and colonic transit was assessed using Spearman’s rank correlation analysis.

Results:

The reference value for small-bowel transit using the geometric mean method was established as ISBT >37% at 4 h, whereas rapid small-bowel transit was defined as the first visualization of activity in the cecum-ascending colon within 2 h. For colonic transit, the reference range was established as CGC 2.8–4.4 at 24 h. Comparing the anterior view and geometric mean methods, there were no significant differences in ISBT and CGC values (P ≥ 0.125). Gender did not affect small-bowel and colonic transit in both methods (P ≥ 0.378), and age showed no significant correlations (P ≥ 0.053).

Conclusion:

This study determined the reference values for small-bowel and colonic transit in the Indian population using routine GES, avoiding the need for additional complex procedures. The results may be generalized to the Indian population, emphasizing the importance of assessing small-bowel and colonic transit in patients with normal gastric emptying parameters to enhance gastrointestinal transit evaluation.
Fluorine-18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Uptake of Jejunal Lymphocytosis Due to Giardiasis Mimicking Lymphoma Recurrence
Authors: Kamaleshwaran Koramadai Karuppusamy , Elumalai Ramkumar , Rangarajan Bharat
Published: March 2024

Giardia lamblia is an intestinal protozoan with oral-fecal transmission. Infection is predominantly located in the small intestine. Giardiasis causes intraepithelial lymphocytosis in the small intestine which causes false-positive fluorodeoxyglucose (FDG) uptake mimicking malignancy. We present here an interesting image of fluorine-18 FDG positron emission tomography/computed tomography showing jejunal uptake caused by giardiasis in a known case of lymphoma.
Rare Case of Primary Leiomyosarcoma of Bone – Findings on 18F-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography
Authors: Kumar Pramit , Singh Parneet , Parida Girish Kumar , Singhal Tejasvini , Ayyanar Pavithra , Pavithra R. , Agrawal Kanhaiyalal
Published: March 2024

Primary leiomyosarcoma of bone (PLB) is a rare tumor, constituting <0.7% of all primary bone malignancies. It is clinically aggressive with heterogeneous presentation and a dismal prognosis. The most common presentation is pain with swelling and pathological fracture at times. Limited literature is available on PLB and only about 150 cases have been reported to date with only a few case reports defining the utility of 18F-fluorodeoxyglucose (18-F FDG) positron emission tomography/computed tomography (PET-CT) in its management. We hereby present a case of primary leiomyosarcoma of the right distal femur and the role of FDG-PET-CT in its management.
Pitfalls of Iodine-131 Whole-Body Scan Mimicking Metastases in Differentiated Thyroid Carcinoma: A Case Series
Authors: Shaik Rishma , Hemalatha Dhamarcherla S , Rallapeta Ramya Priya , Sireesha Polisetty , Gavini Surya Teja , Kalawat Tekchand
Published: March 2024

Thyroid cancer is the most common endocrine malignant tumor and accounts for 1% of all cancers. Management of differentiated thyroid carcinoma is total thyroidectomy, followed by iodine-131 (I-131) radioactive iodine (RAI) therapy for thyroid remnant tissue. I-131 whole-body scan helps in the follow-up evaluation in remnant, residual, and recurrence cases. Principle of uptake of I-131 is through sodium–iodide symporter expression on the cells. Physiological uptake of iodine is usually seen in salivary glands and gastrointestinal tract, and false-positive uptakes are seen in lesions such as mucinous cystadenoma, struma ovarii, hepatic, renal, thymic, and meibomian cysts. Here, we present the review of literature of series of cases observed in our department presenting with false-positive uptake of RAI in vertebral hemangioma, lipoma, sinusitis, teratoma, and uterine leiomyoma.
Pulmonary Tuberculosis and Lung Cancer – Innate Immunity and the Evolutionary Links of Microbe-induced Inflammation with Cancer: A Case Series
Authors: Karunakaran Raseela
Published: March 2024

