bluuebunny/crossref_metadata_2025 huggingface dataset:
Continuous Analgesia through an Extrapleural Catheter: Ropivacaine Alone versus Ropivacaine with Fentanyl
Authors: Kabir Kaushal , Bharang Madhuri , Gill Brejendra Singh , Sharma Aseem , Arora Kishore Kumar
Published: April 2024

Introduction:

Thoracotomy incision causes severe debilitating pain. Local anesthetic infusion in extrapleural paravertebral space via a catheter is a good alternative for postoperative analgesia for such patients. The addition of fentanyl to the local anesthetic infusion may further augment the analgesic efficacy of this technique. The aim was to compare the analgesic efficacy of 0.375% ropivacaine with fentanyl and without fentanyl via extrapleural paravertebral catheter (EPVC) for continuous postoperative analgesia.

Materials and Methods:

This prospective comparative study included 40 patients aged 18–60 years belonging to the American Society of Anesthesiologists (ASA) Grade I, II, and III posted for thoracic surgery. All the patients received general anesthesia as per the standard institutional protocol, and intubation was done with an appropriate size double-lumen endotracheal tube after giving muscle relaxant. An extrapleural catheter was inserted by the surgeon under direct vision external to the parietal pleura just before thoracotomy closure. Patients were randomly allocated to receive an infusion of 0.375% ropivacaine at 0.15 ml/kg/h in Group R or 0.375% ropivacaine with fentanyl 2 mcg/ml at 0.15 ml/kg/h in Group R.F. The dose or rate of infusion was decreased after 2 days or chest drain removal as the pain subsided. Postoperatively, the pain was assessed using a Visual Analog Scale (VAS) at 1, 6, 12, 18, 24, 48, and 72 h after the surgery. Patients who complained of pain with a VAS score of more than or equal to 4 were given injection tramadol 1 mg/kg as rescue analgesic. The peak expiratory flow rates (PEFRs), hemodynamic parameters, and incidence of any adverse effect were compared between groups.

Results:

The analgesia duration was comparable in the two groups (3.46 h in Group R vs. 4.60 h in Group R.F, P = 0.091). The mean VAS score at rest as well as during cough was comparable between the two groups (P > 0.05). There was no statistically significant difference in the mean PEFRs between the two groups.

Conclusion:

Fentanyl 2 μg/ml does not increase the duration of analgesia when combined with ropivacaine 0.375% for continuous EPVC infusion.
A Retrospective Analysis of Diagnostic Accuracy of Frozen Sections Compared to Permanent Sections: A 5 Years Study in A Single Tertiary Care Hospital In South Delhi
Authors: Trisal Monal , Jairajpuri Zeeba S. , Khetrapal Shaan , Rana Safia , Mohroo Rubeena , Bushra  , Nakra Rhea , Khan Shazia , Jetley Sujata
Published: April 2024

Introduction:

Intraoperative frozen section pathology consultation has long been applied to verify/categorize a lesion, evaluate surgical margins, determine the organ of origin, and assess tissue adequacy for further diagnostic studies. Correlation of intraoperative frozen section diagnosis with final diagnosis can be an important component of an institution’s quality assurance process. The aim of this study was to evaluate the concordance and discordance between frozen section and histopathology diagnosis and to assess the reliability and challenges associated with this rapid diagnostic method.

Materials and Methods:

A retrospective review of all intraoperative consultation in the Frozen Section and Histopathology Department of Pathology, Hamdard Institute of Medical Sciences and Research and Hospital, New Delhi from 1st January 2018 to 31st December 2022 was performed. During this five-year study period, a total of 185 patients from surgical departments underwent intraoperative consultation. The final diagnosis from the surgical pathology report was compared to the intraoperative consultation diagnosis.

Results:

Frozen section diagnoses were evaluated on all the 185 cases, with 88 cases identified as positive for malignancy and 97 cases as negative for malignancy. On subsequent histopathology paraffin sections, 92 cases were positive and 93 negative for malignancy. The comparison revealed an approximate result concordance of 97.0% and a discordance of 3.0%.

Conclusion:

Frozen section intraoperative consultation is a reliable rapid method for patient diagnosis and management. Monitoring diagnostic accuracy of intraoperative consultation provides substantial information towards the causes of the errors. Our study suggests that more accurate sampling, and knowledge about clinical history and presentation can reduce the limitation and increase the diagnostic accuracy thus avoiding technical errors and reducing result discordance.
Dermatoglyphic Patterns and Body Mass Indices among Medical Students in India: A Cross-sectional Study
Authors: Singh Arun , Singh Archana
Published: April 2024

Introduction:

Obesity is a disorder for which environment and genetic factors are responsible. Many genetical inherited disorders including obesity have been found to have an association with dermatoglyphics. The present study was done to know the dermatoglyphic patterns of fingerprints of obese and nonobese medical students.

Materials and Methods:

Fingers and palm prints of both the hands of 150 medical students of 18–24 years were collected with the help of ink pad on A4 size of paper. The fingers and palm prints were studied using handheld magnifying lens and their body mass index was calculated with the help of weight and height.

