bluuebunny/crossref_metadata_2025 huggingface dataset:
COVID-19 lockdown: impact on online gambling, online shopping, web navigation and online pornography
Authors: Zamboni Lorenzo , Carli Silvia , Marika Belleri , Giordano Rosaria , Saretta Giulia , Lugoboni Fabio
Published: February 2021

Background: The COVID-19 pandemic and control measures may have had an impact on unpleasant emotions experimented during the lockdown (LD). This may have increased the number of hours spent online and could have impacted the quality of the enacted behavior, in terms of loss of control of Internet use. In this online survey, we were interested in measure how much loss of control was perceived regarding online gambling, online shopping, the fruition of online pornographic content and web navigation.Design and methods: The online survey was carried out during the COVID-19 pandemic in the post-lockdown and 1232 subjects participated in the survey. In the participating sample, healthcare workers (HW) were 43.1% of the sample, of which 18.7% were directly involved in the Coronavirus emergency, and 52.3% of the sample is not a HW. Only 0.6% of the sample gambled online and 37.5% of those reported losing control of their gambling mode. Most of the sample shopped online during the LD (70.1%), but only 7.2% of those lost control by buying and/or spending more than what they had set themselves.Results: Significant data emerged showing that those who lost control while online shopping also lost control regarding the amount of time spent online (p<0.001); 21.6% of the sample, reported making use of online pornographic material during LD, 4.7% of them stated that the frequency increased and 5.1% reported losing control by having spent more money or more time than what was intended. Finally, 44.7% of the sample have experienced loss of control during the web navigation. Furthermore, during the LD 67.8% of the sample reports having experienced unpleasant emotions. Of these, 8.4% state that they enacted behaviors such as online gambling, online shopping, online pornographic material viewing and web navigation to counter their negative emotions. Interestingly, we found a correlation between loss of control during web navigation and online shopping and the emotional states “upset”, “scared” and “restless” (p<0.05).Conclusion: To conclude, there was no significant increase in potentially addictive behaviors, nor an increase in loss of control of these behaviors when enacted online. However, the loss of control in online shopping and web navigation was significantly correlated to the unpleasant emotional states of nervousness, fear and restlessness, whereas those who reported feeling strong and able to handle the situation experienced a lower loss of control in their web navigation. These correlations may suggest that these online behaviors may act as modulators of unpleasant emotional states.
Secondary hydrosalpinx in adolescents: a challenging decision-making process for surgical choice and future fertility preservation
Authors: Riccio Angela , Lisi Gabriele , Miscia Maria Enrica , Di Paolo Gilda , Lauriti Giuseppe , Lelli Chiesa Pierluigi
Published: February 2021

Hydrosalpinx in pre-pubertal children and non-sexually active adolescents is a rare finding with several etiology and negative impact on future female fertility. The therapeutic approach in these specific populations is debated and it must consider its etiology and adult guidelines focused on fertility issues, which suggest laparoscopic salpingectomy. We described two adolescent cases (15 years asymptomatic and 13 years with abdominal pain) presenting a monolateral hydrosalpinx secondary to surgery for Hirschsprung’s disease and complicated appendicitis, respectively. Both patients underwent to uncomplicated robotic-assisted salpingectomy, with uneventful follow-up and preserved ovarian function. Robotic-assisted salpingectomy for hydrosalpinx secondary to previous surgical conditions is a safe and careful approach for adolescents in order to preserve ovarian vascularization, function and future fertility.
Prenatal diagnosis of vascular rings and outcome
Authors: Bakhru Shweta , Koneti Nageswara Rao , Patil Sujata , Dhulipudi Bhargavi , Dash Tapan , Kolar Geeta , Vavilala Suseela
Published: February 2021

Background :

Vascular rings (VRs) present with varied symptoms and may result in significant morbidity before an accurate diagnosis is made. Prenatal diagnosis may be useful to plan surgery after birth.

Objectives :

The purpose of the study was to see the feasibility of accurate diagnosis of VR during antenatal ultrasound examination and describe their outcome.

Methods :

This is a retrospective observational study between January 2014 and December 2019. Vascular rings were diagnosed on the basis of three vessel tracheal view and neck vessels arrangements on fetal echocardiogram. Postnatal evaluation by transthoracic echocardiography and computerized tomography angiogram was performed. Surgical repair was done as per standard indications.

Results :

A total of 35 cases of fetal VRs (median gestational age: 24 weeks [range: 19–35]) were diagnosed during the study period. There were four dichorionic diamniotic twin gestation pregnancies. The right aortic arch (RAA) with anomalous left subclavian artery (ALSA) was suspected in 31 fetuses, double aortic arch (DAA) in 3, and circumflex aorta in 1. Twenty-six (74%) patients had successful deliveries. One patient had a spontaneous miscarriage, 2 underwent termination, and 6 were lost to follow-up. Postnatal assessment showed RAA with ALSA in 18, DAA in 5, circumflex aorta in 2, and no abnormality in 1. Twenty-two (86%) were operated (RAA with ALSA: 17, DAA: 4, and circumflex aorta: 1) and four were waiting for surgery. Two patients died due to prematurity-related complications. All survivors are symptom free during follow-up (median: 2.24; range: 0.2–5.6 years).

