bluuebunny/crossref_metadata_2025 huggingface dataset:
Rare Coagulopathies in Hematologic Spotlight: Isolated Factor V Deficiency and Combined Factor V and VIII Deficiency
Authors: Gangadaran Nandhini , Sekar Mithraa Devi , Rangarajan Vidhyalakshmi , Manivannan Prabhu
Published: May 2024

Rare coagulation disorders pose significant diagnostic challenges emphasizing the importance of clinical vigilance and meticulous hemostatic workup for accurate diagnosis and timely management. We present two cases of exceptionally uncommon coagulopathies – isolated factor V deficiency (F5D) and combined factor V and VIII deficiency (F5F8D). Case 1 features a 24-year-old woman incidentally diagnosed with severe F5D during routine preoperative evaluation for an ovarian cyst. Despite the absence of any reported bleeding manifestations, a timely and accurate diagnosis was rendered. Perioperative management with fresh frozen plasma and postoperative monitoring ensured favorable surgical outcomes. Case 2 features a 10-year-old male presenting with prolonged gum bleeding. Following systematic hemostatic workup, a diagnosis of F5F8D was rendered, thereby guiding optimal therapeutic interventions. We herein aim to contribute valuable insights into the understanding of coagulation physiology and the diagnostic intricacies and management strategies of rare coagulation disorders.
Active Case Finding among Adults using an Individual’s Vulnerability Score for Pulmonary Tuberculosis in a Rural Village of Goa: A Cross-sectional Study
Authors: Dessai Bhargav P. Sawant , Krishnan Malavika , Shah Hemangini K.
Published: May 2024

Background:

“Detect–Treat–Prevent–Build” to achieve tuberculosis (TB)-free India is envisaged in the National Tuberculosis Elimination Program (NTEP). To be able to achieve this, it is important to address the fact that the most vulnerable and hard-to-reach groups need to undertake screening. The present review aimed to examine the vulnerability in connection with TB disparities faced by distinct sub-populations generally viewed as vulnerable and follow these for testing.

Materials and Methods:

The community-based cross-sectional study was conducted in the field practice area of sub-center Carambolim in a rural area of Goa for 3 months. The households were visited, and data collected via personal interviews were recorded on the questionnaire study tool. Based on the data, the participants’ vulnerability mapping was done per the parameters identified.

Results:

Among 223 households, 528 persons were screened for vulnerability. The 47 highly vulnerable participants were advised sputum CBNAAT, of which 9 (19%) tested positive for pulmonary TB, while of the 86 moderately vulnerable participants, 4 (5%) tested positive for pulmonary TB. Among the 34 with symptoms suggestive of TB, 3 (9%) tested positive for pulmonary TB.

Conclusions:

The study detected 16 new TB patients from the population and found a higher incidence of pulmonary TB among the vulnerable group with no symptoms of Pulmonary TB. A further state-wide survey is recommended to diagnose such cases.
Malnutrition and Anemia Among Particularly Vulnerable Tribal Groups of Odisha, India: Needs for Context-Specific Intervention
Authors: Das Arundhuti , Ghosal Jyoti , Khuntia Hemant Kumar , Dixit Sujata , Pati Sanghmitra , Kaur Harpreet , Ota Akhil Bihari , Bal Madhusmita , Ranjit Manoranjan R.
Published: May 2024

Background:

As undernutrition and anemia persist to be prevalent in India, the socioeconomically disadvantaged groups continue to take the greater brunt. Odisha is home to the largest number of particularly vulnerable tribal groups (PVTGs) in India. The study aimed to provide a comprehensive report on the undernutrition and anemia status of all the PVTGs of Odisha.

Methods:

A community-based cross-sectional study was conducted among (N = 1461, 683 males and 779 females) 13 PVTGs spread across 12 districts of Odisha from August 2018 to February 2019.

Results:

Among the under-five children, the prevalence of underweight was observed in 75.26%, stunting in 55.42%, and wasting in 60.00% and all forms of undernutrition were higher among girls. Among children and adolescents belonging to the age group of 5 to 19 years, the prevalence of thinness was 46.7%. In individuals above the age of 20, the prevalence of underweight among males was 37.7% and females was 44.3% and severe anemia was present in 36.5% of females and 35.8% of males. Women in the reproductive age have a higher prevalence of anemia.

Conclusion:

The study shows that undernutrition and anemia remain high in the PVTGs, especially among the under-five children and women in the reproductive age. As the country heads toward fulfilling Sustainable Development Goals (SDG) by 2030, national and state health policies need to be designed and implemented, giving special focus to these vulnerable groups.
Epidemiological Trends of Dengue in One of the Western Hilly Areas of Himachal Pradesh
Authors: Sharma Ekta , Sood Tarun , Katoch Gurmeet , Guleri Rajesh
Published: May 2024

Background:

Dengue is one of the neglected tropical diseases, with a wide spectrum of diseases, ranging from acute febrile illness dengue fever to life-threatening dengue hemorrhagic fever or dengue shock syndrome. In recent years, it has become a major public health concern in many nonendemic areas as well.

Materials and Methods:

A secondary data analysis of records available with district Integrated Disease Surveillance Programme cell was conducted to study distribution (time, place, and person) of dengue from 2017 to 2022 in Kangra, a sub-Himalayan district of Himachal Pradesh (HP).

