bluuebunny/crossref_metadata_2025 huggingface dataset:
Economic Burden of Accidents and Injuries in India: What Does 75th Round of National Sample Survey Imply?
Authors: Thomas M Benson , Pandey Anuj K. , Gautam Diksha , Gopinathan Sandeep , Panolan Sajna
Published: January 2024

Background:

Accidents and injuries constitute a sizable share of mortality and morbidity in low- and middle-income countries. This affects the most productive age group and increases disability-adjusted life years (DALYs). It results in a substantial financial burden on the households. To explore the economic burden of accidents and Injuries on Indian households and to find how the catastrophic health expenditure (CHE) from accidents and injuries affects the population. Another objective is to explore Catastrophic out-of-pocket expenditures (OOPE) patterns and distressed financing of households in India.

Materials and Methods:

The study used data from the 75th round of nationally representative surveys, that is, the National Sample Survey (NSS). Authors have analyzed the data using descriptive binary logistic regression analysis to estimate the rate and average days of hospitalization, average OOPE, and share of the population experiencing the catastrophic impact from the health expenditure separately from the public and private healthcare institutions.

Results:

The study observed that hospitalization in the private sector imposes 72% of households incur CHE at more than 10% cut-off and 41% at more than 25% cut-off. In comparison, it is less in the public sector, with 22% of households incurring CHE at more than 10% of annual per capita household income and 9% at more than 25%.

Conclusion:

The increasing incidence of road traffic accidents (RTA) is a concern for the overstretched health system. The government should provide better healthcare facilities and universal health insurance coverage to ensure patients’ speedy recovery and financial security.
Suicide Attempt by Hanging - A Study on Patients Admitted in Tertiary Care Hospital in Eastern India
Authors: Sahoo Manoj Kumar , Biswas Harshita
Published: January 2024

Background:

Suicide is defined as a fatal self-injurious act with some evidence of intent to die. Despite the evolution of sophisticated methods to commit suicide, hanging remains one of the commonest methods to commit suicide across the world. To evaluate the individuals using hanging as a method of suicide and identify the contributing factors for this behaviour.

Material and Methods:

The study was carried out in a tertiary care hospital, over a period of 1 year on the suicide attempters using the method of hanging. Semi-structured in-depth interviews were conducted with all the 46 attempters. The questions focused on the precipitating events present before the attempt. After the in interview the risk factors of the conversations were identified, tabulated and categorized using descriptive analysis.

Results:

Findings from descriptive analysis reveals that significant age group using this method was below 19 years followed by 20-29 age group, female attempters were more compared to male. Psychiatric diagnosis was present in 8 attempters and 4 attempters had alcohol/substance dependence. The most common personality component in attempters was impulsivity. The most common immediate stressor found were financial stress, conflict with family, spouse, humiliation, substance abuse, exam stress and domestic violence.

Conclusion:

This study demonstrates that the reasons for suicide attempt by hanging is multifactorial. which includes, psychiatric diagnosis, personality factors, immediate stressors, ease of use, and accessibility, Overall, our study adds to understanding the intricates of this method and will help in developing effective suicide prevention strategies.
Food Insecurity and its Association with Dietary Diversity: A Cross-Sectional Study in Rural Households in Jammu
Authors: Langer Bhavna , Gupta Rajiv Kumar , Kumari Rashmi , Mahajan Richa
Published: January 2024

Background:

Food insecurity is a matter of public health concern as it is associated with adverse health outcomes particularly among vulnerable population. Accessibility and availability of nutritious and culturally appropriate food is paramount to achieve zero hunger. To assess the prevalence of household food insecurity, to estimate the household dietary diversity and its association with household food insecurity.

Material and Methods:

Using multistage sampling 381 rural households were surveyed. Household Food Insecurity Access Scale and House hold Dietary Diversity Scale were used as study instruments. Chi square test was used to compare the two groups and P < 0.05 was considered to be statistically significant.

Results:

Prevalence of household insecurity was 33.3% (127) among the surveyed households and 8.1% (31) had severe food insecurity. The mean HFIS score was 6.85 ± 4.82. The household Dietary diversity score was 8.14 ± 1.54 for food secure and 6.51 ± 1.38 for severely food insecure households. There was a statistically significant difference in intake of milk and milk products, fruits, eggs and meat/poultry among food secure and insecure households (P < 0.001 respectively).

Conclusion:

Food insecurity was high in rural households and was associated with lower dietary intake of foods from protein group, necessitating a need to reinforce the food security programmes in rural India with focus to enhance protein rich diet.
A Cross-sectional Study to Estimate the Proportion and Ascertain Risk Factors for Osteoarthritis Knee among Women above 45 Years of Age Attending a Tertiary Care Hospital
Authors: S Rahini , Hadaye Rujuta S.
Published: January 2024

Background:

With aging, women face various health issues, the most common of which are musculoskeletal disorders. Osteoarthritis accounts for 15% of all musculoskeletal disorders in patients above the age of 45 years but receives little attention. This study aims to estimate the proportion of women above 45 years suffering from Osteoarthritis (OA) knee and to ascertain its risk determinants.

Materials and Methods:

A cross-sectional study was conducted among 380 women above 45 years of age attending the Orthopedic outpatient department of a tertiary care hospital over a period of 18 months. American College of Rheumatology clinicoradiological criteria were used for the diagnosis of OA knee. A predesigned case record form was used to collect information on sociodemographic profile and other risk factors.

