bluuebunny/crossref_metadata_2025 huggingface dataset:
Cardiac tamponade and basilar artery aneurysm following leptospirosis: A case report
Authors: Misra Saumitra , Muzaffar Syed Nabeel , Roy Shubhajeet , Prajapati Shashank
Published: December 2023

Complications involving the heart are rare in leptospirosis, and cardiac tamponade is still rarer. We report the case of a 42-year-old hypertensive woman who presented with complaints of cough for 2 months and breathlessness for 1 month. One month later, she developed shortness of breath and loss of consciousness. The patient had a history of hemiparesis. Serum anti-Leptospira immunoglobulin M ELISA was positive. Ultrasound showed pericardial tamponade and hemorrhagic collection. Two-dimensional echocardiography showed minimal effusion posterior to the left ventricle and no effusion present to the right ventricle. High-resolution computerized tomography revealed patchy areas of ground glass opacities in bilateral upper and bilateral lower lobes, prominent bronchovascular markings bilaterally, and minimal pericardial thickening. Magnetic resonance imaging of the brain showed small chronic infarcts in bilateral corona radiata and basal ganglia. A magnetic resonance angiogram of the brain showed a basilar top aneurysm, which was an incidental finding. No signs of rupture of the aneurysm were seen. Digital subtraction angiography showed 50%–70% stenosis at the junction of the V3–V4 segments of the vertebral artery. The right lower limb immobilization, along with ecosprin, ivabradine, amlodipine, and fluconazole, was started, to which the patient responded well.
A narrative review on tofacitinib: The properties, function, and usefulness to treat coronavirus disease 2019
Authors: Hashemian Seyed Mohammad Reza , Farhadi Tayebeh
Published: December 2023

In coronavirus disease 2019 (COVID-19), the formation of cytokine storm may have a role in worsening of the disease. By attaching the cytokines like interleukin-6 to the cytokine receptors on a cell surface, Janus kinase (JAK)-signal transducers and activators of transcription (STAT) pathway will be activated in the cytoplasm lead to hyperinflammatory conditions and acute respiratory distress syndrome. Inhibition of JAK/STAT pathway may be useful to prevent the formation of cytokine storm. Tofacitinib is a pan inhibitor of JAKs. In this review, the main characteristics of tofacitinib and its usefulness against COVID-19 pneumonia were reviewed. Tofacitinib may be a hopeful therapeutic candidate against COVID-19 respiratory injury since it inhibits a range of inflammatory pathways. Hence, the agent may be considered a potential therapeutic against the post-COVID-19 respiratory damage. Compared to other JAK inhibitors (JAKi), the administration of tofacitinib in COVID-19 patients may be safer and more effective. Other JAKi such as baricitinib are related to severe adverse events such as thrombotic events compared to more common side effects of tofacitinib.
A retrospective observational study of injury patterns associated with powered circular saw in subjects presenting to the emergency department of a tertiary care hospital
Authors: Jain Mantu , Radhakrishnan Rakesh Vadakkethil , Mohanty Chitta Ranjan , Shaji Ijas Muhammed , Sahoo Sangeeta , Sahu Ajitesh , Mishra Narayan Prasad , Palai Pramod Kumar , Siddique Ruby Nahan
Published: December 2023

Background:

Powered circular saw-related injuries (PCSRIs) are responsible for a sizable proportion of occupational injuries presented to the emergency department (ED). The present study portrays the mechanisms, injury patterns, epidemiological parameters, and outcomes among subjects presenting with PCSRI to the ED.

Methods:

This retrospective observational study was conducted in the ED of a tertiary care hospital in eastern India. Clinical records of subjects with PCSRI from June 2019 to June 2022 were reviewed. Data pertaining to patients’ demographic profiles and the patterns and mechanisms of injury were retrieved. The Modified Hand Injury Severity Score (MHISS) and the Injury Severity Score (ISS) were calculated. Statistical analysis was performed using R version 4.1.0.

Results:

A total of 175 subjects’ data were analyzed. The median age was 34.5 years, and all subjects were men. The mean year of experience of the subjects was 6.2. The most common job category was carpentry (n = 63 [36%]), followed by “do it yourself work” (n = 26 [14.8%]). One hundred twenty-two (69.7%) subjects had hand injuries (HIs), and the left hand was involved in 85 (69.6%) subjects. The index finger was involved in 36 (29.5%) subjects, followed by the thumb (n = 31 [25.4%]). Laceration (n = 155 [88.5%]) was the most common injury pattern. The subjects’ mean ISS and mean MHISS were 8.52 and 45, respectively.

Conclusion:

PCSRI is associated with moderate-to-severe HIs that are most common in occupational settings. Young male carpenters involved in wood and plywood work are more prone to injuries.
Current application of intense pulsed light for the management of dry eye disease: A systematic review and meta-analysis
Authors: Pratomo Tiara G , Zaifar Abritho , Wibowo Natassha P , Suryono Astrianda N , Aziza Yulia
Published: December 2023

