bluuebunny/crossref_metadata_2025 huggingface dataset:
“Now What Do I Do?” - Practical Challenges Faced By Young Neurosurgeons in their Career Management
Authors: Yagnick Nishant , Deora Harsh , Tripathi Manjul , Goel Atul , Mohindra Sandeep
Published: July 2024

Neurosurgical residency is tough. Grueling hours and tough decisions require a mental makeup unlike many other specialties. But the real examination begins after the residency is over. Many young neurosurgeons are faced with a daunting task of deciding their future as soon as they step out of the medical school. Sometimes, such decisions can shape the entire career of the neurosurgeon. However, over the many years of academic teaching and learning what we are not taught is how to “Manage.” Management of careers, decision making, and understanding the business end of our profession is lacking. Here, we review the career and decisions needed to be taken by a young neurosurgeon through the glass of a business management mindset. We try to define the opportunities and decisions and how they may reflect on the general population and patients as a whole.
Anterior Communicating Artery Aneurysms: Surgical Strategy and Outcome based on Proposed Newer Classification
Authors: Singh Suyash , Bhaisora Kamlesh Singh , Chheda Rushabh Mulchand , Dixit Priyadarshi , Srivastav Arun Kumar , Das Kuntal Kanti , Mehrotra Anant , Kumar Ashutosh , Maurya Ved Prakash , Verma Pawan Kumar , Jaiswal Awadesh , Rajkumar  , Behari Sanjay
Published: July 2024

Background:

The ruptured anterior communicating artery aneurysm is the most frequent intra-cranial aneurysm treated at any neurosurgical department. These aneurysms arise from either the A1-A2-Acom artery junction or Acom artery. The surgical outcome depends on the age of the patient, time duration between ictus and surgery, and Hunt and Hess grade at admission. In this article, we intend to analyze the surgical outcome based on our proposed classification with our overall experience of Acom aneurysm.

Methods:

A retrospective review of our surgical database with 250 patients of ruptured Acom was done, and the location, morphology, and direction of aneurysm, along with other clinical parameters including the demographic profile, radiological findings, and intra-operative details, were studied. We classified the Acom based on both site of origin and morphology (Type I, junctional on the dominant side; Type II, fusiform with an ill-defined neck and branching pattern; Type III, saccular true Acom A) and secondarily as described in the literature on the basis of the direction of fundus (Type A–E). The clinical parameters were compared among the above groups using Fischer-exact and one-way analysis of variance test.

Results:

A total of 250 patients (M: F =113:137) were included (mean age 52.1 ± 11.5 standard deviation years). 55.2% patients had left A1 dominance. Type I Acom A was commonly found on the left dominant circulation (P = 0.00). The difference in aspect ratio of Type I (2.0 ± 0.8) and Type II (1.8 ± 0.52) aneurysms was insignificant (P = 0.28). However, a significant difference in post-operative vasospasm among different types of aneurysms was found (P < 0.05). The Type I Acom A were anteriorly directed, while Type II and III were posteriorly directed (P = 0.001). The mean follow-up of the study was 44.4 ± 25.7 months, with age (P = 0.007) and Hunt and Hess grade (P = 0.001) at admission correlating with surgical outcome.

Conclusion:

Classifying the Acom A pre-operatively based on site and morphology, location, and direction of fundus helps in surgical planning and prognosis. The junctional ‘Type IA aneurysms’ are most common and possess a high intra-operative rupture rate. The anteriorly directed aneurysms have a better prognosis, and visual complaints are usually associated with anterior-inferiorly directed aneurysms.
Comparison of Response First Technique with Reversal First Technique for Quality of Extubation in Patients Undergoing Transsphenoidal Pituitary Surgery: A Randomized Clinical Trial
Authors: Kapil Sonia , Jain Divya , Ganesh Venkata , Panda Nidhi B , Arya Virendra K , Grover Vinod K , Mukherjee Kanchan K , Bhagat Hemant
Published: July 2024

Background and Objective:

Early and smooth extubation following anesthesia is an important concern in patients undergoing transsphenoidal pituitary surgery to permit early neurological evaluation and prevent complications. The aim was to compare the RESPONSE FIRST and REVERSAL FIRST techniques for quality of extubation (QOE) in patients undergoing endoscopic transsphenoidal pituitary surgery.

Methods:

Fifty-six patients aged 18–60 years, with American Society of Anesthesiologists Physical Statuses I–II, and undergoing transsphenoidal surgery for pituitary tumors were randomized into either the RESPONSE FIRST group, in which neuromuscular reversal was given following the patient’s response to oral commands, or the REVERSAL FIRST group, in which reversal of neuromuscular blockade (NMB) was given at the return of spontaneous respiration. QOE was the primary outcome. Hemodynamic response, jugular venous oxygen saturation (SjVO2), time to extubation, and awareness during emergence were assessed as secondary outcomes.

Results:

The QOE in the RESPONSE FIRST group was significantly better than the REVERSAL FIRST group (mean (interquartile range (IQR)), 18 (17–19) vs 14 (12–14.75), P < 0.001). Heart rate (HR) and mean arterial pressure (MAP) were better in the RESPONSE FIRST group when compared to the REVERSAL FIRST group at the time of extubation, at 5 minutes, and 15 minutes following extubation (P < 0.05). SjVO2values were higher in the REVERSAL FIRST group as compared to the RESPONSE FIRST group during extubation and at 5 minutes after extubation (P < 0.01). There was no significant difference in the time to extubation between the groups (P = 0.73).

