bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical outcomes of in-hospital cardiac arrest in a tertiary hospital and factors related to 28-day survival
Authors: Yakar Mehmet Nuri , Yakar Nagihan Duran , Akkılıç Müslüm , Karaoğlu Rasim Onur , Mingir Tarkan , Turgut Namigar
Published: January 2022

OBJECTIVES:

The primary aim was to define factors related to the return of spontaneous circulation (ROSC) after in-hospital cardiac arrest (IHCA), and the secondary aim was to determine factors related to 28-day mortality in patients admitted to intensive care unit (ICU) after ROSC.

METHODS:

In this retrospective study, we included the patients who suffered from IHCA in a tertiary hospital between July 2016 and April 2019. Pre- and post-resuscitation characteristics of the patients and event characteristics were defined to reveal the independent factors associated with ROSC and 28-day survival.

RESULTS:

A total of 254 patients (median age 73 years, 58.3% males) underwent cardiopulmonary resuscitation (CPR). The ROSC rate was 45.7%. Of all, 51 patients (median age, 63 years, 54.9% males) were admitted to in-hospital ICUs. The 28-day survival rate was 31.4%. The independent risk factors were chronic kidney disease (odds ratio [OR], 3.18, 95% confidence interval [CI], 1.37–7.19, P = 0.007), chronic obstructive pulmonary disease (OR, 2.84, 95% CI, 1.23–6.61, P = 0.015), asystole as an initial rhythm (OR, 2.94, 95% CI, 1.27–6.79, P = 0.012), multi-trauma-related complications (OR, 21.11, 95% CI, 4.71–94.69, P < 0.001), and septic shock (OR, 4.10; 95% CI, 1.16–14.54, P = 0.029) for ROSC; and a cerebral performance category score >2 (OR, 20.86, 95% CI, 2.74–158.65, P = 0.003), Acute Physiology and Chronic Health Evaluation II score >14 (OR, 7.58, 95% CI, 1.06–54.23, P = 0.044) for 28-day mortality.

CONCLUSIONS:

Independent risk factors related to ROSC and 28-day mortality were defined in the study. However, further studies are needed to devise new strategies for increased hospital discharge with preserved neurologic functions.
The Prevalence and Risk Factors of Irritable Bowel Syndrome in Saudi Arabia in 2019
Authors: Alqahtani Naif H. , Mahfouz Mohammad Eid M.
Published: January 2022

Background:

Irritable bowel syndrome (IBS) is a common chronic functional gastrointestinal (GI) disorder. The aim of this study is to assess the prevalence of IBS and its risk factors among the general population of Saudi Arabia, as there is no previous study has done so.

Methods:

A cross-sectional study was carried out to evaluate the prevalence of IBS, IBS subtypes and IBS risk factors among the general population of Saudi Arabia from June 22 to November 30, 2019. A designed questionnaire that is based on ROME IV criteria and licensed from Rome Foundation was used. A total of 1,680 eligible individuals from different parts of Saudi Arabia took part in this national survey and were included in the statistical analysis. The statistical analysis was carried out using Statistical Package for the Social Sciences (SPSS) program (version 22).

Results:

The prevalence of IBS in the study was 18.2%. IBS-M was the most common subtype among IBS patients (42.3%). Risk factors that are significantly associated with IBS were shown to be smoking habits, gastroesophageal reflux disease (GERD), food allergy, anxiety, psychological stress, family history of IBS, regular use of non-steroidal anti-inflammatory drugs (NSAIDs), history of infection before occurrence of symptoms and residence in the south of Saudi Arabia (P < 0.05*).

Conclusions:

IBS is prevalent in Saudi Arabia. The most common risk factor among IBS patients is a positive family history of IBS (80%). Raising public awareness and further prospective studies are both advocated and needed.
Strategies for Improving Participation in Human Papillomavirus Vaccination Among Young Adults in the Capital of Iran
Authors: Yarmohammadi Soudabeh , Ghaffari Mohtasham , Mashayekhi Parisa , Ramezankhani Ali , Mirzaei Jamal
Published: January 2022

Background:

Different strategies can promote healthy behaviors. Although the human papillomavirus (HPV) vaccine is very important due to its effect in reducing cervical cancer, the behavior of HPV vaccination is low among young adults in Iran. Therefore, this study aimed to determine strategies for improving HPV vaccination among young adults.

Methods:

The present study was conducted with a qualitative content analysis method. The participants were 30 health professionals and young adults in Tehran city who were selected using purposive and snowball sampling. The data were collected through semistructured interviews and analyzed by Graneheim and Lundman's approach.

Results:

In total, two categories were identified: (1) access to services: access to the vaccine, vaccine insurance coverage; (2) educational coverage: subgroup training, educational content, time for training, educational channels, education strategies, and educational conditions.

Conclusions:

This is the first study conducted to determine strategies for improving HPV vaccination in Iran. The policymakers and planners, schools, and health centers are recommended to use the strategies obtained from this study to increase HPV vaccine imports, as well as increase the community members’ knowledge and acceptance of the HPV vaccine.
Prevalence of Osteoporosis and Osteopenia in People Over 60 Years in Iran
Authors: Nourmohammadi Hassan , Abdan Zahra , Amin Hashemipour Seyed Mohammad , Sarokhani Diana , Abdan Mohsen , Fakhri Moloud , Dehkordi Ali Hasanpour
Published: January 2022

Background:

Osteoporosis in the elderly has dangerous complications, the most important of which are bone fractures and reduced quality of life in the elderly. The present study was aimed at estimating the prevalence of osteoporosis in Iranian elderly using systematic review and meta-analysis.

