bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical Management of Parapharyngeal Tumors: Our Experience
Authors: Joshi Poonam , Joshi Kamal Deep , Nair Sudhir , Bhati Muddasir , Nair Deepa , Bal Munita , Joshi Amit , Mummudi Naveen , Tuljapurkar Vidisha , Chaukar Devendra A. , Chaturvedi Pankaj 
Published: November 2021

AbstractContext Tumors of parapharyngeal space (PPS) are rare and histologically diverse. The management of these tumors requires diligent assessment and planning with due consideration of various anatomical and pathological aspects of the lesion.Aims This retrospective study aims to present our experiences in the clinical and pathological aspects of PPS tumors with a critical evaluation of management.Settings and Design Retrospective analytical study.Methods and Material The electronic medical records of 60 cases of PPS tumors, managed surgically from 2007 to 2017, were reviewed and analyzed using SPSS 22 software. The mean follow-up duration was 44 months.Results The mean age was 45 years with a male-to-female ratio of 1.7 (38:22). The majority of the tumors were benign (71.7%) and the most common presentation being upper neck mass or oropharyngeal mass. Histologically, neurogenic tumors were most common (43.3%) PPS tumors, followed by tumors of salivary gland origin. Magnetic resonance imaging was used as a diagnostic modality in 70% of cases, and computed tomography scan and positron emission tomography/CT were used in 26.7 and 3.3% of cases, respectively. In our study, the diagnostic accuracy of fine-needle aspiration cytology was 71% for benign and 47% for malignant lesions. The most common approach for surgery used was transcervical (72%).Conclusion The study reveals that cranial nerve palsy is the most common complication associated with PPS tumors. Completely resected, malignant tumors originating within PPS have a good prognosis, as compared with tumors extending or metastasized to PPS.
Adult Soft Tissue Sarcoma: A Prospective Observational Real-World Data
Authors: Shivarudraiah Shivashankara Mathighatta , Viswanath Sundaram , Pandalanghat Suresh , Soneji Dharmesh , Kumar Manish , Patel Amol , Guleria Bupesh , Pathi Nikhil , Sud Rahul , Pathak Abhishek , Rathore Anvesh 
Published: November 2021

Abstract
Introduction There is a lacuna of prospective studies on soft tissue sarcoma (STS) from the Indian subcontinent in published literature.
Objectives We conducted this study to describe the clinical profile and outcomes of STS in North India.
Materials and Methods This is a single-center, prospective, observational study conducted from October 2017 to September 2019. All consecutive patients aged ≥18 years with histopathological diagnosis of STS were enrolled. The study end points included overall response rate, progression-free survival (PFS), and overall survival (OS).
Results A total of 140 patients were included with a median duration of follow-up of 14 months (range: 1–25 months). The median age of patients was 45 years. The median duration of symptoms before diagnosis was 5 months (range: 1–18 months). The most common histopathologic subtype was undifferentiated pleomorphic STS (22%). Of 105 localized patients, 21 received neoadjuvant therapy with external beam radiotherapy and/or doxorubicin-based chemotherapy and reported partial response in 38% (8/21) of the patients; the remaining 62% (13/21) of the patients had stable disease. Neoadjuvant therapy resulted in nonsignificantly higher complete resection rates with relative risk of 2.37 (p = 0.19). Of the remaining 35 metastatic STS patients, 31 received chemotherapy and reported partial response in 39.1% (n = 9/23), stable disease in 30.4% (n = 7/23), and disease progression in 30.4% (n = 7/23) of the patients. For localized STS patients, 1-year disease-free survival (DFS) and OS rates were 87.6 ±3.5 and 95.3 ± 2.3%, respectively. The median OS for metastatic STS patients was 23.90 months (95% confidence interval [CI]: 7.43–40.36). Among metastatic STS, median OS was not reached for those who underwent curative resection versus 12.66 months (95% CI: 9.28–16.04) for those who received systemic therapy alone.
Conclusion Median age of 45 years is a decade earlier than seen in the Western population. Neoadjuvant therapy improved complete resection rates, though it was statistically nonsignificant. Curative resection among metastatic STS patients improves survival.
Post-Denosumab-Treated Giant Cell Tumor of Bone: A Retrospective Histomorphological and Immunohistochemical Study
Authors: Kamble Anvesh , Hui Monalisa , Rao K. Nageshwara , Ramakrishna N. , Chandrasekhar P. , Uppin Shantveer G. , Sadashivudu G. 
Published: November 2021

