bluuebunny/crossref_metadata_2025 huggingface dataset:
A Rare Case of Unresectable Solitary Extramedullary Plasmacytoma at the Shoulder Region: Case Report
Authors: Putro Yuni Artha Prabowo , Ekaputra Ericko , Cein C. Rayhan , Tampubolon Yunus Oksikimbawan , Win Raymond , Magetsari Rahadyan , Dwianingsih Ery Kus
Published: July 2022

INTRODUCTION: Plasmacytoma is a solitary neoplastic lesion marked by a localized accumulation of monoclonal plasma cells without an evidence of a systemic proliferation. Plasmacytoma may arise in intramedullar (bone) or extramedullar (soft tissue). Extramedullary plasmacytoma is rare, with the most frequent locations in the nasal cavity and nasopharynx. Here, we describe a case of solitary extramedullary plasmacytoma of the shoulder region.

CASE REPORT: A 49-year-old male patient presented with right shoulder mass that was solid, fixed, ulcerated, and poorly circumscribed, with size 20 × 15 × 10 cm. Shoulder X-ray and MRI results revealed a soft-tissue mass on the right shoulder with the destruction of lateral part of the right clavicle. Biopsy results suggested Non-Hodgkin Lymphoma; however, first panel of immunohistochemical (IHC) analysis showed negative staining of LCA, CK, CD20, and CD3, with high Ki67. Second panel of IHC revealed negative staining of ALK, TdT, and CD79a; meanwhile, CD138 was strongly expressed. Further hematological, biochemical, and radiological examinations that revealed no systemic involvement supported the diagnosis of solitary extramedullary plasmacytoma. Patient received radiotherapy treatment 60 Gy in 30 fractions and zometa within 4 weeks interval and showed remarkable response of the therapy.

DISCUSSION: Solitary extramedullary (soft tissue) plasmacytomas (SEP) are less common than solitary bone plasmacytoma (SBP), yet it has a better prognosis since the majority can be cured by local radiotherapy.

CONCLUSION: We report a case of SEP of the shoulder that showed remarkable response of therapy. In this case report, radiotherapy was shown to be a highly effective modality to treat a patient with solitary extramedullary plasmacytoma.
Cortisol, Prolactin, and Breastmilk Volume; A Promising Pattern for Reducing Postpartum Depression
Authors: Syam Azniah , Qasim Muhammad , Iskandar Imelda , Kadir Arisna
Published: July 2022

BACKGROUND: Research shows postnatal depression and shorter breastfeeding are consistently related, but their causal effect remains debatable. To reduce the impact of mental disorders in the perinatal period, lactation may give a significant neuroendocrine effect.

AIM: This study aimed to examine hormonal patterns and estimated breastmilk volume of mothers with depression.

MATERIALS AND METHODS: This study was conducted during the three-trimester to 6-week postnatal period. It involved 60 pregnant women from South Sulawesi, Indonesia. Analysis of variance with repeated measures was used to compare and review fluctuations and effect sizes of cortisol, prolactin, and breastmilk volume of mothers with depression symptoms.

RESULTS: The mean cortisol levels rose in the 4th week and decreased in the 6th week in both groups. There was no substantial difference in the cortisol levels between these periods (p = 0.534; p = 0.553; and p = 0.660), but the prolactin levels continuously increased by 2 weeks and substantially progressed in the 4th and 6th weeks (p < 0.028, p < 0.009), respectively. There was no positive association between cortisol and prolactin levels (p = 0.384). The breastmilk volume was higher every week only in mothers without depression and it slightly decreased in other categories. This study emphasized the prolactin’s protective effect size on a stressful environment characterized by high cortisol; a significant rise in prolactin levels occurred in the 2nd and 4th weeks of postnatal, marking the higher lactation.

CONCLUSIONS: Breastfeeding hormones may provide protection against postpartum depression in moms. It is critical to establish a history of prior trauma in nursing mothers in order to facilitate diagnosis and proper care.
Factors of Dental Caries, Tooth Mobility, and Periodontal Pockets on the Occupation of Tooth Loss in the Elderly. (A Study in Karikil Village, Mangkubumi District, Tasikmalaya City)
Authors: Sopianah Yayah , Murdiastuti Kwartarini , Amalia Rosa , Taftazani Rieza Zulfahmi , Lestari Ayu Rahayu
Published: July 2022

BACKGROUND: Loss of teeth can disrupt daily activities such as chewing disorders, causing emotional problems, and loss of self-confidence. Tooth loss in the elderly is usually caused by dental caries and periodontal disease which are influenced by several other factors.

AIM: This study aims to obtain a mathematical equation for predicting tooth loss in the elderly based on dental caries, tooth mobility, and periodontal pockets which have been shown to have an effect.

MATERIALS AND METHODS: This research is a survey research with a cross-sectional design. The research subjects were 210 elderly people from Karikil Village, Mangkubumi District, Tasikmalaya City, sampling using the purposive sampling technique affected tooth loss, while the effects were dental caries, tooth mobility, and periodontal pockets. Tooth loss, dental caries, mobility of teeth, and periodontal pockets were measured using the fill-in format from the World Health Organization. Data analysis used the Chi-square correlation test and multiple logistic regression.

RESULTS: The results of the Chi-square test analysis showed that the variables of dental caries and tooth mobility had a very significant effect on tooth mobility (p = 0.000 and 0.007). The pocket periodontal variable did not show a significant relationship to tooth mobility (p = 0.947). The results of the multiple logistic regression analysis of dental caries and tooth mobility together contributed 12.2% (R2 = 0.122) to tooth mobility in the elderly. Dental caries gave the greatest contribution to tooth loss, namely, 87.6%.

