bluuebunny/crossref_metadata_2025 huggingface dataset:
A retrospective study of the comparison of maternal outcomes in in-vitro-fertilization pregnancy versus spontaneous conception
Authors: Yadav Reena , Chopra Kanika , Goyal Aditi
Published: December 2023

Background: The adverse maternal outcomes of newer technology of IVF have not been studied so far, especially in India.  The aim of the study was to compare maternal near miss and mortality between IVF-conceived and spontaneously conceived pregnancies, at a tertiary-level hospital, in Delhi.
Methods: We conducted a retrospective cohort study from 2018-2020. The demographic, obstetrics, past history, obstetric-related morbidity, mode of delivery, details of maternal near miss and mortality, and their reasons were recorded. Similar data from spontaneous conceptions were compiled. Comparison of maternal characteristics was tested using chi-square test, p<0.05 was considered significant. 
Results: Mean age of women in the study group was 33.16±5.58 years and in controls was 26.16±4.28 years. The risk of multiple pregnancy (58.5% versus 2%, p<0.0001), pre-eclampsia (62.8% versus 17.1%, p<0.0001), gestational diabetes mellitus (23.5% versus 14.2%, p=0.0493), intrahepatic cholestasis of pregnancy (32.8% versus 10%, p<0.0001), antepartum haemorrhage (12.1% versus 2.85%, p=0.0066), preterm deliveries (66.4% versus 5.7%, <0.0001), and maternal near miss (12.8% versus 0.7%, OR 20.50, 95% CI-2.6979 to 155.8916, p=0.0035) were much higher in the study group as compared to the control group and was statistically significant. The odds of maternal mortality were 4.0882, 95% CI 0.4512 to 37.0465, p=0.2105 in the study group as compared to the control group.
Conclusions: There is a need to counsel couples wanting to conceive with IVF about not just the procedure and success rates of it, but also the potential for pregnancy complications.
Assessment of maternal lipid profile in early pregnancy and its correlation with pregnancy outcome
Authors: Singh Priyanka , Gupta Renu , Lal Pavika , Gupta Garima
Published: December 2023

Background: Lipoprotein lipid physiology in pregnancy has important implications for the developing fetus as well as the mother. Elevated maternal triglycerides levels measured during early pregnancy have been associated with adverse pregnancy outcomes affecting both maternal and fetal health.
Methods: This was a prospective observational study conducted in the Department of Obstetrics and Gynecology, GSVM Medical College Kanpur between January 2020 to October 2021. A total of 146 antenatal women were enrolled in this study, out of which 26 women were lost to follow-up. Lipid profile was done for each subject and was later accessed.
Results: Total cholesterol were deranged in patients 30%, serum TG in 40.83%, LDL in 28.33%, HDL in 35.83%. Out of total of 120 patients, 18 (15%) patients had HDP, 6 (5%) had GDM, 13 (10.83%) had a preterm delivery, 14 (11.66%) had FGR 9 (15.83%) had SGA babies, 7 (5.83%) had LGA babies and 38 (31.66%) patients delivered by cesarean section. In this study, only 15% of the study population shows hypertensive disorder of pregnancy and had a statistically significant correlation with triglyceride level.10.83% of the study population had preterm delivery. It showed a statistically significant correlation with serum TG level.
Conclusions: Estimation of serum lipid profile during pregnancy can be considered as an early and economical investigation to prevent the deleterious effects of hyperlipidaemia associated with pregnancy.
Maternal request caesarean sections: fear tops the list
Authors: Puramban Poornima , Ravula Pallavi Chandra , Aziz Nuzhat
Published: December 2023

Background: The increasing demand for caesarean delivery on maternal request (CDMR) is adding to the increasing caesarean rates worldwide. Pregnant women and families choose a CDMR for several reasons that include social, economic, and cultural contexts. This study was done in a south Indian state to explore the common local reasons for CDMR, as a first step to reduce this trend.
Methods: Prospective observational, semi structured interview-based study of women who had chosen CDMR. Women with multifetal pregnancy and with previous caesarean sections were excluded. The primary outcomes were the reasons to choose a caesarean section over vaginal birth. The reasons were collected and divided into three themes: social and cultural, emotional reasons and personal previous experiences.
Results: Ninety-two women gave consent to participate in the study and were interviewed. The most common reason to choose a caesarean in the absence of any medical indication was ‘fear’ of harm to the mother or baby, trauma, or vaginal examinations by 65 out of 92 women (70.65%). Theme of social influence was quoted as the reason by seven (7.6%) and previous personal experience with birth outcomes was cited by three women (3.2%).  The majority chose CDMR in the antenatal period even before they set into labour.
Conclusions: Fear was the most common reason for choosing a CDMR, representing a misconception that caesarean birth is a safer, better alternative for the woman and her family. There is a need for change in discussions around antenatal care options, exploration of fears, and support systems to make a better-informed choice.
A retrospective study of umbilical artery S/D ratio assessment on color doppler for monitoring of fetal well-being in patients with intrauterine growth retardation and its correlation with perinatal outcomes
Authors: Bhatia Shweta , Shah Maitri
Published: December 2023