Methods:

This search was conducted using authentic Persian and English keywords in national and international databases including Scientific Information Database, Magiran, IranDoc, PubMed, Scopus, Cochrane, Embase, and Web of Sciencewith no time limit until 20.06.2020. Heterogeneity of studies was assessed using I2 index. Data were analyzed using STATA Ver. 15 software.

Results:

In 30 studies with a sample size of 13,347 people, the prevalence of osteoporosis and low bone density in people over 60 years in Iran were 34% (95% CI: 27%, 42%) and 47% (95% CI: 41%, 53%), respectively. We also found that 34% of women and 41% of men over the age of 60 suffer from osteoporosis. Prevalence of osteoporosis was in lumbar bone 23% (95% CI: 20%, 26%), spine 25% (95% CI: 19%, 31%), hip 35% (95% CI: 7%, 62%), and femur 23% (95% CI: 15%, 31%). Prevalence of low bone density was in lumbar bone 41% (95% CI: 19%, 63%), spine 30% (95% CI: 15%, 46%), and femur 35% (95% CI: 21%, 48%).

Conclusion:

The prevalence of low bone density in people over 60 years is higher than the prevalence of osteoporosis in them. About one-third of Iranian elderly people suffer from osteoporosis, but about half of them have low bone density.
Assessment of Intraorganizational Collaboration in the health sector during Disasters
Authors: Yousefian Shiva , Jahangiri Katayoun , Mehrabi Yadollah , Sohrabizadeh Sanaz
Published: January 2022

Background:

Collaboration, as a key factor in disaster risk management, is a mechanism that prevents the loss of time, investment, and resources. The variety of units in the health sector has made collaboration a major challenge. The present study aimed at developing a tool for assessing collaboration in the health sector during disasters.

Methods:

In this mixed-methods study, a questionnaire was developed by integrating the findings of a systematic literature review and a qualitative study. Face and content validation were performed. The reliability of the tool was tested through a 15-day interval test–retest by Cronbach's alpha and intraclass correlation coefficient (ICC) with 30 participants. Confirmatory factor analysis was done to test the validity and reliability of instrument using SmartPLS in a case study with 450 health sector staff.

Results:

The factors affecting intraorganizational collaboration of the health sector were identified in six categories and 19 subcategories by searching 46 articles in the systematic review and content analysis of 16 semistructured interviews with health sector staff. The results of content validity ratio (=0.81), content validity index (=0.92), Cronbach's alpha (=0.975), and ICC (=0.970) confirmed the validity and reliability of the tool. Convergent validity, discriminant validity, and reliability were approved by AVE (average variance extracted) >0.5, Fornell and Larcker matrix, and CR (composite reliability) >0.7. According to the positive result of R
2, Q
2, and goodness-of-fit (GOF) criteria, the model fit was confirmed.

Conclusion:

The results of validity and reliability measurements approved the proposed tool. The use of this tool is recommended for developing collaboration in the health sectors of different countries.
Radiofrequency Ablation of Varicose Veins, How do I do it?
Authors: Karmacharya Robin Man , Vaidya Satish , Singh Amit Kumar , Dhakal Prasesh , Dahal Sushil , Bhandari Niroj , Bade Sohail , Bade Sahil , Shrestha Prabha
Published: January 2022

Radiofrequency ablation (RFA) is one of the recent yet adequately studied minimal invasive surgery for varicose veins. The aim of this manuscript is to share our technique of RFA for varicose veins. The technique has been revised over time and has been standardized over all the surgeons doing this procedure in our institute. We have been using few of the terms to define specific scenario in relation to the procedure.
Anatomical Variants of the Obturator Artery and Their Clinical Importance
Authors: Thampi Swapna , Oommen Aswathy Maria , Rajasekharan Sreekumar , Sarasammal Suja Robert
Published: January 2022

Context:

The obturator artery (OA) originates from the internal iliac artery (IIA), and it runs on the lateral pelvic wall to leave through the obturator canal. It can have a varied source of origin. A small pelvic space makes it susceptible to injury during repair of femoral and inguinal hernias and pelvic surgeries. Unexpected injury of an aberrant OA can be avoided only with a thorough knowledge of its anatomy.

Aim:

This study aims to estimate the prevalence and describe the course of aberrant obturator arteries.

Settings and Design:

A descriptive, cross-sectional, cadaveric study was conducted in the Department of Anatomy, Government Medical College, Thiruvananthapuram, India.

Materials and Methods:

Sixty-four hemipelvices were dissected. Variations in the origin, course, and relations of the OA were observed and noted.

Statistical Analysis Used:

The results were tabulated, and the prevalence of each variation was calculated.

Results:

Variations were seen in 40.6% cases. OA originated from inferior epigastric artery (23.4%), external iliac artery (3.1%), posterior division of IIA and iliolumbar artery (1.5%), superior gluteal artery (6.2%), internal pudendal artery (1.5%), and inferior gluteal artery (3.1%) cases. Arterial corona mortis, a tortuous anastomotic channel connecting OA (originating from IIA) and inferior epigastric artery was seen along with venous connections in one specimen.