Conclusions :

Fetal echocardiography enables prenatal diagnosis and planning of postnatal repair of VRs.
Pulmonary artery thromboembolism in a critically ill neonate successfully treated using thrombolytic therapy
Authors: Villeda Gerson Valencia , Spencer Robert , Crystal Matthew A , Dayton Jeffrey D , Krishnan Usha
Published: February 2021

Pulmonary artery thromboembolism is a common and treatable cause of adult pulmonary hypertension. Although rare in children, if undiagnosed, it can result in significant morbidity and mortality. We report a case of a cyanotic neonate found to have bilateral pulmonary arterial thrombi who successfully underwent thrombolysis using tissue plasminogen activator with prompt resolution of right ventricular hypertension.
Early diagnosis of diaphragm palsy after pediatric cardiac surgery and outcome after diaphragm plication – A single-center experience
Authors: Parmar Divyakant , Panchal Jigar , Parmar Neha , Garg Pankaj , Mishra Amit , Surti Jigar , Patel Kartik
Published: February 2021

Objective :

The aims of our prospective observational study were to evaluate the (1) reliability of clinical signs in the early detection of diaphragm palsy (DP); (2) reliability of ultrasonography using echo machine as a bedside tool for the diagnosis of DP; and (3) does early diaphragm plication result in the improved outcome? We also sought to determine the incidence and predominant risk factors for DP and diaphragm plication at our center.

Materials and Methods :

This prospective observational study included patients with suspected DP from January 2015 to December 2018. Patients with suspected DP were initially evaluated by bedside ultrasonography using echo machine and confirmed by fluoroscopy. Diaphragm plication was considered for patients having respiratory distress, difficult weaning, or failed extubation attempt without any obvious cardiac or pulmonary etiology. Patients were followed for 3 months after discharge to assess diaphragm function.

Results:

A total of 87 patients were suspected of DP based on clinical signs. DP was diagnosed in 61 patients on fluoroscopy. The median time from index operation to diagnosis was 10 (1–59) days. Diaphragm plication was done among 52 patients and not done in nine patients. Bedside ultrasonography using echo machine was 96.7% sensitive and 96.15% specific in diagnosing DP. Early plication (<14 days) significantly reduced the need for nasal continuous positive airway pressure (65% vs. 96%, P = 0.02), duration of mechanical ventilation (12 vs. 25 days, P = 0.018), intensive care unit (ICU) stay (25 days vs. 39 days, P = 0.019), and hospital stay (30 days vs. 46 days, P = 0.036).

Conclusion :

Hoover's sign and raised hemidiaphragm on chest X-ray are the most specific clinical signs to suspect unilateral DP. Bedside ultrasonography using an echo machine is a good diagnostic investigation comparable to fluoroscopy. Early plication facilitates weaning from the ventilator and thereby decreases the ICU stay and hospital stay.
Intracardiac atrial overdrive pacing as an alternative to extracorporeal membrane oxygenation in the treatment of cardiogenic shock due to drug refractory and incessant persistent junctional reciprocating tachycardia in a 7-month-old infant
Authors: Ksiazczyk Tomasz M , Pietrzak Radoslaw , Werner Bozena
Published: February 2021

In the case of prolonged, undiagnosed persistent junctional reciprocating tachycardia in infants, compensatory mechanisms are exhausted leading to heart failure. However, when cardioverted to sinus rhythm patients often deteriorate due to cardiac output dependency on the higher rates. Extracorporeal membrane oxygenation (ECMO) is often used to stabilize their hemodynamic status. A 7-month-old female infant was admitted in cardiogenic shock due to drug refractory supraventricular tachycardia (SVT). Pharmacological cardioversion to sinus rhythm with heart rate (HR) of 90 bpm was achieved but resulted in hemodynamic deterioration and early recurrence of arrhythmia. Right atrial overdrive pacing (ODP) wire was introduced through femoral vein and allowed to override the tachycardia with 2:1 A:V block and HR of 160 bpm. ODP was continued for 24 h allowing to wean off the inotropic support. We postulate that ODP can be a safe and less invasive alternative to ECMO in stabilizing infants with cardiogenic shock due to intractable SVTs.
A prospective randomized clinical study of perioperative oral thyroid hormone treatment for children undergoing surgery for congenital heart diseases
Authors: Kumar Alok , Tiwari Nikhil , Ramamurthy Harpanahalli Ravi , Kumar Vivek , Kumar Gaurav
Published: February 2021

Context :

Thyroid hormone deficiency is known to occur after cardiac surgery and known as nonthyroid illness (NTI). The beneficial role of perioperative thyroid hormone supplementation in children has been debatable more so with oral supplementation.

Aims :

The aim is to evaluate the role of pre-operative oral thyroid hormone therapy in preventing NTI. To assess its effect on post-operative thyroid hormone levels, hemodynamic parameters, and cardiac function of infants and small children undergoing pediatric cardiac surgery.

Settings and Design :

Prospective randomized, double-blinded controlled trial at a tertiary level pediatric cardiothoracic center.

Materials and Methods :

Sixty-five children aged under 18 months undergoing corrective surgeries on cardiopulmonary bypass were included. Patients were randomized into two equal groups: placebo group (given placebo) and thyroxine group (given thyroxine tablet 10 μg/kg) orally once a day starting on the preoperative evening till the fifth postoperative day. The postoperative hemodynamics, inotropic requirement, ventilatory requirement, and cardiac function on echocardiography were observed.

Statistical Tests :

Shapiro–Wilk test, Mann–Whitney/t-test, Chi-square test, ANOVA with Tukey correction were used.

Results:

Serum triiodothyronine and thyroxine levels postoperatively were significantly higher in the thyroxine group than in the placebo group. There was no significant difference in left ventricular ejection fraction, hemodynamic variables, extubation time, and length of intensive care unit (ICU) stay between the two groups.

