bluuebunny/crossref_metadata_2025 huggingface dataset:
A Prospective Study on the Prevalence of Coronavirus Disease 19 Infection in Antenatal Patients at Term and Its Effects on Maternal-fetal Health and on Early Childhood Development
Authors: Mustajib Ali , Arunav Sharma , Abdul Sheik R. , Bhargava Harshit , Sunil Agrawal
Published: November 2023

Background:

Coronavirus disease 19 (COVID-19) has become a global pandemic; its unparalleled speed of spread has left us all in a worldwide alarming situation.

Aims:

The aim was to study the prevalence of COVID-19 infection in asymptomatic antenatal patients at term and its maternal and fetal outcomes and neonates being followed up till 18 months for developmental assessment. This was a prospective observational study carried out from September 1, 2020, to March 31, 2023.

Materials and Methods:

This prospective observational study was conducted on 250 pregnant women attending the antenatal care outpatient department in a Zonal Hospital in Northeastern India expected to undergo delivery in the next 5 days, and all suspected COVID-19 pregnant women were included in the study. Asymptomatic pregnant women not expecting delivery in the next 5 days were excluded. All neonates born to these 250 mothers were followed till 18 months of age and were then assessed for the impact of COVID-19 on the developmental milestones. The prevalence of COVID-19 was calculated in the study population. The Chi-square test was used to compare categorical variables in COVID-19-positive and -negative groups. P <0.05 was considered significant.

Results:

The prevalence of COVID-19 infection in term pregnancies was found to be 4%. The findings of the study showed no immediate impact on maternal and fetal health from COVID-19 infection. However, on follow-up of these babies (born during the pandemic) at 18 months of age, there was a delay in social and language domains of development in 18.8% of children. Most women were discharged without any significant problems, and there were no signs that COVID-19 had been transmitted vertically.

Conclusion:

COVID-19 infection was found to have no immediate impact on maternal and neonatal health. However, follow-up at 18 months of babies born during the COVID-19 era revealed a delay in social and language milestones in 18.8% of children. Further multicentric studies with a larger population base need to be done to substantiate this claim.
Unusual Inflammatory Clinical Presentation After Cataract Surgery and that Thought-provoking Question: Is this Infection or Toxic Anterior Segment Syndrome?
Authors: Kaplan Anil , Tas Muhammed D. , Selver Ozlem B.
Published: November 2023

PURPOSE:

Toxic anterior segment syndrome (TASS) is a noninfectious anterior chamber reaction caused by ocular surgeries. It usually develops within the first 12–48 h after surgery. In case of clinical suspicion of TASS, endophthalmitis as a devastating disease should always be excluded. However, the fact that TASS and endophthalmitis can look the same, but the treatment for each is different. Therefore, distinguishing between the two conditions is an important factor in coping with both diseases. It was aimed to describe the features and clinical management that are considered when distinguishing the cause of unexpected inflammatory response after cataract surgery.

METHODS:

A retrospective review of medical records of 13 patients who developed TASS in our clinic at Ege University Ophthalmology Department on three different days between July 2022 and December 2022 were included in this study. Anterior segment photographs of those 13 patients and the records of ophthalmological examinations of those patients, including best-corrected visual acuity (BCVA), ocular pressure, biomicroscopic, and fundoscopic examination, were collected. Medical data were evaluated retrospectively.

RESULTS:

The mean time to onset of clinical symptoms was 27.6 h. The main complaint was pain in nine patients. The primary symptom in the remainder of the patients was blurred vision. Severe hypopyon was seen in 5 cases. Despite the presence of pain and hypopyon, patients who were treated with topical steroids were closely followed up (every 2 h) because they were consecutive patients and had relatively acute onset complaints. Inflammation was regressed after an average of 4 h. No factor causing TASS was found. The BCVA was at the minimum level of 8/10 on the 5th day of surgery.

CONCLUSION:

When distinguishing TASS from endophthalmitis, severe pain, relatively late onset, hyperemia, and the presence of severe hypopyon usually lead ophthalmologists to the clinical diagnosis of endophthalmitis. However, in this study, most of the patients diagnosed with TASS had severe pain, a significant portion of them had hypopyon, and the onset of the symptoms was relatively late. Close follow-up immediately after suspicion plays a vital role in clinical diagnosis and management accordingly.
Vestibulo-ocular Reflex – A Narrative Review
Authors: Swain Santosh Kumar , Dubey Debasmita
Published: November 2023

The vestibulo-ocular reflex (VOR) causes movements of the eye that are intended to compensate for head and body movements so that vision remains stable on the retina. VOR helps to stabilize the retinal image by rotating the eyes to compensate for movements of the head. The VOR keeps us steady and balanced even though our eyes and head are continuously moving during the performance of actions. The VORs are driven by signals coming from vestibular labyrinths and use subcortical, short-latency pathways from vestibular afferents to the extraocular motor neurons. The relatively simple neural architecture of these reflexive responses, coupled with their stereotyped but adaptable nature, makes them ideal to understand simple sensorineural transformations. Without VOR, when an individual walks down the street, it is difficult to read signs or even recognize faces. Even an inaccurate VOR can result in a slip of visual image concerning photoreceptors, causing blurring of the images. If the VOR is injured, the retinal slip occurs which causes instability in gaze during rapid head movements. The disruption of the VOR results in oscillopsia and abnormal nystagmus. Oscillopsia causes blurred vision when the head is in motion and objects appear to jiggle and bounce as this object does not fix at one point in the retina. The objective of this review article is to discuss the anatomy of VOR with its bedside examinations, clinical implications, and management of VOR failure.
Diagnostic Criteria of Benign Paroxysmal Positional Vertigo
Authors: Swain Santosh Kumar
Published: November 2023

