bluuebunny/crossref_metadata_2025 huggingface dataset:
ENKAPSÜLASYON VE GIDA TEKNOLOJİSİNDE KULLANIMI
Authors: TUTUN Soner , YURDAKUL Ozen
Published: August 2022

Enkapsülasyon yönteminin kullanımı son yıllarda gıda endüstrisi alanında önemli bir konuma gelmiştir. Gıda işleme prosesinde kolaylıkla bozulabilen önemli gıda bileşenleri enkapsülasyon yöntemiyle korunabilmektedir. Kapsüllenen bu bileşenler, nem, sıcaklık, pH, katkı maddeleri gibi faktörlerden etkilenmediği için daha uzun süre muhafaza edilebilir duruma gelir. Enkapsülasyon işleminde birçok yöntem bir arada uygulanmaktadır. Kapsülleri oluşturmak için, püskürtmeyle kurutma ve soğutma, ekstrüzyonla kaplama, akışkan yatak kaplama, lipozom yakalama, koaservasyon, ekstrüzyon ve emülsifikasyon işlemleri sıklıkla kullanılmaktadır. Enkapsülasyon işlemi ile gıda bileşenlerine doğal ya da yapay tatlandırıcılar, probiyotikler, prebiyotikler, mineraller, vitaminler ve birçok katkı maddesi eklenebilmektedir. Enkapsülasyon teknolojisinde ekipmanlarının geliştirilmesi, prosedürlerinin netleştirilmesi, kapsüllenecek maddelerin enkapsülasyonu için toksik olmayan materyallerin seçilmesi, sindirim sisteminin pH’sına uyarlanmış polimerlerden kapsüller geliştirilmesi ve kapsüllenmiş maddelerin salım mekanizmalarının belirlenmesi gibi zorluklar bulunmaktadır. Enkapsülasyon yöntemlerinin uygulanmasında karmaşık süreçlere sahip olması ve farklı kaplama materyallerin kullanılmasından dolayı yüksek üretim maliyeti olması da sektörlerde kullanımını olumsuz yönde etkilemektedir. Maliyetler, kullanılan yönteme ve materyale bağlı olarak büyük ölçüde değişebilir. Konu ile ilgili çalışmaların sayısının arttırılması ve üretim maliyetlerinin azaltılması sonucunda bu faydalı uygulamanın pratik olarak kullanılmasında etkili olacağı düşünülmektedir. Bu derlemede enkapsülasyon yöntemi, kullanılan yöntemler ve çeşitli gıdalarda kullanımı ile ilgili güncel bilgiler yer almaktadır.
Evolutionary Status of Selected Post-AGB Single and Binary Stars in Gaia DR3
Authors: Parthasarathy M. , Kounkel Marina , Stassun Keivan G.
Published: August 2022

Gaia data is helping to further understand the evolutionary status of post-AGB and related stars. In this paper we present an analysis of Gaia DR3 data of post-AGB stars and post-AGB binaries with accurate parallaxes. Gaia DR3 data of 44 post-AGB candidates are analyzed, including 16 post-AGB binary candidates. Of these, 19 stars have RUWE values >1.4. For several stars, the calculated absolute luminosities confirm that they are indeed in post-AGB evolutionary stage. We find that 12 stars have relatively lower luminosities; some of them may be post-RGB stars and some may be post-HB stars. We find that IRAS 01427+4633 (BD+46 442), IRAS 16230–3410, and IRAS 19199+3950 (HP Lyr) are evolved high velocity stars.
L’Information géographique en contexte : le modèle 1936
Authors: Retaillé Denis
Published: August 2022

Ce premier de deux textes reconstitue les intentions et les contenus d’une revue destinée à l’enseignement de la géographie en France entre 1936, date de sa fondation, et le milieu des années soixante. Prise dans le contexte des temps académique et politique, la pédagogie y paraît comme une ligne de sécurité qu’il était possible de franchir pour enregistrer et dépasser les contraintes qu’impose la transmission d’un savoir social à partager par l’École et au-delà. Le second texte suivra la mutation de la Revue depuis la fin des années soixante jusqu’à aujourd’hui.
Changes in Physical Function using Three Methods of Scoring the Health Assessment Questionnaire in Established Active Rheumatoid Arthritis
Authors: Winchow Lai Ling , Tikly Mohammed , Musenge Eustasius , Chopra Arvind , Huizinga T.W.J. , Salomon-Escoto Karen , Tavares-Costa José , Govind Nimmisha
Published: August 2022

Background:

We investigated sensitivity to change of three scoring methods of the Health Assessment Questionnaire (HAQ) in relation to change in disease activity in patients with active rheumatoid arthritis (RA).

Patients and Methods:

Adult RA-patients with complete data in the Measurement of Efficacy of Treatment in the Era of Outcome in Rheumatology database with respect to the 20 HAQ questions and disease activity score with 28-joint count using the erythrocyte sedimentation rate (DAS28-ESR) for 2 visits, at least 6–12 months apart, and high disease activity (DAS28-ESR >5.1) at visit 1. Changes in HAQ scored by the (1) conventional method (HAQ-8), (2) HAQ-Tomlin method (HAQ-T), and (3) HAQ-20-item method (HAQ-20) were analyzed in relation to the European League Against Rheumatism (EULAR) RA response criteria, dichotomized to good/moderate and no response.

Results:

In 421 patients, mean standard deviation (SD) DAS28-ESR declined significantly (6.1 [0.8]–4.8 [1.6], P < 0.0001), over a mean period (SD) of 8.7 (1.9) months. Median HAQ scores improved by all three scoring methods, HAQ-8 (1.6–1.4); HAQ-T (1.2–0.7); and HAQ-20 (1.2–0.9) with similar effect sizes of 0.97, 0.96, and 0.95, respectively. The proportion who achieved a HAQ minimally clinically important improvement (MCII) of ≥0.22 was significantly higher in 47% of patients with EULAR good/moderate score compared to the no response patients (64% vs. 11%, P < 0.0001). Good/moderate EULAR response, higher baseline DAS28, and higher baseline HAQ (7.11, 1.55, and 1.06, respectively) were independent predictors of achieving a HAQ-MCII.

