bluuebunny/crossref_metadata_2025 huggingface dataset:
Apremilast − a fairly effective drug to manage palmoplantar psoriasis
Authors: Parasramani Shrichand G. , Pillai Jisha
Published: June 2021

Aim

To present real world data for the treatment of palmoplantar psoriasis with Apremilast.

Objectives

To study the efficacy and safety of apremilast in palmo-plantar psoriasis.

Background

Palmoplantar psoriasis (PPP) is a disabling condition that is refractory to treatment. Apremilast an approved oral PDE4 inhibitor was used as a twice daily dose to treat our patients.

Methods

30 patients of PPP were administered apremilast tablets, along with mid potent topical steroids and emollient cream. 23 patients completed the study.

Results

The primary end point was the assessment of clinical response in patients achieving Palmoplantar Physicians Global Assessment 0/1 (ppPGA) at 16 weeks which was seen in 34.7% patients. Secondary end points were assessed as follows: Change in mean ppPGA from baseline to week 24, ppPGA 0/1 was seen in 48.7% patients, three patients who continued long term therapy maintained ppPGA 0/1 and adverse events (AE) reported during the course of the therapy were seen in 26% of the patients.

Conclusions

Apremilast is a fairly effective and safe drug for the management of PPP. It is capable of not only inducing clinically meaningful responses but also keeping PPP under control in the long run.
Serum interleukin-33 level may serve as a new marker for psoriasis diagnosis
Authors: AbdelWahed Mai A. , Elmogy Mohammed H. , Abdelsalam Maha , Zohdy Marwa
Published: June 2021

Background

Psoriasis is a Th1/Th17 disease resulting from a dysregulated interplay between keratinocytes and immune cells, leading to skin hyperproliferation. Increased levels of interleukin (IL)-33 were reported in various Th1/Th17-driven autoimmune diseases, such as rheumatoid arthritis and inflammatory bowel disease, with correlation to disease severity. Increased levels of IL-33 have been reported in lesional skin of psoriatic patients. The authors hypothesized that keratinocyte-released IL-33 might play a role in psoriasis pathogenesis; thus, inhibiting IL-33 activity might be a breaking new therapeutic strategy in its treatment.

Patients and methods

Serum IL-33 levels were measured by an enzyme-linked immunosorbent assay for 30 patients with active psoriasis (group A), 30 patient with stable psoriasis (group B), and 30 healthy age-matched and sex-matched controls (group C).

Results

Serum IL-33 showed statistically significant higher mean value among patients with psoriasis compared with the control group. The level of IL-33 in active psoriasis was significantly higher than in inactive psoriasis. Moreover, there was a statistically significant correlation between IL-33 and psoriasis area and severity index (PASI) score. Receiver operating characteristics curve detected the validity of serum IL-33 in differentiating patients with psoriasis from controls. At the cutoff point of IL-33 as 22.72 pg//ml, psoriasis could be predicted with 96.67% sensitivity and 93.33% specificity. Serum IL-33 was a statistically significant predictor of PASI score, with 63.5% of PASI scores predicted by serum IL-33.

Conclusion

Serum IL-33 may represent a new marker for psoriasis diagnosis as well as a predictor of the disease severity.
Does breastfeeding delay the onset of eczema in infants?
Authors: Al-Abadie Mohammed , Beer Greg , Al-Rubaye Mohammed , Oumeish Faris , Abadie Dina Al
Published: June 2021

Background

Cow’s milk has been shown to contribute to flare-up of atopic dermatitis, whereas breastfeeding was thought to help reduce the severity of the flare-ups of the condition.

Aim

To investigate whether breastfeeding or cow’s milk (bottle formula) has an influence on the course of and onset of atopic dermatitis symptoms. Three feeding modalities were evaluated. These are ‘breastfed,’ ‘bottle-fed,’ or ‘breast and bottle-fed.’

Patients and methods

Medical records from general practice of patients aged 2 years or less with diagnosis of eczema, atopic dermatitis, atopic eczema, and infantile eczema were reviewed. A cohort of 131 patients was divided into three categories: (a) breastfed, (b) bottle-fed, and (c) breast and bottle-fed.

These data were studied according to the data recorded at the 6-week infant health checkup. The age of the child at their first eczematous diagnosis was then calculated in accordance with their date of birth.

Result

New eczema diagnosis showed a similar trend in ‘breast-fed’ babies; however, onset of eczema was significantly delayed in the ‘breast and bottle-fed’ group when compared with bottle-fed alone. Most bottle-fed babies (58% of patients) were diagnosed at 31–60 days, whereas most ‘breast and bottle-fed’ babies (56%) were diagnosed at 91–120 days (P≥0.0001).

