bluuebunny/crossref_metadata_2025_split huggingface dataset:
Perceptions of postgraduate medical students and guides about dissertation: A qualitative study
Authors: Domple Vijay Kishanrao , Kasdekar Pankaj Motilal , Soyam Gajanan Charandas , Joge Umesh S. , Khakse Gautam Marotrao , Solanke Rahulkumar Anil 
Published: December 2024

Introduction:
Health research during medical training is essential to encourage critical thinking and reasoning abilities and a positive attitude among postgraduate (PG) students toward scientific research throughout their medical careers. However, all may not be inclined toward research. Therefore, the present study was formulated to understand the perceptions of PG medical students and guides about dissertations.

Material and Methods:
The current qualitative study was conducted at a tertiary care center in Central India between December 2022 and January 2023. A total of 12 participants (9 PG students and 3 PG guides) were selected by the purposive sampling method. The Institutional Ethics Committee approved the study. For the in-depth interview with audio recording, the interview guide was used. The data were coded, and thematic analysis was done using the Microsoft Word and Excel.

Results:
All participants reported that PG dissertations should be an essential element in the PG curriculum, except two who raised the issue of compulsion. While participants mentioned the positive perspectives about the dissertations, like the development of research skills and expertise, they also pointed out negative perspectives, like single-topic exploration only and minimal connection to clinical practice. Many students were confused, stressed, and disoriented at the beginning of the dissertation. No separate time, patient workload, language barrier, and a lack of academic writing skills and resources were the challenges experienced. The role of a PG guide is indispensable in the process of the dissertation. They felt that the final submission of the dissertation should be at the end of the 2nd year.

Conclusion:
Many participants believed that the dissertation should be an essential component of the PG curriculum. The role of the PG guide is indispensable in the dissertation process. The final submission of the dissertation should be at the end of the 2nd year.
Psychotropic Drugs in Dermatology Part 1: Anti-depressants and Mood Stabilisers
Authors: Kenkare Varsha L. , Madke Bhushan , Choudhary Ankita , Bose Shiti 
Published: December 2024

Abstract
Psycho-dermatology is an evolving speciality of psychosomatic medicine where psychological factors play a role in initiating and/or exacerbating the dermatological conditions. Dermatologists should be well versed with the basic pharmacotherapy of psycho-cutaneous disorders and work in close liaison with the psychiatrists when it comes to the holistic management of the same. The review has been divided into two parts, with part 1 consisting of anti-depressants and mood stabilisers and part 2 consisting of anti-psychotics, anxiolytics, and sedative-hypnotic agents used in psycho-dermatology. This comprehensive review focusses on the various psychotropic drugs which are of paramount significance to the dermatologists. The knowledge of these drugs will lead to the pertinent treatment of the psychiatric dermatoses, which has been a less explored territory in the arena of dermatology. Within the realm of psycho-dermatology, a diverse array of anti-depressants is utilised to address psychiatric dermatoses. These include selective serotonin reuptake inhibitors like citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline, alongside selective serotonin norepinephrine reuptake inhibitors such as venlafaxine, desvenlafaxine, and duloxetine. Additionally, norepinephrine dopamine reuptake inhibitors like bupropion; tricyclic antidepressants including doxepin, amitriptyline, imipramine, and clomipramine; and tetracyclic antidepressants like mirtazapine are commonly employed. Supplementary medications like anti-convulsants (e.g., gabapentin and pregabalin) further enrich the therapeutic landscape in psycho-dermatology. The approach to treatment in psycho-dermatology is meticulous, starting with a precise psychiatric diagnosis and followed by tailored drug interventions. Factors such as individual response, side-effect profiles, potential drug interactions, and concurrent medical conditions guide the selection and titration of medications. Typically, treatment initiates at conservative doses, with adjustments made based on patient progress and tolerability. This comprehensive review not only illuminates the psycho-cutaneous indications of these medications including in patients with co-morbidties but also underscores the imperative of vigilant monitoring for adverse effects and its management. This systematic review aimed to evaluate the use of psychotropic medications, including antidepressants and mood stabilizers, in dermatology. A comprehensive search of PubMed Central was conducted for studies published between 1986 and 2023, focusing on meta-analyses, reviews, and systematic reviews. After screening 2287 records, 26 studies met the inclusion criteria. The findings underscore the potential role of psychotropic drugs in managing dermatological conditions, highlighting the need for further research to strengthen the evidence base in psycho-dermatology.
Effects of Ceramic Membrane Composed of Clay and a Mixture of Rice Husks, Sawdust, Coconut Shell Charcoal, and Coffee Grounds on Reducing Total Coliforms in Well Water
Authors: Aditama Wiwit , Zulfikar Zulfikar , Sofia Sofia 
Published: December 2024

