bluuebunny/crossref_metadata_2025 huggingface dataset:
Mitochondrial Complex I Deficiency Masquerading as Stroke-Like Episode Clinically and as Alexander Disease Radiologically Following Chicken Pox
Authors: Gowda Vykuntaraju K , Bylappa Arun Y. , Kinhal Uddhav , Srinivasan Varunvenkat M. , Vamyanmane Dhananjaya K.
Published: August 2023

Mitochondrial disorders are a group of metabolic disorders with variable presentation and usually affect organs with high energy requirements like the brain, eye, and heart. Seventeen-month-old girl child presented with right hemiparesis and regression of milestones following chicken pox. Investigations showed elevated lactate, white matter signal changes in both periventricular and subcortical white matter with frontal predominance in the MRI of the brain, cardiomyopathy in the echocardiography, with complex I deficiency in respiratory enzyme assay in the muscle biopsy. A homozygous missense variant c.304C>T (p. Arg102Cys) in exon 5 of NDUFS8 gene (chr11:67800682C>T; NM_002496.4) was detected on whole exome sequencing with positive parental Sanger for the same gene. The child was started on a mitochondrial cocktail, ramipril, and frusemide. Mitochondrial complex deficiency should be considered in cases with stroke-like episodes, and predominant white matter involvement on imaging mimicking classical genetic leukodystrophy like Alexander disease.
Hippocampal Volume in Children with Attention Deficit Hyperactivity Disorder and Speech and Language Delay
Authors: Dhikav Vikas , Parakh Manish , Pandey Kajal , Jangid Hemant , Khicher Pankaj
Published: August 2023

Introduction:

Hippocampus is a complex brain structure located deep in the temporal lobes of the brain. The structure has been implicated in several disorders related to cognition. Reports are emerging of its involvement in attention deficit hyperactivity disorder (ADHD). The current study was planned to assess the volume of the hippocampus in children with ADHD and speech and language delay with normal birth history using magnetic resonance imaging (MRI) of the brain.

Material and Methods:

MRI brain of 12 children (age range = 3–6 years) and 22 controls with clinical diagnosis of ADHD as per Diagnostic and Statistical Manual-5 were obtained in oblique coronal sequence (T1 weighted). The entire hippocampus formation was outlined manually using Image-J software available freely from www.freesurfer.com. Results were expressed as volume cubic millimeters ± SD.

Results:

Volumes of the hippocampi of children with ADHD were 2450.2 ± 667 mm3 (R) and 2505.8 ± 878.5 mm3 (L), respectively. The mean volume (bilateral) of the cases was 2478 ± 772.75 mm3. The right hippocampal volume of the controls was 3255.8 ± 1374.3 mm3 (R) and that of the left side was 3159.3 ± 1451 (L) mm3, respectively.

Conclusion:

Current study reported a substantial shrinkage (23%) of the left and right hippocampus in children with ADHD compared to controls.
Efficacy of stellate ganglion interventions for complex regional pain syndrome in the upper limb—A systematic review and meta-analysis
Authors: Purohit Gaurav , Bhandari Baibhav , Kumar Ajit , Talawar Praveen , Gupta Shiwam , Atter Pradeep
Published: August 2023

Background and Aims:

Stellate ganglion (SG) interventions for treating upper limb complex regional pain syndrome (CRPS) have been reported in studies. However, more substantial evidence is required to reach a consensus on its analgesic efficacy. To the best of our knowledge, no systematic review demonstrating the effectiveness of SG intervention for upper limb CRPS has been reported. Hence, this meta-analysis was done to ascertain the efficacy of SG intervention in managing patients with upper limb CRPS.

Methods:

A database search of PubMed, Cochrane, Embase, Scopus and Google Scholar was done for articles published between January 2001 and December 2021. Two independent reviewers extracted data from the included studies, and the studies were evaluated for any potential risk of bias, and a meta-analysis was performed.

Results:

Eight studies were included in the qualitative synthesis, four were randomised controlled trials (RCTs), and the rest were non-RCTs. Six studies were assessed quantitatively. A significant reduction in pain scores post-intervention, up to two weeks, and four to 28 weeks after the procedure was observed, although the included studies exhibited marked heterogeneity. Qualitative analysis of these studies revealed an overall improvement in disability scores and functionality as assessed by an improved range of motion. Most studies reported no complications or only short-term minor complications after the procedure.

Conclusion:

Stellate ganglion interventions improve pain and disability scores with self-limiting short-term complications and no long-term complications. However, further studies with a large sample size are required to validate this treatment modality.
Conventional versus reverse insertion of i-gel® in overweight and obese patients – Interventional randomised controlled trial
Authors: Ahuja Sonali , Kaur Gurpreeti , Garg Kamakshi , Grewal Anju
Published: August 2023

Background and Aims:

The supraglottic airway device, i-gel, is used in obese patients for short- to medium-duration surgical procedures. Insertion techniques have contributed to the successful and proper placement of i-gel in the first attempt. This study aims to compare two techniques for successfully inserting i-gel in the first attempt in overweight and obese patients as measured by oropharyngeal leak pressure (OLP).

Methods:

This interventional, randomised, controlled study was conducted after ethical approval, and trial registration in overweight and obese patients. Patients were randomised into two groups: In Group C, the conventional technique was used, while in Group R, the reverse technique was used to insert i-gel. OLP, successful placement, required manipulations, time taken for insertion, number of attempts, and intraoperative and postoperative complications were studied. The collected data were analysed statistically.