Conclusions:

In infants and small children undergoing corrective cardiac surgery, perioperative oral thyroid hormone therapy reduces the severity of postoperative NTI. It increases the serum level of thyroid hormones but the therapy does not translate to better hemodynamics, reduced inotropic requirement, reduced ventilatory requirement, improved myocardial function or reduced ICU stay when compared to placebo.
Aortopulmonary window
Authors: Bhalgat Parag S , Nabi Fazal , Ray Sudeshna
Published: February 2021

Being a planar structure, fetal diagnosis of aorto-pulmonary window poses great challenge. A few echocardiographic signs can help to clinch the diagnosis.
Transposition of the great arteries with total anomalous pulmonary venous connection in a 1½year-old child
Authors: Abah Rose Okwunu , Prabhu Atul , Katewa Ashish , Sahu Balswaroop
Published: February 2021

Transposition of the great arteries with total anomalous pulmonary venous connection is a rare anomaly with varied management approach depending on the time of presentation; the management of cases which present early is usually by anatomical surgical approach while late presentation is by physiologic approach. This is due to early left ventricular mass regression as a result of the absence of volume and pressure load to the left ventricle (LV). We report a late presentation (at 1½ years of age) that had a successful anatomic surgical correction because the LV was “prepared” by both pressure and volume load from pulmonary arterial hypertension and large ostium secundum atrial septal defect.
Effectiveness and safety of oral acyclovir 1 g twice a day for 3 days in the management of genital herpes
Authors: Verma Kaushal K. , Sonune Mahendra , Dar Lalit , Bhari Neetu , Jangid Banwari Lal
Published: February 2021

Context:

Acyclovir is the most commonly used drug in genital herpes; however, with existing acyclovir regimens, the drug needs to be taken five times a day which is inconvenient for patients.

Aims:

The aim of the study was to evaluate the efficacy and safety of oral acyclovir 1 g twice a day for 3 days in genital herpes.

Methods:

The patients of genital herpes were treated with oral acyclovir 1 g twice a day for 3 days and followed up after day 3, 5, 7, and 10 to determine the response to therapy. The response was assessed by physicians' assessment of percentage healing of the ulcer and mean healing time as well as patients' assessment of improvement in the Visual Analog Scale (VAS).

Results:

Twenty-three patients of genital herpes were recruited of which 21 (91.3%) had recurrent episodes, whereas 2 (8.7%) patients had first episode. One patient was lost to follow-up and 22 were analyzed. Complete healing of ulcer was seen in 9 (40.9%), 17 (77.27%) and 20 (90.90%) patients after day 3, 5 and 7 following the treatment respectively, with a mean healing time of 4.91 ± 2.16 days. The mean healing time of recurrent disease was 4.67 ± 1.87 days. Complete improvement in VAS was seen in 9 (40.9%), 21 (95.45%) and 22 (100%) patients after day 3, 5 and 7 following the treatment respectively, with a mean time for complete improvement being 4.27 ± 1.16 days. There were no significant side effects of therapy.

Conclusion:

Acyclovir 1 g twice a day for 3 days is an effective treatment for genital herpes with advantages of comparable healing time and convenient dosage schedule.
A congenital syphilitic child to an adequately treated syphilitic mother
Authors: Rajakumari R. Suganthy , Gopinath Sudha R. , Mohan Nithya , Sathyamoorthy Durgadevi , Sumithra Sundararaj
Published: February 2021

A mentally ill antenatal mother of 34 weeks gestation was diagnosed as a case of latent syphilis of unknown duration and was treated adequately with benzathine penicillin. One month after last dose of penicillin she delivered a male baby without any clinical or radiological evidence of syphilis, but reactive RPR in 1:64 dilution. Baby was treated as per CDC guidelines. It is also the gestational age at which the mother was treated decides the outcome in child in addition to stage of syphilis. These reported congenital syphilis cases necessitates early screening and adequate treatment of syphilis mainly in pregnancy.
Disseminated violaceous plaques in a HIV-1-positive patient from eastern India
Authors: Sen Sumit , Mallick Subhadeep , Das Somnath , Das Jyoti , Sharma Surabhi , Baisya Subhasmita
Published: February 2021

Kaposi's sarcoma (KS) is an angioproliferative disorder primarily of viral etiology, though multiple cofactors are also responsible. Human herpes virus-8, a gamma herpes virus, is considered to be the causative agent. Acquired immunodeficiency syndrome-associated KS has different clinical pictures than those seen in other types of KS. As it progresses rapidly, early institution of highly active antiretroviral therapy (HAART) after proper diagnosis is expected. Though HAART has reduced the prevalence of KS in HIV disease, HAART has not eliminated the disease. Here, we report a case who is HIV 1 and hepatitis B surface antigen positive with numerous violaceous plaques over the face, upper extremities, and trunk along with oral mucosal involvement. He had received ten sessions of electron beam radiotherapy on the face, and the facial lesions have healed with residual hyperpigmentation.
Bipolar herpes simplex infection in an human immunodeficiency virus-infected individual
Authors: Raghukumar Sonia , Ravikumar C. B.
Published: February 2021

Herpes simplex infection is the most common infection among the human immunodeficiency virus-infected individuals. However, the atypical manifestations of herpes simplex virus may confound even an astute physician. Hand involvement is rarely associated with genital herpes infection and the involvement of widespread areas healing with debilitating scarring is uncommon.
Correlation of six minute walk test and incremental shuttle walk test with severity of airflow obstruction in patients with chronic obstructive pulmonary disease
Authors: Tej Pavirala Sai , Kumar Saka Vinod , Vishnukanth G.
Published: February 2021

Context:

The field walking tests like 6MWT and ISWT are commonly used indicators of functional capacity in patients with cardiopulmonary diseases. This study was designed to assess the correlation of six minute walk distance (6MWD) and incremental shuttle walk distance (ISWD) with the severity of airflow obstruction (FEV1%) in patients with chronic obstructive pulmonary disease.

