bluuebunny/crossref_metadata_2025 huggingface dataset:
Addressing Sensory Challenges in Athletes With Autism Spectrum Disorder: A Clinical Commentary
Authors: Pagnotta Kelly D. , Schiano Natalie R. , Bernabe Kevin , Jean-Claude Jonas , Toole Nicola , Martin Rosanne , Barrett Allison , Lawlor Kathleen , Dumont Rachel L. , Schaaf Roseann
Published: August 2024

Athletes with autism spectrum disorder (ASD) experience lesser care for injuries, and athletic trainers (ATs) report feeling unprepared to provide care competently for this population. Provision of sports-related care can be impacted by sensory differences associated with ASD, such as hyperreactivity to sensation or poor integration of sensory information. An in-depth review of the literature using the Strength of Recommendation Taxonomy guidelines was used to identify articles that address the sensory features of autism for ATs with the purpose of informing ATs about the sensory features of ASD and to present the most current evidence-based recommendations for providing care to athletes with ASD and other neurodivergent individuals who present with sensory differences. Relevant articles were reviewed by 4 independent researchers and organized by theme. Key themes included use of sensory-friendly or sensory-adapted environments, sensory kits, and informed communication strategies that acknowledge sensory differences. Providing individualized care for athletes with ASD and sensory features can improve the quality of and participation in sports for persons with autism.
Alcohol Use Disorders in Patients Suffering from Obsessive–Compulsive Disorder: A Cross-sectional Study
Authors: Dsilva Chrisenn Hansel , Mythri Starlin Vijay , Arora Sahej , Karia Sagar , Desousa Avinash , Reddy M. S.
Published: August 2024

Background:

Comorbidity in obsessive–compulsive disorder (OCD) is known, especially alcohol use disorders (AUDs) in OCD. Data are lacking regarding the prevalence, the obsessions and compulsions in people with OCD with comorbid alcohol use.

Aims and Objectives:

The aim was to study the prevalence of AUDs in people with OCD. The primary objective was to study the prevalence of AUDs in 100 people with OCD. Secondary objective was to study the clinical characteristics, obsessions, and compulsions of people with OCD and comorbid alcohol use.

Settings and Designs:

The study design was a cross-sectional study.

Materials and Methods:

100 patients of Asha Hospital diagnosed with OCD were screened and included in the study after a written informed consent. YBOCS checklist and scoring were done. People satisfying the criteria for AUD were further assessed with SADQ questionnaire. SPSS software was used for statistical analysis.

Results and Conclusions:

The lifetime prevalence of substance use disorders was found 18%. Point prevalence of any substance use was 13%, out of which 7% had AUDs. 2% had a dependence pattern and 5% had an abuse pattern. When comparing people with alcohol versus non-alcohol use, there was a significant difference in the proportion of males in the alcohol group (P = 0.0011). Nicotine was used in higher proportion in the alcohol group (P = 0.0001). Alcohol users were not regular with medications (P = 0.01). Miscellaneous obsessions are more common in them (P = 0.002). Alcohol users had a higher proportion of nil compulsions (P = 0.057) implying that obsessions were more prominent than compulsions in them. Mean scores of OCD in both groups were around moderate severity, with no significant difference between the two.
Management of lupus thrombocytopenia through Ayurveda- A case report
Authors: Harshitha K. S. , Mutha Rashmi , Sahu Ajay Kumar , Joshi Ram Kishor , Gautam Shankar
Published: August 2024

Immune thrombocytopenic purpura (ITP) is one of the complications of systemic lupus erythematosus (SLE). SLE is often complicated by cytopenias. Thrombocytopenia is usually mild and its frequency ranges from 20% to 40%. There are no evidence-based guidelines that will help choose one drug over another. The present article deals with a case diagnosed with SLE-ITP. In Ayurveda, it can be diagnosed with Raktapitta (lupus thrombocytopenia) and was effectively managed with internal medications based on treatment principles of Jwara (fever) and Raktapitta. The platelet count during the first visit was 0.37/lacs/mm3, which was raised to 190 × 109/L after the management with Ayurvedic principles. SLE disease activity index (SLEDAI) was 13 points on her first visit. After treatment, SLEDAI was reduced to two points. The effectiveness of treatment was assessed by improvement in symptoms and platelet count before and after treatment. There was relief in all the symptoms and increase was also noted in the platelet count after the treatment. Ayurveda can definitely be a treatment modality in treating steroid-dependent SLE-ITP.
A case of accelerated recovery in acute retinal pigment epitheliitis with early methylprednisolone intervention
Authors: Tripathi Anchal , Bhalla Sonali , Pathak Lav , Khan Perwez
Published: August 2024

We present a compelling case of acute retinal pigment epitheliitis (ARPE), also known as Krill’s disease, in a 26-year-old female ophthalmology resident, emphasizing the significance of early intervention and its impact on rapid symptom resolution. Comprehensive ocular examination, fluorescein angiography, and spectral domain-optical coherence tomography were employed for the diagnosis. The patient received pulsed methylprednisolone therapy that was initiated promptly due to professional exigencies. Within 3 days of initiating the methylprednisolone therapy, most of the symptoms, including central scotoma and visual impairment, resolved remarkably. This accelerated recovery challenges the conventional notion of ARPE as a self-limiting condition. The case underscores the importance of individualized treatment strategies in professional contexts, where swift resolution is imperative. Advanced imaging techniques, particularly spectral domain-optical coherence tomography, play a pivotal role in both diagnosis and monitoring the disease progression. Further research is crucial to refine the treatment protocols and unravel the intricacies of ARPE pathophysiology.
Public awareness about common ocular diseases among a sample of Egyptian population
Authors: El-Mayah Esraa , Zein Marwa M. , Hegazi Ahmed S. , Abdelghany Eman O.
Published: August 2024

Background

Globally, the most common causes of blindness in adults are cataracts, glaucoma, age-related macular degeneration, and diabetic retinopathy. Inadequate knowledge of these conditions leads to lag in medical advice requisition, losing the opportunity for prevention and early intervention with an increased rate of disease complications.

