bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparative evaluation of different access cavity designs on intracoronal bleaching of endodontically treated teeth using two different agents – An in vitro study
Authors: Talwar Sonali , Mahajan Pardeep , Bajaj Nitika , Monga Prashant , Marya Pratibha , Gandhi Piyush
Published: September 2022

Aim:

The present in vitro study was designed to determine the effect of different access cavity designs on intracoronal bleaching of endodontically treated teeth with two different agents.

Materials and Methods:

Fifty selected permanent maxillary central incisors were stained. Traditional and contracted access cavity designs and two types of bleaching agents, i.e., 35% carbamide peroxide and 35 percent hydrogen peroxide were used for the study. Color measurements were performed with a spectrophotometer: before staining (T1), after staining (T2), at 7 and 14 days (T3 and T4) post bleaching. The values were calculated and subjected to the statistical analysis.

Results:

The results of our study showed that teeth in which traditional access cavity (TAC) was prepared had statistically significant better bleaching results with both 35% carbamide peroxide and 35% hydrogen peroxide than contracted access cavity design. Carbamide peroxide showed better results than hydrogen peroxide irrespective of the access cavity design, but difference was statistically nonsignificant.

Conclusion:

The present study concluded that TAC design showed better results than contracted access with both carbamide peroxide and hydrogen peroxide. Whereas, when bleaching agents were compared 35% carbamide peroxide is better than 35% hydrogen peroxide irrespective of access cavity design used.
Correlation of endodontic infection and cytokine expression in patients with systemic diseases
Authors: Abraham Dax , Singh Arundeep , Kurian Ansy Hanna , Gupta Alpa , Aneja Kritika , Sethi Simar
Published: September 2022

Aim:

The role of various host response mediators in pulpitis has been extensively documented as these components may operate as biomarkers that reflect the condition of pulp tissues. The expression of these biomarkers is further affected in the presence of different systemic diseases. This review aims to assess if a correlation exists in the expression of cytokines and endodontic infection in patients having various systemic diseases undergoing nonsurgical endodontic therapy.

Materials and Methods:

The review includes a complete manual search as well as electronic databases such as PubMed, Scopus, and EBSCOhost. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was used to frame the review process. The critical appraisal checklist for quasi experimental studies developed by Joanna Briggs Institute was used to examine the risk of bias. For prospective clinical studies, eight criteria were used to assess the risk of bias. The studies included were clinical trials that estimated mRNA expression of cytokines from periapical interstitial fluid before and following disinfection of the root canals in patients suffering from various systemic diseases.

Results:

This review included a total of four papers from the initial 122 publications. When compared to normal controls, endodontic infection was associated with altered expression of these cytokines in patients presenting various systemic diseases.

Conclusions:

This information can subsequently be utilized to correctly distinguish between diseased and healthy pulp tissues. The interaction of cytokines in systemic diseases and their possible use in endodontics as a more precise and biologically based diagnostic tool can be planned.
Four distal root canals in a two-rooted permanent mandibular first molar
Authors: Ujariya Urvashi M. , Patel Foram H. , Bharatiya Rajendra P. , Kothari Anjali K.
Published: September 2022

Understanding root canal anatomy and its variations is an essential part of the success of endodontic treatment. This case report represents an extremely rare occurrence of four distal root canals in a two-rooted mandibular first molar (MFM). Nonsurgical endodontic treatment of MFM was performed with the aid of the dental operating microscope and ultrasonic troughing tips. PubMed database (www.ncbi.nim.nih.gov/pubmed) was searched for relevant articles using specific search terminologies for conducting the literature review. Data extraction was performed in relation with the inclusion and exclusion criteria provided in the study. Quantitative data synthesis was performed. Only four cases (including the present case) of four distal root canals in two-rooted MFMs have been reported in dental literature. Among these, three cases were reported in the Indian population. The overall incidence of four canals in a distal root of two-rooted MFMs is 0.09% according to clinical/laboratory studies. The most common distal root canal configurations of two-rooted MFMs found in clinical/laboratory studies were Vertucci type I (68.15%) followed by type II (37.6%) and type III (35.08%). A meticulous understanding of the anatomical variations, preoperative awareness, and intraoperative care to identify the landmarks of usual as well as any unusual anatomy of the root canal system will help to increase the rate of clinical success.
Comparative evaluation of cerium oxide nanoparticles and calcium hydroxide as intracanal medicament against Enterococcus faecalis on tooth substrate
Authors: Sanju Dona , Kumari Veronica Aruna , Thomas Toby , Thomas Julie Toby , Sujeer Ramakrishna
Published: September 2022

Aim:

The aim of this study is to compare the antibacterial efficacy of cerium oxide nanoparticles and calcium hydroxide as intracanal medicaments against Enterococcus faecalis on tooth substrate – an in vitro study.

Materials and Methods:

The experiment was conducted in three stages. In Stage 1, antibacterial susceptibility test of three test materials, cerium oxide nanoparticles, calcium hydroxide, and vancomycin against E. faecalis was done using disc diffusion method. In Stage 2, determination of minimal inhibitory concentration and minimum bactericidal concentration of the cerium oxide nanoparticles was done by tube dilution method. In Stage 3, determination of CFU was carried out using dentinal blocks at 1-day and 5-day intervals at two different dentinal depths (200 μm and 400 μm) for calcium hydroxide (Group 1), cerium oxide nanoparticle dispersion (Group 2), a mixture of calcium hydroxide and cerium oxide nanoparticles (Group 3), and sterile water (Group 4).

