bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Outcome of Operated Neonates with an Isolated Congenital Diaphragmatic Hernia in a Limited Resource Scenario
Authors: Hassan Nibi , Sarma Vivek Parameswara 
Published: January 2021

Introduction:
Congenital diaphragmatic hernia (CDH) is one of the most common neonatal emergencies, and the ideal current therapy requires high standards of neonatal care and advanced facilities. However, majority of neonates born with CDH are treated in public sector hospitals, with limitations in resources and workforce.

Objectives:
The aim of the study was to review and analyze the outcome of operated neonates with isolated CDH in a public sector hospital and medical college where a standard protocol of management was followed, considering the need for optimization of therapy in view of the resource constraints.

Materials and Methods:
A retrospective chart review and analysis of the antenatal, preoperative, operative, and postoperative records of all neonates with operated CDH during the 3-year period from June 2015 to June 2018 at the hospital was done. The standard institutional protocol being followed included preoperative stabilization, risk stratification for patient selection, early decision regarding operative intervention, and continued postoperative ventilation.

Results:
During the 3-year period, 78 children were admitted with CDH, of which 40 newborns with operated CDH were studied. The mean age at surgery was 72 h. Thirty-five of these 40 cases (87.5%) made an uneventful recovery, while mortality was 5/40 (12.5%). All mortalities (5/40) occurred during the postoperative period after 3 days due to respiratory failure while being ventilated.

Conclusion:
The strategy of a uniform protocol in the management of CDH adapted to the practical constraints of the institution yielded good results in the low-to-moderate risk group of neonatal CDH. The approach also facilitated the segregation of high-risk cases and optimal utilization of available facilities in a limited resources scenario.
Can Testosterone Alter the Degree of Hypospadias? A Comprehensive Study
Authors: Khokar Dasmit Singh , Patel Ravi Vadilal 
Published: January 2021

Context:
In this study, we observed using serial injections of parenteral testosterone whether we can alter the degree of hypospadias.

Aims:
The aim was to study the effect of testosterone on different parts of the phallus in hypospadias and to see if we can alter the degree of hypospadias.

Settings and Design:
This was a prospective observational study.

Subjects and Methods:
Forty-five boys with proximal and mid-penile hypospadias below the age of puberty who did not have prior testosterone injection or surgery were recruited in this study for the duration of 1 year and given testosterone injection intramuscularly and measurement taken using Vernier caliper at regular interval followed by surgery. The follow-up was at the 1st, 3rd, and 6th months of surgery.

Results:
Of 45 patients who received intramuscular testosterone injections, 40 showed some degree of response. Of these 40 patients, 23 showed a significant improvement in phallic size, whereas 17 showed a clinically insignificant response only. Of these 23 patients, 14 improved from a mid-penile to a distal penile hypospadias, whereas 7 improved from proximal penile to mid-penile hypospadias, and 2 showed an exceptionally good response and improved from proximal penile to distal penile hypospadias, whereas 5 patients exhibited no response at all.

Conclusion:
Through this study, we can conclude that intramuscular testosterone can be effective in some patients with proximal and mid-penile hypospadias to convert them into either mid- or distal penile hypospadias by the differential response of different parts of the phallus, and this may favorably alter the type of procedure required for the hypospadias repair.
Parenteral Fish-Oil Lipid Emulsions in Retinopathy of Prematurity
Authors: Gharehbaghi Golnaz , Mohagheghi Parisa , Sedaghat Ahad , Riazi-Esfahani Hamid , Mirghorbani Masoud , Khosravi Nastaran 
Published: January 2021

Purpose:
To evaluate the effects of a fish oil-containing regimen on the severity of retinopathy of prematurity (ROP) in preterm infants.

Methods:
In this retrospective, observational study, 82 preterm infants with documented retinal examinations were evaluated. Patients' demographic data, associated morbidities, the worst ROP zone, stage, and the presence of plus disease during the follow-up examinations, and the need for ROP treatment in the two groups were recorded and analyzed.

Results:
Forty-three infants were treated with INTRAlipid®, and 39 infants were treated with 20% SMOFlipid. There were no differences in gestational age, birth weight, and associated morbidities between the two groups. No differences were observed among the two groups in their need for treatment (P = 0.51), ROP zones (P = 0.62), and plus disease (P = 0.38). Although no difference was seen in ROP stages between the groups (P = 0.41), in subgroup analysis, Stage 3 (severe ROP) occurred significantly lower in the SMOFlipid group (P = 0.04) and Stage 0 occurred significantly higher in the SMOFlipid-treated infants (P = 0.05).

