bluuebunny/crossref_metadata_2025 huggingface dataset:
Access to Justice During COVID-19 Challenges and Issues Created by a Virus
Authors: Middha Megha , Paliwal Aseem Chandra
Published: September 2023

Almost all the sectors of the economy around the world were affected due to corona virus. Those confined in prisons were not able to reach out to courts for bail, or those who wanted to file suits found the courts closed due to lockdown. It was then that the courts decided to have hearings virtually. The chapter shall discuss how much these virtual courts have been successful in rendering justice during coronavirus. The chapter shall also try to explore if the process of rendering justice through virtual mode should continue post pandemic era also. The study shall lay emphasis upon how the criminal activities increased during the COVID-19 times and how the courts have been able to render justice in such scenarios. The chapter shall analyze the alternatives one can resort to through online mediation. The plight of migrant laborers who were left to visit their homes by foot were also denied justice. Henceforth, the research shall be based on primary data as well as secondary data available.
Automated Vehicle Number Plate Detection Using Tesseract and Paddleocr
Authors: Parvathi R. , Moloparambil Savio Sajan , Kumar Aswathi M. , Jeyahari R.
Published: September 2023

Automatic number plate recognition (ANPR) is a specialized image processing method that identifies the text on a given vehicle's number plate. The goal is to create a successful automatic approved vehicle identification system that makes use of the license plate. The system may be placed in many scenarios and locations, some of which may include security in prohibited areas like military and testing zones, or the vicinity of important government buildings like the Supreme Court, Parliament, etc. Using image segmentation in an image, the region containing the vehicle number plate from the image of a vehicle is extracted. Character recognition is achieved using an optical character recognition (OCR) approach in order to determine miscellaneous details like the owner of any detected vehicle, the location of registration, the address and whereabouts, etc.
Comparative Study of One Stage V/S Two Stage Surgery for Intra-Articular Distal Tibial Pilon Fracture
Authors: Patil Nitin S. , Patil Paresh
Published: September 2023

Tissue injury, infection, or cardiac infarction may all lead to inflammation. The restoration of normal anatomy to the joint surface and the preservation of mechanical alignment are two of the primary objectives of treatment. Ankle and subtalar range of motion must be protected and improved upon, and correct length and rotation must be maintained. Inflammation can be caused by either infectious or non-infectious triggers. When a tissue is damaged, our bodies send out a series of chemical signals to trigger reactions that promote tissue repair. All of these cues stimulate circulating leukocytes to chemotactically migrate to the site of injury. As a result of being activated, leukocytes release cytokines, which set off other inflammatory processes in the body. Inflammatory disorders can be treated with a wide variety of medications nowadays.
Explainable Deep Reinforcement Learning for Knowledge Graph Reasoning
Authors: Wang Di
Published: September 2023

Artificial intelligence faces a considerable challenge in automated reasoning, particularly in inferring missing data from existing observations. Knowledge graph (KG) reasoning can significantly enhance the performance of context-aware AI systems such as GPT. Deep reinforcement learning (DRL), an influential framework for sequential decision-making, exhibits strength in managing uncertain and dynamic environments. Definitions of state space, action space, and reward function in DRL directly dictate the performances. This chapter provides an overview of the pipeline and advantages of leveraging DRL for knowledge graph reasoning. It delves deep into the challenges of KG reasoning and features of existing studies. This chapter offers a comparative study of widely used state spaces, action spaces, reward functions, and neural networks. Furthermore, it evaluates the pros and cons of DRL-based methodologies and compares the performances of nine benchmark models across six unique datasets and four evaluation metrics.
Plant Species Classification Using Information Measure and Deep Learning for an Actual Environmental Problem
Authors: Dwivedi Pankaj , Sharma Dilip Kumar
Published: September 2023

This chapter's major goal is to examine the issue of real-world recognition to enhance species preservation. As it is a popular topic and a crucial one, the authors focus on identifying plant species. The examples are scanned specimens in traditional plant species identification, and the setting is plain. Real-world species recognition, on the other hand, is more difficult. They begin by looking at realistic species recognition and how it differs from traditional plant species recognition. Interdisciplinary teamwork based on the newest breakthroughs in technology and computer science is provided to cope with the difficult challenge. In this research, they offer a unique framework for deep learning as well as an effective data augmentation strategy. They crop the image before everyone is aware in terms of visual attention. Furthermore, they use it as a data augmentation technique. Attention cropping (AC) is the name given to a revolutionary data augmentation technique. To predict species from a significant quantity of information, fully convolutional neural networks (CNN) are constructed.
On Algorithms Required to Be Used in Military Command and Control Processes
Authors: Şengöz Murat
Published: September 2023

The military command and control process refers to a process of the methods and principles to be followed in order to fulfill military missions or achieve an objective. The main components of this process are the information that has been analyzed and gathered concerning the description, classification, and evaluation of parameters and variables related to the enemy, air and land, in proportion to the available resources. This study examines the algorithms needed for strategic, operative, and tactical-level units, and the usability of algorithms produced by artificial intelligence-supported techniques such as machine learning and deep learning in military command and control processes in a way to adapt to the modern warfare environment, which requires speed, tempo, and flexibility. So, in this study, an explanation was made about the nature of the algorithms required for military command and control and preparation of the operational environment as a component, and suggestions were made for subsequent research.
Antibiotics in the Ghanaian Environment
Authors: Darmey James , Azanu David , Amoatey Nene Kwabla , Adu Abena Owusuaa , Dia Nasser
Published: September 2023

