bluuebunny/crossref_metadata_2025 huggingface dataset:
Analysis of cluster of differentiation 36 expression and genetic variation in blood donors in Zhongshan City, China
Authors: Sun Ainong , Wang Yujue , Wu Yonglun , Ge Feng , Ye Xin , Wang Hongmei , Chen Yezhou , Ding Shaohua , Tian Jingjing , Li Qiao , Liao Yanting , Duan Shengbao
Published: August 2024

OBJECTIVE:

Individuals with a cluster of differentiation 36 (CD36) deficiency are at risk of developing anti-CD36 antibodies after platelet transfusion or pregnancy. Therefore, we investigated CD36 expression on platelets of blood donors in Zhongshan city, and analyzed the frequency of CD36 deficiency and gene polymorphism.

METHODS:

A total of 846 healthy donors were randomly selected. CD36 expression on platelets was tested and monocytes from CD36-negative samples were further analyzed to determine the type of CD36 deficiency through flow cytometry. Genetic variation was analyzed through genomic DNA sequencing of exons 3–14 in the protein-coding region of CD36. Anti-CD36 antibody detection for the donors with CD36 deficiency was performed.

RESULTS:

The frequency of CD36-negative platelets in blood donors was 1.77% (15/846), of which Type I deficiency accounted for 0.12% (1/846) and Type II accounted for 1.65% (14/846). Seven types of gene mutations in eight cases of CD36-negative samples were discovered: 329_330 del AC (n = 2), 287 G > C (n = 1), 220 C > T and 1228_1239 ATTGTGCCTATT (n = 1), 1228_1239 ATTGTGCCTATT (n = 1), 538 T > C and 879 T > C (n = 1), 287 G > C and 1163 A > T (n = 1), and 429 + 3 dup G (n = 1). Moreover, the anti-CD36 antibody was detected in the plasma of donors with Type I CD36 deficiency.

CONCLUSION:

A new mutation site in exon 5 (429 + 3 dup G) was identified. The establishment of a CD36-negative database can provide compatible platelets to improve the efficacy of transfusion.
Autoantibodies mimicking alloantibodies
Authors: Agrawal Soma , Chowdhry Mohit , Gajullupalli Shiva Prasad , Muthukumaravel
Published: August 2024

INTRODUCTION:

Autoimmune hemolytic anemia is characterized by increased red cell destruction and/or decreased red cell survival due to autoantibodies directed against self-antigens on red cells. Since autoantibodies react with self and nonself red blood cells (RBCs), they tend to mask the underlying clinically significant alloantibodies and many a times mimic a specific pattern like alloantibodies.

MATERIALS AND METHODS:

We discuss three immune hematological cases of warm autoantibodies. Antibody screening was performed by solid-phase red cell adherence (SPRCA) technique on a fully automated platform NEO Iris (Immucor Inc., USA). In case of a positive antibody screen, antibody identification was performed using SPRCA, NEO Iris (Immucor Inc., USA). Alloadsorption for adsorbing the autoantibodies was done using in-house prepared allogenic packed RBCs – R1R1, R2R2, and rr.

RESULTS:

All cases had warm autoantibody with a broad specificity against self-Rh antigens. Anti “C” and Anti “e” antibodies were identified in case 1 and autoanti “e” antibody in cases 2 and 3. Case 3 had underlying alloanti “E” along with autoanti “e” which posed a transfusion challenge.

CONCLUSION:

Our case series highlights the importance of detecting the nature of the antibody whether it is alloantibody or autoantibody with antigen specificity. This would help in selecting appropriate antigen negative blood units for transfusion purpose.
A prospective observational study to evaluate effect of heat inactivation on ABO titers performed by column agglutination technology and conventional tube technique
Authors: Pandey Prashant , Setya Divya , Ranjan Shweta , Singh Mukesh Kumar
Published: August 2024

BACKGROUND AND AIMS:

When determining ABO antibody titers, immunoglobulin G (IgG) antibodies can be masked by immunoglobulin M (IgM) antibodies. Hence, the measurement of actual concentration of IgG requires methods like heat inactivation (HI) of plasma. This study was aimed at determining the effects of HI on IgM and IgG titers performed by conventional tube technique (CTT) and column agglutination technique (CAT).

MATERIALS AND METHODS:

This was a prospective, observational study conducted from October 2019 to March 2020. All consecutive A, B, and O group donors who gave consent for participation were included. All samples were consecutively tested by CTT and CAT, before and after HI (pCTT, pCAT).

RESULTS:

A total of 300 donors were included. IgG titers were found to be more than IgM titers. For group O, IgG titer results were higher for both anti-A and anti-B compared to group A and B. For group A, B, and O, pretreatment results were higher than posttreatment IgG titer results. Median anti-A titers were similar to median anti-B titers across all categories. Median IgM and IgG titers were higher for group O individuals than nongroup O individuals. There was reduction in IgG and IgM titers after HI of plasma. One log reduction in median titers was observed when ABO titers were performed by CAT and CTT.

CONCLUSION:

There is one log difference between median antibody titers estimated using heat inactivated and nonheat inactivated plasma. The use of HI for ABO isoagglutinin titer estimation can be considered in low resource settings.
Determining the effects of erythrocyte suspension on total antioxidant status and total oxidative stress values in pediatric intensive care patients
Authors: Koç Beyza , Yorulmaz Alaaddin , Akyürek Fikret , Yilmaz Resul
Published: August 2024

OBJECTIVE:

In the present study, the purpose was to examine the changes in total antioxidant status (TAS), Total oxidative stress (TOS), and oxidative stress index (OSI) values in patients who underwent erythrocyte suspension (ES) transfusion in the pediatric intensive care unit.