Conclusion

Babies from the two groups (‘breast’ and ‘breast and bottle-fed’) experienced a delayed onset of their eczema compare with ‘bottle-fed’ infant group. Breastfeeding can delay the onset of atopic dermatitis.
Treatment of medium-sized facial nevus spilus with a dual-wavelength copper vapor laser
Authors: Ponomarev Igor V. , Topchiy Sergey B. , Andrusenko Yury N. , Shakina Ludmila D.
Published: June 2021

Nevus spilus (NS; synonym: speckled lentiginous nevus) − benign congenital or, more often, acquired melanocytic nevus − is characterized by numerous foci of hyperpigmentation located on a light brown background with possible transformation into malignant tumors. Its prevalence is ∼2% among the general population. NS sizes vary from 2 to 10 cm in diameter, but more extensive lesions have been described. Patients turn to a dermatologist when NS is located in aesthetically significant areas owing to cosmetic problems. Surgical methods for removing NS are associated with a risk of scarring. The use of various types of lasers for the treatment of NS has allowed successful results. However, it is accompanied by adverse effects such as scars, postinflammatory hyperpigmentation, and relapses. Our experience in treating benign melanocytic skin lesions using copper vapor laser (CVL) radiation, which allows selective heating of the pigment and blood vessels, gives us grounds for using CVL to treat NS. For the first time, we describe an innovative method of treating NS with dual-wavelength CVL radiation. A case of NS (medium size 50×40 mm) located in the cheek area was treated in a 39-year-old fair-skinned patient with type II skin, according to Fitzpatrick. NS treatment was carried out with the following parameters of the CVL (Yakhroma-Med model, P.N. Lebedev Physical Institute of the Russian Academy of Sciences): average power 0.6–0.8 W, with a power ratio of 3:2, at wavelengths of 511 and 578 nm. The pulse duration is 20 ns, the repetition rate is 16.6 kHz, the exposure time is 0.2–0.3 s, and the diameter of the light spot on the skin is 1 mm. After six treatments, the color of the hyperpigmented area, dark macules, and papules were eliminated. The follow-up period was 24 months. Medium-sized NS treatment with CVL provided complete elimination of the pathological focus and provided excellent cosmetic results. No relapse was observed within 24 months after treatment.
COVID-19 clinical course and outcomes in a predominantly black, vulnerable patient population in New York City
Authors: Parmar Priyanka , James Alecia , Rosengarten Sabrina , Oommen Alvin , Joseph Michael A. , Wilson Clara , Maini Rohan , Mecklenburg Max , Kim Julie , Edwards Jodi-Ann , Nakeshbandi Mohamed , Breitman Igal , Arquilla Bonnie , Daniel Pia
Published: June 2021

Introduction:

A study examining the impact of social determinants of health on COVID-19 outcomes is necessary to identify which aspects of a vulnerable population make it more susceptible. We describe the epidemiological and clinical characteristics of a patient population disproportionately impacted by COVID-19 and situate the findings within the broader context of health determinants.

Materials and Methods:

A descriptive study of 527 laboratory-confirmed COVID-19 patients hospitalized from March 12 to April 13, 2020, evaluated patient demographics, comorbidities, presentation, and outcomes. The study took place at an academic medical center serving a low-income, Black community (predominantly Caribbean-born) in Brooklyn, New York.

Results:

Compared to previous studies, we report a higher median age of 70 (interquartile range 59–80), a higher percentage of Blacks (91%), a higher prevalence of comorbidities (hypertension [83%], diabetes [53%], and obesity [42%]), a higher prevalence of abnormal findings on presentation (altered mental status [30%], Quick sequential organ failure assessment score ≥2 [27%], elevated random-glucose [77%], elevated creatinine [57%]), and a higher incidence of negative in-hospital outcomes (intensive care unit admission [21%], mechanical ventilation [21%], acute kidney injury [31%], acute respiratory distress syndrome [17%] and acute cardiac injury [18%], and age-adjusted fatality rate [40%.]).

Conclusions:

This study shows the characteristics of a patient population disproportionately impacted by COVID-19. The intersectionality of the Black race, older age, a high prevalence of comorbidities, and residency in a locale severely affected by COVID-19, deserves further consideration to better address health outcomes in vulnerable patient groups.

The following core competencies are addressed in this article:

Practice-based learning and improvement, Patient care and Procedural skills, Systems-based practice.
Knowledge, attitude, and practices regarding COVID-19 outbreak among the personnel providing emergency services in India
Authors: Bhushan Vidya , Rai Shilpa
Published: June 2021

Introduction:

The threat of contracting coronavirus persists among individuals constantly coming in direct or indirect contact with positive cases. Therefore, this study was conducted to assess the knowledge, attitude, and practices (KAPs) regarding the COVID19 outbreak among the personnel providing emergency services in India and also assess their perception toward government measures during this pandemic.

Materials and Methods:

An online survey was conducted among individuals providing services during the period of COVID-19 outbreak. A total of 234 people consented to continue with the survey. Data collection was carried out from April 2020 to June 2020. Data analysis was carried out using Chi-square statistics and Fisher-Freeman-Halton test. The level of statistical significance was set at 0.05 with a confidence interval of 95%.

Results:

Majority of the participants were male and belonged to the age group of 18–54 years. Almost all were aware that COVID-19 is a virus and had knowledge regarding its mode of spread and modes of prevention. Precautions such as covering face with mask, avoiding shaking hands, and washing hands before touching the eyes, nose, and mouth were undertaken by 34.6% of the total participants. Around 70.5% of the males, 53.7% of the females, and 33.3% of the participants from the others' category felt that the funds released by the government to combat corona were efficiently reaching the poor or the needy. Some of the barriers preventing the fair distribution of funds/services to the poor and needy as reported by the participants were corruption, lack of knowledge, delay in delivery and lack of personal protective kits, limited workforce, and no bank account of poor people.

Conclusion:

KAP of personnel providing emergency services is crucial to the containment of this disease. Understanding of the barriers shall aid policymakers to assess the impact of their preventive programs and also take crucial decisions toward its management.

