bluuebunny/crossref_metadata_2025 huggingface dataset:
Correlation between diaphragmatic function and skeletal muscle mass in chronic obstructive pulmonary disease
Authors: Saeed Adel M , AbdelFattah Eman B , Mahmoud Mahmoud M , Farouq Bahaa A
Published: January 2024

Background

Skeletal muscle dysfunction occurs in patients with chronic obstructive pulmonary disease and influences both respiratory and nonrespiratory muscles. This is a very important comorbidity leading to a poor prognosis, including increased mortality and hospitalization. It is the result of a complex combination of functional, metabolic, and anatomical changes that result in suboptimal muscle performance.

Objective

To identify the correlation between change in skeletal muscle mass (SMM) and diaphragmatic thickness and excursion in chronic obstructive pulmonary disease (COPD) patients.

Patients and methods

Cross sectional study, comprising of 44 stable COPD patients underwent transthoracic ultrasound assessment of diaphragmatic thickness and excursion, SMM estimation using body sense smart scale machine, and ultrasound estimation of biceps and triceps thickness and then the results were correlated.

Results

Diaphragmatic thickness and excursion had significant positive correlations with corresponding SMM, biceps thickness and triceps thickness as well as significant negative correlation with smoking pack/years and number of exacerbations in the last year.

Conclusions

Low SMM is a relevant comorbidity in COPD patients and associated with affected diaphragmatic function as regard thickness and excursion. High Smoking pack/years and high number of exacerbations are significant independent factors that decrease diaphragmatic thickness and excursion, and increased the likelihood of having low SMM. Change in SMM and diaphragmatic function negatively affect the health status represented in the number of exacerbations in the last year.
Silent zone detection in asthma and its relation to T2 inflammation
Authors: Samaha Hala , Elhassan Dalia , Tayeb Afnan
Published: January 2024

Objective

Study objectives are to detect small airways disease in asthma and to study T2 inflammatory markers (eosinophil count, IgE, phenotyping) in association with small airways disease.

Methods and patients

The retrospective study at OPC at Al Qassimi Hospital of EHS included 83 patients with confirmed asthma diagnosis. Based on their ACT scores, patients were divided into two groups. An assessment of demographic data, blood eosinophils, fractional exhaled nitric oxide, IgE, PFE25-75, FEV1%, R5-20, X5 and AX was carried out. Analyzing and collecting data.

Results

In this study, a significant correlation was found between the R5-20, X5, and AX values of the small airway and the asthma control test. Uncontrolled asthmatics had a higher fractional exhaled nitric oxide level and blood eosinophilic count.

Conclusion

In asthma management, small airways clinical impact should be investigated actively. Impulse oscillometry is an excellent marker for asthma control.
New challenge in double-bore medical thoracoscopy in Fayoum University Hospital
Authors: Ahmed Mona I , El Hefny Radwa A , Farhat Enas S
Published: January 2024

Background

Thoracoscopy is an invasive technique. When other, less intrusive techniques are ineffective at providing a diagnosis in the case of pleural exudates, thoracoscopy should be employed. The diagnostic and therapeutic thoracoscopy methods used by the pulmonologist are divided into two techniques. In the first technique, a single entry site of a thoracoscope together with a working channel for supplementary tools and optical forceps for biopsy is often created. The alternative method employs two entrance points: one is for the examination telescope and the other is for accessory instruments, including the biopsy forceps.

Aim

The aim of this study is to assess the effect of the use of optical rigid bronchoscopy forceps using one entry site instead of two entry sites in double bore medical thoracoscopy.

Results

Thirty patients with undiagnosed pleural effusion underwent medical thoracoscopy by single entry site (procedure A) using optical rigid bronchoscopy forceps and another 30 patients undergone medical thoracoscopy with two entry sites (procedure B). all patients were subjected to history, examination, computed tomography (CT) of chest, ultrasound examination, laboratory tests. The two groups were matched regarding age, sex, smoking, and co morbidities. There were matched regarding radiology, thoracoscopic picture, and pathological diagnosis with same outcomes. The procedure A was short in duration with less postprocedure complications compared with procedure B.

Conclusion

The use of optical rigid bronchoscopy forceps in medical thoracoscopy as a single entry site is valuable in decreasing procedure duration and postprocedure complications in comparison with two entry sites in medical thoracoscopy.
Evaluation of exercise capacity in chronic obstructive pulmonary disease patients with pulmonary hypertension
Authors: Mohamed Ashraf Z E-A , Shaaban Lamiaa H , Abdalah Amira E E-d , Tohamy Ali , Khaleel Waleed G E
Published: January 2024

Background

Chronic obstructive pulmonary disease (COPD) is ordinarily associated with social and economic burden. Pulmonary hypertension attributed to COPD varies greatly among studies; and accounts for worse quality of life and hence increased morbidity and mortality.

Aim

This study aimed to evaluate impact of pulmonary hypertension on exercise capacity, and possible predictors for exercise intolerance among COPD patients.

Methods

Patients suffering from COPD (73 patients) were grouped according to echocardiographic assessment for the presence of pulmonary hypertension into two groups. The assessment included full clinical history, mMRC dyspnea scale, COPD assessment test, arterial blood gases before and after exercise testing, and assessment of resting pulmonary function test. Also transthoracic echocardiography, cardiopulmonary exercise testing (CPET) using incremental treadmill exercises protocol was done for all participants.

