bluuebunny/crossref_metadata_2025 huggingface dataset:
A Performance Comparison of the HEC-RAS and TELEMAC-2D Models in Flood Risk Assessment - Application to the Medjerda River
Authors: Hammami Saber , Romdhane Hela , Soualmia Amel , Kourta Azeddine
Published: December 2024

River flooding is one of the most frequent catastrophic events, with dramatic consequences regarding loss of life and economic damage. For this reason, flood hazard and risk management now appear as the fundamental activities that public bodies and competent authorities must implement to reduce human and socio-economic losses. In this context, this study refers specifically to the flooding at the Boussalem city, crossed by Medjerda river in Tunisia. This work aims to assess the suitability of different numerical tools for reproducing flood dynamics using two different fully two-dimensional (2D) hydrodynamic models, both based on the Saint-Venant equations: TELEMAC-2D and HEC-RAS 6.0. The study compares the accuracy and performance of the two models in estimating flood hazard and risk. Comparative analysis is conducted on flooded area extents from both models for the 2003 flood event and return periods of 20, 50, and 100 years. This is achieved by identifying the roughness coefficient for each land cover type. The comparison encompasses flooded areas for four height classes along the Medjerda River in Tunisia: <0.5m, 0.5-1m, 1-2m, >2m. Details of the analysis of the total flooded area generated by the models show that the percentage difference between the flooded areas decreases as the discharge increases, with differences of 4%, 6%, 16%, and 27% respectively for the 2003 events and the 20, 50, and 100-year return periods. This observation indicates that TELEMAC-2D tends to generate larger estimates of flooded areas as water height increases, suggesting an increased sensitivity to extreme flood events. Conversely, for depth classes of 0.5 to 1 meter and less than 0.5 meters, HEC-RAS produces larger flooded areas than TELEMAC-2D for events with return periods of 50 and 100 years. This divergence can be explained by the influence of specific modeling methodologies of the two software packages.
Seismic Performance of 2D Regular Reinforced Concrete Frame Buildings Strengthened by Using Shape Memory Alloys
Authors: el Mtili Chayma , Hessissen Loubna , Khamlichi Abdellatif
Published: December 2024

Reinforced concrete frame buildings are at risk of earthquake. Improving their response by adequate strengthening provision is an issue of major importance. Among the recent techniques introduced to increase the seismic resistance of this type of structure, shape memory alloy materials were found to be promising. They have large damping properties and significant re-centering capacity that reduce seismic efforts and limit damage. This work was dedicated to assessing the enhancement of building seismic capacity based on shape memory alloys of different sorts. Reinforcement consists of using rebars made from this material to replace longitudinal steel rebars in the critical zones of beams. A comparison of seismic performance induced by this technique with that associated with the conventional option relying entirely on steel as reinforcement was conducted. This was performed in the case of a medium-rise regular building subjected to medium and strong earthquakes when strengthened using four different shape memory materials including nickel titanium and ferrous-based alloys. SeismoStruct software was used to simulate the building through the static pushover analysis and the nonlinear time-history dynamic analysis. The building was anchored in the soil assumed to be rigid and the inelastic displacement-based beam element was used to discretize the structural members by setting up five integration sections and 150 fibers. In comparison with the steel-based option, it was found in both sites of construction that the use of shape memory yields an improvement in seismic resistance and re-centering performance. By using these smart reinforcements, the residual maximum inter-story displacement was reduced to less than a quarter of its value associated with the steel-based reinforcement. Furthermore, ferrous-based shape memory alloys were identified to yield a cost-effective strengthening alternative with regards to the common nickel titanium option and less than 10% of relative variation was observed in comparison with this latter.
Review on Application of Rice Husk Ash for Production of Hollow Sandcrete Blocks: Towards Sustainable Construction
Authors: Anifowose Mukaila Abiola , Raheem Akeem Ayinde
Published: December 2024

The search for cement substitutes will significantly lower building costs and contribute to a decrease in greenhouse gas emissions from cement production. In mortar and concrete, rice husk ash (RHA) has been extensively researched as a partial cement substitute. The improper usage and disposal of recyclables (rice husk and RHA) produced during rice production is one of the main issues that negatively impact the rice industry. One way to address this is by incorporating waste into construction materials. In this study, past research on sandcrete blocks was reviewed to ascertain the suitable use of RHA for producing sandcrete blocks for sustainable construction. Specific gravity, oxide compositions, X-ray diffraction (XRD), and scanning electron microscopy (SEM) of RHA were reviewed, while strength comparisons between conventional blocks and RHA-blocks were also reviewed. The physio-chemical outcome of the RHA revealed it as a good binding material. The study concluded that hollow sandcrete blocks produced with RHA could be used as non-load-bearing walls and for lightweight construction. Hence, the fineness of RHA and the longer curing age of blocks will determine RHA’s usefulness for producing load-bearing walls. The application of RHA for producing hollow sandcrete blocks will lead to sustainable construction, thereby reducing environmental pollution posed by the rice industry.
Prevalence and Pattern of Morbidity Triads among the Elderly Population: A Cross-sectional Study in Bankura District, West Bengal
Authors: Das Ujjwal , Kar Nishamani
Published: December 2024

Background and Aim:

The multi-morbidity in the elderly is a major public health challenge in most of developing countries. The elderly suffer from multiple chronic health conditions due to differential socioeconomic and demographic conditions in the household. The present study examines the prevalence and pattern of triad morbidity among the elderly in the Bankura district of West Bengal.