This review explored intense pulsed light (IPL) as an alternative treatment for dry eye disease (DED) symptom relief by correcting tear-film homeostasis. A systematic search was performed in March 2022 on five databases (Medline, Embase, SCOPUS, ProQuest, and EBSCO). Studies were extracted for the following outcomes of interest: standard patient evaluation of eye dryness questionnaire (SPEED), ocular surface disease index (OSDI), tear break-up time (TBUT), and corneal fluorescein staining (CFS). All studies published up to March 2022 were reviewed. Cochrane risk of bias tool (RoB 2) was used to screen studies for risk of bias where appropriate. A meta-analysis was done to quantify any reported quantitative data. Thirteen studies were included in this study. A total of 931 individuals and 1454 numbers of eyes were reviewed in this meta-analysis. Among studies that explored and reported the effect of IPL in individuals with DED, TBUT and OSDI improved significantly post intervention, with a standardized mean difference (SMD) of 1.02 [95% CI 0.41–1.64] and 0.28 [95% CI 0.04–0.52], respectively. CFS and SPEED scores, however, showed no statistically significant difference, with an SMD of 0.22 [95% CI −0.19 to 0.64] and 0.28 [95% CI −0.11 to 0.66], respectively. In conclusion, current evidence indicates IPL as a possible adjunctive treatment in individuals with DED in an otherwise limited treatment option. Further studies through more extensive trials are needed to validate this finding and elucidate its mechanism.
Indirect cylopexy in cases with cyclodialysis using flanged prolene cylopexy technique
Authors: Yalcinbayir Ozgur , Gunduz Gamze Ucan , Yildiz Meral , Baykara Mehmet
Published: December 2023

This study aims to describe a new technique of indirect cyclopexy in the treatment of cyclodialysis. Cases who had cyclodialysis for more than 3 h of extent and were resistant to medical treatment underwent flanged prolene cyclopexy (FPC) technique. Five cases were included in this study. Mean duration between the initial surgery and FPC was 4.6 ± 4.3 months. Hypotony maculopathy was present in all cases. All cases underwent FPC in combination with pars plana vitrectomy and silicone oil injection. Circumferential FPC was applied in four cases, while focal FPC was performed in one case. Postoperatively, no complications occurred, visual acuity increased in four cases, and cyclodialysis closed in all cases. In the follow-up, silicone oil was removed in three cases, but silicone oil could not be removed in two cases with ongoing hypotony. Preliminary results showed that FPC is a promising technique in the surgical treatment of cyclodialysis.
An Epidemiological Analysis and Evaluation of 45 Patients between 2006-2021: A Descriptive Study of Rare Tumor
Authors: Demirdover Cenk , Geyik Alper , Vayvada Haluk , Menderes Adnan , Geyik Selin G.
Published: December 2023

Background:

Rare tumors which are derived from the skin and soft tissue include a wide variety of types, but the knowledge and awareness of these tumors are limited. Besides, the number of specialists with specific training and experience in these tumors is very few. They are frequently associated with problems in the diagnosis and treatment.

Purpose:

In this study, we shared our experience and compared the outcome with the literature.

Methods:

Depending on clinicopathological evidence, 45 patients who were treated in our clinic between 2006 and 2021 were included in this descriptive study. Histopathological, etiological, and epidemiological results were analyzed. Tumors are classified as one of two types – either benign (noncancerous) or malignant (cancerous). Malignant tumors are also divided into carcinoma and sarcoma. Radiologic imaging methods and incisional/excisional biopsy were used for the diagnosis and staging. Chemotherapy/radiotherapy was planned after surgical treatment according to the diagnosis.

Results:

Of 45 cases, 40 (81.25%) were malignant and 5 (18.75%) were benign. The ages of the patients ranged from 10 to 94 years, and the mean age was 54.05 ± 20.1. The male/female ratio was 4.5/1. All patients were from the Aegean region of Turkey. The classification of the malignant tumors was carcinoma and sarcoma. The most common type of sarcomas was leiomyosarcoma and synovial sarcoma.

Conclusion:

When we consider the growing interest and knowledge in rare tumors, these case series are beneficial for epidemiological and surgical assessments.
Anorectal Syphilis Presenting at Crohn’s Disease: A Case Report
Authors: Myers Hannah E. , Pennycook Kevin , Buckley Christopher
Published: December 2023

This article reports on a case of anorectal syphilis in a 54-year-old man with a history of Crohn’s disease. The patient began experiencing a new onset perianal rash approximately when his medication regimen for Crohn’s disease was switched from sulfasalazine to mesalamine. There was no reported history of new sexual partners or sexually transmitted infection exposures. Chief differential at this time included Cutaneous Crohn’s disease, Lichen Planus, Extramammary Paget’s Disease, and Porokeratosis Ptychotropica; however, shave biopsy results revealed unexpected syphilis. There is only one other reported case of syphilis presenting as Crohn’s disease, but the incidence of syphilis has been rapidly increasing within the last decade. A high index of clinical suspicion is needed to properly diagnose syphilis, even with a lack of sexual history, for new onset genital lesions.
Delayed Presentation of Cutaneous Endometriosis at the Cesarean Section Scar: A Case Report
Authors: Mitwalli Hadeel , Alfurayh Nuha , Alsharif Sahar
Published: December 2023

Cutaneous endometriosis is a rare skin disease presents with variable symptoms and morphologies. A high degree of suspicion followed by a histopathological examination is required to establish the diagnosis of cutaneous endometriosis. It usually appears shortly following a gynecological procedure. We herein report a delayed presentation of cutaneous endometriosis at a cesarian section scar of a 45-year-old female that started to appear four years following the surgery and continued to grow for seven years prior to her presentation. MRI findings were consistent with cutaneous endometriosis and the histopathological examination result confirmed the diagnosis. We reported this case to increase the dermatologists’ awareness on this rare cutaneous disease.
Sleep Disturbances and Female Gender Predict a Poor Quality of Life in Iraqi Contact Dermatitis Patients: A Cross-sectional Study
Authors: Al-Imam Ahmed , Al-Baghdadi Mohammed H. , Abdullah Sama T. , Al-Jawhar Sama H. , Michalak Michal
Published: December 2023

Background:

Contact dermatitis is a form of eczema triggered by an allergen or an irritant substance. Its impact on the quality of life (QoL) is unknown among Iraqi patients.