Benign paroxysmal positional vertigo (BPPV) is the mos common cause of peripheral vertigo. The pathophysiology of BPPV is canalolithiasis which includes free-floating otoconial debris within the endolymph of a semicircular canal, or cupulolithiasis comprising otoconial debris adherent to the cupula. The posterior and/or lateral semicircular canals are often affected in BPPV. It is characterized by a brief episode of rotatory vertigo associated with positional and/or positioning nystagmus, which is elicited by specific head positions or changes in head position relative to gravity. In the case of the posterior canal type of BPPV, torsional nystagmus is induced by the Dix-Hallpike test. In patients of lateral canal type of BPPV, horizontal geotropic or apogeotropic nystagmus is induced by the supine roll test. The observation of positional and/or positioning nystagmus is needed for the diagnosis of BPPV. The treatment of BPPV includes canalith repositioning procedure (CRP). By series of head position changes, the CRP moves the otoconial debris from the involved semicircular canal to the utricle. This review article presents operational diagnostic criteria for BPPV, formulated by the Committee for Classification of Vestibular Disorders of the Barany Society. This classification reflects the current knowledge of the clinical aspect and pathophysiology of BPPV. These diagnostic criteria will be helpful for the understanding of the disease and will lead to further development in the management of BPPV.
Incident management system comparison: Hospital Incident Command System versus Major Incident Medical Management and Support
Authors: Mzahim Bandr , Alzahrani Abdulrahman , Alzahrani Abdullah Ahmed , Aldharman Sarah , Alkhamis Wala , Almutairi Bandar S. , Sabbagh Abdulrahman Y. , Khan Anas
Published: November 2023

The Hospital Incident Command System (HICS) and Medical Major Incident Management System (MMIMS) are incident management systems that any hospital may utilize to deal with threats, scheduled events, or emergencies. Both are valuable systems since they provide an organizational framework for incident management and include planning, developing, and adjusting that structure. HICS is used in the United States and MMIMS in the United Kingdom. The aim of this study is to find and show the difference, elements, and concepts of MIMMS and HICS. A scoping review of relevant papers and documents for the HICS was conducted. Medical Incident Command System, HICS, Healthcare Incident Command System, MMIMS, and Major Incident Management System are all referred to the same definition of HICS that was mentioned in the introduction. This research took place from March through June of 2022. From January 1, 1995, to June 15, 2022, all publications, books, guidelines, and manuals were extracted. We searched PubMed, Ovid, Springer, Scopus, Web of Science, and Google Scholar for articles. In conclusion, the main principles, strengths and weak points, and characteristics of the HICS and MMIMS appear to be the same. The differences were specified in the elements and chain of commands, which were designed to the geographic and governmental factors. Both systems are efficient and competent to achieve the goal of HICS but should be applied within the country’s borders as it is an integrated system.
Reference for normal measurements of psoas muscle among the adult population in Saudi Arabia
Authors: Wazzan Mohammad Abdulrahim
Published: November 2023

Background:

Psoas muscle measurements and values are generally used to diagnose sarcopenia and evaluate health and well-being. These tests can provide valuable and objective methods to assess patient tolerance to treatments including major surgery, chemotherapy, and physiotherapy.

Aim:

In this study, we validated the normal measurements and values of the psoas muscle in the adult population of Saudi Arabia.

Settings and Design:

This study included a retrospective analysis of computerized tomography (CT) studies of 500 adult patients over 18 years of age without any known medical illnesses.

Methods:

The surface areas and volumes of the psoas muscles on both sides were measured separately on each CT scan in squared centimeters and cubic centimeters (cm3), respectively. The normalized total psoas area (NTPA) was calculated as the total (right and left) psoas area in mm2 normalized to the patient height in meters (m).

Statistical Analysis:

All statistical analyses were performed using SPSS version 23.0 software (IBM SPSS, Chicago, IL, USA). The Student’s t-test was used to evaluate measurement differences between males and females. One-way analysis of variance was used to determine measurement differences due to age. P < 0.001 was considered statistically significant.

Results:

The psoas muscle values of male participants were significantly higher than those of females. The volumes, surface areas, and NTPAs of the psoas muscles were correlated with patient age and sex. Muscle mass decreased with age, especially after the fifth decade of life, and the highest measurement was observed in the fourth decade of life. The mean psoas muscle surface areas at the lumbar vertebra 4 (L4) level measured 14.0 ± 3.4 cm2 and 7.5 ± 2.2 cm2 in the male and female populations, respectively. Furthermore, the mean psoas muscle volumes measured 436.0 ± 140.2 cm3 and 219.1 ± 73.1 cm3 in the male and female populations, respectively. Finally, the total NTPAs measured 995.1 ± 302.9 mm2/m2 and 667.0 ± 538.5 mm2/m2 in the male and female populations, respectively.