Materials and Methods:

A cross-sectional study was conducted among elderly men and women aged 55 years and above in five blocks of Bankura district. The multi-stage random sampling designed was developed to select the requisite number of elderly. The blocks were selected in the first stage, and then the village was selected in the second stage, followed by a selection of the target population in the third stage. The pretested, predesigned, and semi-structured questionnaires were developed for collecting the self-reported morbidity information. Descriptive statistics was used to identify the prevalence of disease-specific burden of triad morbidity. Multivariate logistic regression forms of odds ratio with a 95% confidence interval were used to explore the factors associated with morbidities.

Results:

Out of the 462 elderly persons, 222 (48.05%) were males and 240 (51.95%) were females; 360 (77.9%) were affected by more than one disease. The mean age of affecting triad morbidity among the elderly was 61 years. The highest prevalence of triad morbidity among the elderly was arthritis, hypertension, and heart disease (79.6%), followed by diabetes, hypertension, and depression (78%). The overall disease prevalence was more prominent among the female elderly than males. The prevalence of triad morbidities was strongly correlated with key lifestyle factors such as excess intake of alcohol, smoking, and tobacco consumption and higher food choices of nonvegetarians.

Conclusion:

The health problems of the elderly are aggravated by the no education, lack of physical work, poor socioeconomic condition, and Western types of lifestyle. There is an urgent need to develop comprehensive public health strategies to address the high burden of NCDs in Bankura.
Do Not Miss the Snake in the Grass – An Interesting Case Series of Mimics in Pap Smear Cytology Which May Impact Reporting
Authors: Gaffoor Nidha , Shetty Archana
Published: December 2024

Microscopic examination remains a major component in a diagnostic cytopathology laboratory. Pap smears are one among the commonly reported tests in gynecologic pathology. It is not infrequent to routinely come across artifactual or less significant cytological findings that closely mimic relevant reportable findings both on liquid-based and conventional Pap smear examinations. To an imprudent examiner, this not only results in a merry chase but also affects the quality of the final report generated. We present a series of microscopic findings on Pap smears, encountered over 3 months in our laboratory with their close resembles with a note on points of differentiation. This case series is presented with the intent to highlight the need for cytopathologists to be aware of the potential diverters and avoid overdiagnosing or underlooking findings which may have clinical implications.
Pelvic Floor Rehabilitation in Posttraumatic Masturbatory Syndrome
Authors: Mahishale Arati , Mainuddin Javiriya , Prabha Vikram
Published: December 2024

Traumatic masturbation is characterized as a behavior that involves lying on the bed in a prone posture and stroking penis on the bed, pillow, or hands. This sort of behavior further causes sexual dysfunction and pelvic floor dysfunction. A significant concern is the use of physiotherapy in traumatic masturbatory syndrome (TMS) to treat pelvic floor dysfunction. This is a case study of a 34-year-old male with a complaint of inability to void urine adequately, with decreased urine output and straining during defecation secondary to TMS. The patient was screened using Dyssynergic dysfunction scale and Patient Assessment of Constipation–Quality of Life questionnaire, after which the patient was provided with physiotherapeutic intervention using Pelvic Floor Rehabilitation Protocol in Post TMS. The study concluded that Pelvic Floor Rehabilitation Protocol in post-TMS was found effective in the reduction of the pelvic floor muscle dysfunction.
Mermaid in Pathology from Greek Mythology: A Rare Association with Amelia
Authors: Manjula Chikkanaganna P. , Pranav Vijay Karthik , Kusuma V. , Varadaraj Shilpashree
Published: December 2024

Sirenomelia, also known as mermaid syndrome, is a rare congenital anomaly, with an incidence of 1 in 100,000 live births. It is characterized by variable degrees of fusion of the lower limbs and anomalies of the genitourinary system and gastrointestinal system. We report a 24-week fetus with completely fused lower limbs, absent left upper limb, and Potter’s facies. Absent external genitalia, imperforate anus, bilateral renal agenesis, blind intestinal loop, and single umbilical artery were other findings. X-ray imaging confirmed the fused lower limb bones and was typed as sympus apus or sirenomelia, Type VII of the Stocker and Heifetz classification. Caudal hypoperfusion due to the aberrant blood supply and an embryologic insult to the caudal mesoderm along with gestational diabetes play a role. Sirenomelia is not compatible with life in the majority of the cases as there is bilateral renal agenesis. It is a very rare congenital anomaly among the mermaid syndromes, hence requires documentation.
Hypoglycaemic, anti-hyperlipidemic, and anti-inflammatory activities of Asparagus africanus (Asparaceae) extract on high-fat diet/streptozotocin-induced diabetes in Wistar rats
Authors: Evans Ngwenah Focham , Mahamat Oumar , Christopher Tume
Published: December 2024

Objective:

To investigate the toxicity and effect of the extract on some complications of diabetes in Wistar rats.

Methods:

Type 2 diabetes was induced by a combination of a high-fat diet and streptozotocin (35 mg/kg, i.p.). Aqueous extract of Asparagus africanus (EAA) was prepared and administered (p.o.) for 28 d to groups of diabetic rats as well as to groups of normal rats for toxicity. Fasting blood glucose levels, inflammatory cytokines, and lipid profiles were assessed in diabetic rats. Body and organ weight as well as liver and kidney functions were examined to assess the sub-acute toxicity.

