bluuebunny/crossref_metadata_2025 huggingface dataset:
The Impact of Maternal Predisposing Factors on Level of Maternal Serum Pregnancy-Associated Plasma Protein A and Free Subunit Human Chorionic Gonadotropin and Nuchal Translucency
Authors: Mirsafaie Maryam , Kheirollahi Majid , Moghaddam-Banaem Lida
Published: October 2023

Background:

This study aimed to investigate the relationship between maternal predisposing factors with the level of maternal serum pregnancy-associated plasma protein A and free subunit human chorionic gonadotropin and nuchal translucency.

Materials and Methods:

We performed a cross-sectional-analytical study on 762 pregnant women who referred to the Gene Azma Medical Genetics Laboratory in Isfahan for amniocentesis. All pregnant women at high risk of screening in the first trimester of pregnancy for trisomy 21 and other aneuploidy were referred to a gynecologist for amniotic fluid sampling (amniocentesis). Multiple of the means (MoM) of PAPPA ≤0.5, 0.5 ≥ MoM free β-hCG >2.5, and NT ≥3.5 mm were considered abnormal. We used Chi-square method and Mann–Whitney U-test to compare data qualitative and quantitative, respectively.

Results:

In individuals with less pregnancies and deliveries, the value of abnormal NT was higher (P < 0.01, P < 0.001, respectively). On the other hand, the highest abnormal rate of NT was observed in pregnant women under 35 years (21, 84%, P < 0.012). In addition, abnormal levels of free β-hCG are more common in women < 35 years of age (186, 66.9%, P < 0.02) and female fetuses (171, 58.8%) (P < 0.006).

Conclusion:

According to the results of this study, it can be said that considering the underlying factors of pregnant mothers in performing tests related to screening in the first trimester of pregnancy can lead to a reduction in false positive rates.
Clinical Symptoms of COVID-19 and Their Association with Disease Outcome
Authors: Tavakolifard Negah , Moeini Mina , Haddadpoor Asefeh , Heidari Kamal , Rezaee Mostafa , Amini Zahra
Published: October 2023

Background:

COVID-19 pandemic placed immense pressure on health systems. The current study aimed to evaluate the symptoms of COVID-19 in Isfahan province and their association with disease outcome.

Materials and Methods:

In this cross-sectional study, which was conducted on patients with a definite diagnosis of COVID-19, as a part of the investigations performed by the Deputy for Public Health of the Isfahan University of Medical Sciences, the frequency of underlying diseases, and general, respiratory, gastrointestinal, neurological, renal, cardiac, dermal, hearing symptoms are assessed using a checklist. The participants were followed up 1 month after definitive diagnosis, and the outcome of the disease (recovery or death) was recorded.

Results:

Of 300 patients, 143 (47.4%) were male and 157 (52.6%) were female. The mean age of patients was 43 ± 17.84 years. Muscle pain and fatigue were the most common early symptoms (63% and 60.3%, respectively). Age, sex, level of education, and occupation of patients and general, respiratory, and gastrointestinal symptoms and underlying diseases of respiratory disease showed a statistically significant association with the disease outcome (P < 0.05).

Conclusion:

General, respiratory, and gastrointestinal symptoms were associated with an increased risk of death due to COVID-19. General, visual, and hearing symptoms, and diabetes, cardiovascular diseases, and respiratory disease had a statistically significant association with the hospitalization of patients.
The Association between Exposure to Air Pollution and Type 1 Diabetes Mellitus
Authors: Mozafarian Nafiseh , Hashemipour Mahin , Yazdi Maryam , Hani Tabaei Zavareh Mohsen , Hovsepian Silva , Heidarpour Maryam , Taheri Ensiyeh
Published: October 2023

Background:

This systematic review and meta-analysis aimed to overview the observational studies on the association of exposure to air pollution and type 1 diabetes mellitus (T1DM).

Materials and Methods:

Based on PRISMA guidelines, we systematically reviewed the databases of PubMed, Scopus, Embase, and Web of Science databases to determine the association of air pollution exposure and T1DM. Quality assessment of the papers was evaluated using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for observational studies. The odds ratios (OR) and their 95% confidence intervals (CI) were calculated to assess the strength of the associations between air pollutants (gases and particulate matter air pollutants including PM10, PM2.5, NO2, volatile organic compound, SO4, SO2, O3) and T1DM.

Results:

Out of 385 initially identified papers, 6 studies were used for this meta-analysis. Fixed effects meta-analysis showed a significant association between per 10 μg/m3 increase in O3 and PM2.5 exposures with the increased risk of T1DM (3 studies, OR = 1.51, 95% CI: 1.26, 1.80, I
2 = 83.5% for O3 and two studies, OR = 1.03, 95% CI: 1.01, 1.05, I
2 = 76.3% for PM2.5). There was no evidence of association between increased risk of T1DM and exposure to PM10 (OR = 1.02, 95% CI: 0.99–1.06, I
2 = 59.4%), SO4 (OR = 1.16, 95% CI: 0.91–1.49, I
2 = 93.8%), SO2 (OR = 0.94, 95% CI: 0.83–1.06, I
2 = 85.0%), and NO2 (OR = 0.995,95% CI: 1.05–1.04, I
2 = 24.7%).