Results:

In the present cross-sectional study among 150 participants, 78 were male and 72 were female. In male participants, 46.15% were non-obese and 46.15% were obese, whereas 7.7% were underweight. Among 34 female participants, 47.22% were non-obese, 47.22% were obese, and 5.55% were underweight. In a total of 150 participants, the most common dermatoglyphic pattern was loop (49.73%) on the right side (in male it was whorl and in female loop) and whorl (48.27%) was on the left side (in male it was loop and in female it was whorl). In male participants with normal weight, the most common pattern was loop on the right side (49.45%) and whorl (48.33%) on the left side, whereas in nonobese female participants, whorl was the most common pattern on both right (48.24%) and left (50%) side. In obese male participants, whorl was the most common dermatoglyphic pattern on both the right (56.67%) and left side (51.11%), whereas in obese female participants, loop was the common pattern on both the side (57.64% in the right and 46.47% in the left).

Conclusions:

Whorls in both sides, i.e. the right and left hands palmer prints were most commonly found in obese males, whereas loops were most common in both the sides in obese females. Therefore, the presence of whorls and loops can be associated with the obesity in males and females, respectively, with the help of advanced studies to be carried out in the future and the generated hypothetical information can be tested.
Physical, Psychosocial, and Economic Burden of COVID-19 Disease: A Cross-sectional Study among Adult Population in an Urban Community of North 24 Parganas, West Bengal, India
Authors: Ghosh Sukanya , Mukhopadhyay Dipta Kanti , Das Nivedita , Pal Moumita , Kundu Sampurna
Published: April 2024

Introduction:

It has been observed that the symptoms and clinical sequelae of COVID-19 disease may develop and persist far beyond the initial illness, but there are limited data documenting this. The present study is planned to find out the physical, psychosocial, and economic burden of COVID-19 disease among the adult population in an urban community.

Materials and Methods:

This was a community-based, observational, cross-sectional study conducted among 106 adult individuals, who tested COVID-19 positive by rapid antigen test/reverse transcriptase–polymerase chain reaction between May 21 and October 21, residing in North Dum Dum municipality, N 24 Parganas. A predesigned pretested validated questionnaire was used to assess the physical and social burden of the disease by health-related quality of life (HRQoL) questionnaire, psychological burden by the Perceived Stress Scale, and economic burden in terms of the direct and indirect cost of care, job lost, reduction of income, and cost-cutting measures applied to daily life.

Results:

More than one-third of the study population had HRQoL compromised for almost 1/3 of the past month. The perceived stress was found out to be significantly associated (P < 0.05) with the severity of the disease. The reported median (interquartile range [IQR]) of the direct cost of care for COVID-19 disease was 7000.0 (4000.0–12,000.0) INR, whereas the median (IQR) indirect cost of care was 1250.0 (0–5000.0) INR. C

onclusion:

The severity of COVID-19 has a great impact on HRQoL, perceived, and economic burden of the disease.
Comparison of Post Operative Analgesic Efficacy of Dexamethasone as an Adjuvant with Ropivacaine 0.25% and Plain Ropivacaine 0.25%, Using Ultrasound Guided Tap Block after Total Abdominal Hysterectomy: A Randomized Controlled Trial
Authors: Parihar Ashutosh , Shukla Nidhi , Saxena Atul , Nigam Shuchi
Published: April 2024

Introduction:

Following abdominal surgery, transversus abdominis plane (TAP) block, a peripheral nerve block, can be a useful supplement to multimodal postoperative analgesia. The aim was assessment of postoperative analgesic effectiveness of 0.25% ropivacaine with 4 mg of dexamethasone on each side and 0.25% ropivacaine alone in the management of postoperative pain following total abdominal hysterectomy (TAH).

Materials and Methods:

Sixty adult patients planned for elective TAH with ASA Grades I–II under general anesthesia participated in this prospective, randomized, double-blinded study. Patients of Group A were given 20 mL of 0.25% ropivacaine on both the sides and Group B patients were given 20 mL of 0.25% ropivacaine with dexamethasone 4 mg on each side. The primary objective of this study was a comparison of Visual Analog Scale (VAS) scores between the groups and comparison of mean time of first rescue analgesia. The secondary objectives of this study were a comparison of hemodynamic parameters, postoperative analgesic requirement, patient satisfaction, and incidence of side effects.

Results:

VAS shows no discernible variation in 1 and 4 h after administration of block in Groups A and B. However, a significant difference appeared in VAS 8 h (P = 0.007), VAS 12 h (P = 0.000), and VAS 24 h (P = 0.000) after the administration of block between Groups A and B. The median time for first rescue analgesia was 2.75 h (interquartile range [IQR] = 1 h) and 5.8 h (IQR = 1.6 h) in Groups A and B, respectively, which was highly significant.

Conclusion:

We concluded that, after abdominal hysterectomy, dexamethasone added to ropivacaine TAP block tends to prolong postoperative analgesia and decrease the need for analgesics.
Estimation of vitamin D level in type 1 diabetic children
Authors: Ahmed Hassan Enas H. , Ahmed Yasser A. , Hassan Mostafa A. , Bashir Mohamed A.
Published: April 2024

Background and Aim

Previous studies have shown the relationship between children with type 1 diabetes and vitamin D. To evaluate the level of vitamin D in children with type 1 diabetes and the effect of low vitamin D level on the long-term blood glucose controls reflected by glycated hemoglobin.

Patients and methods

The study included 20 children who had already been diagnosed as having type 1 diabetes mellitus with vitamin D deficiency and 20 normal nondiabetic children as a control group. Full history taking, clinical examinations, and investigations for all children, including serum 25-hydroxy vitamin D level, were done.