Aims:

Comparison of correlation of six minute walk test and Incremental shuttle walk test with the severity of airflow obstruction in COPD patients.

Settings and Design:

Hospital-based prospective cross-sectional study in a tertiary care centre.

Methods and Material:

One hundred and twelve (112) spirometrically confirmed COPD patients underwent 6MWT and ISWT. The diagnosis of COPD and its severity was assessed by the GOLD criteria. 6MWT and ISWT were done on the same patient with a gap of 5–6 hours and the distance walked (6MWD and ISWD) was correlated with the severity of COPD (FEV1).

Statistical Analysis Used:

One way ANOVA to compare mean distance walked in 6MWT and ISWT with different grades of COPD. Pearson Correlation was done to correlate packyears of smoking and age with 6MWD and ISWD.

Results:

The mean distance walked in the 6MWT and ISWT was estimated and compared across the four categories of GOLD grading. There was no statistically significant difference between the study subjects of corresponding GOLD grades based on the distance walked in 6MWT and in ISWT. However, a linear correlation was depicted between ISWD and post-bronchodilator FEV1. A model of linear regression showed that ISWD was an independent contributor to post-bronchodilator FEV1 in our study.

Conclusions:

Incremental shuttle walk test, an externally paced near to standard test with its incremental nature, can be used as an appropriate surrogate for FEV1 in determining the severity of airflow obstruction in COPD patients.
Double hit
Authors: Kumar Kadli Shirish , Prajapat Deepak , Prakash Arjun , Dabral Charul , Talwar Deepak
Published: February 2021

Gastrointestinal Stromal Tumours (GISTs) are rare but remain the most common mesenchymal tumour of the Gastrointestinal tract (GIT). The asynchronous occurrence of other malignancies in patients with GIST during the clinical course is relatively common. However, the synchronous coexistence of GIST and lung cancer has only rarely been reported. We report the case of a 65-year-old male, a former smoker, who was diagnosed with synchronous occurrence of mesenteric GIST and Primary Large Cell Neuroendocrine Cancer (LCNEC) of the lung. There are few case reports on synchronous occurrence of GIST with primary lung cancer but till date no case report exists on GIST with primary LCNEC of lung.
Swyer-James-Macleod Syndrome
Authors: Sharma Neeraj , Gupta Preeti , Yadav Aseem
Published: February 2021

Swyer-James-MacLeod Syndrome (SJMS) is a rare cause of a hyperlucent unilateral hemithorax. It is usually found in childhood and is a long-term sequalae of postinfectious bronchiolitis obliterans. It can be an incidental finding in adults. Most patients are asymptomatic. However, some patients can present with recurrent pulmonary infections, haemoptysis or dyspnoea. The diagnosis of SJMS is made radiographically by chest x-ray and CT scan. Majority of symptomatic patients will require conservative management. It is also important to rule out other diseases which have similar radiological picture as inaccurate diagnoses can lead to inappropriate therapy. Here we report a case of 63-year-old woman who presented with haemoptysis and progressive dyspnoea and was subsequently diagnosed as a case of SJMS.
Utilizing flexible bronchoscopy for the diagnosis of endobronchial tuberculosis with negative sputum acid-fast bacillus
Authors: Huan Nai-Chien , Mohd Yusof Nurul Izzati Azmin , Ramarmuty Hema Yamini , Khoo Teng Shin , Lai Yean Chen , Lo Shan Min , Sivaraman Kannan Kunji Sivaraman
Published: February 2021

Background:

Endobronchial tuberculosis (EBTB) should be viewed as a distinct subset of tuberculosis due to various pitfalls: (a) often diagnosed late, (b) mimicking other conditions, for example, lung carcinoma, and (c) risks of bronchostenosis if treated late. Flexible bronchoscopy (FB) offers a reliable and safe modality to increase the diagnostic yield of EBTB when sputum acid-fast bacillus (AFB) is negative. In this study, we aim to determine the clinical presentation, bronchoscopic characteristics, and safety of FB for the diagnosis of EBTB at our centers.

Methods:

From September 2018 to December 2019, 25 patients with EBTB from Queen Elizabeth Hospital and Labuan Hospital, Malaysia were enrolled in this study. Histopathology and/or microbiology were diagnostic in all patients. All patients underwent FB only after sputum smears for AFB were negative.

Results:

The most common presenting complaint was cough (68%), followed by loss of weight (52%), loss of appetite (36%), fever (32%), hemoptysis (28%), and dyspnea (24%). Lung mass/nodule was seen on imaging in 56% of patients, followed by consolidation (36%), cavity (36%), tree-in-bud appearance (32%), and collapse (24%). The most common Chung’s classification of EBTB appearance was edematous-hyperemic (60%); other appearances in order of descending frequencies were: fibro-stenotic (24%), caseating (24%), tumorous (16%), and granular (16%). Bronchial lavage cultures and/or histopathology cultures were positive for tuberculosis in 72% of patients. No procedure-related mortality or major complications were reported.

