bluuebunny/crossref_metadata_2025 huggingface dataset:
Beyond Barriers: Addressing Challenges and Opportunities of People with Disability During the Pandemic
Authors: Aggarwal Sumit , Tabassum Heena , Agarwal Pragati , Grover Ashoo , Singh Ravinder
Published: July 2024

People with disabilities often experience worse health outcomes than ordinary people because of multiple barriers to accessing healthcare. These inequalities are particularly exposed during the pandemic, indicating an urgent need to strengthen health systems, so that they are inclusive and responsive to the needs of these people during crises. These people are particularly affected by changes in routine services because of diversion of healthcare staff and facilities to respond to the pandemic, e.g., rehabilitation and medications. The combination of these factors substantially imparts negative impacts on their functioning and well-being. Health services research can help address the challenges of maintaining continuity of care during crises as well as addressing systematic inequalities in the health sector that marginalize people with disabilities even during noncrisis times. Therefore, research is needed to understand the health service design and to identify strategies to maximize active participation from this population.
Nuances of Cohort Studies and Risk Ratio
Authors: Doke Prakash Prabhakarrao
Published: July 2024

Post-graduate students and faculty usually conduct case-control studies. However, sometimes they conduct cohort studies that are short-duration. Most investigators enroll the participants in two groups according to the exposure. Then, follow the participants for some duration. At the end of the study, relative risk is calculated, and the work is published in some journal. The exposure may be one time, which may or may not be quantified. The follow-up duration may not be participant-specific, and differential follow-up does not exist. The author has given three examples: the first example of consanguineous marriages and congenital disabilities, the second example of the ABO blood group system and childhood asthma, and the third example of insecticide spraying and stillbirth. In the given examples, cumulative or density incidence cannot be calculated in a true sense and, therefore, risk ratio. Even estimating the incidence of outcome variables in some studies is not appropriate. Risk ratio calculation in such scenarios is questionable because exposure quantification, follow-up period, and combination are the limiting factors. In case-control studies, the prevalence ratio is calculated, which is analogous to relative risk. The author suggests that, in such circumstances, prevalence ratio calculation will be more appropriate.
Appropriate Hand Drying - The Missed Step of Hand Hygiene: A Qualitative Evaluation of Hand Drying Practices among Indian Health Care Workers
Authors: Kumar Rakesh , Wasim Sanober , Pandita Neerul , Suman Pushpang , Gupta Girish
Published: July 2024

Hand hygiene remains one of the most effective methods of preventing healthcare-associated infections. Hand drying is the end point of hand hygiene. Hand drying after hand hygiene is less explored, and the practice varies in different facilities. This explorative study was done to know the various hand-drying methods and practices of healthcare workers in Indian settings. This was a descriptive cross-sectional questionnaire-based observational study initiated from a tertiary care setup in Uttarakhand. Healthcare workers over 18 years of age directly involved in patient care were enrolled. A semi-structured questionnaire with both open-ended and close-ended questions was used with snowballing sampling technique. Statistical analysis was done using Statistical Package for Social Sciences (SPSS). Out of the eligible 395 respondents, 62.8% were female. The mean age of the respondents was 31.34 ± 8.44 years and average working hours were 8.87 ± 2.97 (range 4–24) hours. Only 72.7% did hand hygiene always before touching a patient. Nurses were more compliant about hand hygiene than doctors (P < 0.0001). A total of 82.8% were aware of appropriate hand-drying methods. Staff in the Intensive care unit Intensive care unit (ICU) setup were more aware of hand drying practices (P = 0.033). A total of 21.8% wiped their hands on their clothing to dry their hands. This was more in staff from paraclinical departments (P = 0.001). A total of 35.7% used handkerchiefs to dry hands. Resident doctors used handkerchiefs more than senior doctors or nursing staff (P = 0.01). A total of 49.9% of respondents spent less than 10 seconds in hand drying. Hand-hygiene knowledge is high among healthcare workers in India, but the knowledge of appropriate hand-drying practices is lacking. There is wide variation in the practice of hand drying. Better hand drying guidelines and incorporating hand drying as the essential endpoint of the hand hygiene ritual are warranted.
Association between COVID-19 Vaccination (ChAdOx1-S) and Thromboembolic, Thrombocytopenic, Hemorrhagic Events: A Systematic Review and Meta-analysis of Analytical Epidemiological Studies
Authors: Vaman Raman S. , Kumar Muthusamy S. , Jeyashree Kathiresan , Periasami Ashok , Abdulkader Rizwan S. , Murhekar Manoj
Published: July 2024

We conducted a systematic review of analytical epidemiological studies to assess the association between ChAdOx1-S vaccination and thromboembolic, thrombocytopenic, and hemorrhagic events. We searched Medline, Embase, Google Scholar, WHO-COVID-19 database, and medRxiv for studies evaluating the association between ChAdOx1-S and vascular events. Primary outcomes of interest were cerebral venous sinus thrombosis, peripheral venous thrombosis (PVT), and thrombocytopenia. Two independent reviewers screened for eligible studies, extracted data, and assessed the risk of bias. The DerSimonian-Laird random effects model was used to pool the incidence rate ratios (IRRs) separately for the first and second doses. Heterogeneity was assessed using I2 statistics. Twenty studies were included, of which 11 were self-controlled case series, and nine were cohort studies (254 million participants). Pooling of 17 studies showed a higher risk of cerebrovascular thrombosis (IRR = 3.5, 95% CI = 2.2–5.4, I2 = 79%), PVT (IRR = 2.0, 95% CI = 1.1–3.5, I2 = 95%) and thrombocytopenia (IRR = 1.6, 95% CI = 1.4–1.9, I2 = 93%) among those who received ChAdOx1-S vaccination as compared to controls. No increased risk was seen after the second dose or for secondary outcomes. There is moderate-to-high certainty of the evidence for the increased risk of cerebral venous sinus thrombosis, PVT, and thrombocytopenia following the first dose of the ChAdOx1-S vaccine.

