bluuebunny/crossref_metadata_2025 huggingface dataset:
Delivering public value by selected government departments in South Africa – Perceptions of senior managers
Authors: Pooe David , Munyanyi Watson
Published: August 2022

Background: Over the years, the expectations of both the public and private sectors regarding value have changed significantly, thereby increasing the need for government departments to revisit their public-value creation model.Aim: This study sought to explore perceptions of senior managers in selected national government departments in South Africa with regard to the influence of information sharing, process innovation, stakeholder analysis and engagement in the relational governance and public value.Setting: The respondents were 230 senior managers from the five national government departments who, over time and in various groups, attended the Executive Development Programme hosted by the National School of Government.Methods: A quantitative research approach involving a cross-sectional survey design was followed in the study. Data were analysed by means of structural equation modelling (SEM).Results: In the study a strong, positive relationship was found between information sharing, process innovation, stakeholder analysis and relational governance. Further, a strong positive relationship between relational governance and public value was also established.Conclusion: Based on the perceptions of senior managers, government departments seeking to deliver superior public value need to focus primarily on managing their relational governance. To that end, it is vital that they develop their information-sharing and process innovation, as well as stakeholder analysis and engagement.
The sexual and reproductive health needs of young people living with HIV in Gauteng, South Africa
Authors: Ndlazi Bandile E. , Masango Thembekile
Published: August 2022

Background: HIV has been the focus of health systems strengthening in South Africa for the past two decades. Despite progress, sexual and reproductive health (SRH) challenges such as contraception, condom usage and HIV disclosure of young people living with HIV (YPLHIV) remain inadequately addressed. Therefore, the purpose of the study was to describe the SRH needs of YPLHIV and make recommendations to address identified gaps.Objectives: To explore and describe the SRH needs and potential systemic gaps of YPLHIV with an aim to make recommendations for improvement and contribute to the development of an integrated approach to SRH care in HIV programming.Method: A quantitative cross-sectional research design with purposive sampling was utilised. YPLHIV were recruited from five healthcare facilities in Gauteng, South Africa, for face-to-face interviews.Results: One hundred and six YPLHIV with a median age of 18 years were enrolled. A large proportion (57/106; 53.8%) of respondents reported being either single or double orphaned. Sex-related discussions with parents were reported by only 36/106 (34.0%). History of teenage pregnancy was reported in 39/70 (56.0%) of female respondents. A high prevalence of multiple sexual partnerships 41/97 (42.2%) was noted. Consensual partner HIV disclosure was low at 47/97 (48.4%) and the male gender was associated with low 10/35 (28.6%) disclosure of serostatus to sexual partners.Conclusion: Multiple SRH needs were identified. Interventions are needed to improve parental guidance on SRH issues, increase contraception knowledge and access, and provide better male-centred care.
Eye Signs in Stroke
Authors: Sahonta Rajeshwar , Sebastian Ivy , Aaron Sanjit , Prabakhar Appaswamy T. , Arthur Anupriya , Pandian Jeyaraj D.
Published: August 2022

A large part of the central nervous system is involved in the normal functioning of the vision, and hence vision can be affected in a stroke patient. Transient visual symptoms can likewise be a harbinger of stroke and prompt rapid evaluation for the prevention of recurrent stroke. A carotid artery disease can manifest as transient monocular visual loss (TMVL), central retinal artery occlusion (CRAO), anterior ischemic optic neuropathy or ocular ischemic syndrome (OIS). Stroke posterior to the optic chiasm can cause sectoranopias, quadrantanopias, or hemianopias, which can be either congruous or incongruous. Any stroke involving the dorsal stream (occipito-parietal lobe), or ventral stream (occipito-temporal lobe) can manifest with visuospatial perception deficits. Similarly, different ocular motility abnormalities can result from a stroke affecting the cerebrum, cerebellum, or brainstem. Among these deficits, vision and perception disorders are more difficult to overcome. Clinical, experimental, and neuroimaging studies have helped us to understand the anatomical basis, physiological dysfunction, and the underlying mechanisms of these neuro-ophthalmic signs.
Assessment of Non-Motor Symptoms of Parkinson's Disease and Their Impact on the Quality of Life
Authors: Kumar Anand , Patil Sooraj , Singh Varun K. , Pathak Abhishek , Chaurasia Rameshwar Nath , Mishra Vijaya N. , Joshi Deepika
Published: August 2022

Background:

During the past decade the view of Parkinson's disease (PD) as a motor disorder has changed significantly and currently it is recognized as a multisystem disorder with diverse non-motor symptoms (NMS).

Aims:

The present study aimed to evaluate and characterize the NMS and study their impact on quality of life (QoL) in a PD patient cohort.

Material and Methods:

This was a cross-sectional study where 92 PD patients fulfilling the UK Parkinson's disease society brain bank criteria were enrolled from a movement disorder clinic. All patients were evaluated using unified Parkinson's disease rating scale, non-motor symptoms scale (NMSS) for the non-motor symptoms, and Parkinson's disease questionnaire-39 (PDQ-39) for the QoL. The impact of NMS on QoL was assessed statistically.