Conclusions:

Aberrant origins of OA pose a high risk for significant hemorrhage in trauma and various surgeries. Hence, a sound anatomical knowledge of its origin and course is vital while repairing fractures and hernias in this region.
Peroneal Nerve Palsy Due to Pseudoaneurysm Following Total Knee Arthroplasty
Authors: Solomon Jennifer Sitther , Pawar Pranay , John Bobby , Luther Anil
Published: January 2022

Total knee arthroplasty (TKA) is among the commonly performed orthopedic procedures with a very good safety profile. Vascular injuries following TKA are very rare and usually identified intraoperatively or in the immediate postoperative period. Popliteal artery pseudoaneurysms post-TKA are very rare, and their management can be quite challenging. We describe a case that presented more than 3 months after the index surgery with a peroneal nerve palsy due to a pseudoaneurysm.
Catheter-Directed foam Sclerotherapy in Chronic Venous Insufficiency Patients with Active Ulcer Single-Center Experience
Authors: Shahat Mohammed
Published: January 2022

Introduction:

Varicose vein and chronic venous insufficiency (CVI) is one of the most prevalent health problems in Europe and the United States; in some studies, it may reach 60% of population.

Patients and Methods:

This prospective study involving on 51 patients (C6) is to assess the efficacy and tolerance of sclerotherapy foam in the treatment of great saphenous vein incompetence and ulcer healing in CVI patients at 6 and 12 months and to report our experience regarding the diagnosis and treatment of CVI by catheter directed sclerotherapy (CDS).

Results and Conclusion:

In our experience, CDS safely can contribute to good ulcer healing rate up to 73% at 6 months for a reasonable cost of money and time which might be considered an attractive strategy for providing efficient vascular service in clinical practice.
Total Endovascular Repair with Chimney Grafts for Distal Stent Graft-Induced New Entry After Type B Aortic Dissection
Authors: Umeno Tadashi , Ohki Satoshi , Yasuhara Kiyomitsu , Obayashi Tamiyuki
Published: January 2022

The parallel graft technique is valuable for high-risk patients who are unfit for open repair and who have complex aortic lesions, such as distal stent graft-induced new entry (SINE). The patient had undergone thoracic descending aortic graft replacement because of dilatation of the distal aortic arch after optimal medical therapy for Type B aortic dissection. After 9 years, a new entry occurred at the level of the diaphragm. He was treated with thoracic endovascular aortic repair (TEVAR) due to rapid dilatation and his back pain. However, distal SINE occurred 1 month after TEVAR. Therefore, we performed chimney endovascular aortic repair to maintain perfusion to superior mesenteric artery and bilateral renal arteries. When using a prefabricated branched device in a narrow dissected true lumen, the possibility of selectively catheterizing a visceral branch often has no straightforward solution. However, parallel grafting is a flexible technique that had paramount importance for the surgical outcome in our case.
Comparative Study of the Effects of Two Suturing Techniques of End-to-Side Arteriovenous Anastomosis on Early Outcomes of Radio-Cephalic Fistulas
Authors: Vyahalkar Sameer Vilas , Chaudhari Avinash E , Binnani Pooja G , Kulkarni Amar Vilas , Nagarik Amit Prakash , Jawade Kailash K , Chandrashekhar Shantanu S
Published: January 2022

Introduction:

Radiocephalic arteriovenous fistulas (AVFs) for dialysis have significantly high maturation failure rate. Many surgical technique-related factors are known to impact the outcomes of AVF surgery; anastomotic suturing technique is one such factor for which the published data is sparse.

Patients and Methods:

We retrospectively analyzed the data of patients who underwent end-to-side radio-cephalic AVF surgery during a 2-year period and grouped it according to the two techniques of anastomotic suturing: Anchor technique and parachute technique. Comparative analysis was done to study the effect of the technique on well-defined outcomes within the first 6 months of surgery.

Results:

A total of 119 AVFs (anchor technique = 65, parachute technique = 54) were included in the study. The aggregated primary patency at 6 weeks and 6 months was 85.7% and 78.1% respectively and successful use of fistula was seen in 62.2%. The parachute technique was associated with lower immediate access thrombosis (3.7% vs. 15.4%, P = 0.019) and primary failure (31.5% vs. 43%, P = 0.033) than the anchor technique. The groups did not differ statistically in outcomes like early access failure (P = 0.376), maturation failure (P = 0.105), primary patency at 6 weeks (P = 0.07) and at 6 months (P = 0.083) and successful use of fistula at 6 months (P = 0.196).

Conclusion:

In this retrospective single-center study, the parachute technique of anastomotic suturing was associated with lower incidence of immediate access failure of radio-cephalic AVF as compared to the anchor technique, although other early outcomes were similar with both techniques. The effects of different suturing techniques on surgical outcomes of AVF should be studied in large randomized trials.
A Case of Squamous Cell Carcinoma Due to Neglected AV Fistula for Dialysis
Authors: Pandiaraja Jayabal
Published: January 2022

Squamous cell carcinoma is a malignancy arising from keratinocytes. Arteriovenous (AV) fistula is one of the rare conditions causing chronic inflammation of skin and underlying structure. AV fistula can create catastrophic complications such as squamous cell carcinoma if neglected. There are very few reports of squamous cell carcinoma due to Av fistula. Most of the cases require surgical excision of squamous cell carcinoma with ligation of AV access if infiltrated. Early detection of cutaneous malignancy will reduce the morbidity and mortality related to malignancy and it also salvages the AV fistula.
Effects of two different doses of 3% hypertonic saline with mannitol during decompressive craniectomy following traumatic brain injury: A prospective, controlled study
Authors: Bhatnagar Neelesh , Bhateja Saurabh , Jeenger Lalita , Mangal Govind , Gupta Sunanda
Published: January 2022

Background and Aims:

The current study was designed to compare the effects of two different doses of 3% hypertonic saline with mannitol on intraoperative events during decompressive craniectomy in traumatic brain injury (TBI). Primary outcome measures included assessment of intraoperative brain relaxation, hemodynamic variables, and serum electrolytes. Effect on the postoperative outcome, in terms of the Glasgow coma scale (GCS), length of stay in the ICU, and mortality were the secondary outcome measures.

