bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparing the Effect of Local Application of Peppermint and Cold Compresses on the Severity of Pain from Venipuncture in Dialysis Patients: A Parallel Randomized Clinical Trial Study
Authors: Koushki Bita , Khajeh Mahboobeh , Bagheri Hossein , Talebi Seyedeh Solmaz , Ebrahimi Hossein
Published: February 2024

Pain at the injection site is one of the most common complaints in the clinic and is the most important symptom affecting the quality of life of hemodialysis (HD) patients. The aim of this study was to determine the effect and compare the topical application of peppermint and cold compresses on the intensity of pain caused by the insertion of a needle into the fistula of HD patients. In this parallel randomized clinical trial, 99 HD patients were assigned to three groups receiving peppermint, a cold compress, or a control using six blocks. For the peppermint group, 20 min before the needle's insertion, a peppermint gel was used; for the cold compress group, an ice pack was used; and for the control group, the usual method was applied. The patients' pain was assessed with the Visual Analog Scale immediately after the needle's insertion. The results showed that after the intervention, the mean and standard deviation of the pain score in the intervention groups receiving peppermint (4.81 ± 1.13) or a cold compress (4.78 ± 1.13) were significantly less than those of the control group (8.42 ± 1.22) (P <0.001), but there was no statistically significant difference between the peppermint group and the cold compress group (P = 0.91). The use of peppermint, which is a cheap and uncomplicated herbal medicine, and a cold compress, which is easy to use and available, is recommended to reduce the severity of pain caused by venipuncture in HD patients.
Study of Serum Fibroblast Growth Factor 23 as a Predictor of Endothelial Dysfunction among Egyptian Patients with Diabetic Kidney Disease
Authors: Fayed Ahmed , Mohamed AbdelAal , Ahmed Rabab Mahmoud , Abouzeid Sameh , Soliman Ahmed
Published: February 2024

Endothelial dysfunction in patients with diabetic nephropathy is caused by nontraditional factors in addition to common risk factors (e.g., hypertension) in people with normal kidney function. These nontraditional factors include factors involved in mineral bone disease in these patients. One of these factors is fibroblast growth factor 23 (FGF-23). We aimed to evaluate the relationship between flow-mediated dilatation (FMD) as a measure of endothelial dysfunction and FGF-23. This was a cross-sectional observational study that was conducted on 100 diabetic patients (Group I: 50 patients with nephropathy; Group II: 50 patients without nephropathy) and 50 healthy volunteers (Group III). Serum levels of intact FGF-23, interleukin-6, intact parathyroid hormone, and 25-hydroxyvitamin D (25-(OH)Vit D); estimated insulin resistance; and FMD were evaluated. FGF-23 was significantly higher in Group I (median: 101 pg/mL) and Group II (median: 101 pg/mL) than in Group III (median: 4 pg/mL) (P <0.001), but FGF-23 was not significantly different between Groups I and II. A significant positive correlation was found between serum levels of FGF-23 and phosphorus in Group I. A significant negative correlation was found between serum levels of FGF-23 and 25-(OH)Vit D in Group II. However, FGF-23 failed to show a significant correlation with FMD in patients with diabetic nephropathy. Our data suggest another factor that rises earlier than FGF-23 in diabetic nephropathy and causes endothelial dysfunction.
Association between Hypertension and Atrial Fibrillation in Patients on Hemodialysis
Authors: Almuhana Alanoud Husain , Alkhwaiter Lolo Ibrahim , Alghamdi Abeer , Alsaleem Alreem , Almehrij Arwa , Abdalla Mubarak , Al Sayyari Abdulla Ahmed
Published: February 2024

This study aimed to evaluate the prevalence and the association between hypertension (HTN) and atrial fibrillation (AF) in hemodialysis (HD) patients. A chart review-based, cross-sectional study was conducted on HD patients who had received HD for at least 6 months. Demographic, hemodynamic, and laboratory data were retrieved from the BestCare system, and the main outcomes were blood pressure before and after dialysis, and the presence of AF. Our sample consisted of 304 HD patients; 162 (53%) were male, and the mean age was 63 ± 18 years. Sixty-eight (20%) had AF, of whom 44 (64.7%) were male, with a mean age of 73 ± 12 years. The risk of AF increased by 0.4 [odds ratio: 1.04; 95% confidence interval (CI): 1.02-1.06; P <0.001] for every year of age. Almost the entire sample (66.45%, n = 202) was hypertensive, and those patients had a mean age of 64 ± 17 years, and nearly one-third had a body mass index in the obese category (28.7%, n = 58). In addition, with every increase in the Charlson comorbidity index score by two points, there was a 40% increased risk of developing HTN (OR: 2.47; 95% CI: 1.17–5.18; P = 0.017). The risk factors for the development of HTN and AF in HD patients were found to be increasing age for AF and female sex for HTN. The presence of HTN and diabetes increased the risk of developing AF seven-fold after HD.
Spectrum and Distribution of Biopsy-proven Kidney Diseases: A 12-year Survey of a Single Center in Iran
Authors: Nili Fatemeh , Farahani Elham , Moghimian Mehran , Jahanzad Issa , Minoo Farzaneh-Sadat , Salarvand Samaneh , Abdollahi Alireza , Mirshahvalad Seyed Ali
Published: February 2024

