bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early diagnosis of diaphragm palsy after pediatric cardiac surgery and outcome after diaphragm plication – A single-center experience
Authors: Parmar Divyakant , Panchal Jigar , Parmar Neha , Garg Pankaj , Mishra Amit , Surti Jigar , Patel Kartik 
Published: February 2021

Objective :
The aims of our prospective observational study were to evaluate the (1) reliability of clinical signs in the early detection of diaphragm palsy (DP); (2) reliability of ultrasonography using echo machine as a bedside tool for the diagnosis of DP; and (3) does early diaphragm plication result in the improved outcome? We also sought to determine the incidence and predominant risk factors for DP and diaphragm plication at our center.

Materials and Methods :
This prospective observational study included patients with suspected DP from January 2015 to December 2018. Patients with suspected DP were initially evaluated by bedside ultrasonography using echo machine and confirmed by fluoroscopy. Diaphragm plication was considered for patients having respiratory distress, difficult weaning, or failed extubation attempt without any obvious cardiac or pulmonary etiology. Patients were followed for 3 months after discharge to assess diaphragm function.

Results:
A total of 87 patients were suspected of DP based on clinical signs. DP was diagnosed in 61 patients on fluoroscopy. The median time from index operation to diagnosis was 10 (1–59) days. Diaphragm plication was done among 52 patients and not done in nine patients. Bedside ultrasonography using echo machine was 96.7% sensitive and 96.15% specific in diagnosing DP. Early plication (<14 days) significantly reduced the need for nasal continuous positive airway pressure (65% vs. 96%, P = 0.02), duration of mechanical ventilation (12 vs. 25 days, P = 0.018), intensive care unit (ICU) stay (25 days vs. 39 days, P = 0.019), and hospital stay (30 days vs. 46 days, P = 0.036).

Conclusion :
Hoover's sign and raised hemidiaphragm on chest X-ray are the most specific clinical signs to suspect unilateral DP. Bedside ultrasonography using an echo machine is a good diagnostic investigation comparable to fluoroscopy. Early plication facilitates weaning from the ventilator and thereby decreases the ICU stay and hospital stay.
A prospective randomized clinical study of perioperative oral thyroid hormone treatment for children undergoing surgery for congenital heart diseases
Authors: Kumar Alok , Tiwari Nikhil , Ramamurthy Harpanahalli Ravi , Kumar Vivek , Kumar Gaurav 
Published: February 2021

Context :
Thyroid hormone deficiency is known to occur after cardiac surgery and known as nonthyroid illness (NTI). The beneficial role of perioperative thyroid hormone supplementation in children has been debatable more so with oral supplementation.

Aims :
The aim is to evaluate the role of pre-operative oral thyroid hormone therapy in preventing NTI. To assess its effect on post-operative thyroid hormone levels, hemodynamic parameters, and cardiac function of infants and small children undergoing pediatric cardiac surgery.

Settings and Design :
Prospective randomized, double-blinded controlled trial at a tertiary level pediatric cardiothoracic center.

Materials and Methods :
Sixty-five children aged under 18 months undergoing corrective surgeries on cardiopulmonary bypass were included. Patients were randomized into two equal groups: placebo group (given placebo) and thyroxine group (given thyroxine tablet 10 μg/kg) orally once a day starting on the preoperative evening till the fifth postoperative day. The postoperative hemodynamics, inotropic requirement, ventilatory requirement, and cardiac function on echocardiography were observed.

Statistical Tests :
Shapiro–Wilk test, Mann–Whitney/t-test, Chi-square test, ANOVA with Tukey correction were used.

Results:
Serum triiodothyronine and thyroxine levels postoperatively were significantly higher in the thyroxine group than in the placebo group. There was no significant difference in left ventricular ejection fraction, hemodynamic variables, extubation time, and length of intensive care unit (ICU) stay between the two groups.

Conclusions:
In infants and small children undergoing corrective cardiac surgery, perioperative oral thyroid hormone therapy reduces the severity of postoperative NTI. It increases the serum level of thyroid hormones but the therapy does not translate to better hemodynamics, reduced inotropic requirement, reduced ventilatory requirement, improved myocardial function or reduced ICU stay when compared to placebo.
Effectiveness and safety of oral acyclovir 1 g twice a day for 3 days in the management of genital herpes
Authors: Verma Kaushal K. , Sonune Mahendra , Dar Lalit , Bhari Neetu , Jangid Banwari Lal 
Published: February 2021

Context:
Acyclovir is the most commonly used drug in genital herpes; however, with existing acyclovir regimens, the drug needs to be taken five times a day which is inconvenient for patients.

