bluuebunny/crossref_metadata_2025_split huggingface dataset:
Types of Posterior Capsular Breaks and Their Surgical Implications
Authors: Angra Surinder K , Vajpayee Rasik B , Titiyal Jeevan S , Sharma Yog R , Sandramouli S , Kishore Kamal 
Published: April 2021

ABSTRACT
We studied the pathogenesis, clinical features, and management of posterior capsular breaks in 28 cataract patients during planned extracapsular cataract extraction and intraocular lens implantation surgery. In the age-related cataract group (17 cases), the posterior capsular breaks were fresh, caused by the irrigation-aspiration cannula. Located in the upper part of the posterior capsule, they had thin margins and tended to enlarge with continued irrigation. Nine (52.9%) of these breaks could be plugged with viscoelastic, and after dry aspiration, a posterior chamber lens was implanted successfully. Posterior capsular breaks in traumatic cataracts (11 cases) were preexisting but were detected only during surgery. Centrally located, they had thick fibrosed margins and remained the same size during irrigation- aspiration. The minimal vitreous herniation seen in four (35.3%) of these cases was managed by automated partial anterior vitrectomy through the break. A posterior chamber intraocular lens was implanted in all these cases.
Isolated Fractures of the Orbital Floor: Risk of Infection and the Role of Antibiotic Prophylaxis
Authors: Westfall Christopher T , Shore John W 
Published: April 2021

ABSTRACT
The application of antibiotic prophylaxis to fractures of the orbital floor is controversial. The incidence of infection following this injury remains undefined. We report a case of orbital cellulitis following orbital floor fracture, and attempt to define guidelines for the appropriate use of antibiotics in the setting of an isolated blowout fracture.
Use of High-Density Vitreous Substitutes in the Removal of Posteriorly Dislocated Lenses or Intraocular Lenses
Authors: Liu Kwan-Rong , Peyman Gholam A , Chen Muh-Shy , Chang Kuo-Bin 
Published: April 2021

ABSTRACT
We successfully used high-density vitreous substitutes to remove four dislocated crystalline lenses and three dislocated intraocular lenses (IOLs) from the vitreous cavity. Fluorosilicone oil (300 cs) was used to remove the four lenses and one of the IOLs. Perfluorophenanthrene (Vitreon®! was used to remove the other two dislocated IOLs. The dislocated lenses or 1OLs were floated by the high-density vitreous substitutes and removed safely without damaging the retina; there were no intraoperative complications. Postoperative residual fluorosilicone oil droplets were found in one case.
Using Healon® to Identify the Lumen of the Sac in Dacryocystorhinostomy
Authors: Shiwa Toshihiko , Tazawa Yutaka 
Published: April 2021

ABSTRACT
Sodium hyaluronate (Healon®) injected into the lacrimal sac, facilitates a full-thickness cut of the lacrimal sac in cases in which it is difficult to identify the lumen of the sac. The sodium hyaluronate does not stain tissues, is effective for hemostasis, and is easily irrigated.
A full-thickness cut of the lacrimal sac is required to ensure exact mucosal suturing in dacryocystorhinostomy. However, in cases involving a hypertrophic sac wall, a small lumen of the sac, or earlier perforation of the sac, it is sometimes difficult to identify the lumen during surgery. We describe how sodium hyaluronate, injected into the sac via a canaliculus, can facilitate identifying the lumen in this situation.
A Comparison of Sevoflurane versus Sevoflurane-Propofol Combination on Renal Function in Patients Undergoing Valvular Heart Surgery—A Prospective Randomized Controlled Pilot Study
Authors: Jose Reshmi L. , Damayanathi Deepa , Unnikrishnan Koniaparambil P. , Suneel Puthuvassery R. 
Published: April 2021

Aim:
The objective of the present study was to compare the effect of sevoflurane with the sevoflurane-propofol combination on renal function in patients undergoing valvular heart surgery. The renal protective effect was assessed using a novel marker called neutrophil gelatinase-associated lipocalin (NGAL).

