bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cardiopulmonary exercise testing in patients with obstructive sleep apnea
Authors: El Sokkary Raafat T.I. , Azzoz Ahmed M. , Abd Elhamied Asmaa G. 
Published: October 2024

Background
The cardiopulmonary exercise testing (CPET) is a noninvasive process aiming to evaluate the respiratory and cardiovascular system during exercise.

Aim
To study the effect of obstructive sleep apnea (OSA) on cardiovascular system and exercise capacity and to correlate the severity of OSA with CPET parameters.

Patients and methods
Fifty patients (30 males and 20 females) were enrolled in this study, diagnosed as OSA based on polysomnography (apnea–hypopnea index ≥5). All patients were given a thorough medical history, a thorough physical examination, an arterial blood gas analysis before and after exercise, a pulmonary-function test, polysomnography, and a CPET.

Results
Patients with mild/moderate OSA had significantly higher oxygen consumption (VO2) at peak (ml/min) and predicted value. Predicted VO2/kg was significantly higher among patients with mild/moderate OSA. Also, patients with mild/moderate OSA had significantly higher LT. Out of enrolled patients, three (6%), 15 (30%), and 32 (64%) patients had mild, moderate, and severe exercise impairment, respectively. Majority (90%) of the patients with severe OSA had severe exercise impairment, while majority (70%) of those with mild/moderate OSA had moderate exercise impairment.

Conclusions
OSA causes exercise impairment, which has a positive correlation with the severity of the disease.
The outcome of coronavirus disease 2019 in hospitalized patients with diabetes mellitus at Assiut University Hospital
Authors: Khalaf Mohammad G.A. , El-Sokkary Raafat T.I. , Eskander Martina S.L. , Azzouz Ahmed M. 
Published: October 2024

Rationale
The chronic nature of diabetes renders it a risk factor for lower respiratory tract infections, adversely impacting patient prognosis.

Objective
This study aimed to investigate the influence of diabetes on the outcomes of coronavirus disease 2019 (COVID-19) patients.

Patients and methods
This prospective cohort study enrolled 160 patients admitted and diagnosed with COVID-19. Patients were categorized according to glycated hemoglobin level into two groups: diabetic and nondiabetics (80 patients each). The COVID-19 severity index was calculated for all patients. Follow-up of their in-hospital stay and incidence of complications was documented.

Results
It was found that diabetic patients had a significantly higher percentage of severe COVID-19 cases (83.8 vs. 61.3%) [odds ratio (OR)=1.89, 95% confidence interval (CI)=1.02–3.48]. The diabetic group had higher rates of ICU admission (OR=2.21, 95% CI=1.06–4.57), invasive mechanical ventilation (OR=3.75, 95% CI=1.321–10.803), and mortality (HR=1.69, 95% CI=1.132-2.514) compared with nondiabetic patients (33.8 vs. 18.8%, 20 vs. 6%, and 41.5 vs. 21.2%, respectively). From the nondiabetic group, 68.4% of prediabetic patients had hyperglycemia requiring insulin treatment during their hospital stay versus 31.6% of normoglycemic patients.

Conclusion
Diabetes mellitus is associated with more severe manifestations of the disease, increased complications, ICU admissions, ventilatory requirements, and mortality rates compared to nondiabetic individuals. COVID-19 is associated with poor glycemic control.
Study of malnutrition in patients with idiopathic pulmonary fibrosis
Authors: Dayem Aya A. , Knany Esraa R. , Ruby Dina 
Published: October 2024

Background
Although the interest in Idiopathic Pulmonary Fibrosis (IPF) has increased in recent years due to the appearance of new therapies however the interest has focused on pulmonary involvement with little concern for systemic manifestations such as the nutritional status abnormalities. Thus, our study assessed the malnutrition prevalence in patients with IPF and the best indicators for the assessment of malnutrition among them.

Patients and methods
This work was conducted on 110 stable IPF patients who attended the outpatient clinic of Ain Shams University Hospitals from October 2020 to July 2021. Data about the detailed history and nutritional assessment was collected.

Results
22.7% and 20.9% were malnourished according to the definition of fat-free mass index (FFMI) and body mass index (BMI), respectively. Most malnourished patients according to low FFMI were female; not using PPI was a significant independent predictors of malnutrition. There was a statistically significant relation between low FFMI and low serum albumin, hemoglobin, and oxygen saturation. Our findings also revealed that measuring BMI and being less than or equal to 22.1 kg/m2 and mid-arm circumference (MAC) less than or equal 28.5 cm is significantly related to low free fat mass index (malnutrition) and increases that risk by 31.63 folds.