Background: Intrauterine growth restriction (IUGR) is associated with an increased risk of perinatal morbidity, mortality and impaired neurodevelopment. The objective of this study is to evaluate the role of umbilical artery S/D ratio on color doppler for monitoring of fetal well-being in patient with intrauterine growth retardation and correlation with perinatal outcome.
Methods: This retrospective observational study is carried out at a tertiary health care hospital over a period of 1 year. All clinically diagnosed cases of IUGR on the basis of fundal height are included in this study. The suspected cases of IUGR, color doppler tests were done to confirm the diagnosis of IUGR. The perinatal outcomes of the pregnancy of women with abnormal doppler parameters are then compared with women with normal Doppler parameters.
Results: Out of the total sample size, 58.7% of the study population had abnormal doppler findings which were suggestive of IUGR, and 41.3% had normal doppler parameters. Our study showed that 18.2% newborns of study participants with abnormal S/D ratio had APGAR score at 5 minutes less than 7 as compared to 0% neonates of study participants with normal S/D ratio. This association was statistically significant. Also, statistically significant association was seen between 40 (90.9%) participants having abnormal S/D ratio whose neonates required NICU Admission as compared to 15 (48.4%) study participants having normal S/D ratio whose babies required NICU admission.
Conclusions: Ultrasound examination and Doppler monitoring provide a non-invasive repetitive method for supervising fetuses with growth restriction in order to apply an adequate management.
A vulval leiomyoma: a rare camouflaging tumor
Authors: Mehta Samir , Jain Samrudhi , Borole Supriya , Gupta Salonee
Published: December 2023

Uterine leiomyomas are a benign tumor of human uterus and common problem in gynecology. Despite this, leiomyomas of the vulva are rare, masquerading, and usually misdiagnosed as Bartholin cyst preoperatively. These benign smooth muscle tumors are typically painless, solitary, and well circumscribed and can affect female of any age group. We hereby present a case of a 39-year-old female that presented in OPD at ESIC model hospital, Bapunagar, Ahmedabad with left labial mass and was misdiagnosed as Bartholin cyst initially and later on histopathology final diagnosis of vulvar leiomyoma was made.
Obliterative vaginal procedure for post hysterectomy vault prolapse in severe factor 7 deficiency: a case report and literature review
Authors: Jacob Kirthana Rebecca , Kumari Minakshi , Kumari Pushplata
Published: December 2023

There is a concern about perioperative bleeding with any surgical intervention in patient with congenital factor VII (FVII) deficiency. The optimum dosage regimen for recombinant activated factor VII (rFVIIa) use has been not clearly established. We report a woman with post hysterectomy vault prolapse management with congenital FVII deficiency who underwent obliterative vaginal procedure. A 50-year-women with congenital FVII deficiency was diagnosed as post hysterectomy vault prolapse and planned for partial colpocleisis. She was planned to monitor FVII activity and prothrombin time international normalized ratio (PT/NR) intraoperatively. At the start of surgery, FVII activity was 3% and PT was INR 35.3 with INR of 2.83. (0.8-1.2). Presuming the improvement of 25% activity, 5 mg (70 mcg/kg body wt.) rFVIIa was administered. The PT was improved to 28.4 sec, Surgery was successfully completed without unexpected bleeding. Post operatively there was no oozing hence FVII activity and PT-INR was not checked. An additional rFVIIa dose of 2mg was given prophylactically after 12 hours of surgery. The patient was discharged on the third day after surgery without postoperative complication. In this case, rFVIIa was used just twice and there were no bleeding events during the perioperative period. Previous reports suggested using 15-30 μg/kg of rFVIIa before surgery and subsequent every 4-6 h in the first 24 h, then increasing the interval to 8-12 h. It is necessary to evaluate optimal dose of rFVIIa based on the risk and surgical invasiveness for each case. Our patient with congenital FVII deficiency uneventfully underwent obliterative vaginal procedure.
A rare cause of dysmenorrhea-accessory cavitated uterine malformation: a case report
Authors: Subash Chandra Bose Rajarajeswari Krishnasamy , V. Nandhana
Published: December 2023

Accessory cavitated uterine malformation is a newly recognized mullerian anomaly where the uterine cavity is normal unlike other Mullerian anomalies and hence needs to be described more accurately. These are non-communicating ULMs that occur contiguously along the wall of the uterus. This case report is about a 31 years old female who came with complaints of acute severe dysmenorrhea with a chronic course for the past 2 years and was evaluated for a similar episode in the past where she was diagnosed as fibroid with cystic degeneration and treated with SPRM and OCP which gave no relief from symptoms. With another exacerbation of symptoms two years later, patient was evaluated with an USG suggesting hemorrhagic degeneration in rudimentary horn and gave two differentials- fibroid with cystic degeneration and adenomyoma, wherein the   latter was more likely. As a part of pre-op evaluation, MRI was done. Then came the third differential-ACUM [Accessory cavitated uterine mass]. Patient was counselled about the risk of infertility and uterine rupture in subsequent pregnancy as a post-op complication underwent laparoscopic surgery. Intraoperative and postoperative period was uneventful and HPE of the same confirmed the diagnosis. ACUM is a very treatable cause of severe dysmenorrhea and adequate awareness of this new entity will enable in making the diagnosis early.
Minimally invasive management of pyoperitoneum attributed by spontaneous perforated pyosalpinx and pyometra
Authors: Manisha Polaki , Jeypal Aparajita , Yerkade Vasundhara , Devi Hema , Mishra Juhi , Khoiwal Kavita , Chaturvedi Jaya
Published: December 2023