Conclusion:

Recent publications indicated that exposure to ozone and PM2.5 may be a risk factor for T1DM. However, due to limited available studies, more prospective cohort studies are needed to clarify the role of air pollutants in T1DM occurrence.
Comparison of the Effectiveness of Two Management Strategies in the Pandemic COVID-19 Period in Patient Visits (Face-to-Face Visits vs. a Smartphone) in follow-up the Range of Motion of the Knee in Patients with Anterior Cruciate Ligament Reconstruction
Authors: Aslani Hamidreza , Bonakdar Sona , Gorji Mona , Gholipour Morteza
Published: October 2023

Background:

As the prevalence of the coronavirus increases, there is now more emphasis on reducing “face-to-face” patient visits. Therefore, the use of smartphones and their special medical applications can play an important role in following up patients. The aim of this study was to evaluate the use of smartphone in evaluating clinical outcomes and range of motion (ROM) of patients after anterior cruciate ligament reconstruction (ACLR).

Materials and Methods:

From January to December 2020, 112 patients between 20 and 50 years old were randomly selected at our orthopedic sports center. All patients were visited online through smartphone by a knee fellowship surgeon in the morning (case group) and again all of them were visited online through smartphone in the evening by another knee fellowship surgeon (control group). Both visits were done at regular intervals in the 2nd, 6th, and 12th week after surgery. Patients were evaluated for function outcomes and joint ROM.

Results:

The two groups were similar in terms of mean International Knee Documentation Committee score, Lysholm knee score, and Tegner Knee Score and did not show statistically significant difference (P < 0.05) There was no significant difference in knee ROM measurements between the two groups (face-to-face visits and online through smartphone visits) during the follow-ups (P > 0.05).

Conclusion:

Smartphone apps are highly effective in assessing postoperative condition of knee ROM after ACLR, especially in the short time. However, this ability has been reduced in evaluating the long term. Hence, evaluation is still necessary through direct examination in the presence visit.
Bacterial Superinfection and Antibiotic Management in Patients with COVID-19 Admitted to Intensive Care Medicine in Central Iran: A Follow-Up Study
Authors: Nokhodian Zary , Rostami Soodabeh , Zeraatei Parisa , Rahimkhorasani Marzieh , Abbasi Saeed , Sadeghi Somayeh
Published: October 2023

Background:

Bacterial superinfections are one of the crucial challenges in patients with coronavirus disease 2019 (COVID-19) that are associated with a high mortality rate. The current study was designed to assess bacterial superinfections and antibiotic management in COVID-19 patients admitted to intensive care unit (ICU).

Material and Methods:

Seventy-three adult intubated patients with COVID-19 were included in a cross-sectional study. The lung aspirate samples were collected in two stages and assessed for bacterial growth by standard methods. Antimicrobial susceptibility testing was performed using the Kirby-Bauer method as recommended by the Clinical Laboratory Standard Institute guideline (2021 edition). Also, demographic and clinical data were collected. The statistical analysis was done by chisquare test and Student's t-test, and a P value <0.05 was considered significant.

Results:

Forty men and thirty-three women with a mean age of 64.78 ± 13.90 have included in our study. The mean length of hospitalization and stay in ICU were 18.77 ± 12.94 and 13.51 ± 9.83 days, respectively; 84.9% of cases died. Thirty-three patients had a bacterial superinfection mainly caused by Klebsiella spp and Acinetobacter spp; 21.2% of piperacillin/tazobactam consumers' patients survived that; the differences were significant (p = 0.034). A significant relationship was seen between superinfection and length of hospital stay until intubation (p = 0.033).

Conclusion:

Bacterial superinfection and mortality rates were relatively high in COVID-19 patients admitted to ICU. According to the results, using beta-lactam/beta-lactamase inhibitors antibiotics in hospitalized patients in ICU can effectively control superinfection.
Predictive Value of Middle Cerebral Artery to Umbilical Artery Pulsatility Index Ratio for Neonatal Outcomes in Hypertensive Disorders of Pregnancy
Authors: Zarean Elahe , Azami Nahal , Shahshahan Zahra
Published: October 2023

Background:

Hypertension may lead to notifying adverse perinatal events that should be diagnosed and managed precisely. This study aims to investigate the values of cerebroplacental ration for the prediction of adverse perinatal events in hypertensive disorders of pregnancy.

Materials and Methods:

The current descriptive-comparative study has been conducted on 100 singleton pregnant women with the diagnosis of preeclampsia or pregnancy-induced hypertension. The Cerebroplacental ratio (CPR) was measured for the included population and divided into normal and abnormal ranges of >1 and ≤1. The adverse perinatal outcomes, including abnormal 5 min APGAR, low birth weight, perinatal death, neonatal intensive care unit (NICU) admission, academia, seizure, emergency cesarean delivery, and Tchirikov index as the general manifestation of adverse perinatal outcomes were compared between the groups. The specificity, sensitivity, positive predictive value, negative predictive value (NPV), and accuracy were measured for the adverse perinatal outcomes.