Results:

In the evaluated period (2017–2022), a total of 6008 cases suspected of dengue were tested and test positivity of 7% (441) with male gender predominance was found. Mean age of the diagnosed cases was 37.7 ± 16.8 years. A seasonal trend was observed starting from late August to November in all study years.

Conclusion:

Dengue is still a neglected disease, but it has shown its presence especially in this part of HP, indicating the need for better preparation and sensitization of vector-borne disease control program activities, especially in post-monsoon, to prevent future epidemics.
Awareness among Pediatricians Regarding National Telemedicine Guidelines during the COVID-19 Pandemic: A Survey
Authors: Alam Areesha , Kaur Harpreet , Bhatnagar Shrish
Published: May 2024

The success of telemedicine depends on awareness among doctors on how to implement it. We aimed to assess knowledge about national telemedicine guidelines in pediatricians during the coronavirus disease 2019 (COVID-19) pandemic. A cross-sectional study of pediatricians across India was conducted through a structured online questionnaire containing 16 marks. The mean knowledge score (KS) was calculated. Participants were divided into two groups: poor KS (KS <8) and good KS (KS ≥8). The association between factors and KS was assessed using univariate analysis. A total of 503 pediatricians participated (private sector: 80.7% and public sector: 19.3%). Most (61%) belonged to the age group of 31–50 years and were males (75%). The minimum educational qualification was a Doctor of Medicine (MD) in 57% of cases. Despite work experience of more than 5 years in most (70%) of the cases, very few had provided teleconsultation before the pandemic (13.9%). The mean KS was 10.60 ± 2.8, that is, 66.25%. The minimum KS was 1 (6.25%), and the maximum was 16 (100%). Assam, Chandigarh, Himachal Pradesh, Jharkhand, Odisha, Sikkim, and Tamil Nadu showed higher knowledge than other states, although no significant difference was found. The majority (89.1%) had good KS, which is significantly higher among private practitioners as compared to public practitioners. There was no association between KS and age, gender, qualification, and work experience. Pediatricians have good information regarding telemedicine guidelines in India; however, training programs will further empower doctors working in the public sector.
Simplified Sample Size Formulas for Detecting a Medically Important Effect
Authors: Indrayan Abhaya , Mishra Aman , Bhaskarapillai Binukumar
Published: May 2024

The sample size is just about the most common question in the minds of many medical researchers. This size determines the reliability of the results and helps to detect a medically important effect when present. Some studies miss an important effect due to inappropriate sample size. Many postgraduate students and established researchers often contact a statistician to help them determine an appropriate sample size for their study. More than 80 formulas are available to calculate sample size for different settings and the choice requires some expertise. Their use is even more difficult because most exact formulas are quite complex. An added difficulty is that different books, software, and websites use different formulas for the same problem. Such discrepancy in the published formulas confounds a biostatistician also. The objective of this communication is to present uniformly looking formulas for many situations together at one place in their simple but correct form, along with the setting where they are applicable. This will help in choosing an appropriate formula for the kind of research one is proposing to do and use it with confidence. This communication is restricted to the sample size required to detect a medically important effect when present – known to the statisticians as the test of hypothesis situation. Such a collection is not available anywhere, not even in any book. The sample size formulas for estimation are different and not discussed here.
Validity of “Mid-Upper Arm Circumference” as a Parameter to Identify Undernourished Children in Rural Gujarat
Authors: Chawada Bansari L. , Devaliya Jaydeep J. , Kurian Sneha
Published: May 2024

Introduction:

Mid-upper arm circumference (MUAC) measures the arm muscle and fat area. The use of MUAC as a screening measure for assessing undernutrition has the following advantages; it makes use of a simple equipment, is easy to carry at the field sites, and requires minimal training. In India, “mid-upper arm circumference” is widely used and accepted in many nutritional programs.

Objectives:

This study was conducted with the primary objective to compare different anthropometric parameters of children and to validate the usefulness and limitations of MUAC to screen out undernourished children.

Subject and Methods:

Anthropometric measurements were recorded for all the anganwadi centers of the selected sub-center that comes under the field practice area of our department. The measurements like weight, height, MUAC were done according to the standard guidelines as per WHO, and further, calculations were done with the help of “Anthro software 3.2.2.” Comparisons were done between categorization of MUAC tape and Weight-for-Height Z-scores (WHZ), and hence, the sensitivity and specificity of the MUAC tape to screen the malnourished child were found out.

Results:

Sensitivity of MUAC to categorize a child in red/yellow was only 9.03%, negative predictive value (NPV) was 40.75%, specificity came 95.10%, and positive predictive value was 73.68% on taking WHZ as the gold standard.

Conclusion:

MUAC has a limited role in screening out an undernourished child (red/yellow category), whereas it has a good role in screening healthy children (green category).
Perception and Practices Regarding Stubble Burning in Rural Community of Haryana
Authors: Misra Puneet , Salve Harshal Ramesh , Daniel Roy Arokiam , Dwarkanathan Vignesh , Deori Trideep Jyoti , Kumar Rakesh , Yadav Kapil
Published: May 2024

Background:

Agricultural emissions pose significant health risks, especially in countries like India with abundant agricultural waste. This study focuses on understanding stubble burning perceptions and practices in rural National Capital Region to inform targeted interventions for sustainable farming practices and improved public health.