Materials and Methods:
This was a prospective randomized controlled pilot study conducted at a tertiary care center in India. The study enrolled 36 patients undergoing elective valvular heart surgery, but only 31 were included. All the patients were randomized into two groups, that is, 15 in the sevoflurane group (S-group) and 16 in the sevoflurane–propofol group (SP-group). The baseline NGAL level and test NGAL level at 4 h after cardiopulmonary bypass were measured.

Results:
There was a significant rise in the test NGAL levels compared to baseline in both the groups. The test NGAL level in the S-group was significantly high compared to that of the SP-group (P = 0.034). The number of patients with acute kidney injury was less in the SP-group without reaching statistical significance (P = 0.210).

Conclusion:
Renal function was better preserved in patients anesthetized with a combination of sevoflurane and propofol. This could be due to the enhanced protective effect on renal function by both sevoflurane and propofol.
Comparative Study of Intranasal Dexmedetomidine v/s Midazolam for Sedation of Pediatric Patients During Transthoracic Echocardiography
Authors: Panda Suvendu , Pujara Jigisha , Chauhan Ankit , Varma Abhishek , venuthurupalli Rajesh , Pandya Himani , Patel Sanjay 
Published: April 2021

Background:
Procedural sedation required to improve the quality of Transthoracic Echocardiography (TTE) in infants and children. The ideal drug and route for sedation in children should have a rapid and reliable onset, atraumatic, palatable with minimal side effects, and rapid recovery. So, the aim of our study to evaluate and compare the efficacy and safety of intranasal midazolam and intranasal dexmedetomidine in pediatric patients for sedation during TTE.

Materials and Method:
Hundred children under three year of age, belonging to the American Society of Anaesthesiologists class-I and II, scheduled for TTE were divided into two groups by standard randomization technique. Patients in group-M received intranasal midazolam 0.2 mg/kg, whereas patients in group-D received intranasal dexmedetomidine 2 μg/kg prior to TTE under an adequately monitored anesthesia care. Onset and duration of sedation, heart rate, oxygen saturation, sonographer's, and parent's satisfaction scores were recorded.

Results:
All patients were successfully sedated for TTE. The average onset time, sedation time, awakening time and total time for Group-M were 7.3, 18.8, 29.51, 51 min and group-D were 10.1, 14.2, 24.9, 46.3 min, respectively and all were statistically significant (P < 0.001). TTE scan time of Group-M is 8.84 min and Group-D is 9.18 min and was statistically significant. Sonographer's and Parent's average satisfaction score for Group-M was 9.88, 10 and for Group-D was 7.64, 8.76, respectively, which were statistically significant (P < 0.001).

Conclusion:
Intranasal midazolam and dexmedetomidine are safe and effective for sedation in TTE. Intranasal midazolam was found to be comparatively more effective in view of onset of action, sonographers, and parental satisfaction score, while sedation time, awakening time and total duration was significantly higher as compared to intranasal dexmedetomidine.
Combined off Pump Coronary Artery Bypass Graft and Liver Transplant
Authors: Juneja Rajiv , Kumar Ajay , Ranjan Rajeev , Hemantlal P M , Mehta Yatin , Wasir Harpreet , Vohra Vijay , Trehan Naresh 
Published: April 2021

Background:
Prospective recipients of liver transplant (LT) have a high prevalence rate of coronary artery disease (CAD) requiring revascularization. In patients of Child Turcot Pugh Class B and C performing LT prior to cardiac revascularization on cardiopulmonary bypass leads to a high risk of major adverse cardiovascular events (MACE). Whereas, isolated cardiac surgery prior to LT has perioperative risk of coagulopathy, sepsis, and hepatic decompensation. We present four cases of end stage liver disease who underwent concomitant living donor liver transplant (LDLT) with off pump coronary artery bypass graft (OPCAB) in an effort to decrease the morbidity and mortality.

Methods:
The cases were performed in a tertiary care centre over two years. Four patients scheduled for LDLT, who were diagnosed with significant CAD, underwent single sitting OPCAB and LDLT. Cardiac surgery was performed first and once patient was stable, it was followed by LDLT. The morbidity parameters in terms of duration of intubation, blood transfusion, hospital stay, ICU stay, requirement of dialysis, atrial fibrillation and sepsis was compared with similar studies.

