bluuebunny/crossref_metadata_2025 huggingface dataset:
Effectiveness of Group Emotional Schema Therapy on Psychological Distress, Severity and Frequency of Symptoms in Women with Irritable Bowel Syndrome
Authors: Erfan Arefeh , Aghaei Asghar , Golparvar Mohsen
Published: January 2024

Background:

This study aimed to evaluate the effectiveness of emotional schema therapy on psychological distress, severity and frequency of symptoms in women with irritable bowel syndrome (IBS).

Materials and Methods:

This semi-experimental two-group three-stage (pre and post-test and two-month follow-up) study was done on 30 women of 18-50 years old with IBS. They were randomly assigned to two groups (experimental and control). Psychological distress and Bowel symptoms severity and frequency in the three stages were measured. The emotional schema therapy group was treated for 8 sessions and the control group remained on the waiting list.

Results:

The mean score of pre-test, post-test and follow-up of emotional therapy schema group in psychological distress were 21.23 ± 8.18, 16.08 ± 6.05 and 14.69 ± 4.05; in symptom intensity 7.46 ± 1.98, 5.23 ± 1.30 and 6.46 ± 1.33 and in symptom frequency 7.46 ± 1.98, 6.08 ± 1.66 and 7.54 ± 2.18 respectively. In the control group, there was no difference between the scores of different tests; in the pre-test, post-test and follow-up, the scores of psychological distress were 20.23 ± 5.39, 20.08 ± 5.59, and 20.38 ± 4.75, in the symptoms severity 7.69 ± 1.49, 7.62 ± 1.33, and 7.69 ± 1.80, and in the symptoms frequency 6.92 ± 2.75, 6.54 ± 2.40 and 6.62 ± 2.63 respectively. In the control group, there was no difference between the scores in different tests. In the pre-test, post-test and follow-up, in psychological distress, the scores were 20.23 ± 5.39, 20.08 ± 5.59, and 20.38 ± 4.75 in the symptom severity 7.69 ± 1.49, 7.62 ± 1.33, and 7.69. ±1.80 and in the symptoms frequency 6.92 ± 2.75, 6.54 ± 2.40 and 6.92 ± 2.75 respectively (P < 0.05).

Conclusion:

Emotional schema therapy can be used as a complementary psychological treatment to reduce psychological distress and severity and frequency of symptoms in women with IBS.
Implantation of thyroid tissue after total thyroidectomy in quadriceps femoris muscle
Authors: Aly Mohamed A.H. , Hassanin Mostafa A.G. , Eldin Abu Elnga Ahmed Nagm , Ayoub Mahmoud T.
Published: January 2024

Background

It appears to be relatively simple to control postoperative hypothyroidism after total thyroidectomy (TT) with L-T4 replacement therapy, but from the patient’s perspective, a daily reliance on L-T4 administration and regular follow-up visits to the hospital may become somewhat of a burden and may interfere with reaching euthyroid status utilizing replacement therapy because of patient noncompliance.

Aim and objectives

To evaluate implantation of thyroid tissue in the thigh muscle after TT for benign simple nodular goiter to avoid lifelong use of thyroid hormones as replacement therapy and preservation of autoregulatory mechanism of thyroid hormone production.

Patients and methods

From April 2021 to September 2022, with approval from the Ethics Committee of the Faculty of Medicine at Assiut University, Assiut, Egypt, 40 individuals with simple nodular goiter who required TT participated in a prospective case series study.

Results

There was significant relation between 12 months follow up thyroid-stimulating hormone (TSH) levels and preoperative TSH levels. There was significant relation between 12 months follow up free T4 levels and preoperative TSH levels.

Conclusion

When performed on individuals who have benign thyroid disorders, TT is followed by autotransplantation of the patient’s own thyroid tissue. This technique is safe, straightforward, and applicable, and it results in a postoperative euthyroid state in the vast majority of carefully selected individuals without the need for additional replacement therapy.
Outcome of carotid endarterectomy in patients with symptomatic carotid near occlusion with partial collapse
Authors: Fahada Shabin , Shirsath Sayali , Elmallah Ahmed
Published: January 2024

Background

Symptomatic carotid near occlusion with partial collapse (CNOPC) of the distal internal carotid artery (ICA) is an uncommon condition. Guidelines for its treatment have recommended conservative management, although surgery may be indicated for many patients. In this work, our goal was to examine the postoperative outcomes of CNOPC patients who had undergone carotid endarterectomy (CEA) for symptomatic disease.

Methods

Symptomatic CNOPC patients were identified in this single-center retrospective study from January 2019 to February 2022. Patients’ demographics, comorbidities, and CEA indications were gathered. At 30 days and 1 year after surgery, postoperative complications including stroke and death, hospital stay, and operational details were evaluated.

Results

In the 3-year study period, 128 CEAs were done, and 21 (16.4%) patients had CNOPC. Males were 15 (71.4%) with no sex difference in comorbidities except a significantly higher IHD in men, P less than 0.01. The mean ipsilateral to contralateral distal ICA luminal narrowing ratio was 34.1%. All patients had carotid patches. General anesthesia was associated with more shunt usage, P less than 0.05. High carotid bifurcation lengthened CEA time (P<0.05), but neither anesthetic type, nor the use of a shunt or patch did. At 30-day post CEA, there was only 1 (4.7%) recorded cerebrovascular event (CVA), no mortality, and no carotid restenosis or occlusion was found. At 1-year, no new CVA were reported but 1 (4.7%) fatality was recorded.