CONCLUSION: Dental caries gives the greatest contribution compared to tooth mobility and periodontal pockets to the occurrence of tooth loss in the elderly. In the elderly, the higher the level of dental caries and tooth mobility, the higher the risk of tooth loss.
Accueillir, évaluer et orienter les familles des jeunes adolescents au Relais étudiants-lycéens… de la clinique médico-pédagogique Dupré
Authors: Brault Anthony , Villette Marie , Mora-Oger Agnès , Dumas Nadège
Published: July 2022

Le Relais de Sceaux (clinique Dupré, Fondation santé des étudiants de France), qui reçoit des adolescents et jeunes adultes et leurs familles, est une porte d’entrée aux soins médico-psychologiques. À partir de 2013, l’ouverture de l’accueil aux 11-15 ans a bouleversé le fonctionnement de départ du Relais. À côté du dispositif d’accueil sans rendez-vous des 16-25 ans, un protocole spécifique adapté aux collégiens a été mis en place. Il s’appuie sur un contact téléphonique avec les parents préparant la première rencontre. Via une situation clinique, les auteurs, psychologues et psychiatres exerçant au Relais de Sceaux, exposent les spécificités cliniques de collégiens pour lesquels la rencontre familiale est un préalable indispensable à l’instauration d’un soin psychique individualisé.
Évolution et professionnalisation de l’activité des conseillers en formation continue
Authors: Kempff Françoise
Published: July 2022

L’Éducation nationale a créé, en 1973, les animateurs de formation continue pour développer la formation des adultes en réponse à la loi de 1971. Cinquante ans plus tard, les animateurs devenus conseillers en formation continue n’exercent plus tout à fait la même activité. Si la plupart des intentions initiales perdurent, il n’en demeure pas moins que l’exercice professionnel et les modalités de formation se sont transformés, agrandissant le champ des compétences exercées dans le but de répondre aux évolutions contextuelles du marché de la formation professionnelle.
L’autoconfrontation dans la professionnalisation des conseillers en évolution professionnelle
Authors: Boanca Ioana , Pagoni Maria
Published: July 2022

Cet article, issu d’une recherche menée en région des Hauts de France, porte sur les dynamiques de professionnalisation suscitées par le dispositif « conseil en évolution professionnelle ». Après avoir interrogé les enjeux de la formation institutionnelle sur les pratiques d’accompagnement, l’article se centre sur l’analyse de l’activité de conseil via des entretiens d’autoconfrontation. Les résultats mettent en évidence des formes de régulations de l’activité opérées par les conseillers en situation d’autoconfrontation et les effets potentiels sur leur changement de posture, sur leur professionnalisation.
Les actions de groupe et le droit international privé : une lame de fond ?
Authors: Muir Watt Horatia
Published: July 2022

De nouveaux sujets de droit – composites, métaphoriques, mélangeant le public et le privé, protecteurs d’intérêts collectifs, et bien sûr toujours fictionnels – émergent dans notre paysage juridique. Le canal qui donne à voir ces changements en profondeur est la capacité à ester en justice d’entités inconnues, étrangères ou transplantées d’ailleurs.
Nursing Students' Perceptions of a Community Health Street Outreach Experience: Thematic Analysis
Authors: Snyder Briana L. , Doran Kelly , Doede Megan
Published: July 2022

Background:

There has been increased focus within nursing to address social determinants of health (SDOH), and nurse educators are urged to integrate SDOH into the curriculum, strengthen community and public health (CPH) clinical experiences, and provide service-learning opportunities. Therefore, student feedback was sought for a CPH clinical experience involving street outreach.

Method:

Two groups of nursing students conducted street outreach with unstably housed individuals in an urban area in the eastern United States. Focus groups and thematic analysis were conducted.

Results:

Students expressed high levels of satisfaction with the experience. The following themes were identified: Influence of Prior Experiences, Transformational Experience, and Making a Difference. Following the CPH experience, the majority of students reported they were considering working in CPH nursing.

Conclusion:

Engaging in street outreach and similar experiences has the potential to improve nursing students' perceptions of CPH clinical experiences and prepare them for careers in CPH nursing.[J Nurs Educ. 2022;61(7):394–397.]
$ \acute{C} $iri$ \acute{c} $-Reich-Rus type weakly contractive mappings and related fixed point results in modular-like spaces with application
Authors: Lael Fatemeh , Saleem Naeem , Hüseyin Işık , de la Sen Manuel
Published: July 2022

In this article, we define a new space named the modular-like space with its related concepts to prove the existence of a fixed point and a point of coincidence for mappings on this space. Also, we defined $ \acute{C} $iri$ \acute{c} $-Reich-Rus type weakly contractive mappings on modular-like spaces and discussed some conditions that guarantee the existence of the fixed points for these kind of mappings. Some examples are also provided to elaborate the usability of our main results. It is worth mentioning that a modular-like space is a generalization of a modular space, thus our theorems are more general and applicable than the fixed point theorems on modular spaces.
Du vin en Bretagne dès le premier âge du Fer ? Fabrication et consommation locales
Authors: Cherel Anne-Françoise , Frère Dominique
Published: July 2022