Conclusion:

This study established psoas muscle reference values suitable for defining sarcopenia in the Saudi Arabian population. Our study results suggest that application of these research methods to determine psoas muscle values may enable assessment of future health-care outcomes for individuals. Moreover, the results may be utilized in a unique and constructive way to predict tolerance of patient populations to therapeutic interventions including surgery, cancer treatment, and rehabilitation services.
Tonsillitis Prevalence, Diagnosis, and Treatment among Patients at Al-Baha Region, Saudi Arabia
Authors: Alghamdi Rawan M. , Alzahrani Rajab Ahmed , Alzahrani Abdullah Ali H. , Alghamdi Fayez Saad , Albanghali Mohammad A. , Mir Shazia Shaheen , Almalki Shaia Saleh Rajab
Published: November 2023

Background:

Tonsillitis is considered one of the most otolaryngological diseases affecting children and adults. Tonsillectomy is one of the common surgical procedures mostly with children and in cases of chronic tonsillitis or recurrent tonsillitis.

Aims:

The objective of this study was to examine the incidence of tonsillitis, along with its methods of diagnosis and treatment, among patients residing in the Al-Baha region of Saudi Arabia.

Settings and Design:

A retrospective observational cross-sectional analysis of tonsillitis patients who attended the pediatric, emergency room, adult surgery, and ear, nose, and throat clinics at a hospital in Al-Baha, Saudi Arabia, from January 2019 to January 2023.

Subjects and Methods:

This research used purposive sampling. Covered examining data acquired and analyzed 348 tonsillitis-related throat swabs and blood samples.

Statistical Analysis Used:

Data were statistically analyzed using the Statistical Package for the Social Sciences software version 20.0 IBM (Armonk, New York, USA).

Results:

A total of 348 patients diagnosed with tonsillitis were examined. Males had tonsillitis more than females (n = 208, 60% and n = 140, 40%, respectively). The most frequent bacteria isolated were Streptococcus pyogenes group A beta-hemolytic, Staphylococcus aureus, methicillin-resistant S. aureus, and Klebsiella pneumoniae (n = 68, 19.5%; n = 24, 6.9%; n = 12, 3.4%; and n = 12, 3.4%, respectively).

Conclusions:

Tonsillitis is an oral and public disease affecting both children and adults in Al-Baha region. The emphasis should be on enhancing the public health system to reduce tonsillitis and its consequences via effective awareness efforts. Hospitals may also be urged to develop unique criteria for tonsillitis swabs in order to reduce contamination and improve diagnosing the etiology of bacterial tonsillitis.
Tuberculosis of the scalp in a 13-year-old child: A common entity at an uncommon location – A rare case report
Authors: Hassan Mohammad Jaseem , Ahmed Saqib , Khalid Saifullah , Akhtar Kafil , Hasan Mahboob
Published: November 2023

Tuberculosis (TB) caused by Mycobacterium tuberculosis manifests as pulmonary and extrapulmonary forms with cutaneous TB being rare and TB of scalp even rarer. We report the case of a 13-year-old girl who was admitted with a 4-week history of painful swelling and ulcer on the scalp and occasional cough. She had a history of falling on the head 6 months ago. On physical examination, the ulcer measured 6 cm in diameter and was tender with a yellowish-white crust. Contrast-enhanced computed tomography of the head showed a well-defined hypodense peripherally enhancing lesion overlying the left parietal bone with the destruction of the underlying bone. A clinical diagnosis of frontal bone osteomyelitis was made. Abscess drainage was done with excision of the lesion which on histopathological examination showed abundant necrosis with few ill defined epithelioid cell granulomas, langhans type of giant cells, and chronic inflammatory infiltrates. Ziehl–Neelsen staining for acid-fast bacilli was negative, whereas molecular testing by GeneXpert Rifampicin Assay was positive for M. tuberculosis. Thus, a diagnosis of tubercular osteomyelitis was made. Our patient was prescribed four drugs antitubercular regimen for 1 year. On follow-up after 6 months, she is doing fine without any signs and symptoms of the disease. TB should always be kept in mind as the differential diagnosis keeping its varied presentation and high prevalence in our country.
Acute promyelocytic leukemia with acute perforating appendicitis: A rare occurrence of medical and surgical emergency
Authors: Momin Majed Abdul Basit , Reddy Gutha Sashidhar , Manivasagan Manisegran , Ingle Abhijeet , Rathore Rahul Dev Singh , Jakkani Ravikant
Published: November 2023

Acute promyelocytic leukemia (APML) is a rare subtype of acute myeloid leukemia characterized by the predominance of atypical promyelocytes. Acute perforating appendicitis with atypical promyelocytic infiltration of the appendix is exceptionally rare. The presence of a dual emergency complicates diagnosis, management, and survival. A 31-year-old female presented to the emergency department with a 2-week history of fever with chills, diffuse abdominal pain, and vomiting, followed by swelling and pain in the left lower limb, loose stools, and generalized weakness. Hematological findings and abdominal imaging showed APML and acute perforative appendicitis, respectively. She had an emergency laparoscopic appendectomy, which revealed atypical promyelocytic infiltration with perforative appendicitis on histological examination. Despite aggressive treatment, she died as a result of APML-related complications such as disseminated intravascular coagulation, hemorrhages, and shock. This case highlighted the importance of using an early multidisciplinary approach to diagnose and treat these fatal emergencies as promptly as possible.
Student nurses’ experiences of their first clinical placement in intensive care unit: A descriptive phenomenology study
Authors: D Costa Maria Pramila , Leccio Bherlyn Joy , Unissa Syeda Syadath , Al-Shezawi Hanaa Abdulaziz
Published: November 2023

Background:

Technical complexity of patient care and the critical environment at the intensive care unit (ICU) provides a favorable setting for acquiring complicated and comprehensive skills among nursing students.