Purpose:

We aim to survey the QoL among Iraqi contact dermatitis patients and infer the risk factors influencing it.

Methods:

The current study is cross-sectional among patients admitted to Baghdad Medical City. We used the dermatology life quality index to assess the QoL and collected parameters related to socio-demographics and other eczema-related factors.

Results:

A hundred patients (males = 43%; females = 57%) were in the third decade of life (total = 34 ± 0.97; males = 33 ± 1.5; females = 34 ± 1.3). The multivariable logistic regression had good statistical accuracy and satisfied the Hosmer–Lemeshow goodness-of-fit test (Nagelkerke’s R
2 = 0.13, statistical accuracy = 67%, P = 0.47). Three factors associated with an impaired QoL, including sleep disturbances (odds ratio [OR] =4.8, 95% confidence interval [CI] [1.3, 18], P = 0.021), female gender (OR = 2.6, 95% CI [1.1, 6.4], P = 0.036), and family size (≤4 members) (OR = 3.2, 95% CI [0.99, 10], P = 0.053). Females with contact dermatitis who experience sleep disturbances and live in small households are more likely to suffer from severely impaired QoL.

Conclusion:

The QoL among Iraqi contact dermatitis patients is influenced by sleep disturbances, female gender, and family size.
Evaluation of the Adverse Dermatological Effects Due to Frequent Handwashing Accompanying the COVID-19 Pandemic: A Cross-sectional Study
Authors: Alshammarie Fawwaz F. , Aloufi Asma A. , Alshammari Laila M. , Alanazi Wael S.
Published: December 2023

Background:

Washing hands regularly is among the key suggestions the World Health Organization (WHO) made for the general public. However, intensive handwashing can cause hand dermatitis and is associated with illnesses such as methicillin-resistant Staphylococcus aureus infection.

Purpose:

The purpose of this study was to assess the prevalence and consequences of handwashing during the COVID-19 pandemic.

Methods:

This descriptive cross-sectional study was carried out in a convenience sample of 5000 participants in Saudi Arabia and captured participant handwashing practices, glove use, and potential dermatological side effects from regular handwashing. Data were obtained using a pretested questionnaire and then analyzed using the Statistical Package for the Social Sciences (SPSS), version 24.

Results:

The majority of participants (80%) repeatedly washed their hands with sanitizers and disinfectants. Only 31% used moisturizing soap, and 19% used warm water. A quarter of participants washed their hands for 20–30 s, and roughly 26% washed their hands 1–5 times every day. Moreover, 27% of participants experienced contact dermatitis on their skin because of the use of gloves and sterilizers.

Conclusion:

The repeated use of alcohol-based sanitizers in handwashing is associated with a high risk of eczema in about 27%. Decreasing the number of times they wash their hands and the use of detergents while using more emollients and nonpowdered gloves, may be helpful for avoiding hand dermatitis.
Successful Surgical Management of Periapical Cyst with Accidentally Extruded MTA through Open Apex - A Case Report with One Year Follow up
Authors: Anirudhan Subha , Shoba G. Joy , Ravichandran Kavimalar , Koshy Minu
Published: December 2023

ABSTRACT

An immature tooth with a blunderbuss canal presents a challenge in achieving a hermetic seal. Closure of the wide-open apex with materials such as mineral trioxide aggregate (MTA), biodentine, and endosequence root repair material is required to achieve success. Despite following proper methods, the extrusion of filling material into the periapical region is unavoidable. In this case report, due to a lack of apical stop, MTA was extruded unintentionally. Endodontic surgery was performed to remove the extruded MTA and curettage of the apical lesion was done to remove the cystic lining. Follow-up after regular intervals of 1, 3, 6 months, and 1 year showed resolution of periapical radiolucency with radiopaque corticated borders surrounding the radiolucency. This case report describes the successful surgical management of accidentally extruded MTA through large wide-open apex.

CLINICAL RELEVANCE TO INTERDISCIPLINARY DENTISTRY

Surgical planning involved flap design in collaboration with periodontist for preservation of the interdental papilla.
Mucinous Adenocarcinoma of the Lung Diagnosed by Radial Endobronchial Ultrasound-guided Bronchoscopic Cryobiopsy and Presenting as Interstitial Lung Disease in a Patient with Systemic Sclerosis
Authors: Lin Yan-Ting , Lin Chiung-Hung , Wang Shao-Chung , Huang Yun-Ju , Wu Ren-Chin , Lee Chung-Shu , Chang Chih-Hao
Published: December 2023

