bluuebunny/crossref_metadata_2025 huggingface dataset:
Critical review of the liquid media and methods used in the Hartala (orpiment) purifying process
Authors: Gandhi Piyush Krantikumar , Lagad Chatrgun Eknathrao , Ingole Rajesh Kundlikrao
Published: May 2024

Introduction:

Rasashastra is a pharmaceutical branch that converts metals and minerals into potent and safe medicine. These metals and minerals must undergo many procedures like Shodhana (purifying process) and Marana (the process of making Bhasma) before their administration as potent and safe medicine. Hartala (orpiment) is one such mineral that, after proper processing, becomes highly potent and useful in Sleshmaroga, Raktapitta (bleeding disorders), Vatarakta (gout), Kustha (skin disorders), etc. It also produces toxic effects when used without the Shodhana procedures mentioned in the Rasa classics. The classics quote different pretreatment procedures for Hartala that are scattered throughout the texts of Rasa Shastra.

Aims and Objectives:

Here, an attempt has been made to compile and critically review all such references about Hartala Shodhana in terms of method and media.

Materials and Methods:

The Shodhana processes of Hartala were compiled from 25 classical texts and sorted by method, media, and principle used in the method. Modern literature is reviewed to explore the effect of the method and role of media used in Hartala Shodhana.

Results:

Fifty-two methods of Hartala Shodhana are described in classics on Rasashastra that can be categorized into five basic methods like Swedana (fomentation), Bhavana (wet grinding), Prakshalana (washing), Nimanjana (immersion), and Puṭapāka (incineration). Twenty-seven multiple liquid media, which includes 24 liquid media, two solid drugs (borax and lime), and one fruit (Kushmanda), are used as media for Shodhana.

Conclusion:

This study may serve as a pathway or guideline for further research on Hartala.
Self-collected Saliva
Authors: Anand Kavita Bala , Karade Santosh , Jindamwar Prashant , Sen Sourav , Babu Bhagya , Bobdey Sourabh , Gupta RM
Published: May 2024

Background:

The gold standard for the diagnosis of coronavirus (CoV) disease 2019 in the hospital and community setting is by the real-time reverse transcription-based polymerase chain reaction (RT-PCR) using the respiratory samples. The collection of nasopharyngeal or oropharyngeal swab (NP/OP) needs experienced medical personal and appropriate biosafety conditions. There is need for a simpler strategy for the sample collection without compromising the sensitivity. Saliva sample collection is noninvasive. Therefore, the primary objective of the study was to evaluate the efficacy of severe acute respiratory syndrome CoV-2 (SARS-CoV-2) RT-PCR using self-collected saliva specimen.

Materials and Methods:

This pilot study was carried out at an Indian Council of Medical Research (ICMR) approved molecular laboratory. Self-collected saliva and OP/NP swab in the viral-transported medium (VTM) were collected in parallel from the study participants and processed for SARS-CoV-2 RT-PCR. Cycle threshold (Ct) value of envelope gene (“E”), HKU Orf 1b gene (“HKU”), and Actin (internal control) obtained for saliva and NP/OP swab were tabulated.

Results:

Saliva and OP/NP swab in parallel were collected from 85 individuals. The mean age of the study population was 35.2 years, and 81% were male. The overall sensitivity and specificity of RT PCR on the saliva sample were 95.6% and 92.5%. The concordance between 'E” and “HKU” Ct value obtained by NP/OP and saliva RT-PCR was 97.64% and 95.29%. The positive and negative predictive value of the novel method was 93.5% and 94.9%, respectively.

Conclusion:

Self-collected saliva is a reliable biological sample and promising tool for SARS-CoV-2 testing in the resource-limited setting.
A study of the relationship between Bispectral index and age-adjusted minimum alveolar concentration during the maintenance phase of general anesthesia in elective surgery
Authors: Kumar Nishant , Bansal Gunjan , Jain Aruna
Published: May 2024

Background and Aims:

Bispectral index (BIS) and minimum alveolar concentration (MAC) are commonly used to monitor the depth of anesthesia. The objective was to study the correlation between BIS and age-adjusted minimum alveolar concentration (aaMAC) during the maintenance phase of anesthesia. The influence of variables affecting BIS and or aaMAC was studied to determine an equation between BIS and aaMAC.

Material and Methods:

This prospective observational study was carried out after institutional ethical approval in adult patients 18–60 years of either sex, ASA I and II posted for elective surgery under general anesthesia. Five minutes after airway management, BIS values and aaMAC equivalents were noted during the maintenance phase of anesthesia. aaMAC and corresponding BIS values were recorded every minute for periods, where the anesthetic agent concentration had remained the same during preceding 5 minutes till the switching off of the anesthetic agent. Age, sex, ASA status, use of nitrous oxide, inhalational agent, dose of midazolam, and opioid used were also recorded.

Results:

BIS/aaMAC showed an inverse correlation. Increasing age, ASA II status, morphine equivalent >5, and use of nitrous oxide, sevoflurane, or isoflurane were associated with a higher BIS at equivalent aaMAC. Using the exchangeable correlation structure, a generalized estimation equation was obtained as the best predictor.

