bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of accuracy of four clinical scores and comparison with ultrasonography for diagnosis of acute appendicitis
Authors: Subramaniyan Prabhakar , Iyer Sandhya Padmanabhan 
Published: May 2017

Background: The vagaries of presentation and the variability of signs in acute appendicitis are such that even the most experienced surgeons may remove normal appendices or conserve those with perforation. Diagnostic scoring systems and imaging techniques may reduce the number of unnecessary appendectomies.Methods: 75 patients who presented with acute right Iliac fossa pain were analyzed using four different scoring systems. An abdominal ultrasound was also performed when necessary. The results of these scores, USG findings were compared to the intra operative findings and final histopathological report.Results: The Alvarado score had the best positive predictive value with high sensitivity. The Fenyo score was most sensitive for males, whereas the Teicher score was most sensitive for females. The Teicher score was the most specific. The Ohmann score had the highest negative predictive value. Ultrasonography showed a low sensitivity and specificity.Conclusions: There was a 24% negative appendicectomy rate in our study. The Alvarado score is ideal for borderline cases where a quick decision needs to be taken. Ohmann’s score can be used to rule out appendicitis in the casualty setting as it has the best negative predictive value. Fenyo and Teicher’s score with their high sensitivity can be used to reduce the number of negative appendicectomies.
Study of risk factors of severe acute malnutrition (SAM) in children 6 months to 5 years of age and evaluation of effect of micronutrient supplementation (WHO protocol) on serum zinc and magnesium levels: a case control study
Authors: Madhusudhan Kamatham , P.K Rajeev , A Shireesha , Ushashree Gummadi Vandana 
Published: May 2017

Background: Although risk factors for malnutrition have been identified earlier, individual factors potentially change in specific areas over time and a current characterization of risk factors provide the basis for preventative intervention strategies. No guidelines in relation to duration of micronutrient supplementation for treatment of SAM are available. Thus, the study was done to know the adequacy of dose of micronutrients that are presently being supplemented (WHO Protocols) for treating SAM.Methods: It is a case-control study involving 100 cases with severe acute malnutrition and 100 controls having normal nutrition status 6 months to 5 years of age. Detailed clinical data (using a predesigned questionnaire) and anthropometric measurements were recorded for analysis. Blood assay of Zinc, Magnesium and serum Proteins were done on the day of admission (day 1) and again after 2 weeks of treatment with nutritional supplementation (WHO protocols).Results: Out of 100 SAM Cases, 42% were from rural area whereas 76% of controls belonged to urban region (p value 0.03). Twenty-four (24%) mothers of SAM cases were Illiterate, whereas only 6 % of mothers in controls were illiterate. 57 % SAM cases were given breast feeding after 4 hours of life, where as 61% controls were given their first feed within 1 hour of birth with p value <0.01. Eighty-eight controls (88%) were given colostrum, whereas only 62 % SAM cases were given colostrum feeds with p value <0.01. Seventy controls (70%) were given exclusive breast feeding for 6 months whereas only 40% of cases (SAM) was given exclusive breast feeding till 6months of age (p value of <0.01). 57% of top fed cases were given over diluted feeds, only 27% of top fed controls were given over diluted feeds (p value 0.02). 53% of cases were bottle fed and 14% of controls were bottle fed with p value <0.01. Mean value of magnesium and zinc before supplementation was 2.4 mg/dl and 117 mcg/dl respectively with no significant rise after supplementation.Conclusions: Here is a correlation of severe acute malnutrition with rural area, maternal Illiteracy and low socioeconomic status, deprivation of colostrums feeding, lack of exclusive breast feeding for 6 months, over dilution of top feeds and use of bottle feeding. There is no correlation between SAM and immunization status and demographic parameters like age, sex and religion. SAM is inversely related to duration of exclusive breast feeding. 23% of severely malnourished children had delay of developmental milestones. No significant rise of serum levels was seen with WHO recommended doses of micronutrient supplementation
Outcome of ear surgeries in dry and wet ear
Authors: C. S. Shreyash , . Rajneesh , S. Rahul 
Published: May 2017

