bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract No.: ABS3339: Effects of volume controlled and pressure controlled volume guaranteed modes of ventilation on respiratory dynamics during laparoscopic surgery in children: A prospective observational study
Authors: Vasudevan Vani
Published: September 2024

Background & Aims:

The aim of the study was to compare the effects of Volume controlled ventilation (VCV) and Pressure controlled volume guaranteed ventilation (PCV-VG), which delivers the target tidal volume at the lowest possible pressure, on respiratory dynamics during paediatric laparoscopic surgery.

Methods:

In this prospective observational study, 52 patients of 0-15 years were included; (n= 26) each for VCV and PCV-VG.fraction of inspired oxygen(FiO2)50%, tidal volume 6-10 ml/kg, age appropriate respiratory rate (RR) to maintain end-tidal carbon dioxide (EtCO2) between 35-40 mm Hg, PEEP 4 cm and P-limit 10 cm above the initial peak pressure were set. Peak inspiratory pressure (PIP), Plateau pressure (PlatP), expiredtidal volume (VTe)/kg, compliance (Compl), airway resistance (R), ETCO2 and saturation of O2 (SaO2)were noted after intubation, creation of pneumoperitoneum, changing position, desufflation and change of position to supine.

Results:

Demographic criteria, haemodynamic parameters, set and measured respiratory parameters at all time points were similar inboth groups. Trendelenburg position was required in 11 children in VCV and 13 in PCV-VG group. Following this, there was similar increase in PIP, PlatP, R and decrease in CompL in both groups. However, significant increase in RR was required inVCV group (percentage change in RR- â€”VCV: 3.5Â±5.01, PCV-VG : 0Â±00, p=0.039) to maintain normal ETCO2.

Conclusion:

Either VCV or PCV-VG mode of ventilation, can be used during paediatric laparoscopic surgery in supine position.However, with Trendelenburg position, PCV-VG provides a marginal advantage over VCV mode of ventilation.
Abstract No.: ABS3643: Observation and documentation of minimal cervical spine movement during intubation with The Anesthetist Society (TAS) video laryngoscope
Authors: Dave Mangal
Published: September 2024

Background and Aims:

The hyperangulated shape of TAScope (The Anaesthetist Society scope) (Figure 1) videolaryngoscope enabled endotracheal intubation with minimal neck movements. To record and document the neck movements with fluoroscopy, the cervical spine movement during endotracheal intubation using TAScope Video Laryngoscope were noted.

Methods:

Video recording of intubation procedure and fluoroscopy of neck movement during endotracheal intubation were recorded and later reviewed.

Results:

During fluoroscopic visualisation intubation with TAScope video laryngoscope, showed minimal neck movements. It is thereby assumed that this will prevent any potential damage to the cervical spine and restricted neck movement patients.

Conclusion:

TA Scope can be a useful tool to prevent potential damage caused with neck movements during endotracheal intubation.

JOURNAL/ijana/04.03/01762628-202203001-00070/inline-graphic1/v/2022-09-30T091728Z/r/image-tiff
A CASE REPORT OF CYTOMEGALOVIRUS ASSOCIATED ANOPHTHALMIA IN A PRETERM INFANT
Authors: Khan Alisha Ali , Alam Md. Makhmoor , Mishra Atul , Deb Auromita
Published: September 2024

PURPOSE:

Cytomegalovirus belongs to the family of Herpesviridae, also known as HHV-5. The ocular manifestations of congenital cytomegalovirus infection include chorioretinitis, microphthalmos/anophthalmos, keratitis, cataract and optic atrophy. Anophthalmia is a condition in which there is a complete absence of any visible globe structure, though a microphthalmic remnant or cyst maybe present.

MATERIALS AND METHODS:

A 20 day old preterm baby born at 35 weeks with a birth weight of 2kg presented to the Ophthalmology OPD with microcephaly. No jaundice or hepatosplenomegaly was seen. An ocular examination showed left sided anophthalmia and coloboma iris of RE. USG orbit of left side revealed an ill- defined cystic lesion within the orbital fossa. Real time-PCR done on the sample of the infant was positive for CMV virus. A CT scan was done which showed no periventricular calcification.

RESULTS:

Congenital cytomegalovirus is associated with a high incidence of eye abnormalities and this infant showed findings consistent with CMV in infants.
MANAGEMENT OF THIRD NERVE PALSY- AN OVERVIEW
Authors: Quaiser Ali , Sinha Minu , Shahnawaz Asif , Jha Alka
Published: September 2024

Third cranial nerve is a motor nerve and supplies all extraocular muscles except lateral rectus and superior oblique in addition also supplies sphincter pupillae and ciliary muscles. The paresis or paralysis of one or more of these muscles due to 3rd cranial nerve palsy leads to ocular motility defects, ptosis, anisocoria and loss of accommodation. The article reviews etiopathogenesis, clinical features, evaluation and management of 3rd nerve palsy.
A BEGINNER'S GUIDE FOR UNDERSTANDING AND CARE OF AN OPHTHALMIC OPERATING MICROSCOPE
Authors: Parimal Nihit , Misra Somen
Published: September 2024