Abstract

Aim:
The study was conducted to determine the effects of a ceramic membrane composed of clay and a mixture of rice husks, sawdust, coconut shell charcoal, and coffee grounds on reducing total coliforms in well water.

Methods:
The materials used were clay and a mixture of materials including rice husks, sawdust, coconut shell charcoal, and coffee grounds. These materials were mixed, molded, dried, and burnt. Total coliforms in well water were measured as the observed parameter, and the different material compositions were compared. Coliforms were assessed with the membrane filter method, while data were analyzed with a one-way analysis of variance.

Results:
The results showed that the greatest reduction in total coliforms was found on the ceramic membrane of clay and coffee grounds with a value of 105.8 CFU, while the lowest was observed in a mixture of clay and coconut shell charcoal at 92.8 CFU. The percentage decline rate in total coliforms caused by ceramic membrane with a mixture of land clay and coffee grounds reached 91.3%.

Conclusion:
Although there was no significant difference in the reduction of total coliforms among the various membrane compositions, the combination of clay and coffee grounds caused a reduction reaching >90%.
Outcome of 177Lu-DOTATATE Peptide Receptor Radionuclide Therapy in Progressive Metastatic Neuroendocrine Tumors from a Tertiary Care Center
Authors: Mathew David , Sunny Saumya S. , Benjamin Justin , John Junita R. , Jebasingh Felix K. , Georgy Josh T. , Singh Ashish , Oommen Regi 
Published: December 2024

Abstract

Introduction:
Functioning neuroendocrine tumors (NETs) that do not respond to standard therapies are commonly considered for Peptide Receptor Radionuclide Therapy (PRRT). The benefit of 177Lu-DOTATATE PRRT in patients with progressive metastatic NET was analyzed and survival in multi-organ involvement.

Methods:
Forty-one patients with refractory, progressive, or advanced symptomatic NETs, with or without previous treatment modalities were studied. They were treated with 177Lu-DOTATATE IV infusion 150 mCi per dose up to four cycles. Retrospectively, they were assessed for response to PRRT based on clinical, Imaging-Contrast CT/68Ga-DOTATATE PET-CT, and biochemical markers. After treatment, classification based on disease status, symptomatic improvement, and response to treatment based on Chromogranin A level was done. The organs involved and their respective survival benefits, as estimated by Kaplan Meier, were plotted for 60 months.

Results:
The mean serum Chromogranin A level at baseline was 2841 U/ml (Median = 3150). The main site of primary NET was in the pancreas, and the most common site for metastases was the liver. Following PRRT, all patients, except one, reported an improvement in their baseline complaints. Most (82%) reported no new symptoms, and 50% had a reduction in serum Chromogranin A levels. Follow-up imaging showed regression in one patient, static tumor in 18, and progression in rest. Considering radiological and clinical responses, the overall benefit was noticed in 29 (70%) patients. Despite symptomatic improvement, there was no significant survival benefit for those with pancreatic, liver, or nodal metastasis.