Data about the prevalence of biopsy-proven kidney diseases in Iran are rare, and none of the previous studies used electron microscopy for diagnosis. This study aimed to analyze the prevalence of biopsy-proven kidney diseases in Iran's primary referral center. To the best of our knowledge, this is the most extensive study carried out in Iran. Reports of kidney biopsy samples from patients referred to our center in 2007–2018 were reviewed for demographic data, clinical presentation, and final diagnosis. Statistical analyses were performed. Among the 3455 samples received, 2975 were analyzed. Nephrotic syndrome (39%) was the most common cause of biopsy, followed by subnephrotic proteinuria (18%), hematuria in association with proteinuria (15%), renal failure (9%), isolated hematuria (6%), and lupus nephritis (LN) (4%). The most common diagnoses were membranous glomerulonephritis (17.9%), focal segmental glomerulosclerosis (FSGS) (15.9%), LN (13.7%), minimal histopathological findings (unsampled FSGS vs. minimal change disease, 12.1%), Immunoglobin A nephropathy (IgAN) (6.5%) and Alport syndrome (6.1%). NS and proteinuria were the most common indications for a kidney biopsy. IgAN and LN were the most common causes of primary and secondary glomerulonephritis, presenting with hematuria and proteinuria, respectively. Although membranous glomerulonephritis was the most common disease, it has been replaced by FSGS in recent years.
Renal Survival of Chronic Kidney Disease Patients in a Tertiary Referral Hospital in Malaysia
Authors: Fatin Farhanah Omar , Azrin Ab-Hamid Siti , Norsa'adah Bachok , Adnan Azreen Syazril , Asyikeen Wan-Adnan Wan Nor
Published: February 2024

Chronic kidney disease (CKD) represents a major public health issue, which then progresses to end-stage renal disease (ESRD) sooner or later. This retrospective cohort study aimed to determine the renal survival time of CKD patients. In total, 247 CKD patients in one of the tertiary referral hospitals in Malaysia between January 2005 and December 2015 were enrolled. All CKD patients were included if they were dependent on dialysis. Patients who were transferred out and those with incomplete records were excluded from the study. The renal survival time was calculated from the time of the first diagnosis of CKD to a confirmed ESRD diagnosis or the use of dialysis. In total, 193 (78.1%) CKD patients progressed to ESRD. The mean age of the ESRD patients was 53 years old. The majority of ESRD patients were male (57.0%) and of Malay ethnicity (89.6%). The most common comorbidities among ESRD patients were hypertension (92.2%) and diabetes mellitus (85.5%). The majority of patients were in Stage IV and V (97.9%). The overall renal survival time of CKD patients who develop ESRD was 26 months (95% confidence interval: 20.41, 31.59). Patients who smoked (P = 0.001), had hyperlipidemia (P <0.001) and consumed lipid-lowering agents (P = 0.004) had a significant P-value in the log-rank test. The progression of CKD from diagnosis to ESRD was within 2 years. Therefore, early recognition of CKD is important to improve patients' outcomes and prolong their renal survival time.
Renal Allograft Malakoplakia Presenting as a Pseudotumoral Lesion
Authors: Vishwajeet Vikarn , Nalwa Aasma , Jangid Mahendra Kumar , Choudhary Gautam Ram , Khera Pushpinder , Bajpai Nitin , Elhence Poonam Abhay
Published: February 2024

Malakoplakia is an uncommon inflammatory disease that can involve many organ systems but is often encountered in the urogenital tract. Kidney allograft malakoplakia is even rarer and can have a diffuse parenchymal or a pseudotumoral presentation. We describe a case of grafi malakoplakia in an adult female, who presented with dull aching pain in the right loin, fever, and vomiting. Ultrasonography of the kidney graft showed a heterogeneous lesion (2.6 cm × 2.9 cm), raising suspicion of primary or metastatic renal tumors. The diagnosis was established after a histopathological examination of the kidney biopsy. This pseudotumoral presentation of malakoplakia can mimic renal cell carcinoma, lymphoma, fungal infections, or tuberculosis. It is essential to perform a biopsy for establishing the diagnosis.
The Epidemiology of Acute Pancreatitis in a Tertiary Care Hospital in Dubai
Authors: Alkabbani Sarah S. , AlHalak Rouzy H. , Al Smady Montaser N. , Alsaraj Fuad
Published: February 2024

Background:

The prevalence of acute pancreatitis is rising especially in the Western world, but the prevalence remains unknown in most Middle Eastern Countries. Acute pancreatitis has been attributed with multiple etiologies with the two most common being alcohol abuse disorder and gallstones. The incidence and prevalence of it in the United Arab Emirates are yet to be reported.

Materials and Methods:

The Atlanta criteria were used for the diagnosis of acute pancreatitis and applied to patients that have been admitted to a single tertiary center in the year 2021. Several variables were investigated including gender, age, clinical presentation, etiology, radiological and laboratory results, complications, and outcome. Moreover, the Bedside Index for Severity in Acute Pancreatitis score was used to assess and determine the severity of acute pancreatitis in these patients.

Results:

Nineteen patients were identified in our database with 52% being males. The mean age of patients was 41 years. The most frequent presentation was abdominal pain in 100% of our patients. Moreover, the most common etiology identified was idiopathic (52.63%), followed by biliary (21.05%). The mortality rate was 0%.

Conclusion:

This is the first retrospective study in Dubai on acute pancreatitis. Pancreatitis is a life-threatening condition with multiple etiologies. Physicians should consider multifactorial acute pancreatitis in patients with different comorbidities.
Evaluation of Association between Time in Range, a Continuous Glucose Monitoring Metric, and Cardiac Autonomic Neuropathy in Type 2 Diabetes Patients
Authors: Karthikeyan Aditya , Ramakrishna Manjunath P. , Swamy Niveditha Alok , Latha A. Tharuni
Published: February 2024

Introduction:

Time in range (TIR), a metric of continuous glucose monitoring (CGM) provides better information regarding the individual’s glycemic variability than a static measure like glycated hemoglobin (HbA1c). TIR is emerging as an independent risk factor for diabetic complications, both microvascular and macrovascular complications independent of HbA1c. Hence, this study evaluates the association between TIR and cardiac autonomic neuropathy (CAN) in type 2 diabetic patients.

