bluuebunny/crossref_metadata_2025 huggingface dataset:
An uncommon case of ocular brucellosis in South India
Authors: Kumar K S , Bhavana K , Sharma Rajan
Published: April 2024

We report an uncommon case of ocular brucellosis presenting to the outpatient department with ocular complaints of blurring of vision, redness, increasing floaters, and ocular pain. The patient, a young 20-year-old female, a hostelite was referred to us for ophthalmic consultation by the physician treating her for recurrent episodes of fever. The patient had three episodes of fever in the last 6 months lasting 10–15 days each time and associated with joint pains. The last episode had accompanying ocular complaints for which the patient was referred to us for further management. Ocular examination revealed conjunctivitis, limbitis, episcleritis, and anterior and posterior uveitis. Routine workup for panuveitis was noncontributory; hence, in consultation with the physician, brucellosis as a possible etiology was suspected and relevant serological tests were done. Raised titer of anti-brucella antibodies was detected. The patient was then started on two-drug anti-brucella therapy (doxycycline and rifampicin) and showed significant improvement. Although not common in our region, such presentations should be carefully investigated for brucellosis so that specific treatment can be curative and ocular complications can be avoided.
An unusual case of bilateral conjunctival ulcer post dengue fever: A case report
Authors: Khare Kanishk , Kashyap Anurag Kumar , Sinha Akanksha , Johri Puneet
Published: April 2024

A 25-year-old male patient presented with redness and pain in both eyes since 2 days with history of fever in the past 1 week and tested positive for dengue. On examination, the patient had bilateral nasal congestion and a whitish-yellow lesion in the right eye canthal region measuring 4 mm × 4 mm and 2 mm × 1 mm in the left eye; the lesion was fluorescein stain-positive. A provisional diagnosis of bilateral conjunctival ulcer was made and sent for culture and sensitivity. Culture revealed mixed bacterial and fungal growth of Pseudomonas aeruginosa and Aspergillus niger. The patient was started on fortified vancomycin 50 mg/mL (5%) and ceftazidime 50 mg/dL (5%) along with natamycin 5% eyedrops and oral ketoconazole 200 mg. The patient reviewed after 5 days showed fluorescein stain-negativity in both eyes and was completely asymptomatic on further follow-up. Opportunistic infections are common in dengue fever and should be treated aggressively to prevent further ocular complications.
Delayed manifestation of a full-thickness traumatic macular hole: Probable causes and consequences – A case report
Authors: Gadde Santosh Gopikrishna , Jayadev Chaitra , Prabhu Vishma , Venkatesh Ramesh
Published: April 2024

A 23-year-old male experienced a cricket ball injury to his right eye 1 day ago. Right eye visual acuity was counting fingers close to face. He presented with anterior uveitis, commotio retinae, and vitreous hemorrhage. Steroids and cycloplegics were given. Fundus showed resolved vitreous hemorrhage, a healthy optic disc, patchy epiretinal membrane, choroidal ruptures, peripapillary scarring, and 20/80 vision on follow-up. Patient developed a full-thickness macular hole 11 months after trauma, decreasing vision to 20/120. Exam and optical coherence tomography showed no abnormal posterior vitreous detachment. Macular hole surgery closed the hole with a normal foveal contour without improving vision. At the last follow-up 6 months after surgery, the hole was closed and vision improved to 20/120. A delayed traumatic macular hole unrelated to vitreomacular traction or cystoid macular edema deroofing has not been reported in literature. Traumatic macular hole development may be delayed by secondary epiretinal membrane contraction, ocular movements, or expansion of choroidal rupture.
Genetic and clinical diagnosis of a Chinese family with incomplete congenital stationary night blindness caused by a novel CACNA1F mutation
Authors: Qu Zhen , Xie Xiaohua , Mao Jinglin , Zhang Fanglian , Chen Ying , Xiang Longquan
Published: April 2024

We here describe the clinical features and identify the genetic cause of incomplete congenital stationary night blindness (CSNB) in a Chinese family. Three patients from a three-generation Chinese family were clinically examined. They exhibited nystagmus, hyperopia, and undetectable ERG a-wave and b-wave under scotopic conditions. Based on WES analysis and the subsequent data analysis, a novel c.677T>A missense mutation (p.V226E) was identified in CACNA1F, which co-segregated with the disease in this family. Our study extended the mutational and phenotypic spectra of CACNA1F-associated CSNB and indicated the significance of genetic testing in CSNB.
Antiarthritic potential of ethanolic extract of Ixora coccinea leaves on complete Freund’s adjuvant-induced arthritis in animal model
Authors: Panda Adyasha Anindita , Behera Jayanti Prava , Ramani Y. Roja , Panda Abinash , Kar Padmaja Priyadarshini , Panigrahy Snigdha Rani
Published: April 2024

CONTEXT:

Ixora coccinea leaves possess antioxidant, anti-inflammatory, antinociceptive, antimutagenic, and gastroprotective properties. On this background, its antiarthritic potential was evaluated.

AIMS:

The objective is to evaluate the effect of Ethanolic extract of Ixora coccinea leaves (EEICL) on complete Freund’s adjuvant-induced arthritis in rats.

SETTINGS AND STUDY DESIGN:

PG research laboratory, Pharmacology Department, MKCG Medical College, Berhampur, Odisha.