The use of antibiotics is widespread throughout the world, and Ghana is not an exception. They are one of the most frequently prescribed medications. Antibiotic residue concentrations are rising in the environment and are found in practically all water bodies, including lakes and rivers, because of inadequate management of residential and medical wastes. Contrarily, there is a substantial chance of medication toxicity and resistance. Therefore, removal of these pollutants from water bodies is essential, yet conventional wastewater or water treatment methods frequently fall short of efficiently removing these chemicals. Antibiotics will be used as a case study in this chapter to discuss the concentration of pharmaceutical pollutants in the environment, specifically in Ghanaian waterbodies, and risk evaluations of these pollutants. Additionally, this chapter will look into the possible removal technologies report and establish the present investigation on removing these pollutants with microplastics.
Assessment of Fresh/Dried Makuea Poo-Ung Consumption and Its Benefit on Recommended Daily Allowance
Authors: Fraikue Frances Betty
Published: September 2023

Makuea poo-ung is a seasonal crop which grows abundantly during the rainy periods. The purpose of the chapter was to assess the relation between 50µg/g/ml of nutrients present in fresh/dried makuea poo-ung compared to RDA of children, teenagers, and adults. Laboratory analysis was undertaken to assess nutrients in fresh/dried makuea poo-ung, by the use of proximate analysis, mineral analysis, atomic absorption spectrometer, and liquid chromatography-mass spectrometry. Techniques used to analyse data were SPSS, Independent T. Test, and test for hypothesis. Twenty nutrients were present in fresh/dried makuea poo-ung. Comparing with RDA, it affirmed that a consumption of at least 50 µg/g of makuea poo-ung each day could provide humankind with 12-50% of the dietary allowance needed then serve as a natural food supplement. Assessment of nutrient in makuea poo-ung provided unique results. Hence, commended that consumers patronize makuea poo-ung as natural food supplement.
Corpus-Assisted Multidimensional AI Applications in Language Teaching and an Intelligent Virtual Speaker
Authors: Özbay Ali Şükrü , Hoşoğlu Ayşenur , Uzuner Buse , Öztürk Ercüment
Published: September 2023

The authors propose an evidence-based virtual AI application geared to using a successful implementation of AI for language learners and language teaching professionals and a virtual speaking tool that will serve as a foundation for further research and experimentation. The study promotes interdisciplinary collaboration among corpus linguists, language educators, and computer engineers for fostering the skills and the competences and the exchange of ideas and a shared vision for the future of AI-assisted language learning. The main objective of this action plan is to propose an application in which language teaching professionals and language learners will engage in English-speaking practice through a multidimensional (MD) environment incorporating cubic images and bilateral sound perception (hearing and speaking). The AI application will assign tasks to multidimensional characters using realistic sound effects to create a highly immersive and interactive environment for language teaching professionals.
Innovative Language Learning Approaches
Authors: Chamboko-Mpotaringa Mavis , Manditereza Blandina
Published: September 2023

The advancement of technology over the past two decades has provided various tools and platforms that facilitate and optimize the language-teaching-learning process using diverse teaching methods that help learners to acquire and understand new knowledge interactively. Despite extensive research highlighting the intersection between education and artificial intelligence technologies, many language teachers are unaware of innovative learning approaches at their disposal. As a result, the potential to transform classroom learning is yet to be realized. The chapter aims to close this gap by providing an overview of the transformation of language teaching experiences in the artificial intelligence age and exploring the opportunities and challenges associated with immersive and gamification technologies. The chapter argues that incorporating innovative technologies in teaching significantly contributes to language learning experiences. The chapter provides insight, more understanding and adds to the body of literature of the study area.
Dynamic Intelligence-Driven Engineering Flooding Attack Prediction Using Ensemble Learning
Authors: Angeline R. , Aarthi S. , Regin R. , Rajest S. Suman
Published: September 2023

The rapid evolution of the Internet and communication technologies has fueled the proliferation of wireless sensor network (WSN) technology, which is increasingly important in today's interconnected world. For a broad variety of industries and applications, an enormous number of sensing devices continuously create and/or gather copious amounts of sensory data. However, it has been shown that WSN is susceptible to security flaws. These networks' abrasive and unmanaged deployment, along with their limited resources and the amount of data produced, raise serious security issues. The development of trustworthy solutions that include quick and continuous processes for live data stream analysis allowing the identification of flooding assaults is crucial since WSN applications are of the utmost importance. To put it in plain words: The assault is carried out by repeatedly sending pointless requests to the target computer in an effort to overwhelm it, cause the systems to fail, and prevent people from accessing the network or machine.
Serum Procalcitonin, Ischemia Modified Albumin Biomarkers in Tertiary Hospital Sepsis Patients
Authors: Sontakke A. V. , Patil S. R.
Published: September 2023