Results:

EAA for 28 d did not affect the body weight, the weight of the liver, kidney, and heart as well as the serum level of aspartate aminotransferase, alanine aminotransferase, urea, uric acid and creatinine in normal rats. In diabetic rats, the administration of EAA significantly lowered hyperglycemia, reduced interleukin (IL)-6, IL-1β, and tumour necrosis factor-α levels, and increased the level of IL-10. EAA also lowered cholesterol, triglyceride, and low-density lipoprotein cholesterol levels and augmented high-density lipoprotein cholesterol in the serum. As a result of the anti-lipidemic effect, EAA reduced the atherogenic index, Castelli indices, and atherogenic coefficient in diabetic rats. EAA showed the presence of flavonoids, alkaloids, tannins, saponins, terpenes, and steroids.

Conclusions:

The findings of this study demonstrated that EAA is safe. It has the potential to reduce the glucose level and the risk of inflammation and atherogenesis in diabetic patients.
Cardioprotective effects of total and anthocyanin-rich extracts of Opuntia ficus-indica fruit on epinephrine-induced cardiac injury in rats
Authors: Safaeian Leila , Sadeghi-Dinani Masoud , Haghighatian Zahra , Fatahian Mohammad-Bagher , Khademizadeh Marjan
Published: December 2024

Objective:

To examine the effect of fruit extracts of Opuntia ficus-indica on epinephrine-induced myocardial injury in rats.

Methods:

Rats were pre-treated with hydroalcoholic and anthocyanin-rich extracts (250, 500, and 1 000 mg/kg) orally for 16 days. Epinephrine (2 mg/kg) was injected subcutaneously on days 15 and 16. Then ECG, heart rate, RR interval, cardiac histopathology, and serum parameters of cardiac damage and oxidative stress were evaluated.

Results:

Pretreatment with the hydroalcoholic and anthocyanin-rich extracts of Opuntia ficus-indica at doses of 500 and 1 000 mg/kg reversed epinephrine-induced changes in ECG, heart rate, RR interval, and cardiac histopathology, and attenuated creatine phosphokinase-MB activity and malondialdehyde level. The extracts at all doses diminished heart weight, lactate dehydrogenase, and aspartate aminotransferase, and also elevated total antioxidant capacity. However, 1 000 mg/kg of the anthocyanin-rich extract was more effective than the hydroalcoholic extract.

Conclusions:

Supplementation with fruit extracts of Opuntia ficus-indica, especially anthocyanin-rich extract, could protect against epinephrine-induced cardiac injury in rats by alleviating electrocardiographic, biochemical, histopathological, and oxidative stress parameters, and may be used in the treatment of cardiovascular diseases.
Comparing Cisplatin Dosing Schedules in Concurrent Chemoradiotherapy for Locally Advanced Head-and-Neck Cancer: A Comprehensive Review of Weekly Versus 3-Weekly Regimens
Authors: Yang Oscar Chi-Yu , Su Nai-Wen , Leu Yi-Shing , Chang Yi-Fang
Published: December 2024

Objective:

There are approximately 900,000 new cases of head-and-neck cancer (HNC) annually, with a significant proportion presenting as locally advanced head-and-neck cancer (LA-HNC). Cisplatin-based concurrent chemoradiotherapy (CCRT) has become widely accepted, particularly for patients deemed inoperable. The standard regimen is a high-dose 3-weekly cisplatin schedule, however, this can lead to considerable toxicities. This review evaluates the efficacy, safety, and compliance associated with an emerging alternative: a weekly cisplatin dosing schedule.

Data Sources:

The review of current literature included randomized controlled trials, meta-analyses, and retrospective studies within the past decade, comparing weekly, and 3-weekly cisplatin CCRT regimens for LA-HNC.

Study Selection:

Studies comparing 3-weekly and weekly cisplatin-based CCRT were included.

Results:

Weekly cisplatin regimens demonstrated comparable efficacy to the traditional 3-weekly schedule, with lower toxicity and improved compliance. Key studies suggested that weekly cisplatin may have a more favorable safety profile, with reduced risks of neutropenia, renal impairment, and ototoxicity. However, the potential for slightly better locoregional control with the 3-weekly regimen remains a point of ongoing investigation. Novel agents including immune checkpoint inhibitors, xevinapant, and berzosertib are being actively investigated as combinational therapies with cisplatin-based CCRT.

Conclusion:

Weekly cisplatin-based CCRT is a viable alternative to the traditional 3-weekly regimen for treating LA-HNC, particularly in patients at higher risk of toxicities. Further randomized controlled trials are required to confirm the optimal cisplatin schedule and efficacy of combinational therapies with novel agents. These findings underline the importance of exploring treatment protocols that balance therapeutic benefits with reduced adverse effects and improved compliance.
Adult-onset Renal Neuroblastoma: Case Report and Literature Review
Authors: Yang Yao-Ren , Huang Cih-En
Published: December 2024

