bluuebunny/crossref_metadata_2025_split huggingface dataset:
Recapitulation of Evidence of Phytochemical, Pharmacokinetic and
Biomedical Application of Silybin
Authors: Islam Anas , Mishra Anuradha , Siddiqui Md Aftab , Siddiquie Saman 
Published: July 2021

AbstractSilymarin is a standardized extract obtained from seeds of Silybum marianum (SM)
belonging to the family Asteraceae. It is a flavonolignan complex and consists
of various compounds like silybin A silybin B, isosilybin A, isosilybin B,
silydianin, silychristin and isosilychristin. Silybin is the major active
component present in 60–70% of the silymarin extract. It has
been used traditionally for the treatment of various liver disorders like
cirrhosis, jaundice, and hepatitis. Silymarin possesses antioxidant and
anti-inflammatory properties and is responsible for its antitumor activity.
Other than hepatoprotective effect SM also possesses renoprotective,
anti-diabetic, neuroprotective, hypolipidemic, anti-atherosclerosis and
cardioprotective effects. Rather antimicrobial property of silymarin was
observed against specific microbes, fungi, and viruses. This manuscript covered
recent preclinical and clinical evidence of specific components silybin,
responsible for its efficacy and about clinical studies has been conducted so
far, which proven it’s safety and offers mild effect like nausea,
diarrhea and bloating. This review specifically focused on recent updates on its
active components therapeutic applications against complicated ailments not
covered in earlier reports.
Novel Endoscopic Management of Colovesical Fistula Secondary to Colonic Diverticular Disease
Authors: Mallaiyappan Murugesh , Sankarapandian Ganesh Prasad , Sarveswaran Venugopal , TB Noufal , Venkatesan Jothiprasad , Venugopal Vishmaya 
Published: July 2021

AbstractColovesical fistula (CVF) is an abnormal communication between bowel and urinary bladder. Most common cause is complicated colonic diverticular disease. The treatment of choice for CVF is surgery. Conservative treatment is reserved for highly selected patients who are unfit for definitive surgery. We report the case of an 86-year-old gentleman with multiple comorbidities, who presented with pneumaturia, fecaluria, and recurrent urinary tract infection. He was diagnosed to have sigmoid colonic diverticulosis with a CVF and was successfully managed with the novel combined endoscopic approach (a simultaneous cystoscopy and flexible colonoscopy), which could be the first to be reported from India.
Functional Changes of the Upper Esophageal Sphincter in Gastroesophageal Reflux
Authors: Dantas Roberto Oliveira 
Published: July 2021

Abstract
Introduction The upper esophageal sphincter (UES) is a muscular structure located at the transition from the pharynx to the esophagus, with the cricopharyngeal muscle as the most important component. During gastroesophageal reflux, the pressure in the UES elevates, which is apparently a protective mechanism to prevent esophagopharyngeal reflux and airway aspiration. In gastroesophageal reflux disease (GERD), there may be functional changes in the UES.
Objective The objective of the present review was to determine UES functional changes in GERD.
Data Synthesis In healthy individuals, gastroesophageal reflux causes an increase in the UES pressure. This response of the sphincter is at least partially impaired in patients with GERD. In the disease, the UES has a reduced length and decreased resting pressure. However, other publications found that in chronic gastroesophageal reflux the basal sphincter pressure increase, differences which may be consequent to the measurement method or to disease severity. The UES opening during swallowing has a smaller diameter, and the bolus transit time through the sphincter is longer.
Conclusion The UES of patients with GERD does not open as expected and the bolus flow through the sphincter is longer. This behavior may be associated with dysphagia, a frequent complaint in patients with GERD.
Endoscopic Submucosal Hydrodissection with Paradoxical Movement of the Colonoscope Using Hybrid Knife “Traction Mode” for Malignant Polyp in the Cecum
Authors: Ramos-Zabala Felipe 
Published: July 2021