Results:

The mean OLP (30.46 ± 3.76 vs. 32.12 ± 3.10 mmHg, P = 0.018) and the mean time of insertion (16.42 ± 1.86 vs. 13.98 ± 1.97 s, P = 0.001) for conventional and reverse techniques, respectively, were statistically significant and favourable for Group R compared to Group C. Successful placement of i-gel at the first attempt, ease of insertion, number of attempts and all the manipulations except withdrawal and advancement were comparable in both the groups. No postoperative complications were noted.

Conclusion:

The reverse technique significantly favoured the actual OLP values and the mean insertion time. Successful placement of i-gel at the first attempt was observed with both conventional and reverse techniques.
Minimum effective dose of oxytocin bolus during the caesarean section for patients at high vs low risk of uterine atony: A non-randomized, dual-arm, dose-finding prospective trial
Authors: Tyagi Asha , Deep Sonali , Salhotra Rashmi , Malhotra Rajeev , Singla Anshuja
Published: August 2023

Background and Aims:

There are scanty data for oxytocin dose in patients at high risk of uterine atony. We aimed to compare the effective dose (ED) 90 of oxytocin for adequate uterine tone during the caesarean section in patients at high-risk vs low-risk uterine atony.

Methods:

This dose-finding study was undertaken after ethical approval in non-labouring women aged >18 years with pre-defined risk factors for uterine atony (high-risk group) vs those without such factors (low-risk group) (n = 39 each). Starting dose of oxytocin in the first patient of low-risk and high-risk groups was 1 and 3 IU, respectively. Achieving adequate uterine tone at 3 min of oxytocin bolus was designated ‘success’, while inadequate tone constituted ‘failure’. If the response was ‘failure’, the dose of oxytocin was increased for the next patient by 0.5 or 0.2 IU (high- and low-risk groups, respectively). In case of a successful response, the dose for the next patient was decreased with a probability of 1/9 using the same dosing intervals or otherwise kept unchanged.

Results:

The ED90 (95% CI) of oxytocin bolus was 4.7 (3.3–6.0) IU for the high-risk group and 2.2 (1.3–3.2) IU for the low-risk group (P = 0.044). Oxytocin-associated tachycardia (P = 0.247) and hypotension (P = 0.675) were clinically greater for the high-risk vs low-risk group but statistically similar.

Conclusion:

Non-labouring patients with high-risk factors for uterine atony require a greater dose of initial oxytocin bolus to achieve adequate uterine tone during the caesarean section compared to those without risk factors.
Incidental Detection of Asymptomatic Brain Metastases Due to Carcinoma Prostate in Ga-68 PSMA HBED-CC Positron Emission Tomography-Computed Tomography
Authors: Nellaiappan Harihara Sudhan , Rajaraman Vishnukumar , Halanaik Dhanapathi , Ananthakrrishnan Ramesh
Published: August 2023

Brain metastasis originating in adenocarcinoma of the prostate is rare and can be expected in cases of disseminated bone and soft-tissue disease. Asymptomatic brain metastasis is rare at any point of the disease stage. Ga-68 PSMA positron emission tomography-computed tomography (PET-CT) is one of the useful investigations for assessing the disease status in adenocarcinoma of the prostate. We report a case of asymptomatic brain metastases detected in Ga-68 PSMA PET-CT scan.
Multifocal, Multisystem Presentation of Adult-Onset Langerhans Cell Histiocytosis on 18F-Fluorodeoxyglucose Positron-Emission Tomography–Computed Tomography
Authors: Pankaj Promila , Gupta Pankaj , Pankaj Neelushka , Narula Bhawna Sachdeva
Published: August 2023

Langerhans cell histiocytosis (LCH), also known as histiocytosis X, is a rare systemic disorder arising from clonal proliferation of immature CD207-positive (langerin) myeloid dendritic cells (histiocytes) in the skin and visceral organs with a tendency to involve single or multiple organ systems with variable clinical course and prognosis. The incidence of LCH is very less in adult and occurs almost exclusively in children. Genital, perianal, and lung lesions are considered to be rare manifestations of adult LCH. We describe a case of 31-year-old, nonsmoker female who presented in February 2020 with itching and burning sensation in perianal and vulvar regions accompanied with multiple nonhealing ulcers and papillomatous lesions. These lesions gradually increased in size with no response to antibiotics and topical steroids. She was advised positron-emission tomography– computed tomography (PET-CT) scan for further evaluation. After PET-CT scan, her provisional diagnosis of multisystem, multifocal Langerhans cell histiocytosis with high-risk organ involvement was made. Both vulvar and perianal lesions were biopsied which was suggestive of Letterer–Siwe variant of LCH. The prognosis of this variant is very poor even with aggressive chemotherapy and 5-year survival rate of only 50%. Hence, it requires careful consideration during diagnosis and management.
Evaluation of Radiation Exposure to the Patients Undergoing Positron Emission Tomography/Computed Tomography-Guided Biopsies
Authors: Deva Krishnapriya , Rana Nivedita , Kumar Rajender , Mittal Bhagwant Rai
Published: August 2023

Purpose:

We aimed to evaluate the radiation exposure to patients undergoing positron emission tomography/computed tomography (PET/CT)-guided biopsies.