Results:

Data were analyzed using SPSS version 16.0. Our study found the overall proportion of OA knee to be 69.2%. The Chi-square test was used to find the association of various factors with OA knee. On logistic regression, diabetes mellitus, hypertension, menopause, and increased body mass index were found to be significant for OA Knee.

Conclusion:

The study concludes the possibility of prevention of disabilities by early screening for OA Knee in those with risk factors as a part of wellness clinics.
Prevalence and Barriers of Menstrual Hygiene Practices among Women of Reproductive Age Group in Rural Field Practice Areas of a Tertiary Care Center in Rishikesh
Authors: Saini Bhavana , Khapre Meenakshi , Kumar Prakash , Bharadwaj Ranjan , Gupta Anupam , Kumar Santosh
Published: January 2024

Background:

Menstruation is a natural, physiological process experienced by all adolescent girls and women. The reproductive age group is the largest and most susceptible to various health and illness-related risk factors. This study aims to find the prevalence of satisfactory menstrual hygiene management (MHM) among women of reproductive age group and we also want to explore the cultural practices and beliefs related to menstruation and barriers to satisfactory MHM.

Material and Methods:

This study was conducted in rural field practice areas of Department of Community and Family Medicine, AIIMS, Rishikesh including 271 participants; women of reproductive age group using a mixed method study design (sequential quan–qual). Quantitative data were collected by household surveys and government schools using a validated structured questionnaire. Descriptive statistics were used to analyze the data. Focus group discussions (FGD) were conducted to have insights about understanding menstrual hygiene and barriers to satisfactory hygiene practices.

Results:

It was found that only 70 (29.6%) participants adhered to satisfactory menstrual hygiene practices. The age group of 20–24 years had a higher proportion compared to other groups. Through FGD, the main themes derived were practices related to menstruation (maintenance of personal hygiene), daily activities (physical and mental problems during menses), and barriers faced (cultural, economic, privacy concerns, and shyness).

Conclusion:

The prevalence of satisfactory menstrual hygiene practices was very low only 29.6%, which is a cause of concern; either Taboos associated with menstruation, socio-cultural, economic barriers, or lack of awareness related to menstrual hygiene in the community can be contributing factors for low prevalence.
Comparative Study on Elder Abuse and Neglect Among Geriatric Population in the Rural and Urban Field Practice Areas of a Medical College
Authors: Kumar Prianka Shashi , Rashmi Anusha , Anil Manjula , Sindhu B M
Published: January 2024

Background:

Elder abuse is a multidimensional problem of public importance. According to the World Health Organization (WHO), 16% of older people were victims of elder abuse. A study conducted by HelpAge India in 2018 showed that Mangaluru ranks the highest in elder abuse (47%). Given the scarce literature, this study sought to determine the prevalence of elder abuse and its associated sociodemographic factors.

Material and Methods:

A community-based cross-sectional study was conducted among the senior population in the rural and urban field practice a medical college in Mangaluru for one and a half years. The sample size was 280.

Results:

Most of the study population was in the age group of fewer than 75 years (75.4%), with 50.4% females, 60% Hindus, 56.4% married, 39.3% illiterate, and 88.9% of them retired. The prevalence of elder abuse was 44.6% (rural = 50.7% and urban = 38.6%). Binary logistic regression showed that elder abuse was statistically significant among the unemployed, extended family members, and staying with children.

Conclusions:

The study brings to light the sociodemographic factors that play a role in detecting elder abuse. It also shows the importance of awareness of elder mistreatment among older people. These elements must be considered for implementing and enforcing laws and legislation to help curb elder abuse.
Impact of Lockdown on Air Quality in the Most Polluted Cities of India
Authors: George Noel , Prasad Jang Bahadur , Varghese Elizabeth , Rajesh Richu , Kumar Aravind
Published: January 2024

Background:

COVID-19 has become a global pandemic, prompting lockdowns in practically every country. To prevent the spread of the disease, India has enforced a rigorous nationwide lockdown that commenced in March 2020. The lockdown imposed amid the pandemic ensured that most commercial activities and vehicle transportation ceased, resulting in a significant reduction in air pollution levels.

Material and Methods:

The value of air pollutants PM10, PM2.5, NO2, and SO2 from January to May 2020 was obtained from the Indian Central Pollution Control Board. Before lockdown and during lockdown, relative fluctuations in ambient concentrations of four air contaminants were investigated. The Box–Jenkins approach was used to estimate future air pollution data points using time series data analysis.

Results:

The PM10 level reduced by 61%, 30%, 68%, 37%, and 43% in the selected cities, respectively. Comparison of other pollutant concentrations before and after the lockdown also found a reduction in ambient pollutant concentrations, resulting in improved air quality. Inference of predicted model values to observed values revealed a significant increase in the concentrations of all pollutants. The percentage increases in AQImean from predicted to observed values were 206% in Ghaziabad, 148% in Delhi, 59% in Hyderabad, and 160% in Cochin.