Conclusions:
This study showed no difference between the two groups regarding the need for the treatment. The lower prevalence of severe ROP in preterm infants receiving SMOFlipid emulsion was observed comparing to the INTRAlipid-treated infants.
Outcome of Sclerokeratoplasty in Devastating Sclerocorneal Infections
Authors: Thatte Shreya , Dube Ankita B. , Dubey Trupti , Krishnan Malvika 
Published: January 2021

Purpose:
To assess the achievement of anatomical integrity after primary tectonic sclerokeratoplasty procedure and outcome after subsequent secondary procedures to manage devastating corneoscleral infection threatening the structural integrity of the eyeball.

Methods:
This prospective interventional study comprised 60 patients with severe devastating corneoscleral pathology of infective origin with varying degrees of scleral involvement who underwent tectonic sclerokeratoplasty. They were grouped into three groups according to the involvement of scleral quadrants, i.e., Group A with only one quadrant, Group B with two quadrants, and Group C with more than two quadrants. The demographics, clinical features, microbiological status, postoperative complications, need for secondary procedures, and tectonic outcome in terms of anatomical success were analyzed in all three groups during follow-up between 2 and 5 years.

Results:
The donor graft size in Groups A, B, and C was 9.5–10.5, 11–12, and 12.5–14 mm, respectively. Globe integrity after primary procedure was noted in all patients of Group A, 76% of Group B, and 38% of Group C. Reinfection was observed in 19 cases of Groups B and C, from which 5 Group C patients were eviscerated and 14 underwent regrafting. Postoperative complications (suture related, rejection, graft failure, and secondary glaucoma) were encountered more frequently in Group C patients. Secondary procedures (cataract/posterior segment surgery, secondary intraocular lens, and trabeculectomy) were required more in Groups B and C. After regrafting, 7 eyes were salvaged and 7 (3 in Group B and 4 in Group C) resulted in phthisis bulbi. Thus, tectonic outcome was achieved in 80% of cases.

Conclusions:
Sclerokeratoplasty is an effective tectonic treatment for restoring the globe anatomy in severe corneoscleral infection. Outcome depends on involvement of scleral quadrants, graft size, and severity of disease. Subsequent regrafting procedures are required to overcome reinfection of the primary graft.
Outcome of Corneal Collagen Cross-Linking in Keratoconus
Authors: Peyman Alireza , Feizi Awat , Ganjalikhani-Hakemi Mazdak , Hosseini-Nasab Fahimeh , Pourazizi Mohsen 
Published: January 2021

Purpose:
To evaluate the multiple pretreatment characteristics and topographic factors of keratoconus (KC) patients and their relationship to clinical outcomes of corneal collagen cross-linking (CXL).

Methods:
In this prospective study, 61 patients (106 eyes) with KC as candidates for CXL were included. Demographic data including age, sex, place of birth and residence, atopic constitution, family history, rubbing history, sleep apnea, and blood group were collected via a structured checklist. Complete ophthalmologic examination and tear collection to assess tear interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-α) level were performed. Topometric parameters were evaluated using a rotating Scheimpflug topography device. Changes in best corrected visual acuity (BCVA) and maximum keratometry (K-max) were considered the main predicted variables. Predictive variables were analyzed by univariate and multivariate regression.

Results:
The use of multivariate analysis changes in K-max was significantly associated with rubbing frequency (coefficient = 0.94, P = 0.02), blood group (coefficient = 4.52, P = 0.005), pretreatment corneal asphericity (coefficient = −3.99, P ≤ 0.001), and pretreatment central keratoconus index (CKI) (coefficient = −55.38, P = 0.001). Regarding the changes in BCVA, the multivariate analysis showed a significant association with place of birth (coefficient = −0.08, P = 0.03), pretreatment BCVA (coefficient = −0.67, P < 0.001), pretreatment central corneal thickness (CCT) (coefficient = −0.005, P = 0.04), and pretreatment keratoconus index (KI) (coefficient = 0.53, P = 0.04). Other parameters assessed in the multivariable analysis did not appear to have an individual effect on treatment outcomes.

Conclusion:
Our results demonstrated that blood group, rubbing of eye, place of birth, corneal asphericity, pretreatment BCVA, CKI, KI, and CCT were statistically associated with the outcome of KC following CXL.
Canadian Opinions on Refractive Surgery and Approaches to Presbyopia Correction
Authors: Chung Helen , Sanders Emi , Rocha Guillermo , Bhamra Jamie 
Published: January 2021

Purpose:
To explore the opinions of Canadian ophthalmologists on refractive and presbyopia-correcting surgeries.