Les analyses chimiques de contenus organiques permettent, à partir de biomarqueurs du raisin et de biomarqueurs de fermentation, d’identifier la présence de vin (ou de son dérivé le vinaigre) à l’intérieur de différentes catégories de céramiques armoricaines de l’âge du Fer. La question essentielle est celle de la provenance de ce vin, en sachant que les premières amphores vinaires n’arrivent en Bretagne qu’au IIe siècle av. n. è. S’agit-il d’un vin méditerranéen importé dans des contenants périssables ou d’un vin produit localement ? Si l’hypothèse de vin produit en Bretagne protohistorique paraît, au premier abord, incongrue eu égard aux sources littéraires antiques et aux conditions climatiques de la péninsule, différents éléments permettent, voire exigent, de lancer le débat. D’une part ont existé, au moins dès le Moyen Âge, des vignobles exploités en différents endroits de la Bretagne et d’autre part, pour l’époque protohistorique, la présence de vigne sauvage est solidement attestée par les données archéobotaniques. Les boissons fermentées produites durant l’âge du Fer en Europe tempérée ne se limitaient sans doute pas à la bière et à l’hydromel. L’absence de viticulture et de viniculture n’interdisait pas l’utilisation ponctuelle et opportuniste des baies de vigne sauvage.
Le vin dans les pratiques funéraires. Enquête pluridisciplinaire sur des ensembles de la Celtique méditerranéenne
Authors: Séjalon Pierre , Bel Valérie , Garnier Nicolas
Published: July 2022

Le vin est souvent impliqué dans les rituels gaulois lors des funérailles, du fait de la présence, dans les tombes, de dépôts de vases à boire, d’amphores ou d’objets liés à sa consommation. Plusieurs étapes et gestes accompagnent le défunt sur le bûcher jusqu’à la tombe. Nous avons voulu documenter de manière tangible ces différents moments en utilisant les analyses de chimie organique. Ainsi, il a pu être mis en évidence par une stratégie de prélèvements une part invisible dans les modes de dépôts des vases et des objets. Les libations sur les bûchers, sur les vases fermant les ossuaires, apparaissent nettement. D’autres indices, difficiles à interpréter, suggèrent d’autres pratiques rituelles.
Aqua vitae et aqua ardens. Production et consommation des produits distillés de boissons fermentées (XIIe-XVIIe siècle)
Authors: Thomas Nicolas
Published: July 2022

La distillation de boissons fermentées est attestée dès le XIIe siècle en Occident. Elle est fondée sur des températures d’ébullition différentes entre l’eau et l’éthanol. Les techniques et les alambics se perfectionnent au XIIIe siècle avec la rectification et l’apparition de nouveaux systèmes de refroidissement et de condensation des vapeurs. La concentration en alcool augmente rapidement conduisant à l’apparition d’un liquide étonnant : une eau qui brûle. L’archéologie comme les sources écrites permettent de caractériser les alambics et leur diffusion dans des milieux privilégiés. Sans doute ces appareils sont-ils surtout employés pour la fabrication de l’eau de rose, produit très répandu au Moyen Âge, mais celle de l’alcool est parfois explicite. Quoi qu’il en soit, les alambics découverts en fouille donnent une idée des capacités de production très modestes. L’alcool est d’abord utilisé à des fins médicales. Très tôt, la propriété de ce produit de conserver les corps a été remarquée et de nombreuses vertus lui ont été attribuées comme celle de soigner toutes sortes de maladies. Il faut attendre la fin du XVe siècle pour que l’alcool se démocratise. La consommation de masse passe par des innovations techniques comme la multiplication des alambics dans un même four ou un accroissement spectaculaire des dimensions des cuves. Les produits de la distillation se banalisent et deviennent alors très populaires. Malgré les méfaits évidents liés à une surconsommation, le discours sur les bienfaits de l’alcool est toujours resté très ambigu.
The Age of Pious Erudition: Kircher’s Critics in Context
Authors: Stolzenberg Daniel
Published: July 2022

This essay argues that Kircher and his critics can best be understood in the context of a distinct epoch, “the age of pious erudition”, defined by the alliance of historical criticism and sacred history. It began at the turn of the seventeenth century when Joseph Scaliger and Isaac Casaubon applied the historicizing methods of classical philology to the study of ancient Judaism and the early Church, and it gave way a century later, when historical criticism belatedly revealed itself as a threat rather than a boon to Christian apologetics. Eventually, pious erudition brought about its own demise, but that was a cumulative process that unfolded over a century, rather than a dramatic rupture.
Lever les « mystères sublimes » des hiéroglyphes égyptiens : William Warburton et la réfutation du système kirchérien
Authors: Bourdely Sarah Diane
Published: July 2022

La réfutation de Kircher dans l’Essai sur les hiéroglyphes des Égyptiens de William Warburton a connu une large réception en France, ayant notamment influencé Condillac et servi de référence à l’Encyclopédie, spécialement dans les articles consacrés au langage, à la figure ou à l’énigme. Cet article étudie la façon dont Warburton surpasse les travaux de ses prédécesseurs et entretient un rapport complexe avec les travaux égyptologiques de Kircher. Si Warburton juge, comme la plupart de ses contemporains, la méthode de Kircher peu scientifique, le Theatrum Hieroglyphicum et la China Illustrata lui servent néanmoins de sources précieuses, la plupart des gravures de l’Essai étant issues de ces deux ouvrages dont il reconnaît ainsi la valeur documentaire.
Guselkumab for the treatment of severe plaque psoriasis in a schizophrenia patient
Authors: Bernardini Nicoletta , Skroza Nevena , Prevete Elisabeth , Marraffa Federica , Proietti Ilaria , Tolino Ersilia , Mambrin Alessandra , Rossi Giovanni , Volpe Salvatore , Bersani Giuseppe , Potenza Concetta
Published: July 2022

