bluuebunny/crossref_metadata_2025 huggingface dataset:
Association of Paraoxonase-2 (C1053G) Gene Polymorphism with the Expression of Paraoxonase-2 Gene in Patients of Ischemic Stroke – A Pilot Study in Indian Population
Authors: Kumari Seema , Singh Ritu , Chandra Sudhir , Mehndiratta Mohit , Debnath Ekta , Dhamija Rajinder K
Published: September 2022

Background and Objective:

Oxidative stress plays an important role in atherosclerosis and ischemic stroke. Due to antioxidant properties of Paraoxonase-2, we studied the implication of Paraoxonase-2 gene polymorphism (C1053G) on expression of Paraoxonase-2 gene at mRNA level in ischemic stroke patients.

Material and Methods:

40 patients of ischemic stroke and 40 age and sex-matched controls were included. Paraoxonase-2 genotypes were evaluated by Polymerase Chain Reaction and Restriction Fragment Length Polymorphism and expression of Paraoxonase-2 gene at mRNA level was determined by quantitative real time Polymerase Chain Reaction analysed as delta-CT (△CT).

Result and Discussion:

The observed allele frequencies in patients for C and G allele were 0.61 and 0.39 respectively, and were 0.72 and 0.28 in control group. No significant association was found in C allele of C1053G polymorphism and ischemic stroke. The average △ CT value is significantly (p = 0.0001) higher in patients group (7.68 ± 2.0) as compared to controls (5.70 ± 1.8). We found a significant difference in the average delta-CT value (p = 0.0001), wherein down-regulated paraoxonase-2 gene expression (approximately 0.25 fold) was observed in case of patients as compared to controls. Down-regulated expression of paraoxonase-2 gene was observed in patients with GG genotype as compared to CG and CC genotypes in patients with ischemic stroke (p = 0.0001).

Conclusion:

Down-regulated Paraoxonase-2 gene expression, as evidenced by low mRNA levels in GG genotype may be one of the contributory factors in the progression of ischemic stroke.
Cerebrospinal Fluid Biomarkers for Monitoring Delayed Neurologic Sequelae after Carbon Monoxide Poisoning
Authors: Omi Tsubasa
Published: September 2022

Delayed neuropsychiatric sequelae (DNS), which are related to neuropsychiatric symptoms and severe sequelae, occur within a few days of recovery from acute poisoning. They may involve a slowly progressing demyelinating white matter lesion caused by carbon monoxide cytotoxicity; moreover, the involvement of immune mechanisms has been reported. However, there remains no established treatment or therapeutic gain factors. A 29-year-old man with DNS who experienced carbon monoxide poisoning underwent corticosteroid therapy with concomitant measurements of cerebrospinal fluid levels of MBP, IL-6, and pNF-H. Treatment led to an improvement in symptoms and lesions on magnetic resonance imaging. Corticosteroid therapy and monitoring can be used to treat and monitor DNS.
Reliability of Pre-Induction Inferior Vena Cava Assessment with Ultrasound for the Prediction of Post-Induction Hypotension in Neurosurgical Patients Undergoing Intracranial Surgery
Authors: Goyal Amit , Pallavi Kumari , Krishnakumar Mathangi , Surve Rohini M , Bhadrinarayan V , Chakrabarti Dhritiman
Published: September 2022

Background:

Hypotension is one of the most common complications following induction of general anesthesia. Preemptive diagnosis and correcting the hypovolemic status can reduce the incidence of post-induction hypotension. However, an association between preoperative volume status and severity of post-induction hypotension has not been established in neurosurgical patients. We hypothesized that preoperative ultrasonographic assessment of intravascular volume status can be used to predict post-induction hypotension in neurosurgical patients. Our study objective was to establish the relationship between pre-induction maximum inferior vena cava (IVC) diameter, collapsibility index (CI), and post-induction reduction in mean arterial blood pressure in neurosurgical patients.

Materials and Methods:

A prospective observational study was conducted including 100 patients undergoing elective intracranial surgeries. IVC assessment was done before induction of general anesthesia. Receiver operating characteristic (ROC) curve analysis was used to determine the cutoff values of maximum and minimum IVC diameter (IVCDmax and IVCDmin, respectively) and CI for prediction of hypotension.

Results:

Post-induction hypotension was observed in 41% patients. Patients with small IVCDmax and higher CI% developed hypotension. The areas under the ROC curve (AUCs) were 0.64 (0.53–0.75) for IVCDmax and 0.69 (0.59–0.80) for IVCDmin. The optimal cutoff values were1.38 cm for IVCDmax and 0.94 cm for IVCDmin. The AUC for CI was 0.65 (0.54–0.77) and the optimal cutoff value was 37.5%.

Conclusion:

Pre-induction IVC assessment with ultrasound is a reliable method to predict post-induction hypotension resulting from hypovolemia in neurosurgical patients.
Role of High-Sensitivity Troponin-T And N-Terminal Pro B-Type Natriuretic Peptide as an Early Predictor of Myocardial Dysfunction in Aneurysmal Subarachnoid Hemorrhage
Authors: Sharma Amit K , Singh Daljit , Mahajan Bhawna , Tandon Monica , Singh Hukum
Published: September 2022

Background:

Acute cardiac complications are commonly seen in aneurysmal subarachnoid hemorrhage (aSAH) patients and may vary from subclinical electrocardiographic abnormalities, or reduced ejection fraction on echocardiography, elevated levels of cardiac markers (cardiac troponin and Brain natriuretic peptide) to heart failure.