Conclusion:

Factors affecting both aaMAC and BIS affect the relationship between the two, and although there are wide variations, BIS and aaMAC can be equated and values of either can be calculated if one is known using a generalized estimates equation.
Resurgence of Plasma Sterilization
Authors: Annapurna N. V. , Goud N. Rohit , Nadella Swathi
Published: May 2024

Sterilization is the backbone of a health-care organization and ensures high-quality patient care. While the horizon of medical and surgical devices has undergone vast expansions, not many discoveries have been made as far as novel sterilization procedures are concerned. Steam sterilization remains the most widely used modality of sterilization of equipment to date in most health-care organizations. Its limitation lies in the fact that there are many medical and surgical devices in the market today which are heat and pressure sensitive and can be damaged by the high temperature and pressure levels of steam sterilization. Novel sterilization techniques which are helpful in the sterilization of such sensitive instruments that are being widely used today include ethylene oxide (ETO) gas sterilization and plasma sterilization. ETO sterilization requires the instruments to undergo aeration after the sterilization process, which takes a significant amount of time. Since the sterilized materials can be used only after the aeration period, stocking up of medical instruments is required which incurs extra cost and entails further investment in this regard. In the last few decades, there have also been concerns over the safety of ETO gas itself. Hence, attention has shifted to plasma sterilization which has spiked the interest of medical professionals due to both its safety and economic running costs. This article reviews the evolution of plasma sterilization along with its working principle, methods of inactivation of microorganisms, advantages, and disadvantages. A literature search using the keywords “plasma sterilization” was carried out in PubMed and Google Scholar platforms. Out of the suggestions available, the search was zeroed down to the most relevant articles and a few landmark articles, with focus on the origin of plasma sterilization as a procedure, methods of generation of gas plasma, phases of plasma sterilization, and antimicrobial properties of plasma. A review of articles comparing the efficacy of steam sterilization, ETO sterilization, and plasma sterilization was performed. Standard textbooks, as cited in the references, were referred to as required. The operation and maintenance instruction manual for low-temperature hydrogen peroxide sterilizer ACTIPLAZ

R
model HP-3041, Hanshin Medical Co. Ltd, South Korea, 2019, was used as the primary reference when describing the working of the aforementioned model (HP-3041) of plasma sterilizer.
Anterior Chamber Angle Foreign Body Masquerading as Corneal Edema
Authors: Syamala Pandiri Venkatagiri , Raju Ramya Seetam , Raju C. V. Gopal
Published: May 2024

Open globe injuries (OGIs) with intraocular foreign bodies are a common presentation in ophthalmic practice. Foreign bodies in the angle of the anterior chamber have been described earlier. In this report, two such cases of foreign bodies in the angle, identified on gonioscopy, are described. One case presented with pain and redness of 6-month duration with trauma 3 years ago. Examination revealed corneal edema and a foreign body in the angle. In the other case, early gonioscopy was performed and an angle foreign body was identified. In both cases, the foreign bodies were removed with good visual results. An OGI with a foreign body embedded in the angle was the common feature in both cases which presented as late corneal edema in the first one. Thus, in cases of any OGIs, gonioscopy should be performed as early as possible, so that complications leading to visual loss can be prevented.
The Remaining Quarter of a Pie
Authors: Maiya Anitha S , Shashidhar Gaargi
Published: May 2024

Concurrence of two different neuro-ophthalmic entities in a single patient is rare. The second disease entity may get incidentally detected when the patient is evaluated for one pathology. Such coincidences may be seen in patients having systemic diseases with microvascular complications, such as diabetes mellitus and hypertension. Herein, we report a case of a 62-year-old female patient who was detected to have bilateral inferior altitudinal hemianopia with right homonymous hemianopia as a result of bilateral anterior ischemic optic neuropathy with left occipital lobe infarct.
Conjunctival Tuberculosis
Authors: Raju Ramya Seetam , Raju C. V. Gopal , Rupali C.
Published: May 2024

India has the highest burden of tuberculosis (TB) in the world. In the last few years, there has been a re-emergence of the disease. Ocular TB is a form of extrapulmonary TB. Conjunctival TB is a relatively rare presentation of ocular TB. This report describes two such cases of TB of conjunctiva. One case presented with redness and pain in the right eye of 1-month duration. Examination revealed a conjunctival nodule. The other case presented with a mass in the left eye which showed a pink nodule. The presence of a conjunctival nodule with unresponsiveness to topical steroids and antibiotics was the common feature in both cases. Histopathology showed tuberculous inflammation and antituberculous therapy helped in the resolution of the lesions. Thus, in cases of conjunctival nodules unresponsive to steroids, TB should be suspected and a timely biopsy should be done, especially in a country like ours, which is endemic for TB.
A Review of the Management of Pythium Keratitis
Authors: Raju Ramya Seetam , Raju C. V. Gopal
Published: May 2024

Pythium keratitis is one of the chief etiologies of atypical microbial keratitis. It has an extremely grave prognosis. A low index of suspicion, its resemblance to fungal keratitis, and inappropriate diagnosis and management all contribute to the poor outcomes. The absence of adequate literature recommending a standard regimen further worsens the picture. Although Pythium resembles a fungus, it lacks ergosterol. Hence, antifungals are ineffective. While its successful management using antibiotics has been described, some conclude that surgery is the mainstay and recommend techniques to minimize recurrences. This review article aims to bring together the various modalities of diagnosis and therapy of Pythium keratitis. It focuses on the clues to clinical suspicion which would facilitate a prompt diagnosis. It also highlights the importance of high index of suspicion in presumed fungal keratitis with a poor response to antifungals. A search was carried out using PubMed and Google Scholar for articles in English language using the keywords: Pythium insidiosum, Pythium keratitis, management of Pythium keratitis, investigations in Pythium keratitis, Polymerase Chain Reaction in Pythium keratitis, diagnosis of Pythium keratitis, and treatment of Pythium keratitis. Articles were included if they were of high significance for this article. Case reports also were taken into consideration if they conveyed data of importance.
Evaluation of Fundus Autofluorescence Patterns in Patients with Central Serous Chorioretinopathy - A Prospective, Observational Study
Authors: Sannapuri Vasanthi , Palimar Vasudev , Umamaheshwar V.
Published: May 2024

Aim:

The aim of the study was to evaluate the patterns of fundus autofluorescence (FAF) and analyze the association between FAF and swept-source optical coherence tomography (SS-OCT) in idiopathic central serous chorioretinopathy (CSCR).