Conclusion:

Even in tuberculosis endemic settings, empirical pharmacological treatment of all suspected EBTB cases will inadvertently lead to delay in attaining competing differential diagnoses in some. FB in selected patients is safe and effective as it enhances treatment confidence by providing histological and/or microbiological evidence thereby ruling out other differentials when initial sputum results were inconclusive.
An unusual cause of right upper zone opacity − azygous fissure
Authors: Vishnukanth G. , Ravindra Adimoolam Ganga , Selvaraja C. , Narenchandra V.
Published: February 2021

Azygous lobe is a normal congenital anatomic variant of the right upper lobe. The azygos lobe is not anatomically a separate lobe. Radiologically azygous lobe is noted in the apicomedial region of the right lung and is separated from the rest of upperlobe by azygous fissure. Though not a pathology, azygous lobe can be mistaken for a lung abscess or a bulla. Other complications include hemoptysis or azygous vein aneurysm.
Feasibility of testing bronchodilator responsiveness with glycopyrronium in obstructive airway diseases
Authors: Bhattacharyya Parthasarathi , Saha Dipanjan , Sengupta Sayoni , De Debkanya
Published: February 2021

Background:

The short onset of action of glycopyrronium bromide, makes it a suitable antimuscarinic agent to test bronchodilator-responsiveness in airway diseases. The objective of the study was to explore the feasibility of the testing so.

Methods:

Subjects with features of airflow obstruction (FEV1/FVC < 0.07) were given to inhale a 50-μg single dose of dry powder of glycopyrronium bromide immediately following standard salbutamol-induced bronchodilator reversibility. A repeat spirometry was done after 30 minutes and the changes noted. The impact of both the drugs on spirometric variables suggesting airflow obstruction (FEV1. FEV1/FVC, and FEF25-75) were assessed statistically. A salbutamol-reversibility of ≥12% and >200ml was noted to differentiate asthmatics from chronic obstructive pulmonary disease (COPD) patients.

Result:

In a total of 35 subjects (asthma-10, COPD-25) with moderate baseline airflow obstruction [FEV1/FVC: 0.57 ± 0.12 and FEV1 (%predicted) as 46.17 ± 15.21], there was global improvement across the spirometric variables to serial inhalation of salbutamol and glycopyrronium. The post salbutamol changes in FEV1 (absolute value) were significant (P = 0.0001) overall and also for both asthma and COPD. Following inhalation of glycopyrronium, the changes were again significant for overall (P = 0.0001), asthma (P = 0.0065), and COPD (P = 0.0001). The parallel change in FEF25-75 was, however, showing better reversibility in asthma (P = 0.0008) with salbutamol compared to COPD (P = 0.1846) and the reverse to glycopyrronium inhalation that results in better reversibility in COPD (P = 0.0085) compared to asthma (P = 0.0949).

Conclusion:

Testing the reversibility with glycopyrronium appears feasible and safe in obstructive airway disease. It induced add-on reversibility once used after standard salbutamol reversibility. The observation demands further evaluations.
COVID-19 versus H1N1
Authors: Saluja Manoj , Pillai Drishya
Published: February 2021

Background:

Since December 2019, we have been facing the coronavirus disease 2019 (COVID-19) pandemic. January 30, 2020 marked India’s first case. A similar entity H1N1 was responsible for the last pandemic our civilization saw. Comparing the clinical and radiological characteristics, severity and prognosis of the two is the objective.

Methods :

Cross-sectional, observational, and comparative study of patients diagnosed with COVID-19 (April–May 2020) and H1N1 (January 2017–December 2019).

Results :

We observed raised male to female (M:F) ratio in both, average age higher in H1N1, moderate to severe symptoms with worse clinical status in H1N1, and COVID more often being associated with mild symptoms. Thrombocytopenia, lymphocytosis, and raised lactate dehydrogenase (LDH) were seen in both the diseases but were worse in H1N1; multiorgan involvement was seen in H1N1 (P < 0.001). COVID-19 patients who did report complications were refractory to routine critical care management. Radiographic abnormality was present in both. Poor prognosis was noted in elderly, especially those with comorbidities. This association was less evident in COVID-19.

Discussion:

Though Severe Acute Respiratory Syndrome- Corona Virus 2 has a milder course, sudden deterioration can be fatal. Serial monitoring of history and vitals is the key. Swine flu patients with a comparatively aggressive course need to be managed accordingly, but Sequential Organ Failure Assessment, Acute Physiology and Chronic Health Evaluation Score-II, and similar scoring can help in triage and predicting prognosis. Clinical and laboratory findings are similar − swine flu has more complications but increased risk of cardiac involvement is seen in COVID. Chest X-ray proves sufficient for imaging, reducing the requirement of computed tomography (CT) scans. Studies involving larger sample size and interventional trials are need of the hour.
Pulmonary cryptococcosis presenting as miliary tuberculosis in an immunocompetent patient
Authors: Joshi Sharad , Tayal Nitesh , Gupta Rajesh , Bhatia Ankit , Kapoor Neha
Published: February 2021

Pulmonary Cryptococcosis is a rare and difficult to diagnose entity. It has been found to be associated with immunocompromised patients. Pulmonary Cryptococcosis in an immunocompetent patient is extremely rare condition. A high degree of suspicion is required to diagnose the condition. We hereby present a case of pulmonary cryptococcosis in an immunocompetent young male which is a rare clinical entity.
Surgical Outreach as a Tertiary Hospital's Corporate Social Responsibility
Authors: Babalola Olakunle Fatai , Okunlola Abiodun Idowu , Ibrahim Tayo , Salawu Adedayo Idris , Majengbasan Timothy Oladele , Adebara Idowu Oluwaseyi , Hassan Adeniyi Steven
Published: February 2021

Introduction:

The underserved populations of the rural and suburban communities of developing countries are challenged by the twin hurdles of low-income earning and out-of-pocket payment for surgical care services. This study aims at appraising the process, outcome, and impact of a free surgical outreach programme carried out by a Federal Teaching Hospital in South-western Nigeria.

