bluuebunny/crossref_metadata_2025 huggingface dataset:
New horizons for reduction of blood use
Authors: Shamsasenjan Karim , Gharehdaghi Somayeh , Khalaf-Adeli Elham , Pourfathollah Ali Akbar
Published: August 2024

A countrywide study over the eras indicates overuse of blood transfusion can have considerable risks to patients accompanied by significant costs of blood transfusion for patients, hospitals, and health-care systems. Besides, more than 30% of the world's population is anemic. Typically, blood transfusion helps continue suitable oxygen transfer in anemia, i.e., more and more documented as a threatening factor with several adverse outcomes including long hospitalization, morbidity, and mortality. Transplantation of allogeneic blood is thus like a two-edged sword. There is no doubt that the blood transfusion is a life-saving treatment, but it should be underpinned by much of up-to-date health-care services. The new theory considered for patient blood management (PBM) also discusses the timely application of evidence-based surgical and clinical theories and focuses on patient outcomes. Furthermore, PBM involves a multidisciplinary methodology to reduce unnecessary transfusions, minimize costs, and cut risks.
Evaluation of the consumption of blood products after the patient blood management implementation in a tertiary referral hospital within five consecutive years
Authors: Chegini Azita , Jamalian Ali , Alavi Ali Boroujerdi , Rasouli Mahboobeh , Maghari Amirhossein
Published: August 2024

BACKGROUND AND AIMS:

Patient blood management (PBM) is a multimodal scheme with several principles in the perioperative period which improves the outcome for patients. We prospectively evaluated the blood consumption situation during and after the years of implementation of PBM.

METHODS:

A 5 years’ prospective cross-sectional study was conducted between May 2016 and May 2020 in a tertiary referral hospital (Shahid Lavasani Hospital, Tehran, Iran). The outcome includes utilization rate of blood and its components (red blood cell [RBC], plasma and platelet [PLT]), transfused units per active hospital and intensive care unit (ICU) bed, the cross-match to transfusion ratio, transfusion index (TI), were evaluated before and after PBM implementation. The data were analyzed by the SPSS version 21. One-way repeated measures ANOVA and Friedman test were used.

RESULTS:

During 5 consecutive years, 6290 patients needed blood transfusions and entered to PBM protocol after their consent. Consumption of whole blood ceased in the initial year following PBM establishment. In 2017, RBC product usage (including whole blood and RBCs) decreased by 14.1% compared to 2016. This trend continued with further declines in 2018 (71.22%), 2019 (65.2%), and 2020 (59.10%) compared to 2016 (P < 0.001). The reduction in the number of plasma transfused over time was statistically significant (P < 0.001), as was the decrease in PLT transfusions (P < 0.001). RBC usage per active hospital bed per year declined from 22.83 to 3.61, and the TI showed a significant decrease. The highest RBC usage was observed in surgical departments during this period. RBC utilization per bed in the ICU was 57.7 in 2017, 25 in 2018, 22.7 in 2019, and 11.3 in 2020.

CONCLUSION:

With the implementation of the PBM program, the consumption of blood products in the hospital gradually decreased. The initial reductions in blood product consumption were observed in whole blood, plasma, and then RBCs.
Clinical spectrum of anti-E: A thought for transfusion services
Authors: Basu Debapriya , Sinha Ayesha , Basheela Najla Hannefa , Biswas Durba , Datta Suvro Sankha
Published: August 2024

The rhesus system antigens are of immense clinical importance in transfusion medicine. They can stimulate the production of clinically significant antibodies. Anti-E is one of the most common alloantibodies reported in multi-transfused patients in India which is known to cause delayed hemolytic transfusion reaction and hemolytic disease of the fetus and newborn (HDFN). This antibody can have different clinical presentations and persist for a prolonged period in the plasma. In this case series, we report five such cases where anti-E antibodies were identified in different clinical settings. The clinical scenarios consist of HDFN, hematopoietic stem cell transplantation, and blood donors, where the anti-E antibody was detected during the immunohematological workup. The patients were managed according to the clinical spectrum of the antibody.
Comparative study of the prevalence of HIV using the third- and fourth-generation HIV ELISA in blood donors in South India
Authors: Paudel Purshotam , Sahoo Dibyajyoti , Basavarajegowda Abhishekh , Singh Rakesh , Kulkarni Rajendra G.
Published: August 2024

INTRODUCTION:

Different generations of ELISA have evolved over the years. With the introduction of the fourth-generation ELISA, there is a claim of higher sensitivity over the third-generation HIV ELISA kits. However, few literatures suggest false positive issues. The present study aimed to assess the seroprevalence of HIV and to see the level of agreement between the third- and fourth-generation ELISA for HIV detection.

METHODOLOGY:

Prospective cross-sectional study conducted in a tertiary care hospital from November 2021 to May 2023. All positive samples by either the third- or fourth-generation ELISA were included in the study. If any sample was positive in one generation, and the same whole batch was repeated in another generation ELISA. All positive samples were subjected to molecular testing by polymerase chain reaction. Cohen’s kappa coefficient was used to see the level of agreement between the thrid and fourth-generation HIV ELISA.

RESULTS:

Seventeen samples were positive by the third-generation ELISA versus 50 samples were positive by the fourth-generation ELISA. The prevalence of HIV was found to be 0.9% by the fourth-generation ELISA and 0.3% by the third-generation ELISA. There was a fair level of agreement between the third- and fourth-generation HIV ELISA. Both generations have a sensitivity of 100%, whereas specificity with the third generation was 91% and the fourth was 24%.