METHODS:

The study was conducted with patients aged 1 month–18 years, who were hospitalized in the Pediatric Intensive Care Unit at Selcuk University Faculty of Medicine between 2018 and 2021 and who received a blood transfusion. The TAS, TOS, and OSI values of the patients included in the study were recorded.

RESULTS:

The patients included in the study underwent ES replacement at different times. Although the Hb concentration was 5–7 g/dL in 35.41% of the patients who participated in the study, 64.58% underwent transfusion when the Hb concentration was between 7 and 10 g/dL. No statistically significant differences were detected when the TAS values of the patients included in the study were analyzed before and after the replacement. A statistically significant difference was detected when the TOS and OSI values of the patients were analyzed before and after ES replacement. It was found in the present study that TOS and OSI increased in patients after ES transfusion.

CONCLUSION:

Consequently, the frequency of various chronic diseases might increase due to the inflammation caused by increased oxidative stress, and off-label ES should not be given to avoid this.
Multimodality, multidisciplinary approach to overcome technical challenges in a pediatric stem cell harvest for sickle cell disease with preformed donor-specific antibodies
Authors: Chowdhry Mohit , Lekshmi S. Minu , Thakur Uday Kumar , Kharya Gaurav , Nirmal Garima
Published: August 2024

Sickle cell disease is a group of disorders caused by a mutation in the beta chain of hemoglobin (Hb) leading to a vicious cycle of HbS polymerization, increased adhesion-mediated vaso-occlusion and hemolysis-mediated endothelial dysfunction. Herein, we describe a multimodality approach undertaken in a 10-year-old girl child with sickle cell anemia with preformed donor specific antibody (DSA). The initial autologous stem cell rescue collection had to be aborted due to excessive clotting in the stem cell collection set due to elevated Hb S levels. Red cell exchange was performed in view of this and the subsequent autologous harvest was successful. Five cycles of therapeutic plasma exchanges were done before allogeneic stem cell transplantation to reduce the mean fluorescent intensity value of DSA. The child tolerated the procedures well without any adverse events.
Impact of buffy coat reduction on the severity of febrile nonhemolytic transfusion reactions with red cell components
Authors: Singh Lakhvinder , Prinja Nippun , Jain Ashish , Sharma Ratti Ram , Marwaha Neelam
Published: August 2024

BACKGROUND:

Febrile nonhemolytic transfusion reactions (FNHTRs) are the most common adverse reaction reported under the Haemovigilance Programme of India, and the use of leukodepleted blood products is recommended. The severity of the reaction may affect the morbidity associated with the reaction. This study aims to calculate the incidence of various transfusion reactions in our blood center and to evaluate the impact of buffy coat reduction on the severity of febrile reaction and other hospital resource-consuming activities.

MATERIALS AND METHODS:

It was an observational retrospective study in which all reported FNHTRs were evaluated during the period July 1, 2018–July 31, 2019. Patient demographic details, component transfused, and clinical presentation were analyzed to identify factors affecting the severity of FNHTRs.

RESULTS:

The incidence of transfusion reaction in our study period was 0.11%. Out of total 76 reactions reported, 34 (44.7%) were febrile reactions. Other reactions included allergic reactions (36.8%), pulmonary reactions (9.2%), transfusion-associated hypotension (3.9%), and others (2.7%). The incidence of FNHTR in buffy coat-depleted packed red blood cells (PRBCs) and PRBCs is 0.03% and 0.05%, respectively. FNHTRs are seen more in females with prior history of transfusion (87.5%) as compared to males (66.67%) (P = 0.046). We also found that FNHTRs are less severe with buffy coat-depleted PRBC transfusion than PRBC transfusion as mean ± standard deviation temperature rise was less in buffy coat-depleted PRBC (1.3 ± 0.8) than PRBC (1.74 ± 1.129). The febrile response to buffy coat-depleted PRBC transfusion occurred at higher volume (145 ml) transfusion than PRBC transfusion (87.2 ml), and it was statistically significant (P = 0.047).

CONCLUSION AND SUMMARY:

Leukoreduction remains the main modality to prevent FNHTR, but in developing countries like India, the use of buffy coat-depleted PRBC over PRBC can reduce the incidence and severity of FNHTR.
Incapacitating pain in Parkinson’s disease: A case report
Authors: Jain Agam , Raja Pritam , Vengalil Seena , Chowdary Ravindranadh , Atchayaram Nalini , Yadav Ravi
Published: August 2024

Pain is an important manifestation of Parkinson’s Disease, with multiple mechanisms independently contributing to it. Here, we describe a case with predominant nociplastic pain. A 62-year-old woman with advanced Parkinson’s disease with motor fluctuations presented with a 6-month history of incapacitating pain. She described it as a burning sensation and tightness in her body, including the face, throat, and perineum. The pain precipitated when dopaminergic drugs wore off, lasting for 1–2 hours. Diagnosis of nociplastic pain was considered, and she was started on gabapentin along with optimization of her Parkinson’s medication; she responded to this treatment. Nonmotor manifestations could be the most incapacitating symptom, especially in advanced Parkinson’s disease. The etiology of pain in Parkinson’s disease may be difficult to identify, and its management can be challenging.
Noscapine shows antimalarial activity against Plasmodium falciparum 3D7, its clinical isolate Pf140/SS, and Plasmodium berghei ANKA
Authors: Babu Swaraj Kumar , Maharana Sameer , Chhatria Satyaranjan , Sahoo Dibya Ranjan , Nanda Ashirbad , Kanhar Satish , Behera Prativa K. , Mohanty Sanjib , Naik Pradeep Kumar , Sahu Praveen Kishore
Published: August 2024

Objective:

To evaluate the antimalarial activity of noscapine against Plasmodium falciparum 3D7 strain (Pf3D7), its clinical isolate (Pf140/SS), and Plasmodium berghei ANKA (PbA).