Sepsis is described as a medical emergency situation due to the body's systemic immunological response to an infection that can lead to end-stage organ dysfunction and even death. Sepsis is one of the major causes of morbidity and mortality in critically morbid patients; however, there is a significant advancement in the understanding of the pathophysiology of this clinical syndrome, hemodynamic monitoring tools, and resuscitation measures. Due to the body's systemic immune reaction to an infection, which may result in end-stage organ malfunction and even death, sepsis is referred to as a medical emergency. It is one of the top ten leading causes of death globally. The epidemiological burden of sepsis is difficult to ascertain globally. Despite tremendous progress in the understanding of the pathogenesis of this clinical illness, hemodynamic monitoring systems, and resuscitation techniques, sepsis continues to be one of the leading causes of morbidity and mortality in critically ill patients.
Image Processing Method of a Visual Communication System Based on Convolutional Neural Network
Authors: Sun Liang , Wang Pengsheng , Liu Paiying , Nie Zhengang
Published: September 2023

Unmanned motion platforms are being used in a wide range of industries. Unmanned motion platforms must have an autonomous and intelligent navigation procedure in order to carry out their system functions. Traditional inertial navigation and radio navigation have poor accuracy and autonomy when not dependent on satellite circumstances. The accuracy of image recognition algorithms must meet strict standards. This study and exploration of the high-precision scene image recognition system is based on convolutional neural network structure optimization. To demonstrate the viability of the approach, simulation experiments are carried out on the NUC dataset using the recognition technique based on a convolutional neural network that is proposed. The fundamental network architecture of a convolutional neural network is optimized using the L2 regularization technique. The experimental findings demonstrate that the NUC dataset now has better recognition accuracy. In terms of recognition accuracy, the suggested method satisfies the predetermined requirements.
Testicular schistosomiasis: a clinico-pathological presentation of three pediatric cases and review of literature
Authors: Ukekwe Francis I. , Ezomike Uche O. , Olusina Daniel B.
Published: September 2023

Schistosomiasis is an important communicable disease in developing countries and an important cause of morbidity in the tropics and subtropics. It is a very rare cause of painless testicular swelling that tend to mimic malignancy and cause a diagnostic dilemma. Though histopathologic analysis confirms diagnosis, a high index of suspicion is required especially for patients presenting from endemic areas. We aim to present the clinicopathological features of three pediatric cases of Testicular Schistosomiasis (TS) and to highlight the role of high index of suspicion, incisional biopsy and histopathologic diagnosis in prevention of unwarranted orchiectomy and preservation of testicular function. We report three cases of TS in patients aged 5 years, 12 years and 14 years, who presented with progressive testicular swellings. The diagnoses were made by histopathological analysis and the patients were treated with oral praziquantel. TS should always be considered an important differential in all male children and adults presenting with testicular masses especially when they live in endemic regions. Incisional biopsy, proper histopathologic evaluation and treatment could prevent unwarranted orchiectomy and thus preserve testicular function.
Natural language processing of online support group postings reveals patient perspectives on strategies for managing psoriasis
Authors: Rajalingam Karan , Johansen Phillip , Levin Nicole , Qi Jerry , Marques Oge
Published: September 2023

Psoriasis is a chronic skin disorder, and patients encounter high physical and psychosocial burdens. Social media forums feature extensive patient-generated comments. We hypothesized that analyzing patient-posted comments using natural language processing would provide insights into patient engagements, sentiments, concerns, and support, which are vital for the holistic management of psoriasis. We collected 32,000 active user comments posted on Reddit-forum. We applied Latent Dirichlet Allocation to categorize posts into popular topics and employed spectral clustering to establish cohesive themes and word representation frequency within these topics. We sorted posts into 29 significant topics of discussion and categorized them into four categories: management (37.48%), emotion (21.57%), presentation (19.79%), and others (3.57%). The frequent posts on management were diet (7.23%), biologics (6.95%), and adverse-effects (3.88%). Emotion category comprised negative sentiments (11.02%), encouragement (5.49%), and gratitude (5.06%). Presentation topic included a discussion of scalp (5.69%), flare-timing (3.63%), and arthritis (2.64%). Others comprised differential-diagnosis (5.01%), leaky gut (4.12%), and referrals (3.70%). This study identified patients’ experiences and perspectives associated with psoriasis, which should be considered to tailor support systems to improve their quality of life.
Characteristics and Correlation Analysis of Negative Emotions, Quality of Life, and Chinese Medicine Syndromes in Patients with Lung Cancer after Surgery
Authors: Zhang Cong-Meng , Gu Yi-Feng , Shen Sheng-Ping , Wang Yi-Chao , Qi Ao , Su Ling-Zi , Yao Jia-Lin , Li Jia-Qi , Yang Wen-Xiao , Wang Qin , Jiao Li-Jing , Qin Xiong , Gong Ya-Bin , Xu Ling
Published: September 2023

Objective:

The objective of the study was to observe and analyze the characteristics of negative emotions and quality of life (QoL) in patients with nonsmall cell lung cancer (NSCLC) from 1 to 3 months after surgery, and summarize their population characteristics after surgery.