Conclusion:

Three HAQ scoring methods performed similarly in sensitivity to change with no advantage of alternative scoring methods compared to the conventional HAQ-8 method. A good/moderate EULAR response, despite long disease duration, was associated with a significant likelihood of achieving a HAQ-MCII.
Prevalence and characteristics of ponticulus posticus and its association with cervicogenic headache and migraine
Authors: Mokhtari Nasrin , Ashtari Fereshteh , Razavi Mehdi , Ghaffari Roshanak
Published: August 2022

Background:

Ponticulus posticus (PP) (arcuate foramen) is an abnormal bony bridge in the posterior arch of the atlas, which could possibly cause certain complications such as headache. Our goal was to assess the prevalence and size of PP on lateral cephalometric radiographs and its relationships with cervicogenic headache and migraine.

Materials and Methods:

This cross-sectional study was a descriptive–analytical type and was performed in Isfahan Azad Dental University. Lateral cephalometric radiographs of 150 patients referred to the radiology department were selected to assess the prevalence and size of the anomaly. A checklist was prepared to evaluate cervicogenic headache and migraine among patients.

Results:

Our sample consisted of 97 females and 53 males with an age range between 5 and 56 years. The prevalence of PP was 21.3% (12% complete and 9.3% incomplete), and an insignificant difference was noted between the prevalence of complete and incomplete foramen (P > 0.05). The prevalence of foramen was higher in women (59.4%), but it was not significant. The mean width of complete foramen was 6.40 mm, and the mean heights in individuals with complete and incomplete foramen were 4.71 and 4.84 mm, respectively. Among patients with the anomaly, 43.8% had cervicogenic headache and 9.4% had migraine. There was a significant association between the presence of foramen and both types of headaches (P < 0.05). However, there was no significant correlation between the shape of anomaly and the presence of cervicogenic headache and migraine (P > 0.05).

Conclusion:

Our study showed a high prevalence of PP and its significant association with cervicogenic headache and migraine.
The roles of dipeptidyl peptidase-4 inhibitors in prognosis of COVID-19 infection in patients with type 2 diabetes mellitus
Authors: Sadidi Mohammad , Zare Ahad , Nasrollahzadehsabet Mehrdad , Dastan Farzaneh , Mosadegh Khah Ali , Jafari Asheyani Milad
Published: August 2022

Background:

COVID-19 is responsible for the latest pandemic. Dipeptidyl peptidase-4 (DPP-4) is one of the cellular receptors of interest for coronavirus. The aim of this study was to assess the roles of DPP-4 inhibitors in prognosis of COVID-19 infection in patients with type 2 diabetes mellitus.

Materials and Methods:

retrospective cohort study was performed in 2020 in military medical centers affiliated to AJA University of Medical Sciences in Tehran on 220 patients with type 2 diabetes mellitus who were admitted in medical centers with COVID-19 infection. We collected demographic data of patients including age, gender, drug history, usage of DPP-4 inhibitors, clinical presentations at the time of the first visit, and the disease outcome including hospitalization duration and need for respiratory assist.

Results:

The study population consisted of 133 males (60.5%) and 87 females (39.5%), with a mean age of 66.13 ± 12.3 years. Forty-four patients (20%) consumed DPP-4 inhibitors (sitagliptin and linagliptin). Patients who were treated with DPP-4 inhibitors required less oxygen (O2) therapies compared to other cases (76.7% vs. 88.6%, P = 0.04). Patients who were treated with DPP-4 inhibitors had significantly lower hospitalization duration compared to other cases (6.57 ± 2.3 days vs. 8.03 ± 4.4 days, respectively, P = 0.01). There were no significant differences between the two groups of patients regarding survival rates (P = 0.55). Age was a predictive factor for survival (odds ratio, 1.13; 95% confidence interval, 1.04–1.23; P = 0.004).

Conclusion:

DPP-4 inhibitors could significantly decrease hospitalization days in patients with type 2 diabetes mellitus who were hospitalized for COVID-19. However, DPP-4 inhibitor usage showed no statistically significant impact on survival. Age was the important prognostic factor.
Prophylactic hypogastric arterial ligation before cesarean hysterectomy for controlling complications in pregnant women with placenta adherent abnormality
Authors: Movahedi Minoo , Niakan Zahra , Shahshahan Zahra , Hooshmand Meibodi Amir Reza , Babak Anahita , Saeidi Mahmoud
Published: August 2022

Background:

Placenta adherent abnormality (PAA) is abnormal attachment of the placenta to the myometrium. This abnormal placenta binding has severe clinical consequences for the mother and the fetus. We investigated the outcomes of hypogastric arterial ligation (HAL) before hysterectomy compared to hysterectomy alone in pregnant women with PAA.

Materials and Methods:

In this randomized controlled clinical trial, 70 patients were randomly allocated to HAL along with hysterectomy and hysterectomy alone groups (35 in each Group). The total amount of intraoperative blood loss, the need for intraoperative blood products transfusion, frequency of deep vein thrombosis, duration of surgery, duration of hospitalization, and visceral trauma were compared between 2 Groups.

