bluuebunny/crossref_metadata_2025 huggingface dataset:
A rare case of co-existing branchial cyst and thyroglossal cyst
Authors: Sima Natashya H. , George Jomy , D’Souza Ophelia , Saidha Poonam K.
Published: November 2021

Thyroglossal duct remnants and branchial arch anomalies are the most common congenital neck masses. These anomalies typically present in childhood or early adulthood as cysts, sinuses or cartilaginous remnants, but may rarely present in late adulthood. Although both thyroglossal duct remnants and branchial cysts may be encountered individually, these anomalies are rarely encountered together in the same individual. We report the third such case of co-existing branchial cyst and thyroglossal cyst occurring in the same individual with review of embryological development of thyroglossal duct cysts and second branchial arch anomalies.
Bilateral sudden sensorineural hearing loss in a patient with scrub typhus: a case report
Authors: Babu Mosin , Singh Thingbaijam Sudhiranjan , Yumlembam Shandhyalata , Juhy Nimitha A. M. , Meetei Shapam Ravi
Published: November 2021

Scrub typhus is a febrile illness caused by Orientia tsutsugamushi, a gram negative alpha proteobacterium and transmitted by the bite of leptotrombidium, chigger mite larvae. The disease is endemic to Southeast Asia and Northern Australia and derives its name from the vegetation that harbours the mite. The patient usually presents with high-grade fever, an eschar at the inoculation site, generalised lymphadenopathy, organomegaly and pneumonitis. Rarely, the patient may go into acute renal failure, disseminated intravascular coagulation and shock. A case of scrub typhus presenting with acute sensorineural hearing loss which resolved with treatment is being reported. Hearing impairment with fever in a patient in endemic region of scrub typhus can give a clue to health care worker towards the diagnosis of scrub typhus and thus early administration of treatment.
Types of vaginal microbiomes in PCOS affected females
Authors: Ahmed Dalya Thamer
Published: November 2021

To evaluate and analyze the microbiomes component of the vagina in females with polycystic ovarian syndrome PCOS, and compare it with that of healthy females.

A case- control study included 120 participants, 60 had been diagnosed as having PCOS according to the Rotterdam Criteria for diagnosis of PCOS and the other 60 are healthy females visiting the outpatient private clinics in Hay Aljameaa/ Al-Harthya in Baghdad from October 2020 till march 2021 for different medical problems, statistical analysis was done by using the SPSS computer application for statistical analysis.

Both study groups had L. crispatus in their vagina, while for L. jensonii 93.33% of control group have this microbiota while only 66.66% of PCOS group have it, L. gasseri presents in the vagina of 80% of controls and only 38.33% of PCOS. S. aureus in 41.66% of PCOS group and only 3.33% of control group, S. epidermidis presents in 25% of PCOS females while it not presents in control group. Str. Pyogenes presents in 36.67% of PCOS group and absent in control group (p< 0.0001), Str. Agalactiae presents in 26.67% of PCOS group and 1.67% of control group. Bacteroides presents in 30% of PCOS cases and only in 1.67% of controls (p< 0.0001). For other types of vaginal microbiota e.g. Gardnerella vaginalis we found that it presents in high percentage of PCOS group 66.67% and absent in females of control group, Prevotella spp presents in 55% of PCOS group and only 3.33% of control group, Mobiluncus spp and Fusobacterium spp were absent in both study groups. For candida species, C. albicans presents in 30% and 6.67% of vagina of PCOS and control group respectively.

There is large diversity in the vaginal microbiota with disruption to normal flora in PCOS affected patients so We need further studies to evaluate the relationship between the microbiota and different PCOS symptoms.
Cervical pap smear study and its utility in cervical cancer detection and prevention
Authors: Sudhakar Boinapalli , Karra Vijaya , Ramulu Pamu Shiva
Published: November 2021

The objective of present study to find out women for precancerous lesions with the help of pap smear test as early identification marker. Determine the percentage of cervical cancer in relationship with demographic, education and occupation. To find out pap smear effectiveness in various infections. To find out correlation pap smear findings with symptoms.

This is a cross-sectional study involving the screening of women from the rural population of Siddipet district for the assessment of health status using pap smear test who have attended the outpatient department of Obstetrics and Gynecology conducted during the period of August 2019 to May 2021.

The present study included 1500 Pap smears, of which the most common abnormality was inflammatory smear, which is followed by atrophic smear. Among all the study respondent’s majority (64.5%) of the women were home makers and not working, remaining participants were either self employed or working women. Percentage of abnormal smear reports was reported in group 2 (31-40 years) subjects followed by group 3 (41-50 years) women. In 22 patients, Atypical Squamous Cell of Undetermined Significance (ASCUS) was observed. The present study reported very less cervical cancer prevalence in our study population.