A wide range of comorbid conditions are associated with psoriasis, many studies have drawn attention to a higher prevalence of psychiatric comorbidities in psoriatic population. Herein, we present a case of a Caucasian 44-years-old man suffering from a severe schizophrenia, who received guselkumab (a human monoclonal antibody targeting the p40 subunit of IL-23) for the treatment of a moderate-to-severe plaque type psoriasis. After 3 months, the patient reached complete resolution of psoriasis without any side effects, maintained at 6 months follow up visit. Some studies have highlighted the hypothesis that an hyperactivation of immune response appears to be one of the main mechanisms underlying the increased risk of this association. In particular, the axis il-17/il-23 plays a central role in the pathogenesis of this disease. Further research will be needed to assess whether anti-IL23 drugs could be a more suitable therapeutic option in psoriatic patients with schizophrenia.
Possible relationship between poor skin disorders prognosis and serum zinc level: A narrative review
Authors: Abadie Mohammed , Sharara Zinah , Abadie Miriam , Ball Patrick , Morrissey Hana
Published: July 2022

Zinc is a trace nutrient essential for the normal growth and development of human body. The main aim was to evaluate the significant association between measured zinc status in relation to different skin disorders and their severity. PubMed®, Google® Scholar™ and Cochrane© Reviews databases were searched for studies from January 2017 to June 2021, using the terms; zinc serum levels, zinc plasma levels and different dermatosis in the review, only human studies in English language were reviewed and the studies designs were controlled, cross sectional, observational and analytic types. A total of forty-eight research studies were included in this review. All studies have evaluated serum zinc in skin diseases including psoriasis, atopic dermatitis, pityriasis alba, androgenetic alopecia areata, telogen effluvium, vitiligo, melasma, acne, seborrheic dermatitis and hidradenitis suppuritiva. It was found that 33 studies had validated statistically significant differences in serum zinc levels between patients and controls. There is a predominance of low serum zinc levels in all the dermatoses reviewed. The clinical significance of this finding highlights the possible value, and need to investigate, the use of Zinc supplementation as an adjuvant therapy in the management of chronic inflammatory and autoimmune skin diseases proven to manifest altered zinc levels.
A case of sweat-gland carcinoma with neuroendocrine differentiation (SCAND)
Authors: Koizumi Shigeru , Togawa Yaei , Takashi Inozume , Nakano Michiyo
Published: July 2022

A 73-year-old Japanese male patient presented to our hospital with a red nodule arising from the lower abdomen to the base of the penis. After the biopsy, the tumor was diagnosed as sweat gland carcinoma with neuroendocrine differentiation (SCAND) with bilateral inguinal lymph node metastasis. SCAND is newly proposed entity and very rare disease in 2022. Although SCAND often showed stromal mucin deposition, a tumor mass floating in abundant mucus, which was never reported before in SCAND, was observed histopathologically in our case. Primary cutaneous mucinous carcinoma (PCMC) with neuroendocrine differentiation was considered as a differential diagnosis. However, the feature only occupied a small portion of the tumor (<10%), and PCMC predominantly originated in the head and neck region. Therefore, we considered PCMC could be ruled out. Consequently, while SACND and PCMC sometimes share histologic similarities, their differentiation is important because PCMC rarely metastasizes while SCAND often does.
Prostate Cancer Characteristics
Authors: Ugwumba Fredrick O. , Nnabugwu Ikenna I.
Published: July 2022

Background:

Prostate cancer, previously reported as relatively rare in Nigeria, is currently the leading cancer and leading cause of cancer-related death in men. Late presentation appears to persist despite higher incidence rates and instituted awareness programs. This study assesses current prostate cancer indices at presentation to a 3rd tier referral hospital in South-east Nigeria and compares these indices with reported indices from previous decades.

Materials and Methods:

Retrospectively, the medical records of men presenting with histologically confirmed prostate cancer from January 2009 to April 2018 were reviewed. Age, spectrum and duration of clinical features, serum total prostate-specific antigen (tPSA), and prostate biopsy specimen Gleason Score (GS) at presentation were retrieved for the analysis using the SPSS software version 21. Obtained mean values and proportions were compared to reports from previous decades for observable shifts.

Results:

The medical records of 331 men 51–90 years of age (mean: 69.8 ± 8.0 years) were retrieved. Six (1.8%) men (median tPSA = 28.0 ng/ml; range 10.0–121.4 ng/ml) had screening-detected prostate cancer. About 72.0%, 52.0%, and 30.3% of men present with symptoms after 3 months, 6 months, and 12 months, respectively, and about 55.1% had other clinical features of disease progression beyond lower urinary tract symptoms. Symptom duration, serum tPSA (median 31.4 ng/ml; range 4.0–710.0 ng/ml), and % fPSA (median 20.6%; range 57.1%–8.6%) at presentation, as well as prevalent poorly-differentiated tumor (GS ≥7 [4 + 3] 62.2%) are yet to shift from reports from previous decades.

Conclusions:

Prostate cancer indices at presentation in South-eastern Nigeria, a resource-poor community in sub-Saharan Africa are yet to positively shift despite efforts at prostate cancer awareness.
Primary Hyperparathyroidism
Authors: Salhi Houda , Bouziane Toumader , Maaroufi Mustapha , Alaoui Nadia Ismaili , El Ouahabi Hanan
Published: July 2022

Introduction:

The standard gold treatment of primary hyperparathyroidism (PHP) is parathyroidectomy. Imaging in particular, cervical ultrasound (US) and technetium-99 m- méthoxyisobutylisonitrileparathyroid scintigraphy using the single-photon emission computed tomography (TC-99 m-MIBI-SPECT) are always indicated prior to parathyroid surgery, allowing the location of parathyroid adenomas. The objective of our study is to evaluate the contribution of TC-99 m-MIBI-SPECT and US in the preoperative topographic diagnosis of PHP.