Conclusion
Nearly one-quarter of IPF patients were malnourished and it was found that measuring BMI less than or equal to 22.1 kg/m2 together with MAC less than or equal to 28.5 cm can predict low FFMI and that can be used in our clinical approach.
The role of pulmonary rehabilitation in improving lung functions in patients with ankylosing spondylitis
Authors: Ahmed Nehal M. , Galal Ahmed M. M. , El Helow Mohammed R. , Ahmed Sahar F. , Salama Sherihan M. 
Published: October 2024

Background
Ankylosing spondylitis (AS) is a chronic inflammatory disease characterized by axial and peripheral entheseal inflammation and new bone production(1).
The development of syndesmophytes, enthesophytes, and spinal fusion along the course of the disease is linked to chronic pain, functional impairment, and disability(2).
Fibrosis of the upper lobes of the lungs (interstitial lung disease) and chest wall abnormalities are two of the emerging forms of pulmonary involvement in AS. (3).
Pulmonary rehabilitation is a multifaceted program of education, counselling, breathing exercises, and other modalities that can increase the patient’s independence and ease of functioning(4).

Aim
To estimate the role of pulmonary rehabilitation in enhancing lung function in AS individuals in relation to disease activity, clinical, and functional parameters.

Patients and methods
This study was an interventional study: single-arm group (prospective randomized clinical study). Thirty people (30) participated in that study from those presented to Physical Medicine, Rheumatology and Rehabilitation inpatient and outpatient clinic at Ain Shams University hospitals, diagnosed as radiographic axial spondyloarthropathy (SPA) from 02/2022 to 12/2022. All patients underwent pulmonary rehabilitation program and were exposed to a detailed history, clinical, and pulmonary function testing. Disease activity was evaluated by Ankylosing Spondylitis Disease Activity Score C-reactive protein (ASDAS-CRP), Valuation of function by using Bath Ankylosing Spondylitis Functional index (BASFI), 6-Minute walk test (6MWT), the Modified Borg Dyspnoea Scale (MBS), and Timed Up and Go (TUG) test. All function and clinical scores were done at baseline and repeated after completing pulmonary rehabilitation program.

Result
The mean age of patients was 36.57 ± 7.83 years (23–45 years), with a median disease duration of (5 (3–9) years). In total, there were 19 out of the studied patients with restrictive pattern. With comparison between pre- and postintervention of pulmonary rehabilitation, there was a significant statistical difference in all, disease activity (ASDAS and BASFI) and functional (MBS, TUG, and 6MWT) parameters (P <0.001), except for occiput to the wall. Regarding pulmonary function tests, including forced vital capacity (FVC), expiratory volume in one second (FEV1), and peaked expiratory flow (PEF), there was a statistically significant change at baseline and at the end of exercise (P <0.001).

Conclusion
Improved respiratory function and disease activity and overall functional activity are possible outcomes of pulmonary rehabilitation programs in combination with other rehabilitation interventions.
Validity of a new weaning index of discontinuation from mechanical ventilation in intensive care unit
Authors: Kamal Eman Sabry , Al- Rahman Salem Gamal Abd , Dwedar Ibrahim Aly , El Embaby Dalia Abd Elsattar 
Published: October 2024

Background
Failure to wean from mechanical ventilation (MV) is a frequent problem in the intensive care unit (ICU) setting. Herein, we investigate a new WI measured at the initial spontaneous breathing trial (SBT) in order to predict successful liberation from MV in mechanically ventilated ICU cases.

Patients and methods
This prospective cross-sectional study consisted of two phases; Phase I was designed to create a new WI from the criteria of 60 mechanically ventilated patients, while Phase II aimed to assess the accuracy of that index in another 40 patients.

Results
The incidence of failed weaning was 33.3% in phase I, and 35% in phase II. Multivariate regression analysis was done for phase I variables, and the following equation was created; (((Cough strength×0.743)–1.927)×0.05+((PaCO2 (mmHg)×-0.126)+6.786)×0.08+((mean airway pressure (CmH2O)×-1.304)+14.119)×0.193+((PaO2/FIO2 × 0.268)-58.555)×0.328+((rapid shallow breathing index×-0.485)+24.406)×0.353). Using a cut-off value of >0.69 and Applying this index in phase II, it showed a mean value of -1.43 and 4.67 in the failure and success groups, respectively (P<0.001). This new WI with cut-off value (>0.69) had 88.5% sensitivity, 57.1% specificity, and a 77.5% accuracy to predict the success of weaning from MV.