The following core competencies are addressed in this article:

Medical knowledge, practice-based learning and improvement, and systems-based practice.
Coverage assessment of maternal and child health services provided at Urban Health and Nutrition Day in urban slums of Jamnagar Municipal Corporation area
Authors: Khan Mubashshera Firdous , Kotecha Ilesh S.
Published: June 2021

Introduction:

Urban Health and Nutrition Day (UHND) is an initiative to provide preventive, promotive, and curative maternal and child health services monthly on fixed day. It is mainly designed to reach out to those who are living in urban slums and for serving vulnerable. The study was conducted to assess the utilization of services provided to mother and child at Mamta session.

Materials and Methods:

A cross-sectional study was conducted in urban slums of Jamnagar. In the first stage, 30 Anganwadi centers were chosen by systematic random sampling, and in the second stage, 8 postnatal women with 8 children were included.

Results:

Out of 240 participants, 80% of women registered their pregnancy at Mamta session and 86% were having Mother and Child Protection Card at the time of visit. Basic health checkups containing blood pressure and weight were measured for around 90%, three-fourth of women were checked for hemoglobin % and urine for albumin, and only 29% were done with abdominal examination. Health education component was found to be much-sidelined portion of UHND session in both mother and child care in this study. From surveyed children, 81.6% were registered at session site; from those registered, 62% attend the session regularly; 80% of children were weighed; only 12% of children's weight was recorded in Mamta card; and 50% of mothers were explained about weight and its interpretation. Fifty-four percent of women had given colostrum to their babies, and the same proportion of mother gave prelacteal feed to their children.

Conclusion:

There is a need to sensitize health workers about the importance of giving health education to mothers which is found to be the most poorly executed component of the study.
Cryoglobulinemia unmasked by nivolumab in a patient with hepatitis C-induced hepatocellular carcinoma
Authors: Ramahi Amr , Chan Kok Hoe , Lim Su Lin , Shaaban Hamid S.
Published: June 2021

Hepatocellular carcinoma (HCC) is ranked the fifth-most common cancer in men and ninth most common cancer in women. Immunotherapy has been shown effective in malignancies refractory to chemotherapy and has been used as a second-line therapies in many advanced cancers, including HCC. The advent of immunotherapy has resulted in a brand-new set of side effects, and it has been proposed that it was related to over activated immune system. Herein, we presented the case of 59-year-old African American gentlemen who was diagnosed with HCC caused by Hepatitis C virus, for which he was started on chemotherapy and immunotherapy. However, the patient developed cryoglobulinemia that prompted stopping both therapies and giving rituximab and steroids. We believe that the mixed cryoglobulinemia was unmasked by immunotherapy in our patient. To our knowledge, this is one of the few first cases to describe such adverse effect from immune checkpoint inhibitors.
Use of single-cannula extracorporeal membrane oxygenation in the pulmonary artery to provide right heart support during respiratory failure in a drowning victim
Authors: Volfson Boris , Balabanoff Acosta Christian S , Louro Jack
Published: June 2021

Acute respiratory distress syndrome (ARDS) and respiratory failure can occur after drowning. Some of these patients do not respond to conventional mechanical ventilation and require extracorporeal membrane oxygenation (ECMO). Patients with severe respiratory failure can also develop acute right heart failure. We describe a case of a young drowning victim who developed ARDS and subsequent right heart failure. The patient was initiated on venovenous ECMO with right atrial to pulmonary artery cannulation of ECMO using the Protek Duo (TandemLife, Pittsburgh, PA, USA). The patient recovered from his ARDS and heart failure and was successfully liberated from ECMO. We will discuss the utility of ECMO in drowning victims and the use of this unique cannulation strategy to support the right ventricle in patients with concomitant respiratory failure.
Safety and efficacy of thromboelastography guidance of antifibrinolytic therapy in trauma patients
Authors: Heilbronner Rachel N. , Kincaid Michelle , Walliser Grant , Pershing Michelle , Spalding M. Chance
Published: June 2021

Background:

Tranexamic acid (TXA) is an antifibrinolytic therapy intended to decrease blood loss and improve hemostasis in traumatic hemorrhage. Viscoelastic assays, such as thromboelastography (TEG), allow for the identification of a patient's specific hemostasis. The purpose of this research study was to explore the safety and efficacy of TEG-guided antifibrinolytic therapy in trauma patients.

Methods:

This study was a retrospective review of trauma patients meeting institution-specific inclusion criteria for TXA. Patients were assigned to fibrinolytic groups per TEG LY30 data. Safety outcomes (24-h mortality, overall in-hospital mortality, and thromboembolic events) were compared between patients who did or did not receive TXA and within fibrinolytic groups. Mortality outcomes were adjusted for baseline Injury Severity Score (ISS). Secondary aims included blood product utilization, length of hospital, and intensive care unit stay.

Results:

Hypofibrinolysis was the most common fibrinolytic phenotype. Adjusting for ISS, there were no significant differences in mortality. A 30.7% thromboembolism incidence was identified in the TXA group compared to 16.6% not receiving TXA (P = 0.26), with 72.7% of these patients experiencing fibrinolytic shutdown.

Conclusions:

There were no differences in 24-h mortality, all-cause mortality, or secondary outcomes. The difference in thromboembolic rates between patients receiving TXA and those who did not, while not statistically significant, poses clinical concern.
Serum total triiodothyronine (T3) as a predictor of mortality and morbidity in critically ill patients and its correlation of predictability with acute physiology and chronic health evaluation II score
Authors: Thilak M R , Shetty Seema M. , Kotian Chitra M. , Mohammed Afsal P. , Dhunputh Pushwinder , Umakanth Shashikiran , Saraswat Pallavi P.
Published: June 2021

Background:

The aim is to assess the prognostic value of total T3, total T4, and thyroid-stimulating hormone among critically ill patients admitted to the medical intensive care unit (ICU) in association with mortality and its correlation with the acute physiology and chronic health evaluation II (APACHE II) score.

