bluuebunny/crossref_metadata_2025 huggingface dataset:
The Principles of Home Care for Patients with Stroke: An Integrative Review
Authors: Bahadoram Somayeh , Arsalani Narges , Fallahi-Khoshknab Masoud , Mohammadi-Shahbolaghi Farahnaz , Dalvandi Asghar
Published: September 2024

Background:

Patients With Stroke (PWS), like patients with other chronic health conditions, need long-term care in home settings. Patient transfer from hospital to home is associated with challenges such as care quality impairment and ineffective patient need fulfillment. The aim of this study was to assess the principles of Home Care (HC) for PWS.

Materials and Methods:

This integrative review was conducted in 2023 using the method recommended by Whittemore and Knafl. The Web of Science, Google Scholar, ScienceDirect, ProQuest, Scopus, Cumulative Index to Nursing and Allied Health Literature, PubMed, and specific databases for stroke care guidelines were searched to find relevant articles published between 2010 and 2023. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was used for document screening and selection. The data were analyzed using the constant comparison method.

Results:

Primarily, 2608 documents were retrieved, and 22 of them were included in data analysis. The principles of HC for PWS were categorized into six main categories: principles of transition from hospital care to HC, principles of assessment for HC, principles of education for HC, principles of designing an HC plan, principles of HC measures, and principles of discharge from HC centers.

Conclusions:

The present study provides a detailed overview of the principles of HC for PWS, which can be used to develop standard guidelines and improve the quality of HC for PWS.
Evaluation of Renal Interstitial Fibrosis by Trichrome Staining, Immunohistochemical and Morphometrical Analysis, and Its Correlation with Renal Dysfunction
Authors: Ambroise Moses Marie , Pathak Nabadwip , Gunasekaran Indira , Ramdas Anita
Published: September 2024

Background:

Renal interstitial fibrosis is outcome measure of increasing importance in transplantation and native diseases, and accurate assessment is essential for various scoring systems. There is limited research on the merits of fibrosis measurement methods.

Aim:

This study aimed to quantify and compare the degree of renal fibrosis by using visual analysis and computerized morphometry using trichrome staining and anti-collagen III immunohistochemistry and correlate with renal dysfunction.

Materials and Methods:

Fifty biopsy samples of various native renal diseases with a wide range of fibrosis were included in the study. Fresh sections were cut and stained with anti-collagen III antibody. Masson’s trichrome- and anti-collagen III-stained slides were subjected to visual assessment by two pathologists following standardized criteria. Digital images were evaluated by computerized morphometry using ImageJ software. Renal cortical fibrosis was expressed as a percentage of the total analyzed cortical tubulointerstitial region.

Results:

The percentage of interstitial fibrosis obtained by each method was compared with each other and with the estimated glomerular filtration rate (eGFR). The interobserver agreement was good for visual assessment using Masson’s trichome staining and excellent for visual assessment using anti-collagen III. The results of visual assessment using anti-collagen III correlated well with those of computerized morphometric assessment. Morphometric analysis of Masson trichrome-stained slides was difficult, and digital images could not be segmented satisfactorily. Computerized morphometric and visual analysis of anti-collagen III immunohistochemistry are good predictors of the eGFR.

Conclusions:

Anti-collagen III immunostaining is a very useful tool for accurate measurement of renal interstitial fibrosis. Morphometry is a useful adjunct for assessment of renal interstitial fibrosis.
Role of Endoscopic Ultrasound-Guided Aspiration in the Intra-Abdominal Lesion
Authors: Mohanty Pranita , Agrawal Ankita
Published: September 2024

Background:

Endoscopic ultrasound (EUS) is a reliable, safe, rapid, cost-effective, diagnostic procedure that is, used in various intra-abdominal benign and malignant conditions.

Aim:

EUS-FNA cytology and histology correlation were analyzed with imaging findings and clinical details of the intra-abdominal lesions to assess the malignancy risk/specificity/sensitivity/accuracy for the individual categories.

Materials and Methods:

The present study was a cross-sectional study conducted in a tertiary care hospital within a period of 2½ years. A total of 107 patients with radiologically detected intra-abdominal lesion were included. The demographic data, clinical symptoms, radiologic and EUS findings, laboratory work-up, and cytology results of the study participants were collected and were compared with follow-up histopathology either from a cell block preparation or from an EUS-FNA biopsy, whichever is possible. Cytology preparations were stained routinely with Diff Quik/H&E/PAP stains, and corresponding histology sections were stained routinely with H&E stain. Immunohistochemistry analysis was also performed in difficult cases. Statistical analysis was performed by SPSS statistics software.

Results:

This study comprises a total of 107 cases with the age range of 7–80 years. The maximum number of cases were of the age range 51–60 years in both sexes, and the mean age was 51 years. Sixty-seven cases (63%) were males, whereas 40 cases were females, with M:F ratio = 1.7:1. Maximum cases were sampled from the pancreas, 64 (59.81%), followed by 26 (24.29%) abdominal lymph nodes. Among them, 46 (42.99%) cases were diagnosed to be benign, 41 (38.31%) cases were diagnosed to be malignant, 13 (12.14%) cases were diagnosed as suspicious/atypical, and seven cases (6.54%) were diagnosed as non-diagnostic. Statistical analysis showed 86.53% sensitivity, 84% specificity, PPV 86.53%, NPV 84.09%, and overall accuracy 76.63%.