Results:

The reduction of E. faecalis achieved by cerium oxide nanoparticles dispersion on day 5 was 66.9% as against 46.7% as shown by mixture of the two medicaments and 34.8% by calcium hydroxide paste alone on day 5 at 400-μm depth.

Conclusion:

Cerium oxide nanoparticles show a significantly higher antibacterial efficacy when compared to calcium hydroxide and its combination.
Neutrophil-to-Lymphocyte Ratio and Outpatient Management of Low-Risk Acute Pulmonary Embolism
Authors: Ranhbar Abdolmohammad , Sohrabi Bahram , Hajizadeh Reza , Shoar Mahdi Karimi , Kavandi Hadiseh , Ghodratizadeh Sahar , Sakha Hanieh , Mohammadi Kamran
Published: September 2022

Purpose:

Low-risk pulmonary thromboembolism (PTE) outpatient management has been described recently. The blood neutrophil/lymphocyte ratio (NLR) has been shown to be a useful marker of cardiovascular disease and an independent predictor of cardiac mortality. The predictive value of NLR in predicting mortality of low-risk PTE was evaluated in this study.

Materials and Methods:

The total of 168 patients with definite pulmonary embolism diagnosed by computed tomography angiography whose on-admission simplified Pulmonary Embolism Severity Index (PESI) score was zero enrolled in this study. The survival rate of patients according to their NLR was evaluated.

Results:

During 12 months' follow-up period, eight patients (4.7%) died. None of the patients with an NLR of <3.2 died during the follow-up. The median values of NLR in the nonsurvivor and survivor groups were 9.2 ± 3.03 (2–29.5) and 4.69 ± 0.43 (0.8–24.5), respectively. NLR values were significantly higher in nonsurvivors compared to survivors (P = 0.043).

Conclusion:

This study suggests that patients with zero PESI score and NLR <3.2 could be managed patiently with good results.
A Narrative Review on Exercise and Cardiovascular Events: “Primum Non Nocere”
Authors: Dimitriadis Kyriakos , Bletsa Evanthia , Lazarou Emilia , Leontsinis Ioannis , Stampouloglou Panagiota , Dri Eirini , Sakalidis Athanasios , Pyrpyris Nikolaos , Tsioufis Panagiotis , Siasos Gerasimos , Tsiachris Dimitrios , Tsioufis Konstantinos
Published: September 2022

Exercise provides beneficial effects on the primary and secondary prevention of numerous chronic conditions, including cardiovascular disease, diabetes mellitus, and malignancies. Despite its indisputable benefits, exercise can rarely trigger major adverse cardiovascular events such as ventricular arr hythmias, myocardial infarction, or even sudden cardiac arrest in susceptible individuals. Physiological changes that occur during exercise, including increased sympathetic activity and cardiac oxygen requirements, may account for ischemia and trigger ventricular ectopy with eventually adverse outcomes. Tailored preparticipation screening for exercise and sports engagement is fundamental to unveiling underlying pathological conditions. The present review summarizes the overall impact of exercise on cardiovascular health and highlights the recommended prevention strategies.
Impact of Sleep on Cardiovascular Health: A Narrative Review
Authors: Sum-Ping Oliver , Geng Yong-Jian
Published: September 2022

Sleep is a universal biological function but remains poorly understood and a relatively new field of science and medicine. Over the past decade, there have been rapidly accumulating scientific and clinical data around sleep, including the effects of various sleep aspects on cardiovascular health. Much of the research in the field has focused on sleep-disordered breathing, particularly obstructive sleep apnea. However, other sleep pathologies including hypersomnolence disorders, sleep-related movement disorders, and parasomnia disorders have been linked with cardiovascular health. Other areas of sleep, such as sleep duration, timing, and circadian rhythms, also have a demonstrated association with heart health. In this review, we provide an updated summary of the literature connecting sleep and cardiovascular disease.
Exercise, Advanced Glycation End Products, and Their Effects on Cardiovascular Disorders: A Narrative Review
Authors: Hooshiar Saeedeh Hosseini , Esmaili Helia , Taherian AmirMohammad , Jafarnejad Sadegh
Published: September 2022

Lifelong accumulation of advanced glycation end products (AGEs) is linked to cardiovascular disease (CVD). As a result of AGEs, cardiovascular dysfunction develops and progresses via two main mechanisms: cross-linking AGEs with tissue proteins and binding of AGEs to their receptor for AGE (RAGE). In addition, the formation of atherosclerotic plaques in these patients may be due to increased oxidative stress, leading to an elevation in blood circulation and tissue AGEs. Increasing physical activity is a critical approach among the different strategies to manage the deleterious effects of these changes caused by disease. Exercise prevents the accumulation of AGEs and slows the progression of chronic disease sequels. Exercise reduces AGE levels through a reduction of insulin sensitivity, fat mass, inflammation, and RAGE expression. An improvement in glucose metabolism and glycemic control are also other possible explanations. Reduced peripheral insulin resistance may attenuate AGE accumulation. Physical exercise causes more antioxidant enzyme secretion and reduces oxidative stress. Antioxidant and anti-inflammatory endothelial function is improved by exercise. After exercise, subendothelial matrix stiffness decreases, and endothelial function is improved. In this current study, the association between AGEs and exercise and their interaction effects on CVD are discussed.
The Role of Cortisol in the Development of Post-Stroke Dementia: A Narrative Review
Authors: Edwards Isabella , Singh Indu , Rose'meyer Roselyn B.
Published: September 2022