Aims:
The aim of the study was to evaluate the efficacy and safety of oral acyclovir 1 g twice a day for 3 days in genital herpes.

Methods:
The patients of genital herpes were treated with oral acyclovir 1 g twice a day for 3 days and followed up after day 3, 5, 7, and 10 to determine the response to therapy. The response was assessed by physicians' assessment of percentage healing of the ulcer and mean healing time as well as patients' assessment of improvement in the Visual Analog Scale (VAS).

Results:
Twenty-three patients of genital herpes were recruited of which 21 (91.3%) had recurrent episodes, whereas 2 (8.7%) patients had first episode. One patient was lost to follow-up and 22 were analyzed. Complete healing of ulcer was seen in 9 (40.9%), 17 (77.27%) and 20 (90.90%) patients after day 3, 5 and 7 following the treatment respectively, with a mean healing time of 4.91 ± 2.16 days. The mean healing time of recurrent disease was 4.67 ± 1.87 days. Complete improvement in VAS was seen in 9 (40.9%), 21 (95.45%) and 22 (100%) patients after day 3, 5 and 7 following the treatment respectively, with a mean time for complete improvement being 4.27 ± 1.16 days. There were no significant side effects of therapy.

Conclusion:
Acyclovir 1 g twice a day for 3 days is an effective treatment for genital herpes with advantages of comparable healing time and convenient dosage schedule.
Correlation of six minute walk test and incremental shuttle walk test with severity of airflow obstruction in patients with chronic obstructive pulmonary disease
Authors: Tej Pavirala Sai , Kumar Saka Vinod , Vishnukanth G. 
Published: February 2021

Context:
The field walking tests like 6MWT and ISWT are commonly used indicators of functional capacity in patients with cardiopulmonary diseases. This study was designed to assess the correlation of six minute walk distance (6MWD) and incremental shuttle walk distance (ISWD) with the severity of airflow obstruction (FEV1%) in patients with chronic obstructive pulmonary disease.

Aims:
Comparison of correlation of six minute walk test and Incremental shuttle walk test with the severity of airflow obstruction in COPD patients.

Settings and Design:
Hospital-based prospective cross-sectional study in a tertiary care centre.

Methods and Material:
One hundred and twelve (112) spirometrically confirmed COPD patients underwent 6MWT and ISWT. The diagnosis of COPD and its severity was assessed by the GOLD criteria. 6MWT and ISWT were done on the same patient with a gap of 5–6 hours and the distance walked (6MWD and ISWD) was correlated with the severity of COPD (FEV1).

Statistical Analysis Used:
One way ANOVA to compare mean distance walked in 6MWT and ISWT with different grades of COPD. Pearson Correlation was done to correlate packyears of smoking and age with 6MWD and ISWD.

Results:
The mean distance walked in the 6MWT and ISWT was estimated and compared across the four categories of GOLD grading. There was no statistically significant difference between the study subjects of corresponding GOLD grades based on the distance walked in 6MWT and in ISWT. However, a linear correlation was depicted between ISWD and post-bronchodilator FEV1. A model of linear regression showed that ISWD was an independent contributor to post-bronchodilator FEV1 in our study.

Conclusions:
Incremental shuttle walk test, an externally paced near to standard test with its incremental nature, can be used as an appropriate surrogate for FEV1 in determining the severity of airflow obstruction in COPD patients.
Utilizing flexible bronchoscopy for the diagnosis of endobronchial tuberculosis with negative sputum acid-fast bacillus
Authors: Huan Nai-Chien , Mohd Yusof Nurul Izzati Azmin , Ramarmuty Hema Yamini , Khoo Teng Shin , Lai Yean Chen , Lo Shan Min , Sivaraman Kannan Kunji Sivaraman 
Published: February 2021

Background:
Endobronchial tuberculosis (EBTB) should be viewed as a distinct subset of tuberculosis due to various pitfalls: (a) often diagnosed late, (b) mimicking other conditions, for example, lung carcinoma, and (c) risks of bronchostenosis if treated late. Flexible bronchoscopy (FB) offers a reliable and safe modality to increase the diagnostic yield of EBTB when sputum acid-fast bacillus (AFB) is negative. In this study, we aim to determine the clinical presentation, bronchoscopic characteristics, and safety of FB for the diagnosis of EBTB at our centers.