Conclusion:

The EUS-FNA procedure is effective in diagnosing malignant and benign abdominal lesions and is very helpful for providing a definitive therapy at the earliest.
Degenerative Changes of Neurons in the Perifocal Zone of the Brain in Strokes
Authors: Pospishil Yuri , Falion Ruslana , Beketova Yulia , Pshyk Roman , Dronyk Iryna
Published: September 2024

Introduction:

Cerebral atrophy typically occurs in both strokes and with aging. Each year, the rate of brain atrophy increases by 0.41% in older individuals. Critical disruptions in cerebral blood flow lead to disturbances in intracellular metabolism in neurons. This results in both cell death and neuronal degeneration.

Research Objective:

To compare the severity of degenerative changes in the brain in different stroke variants.

Materials and Methods:

A total of 71 autopsy cases with stroke were examined, including 25 with ischemic stroke (IS), 28 with hemorrhagic stroke (HS), and 18 with IS with hemorrhagic transformation (IS with HT). The material was grouped according to the periods of stroke progression by H.I. Mena et al. (2004) and W. Bradley (2007). A total of 118 histological slides of perifocal brain zone specimens stained with hematoxylin and eosin were examined, measuring neurons, nuclei, and lipofuscin. All protocols were statistically processed.

Results:

In all stroke groups, the number of cases with neurons exhibiting degenerative changes increased with the progression of the disease. Neuron sizes in the IS with HT group were the smallest. Cell sizes in the IS and HS groups were smaller compared to the control group. Significant differences (P < 0.05) in neuron nucleus sizes were found between the IS, HS, and IS with HT groups compared to the control group, with the smallest nucleus sizes observed in the IS with HT group. The highest accumulation of lipofuscin was found in the IS with the HT group. Significant differences in lipofuscin accumulation were observed in all three groups: between HS and IS (P < 0.05), between IS with HT and IS (P < 0.05), and when comparing IS with HT and HS (P < 0.05). The most pronounced changes in neurons were observed in the HS and IS with HT groups.
Effect of Different Methods of Mobile Phone Exposure on the Structure of Hippocampus in Adult Albino Rats
Authors: Moussa Nourhan Ahmad Ali , Farrag Kawthar Abd E. L. Raheem , Kalleny Nagwa Kostandy , Hamam Ghada Galal
Published: September 2024

Introduction:

Using mobile phones has dramatically increased in the last few years, especially during coronavirus pandemic. Mobile phones are carried near the head while talking. Electromagnetic fields (EMFs) emitted from cell phones may exert detrimental effects on the hippocampus.

Aim:

To study the effect of different methods of mobile phone exposure on the structure of the hippocampus in adult rats.

Materials and Methods:

Twenty-eight adult male albino Wistar rats were equally divided into four groups: group I (control). Group II (silent non-vibrating): exposed to 900–1800 MHz cell phone-emitted EMF for 60 min/day. Mobile phones were kept in silent, non-vibrating mode. Group III (silent vibrating): exposed to EMF as in group II, but mobile phones were kept in vibrating mode. Group IV (ringing non-vibrating): exposed to EMF as in group II, but with ringtone turned on and adjusted at 80 dB. After 4 weeks of exposure, hippocampi were harvested from all rats. They were subjected to hematoxylin and eosin, toluidine blue, caspase-3, and glial fibrillary acidic protein immunohistochemical stain, as well as transmission electron microscopic examination. Morphometric and statistical studies were also done.

Results:

Pyramidal and granule cells were affected by EMF exposure with predominant affection of CA3 area. Pyramidal cells in CA3 of group IV showed condensed chromatin clumps, distorted mitochondria, and clumped neurofilaments. A significant decrease in the thickness of the pyramidal cell layer and a significant increase in the mean number of degenerated pyramidal neurons were noticed in the CA3 area of group IV compared to other groups. An increased number of caspase-3 positive cells, as well as the increased number of astrocytes, were noticed in CA3 area of group IV compared to other groups.

Conclusions:

Exposure to EMF causes significant changes in the structure of the hippocampus, especially CA3 area. There is no significant difference between silent and vibrating modes. The worst changes are detected in ringing mode.
Telocytes: Exploring Their Influence on Angiogenesis and Therapeutic Interventions
Authors: El-Sheikh Amal Ahmed
Published: September 2024

Telocytes (TCs), unique interstitial cells characterized by distinctive ultrastructural features, have emerged as key players in angiogenesis, the process of new blood vessel formation. This review explores the diverse roles of TCs in angiogenesis across various organs and tissues, shedding light on their potential therapeutic applications. TCs have been shown to express several angiogenic factors and participate in the regulation of angiogenesis across different organs and tissues in the cardiovascular, pulmonary, gastrointestinal, skin, skeletal muscle, and male and female reproductive systems. Additionally, TCs have developed as potential therapeutic targets for modulating angiogenesis in various pathological disorders, such as myocardial infarction, respiratory distress syndrome, endometriosis, and skeletal muscle repair. Despite promising preclinical therapeutic implications, several limitations, including incomplete understanding of TC-mediated angiogenic mechanisms, heterogeneity of TC populations, and ethical considerations, must be addressed to interpret these findings into clinical applications effectively. Upcoming studies should focus on unraveling the intricate signaling pathways underlying TC-mediated angiogenesis, characterizing TC subpopulations, and optimizing preclinical studies to harness the full therapeutic potential of TCs in angiogenesis-related disorders. Overall, understanding the role of TCs in angiogenesis and therapeutic intervention represents a promising avenue for advancing regenerative medicine and improving patient outcomes.
Frequency of Micronucleated Cells as Expressed in Different Clinical Stages of Oral Submucous Fibrosis and Histopathological Grades of Oral Squamous Cell Carcinoma Patients: A Cross-Sectional and Hospital-Based Study
Authors: Bhushanam Naga , Sultana Shaik Farha , Raman Praveena , Alqahtani Mohammed Thamer , Alqahtani Saeed Mohammed , Alshareef Mohammed Abdullah , Babu J. Suresh , Swarnalatha C. , Nayyar Abhishek Singh
Published: September 2024