METHODS

: Our prospective observational study consists of 257 patients without known thyroid diseases admitted to the medical ICU. The baseline characteristics of the patients were recorded, including the APACHE II score and thyroid hormone levels at ICU admission. Based on the primary outcome of mortality, we analyzed the data by appropriate statistical methods. A P < 0.05 was considered significant.

Results:

Of the 257 patients included in the study, 47 (18.28%) succumbed to their illnesses. A significant difference in T3 levels (P < 0.001), T4 levels (P < 0.001), and APACHE II score (P < 0.001) was found between the survivors and the nonsurvivors. There was negative correlation observed between T3 and APACHE II score (r = −0.448, P < 0.001) and T4 and APACHE II score (r = −0.221, P ≤ 0.001). Multivariate logistic regression analysis determined T3 to be the only independent predictor of ICU mortality among thyroid hormones. The area under the curve (AUC) for T3 (0.811 ± 0.04) was almost equal to that of the APACHE II score (0.858 ± 0.029). The duration of ICU stay and hospital stay in patients with low T3 was significantly higher compared to patients with normal T3.

Conclusion:

Serum T3 is a good indicator for predicting mortality and morbidity among critically ill patients.
Neurogenic Tumors of Parapharyngeal Space – Clinical Evaluation and Management
Authors: Bharathi MB , Rakesh BS , Rudrappa Babu Amabale , Aggarwal Nitish , de Kumar Shankar
Published: June 2021

Context:

Neurogenic tumors are the second most common parapharyngeal space (PPS) lesions, with schwannoma being the most common neurogenic tumor seen. PPS tumors account for 0.5% of all head-and-neck masses, and most surgeons might not encounter it in their lifetime. Anatomical complexity and histological diversity of PPS pose various diagnostic and treatment challenges. Relevant literature about lesions of this space is growing but is still limited.

Aims:

The aim of our study was to evaluate neurogenic tumors of PPS and their management over a period of 5 years.

Settings and Design:

A retrospective study was conducted in our institution for a duration of 5 years from January 2014 to December 2018.

Materials and Methods:

Clinical features were analyzed. All patients were subjected to radio imaging-contrast-enhanced computerized tomography and contrast magnetic resonance imaging, and findings were noted. After imaging, patients were subject to fine-needle aspiration cytology. Transcervical approach was used for 11 cases and endoscopic-assisted transoral transpharyngeal approach (EATA) used for 4 cases.

Results:

A total of 27 patients with PPS tumors were evaluated and treated. The incidence of neurogenic tumors was 55.5% (15 cases). Out of the 15 patients with neurogenic tumors, 11 cases were schwannomas, 1 case was vagal neurofibroma, and 3 cases were paragangliomas from the carotid body.

Conclusions:

Neurogenic tumors of PPS are more common than traditionally thought. Neck swellings and oropharyngeal masses are the most common presenting features. FNAC is a very useful tool to establish a preoperative cytological diagnosis. Both external approach and EATA are effective approaches, provided that careful patient selection is done.
The Nescience of the Art of Conversing and Making the Shift Happen
Authors: Pendyala Gowri , Joshi Sourabh Ramesh , Mani Ameet , Mopagar Viddyasagar , Kale Preeti
Published: June 2021

Background:

Motivational interviewing (MI), a patient-centered therapeutic approach, has demonstrated to be effective for a wide range of health behaviors including dentistry. It resolves patient's ambivalence by evoking their own motivation to change, thereby improving clinical outcomes and enhancing clinician patient relationship.

Objective:

The aim of this study is to evaluate the knowledge and awareness of dental clinicians about MI and predict the likelihood of their use of the MI approach.

Methodology:

A cross-sectional survey was used to collect data. In total, a purposive sample of 600 dentists including dental professionals, postgraduate students, and interns inclusive of both genders participated in the study.

Results:

The results of this study indicated that dentists had inadequate knowledge about MI and also their practical implication was less.

Conclusion:

The results of this study may contribute to positive social change by supporting the development of effective training for dental clinicians as MI is helpful in enhancing patient awareness and obedience leading to better therapy outcomes.
Very Low Price Smartphone Fundus Camera Innovation with Basic Amenities – A Novel Approach Toward Undergraduate Teaching
Authors: Das Sujit , Verma Sanjeev , Sharma Prachi , Midya Urmi , Sahu Rohit , Saini Kanaram
Published: June 2021

In this article, we introduce a very low-price smartphone fundus camera device with basic amenities. It has become very fruitful toward undergraduate teaching at the bedside or in the outpatient department, especially where there are no facilities for the fundus camera unit. A fundus camera unit is an essential part of retina clinic, and it is very costly. Fundus photographs are very essential for disease diagnosis, its follow-up, and for disease monitoring. It cannot be carried to the camp side. Commercially, available fundus cameras are the alternative to this, but again very costly. Almost zero price this innovation helps the students to see the fundus pathologies with their own eyes and make them more clinically oriented.
Role of intramuscular glycopyrrolate in preventing hypotension after subarachnoid block in elderly patients
Authors: Gargava Aseem , Arya Monay , Dali Jaspal Singh , Sharma Kavita
Published: June 2021

Background

Hypotension is one of the most frequent complications during spinal anaesthesia. It is more common in elderly with a reported incidence of 65–75%. While keeping in mind that the hypotension induced by subarachnoid block is related to sympathetic blockade accompanied with bradycardia, the administration of glycopyrrolate could affect hemodynamic during spinal anaesthesia. Thus, we aimed at evaluating the role of intramuscular glycopyrrolate in preventing hypotension after subarachnoid block in elderly patients.