Pap smear testing is a sensitive and effective screening test which can be used for identification of precancerous epithelial lesions. Pap smear test should be recognized as a routine screening method to decrease Mortality and Morbidity due to the cervical cancer. This study also regard us as paps smear is a gold standard for cervical screening. This study also suggests that every woman above the age 30 years should undergo screening programs for cervical cancers. So Morbidity and Mortality due to cervical cancers can be prevented by early identification of cervical cancer by doing screening at regular intervals.
Knowledge, attitude and practices about coronavirus disease (COVID-19) and its spread among pregnant females in rural West Bengal, India
Authors: Ray Sabyasachi , Pandey Jagriti
Published: November 2021

In view of the prevailing COVID-19 pandemic, people should have adequate knowledge about cause of the disease, mode of spread and the protective measures against it. Basic protective measures against the Coronavirus disease have been laid out by WHO for the public which are practicing hand hygiene, social distancing and wearing a mask. Good knowledge status when coupled with optimistic attitude will lead to effective practice of the protective measures.

: This study will assess the knowledge, attitude and practices about Coronavirus disease among pregnant females of rural West Bengal. It will help in finding the limiting factors and assess the association between knowledge and attitude, practices of the respondents.

It is a hospital based cross-sectional study carried out in antenatal out patient department from 18 October, 2020 to 5 December, 2020. 500 pregnant women were enrolled through simple random sampling after proper informed consent.

Significant association between knowledge score and age group (p -0.0457) and literacy status (p -0.0105) was found. The mean COVID-19 knowledge score was 10.70 (SD:2.18, range :1-12) with an overall correct rate of 89.17% (10.70/12* 100). Significant practice of wearing a mask was 6.5625 [OR -6.5625(3.1603, 13.6385; p <0.0001] times more in good knowledge score group.

Practice of preventive measures reduces the chances of contacting the infection, thus reducing maternal mortality and morbidity. Practices of preventive measures can be further strengthened by improving the knowledge of the people thorough awareness at grassroot level.
Comparison of causes of maternal near miss and maternal mortality in Mahatma Gandhi institute of medical sciences which is Tertiary care rural hospital (Januray 2016 to September 2017)
Authors: Shelke Shila , Varma Poonam , Suman Akanksha
Published: November 2021

: A mother is the foundation of a family and also the very root and foundation of a Nation. Maternal health is a matter of great importance all over the world as it defines the social status of women in a country as well as the quality of health services provided by a Nation to its people.

The study was performed in a rural tertiary care institute located in central India. After clearance from the ethical committee of the institute and approval from university for thesis synopsis was received, study was initiated on patients meeting the study requirements from a period of January 2016 to September 2017.

In this study, amongst all cases of Maternal near Miss 36% were due to haemorrhage, 22.4% due to medical disorders, 21.6% due to hypertensive disorders of pregnancy, 15.2% due to infection, and 4.8% were due to labour related disorders. Investigating MNM cases will help to improve the maternal health system more as women has survived catastrophe. Positive feedback to health worker will do miracles.
Role of routine urine culture in predicting asymptomatic bacteriuria in pregnancy and the prevalence of asymptomatic bacteriuria in pregnant women - Our experience
Authors: Krishnamurthy Aparna , Khan Shazia , Singh Tina
Published: November 2021

Asymptomatic bacteriuria (ASB) in pregnancy can flare into frank pyelonephritis and sepsis if untreated due to the low immunity. Apart from causing morbidity in mothers it affects the foetus by increasing the incidence of prematurity and IUGR. The present study was undertaken to determine the prevalence of ASB in the pregnant women attending Ante natal clinic and the significance of routine urine culture.

: Total 310 pregnant women attending the antenatal OPD were enrolled in the study over a period of 10 months. Inclusion criteria included all pregnant women attending antenatal OPD without any urinary symptoms or history of fever. Exclusion criteria included frank UTI symptoms like fever, dysuria, increased frequency of urine, any history of intake of antibiotics, any urinary tract anomaly or renal calculi. Their midstream urine sampling was collected and subjected to both microscopy and culture sensitivity; standard microbiological method was used.

The prevalence of ASB was found to be 11.29% and was maximum in second trimester (54.2%). The study revealed routine urine culture is a sensitive test to diagnose ASB. The commonest bacterium isolated was Escherichia coli (51.4% cases) and the most effective antibiotic was Nitrofurantoin. The neonatal outcomes are discussed in the text while no perinatal deaths were recorded during the period of study. No direct association of asymptomatic bacteriuria with anaemia and preeclampsia was found, but odds ratio was more than one.

The study highlights that asymptomatic bacteriuria is a common occurrence in pregnant women, including urine culture as a part of routine investigation in antenatal patients can help diagnose this condition. Prompt treatment of ASB can prevent any obstetric complication arising from the flareup of asymptomatic bacteriuria in pregnancy and thus reduce maternal and foetal morbidity.
A prospective study of prediction of preterm delivery by cervical assessment by transvaginal sonography
Authors: Arora Garima Bagga , Bodade Asmita , Bodade Ritesh , Vaishnao Lohit S , Bagga Gourav
Published: November 2021

Preterm birth is a major cause of death and a significant cause of long-term loss of human potential amongst survivors all around the world. Complications of preterm birth are the single largest direct cause of neonatal deaths, responsible for 35% of the world’s 3.1 million deaths a year, and the second most common cause of under-5 deaths after pneumonia.

In this study, an attempt has been made to evaluate the usefulness of cervical assessment by TVS in prediction of risk of preterm delivery in low risk pregnant women, thereby earlier management option can be planned and patients specific treatment can be given at the earliest.

