bluuebunny/crossref_metadata_2025 huggingface dataset:
Management and prevention of corneal graft rejection
Authors: Mandal Sohini , Maharana Prafulla K , Kaweri Luci , Asif Mohamed I , Nagpal Ritu , Sharma Namrata
Published: August 2023

The management of an episode of corneal graft rejection (CGR) is primarily by corticosteroids. Immunomodulators are useful for long-term immunosuppression and in dealing with cases of high-risk (HR) corneal grafts. The classical signs of CGR following penetrating keratoplasty (PKP) include rejection line, anterior chamber (AC) reaction, and graft edema. However, these signs may be absent or subtle in cases of endothelial keratoplasty (EK). Prevention of an episode of graft rejection is of utmost importance as it can reduce the need for donor cornea significantly. In our previous article (IJO_2866_22), we had discussed about the immunopathogenesis of CGR. In this review article, we aim to discuss the various clinical aspects and management of CGR.
Clinical outcomes, time span for healing of various ocular surface disorders with amniotic membrane: A prospective, an Indian study
Authors: Anitha Venugopal , Ghorpade Aditya , Haridas R T , Ravindran Meenakshi , Uduman Mohammed S
Published: August 2023

Purpose:

To study the clinical outcomes, time span of healing of various ocular surface disorders with amniotic membrane graft.

Methods:

A total of 41 patients, presenting to cornea clinic were included in the study and divided into five groups depending on the type of diagnosis: Group 1, with either >2 weeks of Persistent epithelial defect following cataract/retinal/glaucoma surgeries or Shield ulcers, Group 2 with >4 weeks of Non healing corneal ulcers, Group 3 with chemical injuries, Group 4 with Epithelial defects following keratoplasty, and Group 5 is the miscellaneous group.

Results:

The mean age of the study subjects was 50.0 years. Overall mean duration between clinical presentation and AMT was 23.59 (30.7) days, a median 16 days (IQR; 2-26 days). Failure rate was high in Group 5 (n = 3: 30.0%) and Group 2 (n = 3: 27.3%). Time taken for epithelial closure was slower in groups 1 and 5 patients. The average time taken for reabsorption of AMG was 14.98 days. The complications included repeat AMG was in four eyes (9.75%), and graft displacement was noted in four eyes (9.75%) required resuturing, three eyes required TPK (7.31%), and one eye underwent evisceration (2.43%) following severe corneal melt secondary to neurotropic ulcer. The mean log MAR visual acuity improved from 1.52 to 1.26 at the 3 months.

Conclusion:

Understanding on timespan for healing of ocular surface disorders with AMG is needed to assess the prognosis of the disease, preoperative counselling for repeat procedures, and the compliance with regard to follow up.
Outcomes of topography-guided PRK/CXL in keratoconus using the NIDEK CXIII system—”Bharat Protocol” (Pilot study)
Authors: Jain Rajat , Shuaib Yusra , Mohan Neha , Mittal Vikas
Published: August 2023

Purpose:

Outcome of topography-guided excimer laser ablation in conjunction with accelerated, high-fluence cross-linking in corneal ecstatic disease using the NIDEK CXIII equipped with CATz algorithm from the FinalFit software—”Bharat Protocol.”

Methods:

Retrospective case record review of 30 eyes of 17 patients of stage 1-3 keratoconus who underwent the procedure was performed. Data collected were for visual acuity, distortion-induced eye pain, and keratometry. Pachymetry, lower order and higher order aberrations, spherical aberrations, and topographic cylinder were documented from by Scheimpflug imaging (Pentacam 70700: Oculus, Wetzlar, Germany).

Results:

At a minimum follow-up of 6 months (range 6.2–13 months), there was significant improvement in UCVA (P < 0.00001), BCVA (P = 0.0061), decrease in Kmax (P = 0.0349), Ksteep (P < 0.0411), Kflat (P = 0.0099), and pachymetry (P = 0.0001). Significant improvement was also seen in distortion-induced eye pain (27/30 to 2/30; P < 0.00001). A more than two-line improvement in UCVA and BCVA was seen in 23/30 and 17/30 cases, respectively. Ectasia was stabilized in all cases at the last follow-up, and no complications were seen.

Conclusions:

The “Bharat” Protocol to arrest keratectasia progression and improve corneal regularity is a safe and efficacious alternative as a keratoconus management option. This is the first such study on Nidek Platform for the same.
Comparison of intraocular lens power prediction accuracy of formulas in American Society of Cataract and Refractive Surgery post-refractive surgery calculator in eyes with prior radial keratotomy
Authors: Shetty Naren , Sathe Priyanka , Aishwarya  , Francis Mathew , Shetty Rohit
Published: August 2023

Purpose:

To evaluate the accuracy of intraocular lens (IOL) power prediction of the formulas available on the American Society of Cataract and Refractive Surgery (ASCRS) post-refractive calculator in eyes with prior radial keratotomy (RK) for myopia.

Methods:

This retrospective study included 25 eyes of 18 patients whose status was post-RK for treatment of myopia, which had undergone cataract extraction with IOL implantation. Prediction error was calculated as the difference between implanted IOL power and predicted power by various formulae available on ASCRS post-refractive calculator. The formulas compared were Humphrey Atlas method, IOLMaster/Lenstar method, Barrett True-K no-history formula, ASCRS Average power, and ASCRS Maximum power on ASCRS post-refractive calculator.