<p class="abstract"><strong>Background:</strong> Chronic suppurative otitis media (CSOM) can present with dry and wet ear (discharging ear). It’s an accepted fact that an actively draining central perforation is not a contraindication for ear surgery. The discharging ear presents the otologists with the dilemma of operating on it or not, this is due to widespread belief that the success rate while doing ear surgeries on wet ears is decidedly inferior. Hence the present dissertation is intended to find the outcome of ear surgeries in dry and wet ear.</p><p class="abstract"><strong>Methods:</strong> The present study comprises of 60 patients who have undergone type 1 tympanoplasty with cortical mastoidectomy, at Fr Muller’s Medical College, Mangalore. These patients were divided into two groups- Wet and Dry, based on the presence or absence of ear discharge at the time of surgery respectively. Inclusion Criteria: Patients of age group 16-60 years and both sexes, with mucosal type of chronic otitis media who underwent type 1 tympanoplasty with cortical mastoidectomy. Exclusion criteria: Patients with squamosal type of chronic otitis media or with ossicular chain erosion. A comparative analysis was done on the hearing improvement and incidence of the graft uptake postoperatively between the two groups.</p><p class="abstract"><strong>Results:</strong> In dry group, complete graft uptake was seen in 90% cases, whereas in wet group, a graft uptake rate of 86.7% was achieved. The graft take up rate is better in high x socio-economic status. Higher take up rates were seen in small and medium perforation compared to subtotal perforations. Hearing improvement, assessed by mean gain of PTA at the end of 6th month postoperatively, was achieved in 86% cases in Wet group and 90% cases in Dry group. There was an average hearing improvement of 13.08 db in speech frequencies in 88.3% cases. The difference between the two groups was statistically insignificant.</p><p><strong>Conclusions:</strong> In our study, we found no statistically significant differences between the success rates of Wet and Dry group, either in terms of graft uptake or the hearing improvement. Thus, from our study, we conclude that the presence of ear discharge at the time of surgery does not affect the success rate of type 1 tympanoplasty. </p>
A study of pregnancy specific dermatoses and their effect on the outcome of pregnancy
Authors: Nair Anju S. , Kurien George , Binesh V. G. 
Published: May 2017

<p class="abstract"><strong>Background:</strong> Pregnancy being a complex state, the interactions of multiple factors result in a number of cutaneous findings that can be separated into physiologic changes, pre-existing dermatoses that can be aggravated or improved during pregnancy and dermatoses that are specific to pregnancy. Dermatoses specific to pregnancy are important to recognise because they may be pruritic or painful to the mother and may pose significant risk to mother, her fetus or both. Early identification of the condition may go a long way in preventing morbidity and mortality<span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> Antenatal women attending dermatology outpatient for dermatologic problems or referred from Obstetrics and Gynaecology, department for skin conditions in a tertiary care hospital in Kottayam, Kerala state were taken up for the study. Pregnancy related dermatoses or physiologic changes due to pregnancy if present were noted. The patients were followed up till delivery and the pregnancy outcome recorded. The results were analyzed using SPSS.<strong></strong></p><p class="abstract"><strong>Results:</strong> 94.3% of the patients had physiological changes, hyperpigmentation being the commonest. Specific pregnancy dermatoses were present in 38.3%. 94% of pregnancy dermatoses occurred during third trimester. The most common specific dermatoses observed was pruritic urticarial papules and plaques of pregnancy (PUPPP)-63.6%. It is more common in primi gravida (30/42), in twin pregnancies, in mothers of babies with more birth weight, male babies and those with gestational diabetes mellitus. None of the specific dermatoses produced adverse fetal outcome<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> Pregnancy dermatoses usually manifest in the third trimester. PUPPP is the commonest pregnancy dermatosis. PUPPP is more common among mothers with increased body weight, gestational diabetes, in twin pregnancy and in mothers with male babies. Most of the common pregnancy dermatoses have no adverse effect on the fetus<span lang="EN-IN">.</span></p>
LAS COMPETENCIAS CIENTÍFICA Y AMBIENTAL A TRAVÉS DE LA LITERATURA INFANTIL
Authors: Almeida Antonio , García Fernández Beatriz 
Published: May 2017