Materials and Methods:

Patients undergoing PET/CT-guided biopsy were recruited prospectively from October 2019 to April 2020. PET/CT-guided biopsy from a tracer avid site was done using an automated-robotic-arm 1 h after intravenous injection of F-18-fluorodeoxyglucose (FDG) (2-5 mCi) or Ga-68-PSMA (1–4 mCi). Regional CT-images were acquired for biopsy planning and confirmation of needle placement. The internal radiation exposure due to the PET component was estimated using the value of activity injected and dose-coefficient for FDG and PSMA. The external radiation exposure due to the CT component was estimated using the value of dose length product and organ coefficients conversion factor. The total effective dose during the procedure was calculated by adding exposure due to both CT and PET components. Percentage contribution from CT and PET component to total effective dose was compared using a paired t-test.

Results:

A total of 101 patients (76 males) were recruited for PET/CT-guided biopsy using FDG (n = 79) and PSMA (n = 22). The mean effective-dose due to PET and CT components and total effective-dose was 2.49 ± 1.02 mSv, 2.35 ± 1.03 mSv and 4.83 ± 1.90 mSv, respectively, for FDG-guided procedures and 1.60 ± 0.57 mSv, 3.06 ± 1.36 mSv, and 4.66 ± 1.37 mSv for Ga-68-PSMA-guided procedures. The percentage contribution of PET and CT in total effective-dose was comparable in F-18-FDG and Ga-68-PSMA PET/CT-guided biopsy procedures; however, for Ga-68-PSMA PET/CT-biopsies, CT contributed a higher radiation dose than PET component.

Conclusion:

PET/CT-guided biopsy is a safe interventional procedure, and radiation exposure to the patients was less than routine whole-body PET/CT-imaging.
Early Demonstration of Spontaneous Perinodal Lymphangiogenesis by Lymphoscintigraphy after Vascularized Lymph Node Transplantation - A Pilot Study
Authors: Subramanyam Padma , Janarthanan R , Palaniswamy Shanmuga Sundaram
Published: August 2023

Background:

Despite the lymphatic system being so important and extensive, the field of lymphatic diseases, research is still very young. Lymphedema is a progressively debilitating condition with no known “cure.” Specific pathologies that could benefit from improved lymphatic drainage by advanced super surgical techniques or engineered tissue transfer are being sought. Microsurgical techniques like lymphovenous bypass and anastomosis have spurred interest as they tend to physiologically restore the damaged lymphatic channels and may be a key to permanent cure. The latest in the field is vascularized lymph node transfer (VLNT), indicated in post mastectomy or other post operative settings producing disruption of regional lymphatic channels and draining lymph nodes. Autologous healthy lymph nodes are transferred along with surrounding fat and vascular pedicle to the affected limb in a bid to promote lymphangiogenesis. Lymphoscintigraphy (LS) is a simple, noninvasive nuclear technique used in identifying upper or lower limb lymphatic dysfunction and obstruction with a high degree of sensitivity. Quantitative LS is extremely useful in follow-up assessment of lymphedema postmanual lymphatic drainage (MLD) or other forms of medical management.

Aim:

We hypothesize that LS can document perinodal lymphangiogenesis post VLNT.

Material and Methods:

Three cases of acquired lymphedema (suspected filariasis and postmastectomy conditions) who underwent VLNT in our institute were prospectively studied with LS. The imaging findings highlight the subtle lymphatic regeneration along with the vascularized graft in all three patients during the early postoperative period.

Conclusion:

This is the first (pilot) study documenting early spontaneous perinodal lymphangiogenesis after VLNT in human subjects.99mTc Nanocolloid LS has been found to be incremental in demonstrating early lymphangiogenesis.
Correlation between Interlimb Coordination with Dynamic Balance and Cognition among Geriatric Population of South Delhi
Authors: Minhal Khan , Hammad A Siddiqui , Charu Chhabra , Himani Kaushik
Published: August 2023

Context:

Aging involves an overall deterioration of sensory functions, affecting the coordinated behavior, and suggesting a decline in the quality of afferent information from the periphery. Extra mental effort is required for the control of these movements and performing complex tasks requiring control of balance.

Aim:

The research was undertaken to determine the correlation between interlimb coordination with dynamic balance and cognition in geriatrics.

Setting and Design:

Cross-sectional study was done on geriatric people from Rehabilitation Center, Jamia Hamdard, Delhi.

Subjects and Methods:

A total of 35 healthy geriatrics were recruited from South Delhi by convenience sampling, based on the inclusion criteria of the study. Ethical approval was obtained from the ethics committee of the university and signed informed consent was obtained before the study. All the participants were assessed for interlimb coordination, dynamic balance, and cognition by Purdue Pegboard Test, Berg balance test, and mini–mental state examination, respectively, at Rehabilitation Center, Jamia Hamdard, Delhi.

Statistical Analysis:

Statistical analysis for correlation was performed through statistical software IBM SPSS Statistics 21.0 and the Pearson correlation test was used with a significance level set at 0.01.

Results:

Mean changes revealed the correlation between interlimb coordination and cognition (P = 0.000). Interlimb coordination and balance did not show any correlation (P > 0.01), and there was no adverse event during the study.

