bluuebunny/crossref_metadata_2025_split huggingface dataset:
What Happens after Therapy? Quality of Life and Neurocognitive Functions of Children with Malignant Posterior Fossa Tumors after Adjuvant Therapy
Authors: Yeole Ujwal , Hegde Shantala , Gothwal Mohit , Prabhuraj A R , Somanna Sampath , Thennarasu K , Arimappamagan Arivazhagan 
Published: September 2024

Purpose:
The health-related quality of life (HRQoL) is an important endpoint in modern clinical practice with improved survival of pediatric posterior fossa malignant brain tumors (PFMBTs). We evaluated the effect of environmental and psychosocial milieu on QoL and cognitive functioning (CF) of Indian children with PFMBT.

Methods:
In a cross-sectional study, 47 children <18 years of age with medulloblastoma or anaplastic ependymoma were evaluated ≥6 months after completion of adjuvant therapy. All clinical and socioeconomic details, educational status of child and family members, socioeconomic status, environmental factors affecting QoL were documented. Children underwent HRQoL evaluation using Pediatric quality of life Inventory (PedsQL) questionnaire and neuropsychological evaluation.

Results:
The median age of the cohort at presentation was 7 years (1–18) and median duration of evaluation after adjuvant therapy was 16 months. In 47 families, 72.34% had low monthly income and 76.6% of mothers took formal education. QoL scores were above median values. Parents reported scores highlighted that Lansky performance score (P = 0.001) and maternal education (P = 0.043) significantly influenced the cognitive component of QoL. Twenty-seven children had below-average IQ. Young age at presentation (P = 0.020), maternal education (P = 0.032), high socioeconomic status (P = 0.001) influenced the IQ score. Even though the majority of children (57.44%) had below-average IQ, they had a score of more than 50 on the cognitive functioning scale. A total of 72.5% of the eligible children in our cohort went back to school following therapy, though often with a delay of one academic year.

Conclusions:
Overall cognitive functioning scores of these children are good, but they are not representative of actual neurocognitive tasks based performance or IQ scores. Children should remain under regular follow-up with a neurocognitive assessment and psychological counseling at regular intervals.
Association of Stressful Life Events with Dementia in North Indian Populations
Authors: Manoj Shalini , Nehra Ashima , Dalal Krishna , Sagar Rajesh , Tripathi Manjari 
Published: September 2024

Background:
Chronic stress is known to be associated with dementia.

Aim:
This study looked for major stressors and their associations with dementia in the elderly demented population.

Methods:
Case group consisted of 60 subjects (age group 55-75 years; M:F = 7:3) with postscreening for mild cognitive impairment (MCI) and mild Alzheimer's type dementia. Control group consisted of two subgroups: related (N = 60) and not-related (N = 60) subjects screened and confirmed not to be suffering from cognitive impairment. Sociodemographic variables were collected using a personal data sheet. The severity of cognitive impairment was assessed using the Clinical Dementia Rating (CDR) Scale. Subjects with a CDR score of range 0.5-1 were included in mild cognitive impairment and mild Alzheimer's type dementia. Stressful life events were evaluated using the Presumptive Stressful Life Event Scale (PSLES). A present stress level of caregivers was evaluated using Depression Anxiety Stress Scales (DASS). Assessed stress level scores were compared and validated with serum and plasma levels of cortisol and ACTH respectively.

Results:
Different groups exhibited distinct PSLES and DASS scores with statistical significance. It was also observed that Cortisol and ACTH levels were elevated in case group as compared with that of both sub-group controls.

Conclusions:
The outcome measures of this study projected that neural degeneration leading to mild cognitive impairment and dementia may be due to accumulative cortisol hormone associated with stressful life events.
Cost of Illness of Major Neurocognitive Disorders in India
Authors: Malapur Puneeth U , Kumar Nripendra , Khandelwal Sudhir K , Tripathi Manjari 
Published: September 2024

Background:
Major neurocognitive disorders (major NCD) predominantly affect the elderly. Major NCD results in significant morbidity and socioeconomic burden.

Objectives:
To estimate the individual cost of care of a person with major NCD according to disease severity and component costs.

Methods and Material:
Fifty patients of major NCD with primary caregivers attending memory clinic of tertiary care center were included. A detailed questionnaire administered after inclusion provided demographic and clinical information. Caregivers were interviewed about details of care provided. Cognitive function was assessed by Hindi mental state examination (HMSE), and major NCD severity was determined by clinical dementia rating scale (CDR).