Materials and Methods:

65 eyes of 65 patients were prospectively included in this study. Patients underwent a complete ophthalmologic examination. We classified patterns on FAF imaging into five types as blocked FAF, mottled FAF, hyper-FAF, hyper/hypo-FAF, and descending tract pattern. Each FAF pattern was then analyzed based on the SS-OCT findings.

Results:

Blocked FAF pattern was seen in 47.69% of patients, mottled in 7.69%, hyper in 23.07%, hyper/hypo in 18.46%, and descending tract in 3.07%. There is a significant difference between FAF patterns in all subjects (P< 0.0001). The blocked FAF pattern (mean [M] = 0.20, standard deviation [SD] = 0.14) showed the best visual acuity among all others. The descending tract FAF pattern group (M = 0.54, SD = 0.08) and hyper/hypo-FAF pattern group (M = 0.38, SD = 0.28) showed the least favorable visual prognosis in our study. The intact ellipsoid zone on the SS-OCT was mostly found in the blocked FAF group, and the disrupted ellipsoid zone was commonly exhibited in the hyper/hypo and descending tract groups. Disrupted external limiting membrane line on the SS-OCT was seen in one patient of the descending tract group only.

Conclusions:

The association between FAF and SS-OCT findings was analyzed in patients with idiopathic CSCR in our study. Detailed investigation using FAF could help estimate the duration of CSCR.
Evaluation of Prediction Accuracy of Barrett Total Keratometry Universal II Formula Using Swept-Source Optical Biometry
Authors: Mannem Surekha , Raju C. V. Gopal , Padmini M. , Raju Ramya S.
Published: May 2024

Purpose:

The purpose of this study was to evaluate the prediction accuracy of Barrett Total Keratometry (TK) Universal II formula using swept-source optical coherence tomography (SS-OCT)-based optical biometer.

Materials and Methods:

One hundred and thirty-five eyes of 135 patients from Visakha Eye Hospital, Visakhapatnam, India, were prospectively enrolled in this study. Ocular parameters were measured using IOLMaster 700 (Carl Zeiss Meditec, Jena, Germany). Emmetropic spherical equivalent intraocular lens (IOL) power was calculated with Barrett TK Universal II formula using TK and Sanders–Retzlaff–Kraff (SRK)/T formula using standard keratometry. Selected IOL power and predicted refractive errors were recorded. Postoperative manifest refraction was measured at 1 month. Absolute prediction errors (APEs), mean absolute error (MAE), median absolute error (MedAE), and percentage of eyes within ± 0.25, ±0.50, and ±1.00 D of predicted refraction were calculated for each formula.

Results:

Barrett TK Universal II formula using TK values showed low APEs, MAE, and MedAE. There were a higher percentage of eyes with APE within ±0.25, ±0.50, ±0.75, and ±1.00 D. This formula gave better results when compared to SRK/T formula using K value. However, it was not statistically significant.

Conclusion:

IOL power calculation using SS-OCT-based optical biometer and Barrett TK Universal II gives better results with the least APE and using TK provides superior refractive outcomes which would be beneficial for the patients undergoing phacoemulsification with toric or multifocal IOLs.
Invasive fungal infections in hematologic malignancies: Incidence, management, and antifungal therapy
Authors: Shafiee Fatemeh , Soltani Rasool , Meidani Mohsen
Published: May 2024

The incidence of invasive fungal infections (IFIs) has increased in recent years as a result of increasing the incidence of hematologic malignancies (HMs). IFIs, as the opportunistic diseases, are the most important concern in these patients with a high mortality rate. These infections are one of the leading causes of morbidity and mortality in HM patients and an important factor in increasing the costs of patients’ management because of the prolonged hospitalization and the inevitable need to use antifungal agents. Due to the changes in the pattern of organisms causing IFIs, unavailability of effective and safe antifungal drugs, and high rate of drug resistance as well as lack of fast and accurate diagnostic methods, these infections have become a serious and life-threatening problem necessitating effective prevention and treatment strategies using suitable antifungal agents, especially in high-risk patients. The aim of the present study was to review the pathogens causing various types of IFIs, diagnostic methods, and novel prophylactic and therapeutic antifungal regimens in HM patients according to the new published studies and clinical trials.
Is skin autofluorescence a novel non-invasive marker in diabetes? A systematic review and meta-analysis of case–control studies
Authors: Hosseini Mahboobeh Sadat , Razavi Zahra , Bahri Razman Arabzadeh , Ehsani Amir Houshang , Firooz Alireza , Aryanian Zeinab , Ehsani Ala , Sadeghi Yasaman
Published: May 2024

Background:

The advanced glycation end product (AGE) is produced from the nonenzymatic reaction between glucose and macromolecules by aging. Accumulation of AGE causes functional and structural changes in body proteins that lead to impairment of tissue protein functions. We aimed to validate AGE measurement by skin autofluorescence (SAF) in diabetes mellitus (DM) compared to the nondiabetes population.