Conclusion:

It was concluded from the study that interlimb coordination is related to cognition and not to dynamic balance in healthy geriatric people.
Focal therapy for localized prostate cancer – Current status
Authors: Atluri Shrikanth , Mouzannar Ali , Venkatramani Vivek , Parekh Dipen J. , Nahar Bruno
Published: August 2023

Focal therapy (FT) has recently gained popularity for the treatment of localized prostate cancer (PCa). FT achieves cancer control by targeting the lesions or the regions of the cancer and avoids damage to the surrounding tissues thus minimizing side effects which are common to the radical treatment, such as urinary continence and sexual function, and bowel-related side effects. Various ablative methods are used to deliver energy to the cancerous tissue. We review the different modalities of treatment and the current state of FT for PCa.
Development of an Indian nomogram for predicting extracapsular extension in prostate cancer
Authors: Ravi Chandran , Sanjeevan Kalavampara V. , Thomas Appu , Pooleri Ginil Kumar
Published: August 2023

Introduction:

The aim of our study was to develop a new Indian nomogram to estimate pathologic extracapsular extension (ECE) risk in prostate cancer, by including PI-RADS v1-based magnetic resonance imaging (MRI) ECE risk score to the clinical variables used in the Partin nomogram (PN).

Materials and Methods:

We analyzed 273 patients who underwent MRI of prostate and radical prostatectomy (RP). Univariate and multivariate logistic regression analyses were performed to identify predictors of ECE. We calculated the area under the receiver operating characteristic curve (AUC) for three variables used in PN and MRI ECE risk score, and a new nomogram was designed using binary logistic regression. Calibration curves assessed the agreement between the actual ECE risk and the predicted probability of the new nomogram.

Results:

Out of 273 patients, 123 patients (45.1) had ECE on MRI, whereas 136 patients (49.8) had ECE on final pathology. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of MRI for predicting ECE were 76.6, 66.9, 70.0, 73.9, and 71.7 (confidence interval 95), respectively. Multivariate logistic regression analyses showed that clinical T-stage (cT), Gleason score (GS), and MRI ECE risk score remained significant. The highest and the lowest values of the AUC for single variables were 0.748 (MRI ECE risk score) and 0.636 (cT stage), respectively, and AUC for PN was 0.67. New nomogram designed using R statistical package has higher predictive accuracy (0.826) compared to PN (0.67) and good calibration.

Conclusions:

MRI adds incremental value to PN. A new Indian nomogram can help in the decision-making process of nerve-sparing RP. This nomogram should be used with caution as validation is pending and will require further studies.
Pneumorrhachis in emphysematous pyelonephritis
Authors: Navriya Shiv Charan , Kumar Sunil , Mittal Ankur , Bhirud Deepak Prakash
Published: August 2023

Emphysematous pyelonephritis (EPN) is a life-threatening infection of kidney with the presence of gas in the renal parenchyma, collecting system, and the surrounding retroperitoneum. We present a case of EPN in a diabetic patient with extension of gas into the spinal epidural space of the lumbar vertebral canal. He was managed conservatively with minimally invasive intervention along with supportive medical management and recovered well.
Role of laparoscopy in the era of robotic surgery in urology in developing countries
Authors: Bansal Devanshu , Chaturvedi Samit , Maheshwari Ruchir , Kumar Anant
Published: August 2023

With the rapid expansion of robotic platforms in urology, there is an urgent and unmet need to review its cost and benefits in comparison to the traditional laparoscopy, especially in reference to a developing country. A nonsystematic review of the literature was conducted to compare the outcomes of pure laparoscopic and robot-assisted urologic procedures. Available literature over the past 30 years was reviewed. Robot-assisted surgery and laparoscopy were found to have similar outcomes in the areas of radical prostatectomy, partial and radical nephrectomy, radical cystectomy, retroperitoneal lymph node (LN) dissection, inguinal LN dissection, donor nephrectomy, and kidney transplantation. Robot-assisted surgery was found to be significantly costlier than pure laparoscopy. In the absence of a clear advantage of robot-assisted surgery over pure laparoscopy, lack of widespread availability and the currently prohibitive cost of robotic technology, laparoscopic urological surgery has a definite role in the developing world.
Raised prostate-specific antigen alone may not be a true predictor in high-risk prostate cancer
Authors: Garg Harshit , Seth Amlesh , Kumar Rajeev
Published: August 2023

Introduction:

Prostate-specific antigen (PSA) >20 ng/mL in isolation is a criterion for classification as “high-risk” prostate cancer (PCa). However, among Indian men, PSA elevation is often seen even in the absence of PCa and patients with PSA as the sole criterion for the high-risk disease may have different outcomes from those categorized as high risk due to adverse pathological features. We compared the operative, oncological, and functional outcomes after robot-assisted radical prostatectomy (RARP) in men with high-risk PCa categorized using PSA alone versus clinical and histopathological findings.

Materials and Methods:

In an Institute Review Board-approved study, men undergoing RARP with high-risk PCa with at least 2-year follow-up were categorized into those with PSA >20 ng/ml being the sole criteria for being high risk (Group A) versus those with Gleason score ≥8 or ≥T2c disease but any PSA level (Group B). The two groups were compared for perioperative, oncological, and functional outcomes.