The operating microscope is a fixture of modern surgical facilities, and it is a critically important factor in the success of many of the most complex and difficult surgical interventions used in Ophthalmology today. The rise of this key surgical tool reflects advances in understanding the principles of optics and vision that have occurred over centuries. The development of reading spectacles in the late 13th century led to the construction of early compound microscopes in the 16th and 17th centuries by Lippershey, Janssen, Galileo, Hooke, and others. Perhaps surprisingly, Leeuwenhoek's simple microscopes of this era offered improved performance over his contemporaries' designs. The intervening years saw improvements that reduced the spherical and chromatic aberrations present in compound microscopes. By the late 19th century, Carl Zeiss and Ernst Abbe ushered the compound microscope into the beginnings of the modern era of commercial design and production. The introduction of the microscope into the operating room by Nylén in 1921 initiated a revolution in surgical practice that gained momentum throughout the 1950s with multiple refinements. Many of the refinements of the last 50 years have greatly improved the handling and practical operation of the surgical microscope, considerations which are equally important to its optical performance.
Recent Advances of Stem Cells in Dentistry
Authors: Dineshshankar Janardhanam , Yokataa Geetha Saravanan , Yoithapprabhunath Thuckanaickenpalayam Ragunathan , Ganapathy Nalliappan , Tamilthangam Periyasamy , Saranya Manikandan
Published: September 2024

Stem cells (SCs) have an ultimate potential of regenerating tissues and organs due to their salient properties. In the contemporary years, emergence of novel tissue bioengineering therapies and gene editing technologies has been a breakthrough in the field of SC research. A combination of these paradigm-shifting technologies with dental SCs definitely has brighter prospects in the upcoming decades. The goal of the current study of literature is to highlight the latest technologies and regenerative applications of SCs in the field of dentistry.
Gender Determination in Deciduous Pulp Tissue using Barr Bodies by Comparing Feulgen Stain, Acridine Orange, and Papanicolaou Stain
Authors: Ragunathan Yoithapprabhunath Thuckanaickenpalayam , Arumugam Aarthi , Nalliappan Ganapathy , Janardhanam Dineshshankar , Vadivel Illayaraja , Maheswaran Thangadurai
Published: September 2024

Background:

Age, sex, stature, and ethnic background are considered a main attributes of biological identity of the individual, which are also called the “Big Four” in forensic. Human identification is of chief importance, in both legal and humanitarian purpose. Teeth can remain virtually unaffected and survive long after other soft tissue and skeletal tissues were destroyed. Hence, its implication in personal identification was gained popularity and high accuracy.

Aim and Objective:

The aim and objective of the study were to determine the reliability of gender determination from deciduous dental pulp tissue by comparing Feulgen stain, acridine orange, and Papanicolaou stain.

Materials and Methods:

This study was carried out on 25 samples, out of which 14 female teeth and 11 male teeth. The pulp was collected from the teeth undergoing pulpectomy. Then, the pulp tissue was transferred to the centrifuge tube containing Carnoy’s fixative. After centrifugation, the cells were collected and stained using Feulgen stain, acridine orange, and Papanicolaou stain.

Results:

The reliability of gender determination is significant, with the female shows 100% positive results and the male shows negative. The Papanicolaou stain shows better nuclear morphology while comparing with Feulgen and acridine orange.

Conclusion:

Hence, gender determination can be identified using deciduous dental pulp.
Dermoid Cyst in the Floor of the Mouth Extending to the Submental Region
Authors: Bala Mujtaba , Braimah Ramat Oyebunmi , Bello Abubakar Abdullahi , Taiwo Abdurrazaq Olanrewaju , Mohammed Umar
Published: September 2024

Dermoid cysts in the floor of the mouth or submental region are developmental cysts that occur due to the entrapment of the ectoderm between the second and third branchial arch during embryogenesis around 3rd–5th week of intrauterine life. This report aimed to report the case of a 21-year-old Nigerian woman who presented with a chief complaint of swelling in the floor of the mouth extending to the submental region. There was associated recent history of pain and difficulty in chewing, speaking, and breathing. Clinical, ultrasonography, and histological evaluations were done to establish a diagnosis of an infected dermoid cyst. The infection was treated with antibiotics, after which surgical excision was done under general anesthesia through nasotracheal intubation. The patient was followed up after the surgery and no complication was recorded.
Rituximab induced remission in systemic lupus erythematosus with lupus nephritis along with nail fold capillaroscopy and trichoscopic findings: a case report
Authors: Mahajan Mohita , Mahajan B.B.
Published: September 2024

Lupus nephritis is a major cause of mortality and morbidity in patients with systemic lupus erythematosus (SLE). Early diagnosis and treatment are important, as early response to therapy is correlated with better prognosis and quality of life. Here, we report a case of 24-year-old male with SLE along with lupus nephritis. The patient was given 3 cycles of rituximab 1 gm 6 months apart following which the patient went into remission. Thus, Rituximab has been found to be an effective therapeutic modality to induce remission in SLE with Lupus Nephritis and also avoids the potential toxicity associated with standard immunosuppressive agents. Nail fold capillaroscopy (NFC) and trichoscopy were done which helped in the diagnosis of the disease.
Vitiligo-associated ocular abnormalities in Egyptian patients
Authors: Khaled Hesham N. , Ahmed Taghreed N. , Salama Ahmed A.
Published: September 2024

Background

Vitiligo is a skin disorder in which the melanocytes are destroyed. Melanocytes can be destroyed anywhere in the body, compromis ing the function of the organs where they are found. Melanocytes in the epidermis and the uveal tract share a common embryological origin in addition to physiological and morphological similarities.

Objective

To evaluate the vitiligo-associated ocular abnormalities in Egyptian patients.