Conclusion
We developed a new WI using formula including (semiquantitative Cough strength, PCO2 gradient mean airway pressure, PO2/FIO2 ratio, Rapid shallow breathing index) with accepted sensitivity and moderate specificity for predicting successful weaning from MV in ICU patients. Its use should be encouraged in the ICU setting, especially by less experienced ICU physicians.
Efficacy and Safety of Radiofrequency Ablation and Trendelenburg Procedure for Varicose Vein Treatment in a Tertiary Care Hospital
Authors: Thulasikumar Rathnaganpathi , Gogineni Mahesh , Ravichandran Manoj Prabakar , Gunasekaran Marun Raj , Subrammaniyan SR 
Published: October 2024

Context:
Varicose veins have been conventionally treated by Trendelenburg procedure, which includes below-knee phlebotomies, juxta-femoral flush ligation of saphenous veins, and below-knee vein stripping. However, radiofrequency ablation (RFA) therapy, a less invasive method that uses high-frequency alternating current to cause thermal damage to the venous tissue, has become increasingly popular due to its reduced adverse effects. This study aimed to compare these two methods regarding early ambulation, return to work, postoperative pain severity, recovery time, and complication rates.

Aims:
To compare the effectiveness and safety of open procedure compared to endovenous ablation.

Settings and Designs:
An analytical cross-sectional study was prospectively conducted at Saveetha Medical College in Chennai.

Subjects and Methods:
This analytical cross-sectional study, conducted prospectively from May 2020 to May 2023, involved 100 individuals diagnosed with varicose veins. Participants were followed up at 3-, 6-, and 12-month intervals. The study was carried out at Saveetha Medical College in Chennai. Fifty patients were treated using the Trendelenburg method (Group I), while 50 patients received RFA (Group II). The data on early ambulation, return to work, postoperative pain severity, recovery time, and complication rates were collected and analyzed using the Epi Info 7 version.

Results:
Group I did not show any significant complications, such as bleeding, hematoma, or inflammation, compared to Group II. Notably, in Group II, there was an earlier hospital discharge, faster return to daily activities and work, and faster patient mobilization.

Conclusions:
This study concludes RFA, compared to the Trendelenburg method, has early ambulation, early return to work, reduced postoperative pain, swift recovery, and fewer complications. Consequently, we recommend RFA as their primary surgical option for patients with varicose veins in the lower limbs.
Pediatric Limb Ischemia: Our Experience from a Tertiary Hospital in Oman
Authors: Al Hinai Meerah , Al Kindi Ibrahim , Stephen Edwin , Al Wahaibi Khalifa 
Published: October 2024

Introduction:
Pediatric acute limb ischemia (PALI) is a consequence of sudden loss of blood flow to an extremity that can progress to irreversible ischemia if not promptly treated. This may unfortunately result in life-changing consequences which include limb loss, limb length discrepancy, emotional trauma, and or financial stress. Due to the rarity of this condition, and the lack of high-quality evidence, treatment strategies have largely been anecdotal or extrapolated from treatment of the adult patient. The article is a guide to improve overall functional outcomes and reduce morbidity of PALI.

Methods:
The authors retrospectively analysed patient data on the electronic patient record of the hospital between January 2021 and December 2023. The patients with PALI were divided into three broad categories: iatrogenic arterial injury managed with the best medical management, managed surgically; iatrogenic deep vein injury/thrombosis, and trauma.

Results:
A total of 13 patients were referred during the study period. 9 were male. 8 cases were line related, 2 trauma and 3 acute deep vein thrombosis [DVT]. Two patients succumbed prior to intervention. Eight patients were managed with best medical therapy, two surgically and one by endovascular means.