Background and Aim:

Genetic insults in lieu of exposure to different carcinogenic agents are often expressed in the form of micronuclei in a cell. The intent of the present cross-sectional and hospital-based study was to assess the frequency of micronucleated cells (MNCs) as expressed in the different clinical stages of oral submucous fibrosis (OSMF) and histopathological grades of oral squamous cell carcinoma (OSCC) patients.

Materials and Methods:

For the present study, 150 subjects, including patients who were detected with OSMF and OSCC, were enrolled, while they were subjected to an oral exfoliative cytology procedure, and the frequency of MNCs was calculated using a differential counter. Comparison of the means was done using the Kruskal–Wallis H-test with post hoc Bonferroni correction applied to conduct pairwise comparisons among independent groups. A probability value (P value) less than 0.05 was contemplated as statistically significant.

Results:

The mean MNC% in controls was calculated as 0.3 ± 0.35% in the present study as against 1.22 ± 0.37% in OSMF patients and 2.0 ± 0.60% in OSCC patients with statistically significant results (P < 0.001). Likewise, the mean MNC% was calculated as 0.71 ± 0.08% in Stage I OSMF as against 1.31 ± 0.18% in Stage II and 1.59 ± 0.17% in Stage III OSMF, while 1.15 ± 0.11% in Stage I OSCC as against 1.59 ± 0.25% in Stage II and 2.23 ± 0.30% and 2.68 ± 0.19% in Stage III and Stage IV OSCC, respectively, with statistically significant differences among them (P < 0.001).

Conclusion:

The mean MNC% increased significantly in OSCC patients as against the control and OSMF groups and OSMF patients as against controls, thus suggesting micronuclei assay as a useful diagnostic adjunct for screening high-risk populations.
Dhaga Syndrome: Unveiling Two Cases and Navigating Diagnosis and Treatment
Authors: Aier Sashitemjen , Sinha Abhinav
Published: September 2024

Dhaga Syndrome, also known as rubber band syndrome, is an exceptionally rare condition predominantly observed in children from the Indian subcontinent. Characterized by the inadvertent forgetting of threads or elastic bands worn for religious or decorative purposes around the wrist or forearm, progressively resulting in constriction and damage to the underlying structures. The hallmark feature of this syndrome is the presence of a circumferential constricting scar accompanied by a discharging sinus. We report on two cases of Dhaga syndrome, both presenting with a painful, swollen hand accompanied by a circumferential scar. One case was attributed to a religious thread, while the other resulted from a rubber band. Diagnosis primarily relies on a high level of clinical suspicion; however, radiographs displaying the constricting sign can provide valuable diagnostic assistance. The treatment of choice involves surgical exploration, with the removal of the constricting band.
Surgical Treatment of Midshaft Clavicle Fractures with Intramedullary Titanium Elastic Nailing System
Authors: Raju G. Bharath , Ravish V. N. , Gowda B. M. Bharath
Published: September 2024

Introduction:

Fractures of the clavicle are common injuries with an incidence of 5%–10% of all fractures. The most common site of fracture in clavicle is the middle third and accounts for approximately 70%–80% of all clavicle fractures. Clavicle fractures are usually associated with some degree of displacement. Displaced midshaft clavicle fractures can cause significant persistent disability, even if they heal uneventfully when treated conservatively. Surgery is required in case of significant fracture displacement and associated neurovascular injuries. Fractures that require internal fixation are usually treated by plate osteosynthesis as the standard procedure. Intramedullary fixation with titanium elastic nailing system (TENS) is an increasingly popular technique for the internal fixation of displaced mid-clavicular fractures. It is a better fixation device for simple displaced midshaft clavicle fractures.

Methodology:

A prospective study was conducted with a sample size of 20 patients for 18 months. After obtaining approval and clearance from the institutional ethics committee, the patients fulfilling the inclusion criteria were enrolled for the study after obtaining informed consent. A thorough clinical examination of the patient was done. The diagnosis was made based on X-ray findings. All patients underwent routine preoperative investigations, and their fitness for surgery was taken. The surgery was performed under general or regional anesthesia. Constant–Murley score was used to evaluate the outcome of the study. The cases were followed for a minimum period of 6 months following surgery at the regular intervals of 6, 12, and 24 weeks.

Results:

The functional outcome in 17 patients was excellent with the union of the fracture site. In one case, there was fixation failure and it had to be converted into plate fixation and was excluded from the study. In four patients, there was hardware prominence at the entry site.

Conclusion:

TENS is a good internal fixation option for simple displaced midshaft clavicle fractures to reduce the duration of the surgery, decrease the surgical site morbidity, and early mobilization.
Diagnosing Shoulder Pathology: Correlating Magnetic Resonance Imaging and Arthroscopy
Authors: Chaurasia Shubham , Pathak Abhishek , Zuber Mohammad , Mishra Santosh Kumar
Published: September 2024

Introduction:

Shoulder pain is the third most common cause of musculoskeletal consultation causing significant pain and disability in performing tasks for daily living. For the diagnosis of shoulder joint pathologies, magnetic resonance imaging (MRI) and arthroscopy are commonly used. Currently arthroscopy is the gold standard in diagnosing shoulder pathologies. Also, many studies have reported MRI to be sensitive and accurate tool for investigations. The aim of the study is to compare the efficacy of MRI and arthroscopy in the diagnosis of shoulder pathologies and find the correlation between MRI and arthroscopic finding.