Methods:

Using ring-stage survival assay, phenotypic assessments, and SYBR-green-based fluorescence assay, the antimalarial activities of noscapine were assessed compared with dihydroartemisinin (DHA) in in vivo and in vitro studies. In addition, hemolysis and cytotoxicity tests were carried out to evaluate its safety. RT-PCR assay was also conducted to determine the effect of noscapine on papain-like cysteine protease Plasmodium falciparum falcipain-2 (PfFP-2).

Results:

The antimalarial efficacy of noscapine against Pf3D7 and Pf140/SS was comparable to DHA, with IC50 values of (7.68±0.88) and (5.57±0.74) nM/mL, respectively, and >95% inhibition of PbA infected rats. Noscapine also showed a safe profile, as evidenced by low hemolysis and cytotoxicity even at high concentrations. Moreover, PfFP-2 expression was significantly inhibited in both noscapine-treated Pf3D7 and Pf140/SS (P<0.01).

Conclusions:

Noscapine has antimalarial properties comparable to standard antimalarial DHA with better safety profiles, which may be further explored as a therapeutic candidate for the treatment of malaria.
Assessment of public perspectives and barriers towards dengue preventive practices using the Health Belief Model in Puducherry, India: A cross–sectional study
Authors: Govindasamy Dharani , Vijalakashmi Gnanasekaran , Vijayakumar Balakrishnan , Rahul Arya
Published: August 2024

Objective:

To assess the perspectives and barriers towards dengue preventive practices among the residents of Puducherry, India.

Methods:

A cross-sectional survey was conducted in 300 households in Puducherry, using a population-proportionate (7:3) distribution from urban and rural areas by grid sampling. One adult interview per household was conducted and the participants were selected using a KISH grid. A semi-structured questionnaire based on the Health Belief Model (HBM) with additional questions on knowledge assessment was used. Knowledge was assessed based on the correctness of answers and the HBM scores were calculated on a 5-point Likert scale. Participants were categorized based on the median score under each domain. Logistic regression was used for adjusted analysis and models were built to predict the performances in each domain.

Results:

Four percent of the participants lacked basic knowledge regarding dengue transmission. While 208 (69.3%) participants did not consider themselves at risk of contracting dengue within the next year, majority perceived dengue as a disease with low severity. Around 49.3% (148) were skeptical about the benefit of time and money spent on dengue prevention. Inadequate government efforts were stated as the major barrier (47.0%) and frequent reminders (142, 47.3%) as the major cue to action. Age above 50 years (aOR 1.78, 95% CI 1.04-3.06, P=0.037)) and rural locality (aOR 2.68, 95% CI 1.52-4.71, P=0.001) were found to be significantly associated with poor knowledge scores. Urban participants had a significantly higher chance to perceive low susceptibility as compared to the rural counterparts (aOR 1.74, 95% CI 1.05-2.9, P=0.03). Participants with less than a high school education had low perceived benefits (aOR 2.46, 95% CI 1.52-3.96, P<0.001) and low self-efficacy scores (aOR 2.66, 95% CI 1.61-4.39, P<0.001).

Conclusions:

This study identifies key gaps in dengue prevention, including low perceived susceptibility, mild disease perception, limited knowledge of breeding sites, and overreliance on government efforts. Tailoring interventions to community needs, stratified to factors influencing the community perspectives can significantly improve dengue prevention efforts.
Mental emotional disorder is a predictor of stroke incidence in adults: Ten year results of the Bogor Cohort Study on Non–Communicable Disease Risk Factors in Indonesia
Authors: Riyadina Woro , Putri Alifa Syamantha , Tuminah Sulistyowati , Suswanti Ika , Turana Yuda
Published: August 2024

Objective:

To determine the stroke predictors for the 10-year of follow-up in Bogor City, Indonesia.

Methods:

The prospective study analyzed the data of 4445 stroke-free subjects aged 25 years and above that was part of "the Bogor Cohort Study on Non-Communicable Disease Risk Factors". Data were collected by interview method with structured questionnaires, physical measurements three times a year, and laboratory examination every two years during a 10-year follow-up (2011-2021, without examination in 2020). The incidence of stroke is based on anamnesis results and examination by a neurologist. Other stroke predictor variables include characteristics, biological conditions, and risk behavior. We analysed 4445 stroke-free samples with Cox proportional hazard regression test.

Results:

During the 10-year observation, stroke incidence was 440 person-years per 100000 population (95% CI 370-530). During the follow-up of ten years, the main predictor of stroke was mental-emotional disorders with HR 4.2 (95% CI 2.8-6.3) after adjustment by age, hypertension, obesity, abdominal obesity, and high LDL-cholesterol levels.