Stroke is defined as a neurological deficit which lasts more than 24 h or leads to death, which is caused by a focal acute injury to the central nervous system with a vascular origin. Strokes are one of the greatest challenges in public health. As an acutely stressful event, strokes have been associated with an increased release in the stress hormone cortisol. Elevated cortisol has been linked to deleterious impacts on the brain, particularly the hippocampus, and has been associated with the development of dementia, though the mechanisms behind this remain unclear. Dementia is also an important stroke outcome, affecting approximately a third of stroke survivors in the long term. This review explores the relationship between strokes and cortisol, to determine the association between cortisol and hippocampal/neuronal damage and poststroke dementia and cortisol.
Facing Sleep and Mental Health Problems in the Covid-19 Era: What Shall We Do?
Authors: Meng Shiqiu , Lu Lin , Yuan Kai , Yang Doris , Zhang Icey
Published: September 2022

In this interview, Prof. Lin Lu introduced ways to improve sleep and relieve stress, influences of sleep on the heart and mental health, essential qualities of psychiatrists, etc. His major viewpoints are: (a) sleep deprivation disrupts physiological functions, (b) prevalence of mental health problems in the general population, health-care workers, and students showed an increasing trend following COVID-19, and (c) it is a tendency for doctors to develop a comprehensive and integrated treatment plan from the physical and mental perspectives.
The Armchair Obtuse Marginals: Anomalous Origin of Obtuse Marginals from Right Coronary Sinus - a Case Report
Authors: Das Debasish , Das Tutan , Pramanik Subhas
Published: September 2022

We report a rare case of anomalous origin of obtuse marginals (OMs) from a common trunk arising from the right coronary sinus in an interesting armchair shape in a 52-year-old female presenting with acute inferior wall myocardial infarction. During routine coronary angiography, the origin of the left anterior descending coronary artery was visualized and the origin of the left circumflex (LCX) coronary artery was not visualized with the sign of nonperfused myocardium in the LCX artery territory. Our case is a rare illustration of armchair OMs with nonperfused proximal and middle LCX coronary artery territory.
Challenges and gender-based differences for women in the Indian urological workforce
Authors: Pandit Shruti Rahul , Venugopal P. , Keshavamurthy Ramaiah , Chawla Arun
Published: September 2022

Introduction:

Entry of women into urology has not kept pace with that in other surgical branches with only 1% of Urological Society of India (USI) members being female. The objective of this study was to explore the personal and professional challenges, practice barriers, and level of satisfaction among female urologists/urology trainees in India.

Methods:

A strictly confidential and anonymous 26-item questionnaire with respect to professional and personal challenges, workplace discrimination, and family satisfaction was circulated as a Google form through email and WhatsApp to all the female members of the USI (full and associate) and trainees (n = 48) based on identification from the USI directory.

Results:

Thirty-three out of 48 female urologists responded (68%). Among the respondents (n = 33), majority had <5 years of experience (60.6%), of which 30.3% were residents, which reflected a recent surge in women joining urology. Majority (57.7%) chose to subspecialize, commonly in “female urology”. Many (72.7%) were encouraged to take this subspecialty. Gender discrimination at workplace was reported by 54.5%, commonly by patients and consultants. 68% of respondents had conceived either before or during residency, leading to additional domestic responsibilities. 9.1% suffered a pregnancy-related complication, which they believed was a direct consequence of their work environment. These obstacles led to 30.3% of women reporting that their personal life had compromised their careers. Professional dissatisfaction was reported by 60.1% of women, with common causes being less operative time than male counterparts and lack of mentorship. Despite these challenges given a chance, 78.7% would choose urology again, and 66.7% would encourage their daughter to pursue a career in urology.

Conclusion:

Professional and personal challenges as perceived by women responding to our survey include gender discrimination in training and work, lack of mentorship, pregnancy-related compilations, and compromised career due to family responsibilities. Despite these, most would choose this specialty again.
A rare neurological presentation of emphysematous pyelonephritis
Authors: Darsan S. Lal , Pillai Biju S. , Krishnamoorthy H.
Published: September 2022

Emphysematous pyelonephritis (EPN) is an acute necrotizing infection of the kidney with features of air formation in the pelvicalyceal system, renal parenchyma, and surrounding structures. Although septic embolization has been reported to occur in distant organs, air pockets occurring intracranially leading to neurological manifestations in EPN have not been reported in the literature. We present a case report of a patient with EPN showing air pockets in renal parenchyma, pelvicalyceal system, renal vein, inferior vena cava, and multiple intracranial venous sinuses, presenting predominantly with neurological symptoms. This patient was aggressively managed with antibiotics, ureteral stenting, and drainage of the right kidney.
Iatrogenic partial glanular amputation
Authors: Sharma Aditya Prakash , Yashaswi Thummala , John Jerry R. , Singh Shrawan Kumar
Published: September 2022