Results:
The annual cost of care per patient with mild to moderate and severe major MCD was INR 78288 and INR 167808, respectively. Costs increased with increasing severity of the disease. Direct nonmedical costs were significantly higher than direct medical costs in severe major NCD group and vice versa was found in mild to moderate major NCD group.

Conclusion:
Increasing population of elderly and prevalence of major NCD suggest an economic burden on caring families and hence the government. Comprehensive health policy toward providing affordable care to people with major NCD is the need of the hour.
Rehabilitation of the Shoulder Subluxation Based on Ultrasonographic Findings among Post Stroke Subjects
Authors: Arya Kamal Narayan , Pandian Shanta , Bhatnagar Nidhi , Sharma Abhishek 
Published: September 2024

Background:
Up to three-fourths of the poststroke subjects may experience shoulder subluxation as a challenging complication. The existing rehabilitation management is based on the clinical assessment. Ultrasonographic evaluation demonstrates findings, which cannot be discerned by the usual methods.

Objectives:
To determine the effect of rehabilitation protocol based on the sonographic findings of the subluxed shoulder on reduction of the subluxation and upper limb motor recovery.

Materials and Methods:

Setting: Department of Occupational therapy of a Rehabilitation Institute. Study Design: A prospective case series. Subjects: 08 Poststroke hemiparetic patients with subluxed shoulder. Outcome measure: Ultrasongraphy of the bilateral shoulder joints, Fingerbreadth palpation method, Visual analog scale (VAS), Fugl-Meyer assessment of upper extremity (FMA-UE). Intervention: As per the findings of the sonography, management in the form of shoulder support, physical agent modalities, motor therapy, and precautions and positioning was provided to the subjects for the period of 3 months.

Results:
Post intervention, the participants showed 1 to 6 mm of reduction of acromion-greater tuberosity distance in addition to the reduction of atrophy and soft tissue or joint effusion. Furthermore, the participants also exhibited FMA-UE change ranging from 5 to 21.

Conclusion:
The ultrasonographic evaluation explores objective measurement and involvement of specific soft tissues among poststroke subject with the shoulder subluxation. The management based on the sonographic findings is an objective and valid approach.
Geometrical and Hemodynamic Characteristic Changes of Small Anterior Communicating Artery Aneurysms during Follow-ups in a Retrospective Analysis
Authors: Xu Lijian , Zhu Yueqi , Zhang Ruijian , Zhu Tingzhun , Wan Jieqing , Liang Fuyou , Zhao Bing 
Published: September 2024

Background:
Small intracranial aneurysms have a low risk of rupture. However, ruptured anterior communicating artery (ACoA) aneurysms are usually smaller in clinical practice. The retrospective study aimed to investigate the geometrical and hemodynamic changes of small unruptured ACoA aneurysms during serial follow-ups.

Materials and Methods:
We retrospectively collected patients with small unruptured ACoA aneurysms that were not repaired, who had serial follow-ups from the Electronic Medical Record System in four tertiary hospitals. The geometrical parameters of ACoA aneurysms were measured using a three-dimensional reconstructed model. Intra-aneurysmal hemodynamic parameters were computed using a high-resolution computational fluid dynamics model. Geometrical and hemodynamic changes of the aneurysms were evaluated at each follow-up.

Results:
Five patients with small unruptured ACoA aneurysms that were not repaired were identified and included in this analysis. Aneurysms rupture occurred in two patients with aneurysm growth. The formation and enlargement of an irregular bleb at the aneurysm neck or dome were observed before the rupture. Ruptured aneurysms showed high wall shear stress (WSS) in the high inflow zone of aneurysm neck while low WSS and high oscillatory shear index (OSI) in the flow-recirculating region of aneurysm dome. Three unruptured aneurysms maintained a stable morphology and a physiological level of WSS.