Materials and Methods:

We searched the PubMed, Cochrane, and Scopus databases from their inception till September 18, 2022, for casecontrol studies measuring AGE by SAF. Nonhuman studies, as well as review articles, study proposals, editorials, case reports, or congress posters, were excluded. We used a random effects model to assess the standard mean difference (MD) of age, body mass index (BMI), HbA1c, and SAF between diabetes and nondiabetes individuals.

Results:

Higher SAF in DM patients indicated more accumulation of AGE compared with the nondiabetic population. Furthermore, HbA1c was considerably higher in DM patients. The MD of age, male gender, and BMI were significantly different between the DM individuals, compared with nondiabetic subjects, which can lead to altered SAF level and AGE production. There was a remarkable heterogeneity between diabetes and nondiabetes when measuring age, gender, and BMI, as well as HbA1c and SAF level.

Conclusion:

This study could not confirm the validity of SAF as a surrogate marker in diabetes patients. Interestingly, metabolic load and high BMI can increase SAF, considerably. Altogether, SAF could be helpful in the future as a marker for metabolic syndrome or diabetes.
“Determining Correlation between Severity of Primary Dysmenorrhea and Resting Metabolic Rate in College-Going Girls of 18–25 Years of Age:” An Observational Study
Authors: Rathi Rajeshree , Mahishale Arati
Published: May 2024

Background:

Dysmenorrhea is painful cramps originating from the uterus that occurs during menstruation. There is a dearth in the literature assessing a possible association between primary dysmenorrhea and resting metabolic rate (RMR).

Aims and Objectives:

To find the the correlation resting metabolic rate and primary dysmenorrhea in college going girls between 18 – 25 years using numeric pain rating scale and Harris benedict equation Material and Method: This study included a total of 206 college-going girls between 18 and 25 years of age with primary dysmenorrhea based on the selection criteria. They were administered with the Numerical Pain Rating Scale (NPRS), which divided them into mild, moderate, and severe pain and demographic data including age (years), height (cm), and weight (kg) which was employed into Harris–Benedict Equation to calculate their respective RMR and then it was correlated with the severity of dysmenorrhea.

Results:

The overall comparison of groups, based on the NPRS values, with RMR scores, showed a statistically significant difference (F = 3.0951, P = 0.0280). While analyzing pair-wise comparison within each group of pain scores for their metabolic rate values, the RMR of females with no pain that is, NPRS score - 0, showed a significantly higher metabolic rate than the ones with mild pain (P = 0.0027), moderate pain (P = 0.0123), as well as the ones with severe pain (P = 0.0036). Spearman rank correlation test revealed no association between different groups of NPRS scores and RMR values (t = −0.0926, P = 0.9263).

Conclusion:

The study concluded that there is no correlation between the severity of primary dysmenorrhea and RMR in girls between 18 and 25 years. However, girls who do not experience dysmenorrhea showed higher RMR than the girls with primary dysmenorrhea.
ABO Blood Types among Iraqi Patients with Coronavirus Disease 2019
Authors: AL-Khikani Falah Hasan Obayes , Alkhafaji Zaytoon Abdulridha
Published: May 2024

Background:

A case–control study was performed to determine ABO blood group distribution in Iraqi hospitalized patients infected with coronavirus disease 2019 (COVID-19) and healthy individuals. The severe acute respiratory coronavirus 2 (SARS-CoV-2) molecularly identified by detecting coronavirus RNA in the nasal swabs.

Materials and Methods:

10770 participants were divided into 200 patients with SARS-CoV-2 and 10570 served as the control group. All patients were confirmed by real-time polymerase chain reaction and computed tomography scans from three hospitals in Babylon, Iraq. For the ABO blood type, three blood drops were obtained from each individual by pricking the tip of the index finger. Each drop was put on a slide that contained an antiblood typing serum to detect A, B, and D antigens. Statistical analysis was performed by Chi-square in SPSS version 23.

Results:

The distribution of the ABO blood group system in the healthy group was 24.30%, 38.80%, 26.02%, and 10.86% for type A, O, B, and AB, respectively, while in the COVID-19 patients, the distribution was 36%, 28%, 26%, and 10% for type A, O, B, and AB, respectively. Blood group type A was significantly high in the patient group (36%) compared to healthy participants, whereas the type O blood group was significantly low in patients (28%) compared to control participants.

Conclusion:

People with blood group A are at high risk to infect with COVID-19 (P < 0001) and the Odds ratio (OR) is 1.7. While blood group O is considered a protective factor against COVID-19 (P = 0.002) and the OD ratio is 0.6. Blood type A was most prevalent in nonsurvivor COVID-19 patients than survivors (P < 0.0001).
Efficacy of Fentanyl versus Clonidine as an Adjuvant to Ropivacaine Compared to Ropivacaine for Postoperative Analgesia in Caudal Block for Infraumblical Pediatric Surgeries: A Prospective Double-Blinded Randomized Control Study
Authors: Prasad T. Krishna , Sankar J. Balu , Govindan Dilip Kumar , Priyadharsini K. Soundarya
Published: May 2024

Background:

Postoperative pain and its management are a budding specialty in the medical field. The additions of adjuvants to local anesthetics were one of the effective methods to improve postoperative analgesia in terms of duration and profile. The study was done primarily to assess the duration of analgesia in terms of pain score and total analgesic requirement among fentanyl and clonidine.