Materials and Methods:

A total of 42 patients with type 2 diabetes mellitus were enrolled in this study and underwent a 3-day CGM using the “FreeStyle Libre Pro Flash Glucose Monitoring System Sensor” along with tests for CAN within the 3 days of attaching the CGM.

Results:

Out of 42 patients, 36 patients (85.7%) were diagnosed with CAN (early CAN 57.1% and definite CAN 28.6%) and the mean TIR was 64.4% ±23.5%. Out of those with TIR <70%, 42.9% were affected with definite CAN compared to only 14.3% among those with TIR >70%. Patients with more severe CAN were found to have a lower TIR (P = 0.115).

Conclusion:

The study found a high prevalence of cardiac autonomic neuropathy (CAN) of around 85.7% in type 2 diabetes patients. Lower TIR values were associated with a higher incidence of definite CAN (42.9% vs. 14.3% in TIR <70% vs. >70% groups). The findings suggest TIR is inversely associated with the presence and severity of cardiac autonomic neuropathy in type 2 diabetic patients and also a potential link between TIR and CAN severity.
Relationship between Emotional Intelligence and Resilience among Surgical Residents
Authors: Jha Ashesh Kumar , Kumar Manoj , Kumar Pragya , Ranjan Rajeev
Published: February 2024

Background and Objective:

Surgical residents face many challenges and stressors during their training. Some residents can cope better with such difficult situations, whereas others experience burnout and anxiety. Emotional intelligence (EI) and resilience are personality traits that may be associated with a better response to adverse situations.

Methodology:

A cross-sectional analytical study using validated questionnaires the Schutte Self-report EI Test (SSEIT) and the Connor–Davidson Resilience Scale (CD-RISC-25) was conducted to assess EI and resilience among the participants. Data were collected through the hard copies of the questionnaires, compiled using Microsoft Excel and analyzed using SPSS version 26. P < 0.5 was considered significant. The scores of EI and resilience were compared to evaluate the relationship between them.

Results:

A correlation analysis was performed between EI and resilience by comparing the scores obtained from SSEIT and CD-RISC. Our analysis revealed a strong positive correlation between EI and resilience (r = 0.59, P < 0.0001).

Conclusion:

Based on our results, we can say that EI and resilience are positively correlated. This means that an emotionally intelligent person should exhibit a resilient behavior.
Knowledge of Symptoms, Risk Factors, and Treatment Centers of Stroke among the General Population of Al-Ahsa, Saudi Arabia
Authors: Alhubail Fatimah Muhanna , Al-Mousa Ali Mousa , Albusaad Renad , Alsumaeel Salma , Alabbadi Mohammed S. , Almulhim Maryam A. , Alnaaim Saud
Published: February 2024

Background:

In Saudi Arabia, stroke is a significant cause of illness and mortality progressively becoming more serious. Studies have indicated that modifiable cardiovascular risk factors are responsible for a significant portion of the burden caused by stroke, which could be targeted through public awareness.

Objective:

We evaluated the level of knowledge about stroke among the general population of the Al-Ahsa, Saudi Arabia. Furthermore, association between stroke level of knowledge and sample characteristics was analyzed.

Methods:

This was a cross-sectional study conducted from February 22, 2023, to March 22, 2023, using a convenience sampling technique. An electronic Google Forms survey was distributed through social media, to reach the maximum number of participants.

Results:

This study included a total of 500 participants from Al-Ahsa, Saudi Arabia. Forty-three percentage of participants were male, while 57% were females. Most participants were of a younger age, where 66.6% were 18–39 years. The most recognized stroke symptom, risk factor, and stroke treatment center were dizziness/vertigo (91%), hypertension (97%), and King Fahad Hospital, respectively. Those with higher education possessed a greater level of stroke-related knowledge than other demographic groupings.

Conclusion:

The general public of Al-Ahsa demonstrated a high level of knowledge about stroke symptoms (82.6%), risk factors (90%), and treatment facilities (80%). However, it was evident that the general public failed to recognize the proper course of action in the event of a stroke.
Comparison of Three Scoring Criteria to Assess Recovery from General Anesthesia in the Postanesthesia Care Unit in the Indian Population
Authors: Aggarwal Shagun , Misquith Julie C R , Rao Sumesh T. , Mahanta Priyanka
Published: February 2024

Background:

Different discharge criteria are available for shifting patients out from postanesthesia care room following surgery. This study was done to compare the three-scoring system namely traditional time-based criteria, Fast track criteria and modified Aldrete score, in Indian population patients who recover after general anesthesia in postanesthesia care unit (PACU).

Materials and Methods:

Three hundred and seventy-five patients scheduled for general anesthesia were included in this study. Induction of anesthesia was done with intravenous (IV) propofol and maintained with sevoflurane inhalation with oxygen and nitrous oxide. Reversal of residual neuromuscular blockade was done with IV neostigmine and glycopyrrolate. Patients were shifted to PACU following tracheal extubation and recovery was assessed using the traditional time-based criteria, fast track criteria, and modified Aldrete score.

Results:

As per modified Aldrete score, mean time of shift out is 19 min with median of 15 min and standard deviation of 21.7 min. As per fast-track score, mean time of shift out is 187 min with median of 30 min and standard deviation of 243.7 min. As per the time-based criteria, mean time of shift out is 222 min with median of 240 min and standard deviation of 136.8 min. While using modified Aldrete score, majority of patients had a shorter stay in PACU and faster time to shift out as compared to fast-track criteria and traditional time-based criteria.