Lung cancer is a chronic inflammatory disease. Postprimary tuberculosis (PPTb) is also a manifestation of chronic lung inflammation induced by Mycobacterium tuberculosis. Both acute and chronic inflammation are macrophage-mediated responses. Persistent lung lesions of both PPTb and lung cancer result from chronic nonresolving inflammation. Metabolic adaptation of macrophages through evolutionarily conserved pathways is termed as macrophage polarization. Progressive inflammation induced by microbes activates metabolic alterations in the tissue microenvironment and consequent tumorigenesis by M2-polarized macrophages. The M2 macrophages are poorly bactericidal, permitting intracellular microbial persistence. Both host and microbes undergo metabolic adaptations through hypoxia-inducible factor-induced gene induction. Three cases of PPTb progressing to lung cancer are presented. All cases were initially smear positive for acid-fast bacilli, and progressed to lung cancer while on antituberculosis treatment. Progressive lung inflammation in these cases induced by M. tuberculosis resulted in the progression of infection-induced inflammation to cancer. Smoking and diabetes were risk factors for progression to lung cancer.
Acute Fibrinous and Organizing Pneumonia
Authors: Gayathri Karedath , Amrutha P. K.
Published: March 2024

Acute fibrinous and organizing pneumonia (AFOP) is a very rare form of acute or subacute lung injury, which is characterized by patches of fibrin deposits within the alveoli. There are no typical clinical features, and hence, it is often misdiagnosed as pneumonia, tuberculosis, or acute lung injury. A definitive diagnosis is obtained from a lung biopsy. AFOP responds to corticosteroids. Here, we present a case of AFOP and discuss the clinical manifestations, radiological findings, and management.
Recent Advances in Research on Acupuncture Treatment for Knee Osteoarthritis
Authors: Yu Shichao , Te Kian Keong , Yap Yau Pin
Published: March 2024

Background and Objective:

Knee osteoarthritis (KOA) is one of the leading causes of disability worldwide. In recent years, the incidence of KOA has been gradually increasing due to population aging and lifestyle changes. As a result, there has been a growing body of research and clinical applications related to acupuncture treatment for KOA. The aim of this study is to analyze and summarize the clinical research progress of acupuncture treatment for KOA in the past 5 years. It seeks to understand the current developments and trends in this field and lay the foundation for future research.

Methods:

Conducted a systematic review and analysis of clinical research literature on acupuncture treatment for KOA published in the last 5 years, both domestically and internationally.

Results:

Acupuncture treatment for KOA has shown diverse and effective methods. However, the quality of research literature varies, leading to differences in reported treatment outcomes and a lack of high-quality research findings.

Conclusions:

It was recommended that future research should develop comprehensive and well-designed study protocols, conduct research with scientific rigor, and improve the overall quality of scientific investigations. In addition, it is advisable to include a few horizontal comparative studies to provide more evidence for the clinical application of acupuncture in treating KOA.
Decoding the Mysteries of the Obturator Nerve
Authors: Mateusz Mazurek , Oliwier Pioterek , Mateusz Drążyk , Dariya Pozdnyakova , Oskar Kozłowski , Victoria Tarkowski , Jurand Domański , Zygmunt Domagała
Published: March 2024

The purpose of this systematic review is to examine the obturator nerve in detail, elucidating its intricate anatomical course and complex branching patterns. Through a comprehensive analysis of existing scholarly sources, this study aims to unravel the complexities of the obturator nerve and provide nuanced insights for professionals in the fields of morphology and clinical practice. This investigation makes a valuable contribution to the body of knowledge on the neuroanatomical intricacies of the obturator nerve, thereby enriching the understanding of anatomists, morphologists, and physicians.
Insulin Resistance through High-sugar Diets and its Effects on the Endometrium in Swiss Albino Mice: An Experimental Study to Elicit the Beneficial Effects of Coconut Sugar
Authors: Ekambaram Gnanagurudasan , Kumar Senthil Kumar Sampath
Published: March 2024

Introduction:

Insulin resistance (IR) has an insidious onset and is mainly due to the consumption of high-energy diets. Refined sugars contain high fructose which predisposes to IR and affects the endometrium since endometrium exhibits high-affinity insulin receptors, and the natural unrefined sugars such as coconut sugar are proved to be beneficial, but scientific studies are scarce to validate the findings.

Subjects and Methods:

A cross-sectional study was carried out, in which 36 female Swiss albino mice were divided into control and high-fructose and high-coconut sugar diet groups. The respective diets were prepared daily and fed for a period of 12 weeks, and the animals were sacrificed by the administration of ether. Biochemical parameters were assessed, and the uterus was removed and processed for histopathological analysis.

