bluuebunny/crossref_metadata_2025 huggingface dataset:
CD9 and Aryl Hydrocarbon Receptor Are Markers of Human CD19+CD14+ Atypical B Cells and Are Dysregulated in Systemic Lupus Erythematous Disease
Authors: Blevins Lance K , Khan D M Isha Olive , Crawford Robert B , O’Neill Christine , Bach Anthony P , Zhou Jiajun , Karmaus Peer W , Ang Dennis C , Thapa Rupak , Kaminski Norbert E
Published: August 2024

Aryl hydrocarbon receptor (AHR) is a ligand-activated transcription factor whose expression regulates immune cell differentiation. Single-cell transcriptomic profiling was used to ascertain the heterogeneity of AHR expression in human B cell subpopulations. We identified a unique population of B cells marked by expression of AHR, CD9, and myeloid genes such as CD14 and CXCL8. Results were confirmed directly in human PBMCs and purified B cells at the protein level. TLR9 signaling induced CD14, CD9, and IL-8 protein expression in CD19+ B cells. CD14-expressing CD9+ B cells also highly expressed AHR and atypical B cell markers such as CD11c and TBET. In patients with active lupus disease, CD14+ and CD9+ B cells are dysregulated, with loss of CD9+ B cells strongly predicting disease severity and demonstrating the relevance of CD9+ B cells in systemic lupus erythematosus and autoimmune disease.
Prevalence of tuberculosis among healthcare workers in India: a systematic review and meta-analysis
Authors: Nath Ravindra , Panwar Nitin , Debnath Aninda , Bhaumik Anirban , Kishore Jugal , Ish Pranav
Published: August 2024

Tuberculosis (TB) poses a significant occupational hazard for healthcare workers (HCWs) in India, a country bearing a substantial portion of the global TB burden. This systematic review and meta-analysis aim to determine the prevalence of TB among HCWs in India. Analyzing ten studies up to 2024, we found a pooled prevalence of 2391.6 cases per 100,000 individuals, underscoring the critical occupational risk. Factors contributing to this high prevalence include inadequate ventilation, insufficient personal protective equipment, and frequent exposure to multidrug-resistant TB strains. Our findings emphasize the urgent need for stringent infection control measures, routine TB screening, and comprehensive educational programs. Policy recommendations include developing national TB screening guidelines and improving healthcare infrastructure. Protecting HCWs is crucial to achieving India's goal of TB elimination by 2025.
Low Serum Magnesium in Acute Ischemic Stroke Patients: Correlations with the National Institutes of Health Stroke Scale Scores
Authors: Kuldeep Jaiprakash , Jain Konika , Salve Chandrakant
Published: August 2024

Introduction:

Stroke profoundly impacts global health, particularly in developing countries, and is a leading cause of death and disability. This study explores the serum magnesium (Mg) concentration in acute ischemic stroke patients on hospital admission, aiming to uncover the correlation between Mg levels and the severity of stroke, as quantified by the National Institutes of Health Stroke Scale (NIHSS). The aim of this study was to analyze the correlation between serum Mg levels and acute ischemic stroke severity as measured by NIHSS scores.

Materials and Methods:

We assessed 100 acute ischemic stroke patients and 100 controls over 2 years in an observational study. Serum Mg levels were measured on the day of admission and on Day 3 and were compared to those of a control group.

Results:

The analysis showed that stroke patients had significantly lower serum Mg levels at admission (1.79 ± 0.54 mg/dl) compared to the control group (2.02 ± 0.48 mg/dl, P = 0.002), as well as on Day 3 (1.98 ± 0.52 mg/dl vs. 2.19 ± 0.40 mg/dl, P = 0.001). Higher NIHSS scores were associated with lower Mg levels, suggesting Mg deficiency in these patients.

Conclusion:

On observing the close correlation between low serum Mg levels and a greater severity of ischemic strokes, this study emphasizes the prognostic relevance of Mg. The findings prompt further research into optimal approaches for Mg-based interventions in stroke care.
A study to determine proportions of red cell phenotypes in the blood donors at a tertiary care blood center in Southern India
Authors: Basavarajegowda Abhishekh , Cherukat Jayasree , Princy Nithya , Naseeba N. P.
Published: August 2024

INTRODUCTION:

The data on the incidence of antigens of various blood groups in the local donor population are of great utility in routine blood transfusion practices, especially in blood centers that handle patients with chronic or repeated transfusions. This study aimed to provide data regarding the frequency of various blood group antigens with their phenotypic expression in donors at a single center in Southern India and compare them with other ethnic groups/populations.

MATERIALS AND METHODS:

This study was performed from January 2019 to June 2022. The phenotyping for Rh antigens c, C, e, E, K, k, Lea, Leb, Lua, Lub, P1, Kpa, Kpb, Jka, JKb, M, N, S, s, Fya, and Fyb was done by system profile cards, namely, I, II, and III from DiaClon ID, Bio Rad Laboratories, Inc; USA. The phenotypic data were expressed as frequencies and percentages.

RESULTS:

A total number of 191 participants were included in the study. The Le (a− b+) was the most common phenotype in the Lewis blood group system, with a prevalence of 61% and 98% for Lu (a− b+). The prevalence of RhD negative donors was 6.3%. C, c, E, and e frequencies were 87%, 58%, 20%, and 98%, respectively. The prevalence of antigens M and N was 88.7% and 68.4%, whereas those of S and s were 54.8% and 91.6%. The prevalence of negativity for K antigen was about 97% and 96% for Kpa.