Results:

Median absolute errors were the least for Barrett True-K and ASCRS Maximum power, that is, 0.56 (0.25, 1.04) and 0.56 (0.25, 1.06) D, respectively, and that of Atlas method was 1.60 (0.85, 2.28) D. Median arithmetic errors were positive for Atlas, Barrett True-K, ASCRS Average (0.86 [−0.17, 1.61], 0.14 [−0.22 to 0.54], and 0.23 [−0.054, 0.76] D, respectively) and negative for IOLMaster/Lenstar method and ASCRS Maximum power (−0.02 [−0.46 to 0.38] and − 0.48 [−1.06 to − 0.22] D, respectively). Multiple comparison analysis of Friedman’s test revealed that Atlas formula was significantly different from IOLMaster/Lenstar, Barrett True-K, and ASCRS Maximum power; ASCRS Maximum power was significantly different from all others (P < 0.00001).

Conclusion:

In post-RK eyes, Barrett True-K no-history formula and ASCRS Maximum power given by the ASCRS calculator were more accurate than other available formulas, with ASCRS Maximum leading to more myopic outcomes when compared to others.
Sequelae of carbide-related thermo-chemical injury: A retrospective analysis
Authors: Arora Anchal , Shanbhag Swapna S , Mishra Dilip K , Malepati Nikhila , Das Sujata , Priyadarshini Smruti R , Mohanty Amrita , Sahu Srikant K
Published: August 2023

Purpose:

To describe the outcomes of eyes with calcium carbide (CaC2)-related thermo-chemical injury.

Methods:

This study included 28 eyes of 23 patients who presented with calcium carbide-related ocular burns. Only patients with more than three months of follow-up were included. Group A included 16 eyes with Dua’s Grade I–III burns, while Group B included 12 eyes with Grade IV–VI burns. Electronic medical records were reviewed to provide data on the etiology of burn, presenting clinical signs and visual acuity, sequelae, and surgical interventions performed, both in the acute and chronic phases.

Results:

The overall mean age was 28.48 ± 11.8 years. Fifteen patients were injured while using carbide to create an explosion to scare away animals on farms. The median presenting BCVA (best-corrected visual acuity) in Group A (20/160) was significantly better than in Group B [(20/2000) (P = 0.002)]. Five eyes in Group A and one eye in Group B underwent medical management. There was no difference in the duration of follow-up for both groups (P = 0.24). The median final BCVA in Group A (20/32) was significantly better than in Group B [(20/200) (P = 0.02)]. Two eyes in Group A and nine eyes in Group B developed LSCD. Two eyes in Group B were phthisical at the last visit.

Conclusion:

Calcium carbide-related ocular injuries can result in significant visual morbidity in young adults. Early presentation and management may improve outcomes. Prevention of these injuries by increasing awareness and increasing advocacy efforts is necessary.
Assessment of the Utility of Point-of-Care Testing Incorporating Ultrasound and Arterial Blood Gas in Patients with Acute Febrile Illness in the Emergency Department to Determine Disease Severity, Disposition, Need for Ventilation and Renal Replacement Therapy
Authors: Chaudhuri Souvik , Ravindra Prithvishree , Gupta Nitin , Rao Shwethapriya , Kudru Chandrashekar Udyavara , Saravu Kavitha
Published: August 2023

Introduction:

Acute febrile illness (AFI) patients present to the emergency department (ED), with fever to multi-organ dysfunction. There is a lack of early point-of-care-based disposition criteria in AFI patients regarding the need for intensive care unit (ICU) or high dependency unit (HDU) care.

Methods:

We enrolled 100 patients with AFI presenting to the ED and evaluated using point-of-care ultrasound with two-dimensional echocardiography (ECHO), lung ultrasound score (LUS), renal arterial resistive index (RRI), and arterial blood gas. The need for ICU/HDU admission, ventilation (either noninvasive or invasive), and renal-replacement therapy (RRT) within 48 h of hospitalization was noted.

Results:

Ninety-five patients were included in the analysis. 72 (75.8%) patients required either ICU or HDU admission, 45 (47.4%) required ventilatory support (either noninvasive or invasive), and 32 (33.7%) required RRT. After logistic regression, LUS ≥16, and arterial lactate ≥12 mg/dL were independent predictors of the need for ICU or HDU admission. The respiratory rate (RR) ≥28/minute, LUS ≥16 and RRI ≥61 were the independent predictors of the need for ventilation. The MAP ≤73 mmHg, LUS (≥16), and RRI (≥67) were the predictors of the need for RRT.

Conclusion:

In AFI patients presenting to the ED, the MAP, LUS, and lactate are predictors of the need for ICU/HDU admission. The LUS and RRI were predictors of the need for RRT whereas the RR, LUS, and RRI were the predictors of the need for ventilation.
Transforming growth factor-beta and microRNA-21, microRNA-29b, microRNA-92, and microRNA-129 in systemic sclerosis patients
Authors: Mohammed Mohammed Hassan , Shaker Olfat G. , Abd El-Raheem Talal A. , Abdulkhaleq Alaa , Khatery Basma H.
Published: August 2023

Background

Systemic sclerosis is characterized by extracellular matrix overproduction by activated fibroblasts. It was reported that microRNAs (miRNAs) participate in the regulation of processes that drive fibrosis, which include transforming growth factor-beta (TGF-β) signaling, fibroblast proliferation, differentiation, and deposition of extracellular matrix proteins.

Objective

To detect whether miRNA-21, miRNA-29b, miRNA-92, and miRNA-129, and TGF-β are considered as biomarkers for systemic sclerosis.

Patients and methods

The current study was a case–control study carried out on 80 Egyptian adults. Of the participants, 30 were apparently healthy controls, while the other 50 patients were classified into 58% with limited skin type, 26% with diffused skin type while 16% of the patients were with unclassified systemic sclerosis. miRNAs were quantitated by real-time PCR while TGF-β was measured by the ELISA technique.