Results:

A total of 92 patients were enrolled with a mean age of 55.40 ± 7.37 years, mean age of onset of disease 51.62 ± 6.38 years, and mean disease duration of 3.78 ± 1.54 years. Type of disease was akinetic rigid variant in 29.3% (n = 27), tremor predominant type in 36.9%(n = 34), and mixed type in 33.6% (n = 31). Mean Hoehn and Yahr stage was 2.12 ± 0.54. In the NMSS, most common symptom was sleep and fatigue (83%), followed by urinary tract symptoms (63%), mood and cognition (51%), cardiovascular symptoms and falls (43%), gastrointestinal tract symptoms (38%), and sexual function (33%). Univariate analyses showed that all NMS domains had a significant correlation with PDQ-39 with P < 001.

Conclusion:

Our study shows that NMS in PDare fairly common and significantly impact the QoL.
Sexual dysfunction in women suffering from major depressive disorder: A cross-sectional study
Authors: Pindikura Ranjit Kumar , Kumar K. Uday , Krishna Javangula Swetha
Published: August 2022

Background:

Compared to a healthy population, sexual dysfunction is higher in major depressive disorder (MDD). Identification and management of sexual dysfunction profoundly impact marital satisfaction, quality of life, and compliance with treatment in patients with depression.

Aims and Objectives:

The primary objective was to determine the proportion of sexual dysfunction among women suffering from MDD attending the psychiatry department of a tertiary care center. The secondary objectives were (1) to study the correlation between the severity of depression and sexual dysfunction in women with MDD and (2) to study the relationship between sociodemographic and clinical variables with sexual dysfunction.

Settings and Design:

This was a cross-sectional study carried out among 40 women diagnosed with MDD attending the psychiatry department of our tertiary care institute.

Materials and Methods:

After taking informed consent, relevant sociodemographic details and clinical variables were recorded using a semi-structured questionnaire. MDD was diagnosed according to the Diagnostic Statistical Manual of Mental Disorders-Fifth Edition, and its severity was assessed using Hamilton rating scale for depression. Sexual dysfunction was measured using the Arizona sexual experience scale.

Statistical Analysis:

Spearman’s correlation coefficient was used to assess the correlation between the severity of depression and sexual dysfunction. The Chi-square test was used to test the relationship between categorical variables. Analysis of data was done using appropriate statistical software.

Results:

The proportion of sexual dysfunction among women with MDD was 65%. The most common sexual dysfunction was low sexual desire (57.5%). There was a positive correlation between the severity of depression and the presence of sexual dysfunction, with Spearman’s correlation coefficient (rho = 0.765,P= 0.000). Age, attainment of menopause, history of alcohol and tobacco use in the spouse, and severity of depression were significant with sexual dysfunction using the Chi-square test.

Conclusions:

The proportion of sexual dysfunction was high among women suffering from MDD. The severity of depression and the presence of sexual dysfunction are positively correlated.
Can hematologic inflammatory parameters predict the severity of coronavirus disease 2019 at hospital admission?
Authors: Mahmoud Manal A. , Khaleel Waleed G. , Medhat Mohammed A. , Hosni Amal , Kasem Ahmed H. , Ramadan Haidi Karam-Allah
Published: August 2022

Background

The ability to forecast the progression and severity of coronavirus disease 2019 (COVID-19) disease is critical for effective management.

Objective

To determine whether hematological parameters can predict severe COVID-19 at the time of hospital admission.

Patients and methods

The study was conducted on 298 admitted COVID-19 patients. They were categorized into severe or nonsevere groups. Blood picture was done with analysis of red-cell distribution width (RDW), neutrophil–lymphocyte ratio (NLR), RDW-to-platelet ratio, and platelet–lymphocyte ratio (PLR). Other investigations like D-dimer, ferritin, C-reactive protein, kidney, and liver functions were assessed and compared between the groups.

Results

Males were predominant in the severe group (65.7%). Compared with the nonsevere group, the severe group had a higher median age (59 vs. 37 years). The severe group showed significantly lower counts for lymphocytes and platelets (P=0.000), while the total leukocytic count and neutrophils were significantly higher compared with the nonsevere group. Also, the severe group showed significantly higher ratios regarding NLR and PLR (P=0.021 and 0.000, respectively). RDW and RDW-to-platelet ratio values were not significantly different between both groups. While assessing the risk factors for severe COVID-19, the highest odds ratio was observed for NLR, odds ratio: 1.954 (confidence interval: 1.404–2.718). A cut-off point of NLR more than 1.67 had high sensitivity 81.3 and 60.2% specificity with high accuracy; area under the curve=0.780. PLR at a cutoff more than 176 showed 70.5% sensitivity and 62% specificity with high accuracy area under the curve=0.760.

Conclusion

NLR and PLR could be used as simple, readily available, and cost-effective biomarkers predicting the severity of cases of COVID-19. Hematologic parameter values mostly alter amid the course of the illness.
Impact of average volume-assured pressure-support mode on the management of obesity hypoventilation syndrome
Authors: El Maksude Hayam Ameen Abd , ElSharawy Dalia E. , Ahmed Laila Mahmoud Said , Elkholy Mohamed Gamal Amer
Published: August 2022

Background

The mode of average volume-assured pressure support (AVAPS) was considered as a newly developed noninvasive ventilation mode that measures the tidal volume of the patient at multiple respiratory cycles and estimates the varieties in positive airway pressure during inspiration to reach to the target tidal volume for the patient.