Conclusions:

Mental-emotional disorders are the strongest predictor of stroke incidence. Hence, psychological factors must be controlled in a stroke prevention program.
Advancing public health preparedness: Establishment of Nipah virus molecular diagnostic test at the National Reference Laboratory, Sri Lanka
Authors: Harshani Hewa Babarandage Chathurika , Ruwan Denagama Vitharanage Rishan Geeth , Samaraweera Udage Kankanamge Isuru Udara , Weligamage Dedunu C U Dias , Abeynayake Janaki I
Published: August 2024

Objective:

To establish Nipah virus diagnostic capabilities at the National Reference Laboratory in Sri Lanka using the NIV Pune real-time PCR kit.

Methods:

Strict safety precautions were adhered during testing due to the high pathogenicity of the Nipah virus, with all diagnostics conducted in a BSL2+ laboratory at the Medical Research Institute in Sri Lanka. RNA extraction was performed using the QIAamp Viral RNA Mini kit. The NIV Pune in-house real-time PCR kit was employed, following established primer/probe sequences and controls. The assay was validated using the Rotor-Gene Q Series Real-time PCR platform.

Results:

The validation run of the Nipah virus real-time PCR test demonstrated robust performance, with positive controls consistently detecting Nipah RNA at a Ct value of 21.50±0.01. Negative controls confirmed assay specificity with an external negative control which was also used as an extraction control and showed no interference. The internal control exhibited stable behavior, enhancing confidence in PCR results. The qPCR analysis graph illustrated the successful detection of internal and positive controls, validating the reliability of the assay.

Conclusions:

Establishing Nipah virus diagnostic capabilities in Sri Lanka signifies a proactive and collaborative response to the persistent global health threat.
Serum Calcium and Phosphorus Concentration in Egyptian Patients with Non-Alcoholic Fatty liver disease
Authors: Mohammed Mohammed F. , Elsayed Sameh S.E. , Yosuf Asem G.
Published: August 2024

Background and aim

Nonalcoholic fatty liver disease (NAFLD) is one of the most common liver diseases worldwide. NAFLD is a multisystem disease that affecting the liver and extrahepatic organs. This study aimed to assess serum calcium, phosphorus levels in patients with NAFLD, and to investigate the association between NAFLD and serum calcium and phosphorus levels.

Patients and methods

A case–control study was conducted on 200 patients; 100 diagnosed with NAFLD cross-matched with 100 individuals without NAFLD regarding to age, sex, and BMI. Serum calcium and phosphorus levels were assessed in both studied groups.

Results

Patients with NAFLD had low levels of serum calcium compared to individuals without NAFLD with highly significant P value less than 0.001.

Conclusion

NAFLD was associated with decreased level of serum calcium.
One-stage correction of angular deformities around the knee using internal fixation
Authors: Galal Sherif
Published: August 2024

Background

Deformity correction has been long performed using internal fixation. Since the introduction of external fixation in orthopedic practice, it has gained popularity in correcting severe deformities, and many orthopedic surgeons have resorted to external fixation to correct severe deformities. The authors asked if internal fixation can be safely used to correct significant deformities with marked mechanical axis deviation thus abolishing the notion that external fixation is the only available option to correct severe deformities.

Patients and methods

A single-center, prospective study was conducted at an academic center from October 2014 to December 2016. A total of 37 patients with lower limb deformities were included in the study. Overall, 13 patients were corrected using locked plates and 24 patients were corrected using intramedullary nails. The average follow-up was 13.5 months (10–18 months).

Results

The desired correction was achieved in all patients. Union was quicker with plates, but this could be attributed to the younger age of patients in that group.

Discussion

Many methods of fixation have been used to correct angular deformities around the knee. With patients’ satisfaction gaining utmost importance recently, surgeons have been revising their approach in managing various orthopedic conditions, and limb deformity is no exception. During the surgeons’ pursuit to achieve their patients’ maximum satisfaction without compromising the accuracy of correction or rigidity of fixation, two new techniques have emerged, namely, fixator-assisted plating and fixator-assisted nailing techniques, which represent a breakthrough in deformity correction, because they combine the advantages of internal and external fixation. The use of internal fixation usually yields higher patients’ satisfaction.

Conclusion

Internal fixation is a safe and effective treatment option for correcting significant deformities of the lower limb.
Direct spondylolysis repair in young adults
Authors: Negm Mohamed A. , Akar Samir A.E.-S.A. , Hasan Faisal , Abdelaziz Mohamed
Published: August 2024

Introduction

Spondylolysis is a common problem affecting all ages, but in adolescent and young adults, especially the athletes, it represents a significant dilemma, as most of them are in their initial phase of their life and need a stable free spine. A minority of old people affected by this disease need medical care, and only a few require surgery, but in athletes and young adults, surgery usually has a main role. Reconstruction of the pars interarticularis is an alternative to segmental fusion; this technique has the advantage of preserving segmental motion. Most authors report good results of spondylolysis repair for young patients without intervertebral disc or facet affection.

Patients and methods

In this study, the fixation of the isthmus was done with a pedicle screw hook system. This stable and strong device is easy to use, allows anatomic pars interarticularis reconstruction, avoids postoperative bracing, and allows early ambulation. A total of 11 patients were assessed in this study. Their mean age at operation was 24 (range: 16–32 years), and the average follow-up was for 24 months (range: 6–36 months). Nine patients showed no preoperative degenerative disc disease and two patients had grade 1 changes. The visual analogical scale and the Oswestry disability index were used for assessment of pain and clinical outcome before and after surgery.