CONCLUSION:

The prevalence of various phenotypes for clinically significant antigen types in our study is similar to those described elsewhere in the country.
Contact dermatitis to a topical formulation of heparin in a blood donor
Authors: Chand Sreethu , Mallhi R. S. , Philip Joseph
Published: August 2024

Contact dermatitis is an inflammatory reaction to an irritant or allergen coming in contact with the skin. In this report, the authors present a case of contact dermatitis in a blood donor, which developed in response to the application of a topical heparin formulation. Topical heparin preparations are regularly used in blood centers for the resolution of hematomas associated with phlebotomy. Blood center personnel must be aware of this possible adverse effect that can add to the discomfort in a donor and use these preparations cautiously.
Near miss event: Sentinel to identifying catastrophic errors in transfusion chain
Authors: Kumari Dixa , Syed Zikra , Kaur Daljit , Banerjee Pradip , Khiamniungan Chanchi B. , Jain Ashish , Negi Gita
Published: August 2024

Although undesirable, near-miss events bring to light those previously overlooked areas and aid in training for strengthening the weaker “error-generating” links in the transfusion chain. These events may occur at the very first interaction with the patient at the hospital registration desk. Here, we present a case of a near-miss event, where an ABO-incompatible transfusion was averted, involving a patient misidentification error at the hospital registration desk, because of checks in the blood center information software.
Management of acute liver failure during pregnancy by therapeutic plasma exchange – A multidisciplinary approach
Authors: Bose Rishabh , Mohan Aswin K. , Prasanth Vaidehi , Cherian Davis , Kumari Om , Jain Ashish , Kaur Daljit , Negi Gita , Sharma Anand
Published: August 2024

Therapeutic plasma exchange (TPE) has been associated to improve survival in critically ill patients with liver failure who are not anticipated to survive until liver transplantation. In pregnant patients with acute liver failure (ALF), standard volume TPE can be done, foreseeing complications such as fetal distress, hypofibrinogenemia, hypercalcemia, and adverse transfusion reactions. TPE has been demonstrated to lower inflammatory cytokine levels, modify adaptive immunity with the potential to minimize infection susceptibility, and lower albumin and water-bound toxin levels in liver failure. In this article, the multidisciplinary approach, efficacy, and technical considerations were elaborated in the management of a young pregnant female diagnosed with ALF by TPE.
ABO incompatibility
Authors: Shah Ripal J. , Harimoorthy V. , Khatwani Geeta
Published: August 2024

ABO antibodies are naturally occurring antibodies. The ABO antibodies found in the Group O individuals include anti-A and anti-B. In Group O individuals, it tends to be predominantly immunoglobulins G (IgG), although immunoglobulins M and IgA components are also present. Infants of Group O mothers are at higher risk for hemolytic disease of the fetus and new-born than those born to mothers with Group A or B because IgG readily cross the placenta. At the same time, abnormal high concentration of ABO antibody in mother can lead to destruction of platelets in neonates and leads to development of neonatal alloimmune thrombocytopenia as human platelets carry detectable quantities of A and B blood group antigens on their surface. Proper and early diagnosis combined with treatment with intravenous immunoglobulins or transfusion with compatible platelets, may be from mother, can save the neonate from bleeding episodes.
Molecular and clinical characterization of the first Palestinian case of anti-Gerbich
Authors: Ballout Alex , Salah Zaidon , Hilo Ihab , Mujahed Ahlam , Eid Maram , Juneidi Lama , Saleh Hani , Salami Khadra , Hindiyeh Musa
Published: August 2024

Antigens of the Gerbich (Ge) blood group system are highly prevalent proteins that are expressed on the glycophorin C and glycophorin D of the human erythrocytes. Three phenotypes of Ge-negative red blood cells (RBC) have been identified serologically and genetically. Alloantibodies against Ge antigens are extremely rare and their identification can be clinically significant. The persistence of Ge alloantibodies in the patients’ blood has not been well investigated. Herein we report a case of a patient with osteosarcoma showed anti-Ge alloantibodies by serology testing following blood transfusion. This case has been further genetically tested and showed a Yus phenotype by molecular analysis. The formed anti-Ge alloantibodies disappeared after 9 months of induction. This case has been successfully managed with compatible Ge2-negative frozen packed RBC. This case reports an extremely rare finding in the Palestinian population characterized by the presence of anti-Ge antibodies and highlights the need for establishing a registry of rare blood groups antigens in Palestine.
A rare case of late developing anti-E antibody in a pregnant female leading to severe hemolytic disease of the newborn: A missed follow-up in COVID-19 epoch
Authors: Sil Suhasini , Kaur Daljit , Singh Poonam , Kumari Dixa , Jain Ashish , Negi Gita
Published: August 2024

With the use of Anti-D prophylaxis for rhesus D-negative pregnant women, other Rh and non-Rh allo-antibodies have become relatively more important. The index case reports severe hemolytic disease of the newborn due to anti-E antibody in a full-term baby boy born to a COVID-19-positive mother. The antibody screening of the mother performed during Booking of pregnancy at 9th week of gestation was negative. Subsequently the mother was lost to follow-up till delivery due to COVID pandemicity. At birth, the baby was icteric but non-hydropic, his direct antiglobulin test (DAT) was strong positive (4+ by column agglutination technology) and required top-up transfusion and phototherapy at Neonatal Intensive Care Unit. Elution of DAT-positive red cells rendered anti-E which could have formed as “late developing” red cell allo-anti-E in the pregnancy. A repeat antibody screening around 28th week gestation is of prime importance to detect any underlying allo-antibody in a multigravida and thus enabling close monitoring of fetus and initiation of early management as desired.
Is every reaction a blood transfusion reaction? An inside story
Authors: Syal Neha , Handa Anjali
Published: August 2024