Conclusion:

The RESPONSE FIRST technique is associated with better QOE and preservation of systemic and cerebral hemodynamics during extubation in patients undergoing transsphenoidal pituitary surgery when compared to the REVERSAL FIRST technique.
Intentional Insertion of Air to Predict the Diagnostic Accuracy of Stereotactic Biopsy and a Uniform Grading System for Reporting
Authors: Deora Harsh , Nadeem Mohammed , Shashidhar Abhinith , Arivazaghan A , Rao Malla Bhaskara
Published: July 2024

Background and Objectives:

Stereotactic biopsies are a relatively safe and reliable way of tissue diagnosis and characterization of eloquent area lesions/neoplasm. However, predicting the accuracy of the site of biopsy with the desired/planned site is not always possible. We describe a technique to identify the precise location of the biopsy site in the post-operative computed tomography (CT) scan using the injection of a low volume of air into the biopsy cannula.

Methods:

Hundred consecutive biopsies were performed in 80 adults/20 children (59 males/41 females, median age 51 years) over 3 years, consisting of 75 frameless and 25 frame-based stereotactic biopsies. After the biopsy specimens had been collected, a small volume of air (median 1 cc) was injected into the site. Post-operative CT was done within 4 hours of the biopsy to see the site of the air bubble, and the same was correlated with the histopathological accuracy.

Results:

Intra-cranial air in the selected target was present in 95 patients (Grade 1 and 2), while the air was seen in the track (Grade 3) in 3% and at an unrelated site (Grade 4) in 2% of cases. Both Grade 4 biopsies were negative on histopathology (diagnostic yield = 98%). Two negative biopsies were reported, which were both predicted with the Grade 4 biopsy. The grading allowed uniform reporting across series and eliminated the chance of upgrading/downgrading the report due to wrong site sampling within the lesion/neoplasm.

Conclusion:

The air-injection manoeuvre proposed for use in stereotactic biopsies of intra-cranial mass lesions is a safe and reliable technique that allows the exact biopsy site to be located without any related complications.
Audit of Presentation, Primary Site, and Pattern of Treatment in 778 Indian Patients with Brain Metastasis in 15 Years (2007–2022)
Authors: Dutta Debnarayan , Surendran Haripriya P , Kalavagunta Sruthi , Sasidharan Ajay , Narmadha M P
Published: July 2024

Background and Aim:

Audit of brain metastasis (BM) patients treated with radiation therapy (RT) in a tertiary cancer center from South India was carried out to assess the incidence of BM by site with a specific focus on their primary origin, with an aim to evaluate the relationship between the primary site and the site of metastases, pattern of care, and RT over the years.

Materials and Methods:

All consecutive BM patients who received RT with whole-brain radiation therapy (WBRT), hippocampal avoidance WBRT (HA-WBRT), and radiosurgery SRS between 2007 and 2022 after radiologic confirmation of a known case of malignancy or histology-proven BM were audited.

Results:

From January 2007 to December 2022, hospital information system (HIS)-identified 778 patients with BM treated with RT were audited. Incidence of BM was 0.64% in 2008 and over the years, it had increased to 0.89% in 2020, 0.93% in 2021, and 1.24% in 2022. Usage of SRS was almost nil in 2007, whereas in 2022, it was 40%. Also, 593 (76%) patients were treated with WBRT, 157 (20%) with SRS, and only 23 (3%) received HA-WBRT. Lung and breast cancers (40%) were the most common primary, and among rare primary tumors were those of larynx (two), tonsil (one), tongue (three), pancreas (one), and blood disorders (two). Lung primary presented with frontal lesion in 51%, parietal lesion in 43%, cerebellar lesion in 38%, and temporal lesion in 33% of cases.

Conclusions:

Audit of BM in the Indian population suggests a shift in treatment paradigm from WBRT to SRS as a primary modality in oligo-brain metastasis with a good performance status. This audit provides us information regarding geographic variation in presentation and primary site.
Safety and Efficiency of Anlotinib in Patients with Recurrent Grade 4 Glioma: A Single-Center Retrospective Analysis
Authors: Wang Qiang , Wei Wuting , Ji Xiangjun , Li Jianrui , Wu Nan , Li Jing , Sun Kangjian , Ma Chiyuan , Pan Hao
Published: July 2024

Purpose:

Anlotinib is a multi-target TKI which has been used in different advanced tumors. However, its efficiency and safety in patients with glioblastoma are still not well discussed. This retrospective study aimed to discover the safety and efficiency of anlotinib in recurrent grade 4 glioma.

Methods:

The clinical data of patients with recurrent grade 4 glioma treated with anlotinib in our center were collected and analyzed. The progression-free survival (PFS), overall survival (OS), and OS after recurrence were calculated by Kaplan–Meier method and compared by log-rank test. Sub-group analysis was used to find possible variables that affect survival.

Results:

From October 2017 to December 2020, seventeen patients with recurrent grade 4 glioma treated with anlotinib were enrolled. The median age was 50 with 13 males. The median KPS was 70. All patients received standard STUPP mode treatment before recurrence. The median PFS was 7 months [95% confidence interval (CI) 5.3–8.6]. The median OS after first diagnosis was 17 months (95% CI 15.7–18.3). The median OS after recurrence was 10 months (95% CI 7.6–12.4). The objective response rate was 33.33% (5/15), and the disease control rate was 60% (9/15). The existence of target genes was identified as a variable affecting the survival after recurrence. The median OS after recurrence in patients with target genes was 12 months (95% CI 6.9–17.1), whereas for patients without targets, the median OS was 4 months (95% CI 1.9–6.1) and for patients with an unknown status, the median OS was 10 months (95% CI 8.4–11.6) (P = 0.013).