Results

A total of 39 (53.4%) COPD patients have pulmonary hypertension. COPD patients with pulmonary hypertension had significantly lower parameters of pulmonary function tests either pre or postbronchodilator; significantly lower pH, PaO2 and SaO2 either before or after CPET. It was found that all parameters of metabolic response during exercise were significantly lower among COPD-PH patients (P<0.001). Pulmonary artery systolic pressure (PASP) showed significant negative correlations with peak VO2 (r=−0.514, P<0.001), VO2/kg (r=−0.443, P<0.001), oxygen pulse (% predicted) (r=−0.459, P<0.001), oxygen saturation post exercise (r=−0.427, P<0.001). Also PASP showed significant positive correlation with VE/VO2 (at peak) (r=0.374, P=0.001), VE/VCO2 (at peak) (r=0.609, P<0.001). Predictors of poor exercise capacity among COPD patients included in the study were COPD-PH group (OR=8.84, 95%CI= 1.79–43.65), PASP (OR=1.11, 95% CI=1.02–1.15), forced expiratory volume (FEV1)% (OR=0.89, 95% CI=0.84–0.95) and mMRC (OR=3.10, 95% CI=1.13–8.47), CAT assessment (OR=1.37, 95% CI=1.14–1.65), MVV L/min (OR=0.91, 95% CI=0.86–0.96) and mean PAP (OR=1.16, 95% CI=1.11–1.29).

Conclusion

Pulmonary hypertension in patients with COPD is negatively correlated with exercise capacity, specifically peak VO2 percent predicted. Furthermore, pulmonary hypertension had a significant impact on gas exchange. Assessment of pulmonary hypertension using echocardiography among COPD patients is a valuable tool for predicting exercise impairment.
Ayurvedic Management of Paripluta Yonivyapad (Pelvic Inflammatory Disease)-A Case Report
Authors: Pandya Matangee , Donga Shilpa , Cholera Meera
Published: January 2024

Pelvic inflammatory disease (PID) is a polymicrobial upper genital tract infection and having common complaint among reproductive age women. In Ayurveda, the disease is correlated with Paripluta Yonivyapad. A 32-year-old female was diagnosed with Paripluta Yonivyapad (PID), with the main symptom being profuse purulent per vaginal discharge with foul smell, fever, pelvic pain, and dyspareunia. Pseudomonas aeruginosa was present in her vaginal smear. Fluid in Pouch of Douglas and a prominent pelvic vein was present in (~ultrasonography [USG]). C-reactive protein (quantitative) was elevated in her biochemical examination. The patient was treated with Punarnavadi guggulu orally and Panchavalkaladi taila yonipichu (~medicated vaginal tampoon) for 2 months. Bimanual examination, the microbiological, and biochemical outcomes were measured before and after treatment. Adopted treatment plan has given favorable result with the absence of microorganism in vaginal smear, normal pelvic USG, and biochemical investigation. The present case signifies the fruitful outcome of Ayurvedic treatment in PIDs.
Comparison of Tuttha Bhasma Prepared by Two Different Methods: A Pharmaceutico-analytical Study
Authors: Ranade Manjiri Anil
Published: January 2024

Introduction:

This research study focuses on the standardization and chemical characterization of Tuttha Bhasma, an essential component of Ayurvedic medicine. Tuttha, a mineral substance, is utilized for its therapeutic properties but requires purification before use to prevent adverse effects. The study aims to standardize two distinct preparation methods (Method A and Method B) for Tuttha Bhasma following traditional procedures and assess their chemical properties for potential therapeutic efficacy.

Materials and Methods:

Raw materials including Tuttha, Nimbu, Lakucha, Shodhit Gandhaka, and Shodhit Tankana were procured and used in the preparation processes. The study involved Nirmalikarana (cleansing), Tuttha Shodhana (purification), and Tuttha Marana (incineration) through both methods. Organoleptic tests and Bhasma Pariksha tests were conducted alongside modern atomic absorption spectroscopy to analyze Tuttha Bhasma’s physical characteristics and chemical composition.

Results:

Tuttha Bhasma prepared using both methods and passed classical Ayurvedic tests, indicating successful preparation. Analysis revealed substantial changes in chemical composition during Tuttha Bhasma preparation. Method A exhibited a significant increase in copper content (65.85%) while Method B displayed elevated copper (67.23%), sulfur (8.51%), and iron (1.76%) levels. Method B’s Tuttha Bhasma exhibited higher proportions of macro- and microminerals.

Conclusion:

The study successfully standardizes Tuttha Bhasma preparation methods and characterizes their chemical properties. Both methods yield Bhasma conforming to classical Ayurvedic tests, indicating their potential efficacy. Method B, involving Gandhaka and Tankana for Marana, results in Tuttha Bhasma with enhanced mineral content, suggesting greater therapeutic potential. These findings contribute to the advancement of Ayurvedic medicine, offering standardized Tuttha Bhasma preparation methods and insights into its chemical composition for future therapeutic exploration.
Exploring the anticancer potential of Eleutherine bulbosa: A systematic network pharmacology study on lung cancer
Authors: Mutiah Roihatul , Rachmawati Ermin
Published: January 2024