<p>La literatura infantil permite trabajar un amplio abanico de competencias que pueden ser abordadas en un contexto formal de aprendizaje. El empleo de la literatura infantil permite generar un nexo entre lo real y la ficción, favoreciendo, más allá de la creatividad, el desarrollo de otras competencias como son la competencia en lectura, la competencia escrita y la competencia en comunicación oral, permitiendo así promover un amplio espectro de interacciones sociales.</p><p>Pese a las ventajas que presenta el empleo de la literatura infantil, su potencial en los ámbitos científico y ambiental ha sido poco explorado. Así, encontramos obras en las que se aproximan los lenguajes literario y científico, pues la naturaleza en general, y los seres vivos en particular, han servido como fuente de inspiración a numerosos autores de literatura infantil. Por ello, en este tipo de obras suelen aparecer conceptos científicos que permiten enriquecer el léxico de niños y niñas, favoreciendo una comprensión más efectiva de los mismos, pues se aprenden en un contexto no asociado específicamente a la enseñanza de las ciencias. Esta aproximación entre los lenguajes científico y literario permite llevar a cabo un análisis más complejo de las obras.</p><p>En este trabajo se ejemplifican estas cuestiones a través de dos obras: “Nham, Nham” de Mick Manning y Brita Granstrom (2000), y ¿Todavía nada? de Christian Voltz (2008), ambas adecuadas para 1º y 2º curso de educación primaria. Se señalan los diferentes conceptos científicos abordados en ambas obras, destacando algunas estrategias de exploración interdisciplinar. Finalmente, destaca cómo en este tipo de obras es complejo abordar separadamente los conceptos científicos y los valores sobre la naturaleza, demostrándose la relevancia de ambas cuestiones para promover la educación ambiental. Mediante estos ejemplos se pretende que los docentes puedan identificar otras obras con similar potencial, incluyéndolas en su práctica pedagógica.</p><p> </p>
Minimum Five-Year Outcomes with Porous Tantalum Acetabular Cup and Augment Construct in Complex Revision Total Hip Arthroplasty
Authors: Jenkins Derek R. , Odland Andrew N. , Sierra Rafael J. , Hanssen Arlen D. , Lewallen David G. 
Published: May 2017

Background:
The use of a trabecular metal revision shell with metal augmentation to fill segmental or irregular defects during complex revision hip arthroplasty has been shown to provide good short-term results in prior published series. Longer-term results of the several cup-augment constructs used clinically are not known. The objective of this study was to report, with minimum 5-year radiographic and clinical follow-up, the outcome of these various constructs in revision total hip arthroplasty.

Methods:
Eighty-four patients (85 hips) underwent revision total hip arthroplasty with use of porous tantalum augments between 2000 and 2007 at a single institution and were retrospectively reviewed. Fifty-seven of the patients (58 hips) had clinical and radiographic follow-up at a minimum of 5 years. At the time of revision, the majority of the hips had acetabular defects classified as Paprosky Type 3A (28 of 58, 48%) or Type 3B (22 of 58, 38%). Eleven (19%) of the hips also had preoperative pelvic discontinuity. All hips were assessed clinically at a minimum of 5 years with use of the Mayo hip score. Postoperative radiographs were reviewed for implant stability, the presence and location of radiolucent lines and healing of the discontinuity if present.