An adverse reaction is an undesirable response or effect in a patient temporally associated with the administration of blood or blood component. In January 2019, a 55-year-old female patient was transfused packed red blood cell (PRBC) to correct anemia. The patient complained of chills within 5 min, so transfusion was stopped and patient’s blood samples and blood bag were sent to blood center for a reaction workup. The second transfusion was attempted the next day with leukoreduced PRBC, but the patient complained of chills again and hence transfusion was stopped. On 3rd day, transfusion was reattempted with all precautions in the presence of transfusion medicine specialist and the patient again complained of chills. When asked in detail, patient said that she could feel cold blood going through her arm, which made her feel cold. The patient was given additional blankets and her room warmed and transfusion was reattempted after 30 min and completed uneventfully. Medical education has raised the vigilance of physicians regarding adverse reactions but has also created an unwanted alarm, which is difficult to pacify. This leads to relating any discomfort patient experiences during transfusion with an adverse transfusion reaction.
Effectiveness of therapeutic plasma exchange in case of rare neurological disorder Isaacs syndrome
Authors: Tripathi Parmatma Prasad , Kumari Sangeeta , Prabhat Nandita , Lamba Divjot Singh , Hans Rekha , Goyal Manoj Kumar , Lal Vivek , Sharma Ratti Ram
Published: August 2024

Isaacs syndrome is a disease characterized by nerve hyperexcitability and pseudomyotonia and treated with immunomodulatory and symptomatic therapy approaches. Here, we report a case of anti-(leucine-rich glioma-inactivated 1) antibody-positive patient diagnosed as Isaacs syndrome and accomplished a nearly complete response to only four sessions of therapeutic plasma exchange (TPE). Our experience suggests that TPE along with other immunomodulatory agents may be beneficial and well-tolerated approach in patient with Isaacs syndrome.
Conservative Management of Odontogenic Myxoma - A Case Report
Authors: Agarwal Srishti , Xavier Soya Alfred
Published: August 2024

Rationale:

This is a 14-year-old girl with odontogenic myxoma of the right posterior mandibular region, which was managed conservatively by intraoral marginal mandibulectomy rather than segmental mandibulectomy.

Patient Concerns:

The patient and her parents were concerned about her aesthetics.

Diagnosis:

The patient came with the complaint of swelling on the right lower back tooth region of the jaw, which was not associated with pain. On palpation, the swelling was bony hard and there was buccolingual expansion. On radiographic examination, there was a sunray appearance. Histopathological examination confirmed it to be an odontogenic myxoma.

Treatment:

Marginal mandibulectomy was done for the patient. The whole procedure was done intraorally and closed using primary closure.

Outcomes:

Postoperatively, the patient was asymptomatic and is on follow-up.

Take-away Lessons:

We can say that odontogenic myxoma can be managed conservatively.
Mpox and related poxviruses: A literature review of evolution, pathophysiology, and clinical manifestations
Authors: Bhardwaj Priya , Sarkar Swarnabha , Mishra Ritu
Published: August 2024

The recently re-emerged mpox (monkeypox) virus that causes mpox disease is a member of genus Orthopoxvirus and has unprecedentedly spread worldwide. Numerous studies have contributed to our understanding of its evolution, pathophysiology, and clinical manifestations. The current outbreak of the mpox virus depicts its novel route of transmission as a new variant. However, the exact reason for its transition from an epidemic to a pandemic remains unclear. Furthermore, other poxviruses such as vaccinia virus, variola virus, and cowpox virus, also belong to the same genus, Orthopoxvirus. In the present review, our objective was to summarize the evidence on evolution, pathophysiology, and clinical manifestations of mpox virus and its related poxviruses. The present review would aid in a better understanding of the current circulating mpox virus and its differences from other poxviruses. In addition, the shared genetic factors contributing to virulence in these Orthopoxvirus highlight their evolutionary connections and genetic similarities. While they exhibit differences in virulence, studying these genetic relationships is crucial for understanding their biology, pathogenicity, and the development of effective vaccines and antiviral therapeutics to curb mpox disease.
Longitudinally extensive transverse myelitis associated with scrub typhus: A case report
Authors: Kumar Amit , Chetiwal Rajesh , Tanwar Shweta
Published: August 2024

Rationale:

Longitudinally extensive transverse myelitis (LETM) is a rare inflammatory demyelinating disease predominantly associated with autoimmune and inflammatory disorders. Scrub typhus can cause a variety of neurological complications, which may result in poor recovery and long-term disability. This report reveals a rare linkage between LETM and scrub typhus.

Patient concerns:

A 24-year-old female presented with a history of fever for 10 days associated with progressive quadriparesis. Physical examination revealed bilateral lower limb weakness (grade 0/5) and bilateral upper limb weakness (grade 2/5) with reduced sensation below the T3 dermatome.

Diagnosis:

Scrub typhus presenting with longitudinally extensive transverse myelitis.

Interventions:

Steroid pulse therapy with antibiotics supported by early intensive rehabilitation.