Results:

The two groups were remarkably different in terms of 5 min APGAR, low birth weight, cesarean section delivery, and Tchirikov index (P < 0.05). The specificity of CPR for prediction of small-for-gestational age, poor APGAR, requirement of assisted respiration, academia, Tchirikov score and NICU admission was 93.1%, 93.1%, 67.1%, 91.8%, 71.2%, and 63%, and its sensitivity was 26%, 14.8%, 51.8%, 14.8%, 51.8%, and 37%, respectively.

Conclusion:

CPR seems to be an appropriate means for the prediction of adverse perinatal outcomes with diversity in the prediction values of different determinants of adverse perinatal outcomes; however, in general, it had sensitivity, specificity, PP, NPV, and accuracy of 51.8%, 71.2%, 40%, 80%, and 66%, respectively.
Green Synthesis of Silver Nanoparticles Using Nisin and its Antibacterial Activity against Pseudomonas aeruginosa
Authors: Yazdi Mohamad , Yousefvand Amin , Hosseini Hamideh Mahmoodzadeh , Mirhosseini Seyed Ali
Published: October 2023

Background:

Green synthesized silver nanoparticles (AgNPs) have been used in a wide range of biological applications, including their use as antimicrobial agents. The aim of this study was to evaluate the antibacterial activity of green synthesis AgNPs using nisin against Pseudomonas aeruginosa (P. aeruginosa).

Materials and Methods:

In order to synthesize Ag-nisin, a 1 mg/ml nisin solution was mixed with a 1-mM silver nitrate solution and incubated. The Fourier transform infrared spectroscopy (FTIR) analysis was employed to determine the presence of various biomolecules around AgNPs. The AgNPs were morphologically observed and characterized using field emission scanning electron microscopy assessment, dynamic light scattering (DLS), and zeta potential analysis. The microdilution broth method based on CLSI principles was used for the assessment of the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of nisin on P. aeruginosa isolates.

Results:

Field emission scanning electron microscope showed spherical shaped nanoparticles. DLS revealed that the average size of nanoparticles was 37.2 nm. The zeta potential of AgNPs was − 13.3 mV. FTIR findings revealed that nitrogen atoms of nisin’s amine and amide groups are responsible for the capping and stability of the nanoparticles. The MIC and MBC showed that Ag/nisin nanoparticles had higher antimicrobial activity than nisin or AgNPs alone.

Conclusion:

The findings of this study show that the antibacterial activity of nisin can be increased by assembling it into the AgNP interface using a green chemical synthesis method. As a result, the technique may be used to develop an antibacterial formulation to enhance the effectiveness of nisin.
Artificial Intelligence in Diagnostic Dermatology: Challenges and the Way Forward
Authors: Sengupta Dipayan
Published: October 2023

Artificial Intelligence (AI) has emerged as a transformative force in the field of diagnostic dermatology, offering unprecedented capabilities in image recognition and data analysis. Despite its promise, the integration of AI into clinical practice faces multifaceted challenges that span technical, ethical, and regulatory domains. This article provides a narrative overview of the current state of AI in dermatology, tracing its historical evolution from early diagnostic tools to contemporary hybrid supervised models. We identify and categorize six critical challenges: data quality and quantity, algorithmic development and explainability, ethical considerations, clinical workflow integration, regulatory frameworks, and stakeholder collaboration. Each challenge is dissected from the perspectives of academia, industry, and healthcare providers, offering actionable recommendations for future research and implementation. We also highlight the paradigm shift in AI research, emphasizing the potential of transformer architectures in revolutionizing diagnostic methodologies. By addressing the challenges and harnessing the latest advancements, AI has the potential to significantly impact diagnostic accuracy and patient outcomes in dermatology.
Topical and Systemic Therapies in Melasma: A Systematic Review
Authors: Sarkar Rashmi , Handog Evangeline B. , Das Anupam , Bansal Anuva , Macarayo Ma. Juliet , Keshavmurthy Vinay , Narayan Vignesh , Jagadeesan Soumya , Pipo Eugenio , Ibaviosa Grace Monica , Podder Indrashis , Bansal Shivani
Published: October 2023

Introduction:

Melasma is an acquired disorder, which presents with well-demarcated, brown-colored hyperpigmented macules, commonly involving the sun-exposed areas such as the face. It is a chronic and distressing condition, affecting the patients' quality of life, and has been conventionally treated with “first-line” agents including hydroquinone (HQ) alone or as a part of a triple combination cream (TCC), while “second-line” options include chemical peels, and third line options include laser therapy.

Materials and Methods:

A systematic search was performed for all topical and systemic treatments for melasma up till May 4, 2021, using the PubMed and EMBASE databases, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. The search terms “melasma” and “treatment” were used to search for the relevant articles on both these databases, and a total of 4020 articles were identified. After removing the duplicate entries and screening the titles, abstracts, and full-text articles, we identified 174 randomized controlled trials (RCTs) or controlled clinical trials.

Results:

Based on our review, HQ, TCCs, sunscreens, kojic acid (KA), and azelaic acid receive grade A recommendation. Further large-scale studies are required to clearly establish the efficacy of topical vitamin C, resorcinol, and topical tranexamic acid (TXA). Several newer topical agents may play a role only as an add-on or second-line drugs or as maintenance therapy. Oral TXA has a strong recommendation, provided there are no contraindications. Procyanidins, Polypodium leucotomos (PL), and even synbiotics may be taken as adjuncts.