Material and Methods:

Ninety patients with TBI undergoing craniotomy were enrolled. Patients were assigned to receive 300 mL (328 mOsm) of mannitol (n = 26, M) only or 300 mL of mannitol with 150 mL (482 mOsm) of 3% HS (n = 35, HS1) or with 300 mL (636 mOsm) of 3% HS (n = 29, HS2). Brain relaxation was assessed and if required, a rescue dose of mannitol (150 mL) was given. GCS was assessed preoperatively, 24 h postoperatively, and at the time of discharge from the ICU and total duration of stay was noted.

Results:

Acceptable brain relaxation was observed in 89.66% (n = 26, HS2) and 80% (n = 28, HS1) patients as compared to 46.1% (n = 12, M) patients (P < 0.001) with significantly less number of patients requiring rescue doses of mannitol in groups HS1 and HS2(n = 7 and 3, respectively) as compared to group M (n = 14) (P < 0.05). There was a significant improvement in GCS at 24 h and at the time of discharge from the ICU in patients with a severe head injury in group HS2 (P = 0.029). In patients with moderate head injury there was a significant improvement in GCS at the time of discharge among all the three groups (P < 0.05).

Conclusion:

Increasing osmotic load by addition of 3% HS to mannitol provides better intraoperative brain relaxation than mannitol alone during decompressive craniectomy. An addition of 300mL 3% HS was found to be more effective in improving GCS in patients with severe TBI.
Anaesthetic implications of free-flap microvascular surgery for head and neck malignancies – A relook
Authors: Goswami Upasana , Jain Anurag
Published: January 2022

Head and neck free-flap microvascular surgery is a type of surgery where multiple anaesthetic factors play a very important role in the outcome of the surgery while the conduct of anaesthesia itself may be quite challenging for the anaesthesiologist. In microvascular reconstruction of head and neck malignancies, flaps are used to reconstruct a primary defect formed by wide local excision. A free flap is raised after removing the neurovascular pedicle from the donor site and transplanting it by microvascular anastomosis to the new location. This gives rise to a secondary defect which is then repaired by direct suture or skin graft. The anaesthesiologist’s role includes optimizing the physiological conditions for the survival of the flap while decreasing morbidity at the same time. Failure of the free flap is attributed to numerous causes. This is an attempt to highlight them along with discussion of the anaesthesia-related issues that are faced during this type of surgery. The various pre-, intra- and postoperative factors affecting flap survival and overall postoperative outcome in the patient are discussed here.
Comparative evaluation of efficacy of oxygenation using high flow nasal cannula vs. conventional nasal cannula during procedural sedation for endoscopic ultrasound: A pilot study
Authors: Shukla Kamalendra , Parikh Badal , Kumar Alok , Nakra Monish
Published: January 2022

Background and Aims:

High flow nasal cannula (HFNC) has numerous advantages against conventional oxygen therapy delivery systems. However, there is limited evidence supporting the use of HFNC in endoscopic ultrasound (EUS) under procedural sedation. The aims of this study is to evaluate the efficacy of two different oxygen delivery devices, that is,HFNCand conventional nasal cannula on the oxygenation status of patients during procedural sedation for EUS.

Material and Methods:

Sixty adult patients undergoing EUS for various ailments were randomized to two groups group HFNC (n=30) and group nasal cannula [NC (n = 30)]. HFNC (AIRVO2, Fisher and Paykel Healthcare, New Zealand) was used on patients in the group HFNC. Respiratory status of the patients was assessed using pulse oximetry, respiratory rate, procedural airway complications, and oxygen therapy adjustments. The endoscopist assessed the ease of performing EUS at the end of the procedure and patient satisfaction score (PSS) was assessed by using a Likert score in the post-anesthesia care unit.

Results:

SpO2 measurements in the HFNC group during the procedure were marginally better compared to the NC group but this failed to reach statistical significance. Also, no significant association was found between both groups while comparing desaturation events (P = 0.499), patient satisfaction score (PSS) and endendoscopist’s satisfaction score (ESS) (P = 0.795). Both the groups were comparable in terms of airway manipulation, use of airway adjuncts, need to increase oxygen flow rate, endoscope removal, apneic episodes, hypotension, and bradycardia. No major complications were observed in either group.

Conclusion:

HFNC use in patients undergoing EUS is not superior when compared to conventional nasal cannula oxygen therapy. HFNC failed to show any significant impact on decreasing the risk of desaturation events and airway manipulation during the procedure.
A comparative study of propofol, thiopentone sodium, and ketofol as induction agents for electro convulsive therapy
Authors: Gaddam Nagraju R. , Kelkar (Sasturkar) Vasanti P. , Kulkarni Sanhita J. , Joshi Pradnya S. , Bhale Pramod V.
Published: January 2022

Background and Aims:

Thiopentone and propofol are most commonly used induction agents for electro convulsive therapy (ECT). Recently, ketofol, an admixture of propofol and ketamine, is being tried in ECT. We aimed to compare propofol, thiopentone, and ketofol as induction agents during ECT regarding their effects on ECT-induced hemodynamic changes, seizure duration and recovery parameters.