Results

The results showed that the fold change level of miRNA-21 and miRNA-92 were upregulated compared with the control group with a P value of 0.001 each. Meanwhile, the fold change levels of miRNA-29b and miRNA-129 were downregulated compared with the control group (P=0.001, 0.048), respectively. The present study showed that the mean value of the serum level of TGF-β was 145.0±42.84 pg/ml compared with the control group 23.42±5.79 pg/ml with a P value of 0.001. There was a statistically significant negative correlation between miRNA-29 and TGF-β (r=−0.31, P=0.05) among cases. The cutoff points of miRNA-21, miRNA-29b, miRNA −92, and miRNA −129 were 2.45, 0.49, 5.38, and 0.55 fold changes. While for TGF-β, the cutoff point was 120 pg/ml. For miRNA-21, miRNA-29b, miRNA-92, and miRNA-129 sensitivities were 70.5, 41.1, 54.5, and 73.5%, respectively, and 70.5% for TGF-β. Specificity was 100% for all except 98% for miRNA-29b and 99% for miRNA-129. There was no significant relation of all these markers regarding the extent of skin involvement or duration of disease.

Conclusion

It was concluded that miRNA-21, miRNA-29b, miRNA-92, and miRNA-129 as well as TGF-β can be considered as biomarkers for the diagnosis of systemic sclerosis.
Clinical Presentation and Pattern of Cardiac Involvement in Patients with Rheumatic Heart Disease: A Prospective Observational Study
Authors: Arjun M. , Rajasekhar D. , Mohan Alladi , Chandra Abha , Devi B. Vijayalakshmi , Sangaraju Sai Lahari
Published: August 2023

Context:

Rheumatic heart disease (RHD).

Aim:

The aim of the study was to study the clinical presentation and pattern of cardiac involvement in adult patients with RHD.

Settings and Design:

This was a prospective observational study from a tertiary care hospital in South India.

Subjects and Methods:

Consecutive adult patients diagnosed with and treated for RHD in our tertiary care teaching hospital in Tirupati were screened for inclusion. In all patients, details of appropriate laboratory and imaging investigations that have been carried out were noted.

Statistical Analysis Used:

Descriptive statistics (frequencies, mean standard deviation, and median [interquartile range (IQR)]) were reported.

Results:

A total of 120 patients were enrolled. Their mean age was 45.7–12.2 years; there were 79 females. The median (IQR) follow-up was 364 (156–702) weeks. Single-valve disease was seen in 51.7% (n = 62); others (n = 58) had multivalvular disease (mitral stenosis [MS] + aortic regurgitation [AR] [n = 47, 81%] and mitral regurgitation + AR [n = 11, 19%]). Among patients with single-valve involvement, 58 (93.5%) had mitral valve disease. Overall, 116 of 120 (96.6%) patients had mitral valve involvement. Among patients with mitral valve disease (n = 116), MS was severe in 62 (51.6%). Atrial fibrillation was evident in 59 (49.2%) patients; of these, 8 had cardioembolic strokes. Forty-four (36.7%) had undergone percutaneous transvenous mitral commissurotomy. Prosthetic mitral valve obstruction was observed in 2/20 patients who had undergone mitral valve replacement or double-valve replacement.

Conclusions:

In patients with RHD, mitral valve involvement (either alone or in combination with the aortic valve) was most common; MS was most common.
Epidemiology, Pattern, and Management of Midsagittal and Parasagittal Palatal Fractures through Placement of Intra-arch Wire
Authors: Sharma Divashree , Khan Tauseef Ahmed , Tripathi Geeta Mishra , Mishra Ambrish
Published: August 2023

Aim:

The aim of this prospective study was to evaluate the epidemiology, pattern, and concomitant injuries associated with midsagittal and parasagittal palatal fractures and to assess the postoperative complications associated with treatment by placement of intra-arch wiring for their management.

Materials and Methods:

A prospective study was carried out on 22 patients of maxillofacial trauma who were diagnosed with midsagittal or parasagittal palatal fractures and were treated by placement of intra-arch wires during August 2020 to January 2022 in the Department of Dentistry, Shyam Shah Medical College Rewa. All the cases were treated with open reduction/closed reduction for the management of concomitant injury.

Results:

Out of a total of 31 cases diagnosed with palatal fractures during the study duration, the most common palatal fractures were parasagittal (41.93%) and sagittal fractures (29.03%), which met the inclusion criterion of the study (n = 22). Sagittal and parasagittal fractures of the palate were commonly seen in males with a male-to-female ratio of 10:1. The mean age of occurrence was 32.04 ± 11.29 years. The mean duration of surgery was 7.9 ± 2.28 min. Occlusal discrepancy requiring an orthodontic intervention for correction was seen in 1 (4.54%) patient. In 3 (13.63%) patients, occlusal discrepancy was managed by prolonging the duration of intermaxillary fixation.