Discussion:

Several newer topical and systemic agents with multimodal mechanisms of action have now become available, and the balance seems to be tipping in favor of these innovative modalities. However, it is worth mentioning that the choice of agent should be individualized and subject to availability in a particular country.
Community Dermatology: Current Status and the Way Forward
Authors: Asokan Neelakandhan
Published: October 2023

Community health interventions in dermatology have the potential to deliver healthcare to large populations. Such interventions can bridge the gap between increasing demands from vast populations and limited availability and asymmetric geographical distribution of specialist doctors. This narrative review aims to delineate various areas in which community dermatology initiatives are useful, the different approaches used, and the factors which could determine their effectiveness. We did a PubMed search using the search terms, “Community Health Services”[Mesh]) AND “Dermatology”[Mesh]. A further literature search was performed by cross-referencing these articles. In addition to its primary purpose of increasing access, community involvement can augment medical education, foster research, and help to develop more patient-centered clinical guidelines, understand disease trends and influences of the environment on various diseases, and formulate population-centered health policy. Task shifting, development of culture-sensitive and gender-sensitive community healthcare teams, disease-specific patient support groups, and use of advances in technology such as telemedicine are some of the important methods used in community dermatology. Task shifting may be performed at different levels – general practitioners, pharmacists, nurses, and community health workers. Community interventions harness volunteerism among health professionals as well as various stakeholders in the community. Partnering with non-governmental organizations, involving members of the community, and being a part of a long-term public health program help to sustain community interventions. The interventions should adapt to the ethical and cultural norms of the community. Continuity of care, fidelity, and evidence support are crucial for the success of community interventions in dermatology.
A Study to Describe the Pattern of Cutaneous Adverse Effects of COVID-19 Vaccines (Covishield and Covaxin)
Authors: Saraswat Neerja , Tripathy Durga M. , M Murali , Boruah Jahnabi , Mitra Debdeep , Chopra Harleen , Bhatnagar Anuj
Published: October 2023

Background:

Vigorous administration of COVID-19 vaccines to tackle the ongoing pandemic has led to increasing research on adverse effects including both systemic and cutaneous.

Objective:

A prospective observational study to delineate the cutaneous adverse effects of two vaccines, namely Covishield and Covaxin, administered in two doses in northern India.

Materials and Methods:

The study was conducted in a tertiary hospital in northern India wherein patients were asked to report voluntarily any cutaneous adverse effects after COVID-19 vaccination to the dermatology department. The data were collected using excel sheets and later analyzed taking into consideration the age, vaccine types, and duration of onset of adverse effects.

Results:

Of the 19,672 vaccination jabs, 296 (1.5%) developed cutaneous adverse effects of which the incidence was higher in Covishield vaccine group compared to Covaxin vaccine group. The incidence of side effects was more with the first dose of either vaccine compared to the second dose. All the side effects were benign and were managed symptomatically or were self-limiting.

Limitations:

The number of vaccine recipients was limited and there was a considerable overlap of adverse effects with both vaccines. Voluntary reporting of cases is not an accurate representation of the scale of patients with adverse effects.

Conclusion:

Rampant administration of vaccines along with widespread advertisement of vaccine-induced side effects via social media has created apprehension in the general population. This warrants studies improving awareness about the most vital preventive measure available to halt and eventually end the COVID-19 pandemic.
Data Privacy in Healthcare: In the Era of Artificial Intelligence
Authors: Yadav Neel , Pandey Saumya , Gupta Amit , Dudani Pankhuri , Gupta Somesh , Rangarajan Krithika
Published: October 2023

Data Privacy has increasingly become a matter of concern in the era of large public digital respositories of data. This is particularly true in healthcare where data can be misused if traced back to patients, and brings with itself a myriad of possibilities. Bring custodians of data, as well as being at the helm of disigning studies and products that can potentially benefit products, healthcare professionals often find themselves unsure about ethical and legal constraints that undelie data sharing. In this review we touch upon the concerns, leal frameworks as well as some common practices in these respects.
Utility of Dermoscopy in the Diagnosis of Erythroderma: A Cross-Sectional Study
Authors: Batra Jayati , Gulati Samridhi , Sarangal Rishu , Chopra Dimple , Puri Sulabh , Kaur Ravneet
Published: October 2023

Background:

It is difficult to diagnose the underlying cause of erythroderma on mere clinical presentation. The role of dermoscopy in diagnosing erythroderma secondary to various etiologies is evolving.

Aim and Objectives:

This study aimed to observe the dermoscopic features of erythroderma secondary to different cutaneous disorders and compare them with clinical features and histopathology.

Materials and Methods:

Twenty-nine consecutive patients of erythroderma were enrolled in the study. Dermoscopy was performed on every case using a Heine Delta II Dermatoscope with 10x magnification in polarized mode. A histopathological examination was conducted to confirm the diagnosis.

Results:

Eight patients were diagnosed with psoriasis, five with endogenous eczema, four with pityriasis rubra pilaris (PRP), three with pustular psoriasis, two with drug rash secondary to antitubercular therapy, two with dermatophytic infection, one patient each of atopic dermatitis, crusted scabies, pemphigus foliaceous, drug reaction with eosinophilia and systemic symptoms, and mycosis fungoides. Characteristic dermoscopic features were observed in erythroderma due to psoriasis, PRP, pustular psoriasis, endogenous eczema, scabies, and dermatophytosis. Differentiation of other disorders based on dermoscopy alone was difficult, and clinico-histopathological correlation was crucial to reach a diagnosis.