Results:

Glucose, insulin, and homeostasis model assessment-IR were assessed, in which there was an increase in the levels in the high-fructose group than the control and coconut sugar groups. The values were statistically significant in the Kruskal–Wallis analysis (P < 0.001) and post hoc test showed a significant difference between the control and fructose diet groups. Hormonal assay showed elevated testosterone levels in the fructose group (Kruskal–Wallis test, P < 0.001), which showed significance in post hoc test when compared with the control group (P < 0.030). Histopathological examination revealed complex hyperplasia with nuclear atypia in the fructose group, whereas the findings were normal in the coconut sugar and control groups.

Discussion:

The present study proved coconut sugar to be beneficial, and there is a strong correlation of high-energy diets on the endometrium due to IR.

Conclusion:

The present study concludes that the intake of natural sugars does not cause damage to the endometrium which is sensitive to insulin resistance.
Investigating the Integration of Anatomical Variabilities into Medical Education as a Potential Strategy for Mitigating Surgical Errors
Authors: Asghar Adil , Patra Apurba , Naaz Shagufta , Kumar Rajesh , Babu C. S. Ramesh , Singh Brijendra
Published: March 2024

Introduction:

Surgical errors burden health-care systems globally, with anatomical variations being a significant contributor. This review examined the role of these variations and offers valuable insights for medical practitioners, educators, and policymakers to develop strategies to address and mitigate challenges posed by these variations.

Materials and Methods:

They keywords were generated from the title and online databases were searched with the help of a search string of keywords and Boolean operators.

Results:

A total of 13 articles were included in the present review. Thematic data analysis identified seven key themes highlighting the significance of anatomical variations in medical education. These include incorporating variations, determining optimal introduction and contact levels, identifying significant variations, teaching methods, visualization techniques, and challenges in integrating them. This systematic review has shown that earlier literature underscores the importance of anatomical variations in the context of medical education. However, there is evidence that students and trainees lack the necessary skills to effectively understand the concepts of anatomical variability and their application in the clinical setting. The final theme discusses potential solutions to enhance students’ understanding of human anatomy.

Conclusion:

Medical education aims to produce qualified physicians who provide competent and safe patient care. However, students and trainees often lack the skills to understand anatomical variations, leading to misdiagnoses and health-care malpractice. Active medical education professionals should ensure familiarization with anatomical variations to clear misconceptions about the human body, provide valuable knowledge about patient uniqueness, and spark interest in physicians.
Self-perceived Functional Disabilities due to Chronic Musculoskeletal Knee Pain among Elderly People Residing at Ahmedabad City, India: A Mixed Method Approach with a Community Perspective
Authors: Patel Kalgi Ashok , Dave Viral R. , Parmar Mira , Rathod Vasu
Published: March 2024

Introduction:

One of the disabilities perceived by elderly people which has the most profound effect on day-to-day living is knee osteoarthritis. The present study focused on elderly people with objectives of assessing the prevalence of functional disabilities due to chronic musculoskeletal knee pain with concerned determinants. Assessment of quality of life (QoL) and exploring various perceptions regarding debility were ancillary objectives.

Methodology:

A cross-sectional study with a mixed method approach was conducted among elderly people at urban field practice area of one of the tertiary health-care institutes of Ahmedabad city, Gujarat. The calculated sample size of 220 was collected by systematic random sampling. A pretested, validated, semistructured questionnaire including Western Ontario and McMaster Universities (WOMAC) Osteoarthritis index with information pertaining to pain, stiffness, and functional disability was used to collect quantitative part. For qualitative assessment, in-depth interviews were taken using interview guide.

Results:

The prevalence of chronic knee pain was 70%, of which 63% had functional disability. Various determinants such as gender, age, socioeconomic class, occupation, and body mass index were found to have a statistically significant association with severity of knee pain/functional disability. Qualitative research revealed that majority of participants were dissatisfied with their current QoL, primarily due to dependent attitude for quotidian chores, while some of them perceived socially isolated due to compromised physical capacity. Acceptance for ailment with belief of “condition is common unpreventable fate in old-age” and surgical intervention with adverse/futile outcome in a few peer age-group cohorts enrooted attitude of not visiting any health-care facility among study participants.