Conclusion:

The strict lockdown has resulted in a significant drop in air pollutant levels. Upgrading present technologies could help keep pollution to a minimum of 37% under control. The findings would prompt the government to consider how to strictly reduce vehicle and industrial pollution to improve air quality and maintain improved public health.
Surgery for supplementary motor area gliomas—Controversies and rationale for surgical approach: A perspective
Authors: Pasricha Paurush , Raheja Lakshay , Moiyadi Aliasgar
Published: January 2024

Supplementary motor area (SMA) has a role in planning and coordinating motor movements as well as in speech (dominant SMA). SMA gliomas are complex tumors to operate on and sufficient knowledge regarding connection fibers is needed to plan and prevent complications, the most important being SMA syndrome. Development of SMA syndrome causes significant morbidity and although SMA syndrome is transient and the majority of symptoms are relieved over time some symptoms persist that may lead to loss of quality of life in these patients. A thorough review of the literature was done to expand on the white matter tracts connecting SMA to other eloquent regions, SMA syndrome, best surgical practices for SMA gliomas (addressing the dilemma of awake vs. asleep craniotomy), and intraoperative monitoring techniques being used currently. An attempt has been made to address the debate regarding outcomes and controversies in the treatment of SMA region gliomas and we have also presented our experience through three case illustrations, which include two cases of SMA gliomas operated under asleep monitoring and one case operated under awake monitoring.
Plasmocitoma/multiple myeloma with severe cord compression: Case reports
Authors: Sincari Marcel , Cabrita Francisco , Pina Gabriel , Nunes André Fernando
Published: January 2024

Introduction:

Multiple myeloma (MM) is generally located in the bone marrow (BM) and is associated with a wide spectrum of clinical, laboratory, and radiological findings.[1] Conversely, solitary plasmacytoma (SP) is characterized by a single mass of clonal plasma cells, with no or minimal BM plasmacytosis and with no other symptoms than those derived from the primary lesion.[2] The cases with spine involvement and spine cord suffering from compression always were very complicated and challenging.

Materials and Methods:

We describe two cases of SP and MM with severe spine cord compression treated surgically with an indication to address the compression and stabilization of the affected segments with subsequent treatment in hematology and oncology.

Results:

In both cases, the surgery was a success, the patient with SP survived 3 years and 1 month, and the patient with MM survived 1 year and 3 months.

Conclusion:

The outcomes of surgical interventions for these patients with spine cord compression and spinal instability due to MM and plasmacytoma of the spine were improved with neurological function following surgery and no instrumentation failure.
Giant convexity enchondroma mimicking a meningioma: A case report and literature review
Authors: Patil Monali M , Patil Sagar M , Balasubramaniam Srikant , Nadkarni Trimurti D
Published: January 2024

Most intracranial enchondromas are located in the skull base. Intracranial enchondromas over convexity are very rare benign extra-axial tumors that tend to present with protracted symptomatology and as large dural-based space-occupying lesions. We report a large convexity enchondroma in a 23-year-old male who presented with 3 years of recurrent seizures. Surgical gross total removal resulted in a good outcome. This case report emphasizes the unusual location of enchondroma in the form of an extra-axial space-occupying lesion in the parietooccipital lobe and further adds to the literature on this pathological entity. Our objective is to report this rare case and review the pertinent literature, especially concerning presentation, pathology, and management.
Factors Associated with Therapeutic Outcomes in the Treatment of Nontraumatic Acute Upper Limb Ischemia at a Tertiary Care Center in South India: A Prospective Analysis
Authors: Sreevathsa K S P , Vairagar Siddhant Rajendra , Ramshankar S P , Munuswamy Hemachandren , Malladi Varsha , Sunil Julia
Published: January 2024

Background:

The outcomes of acute upper extremity ischemia (AUEI) demonstrated lower rates of limb loss (0%–3.1%) and mortality (~6%) compared to acute lower extremity ischemia. However, AUEI still is a challenge for a vascular surgeon as delays in diagnosis and treatment are likely to result in severe functional disability, even in the absence of overt tissue loss.

Objectives:

The objectives of this study are to determine the association of factors affecting the clinical outcomes of acute upper limb ischemia treatment.

Methodology:

A single-center prospective observational study was done between July 2021 and July 2023 on patients with AUEI who came to our emergency medicine department at a tertiary care center in South India. The demography, risk factors, duration of ischemia, time from onset of complaints, and primary intervention chosen were recorded. Functional improvement on subsequent follow-up intervals was analyzed to describe the surgical outcome.

Results:

Of 53 patients with AUEI, 31 (58.5%) had atrial fibrillation. In 81.1% of patients, thrombosis was the primary cause of acute limb ischemia. Most patients belonged to the 2A Rutherford classification (47.2%), followed by 2B (26.4%). Regardless of the severity of ischemia, the patients (n = 10) who arrived after 36 h had a higher rate of amputation (5; 50%). Lower levels of preoperative serum lactate dehydrogenase and serum glutamic-oxaloacetic transaminase were associated with better postoperative outcomes (P = 0.007) and lesser amputation rates (P = 0.017). Lower grades of ischemia, prompt intervention, and early consultation were all linked to better postoperative functional outcomes (P = 0.026).

Conclusion:

At our facility, AUEI due to cardiac or noncardiac emboli, thrombosis, or both was a significant cause of inhospital morbidity. An important risk factor for worse outcomes was hypertension. The availability of appropriate interventional care, and the timing of presentation after the onset of symptoms are thus significant modifiable factors in lowering the rates of amputation.
Approach to the Management of Vascular Malformations of Head and Neck and Its Challenges: An Institutional Experience
Authors: Senthilnathan K , Duraichi B Vella , Sritharan Narayanan , Jayachander K , Kumar P Ilaya , Kumar S Prathap , Babu R Ranjith , Ramya M
Published: January 2024

Background:

Vascular malformations (VMs) in the region of the head and neck are a complex group of lesions that present with serious challenges in diagnosis and management. We sought to study the efficacy and safety of a therapeutic algorithm emphasizing multimodal management in the treatment of head and neck VMs.