Materials and Methods:

The consolidation rehabilitation period was defined as 1 to 3 months after surgery. The main observation indicators were the general Hospital Anxiety and Depression Scale, the European Organization for the Research and Treatment of Cancer Core QoL Questionnaire (EORTC QLQ-C30), and EORTC QLQ-Lung Cancer-13. The secondary observation indicators were peripheral blood cytokines and immune function indicators. Statistical methods such as one-way analysis of variance and logistic regression were used to analyze the characteristics of this part of the population.

Results:

Among patients who underwent lung surgery, the overall incidence of anxiety during consolidation recovery was 13.66%, and that of depression was 10.38%. The scores of fatigue, pain, dyspnea, insomnia, and loss of appetite were significantly higher than those of other symptoms (P = 0.000). The presence of anxiety was associated with the site of surgery (P < 0.05) and the presence of depression was associated with emotional functioning and dyspnea (P < 0.05).

Conclusions:

The occurrence of negative emotions in the postoperative NSCLC population is related to gender, and the degree of emotions is negatively correlated with QoL and positively correlated with the degree of symptoms. The main relevant syndromes are the pulmonary and meridian categories.
Do Mean Platelet Volume and Platelet Distribution Width Have An Association with White Matter Hyperintensities in Migraine Patients?
Authors: Iyigundogdu Ilkin , Derle Eda
Published: September 2023

Objective:

Increased prevalence of white matter hyperintensities (WMH) is reported in migraine patients; however, the pathophysiology and the progression of these lesions are not definitely clear. Mean platelet volume (MPV) and platelet distribution width (PDW) are easily obtained markers for platelet activity. The aim of this study is to evaluate the relationship between the presence of WMH and MPV and PDW in patients with migraine in order to determine the role of platelet activity in the pathophysiology of WMH.

Methods:

Patients who were admitted to the neurology outpatient clinics of Baskent University Hospital from January 2011 to December 2015 with migraine and between 18 and 55 years of age were evaluated retrospectively. The blood samples were taken and total blood count parameters including MPV and PDW were analyzed. Brain magnetic resonance images were evaluated.

Results:

Totally, 218 patients were evaluated in this study. Forty-eight (22.0%) patients had WMH in the brain magnetic resonance imaging. In patients with WMH, the median of age was higher than the patients without WMH and the difference was statistically significant (P < 0.05). There was no statistically significant difference between MPV, PDW values, and the presence of WMH.

Conclusions:

There are multiple theories suggested for the mechanism of WMH, but the major cause and pathophysiology are still undetermined. Our data suggested that increased platelet activity is insufficient by itself to explain the pathophysiology of WMH in migraine patients and to improve the knowledge on this issue further large longitudinal studies should be performed.
Association of Neutrophil-to-lymphocyte Ratio with Prognosis in Sepsis – An Observational Study from a Tertiary Care Center
Authors: Thakran Birjesh Kumar , Chahar Yogesh Kumar , Jain Shikha , Jain Sundeep
Published: September 2023

Objectives:

This study aims to determine the association of neutrophil-lymphocyte ratio (NLR) with sequential organ failure assessment (SOFA) score, ventilator use, duration of intensive care unit (ICU) stay, and mortality among patients with sepsis.

Methods:

This prospective observational study included 220 patients with sepsis admitted to the ICU. Details such as age, gender, comorbidities, complaints, SOFA score, diagnosis, and outcomes were collected. Routine investigations included complete blood count, C-reactive protein, and procalcitonin. NLR was derived using the Beckman Coulter DXH-800 Hematology Analyser. A cutoff of 9.11 was taken as high NLR. Patients were followed up till 28 days after treatment. The outcomes studied included 28-day mortality and ICU stay.

Results:

The mean SOFA score were 7.07 ± 2.56. Based on NLR cutoffs, 146 (66.36%) patients had high NLR while 74 (33.64%) cases had normal or low NLR. SOFA score showed no significant association with high NLR (P = 0.62). Ventilator was used in 118 (53.6%) cases with median of 3.5 days’ duration. The overall ICU stay was 5.6 ± 4.9 days. Mortality was seen in 46 (20.9%) cases. Compared to those with normal NLR, patients with high NLR had significantly more ventilator use (60.9% vs. 39.1%, P = 0.0027) and mortality (30.14% vs. 2.7%, P = 0.0004). The duration of ventilator use and ICU stay was statistically comparable.

Conclusion:

High NLR shows a significant association with adverse outcomes of sepsis patients in terms of ventilator use and mortality. Since it is cheap and easy to use, it can be applied in more basic settings while monitoring sepsis patients.
Estimation of Risk and Proportion of Coronary Artery Disease in People Living with HIV/AIDS in Indian Setting: A Pilot Study
Authors: Sharma Anmol , Sagar Amitabh , Singh Navreet
Published: September 2023

Objective:

The objective of this study was to assess the Framingham Risk Score as well as the prevalence of coronary artery disease (CAD) in people living with HIV/AIDS (PLHA) male patients, in an Indian setting.

Design:

This descriptive pilot study was conducted in a multispecialty hospital which is a reference center for HIV/AIDS.

Materials and Methods:

The study included 50 HIV-positive male patients who underwent basic biochemical analysis, namely lipid profile, blood sugar (fasting), electrocardiogram, CD4 count along with basic personal history (including smoking habits and lifestyle), course of disease progression, and drug history. All were subjected to a two-dimensional echocardiogram and treadmill test (TMT). Subjects with a positive TMT underwent a confirmatory stress thallium/coronary angiography. Framingham Risk Scores were calculated, using standard scoring charts. Standard protocol forms were made for each patient.