Circumcision is a customary ritual across many cultures. However, the safety of such procedures remains a concern. A boy underwent circumcision in 2014 by a religious worker at the age of 7 years. Post circumcision, the patient had gradual narrowing of the penis, between the glans and the shaft, with an iatrogenic partial glanular amputation and presented to us at the age of 14 years. The patient underwent end-to-end urethroplasty and glansplasty. Postoperatively, the patient did well and the wound remained healthy. Circumcision has complications even in expert hands. Religious circumcision can result in dreadful complications in children and adolescents.
A prospective, observational study to assess the feasibility and safety of supine percutaneous nephrolithotomy under regional anesthesia for obese patients with a body mass index ≥30
Authors: Morsy Samer Mahmoud , Abdelaziz Islam Nasser , Rammah Ahmed Mohamed , Labana Mahmoud Abdelaziz , Hussein Hussein Aly
Published: September 2022

Introduction:

Besides being a risk factor for urolithiasis, obesity is a challenge in the treatment of urolithiasis from the perspective of both the surgeon and the anesthetist. In this study, we tried to assess the feasibility and safety of supine percutaneous nephrolithotomy (PCNL) under regional anesthesia in obese patients with a body mass index (BMI) ≥30.

Methods:

This was a prospective observational study and included 51 obese patients (BMI ≥30 kg/m2) with renal stones planned for PCNL. All patients underwent supine PCNL under regional anesthesia with the standard technique. A decision for totally tubeless or a tubeless PCNL was made at the end of the procedure and the intraoperative and postoperative data were recorded. All patients underwent computed tomography (CT) imaging at 1 month after surgery to assess the stone-free status and the need for additional treatment.

Results:

The mean age of the patients was 53.2 ± 8.09 years, and the mean BMI was 34.4 ± 2.369 kg/m2. The mean operative time was 73.3 ± 26.2 min, the mean hospital stay was 58.3 ± 22.1 h, and the mean postoperative Visual Analog Score (VAS) for pain was 3.8 ± 1.4. The stone-free rate was 68.6% on the follow-up CT performed after 1 month, and 31.4% of the patients had significant residual fragments which required re-treatment either by retrograde intrarenal surgery (RIRS) in 19.6% (either as primary RIRS for the residual calculi in one patient [1.9%] or as RIRS for post shock wave lithotripsy (SWL) or alkalinization failure in 9 patients), SWL in 21.6%, or urine alkalinization in 7.8%.

Conclusion:

Supine PCNL under regional anesthesia, in this subgroup of obese patients, was found to be feasible and safe with satisfactory stone-free rates and minimal postoperative pain.
Renal vein injury during percutaneous nephrolithotomy
Authors: Aggarwal Amit , Bhargava Priyank , Bhirud Deepak Prakash
Published: September 2022

Percutaneous nephrolithotomy (PCNL) is the treatment of choice for large and complex renal calculi. We encountered a patient who was planned for PCNL in a peripheral hospital, without a preoperative computed tomography scan but was abandoned during tract dilatation due to intractable bleeding and was referred to our institute with nephrostomy in situ in a clamped state. After evaluation, the tip of the nephrostomy tube was found to be in the left renal vein causing secondary thrombosis. Due to the nonfunctional status of the kidney in the dynamic scan, the patient underwent laparoscopic left simple nephrectomy with thrombectomy without any major intraoperative complication and was discharged in stable condition.
A 46,XX Karyotype in Men with Infertility
Authors: Kouvidi Elisavet , Tsimela Hara , Lazaros Leandros , Manola Kalliopi N. , Zachaki Sophia , Dobrescu Ruxandra , Sfakianoudis Konstantinos , Tsoni Theodora , Katsidi Christina , Tsarouha Haralambia , Kanavakis Emmanuel , Mavrou Ariadni
Published: September 2022

46,XX male sex reversal syndrome is a rare genetic cause of male infertility. We report on two new cases of this syndrome in men presenting with hypogonadism and infertility. Cytogenetic and molecular analysis was performed in both patients. An extensive review of the literature for 46,XX male sex reversal syndrome cases related to infertility was also performed to fully characterise this syndrome. Genetic analyses showed translocation of the SRY on Xp chromosome and complete absence of all Azoospermia factor (AZF) genetic regions. All patients included in the review presented hypergonadotropic hypogonadism. Small testes were the most common clinical characteristic present in 90.2% of the patients, followed by small penis (31.8%), gynecomastia (26.8%) and poor hair distribution (15.4%). The presence of the SRY was identified in 130/154 (84.4%) patients: in 98.5% of cases, it was translocated on the Xp chromosome and in 1.5% on an autosome. All patients were azoospermic, due to the lack of AZF genetic regions. Males with normal phenotype and primary hypogonadism should be properly evaluated by the physicians and must be referred for cytogenetic and molecular analysis to exclude or confirm 46,XX male sex reversal syndrome. More cases of this syndrome with SRY translocated on an autosome are needed to identify if these patients have different characteristics than those with SRY translocated on Xp chromosome. Whole genome analysis of these patients is required to elucidate the genetic differences which are responsible for the phenotypic variability of the syndrome.
Comparison of Treatment outcomes following Ovarian Stimulation with Intrauterine Insemination in Minimal or Mild Endometriosis versus Unexplained Infertility
Authors: Sarkar Sharmistha , Joseph Treasa , Yadav Bijesh , Kamath Mohan Shashikant , Kunjummen Aleyamma Thayparmbil
Published: September 2022

Background:

Infertility is a global health issue. The variation in the prevalence of unexplained infertility is attributed to the choice of investigation. There remains a knowledge gap on the impact of minimal and mild endometriosis on treatment outcomes following intrauterine insemination (IUI).