Pyoperitoneum, apart from bowel perforation, can occur due to gynecologic causes like ruptured pyometra or ruptured tubo-ovarian abscess. Earlier, the management of pyoperitoneum included broad-spectrum antibiotics and emergency laparotomy with or without a hysterectomy and bilateral saphingo-oophorectomy. A higher rate of surgical complications like bowel or bladder injury was noted with surgery, and future fertility was also compromised in these patients. Later on, treatment strategies improved to laparoscopic drainage of pus with antibiotics without extensive surgery. However, such cases can be managed with an even more minimally invasive approach by image-guided pigtail drainage. In this report, we describe two cases of pyoperitoneum that were managed successfully with pigtail insertion and continuous drainage of pus along with antibiotics obviating the need for anaesthesia and surgery. It seems to be a promising approach for pyoperitoneum in a hemodynamically stable patient, not showing any features of severe sepsis.
Emergency laparoscopic myomectomy in a rare case of hemoperitoneum from uterine leiomyoma
Authors: D. Kavitha Yogini , G. Vishnu Priya , Dharshini Sai , Vijayalakshmi
Published: December 2023

The most common benign tumour in reproductive age group –uterine leiomyoma can rarely present with bleeding into the peritoneal cavity leading to hemodynamic instability. A 36-year parous woman presented with acute abdomen and hypovolemic shock. Pregnancy test reported to be negative. Emergency laparoscopy was done and detected to have a surface bleeder and emergency laparoscopic myomectomy done.
Adenomyosis-a rare cause of chronic lumbago in adolescents
Authors: Yogini Kavitha , Maran Varsha
Published: December 2023

Adenomyosis is a benign condition of the uterus that was previously diagnosed through histology after hysterectomy. Specifically, ectopic endometrial glands and stroma were seen at a minimum depth of 2.5 mm below the Endo myometrial junction, along with hypertrophic and hyperplastic surrounding myometrium. Adolescent adenomyosis is not known to occur frequently. Furthermore, in extremely young individuals, the classic diagnostic indicators of adenomyosis may not be present during clinical, sonographic, or radiologic testing. Although cystic form of adenomyosis is more common in the younger age group, diffuse adenomyosis should always be considered in refractory pelvic pain. Ultrasound and MRI done together has improved sensitivity for the diagnosis of adenomyosis. Dienogest, the millennial molecule, not only serves its purpose in endometriosis but also one of the first line drugs in the management of adenomyosis, particularly the diffuse forms.
Management of heavy menstrual bleeding in women on long term anticoagulants
Authors: Vishalakshi L. Ashwini
Published: December 2023

Women taking anticoagulants for therapeutic or prophylactic indications has been on the raise since the past few years. Heavy menstrual bleeding (HMB) due to anticoagulant use is also on the raise. Hence, we need to explore various treatment strategies which can reduce or stop the HMB. Various methods that have been tried like reducing the dose of anticoagulants, changing over to a different anticoagulant with lower incidence of HMB, addition of tranexamic acid or progesterone, use of combined oestrogens and progesterone contraceptives etc. In cases of intractable bleeding not controlled with medical measures surgical options like intrauterine balloon tamponade, endometrial ablation or uterine artery embolization may be tried. The last resort is hysterectomy. This review discusses about the various options available that can used in treating women with HMB who are on anticoagulation.
Comparison of American orthopedic foot and ankle society score between anterior to posterior lag screws versus posterior buttress plating for posterior malleolus fixation in tri-malleolar ankle fracture
Authors: Ali Khandoker Muhammud Mazher , Islam Muhammad Mozaherul , Badar Uddin K. M. , Rukanuddawla Khan M. , Atikur Rahman Shojib M.
Published: December 2023

Background: Posterior malleolar fractures are frequent, occurring in up to 44% of all ankle fractures. Surgical management typically involves anterior to posterior (AP) lag screws or posterior buttress plates. This study aimed to compare the AOFAS (American orthopedic foot and ankle society) score between AP lag screw and posterior buttress plating for posterior malleolus fixation in tri-malleolar ankle fracture.
Methods: This quasi-experimental study was conducted at the department of orthopedics and traumatology, Chittagong medical college hospital, Chattogram, Bangladesh, from November 2020 to October 2021. It involved 28 patients with ankle fractures, equally divided into two groups. Group A received AP lag screw fixation, and group B underwent posterior buttress plating. Data analysis was performed using MS office tools and SPSS version 23.0.
Results: The posterior plating group demonstrated superior postoperative AOFAS scores compared with the AP screw group with statistically significant differences (88 versus 81, p=0.008).  Significant differences were noted in the AOFAS pain score (p=0.045) and function score (p=0.019) at the final follow-up between the two groups.
Conclusions: Patients with tri-malleolar ankle fractures in whom the posterior malleolus is treated with posterior buttress plating show superior postoperative AOFAS scores at follow-up compared to those treated with AP screws.
Outcomes of early active mobilization after surgical repair of injured extensor tendon of hand and forearm
Authors: Kundu Sujit , Dutta Shawon , Islam Mohammed Amirul , Alam Daniul
Published: December 2023