Methods:

A free day-case surgical outreach programme was announced through a popular radio jingle for a period of 1 week to attract would-be beneficiaries of the programme. A 2-day screening exercise was conducted by the concerted efforts of various specialists in the department of surgery and ophthalmology to select those who are suitable for day-case surgery. A cross-sectional survey of patients who participated in the 5-day surgical outreach programme was carried out. A structured questionnaire was used to obtain information on biodata, diagnosis, surgical operations, complications, and level of satisfaction. A 3-point bipolar satisfaction outcome scale was used to assess the level of satisfaction. The data obtained were analyzed using the SPSS software version 20.0.

Results:

One hundred and fifty-eight patients were screened, but only 124 participated. Ophthalmic cases constituted 60.5%, whereas the rest (39.5%) were non-ophthalmic cases. Patients with cataract were 73 (58.9%) of all the surgical lesions operated during the outreach programme. Two (1.6%) patients with pterygium were the other ophthalmic cases, whereas the non-ophthalmic cases were mainly hernias. A total of 129 surgical operations were performed in the 124 patients, with 5 (0.4%) of them having bilateral cases. One hundred and seventeen patients (94.4%) expressed satisfaction with their experience of the programme.

Conclusions:

Optimal corporate social responsibility of tertiary hospitals can be performed effectively and satisfactorily through a properly organized surgical outreach.
Cutaneous Malignant Melanoma in Skin of Color Individuals
Authors: Anaba Ehiaghe Lonia
Published: February 2021

Cutaneous malignant melanoma (CMM) is a malignancy with a worldwide incidence. Literature is replete in the Caucasian population, but in skin of color, there is a dearth of literature. Documented reports of the epidemiology of cutaneous melanoma reveal a low incidence in the skin of colour individuals (SCIs). However, this incidence is rising. It is also documented that when CMM does occur, it is commonly acral, unlike in Caucasians in whom it is truncal, and the most common histopathological pattern is acral lentiginous melanoma. There are as yet no observed differences in the histopathology of melanoma in individuals with skin of color and that in Caucasians. SCIs have a low awareness of CMM with consequently advanced lesion presentation, ulcerated lesions, and poor survival compared to Caucasians. The genetics of CMM in the skin of color has not been well studied. The only available study of the genetics of melanoma reveals a difference in melanoma genetics between SCIs and Caucasians. In SCIs, due to the low incidence of cutaneous melanoma, cutaneous melanoma is commonly misdiagnosed. This misdiagnosis can be both clinical and histopathological. Awareness of the features of cutaneous melanoma and sun protection practices is poor in individuals with skin of color. A high index of suspicion should be entertained of any hyperpigmented lesion in any SCI, especially if it is acral and a histopathological assessment should be made as early treatment improves survival.
Hypocalcemia and Vaso-Occlusive Painful Crises in Pediatric Sickle Cell Anaemia
Authors: Nlemadim Anthony Chibueze , Okpara Henry Chima , Uzomba Chigozie Ikechukwu , Anah Maxwell Udo , Meremikwu Martin Madu
Published: February 2021

Background:

Low serum calcium (hypocalcemia) occurs in sickle cell anaemic (SCA) children. Concomitant presence of prolonged corrected QT (QTc) interval on electrocardiogram can ascertain hypocalcemia, especially during vaso-occlusive painful crises (VOC).

Aim:

The aim of the study was to determine the relationship between hypocalcemia and VOC.

Methods:

It was a prospective cohort study of 38 SCA children aged 4–17 years during VOC and when the same children were in steady state. Information regarding bone pain and clinical examination were obtained, following which electrocardiography was done during both clinical states. Blood was drawn for total calcium and serum albumin estimation.

Results:

The mean (standard deviation [SD]) of total calcium was significantly lower during VOC (1.90 [0.19] mmol/l) than during follow-up steady state (2.24 [0.22] mmol/l), P < 0.001. The mean rank of QTc interval was significantly higher during VOC (19.93) than in follow-up steady state (14.50), P < 0.001. Total calcium negatively correlated with QTc intervals during VOC (r

s
[36] = −0.36, P = 0.029) and follow-up steady state (r
s[36] = −0.49, P = 0.002), while QTc interval was highly predictive of hypocalcemia (area under the curve [AUC] = 0.82, P < 0.001). Similarly, total calcium was highly predictive of VOC (AUC = 0.89, P < 0.001) at cutoff point of 2.13 mmol/l with 89.5% sensitivity and 81.6% specificity. Hypocalcemia was significantly observed during VOC than follow-up steady state (89.5% vs. 21.1%, P < 0.001) with odds ratio of 21.28 (95% confidence interval: 0.012–0.189; P < 0.001).

Conclusion:

Total calcium <2.13 mmol/l is associated with VOC. Regular total calcium tests should be done. SCA children may benefit from routine oral calcium to reduce frequency of VOC.
A Rapid Review of the Reopening of Schools in this COVID-19 Pandemic? How Ready are We in Nigeria?
Authors: Ezeonu Chinonyelum Thecla , Uneke Chigozie Jesse , Ezeonu Paul Olisaemeka
Published: February 2021