Materials and Methods:

The prospective, comparative study was conducted between January 2020 and July 2021; patients presenting to the institute with chronic shoulder pain were included in the study after applying selection criteria. MRI followed by shoulder arthroscopy was performed for all patients, and the data were statistically analyzed.

Results:

Synovitis (65.9%) was the most common pathology. MRI reported high specificity (100%) for full-thickness rotator cuff tear, rotator cuff tendinitis, subacromial bursitis, and Bankart’s lesion followed by superior labrum, anterior and posterior (SLAP) lesion (96.6%), and bicep tendinitis (95.8%) while moderate specificity for synovitis (78.6%) and partial rotator cuff tear (66.7%). MRI reported to have high sensitivity for Hill–Sachs lesion, subacromial bursitis, and partial-thickness rotator cuff tear and Bankart’s lesion and low sensitivity for full-thickness rotator cuff tear, synovitis, SLAP lesions, and bicep tendinitis. MRI detected subacromial bursitis (0.807), Bankart’s lesion (0.792), and Hill–Sachs lesion (0.707) with substantial correlation whereas it detected synovitis (0.064) with only slight correlation. The accuracy of MRI was highest in diagnosing subacromial bursitis (0.90) and Bankart’s lesion (0.90) and lowest for synovitis (0.46).

Conclusion:

MRI is an effective technique for the diagnosis of rotator cuff tears, subacromial bursitis, synovitis, and rotator cuff tendinitis but was less effective in detecting SLAP lesions and less in differentiating the partial or complete rotator cuff tear.
Effectiveness of Myofascial Release Techniques versus Hip-strengthening Exercise along with Static Stretching in Patients with Plantar Fasciitis
Authors: Kumar Virender , Chopra P. T. Robin , Meetu P. T. , Kamboj Pradeep , Singh Roop , Paul Shagnik , Jaiswal Surinder
Published: September 2024

Objective:

The objective of the study was to determine the effectiveness of myofascial release techniques versus hip-strengthening exercises along with static stretching in patients with plantar fasciitis.

Materials and Methods:

This was a prospective study carried out at Pt. B.D. Sharma PGIMS Rohtak. The study comprised 76 patients with 38 in each group. Group A received myofascial release technique, whereas Group B received gluteal muscle-strengthening exercises with static stretching of the hamstring and calf muscles along with ultrasonic therapy exercise followed by cryotherapy. The pain was measured using the Numeric Pain Rating Scale, and lower limb functions were measured using the foot function test.

Results:

Gluteal muscle strengthening when combined with static stretching exercises reduced heel pain and improved lower limb function, but was not as considerable when compared to myofascial release techniques. There was a statistically significant difference between the results of both the groups at baseline, at the end of the 2nd week, or at the end of the 4th week in pain/disability/range of motion and quadriceps muscle strength values.

Conclusion:

Myofascial release therapeutic interventions are much more effective than other therapeutic interventions in terms of pain reduction and functional disability improvement in patients with plantar fasciitis, which in addition leads to increased muscle strength and remarkable changes in joint range of motion.
Sociophysical Predictors of Facet Joint Arthritis in a Mountain Farming Community: A Computed-tomography-based Analytical Cross-sectional Study
Authors: Tiwari Punit , Kaur Harmeet , Kaur Harpreet
Published: September 2024

Background:

Arthritis of the diarthrodial zygapophysial joints, located in the posterior column of the spine, commonly known as facet joint arthritis (FJA) is a leading cause of back pain and related disability. In the literature, mainly the anatomy, innervation, diagnostic, and management part of FJA have been adequately published to date. Its etiology and association with various social and physical parameters remain underinvestigated. An insight into these associations can help develop a preventive strategy.

Materials and Methods:

This study was conducted to evaluate its relationship with various purported causative sociophysical factors. A total of 210 participants who underwent computed tomography for nonorthopedic complaints and met the inclusion criteria were consecutively enrolled. The sociophysical profile information was gathered through a structured questionnaire. FJA was defined as at least one joint affected by facet joint disease (Grade ≥2). The data collected were checked, edited, coded, and analyzed using the SPSS 25.0 version.

Results:

FJA was found in 74.3% of the study population. On multivariate logistic regression analysis, the odds of having FJA were 6 times more in the participants who spent 4 h or more picking fruits, and vegetables (adjusted odds ratio [AOR] = 6.01; 95% confidence interval [CI]: 1.80–20.057) and 3 times more in participants whose daily milk intake was <250 mL (AOR = 3.044; 95% CI: 1.045–8.869). Smokers were found to be having significantly higher odds of having FJA than nonsmokers (AOR = 5.248; 95% CI: 1.927–14.292). FJA was found to be significantly higher in the illiterate participants (AOR = 9.736; 95% CI: 2.594–36.546) than in those who were educated above matric.