Results

Vitamin D deficiency was present in ∼85% of children with type 1 diabetes compared with nondiabetic control, who showed good vitamin D level.

Conclusion

Type 1 diabetic children are associated with low vitamin D level. Perhaps infants supplemented with vitamin D level might be a safe and effective plan for decreasing the risk of type 1 diabetes and also may decrease and improve levels of glucose and glycated hemoglobin levels in type 1 diabetes mellitus.
Assessment of post-LASIK flap thickness created by mechanical microkeratomes by anterior segment optical coherence tomography
Authors: Amr Islam A.M. , Yousef Hassan S.E. , Ahmed Asaad N.
Published: April 2024

Background and aim

Laser-assisted in situ keratomileusis (LASIK) is the most popular refractive surgical operation for the correction of myopia, hyperopia, and astigmatism. Corneal flap creation is an essential step for the success of LASIK. The aim of the work is to evaluate the accuracy of the post-LASIK flap thickness created by mechanical microkeratomes using Anterior segment optical coherence tomography (ASOCT).

Patients and methods

This study included 60 eyes (of 30 patients), who underwent LASIK for refractive error correction. The patients were divided into two groups: (a) group A involved 30 eyes of 15 patients; in this group, the mechanical microkeratome Moria M2 (Moria M2, 110) was used. (b) Group B involved 30 eyes of 15 patients; in this group, the microkeratome Moria M2 (Moria M2, 100 with medlogic plano head) was used.

Results

As regards postoperative changes in flap thickness, the results of the current study showed that there were no considerable changes in thickness of the flap between 1 week, 1 month, 3 months, and 6 months postoperatively in either group.

Conclusion

Moria M2 100 with medlogic plano head created LASIK flaps with thinner thickness, and more predictability and more preservation of bed thickness than those created with the Moria M2 110.
Prevalence of pathological myopia in Upper Egypt
Authors: Ahmed Mohamed E.
Published: April 2024

Background and aim

Pathological myopia (PM) is one of the main causes of blindness globally, and its prevalence continues to increase rapidly over time. The aim of this study was to investigate the prevalence of PM in the clinical population in Assiut City, Upper Egypt, during a period of 1 year.

Patients and methods

This cross-sectional study was carried out on a clinical population attending a large ophthalmology center in Assiut City, Upper Egypt, during the period from January to December 2018. All patients were subjected to full ophthalmologic examination. The noncycloplegic refraction was measured using an autorefractometer. The examined eyes were diagnosed as PM if they had refraction of more than or equal to −6 D spherical equivalent or an axial length of more than or equal to 25.5 mm.

Results

The study included 1548 eyes of 812 patients. Pathologically myopic eyes represented 152 eyes, with a prevalence of 9.82%. Of the total included patients, 102 (12.6%) patients had at least one pathologically myopic eye. Patients with bilateral PM represented 73 (71.6%) cases. Their refractive error ranged from −6.0 to −26.0 D, with a mean of −13.24±4.13 D, and their mean axial length was 28.2±2.14 mm and ranged from 26.1 to 35.2 mm.

Conclusion

The prevalence of PM in the studied sample was 9.82%, which was obviously higher compared with studies on other populations. Further large community-based studies are warranted to determine its prevalence as a step to overcome this true burden.
A study of activated platelet by flow cytometry in diabetic patients with peripheral arterial disease
Authors: Abdel Wahab Maisa A. , Mohammed Shaymaa A. , Ahmad Inass H. , Elshennawy Salwa I. , Mostafa Sadek
Published: April 2024

Background and aim

Diabetes mellitus (DM) is a major risk factor for atherosclerosis that increases platelet activation and aggregation. Aim This study aimed to investigate the different types of platelet activation markers in diabetic patients with peripheral arterial disease (PAD).

Patients and methods

Using flow cytometry on forty noninsulin-dependent diabetic type II patients with PAD receiving antiplatelet therapy, participants were divided into two groups: those with controlled, uncontrolled DM and 20 control samples.

Results

There was a highly significant increase in mean platelet volume, CD62P%, CD62 mean fluorescence intensity, and CD63% in the uncontrolled DM group compared with the control group, in addition to a highly significant correlation between CD62P% and glycated hemoglobin in all cases, with a P value of 0.015.

Conclusion

The CD62P% is a more selective platelet marker that is activated in uncontrolled DM, causing atherosclerosis and leading to PAD. Glycemic control is the most important factor in the prevention of atherothrombotic progress than antiplatelet treatment.
Autonomic function assessment in Egyptian patients with Behçet's disease
Authors: Ali Anwar M. , Talaat Esraa A. , El Nazer Saber A.E.H. , Hasanein Manal M.
Published: April 2024

Background

Behçet's disease (BD) is considered a chronic multisystem disorder, where neurological manifestations are common. There is scarcity of investigations that have assessed the autonomic nervous system dysfunction in BD, with conflicting results.

Objectives

The current study aimed to identify presence of autonomic nervous system dysfunction using neurophysiological assessment in BD and to investigate the relationship between the indicators of autonomic function and the disease activity parameters.

Patients and methods

The study involved 30 patients with BD in accordance with the Universal Criteria for Behçet's Diseases and 25 controls, who were subjected to clinical evaluation and Palmar sympathetic skin response (SSR).

Results

Patients with BD had a significant difference in SSR (P<0.001) compared with controls. Moreover, a significant positive association was found among neuropathic pain and disease activity parameters.