Objective:

This study was done to evaluate the role of cardiac markers (high-sensitive Troponin-T and N-terminal pro-B-type natriuretic peptide) in early identification of cardiac complications and hence dysfunction.

Methods:

All consecutive patients with aSAH without any previous cardiac history were included. At admission, neurological evaluation using Hunt and Hess grading (H and H grade), with electrocardiography to look for any changes, echocardiography for ejection fraction, and any wall motion abnormalities was also done. The serial serum levels of high-sensitive Troponin-T (hsTnT) and N-terminal pro B-type natriuretic peptide (NT pro-BNP) for 7 consecutive days was measured with hsTnT >0.14 ng/ml and NT pro-BNP >150 pg/mL considered elevated.

Results:

A total of 69 patients were included. The elevated peak level of hsTnT and NT pro-BNP was seen in 55.1% and 69.6% of patients. A positive correlation was seen between hsTnT (P = 0.033) and NT pro-BNP (P = 0.011) and poor SAH grade (H and H grade 3-5), similarly, abnormal ECG also significantly correlated with elevated peak hsTnT (P = 0.002) and NT proBNP (P = 0.000). Also, significant difference in peak hsTnT (P = 0.000) and NT-proBNP (P = 0.000) in patients with or without reduced ejection fraction (EF).

Conclusion:

The elevated peak levels of hsTnT and NTproBNP along with ECG and echocardiography abnormalities may help in early identification of myocardial injury, hence cardiac dysfunction.
Basal Cisternostomy in Head Injury
Authors: Kumar Punit , Goyal Nishant , Chaturvedi Jitender , Arora Rajnish K , Singh Prashant R , Shakya Jitender , Rekapalli Rajasekhar , Sadhasivam Saravanan , Sihag Rakesh , Bahurupi Yogesh
Published: September 2022

Background:

Cisternostomy has recently been reintroduced in the setting of severe TBI as an adjuvant surgical technique for decreasing brain edema and refractory intracranial hypertension. However, there is not much clarity regarding its role in head injury.

Objective:

Study the effect of cisternostomy on intracranial pressure, morbidity, and mortality in head-injured patients.

Material and Methods:

We conducted a single-center quasi-experimental study between November 2018 and November 2020. All candidates for decompressive hemicraniectomy (DHC) were divided into two groups: DHC-BC (undergoing basal cisternostomy with DHC) and DHC (undergoing DHC alone). We compared the impact of surgery on decreasing ICP and clinical outcomes in both groups.

Results:

During the study duration, we admitted 659 head-injury patients. Forty patients were included in the study (9 in the DHC-BC group and 31 in the DHC group). Both the groups were comparable in terms of baseline clinical characteristics such as age, gender, preoperative GCS, head injury severity, radiological features, and opening ICP. Patients in both groups had a decline in ICP following surgery. The mean closing pressure in the DHC-BC group (11.3 ± 5.9) was significantly higher than that in the DHC group (5.3 ± 3.5) (P = 0.003). The mean drop in ICP in the DHC-BC group was 14.4 ± 11.5 while that in the DHC group was 18.9 ± 12.4 (P = 0.359). The average total number of hours of ICP >20 mm Hg and intracranial hypertension index were higher for the DHC-BC group. The average number of days of stay in the ICU and hospital were lower for the DHC-BC group (7.0 ± 6.1 and 15.0 ± 20.2, respectively) compared to the DHC group (10.6 ± 9.3 and 19.3 ± 13.9, respectively). The 30-day mortality rate was higher for the DHC-BC group (66.6%) than the DHC group (32.2%). The mean GCS at discharge was better in the DHC-BC group (11.7 ± 2.9) compared to 10.5 ± 3.7 in the DHC group, while 11.1% of patients in the DHC-BC group had a favorable outcome (1-month GOS-E) compared to 9.7% patients in the DHC group.

Conclusions:

Our preliminary single-center study failed to show a clear benefit of adding basal cisternostomy to decompressive hemicraniectomy in patients with head injuries.
Traumatic Floating Neural Arch of the Subaxial Cervical Spine
Authors: Hadhri Khaled , Salah Mohamed Ben , Bellil Mehdi , Kooli Mondher
Published: September 2022

Bilateral traumatic pedicle fracture in the lower cervical spine is a very unusual lesion. Its association with bilateral facet dislocation has been reported once in the literature. We report a unique traumatic lesion considered as subaxial cervical floating neural arch with special emphasize on reduction maneuvers and surgical management. It was a case of bilateral C7 pedicle fracture with bilateral C6/C7 facet dislocation in a neurologically intact 70-year-old patient. Open posterior reduction with fixation followed by anterior fusion was performed with good functional and radiological outcomes at last follow up. The floating neural arch lesion is the combination of bilateral pedicle fracture and facet dislocation. The detection of such lesions imposes a two-stage surgery with open posterior reduction and anterior fusion.
MRI Spectrum of Toxic Encephalopathy—An Institutional Experience
Authors: Biswas Shamick , Pendharkar Hima S , Murumkar Vivek S
Published: September 2022

Background:

There are numerous toxins that affect our nervous system, both central and peripheral. Innumerable differentials exist in patients of acute encephalopathy and the list can be narrowed down with appropriate imaging. Specific neuroradiological features point to a particular diagnosis in a substantial number of cases.

Objective:

Through this study, we aimed to demonstrate the varied imaging findings of toxic encephalopathy on MRI encountered at our institute.

Material and Methods:

A retrospective analysis of the patients clinically diagnosed as toxic encephalopathy and referred for imaging between March 2015 and December 2019 was done. A total of 25 patients were included. Patient records were reviewed for clinical details, laboratory investigations, and treatment; the institute Picture Archiving and Communication System provided the imaging findings.