Conclusion:

Dermoscopic features of classical patterns of skin disorders are preserved even in the corresponding erythrodermic or unstable stage. Dermoscopic features of erythroderma secondary to psoriasis, pustular psoriasis, PRP, endogenous eczema, scabies, and dermatophytosis are clearly differentiating, whereas the dermoscopic features in other causes of erythroderma are overlapping. Thus, dermoscopy can be a good screening tool in the clinical assessment of erythroderma.
Identification of mutation in synaptonemal complex protein 3 gene and its interaction with methotrexate in case of breast cancer in female Albino mice
Authors: Sinha Shardhanjali , Kumar Aniket , Ghosh Ashis Kumar
Published: October 2023

Introduction:

To date, a few research studies have reported the significance of synaptonemal complex protein 3 (SYCP3) gene mutation in breast cancer. The present study aims to identify SYCP3 gene mutation in the case of breast cancer in female Albino mice and to assess the interaction of mutated SYCP3 protein with the drug methotrexate (MTX).

Materials and Methods:

To induce breast cancer in female Albino mice, the carcinogen 7, 12-Dimethylbenz (a) anthracene was used. The blood samples were collected from mice that developed breast cancer and a polymeric chain reaction was performed to check the mutation in the SYCP3 gene with a specific primer. Thereafter, whole genome sequencing was performed, which was further validated by referring to online bioinformatics databases and tools.

Results:

After performing whole genome sequencing and translation, the normal SYCP3 sequence was compared with the mutated one, where a frameshift mutation was observed in which 1 bp was deleted at position (643delA) (Al ─A that codes for ILE at position 197 (ILE ─I in protein sequence. The free binding energy released by the interaction of MTX with the mutated SYCP3 protein (MET, GLU, GLN, GLU, and ILE) was lower (−3.09 Kcal/mol) than that of the interaction of normal SYCP3 protein. Therefore, the mutated SYCP3 and MTX interaction can be considered the best molecular docking interaction.

Conclusion:

The present study is imperative to recognize a potential therapeutic agent to cure breast cancer. It ultimately paves the way to modify the existing line of treatment for different pathological conditions of breast cancer and promote personalized medicine.
COVID-19 association in an unresponsive case of acute disseminated encephalomyelitis
Authors: Kumar Mukesh , Bhoi Sanjeev Kumar , Jha Menka , Naik Suprava
Published: October 2023

The involvement of the central nervous system in COVID-19 is now widely known. Acute disseminated encephalomyelitis (ADEM) as a presentation of COVID-19 is sparse. We would like to present clinical and radiological features of a COVID-19 adult patient and evocative of virus-associated ADEM. During the early stages of the COVID-19 epidemic, the patient succumbs to his illness despite all available treatments.
Study on asymptomatic carotid artery disease in high-risk population: A hospital-based study in the eastern part of India
Authors: Kumari Manisha , Kumar Govind , Suman Sanjay Kumar , Prakash Ved
Published: October 2023

Background:

Stroke is the most important cause of mortality and morbidity. Carotid artery disease is the leading cause of ischemic stroke. Carotid intima-media thickness can be used as an important tool for severity of atherosclerosis. This study revised the usefulness of carotid Doppler as a useful tool for stroke.

Aim and Objective:

(1) To assess the prevalence of asymptomatic carotid artery stenosis (extra cranial) in high-risk individuals of the North-East Indian region (2) To find out the relationship of underlying disease with the severity of carotid artery stenosis.

Methods:

It was a prospective, cross-sectional study. The patients attending the department of general medicine, endocrinology, and cardiology were studied. Carotid duplex ultrasound was used to evaluate carotid arteries on 100 individuals having high risk factors such as age more than 40 years, hypertension, dyslipidemia, diabetes mellitus, and coronary heart disease for atherosclerotic diseases.

Results:

The age range was 40–79 years. Forty-four percent participants had carotid artery diseases of which 6% had significant carotid artery stenosis. In our study, established risk factors for atherosclerosis as advancing age >60 years, hypertension, diabetes, and dyslipidemia were not significantly associated with severe carotid artery stenosis.

Conclusion:

In this study, established independent risk factors for atherosclerosis were not statistically significant in causing severe carotid artery stenosis. This result may be due to the small study population. However, it is suggested to do study on large populations to establish or to rule out the association of significant carotid stenosis with established risk factors of atherosclerosis.
Understanding mechanism of traumatic spinal cord injury in an emergent nation: A coast to coast survey
Authors: Singh Abhinav , Kumar Ganesh , Kumar Raj
Published: October 2023

Background:

People with a spinal cord injury (SCI) have poor survival rates in low- and middle-income group countries. SCI prevention is critical to decreasing societal and individual health expenditure. Knowledge of the mechanism of SCI and contributory factors is necessary for successful prevention programs. There are limited population-based studies that explain the cause of SCI in an emergent economy like India. Available studies are limited to a specific region or hospital. Our study was done to understand the causes of traumatic SCI all over India.