Conclusion:

Modified Aldrete score when compared to fast-track scoring and time-based criteria shows early recovery and reduces the length of stay in PACU.
Anesthetic Management in a Huge Hydrocephalus
Authors: Kumari Neha , Sai Amritha , Sharma Aditya , Kachhap Archana , Singh Dipali , Kumar Tushar
Published: February 2024

The pediatric age group with massive hydrocephalus posted for ventriculoperitoneal (VP) shunt presents a lot of confrontation to anesthesiologists due to macrocephalus and associated congenital anomalies. Here, we presented a case report with massive hydrocephalus with aqueduct stenosis, posted for VP shunt placement, and retained a difficult airway.
Alternative First-line Malaria Treatment
Authors: Maafoh Cassandra , Onyedibe Kenneth
Published: February 2024

Malaria is a disease affecting millions of people, especially in Africa, Asia, and South America, and has become a substantial economic burden. Because malaria is contracted through the bite of a mosquito vector, it is very challenging to prevent. Bed nets and insect repellents are used in some homes; others do not have or use them even when available. Thus, treatment measures are crucial to controlling this disease. Artemisinin-based combination therapy (ACT) is currently the first-line treatment for malaria. ACT has been used for decades, but recently, there has been evidence of potential resistance. This threat of resistance has led to the search for possible alternatives to ACT. In sub-Saharan Africa, Azadirachta indica, or simply neem, is a plant used to treat a variety of ailments, including malaria. Neem is effective against one of the more deadly malaria parasites Plasmodium falciparum. Reports show that neem inhibits microgametogenesis of P. falciparum and interferes with the parasite’s ookinete development. Although there is substantial in vitro research on the biological activity of A. indica (neem), there is limited in vivo research. Herein, we discuss the in vivo effects of neem on malaria parasites. With A. indica, the future of malaria treatment is promising, especially for high-risk patients, but further research and clinical trials are required to confirm its biological activity.
Serpent Strikes, Sapien Sways: A Rare Case of Bilateral Cerebellar Infarct following Viper Bite
Authors: Srinath K. M. , Sethi Mahim , Madhu B. , Prasad M. C. , Sangappa Sunila B.
Published: February 2024

Ischemic stroke following snake bite is rare. We report a posterior circulation infarct involving bilateral cerebellum and occipital lobe following Russell’s viper bite in a previously healthy individual. A 50 years old healthy individual, soon after being bitten by the Russel viper on the left foot he developed pain and swelling followed by drooping of eyelids, slurring of speech and giddiness with multiple episodes of vomiting. The patient was administered ASV as well as neostigmine and atropine injections. Following this, the neurological manifestations resolved except dysarthria. CT brain study done was normal. On day 2 of hospitalization, he developed left cerebellar signs (positive finger nose finger test, rebound phenomenon, dysdiadochokinesia, a positive heel shin test). Subsequently, an MRI with MR angiogram was done which showed acute infarcts in bilateral cerebellar hemispheres, with the left superior cerebellar peduncle showing restricted diffusion and low ADC values. Ischemic infarction following viper envenomation has been described by only few authors. In majority of the cases reported, ischemic infarction involved the anterior circulation. The possible mechanisms of infarction in this scenario are discussed. Patient was treated with anti-snake venom and showed a good recovery. Early imaging and early treatment with anti-snake venom is important for a favourable outcome.
Diagnostic Utility of Reticulocyte Hemoglobin Equivalent Parameter in the Evaluation of Microcytic Hypochromic Anemia – Our Experience from Northeast India
Authors: Rao H. R. Sohan , Mirji Sadiya
Published: February 2024

Background:

Reticulocytes are red blood cell precursors with an average lifespan of 1–2 days. Reticulocyte hemoglobin equivalent (Ret-He) is an early marker of iron deficiency (ID) erythropoiesis and reflects real-time information regarding the synthesis of young erythrocytes in the bone marrow. The objective of this study is to determine the diagnostic utility of Ret-He in patients having microcytic hypochromic anemia in comparison with serum ferritin and iron studies.

Objectives:

The objective of this study is to determine the diagnostic utility of the Ret-He parameter in patients having microcytic hypochromic anemia in comparison with the serum ferritin, iron studies and its role in routine hematological screening for nutritional deficiency anemia like ID.

Design and Settings:

The design involves observational study.

Materials and Methods:

A hospital-based observational study was carried out in a referral hospital. Hematological parameters were processed using Sysmex XN1000 (Sysmex Corporation, Kobe, Japan) analyzer and were compared with Serum iron studies using biochemistry analyzer (VITROS® 250 Chemistry System) from 201 participants who presented with microcytic hypochromic anemia.

Main Outcome and Measures:

Relationship of Ret-He parameter and its diagnostic utility for screening of iron-deficient states.

Sample Size:

The sample size was 201.

Results:

When serum ferritin is taken as “the gold standard” to detect ID, with Ret-He cutoff of 27.15 pg/cell, we found a statistically significant positive correlation between Ret-He and serum ferritin (P < 0.001). We found a sensitivity of 57.37% and specificity of 75.95% with area under the curve of 0.681, positive predictive value of 100%, negative predictive value of 3.8%, and accuracy of 62.19% for Ret-He in detecting ID anemia (IDA). Also found a statistically significant negative correlation between Ret-He and total iron binding capacity (P < 0.001). There was no statistical correlation between Ret-He and serum iron levels in our study.

Conclusions:

The present study suggests Ret-He is one of the better and more reliable hematological parameters indicating ID and, when used along with biochemical parameters like serum ferritin, can give valuable inputs in a better screening and diagnosis of IDA; hence proper treatment is possible.