Aim:

The aim of this study was to compare treatment outcomes following ovarian stimulation (OS) and intrauterine insemination (IUI) between minimal and mild endometriosis versus unexplained infertility.

Settings and Design:

A retrospective analysis of women undergoing OS with intrauterine insemination during the year 20142020 in the Department of Reproductive Medicine and Surgery, Christian Medical College, Vellore, was considered for the study.

Materials and Methods:

Women with minimal and mild endometriosis or unexplained infertility diagnosed by diagnostic hysterolaparoscopy were included for the analysis. Univariate and multivariate analysis was done. The primary outcome was live birth rate (LBR) per cycle. The secondary outcomes measured were clinical pregnancy rate (CPR) , cumulative LBR (CLBR) per women, cumulative CPR (CCPR) per women and miscarriage rate.

Statistical Analysis Used:

The baseline parameters were compared using a t-test for continuous data, and categorical data were compared using the Chi-square/Fisher's exact test as appropriate. The outcomes were assessed using logistic regression analysis and expressed as odds ratio (OR) with 95% confidence intervals (CI).

Results:

There were no significant differences in CPR per cycle (14.28% vs. 18.8%, OR: 0.71; 95% CI: 0.401.28) and LBR per cycle (14.28% vs. 16.6%, OR: 0.84; 95% CI: 0.461.51) between the endometriosis and unexplained infertility groups. The cumulative LBR per woman and CCPR per woman also did not show any significant difference in between the two groups.

Conclusion:

The current study did not find any significant differences in cumulative LBR and CPR following OS-IUI in women with minimal or mild endometriosis and unexplained infertility.
A Rare Case of Mosaic Ring Turner Syndrome with Horseshoe Kidney
Authors: Pritti Kumari , Mishra Vineet , Patel Hetvi
Published: September 2022

Rearranged X chromosomes in Turner syndrome (TS) generally present with a mild phenotype, but in cases of ring X chromosomes, the incidence of intellectual disability and other congenital abnormalities can be significantly higher depending on the size of the ring and the involvement of X-inactive specific transcript (XIST) region. Here, we report a 17-year-old female who was referred for a cytogenetic analysis because of primary amenorrhoea. The patient, of normal intelligence, had been found to have traits of TS, especially short stature and some rare findings such as horseshoe kidney and short fourth toe. Cytogenetic analysis showed a mosaic 45, X/46, X and r(X) karyotype. Fluorescence in situ hybridisation analysis using sex chromosome probes permitted us to identify the marker as a ring X chromosome, detected in 30% of cells. The r(X) might include the XIST locus, which would have caused X-inactivation of this abnormal ring chromosome leading to mild phenotype in our patient but with atypical features present in the form of horseshoe kidney and short fourth toe.
Sperm Quality Parameters and Oxidative Stress
Authors: Khan Imtiaza
Published: September 2022

Background:

Assessment of male fertility needs evaluation of sperm quality parameters, namely sperm count, viability, motility and morphology.

Aims:

The present study aimed to analyse and correlate oxidative stress with sperm quality parameters.

Settings and Design:

The male Wistar albino rats, weighing between 100 and 150 g, were employed in the present study under the Committee for the Purpose of Control and Supervision of Experiments on Animals guidelines with ethical clearance from the Institutional Ethical Committee. These rats were categorised into four groups with six rats in each as control and test animals.

Materials and Methods:

Young male Wistar albino rats, weighing between 100 and 150 g, were divided into four groups of six rats each. The first group of rats served as control (n = 6) and was maintained under normal laboratory condition and was provided with clean drinking water, whereas rats in the second (n = 6), third (n = 6) and fourth (n = 6) groups were orally intubated with sodium fluoride of 100 ppm, 200 ppm and 300 ppm, respectively, for 40 days.

Statistical Analysis Used:

After the treatment period of 40 days, animals were sacrificed and alterations in sperm quality parameters were analysed by complete randomised design SAS 9.4 and Statistical Package for the Social Sciences (SPSS) IBM 17 and judged significant if P < 0.05.

Results:

In the experiment, a negative correlation emerged between sperm motility, viability, count versus malondialdehyde (MDA) levels, whereas the level of MDA has a positive correlation with sperm abnormalities. Sperm motility, viability and count were positively correlated with activities of superoxide dismutase and catalase, whereas decreased activities of antioxidants were related to increased sperm morphological abnormalities.

Conclusion:

These results suggest that MDA causes a decline in sperm motility, count and viability and an increase in morphological abnormalities via oxidative damage of membrane lipids.
E-Z Point
Authors: Shukr Ghadear , Gonte Madeleine R. , Webber Victoria E. , Zwain Omar , Eisenstein David
Published: September 2022

Background:

Over half of all fatal complications occur during primary laparoscopic entry. In our practice, we developed a novel modification of closed LUQ entry at Palmer's point and designated it “E-Z” entry.

Aims:

To evaluate the risks and safety of left subcostal entry, a technique we have designated ’E-Z’ entry at our institution.

Settings and Design:

A retrospective chart review was conducted at a tertiary care medical centre of patients who underwent laparoscopic procedures by a single surgeon known to perform left subcostal entry for the last 10 years, using the E-Z entry technique.