Conclusion

Carotid endarterectomy for patients with carotid near occlusion and partial distal collapse is safe and may be considered despite marginally higher procedural risks than patients with low-to-moderate risk anatomy.
Comparative study between anterior component separation and transversus abodominis muscle release in reconstruction of abdominal wall defect
Authors: Rasmy Joseph E. , ElShafei Mahmoud A. , Kamal Ahmed M. , Ayman M. Boutros  , Boutros Ayman M.
Published: January 2024

Background

Ventral hernia repair is one of the most common operations performed today, yet when complex and huge, it presents a true challenge for the surgical team.

Patients and methods

Based on our prospective randomized study, a few preliminary conclusions can be drawn. There was no significant difference in most outcomes between patients who underwent repair with the Transversus abdominis muscle release (TAR) technique or with perforator-preserving component separation when using the same type of polyprolene mesh and in the same retro-muscular position.

Results

The mean hospital stay was slightly higher when performing the TAR technique (5.2 days), while it was 4.3 days after the perforator-preserving approach. There is a nearly equal incidence of postoperative wound complications and also no statistically significant difference in the rate of recurrence between the two methods, and the rate of wound complications and recurrence is significantly lower than the classic, commonly used method of anterior component separation.

Conclusion

After this comparative study, both the TAR and anterior component separation (perforator preserving) techniques are effective and reliable methods in experienced hands, and if there is no special indication for one of them, the choice between both should depend on surgeon preference and experience.
Intersphincteric resection of low rectal cancer: a retrospective study
Authors: Gabr Hany G.M. , El-Sibai Olfat , Shafik Ali A. , El-Gamal Ahmed S. , El-Satar Mohamed H.A.
Published: January 2024

Background

The use of sphincter-saving resection without a permanent stoma in place of abdominoperineal resection (APR) has been one of the greatest advancements in the area of surgical therapy for low rectal cancer.

Aim

To assess the oncological and functional outcomes of inter-sphincteric resection of low rectal cancer in order to achieve radicality and a standard of living.

Patients and methods

At the hospitals affiliated with Menoufia University, a retrospective analysis was done. Forty patients with rectum cancer who were undergoing general surgery at Menoufia University Hospitals were the subject of this investigation. We comprised: older than 18 years old, sexes of both genders, low rectum and anal canal, with internal sphincter or rectal wall restriction on magnetic resonance imaging, differentiated tumour, tumour diameter of 1–5, and good continence.

Results

Mean operative time was 261.8 (±96.6 SD), the mean blood loss was 185.8 (±156.5 SD). Mean postoperative hospital stay was 11.2 (±4.1S D), the mean pain severity 1 h postoperatively was 5.5 (±1.0 SD), the mean 1 day postoperatively was 5.9 (±1.5 SD), the mean 5 day postoperatively was 3.3 (±1.2 SD), there were three with Anastomotic leakage, two with wound infection, two with hemorrhage, one with urinary tract infection, one with ileus. Regarding complications, mean score of micturition problems was 28.2 (±4.1 SD), the mean GIT symptoms was 32.2 (±3.1 SD), the mean weight loss was 5.5 (±1.0 SD), the mean CTX side effects was 13.9 (±1.5 SD), the mean body image was 70.3±6.2.

Conclusion

The intersphincteric resection approach improves the rate of sphincter preservation while maintaining oncological and functional results. Symptom-specific quality of life may be adversely affected by preoperative radiation.
Rectal cancer complete responders after neoadjuvant chemoradiation: when to spare their organs?
Authors: Saleh Ahmed M. , Mazloum Mohamed , Ismail Abdelsalam , Emara Doaa
Published: January 2024

Objective

The aim of this study is to identify possible clinical predictors of complete response after neoadjuvant treatment (NAT) in locally advanced rectal cancer (LARC) patients.

Materials and methods

This study included 40 LARC patients (16 males and 24 females) who received NAT followed by total mesorectal excision (TME) in the period between August 2020 and February 2023. Two different NAT protocols were used; long-course chemoradiotherapy (LCRT) or consolidation total neoadjuvant treatment (TNT) according to the decision of the multidisciplinary team (MDT). Reassessment of response is done after completion of radiotherapy by digital rectal examination (DRE), proctoscopy, and pelvic MRI to define complete responders. All these responders received TME and were classified according to their pathology specimens into the pathological complete response group (pCR=22 patients) and nonpathological complete response group (non-pCR=18 patients). Statistical analyses were performed to compare the two groups and identify clinical factors associated with pCR.

Results

The significant clinical predictors of pCR in the univariate analysis were patients’ age, preneoadjuvant carcinoembryonic antigen (CEA) level and preneoadjuvant lymphocytic ratio (P=0.030, 0.007, and 0.001, respectively). In multivariate analysis, lymphocytic ratio was the only independent predictor for pCR (P=0.017). Lymphocytic ratio (>26%) has high diagnostic performance for predicting pCR, while age (>50 years) and normal CEA (≤5 ng/ml) have lower diagnostic performance which can be much improved when both are used in combination to predict pCR.