Patients and methods

It’s a randomized double blind study. Forty four patients (60–80 years of age, ASA I and II) posted for lower abdominal surgery or lower limb surgery were given subarachnoid block using standard anaesthesia technique. They were administered either 1 ml of normal saline (group N) or 0.2 mg glycopyrrolate (group G) intramuscularly 15 minutes before subarachnoid block. Parameters like blood pressure and heart rate (at preset time intervals), total requirement of ephedrine, time to first rescue vasopressor i.e. ephedrine, incidence of nausea and vomiting and requirement of Ondansetron, incidence of bradycardia and requirement of atropine, presence of dry mouth etc was recorded.

Results

Eleven of 22 (50%) patients in group N experienced hypotension compared with two of 22(9.09%) patients in group G (difference=40.91%; P=0.001). The mean ephedrine requirement in group G is 0.45±1.47 mg while, in group N is 3.63±4.41 mg (P=0.001). There was no case of bradycardia reported in group G although, two out of 22 patients (9.09%) in group N reported bradycardia (P=0.55). There is no incidence of nausea and vomiting in group G while, 3 patients in group N complained about nausea and vomiting (P=0.03).

Conclusion

The intramuscular administration of 0.2 mg glycopyrrolate in elderly patients undergoing subarachnoid block significantly reduces the incidence and degree of hypotension; and reduces the total consumption of rescue vasopressor without any clinically significant side effect.
Fragmented QRS complex and ventricular arrhythmias in patients with myocardial infarction
Authors: Mawla Tamer Sayed Mohamed Abdel , Hameed Asmaa Mizar Abdel , Zaky Sherif Hamed , El khashab Khaled Ahmed
Published: June 2021

Aim

In our study we aimed to determine whether fragmented wave in electrocadiogram (QRS) (fQRS) is associated with increased incidence of ventricular arrhythmias in patients with coronary artery disease (CAD) or not.

Methods

300 patients with CAD were included. Patients were divided into two groups according to presence or absence of fQRS on admission ECG. Group I (n=51) was defined as fQRS (+ve) and group II (n=249) was defined as a fQRS (-ve). All patients were subjected to full history taking, complete physical examination, and ECG, echocardiography and laboratory investigations.

Results

There was higher incidence of fQRS in hypertensive patients (72.5 %). FQRS was found to be associated with increased incidence of ventricular arrhythmias, 51.1 % in group I versus 25% in group II. EF was significantly lower in group I than in group II with P value <0.0001. Fragmented QRS was an independent predictor of mortality with P value <0.0001.

Conclusion

FQRS on the resting surface electrocardiogram is a simple, fast and inexpensive modality of noninvasive investigation for evaluation of CAD patients. Patients who have known CAD present with a FQRS have increased rates of ventricular tachyarrhythmias, death risk, and low ejection fraction.
Comparing the efficacy of preoperative nebulized ketamine, magnesium sulfate, and lidocaine in attenuating postoperative sore throat after endotracheal intubation
Authors: Kamel Alshaimaa Abdel Fattah , Nasrallah Marwa A.
Published: June 2021

Background

and objectives Postoperative sore throat is a common complication after endotracheal intubation, and different methods have been proposed to attenuate it. The aims were to compare the intensity of sore throat and the sedation level of preoperative nebulized ketamine, magnesium sulfate, and lidocaine in attenuating postoperative sore throat after endotracheal intubation.

Patients and methods

A prospective comparative double-blind randomized study was conducted on 100 patients who were divided into four groups: group K (n=25) included patients who received nebulized ketamine 50 mg (1 ml) plus 4-ml normal saline; group M (n=25) included patients who received nebulized magnesium sulfate 250 mg (2.5 ml) plus 2.5-ml normal saline, group L (n=25) included patients who received nebulized lidocaine 2% 100 mg (5 ml), and group C (n=25) included patients who received nebulized normal saline 5 ml (control group). So, total volume used was 5 ml. Patients were preoperatively nebulized by compressor nebulizing for 15 min.

Results

Sore throat scores were statistically significant lower (0 and 1 point) in group L and group K at 0, 2, and 4 h compared with group C and group M (P<0.05). Group K showed statistically significant lower sore throat scores at 8, 12, and 24 h compared with group L, but statistically significant high sore throat scores (2, 3, and 4 points) compared with group M (P<0.05). The level of sedation assessed using A=alertness, V=response to verbal, P=response to painful stimulus, and U=unresponsive (AVPU) was statistically insignificant among groups (P>0.05).