Results:

Fifty-three patients with high-risk disease were included. Twenty-six patients (48.9%) were classified into Group A while 27 patients (50.9%) were classified into Group B. The median PSA was significantly higher in Group A (31 [26–35] ng/ml in Group A vs. 21 [12–34] ng/ml in Group B, P = 0.006) and on histopathology of radical prostatectomy specimen, 24 (92.3%) patients had GG ≤3 disease in Group A versus 10 (37%) patients in Group B (P < 0.001). Patients in both the groups had similar perioperative and continence outcomes. However, Group A had significantly lower biochemical recurrence rate (3/26 [11.5%]) as compared to Group B (11/27 [40.7%]) (P = 0.012).

Conclusions:

PSA >20 ng/ml is the single most common criterion for stratification as high-risk PCa. However, men with PSA >20 ng/ml in isolation, without another adverse criterion, have better outcomes than men with adverse clinical or pathological criteria for high-risk disease.
Minimal invasive approaches in lymph node management of carcinoma of penis
Authors: Kandasamy Shreedhar Gurunathan , Chandran Kosur Ravi , Pooleri Ginil Kumar
Published: August 2023

Introduction:

Inguinal lymph node dissection (ILND) is an integral part in the management of carcinoma penis. The concerns about the postoperative morbidity associated with open ILND led to modification in the template of dissection and adoption of minimally invasive techniques such as video endoscopic inguinal lymphadenectomy (VEIL) and robotic-assisted VEIL (R-VEIL). In this review, we aim to describe the techniques, case selection, perioperative outcomes, and oncological outcomes of VEIL and R-VEIL and to compare it with open ILND.

Methods:

Databases of PubMed, Embase, and Google Scholar were searched to identify the articles for VEIL and R-VEIL. Using PRISMA guidelines, literature search yielded 3783 articles, of which 32 full-text articles relevant to the topic were selected and reviewed, after consensus from authors.

Results:

After the first description of VEIL, various modifications in port placements and approaches were described. Several studies have shown, VEIL and R VEIL are safe and feasible in both node-negative and node-positive Ca penis patients. Compared to open ILND, VEIL had fewer wound infections and skin necrosis, minimal blood loss, shorter mean hospital stays, and reduced duration of drain kept. There is no difference in mean lymph node yield and recurrence rates between open ILND, VEIL, R-VEIL.

Conclusion:

VEIL and R-VEIL are safe and have comparable oncological outcomes with open ILND.
Refractory Seizures with Encephalopathy May be Due to Hashimoto Encephalopathy
Authors: Samanta Atraya , Deb Agniva , Karmakar Indranil , Roy Santanu
Published: August 2023

Background:

Hashimoto's encephalopathy, also known as steroid-responsive encephalopathy associated with autoimmune thyroiditis, is a relatively uncommon neurological disorder, mostly in adults, with an extremely rare occurrence in children.

Clinical Description:

A 9-year-old girl presented with unprovoked seizures and encephalopathy. She had been diagnosed with hypothyroidism, at around 6 ½ years of age, though was noncompliant to therapy with levothyroxine.

Management:

The child was managed with intravenous (IV) antiepileptics and other supportive care. Seizures were refractory and with worsening sensorium, she required mechanical ventilation. The magnetic resonance imaging of the brain was unremarkable, as also the cerebrospinal analysis. Autoimmune encephalitis panel was negative. The electroencephalogram showed background activity of 10–11 Hz and few areas with generalized slow waves. As she was a known case of hypothyroidism without taking thyroid supplements for the past few months, thyroid profile was sent. Reports showed FT3-1.1 pg/dL, FT4-0.515 ng/dL, and thyroid-stimulating hormone (TSH) - 107.3 μIU/mL. Thyroid antibody profile revealed antithyroid peroxidase antibody >500 IU/mL and antithyroglobulin antibody >1000 IU/mL. Following this, an ultrasound of the neck was done which showed features of thyroiditis. Considering the possibility that the underlying thyroiditis could explain the obtunded state and refractory seizures, the patient was started on levothyroxine and IV methylprednisolone. The sensorium of the child improved dramatically, and she got extubated. There were no further seizures and her TSH level reduced gradually and eventually, she was discharged.

Conclusions:

In a child with altered sensorium and refractory seizures, Hashimoto encephalopathy is a diagnosis of exclusion and may be considered when most of the common causes of encephalopathy and seizures have been ruled out, especially in the setting of some clinical clues of hypothyroidism. The condition is often reversible with good response to steroid therapy.
Resolution of Fetal Hydrops-not a Favorable Outcome in Congenital Pulmonary Malformation Type 1
Authors: Gobbi Dalia , Filippi Elisa , Bracalente Gabriella , Baciorri Francesca , Midrio Paola
Published: August 2023

Background:

Congenital pulmonary airway malformations (CPAMs) comprise a spectrum of anatomical anomalies of the lungs and respiratory tree. The natural history of prenatally diagnosed CPAM varies from in utero resolution to progression to hydrops and intrauterine death. The majority of fetuses (90%) have a good outcome. However, in a minority (10%), the mass may grow so large that it is associated with complications and becomes life-threatening to the fetus.

Clinical Description:

Prenatal diagnosis of giant left CPAM type 1 was made at 24 weeks of gestation in a 29-year-old primigravida woman. The lesion consisted of multiple large cysts with a CPAM volume ratio of 4.7. Since the diagnosis, the mass was associated with nonimmune fetal hydrops and polyhydramnios which got worse throughout the following 4 weeks of gestation. Doppler studies remained normal until term.