Conclusion

Preneoadjuvant lymphocytic ratio and the combined use of age and preneoadjuvant CEA level are significant predictors of pCR, this may help the MDT select rectal cancer patients with complete clinical response (cCR), who are candidates for organ preserving strategies, to spare their rectum and avoid unnecessary radical surgeries.
Meta-analysis of laparoscopic versus open D2 gastrectomy in managing locally advanced gastric cancer: early postoperative course and pathological outcomes
Authors: Attia Abeer M.A. , Gad Khaled H. , El Hefny Amr M.M. , Hamed Mohammed A.A.
Published: January 2024

Background

With a fifth incidence and a third death rate among all malignancies, stomach cancer is a serious worldwide health problem. The best course of treatment is removing all lymph nodes together with the tumor, increasing the likelihood of survival. Laparoscopic gastrectomy has become more common because of its advantages in terms of appearance, decreased discomfort, and shorter hospital stays; this is especially true in Korea and Japan. For locally advanced gastric cancer, it is still unclear if laparoscopic D2 gastrectomy is more feasible and effective than open surgery.

Patients and methods

This study conducted a systematic review and meta-analysis to evaluate the differences between laparoscopic and open D2 gastrectomy in terms of feasibility, radicality, surgical outcomes, and postoperative complications. PRISMA statement guidelines and Cochrane handbook for Systematic Reviews of Interventions were followed. Relevant databases were searched, and studies published between 2017 and September 2022 were included. Key outcome measures included operative time, blood loss, postoperative recovery, pathological outcomes, and lymph node involvement.

Results

The meta-analysis included a total of 22 studies. The operative time was significantly shorter for laparoscopic D2 gastrectomy compared with open surgery. However, laparoscopic D2 gastrectomy was associated with higher blood loss. Postoperative recovery measures, such as the time to first flatus and first oral intake, were significantly shorter for laparoscopic D2 gastrectomy. Pathological outcomes showed no significant differences in terms of resection margins and tumor size. The number of harvested lymph nodes did not significantly differ between laparoscopic and open D2 gastrectomy. Laparoscopic D2 gastrectomy demonstrated a lower rate of positive lymph nodes compared with open surgery.

Conclusion

Based on the findings of this meta-analysis, laparoscopic D2 gastrectomy seems to be a safe and practical procedure for treating patients with locally advanced gastric cancer. It is associated with reduced blood loss, faster postoperative recovery, equivalent postoperative complications, and comparable oncological safety. These results support the use of laparoscopic D2 gastrectomy as an effective alternative to open surgery in the management of advanced gastric cancer.
Evaluation of early outcome of laparoscopic versus open left hemicolectomy in patients with left colon cancer
Authors: Badr Mohamed L.A. , Ammar Mohamed S. , Elwahab Ali Mohamed G.A. , Al-Abbasy Mahmoud M.
Published: January 2024

Background

Colorectal cancer is a prominent global health concern, and while laparoscopic surgeries offer minimally invasive benefits, there is a noted underrepresentation of left-sided colon cancer in current research. This study seeks to bridge the gap by assessing the safety and efficacy of laparoscopic (LC) versus open left hemicolectomy (OC) in patients with left-side colon cancer.

Patients and methods

This prospective, nonrandomized study was conducted from May 2020 to May 2022 at Menoufia University Hospital and Damanhur Medical National Institute, enrolling 40 patients diagnosed with left-sided colonic carcinoma. Participants were divided into two groups: 20 underwent LC, and 20 had OC. The primary outcomes were operative time, blood loss, and incision length, with several secondary outcomes like analgesic needs and postoperative hospital stay.

Results

Both groups showed no significant differences in age, BMI, and other demographic characteristics. However, intraoperatively, the OC group completed procedures significantly faster than the LC group, with average times of 2.58 h compared with 4.48 h (P<0.001). Postoperatively, the LC group showed faster recovery, taking 2.35 days (P=0.019) to resume a liquid diet compared with 4.45 days for the OC group and 2.35 days (P<0.001) to pass the first flatus versus 3.45 days in the OC group. The LC group also had a shorter hospital stay, averaging 4.1 days compared with the OC’s 8.75 days (P<0.001), and harvested a higher number of lymph nodes (13 vs. 11.85, P<0.001).

Conclusion

The findings of this study demonstrate that LC and OC were comparable as regards intraoperative and postoperative complications. On the other hand, LC was considered a good and effective method for resection of left colonic carcinoma as it has many benefits, such as early recovery and short hospital stay.
Laparoscopic Roux-En-Y gastric bypass versus mini-gastric bypass for the treatment of morbid obesity and effect on glucagon-like peptide-1 level: a randomized comparative study
Authors: Kandel Mohamed M. , Elkeleny Mostafa R. , Header Doaa A. , Korayem Islam M. , Hassan Mohamed M.
Published: January 2024

Background

The gold standard malabsorptive technique for patients who are morbidly obese that promotes sustained weight loss is laparoscopic Roux-en-Y gastric bypass (LRYGB). An alternative that has gained popularity is laparoscopic mini-gastric bypass (LMGB), which has the advantages of being more technically straightforward, needing less time during surgery, and having a higher food tolerance. This study compares the short-term effects of LMGB and LRYGB on weight reduction and postoperative levels of glucagon-like peptide-1 (GLP-1).

Methods

This prospective study included 50 morbidly obese patients who were randomly assigned to receive either LRYGB or LMGB, with 25 patients/group in the period from March 2020 to February 2021.