Material and Methods:

This prospective randomized double blind study was conducted in 30 patients between 18 and 65 years with ASA status I and II scheduled for ECT. All patients received all study agents for first three sessions of ECT. The observations were compiled as Group K (Inj. Ketofol i.e., Inj. propofol 0.5mg/kg + Inj. ketamine 0.5mg/kg), Group P (Inj. propofol 1mg/kg), and Group T (Inj. thiopentone 3mg/kg).Heart rate (HR) and blood pressure (systolic, diastolic, and mean) was recorded at pre op, 0, 5, 10, and 20 min after ECT. The seizure duration, time to spontaneous eye opening, andobeying verbal commands and agitation score were recorded.

Results:

Statistically significant difference was seen in HR at 10 min after delivery of shock; in systolic BP at 2 min after shock; in diastolic BP after administration of study drug and immediately after shock and in mean arterial pressure at post induction, 0and2 min after shock with group T showing higher values compared to group K and P (p < 0.05). At all other times HR andBP was comparable in all the three groups.Seizure duration was more in group T than Groups P and K although the difference was statistically insignificant.Time to spontaneous eye opening and obey verbal commands was comparable in all groups.Mean agitation score was highest in group T than Groups P& Kwith Group P showing least value (p = 0.003).

Conclusion:

Propofol and ketofol showed superior hemodynamic stability than thiopentone but comparable seizure duration and recovery parameters. Thus, propofol and ketofol can be effectively used as induction agents for ECT although propofol is associated with lesser agitation than ketofol.
Low-volume C5–6 interscalene and supraclavicular nerve blocks for arthroscopic shoulder surgery: A case series
Authors: Diwan Sandeep , Sethi Divya , Kamath Nilesh , Nair Abhijit
Published: January 2022

Interscalene block (ISB) is considered a gold standard regional anesthesia technique for shoulder surgery. Conventionally, 20 ml of local anesthetic is used for ISB. Nevertheless, this high-volume traditional ISB is associated with a high incidence of hemidiaphragmatic paresis due to phrenic nerve block. Recent evidence suggests that low-volume ultrasound-guided (USG)-ISB can provide effective analgesia whilst avoiding complications. Thirty patients of American Society of Anaesthesiologist ASA status I/II undergoing arthroscopic rotator cuff repair surgery under general anesthesia were administered low-volume USG-ISB and supraclavicular nerve block (SCNB). The block provided effective analgesia in 90% (27/30) of the patients as their visual analog score was below 4 at all times in the 24-h postoperative period. Only three patients required a single dose of rescue analgesic (diclofenac 50 mg iv) in the 24-h postoperative period. In postoperative recovery, two patients (6.67%) had desaturation due to hemidiaphragmatic paresis and three patients (10%) had a transient neurological deficit. In conclusion, low-volume USG-ISB with SCNB provides effective analgesia for arthroscopic rotator cuff repair surgery. The advantages of this technique include a low incidence of respiratory and neurological complications.
Comparison of equipotent doses of Ramosetron, Ondansetron, and sub-hypnotic dose of Propofol for prevention of postoperative nausea and vomiting in laparoscopic cholecystectomy
Authors: Acharya Shilpa Amol , Patil Kalyani Nilesh
Published: January 2022

Background and Aims:

For prevention of Postoperative nausea vomiting (PONV) in laparoscopic surgery, ramosetron is a selective 5-HT3 receptor antagonist with higher receptor affinity and slow dissociation than ondansetron. We compared these 2 drugs with propofol which has also shown antiemetic properties.The aim was to study ondansetron, ramosetron, and propofol with respect to incidence of PONV, its severity and the need for rescue antiemetic along with the side effects. Prospective, randomized, double blind study.

Material and Methods:

We compared antiemetic properties of ondansetron (4 mg i.v; n = 40) and ramosetron (0.3 mg i.v; n = 40) with propofol (0.5 mg/kg i.v; n = 40) on 120 ASA I/II patients scheduled for laparoscopic cholecystectomy. The side effects associated with study drugs, time to recovery from anesthesia, readiness for PACU discharge and patient satisfaction was also compared. Qualitative data variables are expressed by using frequency and percentage and quantitative data variables are expressed by using mean and SD. Quantitative data variables were compared using ANOVA test and others were compared by post hoc ANOVA Tukey’s test.

Results:

Incidence of vomiting and need for rescue antiemetic was lowest with Ramosetron and highest in Propofol group. Time to recovery was more in Propofol group which was statistically significant. Readiness for PACU discharge was comparable in all the three groups.

Conclusion:

Subhypnotic dose of propofol requires more rescue antiemetic than Ondansetron and Ramosetron because of its short duration of action. Between Ondansetron and Ramosetron the latter is more effective in PONV prevention.
Publication performance of Indian authors in high impact anesthesiology journals: Are we doing enough?
Authors: Kar Prachi , Kar Akhya Kumar , Gopinath R.
Published: January 2022

Background and Aims:

Over the years, there is a continuing increase in the number of anesthesia journals and good quality articles are being submitted to these journals from all over the world. The aim of the study was to assess the contribution of Indian authors to high impact anesthesia journals.

Material and Methods:

The study is a literature survey design and thus ethics committee clearance was not required. Based on The Journal citation report (2017), top six anesthesia journals with highest impact factor were selected. Subspecialty journals were excluded. A search was conducted for articles published by Indian authors between September 2008 and August 2018 and subcategorized to review articles, original articles, case reports, correspondence, and miscellaneous. Corresponding author was noted in articles with authors from more than one country. The percentage of articles in each of the above categories by Indian authors were calculated and state and city wise distribution was also assessed.