Reopening schools raise several ethical issues, including safety, privacy, autonomy, vulnerability. Some countries have gradually reopened their schools with explicit guidelines for safety. The safe reopening of schools demands sensitivity to community inequities. We aimed to conduct a rapid review of the strategies adopted in the reopening of schools in some countries amid the Covid-19 and highlight the lessons learned and to consider the feasibility of some of the existing Nigerian guidelines on school reopening. A rapid review technique using PubMed search was conducted using the combination of the following keywords: Covid-19, school, reopening along with a Google search using the phrase 'schools reopened in COVID-19 pandemic.' Ten articles met the inclusion criteria and were reviewed. Eight countries namely China, Taiwan, South Korea, Norway, Denmark, Germany, Australia, and Israel were identified. All the countries started with phased reopening and a reduction in class size. Wearing masks was mandatory in some countries. Hand hygiene and strict cleaning of high-touch surfaces were ensured. The Nigerian government's guidelines towards the reopening of schools sound good, but the feasibility, acceptability, and effectiveness need to be objectively assessed and contextualized across all tiers of the government and at all levels of development to avoid COVID -19 resurgence.
Effects of Distal Mandibular Skeletal Injury on Temporomandibular Joint Soft Tissue without Bony Injury to the Joint
Authors: Bhargava Darpan , Sharma Yogesh , Beena Sivakumar , Koneru Ganesh , Pandey Ankit
Published: February 2021

Introduction:

Trauma to the temporomandibular joint (TMJ) may be associated with injury to its associated soft tissues along with the bony condyle. However, it is often neglected that even in the absence of fracture of the mandibular condyle, there may be damage to the associated soft tissues of the joint. The routine radiographic study does not reveal the soft-tissue injury around the joint and its extent. Such injuries may progress to temporomandibular joint disorders (TMDs) in the future.

Materials and Methods:

A prospective study was conducted among 50 patients diagnosed with anterior mandibular fractures without condylar fracture. The patients were assessed for soft-tissue injury around the TMJ using an arthroscopic examination by a single qualified operator. Patients were evaluated clinically and arthroscopic examination was performed to examine the TMJ soft tissues at the time of surgery for facial fracture reduction under general anesthesia.

Results:

Among the 50 patients, n = 37 (74%) patients had severe injury to the soft tissues surrounding the TMJ. Majority of the patients had arthroscopic evidence of soft-tissue injury around the joint.

Conclusion:

From this study, we observe that patients with mandibular fracture without condylar involvement should be evaluated for TMJ soft-tissue injuries and subjected to long-term follow-up to prevent TMDs in the late postoperative period.
Assessment of Resident Doctors' Perception of Postgraduate Medical Education in Nigeria Using the SPEED Tool
Authors: Taiwo Funmilola T. , Adesegun Oluwaseyitan A. , Idowu Akolade O. , Mene Andrew , Imaralu John O. , Adekoya Adesola O. , Osibowale Bamikole T.
Published: February 2021

Background:

Obtaining feedback from trainees is important in the evaluation and evolution of Postgraduate Medical Education (PME), and policies made based on their felt needs would go a long way in making residency training a worthwhile experience. This pilot study aimed to assess resident doctors' perception of the training content, atmosphere, and organization using the Scan of Postgraduate Educational Environment Domains (SPEED) tool.

Methodology:

This was a cross-sectional study conducted amongst resident doctors at Babcock University Teaching Hospital (BUTH) in Nigeria, between May and August 2019. A self-administered questionnaire was used to collect participants' sociodemographic data, their perception of PME in their respective departments, as well as the strengths and weaknesses of the training programmes. Validity and reliability indices were assessed, and descriptive, inferential, and correlational analyses were run where appropriate.

Results:

The mean score for the resident doctors' perception of training content, atmosphere, and organization was 4.0 ± 0.4, 4.2 ± 0.5 and 3.69 ± 0.60 respectively, out of a maximum of 5, indicating a positive perception of training in BUTH. The major strengths perceived by most residents were good inter-personal relations between residents and their trainers, as well as conducive learning and work environment; while the weaknesses include poor remuneration and limited staffing which hampers rotations.

Conclusion:

Resident doctors in BUTH mostly had a positive outlook on their training. This study serves as a reference point for local policy change (in BUTH), and a framework from which future studies on PME can emerge.
A Rare Complication of Burr Hole Drainage of Chronic Subdural Hematoma
Authors: Obanife Henry Olayere
Published: February 2021

Chronic subdural hematoma is a common neurosurgical problem, especially in the elderly, which is frequently treated by burr hole drainage. Recurrence is the most frequent complication of chronic subdural hematoma surgery reported in literature. However, cerebrospinal fluid leak resulting subgaleal pseudomeningooele has been reported. We report a 67-year-old man who had burr hole drainage of chronic subdural hematoma and subsequently developed cerebrospinal fluid fistula which was drained by subdural drain inserted intraoperatively. A 67-year-old right-handed man who presented with nine days' history of progressive pan-cranial persistent headache following a fall from the bathroom associated with irrational behavior and weakness of the left side of the body. His Glasgow Coma Score (GCS) was 12/15, with generalized hypertonia, left-sided hemiparesis, and left-sided grade + 3 deep tendon reflexes. Brain computed tomography scan [Figure 1] showed right-sided fronto-temporoparietal chronic subdural hematoma with midline shift and effacement of the ipsilateral lateral ventricle. He had right frontal and right parietal burr holes, such as subdural hematoma and insertion of nonnegative subdural drain through the parietal burr hole. He developed cerebrospinal fluid leak, which drained into the drainage bag and subsequently managed conservatively. Cerebrospinal fluid leaks can occur following burr hole drainage of chronic subdural hematoma. Subdural drain inserted intraoperatively is helpful in preventing the sequelae of cerebrospinal fluid accumulation in the subdural and subgaleal spaces.
Undiagnosed Hypertension and Diabetes
Authors: Oparah Sidney Kelechi , Ukweh Ofonime Nkechinyere , Ukweh Ikechukwu Henry , Iya-Benson Joy N
Published: February 2021

Background:

Hypertension and diabetes rank high among cardiovascular risk factors, and in Africa, many affected persons are undiagnosed. Urban market traders are constrained from regular clinic visits by the fear of revenue loss occasioned by their absence from the stores, contributing to the reportedly high rates of undiagnosed and poorly treated cardiovascular conditions. This study determined the rate of undiagnosed hypertension and diabetes among traders in an urban market in Calabar, Nigeria.