AbstractThe water-jet hydro dissection technique has been shown to be effective for colorectal tumors. This case report illustrates type T hybrid knife for the elevation of the submucosal layer, cutting the mucosa and dissecting submucosal fibers. ESD was performed using ERBEJET 2 hydrodissection system and hybrid Knife. The resection was completed en bloc within 135 minutes without adverse events. Pathology examination revealed a well-differentiated adenocarcinoma confined to the shallow submucosal layer with free resection margins.
Morphology and Biochemistry of Ovulation
Authors: Medeiros Sebastião Freitas de , Barbosa Bruna Barcelo , Medeiros Matheus Antonio Souto de , Yamamoto Márcia Marly Winck 
Published: July 2021

AbstractThe process of ovulation involves multiple and iterrelated genetic, biochemical, and morphological events: cessation of the proliferation of granulosa cells, resumption of oocyte meiosis, expansion of cumulus cell-oocyte complexes, digestion of the follicle wall, and extrusion of the metaphase-II oocyte. The present narrative review examines these interrelated steps in detail. The combined or isolated roles of the follicle-stimulating hormone (FSH) and luteinizing hormone (LH) are highlighted. Genes indiced by the FSH genes are relevant in the cumulus expansion, and LH-induced genes are critical for the resumption of meiosis and digestion of the follicle wall. A non-human model for follicle-wall digestion and oocyte release was provided.
A Collaborative Partnership between the Multicenter Handoff Collaborative and an Electronic Health Record Vendor
Authors: Hong Mershon Bommy , Vannucci Andrea , Bryson Trent , Lin Felix , Greilich Philip E. , Dear Guy , Guffey Patrick , Agarwala Aalok 
Published: July 2021

Abstract
Objectives The operating room is a specialized, complex environment with many factors that can impede effective communication during transitions of care between anesthesia clinicians. We postulated that an efficient, accessible, standardized tool for intraoperative handoffs built into standard workflow would improve communication and handoff safety. Most institutions now use an electronic health record (EHR) system for patient care and have independently designed intraoperative handoff tools, but these home-grown tools are not scalable to other organizations and lack vendor-supported features. The goal of this project was to create a standardized, intraoperative handoff tool supported by EHR functionality.
Methods The Multicenter Handoff Collaborative, with support from the Anesthesia Patient Safety Foundation, created a working group of frontline anesthesia experts to collaborate with a development team from the EHR vendor (Epic Systems) to design a standardized intraoperative handoff tool. Over 2 years, the working group identified the critical elements for the tool and software usability, and the EHR team designed a standardized intraoperative handoff tool that is accessible to any institution using this EHR.
Results The first iteration of the intraoperative handoff tool was released in August 2019, with a second version in February 2020. The tool is standardized but customizable by individual institutions.
Conclusion We demonstrate that work on complex health care processes critical to patient safety, such as handoffs, can be performed on a national scale through cross-industry collaboration. Frontline experts can partner with health care industry vendors to design, build, and release a product on an accelerated timeline.
First Study of the Prevalence and Characterization of Brachial Plexus Injuries in Guatemala
Authors: González Lemus Carmen Joanna , Romero Prieto Fernando Xavier 
Published: July 2021

Abstract
Objective This study aimed to estimate the prevalence of brachial plexus injuries and to characterize clinically and epidemiologically patients with brachial plexus injury.
Materials and Methods In this cross-sectional descriptive study, 2,923 medical records of patients aged 1 to 64 years who presented at outpatient peripheral nerve unit of the Orthopedic Surgery Department of Hospital Roosevelt, Guatemala, from January 2017 to December 2017, were prospectively analyzed to identify the prevalence and factors associated with brachial plexus injuries.
Results The prevalence rate of brachial plexus injuries in patients was 5.74%. This injury is more common in men (90.5%) aged 24 to 64 years. Brachial plexus injuries occurred secondary to motorcycle accident in 72% of the cases, with the majority affecting the dominant upper extremity. In addition, 64.28% of the patients took 1 to 6 months to seek consultation, whereas only 16.07% requested medical assistance <1 month from the onset of symptoms, and this result was associated with early diagnosis and adequate recovery during follow-up. Furthermore, 66.67% presented upper brachial plexus injury with no associated fractures or vascular injury, manifesting distress while performing daily activities that required hand, arm, and elbow movements.
Conclusion The risk of suffering BPIs in Guatemala increases in economically active male patients that use motorcycles as main mode of transportation. Patients should consult immediately after injury onset to optimize management results. For this reason, hospitals must develop specialized clinical guidelines to speed up the identification and treatment of BPI injuries.
Gastric Foreign Bodies in Prison Inmates
Authors: Kumar Manish , Sachdeva Sanjeev , Kumar Ajay , Sonika Ujjwal , Gupta Manish , Srivastava Siddharth , Dahale Amol , Dalal Ashok 
Published: July 2021