Management:

The family received prenatal counseling. Parents refused termination of pregnancy and any other invasive or pharmacological therapy in light of the bad prognosis. The pregnancy was strictly monitored using standard fetal lung parameters. By 31 weeks' gestation, hydrops spontaneously improved to resolution but without any change in the size of the cysts. A baby girl was delivered at term, with birth asphyxia, who, despite all efforts by a multidisciplinary team, could not be revived. Autopsy and histopathological findings were compatible with type 1 CPAM.

Conclusion:

Hydrops is a well-known complication in fetuses with congenital cystic adenomatoid malformation. The present case reminds the possibility of its spontaneous resolution during pregnancy, even though the cyst size remains unaltered. The eventual neonatal survival depends not on the presence of hydrops but on the cyst volume and underlying lung hypoplasia.
Double-site Intussusception in an Infant
Authors: Gupta Rahul , Raj Monish , Shukla Arvind Kumar , Sevar Ravindra
Published: August 2023

Background:

Although intussusception is a well-known phenomenon in childhood, double-site intussusception is rarely encountered. We report an interesting case of idiopathic double-site, two ileoileal intussusceptions.

Clinical Description:

An 11-month-old baby girl presented with acute-onset vomiting and abdominal distension over 3 days. There was no associated history of fever, respiratory tract infection, or gastroenteritis. The infant was otherwise healthy, thriving well, without any significant medical or surgical illness in the past. On examination, the infant was alert, but irritable, hemodynamically stable, with abdominal distension without any lump or organomegaly.

Management:

The infant was stabilized with supportive care initially. The abdominal radiograph revealed multiple air–fluid levels with a paucity of distal gas shadows. Ultrasound showed a single-target sign in the right lumbar region. At laparotomy, an ileoileal intussusception was detected. During manual reduction, another intussusception was identified; the distal one was also ileoileal at the terminal ileum with its apex at the ileocecal junction. Both intussusceptions were successfully reduced. No pathological lead point was observed for each intussusception. Symptoms resolved, and there was no recurrence.

Conclusion:

This case creates awareness about the rare occurrence of double-site intussusceptions, which are not always detected by imaging methods. A careful inspection of the entire gut intraoperatively is essential to avoid missing such unsuspected second intussusceptions.
Global Longitudinal Strain Right Ventricle (GLS RV) as a Predictor for Mean Pulmonary Artery Pressure (MPAP) on Secundum Atrial Septal Defect (ASD) with Pulmonary Hypertension
Authors: Rahmianti Nia Dyah , Dinarti Lucia Kris , Mumpuni Hasanah , Triastuti Fita
Published: August 2023

Objectives:

The objectives of the study were to determine the association between global longitudinal strain right ventricle (GLS-RV) and mean pulmonary artery pressure (mPAP) on secundum atrial septal defect (ASD) with pulmonary hypertension (PH).

Methods:

This study was an analytic observational with the cross-sectional approach. This study was conducted with secundum ASD patients who underwent right heart catheterization (RHC) from February 2019 to July 2019 at Sardjito General Teaching Hospital Yogyakarta. Demographic data were collected and echocardiographic parameters were evaluated based on the standard examination. The results were statistically analyzed using the correlation hypothesis test. If the data were normally distributed, the Pearson’s correlation test was used, if the data were not normally distributed, Spearman’s correlation test was used to analyze the correlation.

Results:

Thirty-four patients were enrolled in this study. There was strongly significant positive correlation between GLS-RV and mPAP found in patients with Secundum ASD (P = 0.0001, r = 90.5%).

Conclusions:

This is the first study in Indonesia that analyzed the association between GLS-RV and mPAP in Secundum ASD patients. There was a strongly significant positive correlation between GLS-RV and mPAP in patients with Secundum ASD after RHC. We assume that the association is influenced by progressivity and degree of disease severity.
Comparison of spinal anaesthesia and erector spinae plane block in unilateral inguinal hernia: Randomised clinical trial
Authors: Kaçmaz Mustafa , Bolat Hacı , Erdoğan Alirıza
Published: August 2023

Introduction:

The objective of our study was to compare erector spinae plane block (ESP) with spinal anaesthesia (SA) for inguinal hernia repair with respect to anaesthetic efficacy, post-operative analgesia, mobilisation, discharge, complication and side effects.

Patients and Methods:

The study included 52 patients over 50 years of age, with the American Society of Anaesthesia physical status Class I-III. Group ESP (n = 26) was applied 30 ml of mixed local anaesthetic mixture applied at the L1 level to the plane of the erector spinae and 10 ml of tumescent when necessary, while Group SA (n = 26) was applied 3 ml of 0.5% bupivacaine at the L3–L4/L2–L3 level.

Results:

Intraoperative Visual Analogue Scale (VAS) value was lower in Group S, whereas the 6th-h VAS value was lower in Group ESP (P < 0.05). There was no significant difference between the VAS values at hour 12 and 24 (P > 0.05). Reaching post-anaesthesia discharge criteria 9 and time to mobilisation and oral feeding was shorter in Group ESP, whereas post-procedure waiting time was shorter in Group S (P < 0.05). While the need for post-operative analgesics was higher in Group S (P < 0.05), there was a high level of patient satisfaction in Group ESP (P = 0.05). Intraoperative midazolam requirement was lower in Group S, post-operative diclofenac requirement was lower in Group ESP (P < 0.05), post-operative urinary retention and tremor were higher in Group S (P = 0.05).