Results:

The median diagnosed duration of HIV disease was 2.8 years (range: 0.5–7 years). The median 10-year risk of CAD (as calculated from the Framingham scores) was 1%. Major contributing risk factors were dyslipidemia, diabetes, and hypertension and were found to be greater as compared to published literature. Four patients had positive TMT, but all four had a negative, coronary angiogram.

Conclusions:

Biological plausibility suggests that CAD may be more common in PLHA due to the chronic inflammatory nature of the disease and the effects of the dyslipidemia effect of ART; however, our pilot study with the limitations could not substantiate this.
Primary Arthroscopic Bicruciate Repair in Multiligamentous Knee Injury with Ipsilateral Long Bone Fracture
Authors: Singhi Prahalad Kumar , Elangovan Ajay Gowtham Amutham , Raju Sivakumar
Published: September 2023

Long bone fractures and multiligamentous knee injury (MLKI) have a firm relationship. Primary arthroscopic bicruciate repair along with long bone fixation has not been reported hitherto. Here, we report two cases of long bone fracture with MLKI treated with long bone fixation and primary arthroscopic bicruciate repair with open lateral collateral ligament repair for one patient. Both patients had good clinical outcomes at 1-year follow-up. With the present-day advancements in the field of arthroscopy, there is a place for primary arthroscopic ligament repair in specific tears along with long bone fixation.
Transphyseal Anterior Cruciate Ligament Reconstruction in Adolescent Athletes Provides Good Functional Outcomes
Authors: Gupta Ravi , Kapoor Anil , Masih Gladson David , Vashisht Deepam , Mehat Rohil
Published: September 2023

Background:

In adolescent athletes, the treatment of anterior cruciate ligament (ACL) tear is still a topic of debate. The present study aimed to evaluate the functional outcomes and complications of transphyseal ACL reconstruction (ACLR) in adolescent athletes.

Materials and Methods:

Thirty-four athletes who underwent transphyseal ACLR using a hamstring tendon graft participated in this study. Functional outcomes (Lysholm and Tegner activity score) and potential complications (graft rupture, angular deformity [AD], or limb length discrepancy) after transphyseal ACLR were assessed at the final follow-up.

Results:

The average age at the time of the surgery was 13.1 ± 0.8 years. Lysholm and Tegner activity score was 96.5 ± 5 and 8.1 ± 1.4, respectively, at a mean follow-up of 64.9 ± 23.9 months. 27/34 (79%) of patients returned to the same level of sports. The mean time to return to sports was 8.3 ± 1.5 months. Three patients had graft tears, and none of the patients had any deformity.

Conclusion:

Transphyseal ACLR is a safe procedure with good functional outcomes.

Level of Study:

Level III.
Settings and Indications of Ultrasound in Imaging of Shoulder, Foot, and Ankle
Authors: Narang Yajur , Clemente Gabriele , Aniq Hifz , Campbell Rob , Mistry Alpesh
Published: September 2023

Ultrasonography is a well-established musculoskeletal imaging technique with a multitude of advantages when compared to other modalities. It provides great spatial resolution in the evaluation of superficial articular and peri-articular structures including tendons, ligaments, bursae, and nerves. Given that it is the only modality which allows dynamic assessment, it also plays a crucial role in diagnosing impingement, subluxation/dislocation, and instability. The purpose of this article is to review the settings and indications of US in the imaging of shoulder, foot, and ankle in particular. Relevant literature, predominantly in the form of peer-reviewed journal articles was obtained from the electronic databases such as PubMed and MEDLINE and reviewed in a structured manner. This was combined with background knowledge and expertise in this field.
CT Based Measurement of Coracoid Process Dimension and a Technique to Measure in our Population
Authors: Arun GR , Babhulkar Ashish Suresh , Unnithan Vishnu , Srinivasan Namratha , Sindhu B , Sunil Kumar PC
Published: September 2023

Aim:

The aim of this study was to do computed tomography (CT)-based measurement of coracoid process dimension and a technique to measure in our population.

Materials and Methods:

One hundred and twenty-three shoulder CT scans were analyzed in the adult Indian population. The images were processed using curviplanar reconstruction method to straighten out the curved coracoid process. The mean dimensions of coracoid process in relation to anteroposterior length, mediolateral distance, and supero-inferior distance were measured and tabulated along with age and gender differences. Paired t-test or Wilcoxon signed-rank test was used as a test of significance, and P < 0.05 was considered statistically significant.

Results:

In the study, the mean anteroposterior length was 25.80 ± 3.09 mm, the mean mediolateral length was 12.02 ± 1.82 mm, and the mean supero-inferior length was 10.27 ± 1.64 mm. No statistically significant difference was seen between the two observers, giving power to the method used.