Aim

This study aimed to detect the level of public awareness about common eye problems in Egypt to help build strategies to prevent complications related to these eye problems.

Patients and methods

This is a prospective cross-sectional analytical study that used a pre-tested e-questionnaire to collect data from the study participants during the period from September 2022 to June 2023 at Kasr Alainy School of Medicine, Cairo, Egypt. A Google form was created, and participants were invited through social media. It included four sections: socio-demographic characteristics, medical history of study participants, knowledge about common ocular diseases, and sources of gaining knowledge.

Results

The study included 802 participants, 54.2% of them were females, more than 55% of them were between the ages of 18–30 years, and 74.4% were university graduates. Awareness of cataracts, glaucoma, corneal opacity, diabetic retinopathy, and age-related macular degeneration was reported in 45.7, 34.8, 38.3, 80, and 77.5% of the study participants, respectively. Physicians and social media were the most common efficient sources of gaining knowledge. Higher education and working in a medical profession, especially physicians and pharmacists were associated with higher knowledge scores.

Conclusion

Low levels of knowledge of most of the blinding conditions among the study participants raise the importance of adopting health education programs by our healthcare systems taking into consideration that physicians and social media were among the most convenient routes to reach the targeted population.
Six surgical principles for safe excision of superotemporal dermolipoma
Authors: Awad Ahmad A. , Aly Momen A.M.
Published: August 2024

Purpose

The aim of this study was to describe six surgical principles that were applied for safe excision of superotemporal dermolipomas.

Patients and methods

This retrospective interventional clinical study included 32 dermolipomas (in 29 patients) that presented to the Orbit Clinic of Assiut University Hospital, Assiut, Egypt and were subjected to surgical excision. The six surgical principles applied for safe dermolipoma excision were: conjunctival incision at the junction between normal and abnormal conjunctiva sparing as much bulbar conjunctiva as possible, hooking the lateral rectus muscle and dissecting the lesion free from the muscle and the covering Tenon’s capsule, eversion of the upper lid using Descemar’s retractor, incision at the upper bulbar conjunctiva, and dissection of the superior surface of the lesion away from the levator muscle, dissection of the lateral surface of the lesion from its attachment to the lateral canthus sparing a stump of the conjunctiva, dissection of the deep part of the lesion from the underlying normal orbital tissue, and suturing the bulbar conjunctiva to the preserved conjunctival stump at the lateral canthus. The follow up ranged from 3 to 35 months (mean=21±3.2 months) during which the patients were assessed for improvement in the presenting manifestations as well as for the presence of complications such as ptosis, dry eye, strabismus, limitation of ocular motility, or symblepharon.

Results

The surgery was successful in all patients without permanent dry eye, blepharoptosis, or permanent strabismus. Temporary limitation of adduction was observed in two patients that resolved spontaneously within 1 month.

Conclusion

Adherence to the six surgical principles outlined in the study allowed the authors to safely excise the dermolipomas without damaging the lateral rectus, levator complex, and lacrimal gland ductules. Thus, postoperative squint, ptosis, and dry eye were avoided. In addition, preserving the forniceal conjunctiva and suturing the bulbar conjunctiva prevented symblepharon formation and restricted mobility.
Corneal endothelium and central corneal thickness changes in patients with type 2 diabetes mellitus
Authors: Dardyr Mohammed E.A. , Mostafa Shaimaa M. , Elsayed Sherif F.
Published: August 2024

Background

Understanding the effect of diabetes mellitus on the corneal endothelium is essential for developing effective strategies for early detection, monitoring, and management of diabetic eye disease.

Aim

The aim of this study was to investigate the changes in corneal endothelium and central corneal thickness (CCT) in patients with type 2 diabetes mellitus.

Patients and methods

This is a prospective, nonrandomized, comparative study that included 500 eyes of 500 participants that were divided into two groups: group A: 250 eyes of type 2 diabetic patients and group B: 250 eyes of healthy controls. The diabetic group was further subdivided into two subgroups based on the duration of diabetes (<10 years and >10 years) and glycemic control (uncontrolled diabetes and controlled diabetes). Specular microscopy was performed in all eyes.

Results

The CCT was significantly higher in the diabetic group (516.93±36.43 μm) than in the control group (503.47±41.89 μm) (P=0.001). However, the two groups were relatively similar in cell density (CD) (cells/mm2), coefficient of variation (%), and hexagonality, with no statistically significant differences (P>0.05 for all). The CD was significantly higher in the patients with a duration of diabetes less than 10 years than those with a duration more than 10 years (2834.04±268.54 vs. 2277.13±244.54 cells/mm2, respectively, P=0.001). In addition, the hexagonality was significantly less in those with the duration of diabetes of more than 10 years (P=0.005). The CD was significantly less in the uncontrolled group than in the controlled group (2292.27±263.4 vs. 2644.69±370.88 cells/mm2, respectively, P=0.001).