Results:
The blood transfusion requirement (median 8 units PRBC), incidence of atrial fibrillation (25%), sepsis (25%), and renal dysfunction (0%) was less than the combined surgery conducted on cardiopulmonary bypass. The rate of median intubation time, length of ICU stay, hospital stay, and one year mortality rate was comparable with other studies.

Conclusions:
Morbidity with combined OPCAB and LDLT is less than combined on pump coronary artery bypass surgery with LDLT. Combined CABG with LDLT may be performed with acceptable outcomes in CTP class B and C cirrhosis.
Factors Associated with Delirium after Cardiac Surgery
Authors: Ordóñez-Velasco Lina Maria , Hernández-Leiva Edgar 
Published: April 2021

Background:
Delirium is a frequent complication after cardiac surgery and is associated with a higher incidence of morbidity and mortality and a prolonged hospital stay. However, knowledge of the variables involved in its occurrence is still limited; therefore, in this study, we evaluated the perioperative risk factors independently associated with this complication.

Methods:
This study was conducted in a referral tertiary care university hospital with a cardiovascular focus. A total of 311 consecutive adult patients undergoing any type of cardiac surgery were evaluated. The subjects were examined at regular intervals in the postoperative period using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) tool.

Results:
The incidence of postoperative delirium (PD) was 10%. Among the 18 pre-, intra- and postoperative variables evaluated, the logistic regression analysis showed that low education level, history of diabetes or stroke, type of surgery, prolonged extracorporeal circulation, or red blood cell transfusion in the intra- or postoperative period were independently associated with delirium after cardiac surgery. An increased body mass index was identified as a protective factor.

Conclusions:
The aforementioned risk factors are significantly and independently associated with the presentation of PD. Because some of these factors can be treated or avoided, the results of this study are highly relevant to reduce the risk of this complication and improve the care of patients undergoing cardiac surgery.
Blood donation among university students: Practices, motivations, and barriers in Saudi Arabia
Authors: Mahfouz Mohamed Salih , Ryani Majed , Nawar Hamzi Ahmed Saleh , Zaeri Dhaifallah Abdullah , Dahdoh Abdullah Abdulrahman , Almalki Abdulaziz Jaber , Jubran Hakami Ahmed Ali , Abkr Aqeeli Abdu Ahmed , Tawashi Ibrahim Hussien 
Published: April 2021

Abstract
Context: Blood transfusion is an essential medical procedure conducted with various purposes to provide patients with blood needed. The procedure saves patients’ lives, as blood cannot be manufactured artificially and can only be obtained from human blood sources. Aims: To assess the awareness of, perceptions of, motivations regarding, and barriers to blood donation among a sample of Jazan University students in the Kingdom of Saudi Arabia (KSA). Settings and Design: An observational cross-sectional study was conducted among the undergraduate students of Jazan University. Materials and Methods: Stratified random sampling was used to collect information from 440 students, and a predesigned, structured questionnaire was used to collect data on the study variables. Statistical Analysis: Involved descriptive statistics and inferential statistics. SPSS was used for data analysis. Results: The prevalence of blood donation was 29.0% (95% CI, 25.0–33.3), significantly higher for males at 44.3% (95% CI, 38.3–50.4) than for females at 10.5% (95% CI, 7.3–16.0; P < 0.001), and with odds ratio (OR) = 6.8; [95% CI, 4.1–11.2] than females. Students’ level of knowledge regarding blood donation was low. The main barriers to blood donation were identified as being unqualified for blood donation (57.5%) and risk of contracting infectious disease (48.7%) and the desire to donate in the future to a close friend (38.6%). The main motivations for donating blood were identified as religious reasons (77.5%), altruism (77.5%), and to serve the homeland and meet the call of need (77.5%). Conclusions: The prevalence of blood donation was found to be low, and students’ knowledge regarding blood donation appeared to be lacking. The development of awareness programs among the university’s students will address students’ misconceptions about blood donation and encourage them to join donation campaigns.
Key Messages: Students’ knowledge regarding blood donation appeared to be lacking. The prevalence of blood donation was also not satisfactory. Being unqualified for blood donation and fear and misconceptions regarding blood donation were observed to be the main causes of non-donation. The development of awareness programs among the university’s students will encourage them to join donation campaigns.
Rapid Multiplex Loop-Mediated Isothermal Amplification (m-LAMP) Assay for Differential Diagnosis of Leprosy and Post–Kala-Azar Dermal Leishmaniasis
Authors: Joshi Shweta , Dixit Keerti K. , Sharma Vanila , Ramesh V. , Singh Ruchi , Salotra Poonam 
Published: April 2021