Materials and Methods:

The study was a double-blinded randomized control trial among 72 pediatric subjects where the subjects were randomly allocated into: Fentanyl group: received 0.75 ml/kg ropivacaine 0.2% along with fentanyl 1 μg/kg, clonidine group received 0.75 ml/kg ropivacaine 0.2% along with clonidine 1 μg/kg and ropivacaine alone group received 0.75 ml/kg 0.2% ropivacaine alone. Pain was assessed by objective pain scale score and Ramsay Sedation Scale was used to assess postoperative sedation. The data were entered into Microsoft Excel and analyzed using SPSS 16.

Results:

Clonidine group showed bradycardia and hypotension intraoperatively and postoperatively as compared to the other groups (P < 0.05). Both the fentanyl and clonidine group showed increased sedation (3.13 [0.34] vs. 2.13 [0.54] and 1.96 [0.36]) longer duration of analgesia (15.50 [1.35], 11.67 [3.71] and 9.17 [1.86]) and lesser pain score compared to the placebo group (P < 0.05). Among the groups, clonidine showed a better profile.

Conclusion:

The study concluded that both fentanyl and clonidine as an adjuvant to ropivacaine showed longer duration of analgesia with increased sedation score and lesser pain score. Clonidine showed a better profile in terms of duration of analgesia, pain, and sedation.
Unusual Combined Dental Attrition and Erosion of Primary Teeth with its Multiple Risk Factors: A Rare Pediatric Case Report with Literature Review
Authors: Khan Mohammad Kamran
Published: May 2024

Tooth wear (erosion, attrition, or abrasion) has been reported with variable prevalence in children. These clinical entities present a wide range of dental problems and difficulty in dental management in growing children. If tooth wear and its causative/risk factors in primary dentition are not timely addressed, it may negatively affect the permanent teeth later. The current article presents the pediatric case report of successful and effective dental management of a 7-year-old healthy child having dental erosion and attrition with the past history of gastroesophageal reflux disease and Bruxism concurrently in addition to dietary factors (acidic fruits juices and soft-drink). This case presentation has been thoroughly described in a step-wise systematic manner to demonstrate the evidence-based clinical approach for managing such tooth wear problems (combined lesions of erosion and abrasion) in the young pediatric patient by preventive and conservative dental treatment modalities along with appropriate behavior management techniques. Moreover, a review of relevant dental literature about tooth wear and its different clinical aspects has been discussed in this article.
Melasma-like Hyperpigmentation: A Rare Side Effect of Imatinib Mesylate
Authors: Agrawal Shreya , Madke Bhushan , Jawade Sugat , Singh Adarsh Lata
Published: May 2024

Imatinib mesylate is an oral tyrosine kinase inhibitor used chiefly to treat chronic myeloid leukemia. In the literature, hypopigmentation is a commonly reported side effect of imatinib therapy; however, the cases of melasma-like hyperpigmentation due to imatinib have also been sparingly reported. We report a 35-year-old male patient who had asymptomatic hyperpigmentation over the cheeks and nose for 3 months after being started with oral imatinib. Examination showed pigmentation confined to the cheeks and nose. The diagnosis was made clinically along with dermoscopy, and the patient was treated with conventional skin-lightening regimen and sunscreen.
Fetus Papyraceus in Twin Pregnancy: A Rare Case Report
Authors: Dharwadkar Arpana , Viswanathan Vidya , Vimal Shruti , Iqbal Banyameen
Published: May 2024

Fetus papyraceous is the intrauterine fetal demise of one of the twins in early pregnancy which gets retained resulting in compression and resembles parchment paper. We report one such case of twin pregnancy where a 23 years primigravida with 36 weeks amenorrhea was referred to our hospital for delivery. Ultrasonography done during antenatal visits revealed twin pregnancy with one dead fetus. She delivered one healthy baby, placenta, and another pale white membranous tissue with firm areas. Multiple sections from the tissue revealed areas of developing bone, cartilage, ciliated epithelium, and muscular tissue confirming the diagnosis of fetus papyraceus. The basic concern of fetus papyraceus is its effect on the surviving fetus and on the mother. To avoid possible complications, intrauterine diagnosis of fetus papyraceus by serial ultrasound examinations and routine placental examination postdelivery to search for fetus papyraceus should be keenly followed.
Correlation of Serum Prostate-Specific Antigen with Gleason’s Score/Grade Group in Prostate Cancers and their Histopathological Findings: A 4-Year Retrospective Study at a Tertiary Care Center
Authors: Sharma Ritu , Bansal Megha , Sharma Honey Bhaskar , Kumar Nikhilesh , Vinish  , Gupta Monika , Sirohi Manju Singh
Published: May 2024

Background:

Prostate-specific antigen (PSA) has been widely used as a screening method in different prostatic pathology including prostate cancer. The malignant potential of prostate cancer is associated with tumor volume at diagnosis and studies of the correlation between serum PSA levels and Gleason’s grading which remains one of the most powerful predictors of prostate cancer.

Aim:

To correlate serum PSA and Gleason’s score/Group grade in various neoplastic prostatic biopsies and to study their histopathological findings at a tertiary care center.