Conclusion

Diabetic patients may exhibit alterations in their corneal parameters, particularly the CCT and endothelial CD. These changes are more in diabetic patients with a disease duration of more than 10 years and those with poor glycemic control.
Screening for Fabry disease in patients on Hemodialysis
Authors: Batta Gaurav , Vishnuprasad R. , Batta Anshita , Santhanalakshmi D. , Dwivedi Aradhana
Published: August 2024

Background:

Fabry disease is an under-recognized X-linked lysosomal storage disorder characterized by the accumulation of trihexosylceramides in multifarious tissues, leading to end-organ damage, including progressive renal failure. Antecedent screening studies worldwide have shown inconsistent prevalence in the hemodialysis population. We conducted this study to screen for Fabry disease in patients undergoing dialysis at a tertiary care hospital.

Materials and Methods:

All patients undergoing dialysis were screened with a gal assay using dried blood spots (DBS) on filter paper using the fluorescence method. Patients with positive DBS test results were further tested for underlying mutations.

Results:

A total of 112 patients (64.3% males and 35.7% females) on dialysis were screened. Nineteen patients (13 males and 6 females) were found to have low enzyme activity on DBS. Further mutation analysis confirmed that one female patient had Fabry disease. The mutation detected was a heterozygous missense variation in exon 7 of the GLA gene, which resulted in the amino acid substitution of histidine for arginine at codon 363 (p.Arg363His). Subsequent screening of the family members revealed that the son of the patient was asymptomatic and carried the same genotypic mutation. Genetic counseling was performed, and enzyme replacement therapy was offered to both patients.

Conclusions:

Fabry disease remains underdiagnosed, especially in high-risk populations such as those undergoing dialysis. DBS is a convenient and effective screening tool for Fabry disease. Facilities should be augmented for similar screening studies in the dialysis population.
A Giant Basal-Cell Carcinoma: A Rare Subtype at a Rare Site
Authors: Chandanwale Shirish Sahebrao , Singh Madhuri , Raj Akshi , Viswanathan Vidya , Bharadwaj Saloni
Published: August 2024

Giant basal-cell carcinoma (BCC) is a rare subtype of BCC which is characterized by aggressive biological behavior with extensive local invasion, frequent metastasis, and poor prognosis. It arises almost exclusively on hair-bearing skin. It has been rarely reported on sole. Various pathogenic factors such as arsenic exposure, ionizing radiation, repeated trauma, and hereditary syndromes have been implicated. A combination of optical coherence tomography and reflectance confocal microscopy can provide useful information for both depth and horizontal extension of tumor and could be used before surgery to explore subclinical extension. Wide local excision of the lesion with histologically confirmed negative margins for the reconstruction of the defect, followed by adjuvant chemoradiation gives a better outcome compared to radiotherapy or chemotherapy alone. Chemotherapy with cisplatin-based treatment is the most common regimen. We report a case of giant BCC on the sole in an elderly male. After excision, the defect was treated with skin grafting.
Aberrant Right Coronary Artery from the Left Coronary Sinus Presenting with Inferior Wall Myocardial Infarction
Authors: Toshniwal Saket Satyasham , Toshniwal Satyasham S. , Kumar Sunil , Acharya Sourya
Published: August 2024

Coronaries arise normally from the aortic sinus which consists of one anterior and two posterior cusps of which the right coronary artery (RCA) arises from the anterior cusp and the left coronary artery arises from the left posterior cusp. Abnormal origin of coronary arteries is very rare and counts for about 2.33% of prevalence and below 1% incidence and are comparatively very difficult to diagnose through routine investigations. Till date, only one case has been reported in the literature where the culprit vessel was the victim as seen in our case. We report a case of a 68-year-old male, who underwent coronary angiography for his anginal chest pain, was diagnosed with coronary artery disease with an “abnormally arising RCA” from the left coronary cusp with a proximal stenotic lesion in the anomalously arising RCA, which was confirmed on multidetector computed tomography three-dimensional reconstruction volume-rendered imaging.
Correlation of Follicle-stimulating Hormone, Anti-Mullerian Hormone, and Antral Follicle Count with Age in Ovarian Reserve Testing
Authors: Das Subrata , Bhattacharya Namrata , Mahata Ritu , Ghosh Sudip , Bhar Anindya Sundar , Srivastava Pragati
Published: August 2024

Objective:

Ovarian reserve and hence ovarian response has a key role in assisted reproductive technology and predicting response to gonadotrophins in controlled ovarian hyperstimulation. Various tools, namely follicle-stimulating hormone (FSH), anti-Mullerian hormone (AMH), antral follicle count (AFC), estradiol, etc., have been studied to discover the best determinant of ovarian reserve. The aim of our study is to correlate different reproductive hormones with age of women to estimate ovarian reserve and to evaluate reliable marker for aiding infertility treatment.

Materials and Methods:

It is an observational study performed for 6 months, with 88 women (aged 21–39 years) having a complaint of infertility, enrolled in the infertility clinic of a tertiary care hospital. Baseline scan for AFC was done for every patient and their blood was sent for serum FSH, AMH analysis. Statistical procedures were employed to determine the association between age and reproductive hormones (i.e. FSH and AMH) as independent variables and AFC as a dependent variable.

Results:

A strong negative correlation was noted between FSH and AMH and between age and AMH (r = −0.492 and r = −0.498, respectively). A weak negative correlation was seen between AMH and total AFC (r = −0.241). A moderate positive correlation was seen on comparing age and FSH (r = 0.331), whereas no correlation was seen on comparing FSH with AFC and AMH with AFC. The presence of ovarian cyst did not affect AMH or AFC but reduced FSH values significantly.

