bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 71
Authors: Mukherjee Soham , Bhadada Sanjay , Pal Rimesh , Dhiman Vandana , Verma Anmol , Kaur Amanpreet
Published: February 2023

Background: Type 1 diabetes mellitus (T1D) is characterized by autoimmune destruction of pancreatic β- cells with consequent absolute insulin deficiency and hyperglycemia. Adult patients with T1D have a sixfold increased fracture risk. However, this increase in fracture risk in T1D patients could not be explained by BMD alone. As far as skeletal microarchitecture in T1D is concerned, data is sparse in world literature and absent in Indian population. Hence, we aimed to study the skeletal microarchitecture in T1D subjects as assessed by High Resolution Peripheral Quantitative Computed Tomography (HR-pQCT) and compared these parameters with age, sex and BMI matched controls.

Methods: We recruited 31 T1D cases without celiac disease (Group A: Male15, Female 16), 11 T1D cases with celiac disease (Group B: Male 5, Female 6) and 19 age, sex and BMI matched healthy control (Group C: Male 10, Female 9). Blood biochemistry and hormonal profile including calcium profile, 25(OH) vitamin D, iPTH and HbA1C level between the Group A and B were compared. The HR-pQCT parameters among the three groups were also compared.

Results: The median age of male and female participants in Group A [22 (20-25) years and 23 (22-26) years], Group B [26 (22-31) and 23 (21-24) years] and Group C [27 (18-28) years and 26 (25-27) years] were comparable. BMI was also comparable between the three groups. The duration of diabetes, insulin dose per kg body weight, calcium profile, 25(OH) vitamin DandiPTH level were similar between Group A and B. Median HbA1C value in male and female subjects within Group A and B were 7.05 (6.4-8.0)% and 8.2 (7.2-10.2) %, 8.2 (6.4-9.6) %, and 9.2 (7.9-12.3) %, respectively; and when sex specific comparison was done, the differences were statistically insignificant. Radial cortical vBMD (volumetric BMD) was significantly higher in male subjects in Group B as compared to male cases in Group C. Tibial trabecular vBMD in female participants was significantly lower in Group B as compared to Group C. Tibial trabecular bone volume fraction in female was greater in Group C as compared to the other groups. Trabecular thickness in femaletibiawas also greater in Group C compared to other two groups; while, trabecular thickness of female radius was higher in Group C compared to Group A.

Conclusions: Skeletal microarchitecture is altered in T1D subjects with and without celiac disease. This may explain higher skeletal fragility in this subgroup of patients.
Abstract 72
Authors: Jadhao Pooja , Sravya S. L. , Swain Jayshree , Mangaraj Swayamsidha , Kanwar Jaya Bhanu , Sahoo Abhay
Published: February 2023

Background: Diabetic peripheral neuropathy (DPN) is one of the most common complications of type 2 diabetes mellitus (T2DM) leading to major comorbidities. Our objective is to determine the prevalence of DPN in newly diagnosed T2DM patients by various commonly used tools and establish its predictors.

Methods: We recruited consecutive newly diagnosed T2DM patients visiting the outpatient department. Detailed demographic parameters, history, physical examination and biochemical investigations were carried out. Patients were screened for DPN using Diabetic Neuropathy Symptom (DNS) score, revised Disability Neuropathy Score (NDS), Vibration Perception threshold (VPT) using a biothesiometer and 10 g SW monofilament test.

Results: Total 156 patients of newly diagnosed T2DM with mean age of 44.29 ± 13.29 were included in the study. The prevalence of DPN was found to be 30.8% using the DNS and NDS score. Vibration perception threshold was moderately impaired in 20.5% patients and severely impaired in 9% patients and monofilament testing revealed loss of protective sensation in 23% patients. Patients with DPN were older with mean age of 51.50 ± 12.5 years vs 41.09 ± 12.0 (p < 0.001) years in patients without DPN. Patients with DPN had higher HbA1C levels 9.55 ± 2.5 vs 7.97 ± 1.5 (p 0.044), higher triglyceride levels 268.44 ± 17.6 vs 206.20 ± 23.5 (p 0.001) and higher LDL cholesterol levels117.92 ± 34.4 vs 99.15 ± 31.6 (p 0.033) than patients without DPN. After multiple regression analysis DPN was significantly associated with increasing age (p 0.03), presence of hypertension (p 0.01), increasing LDL cholesterol (p 0.024) and reduced BMI (p 0.04). It did not have significant correlation with fasting plasma glucose, HbA1C levels or triglyceride levels.

Conclusions: The prevalence of DPN is high even in newly diagnosed T2DM and associates significantly with age of the patient, hypertension and LDL cholesterol levels. Earlier screening for DPN, especially in older subjects is necessary along with aggressive control of blood pressure and LDL cholesterol levels.
Abstract 78
Authors: Mohanta Bibhutibhusan , Dabadghao Preeti , Gupta Sushil Kumar
Published: February 2023

Background: Dorsal pancreatic agenesis is a rare developmental anomaly characterised by absence of pancreatic body and tail.

Aims and Objectives: Case-series to describe clinical, biochemical characteristics and outcomes among dorsal pancreatic agenesis patients in our institute during the time period Feb 2021-Sept 2022.