Results:

The six highest impact journals were Anesthesiology, British Journal of Anaesthesia, Anaesthesia, Anaesthesia analgesia, European journal of Anaesthesia and Canadian Journal of Anaesthesia with impact factor of 6.52, 6.49, 5.43, 3.46, 3.9, 3.37, respectively. A total of 22,298 articles were published in the six journals in the study period, out of which 242 (1.08%) were authored by Indians. Majority of the articles were published as correspondence (58%). Only 20% of total publication were original articles. Most publications were contributed from Delhi (76), followed by Chandigarh (49).

Conclusion:

Publication performance of Indian authors in high impact journals is poor. There is an uneven distribution of publication across various regions.
Effect of addition of intrathecal magnesium sulphate to 0.5% hyperbaric bupivacaine and 0.5% isobaric levobupivacaine on duration of analgesia in parturients undergoing elective caesarean section: A prospective randomised study
Authors: Deepa T. , Chandran Deepa
Published: January 2022

Background and Aims:

Addition of magnesium sulfate to local anesthetics improves the quality of spinal anesthesia for caesarean section. The aim of this study was to compare the effects of intrathecal 0.5% hyperbaric bupivacaine with 75-mg magnesium sulfate (MgSO4) and 0.5% isobaric levobupivacaine with 75-mg MgSO4 on the duration of analgesia in parturients undergoing elective caesarean section.

Material and Methods:

This prospective randomized double-blind parallel-group study was conducted in 60 parturients undergoing elective caesarean section who were randomly allocated to Group I or Group II to receive either 2 ml of 0.5% levobupivacaine with 75-mg MgSO4 or 2 ml of 0.5% hyperbaric bupivacaine with 75-mg MgSO4 intrathecally. The duration of postoperative analgesia along with sensory and motor block characteristics and hemodynamics were studied.

Results:

The duration of analgesia did not show a significant difference in the two groups (P = 0.175). The sensory onset time was faster in Group I (3.5 ± 1.3 min) as compared to that in Group II (4.8 ± 2 min; P = 0.004). The onset of motor blockade was not different in the two groups (P = 0.265), but there was a significant delay (P = 0.002) in motor recovery in Group II (267 ± 130.6 min) as compared to Group I (225 ± 85.4 min). Hemodynamics were comparable in the two groups.

Conclusion:

Intrathecal levobupivacaine with MgSO4 produces a similar duration of postoperative analgesia as compared to hyperbaric bupivacaine with MgSO4. Early motor recovery allowing early ambulation postoperatively makes isobaric levobupivacaine with MgSO4 a good alternative for caesarean sections.
Assessment of podoplanin lymphatic vessel density in oral epithelial dysplasia
Authors: Lunawat Snehal Dilip , Prakash Nilima , Pradeep G. L. , Chaware Smita Jembu , Chaudhari Nayana Rajendra , Salunkhe Vaibhavi Parikshit
Published: January 2022

Background:

Oral squamous cell carcinoma (OSCC) can be preceded by the appearance of lesions which have the potential to develop into cancer. Recently, it was suggested that the tumor-associated lymphatic vessels formation plays an active role in tumor progression and metastasis of several human malignancies including OSCC. There is the view that, in an individual lesion, the more severe the dysplasia, the greater the likelihood is of progression to malignancy.

Aim:

This study is aimed to investigate podoplanin (PDPN) immunoexpression in lymphatic vessels of oral epithelial dysplasia (OED) and to assess the lymphatic vessel density (LVD) in histologic grades of OED.

Materials and Methods:

The study group comprised thirty histopathologically diagnosed cases of OED with various grades of differentiation and thirty cases of clinically normal oral mucosa. After immunohistochemical staining, cases of OED were immunohistochemically analyzed quantitatively for PDPN (D2-40) LVD.

Statistical Analysis:

The statistical analysis was done using Kruskal Wallis analysis of variance; pair-wise Tukey's post hoc test was applied to evaluate the significant differences among the mean values in different groups. Results with “P < 0.05” were considered to be statistically significant at 95% of confidence level.

Results:

PDPN LVD scores increased with increasing grades of dysplasia. Pair-wise comparisons of the PDPN LVD scores and the histopathologic grades of OED were found to be statistically significant (P < 0.05).

Conclusions:

Increase in PDPN LVD in OED represents a promising tool for more wide spread studies of tumor lymphangiogenesis and its role in progression of dysplastic lesion to human cancer.
Maxillary brown tumor due to secondary hyperparathyroidism in a Hemodialysis patient
Authors: Aravindhan R , Magesh K T , Vivek N , Saravanan C
Published: January 2022

Hemodialysis is one of the commonly used renal replacement therapies in treating end-stage renal failure patients. Patients with long-term dialysis may develop frequently complications such as secondary hyperparathyroidism (SHPT), bone diseases, amyloidosis, endocrinal disturbances, cardiovascular complications and infections. Brown tumors (BTs) are erosive giant cell bony lesions that arise in some patients as a result of primary or SHPT. About 2% of all the reported cases showed involvement of facial skeleton, of which the mandible is the favorite site. A complete clinical, biochemical, radiological and histopathological correlation is required for definitive diagnosis. We report here a case of BT in 37-year-old female hemodialysis patient with SHPT.
Granular cell ameloblastoma − A rare entity with recurrence after 48 years
Authors: Anila K R , Varghese Bipin T , Mathew Sherin S , Rakesh C A
Published: January 2022