Materials and Methods:

this is a descriptive and analytical retrospective study, conducted in our department of Endocrinology, Diabetology and Metabolic Diseases in Hassan II University Hospital of Fez between 2009 and 2018. All patients who received a para-thyroidectomy for PHP were recruited. All patients had received a cervical US and a TC-99 m-MIBI-SPECT. We compared imaging data before surgery with data from intraoperative exploration and anatomopathological findings of surgical samples.

Results:

Forty-eight patients were collected. US correctly identified parathyroid adenoma in 85.40% of patients with PHP versus 89.50% in TC-99 m-MIBI-SPECT. US correctly predicted surgical outecomes in 97.60% of patients and TC-99 m-MIBI-SPECT in 97.72% of cases. Their combination had better results in sensitivity and positive predictive value.

Conclusion:

TC-99 m-MIBI-parathyroid scintigraphy SPECT had a higher probability for solitary parathyroid adenoma compared to cervical US. Its use coupled with the TC-99 m-MIBI-parathyroid scintigraphy SPECT allows reliable preoperative tracking.
Prophylactic Use of Hydroxychloroquine (HCQS) in COVID-19
Authors: Rangari Gaurav Manikrao , Sharma Sushil , Bhaisare Roza Gorakhnath , Madhavrao C. , Misra Arup Kumar
Published: July 2022

Background:

Coronavirus disease-2019 (COVID-19) pandemic has engulfed the whole world with millions getting infected and losing their lives. Health care professionals (HCPs) who are in the front line of fighting with COVID-19 are particularly vulnerable and it is crucial to protect them from COVID-19. In this regard, the Indian Council of Medical Research (ICMR) has recommended hydroxychloroquine (HCQS) chemoprophylaxis in HCPs. However, considering the lack of sufficient evidence the HCP are in a dilemma about this aspect. Moreover, there is a paucity of data on use of HCQS as a chemoprophylaxis among Indian HCP. Hence, this study was carried out to study the extent of use and also the perception of Indian HCP toward use of HCQS as a chemoprophylaxis for COVID-19.

Materials and Methods:

This was a cross-sectional study done on 205 HCPs working across India. The responses were collected electronically using a prevalidated semi-structured questionnaire.

Results:

62.9% (129/205) respondents reported having taken HCQS chemo-prophylaxis for COVID-19 while 34.7% (76/205) did not take it. Among HCP, who did not take the prophylaxis, the main reasons cited were concern about adverse effects (61.5%) and lack of robust evidence (24%). Only 14% of respondents felt that there was sufficient evidence to justify use of HCQS for prophylaxis while an overwhelming majority (86%) felt otherwise or were uncertain.

Conclusion:

The majority of participants felt that despite a lack of proven efficacy, ICMR guidelines on HCQS prophylaxis in COVID-19 are justified considering the pandemic situation. Our study also found that HCQS is well tolerated by participants and there was no reported serious adverse effect and cardiac-related side effects among them.
WhatsApp-Based Virtual Consultation in Clinical Practice during COVID Times
Authors: Panchangam Ramakanth Bhargav , Puthenveetil Pradeep , Kota Sunil Kumar , Mayilvaganan Sabaretnam
Published: July 2022

Background:

As the novel coronavirus disease 2019 (COVID-19) continues its pandemic surge globally, the attention toward the treatment of non-COVID diseases has become difficult. Software-based systems and social media platforms could provide alternatives for ensuring regular health-care non-COVID diseases. In this context, we evaluated our own experience with virtual consultation (VC) for the management of endocrine surgical patients during the current COVID pandemic.

Materials and Methods:

This prospective study was conducted in the endocrine surgery department spanning 4 months from April to July 2020. We employed WhatsApp-based group video conferencing for VC with both new and follow-up outpatients. We evaluated the satisfaction quotient of patients, regarding the three types of consultations (no consultation, VC, and direct consultation) on an ordinal scale of three modes of consultation.

Results:

Virtual consultation was performed with 102 new and 285 follow-up patients. Goiters, clinical findings, and wounds/scars (in post-operative cases) were evaluated virtually. Dosage of thyroxine replacement, calcium supplementation, and other medications was prescribed based on findings and history. Patients who needed surgery (25/102 cases) were given appropriate appointment. More than 82% of the patients in both groups preferred VC during this COVID pandemic.

Conclusions:

More than 82% of both new and follow-up patients preferred VC over direct or no consultation during this COVID pandemic. Our findings suggest that VC through social media platforms is capable of ensuring appropriate treatment and follow-up for endocrine diseases.
Ovarian Cell Tumor in a Child with Neurofibromatosis Type 1
Authors: Qutub Lujain Majdi , Al-Agha Abdulmoein Eid
Published: July 2022

Juvenile granulosa cell ovarian tumor is a rare cause ofpseudo-precociouspuberty. We report a case of a 6-year-old female with neurofibromatosis type 1 (NF1), associated with pseudo-precocious puberty (PPP). A thorough workup revealed a large multi-cystic right ovarian mass, which turned out to be a juvenile granulosa cell tumor (JGCT). This report documented a rare case of PPP caused by JGCT in a child with NF1. Verbal consent was taken from the family.
Enhancing the Quality of Neonatal Care by Improving Mothers' Knowledge, Attitude, and Practice through Checklist Intervention
Authors: Arunakumar Sanmithra Patavardhan Koppa , Ramabhatta Sujatha , Lakshmipathy S. R. , Raghunandan B. G. , Rashmi K. , Kumaraswamy Dudala , Mol P. Priya , Anushree C.
Published: July 2022

Objectives:

The objective of this study is to improve the newborn and self-care practices among postnatal mothers through quality improvement techniques and to create awareness about newborn and perinatal care practices in the Mother and Child Protection (MCP) Card.