Conclusion:

More than three-fifth of the study participants had severe/extreme WOMAC score which was most probable reason for perceived dissatisfied life quality. More than three-fifth of the study participants had severe/extreme WOMAC score representing reason for perceived dissatisfied life quality. Adopted common ethnicity of demeanor in routine chores found statistically significant association with functional disability, while certain beliefs were decisive for initiating or sustained treatment.
Investigating the effect of Aloe vera on the prevention and treatment of radiotherapy-induced oral mucositis in patients with head-and-neck cancer
Authors: Najafizade Nadia , Dehkordi Roya Mobini , Hemati Simin
Published: March 2024

Background:

Oral mucositis is one of the main complications of radiotherapy (RT) while treating head-and-neck cancers and can affect the patients’ treatment process and life. Therefore, this study evaluated the effect of Aloe vera on the prevention and treatment of radiotherapy-induced oral mucositis (RIOM) in patients with head-and-neck cancer.

Materials and Methods:

This was a double-blind clinical trial performed in 2019 on 75 patients with head-and-neck cancer. Patients were randomly assigned to two groups receiving gargles of 5 cc Aloe vera and the same dose of placebo mouthwash three times a day, respectively. Then, the incidence and severity of RIOM were evaluated and compared between the two groups over 6 weeks of RT.

Results:

There was no significant difference between the two groups in terms of the severity of RIOM from the 1st to 3rd weeks of RT (P > 0.05). However, the severity of RIOM in the 4th, 5th, and 6th weeks of RT was significantly lower in the Aloe vera group compared with the placebo group (P < 0.05).

Conclusion:

According to the results of the present study, the long-term use of Aloe vera mouthwash can reduce the severity of RIOM.
Serum zinc levels in hemodialysis and peritoneal dialysis patients: A retrospective observational study
Authors: Mahmoudi Masoud , Moeinzadeh Firouzeh , Atapour Abdolamir , Seirafian Shiva , Azhir Zhina
Published: March 2024

Background:

Zinc is vital for cellular functions, but kidney failure increases zinc deficiency risk. We compared zinc levels in hemodialysis (HD) and peritoneal dialysis (PD) patients in Isfahan, Iran.

Materials and Methods:

A retrospective study included 150 patients (75 PD and 75 HD). Serum zinc levels were assessed through photometry. Statistical analysis employed Chi-square, independent t-test, and correlation.

Results:

Serum zinc was below normal in both groups (P < 0.01). HD patients had lower zinc levels (70.85 ± 7.68 mg/dL) compared to PD (75.04 ± 13.55 mg/dL, P = 0.021), remaining significant after adjusting for confounders (P = 0.011).

Conclusion:

Zinc levels in PD and HD patients are lower than in the general population, with HD patients having lower levels than PD patients.
First Iranian guidelines for the diagnosis, management, and treatment of hyperlipidemia in adults
Authors: Kholenjani Fahimeh Bagheri , Shahidi Shahla , Vaseghi Golnaz , Ashoorion Vahid , Sarrafzadegan Nizal , Siavash Mansour , Heidarpour Maryam , Shahidi Shahrzad , Sadeghi Masoumeh , Mohammadifard Noushin , Jorjani Masoumeh , Mobarhan Majid Ghayour , Shafie Davood , Farshidi Hossein , Khorvash Fariborz , Ghabaei Mojdeh , Teimouri-Jervekani Zahra , Mortazavi Mojgan , Hajhashemi Valiollah , Roshanravan Neda , Yazdanpanah Leila , Davari Majid , Fatemi Behzad , Khorasani Elaheh , Hoseinkhani Ramesh , Zarean Elaheh , Ahmadi Alireza , Babadi Maryam Eghbali , Assareh Ahmadreza , Shadmani Mehdi , Kojuri Javad , Shirani Farimah , Sanjari Mojgan , Haghighatdoost Fahimeh , Hassannejad Razieh , Hashemi Elham , Moaddab Mohammad Hassan , Gheisari Alaleh , Dehghan Bahar , Naseri Mitra , Ghaemi Nosrat , Noohi Fereidoun , Haghdoost AliAkbar , Salehi-Abargouei Amin , Beigrezaie Sara , Doosti-Irani Amin , Ramezani-Jolfaie Nahid , Eraj Bijan , Hashemipour Mahin , Nematipour Ebrahim , Kopaei Mahmoud Rafieian
Published: March 2024