Conclusion:

For recurrent grade 4 glioma, anlotinib can be considered as a supplement to the standard STUPP treatment, especially for the patient with anlotinib target genes.
Truncal Ataxia: An Overlooked Symptom in Patients with Lambert–Eaton Myasthenic Syndrome in the Early Stage
Authors: Özenç Betül , Işık Kübra , Odabaşı Zeki
Published: July 2024

ABSTRACT

Background:

The classic triad in LEMS is proximal muscle weakness, areflexia, and autonomic dysfunction. We have frequently observed truncal ataxia as the first complaint in LEMS patients. In this study, we aimed to show the presence of ataxia in 10 newly diagnosed LEMS patients in the past 3 years and what factors influence it.

Methods:

We present the clinical findings, voltage-gated calcium channels antibody positivity, and electrophysiologic findings of newly diagnosed LEMS patients who presented to our tertiary care center during the past 3 years.

Results:

Of the 10 LEMS patients examined, 60% (6) were males and 40% (4) were females. The first and most dysfunctional symptoms were gait disorder and loss of balance in seven of the patients. These patients had ataxia, a gait disturbance that was disproportionate to the proximal weakness. Although the patients had mild proximal weakness in the lower extremities, they had considerable difficulty walking. Proximal muscle weakness was present in six patients, speech disorders in three patients, dysphagia in three patients, dry mouth in three patients, ptosis in two patients, diplopia in two patients, and nystagmus in one patient.

Conclusion:

We believe that more caution is needed in patients with truncal ataxia when LEMS is suspected. This is because we have seen that the first complaints in 7 out of 10 LEMS patients were truncal ataxia, loss of balance, and gait disturbance.
A Meta-analysis on the Comparison of Carbetocin Versus Oxytocin on Additional Uterotonic Use, Incidence of Postpartum Hemorrhage, and Need for Blood Transfusion after Cesarean Section under Neuraxial Anesthesia
Authors: Bonus Guada Marie M. , Quintin Ma. Patricia Mae J. , Carandang Rafael Jacob T.
Published: July 2024

ABSTRACT

Postpartum hemorrhage (PPH) remains to be the leading cause of maternal deaths worldwide. The first-line treatment in its prevention is the administration of uterotonics before the delivery of the placenta. Recently, a newer synthetic analog has been developed – carbetocin. With its introduction, new questions arise as to which is more effective in preventing PPH. Four major electronic databases were searched for randomized controlled trials comparing carbetocin and oxytocin in terms of additional uterotonic use, incidence of PPH, and need for blood transfusion. Only randomized controlled studies involving pregnant women undergoing cesarean section under regional anesthesia were included. Outcomes included are the need for additional uterotonic use, the incidence of PPH, and the need for blood transfusion. Of the three outcomes, carbetocin was found to show statistically significant protection against the need for additional uterotonic administration and the need for blood transfusion. Results showed that carbetocin provided a statistically significant risk reduction for the need for additional uterotonics (risk ratio [RR] = 0.53, 95% confidence interval [CI] 0.46–0.81, P < 0.00001) and need for blood transfusion (RR = 0.34, 95% CI 0.19–0.62, P = 0.0004). Need for additional uterotonics and for blood transfusion was found to be almost twice (1/0.53 = 1.88) and almost thrice (1/0.34 = 2.94) as likely, respectively, to occur in the oxytocin group versus the carbetocin group. Reduction of PPH pointed toward carbetocin providing greater protection against it, but it was found not to be statistically significant (RR = 0.85, 95% CI 0.56–1.28, P = 0.43).
Effect of Tamarindus indica L. fruit pulp and seed extracts on experimental ulcerative colitis in rats
Authors: Minaiyan Mohsen , Abolhasani Sepehr , Sima Setareh , Yegdaneh Afsaneh
Published: July 2024

Background and purpose:

Tamarindus indica L. which has anti-inflammatory, radical scavenging, and ulcer healing effects can be useful for the alleviation of inflammatory bowel disease (IBD). Therefore, the effects of T. indica fruit pulp (TIPE) and seed extracts (TISE) were investigated on experimental colitis.

Experimental approach:

TIPE and TISE (125, 250, and 500 mg/kg) were made by maceration (ethanol/water: 80/30) and administered to male Wistar rats with acetic acid-induced colitis. Prednisolone (4 mg/kg) and mesalazine (100 mg/kg) were used as reference drugs. The colon tissues were examined for macroscopic and pathologic parameters and myeloperoxidase (MPO) and malondialdehyde (MDA) values.

Findings/Results:

The total phenols were 45.7 ± 1.1 and 453.0 ± 3.3 mg/g in terms of gallic acid for TIPE and TISE, respectively. Both of the extracts significantly improved most of the investigated parameters including body weight loss, the weight of colons, indices of ulcers, and total colitis. MPO activity and MDA in the treatment groups (except for TIPE at 125 mg/Kg) significantly decreased compared to the control.

Conclusion and implications:

Both TIPE and TISE were effective in the treatment of colitis however it seems that the effective ingredients were more concentrated in seeds rather than pulp extract so the highest dose of seed extract had a competitive effect with reference drugs. More studies are needed to introduce T. indica as a suitable complementary medicine or food for patients with IBD.
A bioinformatics approach of specificity protein transcription factors in head and neck squamous cell carcinoma
Authors: Sichani Adel Rezvani , Sichani Ziba Rezvani , Yazdani Behnaz , Looha Mehdi Azizmohammad , Sirous Hajar
Published: July 2024

Background and purpose:

The seventh most common type of cancer with increasing diagnosis rates around the world is head and neck squamous cell carcinoma (HNSCC). Specificity proteins (SPs) have been known for their role in the regulation of cellular division, growth, and apoptotic pathways in various cancers. In this work, we analyzed the expression levels of SPs in HNSCC to assess their diagnostic and prognostic biomarker potential.

