bluuebunny/crossref_metadata_2025 huggingface dataset:
Preliminary modelling of ground ice abundance in the Slave Geological Province, Northwest Territories and Nunavut
Authors: O'Neill H B , Wolfe S A , Duchesne C
Published: March 2022

New infrastructure corridors within the Slave Geological Province could provide transportation, electric, and communications links to mineral-rich areas of northern Canada, and connect southern highway systems and Arctic shipping routes. Relatively little
information on permafrost and ground ice is available compared to other regions, particularly in the north of the corridor. Improved knowledge of permafrost and ground ice conditions is required to inform planning and management of infrastructure. Work within the Geological Survey of Canada's (GSC)
GEM-GeoNorth program includes mapping periglacial terrain features, synthesizing existing permafrost and surficial data, and modelling ground ice conditions along the Yellowknife-Grays Bay corridor. Here we present initial modelling of ground ice abundance in the region using a methodology developed
for the national scale Ground ice map of Canada (GIMC), and higher resolution surficial geology mapping. The results highlight the increased estimated abundance of potentially ice-rich deposits compared to the GIMC when using more detailed surficial geology as model inputs.
Comparative Evaluation of Anesthetic Efficacy of 4% Articaine and 2% Lidocaine for Buccal Infiltration in Adult Patients with Irreversible Pulpitis of Maxillary First Molar
Authors: Syed Gufaran Ali , Mulay Sanjyot A
Published: March 2022

Objective:

The purpose of this prospective, randomized study was to evaluate and compare the anesthetic efficacy of 0.8 ml of 4% articaine and 1.6 ml of 2% lidocaine administered through buccal infiltration (submucosal) only in adult male and female patients with irreversible pulpitis of maxillary 1st molar.

Study Design:

Two hundred patients with irreversible pulpitis of the maxillary first molar were divided into four study groups and received only buccal infiltration of either 0.8 ml of 4% articaine or 1.6 ml of 2% lidocaine. Endodontic access was begun 7 min after the solution deposition. The success was defined as “no pain (0 mm)” or “weak/mild pain (>0 mm and ≤54 mm)” during access opening, and during the first file insertion till working length.

Results:

The compiled data of the number of failed cases were analyzed by two sample proportion test and of mean pain scores were analyzed by Student's unpaired t-test. P < 0.05 was taken as statistically significant. No significant difference was found in the number of failed cases on using 4% articaine and 2% lidocaine (P > 0.05). Moreover, no significant difference was found in the number of failed cases between the genders in Group I (4% articaine with 1:100,000 epinephrine) and also in Group II (2% lidocaine with 1:80,000 epinephrine). On comparing the mean pain scores of failed cases, it has been found that females experience more pain than males in Group I (not significant) and Group II (significant).

Conclusion:

The efficacy of 4% articaine with 1:100,000 epinephrine has been found to be better than 2% lidocaine with 1:80,000 epinephrine, as only 0.8 ml of 4% articaine with 1:100,000 epinephrine was effectively used as compared to 1.6 ml of 2% lidocaine with 1:80,000 epinephrine. Furthermore, females experience more pain as compared to males.
Evaluation of Platelet-Rich Fibrin Matrix as a Regenerative Material in the Surgical Management of Human Periodontal Intraosseous Defects – A Randomized Controlled Trial
Authors: Walia Komal Deep , Belludi Sphoorthi Anup , Pradhan Neha , Jain Vipin , Shaik Sharaz
Published: March 2022

Background:

Platelet-rich fibrin matrix (PRFM) has not been extensively studied as other platelet concentrates such as Choukron's platelet-rich fibrin (PRF). This randomized controlled trial aimed to evaluate PRFM regenerative ability in human periodontal intrabony defects.

Materials and Methods:

Fifteen patients (age: 30–55 years) having probing pocket depth (PPD) ≥6 mm, and radiographic evidence of bilateral vertical intrabony defects were recruited. A split-mouth design was used in each patient; one quadrant of the arch was treated with open flap debridement (OFD) alone (control group) and the other quadrant with OFD + PRFM (test group). The PRFM was prepared by dual-spin technology using a patented thixotropic separator gel. Outcome measures comprising plaque index, gingival index (GI), PPD, clinical attachment level (CAL), depth of the defect, defect fill (DF), and percentage of DF (PDF) were recorded at baseline, after 3 months and 6 months. The parameters were applicably analyzed using the Friedman test, Fisher's exact test, t-test, paired t-test, repeated measures ANOVA, and Post Hoc-Bonferroni correction.

Results:

The GI, a net reduction in CAL, and PPD of the test group were significantly better than the control group at 3 months and 6 months (P < 0.05), while DF and PDF showed significant results at 6 months (P < 0.05). A consistent early wound healing index of 1 at 1 week was displayed in the test group (66.7%) in comparison to the control group (33.7%).

Conclusion:

PRFM can be a clinically significant periodontal regenerative material in the treatment of vertical intraosseous defects.
Transfiguration of Smile by Anterior Tooth Replacement through Remodeling of Hard and Soft Tissue Profile with Adjunct to Implant Osseointegration
Authors: Chopra Devendra , Bhaumik Kaushitaki , Mishra Sumit Kumar
Published: March 2022

The treatment choice for the recovery of missing teeth has been expanded for two patients and clinicians with the utilization of dental implants. For the success of dental implants, the quality and the amount of the available bone and soft tissues in the recipient site are very important factors. However, because of the tumor, injury, periodontal ailment, and so on, these variables might be undermined or inaccessible which again brings out the need for extra hard and soft tissue manipulation. This paper outlines a technique using a modified rolled palatal pedicle connective tissue graft with an autogenous bone graft from the mandibular symphysis area to achieve a predictable long-term success of dental implants prosthesis.
Extended RAS mutations (KRAS and NRAS) in patients with colorectal cancers in eastern India
Authors: Chatterjee Koushik , Mukherjee Pratyusha , Hoque Jeaul , Das Manitirthankar , Saha Subhayan
Published: March 2022

Background:

All treatment guidelines currently mandate KRAS and NRAS mutation analysis as a pretreatment workup of colorectal cancers (CRCs), in view of their prognostic and predictive significance.