Results: During this period we found 10 subjects, of which 60% were males. The median age at diagnosis was 23.5 yr (range 16-52 yr). The median duration of diabetesat presentation was 3.5 yrs (range 1-14 yr). The most frequent clinical manifestations were found to be diabetes (100% cases) and non-specific abdominal pain (80%). Steatorrhea was seen in 30% cases. None of the patients presented with DKA. Anti GAD antibody was negative in 4 out of 4 cases tested. Serum amylase and lipase levels were normal in the cases presenting with pain abdomen. All the patients underwent CT abdomen which showed non-visibility of distal body and tail of pancreas. MRCP was done in 2 cases whichrevealed absent dorsal pancreatic duct. Next generation sequencing for MODY panel was done in 7/10 cases and no pathogenic variants were detected. Two patients are on OHA and rest 80% (8/10) cases are on treatment with insulin. Symptoms and signs of micro or macrovascular complications were not found in any of the cases.

Conclusion: Dorsal pancreaticagenesis is a rare condition diagnosed during imaging for common abdominal symptoms. It is an important differential diagnosis in young patients presenting with diabetes mellitus and pain abdomen.
Abstract 8
Authors: Yadav Suchitra , Sahlot Rahul , Sharma Balram , Saran Sanjay
Published: February 2023

Methods: We describe a case report of a male with primary infertility presented to SMS endo OPD

Results: CD is an autoimmune disorder characterized by intestinal inflammation in response to gluten. We describe a case of 24-year-old male who presented to SMS OPD with primary infertility with raised LH = 16.7 IU/L, FSH = 15.6 IU/L, S. Testosterone: 1200 ng/dl and azoospermia on semen analysis. On evaluation patient was found to have coeliac disease IgATTG positive with Marsh 3A classification on D2 biopsy. Patient was started on Gluten free diet and the androgens levels got restored to normal levels and on semen analysis sperm counts improved to 15 million per ml over a period of 9 months

Conclusions: CD is an acquired cause of androgen resistance and response to treatment is rewarding
Abstract 80
Authors: Palle Sharmila , Bhandiwad Chandrashekhar , Paidipally Srinivasa Rao , Danda Vijay Sheker R.
Published: February 2023

177Lu-DOTATATE-based peptide receptor radionuclide therapy (PRRT) is a promising therapy for metastatic and/or inoperable pheochromocytoma and metastatic insulinomas that can result in reduced tumor burden and improved quality of life. We present our experience with 2 cases of metastatic pheochromocytoma and metastatic insulinoma who received PRRT.

Case 1: A 35 year male presented with pain in left lumbar region, palpitations, episodic sweating and headache in 2017. Metanephrines and normetanephrines in urine were 587 ng/L and 1062 ng/L respectively. On CT abdomen there was a left suprarenal mass. After adequate preparation he underwent left adrenalectomy in 2017. He was lost to follow up till 4 years after surgery. Now again he presented with episodic palpitations, anxiety, sweating and headache. Metanephrines and normetanephrines in urine were 338 ng/L (7.90-88) and 809 ng/L (20-135) respectively. On Gallium 68 DOTANOC PETCT there were multiple nodular densities in postoperative bedand metastasis to left paraaortic, peripancreatic lymph nodes and multiple vertebrae. After adequate preparation he was given 150mCi Lu DOTATATEiv. After 30 minutes into transfusion, patient had sudden onset palpitations,15 episodes of vomitings, his BP was 200/150 mm Hg and heart rate was 149bpm. He was given Metoprolol and prazosin and after 10 min his BP was 76/45mm Hg and HR was 193bpm. USG abdomen showed collapsed inferior venacava. He was stabilized with iv fluids. He was under observation for 10 days. During this period he had recurrent episodes of vomitings, nausea, palipitations and fluctuating BP. At the time of discharge his BP was stable. This case illustrates the risk of crisis episodes in metastatic pheochromocytoma and the need to monitor for crisis episodes for 10 daysafter undergoing PRRT.

Case 2: A 21 year male known case of MEN 1, initially presented with pituitary microadenoma and insulinoma in 2014, underwent distal pancreatosplenectomy and in 2018 underwent parathyroid adenoma excision. After 4 years he presented with hypoglycemic episodes. Ga 68 DOTATATE PET CT showed an enhancing lesion at post operative site of 1.4 Χ 1 cm with multiple peripancreatic nodal and peritoneal metastasis. He was on injection octreotide 30 mg IM depot monthly. After stopping injection octreotide, he was given 150 mCi lutetiumiv. He did not develop any hypoglycemic or hypercalcemic crisis after PRRT. Now he was off injection octreotide and doing well with no further hypoglycemic episodes after PRRT.

As the treatment options are limited in metastatic neuroendocrine tumors, we subjected them to PRRT which is minimally invasive, improved symptoms of both the patients and both are under followup.
Abstract 88
Authors: Jain Abhilasha , Kalra Sanjay
Published: February 2023

Background: Hypercalcemia is arelatively common conditionin hospital settings, etiology being malignancies, symptomatic PHPT and granulomatous diseases. Still, it is under evaluated in clinical practice. Awareness amongst practitioners regarding evaluation and management is far more less. We are here to report two such cases of missed hypercalcaemic crisis, where more endocrine awareness would have helped managing patients.