Conclusion:

In the quest to determine a panel test for ovarian reserve testing we conclude, FSH and AFC should perform fairly in poor resource and low socioeconomic setting. The combination of FSH with AMH and AFC might aid in better determination of ovarian reserve in tertiary centers with available resources.
“Stamp the tunnel”- Innovative tool - for perfection in manual small incision cataract surgery
Authors: Fathima Allapitchai , Vedachalalm Rajesh , Venkatesh Rengaraj , Meenakshi Ravindran , Aladin Darwesh MK , Drishti C.
Published: August 2024

Background:

Manual small incision cataract surgery (SICS) is a cost-effective and safe procedure offering comparable outcomes to phacoemulsification. It holds significance for outreach and economically disadvantaged patients in developing countries, while also being important for complex cataracts in developed nations. The SICS technique revolves around a three planar self-sealing sclero corneal tunnel (SCT), a critical element for rapid and suture-less healing. The tunnel’s components include the incision, side pocket, internal entry, and depth each affecting astigmatism and successful nucleus delivery.[1-3] Various incision types are explored, with the frown incision yielding minimal astigmatism but posing challenges.[2,4] Inappropriate SCT leads on to high induced astigmatism, post op hypotony, and chances of infection.

Purpose:

This video introduces “Tunnel stamp” which is a novel device designed to guide the incision length, internal entry line, and side pocket accuracy thus making a perfect SCT particularly for novice surgeons, who often encounter intraoperative and postoperative complications due to inappropriate SCT. The device is produced through 3D printing with thermoplastic polyurethane (TPU), an easily available and economically feasible material. The prototype’s practicality is demonstrated through successful wet lab trials on goat eyes and subsequently on human eyes. The device is aligned using a limbus-matching step and a sterilized marker pen.

Synopsis:

This device has unique advantage to take care of the three aspects of SCT, that is, incision, side pocket, and internal entry. One can have custom-made guarded knife to perform scleral groove in optimum depth, which is another important dimension of SCT. Future developments involve creating the tunnel stamp in transparent flexible silicon to enhance alignment accuracy. Given the diversity of cataract types, multiple sizes of the device are envisioned to accommodate nucleus size variability and different stages of cataract development. To aid novice surgeons, two variations of incision guides (straight and frown) are proposed for immature and harder cataracts reducing induced astigmatism.

Highlights:

Overall, this innovative tunnel stamp aims to enhance SICS outcomes, enabling more precise and consistent SCT creation while addressing challenges posed by various cataract types and surgeon experience levels.

Video link:

https://youtu.be/yzV-UC4jwPg
Trends in infectious adverse events after elective optical keratoplasty (PK, EK, and ALK) - Ten years’ analysis from an eye bank
Authors: Chaurasia Sunita , Sri Sushma , Srinivas Kandibanda , Joseph Joveeta , Tyagi Mudit , Dave Vivek Pravin , Jalali Subhadra
Published: August 2024

Purpose:

To report the clinical profile and donor characteristics of post-optical keratoplasty adverse events notified at an eye bank.

Methods:

Between January 2013 and December 2022, 37,041 donor corneas were utilized for keratoplasty, of which 16,531 were used for penetrating keratoplasty (PK), 12,171 for endothelial keratoplasty (EK), and 1356 for anterior lamellar keratoplasty (ALK). EK included 10,956 Descemet stripping automated endothelial keratoplasty (DSAEK) and 1215 Descemet membrane endothelial keratoplasty (DMEK). The adverse events reported within the first 6 weeks of optical keratoplasty were analyzed for donor-related parameters.

Results:

A total of 41 (0.11%) recipients had post-keratoplasty infections. Of these, 33 occurred after EK (29 after DSAEK, and four after DMEK), two after ALK, and six after PK. The clinical presentation was keratitis alone in 16 eyes and associated with endophthalmitis in 25 eyes. The organisms isolated were gram-negative bacteria in 26 eyes, fungus in eight eyes, gram-positive bacteria in four eyes, mixed infection in five eyes, and microbiology inconclusive in seven eyes. The majority (78%) of the gram-negative infections were due to multidrug-resistant organisms. Most (88%) donor corneas were harvested from hospital premises. The most common cause of donor mortality was trauma. The median duration of presentation from surgery was 4.46 (range: 1–30) days. The death to preservation time was 4.18 (1.5–7.65) hours. The death to utilization time was 3 (2–4.7) days.

Conclusion:

The overall risk of infectious adverse events after keratoplasty was 0.11%, ranging from 0.08% to 0.36%. Most (80.4%) of the adverse events occurred after EK. The majority (78.9%) of the adverse events were of bacterial etiology, of which gram-negative infections (68.4%) were the most common. The trends and microbiological spectrum of organisms associated with infections should be thoroughly documented in eye banks to gain insights and formulate guidelines on the management of adverse events.
Comparison of Pacman cutting technique and trisection cutting technique for hydrophobic acrylic intraocular lens removal
Authors: Bao Xianyi , Chen Sheng , Wang Yong , Ortega-Usobiaga Julio
Published: August 2024