Objectives:

In this study, we aimed to assess the prevalence of the extended-spectrum of KRAS and NRAS mutations in patients with CRCs from Kolkata, in eastern India.

Materials and Methods:

This retrospective observational study was conducted from January 2017 to January 2020 in patients registered for treatment at the IPGMER and SSKM Hospitals, in Kolkata, India. Patients diagnosed with CRCs with adenocarcinoma histology were included in the study. The formalin-fixed paraffin-embedded tumor tissues of the patients were assessed for the extended-spectrum of KRAS and NRAS mutations using a real-time polymerase chain reaction. The cut-off used for “Tumor Not Present” (TNP) reporting was 15%. These mutations were then mapped with the tumor location. Data were analyzed in a de-identified manner, using simple descriptive statistical methods. The two-tailed Fisher's exact test was used to determine any statistically significant association between variables.

Results:

TNP was reported in 13 (8.12%). A total of 147 patients with CRC were included in the study. Extended RAS mutations were found in 59 (40.1%) patients. KRAS and NRAS were found to be mutated in 55 (37.4%) and 4 (2.7%) patients, respectively. The most common mutation in KRAS was in G12 in exon 2 (34, 61.8%). Followed by Q61 in exon 3 (8, 14.5%) and A146 in exon 4 (8, 14.5%). Half of the NRAS mutations were in codons 12–13 in exon 2 and half were in codon 61 in exon 3. Dual KRAS mutations were observed in one patient, while two patients had both a KRAS and an NRAS mutation. Extended RAS, KRAS, and NRAS mutations were numerically more common in right-sided CRCs (47.2%, 43.4%, and 3.8%, respectively) than in left-sided CRCs (37.2%, 34%, and 2.1%, respectively). The rectum had numerically higher extended RAS and KRAS mutations but lower NRAS mutations (43.1%, 41.37%, and 1.72% respectively) as compared to the colon (37.36%, 34.06%, and 3.29% respectively).

Conclusions:

Extended RAS mutations are present in about 40% of the patients with CRC in eastern India, with KRAS (37.4%) mutations more prevalent than NRAS (2.7%) mutations. The right-sided CRCs have predictably more RAS mutations than the left.
Optimal dose of bevacizumab in recurrent glioma
Authors: Dsouza Hollis , Singh Gunjesh Kumar , Menon Nandini , Abhyankar Anuja , Puranik Ameya , Mahajan Abhishek , Janu Amit , Kalra Devanshi , Dale Ochin , Varghese Litty , Epari Sridhar , Chatterjee Abhishek , Krishnatry Rahul , Gupta Tejpal , Jalali Rakesh , Patil Vijay M
Published: March 2022

Background:

Recurrent gliomas have a dismal prognosis. They can be treated with re-surgery and re-irradiation. Bevacizumab as a single agent or in combination with chemotherapy is an alternative treatment option. However, in our country, a considerable proportion of patients cannot afford the approved 10 mg/kg dose.

Objective:

This study was aimed at evaluating the efficacy of low-dose bevacizumab in recurrent gliomas.

Methods:

Patients with recurrent gliomas presenting to our Neuro-Medical Oncology unit between July 1, 2015, and November 30, 2018, were retrospectively analyzed. The patients were divided into two groups, those treated with ≤5 mg/kg of bevacizumab (low dose) and those treated with >5–10 mg/kg (standard dose) of bevacizumab. The status of isocitrate dehydrogenase (IDH) and O[6]-methylguanine-DNA methyltransferase was recorded. The primary endpoint of the study was overall survival (OS), and the secondary endpoints were progression-free survival (PFS) and adverse events.

Results:

A total of 68 patients were treated with bevacizumab, of which 23 (33.8%) received the low-dose regimen. At a median follow-up of 26.2 months, there was no difference in the median PFS (low-dose group: 3.60 months; 95% confidence interval [CI], 2.5–7.47 vs. standard-dose group: 3.67 months; 95% CI, 2.17–4.53) (P= 0.18) and median OS (low-dose group: 7.33 months; 95% CI, 3.97–9.10 vs. standard-dose group: 5.47 months; 95% CI, 4.67–6.2) (P= 0.27). In addition, the adverse events were not significantly different between the two groups.