ABSTRACT

Chemotherapy application in lung cancer patients has several side effects and shows lower effectiveness due to chemoresistance. Although Eleutherine bulbosa (Mill.) Urb. (EBE) elicit anticancer properties, yet the exact profile of its active compounds and lung cancer inhibition mechanisms were not fully understood. This study aimed to identify suggestive compounds from EBE extract and explain the molecular mechanisms of EBE against lung cancer. Identification of the compound from the EBE extract was confirmed using liquid chromatography–tandem mass spectrophotometry (LC–MS/MS). The bioavailability profile of three major metabolites was identified using absorption, distribution, metabolism, excretion, toxicity software. The anticancer molecular mechanism prediction of the drugs was ascertained by network pharmacology using Cytoscape 3.9.1 and the protein–protein interaction network technique with STRING 11.0. Interaction between resveratrol and extracellular growth factor receptor (EGFR) was analyzed using site-specific molecular docking with erlotinib as the control using PyRx Autodock Vina 9.0 and BIOVIA Discovery Studio. A total of 16 active compounds were identified from LC-MS/MS. Only resveratrol showed anticancer properties by its interaction with 13 genes and 6 signaling pathways related to lung cancer. The molecular docking result supports the network pharmacology finding. The binding affinity of resveratrol with EGFR, important receptor in lung cancer, was more negative (−6.9 kcal/mol) than erlotinib (−6.2 kcal/mol) as the control. Evidence suggested that resveratrol in EBE exhibits anticancer effects by modulating lung cancer cell proliferation and apoptosis through EGFR binding.
Garcinia dulcis and Garcinia forbesii King fruit peel extract: Secondary metabolite composition, antioxidant, and elastase inhibitory activity evaluation
Authors: Ambarwati Neneng Siti Silfi , Sukma Nurnisya Tiara , Desmiaty Yesi , Auliya Annisa , Budi Setia , Arifuddin M. , Ahmad Islamudin
Published: January 2024

ABSTRACT

Garcinia dulcis and Garcinia forbesii King are native plants from Indonesia and have tremendous potential as a source of raw medicines based on local wisdom. However, scientific data for strengthening pharmaceuticals are still limited. Therefore, it is necessary to conduct a study to strengthen and develop the potential of both plants using the approach of traditional medicine. This study aimed to explore the secondary metabolite composition and biological activity (antioxidant and antielastase) of both plants. Both samples were extracted using 70% ethanol and microwave-assisted extraction with a microwave power of 120 watts for 15 min. The extract obtained was then screened for phytochemicals using specific reagents. The total phenolic content (TPC) was determined using spectrophotometry with a 96-well microplate reader method. The total flavonoid content (TFC) was determined using the colorimetric method, whereas metabolite profiling analysis was conducted using the UPLC-QToF-MS/MS system. Meanwhile, biological activity was tested for antioxidant activity and antielastase as measured by a microplate reader 96-well spectrophotometry method at specific wavelengths. According to the results, G. dulcis and G. forbesii fruit peel extracts showed positive detection of particular secondary metabolites. TPC and TFC values were 13.98 ± 1.90 mg GAE/g and 10.33 ± 1.90 mg QE/g for G. dulcis and 11.98 ± 2.04 mgGAE/g and 1.96 ± 0.36 mgQE/g for G. forbesii. Metabolite profiling detected some compounds from G. dulcis, including ephedrannin B, hinokiflavone, mahuannin J, and candidate mass C9H12O8, and G. forbesii, including 5-Hydroxy-7,8,2’- trimethoxyflavone, lucialdehyde B, candidate mass C21H39NO4, candidate mass C14H10O6, and candidate mass C14H12O6. Meanwhile, the biological activities (antioxidant and antielastase) were 137.721 μg/mL and 108.893 μg/mL for G. dulcis and 481.948 μg/mL and 250.611 μg/mL for G. forbesii, respectively. Both plants showed different profiles of secondary metabolites and biological activities (antioxidant and antielastase) according to their respective characteristics.
Stability study and development of the validated infrared spectrometric method for quantitative analysis of sevoflurane compared with the gas chromatographic method
Authors: Hasson Kahtan Jassim
Published: January 2024

ABSTRACT

Sevoflurane, also called fluoromethyl ether, is an inhalation anesthetic agent used to initiate and maintain general anesthesia for adults and pediatric patients during surgical procedures. Several analytical methods have previously been applied to follow the properties and quality of sevoflurane, including mass spectrometry and gas chromatography methods. These methods are practically tedious and need sophisticated apparatus. In the present work, an attenuated total reflectance–Fourier transform infrared (ATR-FTIR) spectrometric method was used for the quantitative determination of sevoflurane which is characterized as a fast, accurate, and available technique for most pharmaceutical laboratories, besides the gas chromatographic method which is the most suitable for the detection of impurities. Sevoflurane is a liquid and it is applied directly on the glass top of the ATR-FTIR either as a concentrated solution or diluted with hexane as a diluent, which did not interfere with sample determination within the specified wavelength range of the IR spectrum, particularly the wavelength of the ethereal group at 1200 cm−1. This method can be applied to the identification test and quantitative assay of sevoflurane since it is validated for the precision, accuracy, reproducibility, and specificity in the analysis of sevoflurane as a pharmaceutical product. However, still, there is a need for a gas chromatographic method to detect the impurities and degradation products during the stability study of sevoflurane.
Effectiveness of Aculief acupressure device on pain perception during local anesthesia in children: A double-blinded study
Authors: Pushpasanthy M. , Ephraim Rena , Ayilliath Ambili , Dhanya K. B.
Published: January 2024

Aim:

The aim of this study was to evaluate the effect of the Aculief acupressure device on the reduction of pain during local anesthesia (LA) in children and to compare it with the cryotherapy technique.