Conclusion:
A majority of patients who were treated with PRRT demonstrated clinical, radiological as well as biochemical positive responses warranting an earlier consideration for this well-tolerated treatment modality.
The Impact of Epigenetics on the Pathophysiology of Type 2 Diabetes and Associated Nephropathic Complications
Authors: Mukherjee Amit , Debbarman Tanusree , Banerjee Basu D. , Siddiqi Sheelu S. 
Published: December 2024

Abstract
Type 2 diabetes (T2D) is a long-term metabolic condition that presents considerable health challenges globally. As the disease progresses, the interplay between genetic, environmental, and lifestyle factors becomes increasingly evident, leading to complications. Epigenetics has emerged as a critical area of research, providing insights into how these factors can modify the expression and cellular behavior without altering the underlying DNA sequence. Various epigenetic mechanisms, including DNA methylation, histone modifications, chromatin remodeling, and non-coding RNA regulation, drive cell dysfunction, inflammation, and fibrosis, aggravating diabetes and its complications. Amongst all the complications diabetic kidney disease (DKD) also known as diabetic nephropathy (DN), is a significant microvascular complication often regarded as a silent killer, as early diagnosis remains highly complicated. This review investigates various epigenetic modifications associated with T2D and DKD, employing a database search strategy incorporating the PICO framework method to ensure comprehensive coverage of relevant literature. Advancements in epigenome profiling provide valuable insights into the functional outcomes and chromatin states of cells impacted by T2D. Understanding epigenetics thus emphasizes its crucial role in the development and progression of T2D and transition to DKD, while also highlighting the potential reversibility of epigenetic modifications and potency as a biomarker for predicting DKD. More extensive research is needed to identify specific epigenetic mechanisms involved in DKD to further refine predictive models and therapeutic strategies. This unified exploration of significant epigenetic modifications offers a focused analysis of how these alterations influence the trajectory of disease and presents new avenues for therapeutic intervention.
Surveying the Perceived Impact of Stress on Periodontal Health, Including Patient Experiences with Stress-related Periodontal Issues and Coping Mechanisms
Authors: Mathur Ritu 
Published: December 2024

Background::
Stress has been identified as a contributing factor to periodontal disease due to its impact on immune function and behavioral responses. This study aims to explore the perceived influence of stress on periodontal health from the patient’s perspective, focusing on stress-related periodontal issues and coping strategies.

Objectives::
The objectives of this study were to assess patient-reported experiences of stress-related periodontal problems and the coping mechanisms employed to manage these issues.

Materials and Methods::
A cross-sectional survey was conducted with 400 participants recruited from dental clinics and online platforms. The survey included questions about demographics, perceived effects of stress on periodontal health, common stressors, and coping mechanisms. Descriptive statistics, Chi-square tests, and logistic regression analyses were performed to identify significant associations.

Results::
Of the 400 participants, 65% (n = 260) reported experiencing periodontal issues related to stress. The most common symptoms were gum bleeding (40%), gum recession (30%), and tooth mobility (20%). Work-related stress was the most frequently cited source of stress (55%), and physical exercise (45%) was the most commonly reported coping mechanism. However, 35% of participants engaged in unhealthy coping behaviors, such as smoking or poor diet.

Conclusions::
The findings highlight the significant perceived impact of stress on periodontal health, with work and financial stress being major contributors. Although many participants utilized healthy coping mechanisms, a substantial proportion engaged in behaviors that could exacerbate periodontal disease. Dental professionals should consider stress management as part of comprehensive periodontal care.
Acute intraoperative fluid misdirection managed with anterior approach irido-zonulo-hyaloido-vitrectomy
Authors: Dikshit Siddharth , Tuluva Sushma , Senthil Sirisha 
Published: December 2024

Purpose:
To evaluate the causes of acute fluid misdirection (AFM) and the role of irido-zonulo-hyaloido-vitrectomy (IZHV) in the management of AFM.

Methods:
Among the 95,712 cataract surgeries performed between April 2017 and August 2022 at a tertiary center, six eyes of six patients developed intraoperative AFM and underwent IZHV through the anterior approach. AFM was diagnosed intraoperatively when there was sudden shallowing of the anterior chamber with markedly elevated intraocular pressures (IOPs) not attributable to external causes or choroidal effusion/hemorrhage. The condition resolved with deepening of AC following IZHV.