Methods:
We distributed an online survey to the Canadian Ophthalmological Society members, covering laser refractive surgery (LRS), femtosecond laser-assisted cataract surgery (FLACS), lenticular refractive surgery (lenRS) that includes cataract refractive surgery (CRS) with premium intraocular lens (IOL) implantation, and presbyopia correction.

Results:
There were 68 (7.6%) total respondents. Most respondents would not consider LRS (62.5%) nor FLACS (73.9%) for themselves. Male sex and performance of LRS or FLACS was significantly associated with consideration of these procedures for self. Most respondents (59.3%) would consider lenRS for themselves. The top method of personal presbyopia correction was spectacles, chosen by 52.5%.

Conclusions:
When surveying the wide body of Canadian ophthalmologists, most respondents preferred spectacle correction of presbyopia and would consider lenRS, but not LRS or FLACS for themselves. Surgeons performing these procedures were more likely to consider them for self.
Influence of JAK2V617F allele burden on
clinical phenotype of polycythemia vera patients:
A study from India
Authors: Sazawal Sudha , Singh Kanwaljeet , Chhikara Sunita , Chaubey Rekha , Mahapatra Manoranjan , Saxena Renu 
Published: January 2021

Abstract
Background: Elevated JAK2V617F allele
burden is associated with enhanced expression of
downstream target genes in Philadelphia negative
chronic myeloproliferative neoplasms (CMPNs) which
include PV, ET & PMF. Previous studies have
shown the impact of JAK2V617F allele burden on
clinical phenotype of CMPNs. However, there is no
data from India regarding the association between
JAK2V617F allele burden and clinical phenotype in
PV. Aims/Settings and Design: We aimed to
investigate the effect of allele burden on
clinical phenotype in 90 JAK2V617F positive PV
patients and to see its influence on disease
related complications. Material and Methods:
Allele burden of 90 JAK2V617F positive PV patients
was quantified by Real-time polymerase chain
reaction (RQ-PCR). Results: 74/90 (82.22%) were
males and 16/90 (17.78%) were females (median 45
years, range 35-78). Patients with age >50
years had significantly higher JAK2V617F allele
burden (median 40.15%, range 0.49–91.62 %) than
patients with ≤ 50 years age (median 48.59 %,
range 0.56–86.74 %; P < 0.032). Patients with
splenomegaly had significantly higher JAK2V617F
allele burden (mean 50.24%, range 6.91–84.17%)
than patients without splenomegaly (mean 33.82 %,
range 0.49–71.83 %; P < 0.017). Patients with
higher allele burden (median 57.20, range
43.4–72.03%) had significantly raised thrombotic
events than the patients with lower allele burden
(median 37.38, range 0.49–84.17% P < 0.043).
49/90 (54%) were homozygous and 41/90 (46%) were
heterozygous. Conclusions: Higher JAK2V617F allele
burden showed association with increased age,
splenomegaly and thrombotic events. Thus, it may
be considered for prognostication and setting up
the treatment protocol in PV patients.
Systemic chemotherapy and short-course
radiation in metastatic rectal cancers: A feasible
paradigm in unresectable and potentially
resectable cancers
Authors: Ostwal Vikas , Kapoor Akhil , Engineer Reena , Saklani Avanish , deSouza Ashwin , Patil Prachi , Arya Supreeta , Ankathi Suman Kumar , Chopra Supriya , Patil Mangesh , Jain Shanu , Ramaswamy Anant 
Published: January 2021