Conclusion:
Since experience worldwide is limited with PALI, we decided to share our experience and a propose comprehensive algorithm for the management of PALI emphasizing a multi-disciplinary team approach that we follow at our hospital. Early and decisive involvement of vascular surgeons, hematologists, intervention radiologists, and pediatric intensive care physicians is necessary to achieve the most favorable outcomes.
Synchronous off-pump Coronary Bypass and Extra-anatomic Thoracic Aortobifemoral Graft Using Anterolateral Thoracotomy Single-center Experience
Authors: Shah Apurva , Shah Kesha , Dixit Sunil , Mittal Sourabh 
Published: October 2024

Background:
Aortoiliac occlusive disease can coexist with coronary artery disease in many instances leading to the dilemma of which problem to address first as for these patients with multiple comorbidities and high surgical risk, it is critical to decrease the overall physiologic burden of surgery when possible. Furthermore, with severe or complete occlusion of vascular supply to lower limbs, it proves beneficial to avoid two-stage surgeries because of the high risk of irreversible ischemia necessitating amputation.

Material and Method:
Hence, we attempted single-stage combined coronary artery bypass grafting with thoraco-bifemoral bypass grafting through left anterolateral thoracotomy in five cases.

Results:
In all 5 cases we got successful results with no major complications.

Conclusion:
Thus, CABG with thoracofemoral bypass grafting in single surgery can prove to be good alternative for patients with concomitant PVD (peripheral vascular disease) with CAD (coronary artery disease).
New Classification of Inferior Phrenic Artery Variations Correlated with Computed Tomography Angiography: Clinical Significance
Authors: Kumar Suresh D , Rajkumar R Vivil Vidya , Anish N , Ethiraj Dillibabu 
Published: October 2024

Background and Aim:
A comprehensive understanding of the variations in the inferior phrenic artery (IPA) origin is essential for various interventional and surgical procedures utilized in treating conditions such as hepatocellular carcinoma, hemoptysis, trauma, iatrogenic injuries, and organ transplantations. In this study, we analyzed 1008 computed tomography angiography (CTA) cases and correlated the findings with the newly proposed classification of IPA variations of our study.

Materials and Methods:
Retrospectively evaluating IPA variations in 1040 cases, excluding 32 subjects, this study collected patient data from the hospital’s picture archiving and communication system. The analysis focused on IPA origins, including connections to the celiac artery, left gastric artery, and renal arteries. The inclusion criteria comprised routine CTA of the upper abdomen, with exclusion criteria excluding major vascular pathologies, upper abdominal surgeries, and motion artifacts.

Results:
An evaluation of 1008 CTA studies revealed the prevalence of IPA variations, leading to a new classification system grounded in embryology. IPA was categorized into four main types and respective subtypes: Type I (41.8%), Type II (41.4%), Type III (3.3%), and Type IV (7.2%), with detailed breakdowns of subtypes within each category.

Conclusion:
While recognizing the significant clinical importance of IPA variations, this study addresses the scarcity of comprehensive research on the topic. By presenting a various IPA variations, this research aims to simplify the identification and reporting of these variations for improved clinical practice.
Pre-Requisites for Novice Researchers to Conduct Clinical Research
Authors: Rath Padmalya , Jana Shib Narayan , Nayak Chaturbhuja , Saraswat Kruiti 
Published: October 2024

Abstract
Clinical research or medical research is an important and emerging research field which intends to produce the latest knowledge about healthcare, interventions, complications, etc. A clinical trial should be well-designed, planned, and executed. This article aims at guiding the researchers, especially the novice ones, to conduct clinical research methodologically. The key points essential for the researchers to undertake research projects are mentioned in this paper. This paper will be a practical, user-friendly manual for medical professionals, that is, physicians, nurses, study coordinators, and investigators, especially the new entrants in the respective fields, to carry out clinical trials. It presents the approach and guidance in a step-by-step way for conducting any clinical or medical research in an efficient way. The data obtained therefrom will be acceptable to the profession, and the acceptance of research findings by the scientific world will be increased.
All-inside Technique versus Conventional Full-tunnel Reconstruction for Anterior Cruciate Ligament Tears of the Knee: A Systematic Review and Meta-analysis
Authors: Banerjee Sumit , Gupta Akshat , Roy Sanchit , Jain Chirag , Elhence Abhay 
Published: October 2024

Introduction:
There is a paucity of evidence in literature regarding the efficacy of all-inside anterior cruciate ligament reconstruction (AIACLR) vis-à-vis the traditionally used full-tunnel (FT) technique. The primary aim of this review, thus, was to shed light on this discrepancy and determine which of the two methods had more optimum results.