Results:
Five eyes had angle closure disease (one of them also had pseudoexfoliation), and one eye had open-angle glaucoma. The mean preop IOP was 25.8 ± 7.3 mmHg, with an IOP range of 18–36. The mean number of preop AGM was 3 ± 1.7. Four eyes developed AFM during combined cataract and trabeculectomy, and two eyes during cataract surgery. Four eyes had aqueous misdirection during or after cortical aspiration, and two eyes after creation of internal trabeculectomy ostium. IZHV was performed for all eyes through an anterior approach using a 23G vitrector, which resulted in instant resolution and deepening of the anterior chamber. The mean follow-up was 8.75 months (1–48 months), the mean postoperative IOP was 16.1 ± 2.6 mmHg, and the mean number of AGM at the last follow-up was 2.8 ± 2.2. The anterior chamber was deep, and IOP was under control in all eyes with four eyes needing AGM. One eye developed postoperative aqueous misdirection due to blockade of the IZHV opening.

Conclusion:
IZHV can be an effective solution for acute intraoperative AFM, which can be performed via an anterior approach by the anterior segment surgeon.
Visualizing the obscure– Chromophore-assisted retinal break detection
Authors: Verghese Shishir , Joseph Verghese 
Published: December 2024

Background:
Finding a retinal break which is responsible for retinal detachment is a critical step in the surgical treatment of this condition. In spite of improvement in visualization systems in pars plana vitrectomy, identifying the break which is the source of subretinal fluid (SRF) could pose a challenge, especially in complex retinal detachments or re-detachments with extensive laser scars.

Purpose:
The current technique of break identification involves direct detection of the break via peripheral indentation or using perfluorocarbon liquid (PFCL) to displace SRF from the posterior retina to the periphery and visualizing the proteinaceous SRF egress from the retinal break. In retinal detachments, if no peripheral breaks are visualized, surgeons tend to make a posterior draining retinotomy and drain SRF, the necessity of which can be confirmed after subretinal brilliant blue green (BBG) dye injection. In addition, in already vitrectomized eyes where it can be difficult to identify SRF egressing via the break, subretinal BBG dye provides a color contrast that enhances break visualization.

Synopsis:
A method to identify these occult breaks was required, which is described in this video. Hence, the idea of BBG dye injection into the subretinal space with a 41G subretinal needle was thought of. PFCL would be placed over the posterior pole, which would displace the dye to the periphery, and this would disperse out into the vitreous cavity into a blue plume via the break, thereby leading to its identification.

Highlights:
Subretinal dye injection is useful for occult retinal break detection as it provides a color contrast. A posterior draining retinotomy can be avoided. It is also useful in recurrent retinal detachments. We describe the use of BBG, which is the least toxic dye available, and report the use of this technique in Indian eyes.

Video Link:

https://youtu.be/JGXQjNV9asw
Klippel–Trenaunay syndrome presenting as pulmonary embolism in an elderly person
Authors: Surendran P. K. , Asha Krishnan L. , Ali Sayyad C. M. , Udayabhaskaran V. 
Published: December 2024

Abstract
An elderly woman was admitted with acute-onset breathlessness and right-sided chest pain suggestive of pleurisy. The initial impression of the chest X-ray was ‘right upper lobe consolidation’. Her hypertrophied leg along with the presence of large visible arteriovenous malformation was suggestive of Klippel–Trenaunay syndrome (KTS). A conscientious relook at the X-ray revealed other radiological features suggesting a possible pulmonary embolism. Subsequent D-dimer and echocardiography supported the diagnosis, and a computerised tomography pulmonary angiogram confirmed the same. Prompt systemic anticoagulation along with supportive therapy led to a smooth recovery of the patient over the next few days.
Guillain–Barré syndrome following Covishield vaccination in Telangana
Authors: Rao Veeramalla N. Madhava , Veeramalla Shivani , Tekuru Yogesh , Kandimalla Ramesh 
Published: December 2024