Patients and methods

The study included 30 vitiligo patients and 30 age and sex-matched healthy volunteers as a control. Complete history taking, general, dermatological, and ophthalmic examination including visual acuity test and dilated fundoscopy were performed on all patients as well as controls.

Results

Regarding ocular changes, it was significantly higher in cases than controls. Also, there was a significant relation between the presence of ocular changes and certain types of vitiligo (the facial then the acrofacial). Moreover, there was a significant relation between VASI score and family history.

Conclusions

There is a reasonable percentage of Egyptian vitiligo patients who are found to have ocular changes. Also, there is an important relationship between ocular changes and the history of vitiligo in the family. It is possible to predict ocular changes in some patients because we know that they are associated with a certain type of vitiligo which is the facial then the acrofacial.
Vesicoureteral Reflux – Insights into Diagnosis and Management
Authors: Belli Afroditi , Nikolakea Melina , Mourmouris Panagiotis I.
Published: September 2024

Vesicoureteral reflux (VUR) is the most common congenital condition of the urinary tract. A plethora of imaging methods and treatment plans are described in literature and are used in clinical practice. The aim of this article is to analyze the available diagnostic tests and the pharmaceutical, endoscopic, and surgical options of our therapeutic armamentarium. A literature search on the PubMed database was conducted by two writers. Randomized controlled trials and meta-analyses were included, all published in PubMed and in the English language from 2011 to this day. After reviewing the full texts, we excluded duplicates, papers regarding secondary disease and those without a pediatric reference population. Regarding the mostly used imaging tests, voiding cystourethrography is considered the reference method for the diagnosis and grading of the disease, but it entails exposure of patients to ionizing radiation. Voiding urosonography has a similar sensitivity but is highly dependent on the operator’s experience. Renal scintigraphy with dimercaptosuccinic acid remains a useful test for detecting renal scars. As far as management is concerned, continuous antibiotic prophylaxis, though previously doubted, remains a valid therapeutic option, especially for lower grades of VUR. Open surgical techniques and their modern–laparoscopic and robotic–variations are useful for dealing with high-grade disease, while endoscopic methods have sufficient efficacy and are utilized more and more. The diagnosis and treatment of VUR are constantly evolving areas. New diagnostic methods are replacing the older ones, while the treatment algorithm is individualized.
Inflammatory Pseudotumour Post - Hernia Repair: An Unusual Cause of a Right Groin Mass
Authors: Xanicia Long Jiahuan
Published: September 2024

Inflammatory pseudotumors (IPTs) are rare benign lesions resulting from unregulated growth of inflammatory cells and can be found in different anatomical locations. They are most commonly reported in the lungs or head-and-neck region, and less commonly in the genitourinary system. We report a case of an 85-year-old male with a history of hernia mesh repair presenting with a right groin mass. Radiological investigations revealed a solid inguinal mass without intrascrotal extension. The mass was excised en bloc, and postoperative histopathological examination revealed an IPT.
The Role of l-Methionine in the Reduction of Recurrences of Chronic Bacterial Prostatitis: A Pilot Study
Authors: Stamatiou Konstantinos , Perletti Gianpaolo , Naber Kurt
Published: September 2024

Introduction:

L-methionine has been used for many years as an aid in the treatment of urolithiasis and as a prevention of further occurrence of struvite crystal formation by the acidification of the urine. Acidification of urine has been also used as a technique to treat and prevent symptomatic urinary tract infections. The current pharmacological research in the field of bacterial prostatitis focuses on the combinations of available antibiotics with prostatic microenvironmental modifiers for the prevention and treatment of chronic bacterial prostatitis (CBP) clinical recurrences. We aimed to study whether, in addition to antibiotic therapy, acidification of urine and prostatic microenvironment decreases CBP recurrences.

Materials and Methods:

This study was conducted between February 01, 2019, and December 20, 2020. The patient population included subjects with a confirmed diagnosis of CBP (National Institutes of Health [NIH] category II), history of CBP recurrences, and prostate calcifications confirmed on the transrectal ultrasound (TRUS) examination of the prostate. Symptom severity was self-estimated with the NIH-Chronic prostatitis Symptom Index (CPSI) and the International Prostatic Symptom Score (IPSS) questionnaires. Participants were randomly assigned to two groups. All underwent TRUS and the Meares–Stamey “four-glass” test. Patients of both groups received antimicrobial treatment (according to the results of susceptibility tests) for 30 days, while patients of Group 2 received additionally l-methionine 500 mg b. i. d for 2 months. After 4 weeks of therapy, the NIH-CPSI and IPSS tests were repeated. Follow-up included also interview, physical examination, TRUS, and “four-glass” test. Patients were followed for 6 months.

Results:

A total of 10 patients (5+5) were investigated in both groups. No significant differences were found between groups regarding median age, prostate volume, and bacterial susceptibility. Microbiological eradication occurred in similar proportions between the two groups. Similarly, the resolution of clinical symptoms occurred in equivalent numbers of patients belonging to Groups 1 and 2. Analysis showed in both groups highly significant improvements of symptoms, assessed with both the NIH-CPSI and IPSS tests. No difference in the number and location of calcifications after treatment between groups was also found. One patient of Group 1 experienced a clinical recurrence within 6 months after conclusion of treatment.