SUBJECTS AND METHODS:

Thirty-six Wistar albino rats were randomly distributed into sixgroups (n = 6) as follows: Gr 1 (normal control)-DW p.o, Gr-2 (disease control [DC] - Tween 80 p.o), Gr-3 (piroxicam 0.9 mg/kg p.o), Gr-4 (EEICL-1 g/kg, p.o, Gr 4-EEICL-1.5 g/kg p.o, Gr 5-ED50 (0.82 g/kg) + piroxicam (0.45 mg/kg) p.o. After induction of arthritis, drugs, and vehicles were administered daily from 5th to 25th day. On 0, 5th, 10th, 15th, and 25th day, parameters like body weight, rotarod fall time, paw volume displacement, and arthritis index were measured. On the last day, Erythrocyte sedimentation rate (ESR), tissue malondialdehyde (MDA), and histopathological analysis were done.

STATISTICAL ANALYSIS USED:

Analysis of parametric data was done by one-way ANOVA and nonparametric data by Kruskal–Wallis test using graph pad prism 7.0. P < 0.05 was considered statistically significant.

RESULTS:

EEICL (1.5 mg/kg) showed anti-arthritic effect compared with DC. Rotarod fall-off time 137.5 ± 2.5 sec and body weight (139 ± 12.74 g) were increased significantly. The percentage inhibition of paw volume was increased(52%) whereas arthritic score(0.33), ESR(3.51mm/hr), synovial tissue MDA level (0.62±0.13µmol/gm) and Mankin score(2) were reduced significantly as compared to disease control.

CONCLUSIONS:

EEICL has anti-arthritic potential in rat model.
Wound-healing effect of topical nanoemulsion-loaded cream and gel formulations of Hippophae rhamnoides L. (sea buckthorn) fruit oil and their acute dermal toxicity study on female SD rats
Authors: Gore Dattatraya Dinkar , Sharma Nisha , Mishra Nidhi , Parmar Prashantkumar K. , Ranjana Soni , Kumar Dinesh , Jachak Sanjay M. , Jena Gopabandhu , Tikoo Kulbhushan , Bansal Arvind K. , Singh Inder Pal
Published: April 2024

OBJECTIVE:

The objective of this study was to evaluate the efficacy and safety of topical nanoemulsion (NE)-loaded cream and gel formulations of Hippophae rhamnoides L. (sea buckthorn [SBT]) fruit oil for wound healing.

MATERIALS AND METHODS:

The NE-loaded cream and gel formulations of H. rhamnoides L. (SBT) fruit oil (IPHRFH) were prepared and evaluated for their wound-healing activity on female Sprague–Dawley (SD) rats. They were further divided into groups (seven) and the wound-healing activity was determined by measuring the area of the wound on the wounding day and on the 0th, 4th, 8th, and 10th days. The acute dermal toxicity of the formulations was assessed by observing the erythema, edema, and body weight (BW) of the rats.

RESULTS:

The topical NE cream and gel formulations of H. rhamnoides L. (SBT) fruit oil showed significant wound-healing activity in female SD rats. The cream formulation of IPHRFH showed 78.96%, the gel showed 72.59% wound contraction on the 8th day, whereas the positive control soframycin (1% w/w framycetin) had 62.29% wound contraction on the 8th day. The formulations also showed a good acute dermal toxicity profile with no changes significantly affecting BW and dermal alterations.

CONCLUSIONS:

The results of this study indicate that topical NE-loaded cream and gel formulation of H. rhamnoides L. (SBT) fruit oil are safe and effective for wound healing. The formulations showed no signs of acute dermal toxicity in female SD rats.
Antitumor activity of extracellular signal-regulated kinases 1/2 inhibitor BVD-523 (ulixertinib) on thyroid cancer cells
Authors: Chen Yulu , Xiao Xi , Hu Guanghui , Liu Rengyun , Xue Junyu
Published: April 2024

Objective:

This study aimed to investigate BVD-523 (ulixertinib), an adenosine triphosphate (ATP)-dependent extracellular signal-regulated kinases 1/2 inhibitor, for its antitumor potential in thyroid cancer.

Materials and Methods:

Ten thyroid cancer cell lines known to carry mitogen-activated protein kinase (MAPK)-activated mutations, including v-Raf murine sarcoma viral oncogene homolog B (BRAF) and rat sarcoma virus (RAS) mutations, were examined. Cells were exposed to a 10-fold concentration gradient ranging from 0 to 3000 nM for 5 days. The half-inhibitory concentration was determined using the Cell Counting Kit-8 assay. Following BVD-523 treatment, cell cycle analysis was conducted using flow cytometry. In addition, the impact of BVD-523 on extracellular signal-regulated kinase (ERK)- dependent ribosomal S6 kinase (RSK) activation and the expression of cell cycle markers were assessed through western blot analysis.

Results:

BVD-523 significantly inhibited thyroid cancer cell proliferation and induced G1/S cell cycle arrest dose-dependently. Notably, cell lines carrying MAPK mutations, especially those with the BRAF V600E mutation, exhibited heightened sensitivity to BVD-523’s antitumor effects. Furthermore, BVD-523 suppressed cyclin D1 and phosphorylated retinoblastoma protein expression, and it robustly increased p27 levels in an RSK-independent manner.

Conclusion:

This study reveals the potent antitumor activity of BVD-523 against thyroid cancer cells bearing MAPK-activating mutations, offering promise for treating aggressive forms of thyroid cancer.
Hepatic artery infusion chemotherapy with systemic capecitabine and camrelizumab for treating unresectable hilar cholangiocarcinoma: An initial investigation of efficacy and safety
Authors: Li Long , Liu Song , Wang Qingdong , Wang Yanhua , Yu Guangji
Published: April 2024

Objective:

This study aimed to evaluate the efficacy and safety of sequential treatment of continuous transcatheter hepatic artery infusion chemotherapy (HAIC) with systemic capecitabine monotherapy and camrelizumab for treating unresectable hilar cholangiocarcinoma (HCCA).