Results:

Patients presenting were aged between 22 and 55 years (mean—34.3 years). Four patients (16%) presented with imaging findings characteristic of Marchiafava-Bignami disease and six patients (24%) had MRI findings of Wernicke encephalopathy. Three patients (12%) had methanol poisoning sequelae while imaging findings of nitroimidazole drug toxicity were observed in another three patients (12%). Two patients (8%) each of carbon monoxide poisoning and lead toxicity were seen. We had one patient (4%) each of isoniazid, methyl iodide, dextropropoxyphene toxicity, chronic toluene abuse, and hyperglycemia-induced hemiballismus-hemichorea.

Conclusion:

Our study illustrates the amalgamated spectrum of MRI appearances in various subgroups of toxic encephalopathies. Imaging substantiated by relevant history and clinical manifestations can accurately diagnose the possible causative agent in the majority of the cases.
Proof-of-Principle for AVM Embolization Complications Caused by the Proximal Occlusion Technique Using Onyx
Authors: Zhang Huachen , Liang Shikai , Lv Xianli
Published: September 2022

To analyze the complications of the standard proximal plug technique in arteriovenous malformations (AVMs) embolization by Onyx and promote ante-grade drifting technique for AVM embolization. Seven publications reporting complications of AVM embolization by Onyx were identified and reviewed. Render descriptive statistics regarding causes of ischemic and hemorrhagic complications within 1 month following treatment were provided. A novel Onyx injection technique was proposed to overcome these problems. All reported transarterial Onyx AVM embolizations were conducted by employing the proximal plug technique. Causes of complications elicited by utilizing this strategy may generally be attributed to long-fluoroscopy and long-procedure times, embolisate reflux across a considerable extent of the vessel, catheter entrapment, extravasation of Onyx from the arterial lumen, catheter transgression through the arterial wall, the use of an Onyx volume exceeding, and venous occlusion preceding arterial feeder shutdown. Complications occurring during the course of attempts at embolizing AVMs utilizing Onyx constitute unfortunate causes of patient morbidity resulting from this conventional technique. We suggest that institution of a novel “ante-grade drifting technique” for Onyx injection may avoid these commonly elicited deficits. The proximal plug technique has a series of drawbacks that lead to serious adverse outcomes of AVM embolization. The Onyx embolization technology for AVM could be updated to improve clinical outcomes.
Occipital Interhemispheric Transtentorial Approach for Tumors of Posterior Third Ventricular Region
Authors: Sai Kiran Narayanam A. , Vidyasagar Kanneganti , Srinivasa Rakshith , Sivaraju Laxminadh , Raj Vivek , Furtado Sunil V. , Thakar Sumit , Aryan Saritha , Mohan Dilip , Hegde Alangar S.
Published: September 2022

Background:

Controversies exist regarding the ideal surgical approach for tumors in posterior third ventricular region (PTV).

Objective:

To evaluate the results of occipital interhemispheric transtentorial (OITT) approach for tumors in PTV.

Materials And Methods:

Thirty-three patients underwent surgery via OITT approach for PTV tumors at Sri Sathya Sai Institute of Higher Medical Sciences during the study period of 5 years (June 2011–May 2016). Ideal trajectory for OITT approach was determined by neuronavigation. Endoscope was used for removing any residual lesion at the blind spots.

Results:

Postoperative magnetic resonance imaging (MRI) performed in all the patients revealed gross total or near-total (>95%) excision of tumor in 31 patients (93.9%). Preoperative neurological deficits improved either completely or significantly following excision of the tumor in 73.3% (11/15) of the patients. Outcome was good (modified Rankin scale ≤2) at discharge in 93.9% (31/33) and at a final follow-up of 3 months or more in 96.8% (30/31) of the patients. None of the patients died during the postoperative period. Complications included upgaze palsy (transient- 6.1% [2/33], persisting- 3% [1/33]), visual field defects (transient- 3% [1/33], persisting- 3% [1/33]), transient third nerve paresis (1/33-3%), transient hemiparesis (1/33-3%), operative site hematoma (1/33-3%), small posterior cerebral artery (PCA) territory infarct (1/33-3%), and small venous infarct (1/33-3%). At least one follow-up MRI could be performed in 23 patients. Final follow-up MRI revealed no recurrence or increase in the size of the residual lesion compared to postoperative images in 20 patients (20/23-87%) and large recurrence in 3 patients (3/23-13%) with high-grade lesions.

Conclusion:

Gross total/near-total excision can be performed in majority of the PTV tumors through OITT approach with minimal morbidity and mortality.
Correlation of Preoperative Functional Magnetic Resonance Imaging (fMRI) with Intraoperative Cortical Stimulation in Surgeries of Eloquent Brain Lesions
Authors: Chawla Pawan , Misra Basant K , Udani Vrajesh , Desai Neelu , Gupta Santosh
Published: September 2022

Background:

Direct Cortical Stimulation (DCS) represents the gold standard for mapping of eloquent brain cortex. However, DCS is an invasive and time-consuming procedure. fMRI has become a useful tool to delineate motor and sensory eloquent cortex from the areas of planned neurosurgical resection. In our study, we will be studying the reliability of preoperative imaging when compared with the intraoperative DCS.

Objectives:

The aim of this study was to assess the reliability of fMRI by comparing it with DCS.