Conclusion:

Low-dose bevacizumab may be effective in the treatment of recurrent gliomas and should be compared with standard dose in prospective randomized studies.
Treatment of advanced non-small-cell lung cancer
Authors: Prabhash Kumar , Vora Amish , Limaye Sewanti , Sahoo Tarini Prasad , Batra Ullas , Patil Shekhar , Patil Vijay M. , Noronha Vanita , Bhosale Bharat , Raut Nirmal Vivek , Warrier Narayanankutty , Vaswani Bharat , Babu Govind , Gore Adwaita , Rohatgi Nitesh , Bondarde Shailesh
Published: March 2022

The management of patients with advanced non-small-cell lung cancer (NSCLC) is becoming increasingly complex, with the identification of driver mutations/rearrangements and the development and availability of appropriate targeted therapies. In 2018, a group of medical oncologists with expertise in treating lung cancers used data from the published literature and experience to arrive at practical consensus recommendations for the treatment of advanced NSCLC for use by the community oncologists. These recommendations were subsequently published in 2019, with a plan to be updated annually. This article is an update to the 2019 consensus statement. For updating the consensus statement, a total of 25 clinically relevant questions on the management of patients with NSCLC on which consensus would be sought were drafted. The PubMed database was searched using the following terms combined with the Boolean operator “AND:” (lung cancer, phase 3, non-small cell lung cancer AND non-small-cell lung cancer [MeSH Terms]) AND (clinical trial, phase 3 [MeSH Terms]) AND (clinical trial, phase iii [MeSH Terms]). In addition, “carcinoma, non-smallcell lung/drug therapy” (MeSH Terms), “lung neoplasms/drug therapy” (MeSH), clinical trial, phase III (MeSH Terms) were used to refine the search. The survey results and literature were reviewed by the core members to draft the consensus statements. The expert consensus was that molecular testing is a crucial step to be considered for patients with NSCLC at baseline, and in those who progress on first-line chemotherapy and have not undergone any prior testing. For mutations/rearrangement-negative patients who progress on first-line immunotherapy, doublet or single-agent chemotherapy with docetaxel and/or gemcitabine and/or ramucirumab should be considered. Patients who progress on the newer anaplastic lymphoma kinase inhibitors should be considered for second-line therapy with lorlatinib or systemic chemotherapy. Maintenance therapy with pemetrexed is preferred for NSCLC with non-squamous histology and should be avoided in NSCLC with squamous histology.
The impact of alcohol intoxication on early Glasgow Coma Scale-Pupil reactivity score in patients with traumatic brain injury
Authors: Thamminaina Abhinov , Prasad K. J. Devendra , Abhilash T. , Moorthy D. G. S. R. Krishna , Rajesh K.
Published: March 2022

Background:

A simple arithmetic combination of the Glasgow Coma Scale (GCS) score and pupillary response, the GCS-Pupil (GCS-P), extends the information provided about the patient outcome to an extent comparable to that obtained using more complex methods. The objective of the study was to compare the changes in the GCS-P score of patients with traumatic brain injury (TBI) under alcohol intoxication and nontoxication over time.

Methods:

A prospective observational study was done in a hospital at the Level I trauma center. The patients admitted to the emergency department (ED) with TBI were the study participants. They were grouped into intoxicated and nonintoxicated based on blood alcohol concentration (BAC). BAC of 0.08% and above was considered intoxication. GCS-P score in the ED and the best day 1 GCS-P score were the outcome variables. For nonnormally distributed quantitative parameters, medians and interquartile range were compared between study groups using Mann−Whitney U-test. P <0.05 was considered statistically significant.

Results:

A total of 216 patients were included in the final analysis. There was no statistically significant difference between BAC in GCS-P score at different follow-up periods, GCS-P score (ED), and GCS-P score (best day 1).

Conclusion:

This prospective observational study showed a low GCS-P score for alcohol-intoxicated patients compared to nonintoxicated patients, which was not statistically significant. There was no significant difference in emergency GCS-P score and best day 1 score between alcohol-intoxicated and nonintoxicated patients.
Aortoiliac thrombosis in COVID-19 patients
Authors: Ramakrishnan Ganesh , Xia Tony , Yannes Michael , Domer Gregory , Sheth Sharvil U.
Published: March 2022

Severe acute respiratory syndrome coronavirus 2 infection has been associated with a prothrombotic state. Reports of arterial and venous thrombosis have emerged. Here, we report three cases of aortoiliac thrombosis presenting as mesenteric and lower extremity ischemia in coronavirus disease 2019 patients with no identifiable proximal embolic source or history of prothrombotic condition.
Direct medical cost and cost analysis of COVID-19 in Iran
Authors: Mirhashemi Seyed Hadi , Mostafavi Hakimeh , Mollajafari Fariba , Ahmad Zohreh Zadeh , Hashempour Reza
Published: March 2022

Background:

Although our daily life and economics were severely affected by COVID-19, cost analysis of the disease has not been conducted in Iran. Hence, we aimed to perform a cost analysis study and then estimate direct medical costs of COVID-19.

Methods:

A cross-sectional study was performed in Tehran and recorded medical files from March 1, 2020, to September 1, 2020, were examined. A predefined electronic form was developed and all required variables were included. All people whose both first and final diagnoses were COVID-19 positive and were admitted in governmental hospitals were considered for inclusion. Using stratified random sampling method, 400 medical records were evaluated to gather all data. STATA 14 was used for data analysis.

Results:

We evaluated 400 medical records and the age of patients ranged from 22 to 71 years. The mean cost of COVID-19 was 1434 USD. Of 400 patients, 129 of them had underlying disease and statistical significance was observed in people who had underlying diseases than people who did not have underlying disease.

Conclusion:

Beds and medications were the most important factors that added to the costs. COVID-19 has undoubtedly imposed a high financial burden on the health system. It is highly recommended that patients with positive test result be strictly encouraged to stay at home and adhere to safety protocols.
Impact of the COVID-19 lockdown on trauma team activations in a single major Lithuanian trauma center
Authors: Aukstakalnis Vytautas , Blaziene Kristina , Cepla Juozas , Vileitaite Greta , Stasaitis Kestutis , Vaitkaitis Dinas
Published: March 2022

Background:

As a result of the coronavirus disease 2019 (COVID-19) pandemic and national quarantine, different levels of social and movement restrictions, and stay-at-home requests, trauma trends have changed. The aim of the present study was to determine the impact of lockdown on patients treated by the trauma team (TT) at a single major Lithuanian trauma center during the COVID-19 pandemic.