Conclusion:

ESP block provides adequate surgical anaesthesia compared to SA (non-inferiority) for inguinal hernia repair. It is associated with less analgesic requirement, low post-operative pain, less complication rate and high patient satisfaction in the post-operative period.
Application of self-pulling and latter transection in totally laparoscopic total gastrectomy
Authors: Zhao Yang , Bai Zhi-Xia , Wang Tao , Song Dong , Li Tao
Published: August 2023

Background:

Recent years have seen an increase in gastric cancer incidence. The most effective method of treating gastric cancer is still surgical resection. Over the past few decades, minimally invasive surgery has rapidly developed, reducing post-operative complications and speeding up recovery. However, the technical difficulties, especially during anastomosis, hinder the widespread use of this advanced surgery. The aim of this study was to investigate the safety and efficacy of self-pulling and latter transection in totally laparoscopic total gastrectomy (SPLT-TLTG).

Patients and Methods:

A retrospective study compared the outcomes of laparoscopic-assisted total gastrectomy (LATG) and SPLT-TLTG in patients with gastric cancer. Eighty patients who underwent either LATG or SPLT-TLTG between January 2016 and June 2018 were included in the study. Clinical information was used to compare patients who underwent these surgeries.

Results:

Compared to LATG, patients who received SPLT-TLTG surgery recovered faster than those who received LATG time (operation and digestive tract reconstruction), blood loss, rehabilitation, first flatus, oral food intake, average pain score and hospital stay were significantly shorter in the SPLT-TLTG group than in the LATG group (P < 0.05). However, the two groups had no significant differences in LNs and baseline characteristics.

Conclusions:

The findings of this study provide significant evidence in support of the use of self-pulling and the latter transection procedures in total laparoscopic gastrectomy.
Analysis of ligature marks in hanging
Authors: Singh Salam Bitam , Devi Seram Elizabeth , Phanjoubam Memchoubi , Devi Th. Meera
Published: August 2023

Background:

Many times, a ligature mark may be the only evidence available in cases of asphyxial deaths due either to hanging or strangulation. A thorough examination of the ligature mark and analysis of the information provided by it is, therefore, a must to confirm the death as due to hanging.

Materials and Methods:

A retrospective study was conducted at the Department of Forensic Medicine and Toxicology, Regional Institute of Medical Sciences, Imphal, between 2011 and 2019 to assess the information provided by a ligature mark in such cases.

Results:

We found that deaths due to hanging constituted 7.1% of the total unnatural deaths subjected to medicolegal autopsy. Rope (34.93%) was the most common ligature material used. Majority of the victims preferred slip knots (53.61%), followed by fixed knots (46.38%). In most of the cases, the mark was obliquely placed (83.73%) and above the larynx (77.1%). Imprint over the groove when present corresponded with the ligature material used in all the cases.

Conclusion:

It was concluded that a thorough, scientific examination of the ligature mark, though not conclusive, is the most important part of the postmortem examination of deaths due to hanging.
Dyserythropoiesis: A morphology-based study on bone marrow specimens
Authors: Misra Sunayana , Bharati Purnima , Majumder Ankur , Kumar Vijay
Published: August 2023

Background and Aims:

Dyserythropoiesis is an altered state of erythropoiesis in bone marrow, classically seen in myelodysplastic syndrome (MDS) and congenital dyserythropoietic anemia. However, it can manifest in a variety of other disorders like stress erythropoiesis resulting from intense erythropoietic proliferative drive. We aim to quantify and study the light microscopic dyserythropoietic features in various reactive hematological and nonhematological disorders on bone marrow aspirates.

Materials and Methods:

Of a total of 150 bone marrow aspirate smears showing dyserythropoietic features, 132 smears met the adequacy criteria and were included. They were categorized into seven broad groups based on bone marrow diagnosis. The percentage of erythroid cells showing dyserythropoiesis on bone marrow aspirate, and the morphological features of dyserythropoiesis, including nuclear budding, multinuclearity, internuclear bridging, karyorrhexis, megaloblastosis, and cytoplasmic vacuoles, were scored semiquantitatively in each case. These features were compared between the above-mentioned groups.

Results:

Bone marrow diagnoses included erythroid hyperplasia, megaloblastic erythroid hyperplasia, reactive marrow, megakaryocytic thrombocytopenia, acute lymphoblastic leukemia in remission, hemophagocytic lymphohistiocytosis, and eosinophilia. The maximum dyserythropoietic changes were noted in erythroid and megaloblastic erythroid hyperplasia (75%–90%). Nuclear budding was the most frequent change seen through all groups, while cytoplasmic vacuoles followed by internuclear bridging were less frequently observed.

Conclusions:

Of all three hematopoietic lineages, erythroid series is the most prone to dysplasia. Erythroid hyperplasia, due to an increased erythropoietic drive, can show prominent dyserythropoietic changes on bone marrow aspirate and is indicative of reactive rather than neoplastic process. Therefore, the use of isolated dyserythropoiesis in diagnosing clonal disorders (MDS) warrants an extreme caution.
Estimation of systemic and mucosal toll-like receptors 4 and 6 in women with breast tumor
Authors: Shaheed Thamer Shather , Barem Wala Noori Majeed , Abd Frial Gemeel , Al-Khikani Falah Hasan Obayes
Published: August 2023

Background:

Toll-like receptors (TLRs) have generated an extraordinary amount of interest in cancer research in the last decade. More recently, TLR-mediated signaling pathways have been shown to support tumor cell growth in vitro and in vivo.