Experimental approach:

Differential gene expression and correlation analysis methods were used to determine the top dysregulated genes in HNSCC. Functional enrichment and protein-protein interaction analyses were done with the DAVID database and Cytoscape software to understand their function and biological processes. Receiver operating test, logistic regression, and Cox regression analyses were performed to check SP genes’ diagnostic and prognostic potential.

Findings/Results:

SP1 (LogFC = -0.27, P = 0.0013) and SP2 (LogFC = -0.20, P = 0.0019) genes were upregulated in HNSCC samples, while SP8 (LogFC = 2.57, P < 0.001) and SP9 (LogFC = 2.57, P < 0.001) genes were downregulated in cancer samples. A moderate positive correlation was observed among the expression levels of SP1, SP2, and SP3 genes. The SP8 and SP9 genes with AUC values of 0.79 and 0.75 demonstrated diagnostic potential which increased to 0.84 when both genes were assessed by logistic regression test. Also, the SP1 gene held a marginally significant prognostic potential.

Conclusion and implications:

Our findings clarify the potential of SP transcription factors as candidate diagnostic and prognostic biomarkers for early screening and treatment of HNSCC.
Persianolide-A, an eudesmanolide-type sesquiterpene lactone from Artemisia kopetdaghensis, induces apoptosis by regulating ERK signaling pathways
Authors: Ebrahimi Seyyed Moein , Asadi Jahanbakhsh , Fattahian Maryam , Jafari Seyyed Mehdi , Ghanadian Mustafa
Published: July 2024

Background and purpose:

Herbal components, particularly sesquiterpenes, are progressively recognized as a crucial resource for developing effective therapeutic agents for breast cancer. In this study, the effect of a sesquiterpene lactone known as 8-O-dihydroxy-11a,13-dihydroeudesma-4(15)-en-12,6a-olide (persianolide- A) was examined in breast cancer cell lines.

Experimental approach:

MDA-MB-231 and MCF-7 cancer cells were grown in DMEM solution with 10% FBS. Then, an MTT assay was performed to evaluate cell viability. Apoptosis was detected by annexin-PI staining. A caspase 3/7 activity assay kit was used to assess the activity of caspase-3 and caspase-7. Protein expression of Bcl-2, Bax, and p-ERK1/2 was determined by western blotting.

Findings/Results:

This study showed that the IC50 values of the persianolide-A for MCF-7 and MDA-MB- 468 cells are 34.76 and 54.48 μM, respectively. In addition, persianolide-A showed a significant increase in apoptosis in both MDAMB-231 and MCF-7 breast cancer cell lines. Persianolide-A significantly increased the expression of the pro-apoptotic protein Bax and decreased the expression of the anti-apoptotic protein Bcl-2. Also, presinolide-A treatment led to a substantial increase in caspase activity with a ratio of 3/7 in both MCF- 7 and MDA-MB-231 cancer cells. In addition, the study showed that persianolide-A decreased the expression of p-ERK1/2 protein.

Conclusion and implications:

The results of this study suggest that persianolide-A, sourced from Artemisia kopetdaghensis, induces cell apoptosis in breast cancer cell types. The molecular mechanisms could be implicated in the modulation of the ERK1/2 signaling pathway.
Pharmacological evaluation of anti-inflammatory, antipyretic, analgesic, and antioxidant activities of Castanopsis costata leaf fractions (water, ethyl acetate, and n-hexane fractions): the potential medicinal plants from North Sumatra, Indonesia
Authors: Alkandahri Maulana Yusuf , Sadino Asman , Pamungkas Barolym Tri , Oktoba Zulpakor , Arfania Maya , Yuniarsih Nia , Wahyuningsih Eko Sri , Putri Dea Eka
Published: July 2024

Background and purpose:

Inflammation, fever, and pain can be associated with several diseases, and the synthetic drugs used in the treatment of these conditions often have severe side effects. As a result, there is a need for effective, economical, and safe alternative drugs, such as those derived from medicinal plants. Therefore, this study aimed to evaluate the anti-inflammatory, antipyretic, analgesic, and antioxidant activities of Castanopsis costata leaf fractions (CcLF), as well as its acute toxicity.

Experimental approach:

For anti-inflammatory, antipyretic, and analgesic tests, rats were given CcLF (WFCC, EAFcC, and n-HFCC) at 50 and 100 mg/kg, diclofenac sodium (10 mg/kg), paracetamol (150 mg/kg), aspirin (100 mg/kg), and tramadol (20 mg/kg). For the antioxidant activity test, various concentrations of CcLF were used ranging from 25 to 200 μg/mL. This study also looked into whether there could be any acute toxicity and histopathology of the liver, stomach, and kidneys in experimental animals.

Findings/Results:

The administration of CcLF significantly inhibited the increase in foot edema volume, and CcLF (EAFCC at 100 mg/kg) considerably decreased rectal temperature and was proportional to the standard drug paracetamol, and significantly inhibited pain sensation in various models. Additionally, CcLF showed strong antioxidant activity, and its administration at a dose limit of 5000 mg/kg/day did not show any toxic effects or death in test animals.