CONCLUSION:

Both the fourth- and third-generation ELISA are highly sensitive; however, the specificity of the fourth-generation kit is less, leading to more false positive results.
Minimizing the error in the hemoglobin estimation of blood donors as an articulate step toward donors’ blood management
Authors: Roy Manisha , Kumari Sangeeta , Sachdev Suchet , Sharma Ratti Ram
Published: August 2024

INTRODUCTION:

Hemoglobin (Hb) estimation in blood donors is conducted using capillary samples on portable hemoglobinometers, representing measurement methods in practice. The reference standard is conducted using a venous sample on a hematology analyzer, representing the mentor measurement method or the true value. The correction involves the calculation of the secondary adjustment factor (SAF) to mitigate the difference between the two values.

MATERIAL AND METHODS:

A cross-sectional study enrolled 187 blood donors after approval from the institute’s ethics committee. On each donor, capillary Hb was performed on the first drop and the second drop of blood using the hemoglobinometer (HCC-1 & 2) and venous Hb using the hemoglobinometer (HC-V) and hematology analyzer (HA-V) consecutively. The secondary adjustment factor was derived from the slope of the regression equation by calculating the ratio of change in HA-V to the corresponding change in HCC -1 & 2.

RESULTS:

The Hb on HCC-1 & 2 was 15.02 ± 1.30 g/dL & 15.03 ± 1.34 g/dL, whereas the Hb on HC-V & HA-V was 15.00 ± 1.24 g/dL & 14.41 ± 1.19 g/dL respectively. No difference in means of Hb between HCC-1 & HCC-2 was observed. The equation to calculate SAF was HA-V = 3.25 + 0.74 × HCC-1 and HA-V= 3.58 + 0.72 × HCC-2 respectively.

CONCLUSION:

The study highlights the need for Hb cut-off for blood donors specific for the type of sample, the drop of blood in case of capillary sample and use correction with secondary adjustment to strengthen quality assurance.
Patient outcome in antibody-positive systemic vasculitis treated with therapeutic plasma exchange
Authors: Tiwari Aseem Kumar , Setya Divya , Tanna Dhaval , Arora Dinesh , Aggarwal Geet , Gupta Rajiva , Bansal Shyam Bihari , Sethi Sidharth Kumar
Published: August 2024

BACKGROUND:

Therapeutic plasma exchange (TPE) has been advocated as an adjunct to steroids and cytotoxic drugs in treating patients suffering from vasculitis and presenting with active disease, but we still have insufficient evidence on its effectiveness in improving the clinical response, especially in India. This study was planned to study the clinical outcome in severe vasculitic presentations treated with TPE as an adjunctive therapy.

MATERIALS AND METHODS:

A retrospective analysis of TPE procedures performed from July 2013 to July 2017 in the department of transfusion medicine at a large tertiary care hospital was done. All consecutive patients admitted with new diagnosis of systemic vasculitis presenting with active disease and severe presentations such as advanced renal failure or severe respiratory abnormalities or life-threatening vasculitis affecting the gastrointestinal tract, neurological and musculoskeletal system; who needed TPE for removal of preformed antibodies, were included in the study.

RESULTS:

There were a total of 31 patients in whom TPE was performed for severe systemic vasculitis; 26 adults and five pediatric. Six patients tested positive for perinuclear fluorescence, 13 for cytoplasmic fluorescence (cANCA), two for atypical antineutrophil cytoplasmic autoantibody, seven for anti-glomerular basement membrane antibodies, two for antinuclear antibodies (ANA), and one patient tested positive for ANA as well as cANCA before the augmentation of TPE. Out of 31, seven patients showed no clinical improvement and succumbed to the disease. At the end of desired number of procedures, 19 tested negative and five tested weak positive for their respective antibodies.

CONCLUSION:

Favorable clinical outcomes were observed with TPE in patients with antibody-positive systemic vasculitis.
Current updates in Restless Legs Syndrome: A pragmatic review
Authors: Makharia Archita , Agarwal Ayush , Srivastava Achal Kumar , Garg Divyani
Published: August 2024

Restless legs syndrome (RLS), also called Willis–Ekbom disease (WED), affects approximately 3% of the global population, with higher incidence in Caucasians and women. This review explores the latest advancements in the diagnosis, pathophysiology, and management of RLS, and it highlights the recent changes in diagnostic criteria that improve specificity. The diagnostic spectrum now includes atypical presentations involving the upper limbs and other body parts. The new diagnostic specifiers categorize RLS more effectively into chronic-persistent or intermittent types, and a clinical significance specifier has been introduced to better address the disorder’s effects on daily life. RLS management has shifted toward a balanced approach with non-pharmacological strategies and lifestyle changes, supported by updated pharmacological treatment protocols including iron therapy designed to mitigate risks such as augmentation. Notably, gabapentinoids have emerged as a superior treatment option over dopamine agonists owing to their lower risk of augmentation and superior safety profile. Innovative treatments, such as the FDA-approved tonic motor activation device and new pharmacological agents, serve as alternatives for treating medication-refractory RLS, thereby expanding the therapeutic landscape. Additionally, this review addresses the specific considerations for managing RLS in special groups, including pregnant women, individuals with chronic kidney disease, and patients with comorbid conditions such as Parkinson’s disease and multiple sclerosis. We emphasizes the dynamic nature of RLS research and highlight the critical need for ongoing studies to further elucidate the complex mechanisms underlying RLS, as well as to refine the treatment modalities to enhance patient outcomes.
Mitochondrial ataxia - Unravelling the puzzle
Authors: Pandita Neha , Ganguly Jacky , Kumar Hrishikesh
Published: August 2024