Systematic Review Registration: PROSPERO CRD42022372768.
A Cross-sectional Study for Examining Catastrophic Healthcare Expenditure Across Socio-demographic Variables among Employees in a Sedentary Occupation
Authors: Yadav Monika , Bathirasamy Viji
Published: July 2024

Health expenditure above a certain threshold level can result in a financial catastrophe by reducing the expenses on necessities. Certain socio-demographic variables have been observed to play a role in influencing catastrophic healthcare expenditure, guiding the present study to examine this scenario for employees in sedentary occupations. A cross-sectional study has been conducted among 370 employees recruited through a random sampling technique. Multinomial logistic regression was used to test the main objective of the study. The factors associated with a higher probability of catastrophic healthcare expenditure were males with increasing age. Years of work experience tend to be associated with a lower likelihood of catastrophic healthcare expenditure. No conclusive evidence could be drawn for BMI, income, marital status and education.
Diabetes Mellitus as a Risk Factor for Tuberculosis: A Community Based Case Control Study
Authors: Kokiwar Prashant R. , Soodi Reddy Arun K.
Published: July 2024

Background:

Prevention of diabetes in the general population can help reduce the incidence of tuberculosis. Hence it is necessary to document that diabetes is strongly associated with tuberculosis as a risk factor.

Objective:

To study if diabetes is associated with tuberculosis compared to controls.

Materials and Methods:

A community based case-control study was carried out. 215 newly diagnosed cases of tuberculosis on treatment for not more than three months were selected randomly from the randomly selected tuberculosis unit. 215 neighbourhood controls were selected. They were matched for the age group of ± 10 years and sex. Fasting blood sugar (FBS) was estimated using a glucometer.

Results:

Tobacco chewing, residence and family history of TB were significantly more in cases (P < 0.05). Mean BMI was significantly lower in cases compared to controls. The proportion of TB cases among the known cases of diabetes was 67% compared to 33% in controls, which was statistically significant. Mean FBS was significantly higher in cases compared to controls (P < 0.05). The odds of cases being diabetic was 2.456 times more than those of controls. On binary logistic regression, diabetes was an independent risk factor for tuberculosis. Other independent risk factors were tobacco chewing, and family history of TB.

Conclusion:

Family history of tuberculosis, and tobacco chewing were positively associated with tuberculosis whereas body mass index was negatively associated with tuberculosis. Diabetes was significantly associated with tuberculosis.
Survival Analysis of the Geriatric Population having Multiple Diseases in the Jammu District, J and K, India
Authors: Shivgotra Vijay K. , Kumar Manjeet , Nanda Himani
Published: July 2024

Aging is a complex, multifactorial, and inevitable process, which begins before birth and continues throughout the life. Multimorbidity prevailing among the geriatric population is an important health challenge for most of the developing countries. To examine the effect of gender and increasing age on the survival of the geriatric population suffering from multimorbidity. A cross-sectional study was conducted among the geriatric population of the Jammu district, J and K, using multistage sampling procedure, and the analysis was conducted using the Kaplan-Meier method and survival analysis using software IBM SPSS version 24.0. Our study included 1150 study subjects, of whom 610 (53%) were males and 540 (47%) were females, respectively. It was indicated that the probability for the survival of the study population suffering from morbidity belonging to 60–64 years was higher than the survival of the geriatric population belonging to other age-groups or we can say that survival probability of the geriatric population suffering from morbidities decreases with the increase in age. Also, it was reported that probability for the survival of the female geriatric population suffering from morbidity was slightly higher than the survival of the male geriatric population. Gender had no significant effect on survival of the geriatric population suffering from morbidities, whereas baseline age had a significant effect on the survival of the geriatric population suffering from morbidities as their survival probability decreases with the increase in age.
Effectiveness of “Healthy Living Training Program” on Obese Policemen
Authors: Sabale Rupali V. , Velhal Gajanan , Kabra Yashovardhan , Nellikkal Shilpa
Published: July 2024

Background:

Considering the concerns of obesity problems, Mumbai Police authorities had launched full-day residential “Healthy Living Training Program” in February 2019 for obese policemen. We studied the effectiveness of the program by assessing health profile of the participants, and change in anthropometric measurements and blood pressure readings.

Methods and Materials:

Permission from the concerned authorities and approval from the Institutional Ethics Committee (IEC) were taken. Health profiles of 143 policemen were assessed. Anthropometric measurements and blood pressure recordings were done on the first and the last day of the 28-day program. The data were coded and entered in password-protected Microsoft Excel. Paired t-test was applied to test statistically significant differences. The association of some of the variables with weight change was assessed by the Chi-square test for categorical variables.

Results:

The mean age of participants was 49.6 ± 5 years. The proportion of hypertensive, diabetics, vision problems, and bone and joint problems were 48.2%, 23.2%, 57.1%, and 46.4%, respectively. Only 70% of them had home-cooked food in the lunch. Daily, 50% of the participants do physical activity. There was statistically significant weight reduction (105.6 ± 12.1s vs. 103.3 ± 12 kg), body mass index (BMI) (36.3 ± 3.4 vs. 35.5 ± 3.3), waist circumference (110.8 ± 7.9 vs. 109.5 ± 7.9), and hip circumference (115.6 ± 8.1 vs. 106.8 ± 15.0) of the participants after 28 days of training program.