Materials and Methods:

This study uses PSA as a screening tool and to correlate serum PSA level to Gleason scores/group grades in various neoplastic and nonneoplastic prostatic biopsies, received at the Department of Pathology, T. S. Misra Medical College and Hospital, Lucknow during 4 years from June 2016 to July 2020.

Results:

The mean serum PSA value in benign prostatic hyperplasia (BPH) without prostatitis cases was 1.80 ng/ml and BPH with prostatitis was 5.86 and in malignant cases was 55.2 ng/ml. Serum PSA in the range of 0–4 ng/ml was significantly associated with benign lesions and a value of more than 20 ng/ml was significantly associated with malignant lesions. The most frequent Gleason score was 7 and Grade group II was the highest in number. The highest incidence of malignancies and prostatic hyperplasia occurred among the 60–69 years of age group. PSA values increased significantly (P < 0.05) in prostatic carcinoma cases (Group grade II and III).

Conclusion:

PSA is a valid, sensitive, and early screening method for the diagnosis of both neoplastic and nonneoplastic lesions of the prostate. PSA values correlated significantly with Gleason’s score/grade groups of prostatic carcinoma.
Drug Prescription Practice and Behavior
Authors: Gzllal Nouran , Gharibe Malak , Atia Ahmed
Published: May 2024

Counseling has evolved into an essential component of community pharmacy practice. Patient counseling and addressing drug-related problems are the pharmacist's key activities to ensure the safe and effective use of medicines. There are currently no solid theoretical foundations for research on physician prescribing choices. In fact, doctors' drug prescriptions are a complex phenomenon that are influenced by a number of factors. The majority of current studies in the field of drug prescription use an exploratory approach rather than a theoretical one to describe how doctors make decisions. In Libya, a prescription of medications can easily be obtained from community pharmacies without prescription, resulting in potential drug misuse and health hazard. It was stated previously that there was overprescribing of certain categories of drugs written by Libyan physicians which necessitating further improvement. This review aimed to describe the dispensing practice of prescribed medicines in daily community pharmacy practice in Libya, focusing on counseling, and rational prescription based on the World Health Organization prescribing indicators.
The Practiced Pattern of Vascular Access used in Hemodialysis
Authors: Bitrou Rodaba Ahmed , Shaibani Badreddin , Ahmed Hajir Salih , Ayad Khiri
Published: May 2024

Background:

The incidence of end-stage renal disease (ESRD) is increasing considerably worldwide; moreover, most of the patients start their therapy by hemodialysis (HD). Arteriovenous fistula (AVF) is the best type of vascular access for use in such therapy, due to its decreased rate of complications, followed by arteriovenous graft (AVG) and finally, central venous catheters, which are associated with, increased mortality and morbidity. In this study, we aim to find out the proportion of the current to initial vascular access used, the timing of creating permanent access, and any complications experienced.

Patients and Methods:

A cross-sectional study was conducted on two hundred eighteen patients currently on regular hemodialysis program. Their records were reviewed and the data was analyzed for vascular accesses type used at the start of hemodialysis and at the current time, the timing of the creation of permanent access, and the complications occurred. Data collected were statistically analyzed using IBM-SPSS statistics software Inc. Chicago, IL, USA.

Results:

Out-of-the 218 patients on hemodialysis, 193 patients (88.5%) started hemodialysis via Central venous catheters (CVC), 23 patients (10.5%) had an arterio-venous fistula (AVF), and only two patients (0.9%) used tunneled CVC, while no one has AV-graft. Currently, 82.1% of patients have AVF, 7.8% have chronic CVC, 5.9% have acute CVC and only 4.1% have AV-Graft, Many complications are noted in all types of access with different percentages of occurrence.

Conclusion:

We concluded that although a high percentage of patients have AVF, still pre-emptive AVF counts very low percentage, serious complications are still happening and we recommend the establishment of joined pre-dialysis clinic with surgeons and psychologists in each dialysis center.
Limbal Versus Fornix Incision for Strabismus Surgery
Authors: Alfreihi Shatha , Ammar Hebatallah
Published: May 2024

PURPOSE:

This study aims to identify the use of limbal versus fornix incisions among strabismus surgeons in Saudi Arabia and the preferred approach to teaching trainees with the shortest learning curve.

METHODS:

Two designed questionnaires were sent to local strabismus surgeons and ophthalmology trainees.

RESULTS:

A total of 127 participants responded to our survey: fifty-nine consultants (53% Saudi nationals and 43% expat ophthalmologists) and 68 trainees. The limbal approach was the preferred approach for all settings, including the primary pediatric procedure (30, 55.9%), pediatric reoperation (40, 64.7%), adult primary procedure (32, 55.9%), and reoperation (40, 70%). The reason was attributed to better exposure. As for fornix incision, the most commonly cited reason was less pain and discomfort. For the adjustable suture technique, 29 (49.2%) did not use adjustable sutures, and 22 (37.3%) prefer the limbal approach. When we compared Saudi versus non-Saudi surgeons, 26 (83.87%) Saudi surgeons were trained to perform the limbal method, whereas 16 (57.14%) non-Saudi surgeons were trained to perform the fornix approach. Of the trainees, 35 (51%) were trained on the limbal approach. When asked about the learning curve for different methods, 41 (60.3%) noted a faster learning curve with the limbal approach.