Results

The results were from ‘excellent’ to ‘good’ for 10 patients and ‘fair’ for one of them. The fusion rate was observed in all cases. Among the patients, the results were from ‘good,’ to ‘excellent’ in all cases, and consolidation was always observed. All of them showed normal disc height after the surgery.

Conclusion

Direct spondylolysis repair by pedicle screw hook system is an excellent and reliable method in the management of spondylolysis, especially in intact disc in young adults.
Minimally invasive percutaneous plate osteosynthesis for lateral malleolus fractures
Authors: Zakaria Zeiad M. , Moustafa Sherif , Metwaly Radwan G.
Published: August 2024

Background

Lateral malleolus fracture is one of the most common fractures that may occur as a part of ankle joint trauma. Open reduction and internal fixation is considered as the state of the art for displaced lateral malleolar fractures in order to obtain congruent ankle mortise. But in certain conditions, soft-tissue status together with patient comorbidities may impede this technique. Minimally invasive percutaneous plate osteosynthesis (MIPPO) for lateral malleolus may be a suitable solution for ankle fractures with soft-tissue problems.

Patients and methods

Through the period between May 2012 and May 2016 in Ain Shams University hospitals, a prospective study on 51 patients with displaced lateral malleolus fractures as a part of ankle trauma with bad soft-tissue condition has been managed through the MIPPO approach. All patients have been evaluated as regards the grade of soft-tissue injury, timing of surgery from trauma, duration of the procedure, time to union, postoperative ankle function, and reported superficial peroneal nerve injury. Open fractures, associated pilon fractures, and established Charcot neuropathic joints had been excluded from the study.

Results

The minimum follow-up for all the patients was 12 months and maximum was 25 months with a mean of 13.7 months postoperatively. Thirty patients (58.8%) were grade III according to Tscherne classification of closed soft-tissue injury. Mean time of surgery from trauma was 45.9 h (12 h to 6 days). The average procedure time was 56 min (20–80 min). The average time to union was within 7 weeks (5–10 weeks), all patients had good-to-excellent ankle function with a mean of 89.9 according to the American Orthopedic Foot and Ankle Score, and no superficial peroneal nerve injury was documented.

Conclusion

MIPPO for lateral malleolus is an effective and safe technique, provided that ankle mortise congruity is obtained.
Teaching Letournel classification
Authors: AS Hammad , Abu-Sheasha
Published: August 2024

Background

The aim of Letournel classification was to identify accurately the pathological anatomy of the fractured acetabulum. For orthopedic residents, this classification system is somewhat cumbersome. An important objective is to facilitate the understanding of this classification system among the junior residents. The aim of this study was to compare two educational tools, namely the systematic analysis of the plain films and the 3D computed tomography (CT) scans in improving the diagnostic performance of orthopedic residents.

Patients and methods

Twenty x-rays set for acetabular fractures, including A/P, iliac, and obturator view, were selected from our hospital database. These sets were prepared in a quiz form. Thirty residents were asked to diagnose the given fracture using x-rays only. Then, the residents were randomly allocated to two groups. Group I was asked to repeat the same quiz with the addition of 3D CT-reformatted images (A/P and obliques). Group II was asked to analyze the same x-rays using an algorithm. Data collected included the training period of the resident, the answers in pre- and post-tests together with the subjective assessment of how difficult each diagnosis was.

Results

While the two groups showed a significant and similar improvement in reaching the right diagnosis, using the algorithm was significantly easier.

Conclusion

Compared with the advanced imaging technology, plain x-ray film if analyzed systemically is an easier way to understand Letournel classification when educating junior orthopedic residents.
Uncommon and Unusual Variants of Autoimmune Bullous Diseases
Authors: Kiran  , Rao Raghavendra
Published: August 2024

Background:

Autoimmune blistering diseases (AIBDs) are a type of dermatosis with antibodies produced against various structural proteins of the epidermis or dermoepidermal junction. AIBDs are broadly divided into intraepidermal and subepidermal types. Apart from the common AIBDs, there is an array of uncommon AIBDs.

Objective:

To discuss uncommon variants of AIBDs so that the readers are updated about them.

Methods:

In this review, we have discussed uncommon and unusual variants like pemphigus herpetiformis, IgA pemphigus, paraneoplastic pemphigus, induced pemphigus, IgG/IgA pemphigus, oral lichenoid pigmentation in pemphigus, pemphigus acanthoma, and follicular pemphigus. Rarer variants of the pemphigoid group of disorders include anti-laminin 332 pemphigoid, mixed linear IgA/IgG pemphigoid, anti-p200 pemphigoid, Brunsting-Perry pemphigoid, IgM pemphigoid, granular C3 pemphigoid, anti-p105 pemphigoid, ORF-induced anti-laminin 332 pemphigoid, and acral purpura in dermatitis herpetiformis.