Methods and Material:

This community-based cross-sectional study was conducted among the randomly selected households of rural Ballabgarh, Haryana. A pre-tested, semi-structured questionnaire was used to obtain information on perception and practices on stubble burning. Data were collected in Epicollect 5 and analyzed in STATA 14.

Results:

Of the 2000 households approached, 1813 responded with a response rate of 90.7%. Around 53% of the study participants believed that vehicular pollution is the main reason for air pollution, and 90% of them were unaware of the Government schemes related to stop stubble burning and with respect to the practices of stubble disposal. Around 70% of the participants mentioned that respiratory illness is the most severe effect of air pollution.

Conclusion:

The public was mostly unaware of the government’s efforts to reduce stubble burning. Health promotion initiatives must be carried out to raise community knowledge about the programs available to combat stubble burning, therefore decreasing air pollution and its health implications.
Serum level of human transforming growth factors β3 in Iraqi patient with chronic myeloid leukemia
Authors: Naeem Noor Tariq , Alsaadi Basima Qasim Hasan
Published: May 2024

BACKGROUND:

The Philadelphia chromosome serves as the molecular marker for chronic myeloid leukemia (CML) result from fusion oncogene, leading to genetic instability including chromosomal aberrations and common altered genes that regulate cell proliferation and apoptosis. Transforming growth factor-β (TGF-β) signaling pathway is an important regulator of cellular functions, such as proliferation, differentiation, migration, and cell survival.

OBJECTIVES:

The objective of this research was to investigate the role of TGFs-β3 as predictive biomarker on disease progression.

MATERIALS AND METHODS:

This study includes three groups (50) individuals: newly diagnosed CML patients (male: 28 and female: 22), (50) CML chronic phase (male: 25 and female: 25), and (50) apparently healthy volunteers (male: 30 and female: 20). The National Center of Hematology at Mustansiriyah University admitted the patients. An analysis of each patient was diagnosed using a complete blood count, a bone marrow test, and a BCR-ABL gene test. ELISA technique was applied to assess the serum level of TGFs-β3.

RESULTS:

the results displayed high significant differences among patients (newly diagnosed) compared to the chronic phase, it was 59.7517 and 39.9167 pg/mL, respectively, and high significant differences among patients (newly diagnosed) compared to control, it was 59.7517 and 36.8861 pg/mL, respectively, as well as the serum level of TGF-β3, was elevated with some hematological marker.

CONCLUSION:

Elevated TGF-β levels can promote the development of myelofibrosis and some hematologic malignancies by influencing the immune system.
A comparative study to assess diagnostic efficacy of micro typing gel technique versus conventional tube technique in blood cross-match in blood bank at a tertiary care hospital
Authors: Gawande Rutuja , Soni Ramawatar Ramprasadji , Rode Vikram Vinod
Published: May 2024

BACKGROUND:

In transfusion medicine, cross-matching and compatibility are determined using the conventional tube approach. The goal of the current study is to compare the microtyping gel approach to the conventional tube method for studying blood cross-match.

OBJECTIVES:

The objective of the study was to assess the compatibility of donor’s blood with recipient blood by microtyping gel technique and conventional tube technique and comparison of advantages and disadvantages of the two techniques.

MATERIALS AND METHODS:

This observational, cross-sectional study investigation was carried out in a tertiary care facility’s blood bank for 1½ years. It was decided to compare the effectiveness of the traditional tube and gel techniques.

RESULTS:

In the current investigation, we evaluated the age of the study participants and found that the majority of the study participants were male (63.17%) and most of them were between the ages of 21 and 40 years. The men-to-women ratio in this study was 1.71:1. About 2300 blood samples were subjected to compatibility testing using both the traditional test tube technology and the microtyping gel technology. The conventional method and the gel card approach are equivalent in terms of sensitivity and specificity. However, the gel card approach is simple to use, quick, reliable, and allows for the recording of data. The spin saline tube approach, in comparison, takes longer and produces unreliable results. This makes the gel card approach preferable to the conventional method. The findings were examined.

CONCLUSIONS:

Although the conventional tube technology is still regarded as the gold standard for pretransfusion analysis, it nevertheless has several drawbacks and relies on the precise hand–eye coordination of the laboratory staff. We advise using the microtyping gel approach due to its ease of use, stability of outcomes, dispensing of controls and absence of washing process, and equivalent specificity and sensitivity.
Microsurgical techniques and tumor control in cavernous sinus meningiomas
Authors: Raju Bharath , Jumah Fareed , Nagaraj Anmol , Nanda Anil
Published: May 2024

Meningiomas are the most common tumors of the cavernous sinus (CS) and are one of the most challenging/formidable tumors to operate on due to the complex anatomy and rich neurovascular contents of the space. Parkinson's initial approach to this surgical “no man's land” triggered the interest in the microsurgical removal of tumors within this region over the next three decades. However, this initial enthusiasm to attempt complete removal of meningiomas has been met with exceedingly high surgical morbidity, especially cranial nerve palsies, and considerable mortality, predominantly due to vascular complications. The later introduction of radiosurgery and its excellent tumor control rate and minimal complications has allowed surgeons to select less invasive approaches such as primary radiosurgery or partial resection followed by radiosurgery. The authors aim through this work to discuss the relevant microsurgical anatomy, evolution of approaches, and techniques of CS meningioma excision including the endoscopic endonasal approach. We discuss the available alternatives and adjuvant management options, proposing an up-to-date multimodality treatment algorithm to optimize outcomes.
Surgical management of benign tumors at the foramen magnum region
Authors: Sekhar Laligam N. , Shenoy Varadaraya S. , Qazi Zeeshan
Published: May 2024