Methodology:

A retrospective study was conducted reviewing all the patient information from the database who were treated for VM of the head and neck at the institution. Patients who presented during the period between January 2012 and December 2022 were included in the study. Conservative care, sclerotherapy, embolization, surgical excision, or a combination of these techniques were among the management options based on the clinical profile of the patient as well as the characteristics of the lesion.

Results:

91 VMs in the region of the head and neck included 45 (49%) males and 46 (51%) females, with an age range of between 4 years and 71 years (mean 23.9 ± 14.06 years). There were 53 low-flow vascular malformations (LFVMs), of which 6 (11.9%) were managed conservatively, 26 (49.05%) were treated with sclerotherapy, 20 (37.7%) underwent excision, and 1 (1.8%) was treated with combination therapy. Of the 38 high-flow vascular malformations (HFVMs), 12 (31.5%) were treated with arterial embolization, 13 (34.2%) were primarily resected, 2 (5.2%) with excision and reconstruction, 5 (13.1%) underwent embolization and excision, and 1 (2.6%) underwent emergency external carotid artery ligation. In the LFVM group, response to sclerotherapy led to improvements in 24 (92%) patients, while surgical resection led to improvements in 20 (100%) individuals. In the HFVM group, embolization therapy improved 9 (75%), combination therapy improved 5 (100%), and surgical resection improved 15 (100%) of the patients.

Conclusions:

In our experience, the implementation of a multimodal management algorithm has had favorable outcomes with an acceptable complication rate in head and neck VMs.
Evaluation of Serum Cysteine-rich Angiogenic Inducer 61 for Peripheral Arterial Disease in Patients with Type 2 Diabetes Mellitus
Authors: Rahman Nabila , Khan Siraj Ahmed , Mahapatra Sandeep , Bhaskar M. Vijaya , Baba K. S. S. Sai , Noorjahan M. , Sreedevi N.
Published: January 2024

Background:

Peripheral artery disease (PAD) is a common manifestation of atherosclerotic disease, which is related to considerable disability and mortality. Currently, approximately 202 million people worldwide are suffering from lower extremity arterial disease, giving rise to a major public health problem and a heavy economic burden. Type 2 diabetes mellitus (T2DM) is one of the major risk factors for atherosclerosis, and the prevalence of PAD increases with the prevalence of T2DM.

Materials and Methods:

A cross-sectional case–control study comprising 100 cases and 40 age- and sex-matched healthy controls was done. The cases were divided into three groups: Group 1 (T2DM with PAD) – 40, Group 2 (T2DM without PAD) – 40, and Group 3 (PAD without T2DM) – 20. The serum cysteine-rich angiogenic inducer 61 (CYR61) levels were assessed using the sandwich enzyme-linked immunosorbent assay. Statistical analysis was done using MedCalc version 20.114. P <0.005 is taken as statistically significant.

Results:

The mean concentrations of CYR61 in Group 1, Group 2, and Group 3 were 3680 pg/ml, 3059 pg/ml, and 2866 pg/ml, respectively, whereas, in controls, it was 2318 pg/ml. The serum CYR61 levels were significantly higher in cases compared to controls (P < 0.0001). CYR61 concentrations are significantly higher in Group 1 compared to the other two groups – Group 2 and Group 3. CYR61 levels showed a statistically significant difference between Stage 2 and Stage 4 of PAD in Group 1. Receiver operating characteristic analysis has shown area under curve (0.946) for CYR61 higher than ankle-brachial index (0.750).

Conclusions:

CYR61 proved to be a better marker for diagnosing PAD in patients with T2DM.
Emergency Endovascular Management of Gluteal Artery Pseudoaneurysm
Authors: Yadamreddy Rohit Kumar , Lakshmidharan M , Raju Radhakrishnan , Ayyappan M K
Published: January 2024

Introduction:

Gluteal artery pseudoaneurysms are rare, yet the most common in cases involving the superior gluteal artery. Pseudoaneurysms of the inferior gluteal artery are uncommon and are often related to blunt or penetrating trauma, infections and fractures of the pelvis.

Presentation of Case:

The authors describe a case of pseudoaneurysm which was presented to the emergency department. A thorough workup revealed a history of pelvic fracture that could constitute a probable cause of the pseudoaneurysm, which was treated with selective embolization of the artery during angiography.

Discussion:

The most common manifestation pseudoaneurysm of inferior gluteal artery is the presence of a painful mass in the buttock. However, both diagnosis and therapy are facilitated by catheter angiography.

