bluuebunny/crossref_metadata_2025_split huggingface dataset:
Paradoxical Reactions in Spinal Tuberculosis
Authors: Zaveri Gautam R. , Jaiswal Nitin P. 
Published: July 2021

Introduction:
Clinical or radiological worsening of pre-existing tubercular lesions or appearance of new lesions in patients who have shown initial improvement following antitubercular chemotherapy (ATT) is termed as a paradoxical reaction (PR). The appearance of these lesions after spine surgery raises the possibilities of drug resistance, treatment failure, and surgical site infection. This retrospective case series aims to describe the presentation of PRs in spinal tuberculosis (TB), identify risk factors, and propose a treatment plan for PRs within the spine.

Materials and Methods:
Nine patients (2 males and 7 females; mean age 31.2 years), who underwent posterior transpedicular decompression and instrumented fusion for spinal TB, presented 4–7 weeks later with a soft, large swelling at the surgical site. In one patient, the swelling had burst through the skin resulting in a discharging wound. Two patients had screw pullout with local kyphosis. All patients had been started on ATT only after index surgery and had experienced improvement in constitutional symptoms, pain, and neurology. Magnetic resonance imaging showed large fluid collection at the surgical site without any new bony lesions.

Results:
All patients underwent surgical debridement with two patients requiring revision instrumentation. Examination of tissue and fluid revealed caseating granulomas and mycobacteria. Continuation of the same ATT led to uneventful healing.

Conclusion:
PRs in patients with spinal TB presented with a cold abscess at the surgical site between 4 and 7 weeks after starting ATT. Surgical drainage with debridement and continuation of ATT without changes to the regimen led to uneventful healing in all patients. Young age, female sex, thoracic lesions, and patients virgin to ATT prior to surgery were risk factors.
Early Experiences in the Management of Traumatic Spinal Injuries at a Level 1 Trauma Center in India During the COVID-19 Pandemic
Authors: Farooque Kamran M. , Nayak Tushar R. , Siamwala Burhan S. , Aryal Aayush 
Published: July 2021

Context:
Overwhelmed by COVID-19 patients requiring urgent medical attention and intensive care beds, majority of our medical resources are allocated for the management of the current pandemic. Other urgent cases requiring surgical attention also need to be optimally addressed.

Aims:
The aim of this article is to report the early results and organizational protocol in the management of traumatic spinal fractures at a level-1 trauma center during the current pandemic.

Settings and Design:
This is a retrospective study of patients with vertebral fractures operated by a single surgeon between April and October 2020. All patients were tested for the SARS-CoV-2 virus, and the tests were repeated every 72 h. We modified our institutional protocol to aid the early management of emergency traumatic spine cases during this pandemic. Descriptive analysis of data collected from hospital records was carried out using Statistical Package for Social Sciences, Virginia, USA, Version 20.

Results:
A total of 44 patients were operated. Burst fracture was the most common fracture with a fall from height being the most common mechanism of injury. Two patients tested positive for the novel corona virus. There were no complications and none of the healthcare staff involved in the patient care or patients reported symptoms of COVID-19 during a 30-day follow‐up period.

Conclusion:
Surgical treatment of patients with vertebral fractures, with strict adherence to personal protective measures and local guidelines, did not increase the risk of contracting SARS‐CoV2 to either healthcare workers or patients during the lockdown period.
Desmopressin nasal spray reduces blood loss and improves the quality of the surgical field during functional endoscopic sinus surgery
Authors: Safaeian Reza , Hassani Valiollah , Ghandi Arman , Mohseni Masood 
Published: July 2021

Background and Aims:
Making a dry surgical field during functional endoscopic sinus surgery (FESS) is a challenge for anesthetists. This study was conducted to evaluate the pre-emptive hemostatic effects of a single dose of an intranasal spray of desmopressin (DDAVP) in sinus surgery.

Material and Methods:
Sixty consecutive patient's as first-time candidates for FESS due to chronic sinusitis were enrolled. They were randomly allocated to receive either a nasal spray of DDAVP 20 μg or sterile water before induction of anesthesia. Management of anesthesia was achieved with propofol and remifentanil infusions. Blood loss, quality of the surgical field, and surgeon's satisfaction were compared between the two groups.

Results:
Blood loss in the DDAVP group was 147 ± 43 mL and in the placebo group 212 ± 64 mL (mean ± SD, P < 0.01). The quality of the surgical field in the DDAVP group was better than the placebo group. (median score, 1 (1–2) vs. 2 (1–3), P = 0.017). Surgeons were more satisfied with the surgical field in the DDAVP group than in the control group (median score, 4 (2.8–5) vs. 3 (2-3), P = 0.04).