Conclusion

The study confirms the presence of sympathetic autonomic dysfunction in BD, which related to disease activity using a simple noninvasive test such as SSR.
Role of single-breath diffusing capacity for carbon monoxide in patients with chronic obstructive pulmonary disease
Authors: Abd-Allah Hamdy M. , Abdalla Hytham , Ahmed Shazly , Mohammed Mahmoud H.
Published: April 2024

Background

Chronic obstructive pulmonary disease (COPD) is a common, preventable, and treatable disease characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities, usually caused by significant exposure to noxious particles or gases. The chronic airflow limitation that characterizes COPD is caused by a mixture of small airway disease (e.g. obstructive bronchiolitis) and parenchymal destruction (emphysema), the relative contributions of which vary from person to person.

Aim

The aim of the study was to measure diffusing capacity for carbon monoxide using single-breath technique in different stages of COPD.

Patients and methods

A total of 100 patients with COPD with mild to very severe obstruction were included in the study.

Results

There was a statistically significant negative (inverse) correlation between both transfer capacity of the lung (TLCO%) and KCO and PCO2 and HCO3, and there was a statistically significant positive (direct) correlation between both TLCO% and KCO and PO2, and arterial oxygen saturation. There was a statistically significant positive (direct) correlation between forced vital capacity %, forced expiratory volume in 1 s%, forced expiratory flow (FEF)25%, FEF50%, and FEF75% and each of TLCO% and KCO.

Conclusion

Decline in forced expiratory volume in 1 s/forced vital capacity is associated with decline in diffusing capacity of the lung for carbon monoxide, and it is affected more in patients with severe and very severe degrees of chronic obstructive pulmonary disease (COPD).
Assessment of right ventricular function after successful percutaneous coronary intervention to chronic total occlusion using different echo-Doppler modalities
Authors: Zaki Eman R.
Published: April 2024

Background and aim

Chronic total occlusion is a common condition in patients with coronary artery disease and represents one of the most challenging targets of lesion recanalization with successful percutaneous coronary intervention (PCI). Different echo-Doppler modalities can be used for the assessment of right ventricular (RV) performance in patients undergoing PCI with reported superiority of the newer modalities. The aim was to assess the effect of successful PCI for chronic totally occluded vessel on the RV performance by different echo-Doppler modalities.

Patients and methods

The present study enrolled 25 patients with chronic total occlusion for whom PCI was performed. Patients were subjected to history taking, clinical assessment, 12-lead surface ECG, and evaluation of RV functions before, within 48 h after successful PCI, and 1 month later, using conventional and new echo-Doppler modalities. Echo-Doppler parameters included RV dimensions, Doppler flow velocities (E, A, and E/A) across tricuspid valves, RV fractional area change (RV-FAC), tricuspid annular plane systolic excursion, tissue Doppler systolic, and diastolic velocities (Sa, Ea, and Aa) at the lateral tricuspid annulus, in addition to evaluation of RV global longitudinal strain (RV-GLS).

Results

There was no significant improvement of parameters reflecting RV function comparing the pre-PCI and 48-h post-PCI values. On the contrary, significant improvement was detected comparing the echo-Doppler measures of either the pre- or 48-h PCI value with those of 1 month later. There was a significant increase of RV-FAC, tricuspid Sa and Ea, and RV-GLS (P<0.05). The E/A ratio of tricuspid flow and tricuspid annular plane systolic excursion showed no significant difference from pre- to 48 hr or 1-month PCI value.

Conclusion

RV performance improves after successful PCI of chronic totally occluded vessels. Newer echo-Doppler modalities appear to be better tools for assessment of RV performance.
Evaluation of serum sodium levels and mean platelet volume in children with community-acquired pneumonia
Authors: Hamed Amira Mohamed , Ibrahim Mohamed Fahmey , Fayed Hamada Kawshty , Abd EL-Meguid Mona Mohamed , Hassen Shimaa Esmail
Published: April 2024

Background and aim

Community-acquired pneumonia (CAP) is one of the frequent causes of hospital admission, whereas hyponatremia (HN) is a common electrolyte abnormality in hospitalized patients and is associated with considerable morbidity and mortality. Mean platelet volume (MPV) may be a useful predictor for the diagnosis of CAP but not in disease severity. The purpose of this study was to evaluate serum levels of sodium and MPV in a child with CAP.

Patients and methods

This is a case–control study that has been carried out in a Malawi General Hospital. The total (100) participants included in the study were classified into two groups as follows: group I which is the case group included 50 children with clinical and laboratory evidence of pneumonia ranging from 1 month to 3 years. Group II which is the control group included 50 children (apparently healthy control) who attended for nonchest problem or serious medical condition. Serum sodium levels, hemoglobin levels, MPV, platelet count, total leukocyte count, and C-reactive protein were done to all children.

Results

HN was present in 82% of patients with CAP (41 out of 50). Patients with CAP had lower MPV than their healthy counterparts (7.11±0.42 vs. 9.14±1.04 fl; P<0.001). There was a statistically significant negative correlation between the grade of respiratory distress and the level of serum sodium and a positive correlation between the grade of respiratory distress and MPV (P<0.001).