Conclusion:

No clear recommendations can be made from this pilot study. Thus, the preventive effect of l-methionine remains unknown and evidence for its use in this setting is lacking, but randomized trials with large numbers of participants would help to determine the role of urinary acidification in the treatment or prevention of recurrent CBP.
Effects of fentanyl and dexmedetomidine as adjuvants to bupivacaine in paravertebral block for postoperative analgesia in patients undergoing modified radical mastectomy: A prospective randomised double-blind study
Authors: Pani Nibedita , Sahu Padmalaya , Swain Deepti , Biswal Chetna , Pradhan Amit , Routray Sidharth Sraban
Published: September 2024

Background and Aims

Paravertebral block (PVB) is an established method, indicated for postoperative analgesia after modified radical mastectomy (MRM). Although many additives to bupivacaine in PVB have been tried to prolong the analgesia in postoperative period, no additive has been found without any adverse effects. We have compared the duration of analgesia in PVB using adjuvants like dexmedetomidine and fentanyl with bupivacaine after MRM.

Methods

A total of 60 female patients enroled for MRM were divided into two groups of 30 patients each. Group BF received PVB with 20 ml bupivacaine 0.25% with fentanyl 1 mg/kg and group BD received 20 ml bupivacaine 0.25% with dexmedetomidine 1 mg/kg for PVB. After confirming successful PVB, surgery was done under general anaesthesia. Time for first rescue analgesic request was the primary outcome of the study. The secondary outcome was comparison of visual analogue scale scores for pain and total analgesic consumption. Side effects like sedation, nausea, vomiting, bradycardia and hypotension in the postoperative period till 24 h were also assessed.

Results

The time for first rescue analgesic request was 6.32 ± 1.75 h in the BD group contrary to 3.94 ± 2.12 h in group BF (P < 0.05). Total paracetamol consumed as rescue analgesia in the first 24 h of postoperative period was remarkably reduced in group BD (1.7 ± 0.94 gm) in contrary to group BF (2.6 ± 0.98 gm) (P < 0.05). There was no significant difference in the incidence of complications between the groups.

Conclusion

Dexmedetomidine provides prolonged postoperative analgesia compared with fentanyl when used as an adjuvant to bupivacaine in PVB after MRM.
Comparison of the analgesic efficacy of ultrasound-guided transmuscular quadratus lumborum block versus thoracic erector spinae block for postoperative analgesia in caesarean section parturients under spinal anaesthesia—A randomised study
Authors: Bakshi Apoorva , Srivastawa Surabhi , Jadon Ashok , Mohsin Khalid , Sinha Neelam , Chakraborty Swastika
Published: September 2024

Background and Aims

Truncal blocks play an important role in multimodal analgesia regimens to manage the postoperative pain after lower segment caesarean section (LSCS). This study was aimed to compare the analgesic efficacy of ultrasound (US)-guided transmuscular quadratus lumborum block (TQLB) and thoracic erector spinae plane block (TESPB) in parturients of LSCS done under subarachnoid block (SAB).

Methods

In a randomised and double blind study, 60 parturients scheduled for

LSCS under spinal anaesthesia were randomly divided into two equal groups

group E (n = 30) and group Q (n = 30). After surgery, each parturient received either US guided bilateral TQLB (group Q) or TESPB (group E) with 20 ml 0.375% ropivacaine and 4 mg dexamethasone on each side. Assessments were done at 2, 4, 6, 8, 10, 12 and 24 h. The primary objective was to compare the duration of analgesia (first request to rescue analgesia) and the secondary objectives were to compare pain scores [numerical rating score (NRS)], total amount of tramadol consumption, incidence of nausea-vomiting, parturient satisfaction and other adverse effects in 24 hours postoperatively.

Results

The duration of analgesia (mean ± standard deviation) was comparable in group E (11.90 ± 2.49 h) and group Q (12.56 ± 3.38 h), P = 0.19. Pain scores (NRS) at rest and on movement were comparable at all time points of 2, 4, 6, 8, 10, 12, and 24 h (P > 0.05). The amount of tramadol used was comparable in group E and group Q (P = 0.48).

Conclusion

TESPB and TQLB are equally efficacious to provide postoperative analgesia after LSCS done under SAB when used as a part of multimodal analgesia.
Investigating molecular features that influence blood − brain barrier permeability of compounds
Authors: Saxena Deeksha , Sharma Anju , Siddiqui Mohammed Haris , Kumar Rajnish
Published: September 2024

Introduction:

The blood–brain barrier (BBB) is a semipermeable border that is responsible for maintaining central nervous system (CNS) homeostasis in the brain. Screening compounds based on their BBB permeability is an important consideration for CNS-acting drug development. Several studies have attempted to link physicochemical properties to specific BBB permeability; however, there is no widely accepted rule that can determine how and to what extent molecular properties affect the BBB permeability of compounds. To understand the complex phenomenon of BBB permeability, we explored the vast molecular space of the compounds to determine whether some features could differentiate the compounds based on their BBB permeability.

Materials and Methods:

A dataset of 1951 compounds containing 1246 BBB-permeable and 705 BBB-nonpermeable molecules was used in the study. Each compound encoded 499 molecular features. Feature selection was performed using feature selection algorithms, feature-to-feature, and feature-to-permeability correlation analysis. The findings of the feature selection algorithms were merged to select the best set of 53 features.

Results:

The descriptive analysis of the molecular features suggests that nCXr (number of X on ring C[sp3]) feature values for BBB nonpermeable compounds are zero for all considered compounds except for compounds with PubChem ID 71260, Flurithromycin. In addition, the majority of compounds were found to have nCrq (number of ring quaternary C[sp3]) feature values of zero for BBB nonpermeable compounds. For BBB-permeable compounds, MACCS fingerprints 8 feature values for all 1951 compounds were found to be zero except for the compound with PubChem ID 146291, Dezinamide.