Tumors in the foramen magnum region are among the most challenging neurosurgical lesions to operate. They may be divided into intradural and extradural tumors, which have differing pathologies. Meningiomas represent the most common intradural tumor in this region. Anatomical constraints caused by adjacent critical areas of the brainstem, proximity to the lower cranial nerves (CNs), and vertebral arteries add to the complexity and make total tumor resection difficult without damaging the brain stem, CNs, or the vertebral artery and branches. This review article summarizes the surgical approaches and relevant anatomical landmarks with illustrations at each step. We also illustrate with example cases, the decision-making process and highlight key strategies for the safe resection of these tumors.
Giant pituitary adenomas
Authors: Sharma Ravi , Suri Ashish
Published: May 2024

Giant pituitary adenomas (GPAs) are a subset of pituitary tumors characterized by their large size and invasive nature. Diverse surgical techniques including microscopic transsphenoidal, endoscopic transsphenoidal, transcranial transcavernous, and a combination of both suprasellar and infrasellar techniques have been developed to treat such giant tumors with extension into surrounding structures. In this review, we attempt to summarize the different operative strategies, nuances, the pearls and pitfalls of different techniques, and the outcome following surgery for GPAs.
Bony Calvarial and Skull Base Tumors
Authors: Dwarakanath Srinivas , Deora Harsh
Published: May 2024

The calvaria or skull vault, in general, has a limited spectrum of oncological disorders which are both unique to it and ubiquitous throughout the body. Lesions of the calvarium may originate from the bony structures or may be secondary to an invasion of scalp-based lesions or brain-based lesions into the skull vault. A PubMed/Medline search was conducted using the MESH keywords “Calvarial tumors”, “Bony tumors”, “Skull base bony lesions” and all reported cases and series were collected, and relevant details extracted from the same. Data were extracted concerning the type of study, the number of cases, follow-up duration, the primary treatment offered, details of adjuvant therapy, overall survival, and recurrence rates where relevant. All data were then tabulated and reviewed. Cases showing relevant information on treatment modalities and their effect on outcomes and survival were only included. A total of 1020 results were found on the PubMed database (until March 2021) and after duplicates removal, a total of 9 studies were found to be relevant for calvarial tumors with 1 case series and 4 retrospective reviews of intraosseous meningiomas which included 2 review papers as well. Most of these results were either retrospective case series or case reports along with a single systematic review of intraosseous meningioma. The primary treatment modality in almost all cases was either surgery or biopsy followed by adjuvant radiotherapy. The skull base and cranial vault is a Pandora's box of malignancies with varied shapes and appearances. Presentation is either due to pressure symptoms or swellings, and whenever accessible, complete excision offers the best management. Imaging findings are of germinal importance and help differentiate lesions, which often decides management. When in doubt, a biopsy may offer the best solution. Bony reconstruction and adjuvant therapy with close follow-up often decide prognosis.
Complications of stereotactic radiosurgery
Authors: Tripathi Manjul , Deora Harsh , Gupta Sunil K
Published: May 2024

Gamma knife radiosurgery (GKRS) is a popular radiosurgical tool for various benign and malignant intracranial pathologies. Our objective was to evaluate the spectrum of complications of GKRS, the timeline of adverse events, and the outcome following the radiosurgical intervention. We systematically searched for articles related to various complications using the following keywords: “Vascular complications”, “Gamma-knife”, “stereotactic”, “radiosurgery”, “complications”, “edema”, “vascular changes”, “malignancy”, and “alopecia”. The literature was separately evaluated for 'early ' (within 12 weeks of GKRS)' or 'delayed' (after 12 weeks of GKRS) sequalae. We separately evaluated the relevant animal studies for literature analysis, and for the histopathological changes that take place after radiosurgery. Following the systematic analysis, 543 articles were evaluated. With the predetermined criteria, we identified 36 studies detailing 72 cases. Vascular complications, radiosurgery induced malignancy, radiation necrosis and radiation induced edema were the major reported complications. A delayed hemorrhage after a latency period was the most common complication while administering GKRS for arteriovenous malformations. A repeat radiosurgical intervention was identified as the significant factor responsible for delayed hemorrhage. Post-radiosurgery intratumoral hemorrhage was observed in meningiomas, vestibular schwannomas, pituitary adenomas, pineocytomas and cerebellar astrocytomas. Following the administration of single fraction stereotactic radiosurgery (SRS) for brain metastases, necrosis was observed in 5.2% patients at 6 months, in 17.2% at 12 months, and in 34% patient population at 24 months. Delayed occlusive or proliferative vasculopathy, malignancy, necrosis and edema are rare, albeit probable, complications that occur after GKRS. There are no definite identifiable markers for determining the probability of developing these complications. The risks of radiosurgery-induced complications are more in patients with a history of prior radiation therapy, a large tumor volume, and the usage of non-conformal dose plans. The risk of radiation-induced tumour formation after a single-function radiosurgery is very low and should not be used as a reason to choose alternative treatment strategies for appropriate patients. The clinician should explain these probable risks to the patient before considering GKRS as a treatment option.
Balloon dacryoplasty: A boon for dacryologists in managing persistent congenital nasolacrimal duct obstructions
Authors: Singh Manpreet , Kaur Manpreet , Grewal Aditi Mehta , Abhaypal Khushdeep , Sharma Manjula , Anjum Nazia , Malik Meenakshi
Published: May 2024

Purpose:

To study the outcomes of balloon dacryoplasty (BD) or (BDCP) in children with persistent congenital nasolacrimal duct obstruction (pCNLDO) by using new and reused balloon catheters.