The present study was carried out in tertiary care teaching hospital for 1 year from 1 Jan 2019 to 31 Dec 2019. Total of 100 study participants who underwent TVS assessments of cervix regularly followed up who underwent TVS assessment of cervix and were regularly follow up and delivered.

The mean cervical length in all these women was 30±6.68 mm. It was observed that 51.72% of patients with short cervical length less than 25 mm had preterm labour compared to the patients with cervical length more than 25mm i.e. 4.22%.

Cervical assessment by TVS is effective in predicting preterm labour.
Pregnancy following Brown-Séquard syndrome: A rare case report
Authors: Bharathi Shree , Jha Niveditha , Rengaraj Sasirekha , Ranjan Veena
Published: November 2021

Brown-Séquard syndrome is an incomplete spinal cord lesion characterized by hemisection injury of the cord. We present a case of pregnancy, delivery and postpartum course following this rare neurological condition. A 42-year-old woman presented with past history of idiopathic hemicord myelitis leading to right sided hemiplegia with decreased contralateral sensation of pain and temperature, consistent with Brown-Séquard syndrome, which was treated with steroids and Therapeutic Plasma Exchange. Thereafter, she had near-complete motor recovery and complete sensory recovery over the next 3months. Three years later, she presented to us at 37+2 weeks of gestation with residual hemiparesis with motor power grade of 4/5 in right upper and lower limbs. She underwent Caesarean section for breech presentation, which was done under general anaesthesia in view of prior spinal cord lesion. She was discharged for follow-up in Neurology outpatient clinic and physical rehabilitation. At follow up after 12 months of delivery, she had complete motor and sensory recovery. Management of spinal cord lesions in pregnancy and delivery requires specialist multidisciplinary care due to risk of medical and obstetric complications. This case demonstrates a rare scenario of a primigravida at term gestation with residual deficits of a past spinal cord lesion.
Characteristics of granulosa cell tumor at Dr. Soetomo general hospital from 2014 to 2019
Authors: Tjokroprawiro Brahmana Askandar , Santoso Eko , Pradnyani Ni Nyoman Ratih
Published: November 2021

The aim of the present study was to investigate tumor characteristics, treatment, recurrence, and prognosis in both Granulosa Cell Tumor types.

A retrospective review study of 38 patients in a single institute; We identified patients with GCTs diagnosed between 2014 and 2019 in the Regional General Dr. Soetomo Hospital. Surgical outcome, pathological findings and follow-up data were analyzed. Statistical analyses were conducted using Fisher exact test and Kaplan-Meier survival curves and compared with the log-rank test.

The prevalence of AGCT subtypes as the most common type occurring in 97% of cases. The median age at diagnosis among patients with AGCT is 47.5 years (range 41-59), and most women are premenopausal and multiparous. In our literature review Stage 1 disease is 76% with Overall Survival (OS) for 5years is 89.7%. FIGO stage and adjuvant therapy was not shown a positive correlation with recurrency (p >0.05). Rate of recurrence in AGCT is reported to be as high as 5.26%.

GCT is a rare low malignant tumor, majority of patients present with early-stage disease and generally have a favorable prognosis. Stage is not considered as the most important prognostic factor. The role of adjuvant chemotherapy treatment is debatable as it was not shown to reduce recurrence rates. Long-term surveillance including routine clinical follow-up and tumor markers serial evaluation is mandatory to evaluate recurrency.
Morphological spectrum of salivary gland tumors withspecial reference to mucin stains
Authors: Begum Faeeza , Choudhary Shaista
Published: November 2021

Salivary gland neoplasm are rare and constitute about 3% of all head and neck neoplasms. Mucins are altered in pathological states and are stained by special stains like Periodic Acid Schiff, Alcian Blue and Mucicarmine.

To study the histomorphology of resected salivary gland tumors and mucin staining pattern wherever indicated.

Surgically resected specimens received at our tertiary care hospital and subjected to histopathological examination. Specimens were fixed in 10% formalin, processed and embedded in paraffin blocks, serially cut to get sections of 3-5 microns thickness. Stained with hematoxylin and eosin for all. Mucin stains were used wherever applicable.

Total number of cases studied were 70. Out of which 46 were benign (65.7%) and 24 were malignant (34.3%). Among benign tumours, Pleomorphic adenoma was the commonest tumour (48.57), followed by Warthin tumor (7.14%), Basal cell adenoma (4.28%), Myoepithelioma (1.43%), Oncocytoma (1.43%), Hemangioma (1.43%), Sailolipoma (1.43%). The Mucoepidermoid carcinoma was the most common malignant tumor (17.14%) followed by Adenoid cystic carcinoma (5.71%), Acinic cell carcinoma (4.28%), Polymorphous adenocarcinoma (1.43%), Epithelial myoepithelial carcinoma, Squamous cell carcinoma (1.43%), Salioblastoma (1.43%), Lymphoma (1.43%). Parotid was most common site for both benign and malignant tumor. Females are affected more commonly than males. Mucin staining pattern was noted.