Methods: First case was a 54-year-old male, who presented to general practitioner with complaints of fever, weight loss, abdominal distention, and inconsolable cry for last 3-4 months. He was found to have raised ESR (82 mm/hr), raised calcium (14.1 mg/dl), ascites on USG abdomen and right upper zone infiltrates on chest radiography. Ascitic tap suggested low serum albumin, ascitic fluid albumin gradient and raised adeno-deaminase, in view of which he was started on ATT. Contrast enhanced MRI brain was normal. His neurological symptoms did not improve after 15 days of treatment. He presented to us with these complaints, diagnosis was reconfirmed but he was found to have persistent hypercalcemia (14.2 mg/dl), normal phosphate (4.5 mg/dl) and raised creatinine (1.4 mg/dl). On further evaluation, he had PTH independent hypercalcemia (6 pg/ml) with raised 1,25 (OH)D. A diagnosis of hypercalcemic crisis secondary to active tuberculosis was made and patient was given iv zoledronic acid and started on methylprednisolone. Over next one week, calcium and creatinine improved to 9.9 mg/dl and 0.9 mg/dl. Patient’s neuropsychiatric symptoms improved markedly with improvement of serum calcium.

Second case, 56-year-old female who was on hemodialysis for 3 months after being diagnosed chronic kidney disease, presented to us with complaints of altered sensorium for last 1 day. She was evaluated and found to have persistent hypercalcemia (14.1 mg/dl, 14 mg/dl), raised phosphate (5.5 mg/dl) and creatinine (6.5 mg/dl). She was found to have PTH independent hypercalcemia (PTH 3 pg/ml, raised 1,25 (OH)D). Further, myeloma workup and bone marrow biopsy revealed positive M band, raised kappa lambda free light chain ratio and bright CD 38 positivity. Bone marrow also confirmed the diagnosis of multiple myeloma (30% plasma cells). Meanwhile, she underwent dialysis, started on dexamethasone and single dose of denosumab was given with which calcium improved and sensorium of the patient improved.

Conclusions: Though hypercalcemia is not an uncommon finding in clinical practice but its evaluation is seldomdone. More awareness is needed for the evaluation and management of hypercalcemia.
Abstract 94
Authors: Praveen N , Saikia Uma Kaimal , Bhuyan Ashok Krishna , Baro Abhamoni
Published: February 2023

Objective: In patients without cardiovascular disease (CVD), subclinical hypothyroidism (SCH) as a cardiovascular risk is controversial. In this study we aim to correlate carotid intima-media thickness (CIMT) as a CV risk marker with thyroid profile in patients with subclinical hypothyroidism.

Methods: This was a cross-sectional study with 79 newly diagnosed SCH patients (defined as TSH: 4.3-10 mIU/L with FT4: 1-1.6 ng/dL), in which 53 had no comorbidities, while 26 patients had both hypertension and type 2 diabetes mellitus (T2DM). We also included 53 healthy participants (defined as TSH: 0.5- 4.2 mIU/L with FT4: 1-1.6 ng/dL). BMI, pulse, BP, TSH, FT4, lipid profile and CIMT of both carotid arteries were done in all participants. Statistical data were analysed using XLSTAT software with t test and Pearson correlation for continuous variables and p value < 0.05 were considered significant.

Results: The mean TSH values among euthyroid controls, SCH with comorbidities and SCH without comorbidities were 2.56 ± 10.5 mIU/L, 7.08 ± 1.31 mIU/L and 7.17 ± 1.36 mIU/L respectively. There was no statistically significant difference in mean TSH value in between the two SCH groups. The patients with SCH without comorbidities had higher CIMT mean values than euthyroid participants which was statistically significant. The mean difference of left and right sided CIMT between these two groups was -0.088 mm (p < 0.001) and - 0.094 mm (p < 0.001) respectively. On the other hand, although patients with SCH with comorbidities had higher CIMT mean values than patients without comorbidities, it was not found to be statistically significant. The mean difference of left and right sided CIMT in between these two groups was -0.051 mm (p = 0.089) and -0.055 mm (p = 0.071) respectively. Age, TSH, total cholesterol and LDL were found to correlate significantly with CIMT in patients of SCH without comorbidities.

Conclusion: CIMT as surrogate marker for CVD was found to be increased in SCH patients without prior CVD. Further large sized and long-term outcome studies are needed to establish SCH as risk factor in patients without CVD. Whether therapy with levothyroxine will improve CIMT and decrease CVD risk needs further evaluation.
Abstract 96
Authors: Rakesh Sahay , Ravi Kotadia , Ameet Soni , Pratik Patel , Hiten Saresa , Kushagra Khanna , Neeraj Kumar , Annie Gupta
Published: February 2023

Objective/ Background: Various oral formulations of cholecalciferol are available in world. To ensure optimal and appropriate delivery and absorption of these formulations, it is important to study their bioavailability and biodistribution within the human body. Gamma scintigraphy is a technique used to map various drug formulations as it traverses the human body in real-time. Combining this information with the pharmacokinetic data (pharmacoscintigraphy) gives valuable information about the release and absorption mechanisms of drug formulations, including the ability of a formulation to reach a specific target location, the rate of erosion in comparison with in vitro dissolution data, and the impact of absorption windows on bioavailability. It is required to study the bioavailability and biodistribution of specific cholecalciferol formulations before prescribing.