Outcomes:

Complete recovery was achieved.

Lessons:

This case report highlights the importance of considering scrub typhus as a potential cause of LETM in endemic regions, particularly in patients presenting with febrile illness and neurological symptoms.
Patterns of noncicatricial alopecia in children: a cross-sectional study
Authors: Mohamed Essam Elden M. , Abdel-Aleem Hazem L. , Tawfik Yara T.
Published: August 2024

Background and aim

Hair loss in children is an unpleasant complaint. It represents a challenge for the treating physician, is extremely upsetting to the parents, and has a psychosocial complication for the growing child. Our study aims to clarify the causes and forms of noncicatricial alopecia in a sample of pediatric patients and to identify the common trichoscopic features of each illness.

Patients and methods

This study was conducted on 300 children who attended the outpatient dermatology clinics at Al-Azhar University in Assiut. Their ages ranged between 2 and 18 years old and they complained of scalp disorder and hair loss.

Results

Tinea capitis (TC) was the most common form of pediatric alopecia (136 patients, 45%), while alopecia areata (AA) and marginal traction alopecia were the second most common causes with a frequency of 57 (19%) and 56 (18.7%), respectively. Toxic alopecia was identified in 30 (10%) of the patients, telogen effluvium in 11 (3.7%), while six (2%) patients presented with female pattern hair loss, three (1%) patients had short anagen syndrome and only one patient presented with Trichotillomania. The most common trichoscopic features in patients who had TC were comma hair and short, broken hair, while microexclamation marks were the most common trichoscopy features among AA patients.

Conclusion

TC was the most common cause of pediatric alopecia, followed by AA and marginal traction alopecia. Diagnosis of hair and scalp disorders enhances the diagnostic power beyond basic clinical examination and exposes unique aspects of the diseases, leading to better management.
Transforaminal lumbar interbody fusion in iatrogenic lumbar instability
Authors: Nafea Waleed , Fawzy Mohsen , Elnagar Ahmed
Published: August 2024

Background

Lumbosacral instability is one of the causes of failed back surgery syndrome, and it is characterized by loss of disc height with translational and in many cases rotational instability in the sagittal plane. Transforaminal lumbar interbody fusion (TLIF) is a modification of posterior lumbar interbody fusion that requires less retraction of the thecal sac and neural element. TLIF corrects most of the pathologies in patients with iatrogenic lumbar instability as it provides rigid stabilization of the spine with high incidence of fusion, decompression of central and lateral recess with facet and disc resection, restoration of disc and foraminal heights together with sagittal plane deformity correction.

Aim

This study was carried out to evaluate the efficacy of TLIF in the treatment of patient with iatrogenic lumbar instability.

Patients and methods

A total of 16 cases were diagnosed as iatrogenic lumbar instability according to the radiological method proposed by Dupuis and colleagues. Sex distribution was nine females and seven males. Plain radiograph (static and dynamic) and MRI with gadolinium enhancement were done for all patients. Single-level transforaminal lumbar interbody fusion (TILF) was performed in 11 cases and double-level TLIF was performed in five cases. Clinical evaluation was made using Oswestry disability index. Patients were examined for occurrence of solid interbody fusion at 9- and 12-month follow-up visits.

Result

A total of 14 patients showed obvious clinical improvement with reduction of their Oswestry disability index from 76.75% preoperatively to 36.9% at 6 month and 22.7% after 1 year. Overall, two cases had shown no clinical improvement: one had deep wound infection and the other had pseudoarthrosis. Solid fusion occurred in 14 (87.5%) cases. One case with pseudoarthrosis was the patient who had developed deep wound infection; the other case was a patient undergoing double-level TILF with pseudoarthrosis at L5–S1.

Conclusion

TLIF is a safe and effective technique in the treatment of patients with postlaminectomy lumbar instability with minimal complication rate.
Management of Lisfranc injuries of the foot
Authors: Elgioushy Ali M. , El Aziz Hassan Mohammed A. , Gaballah Gaballah A.-E.
Published: August 2024

Background

The term ‘Lisfranc injury’ strictly refers to an injury where one or more of the metatarsals are displaced from the tarsus. The term is more commonly used to describe an injury to the midfoot centered on the second tarsometatarsal joint. The injury is named after Jacques Lisfranc de St. Martin (1790–1847), a French surgeon and gynecologist who first described the injury in 1815. ‘Lisfranc injury’ encompasses a broad spectrum of injuries, which can be purely ligamentous or involve the osseous and articular structures. They are often difficult to diagnose and treat, but if not detected and appropriately managed, they can cause long-term disability.

Aim

The aim of this work was to evaluate the proper management of lisfranc injuries and identify the best method of diagnosis and treatment.

Patients and methods

This is a prospective study that included 15 patients with Lisfranc injures of the foot who presented to the Emergency Department of Al-Azhar University Hospitals (Al Hussein and Sayed Galal Hospitals) between January 2016 and June 2017 and followed up for 3–9 months, with an average of 6 months. Fractures were classified according to the Myerson’s and Hardcastle classification. All patients were treated by emergency surgery by screws or Kirschner wires (K-wires). The American Orthopaedic Foot & Ankle Society (AOFAS) functional scale was used to assess results in the midfoot and patient satisfaction was also evaluated.

Results

After a mean 6 months of follow-up, the mean score on the AOFAS scale was 81.8, with a high level of satisfaction in nearly all patients. The results obtained with screw fixation were similar to those with K-wires.