Abstract
Introduction Giant cell tumors of bone (GCTBs) are treated with surgery with or without local adjuvants. Denosumab is a human monoclonal antibody that has recently emerged to be effective in treating unresectable and recurrent GCTBs.
Objective In this study, we analyzed the histomorphological changes in GCTB following treatment with denosumab. The expression of histone mutation H3.3G34W by immunohistochemistry (IHC) using mutant specific antibody was also determined.
Materials and Methods Of the total 109 GCTBs encountered during the study period, 14 cases with neoadjuvant denosumab therapy were analyzed retrospectively. The post-treatment changes on histopathology were examined on routine hematoxylin and eosin-stained sections. IHC was done using antihistone H3.3G34 antibodies. Statistical analysis was limited to descriptive statistics. No hypothesis testing was performed.
Results All these cases except three showed fibrosis with areas of hyalinization, prominent newly formed woven bone along with spindle cells in short fascicles and storiform pattern. There was complete absence and marked reduction in osteoclast-like giant cells in six and five patients, respectively. Only three patients showed a substantial amount of residual osteoclast-like giant cells. IHC with antihistone H3.3G34W antibody showed unequivocal nuclear positivity in the mononuclear cells in nine cases. The mononuclear cells rimming and entrapped within the woven bone were also positive on IHC. The spindle cells in the benign fibrous histiocytoma-like areas and septa of aneurysmal bone cyst-like areas also retained nuclear staining.
Conclusion Awareness of post-denosumab-related histopathological changes are necessary to avoid misdiagnosis as fibroosseous lesion and low-grade central osteosarcoma. Expression of mutant-specific H3.3 G34W antibody suggests that the neoplastic stromal cells are largely retained after denosumab therapy. The positive staining of cells both within and those rimming the newly formed woven bone point toward osteoblastic phenotype of the neoplastic stromal cells.
Clinical and Postoperative Outcomes of Cancer Surgeries during the COVID-19 Pandemic: A Comparative Study with its Pre-COVID Surgical Audit at Five Major Tertiary Care Hospitals’ Cancer Departments in India
Authors: Heroor Anil , Talwar Rajnish , Joshi Rama , Nayak Sandeep , Naik B. Niranjan , Tiwari Alok , Jain Sushil Kumar , Kapoor Rajeev , Jagad Vijay , Bansal Naval , Gangadhara Bharath , Bora Rashmi , Verma Harish , Nambiar Yadhukrishnan , Patil Akshay , Singhavi Hitesh 
Published: November 2021

Abstract
Introduction There has been an exponential rise in number of coronavirus disease 2019 (COVID-19)-positive infections since March 23, 2020. However, cancer management cannot take a backseat.
Objective The aim of this study was to identify any difference in the complication and mortality rates for the cancer patients operated during the ongoing COVID-19 pandemic.
Materials and Methods This was a retrospective study of a prospectively maintained database of five centers situated in different parts of India. Variables such as demographics, intraoperative, and postoperative complications were compared between COVID-19 (group A—March 23, 2020–May 22, 2020) and pre-COVID time period (group B—January 1 to January 31, 2020).
Results One-hundred sixty-eight cancer surgeries were performed in group B as compared with 148 patients who underwent oncosurgeries in group A. Sixty-two percent lesser cancer surgeries were performed in the COVID-19 period as compared with the specific pre-COVID-19 period. There was no significant difference in age group, gender, comorbidities, and type of cancer surgeries. Except for the duration of surgery, all other intraoperative parameters like blood loss and intraoperative parameters were similar in both the groups. Minimally invasive procedures were significantly lesser in group A. Postoperative parameters including period of intensive care unit stay, rate of infection, need for the change of antibiotics, and culture growth were similar for both the groups. While minor complication like Clavien-Dindo classification type 2 was significantly higher for group A, all other complication rates were similar in the groups. Also, postoperatively no COVID-19-related symptoms were encountered in the study group. A subset analysis was done among the study groups between those tested preoperatively for COVID-19 versus those untested showed no difference in intraoperative and postoperative parameters. No health-care worker was infected from the patient during the time period of this study.
Conclusion Our study shows that there is no significant difference in the incidence of postoperative morbidity and mortality rates in surgeries performed during COVID-19 pandemic as compared with non-COVID-19 time period.
A Retrospective Cohort Study of Upfront Nilotinib in Chronic Myeloid Leukemia: A Single-Center Experience
Authors: Singh Reema , Kapoor Jyotsna , Ahmed Rayaz , Mehta Pallavi , Khushoo Vishvdeep , Agrawal Pragya , Bhurani Dinesh , Agrawal Narendra 
Published: November 2021