Abstract.Leprosy and post–kala-azar dermal leishmaniasis (PKDL) are co-endemic neglected tropical diseases often misdiagnosed because of close resemblance in their clinical manifestations. The test that aids in differential diagnosis of leprosy and PKDL would be useful in endemic areas. Here, we report development of a multiplex loop-mediated isothermal amplification (m-LAMP) assay for differential detection of Mycobacterium leprae and Leishmania donovani using a real-time fluorometer. The m-LAMP assay was rapid with a mean amplification time of 15 minutes, and analytical sensitivity of 1 fg for L. donovani and 100 fg for M. leprae. The distinct mean Tm values for M. leprae and L. donovani allowed differentiation of the two organisms in the m-LAMP assay. Diagnostic sensitivity of the assay was evaluated by using confirmed cases of leprosy (n = 40) and PKDL (n = 40) (tissue and slit aspirate samples). All the leprosy and PKDL samples used in this study were positive by organism-specific QPCR and loop-mediated isothermal amplification assays. The diagnostic sensitivity of the m-LAMP assay was 100% (95% CI: 91.2–100.0%) for detecting PKDL and 95% for leprosy (95% CI: 83.1–99.4%). Our m-LAMP assay was successfully used to detect both M. leprae and L. donovani in a patient coinfected with leprosy and macular PKDL. The m-LAMP assay is rapid, accurate, and applicable for differential diagnosis of leprosy versus PKDL, especially in endemic areas.
Trainee Perspectives Regarding Advanced Clinical Global Health Fellowships in North America
Authors: Frange Adam , Duffy Sean , Al-Rousan Tala , Evensen Ann , Nelson Brett D. 
Published: April 2021

Abstract.Postgraduate clinical global health (GH) training is a rapidly evolving field. To understand and improve training opportunities, we sought the perspectives of current and former trainees related to their advanced clinical training or global health fellowships and the anticipated impact on their careers. Clinical GH fellowships across North America were identified through websites and previous studies. An e-mail was sent to program directors to invite all current and former GH fellows to complete a web-based questionnaire. We contacted 100 GH fellowship programs. Fifty-two fellows from 10 different specialties completed the survey. The median fellowship length was 23.3 months, with an annual median of 4.8 months spent in low-income and middle-income countries, which was less than their reported ideal of 6 months. The majority reported satisfaction, the anticipation of career benefits, and that they would recommend fellowship training to others. Challenges included insufficient funding, mentorship, and formal curricula. Conducting research in high-income countries was a significant negative predictor of fellowship satisfaction. Most fellows (73.1%) were not at all or only a little concerned about the absence of fellowship accreditation, with only 17.3% desiring accreditation. Survey respondents were largely satisfied with their training and valued program flexibility and educational opportunities, including advanced tropical medicine certificates or diplomas. However, to improve fellowship training, improvements are needed in mentorship, standardized curricula, institutional support, and funding. For GH fellowship training to be effective and sustainable, institutions will need to balance the needs of fellows, training programs, and the communities (low-, middle-, and high-income countries) where the fellows serve.
Uric acid lowering improves insulin sensitivity and lowers blood pressure: a meta-analysis of randomized parallel-controlled clinical trials
Authors: Zong Qunchuan , Ma Guanyi , Wang Tao 
Published: April 2021