Materials and Methods:

The barriers to low newborn and self-care practices were identified and evaluated using fishbone analysis. An operational team was formed, and a checklist was created. A total of four Plan-Do-Study-Act (PDSA) cycles were carried out. Baseline knowledge was collected using the questionnaire from the checklist. Appropriate education and counseling regarding newborns and self-care practices were taught. A variety of measures were used during counseling. The educated mothers were recalled after 5–7 days to assess their knowledge.

Results:

A total of 102 postnatal mothers were enrolled in the study, and 78 were available for follow-up after 5–7 days. During all study cycles, median checklist scores increased from 38 to 57 (PDSA 1), 37 to 58 (PDSA 2), 37 to 57 (PDSA 3), and 32.5 to 56 (PDSA 4). The increase in median checklist scores in all the PDSA cycles was statistically significant (P < 0.05). The median difference in checklist score from baseline in the chronological order of PDSA cycles was 19, 21.5, 22, and 23. After educating the mothers about the MCP Card, the percentage of mothers who read the information in the MCP Card increased from <5% to 38%.

Conclusion:

Quality Improvement principles such as the introduction of a checklist can be successfully implemented to improve the quality of newborns and self-care practices among postnatal mothers.
Self-Regressing Scalp Arteriovenous Malformation in a Neonate
Authors: Malwade Sudhir , Nayak Manas , Gangadharan Anand , Agarkhedkar Sharad
Published: July 2022

Congenital AV malformations of scalp are rare congenital vascular malformations and often misdiagnosed as hemangiomas. Only 3 cases of neonatal scalp AVM have been reported till date. We report a rare case of self regressing scalp AV malformation in a neonate. An hour old full term female baby, presented with a soft, pulsatile large lesion (5cm x 4cm) with elevated borders and crusting over left parieto-occipital area, with bruit on auscultation. The infant had a soft cardiac murmur. USG cranium was likely suggestive of AV malformation or cephalhematoma. MR brain venography showed extra-calvarial network of multiple dilated tortuous veins draining into the left transverse sinus, sigmoid sinus and IJV. CT brain with CT carotid angiography revealed multiple arterial feeders from the left ECA and its branches, middle meningeal artery and left vertebral artery with multiple venous channels seen draining into the left transverse sinus, sigmoid sinus, IJV and EJV, the possibilities were arteriovenous malformation and less likely infantile hemangioma. Echocardiography showed small midmuscular VSD. Endovascular embolization was planned but didn't do immediately as the baby didn't show any signs of cardiac failure. The baby is on regular follow up and is growing well, with the lesion being regressing on its own. The baby doesn't have any signs of cardiac failure till now, hence only supportive care is being given. Early detection and comprehensive management of AVM result in a positive outcome. Embolization is only recommended if benefit outweighs the risk.
Difference in the Nucleated Red Blood Cell Counts among Donor and Receipt Twins Affected by Twin[FIGURE DASH]Twin Transfusion Syndrome
Authors: Manzar Shabih
Published: July 2022

A high nucleated red blood cell (NRBC) count at birth is taken as a biomarker of fetal hypoxia. In twin-to-twin transfusion syndrome (TTTS), the communication of placental vessels between the donor and recipient twin creates an imbalance of blood flow resulting in anemia in the donor and polycythemia in the recipient. The anemia in donors results in hypoxia. The NRBC count could be used as a biomarker of chronic hypoxia in donor twins. A literature search shows no previous report on the NRBC count at birth comparing donor and recipient twins in TTTS. We present a case of TTTS with a discussion on the pathophysiology of elevated NRBC at birth in donor twins.
Post-operative outcomes of intra-operative restrictive and conventional fluid management in laparoscopic colorectal cancer surgery
Authors: Erdogan-Ongel Elif , Coskun Nilufer , Meric Ayse Hilal , Goksoy Beslen , Bakan Nurten
Published: July 2022

Context:

Intra-operative fluid management has been shown to significantly alter a patient’s clinical condition in peri-operative care. Studies in the literature that investigated the effects of different amounts of intra-operative fluids on outcomes reported conflicting results.

Aims:

To compare the post-operative results of intra-operative restrictive and conventional fluid administrations in laparoscopic colorectal cancer surgery.

Settings and Design:

All patients with ASA I, II and III, and those who had undergone laparoscopic colorectal cancer surgery were included. It was a retrospective, cohort study.

Subjects and Methods:

A review of laparoscopic colorectal cancer surgeries performed by the same fellow-trained colorectal surgeon with different anaesthesiologists between 1 January, 2018 and 30 November, 2021.

Results:

In total 80 patients were analysed; 2 patients were excluded, 28 patients were in restrictive (Group R) and 50 patients were in the conventional (Group C) group. The median age of all patients was 63 years and 74% were male. The median (interquartile ranges 25 to 75) intra-operative fluid administration was significantly different between groups; 3 ml/kg/h in Group R, and 7.2 ml/kg/h in Group C. (P < 0.001) Patients in Group C had significantly high post-operative intensive care unit admission (P < 0.05), and hospital length of stay (P = 0.005) compared to Group R.