Results

Group B experienced a much shorter hospital stay and operation time than group A. There was no discernible difference between the two groups in terms of intraoperative errors or postoperative problems. Throughout the follow-up period, the patients’ weights and BMI dramatically fell in both groups, with the LMGB group seeing a much larger mean excess BMI reduction percent. Preoperative comorbidities were significantly resolved in both operations, and there was no discernible difference between the two groups. GLP-1: Following surgery, both groups exhibit a noteworthy rise in postprandial GLP-1 levels.

Conclusions

Compared with LRYGBP, the LMGB technique produced a greater weight loss with a similar efficiency on metabolic control.
Survival rate between total thyroidectomy and lobectomy in papillary thyroid cancer
Authors: Alhanafy Saad S. , Elsisy Alaa A.E. , Alanazi Ahmed B. , Abuelfetouh Mohamed , Alabassy Mahmoud M.
Published: January 2024

Background

Regarding papillary thyroid cancer, comparisons between lobectomy (LT) and total thyroidectomy (TT) have not addressed major risks to reliable conclusions drawn from observational data. This research aimed to evaluate the survival rate following thyroidectomy (TT) and LT for papillary thyroid carcinoma.

Methods

A total of 155 patients with papillary thyroid cancer who had LT or TT at Menoufia University Hospitals between January 2018 and April 2023 were included in this retrospective cohort analysis. Overall survival was the main result, which was assessed using inverse probability weighting on the propensity score and flexible parametric survival models.

Results

Of the patients receiving treatment, 78% were female and the median age was 48 (range: 37–59). There were no statistically significant differences in the 5-year overall survival between individuals who underwent a complete thyroidectomy or LT. Furthermore, we did not find any statistically significant variation in survival by subgroups, such as age (<65 or ≥65), tumor size (<4 cm or ≥4 cm), or projected risk of death.

Conclusion

Based on our data, TT, independent of tumor size, patient age, or overall risk of mortality, is unlikely to provide a survival benefit over lobectomy.
Evaluation of the Curative Effect of Topical Insulin Application on Burn Wounds of Non-Diabetic Patients with Minor to Moderate Partial Thickness Burns
Authors: Mohamed Ahmad E. , Mahmoud Radwa E.-S.
Published: January 2024

Background and aim

Burns are one of the most common traumatic conditions. Heat, chemicals, electrical currents, and radiation are all examples of physical or chemical factors responsible for burns. A previously conducted study of diabetic individuals found that the local injection of insulin for wound treatment promoted the processes of angiogenesis and fibrosis with no significant negative effects. This study was aimed at evaluating the curative effects of local insulin application in the treatment of minor to moderate partial-thickness burns in nondiabetic burned patients.

Patients and methods

This was a case–controlled, randomized clinical study of 50 patients of both sexes, nondiabetic, with minor to moderate partial-thickness burns, aged 20–55 years, who were allocated into two groups: the study group that received topical insulin application and the control group that received the usual treatment. Each group was treated for 14 days. The following items were assessed in both groups: wound healing time, pain, scar healing, incidence of adverse reactions, and Sequential Organ Failure Assessment score.

Results

Across the two groups, the wound healing time and the average number of burn dressing changes in the study group were substantially less than those in the control group. Before intervention, there was no significant difference in the level of pain, while after intervention, the study group was substantially less than the control group (P<0.05) in the level of pain and scar healing.

Conclusion

Topical insulin application was effective and harmless in the treatment of minor to moderate partial-thickness burns in nondiabetic burned patients.
Adding quilting sutures to Y plasty to avoid postmastectomy lateral dog ears in patients with large cup sized breast
Authors: Alhussini Mahmoud A. , Awad Ahmed T. , Kholosy Hassan
Published: January 2024

Background

Total mastectomy without reconstruction is a commonly adopted procedure for managing breast cancer. Formation of lateral dog ears is very common, especially with large breast cup size. In this study, we assessed the feasibility of adding quilting sutures to the Y plasty technique to achieve more acceptable results in the avoidance of lateral dog ears in comparison to using Y plasty alone.

Methods

The study included 150 female patients with large breast cup size. Patients were randomized 2 : 1 between group A and group B. In group A, 3–5 quilting sutures were added to the lateral flaps of Y plasty. In group B, Y plasty only was adopted without the quilting sutures. Patients were followed up at 4-month intervals for at least 1 year. One year after surgery, patients filled in a questionnaire inquiring about the degree of discomfort in the area beneath the arm. Also, a plastic surgeon was asked to give a score about the cosmetic outcome of managing lateral dog ears both at 3 weeks and 12 months after surgery.

Results

Both groups were comparable in regard to age, BMI, breast cup size, and postoperative radiotherapy exposure. Patients in group A had better scores for satisfaction with the shape of the scar and comfort with the bra. Also, the blinded cosmetic outcome assessment was in favor of group A.

Conclusion

Adding quilting sutures to the lateral flap of the V-Y plasty technique is associated with a better cosmetic outcome in the management of lateral dog ears in mastectomy patients with large breast cup size.
Role of laparoscopic lumbar sympathectomy in chronic limb-threatening ischemia due to nonreconstructable peripheral arterial disease
Authors: Ahmed Ahmed H.S. , Mahmoud Amr A. , Abdelmalek Wageeh F. , Rizk Mohamed A.E.M.
Published: January 2024

Background

Lumbar sympathectomy (LS) was traditionally performed for intermittent claudication but is now eclipsed by revascularization for that indication. However, it retains a role in the management of chronic limb-threatening ischemia and other conditions causing lower limb pain with or without ischemia. In this study, we identify its role in the management of chronic limb-threatening ischemia in cases of nonreconstructable peripheral arterial disease.