The objective of this retrospective cohort study is to compare the Pacman cutting technique with the trisection cutting technique for hydrophobic acrylic intraocular lens extraction. A total of 29 eyes of 29 patients requiring IOL removal were selected and enrolled in this study. The patients in group 1 (13 cases) underwent the conventional trisection cut technique from May 2022 to Dec. 2022. The patients in group 2 (16 cases) underwent the modified partial IOL cutting technique (Pacman cutting technique) from Jan. 2023 to June 2023. Corneal endothelial cells (CECs) count, slit-lamp examination, and intraocular pressure (IOP) measurement were conducted at all preoperative and postoperative visits. Surgical time, intraoperative and postoperative complications were recorded. The mean surgical time was 3.48 ± 1.54 minutes (range: 2 to 7 minutes) for the trisection cut technique group and 2.52 ± 1.18 minutes (range: 2 to 5 minutes) for the Pacman cut technique group. There was a statistically significant difference between the two groups in terms of surgical duration (P < .05). There was no difference in the mean preoperative CEC counts (group 1: 1924 ± 462, group 2: 1876 ± 516, P > 0.05). However, three months after the operation, the count of CECs decreased by 213 ± 72 (11%) in group 1 and 142 ± 57 (8%) in group 2. The decrease in CECs in group 1 was greater than that in group 2, and the difference was statistically significant (P < .05). There were no serious complications affecting vision in either group during the follow-up period. This study showed that the Pacman cutting technique is more effective and safer than the trisection cutting technique for hydrophobic acrylic IOL removal.
Knowledge and awareness of pediatricians about early interventions performed by pediatric dentists in the management of cleft lip and palate – A questionnaire-based study
Authors: Baviskar Mansi Gandhy , Naik Shilpa Shetty , Joshi Amil , Chaudhary Chinmaya Milind , Sharma Rachna , Mehta Aayushi
Published: August 2024

Background and Introduction:

Cleft lip and palate (CL/P) is one of the most common congenital anomalies which require multidisciplinary care. Patients with CL/P require appropriate corrective treatment to improve health, function, and esthetics. Knowledge about the various treatment procedures available and the timing of the procedures among pediatricians is vital for them to refer the patient at the correct stage to the appropriate specialist for the best possible rehabilitation.

Aim:

The aim of this study was to evaluate the knowledge and awareness of pediatricians about early interventions performed by pediatric dentists in the management of CL/P.

Materials and Methods:

A closed-ended questionnaire that included questions regarding the knowledge and awareness of obturators, lip taping, and nasoalveolar moldings was formulated. A questionnaire with 20 questions was circulated among the pediatricians through a web-based portal. Their knowledge and awareness about early interventions performed by pediatric dentists in the management of CL/P were assessed.

Results:

Results showed that out of 323 pediatricians who participated in the survey, 99.4% had heard of obturators. Awareness about lip taping was 78.3% while that of nasoalveolar molding was 55.1%. The benefits of the procedure and appliance were not well known.

Conclusion:

To improve the health, psychological, and social support of patients with CL/P, more awareness needs to be created among pediatricians regarding the management to provide better and timely oral rehabilitation.
Total Anomalous Pulmonary Venous Drainage with Malaligned Atrial Septum: A Case Series and Descriptive Study
Authors: Koirala Satish , Ayoub Touseef Ul , Awasthy Neeraj , Iyer K. S.
Published: August 2024

Total anomalous pulmonary venous drainage (TAPVD) is a complex congenital heart anomaly characterized by abnormal venous return from the pulmonary veins. The classification of TAPVD has been a matter of debate, particularly when pulmonary veins open into the anatomically left atrium but functionally into the right atrium due to a malaligned interatrial septum. This case series aimed to assess clinical significance of malalignment of interatrial septum and to differentiate between TAPVD and total anomalous pulmonary venous connection (TAPVC) by echocardiography before sending the patient for surgery. This retrospective case series involved seven patients diagnosed as TAPVD between 2011 and 2023. The age of the patients ranged from 1 month to 3 years, mostly presenting within the first few months of life. One case was diagnosed during fetal echocardiography. The commonest complaints were failure to thrive, fast breathing and recurrent chest infection. All cases were diagnosed by echocardiography and confirmed during surgery. 5 patients had situs solitus, 1 had situs inversus and one had left isomerism. In all cases, surgical repair was done which included excision of malaligned interatrial septum and closing the interatrial defect with dacron patch, thus directing the flow of the pulmonary vein to the left atrium. In summary, TAPVD with malaligned interatrial septum and TAPVC are two completely different entities and must be differentiated before sending the patient for surgical repair. The normal anatomical connection of pulmonary veins to left atrium is preserved in TAPVD.
Echocardiographic Evaluation of Left Ventricular Hypertrophy
Authors: Shah Rajesh K.
Published: August 2024

Left ventricular hypertrophy (LVH) can occur as a result of increase in the left ventricular (LV) wall thickness or increase in the LV cavity size, thus leading to increase in the LV mass. Strength training and aerobic exercise lead to physiological LVH, whereas conditions such as hypertension and aortic stenosis (AS) cause pathological LVH. It is one aspect of ventricular remodeling. LVH can also occur because of some primary myocardial diseases as well as due to certain infiltrative disorders. LVH is not a disease in itself, but a manifestation of some other disease. LVH is a marker of adverse cardiovascular health and remodeling and is associated with a high risk of adverse cardiac outcomes. Besides this, LVH itself can lead to heart failure or sudden cardiac death. Hence, a thorough assessment of LVH is important for proper management of the underlying condition. Echocardiography and cardiac magnetic resonance imaging are the two most important imaging modalities used for the assessment of LVH. This review describes various echocardiography techniques for LVH assessment as well as echocardiographic recognition of the underlying etiological condition.
Diffuse Esophageal Leiomyomatosis and the Surgical Challenges Encountered
Authors: Luthra Tanvi , Anand Sachit , Dhua Anjan Kumar , Yadav Devendra , Jain Vishesh , Goel Prabudh , Kandasamy Devasenathipathy , Agarwala Sandeep , Malik Rohan
Published: August 2024