Methods:

This is a retrospective, descriptive study of adult (≥18 years old) trauma patients (for whom the TT was activated). Consequently, we analyzed the national lockdown periods from 16 March to 15 May 2020 and from 16 December 2020 to 28 February 2021, compared with the corresponding period of the previous year.

Results:

There was a 10% reduction in TT activations during the national lockdown period. No significant differences were noted in patient demographics. In the COVID-19 cohort, patients had higher Injury Severity Score (14 [IQR 6−21] vs. 9 [IQR 3−18], P = 0.025) and longer time to computed tomography scan (33 [IQR 25−43] vs. 23 [IQR 20−31] min, P < 0.001). Moreover, in the COVID-19 cohort, three times more patients were transferred from the emergency department (ED) straight to the operating room (n = 12 [19%] vs. n = 4 [5.7%], P = 0.018, Cramer's V = 0.21).

Conclusion:

Patients were more severely injured, and more patients required emergent surgery during the lockdown. In addition, it took longer to transfer patients to the ED and to perform a computed tomography scan.
Primary Lower-Limb Arterial Stent Infection Managed with Resection and in Situ Bovine Pericardial Revascularization
Authors: Lovelock Thomas , Thoo Catherine
Published: March 2022

Peripheral arterial stent infection is a rare but morbid condition. We present the case of a patient with primary stent infection of his superficial femoral artery (SFA) and popliteal artery, managed with surgical explant and in situ reconstruction using rifampicin-soaked bovine pericardial tube graft. A 69-year-old man presented with a 3-day history of left groin pain. He had had stents placed into his SFA and popliteal artery in 6 months prior. Duplex ultrasound demonstrated a pseudoaneurysm of the common femoral artery (CFA), with ying-yang flow. A computed tomography angiogram confirmed this pseudoaneurysm, which had a thick rind of nonenhancing soft tissue. Blood cultures were positive for methicillin-sensitive Staphylococcus aureus. The patient was taken to the operating theater, and the CFA, profunda femoris artery, and SFA were exposed. After heparinization and clamp control, the pseudoaneurysm was incised, which revealed that the proximal SFA had been completely eroded. All infected tissues were resected. In situ arterial reconstruction was undertaken using a rifampicin-soaked bovine pericardium tube graft. A subsequent positron emission tomography scan revealed high fluorodeoxyglucose uptake around the patients remaining distal SFA and popliteal artery stents. These were explanted in the same manner described above. There is limited evidence regarding the prevention of infection when placing peripheral arterial stents. The Society of Interventional Radiology does not recommend routine prophylactic antibiotics when placing peripheral stents. In situ reconstruction using bovine pericardium is a well-described technique in the management of aortic graft infections, but there is limited experience in its use in a peripheral setting.
Retrospective Validation of Global Limb Anatomic Staging System with Respect to Technical Failures in Endovascular Infrainguinal Revascularization for Critical Limb Threatening Ischemia
Authors: Fathima Shabnam , Subramanian Sairam
Published: March 2022

Introduction:

The Global Vascular Guidelines proposed the Global limb anatomic staging system (GLASS) to overcome the shortcomings of previous multiple classification system. It grades the infrainguinal disease into three stages with a specific algorithm to score the femoropopliteal and tibial segments. We aim to retrospectively validate the GLASS staging in primary endovascular therapy with respect to immediate technical failures (ITFs).

Materials and Methods:

Retrospective data from November 2017 to September 2021 were collected from the existing clinical database. All patients who underwent primary infrainguinal endovascular intervention for critical limb-threatening ischemia were included in the study. The patient who had isolated infrapopliteal disease without a named tibial outflow and only inframalleolar disease were excluded. The GLASS scoring was applied to the angiographic details in the database. The ITFs from the database were compared to the predicted technical failure according to GLASS staging. Statistical analysis was done.

Results:

Hundred thirty-two patients were studied from clinical database. We had 13 (9.8%) ITFs. None of those in GLASS Stage I had failure. Among 26 patients in Stage II, 1 (4%) had failure, against the predicted failure rate of lesser than 20%. Among 89 patients in GLASS Stage III, only 12 (13.5%) had failures against the predicted failure rate of more than 20%. The majority of failures had occurred in higher GLASS staging.

Conclusion:

Higher failures in higher GLASS staging have been validated by our study. However, it is limited considering the small cohort and retrospective analysis.
How to Conduct Inferential Statistics Online
Authors: Mondal Shaikat , Saha Swarup , Mondal Himel , De Rajesh , Majumder Rabindranath , Saha Koushik
Published: March 2022

Introduction:

Research data are first organized and visualized with the help of descriptive statistics. The next step is the inferential statistics. Result of the inferential statistics helps to conclude the finding. Many researchers and medical students may not have access to dedicated software for biostatistics.

Aim:

This study aimed to provide a guide on the conduct of common inferential statistics that can be done online.

Methods:

Common inferential statistical tests for both numerical data and categorical data were described in this study. All the tests were conducted online and the process is described step by step with example data.

Results:

The following tests were described-one-sample t-test, one-sample median test, unpaired t-test, Mann–Whitney U-test, paired t-test, Wilcoxon signed-rank test, one-way analysis of variance (ANOVA), Kruskal–Wallis test, repeated-measure ANOVA, Friedman Test, Pearson correlation test, Spearman correlation test, Binomial test, Chi-square test, Fisher's exact test, and MacNemar test. All these tests could be conducted online from a computer connected to the internet.