Method: We evaluated the bioavailability and biodistribution pattern, transit time, and gastrointestinal clearance of a single dose of Calcirol® soft gelatin capsule 60,000 IU [an oral cholecalciferol (vitamin D) formulation] using pharmacoscintigraphy. Six male healthy adult volunteers were administered with a single oral dose of Calcirol® soft gelatin capsule labeled with technetium-99m. Post-dosing, Sequential static gamma imaging for 24 hrs was performed to evaluate the biodistribution and serial venous blood samples were collected till day 27 for the estimation of the plasma levels of 25-hydroxycholecalciferol and 1,25-dihydroxycholecalciferol levels. Different pharmacokinetic parameters were calculated.

Results and Discussion: This was the first pharmacoscintography study in the world to demonstrate the favorable biodistribution of Calcirol® soft gelatin capsules, supporting its use for vitamin D supplementation. The overall absorption of Calcirol® soft gelatin capsule was 93.23%, which was fully from the small intestine. The small intestinal residence time was around 16 h. Table-1 shows the different pharmacokinetic parameters of 25-hydroxycholecalciferol and 1,25-dihydroxycholecalciferol. Results shows that exogenous cholecalciferol in the form of soft gelatin capsule achieves a sufficient level of 25-hydroxycholecalciferol (>60 ng/ml) within 6 hr of oral intake. No adverse event was noted.

Conclusion: An in-depth understanding of Cholecalciferol absorption pattern can be achieved using pharmacoscintigraphy.
Bilateral Facial Nerve Palsy as a Rare Presentation of Systemic Lupus Erythematosus
Authors: Raju Tagru , Garg Tulika , Kaur Jaspreet , Gupta Monica
Published: February 2023

Systemic lupus erythematosus (SLE), a disease of the immune system, has a relapsing-remitting course. It is known to affect multiple organ systems of the body, including the nervous system. Cranial neuropathy, particularly facial neuropathy, is an unusual complication of SLE whose pathogenic mechanism is still not understood. Cardiac involvement, like myocarditis and papilledema, is another rare presentation of SLE. A 23-year-old male had bilateral lower motor neuron type of facial palsy which on a thorough investigation was found to be as a manifestation of SLE confirmed by antinuclear antibodies and double-stranded DNA antibody positive test. Electrocardiogram and echocardiography were suggestive of myocarditis. Fundus examination revealed Grade 2 papilledema. The patient was managed with symptomatic treatment along with corticosteroids, to which he responded gradually. Bilateral facial nerve lower motor neuron type palsy is a rare manifestation of SLE which should be diagnosed promptly and can be managed with corticosteroids. The clinician should also keep an eye on infrequent manifestations like myocarditis and papilledema.
To Study Demographic Profile, Risk Stratification, and Response to Treatment in Chronic Myeloid Leukemia Patients
Authors: Chandey Manish , Kaur Rajandeep , Gupta Rajeev , Mohan Gurinder
Published: February 2023

Background:

Chronic myeloid leukemia (CML) is the most common leukemia in India. The annual incidence of CML in India was originally reported to be 0.82.2 per 100,000 population. CML is a clonal disorder that is usually easily diagnosed by the Philadelphia chromosome. The approval of tyrosine kinase inhibitors has significantly reduced the mortality rate associated with CML and revolutionized treatment.

Materials and Methods:

Eighty patients diagnosed with CML were studied. Investigations were done and with European Treatment and Outcome Study (EUTOS) patients were stratified into low- and high-risk group and then treatment with Imatinib was given to all patients and molecular response was evaluated.

Results:

In the study population, out of 80 patients, 40 were female and 40 were male with M: F is 1:1. Out of total 80 patients’, maximum patients (54) were in 31-60 years age group. Our study showed that the most common symptom of presentation is abdominal discomfort followed by fever. Out of total 80 patients, 25 (31.3%) patients had high EUTOS score and 55 (68.8%) patients had low EUTOS score. On 6 months’ follow-up, 36.3% patients had complete molecular response, 16.3% patients had major molecular response and 47.5% patients had no molecular response, but on 12 months’ follow-up, 71.3% patients had complete molecular response, 16.25% patients had major molecular response, and 12.5% patients had no molecular response.

Conclusion:

In this observational study, we found a significant correlation between EUTOS score and molecular response at 6 months and 12 months follow-up after Imatinib therapy.

Chronic myeloid leukemia, European treatment and outcome study score, response, tyrosine kinase inhibitor
A Systematic Literature Review of Demographics, Clinical Presentation and Surgical Procedures Performed for the Appendico-Umbilical Fistula for the PasQAt 100 Years
Authors: Ghritlaharey Rajendra Kumar
Published: February 2023