We report a patient with systemic sclerosis who was diagnosed with advanced-stage mucinous adenocarcinoma of the lungs. The clinical presentation, imaging findings, pathological results, and molecular diagnoses are presented. A 64-year-old woman with systemic sclerosis was administered prednisolone and hydroxychloroquine sulfate to control her disease. High-resolution computed tomography (HRCT) revealed an interstitial pattern in both lungs during annual imaging. Connective tissue disease-associated interstitial lung disease (CTD-ILD) was diagnosed using blood tests, pulmonary function tests, and imaging findings. One year later, the patient underwent follow-up chest HRCT, which showed progressive lung disease. The patient underwent endobronchial ultrasound (EBUS)-guided transbronchial lung cryobiopsy and computed tomography-guided biopsy for a pathological diagnosis. The pathology reports of bilateral lungs disclosed mucinous adenocarcinoma. After tumor staging and mutation testing, the patient received chemotherapy with pemetrexed and cisplatin. The bilateral lung lesions subsided after four cycles of first-line chemotherapy. Patients with CTD and lung involvement may be diagnosed with CTD-ILD. Although histopathological results are not mandatory for ILD diagnosis, EBUS-guided transbronchial lung biopsy or lung cryobiopsy should be considered when ILD has atypical or unexplained features.
Paracetamol induced facial puffiness: An uncommon case report
Authors: Siddhu Charis Kaur , Joseph Girish , Bhatti Neena , Badyal Dinesh
Published: December 2023

Paracetamol is one of the most commonly used antipyretic medications. paracetamol is a nonopioid synthetic, centrally acting analgesic and antipyretic drug with poor anti-inflammatory action. The World Health Organization (WHO) has approved the use of paracetamol in patients of almost all ages. The adult dose ranges from 1000 mg to 4000 mg/day. However, most people are unaware of the potential issues that can occur with paracetamol consumption. The adverse events (AEs) include edema of the eye and orbital region, edema of the rest of the head and neck, and edema of the respiratory system. Swelling of the throat, tongue, or face and reports of edema with an unspecified location is the less frequent AEs. This case involves a 21-year-old patient who had taken paracetamol 500 mg once a day for fever, following which he noticed generalized facial puffiness with swelling of the eyes and lips. It has been reported that more than 25% of all serious AE reported with paracetamol were hypersensitivity reactions. However, in this patient, hypersensitivity was ruled out by performing immunoglobulin E hypersensitivity testing.
Low-dose aspirin-induced upper gastrointestinal bleed and ulceration
Authors: Parikh Vrunda T. , Shah Meet K. , Gupta Sapna D. , Malhotra Supriya D.
Published: December 2023

We present the case of a 58-year-old male patient who developed upper gastrointestinal bleeding (UGIB) after taking dual antiplatelet therapy (DAPT). He also tested positive for Helicobacter pylori (H. pylori) infection. He was on low-dose aspirin (LDA), i.e. 75 mg, as a part of DAPT. In clinical practice, UGIB is a common medical condition that is encountered; its three most frequent causes are peptic ulcer disease (PUD), esophagogastric varices, and erosive esophagitis. H. pylori and aspirin and/or nonsteroidal anti-inflammatory medicine are the two most common causes of PUD. In our case, the patient is a known case of hypertension, diabetes mellitus, and ischemic heart disease. He was diagnosed with multiple gastric ulcers on an upper gastrointestinal endoscopy. He was started on triple therapy for H. pylori and shifted to single antiplatelet therapy from DAPT. In our case, we discuss the factors that could have aggravated the development of multiple gastric ulcers on LDA treatment.
Late complications of scleral buckles in the orbit
Authors: González Mondragón Juan Edric , Davila-Camargo Adriana
Published: December 2023

A scleral buckle is a surgical procedure used for rhegmatogenous retinal detachment repair. Different materials have been used for this technique over the years. During the 1980s, MIRAgel (MIRA Inc., Waltham, Mass) introduced hydrogel bands. This material allowed easy handling for the surgeon and self-expansion over time. A decade after their introduction, late complication reports began to appear, associated with uncontrolled expansion and the need for surgical removal. We present two complete cases and a literature review of patients presenting with ophthalmoplegia, pain, and proptosis, 25 years after hydrogel scleral buckle surgeries.
Correlation of the severity of mucormycosis with levels of inflammatory markers in COVID-19 patients
Authors: Kruthika S. , Inchara N. , Madala Poojitha
Published: December 2023

Purpose:

The purpose of the study is to explore the clinical spectrum of rhino-orbital cerebral mucormycosis (ROCM) and to correlate its severity with the levels of inflammatory markers of COVID-19 patients.

Materials and Methods:

It is an observational analytical study. Clinical and laboratory data of the patients with mucormycosis admitted in COVID-19 wards in a notified nodal tertiary care center were collected and stratified clinically according to the severity of ROCM. Serum ferritin, serum lactate dehydrogenase (LDH), D-dimer, total count, neutrophils, and lymphocyte count were considered primary outcome variables. The severity of the ROCM (Stage II, Stage III, and Stage IV mucormycosis) was considered the primary explanatory variable.

Results:

Forty-five participants were included, of which 38 (84%) were male and 7 (16%) were female. The mean age was 48.71 ± 10.71 years, which ranged from 29 to 75 years. In people with the severity of the ROCM, 26 (58%) were in Stage II, 15 (33%) were in Stage III, and 4 (9%) were in Stage IV. The mean serum ferritin, mean serum LDH, and D-dimer across the severity of ROCM were statistically significant. The median total count, mean neutrophils, and mean lymphocytes across the severity of ROCM were not statistically significant.