Objectives

The present prospective observational randomized study’s goal is to evaluate the advantages of new spontaneous timed/AVAPS mode compared with the conventional spontaneous/timed mode as a noninvasive ventilation for management of obesity hypoventilation syndrome regarding daytime hypercapnea, body activities, and quality of life related to health.

Patients and methods

Our study included 40 patients with a syndrome of obesity hypoventilation and were classified into group I: 20 patients received positive airway pressure by bilevel positive pressure ventilation/spontanous timed (BPV/ST) mode and group II: 20 patients ST/AVAPS mode. Clinical assessment with gasometric measurements and severe respiratory-insufficiency questionnaire were performed to all studied participants.

Results

PaCO2 significantly decreased at 48 h during spontaneous/timed mode of noninvasive ventilation by 62.93 ± 10.19 mmHg, but significantly decreased earlier at 12 h during spontaneous/timed-AVAPS mode of noninvasive ventilation by 55.10 ± 5.75 mmHg. After 6 weeks, the exhaled volume was higher significantly, also, the leak volume tended to be less significantly during spontaneous/timed-AVAPS group with improvement of severe respiratory-insufficiency summary-scale score.

Conclusions

AVAPS/ST mode provided additional benefits on BPV/ST mode, including earlier and higher decrease in PaCO2 level with more tolerability and lower leaks.
Can simple blood markers predict the outcome of coronavirus disease 2019 (COVID-19) infection?
Authors: Elmorshedy Reham M. , El-Kholy Maha M. , Abdel Moniem Alaa E. , Hassan Shimaa A. , Sadek Samiaa H.
Published: August 2022

Background

Several millions of humans all over the world were affected by the novel coronavirus that emerged in Wuhan, Hubei, China, at the end of December 2019, known as severe acute respiratory syndrome coronavirus 2. The epidemic has gradually spread to 208 countries, leading to the death of more than two million and a half people, and this number is rapidly increasing. The rationale of the current study was to assess the role of some simple blood markers in suspecting the outcome of patients with severe infection.

Patients and methods

A cohort retrospective study was carried out that included critically ill coronavirus disease 2019-infected patients with positive PCR test result who were admitted to the critical care unit within 2 months. Information concerning clinical presentation, laboratory, and radiological findings was collected; moreover, the outcome and the length of critical care stay were documented. Statistical analysis was done, where collected data were compared between survivors and nonsurvivors. Receiver operating characteristic curve was used for the assessment of sensitivity and specificity of blood markers in predicting mortality.

Results

The number of patients included in the present study was 103. Most patients presented with fever and cough, and the main radiological finding was bilateral ground-glass lesions. On comparing both groups, the group that survived had elevated baseline values of PaO2/FiO2 ratio and lymphocyte count. However, the number of neutrophils, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio, D-dimer, and serum level of ferritin were lower in this group; nonsurvivors had longer ICU stay. The following parameters were predictors for mortality: older age; increased neutrophil count, NLR, and D-dimer levels; and lower values of PaO2/FiO2 ratio. D-dimer and NLR had the highest sensitivity (81.3 and 87.5%, respectively) with area under the curve of 0.82 and 0.76, respectively.

Conclusion

Simple blood markers are sensitive parameters for suspecting outcome of severe coronavirus disease 2019 infection.
Indications and prognostic outcome of inferior vena cava filter
Authors: Eldaboosy Safwat A.M. , Farouk Mahmoud , Farouk Abdullah , Antar Ahmad , Awad Amgad , Nour Mohamed O. , Ahmed Gasmelseed Y.
Published: August 2022

Background

An inferior vena cava (IVC) filter is useful in patients with venous thromboembolism (VTE) who have any of the following conditions: contraindications to anticoagulants, recurrent pulmonary embolism (PE) despite anticoagulants or complications related to anticoagulants, and low cardiopulmonary reserve. This study aimed to assess indications, efficacy, and outcome of IVC filter insertion for patients with VTE.

Patients and methods

A retrospective study was conducted at Almoosa Hospital, Al Alhsa, Kingdom of Saudi Arabia, in the period between August 2017 and September 2020. All adult patients who underwent IVC filter were included.

Results

The study included 1350 cases. The patients were divided into two groups: group 1 included 1310 patients who had VTE without the need for an IVC filter, and group 2 included 40 patients, 39 of whom had VTE and required an IVC filter, and one patient with polytrauma (cerebral hemorrhage, pelvic hematoma) in whom an IVC filter was used prophylactically. A total of 40 IVC filters were used. Thirty (75%) patients had submassive PE with pulmonary hypertension and low pulmonary vascular reserve, nine (22.5%) patients had VTE with contraindications for an anticoagulant (due to gastrointestinal bleeding, cerebral hemorrhage, or major trauma), while one (2.5%) patient had an IVC filter inserted prophylactically although no VTE was present. The rate of IVC removal was 30% (12 cases), with no reported complications of IVC insertion or removal, except in one case where the filter was removed in two separate sessions.