Abstract
We observed a noteworthy case of Guillain–Barré syndrome (GBS) in Telangana, India. The onset of GBS symptoms was observed 4 days after the patient received the initial dose of the Covishield ChAdOx1 nCoV-19 Corona recombinant virus vaccine. Our patient was a 54-year-old female with an unremarkable medical history. Her initial presentation included symmetrical weakness in the lower limbs, which subsequently progressed to involve the upper limbs, facial muscles and oropharyngeal area. Of particular note was the cranial nerve involvement, marked by facial paresis that advanced from House–Brackmann Grade III to Grade V within 2 days. The patient also reported severe dysaesthetic pain, and the condition exhibited a rapid progressive course, with the maximum deficit observed within just 7 days. Laboratory investigations, including magnetic resonance imaging of the lumbosacral spine, high-resolution computed tomography of the chest were normal. Administration of intravenous immunoglobulin had resulted in amelioration in muscle strength, paraesthesias and a complete remission of facial weakness. On re-evaluation at 2-months only mild residual weakness, hyporeflexia and an absence of sensation of sensory modalities were evident.
Role of Dobutamine Stress Echocardiography in the Evaluation of Patients Undergoing Noncardiac Surgeries in the Contemporary Era
Authors: Chaudhary Tanu , Bansal Manish , Kasliwal Ravi R. 
Published: December 2024

Abstract

Objective:
Dobutamine stress echocardiography (DSE) is a widely used diagnostic modality for preoperative cardiac risk assessment in patients undergoing major noncardiac surgeries. However, its role in facilitating safe noncardiac surgery in the contemporary era needs to be evaluated.

Materials and Methods:
A total of 1283 participants (mean age – 63.8 years and 54.9% males) undergoing DSE for preoperative cardiac evaluation before nonemergent, noncardiac, major surgeries were included. DSE findings were recorded, and the Revised Cardiac Risk Index or Lee’s score was also calculated. The patients were followed up for in-hospital adverse cardiac events.

Results:
DSE showed evidence of inducible myocardial ischemia in 19 (1.5%) patients, whereas Lee’s score was elevated (>3) in 43 (3.4%) patients. The overall in-hospital event rate was 0.7%. Among 1264 patients with normal DSE, 5 (0.4%) had a perioperative cardiac event (negative predictive value 99.6%). Of the 19 patients with abnormal DSE, all underwent coronary angiography which was abnormal in 16 patients. Of these 16 patients, 4 had a perioperative cardiac event. A Lee’s score value >3 had a sensitivity of 68.4% (95% confidence interval [CI] - 43.5–87.4), specificity of 97.6% (95% CI - 96.6–98.4), positive predictive value of 30.2% (95% CI - 21.4–40.9), and negative predictive value of 99.5% (95% CI - 99.1–99.8) for predicting abnormal DSE.

Conclusion:
Our study reinforces the clinical utility of DSE in facilitating major, nonemergent, noncardiac surgeries in a contemporary setting in India. A normal DSE had a very high negative predictive value for an adverse cardiac event, whereas an abnormal DSE identified the population at high risk for perioperative cardiac events requiring appropriate risk mitigation strategies.
Blood Pressure Variability as a Predictor of Left Atrial Dilatation in Hypertensive Patients: A Comparative Cross-sectional Study
Authors: Setouhi Amr , Taha Mohammad-Alaa S. , Ibrahim Alaa M. , Farrag Hazem M. A. 
Published: December 2024

Abstract

Background:
Short-term blood pressure variability (BPV) has been associated with adverse cardiovascular outcomes, but its impact on left atrium (LA) function and structure remains unclear. This study aims to explore the relationship between short-term BPV and LA function in patients with controlled and uncontrolled hypertension, using speckle-tracking echocardiography (STE).

Methods:
In this cross-sectional study, 150 hypertensive patients were recruited and categorized into controlled and uncontrolled hypertension groups based on ambulatory blood pressure (BP) monitoring. BPV was calculated from 24-h ambulatory BP recordings, and LA function was assessed using STE to measure LA volume, strain, and strain rate parameters. Univariate and multivariate analyses were performed to investigate associations between BPV and LA functions.

Results:
Higher short-term BPV was significantly associated with impaired LA function, including reduced LA strain and increased LA volume index, in both hypertensive groups. After adjusting for confounding factors such as age, body mass index, and duration of hypertension, BPV remained an independent predictor of LA dysfunction (P < 0.01). The relationship was more pronounced in the uncontrolled hypertension group.

Conclusion:
Short-term BPV is independently associated with left atrial dysfunction in hypertensive patients, particularly in those with uncontrolled hypertension. These findings suggest that BPV could serve as a potential marker for early left atrial remodeling in hypertensive populations, providing insights for better risk stratification and management.