Aim

The main aim of this study is to determine if LS procedure has an effective role in limb salvage and pain control for patients with nonreconstructable peripheral limb ischemia. The primary endpoint was limb salvage in the target limb, while the secondary endpoint targeted assessment of pain improvement in the same limb.

Patients and methods

This study is a prospective single-arm cohort study conducted using 21 patients between the January 1, 2021 and the January 1, 2023 at two hospitals, Ain Shams University Hospital and Nasser Institute Hospital. Patients complained of nonreconstructable peripheral arterial disease and there was no chance for revascularization either endovascular or surgical bypass.

Results

This study included 60 patients; one patient was excluded due to being lost to follow-up, and presented with nonconstructable critical limb ischemia between the January 1, 2021 and the January 1, 2023. There were 42 (70%) males and 18 (30%) females. Follow-up for all patients was subjected to measurement of ankle brachial pressure index, digital pulse oximetry, toe pressure and numerical rating scale for pain scoring preoperative and postoperative. On follow-up we noticed that there was no change in either ankle brachial pressure index or toe pressure immediately postoperatively and after 12 months. However, the digital pulse oximetry showed significant improvement immediately postoperatively from 68.40±7.36 to 81.15±12.23 with a P value of 0.001. The most remarkable improvement was found in pain scoring immediately, 1, 3, 6, and 12 months postoperatively with P values showing statistical significance. As for limb salvage, there was a 100% limb survival for 3 months. After 6 months, only nine cases underwent above-knee amputation, one of them was due to severe limb infection, and three cases had minor amputation ‘toe amputation.’ We noticed that three out of the nine cases suffering major amputations had femoropopliteal disease. Of the patients, 80% suffered no minor or major amputation, while 15% had major amputations beyond the tarsometatarsal joint and only 5% underwent minor toe amputation or debridement. Fortunately, there was no mortality among the studied cases.

Conclusion

Retroperitoneoscopic LS is significantly less invasive than open surgical technique with fewer wound complications and less hospital stay period and offers a longer duration of pain relief and less incidence of recurrence of manifestations.
Excision hemorrhoidectomy versus laser hemorrhoidoplasty in second and third degree hemorrhoids: a prospective cohort study
Authors: Mahmoud Mahmoud A. , Ouf Tarek I.A. , Ghaly Ayman M.B. , El Aziz Heba T.A.
Published: January 2024

Background

Hemorrhoids are considered the commonest benign anorectal diseases globally, being the most annoying anorectal problem. They commonly present with discomfort, prolapse, and bleeding.

Aim

The aim of this study is to compare between surgical excision of hemorrhoids and laser hemorrhoidoplasty (LHP) in the treatment of second and third-degree hemorrhoids.

Patients and methods

The study was conducted on 80 patients. The patients were divided into two equal groups. First group underwent surgical excision of hemorrhoids while the second group underwent LHP. We compared the outcomes of surgical excision of hemorrhoids with LHP in the of duration of surgery, intraoperative bleeding, postoperative pain, postoperative hospital stay, and the time needed for work return and short and long-term postoperative complications.

Results

LHP had a significantly lower time of surgery, intraoperative blood loss and pain postoperative with no effect on defecation. There were no significant difference in the complications postoperative.

Conclusion

LHP is a safe and effective modality in treatment of second and third degree hemorrhoids and being more superior than traditional surgical excision of hemorrhoids.
Impact of bariatric surgery on morbidly obese hypothyroid patients
Authors: Afifi Amr H. , Nagy Mostafa , Naga Mohamed Abo
Published: January 2024

Background

Obesity is considered a risk factor for many health issues, which includes cardiovascular, psychological, neurological, and musculoskeletal diseases. It is known that overt hypothyroidism induces obesity if not properly managed. The aim of current study is to evaluate effect of different bariatric surgeries on morbidly obese hypothyroid patients regarding thyroid-stimulating hormone, free T4, and dose of levothyroxine supplement needed.

Patients and methods

A retrospective cohort study was conducted on patients with morbid obesity and hypothyroidism from January 2021 to January 2023. We included patients more than 18 years old, obese (BMI >40 kg/m2 or >35 kg/m2 in association with uncontrolled comorbidities such as diabetes, hypertension, hyperlipidemia, and obstructive sleep apnea) with hypothyroidism undergoing bariatric surgery. Secondary objectives include assessment of weight reduction after bariatric surgery as excess weight loss and excess body mass index loss.

Results

The mean excess weight loss was 44.2%, while the mean excess body mass index loss was 88.22%. Sleeve gastrectomy surgery had the highest percentage of patients who reduced their thyroid hormone replacement (THR) dose (61.9%), followed by the Mini Gastric Bypass (MGB) group (47.5%). The Roux-en-Y Gastric Bypass (RGB) group had the highest percentage of patients who were off their THR dose (56.3%), followed by the sleeve group (31.8%). Only one (4.5%) patient in the sleeve group had an increased THR dose.