Conclusion:

We could conduct common inferential statistical tests online without any installed software. Anyone without prior data analysis knowledge may conduct the tests with example data on any internet browser. We presume that these would help the medical undergraduate and postgraduate students.
Evolving Paradigm of Hybrid Repair for Aortic Arch Pathologies
Authors: Unnikrishnan Madathipat , Viswanathan Sidharth , Pitchai Shivanesan , Savlania Ajay , Ramachandran Harishankar , Kumar Vineeth P M , Mohanan Arun Mohan , Gopalakrishnan Praveen , R Kapilamoorthy T , Dash Prasanta Kumar
Published: March 2022

Background:

Critical domain of thoracic aorta, the aortic arch, is affected by diverse pathologies mandating effective yet less strenuous management to save life, preserve organ function, and provide quality of life. Conventional open repair, minimally invasive total endovascular, and hybrid aortic arch repair are therapeutic options available. We present our experience and results with hybrid arch procedures.

Materials and Methods:

A cohort of 75 patients who were operated upon by the senior author from 2007 to 2020 formed the basis for this report. Male: female ratio was 11:1 for this group whose age ranged from 22 to 82 years with a mean of 70. Clinical indications were degenerative aneurysm (n = 49), Stanford B aortic dissection (n = 21), residual lesion following earlier Stanford A repair (n = 4) and a solitary patient with aortic trauma. Pan-arch debranching or hemi-arch debranching was performed in nearly all along with deployment of stent-graft at Zone 0 or Zone I, respectively. Sixty-seven elective (89.3%) procedures were staged and 8 (10.7%) were synchronous on account of being emergency interventions. Postoperative follow-up was performed at 3 and 6 months and yearly. Computed tomography aortogram was done before discharge from hospital or within 1 month followed by 1 year.

Results:

Technical success was achieved in 97.3%. Inhospital/30-day mortality was 9.3% (7/75 patients). Neurological complications, albeit less common, were the leading cause of perioperative morbidity. No endoleaks or graft migration was encountered in follow-up. Late mortality occurred in 10.3% (7/68 patients) from 6 months to 5 years, with massive hemoptysis in three despite asymptomatic clinical status and satisfactory imaging. Two patients were lost for follow-up, while the rest 59 patients are keeping well.

Conclusion:

Hybrid repair of aortic arch lesions, though initially intended to compliment stressful conventional surgery, has now evolved as the primary modality in this domain. This relatively safe therapeutic option, performed in a staged setting coupled with attention to achieve a liberal proximal seal, provided excellent initial results and long-term survival.
Use of Medial Gastrocnemius Muscle Flap in Traumatic Popliteal Artery Injury Due to Posterior Dislocation of Knee Joint
Authors: Korambayil Pradeoth Mukundan , Dilliraj Vinoth Kumar , Babu Edwina Mary , Varkey Prashanth Ambookan
Published: March 2022

Introduction:

Injury to the popliteal region affects vascularity and soft tissue necrosis. The purpose of the study is to use the medial gastrocnemius muscle flap to enhance the soft tissue cover of the injured area.

Materials and Methods:

This retrospective study was conducted in the Department of Plastic surgery from January 2019 to December 2020. All patients admitted under the department with posterior dislocation of the knee with vascular compromise to the limb were enrolled in the study.

Results:

Five patients were included in the study. In all the five cases, the limb was salvaged with reverse saphenous vein graft harvested from the thigh region of the opposite limb with soft tissue cover of medial gastrocnemius muscle flap. Postoperative limb movements were satisfactory. The average duration of hospital stay was approximately 21 days.

Conclusion:

Usage of medial gastrocnemius flap serves an adequate soft tissue coverage in traumatic popliteal artery injury
Giant Venous Malformation of the Trunk
Authors: Cherkaoui Ghita Belmaati , El Adak Hanane , Oufkir Ayat Allah , Benzirar Adnane , El Mahi Omar
Published: March 2022

Venous malformations (VMs) are dyssembryogenias of the venous vascular system. Giant VMs are rare but frequently associated with hemostasis disorders of variable severity. Their treatment is long and complex. The combination of several therapeutic modalities can reduce symptoms without eliminating the VM. A multidisciplinary approach is essential. A clinical case illustrates the difficulty of managing these malformations.
Endovascular Aortic Repair of Mycotic Abdominal Aortic Aneurysm with Multiple Systemic Abscesses
Authors: Miki Takao , Ohki Satoshi , Yasuhara Kiyomitsu , Obayashi Tamiyuki
Published: March 2022

Mycotic abdominal aortic aneurysms (MAAAs) are rare, but severe aortic infection and subsequently infected aortic aneurysms can cause a lethal condition. The gold standard for treatment is resection, infected tissue debridement, and graft replacement. Despite meticulous surgical planning, the mortality rate after open surgical repair can reach 40%. Endovascular aortic repair (EVAR) is another treatment option because of its simplicity and low invasiveness. We report a case of symptomatic MAAA successfully treated with EVAR and antibiotic therapy. EVAR is valuable for postoperative physical recovery. Here, the endovascular approach was feasible, and an acceptable outcome could be obtained.
Diarrhea associated with Pentatrichomonas hominis in an infant
Authors: Khan Sameena , Gandham Nageshwari R. , Das Nikunja K. , Patil Rajashri A. , Mirza Shahzad , Kannuri Sriram
Published: March 2022