Conclusion:

This review will help in early diagnosis and treatment of uncommon and unusual variants of AIBDs.
Pediatric Basidiobolomycosis: An Uncommon and Misdiagnosed Entity
Authors: Choudhary Ritul , Tiwari Charu , Borkar Nitinkumar , Ganguly Satyaki , Keche Archana
Published: August 2024

Basidiobolomycosis is an unusual chronic subcutaneous zygomycosis reported from tropical regions which is usually misdiagnosed because of its rarity. In this retrospective review, we describe 6 children with basidiobolomycosis who were managed in the Department of Paediatric Surgery at a tertiary institute in central India over a period of four and half years (January 2018 to June 2022). All patients were less than 5 years of age and had no co-morbidities (immune-competent). All were males. All were misdiagnosed at outside hospital. All responded well to anti-fungal therapy. High index of suspicion and biopsy of the lesions lead to appropriate diagnosis and management. Management appears good with triazole antifungals with fewer side effects and safety in children.
Resuscitation Endpoints in Polytrauma Patients: Fixed or Dynamic
Authors: Ali Sarah M. , Faqiri Shahad A. , Osman Adel G. E. , Othman Arwa A. , Almarri Ahmed K.
Published: August 2024

Shock results from insufficient oxygen delivery, leading to metabolic acidosis, inflammation, and coagulopathy. Resuscitation aims to restore normal physiology by addressing various haemodynamic, metabolic, and regional endpoints that gauge the severity of shock. While numerous endpoints exist, no universal standard applies. This review critically examines the importance of endpoints in resuscitation in the management of shock and the improvement of trauma patients’ outcomes. A thorough literature search and analysis highlighting effective endpoints in clinical practice and areas necessitating further investigation was carried out. Established markers such as serum lactate, base deficit, and pH offer valuable insights over time, although a single value may not suffice. Early controlled resuscitation in haemorrhagic shock and tailored haemostatic approaches enhance survival rates. Damage control resuscitation strategies have been proven to improve outcomes by prioritizing haemorrhage management as an additional endpoint. As trauma is a dynamic condition that changes from minute to minute based on the patient’s condition during the acute phase, it is imperative that resuscitation strategies and endpoints remain dynamic during this phase to effectively accommodate changes in the patient’s condition. This belief is supported by the wide variation in endpoints without a consensus on a single endpoint or value.
Resuscitative Thoracotomy for Penetrating Trauma, a Valid Option in the Right Circumstances
Authors: Alhussain Youssef F. , Almuhanna Mustafa T. , Bawab Hatem Y. , Osman Adel G. E. , Nabri Mamoun A. , Nasr Ayman O.
Published: August 2024

The need to perform a clamshell thoracotomy in the emergency department for thoracic injuries is infrequent. The rates of survival after emergency thoracotomy are considerably low, with penetrating trauma cases exhibiting survival rates of 9% to 12%, and blunt trauma cases observing survival rates of 1% to 2%. We present an atypical instance of survival following resuscitative thoracotomy performed in the emergency department. The procedure was undertaken on a 30-year-old male victim of gunshot wounds to the chest and abdomen. On arrival to emergency department, the patient had a traumatic cardiac arrest. A resuscitative thoracotomy was carried out, restoring a spontaneous heart rhythm before transferring the patient to the operating room. A midline exploratory laparotomy was performed for abdominal injuries. Remarkably, the patient survived the procedure and fully recovered. This case serves as an illustration of how clamshell thoracotomy can be an effective resuscitative lifesaving intervention for penetrating thoracic trauma when accompanied by the appropriate setup.
Comparison of Two Educational Methods for Teaching European Paediatric Advanced Life Support to Adults: Formative Versus Summative Evaluation—A Pilot Investigation
Authors: Alouini Amenne , Biarent Dominique , Mbarek Rabeb , Tilouche Samia , Alouini Souhail , Haggenmacher Caroline
Published: August 2024

Background:

This study compared formative assessment with traditional summative assessment during European Paediatric Advanced Life Support (EPALS) courses. With increasing emphasis on the effectiveness of medical teaching methods, this study aimed to evaluate the impact of these assessment approaches on perceived stress levels and overall satisfaction of healthcare professionals participating in the EPALS course.

Materials and Methods:

A pilot investigation study was carried out to compare two EPALS courses run simultaneously. The courses used two different assessment methods: one used a summative evaluation at the end of the course, while the other implemented summative assessment throughout. The study examined the stress levels perceived by participants during the different phases of training when using subjective measures. In addition, participants’ satisfaction with the course, assessment methods, and overall experience was assessed using Likert scale responses.

Results:

Participants undergoing formative assessment reported significantly lower stress levels during assessment periods than those in the summative evaluation group. Both groups of participants were satisfied with the course. However, the formative group preferred formative assessment, while the summative group was more neutral. The formative group strongly believed that formative assessment was more objective than a summative test (P = 0.011) and that certification held the same value as after a summative test (P = 0.046), whereas the summative group believed that a formative assessment was neither more nor less objective.

Conclusion:

This study sheds light on the potential benefits of formative assessment in reducing perceived stress during training and increasing the satisfaction of participants of EPALS courses.
Determining the effects of botulinum toxin A treatment on pain, resting vaginal pressure, and female sexual distress scale among vulvodynia patients
Authors: Rajar Uzma D.M. , Ayub Uzma T. , Qazi Sumayya
Published: August 2024

Introduction

Vulvodynia is a painful and constant vulvar discomfort. This condition is often described as a searing or stinging sensation, with an increased awareness of pain (hyperalgesia) and pain sensitivity (allodynia).

Objective

To determine the effects of botulinum toxin A treatment on pain, resting vaginal pressure, and female sexual distress scale among vulvodynia patients.

Patients and methods

A quasi-experimental study was performed on 40 patients with vulvodynia. The assessment was done 3 months after botulinum toxin injection by visual analog scale, vaginal pressure at rest, and female sexual distress scale.