Conclusion

Like most authors, the best results are obtained by the early reduction and fixation of the injury. The authors rule out nonoperative treatment and favor an ORIF procedure with Kirschner wires and screws, provided that the condition of the soft tissues allows it. The results obtained with K-wires were similar to those found in screw fixation, and anatomic reduction is the main predictor of outcome in patients with Lisfranc fracture dislocations.
Sex-specific versus standard posterior cruciate-substituting total knee prosthesis
Authors: Ebied Ayman M. , Elsayed Hany , Gamal Osama
Published: August 2024

Background

The introduction of sex-specific (SS) knee prosthesis designs was an approach to offer more sizing options and is based on the anatomic sex differences. These SS components were though to provide better fitting to female femora and consequently improve the clinical outcome.

Materials and methods

In the period between February 2011 and March 2013, a prospective superiority randomized controlled clinical trial was conducted to compare the clinical outcome of SS versus the standard posterior stabilized (PS) knee prosthesis in women. The primary outcome measure was the postoperative range of knee flexion, and the secondary outcome measure was the knee function as reflected on the performance of daily activities. The OXFORD Knee Score, Knee Society Score, and Knee Society Score for function were recorded preoperatively and then at 3, 12 months, and annually thereafter. Female patients with degenerative or inflammatory arthritis who were 50 years or older and their knee deformities were totally articular were included. A total of 64 patients with 80 knees were enrolled in this trial, and 40 knees were allocated to each group. Knees in the SS group had total knee arthroplasty using SS knee prosthesis, with SS femoral component (the experimental group), whereas knees in the PS group had standard PS knee design with standard femoral component (the control group). Equal randomization (1 : 1 ratio) was undertaken according to a computer-generated randomization table.

Results

The mean preoperative knee flexion range of motion (ROM) was 110 and 108° in the SS and PS groups, respectively. At the latest follow-up, the mean postoperative knee flexion ROM was 115 and 113° the SS and PS groups, respectively. The mean improvement in the knee flexion ROM in both groups was 5° (range: 0–25), with no statistically significant difference between the two groups. All knees except one had full extension. No statistically significant difference was observed between the two groups when the OXFORD Knee Score, the Knee Society Score, and the Knee Society Score for function were compared.

Conclusion

No clinical advantage was observed in the ROM or function between knees that received SS knee prosthesis when compared with those who received PS knee implants. The SS total knee arthroplasty though designed to provide better fitting to the female distal femur does not provide any clinical advantage over the standard PS knee prosthesis. A logic question is whether a separate implant is required for women or modifications to the knee prostheses geometry and more sizes are required to accommodate all patients?

Level of evidence

Level II.
Midterm results of modified coracoclavicular ligament repair using suture anchors for acute acromioclavicular joint dislocation
Authors: El-Adawy Moawed F. , El-Herraoui Ahmed A.-S.
Published: August 2024

Purpose

The aim was to prospectively gauge the clinical and functional patient outcomes of modified coracoclavicular ligament repair and stabilization using suture anchors and disc reduction in management of acute acromioclavicular joint (ACJ) dislocation at a minimum 2 years of follow-up.

Study design

This was a case series, and the level of evidence was IV.

Patients and methods

This study was carried out on 30 consecutive patients who had acute ACJ dislocation Rockwood types III–V in the period between June 2009 and March 2014. Average follow-up was 34.7 (25–75) months. This study was conducted in two tertiary centers: Suez Canal University Hospitals and El-Galaa Military Hospital. All patients were operated within 1 month of injury using an anchor with loaded sutures that was inserted into the dorsal part of coracoid base. The ends of the sutures were then passed through clavicular holes placed at coracoclavicular ligament attachment, and each suture strand was separately tied.

Outcome measures

Patients were evaluated postoperatively for persistence of good reduction, complications, range of motion, and return to preinjury activity level. Visual analog scale was used to assess postoperative pain. The functional outcomes of the shoulder were evaluated by Disabilities of the Arm, Shoulder, and Hand and Constant shoulder scores.

Results

A total of 28 patients (93.33%) returned to work and resumed sports activities. The mean Constant score was 88.2 points. The mean Disabilities of the Arm, Shoulder, and Hand score was 12.2 points.

Conclusion

Treatment of acute ACJ dislocation with coracoacromial ligament repair and stabilization using suture anchors and disc reduction is technically simple and showed encouraging midterm clinical results with a low complication rate.
Supracondylar femoral dome extension osteotomy in treatment of knee flexion deformity
Authors: EL Ghafar KhaledAbd , Diab Ramy A.
Published: August 2024

Background

Flexion contracture of the knee can happen by different etiologies such as burns and scars, inflammatory conditions such as juvenile rheumatoid arthritis, and neuromuscular disorders such as cerebral palsy, poliomyelitis, and many others. Supracondylar femoral extension osteotomy is widely used in treatment of such type of deformities with good results. Dome osteotomy is a circular-shaped osteotomy. The authors conducted this study to assess the effectiveness of supracondylar femoral dome extension osteotomy (SCDEO) in management of sagital plane deformity in the form of fixed-flexion deformity of the knee.