Background: Extensor tendon injuries in the hand and forearm, if left untreated, can significantly impair backhand function. Timely and effective treatment is crucial. Recent evidence suggests that early active mobilization post-surgery yields better short-term outcomes, with less disparity in long-term results.
Methods: This prospective observational study was conducted at the department of orthopedic surgery, BSMMU, Dhaka, Bangladesh, from March 2014 to August 2016, with a total of 40 patients.
Results: The study evaluated the efficacy of early active mobilization following surgical repair of extensor tendon injuries in zones V-VIII of the hand and forearm. At 12 weeks post-surgery, 75% of patients reported no pain, increasing to 90% at 6 months and stabilizing at 85% by 12 months. Furthermore, 75% of patients regained a range of motion greater than 120 degrees at 6 months, with 60% maintaining this at 12 months. Notably, 90% of the patients maintained normal grip strength at both 6 and 12 months. Final assessments using the Mayo wrist score showed satisfactory outcomes for 70% of patients at 12 weeks, 90% at 6 months, and 95% at 12 months. The Dargan criteria echoed these positive results, with satisfaction rates of 80% at 12 weeks, 90% at 6 months, and 95% at 12 months. Complications were minimal, including superficial skin infections (5%), hypertrophic scars (10%), and tendon rupture (5%).
Conclusions: The study concludes that early active mobilization, complemented by a simple static splint, facilitates faster recovery, full range of motion, improved grip strength, and earlier return to work in the early postoperative period.
An observational retrospective study on safety and functional outcomes of arthroscopic anterior cruciate ligament reconstruction using Sironix suture button and interference screw
Authors: Mohammed Murtuza Ahmed , Parameswaran Apurve , Ponnala Vinay Kishore , Eachempati Krishna Kiran , Apsingi Sunil , Moharana Ashok Kumar , Angrish Sachin , T. S. Deepak
Published: December 2023

Background: Anterior cruciate ligament (ACL) injury is a persistent orthopaedic condition that affects a wide spectrum of people. ACL reconstruction (ACL-R) stands out as the primary treatment option. Graft fixation with suture buttons and interference screws has proven to be a highly successful and reliable method for ACL-R. In this context, our research aims to assess the safety and functional outcomes of patients who underwent arthroscopic ACL-R using the Sironix suture button and interference screw.
Methods: This was a retrospective observational study. Patients who underwent arthroscopic ACL-R using Sironix suture button and interference screw (January 2018-March 2022) were included in the study. Functional outcomes of patients were evaluated using the international knee documentation committee (IKDC) assessment, the Tegner activity scale (TAS), the Lysholm knee scoring scale, the modified knee injury and osteoarthritis outcome score (KOOS) quality of life subscale, and the single assessment numerical evaluation (SANE) score. Adverse events, if any, were recorded.
Results: All patients achieved excellent outcome measures for IKDC, Tegner, Lysholm, KOOS, and SANE scores. The mean (SD) IKDC score was 88.76 (7.16), Tegner activity score was 5.9 (1.13), while the Lysholm score was 96.9 (6.56). The overall KOOS score was 93.7 (7.52), and the overall SANE score for the affected joint was 94.5 (7.22).
Conclusions: Arthroscopic ACL-R using Sironix implants (Helysis titanium interference screw, Helysis PLDLA+β-TCP interference screw, Infiloop fixed loop UHMWPE suture titanium button, Proloop adjustable loop UHMWPE suture Titanium button, and Titanium suture disc) demonstrated safety and good functional outcomes.
Prospective study of surgical management of femoral shaft fractures in children using tens nail
Authors: Hathiwale Mohammed Ismail , Mundewadi Vishwas M. , Ahmed Mohammed Nadeem
Published: December 2023

Background: Pediatric femoral shaft fractures are uncommon, constituting less than 2% of all fractures in children; yet they are a significant burden on healthcare systems and families as they are the most common fractures requiring hospitalization in children. In the recent studies, technique of flexible stable intra medullary pinning using titanium pins which is now popularly known as TENS has become the choice of operative management for pediatric femoral shaft fractures. We conducted a clinical prospective study on the use of Titanium Elastic Nailing System (TENS) for the treatment of femoral shaft fractures in children.
Methods: This prospective study was carried out at Al-Ameen Medical College and Hospital, Vijayapura. Forty patients (32 males and 8 females) aged between 5-15 years with diaphyseal femur fracture were included in our study. Patients were treated with closed reduction and internal fixation with TENS. They were followed up for 6 months both clinically and radiologically. The functional outcome was evaluated using Flynn’s scoring criteria.
Results: Forty patients were followed up for 6 months and their results were evaluated. The functional outcome using Flynn’s criteria was excellent in 24 patients, satisfactory in 14 patients and poor in 2 patients. Complications observed were limb length discrepancy, knee stiffness, superficial infection and nail protrusion.
Conclusions: TENS has the advantages of early union, early mobilization, and manageable complications, making it an excellent choice for treating paediatric shaft femur fractures in patients aged 5 to 15 years.
A prospective and comparative study to evaluate the efficacy of oral pregabalin vs gabapentin combined with IV paracetamol as preemptive analgesic for post-operative pain in patients undergoing single level open lumbar spine decompression surgery in a tertiary health care center
Authors: Garg Rohit N. , Vaje Shweta Sonu , Patil Hrishikesh , Bajaj Sanket
Published: December 2023