Conclusion:

The study shows that raised serum ferritin, LDH, and D-dimer levels at admission significantly predict disease severity in COVID-19 patients with mucormycosis. Mucormycosis and its severity are associated with higher inflammatory markers levels than the mild disease in COVID-19 patients. Tracking these markers may allow early identification or even prediction of disease progression.
Kjer's optic neuropathy
Authors: Machado Teles Lucas Pinheiro , Marinho Gindri Lyara Meira , Meneguette Nathalie Stéphanie , de Andrade Eric Pinheiro
Published: December 2023

Kjer's optic neuropathy, also known as optic atrophy type 1 (OPA-1), is a genetic condition that usually presents with the bilateral pallor of the optic disc (OD) associated with decreased visual acuity (VA), in addition to defects in the visual field (VF) and color vision. This article aims to report a case of OPA-1 diagnosed through genetic testing. A 22-year-old male patient searched for neuro-ophthalmological care, complaining of low VA, difficulty adapting to both light and dark, and photophobia in both eyes (BE) since 6 years old. He denies VF loss, nyctalopia, or hearing deficit and has maternal relatives with similar conditions. The patient presented VA of 20/63 in the right eye (RE) and 20/50 in the left eye (LE) with dyschromatopsia and bilateral OD pallor, in addition to reduced foveal brightness. Humphrey's visual perimetry showed centrocecal scotoma in the LE only and a nonspecific loss in the RE. He brought a pattern electroretinography (PERG) examination showing the reduced function of ganglion cells in the macular area and optic nerve in BE and multifocal electroretinogram with cone system function slightly reduced in BE. A genetic panel was performed to search for mutations in the OPA-1 gene, which showed a variant associated with this disease in the patient described and in his mother. Thus, this report exemplifies a case of OPA-1 hereditary OPA, emphasizing the importance of combining clinical evaluation, electrophysiological, and genetic tests for a precise and accurate diagnosis.
Susac syndrome – A Portuguese experience
Authors: Portela Mariana , Nogueira Vanda , Liverani Marco , Figueira Luís , Jesus Jeniffer , Lorga Tiago , Baptista Margarida , Guedes Marta
Published: December 2023

Introduction:

Susac syndrome (SS) is characterized by microvascular occlusions in the brain, retina, and inner ear. Despite significant advances in understanding this disorder, it remains an under- and misdiagnosed entity in the clinical setting.

Methods:

This study was retrospective review of clinical records.

Results:

We present the cases of three young adults complaining of visual loss, hearing impairment, and headache. In all patients, the fundoscopy and fluorescein angiography revealed nonperfused arteriolar segments and multifocal arterial vasculitis. The brain magnetic resonance imaging demonstrated characteristic white matter brain lesions and the audiometry revealed low-frequency hearing loss. The diagnosis of SS was therefore established. We present and discuss the different treatment regimens applied and the course and outcomes of each case.

Conclusion:

SS is a rare and complex disease with possibly severe consequences that must be promptly diagnosed and treated. However, as no prospective or randomized controlled trials exist, empirical treatment strategies are still the norm, mainly based on the case reports and series.
Descemet's membrane detachment: Insights
Authors: Bhatia Rahul , Gautam Priyanka , Beri Nitika , Sharma Isha
Published: December 2023

Descement's membrane detachment (DMD) is separation of Descemet's membrane (DM) from the overlying stroma. It is manifested as corneal oedema at the site of detachment. With the rising number of phacoemulsification in the world, the DMD becomes an important complication that may require additional surgical intervention leading to an increase in economic as well as a social burden on the patient and hospital. Descemet's membrane detachment(DMD) is an uncommon complication of cataract surgery that may lead to corneal scarring and poor post-op vision gain. Till now, there is no standardized protocol for the management of DMD. Various authors have tried to classify DMD. Newer techniques such as AS-OCT, Schiemflug imaging, etc have helped in the early detection of DMD chance improving the prognosis.
Ophdthalmological profile in the elderly aged 80 years or more in the city of Maués – Amazonas
Authors: Osório Chaves Cláudia Maria , Cypel Marcela Colussi , Belfort Jr Rubens
Published: December 2023

Objective:

The objective of this study was to determine the frequency and main causes of visual impairment and blindness in the elderly aged 80 years or more, predominantly living in the urban area of the municipality of Maués – Amazon/Brazil.

Methods:

This was a cross-sectional study of a population of 360 elderly people aged 80 years or more, predominantly living in the urban area of the City of Maués-AM, who were invited to a complete eye examination along with a questionnaire to describe nutritional habits and frequency consumption of guarana. Uncorrected visual acuity, presented visual acuity, and best-corrected visual acuity of each eye were obtained. If necessary, prescription for glasses, surgery, or other types of treatment was provided free of charge.

Results:

A total of 360 individuals aged between 80 and 108 years (mean: 86.02 ± 5.57 years) were submitted to an ophthalmological evaluation. Of these, 182 (50.5%) were male and 178 (49.5%) female. Of the total number of eyes examined, the causes of visual impairment and blindness were cataract (51.8%), refractive errors (12.2%), age-related macular degeneration (9.1%), other nerve atrophies (3.9%), posterior capsule opacity (3.6%), glaucoma (3.5%), corneal changes (3.3%), absent globe/phthisis (3.1%), other retinal changes (1.1%), diabetic retinopathy (1.0%), pterygium (0.6%), amblyopia (0.4%), and other causes (1.8%). According to the Nutritional Screening Initiative Nutritional Dysfunction Questionnaire, 45.0% of the participants had low risk of nutritional dysfunction, 51.7% moderate risk, and 3.3% high risk.