Methods:

Online survey was conducted among SCI patients. Patients were given objective questions. Consecutive participants in 6 months were included from April 2022 to October 2022. Snow-bowling method was followed. Participants who had a SCI with known etiology were included in the analysis (n = 96). Different mechanisms of SCI documented in the databases were stratified by personal characteristics using descriptive analysis.

Results:

Road traffic accidents (RTAs) followed by fall from height were the biggest contributor of SCI. The most common causes of SCI were RTAs (50%) and fall from height (37.50%), followed by assault (4.17%), and others (8.33%).

Conclusion:

In primarily agriculture-based countries, fall from height (especially tree) was expected to be a major mechanism of SCI; however, our study shows a reversal of a trend. Improvement in rural infrastructure is decreasing the gap between RTA and falls from height as a major mechanism of SCI. It is time to make health policies primarily to prevent RTA and fall from height.
Anesthetic management of renal transplant surgery in a patient with severe mitral regurgitation and moderate pulmonary hypertension as sequelae of infective endocarditis
Authors: Mitra Titisha Sarkar , Thiek Vanrokhawl
Published: October 2023

Patients with end-stage renal disease require regular dialysis, mainly through a subclavian or jugular venous catheter, putting them at high risk of infection both due to the invasive catheter and low immunity. We report the successful management of renal transplant in a patient who developed severe mitral regurgitation (MR) due to posterior mitral leaflet perforation and also moderate pulmonary hypertension (PH) and moderate tricuspid regurgitation. The anesthetic target was maintenance of relative tachycardia and prevention of hypothermia, hypoxia and acidosis to prevent further increase in pulmonary resistance as well as correction of any electrolyte imbalance due to underlying chronic kidney disease. This may be the first case of a successful renal transplant in a patient of postinfective endocarditis with sequelae of severe MR and moderate PH.
National quality assurance standards in neonatal intensive care unit
Authors: Ellenkil Anitta Jose , Bhardwaj Nitin Dutt , Mishra Udai Bhasker
Published: October 2023

Background and Objectives:

The Goal of National Health Mission has been to enhance the availability and access of good quality health care for vulnerable population. The study evaluates the compliance of a neonatal intensive care unit (NICU) in a tertiary care government teaching hospital with national quality assurance standards (NQAS).

Materials and Methods:

A descriptive, observational, cross-sectional study was conducted using validated checklist adopted from NQAS. The data were collected by utilizing data collection techniques such as observation, staff interview, and record review.

Results:

The NICU has achieved a total score of 65% in service provision. Major gaps n = 126 (29%) were identified. The number of checkpoints which needed to be fulfilled at the departmental level was n = 137 (80%), to be fulfilled at the institutional level was n = 34 (19.2%), and those to be fulfilled at the top-level administration was n = 1 (0.8%); recommendations were made accordingly for improvement.

Conclusion:

The study concludes that there were n
= 126 (29%) noncompliant checkpoints/major gaps, particularly with respect to the quality management and outcome. Based on the findings of the study, the author recommends the development of a dedicated checklist with new checkpoints that need to be incorporated for medical college hospitals and institutes in the country to ensure quality patient care, which will consecutively improve the medical education and research.
Long-term central venous access: A narrative review
Authors: Kakroo Shivani Abhishek , Patel Jatin Vinodbhai , Bhalodia Nirav , Shah Kush Shaileshkumar
Published: October 2023

Modern medicine is witnessing boom both on medical and surgical front, but venous access which is the basic and the most important step in patient care still remains an untouched and unexplored area. This review explains the different types of long-term venous access devices, their crucial role in the administration of various treatments and therapies to the patients, complications associated with their use, ways to manage these complications, and care and maintenance of these venous access devices. To change the perspective of the medical practitioners toward necessity of long-term sustainable and patient-friendly modality of venous access, is the need of the hour.
Catamenial haemothorax—A rare cause of pleural effusion
Authors: Chetambath Ravindran , Kumar Praveen , V Nandini , Chandran Shilpa , Chacko Anju
Published: October 2023

Common causes of haemorrhagic pleural effusions include malignancy (primary or metastatic), tuberculosis, pulmonary embolism, collagen vascular diseases, trauma and iatrogenic causes. Clinical history along with pathologic, microbiologic and biochemical evaluation of pleural fluid confirms the diagnosis in most cases. However, if there is recurrent haemorrhagic effusion without corroborative history or mass lesion in lung, or evidence of microorganisms, then we should think of uncommon causes. Catamenial haemothorax (CHt) is a rare cause of haemorrhagic pleural effusion, which recurs during each menstrual cycle. This is a manifestation of thoracic endometriosis syndrome (TES) caused by ectopic endometrial tissue in the thoracic cavity in women of child-bearing age. This extremely rare condition is difficult to diagnose, unless direct correlation with the menstrual cycle is established. TES consists of pleural forms such as catamenial pneumothorax, non-catamenial endometriosis-related pneumothorax and haemothorax; and parenchymal forms such as catamenial haemoptysis and lung nodules. Here we report a case of CHt in a 43-year-old female whose diagnosis was established by thoracoscopic pleural biopsy.
Persistent respiratory symptoms and lung function abnormalities in recovered patients of COVID-19
Authors: S Vishnu N. , Sodhi Mandeep K. , Aggarwal Deepak , Puri Sonia , Saini Varinder
Published: October 2023

Background and Objectives:

COVID-19 is a disease caused by SARS-CoV-2 which belongs to a family of coronaviruses. After the acute phase of illness, the majority of the patients recover quickly but, in some cases, symptoms can persist for a variable duration, bringing into light another entity known as post-COVID syndrome. The objective was to estimate the burden of various persistent respiratory symptoms and lung function abnormalities among recovered patients of COVID-19 and also to correlate them with initial disease severity, demographic factors and comorbidities.