Pentatrichomonas hominis is a flagellated protozoan parasite that resides in the digestive tract of humans and is generally nonpathogenic. Although parasites of diarrheal etiology are widespread, neonatal infection with P. hominis is an uncommon incident. This case report depicts an instance of active P. hominis in an 8-month-old child with complaints of fever, vomiting, and loose stools. Stool examination was done with saline and iodine wet mount that showed motile trophozoites of P. hominis with a jerky movement. Treatment with metronidazole was effective as no parasite was found on repeated stool examinations. Pentatrichomonas hominis should be recognized as a cause of diarrhea in neonates, despite being rare.
Nosocomial infections-related antimicrobial resistance in a multidisciplinary intensive care unit
Authors: Kumar Amit , Tanwar Shweta , Chetiwal Rajesh , Kumar Rohit
Published: March 2022

Background:

Intensive care units (ICUs) have become hubs of nosocomial infections worldwide. There has been a continuous rise in the development of antimicrobial resistance among ICU-acquired infections. Particularly, the Gram-negative bacteria implicated in ICU-acquired infections have become resistant to the majority of the antibiotics leading to a critical therapeutic problem. The present study was conducted to determine the antimicrobial resistance pattern of microorganisms causing nosocomial infections (ventilator-associated pneumonia [VAP], central line-associated bloodstream infection [CLABSI], and catheter-associated urinary tract infection [CAUTI]) in a multidisciplinary ICU.

Materials and Methods:

This prospective observational cohort study included the patients with ICU stay ≥ 48 h and any of the ICU-acquired infections: VAP, CLABSI, or CAUTI. The appropriate specimen was collected as per the standard procedure and cultured. The antimicrobial susceptibility of all the bacterial isolates recovered from the samples was performed according to the Clinical and Laboratory Standards Institute (CLSI) recommendations. The antimicrobial resistance data were analyzed using WHONET Microbiology Laboratory Database software 5.6 (WHONET 5.6).

Results:

Gram-negative microorganisms were the principal pathogens causing various infections in the ICU, out of which Pseudomonas aeruginosa and Klebsiella pneumonia were the commonest. Most of the Gram-negative bacteria showed a high degree of resistance to the majority of the antibiotics. Colistin was observed to be the most effective antimicrobial for Gram-negative pathogens followed by doripenem, meropenem, and tigecycline. The majority of Staphylococcus aureus isolates (71.4%) were methicillin-resistant S. aureus; however, all were sensitive to vancomycin and linezolid. Vancomycin-resistant Enterococci constituted 43% of Enterococcus isolates and were sensitive to linezolid and tigecycline.

Conclusion:

Antimicrobial resistance was very high among the pathogens causing nosocomial infections in the ICU, especially Gram-negative bacteria demonstrated a substantially high degree of resistance to the majority of the antibiotics. Antibiotic stewardship will help control the emergence of multidrug-resistant microbes.
Evaluation of the efficacy of levonorgestrel intrauterine system in the management of heavy menstrual bleeding
Authors: Halder Koyel , Ray Rathindra Nath , Biswas Priyam , Kolay Pritha , Kumari Shefali , Das Dibyojyoti
Published: March 2022

Background:

Heavy menstrual bleeding (HMB) poses threat to the quality of life among women. To prevent HMB, the levonorgestrel-releasing intrauterine system (LNG-IUS) is a well-known nonsurgical, long-performing, and alternative method.

Objectives:

The objective of this study was to determine the efficacy of LNG-IUS in women with HMB through an analytical observational study.

Materials and Methods:

This study was performed among 60 patients who visited the gynecology and obstetrics outpatient department (OPD) at the Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital (IPGMER and SSKMH), Kolkata, West Bengal, India from May 2019 to April 2020 due to HMB. The mean demographic and clinical profiles were evaluated, and comparative analysis was performed for hemoglobin (Hb), spotting, pain, and endometrial thickness on day 0 and follow-up 3 months, 6 months, and 12 months.

Results:

The mean age of patients was 37.77 ± 4.58 years was obtained. The Hb level was significantly (P < .001) increased, whereas pictorial blood loss assessment chart (PBAC) score, endometrial thickness, spotting, and pain were significantly (P < .01 and P < .001) reduced. The majority of patients had pallor, but the rates of spontaneous expulsion and hysterectomy were observed lower after using LNG-IUS among studied patients.

Conclusion:

the usage of LNG-IUS is potential in the treatment of HMB in women, which may lead to a better quality of life. This can be the alternative to hysterectomy and oral pills for long-term use. It is suggested in a future study with larger sample size and multicentric approach to minimize hospital biasness.
Methylene blue treatment for moderate-to-severe cases of acute respiratory syndrome due to COVID-19 infection
Authors: Ghodke Babita A. , Ghodke Ashok , Mahadik Virendra , Thorat Pooja
Published: March 2022

Background:

We studied the real-life experience with Methylene blue administration among the moderate and severe cases of acute respiratory distress syndrome due to Covid-19 infection with the standard of care.

Materials and Methods:

This study is a prospective, single-center study including 103 hospitalized patients conducted in a tertiary healthcare center from June 2020 to July 2021. The route of administration of Methylene blue was through nebulization (0.5 mL 0.5% solution of Methylene blue + 2.5 mL of distilled water) three times a day as long as the patient was admitted. An ampoule of 10 mL of Methylene blue with 90 mL of potable water through oxygen port was administered as long as they needed oxygen. About 2 mg/kg body weight of Methylene blue in 300 mL of N.S. over 3 h was given once a day for 5 days.