Conclusions and implications:

The results of the current confirmed that CcLF has demonstrated anti-inflammatory, antipyretic, analgesic, and antioxidant properties in experimental models, and is practically non-toxic.
Isolation of two steroidal saponins with antileishmanial activity from Allium giganteum L.
Authors: Chaparian Farnaz , Delazar Zeinab , Dinani Masoud Sadeghi
Published: July 2024

Background and purpose:

Alliums are rich sources of steroidal saponins, flavonoids, and sulphoric compounds of which steroidal saponins have recently received more attention due to their important pharmacological activities. Allium giganteum (giant onion) which is named locally “Couria” in the Northeast of Iran, is grown widely in “Kouh-Sorkh” mountains in Khorasan province.

Experimental approach:

Phytochemical investigation of chloroform-methanol and aqueous extract of the plant resulted in the isolation and identification of two steroidal saponins, using comprehensive spectroscopic methods including 1D and 2D NMR and MS.

Findings/Results:

The chemical structures of the isolated saponins were determined as (22S)-cholesta-1b,3b,16b,22b-tetraol 5-en, and 3-O-β-D-glucopyranosyl26-O-β-D-glucopyranosside and (25R)-26-O-β-D-glucopyranosyl-5α-furostan-1α,3β,22α,26-tetraol3-O-{β-D-galactopyranosyl-(1→2)-O-[β-D-xylopyranosyl- (1→3)]-O-β-D-glucopyranosyl-(1→4)-β-D-galactopyranoside}. Investigation of in vitro antileishmanial activity of the isolated compounds at 10, 50, and 100 μg/mL exhibited significant leishmanicidal against the promastigotes of Leishmania major.

Conclusion and implications:

The results established a valuable basis for further studies about A. giganteum and the anti-parasitic activity of steroidal saponins.
Spiroconjugated 1,2,3-triazolo[5,1-b]1,3,4-thiadiazine stimulates functional activity of fibroblasts under skin injury regeneration
Authors: Petrova Irina M , Chebanova Sofya Iu , Khatsko Sergey L , Kalinina Tatyana A , Zaitsev Dmitry V , Glukhareva Tatyana V
Published: July 2024

Background and purpose:

One of the most important mechanisms of tissue regeneration is the high functional activity of cells, including proliferation. Currently, there are practically no effective skin cell activators on the pharmaceutical market. The purpose of this work was to demonstrate the stimulating effect of spiroconjugated 1,2,3-triazolo[5,1-b]1,3,4-thiadiazine (STT) on the functional activity of fibroblasts.

Experimental approach:

STT containing ointment for dermal application was made. To assessin vivoeffect of the STT a linear wound model in rats was tested. A combination of histological techniques and mechanical testing was employed to estimate the stimulating effect of STT on the functional activity of fibroblasts.

Findings/Results:

The STT significantly increased the number of fibroblasts as well as the density and order of produced collagen fibers in the dermis during the wound healing process. As a result, a tissue was formed at the site of damage with the structure corresponding to normal skin. In addition, skin functions were restored, in particular mechanically.

Conclusion and implications:

The results suggested the stimulating effect of the STT on fibroblast activity and demonstrated its potential for skin regeneration.
Baclofen-induced neurotoxicity in a dialysis patient managed with continuous venovenous hemodialysis: A case report and literature review
Authors: Ellouze Nejah F. , Hazra Darpanarayan , Al Abri Suad
Published: July 2024

Despite documented cases of baclofen toxicity in individuals with kidney disease, the drug is widely prescribed for various medical conditions, primarily spasticity, hiccups, and multiple sclerosis. Baclofen, a gamma-aminobutyric acid derivative, relies on renal excretion, rendering those with impaired kidney function susceptible to toxicity – a concern often underestimated by health-care providers. Adverse reactions, including single or double doses, are well documented in addition to multi-dose toxicity. This report discusses a case of baclofen-induced neurotoxicity in an end-stage renal disease patient undergoing dialysis, highlighting the subsequent management with continuous venovenous hemodialysis. In addition, it provides a comprehensive review of existing literature on baclofen toxicity in cases of renal insufficiency. Strikingly, the literature lacks clear guidelines regarding baclofen safety, dose adjustments, or renal function thresholds for contraindication. This contribution aims to augment understanding of this critical issue, emphasizing the need for heightened awareness and careful consideration of baclofen use in patients with kidney disease.
Identifying high-risk undifferentiated emergency department patients with hyperlactatemia: Predictors of 30-day in-hospital mortality
Authors: Kaçar Ayşen Aydın , Aksay Ersin , Bayram Başak , Kıran Emre , Güldalı Bahar Elif
Published: July 2024

BACKGROUND:

Hyperlactatemia has been recognized as a significant prognostic indicator in critically ill patients. Nonetheless, there remains a gap in understanding the specific risk factors contributing to increased mortality among undifferentiated emergency department (ED) patients presenting with elevated lactate levels.

OBJECTIVES:

The objective of the study is to investigate potential risk factors for 30-day in-hospital mortality in ED patients with hyperlactatemia.

METHODS:

All nontraumatic adult presentations to the ED who had a lactate level of ≥2.5 mmol/L were included. Comorbidities, vital signs, lactate levels, lactate clearance, lactate normalization, and final diagnosis were compared with 30-day in-hospital mortality.