Conclusion:

In this CT-based analysis of coracoid process, we can estimate the average dimension of coracoid process available in our population and also the preference of surgical procedure according to the glenoid bone loss. Furthermore, it was concluded that CT-based measurements of coracoid process were well correlated between the orthopedician and the radiologist. Hence, these measurements can be used as a tool to estimate the average length available for transfer in the Latarjet procedure in our population.
Complications of the Open Latarjet Procedure are not Related to the Learning Curve: Analysis after 11 Years of Experience
Authors: Zúñiga Daniela Gutiérrez , Ordóñez Camila , Valbuena Felipe José , Largacha Mauricio
Published: September 2023

Introduction:

The purpose of this study is to determine a relationship between complications of the open Latarjet procedure with the surgeon’s learning curve during an 11-year experience in shoulder surgery.

Methods:

We conducted a retrospective descriptive observational case series of all open Latarjet procedures performed by a single shoulder surgeon between June 2011 and September 2021. Latarjet procedure was indicated in patients with glenoid bone defects of more than 15% or revision after a failed Bankart repair. Complications were recorded as well as patients’ demographic data. We described the time between surgery and complication and correlated complication presentation with the surgeon’s surgical curve.

Results:

Sixty-two consecutive patients were included (96, 8% male patients with an average age of 30 years). Eight patients presented with a complication (12, 5% of all patients). These complications were classified as graft related (n = 3), hardware related (n = 3), wound related (n = 1), and other (n = 1). There were no instability recurrences and no neurologic injuries. Complications were present in all periods of the surgeon’s learning curve.

Conclusions:

The Latarjet procedure is technically demanding and complications can be present regardless of the surgeon’s learning curve. Nevertheless, it is a successful procedure in most patients, with a low recurrence rate of instability.
Total Elbow Arthroplasty: An Update on Surgical Techniques and Approaches
Authors: Skipper Zachary Tyler , Rajagopalan Senthilvelan , Kambhampati Srinivas B. S. , Manne Bhavya Chand , Kamineni Srinath
Published: September 2023

Total elbow arthroplasty (TEA) has significantly evolved over the last few decades and is used to treat advanced elbow arthritis (rheumatoid, primary, and posttraumatic), trauma sequelae, and acute unreconstructable fractures. TEA design varies between linked, unlinked, and convertible types. Long-term complications including infection, aseptic loosening, instability, and periprosthetic fractures continue to be significant. The current evidence for TEA is summarized in this article, which includes surgical approaches, designs of elbow replacements, outcomes, and surgical tips based on the previous literature.
Three-dimensional Versus Two-dimensional Strain for the Assessment of Myocardial Function: A Case Series
Authors: Dillikar Monica Vinesh , Venkateshvaran Ashwin , Barooah Banajit , Varyani Reeta , Kini Prayaag , Dash P. K. , Sola Srikanth
Published: September 2023

Introduction:

Two-dimensional (2D) strain assessment is an important diagnostic and prognostic tool in various clinical conditions, particularly coronary artery disease (CAD). However, these measurements are limited in that the information is obtained in only a single plane (2D). Three-dimensional (3D) strain tracks the myocardium in all 3D, potentially overcoming the limitation of 2D strain. The objective of this study was to establish normal values for 3D strain in a population of healthy, normal controls and to compare these values with 2D strain values. In addition, we sought to evaluate the utility of 3D strain in patients with known or suspected CAD.

Methods:

We conducted a prospective study at a single major tertiary care center. Individuals were recruited for the study and divided into two groups: a normal control group and a CAD group. Global longitudinal strain (GLS) and global circumferential and global radial strain were calculated by both 2D and 3D strain methods. In addition, 3D was used to calculate area strain.

Results:

We enrolled a total of 43 individuals (20 normal control group, mean age 33 ± 2.7 years, and 23 CAD group, mean age 57 ± 2.8 years, 80% male). Values for 3D strain were consistently lower for GLS and global circumferential strain in both groups compared with 2D measurements. In the control group, the mean 2D GLS was −20 ± 1.6% versus −17.5 ± 1.5% for 3D GLS (P < 0.001). Similarly, the mean 2D circumferential strain was −17.7 ± 2.3% versus −15.6 ± 2.1% for 3D circumferential strain (P < 0.001). Combining both groups, the sensitivity of GLS for CAD was 80% for 2D versus 93% for 3D. Similar findings were seen for global circumferential strain (sensitivity 87% for 2D vs. 100% for 3D). However, the sensitivity of 3D global radial strain was lower (93% for 2D vs. 47% for 3D). 3D strain data were acquired in a shorter time span compared with 2D (2.2 ± 1 min vs. 3 ± 1 min).

Conclusions:

3D strain assessment of longitudinal and circumferential strain is similar but mildly reduced compared with 2D techniques, with similar sensitivity for CAD. Radial strain measurements by 3D, however, are not accurate and correlate poorly with 2D.
Fetal Echocardiography: A Systematic Approach
Authors: Karande Atul , Nagar Shweta
Published: September 2023