Methods:

This study retrospectively analyzed patients with unresectable HCCA admitted to Linyi Cancer Hospital in Shandong Province from October 2019 to December 2021. All enrolled patients were treated with HAIC (mFOLFOX7) + camrelizumab for 2–6 cycles and administered systemic therapy with capecitabine and camrelizumab. The objective response rate (ORR), disease control rate (DCR), and adverse reactions of patients were assessed. The Kaplan–Meier method was used to describe overall survival (OS), and univariate and multivariate Cox regression models were utilized to analyze the influencing factors of OS.

Results:

This study included 34 patients, ORR was 61.76% (21/34), and DCR was 97.06% (33/34) after two HAIC cycles. The median follow-up time was 17.5 months, with an average of 18.32 ± 8.06 months, and the median OS was 20.0 months. HAIC-related adverse reactions included mainly gastrointestinal symptoms and hematological toxicity caused by chemotherapy drugs, all of which were grades 1–2. Further, adverse events for camrelizumab treatment included fatigue, skin rash, and hypothyroidism, all of which were grade <3. Cox regression analysis revealed that the periductal infiltrating type of growth pattern indicated a worse OS, whereas more HAIC cycles (5 ~ 6) were a protective factor for OS.

Conclusion:

HAIC sequentially combined with systemic capecitabine chemotherapy and a programmed death-1 inhibitor displayed favorable effects for unresectable HCCA, with controllable adverse reactions.
New advances in the treatment of chondrosarcoma under the PD-1/PD-L1 pathway
Authors: Yin Jiawei , Ren Peng
Published: April 2024

Bone sarcomas encompass a group of spontaneous mesenchymal malignancies, among which osteosarcoma, Ewing sarcoma, chondrosarcoma, and chordoma are the most common subtypes. Chondrosarcoma, a relatively prevalent malignant bone tumor that originates from chondrocytes, is characterized by endogenous cartilage ossification within the tumor tissue. Despite the use of aggressive treatment approaches involving extensive surgical resection, chemotherapy, and radiotherapy for patients with osteosarcoma, chondrosarcoma, and chordoma, limited improvements in patient outcomes have been observed. Furthermore, resistance to chemotherapy and radiation therapy has been observed in chondrosarcoma and chordoma cases. Consequently, novel therapeutic approaches for bone sarcomas, including chondrosarcoma, need to be uncovered. Recently, the emergence of immunotherapy and immune checkpoint inhibitors has garnered attention given their clinical success in various diverse types of cancer, thereby prompting investigations into their potential for managing chondrosarcoma. Considering that circumvention of immune surveillance is considered a key factor in the malignant progression of tumors and that immune checkpoints play an important role in modulating antitumor immune effects, blockers or inhibitors targeting these immune checkpoints have become effective therapeutic tools for patients with tumors. One such checkpoint receptor implicated in this process is programmed cell death protein-1 (PD-1). The association between PD-1 and programmed cell death ligand-1 (PD-L1) and cancer progression in humans has been extensively studied, highlighting their remarkable potential as biomarkers for cancer treatment. This review comprehensively examines available studies on current chondrosarcoma treatments and advancements in anti-PD-1/PD-L1 blockade therapy for chondrosarcoma.
Anti-epileptic drug use during adjuvant chemo-radiotherapy is associated with poorer survival in patients with glioblastoma: A nationwide population-based cohort study
Authors: Lee Peng-Yi , Wei Yu-Ting , Chao Kun-San Clifford , Chu Chin-Nan , Chung Wen-Hui , Wang* Ti-Hao
Published: April 2024

Introduction:

There are emerging but inconsistent evidences about anti-epileptic drugs (AEDs) as radio- or chemo-sensitizers to improve survival in glioblastoma patients. We conducted a nationwide population-based study to evaluate the impact of concurrent AED during post-operative chemo-radiotherapy on outcome.

Material and Methods:

A total of 1057 glioblastoma patients were identified by National Health Insurance Research Database and Cancer Registry in 2008–2015. Eligible criteria included those receiving surgery, adjuvant radiotherapy and temozolomide, and without other cancer diagnoses. Survival between patients taking concurrent AED for 14 days or more during chemo-radiotherapy (AED group) and those who did not (non-AED group) were compared, and subgroup analyses for those with valproic acid (VPA), levetiracetam (LEV), or phenytoin were performed. Multivariate analyses were used to adjust for confounding factors.

Results:

There were 642 patients in the AED group, whereas 415 in the non-AED group. The demographic data was balanced except trend of more patients in the AED group had previous drug history of AEDs (22.6% vs. 18%, P 0.078). Overall, the AED group had significantly increased risk of mortality (HR = 1.18, P 0.016) compared to the non-AED group. Besides, an adverse dose–dependent relationship on survival was also demonstrated in the AED group (HR = 1.118, P 0.0003). In subgroup analyses, the significant detrimental effect was demonstrated in VPA group (HR = 1.29,P 0.0002), but not in LEV (HR = 1.18, P 0.079) and phenytoin (HR = 0.98, P 0.862).