Methods:

In this cross-sectional study, we used an interviewer-administered questionnaire to collect data from 105 traders at Marian market Calabar, including information on demographic characteristics and self-reported statuses regarding hypertension and diabetes. Subsequently, blood pressure and random blood sugar values were measured.

Results:

Forty-three (41.0%) of the respondents correctly reported their statuses regarding hypertension and 93.3% of the respondents correctly reported their statuses regarding diabetes. 62 (59%) and 7 (6.7%) of them had hitherto undiagnosed hypertension and diabetes, respectively. Only two (9.5%) out of those with a self-reported history of hypertension had normal blood pressure values. There was no agreement between the self-reported and actual profiles of hypertension among the respondents (kappa = 0.000, P = 0.008), and a weak level of agreement between the self-reported and actual profiles of diabetes among the respondents (kappa = 0.559, P < 0.001). Educational level was the identified predictor of correct self-report of status regarding hypertension (P = 0.031);

Conclusion:

There was a high rate of undiagnosed hypertension and, to a lesser extent, diabetes among this set of urban market traders.
Assessment of Zinc Level and its Relationship with Some Hematological Parameters among Patients with Sickle Cell Anemia in Abakaliki, Nigeria
Authors: Ugwu Ngozi Immaculata , Okike Clifford , Ugwu Collins N. , Ezeonu Chinonyelum T , Iyare Festus E. , Alo Chihurumnanya
Published: February 2021

Background:

Sickle cell anemia (SCA) is an inherited hemoglobin (Hb) disorder with susceptibility for oxidative damage due to chronic redox imbalance in red blood cells (RBCs) which often results in hemolysis, endothelial injury, recurrent vaso-occlusive episodes, and derangement in hematological parameters. Zinc is an antioxidant which helps to reduce oxidative damage. This study aimed to assess the serum level of zinc and its relationship with some hematological parameters in patients with SCA (HbSS).

Materials and Methods:

This was a cross-sectional comparative study which involved HbSS patients in steady state with sex- and age-matched HbAA control. Assay of Hb phenotype, serum zinc level, and some haematological parameters were done. Ethical approval was gotten from the institutional review board, and each participant gave informed written consent before recruitment into the study. Analysis of all data obtained was done using SPSS software, version 20.

Results:

Thirty adult patients with SCA and thirty sex- and age-matched controls with a mean age of 26.7 ± 7.6 years and 27.7± 5.3, respectively, were studied. There was a significant decrease in serum zinc level among patients with HbSS compared to those with HbAA (P = 0.038). Similarly, patients with HbSS had significantly lower Hb level, packed cell volume, and RBC count compared to HbAA control (P < 0.05). On the contrary, patients with HbSS had significantly higher white cell count and platelet count compared to HbAA individuals (P < 0.05). Correlation between serum zinc level and blood counts showed weak positive relationship between zinc level and Hb level (r = 0.04, P = 0.8) and weak negative relationship between serum zinc level and platelet count (r = −0.3, P = 0.1), as well as zinc and white blood cell (WBC) count (r = −0.2, P = 0.4).

Conclusion:

There was a significantly low level of zinc among patients with HbSS compared with HbAA controls. Patients with HbSS had zinc levels that weakly correlated with Hb level positively but weakly negatively correlated with platelet and WBC counts. Further studies are required on a wider scale to assess whether zinc supplementation may improve blood counts in patients with SCA.
Telemedicine for Children with Sickle cell Anemia in a Resource-Poor Setting During COVID-19 Pandemic
Authors: Nlemadim Anthony Chibueze , Okoi-Obuli Jacintha Banku , Odey Friday Akwagiobe , Meremikwu Martin Madu
Published: February 2021

Background:

The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic has continued to disrupt medical care among patients with sickle cell anemia (SCA). The city lockdowns and restrictions to minimize virus transmission in countries have created gaps in the optimal management of children with SCA.

Aim:

The aim of this study was to access the clinical experience in the use of mobile health telemedicine for the care of children with SCA.

Methods:

At the start of national lockdown, text messages were sent to parents of children with SCA who are attending a tertiary hospital in Nigeria. The message included advice to call consultants in the pediatric hemato-oncology unit whenever their wards were sick or due for a routine clinic visit. Information obtained include date of call or text message, complaints, intervention prescribed, and feedback from the parents.

Results:

There were 115 calls and 43 texts from the parents from April through July 2020. The proportion of calls increased from 16.5% to 33.9%, while texts increased from 23.3% to 30.2% over the months. Responses were significant (P = 0.047). Respiratory symptoms (40%) were the most common complaints. The most frequent interventions were counseling (59%) and drug prescriptions (31%) with the resolution of most symptoms by day 7 (P < 0.001). Parents (60.8%) preferred phone interactions across the months (P < 0.05). No confirmed case of SARS-CoV-2 was recorded.

Conclusion:

Mobile health telemedicine is a beneficial tool in the maintenance of care and possibly prevention of SARS-CoV-2 infection among children with SCA in a resource-limited region. Efforts should be made by stakeholders to institute and promulgate telemedicine during this pandemic.