RESULTS:

A 30-day in-hospital mortality rate of 10.4% was observed in 979 patients. The mortality rate was higher in hypotensive patients (odds ratio [OR] 4.973), in nursing home patients (OR 5.689), and bedridden patients (OR 3.879). The area under the curve for the second lactate level (0.804) was higher than the first lactate level (0.691), and lactate clearance (0.747) for in-hospital mortality. A second lactate level >3.15 mmol/l had a sensitivity of 81.3% in predicting in-hospital mortality. The OR for mortality was 6.679 in patients without lactate normalization. A higher mortality rate was observed in patients with acute renal failure (OR 4.305), septic shock (OR 4.110), and acute coronary syndrome (OR 2.303).

CONCLUSIONS:

A second lactate measurement more accurately predicts in-hospital mortality than lactate clearance and the first lactate level in ED patients. Nursing home patients, bed-ridden patients, hypotensive patients on initial ED presentation, patients without lactate normalization, and patients with a final diagnosis of acute renal failure, septic shock, and acute coronary syndrome had a higher mortality rate.
Schizophyllum Commune- A Rare Cause of Fungal Keratitis- Case Report and Review of Literature
Authors: Nataraja Parvatha Sundari , Shanmugam U Vijaya , Bhale Komal Vinayak , Selvaraju Sangeetha
Published: July 2024

We present a 57-year-old male patient with keratitis, he was initially started on topical 0.5% moxifloxacin eye drops, but his symptoms did not resolve and infiltrate continued to increase. Corneal scrapings and microbiological reports suggested the diagnosis of the fungus, Schizophyllum commune, the patient was then switched to topical 5% natamycin eye drops hourly for 1 week followed by eight times per day for 2 weeks and oral tablet fluconazole 200 mg twice daily, following which the infiltrate was reduced, hypopyon resolved and visual acuity improved after 2 weeks of treatment.
Correlation of Mantoux Test and Serum Angiotensin-Converting Enzyme (ACE) Levels with Clinically and Radiologically Diagnosed Ocular Tuberculosis and Ocular Sarcoidosis
Authors: Balakrishnan Harinikrishna , Thundikandy Radhika , Ravindran Ram S. , Balakrishnan Logesh , Rajesh Vedhanayaki , Sivakumar Rathinam
Published: July 2024

Aim:

To evaluate the role of combined Mantoux test and serum angiotensin-converting enzyme (ACE) levels in the diagnosis of ocular tuberculosis (TB) and ocular sarcoidosis.

Materials and Methods:

A prospective and observational study including patients with bilateral granulomatous uveitis diagnosed both radiologically and clinically as ocular TB or ocular sarcoidosis within a six-month period. CT Thorax/CT abdomen was done, and findings were noted. Mantoux test and serum ACE levels were recorded, and findings were correlated.

Results:

The study included a total of 60 patients: 32 patients with ocular TB and 28 patients with ocular sarcoidosis. Using Mantoux test, 84.4% in the TB group tested positive and were correctly identified (sensitivity), and 96.4% in the sarcoid group tested negative and were correctly identified as sarcoidosis. Hence, the association between Mantoux test and diagnoses was statistically significant (P < 0.001). In the TB group, 25 subjects had normal and seven had elevated serum ACE levels. In the sarcoidosis group, 22 subjects had elevated and six had normal serum ACE levels. Hence, 78.1% were correctly identified with normal serum ACE levels (sensitivity) in the TB group and 78.6% were identified with elevated serum ACE levels in the sarcoidosis group, and the proportion difference was statistically significant (P < 0.001).

Conclusion:

Mantoux test and serum ACE levels are cost-effective investigations and can be used for the diagnosis of ocular TB and sarcoidosis when combined with clinical and radiological evidence. The combined use of serum ACE and Mantoux test is useful in differentiating between sarcoidosis and TB.
A Novel Fusion deep Learning Approach for Glaucoma Severity Classification – An Optical Coherence Tomography-Based Bimodal Artificial Intelligence Model
Authors: Ramesh Prasanna Venkatesh , Chinasigari Puja , Kadadi Shreyank , Gupta Aditya , Nivash Archana , Ariga Murali , Nivean Pratheeba Devi , Mohan Sujatha
Published: July 2024

From the inception of artificial intelligence (AI) in optical coherence tomography (OCT) for glaucoma diagnosis, the emphasis has always been on models focusing on visual data. The visual signals are extrapolated from the optic disc and retinal nerve fibre layer (RNFL) region and are processed visually. This manuscript introduces a novel bimodal AI model that combines visual data from OCT with numerical metrics such as RNFL thickness, vCDR, rim area, and cup volume. Furthermore, our unique model utilises an algorithm that goes one step further than existing models in the literature by providing multi-classification (normal vs mild/moderate vs severe) as opposed to binary classification.
Update on Sympathetic Ophthalmia
Authors: Khan Nida , Palani Janakiraman , Biswas Jyotirmay
Published: July 2024

Sympathetic ophthalmia (SO) is a rare bilateral diffuse granulomatous intraocular inflammation, which occurs days or months following surgery or trauma to one eye. After penetrating ocular injuries and during intraocular surgery, the incidence of SO varies from 0.2% to 0.5% and 0.01%, respectively. Other risk factors include cyclodestructive operations and vitreoretinal surgery. With 80% of cases appearing within three months following injury to the exciting eye and 90% occurring within one year, the temporal interval between ocular injury and the onset of SO varies widely, ranging from a few days to decades. The diagnosis is based on clinical findings. It manifests as bilateral diffuse uveitis. In the sympathetic, uninjured eye, patients describe a sneaky beginning of blurred vision, discomfort, epiphora and photophobia. Typically, this is accompanied by conjunctival injection and a granulomatous anterior chamber reaction, resulting in mutton fat keratic precipitates (KPs). The degree of inflammation in the posterior chamber can differ. One of the initial lines of treatment for SO is systemic corticosteroids. Long-term immunomodulatory therapy may involve azathioprine, mycophenolate mofetil, cyclosporine or other immunosuppressive drugs if patients do not respond to steroid therapy or if their side effects are clinically substantial.
Long-term Outcomes of Deep Anterior Lamellar Keratoplasty in Macular Corneal Dystrophy—A Retrospective Analysis
Authors: Kodavoor Shreesha K. , Neemuchwala Tasneem , Dandapani Ramamurthy
Published: July 2024

Purpose:

To study the long-term outcomes and complications in patients who underwent deep anterior lamellar keratoplasty (DALK) for macular corneal dystrophy (MCD).