A 64-year-old female with complaints of swelling right preauricular region was referred to our tertiary cancer center with fine-needle aspiration cytology (FNAC) report of mucoepidermoid carcinoma and radiological differential of malignant salivary gland neoplasm and sarcoma. On examination, there was a mass over her right parotid region Clinical diagnosis was malignant salivary gland neoplasm. Slide review of FNAC was inconclusive. Biopsy was done. Histopathology showed neoplasm comprising of nests of cells with abundant granular eosinophilic cytoplasm with focal area showing peripherally arranged columnar cells with palisading. On enquiry, the patient gave a history of surgery of right mandible 48 years back. Correlating histopathology and clinical history, a diagnosis of granular cell ameloblastoma was rendered. Radiological evaluation showed a solid-cystic lesion in the right masticator space. Right mandible showed only part of head of mandible consistent with previous surgery. Radical surgery was done. Final report confirmed the biopsy diagnosis.
Histopathologic evaluation of oral lichen planus and oral lichenoid reaction
Authors: Aravind Thara , Janardhanan Mahija , Suresh Rakesh , Savithri Vindhya , Mohan Mridula
Published: January 2022

Background:

Lichen planus is a chronic mucocutaneous disease of unknown etiology with well-established clinical and microscopic features. Oral lichenoid reactions are a family of lesions triggered by contact with specific agents such as metallic restorative materials, resins and drugs. Oral lichenoid reactions share clinical and histological features of oral lichen planus (OLP) but has varied management options. Hence, the discrimination between these two lesions is a major challenge for clinicians as well as pathologists.

Aim:

Histopathologic categorization of OLP and oral lichenoid reaction by comparing the thickness of basement membrane and the distribution of mast cells using special stains.

Materials and Methods:

The test group consists of formalin-fixed paraffin-embedded blocks of OLP (n = 15), and oral lichenoid reactions (n = 15) obtained from the archives of the Department of Oral Pathology, Amrita School of Dentistry. Three serial sections of 4 μm thickness were cut from each block. The sections were stained with H & E, periodic acid-Schiff (PAS) and toluidine blue, respectively.

Results:

A significant increase in the maximum basement membrane thickness (BMT) was noticed in OLP when compared to oral lichenoid reaction. A definite increase was also noticed in the number of mast cells in OLP and oral lichenoid reaction when compared to normal oral mucosa. There was a statistically significant increase in the number of degranulated mast cells in the deeper connective tissue in oral lichenoid reaction when compared to OLP.

Conclusion:

OLP and oral lichenoid reactions are two different entities showing similar clinical and microscopic presentation. The histochemical analysis of basement membrane and mast cells in these lesions might provide a more authentic method for differentiating these two lesions and might be of utmost value in deciding the treatment options.
Association of bedtime with recurrent aphthous stomatitis
Authors: Kamat Mamata , Datar Uma , Wadgave Umesh , Varsha V K
Published: January 2022

Background:

Although recurrent aphthous stomatitis (RAS) is the most common oral mucosal disease, the etiology remains poorly understood till date. In addition, RAS lacks definitive therapeutic options, and hence, it becomes even more important to know the etiological factor so as to relieve the symptoms and render treatment effectively. Recently, late bedtime has been shown to be associated with RAS. Due to prolonged duty hours along with lengthy learning and training periods, late bedtime is a frequent observation among health-care professional students. However, this is a less explored field in the previous studies on RAS.

Aims:

This study aimed to evaluate the role of bedtime in the causation of RAS among health-care professional students.

Methods:

This present cross-sectional survey was carried out among medical, dental and nursing students studying in our medical campus, using an anonymous, self-administered questionnaire consisting of 18 items. The collected data was statistically analyzed and interpreted. Descriptive analysis and Chi-square tests were employed to assess the association of RAS with various variables.

Results:

Among a total of 1111 students who participated in the study, 39.8% (n = 442) experienced RAS. Factors such as history of digestive tract disease, family history and stress showed a positive correlation with RAS. Interestingly, both during examination and nonexamination period, RAS was more prevalent among students with bedtime >11pm than in students with bedtime <11 pm.

Conclusion:

The study indicates that late bedtime is an independent risk factor for RAS and thus clinicians should focus on recommending a healthy lifestyle with adequate sleep to patients with RAS. This would benefit patients with RAS, especially health-care professional students, and could probably contribute to long-term remission in RAS.
Identification of candida albicans and nonalbicans candida resistant species in tobacco users and oral squamous cell carcinoma patients
Authors: Saxena Ankit , Nagi Ravleen , Sandeep T , Patil Deepa Jatti , Choudhary Ruchika , Kaur Aninditya
Published: January 2022

Introduction:

Candida is most common fungal pathogen in the immunocompromised and medically ill patients. Higher prevalence of Candida albicans has been reported in tobacco users and oral squamous cell carcinoma (OSCC) patients which may be due to immunosuppression. Recently, emergence of nonalbicans candida (NAC) species resistant to conventional antifungal treatment has been observed that requires accurate identification of organisms at species level for reduction of progression of suspicious oral lesions toward malignancy.

Aims and Objectives:

To detect and compare the prevalence of C. albicans and NAC species smokeless tobacco chewers, histopathologically confirmed oral squamous cell carcinoma patients and the normal individuals. Effectiveness of automated Vitek 2 system in comparison to HiCrome agar color media in the identification of the candida species was also evaluated.