Primary mitochondrial diseases (PMDs) can be caused by a defect in any of the mitochondrial metabolic pathways, due to mitochondrial or nuclear DNA mutations, or occurring de novo. Ataxia is one of the most common presentations in mitochondrial disorders and may present as pure cerebellar, sensory or mixed ataxia. Understanding the basic mitochondrial physiological mechanisms, the classification of mitochondrial ataxias, phenotypic heterogeneity, and respective diagnostic evaluation methods is paramount to recognize this disorder. We conducted a comprehensive literature search using the PubMed database before July 1, 2024, to synthesize this narrative review, focusing on various aspects of primary mitochondrial disorders, particularly those associated with ataxia.
Levisticum officinale extract protects against CCl4-induced hepatotoxicity through anti-inflammatory, anti-fibrotic, and antioxidant properties in rats
Authors: Ghaedi Nahid , Pouraboli Iran , Mirtadzadini Mansour , Moeini-aghtaie Mohammad-mehdi
Published: August 2024

Objective:

To investigate the hepatoprotective effects of Levisticum officinale extract on CCl4-induced hepatotoxicity.

Methods:

Different doses of Levisticum officinale extract were given orally to rats for 10 days, then rats received a single dose of CCl4 (2.5 mL/kg, 50% v/v in liquid paraffin). Biochemical and histopathological assays were performed to assess the effects of the extract on liver function and architecture. Moreover, antioxidant and oxidative markers as well as inflammatory and fibrotic indicators were measured.

Results:

Pretreatment with Levisticum officinale extract significantly mitigated CCl4-induced damage to liver structure, improved serum levels of alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, urea, total bilirubin, and total protein, enhanced glutathione content and superoxide dismutase and catalase activities in the liver, as well as decreased plasma and hepatic malondialdehyde levels. Immunohistochemical results demonstrated that the extract reduced Ki-67 and α-SMA expression and Masson’s trichrome staining revealed decreased liver collagen in rats treated with Levisticum officinale extract. Moreover, Levisticum officinale extract markedly decreased the gene expressions of TNF-α, 1L-6, TGF-β1, MCP-1, and COX-2.

Conclusions:

Levisticum officinale extract exerts hepatoprotective effects on CCl4-induced hepatotoxicity through antioxidant, anti-inflammatory, and anti-fibrotic activities.
Flavone improves liver damage in nicotine-exposed rats via the Nrf2/HO-1 pathway
Authors: Elsayed Nora A. , Moawed Fatma SM , Ahmed Esraa SA , Hammad Ahmed , Abo-Zaid Omayma AR
Published: August 2024

Objective:

To assess the hepatoprotective effects of flavone on nicotine-induced liver damage.

Methods:

Thirty-six rats were allocated into six groups: the control group, the nicotine group, the flavone alone groups (10 and 25 mg/ kg/body weight), and the nicotine groups treated with flavone (10 and 25 mg/kg/body weight). Liver function, oxidative stress, Nrf2 pathway (HO-1, Nrf2, and Keap-1), and inflammatory markers (IL-17, TNF-α, and NF-κB) were evaluated. Additionally, a histopathological examination of liver tissues was performed.

Results:

Nicotine increased liver damage, inflammation, and oxidative stress. However, flavone suppressed nicotine-induced liver enzymes, oxidative stress, and inflammation, as manifested by increased antioxidants and decreased malondialdehyde level, liver enzymatic activities, and inflammatory markers. Flavone (10 and 25 mg/kg/body weight) also reduced the level of Keap-1 and increased HO-1 and Nrf2 levels in the liver of nicotine-exposed rats.

Conclusions:

Flavone has hepatoprotective properties and may slow the progression of liver injury by reducing oxidative stress, liver enzymes, and inflammation possibly via the Nrf2 pathway.
Immunomodulatory activity of polycaprolactone nanoparticles with calcium phosphate salts against Leishmania infantum infection
Authors: Kelleci Kübra , Allahverdiyev Adil , Bağırova Melahat , Ihlamur Murat , Abamor Emrah Şefik
Published: August 2024

Objective:

To prepare and characterize polycaprolactone (PCL) nanoparticles loaded with sonicator fragmented (SLA) and freeze- thaw Leishmania antigens (FTLA) and to investigate the in vitro immunogenicity of antigen-encapsulated nanoparticles with calcium phosphate adjuvant.

Methods:

The water/oil/water binary emulsion solvent evaporation method was used to synthesize antigen-loaded PCL nanoparticles. Particles were characterized by scanning electron microscopy and zeta potential measurements. Their cytotoxicity in J774 macrophages in vitro was determined by MTT analysis. In addition, the amount of nitric oxide and the level of cytokines produced by macrophages were determined by Griess reaction and ELISA method, respectively. The protective effect of the developed formulations was evaluated by determining the infection index percentage in macrophages infected with Leishmania infantum.

Results:

Compared to the control group, SLA PCL and FTLA PCL nanoparticles with calcium phosphate adjuvant induced a 6- and 7-fold increase in nitric oxide, respectively. Additionally, the vaccine formulations promoted the production of IFN-γ and IL-12. SLA PCL and FTLA PCL nanoparticles combined with calcium phosphate adjuvant caused an approximately 13- and 11-fold reduction in infection index, respectively, compared to the control group.