CONCLUSION:

Despite the many advantages of the fornix incision, it remains uncommon in our region. Each technique of strabismus surgery has its advantages and disadvantages. Programs should teach all methods to trainees. One should add all styles to his armamentarium and choose the appropriate one for each patient.
Prevalence of Diabetic Retinopathy and Risk Factors among Diabetic Patients at University of Gondar Tertiary Eye Care and Training Center, North-West Ethiopia
Authors: Ejigu Tesfahun , Tsegaw Asamere
Published: May 2024

PURPOSE:

Diabetic retinopathy (DR) is one of the most serious complications of diabetes mellitus (DM). It is the most common cause of blindness among the working age group in the developed world and the fifth leading cause of global blindness. In Sub-Saharan Africa, 2.8% of all blindness is caused by DR. Studies addressing the prevalence of DR and associated factors are scarce in Ethiopia. The objective of this study was to determine the Prevalence and associated factors of DR development among DM patients attending University of Gondar, Tertiary Eye Care and Training center.

METHODS:

A cross-sectional study was carried out from March 2019 to February 2020 involving all consecutive diabetes patients who visited the center during the study period. Data were collected using a semi-structured questionnaire and data extraction check list and entered into SPSS version 20 and analyzed. Univariate and multivariable logistic regression analysis were done to identify predictors of DR. Statistical significance was determined with 95% confidence interval (CI) using odds ratio and P < 0.05.

RESULTS:

A total of 225 DM patients with a mean age of 55.4 ± 13.5 years were studied, of whom 95 (42.2%) had DR. Duration of diabetes ≥6 years (AOR = 2.91: 95% CI; 1.01–8.35) and baseline age < 60 years (AOR = 3.2: 95% CI; 1.19–8.63) were significantly associated with DR. DR was significantly associated with the form of therapy. Those on insulin (P = 0.025) and oral hypoglycemic agents (OHA) with insulin combination (P = 0.014) had statistically significantly associated with the development of DR. Patients with systolic blood pressure of <140 mmHg were 3.6 times (AOR = 0.28: 95% CI: 0.09–0.82) less likely to have DR. A majority of patients had nonproliferative DR without diabetic macular edema (DME) (34.2%). DME and proliferative DR were seen in 5.7% and 3.6% of the patients, respectively. Vision threatening DR (VTDR) was seen in 10.7% of patients. There was a significant association between age <60 years and VTDR (AOR = 4.19: 95% CI; 1.23–14.35).

CONCLUSION:

The prevalence of DR among our study patients was very high. Longer duration of diabetes, higher systolic blood pressure, baseline age <60 years, use of insulin alone, and use of combination of insulin with OHA were independently associated with DR. Health education, early screening, and treatment are recommended.
Strabismus Surgery Outcomes and Their Determinants in Patients with Chronic Sixth Nerve Palsy
Authors: Alghofaili Ruba S. , Sesma Gorka , Khandekar Rajiv
Published: May 2024

PURPOSE:

Patients with chronic sixth nerve palsy (CSNP) comprise a heterogeneous population, and the optimal surgical solution remains uncertain. Here, we present the success rate and factors associated with the success of strabismus surgeries for CSNP.

METHODS:

This was a retrospective cohort study of patients with strabismus due to CSNP operated on between 2015 and 2019 in a tertiary eye hospital in central Saudi Arabia. Surgical success was defined as a horizontal deviation of ≤10 prism diopters (PDs) assessed at least 12 months after surgery. Differences between groups with respect to the primary outcome were assessed.

RESULTS:

Fifty-five patients were analyzed with a median follow-up of 24 (range 12–48) months. Superior rectus and inferior rectus transposition (34.5%) and medial rectus recession with lateral rectus resection (32.7%) were the main surgeries performed. The overall success rate was 67.3% (95% confidence interval 54.9–79.7). Bilateral CSNP (P = 0.05), a higher preoperative angle of deviation (P = 0.002), or a greater degree of preoperative limitation of abduction (P = 0.012), but not the type of surgery (P = 0.09), were more likely to result in an under-corrected outcome of >10 PD. The preoperative deviation angle showed a trend toward being associated with a poor outcome after surgery (P = 0.06). Six patients with high-angle deviation before surgery required second surgery.

CONCLUSION:

While the surgical procedure does not impact outcomes, the severity of preoperative horizontal deviation might impact surgical success and the need for reoperation. Patients with severe CSNP should be counseled appropriately about the chances of surgical success and the potential need for further interventions.
Correlation of C-Reactive Proteins With Chronic Periodontitis. A Prospective Study
Authors: Santhosh V. C. , Varkey Anish , Reddy R. Naveen , Vempalli Swetha , Shivappa Anil B. , Mohammed Azhar , Mahajan Ankit
Published: May 2024

Context:

The C-reactive protein (CRP) is an acute-phase reactant protein that is produced in response to various inflammatory and noxious stimuli that include exposure to heat, traumatic conditions, varieties of infectious processes, and conditions of hypoxia. Estimation of CRP levels in serum samples helps in providing important information related to the diagnosis, monitoring, and treatment of inflammatory processes and various associated diseases.

Materials and Methods:

This prospective longitudinal study was designed to evaluate serum CRPs in subjects who were selected for study participation after fitting into inclusion criteria, which were as follows: a) study participants who were clinically diagnosed with chronic generalized periodontitis along with periodontal pocket depths of ≥5 mm and also radiographic alveolar bone loss; b) subjects within the age range of 35 to 55 years; and c) no smoking habit or use of tobacco in any other form. Results: Patients were assessed for clinical parameters such as gingival index, sulcular bleeding index, mean depth of periodontal pocket, and loss of clinical attachment. Blood was collected at required visits, and CRP was evaluated. Study evaluation periods were baseline (day 0), day 14 (2nd appointment), and day 45 (3rd appointment).