Salivary gland tumors have complex range of morphological spectrum. Histopathological examination is the golden standard for diagnosis and mucin stain would add as an adjunct to the diagnosis.
Identification of thawed and frozen soil state in some Siberia regions by multi-temporal Sentinel 1 radar data in 2017-2018
Authors:   Institute of Radioengineering and Electronics, Russian Academy of Sciences, Vvedenskiy sq. 1, Fryazino, Russia, 141190, Rodionova Natalia
Published: November 2021

The paper deals with the identification of thawed/frozen soils in the topsoil layer for three stations in Siberia: Salekhard, Tiksi and Norilsk by using Sentinel 1B C-band radar data for the period of 2017-2018. Determination of the frozen/thawed soil state is carried out in three ways: 1) by multi-temporal radar data on the basis of a significant in 3-5 dB difference in the backscatter coefficient 0 in the transition of freezing/thawing soil state, 2) by finding the threshold value of 0 at which the temperature in the topsoil layer falls below 00C, 3) by texture features. The first method allows determining the period of time during which the process of freezing/thawing of the soil occurs. The second and third methods allow making local maps of frozen/thawed soils. It is shown that for the studied areas the Spearman correlation coefficient between 0 and air temperature for cross - polarization exceeds the correlation coefficient for co-polarization. The graphs of the AFI (air freezing index) for the period of 2012-2018 are constructed based on the archive data of air temperature for the study areas.
Preface
Authors:   Samara National Research University, Moskovskoe Shosse 34, Samara, Russia, 443086, Kudryashov Denis ,   Image Processing Systems Institute of the RAS - Branch of the Federal Scientific Research Centre “Crystallography and Photonics” of Russian Academy of Sciences, Molodogvardeyskaya str. 151, Samara, Russia, 443001, Kozlova Elena ,   Samara National Research University, Moskovskoe Shosse 34, Samara, Russia, 443086,   Image Processing Systems Institute of the RAS - Branch of the Federal Scientific Research Centre “Crystallography and Photonics” of Russian Academy of Sciences, Molodogvardeyskaya str. 151, Samara, Russia, 443001
Published: November 2021

This volume contains the papers presented at the session "Image Processing and Earth Remote Sensing" and "Data Science" within the V International Conference on Information Technology and Nanotechnology (ITNT-2019).
Composition of the Council of Ministers of ASSR at a time of reform of 1985–1991: changes and main features (on the example of Mordovia)
Authors: Bikeykin E. N. , Uchvatov P. S.
Published: November 2021

In the article the senior management of the regional executive and administrative authority as an example of the supreme body of State governance of an autonomous republic the Council of Ministers of the Mordovian Autonomous Soviet Socialist Republic is considered. The changes in the Council of Ministers in the last years of the existence of the USSR is analyzed. The reforms initiated by the General Secretary of the CPSU Central Committee M.S. Gorbachev affected practically all sectors of society, including the functioning of public administration. Meanwhile, the system of power in Mordovia had some peculiarities, largely associated with the conservatism and external cohesion of the regional elites, which have had to respond to processes in the country at the same time. In the chronological period selected in the article, there were two compositions of the Council of Ministers, which were formed on March 15, 1985 at the first session of the MASSR Supreme Council of the 11th convocation and on April 10, 1990 at the first session of the MASSR Supreme Council of the 12th convocation. The authors provide information about age, social origin, nationality, educational level, tenure for members of the MASSR Government. In preparing the article, materials from the funds of the Central State Archives of the Republic of Mordovia, the regional press, published memoirs of participants in the events, as well as biographical information about the Soviet, Party and economic leaders from open sources were used.
Alterations in mitochondrial function and energy metabolism-related properties in thyroid cancer stem cells
Authors: Ren Yu , Liang Hongyu , Wang Xiao , Cao Zhongwei , Ma Yuzhen , Liu Xiaoling
Published: November 2021

Increasing evidence indicates that cancer stem cells (CSCs) are initiators of the occurrence, development, and recurrence of malignant tumors. Mitochondria are important organelles in eukaryotic cells, not only responsible for converting part of energy released during nutrients oxidation into the energy-yielding molecule adenosine triphosphate (ATP) to fuel the activities of cell, but also play essential roles in processes such as cell apoptosis and cellular proliferation. The mitochondrial-related abnormalities have also been considered to have an important role in the origin and development of tumors. This study aimed at testing the abnormalities in mitochondrial function and energy/metabolism-related phenotypes in thyroid cancer stem cells (TCSCs). TCSCs were isolated and identified from MDA-T32 thyroid carcinoma cell line. The mitochondrial mass and mitochondrial arrangement, amount of mitochondrial DNA (mtDNA), mitochondrial membrane potential (MMP), oxygen/glucose consumption, and intracellular concentrations of reactive oxygen species (ROS) and ATP levels were examined. Perinuclear mitochondrial distribution, low amount of mtDNA and oxygen/glucose consumption, high MMP, and low intracellular ROS and ATP concentrations were observed in TCSCs. Alterations in mitochondrial function and cellular energy metabolism may be used as novel indicators of thyroid cancer.
The Production of Liquid Fuel Products by the Catalytic Hydroliquefaction of Sapropels Using Nickel and Nickel-Tungsten Catalysts
Authors: Terekhova E. N. , Belskaya O. B.
Published: November 2021