Aims:

The current research aims to explore the nursing students’ experiences of their first clinical placement in the ICU and identify the factors that facilitate or hinder their learning.

Settings and Design:

A study using a qualitative descriptive phenomenological approach was conducted in one of the Oman College of Health Sciences branches.

Materials and Methods:

A purposive sampling technique was used to recruit 12 Year II students enrolled in the Adult Health Nursing practicum course for in-depth face-to-face interviews. The data were collected in July 2020 following approval of the Ethical Review Board.

Statistical Analysis Used:

All the interviews were transcribed verbatim and analyzed using Colaizzi’s descriptive phenomenological method.

Results:

The study results revealed three themes with several subthemes under each. The “experience,” “challenges,” and “the facilitating and hindering factors for learning” were the themes that emerged from the data analysis.

Conclusions:

Overall, students showed unfavorable responses toward the ICU experience. In addition, the unsupportive interaction with ICU staff contributed significantly to the overall impression. Therefore, strategies to enhance communication and interaction with the ICU staff are essential for a positive ICU learning experience, as students rely on the ICU staff for patient-specific information beyond their academic needs. Therefore, curriculum designers must consider these experiences to facilitate a positive experience in future clinical placements.
A model of medical students’ engagement in quality assurance system at educational program level in Saudi Arabia
Authors: Amer Mona Gomah , Mohamed Nader M. , Nemenqani Dalal M.
Published: November 2023

Background:

Active involvement of students as partners in quality processes at the college is promising in ensuring the quality of the medical school and creating a quality culture for a proper accreditation system.

Aim:

The aim of this study was to explore a model of undergraduate medical students’ perception and understanding of quality assurance (QA) in higher education and identify the challenges and empowerment factors for student involvement in Saudi Arabia.

Setting and Design:

For this purpose, students were involved as official members with the quality team at Saudi medical college. They were included in different tasks and initiatives related to QA, including a peer orientation initiative, through which they became responsible for orienting their colleagues regarding the quality principles and accreditation standards.

Methods:

A questionnaire (pre-and post) was used to evaluate the peer orientation initiative. Furthermore, another questionnaire was directed to the quality team of students to evaluate their experience.

Statistical Analysis:

Done using an independent t-test to measure the efficiency of the student’s peer orientation program through comparing pre- and postquestionnaire results.

Results:

A significant increase in knowledge and improved attitude toward quality and accreditation process at the college was detected after attending the peer orientation program. Students of the quality team recognized the importance of their active engagement and found themselves having voices and able to make changes they confirmed that transparency of QA activities and continuous communication with faculty members and program leaders in regular meetings enhance student’s self-perception, impact their future employment skills, and establish a quality culture in Saudi Arabia.

Conclusion:

The experience should be generalized and disseminated to other health profession education programs with similar students’ populations with adequate rewards and resources.
Assessment of plasma D-dimer level for prognosis, disease progression, and survival in solid malignancies
Authors: Kalwaghe Rucha , Ghongade Pravinkumar , Gupta Anupama
Published: November 2023

Background:

D-dimer is a fibrin degradation product (FDP), a small protein fragment present in the blood after a blood clot is degraded by fibrinolysis.

Aim:

To evaluate the association of D-dimer level with prognosis, disease progression and survival of patients in cases of solid malignancies.

Setting and Design:

Analytical cross sectional study conducted from February 2021 to February 2023.

Materials and Methods:

Data regarding 100 solid malignancy cases including their preintervention D-dimer levels and its value at follow up, grading, TNM [Tumor size (T), node (N), and metastases (M)] staging of tumor, disease progression and patient status were recorded.

Statistical Analysis:

Kaplan–Meier curve and Log Rank.

Results:

Amplified D-dimer level was noted in 85% cancer cases. 76.3% of oral cancer, 82% of breast cancer, 100% cases of digestive tract and ovarian cancer were presented with high D-dimer level. D-dimer in T1 + T2 stage was statistically lower than the D-dimer level of T3 + T4 stage. (χ
2 = 5.40, P = 0.002). Comparison of Lymph node in N0 versus N1 + N2 stage (χ
2 = 5.82, P = 0.0001) as well as no metastases stage (Mo) versus M1 stages (χ
2 = 3.02, P = 0.003) of solid malignancies had significant difference in D-dimer level. D-dimer increased significantly and linearly with recurrence and advancement of solid malignancy. Dead patient had higher D-dimer than alive patients (t = 3.75, P = 0.0001). Increased D-dimer was associated with elevated mortality (P = 0.023, odd ratio = 3.73, survival coefficient = 1.31 with standard error = 0.578).

Conclusion:

D-dimer is a promising prognostic biomarker which can predict poor clinical outcomes in cancer patients, cancer recurrence, progression, metastases, poor survival.
Impact of the coronavirus disease 2019 pandemic on neurosurgical patients in Taif city, Saudi Arabia
Authors: Mubaraki Adnan A , Matter Amgad El-Said , Alalawi Rahaf Mansi , Alhulayfi Raghad Mashhour , Al-Towariqi Lamees Khaled , Alghamdi Ghaida Mohammed
Published: November 2023

Background:

During the coronavirus disease 2019 (COVID-19) pandemic, the healthcare systems were obligated to work at more than maximum capacity for time due to the high transmission rate and incidence of newly infected cases. During the pandemic, all priority was given to COVID-19 cases, as the pandemic stream may exceed the health-care system’s available resources, affecting many other patients, including those with neurosurgical disorders.

Aim:

This study was designed to assess how COVID-19 affected neurosurgical patients.