ABSTRACT

Diffuse esophageal leiomyomatosis (DEL) is a rare condition characterized by the growth of multiple benign smooth muscle tumors (leiomyomas) in the esophagus. These tumors can cause obstruction and functional impairment of the esophagus, leading to symptoms such as difficulty swallowing, chest pain, and weight loss. The disease can present with leiomyomas or glomerular nephropathy in other body parts, hearing defects, astigmatism, or myopia (Alport’s syndrome). However, isolated cases are also reported in the literature. Surgical management of DEL presents several challenges due to the location and extent of the tumors. Herein, we describe a girl afflicted with DEL and required multiple surgeries for management, highlighting the unique challenges faced by the surgical team in restoring esophageal function and improving the patient’s quality of life.
Development of a Tool for the Assessment of Job Satisfaction amongst the Community Health Workers
Authors: Revadi G , Baravakar Jalindar , Kumar Amit , Joshi Ankur , Pakhare Abhijit P.
Published: August 2024

Introduction:

Amongst the various factors influencing the performance of community health workers (CHWs), job satisfaction serves as a potential drive to perform better. This study aimed at developing a tool to measure how well the CHWs are satisfied pertaining to individual, community and health system determinants.

Methodology:

This cross-sectional study was conducted in a rural block of Madhya Pradesh (Central India). The CHWs were administered a self-reported questionnaire that contained individual, health system and community level determinants of job satisfaction with a 5-point Likert scale to mark their perception.

Results:

The job satisfaction scale of 15 items was initially administered to the 92 CHWs. Their scale content validity index (average) was 0.83. The finalised tool consisted of 13 items under three factors following the exploratory factor analysis namely, health system, supervision and peer support and intrinsic job satisfaction. Their overall Cronbach’s alpha was 0.81, with the median (interquartile range) score of job satisfaction for both the Relatively Low Performing and Relatively High Performing Community Health Workers being 4 (4–5).

Conclusion:

The CHWs in this study were satisfied with their performance as voluntary village health workers following the assessment using a complex job satisfaction scale.
Immunoglobulin G subclass 4-related disease of the lacrimal sac presenting as bilateral lacrimal sac nodules: A rare case report
Authors: Alshaibani Askar K. , Al-Mulla Abdullah H. , Nassim Hala M.
Published: August 2024

Immunoglobulin G subclass 4-related (IgG4) disease is a fibro-inflammatory systemic disease. It can present in different and wide variety of clinical presentations. The ocular manifestations of IgG4 disease are diverse, but the most common presentation is lacrimal gland involvement presenting as dacryoadenitis. In this case, we are going to present a rare presentation of IgG4-related disease involving the lacrimal sac on both sides of a 55-year-old Saudi male patient.
Factors Influencing Older People’s Intentions to Vaccinate
Authors: Olds Rolanda , Seibert Casondra , Metzger Anne H. , Chen Aleda M. H.
Published: August 2024

Vaccination is crucial in reducing the spread of disease and improving overall patient mortality. Limited information exists regarding pharmacist accessibility outside traditional medical settings or impact on older patients’ intention to vaccinate. This study aimed to examine
patient perceptions regarding pharmacist accessibility and vaccination intention. Researchers used a quantitative research method of older people from Ohio, Kentucky, and Indiana. A survey was given to community-dwelling older people who attended different vaccine clinics. The survey included
10 questions describing reasons for not receiving vaccines in the past, how likely they are to receive vaccines if administered at community events, and the importance of having easy access to vaccines. For Likert-type items, a 5-point scale was used. The surveys were collected electronically
and anonymously from several community events. Aggregate data were analyzed with descriptive and inferential statistics. One hundred seventy-eight responses were collected. The average age of participants was 75 years, and 70.8% were females. Of the respondents, 44.9% preferred to receive
vaccines at a community center, 17.4% at the doctor’s office, 4.5% at a clinic, and 9.6% at a sporting event like a boxing match. Men were more likely to receive a vaccine at a sporting event, while women were more likely to be interested in receiving a vaccine at a community center
(P < 0.05). Respondents somewhat agreed (median = 4, interquartile range = 3-5) that they do not have transportation to places with vaccines. Age was significantly and negatively correlated with educational attainment (P < 0.001). However, as participants’ ages increased,
they were significantly more likely to have a belief that vaccines do not work (P = 0.011). The study addressed how pharmacists should consider more community outreach events in convenient locations, like community centers, for older people to improve vaccination rates.
Increased red cell distribution width predicts mortality in COVID-19 patients admitted to a Dutch intensive care unit
Authors: Mompiere Anthony D. , Noble Jos L.M.L. le , Fleuren-Janssen Manon , Broen Kelly , Osch Frits van , Foudraine Norbert
Published: August 2024

Background: Abnormal red cell distribution width (RDW) is associated with poor cardiovascular, respiratory, and coronavirus disease 2019 (COVID-19) outcomes. However, whether RDW provides prognostic insights regarding COVID-19 patients admitted to the intensive care unit (ICU) was unknown. Here, we retrospectively investigated the association of RDW with 30-day and 90-day mortalities, duration of mechanical ventilation, and length of ICU and hospital stay in patients with COVID-19.Methods: This study included 321 patients with COVID-19 aged >18 years who were admitted to the ICU between March 2020 and July 2022. The outcomes were mortality, duration of mechanical ventilation, and length of stay. RDW >14.5% was assessed in blood samples within 24 hours of admission. Results: The mortality rate was 30.5%. Multivariable Cox regression analysis showed an association between increased RDW and 30-day mortality (hazard ratio [HR], 3.64; 95% CI, 1.54–8.65), 90-day mortality (HR, 3.66; 95% CI, 1.59–8.40), and shorter duration of invasive ventilation (IRR, 2.72; 95% CI, 0.225.22).Conclusions: Increased RDW in COVID-19 patients at ICU admission was associated with increased 30-day and 90-day mortalities, and shorter duration of invasive ventilation. Thus, RDW can be used as a surrogate biomarker for clinical outcomes in COVID-19 patients admitted to the ICU.
Rıfat Ilgaz'ın "Alişim" Şiirinde Ötekilik
Authors: Dağlar Doğanay , Akça Hilal
Published: August 2024