Conclusions:

A high frequency of blindness (43.6%) was detected in this sample of very elderly people living in urban areas in the city of Maués. The main causes of blind eyes would be preventable with provision for cataract surgery followed by postoperative actions and prescription of glasses. Half of the elderly (50.0%) reported frequent consumption of guarana, at least once a week, but this did not prove to protect against visual impairment and blindness. These results reflect this population's limited access to eye care services, reinforcing the need for sustainable actions to improve eye health in remote areas of Brazil.
Artificial intelligence at the pen’s edge: Exploring the ethical quagmires in using artificial intelligence models like ChatGPT for assisted writing in biomedical research
Authors: Sharma Hunny , Ruikar Manisha
Published: December 2023

Chat generative pretrained transformer (ChatGPT) is a conversational language model powered by artificial intelligence (AI). It is a sophisticated language model that employs deep learning methods to generate human-like text outputs to inputs in the natural language. This narrative review aims to shed light on ethical concerns about using AI models like ChatGPT in writing assistance in the health care and medical domains. Currently, all the AI models like ChatGPT are in the infancy stage; there is a risk of inaccuracy of the generated content, lack of contextual understanding, dynamic knowledge gaps, limited discernment, lack of responsibility and accountability, issues of privacy, data security, transparency, and bias, lack of nuance, and originality. Other issues such as authorship, unintentional plagiarism, falsified and fabricated content, and the threat of being red-flagged as AI-generated content highlight the need for regulatory compliance, transparency, and disclosure. If the legitimate issues are proactively considered and addressed, the potential applications of AI models as writing assistance could be rewarding.
Evaluation of factors that act as barriers in conducting academic trials – An investigator’s perception
Authors: Gajbhiye Snehalata Vijayanand , Dakhale Ganesh Natthuji , Chindhalore Chaitali Ashish , Gupta Ashish Vijay , Selvi E Tamil
Published: December 2023

Background:

Academic trials are essential in investigating health research questions relevant to the society. Only a few leading research institutions in India have been engaged in academic trials. Thus, there is a need to understand what factors dampen the spirit of the academician in conducting academic clinical trials.

Aims and Objectives:

The aim of the study is to evaluate the investigator’s perception of obstacles to carrying out academic trials and to identify factors that will motivate investigators in conducting academic trials

Materials and Methods:

We conducted a prospective observational study in a tertiary care hospital for 6 months. Faculty members working in academic institutes were selected. A structured questionnaire was designed for the study and administered using google forms. Responses were taken on a Likert scale. Validity and reliability assessments were carried out. Mann-Whitney test was applied to assess differences between demographic groups. P <0.05 was considered significant.

Results:

Most of the participants rated applying for research grants (76%), obtaining funding for the study and making arrangements for compensation for trial-related events (75%) as extremely challenging. We found that the degree of challenge is significantly lower in the faculty members who conducted clinical trials in the past as against those who did not (P = 0.00069). We also found that the degree of challenge is significantly higher in the faculty members with <10 years of experience than those with >10 years of experience (P = 0.00001).

Conclusion:

Thus, to conclude the challenges faced by investigators were at multiple levels, most common being applying for research grants and making arrangements for the funds for payment towards participation or study-related injury. Faculty members with exposure to conducting clinical trials and with experience of more than 10 years had perceived a reduced degree of challenges.
Surgical rescue strategies and techniques for gastrointestinal fistulas
Authors: Ren Jianan , Teng Yitian
Published: December 2023

A gastrointestinal fistula is a severe medical condition that may lead to sepsis or septic shock. It requires immediate response and valid treatment to prevent subsequent deterioration. Surgical rescues are effective measures to cope with aforementioned situations, but there remain challenges in successful implementation. Institutional factors, including constrained hospital volume, technological gap, and limited competence of surgeons and nurses, could lead to surgical failure to rescue (FTR), while high-risk patient characteristics such as aging, diabetes mellitus, and chronic organ dysfunction have a bearing on the outcome as well. Surgical rescue strategies encompass damage control surgery and resuscitation. Based on disease severity, sequential damage control measures involving vessel catheter removal, abdominal drainage tube replacement, trocar-assisted percutaneous abscess drainage, laparoscopic drainage, and open abdomen therapy should be applied accordingly.
Therapeutic factors of exclusive enteral nutrition-induced remission in adult patients with Crohn’s disease
Authors: Tu Jiancheng , Guo Kun , Fang Jian , Tao Lei , Huang Long
Published: December 2023

Objective:

The objective of this study was to explore the role of exclusive enteral nutrition (EEN) in inducing remission of Crohn’s disease (CD) during the active phase.

Methods:

A total of 86 patients who were admitted to many hospitals in Zhangjiagang City from January 2018 to December 2019 and were diagnosed with CD were enrolled in this study. According to the random number method, they were divided into the EEN group and the glucocorticoid group, with 43 patients in each group. Patients in the EEN group were treated with EEN support, and the glucocorticoid group was treated with hydrocortisone. Patients in the EEN group were treated with EEN support, and the glucocorticoid group was treated with hydrocortisone. Both were treated for 6 weeks and followed up every 7 days. Patients in the two groups were observed and compared, observe and analyze patients’ treatment compliance, hospitalization time, hospitalization costs, and quality of life after treatment. The improvement of CD activity index (CDAI) after treatment and clinical recurrence indicators of patients in the two groups were observed and compared, observe and analyze patients’ treatment compliance, hospitalization time, hospitalization costs, and quality of life after treatment indexes such as scores, adverse reactions, and complications.