Conclusion:
Premedication with nasal spray DDAVP 20 μg effectively reduces bleeding and improves the surgical field during FESS.
Comparative evaluation of dexmedetomidine and fentanyl in total intravenous anesthesia for laparoscopic cholecystectomy
Authors: Siddiqui Tabish Husnain , Choudhary Nitin , Kumar Abhijit , Kohli Amit , Wadhawan Sonia , Bhadoria Poonam 
Published: July 2021

Background and Aims:
Laparoscopic cholecystectomy is one of the commonly performed ambulatory surgeries. The selection of anesthetic agents for ambulatory surgeries should be done bearing in mind the need for early discharge. Opioids form an integral component of total intravenous anesthesia (TIVA) but their associated side effects may result in an increased hospital stay. Hence, we planned a study to compare the opioid (fentanyl) and non-opioid (dexmedetomidine) based technique of TIVA for laparoscopic surgery.

Material and Methods:
Ninety ASA I and II patients between 18-60 years of either sex posted for laparoscopic cholecystectomy were randomly allocated into two groups namely group D (Dexmedetomidine) and group F (Fentanyl). Patients received propofol infusion along with group specific drug infusion, after which an appropriate size proseal laryngeal mask airway was placed. The patients were assessed for discharge time from post-anesthesia care unit (PACU), on table recovery time, time to first rescue analgesia, hemodynamic parameters, incidence of postoperative nausea and vomiting (PONV) and any other complication.

Results:
Demographic profile of both the groups was comparable. Group D had longer on table recovery time (13.00 ± 2.34 min vs 6.29 ± 2.46 min; P < 0.001) and time to discharge from PACU (6.80 ± 3.96 min vs 2.36 ± 1.67 min; P < 0.001) compared to group F. Group F had better hemodynamic stability compared to group D. In group D, 77% patients required rescue analgesia in first one hour post surgery, unlike 22% in group F. No patient in group D had PONV.

Conclusion:
Opioid based technique (Fentanyl) of TIVA is superior over non-opioid based (dexmedetomidine) technique with faster recovery, early discharge, decreased postoperative pain scores and better hemodynamic stability. PONV is observed with opioids which can be treated successfully with antiemetics.
A randomized comparison of epidural, dural puncture epidural, and combined spinal-epidural without intrathecal opioids for labor analgesia
Authors: Bakhet Wahba Z. 
Published: July 2021

Background and Aims:
Dural puncture epidural (DPE) has been shown to improve labor analgesia over epidural (EPL), with fewer side effects than a combined spinal-epidural (CSE). However, there is some debate regarding the superiority of DPE over EPL and CSE. Therefore, we aimed to compare the effects of EPL, DPE, and CSE without intrathecal opioids on the epidural local anesthetic (LA) consumption and occurrence of side effects in early labor.

Material and Methods:
We randomly assigned parturient to one of the 3 groups; EPL, DPE, or CSE. EPL and DPE groups received a 10 mL loading dose of 0.1% bupivacaine with fentanyl 2 μg/mL. CSE group received intrathecal 2.5 mg bupivacaine (without opioids). Labor analgesia was maintained in all patients via patient-controlled epidural analgesia (PCEA). The primary outcome was the mean hourly consumption of epidural LA.

Results:
The mean hourly consumption of epidural LA anesthetic was significantly lower in CSE (9.55 mL), compared with the EPL (11 mL), and DPE (10.5 mL), P < 0.01; but no significant difference was seen between EPL and DPE. Compared with EPL and DPE, CSE achieved faster time to complete analgesia defined as a numeric rating pain scale (NRPS) ≤1 and sensory block, lower NRPS in the first hour and higher frequencies of complete analgesia. There were no differences between groups in terms of physician top-up boluses, the occurrence of side-effects, mode of delivery, Apgar scores, and maternal satisfaction.

Conclusion:
Compared with EPL and DPE, CSE without intrathecal opioids, had a less epidural LA consumption, faster onset of analgesia, with no difference in the incidence of side effects.