Results

The findings revealed that the effect of treatment was turned out to be significantly effective (P<0.05) in reducing pain and measured using visual analog scale where the values at baseline were 8.25±3.41, which reduced to 4.37±2.12 after 3 months of intervention. In addition to that female sexual distress scale also shown a significant reduction after 3 months of treatment. The improvement was noticed with a mean difference of mean differnce=8.21±3.58 (P<0.05, 95% confidence interval). Furthermore, it was shown that botulinum toxin A therapy significantly decreased resting vaginal pressure.

Conclusion

Botulinum toxin type A therapy is a potential alternative for treating female vulvodynia.
Interdisciplinary Triumph: Molar Preservation through the Unity of Periodontology, Prosthodontics, and Endodontics
Authors: Punj Anahita , Vasudevan Sanjay , Reddy P. Ajay , Atchuta Abhinav
Published: August 2024

Preserving teeth is a long-term goal for each specialty of dentistry. Many times, it involves the use of interdisciplinary work and team effort to reach the desired goal. With the advancement of age and patient education, many patients have the desire to save their teeth as long as possible. Incorrect brushing techniques can lead to gingival recession, which, over a period of time, can advance to severe attachment loss of periodontal structures, causing complete denudation of the tooth root. Ultimately, it results in dentinal hypersensitivity and, consequently, chronic pulpitis. Over a period of time, it can result in food lodgment and the development of a periodontal pocket. Many times, the patient reports at the advanced stage of the disease when the treatment becomes complicated and requires interdisciplinary approaches.
Effect of Photobiomodulation Therapy in Type 2 Diabetic Patients on Peri-implant Osteoblastic Activity, Soft-tissue Healing, and Postoperative Pain Discomfort: A Pilot Study
Authors: Selvam Divyabharathi , Natrajan Shanmuganathan , Seenivasan Madhan Kumar , Lavu Vamsi
Published: August 2024

Background:

Surgical and postoperative challenges impose the need for noninvasive techniques to enhance bone healing process and reduce complications during implant therapy in diabetic patients. Photobiomodulation therapy (PBMT) has shown a substantial effect in the management of postoperative pain, neurosensory recovery, and healing at surgical sites.

Objectives:

The present study aimed to assess the effect of PBMT on peri-implant osteoblastic activity, soft-tissue wound healing, and Post operative pain discmofort among type 2 diabetic patients.

Material and Methods:

Five type 2 diabetic patients with bilaterally edentulous mandibular posterior teeth necessitating 10 implants with two-segment variant type were included in the study. The study site (SS) with implants was treated with PBMT (gallium–aluminum–arsenide diode laser 810 nm), and the control site (CS) with implant (opposite side) was left untreated. The Wound Healing Index (WHI), Visual Analog Scale, and bone scintigraphy were used to assess postoperative discomfort and peri-implant osteoblastic activity, respectively.

Results:

The average WHI scores and Visual Analog Scale at the SS were not significantly higher than the CS score. Although lack of significant increase in osteoblastic activity was observed under bone scan, the difference in experimental values highlights a possible association of PBMT and osseointegration potential among the study group.

Clinical Implications:

The application of Photobiomodulation Therapy (PBMT) as an adjunct around dental implants will improve osteoblastic activity and bone healing to reduce the probability of early-onset failures in patients diagnosed with type 2 diabetes mellitus. However, to assess the impact of the PBMT on peri-implant bone with different bone densities, further well-controlled long-term trials on larger study groups are needed.

Conclusion:

Within the limitations of the study, irradiation using PBMT at the peri-implant tissue site has shown favorable osteoblastic activity, WHI score, and Visual Analog Score postoperatively, but the results were statistically not significant. However, further long-term trials on diabetic individuals on a larger scale are needed for validating these study results.
Intramuscular Hemangioma of the Tongue Misdiagnosed as Cystic Hygroma
Authors: Yadav Renu , Patil Rahul , Sonawane Sarang
Published: August 2024

Intramuscular hemangiomas, although considered rare, represent a unique subset of vascular tumors that arise within the skeletal muscle tissue. These benign neoplasms are characterized by the proliferation of blood vessels within the muscle fibers, and their clinical presentation can vary widely, often posing diagnostic challenges for clinicians. The management of intramuscular hemangiomas is often dictated by the lesion’s size, location, and symptomatic impact on the patient. The present case report aims to contribute to the evolving understanding of intramuscular hemangiomas by presenting a comprehensive analysis of a recent clinical case, discussing diagnostic modalities, and highlighting management strategies that can aid health-care professionals in their approach to this rare vascular entity.
Prevalence of Inborn Errors of Immunity in Children with Recurrent Multilobar Pneumonia in a Tertiary Care Center in Tamil Nadu
Authors: Balaji B. Sarath , Arunagirinathan V. , Karthikeyan S.
Published: August 2024

Background and Objective:

Underlying immunodeficiency is a risk factor for recurrent pneumonia. We tried to estimate the prevalence of inborn errors of immunity (IEI) in children with recurrent multilobular pneumonia and analyzed the history, examination findings, and basic investigations to derive clues for early diagnosis in a resource-poor hospital setting.

Materials and Methods:

This prospective observational study was conducted in a tertiary care pediatric teaching hospital in South India over 2 years. Details about each patient including demographics, clinical profile, treatment history, and outcomes were obtained.