Conclusions:

The encapsulation of antigens obtained by both sonication and freeze-thawing into PCL nanoparticles and the formulations with calcium phosphate adjuvant show strong in vitro immune stimulating properties. Therefore, PCL-based antigen delivery systems and calcium phosphate adjuvant are recommended as a potential vaccine candidate against leishmaniasis.
Plasma plasminogen activator inhibitor-1 as a predictive marker of type 2 diabetic nephropathy in Egyptian patients
Authors: El-Bawab El-Saeid M.E.-S. , Alomairi Mostafa M.M. , El- Kabeer Ashraf M. , Abd-Allah Sayed F.A.
Published: August 2024

Background

The study investigates the relationship between Plasminogen activator inhibitor-1 (PAI-1) levels and the progression of diabetic nephropathy (DN). The fibrinolytic system is impaired in type 2 diabetes mellitus (DM), leading to elevated PAI-1 levels, increasing the potential for renal fibrosis and worsening nephropathy.

Patients and methods

The research involved 196 type 2 DM patients and 50 healthy control individuals divided into four groups based on Urinary albumin excretion (UAE).

Results

The diabetic group had significantly higher PAI-1 levels than the control group. The study also found that diabetic patients with macroalbuminuria had higher PAI-1 levels than the control group. Patients with higher UAE and PAI-1 levels had significantly higher serum creatinine concentrations. The study found a significant negative link with creatinine clearance and a significant positive correlation between PAI-1 and serum creatinine and 24-h urine albumin in terms of PAI-1.

Conclusions

There was a notable positive association with the 24-h UAE, suggesting that increases in PAI-1 were linked to a decline in renal function.
Serum amyloid A protein as a predictor of severity in coronavirus disease 2019-infected Egyptian patients
Authors: Negm Dalia A.E.M.A.E.R. , Elzefzafy Wafaa M.A.E.-W. , El Raheem Sabah E.A. , El Deen Nessren M.B.
Published: August 2024

Background

The coronavirus disease 2019 (COVID-19) pandemic is a worldwide pandemic of COVID-19 caused by severe acute respiratory syndrome coronavirus. Serum amyloid A (SAA) is an acute-phase protein secreted during the acute phase of inflammation and can be used to predict the severity of COVID-19 disease. When inflammatory stimuli occur, levels of SAA increase within hours and the magnitude of response becomes great and may be greater than that of C-reactive protein (CRP).

Aim

Assessment of the level of SAA in COVID-19 Egyptian patients to predict the severity of the disease.

Patients and methods

This was an observational case–control study conducted on 80 participants: 60 patients with RT-PCR positive and computed tomography chest for COVID-19 disease classified into three groups according to disease severity: group I (20 patients) mild cases, group II (20 patients) moderate cases, and group III (20 patients) severe cases, and 20 participants as a control group. All participants were investigated for complete blood count, Serum Glutamic Pyruvic Transaminase (SGPT), Serum Glutamic Oxaloacetic Transaminase (SGOT), blood urea, serum creatinine, CRP, D-dimer and SAA.

Results

There is no statistical significance among the comparison groups as regards SAA.

There was a high statistically significant decrease in the number of lymphocytes in COVID-19 patient groups compared with the control group. There was a statistically significant difference as regards platelet count, CRP, D-dimer, serum urea, and creatinine among the groups (I, II, and III) compared with the control group.

Conclusion

Single use of SAA during the pandemic could not achieve prediction of severity or the prognosis of COVID-19.
Echocardiographic evaluation of cardiac function among male adolescents at high risk of coronary heart disease
Authors: Mahmoud Alaaeldin A. H. , Abdelgawad Mohammed E. M. , Elmorsy Walid A. a. , Al-khayat Mohammed S. , Elbadry Noha M.
Published: August 2024

Background and aim

Obesity, and family history (smoking, obesity, and hypertension) are the most important risk factors for the development of coronary heart disease (CHD) among adolescents. The study aims to evaluate the cardiac function among male adolescents at high risk for coronary heart disease.

Patients and methods

A total of 100 male adolescents were selected by written questionnaire in addition to 30 normal adolescents as control. Thorough history taking and physical examination. Echocardiographic examination, serum lipids, and routine laboratory investigations.

Results

Obesity, and a family history of (smoking, hypertension, and obesity) are among the most frequent risk factors for CHD among male adolescents. We found a statistically significant elevated concentration of serum cholesterol and triglyceride and a significant decrease in high-density lipoprotein levels among diabetic and hypertensive children in addition to a significantly elevated concentration of serum low-density lipoprotein among hypertensive children and children with a sedentary lifestyle. The echocardiography reflects a significant increase in early and decreases in late diastolic flow velocity (E and A) among hypertensive and obese adolescents versus controls. A statistically significant differences between diabetics and controls for left ventricular posterior wall diameter, inter-ventricular septal diameter, and early and late diastolic flow velocity.

Conclusion

Obesity and a family history of smoking, obesity, and hypertension are among the most frequent risk factors for CHD among male adolescents. Echocardiography and lipid profiles should be performed for any adolescent at high risk for development of CHD.
Incidence of hypoparathyroidism after total thyroidectomy using conventional versus harmonic scalpel
Authors: Abdelaty Walid R.
Published: August 2024

Background

As complete thyroidectomies are common procedures, we examine the effects on parathyroid hormone (PTH) levels of using a harmonic scalpel in conjunction with standard techniques.