Congenital heart disease (CHD) is the most common birth defect worldwide. The optimal timing for performance of a comprehensive transabdominal fetal echocardiogram is 18–22 weeks gestation. All radiologists should perform screening of the heart during all obstetrical ultrasound studies beyond 18 weeks of gestation. Detailed fetal echocardiography can be performed only with the help of a technically well-quipped ultrasound machine. Skilled expertise and appropriate knowledge are required to perform detailed fetal echocardiography. Despite of limitations, fetal echocardiography can identify most of the CHDs which have major pre- and post-natal implications. This is necessary to delineate the high-risk group of fetuses who are suffering from complex cardiac defects and would require tertiary hospital setup for delivery. This further aids in appropriate postnatal medical as well as surgical management, antenatal parent counseling, and explaining risk factors as well as postnatal outcome.
Carcinoid Heart Disease: A Pictorial Report
Authors: Kumar Amit , Bansal Bharat , Kumar Raj , Mehrotra Rahul
Published: September 2023

Carcinoid tumors are rare, mostly seen in gastrointestinal tract and bronchus. Carcinoid heart disease occurs in up to half of these patients with characteristic involvement of right-sided valves.
Morphology of Right Heart Thrombi in Pulmonary Embolism: A Case Series and Analysis
Authors: Kajamohideen Nisamudeen , Swaminathan N , Palanisamy G , Gnanavelu G , Sangareddi Venkatesan
Published: September 2023

Introduction:

The occurrence of right heart thrombus (RiHT) in pulmonary embolism (PE) carries poor prognosis. Type A Thrombi are serpiginous, highly mobile with high mortality. Type B Thrombi are less mobile and have better prognosis. Type C is intermediate in all characteristics.

Methods:

This is an observational study done in patients presenting with RiHT with PE to the emergency unit of our institute from March to August 2016. A total of seven patient's clinical and electrocardiographic data were collected with a history of deep vein thrombosis or hypercoagulability.

Results:

This case series of seven patients with right heart thrombi in pulmonary embolism showed a predominance of male patients, with right ventricle dysfunction and pulmonary hypertension in all cases.

Conclusion:

Early fibrinolysis in type A thrombus had a favourable outcome. Mortality was 29% in our series.
A Journey from Adult to Fetal Echocardiography
Authors: Singh U P , Singh Hargunbir , Kaur Ladbans
Published: September 2023

As a cardiologist in a group practice or hospital settings, many a times you are requested to comment on fetal Echocardiography performed by radiologist or fetal medicine specialist. With overconfidence, we perform or comment on fetal echocardiography without knowing critical differences between adult and fetal echocardiography. First, fetal heart at 20 weeks of gestation is of the size of an almond. Due to the limitation of resolution of ultrasound machines, small size of fetal heart makes it difficult to visualize many direct signs of congenital heart defects such as total anomalous pulmonary venous connection (TAPVC), transposition of the great arteries (TGA), coarctation, and double outlet right ventricle (RV). Hence, in fetal echo, we use indirect signs and clues to diagnose these disorders. Second, there are two physiological shunts in fetal circulation; fossa ovalis and ductus arteriosus which make its very different from adult circulation. A cardiologist needs to know about indirect signs, special views, peculiar fetal cardiac defects, and hemodynamics of fetal circulation before attempting fetal echocardiography. Many of us have an impression that fetal heart is just a miniature form of adult heart. Fetal echocardiography is a lot different from adult or pediatric echocardiography because there are many structural and functional differences in fetal circulation. Moreover, many congenital heart defects such as TGA, TAPVC, and ventricular septal defect, can present with only subtle findings, so we need to be more vigilant while performing fetal echocardiography.
Novel Demographic Capture Employing Electronic and Social Media: Preliminary Report from the National Cardiac Sonographer Survey
Authors: Kumar K. Praveen , Rambothu Raju , Shah Rupali , Thakur Aparna Sacchit , Nandakumar Sandya , Kumarvel P. S. , Meesala Vidyasagar Reddy , Umashankar Aswini , Gunasekar Prashanth , Venkateshvaran Ashwin
Published: September 2023

Background:

While cardiac sonography is recognized as a skilled allied health profession in the developed world, sonographers are relatively unorganized in India. This survey aimed to capture basic demographic data of this organically growing community employing electronic and social media platforms.

Materials and Methods:

A predominantly multiple-choice-based questionnaire was created using a free, open-access survey platform and circulated on available sonographer social media forums, messenger groups, and E-mail lists. Information distribution, data collection, and response analysis were entirely paperless.

Results:

Between July 2017 and April 2018, 290 sonographers from 19 states participated in this survey. Forty-six allied health courses offering echocardiography were identified across India. A majority of respondents and identified courses were based in the South and West India. About 62% of the sonographers were women, and approximately 60% were <30 years old. Multiple training pathways were displayed, and >30% held university-level degrees in echocardiography. More than 50% were early to mid-career sonographers and scanned more than 20 patients a day. All sonographer scanned under authorized supervision. A minority were credentialed after training. Less than 1 in 3 were members of the National Indian Academy of Echocardiography.