Conclusion

IVC filter insertion, when used correctly, is a safe and effective method of preventing a potentially fatal PE by blocking the passage of thrombi from the lower extremities and pelvis to the lungs when used correctly.
A case series of interventional pulmonology in the era of coronavirus disease 2019
Authors: Singh Gurmeet , Fauzi Nova B.
Published: August 2022

The coronavirus disease 2019 (COVID-19) pandemic is still ongoing, and respirology associations globally are updating and releasing guidelines to provide appropriate care for health care workers and patients. The virus can become airborne if aerosol-generating procedures (AGPs) are performed. Interventional pulmonology procedures were performed on 63 patients within the period of March–May 2020. During this pandemic, personnel involved per procedure is limited, personal protective equipment level 3 is utilized in AGPs, and level 2 personal protective equipment is used in non-AGPs. The majority of patients were male (54%) and were aged 30–49 years (35%). Bronchoscopy was the most frequent procedure performed (62%). The most common pulmonary conditions in these patients were pneumonia, pleural effusion, and lung mass/consolidation (all 24%). There were seven (11%) patients diagnosed as having probable COVID-19. Interventional pulmonology procedures can still be performed in the era of COVID-19 pandemic.
Role of chest ultrasonography in the diagnosis of the causes of acute respiratory failure
Authors: Azab Nourane Y. , El Wahsh Rabab A. , Ammar Mohammed E. , El-Koa Amal A.
Published: August 2022

Objective

To evaluate the role of chest ultrasonography (US) in diagnosing the causes of acute respiratory failure (ARF).

Background

ARF is a common critical problem and can arise from many diseases. Several modalities such as chest radiograph, US, and computed tomography (CT) scan are being used to diagnose and detect the causes of ARF.

Patients and methods

The study included 50 patients with ARF admitted to the ICU of Menoufia University Hospital and ICU of Kafr El-Sheikh Chest Hospital. We compared between chest radiograph, chest US, and CT as diagnostic tools to detect the etiology of ARF.

Results

The sensitivity, specificity, positive predictive value, and negative predictive value and accuracy of lung US in the detection of chest disorders causing ARF were 93.7, 50, 97.8, 45, and 92%, respectively, compared with chest CT as a gold-standard Bedside Lung Ultrasonography in Emergency department protocol was used in the diagnosis of different causes of ARF. Lung US was free in 6% of patients, A profile was found in 12%, A’ profile was found in 2%, A’ profile with anechoic area or hypoechoic area in 6%, B profile was found in 12%, B’ profile in 12%, B’ profile with anechoic area or hypoechoic area in 32%, A/B profile in 6%, no color sign was found in 10%, and hypoechoic simple effusion in 2% of selected patients.

Conclusion

Chest US is a reliable, quick, bedside, low-cost, noninvasive, and nonionizing imaging tool for early detection of chest-disease causes of ARF.
Does pulmonary fibrosis increase lung cancer risk?
Authors: Ali Ahmed , El-Helbawy Rana , Khaled Nagwan S. , Al-Dahdouh Sami
Published: August 2022

Background

The concepts in lung fibrosis and increased lung cancer risk have arisen from clinical observations of the concurrent findings during the autopsy of lung cancer and pulmonary fibrosis. Scar carcinoma attributes the origin of carcinomas to abutting areas of scarring. The association between fibrosis and lung cancer risk immediately raises a query: whether lung fibrosis induces lung cancer?

Aim

The study was done to elucidate the incidence, risk factors, and clinical characteristics of lung cancer in diffuse lung fibrosis.

Patients and methods

A cohort study was done based on a prospective group of 50 patients with diffuse lung fibrosis to evaluate the incidence of lung cancer, as well as a retrospective group of 50 patients with lung cancer to search for background of pulmonary fibrosis between 2019 and 2020. Demographic, radiographic, and histologic characteristics were reviewed for both groups.

Results

Among 50 patients with interstitial lung disease, lung cancer developed in 2/50 (4%) during the follow-up, whereas in the retrospective group, 8/50 (16%) were diagnosed as having lung cancer with diffused lung fibrosis between 2019 and 2020. Lung cancer risk factors were male sex, smoking, and occupational dust exposure. Squamous carcinoma followed by adenocarcinoma was the commonest histologic form.

Conclusion

Evidence shows an association between interstitial lung diseases and lung cancer emergence. Epidemiological evidence differs owing to the various study designs and populations.
Accuracy of chest ultrasonography in the diagnosis of coronavirus disease 2019 pneumonia
Authors: Ahmed Mostafa K. , Abdelaleem Nermeen A. , Mohamed Marwan N.
Published: August 2022

Background

Coronavirus disease 2019 (COVID-19) virus infection is an ongoing, catastrophic, worldwide pandemic with significant morbidity and mortality. Large numbers of people who are getting COVID-19 virus infection are at high risk of developing COVID-19 pneumonia; early diagnosis of COVID-19 pneumonia, patient care, and isolation using simple, less expensive images are required. High-resolution computed tomography chest (HRCT chest) is the reference standard method for the diagnosis of COVID-19 pneumonia; however, it is expensive with increasing the exposure risk; chest ultrasonography (CUS) may be an alternative method.

Patients and methods

CUS is performed on patients accepting to participate in the study at presentation of COVID-19 suspicious cases. HRCT chest to confirm COVID-19 pneumonia were done within 24 h of CUS examination. Two chest consultants who are experts in CUS at Assiut University Hospital performed CUS. The CUS is done using a convex probe of 3.5 MHz. The CUS was considered positive for pneumonia if the examiners find the presence of abnormal multiple vertical B lines with or without the presence of consolidation dots unilateral or bilateral with good cardiac function; HRCT chest results are recorded.