Background: Post-operative pain in spine surgery, whether neuropathic or nociceptive, presents a significant challenge for both surgeons and patients. Previous research has demonstrated the effectiveness of pre-operative oral gabapentinoids in reducing postoperative pain, extending the time to first rescue analgesia, and diminishing overall analgesic requirements.
Methods: This study involved 120 patients undergoing lumbar discectomy for disc herniation. They were randomly assigned to receive pre-operative oral pregabalin, gabapentin, or a placebo, along with IV paracetamol as preemptive analgesia. The study assessed their efficacy through post-operative pain scores (VAS), and sedation scores (Ramsay sedation score) at various intervals, time to first rescue analgesia, and total analgesia consumption.
Results: No significant differences were found in demographic variables, surgical levels, or duration among the groups. The placebo group had the shortest time to first rescue analgesia, while the pregabalin group showed the longest, with a notable difference. Across most time frames, the pregabalin group reported the lowest mean postoperative VAS scores, whereas the placebo group had the highest. Initial variations in sedation scores converged in later time frames, with the placebo group consistently recording the lowest scores. Total rescue analgesia (tramadol) in the initial 24 hours was highest in the placebo group, followed by the gabapentin group, and lowest in the pregabalin group, with no significant variance.
Conclusions: This study affirms the superiority of pre-operative oral pregabalin with IV paracetamol. It effectively prolongs the time to first rescue analgesia and reduces overall analgesic consumption post-lumbar spine surgery, compared to pre-operative oral gabapentin with IV paracetamol.
Evaluation of the role of computed tomography guided biopsy in effective diagnosis and management of patients with Koch’s spine in India
Authors: S. Subith , Dussa Kumar R. , Kokate Sagar , Tungenwar Shubham , Dakhode Shubham
Published: December 2023

Background: In the Indian population, tuberculosis and malignancy are the most common spinal pathologies. Radiological findings are often non-specific, thus non-diagnostic and fail to provide a prognostic perspective if the disease is established. Therefore, bacterial and/or histological evidence must be obtained to distinguish one infection from another or neoplasm. In this study, we evaluated the role of Computed Tomography-guided biopsy in Koch's spine by assessing diagnostic yield, the incidence of patients with drug-resistant tuberculosis, and drug sensitivity.
Methods: Patients with suspected Koch's spine attending outpatient department of tertiary health care centre in India were selected for the study. Data were collected using proforma containing demographic, clinical, radiological and other laboratory variables. In addition, biopsy samples were sent for microbiological and histopathological analysis. Patients were followed up at an interval of 3 months to one year.
Results: Most patients had Lumbar vertebra involvement followed by dorsal and least with cervical spine.41.25% of cases were drug resistant. In resistant cases, Isoniazid resistance is more seen, followed by Rifampicin. The clinical assessment revealed a significant difference in fever, back pain, Weight WBC count, Erythrocyte Sedimentation Rate and C Reactive Protein post-biopsy and treatment.
Conclusions: Patients with Koch's spine should have tissue sampling for diagnosis and drug sensitivity; otherwise, they will not receive adequate treatment, leading to delayed recovery, disease worsening and resistance. Computed tomography guided biopsy thus helps early diagnosis and guides to proper anti-tuberculous treatment. In addition, it helps to decrease the burden of morbidity associated with Koch's spine.
Impact of COVID-19 related delays on outcome of intertrochanteric neck femur fractures
Authors: Yeotiwad Ganesh R. , Argekar Harshad G. , Upadhyaya Mohit R. , Bhardwaj Lakshya L. , Yadav Amit S.
Published: December 2023

Background: We are aware of no other study that has examined how the epidemic has affected an emergency service. Hence, the present study aims to determine the functional outcomes of delayed fixation to understand the impact of COVID-19 related hindrance to emergency service.
Methods: During the 1st wave of COVID-19, prevailing staff shortages and need for COVID tests resulted in minimum delay of 10 days between admission and surgeries as compared to the recommended urgent fixation standard. Harris Hip Score was calculated at 1 year follow up for these patients.
Results: The results showed that the mean age of the patients was 68.65±8.03 years. Out of all the patients, 50.9% were males and 49.1% were females. The mean Harris Hip score at 1 year follow-up was 78.76±11.65. Out of all, 3.63% were lost to follow up, and 20% were expired.
Conclusions: Early surgery seems to improve survival and decline in pressure sores. Conservative management should be well planned and used on patients who actually have a good risk to benefit ratio to it as the patients can develop increased risk of pulmonary, skin, and urinary infections. Efforts should be made to operate patients on within one to two days. Despite the fact that the overall number of trauma cases declined in this unprecedented COVID-19 scenario.
Para-tricipital approach for extra articular fractures of the distal humerus: a case series
Authors: Rashid Rasiq , Beigh Imtiyaz Ahmad , Khan Shahid Shabir , Dar Reyaz Ahmad , Maajid Saheel
Published: December 2023

Extra-articular fractures of the distal humerus are frequently managed surgically as these fractures are often unstable and have associated radial nerve injury. Different surgical approaches can be used to fix this fracture. We operated on a series of 9 patients with extra-articular fractures of the distal humerus utilizing the para-tricipital approach. Clinical outcomes were assessed by Mayo elbow performance score and visual analog scores. Radiological outcomes were assessed by plain radiographs. Time to union was an average of 4.2 months. Mean range of motion achieved at final follow-up was 122.50. Mean Mayo elbow performance score was 92.4. Excellent clinical results can be achieved by utilizing para-tricipital approach in extra-articular fractures of the distal humerus. Besides providing adequate exposure for rigid fracture fixation, this approach prevents the morbidity associated with triceps injury.
Ewing sarcoma: a tumor with an uncanny predilection for uncommon sites
Authors: Subbiah S. , P. A. Sandhya
Published: December 2023