Methods:

Eighty-five post-COVID patients were recruited as per inclusion/exclusion criteria. Detailed history taking, physical examination and spirometry were done in all patients and data were correlated with baseline disease severity.

Results:

Fatigue and breathlessness were the most common symptoms followed by cough, chest pain and fever. Persistent symptoms and their severity were significantly higher in severe/moderate cases. Spirometry was abnormal in 45.88% of subjects and the most common pattern was restrictive type. It was seen that the likelihood of persistent symptoms and abnormal lung function increased significantly with the severity of COVID-19, age, comorbidities, hospital stay duration and steroid/oxygen therapy.

Conclusion:

The current study estimated the burden and array of various pulmonary sequelae encountered by post-COVID patients and elicited various risk factors associated with their occurrence after recovery from active infection. Awareness of these symptoms/sequelae and their risk factors is necessary for their follow-up and timely management, as the threat of this relatively new virus has still not abated.
Ewing's sarcoma of rib presenting as pleural effusion in a young child
Authors: Bisen Pratima , Kavishwar Madhura , Wade Poonam , Khandkar Omkar , Balasubramanian Meenakshi
Published: October 2023

Ewing's sarcoma of rib is a rare primary malignant bone tumour which poses diagnostic dilemma and has complex treatment. The diagnosis is based on the combination of clinical, imaging, pathology and immunohistochemistry findings. We here present a case of 3.5 years old male child who presented acutely with the complaints of fever, cough and breathlessness mimicking the diagnosis of pneumonia. Massive right-side pleural effusion was seen on chest radiograph. Further radiological investigation of high-resolution contrast computed tomography (HRCT) and Positron emission tomography (PET) scan along with biopsy and immunohistochemistry lead to the diagnosis of Ewing's sarcoma arising from right rib. Patient was treated with chemotherapy, and there was significant reduction in lesion, along with clinical improvement in symptoms.
Transoesophageal bronchoscopic ultrasound-guided fine-needle aspiration (EUS-B-FNA) for left adrenal gland (LAG) sampling: A report of three cases with a review of the literature
Authors: Vadala Rohit , Mittal Saurabh , Nambirajan Aruna , Hadda Vijay , Mohan Anant , Guleria Randeep , Madan Karan
Published: October 2023

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a standard-of-care modality for evaluating mediastinal lymph nodes and masses. The EBUS bronchoscope may also be introduced through the oesophageal route to perform sampling of accessible lesions, a technique described as transoesophageal bronchoscopic ultrasound-guided fine-needle aspiration (EUS-B-FNA). Because of the central oesophageal approach, EUS-B-FNA provides easy access to the left para-tracheal, subcarinal and para-oesophageal lymph nodes. In addition, the left adrenal gland (LAG) can also be imaged and sampled during the EUS-B-FNA procedure. In patients with suspected lung cancer, accurate staging is essential. Adrenal metastasis is relatively common and may often be a solitary metastatic site. We describe three cases where EUS-B-FNA was performed to safely sample the enlarged LAG in suspected lung cancer. We also review the literature on the performance characteristics of EUS-B-FNA for LAG aspiration.
Cylindrical singular minimal surfaces
Authors: Dierkes Ulrich , López Rafael
Published: October 2023

We construct a foliation of the upper half space in

\mathbb{R}^3

consisting of minimizing cylindrical

\alpha

-singular minimal surfaces when

\alpha<0

. Furthermore, we discuss stability results for the

\alpha

-catenaries when

\alpha>0

and relate these to the geodesics of a conformal metric.
Энтропийное решение для уравнения с мерозначным потенциалом в гиперболическом пространстве
Authors: Vildanova Venera Fidarisovna , Mukminov Farit Khamzaevich
Published: October 2023

В гиперболическом пространстве рассматривается задача Дирихле для нелинейного эллиптического уравнения второго порядка с сингулярным мерозначным потенциалом. Ограничения на структуру уравнения формулируются в терминах обобщенной $N$-функции. Доказано существование энтропийного решения задачи.
Библиография 16 названий.
Плотные слабо лакунарные подсистемы ортогональных систем и оператор мажоранты частных сумм
Authors: Limonova Irina Viktorovna
Published: October 2023

Для конечной ортогональной системы функций, ограниченных единицей по норме в $L_p$ при $p>2$, установлено существование достаточно плотной подсистемы со свойством лакунарности в пространстве Орлича. Показано, что норма оператора мажоранты частных сумм по такой подсистеме оценивается лучше, чем гарантирует классическая теорема Меньшова-Радемахера для общих ортогональных систем.
Библиография: 17 названий.
Establishment and application of three predictive models of anastomotic leakage after rectal cancer sphincter-preserving surgery
Authors: Li Hui-Yuan , Zhou Jiang-Tao , Wang Ya-Nan , Zhang Ning , Wu Shao-Fen
Published: October 2023