Methodology:

20 children of age group between 6 and 9 years, requiring pulpectomy or extraction bilaterally were chosen for the study. After ethical clearance and parental consent, children who were not experienced to prior local anesthesia were chosen for the study. A split-mouth study design was done to avoid bias, and children were divided into two groups. During the first visit cryotherapy application was done on any one side followed by the LA, and during the second visit Aculief acupressure application was done, which was followed by the LA. The objective and subjective evaluation of pain during the LA was carried out and analyzed.

Results:

The objective perception of pain was evaluated using the Sound-Eye-Motor Scale by an observer who was blinded, and the subjective perception of pain by the Wong–Baker Faces Pain Rating Scale was evaluated by the child patient. The statistical analysis and comparison of values were done using the Wilcoxon signed-rank test. The pain during administration of LA was eliminated after the application of the Aculief acupressure device, and the results were superior to the cryotherapy technique.

Conclusion:

The Aculief acupressure device can be effectively used to eliminate pain perception while administering LA in children. It is a simple, safe, noninvasive, and effective device and is easy to perform.
Anesthetic efficacy of 4% articaine versus 2% lignocaine in root canal treatment of teeth with molar incisor hypomineralization
Authors: Thomas Ann Mary , George Sajeena , Anandaraj S.
Published: January 2024

Context:

Inferior alveolar nerve block (IANB) is considered the cornerstone in achieving anesthesia for mandibular molars. However, failure of routine lignocaine IANB to achieve profound anesthesia of the pulp has been reported in patients with molar incisor hypomineralization (MIH). Articaine 4% with epinephrine 1:100,000 has proven to provide total pain relief during most dental procedures.

Aims:

This study aimed to assess and compare the pain perception level in children using Visual Analog Scale (VAS) during root canal treatment after administering 4% articaine buccal infiltration (BI), 4% articaine IANB, and 2% lignocaine IANB.

Subjects and Methods:

Twenty-seven children aged 8–12 years, requiring root canal treatment of mandibular first permanent molars with MIH were randomly allocated into three groups - 4% articaine (1:100,000 epinephrine) BI, 4% articaine (1:100,000 epinephrine) IANB, and 2% lignocaine IANB. The efficacy of the anesthetic was determined by rating the pain perception of the child using a VAS.

Statistical Analysis Used:

The scores marked by the children on the VAS were recorded and were statistically analyzed. Data were entered into Microsoft excel data sheet and were analyzed using SPSS for Windows version 17.0.

Results:

Patients anesthetized with 4% articaine IANB presented lesser pain scores compared to IANB with 2% lidocaine and 4% articaine BI on access opening and instrumentation of the root canals.

Conclusion:

4% articaine IANB has better anesthetic efficacy than 4% articaine BI and 2% lignocaine IANB in anesthetising mandibular first permanent molars with MIH.
A comparative evaluation of the fluoride content in commercially available infant formulae in India: An in vitro study
Authors: Satti Asha Supriya , Muppa Radhika , Kotha Ravichandra Sekhar , Koya Srikanth , Kantipudi Mrudhula J. N. , Harika Ch Deepthi Siva
Published: January 2024

Context:

The most critical period for enamel fluorosis to develop is during the early years of life when enamel formation occurs. To minimize the risk of dental fluorosis development, monitoring fluoride intake during teeth development has been suggested. As infant formulae are major source of nutrition in infants, it is important to determine the fluoride content in them in order to monitor the fluoride intake in infants.

Aims:

To estimate and comparatively evaluate the fluoride content in different commercially available infant formulae in India.

Methodology:

A total of 16 commercially available infant formulae were collected from local pharma/grocery stores, in which 14 were milk based (Group M) and 2 were soy based (Group S). Fluoride content of the formulae was evaluated using ORION F selective electrode.

Statistical Analysis Used:

ANOVA test, t-test.

Results:

The mean F values for groups M and S were found to be 0.031 and 0.07 ppm, respectively. Fluoride content of milk-based formulae was significantly lesser (P < 0.001) than soy-based formulae. Daily fluoride intake through the tested formulae was in the range of 0.013 mg and 0.105 mg when calculated following the manufacturer’s preparation guidelines.

Conclusions:

Infant formulae alone were unlikely to be a risk factor for dental fluorosis, but when reconstituted with optimally fluoridated water, they can be a risk factor for the development of dental fluorosis.
Evaluation of dental anxiety in children with Down’s syndrome using dog-assisted therapy: A pilot study
Authors: Naik Shilpa S. , Joshi Amil , Winnier J. Jasmin , Patil Diksha D. , Gore Priya Jayant , Mali Sonal Sanjay
Published: January 2024

Background:

Dental anxiety and fear are the major treatment challenges faced by pediatric dentists. Oral hygiene in children with Down’s syndrome is highly compromised in comparison to their healthy counterparts. Animal-assisted therapy, through dogs, has been beneficial in alleviating dental fear and anxiety in healthy pediatric population.

Aim:

The aim of the study was to assess the impact of dog-assisted therapy (DAT) on children with Down’s syndrome undergoing dental examination and fluoride varnish application in dental operatory.

Materials and Methods:

Twenty children with Down’s syndrome between 5 and 12 years of age were selected. Group A (intervention group): DAT was carried out in the dental operatory. Group B (control group): Dental treatment was performed in the absence of a therapy dog in the dental operatory. Anxiety levels were evaluated by recording the pulse rate and revised modified faces version of the Modified Child Dental Anxiety Scale (MCDAS[f]).