Methods and Materials:

Thirty patients with eloquent cortex lesions were admitted. Preoperative fMRI sequences were loaded into a neuro-navigational system. Intraoperative motor mapping was done by DCS. The location of all cortical stimulated points was correlated with the cortical functional structures. Based on it, specificity, sensitivity, positive predictive value, negative predictive value of fMRI was calculated. Preoperative and postoperative Karnofsky score and MRC grading was then noted.

Results:

Concordance between fMRI and DCS was noted in 26 cases. Overall mean sensitivity, specificity, positive and negative predictive value of fMRI as compared to DCS was 95%, 92.48%, 85.56%, and 96.08%, respectively. Preoperative and Postoperative Karnofsky score stayed same in most of the cases [25/30].

Conclusions:

DCS remains the gold standard for mapping eloquent cortex in-spite of its invasiveness, side effects such as seizures and cost concerns. Although fMRI cannot replace DCS, it can guide and increase the efficacy in resection, select high-risk patients for intraoperative monitoring, help in preoperative stratification of risk counseling and preservation of neurological status in eloquent brain lesions.
Temporal Lobe Encephalocele with Epilepsy in A Young Female
Authors: Thottiyil Jasica J , Prasad Arun , Dutta Durllav J , Anand Rajeev , Panikar Sujith A N S , Nadarajah Jeyaseelan , George Sabin
Published: September 2022

Idiopathic intracranial hypertension (IIH) is typically described in a middle-aged female and present with symptoms of headache, transient visual obscuration, photophobia, diplopia, rarely with pulsatile tinnitus. Seizure as a sole manifestation is very rare. Here we present a case of a young non-obese female with epilepsy, and imaging revealed temporal lobe encephalocele with typical imaging features of IIH. She underwent further workup, which confirmed the diagnosis of idiopathic intracranial hypertension.
Evaluation of Progesterone Receptor Antagonist and Maxi-K Channel Agonist as Neuroprotective in Feeney's Weight Drop Model of TBI
Authors: Kumar-M Praveen , Rajput Rohit , Ralta Arti , Quintans-Júnior Lucindo J , Gutierrez Stanley J C. , Barbosa-Filho Jose Maria , Shekhawat Devendra , Radotra B D , Gupta S K , Medhi Bikash
Published: September 2022

Background:

Neuroprotection in traumatic brain injury (TBI) is an unmet medical need.

Objective:

We evaluated two agents, aglepristone (progesterone receptor antagonist) and N-salicyloyltryptamine (STP) (activator of Maxi-K channel in GH3 cells), for neuroprotection in Feeney's weight drop model of TBI.

Material and Methods:

Forty-eight male Wistar rats were divided into six groups (n = 8 per group). A battery of six neurobehavioral tests was evaluated at the end of the first week (EO1W), second week (EO2W), and third week (EO3W). In addition, histopathological and immunohistochemistry (BAX, Bcl-2, and M30 Cytodeath) tests were performed at EO3W.

Results:

Aglepristone at 10 mg/kg showed significant neuroprotection compared to control as assessed by Rota-rod test at EO1W, VEFP right paw and 28-point neurobehavioral test at EO2W, MWM test at EO3W, and positive histopathological and IHC findings. Aglepristone at 20 mg/kg showed negative results as assessed by BAX expression, downregulation of Bcl-2, and positive M30 Cytodeath, thereby suggesting toxicity at higher doses. STP 100 mg/kg showed modest neuroprotective activity but failed to show a dose-response relationship at a dose of 50 mg/kg.

Conclusion:

The study shows that progesterone receptor antagonists have neuroprotection at lower doses and toxicity at higher doses.
Gender Differences in Perceived Stress among Neurosurgeons
Authors: Jagetia Anita , Vaitheeswaran Krishna , Mahajan Mahesh , Dholakia Binita , Devi B Indira
Published: September 2022

Purpose:

Surgeons are subjected to enhanced levels of work-related stress and women are likely to face unique challenges due to sub-optimal representation. The present study was conceived with a primary objective to study the gender differences faced by surgeons and neurosurgeons in particular. The secondary objective was to assess the correlation between the various stress inducers and busters of normal working and daily life and the mental state of neurosurgeons.

Methods:

The study was a cross-sectional, multi-centric study in which a structured questionnaire was sent to neurosurgeons through various neurosurgical forums of the country. A total of 93 complete responses were included in the study. The questions were broadly divided into four themes, demographic working data, stress inducers, stress busters, and questions to reflect the mental state of the respondent.

Results:

There were 74 males and 19 females in the study, with an average age of 39.34 ± 8.57 years. Statistically significant gender differences were noted in rating the out-patient department (OPD) hours, lectures and seminars, performing and assisting surgeries, attending conferences and working in the intensive care unit (ICU), with women scoring lower than men for these activities. There were no significant gender differences in the mental state of the respondents. A strong correlation was found between scoring for performance and assisting of surgery and the mental state questions, and a strong negative correlation was noted between music, playing games, going to the gym, practicing yoga and the mental state questions, indicative of a protective effect.

Conclusions:

There was no significant gender differences in the perceived stress levels among neurosurgeons. Women appeared more comfortable with certain normal activities of working. A strong negative correlation was reported for activities such as music, playing games, yoga, and going to the gym, indicating a protective effect.
Comparison of Periodic in-Person and Remote Visits via Smartphone Applications during COVID-19 Pandemic in Clinical Follow-up of Range of Motion in Patients with Distal Radius Fracture
Authors: Sabbaghzadeh Amir , Bonakdar Sona , Khoshkholghsima Maryam , Moshirpour Melina , Gorji Mona , Gholipour Morteza
Published: September 2022

Background:

Wrist function has a significant impact on quality of life, which is why restoring normal wrist movement after surgery is so important. Due to the COVID-19 pandemic, and the restrictions imposed on “face-to-face” visits, using smartphones has become more important in tracking patients. The main purpose of this study was to determine the accuracy of telemedicine in following up patients who had undergone distal radius fracture operation.