Trial Registration:
This study was registered at www.clinicaltrials.gov (NCT03980951).
Comparative evaluation of analgesic efficacy of buprenorphine transdermal patch and fentanyl patch in management of postoperative pain after arthroscopic lower limb surgery
Authors: Khandelwal Hariom , Negi Anoop , Govil Nishith , Singh Ashutosh , Parag Kumar , Bhardwaj Bharat Bhushan 
Published: July 2021

Background and Aims:
Transdermal opioids are newer modality in use for the control of postoperative pain, because of its noninvasiveness, longer duration of action, sustained blood levels, and with minimal side effects. The study was aimed to evaluate the efficacy of analgesia of buprenorphine patch 10, 20 μg·h-1 and fentanyl patch 25 μg·h-1 for relief of pain in the postoperative period in patients undergoing arthroscopic lower limb surgeries.

Materials and Methods:
It was a randomized, double-blinded, prospective study in which adult patients undergoing lower limb arthroscopic surgery were randomly segregated into three groups. In Group 1 (fentanyl patch 25 μg·h-1), Group 2 (buprenorphine patch 10 μg·h-1), and Group 3 (buprenorphine patch 20 μg·h-1), transdermal patches were applied 12 h prior to surgery. Mean NRS score, total rescue analgesic requirement, drug-related adverse effects, and hemodynamic status were evaluated till 72 h in the postoperative period.

Results:
Out of 175 screened patients, 150 patients were finally analyzed. Baseline characteristics were the same among all the three groups. Median NRS score was lowest in Group 3 [P value < 0.05 at 2, 4, 8, 12, and 24 h after surgery (Kruskal Wallis test). The total consumption of postoperative rescue analgesic diclofenac was the lowest in Group 3 as compared to other groups without any significant increase in adverse events.

Conclusions:
In arthroscopic lower limb surgery, buprenorphine patch (20 μg·h-1) applied 12 h prior to surgery is an effective postoperative analgesic and it is not associated with any significant adverse effects.
Effect of airway device and depth of anesthesia on intra-ocular pressure measurement during general anesthesia in children
Authors: Darlong Vanlal , Kalaiyarasan Ramkumar , Baidya Dalim K. , Pandey Ravindra , Sinha Renu , Punj Jyotsna , Dada Tanuj 
Published: July 2021

Background and Aims:
Accurate measurement of intraocular pressure (IOP) under anaesthesia is essential for diagnosis and further management of pediatric glaucoma patients. However, depth of anaesthesia and use of airway device like laryngeal mask airway (LMA) or endotracheal tube can influence IOP values measured. We planned this study to compare change of IOP with facemask or LMA. Change of IOP at varying depth of anaesthesia was also assessed.

Material and Methods:
After Institutional ethical clearance and informed parental consent, 89 children of glaucoma aged 0-12 years were included in this prospective randomized controlled trial. The children were randomized to facemask (Group M) and LMA (Group L). Sevoflurane was the sole general anaesthetic used in both the groups and IOP were recorded after induction, at BIS 40-60, after LMA insertion (Group L), at BIS 60-80 and BIS more than 80.

Results:
The IOP values did not differ significantly between the groups at BIS 40-60 and at BIS 60-80. Moreover, pre and post LMA insertion IOP values were also comparable in Gr L (p = 0.11). However, significant increase in IOP values were observed with increasing BIS values within each group. The mean IOP in Group M at BIS 40-60 was 13.41 ± 4.04 as compared to 14.18 ± 3.64 at BIS 60-80 (p = 0.003). There was a similar pattern observed in Group L, where mean IOP at BIS 40-60 & BIS 60-80 was 14.13 ± 4.90 and 15.52 ± 4.57 respectively (p < 0.001).

Conclusion:
Either facemask or classic LMA can be safely used as per anaesthesiologist's preference without any significant effect on IOP. BIS monitoring may be used during IOP measurement in paediatric glaucoma suspects for accurate assessment of IOP.
Investigation of the Lower Punctum Parameters
Authors: Sabermoghaddam Aliakbar , Golestani Shahin , Hassanpour Kiana , Bakhtiari Elham 
Published: July 2021

Purpose:
To evaluate the dimensions of lower punctum in a sample of Iranian normal population using spectral domain anterior segment optical coherence tomography (OCT).

Methods:
In this cross-sectional study, 102 eyes of 102 healthy volunteers were enrolled. All participants underwent a detailed history and complete ophthalmic examination. Lower punctum metrics were measured using OCT (Spectralis, Heidelberg) with the anterior segment module. External punctal diameter was defined as the largest diameter at the surface of the punctum. Internal punctal diameter was measured at two different depths of 100 μm and 500 μm from the external surface. Measurements were repeated for 30% of data by another grader. The agreement was measured using intraclass correlation coefficient (ICC).