Conclusions:
Aneurysm growth, low WSS, and high OSI at the dome and/or high WSS at the neck potentially contribute to the rupture of small ACoA aneurysms. These aneurysms should be considered for the treatment regardless of the small size.
Factors Affecting Time to Emergence From General Anesthesia Following Clipping of Ruptured Aneurysms
Authors: Bhairwa Devendra P , Kapil Sonia , Mahajan Shalvi , Bhardwaj Avanish , Dhandapani Sivashanmugam , Bhukal Ishwar , Tewari Manoj K , Bhagat Hemant 
Published: September 2024

Introduction:
Early emergence from anesthesia is valuable, especially among neurosurgical patients for postoperative neurological evaluation and appropriate interventions. However, the factors affecting the emergence in patients undergoing clipping of ruptured aneurysms have not been studied.

Materials and Methods:
This was a prospective observational study on patients of aneurysmal subarachnoid hemorrhage with World Federation of Neurological Surgeons (WFNS) Grades I to III, undergoing surgical clipping. All relevant preoperative and intraoperative details were collected and analyzed to assess the factors affecting emergence time.

Results:
A total of 67 patients with a median age of 46 years were included in the study. The number of patients with Fisher Grades I, II, III, and IV was 6, 20, 25, and 16, respectively. The median time to emergence was 17 minutes (interquartile range 10–240 minutes). On univariate analysis, the factors that were found to have a significant relationship with time to emergence were preoperative Glasgow Coma Score (GCS; P = 0.02), WFNS grade (P = 0.005, temporary clipping time (P = 0.03), and the temperature at the end of surgery (P < 0.001) In the multivariate analysis using generalized linear model, preinduction GCS (P < 0.001), patient's temperature at the end of surgery (P < 0.001), and temporary clipping time (P = 0.01) had a significant impact on the emergence time, independent of age, American Society of Anesthesiologists grade, Fisher grade, duration of anesthesia and of each other, with GCS and temperature having the maximum impact. ROC curve for temperature had a cutoff value at 35.3°C with an 83% probability of awakening beyond 15 minutes if the temperature decreased below 35.3°C.

Conclusion:
The preinduction GCS, the temperature of patients at the end of surgery, and the duration of temporary clipping have a significant independent impact on the time to emergence from neurosurgical anesthesia, in the order of the strength of the association.
Idiopathic Normal Pressure Hydrocephalus Presenting as Psychosis
Authors: Mathew Robert , Archana N U , Sheetal S 
Published: September 2024

Background:
Normal pressure hydrocephalus (NPH) is a syndrome characterized by gait disturbance, dementia, urinary incontinence, and dilation of ventricular system with normal opening cerebrospinal fluid pressure. Idiopathic NPH (i NPH) presenting as psychosis is uncommon.

Objectives:
The objective of this study is to describe idiopathic NPH presenting as Psychosis.

Subjects and Methods:
Patients availing dementia care service from three tertiary care hospitals, across Kerala, with a diagnosis of psychosis were evaluated.

Results:
Three patients with NPH, diagnosed as per the consensus criteria, presenting as psychosis are described. Patient 1: Fifty-five-year-old lady with psychosis was found to have iNPH. She gave history of psychosis relieved with successful shunting of the hydrocephalus. She developed recurrence of psychosis each time the hydrocephalus recurred due to shunt malfunction and was relieved with correction of hydrocephalus with shunting. Patient 2 was a 67-year-old gentleman with long history of pyschosis with paranoid ideas. Five years after onset of illness, he developed gait apraxia, and a CT scan done showed normal pressure hydrocephalus. Patient 3 had bipolar illness since age of 60 years of age. He also developed gait apraxia 5 years into the illness and was diagnosed as having iNPH following imaging.

Conclusions:
All the patients had psychosis much before other features of iNPH developed. One of the patient's psychosis was temporally associated with onset and offset of hydrocephalus, thereby strongly supporting the causative nature of iNPH. iNPH though rare can be one of the causes for late onset secondary psychosis.
Nonobstructive azoospermia: an etiologic review
Authors: Hubbard Logan , Rambhatla Amarnath , Glina Sidney 
Published: September 2024