Conclusions:

Intra-operative fluid management was significantly associated with post-operative hospital length of stay and intensive care unit admission. Excessive intra-operative fluid management should be avoided in daily practice to improve the outcomes of laparoscopic colorectal cancer surgery.
Transabdominal preperitoneal repair for a recurrent inguinal hernia after Kugel procedure using the medial umbilical ligament
Authors: Wang Congfei , Lin Ronggui , Lin Xianchao , Lu Fengchun , Chen Yanchang , Huang Heguang
Published: July 2022

The Kugel procedure resulted in extensive adhesion in the preperitoneal space. Performing a transabdominal preperitoneal repair (TAPP) for recurrent hernia after Kugel procedure is extremely difficult. In this case report, we present the case of a 81-year-old male who presented with recurrent inguinal hernia after Kugel procedure 8 years ago. Transabdominal laparoscopy was performed first. Indirect hernia formed inferior to the lateral edge of the previous mesh was diagnosed under laparoscopy. The patient's medial umbilical ligament (MUL) was big enough and could be completely released by separating the Retzius space. Finally, TAPP was successfully performed by using the MUL to create and close the preperitoneal space. No perioperative complications or hernia recurrence was observed 1 year after the surgery. Using the MUL to deal with preperitoneal problems was practical and feasible.
Missing the main actor: Intra-operative diagnosis of agenesis of the gallbladder - When late is not ‘too’ late
Authors: Portale Giuseppe , Mazzeo Antonio , Cipollari Chiara , Isoardi Roberto , Spolverato Y , Zuin Matteo , Fiscon Valentino
Published: July 2022

Agenesis of the gallbladder (AGB) without extrahepatic biliary atresia is a rare congenital disease. Ultrasound (US) examination can be misleading and reveal a contracted shrunken gallbladder when there is not any and the patient in most cases is taken to the OR for a standard cholecystectomy. We describe the case of a 54-year-old female with colicky right upper abdominal pain with nausea. US revealed a contracted scleroatrophic gallbladder and the patient was listed for laparoscopic cholecystectomy. At laparoscopy, despite careful search, the gallbladder was never visualised, and the suspicion of AGB was raised. An intra-operative cholangiography confirmed the hypothesis. The post-operative recovery was uneventful, and abdominal computed tomography scan failed to show the presence of gallbladder, therefore confirming the diagnosis of AGB. Lack of awareness of this condition among radiologists and surgeons is the main reason for unnecessary operations and potentially damages to the biliary tract.
A newer method of seroma reduction by fenestration of pseudo-sac during laparoscopic repair of direct inguinal hernia: A randomised, controlled pilot study
Authors: Lodha Mahendra , Meena Satya Prakash , Parihar Yash K. , Badkur Mayank , Puranik Ashok K. , Kompally Prathyusha V.
Published: July 2022

Background:

Minimally invasive surgeries for inguinal hernia repair have been reduced post-operative morbidity. However, certain complications such as seroma formation are unavoidable. In this study, we introduce a newer technique of reducing seroma formation by fenestration of the pseudo-sac (thickened transversalis fascia) in patients undergoing laparoscopic hernia repair for uncomplicated direct inguinal hernia.

Patients and Methods:

A randomised, controlled pilot study was conducted from January 2019 to December 2020 for the patients undergoing laparoscopic hernia repair for uncomplicated direct inguinal hernia. Study participants were randomised into interventional group and control groups. Demographics, operative duration and complications including post-operative pain and seroma on days 1, 10 and 30 were analysed between both the groups.

Results:

A total of 20 cases with 30 hernias were included in the study. Demographic data were comparable between the two groups. The intervention group showed a statistically significant decrease in the incidence of seroma formation on the post-operative day 10 (13.3% vs. 46.6%, P = 0.046). The mean volume of seroma on day 10 was also less compared to the non-fenestration group (2.5 vs. 6.58 ml, P = 0.048). After the 30th day, no patient had a presence of seroma. There were no statistically significant differences in terms of mean operative duration, post-operative pain and other complications.

Conclusion:

Fenestration of pseudo-sac in laparoscopic hernia repair for uncomplicated direct inguinal hernia is a simple and effective technique. It has reduced the incidence and volume of seroma formation without any increased risk of infection, acute or chronic pain and recurrence.
Maternal and neonatal characteristics, operative details and outcomes in COVID-19 positive parturients undergoing cesarean sections: A retrospective observational study
Authors: Venkateswaran V. , Parida R. , Khanna P. , Bhoi D. , Singh A.K. , Mathur P. , Sahoo D. , Dass C. , Gupta A. , Aravindan A. , Trikha A.
Published: July 2022

Background and Aims:

There is a marked inclination towards cesarean sections as the preferred mode of delivery in parturients with COVID-19 disease. However, the challenges associated with planning and performing a surgery in the COVID-19 setup are considerable. These factors may lead to widespread changes in obstetric decision-making, operative planning, and perioperative outcomes. Thus, our study aimed to study the clinical and logistical factors involved in cesarean sections in COVID-19 parturients.

Material and Methods:

This was a retrospective observational study performed at a dedicated COVID-19 tertiary care center in India. All women undergoing cesarean section in the specially earmarked operating room between 1st May 2020 and 31st December 2020 were included in the study. The clinical characteristics, operative details, and neonatal details, along with maternal and fetal outcomes were noted and analyzed.

Results:

A total of 44 women underwent cesarean section during the study period, with elective and emergency surgeries numbering 22 each. No indication, apart from COVID-19 status, was listed in over one-fourth of the women (13/44). The most common preoperative comorbidity was hypothyroidism (12/44). Median surgical duration was 117.5 min (IQR 100-133), with a median of 7.5 (IQR 6-8.25) healthcare personnel in the OT. Over one-fourth (12/44) of the delivered babies had low birth weight, while 4.5% (2/44) tested positive for SARS-CoV-2.