Results

In all, 197 patients were included in the study (102 males, mean age 48 ± 16.2 years). Regarding comorbidity: 10% had diabetes mellitus and 9% had hypertension. Ten (5%) patients needed hospitalization with a mean oxygen saturation of 95 ± 5%. One hundred fifty-two patients confirmed COVID-19 pneumonia with HRCT chest, while 45 patients had normal HRCT chest. CUS showed positive pneumonic finding in 128 patients and normal picture in 69 patients. There was good association (r=0.690, P<0.001) between both diagnostic modalities in COVID-19 pneumonia diagnosis. Sensitivity and specificity and accuracy of CUS in the diagnosis of COVID-19 pneumonia were 84.56, 95.83, and 87.31%, respectively, when compared with HRCT chest. One hundred and two patients were successfully followed; all of them showing clinical and ultrasonographic improvement.
Effect of mandibular advancement device in the treatment of obstructive sleep apnea
Authors: Saleh Yousra A.G. , Fouda Ahmed M. , El sayed Morsy Nesreien , Abdel-Khalek Elsayed , Saleh Abdelbaset
Published: August 2022

Background

Obstructive sleep apnea (OSA) is a situation of repetitive and interrupted collapse of the upper airways (UAs) during sleep. The physiopathology of OSA is multifactorial. Provided that continuous positive airway pressure is the gold standard for treatment of OSA, the American Academy of Sleep Medicine in 2015 stated that mandibular advancement device (MAD) was indicated as a first-line therapy for mild OSA and a second-line therapy for moderate to severe OSA with lower BMI.

Aim

This study is aimed to evaluate the MAD success rate in patient with OSA and to assess improvement in sleep quality.

Patients and methods

This was a prospective one-group pretest–post-test quasiexperimental study carried out on 30 patients with OSA admitted to the sleep center at Chest Medicine Department of Mansoura University Hospitals through the period from February 2019 to January 2021. All patients had thorough clinical examination. The clinical assessment was scored according to the following questionnaires: the Epworth Sleepiness Scale, the Berlin questionnaire, the STOP-Bang questionnaire, and the Pittsburgh sleep quality index. Patients also had polysomnography, drug-induced sleep endoscopy, and dental volumetric computerized tomography (CT) scan. All patients were treated by MAD, and then patients began home adjustment as patients were instructed to advance the device 0.5 mm each night as tolerated. After two weeks, patients repeated PSG and CBCT to assess airway volume and airway area after treatment of OSA by the MAD.

Results

A total of 30 patients with OSA were included, comprising 14 males and 16 females, with a mean age of 42.9 ± 7.0 years. The types of UA obstruction were detected by both drug-induced sleep endoscopy (DISE) and dental volumetric cone-beam CT (CBCT). A total of 30 patients were studied and showed that multiple-level obstruction was the most frequent type of UA obstruction detected by both dental volumetric CBCT and DISE, representing 53.3 and 60%, respectively. Regarding polysomnographic data of the studied patients before and after treatment by MAD, there is very high significant improvement of apnea-hypopnea index among the studied patients whose were treated by MAD.

Conclusion

MAD has a high success rate in treatment of OSA and improves sleep quality. DISE and CBCT can be useful tools for assessing the success of MAD in the treatment of OSA.
Prediction of development of disease among contacts of COVID-19 patients
Authors: Ibrahim Dalia A. , Hassan Tarek H.
Published: August 2022

Objectives

Coronavirus disease 2019 (COVID-19) is a very progressive disease that concerns everyone regarding its infection and spread. This study predicted infection among people who came in contact with COVID-19-infected patients. The authors observed many categories of patients to get the best results. The aim of this work was to study the contact status of patients with COVID-19 in Sharkia Governorate, Egypt, and to assess the criteria of contacts being infected.

Patients and methods

This is a retrospective cohort study that used the data of Zagazig University Hospitals in Sharkia Governorate, reviewing people who came in contact with COVID-19 cases for appearance of symptoms, so that the authors can predict (later on) the probability of contacts getting infected.

Results

Of the 101 contacts, 49 were positive according to symptoms, 27 were positive according to computed topography (CT), and 38 were positive according to laboratory investigations, so contacts who were getting infected were according to the definition of suspect and probable cases. Overall, the suspect and probable contacts were 61, and about 27 (of 68 contacts who did CT from our sample) were moderate and severe cases.

Conclusion

Contact cases with comorbidity and old age were more liable to get infected and to be more serious cases than young age with no comorbidity. Of all contacts (101), 42 had comorbidities and about 31 of them had the disease.
Role of miRNA-204 as a putative diagnostic marker in nonsmall-cell lung cancer
Authors: Younan Ramy A. , Korraa E. , Elsayed Mohamed Ali , Abdelkader Maryam A. , El-khazragy Nashwa
Published: August 2022

Background

The most common cause of deaths related to cancer worldwide is lung cancer. In the GLOBOCAN 2018 database, two million newly diagnosed cases and 1.7 million deaths from lung cancers were estimated. This study aimed to detect the efficacy of miR-204 as a novel early diagnostic marker in nonsmall-cell lung carcinoma (NSCLC) via comparing its value in both serum and bronchial tissue samples.