Patients and methods

Eighty participants of this prospective, randomized research who had total thyroidectomies in the General Surgery Department were divided into two equal groups at random: complete thyroidectomy was performed with a harmonic scalpel in group I and a standard approach in group II.

Results

There is a significant correlation between the surgical technique used and the decrease in PTH after surgery.

Conclusion

If the conventional method was applied following thyroidectomy, there was noticeable decrease in the postoperative serum PTH. When harmonic scalpel is used throughout a thyroidectomy, there is minimal risk of hypoparathyroidism, excellent dissection, and safety.
Reverse sural artery flap for posterior ankle soft tissue defect
Authors: Ali Abdelaziz M.
Published: August 2024

Background and aim

Soft tissue defects of the ankle provide a significant challenge to reconstructive surgeons. Several techniques have been documented for this reconstruction, and all of these techniques varied in cost, difficulty, and outcomes. This study aims to evaluate the reverse sural artery flap for posterior-ankle soft tissue defect reconstruction.

Patients and methods

Nine patients with posterior ankle soft tissue defects due to different etiologies and requiring reconstruction were included and operated in the reconstructive microsurgery unit of Al-Azhar University Hospital, Assiut, Egypt, during the period between 2019 and 2022. These defects were covered by the reverse sural artery flaps. The follow-up period ranged from 18 to 36 months, and all the patients were evaluated for functional outcomes in terms of ulceration, sensation, patient satisfaction, and complications.

Results

All flaps survived with no complications. The mean operative time was 1.4±0.33 h. (1–2 h) and the mean hospital stay period was 2.4±0.52 days. Postoperatively, ulceration was recorded in 2 (22.2%) cases and sensation in all cases and the majority of patients were satisfied with the results (8 cases, 88.9%). Five cases had good Maryland score (55.6%), 2 (22.2%) cases had excellent, and only 1 case was recorded for poor and fair scores. All the defects were covered effectively with no complications.

Conclusion

The reverse sural artery flap could be one of the effective treatment methods for reconstructing posterior-ankle soft tissue defects. Besides, it has high reliability, ease, and versatility.
Favorable Response to Adjuvant Tofacitinib in a Case of Anti-Melanoma Differentiation-Associated Gene-5 Antibody Positive Clinically Amyopathic Dermatomyositis
Authors: Patel Nayankumar H. , Padhiyar Jigna K. , Patel Jahnvi R. , Pandya Keval V.
Published: August 2024

Anti-melanoma differentiation-associated gene-5 antibody (anti-MDA-5 Ab) associated with clinically amyopathic dermatomyositis (CADM) is characterized by vasculopathic ulcers, mechanic’s hands, and progressive interstitial lung disease (ILD). We present a case of 38-year-old female who presented with all these classical clinical features. Her investigations revealed normal serum muscle enzyme levels and the presence of anti-Mi2 and anti-MDA-5 antibodies by immunoblot. Imaging study revealed changes suggestive of ILD. She was treated with rituximab along with oral glucocorticoid and other supportive treatment to which she didn’t respond adequately. Recently, it has been postulated that plasmacytoid dendritic cells produce interferon which is responsible for tissue injury in dermatomyositis (DM). Tofacitinib, by inhibiting JAK-STAT pathway, inhibits downstream cytokines, mainly type 1 interferon. So, we added tofacitinib as adjuvant therapy in our patient. Post-six months of commencement of adjuvant tofacitinib, patient experienced remarkable improvement in cutaneous features as well as in pulmonary fibrosis.
Novel Inflammatory Markers Associated With Cutaneous Leukocytoclastic Vasculitis Etiology
Authors: Dhrif Omar , Hamdi Mohamed Salah , Kechaou Ines , Cherif Eya , Boukhris Imen , Hassine Lamia Ben
Published: August 2024

Objectives:

We aimed to compare inflammatory markers and determine their potential role in distinguishing secondary leukocytoclastic vasculitis (SLV) from idiopathic leukocytoclastic vasculitis (ILV).

Materials and Methods:

We included in this cross-sectional study patients with cutaneous leukocytoclastic vasculitis (CLV) diagnosed on cutaneous biopsy. We assessed clinical and laboratory data and then calculated platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), C-reactive protein (CRP)-to-albumin ratio (CAR), and fibrinogen-to-albumin ratio (FAR). We have also defined the number of positive etiological examination (NPE) as the sum in a unique patient of the positive paraclinical examinations involved in the etiological assessment of CLV.

Results:

In total 77 patients were included, with 52 SLV group patients and 25 in the ILV group, mean age was 44+/-18 vs 49+/-21, and gender ratio was 29/23 vs 11/14. Comparison of PLR, NLR, CAR, and FAR showed significant differences in mean values between SLV and ILV groups with 199.1 (117.3-309.8) vs 126.8 (79-193) (P = 0.01) for PLR, 3.6 (1.9-5.1) vs 2.3 (1.7-3.4) (P = 0.048) for NLR, 1.9 mg.g-1 (0.4-3.6) vs 0.6 mg g-1 (0.2-1.9) (P = 0.043) for CAR, and 155.8 mg.g-1 (90.7-192.3) vs 108.7 mg.g-1 (82.2-148.1) (P = 0.034) for FAR. PLR, CAR, and FAR were positively correlated to NPE (r = 0.463, P < 0.001; r = 0.434, P < 0.001; and r = 0.411, P < 0.001, respectively), and there was no significant correlation between NLR and NPE (r = 0.165, P = 0.151).