Aim:

Estimating the concentrations of TLR6 and TLR4 in serum and breast tissue of women with breast tumors.

Materials and Methods:

Blood and breast tissue were collected from 50 women (14–60 years) undergoing breast surgery at AL-Hilla Teaching Hospital and Al-Sadiq Hospital in Babylon Province. Histological confirmation of breast diseases, whether benign or malignant tumors, was done by the histological laboratory in the hospital. Twenty blood samples were collected from healthy women as controls. TLR4 and TLR6 were determined by the enzyme-linked immunosorbent assay in the serum of patients and controls as well as they were also determined in supernatant of cells in patients’ breast tissues.

Results:

The mean of TLR4 concentration was nonsignificantly increased in the serum of patients 4.58 ± 1.60 pg/ml than controls 4.18 ± 0.72 pg/ml (P = 0.28). The systemic mean of TLR6 in the serum of the patient was 2.11 pg/ml, while in control was 1.58 pg/ml with significant differences (P = 0.01). TLR4 concentrations also appeared systemically higher than local in different diseases. TLR6 concentrations were increased in local (tissue) than systemic with different disease types. There was a significant positive correlation between the concentration of TLR4 and TLR6 in the serum (systemic) of women with breast tumors (r = 0.353; P = 0.04).

Conclusions:

The systemic mean of TLR6 in the serum of the patient was 2.11 pg/ml, while in control was 1.58 pg/ml with significant differences (P = 0.01).
Filicide in Northeast India: A study of 10 cases
Authors: Neha Soibam , Phanjoubam Memchoubi
Published: August 2023

Background:

Filicide, or the murder of one’s own child, is an unfathomable crime. Every now and then, filicide gets media attention. One positive outcome that may be derived from this factor is practitioners’ heightened awareness that parents may, for a variety of reasons, be compelled to kill their children.

Materials and Methods:

This article presents 10 cases of paternal filicide to spread awareness about the concept of filicide, its prevalence, modus operandi, and causes in contemporary times. These cases were studied from the postmortem records of a tertiary health-care center in Northeast India during the past 10 years, i.e., from 2012 to 2022.

Results:

All the cases were paternal filicides. The ages of the victims ranged from newborns to adolescents. The motives were usually associated with mental and social disturbances in the family life of the perpetrators. Modus operandi ranged from smothering to the use of blunt and sharp weapons and from impulsive to calculated acts. Many factors are involved in the dynamics of a filicidal situation. It is therefore difficult to identify specific warning signals for the prevention of this type of homicide.

Conclusion:

The knowledge of filicide will hopefully bring about clinicians’ increased exploration of patients’ thoughts of harming their children, which may ultimately lead to the prevention of these senseless crimes. Mental health professionals and the general population must be made aware of the importance of early assessment of possible filicidal tendencies when a man verbalizes delusional ideas about his child and/or if he manifests disorganized and bizarre behavior.
Maternally inherited diabetes mellitus and deafness (MIDD): A case report and review of literature
Authors: Agrawal Prabhat K , Pursnani Nikhil , Gautam Ashish , Singh Akhil P , Singh Awadhesh K
Published: August 2023

Maternally inherited diabetes and deafness (MIDD) is a rare subtype of diabetes with a prevalence of up to 1% globally but often missed if not suspected. We present a case of MIDD and a thorough review of the literature related to it. The phenotypic presentation of diabetes depends on heteroplasmy levels of m.3243A>G mutation of the individual patient. Patients with MIDD may have involvement of other organs such as eye, muscles, kidney, and heart. In our patient, along with diabetes and deafness, there was also an associated vision loss with a strong maternal inheritance of diabetes. A young male who presented with diabetic ketoacidosis (DKA) and hearing and vision impairment and on further diagnostic work up turned out to be a case of genetically confirmed (m.3243A>G mutation) MIDD. To the best of our knowledge, this should be the first case of MIDD presenting as DKA being reported from India.
Nutritional status impacting academics among school children in selected schools of North Chennai
Authors: A Bhooma Devi , M Revathy
Published: August 2023

Background:

Though numerous variables affect academic performance in children, one of the primary underlying causes is poor nutrition. Nutritional status determines how the body develops, how the mind works, and how one behaves and hence should be given sufficient priority in growing children. The likelihood of acquiring type 2 diabetes is becoming more common in children and adolescents with poor nutrition and unhealthy eating habits.

Aim:

This study aimed to determine the nutritional status of girls and boys studying in grade 9 and the influence of nutritional status with respect to achievements in academics.

Materials and Methods:

This was a descriptive study done based on the permission obtained in a private school located in North Chennai. The sample of 210 children of grade 9 was selected based on their academic performance, socioeconomic status, age, type of school, sex, family size (siblings order), and parent’s educational status randomly. Data were collected in the form of questionnaire to understand the impact of nutritional status influencing academic achievements.

Results:

Of the 210 participants studied, the nutritional status among boys and girls was perceived differently (P < 0.01). The nutritional status with respect to parental education and sibling order also had a significant difference (P < 0.01). There was a positive correlation between academic achievement in the quarterly and half-yearly exams and the nutritional status of the students.

Conclusions:

The study report clearly indicates that there is a relationship between the nutritional status of the children and their academic achievement. The nutritional status of children has also an impact on their risk of developing diabetes.