Abstract
Azoospermia is the complete absence of spermatozoa in the ejaculate in two or more semen analyses after centrifugation. Nonobstructive azoospermia (NOA) represents the most severe form of male factor infertility accounting for 10%–15% of cases and stems from an impairment to spermatogenesis. Understanding of the hypothalamic–pituitary–testicular axis has allowed NOA to be subcategorized by anatomic and/or pathophysiologic level. The etiologies of NOA, and therefore, the differential diagnoses when considering NOA as a cause of male factor infertility, can be subcategorized and condensed into several distinct classifications. Etiologies of NOA include primary hypogonadism, secondary hypogonadism, defects in androgen synthesis and/or response, defective spermatogenesis and sperm maturation, or a mixed picture thereof. This review includes up-to-date clinical, diagnostic, cellular, and histologic features pertaining to the multitude of NOA etiologies. This in turn will provide a framework by which physicians practicing infertility can augment their clinical decision-making, patient counseling, thereby improving upon the management of men with NOA.
Comparative evaluation of continuous and sequential chelation on the dentinal tubule penetration of bioceramic-based sealer – A confocal laser scanning microscopic study
Authors: Gupta Komal , Shetty Soumya S. , Tandale Anita B. , Srikurmam Manisha , Nihalani Harsha 
Published: September 2024

Context:
Effective endodontic treatment relies heavily on proper instrumentation, thorough disinfection, and precise three-dimensional obturation of the root canal system.

Aims:
This study aims to evaluate and compare continuous chelation (etidronic acid and sodium hypochlorite [NaOCl]) and sequential chelation (citric acid and NaOCl) on the dentinal tubule penetration of bioceramic-based sealer (Bio-C)-A confocal laser scanning microscopic study.

Settings and Design:

In vitro experimental study.

Subjects and Methods:
Sixty extracted permanent single-rooted teeth were selected and decoronated below cementoenamel junction to get a standardized length of 12 mm across all samples followed by enlargement of root canals till rotary ProTaper F3. The samples were randomly divided into three groups: Group I (control): Canals were irrigated with 3 mL 17% ethylenediaminetetraacetic acid/3 mL 3% NaOCl; Group II: Canals were irrigated with 10 mL etidronic acid + NaOCl solution; and Group III: Canals were irrigated with 3 mL 10% citric acid followed by 3 mL 3% NaOCl. 0.1% rhodamine B dye was mixed with Bio-C sealer followed by obturation. All the samples were subjected to confocal laser scanning microscopy evaluation.

Statistical Analysis Used:
One-way analysis of variance with the Bonferroni post
hoc test was used for the statistical analysis. The level of significance was set at P < 0.05.

Results:
The pairwise comparison of depth of penetration showed statistically significant results in all the coronal, middle, and apical thirds. Group II showed better depth of penetration than Groups I and III.

Conclusions:
Continuous chelation protocol using etidronic acid and NaOCl showed greater and statistically significant sealer penetration depth when compared to the sequential chelation protocol, i.e., citric acid at all three levels.
Comparison of proximal contact and contours of class II restoration in premolars and molars restored with three different matrix systems using FDI criteria: An in vivo study
Authors: Sankhyan Vanshish , Makkar Sameer , Negi Shabnam , Gupta Simran , Jain Ayushi , Arora Garima 
Published: September 2024

Context:
Sectional matrix systems, namely, Garrison and Bioclear with contact rings, are valuable aids to establish proximal contact tightness and contours in Class II composite restorations when compared with the circumferential matrix system Tofflemire.

Aims:
This study aimed to compare the proximal contact and contours of Class II restoration in premolars and molars restored with Tofflemire, Garrison, and Bioclear matrix system by FDI criteria of approximal anatomical form using floss or 25-µm metal blade and radiographic examination.

Subjects and Methods:
Sixty Class II patients were selected, and a preoperative bitewing radiograph was taken. Initially, caries removal was done by round diamond bur, followed by 245 carbide bur. Samples were divided randomly into three groups based on the type of matrix system used for restoration. Group 1 (n = 20): Tofflemire, Group 2 (n = 20): Garrison matrix system, and Group 3 (n = 20): Bioclear matrix system. Matrix systems were applied according to the manufacturer’s instructions, and composite restoration was done. The clinical evaluation of proximal contact and contour was done by a blinded observer immediately after placement of composite restoration using FDI criteria by passing dental floss or 25-µm metal blade, whereas marginal gaps and overhangs were checked using a radiograph. Results were statistically analyzed.

Statistical Analysis Used:
The statistical analysis was done using the Statistical Package for the Social Sciences (SPSS for Windows, Version 19.0). Descriptive statistics was calculated as frequency and percentage. The comparison of characteristics of the contact points, contour, and radiographic examination was carried out using the Chi-square test. Multiple comparisons were done by comparing column proportions with Bonferroni adjustments. The level of significance for the present study was fixed at P < 0.05.