Limitations:

The multicentric study is required to standardize Ret-He reference values, and follow-up to therapy of the subjects was not done. Additional hemoglobin variant analysis data would have been favorable to the study.
Utility of “Acanthosis Nigricans” and “Skin Tags” as a Screening Tool for Risk of Developing Noncommunicable Diseases: A Cross-sectional Study at a Health Facility in Lucknow (India)
Authors: Dixit Sumeet , Chandra Aditya , Kariwala Peeyush , Sachan Beena , Singh Bhanu Pratap , Pathak Anurag , Singh Arvind K. , Kandpal S. D.
Published: February 2024

Context:

Over the past three decades, there has been a significant rise in the prevalence of noncommunicable diseases (NCDs) globally, accompanied by a relative decline in communicable diseases.

Aims:

With this background, the research was planned to determine the prevalence of acanthosis nigricans (AN) or skin tags (STs) in the study population and to examine the relationship between the presence of AN and ST with commonly used indicators such as waist-to-height ratio (W/Ht.), Indian Diabetes Risk Score (IDRS), and body mass index for predicting the risk of NCDs.

Settings and Design:

This cross-sectional study was done at a health facility in Lucknow (India).

Methodology:

Consecutive sampling was employed to select 152 apparently healthy adults as the participants. Data collection involved administering a questionnaire and conducting anthropometry using standardized methods. Visual inspection was conducted to identify AN or ST on the common sites.

Statistical Analysis Used:

Data entry was done in Microsoft Office Excel, followed by data analysis using SPSS. To test the association between variables “significance of difference of mean,” Chi-square test, logistic regression analysis, and estimation of Kohen’s kappa were used. A “P” value was considered statistically significant at <0.05 level. The sensitivity and specificity of AN and ST were also estimated in predicting the risk of NCDs.

Results:

The prevalence of AN was 19.08% (95% confidence interval [CI] = 12.76%–25.40%), while the prevalence of STs was 28.29% (95% CI = 21.05%–35.53%). AN showed a sensitivity of 22.4% and specificity of 96.3% with W/Ht. ratio as the standard, and a sensitivity of 26.44% and specificity of 90.77% with IDRS as the standard. ST exhibited a sensitivity of 32.0% and specificity of 88.89% with W/Ht. ratio as the standard, and a sensitivity of 37.93% and specificity of 84.62% with IDRS as the standard.

Conclusion:

AN and ST can be used as simple and time-saving tools in screening protocols for (NCDs). Further research is desirable to validate the findings.
Experience with Colostomy and Colostomy Reversal in Children in Bauchi
Authors: Bwala Kefas John , Wabada Samuel , Aminu Mohammed Umar , Ja’afar Abubakar Bappah , Adamu Sani , Oloko Nasirudeen Lanre
Published: February 2024

Background:

Colostomy is one of the common surgical procedures performed in pediatric surgical practice. The aim of this study was to retrospectively review our experience with colostomy and closure (reversal) in children.

Patients and Methods:

A retrospective review of the data of all children aged 15 years and below who had colostomy and colostomy closure in the past 5 years.

Results:

Of the 67 children who had colostomy 42 (62.7%) boys and 25 (37.3%) girls, with an age range between 13 months and 8 years. Fifty-six (83.6%) of the children were <2 years. Anorectal malformation 53 (79.1%) was the common indication. Divided colostomy was performed in 62 (92.5%) patients and loop colostomy was performed in 5 (7.5%) patients. All the patients had intraperitoneal colostomy closure. A complication rate of 26.4% was seen. Duration of hospital stay ranged between 4 and 10 days. No mortality was recorded.

Conclusion:

Colostomy reversal is a safe procedure but morbidity may ensure and can easily manage.
Prevalence of Paratuberculosis in Dairy Cattle in Ecuador
Authors: Echeverr Gustavo , Escobar Henry , Changoluisa Darwin , Ron Lenin , Proaño Andrea , Proaño-Pérez Freddy , Zumárraga Martin J. , de Waard Jacobus H.
Published: February 2024

Background:

Mycobacterium aviumsubsp.paratuberculosis(MAP) is the causal agent of paratuberculosis, a chronic infectious contagious disease of the intestinal tract of ruminants that are also associated with Crohn's disease in humans. The existence of paratuberculosis in Ecuador is virtually unknown; hence, the present study was performed to gain insight into the prevalence of this disease.

Methods:

Three dairy cattle farms in different geographic regions in Ecuador were investigated for the infection with MAP, and 600 blood samples, 200 of each cattle herd, were processed with an indirect enzyme-linked immunosorbent assay. Fecal samples of the seropositive cows were processed for culture on modified Löwenstein–Jensen medium.

Results:

One hundred and fifty bovines (25%) resulted seropositive and we confirmed with culture the presence of MAP in 4.7% (7/150) of the seropositive cows. Approximately 20% of the fecal samples of seropositive cows yielded nontuberculous mycobacteria (NTM) species includingM. aviumsubsp.avium,a NTM species closely related to MAP.