Methods:

This is a retrospective analysis of all patients who underwent DALK in a tertiary eye care hospital in South India from 2011 to 2020. A total of 51 eyes of 33 patients were evaluated. All eyes underwent successful DALK by big bubble technique (32 eyes) or layer-by-layer dissection (19 eyes). Patients were followed up for 18 months to 9 years.

Results:

There was a significant improvement in vision (uncorrected and best-corrected visual acuity) post-DALK. The best corrected visual acuity after surgery was 0.3 logMAR (20/40) or better in 66.7% of operated eyes. Complications noted during surgery were intra-operative perforation. Post-operative complications include double AC, cataract, raised intraocular pressure, interface vessels and recurrence of the dystrophy.

Conclusion:

DALK is a safe and viable procedure for MCD management and gives good visual outcomes.
A Simplified Treatment Algorithm for the Management of Primary Double-headed Pterygium
Authors: Kodavoor Shreesha K. , Joseph Ashalyne J. , Dandapani Ramamurthy
Published: July 2024

Aim:

To study different methods in the management of primary double-headed pterygium and to propose a simplified treatment algorithm for its surgical management.

Methods:

A retrospective study was performed on 335 eyes. All the surgeries were carried out under subconjunctival infiltrative anaesthesia. In Group I, patients underwent excision of pterygium with a horizontal conjunctival autograft (CAG). Patients in Group II underwent a vertical split CAG with limbal orientation, while in Group III, limbal orientation was not maintained. In Group IV, patients underwent conjunctival tissue graft from pterygium and conjunctival autografting.

Results:

Recurrence was observed in five of the 96 eyes in Group I (5.2%) and among 12 of the 99 eyes in Group II (4.04%). Recurrence was observed in three out of 87 eyes (3.45%) in Group III, and four out of 53 eyes (7.5%) in Group IV. All four groups had low and comparable recurrence rates. The follow-up period for all patients was extended for a minimum of 6 months, with mean follow-up durations of 16.79 months in Group I, 18.30 months in Group II, 17.28 months in Group III and 14 months in Group IV.

Conclusion:

Outcomes of horizontal and vertical split conjunctival autografting with/without limbal orientation and conjunctival tissue from pterygium with conjunctival autografting were studied. All these methods had low and comparable rates of recurrence and are therefore effective in the surgical treatment of double-headed pterygium.
Pharmaco-Therapeutic Factors Influencing the Quality of Life in Patients on Anti-Glaucoma Medications for the Treatment of Primary Open-angle Glaucoma: A Cross-Sectional Study
Authors: Dayanand Anushree , Muraraiah Sushma , Naik Yogita U. , Khayoom Nishat S.
Published: July 2024

Purpose:

Vision significantly affects a person’s quality of life (QOL). This study aims to determine the pharmaco-therapeutic factors influencing it among patients on anti-glaucoma medications.

Materials and Methods:

A total of 100 patients diagnosed with primary open-angle glaucoma (POAG) on medications for six weeks were included in this cross-sectional study. QOL was assessed using a pre-validated Glaucoma Quality of Life-15 (GQOL-15) Questionnaire. Adverse drug reactions (ADRs) to the anti-glaucoma medications were determined using the pre-validated Comparison of Ophthalmic Medications for Tolerability (COMTOL) checklist. The Chi-square test, Fisher’s exact test and multiple logistic regression analysis were performed to test the statistical significance of the data. A P value of < 0.05 was considered statistically significant.

Results:

Out of the 100 patients, 76 had good QOL and 24 had poor QOL. Among them, 67 patients were on a single drug, 27 were on a two-drug combination and six were on a three-drug combination for the management of glaucoma. Patients receiving multiple drugs for the management of POAG were associated with poor QOL (P = 0.006). Out of the other variables tested for association, the presence of ADRs, patients having a positive family history of POAG, patients with a duration of illness of more than three years, hypertensives and diabetics had a statistically significant association with poor QOL.

Conclusion:

POAG patients on multiple anti-glaucoma medications had poor QOL compared to those on a single drug. Multiple drug combinations caused a greater number of ADRs compared to single drug use. Patients with ADRs had poor QOL. The presence of co-morbidities like diabetes, hypertension and positive family history were associated with poor QOL.
Blepharochalasis and Lichen Planus Pigmentosus: A Very Rare Association
Authors: Das Sujit , Singh Sakshi , Mishra Ram Mohan , Yadav Mitali
Published: July 2024