Patients and methods

Serum and tissue samples were collected from 50 patients who participated in the study. They were subclassified into two groups, including patients with NSCLC (n=25) and nonmalignant patients who resemble the NC group (n=25). The miR-204 expression level was measured using quantitative real-time PCR.

Results

miR-204 expression was significantly downregulated by twofold in serum and tissue samples of patients with NSCLC compared with nonmalignant patients.

Conclusion

miR-204-5p is a promising non-invasive blood-based diagnostic biomarker in patients with NSCLC, which reflect its significant diagnostic and prognostic potential; thus, it could be used as a therapeutic biomarker in the near future.
Occupational pulmonary embolism − A silent killer on the roads
Authors: Ojha Umesh Chandra , Choudhari Omkar K. , Dipti Gothi , Sonam Spalgis
Published: August 2022

Some occupation-related practices contribute significantly to the morbidity because both employer and employee are unaware of the risk. The authors have described two subjects with job profile of ticketing on board (bus conductors) who had a habit of sitting continuously at a designated conductor place for ticketing in their 8-h duty and rarely getting up in between. They presented with dyspnea in the outpatient department of pulmonary medicine without an antecedent history of any chronic ailment or family history of coagulopathy. These professionals had venous stasis, leading to pulmonary thromboembolism (PTE). PTE was diagnosed on the basis of contrast-enhanced computed tomography pulmonary angiography. The other causes of PTE were ruled out. They were treated as per the guidelines on PTE and were advised frequent walking in the bus during their duty hours. However, this has to be instructed to all the employees by the employer.
Primary Pure Large-Cell Neuroendocrine Carcinoma of the Ovary
Authors: Yadav Reena , Chopra Kanika , Jaiswal Nishtha , Aggarwal Shilpi
Published: August 2022

Primary pure large-cell neuroendocrine carcinoma is a rare entity with 17 cases reported till now. A 48-year-old, Para6 Live4, postmenopausal woman presented with complaints of pain abdomen, constipation for 6 months, and postmenopausal bleeding for 1 month. On per abdominal examination, an irregular, hard, fixed, and tender mass was felt in the pelvis corresponding to 32 weeks size gravid uterus. Her magnetic resonance imaging findings were suggestive of a large abdominopelvic mass of size 10.2 cm × 12.7 cm × 14.2 cm with inferior extension into the left adnexa and 3.1 cm × 2.2 cm × 2.1 cm right adnexal mass. Debulking surgery was done. The intraoperative findings were of a large abdominopelvic mass adhered to the sigmoid colon and retroperitoneal space. Histopathological and immunohistochemistry findings were suggestive of bilateral large-cell neuroendocrine carcinoma of ovaries with strong positive for Bcl2, CD56, NSE, PR, and P53. The patient was started on tablet etoposide as adjuvant treatment. After 5 months of primary surgery, contrast-enhanced computed tomography of the chest, abdomen, and pelvis revealed recurrence. She succumbed to her illness 6 months after primary surgery. Owing to its rarity and difficulty in diagnosis, it is suggested that all such cases should be registered at national level and critically analyzed to find the high risk and associated prognostic factors.
A Comparative Analysis of Nondescent Vaginal Hysterectomy, Laparoscopy-Assisted Vaginal Hysterectomy, and Total Laparoscopic Hysterectomy for Benign Uterine Diseases at a Rural Tertiary Care Center
Authors: Kanti Vaibhav , Verma Vandana , Singh Mamta , Vishwakarma Soniya , Mittal Nupur , Singh N. P.
Published: August 2022

Objectives:

The aim of this study was to compare operative data and postoperative complications among nondescent vaginal hysterectomy (NDVH), laparoscopy-assisted vaginal hysterectomy (LAVH), and total laparoscopic hysterectomy (TLH) at a rural tertiary care center.

Materials and Methods:

This is a prospective analytical study, of 145 hysterectomies for benign conditions with or without salpingo-oophorectomy in women from 30 to 60 years, over 3 years from January 2016 to December 2019, with 60 cases of NDVH, 46 cases of LAVH, and 39 cases of TLH. The three groups were compared intraoperatively in terms of blood loss, operating time, and intraoperative complications and postoperative complications and postoperative duration of hospital stay.

Results:

There was no significant difference between the three groups in terms of age, parity, body mass index, and indications for hysterectomies. The mean operative time was significantly shorter (P = 0.000) in the NDVH group (54.67 ± 15.67 min) as compared to the LAVH (102.45 ± 10.53 min) and TLH (126.79 ± 8.7 min) groups. Intraoperative blood loss was greater (P = 0.000) in the TLH group (111.025 mL ± 20.8) as compared to the NDVH (59.50 mL ± 16.7) and LAVH (91.85 mL ± 10.66) groups. The intraoperative complications and postoperative complications were higher in the TLH group as compared to the LAVH and NDVH groups. The duration of hospital stay was almost similar in all the groups.