Conclusion

HN is common among hospitalized children with CAP and MPV may be a useful predictor for the diagnosis of CAP.
Comparative study between hysteroscopy and transvaginal ultrasound in evaluation of unexplained infertility
Authors: EL-Darwish Abd-Elaziz , EL-Rashidy Mahmoud , Badawy Mahmoud , Mohammad Hend A.
Published: April 2024

Background

Three types of uterine factors have been implicated in infertility: leiomyomas, endometrial polyps, and intrauterine adhesions. Mechanisms of infertility have not clearly been elucidated; however, the end result is decreased endometrial receptivity and reduced likelihood of embryo implantation. Transvaginal sonography is a sensitive method for the evaluation of the uterine masses and abnormalities.

Objective

To evaluate the diagnostic accuracy of transvaginal ultrasonography in detection of intrauterine abnormalities compared with hysteroscopy in women with history of unexplained infertility.

Patients and methods

The study was conducted in infertility clinic of Al-Azhar Assiut University Hospital. A total of 30 cases were included in the study during the period between August 2018 and March 2019. The chief complaint of patients was unexplained infertility. All candidates underwent transvaginal ultrasound, and the uterus was examined in longitudinal and transverse planes (two-dimensional transvaginal ultrasound) and the three-dimensional transvaginal ultrasound), and hysteroscopic examination was done for all cases using general anesthesia.

Results

In our current study, using transvaginal ultrasound, we diagnosed 28 cases with abnormalities (nine intrauterine adhesions, seven fibroids, six polyps, four irregular endometrium, one case of endometritis, and one case of septum). By hysteroscopy, 27 cases were confirmed to have abnormalities (11 intrauterine adhesions, five fibroids, seven polyps, two endometritis, and two cases of septum).

Conclusion

Routine use of transvaginal sonography (two dimensional and three dimensional) in diagnosing uterine cavity abnormalities is satisfactory and consequently is becoming a basic tool in investigating infertile patients. Hysteroscopy which is the gold standard in investigating the uterine cavity should be used to confirm the findings of transvaginal sonography and also when transvaginal sonography gives doubtful results.
Role of the lung function test in asthmatic children admitted to Al-Azhar University (Assiut)
Authors: Hamed Amira M.M. , Mohammed Mohammed F. , Awad Khaled H. , Abdel-Rahman Yousry A.A.H.
Published: April 2024

Background and aim

Lung function, especially spirometry, is an important investigatory tool in the evaluation of asthma in children. This study aimed to compare the clinical condition of asthmatic children using the lung function test before and after treatment and after 3 months as a follow-up of asthmatic patients admitted to Al-Azhar Assiut University Hospital.

Patients and methods

This clinical study was a prospective study that included 60 asthmatic children aged 6–16 years with bronchial asthma plus 30 children matched for age, sex and nutritional status as a control group over a period of 13 months from December 1, 2019 to December 31, 2020.

Results

The age of the children included in this study was found to be mean±SD 9.033±2.843, with a male predominance (male : female ratio 58% : 42%) and a positive family history of asthma (61%) and other allergic disorders (65%). There was a statistically significant change in forced expiratory volume at first second (FEV1), forced vital capacity (FVC), and the FEV1/FVC ratio that showed considerable improvement in both age groups at admission, after receiving the suitable treatment and at follow-up 3 months after discharge.

Conclusion

Pediatric asthma is a major clinical concern and represents a huge burden on the family and society, hence the importance of prompt and early diagnosis that includes lung function testing, especially FEV1, FVC, and FEV1/FVC ratio, in not only diagnosis but also for monitoring the efficacy of treatment and follow-up.
Bile leak following T-tube removal
Authors: Shemy Gamal G. , Hassan Ahmed M. , Elias Abd Al-Kareem
Published: April 2024

Background and aim

and objectives T-tube choledochostomy is performed following open or laparoscopic common bile duct exploration. There is increased concern regarding safety and efficiency of choledochostomy. The present paper evaluates the short-lived effectiveness and safety of T-tube bile leak after its removal.

Patients and methods

A total of 86 cases of choledocholithiasis were admitted to Al-Azhar University Hospital, Assiut. They underwent cholecystectomy (open), choledochotomy, and T-tube choledochostomy. T-tube choledochography was performed 10 days after surgery, and removal of the tube was done after 12 days.

Results

Morbidities, mainly bile leak and peritonitis, were estimated. A total of 10 patients had evidence of radiological leak. Marked biliary reactions were noticed in six cases promptly following T-tube removal. Five of these cases had clinical peritonitis, treated conservatively. Only one patient had biliary peritonitis and required reoperation.

Conclusion

The operative use of T-tube choledochostomy has been in dramatical decline in the past 20 years (owing to the development and adoption of removal lesser invasive maneuvers of choledocholithiasis removal). Manipulation of T-tube (situation and extraction) is technically exigent. Intricacy and morbidity are critical; thus, it is recommended not to be performed as a routine maneuver. Easier options must be taken into account initially.
Gastric Mallory–Weiss tear after cardiopulmonary resuscitation
Authors: Esmat Rami , Wifi Mohamed-Naguib , Abdellatif Abeer A. , Alboraie Mohamed
Published: April 2024