Results:

Among 76 children with recurrent multilobar pneumonia, 30 children (39.47%) were proved to have IEI. The significant pointers to the diagnosis of IEI in history were chronic recurrent rhinosinusitis (P < 0.001), otitis media (P = 0.033), tonsillar atrophy (P = 0.022), widespread skin and soft-tissue infections and abscesses (P < 0.001), mucosal candidiasis (P = 0.008), recurrent diarrhea (P = 0.016), lymphopenia for age (P < 0.001), thrombocytopenia (P = 0.005), and abnormal peripheral smear other than hypochoromic microcytic anemia (P < 0.001).

Conclusions:

IEI prevalence is higher than expected with some easily appreciable clues in basic examination and laboratory findings. Clinicians should keep these pointers in mind while dealing with any child with recurrent pneumonia.
Unveiling the mystique of Kulisam (Amulet) with scientific insight
Authors: Ramasamy Kayathri , Ulaganathan Sarojini , Sengottaiyan Geetha Devi
Published: August 2024

Background:

Kulisam is an unexplored therapy of Siddha paediatrics. In which an amulet is prepared with medicinal herbs, metals and some animal product. Most of the herbal ingredients of Kulisam contain essential oils. It enters the body through the skin inhalation and ingestion routes, it gets mixed with the circulation and cures the specified diseases thus acting as a therapeutic agent.

Materials and Methods:

The data were obtained from Siddha classics such as, TV Sambasivam Pillai dictionary, Kuzhandhai maruthuvam, Vaazhai vagadam and various research articles searched in Pubmed, Google Scholar and Science Direct through specific keywords.

Result and Discussion:

The herbal and metal amulets used in Siddha pediatrics have been explored with the help of science. Therefore, Kulisam can act as a potent therapeutic, pharmaceutical and, nutraceutical tool for Siddha paediatrics. For a long period of time the unique therapy of Siddha system of medicine – Kulisamaadal has been alienated due to the unexplored science base behind it and a lack of research in this aspect, it's left as an unexplored treasure. Having a significant scientific base behind further research on this aspect will take Siddha pediatrics to the next level.

Conclusion:

Kulisam is a therapeutic tool of Siddha paediatrics. Being an unexplored therapy of the Siddha system, it is essential to conduct further studies and research on this aspect.
Clinical management of Kandamaalai (Cervical Lymphadenopathy) through higher-order Siddha medicines: A case report
Authors: Thangapandi Swathi , Shanthirappa Udayar Sivakkumar
Published: August 2024

Cervical lymphadenopathy, characterized by the swelling of lymph nodes in the neck region, presents a complex clinical scenario with varied aetiologies. The integration of traditional medicinal systems, like Siddha, offers potential alternative therapeutic approaches. This case study deals with the management of bilateral cervical lymphadenopathy using Siddha remedies tailored for Kandamaalai. A 47-year-old female patient presented with a two-month history of cervical swelling, throat discomfort, otalgia, rhinitis, and anorexia. Diagnosis revealed bilateral cervical lymphadenopathy, akin to the Siddha concept of Kandamaalai. Treatment involved Siddha medications targeting Kandamaalai, administered without adverse effects. Subsequent improvement was clinically observed, with the resolution of symptoms and reduction in lymph node size corroborated by ultrasound (USG) findings. This case underscores the potential efficacy of Siddha therapy in treating cervical lymphadenopathy, particularly Kandamaalai. Further research, including robust clinical trials, is essential to validate these outcomes and elucidate the role of Siddha medicine in contemporary healthcare settings.
Visual Impairment Among Adult Diabetic Patients and Associated Factors at Debre Brihan Referral Hospital, Central Ethiopia, 2017
Authors: Demilew Ketemaw Z. , Adimassu Nebiyat F. , Alemu Destaye S.
Published: August 2024

PURPOSE:

The study aimed to assess the proportion of visual impairment and associated factors among diabetic patients at Debre Berhan Referral Hospital (DBRH).

METHODS:

A hospital-based cross-sectional study was carried out from April 27 to May 19, 2017. All adult diabetic patients attending DBRH during the study period were included in the study. A pretested, structured questionnaire and clinical examinations were used for data collection. The collected data were entered into Epi Info 7 and exported to the Statistical Package for Social Sciences version 20 for analysis. The descriptive analysis was summarized by frequency, percent, and summary statistics. Association between visual impairment and independent variables was determined via bivariable and multivariable binary logistic regressions. P < 0.05 was considered statistically significant. Adjusted odds ratio (AOR) and 95% confidence interval (CI) were used to determine the strength of association. Hosmer and Lemeshow goodness of fit was used to check for model fitness.

RESULTS:

A total of 388 study subjects with a 92% response rate took part in the study. The prevalence of visual impairment was 29.38% (95% CI: 24.83%–33.93%). Age >56 years (AOR = 5.24, 95% CI: 1.37–20.04), physical inactivity (AOR = 2.34, 95% CI: 1.33–4.14), presence of visual symptoms (AOR = 4.48, 95% CI: 2.35–8.57), lower body mass index (AOR = 6.23, 95% CI: 1.87–20.68), and diabetic retinopathy (AOR = 5.12, 95% CI: 1.91–13.70) had a statistically significant association with visual impairment.

CONCLUSION:

A high proportion of diabetic patients had visual impairment. Independent variables older age, physical inactivity, presence of visual symptoms, lower body mass index, and diabetic retinopathy had a positive statistically significant association with visual impairment.