Conclusion:

Farm drudgery and prolonged abnormal postures are an important but not the sole cause of FJA in the mountain farming community. Other modifiable factors such as diet, smoking, and education also have a role to play.
Association between COVID-19 Infection and Avascular Necrosis of the Femoral Head: A Cross-sectional Observational Study
Authors: Srivastava Anikrit , Pundkare Gopal , Khadilkar Madhav , Patil Sanjay N.
Published: September 2024

Background:

The COVID-19 pandemic, caused by SARS-CoV-2, has introduced numerous health complications beyond its primary respiratory effects. Notably, there is growing concern about its role in avascular necrosis (AVN) of the femoral head, a condition where disrupted blood supply leads to bone death. Factors such as hypercoagulability, extensive corticosteroid use, and potential direct vascular effects from the virus may contribute to this association. This article explores the link between COVID-19 and AVN, examining its mechanisms, prevalence, and clinical implications.

Materials and Methods:

This cross-sectional, observational study enrolled 32 patients who had COVID-19 infection and subsequently developed AVN of the femoral head. Various factors influencing AVN development were considered, including the timing of COVID-19 infection during the pandemic’s first and second waves, steroid treatment duration, and alcohol consumption history. The diagnosis was made using X-ray and magnetic resonance imaging findings.

Results:

Out of 32 patients, 19 contracted COVID-19 during the first wave, while 13 were infected during the second wave, indicating a higher virulence rate during the first wave. Although 20 patients received short-term steroid therapy, the duration and the dosage were not significant for AVN development. Similarly, the duration and amount of alcohol consumption among 11 patients were not significant enough to cause AVN. Therefore, we feel that the pathogenesis of COVID-19 infection itself likely plays a key role in AVN development, with factors such as steroid use and alcohol consumption being incidental findings.

Conclusions:

According to this study, we feel that the pathogenesis of COVID-19 infection itself likely plays a key role in AVN development, with factors such as steroid use and alcohol consumption being incidental findings.
Study of Restorative Spinoplasty in Midline Decompression and Discectomy for Intervertebral Disc Prolapse
Authors: Raju G. Bharath , N Ravish V. , Karan C. L.
Published: September 2024

Objective:

The objective of the study was to evaluate the role of spinoplasty in the surgical management of intervertebral disc prolapse by midline decompression and discectomy.

Materials and Methods:

Our study included 30 patients diagnosed with lumbar intervertebral disc prolapse at one level between July 2018 and October 2021. The patients belonged to the age group 18–45 years and comprised both males and females. All the patients in our study were operated by fenestration and discectomy of the involved level. Intraoperatively, the spinous process was not removed at the involved level. The spinous process was cut at the base, at the insertion of interspinous ligament, retracted along with the ligament complex, and the lamina was exposed. After the decompression of neural tissues, the spinous process was anatomically restored by performing a spinoplasty. All patients were followed up postoperatively and evaluated by the Oswestry Disability Index (ODI), Visual Analog Scale (VAS), and patient satisfaction.

Results:

In our study, most patients had involvement of L4–5 disc (70%). Intraoperatively, satisfactory neurological decompression was achieved and all patients had relief of symptoms immediately. The mean ODI and VAS scores were 58% and 8.2 preoperatively which reduced significantly to 15.5% and 0.8 during 6 months postoperative follow-up. The patients were mobilized on the 2nd day after surgery and had a faster recovery time with good functional outcomes.

Conclusion:

The goal of treatment of intervertebral disc prolapse is to improve the quality of living and reduce the economic burden of the disease. Spinous process osteotomy carried out and restorative spinoplasty done after nerve decompression provided satisfactory functional outcomes.
Transdural Approach in Difficult Giant Disc Herniation Cases
Authors: Haque Mohtashemul , Patel Dipesh Kumar , Kumar Avinash , Ahmad Fazal , Afsal Mohamed
Published: September 2024

Background:

Massive central lumbar disc herniations can pose a significant operative challenge. A protruding disc can be approached either through the axilla of the cord or transdurally.

Aim of Study:

This study aimed to study the outcome of transdural approach in a massive disc prolapse causing cauda equina syndrome.

Materials and Methods:

Of all the cases of disc prolapse, only patients presenting with massive disc protrusion/cauda equina syndrome were selected for the transdural approach. Seven males and three females in the age group of 40–60 years were treated by this method.

Results:

The transdural approach in a cauda equina patient was remarkably safe, short duration, and satisfactory results.

Conclusion:

Paraspinal approach through the axilla was superior for disc prolapse were exiting nerve root compression was present. For a fully blown cauda equina syndrome, the trandsural approach was easy, safe, and satisfactory.
Orthopedic Manifestations in Patients of Long COVID-19 Syndrome
Authors: Goel Aditya , Qidwai Shakeel A. , Mishra A. N.
Published: September 2024

Background:

It has been widely reported that the new coronavirus has adverse effects on the musculoskeletal system. The primary goal of this study is to establish the frequency of musculoskeletal complaints with extended COVID-19 syndrome.

Methods:

This retrospective cohort research examined the occurrence of musculoskeletal problems in patients with chronic COVID-19 syndrome.

Results:

About 100 COVID-19 patients tested positive, of which 27 (27.0%) had a minimum of one orthopedic impairment. Patients with orthopedic conditions were significantly younger than those without (53.7 years vs. 58.1 years, P = 0.003), and their incidence was significantly higher in obese than nonobese patients (P = 0.022). Furthermore, patients with diabetes had significantly more orthopedic symptoms than those with cardiac or pulmonary complications.