Conclusion:

“Healthy Living Training Program” was effective in reducing weight, blood pressure, BMI, and waist and hip circumference. The program benefitted the participants by inculcating healthy lifestyles and raising awareness of health issues.
Pathogenicity role of human herpesvirus-8 in patients with acute myeloid leukemia
Authors: Abdullah Zahraa Ali , Yasir Luma Amer , Ewadh Ruqaya Munther J. , Al. Alwany Shakir H. Mohammed
Published: July 2024

BACKGROUND:

Certain hematologic cancers, including Kaposi’s sarcoma (KS), have been associated with the pathogenicity of human herpesvirus-8 (HHV-8). HHV-8’s involvement in acute leukemia patients is yet unclear, nevertheless. The diagnosis, categorization, and course of treatment for acute myelogenous leukemia, an aggressive heterogeneous hematologic malignancy, have changed dramatically in recent years.

OBJECTIVE:

This study aims to investigate the pathogenicity role of HHV-8 in patients with acute myeloid leukemia (AML) of a group of the Iraqi population.

MATERIALS AND METHODS:

Case–control research has been carried out on 75 fresh blood samples recruited from the Mirjan Teaching Hospital in Al-Hilla City. The studied blood samples were obtained from patients with AML enrolled in this study, whereas control groups in the current study included 75 fresh whole blood. The specimens were collected during the period from June 2023 to February 2024. Conventional polymerase chain reaction (PCR) was used to identify HHV-8.

RESULTS:

The results show that the mean age of the patients with AML (48.5 ± 10.23 years) was more than that of the apparently healthy control (46.26 ± 11.21 years). There was a nonsignificant difference between patients with AML and the control group. In addition, the male in this study group constituted 56% (42/75), whereas 44% (33/75) were female. Furthermore, the positive of viral genome extraction was found in 41.3% (31 out of 75 of the specimens with viral genome), whereas 59.7% (44/75) specimens did not contain viral genome. The PCR results showed that in the AML patient group, the rate of HHV-8 infection was 35.4% (11 out of 31 cases).

CONCLUSION:

Considering the relatively small numbers included in our results, the positive results lead to the idea that HHV-8 works as a cofactor in the tumor biology of the AML subset under consideration and may have contributed to its development.
Influence of intraocular inflammatory cytokine levels on postoperative complications in congenital cataract surgery
Authors: Kaur Savleen , Sharma Surya Prakash , Sukhija Jaspreet , Ram Jagat , Singh Nirbhai
Published: July 2024

Purpose:

Posterior capsular opacification (PCO) accounts for the most significant and most challenging complication after successful cataract surgery in children. Our study aimed to investigate the levels of cytokines in the aqueous humor of children afflicted with congenital cataracts and their association with PCO.

Methods:

This was an observational study conducted at a tertiary referral center in India. Consecutive children aged less than 5 years with unilateral/bilateral isolated idiopathic congenital cataracts and planned for cataract extraction with intraocular lens implantation were included. During cataract surgery, 100–500 µl of aqueous samples were collected and the levels of inflammatory cytokines were quantified in the aqueous humor.

Results:

An analysis of 28 samples was done. The mean age of the patients was 16.7 ± 0.4 months (range 3–60 months) with a mean follow-up 14.2 ± 2.3 months. On binary logistic regression, the level of MCP-1 was significantly related to the development of PCO at 1 year (P = 0.0072). Levels of IL-6 and IL-8 were not associated with the development of PCO (P = 0.05 and P = 0.07, respectively).

Conclusion:

Inflammatory markers like IL-6 and IL-8 were raised in children with pediatric cataracts in our study. Chronic high levels of MCP-1–induced fibrosis may be associated with PCO.
SARS-CoV-2 positivity rates in tear secretions of inpatient COVID-positive individuals in an Indian tertiary care setting
Authors: Raj Amit , Nishant Prateek , Pati Binod K , Saha Bhawesh C , Singh Prabhakar , Sarfaraz Asim , Sravani Sanepalli , Shrivastav Kopal
Published: July 2024

Purpose:

In the third wave of the coronavirus disease 2019 (COVID-19) pandemic, despite progressive vaccination coverage, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was rapidly spreading and the possibility for ocular transmission of COVID-19 was most relevant. This study aimed to determine the presence of SARS-CoV-2 RNA in tears as detected by real-time polymerase chain reaction (RT-PCR), among individuals who tested COVID-positive during the third wave of the COVID pandemic.

Methods:

Among 90 patients admitted with mild to severe COVID-19 infection (ranging from asymptomatic to severe symptoms), separate conjunctival samples were obtained from both eyes without topical anesthesia taking precautions to avoid contamination. Inferior fornices of the eyes were swept slowly with sterile Dacron swabs for 10 s or until visibly wet. They were inoculated directly in a viral lysis buffer containing carrier RNA and transported to the Virology Laboratory for the detection of SARS-CoV-2 RNA by RT-PCR. Conjunctival swabs were declared positive based on cycle threshold values of <37.

Results:

Seven of 180 conjunctival swabs were positive (3.9%). Five patients had unilateral positive and one patient had bilateral positive conjunctival swabs. Thirty-six (40%) patients had their conjunctival swabs taken on the same day of detection of the first positive nasopharyngeal swab, while the rest (54) had their conjunctival swabs taken up to 3 days later. Overall, 20 (22.2%) patients were symptomatic for COVID-19.