Ewing sarcoma is one of the most common bone tumors diagnosed in pediatric age group second only to osteosarcoma. The tumor is known to involve most commonly pelvic bones and long bones while extra-skeletal Ewing sarcoma accounts for 15%. Ewing sarcoma of other sites like scapula, clavicle, hands, and feet are quite rare, accounting for only 3-5%. To determine the epidemiological profile of Ewing sarcoma of unusual sites treated in our department including age at diagnosis, site of origin and mode of management along with survival data. Details of Ewing sarcoma patients reported our department in last 9 years were collected and data was analysed. We report a total of 20 cases of Ewing sarcoma in last 9 years with 4 (20%) extra skeletal Ewing sarcoma arising from soft tissues of extremities and 30% from rare sites (3 scapula, 1 clavicle, 1 phalanx, 1 calcaneum). All patients were operated after 4-7 cycles of chemotherapy with 66% limb salvage rate. With an average necrosis of 40%, with a median follow up of 36 months, the overall survival of the group was found to be 77.7%. Ewing sarcoma is one of the rare tumors of bone and soft tissue with the predilection for unusual sites, with reasonable survival outcomes in localized disease. Though scapula, clavicle, hands and feet are rare sites for Ewing sarcoma, they accounted for 30% in our department, possibly because of the referral patterns.
Step-cut, biplanar, elongation and angulation ulnar osteotomy with annular ligament reconstruction in neglected Monteggia fracture dislocation in children: a retrospective study
Authors: Garg Rohit Nirbhay , Gupta Dinesh , Kundu Soutrik , Vaje Shweta Sonu
Published: December 2023

Monteggia fracture dislocation is an infrequent injury in children, with around 20-50% cases being missed on initial consultation; leading to their chronic and neglected forms leading to number of complications; thus justifying their operative management. Various treatment modalities have been suggested in the literature for these neglected injuries. A retrospective study of 7 patients (5 males and 2 females), with mean age of 9.58 years (7-14 years); with neglected Monteggia fracture dislocation undergoing corrective reconstructive surgery in the form of elongation and angulation proximal ulnar osteotomy with radial head reduction combined with annular ligament reconstruction was conducted and was then evaluated clinically and functionally using Mayo Elbow Performance Index (MEPI) score; and radiographicaly were graded as good, moderate or poor. The mean interval from time of injury to the time to corrective surgery was 10.58 weeks (range 6-16 weeks). The mean improvement in the post operative MEPI score was 23.57. The mean improvement in the post operative flexion-extension arc was 28.57˚, while that in the supination-pronation arc was 20.72˚. We concluded that Step-cut, biplanar, elongation and angulation proximal ulnar osteotomy with additional reinforcement in the form of annular ligament reconstruction is an effective technique to treat neglected Monteggia fracture dislocations in children; having excellent clinical, functional and radiological outcomes.
Arthroscopic decompression and debridement for the treatment of anterior cruciate ligament ganglion cyst in a 45-year-old female
Authors: Krishnan Rahul , Mohan Sandeep
Published: December 2023

Anterior cruciate ligament (ACL) cysts are infrequently encountered in clinical practice, with limited reported cases. These cysts usually present with chronic knee pain and clinical examination is usually unremarkable except for knee tenderness. Due to the lack of characteristic symptoms and deficiency of precise clinical techniques to diagnose the condition, timely diagnosis requires a high index of suspicion, supported by magnetic resonance imaging (MRI). Hence management of ACL ganglion cysts poses unique challenges for healthcare providers. We present a case study of a 45-year-old female with an ACL ganglion cyst successfully treated with arthroscopic decompression and debridement. This article outlines the clinical presentation, diagnostic workup, surgical intervention, and post-operative outcomes of this case, providing insights into the effective management of this uncommon condition. Furthermore, we provide a comprehensive review of the existing literature on ACL ganglion cyst, emphasizing findings and treatment outcomes reported in previous studies. This case underscores the importance of considering ACL cysts in the differential diagnosis of knee pain and discomfort. Early identification and appropriate management, such as arthroscopic cyst excision, can lead to favorable outcomes and complete recovery.
Iatrogenic femoral nerve palsy after a routine knee ligament surgery
Authors: Prithvi Raj Prunav Adhav , Mohan Madan , Pilar Anoop , Kodi Harish , S. Amaravathi Rajkumar
Published: December 2023

Peripheral nerve injuries following surgery can have a significant impact on the rehabilitation process. We report a case of a 25-year-old male who was unable to actively raise his leg and extend his knee following knee surgery (Arthroscopic Posterior cruciate ligament reconstruction and Posterolateral corner reconstruction). Following the surgery, it was noticed that the patient's knee range of movements and power was 0/5 as per the Medical Research Council (MRC) scale. On subsequent evaluation, it was found to be due to femoral nerve axonal neuropathy. We report such a case of femoral nerve axonal neuropathy following arthroscopic posterior cruciate ligament (PCL) reconstruction and posterolateral corner (PLC) reconstruction.
Navigating challenges: a case report on complications in clavicle fracture management with 'K' wire fixation
Authors: Prasath G. Lakshman
Published: December 2023