Conclusion:

Intra-arch wiring is a simple, cost-effective, and quick method for the management of midsagittal and parasagittal fractures of palatal fractures. It eliminates the need of a second surgery for the removal of plates that are placed in open reduction of palatal fractures.
Hyperacute spontaneous closure of a traumatic macular tear in a middle-aged female
Authors: Khadar Syed Mohideen Abdul , Jaffar Jahnara
Published: August 2023

We report a case of a keyhole-shaped macular tear following blunt trauma and its spontaneous closure within 2 weeks in a middle-aged female. A 45-year-old female presented with unilateral acute diminution of vision following blunt trauma. Clinical examination revealed an atypical keyhole-shaped macular tear. Spontaneous closure of the tear was noted at the next review at 2 weeks. Most cases of spontaneous closure reported in the literature are in younger patients and after 1 month of trauma. Our case is unique because of the relatively older age of the patient, early spontaneous closure, and atypical configuration of tear.
Frontalis sling in a bilateral ptosis with external ophthalmoplegia and poor bell’s phenomenon: A 5-year follow-up
Authors: Latha N. V. , Vishnupriya M
Published: August 2023

Congenital ptosis with ophthalmoplegia is a rare condition. We present a 17-year-old patient with congenital ptosis with severe restriction of ocular movements with poor Bell’s phenomenon. He was managed with silicone rod frontalis sling surgery. After 5 years, the sling is intact with no lagophthalmos and exposure keratopathy.
An observational study on the clinical picture of vernal keratoconjunctivitis at a tertiary care center in Western India
Authors: Agrawal Mohini , Dubbaka Srujana , Vats Sumedha
Published: August 2023

Aim:

To study the clinical profile and presence of perilimbal pigmentation in cases of vernal keratoconjunctivitis (VKC).

Methods:

This was an observational, cross-sectional study conducted at a tertiary eye care center in western-Maharashtra from March 2019 to February 2020. One hundred fifty-two cases of VKC were identified by history, characteristic symptomatology, and slit-lamp examination. The Statistical Package for the Social Sciences (SPSS) version 20.0 for Windows was used. The relationship of extent of pigmentation with severity and duration of the disease was analyzed using Chi-squared test. A P value of less than 0.05 was considered significant.

Results:

Out of 152 cases, 79.61% were males. The mean age at presentation was 11.4 ± 5.62 years. A majority (38.82%) reported in the months of May–June. Most of them had mixed form followed closely by palpebral form. The most common symptom was itching. However, complications like focal-limbal stem-cell deficiency and shield-ulcer were seen in a few cases. Notably, the characteristic perilimbal-bulbar pigmentation was noted in 81 cases (53.29%; 95% CI 45.03%–61.42%; P < 0.0001), of which 15 had pigmentation in all the four quadrants (P = 0.0033). The extent of pigmentation corelated significantly with the severity of the disease (P < 0.0001). However, it did not correlate with the duration of the disease (P = 0.0794).

Conclusion:

Studies on VKC in India provide limited epidemiological data, and there has been no significant series that has explained its clinical pattern in the western part of the country. The presence of perilimbal pigmentation may be a diagnostic sign in mild VKC when signs and symptoms are subtle. This knowledge will help in early diagnosis and management and thus, help prevent sight-threatening complications of VKC.
A rare case of central retinal artery occlusion following severe orbital blowout fracture
Authors: Panigrahi Pradeep Kumar , Minj Anita , Gupta Priya , Mehra Lipika
Published: August 2023

A 16-year-old male presented with sudden-onset loss of vision in the left eye (LE) 2 weeks following a road traffic accident. Clinical and radiological investigations lead to a diagnosis of orbital blowout fracture with central retinal artery occlusion in LE. Central retinal artery occlusion is a rare complication occurring simultaneously with an orbital blowout fracture and is associated with a very poor prognosis.
Presumed silicone oil droplets following intravitreal bevacizumab injection
Authors: Panigrahi Pradeep Kumar , Satapathy Jasmita , Srija Yamijala Neha
Published: August 2023

A 67-year-old male presented with loss of vision in the right eye of 3-month duration. He was diagnosed as superotemporal branch retinal vein occlusion with macular edema and was treated with 4 monthly intravitreal bevacizumab injections. Following the fourth injection, multiple tiny presumed silicone oil droplets were noted in the vitreous. The patient was asymptomatic, and the oil droplets stayed stable during the follow-up period.
Endobronchial Actinomycosis
Authors: Afsin E. , Bacaksu E.
Published: August 2023

An extremely rare disease with a slow course, actinomycosis has a high mortality risk when not properly treated. Pulmonary actinomycosis is clinically and radiologically analogous with tuberculosis, foreign body aspiration, lung abscess, or lung cancer. Therefore, it often causes misdiagnosis or delay in diagnosis. A 65-year-old male patient, being followed up with the diagnosis of chronic obstructive pulmonary disease (COPD) and lung adenocarcinoma, was admitted to our outpatient clinic with complaints of chronic cough. On chest CT, a cavitary lesion in the upper lobe of the right lung was observed. Sputum Acid Fast Bacilli (AFB) was negative for 3 consecutive times, fungal direct examination was negative, and there was no growth in mycobacterium culture and fungal culture. Flexible bronchoscopy revealed a raised, hard, white-colored lesion on the mucosa obliterating the apical and anterior segment bronchial entrance of the right lung upper lobe. A diagnosis of actinomycosis was made with sulfur granules seen in the pathology as a result of biopsy and lavage. Detection of sulfur granules in biopsy is essential for the diagnosis of actinomycosis, and a nearly complete response is usually obtained with long-term antibiotic treatment. Alternative methods such as surgical debridement should be considered in cases that do not respond to antibiotic treatment.
Serum Folate Levels in Children with Epilepsy Seen in a Tertiary Health Care Facility in North Central Nigeria
Authors: Omefe PN , Adeboye MAN , Biliaminu SA , Ojuawo Ayodele
Published: August 2023

Background:

Children suffering from epilepsy are maintained on antiepileptic drugs (AED) to ensure a reasonable quality of life. These drugs, however, are not without side effects. Notable among which is interference with the metabolism of folate with its attendant clinical implications such as megaloblastic anemia and bleeding diathesis.

Aim:

This study was carried out to determine the serum folate levels of children with epilepsy, compare the folate levels of these children with that of controls, the levels in subjects on different AED, and to investigate the possible effect of duration of AED use on serum folate levels.