Statistical Analysis:

The intergroup comparison of pulse rate was done using an unpaired t-test, whereas the variation in intragroup pulse rate was analyzed using the Analysis of Variance test. The anxiety scores were subjected to a paired t-test for intragroup comparison with P < 0.05 considered to be statistically significant.

Results:

Reduction in dental anxiety was observed in the intervention group (P < 0.001).

Conclusion:

DAT can be used as an effective behavior management technique for children with Down’s syndrome undergoing dental examination and simple dental procedures in the dental operatory.
Benign Phyllodes Tumor with Extensive Cystic Squamous Metaplasia, Clinically Presenting as Malignant Phyllodes
Authors: Agrawal Mousmi , Hussain Nighat , Ramchandani Radhakrishna , Chowhan Amit Kumar
Published: January 2024

Phyllodes tumor are very rare fibroepithelial lesions which comprises 0.3%–1% of all primary breast tumors with peak age around 40–50 years. Phyllodes tumor are classified ino three types: Benign, borderline and malignant tumors. Metaplastic change is very rare in these tumors and can involve both epithelial or stromal components. Stromal metaplastic changes include cartilage, bony or fatty change. Epithelial metaplastic changes include apocrine or squamous change. About 10% of phyllodes tumor show squamous metaplasia. We report a case of 47-year-old patient presenting with large lump in right breast measuring 16 cm × 15 cm × 11 cm, occupying all four quadrants. Clinically, it appeared as malignant phyllodes. But, microscopically, it was benign phyllodes tumor having extensive cystic squamous metaplasia.
Expression of Fibroblast Activation Protein-alpha in Odontogenic Lesions – A Retrospective Immunohistochemical Study
Authors: Tamgadge Sandhya , Pereira Treville
Published: January 2024

Background:

The tumor microenvironment (TME) includes cellular and noncellular components that play important roles in tumor genesis, progression, and therapy response. While much study has been done on the TME in other types of cancer, our understanding of its involvement in odontogenic lesions is still restricted.

Materials and Methods:

The study group included total (171) odontogenic lesions, which were further divided into two categories. Odontogenic tumors (80) and (2) odontogenic cysts (91). There were 50 cases in the control group. Lymphoma was chosen as the negative control, whereas colorectal and breast carcinomas were chosen as the positive controls. All groups were immunohistochemically stained with the fibroblast activation protein (FAP)-alpha antibody. The samples from the study groups were compared to clinical parameters and statistically evaluated using the Chi-square and Kendall’s tau tests. Unpaired t-test was used to compare the final immune reactivity score (IRS) with the presence or absence of epithelium, radiographic locularity, and ramus involvement. Cronbach’s alpha was used to calculate inter-rater reliability.

Results:

The ameloblastoma tumor group and the odontogenic keratocysts in the cyst group showed a high mean IRS. When the final IRS was compared to a few clinical characteristics such as lesion extension and ramus involvement, showed statistical co-relation.

Conclusion:

With significant connections between the final IRS and a few clinical features, FAP-alpha appears to be a reliable marker for odontogenic lesions. It could be employed as a therapeutic and prognostic marker in future.
Presenting Symptoms of Colorectal Cancer in a Tertiary University Hospital in Saudi Arabia
Authors: Madkhali Abdossalam M. , Almozini Mohammed Abdullah
Published: January 2024

Background:

Colorectal cancer (CRC) is the most common cancer among Saudi males with age standardized rate (SAR) of 12.9 and 12.5/100,000 in 2016 and 2017, respectively, and the third most common cancer among Saudi females with (SAR) of 9.5 and 10.9/100,000 in 2016 and 2017, respectively.

Aim:

The aim of this study is to identify the presenting symptoms of CRC in our population and to improve our ability to diagnose it and treat it as early as possible.

Materials and Methods:

In this retrospective analysis, the medical records of all patients diagnosed with CRC in King Khalid University Hospital during 2016 and 2017 (n = 266), were reviewed.

Results:

The median age at diagnosis was 59 years (standard deviation = 13.6), 52 (22%) of those patients were younger than 50 years old, and 20 (9.9%) were younger than 40 years old. 137 (58%) of them are males. The most common presenting symptoms were abdominal pain (n = 115, 54.8%), weight loss (n = 96, 45.7%), and hematochezia (n = 88, 41.9), For more than half of the patients, bleeding per rectum was not reported, and for the majority of the patients younger than 50 years old, only (n = 24, 49%) presented with bleeding per rectum, abdominal pain (n = 32, 65.3%) and weight loss (n = 21, 42.9%). 87 patients (48%) had stage III tumor at presentation while 44 (24%) had stage IV.

Conclusion:

diagnosis of CRC should have a high index of suspicion to diagnose it at an earlier stage and have a better outcome, especially in the younger population.
Effectiveness of Team-based Learning Methodology in Improving Learning Outcomes Among 2nd-year Undergraduate Medical Students in Pathology
Authors: Amita K. , Ningappa Asharani , Kusuma K. N. , Shankar Nachiket , Umesh Soumya
Published: January 2024

Introduction:

Team-based learning (TBL) is a student-centric teaching–learning (TL) method and fosters active learning. TBL has an advantage over other small group TL methods for balancing teaching time and resources.

Aim:

The study aimed to determine the effectiveness of TBL methodology in improving learning outcomes among 2nd-year undergraduate medical students in pathology.