Conclusions:

The seroprevalence of paratuberculosis in this first study for Ecuador is high (25%). We discuss a possible interference of NTM species, isolated from fecal samples, with the diagnosis of paratuberculosis. With this report, a baseline study, we confirm for the first time the presence of paratuberculosis in Ecuador, and we provide the necessary information for future studies and control of this disease.
An Overview of Pulmonary Infections Due to Rapidly Growing Mycobacteria in South Asia and Impressions from a Subtropical Region
Authors: Shrivastava Kamal , Kumar Chanchal , Singh Anupriya , Narang Anshika , Giri Astha , Sharma Naresh Kumar , Gupta Shraddha , Chauhan Varsha , Gunasekaran Jayanthi , Balasubramanian Viswesvaran , Chaudhry Anil , Singla Rupak , Prasad Rajendra , Varma-Basil Mandira
Published: February 2024

Background:

Rapidly growing mycobacteria (RGM) comprise nearly half of the validated species of nontuberculous mycobacteria (NTM) and have been reported to have a higher incidence in Asia as compared to Europe and America. There is limited information on RGM infections from South Asia. Hence, the present study aimed to ascertain the incidence of pulmonary infections due to RGM in Delhi and to review the status of available information on the prevalence of RGM in South Asia, a region endemic for tuberculosis.

Methods:

We analyzed 933 mycobacterial isolates obtained from pulmonary samples in Delhi and performed species identification by polymerase chain reaction (PCR)-restriction analysis (restriction fragment length polymorphism) and line probe assay. Drug susceptibility testing (DST) was performed by broth microdilution method. We also reviewed reports available on pulmonary infections in South Asia, attributed to RGM.

Results:

Of the 933 mycobacterial isolates studied, NTM were identified in 152 (16.3%). Of these, 65/152 (42.8%) were RGM comprising Mycobacterium fortuitum (34/65; 52.3%), Mycobacterium abscessus (25/65; 38.5%), Mycobacterium chelonae (3/65; 4.61%), Mycobacterium mucogenicum (2/65; 3.1%), and Mycobacterium smegmatis (1/65; 1.5%). On applying the American Thoracic Society/Infectious Diseases Society of America guidelines, 11/25 (44%) M. abscessus, 3/3 (100%) M. chelonae, and both isolates of M. mucogenicum were found to be clinically relevant. DST revealed that maximum susceptibility of the RGM was seen to linezolid, clarithromycin, and amikacin.

Conclusions:

Of the RGM isolated in the present study, 16/65 (24.6%) were found to be clinically relevant. Hence, it is important to recognize these organisms as potential pathogens to identify patients with RGM disease to initiate appropriate therapy.
Disseminated Mycobacterium Scrofulaceum Infection in a Patient with Anti-Interferon-γ Autoantibodies
Authors: Chaononghin Surachai , Visuttichaikit Suttichai , Apisarnthanarak Anucha , Khawcharoenporn Thana
Published: February 2024

Mycobacterium scrofulaceum is an environmental mycobacterial species rarely reported to cause disseminated infection in adults. We report the case of a disseminated M. scrofulaceum infection in a 55-year-old nonhuman immunodeficiency virus-infected Thai man with anti-interferon-γ autoantibodies. The clinical signs of the infection improved after the induction regimen with amikacin, rifampicin, ethambutol, and clarithromycin, followed by the consolidation regimen with ethambutol, clarithromycin, and trimethoprim/sulfamethoxazole. Our review of previous reported cases of this infection indicates its association with immune deficiency, complex treatment, and a high rate of unfavorable outcomes.
Metastatic Tuberculous Chest Wall and Massive Psoas Abscesses in an Immunocompetent Patient
Authors: Abdulla Mansoor C.
Published: February 2024

Extrapulmonary tuberculosis (TB) is rare in immunocompetent healthy adults. TB of the chest wall accounts for 1%–5% of all cases of musculoskeletal TB. Psoas abscess can be either primary or secondary to diseases like Pott's spine. We describe a patient with massive lower chest wall abscess extending to abdominal muscles and an asymptomatic large psoas abscess detected on imaging due to spine TB which responded well to antitubercular therapy and drainage without surgical measures. The concomitant presence of a massive chest wall abscess and psoas abscess due to TB in an immunocompetent patient was not reported previously.
Persistent Laparoscopic Port-site Discharging Sinus
Authors: Muhammed Niyas Vettakkara Kandy , Keri Vishakh C. , Singh Binit Kumar , Kumar Prabhat
Published: February 2024

Laparoscopic port-site infections, though infrequent, undermine the advantages provided by minimally invasive surgeries. Persistent nonhealing discharging sinuses, not responding to conventional antibiotic therapy, pose diagnostic and therapeutic challenges. Sizeable number of these infections is caused by rapidly growing nontuberculous mycobacteria (NTM), and diagnosing these requires a high index of suspicion. We present a case of a nonhealing laparoscopic cholecystectomy umbilical port-site infection caused by Mycobacterium senegalense, a rare NTM. The patient recovered completely after 6 months of combination therapy with clarithromycin, trimethoprim-sulfamethoxazole, and levofloxacin.
Dominant Marker (Inter-Simple Sequence Repeat-Polymerase Chain Reaction) versus Codominant Marker (RLEP-polymerase Chain Reaction) for Laboratory Diagnosis of Leprosy
Authors: Mohanty Partha Sarathi , Bansal Avi Kumar , Naaz Farah , Patil Shripad A. , Arora Mamta , Singh Manjula
Published: February 2024

Background:

Leprosy is a contagious disease and was eliminated globally in 2002. Since then, new cases were continuously detected from different parts of the world. Untreated leprosy cases shed millions of bacteria and are the main cause of dissemination of the disease. Currently, leprosy is detected by acid-fast bacilli (AFB) microscopy and has a low sensitivity ranging from 10% to 50%. The correlation between clinical findings and microscopy is unable to provide a conclusive case detection. Thus, in the present study, we compared to molecular methods, namely RLEP-polymerase chain reaction (RLEP-PCR) and inter-simple sequence repeat-PCR (ISSR-PCR) taking AFB microscopy as a gold standard for the detection of leprosy.