Conclusions:

Improved survival was not observed in patients with concurrent AEDs during chemo-radiotherapy. Our real-world data did not support prophylactic use of AEDs for glioblastoma patients.
Application of statistics in biomedical research
Authors: Padhee Sourav , Ahmed Sakir
Published: April 2024

Statistical tools for data analysis vary depending on the kind of data and measurement scales used. The objective of this review is to offer a deep insight into these various data types and measuring systems. This overview offers comprehensive details on the various data kinds and measurement scales along with examples. Applying the proper statistical techniques and drawing reliable conclusions require knowledge of the relevant data type or analysis procedure.
Demystifying the pink enigma: A succinct overview on the interdental papilla
Authors: Kshirsagar Jaishree Tukaram , Monika A. , Nithiyaraj S. , Sathyasree S. , Sharma K. Shyam
Published: April 2024

Nowadays, the scope of dentistry has extended beyond the realm of functionality to include the elusive domain of esthetics as well. Gingival black triangle (GBT) is a cosmetic aberration caused by the absence of the papilla, resulting in black gaps or exposed embrasures. Loss of interdental papilla is significantly linked to advancing age, periodontal diseases, and orthodontic therapy. The lack of an interdental papilla raises the concerns about phonetics, food accumulation, and plaque deposition, all of which exacerbate the current situation and cause esthetic issues. In dental procedures, replacing the missing interdental papilla is a difficult and unpredictable process. Because of its complicated anatomy and numerous contributing elements, attaining a successful reconstruction is not always assured. This review article discusses the anatomy of interdental papilla, different classifications of interdental papillary loss, the etiology of the GBT, and the currently available nonsurgical and surgical treatment modalities recommended for preservation of interdental papilla and management of interdental papilla loss.
ProTaper universal retreatment retreatment potential in oval-shaped canals filled with different obturation techniques—A micro-computed tomography study
Authors: Zongova-Adem Sherihan E , Tsenova-Ilieva Irina Kalinova , Dogandzhiyska Violeta Dimitrova , Topalova-Pirinska Snezhanka Zaprinova , Karova Emilia Goshova
Published: April 2024

Abstract

Aim:

The objective of this in vitro micro-computed tomography investigation is to assess the efficacy of the ProTaper Universal Retreatment System in retreating oval-shaped root canals filled with three obturation procedures.

Materials and Methods:

Thirty-six lower incisors with a single oval root canal were prepared using XP-Endo Shaper up to size 30/0.04, and allocated into three equal groups based on the filling technique: Group 1: Warm vertical condensation technique; Group 2: GuttaCore obturators; Group 3: Cold lateral condensation technique. All samples were further retreated using the ProTaper Universal Retreatment system. Micro-CT analysis was performed before and after the retreatment procedure. Statistical analysis was performed with a significance level of 0.05. Data analysis was conducted using the Kolmogorov-Smirnov and Kruskal–Wallis H tests.

Results:

The best performance of the files was achieved when the removal of the filling in the entire canal was considered. However, this outcome was not statistically significant when compared with the other observed root canal levels. The retreatment procedure could not ensure thorough cleanliness of the canal walls from filling remnants, regardless of the obturation technique and observational level.

Conclusions:

The ProTaper Universal Retreatment system used for the removal of gutta-percha and sealer in oval-shaped root canals demonstrated equal effectiveness, regardless of the obturation technique used.
Family Caregivers’ Experiences of Caring for Patients with Heart Failure: A Qualitative Study
Authors: Tunsi Afnan , Idrees Maha , Al-faifi Najwa , Heliebi Nouf , Al-zahrani Shuaa , Alaamri Marym , Alhofaian Aisha
Published: April 2024

Background:

Heart failure (HF) is a global health concern. People living with the disease require continuous care and support, which is frequently provided by informal caregivers. Although HF caregivers occupy a key position in improving patients’ outcomes and reducing health-care costs, many of them experience adverse impacts on their physical and psychological health, which is largely unknown.

Objective:

The purpose of this study was to explore the experiences, needs, and challenges facing HF caregivers in Saudi Arabia to identify priority areas for developing tailored interventions.

Materials and Methods:

An exploratory descriptive qualitative study was conducted using semi-structured interviews with 12 caregivers (age range, 18–57; mean, 32). Interview data were analyzed thematically following Braun and Clarke’s approach.

Results:

Analysis of the interviews yielded four distinct overarching themes: role definition; coping and support; unmet caregiver needs; and emotional impact.

Conclusion:

Caregiving is a complex and life-altering role with many health and well-being implications. An in-depth understanding of HF caregivers’ experiences and needs provides valuable insight into how they can be supported in their roles to improve both caregivers’ and patients’ outcomes.
Efficacy of an Oral Solution Containing Five Herbal Extracts in the Treatment of Urolithiasis: A Randomized, Single-blind, Placebo-controlled Clinical Trial
Authors: Samandarian Sahand , Soltani Rasool , Hajhashemi Valiollah , Dehghani Mehdi , Matinfar Mohammad , Mahboubi Mohaddese , Mohsenzadeh Afsaneh
Published: April 2024

Objective:

The high prevalence of urolithiasis and its recurrence entail the preparation of an efficient drug with the least side effects. Tribulus terrestris, Urtica dioica, Adiantum capillus-veneris, Stigma maydis (corn silk), and Cucumis melo are herbal remedies utilized in traditional medicine for urolithiasis. This study aimed to assess the efficiency of these plants’ extracts in treating urolithiasis.