Materials and Methods:

A retrospective study included all patients who were admitted to the neurosurgical department at King Abdulaziz Specialist Hospital, King Faisal Medical Complex, and Al-Hada Armed Forces Hospital during the COVID-19 pandemic. The data were collected in 5 months (April–August 2022) from the records of accessible patients.

Results:

A total of 777 neurosurgical patients were included 474 (61%) patients were male and 303 (39%) were female. The mean age of the patients was 41.2 ± 13.9 years old. A total of 481 (61.9%) patients were admitted before the pandemic, and 120 (15.4%) were admitted during the lockdown, 176 (22.7%) were admitted after the lockdown. The patient’s length of stay ranged from 1 day to more than 1 year, where 307 (39.5%) stayed for 1 week, and only 87 (11.2%) stayed for more than 2 weeks. 338 (70.7%) cases were Priority 1A emergencies, 17.8% improved, 52 (6.7%) remained stationary, while 7 (0.9%) showed clinical deterioration, and 15 (1.9%) died.

Conclusion:

According to the results of this study, both the admission rate for cases and the clinical outcome for neurosurgical patients were adversely affected by the COVID-19 pandemic. Compared to nonurgent cases, urgently admitted cases showed greater improvement.
Comparison of two volumes for extra-amniotic Foley catheter balloon inflation at preinduction of labor cervical ripening in nulliparae
Authors: Ilevbare Fidelis Oziengbe , Iribhogbe Ignis Osehie , Ande Adedapo Babatunde Anibaba , Enaruna Nosakhare Osasere
Published: November 2023

Background:

The success of induction of labor is dependent on how favorable the cervix is and the unripe cervix thus remains a well-recognized impediment to the successful induction of labor.

Objective:

The objective is to compare the efficacy of 50 ml versus 30 ml fluid inflation of Foley catheter balloon for cervical ripening in postdate nulliparous women billed for induction of labor.

Materials and Methods:

A comparative analytical study with randomization involving 88 nulliparous women with postdated pregnancy requiring cervical ripening prior to induction of labor was carried out from January 1, 2018, to August 31, 2018. They were randomized into Group A consisting of women who had 50 ml (study) and B who received 30 ml (control). Bishop score was assessed 12 h later. Data were entered into a pro forma and analyzed using the IBM Statistical Package 20.

Results:

A total of 88 patients participated in the study. A statistically significant higher mean change in Bishop score was observed in the study group when compared to the control group (5.6 ± 2.5 vs. 3.1 ± 1.6,P= 0.0001), and the difference was statistically significant. Similarly, 41 (93.2%) patients in the study group had a favorable cervix post-ripening, while in the control group, 30 (68.2%) patients had a favorable cervix (P = 0.003). More of the control group had repeat Foley catheter insertion compared to the study group (31.8% vs. 6.8%,P= 0.008).

Conclusion:

The use of 50 ml of fluid to inflate Foley catheter balloon for cervical ripening improves Bishop score better than the smaller volume of 30 ml.
Management of pancreatic abscess following acute pancreatitis
Authors: Nwashilli Nnamdi Jude , Igbinedion Blessing Ose-Emenin
Published: November 2023

Pancreatic abscess occurs as sequelae of acute pancreatitis. The standard treatment of infected pancreatic abscess is open surgical drainage and antibiotics. Recently, minimally invasive drainage methods such as image-guided percutaneous catheter drainage, transluminal endoscopic drainage through the stomach or duodenum, and retroperitoneal surgical drainage are becoming the trend. Open surgical drainage has a drawback of triggering a strong inflammatory response that can lead to multi-organ failure, bleeding, and gastrointestinal fistula unlike the minimally invasive approach. However, in the absence of facilities and expertise for minimally invasive drainage techniques, coupled with a patient with extensive/diffuse pancreatic necrosis and clinical deterioration, open surgical drainage may suffice. We report a case of pancreatic abscess which developed in a middle-aged man after few months of treatment and recovery from acute pancreatitis that was managed by open surgical drainage and parenteral antibiotics with good outcome.
Macrodrip infusion dose error among nurses
Authors: Eleke Chinemerem , Agu Ifeyinwa S. , Ngbala-Okpabi Sabinah , Bempong-Eleke Esther N.
Published: November 2023

Background:

Infusions must be administered as prescribed as too fast or slow a dose could have deleterious effects.

Objectives:

This study examined the risk for macrodrip infusion dose error among nurses in selected tertiary hospitals in southern Nigeria.

Materials and Methods:

This cross-sectional study was conducted in five university teaching hospitals in 2019. To establish the drop factor of commonly available macrodrip sets, 25 macrodrip sets were randomly sourced from the hospitals' pharmacies. A sample of 291 nurses was selected using proportionate random sampling technique. Data were collected using the adult infusion dose calculation quiz. Collected data were described and analyzed at 5% level of significance.

Results:

About 20 (80%) of the sampled macrodrip sets revealed 20 drops/ml (gtts/ml) drop factor value displayed on the packaging. When measured experimentally, all (100%) of the macrodrip sets delivered exactly 20 gtts/ml. About 255 (87.6%) respondents calculated macrodrip infusion dose while using a wrong drop factor of 10–18 gtts/ml while an additional 12 (4.2%) could not arrive at the expected infusion dose due to formula and arithmetic anomalies. In all, 267 (91.8%) respondents demonstrated tendency for infusion dose calculation error. Nonattendance of training on infusion administration significantly increased the risk for error by 21% (P = 0.001).