Conclusion:

Although pseudoaneurysms are rare, pseudoaneurysms of the inferior gluteal artery require a high index of suspicion and careful physical examination by the physician in order to avoid misdiagnosis. In addition, the treatment performed using the endovascular technique is less invasive than the conventional technique, giving the patient better recovery.
Splenic Artery Pseudoaneurysm Rupture in Pseudocyst of Pancreas Successfully Managed with Coiling: A Rare Case Report
Authors: Batra Nitish , Phate Neha , Soni Raj Jaydeep , Kumar Sunil , Acharya Sourya , Banode Pankaj
Published: January 2024

Splenic artery pseudoaneurysm is a rare condition with approximately 1% prevalence. Potential risks of splenic artery aneurysms (SAAs) include rupture and life-threatening hemorrhage, which can occur in about 10% of cases. The ratio of splenic artery pseudoaneurysms in female-to-male is 4:1. It is significantly higher in patients older than 60 years and patients with portal hypertension. Such patients are usually asymptomatic, but 20% of them present with complaints such as abdominal pain and chest pain and most are usually diagnosed incidentally. In this case report, we have highlighted a 40-year-old patient who presented with pain abdomen and shock, which, after a thorough workup, came out to be a case of pseudocyst of the pancreas with rupture of SAA as well as eventration into the mediastinum through hiatus hernia. The patient was successfully managed with splenic artery coiling.
Comparison of the Long-term Results of Bypass Surgery versus Below-the-knee Angioplasty in Infrapopliteal Lesions that Results in Ulcer or Toe Gangrene
Authors: Motamedi Mohammad Reza Kalantar , Tadayon Niki , Sabet Babak , Abdolalian Younes
Published: January 2024

Background and Aim:

The optimal revascularization strategy for patients with severe leg ischemia remains uncertain. The purpose of this study was to compare outcomes of bypass surgery and angioplasty in isolated below-the-knee lesions.

Methods:

Patients with ulcers or toe gangrenes, undergone below-the-knee bypass surgery or angioplasty from January 2015 to December 2017, were included in the study. Amputation-free survival (AFS) and overall survival (OS) were assessed using the Kaplan–Meier and Cox regression tests.

Results:

Eighty-eight patients were included in this study, of which 43 underwent bypass surgery and 45 underwent endovascular interventions. The mean age in the bypass group was 73.1 (±7.1) years and 73.9 (±7.2) years in the angioplasty group. There were no significant differences in sex, diabetes, hypertension, history of smoking, history of stroke, and renal insufficiency between the two groups. AFS was 43.4 (±8.5) months in the bypass group and 39.8 (±8.9) months in the angioplasty group which was significantly better in the bypass group (P = 0.05). OS was 49.6 (±10.6) months in the bypass group and 46.2 (±11.7) months in the angioplasty group but did not differ statistically significant (P = 0.32).

Conclusion:

AFS was significantly higher in the bypass group. Thus, bypass surgery seems preferable to angioplasty for all patients with severe leg ischemia except those with multiple comorbidities and those whose vein is not adequate for bypass.
Correlation of behavioral and psychological symptoms of dementia with patients’ sociodemographic & clinical details and caregivers’ distress
Authors: Deo Vinay Kumar , Singh Krishna Kumar , Sinha Niska , Kumar Abhay , Kumar Santosh
Published: January 2024

Background:

Behavioral and psychological symptoms of dementia (BPSD) influence dementia care significantly. BPSD can be affected by factors related to the patient’s illness and socio-cultural background.

Aim:

This study aimed to find a relationship between BPSD with patients’ socio-demographic and clinical profiles and their caregivers’ distress in a tertiary care center.

Materials and Methods:

In this hospital-based cross-sectional study, the purposive sampling technique was used to select 100 dementia patients. A comprehensive record of socio-demographic and clinical details was made on a self-prepared semi-structured data sheet. The Neuropsychiatric Inventory Questionnaire was the principal tool to find the BPSD and related caregivers’ distress.

Results:

The sample comprised predominantly Hindu (91%) male patients (66%) with Alzheimer’s dementia (76%) coming from rural backgrounds (74%) and joint familial systems (96%), with a mean age of 71.77 ± 7.41 years. Patients’ main caregivers were their children/children-in-law (65%). The severity of an overall BPSD and its variable individual domains were directly related to the duration of dementia, patients’ age, their cognitive decline, and related decline in activities of living, as well as their caregivers’ distress. In comparison to Alzheimer’s disease patients, those with other dementia types had more impairment in cognitive functions and activities of daily living and they had a higher number and severity of BPSD.

Conclusion:

The advancing age, increased duration of dementia, and decline in cognition and related activities of daily living of the patients, as well as their caregivers’ distress, are important correlates of BPSD. The findings are essential for the better management of dementia patients.
Inflammatory myofibroblastic disease of right petrous apex: A rare case with review of literature
Authors: Mahadev Doddala Sankara , Praveen N. V. S , Suryadevara Aparna , Naga Kishore M. G
Published: January 2024

Inflammatory myofibroblastic tumor (IMFT) is a rare tumor of unknown etiology. It can involve any part of the body. The IMFT involving the base of skull is rare with only 36 cases reported in the literature. We report a rare case of IMFT of temporal bone with review of literature. A 42 year old male presented with complaints of headache and double vision and MRI brain showed lesion in the right petrous apex region suggestive of a neurogenic mass. He had excision of lesion and histopathology was suggestive of IMFT with IgG4 and ALK positive. He had complete clinical response but a month later he presented with right eyelid ptosis and decreased rotation of eye medially with recurrent lesion on MRI. Patient received radiation by SRT technique and then started on Ceretinib with partial response. The IMFT is rare tumor of unknown etiology and tumors of temporal bone are more aggressive. It is benign but locally invasive tumor. Treatment of IMFT is controversial. Extensive surgery with complete excision has about 80% response rates and with intracranial extension, adjuvant radiation is need. In head and neck IMFT response rates are lower (30 to 40%). Monoclonal antibodies and steroids are used in IMFT at recurrence. In advanced or metastatic ALK positive tumors, Crizotinib is used with a response rate of 50%. Radiotherapy (25 to 30 Gy) induces remission and helps to taper the steroids. Temporal bone IMFT is a rare tumor with multimodality approach and variable response to treatment.
Origin and survival outcomes of Pseudomyxoma peritonei—A retrospective study
Authors: Nayanar Sangeetha K. , Markose Anu Jose , Avaronnan Manuprasad , Dharmarajan Adarsh
Published: January 2024