Patients and Methods:

It was a comparative cross-sectional study involving children with epilepsy aged 2–14 years attending the paediatric neurology clinic of University of Ilorin Teaching Hospital (UITH), Ilorin. A total of 140 epileptic and 140 age-and-sex-matched nonepileptic children as controls were recruited into the study.

Results:

Mean serum folate levels in subjects of 6.3 ± 1.6 ng/mL was significantly lower than 7.5 ± 1.5 ng/mL in controls (P = 0.001). The mean serum folate level in subjects on AED was comparable with the value in AED naïve subjects. The mean serum folate level was also comparable among subjects on carbamazepine, phenobarbitone, and valproate as monotherapy. There was no correlation between the duration of AED use and the mean serum folate levels (r = −0.180; P = 0.069).

Conclusion:

The mean serum folate level in subjects was significantly lower than the value in controls; but was comparable in subjects on carbamazepine, phenobarbitone, and valproate as monotherapy. There was no correlation between the duration of AED use and mean serum folate levels
Timing of Laparoscopic Cholecystectomy in Acute Cholecystitis
Authors: Yuksekdag S , Bas G , Okan I , Karakelleoglu A , Alimoglu O , Akcakaya A , Sahin M
Published: August 2023

Background:

Timing of laparoscopic cholecystectomy (LC) in acute cholecystitis (AC) is still debated.

Aims:

The aim of this study was to investigate the effect of timing on operative results; from the first appearance of symptoms to the operation.

Methods:

The study included 57 sequential patients operated laparoscopically for AC. Patients operated within the first 3 days of admission (Group 1), those operated between 4th and 7th days (Group 2) and those operated after 7th day (Group 3) were evaluated and compared with respect to demographics, time from admission to operation, duration of operation, adhesion score, complications, conversion rates, duration of hospital stay, morbidity and mortality rates, bile culture results, and histopathological evaluation.

Results:

A total of 63% of the patients were female and 21 (37%) were male. The mean age was 48 years (range, 21–74). There was no significant difference among the groups with respect to demographics (P > 0.05, for each). The duration of operation was significantly shorter in Group 1 than both Groups 2 and 3 (P < 0.05 and P < 0.001, respectively). Duration of operation was also significantly shorter in Group 2 than Group 3 (P < 0.001). Group 1 had significantly fewer adhesions compared to Group 2 and Group 3 (P < 0.05 and P < 0.001, respectively), and no significant difference was found between Group 2 and Group 3 (P > 0.05). Duration of hospital stay was significantly shorter in Group 1 compared to Group 2 and Group 3 (P < 0.001) and also was significantly shorter in Group 2 than Group 3 (P < 0.05). Group 1 had significantly lower rate of culture proliferation than Group 3 (P < 0.001), whereas no significant differences were evident in other inter-group analyses (P > 0.05, for each).

Conclusion:

LC can safely be performed within 7 days of admission in cases of AC.
Expression Level and Clinical Significance of Inflammatory Cytokines and Biochemical Markers in Gingival Crevicular Fluid During Different Crown Adhesion Patterns of Dental Implant
Authors: Wang L , Fan S , Yang J , Liu Q , Wang F , Hou X
Published: August 2023

Objective:

The aim of this study was to investigate the expression level and clinical significance of inflammatory factors and biochemical markers in gingival crevicular fluid during different crown-binding styles in dental implant patients.

Methods:

A total of 38 patients with posterior tooth loss and implant repair were recruited and divided into two groups according to the different ways of crown bonding, including 19 prostheses (19 patients) in the adhesive retainer group and 19 prostheses (19 patients) in the modified adhesive retainer group. Moreover, the peri-implant gingival sulcus fluids of each group of patients were collected at 7, 15, 30, 60, and 90 d of post-treatment, and the expression level of each cytokine as well as biochemical marker were analyzed by enzyme-linked adsorption method, respectively.

Results:

Compared with the control group, the peri-implant plaque index and gingival bleeding index were decreased in the observation group. In addition, the secretion of peri-implant gingival crevicular fluid in the observation group was significantly higher than that of the control group. The level of IL-6, TNF-α expressions in peri-implant gingival crevicular fluid were gradually decreased with follow-up time, and the rate of decline gets slow at 15 h after operation. The TGFα in peri-implant gingival crevicular fluid in the two groups began to increase at 7 d, reached a peak at about 15 d, then slowly decreased and stabilized after 60 d. While the OCN was gradually increased during the whole detection process, slowly released before 30 d, then increasingly released and maintained at a peak state after 60 d. All the above differences were statistically significant (P < 0.05).

Conclusion:

Different crown-binding patterns of implant teeth have a significant effect on the secretion amount of peri-implant gingival crevicular fluid and the expression level of inflammatory cytokines as well as biochemical markers.
Is Idiopathic Mild Hyperprolactinemia a Cardiovascular Risk Factor?
Authors: Koca AO , Dağdeviren M , Akkan T , Keskin M , Pamuk N , Altay M
Published: August 2023

Background:

There is a strong relationship between arterial stiffness and endothelial dysfunction and hypertension. How arterial stiffness is affected in elevated PRL conditions is uncertain. Biological action of prolactin contributing to the atherosclerotic process is a new research area.

Aims:

We aimed at investigating cardiovascular risk predictability by conducting arterial stiffness measurement in patients with idiopathic hyperprolactinemia.

Subjects and Methods:

The biochemical parameters and arterial stiffness analyses of 54 patients with idiopathic hyperprolactinemia, who had applied to our polyclinic in 2017 and 2018, and 55 healthy volunteers having similar characteristics with regard to age, sex and body mass index.