Results:

The number of patients in the EEN group whose CDAI decreased ≥70 after 4 weeks of treatment was significantly higher than that in the glucocorticoid group, and the difference between the two groups was statistically significant (P < 0.05); the patients in the EEN group had CDAI >250 after treatment and enhanced glucocorticoid therapy. The incidence of other medical treatments and surgical treatments was lower than that of the glucocorticoid group. There was a statistically significant difference in the incidence of CDAI >250, glucocorticoids intensive treatment, and other drug treatments between the two groups (P < 0.05). Treatments between the two groups (P < 0.05); the comparison of secondary outcome indexes between the two groups after treatment showed that the scores of quality of life and treatment compliance in the EEN group were significantly higher than those in the glucocorticoid group, and the length of stay, incidence of adverse reactions, and complications in EEN group were significantly higher than those in the glucocorticoid group. The incidence of adverse reactions and complications in the EEN group was lower than those in the glucocorticoid group, with statistical significance between the two groups (P < 0.05–0.05).

Conclusion:

The EEN can significantly improve the nutritive index of patients with CD during the active phase, reduce the CDAI score, and significantly improve the patient’s quality of life score. The hospital stay is short, and the treatment effect is safe and effective. The hospital stay is short, and the treatment effect is safe and effective.
What’s new in genitourinary pathology 2023: WHO 5th edition updates for urinary tract, prostate, testis, and penis
Authors: Choy Bonnie , Tretiakova Maria , Zynger Debra L.
Published: December 2023

The 5th edition WHO Classification of Urinary and Male Genital Tumours (2022) introduced many significant changes relevant to urologic daily practice, mainly to renal tumors which was covered in the What’s New newsletter in September 2022. In this newsletter, we summarize the notable changes to bladder, prostate, testis, and penis based on the 5th edition of the WHO.
Efficacy of pantoprazole plus perforation repair for peptic ulcer and its effect on the stress response
Authors: Leng Zi-Yan , Wang Jia-Hao , Gao Lei , Shi Ke , Hua Hai-Bing
Published: December 2023

BACKGROUND

Peptic ulcer (PU) is an abnormal phenomenon in which there is rupture of the mucosa of the digestive tract, which not only affects patients' normal life but also causes an economic burden due to its high medical costs.

AIM

To investigate the efficacy of pantoprazole (PPZ) plus perforation repair in patients with PU and its effect on the stress response.

METHODS

The study subjects were 108 PU patients admitted between July 2018 and July 2022, including 58 patients receiving PPZ plus perforation repair [research group (RG)] and 50 patients given simple perforation repair [control group (CG)]. The efficacy, somatostatin (SS) concentration, stress reaction [malondialdehyde (MDA), lipid peroxide (LPO)], inflammatory indices [tumor necrosis factor (TNF)-α, C-reactive protein (CRP), interleukin (IL)-1β], recurrence, and complications (perforation, hemorrhage, and pyloric obstruction) were compared.

RESULTS

The overall response rate was higher in the RG than in the CG. Patients in the RG had markedly elevated SS after treatment, which was higher than that of the CG, while MDA, LPO, TNF-, CRP, and IL-1β were significantly reduced to lower levels than those in the CG. Lower recurrence and complication rates were identified in the RG group.

CONCLUSION

Therefore, PPZ plus perforation repair is conducive to enhancing treatment outcomes in PU patients, reducing oxidative stress injury and excessive inflammatory reactions, and contributing to low recurrence and complication rates.
Percutaneous microwave ablation and transcatheter arterial chemoembolization for serum tumor markers and prognostics of middle-late primary hepatic carcinoma
Authors: Lin Zhi-Peng , Huang Da-Bei , Zou Xu-Gong , Chen Yuan , Li Xiao-Qun , Zhang Jian
Published: December 2023

BACKGROUND

Primary hepatic carcinoma (PHC) has an insidious onset and is usually diagnosed in the middle and late stages. Although transcatheter arterial chemoembolization (TACE) is the preferred option for treating middle- and advanced-stage PHC, it has limited efficacy in killing tumor cells and poor long-term efficacy. TACE plus percutaneous microwave coagulation therapy (PMCT) is more effective than interventional therapy alone and can improve survival time. However, there are few reports on the effects of TACE and PMCT on serum marker levels and the prognosis of patients with advanced PHC.

AIM

To investigate the effect of PMCT + TACE on serum tumor markers and the prognosis of middle-late PHC.

METHODS

This retrospective study included 150 patients with middle-late PHC admitted to Zhongshan People’s Hospital between March 2018 and February 2021. Patients were divided into a single group (treated with TACE, n = 75) and a combined group (treated with TACE + PMCT, n = 75). Before and after treatment, the clinical efficacy and serum tumor marker levels [carbohydrate antigen 19-9 (CA19-9), alpha-fetoprotein (AFP), and carcinoembryonic antigen (CEA)] of both groups were observed. The 1-year survival rates and prognostic factors of the two groups were analyzed.