Conclusion:

According to our research, patients who are obese or diabetic have a higher probability of experiencing musculoskeletal symptoms when infected with COVID-19. In addition, analysis is needed to determine whether these orthopedic conditions persist during active disease and postinfection.
Intra-Articular Injection of 0.5% Buprenorphine in Early Osteoarthritis of Knee Joint: A Study of 50 Cases
Authors: Dave Mittal B. , Savajiyani Dixit Nitinkumar , Chauhan Nishant C. , Patel Akash D.
Published: September 2024

Background:

Osteoarthritis (OA) of the knee is a disabling disease. Recently, relatively younger patients with early OA and knee pain are increasing. Intra-articular (IA) therapies need to address the inflammation associated with OA along with pain relief. Recent reports suggest the presence of opioid receptors in peripheral locations and presence of their anti-inflammatory actions of IA opioid injections.

Aim:

To study the role of IA buprenorphine injection in the management of early OA of the knee joint.

Materials and Methods:

A prospective study of 50 patients with early OA was carried out. Patients were administered 2 ml IA 0.5% buprenorphine on days 1 and 7. The results were assessed with Oxford Knee Score (OKS) and Visual Analog Scale (VAS) on days 1, 7, 15, 30, and 90.

Results:

There was a significant improvement in mean OKS till day 30 (P < 0.0001) with values at day 90 showing similar results to day 1. The mean VAS values also showed a significant improvement till day 30 (P < 0.0001). There was no significant change in total neutrophil counts in synovial fluid on day 7. The most common adverse effect reported was nausea and vomiting (24%), pointing to systemic absorption.

Conclusion:

IA injection of buprenorphine showed no reduction in neutrophil counts in synovial fluid in this study and the pain relief resulting may in part be attributable to systemic absorption of the drug. Better depot preparations and further research into chondroprotective action of IA opioid injections are still needed to recommend it as a viable therapeutic option in early OA of the knee.
Platelet-rich Plasma Versus Steroid Injection under C-Arm Guidance in the Management of Sacroiliitis
Authors: Kumar Ashutosh , Kumar Rishabh , Shankar Anand , Kumar Rakesh
Published: September 2024

Objective:

The objective is to evaluate the efficacy of platelet-rich plasma and steroid injection in the management of sacroiliitis.

Background:

Sacroiliitis is considered a diagnostic feature of seronegative spondyloarthropathy (SPA). Sacroiliac joint steroid injection is the most commonly used method. Currently steroid, injection therapy and platelet-rich plasma (PRP) therapy are current treatment trends.

Material and Methods:

This interventional study included 60 patients with seronegative axial SPA. Patients were divided into two groups: group I received a c arm guided steroid injection and group II received a PRP injection. Patients were assessed by Visual Analog Scale and Modified Oswestry Disability Questionnaire (MODQ) at 4 and 8 weeks postinjection and by magnetic resonance imaging (MRI) at 8 weeks postinjection.

Result:

Steroids and PRP are effective in treating sacroiliitis. The improvement was significant and lasted longer in group II (68.6% mild pain by Vas and 74.3% minimal disability related to MODQ) compared to group I at 8 weeks postinjection. Steroid-treated patients improved significantly in 4 weeks (60% of patients experienced mild pain in Vas and 45.7% had minimal defects in MODQ), but efficacy declined after 8 weeks. According to follow-up MRI, active sacroiliitis can be completely improved with PRP injection (57.1% with normal MRI results after 8 weeks).

Conclusion:

Steroids and PRP were effective in the treatment of sacroiliitis in seronegative SPA under C arm guidance. But PRP was persistent and prolonged.
Myopericarditis following COVID-19 vaccination in children: a systematic review and meta-analysis
Authors: Thenpandiyan Ashiley Annushri , Ling Ryan Ruiyang , Grignani Robert , Ling Megan Ruien , Thenpandiyan Arthena Anushka , Tai Bee Choo , Somani Jyoti , Ramanathan Kollengode , Quek Swee Chye
Published: September 2024

Introduction:

Myopericarditis is a rare but serious coronavirus disease 2019 (COVID-19) vaccine-related adverse event primarily affecting adolescents. Given recent approvals for childhood vaccination, we performed a meta-analysis investigating myopericarditis following messenger ribonucleic acid COVID-19 vaccination in children aged <19 years, focusing on its overall risk and high-risk subgroups.

Methods:

We searched MEDLINE via PubMed, Embase and Scopus from inception to 1 August 2022 for observational studies reporting myopericarditis in temporal relation to paediatric COVID-19 vaccination. We conducted random-effects meta-analyses (DerSimonian and Laird) on myopericarditis (primary outcome), myocarditis and pericarditis (secondary outcomes).

Results:

Of 2115 studies, 12 (59,229,160 doses) studies were included in our analysis. There were 19.8 (95% confidence interval [CI]: 10.4–37.6) myopericarditis cases reported per million doses in children, compared to 23.7 (95% CI: 12.2–46.1) cases in adults (eight studies, 376,899,888 doses; P = 0.70). Compared to the second dose (34.4, 95% CI: 15.2–77.8), the number of cases post-first dose was significantly lower (9.1, 95% CI: 4.4–18.8; P = 0.017), while the number of cases post-third dose was not higher than that of post-second dose (28.4, 95% CI: 10.4–61.8; P = 0.57, global P = 0.031). Males were at higher risk of myopericarditis (67.4, 95% CI: 36.5–124.5) than females (6.9, 95% CI: 3.1–15.3; P < 0.0001). Finally, the number of cases was higher (overall P < 0.0001) among children aged ≥12 years (39.9, 95% CI: 24.1–66.0) than among children aged <12 years (3.0, 95% CI: 2.3–3.9).