Conclusion:

Twenty gtts/ml is the drop factor of common macrodrip sets in southern Nigeria, and nurses were prone to infusing patients at a lower dose than prescribed. Attending training on infusion therapy might remedy this malady.
Assessment of carotid atherosclerosis disease as an incremental predictive value for cardiovascular disease risk
Authors: Laksono Sidhi , Kusharsamita Hillary
Published: November 2023

Assessment of the carotid atherosclerosis disease can give a prognostication of a patient’s cardiovascular risk. The assessment of carotid atherosclerosis is essential because of the complication of risk factors resulting in severe cardiovascular disease (CVD). This review article aims to summarize systematically the pathophysiology, followed by diagnostic assessment and therapeutic uses of imaging and treatment for carotid atherosclerosis disease. Duplex ultrasound (DUS) of the carotid artery, transcranial Doppler imaging, computed tomographic angiography (CTA), magnetic resonance angiography, and cerebral digital subtraction angiography are diagnostic techniques for carotid stenosis. Currently, DUS of the carotid arteries is the primary screening method for carotid stenosis. Recent interest has focused on carotid intima-media thickness measurements as a possible indicator of early-stage carotid atherosclerosis or CVD risk prediction. Through the growing fields of stress tests and carotid plaque screening, the classification of cardiovascular risk may be improved.
The evidence of chimney grafts in treating aortic arch diseases
Authors: Chen Yanqing , Lu Qingsheng
Published: November 2023

Steep aortic arch (such as Type III arch) and small angle between the chimney artery and aortic arch are two anatomic conditions suitable for chimney grafts (CGs). The more the number of chimneys, the higher the incidence of endoleak and branch occlusion; thus, the triple-chimney technique should be avoided unless the lesion involves zone 0 and no other better option is available, or a pending rupture is present and requires emergent repair. For the oversize of multiple chimneys, we suggest that the aortic stent and chimney stent should be increased by 5%, respectively, on the basis of single chimney. Moreover, the direction of the chimney stent is decided by the relative position of the proximal tear in patients with dissection. When the tear is located in the anterior segment, the chimney graft should be deployed behind the aortic stent graft, close to the posterior wall of the thoracic aorta, and in front of the aortic stent grafts when the tear is located in the posterior segment. In conclusion, if the endoleak is small and the patient’s condition is stable with no obvious discomfort, for most of the patients, the endoleak will disappear spontaneously in the follow-up. If the endoleak is large, microcoil could be implanted through the narrow and long gap to block the endoleak under the guidance of ultrasound. CGs technique needs to be scrutinized continuously as new data emerge. Special configurations of aortic and chimney endograft need to be developed to better treat aortic pathologies involving supra-arch branches.
A Case of Acute Intestinal Obstruction in an Infant during the COVID-19 Pandemic
Authors: Aihole Jayalaxmi Shripati
Published: November 2023

Anomalous congenital bands are rare causes of intestinal obstruction in children, adults, and neonates. They are rarely reported, and their etiopathogenesis is unknown, without malrotation in children. Their presentation and radiographic features are similar to any acute intestinal obstruction. The author found approximately 50 similar cases in the literature; however, during and after COVID-19 pandemic, this is the first case of anomalous congenital obstructing band without mal rotation to be reported to date. This is a rare case of infantile intestinal obstruction managed during COVID-19 pandemic. Acute intestinal obstruction due to a congenital anomalous band is rare in infants and children, and if not treated promptly, can lead to morbidity and mortality. Various reasons, such as congenital, acquired, and extrinsic or intrinsic pathologies in children and adults, may be the cause for acute intestinal obstruction. Congenital anomalous bands account for 3% of the intestinal obstructions in infants and children. These bands may cause ischemia and gangrene of the bowel without timely intervention.
Real-Time Artificial Intelligence-Assisted Colonoscopy and the Effect of Endoscopist Experience on Polyp Detection Rates at a Tertiary Referral Center
Authors: Seow-En Isaac , Khor Shao Nan , Zhao Yun , Ng Yvonne Ying-Ru , Tan Emile John Kwong Wei
Published: November 2023

Background:

In recent years, new technology has emerged with the potential to considerably influence the future landscape of gastrointestinal endoscopy. One example of this is real-time artificial intelligence-assisted colonoscopy (AIC). Reported improvements in polyp detection rate (PDR) and adenoma detection rate (ADR) over standard colonoscopy (SC) have led to its rapid adoption in several tertiary endoscopy centers worldwide. However, many clinicians have mixed attitudes concerning the use of AIC. Similar to other skill-based procedures, the quality of endoscopy is directly proportional to the technical expertise and proficiency of the endoscopist.

Objective:

To evaluate the use of real-time AIC versus SC at a tertiary, high-volume referral center.

Design:

Retrospective cohort study.

Settings:

Single tertiary referral center.

Patient and Methods:

Data was retrospectively analyzed from patients who underwent elective colonoscopy at Singapore General Hospital from August 1, 2022 to October 31, 2022.

Main Outcome Measures:

The primary study outcome was PDR and ADR. Subgroup analysis assessed the differences in polyp detection according to the experience level of the endoscopist.

Sample Size:

Eight hundred and fifty-nine patients.