Results:

Approximately 103 patients were seen with a mean age of 56.49 years. The most prevalent comorbid condition was diabetes. The SpO2 improved by 7.827%. On post-Methylene blue administration, the serum ferritin, C-reactive protein, lactate dehydrogenase, and D-dimer were reduced in comparison to pre-Methylene blue administration. Also, the average total length of stay was 14

±

4.20, 13

±

5.66, and 14

±

3.50 days in 26.78% of patients in intensive care unit, 17.51% of patients in high dependency unit, and 58.71% of patients in Covid general ward, respectively. About 86.4% of the patients recovered and got discharged post-Methylene blue administration. The all-cause mortality was 13.59%, which could be due to underlying comorbidities and complications of Covid-19 infections.

Conclusion:

Methylene blue administration accelerated recovery in our patients with moderate and severe Covid-19 disease by controlling the hyperimmune response. The clinical improvement was seen by decreased levels of inflammatory markers, improved oxygen saturation, reduced length of hospital stay, and clinical improvements. Methylene blue administered in nebulization form, through oxygen port, and through intravenous infusion in the dose of 2 mg/kg body weight for 5 days and improved patients’ recovery, so it can be considered as a therapeutic option in moderate and severe Covid-19 disease.
A cross-sectional study of immunohistochemical evaluation of surface epithelial ovarian tumors
Authors: Pandey Vikas , Mishra Jyotirmayee , Potdar Pralhad S.
Published: March 2022

Background:

Ovarian cancer is one of the most common malignancies in female patients. In recent years, immunohistochemistry (IHC) has emerged as an important tool in the diagnosis of ovarian tumors. The study aimed to assess estrogen receptors (ERs), progesterone receptors (PRs), Her-2-neu, and Ki-67 by IHC in surface epithelial ovarian tumors and to correlate the findings with different variables.

Materials and Methods:

It was a cross-sectional study. Oophorectomy/salpingo-oophorectomy/cystectomy specimens were included in this study. IHC was done on 10% neutral buffer formalin-fixed paraffin-embedded tissue sections by using Dako FLEX Ready to use mouse monoclonal antibodies and DakoEnvisionTM FLEX/HRP detection reagent.

Results:

The study includes 81 cases of surface epithelial ovarian tumors (a benign serous tumor [20], a benign mucinous tumor [18], a borderline mucinous tumor [5], low-grade serous carcinoma [8], high-grade serous carcinoma [19], mucinous carcinoma [7], endometrioid carcinoma [2], borderline Brenner tumor [1], and malignant Brenner tumor [1]. ER had higher expression in malignant cases (51.33%) than in benign cases (15.8%). PR had higher expression in malignant tumors (54.05%) incomparable to benign (18.42%) and borderline tumors (16.66%). PR had higher expression in high grade. Expression of Her-2-neu positivity was found to be 29.7% out of the total 81 cases. Her-2-neu was found in 11 high-grade tumors among 31 malignant cases. CA-125 levels were significantly higher in malignant ovarian tumors (P = 0.0143). Proliferation activity was considered low if proliferation index (PI) <10% and high if PI >10%. The study showed high PI in malignant tumors.

Conclusion:

Expression of these marks in adjunct to H&E diagnosis may prove beneficial in differentiating benign, borderline, and malignant cases, in which a diagnosis of borderline cases based on sole H & E is doubtful.
Trends in the use of skilled birth attendants among women of reproductive age in a resource-limited setting
Authors: Bassey Uduak , Oyewande Azeezat A. , Chukwunonye Aneke I. , Ajani Olumide F. , Sunday Sola T. , Omole Timilehin M. , Igbinovia Friday I. , Chiroma Blessing B. , Gwa Zachary T. , Abiodun Olaiya P. , Sanni Felix O.
Published: March 2022

Background:

Although there has been growing awareness on the need for professional assistance at delivery, and this has improved health-seeking behavior and the use of antenatal care (ANC) of pregnant women, presenting for ANC does not directly imply that a woman would use a skilled birth attendant (SBA) at delivery. This study analyzed the trend in the use of SBAs at delivery among Nigerian reproductive women from 2007 to 2017.

Materials and Methods:

The study used the United Nations Children’s Fund, Multiple Indicator Cluster Surveys data for the years 2007 (n = 1021), 2011 (n = 2927), and 2016/2017 (n = 4155). Multivariate logistic regression was used to determine the relationship between the use of SBAs and demographic characteristics of women aged 15–49 years in Nigeria.

Results:

There was a significant decline in the utilization of SBAs at delivery from 82.7% in 2007 to 71.8% in 2016/2017 (P < 0.001). There was a decline in the proportion of doctors and nurses/midwives as birth attendants from 28.3% and 54.4% in 2007 to 22.8% and 49.0% in 2016/2017, respectively (P < 0.001), whereas the use of traditional birth attendants increased from 5.2% to 8.0% during the periods (P = 0.003). Urban residence [adjusted odds ratio (AOR)=1.32, 95% confidence interval (CI)=1.18–1.47, P < 0.01], higher maternal age (AOR=1.49, 95% CI=1.30–1.70; P < 0.01), and education attainment (AOR=3.78, 95% CI=3.39–4.22; P < 0.001) were associated with higher odds of the utilization of SBAs.

Conclusion:

There is a need for intervention programs for women in rural areas and women with a low level of education and lower maternal age. This will further reduce the maternal mortality ratios of the country.
COVID immunity in the Angolan population
Authors: Almeida Renata , Desormais Ileana , Taton Philippe , Morales Elvis , Reis Andre , Simba Yara
Published: March 2022

Background:

The numbers of severe COVID cases and COVID-related deaths on the African continent are lower than expected. We hypothesize that this paradox may be due to the achieved immunity in black Africans.