Blepharochalasis syndrome is a condition of the eyelids consisting of episodic inflammation and chronic skin changes. It is usually bilateral and tends to manifest in the upper eyelids. But, there are cases of unilateral presentation also which exclusively affects the lower eyelids. There are multiple theories regarding the etiology of blepharochalasis. Blepharochalasis is believed to be a manifestation of angioneurotic edema. Hormonal changes may play an important role in the disease process. Immunohistochemical analysis of excised eyelid skin has demonstrated the presence of IgA in several studies. These findings suggest that there may be a concomitant inflammatory process accompanying the extravasations’ of fluid and localized edema occurring at the capillary level. Blepharochalasis might also present as part of systemic disease. The disease, lichen planus pigmentosus, is a variant of lichen planus and has also been noted the presence of IgA and IgG along with complement C3 in the epidermal cells in several studies.
Trematode Granuloma: Journey of the Worm from the River Bed to the Agar Plate
Authors: Rajesh Vedhanayaki , Sivakumar Rathinam , Thundikandy Radhika
Published: July 2024

Trematode granuloma has been reported as one of the common causes of infectious uveitis in paediatric age group in recent times in Tamil Nadu. These granulomas occur after exposure to the trematode-infested water resources. Studies from South India have established the cause of granuloma as trematode by histopathological and molecular diagnostics. The smaller granulomas responded to topical and oral steroids while larger lesions needed surgical excision. Untreated cases develop retro corneal membrane, cataract, glaucoma and even phthisis in the long run. Early identification and prompt treatment are needed to prevent visual morbidity in these children.
The Making of Psychiatrists in Japan
Authors: Nakagami Yukako , Oya Nozomu , Horinouchi Toru , Aki Morio
Published: July 2024

Background:

Like in most countries in the world, Japan has its own system of how a medical graduate becomes a psychiatrist.

Methods:

The authors, young Japanese psychiatrists, describe what they have personally been through the education and training before becoming full-fledged psychiatrists who can treat patients with psychiatric diseases. All those personal experiences are validated with related documents.

Results:

In Japan, the pathway to become psychiatrists involves a rigorous process starting with a competitive entrance to medical school, followed by a six-year educational curriculum influenced by international accreditation standards. After graduating from medical schools, physicians receive a two-year junior residency training, which briefly introduces them to psychiatry, influencing some to specialize in the field. Specialization requires further training and certification, facilitated by the Japanese Society of Psychiatry and Neurology (JSPN) and the Ministry of Health, Labor, and Welfare, encompassing various psychiatric settings and disorders. Beyond initial certification, there are continuous professional development opportunities, including advanced specializations and educational programs supported by professional societies such as the JSPN and the Japan Young Psychiatrists Organization.

Conclusion:

This system ensures a comprehensive and structured approach to psychiatric education and specialization in Japan, offering a wide range of opportunities for aspiring psychiatrists.
Variations of Sleep Patterns and Their Relations with Positive and Negative Domains of Schizophrenia in Eastern Indian Population
Authors: Pal Amit Kumar , Kundu Partha Sarathi , Halder Arghya , Ray Sagarika , Bhattacharya Amit Kumar
Published: July 2024

Objectives:

Schizophrenia is a persistent and incapacitating psychiatric condition characterized by symptoms with positive, negative, affective, and cognitive domains. Sleep disturbances represent an important facet of this disorder, impacting both the quality of life and influencing its overall outcome. In the cross-sectional study, we intended to investigate the polysomnographic findings of patients with schizophrenia showing predominantly positive symptoms as opposed to those presenting with predominantly negative symptoms and also as compared to normal population.

Methods:

This study had a cross-sectional design, involving the recruitment of 60 medication-naive patients diagnosed with schizophrenia according to the ICD-10 criteria and 30 study participants representing normal population. The cases were subdivided into two groups: one characterized by predominantly positive symptoms and the other characterized by predominantly negative symptoms. Both the groups received overnight polysomnography, and study variables were recorded.

Results:

All the sleep parameters were deranged in patients with schizophrenia as compared to normal controls in the general population, with significantly more pronounced differences found in those with predominant positive symptoms for most variables (p < 0.001). The only exception was the duration of N3 (slow-wave sleep) which was significantly decreased in patients with negative symptoms compared to those with positive symptoms (p < 0.001). But no significant differences were found between the negative and positive symptom domain groups in mean rapid eye movement (REM) latency, duration of N1 and N2 sleep, and total percentage of REM sleep.

Conclusion:

This study highlights substantial variations in sleep patterns between the negative and positive symptom domains of schizophrenia and also as compared to the general population. Further study is imperative to explore the link between circadian integrity and symptoms of the various domains of schizophrenia.
The Effect of Listening to Pachelbel’s Canon in D Major on Anxiety Level during Pulmonary Rehabilitation: A Pilot Study
Authors: Fan Jui-Chia , Chao Ke-Yun , Wu Chia-Chun , Shih Yi-Nuo
Published: July 2024

Objective:

Many patients with chronic obstructive pulmonary disease (COPD) feel anxious during the pulmonary rehabilitation process. How to reduce the anxious level in patients with COPD is a worthy issue for mental health. Johann Pachelbel’s Canon is a commonly used musical material in clinical practice. In this pilot study, we intended to investigate the effectiveness of using Pachelbel’s Canon in D major as a music therapy to reduce anxiety levels in patients receiving pulmonary rehabilitation for chronic obstructive pulmonary disease (COPD).

Methods:

Fifty patients with COPD receiving pulmonary rehabilitation from a hospital in New Taipei City. They were randomly assigned in blocks for two groups, control group in a quiet environment, and experimental group listened to the Pachelbel’s canon in D major.

Results:

A significant difference in the anxiety score during pulmonary rehabilitation between the experimental group and the control group was found through an independent sample t-test in this study (p < 0.05).

Conclusion:

Listening to the music of Pachelbel’s canon in D Major decreased the anxiety level of patients with COPD during pulmonary rehabilitation.