Mallory–Weiss tear is a rare complication that could result following cardiopulmonary resuscitation, leading to vigorous upper gastrointestinal bleeding. We illustrate a case of an 84-year-old male patient, admitted to the hospital for investigation of lung nodules and bilateral pleural effusion. The patient developed cardiac arrest during pleural aspiration, and cardiopulmonary resuscitation was done, which was followed shortly by an attack of acute upper gastrointestinal bleeding. Urgent upper endoscopy revealed a mucosal tear with submucosal oozing of blood and two large vessels in its floor, which were successfully managed endoscopically with both injection and hemoclips. This case report emphasizes the importance of considering this potential complication, especially after performing a successful cardiac resuscitation.
Comparative study of the effect of intramyometrial carbetocin injection and rectal misoprostol on blood loss during myomectomy operations
Authors: Mohamed Ashraf H. , Saeed Ahmed M. , Taha Mohamed F.
Published: April 2024

Background and aim

Investigating the influence of intramyometrial carbetocin injections and rectal misoprostol on bleeding throughout myomectomy surgeries. Fibroids are firm benign tumors consisting of smooth muscle cells and fibrous connective tissues. Benign uterine leiomyomas (fibroids) are the commonest pelvic tumor in females, impacting 20–40% of all women, over the age of 35 and 50% of African–American women. This work aims to compare the effectiveness of intramyometrial carbetocin injections and rectal misoprostol on blood-loss amounts throughout myomectomy surgeries.

Patients and methods

A prospective randomized comparative study was performed on 120 females having myoma(s) recruited from the clinic. The 120 study participants were divided into three groups: group I involved 40 women who received intramyometrial injection of 100 µg of carbetocin, group II involved 40 women who received 400 µg of misoprostol, and group III involved 40 women who received nothing during the myomectomy operation.

Results

The mean blood loss was more in group III in comparison with misoprostol (group II) in comparison with carbetocin (group I) with a statistically significant difference among the three groups, it was 177.43±21.25 ml in group I, 238.00±43.87 ml in group II, and 288.00±29.72 ml in group III.

Conclusion

The usage of intramyometrial carbetocin injections throughout abdominal myomectomy surgery is more efficient in reducing the blood loss than the usage of rectal misoprostol than using nothing at all.
Two nitazoxanide-based quadruple regimens for eradication of Helicobacter pylori infection
Authors: Hassan Amro M. , Eid Khaled , Eliwa Khaled A.M. , Abdel-Gawad Muhammad
Published: April 2024

Background and aim

Eradication of Helicobacter pylori becomes an ongoing challenge worldwide because eradication rates of H. pylori are declining to less than 60% in some countries. As there is no acceptable definite long-standing used therapeutic regimen for H. pylori, clinicians are doing their best to find new regimens to improve eradication rates of H. pylori. Nitazoxanid and fluoroquinolones, including moxifloxacin and levofloxacin, have been used in treatment of H. pylori. The study aimed to assess and compare the efficacy of two nitazoxanide-based quadruple regimens in treatment of patients infected with H. pylori.

Patients and methods

This prospective randomized controlled trial was conducted on 100 patients diagnosed to be infected by H. pylori by stool antigen test (one-step H. pylori Antigen test Device). They were randomized into two groups: group 1: 50 patients were treated for 14 days with quadruple therapy, including nitazoxanide, moxifloxacin, omeprazole, and doxycycline; and group 2: 50 patients were treated for 14 days with quadruple therapy, including nitazoxanide, levofloxacin, omeprazole, and doxycycline. Eradication of H. pylori was assessed 4 weeks after the end of treatment by stool antigen test (one-step H. pylori Antigen test Device).

Results

Eradication rate of H. pylori infection was higher in patients treated with nitazoxanide–moxifloxacin-based quadruple therapy 37 (74%) than in patients treated with nitazoxanide–levofloxacin-based quadruple therapy 32 (64%), but there were no significant differences between the studied groups with P value (P<0.28). By subgroup analysis of eradication rate among anemic and nonanemic patients treated by nitazoxanide–moxifloxacin and nitazoxanide–levofloxacin-based quadruple therapy, we found that eradication rate was higher in anemic patients 88% and 80% than nonanemic patients 60% and 45%, with significant P values 0.02 and 0.01, respectively.

Conclusions

Use of moxifloxacin instead of levofloxacin in the nitazoxanide-based quadruple regimen improves eradication therapy of H. pylori.
Immunohistochemical study of hepatocyte paraffin 1 antibody, monoclonal antibody 31, and cytokeratin 7 in primary and secondary liver carcinomas
Authors: Mohamed Said Abu-Alkhair
Published: April 2024

Background

Primary hepatic malignant epithelial neoplasia includes several different types of tumors, among which includes cholangiocarcinoma (CC), the second most frequent cancer of the liver after hepatocellular carcinoma (HCC). However, the most common hepatic epithelial malignant neoplasms are metastatic adenocarcinomas (AC). Hepatocyte paraffin 1 antibody (Hep Par 1) is a monoclonal antibody that reacts with normal and neoplastic liver cell. Anti-epithelial cell adhesion molecule monoclonal antibody 31 (MOC-31) is an antibody directed against a cell surface glycoprotein. Cytokeratin 7 (CK7) is expressed in normal and neoplastic epithelia.

Aim

To study the usefulness of the immunohistochemistry of Hep Par 1, MOC-31, and CK7 in differentiating primary and secondary carcinomas in the liver. Materials and methods The present study included 45 specimens from cases of primary and metastatic liver tumors, including 15 primary HCCs in the liver, four intrahepatic CCs, and 26 metastatic ACs in the liver. They were studied to evaluate Hep Par 1, MOC-31, and CK7 expression.