Conclusion:

The descriptive and nonparametric tests confirm that molecular feature distributions are significantly different for BBB permeable and BBB nonpermeable compounds.

The following core competencies are addressed in this article:

Medical knowledge.
Knowledge, Attitude, and Practice on Mercury Disposal by Preclinical and Clinical Students of a Dental College in Puducherry – A Questionnaire Survey
Authors: Ragavi R. Rai , John Bindu Meera , Jayakumar Srilekha , Sridhar Dinesh D. , Arumugam Karthikeyan , Srinivas Vineetha Chakravarthy
Published: September 2024

Background:

Mercury-containing waste cannot be disposed of with other biomedical waste and has to be handled carefully. It is essential that students understand the proper guidelines regarding the same.

Objective:

The objective of this study was to evaluate the knowledge, attitude, and practices of handling mercury and mercury-containing waste among dental students.

Methodology:

A cross-sectional questionnaire survey was conducted among 237 preclinical and clinical students of a private dental college in Puducherry UT, India. A closed-ended, self-administered questionnaire consisting of 30 items was designed to elicit responses from study participants. The questionnaire had separate items to assess their knowledge, attitude, and practice.

Results:

Study participants provided wrong answers (<50% right responses) for a majority of items related to mercury/dental amalgam. A higher proportion of clinical students provided right answers for items relating to allergic response of mercury (P = 0.05), labeling containers with biohazard symbol (P = 0.05), handling characteristics (avoiding skin contact with freshly mixed amalgam) (P = 0.03), the storage of contact and noncontact amalgam (P = 0.03), and in following the protocol (P = 0.04).

Conclusions:

Overall, clinical students provided more right answers than nonclinical students. However, a statistically significant difference between the two groups of students was limited to only five items. Appropriate handling, manipulation, and disposal of mercury can be practiced only when there is adequate knowledge, awareness, and practice that was found to be lacking for 12 items and no significant differences for the remaining 13 items.
Effect on Quality of Life and Psychosocial Issues of Patients with Maxillofacial Fractures in Rural Setting
Authors: Sureshkumar Laxmi , Patil Pankaj , Iyer Yamuna
Published: September 2024

Background:

Maxillofacial injuries are a serious public health problem and are often associated with severe morbidity, disfigurement, and psychological problems. The life of the patient often takes a turn for the worst and he/she has to face many difficulties moving forward. Analysing and determining the quality of life of such cases will give us a better understanding and insight and will further improve the care and treatment of the patients.

Aims:

Analyse and evaluate the psychosocial impact of maxillofacial fractures on individuals who were healthy pre-trauma.

Material and Methods:

The participants are the 30 patients with facial trauma reported to the Department of Oral and maxillofacial surgery of the School of Dental Sciences and Krishna hospital, Karad, who will be required to undergo surgical treatment (i.e., Open reduction and internal fixation for facial fractures) and are willing to participate in this study. All 30 patients were given a questionnaire form modified from the pre-existing Acute Stress Disorder Scale, Oral Health Impact Profile questionnaire and Posttraumatic Diagnostic Scale, which includes questions regarding speech, sense of taste, pain, uncomfortable eating, orientation, tension, unsatisfactory diet, interrupted meals, difficulty to relax, embarrassment, irritability, occupational dysfunction, etc. during their 15 days follow up appointment post-surgery. This obtained data was then analysed and was subjected to appropriate statistical analysis.

Result:

In a study sample of 30 patients, 8% were found with intense psychosocial issues due to trauma, 14% had a moderate, and 18% had mild issues that affected the quality of their life post-trauma.

Conclusion:

The study shows a great need for psychological screening and evaluation of patients with maxillofacial injury/fractures due to trauma to improve the patient's physical and psychological recovery.
Evaluation of Two Colorimetric Microplate Microtiter Tests for Susceptibility Testing of Clinical Isolates of Mycobacterium tuberculosis to First-line Antituberculosis Drugs
Authors: Tarhan Gülnur , Akgün Sadik , Bilgin Mehmet , Akbulak Sami
Published: September 2024

Background:

Drug-resistance tuberculosis (TB) is one of the most important global public health problems. Accurate and rapid drug-susceptibility testing is critical for the effective treatment of TB patients. Various colorimetric methods are used for anti-TB drug-susceptibility testing (DST) and minimum inhibitory concentration (MIC) determination. This study was conducted to evaluate the resazurin microtiter assay (REMA) and malachite green decolorization assay (MGDA).

Methods:

A total of 65 Mycobacterium tuberculosis strains isolated from patients with suspected TB using REMA and malachite green microtiter assay methods were tested against streptomycin (SM), isoniazid (INH), rifampicin (RIF), and ethambutol (ETB). The Mycobacterial Growth Indicator Tube 960 DST method was accepted as the gold standard in the evaluation of test results.

Results:

The sensitivity of REMA and MGDA tests was found to be 87.5% and 62.5% for INH, respectively. RIF and SM sensitivity for both tests was 100%. While ETB sensitivity was 81.8 for the REMA test, this rate was 60% for the MGDA test. Specificity of both tests varied between 92.5% and 98.2% according to the drug types.