Results:

Finally, 64 patients completed the study protocol with mean age of 33.84 ± 4.25 years. The study groups were comparable in terms of basic baseline demographic and clinical characteristics. Visceral trauma was less frequently occurred in HAL group compared to hysterectomy alone (0% vs. 15.6%; P = 0.02). Intraoperative blood loss (1525 ± 536.41 cc vs. 2075 ± 889.36 cc; P = 0.001) and were significantly lower in HAL group compared to hysterectomy alone. Duration of operation (179.06 ± 36.28 vs. 197.66 ± 39.47; P = 0.05) and hospitalization (4.97 ± 2.20 vs. 6.10 ± 2.39; P = 0.03) also were significantly lower in HAL group.

Conclusion:

Our findings suggest that prophylactic HAL has a protective effect on the reduction of blood loss and less visceral trauma in pregnant women with PAA.
Are the Aetiologies of Traumatic Injuries Changing in Nigeria? Evidence from the Emergency Department of a Referral Hospital in Southwest Nigeria
Authors: Ojo Dele Owolabi , Oluwadiya Kehinde Sunday , Akanni Saheed Olatunde
Published: August 2022

Background:

Traumatic injuries are a serious public health problem. The burden of these injuries is increasing globally, and there is evidence that the pattern is changing.

Objective:

The study had two objectives. The first was to determine the aetiology and clinical spectrum of trauma in a teaching hospital. The second was to determine whether these have changed compared with previous reports from the region.

Materials and Methods:

Between September 2017 and August 2018, data from injured patients who presented consecutively to the accident and emergency department at the Federal Teaching Hospital Ido-Ekiti, Nigeria, were prospectively collected using a trauma data form and analysed.

Results:

Road traffic crashes (RTCs) caused 75.6% of the injuries, and motorcycle crashes accounted for more injuries than all the other major causes of injuries combined. Compared with previous studies from the same hospital, assault has risen to the second position, whereas falls have fallen to the third position as causes of traumatic injuries. The Injury Severity Scores (ISS) of the patients ranged from 1 to 75, with a mean score of 7.01. The mortality rate was 2.5%. Time to treatment: odds ratio (OR) = 3.25 (1.1–10.0), ISS: OR = 1.172 (1.07–1.28), age: OR = 1.097 (1.013–1.188), and systolic blood pressure: OR=1.07 (1.106–1.025) were the significant predictors of mortality. No patient was transported to the hospital in an ambulance.

Conclusion:

The pattern of trauma in the subregion is changing as the proportion secondary to RTCs and motorcycle crashes is higher than previously reported studies from the area. The implication of this finding for the prevention of RTCs is discussed.
The Pain Control Efficacy of Zolpidem Versus Melatonin after Intervertebral Disc Herniation Surgery under General Anaesthesia
Authors: Modir Hesameddin , Moshiri Esmail , Mohammadi Alireza , Aghdasi Seyed V
Published: August 2022

Background:

Postoperative pain management has been linked with multiple clinically relevant complications such as thromboembolism, myocardial ischaemia, and cardiac arrhythmias.

Objectives:

The present study moves towards an evidence-based approach to the therapeutic efficacy of zolpidem and melatonin in a better clinically meaningful pain relief following intervertebral disc herniation surgery under general anaesthesia.

Materials and Methods:

Undertaking a randomised, parallel-group, double-blind, clinical trial, 60 patients meeting eligibility (mean age ≈ 39, 50% female and 50% men) were offered intervertebral disc surgery at the Arak-based Valiasr Hospital and stratified into two interventional arms by block randomisation. Data including (i) pain (visual analog scale) and sedation (Ramsay sedation scale) scores during recovery and at all five initial 24-h time points (two, four, six, 12, 24); (ii) adverse events inclusive of mild nausea and dizziness, pethidine consumption; and (iii) ongoing haemodynamic parameters, including heart rate, blood pressure, and oxygen saturation were collected. Data were analysed at a significance level of P = 0.05 (SPSS 20.0, IBM Corp).

Results:

Our results showed no perceived statistically significant between-arm difference in three functional haemodynamic parameters, duration of surgery, and adverse events, as well as in sedation and pain scores (P < 0.05). Our results showed no between-arm difference in analgesia and sedation, haemodynamic changes, and postoperative adverse events.

Conclusion:

The findings taken together lent a strong support for the highly encouraging efficacy of both drugs in affording adequate analgesia at 24 postoperative hours without any adverse events needing to be thought of. Therefore, both zolpidem and melatonin were promising postoperative pain relievers, while no drug is demonstrably superior to the other.
Early Functional Outcome of Hemiarthroplasty in the Elderly with Neck of Femur Fracture
Authors: Chiroma Muhammad Musa , Ibrahim Mustapha Usman , Salihu Muhammed Nuhu , Awonusi Francis Olusoji , Mamuda Abdul Rahman Alhaji , Abubakar Muhammad Kabir , Adamu Kabir Musa , Muhammad Shamsuddeen , Bello Bashir
Published: August 2022

Introduction:

Neck of femur fractures in the elderly population are common and often a devastating condition. The optimal treatment has been a subject of debate. Arthroplasty has been shown to be the most viable treatment option. The high cost of total hip replacement makes hemiarthroplasty a suitable option in our environment.

Materials and Methods:

This study was designed to measure the outcome of hemiarthroplasty after femoral neck fracture using Harris hip score in patients aged 60 and above at the National Orthopaedic Hospital, Dala, Kano, Nigeria.

Results:

Twenty-five consecutive patients 60 years and above with femoral neck fracture who met the inclusion criteria and gave consent were enrolled into the study. The mean Harris hip score at the pre-operative period was 16.92. Fourth week after the surgery, the mean Harris hip score was 69.96. The score rose further to 75.24 and 80.96 at 12 weeks and 6 months post-operatively. The difference between the mean pre-operative and post-operative scores at 4th week, 12th week, and 6th month was statistically significant. During the pre-operative period, all patients had a poor Harris hip score grade. Six months after the surgery, 7 patients (28%) had an excellent Harris hip score grade, 12 patients (48%) had good grades, and 1 patient (4%) had a fair Harris hip score grade. Five patients (20%) had a poor Harris hip score grade at 6 months.