Results:

Over the 3-month study period, 859 patients underwent complete colonoscopies performed by nine accredited endoscopists; 430 patients underwent SC and 429 underwent AIC. Both groups were statistically similar in age, gender, and indication for colonoscopy. The median ADR was 34.2% (range, 24.6%–57.3%) for the entire cohort. Overall detection rates were higher for AIC than SC for diminutive polyps (≤5 mm) (45.7% vs 38.6%, P = 0.045), sessile polyps (48.5% vs 37.4%, P = 0.009), and polyps with adenomatous (42.4% vs. 36.3%, P = 0.043) or serrated histology (1.2% vs. 0%, P = 0.025). Using SC, PDR among junior versus senior endoscopists was comparable at 47.9% vs 45.6% (P = 0.672) and ADR at 36.1% vs 36.8% (P = 0.912). With real-time AI enhancement, PDR and ADR for junior endoscopists considerably increased over their senior counterparts, with PDR at 69.5% vs 44.9% (P = 0.0001) and ADR at 50.0% vs 37.7% (P = 0.016). Among senior endoscopists, AIC did not result in any statistical improvement of PDR (P = 0.999) and ADR (P = 0.854) compared to SC.

Conclusions:

AIC significantly increases PDR and ADR compared to SC, particularly for detecting diminutive and sessile polyps. This benefit was only observed among less experienced endoscopists.

Limitations:

This study is limited by its retrospective nature, short study duration, and availability of the AI system, leading to practical constraints.

Conflict of Interest:

The authors have no conflict of interest to declare.
The Asian Thyroid Working Group, from 2017 to 2023
Authors: Kakudo Kennichi , Jung Chan Kwon , Liu Zhiyan , Hirokawa Mitsuyoshi , Bychkov Andrey , Vuong Huy Gia , Keelawat Somboon , Srinivasan Radhika , Hang Jen-Fan , Lai Chiung-Ru
Published: November 2023

The Asian Thyroid Working Group was founded in 2017 at the 12th Asia Oceania Thyroid Association (AOTA) Congress in Busan, Korea. This group activity aims to characterize Asian thyroid nodule practice and establish strict diagnostic criteria for thyroid carcinomas, a reporting system for thyroid fine needle aspiration cytology without the aid of gene panel tests, and new clinical guidelines appropriate to conservative Asian thyroid nodule practice based on scientific evidence obtained from Asian patient cohorts. Asian thyroid nodule practice is usually designed for patient-centered clinical practice, which is based on the Hippocratic Oath, “First do not harm patients,” and an oriental filial piety “Do not harm one’s own body because it is a precious gift from parents,” which is remote from defensive medical practice in the West where physicians, including pathologists, suffer from severe malpractice climate. Furthermore, Asian practice emphasizes the importance of resource management in navigating the overdiagnosis of low-risk thyroid carcinomas. This article summarizes the Asian Thyroid Working Group activities in the past 7 years, from 2017 to 2023, highlighting the diversity of thyroid nodule practice between Asia and the West and the background reasons why Asian clinicians and pathologists modified Western systems significantly.
Inconstitucionalidad del artículo 94 bis del Código Penal, que establece la imprescriptibilidad de la acción penal respecto a ciertos delitos sexuales cometidos contra menores de edad
Authors: Castillo Montt Pablo
Published: November 2023

El trabajo analiza la constitucionalidad del artículo 94 bis CP a la luz de la fundamentación entregada durante la tramitación de la ley N° 21.160 para justificar la eliminación de los plazos de prescripción de un catálogo de delitos sexuales que involucran a menores de edad. Para efectos del análisis, el trabajo presenta las concepciones actuales de la institución de la prescripción en derecho penal y propone adoptar la teoría desarrollada por Martin Asholt en Alemania, según la cual la prescripción es consecuencia de un proceso objetivo de pérdida de relevancia penal del injusto. El trabajo también expone de manera crítica la razón central que motivó la introducción del art. 94 bis CP: la idea de que la víctima tendría un derecho a la imprescriptibilidad de la acción penal en razón de que la interacción sexual con un menor produce, frecuentemente, graves y duraderas afecciones bio-psicológicas que le impiden denunciar el hecho hasta su recuperación bio-psíquica, lo que, en general, solo podría ocurrir, muy avanzada su edad adulta y con ayuda terapéutica.
Subsistencia de la reserva legal de cabotaje de carga en Chile
Authors: Genskowsky Moggia Max , Barroilhet Acevedo Claudio
Published: November 2023

Dentro del contexto del debate acerca de la subsistencia de la reserva legal de cabotaje, y los argumentos de distinta índole que se emplean e intercambian en el mismo, el propósito de este artículo es aportar a este debate, con algunas reflexiones que lo hagan más objetivo, coherente y fructífero.
El Derecho humano y el deber del Estado de acceso al agua (potable) en la doctrina de la Corte Suprema de Chile
Authors: Peña Neira Sergio Ramiro , Araya Meza Patricio Ignacio
Published: November 2023

Este trabajo revisa una línea jurisprudencial de la Corte Suprema de Chile sobre reconocimiento del Derecho a y el deber del Estado a un mínimo de agua (potable) para uso y consumo de seres humanos. El trabajo se centra metodológicamente en la dogmática y análisis lógico de la interpretación y aplicación de las normas jurídicas constitucionales e internacionales y la doctrina sustentada por la Corte Interamericana de Derechos Humanos en 2019. Es posible sostener la necesidad de reconocer derechos no consagrados en normas jurídicas constitucionales o internacionales, aunque derivadas de las mismas por procesos de razonamiento lógico. A su vez, resulta interesante desde el punto de vista de la integración de reconocimientos jurisprudenciales de este tribunal a un problema ambiental y de salud humana el desarrollo de un razonamiento concordando normas jurídicas a fin de proteger la vida humana.
Ampliación del derecho humano de acceso al agua potable: Corte Suprema (Chile), Rol Nº 5295-2022, de 26 de septiembre de 2022
Authors: Peña Neira Sergio , Araya Meza Patricio
Published: November 2023