Patients and methods

Seven patients (11 knees) with knee flexion deformity underwent SCDEO fixed by anatomical locked plate and screws, three patients had a bilateral deformity as sequelae of juvenile rheumatoid arthritis, while four patients as sequelae of poliomyelitis, and three of them had unilateral deformity, while only one patient had bilateral deformity. The knee flexion deformity angle ranged from 20 to 50° with a mean of 32°. Patients were followed up every 2 weeks with monthly radiographies done till full union of the osteotomy, full weight bearing was started at 4 weeks postoperatively, in bilateral cases, the other side was operated after full osteotomy union, and all patients were followed up for 12 months with radiographies to assess the knee flexion deformity angle.

Results

All osteotomies eventually united in the period ranging from 10 to 14 weeks (average 12 weeks), no postoperative infection, nonunion, neurological, or vascular compromise occurred. All of the patients were satisfied regarding improved gait and posture, the total range of knee motion at 12 months postoperatively ranged from 60 to 100° (average 85°). Knee flexion deformity angle measured at 12 months postoperatively ranged from 8 to 15° with an average of 11°. Only one patient with juvenile rheumatoid arthritis showed significant recurrence of the deformity at 12 months of follow-up postoperatively, with flexion deformity angles of 20 and 25° in the right and left knee, respectively, whereas the preoperative flexion deformity angle in this patient was 30 and 35° in the right and left knee, respectively.

Conclusion

SCDEO fixed by anatomical locked plate and screws is an effective means of management of knee fixed-flexion deformity.
Unilateral partial pediculectomy combined with contralateral instrumented fusion in treatment of osteoid osteoma localized in lumbar spine pedicles
Authors: El Zahlawy Hany , Abdelrady Abdelrady M. , Ibrahim Mohamed Z.
Published: August 2024

Background

Treatment of osteoid osteoma of the spine may be challenging when located in the pedicles.

Patients and methods

Twelve patients with osteoid osteoma located in lumbar spine pedicles were treated via partial pediculectomy to excise the nidus completely combined with contralateral instrumented fusion to prevent instability. Their demographic data, back pain as measured by visual analog scale, and radiographs were recorded and analyzed. The patients were followed up for a period of at least 12 months.

Results

Their mean age was 18.1 years. Nine were males and three females. The mean preoperative visual analog scale was 8. This improved to 2.5 1 month after surgery and 0.83 at the final follow-up (P<0.001). The mean operative time and blood loss were 124 min and 660 ml, respectively. Fusion was obtained in all cases.

Conclusion

When lesions with a relatively large nidus involve the pedicle, partial pediculectomy to access the nidus combined with contralateral instrumented fusion appears to be an effective and justifiable method of treatment.
Updates on the Management of Autoimmune Bullous Diseases
Authors: Choudhary Rajat , Gupta Vishal , Khandpur Sujay
Published: August 2024

Background:

Autoimmune bullous diseases are associated with high morbidity and mortality. Traditionally, systemic corticosteroids and conventional immunosuppressive agents have been the mainstay of treatment, but their broad immunosuppressive effects and long-term complications have prompted the exploration of newer more targeted therapies.

Materials and Methods:

This review explores the evolving landscape of therapeutic options for immunobullous diseases, with a particular focus on pemphigus, bullous pemphigoid (BP), and mucous membrane pemphigoid, by searching PubMed, clinicaltrials.gov, and Cochrane databases for published literature from 2014 to 2023.

Results/Discussion:

We discuss emerging treatments for pemphigus such as B cell modulatory drugs, anti-inflammatory drugs, those inhibiting autoantibody half-life or blister-inducing activity, and stem cell therapy, while offering insights into the level of evidence, potential benefits, and limitations of each approach. The role of biologics and novel therapies like rituximab, omalizumab, and dupilumab in reshaping the management of BP is also discussed.

Conclusion:

The article highlights the need for further research, clinical trials, and comparative studies to determine the most effective and safest treatment options for patients with immunobullous diseases.
Premature Graying of Hair: A Comprehensive Review and Recent Insights
Authors: Poonia Kavita , Bhalla Mala
Published: August 2024

Background:

Hair symbolizes well-being and self-expression, with graying occurring naturally among different racial groups at varying ages. Premature graying has psychological and societal impacts, influencing self-esteem and quality of life. Gray hair usually advances gradually and is permanent, with occasional reports of natural repigmentation. Premature graying of hair (PMGH) results from a complex interplay of genetic, environmental, and cellular factors.

Materials and Methods:

Studies exploring links between gray hair and conditions such as osteopenia, hearing loss, smoking, obesity, dyslipidemia, and cardiovascular disease have yielded mixed results. Despite continuous research into the causes of gray hair, effective, evidence-based treatments are lacking and still need to be improved.

Conclusion:

Herein, we reviewed the causes, mechanisms, risk factors, psychosocial effects, and emerging therapies for PMGH.
Clinicopathological Profile of Pyoderma Gangrenosum: A 10-Year Retrospective Study from a Tertiary Care Center in South India
Authors: George Anju , Sathishkumar Dharshini , Mathew Lydia , Gupta Ankan , Chiramel Minu Jose , Singh Vartika , Thomas Meera
Published: August 2024

Background:

Pyoderma gangrenosum (PG) is a reactive neutrophilic inflammatory dermatosis with a varied clinicopathologic presentation. It commonly manifests as rapidly progressive painful ulcers, mimicking varied conditions including infections, vasculitis, and malignancies, and is a diagnosis of exclusion. There are scarce data on PG from the Indian subcontinent.

Aim and Objectives:

The aim of the study was to study the clinicopathologic profile of patients with PG and their underlying systemic associations.