Conclusion:

From the findings of this study, it can be concluded that early functional outcomes of hemiarthroplasty for femoral neck fracture in the elderly are good and satisfactory.
Day Case Anterior Cruciate Ligament Reconstruction Surgery – a Study of Early Treatment Outcomes in a Regional Orthopaedic Centre
Authors: Babalola Oladimeji Ranti , Itakpe Shopekhai E , Oladunjoye Tale Olajire , Akpan James Imeh , Madubueze Christian C , Koyejo Temitayo
Published: August 2022

Background:

Day-case anterior cruciate ligament reconstruction has the potential benefit of reduced hospital stay and reduced cost of care. The goal of this preliminary report was to compare the outcome of day-case arthroscopic anterior cruciate ligament reconstruction with those of in-patient care in terms of pain control and short-term functional outcome.

Materials and Methods:

This was a prospective comparative study involving patients who had anterior cruciate ligament reconstruction performed in our unit between January 2019 to July 2021 for isolated anterior cruciate ligament rupture. The patients were offered the option of in-patient and day-case anterior cruciate ligament reconstruction. All cases were isolated anterior cruciate ligament ruptures with no other ligament injury.

Results:

A total of twenty-one-day case and twenty-five in-patient anterior cruciate ligament reconstruction were managed during the period of the study. The median numeric pain scores at day 2 and 7 in the day case group was 8.0 (IQR=2.0) and 5.0 (IQR= 3.0) respectively and in-patient group was 7.0 (IQR =1.5) and 4.0 (IQR= 2.0) respectively. The international knee documentation score (IKDC) at 6 months in the day case and in-patient groups were 68.6 (IQR= 9.3) and 67.2 (IQR= 25.0) respectively. The Mann-Whitney U test indicated that patients who had ACL reconstruction on in-patient care basis had statistically significant lower visual analogue scale pain scores on the second (z=-2.58, P = 0.01) and seventh (z=-3.41 P = 0.001) post-operative days compared to patients who had ACL reconstruction on day case basis. There was no statistically significant difference in the median IKDC scores of both groups at 6 months. The cost of care in the day case group was 40% lower than those of the in-patient group.

Conclusion:

Although the cost of care in the day case group appeared lower as compared to the in-patient group, the day case group had higher post-operative pain scores compared to the in-patient group. Although the post-operative functional scores were similar in both groups, this was not statistically significant
The Therapeutic Antiemetic and Hemodynamic Effects of Dexmedetomidine, Ephedrine, and Dexamethasone in Combination with Midazolam on Laparoscopic Cholecystectomy Patients
Authors: Dalaei Dorsa , Modir Hesameddin , Pazoki Shirin , Naimi Amir Reza
Published: August 2022

Objective:

The objective was to compare the hemodynamic and antiemetic effects of the combination of midazolam with ephedrine, dexamethasone, and dexmedetomidine in laparoscopic cholecystectomy surgical patients.

Materials and Methods:

This randomised, parallel-group, double-blind clinical trial was conducted by enrollment of 96 patients who were referred for laparoscopic cholecystectomy. Patients assigned into three equal-sized intervention arms having received anaesthesia induction with midazolam-ephedrine, midazolam-dexamethasone, and midazolam-dexmedetomidine using a block randomisation method. Frequency and severity of nausea and vomiting were observed from recovery to 24 h later, adverse events, and sedation on Ramsay sedation scale at recovery, 1, 2, and 4 h postoperatively. Data were recorded and analysed at a significance level lower than 0.05 in SPSS software.

Results:

The clinical parameters including mean blood pressure at all times and heart rate in 60–90 min were lower in the dexmedetomidine group when compared with other groups. The lowest severity of postsurgery nausea occurrence was observed in the midazolam-dexamethasone group and those receiving midazolam-dexmedetomidine from 4 to 24 h. In addition, vomiting scores were lower throughout recovery up to postoperative 4 h in the dexamethasone and dexmedetomidine groups (all P < 0.05). The highest sedation score was observed in the dexmedetomidine group during recovery up to 2 h (P = 0.001), reflecting a more clinically superior effect than dexamethasone (P = 0.01).

Conclusions:

A positive implication of dexmedetomidine was observed in attenuating postoperative nausea and vomiting and potentiating sedation. Nevertheless, it is providing a drop in the blood pressure and heart rate. Lending support to the potent adjuvant efficacy of dexamethasone following dexmedetomidine, consequently, a hypothesis can be put forward, stating that the dexmedetomidine and dexamethasone as adjuvants to midazolam are expected to bring the advantages of avoiding the adverse events and improving postoperative sedation.
Is Blood Transfusion Justified During Soft Tissue Surgery in Noma Patients? a One-Year Appraisal at Noma Children Hospital, Sokoto, Nigeria
Authors: Bala Mujtaba , Gbolahan Olalere Omoyosola , Taiwo Abdurrazaq Olanrewaju , Braimah Ramat Oyebunmi , Ibikunle Adebayo Aremu , Abubakar Muhammad Kaura
Published: August 2022

Background:

Non-utilization of blood and inappropriate blood transfusion are common in surgical operations. Some surgical procedures are associated with minimal bleeding that does not warrant blood transfusion. No previous study has looked at the pattern of blood loss in noma defect repair to determine the possible need for blood transfusion.

Aim/Objectives:

This study aimed to determine the total amount of blood loss, the number of units of blood transfused, and the correlation between estimated blood loss and total operating time in patients who had surgical correction of noma defects.

Materials and Methods:

This is a hospital-based cross-sectional study of 35 patients who underwent surgical correction of noma defects. Age, sex, pre- and post-operative haemoglobin (Hb), number of requested blood units, total operating time, and total estimated blood loss were recorded. The methods used for the blood loss estimation were gauze swabs, Abdo-packs, drapes, and suction bottles.