Background:

Pseudomyxoma peritonei (PMP) is an unusual clinical condition typically presenting with widespread mucinous neoplastic lesions within the peritoneum resulting in gelatin material-rich ascites. It was first described by Werth in 1884. Ever since, its clinical presentation, definition, site of origin, and prognosis have been a subject of debate. However, many histopathologic, immunohistochemical, and genetic studies have attempted to locate the primary lesion in the appendix in both genders.

Objectives:

To analyze the histological origin and survival outcomes of pseudomyxoma peritonei in patients treated at a regional cancer center.

Materials and Methods:

Fifteen cases of PMP were diagnosed during the five-year study period. The demographic and clinicopathological details were retrieved; the slides were reviewed and histological parameters reassessed. Descriptive statistics were used to express proportions. Continuous variables were recorded as mean (SD) or median (IQR). Kaplan–Meier (KM) curve was used to estimate overall survival.

Results:

Mean age for PMP was found to be 47.5 years for low grade Mucinous Carcinoma Peritonei (MCP), 54.2 years for high grade MCP, and 58 years for high grade MCP with signet ring cells. Most common overall presentation was abdominal distension in 53.3% (8/15) of cases, followed by acute appendicitis in 20% (3/15) cases. PMP was detected synchronous with the primary tumor in 9/15 cases (60%). Primary lesion in the appendix was grossly identified in 7/15 cases, while it was not explored in the remaining eight cases. Yet, by combined clinical, radiological, histopathological, and immunohistochemical analysis, we identified that most of the cases (14/15) had an appendiceal origin (93.3%). The overall survival for 12 months was 50% and for 18 months was 37%.

Conclusion:

The surgeon and radiologist may well bear in mind the most common possibility of an appendiceal origin for PMP and resect the appendix, irrespective of the presence of a grossly or radiologically detectable lesions. We emphasize that immunohistochemistry helped to detect the site of origin even when the primary was occult.
Outcomes of 3-year follow up with induction vs first line chemotherapy in oral cancer patients: An observational hospital-based study
Authors: Sahoo Pranab Kumar , Bhowmick Anup Kumar , Sarkar Sinjini , Mahata Sutapa , Pal Ranita , Mistry Tanuma , Ghosh Sushmita , Choudhury Trisha , Kumar R. Suresh , Mondal Syamsundar , Datta Sriparna , Nath Partha , Mukherjee Kalyan Kusum , Nasare Vilas D.
Published: January 2024

Objective:

Our study aims to analyse and compare the efficacy, adverse effect profile and survival among the Paclitaxel/Cisplatin/5-Flurouracil (TPF) induction chemotherapy and Paclitaxel/carboplatin (PC) first line or cisplatin chemotherapy in a high-volume tertiary care cancer centre.

Materials and Methods:

215 patients with oral cavity cancer were recruited in this study. Patients with stages I-IIc underwent surgical resection or radiation therapy 66-74 GY/fraction. Patients of Stages III-IV were administered with either induction chemotherapy TPF or PC or cisplatin regimen. Treatment responses were assessed by CT and MRI. Response rates, survival and adverse effects data were tabulated and analysed.

Results:

The mean age was 49.2 ± 11.68 years. Symptoms were ulceration (33.5%), growth (20.5%), pain (13%), ulcer-proliferative growth (8.4%) and swelling (13, 6%). The tumour site was found at the base of the tongue, C01 (42.2%) followed by C06 (35.8%), C08 (6.5%), C07 (5.2%) and C05 (4.6%). There were no significant differences (P > 0.05) in efficacy and survival outcomes between the different groups of treatment. Median survival was achieved within 36 months. The major side effect observed were anaemia (15.81%), diarrhoea (36.2%), dyspepsia (28.8%), fever (33.95%), mucositis (28.85%), myalgia (33.95%) and nausea (7.9%). Survival among the responder categories (CR, PR and NR) was significantly different as per Log-rank analysis (P = 0.015).

Conclusions:

TPF induction therapy and PC first line chemotherapy showed similar efficacy, safety profile and survival whereas cisplatin shows poor efficacy and safety and survival in Indian oral cancer patients.
Pancreatic heterotropia in gallbladder with adenocarcinoma: A rare incidental finding
Authors: Rana Deepika , Paul Sreoshi , Mallya Varuna , Mandal Shramana , Vindal Anubhav , Singh Kishore
Published: January 2024

Heterotopic pancreas is defined as the presence of aberrant pancreatic tissue present outside the pancreas without connection to its neural, vascular, and anatomic location. The commonly seen locations are stomach, duodenum, jejunum, Meckel commonly seen locatio, and ampulla of Vater. The gallbladder is an extremely rare site for pancreatic heterotropia. Its association with adenocarcinoma has not been described yet. A case of 50-year-old male with pancreatic heterotropia along with carcinoma gallbladder is being presented here.
Oral glutamine: Is there a role in the amelioration of radiation-induced mucositis? A prospective case-control study at a tertiary care centre in North India
Authors: Fatima Kaneez , Andleeb Asifa , Nasreen Shahida , Sofi Mushtaq A. , Najmi Arshad M. , Qadri Sumyra K. , Ryhan Rubyiya , Roohi Shagufta , Afroz Fir , Khan Nazir A.
Published: January 2024

Background:

The most frequently occurring painful and dose-limiting side effect of radiation therapy (RT) to the head and neck region is oral mucositis (OM). Several studies demonstrated that glutamine may reduce the severity and the duration of OM significantly during RT and chemo-radiotherapy in patients with head and neck cancer (HNC).