Neuroblastoma is an extremely rare neoplasm in adults, with a poorer prognosis compared to pediatric neuroblastoma. Due to its rarity, there are no specific treatment guidelines for adult neuroblastoma. Here, we report a case of adult renal neuroblastoma presenting initially with painless and gross hematuria. Enhanced computed tomography revealed an infiltrative, heterogeneously enhanced renal mass at the lower pole of the right kidney, accompanied by regional lymphadenopathies. The initial impression was renal cell carcinoma, and a right nephroureterectomy with regional lymph node dissection was performed. Pathologic examination confirmed the diagnosis of primary renal neuroblastoma with a differentiating subtype. The patient was classified as having International Neuroblastoma Staging System stage 2B or International Neuroblastoma Risk Group Staging System stage L2. The patient underwent six courses of adjuvant chemotherapy, and no disease recurrence was observed during a 7-year follow-up period.
5-Fluorouracil, Leucovorin, Oxaliplatin, and Irinotecan as a Potential Standard for Second-line Therapy in Extrapulmonary Neuroendocrine Carcinomas
Authors: Ho I-Wei , Chiang Nai-Jung , Lai Jiun-I , Chang Peter Mu-Hsin , Chen San-Chi , Hung Yi-Ping , Chen Ming-Huang
Published: December 2024

Background:

Neuroendocrine carcinomas (NECs) are classified by the World Health Organization as poorly differentiated, aggressive Grade 3 tumors with high proliferative indices and frequent lung involvement. While initial treatment for advanced NEC typically involves etoposide and platinum-based therapies, standardized options for subsequent lines of treatment are lacking. This study evaluates the efficacy and outcomes of various second-line treatments for NECs following progression after initial therapy.

Materials and Methods:

A retrospective cohort study was conducted at Taipei Veterans General Hospital, Taiwan, from January 2016 to June 2023. The study included patients aged 18 years or older diagnosed with extrapulmonary NEC who had progressed following initial platinum and etoposide therapy. Treatment response and survival outcomes were assessed.

Results:

The study analyzed 34 patients across four treatment regimens: 5-fluorouracil, leucovorin, oxaliplatin, and irinotecan (FOLFOXIRI), 5-fluorouracil, leucovorin, and irinotecan, 5-fluorouracil, leucovorin, and Nivolumab + Ipilimumab. The FOLFOXIRI regimen demonstrated the highest objective response rate of 33.3% and a disease control rate of 66.7%, compared to the other groups, with a median progression-free survival of 4.1 months and median overall survival of 9.7 months.

Conclusion:

The FOLFOXIRI regimen shows potential as an effective second-line treatment for patients with extrapulmonary NEC who have progressed after first-line therapy with platinum/etoposide.
The pivotal image findings of progressive multifocal leukoencephalopathy: A case report
Authors: Ma Shou-De , Wei Chih-Wei , Huang Tai-Lin , Wu Chao-Hsin , Chang Shiang-Yu
Published: December 2024

Progressive multifocal leukoencephalopathy (PML) is a rare disease associated with the reactivation of the JC virus, particularly in immunocompromised patients. A 60-year-old woman, who was on immunosuppressive therapy, presented with a sudden seizure and was diagnosed with PML based on magnetic resonance imaging (MRI) findings. Typically, PML appears on computed tomography scans as asymmetric focal zones of low attenuation in the periventricular and subcortical white matter, while MRI findings usually show multifocal demyelination in these areas. The imaging results in this case are consistent with the typical presentation of PML.
Antifungal Susceptibility of Dermatophyte Isolates from Patients with Chronic and Recurrent Dermatophytosis
Authors: Amin Nikhitha , Shenoy Manjunath M. , Pai Vidya
Published: December 2024

Background:

The widespread occurrence of chronic and recurrent dermatophytosis has significantly affected the quality of life for patients in India and beyond. Identifying the causative dermatophytes and understanding their antifungal susceptibility can aid clinicians in tailoring effective antifungal therapies.

Materials and Methods:

Patients with chronic and recurrent dermatophytosis were enrolled, and conventional fungal cultures were conducted on skin scrapings. Identified isolates underwent antifungal susceptibility testing using the Clinical and Laboratory Standards Institute broth microdilution method (CLSI M38-A2) for common systemic antifungals, determining the minimum inhibitory concentration (MIC) range and calculating MIC 50 and MIC 90.

Results:

Sixty samples were tested. Tinea corporis was the most common presentation (66.6%). Trichophyton mentagrophyte species complex was the prevalent species (45, 75%), followed by Trichophyton rubrum (7, 11.7%). In Trichophyton mentagrophytes species complex, MIC range was 8-64 μg/mL for fluconazole, 0.06-0.25 μg/mL for terbinafine, and 0.125-0.5 μg/mL for griseofulvin. For Trichophyton rubrum, the MIC range was 8-64 μg/mL for fluconazole, 0.06-0.25 μg/mL for terbinafine, and 0.125-0.5 μg/mL for griseofulvin. For all species, itraconazole MIC was ≤0.125 μg/mL. Hence, itraconazole and terbinafine had the best MIC range against tested isolates in our study.

Limitations:

Absence of genotyping of isolate and not compared the results with studies where sequence-based identification to species level was done.

Conclusion:

In vitro, resistance to itraconazole for any of the four isolated agents was not seen. Terbinafine resistance appears to be an uncommon occurrence in South India. In vitro susceptibility tests shall be regularly done to design the epidemiological cutoff values.
Prospective Study of Dobutamine Stress Echocardiography in Comparison with 18F-fluorodeoxyglucose Positron Emission Tomography for Myocardial Viability in Ischemic Cardiomyopathy
Authors: Kumari Nuthalapati Rama , Sunitha Arumulla , Rajashekhar Sama
Published: December 2024

Background:

Myocardial viability is utilized in the decision-making process for suitability of revascularization in patients with coronary artery disease and depressed left ventricular (LV) function.