Results:
There were significantly higher proportions of normal contacts in Garrison (60%) and Bioclear (70%) compared to that in the Tofflemire (20%) matrix system (Bioclear > Garrison > Tofflemire). Comparison of contours showed normal contours with Garrison (50%), Bioclear (50%), and Tofflemire (15%) matrix system (Bioclear = Garrison > Tofflemire). In radiographic examination, harmonious transitions between the restoration and the tooth were similar in Garrison (30%) and Bioclear (30%) compared to the Tofflemire (15%) matrix system (Bioclear = Garrison > Tofflemire).

Conclusions:
Garrison and Bioclear sectional matrix systems established superior contacts and contours than the Tofflemire circumferential system.
Comparative evaluation of postoperative pain and periapical healing after root canal treatment using three different endodontic sealers: A randomized controlled clinical trial
Authors: Pandey Ruchika , Kararia Nitin , Sharma Deepak Kumar , Rathod Vishal , Bansod Anand Vilas , Desai Dhaval 
Published: September 2024

Aims:
A randomized controlled clinical trial to evaluate postoperative pain and investigate periapical healing after root canal treatment using eugenol, resin-based, and calcium silicate-based sealers (CSBSs) sealers.

Materials and Methods:
Sixty-three individuals diagnosed with apical periodontitis confirmed using cold test and electronic pulp tester, periapical pathology with periapical index score of 2 or more, previous endodontic treatment failure exhibiting a visual analog scale pain score of 3 or above, were enrolled in this investigation. The patients were randomly allocated into three groups and following biomechanical preparation, the canals were obturated using Meta CeraSeal, AH plus, and eugenol-based sealers. Postprocedural pain intensity was assessed at 24 h, 48 h, and 7 days, while periapical healing was evaluated at 3- and 6-month follow-ups. Statistical analysis was done using the Chi-square and Friedman’s test.

Results:
The mean of periapical lesions for Meta CeraSeal (4.7, 1.6), AH Plus (4.68, 3.19), 24 and eugenol-based (2.66, 1.75) at 3 months and 6 months, respectively. The mean & std. deviation of pain scores at 24 h for Meta CeraSeal (0.62 ± 1.857), AH Plus (1.62 ± 1.962), and eugenol-based (0.48 ± 1.250). At 48 h for Meta CeraSeal (0.33 ± 1.528), AH Plus (1.33 ± 1.798). On the 7th day, Meta CeraSeal (0.24 ± 1.091) and AH Plus (0.71 ± 1.384) for eugenol-based at 48 h, and on the 7th day, none of the patients had pain. Evaluation of the apical sealer puff displayed no suggestive variations (P = 0.634). Notably, no analgesics were taken.

Conclusions:
No suggestive dissimilarity was noted between eugenol, resin-based, and CSBSs sealers.
Estimation of the effect of acetone- or ethanol-based solvents on shear bond strength of composite resin using air- and blot-dry techniques
Authors: Jain Deepti , Kunhappan Sanjeev , Maheshwari Diksha , Goyal Manisha , Agarwal Arushi , Roy Ankita 
Published: September 2024

Background:
An adequate amount of water is necessary to maintain the shape of collagen fibrils while excess water hampers dentin–resin bonding. Air-drying lacks control while blot-drying displaces water in a controlled manner. Solvents in adhesives affect the configuration of collagen fibrils. Thus, the present study aimed to compare the influence of air- or blot-drying methods on shear bond strength (SBS) of acetone- and ethanol-based adhesives.

Materials and Methods:
Thirty-six extracted noncarious third molars with similar crown heights were selected. Teeth were decoronated and randomly divided into two groups: after acid etching, Group I was treated with acetone-based adhesives and Group II with ethanol-based adhesives. They were again subdivided into subgroups A (blot-dried) and B (air-dried) containing nine samples each. Dentin surfaces were etched and rinsed. After the respective drying method, adhesive application and composite buildup were done. SBS was measured. The data were subjected to statistical analysis.

Results:
Acetone-based adhesive showed the highest SBS in both drying methods. Further, blot-dried dentin produced significantly higher SBS than air-dried dentin.

Conclusion:
Solvent type and drying methods have an effect on the bond strength of total-etch adhesives to dentin. Acetone-based adhesives used with blot-drying techniques showed the best results.