Ni catalysts with the carbon-mineral supports obtained from sapropel were synthesized and studied in the catalytic hydroliquefaction of sapropel. It was found that catalysts with the supports obtained from mineral sapropel are more active as compared to those based on organic sapropel; therewith, bimetallic NiW catalysts showed a higher activity than monometallic nickel, irrespective of the support nature. The conversion of the organic matter of sapropel and the composition of liquid products are affected by both the features of supported metal and the composition of support. The liquid products of hydroliquefaction contain mostly the nitrogen- and oxygen-containing compounds. The maximum yield of С5-С21 hydrocarbons is achieved for the catalysts with the supports obtained from mineral sapropel. The composition of the liquid products of sapropel hydroliquefaction is similar to that of biofuels obtained from other renewable sources; such products can be introduced in the known schemes of further processing.
Telehealth in Management of COVID-19 Pandemic: A Scoping Review
Authors: Almasi Sohrab , Asadi Farkhondeh
Published: November 2021

COVID-19 has created major health-related, economic, and social challenges in societies, and its high contagion has dramatically altered access to healthcare. COVID-19 management can be improved by the use of telehealth. This study aimed to examine different telehealth technologies in the management of COVID-19 disease in the domains of surveillance, diagnosis, screening, treatment, monitoring, tracking, and follow-up and investigate the challenges to the application of telehealth in COVID-19 management. This scoping review was conducted based on Arksey and O’Malley's framework. Searches were performed in Web of Science, PubMed, and Scopus databases to examine the evidence on the effectiveness of telehealth in COVID-19 management. Eventually, 36 articles were selected based on the inclusion criteria. The majority of these studies (33%) were conducted in China. Most services offered via telehealth focused on surveillance, tracking, and follow-up, in that order. Moreover, the most frequently used technologies were social networks, web-based apps, and mobile apps, respectively. The use of telehealth in COVID-19 disease management plays a key role in surveillance, diagnosis, screening, treatment, monitoring, tracking, and follow-up.
Cost-Effectiveness of Osteoporosis Screening in Women Over 40-Year-Old
Authors: Keshavarzi Fereshte , Aflaki Elham , Askarian Mehrdad , Hatam Nahid
Published: November 2021

Osteoporosis is a disease recognized by bone density reduction and is particularly common among older women, which imposes them to fractures. The evidence shows that if do no serious conflict with this issue, in the far little future, huge costs will be imposed on individuals, families, and the country. In this study, we studied the cost-effectiveness of osteoporosis screening in women over 40 years of age in Shiraz in 2016. This cross-sectional study was performed on 240 persons who were screened and 240 non-screened persons in the bone mineral density ward of Shiraz Namazi Hospital. The costs were identified and from the perspective of the insurer and the payer, which included only direct health care costs. To measure the effectiveness, the use of indicators as quality-adjusted life-years (QALY), the expected cost and effectiveness, and the Incremental cost-effectiveness ratio were calculated. The results showed that non-screening is the best strategy, given that the amount of ICER was obtained at $38484.56 and the threshold. As a result, the non-screening method compared to screening is cost-effective. The relevant authorities and proficients should prevent the progression of disease complications and consequently prevent the increase of the disease cost and improve the quality of life of the patients.
Vitamin D Insufficiency in Disease Severity and Prognosis of the Patients With SARS Corona Virus-2 Infection
Authors: Asgari Ali , Hazrati Ebrahim , Soleiman-Meigooni Saeed , Rajaeinejad Mohsen , Alahyari Sam , Nasiri Malihe
Published: November 2021

The global crisis caused by the SARS Corona virus-2 infection is continuing through 2021, with more than 3.5 million deaths. Several risk factors for this virus’s severity and death were documented, including diabetes, hypertension, and ischemic heart disease. To evaluate the relation between serum vitamin D3 level, the disease severity, and prognosis of the patients with SARS Corona virus-2 infection. Patients with COVID-19 were evaluated for serum vitamin D levels and laboratory data. Correlation between vitamin D levels and laboratory data with disease severity and prognosis was assessed. Cox and logistic regression tests, as well as ROC curves, were used for data analysis. Ninety-eight patients with Corona virus-2 disease (COVID-19), which consisted of sixty patients with moderate COVID-19 in the general wards, and thirty-eight patients with severe COVID-19 in the intensive care unit (ICU), were evaluated. The mean age in the general wards was lower than in ICU (60.96±14.86 compared to 67.94±16.46, P=0.001), and the mean serum vitamin D level in the patients admitted in the general wards was higher than in the ICU (31 ng/mL compared to 20.57 ng/mL, P=0.003). Furthermore, vitamin D deficiency (25 (OH) D <25 ng/ml) significantly increased the risk of severe disease. (odds ratio=2.91, P=0.019) and mortality (odds ratio=3.64, P=0.026). Vitamin D deficiency is a risk factor for disease severity and poor prognosis in COVID-19. Vitamin D levels of 25 ng/mL can be used as a cut-off value for predicting severity and prognosis.
Acquired Diverticulosis of the Vermiform Appendix: A Rare Case Report
Authors: Hosseini Saeedeh , Niknejad Nakisa , Dehghan Arash , Niknezhad Nasim , Hedayati Sorena
Published: November 2021