Abstract
Context Nilotinib is a second-generation BCR-ABL1 tyrosine kinase inhibitor used in the treatment of chronic myeloid leukemia (CML).
Aims We aim to evaluate the responses and safety of upfront Nilotinib therapy in Indian CML patients.
Setting and Design We retrospectively reviewed the medical records of CML patients who received Nilotinib as an upfront treatment at our center between January 1, 2011 and October 15, 2019.The follow-up was taken till March 31, 2020.
Results Forty One patients (n = 36 chronic phase and five accelerated-phase CML) received frontline Nilotinib. Median age was 39 years (21–63) with male-to-female ratio of 1.1: 1. At 3 months, 96.9% patients achieved BCR-ABL of ≤10% at international scale. By the end of 12 months, 71.5% patients achieved major molecular response (BCR-ABL ≤0.1%) and 91.4% patients achieved complete cytogenetic response assessed by BCR-ABL polymerase chain reaction of ≤1%. Common toxicities observed were weight gain, thrombocytopenia, corrected QT prolongation, and elevated serum amylase in 14 (34.1%), 7(17.07%), 4(9.7%), and 4(9.7%) patients, respectively. Overall, five patients had loss of response with further progression and death in three patients. At a median of 43.7 months, 38 patients survived with estimated 3 year event-free survival and overall survival of 65 ± 9 and 93 ± 5%.
Conclusion This study showed remarkable good response with upfront Nilotinib in Indian patients with CML.
Evaluating the Effect of Health Education Intervention on the Health Beliefs and Behaviors of First-Degree Female Relatives of Breast Cancer Patients
Authors: Olgun Sule , Dizer Berna 
Published: November 2021

Background Breast cancer risk increases by 80% in the presence of BRCA1 and BRCA2 gene mutations in the same family. In particular, a woman whose sister or mother has breast cancer has a 2- to 5-fold higher risk of developing breast cancer compared with other women. For this reason, recommendations should have been made regarding breast cancer prevention and/or early detection for women with first-degree family history of breast cancer.
Aim The aim of this study was to evaluate the effect of health education, which was provided to first-degree female relatives of breast cancer patients, on their health beliefs and behaviors.
Study Design and Methods The study sample included 50 women with a first-degree relative being treated for breast cancer in the chemotherapy and radiotherapy unit of a university hospital. A one-group pretest-posttest design was used. The pretest consisted of the health belief model scale and a questionnaire regarding the women's sociodemographic information and breast cancer screening behaviors. After the pretest, the patients received health education regarding breast cancer risk factors and screening methods. The posttest was conducted 3 weeks after the education using the same assessment tools.
Results After education, there were statistically significant increases in rates of practicing breast self-examination, having clinical breast examinations, and undergoing breast ultrasound/mammography compared with pretest results.
Conclusions Health workers should possess knowledge and experience about breast cancer which will enable them to effectively undertake an educational role, especially for high-risk groups such as women with first-degree family history of breast cancer.
Factors Affecting Short-Term Outcome of Critically Ill Children with Malignancies Admitted in Pediatric Intensive Care Unit: A Retrospective Observational Study
Authors: Aggarwal Priyanka , Kumar Ishan , Rao Sunil Kumar , Pradhap K , Gupta Vineeta 
Published: November 2021