Conclusion:

This is the first study to investigate PLR, NLR, CAR, and FAR in CLV, and it demonstrates that elevation of these ratios is associated with SLV, which leads us to suggest to exhaustively explore patients with elevated ratios.
Evolving Technologies in Atrial Fibrillation Ablation
Authors: Ling Tian-You , Wu Li-Qun
Published: August 2024

Pulmonary vein isolation is the cornerstone of atrial fibrillation ablation. Besides traditional radiofrequency ablation, evolving technologies have been developed. These new atrial fibrillation ablation technologies, such as different balloon-based ablation approaches and pulsed field ablation, have their own unique theoretical basis and ablation characteristics. This review focuses on these new atrial fibrillation ablation technologies, which can help to achieve pulmonary vein isolation more easily and quickly.
Chinese Expert Consensus on Primary Care of Ventricular Arrhythmias
Authors:   Chinese Society of Pacing and Electrophysiology,   Chinese Society of Arrhythmias
Published: August 2024

Ventricular arrhythmias (VAs) are common in clinical practice, occurring in patients with structural heart disease, hereditary arrhythmia syndrome, and individuals with normal heart structures. Different types of VAs have varying effects on patients, some with good prognosis, while others can cause significant palpitation, syncope, or even sudden cardiac death. To help primary care physicians better understand VAs, improve diagnosis and treatment levels, and reduce the mortality rate associated with VAs, the Chinese Society of Pacing and Electrophysiology and Chinese Society of Arrhythmias have organized domestic experts to write the “Chinese Expert Consensus on Primary Care of Ventricular Arrhythmias.” We hope this consensus document will help promote the standardized diagnosis and treatment of VAs by primary care physicians in China.
Prognostic Factors of Hip Fracture in Elderly: A Systematic Review
Authors: Kalan Farmanfarma Khadijeh , Yarmohammadi Soudabeh , Fakharian Esmaeil , Gobbens Robbert J. , Mahdian Mehrdad , Batooli Zahra , Lotfi Mohammad-Sajjad , Abedzadeh-Kalahroudi Masoumeh , Vatan Reza Fadaei , Khosravi Gholamreza Reza , Fazel Mohammad Reza , Sehat Mojtaba
Published: August 2024

The hip fracture causes significant disabilities in many elderly people. Many studies around the world have identified various risk factors for the hip fracture. The aim of this study was to systematically investigate the risk factors of hip fractures. This study is a systematic review of risk factors for hip fractures. All published papers in English and Persian languages on patients in Iran and other countries between 2002 - 2022 were examined. The search strategy used keywords matching the mesh, including : predictors, hip fracture, and disability. Articles were selected from international databases (PubMed, Proquest ,Web of Sience, Scopus, Google scholar and Persian(Sid,Magiran), and the Newcastle Ottawa Scale was used to assess the risk of bias. The study has identified several factors that were significantly correlated with the risk of hip fracture, including age, cigarette and alcohol consumption, visual and hearing problems, low BMI levels, history of falling, weakness, and diseases such as stroke, cardiovascular disease, high blood pressure, arthritis, diabetes, dementia, Alzheimer’s, Parkinson’s, liver and kidney diseases, bone density, osteoporosis, vertebral fracture, and hyperthyroidism. However, the study did not find any significant correlations between the consumption of calcium and vitamin D, history of fractures, cognitive disorders, schizophrenia, and household income, and the risk of hip fracture. The results of this study reveal the determining role of some risk factors in hip fracture in older persons. Therefore, it is recommended that health policy makers provide the possibility of early intervention for some changeable factors.
Information-seeking Behavior of Iranian Young Adults (18–28 Years Old) Regarding HPV on Social Media: A Preventive Approach to HPV
Authors: Latifi Masoomeh , Alishan Karami Nader , Allahbakhshian Leili , Aghaesmaeili Narges , Ghasemi Tehrani Hatav
Published: August 2024

Background:

Health information-seeking behavior refers to individuals’ targeted actions to satisfy their health information needs and search for relevant disease-related information. Nowadays, social media platforms provide a great opportunity for meeting health information needs and delivering preventive education regarding human papillomavirus (HPV). The purpose of this study is the information-seeking behavior of Iranian young adults (18–28 years old) regarding HPV on social media, a preventive approach to HPV.

Methods:

The present descriptive-analytical study was conducted in 2023 among Iranian boys and girls aged 18–28 years. A multistage cluster sampling method was used to select 3840 participants. The data collection tool was Longo’s Health Information-Seeking Behavior Questionnaire. The collected data were analyzed using the SPSS software.

Results:

The results showed that Iranian youth aged 18–28 were more inclined to seek information on social media about the transmission routes and preventive measures for HPV. The primary informational need regarding transmission was “I want to know the main route of HPV transmission is through vaginal and anal intercourse?”, and regarding prevention, it was “Can condoms prevent HPV infection?” Additionally, the findings indicated that young individuals sought information about HPV after their first sexual encounter. Most of the information needs of the youth were fulfilled through YouTube, Instagram, and WhatsApp, mainly in video format. Approximately 85.10% of the youth were satisfied with the information obtained from social media. The results revealed a significant and positive relationship between the health information needs of young adults (18–28 years old) in the area of HPV and personal factors. Gender, age, marital status, education level, history of HPV infection, and engaging is unprotected extramarital sex were identified as significant influential factors on the level of information needs of young individuals, especially regarding HPV preventive measures (P < 0.05).