The persistent vitellointestinal duct (PVID) is the rarest of all the vitelline duct anomalies. The enteric end of the vitelline duct mostly connects to the terminal ileum. The appendico-umbilical fistula (appendiceal-umbilical fistula) in which the proximal end of the vitelline duct connects to the appendix is a rare clinical entity. This systematic literature review was carried out to review the demographics, clinical characteristics and operative procedures executed for the appendico-umbilical fistula. Literature/cases with incomplete desired details for the above-mentioned anomaly were excluded. The guidelines of the preferred reporting items for systematic reviews and meta-analyses are followed for presenting this manuscript. An online search was made for the retrieval of the published manuscripts. The search was performed for the previous 100 years from 1921 to December 2021. A total of n = 21 (n = 12 female and n = 9 males) cases of the appendico-umbilical fistula were included in the systematic review. All the cases, except one, were infants and n = 10 of the cases were neonates/newborn babies. Their ages ranged from 1 day to 5 years. Three-fourths (n = 16) of the children presented with the chief complaint of discharge of mucus/stool through the umbilicus. An appendicectomy with resection of the PVID/fistulous duct/prolapsed mucosa was executed as the standard operative procedure for the entire case. A peri-umbilical incision was preferred and frequently employed for surgical therapy. This review revealed only one (4.76%) post-operative death that was unrelated to the surgical procedure. PVID connected to the appendix, presented clinically as appendico-umbilical fistula is a rare entity. The standard surgical procedure performed for the appendico-umbilical fistula was an appendicectomy with resection of the PVID/fistulous duct/prolapsed mucosa.
Advocating for Routine Post-natal Surveillance and Urgent Neonatal Inguinal Hernia Repair
Authors: Dudhani Shreyas , Jana Sourav , Singh Ramjeewan , Sinha Amit Kumar , Kumar Bindey
Published: February 2023

Inguinal hernias are more common in preterm and neonates and incidence of incarceration are reported to be more in the first 6 months of life. Strangulation follows incarceration and various incarcerated and strangulated contents having been reported in the sac. The fistulation of the herniated content through the scrotal skin is quite rare with only a few reported cases. We present the case of entero-scrotal fistula in a neonate managed with staged repair along with a brief review of the literature. A 27-days-old, full-term male presented with faecal discharge from the right scrotum. He had no tell-tale signs of obstructed hernia. A faecal fistulous opening was located in the right hemi-scrotum. The terminal ileum was seen as the content with an antimesenteric perforation, divided ileostomy and scrotal debridement was done and later ileo-ascending anastomosis was performed electively. Neonatal hernias should be considered an urgency and we advocate early surgery. The resource-limited setting and poor post-natal surveillance may have added to the worries. In our case, swelling and fistulation occurred in a very brief period of 36 h. We managed the child with a diversion stoma followed by ileo-ascending anastomosis later.
Pre-treatment “Lung Cancer Imaging - Reporting and Data System” (LCI-RADS) and “Post-therapy Lung Cancer Imaging - Reporting and Data System” (pLCI-RADS): A narrative review of comprehensive synoptic reporting formats for lung cancer imaging
Authors: Chakrabarty Nivedita , Mahajan Abhishek
Published: February 2023

A synoptic reporting template is pivotal in influencing patient management by effectively and comprehensively communicating relevant imaging findings to the treating physician. Proper cancer image reporting requires two separate templates, one for recording baseline findings and the other for conveying the post-therapy response. However, no such separate reporting templates have been prepared to date. In this manuscript, through the synoptic reporting template 1 on “Pre-treatment Lung Cancer Imaging - Reporting and Data System (LCI-RADS)”, we intend to provide the tumor node metastasis (TNM) stage at the end of the report, with a provision for mentioning pertinent clinical/laboratory findings as well as information on the molecular testing. Through the synoptic reporting template 2 on “Post-therapy Lung Cancer Imaging - Reporting and Data System (pLCI-RADS),” we intend to describe the post-therapy response after comparison with the previous scan following surgery/chemotherapy/targeted therapy/immunotherapy/radiotherapy. Besides, the categories of post-therapy lung injury and follow-up recommendations will also be provided at the end of pLCI-RADS. Both LCI-RADS and pLCI-RADS will require acute (urgent) findings to be mentioned at the beginning of the report. We believe the implementation of these two comprehensive synoptic reporting templates will positively impact patient management. To prepare this review, we searched the internet using Google and referred to all the relevant articles and their references published in the preceding 25 years. In addition, we referred to the management guidelines of the National Comprehensive Cancer Network, version 2.2022, for formulating the synoptic reporting formats.
Second opinion interpretations by specialty radiologists in head-and-neck oncology and their impact on clinical management: A retrospective observational study
Authors: Mahajan Abhishek , Shukla Shreya , Mali Raghvendra , Agarwal Ujjwal , Sable Nilesh , Vaish Richa , Ankathi Suman Kumar , Patil Vasundhara , Janu Amit K. , Prabhash Kumar , Noronha Vanita , Pai Prathamesh , Laskar Sarbani G. , Patil Asawari , Patil Vijay , Menon Nandini , Thiagarajan Shivakumar , Chaturvedi Pankaj
Published: February 2023

Background:

Patients with medical imaging performed and interpreted elsewhere often come to tertiary referral centers for further management. At our tertiary cancer hospital, external imaging studies of patients with head-and-neck cancer undergo formal second opinion reporting by subspecialty oncoradiologists.

Objectives:

We aimed to audit the second in-house review of outside scans by specialized head-and-neck radiologists to estimate the potential impact on patient management. Our secondary objective was to determine the direct impact of the second opinion by head-and-neck specialist radiologists on the change in diagnosis, stage, and management of patients. We also aimed to determine the indirect impact on the cost–benefit ratio and the time taken for decision making.