Results:

Comparison of the mean pre- and post-operative Hb did not yield any statistically significant difference. The total estimated blood loss in these surgeries was in the range of 65–209 mL, with a mean of 117.20 ± 35.88 mL. No correlation between estimated blood loss and total operating time was noted (P= 0.940). No blood was transfused in any of the subjects.

Conclusion:

This study observed minimal blood loss in surgical corrections of the soft tissue noma defect. Apart from blood grouping, there may be no need for routine cross-matching of blood pre-operatively for surgical repair of noma defect. However, more studies are needed to buttress this finding.
The Cost of Setting Up An Ent Endoscopic Practice in Lower Middle-Income Countries of Sub-Saharan Africa
Authors: Ayodele Samuel Oluyomi , Aremu Shuaib Kayode
Published: August 2022

Ear, nose, and throat (ENT) surgeons in developing countries are constrained to practicing with lower technology, lower cost surgery, and reliance on outdated surgical techniques carried out with improvised instruments when compared with their counterparts in the developed world. In this review, we planned to lay open the bottle necks militating against setting up an ENT endoscopy practice in our setting with possible outcomes. The literature search was carried out to retrieve relevant published articles, books, and guidelines. Unpublished literatures were excluded. The search was limited to articles in English. ENT clinical practice in lower middle-income countries (LMICs) where there are limited or no ENT endoscopic setup due to high cost of procurement and maintenance, human resources, lack of subspecialty training, and inadequate funding by policy makers poses major challenges that can militate against the provision of adequate and effective surgical management. A continually improved management practices will positively affect the organisational structure, efficiency, and safety of a system. That is, an affordable and standard ENT endoscopic setup will go a long way to improve the access to training and practice for both ENT clinical and surgical purposes. The expansion of ENT endoscopic specialist training will improve both the diagnostic and therapeutic acumen in ENT practice in LMICs. The budget for health and the health-funding systems of our institutions must receive special and specific attentions tailored towards putting our health facilities in better shapes, subspecialty training, and procurement of state-of-the-art endoscopic equipment with proper plans on maintenance culture.
Eye Health-Seeking Behaviour of Traders in Rural Nigeria
Authors: Onyiaorah Adaora Amaoge , Kizor-Akaraiwe Nkiru , Nwosu Sebastian NN
Published: August 2022

Aim:

The aim of this article was to determine the healthcare provider first sought, reasons for the choice, and symptom duration before hospital presentation among traders in rural Nigeria.

Materials and Methods:

This was a cross-sectional study of traders at a rural Nigerian market, selected by systematic random sampling. A structured questionnaire was used to obtain information on sociodemographics, eye disease symptoms, eye care provider first sought, and reasons for choice. The analysis was carried out with Statistical Package for Social Sciences using descriptive and inferential statistics with an alpha level at 0.05.

Results:

Of the 177 traders, 88 (49.7%) were males and 89 (50.3%) were females. The mean age was 46.5 ± 13.75 years (range 19–72). Of the 83 traders who had ocular symptoms 23 (27.7%) never sought any care. The eye care providers first sought were patent medicine vendors 22 (26.5%), orthodox hospital 17 (20.5%), eye glass vendors 3 (3.6%), and traditional healers 3 (3.6%). The median symptom duration before presentation to an eye health facility was 83 days. Reasons for not seeking orthodox eye care first included cost 33 (39.8%), ‘ailment not serious’ 22 (26.5%), and advice from friends 7 (8.4%). Females were more likely to seek orthodox care (χ
2=4.22, P=0.04), whereas males were more likely to feel that their ailment was not serious. Traders aged >50 years were less likely to seek any care for eye ailment (χ
2 =8.41, P=0.04).

Conclusion:

Traders with eye disorders seek care late and most first seek care outside the orthodox hospital. Cost and feeling that ailment was not serious are barriers to seeking orthodox eye care. Eye health education and cost reduction would improve uptake of orthodox eye care services.
A Comparison of the Effect of Isoflurane and Propofol on Liver Enzymes
Authors: Oladimeji Motunrayo Adebukunola , Desalu Ibironke , Adekola Oyebola Olubodun , Akanmu Olanrewaju , Adesida Adeniyi Abiodun
Published: August 2022

Background:

Isoflurane and propofol are routinely used for the maintenance of general anaesthesia. However, recently, they have been implicated in hepatotoxicity resulting in acute liver failure.

Objective:

We compared the effects of isoflurane and propofol on liver enzymes; aspartate transaminases (AST), alanine transaminases (ALT), alkaline phosphatase (ALP) and total bilirubin (Tbil) following general anaesthesia.

Materials and Methods:

This randomized, controlled clinical trial involved 60 ASA I and II patients aged 18–64 years scheduled for elective surgery requiring general anaesthesia. Anaesthesia was induced with intravenous sodium thiopentone 5 mg/kg and atracurium 0.5 mg/kg, and maintained in group I with isoflurane (MAC, 0.8%-1.5%) and in group P with (propofol infusion, 100–200µg/kg/minute). Blood samples were taken pre-induction, immediate- and 24 hours post operatively. The serum levels of AST, ALT, ALP, Tbil were analyzed and compared in both groups. Risk factors for post operative hepatotoxicity were determined.

Result:

Propofol caused a significant reduction in ALP (P = 0.005) but increase in Tbil (P = 0.010) 24 hours postoperatively. Though isoflurane had consistently higher values of AST, ALP and Tbil than propofol, only the mean AST values at 24 hours post-operative was significantly higher (P = 0.045). There was a significant increase in the 24 hours post-operative Tbil following massive blood loss; [odd ratio 23.91, 95%, CI (1.685–339.315)], P = 0.019.