Conclusion:

Health authorities and disease control and prevention centers need to harness the potential of social media in meeting the informational needs of youth and providing education and awareness, especially concerning the transmission and prevention of HPV.
Barriers to Effective Prehospital and Hyperacute Stroke Care in India: A Physician Perspective
Authors: Abraham Siju V. , Joy Anita , Sahu Ankit Kumar , Ravindra Prithvishree , Dhar Shirshendu , Teja Ravi , Krishnan S. Vimal , Liu Renyu , Rudd Anthony George , Ford Gary A.
Published: August 2024

Introduction:

The incidence of stroke is increasing in India. Prehospital stroke care is crucial for reducing stroke morbidity and mortality, but its implementation in India faces several challenges. Limited original research exists on prehospital stroke care in India, making it essential to identify the problems in implementing effective prehospital stroke care.

Methods:

A web-based survey was conducted among registered medical practitioners in India who treat acute stroke. The survey questionnaire was developed in English and included 26 questions divided into five parts: questions about the physician’s practice setup/hospital in India, perception of community awareness, existing prehospital care/systems, in-hospital stroke care availability, and specific issues faced.

Results:

Eighty-three doctors in India participated in the survey (43% response rate). Most of the respondents worked in private hospitals (68%) and urban areas (76%). While 89% of hospitals had ambulance services, over 33% reported that patients had to pay for ambulance transport. Among respondents, 12% reported a community stroke care network, with infrequent prehospital procedures such as random blood glucose measurement (22%), stroke identification (15.7%), “last seen normal” documentation (14.5%), and low prehospital notification to hospitals (5%). Delays in referral from peripheral centers were reported by 73% of respondents. Most hospitals had standard operating procedures (SOPs) (84%), computed tomography (CT) (94%), magnetic resonance imaging (MRI) (85%), and offered intravenous thrombolysis (IVT) (77%). However, 24 h availability of CT was reported only by 6%, MRI by 19% and IVT by 12%. Nearly half (45%) reported treatment with thrombolysis was not covered by insurance. Mechanical thrombectomy was available in 34% of hospitals and 63% of hospitals conducted in-hospital audits for stroke patients.

Conclusions:

The capabilities of stroke-catering hospitals in urban settings are encouraging, with many having SOPs, imaging capabilities, and thrombolysis and mechanical thrombectomy services. However, there is much room for improvement, in making the essential stroke care services financially accessible to all and available around the clock.
Lipomembranous fat necrosis of the subcutaneous tissue − a distinct entity with diverse etiologies: A case report with review of the literature
Authors: Ashwini Padubidri Kombettu , Ravishankar Namratha , Papishetty Prathyusha , Shastry Veeranna
Published: August 2024

Lipomembranous fat necrosis (LFN) is a term used to describe a distinctive alteration of the fatty tissue, which may be primary or associated with other systemic diseases. It is characterized by fatty cysts of various sizes in the subcutaneous tissue lined by a wavy eosinophilic hyaline membrane, forming pseudopapillary membrane projections into the cysts. This specialized type of necrosis of the adipose tissue has been reported as a focal phenomenon and, rarely, as an extensive one in several pathologies of the subcutaneous tissue. We describe a case of a 41-year-old female with systemic sclerosis who was incidentally also found to have venous insufficiency, who presented with painful dark raised lesions over both legs associated with thickening of the subcutaneous fat tissue. Biopsy and histopathological examination revealed LFN with features of stasis dermatitis. Through this case report, we discuss the clinicopathological features of this phenomenon to highlight this presentation of LFN in association with two predisposing conditions, to review the associated literature and to postulate the pathogenic mechanisms leading to this phenomenon.
A concise review of pharmacological and nonpharmacologic therapeutics in psychodermatology
Authors: Bubna Aditya K.
Published: August 2024

Often psychiatric co-morbidity has been observed in dermatology patients. Apart from regular dermatologic therapy employed in treating them; certain psychiatric drugs, along with other non-pharmacological measures, if combined in managing these patients, would certainly yield superior results. This comprehensive review throws light on various psychiatric drugs along with other adjuvant treatment modalities that could serve as a ready reckoner to skin specialists while encountering patients who apart from having cutaneous problems, also manifest with an associated psychological component that may need scrupulous evaluation in order to obtain a proper solution.
Mask-related dermatological problems during COVID-19 pandemic among a sample of Egyptian population
Authors: Younis Ihab , Elsabbagh Sherine M. , Ibrahim Samah E.
Published: August 2024

Background

During the coronavirus disease 2019 pandemic, mask wearing was obligatory in many countries to decrease infection risk among individuals. However, long-term mask wearing was associated with the development of various adverse skin reactions.

Objective

To assess possible dermatological complications due to mask wear during the coronavirus disease 2019 pandemic among a sample of the Egyptian population.

Patients and methods

The present hospital-based cross-sectional study included 320 patients who had attended outpatient dermatology clinic of the university hospitals with any dermatological symptoms. Patients wore face surgical masks during the pandemic for at least 3 months during outdoor activity. All patients were subjected to detailed history taking about onset, duration of the skin condition, whether an initial attack or pre-existing condition, and complete dermatological examination to confirm the diagnosis and evaluate severity level.