Methods:

In a randomized, single-blind, placebo-controlled clinical trial, participants meeting inclusion criteria were randomly allocated to the drug (n = 27) and placebo (n = 27) groups to take herbal or placebo solutions, respectively, at a dose of 60 drops 3 times daily for 4 weeks with standard treatment. Before and after the intervention, 24-h urine volume and the quantities of calcium, sodium, citrate, oxalate, urea, creatinine, and uric acid in 24-h urine, and urinary pH were measured. The number and size (diameter in mm) of stones were determined by ultrasonography and recorded for each patient.

Findings:

Except for 24 h urine volume, other urinary parameters did not alter significantly at the end of the intervention compared to baseline. Furthermore, the two groups had no significant difference regarding these indices. Regarding stone parameters, the stone size decreased significantly in the drug group compared to the placebo group (P = 0.049). The number of cases with complete stone expulsion in the drug group was significantly higher than in the placebo group (12 cases vs. 4 cases, respectively, P = 0.017).

Conclusion:

Oral consumption of the herbal solution causes stone size reduction and stone expulsion in patients with urolithiasis.
Hypoglycemic Agents and Anesthetic Techniques to Ameliorate Stress Hyperglycemia in Critically Ill Patients: A Systematic Review
Authors: Rahimpour Fatemeh , Nejati Malihe , Moghaddas Azadeh , Farsaei Shadi , Feizi Awat
Published: April 2024

The concurrent utilization of hypoglycemic agents and anesthetic techniques has been demonstrated to mitigate stress hyperglycemia in critically ill patients without diabetes, thereby contributing to enhanced patient outcomes. Stress hyperglycemia, characterized by elevated blood glucose levels as a result of acute illness or physiological stress, frequently manifests in patients experiencing critical illness. This condition has been linked to augmented morbidity, protracted hospitalization durations, and elevated mortality rates. This review aims to introduce and critically assess various hypoglycemic agents and anesthetic techniques employed to alleviate stress hyperglycemia, emphasizing the necessity for continued research to comprehensively ascertain the safety and efficacy of these approaches, which will facilitate their broader integration.
RV in COPD – The complicated matters of the heart – Correlation of ECHO and biomarker with COPD severity and outcome
Authors: Bhat Rajesh , Kamath Sindhu , Jain Arpit , Acharya Vishak , Antony Thomas , Holla Ramesh , Jha Abhavya
Published: April 2024

Background:

Patients with chronic obstructive pulmonary disease (COPD) have an increased risk of cardiovascular involvement, which is among the leading causes of morbidity and mortality worldwide. Echocardiography (ECHO) could be a reliable, non-invasive tool for predicting the risk of cardiovascular modalities in patients with COPD. Combining the ECHO parameters with highly selective cardiac troponin could predict the severity and outcome of patients with COPD.

Methods:

This prospective observational study was conducted at a tertiary care hospital in South India. All patients who met the criteria were included. Patients with other concomitant chronic lung diseases were excluded. An echocardiographic examination was performed, and blood samples for hs-Tnt were taken on admission for patients admitted with COPD. Categorical variables were analyzed using Pearson’s Chi-square test, and the T-test was used to compare the means. One-way analysis of variance (ANOVA) followed by the Bonferroni multiple comparison tests was done to compare different echo parameters concerning COPD severity.

Results:

The mean tricuspid annulus plane systolic excursion (TAPSE) and right ventricle (RV) fraction area change (FAC) values were lower with the increase in the disease severity (P < 0.001). There was a significant increase in the mean systolic pressures in the right atrium and ventricle in patients with severe COPD (P < 0.001). The mean hs-TnT values were significantly higher in patients with severe COPD (18.86 ± 18.12) and correlated well with the increase in the severity of the disease (P < 0.001). Changes in the echo parameters, such as mean TAPSE and RV FAC values, negatively correlated with COPD severity. There was an increase in systolic pressure in both atria and ventricles with the progression of COPD. Troponin helped predict mortality during hospitalization.

Conclusion:

Comprehensive echocardiographic parameters, such as TAPSE and RV FAC, help assess the disease’s severity, predict mortality, and evaluate whether the proper ventricular function is reliable. Troponin is a valuable adjunct that is an independent and strong predictor of overall mortality in patients with COPD.
Clinical behaviour and mortality in idiopathic vs secondary nonspecific interstitial pneumonia
Authors: Wijayaratne Thisarana , Owen James , Fahim Ahmed
Published: April 2024

Rationale:

Nonspecific interstitial pneumonia (NSIP) is a subtype of interstitial lung disease which can either be idiopathic or secondary to other conditions. Idiopathic NSIP is a relatively rare entity and diagnosis should be considered carefully as it is mainly a diagnosis of exclusion. The aim of this retrospective study was to evaluate a cohort of NSIP patients with a view to identifying any clinical and mortality differences between idiopathic and secondary varieties.

Methods:

We screened 700 patients from our interstitial lung disease database and identified 44 cases of NSIP retrospectively. Statistical analysis was conducted to evaluate if there was a difference in demographics such as gender and ethnicity, physiological parameters including forced vital capacity, diffusing capacity, average oxygen saturations, and immunology profile between two groups. Furthermore, a difference in mortality was evaluated between idiopathic and secondary NSIP.