Conclusions

Bariatric surgery has a significant impact on the THR dose in patients with hypothyroidism. The type of surgery also affects the percentage of patients who reduced, stopped, or maintained their THR dose.
Clinical and pathological parameters predicting pathologic complete response after neoadjuvant chemoradiotherapy for locally advanced rectal cancer
Authors: Ashoor Ahmed S. , Elshazly Walid G. , El Gendi Saba M. , Darwish Azza M.
Published: January 2024

Objective

The aim of this study is to identify possible clinical predictors of complete response after neoadjuvant treatment in locally advanced rectal cancer (LARC) patients.

Background

Preoperative chemoradiotherapy (CRT) followed by total mesorectal excision and postoperative adjuvant chemotherapy for LARC is the standard of care with a local recurrence rate of only 5–10%.

On the other hand, various people react differently to neoadjuvant CRT. Neoadjuvant CRT is well received by the majority of patients, with a pathologic complete response (pCR) occurring in 10–30% of cases.

Predicting the response to neoadjuvant CRT is crucial from a clinical standpoint, since patients with pCR have a better prognosis and may require a different treatment plan than patients without pCR.

As a result, predicting pCR following neoadjuvant CRT for rectal cancer continues to be extremely useful for treating physicians.

To identify the clinical and pathological variables linked to a full response to preoperative CRT for rectal cancer, we assessed a group of patients with pCR in this study.

Patients and methods

The study included 153 patients with LARC that were enrolled in the study based on specific inclusion and exclusion criteria. Patients were treated by standard neoadjuvant therapy. Surgical resection was planned for 6–8 weeks after the completion of neoadjuvant CRT, irrespective of the response to CRT.

Pathological examination was performed to assess pathological response in the resected specimen. pCR was defined as the absence of viable tumor cells in the surgical specimen, including lymph nodes.

Results

After neoadjuvant chemoradiation, the pCR rate for rectal cancer patients was 20.8%; patients were split into pCR and non-pCR groups. Age, sex, BMI, performance score, tumor stage, tumor differentiation, tumor location, and surgical method were all evenly distributed across the two groups. The results of the multivariate analysis showed that pretreatment lymph node status, tumor size, and a carcinoembryonic antigen level of less than or equal to 5 ng/ml were independent risk factors of an elevated likelihood of pCR, as was an interval of more than or equal to 8 weeks between the completion of chemoradiation and treatment.

Conclusion

The pCR in rectal cancer following neoadjuvant chemoradiation is predicted by pretreatment carcinoembryonic antigen level of less than or equal to 5 ng/ml, an interval of more than or equal to 8 weeks between the end of chemoradiation and surgical resection, tumor size greater than 5 cm, and pretreatment lymph node status. By utilizing these predictive variables, we are able to forecast patients’ outcomes and create flexible treatment plans. In certain, very specific situations, a wait-and-see policy might be appropriate.
The Relationship between Healthy Eating Index and Lipid Profile in Healthy Individuals: A Systematic Review
Authors: Faraji Hossein , Jamshidi Sanaz , Ferrie Suzie , Azar Pouria Sefidmooye
Published: January 2024

Background:

The Healthy Eating Index (HEI) and Alternate Healthy Eating Index (AHEI) are instruments developed by competing American research teams, aiming to assess the level of adherence to a dietary pattern, claimed to prevent chronic illness conditions such as dyslipidemia. This systematic review evaluated cross-sectional studies examining the association between HEI/AHEI score and the lipid profile in healthy participants.

Methods:

The systematic review was Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) compliant, and a search process was conducted through Scopus, Web of Knowledge, Google Scholar, Cochrane, PubMed, and ScienceDirect up to November 2022. Studies assessing the relationship between HEI/AHEI and lipid profile (low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and triglyceride (TG)) were eligible for inclusion. The statistical differences in outcomes, anthropometric indices, and demographic data were extracted from the selected studies. Also, the quality assessment of studies was performed using the Newcastle–Ottawa scale.

Results:

The systematic search presented 17 cross-sectional studies. Most of the studies revealed a significant correlation between HEI score and lipid profile (LDL-C, HDL-C, TG, and TC) (P < 0.05), while a few of them indicated a significant relationship between AHEI score and these factors. Overall, the elevation of HEI/AHEI score was associated with the improvement in lipid profile (P < 0.05), though this association was more obvious for HEI compared with AHEI.

Conclusions:

Overall, the results of the study indicated that an improved lipid profile in healthy individuals is associated with a higher score in either HEI or AHEI. Further research in the future is required to confirm the claim.
Multidisciplinary model of teacher training: Empowering teachers to identify dyslexia in an integrated school setup
Authors: Raju Suma , Sahana Kashyap , Narasimhan Srirangam Vijayakumar
Published: January 2024

Purpose:

The purpose of the present study was to train teachers using a multidisciplinary approach and to document the effect of this training on their awareness regarding dyslexia, knowledge of dyslexia, and the identification of children with dyslexia.

Materials and Method:

The study included 100 primary school teachers (23 males and 77 females) having Kannada as their mother tongue and English as their second language. A questionnaire in Kannada was developed by the investigators to collect the responses before and after the teacher training from the primary school teachers about knowledge of dyslexia. The questionnaire was developed based on the Dyslexia Assessment for Languages in India (DALI).