Materials and Methods:

Retrospective chart review and description of surgical technique.

Statistical Analysis Used:

Simple descriptive statistics and univariate two-group comparisons.

Results:

One hundred ninety-eight laparoscopic cases were identified as performed by a single surgeon in the last 10 years: 149 underwent umbilical entry and 49 underwent E-Z entry. The average number of previous abdominal surgeries was higher in the E-Z entry group compared to the umbilical group, 1.3 versus 0.5, respectively (P = 0.003). The umbilical entry group had no complications. One complication was noted with the E-Z entry technique, in which the Veress needle was noted to perforate the liver capsule but was managed expectantly.

Conclusion:

We propose the E-Z entry technique for Veress needle entry as an ergonomic and easily reproducible entry technique in the left upper quadrant in the setting of suspected intraperitoneal adhesions.
Effect of Reproductive and Lifestyle Factors on Anti-Mullerian Hormone Levels in Women of Indian Origin
Authors: Banerjee Kaberi , Thind Amardeep , Bhatnagar Nisha , Singla Bhavana , Agria Kiran , Bajaj Payal , Jindal Anshu , Arora Sunita , Goyal Poonam , Mittal Bhavana , Malhotra Keshav , Pai Hrishikesh , Malhotra Jaideep , Goel Pallaavi , Jindal Nikita
Published: September 2022

Background:

Infertility is a world-wide problem and one third females. Over the years, anti-mullerian hormone (AMH) has emerged as a major marker of ovarian reserve. There is also increasing interest in determining the factors which can impact AMH levels.

Aims:

To correlate the association of reproductive and lifestyle factors on AMH levels in women of Indian origin.

Settings and Design:

Multicentric cross sectional study.

Materials and Methods:

The study was conducted using data extracted from the patient records of seven private fertility practices located in North India. Women who were attending these clinics for fertility treatment were requested to fill the questionnaire related to reproductive and lifestyle factors.

Statistical Analysis used:

Our outcome variable was level of AMH measured in the past 3 months, and was assessed as normal or low. All analyses were conducted using STATA 17.

Results:

We found a direct association of low AMH with increasing age, short cycles, amenorrhea and women with family history of premature menopause. We found a direct correlation of high AMH and women with polycystic ovary syndrome and those whose partners had Oligoasthenoteratozoospermia (OATS) or azoospermia. There was no correlation with smoking, sleep, diet, body mass index, cell phone or laptop use in our study.

Conclusion:

Reproductive and lifestyle factors may affect ovarian reserve and but there was a dearth of human studies in this area. To the best of our knowledge this is the first human study on the effect of AMH on Laptop and Cell phone use. We urgently need more studies to confirm or refute our findings so that we can counsel our patients well.
Perspectives of Lavana in Charaka samhita
Authors: Prabhakar Archana , Ruknuddin Galib , Prajapati Pradeep K.
Published: September 2022

Salt plays an important role in maintaining normal physiology of the human body health. Salts are referred as Lavana in Ayurveda that are vital ingredients in food and in medicine as well. Traditionally, Ayurveda classics distinguish several varieties of Lavanas. Specific salts have been described along with respective properties and actions. Charaka samhita, a familiar text for medical treatment, has advocated varieties of Lavanas and their applications in multiple pathological conditions. However, the information is found scattered across the classical texts. The current review is an attempt to screen this classical treatise and to compile information pertaining to utilization of various Lavanas for medicinal and other purposes referred. Screening through the classic revealed description of about 16 different Lavanas and about 250 compound formulations with salt as a component, inferring that different types of salts have specific action on health and/or disease. Judicious consumption of Lavana is repeatedly advised, and it is said that Lavanas produce good results when used properly (aapaatbhdra prayogasamsaadgunyaat), whereas injudicious use may cause exacerbation of various doshas leading to the manifestation of diseases. Though an important component of life cycle, salts are to be used in limited quantities judiciously.
Non-invasive management of suppurative skin nodule (metastatic cutaneous abscess)
Authors: Reetu  , Kajaria Divya
Published: September 2022

The paradigm of cutaneous adverse drug reactions (CADRs) due to the resurgence of Dushi-visha (~cumulative poison) is less reported. Clinical evidence of Dushi-visha is not commonly diagnosed in the clinics. This is the era of polypharmacy; the long duration of medication along with a multi-therapeutic approach causes drug intolerance and complicates with reduced assimilation. Improper elimination causes an increased concentration of these medicines in the plasma and produces toxic side effects. These cumulative endotoxins are termed as Dushi-visha in Ayurveda. A 60-year-old male diagnosed with abdominal tuberculosis had undergone anti-tubercular treatment and suffered from pyogenic abscess over back, and rectal area, around the umbilical area. Pus culture isolated coagulase-negative Staphylococcus. In due course of time, the patient took treatment but abscess continued to develop over different parts of the body. This is a suspected case of tuberculous gumma based on clinical presentation and history of the disease, and according to Ayurveda, this is a case of Dushi-visha. The classical treatment of an abscess is focussed on incision and drainage, but this case was handled with Vishaghna chikitsa (~anti-toxin treatment) and other potential treatments considering the resurgence of Dushi-visha without any surgical intervention. Many conditions, which generally seem idiopathic due to lack of proper history, may be due to reactivation of Dushi-visha. This case report opens up the way to clinically identify and potentially treat the condition with Ayurveda.
Ayurved management of a case of intensive Dadru (dermatophytosis)—A case report
Authors: Lakkawar Medha C. , Gaikwad Pratima R. , More Anand B. , Rai Shalini
Published: September 2022