Materials and Methods:

From February to October 2020, 126 patients between 20 and 60 years old were randomly selected at our orthopedic trauma center. All patients were visited in person by an orthopedic surgeon in the morning (control group) and again all of them were visited online via smartphone in the evening by another orthopedic surgeon (case group). Both visits were done at regular intervals in the 2nd, 6th, and 12th weeks after surgery. Patients were evaluated for extremity function outcomes and joint range of motion.

Results:

The two groups were similar in terms of mean Patient-Rated Wrist Evaluation score and Disabilities of the Arm, Shoulder, and Hand score and did not show a statistically significant difference (P < 0.05). There was no significant difference in wrist range of motion measurements between the two groups (in-person visits and smartphone visits) during the follow-ups (P > 0.05).

Conclusion:

Changes in wrist range of motion after surgery can be assessed with high accuracy using smartphone applications and this method can be considered as a proper alternative to frequent in-person visits to evaluate postsurgical wrist condition.
Intoxication-Related Deaths in a Poisoning Center in Isfahan
Authors: Dorooshi Gholamali , Meamar Rokhsareh , Kalantar Kamran , Amini Zahra
Published: September 2022

Background:

The aim of this study was to investigate the frequency of poisoning mortality in the 5-year period of 2014–2019 in Isfahan Khorshid Hospital, Iran.

Materials and Methods:

This study is a cross-sectional descriptive analytical study, which was performed in 2020. The demographic and clinical data about the patients were extracted from the patients’ files and were then analyzed.

Results:

The number of deaths due to poisoning in the study period was 264, and the mean age of the deceased was 42.33 ± 20.097. One hundred and ninety-three (73.1%) patients were male. The frequency of deaths in the poisoning ward was 0.84%. The causes of death were accidental overdose (73, 26.9%), suicide (155, 63.2%), accidental use (18, 7.3%), and homicide in one patient. The mean age, time between exposure of toxin until death and history of addiction, substance use, and suicide in men patients was significantly higher than women (P < 0.05), however, such significant results were observed in married when compared with single patients. The differences between the two genders based on the type of toxic substance were statistically significant (P < 0.001). The most common causes of death were pesticides poisoning (n = 121), especially paraquat (n = 48) and Aluminum phosphide (n = 45), and multidrug poisoning (n = 48).

Conclusion:

In this study, we showed that the death rate due to poisoning in our center was lower than other centers. The highest number of poisoning was in men as well as married patients. It is also recommended that more serious educational and preventive strategies should be used in this regard.
Evaluation of the association between nasopharyngeal depth and respiratory complications after cleft palate surgery in children between 9 and 18 months old
Authors: Shahhosseini Sedighe , Shafa Amir , Saadati Mohammadali , Omid Mohammad , Memarzadeh Mehrdad , Montasery Mohammad
Published: September 2022

Background:

Considering the incidence of respiratory complications after cleft lip and palate surgery and its significance in the survival of children undergoing the mentioned surgery, the present study was performed to evaluate the association between the nasopharyngeal depth and the incidence of respiratory complications after cleft palate surgery.

Materials and Methods:

The present cross-sectional study was performed on 222 children who aged 9–18 months and were the candidates for cleft palate surgery. After performing general anesthesia and implanting mouth gag and before surgery, the nasopharyngeal depth and the cleft palate width were measured with a calibrated ruler and an ophthalmic caliper, respectively. At the end of the surgery and after extubation, the incidence of respiratory complications such as respiratory distress, laryngospasm, bronchospasm, and need for intubation was recorded.

Results:

The nasopharyngeal depth in children with respiratory complications with a mean of 7.57 ± 3.12 mm was significantly less than that of children without respiratory complications with a mean of 10.82 ± 2.14 mm (P < 0.001). The nasopharyngeal depth of ≤8 mm with a sensitivity of 80% and a specificity of 89.60% had a significant predictive value in the incidence of respiratory complications (P < 0.001).

Conclusion:

According to the results of the present study, it seems that the nasopharyngeal depth of ≤8 mm can make the incidence of respiratory complications more likely. Therefore, considering the simplicity and convenience of measuring the nasopharyngeal depth and the cleft palate width, it is suggested to perform further studies to evaluate the anatomy of palate before this surgery using the employed method and address its association with respiratory complications.
A case of acrodermatitis enteropathica mimicking mutilating palmoplantar keratoderma
Authors: Behera Binodini , Mohapatra Liza , Sahu Bharati , Patnaik Monali
Published: September 2022

Acrodermatitis enteropathica (AE) is a rare inherited form of defective zinc absorption usually manifesting as eczematous and erosive dermatitis preferably over periorificial and acral areas which at times mimics various hereditary palmoplantar keratodermas (PPK). We reported a 6-year-old boy who presented with hard plaques over both palm and sole, and periorificial areas, and flexion attitude of digits without any history of diarrhea and prolonged illness. The patient improved dramatically with zinc supplementation including correction of flexion deformities of the fingers. There was improvement of serum alkaline phosphatase level within 3 months. The lesions reappeared again whenever there was discontinuation of therapy for few weeks, thus confirming it to be zinc deficiency dermatoses. This kind of manifestation has rarely been described in earlier literature.
Migratory Panniculitis with Autoimmune Cholangitis and Pancreatitis (IgG4- Related Disease)
Authors: Malkani Ram H , Nagral Aabha , Karmakar Suman , Setia Maninder Singh
Published: September 2022