Conclusion:

COVID-19 status alone continues to be a common indication for cesarean section. Operative time is increased, but the number of healthcare personnel involved can be trimmed with proper planning. Maternal and fetal outcomes are largely positive, with low transmission rates, but a considerable proportion of low-birth-weight neonates.
Aerosol-generating procedures, how best did anesthesiologists use available personal protective equipment during early COVID-19 pandemic in a tertiary care center of southern India? A prospective cross-sectional study
Authors: Suda Naveen K. , Smithamol PB , Toms Ann S. , Meera GK , Rebekah Grace J. , Trinaya S , Mohammed A Haroon , Sahajanandan Raj , Rai Ekta
Published: July 2022

Background and Aims:

Anesthesiologists are involved in high-risk procedures for transmission of SARS-CoV-2 like aerosol-generating procedures (AGPs). The present study was conducted to assess the compliance toward the use of personal protective equipment (PPE) and proposed modifications in anesthesia techniques to prevent dissemination of the virus among healthcare workers.

Material and Methods:

This prospective cross-sectional study was conducted during the first wave of the COVID-19 pandemic and included all elective surgeries involving AGPs inside operation theatres and remote areas. Participants were anesthesia consultants and trainees. Trained anesthesia technicians observed and documented all the AGPs and data entry with analysis was done using EPI Data 3.1, SPSS 21.0. Descriptive statistics were reported using mean ± SD for continuous variables.

Results:

Preoperative COVID-19 test was done in 96.3% of patients. Most (74.8%) of the AGPs were performed by consultants. In our study, compliance for N95 masks usage and hand hygiene was found to be 99.2% and 55.9%, respectively. Avoidance of crowding was followed in only 38.9% during intubation. To contain the aerosol-based spread of virus, modification of anesthesia practices like acrylic boxes (6.4%), plastic sheets (5.5%), video laryngoscopy (39%), rapid sequence intubation (RSI) (42.7%), and 59.3% of deep extubation were incorporated.

Conclusion:

In our study, we found satisfactory compliance toward usage of N95 masks alone, whereas compliance toward other available PPE and modification in anesthesia practice was found to be unsatisfactory.
Development of an institutional protocol for percutaneous dilatational tracheostomy in critically ill COVID-19 patients: Initial experience
Authors: Damarla Haritha , Pangasa Neha , Hirolli Divya , Jha Parthadeep , Garg Heena , Khan Tazeen , Soni Lipika , Maitra Souvik , Anand Rahul K. , Ray Bikash R. , Baidya Dalim K.
Published: July 2022

Background and Aims:

Percutaneous dilatational tracheostomy (PDT) may improve the outcome in critically ill COVID-19 patients on mechanical ventilation. However, the timing of performing tracheostomy may be controversial, and it is an aerosol-generating procedure with a potential risk of viral exposure to healthcare workers.

Material and Methods:

An operational protocol for performing PDT was made and subsequently followed in a designated COVID-19 ICU. Critically ill adult patients on mechanical ventilators who underwent PDT were included in this retrospective cohort study. Case files were retrospectively reviewed and patient characteristics, clinical outcome, and procedure-related details were noted.

Results:

Forty-one patients were included in the analysis. The median age was 49 (39–67) years, and 41.5% of patients were females. The median duration of mechanical ventilation before tracheostomy was 10 (8–16) days, and the median (IQR) PaO2/FiO2 ratio on the day of PDT was 155 (125–180) mm Hg. Further, 48.8% of patients had transient desaturation to SpO2 <90%, and 41.5% survived to ICU discharge. None of the health care providers involved in PDT developed any symptoms of COVID 19.

Conclusion:

This descriptive study demonstrates the feasibility, implementation, and apparent safety of the PDT protocol developed at our institution.
Nationwide impact of COVID-19 pandemic on postgraduate medical teaching, research, and mental stress: A cross-sectional online questionnaire-based survey
Authors: Gupta Anju , Haritha Damarla , Ramachandran Rashmi , Subramaniam Rajeshwari , Sai Gudela Mohan , Chikoti Geetanjali , Gupta Nishkarsh , Malhotra Rajeev Kumar , Kaloiya G. S. , Trikha Anjan
Published: July 2022

Background and Aims:

Coronavirus disease-2019 (COVID-19) pandemic has affected postgraduate medical education, training, and ongoing research work across specialties. Our survey aimed to analyze the effect of COVID-19 on challenges in pursuing research and academics and ascertain the stressors on residents across medical specialties.

Material and Methods:

The questionnaire was validated by 10 experts and following ethical approval, this google form-based survey was circulated to postgraduates across specialties across the country through social media platforms over 1 month (22 August 2020 to 21 September 2020). On clicking the link, the participants received brief information regarding the survey followed by the questionnaire. Weekly reminders were sent to the nonresponders till the desired sample size was attained, after which the survey was closed, and responses were analyzed.

Results:

Four hundred and nineteen of 900 residents completed the survey (46.6% response rate). Majority (88.8%) admitted that the inability to conduct the thesis and break in academics caused a significant amount of mental stress upon them. Though classes had resumed through online platforms for most residents (75.4%), the residents reported that lack of bedside learning (65.4%), inadequate progress tests (26.4%), and delay in thesis topic allotment (84.6% among those not allotted thesis) correlated with increased stress. Fear of extension of the course (53%; P = 0.019) and getting infected with COVID-19 (46.6%; P = 0.019) were most cited reasons for significant stress in most of the residents. Many residents (26%) were unable to sleep properly and 22.1% were unable to concentrate on academics. Majority believed that extension of the submission deadline, reduction in sample size, and change in topic would help to complete thesis.

Conclusion:

The present survey revealed that there is a major impediment to research and academics of medical postgraduates during COVID-19 pandemic which has markedly increased their stress levels.