Conclusions

Preoperative nebulized 100-mg lidocaine and 50-mg ketamine relieves throat pain earlier in the first 24 h after endotracheal intubation, but it persists for shorter duration than 250-mg magnesium sulfate, without any changes in sedation level.
Preemptive analgesia for endoscopic sinus surgery: a retrospective study
Authors: Nakashima D. , Mori E. , Takeda T. , Hosokawa Y. , Takaishi S. , Omura K. , Kojima H. , Otori N.
Published: June 2021

Background: Chronic rhinosinusitis (CRS) is a common disease, and endoscopic sinus surgery (ESS) is widely performed. However, there is no consensus regarding postoperative pain control after ESS, and postoperative opioid abuse is a problem in many countries. Acetaminophen is reportedly effective for postoperative pain control. Preemptive analgesia has received more attention lately, wherein pain is prevented before it occurs. In this study, we assessed the use of acetaminophen for preemptive analgesia during the perioperative period in ESS. Methodology: This is a retrospective study of 175 patients who underwent ESS, septoplasty, and bilateral inferior turbinate mucosal resection at our hospital from April 2016 to February 2018. In total, 82 patients received 1,000 mg of acetaminophen during surgery and 4 hours after the first dose, while 93 patients did not receive it routinely. We compared these two groups. The primary outcome was the need to use additional analgesics prescribed by the ward physician and the secondary outcomes included postoperative pain, postoperative bleeding, reoperation, blood pressure, and body temperature. Results: The use of additional oral and intravenous analgesics was significantly reduced in the patients who received acetaminophen perioperatively. Conclusion: Preemptive analgesia during the perioperative period of ESS could lead to satisfactory postoperative pain control.
Does time to endoscopic sinus surgery impact outcomes in Chronic Rhinosinusitis? Prospective findings from the National Comparative Audit of Surgery for Nasal Polyposis and Chronic Rhinosinusitis
Authors: Hopkins C. , Rimmer J. , Lund V.J.
Published: June 2021

Objectives: Patients with chronic rhinosinusitis refractory to medical management undergo elective surgery. The time from initial diagnosis to surgery varies considerably. The impact of this delay on surgical success has never previously been evaluated. Design: First-time patients within the National Comparative Audit of Surgery for Nasal Polyposis and Chronic Rhinosinusitis were grouped based on time to surgery: 1) Early cohort: %lt; 12 months; 2) Mid cohort: 12-60 months; and 3) Late cohort: > 60 months. Co-morbidities and preoperative CT scores were analysed for all patients. Main outcome measures: The 22-item Sino-Nasal Outcome Test scores (SNOT-22) were collected at 0, 3, 12 and 60-months. Absolute and relative SNOT-22 changes from baseline were evaluated. Results: Asthma and allergies were significantly more prevalent in the Late versus the Early and Mid-cohorts. In addition, patients in the Late cohort had greater symptom burden on the SNOT-22 and more extensive preoperative radiographic disease as determined by Lund-Mackay (LM) scores. SNOT-22 scores demonstrated greater percentage improvements in the Early versus the Mid- and Late cohorts, at all time points after surgery. At 12 and 60 months after surgery, significantly more patients in the Early group achieved a clinically important change in SNOT-22 scores compared with the other groups. These differences were maintained when cohorts were matched for preoperative co-morbidities. Conclusion: Patients with asthma and/or allergies are more likely to experience delayed surgical intervention versus other patients. Overall, patients with delayed surgery reported less improvement in SNOT-22 scores than patients treated at earlier time points, regardless of co-morbid status. Delaying surgical intervention may worsen long term clinical outcomes.
Sinonasal morbidity following tumour resection with and without nasoseptal flap reconstruction
Authors: Harvey Richard J. , Malek Joanne , Winder Mark , Davidson Andrew , Steel Tim , Mrad Nadine , Barham Henry , Knisely Anna , Teo Charles
Published: June 2021

Background: Sinonasal function can be affected by multiple treatment modalities but surgical techniques, such as the nasoseptal flap or Draf 3 procedure, have been implicated in poor post-treatment function. Prior studies have rarely used comparable populations and this study aims to assess the impact of surgical technique, mainly the nasoseptal flap, on sinonasal function in a group of comparable patients. Methods: A prospective cohort of patients undergoing endoscopic surgery for sinonasal and skull base tumours was studied. Patients were analysed according to whether a nasoseptal flap was used. Other treatment factors included; use of the Draf 3, radiotherapy, removal of olfactory apparatus and dural resection. The Sinonasal Outcome Test 22 (SNOT22), a nasal symptom score (NSS), global function score and nasal obstruction scores were recorded pre and post treatment. Results: One hundred and eighteen patients were assessed. Forty-two patients had a nasoseptal flap. Perioperative radiotherapy was higher in the nasoseptal group, as was dural resection and the need to remove the olfactory apparatus. Despite this, there was no significant difference in SNOT22 scores and NSS. Radiotherapy was detrimental to sinonasal function with SNOT22 and NSS. Conclusion: The use of a nasospetal flap in surgery does not affect patient quality of life and sinonasal function after endoscopic tumour resection. Pathology is a better predictor of morbidity, with loss of function from radiotherapy or resection of functional areas such as the olfactory apparatus having a greater impact.
The effect of "Pyriform Turbinoplasty" on nasal airflow using a virtual model
Authors: Simmen Daniel , Sommer Fabian , Briner Hans Rudolf , Jones Nick , Kroger Ralf , Hoffmann Thomas Karl , Lindemann Jorg
Published: June 2021