Results

The sensitivity of Hep Par 1 for HCC in the study group was 73.3%, whereas its specificity was 100%. The sensitivity of MOC-31 for AC in the study group was 96.4%, whereas its specificity was 91%. The sensitivity of CK7 for CC in the study group was 100%, whereas its specificity was 54%.

Conclusion

Hep Par 1 has very sensitive and specific immunostaining for HCC, MOC-31 is a useful marker for AC with high sensitivity and specificity, and CK7 is highly sensitive for CC but its specificity is low. A combination of Hep Par 1 and MOC-31 is the most useful combination of two antibodies for the distinction between HCC and AC.
Role of food allergy in otitis media with effusion
Authors: Fouad Wessam A. , Makhemaer Sayed M. , Mohamed Hala Abd El-Hassib , Awwad Ayat A.
Published: April 2024

Background and aim

The role of food allergy (FA) in chronic otitis media with effusion (OME) is argumentative. New proof from cellular biology and immunology clarifies the essentials of allergic responses and permits exact diagnosis more than before for allergies and inflammatory disease. We aimed to detect the occurrence of FA in patients with chronic OME.

Patients and methods

This a prospective, cohort randomized controlled study that was conducted at Al Azhar University Hospital, Otorhinolaryngology Department, on 40 patients divided into two groups: patient group included 20 patients with OME, and control group included 20 patients without any medical problems about FA or OME. The prevalence of FA was detected by skin prick test and assessment of serum immunoglobulin E and eosinophil count.

Results

There were highly statistically significant correlations between increase in the total serum immunoglobulin E and eosinophil count and developing OME (P<0.00); however, there were no statistically significant correlations between age and developing OME (P<0.396).

Conclusion

The possibility of association and the contribution of FA should be kept in mind in OME cases.
Knowledge, attitude, and practice of endodontists for use of apex locators in clinical practice in India: A survey-based study
Authors: Ansari Mohd. Irfan , Yadav Vijay , Miglani Sanjay , Mansoori Shahnaz , Singh Neelam
Published: April 2024

Aim:

The present study aimed to evaluate the knowledge, attitude, and practice (KAP) of endodontists in India for working length measurements using Apex locators.

Methods:

This study is an online questionnaire-based survey consisting of 24 questions in total, divided into five parts. The first part consisted of questions related to demographic details, the second part inquires about the tools and technology used for working length determination, and the remaining questions evaluate the KAP regarding the use of apex locators to determine working length (five questions each). Participants in the study were either pursuing or completed postgraduation in endodontics. A total of 257 responses were recorded; however, six participants were excluded due to incomplete submission. Thus, 251 responses were analyzed as descriptive analyses. Correlation analysis and Chi-square tests were performed to find any association between demographic variables and years of experience in practice with KAP of using apex locators by endodontists.

Results:

In this study, it was observed that the knowledge of the majority of endodontic practitioners was fair, with a positive attitude and practice of using apex locators. Knowledge of the study participants was significantly (P ≤ 0.05) associated with the good attitude and practice of the study participants. Furthermore, years of experience in practice have a positive association with the KAP of endodontists.

Conclusion:

It can be concluded that endodontists have better clinical acceptance, as they show positive attitudes and practices for using apex locators for working length determination.
Effects of oral sarcopenia and malnutrition on the elderly
Authors: Chen Chieh , Liao Da-Ming
Published: April 2024

Old-aged adults often suffer from nutrient deficiency or appetite loss resulting from taste and smell degeneration, poor oral and dental functions, and chewing and swallowing difficulties in addition to having poor digestion and gastrointestinal tract absorption or delayed stomach emptying. Consequently, anorexia and less food consumption occur, not to mention the medication–food interaction that will aggravate insufficient nutrient intake. Moreover, aged people tend to isolate or suffer from depression, and insomnia, which can all weaken and empty their body and soul, leading to undernourishment. Older adults who are picky eaters are 2.5 times more prone to develop weakness in the future than average individuals, as well as a significant increase in disability risk by 40%. Anorexia nervosa, which refers to a decline in appetite or food intake, is common in this population because of the degradation of chewing and swallowing functions. In fact, those who are 65 years old and above have a 21.8% chance of choking on food at least thrice a week, for which 12.8% of them were diagnosed with dysphagia, statistically equivalent to 1 out of every 10 old-aged adults having a mild or more severe swallowing disorder.
Quality of Life and Perceived Stress in Chronic Spontaneous Urticaria: Counting the Burden
Authors: Reeshma Jose , Mariyath Olasseri Kalathingal Reena , Dayal Narayan KTP , Devi Keerankulangara , Ajithkumar Kidangazhiyathmana
Published: April 2024

Background:

Chronic spontaneous urticaria (CSU) is a dermatosis with a significant psychological component. Only a few studies have assessed the quality of life (QoL) and perceived stress in CSU patients.

Objectives:

To evaluate the QoL and perceived stress in patients with CSU.

Materials and Methods:

A cross-sectional study was done on 54 patients of CSU attending the Urticaria clinic of the Dermatology department in a tertiary care postgraduate teaching hospital in North Kerala. QoL in chronic urticaria was assessed using the Chronic Urticaria-Quality of Life (CU-QoL) questionnaire and perceived stress was assessed using the Perceived Stress Scale (PSS).

Results:

The mean scores of CU-QoL and PSS were 55.78 and 16.31, respectively. Out of 54 patients, 26 (48.1%) had mild impairment, 26 (48.1%) had moderate impairment, and 2 (3.7%) had severe impairment of QoL. Low stress was seen in 20 (37%) patients, moderate stress in 28 (51.9%), and six (11.1%) patients had high stress.