Aims:

The aim of this study was to compare the accuracy of dobutamine stress echocardiography (DSE) with the 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) for the identification of viable myocardium in patients with previous myocardial infarction and LV dysfunction.

Settings and Design:

This was a prospective observational study done at Nizam’s Institute of Medical Sciences.

Materials and Methods:

Patients with coronary artery disease with previous myocardial infarction with significant LV dysfunction were included in the study.

Statistical Analysis:

Categorical variables were presented in number and percentage (%), and continuous variables were presented as mean ± standard deviation. Student’s paired t-test was applied to test the difference between the outcomes of 18F-FDG PET and dobutamine stress echo. The statistical software SPSS 17.0 version was used in the analysis of the data.

Results:

In our study population, the mean LV ejection fraction was 35.1%. A total of 800 myocardial segments were evaluated with resting two-dimensional echocardiography examination, of which 250 (31.2%) were normal and 550 (68.8%) were abnormal segments. The dysfunctional 550 segments were further assessed with DSE followed by 18F-FDG PET. In our study, 453 segments were viable on 18F-FDG PET and 407 segments viable on DSE (P = 0.001). Viability was detected by both modalities in 88.1% and discordance in 11.9% of segments. These results yielded a positive predictive value of 97.8% and negative predictive value of 61.1% of DSE.

Conclusions:

On considering 18F-FDG PET a gold standard for detection of viable myocardial segments, DSE has shown a sensitivity of 87.6% and specificity of 90.7%. Thus, DSE can be used as a good alternate to 18F-FDG PET where facility for FDG PET is not available. However, patients detected to have nonviable dysfunctional segments on DSE can be evaluated further with 18F-FDG PET for confirmation of viability.
Benign paroxysmal positional vertigo
Authors: Swain Santosh Kumar
Published: December 2024

Benign paroxysmal positional vertigo (BPPV) is the leading etiology of peripheral vertigo. It manifests with transient, recurring bouts of vertigo brought on by movements of the head. BPPV happens when particles known as otoliths, which can either float freely (canalithiasis) or become attached to the cupula (cupulolithiasis), stimulate semicircular canals abnormally. The clinical symptoms of the BPPV are triggered when the head changes position so that the involved semicircular canal aligns vertically with gravity. During the Dix–Hallpike maneuver (used to diagnose posterior canal BPPV) and the supine roll test (used to diagnose horizontal canal BPPV), patients typically experience a brief delay followed by acute vertigo and nystagmus. Reversing the head position often causes the nystagmus to change direction. The location of otolith debris and the semicircular canal that is affected determine the severity, frequency, and length of symptoms in BPPV. There may be a spontaneous recovery of the BPPV with the help of conservative treatments. However, an important treatment option such as the canalith repositioning maneuver is helpful for giving an immediate resolution of the symptoms by clearing otolithic debris from the semicircular canal into the vestibule. This review article will discuss the prevalence, etiopathology, clinical features, differential diagnosis, and management of different types of BPPV including medical and surgical treatment and rehabilitation for BPPV.
An unanticipated failure of nasogastric tube placement due to peripancreatic collection: A case report
Authors: Gautam Pooja , Tarafdar Yashashvi , Sanjeev Om P. , Sundar Shyam
Published: December 2024

Nasogastric tube (NGT) placement is a very common clinical procedure in the emergency department (ED). The procedure is very simple, yet difficulties and catastrophes of misplacement are much more than reported. We hereby report a case of failure of the NGT placement in a patient with acute pancreatitis with a huge abdominal collection and its interesting solution. A 33-year-old male presented to ED with severe pain abdomen, abdominal distension, and shortness of breath. Abdominal examination showed a tense swelling in the upper abdomen with a grossly distended abdomen. Respiratory distress and fatigue were detected, warranting quick interventions. The reason for respiratory fatigue was figured out to be increased abdominal pressure resisting diaphragmatic pull down. As the abdomen was tense, NGT placement was to be done as part of routine care. Placement of the NGT was challenging, and multiple attempts failed to negotiate it beyond 35–40 cm, even with the best hands. An upper abdomen scan with ultrasonography (USG) point of care ultrasonography revealed hypoechoic images, likely a huge collection. A percutaneous drainage was planned immediately, a USG-guided pigtail catheter of 10 F was placed, and almost 2000 ml of fluid was aspirated. It was decided to push Ryle’s Tube (RT), and surprisingly, it was easily negotiable by now. After confirmation by the auscultation method, it was fixed at the 60 cm mark. In our case, there was compression of the stomach by the huge peripancreatic collection to the extent that there was no patent lumen to pass on anything.
Rathke’s cleft cyst: A case report
Authors: Swain Santosh Kumar
Published: December 2024