Abstract
Objective Gastric foreign bodies are a common problem brought to an endoscopist. Prisoners are more prone to ingesting unusual foreign bodies for a secondary gain. The objective of this study was to study the profile of foreign body ingestion among the prisoners brought to a tertiary care center.
Methods This is a retrospective case series. All the prisoners brought for endoscopic removal of foreign bodies between January 2018 to December 2019 were included in the analysis. Patients’ baseline characteristics, type of foreign body, management, and outcome were noted
Results A total of eight inmates presented with ingestion of foreign body to our department. Most common foreign bodies ingested were drug packets and mobile phones. All ingestions were for secondary gain. Endoscopic removal was successful in all cases.
Conclusion Endoscopic removal can be tried with all necessary precautions by an expert endoscopist.
Sexuality of Female Spina Bifida Patients: Predictors of a Satisfactory Sexual Function
Authors: Motta Guilherme Lang , Bujons Anna , Quiróz Yesica , Llorens Erika , Zancan Maira , Rosito Tiago Elias 
Published: July 2021

Abstract
Objective To assess the sexual function of women with spina bifida (SB), and to verify the factors that influence their sexual function.
Methods A cross-sectional study in which a validated female-specific questionnaire was applied to 140 SB female patients from four different cities (Porto Alegre, Brazil; and Barcelona, Madrid, and Málaga, Spain) between 2019 and 2020. The questionnaires collected data on the clinical characteristics of SB, and female sexual function was assessed using the 6-item version of the Female Sexual Function Index (FSFI-6) validated to Portuguese and Spanish.
Results Half of the patients had had sexual activity at least once in the life, but most (57.1%) did not use any contraception method. Sexual dysfunction was present in most (84.3%) patients, and all sexual function domains were impaired compared those of non-neurogenic women. The presence of urinary and fecal incontinence significantly affected the quality of their sexual activity based on the FSFI-6.
Conclusion The specific clinical aspects of the SB patients, such as urinary and fecal incontinence, should be properly addressed by their doctors, since they are associated with reduced sexual activity and lower FSFI-6 scores in the overall or specific domains. There is also a need to improve gynecological care among sexually-active SB patients, since most do not use any contraceptive methods and are at risk of inadvertent pregnancy.
Severity of Maternal SARS-CoV-2 Infection in Pregnancy Predicts Neonatal Outcomes
Authors: Yasa Beril , Memur Seyma , Ozturk Dilek Yavuzcan , Bagci Onur , Uslu Sait Ilker , Polat Ibrahim , Cetinkaya Merih 
Published: July 2021

Objective The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak had an enormous global impact. Pregnant women with SARS-CoV-2 appear to have higher morbidity and mortality. This study aimed to evaluate the effect of the severity of maternal SARS-CoV-2 infection on neonatal outcomes.
Study Design The clinical and laboratory data of 40 women and neonates evaluated retrospectively.
Results This retrospective study showed that SARS-CoV-2 infection had an adverse impact on neonatal outcomes proportionally with the maternal disease severity including increased prematurity rates, postnatal resuscitation need, prolonged hospital stay and longer ventilatory support requirement in infants born to mothers with moderate or severe disease.
Conclusion Maternal disease severity had adverse effects on neonatal outcomes. The severity of maternal disease was found to be associated with increased rates of prematurity, requirement of postnatal resuscitation, prolonged hospital stay, and longer ventilatory support.
Key Points
The Status of Interventional Radiology as a Specialty among Medical Students in India—Knowledge, Interest, and Exposure
Authors: Sebastian Bibin , Keshava Shyamkumar N. , Lakshminarayan Raghuram 
Published: July 2021