Settings and Design:

This was a quantitative interventional study involving 100 2nd-year MBBS students in pathology at AIMS, BG Nagara.

Methodology:

Two groups of 50 students were exposed to three TBL and case-based learning (CBL) sessions on similar topics. For the TBL session, individual readiness assurance test scores and team readiness assurance test scores were obtained.

Statistical Analysis Used:

For both the TBL and CBL sessions, retention test scores were obtained after 2 weeks and the effectiveness of two methods of learning was determined by comparing the retention test scores by independent Student’s t-test. Feedback on students’ perception of TBL was obtained using a five-point Likert scale.

Results:

The mean test score of the TBL session was significantly higher than that of CBL sessions (19.80 vs. 15.86, P < 0.0001). Similarly, it was also observed that the retention scores were higher among average performers after the TBL session (19.71 vs. 12.50, P < 0.0002).

Conclusion:

TBL is more effective than CBL in fostering learning and it selectively benefits average performers more than higher performers, evidenced in this study by better retention of knowledge.
Specific Immunological Investigation in the Management of Patients with Spine and Joint Pathology
Authors: Delevskyi Yuriy P. , Leontieva Frida S. , Morozenko Dmitriy V. , Dielievska Valentyna Yu
Published: January 2024

Objective:

The immunological investigation is used for the improvement of the quality of the treatment of various diseases. The aim of the study was to estimate the significance of specific immunological methods in the management of inflammatory diseases.

Materials and Methods:

Determination of the level of autoimmune lymphocytotoxic and granulocytotoxic antibodies (ALA and AGA) and reaction of inhibition of leukocyte migration were used for investigation of persons with orthopedic, metabolic, and lung pathology.

Results:

The study showed increased serum levels of ALA and AGA, decreased nonspecific LIF production and increased level of LIF in the presence of own serum, increased leukocyte migration to synovial membrane, bone, cartilage, Candida lusitaniae, Staphylococcus epidermidis, Staphylococcus aureus in persons with periprosthetic infection.. Decreased leukocyte migration to the antigens of S. aureus, Streptococcus pyogenes, Escherichia coli, and Pseudomonas aeruginosa and connective tissue antigens was determined in persons with inflammatory diseases of bones. Increased ALA, reduced LIF, and leukocyte migration enhancement to synovial membrane were revealed in impaired glucose metabolism. The persons with anemia were characterized by increased ALA, sensitization to bone and cartilage, Staphylococcus, and humoral sensitization to E. coli. Increased serum levels of ALA, AGA, decreased level of nonspecific LIF production and sensitization to connective tissue, Streptococcus and E. coli were determined in persons with impaired cholesterol level. Chronic obstructive pulmonary disease patients were characterized by sensitivity to S. aureus, P. aeruginosa, and humoral sensitization to the lung tissue.

Conclusions:

Inflammatory diseases are characterized by specific signs of immunological status and require definition of individual tactics of the treatment.
Deciphering the Relationship between Salivary Cortisol Levels and Hypertension Using Enzyme-linked Immunosorbent Assay – An Observational Study
Authors: Sathiyamoorthy Mounika , Divya Bose , Ramadoss Ramya , Dineshkumar Thayalan , Narayan Madhu , Vasanthi V. , Rameshkumar Annasamy , Rajkumar Krishnan
Published: January 2024

Background:

Cortisol plays a major role in stress crises and is higher among patients with hypertension. Assessment of cortisol levels can serve as a predictor for the prevention of complications of hypertension.

Aim:

The study aimed to investigate the relationship between salivary cortisol levels and hypertension.

Materials and Methods:

Twenty hypertensive individuals (Group I) and 20 control subjects (Group II) participated in the study. Their blood pressure was measured, followed by the collection of morning and evening saliva samples. Salivary cortisol levels were estimated using an enzyme-linked immunosorbent assay kit. Unpaired Student’s t-test and Pearson’s correlation coefficient were done to statistically analyze the data using SPSS statistical analysis software.

Results:

Group I had mean morning cortisol levels that were higher (0.376–0.458 g/dL) than those in Group II (0.005–0.0001 g/dL). In Group I participants, there was a positive correlation between evening cortisol levels and pulse pressure (P = 0.05).

Conclusion:

In this study, we found high cortisol levels in patients with hypertension. Increased salivary cortisol levels could be an indicator of underlying cardiovascular complications.
Microbiology and Antimicrobial Resistance Profile of Infectious Peritonitis: A Cohort Study with 10-year Follow-up
Authors: Aldriwesh Marwh Gassim , Alaqeel Raghad A. , Alangari Reem O. , Alzaben Shog A. , Albass Hessa S. , Alajroush Lama N. , Hakami Abdulrahim R.
Published: January 2024

Objectives:

Peritoneal dialysis (PD) is a feasible option for patients with renal failure, but infectious peritonitis has long been a common complication in PD. The purpose of the current study was to provide epidemiological data about the rate, microbiology profile, and antimicrobial susceptibility pattern of infectious peritonitis in adult PD patients in Saudi Arabia.

Materials and Methods:

A descriptive study was performed. Demographics and diagnostic data of adult PD patients between 2009 and 2019 were collected. The infectious peritonitis episodes were explained per patient and the microbiology profile along with antimicrobial susceptibility testing results were analyzed.