Conclusion:

Our meta-analysis showed 19.8 cases of myopericarditis per million doses among children, not significantly different from that of adults. Higher risk subgroups included adolescents, males, and those receiving their second dose of vaccination.
Role of cerebrospinal fluid adenosine deaminase measurement in the diagnosis of tuberculous meningitis: an updated systematic review and meta-analysis
Authors: Ngiam Jinghao Nicholas , Koh Matthew Chung Yi , Lye Priscillia , Liong Tze Sian , Ong Lizhen , Tambyah Paul Anantharajah , Somani Jyoti
Published: September 2024

Introduction:

Tuberculous meningitis (TBM) can be difficult to diagnose. Elevated cerebrospinal fluid (CSF) adenosine deaminase (ADA) is often seen in TBM, but its reliability has been questioned. A previous meta-analysis in 2017 had demonstrated the diagnostic utility of CSF ADA in TBM versus non-TBM. We sought to update this meta-analysis with more recent studies, to determine whether CSF ADA could be used to aid in the early recognition of TBM.

Methods:

Electronic searches were performed in PubMed and Scopus on studies published from 2016 to 2022. Ten additional studies were identified and added to 20 studies (from 2000 to 2016) from a previous meta-analysis. Meta-analysis was conducted using the random effects method, estimating the pooled diagnostic odds ratio (DOR) for elevated CSF ADA in the diagnosis of TBM.

Results:

Of the 30 studies included, 16/30 (53.3%) used the Giusti method for measuring ADA. Fourteen (46.7%) studies used an ADA cut-off of 10 IU/L, and 11 (36.7%) studies used an even lower cut-off. The pooled DOR for elevated CSF ADA in the diagnosis of TBM was 45.40 (95% confidence interval [CI] 31.96–64.47, I
2 = 44%). When only studies using the Giusti method were considered, DOR was 44.21 (95% CI 28.37–68.91, I
2 = 40%). Among the studies that used a cut-off of 10 IU/L, DOR was 58.09 (95% CI 33.76–99.94, I
2 = 41%).

Conclusion:

Studies remain heterogeneous but demonstrate that CSF ADA can differentiate TBM from non-TBM. In line with most studies, CSF ADA >10 IU/L supports the diagnosis of TBM in a patient with compatible symptoms and high-risk epidemiology.
An unexpected parasite in bone marrow: Uncommon presentation of a common disease
Authors: Singh Anurag , Rawat Shalini , Verma Anuragani , Kushwaha Rashmi
Published: September 2024

Elephantiasis, also known as filariasis, is a severe public health issue in India. Microfilariae in the bone marrow smears are an unusual and incidental finding. Every peripheral blood and bone marrow aspirate smear must be screened for microfilariae in endemic areas to identify asymptomatic carriers. Here, we report a case of a 50-year-old man who presented with pyrexia of unknown origin. He had mild pallor and right-side inguinal lymphadenopathy. Peripheral blood showed anemia and leukocytosis with neutrophilia. Other serological tests, radiological examination, and aspiration cytology from the lymph node were inconclusive. The bone marrow aspirate smears incidentally displayed microfilaria, and the inguinal lymph node demonstrated an adult filaria worm. The association of microfilaria infection with pyrexia of unknown origin (PUO) and peripheral blood neutrophilia has been rarely reported in the literature. The patient recovered from fever and weakness with antifilarial medication and hematinics.
Employing patient-centric health education for the prevention of parasitic infections
Authors: Khanna Vinay , Khanna Ruchee , Chandrashekar U. K. , Ashok Lena
Published: September 2024

Background:

Soil-transmitted infections such as Ascaris lumbricoides, Hookworm, Trichuris trichiura, and Strongyloides stercoralis are common in South India. Factors such as diet, sanitation, and living conditions play a role in the prevalence of helminthic diseases. Many individuals remain asymptomatic carriers. Timely intervention is essential to prevent these infections.

Materials and Methods:

This is a prospective, randomized intervention study that enrolled 52 participants, excluding children, all of whom had parasitic infections. A prevalidated questionnaire was given to assess the risk factors for parasitic diseases, and fecal examinations were conducted to identify parasitic infestations. The World Health Organization’s hand hygiene self-assessment framework was used to evaluate handwashing skills. Subsequent posttesting and resampling of patients allowed for score comparison, assessment of reductions in parasitic load, determination of cure rates, and monitoring of patient readmission rates.

Results:

After the health education intervention, a statistically significant improvement (P < 0.01) was observed in patients’ knowledge and attitudes toward parasitic infections, as shown by their posttest scores compared to their pretest scores. In addition, there were notable improvements in handwashing skills following the implementation of the handwashing educational program.

Conclusion:

This research confirms that health education is vital in promoting proper hand hygiene, reducing parasitic infections, and urging timely medical care for these conditions.
Free-living amoebic encephalitis – Case series
Authors: Puthanpurayil Sithara Nasar Thottathil , Mukundan Aiswarya , Nair Suryakala Ravi , John Anu Pudurkara , Thampi Mithuna Rohini , John Reena , Sehgal Rakesh
Published: September 2024

Introduction:

Free-living amoeba is ubiquitous in fresh water, mud, and moist soil; although seldom pathogenic to humans, Naegleria fowleri, Acanthamoeba spp., and Balamuthia spp. are known to cause infections of the central nervous system.