Materials and Methods:

This was a retrospective review of original and second opinion reports for consecutive patients that came with films/compact discs (CDs) and reports of computed tomography (CT), magnetic resonance imaging (MRI), or positron resonance imaging - computed tomography (PET-CT), initially performed and interpreted at another institution, and later, a second opinion review of imaging was done by the in-house subspecialty radiologists in head-and-neck onco-imaging between May 2016 and December 2017. The rates of discrepancy for staging and recommended management and the report accuracy were determined and compared to the gold standard: pathological staging.

Results:

Following the specialist in-house radiologist’s second opinion review, the cancer stage changed in 28% (139/492) cases, and the management recommendation changed in 6.7% (67/492) of the patients with head-and-neck cancer. Compared to the histopathology results that were available for 93/492 (19%) cases, the second opinion interpretation was correct 87% of the time (81/93). The average time saved by the second radiology opinion was 8.6 days. Significant monetary savings amounting to

JOURNAL/crsat/04.03/02201859-202205040-00007/652FF01/v/2023-03-21T130949Z/r/image-tiff

11,35,590 ($13,788.3) were achieved.

Conclusion:

A second opinion review of outside imaging in patients with head-and-neck cancer by expert in-house onco-radiologists results in a change in the stage of cancer and the management plan in a significant number of cases, saves time by expediting the work-up, and helps to avoid expenditure on repeat imaging.
Comparison of oropharyngeal leak pressure of LMA Protector and LMA-ProSeal in different head and neck positions in anaesthetized and paralyzed patients; A prospective randomized study
Authors: Kerai Sukhyanti , Bhatt Garima , Saxena Kirti N , Gaba Prachi , Wadhwa Bharti
Published: February 2023

Background and Aims:

Oropharyngeal leak pressure (OLP) of LMA Protector is reported to be higher compared to other second generation supraglottic devices (SGDs) indicating better seal with patient’s airway and hence enhanced safety. To ascertain its benefit in patients undergoing surgeries where head and neck position other than neutral is required, we conducted a prospective randomized study to compare OLP of LMA Protector with LMA-ProSeal (PLMA) with head and neck in neutral, extension, flexion, and rotation position.

Methods:

80 American Society of Anesthesiologists (ASA) I-II patients aged more than 18 years undergoing elective surgery under general anaesthesia were recruited. Patients were randomized in the LMA Protector or PLMA group. After induction of anaesthesia, OLP was measured in both the groups in different head and neck position. The insertion characteristics of both SGDs were also recorded and compared.

Results:

The OLP of LMA Protector and PLMA was found to be comparable in neutral head position (p = 0.08). There was no significant difference in OLP of both devices in extension, flexion, or head rotation. In both the study groups, head extension position led to significant decrease in OLP compared to supine position. With the flexion and rotation positioning of head and neck, significant increase in OLP in each group was noted.

Conclusion:

The OLP of LMA Protector and PLMA are comparable in different head and neck position. With both the devices, there was significant decrease in OLP with extension whereas significant increase was noted in flexion and rotation of head and neck.
A Rare Case of Posterior Spinal Cord Syndrome Following Commando Surgery
Authors: Dave Bharat R. , Patel Saral J. , Patel Ravi B. , Dave Akruti M.
Published: February 2023

A 60-year-old male who underwent commando surgery for oral cancer in a supine position and 20-degree neck extension developed sensory ataxia with a loss of proprioception in bilateral lower limbs and hands in the immediate postoperative period. The magnetic resonance imaging (MRI) of brain and screening of spine done within 6 h of surgery indicated a degenerative cervical canal stenosis from C3 to C7 level. A final diagnosis of posterior spinal cord syndrome (PCS) was made after excluding other causes clinically and radiologically. Emergency surgical decompression in the form of C3–C7 laminectomy and intravenous methylprednisolone were administered within 12 h of index surgery. An early diagnosis and treatment resulted in a good neurological recovery by the seventh postoperative day and he was ambulatory with minimal support at 3-month follow-up.
Spinal Hemangioblastoma Causing a Holocord Syrinx
Authors: Bansal Tungish , Kamra Devasheesh , Borkar Sachin
Published: February 2023

Intramedullary spinal hemangioblastomas are often associated with syringomyelia. However, holocord syrinx associated with such lesions is a rare entity. We present two cases of dorsal spinal hemangioblastoma associated with holocord syrinx. Both the cases were treated with surgical excision which resulted in the resolution of holocord syrinx and good neurological recovery. In this case report, we discuss the various aspects of the diagnosis and surgical management in such cases. We also present an extensive review of literature of such lesions.
Pre-operative Halo-gravity Traction in the Treatment of Complex Spinal Deformities
Authors: Pratheep Guna K. , Viswanathan Vibhu K. , Manoharan Sakthivel R.R.
Published: February 2023