Results:

One hundred renal failure adult patients underwent PD during 2009–2019, with 55.0% were female. Ninety-three infectious peritonitis episodes were identified in 52 patients and the overall peritonitis rate was 0.56 episodes per patient-year. Gram-positive bacteria were more responsible (61.3%) for infectious peritonitis than Gram-negative bacteria (37.6%) and expressed more antimicrobial resistance patterns. Coagulase-negative Staphylococci were the most frequently isolated Gram-positive bacteria from the PD fluid culture (27.9%). Acinetobacter baumannii, followed by Pseudomonas luteola, Pseudomonas aeruginosa, and Klebsiella pneumoniae were the most common Gram-negative bacteria identified at 6.5%, 5.4%, 5.4%, and 5.4%, respectively, with susceptibility patterns detected against most of the antimicrobials tested.

Conclusions:

The overall rate of infectious peritonitis was 0.56 episodes per patient-year, which is higher than the reported target published by the International Society for PD. More intense training programs and establishment of a national infectious peritonitis registry are recommended to minimize infection risk and improve patients’ quality of life.
The Role of Predictive Models in Shaping Health-care Policies during COVID-19 Pandemics: Lessons Learned and Future Directions
Authors: Khan Anas A.
Published: January 2024

COVID-19 has substantially impacted health systems and the global economy. Moreover, it is more likely to have a detrimental influence on unstable nations than on more stable ones. All these consequences encouraged investigators to develop mathematical models to predict new cases, fatalities, and recoveries. These models allow a better understanding of the reasons and mechanisms of infection spread and preventive methods. In addition, these models help us understand the infection’s origin, mode of transmission, and the impact of national responses on these variables. On the other hand, the efficacy and accuracy of these models during the COVID-19 pandemic are questionable. This review highlights several types of predictive models for forecasting the transmission of infectious diseases. Despite the crucial role of mathematical models in understanding outbreaks, most models fail because of the misunderstanding of their assumptions or the misuse of the best model for the targeted scenario.
Outcome Analysis in Ipsilateral Proximal Femur and Shaft Fractures Treated by Intramedullary Nail and Plate Combinations: A Comparative Study
Authors: Sathappan Sivaraj , Samraj Arularasan , Palaniappan Gajapriya , Velu Madhan Kumar
Published: January 2024

Introduction:

Ipsilateral neck and shaft fractures of femur are not common. They result from high-energy trauma mechanisms, including motor vehicle traffic accidents and falls from heights. Surgical stabilization of such fractures remains a challenge. This study was planned to compare reconstruction-type intramedullary nailing and various plate combinations on the fracture healing and functional outcome in patients with these fractures.

Aim:

The aim was to study and compare the clinical, radiological, and functional outcomes of ipsilateral proximal femur and femoral shaft fractures treated by two methods nailing/plating.

Subjects and Methods:

We included 20 patients admitted from March 2020 to September 2020 to assess the clinical, radiological, and functional outcomes of ipsilateral proximal femur fractures associated with femoral shaft fractures, treated either by intramedullary nailing or by various plate combinations at the Department of Orthopaedics and Traumatology, Thiruvarur Medical College and Hospital, Thiruvarur, Tamil Nadu.

Statistical Analysis Used:

Continuous variables were summarized as mean and standard deviation, and the significance between their mean variables was analyzed using t-test.

Results:

We found that ipsilateral proximal femur and femoral shaft fractures are common in the 3rd, 4th, and 5th decades of life. There was a statistical significance in mean duration of surgery in nailing group 140.00 ± 24 compared with plating group 158.00 ± 18.7. In terms of average union time for proximal femur and femoral shaft fractures, age of the patient, delay in duration of surgery, and outcome results of both groups were similar and showed no statistical significance.

Conclusion:

Both treatment methods achieve satisfactory functional outcomes in patients with ipsilateral proximal femur and shaft fractures.
Trifid Radial Nerve Complicating a Routine Posterior Approach to Humeral Shaft
Authors: Naik Ashish Shankar , Shah Dhruv , Singh Sanjeev , Jain Deepak
Published: January 2024

The posterior approach to the humerus is one of the most common approaches used for osteosynthesis and exploration of the radial nerve. The radial nerve anomalies even though rare are a possibility that the operating surgeon should be aware of during radial nerve exploration. A 42-year-old female presented with closed shaft of humerus fracture. The plan was to expose fracture site using a routine posterior approach and fix it with a dynamic compression plate but to our surprise found a trifurcation of radial nerve in the spiral groove. We describe a rare anomaly of trifurcation of radial nerve in the spiral groove. The nerves were protected, and the fracture was reduced and fixed with a dynamic compression plate.
Malignant Lesion of Clavicle
Authors: Channappa T. S. , Shivkumar H. B. , Singh Shuvam Priyadarshi
Published: January 2024

This case is reported to increase the awareness among clinicians about the malignant lesions of the clavicle. Plasmacytoma is a rare tumor occurring in the clavicle. Here, we report a 55-year-old female who presented with swelling in her left clavicle for 2 months associated with no pain. On examination, diffuse swelling was noted over the medial end of clavicle, nontender, hard in consistency, and ill-defined margin. Radiograph of the left clavicle showed an expansile lytic lesion. Ultrasonography neck revealed an expansile lesion in the medial end of the left clavicle with matted lymph nodes. Fine-needle aspiration cytology from clavicular lump showed plasma cell in hemorrhagic background. Excision biopsy of the lesion showed sheaths of plasma cells with eccentric placed nuclei confirming the diagnosis of plasmacytoma of clavicle. Plasmacytoma of the clavicle is a rare entity; there is a need for physicians to recognize the epidemiology and radiological findings and offer the suitable treatment options.
Role of Surgical Drains in Orthopedics
Authors: Goel Aditya , Singh Shivendra , Shukla Navin K.
Published: January 2024