Conclusion:

Considering the contagious nature of SARS-CoV-2 in the third wave, there is a possibility that ocular surface fluid might have been a contributing factor along with other modes of transmission of COVID-19.
“Inverted flap rhexis” – Salvation of intumescence
Authors: Singh Reetesh K , Popat Aarti
Published: July 2024

Intumescent cataract can be a challenge even for an experienced surgeon, particularly for creating a continuous curvilinear capsulorhexis (CCC) because of increased endolenticular pressure. CCC in white intumescent cataract is associated with increased risk of extension of rhexis margin leading to radial tear or biradial extension causing “Argentinian flag sign” and associated complications. We describe a novel technique for CCC, in which we manipulate the vector forces acting in creating a capsulorhexis. After making a mini CCC, a flap is raised and then inverted under the rhexis margin and CCC is done by keeping the flap inverted using shearing and tearing forces, keeping the direction of force down and toward the center in a curvilinear fashion. It is a new surgical technique to perform a successful and safer CCC in intumescent cataract with consistent outcome.
Peripapillary and subfoveal choroidal vascular index in patients with tension-type headache and migraine
Authors: Icoz Mehmet , Akdeniz Merve
Published: July 2024

Purpose:

This study aimed to evaluate the choroidal vascular characteristics of patients followed up with different headache diagnoses.

Design:

Prospective comparative study.

Methods:

This study included 21 patients with migraine with visual aura (MwA), 20 with migraine without aura, 29 patients experiencing episodic tension-type headache, and 30 healthy participants. The participants was performed refraction values, axial length, and intraocular pressure were examined. Choroidal thickness was determined in all participants with HD-line optical coherence tomography (OCT) in the subfoveal, nasal, and temporal quadrants 500 μm from the fovea. Using special image processing software, luminal area (LA), stromal area, total choroidal area, and choroidal vascular index (CVI) values were calculated in both macular and peripapillary regions. OCT was also used to perform peripapillary retinal nerve fiber layer (pRNFL) thickness and optic disc head measurements.

Results:

Spherical refraction, axial length, and intraocular pressure values did not significantly differ among the four groups with similar gender and age distributions (P > 0.05). The LA values in both macular and peripapillary regions were found to be statistically significantly lower in the MwA group (P = 0.007 and P = 0.005, respectively). There was no statistically significant difference among the groups in terms of the remaining choroidal area parameters or CVI values (P > 0.05). The groups also did not show any significant difference in the pRNFL or optic disc head measurements performed in different quadrants (P > 0.05).

Conclusion:

While LA, one of the choroidal vascular parameters, was found to be lower in the MwA group in both the macular and peripapillary regions, there were no statistically significant differences between the groups in terms of the peripapillary or macular CVI values.
Increased serum ferritin is associated with severity of orbital disease in COVID-19–associated rhino-orbito-cerebral mucormycosis: A quantitative analysis
Authors: Tanwar Shashi , Mishra Nibha , Sharma Prachi , Kaur Apjit
Published: July 2024

Context:

Effect of serum ferritin on severity of coronavirus disease 2019 (COVID-19)-associated rhino-orbito-cerebral mucormycosis.

Purpose:

To study the association between increased serum ferritin and severity of orbital disease in COVID-19–associated rhino-orbito-cerebral mucormycosis.

Settings and Design:

A cross-sectional study.

Methods:

Hundred (n) out of 155 treatment-naive patients of COVID-19 infection presenting with the signs and symptoms of rhino-orbito-cerebral mucormycosis were enrolled in study. Based on the classification proposed by Honavar, the study patients were classified into four stages: Stage 1: involvement of the nasal mucosa (n = 11), Stage 2: involvement of paranasal sinuses (n = 14), Stage 3: involvement of the orbit (n = 37), Stage 4: involvement of the central nervous system (n = 38). Stage 3 was further divided into four substages: 3a: nasolacrimal duct, medial orbit, vision unaffected (n = 4); 3b: diffuse orbital involvement (>1 quadrant or >2 structures), vision unaffected (n = 15); 3c: central retinal artery occlusion or ophthalmic artery occlusion, superior ophthalmic vein thrombosis, involvement of superior orbital fissure, inferior orbital fissure, orbital apex, diminution or loss of vision (n = 13); 3d: bilateral orbital involvement (n = 5). Fasting blood sugar (FBS), postprandial blood sugar (PPBS), and inflammatory markers (serum ferritin, interleukin-6, C-reactive protein, and D-dimer) were assessed. Serum level of ferritin was analyzed by using chemiluminescence immunoassay method.

Results:

Mean FBS (mg/dl) was 165.03 ± 70.43 for stage 1, 185.67 ± 64.82 for stage 2, 159.05 ± 68.60 for stage 3, and 158.20 ± 62.05 for stage 4. Mean PPBS (mg/dl) was 238.70 ± 141.29 for stage 1, 252 ± 103.69 for stage 2, 257.09 ± 103.48 for stage 3, and 229.53 ± 76.81 for stage 4. Mean serum ferritin (μg/l) was 302.67 ± 266.95 in stage 1, 444.19 ± 116.36 in stage 2, 504.85 ± 205.99 in stage 3, and 825.95 ± 777.30 in stage 4. A statistically significant increase in serum ferritin levels with severity of disease (P = 0.005) was noted. Similar trend was observed in substages of stage 3. Pearson correlation analysis showed a positive correlation between serum ferritin and severity of disease (P = 0.0007).