Introduction:

Dermatophytosis (tinea) infections are superficial fungal diseases caused by dermatophytes, a fungus genus that penetrates and grows in dead keratin leading to reddish-colored erythematous cutaneous eruptions in circular lesions presenting with itching. If neglected, fungal infections are more likely to come back and can cause the emergence of more severe conditions. Relapses and recurrences demonstrate that the pathogenic organism is not simply eradicated, demanding more research to create new therapeutic options. Numerous medications used in Ayurveda are thought to have the Krimighna effect, which can result in a more effective course of therapy. Dermatophytosis can be simulated with Dadru Kushtha because the clinical characteristics of the disease are more closely related to those of dermatophytosis.

Materials and Methods:

This case report documents the case of a 37-year-old female patient with complaints of red circular patches and elevated edges over genitals, groin, flanks, axilla, and forehead regions with severe itching diagnosed with Dadru Kushtha. The case was intervened with Ayurvedic Shaman (pacifying therapy) and Bahirparimarjana chikitsa (external therapy).

Result:

A significant reduction was observed in Kandu, Daha, Raga, number and size of Mandala, and Pidaka after treatment and after follow-up.

Conclusion:

Dermatophytosis can be successfully treated with Ayurvedic oral and topical treatments, dietary and lifestyle limitations, and personal hygiene.
0.9% Sodium Chloride Versus Dextrose 5% in Water Safety as Medication's Diluents in Critically Ill Patients
Authors: Alsohimi Samiah , Almagthali Alaa Ghazi , Eljaaly Khalid , Korayem Ghazwa B. , Sulaiman Khalid Al , Aljuhani Ohoud
Published: September 2022

Adverse drug effects such as electrolyte abnormalities and acid-base disturbances are commonly associated with intravenous (IV) fluids administered in the intensive care units (ICUs). Although several studies have addressed the risk associated with resuscitative fluids in ICU patients, limited data evaluating the safety of IV medications diluents and their association with clinical outcomes in critical care settings. We conducted a systematic review and meta-analysis to compare the safety of 0.9% sodium chloride (0.9% NaCl) and dextrose 5% in water (D5W) as drug diluents in ICU settings. We searched PubMed, MEDLINE, Cochrane Library bibliographic databases, and conference abstracts for studies comparing medication diluents in adult critically ill patients. Our primary outcome was the risk of hypernatremia. The secondary outcomes included hyperchloremia, acute kidney injury (AKI) rate, ICU length of stay (LOS), ICU mortality, and hospital mortality. Three observational studies were included (1549 patients), all received 0.9% NaCl as standard diluents and D5W was the comparison. Our results shows that hypernatremia and hyperchloremia were significantly higher in 0.9% NaCl group (risk ratio [RR], 1.84; 95% confidence interval [CI], 1.38–2.47; P ≤ 0.001; I = 0%), (RR, 1.78; 95% CI, 1.38–2.31; P < 0.001, I
2 = 0%), respectively. There was no significant difference in AKI risk, hyperglycemia, and hospital mortality between the groups. However, the 0.9% NaCl group has a longer ICU LOS (mean difference 0·407, 0·062–0·752; P = 0.021). The utilization of D5W as medication diluent in critical care settings was associated with a lower incidence of hypernatremia and hyperchloremia, In addition, may be associated with shorter ICU LOS.
Advanced Medical Directives or Written Living Wills Among Saudi Intensive Care Units, Current Practice and Need to Optimization
Authors: Alsayed Eyad Fareed , Tayeb Baraa O , Boker Abdulaziz
Published: September 2022

Background:

Ethical dilemmas are mostly developed in critically ill patients near the end of life. The point where the treating physician decides to withhold the intensive medical support represents a daily challenge on the current intensive care medicine. Considering patients' wishes in near-death events and their vision, through writing an advance medical directive (also known as Living Will), was introduced early in the developed western countries. On the other hand, it is not easy to talk about near-death events in many other regions of the world, mainly because of cultural and religious differences.

Objectives:

The study aimed to explore the current practice regarding near-death events in one of the Middle Eastern countries, particularly in Saudi Arabia. The main objectives of this study were measuring the involvement of patient's wishes in near-death medical decisions and analyzing the need and usefulness of encouraging the practice of writing advance medical directives in this demographic area.

Methods:

The data were obtained from a group of Saudi intensivists, who are dealing the most among other groups of physicians with near-death events, almost daily. They were affiliated with ten hospitals or intensive care units in Saudi Arabia. Data were collected during the period from March 2018 to July 2018. It was done based on participants' knowledge. Due to the low response rate, data were analyzed using descriptive statistics only.

Results:

A total of 51 physicians working in different intensive medical care units had responded to our survey. About 88% of them were male, 47% aged between 31 and 40 years of age; with different levels of experience (45% were residents, 35% worked as a senior registrars and 20% were consultants' intensivists). Although in Saudi Arabia, a (living will) be not considered legal writing, 31.35% of the respondents had seen many cases where patients openly discussed their near-death wishes with the family members. From the respondents, 84.31% believed that a living will tend to help in their decision-making, and 92.16% considered living wills helpful in making the final call regarding withholding/withdrawing the treatment. According to 72.55% of them, the presence of living wills would help in decreasing the near-death anxiety and depression among family members of a deceased patient and tend to help ease out the situation as they consider it as a final wish of the patient.