Conclusion:

NDVH may be the preferred approach for experienced surgeons, as it is less time-consuming, has a small amount of blood loss, and is a scarless surgery, whereas LAVH and TLH may be the preferred approaches in the cases of presence of adnexal masses and adhesions or whenever salpingo-oophorectomy is indicated.
Variations in Procedures for Ureterolysis with Sharp Dissection in Minimally Invasive Hysterectomy
Authors: Tanase Yasuhito , Kato Mayumi Kobayashi , Uno Masaya , Ishikawa Mitsuya , Kato Tomoyasu
Published: August 2022

To safely perform minimally invasive hysterectomy (MIH), including laparoscopic hysterectomy and robot-assisted hysterectomy, partial ureterolysis, or visualizing only the ureter without dissection is often inadequate. Moreover, careless blunt dissection could injure the blood vessels. We present our surgical method for ureterolysis using sharp dissection during MIH. First, the outer portion of the ureter is dissected. Dissecting between the pelvic sidewall and the posterior leaf of the broad ligament creates a pararectal space outside the ureter, enabling the easy identification of the ureter running on the posterior leaf. Second, the inner portion of the ureter is dissected. After determining the location of the ureter, a better partial dissection of the ureter can be performed from the posterior leaf, instead of dissecting along the entire circumference. If fine surgery has to be performed, the ureter can be dissected by enclosing it within its sheath. We primarily perform dissections using a monopolar device, which allows a sharp dissection. Furthermore, in our method, we often include the dissection of the ureteral tunnel. It is important to understand the anatomy and membrane structure of the ureter in each patient and adjust the extent of ureterolysis based on individual differences.
Lin's Self-Retaining Abdominal Ultrasound Probe Method for Hands-Free Ultrasound-Guided Hysteroscopic Procedures
Authors: Lin Bao-Liang , Adlan Aizura-Syafinaz , Azhary Jerilee M. K.
Published: August 2022

Objectives:

Conventionally, an assistant would be required to hold the ultrasound probe during therapeutic hysteroscopy. To manage without a skilled assistant, Lin developed a self-retaining hands-free probe method that can be used to hold an abdominal ultrasound probe. One can now perform ultrasound-guided hysteroscopic procedures single-handedly. The purpose of this study is to report the successful development of a method to keep an abdominal ultrasound probe self-retained without an assistant's help.

Materials and Methods:

A technique derived from improvisation with available equipment.

Results:

The hands-free ultrasound probe was used successfully in 2680 cases needing therapeutic hysteroscopy management for various endometrial pathologies. We only encountered one case of latex allergy, which serves as a reminder to ask about latex allergy before the procedure. Upon notification, the handle can be improvised to a latex-free solution. Compression indentation marks were of negligible concern as they resolved spontaneously within 1–2 h postsurgery. We have used this method successfully and to good effect, particularly in guiding us to avoid uterine perforations during dilation of the cervix as well as during the therapeutic hysteroscopy surgery itself. This device facilitates efficient and safe therapeutic hysteroscopic surgeries. In addition, this method encourages the reuse and recycling of plastic water bottles.

Conclusion:

The usage of Lin's self-retaining ultrasound probe method is practical, cheap, and not dependent on an assistant's participation during procedures.
Laparoscopic Simulation Training for Residents in Obstetrics and Gynecology Over 12 Months
Authors: Raffel Ryan A. , Fogel Joshua , Itzhak Petr
Published: August 2022

Objectives:

As gynecology surgical cases are declining across the country, residency programs can benefit by training residents with simulation. We evaluate five Fundamentals of Laparoscopic Surgery (FLS) tasks over 12 months.

Materials and Methods:

This was a retrospective study of 16 obstetrics and gynecology residents. Residents practiced on a FLS simulation box trainer. They were evaluated on completion time and pass/fail performance for the five tasks of peg transfer, precision cutting, loop ligation, suture with extracorporeal knot, and suture with intracorporeal knot. Resident satisfaction with FLS simulation box training was evaluated.

Results:

We found improvement of reduced time from baseline to 12 months for the tasks of peg transfer, precision cutting, suture with extracorporeal knot, and suture with intracorporeal knot. No time improvement was noted for loop ligation. We only found increased passing rates for the precision cutting task from baseline to 12 months. Residents agreed that simulation training improves surgical skills, improves patient safety, and improves confidence level in the operating room.

Conclusion:

We found improvement of decreased time with FLS simulator box training for FLS tasks of peg transfer, precision cutting, suture with extracorporeal knot, and suture with intracorporeal knot. We recommend that routine practice with the FLS simulator box trainer will increase resident confidence level and potentially improve surgical outcomes when in the operating room. We recommend including a dedicated portion of the academic curriculum for simulation training. FLS box training can be an essential tool for residency programs in obstetrics and gynecology.
Adaptive optics scanning laser ophthalmoscopy may support early diagnosis of glaucoma
Authors: Choudhari Nikhil S , Kumar Sanjay , Richhariya Ashutosh , Krishnamurthy Rashmi , Priya Ruchi , Garudadri Chandra Sekhar
Published: August 2022

Purpose:

To compare image characteristics of retinal nerve fiber layer (RNFL) between glaucoma patients and healthy controls using adaptive optics scanning laser ophthalmoscopy (AOSLO).