Abstract
Purpose Interventional radiology (IR) is a young medical specialty where image guidance is utilized in minimally invasive procedures as a treatment option and/or as a diagnostic tool. There is an exponential increase in awareness and interest in IR amongst medical students. This trend is continuing despite lack of proportionate representation of IR in the current medical curriculum. This study aims to understand the exposure to IR as a specialty amongst medical students in India.
Materials and Methods Anonymous, voluntary, online questionnaire was sent to medical students from different parts of the country. The survey comprised 15 questions regarding exposure and awareness on IR.
Results The responses were obtained from 1,024 medical students from 98 medical colleges across the country, majority (57.0%) in the clinical years of their training. Thirty-six percent of them were interested in an IR career. Lack of awareness was the most (61.6%) cited reason for not choosing an IR career. Majority (57.9%) would consider IR as a clinical management option and believe that IR holds an important place in medical practice (68.4%).
Conclusion There is an evident under-representation of IR in the medical curriculum. However, an increasing awareness and interest among medical students toward IR as a specialty is demonstrated. Incorporation of IR into current medical curriculum in a systematic way is the need of the hour. This would ultimately benefit a wide cohort of patients across multiple specialties.
Analysis of Factors Affecting Air Kerma Area Product Obtained during Uterine Artery Embolization Procedures Using Logistic Regression
Authors: Soliman Khaled , Almutairi Ahmed , AlHarbi Murdhi , Almutairi Khaleel , Almutairi Turky , Bakkari Mousa 
Published: July 2021

Abstract
Purpose Uterine artery embolization (UAE) is a common interventional radiology procedure used in medicine; the procedure is safe but there is always a concern regarding radiation dose received by the patient. The aim of this study was to use multivariable logistic regression analysis (MLRA) to study a certain number of independent prognostic variables believed to provide an estimate of the likelihood of obtaining a high kerma area product (P
KA) at the end of the procedure.
Method Radiation dose indices registered by the angiographic system structured dose report, the total fluoroscopy time (FT), the patient’ body mass index (BMI), the number of images taken during the procedures (IMGS), and the performing physician experience (EXPER) were used to drive a logistic regression model (LRM).
Results The LRM found was: Logit (P
KA) = −6.1525 + 0.0416 (FT) + 0.1028 (IMGS) + 0.1675 (BMI) – 0.1012 (EXPER). The prediction accuracy of the LRM was assessed using receiver operating characteristic (ROC) curve; by calculating the area under the curve (AUC), we found AUC = 0.7896, with optimal ROC point of 0.3261, 0.8036.
Conclusion The suggested LRM seems to indicate that patients with higher BMI, have taken longer FT, acquired higher IMGS and the procedure done by a less experienced performing physician is more susceptible to receive a higher P
KA at the end. The proposed LRM is useful in predicting the occurrence of higher radiation exposure interventions and can be used in patients’ radiation dose optimization strategies during UAE procedures.
Idiopathic Pulmonary Hemosiderosis: An Unexplored Cause of Treatment Refractory Pediatric Iron Deficiency Anemia
Authors: Reghunath Anjuna , Biswas Joyutpal , Mittal Mahesh Kumar , Kanaujiya Reeta , Khanna Geetika 
Published: July 2021

AbstractIdiopathic pulmonary hemosiderosis (IPH) is an unusual cause of pediatric iron deficiency anemia (IDA) characterized by alveolar hemorrhage leading to hemosiderin deposition and fibrosis in the lungs. Though the typical triad of presentation is hemoptysis, IDA, and lung opacities on thoracic radiographs, often the sole manifestation of IPH may be severe IDA in children.
Evaluation of White Matter Tracts Fractional Anisotropy Using Tract-Based Spatial Statistics and Its correlation with Amyotrophic Lateral Sclerosis Functional Rating Scale Score in Patients with Motor Neuron Disease
Authors: Mohan Amutha Bharathi , Adithan Subathra , Narayan Sunil , Krishnan Nagarajan , Mathews Donna 
Published: July 2021