Conclusion:

Both agents had a varied effect on liver enzymes. Isoflurane resulted in a significantly higher increase in 24 hours post-operative serum AST than propofol. Propofol caused a significant increase in 24 hours post-operative total bilirubin. Caution is therefore recommended in their use in patients with altered liver enzymes.
Fibreoptic Laryngoscopic Assessment of Patients with Hoarseness
Authors: Adamu Auwal , Kolo Emmanuel Sara , Ajiya Abdulrazak , Mahmud Ahmad , Shuaibu Iliyasu Yunusa , Nwaorgu Onyekwere George B.
Published: August 2022

Background:

Hoarseness is a common clinical manifestation of laryngeal diseases. The cause of hoarseness may not always be a simple inflammatory disease, but it can be from other serious life-threatening conditions such as laryngeal cancer, for which a delay in diagnosis of such condition may compromise treatment, resulting in poor prognosis and a decreased survival rate. Against this background, we evaluated the causes of hoarseness using fibreoptic laryngoscopy in our environment.

Materials and Methods:

This was a cross-sectional study of patients with hoarseness attending ENT clinic of our institution. Ethical clearance and consent were obtained. A questionnaire was used to collect relevant clinical data, fibreoptic laryngoscopy was carried out, and the data was analysed using the Statistical Products and Service Solution version 20.0.

Results:

The study recruited 90 patients with hoarseness. The age of the patients ranged between 18 and 70 years with a mean of 40.1 ± 14.8 years. There were 51 (56.7%) males and 39 (43.3%) females. About 46 (51.2%) of the patients had intermittent hoarseness, whereas 44 (48.8%) had persistent hoarseness. Most of the patients, 49 (54.4%), had hoarseness for less than 6 months before presentation. The fibreoptic laryngoscopic findings were non-specific laryngitis 49 (54.5%), laryngeal tumor 20 (22.2%), vocal cord polyp 7 (7.7%), laryngeal papilloma 6 (6.7%), vocal cord palsy 5 (5.6%), and others 3 (3.3%).

Conclusion:

Laryngeal tumour constituted a significant percentage of fibreoptic laryngoscopic findings in patients with hoarseness after nonspecific laryngitis. Therefore, fibreoptic laryngoscopy is recommended for all patients with hoarseness in order to detect sinister pathology early.
Correlation of Sonographic Findings and Histopathological Diagnoses in Women Presenting with Breast Masses
Authors: Akinnibosun-Raji Hafsat Oluwatosin , Saidu Sule Ahmed , Mustapha Zainab , Ma'aji Sadisu Muhammad , Umar Mohammed , Kabir Farouk Umar , Udochukwu Uzoma Glosson , Garba Kwefi Joshua , Raji Mansur Olayinka
Published: August 2022

Background:

Breast lumps have been reported as the most common breast symptom among adult females in Western Nigeria and are benign in 60% of cases. In South-Eastern Nigeria, fibroadenoma has been reported as the most common breast disease (47.5%), followed by carcinoma (30.4%) and fibrocystic disease. The aim of this study was to determine the correlation between sonographic and histopathologic findings in women who presented with breast masses.

Materials and Methods:

This was a cross-sectional study conducted among 160 consecutive female patients who presented with breast masses. A breast ultrasound scan was carried out to categorize the masses using the American College of Radiology Breast Imaging Reporting and Data System classification, and the histopathological diagnoses of the masses were obtained. The correlation of the sonographic findings and histopathological diagnoses was determined using the Statistical Package for Social Sciences (SPSS) IBM version 23.0.

Results:

Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were found to be 79.5%, 98.3%, 93.9%, 93.7%, and 93.8%, respectively. There was a positive correlation between the sonographic findings and histopathological diagnoses of the breast masses, which was statistically significant (P = 0.000, r = 0.846).

Conclusion:

This study found a statistically significant positive correlation between sonographic findings and histopathological diagnoses of breast masses.
Management of Traumatic Diaphragmatic Injury—A Peep into Bowel Repair Via Thoracotomy
Authors: Okonta Kelechi E , Ekwunife Christopher N , Okonta Emeka M , Aghaji Martin AC
Published: August 2022

Background:

Traumatic diaphragmatic injury (TDI) is a relatively rare condition, and there is a high tendency for it to be missed if thorough clinical assessment and imaging review are not carried out. The surgical approach for TDI can be challenging, especially with bowel perforation.

Materials and Methods:

This is a retrospective case series of all consecutive patients with TDI from two tertiary hospitals in the southern part of Nigeria between January 2013 and December 2019. The demographic data of the patients, type, cause, and clinical diagnosis, intraoperative findings, Injury Severity Score, and outcome were noted. The descriptive statistics were presented in percentages and fractions.

Results:

Fourteen (4.3%) of the 326 chest trauma patients had TDI with 57.1% from penetrating causes and 42.9% from blunt causes. The causes of the TDI were gunshot injuries (42.9%), road traffic crashes (35.7%), stab injury (14.3%), and domestic accidents (7.1%). The preoperative method of diagnosis was mainly by massive haemothorax necessitating open thoracotomy (42.9%) and mixed clinical evaluation, chest radiograph, and upper gastrointestinal contrast studies (35.7%), and the drainage of intestinal content following the insertion of a chest tube to initially drain haemothorax (21.4%) and other modality of diagnoses (7.1%). The operative finding was mainly intestine content in the chest (50%) and only diaphragmatic injury (35.7%). The major complication after surgery was empyema thoracis (14.3%) and the mortality rate (14.3%).