A Rathke cleft cyst (RCC) is a nonmalignant growth originating from Rathke’s pouch, which is the precursor to the anterior pituitary gland during early development. Most RCCs are asymptomatic and are typically discovered incidentally during computed tomography scans or magnetic resonance imaging (MRI). The progressive enlargement of the RCC is often symptomatic due to compression of the adjacent structures. The clinical presentations of the RCC are headache, visual disturbances, pituitary dysfunction causing hypogonadism, hyperprolactinemia, deficits of growth hormones, hypothyroidism, and diabetes insipidus. The conventional treatment of the symptomatic RCC is surgical excision through a transsphenoidal approach. Here, we are presenting a patient of Rathke’s cleft cyst presenting severe headache that was relieved after endoscopic transsphenoidal decompression of the cyst.
Isolated Posterior Element Spinal Tuberculosis, Its Management, and Our Experience with Novel Technique of Flipped Repositioning Laminoplasty: A Retrospective Cohort Study
Authors: Kumar Sumit , Sreenivasan Ravi , Sareen Atul , Gowda Manu B. B. , Patralekh Mohit Kumar , Boruah Tankeswar , Kumar Narendra
Published: December 2024

Background:

Isolated posterior element tuberculosis is atypical and rare with reported incidence of <5% of total cases of spinal tuberculosis. Laminectomy is the classical workhorse for surgical management of these lesions. In this study, we describe the clinical features, diagnosis, and management of isolated posterior element tuberculosis with emphasis on a novel technique of flipped repositioning laminoplasty.

Methodology:

In this retrospective and follow-up study, clinical and radiological records of confirmed cases of isolated posterior element tuberculosis were taken from the hospital database from January 2015 to January 2020 and patients with minimum 18 months of follow-up at the time of study were included. Patients’ chief complaints at presentation, level of vertebral involvement, part of vertebra involved, presence of posterior epidural abscess, neurology at the time of presentation and treatment given were noted.

Results:

Records of 25 patients were reviewed. The median age of presentation was 28 (8–48) years. The most common presenting complaints were backache and weakness of both lower limbs. Thoracic spine was most commonly involved, that is in 19 patients. Ten patients were managed on antitubercular therapy alone and recovered fully. Fifteen patients required decompressive surgery in which flipped repositioning laminoplasty was done in 11 patients and laminectomy was done in four patients.

Conclusion:

Atypical presentation of isolated posterior spinal element tuberculosis and lack of findings on radiographs in early stages often causes delay in diagnosis. Flipped repositioning laminoplasty is an effective technique of decompression that provides adequate exposure and additional stability postoperatively.
Functional Outcome Assessment in Neglected Proximal Interphalangeal Joint Dislocation Managed by Dynamic Suzuki Frame External Fixator
Authors: Kothiyal Pranav , Vij Kunal , Gautam Pritish , Ahuja Yogesh
Published: December 2024

Aims and Objectives:

This research article evaluates the functional outcomes of patients treated for neglected proximal interphalangeal (PIP) joint dislocations using the dynamic Suzuki frame external fixator.

Material and Methods:

Patients with neglected interphalangeal joint dislocations were managed initially by distractor application followed by dynamic suzuki frome application and were then followed up for improvement in hand functions. The study employs the Visual Analog Scale score, range of motion at interphalangeal joints, and the Sollerman Hand Function Test to quantify hand functionality pre and post treatment.

Results:

Indicate significant improvements in hand function and patient satisfaction, underscoring the efficacy of this intervention for neglected PIP joint dislocations.

Conclusion:

Dynamic suzuki frame can be considered as a effective and promising option for management of neglected Interphalangeal joint dislocations.
Rescuing the Knee: Arthroscopic Extraction of a Long-neglected Glass Fragment
Authors: Gulia Anil Kumar , Kumar Sanjeev , Sharma Mohit , Mittal Prabhat , Kumar Rakesh
Published: December 2024

The knee joint frequently encounters penetrating injuries and has ample space to harbor foreign objects. This case study delves into the experience of a 22-year-old male who suffered persistent pain due to a neglected foreign object in his knee joint. After its arthroscopic removal, a complete resolution of symptoms was achieved. It highlights the importance of prompt arthroscopic intervention for optimal outcomes. Arthroscopy stands as the favored minimally invasive method for extracting foreign bodies from the knee joint, especially from its deeper and less accessible regions.
Association of Vitamin D Levels and Clothing Pattern in Women of Reproductive Age Group Having Chronic Back Pain
Authors: Saraswat Shubham , Rastogi Anuj , Mohammad Farid , Pawaskar Rachhanaa
Published: December 2024

Background:

Chronic low back pain has been one of the most common musculoskeletal problems from the public health perspective owing to its high impact on disability and loss of productive years. The usefulness of Vitamin D in musculoskeletal health is widely acknowledged. The relationship between chronic low back pain in women and Vitamin D status becomes an important issue in context with clothing patterns owing to various cultural, social and religious factors. While there are many studies investigating the Vitamin D status in women with low back pain yet there are limited or almost no studies evaluating this problem in context with their clothing pattern. Hence, the present study was planned to determine the association between Vitamin D levels and clothing habits in women of reproductive age group having chronic back pain without any apparent clinico-radiological pathology.

Materials and Methods:

A cross-sectional study was done from September 2022 to March 2024 following ethical clearance from the institutional ethics committee. Two hundred and fifty-one women in the reproductive age group were included in the study after taking informed consent. Demographic and other details related to their diet, clothing pattern, and obstetric history were taken using a pretested questionnaire. Serum 25 (OH) Vitamin D level estimation was done. Data collected were analyzed using SPSS version 26.0; appropriate tests were applied and the following results were drawn.