Abstract
Background Motor neuron diseases cause progressive degeneration of upper and lower motor neurons. No Indian studies are available on diffusion tensor imaging (DTI) findings in these patients.
Aims This study was done to identify white matter tracts that have reduced fractional anisotropy (FA) in motor neuron disease (MND) patients using tract-based spatial statistics and to correlate FA values with Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R) score.
Settings and Design A case–control study in a tertiary care hospital.
Materials and Methods We did DTI sequence (20 gradient directions, b-value 1,000) in 15 MND patients (10 men and 5 women; mean age: 46.5 ± 16.5 years; 11 amyotrophic lateral sclerosis [ALS], 2 monomelic amyotrophy, 1 progressive muscular atrophy, and 1 bulbar ALS) and 15 age- and sex-matched controls. The data set from each subject was postprocessed using FSL downloaded from the FMRIB Software Library, Oxford, United Kingdom (http://www.fmrib.ox.ac.uk/fsl).
Statistical Analysis The statistical permutation tool “randomize” with 5,000 permutations was used to identify voxels that were different between the patient data set and the control data set. Mean FA values of these voxels were obtained separately for each tract as per “JHU white-matter tractography atlas.” SPSS was used to look to correlate tract-wise mean FA value with ALSFRS-R score.
Results We found clusters of reduced FA values in multiple tracts in the brain of patients with MND. Receiver operating characteristic curves plotted for individual tracts, showed that bilateral corticospinal tract, bilateral anterior thalamic radiation, bilateral uncinate fasciculus, and right superior longitudinal fasciculus were the best discriminators (area under the curve > 0.8, p < 0.01). FA values did not correlate with ALFRS-R severity score.
Conclusion In MND patients, not only the motor tracts, but several nonmotor association tracts are additionally affected, reflecting nonmotor pathological processes in ALS.
Multifocal Osseous Tuberculosis Mimicking Langerhans’ Cell Histiocytosis: A Case Series
Authors: Singh Rashmi , Naranje Priyanka , Kandasamy Devasenathipathy , Jana Manisha , Gupta Aditya K. , Ramateke Prashant P. 
Published: July 2021

AbstractLangerhans cell histiocytosis (LCH) is a common cause of multifocal lytic skeletal lesions in children. However, multifocal osseous tuberculosis can affect children and mimics LCH on imaging, especially in endemic regions. We report cases with atypical manifestations of multifocal osseous tuberculosis which were presumptively diagnosed as LCH. The findings of our series of cases suggest that on computed tomography (CT) irregular sclerotic margins, abscess formation, sclerosis of involved bone, and button sequestrum point toward a diagnosis of multifocal osseous tuberculosis, especially in endemic regions.
Imaging in a Rare Case of Unilateral External and Middle Ear Anomalies Associated with Inner Ear Malformation
Authors: Joshi Anagha R. , Talreja Anisha O. , Rahatgaonkar Mrinalini M. , Badgujar Harshal A. 
Published: July 2021

AbstractExternal ear malformations are commonly associated with middle ear malformations due to their closely related embryogenesis. Inner ear anomalies are less consistently seen due to their independent development. Cross-sectional imaging has come to play a critical role in the workup of congenital deafness in the pediatric age group. To optimize speech and language development, early diagnosis and treatment are very crucial. Identification of these anomalies is additionally important when operative intervention is being planned because they may complicate or perhaps preclude the surgery.
The Bubble Eye Sign: Understanding the Radiological Imaging of Gas inside the Orbit
Authors: Au Sunny C. L. , Ko Callie K. L. 
Published: July 2021

AbstractGas, appears as radiolucent on X-ray, is normally absent in the orbit. However, intraocular surgeries occasionally utilize retained intraocular gas for tamponade effect. Intravitreal gas persists after retinal surgery, being confounded by the scleral shell of the operated eye, outlines the shape of the eyeball, and gives the characteristic bubble appearance on skull X-ray. This is different from orbital emphysema caused by orbital fracture when gas is located outside the globe but confined by the orbit, giving a crescent or concave shape over the superior orbit usually. Falls is common after intraocular retinal surgeries due to change of usual stereopsis, prolonged prone posturing, and other systemic comorbidities. By identifying the “Bubble Eye sign” described, attending physician should alert the presence of intravitreal gas, most commonly iatrogenic. Further ophthalmological history taking and examinations are thus indicated, instead of exposing patients to unnecessary radiation under computed tomography scan for orbital fracture investigation.