This guideline is the first Iranian guideline developed for the diagnosis, management, and treatment of hyperlipidemia in adults. The members of the guideline developing group (GDG) selected 9 relevant clinical questions and provided recommendations or suggestions to answer them based on the latest scientific evidence. Recommendations include the low-density lipoprotein cholesterol (LDL-C) threshold for starting drug treatment in adults lacking comorbidities was determined to be over 190 mg/dL and the triglyceride (TG) threshold had to be >500 mg/dl. In addition to perform fasting lipid profile tests at the beginning and continuation of treatment, while it was suggested to perform cardiovascular diseases (CVDs) risk assessment using valid Iranian models. Some recommendations were also provided on lifestyle modification as the first therapeutic intervention. Statins were recommended as the first line of drug treatment to reduce LDL-C, and if its level was high despite the maximum allowed or maximum tolerated drug treatment, combined treatment with ezetimibe, proprotein convertase subtilisin/kexin type 9 inhibitors, or bile acid sequestrants was suggested. In adults with hypertriglyceridemia, pharmacotherapy with statin or fibrate was recommended. The target of drug therapy in adults with increased LDL-C without comorbidities and risk factors was considered an LDL-C level of <130 mg/dl, and in adults with increased TG without comorbidities and risk factors, TG levels of <200 mg/dl. In this guideline, specific recommendations and suggestions were provided for the subgroups of the general population, such as those with CVD, stroke, diabetes, chronic kidney disease, elderly, and women.
Predictors of gastrointestinal bleeding in patients with acute coronary syndrome and the optimal duration of dual antiplatelet therapy
Authors: Wang Yanyu , Wu Yingle , Wang Jingqiao , Zhang Hengliang , Du Laijing , Wang Ke , Duan Hongqiang
Published: March 2024

Background:

This study aims to estimate the risk factors of gastrointestinal (GI) bleeding in patients with acute coronary syndrome (ACS) and to evaluate the optimal duration of dual antiplatelet therapy (DAPT).

Materials and Methods:

We enrolled 1266 patients with ACS in a telephone follow-up program to determine whether any of the patients were hospitalized for GI bleeding. We collected baseline data, laboratory tests, electrocardiograms, and echocardiography covering all ACS patients. Multivariable regression was performed to adjust for confounders and predictors of GI bleeding. At the same time, the optimal duration of DAPT for ACS patients was evaluated.

Results:

A total of 1061 ACS patients were included in the study. After 13–68 months, 48 patients (4.5%) were hospitalized for GI bleeding. The risk of GI bleeding was significantly increased in patients treated with DAPT for more than 18 months (hazard ratio 12.792, 5.607–29.185, P < 0.01). Receiver Operating Characteristic curve showed that the duration of DAPT using a cutoff of 14.5 months resulted in a sensitivity of 66.7% and a specificity of 77%.

Conclusion:

In patients with ACS, DAPT time are the main risk factors of GI bleeding. The optimal duration of DAPT is 14.5 months.
The augment effects of magnesium hydride on the lipid lowering effect of atorvastatin: an in vivo and in vitro investigation
Authors: Chen Wanqiu , Zhang Yinyin , Miao Gen , Ying Yajing , Ren Zifu , Sun Xuejun , Cai Jianming , Shen Hui , Lu Hongtao
Published: March 2024

There is strong evidence connecting increased serum lipid levels to cardiovascular disorders, including atherosclerosis. Statins is prescribed as the primary medication to decrease lipid levels. Recent research has demonstrated that hydrogen possesses anti-inflammatory and antioxidant properties by modulating the expression of peroxisome proliferator-activated receptor gamma coactivator-1α, ultimately leading to the preservation of lipid homeostasis. Magnesium hydride (MgH2) is a prolonged stable hydrogen storage medium, which can be utilized to investigate its synergistic lipid-lowering effect with statins and its detailed molecular mechanism, both in vivo and in vitro. To ascertain the safety and efficacy of MgH2, we executed a comprehensive research of its influence on both physiological and pathological metrics. We noted a substantial diminution in lipid levels when MgH2 was integrated with atorvastatin, as attested by oil red staining. Furthermore, we scrutinized the regulatory effect of MgH2 on cytochrome P450 3A, which is a metabolic enzyme of statins, and discovered that it could be reduced by the MgH2. Concluding from our results, we propose that MgH2 inhibits the expression of cytochrome P450 3A in the liver and exerts an auxiliary lipid-lowering effect by increasing the blood concentration of statins. By augmenting our comprehension of MgH2’s role in ameliorating lipid metabolism, we aspire to develop more promising therapies in the future.