Diverticulosis of the appendix, as a rare and incident disorder, mimics acute or chronic appendicitis and is characterized by herniation of the appendiceal mucosa through the muscular wall. Symptom and laboratory data of diverticular disease usually represent chronic inflammation. In this study, a 43-year-old female with a history of right lower quadrant pain and anorexia represented abdominal tenderness and rebound tenderness in the physical examination and normal laboratory tests. Abdominal sonography did not show any evidence of acute appendicitis. The removed appendix was 12 cm in length and had multiple diverticular protrusions along with it. The histologic examination showed diverticulosis without evidence of inflammation. The patient was discharged two days later in optimal clinical condition. Diverticulosis of the appendix often is confused with acute or chronic appendicitis based on similar presenting symptoms and imaging studies. Although surgery is the definitive treatment of both conditions, an appropriate diagnosis of diverticular disease before surgery is very important because of the association of appendiceal diverticular disease with neoplasm and other complications.
Management Approach Combining Prognostic Screening and Targeted Treatment for Patients with Low Back Pain Compared with Standard Physiotherapy: A Systematic Review & Meta-analysis
Authors: Ogbeivor Collins
Published: November 2021

Introduction: Research evidence suggests that a stratified care management approach is better at improving clinical and economic outcomes for low back pain (LBP) patients compared with usual care in the short term. However, it is unclear if these health and economic benefits are sustainable in the longer term. The aim of this study was, therefore, to determine the effectiveness of stratified care compared with standard physiotherapy for LBP treatment.
Methodology: A comprehensive search was undertaken of seven electronic databases (CINAHL, MEDLINE, Pedro, EMBASE, PsycINFO, Cochrane Register for Controlled Trials, and Web of Science with full text). Although no time limits were applied, studies were limited to English language publications and those involving human participants only. Study selection, data extraction, and appraisal of study were independently undertaken by both reviewers (CO and LE).
Result: In total, 6842 patients (aged 18 years and above) were included in the eight trials reviewed;  four were randomized controlled trials (RCTs) and four were non-RCTs. The pooled analysis of three studies (n = 2460) demonstrated a strong evidence in favor of stratified care over standard care at improving overall pain (Weighted Mean Difference (WMD) [random] 0.46 [95% CI 0.21, 0.71]; P < 0.0003), with overall effect (Z = 3.6) and (Roland-Morris disability questionnaire (RMDQ) scores (WMD [random] 0.71 [95% CI 0.05, 1.37]; P < 0.03), with overall effect (Z = 2.11) at three-, four-, and six-months’ follow-up periods.
Conclusion: This current review demonstrated that a stratified care approach provides substantial clinical, economic, and health-related cost benefits in the medium- and high-risk subgroups compared with usual care. Further research is needed for longer-term benefits.
Posterior Lumbar Interbody Fusion with Preservation of Posterior Structures for Management of Lumbar Spondylolisthesis
Authors: Aly Tarek
Published: November 2021

Introduction: Successful posterior lumbar interbody fusion requires excessive removal of posterior spinal elements and distraction of neural structures. It also requires a large amount of bone graft. The authors have developed this technique to assess results of treatment of degenerative spondylolisthesis by posterior lumbar interbody fusion with preservation of posterior spinal elements and also to examine the safety and efficacy of the recapping  T-saw laminoplasty technique for the management of degenerative lumbar spondylolisthesis using posterior lumbar interbody fusion by interbody cages with preservation of posterior elements.
Methodology: Twenty-five patients with degenerative spondylolisthesis underwent recapping T-saw laminoplasty in the lumbar spine for posterior lumbar interbody fusion with interbody cage. The T-saw was used for the division of the posterior elements. After discectomy and insertion of cages, the excised lamina was replaced exactly in situ to their original anatomic position. Patients were followed neurologically and radiologically.
Result: Only one lamina was excised and replaced again. Primary bone healing was obtained in all patients by four to six months post surgery. No complications such as postoperative spinal canal stenosis, facet arthrosis, or kyphosis were observed.
Conclusion: This technique of posterior lumbar interbody fusion through recapping laminoplasty provide wide space for easier insertion of cages and allow anatomic reconstruction of the vertebral arch preserving its important mechanical roles.
Minimally Invasive versus Open Thoracolumbar Surgery for Lumbar Spinal Stenosis in Patients with Diabetes: A CSORN Study
Authors: Hathi Kalpesh
Published: November 2021

Introduction: This study was aimed at comparing outcomes of minimally invasive (MIS) versus OPEN surgery for lumbar spinal stenosis (LSS) in patients with diabetes.
Methodology: This retrospective cohort study included patients with diabetes who underwent spinal decompression alone or with fusion for LSS within the Canadian Spine Outcomes and Research Network (CSORN) database. Outcomes of MIS and OPEN approaches were compared for two cohorts: (i) patients with diabetes who underwent decompression alone (N = 116; MIS, n = 58, OPEN, n = 58) and (ii) patients with diabetes who underwent decompression with fusion (N = 108; MIS, n = 54, OPEN, n = 54). Mixed measures analyses of covariance compared modified Oswestry Disability Index (mODI) and back and leg pain at one-year post operation. The number of patients meeting minimum clinically important difference (MCID) or minimum pain/disability at one year were compared.
Result: MIS approaches had less blood loss (decompression alone difference 99.66 mL, p = 0.002; with fusion difference 244.23, p < 0.001) and shorter LOS (decompression alone difference 1.15 days, p = 0.008; with fusion difference 1.23 days, p = 0.026). MIS compared to OPEN decompression with fusion had less patients experience an adverse event (difference, 13 patients, p = 0.007). The MIS decompression with fusion group had lower one-year mODI (difference, 14.25, p < 0.001) and back pain (difference, 1.64, p = 0.002) compared to OPEN. More patients in the MIS decompression with fusion group exceeded MCID at one year for mODI (MIS 75.9% vs OPEN 53.7%, p = 0.028) and back pain (MIS 85.2% vs OPEN 70.4%, p = 0.017).
Conclusion: MIS approaches were associated with more favorable outcomes for patients with diabetes undergoing decompression with fusion for LSS.
Complications of Surgical Treatment of Adult Scoliosis
Authors: Wafa Mohamed
Published: November 2021