Results:

Mean age of the 251 participants who complained of chronic back pain was 33.16 ± 10.27 years. The duration of pain ranged from 6 to 36 months. Majority of patients (n = 201; 80.1%) had duration of pain <12 months followed by 12–18 months (n = 44; 17.5%), 18–24 months and >24 months (n = 3; 1.2% each), respectively. The mean duration of pain was 9.97 ± 4.60 months. Almost half (n = 124; 49.4%) of the study participants preferred to use veil, while the rest half (n = 127; 50.6%) did not. Vitamin D levels ranged from 7.2 to 99.2 ng/mL with a mean of 26.31 ± 18.75 ng/mL. The prevalence of Vitamin D deficiency, insufficiency and sufficiency was 46.2%, 21.9% and 31.9% respectively. No statistically significant association was found between the duration of pain and Vitamin D status (P = 0.347). Furthermore, factors such as age, gravida status and place of residence (urban/rural) were not found to be associated with Vitamin D deficiency. Statistically, there was a significant difference in Vitamin D status between veiled and unveiled women (P = 0.001).

Conclusions:

Mean Vitamin D levels did not show any significant association with age, place of residence, gravid status and duration of pain. However, veiled women had a significantly higher prevalence of Vitamin D deficiency or insufficiency compared to nonveiled women.
Clinical Outcome of High Tibial Osteotomy by Hemicallotasis Using a Dynamic Axial Fixator on 52 Knees
Authors: Gupta Anand Kumar , Mukherjee Debojyoti , Kumar Sanjay
Published: December 2024

Background:

Osteoarthritis (OA) is the major cause of osteoarticular disability in the elderly population. The knee is the most commonly affected joint, and replacement surgeries are the main modality of treatment in advanced cases. Whereas in unicompartmental disease especially in relatively younger age groups, joint preserving surgeries are preferred. The aim of the present study was to evaluate the functional outcome of graduated open wedge high tibial osteotomy (HTO) in patients with OA of the knee with <65 years of age.

Methods:

HTO through medial open wedge technique was done in 48 patients (52 knees) and stabilized by limb reconstruction system. Distraction was started at the 7th day at the rate of 1 mm/day and continued till proper alignment was achieved. The clinical outcome of patients has been calculated on the basis of anatomical correction and functional improvement. Anatomical correction was determined on the basis of a radiological criterion (Hip-Knee-Ankle [HKA] angle) on the scanogram. Whereas, the functional outcomes of the patients were measured on Oxford Knee Score (OKS) and Western Ontario and McMaster Universities OA Index (WOMAC) score scales.

Results:

The valgus correction in varus knees of patients were achieved by gain in mean HKA angle (increase by 11° ±0.9°). The desired range of correction in HKA angle was seen at the final follow-up of 41 out of 52 knees (78.8%). There was undercorrection in 4 knees (7.7%) and overcorrection in 7 (13.4%) knees. All the functional scores showed significant improvement in the postoperative scores. There was a positive correlation between the HKA angle with OKS and WOMAC Score. The most common complication was superficial pin tract infection, which was seen in 7 (13.4%) patients.

Conclusions:

HTO by unilateral external fixator produces good clinical outcomes and also has its added benefits. It is less invasive, no internal hardware present, and safer in terms of neurovascular complications.
Study Imbalance of Some Cytokines and Vaginitis Agents in Women with Recurrent Abortion Women
Authors: Al-sallami Muna Hamid , Al-Salihi Samara Abd Al-Hameed Ouda , Darweesh Mayyada Farhan
Published: December 2024

Background:

Cytokines play a key role in the success or failure of pregnancy. On the other hand, a plethora of bacterial and viral infectious agents have been associated with an increased risk of recurrent abortion (RA).

Objective:

This search focused on the association between cytokines imbalance and vaginitis infection with RA cases.

Materials and Methods:

A case-control study was designed on 65 aborted women attending AL-Hakeem Hospital in AL-Najaf province suffering from at least two or more aborting cases and 40 healthy delivery women as the control group. Two milliliters of blood samples were collected from all participants to measure interleukin-17 (IL-17), interleukin-23 (IL-23), and interleukin-10 (IL-10) levels by enzyme-linked immunosorbent assay (ELISA). High vaginal swabs were taken from all patients, cultured on differential media for 24 h at 37°C, and then positive bacterial growth re-culturing to obtain a pure single colony.

Results:

The results showed that the mean age of aborted women was 29.8 vs 27.4 years, and 33% have a positive family history; according to bacterial infection, the results found that positive bacterial growth appeared in 23 (35.3%) of high vaginal swabs (HVSs), while 42 (64.7%) gave negative results. The prevalence of bacteria was as follows: E. coli was isolated from 8/23 (34.8%) patients, followed by P. aeruginosa from 6/23 (26.0%). The results confirmed that IL-17 and IL-23 were higher in aborted women (126.4 ± 34.8, 84.9 ± 23.7 pg/ml) compared to delivered women (37.5 ± 11.2, 26.8 ± 9.6 pg/ml). Also, infected women had highly elevated levels of both cytokines (180.2 ± 28.5, 104.7 ± 43.4 pg/ml) compared to non-infected women (72.8 ± 24.9, 67.3 ± 18.5 pg/ml), while IL-10 decreased in aborted women compared to healthy women.