Background: A new procedure, pyriform turbinoplasty, is described and nasal airflow is measured before and after this procedure in a virtual model. Methodology: Pyriform turbinoplasty is the submucosal reduction of the bone of the frontal process of the maxilla and the lacrimal bone. It opens part of the lateral margin of the nasal valve area with minimal damage to nasal mucosa. The resection of bone in this area can be extended by "nasal wall lateralization" when the lacrimal bone that joins the uncinate process behind the lacrimal duct as well as the base of the inferior turbinate and the edge of the maxilla at the rim of the pyriform aperture are removed. Nasal airflow was simulated using computational fluid dynamics and ANSYS Fluent solver. Results: Analysis using fluid dynamics showed that these procedures help ventilation in the main airflow areas without substantially altering the normal pattern of airflow. Conclusions: The changes after performing a pyriform turbinoplasty seem to be an improvement when compared to the changes after inferior turbinate surgery that can misdirect the airflow largely through the inferior meatus.
Th2 biased upper airway inflammation is associated with an impaired response to viral infection with Herpes simplex virus 1
Authors: Lan Feng , Wang Xiang Dong , Nauwynck Hans J. , Holtappels Gabriele , Zhang Luo , Johnston Sebastian L. , Papadopoulos Nikolaos G. , Bachert Claus , Zhang Nan
Published: June 2021

Background: We aimed to elucidate possible differences in antiviral defense in chronic rhinosinusitis with nasal polyps (CRSwNP) mucosal tissue compared to healthy mucosal tissue (HMT) upon herpes simplex virus 1 (HSV1) exposure. Methodology: HMT and CRSwNP samples were infected with HSV1. We visualized the virus location by immunofluorescence and monitored invasion by a score. The mediators Interferon (IFN)-α, IFN-β, IFN-λ, IFN-γ, Interleukin (IL)-6, IL-1β, Tumor necrosis factor (TNF)-α, IL-17, IL-5, IL-10 were measured in culture supernatants at baseline and at 24 h, 48 h and 72 h after virus incubation. Results: CRSwNP mucosal tissue showed a significant deficit in IFN-γ and IL-17 release within 24 to 72 hours after infection in comparison to HMT, at the same time releasing significantly more pro-inflammatory cytokines including IL-1β and TNF-α. These findings were associated with significantly higher viral invasion scores at 48 and 72 h in CRSwNP mucosa compared to those for the HMT. Conclusions: We demonstrate for the first time in a human ex-vivo mucosal model that the inadequate response of CRSwNP may be associated with a deeper intrusion of viruses into the mucosal tissue, and may contribute to more and longer symptoms upon acute infection, but also to the persistence of inflammation in CRSwNP tissue.
A case of Cushing Syndrome due to accidental intake of dexamethasone: a call for enforcement of regulatory laws
Authors: T. Asamoah Kofi , Akpalu Josephine , Atiase Yacoba , Yorke Ernest
Published: June 2021

Cushing syndrome could be a complication of long-term steroid use, resulting in a wide range of clinical presentations. Whereas some patients take medically prescribed doses of conventional medicines, including steroids for various ailments, others inadvertently consume unspecified doses by adulterating traditional medicines with these orthodox medications to increase their therapeutic appeal. Furthermore, some individuals with access to conventional medications may sell them in unlabelled packages as traditional medicines (TMs) to unsuspecting customers. This may lead to undesirable side effects and safety concerns. The case report highlights the problem of poorly regulated access to medications and makes suggestions to protect patrons' health of traditional medicines.
Islamic Agricultural Economic Financing Based On Zakat, Infaq, Alms And Waqf In Empowering The Farming Community
Authors: Mohamed Muhammad Izzat , Shafiai Muhammad Hakimi Mohd.
Published: June 2021

In the development of the agricultural sector, farmers are the key to its success. However, to a certain extent, specific interventions need to be done considering the problems faced by most farmers, such as financial constraints, lack of assistance, facilities, agricultural tools, and lack of land, which are obstacles to developing farmers enterprises. Therefore, this study attempts to analyze the potential of Islamic social finance tools in farmers development, particularly in facilitating financial problems of farmers in line with the government efforts in strengthening the agricultural sector. The distribution of productive zakat, infaq, alms and waqf (ZISWAF), based on the application of contractual contracts inherent from Islamic legislation and the management of productive ZISWAF, will be highlighted in this paper. The methodology of this study is based on a qualitative approach like gathering information from library research, and hence it is analyzed based on a deductive approach. The management of ZISWAF is divided into two, namely consumptive and productive ZISWAF. Consumptive ZISWAF can assist farmers in meeting their daily needs. At the same time, productive ZISWAF can develop farmers agricultural enterprises through musaqah, muzaraah, mukharabah, and ijarah contracts. Accordingly, it can be argued that Islamic social finance can play a positive role and be an alternative solution to farmers to promote agricultural land development.
El beato Marcelo Spínola y Maestre: Su modo particular de presentar el sacerdocio
Authors: Domínguez Manchado Amador
Published: June 2021

Estudio de la originalidad del sacerdocio del beato Marcelo Spínola y Maestre, para el cual nos servimos de la exposición y explicación pormenorizada de distintos aspectos de su vida, obra y magisterio. Así, abordaremos el lugar central que ocupó el Corazón de Jesús en su espiritualidad y enseñanzas, así como su implicación política y social, siempre acorde al mensaje evangélico y defendiendo a la Iglesia. Para la elaboración de este artículo hemos llevado a cabo una investigación histórica en la que hemos acudido a variadas y abundantes fuentes, dando un lugar prioritario a los escritos del beato Spínola.
Escuela Diocesana de Teología para Seglares de Sevilla: historia y documentos (1968-2014)
Authors: Martín Riego Manuel
Published: June 2021