Methods:

Our retrospective analysis focused on managing pCNLDO by using the BD or BDCP technique. The study included children aged >1 year to <12 years who underwent single or multiple probings before. Our specific lacrimal workup included a detailed history and examination, as published earlier. We used conventional, straight, 2 mm × 13 mm/3 mm × 15 mm lacrimal balloons (FCI, Ophthacath). We have described a technique to use the same catheter for three BD procedures (1 new + 2 reuse). The outcomes were categorized as complete success, partial success, and failure. The minimum follow-up of each child was 6 months.

Results:

We analyzed 64 children (89 eyes) with a mean age of 58 months (15–132 months). All children (100%) had epiphora with discharge and positive FDDT. All children underwent BD under general anesthesia – new balloons in 59 eyes and reused balloons in 30 eyes. The balloons were plasma sterilized akin to vitrectomy cutters and tubings of phaco machines. We noted three leaks from reused balloons (2 from the balloon tip and 1 from the plastic hub). At a mean follow-up of 14.5 months, complete success was noted in 77 eyes (86.5%) (52 new and 25 reuse), while 8 eyes had partial success (8.9%) (4 new and 4 reuse). Failure of BD was noted in four eyes (4.5%) (3 new and 1 reuse). None had significant complications with new or reused balloons.

Conclusion:

BD or BDCP is a quick, safe, easy, and effective procedure that resolves pCNLDO symptoms satisfactorily. Carefully reusing a conventional balloon catheter is possible with comparable efficacy and no additional complications in pCNLDO.
Lid-wiper keratopathy and mucous membrane grafting
Authors: Singh Prabhakar , Tiwari Pragati , Biswas Saranya , Raj Amit
Published: May 2024

Background:

A healthy lid-wiper is an important component of a healthy ocular surface. Any abnormality or irregularity of the lid wiper can potentially damage a relatively healthy ocular surface. Stevens–Johnson syndrome, toxic epidermal necrolysis, and ocular cicatricial pemphigoid are some of the examples that can result in lid-margin keratinization during the course of the disease. These permanent changes at the lid margin mechanically abrade the corneal surface and facilitate corneal neovascularization. The corneal clarity is lost over time, and the patients have corneal blindness.

Purpose:

This video discusses the role of a healthy lid-wiper, conditions causing lid-margin keratinization and subsequent lid-wiper keratopathy, and surgical technique in mucous membrane grafting.

Synopsis:

The video demonstrates the technique of restoration of a healthy lid margin by doing a mucous membrane graft for lid-margin keratinization and its role in the prevention of corneal blindness.

Highlights:

Lid-margin keratinization is essentially a chronic sequela and is often ignored till irreversible corneal changes develop. Early intervention in the form of mucous membrane grafting can prevent corneal vascularization and loss of corneal clarity.

Video link:

https://youtu.be/NGMlqUp_qLU
Navigating a world in conflict: The mental health implications of contemporary geopolitical crises
Authors: Ventriglio Antonio , Ricci Fabiana , Torales Julio , Castaldelli-Maia João Mauricio , Bener Abdulbari , Smith Alexander , Liebrenz Michael
Published: May 2024

Throughout history, armed conflicts have profoundly affected individuals and societies, with recent events in Ukraine, the Middle East, and beyond bringing into sharp focus the severe mental health and humanitarian consequences of geopolitical crises. Such situations often result in mass fatalities, destruction, displacement, forced migration, and other critical life events. Amid these scenarios, the adverse outcomes for mental health and well-being in both the short and long term must be emphasized. As a conceivable example of the latter, the proposed concept of intergenerational trauma could have far-reaching implications. In particular, in certain regions, civilians have repeatedly experienced instances of violence and may have continually been exposed to critical life events and traumatic stress. In this context, the consequences of these events for individual well-being and global mental health will likely be registered for years to come. Accordingly, urgent help and actions to address the mental health burdens within contemporary conflicts should be accentuated in humanitarian, political, and diplomatic interventions. Equally, health policies must adopt a long-term approach to support initiatives under the purview of global and public mental health objectives.
Tuberculous Empyema Necessitans – Case Series
Authors: Natraj M. , Parveen Nisha , Vignesh S.
Published: May 2024

Empyema necessitans (EN) is a rare complication of untreated pleural infection. Tuberculosis is the most common cause. It can be found in both immunocompromised and immunocompetent patients, especially in endemic areas. Diagnosis can be challenging due to long duration and indefinite symptoms. Here, we present a case series of three patients with EN.
Anterior Chest Wall Sarcoma: An Aggressive Tumor
Authors: Rajeev Vyshnavi , Mehrin Riha , Lawrence Ria , Narasimhan Aarthi
Published: May 2024