Results:
The mean age of the participants was 61.5 ± 7.9 years. The mean external punctal diameter was 425.6 ± 124.3 μm. The mean internal punctal diameter at 100 μm and 500 μm was 183 ± 97.5 μm and 77.7 ± 51.4 μm, respectively. The agreement between the graders was high in assessing all punctal characteristics (ICC >0.9 for all measurements).

Conclusion:
The spectral domain OCT can be used for measuring lower punctum diameter with acceptable reproducibility.
Tolosa–Hunt Syndrome
Authors: Dutta Paromita , Anand Kamlesh 
Published: July 2021

Purpose:
To review the diagnostic criteria for Tolosa–Hunt syndrome (THS) and utility of recent modifications.

Methods:
We searched PubMed for keywords Tolosa Hunt and magnetic resonance imaging. We compared the three editions of International Classification of Headache Disorders and isolated case reports and case series with the assessment of cavernous internal carotid artery (ICA) caliber to find the prevalence of vascular anomalies. We also evaluated cases of THS with the involvement of extracavernous structures and the possible role of idiopathic hypertrophic pachymeningitis (HP). Cases diagnosed falsely as THS were also reviewed for the presence of atypical features and relevance of criterion D. We assessed nonconforming cases (those with normal neuroimaging benign THS) and idiopathic inflammatory orbital pseudotumor (IIPO).

Results:
Vascular abnormalities were found in 36.36% of THS cases. Benign THS may also show changes in ICA caliber. Evidence suggestive of idiopathic HP could be found in 57% of cases with the involvement of extracavernous structures, such as facial nerve and pituitary gland. Both THS and IIPO are steroid-responsive pathologies with similar clinical and radiological features. False-positive diagnosis of THS results from early labeling, based solely on clinical features and symptom resolution after steroid therapy.

Conclusions:
Benign THS may be a result of limitation of resolution of available neuroimaging technique or early testing. Early and late vascular changes can be seen in both THS and its benign variant; some of them are not innocuous. THS may be considered a type of focal idiopathic HP. IIPO may represent an anterior variant of THS. In the absence of histopathological diagnosis, steroid-induced resolution of symptoms should be confirmed radiologically and followed-up.
Tonometry by Ocular Response Analyzer in Keratoconic and Warpage Eyes in Comparison with Normal Eyes
Authors: Alipour Fateme , Hassanpoor Narges , Letafatnejad Moggan , Beheshtnejad Amir-Hooshang , Mohammadi Seyed-Farzad 
Published: July 2021

Purpose:
To compare intraocular pressure (IOP) values measured by ocular response analyzer (ORA) in contact lens-induced corneal warpage, normal, and keratoconic eyes.

Methods:
In a prospective, observational case–control study, 94 eyes of 47 warpage-suspected cases and 46 eyes of 23 keratoconic patients were enrolled. Warpage-suspected cases were followed until a definite diagnosis was made (warpage, nonwarpage normal, or keratoconus). ORA tonometry and corneal biomechanics testing were performed for all cases in each visit. We had 2–3 measured corneal-compensated IOP (IOPcc) and Goldmann-correlated IOP (IOPg) for each patient (based on group) with at least 2-week interval.

Results:
After following up of warpage-suspected patients, finally 44 eyes of 22 patients had confirmed soft contact lens-related corneal warpage. Forty-six eyes of 23 people were finally diagnosed as nonwarpage normal eyes. Forty-six eyes of 23 known keratoconus patients were also included for comparison. The demographic and refractive data were not different between the warpage and nonwarpage normal groups but were different in the keratoconus group. Both IOPcc and IOPg were statistically different with the highest value in the warpage group followed by normal and keratoconus groups; the same trend was observed in central corneal thickness (CCT). The mean of IOPg was 14.94 ± 2.65, 13.7 ± 2.33, and 10.86 ± 3 and IOPcc was 15.73 ± 2.4, 15.28 ± 2.43, and 14.08 ± 2.55 in the warpage, normal, and keratoconus groups, respectively. IOPg and IOPcc in the warpage group (based on baseline diagnosis) did not regress to become closer to IOP of normal eyes after discontinuation of contact lens in their follow-up visits (P value for IOPg and IOPcc trends in the warpage group was 0.07 and 0.09 controlling for CCT, respectively). Both IOPcc and IOPg were significantly lower in keratoconic eyes in comparison with normal eyes. After correction for the confounding effect of CCT, a lower IOPcc in keratoconus versus warpage remained significant (P = 0.02).