Materials and Methods:

A retrospective observational study was done between 2011 and 2021, and patients diagnosed as PG based on the diagnostic tool proposed by Maverakis et al. were recruited and their demographic, clinical, and histological findings were obtained.

Results:

Among 54 patients with suspected PG, 17 patients (eight males and nine females) fulfilled the diagnostic criteria, and the mean age of disease onset was 32.1 years (range: 3–60 years). Ulcerative variant was the most common type (9/17, 52.9%), and 29.4% had systemic associations including autoinflammatory syndromes. The onset at atypical sites such as face and hand were noted in one patient each. Histopathology revealed a polymorphous dermal infiltrate with neutrophilic predominance in the majority (94.1%). Systemic steroids (dose ranging from 0.5–1 mg/kg prednisolone equivalent) were used in 11/17 (64.7%) patients. The commonly used alternative drugs included clofazimine (47%), minocycline (29%), thalidomide (23.5%), adalimumab and mycophenolate mofetil in 17.6% each, dapsone and ciclosporine in 11.7% each. Remission was achieved between two weeks and three months in 10 (58.8%) patients after treatment initiation and two mortalities (11.7%) were recorded.

Conclusion:

PG can affect any age group and may be localized to rarer, atypical sites. The possibility of underlying autoinflammatory conditions should be considered in addition to the evaluation of other disorders like inflammatory bowel disease, hematological disorders, and rheumatological disorders.
Novel laparoscopic “lateral three-port technique” of extended totally extra peritoneal approach for ventral hernias: Short-term results and technical aspects of 100 consecutive cases from a single center
Authors: Shenoy K. Ganesh , Thomas Marina , B S Ramesh , Jeur Amol Siddalingappa , Jan Nawab
Published: August 2024

OBJECTIVES:

The purpose of this study was to develop a simplified technical modification with an attempt to standardize the extended totally view extraperitoneal–Rives Stoppa (ETEP-RS) procedure. In this article, we present the technical aspects to perform this procedure by using novel lateral three ports and the short-term results of our experience in this subset of patients.

MATERIALS AND METHODS:

A retrospective analysis of 100 consecutive patients who underwent laparoscopic ETEP-RS using the lateral three-port technique between January 2022 and July 2023 was done. In this technique, three lateral ports were placed for both midline and lateral ventral hernias (VH), with no need to shift camera, working ports, and monitor positions throughout the procedure. It can be coupled with repair of associated right inguinal hernia, divarication of recti (DR), and transversus abdominis release (TAR).

RESULTS:

Of 100 consecutive patients who underwent ETEP approach for VH by using our lateral three-port technique, 84 patients underwent ETEP-RS and 16 patients underwent ETEP-TAR. Out of these 100 patients, 4 patients underwent ETEP for associated right inguinal hernia. The mean operating time was 119.9 min with a range from 45 min to 185 min. The mean defect width was 7.24 cm. We used 20 cm × 15 cm medium weight polypropylene mesh for most of our patients. There were no recurrences in the follow-up period. One patient required laparoscopic re-exploration for posterior rectus sheath rupture.

CONCLUSION:

The laparoscopic novel lateral three-port ETEP-RS technique is safe, feasible, cost-effective, and reproducible. This can be combined with right-sided TAR, right inguinal hernias, and repair of DR. It can be standardized; however, larger studies and longer follow-up are needed to have an evidence-based answer.
Laparo-endoscopic technique of management of a rare case of incarcerated urinary bladder hernia in a female
Authors: Shenoy Ganesh K. , Jeur Amol S. , Thomas Marina
Published: August 2024

Inguinoscrotal hernia containing the urinary bladder is a rare entity, found in 1%–5% of inguinal hernias. We herein present a rare case of a 60-year-old female status post open hysterectomy who presented to emergency department with painful groin swelling and contrast enhanced computerized tomography of abdomen showed features of incarcerated urinary bladder hernia. She underwent emergency laparo-endoscopic bilateral inguinal hernia mesh repair. After extensive literature search, we believe that this is the first case report of incarcerated urinary bladder hernia in a female with infra-umbilical scar who underwent emergency laparo-endoscopic bilateral inguinal hernia mesh repair.
A Randomized Trial Assessing the Effectiveness of High-fidelity Simulation Training in Managing Maternal Cardiac Arrest among Emergency Medical Professionals in India
Authors: Rishipathak Parag , Vijayaraghavan Shrimathy
Published: August 2024

Introduction:

Maternal cardiac arrest is a rare but critical event that poses significant risks to both the mother and the fetus. As majority of population in India lives in the rural areas, Emergency Medical Professionals assist in childbirth in transit in ambulances. This timely assistance ensures the safe transportation of both mother and new born baby to the hospital. The aim of this study was to assess the effectiveness of high-fidelity simulation training in the management of maternal cardiac arrest among emergency medical professionals.

Methods:

The randomized simulation study aimed to assess the effectiveness of high-fidelity simulation in managing maternal cardiac arrest. Two hundred and fifty emergency medical professionals were randomly assigned to 50 groups. Participants underwent a prebriefing session before engaging in simulation scenarios. After the initial scenarios, participants received a debriefing session emphasizing the standardized algorithm for maternal cardiac arrest management. A week later, participants engaged in a second simulation scenario, and their adherence to the algorithm was assessed. The data were analyzed using statistical tests, and the entire simulation session was video recorded for reliability.