Materials and Methods:

Between January 2021 and August 2022, a prospective single institutional case-control study compared the efficacy and safety of oral glutamine on radiation-induced mucositis in patients with HNC. Of 60 biopsy-proven patients with HNC, 30 patients in the study arm received oral glutamine suspension (10 g in 500 mL of water) orally once daily, 2 hours before RT, receiving definitive or adjuvant RT and chemo-radiotherapy, while as 30 patients in the control arm received placebo with the same dose and schedule (n = 30 in the study arm and n = 30 in the control arm).

Results and Analysis:

A total of 27 (90%) in the glutamine arm and 28 (93.33%) patients in the control arm developed mucositis. Grade 3 mucositis (13.33%) and Grade 4 mucositis (6.66%), respectively, were significantly less (P = .040 and P = .004) in the glutamine arm. The mean duration of grade 3 and grade 4 mucositis was significantly less in the glutamine arm (8.94 days in the study arm vs. 14.54 in the control arm; P = .0001). The mean time of onset of OM was significantly delayed in the glutamine arm in comparison to the control arm with P < .001.

Conclusion:

Glutamine delays the onset of OM and decreases the severity of OM in patients of HNC receiving RT with or without chemotherapy.
Periprosthetic metastases in carcinoma of unknown primary: A rare association
Authors: Singla Aditya , Goyal Shikha , Mitra Saikat , Kumar Rajender , Periasamy Kannan , Bal Amanjit , Madan Renu , Khosla Divya
Published: January 2024

Septic or aseptic loosening may cause bone loss around artificial prosthesis leading to prosthesis failure. This occurrence due to metastatic infiltration of bone or surrounding soft tissues is rare but has been occasionally reported. We report a case of an elderly lady presenting with swelling and pain at the site of previous hemiarthroplasty performed for traumatic injury. On evaluation, she was found to have a lytic femur lesion with a large soft-tissue component around the prosthetic joint. Biopsy suggested a metastatic carcinoma of renal origin, but screening of kidneys did not reveal any primary lesion. She had additional skeletal metastatic lesions but no other primary site was detected either. She was given palliative radiotherapy and systemic therapy (sunitinib) based on the histologic diagnosis of renal cell origin but did not tolerate it. Thereafter, she is continuing on zoledronate every 4 weeks and best supportive management since 4 months from diagnosis.
Metastatic papillary thyroid carcinoma masquerading as lymphangioma: A rare case report and review of literature
Authors: Goswami Rashmi R. , Daimary Michimi , Datta Balmiki , Bordoloi Krishangee , Anam Piyar
Published: January 2024

Papillary thyroid carcinoma coexisting with lymphangioma is a rare presentation of a cystic neck mass. Here, we report a case of papillary thyroid carcinoma masquerading as lymphangioma in the neck clinically and radiologically. Our patient was a 31-year-old man who presented with swelling on the left side of the neck for four months. A detailed history and investigation are summarized, and a review of published literature on similar cases is obtained. The initial computed tomography (CT) scan reported it as lymphangioma, and the fine-needle aspiration cytology (FNAC) reported it as a cystic lesion. However, the excision biopsy showed a picture of metastatic papillary carcinoma of the thyroid with cystic changes and associated lymphangioma. The patient finally underwent total thyroidectomy, which again revealed multifocal papillary thyroid carcinoma with capsular invasion and lymph node metastasis on histopathological examination (HPE). Primary occult carcinoma of the thyroid with metastatic deposits presenting as lymphangioma is a very rare presentation of a cystic neck mass, and very few cases have been reported in the English language literature.
Molecular mechanisms underlying SARS-CoV-2 hepatotropism and liver damage
Authors: Quarleri Jorge , Delpino M Victoria
Published: January 2024

In coronavirus disease 2019 (COVID-19), severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) primarily targets the respiratory system, but evidence suggests extrapulmonary organ involvement, notably in the liver. Viral RNA has been detected in hepatic tissues, and in situ hybridization revealed virions in blood vessels and endothelial cells. Electron microscopy confirmed viral particles in hepatocytes, emphasizing the need for understanding hepatotropism and direct cytopathic effects in COVID-19-related liver injury. Various factors contribute to liver injury, including direct cytotoxicity, vascular changes, inflammatory responses, immune reactions from COVID-19 and vaccinations, and drug-induced liver injury. Although a typical hepatitis presentation is not widely documented, elevated liver biochemical markers are common in hospitalized COVID-19 patients, primarily showing a hepatocellular pattern of elevation. Long-term studies suggest progressive cholestasis may affect 20% of patients with chronic liver disease post-SARS-CoV-2 infection. The molecular mechanisms underlying SARS-CoV-2 infection in the liver and the resulting liver damage are complex. This “Editorial” highlights the expression of the Angiotensin-converting enzyme-2 receptor in liver cells, the role of inflammatory responses, the impact of hypoxia, the involvement of the liver's vascular system, the infection of bile duct epithelial cells, the activation of hepatic stellate cells, and the contribution of monocyte-derived macrophages. It also mentions that pre-existing liver conditions can worsen the outcomes of COVID-19. Understanding the interaction of SARS-CoV-2 with the liver is still evolving, and further research is required.
Pylephlebitis-induced acute liver failure: A case report and review of literature
Authors: Hapshy Vera , Imburgio Steven , Sanekommu Harshavardhan , Nightingale Brandon , Taj Sobaan , Hossain Mohammad A , Patel Swapnil
Published: January 2024