Conclusion:

Increased serum ferritin was significantly independently associated with severity of orbital disease in COVID-19–associated rhino-orbito-cerebral mucormycosis.
Efficacy of gonioscopy-assisted transluminal trabeculotomy and trabeculectomy in patients with primary open-angle glaucoma and pseudoexfoliative glaucoma: A single surgeon’s experience
Authors: Cakir Ihsan , Balci Ali Safa , Alagoz Nese , Yalcinkaya Cakir Gülay , Altan Cigdem , Yasar Tekin
Published: July 2024

Purpose:

To compare the intraocular pressure (IOP)-lowering efficiency of gonioscopy-assisted transluminal trabeculotomy (GATT) and trabeculectomy (TRAB) with mitomycin C in patients with primary open-angle glaucoma (POAG) and pseudoexfoliative glaucoma (PEXG).

Methods:

In this retrospective comparative study, consecutive patients with POAG or PEXG who underwent GATT or TRAB by a single surgeon and with a follow-up period of at least 1 year were included. Surgical success rates, change in best-corrected visual acuity, IOP, the need for antiglaucoma medication, surgical complications, and the need for additional glaucoma surgery were compared. Surgical success was defined as an IOP reduction of ≥30% or an IOP of ≤18 mmHg. Complete success was defined as without medication. Qualified success was defined as with or without topical medication.

Results:

The mean baseline IOP was 27.4 ± 8.3 and 24.6 ± 7.6 mmHg (P = 0.13) with the mean number of medications being 3.7 ± 1.0 and 3.7 ± 1.1 (P = 0.98) in TRAB and GATT, respectively. At 12 months, the mean IOP was 15.3 ± 3.5 and 12.5 ± 4.6 mmHg (P = 0.24) with the mean number of medications being 0.9 ± 1.2 and 0.8 ± 1.4 (P = 0.76) after GATT and TRAB, respectively. IOP was lowered from baseline by 52.7% ± 17.5% after TRAB and 45.7% ±18.6% after GATT (P = 0.12). There was no decrease in best-corrected visual acuity in either group. The qualified surgical success rate was 94.4% in the GATT group and 94.9% in the TRAB group (P = 0.75). Percentage of complete success was 64.1% and 52.8% (P = 0.22) after TRAB and GATT, respectively.

Conclusion:

In patients with POAG and PEXG, GATT was as effective and safe as TRAB in lowering IOP and reducing the number of antiglaucomatous drugs.
Short-term outcomes of Tanito microhook ab interno trabeculotomy combined with phacoemulsification in primary open-angle glaucoma – A pilot study
Authors: Sasidharan Ajita , Shah Paraali , Thulasidas Mithun
Published: July 2024

Purpose:

The aim of the study was to assess the early postoperative efficacy and safety of Tanito microhook (TMH) ab interno trabeculotomy combined with phacoemulsification in patients with primary open-angle glaucoma (POAG).

Methods:

This prospective interventional study was conducted on consecutive patients with visually significant cataract and mild-moderate POAG. All patients underwent a temporal clear corneal phacoemulsification combined with TMH ab interno trabeculotomy. Postoperative evaluation was done on day 1, 1 month, and 3 months. The outcome measures included intraocular pressure (IOP) at different follow-ups and postoperative complications.

Results:

In total, 30 eyes of 30 patients were included in the study. There were 16 (53.3%) females and 14 (46.7%) males with a mean age of 62.63 ± 6.7 years. The mean IOP reduced from 23.57 ± 1.65 to 17.33 ± 2.84 at 3 months (P < 0.001). All eyes had a corrected distance visual acuity ≥6/9 at 1 month postoperatively. Postoperative complications included corneal stromal edema in eight (26.7%) eyes, hyphema in four (13.3%) eyes, and IOP spike in one (3.3%) eye.

Conclusion:

TMH ab interno trabeculotomy combined with phacoemulsification in patients with mild-moderate POAG is an effective and safe procedure with fewer complications.
Combined corneal biomechanical and tomographical indices in subclinical and forme fruste keratoconus
Authors: Ganesh Meghna , Arora Ritu , Titiyal Jeewan S
Published: July 2024

Purpose:

Evaluation of combined corneal tomographic and biomechanical parameters in subclinical/forme fruste keratoconus (ScKC/FFKC).

Design:

Cross-sectional observational case-control study.

Methods: Inclusion Criteria:

Thirty-one eyes with ScKC (fellow eye of KC with any one sign: keratometry >47 diopters, cylinder >1.5 D, central corneal thickness <500 µm, with/without abnormal topography) or FFKC (fellow eye of KC with normal topography and slit lamp examination) >13 years (cases) and 44 eyes of age-matched 22 healthy subjects (controls).

Exclusion Criteria:

Clinically diagnosed KC, presence of corneal scars, and prior ocular surgery eyes.

Study Parameters:

Sixteen Pentacam, 15 Corvis ST, and five Sirius parameters were analyzed using paired sample t-test, and a subsample found to be significantly different was used in receiver operating characteristic curve analysis. The Youden index was calculated, and Pearson’s correlation analysis was done.

Results:

Five Pentacam, three Corvis ST, and two Sirius parameters had an area under curve (AUC) >0.75. Tomographic and biomechanical index (TBI) (cutoff 0.59, 95% specificity, 77% sensitivity), Belin Ambrosio enhanced ecstasia display (cutoff 1.8, 81% specificity, 80% sensitivity), and symmetry index of posterior corneal curvature (cutoff 0.16, 97% specificity, 67% sensitivity) best identified early KC. TBI strongly correlated with maximum Pentacam parameters in both cases and controls. Corvis biomechanical index strongly correlated only in cases, and SP-A1-SD weakly correlated in cases.