Bu çalışma Rıfat Ilgaz’ın şiir türündeki eserlerinden “Alişim”in özne ve ötekilik kavramları etrafında incelenmesi hakkındadır. Adı geçen metinden hareketle şiir öznesinin sosyal konumu itibarıyla öteki kimliğinin nasıl kurulduğunun aydınlatılması amaçlanmaktadır. Bu doğrultuda şiir öznesinin toplumsal kimlikle olan ilişkisine ve bu ilişki sonucunda ortaya çıkan ötekinin konumlandırılma biçimine dikkat çekilmiştir. Çalışma iki bölümden oluşmaktadır. İlk bölüm ötekinin sosyal kimlik kuramları çerçevesindeki yerine ve öteki kimliğin aydınlatılması noktasında ele alınan çalışmalara ayrılmıştır. Bu açıdan ötekinin tanımlamaları, ilişkileri ve Türk edebiyatındaki yeri dikkate alınmıştır. Bu kimliğin toplumsal kimlik karşıtlığındaki önemi belirtilerek bir kimlik modeli olduğu gösterilmiştir. İkinci bölümde ise “Alişim” şiirinin incelemesine yer verilmiştir. Ötekinin kurgulanma biçimi, özne, öteki, iktidar ilişkileri ve metnin ötekiye dair nasıl bir anlatı sunduğu aktarılmıştır. Böylece bir kimlik olarak ötekinin yorumlama alanına açıklığı gözler önüne serilmiştir. Yapılan incelemeler sonucunda “Alişim” şiirinin öznesinin bir tür kimlik anlatısı olarak çözümlenebileceği görülmüştür. Ötekinin biz kimliği ile olan ilişkisi sergilenmiştir. Ele alınan bu ilişki sonucunda ötekinin sosyal bir özellik taşıdığını göstermiştir.
A comparison of endoscopic ultrasoundguided fine needle aspiration and fine needle biopsy for pancreatic masses, gastrointestinal subepithelial lesions, and lymph nodes
Authors: Yang Patrick , Pais Shireen , Zhou Zhongren
Published: August 2024

Background: Endoscopic ultrasound-guided tissue acquisition (EUS-TA) is a well-established diagnostic tool to obtain tissue from solid pancreatic masses, gastrointestinal subepithelial lesions, lymph nodes, liver as well as other neighboring organs. EUS-TA has proven to have a major clinical impact in diagnosis and staging, decreasing the need for invasive diagnostic procedures, such as thoracoscopy, mediastinoscopy, laparoscopy and open surgery. EUS-TA includes endoscopic ultrasound guided fine needle aspiration (EUS-FNA) and endoscopic ultrasound guided fine-needle biopsy (EUS-FNB). Both procedures are safe and yield high diagnostic value. Despite its high diagnostic yield, EUS-FNA limitations include the inability to determine histologic architecture, and a small quantitative sample which may be inadequate for further immunohistochemical staining or molecular testing. EUS-FNB, with its larger core biopsy needle, was designed to overcome these potential limitations. It remains unclear if EUS-FNB has truly overcome these obstacles, and the optimal selection of FNA or FNB in different clinical contexts for different lesions is yet to be determined. We present a review on studies examining EUS-FNA vs EUS-FNB.

Conclusion: For solid pancreatic masses, there is no difference in diagnostic accuracy or tissue cores rates when accompanied by rapid on-site evaluation (ROSE). The diagnostic yield is higher in FNB compared to FNA in cases where ROSE is not accessible. In addition, one study indicated that the combined approach of EUS-FNA + FNB resulted in a higher diagnostic yield than EUS-FNA alone, accompanied by a reduced number of needle passes required.

In solid gastrointestinal lesions, FNB is associated with a relatively better diagnostic adequacy and tissue cores rates, with less number of needle passes.

Regarding lymph node biopsy, the availability of prospective trials is limited. Based on the current literature, we would like to propose EUS-FNB as the recommended approach for lymph nodes.
Acquired cutis laxa: Hematological insights and therapeutic implications in a paraneoplastic context
Authors: Khodeir Joe , Ohanian Paul , Zhou Zhongren
Published: August 2024

Background: Acquired cutis laxa (ACL) is an uncommon dermatological condition characterized by loose, inelastic skin due to the degradation of elastic fibers. Traditionally studied within dermatology, recent insights have highlighted significant associations with hematological disorders, particularly monoclonal gammopathies.

Objective: This commentary extends the discussion presented in the review article "Acquired cutis laxa: a clinical review" by Khodeir et al., emphasizing recent advancements in the understanding of ACL’s hematological connections. It focuses on paraneoplastic associations and their treatment, alongside a newly documented case linking ACL with IgA gammopathy.

Methods: A comprehensive review of recent literature and new cumulative data on ACL associated with neoplastic disorders was conducted. A detailed case report illustrates the clinical and pathological findings of ACL associated with IgA lambda paraproteinemia.