Materials and Methods:

A prospective study was conducted on Angolan people who performed the Panbio Abbott COVID-19 IgG/IgM Rapid Test in a health unit in Luanda. One hundred randomly selected subjects in those with positive immunoglobulin G (IgG) underwent the serological mini VIDAS BIOMERIEUX test.

Results:

In our population study (2409 subjects), 791 (32.83%) had positive IgG at the Panbio Abbott COVID-19 test. One hundred were randomly selected. The mean age was 39.55, and 96% were males. The positivity to IgG was validated in 72 subjects at the mini VIDAS BIOMERIEUX test.

Conclusion:

These results support our hypothesis that in the Angolan/African population a previously achieved immunity may be one of the reasons why this continent was not affected by COVID-19 as expected.
Role of Physiotherapy Interventions in Treating Varicose Veins
Authors: Shah Rachna , Sadhu Sakshi
Published: March 2022

The lower limb venous system is responsible for returning blood from the foot, leg, and thigh toward the heart. Chronic venous disease occurs by an inability of the blood to completely return due to structural or functional abnormalities of the veins of the lower limbs. Varicose veins are enlarged veins that have become tortious and abnormally swollen. This study was taken to evaluate, diagnose, and rehabilitate varicose veins by physiotherapy interventions. The patient presented at our outpatient department with severe varicose veins. She was assessed, and a patient-specific 2-month rehabilitation program was formulated. This study helps us to understand various aspects involved in the condition, its prognosis, and management by physiotherapy interventions.
Windblown Hand
Authors: Singh Kuldeep , Aggarwal Krittika
Published: March 2022

Introduction:

Windblown hand or congenital ulnar drift of hand is a rare deformity which affects all the digits including the thumb and can lead to functional impairment. Associated syndromes affecting the head, face, and feet should be ruled out. Windblown hand has three main features: (1) Contracture of the fingers with flexion deformity, (2) adduction contracture of the thumb causing narrowing of the first webspace, and (3) ulnar deviation of the fingers at the metacarpophalangeal joint. Early treatment is effective.

Methods:

We performed surgical correction in three cases of bilateral windblown hands. The extensor digitorum tendons were repositioned over the metacarpophalangeal heads by longitudinal plication of radial sagittal bands. In one case, skin contracture release for the first webspace was also done. Splinting with radial deviation and extension at metacarpophalangeal joint was done for 3 weeks. The average follow-up time was 6 months.

Results:

No skin necrosis or infection was seen in postoperative period. The patient satisfaction ranged from very good to excellent. For all the patients, first, the nondominant hand was operated, then all opted for surgical correction of the opposite hand as well.

Conclusions:

Windblown hand can lead to functional impairment and needs early correction. Parents and patients should be counseled about the chances of recurrence and incomplete correction. However, surgical treatment and subsequent physiotherapy can improve the functional range and aesthetics of the hand.
Orbital and Maxillary Sinus Wall Fractures as a Late Complication of Endosteal Implants
Authors: Ekinci Can , Ozdogan Furkan , Basyazici Gizem , Cetin Cengiz
Published: March 2022

A 63-year-old woman applied to us with a complaint of ecchymosis on the left half of her face and left subconjunctival hemorrhage after talking on her cell phone. There was no history of trauma or known medical diseases, but the patient had multiple endosteal implants, nine of them from 12 years ago, and a recent one on her left maxilla from last year. After detailed anamnesis, it is learned that the patient was not using any bisphosphonate treatment, but she was on Vitamin D treatment due to Vitamin D deficiency and using mirtazapine and alprazolam for anxiety. However, her T-score calculated for osteoporosis was above −2.5. All of the maxillofacial examinations were normal except for suspicious step deformity in the palpation of the left infraorbital rim. However, on the computed tomography imaging, it showed that there were fractures on the left lateral and infraorbital wall and left inferior maxillary sinus wall. MRI imaging ruled out any possible fracture caused by an aneurysmal bone cyst. With all these findings and careful examinations, the cause of these fractures was considered a late complication of her dental implants.
Hydrogeological Relationships of the Golubinka Karst Spring in Ljubač Bay, Dalmatia, Croatia
Authors:   Croatian Geological Survey, Zagreb, Croatia, Pavičić Ante , Terzić Josip ,   Croatian Geological Survey, Zagreb, Croatia, Berović Nicoletta ,   Vodovod Ltd., Water Supply Co.
Published: March 2022

The Golubinka spring is a typical karst spring situated in northernDalmatia, Croatia. The catchment area is mostly composed of limestonesof the Cretaceous and Palaeogene, with some dolomitic parts.Hydrogeological barriers are composed of flysch or Quaternarysediments, and most of them are “hanging” barriers, so that the karstwater can flow underneath. Many spelaeological features in the vicinityof the spring point to a typical karst conduit flowing under ground.This has been proven by tracer tests, because a connection exists tothe periphery of the catchment with an apparent velocity of 8.1 cm/s.The whole area is situated in the Mediterranean climatic belt, so theprecipitation distribution is quite unfavourable – summers are long,hot and dry. This is why the summer seasons usually end with seawater intrusion into the aquifer with a significant increase in chlorideion concentration. Since the spring is capped for water supply, there isa bulk monitoring system established. The data obtained were processed by means of multivariate analysis, and three main types of quality deterioration were recognized. The first is connected with pollutionfrom agriculture and inhabited areas without sewage, the secondrepresents occasional sea water intrusions, while the third relates toheavy rainfall events accompanied by turbidity and pollution. Togetherwith the other conclusions, these results should have a practical purpose primarily in the matter of water protection.