Methods:
PubMed and Cochrane Library databases were systematically searched by two independent reviewers. Selection criteria were laid down as per the patient, intervention, control, and outcome (PICO) format. All included studies were checked for quality and methodological strength using well-defined risk-of-bias assessment tools. Techniques were compared with respect to their graft and tunnel dimensions, functional outcome scores, and complication rates. Data analysis was carried out using the RevMan 5.3® software.

Results:
A total of 12 articles (six randomized control trials or randomized clinical trials and six prospective/retrospective cohort studies) with 880 knees were included in this study. In most instances of AIACLR, a short and thick quadrupled semitendinosus graft was used for reconstruction. Suspensory fixation devices alone or in combination with interference screws were used for graft fixation. The two techniques were comparable in terms of their functional outcomes, with a slightly lower graft failure rate with AIACLR.

Conclusion:
The AI technique provides a safe and reliable alternative to conventional ACLR in terms of comparable functional results, reduced postoperative pain, and lower graft failure rates. However, more comparative trials with long-term follow-ups are needed before a definitive statement can be put forward.
Clinicoradiological and Arthroscopic Correlation of Meniscal Injuries
Authors: Date Jay Yashavant , Bhalerao Nitin , Chaughule Chandrasen , Tanpure Sanket 
Published: October 2024

Background:
Menisci in knee joint serve very important functions of distributing joint stresses and stabilizing the joint. Meniscus tears are on the rise because of increased sports participation. Along with detailed history taking, the physical examination and special investigations such as magnetic resonance imaging (MRI) are required to diagnose meniscal injuries. A diagnostic arthroscopy is considered as the gold standard. Owing to heavy work duties, overdependence on MRI without due clinical examination is on the rise. The aim of our study was to correlate the findings of clinically diagnosed meniscal tears with its radiological and arthroscopic findings and to find out the reliability of clinical examination and MRI in meniscal injuries considering arthroscopy as the gold standard.

Materials and Methods:
It was a prospective, longitudinal study performed over 12 months. All patients fulfilling inclusion criteria underwent clinical examination and MRI scan; the data obtained were evaluated and correlated with arthroscopic findings. Using necessary equations sensitivity, specificity and accuracy were calculated.

Results:
The clinical examination showed sensitivity, specificity, and accuracy of 75%, 90.62%, and 83.33%, respectively, when correlated with arthroscopy. MRI scan showed sensitivity, specificity, and accuracy of 82.86%, 92%, and 86.67%, respectively, when correlated with arthroscopy.

Conclusion:
MRI and clinical examination are comparably sensitive, specific, and accurate for diagnosing meniscal injuries with a subtle preference toward MRI. Author recommends a thorough clinical examination should suffice, but having a MRI scan beforehand is always beneficial in the absence of other concerns to do MRI.
The Association between the Duration of Anterior Cruciate Ligament Rupture-reconstruction with Meniscal Lesions and Knee Functional Outcomes
Authors: Khorasani Ahmad Ghoochani , Afshar Cyrus , Aghili SeyedHadi , Ranjbar Mehri Farhang , Golshaninejad Amirhossein 
Published: October 2024

Background:
Given the controversial correlation between the duration of anterior cruciate ligament (ACL) rupture-reconstruction and knee functional outcomes reported in previous studies, this study aimed to investigate the correlation between the duration of ACL rupture-reconstruction with knee meniscal lesions and functional outcomes.

Patients and Methods:
This retrospective cohort study was conducted on 221 patients with ACL rupture who underwent ACL reconstruction at a referral hospital in Tehran, Iran, from April 2021 to May 2023. Demographic characteristics and data about the duration of ACL rupture reconstruction were collected using the patients’ clinical documents. The status of knee meniscal lesions had been evaluated using magnetic resonance imaging report or operation note. After that, knee functional outcomes had been assed using Osteoarthritis Outcome Score scale. The correlation between the duration of ACL rupture-reconstruction with knee meniscal lesions and functional outcomes was evaluated using the multivariate regression test.

Results:
Most patients were male, with a mean age of 28.38 ± 7.33 years. The correlation between the duration of ACL rupture-reconstruction and knee meniscal lesions was statistically significant (P = 0.026); however, the correlation between the duration of ACL rupture-reconstruction with the KOOS questionnaire scale score and all its dimensions as a scale for assessing knee outcomes was not significant (P > 0.05).

Conclusion:
Although early ACL reconstruction is accompanied by reduced knee meniscal lesions, this cannot improve knee functional outcomes.