Results:

The median prolactin level of the idiopathic hyperprolactinemia patients with a median age of 31 was found to be 45 ng/mL. The peripheral and central blood pressures and pulse wave velocities (PWV) of both the patient group and the control group were found to be similar. Any relations between prolactin levels and blood pressure and arterial stiffness could not be found.

Discussion:

Our study showed that arterial stiffness did not increase in young patients with idiopathic mild hyperprolactinemia. However, the long-term effects of mildly elevated prolactin levels are unknown. Prospective randomized studies are required, that could reveal more clearly the prolactin-cardiovascular risk relation, and the clinical effects of extra-pituitary hyperprolactinemia.
Awareness of Risk Factors and Warning Signs of Stroke Among Nursing Students
Authors: Kankaya H , Yeşilbalkan Ö Usta
Published: August 2023

Background:

It is important to inform nursing students about stroke and improve their role in the clinic.

Aims:

We aimed to assess the awareness/knowledge of stroke risk factors and warning signs among nursing students. Therefore, we aimed to assess the awareness/knowledge of stroke risk factors and warning signs among nursing students.

Materials and Methods:

The descriptive and cross-sectional study was carried out between December 2017 and March 2018 with intern students at the faculty of nursing of a university. The sample consisted of 173 students. The data were collected by researchers using “Student Information Form” and “Information Form about Stroke”. The ethical and institutional permission were obtained to conduct the research.

Results:

Hypertension (96.5%) for risk factors, weakness (98.8%) for warning signs, blood pressure control (96.5%) for prevention measures were the most commonly identified factors. Approximately half of the students had a good level of awareness/knowledge of risk factors (53.2%) and warning signs (53.8%) for stroke. The majority of students (84.4%) had a good level of awareness/knowledge of prevention measures. Ninety-five percent of the students stated that calling an ambulance would be the first appropriate action.

Conclusion:

Students had a good knowledge of some of the warning signs and risk factors about stroke. Therefore, it is recommended that this subject should be emphasized more in course contents.
Demographic, Clinical, and Anthropometric Profiles and Postoperative Outcomes in Patients with Chronic Limb Threatening Ischemia
Authors: Wu Lily P. , Milambo Jean Paul , Naidoo Nadraj
Published: August 2023

Background:

Chronic limb-threatening ischemia (CLTI) is a complex disease caused by peripheral artery disease. It is associated with ischemic foot pain (rest pain) and tissue loss in the form of chronic nonhealing foot ulcers or gangrene. CLTI has a high short-term risk of limb amputations, postoperative sepsis, and cardiovascular-related events.

Aims:

The present study was conducted to assess the demographic and anthropometric profile of patients with CLTI and their postoperative outcomes after 2-year follow-up at Groote Schuur Hospital, Cape Town, South Africa.

Methods:

This prospective descriptive pilot study, nested in a prospective cohort study, included adult patients with CLTI admitted to Groote Schuur Hospital from 1st January 2015 to 31st December 2016. Demographic data, anthropometric markers of CLTI, and the postoperative outcomes were documented using piloted and pretested vascular questionnaire. Descriptive statistics were used for baseline data, and postoperative outcomes were presented using actuarial life-table method (Kaplan–Meier analysis). Odds ratio, 95% confidence interval, and P value < 0.05 were used to test the hypothesis.

Results:

Thirty-seven (50.6%) patients had a BMI >25.0. The mean waist: hip ratio was 0.96. Prevalence of smoking was 86%. Limb salvage and ambulation at 1 year were 79% and 67%, respectively. Majority of the patients who were ambulant preoperatively remained ambulant postoperatively.

Conclusion:

Most patients had truncal obesity with a high prevalence of smoking. High postoperative ambulatory recovery among ambulant preoperative patients was a significant outcome observed in our study.
Subclinical Hypothyroidism in Children with Idiopathic Childhood Nephrotic Syndrome at a Tertiary Institution in South-West Nigeria
Authors: Solarin AU , Dada AO , Akinyosoye G , Oladimeji AB , Akinola IJ , Njokanma FO
Published: August 2023

Background:

Hypothyroidism in children with nephrotic syndrome (NS) is often attributed to prolonged loss of thyroxine binding globulin and thyroid hormones alongside protein in the urine. It has been historically associated with steroid-resistant NS alone. However, recent evidence supports the fact that subclinical hypothyroidism (SCH) does occur even in children with steroid responsive NS. Complications such as weight gain, hypercholesterolemia, delayed growth, delayed puberty, and depression could result from hypothyroidism and be erroneously attributed to NS, or the effect of steroid used in treatment. Incidentally salt intake, the major form of dietary iodine is often restricted in children with NS, possibly exacerbating any underlying hypothyroid state.

Aim:

The study aimed to determine the burden of SCH among our cohort of NS patients.

Patients and Methods:

A comparative cross-sectional study was designed to assess SCH [defined by high TSH (>6.0 mU/L and normal free T4 (0.8–2.0 ng/dl)] in hundred children with NS aged between one and fifteen years compared with hundred age and gender matched comparison group without NS. Blood and urine samples were collected to analyze thyroid function, serum albumin, serum protein and urinary protein.