Patients with chest wall tumors present diagnostic and therapeutic challenges. The differential diagnosis of these tumors is broad because they can present a heterogeneous spectrum of diseases such as primary benign or malignant tumors, metastasis, local extension of adjacent tumors, and infectious or inflammatory conditions. Among that, primary chest wall tumors are rare.
A Case of Quadrivial Pattern of Right Upper Lobe Bronchus
Authors: Deivasigamani Mohanakrishnan , Chockalingam Chandrasekar , Santhalingam Balamurugan , Nagesh Manikandan
Published: May 2024

The knowledge of the tracheobronchial tree is fundamental for a bronchoscopist, especially for diagnostic, therapeutic, and surgical options that are under consideration. Among all lobes, the right upper lobe (RUL) has a relatively high incidence of tumor and airspace diseases. Most bronchial anomalies are on the right side. Bifurcation is the most common anatomical variation. Quadrification has a very low prevalence. We report the case of a 54-year-old male who came with complaints of hemoptysis and showed a quadrivial type of bronchial division of RUL during a bronchoscopic examination after which three-dimensional computed tomography bronchography showed a supernumerary lateral or axillary segment bronchus. Awareness of this variant may explain otherwise confusing findings and its clinical implication is important for every pulmonologist.
Role of Pleural Fluid Lactate Dehydrogenase to Adenosine Deaminase Ratio in the Etiological Differentiation of Exudative Pleural Effusion
Authors: Indhu S. , Mohanraj S , Chaitanya Vishnu , Patrudu B. M. S.
Published: May 2024

Background:

Although pleural fluid adenosine deaminase (ADA) level >70 U/L suggestive tuberculous pleural effusion (TPE). High ADA levels can also be seen in pneumonia, empyema, lymphoma, malignancy, and rheumatoid pleuritis. Elevated pleural fluid lactate dehydrogenase (LDH) is seen in tubercular pleural effusion (TPE), parapneumonic pleural effusion (PPE), and malignant pleural effusion (MPE). Therefore, it is challenging distinguish between TPE, PPE, and MPE based on elevated pleural fluid ADA and LDH levels. In this study, we evaluated the use of pleural fluid LDH/ADA ratio as a new parameter for etiological differentiation of exudative pleural effusions.

Materials and Methods:

A retrospective hospital-based observational study conducted in GHCCD, Visakhapatnam. A total of 52 patients (TPE – 19, PPE – 16, and MPE – 17) with exudative pleural effusion who fulfilled inclusion criteria were taken into study. Qualitative variables have been described in the form of frequency and percentages. Median and interquartile ranges were used for nonnormal distribution values. Receiver operating curve (ROC) curves with area under the curve (AUC) were calculated. P ≤ 0.05 was considered statistically significant.

Results:

The mean ADA value for TPE was 75.4 U/L (25–195 U/L), PPE was 59.1 U/L (13–180 U/L), and for MPE was 35.52 U/L (10–75 U/L). The mean LDH value for TPE was 887.8 U/L (139–2213 U/L), PPE was 1128 U/L (334–3110 U/L), and for MPE was 1470 U/L (234–4285 U/L). On ROC analysis, pleural LDH/ADA ratio ≤20.81 diagnose TPE with (sensitivity – 84.2%, specificity – 63.6%) with AUC of 0.758 (95% confidence interval [CI]: 0.619–0.866) (P = 0.0001) whereas LDH/ADA ratio in the diagnosis of PPE was found to be >23.39 (sensitivity – 50%, specificity – 66.7%) with AUC of 0.535 (95% CI: 0.391–0.674) (P = 0.689) and the cutoff LDH/ADA ratio in the diagnosis of MPE was found to be >20.86 (sensitivity – 70.6%, specificity – 68.6%) with AUC of 0.724 (95% CI: 0.583–0.839) (P = 0.007). The cutoff value of the LDH/ADA ratio in PPE does not reach the statistical significant value.

Conclusion:

Pleural fluid LDH/ADA ratio ≤20.81 U/L is predictive of TPE, and >20.86 U/L is predictive of MPE and the cutoff value of 20.8 U/L can be used for etiological differentiation of pleural effusion.
Evaluating the Renal Toxicity Profile of Moringa oleifera Seed: Associating its Wide Consumption with Renal Failure – Subacute In vivo Study
Authors: Ezemagu Uchenna Kenneth , Okafor Chiagozie C. , Anibeze Chike P. , Ojobo Chioma M. , Okechukwu Getrude N. , Ezemagu Eunice I.
Published: May 2024

Background:

The alarming rate of kidney failure in Africa and Asia could be associated with wide levels of consumption of Moringa oleifera seed preparations in the continent.

Objectives:

The study aims to ascertain the phytochemicals in aqueous and ethanol extracts of M. oleifera seed and determine how its consumption affects the histopathology and function of the kidney.

Materials and Methods:

Albino rats (32) about 7 weeks old and weight, 120 g each, were divided into Groups 1–8, using nonprobability sampling technique. The rats in Groups 2–8 were fed daily, 100 mg, 200 mg, 400 mg, 800 mg, 1600 mg, 3200 mg, and 6400 mg/kg body weight of M. oleifera seed powder dissolved in 2 mL of distilled water, respectively, for 9 days, with the aid of a syringe and cannula. Group 1 (control) received 2 mL of distilled water daily. On the 8th day, two rats were randomly selected from Group 8 and fed with 15,000 mg/kg body weight (Group 9).