Conclusion:

Penetrating injury of the chest was the major factor responsible for the TDI, and even with bowel perforation and acute TDI, thoracotomy offered an effective surgical approach for all the patients.
Pit Pattern Analysis of Colorectal Polyps Using Storz Professional Image Enhancement System (Spies) Endoscopy
Authors: Ray-Offor Emeka , Abdulkareem Fatimah Biade , Jebbin Nze J
Published: August 2022

Background:

Endoscopic management of colorectal polyps includes detection, characterization, and therapeutic strategies. Pit pattern analysis is a useful tool when differentiating neoplastic and non-neoplastic colorectal polyps.

Aim:

To correlate pit pattern characterization of colorectal polyps using SPIES endoscopy and the histopathology.

Materials and Methods:

Total colonoscopy was performed on 189 patients by same endoscopist from January 2020 to September 2021 using Image 1 Connect (TC200), Image 1 H3-Link (TC300) and video-colonoscope (Karl Storz, Tuttlingen, Germany). Identified polyps were classified using Paris classification for mucosal lesions and the pit pattern according to Kudo's modified criteria using SPIES endoscopy. All lesions were diagnosed by histopathological examination. Kappa index (κ) was used to evaluate the agreement of SPIES endoscopy Kudo's pit classification with the histopathological diagnosis. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were independently determined.

Result:

Thirty-four polyps were detected in twenty-nine patients with twenty-one (61.8%, 21/34) polyps histologically confirmed as neoplastic. SPIES endoscopy characterized seventeen (50%, 17/34) of the polyps as neoplastic, four (1.8%, 4/34) as non-neoplastic (false negative) and four (1.8%, 4/34) as false positives. The sensitivity and specificity of SPIES endoscopy were 81.0% and 69.2% respectively and same values for PPV and NPV. The diagnosis of neoplastic polyps by SPIES endoscopy was in moderate agreement with histopathological diagnosis (κ = 0.502)

Conclusion:

SPIES endoscopy is a useful, rapid, and non-invasive tool in the endoscopic assessment of colorectal polyps.
Autoimmune pulmonary alveolar proteinosis and sarcoidosis in the same patient
Authors: Shrestha Deepa , Muthu Valliappan , Sehgal Inderpaul S. , Bal Amanjit , Agarwal Ritesh , Dhooria Sahajal
Published: August 2022

Pulmonary alveolar proteinosis (PAP) is a rare pulmonary disorder characterized by surfactant accumulation in the alveolar spaces while sarcoidosis is a multisystem granulomatous disease of unknown etiology. The occurrence of PAP and sarcoidosis in the same patient is rare. A 37-year-old woman presented with cough and breathlessness and was diagnosed to have autoimmune PAP. She responded well to subcutaneous injections of recombinant granulocyte macrophage colony stimulating factor. Three years later, she developed fever, chest pain, cough, and facial palsy. The evaluation revealed a diagnosis of sarcoidosis that responded to immunosuppressive treatment. We discuss the link between PAP and sarcoidosis and review the literature on this association.
Lung ultrasound (LUS) in pre-term neonates with respiratory distress
Authors: Kartikeswar Gouda Ankula P. , Parikh Tushar , Pandya Dhyey , Pandit Anand
Published: August 2022

Aim:

To find out the diagnostic use of lung ultrasound (LUS) in respiratory distress in neonates by taking clinico-radiological (clinical plus X-ray) diagnosis as the gold standard. Secondary objectives were to find out if modified LUS score can predict the need for surfactant therapy.

Methods:

A prospective observational study was done in a tertiary care neonatal intensive care unit over a period of 1 year (January–December 2018). All pre-term infants with respiratory distress were screened with LUS and CXR within 2 h of admission and modified LUS score was calculated to find out the lung water content and its correlation with the severity of respiratory distress syndrome (RDS).

Results:

In total, 92 neonates were screened during the study period, and 61 were finally diagnosed as RDS. The Kappa statistic between the clinico-radiological diagnosis and LUS diagnosis was 0.639. LUS diagnosis and CXR diagnosis had a Kappa correlation value of 0.786 (95% CI: 0.678–0.983). The most common LUS feature in RDS was pleural line thickening (100%), followed by whiteout lungs (75.4%). The modified LUS score was higher in babies who needed surfactant therapy (median (IQR): 49 (44, 53.5) vs. 29.5 (21, 46)) (P < 0.0001).

Conclusion:

Our study shows that LUS in neonatal RDS can predict the severity of the disease, need for surfactant therapy and has good agreement with clinical and Xray diagnosis.
A rare case of sarcoidosis with necrotizing mediastinal lymphadenitis misdiagnosed as multidrug-resistant tuberculosis (MDR- TB)
Authors: Prasad Rajendra , Shamim Huda , Kacker Rishabh , Gupta Nikhil
Published: August 2022

Sarcoidosis, a multisystem disorder of unknown cause, is characterized by the presence of non-caseating granulomas and the proliferation of epithelioid cells. Sarcoidosis mostly affects the lungs and mediastinal lymph nodes in 90% of cases. Caseation and necrosis are very rare. We report the present case in view of its rarity, as sarcoidosis with significant necrosis in mediastinal lymph nodes is a rare phenomenon and can mislead the treating physician into diagnosing it as tuberculosis, which can lead to exposure of the patient to undue side effects of anti-tubercular drugs.
Therapeutic efficacy of oscillating positive expiratory pressure therapy in stable chronic obstructive pulmonary disease
Authors: Gupta Aayushi , Sodhi Mandeep Kaur , Jaggi Surabhi , Aggarwal Deepak , Saini Varinder
Published: August 2022

Background:

Chronic obstructive pulmonary disease (COPD) is characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airway and the lung to noxious particles or gases. Sputum production is a cardinal feature in COPD. Airway clearance techniques have been the mainstay of management. Oscillating positive expiratory pressure (OPEP) devices are handheld devices that provide a combination of positive expiratory pressure (PEP) with high frequency oscillations which involve exhaling against a resistance that is fluctuating. It encourages airflow within secretions, whereas oscillations induce vibrations within airway wall to displace secretions into airway lumen and help in expectoration.