Conclusion:

REMA and MGDA are a simple, rapid, and low cost. They can be used as an alternative test for drug-susceptibility testing and MIC determination. Extensive studies and standardization are needed for the routine use of both tests.
Role of Prophylactic Surgery in Spinal Tuberculosis: A Retrospective Study from Eastern India
Authors: Acharya Abhijit , Panigrahi Souvagya , Senapati Satya Bhusan , Deo Rama Chandra , Mahapatra Ashok Kumar , Puppala Sumirini , Panigrahi Subhankar
Published: September 2024

Background:

Tuberculosis (TB) is broadly classified into pulmonary and extrapulmonary TB. Skeletal TB is considered to be a form of extrapulmonary TB whose incidence is around 1% of all forms of TB. The incidence of spinal TB is more than 50% of the entire skeletal TB.

Methods:

A total of 92 consecutive patients, treated over a period of 2 years (January 2021–January 2023), are retrospectively analyzed.

Results:

In our study, out of 92 patients, the pain had subsided in 90% of cases, and 12 patients showed improvement in motor power postoperatively. In our study, the patients have benefited due to the surgical intervention in decrease of pain and improvement in motor deficits in patients. The 29 patients who were operated on prophylaxis with pain as the only symptom benefitted from the resolution of the symptom of pain and did not develop any morbidity in their long-term follow-up. The sensory and bladder/bowel symptoms did not improve after surgery.

Conclusions:

In the author’s view, prophylactic surgery for spinal TB is safe and effective with confirmation of the disease. However, a well-designed randomized controlled trial, to definitely and objectively prove the usefulness of prophylactic surgery, is needed.
Disseminated Tuberculosis: Clinical Presentation, Diagnosis, and Outcomes in a Tertiary-Care Hospital in Saudi Arabia
Authors: Abuabat Faisal , Badri Motasim , Abuabat Salman , Alsultan Sultan , Baharoon Salim , Alharbi Abdullah , Khan Ayaz , Al-Jahdali Hamdan
Published: September 2024

Background:

Tuberculosis (TB) is the primary infectious cause of mortality worldwide. Although TB incidence and prevalence are declining, the use of immunosuppressive drugs and the growing prevalence of immunocompromising conditions such as comorbidities, malignancies, and the use of immunosuppressive agents are risk factors for disseminated TB (DTB). This study aims to identify the relevant clinical, laboratory, radiological, and histopathological features of DTB, as well as to assess the typical anatomical distributions and treatment outcomes of patients diagnosed with the disease at King Abdulaziz Medical City (KAMC).

Methods:

A retrospective chart review was conducted, including all patients diagnosed with miliary or DTB at KAMC with retrievable medical files.

Results:

The study included 55 patients, of whom 35 (63.6%) were male and the median age was 64 years old. 35 (63.6%) of the infected patients were timely diagnosed and eventually cured from the illness. The most common comorbid conditions were diabetes, chronic kidney disease, and immunocompromising conditions, which were present in 37 (67.2%), 12 (21.8%), and 11 (20%) of the patients, respectively. The most common presenting symptoms were fever and cough, present in 31 (56.3%) and 26 (47.2%) of the patients, respectively, followed by weight loss in 25 (45.4%), night sweats in 15 (27.2%), and shortness of breath in 14 (25.4%). Approximately two-thirds of the patients had pulmonary miliary TB (MTB) (38; 69.1%), followed by TB lymphadenitis (21; 38.2%), central nervous system involvement (13; 23.6%), skeletal involvement (11; 20%), gastrointestinal involvement (5; 9.1%), pleural involvement (3; 5.5%), and urogenital TB (2; 3.6%). The mortality rate was 14 (25.5%) patients.

Conclusion:

MTB is challenging to diagnose due to nonspecific clinical, laboratory, and imaging findings. Clinicians dealing with patients who are at risk of developing DTB should be aware of the typical presentations and abnormal clinical findings. They should also have a low threshold to initiate specific investigations for the disease, as early diagnosis and effective treatment is critical in reducing morbidity and mortality rates.
A Critical Review of Risk Factors Influencing the Prevalence of Extensive Drug-Resistant Tuberculosis in India
Authors: Khan Amer Hayat , Nagoba Basavraj Sayabanna , Shiromwar Shruti Subhash
Published: September 2024

Globally, extensive drug-resistant tuberculosis (XDR-TB) is a major element to cause morbidity and death among tuberculosis patients. The present study identifies the vital risk variables contributing to XDR-TB prevalence in India. Scopus, PubMed/Medline, Science Direct, and Google Scholar databases were searched thoroughly for the articles, using medical subject heading as a key term published between the years 2012 and 2022. According to the inclusion criteria, 11 publications were selected. Socioeconomic characteristics include employment, educational attainment, undernourishment, and the rest, and demographic factors such as gender, age, and more. Were examined in the review, whereas alcoholics, smoking, and diabetes mellitus were investigated under comorbidities and behavioral risk factors. We observed that noncompliance, poor knowledge, and insufficient health-care facilities could significantly accelerate the spread of XDR-TB, and the present review imparts a remarkable and detailed evaluation of XDR-TB. The study analysis is markedly useful for policymakers as well as researchers to discover and implement effective solutions for tuberculosis-infected patients.
Antibody Reactivity to Mycobacterium tuberculosis-specific Regions of Differences 1 and Regions of Differences 9 Proteins and Peptides in Rabbits, Mice, and Humans
Authors: Hanif Shumaila N. M. , Al-Attiyah R. , Mustafa A. S.
Published: September 2024

Background:

The major antigens encoded by Mycobacterium tuberculosis-specific genomic regions of differences (RDs) could be useful in the development of new vaccines and/or diagnostic reagents using T-cell and/or antibody assays. In particular, RD1 proteins PE35, PPE68, ESXA, ESXB, and RD9 protein ESXV and their peptides have been identified as major T-cell antigens. However, little is known about their antibody reactivities in different mammalian species. This study aims to determine the antigen-specific antibody reactivities to the above antigens and their peptides in three different mammalian species, i.e., rabbits, mice, and humans.