Postcholecystectomy bile duct injury (BDI) remains a devastating iatrogenic complication that adversely impacts the quality of life with high healthcare costs. Despite a decrease in the incidence of laparoscopic cholecystectomy-related BDI, the absolute number remains high as cholecystectomy is a commonly performed surgical procedure. Open Roux-en-Y hepaticojejunostomy with meticulous surgical technique remains the gold standard surgical procedure with excellent long-term results in most patients. As with many hepatobiliary disorders, a minimally invasive approach has been recently explored to minimize access-related complications and improve postoperative recovery. Since patients with gallstone disease are often admitted for a minimally invasive cholecystectomy, laparoscopic and robotic approaches for repairing postcholecystectomy biliary stricture are attractive. While recent series have shown the feasibility and safety of minimally invasive post-cholecystectomy biliary stricture management, most are retrospective analyses with small sample sizes. Also, long-term follow-up is available only in a limited number of studies. The principles and technique of minimally invasive repair resemble open repair except for the extent of adhesiolysis and the suturing technique with continuous sutures commonly used in minimally invasive approaches. The robotic approach overcomes key limitations of laparoscopic surgery and has the potential to become the preferred minimally invasive approach for the repair of postcholecystectomy biliary stricture. Despite increasing use, lack of prospective studies and selection bias with available evidence precludes definitive conclusions regarding minimally invasive surgery for managing postcholecystectomy biliary stricture. High-volume prospective studies are required to confirm the initial promising outcomes with minimally invasive surgery.
Identification of multiple risk factors for colorectal cancer relapse after laparoscopic radical resection
Authors: Luo Jun , He Mei-Wen , Luo Ting , Lv Guo-Qing
Published: October 2023

Postcholecystectomy bile duct injury (BDI) remains a devastating iatrogenic complication that adversely impacts the quality of life with high healthcare costs. Despite a decrease in the incidence of laparoscopic cholecystectomy-related BDI, the absolute number remains high as cholecystectomy is a commonly performed surgical procedure. Open Roux-en-Y hepaticojejunostomy with meticulous surgical technique remains the gold standard surgical procedure with excellent long-term results in most patients. As with many hepatobiliary disorders, a minimally invasive approach has been recently explored to minimize access-related complications and improve postoperative recovery. Since patients with gallstone disease are often admitted for a minimally invasive cholecystectomy, laparoscopic and robotic approaches for repairing postcholecystectomy biliary stricture are attractive. While recent series have shown the feasibility and safety of minimally invasive post-cholecystectomy biliary stricture management, most are retrospective analyses with small sample sizes. Also, long-term follow-up is available only in a limited number of studies. The principles and technique of minimally invasive repair resemble open repair except for the extent of adhesiolysis and the suturing technique with continuous sutures commonly used in minimally invasive approaches. The robotic approach overcomes key limitations of laparoscopic surgery and has the potential to become the preferred minimally invasive approach for the repair of postcholecystectomy biliary stricture. Despite increasing use, lack of prospective studies and selection bias with available evidence precludes definitive conclusions regarding minimally invasive surgery for managing postcholecystectomy biliary stricture. High-volume prospective studies are required to confirm the initial promising outcomes with minimally invasive surgery.
Timing of surgical operation for patients with intra-abdominal infection: A systematic review and meta-analysis
Authors: Song Shu-Rui , Liu Yang-Yang , Guan Yu-Ting , Li Ruo-Jing , Song Lei , Dong Jing , Wang Pei-Ge
Published: October 2023

Postcholecystectomy bile duct injury (BDI) remains a devastating iatrogenic complication that adversely impacts the quality of life with high healthcare costs. Despite a decrease in the incidence of laparoscopic cholecystectomy-related BDI, the absolute number remains high as cholecystectomy is a commonly performed surgical procedure. Open Roux-en-Y hepaticojejunostomy with meticulous surgical technique remains the gold standard surgical procedure with excellent long-term results in most patients. As with many hepatobiliary disorders, a minimally invasive approach has been recently explored to minimize access-related complications and improve postoperative recovery. Since patients with gallstone disease are often admitted for a minimally invasive cholecystectomy, laparoscopic and robotic approaches for repairing postcholecystectomy biliary stricture are attractive. While recent series have shown the feasibility and safety of minimally invasive post-cholecystectomy biliary stricture management, most are retrospective analyses with small sample sizes. Also, long-term follow-up is available only in a limited number of studies. The principles and technique of minimally invasive repair resemble open repair except for the extent of adhesiolysis and the suturing technique with continuous sutures commonly used in minimally invasive approaches. The robotic approach overcomes key limitations of laparoscopic surgery and has the potential to become the preferred minimally invasive approach for the repair of postcholecystectomy biliary stricture. Despite increasing use, lack of prospective studies and selection bias with available evidence precludes definitive conclusions regarding minimally invasive surgery for managing postcholecystectomy biliary stricture. High-volume prospective studies are required to confirm the initial promising outcomes with minimally invasive surgery.