Methods:

This was a cross-sectional pilot study with two groups: a glaucoma group with patients with moderate or severe glaucoma as per the Hodapp–Parrish–Anderson classification system and a control group with healthy individuals. The optic nerve damage in moderate glaucoma was predominantly located in only one hemisphere; the other hemisphere was un- or minimally affected on optical coherence tomography and automated perimetry and is referred to as early glaucoma. The structure of RNFL bundles and gain (%) in RNFL images with mean pixel values between 15 and 35 were analyzed. Imaging was performed one degree away from the optic disc margin at two and four cardinal clock positions in the glaucoma and control groups, respectively. The field of view was 1.3° at 2.3 m resolution. We studied one eye per participant.

Results:

There were 11 glaucoma patients and 7 healthy controls. Imaging was successful at 88% of the locations in controls and early glaucoma; the reflectivity differed significantly (0.51 and 0.56, respectively, P < 0.001) but not the structure of RNFL bundles (Cohen’s Kappa 0.11) between them. In patients with moderate and severe glaucoma, imaging was successful only at 46% of the locations; RNFL bundles were not discernible, and RNFL reflectivity did not differ from those with early glaucoma (P < 0.11).

Conclusion:

The recorded gain (%) of RNFL images obtained using AOSLO could be an objective indicator of early glaucoma.
A rare ophthalmic complication: Expulsive suprachoroidal hemorrhage
Authors: Doctor Mariya B , Murthy Somasheila
Published: August 2022

Background:

Expulsive suprachoroidal hemorrhage is a rare but dreadful complication of any ophthalmic surgery. Hence an ophthalmologist should know about the various risk factors, methods for preventing such a situation, and be aware of the various options for timely management to tackle the situation.

Purpose:

To discuss the risk factors, intraoperative signs, and ways of managing expulsive choroidal hemorrhage.

Synopsis:

We discuss two cases having multiple risk factors, where the patients underwent tectonic penetrating keratoplasty. In view of extensive involvement of ocular structures, the patients were clearly explained about the guarded visual prognosis and the risk of auto-evisceration. Following trephination of host cornea, rise in intraocular pressure was identified by the increasing size of the vitreous seen prolapsing through the wound and markedly visible pulsations, along with subconjunctival bleeding. Suprachoroidal hemorrhage was suspected and immediate tamponade was given. However, bleeding was not controlled, and eventually, expulsion of all the intraocular contents occurred.

Highlights:

A surgeon must be aware of the risk factors, be prompt to identify the signs, and must take immediate actions for the management of expulsive choroidal hemorrhage, a rare but dreadful complication of intraocular procedures.

Online Video Link:

https://youtu.be/UnCH-lWGzwU

Key words: Expulsive suprachoroidal hemorrhage
Holographic elysium of a 4D ophthalmic anatomical and pathological metaverse with extended reality/mixed reality
Authors: Ramesh Prasanna V , Joshua Tensingh , Ray Prajnya , Devadas Aji K , Raj Pragash M , Ramesh Shruthy V , Ramesh Meena K , Rajasekaran Ramesh
Published: August 2022

Extended reality is one of the leading cutting-edge technologies, which has not yet fully set foot into the field of ophthalmology. The use of extended reality technology especially in ophthalmic education and counseling will revolutionize the face of teaching and counseling on a whole new level. We have used this novel technology and have created a holographic museum of various anatomical structures such as the eyeball, cerebral venous system, cerebral arterial system, cranial nerves, and various parts of the brain in fine detail. These four-dimensional (4D) ophthalmic holograms created by us (patent pending) are cost-effectively constructed with TrueColor confocal images to serve as a new-age immersive 4D pedagogical and counseling tool for gameful learning and counseling, respectively. According to our knowledge, this concept has not been reported in the literature before.
Clinical implication of recent randomized control trial in primary angle-closure disease management
Authors: Parikh Shefali R , Parikh Rajul S
Published: August 2022

Blindness due to primary angle-closure glaucoma (PACG) can be reduced significantly if the ongoing angle-closure process is arrested at an early stage. Various treatments such as laser peripheral iridotomy (LPI), iridoplasty, and clear lens extraction (CLE) have been advocated as first-line therapy for primary angle-closure (PAC), PACG, and high-risk cases of primary angle-closure suspect (PACS). EAGLE study, propagated the effectiveness of CLE over LPI for the management of primary angle closure and have sparked controversy regarding the role of LPI as a first line procedure. Randomized controlled trials (RCT), systematic reviews, and meta-analyses of RCTs done on the same question provide us with a solid base for creating guidelines/modules for our day-to-day clinical practice. A systematic review was conducted, searching several databases, including PubMed, Cochrane Library, EMBASE, and ClinicalTrials.gov, for the last 16 years (January 2005–December 2021) for RCTs with data published related to primary angle-closure disease (PACD). The search strategy included the following terms: “Primary Angle Closure disease,” “Primary Angle Closure Glaucoma,” “Primary Angle Closure,” “Primary Angle Closure Suspect,” “clear lens extraction,” “laser iridotomy,” “laser peripheral iridotomy,” “argon laser peripheral iridoplasty,” “selective laser trabeculoplasty,” “trabeculectomy,” “randomized control trial,” and “meta-analysis of randomized control trial.” In this review, we will discuss recently published RCTs (within the last 16 years) for the management of PACD and their clinical implications in day-to-day practice.