Methods:

A total of 168 clinically diagnosed leprosy patients were recruited in this study including 58 multibacillary and 110 paucibacillary patients. Slit-skin smear samples were taken for both microscopy and molecular study. Primers for RLEP-PCR were taken from the previous reports. The primers for ISSR-PCR were designed by screening the whole genome of Mycobacterium leprae TN strain (GenBank accession AL450380) for the presence of simple sequence repeats. One primer (TA)8CA3was synthesized and used for molecular amplification of ISSR-PCR.

Results:

We found that the efficacy of the AFB microscopy was 24.40%, whereas the efficacy of RLEP-PCR and ISSR-PCR was 63.09% and 73.21% (P = 0.000, 0.000, and 0.469), respectively. The area under the curve of receiver operating characteristic curve for the comparison of three diagnostic methods was 0.845. An enhancement of 48.81% in the case detection rate by ISSR-PCR over AFB microscopy and 10.12% over RLEP-PCR was also found. Our study clearly reveals that ISSR-PCR is a better tool for diagnosis of leprosy than AFB microscopy and RLEP-PCR. Interestingly, both the PCR techniques RLEP-PCR and ISSR-PCR are able to detect samples which were negative for AFB microscopy.

Conclusion:

Thus, the demonstration of ISSR-PCR in SSS samples can provide a better sensitive and confirmative tool for early diagnosis of leprosy.
Evaluation of the Intracellular Accumulation of Fluoroquinolones in Mycobacteria by Fluorometric Assays
Authors: Deo Nirmala , Sharma Divakar , Bisht Deepa , Venkatesan Krishnamurthy
Published: February 2024

Background:

Fluoroquinolones (FQs) are being used as second-line agents in the treatment of tuberculosis caused by multidrug-resistant strains. Ofloxacin (OFX) is being tried as a part of modified multidrug therapy regimens for leprosy. A preliminary study was carried out to evaluate the accumulation of FQs – OFX, levofloxacin (LFX), norfloxacin (NFX), and ciprofloxacin (CIF) in Mycobacterium smegmatis.

Methods:

M. smegmatis were grown in Sauton's medium till log phase, harvested and resuspended in phosphate buffer (0.1 M, pH 7.2, Optical Density (OD) of 0.4–0.5) The suspensions were incubated with OFX, LFX, NFX, and CIF (10 μg/ml) at 37°C. The drugs were estimated in the supernatants using spectrofluorimeteric methods. The experiments were also conducted with the addition of carbonyl cyanide m-chlorophenyl hydrazone (CCCP), a proton motive force inhibitor, at 100 μM, 10 min before and/or immediately after the addition of the drugs.

Results:

The time taken to achieve a Steady State Concentration (SSC) of OFX in M. smegmatis was 3 min and the level of accumulation was 102 ng/mg dry weight of the bacilli; with LFX the time for SSC was 5 min and the level of accumulation was 90 ng/mg; in case of NFX the accumulation to SSC was 87 ng/mg in 3 min. CIF accumulation attained a steady state (SSC level of 79 ng/mg) in 4 min. The accumulation kinetics for NFX in M. smegmatis using the spectrofluorimetric method is comparable with radioactive assays. Dose-related accumulation was observed with 10 μg/ml exposure concentrations. The addition of CCCP failed to influence the accumulation of each of these quinolones.

Conclusion:

The findings of dose-related accumulation of OFX, LFX NFX, and CIF suggest simple diffusion as the possible mechanism of transport of these drugs.
Risk Factors for Hypercalcemia in Patients with Tuberculosis
Authors: John Sujith Mathew , Sagar Sheeba , Aparna Joshi Krishnakumari , Joy Sharon , Mishra Ajay Kumar
Published: February 2024

Background:

Tuberculosis (TB) is prevalent worldwide and causes significant morbidity and mortality. TB is known to cause hypercalcemia. We aimed to assess the prevalence and risk factors for developing hypercalcemia among patients with TB.

Methods:

In this retrospective case–control study, patients with microbiological evidence of TB and an available serum calcium value were included between 2005 and 2016. The demographic, clinical, and laboratory details were recorded. Various risk factors were compared in TB patients with and without hypercalcemia.

Results:

A total of 129 patients fulfilled the inclusion criteria. Twenty percent were found to have an elevated serum calcium level, 65% of them had clinical features of hypercalcemia. In comparison, the odds of developing hypercalcemia in the presence of disseminated TB, diabetes and renal failure was 1.83, 1.60, and 7.33, respectively.

Conclusion:

One-fifth of patients with TB have hypercalcemia. Risk factors of the same are renal failure, diabetes, and disseminated TB.
Evaluation of Mycobacterium kansasii Extracellular Vesicles Role in BALB/c Mice Immune Modulatory
Authors: Tavassol Zahra Hoseini , Aziziraftar Shahrbanoo Keshavarz , Behrouzi Ava , Ghazanfari Morteza , Masoumi Morteza , Fateh Aboulfazl , Vaziri Farzam , Siadat Seyed Davar
Published: February 2024

Background:

Mycobacterium kansasii as a nontuberculosis mycobacteria, naturally release extracellular vesicles (EVs) with widespread utilities. The aim of the present study was the extraction and biological evaluation of M. kansasii EV and its role in BALB/c mice immune modulatory by considering EVs medical usage specificities.

Method:

Density gradient ultracentrifugation method was used to EVs extraction from standard species of M. kansasii. Biologic validation of EVs has been performed by physicochemical experiments. Immunization has been done by subcutaneous injection to BALB/c mice, then spleen cell isolation and lymphocyte transformation test and eventually ELISA cytokine assays were made for interleukin-10 (IL-10) and interferon-gamma (IFN-γ). IBM SPSS version 22 software (SPSS. Inc., Chicago, IL, USA) was used for the data calculation. The evaluation of variables was conducted using one sample t-test.