Results:

The data analysis showed that 63.6% (28 of 44) of patients had idiopathic NSIP versus 36.4% (16 of 44) of patients had secondary NSIP. Majority of the secondary NSIP patients had an underlying connective tissue disease. In the idiopathic variety, there was a male preponderance (64.2%, P = .02) which was statistically different compared to relatively equal gender divide in secondary NSIP which was statistically insignificant (male vs. female: 43.8% vs. 56.3%, respectively, P = .42). The mean age of the idiopathic group was 74 years compared to 64 years in the secondary group which was statistically different (P = .01). In both groups (idiopathic and secondary NSIP), more than two-thirds (68%) were of White British ethnicity. Immunology profile was similar across both groups with no statistical difference in IgM, IgG, or IgA levels. At the time of analysis, there were 17.9% deaths (5 of 28) in the idiopathic NSIP group versus 6.3% (1 of 16) in the secondary NSIP group but this was not statistically significant (P = .14). Similarly, there was no statistically significant difference in the forced vital capacity (P = .59), diffusing capacity (P = .88), and resting oxygen saturations (P = .28) between idiopathic and secondary NSIP varieties.

Conclusion:

Our analysis showed that there was a statistically significant difference in gender (male preponderance in idiopathic NSIP only) and mean age difference among both varieties. There were no statistically significant differences in the clinical features and outcomes including mortality, physiological, and immunological parameters between idiopathic and secondary NSIP. Idiopathic NSIP was more common than secondary NSIP and secondary NSIP is mostly due to underlying connective tissue disease.
A case report on new-onset peritoneal tuberculosis in ankylosing spondylitis patient on adalimumab
Authors: Bhavsar Bhumika Harishkumar , Prajapati Vipul , Shukla Dhaiwat , Malhotra Supriya
Published: April 2024

Adalimumab, a widely employed tumor necrosis factor-alpha inhibitor for autoimmune diseases, raises concern about reactivating latent tuberculosis (TB) and new-onset TB. Despite its established efficacy in managing inflammation, clinicians must recognize and manage adalimumab-induced TB promptly to minimize associated morbidity. This case report explores guidelines for TB screening in adalimumab-treated patients, utilizing interferon-gamma release assays and tuberculin skin tests, and discusses treatment considerations. Increased TB incidence in adalimumab-treated patients necessitates vigilant screening for latent TB before therapy initiation. Therapeutic decisions must balance the need for continuing immunosuppressive therapy against the potential risks of uncontrolled TB. Diagnostic challenges arise from atypical presentations and the intricate interplay between adalimumab therapy and TB manifestations. Given adalimumab’s expanding use, clinicians should be mindful of potential TB reactivation, emphasizing thorough screening, diagnosis, and management for improved patient care and safety amidst immunosuppressive therapies. Here, we are presenting the case of adalimumab-induced peritoneal TB.
The effect of anticonvulsant drugs on serum lipid profile
Authors: Neethu T. T. , Sreedharan Syam , Vijayan Beena Vasanthy , Palappallil Dhanya Sasidharan
Published: April 2024

BACKGROUND AND OBJECTIVES:

Epilepsy is a potentially life-shortening brain disorder, the symptoms of which can be successfully treated in most patients with one or more antiepileptic drug (AED). The literature explains the association of AED therapy and dyslipidemia. The changes in lipid fraction may vary with different AED, age group, and study population. The present study was planned to assess the serum lipid profile of adult epileptic patients receiving phenytoin, carbamazepine or sodium valproate therapy and attending Neurology Outpatient Department of Government Medical College, Kottayam, compared to normal healthy controls.

METHODOLOGY:

A total of 150 epileptic patients on AED monotherapy attending the outpatient department of neurology were evaluated for serum lipid profile. Demographic data and medical history of consenting participants were collected by the use of a semi-structured questionnaire. Fifty age- and sex-matching healthy controls also underwent similar investigation.

RESULTS AND DISCUSSION:

Over 12 months, 150 patients were recruited with a mean age of 35.54 ± 10.72 years (male-to-female ratio 1:1.27). When compared to normal control population observed statistically significant high mean total cholesterol, triglyceride level in the group receiving phenytoin therapy for more than 1 year. Only significant hypertriglyceridemia is observed in carbamazepine and sodium valproate treated patients. A significant correlation between the duration of anticonvulsant therapy and lipid profile was established.

CONCLUSION:

Conventional anticonvulsants induce dyslipidemia and monitoring of lipid profile should be done routinely to decrease the morbidity and preserve the quality of life in these (asymptomatic) patients.
Antitubercular medications and levetiracetam-induced symmetric drug-related intertriginous and flexural exanthema
Authors: Raju Linta Mariyam , Sharma Chetan , Kaur Prabhjot , Badyal Dinesh K.
Published: April 2024

Symmetric drug-related intertriginous and flexural exanthema (SDRIFE) is a rare, distinctive cutaneous adverse reaction associated with various medications. Here, we present the case of a 48-year-old male, admitted with complaints of slurring of speech with a deviation of face with abnormal movements and posturing of hands and limbs and loss of consciousness for about 15 min. Magnetic resonance imaging (MRI) brain with angiography was done which was suggestive of a ring-enhancing lesion with perilesional edema hinting toward the possibility of tuberculoma. A contrast MRI brain was done which was suggestive of leptomeningeal and pachymeningeal left frontal region with perilesional edema suggestive of tuberculoma so the patient was started on antitubercular therapy and dexamethasone and levetiracetam. The patient developed redness over the lower abdomen which gradually progressed to involve the lower back, bilateral axilla, and upper back. Potential suspected drugs such as antitubercular therapy and levetiracetam were stopped and the patient improved. The patient was started on another antiepileptic injection lacosamide. Antitubercular therapy was started again, on starting isoniazid 75 mg the patient started developing itching again, which was managed by giving antihistaminic. This case report highlights the importance of recognizing and managing SDRIFE as a potential complication of combination drug therapy and the need for vigilant monitoring of patients receiving such medications.
Post-traumatic Cerebral Infarction: A Severe form of Secondary Brain Injury in Traumatic Brain Injury Patients with a Critical Neutrophil-to-lymphocyte Ratio
Authors: Kusuma Gede Febby Pratama , Niryana I Wayan
Published: April 2024