Conclusion:

Upon combined analysis, the average sensitivity and specificity, respectively, of top three parameters (according to AUC) from Pentacam and Corvis ST were 74.1% and 95.4% for posterior elevation and TBI.

Trial Registration:

The trial was registered in Clinical Trial Registry of India on January 28, 2022. The Trial Registration Number is REF/2022/01/050638.
The Association between Number of Follicular Stelae and Severity and Treatment Response of Alopecia Areata Cases: A Retrospective Study
Authors: Gencebay Güllü , Aşkin Özge , Aydin Övgü , Serdaroğlu Server
Published: July 2024

Background:

Alopecia areata (AA) is an autoimmune disease characterized by peribulbar lymphocytic infiltration, follicular miniaturization, catagen/telogen follicles, and increased follicular stelae (streamers) in skin biopsies.

Objectives:

Our aim was to assess the number of follicular stelae of patients with AA and to evaluate their association with clinical type and severity and treatment response of AA.

Materials and Methods:

Histopathologic features including the number of follicular stelae were recorded in skin biopsies taken from lesions of AA in 142 patients who attended our dermatology clinic from 2011 to 2017.

Results:

There was a statistically significant correlation between patient age and the number of follicular stelae (P = 0.001). There was a statistically significant correlation between the severity of disease and number of follicular stelae (P = 0.005). AA subtypes (0%–25% scalp hair loss) had a significantly lower number of follicular stelae than 75%–100% of scalp hair loss and alopecia universalis (7.92 ± 4.21 vs. 13.23 ± 7.28). There was no statistically significant correlation between treatment response and the number of follicular stelae (P = 0.75).

Conclusion:

Our results showed that the number of follicular stelae varied among AA clinical types and correlated with severity. This study was the first to evaluate the correlation between the number of follicular stelae and severity of AA.
Trichoscopy in Trichotillomania – Monitoring Treatment Response
Authors: Srisukhirthi S. , Kuruvila Sheela , Ramamurthy Parthasarathy
Published: July 2024

Trichotillomania is nonscarring alopecia with recurrent pulling out of one’s hair and repeated attempts to reduce hair pulling. Clinical improvement in the urge to pull out hairs in trichotillomania is often not quantifiable and based on unreliable history. Here, we present a case of trichotillomania with follow-up features on trichoscopy during treatment. By this, we propose trichoscopy as an objective tool to visualize clinical improvement in the urge to pull out hairs and assess treatment efficacy.
Functional Outcome of Patients with Malignant Tumors around the Knee Treated by Modular Endoprosthesis: A Comparative Study between Patellar Resurfacing and Nonresurfacing
Authors: Ebeid Walid Atef , Mehanna Mohamed Taha A. , Moustafa Mohamed Saleh , ElNasr Khaled Mohamed Ahmed Abo , ElFadl Sameh Mahmoud Abo
Published: July 2024

Background:

Patellar resurfacing with knee arthroplasty has always been controversial. The literature contains data that support both resurfacing and not resurfacing the patella. However, the literature does not review a lot of studies that address the impact of patellar resurfacing on the functional outcome following resection of distal femur tumors and limb salvage using modular prosthesis.

Questions/Purposes:

Is patellar resurfacing better than nonresurfacing as regards functional outcome of modular prosthesis used for the treatment of tumors around the knee?

Patients and Methods:

Two groups of patients; both were subjected to wide excision of tumors around the knee and limb salvage using modular prosthesis. The first group underwent reconstruction with patellar resurfacing, while the second underwent reconstruction without patellar resurfacing. The age of these groups of patients ranged from 11 to 71 years. The patients were 17 males and 19 females. We evaluated patients using the musculoskeletal tumor society scoring system (MSTS), knee society final score, knee society function score, and anterior knee pain score.

Results:

We found that MSTS functional score, knee society final score and knee society function score, and anterior knee pain score were all better in patients who underwent patellar resurfacing compared to nonresurfacing patients. However, only the difference in anterior knee pain score was statistically significant (P = 0.030). Differences in other scores between these two groups were all statistically insignificant (P value of the MSTS difference = 0.103, P value of the knee society final score difference = 0.423, and P value of the knee society function score difference = 0.337).

Conclusions:

Patellar resurfacing could be helpful in decreasing anterior knee pain and the necessity to future surgeries addressing patellofemoral pain, especially in revision cases, patients with patellofemoral problems, and patients with extensor mechanism weakness and those with anterior knee pain. Since Anterior Knee Pain Scale was the only scoring system, among all scoring systems used, that confirmed a significant impact of patellar resurfacing on the outcome following resections and reconstructions; we cannot give an explicit strong recommendation favoring the routine patellar resurfacing in all cases undergoing resections and reconstructions using modular prosthesis. We recommend patellar resurfacing in older patients, based on our results, which show possible benefit of patellar resurfacing in older patients. We think that old age and the preexisting knee arthritis could be relative indications for patellar resurfacing.
Short-Term Results after Reverse Total Shoulder Arthroplasty
Authors: Shoukry Mahmoud , El-Rhaman Amr Ahmed Abd , Abdelazim Haytham , Khater Ahmed Hany , El-Wahab Mahmoud M. Abd , Abouelsoud Maged
Published: July 2024

Background:

The loss of the shoulder’s center of rotation is caused by massive rotator cuff tears, which can occur with or without arthritis and proximal humerus fractures that are nonunion or malunion. Because anatomical total shoulder arthroplasty cannot provide a stable center of rotation, reverse total shoulder arthroplasty (RTSA) is the appropriate procedure for these indications and in older patients who have primary glenohumeral osteoarthritis. Anatomical total shoulder arthroplasty carries a risk of failure because of the loosening of the glenoid component or cuff tear. The purpose of this study was to determine the short-term outcomes following RTSA in patients who had primary glenohumeral osteoarthritis, acute proximal humerus fractures, malunited or nonunited proximal humerus fractures, and massive cuff tears.