RESULTS

The combined group had 21 and 35 cases of complete remission (CR) and partial remission (PR), respectively. The single group had 13 and 25 cases of CR and PR, respectively. After 4 wk of treatment, the serum CA19-9, CEA, and AFP levels in the single and combined groups decreased, with the decrease in the combined group being more significant (P < 0.05). The 1-year survival rate of the combined group (80.00%) was higher than that of the single group (60.00%) (P < 0.05). The average survival time within 1 year in the combined group was 299.38 ± 61.13 d, longer than that in the single group (214.41 ± 72.97 d, P < 0.05). COX analysis revealed that tumor diameter, tumor number, and the treatment method were prognostic factors for patients with middle-late PHC (P < 0.05).

CONCLUSION

TACE + PMCT is effective in treating patients with mid-late PHC. It reduces the levels of tumor markers, prolongs survival, and improves prognosis.
Laparoscopic resection and endoscopic submucosal dissection for treating gastric ectopic pancreas
Authors: Zheng Hui-Da , Huang Qiao-Yi , Hu Yun-Huang , Ye Kai , Xu Jian-Hua
Published: December 2023

BACKGROUND

Gastric ectopic pancreas (GEP) is a rare developmental abnormality that refers to the existence of pancreatic tissue in the stomach with no anatomical relationship with the main pancreas. It is usually difficult to diagnose through histological examination, and the choice of treatment method is crucial.

AIM

To describe the endoscopic ultrasound characteristics of GEP and evaluate the value of laparoscopic resection (LR) and endoscopic submucosal dissection (ESD).

METHODS

Forty-nine patients with GEP who underwent ESD and LR in the Second Affiliated Hospital of Fujian Medical University from May 2018 to July 2023 were retrospectively included. Data on clinical characteristics, endoscopic ultrasonography (EUS), ESD, and LR were collected and analyzed. The characteristics of EUS and the efficacy of the two treatments were analyzed.

RESULTS

The average age of the patients was 43.31 ± 13.50 years, and the average maximum diameter of the lesions was 1.55 ± 0.70 cm. The lesion originated from the mucosa in one patient (2.04%), from the submucosa in 42 patients (85.71%), and from the muscularis propria in 6 patients (12.25%). Twenty-nine patients (59.20%) with GEP showed umbilical depression on endoscopy. The most common initial symptom of GEP was abdominal pain (40.82%). Tumor markers, including carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA-19-9), were generally within the normal range. One patient (2.04%) with GEP had increased CEA and CA-19-9 levels. However, no cancer tissue was found on postoperative pathological examination, and tumor markers returned to normal levels after resecting the lesion. There was no significant difference in surgery duration (72.42 ± 23.84 vs 74.17 ± 12.81 min) or hospital stay (3.70 ± 0.91 vs 3.83 ± 0.75 d) between the two methods. LR was more often used for patients with larger tumors and deeper origins. The amount of bleeding was significantly higher in LR than in ESD (11.28 ± 16.87 vs 16.67 ± 8.76 mL, P < 0.05). Surgery was associated with complete resection of the lesion without any serious complications; there were no cases of recurrence during the follow-up period.

CONCLUSION

GEP has unique characteristics in EUS. LR and ESD seem to be good choices for treating GEP. LR is better for large GEP with a deep origin. However, due to the rarity of GEP, multicenter large-scale studies are needed to describe its characteristics and evaluate the safety of LR and ESD.
Holistic conditions after colon cancer: A randomized controlled trial of systematic holistic care vs primary care
Authors: Wang Jing , Qiao Jian-Hong
Published: December 2023

BACKGROUND

Study showed that systemic holistic care not only aids in disease treatment and physical recovery to a certain extent but also effectively enhances patient psychological well-being, social support, and overall quality of life (QoL).

AIM

To assess systematic holistic care impact on the recovery and well-being of postoperative patients with colon cancer.

METHODS

Our randomized controlled trial included 98 postoperative patients with colon cancer admitted to our hospital from June 2021 to June 2022. Patients were divided into control and study groups. The control group received conventional postoperative nursing care, whereas the study group received systematic holistic nursing care. We monitored gastrointestinal function recovery, and recorded changes in serum albumin (ALB), prealbumin (PA), psychological state, self-management, self-efficacy, QoL, and the occurrence of complications in patients before, at discharge, and 2 wk post-discharge. Spearman analysis assessed correlations between psychological state, self-management, self-efficacy, and QoL of patients in the study group 2 wk post-discharge.

RESULTS

Following the nursing intervention, we observed significantly shorter postoperative bowel sound recovery time, anal exhaust time, and defecation time in the study group than in the control group (P < 0.05). Patient ALB and PA levels, psychological status, self-management ability, self-efficacy and QoL at discharge and 2 wk post-discharge significantly improved, with greater improvements observed in the study group (P < 0.05). Both groups experienced complications post-interventions, but the intervention group had significantly lower complication rate (3/49, 6.12%) (P < 0.05). In the study group, patient anxiety, depression, self-management and QoL scores at 2 wk post-discharge exhibited a significant negative correlation (3/49, 6.12%) with QoL scores, with correlation coefficients of r = -0.273, -0.522, -0.344, and P < 0.01, respectively. Conversely, patient self-efficacy scores 2 wk post-discharge showed a positive correlation with QoL scores (r = 0.410, P = 0.000).

CONCLUSION

Systemic holistic nursing significantly benefits postoperative patients with colon cancer by promoting gastrointestinal recovery, improving post-operation well-being, reducing complications, and enhancing QoL.