Introduction: With the increase in global life expectancy, the number of patients presenting with progressive spinal deformities is also on rise. The increasing frequency of surgical intervention as a treatment of this group of patients is associated with many complications and also with increasing rate of reoperation.
Methodology: Seventy-two cases of adult scoliosis were treated surgically in Ain Shams spine unit with a minimum follow-up of five years (average, 76 months). Preoperative clinical and radiological evaluation was done, with special emphasis on the degree of pains (back and leg), Oswestry Disability Index (ODI), scoliosis angle, lumbar lordosis, any instability, and the level of spinal canal stenosis needing decompression. The pelvic incidence was measured preoperatively to plan the amount of lordosis needed to be restored.
Result: The mean preoperative scoliosis angle was 22 ± 10.4º (16 to 34º) and the mean preoperative lordosis angle was 20.3 ± 12.7º (–15 to –28º). The mean preoperative ODI score was 54.7 ± 5.5, and the mean postoperative scoliosis angle improved to 7.4 ± 3.3. The mean postoperative lordosis angle became 37.3 ± 8.6, and the mean postoperative ODI score was 21.3 ± 3.8.
Conclusion: The list of complications included seven cases of pseudoarthrosis and screw loosening, adjacent segment fracture in nine cases, and one case of spondylodiscitis at a level just proximal to the fused level. These 17 cases needed reoperations (24%). Additionally, there were five cases of dural tear, prolonged graft side pain in one case, and two cases of superficial wound infections.
Comparison of Pain Location and Extent Between Adults with Ankylosing Spondylitis-related Inflammatory versus Chronic Nonspecific Low Back Pain
Authors: AlRashed AlHumaid Lolwah
Published: November 2021

Introduction: Pain among adults with ankylosing spondylitis-related inflammatory low back pain (AS-ILBP) is not well-characterized, and individuals with AS-ILBP are frequently misdiagnosed with chronic nonspecific low back pain (CNSLBP). This study digitally quantifies and compares the location and extent of pain between adults with AS-ILBP and those with CNSLBP and examines the relationship between the pain extent and functional, psychological, and condition-specific factors in those with AS-ILBP.
Methodology: The location and extent of pain in adults with AS-ILBP (n = 27) or CNSLBP (n = 22) was quantified using a digital pain drawing analysis. Relationships between pain extent and perceived pain intensity and disability, pain-related cognitive factors (back beliefs, fear of movement, pain catastrophizing, pain coping, and self-efficacy), psychological distress, and AS-specific features were examined in those with AS-ILBP.
Result: Pain extent in the dorsal region of the body was greater in those with AS-ILBP than in CNSLBP (P < 0.05). In AS-ILBP, the most prevalent pain location was the lumbar region (88.9%), followed by the buttock (70.4%); the frequencies of reported pain in these regions were similar between groups (P > 0.05). The AS-ILBP group more frequently reported pain in the thoracic (70.4%) and cervical (51.8%) regions (P < 0.05). In the AS-ILBP group, larger pain extent was moderately associated with negative back beliefs (rs = –0.44 to –0.41, P < 0.05) and lower self-efficacy (rs = –0.58 to –0.42, P < 0.05), but not with any of functional outcomes. Larger pain extent was associated with higher disease activity (P < 0.05).
Conclusion: Adults with AS-ILBP perceive larger pain extent in spinal regions and the degree of pain extent is associated with negative back beliefs, lower self-efficacy, and higher disease activity. Pain drawings may assist in the differential diagnosis of CNSLBP and AS-ILBP. Further, they may aid psychological screening in adults with AS-ILBP.
Management of Low Back Pain in Primary Healthcare Settings: Physician’s Knowledge and Practices Based on Red Flags of Low Back Pain in Jazan Region – A Cross-sectional Study
Authors: Arishy Alshaymaa
Published: November 2021

Introduction: This study assessed the primary healthcare physicians’ knowledge and practices toward the red flags of low back pain (LBP) and factors associated with awareness.
Methodology: This cross-sectional study was conducted between October 2020 and June 2021 in primary healthcare (PHC) settings in Jazan, Kingdom of Saudi Arabia. Questionnaires were electronically distributed among 261 primary physicians with a 96.1% response rate.
Result: Of the 261 physicians included, 56% were male, 49.4% were aged between 35 and 44 years, and 76.9% were non-Saudi. Moreover, 49% of the physicians had one to nine years of experience and 33.1% indicated that they deal with >30 patients with back pain per month. Furthermore, it was found that 86.9% of the participants were aware of the overall red flags of LBP. Job category and the number of cases were significant factors of perceived awareness. The highest level of self-reported awareness was among consultants. The rate of referral patients with nonspecific back pain was highest among general practitioners. More than 95% of the participants would refer patients to hospital if they noticed the presence of red flags for LBP.
Conclusion: Awareness of physicians practicing in PHCs through the red flags of LBP in Jazan is good, and recognition of the need for the referral of a patient with suspected critical illness is good as well.
Occupational Therapy Treatment Time During Spinal Cord Injury Rehabilitation: A Retrospective Study in Riyadh
Authors: Almohimeed Teif
Published: November 2021