Orthopaedic metallic pins and wires are commonly used for the fixation of fractures and dislocations, with the shoulder girdle being one of the common areas for their application. Despite recent precautionary measures, complications related to migration of these devices into the pleural cavity continue to be reported. We present a case of a Kirschner wire (K-wire) migration from a left clavicle fracture to the first rib, highlighting the importance of vigilance and immediate intervention in such cases. A 35-year-old female, previously operated for a left clavicle fracture using K-wire and tension band wiring, presented with left shoulder and chest pain eight years later. Radiological investigations revealed a broken K-wire in the pleural cavity, with one portion near the acromio-clavicular region and the other at the posterior aspect of the first rib. Surgical intervention was performed, involving the removal of the K-wire from the chest cavity and clavicle, with subsequent patient recovery. The migration of orthopaedic pins and wires into the chest cavity is a rare but well-documented complication. Previous reports have demonstrated severe consequences, including cardiovascular complications and fatalities. Theories explaining wire migration include muscle action, shoulder mobility, negative intrathoracic pressure during respiration, regional bone resorption, gravitational forces, and even capillary action. To minimize such complications, subcutaneous K-wire ends should be bent, and restraining devices should be used. Close clinical and radiographic follow-up is essential until the pins and wires are removed after achieving the therapeutic goal. In case of migration, prompt removal is necessary to prevent fatal complications. This case report emphasizes the significance of vigilance and proper precautions when using orthopaedic pins and wires for shoulder girdle fractures. Timely intervention is crucial to mitigate severe complications associated with migration. Sharing experiences and lessons learned can contribute to the safer application of these fixation devices in orthopaedic practice.
A benchmarking analysis on electric vehicle emissions of leading countries in electricity generation by energy sources
Authors: UĞURLU Adem
Published: December 2023

A benchmarking analysis on vehicle emissions has been performed in this study. Sport Utility Vehicle (SUV) powered by electricity is taken into consideration in emission analysis. Calculations have been conducted for leading G20 countries in certain energy sources in electricity generation. According to the analysis, most optimal results are obtained in Volatile Organic Compounds (VOC), Carbon Monoxide (CO), Particulate Matters (PM10 & PM2.5), Sulfur Oxides (SOx), and Carbon Dioxide (CO2) emissions, if the vehicle is charged in France. Only Nitrogen Oxides (NOx) emissions are calculated as to be the lowest values in Canada, compared to other countries. Emissions of an average SUV Internal Combustion Engine Vehicle (ICEV) powered by gasoline are also added to the comparison.
Experimental investigation of heat transfer performance of different nanofluids in engine cooling system
Authors: YÜKSEL Tahsin , KAPICIOĞLU Abdullah
Published: December 2023

Cooling systems are needed for internal combustion engines to operate efficiently. The fluid traditionally used to transfer heat in cooling systems is a mixture of ethylene glycol (EG) and water (W). These fluids generally exhibit an effect that extends the operating temperature range and limits the heat output. On the other hand, nanofluids are known to increase the thermal capacity of liquid suspensions and have been studied in many experimental and numerical studies. This study examines the effects of nanofluids instead of currently used EG-Water on an actual vehicle. Three different nanofluids (TiO2, Al2O3, and SiO2) were used, and the concentration ratios of these fluids were determined as 0.1% and 0.2%. A real vehicle engine cooling system with a volume of 1400 cm3 operating at an average of 2000 rpm was used in the studies. Fluids that are widely studied in the literature were taken into account when selecting nanofluids. The results showed that SiO2 achieved the highest performance, with an increase of 15% compared to the base fluid. On the other hand, it was observed that increasing the concentration value of TiO2 exhibited a lower performance increase compared to other nanofluids. Finally, it has been observed that the operating temperature range of nanofluids affects.
İbâdî Âlim Ebû Ya‘kūb el-Vercelânî’ye Göre Halku’l-Kur’ân
Authors: BİLEN Osman
Published: December 2023

Halku’l-Kur’ân tabiri Kur’ân’ın yaratılmış olup olmadığıyla ilgilidir. Bu kavram Kur’ân-ı Kerim’de yer almamaktadır. Erken dönem hadis kaynaklarında da bu tabire rastlamak mümkün değildir. Bu mesele ilâhî sıfatlar çerçevesinde tartışılmıştır. Bu tartışmaların sonucunda fırkaların ayrışmasında odak konulardan birisi durumuna gelerek, siyasi ve itikadî bir mesele halini almıştır. İtikadî ve siyasi sonuçları olması nedeniyle farklı düşünen grupların ve tarafların ortaya çıkmasına neden olmuştur. Toplumda meydana gelen kamplaşmalar dolayısıyla yöneticilerin tutumlarını da etkilemiştir. Halku’l-Kur’ân konusu Abbasiler döneminde yöneticilerin sert tutumları nedeniyle içinde âlimlerin olduğu birçok kesimi olumsuz yönde etkilemiştir. Siyasi ve itikadî tartışmaları beraberinde getiren bu konunun İbâdîler tarafından nasıl tartışıldığını, hangi konular merkeze alındığını İbâdîlerin önemli bir âlimi olan Ebû Ya‘kūb el-Vercelânî’nin (ö. 570/1175) eserlerini inceleyerek ortaya koymaya çalıştık. İbâdîlerin önemli âlimlerinden olan Ebû Ya‘kūb el-Vercelânî’nin ed-Delîl ve’l-burhân li-ehli’l-ʿuḳūl adlı eserinde Vercelânî, Halku’l-Kur’ân konusunu ilâhî sıfatları merkeze alarak izah etmeye çalışmış ve bu konuda farklı düşünen fırkalara karşı eleştirilerini ortaya koymuştur. Çalışmamızda İbâdîlerin Halku’l-Kur’ân meselesine dair fikirlerini ve Vercelânî’nin meseleye dair görüşlerini, iddialarını ve eleştirilerini tespit etmeye çalıştık.
The emerging role of MALAT1 lncRNA in diabetic nephropathy: based on the review of the literature and bioinformatic analysis
Authors: Nikooei Shekoofeh , Azadifar Erfan , Alipoor Behnam
Published: December 2023