Results:

Physicochemical experiment results contribute that extracted EVs have intransitive capability to use in immunization schedule. Finally, ELISA test results showed that EVs induced IL-10 production, but have no effect on IFN-γ.

Conclusions:

In this current study, EVs were prepared in high-quality composition. The results of cytokine assay revealed that the extracted EVs have anti-inflammatory property. Accordingly, this macromolecule can be used as immune modulatory agents to prevent severe immune reactions, especially in lungs disorders.
Outcomes of Pulmonary Mycobacterium abscessus Infection
Authors: Flight William G. , Hough Natasha E. , Chapman Stephen J.
Published: February 2024

Background:

Treatment of Mycobacterium abscessus pulmonary disease (PD) is challenging with frequent side effects and uncertain rates of success.

Methods:

We performed a retrospective review of all patients at our center with at least one respiratory sample positive for M. abscessus between 2014 and 2019. Electronic health records were reviewed to determine factors associated with M. abscessus infection and clinical outcomes.

Results:

Thirty-seven patients were identified including 24 with cystic fibrosis (CF), 10 with bronchiectasis, two with chronic obstructive PD (COPD), and one with asthma. American Thoracic Society/Infectious Diseases Society of America criteria for nontuberculous mycobacteria PD were met in 21/37 (56.8%) of cases. Evidence of Aspergillus lung disease was noted in 18 (75.0%) CF patients compared with 3 (23.1%) non-CF patients (P = 0.005). Induction therapy for M. abscessus was given to 22/37 (59.5%) patients (18/24 [75%] with CF and 4/13 [30.8%] without CF). Median duration of induction therapy was 6 weeks (range 3–12). Maintenance antibiotic therapy was prescribed to 17/22 (77.3%) of treated patients. Culture conversion was seen in 15/24 (62.5%) of CF patients compared with 3/13 (23.1%) in the non-CF group (P = 0.034). Culture conversion occurred in 10/22 (45.5%) of treated patients compared with 8/15 (53.3%) untreated patients. Three patients (8.1%) died during follow-up: one with CF and two with COPD.

Conclusions:

Culture conversion following isolation of M. abscessus from respiratory samples not only is more common in CF than in patients without CF but also frequently occurs spontaneously in both groups. Targeted treatment for M. abscessus did not clearly impact rates of culture conversion.
Diagnostic utility of LMO2 immunohistochemistry in distinguishing T-lymphoblastic leukemia/lymphoma from thymoma
Authors: Bansal Divya , Pasricha Sunil , Gupta Gurudutt , Sharma Anila , Durga Garima , Kamboj Meenakshi , Mehta Anurag
Published: February 2024

Distinguishing T-lymphoblastic leukemia/lymphoma (T-ALL/T-LBL) from thymomas (especially B1 or B2 type) can be challenging particularly in limited trucut biopsy material where appreciating architecture is difficult or the background epithelial component does not provide tangible evidence for definite diagnosis. As a pathologist, it is important to accurately diagnose these neoplasms because they have entirely distinct management protocols. Recent studies have reported that LIM Domain Only 2 (LMO2) is expressed in neoplastic lymphoblasts of T-ALL/T-LBL and is absent in thymocytes of normal thymuses or thymomas. An observational study was done to test the sensitivity and specificity of LMO2 in differentiating neoplastic lymphoblasts from thymocytes of thymomas/normal thymuses. Our study showed that LMO2 had sensitivity of 70% and specificity of 100% in diagnosing LBL. None of the thymomas (B1 or B2 type) showed expression of LMO2 in the neoplastic cells. LMO2 is a reliable marker of transformed T-cell precursors and should be routinely included in immunohistochemical panel when evaluating thymic/mediastinal neoplasms.
Perception of Undergraduate Physiotherapy Students toward Objectively Structured Practical Examination Checklist as a Tool for Assessment and Learning Active Cycle of Breathing Techniques Skill: A Cross-sectional Descriptive Study
Authors: Kulkarni Madhur , Sinha R. K. , Sinha Saumi , Mahajan Aashirwad
Published: February 2024

Context:

Demonstration of any psychomotor skill is a very important part of physiotherapy education as it deals with the utilization of that particular skill in patients. Hence, efforts should be taken to make students understand all the necessary steps practically and assess their performance. Furthermore, techniques to reduce stress levels of students should be incorporated to reduce examination-related stress.

Aim:

The study aims to determine the perception of undergraduate physiotherapy students and faculty members regarding the Objectively Structured Practical Examination (OSPE) checklist used for assessing Active Cycle of Breathing Technique (ACBT) skills as a tool to improve learning and skill performance.

Settings and Design: The study was a cross-sectional descriptive design with purposive sampling conducted in a Physiotherapy college in Maharashtra.

Subjects and Methods:

160 undergraduate physiotherapy students and 6 faculty members participated in the study. Theoretical and practical sessions of ACBT were conducted by the subject teacher for undergraduate physiotherapy students and assessment was done in the form of a traditional practical examination first. After that students and examiners were sensitized about the nature of the OSPE checklist and an assessment was carried out along with the scoring. After the activity, feedback was noted and analysed.

Results:

98.75% of students rated the questionnaire as being accessible and understandable, 96.25% reported improvement in confidence to perform the skill, 85% of students denoted positive responses regarding reducing the stress of performance of the practical skill.

Conclusion:

The study concludes that the use of a checklist for ACBT skill assessment can facilitate a favourable learning and teaching environment. It is useful to perform the skill precisely, improving confidence and clarity to perform the skill.