Methods:

A randomized control trial was conducted at the department of pulmonary medicine, Government Medical College & Hospital, Chandigarh, in which 50 patients with stable COPD were enrolled for one- and- half years. After taking proper history, they were subjected to spirometry, six- minute walk test, and were asked to fill the St. George’s Respiratory Questionnaire (SGRQ) and COPD Assessment Test (CAT). These patients were randomized into group A (intervention group) and group B (control group), where group A was prescribed Aerobika OPEP device for daily use for a period of three months. After three months of use of device, the patients were again subjected to assessment parameters and inquired about any exacerbation within the three- month period.

Results:

At the end of three months were compared with baseline results. The median change in FEV1, FVC, 6MWD from baseline in group A was significantly more as compared to group B (FEV1: P < 0.001; FVC: P < 0.001; 6MWD: P = 0.08), whereas SGRQ score showed a significant improvement in both the intervention and control groups (P < 0.001) and CAT score showed significant improvement in comparison to the control group (P < 0.001). The median change in 6MWD and CAT from baseline in group A was significantly more as compared to group B (SGRQ: P < 0.001; CAT: P < 0.001), whereas it was not significant in case of SGRQ (P = 0.233). There was no significant difference in the incidence of exacerbation in the two groups (P = 0.19). The device did not help in controlling the rate of exacerbation in the present study at three months.

Conclusion:

Stable COPD patients who were given OPEP therapy as an adjunct to the standard drug therapy showed improvement in the spirometry parameters, exercise capacity and symptom burden in comparison to the drug only group.
Step-in step-down approach in the management of bronchial asthma in adolescents and adults
Authors: Gupta Prahalad Rai , Sarnaik Ravindra , Gupta Neeraj
Published: August 2022

Introduction:

Despite the step-up step-down approach of asthma management suggested by the Global Initiative for Asthma (GINA), control of asthma continues to be poor. It was hypothesized that a new “Step-in Step-down approach” could prove to be a better alternative. The present study was carried out with the objective to assess the efficacy and adverse effects of this new approach in the control of asthma.

Materials and Methods:

All treatment-naïve asthma patients were randomly allocated to either Group I (patients received budesonide 400 mg + formoterol 6 mg twice daily via dry powder inhalation device along with as-needed salbutamol) or Group II (patients received stepwise treatment as per GINA guidelines, 2017). Patients were monitored on a fortnightly basis for control of symptoms, spirometry, and complications if any. Asthma Control Questionnaire (ACQ-7) was used to assess control of asthma. Adverse effects, if any, were recorded and managed appropriately. Step-down was attempted on achieving sustained control of asthma, i.e., ACQ score of <0.75 on two consecutive fortnight assessments in both the groups. In Group I patients, long-acting b2-agonist was withdrawn first. Subsequently, a dose of budesonide was also reduced. In Group II patients, the treatment was decreased to the next lower step medicines as per the GINA guidelines.

Results:

After exclusions, a total of 787 patients were randomized to either Group I or II. The demographic profile of patients in the two groups was similar. Patients on “step-in step-down” approach had a statistically significant advantage over those on conventional step-up step-down approach in terms of (a) time to the first control (271 vs. 98 within first 4 weeks), (b) need for rescue steroids (two patients in Group 1 vs. 40 in Group 2), (c) number of exacerbations (30 vs. 232), and (d) use of rescue SABA (Only 30 patients in group I required > 5 inhalations per week as compared to all in group II). Adverse reactions were not observed in any of the patients in either group.

Conclusion:

We conclude that step-in step-down approach is a more robust and safer approach for control of asthma.
Pleural fluid lysozyme as a diagnostic biomarker of pleural tuberculosis
Authors: Aggarwal Ashutosh Nath , Agarwal Ritesh , Dhooria Sahajal , Prasad Kuruswamy Thurai , Sehgal Inderpaul Singh , Muthu Valliappan
Published: August 2022

Objective:

Pleural fluid lysozyme (LP) and its ratio to serum lysozyme (LP/LS) have been proposed as potential biomarkers for diagnosing tuberculous pleural effusion (TPE). We assessed the diagnostic accuracy of LP and LP/LS for TPE and evaluated their ability to differentiate TPE from other effusions.

Methods:

We queried the PubMed and Embase databases for studies indexed until October 2021. We included studies that (a) provided information regarding the sensitivity and specificity of LP or LP/LS for the diagnosis of TPE, or (b) compared LP or LP/LS between TPE and malignant or parapneumonic effusions. We used hierarchical summary receiver operating characteristic plots to model summary sensitivity and specificity. Random effects modeling was employed to pool standardized mean differences (SMD) across descriptive studies comparing TPE and other effusions.

Results:

We included 11 publications in our review, most of which were small and of poor quality. The summary estimates for sensitivity, specificity, and diagnostic odds ratio (DOR) were 0.94 (95% confidence interval [CI] 0.53–1.00), 0.89 (95% CI 0.63–0.97), and 129.88 (95% CI 6.26–2695), and 0.98 (95% CI 0.58–1.00), 0.91 (95% CI 0.84–0.96), and 708.47 (95% CI 11.42–43946), respectively, for LP and LP/LS. Mean LP and LP/LS in TPE were significantly higher than in malignant effusions (summary SMD 1.51 [95% CI 1.04–1.98] and 1.77 [95% CI 1.31–2.22], respectively), and parapneumonic effusions (summary SMD 0.86 [95% CI 0.51–1.22] and 1.15 [95% CI 0.64–1.66], respectively).

Conclusion:

There is low-quality evidence of good diagnostic accuracy for both LP and LP/LS in identifying TPE, the latter being marginally superior.