Methods:
From September 2018 to December 2019, 25 patients with EBTB from Queen Elizabeth Hospital and Labuan Hospital, Malaysia were enrolled in this study. Histopathology and/or microbiology were diagnostic in all patients. All patients underwent FB only after sputum smears for AFB were negative.

Results:
The most common presenting complaint was cough (68%), followed by loss of weight (52%), loss of appetite (36%), fever (32%), hemoptysis (28%), and dyspnea (24%). Lung mass/nodule was seen on imaging in 56% of patients, followed by consolidation (36%), cavity (36%), tree-in-bud appearance (32%), and collapse (24%). The most common Chung’s classification of EBTB appearance was edematous-hyperemic (60%); other appearances in order of descending frequencies were: fibro-stenotic (24%), caseating (24%), tumorous (16%), and granular (16%). Bronchial lavage cultures and/or histopathology cultures were positive for tuberculosis in 72% of patients. No procedure-related mortality or major complications were reported.

Conclusion:
Even in tuberculosis endemic settings, empirical pharmacological treatment of all suspected EBTB cases will inadvertently lead to delay in attaining competing differential diagnoses in some. FB in selected patients is safe and effective as it enhances treatment confidence by providing histological and/or microbiological evidence thereby ruling out other differentials when initial sputum results were inconclusive.
Feasibility of testing bronchodilator responsiveness with glycopyrronium in obstructive airway diseases
Authors: Bhattacharyya Parthasarathi , Saha Dipanjan , Sengupta Sayoni , De Debkanya 
Published: February 2021

Background:
The short onset of action of glycopyrronium bromide, makes it a suitable antimuscarinic agent to test bronchodilator-responsiveness in airway diseases. The objective of the study was to explore the feasibility of the testing so.

Methods:
Subjects with features of airflow obstruction (FEV1/FVC < 0.07) were given to inhale a 50-μg single dose of dry powder of glycopyrronium bromide immediately following standard salbutamol-induced bronchodilator reversibility. A repeat spirometry was done after 30 minutes and the changes noted. The impact of both the drugs on spirometric variables suggesting airflow obstruction (FEV1. FEV1/FVC, and FEF25-75) were assessed statistically. A salbutamol-reversibility of ≥12% and >200ml was noted to differentiate asthmatics from chronic obstructive pulmonary disease (COPD) patients.

Result:
In a total of 35 subjects (asthma-10, COPD-25) with moderate baseline airflow obstruction [FEV1/FVC: 0.57 ± 0.12 and FEV1 (%predicted) as 46.17 ± 15.21], there was global improvement across the spirometric variables to serial inhalation of salbutamol and glycopyrronium. The post salbutamol changes in FEV1 (absolute value) were significant (P = 0.0001) overall and also for both asthma and COPD. Following inhalation of glycopyrronium, the changes were again significant for overall (P = 0.0001), asthma (P = 0.0065), and COPD (P = 0.0001). The parallel change in FEF25-75 was, however, showing better reversibility in asthma (P = 0.0008) with salbutamol compared to COPD (P = 0.1846) and the reverse to glycopyrronium inhalation that results in better reversibility in COPD (P = 0.0085) compared to asthma (P = 0.0949).

Conclusion:
Testing the reversibility with glycopyrronium appears feasible and safe in obstructive airway disease. It induced add-on reversibility once used after standard salbutamol reversibility. The observation demands further evaluations.
COVID-19 versus H1N1
Authors: Saluja Manoj , Pillai Drishya 
Published: February 2021

Background:
Since December 2019, we have been facing the coronavirus disease 2019 (COVID-19) pandemic. January 30, 2020 marked India’s first case. A similar entity H1N1 was responsible for the last pandemic our civilization saw. Comparing the clinical and radiological characteristics, severity and prognosis of the two is the objective.

Methods :
Cross-sectional, observational, and comparative study of patients diagnosed with COVID-19 (April–May 2020) and H1N1 (January 2017–December 2019).