Results

This study showed that long‐term mask use caused new-onset skin diseases and increased dermatological facial diseases. The most common skin finding was Maskne (46.9%), followed by contact dermatitis, perioral dermatitis, and rosacea (14.1, 9.4, and 7.8%, respectively), while the remaining 21.9% were complaining of nonmask-related dermatoses. There was a significant positive correlation between mask-wearing duration and disease severity (P<0.001).

Conclusion

Prolonged mask wearing could induce new-onset skin diseases and exacerbate chronic pre-existing conditions such as acne, contact dermatitis, perioral dermatitis, and rosacea.
Intentional Replantation of Failed Root Canal Treated Tooth
Authors: Agrawal Pritesh Kisanlal , Jibhkate Narayan G. , Redij Saurabh A.
Published: August 2024

Intentional replantation (IR) should not be considered a treatment of last resort. Long-term studies have shown that the success rate of IR is somewhat similar to periapical surgery. It is indicated in failed endodontic cases. However, many times, it is the last option to save the tooth when retreatment or surgical treatment is not possible and the patient cannot afford implant placement. This article presents a case of failed root canal treatment due to instrument separation extending periapically in mandibular first molar. The tooth was extracted atraumatically and the retrograde cavity was prepared and filled extraorally with mineral trioxide aggregate. Emdogain was applied to the root surfaces before replantation. The extraoral time was <10 min. The tooth was reimplanted in the socket and splinted with a composite fiber splint. The patient’s desire to save the tooth and the use of the best possible materials and techniques has resulted in the continued retention of the tooth.
School-based Novel Tobacco Control Model for Encouraging Tobacco Prevention and Cessation
Authors: Reddy Sujatha Sampangi , Venkataramana Shwetha , Nagaraju Rakesh , Tupakula Pavan Kumar , Kar Ankita , Ramkrishnan Priyadharshini , Gupta Divya , Salma Z. Ummu , Prashanth Radha
Published: August 2024

Context:

A school-based novel tobacco control model can play a crucial role in encouraging tobacco prevention and cessation among students. Tobacco use is a global public health concern, and targeting prevention and cessation efforts at a young age is essential to curb the long-term health consequences associated with tobacco consumption. Incorporating games, interactive activities, and educative movies can significantly enhance tobacco prevention and cessation efforts. This multifaceted approach engages individuals in various ways, making the message more memorable and impactful. By combining these elements, we can create a comprehensive approach that caters to different learning styles and preferences especially for younger audiences who are more accustomed to digital and interactive experiences. The key is to make the educational experience engaging, informative, and motivating, ultimately increasing the likelihood of successful tobacco prevention and cessation outcomes.

Aim:

To create a comprehensive and effective program that can raise awareness, prevent initiation and promote cessation of tobacco.

Design:

Pre-Post Intervention Quasi-Experimental Study.

Setting:

Schools across Bangalore city, India.

Participants:

High school Students.

Methods:

A 90-minute comprehensive session on tobacco awareness was developed for a classroom setting to educate, train, and promote positive changes in attitudes and behaviours among school children, which includes five components: an antitobacco short film, educational games and a mobile app, an interactive PowerPoint presentation, and small group activities for brainstorming and practicing resistance skills. These tools are strategically designed as motivational aids to encourage tobacco cessation and prevention.

Main Outcome(s) and Measure(s):

Knowledge enhancement, attitude change, behaviour modification, engagement and participation and program effectiveness. Measures used were pre-and post-intervention assessments, feedback from students, educators, and quantitative data analysis.

Results:

Results suggest students' positive perceptions of the games within the tobacco control model, specifically user-friendliness (P < 0.05), usefulness (P < 0.01), and acceptability (P < 0.01), and higher intention to quit tobacco. This finding underscores the importance of creating engaging and well-designed interventions, such as interactive games, to effectively influence students' attitudes and behaviours related to tobacco use.

Conclusions and Relevance:

The school-based novel tobacco control model stands as a promising and relevant approach to addressing tobacco prevention and cessation among students.
Management of Krimidanta janya-shoola (Carious Odontalgia) with Hingu dharana – An Open-label Randomized Controlled Clinical Trial
Authors: Sharma Anjali , Angadi Savita Shivappa , Lagali-Jirge Vasanti
Published: August 2024

Background:

Dental caries is a disease which results in progressive destruction of the tooth and gradually leads to sensitivity or pain in that tooth, i.e., toothache the prevalence of which is about 49%–83% worldwide. There are various causes for orofacial pain, of which toothache is quite common. When severe, its unbearable and extremely disturbing for the patient, hence, considered as dental emergency. As per Ayurveda, Krimidanta has clinical features similar to dental caries. Various treatment procedures are mentioned to manage Krimidanta janya-shoola (pain due to dental caries), of which one is the topical placement of Koshna (warm) Hingu over the affected tooth.

Materials and Methods:

An interventional study was done for which patients were selected from the outpatient department and inpatient department of Shalakya Tantra and were randomly divided into two Groups A and B. Group A was asked to topically place Koshna Hingu (warm asafoetida) at the site of Krimidanta janya shoola three times a day for 3 days and Group B was advised to take paracetamol (acetaminophen) three times a day for 3 days. A total of 30 patients were enrolled in the study and all of them completed the treatment.

Results and Conclusion:

The study showed that both Hingu and tablet paracetamol were effective in managing the pain caused due to dental caries, although the results were slightly better for the group which was given Hingu topically.