A 30-year-old woman presented with an acute-onset high-grade fever (103°F), multiple episodes of throbbing abdominal pain in the right quadrant, and pustular red lesions on the left leg. The radiological findings were suggestive of autoimmune cholangitis and pancreatitis. The skin lesions recurred on different portions of the body, and histopathological findings showed lobular and septal lymphohistiocytic infiltrate without vasculitis. The epidermis had focal ulcerations, and the dermis showed the presence of subcutaneous fat and an infiltrate of lymphocytes, histiocytes, and neutrophils (described as lobular and septal panniculitis without vasculitis). Based on the clinical and histopathological features, a diagnosis of migratory panniculitis was made. The patient was managed with analgesics, antibiotics, and a long course of steroids; the patient responded well to these medications. To the best of our knowledge, this is one of the first case reports of migratory panniculitis associated with IgG4-related disease. Patients with migratory panniculitis should be investigated for the presence of IgG4-related autoimmune disease. However, steroids remain the drug of choice when these conditions occur together.
Evidence-Based Guidelines for SARS-COV-2 Vaccination of Patients of Skin Allergic Diseases and Patients on Immuno-Therapeutics
Authors: Das Anupam , De Abhishek , Godse Kiran , Sangolli Prabhakar , Zawar Vijay , Sharma Nidhi , Girdhar Mukesh , Podder Indrashis , Shah Bela , Dhar Sandipan
Published: September 2022

There is a dearth of data regarding the safety and timing of the severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) vaccination of patients on immunosuppressive or immunomodulatory therapies. However, data from other vaccine trials may be extrapolated to get an idea regarding the recommendation of SARS-COV-2 vaccines. All the novel SARS-COV-2 vaccines are non-live, thus ensuring the safety of the vaccines. However, the vaccines may not be able to generate an equipotent immunogenic response in patients receiving immunotherapeutics, in comparison to those who are not. We have attempted to put forward certain statements, with respect to SARS-COV-2 vaccination of patients who are on treatment for different dermatological conditions. However, the risk-benefit ratio must be discussed between the patient and the physician, and the final call should be individualized.
How to Predict the Diagnosis of Cutaneous Leishmaniasis in a Non-Endemic Region
Authors: Altinel Yuksel , Tas Betul
Published: September 2022

Background:

Cutaneous leishmaniasis (CL) is a parasitic infection transmitted by the female sandfly, which has limited knowledge in non-endemic areas.

Aims:

To predict the epidemiological and clinical characteristics of CL cases on treatment during the period of Syrian refugees’ settlement.

Methods and Material:

The epidemiological and clinical data of 81 patients with CL who were admitted to the Istanbul Bagcilar Research and Training Hospital between March 2010 and April 2017 were conducted as a retrospective cohort study. A logistic regression analysis was performed.

Results:

Most detected demographics were Syrians (n = 56, 69.1%), ages <= 18 (n = 37, 45.7%), males (n = 49, 60.5%), elementary-school graduates (n = 35, 43.2%), and $500–750 income (n = 42, 51.9%). Most detected clinical characteristics were head/neck location (n = 38, 46.9%), acute-dry localized type (n = 71, 88%), crusted-papule (n = 79, 97.5%), and two lesions (n = 29, 35.8%). Means for age, family population, and session were 25.28 ± 20.90, 7.04 ± 2.03, and 11.27 ± 3.52, respectively. Majority of patients were admitted in 2014 and June. Significant factors by age were location, lesion type/number, and disease-duration. Lesion number ≥10, ages ≥41, crusted-nodule, cicatrix, and dissemination increased in session numbers, whereas crusted-nodule showed significant predictivity (P = 0.01).

Conclusion:

Location, lesion type/number, and disease duration may change by age in CL cases, whereas the presence of a crusted nodule may have a predictive effect on the number of treatment sessions.
Hemostatic and Coagulation Profile in Psoriasis
Authors: Mir Mubashar M , Dogra Devraj , Koul Kuldeep K
Published: September 2022

Context:

Psoriasis is a chronic inflammatory dermatosis associated with an increased risk of cardiovascular disease and atherothrombosis.

Aims:

This study was conducted to assess the levels of various hemostatic and coagulation parameters in psoriasis and their correlation with disease severity.

Settings and Design:

This was a hospital-based observational study.

Methods and Material:

Seventy-five patients with psoriasis and seventy controls were included in the study. History taking, clinical examination, and calculation of Psoriasis Area and Severity Index (PASI) were done. Blood analysis for Platelet count (PC), mean platelet volume (MPV), Vitamin B12, Thrombin Time (TT), Prothrombin time (PT) and Activated partial thromboplastin time (APPT) were done in both groups.

Results:

MPV which is a marker of inflammation and platelet activation was significantly increased in cases and positively correlated with the disease severity. Vitamin B12 is an important cofactor in homocysteine (Hcy) metabolism and correlates inversely with serum Hcy which is a known atherothrombotic marker. Vitamin B12 levels were significantly decreased in the cases with a significant negative correlation between Vitamin B12 level and PASI. There was also a significant decrease in serum level of PT, aPTT and TT in cases as compared to controls; however they showed no significant correlation with PASI.