Methodology:

One hundred and fifty patients (90 males, 60 females) aged between 20 and 76 years were divided into three groups: Group I individuals with habit of chewing Gutka, and betel quid/pan masala with or without tobacco, Group II individuals with clinically and histopathologically confirmed oral squamous cell carcinoma and Group III comprised of controls. Salivary samples were cultured on HiCrome agar color media and results were compared with those of Vitek 2 system in the accurate identification of candida species. Data were statistically analyzed and Chi-square test was used to estimate the effectiveness of color and Vitek method in the identification of candida species in all the three groups. P < 0.05 was considered to be statistically significant.

RESULTS:

HiCrome agar color method identified six candida isolates C. albicans, Candida tropicalis, Candida krusei and Candida glabrata isolates in all the three groups, with 0.00 unidentified organisms (P = 0.00001) whereas VITEK 2 system identified five isolates of candida; C. albicans, Candida famat, Candida ciferri, Candida gulleri, C. tropicalis, unidentified organisms were observed in 26% of subjects. Further confirmation by supplemental tests indicated the presence of two or three organisms of different species/or subspecies with low reactivity biopattern. Higher incidence of opportunistic infections was seen in Group II OSCC patients (P = 0.00001).

Conclusion:

The results suggested that there is shift toward NAC species, with higher species diversity in OSCC patients followed by gutka, betel quid/pan masala with or without tobacco users. Conventional agar media culture methods of species identification should be used in conjunction with automated Vitek 2 method for better control of candida-associated oral cancer.
Melanin and odontogenic cysts
Authors: Nitin Priyanka , Sreeshyla HS , Vidya GD , Premalatha BR
Published: January 2022

Pigmentation in the head-and-neck lesions is an uncommon feature. The presence of it is fascinating, but its relevance is unknown. Various odontogenic and nonodontogenic lesions show the presence of melanin pigment. Although the presence of melanin is normal in the epithelium and connective tissue, the role of melanin pigmentation in odontogenic cysts is unclear. Apart from maintaining the skin balance, varying other functions of melanin is being researched. However, not much study has been done regarding it in odontogenic lesions. As the literature regarding such cases are scanty, here, we present a case of pigmented dentigerous cyst and an attempt to understand their relationship.
Saliva as an alternative non-invasive biomarker for the estimation of uric acid levels during pregnancy
Authors: Deepashree Pramod Gujjar , Madhushankari Gunjiganur Shankarappa , Nandini Doddabasavaiah Basavapur , Priya Nagur Karibasappa , Ashwini Ramakrishna , Shruthy Ramappa
Published: January 2022

Background:

Pregnancy is a physiological condition in which the maternal environment undergoes many changes. Serum uric acid (UA) levels have been used for the early diagnosis of preeclampsia, predictor of reduced birth weight and fetal outcome. UA is also expressed in saliva, and collection of saliva sample is a noninvasive method which will be more acceptable by the patients.

Aims and Objectives:

The present study aimed to estimate and compare serum and salivary UA levels in age-matched healthy nonpregnant and healthy pregnant women at different trimesters longitudinally.

Methodology:

Forty female participants with age ranging between 20 and 38 years comprised the study population. The study group consisted of 20 healthy nonpregnant women (controls) and an equal number of confirmed cases of healthy pregnant women in the first trimester (cases). The cases were followed in their second and third trimesters for the sample collection.

Results:

Both serum and salivary UA levels were significantly reduced in the first trimester of pregnancy than the controls. In the second and third trimesters, the values of serum and salivary UA levels gradually increased and gained values similar to that of nonpregnant women. Salivary UA levels showed a highly significant positive correlation with serum levels in both controls and cases.

Conclusion:

Salivary estimation, being a noninvasive procedure, is easily accepted by the patients and carries minimal risk of exposure to the blood-borne pathogens compared to serum estimation. Our findings warrant the use of saliva instead of blood for UA estimation.
Mucoepidermoid carcinoma
Authors: Jeergal Prabhakar A. , Karim Namazi Nasim Abdul , Patil Shashi , Kochar Anagha , Sohoni Rohan , Bussari Smita B.
Published: January 2022

Background:

Salivary gland tumors are rare and clinically represent a diverse group of neoplasms among which mucoepidermoid carcinoma (MEC) is a relatively common salivary gland tumor with varying potential for aggressive behavior. The purpose of the study was aimed at to analyze the relative frequency and correlate with age, sex, anatomical site and histological grade of MEC and compare the findings with epidemiological data from different geographic locations.

Materials and Methods:

Twenty-five cases diagnosed with MEC during the period June 1985 to June 2004 (19 years) were retrieved from the Department of Pathology, Government Medical College and Hospital, Ambajogai, and clinical data were recorded and reviewed histopathologically.

Results:

The relative frequency of MEC was 13.15%. Low-grade MEC (44%) was the most common, followed by intermediate-grade MEC (36%) and high-grade MEC (20%). The mean age for occurrence of MEC was 44.28 ± 13.29 years. MEC was predominant in females (60%) than males (40%). Thus, the overall female-male ratio was 1.5:1. Among minor salivary glands, palate (48%) was the most common site, and among major salivary glands, parotid gland (16%) was the common site.

Conclusion:

Comparing the present data with previous studies on MEC, one may infer that some demographic characteristics and the predominance vary in different geographic regions. Analysis of the distribution and particular features of MEC in a specific population helps in establishment of appropriate treatment.