Results:

The results showed that participants demonstrated an improvement in managing both maternal and obstetric interventions in the posttraining scenario compared to the pretraining scenario. The successful implementation of the advanced cardiac life support algorithm and the debriefing session were key factors in improving participants’ performance. However, continuous exposure and practice are necessary to maintain and enhance these skills.

Conclusion:

Health-care professionals should actively seek opportunities for ongoing training and education to stay updated with the latest guidelines and advancements in managing maternal cardiac arrest.
Evaluation of napkin lesions in Egyptian pediatric patients during the first three years of life: a hospital based study
Authors: Dogheim Noha N. , AbdElnabi Hend H. , Elsotohy Esraa M. , Elhawary Esraa E.
Published: August 2024

Background

Napkin rashes represent different varieties of cutaneous lesions that affect the napkin area and cause a burden on infants and their parents.

Objective

To evaluate different diaper rashes in pediatric patients less than 3 years old.

Patients and methods

All 300 pediatric patients with napkin lesions were included in the study. Every patient’s personal and medical history as well as photographs were compiled and recorded in data sheets.

Results

The most common rashes affecting the napkin area were contacted napkin dermatitis (29%) and napkin candidiasis (28%) followed by hand-foot mouth disease (12%). There was a statistically significant relation between the rate of daily napkin changing and the occurrence of contact napkin dermatitis.

Conclusion

Different types of cutaneous rashes could affect the napkin area other than contact napkin dermatitis and candidiasis, which should be taken into consideration during the evaluation of napkin lesions.
A comparative study of narrow-band ultraviolet B alone versus with low dose simvastatin in the treatment of vitiligo: impact on chemokine C-X-C motif ligand 10 and chemokine C–C motif ligand 8
Authors: Omar Shaimaa I. , El Shafey Adel , Eldabah Nermeen , Hafez Asmaa
Published: August 2024

Background

Our knowledge of the pathophysiology of vitiligo has advanced significantly. However, there are still some unclear aspects. Chemokine C-X-C motif ligand 10 (CXCL10) is a biomarker of vitiligo activity and chemokine C–C motif ligand 8 (CCL8) is a chemokine that has been studied recently in vitiligo pathogenesis.

Objective

The primary objective was to compare the efficacy and safety of adding low-dose simvastatin to narrowband ultraviolet B (NB-UVB) versus NB-UVB monotherapy for vitiligo treatment including the effect on CXCL10 and CCL8. The secondary objective was to look for any potential links between CCL8 and vitiligo.

Patients and methods

In this interventional comparative study 50 vitiligo patients were enlisted and randomly split into two groups: the treatment group received NB-UVB plus simvastatin, while the control group received NB-UVB alone for 3 months. Enzyme-linked immunosorbent assay kits were used to test the serum levels of CXCL10 and CCL8, and the vitiligo area scoring index (VASI) score was computed both before and after therapy.

Results

Following treatment, the median values of the VASI score reduction were considerably higher (P=0.037) in the treatment group (1.50) in comparison with controls (0.52). In addition, the median serum levels of CXCL10 and CCL8 were significantly lower (P=0.003 and 0.030, respectively) in the treatment group (132.6 and 110.8 ng/l, respectively) than in the control group (155 and 122.8 ng/l, respectively). There were no side effects noted. CCL8 and CXCL10 serum levels had a positive correlation.

Conclusion

The outcomes of the therapy point to the potential for simvastatin to work in conjunction with NB-UVB to treat vitiligo. Current findings also suggest that CCL8 may play a role in the pathogenesis of vitiligo. In this study, CXCL10 is not correlated with disease severity.
Fractional carbon dioxide laser monotherapy and its combination with topical platelet-rich plasma in the management of striae distensae
Authors: El-Domyati Moetaz , Moawad Osama , Abdel-Wahab Hossam , Behairy Ezzeldin F. , Rezk Ahmed F.
Published: August 2024

Background

A variety of therapeutic approaches have been introduced for striae distensae (SD) with modest outcomes. Fractional carbon dioxide laser (FCL) and platelet-rich plasma (PRP) are effective separately in improving SD.

Objective

To assess the safety and efficacy of topically applied PRP combined with FCL in the management of SD.

Patients and methods

In this prospective, single-blinded, randomized, comparative intrapatient study, 24 patients with bilateral SD lesions were subjected to FCL on both sides and followed by topical application of PRP on one side only allocated by simple randomization. The sessions were performed biweekly for a total of six sessions. Overall clinical improvement was graded using the Quartile Grading Scale. Biopsies, before and after treatment, were stained with H and E, Masson’s trichrome, and Orcein stains. In addition, collagen I and elastin immunohistochemical staining were performed.

Results

In this study of 24 SD patients (19 females, 5 males; aged 19–39 years), topical PRP with FCL achieved moderate to excellent outcomes 3 months after the last session. Early striae rubra improved after the initial session, reaching marked excellent outcomes within a month after the second session. Manageable side effects were reported. Histological examination showed improved epidermal and dermal thickness, collagen, and elastic fiber quality after treatment, with the combined PRP and FCL side exhibiting more significant outcomes than the FCL-treated side.

Conclusion

Topical PRP application post-FCL proves to be a highly effective therapeutic approach for SD, expressing superior treatment outcomes, and heightened patient satisfaction compared with the use of FCL alone. In additio, topical application is preferred over intradermal injection, offering practicality, effectiveness, and noninvasiveness.