Conclusion:

Cytokines imbalance leads to impaired state of pregnancy, and there is a highly significant relationship between IL-17, IL-23, and IL-10 levels with abortion, especially in women who suffer from bacterial vaginitis
Forkhead Box Protein-3 Gene Expression of Purified Human Peripheral Blood Mononuclear Cells Treated with Methicillin-Resistant Staphylococcus aureus-Somatic Antigens and Hepatitis B Virus Vaccine
Authors: Hadi Entidhar A. , Al-Saadi Mohammad A. K. , Madlum Kaiser N.
Published: December 2024

Background:

Optimal hepatitis B virus (HBV) vaccine efficacy linked to producing systemic and mucosal antibodies and cellular immunological memory requires a complete set of immunological responses. Numerous variables affect how strong the immunological response is important variables include the vaccine’s kind and any additional adjuvants, which can dramatically enhance antigen presentation and cell activation.

Objectives:

This study aimed to illustrate the purified human peripheral blood mononuclear cells’ immunological response against somatic antigens of methicillin-resistant Staphylococcus aureus (MRSA) and to study the immunodulatory effect of HBV antigens on this immune response represented by gene expression of forkhead box protein-3 (FOXP3) as a regulatory gene for immune cells.

Materials and Methods:

Case‐control research was conducted on 75 peripheral blood mononuclear cells (PBMCs) samples. This work involved five experimental groups each group involving 15 samples. Group I involves separated PBMCs (1 × 106 cells/mL) alone as a control; Group II involves PBMCs stimulated with killed somatic MRSA antigen; Group III of PBMCs were stimulated with HBV vaccine only; Group IV involves PBMCs pretreated with HBV vaccine for 48 hr, and then with killed somatic MRSA antigen. Group V involves PBMCs stimulated with mixed of killed somatic MRSA antigen and HBV vaccine. The immune response against MRSA somatic antigens was assessed by the genetic parameter was done to detect the level of FOXP3 mRNA gene expression by real-time polymerase chain reaction (PCR).

Results:

The results of relative gene expression in the (P < 0.05) FOXP3 gene showed that the mean concentration of FOXP3 gene expression level was significantly increased in Group II, Group III, Group IV, and Group V, respectively, as compared to Group I.

Conclusion:

MRSA-somatic antigens and HBV vaccine are significantly increased the regulatory FOXP3 gene expression as an indicator for increasing the immune response.
Long Coronavirus Disease Symptoms and their Association with Different Risk Factors
Authors: Jasim Rasha A. F.
Published: December 2024

Background:

Although there are some studies trying to detect various long or post coronavirus disease (COVID-19) symptoms and some risk factors, long COVID-19 symptoms and their association with some possible risk factors such as age, sex, blood group, and oxygen level are still not well understood and required more studies worldwide.

Objective:

Therefore, this study included 206 patients. My questionary has different questions for the participants such as the type of symptoms they had post COVID-19 infection, to determine the most prevalence long symptoms.

Materials and Methods:

Moreover, to determine the association of post-acute sequelae of COVID-19 with some risk factors, the questionnaire included questions about the participant’s age, gender, blood group, and oxygen rate during the infection.

Results:

My results showed that fatigue and muscle pain are the most prevalent long or post COVID-19 symptoms followed by forgetfulness and depression, chest pain and cough, loss of smell and taste, diarrhea, and abdominal pain. Also the results found that female patents, and persons with age from 19 to 29, as well as positive Rh blood group except AB+ are more susceptible to long symptoms. Moreover, the results showed that there is an association between oxygen rate reduction and the long COVID-19 symptoms.

Conclusion:

Some corona virus patients develop post disease symptoms, and it looks like that variable factors influence that. So understanding the correlation between appearance of the long COVID-symptoms and these the risk factors presents valuable insights, the conclusions warrant justification through larger clinical trials.
The Role of Visfatin, Leptin, and IL-18 in Polycystic Ovarian Syndrome Patients
Authors: Rashed Sukayna H. , Hadi Eman A.
Published: December 2024

Background:

Several local studies revealed there is a rising occurrence of polycystic ovarian syndrome in the city of Mosul at different ages, even among unmarried females.

Objectives:

The aim of this study was to investigate the impact of body mass index (BMI) on a range of biochemical markers among PCOS patients and healthy women at Mosul women's clinics and hospitals.

Materials and Methods:

A total of 26 non-obese women with PCOS who have BMIs ≤ 25 kg/m2, along with 34 obese women with PCOS symptoms were enrolled in this study. Patients with and without IR in PCOS were also classified. Insulin resistance was measured with the help of the homeostatic model index (HOMA-IR). Blood samples were collected during the second and third days of the menstrual cycle. The following biochemical variables were also evaluated: fasting blood sugar, fasting insulin, insulin resistance, leptin, visfatin, and IL-18.

Results:

The results found that there were 27 cases of PCOS without insulin resistance (HOMA-IR< 2.69) and 33 cases with insulin resistance (HOMA-IR≥2.69). In all the groups included in this study, the findings were statistically evaluated to determine a correlation coefficient between the variables that were assessed with each other and their correlation with the development of the disease condition and the possibility of employing them as a diagnostic indicator. Patients with PCOS had significantly elevated serum IL-18 and visfatin levels but normal leptin concentrations.

Conclusion:

The study suggests that leptin acts locally in the follicle and that visfatin may play a role in most cases. Insulin resistance can be found in this particular group of patients. However, for the time being, it is unclear if it will be recognized as a true adipocytokine associated with the pathophysiology of PCOS. In PCOS women, elevated levels of IL-18 were associated with insulin resistance and BMI.