Results :
We observed raised male to female (M:F) ratio in both, average age higher in H1N1, moderate to severe symptoms with worse clinical status in H1N1, and COVID more often being associated with mild symptoms. Thrombocytopenia, lymphocytosis, and raised lactate dehydrogenase (LDH) were seen in both the diseases but were worse in H1N1; multiorgan involvement was seen in H1N1 (P < 0.001). COVID-19 patients who did report complications were refractory to routine critical care management. Radiographic abnormality was present in both. Poor prognosis was noted in elderly, especially those with comorbidities. This association was less evident in COVID-19.

Discussion:
Though Severe Acute Respiratory Syndrome- Corona Virus 2 has a milder course, sudden deterioration can be fatal. Serial monitoring of history and vitals is the key. Swine flu patients with a comparatively aggressive course need to be managed accordingly, but Sequential Organ Failure Assessment, Acute Physiology and Chronic Health Evaluation Score-II, and similar scoring can help in triage and predicting prognosis. Clinical and laboratory findings are similar − swine flu has more complications but increased risk of cardiac involvement is seen in COVID. Chest X-ray proves sufficient for imaging, reducing the requirement of computed tomography (CT) scans. Studies involving larger sample size and interventional trials are need of the hour.
Surgical Outreach as a Tertiary Hospital's Corporate Social Responsibility
Authors: Babalola Olakunle Fatai , Okunlola Abiodun Idowu , Ibrahim Tayo , Salawu Adedayo Idris , Majengbasan Timothy Oladele , Adebara Idowu Oluwaseyi , Hassan Adeniyi Steven 
Published: February 2021

Introduction:
The underserved populations of the rural and suburban communities of developing countries are challenged by the twin hurdles of low-income earning and out-of-pocket payment for surgical care services. This study aims at appraising the process, outcome, and impact of a free surgical outreach programme carried out by a Federal Teaching Hospital in South-western Nigeria.

Methods:
A free day-case surgical outreach programme was announced through a popular radio jingle for a period of 1 week to attract would-be beneficiaries of the programme. A 2-day screening exercise was conducted by the concerted efforts of various specialists in the department of surgery and ophthalmology to select those who are suitable for day-case surgery. A cross-sectional survey of patients who participated in the 5-day surgical outreach programme was carried out. A structured questionnaire was used to obtain information on biodata, diagnosis, surgical operations, complications, and level of satisfaction. A 3-point bipolar satisfaction outcome scale was used to assess the level of satisfaction. The data obtained were analyzed using the SPSS software version 20.0.

Results:
One hundred and fifty-eight patients were screened, but only 124 participated. Ophthalmic cases constituted 60.5%, whereas the rest (39.5%) were non-ophthalmic cases. Patients with cataract were 73 (58.9%) of all the surgical lesions operated during the outreach programme. Two (1.6%) patients with pterygium were the other ophthalmic cases, whereas the non-ophthalmic cases were mainly hernias. A total of 129 surgical operations were performed in the 124 patients, with 5 (0.4%) of them having bilateral cases. One hundred and seventeen patients (94.4%) expressed satisfaction with their experience of the programme.

Conclusions:
Optimal corporate social responsibility of tertiary hospitals can be performed effectively and satisfactorily through a properly organized surgical outreach.
Hypocalcemia and Vaso-Occlusive Painful Crises in Pediatric Sickle Cell Anaemia
Authors: Nlemadim Anthony Chibueze , Okpara Henry Chima , Uzomba Chigozie Ikechukwu , Anah Maxwell Udo , Meremikwu Martin Madu 
Published: February 2021

Background:
Low serum calcium (hypocalcemia) occurs in sickle cell anaemic (SCA) children. Concomitant presence of prolonged corrected QT (QTc) interval on electrocardiogram can ascertain hypocalcemia, especially during vaso-occlusive painful crises (VOC).

Aim:
The aim of the study was to determine the relationship between hypocalcemia and VOC.

Methods:
It was a prospective cohort study of 38 SCA children aged 4–17 years during VOC and when the same children were in steady state. Information regarding bone pain and clinical examination were obtained, following which electrocardiography was done during both clinical states. Blood was drawn for total calcium and serum albumin estimation.