Abstract
Introduction Pediatric cancer contributes <1% of all malignancies. Childhood cancer survival has improved dramatically with the use of more intensive chemotherapy regimens, better stratification, and improvement in supportive care with enhanced facilities in pediatric intensive care unit (PICU).
Objective The aim of this study was to identify the risk factors responsible for poor outcome in critically ill children with malignancies admitted in PICU.
Materials and Methods Sixty-four children with a primary diagnosis of malignancy admitted in PICU with disease or treatment related complications were enrolled retrospectively. The short-term outcome, that is, shifting from PICU to ward, was assessed in relation to the presence of febrile neutropenia, organ failure, hepatitis, acute renal failure as well as requirement of inotropes and mechanical ventilation. Death was considered as an adverse outcome in this study.
Results The mean age of study population was 6.25 ± 3.91 and M:F ratio 2.4:1. The majority of children had hematological malignancies (81.25%), that is, pre-B acute lymphoblastic leukemia (ALL) (45.3%), non-Hodgkin lymphoma (21.3%), acute myeloid leukemia (12.5%), T ALL (10.9%), and Hodgkin lymphoma (3.1%). Few children also had retinoblastoma (4.7%) and Langerhans cell histiocytosis (1.6%). The mean duration of PICU stay was 3.16 ± 2.31 days. Sepsis (37.5%) was the most common indication for PICU admission, followed by metabolic disturbance (26.6%), respiratory failure (17.2%), neurological complaints (15.6%), and anaphylactic shock (3.1%). Children requiring mechanical ventilation (p < 0.001), inotrope support (p < 0.001), having acute renal failure (p = 0.001), and >1 organ failure (p < 0.001) were associated with adverse outcome. The overall survival at the time of discharge from PICU was 64%.
Conclusion In the context of low- and middle-income countries, optimal resource utilization by early identification of risk factors for clinical deterioration is required to allow timely admission to PICU and delivery of life-saving therapy to salvageable patients.
Challenges of Implementing Artificial Intelligence in Interventional Radiology
Authors: Mazaheri Sina , Loya Mohammed F. , Newsome Janice , Lungren Mathew , Gichoya Judy Wawira 
Published: November 2021

AbstractArtificial intelligence (AI) and deep learning (DL) remains a hot topic in medicine. DL is a subcategory of machine learning that takes advantage of multiple layers of interconnected neurons capable of analyzing immense amounts of data and “learning” patterns and offering predictions. It appears to be poised to fundamentally transform and help advance the field of diagnostic radiology, as heralded by numerous published use cases and number of FDA-cleared products. On the other hand, while multiple publications have touched upon many great hypothetical use cases of AI in interventional radiology (IR), the actual implementation of AI in IR clinical practice has been slow compared with the diagnostic world. In this article, we set out to examine a few challenges contributing to this scarcity of AI applications in IR, including inherent specialty challenges, regulatory hurdles, intellectual property, raising capital, and ethics. Owing to the complexities involved in implementing AI in IR, it is likely that IR will be one of the late beneficiaries of AI. In the meantime, it would be worthwhile to continuously engage in defining clinically relevant use cases and focus our limited resources on those that would benefit our patients the most.
Chronic Paronychia of Great Toe Treated with Excision of Nail Plate along with Surrounding Tissue and Split Thickness Skin Graft: An Observational Prospective Study
Authors: Panda Radharaman 
Published: November 2021

AbstractParonychia is an inflammatory condition of alongside of nail of toe or finger. It is seen commonly in housewives and housemaids. Paronychia may be acute or chronic. Majority of patients with acute paronychia respond well to nonsurgical treatment. Patients with chronic paronychia of great toe do not respond to nonsurgical treatment. Patients suffer from chronic pain in finger or toe. Many treatment methods are available for chronic paronychia of great toe. All have merits, demerits, and different outcomes. This study is conducted to find out the outcome of a modified surgical technique in chronic paronychia of great toe of patients. This is a method adopted with a little modification of existing method.This study was conducted among 50 patients of chronic paronychia of great toe, who were between 15 to 55 years of age, from December 2019 to December 2020. These patients were operated and kept on follow-up for 1 year and observed for different outcomes likes skin graft take off, complete wound healing of operated area, relief from chronic pain of great toe, acceptance of cosmetic appearance, and recurrence of disease. Clinical data was recorded in case record form by examining the patient, asking questions to them, and conducting descriptive analysis. Results in terms of skin graft take off, complete wound healing of operated area, relief from chronic pain of great toe, acceptance of cosmetic appearance, and recurrence of disease were assessed during follow-up period. Postoperative result showed that 98% of patients had complete wound healing and complete graft take up, acceptance of cosmetic appearance was 94%, recurrence was 2%, and 90% were relieved from chronic pain of disease great toe. It was concluded that this was a better method for treatment of chronic paronychia of great toe.
A Comparative Study between the Use of Negative Pressure Wound Therapy and Silver-Releasing Foam Dressings in the Management of Diabetic Ulcers
Authors: Taliat George , D'Souza Clement 
Published: November 2021