Results:

The prevalence of SCH was significantly higher in subjects with NS than their age, sex matched comparison group (12% vs. 2%, P = 0.006). The highest proportion (24.1%) of the children with NS who had SCH was found in the age range of 11–15 years and majority were females (19.4% vs. 7.8%, respectively, P = 0.086). The proportion of children with SCH were higher in those with steroid-resistant NS than those responsive to steroids (26.3% vs. 8.6% P = 0.033). The average values of serum albumin and protein were also significantly lower in children with SCH than those without (2.91 mg/dl ± 0.8 vs. 3.78 mg/dl ± 0.9 and 3.99 mg/dl ± 1.3 vs. 5.02 mg/dl ± 1.3, respectively, P < 0.005). Also, the average value of urinary protein was significantly higher in those with SCH than those without [94.29 mg/dl (42.3–101.0) vs. 69.19 mg/dL (31.2–108.2), respectively, P = 0.023]. Participants with steroid-resistant NS have almost three-folds odd of developing SCH compared to steroid sensitive subjects (AOR 2.901; 95% CI 1.831–4.012; P = 0.038).

Conclusion:

Screening of children for SCH with NS especially steroid-resistant NS and frequent relapsing steroid sensitive NS for hypothyroidism before complications arise is pertinent to their holistic management. This becomes even more imperative in our environment as iodine deficiency hypothyroidism is still prevalent in some parts of the country.
The Relationship of CRP/Albumin Ratio Level and Prognosis in Pregnant COVID-19 Patients
Authors: Yilmaz N. , Tosun F. , Comert E. , Duran M. , Tuna VD
Published: August 2023

Background:

The C-reactive protein (CRP)/albumin ratio (CAR) is one of the new tools to assess the severity of inflammation. It is used to determine clinical severity and prognosis in many diseases.

Aim:

The present study aimed to investigate the relationship between C-reactive protein (CRP)/albumin ratio (CAR) and prognosis in pregnant patients with more severe COVID-19 infection. Retrospective study.

Patients and Methods:

The study was conducted in a retrospective manner by scanning the files of pregnant patients who had a positive polymerase chain reaction test result and were hospitalized in Adıyaman Training and Research Hospital. The patients were divided into two groups: patients who were admitted to the intensive care unit and patients who were not admitted. CRP/albumin ratio (CAR) levels were compared between these two groups. The cut-off value was determined in the prediction of intensive-care admission and poor prognosis.

Results:

117 patient files were reviewed. 13 patients were followed up with intensive care, whereas 104 patients completed their treatment in the service. The CAR levels of the patients admitted to intensive care were significantly higher (P < 0.01). In the estimation of intensive-care admission, the CAR level was determined to be 0.970 in the area under the curve with 100% sensitivity and 86.5% specificity in the receiver operating characteristic (ROC) curve. The cut-off CAR level was calculated as 1.8.

Conclusion:

CAR is a valuable biomarker for predicting prognosis, as well as follow-ups of pregnant COVID-19 patients.
Abdominal Wall Reconstruction for Desmoid Tumors Following Radical Resection from the Abdominoplasty Incision
Authors: Erdogan Osman , Parlakgumus A , Kulahci O , Irkorucu O
Published: August 2023

Desmoid tumours are rare and locally invasive neoplasms that originate from the muscles and their aponeurosis. Incomplete excision causes recurrences; therefore, patients require aggressive resection that essentially entails tumour excision with a clear surgical margin. After radical resection, the resultant wide defect may lead to difficulty in closure of the anterior abdominal wall. Here, we report a case having surgery for large desmoid tumour of the anterior abdominal wall through an abdominoplasty incision followed by an abdominal wall reconstruction with a dual-sided composite mesh.
Investigation of Effect on Activities of Daily Living and Symptoms in Hemodilaysis Patients
Authors: Mollaoğlu M , Başer E
Published: August 2023

Background:

Hemodialysis patients develop many physical and psychosocial symptoms associated with chronic kidney disease and its treatment. The presence of these symptoms also adversely affects an individual's activities of daily living.

Aim:

The aim of this study was to evaluate the symptoms seen in hemodilaysis patients and to examine the effect on daily living activities.

Materials and Methods:

This was a cross-sectional descriptive study carried out on 126 patients in two dialysis centers in Turkey. Patient Information Form, Dialysis Symptom Index (DSI) and Katz Activities of Daily Living Scale (KADL) were used as data collection tools.

Results:

The most frequent symptoms described by the patients undergoing hemodialysis were tiredness, sadness, and muscle-joint pain. The mean of the DSI was 30.03 (SD: 14.7). There was a statistically significant relationship between dialysis symptom index and disease duration and hemodialysis vintage (P < 0.05). In addition, the mean score of the Patients' KADL was 14.48 (SD: 2.55). Eighty-two (65.1%) patients maintain their daily living activities independently. On the other hand, 26.2% of the dialysis patients maintained their daily living activities as semi-dependent, while 8.7% were totally dependent on others. A statistically significant relationship was found between KADL, marital status, year of dialysis and presence of another chronic disease (P < 0.05). There was statistically significant relationship between DSI and KADL. In hemodilaysis patients, as the DSI score increased, the dependence on daily living activities increased.

Conclusion:

The symptoms seen in patients have a negative effect on maintaining their daily living activities. Health workers should perform symptom evaluation in patients undergoing dialysis. Thus, each patient-specific individualized care plan should be designed for effective management of these symptoms in patients. Effective symptom management will be effective in maintaining patients' daily living activities.
A Mini-National Surveillance Study of Resistance Profiles of Staphylococcus Aureus isolated from Clinical Specimens across Hospitals in Nigeria
Authors: Medugu Nubwa , Nwajiobi-Princewill Philip I. , Shettima Shuwaram A. , Mohammed Manga M. , Mohammed Yahaya , Wariso Kennedy , Akujobi Comfort N , Oduyebo Oyinlola O , Iregbu Kenneth C.
Published: August 2023

Background:

Infections with Staphylococcus aureus cause significant morbidity and mortality worldwide. Resistant strains of S. aureus to commonly used antibiotics are being increasingly encountered in clinical practice, necessitating the need to determine the resistance pattern in Nigeria.