Results:

The seed has moderate alkaloids, saponins, glycosides, and terpenoids concentrations, and it is rich in carbohydrates, protein (aromatic amino acids), and oil. The renal tissues of rats in Groups 3–9 were distorted and necrosed. The rats in Groups 6–9 had an appreciable reduction in concentrations of blood creatinine and urea, and mortality was recorded in Groups 8 and 9.

Discussion and Conclusion:

Although subacute consumption of 100 mg/kg body weight daily of M. oleifera seed could not distort the renal architecture, blood electrolytes, creatinine, or urea concentration of the rats, relatively high-grade level of consumption could precipitate renal failure. An urgent need to standardize the consumption of the seed preparations of the “miracle plant” is required.
Triorchidism: A Differential Diagnosis of Inguinal Swelling in a 28-Year-Old Male
Authors: Nuveen A. K.
Published: May 2024

Polyorchidism, more than two testicles, is a rare congenital anomaly of urogenital system. In majority of the cases, supernumerary testis is located intrascrotally. However, testis in the retroperitoneal space is reported rarely. About 50% of cases are detected between 15 and 25 years of age. In this case report, we present a case of triorchidism in a 28-year-old male who came with a complaint of left groin swelling.
Role of Vermal Anteroposterior Length and Width in Age Determination of Fetus
Authors: Ahmad Nadia , Singh Deepa , Jethani Sunder Lal
Published: May 2024

Background:

Early differentiation of the cerebellum during fetal life makes it the center of interest in the field of obstetrics and gynecology. Moreover, the cerebellar vermis develops a little ahead of the hemispheres. Hence, the morphological parameters of the vermis can be a guide to ascertaining gestational age and assessing any anomalies related to posterior cranial fossa development.

Aims and Objectives:

The study was taken up with the objective of building up a timeline for the appearance of folia and important fissures. Moreover, establishing a correlation between the growing fetus and vermal parameters.

Material and Methods:

A total of 60 human fetal fixed cerebella were included in this observational and descriptive type of study. Fetuses affected with any congenital or neurological deficit were excluded. Grouping of the fetuses was done, based on their gestational age in weeks. The first group from 13-17 weeks, the second group from 18-22weeks, the third group from 23-27 weeks, and the fourth group from 28-32 weeks.

Observation:

Time of appearance of folia and fissures were noted. Vernier calipers were used to measure vermal width and anteroposterior length. Statistical tools like IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp. and one-way analysis of variance were applied to the data obtained.

Conclusion:

A posterolateral fissure appeared at 13 weeks of gestation while folia and other fissures appeared from the 18th week onwards. Both the parameters of vermis showed a linear correlation with gestational age. Such a timeline and correlation shall prove to be helpful in calculating fetal age in the field of forensic studies.
Spinal extradural meningioma: Report of two cases
Authors: Redhu Rakesh , Pavithra H. N.
Published: May 2024

Purely extradural spinal meningiomas are rare and often confused with metastases and schwannomas. Only a few cases have been described in the literature, and they are located mainly in the cervical and dorsal regions. We present two cases of extradural meningiomas, one well-defined nodular growth present at a cervicodorsal junction that was confused with schwannoma preoperatively and the other typical meningioma extending both intra and extradurally in the upper dorsal spine.
Posterior vertebral column resection: Exploring practical uses in clinical settings
Authors: Çaçan Mehmet Akif , Birinci Murat , Mertsoy Yilmaz , Uzel Kadir , Bostanci Bilal , Uçar Bekir Yavuz
Published: May 2024

Background:

The purpose of this study was to present our experience in patients who had been treated with posterior vertebral column resection (PVCR) for various spinal deformities.

Methods:

Thirty-seven patients who performed PVCR between 2015 and 2018 were evaluated retrospectively. The mean follow-up period was 24 months (range: 12–50 months). The demographic data of the patients, mean blood loss, amount of blood replacement, duration of operation, intensive care and hospitalization period, PVCR level, instrumentation level, amount of preoperative curvature, amount of postoperative curvature improvement, preoperative and postoperative neurological status, and complications were examined. Angular measurements were performed on X-ray.

Results:

The mean age of the patients was 37.5 years (range: 3–80 years). PVCR was applied to patients due to different pathologies (congenital, tumor metastasis, posttraumatic kyphosis, revision scoliosis, and infection). The mean operation time was 445.5 min (260–720) with an average blood loss of 1903 ml (400–7000 ml). It was observed that the average local kyphosis angle decreased from 67.65° to 7.42° in 26 patients who were operated for advanced deformity (P < 0.001). When these values were compared in all 34 patients, the preoperative angle value decreased from 55.1° to 3.5° (P < 0.001) and decreased from 70° to 0° in 13 congenital kyphosis patients.

Conclusion:

PVCR is an effective method for correcting severe spinal deformities and can be used to correct curvature in different patient groups.