AbstractIntroduction Diabetic foot ulcers are one among the most commonly encountered complication of diabetes mellitus tackled by the surgical department worldwide. Negative pressure wound therapy (NPWT) and silver-releasing foam dressings are effective modalities for the treatment of ulcers. This study compares the two treatment modalities.Methods Sixty adult patients admitted with diabetic foot ulcers undergoing NPWT (vacuum-assisted closure [VAC]) or silver-releasing foam dressing (Biatain Ag) treatment were included in the study. Patients undergoing either of the treatment modalities were observed and followed up on a weekly basis prospectively. Wounds were routinely examined for the size of ulcer in area (cm2) and time taken for wound healing. Patients were also assessed qualitatively by means of a questionnaire to find out patient satisfaction and compliance.Results Time taken for wound healing among Biatain Ag group was found to be 24±9.483 days compared with only 19.73±7.575 days in the VAC group. Decrease in size ulcer measured in area was found to be 38.79% in Biatain Ag group, whereas in the VAC group it was found to be 26.56%. Patients were satisfied with both modalities of treatment; however, patient compliance was better for the Biatain Ag Group due to decrease in restriction of mobility and decrease in cost.Conclusion Overall, both modalities of treatment were found to be comparable and can be used with similar efficacy. It can be concluded that silver-releasing foam dressing can act as a beneficial alternative to NPWT in the treatment of diabetic ulcers.
Tuberculosis is still the most Common Cause of Mediastinal and Intra-abdominal Lymphadenopathy by EUS-FNA in India
Authors: Behera Manas Kumar , Narayan Jimmy , Agarwal Shobhit , Mishra Debakanta , Reddy Pruthvi , Singh Ayaskanta , Pati Girish Kumar , Sahu Manoj Kumar 
Published: November 2021

Abstract
Background Lymph nodal tuberculosis is reported to occur in 4% to 7% of all tuberculosis, and mediastinal lymphadenopathy accounts for 10% of lymph nodal tuberculosis but the diagnosis still remains a challenge due to inaccessibility to these sites. There is a scarcity of recent data from India about the etiology of intra-abdominal and mediastinal lymphadenopathy despite being frequently detected in cross-sectional imaging.
Methods A retrospective study was conducted after reviewing hospital records over a period of 3 years from December 2017 to December 2020 who underwent endoscopic ultrasonography (EUS). A total of 126 patients with mediastinal and/or intra-abdominal lymphadenopathy detected by cross-sectional imaging were examined for clinical features, EUS, and histopathology records.
Results The mean age of patients was 53.12 ± 14.15 years. Seventy-one patients (56%) had intra-abdominal lymph nodes and 55 (44%) had mediastinal lymph nodes. The average number of needle passes was 2.35 ± 0.58 (range: 2–4). The majority of patients had tubercular etiology (53.2%) followed by metastatic (26.2%). Other etiologies were reactive (4.8%), lymphoma (4.8%), sarcoidosis (3.2%), and GIST (1.6%). No diagnosis could be ascertained in 6.3% of patients. The EUS features that favored tubercular etiology over metastatic were heterogeneous echotexture (72% vs. 30%), irregular shape (78% vs. 12%), indistinct borders (81% vs. 30%) and calcification (43% vs. 15%). Partial anechoic area and hyperechoic area were seen in 21% and 64% of tubercular patients, respectively. EUS only had sensitivity and specificity of 63% and 84%, respectively, and EUS FNA had a very high sensitivity and specificity of 93% and 100%, respectively.
Conclusion Tuberculosis is still the most common cause of lymph nodes. EUS FNA had a very high sensitivity and specificity of 93% and 100%, respectively, for the diagnosis of mediastinal and intra-abdominal lymphadenopathy.