Results:

The mean responses of the participants were higher during post-training compared to pre-training conditions. The standard deviation values were higher during pre-training compared to post-training conditions. Wilcoxon signed-rank test revealed that there was a statistically significant difference between the ratings of pre-training and post-training conditions. Therefore, it was inferred that training teachers to identify the characteristics of dyslexia significantly improved the knowledge of the teachers on general facts and myths about dyslexia, signs, and symptoms exhibited by children with dyslexia.

Conclusions:

The findings of the present study revealed that a structured multidisciplinary model of teacher training programs focusing on the knowledge and skills to identify possible dyslexic children can be very effective to prepare the teachers to identify and manage these children in a school setup where professional help is limited.
Convalescent plasma, cytomegalovirus infection, and persistent leukopenia in COVID-19 recovery phase
Authors: Shah M , Kakar A , Gogia A , Langer S
Published: January 2024

Therapies used to tide over acute crisis of COVID-19 infection may lower the immunity, which can lead to secondary infection or a reactivation of latent infection. We report a 75-years-old male patient who had suffered from severe COVID-19 infection three weeks earlier and who had been treated with corticosteroids and convalescent plasma along with other supportive therapies. At time of discharge he had developed leukopenia which worsened at 1-week follow up visit. On 18th day post-discharge, he became very sick and was brought to our hospital with complaints of severe persistent dysphagia. During evaluation he was diagnosed to have an acute cytomegalovirus infection and severe oropharyngeal thrush. Both COVID-19 and cytomegalovirus are known to cause synergistic decrease in T cells and NK cells leading to immunosuppression. The patient made complete recovery with a course of intravenous ganciclovir and fluconazole. Persistent leukopenia in high risk and severely ill cases should give rise to a suspicion of COVID-19 and cytomegalovirus co-infection.
Evaluation of pharmacokinetics of single-dose primaquine in undernourished versus normally nourished children diagnosed with Plasmodium vivax malaria in Mumbai
Authors: Gogtay NJ , Karande S , Kadam PP , Momin S , Thatte UM
Published: January 2024

Background:

The pharmacokinetics of primaquine [PQ] have been the subject of studies in both adults and healthy participants. However, there is no study on its pharmacokinetics in a setting of undernourishment. In India, there is evidence to show considerable malnourishment in children that in turn can affect drug pharmacokinetics. Given that the country is moving towards malaria elimination, the present study was planned with the objective of comparing pharmacokinetics of the drug in undernourished children relative to normally nourished children.

Materials and Methods:

After Institutional Ethics Committee approval, children of either gender between the ages of 5 and 12 years and smear-positive for Plasmodium vivax malaria were included. Nourishment status was determined using the Indian Academy of Pediatrics classification of protein energy malnutrition based on Khadilkar's growth charts. Twelve children each were enrolled in the two groups. PQ was given in the dose of 0.3 mg/kg/d and blood collections were made at 0, 1, 2, 3, 4, 6, 8 and 24 hours post-dosing. Levels were estimated by high-performance liquid chromatography. Chloroquine in the dose of 25 mg/kg was given over three days along with supportive care.

Results:

Of the 24 children, there were 17 boys and 7 girls. There was a statistically significant difference in the body weight between the undernourished and the normally nourished children [21.5 ± 5.52 vs. 28.8 ± 8.84, P < 0.05]. PQ levels showed wide inter-individual variation in both groups. No significant difference was seen in any pharmacokinetic parameter between the two groups.

Discussion:

This study adds to the limited body of evidence on the pharmacokinetics of PQ in children with malaria and indicates that the dosing of primaquine could potentially be independent of the nourishment status.
Assessment toolbox for Indian medical graduate competencies
Authors: Singh T , Saiyad S , Virk A , Kalra J , Mahajan R
Published: January 2024

The new competency-based medical education curriculum for Bachelor of Medicine and Bachelor of Surgery is being implemented in a phased manner in medical colleges across India since the year 2019. The Graduate Medical Education Regulations enlist a total of 35 global competencies for the five roles expected of an Indian medical graduate, the roles being clinician, communicator, leader, professional, and life-long learner. Along with an effective implementation of the new curriculum, both in spirit and in action, it is imperative to assess the listed competencies. The new curriculum demands a more careful and mature selection of assessment tools, based on the competency and its expected level of achievement. It is these two variables that make choosing the right assessment method not just a matter of choice, but also of expertise. An array of tools in our armamentarium can sometimes separate confuse and the teachers. So, using the right tool, in the right context, at the right juncture, supplemented by other tools, and backed by constructive feedback, can help nurture the good intent ingrained in the competency-based curriculum. Hence, an attempt was made to compile an assessment toolbox for various global competencies. A PubMed, Science Direct and Google Scholar search, with relevant keywords was carried out. To the initially extracted 90,121 articles, limitations were applied, duplicates were removed and screening for assessment of global competencies and its attributes was done to select 232 articles. Finally, 31 articles were used for designing the proposed toolbox. Prioritization for the tools for the global competencies was based on thorough literature review and extensive discussion. The evolved assessment toolbox is presented in this article, which would help teachers pick the most useful methods of assessment for global competencies.
Willingness to quit tobacco and its correlates among Indian tobacco users—Findings from the Global Adult Tobacco Survey India, 2016–17
Authors: Kar SS , Sivanantham P , Rehman T , Chinnakali P , Thiagarajan S
Published: January 2024

Background:

Willingness to quit in a tobacco user forms the basis for future quit attempts and quitting successfully.