Methods:

Sera were obtained from (i) rabbits immunized with purified recombinant proteins PE35, PPE68, ESXA, ESXB, and ESXV; (ii) mice immunized with recombinant DNA vaccine constructs of pUMVC6 and pUMVC7 containing RD1 and RD9 genes; and (iii) tuberculosis (TB) patients and healthy humans. Enzyme-linked immunosorbent assays (ELISAs) were performed with the sera to determine the antibody reactivity to purified recombinant proteins, peptide pools, and individual peptides of RD1 and RD9 proteins.

Results:

The ELISA results with sera from rabbits immunized with pure recombinant proteins showed positive antibody reactivity with all of the immunizing proteins and their synthetic peptide pools. Testing of the sera with individual peptides showed positive antibody reactivity with PE35 peptides P1 (aa 1–25), P2 (aa 16–40), P5 (aa 61–85), and P6 (aa 76–99); PPE68 peptides P9 (aa 121–145), P11 (aa 151–175), P14 (aa 196–220), P22 (aa 316–340), P23 (aa 331–355), and P24 (aa 346–371); all peptides (P1 to P6) of ESXA and ESXB; and ESXV peptides P1 (aa 1–25), P2 (aa 16–40), P3 (aa 31–55), P5 (aa 61–85), and P6 (aa 76–94). The sera from mice immunized with DNA vaccine constructs showed antibody reactivity to all proteins and the peptide P6 (aa 76–99) of PE35 and peptides P19 (aa 271–295) and P24 (aa 346–371) of PPE68. In humans, the peptides P11 (aa 151–175), P14 (aa 196–220), P22 (aa 316–340), P23 (aa 331–355), and P24 (aa 346–371) of PPE68 and the peptides P4 (aa 46–70), P5 (aa 61–85), and P6 (aa 76–94) of ESXV showed positive reactivity with sera from TB patients and healthy controls.

Conclusion:

The results demonstrate the presence of several antibody epitopes in each protein, but variations in the epitopes recognized were observed among mice, rabbits, and humans, which could be due to mammalian species differences and/or mode of antigen delivery.
A Systemic Review of Mycobacterium nebraskense Case Reports up to October 2023, Featuring Our Unique Case Study
Authors: Rajani Aayushi J. , Roach Dawn , Raval Darshankumar , Amin Juhi , Kempaiah Prakash , Chitale Rohit , Durvasula Ravindra , Oring Justin
Published: September 2024

Background:

Mycobacterium nebraskense is a rare, slow growing nontuberculous mycobacterium species with limited documented cases. This systematic review aims to comprehensively analyze the clinical characteristics, presentation, and management of M. nebraskense infections by analyzing the available literature, including a newly reported case that we present in this article.

Methods:

A comprehensive search was conducted using PubMed and Google Scholar to identify relevant cases up to October 2023. Only seven reported cases were found, highlighting the scarcity of information on this pathogen.

Results:

Our analysis revealed several key findings. First, gender disparities were observed, with females being more susceptible to M. nebraskense infections. Additionally, a significant portion of patients presented with asymptomatic infections. Most affected individuals were over the age of 60, emphasizing potential age-related susceptibility. Comorbidity profiles varied widely among cases, and patients with preexisting lung comorbidities were at an increased risk of infection. The decision to treat or observe depended on clinical presentation, with even immunosuppressed individuals not always requiring treatment. Regarding treatment, we proposed an empirical approach with amikacin, clarithromycin, or rifabutin, considering the reported resistance to doxycycline and minocycline. Combination therapy was commonly employed to minimize resistance development, consistent with mycobacterial infection management.

Conclusion:

This study underscores the need for further research to validate these findings and enhance our understanding of M. nebraskense infections. As limited data are available, this review aims to provide valuable insights into a rare and emerging pathogen to guide clinical practice and future research endeavors.
Anergy to Purified Protein Derivative and Chronic Energy Deficiency in Sputum-Positive Pulmonary Tuberculosis: Dynamic Assessment at Baseline and Treatment Completion
Authors: Alexander Vijay , Sindhu Kulandaipalayam Natarajan , Ralph Ravikar , Paul Jackwin Sam , Manimegalai Babuji , Zachariah Anand
Published: September 2024

Background:

Tuberculosis (TB) remains a high burden disease in India. Nutrition plays a pivotal role in holistic recovery of the same.

Methods:

Patients with sputum positive pulmonary TB were consecutively recruited into the study aimed to observe the incidence of under nutrition and anergy purified protein derivative (PPD). Anthropometry and PPD testing were done at baseline. Patients were followed-up at 6 months, with PPD intradermal test repeated to study tuberculin conversion. Nutritional recovery, tuberculin conversion, and determination of persistent anergy were the outcomes of interest.