Methods:

We report two interesting cases, both of which presented with a rapid-onset and fulminant course. The first case details a 36-year-old male with a history of surgically corrected nasal bone fracture 15 years back, who presented with acute onset of fever, headache and convulsions.

Results:

Direct smears of cerebrospinal fluid (CSF) revealed motile trophozoites resembling N. fowleri and were later confirmed by molecular diagnosis (polymerase chain reaction [PCR]). Subsequently, the source was identified as water used for religious purposes. Unfortunately, the patient succumbed to cardiac arrest. The second case is that of a 4-year-old boy from Palakkad district, Kerala, who presented with sudden onset of nasal discharge, fever, headache, vomiting, seizures and altered sensorium. His CSF smear examination showed motile trophozoites resembling Acanthamoeba spp. While undergoing treatment, he seized thrice before going into cardiac arrest. Despite extensive resuscitation measures, the child could not be revived and passed away. The postmortem CSF sample sent for molecular analysis confirmed infection by Acanthamoeba spp.

Conclusion:

Rapid progression and lack of definite treatment options make this a highly fatal condition. Although clinical presentations of both patients were indicative of pyogenic meningitis, parasitic infection was suspected when the CSF was found turbid with no bacteria, high protein, and low sugar. High index of suspicion helped us to get an early preliminary diagnosis from direct microscopy.
Isolated cysticercosis of the liver – A rare case report on diagnosis and management of an incidental finding during prepyloric perforation peritonitis repair
Authors: Babu Basil , Jayant Divij , Behera Arunanshu , Tandup Cherring , Thakur Vipul , Kothari Anand , Nada Ritambra
Published: September 2024

Cysticercosis is one of the most common parasitic infections seen in the human population which most commonly affects the nervous system. Isolated cysticercosis of the liver is rare, and only less than five cases have been reported in the literature. Here, we describe an isolated cysticercosis of the liver. The cyst appeared as a firm nodule on the surface of the liver during a prepyloric perforation repair. The biopsy of the nodule revealed a cyst wall, and a contrast-enhanced computed tomography postoperative showed cysts in the liver. The patient was further evaluated with whole-body imaging which did not reveal any other cysts elsewhere.
Dirofilariasis in the hiding in oral cavity of a patient from Karnataka, India
Authors: Veetil Sreelatha Shankaran , Ashraf Asem Ali , Koshy Jerlin , Karnaker Vimal Kumar
Published: September 2024

“Human dirofilariasis, caused by filarial worms of the genus Dirofilaria, is considered an emerging zoonotic filarial infection transmitted to humans by zoo-anthropophilic blood-sucking insects. The most common Dirofilaria species causing human infections include Dirofilaria repens and Dirofilaria immitis. In this case report, we present the case of a 60-year-old male patient who reported the presence of an intraoral swelling in the right maxillary vestibular region. Upon excision of the lesion and further microscopic and histological examination, a female Dirofilaria was identified as the causative agent.”
Prevalence of intestinal parasitic infections among the pregnant women in South and South East Asian countries: A systematic review and meta-analysis
Authors: Garg Shubha , Garg Ankur , Ravishankar N. , Garg Vinay
Published: September 2024

Intestinal parasitic infections (IPIs) are a major health concern in resource-limited countries of South/South-East Asian region. Despite posing a potential threat to maternal and fetal health, there is limited data available on the actual burden of IPI among pregnant women. Through this systemic review and meta-analysis, we sought to determine the pooled prevalence of IPI and species-specific prevalence among pregnant women in this region. Subgroup analysis was done by region, stool examination technique, and study settings. Among 220 retrieved studies, 21 studies from 8 countries across the region were found eligible and included in this study. The estimated overall pooled prevalence of IPIs among pregnant women was 43.15% (95% confidence interval: 30.66–56.10). The most prevalent IPI was Ascaris lumbricoides (25.14%) and predominant protozoa was Entamoeba histolytica/dispar (6.96%). In subgroup analysis, the estimated pooled prevalence of IPIs in Nepal, India, Thailand, and Thai–Burmese Border was 40.88%, 28.33%, 55.38%, and 23.78%, respectively. Studies using Kato-Katz technique for stool examination showed the highest estimated pooled IPI prevalence (62.70%). The prevalence of IPI was found to be lower in facility-based studies (38.12%) than that of studies done in the community (66.21%). Considering the high burden of IPI in pregnant women as estimated in our review and the already established impact of IPI infection on maternal health and fetal outcomes, we recommend implementation of the preventive chemotherapy during routine antenatal checkups.
Colorectal cancer with a germline BRCA1 variant inherited paternally: a case report
Authors: Kim Kyoung Min , Lee Min Ro , Ahn Ae Ri , Chung Myoung Ja
Published: September 2024

BRCA genes have well-known associations with breast and ovarian cancers. However, variations in the BRCA gene, especially germline variations, have also been reported in colorectal cancer (CRC). We present the case of a rectal cancer with a germline BRCA1 variation inherited from the paternal side. A 39-year-old male was admitted with rectal cancer. The patient underwent surgical resection and the pathologic diagnosis was adenocarcinoma. Next-generation sequencing was performed and a BRCA1 variant was detected. Reviewing the public database and considering the young age of the patient, the variant was suggested to be germline. The patient’s father had had prostate cancer and next-generation sequencing testing revealed an identical BRCA1 variant. In the BRCA cancer group, there is relatively little attention paid to male cancers. The accumulation of male CRC cases linked to BRCA variations may help clarify the potential pathological relationship between the two.