Introduction:

The use of drains in orthopedic practice has been affected by the concept of evidence-based medicine, which is accepted as the standard of care for all surgical or medical practices. This concept questions all care processes that cannot be backed by evidence to be beneficial to the patient. There have been a large number of multi-center meta-analytical studies that have found drains to be of little or no benefit in trauma and orthopedic surgeries. As a result of these studies, there are few situations where drains are routinely used, such as calcaneal fractures in developed countries. Even major procedures such as total knee and arthroplasties are being performed without drains. We aim to investigate whether similar evidence can be found in our practice.

Materials and Methods:

This sounds like the description of a prospective randomized controlled trial studying the use of drains in certain types of surgical procedures. The study population consisted of 86 patients matched for sex and type of injury, and they were assigned to either a group that used drains or a group that did not use drains during their operations. The study aimed to observe and compare the rates of complications, such as hematoma, drain migration, infection, and inadvertent drain stitching, between the two groups.

Results:

Eighty-six major orthopedic operations were studied. There was no evidence of the occurrence of complication arising from nonuse of drains in the undrained group. Those patients whose wounds were drained had no need for drain change, thus making the wound care less eventful.

Conclusion:

Wound drains can help reduce tissue swelling in the postoperative period, but there is no significant difference in infection rates, hematoma, or seroma formation between drained and undrained wounds.
Comparative Study of Functional and Radiological Outcome of Pertrochanteric Fracture Fixation by Proximal Femoral Nail Antirotation 2 and Old Proximal Femoral Nail
Authors: Kaushal Ashish , Anand Atul , Sethy Priyaranjan , Priyadarshi Swapnil
Published: January 2024

Context:

Pertrochanteric fractures include the fractures in the region which extend from the extracapsular basilar neck region to the region along the lesser trochanter of femur. Pertrochanteric femur fracture accounts for the most common hip fracture. Most of pertrochanteric fractures, in younger as well as in the elderly patients, are unstable and slightly or partially displaced and require operative intervention. There are different types of fixation for pertrochanteric femur fracture such as proximal femoral nail (PFN), proximal femoral nail antirotation-2 (PFNA-2), Dynamic hip screw (DHS), Dynamic condylar screw (DCS), and angled blade plate. The PFNA-2 has been introduced to reduce implant-related complications, operative time, and intraoperative blood loss, especially in elderly osteoporotic individuals. This study was done with the belief that unstable pertrochanteric fractures can be better reconstructed with PFNA-2 designed specifically for the Asian population than with PFN and thereby enhance the functional outcome.

Materials and Methods:

A total of 40 patients were selected randomly. The fracture pattern included for the study was pertrochanteric fracture of the femur. The selection was based on performed inclusion and exclusion criteria. The functional outcomes and clinical results of the patients were evaluated and graded using the Harris hip score.

Statistical Analysis Used:

Statistical package for the social sciences software version 22.0 (IBM software package) was used for statistical analysis.

Results:

In our study, there were 20 (50%) patients who were treated with PFN and 20 (50%) were treated PFN-A2. The mean age in the PFN group was 43.90 ± 16.88 years and in the PFNA-2 group was 47.80 ± 17.25 years. In the PFNA-2 group, the average time of surgery was 67.00 min, and with PFN, the average time of surgery was 90.25 min. Mean intraoperative blood loss, in the PFNA-2 group was 68.25 ± 5.20 mL and in the PFN Group, it was 86.50 ± 10.37 mL. The group with PFN-A2 had a better hip score when compared with the PFN group. The complication rates were significantly lower in the PFN-A2 group.

Conclusions:

The newer alternative PFNA-2 was found to be much better than PFN in terms of lesser surgical time, small incision resulting in lesser blood loss, lesser number of image intensifier shoots, lesser duration of surgery, and advantage of compression mechanism at fracture site and lesser chances of biomechanical failure compared to PFN.
Functional Evaluation of Long Bone Nonunion Managed by Limb Reconstruction System
Authors: Dake Sathish Kumar , Suvvari Mahesh Chandra , Kakumanu Ravi Kiran , Paka Varun Kumar
Published: January 2024

Background:

The management of infected nonunion of long bones is a demanding task for the treating surgeon. Various treatment options have been tried in the past with less than satisfactory outcome. The purpose of the study was to establish the efficacy of limb reconstruction system (LRS) in the treatment of nonunion of the tibia and the possibility of correcting any bone length discrepancy.

Materials and Methods:

A prospective cohort study was performed on 30 patients with infected nonunion of lower limb long bones, treated with LRS for 2 years between November 2018 and December 2020, in our institution. The outcome was evaluated on the basis of bone union and functional outcome using the Association for the Study and Application of the Method of Ilizarov (ASAMI) score.

Results:

According to the ASAMI score, results were excellent in 75% good in 10%, fair in 5%, and poor in 10% of patients. The average union time was 44 weeks and average fixation time was 46 weeks.

Conclusion:

LRS is a lightweight, patient-friendly device that does not interrupt patient’s day-today activities. It is useful for managing limb length discrepancies, allows early mobilization and better wound management, thus it is an effective and versatile treatment modality in infected nonunion of the tibia.