BACKGROUND

Pylephlebitis is an extremely rare form of septic thrombophlebitis involving the portal vein, carrying high rates of morbidity and mortality.

CASE SUMMARY

We present a case of a 42-year-old male with no past medical history who presented with acute onset of abdominal pain and altered mental status with laboratory tests demonstrating new-onset acute liver failure. Pylephlebitis was determined to be the underlying etiology due to subsequent workup revealing polymicrobial gram-negative anaerobic bacteremia and complete thrombosis of the main and left portal veins. To our knowledge, this is the first documented case of acute liver failure as a potential life-threatening complication of pylephlebitis.

CONCLUSION

Our case highlights the importance of considering pylephlebitis in the broad differential for abdominal pain, especially if there are co-existing risk factors for hypercoagulability. We also demonstrate that fulminant hepatic failure in these patients can potentially be reversible with the immediate initiation of antibiotics and anticoagulation.
Metabolomics in liver diseases: A novel alternative for liver biopsy?
Authors: Tanaka Yasuo
Published: January 2024

Hepatitis C virus (HCV) remains a significant public health problem as it can cause acute and chronic hepatitis. Chronic HCV infection is a major cause of liver fibrosis, and evaluation of liver fibrosis is essential because the prognosis of patients with chronic HCV infection is closely related to the stage of fibrosis. Liver fibrosis is traditionally evaluated based on pathological analysis of biopsy specimens, which is considered the gold standard. Nevertheless, liver biopsy is invasive and susceptible to sampling error and inter- and intraobserver variation in pathological interpretation; it is also costly. Therefore, noninvasive diagnostic investigations have been developed, including the use of fibrotic markers, scoring systems based on routine blood tests, and transient elastography with magnetic resonance imaging or ultrasonography. Recently, metabolomics, an emerging technology, has been used to detect the fibrosis stage. In this editorial, I comment on the article titled “Metabolomics in chronic hepatitis C: Decoding fibrosis grading and underlying pathways” by Ferrasi et al published in the recent issue of the World Journal of Hepatology . I discuss previous studies on the use of metabolome analysis for the diagnosis of HCV-related liver fibrosis and the potential development of biopsy-free diagnostic techniques.
Direct-acting antivirals failed to reduce the incidence of hepatocellular carcinoma occurrence in hepatitis C virus associated cirrhosis: A real-world study
Authors: Tao Xue-Mei , Zeng Ming-Hui , Zhao You-Fei , Han Jia-Xin , Mi Yu-Qiang , Xu Liang
Published: January 2024

BACKGROUND

Direct-acting antivirals (DAAs) revolutionized the treatment of chronic hepatitis C virus (HCV)-associated disease achieving high rates of sustained virological response (SVR). However, whether DAAs can reduce the occurrence of hepatocellular carcinoma (HCC) in patients with HCV-associated cirrhosis who are at high risk have not been concluded.

AIM

To investigate the effect of DAAs on the occurrence of HCC in patients with HCV-associated cirrhosis after achieving SVR.

METHODS

Of 427 inpatients with HCV-associated cirrhosis were enrolled in Tianjin Second People's Hospital from January 2014 to April 2020. 118 patients weren’t received antiviral treatment with any reasons named non-antiviral treatment group, and 236 patients obtained from the 309 DAAs treatment patients according to the propensity score matching named DAAs treatment group. Demographic information and laboratory data were collected from baseline and the following up. Kaplan-Meier curve and Log-Rank test were used to compare the incidence and cumulative incidence of HCC between the two groups. Cox proportional risk regression was used to re-evaluate the risk factors for HCC.

RESULTS

HCC incidence was 4.68/100PY (95%CI, 3.09-6.81) in the DAAs treatment group, while it was 3.00/100PY (95%CI, 1.50-5.37) in the non-antiviral treatment group, and the relative risk was 1.82 (95%CI, 0.93-3.53, P > 0.05). The incidence of HCC at 12, 24, 36 and 48 months was 3.39%, 6.36%, 8.47% and 10.17% in the DAAs treatment group, and it was 0%, 0%, 3.39% and 9.32% in the non-antiviral treatment group, respectively. Age > 58 [hazard ratio (HR) = 1.089; 95%CI, 1.033-1.147; P = 0.002] and liver stiffness measurement > 27.85 kPa (HR = 1.043; 95%CI, 1.022-1.065; P = 0.000) were risk factors for HCC in all patients (n = 427), and DAAs treatment didn’t show protective efficacy.

CONCLUSION

DAAs treatment seems failed to reduce the incidence of HCC occurrence in HCV-associated cirrhosis in 48 months, and even increased the incidence of HCC in 36 months.