Methods:

Antibiotic susceptibility testing was performed on 360 S. aureus isolates from clinical specimen from seven hospitals across the six geo-political regions of Nigeria using Kirby Bauer disc diffusion technique, and E-test for vancomycin. Cefoxitin 30 μg disc was used to determine methicillin resistance, and D-test for inducible clindamycin resistance.

Results:

Methicillin-resistant S. aureus was confirmed in 176 (48.9%) of the isolates, 346 (96%) for penicillin G and 311 (86.4%) for trimethoprim. 175 (99.4%) of the 176 resistant to methicillin were susceptible to vancomycin. Linezolid, tigecycline, chloramphenicol and clindamycin had susceptibilities of 341 (94.7%), 332 (92.2%), 298 (82.8%) and 290 (80.6%) respectively. Inducible clindamycin resistance was elucidated in 25 (29.1%) of the 86 isolates. Generally, MRSA isolates were more resistant than methicillin-sensitive S. aureus (MSSA) to all antibiotics tested.

Conclusion:

Staphylococcus aureus rates of resistance are high and call for urgent action such as antibiotic stewardship programmes and periodic surveillance to enhance clinical outcomes. While targeted therapy is preferred, options for empiric treatment include chloramphenicol, clindamycin, linezolid or vancomycin.
Evaluation of Biomarkers of Oxidative Stress and Female Reproductive Hormones in Post Menopausal Women with Breast Cancer in Southern Nigeria
Authors: Nsonwu-Anyanwu AC , Usoro A , Etuk EB , Chukwuanukwu RC , Usoro CAO
Published: August 2023

Background:

Reproductive hormones and reactive oxygen species produced by either hormonal or aerobic metabolism have been implicated in carcinogenesis of the breast and disease progression. Perturbations in the homeostasis of female reproductive hormones and oxidative stress indices in breast cancer (BCa) could be used for monitoring disease prognosis.

Objectives:

The aim of this study was to assess levels of some biomarkers of oxidative stress and female reproductive hormones in postmenopausal women with BCa at different stages.

Methods:

Reduced glutathione (GSH), total antioxidant capacity (TAC), total plasma peroxides (TPP), nitric oxide (NO), malondialdehyde (MDA), estradiol (E2), and prolactin (PRL) levels were determined in 50 post-menopausal women with BCa (stages II–IV) and 50 women without BCa (controls) by colorimetry and ELISA methods. Oxidative stress and body mass indices (OSI &BMI) and clinical history were obtained.

Results:

Post-menopausal women with BCa had significantly higher BMI (26.60 ± 5.17 vs 22.73 ± 1.21 kg/m2, P=<0.001), TAC (5.59 ± 2.38 vs 4.43 ± 2.66 mmol/l, P = 0.023), TPP (4.92 ± 3.59 vs 2.98 ± 2.82 mmol/l, P = 0.003), NO (31.96 ± 10.73 vs 23.92 ± 6.37 μmol/l, P=<0.001) and E2 (78.89 ± 54.54 vs 11.08 ± 14.80 pg/ml, P = 0.003) levels and lower mean age at menarche (13.16 ± 0.87 vs 14.14 ± 1.60 years, P=<0.001) compared to controls. Controls had significantly lower E2 (P = 0.003), TPP (P = 0.005) and OSI (P = 0.043) compared to women with stage II BCa; lower E2 (P=<0.001), NO (P = 0.010), TAC (P = 0.010) and TPP (P=<0.001) compared to stage III BCa; and lower E2, (P=<0.001), NO (P = 0.044) and MDA (P = 0.020) compared to stage IV BCa respectively. Prolactin correlated positively with E2 (r = 0.296, P = 0.037), and TAC (r = 0.336, P = 0.011) in women with BCa.

Conclusion:

Postmenopausal women with BCa at different stages have increased estradiol, antioxidants, lipid peroxidation, and oxidative stress index suggesting that these indices may be useful for clinical assessment and monitoring progression of breast cancer.
High-Risk Surgeries, Anesthetic Challenges, and Real Benefits of Peripheral Regional Techniques Revisited
Authors: Jasper AO , Onohwakpor EA , Akhator A
Published: August 2023

Patients with high-risk conditions for surgery may benefit from some form of regional block when neuroaxial regional blocks may be life threatening. Despite the increased use of ultrasound-guided peripheral regional blocks internationally, local infiltration and targeted nerve blocks aided by knowledge of anatomical landmarks remain helpful in these two patients presented. A 48-year old woman, presented with bleeding left breast mass, mild respiratory distress, and radiological features of lung metastases (Carcinoma of the breast stage 4). Her American Society of Anesthesiologist risk assessment (ASA) was grade 4. Anesthetic technique was mainly local infiltration and intercostal nerve block with 1% lignocaine (10 mg) and 2.5% bupivacaine (62.5 mg) and a 1 in 100,000 dilution of adrenaline in cardiac position with mild sedation with good analgesia and outcome. Another 24-year-old pregnant woman with dilated cardiomyopathy was being managed by a multidisciplinary team. Her cardiac state deteriorated as pregnancy progressed. Caesarean section was done successfully at 35 weeks gestation under local infiltration and rectus sheath block with local anesthetic agents, sedation, and oxygen masks in the cardiac position with good outcome. The good outcomes in these two patients showed the benefit of peripheral regional blocks in high risk patients. Early recognition of high-risk patients and appropriate anesthetic and clinical assessment with the formulation of right techniques can help salvage lives. This thought is more apt in equipment challenged environments like ours in Nigeria, when resources for ultrasound assisted peripheral nerve blocks are not always available.