Conclusions:

Inflammation in psoriasis may drive the process of abnormal platelet activation and coagulation abnormalities thus predisposing psoriatic patients to an atherothrombotic state and increasing the cardiovascular risk in psoriatic patients.
Toponyms in Dermatology
Authors: Ramesh Heera , Somashekar Sachin
Published: September 2022

The term toponym means any name that is derived from a place name. Numerous dermatological conditions have their names derived from geographic places. Although most conditions may have some association to the place they have been derived from, some of them are fortuitous.
Predictors of Quality of Life in Adults and Adolescents with Acne
Authors: Yıldırım Fatmaelif , Mert Başak , Çağatay Enis Yilmaz , Aksoy Berna
Published: September 2022

Background:

Acne is becoming more prevalent in adults, particularly women across the globe. Although previous studies have compared clinical and epidemiologic characteristics of adolescent and adult acne, an adequate understanding of the quality of life (QoL) of adult acne patients and associated comorbidities are still lacking.

Objectives:

We sought to compare the differences between adolescent and adult patient groups, regarding gender, socio-clinico-demographic factors, and comorbid associations, as well as their relatedness with life quality.

Methods:

This is a cross-sectional study with 1013 acne patients. Data on the severity, onset and location of acne, sex, family history of acne, smoking and alcohol habits, medication history, presence of seborrhea, and other comorbidities were collected. We employed the classification used by the American Academy of Dermatology for assessing acne severity. To assess the QoL in the patients, the Dermatology Life Quality Index (DLQI) score was used.

Results:

Of the 1013 patients included in this study; 380 (female: 333, male: 47) were adult, and 633 (female: 535 and male: 98) were adolescent cases. The median total DLQI scores of adult and adolescent groups were not significantly different. Our results showed that factors such as age, gender, duration, body mass index, family history, and psychiatric disorders exhibited no impact on QoL in both adolescents and adults. Age of onset was correlated with DLQI scores in the adult group. The main influencers of DLQI in the adult group were allergic disorders, hormonal imbalances, and previous treatment history. Besides, major influencers in adolescent patients were acne severity, acne location, hirsutism, hyperseborrhea, premenstrual exacerbation, menstrual irregularities, previous treatment history, and smoking.

Conclusions:

The findings of our current study have shown that DLQI has been influenced by different factors in adolescents and adults that should be kept in mind.
Clinico-Dermoscopic-Pathological Features of a Rare Case of Locally Invasive Multifocal Primary Cutaneous Diffuse Large B Cell Lymphoma-Leg Type Over the Face and Scalp
Authors: Behera Biswanath , Palit Aparna , Nayak Ashish Kumar , Panigrahi Ashutosh , Mishra Pritinanda , Sethy Madhusmita
Published: September 2022

Primary cutaneous diffuse large B-cell lymphoma-leg type (PCDLBCL-LT) is characterized by diffuse monotonous proliferation of centroblasts and immunoblasts. It commonly presents as erythematous to violaceous nodules on one or both the legs and has a poor prognosis. We report the clinico-dermoscopic-pathological features and therapeutic response of a rare case of PCDLBCL-LT in a 62-year-old diabetic man, who presented with multifocal plaques, one lobulated and two arcuate-shaped, on the face and scalp. During the investigation, one of the plaques had eroded the underlying bone without any evidence of malignant cells in the cerebrospinal fluid. He was successfully treated with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) along with intrathecal methotrexate.
CTLA4 Gene Polymorphism and its Association with Disease Occurrence, Clinical Manifestations, Serum Markers and Cytokine Levels in SLE Patients from North India
Authors: Kailashiya Vikas , Singh Usha , Kailashiya Jyotsna
Published: September 2022

Background:

Cytotoxic T lymphocyte-associated protein-4 (CTLA-4) or CD152 is an inhibitory receptor expressed constitutively on CD4+CD25+ T regulatory lymphocytes (Treg) and transiently on activated CD4+ and CD8+ T lymphocytes. Association of CTLA4 gene polymorphisms with Systemic Lupus Erythematosus (SLE) has been reported in south Indians, but not in north Indians. This study aims to investigate CTLA4 gene polymorphism and its association with the occurrence of SLE, its clinical manifestation and serological markers in north Indians.

Methods:

This cross sectional study was done in a tertiary health care centre in north India. Patients reporting to the hospital and diagnosed with systemic lupus erythematosus were included in study. +49 A/G (snp- rs231775) CTLA4 gene polymorphism was analysed in 41 SLE patients and 21 matched healthy controls by real time PCR method. ANA (Antinuclear Antibody), anti dsDNA, Interferon-γ (IFN- γ), TGF-β, IL-10 were measured by ELISA kits. Complement (C3 and C4) and immunoglobulins (IgA, IgG, IgM) estimation were done with the turbidometry method. Chi-square test was used for comparison between groups and odds ratio with 95% confidence interval was calculated to estimate the associated risk.

Results:

A/A genotype was most common (51.2%) followed by the A/G genotype (46.3%) and G/G genotype (2.4%, detected in only 1 patient). The frequency of A allele was 74.4%, while of G allele was only 25.6%. A/G genotype SLE patients showed a higher risk (odds ratio 37.5, 95% CI- 6.048-232.51) of developing edema compared to A/A genotype patients. There was no statistically significant association of various CTLA4 genotypes with the occurrence of SLE and serum markers.