Materials and Methods:

This single-arm clinical trial (interventional study) was done in Ain Shams University Hospitals; 16 patients were included who underwent RTSA. Constant score, American Shoulder and Elbow Surgeon score, Visual Analog Scale score, and range of motion (ROM) were the short-term outcomes. Patients with cuff tear arthropathy, irreparable cuff tear with or without glenohumeral arthritis, elderly patients with unreconstructable proximal humerus fracture, proximal humerus fracture malunion or nonunion, and patients with glenohumeral osteoarthritis were included. Patients under the age of 50, as well as those with deltoid muscle dysfunction or injuries to the axillary nerve, were excluded.

Results:

There were 16 patients in this study, 8 of whom were male and 8 of whom were female. The follow-up period lasted 2 years following surgery, with a mean age of 64.19 years. The study included 7 patients with irreparable cuff tears one of them had associated anterior shoulder instability and recurrent anterior shoulder dislocation. One patient had a neglected shoulder dislocation, two patients had proximal humerus fracture dislocation, two patients had a nonunited proximal humerus fracture, three patients had unreconstructable proximal humerus fracture, and two had glenohumeral osteoarthritis.

Conclusion:

Not only did RTSA provide good clinical and functional outcomes for the standard indication of a massive cuff tear, but it also proved beneficial for other disorders such as primary glenohumeral osteoarthritis, nonunited fracture, and acute proximal humerus fracture. Among all indications, irreparable cuff tears yielded the highest results; nonunited fractures displayed the least improvement regarding clinical outcomes. Enhancements in the design of prostheses, the expertise of surgeons, and clinical outcomes are crucial to maximize their effectiveness in treating various shoulder disorders.
Arthroscopically Assisted Technique in the Treatment of Ankle Fractures with Posterior Malleolus Fragment in Adults
Authors: Elhabet Mohamed Atef Mohamed , Abo-Elnasr Khaled Mohamed , Henawy Ayman Tawfik , Metwally Ahmed Mahroos , Toreih Ahmed Aly
Published: July 2024

Introduction:

Ankle fractures constitute a challenging condition due to its high impact on the long term. Thus, advancements in management have been proposed to ensure the best possible outcome. Hence, we aimed to assess the role of arthroscopy in the treatment of ankle fractures that involve posterior malleolus fragments in adults.

Patients and Methods:

In a quasi-experimental, interventional, prospective, nonrandomized study, we included 16 adult patients with acute ankle fracture with posterior malleolus fragment. They underwent arthroscopically assisted technique for their fracture treatment. A standard systematic arthroscopic ankle examination, their fracture grade, and classification were assessed, and subsequent management was conducted. The patients were followed up for 6 months using the American Orthopedic Foot and Ankle Society (AOFAS) score and radiographic monitoring with standard X-ray.

Results:

The mean AOFAS score improved significantly after 6 months of follow-up (from 84.81 in the 3rd month to 92.81 in the 6th month). Ankle dorsiflexion angle and ankle plantar-flexion angle showed a gradual increase during follow-up, reaching 17.31° ± 3.25° and 45° ± 5°, respectively. Only two patients developed complications. Age, body mass index, and grade of the osteochondral lesion were negatively correlated statistically significantly with the AOFAS score. This proves the effective role of arthroscopically assisted technique in the treatment of ankle fractures with posterior malleolus fragment.

Conclusion:

Arthroscopically assisted technique in the treatment of ankle fractures with posterior malleolus fragment in adults resulted in good functional outcomes with less complications and it allows the assessment of associated intra-articular injuries. Further studies with longer follow-up periods are needed for the assessment of outcomes and complications for comparison.
Trabecular Metal Augments for Reconstruction of Acetabular Bone Defects in Revision Total Hip Replacement: Short-Term Outcomes
Authors: El Axir Husam M. , Alashhab Mohamed G. , Khater Karim S.
Published: July 2024

Background:

Revision hip surgeries are increasing dramatically nowadays, and achieving hip center of rotation is challenging. Obtaining a press-fit implant and restoring the hip’s center of rotation might be difficult during the restoration of acetabular deformities during revision total hip arthroplasty (THA).

Aim:

The aim of the study was to evaluate the outcomes of using trabecular metal augments for reconstruction of the acetabulum in patients undergoing revision THA with short-term follow-up.

Patients and Methods:

This study was conducted in Benha University Hospital between April 2019 and March 2023. It is a prospective cohort study including 20 patients who are undergoing revision THA with acetabular defects.

Results:

The mean age of patients in this study was 59 years old. According to Paprosky classification: 45% of type 2B. The postoperative Oxford Hip Score showed marked improvement in the outcomes, the score was excellent in 55% (11 patients), good in 40% (8 patients), and fair in only 5% (1 patient) over 16 months’ mean follow-up period.