Comentario a la sentencia de la Corte Suprema (Chile), Rol Nº 5295-2022, de 26 de septiembre de 2022.
Límites del abuso sexual por sorpresa como tipo penal residual
Authors: Mayer Lux Laura , Vera Vega Jaime
Published: November 2023

El presente artículo analiza el delito de abuso sexual por sorpresa, incorporado al ordenamiento jurídico penal chileno el año 2019. Con dicho fin, se plantea la necesidad de interpretar el texto que lo describe sistemáticamente, considerando especialmente la regulación del abuso sexual, del estupro y de la violación en el Código Penal chileno. Gracias a ello, sería posible superar una interpretación desmedida del tipo penal, que lo identifique, sin más, como un delito residual respecto de otros delitos contra la indemnidad sexual.
Involutive knot Floer homology and bordered modules
Authors: Kang Sungkyung
Published: November 2023

We prove that, up to local equivalences, a suitable truncation of the involutive knot Floer homology of a knot in

S^3

and the involutive bordered Heegaard Floer theory of its complement determine each other. In particular, given two knots

K_1

and

K_2

, we prove that the

\mathbb{F}_2[U,V]/(UV)

-coefficient involutive knot Floer homology of

K_1 \sharp -K_2

is

\iota_K

-locally trivial if

\widehat{CFD}(S^3 \backslash K_1)

and

\widehat{CFD}(S^2 \backslash K_2)

satisfy a certain condition which can be seen as the bordered counterpart of

\iota_K

-local equivalence. We further establish an explicit algebraic formula that computes the hat-flavored truncation of the involutive knot Floer homology of a knot from the involutive bordered Floer homology of its complement. It follows that there exists an algebraic satellite operator defined on the local equivalence group of knot Floer chain complexes, which can be computed explicitly up to a suitable truncation.
Skin Prick Automated Test device offers more reliable allergy test results compared to a manual skin prick test
Authors: Seys S F , Roux K , Claes C , Van Cappellen L , Werpin L , Thompson M , Loeckx D , Sebrechts H , Gorris S , Van Gerven L
Published: November 2023

Background: The skin prick test (SPT) is the gold standard for identifying allergic sensitization in individuals suspected of inhalant allergy. A novel device, SPAT or Skin Prick Automated Test, that enables more standardized allergy testing has been developed. Previous research has shown reduced intra-subject variability of histamine wheals by SPAT. Objective: This study aimed to evaluate within-test agreement (% of patients with consistent test results) to detect sensitization to common inhalant allergens when a SPT is executed automated by SPAT or by manual SPT (SPMT) procedure. Methods: The 110 volunteers prospectively enrolled underwent both SPAT and SPMT with 3 pricks of house dust mite, timothy grass and birch, 2 pricks of histamine and 1 prick of glycerol. The proportion of consistent (3x positive – 3 x negative) and inconsistent (2x positive/negative – 1x positive/negative) test results were analysed. Results: The proportion of inconsistent test results was significantly lower in the SPAT compared to the SPMT group. The delta histamine to control pricks was significantly higher in SPAT compared to SPMT group. Coefficient of variation was lower in SPAT compared to SPMT for house dust mite, timothy grass, birch pollen. Visual analogue scale for discomfort was significantly lower in SPAT compared to SPMT group. Conclusion: SPAT showed a 34% reduction in the number of inconsistent test results compared to manual SPT with common inhalant allergens. Patient experience is significantly improved when an allergy test is performed by SPAT compared to a manual SPT.
Heart Rate Variability Measured from Wearable Devices as a Marker of Disease Severity in Tetanus
Authors: Hai Ho Bich , Cattrall Jonathan W. S. , Hao Nguyen Van , Van Hoang Minh Tu , Thuy Duong Bich , Nhat Phung Tran Huy , Khanh Phan Nguyen Quoc , Duong Ha Thi Hai , Duong Tran Duc , Lu Ping , Phuong Le Thanh , Greeff Heloise , Zhu Tingting , Yen Lam Minh , Clifton David , Thwaites C. Louise
Published: November 2023

Tetanus is a disease associated with significant morbidity and mortality. Heart rate variability (HRV) is an objective clinical marker with potential value in tetanus. This study aimed to investigate the use of wearable devices to collect HRV data and the relationship between HRV and tetanus severity. Data were collected from 110 patients admitted to the intensive care unit in a tertiary hospital in Vietnam. HRV indices were calculated from 5-minute segments of 24-hour electrocardiogram recordings collected using wearable devices. HRV was found to be inversely related to disease severity. The standard deviation of NN intervals and interquartile range of RR intervals (IRRR) were significantly associated with the presence of muscle spasms; low frequency (LF) and high frequency (HF) indices were significantly associated with severe respiratory compromise; and the standard deviation of differences between adjacent NN intervals, root mean square of successive differences between normal heartbeats, LF to HF ratio, total frequency power, and IRRR, were significantly associated with autonomic nervous system dysfunction. The findings support the potential value of HRV as a marker for tetanus severity, identifying specific indices associated with clinical severity thresholds. Data were recorded using wearable devices, demonstrating this approach in resource-limited settings where most tetanus occurs.