Results:

Statistically significant reductions in both clinical and serum CRP levels were obtained at subsequent appointments.

Conclusion:

This study has demonstrated and supported the evidence that serum CRPs act as a biomarker in determining the prognosis of chronic periodontitis patients after nonsurgical periodontal treatment.
Prevalence of HPV in Oral Squamous Cell Carcinoma Through p16 IHC: A Hospital-Based Study in Eastern India
Authors: Rout Twinkle , Panda Sangram Keshari , Shankar Kottareddygari Vikas , Kar Dattatreya , Mohanty Debi Prasad , Agrawala Sunil
Published: May 2024

Context:

Oral squamous cell carcinoma (OSCC), the third most prevalent solid cancer in India with 45% incidence, is associated with 20%–50% of cases having human papillomavirus (HPV) infection; however, the current role of HPV in managing OSCC remains unclear, particularly in high-incidence areas such as Eastern India.

Aim:

The study aims to determine the prevalence of HPV in OSCC patients and evaluate its role as an independent risk factor in the progression of OSCC.

Settings and Design:

This cross-sectional study, conducted in an Eastern Indian tertiary care hospital, involved 140 identified and treated OSCC patients.

Materials and Methods:

Immunohistochemistry (IHC) was used to determine HPV immunoreactivity using the marker p16. The data were analyzed using SPSS version 27.0 with a significance level of P < 0.05.

Results:

Among 140 patients, 11 showed strong P16 positivity (>70%) for HPV, resulting in a prevalence rate of 7.86%. However, no statistically significant association of HPV (p16 positivity) with any groups was found. Interestingly, all P16-positive patients in our study had a history of tobacco use (9.5%), suggesting that HPV may not be considered an independent factor for oral cancer.

Conclusion:

In our cases, p16 positivity is seen in 7.85% of cases. This finding suggests that further sub-analysis concerning p16 as a prognostic marker and its therapeutic implication is further required in oral cancer. Correlation with PCR is also required to substantiate TNM staging of p16 by the IHC method.
A Pilot Study for Drug-Resistant Tuberculosis Disease Patients Suggests that A964G (rs153109)—Interleukin 27 may be Protective
Authors: Badamasi Ibrahim Mohammed , Yusuf Abdullahi Asuku , Abubakar Isa Sadeeq , Bala Jamilu Abubakar , Aliyu Isah Abubakar , Salman Julius , Salami Kolawale , Kabir Imam-Malik
Published: May 2024

Context:

Variation in the transcription of host genes of inflammatory cytokines may underscore variation in their production. Thus, the host-immune status plays a vital role in determining the fate of the invading bacilli.

Materials and Methods:

Two hundred consenting volunteers and drug-resistant tuberculosis (DR-TB) patients had their blood samples amplified for the A964G (rs153109) gene. The amplicons were digested using the Xhol enzyme for genotyping purpose.

Results:

Among the cases: AA (homozygous wild type; n = 33), AG (heterozygous wild type; n = 36), GG (homozygous mutant, n = 10), A (wild allele, n = 102), and T (mutant allele; n = 66); while among the healthy volunteers: AA (homozygous wild type; n = 20), AG (heterozygous wild type; n = 40), GG (homozygous mutant, n = 4) A (wild allele, n = 80), and T (mutant allele; n = 48). The Hardy Weinberg Equilibrium (HWE) assessment of the samples from the control participants was statistically significant (P = 0.015). Nevertheless, the assessment of the association between the genotypes and the phenotypes assessed revealed that the healthy volunteers had more (twice) heterozygous genotype (AG) (crude statistics: P =0.045, OR = 1.99 (1.02–3.90)) when compared to the DR-TB patients.

Conclusion:

Although the AG genotype of A964G (rs153109)—Interleukin 27 gene may have a protective role against the development of MTB/XPERT positive DR-TB disease, the significant HWE finding among the genotype from the samples of the healthy volunteers suggests that this current result may be a false positive finding.
Role of metabolic dysfunction and inflammation along the liver–brain axis in animal models with obesity-induced neurodegeneration
Authors: Asimakidou Evridiki , Saipuljumri Eka Norfaishanty , Lo Chih Hung , Zeng Jialiu
Published: May 2024

The interaction between metabolic dysfunction and inflammation is central to the development of neurodegenerative diseases such as Alzheimer’s disease and Parkinson’s disease. Obesity-related conditions like type 2 diabetes and non-alcoholic fatty liver disease exacerbate this relationship. Peripheral lipid accumulation, particularly in the liver, initiates a cascade of inflammatory processes that extend to the brain, influencing critical metabolic regulatory regions. Ceramide and palmitate, key lipid components, along with lipid transporters lipocalin-2 and apolipoprotein E, contribute to neuroinflammation by disrupting blood–brain barrier integrity and promoting gliosis. Peripheral insulin resistance further exacerbates brain insulin resistance and neuroinflammation. Preclinical interventions targeting peripheral lipid metabolism and insulin signaling pathways have shown promise in reducing neuroinflammation in animal models. However, translating these findings to clinical practice requires further investigation into human subjects. In conclusion, metabolic dysfunction, peripheral inflammation, and insulin resistance are integral to neuroinflammation and neurodegeneration. Understanding these complex mechanisms holds potential for identifying novel therapeutic targets and improving outcomes for neurodegenerative diseases.