Abstract
Background: The optimal use and
sequencing of short-course radiotherapy (SCRT) in
metastatic rectal cancers (mRCs) are not well
established. Materials and Methods: We
retrospectively reviewed the records of mRC
patients receiving SCRT followed by palliative
chemotherapy between January 1, 2013, and December
31, 2016, in Tata Memorial Hospital. Patients were
classified as having “potentially resectable”
disease (local and metastatic) or “unresectable”
disease at baseline based on prespecified
criteria. Results: A total of 105 consecutive
patients were available for analysis. The median
age of patients was 48 years (range: 16–62 years),
and 57.1% were male patients. Signet ring
histology was seen in 13.3% of patients. The most
common site of metastases was liver limited
(29.5%), nonloco-regional nodes (12.4%), and lung
limited metastases (9.5%). Chemotherapeutic
regimens administered were
capecitabine-oxaliplatin (70.5%), modified 5
fluorouracil (5
FU)-leucovorin-irinotecan-oxaliplatin (10.5%), and
modified 5 FU-leucovorin-irinotecan (8.6%).
Targeted therapy accompanying chemotherapy was
administered in 27.6% of patients. About 42.1% of
patients with potentially resectable disease and
11.1% with the unresectable disease at baseline
underwent curative-intent resection of the primary
and address of metastatic sites. With a median
follow-up 18.2 months, median overall survival
(OS) was 15.7 months (95% confidence interval:
10.42–20.99). Patients classified as potentially
resectable had a median OS of 32.62 months while
patients initially classified as unresectable had
a median OS of 13.04 months (P = 0.016). The
presence of signet ring morphology predicted for
inferior mOS (P = 0.021). Conclusions: SCRT
followed by systemic therapy in mRC is a feasible,
efficacious paradigm for maximizing palliation,
and achieving objective responses. The
classification of patients based on resectability
was predictive of actual resection rates as well
as outcomes. Signet ring mRC show inferior
outcomes in this cohort of patients.
Plasmablastic lymphoma in immunocompetent
and in immunocompromised patients: Experience at a
regional cancer centre in India
Authors: Rudresha A.H. , Lakshmaiah K.C. , Agarwal Ankit , Babu K. Govind , Loknatha D. , Jacob Linu Abraham , Babu Suresh , Lokesh K.N. , Rajeev L.K. 
Published: January 2021

Abstract
Introduction: Plasmablastic lymphoma
(PBL) is a rare lymphoma associated with
immunosuppression. It is strongly associated with
immunosuppression (human immunodeficiency virus
[HIV]) and often occurs within the oral cavity.
PBL is also seen in patients receiving
immunosuppressive therapy; however, despite its
predisposition for the immunocompromised patients,
PBL has been diagnosed in immunocompetent
patients. Aim: This study aims to prognostic
factors and outcome of PBL in immunocompromised
and in immunocompetent patients. Materials and
Methods: We conducted a retrospective study at our
institute from the year 2008 to 2015. Results: A
total of 13 patients (8 males and 5 females) with
PBL were identified. Eight patients (61.5%) had
extraoral PBL (median age 30.2 years) and 5
patients (38.5%) had oral PBL (median age 44
years). Most common extraoral site was
gastrointestinal tract. Eight (61.5%) out of 13
patients were HIV positive. More than 50% of
patients had Ann Arbor Stage III or IV. All the
cases were CD20 negative and CD138 positive. Seven
out of 13 patients had Ki-67 more than 80%. Nine
patients received cyclophosphamide, doxorubicin,
vincristine, and prednisone chemotherapy. Three
patients were on best supportive care due to poor
performance status (PS). One patient received
intensive chemotherapy with CODOX-M/IVAC. The
median overall survival was 9 months in
HIV-positive patients and 6 months in HIV-negative
patients. The prognosis was worse in patients with
Ki-67 of >80%. Statistical Analysis: Survival
curves were generated using the Kaplan–Meier
method and analyzed using log-rank test and
Fisher's t-test. Conclusion: The present study
confirms that PBL in both HIV-positive and in
HIV-negative patients has an overall unfavorable
outcome. The most important prognostic factors are
stage, ki-67, and the Eastern Cooperative Oncology
Group PS of the patient at the time of
presentation.
Burden of acute toxicities in head-and-neck
radiation therapy: A single-institutional
experience
Authors: Muzumder Sandeep , Srikantia Nirmala , Udayashankar Avinash H. , Kainthaje Prashanth Bhat , John Sebastian M. G. 
Published: January 2021

Abstract
Introduction: Combined modality therapy
is the standard of care in locally advanced
head-and-neck cancer (HNC). The incidence of acute
toxicities increases with additional therapy. The
present study investigated the incidence and
patterns of mucositis, dysphagia, aspiration,
feeding tube use, admission for supportive care,
and treatment compliance in patients with HNC
treated curatively with radiation therapy (RT)
with or without chemotherapy. Methods and
Material: A retrospective review of 164
consecutive HNC patients treated with RT at St.
John's Medical College Hospital, Bengaluru, from
January 2013 to June 2017 was done. Results: A
total of 148 HNC patients were treated with a
curative intent and 122 (82.4%) were locally
advanced HNC. Combined Modality treatment was
received by 119 (80.4%) patients. Eighty-four
(56.7%) patients were treated by concurrent
chemo-radiation. IMRT technique was used in 125
(84.5%) patients. The incidence of grade 3-4
mucositis, dysphagia and aspiration was 25%, 46%,
and 10%, respectively. Nasogastric tube feeding
was necessitated in 18.9% (n=28) and 27% (n = 40)
required inpatient admission for supportive care.
Twenty-nine (19.6%) patients did not complete
planned RT dose and 46 (31%) patients had
unscheduled RT break (>2days). Fifty-six
(66.7%) patients did not receive planned
chemotherapy. Conclusions: Acute toxicity due to
RT in HNC remains a challenge despite using modern
techniques. A significant proportion of patients
require supportive therapy for more than 12 weeks
and did not complete the scheduled
treatment.
Reproductive factors and breast cancer
risk: A meta-analysis of case–control studies in
Indian women
Authors: Vishwakarma Gayatri , Ndetan Harrison , Das Durgesh Nandini , Gupta Garima , Suryavanshi Moushumi , Mehta Anurag , Singh Karan P. 
Published: January 2021