Objective:

To determine the prevalence and correlates of willingness to quit among tobacco users in India using the Global Adult Tobacco Survey (GATS), India, 2016–2017.

Methods:

GATS, 2016–17 was a multistage geographically clustered sample survey done among 74,037 individuals aged 15 years and above across all the states and two of the Union Territories of India. Data of all those reported using any form of tobacco were studied for past attempts to quit tobacco, advised to quit by a health care provider, and exposure to anti-tobacco messages delivered through various media and the correlation of these with the willingness to quit using multivariate analysis.

Results:

Of the 21,085 current tobacco users in the survey, 11,679 (52.2%), were willing to quit all forms of tobacco. Multivariate analysis showed that those in younger age groups (OR: 1.39 [1.23–1.56]), higher education levels (OR 1.15 [1.05–1.18]), time of first tobacco use in the day being more than 60 min after waking up in the morning (OR 1.11 [1.03–1.2]), history of attempts to quit in the past 12 months (OR 1.78 [1.69–1.87]), those advised to quit by health care provider in the past 12 months (OR 1.11 [1.06–1.17]), those using single form of tobacco (OR 1.1 [1.05–1.17]), those exposed to anti-tobacco messages in newspapers/magazines (OR 1.1 [1.05–1.17]), and cinemas (1.14 [1.08–1.20]) were more willing to quit compared to their counterparts.

Conclusion:

Enhanced publicizing of anti-tobacco messages through the currently employed media, and ensuring that doctors give a brief advice to quit during any contact with a tobacco user could improve the willingness to quit and the consequent quit rate, especially among those tobacco users who are in younger age groups and who have attempted to quit earlier.
Comparison of primary arthrodesis versus open reduction with internal fixation for Lisfranc injuries
Authors: Han PF , Zhang ZL , Chen CL , Han YC , Wei XC , Li PC
Published: January 2024

Objective:

Multiple studies have compared primary arthrodesis versus open reduction with internal fixation (ORIF) for surgical treatment of fractures of the Lisfranc joint, but their results have been inconsistent. Therefore, the present systematic review and meta-analysis was performed to compare the clinical efficacy of arthrodesis versus ORIF for the treatment of Lisfranc injuries.

Methods:

Through searching the Embase, PubMed, PMC, CINAHL, PQDT, and Cochrane Library databases (from July 1998 to July 2018), we identified five case-controlled trials and two randomized controlled trials that compared the clinical efficacy of primary arthrodesis and ORIF for treating Lisfranc injuries. The extracted data were analyzed using Review manager 5.3 software.

Results:

Through comparisons of data for primary arthrodesis and ORIF groups, we found no significant differences in the anatomic reduction rate, revision surgery rate, and total rate of complications between the different treatment approaches. However, arthrodesis was associated with a significantly better American Orthopedic Foot and Ankle Society (AOFAS) score, return to duty rate, and visual analog scale score with a lower incidence of hardware removal compared with ORIF.

Conclusions:

For the treatment for Lisfranc injuries, primary arthrodesis was superior to ORIF based on a higher AOFAS score, better return to duty rate, lower postoperative pain, and lower requirement for internal fixation removal. Further evidence from future randomized controlled trials with higher quality and larger sample sizes is needed to confirm these findings.
Predictors of response to pulmonary rehabilitation in stable chronic obstructive pulmonary disease patients
Authors: Ragaselvi S , Janmeja AK , Aggarwal D , Sidana A , Sood P
Published: January 2024

Context:

Pulmonary rehabilitation (PR) has become a standard of care in the management of chronic obstructive pulmonary disease (COPD). However, a significant proportion of the patients do not show benefit after the PR program.

Aims:

The study was planned to find different patient- and/or disease-related factors that may predict response to PR in stable COPD.

Subjects and Methods:

A total of 102 stable COPD patients were prospectively enrolled. Baseline evaluation and investigations, including spirometry, arterial blood gas analysis, and bone mineral density assessment, were done. Thereafter, all patients underwent an 8-week comprehensive outpatient PR program that consisted of exercise training, education, nutritional, and psychological counseling. The response to PR was dichotomously (yes/no) defined by the combined improvement in exercise tolerance (6-min walk distance [6MWD] +54 m) and quality of life (St. George's Respiratory Questionnaire [SGRQ] score - 4 points) measured before and after the program. Thereafter, different predefined factors were analyzed for their possible association with the PR response.

Results:

A total of 80 patients (78.4%) completed the PR program and were subjected for analysis. Out of them, 42 (52.5%) showed improvement in both 6MWD and SGRQ score (46 in 6MWD and 54 in SGRQ score). After application of multivariate logistic regression analysis, forced expiratory volume in 1 s <50% predicted (odds ratio [OR]: 2.9; 95% confidence interval [CI]: 1.1–8.3; P = 0.04) and osteoporosis (OR: 0.26; 95% CI: 0.13–0.53; P < 0.001) were found as independent factors predicting PR efficacy.

Conclusions:

Poor baseline lung function predicts a short-term improvement in exercise capacity and quality of life in COPD patients, whereas osteoporosis is a negative predictor of PR response. Active search for these factors may help in better patient selection, thus leading to improved outcome after PR.