Post-traumatic cerebral infarction (PTCI) is one of the most severe forms of secondary brain injury (SBI) post-traumatic brain injury (TBI). The PTCI incidence is not very often and is associated with a high mortality rate even after appropriate medical and surgical interventions. SBI is still challenging to prevent even though several laboratory tests such as neutrophil-to-lymphocyte ratio (NLR) were available for early detection and monitoring the severity of SBI progression. This study aimed to report the case of PTCI post-TBI which was correlated with an extremely high NLR result. This case report shows that early recognition and close monitoring is necessary to prevent the occurrence of PTCI in TBI patients. NLR is very beneficial to be used to monitor and detect the early progression of SBI post-TBI.
The level of discomfort during the use of different circuits of the mechanical ventilator
Authors: Liu Meng-Yi , Hsu Pei-Shan , Wu Chiu-Feng , Wu Yao-Kuang , Yang Mei-Chen , Su Wen-Lin , Tzeng I-Shiang , Lan Chou-Chin
Published: April 2024

ABSTRACT

Objectives:

Endotracheal tube (ETT) intubation is a life-saving procedure in patients with respiratory failure. However, the presence of an ETT can cause significant discomfort. A tracheostomy tube is used to administer a mechanical ventilator, resulting in a more stable airway and fewer serious injuries. Noninvasive ventilators (NIPPVs) administer ventilation through masks and must be tightly fixed to the face. ETT, tracheostomy, and NIPPV are the most common methods of ventilator maintenance. However, these interventions often cause discomfort to patients. This study aimed to compare discomfort associated with ETT, tracheostomy, and NIPPV.

Materials and Methods:

Forty-nine conscious patients with postextubation NIPPV and eight conscious patients who underwent postextubation tracheotomy were evaluated for discomfort. A questionnaire survey on discomfort was performed before and after NIPPV or tracheostomy. These patients reported their level of discomfort on a visual analog scale.

Results:

The levels of sore throat, nasal pain, body pain, activity limitation, respiratory discomfort, oral discomfort, difficulty coughing sputum, worry about respiratory tube disconnection, back pain, anxiety, worry about long-term admission, sleep disturbance, and general discomfort during ETT intubation were higher than during tracheostomy or NIPPV (all P < 0.05). The mean level of discomfort was approximately 5–6 points (moderate) in patients with ETT and 2–3 points (mild) in patients with NIPPV or tracheostomy.

Conclusion:

The level of discomfort was higher in patients who underwent ETT intubation than in those who underwent NIPPV or tracheostomy. However, the level of discomfort was similar between the patients with NIPPV and those who underwent tracheostomy.
Responding to “Pharmacogenomics in Clinical Practice for Older People”
Authors: Ruggles Tamara
Published: April 2024

The author comments on the article in the April 2024 issue of the journal regarding pharmacogenomics.
Impact of Pharmacist Transitions of Care on 30-Day Readmissions Within a Primary Care-Based Accountable Care Organization
Authors: Benny Tina , Jain Kajal , Marie Hale Genevieve , Acharya Rucha , Moreau Cynthia , Rosario Elaina , Perez Alexandra
Published: April 2024

Previous studies in the ambulatory care setting have shown inconsistent results in regard to, or with respect to pharmacist telephonic transitions of care (TOC) encounters and reduction in 30-day readmission rates. No studies that have been completed within an accountable care organization
(ACO) evaluating the impact of telephonic TOC encounters performed by a pharmacist have been identified. The objective of this study was to analyze the impact of clinical pharmacy telephonic TOC encounters on readmission rates within a primary care-based ACO. In this retrospective chart review,
data for those who had a pharmacist telephonic TOC encounter and those who had an attempt were collected. The primary outcome of this study was all-cause 30-day readmission rate. Secondary outcomes included 30-day readmission rate for targeted disease states, time to readmission, and readmission
reason the same as previous discharge reason. For subjects who received a telephonic TOC encounter, pharmacist intervention type and provider acceptance of intervention(s) were described. For the final analysis, 154 encounters were included, 83 encounters in the telephonic TOC encounter group,
and 71 did not receive a telephonic TOC encounter. The 30-day readmission rates were similar among those who received a telephonic TOC encounter and those who did not: the difference was not significant (15.7% vs. 28.2%; P = 0.059). There was also no statistical difference in the secondary
outcomes. Even so, the results of this study suggest that performing a pharmacist telephonic TOC encounter in a primary care-based ACO setting has the potential to reduce 30-day readmission rates and further research appears to be warranted in this important area of practice.
Preparation Times and Estimated Costs for Vancomycin Formulations: Does the Difference Matter?
Authors: Lee Merton , Worz Chad , Gaal Dana , Brandt Nicole
Published: April 2024