Abstract
Background/Objective: India is the
world's most biodiverse region and is undergoing a
period of dramatic social and economic change. Due
to population's explosion, climate change and lax
implementation of environmental policies, the
incidence of breast cancer is increasing. From
population-based cancer registry data, breast
cancer is the most common cancer in women in urban
registries where it constitutes more than 30% of
all cancers in females. We conducted a
meta-analysis of all breast cancer case–control
studies conducted in India during 1991–2018 to
find pooled estimates of odds ratio (OR).
Materials and Methods: Eligible studies were
identified through a comprehensive literature
search of PubMed, EMBASE, and HINARI databases
from 1991 to January 2018. This analysis included
24 observational studies out of 34 that reported
the case–control distribution of reproductive
factors, body mass index (BMI) and type of
residence. The analysis was performed using RevMan
5.3 (Review Manager, 2017) applying the
random-effects model. Results: A total of 21,511
patients (9889 cases and 11,622 controls) were
analyzed, resulting in statistically significant
association between breast cancer and the
following reproductive factors: never breastfeed
(OR: 3.69; 95% confidence interval [CI]: 1.70,
8.01), menopausal age >50 years (OR: 2.88; 95%
CI: 1.85, 3.85), menarche age <13 years (OR:
1.83; 95% CI: 1.34, 2.51), null parity (OR: 1.58;
95% CI: 1.21, 2.06), postmenopause (OR: 1.35; 95%
CI: 1.13, 1.62), and age at the 1st pregnancy
>25 years (OR: 1.57; 95% CI: 1.37, 1.80).
Family history (FH) of breast cancer (OR: 5.33;
95% CI: 2.89, 9.82), obesity (OR: 1.19; 95% CI:
1.00, 1.42), and urban residence (OR: 1.22; 95%
CI: 1.03, 1.44) were also found to be significant
risk factors. Conclusion: The results of this
meta-analysis are indicative of significant
associations between reproductive factors and
breast cancer risk, profoundly so among women
experiencing menopause after the age of 50, women
who never breastfeed and FH of breast
cancer.
Evaluation of cytology as secondary triage
in visual inspection after application of 4%
acetic acid-based cervical cancer screening
program
Authors: Mishra Gauravi A. , Pimple Sharmila A. , Gupta Subhadra D. 
Published: January 2021

Abstract
Context (Background): Visual-based
screening techniques are low cost and have good
sensitivity. Hence, they appear promising for
primary screening in low-resource settings.
However, to reduce referrals for diagnostic
colposcopy, there is need to triage these
screen-positive women with test with good
specificity. Aims: The study aims to evaluate the
performance of cytology as triage for visual
inspection after application of 4% acetic acid
(VIA) screen-positive women. Settings and Design:
Community-based cervical cancer screening using
VIA was implemented among socioeconomically
disadvantaged women in Mumbai, India. Methods:
Cytology was performed on screen-positive women.
All primarily screen-positive women underwent
colposcopy. Directed biopsies were obtained among
women with positive findings on colposcopy. The
gold standard used for final disease status was
histopathology or negative colposcopy. Statistical
Analysis Used: Test characteristics of cytology as
triage test. Results: Among the 138,383
population, 16,424 eligible women were screened
with VIA. 785 (4.78%) women were VIA positive and
580 women participated in triage with cytology.
The sensitivity and specificity of cytology at
threshold of atypical squamous cells of
undetermined significance in detecting ≥cervical
intraepithelial neoplasia (CIN) 2 were 75.0 and
94.7, respectively. The positive and negative
predictive values of cytology as triage test were
23.1 and 99.4, respectively, and the false
positivity and false negativity rates were 5.34
and 25.0, respectively. Conclusion: Cytology
triage with VIA can reduce referrals for
colposcopy to 4.97% of original referrals but may
miss around 25%, of high-grade CIN. The
substantial reduction in referrals has special
implication for low-resource settings, wherein
compliance to referral and availability of
diagnostic facilities are poor.