Introduction: Occupational therapy (OT) is a part of rehabilitation that facilitates and enables individuals with traumatic spinal cord injuries (TSCI) to engage in daily occupations independently. Little is known about the type of OT treatment plan and the amount of time spent selecting the treatment intervention during TSCI rehabilitation. This study aimed to describe the overall time spent by patients with TSCI throughout their inpatient rehabilitation stay.
Methodology: A chart review was conducted of patients attending inpatient rehabilitation for TSCI at King Abdulaziz Medical City between 2016 and 2020. For each patient, an electronic medical file, the documented rehabilitation session, including the time spent and type of therapeutic activity, were extracted. Demographic, clinical data related to the type of injury and the level of spinal cord injury (SCI) involved were also collected. We estimated the time that each patient had among all sessions and examined it with clinical factors.
Result: A total of 50 eligible patients were included in this analysis. The mean age of the study population was 28 (interquartile range [IQR], 22–41) years, and the majority were male patients (82%). The most common reason for the SCI was a motor vehicle accident (94%), in which 56% required ICU admission. Among the study population, 58% had paraplegia and 42% had quadriplegia. The most common specific therapeutic activity was education (100%), equipment prescription (96%), transfer training 86%, and toilet training (70%). The mean total time spent over the patients’ entire stay was 1785 min (IQR 660–3300 min), with approximately 43.7 hr (SD 52 hr) of occupational rehabilitation. After categorizing the spinal cord injury, a mean total of 33 (IQR, 20–110) hr of session was received for patients who had an SCI level between C1 and C4 over the course of rehabilitation, and this was 25 (IQR, 15–32) hr of session for patients with an SCI level between C5 and C8, 36 (IQR, 5–8) hr of session for patients with an SCI level of <T1–T6, and 29 (IQR, 5–53) hr of session for patients with an SCI level of <T6.
Conclusion: Almost all patients with TSCI participated in strengthening/Range of Motion (ROM) exercises and Activities of Daily Living (ADLs) training during OT treatment; these two were the most time-consuming interventions. When examining therapy, we found that lower body dressing training was the most time-consuming ADL. Significant variation were seen in time spent among TSCI for all OT interventions when examining both the total time spent and a calculated number of minutes per session. Some of this variation could be explained by patient and injury characteristics.
Knowledge and Attitude Toward Lumbar Puncture Among Medina Population
Authors: Alshanqiti Asma
Published: November 2021

Introduction: Lumbar puncture (LP) is one of the invasive procedures performed to obtain information about cerebrospinal fluid. It has diagnostic and therapeutic purposes for various neurological cases. Previous studies among different populations have indicated that there is a lack of research focusing on individuals’ knowledge and attitude toward LP. Patient who refuse LP may be exposed to unneeded hospital admission, or unnecessary empirical antibiotic treatment. A literature search found a lack of studies regarding LP knowledge and perception among Al-Medina residents. To address that gap, this study aimed at assessing the knowledge and attitude toward LP among the Al-Medina population.
Methodology: A cross-sectional study was conducted among adults 18 years of age residing in Medina, Saudi Arabia. An online survey using a self-administrated questionnaire that included demographic characteristics, knowledge, and attitude questions was randomly distributed from January 2020 to August 2020. The questionnaire was pretested and validated (Cronbach’s alpha = 0.701).
Result: A total of 512 participants were included: 51.3% of the participants were aged between 18 and 25 years; 85.5% were female; and 68.6% had a bachelor’s degree. Most participants (65.6%) showed a poor knowledge of LP. Of the total participants, 29.7% had a poor attitude toward LP, while 69.7% had a good attitude. A significant positive correlation was found between knowledge and attitude toward lumbar procedures (r = 0.186, p < 0.001). Respondents who received their information from a healthcare worker had the highest level of knowledge (p < 0.001). A positive significant correlation was found between attitude and age; younger participants had a better attitude (p < 0.001).
Conclusion: This study assessed the knowledge and attitude toward LP, and the relation between them which leads to a great impact on diagnosis and treatment. The study demonstrated that few participants had a previous experience with LP. There is a crucial need to know how these personal LP experiences affect the decisions and attitude toward LP in the future. The study also showed that the level of knowledge about LP is relatively poor among the public. The level of awareness should be raised to improve patient’s understanding toward LP. Interventions are needed to scale up the level of knowledge about LP. Some potential interventions include: intensifying health promotion campaigns, increasing involvement of physicians in patients’ education to improve knowledge, as well as maintaining the quality and reliability of information provided concerning LP and carrying out further research to evaluate the effect of intervention programs on the knowledge and attitude.