Previous studies have found that the metastasis-associated lung adenocarcinoma transcript 1 (MALAT1) exerts its biological effects on the progression of diabetic nephropathy by sponging microRNAs and affecting the gene transcription of downstream molecules. In this study, the primary emphasis is placed on the functions that MALAT1 plays in relation to the pathophysiology of diabetic nephropathy as well as the processes that underlie these roles. In addition, the usage of this long noncoding RNA as a possible biomarker or therapeutic target for diabetic nephropathy will be discussed.
Adipokines as a link between adipose tissue with inflammation and insulin resistance in cardiometabolic diseases
Authors: Fadaei Reza
Published: December 2023

Obesity, a global health crisis, is associated with metabolic disorders and escalating healthcare burdens. This review explores the multifaceted dynamics of obesity, investigating the interplay of genetic, physiological, and environmental factors. Adipose tissue, traditionally regarded for energy storage, now emerges as a crucial contributor to systemic metabolism through the secretion of adipokines. Key adipokines, such as adiponectin, leptin, and the CTRPs superfamily (CTRP1, CTRP3, CTRP9, and CTRP12), are examined for their influence on inflammation, insulin resistance, and atherosclerosis. A critical understanding of the complex interplay between adipokines, inflammation, and insulin resistance is essential for comprehending the intricacies of metabolic dysfunction in obesity. Adipokines emerge as potential therapeutic targets to alleviate inflammation-related pathologies associated with obesity and related disorders. Ongoing research is pivotal to deepen the understanding of adipokine roles, paving the way for innovative therapeutic interventions. This review delves into the role of adipokines in cardiometabolic diseases, particularly emphasizing the intricate links between inflammation and insulin resistance in the context of obesity.
Changes of biochemical parameters in normal weight and overweight/obese women with polycystic ovary Syndrome
Authors: Narani Mahshad Sheikhi , Vatannejad Akram , Kheirollahi Asma , Teimouri Maryam , Bayat Sara , Jadidzadeh Farah
Published: December 2023

Objectives: Polycystic ovary syndrome (PCOS) is an endocrine disease in reproductiveage women, which interferes with fertility, menstruation, and body composition. Some biochemical parameters change in women with PCOS, a feature which can be a consequence of the disease itself or of the accompanying obesity. This study investigated the glucose and lipid profiles, sex hormones, and hsCRP in normal weight and overweight/ obese Iranian women with and without PCOS.
Methods: 314 women with PCOS and 138 healthy and fertile women were recruited for the study. The patients and controls were divided according to body mass index (BMI) into two groups as follows: BMI<25 Kg/m2 and BMI≥ 25 Kg/m2 . Blood samples were collected from all participants to assess fasting blood glucose, fasting insulin, lipid profile, FSH, LH, free testosterone, and hs-CRP levels. The homeostasis model of insulin resistance (HOMA-IR) was calculated for assessing insulin sensitivity.
Results: BMI, fasting insulin, HOMA-IR, triglyceride, FT, LH, and hs-CRP levels were significantly higher in the PCOS group, while lower levels of FSH were observed in comparison to non-PCOS women. Among overweight PCOS women, hs-CRP levels were significantly elevated compared to normal-weight PCOS women. However, there was no significant difference in circulating hs-CRP levels between normal-weight and overweight participants in the control group.
Conclusion: The study results suggest that both insulin resistance and an increase in hs-CRP may be relevant to PCOS. Moreover, the findings indicated that chronic inflammation in PCOS is not solely dependent on the pathogenesis of the disease but may be exacerbated by increased body weight.
Inflammatory indices IL-6, TNF-α, CRP, and hs-CRP in candidates for coronary artery bypass graft surgery
Authors: Pourghadamyari Hossein , Moghadam Esmaeil sajadi , Eghbali Mohsen , Borji Hossein , Dialamy Masood , Sadeghi Asie
Published: December 2023

Objectives: The elevation of inflammatory factors, such as tumor necrosis factor α (TNF-α) and high-sensitivity C-reactive protein (hs-CRP), is associated with a high risk of coronary artery disease (CAD). The primary objective of the present study was to identify the primary inflammatory factors in patients who were candidates for coronary artery bypass graft (CABG).
Methods: This study included 30 subjects scheduled to undergo CABG surgery, as well as 30 control subjects. Serum levels of hs-CRP, interleukin 6 (IL-6), and TNF-α were analyzed using enzyme-linked immunosorbent assay (ELISA) kits.
Results: There were no significant differences in body mass index (BMI) and age between the patient and control groups. However, the patient group had significantly higher triglyceride (TG) levels compared to the control group (P < 0.05). Additionally, the patient group exhibited significantly elevated levels of inflammatory cytokines IL-6 and TNF-α (P < 0.001 for both), as well as higher circulating levels of CRP and hs-CRP compared to the control group.
Conclusion: The findings of the present study indicated that patients recommended for surgical intervention often have elevated levels of inflammatory factors. It is advisable to take these findings into consideration before proceeding with surgery.