Conclusions:

Preliminary analysis in this ongoing survey suggests that the Indian sonographer community is young, predominantly female, and generally work in hospital-based clinical environments. Sonographer credentialing, enhanced society engagement and continuous medical education may support career development and contribute to the society's goals to promote echocardiography practice and education in India.
Evaluation of Right Ventricle
Authors: Banerjee Sulagna , Kumar Soumitra
Published: September 2023

Right Ventricle (RV) has been treated as the neglected cardiac chamber for a long time. Advent of cardiac MRI and advancements in echocardiography have facilitated the understanding of RV structure and function and elucidated its role in management and prognosis of various cardiac ailments. Further refinement of three-dimensional (3D) and strain imaging and their application to study of right ventricular structural and functional abnormalities will be helpful in early identification of cardiac pathologies and their timely intervention.
Transthoracic Three-Dimensional Echocardiography of Tricuspid Valve
Authors: Mehrotra Rahul , Kumar Raj
Published: September 2023

Imaging of the tricuspid valve (TV) by three-dimensional echocardiography (3DE) has not received much attention. 3DE allows users to visualize the whole TV apparatus from any perspective and enables a comprehensive evaluation of the leaflets. This review summarizes the current status of real time 3DE evaluation of TV morphology and function with its potential implications for TV disease assessment, as well as its clinical applications and limitations.
Journey from Two-Dimensional to Four-Dimensional Strain and Left Ventricle Torsion in the Evaluation of Coronary Artery Disease
Authors: Amuthan V. , Ananthcal R. V. A.
Published: September 2023

The use of echocardiography in the diagnosis of suspected myocardial infarction has been classified as appropriate. The use of regional strain which is a dimensionless measurement of deformation, expressed as a fractional or percentage change from an object's original dimension, greatly enhances the accuracy of detecting the regional wall motion abnormality in a scale (-20 to +20) ten times that of eye balling. Speckle-tracking echocardiography (STE) is a novel technique which has emerged as one of the best methods that analyses motion and strain by tracking natural acoustic reflections and interference patterns within an ultrasonic window. In patients with acute myocardial infarctions (MIs), accuracy for the prediction of global functional improvement as well as LV remodelling by 2D STE is comparable with that of late gadolinium enhancement cardiac magnetic resonance (CMR) imaging. Global longitudinal strain (GLS) has evolved as one of the most robust parameter, and this has been shown to identify subclinical LV dysfunction.3D STE has emerged as an alternative non -invasive technique to assess LV rotation. In anterior wall myocardial infarction, systolic twist is decreased, and diastolic untwisting is depressed in accordance with LV systolic dysfunction. These results suggest the significant impact of global LV systolic function on LV twist and twist-displacement loops in patients with anterior wall MI. Although to date, no prognostic information exists on the role of rotational parameters of LV function, further ongoing studies would shed more light on this important technique.
Echocardiographic Assessment of Diastolic Function
Authors: De Aniruddha
Published: September 2023

The stepwise approach in evaluation of left ventricular (LV) diastolic function is essential in any patients with dyspnea on exertion or heart failure. Many of them have normal to near-normal ejection fractions (EFs). These subsets of patients are labeled as diastolic heart failure or heart failure with preserved EF. It is important to differentiate diastolic dysfunction from dyspnea of pulmonary origin for further management and future prognosis. LV filling pressures is usually synonymous with pulmonary capillary wedge pressure (PCWP), mean left atrial pressure (LAP), mean LV diastolic pressure, and LV end-diastolic pressure (LVEDP). PCWP on the other hand is also an indirect estimate of LV diastolic pressures. LVEDP is often elevated in early diastolic dysfunction because of a large atrial pressure wave, while mean PCWP and LAP remain normal. While mean PCWP and LAP increased during tachycardia and where there is increased LV afterload which is the basis for the diastolic stress test. It is essential that certain Doppler variables correlate well with an increase in LVEDP only and not reflecting the increase in either LAP or LVEDP. Therefore, early evaluation of LV filling pressures and LVEDP are more important than mean LA pressure which is elevated later. Echocardiography is the best evaluation tool to evaluate LV diastolic function. The purpose of this article is to provide the simplest stepwise approach of different diastolic parameters which are used as routine protocol with minimal use of the newer modalities at various clinical settings.
Nutritional Status and Risk of Sarcopenia among Hospitalized Older Adults Residing in a Rural Region in Turkey
Authors: Alatas Hacer , Serin Yeliz , Arslan Nurgül
Published: September 2023

Background: This study aimed to determine the prevalence of sarcopenia and its associated factors in community-dwelling older adults at risk of malnutrition based on the Mini Nutritional Assessment (MNA), Prognostic Nutritional Index (PNI), and Geriatric Nutritional Risk Index (GNRI).Methods: The study participants were 345 adults aged >65 years who visited Geriatric Internal Medicine outpatient clinics. The study included people without acute illness for whom the risk of malnutrition could be assessed and appropriate measurements taken. At the baseline visit, participants’ data and measurements were gathered. The primary data included sociodemographic details, anthropometric measurements, malnutrition screening tests, and functional assessments. Results: The participants’ mean age was 76.21±5.59 years, and 57.1% were men (n=97). The prevalence rate of sarcopenia was 45.5%. Compared to individuals without sarcopenia, those with it were older; had lower MNA, PNI, and GNRI scores; and had lower muscle mass, muscle strength, and lower leg circumferences (p<0.001). After adjusting for potential confounding factors, we found that sarcopenia, advanced age, male sex, high risk of malnutrition, calf circumference, and a low PNI score were all significantly associated with a low GNRI score (p<0.001).Conclusion: Sarcopenia was significantly associated with advanced age, male sex, and high risk of malnutrition. Patients’ nutritional and functional status should always be assessed for therapeutic interventions and lifestyle changes.