Conclusion:

It is concluded that the patient's wishes are essential in making an end-of-life decision; they should be represented by the patient and should also be respected by the clinical staff. However, more studies needed to explore the willingness of the general population in this culture to express their wishes and the best method to elicit these wishes should be sought, with respect to the cultural and religious beliefs and differences.
Thoracoscopy and Fluoroscopy Assisted Broviac Central Line Insertion Utilizing Bedside Echocardiogram to Prevent Cardiac Tamponade
Authors: Aboo Muhammed Nishil , Al-Hasani Mohammed , Zahraa Jihad , Al-Jubab Abdulwahab
Published: September 2022

Prolonged and multiple requirements of central venous catheters in some patients gradually make access to the central vein problematic due to possible formation of obstructive thrombi. Here, we describe a case of chronic intestinal failure and difficult access of central vein, where cardiac tamponade (CT) developed even after thoracoscopy and fluoroscopy-guided insertion of a Broviac catheter. This report points out the importance of a postprocedural echocardiogram after central venous line placement in difficult cases to detect fatal complications such as CT.
Remote Programming of Cochlear Implants
Authors: Aljazeeri Isra , Saleh Shaza , Alkahtani Maram , Almuhawas Fida , Abdelsamad Yassin , Hagr Abdulrahman
Published: September 2022

Objectives:

This work aimed to study the feasibility and stakeholders' satisfaction with remote programming (RP) of cochlear implants.

Materials and Methods:

This prospective study was conducted in a tertiary referral ear specialist center. The audiological and speech outcomes of the patients were measured. The satisfaction of all stakeholders, including remote experts (REs), local hosts (LHs), and patients/families, was evaluated through detailed questionnaires.

Results:

Twenty-two RP sessions for 15 patients were included. The satisfaction levels of LH, REs, and patients/families with the RP sessions were all above 6/10, 5/10, and 7/10 Likert scale, respectively (with 10/10 being the most satisfied). All stakeholders would recommend RP to others. There was no statistically significant difference in the audiological outcomes including for Pure Tone Average (PTA4), speech reception threshold, and word recognition score between the session preceding RP, RP session and the session after the RP (Wilcoxon test, P value ranging from 0.06 to 0.73). Data logging after the RP session showed a higher duration of speech processor usage (mean difference 0.64 h/day, Wilcoxon test, P = 0.006).

Conclusion:

In the era of coronavirus disease 2019 pandemic, RP of confidence interval (CI) can be a safe, feasible, and satisfactory alternative to classical in-office programming sessions. Further studies and efforts should be done to make the RP an available option for CI recipients to save time and cost.
Organism Growth and Antibiotic Treatment for Patients Diagnosed with Deep Neck Space Infection in Asir Central Hospital, Saudi Arabia, 2022
Authors: Najmi Albaraa Abdullah , Alqahtani Mubarak Shaie , Najmi Ali H. , Gohal Norah M. , Al Hamoud Mohammed A. , Alqahtani Abdulrahman J. , Alzahrani Mohammed , Mubarki Musleh , Magboul Nasir A.
Published: September 2022

Background:

Deep neck infections (DNIs) are characterized by inflammation in the deep spaces and fasciae of the head and neck, with or without pus. Parapharyngeal, infratemporal, pterygomaxillary, temporal, parotid, masticator, submandibular, visceral, carotid sheath, peritonsillar-pharyngeal mucosal, retropharyngeal, danger, and prevertebral spaces are the different types of DNIs. These infections are potentially fatal, and they spread quickly, causing serious problems. Even in recent research on DNSI cases, potentially life-threatening complications have been recorded at a rate of 10%–20%.

Objective:

The objective of this study was to identify the most common organisms causing DNIs in Asir Central Hospital (ACH), Saudi Arabia in addition to identifying the most common sensitive antibiotic using to treat DNIs in ACH.

Results:

Data were retrieved from the records of 108 patients with DNIs (67.6% males, 91.7% Saudis). These included 23 patients in the pediatric group (21.3%) and 85 patients (78.7%) in the adult group. The most common sites for neck abscesses in the whole sample included the submandibular abscess (46.3%). Two types of DNIs were predominating in the pediatric group, including submandibular abscess and anterior neck abscess (30.4% for each type), while submandibular neck abscess was the most common type in the adult group (50.6%). Regarding the previous onset of a recent infection, a total of 67 infections were reported in 63 patients. Upper respiratory tract infections represented the majority of infectious conditions (77.6%) followed by dental infections (22.4%). Among the whole sample, the most commonly isolated pathogen was Staphylococcus species (n = 14, 13.0%), of which 12 Staphylococcus aureus isolates were detected. The 25 isolates with positive cultural growth had undergone culture sensitivity analysis; these showed sensitivity to 89 antibiotics. Bacterial isolates were predominantly sensitive to vancomycin (n = 16, 18.0%), linezolid (n = 14, 15.7%), and ciprofloxacin (n = 13, 14.6%).

Conclusion:

DNIs in children feature different characteristics from those in adults regarding severity and preceding illness. However, the causative microorganisms and antibiotics sensitivity were similar. S. aureus and vancomycin were the most common bacteria and sensitive antibiotic, respectively.