Conclusion:

Due to its modularity, tantalum augments are considered a valuable method in the reconstruction of acetabular defects.
Calculation of Organ Dose Distribution (in-field and Out-of-field) in Breast Cancer Radiotherapy on RANDO Phantom Using GEANT4 Application for Tomographic Emission (Gate) Monte Carlo Simulation
Authors: Behmadi Marziyeh , Toossi Mohammad Taghi Bahreyni , Nasseri Shahrokh , Ravari Mohammad Ehsan , Momennezhad Mahdi , Gholamhosseinian Hamid , Mohammadi Mohammad , Mdletshe Sibusiso
Published: July 2024

Introduction:

Organ dose distribution calculation in radiotherapy and knowledge about its side effects in cancer etiology is the most concern for medical physicists. Calculation of organ dose distribution for breast cancer treatment plans with Monte Carlo (MC) simulation is the main goal of this study.

Materials and Methods:

Elekta Precise linear accelerator (LINAC) photon mode was simulated and verified using the GEANT4 application for tomographic emission. Eight different radiotherapy treatment plans on RANDO’s phantom left breast were produced with the ISOgray treatment planning system (TPS). The simulated plans verified photon dose distribution in clinical tumor volume (CTV) with TPS dose volume histogram (DVH) and gamma index tools. To verify photon dose distribution in out-of-field organs, the point dose measurement results were compared with the same point doses in the MC simulation. Eventually, the DVHs for out-of-field organs that were extracted from the TPS and MC simulation were compared.

Results:

Based on the implementation of gamma index tools with 2%/2 mm criteria, the simulated LINAC output demonstrated high agreement with the experimental measurements. Plan simulation for in-field and out-of-field organs had an acceptable agreement with TPS and experimental measurement, respectively. There was a difference between DVHs extracted from the TPS and MC simulation for out-of-field organs in low-dose parts. This difference is due to the inability of the TPS to calculate dose distribution in out-of-field organs.

Conclusion and Discussion:

Based on the results, it was concluded that the treatment plans with the MC simulation have a high accuracy for the calculation of out-of-field dose distribution and could play a significant role in evaluating the important role of dose distribution for second primary cancer estimation.
Cytokeratin 8 depicts nodal metastasis in head and neck squamous cell carcinoma
Authors: Thamilselvan Snega , Pandiar Deepak , Krishnan Reshma P. , Chitra S.
Published: July 2024

Background:

Nodal involvement in squamous cell carcinoma is an important feature directly associated with the poor prognosis in patients with head and neck squamous cell carcinoma (HNSCC). There are no clear cut indicators available currently to identify the lymph node metastases and overall prognosis in HNSCC. Thus, the current study was conducted to correlate the immunoexpression of cytokeratins (CK) 8, 10, and 14 with lymph node metastases and tumour differentiation in patients with HNSCC.

Material and Methods:

The study population included 61 retrospective cases of HNSCC with lymph node metastases (n = 31) and without lymph node metastases (n = 30). Expression of CK 8, 10, and 14 was assessed by immunohistochemical staining procedure. Using Pearson’s Chi-square test and Spearman’s correlation coefficient, the correlation of these markers with lymph node metastases and tumour differentiation was statistically analysed.

Results:

The expression of CKs in HNSCC cases was higher than in controls. In nodal metastasis cases, CK 8 expression was noted in >50% of the tumour cells at the invasive tumour front (ITF) (P value 0.008), and in cases without nodal metastasis, <1% or negative expression was noted. CK 10 expression gradually decreased as the tumour grade increased. Association of CK 10 expression and tumour differentiation exhibited statistically significant results (P value 0.03). CK 14 expression was noted in the entire epithelium and at the ITF, strongly in most cases; however, CK 14 did not correlate with the lymph node metastasis and tumour differentiation as well.

Conclusion:

We found a strong correlation of CK 8 expression with nodal metastasis in HNSCC, and it can be utilised as a reliable prognostic indicator.
Animal metaphors in oral pathology-A review
Authors: Maraimalai Nivedhitha , Trimukhe Akshay C. , Chettiankandy Tabita J. , Tiwari Saumya
Published: July 2024

Oral pathology is a challenging yet intriguing subject. By comparing pathological traits to things we typically encounter, it is possible to reduce the difficulty of memorising these qualities. Hence, the usage of various analogical methods, like the usage of metaphors, conveys likeliness or similarities between two items and can help the students. A lot of pathological features have a resemblance to animals we see on a frequent basis. Students might find comparing, examining and comprehending oral pathology easier when the information is compared with familiar animals. This article is an attempt to compile animal metaphors related to oral pathology.
Unusual presentation of primary central xanthoma of the maxilla associated with impacted canine: An update on immunohistochemistry in the diagnosis
Authors: Shivananda S , Doddawad Vidya G , Vidya C S , Sowmya S
Published: July 2024

A xanthoma is an extremely rare condition that affects the soft tissues and bones and is characterized by a predominance of lipid-rich foamy histiocytes. The onset of xanthomas is frequently accompanied by primary or secondary hyperlipidemia. Primary bone xanthomas are very uncommon benign bone lesions that are not linked to hyperlipidemia. Histopathologically, they are distinguished by histiocytes, an abundance of foam cells or xanthoma cells that contain lipids, and a paucity of multinucleated giant cells. There have only been four reports of primary maxillary xanthoma in the medical literature. We present a rare primary intrabony xanthoma of the anterior maxilla in a 23-year-old normolipidemic female patient with solitary radiolucency. Using CD68, S-100, and CD1a immunohistochemical staining, it is possible to distinguish between macrophage/non-Langerhans histiocytes and Langerhans histiocytes. Therefore, a diagnosis of a central xanthoma of the jaws must be made.