Conclusion:
Both IOPcc and IOPg were statistically different with the highest value in the warpage group followed by normal and keratoconus groups, just like their CCT. After correction for the confounding effect of CCT, there was no statistically significant difference between the three groups in their measured IOPcc and IOPg except for IOPcc in keratoconus versus warpage (P = 0.02).
Glaucoma Care of Incarcerated Patients at An Academic Institution
Authors: Kanu Levi N , Oh Daniel J , Jang Inae , Henry Michael , Mehta Amy A , Dikopf Mark S , Vajaranant Thasarat S , Aref Ahmad A , Edward Deepak P 
Published: July 2021

Purpose:
To evaluate medication and follow-up adherence in incarcerated patients examined at an academic glaucoma clinic, in comparison to nonincarcerated controls.

Methods:
Retrospective, case-control study. Consecutive prisoners presenting for initial visits in the Glaucoma Clinic at the Illinois Eye and Ear Infirmary between December 2015 and December 2017 were included in the study. Nonincarcerated patients seen in the same Glaucoma Clinic with similar initial visit dates, age, race, sex, and disease severity were selected as controls. Glaucoma Clinic visits from each patient were reviewed until December 2018. Examination information, surgical intervention, follow-up and treatment recommendations, and patient-reported medication usage were recorded for each visit. Number of visits, loss to follow-up, follow-up delays, and medication nonadherence were studied as primary outcome measures.

Results:
Twenty-four prisoners and 24 nonincarcerated controls were included. Prisoners had an average of 2.46 ± 2.38 visits during the study period, compared to 5.04 ± 3.25 for controls (P = 0.001). Follow-up visits occurred more than 30 days after the recommended follow-up time in 57.4% (95% confidence interval [CI]: 44.2%–70.6%) of prisoners, compared to 17.9% (95% CI: 10.2%–25.6%) of controls (P < 0.00001). 70.8% of prisoners (95% CI: 66.3–74.5%) were lost to follow-up, compared to 29.2% of controls (95% CI: 25.5%–32.9%; P < 0.01). Medication nonadherence rates were similar between prisoners (13.6%; 95% CI: 12.1%–15.2%) and controls (12.0%; 95% CI: 11.4%–12.6%; P = 0.78).

Conclusions:
Glaucoma follow-up adherence was significantly worse in prisoners compared to a nonincarcerated control population. Further study into causative factors is needed.
Low-Level Laser Therapy with 670 nm Alleviates Diabetic Retinopathy in an Experimental Model
Authors: Ahmed Salwa Abdelkawi , Ghoneim Dina Fouad , Morsy Mona Ebrahim , Hassan Aziza Ahmed , Hassan Mahmoud Abdel Rahman 
Published: July 2021

Purpose:
To evaluate the effects of low-level laser therapy (LLLT) on the retina with diabetic retinopathy (DR).

Methods:
Eight Wistar rats were used as a control group, and 64 rats were injected intraperitoneally with 55 mg/kg of streptozotocin to induce diabetes and served as a diabetic group. After the establishment of the DR, the rats were separated into (a) 32 rats with DR; did not receive any treatment, (b) 32 rats with DR were exposed to 670 nm LLLT for 6 successive weeks (2 sessions/week). The retinal protein was analyzed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis, total antioxidant capacity (TAC), hydrogen peroxide (H2O2), and histological examination.

Results:
LLLT improved retinal proteins such as neurofilament (NF) proteins (200 KDa, 160 KDa, and 86 KDa), neuron-specific enolase (NSE) (46 KDa). Moreover, the percentage changes in TAC were 46.8% (P < 0.001), 14.5% (P < 0.01), 4.8% and 1.6% (P > 0.05), and in H2O2, they were 30% (P < 0.001), 25% (P < 0.001), 20% (P < 0.01), and 5% (P > 0.05) after 1, 2, 4, and 6 weeks, compared with the control. DR displayed swelling and disorganization in the retinal ganglion cells (RGCs) and photoreceptors, congestion of the capillaries in the nerve fiber layer, thickening of the endothelial cells' capillaries, and edema of the outer segment of the photoreceptors layer. The improvement of the retinal structure was achieved after LLLT.

Conclusion:
LLLT could modulate retinal proteins such as NSE and NFs, improve the RGCs, photoreceptors, and reduce the oxidative stress that originated in the retina from diabetes-induced DR.