Conclusions:

A/A was the most common CTLA4 genotype in both SLE patients and healthy controls of north India. Contrary to the previous report in south Indians, there was no statistically significant association between CTLA4 genotype and occurrence of SLE in north Indians. Only the presence of generalised edema was found significantly associated with the A/G genotype.
Atopic March
Authors: Dhar Sandipan , Jagadeesan Soumya
Published: September 2022

The progression of allergic diseases with the development of atopic dermatitis and food allergy in infancy and subsequent asthma and allergic rhinitis in the later childhood is known as 'atopic march'. There have been many arguments in favour of and against this concept. This article reviews the latest epidemiology, immunological mechanisms and translational implications in clinical practice and research, which is relevant to the dermatologists. The role of skin as a site of initiation and the potential for interventions on skin that may prevent subsequent allergic diseases is also highlighted.
Assessment of Lornoxicam as a Mouth Dissolving film in Management of Post Extraction Pain-A Randomized Control Trial
Authors: Vijayan Aparna M , Mahesh KP , Patil Karthikeya
Published: September 2022

Background:

Mouth dissolving film (MDF) is a fast-dissolving drug delivery system that provides a practical means to administer drugs not just to special populations with swallowing difficulties but also to the general public. MDFs are novel dosage forms that dissolve and disintegrate quickly within the mouth.

Aim:

To assess the efficacy of lornoxicam mouth dissolving film as a potent analgesic and drug delivery system and compare it with the aceclofenac tablet in the management of post-extraction pain.

Methodology:

The study group comprised 60 subjects of either sex of age group 20–50 years who were divided into an experimental group (group A) and a control group (group B). Group A was administered lornoxicam MDF and group B was administered aceclofenac tablets. Pre-treatment and post-treatment pain assessments were recorded using a visual analog scale (VAS) and an oral pain scale (OPS).

Results:

In a comparison of the mean value of pre-treatment VAS and VAS after 24 h, the percentage of pain reduction in group A was 86.66%, and in group B was 75%. When comparing the mean value of pre-treatment OPS and OPS after 24 h, the percentage of pain reduction in group A was 93.33% and in group B was 75%. These results were statistically significant, with a P value of 0.00 in both groups.

Conclusion:

Lornoxicam as an MDF showed promising results in managing post-extraction pain. The potential delivery of lornoxicam through the MDF was safe, with better patient compliance, and no reported cases of adverse effects.
Evaluation of Serum Urea, Uric Acid and Creatinine in OSMF Patients
Authors: Verma Swati , Bhowate Rahul R.
Published: September 2022

Introduction:

Oral submucous fibrosis (OSMF) is described as a chronic debilitating disease of the submucosal tissue. Leaching out compounds from areca nut is the main etiology for OSMF. Biochemical examinations have concentrated on demarcating changes in the blood, serum, or tissues of patients with this disease. Such examinations have given insights into the possible pathogenesis of OSMF.

Aim:

Estimation of serum urea, uric acid (UA), and creatinine (Cn.) in OSMF patients.

Objective:

To estimate the level of serum urea, UA, and Cn. in OSMF patients and compare them with habitual betel nut chewers.

Materials and Methods:

The purposive samples were selected from patients attending the OPD of the Oral Medicine and Radiology (OMR) Department. In total 180 patients were included and divided into three groups. Group I-Patients suffering from OSMF, Group II-Habitual control, and Group III-Healthy control.

Results:

The mean value of serum UA (mg/dL) in Group I was 7.82 ± 2.18, Group II was 5.83 ± 1.22, and Group III was 5.28 ± 1.10. The mean value of serum Cn. (mg/dL) in Group I was 1.05 ± 0.27, Group II was 1.15 ± 0.22, and Group III was 0.72 ± 0.21. One-way analysis of variance (ANOVA) was applied between the groups and significant differences were found for both serum UA and Cn. with P < 0.0001, whereas no significant difference was found for serum urea.

Conclusion:

It can be concluded from this study that serum urea, UA, and Cn. of OSMF patients should be evaluated for liver and renal involvement and for overall improving the disease prognosis.
Frequency of Recommending Cone Beam Computed Tomography in Comparison to Panoramic Radiograph, While Diagnosing a Pathology/Status of Vital Structures Around Mandibular Impacted Third Molar
Authors: Naik Veena , Prakash Saurabh , Chuan Ng Wen , Nishanthisri  , Ying Ooi Chin
Published: September 2022

Objective:

This study assesses the quantity and quality of reliability of both conventional and cone-beam computed tomography (CBCT) in evaluating external root resorption (ERR) and proximity of inferior alveolar canal (IAC) around impacted mandibular third molars and also the practicability to advise CBCT as the first radiographic examination in every patient with above pathology.

Methodology:

A prospective cross-sectional study was conducted with a sample of 73 individuals, aged between 18 and 40 years, irrespective of their sex. Digital panoramic radiograph (PAN) and CBCT were carried out for individuals with mandibular impacted third molars, which were evaluated by three observers independently for ERR and relation of impacted teeth with inferior alveolar nerve (IAN) canal (resorption of IAN cortical plate, impingement, and approximation). The data was analyzed by Kappa test and the PAN and CBCT findings were compared using Wilcoxon signed-rank test.

Results:

Out of 73 subjects, 13 subjects showed resorption of the IAN cortical plate in CBCT, among which only five were confirmed in PAN. Forty-three cases showed impingement of the third molar on the IAN in PAN, which was completely absent in CBCT. Among 14 subjects who presented contact or approximation of the third molar with the canal in PAN, only seven were confirmed in CBCT. Twenty-five cases actually showed ERR in CBCT, whereas PAN confirmed only eight cases. Pathologies seen on PAN were considerably very less in comparison with CBCT.

Conclusion:

Thus, we conclude that two-dimensional (2D) radiographs are the first choice of diagnostic radiographs, even though the CBCT is accurate in displaying the pathology; however, the decision to advise CBCT image should depend on whether the information from CBCT changes the surgeon's diagnosis and treatment planning.