Objectives: This meta-analysis aimed to investigate whether uric acid lowering treatment can improve β-cell function and insulin sensitivity.
Methods: PubMed, Cochrane Library, EMBASE and China Biology Medicine were searched up to March 1, 2020. Rand- omized controlled clinical trials of urate lowering therapy in hyperuricemia patients were included in meta-analysis. Effect size was estimated as mean difference with 95% confidence interval (CI).
Results: Our search yielded 7 eligible trials with 503 participants. This meta-analysis showed that uric acid-lowering thera- py decreased fasting insulin -1.43 μIU/ml (weighted mean differences (WMD, 95% CI -2.78 to -0.09), homeostasis model assessment of insulin resistance -0.65 (WMD, 95% CI -1.05 to -0.24), systolic blood pressure -2.45 mm Hg (WMD, 95%CI -4.57 to -0.33) and diastolic blood pressure -3.41 mm Hg (WMD, 95%CI -3.87 to -2.95). However, the treatment had no significant effect on fasting plasma glucose (WMD -0.19 mmol/L, 95%CI -0.42 to 0.05), homeostasis model assessment of β-cell function index (WMD -0.02, 95%CI -0.28 to 0.24), total cholesterol (WMD 0.18 mg/dl; 95%CI, -1.39 to 1.75) and triglyceride (WMD 3.15 mg/dl, 95% CI -9.83 to 16.14).
Conclusion: Uric acid-lowering therapies might improve insulin sensitivity and lower blood pressure, but had no significant effect on HOMA-β and serum lipids.
Keywords: Hyperuricemia; uric acid lowering treatment; β-cell function; insulin sensitivity.
Isolated acute pseudobulbar palsy with infarction of artery of percheron: case report and literature review
Authors: Pitton Rissardo Jamir , Fornari Caprara Ana 
Published: April 2021

Introduction: Pseudobulbar palsy (PBP) is characterized by supranuclear lesions in the corticobulbar pathway. Neoplasia, inflammatory, demyelinating, and stroke are possible etiologies of this disorder.
Case report: We report an elderly female who presented with dysarthria. She was dysarthric with a hypernasal voice, no apraxia or aphasia was observed. Tongue movements were slow with limited amplitude. Her soft palate dropped bilaterally; gag reflex was present. Also, she reported swallowing difficulty and choking with her saliva. Bilateral vertical and horizontal gaze were intact to either voluntary or oculocephalic movements. A cranial CT scan was suggestive of artery of Percheron (AOP) infarction. Brain magnetic resonance imaging showed hypersignal on diffusion-weighted and T2-weighted images and hyposignal on apparent diffusion coefficient in both thalami. CT angiography scan revealed an AOP originating from the left posterior cerebral artery. The swallowing study with a videofluoroscopic demonstrated oral and pharyngeal phases with severe dysfunction.
Conclusion: To the authors’ knowledge, there are two cases of individuals with artery of Percheron infarction who devel- oped PBP associated with other clinical syndromes. Still, isolated PBP following infarction of Percheron’s artery was not reported. We hypothesized that the PBP may have occurred because of the existence of vascular territory variations in the perforating arteries that arise from the AOP.
Keywords: Pseudobulbar palsy; thalamus; infarction.
Risk factors of multidrug-resistant bacteria in community-acquired urinary tract infections
Authors: Guclu Ertugrul , Halis Fikret , Kose Elif , Ogutlu Aziz , Karabay Oğuz 
Published: April 2021

Background: Urinary tract infections (UTIs) are one of the most seen infection among community.
Objectives: In this cross-sectional study we aimed to investigate the risk factors of multidrug-resistant (MDR) bacteria that caused community-acquired UTI (CA-UTI).
Methods: Consecutive patients admitted to the Urology and Infectious Diseases policlinics with the diagnosis of CA-UTI were included in the study. A standard form including possible predisposing factors for MDR bacteria was applied.
Results: In total, 240 patients (51.3% females) were enrolled in the study. The mean age of participants were 59.8 ± 18.3 years old. Escherichia coli (n =166; 69.2%)was the most frequently isolated bacteria and its incidence was higher in females than in males (p=0.01). In total, 129 (53.8%) of the identified pathogens were MDR bacteria. According to multivariate analysis, the use of antibiotics three or more times increased the risk of infection with MDR bacteria by 4.6 times, the history of urinary tract infection in the last 6 months by 2 times, being male and over 65 years old by 3 times.
Conclusion: Doctors should consider prescribing broad-spectrum antibiotics in patients with severe UTIs with a history of UTI, advanced age, male gender, and multiple antibiotic usage, even if they have a CA-UTI.
Keywords: Urinary tract infection; community acquired; multidrug-resistant; male; multiple antibiotic usage; advanced age.