Results: Among 110 patients reviewed, 30 cases (27%) were linked to paraneoplastic disorders, primarily multiple myeloma and monoclonal gammopathy of undetermined significance. ACL typically preceded the diagnosis of these conditions by an average of 2.4 years. The newly reported case of ACL with IgA gammopathy further reinforces the link between ACL and monoclonal gammopathies. The pathogenesis involves complex mechanisms including enzymatic degradation of elastic fibers, immunoglobulin-mediated elastolysis, and chronic inflammation.

Conclusion: ACL presents a dermatological challenge increasingly linked to hematological disorders, particularly monoclonal gammopathies. Recognizing ACL as a potential paraneoplastic marker underscores the need for thorough hematological evaluation and long-term follow-up in patients. Continued research into the pathogenesis and therapeutic strategies is crucial for improving clinical outcomes and refining management guidelines for ACL.
THE CONCEPT OF DHATU AND THEIR ROLE IN PATHOPHYSIOLOGY OF DIS-EASES
Authors: Chandrakar Nidhi , Chandrakar Rupendra , Bhagat Prema
Published: August 2024

Dhatu is known to be the Structural and functional unit of our body. It provides strength, Energy, and support to
our body. Normal and abnormal functioning of dhatu is important for the overall growth of our body. In Ayurveda Samhitas, it is mentioned that when dhatu is in a normal state it makes the individual healthy. When it gets
disturbed it causes disease. It is mentioned here the concept of Dhatu, its anatomy, Physiology, and Pathology and
treatment which help us to know the critical aspects. The physiology of dhatu is well explained by Dhatu Poshan
Nyaya. It is for 4 types as mentioned in Samhitas i.e. Kshir Dhadhi Nyaya, Kedari Kulaya Nyaya, Khale Kapota
Nyaya, Ek Kala Dhatu Poshan Nyaya. With the help of these Nyaya, we understand the formation and nourishment of Dhatu from Ahar Rasa. When the Formation of Dhatu gets disturbed at any level as due to Apathya
Ahara Vihar, Agni dushti, Srotodushti, or defective Ahara rasa it results in the formation of diseases. Hence the
Pathology of diseases also depends on Dhatu which is well explained by Rogamarga and is similar to Samprapti
of diseases. I tried to explain Rogamarga in an elaborate way to know the prognosis and level of diseases because
due to advancing modern science the concept of dhatu and the pathway of diseases are unknown to common people. So, this article helps to make every one of the concepts which further help in the diagnosis and treatment of
diseases.
ROLE OF THE AGNI IN DIGESTION: A REVIEW
Authors: Nautiyal Shashank , Singh Yadav Saurabh , sharma Anuriddhi
Published: August 2024

Modern correlation of agni in the process of digestion. It is called bioenergy of the body, which helps in local activities and metabolic activities of our body. Agni in Sanskrit generally means fire; it is typically one among
Panchmahabhootas. Agni leads to the transformation of food into body tissues. Agni is responsible for the digestion of food and metabolism in our body. Mainly, jatharagni plays a significant role in this, so it is known as koshtagni as it is situated in our koshta. Jatharagni is also responsible for activating two other types of agnis, that is,
-7 types of dhatva agni and 5 types of bhutagni. Food that we intake contains various nutrients that are consumed
by humans and undergo multiple metabolic processes in the gastrointestinal tract (GIT), where agni plays an important role.
THE POTENTIAL AYURVEDIC SHODHANA TREATMENT PROTOCOL IN THE
MANAGEMENT OF EKAKUSTHA W.S.R. TO PLAQUE PSORIASIS – A CASE
STUDY
Authors: - Kavita , Datta Shukla Gyanendra
Published: August 2024

The Kustha Vyadhi mentioned in Ayurvedic texts occurs due to the vitiation of Tridosha and 4 Dushya (Saptko-dravya sangrah). They are divided into two main parts: Maha and Kshudra- Kustha. Eka Kustha (Psoriasis) is one of among the Kshudra Kustha. It is a chronic inflammatory skin disease usually present in the extremities, trunk, scalp, hairs, etc. This case study deals with a thirty-five-year-old female patient suffering from brown scaly plaques (Matsyashaklopama), Sarvang Kandu (Itching) and Ragata (Redness) who came to our college. In this case study, one sitting of Ayurvedic Bahu-Sanshodhana (i.e., Vaman followed by Virechan followed by Nasya and Raktmokshan Karma) was done.
Progression of the Baton Devices in Obturpaedic Cleft Treatment
Authors: Prinsloo Rolanda
Published: August 2024

Neonates born with clefts of hard and soft palate, particularly those diagnosed with Pierre Robin Sequence, often face life-threatening upper airway obstruction, leading to interrupted or continuous apnoea. Immediate intervention is critical to save their lives. This review presents multiple advancements and modifications in most conservative obturpaedic devices that can be swiftly manufactured and fitted without the need for major anaesthesia and surgical interventions. An in-depth description of the developmental progression is provided of various types of Baton devices, highlighting their specific applications through detailed photographs. The review categorises the described two major Obturpaedic divisions into further four subdivisions, demonstrating their positive outcomes in critical neonatal period immediately after birth. Additionally, we observe that these devices have long-term benefits, including improved tongue position, mandibular micrognathic growth and enhanced sucking and feeding abilities. For upper airway obstruction the clinical implication is extremely important for survival of the neonate. Future research is needed, concerning manufacturing material to be used and non-invasive electronic scanning to have these devices directly manufactured in a laboratory.