Conclusion:

This study shows that more than half of the patients with CSU had moderate to severe impairment of QoL and had moderate to severe stress.
Vascular Malformations
Authors: Bhari Neetu , Agarwal Akash , Asritha C. V. V. , Panda Maitreyee , Mahajan Rahul
Published: April 2024

Vascular malformations are intricate anomalies of the circulatory system, presenting a diverse array of clinical manifestations, and posing significant challenges in diagnosis and treatment. The pathogenesis of vascular malformations is explored through the lens of genetic and molecular mechanisms, shedding light on the pivotal role of somatic mutations and dysregulated signaling pathways. Clinical presentations of vascular malformations are widely variable, ranging from cosmetic concerns to life-threatening complications. The utility of imaging techniques, such as magnetic resonance imaging (MRI), computed tomography (CT), and angiography, are discussed in detail, emphasizing their role in precise delineation and characterization. Therapeutic strategies for vascular malformations are multifaceted, considering factors such as lesion size, location, potential complications, and patient-specific factors. Traditional interventions, including surgical excision and embolization, are appraised alongside emerging approaches like targeted molecular therapies and minimally invasive procedures. The manuscript underscores the need for an individualized treatment approach, optimizing outcomes while minimizing risks and complications. In summation, this manuscript offers a comprehensive analysis of vascular malformations, encompassing their underlying pathogenesis, clinical nuances, diagnostic methods, and therapeutic considerations. By synthesizing current knowledge and highlighting gaps in understanding, this review serves as a valuable resource for clinicians, researchers, and medical practitioners, fostering an enhanced comprehension of vascular malformations and paving the way for improved patient care and innovative research endeavors.
Effect of Topical 5% 5-Fluorouracil with Microneedling in Vitiligo Patients as an Additional Modality to Standard Treatment at Tertiary Care Hospital
Authors: Desai Valay A. , Momin Anjum M. , Vaishnani Jignesh B.
Published: April 2024

Background:

Vitiligo is an inveterate disease of great aesthetic concern presenting with depigmented macules and patches. It is often incorrigible to medical treatment.

Aim:

To study the clinical profile of vitiligo patients and evaluate the effect of 5% 5-fluorouracil (5-FU) cream with microneedling.

Materials and Methods:

This observational analytical study was conducted from November 2019 to July 2021. A total of 33 adult vitiligo patients were treated with oral mini-pulse (dexamethasone) therapy and topical corticosteroid (clobetasol propionate 0.05%). Patient’s total number of vitiligo lesions with <10-cm size were counted and half of the lesions were treated with 5-FU + microneedling (Group A), while a remaining number of lesions were not treated with 5-FU + microneedling (Group B). In the case of the odd number of lesions, the total number of lesions minus one was considered and then divided into equal numbers for treatment. The procedure was performed every 2 weeks for 3 months. Clinical improvement was assessed monthly till 6 months by serial clinical photographs and grading scores.

Results:

Initiation of repigmentation started in the first month in Group A, whereas in Group B, it was seen in the second, which was statistically significant (P < 0.0001). Excellent improvement (>75% repigmentation) was noted in Group A as compared to Group B at the end of 6 months (P < 0.0001).

Conclusions:

Needling with 5% 5-FU appears to be a simple, safe, and effective treatment in vitiligo. It can be used in poor responders to conventional therapy.
IJCM_101A: Prevalence of postoperative delirium in geriatric patients with hip fracture.
Authors: Mohan Pallavi , Vijayakumar Priya
Published: April 2024

Background:

Geriatric hip fractures are a major cause of concern globally and often a frequent reason for morbidity and mortality. Postoperative delirium (POD) is frequent but often under-diagnosed complication, especially after a major hip surgery. Some of the factors contributing to delirium are sepsis, dyselectrolytemia, elevated blood sugars, blood pressure fluctuation, constipation, and malnutrition. It very important to prevent delirium and to treat the underlying cause contributing to it.

Objective:

Prevalence of postoperative delirium in Geriatric patients with hip fracture and to determine various factors associated with it.

Methodology:

Prospective study Samples are collected from geriatric hip fracture patients admitted in a tertiary health care centre. Data regarding preoperative blood investigations, hypertension, and diabetes status, MNA (mini nutritional assessments) status, serum albumin, and serum electrolytes values were recorded. The Confusion Assessment Method tool (CAM) was used to diagnose delirium in the postoperative period.

Results:

140 patients fulfilling the inclusion and exclusion criteria were admitted to the study. Among the one hundred and forty patients, forty-nine patients developed delirium. The incidence of delirium in the postoperative period was 35%. The percentage of patients developing delirium was directly proportional to their advancing age In these patients major risk factor associated with delirium was pain, constipation, urosepsis (fever), dyselectrolytemia, uncontrolled glycemic status and prolonged hospital stay (delayed rehabilitation)

Conclusion:

Delirium is a common feature in the post-operative period in the elderly patients associated with acute alteration in attention and cognitive impairment, which is responsible for the significant increase in both morbidity and mortality. Multiple factors predispose a patient to different forms of delirium. The reversible causes must be identified and treated promptly. A wider knowledge of pathophysiology and clinical awareness can help to counter the possible deleterious effects of delirium during the post-operative period.