Results:
The mean (standard deviation [SD]) of total calcium was significantly lower during VOC (1.90 [0.19] mmol/l) than during follow-up steady state (2.24 [0.22] mmol/l), P < 0.001. The mean rank of QTc interval was significantly higher during VOC (19.93) than in follow-up steady state (14.50), P < 0.001. Total calcium negatively correlated with QTc intervals during VOC (r

s
[36] = −0.36, P = 0.029) and follow-up steady state (r
s[36] = −0.49, P = 0.002), while QTc interval was highly predictive of hypocalcemia (area under the curve [AUC] = 0.82, P < 0.001). Similarly, total calcium was highly predictive of VOC (AUC = 0.89, P < 0.001) at cutoff point of 2.13 mmol/l with 89.5% sensitivity and 81.6% specificity. Hypocalcemia was significantly observed during VOC than follow-up steady state (89.5% vs. 21.1%, P < 0.001) with odds ratio of 21.28 (95% confidence interval: 0.012–0.189; P < 0.001).

Conclusion:
Total calcium <2.13 mmol/l is associated with VOC. Regular total calcium tests should be done. SCA children may benefit from routine oral calcium to reduce frequency of VOC.
Effects of Distal Mandibular Skeletal Injury on Temporomandibular Joint Soft Tissue without Bony Injury to the Joint
Authors: Bhargava Darpan , Sharma Yogesh , Beena Sivakumar , Koneru Ganesh , Pandey Ankit 
Published: February 2021

Introduction:
Trauma to the temporomandibular joint (TMJ) may be associated with injury to its associated soft tissues along with the bony condyle. However, it is often neglected that even in the absence of fracture of the mandibular condyle, there may be damage to the associated soft tissues of the joint. The routine radiographic study does not reveal the soft-tissue injury around the joint and its extent. Such injuries may progress to temporomandibular joint disorders (TMDs) in the future.

Materials and Methods:
A prospective study was conducted among 50 patients diagnosed with anterior mandibular fractures without condylar fracture. The patients were assessed for soft-tissue injury around the TMJ using an arthroscopic examination by a single qualified operator. Patients were evaluated clinically and arthroscopic examination was performed to examine the TMJ soft tissues at the time of surgery for facial fracture reduction under general anesthesia.

Results:
Among the 50 patients, n = 37 (74%) patients had severe injury to the soft tissues surrounding the TMJ. Majority of the patients had arthroscopic evidence of soft-tissue injury around the joint.

Conclusion:
From this study, we observe that patients with mandibular fracture without condylar involvement should be evaluated for TMJ soft-tissue injuries and subjected to long-term follow-up to prevent TMDs in the late postoperative period.
Assessment of Resident Doctors' Perception of Postgraduate Medical Education in Nigeria Using the SPEED Tool
Authors: Taiwo Funmilola T. , Adesegun Oluwaseyitan A. , Idowu Akolade O. , Mene Andrew , Imaralu John O. , Adekoya Adesola O. , Osibowale Bamikole T. 
Published: February 2021

Background:
Obtaining feedback from trainees is important in the evaluation and evolution of Postgraduate Medical Education (PME), and policies made based on their felt needs would go a long way in making residency training a worthwhile experience. This pilot study aimed to assess resident doctors' perception of the training content, atmosphere, and organization using the Scan of Postgraduate Educational Environment Domains (SPEED) tool.

Methodology:
This was a cross-sectional study conducted amongst resident doctors at Babcock University Teaching Hospital (BUTH) in Nigeria, between May and August 2019. A self-administered questionnaire was used to collect participants' sociodemographic data, their perception of PME in their respective departments, as well as the strengths and weaknesses of the training programmes. Validity and reliability indices were assessed, and descriptive, inferential, and correlational analyses were run where appropriate.

Results:
The mean score for the resident doctors' perception of training content, atmosphere, and organization was 4.0 ± 0.4, 4.2 ± 0.5 and 3.69 ± 0.60 respectively, out of a maximum of 5, indicating a positive perception of training in BUTH. The major strengths perceived by most residents were good inter-personal relations between residents and their trainers, as well as conducive learning and work environment; while the weaknesses include poor remuneration and limited staffing which hampers rotations.

Conclusion:
Resident doctors in BUTH mostly had a positive outlook on their training. This study serves as a reference point for local policy change (in BUTH), and a framework from which future studies on PME can emerge.