En este artículo de investigación nos acercamos a la Escuela Diocesana de Teología para Seglares (1968-2014) desde dos aspectos: su historia y la documentación que ha ido generando desde su erección en noviembre de 1968 hasta finales del curso 2013-2014 con su extinción. A través de los documentos, ofrecemos los siguientes aspectos: historia, directores, secretarios, profesorado y alumnado de la Escuela. Desde el archivo analizamos: correspondencia, programas de las asignaturas y seminarios, libros de actas, expedientes académicos, convalidaciones, diplomas, certificados de estudios, asociación de antiguos alumnos “San Telmo”. Y por último, los aspectos económicos: libros de cajas y cuentas corrientes, presupuestos, informes y administración. De los documentos del archivo ofrecemos cun cuadro de clasificación y el vaciado de las cajas.
La restauración de la Orden Franciscana en España: La Provincia Bética Franciscana (1881-1888).
Authors: Villena Villar Manuel
Published: June 2021

La llegada de Alfonso XII y la expulsión de los religiosos de Francia provocaron la conjunción perfecta para que el franciscanismo sevillano se revitalizara y restableciera. En el presente trabajo presentamos un acercamiento a la restauración del franciscanismo en la diócesis de Sevilla de la mano de la observancia francesa, expulsada de Francia, y que entroncará con la antigua Provincia Bética Franciscana.
Estudio histórico-artístico de la Torre de la Merced de Rota (Cádiz)
Authors: Monclova González Francisco Javier
Published: June 2021

La Torre de la Merced es uno de los escasos restos del desaparecido convento mercedario de Rota. El artículo trata los aspectos constructivos y de estilo, aportando una hipótesis de autoría en la figura del arquitecto Alonso Moreno. Por último, se realiza la descripción del edificio en su estado actual.
Portre Sanatında Temsil ve Dışavurumcu Tavır Kapsamında Kimliğin Soyutlanması
Authors: KARAALİOĞLU Onur
Published: June 2021

İnsanoğlu varoluşundan itibaren kendi yaşamına ait öğeleri bir yüzey üzerine aktarma ihtiyacı hissetmiştir. Bu öğeler kimi zaman çevresine değer katma amacıyla kimi zaman ise yok olmaya karşı ölümsüzleşme arzusuyla yapılmıştır. Bireyin ayırt edici en temel özelliklerini yansıtan portreler ise bir ölümsüzleştirme pratiği ve ifade biçimi olarak sanat alanındaki varlığını uzunca bir süredir devam ettirmektedir. Portreler fiziksel olarak ayırt edici özellikleri sunmasının yanı sıra, ele alınan kişiye ilişkin misyonu taşıyıcı bir rol de üstlenmektedir. Her ne kadar kavram olarak ele alınan kişinin kimliğini yansıtan bir tür olarak kabul edilse de çağın değişen ihtiyaçlarına, üslupsal eğilimlere ya da bakış açılarına göre bağlamı sürekli bir biçimde değişime uğramaktadır. Özellikle değişen dünya koşulları ve buna koşut olarak yaratılan yeni plastik değerlerle geleneksel yaklaşımlardan uzaklaşan portrelerin kimliği yansıtan misyonunun yerini anlık dışavurumların aldığı görülmektedir. Portreler, biçim-içerik yönünden geçirdiği evrim neticesinde, yapılış anına ilişkin saptanan verilerin taşıyıcısı durumundan, sanatçının bakış açısının ön plana çıktığı, yalnızca plastik bir düzenleme ya da ele alınan model üzerinden mesaj ileten bir aygıta dönüşmektedir. Portrelerin dışavurumcu yaklaşım ile kimliğinden soyutlanma sürecini ele alan bu makale, portre sanatının ilk örneklerden başlayarak, süreç içerisinde geçirdiği biçimsel değişimleri ve kimliğe ilişkin sorunları örnek çalışmalarla analiz ederek, günümüz portrelerindeki deforme etme eğilimini nedenleriyle birlikte ortaya koymayı amaçlamaktadır.
Double renal vein Anastomosis for rare venous anomaly: A method to achieve good venous outflow in the transplanted kidney
Authors:   Clinical Assistant Professor of Surgery, Department of General, HPB Surgery and Transplant Division, Medical College of Georgia, Augusta University Hospital and Medical Center, Mirza Ahmad , Gani Imran ,   Department of Transplant, Augusta University Medical Center, Medical College of Georgia, Mallavarapu Ravi ,   Department of Transplant, Augusta University Medical Center, Medical College of Georgia, Mulloy Laura ,   Department of Transplant, Augusta University Medical Center, Medical College of Georgia, Kapoor Rajan ,   Department of Transplant, Augusta University Medical Center, Medical College of Georgia, Saeed Irfan ,   Department of Transplant, Augusta University Medical Center, Medical College of Georgia
Published: June 2021

Multi-organ procurement was performed on a 48-year-old donor after the patient was declared brain dead. A standard approach was performed for two dissections of abdominal organs. During the cold phase of dissection, an additional left sided retro-aortic vein was identified. The second vein had separate opening to the inferior vena cava in addition to the normal positioned pre-aortic left renal vein. Both veins were divided close to the origin from the inferior vena cava. During the back table preparation, it was noticed that same volume of preservative fluid was identified to be draining from both veins. Both veins were isolated and anastomosed separately on the 61-year-old recipient. Patient was initiated on anti-platelet therapy and made successful recovery.