Spinal deformity surgeries are complex procedures associated with a high risk of complications. Halo-gravity traction (HGT) is a useful option that provides a gradual traction force to aid in deformity correction. Though its benefits are well-acknowledged, there still exist major ambiguities regarding its role in the management of complex spinal deformities. We performed a systematic review of the electronic databases including EMBASE, MEDLINE, PubMed, and Cochrane on November 12, 2021 to identify relevant articles on HGT; to analyze the existing literature on pre-operative HGT; and to compare the existing protocols for HGT in spinal deformity patients, its varied effects on the radiological parameters and general health status of the patients, and its associated complications. Among the 284 articles available in the literature, 34 articles were finally included and a total of 1151 patients [mean age, 14.6 years] were analyzed. Mean pre-traction coronal Cobb angle of 107° (72°–140.7°) was reduced by 24.8% [to a mean of 80.5° (42°–120.2°)] following HGT. Mean pre- and post-traction sagittal Cobb angles were 88° (56°–134.7°) and 65.4° (36°–113°; a reduction by 25.7%), respectively. Following HGT, mean body weight and body mass index (BMI) of patients improved by 7.2% and 9.1%, respectively. Mean improvement in forced vital capacity and forced expiratory volume has been reported to be 14.5% and 13.9%, respectively. Pre-operative HGT is a useful option in the treatment of spinal deformities. It aids in reducing curve magnitude and provides optimal time for improving general condition (pulmonary and nutritional status) of patients pre-operatively. It is a safe procedure with 2.1% neurological and 11.6% non-neurological complication rates.
Anterior Cervical Discectomy and Fixation Fusion for Hirayama Disease in a Young Male
Authors: Gupta Ashish , Bharti Rajesh Kumar
Published: February 2023

Hirayama disease (HD) is a rare, monomelic amyotrophy described by Hirayama in 1959. The condition is caused by chronic ischemic changes to the anterior horn cells of the cervical spine, caused by posterior dural sac laxity. It is a nonprogressive and self-limiting disease and has been noted to be a source of significant disability for affected young individuals. Early surgical intervention in HD limits the progression and thus decreases the degree of disability.
Identifying strategies for dealing with the aging population from the perspective of health system experts
Authors: Samouei Rahele , Keyvanara Mahmoud
Published: February 2023

BACKGROUND AND AIM:

Given the growing trend of aging and the limited resources of the health system, the lack of long-term prior government planning, and reduced growth of the productive force of society, identifying strategies for planning and action to deal with future aging is very important. In this regard, the study was conducted to identify strategies for dealing with the aging population from the perspective of health system experts.

METHODS:

The qualitative content analysis study was performed on 29 Iranian male and female experts in the aging and health scope from Isfahan, Tehran, Tabriz, and Babol who purposefully participated in the semi-structured interview. Data were classified by qualitative content analysis.

RESULTS:

Two concepts emerged according to the participated experts’ opinions, regarding the strategies of the Iranian health system in dealing with future aging: “executive policy” strategies, including “design, planning and implementation,” “evaluation and standardization,” “strengthening demand-driven” and “modeling national and international experiences,” “preventive policies” strategy, which includes “Focus on prevention,” “Focus on values and competencies,” “Educational empowerment,” “Knowledge-based empowerment,” “Empowerment of age-related groups,” “Economic empowerment,” and “Social support.”

CONCLUSION:

The diversity and breadth of the mentioned strategies indicate the necessity of comprehensive readiness and adaptation of health services to the elderly conditions and characteristics. Purposeful planning and timely implementation of programs and policies to better address the health system with future aging will be possible by using practical strategies.
Assessment of medication administration of nurses in medical cardiac wards and its relationship with some demographic characteristics
Authors: Najafi Hajar , Farzi Sedigheh , Tarrahi Mohammad Javad , Babaei Sima
Published: February 2023

BACKGROUND:

Unsafe medication administration and medication errors pose a threat to medication safety. Safe medication is one of the most important nursing practices that plays an important role in preventing medication errors. The aim of this study was to assess the medication administration of nurses in cardiac wards and its relationship with some demographic characteristics.

MATERIALS AND METHODS:

The present study was conducted as an observational study in 2021 with the 60 nurses who working in the medical cardiac wards of one selected hospital affiliated with the Isfahan University of Medical Sciences. Data were collected using three-part tools (demographic information, medication checklist (55 items), and documentation checklist (8 items). The checklist was completed by the observer after observing the nurses’ medication administration. Data analysis was conducted using descriptive and inferential statistics in the SPSS software (version 16, SPSS Inc., Chicago, IL, USA). A P < 0.05 was considered statistically significant.

RESULTS:

The mean total score of the principles of injection and oral medication administration were 82.53 ± 10.75 and 75.76 ± 9.62, respectively. The mean score of the principles of injection and oral medication administration in the morning shift was significantly higher than the evening and night shifts (P < 0.001). The relationship between the mean score of the principles of injection medication (r = 0.234, P = 0.067), oral medication (r = 0.222, P = 0.083), and the nurses’ work experience no significant. The rate of adherence to the principles of medication administration in the premedication administration stage was higher than during and after drug administration.

CONCLUSION:

Although the mean score of medication administration of nurses in the medical cardiac wards was at the desired level, it is necessary to monitor and plan by nursing managers to improve medication administration. Reducing the number of night shifts, adhering to accreditation programs in the hospital, continuous monitoring of nurses in terms of compliance with the principles of medication are among the proposed solutions to improve the safe medication in nurses.
Efficacy of capacity building educational interventions in the management of obstetric complications
Authors: Santhoshkumari M , Sharmil S Hepsibah
Published: February 2023

BACKGROUND:

Delay in the diagnosis and management of obstetric complications lead to raised mortality rate. This can be curtailed by appropriate implementation of the educational intervention among the health-care providers. Hence, this review aimed to identify the literature evidence of the efficacy of various educational interventions training in the management of obstetric complications.