Results:

Of the 134 patients enrolled in the study, 43.2% were anergic to PPD at baseline. While 50.8% patients had normal body mass index (BMI), 14.2%, 9.7%, and 25.4% had chronic energy deficiency (CED) Grades I, II, and III, respectively. BMI at baseline showed a positive linear correlation with PPD response (r = 0.44, P < 0.001), and anergy was associated with CED (odds ratio - 3.25, P = 0.001). Forty-six patients completed follow-up and 19.6% showed anergy to PPD. At follow-up, 69.6% had normal BMI. Overall, there was an improvement in anthropometry and PPD reactivity in patients at 6 months, compared to baseline assessment.

Conclusion:

Anergy was significantly associated with CED at baseline in patients with TB. While most patients had an improvement in nutritional status and PPD reactivity, a small subset of patients had persistent anergy. Recovery from TB is multifactorial and its determinants include microbiological cure, nutritional status, and immunological recovery.
Specific Targeting to the Mycobacterium tuberculosis P-type ATPase Membrane Transporter, CtpF, of Antituberculous Compounds Obtained by Structure-based Design
Authors: Santos Paola , Salazar Luz M. , Maya-Hoyos Milena , Soto Carlos Y.
Published: September 2024

Background:

The resurgence of Mycobacterium tuberculosis (Mtb) strains that resist anti-tuberculosis (anti-TB) drugs used currently stresses the search for more effective low-toxicity drugs against new targets. Due to their role in ion homeostasis and virulence, Mtb plasma membrane P-type ATPases are interesting anti-TB targets, in particular, the Ca2+ transporting P2-type ATPase CtpF which is involved in oxidative stress response and persistence.

Methods:

In this study, the effect on the transcription level of the ctpF gene and other Mtb P2-type ATPases of two anti-Mtb hits was assessed by quantitative reverse transcription polymerase chain reaction (qRT-PCR). Both anti-Mtb hits ZINC14541509 and ZINC63908257 had been previously identified using pharmacophore-based virtual screening and MM-GBSA binding free energy. In addition, the bacterial activity of both compounds on Mycobacterium bovis was evaluated to see whether or not there is an effect on other mycobacteria of the Mtb complex.

Results:

qRT-PCR experiments showed that the ctpF transcription level was significantly higher in the presence of both compounds, especially ZINC14541509, strongly suggesting that CtpF may be a specific target of the selected compound.

Conclusions:

ZINC14541509 should be considered as an alternative for the structural-based design of novel anti-TB drugs.
Systemic Assessment of Solute Carrier Family 11-member A1 (rs17235409) Gene Polymorphism and Mycobacterium Tuberculosis Risk in Asian and Caucasian Population: A Comprehensive Updated Meta-analysis
Authors: Pauline Rashmi , Devaraj Danis Vijay , Sivasubramanian Jayanthi , Velmurugan Saranya , Stephen Sharon Benita , Yasam Santhosh Kumar , Kulanthaivel Langeswaran , Subbaraj Gowtham Kumar
Published: September 2024

Background:

The present meta-analysis was assessed to confirm the association between solute carrier family 11-member A1 (SLC11A1) gene (rs17235409) polymorphism with the Mycobacterium tuberculosis infection in the Asian and Caucasian populations.

Methods:

A search was conducted using the databases including Google Scholar, Science Direct, Embase, and PubMed to find the case–control studies related to SLC11A1 gene polymorphism and tuberculosis (TB) infection. The MetaGenyo programme was used to perform statistical analyses of the data. The odds ratio and 95% confidence interval were calculated based on genetic models such as allelic model, dominant model, recessive model, and overdominant. The heterogeneity and publication bias for the present study were examined to assess its quality. The study was registered in PROSPERO (ID Number: 461434).

Results:

This current study revealed the association between the SLC11A1 gene polymorphism with TB. The statistical value obtained at P < 0.05 was deemed to be statistically significant. The meta-analysis results revealed that allele contrast and recessive models are significant association between SLC11A1 gene polymorphism with risk of TB infections, and dominant and overdominant models have no significant association with TB risk. In addition, the subgroup analysis based on the ethnicity dominant revealed a significant association with the risk of TB. Therefore, this results that the gene SLC11A1 has a significant association for allelic and recessive and has no significant association for dominant and overdominant with the risk of TB.

Conclusion:

According to the data retrieved from the database with respect to the present study revealed that SLC11A1 gene polymorphism rs17235409 for allelic, recessive models have been associated with TB infections, but dominant and overdominant models have not been associated with TB infections.
Co-infection of Mycobacterium tuberculosis and Mycobacterium leprae Complicated by Pulmonary Embolism: A Rare Case Report
Authors: Ruthramoorthy Prasana , Jose Jince Ann , Revendran Jayamol , Elango Ragavi
Published: September 2024

A 35-year-old male patient with lepromatous leprosy came to the emergency room (ER) due to breathlessness and chest pain. The patient was diagnosed with pulmonary tuberculosis (TB) after a bronchoscopy and started on antitubercular therapy. However, the patient continued to experience tachycardia and desaturation, and on further evaluation, Computed tomography pulmonary angiography revealed an embolus in the right descending pulmonary artery. The patient was found to have an elevated d-dimer. Further investigation revealed that the cause of the pulmonary thromboembolism (PTE) was the thalidomide medication that the patient was taking for type 2 leprosy reaction. The medication was stopped, and the patient was treated with low-molecular-weight heparin and discharged with apixaban for six months. The patient’s condition improved on follow-up. This case is unique due to the rare combination of pulmonary TB, leprosy, and pulmonary embolism brought on by thalidomide administration. Physicians should be aware of the possibility of co-infection of TB and leprosy and the need to rule out thromboembolism when patients are on thalidomide.