Level of Evidence:

Level 3.
Understanding spinal gout: A comprehensive study of 88 cases and their clinical implications
Authors: Nazwar Tommy Alfandy , Bal’afif Farhad , Wardhana Donny Wisnu , Panjaitan Christin
Published: May 2024

Background:

Spinal gout, a rare and often underdiagnosed condition, significantly impacts patients’ quality of life. Therefore, the aim of the research is to analyze cases of spinal gout, including clinical features, anatomical location of spinal gout, laboratory studies, imaging studies, treatment choices, and outcomes from various cases of spinal gout.

Methods:

The author conducted a systematic literature search in the PUBMED and Science Direct databases from 2013 to 2023. We included clinical case presentations of spinal cases in adults, published in English. The three researchers independently reviewed the title and abstract of each article, and any differences in opinions were resolved through consensus. The extracted data were subsequently analyzed descriptively.

Results:

A total of 88 cases of spinal gout were obtained and studied. Out of the total reviewed cases of spinal gout, 89.77% of the subjects were male, with an average age of 51.9 years (age range 16–87 years). Common symptoms include back/neck pain (78.41%) and lower extremity weakness (37.50%). The lumbar spine is the most frequently affected region (62.50%), diagnosed primarily through magnetic resonance imaging (MRI) scans. Surgery, performed in 61.36% of cases, commonly involves decompressive laminectomy. Posttreatment, symptoms resolve in 87.50% of cases.

Conclusion:

Cases of spinal gout present with a variety of symptoms, including back pain and weakness. Diagnosis typically involves an MRI examination and synovial fluid analysis for confirmation. Treatment varies and includes medication therapy and surgical interventions. A deeper understanding of these cases can assist healthcare practitioners in the management and diagnosis of spinal gout cases.
Calcified Thoracic Disc – A descriptive classification with clinical and management implications
Authors: Haleem Shahnawaz , Adlan Amirul , Azzopardi Christine , Botchu Rajesh
Published: May 2024

Introduction and Objective:

Thoracic disc calcification is a radiological finding which may be incidental or diagnosed in patients presenting with myelopathy due to spinal cord compression. We performed a study to analyze the imaging patterns of calcified thoracic discs (CTDs).

Patients and Methods:

A retrospective review of the spinal and radiology database of a tertiary referral orthopedic hospital was conducted for the incidence of CTDs between 2007 and 2020. Patients’ demographics and radiological findings were recorded. The relationship between disc size, morphology, spinal cord compression, and management was assessed.

Results:

Fifty-one cases of CTDs were identified. The mean size of CTD was 806.2 mm3 (range: 144–2340). The most common level of disc calcification was T9–T10 (24%) in 12 patients. Thoracic disc calcifications in our series commonly involved disc “protrusion” in 67% (34 patients), followed by “mushroom” type in 31% (16 patients) and “extrusion” in 2% (1 patient). 37% (19 patients) had spinal cord compression with 12% (6 patients) undergoing surgical interventions. There was no statistically significant difference in the mean sizes of CTD between the groups with and without spinal cord compression (P = 0.566, independent sample t-test). Patients with “mushroom” type calcification were more likely to have surgical intervention (P = 0.01, Fisher’s exact test).

Conclusion:

Thoracic disc calcifications, while common, can still be underdiagnosed till late myelopathic deterioration. Care of the elderly physicians, spinal surgeons, and radiologists need to be aware of them to guide diagnosis and management. Our study demonstrates that disc morphology plays a vital role in myelopathic presentation and therefore determines the need for surgical intervention instead of the absolute size of disc calcification.
A systematic review of risk factors and adverse outcomes associated with anterior cervical discectomy and fusion surgery over the past decade
Authors: Rai Vikramaditya , Sharma Vipin , Kumar Mukesh , Thakur Lokesh
Published: May 2024

Background:

Anterior cervical discectomy and fusion (ACDF) is one of the most frequently performed cervical surgeries in the world, yet there have been several reported complications.

Objective:

To determine the actual incidence of complications related to ACDF as well as any risk variables that may have been identified in earlier research.

Methods:

To evaluate the origin, presentation, natural history, and management of the risks and the complications, we conducted a thorough assessment of the pertinent literature. An evaluation of clinical trials and case studies of patients who experienced one or more complications following ACDF surgery was done using a PubMed, Cochrane Library, and Google Scholar search. Studies involving adult human subjects that were written in the English language and published between 2012 and 2022 were included in the search. The search yielded 79 studies meeting our criteria.

Results:

The overall rates of complications were as follows: Dysphagia 7.9%, psudarthrosis 5.8%, adjacent segment disease (ASD) 8.8%, esophageal perforations (EPs) 0.5%, graft or hardware failure 2.2%, infection 0.3%, recurrent laryngeal nerve palsy 1.7%, cerebrospinal fluid leak 0.8%, Horner syndrome 0.5%, hematoma 0.8%, and C5 palsy 1.9%.

Conclusion:

Results showed that dysphagia was a common postoperative sequelae with bone morphogenetic protein use and a higher number of surgical levels being the major risk factors. Pseudarthrosis rates varied depending on the factors such as asymptomatic radiographic graft sinking, neck pain, or radiculopathy necessitating revision surgery. The incidence of ASD indicated no data to support anterior cervical plating as more effective than standalone ACDF. EP was rare but frequently fatal, with no correlation found between patient age, sex, body mass index, operation time, or number of levels.