Objective Infections from methicillin-resistant Staphylococcus aureus are increasingly treated in longterm care facilities, but long-term care pharmacies face high costs in the provision of sterile vancomycin for intravenous administration. This study compares pharmaceutical
costs of outsourced, compounded, and room temperature premixed vancomycin formulations in a long-term care pharmacy. Design This retrospective observational study reviewed 124 orders of vancomycin. Means for total pharmacy preparation time, pharmacist labor time, and extrapolated
time over complete course of treatment were compared for three vancomycin preparations: outsourced, compounded by pharmacy, and room temperature premixed vancomycin formulations. Cost calculations were generated using ingredient costs as reported by the pharmacy and median pharmacist labor
costs as published from national sources. Results Mean total preparation times and pharmacist preparation times were shortest for premixed vancomycin. Over full courses of treatment, mean pharmacy preparation time for compounded was 5 hours 3 minutes (mean of 28 treatments)
and 2 hours 8 minutes for premixed (mean of 54 treatments). Data on pharmacist time in outsourced orders were not available. Total pharmacy costs were $993.94 for compounded vancomycin, $2220.34 for outsourced, and $809.36 for room temperature premixed vancomycin.
Conclusion There were reduced preparation times for room temperature premixed vancomycin compared with compounded and outsourced formulations for skilled nursing facilities. As multiple drug-resistant organism infections are increasingly treated in long-term care, finding cost-effective
approaches to medication provision from pharmacies is critical.
Efficacy of Lenvatinib Combined with Anti–PD-1 Antibodies Plus Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma with Portal Vein Tumor Thrombus: A Retrospective, Multicenter Study
Authors: Ou Xiangye , Wu Junyi , Wu Jiayi , Fu Yangkai , Zeng Zhenxin , Li Shuqun , Li Yinan , Liu Deyi , Li Han , Li Bin , Zhou Jianyin , Zhuang Shaowu , Cheng Shuqun , Zhang Zhibo , Wang Kai , Qu Shuang , Yan Maolin
Published: April 2024

Purpose The prognosis of patients with hepatocellular carcinoma (HCC) and portal vein tumor thrombus (PVTT) is extremely poor, and systemic therapy is currently the mainstream treatment. This study aimed to assess the efficacy and safety of lenvatinib combined with anti–programmed cell death-1 antibodies and transcatheter arterial chemoembolization (triple therapy) in patients with HCC and PVTT.Materials and Methods This retrospective multicenter study included patients with HCC and PVTT who received triple therapy, were aged between 18 and 75 years, classified as Child-Pugh class A or B, and had at least one measurable lesion. The overall survival (OS), progression-free survival (PFS), objective response rates, and disease control rates were analyzed to assess efficacy. Treatment-related adverse events were analyzed to assess safety profiles.Results During a median follow-up of 11.23 months (range, 3.07 to 34.37 months), the median OS was greater than 24 months, and median PFS was 12.53 months. The 2-year OS rate was 54.9%. The objective response rate and disease control rate were 69.8% (74/106) and 84.0% (89/106), respectively; 20.8% (22/106) of the patients experienced grade 3/4 treatment-related adverse events and no treatment-related deaths occurred. The conversion rate to liver resection was 31.1% (33/106), with manageable postoperative complications. The median OS was not reached in the surgery group, but was 19.08 months in the non-surgery group. The median PFS in the surgery and non-surgery groups were 20.50 and 9.00 months, respectively.Conclusion Triple therapy showed promising survival benefits and high response rates in patients with HCC and PVTT, with manageable adverse effects.
Reduction in Acute Post-Streptococcal Glomerulonephritis Incidence in Counties Manukau, New Zealand, after the COVID-19 Pandemic
Authors: Taylor Amanda , Neutze Jocelyn , Moreland Nicole J. , Webb Rachel
Published: April 2024

The COVID-19 pandemic has altered the epidemiology of many common childhood infections, including Group A streptococcal (GAS) disease. Acute post-streptococcal glomerulonephritis (APSGN) is a nonsuppurative complication of GAS pharyngitis and pyoderma. It remains the most common cause of pediatric acute glomerulonephritis globally. In Counties Manukau, New Zealand, APSGN rates have previously been shown to be the highest in the country, with marked ethnic and socioeconomic disparities. We performed a retrospective review of children aged 0–14 years who were discharged from Kidz First Hospital, Counties Manukau, between 2015 and 2023 and met the Strep A Vaccine Global Consortium consensus definition of APSGN. We describe a marked, sustained reduction in APSGN hospitalizations, temporally associated with the COVID-19 pandemic. This ongoing reduction in APSGN incidence is notable in light of contrasting reports of increasing incidence of rheumatic fever in New Zealand and invasive GAS disease internationally.
The Role of School Administration in Spreading the Culture of Information and Communicate Technology Usage in Jordanian Secondary Schools
Authors: Al-Sarairah Khaled Ahmad , Al-Sarayrah Nawal Suleiman
Published: April 2024

The study aimed to investigate the role of school administration in spreading the culture of information and communicate technology in the Jordanian secondary schools from the teachers' point of view, To achieve this goal the researchers developed a questionnaire composed of (42) items, distributed into five domains: the deployment of cultural digital literacy, in the school environment, principals of the school and information and communicative technology, and providing technical support and maintenance, and the provision of appropriate infrastructure, and encourage teachers to use information and communication technology. It has been confirmed the validity and reliability. The study sample consisted of 1,000 teachers, the study discoverd the following results revealed that the role of school administration in spreading the use of information and communicative technology was medium at the macro level and in all domains with the exception of the domains of principals of the school and information and communicative technology were high, the presence of statistically significant differences due to the variable of sex at the macro level and at the level domains on an individual basis with the exception of the domain of the provision of technical support and maintenance.