MATERIALS AND METHODS:

We searched PUBMED, Web of Science, SCOPUS, Google Scholar, Cochrane, and maternity care databases with studies published from 2011 to 2021 for identifying studies related to this educational intervention review using MeSH terms and free terms. The search process was also done on the websites of the World Health Organization and the reproductive health library in the English language. From the 1823 abstracts reviewed, 16 studies were included (15 quasi-experimental, 01 randomized clinical trial, and 01 exploratory research design). We identified studies that included skill assessment of nurses, midwives, auxilliary nurse-midwives (ANMs), medical students, interns, and doctors after implementing various educational interventions.

RESULTS:

According to the findings of this literature, achieving enhanced nursing management of obstetric complications has been developed. Especially, it suggests through better nursing training and education and also by providing sufficient resources, time, and coordination with obstetric specialists, nurses and midwives will be able to implement their care roles, which include proper diagnosis, appropriate intervention, advanced care, client education, and psychological support. The efficacy of each educational intervention varies and depends on the participants’ understanding, interest, and the advancement of the teaching-learning method used.

CONCLUSION:

This systematic review reveals abroad and logical move towards the evaluation of various educational interventions in the field of obstetric complications. Among all the educational interventions implemented, mobile application, and simulation-based training play a major role in improving the knowledge and skills of health-care providers in the management of obstetric complications.
Evaluation of cancer awareness, cancer education, and prevention intervention techniques among university-level students in the United States and India
Authors: Burke Adam D. , Burns Jared W. , Chakraborty Swati , Saha Tanima , Ray Amitabha , Borsch Daniel M.
Published: February 2023

BACKGROUND:

Cancer is one of the leading causes of death globally. A considerable number of different cancer types may be preventable, using primary intervention techniques, such as health education, cancer awareness, behaviors and lifestyle modifications. The present study conducted a comparative assessment of cancer awareness among undergraduate students of the United States and India.

MATERIALS AND METHODS:

Students from an Institution in India (KC) (55 females, 33 males), and an Institution in the United States of America (SHU) (226 female, 58 male) during 2019–2020 participated in this study. Participants (n = 372) across all majors and all years (first through fourth year) completed an online questionnaire and answered the questions on their demographic characteristics (e.g., gender, age, and location), academic status (e.g., year of study, major), multiple-choice questions about cancer knowledge, and opinion questions (e.g., “where would you find info,” “should therapies be free”). Student responses were collected using Qualtrics Survey Software. Excel was used to analyze responses. We conducted statistical Χ2 tests for independence to determine whether there is a statistically significant difference between the expected frequencies and the observed frequencies in one or more categories of a contingency table, with a significance of ɑ = 0.01. While small sizes due to the small institutions and the response pool, we note that we achieved the necessary “n” for all tests reported.

RESULTS:

Our research shows a few important statistically significant differences, including knowledge of cancer and breast lumps is dependent on location, ranking of global cancer deaths is dependent on location, and that cancer knowledge is dependent on the information source. All for Χ2 tests with P < 0.001.

CONCLUSIONS:

Further encouragement of education for young people in various aspects of cancer and cancer prevention, as well as information facility and sources of reliable data, could be helpful for improving the overall health and primary prevention. A thorough assessment is needed to understand the responsible factors for the observed cancer knowledge variations among students of two different places.
Cognitive style and working memory among adolescents with specific learning disability
Authors: Daniel Monica , John Romate , Rajkumar Eslavath , George Allen Joshua , Abraham John
Published: February 2023

BACKGROUND:

In a world where education directly influences the quality of life of an individual, educational handicaps are a grave issue that plagues the lives of those affected. The current study aims to find out whether there is a difference in the cognitive style and working memory capacity among adolescents with specific learning disability (SLD) in comparison to their age-matched equivalent group without SLD. The study also targets to find out if there exists any relationship between cognitive style and working memory.

MATERIALS AND METHODS:

A total of sixty participants were selected (thirty adolescents with learning disability and thirty age-matched adolescents without learning disability) from Bangalore district of Karnataka and Thrissur district of Kerala using purposive sampling method. The tools used were the Indian adaptation of Embedded Figures Test by Nigam (1997) and the Wechsler Intelligence Scale for Children-Fourth Edition by Wechsler (2003).

RESULTS:

The results showed that there exists a significant difference in cognitive style dimensions of field dependence and independence between adolescents with learning disability (M = 11.6, standard deviation [SD] = 6.52) and adolescents without learning disability (M = 25.2, SD = 7.33) as well as in the working memory capacity between adolescents with learning disability (M = 66.7, SD = 19.26) and adolescents without learning disability (M = 102, SD = 14.93) groups under study (p < 0.01). The results also indicate that there exists no significant relationship between cognitive style and working memory.

CONCLUSION:

Adolescents with SLD was found to be field dependent and has low working memory capacity than adolescents without learning disability. The results reflect the need for developing cognitive interventions to enhance working memory capacity and cognitive style for helping adolescents with learning disability in all areas of their functioning, such that the society benefits as a whole.