Results:
In 2 (3%) of the 58 hips, the constructs failed because of aseptic loosening of the acetabular component and re-revision was indicated. Six (10%) of the 58 hips demonstrated a radiolucent line between the trabecular metal shell and bone in DeLee and Charnley zone 3. In 1 hip that underwent re-revision and in 5 of the 6 hips with a zone-3 radiolucency, a pelvic discontinuity was present at the time of the index revision. The mean preoperative Mayo hip score was 35.7, which improved to 61.9 at 3 months and was 61.7 at the minimum 5-year follow-up.

Conclusions:
With failure defined as aseptic loosening requiring repeat revision surgery, this cohort demonstrated 97% survivorship and maintained satisfactory hip function at the minimum 5 years after the index revision surgery. Six of the 11 hips with preoperative pelvic discontinuity either failed or developed a radiolucency in zone 3 and are considered at risk for future revision. Pelvic discontinuity should prompt consideration of the addition of adjunctive fixation or the use of alternative techniques.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Modular Fluted Tapered Stems in Aseptic Revision Total Hip Arthroplasty
Authors: Abdel Matthew P. , Cottino Umberto , Larson Dirk R. , Hanssen Arlen D. , Lewallen David G. , Berry Daniel J. 
Published: May 2017

Background:
Modular fluted tapered stems have become the most commonly employed category of femoral component in revision hip arthroplasty in North America as a result of favorable early results and simplicity of use. Despite wide adoption, the majority of published data are limited to relatively small series with modest follow-up. The goal of the current study was to determine the success rate and factors associated with success, failure, and complications of the use of modular fluted tapered stems in aseptic revision total hip arthroplasties (THAs) in a large patient cohort.

Methods:
We identified 519 aseptic femoral revisions during which a modular fluted tapered stem was utilized. Clinical outcomes, Kaplan-Meier survivorship, radiographic outcomes, and complications were assessed. The mean age at revision arthroplasty was 70 years, the mean body mass index (BMI) was 29 kg/m2, and the mean duration of follow-up was 4.5 years (range, 2 to 14 years).

Results:
The mean Harris hip score (HHS) improved significantly from 51 points preoperatively to 76 points at 2 years (p < 0.001). This improvement was maintained at the last follow-up evaluation (mean HHS = 75 points). At the time of the most recent follow-up, 16 femoral revisions had been performed: 6 because of aseptic loosening, 4 because of infection, 3 because of instability, 2 because of periprosthetic fracture, and 1 because of stem fracture. The 10-year survivorship was 96% with revision for any reason as the end point and 90% with any reoperation as the end point. Of the patients who were alive and had not undergone revision at the time of final follow-up, 12 had stem subsidence but all but 1 of these stems had stabilized after subsiding. Postoperative complications were noted in 12% of the cases. Repeat revision due to femoral component loosening was not correlated with the preoperative bone-loss category or patient demographic factors.

Conclusions:
In this large series, femoral revision with a modular fluted tapered stem provided a high rate of osseointegration and sustained improvement in clinical scores at the time of the last follow-up. There was also a high rate of successful implant fixation across all categories of preoperative bone loss and an acceptable rate of complications.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Leptin Elevation as a Risk Factor for Slipped Capital Femoral Epiphysis Independent of Obesity Status
Authors: Halverson Schuyler J. , Warhoover Tracy , Mencio Gregory A. , Lovejoy Steven A. , Martus Jeffrey E. , Schoenecker Jonathan G. 
Published: May 2017

Background:
Slipped capital femoral epiphysis (SCFE) is strongly associated with childhood obesity, yet the prevalence of obesity is orders of magnitude greater than the prevalence of SCFE. Therefore, it is hypothesized that obesity is not, by itself, a sufficient condition for SCFE, but rather one component of a multifactorial process requiring preexisting physeal pathology. Leptin elevation is seen to varying degrees in patients with obesity, and as leptin has been shown to cause physeal pathology similar to the changes seen in SCFE, we propose that leptin may be a factor distinguishing between patients with SCFE and equally obese children without hip abnormalities.

Methods:
Serum leptin levels were obtained from 40 patients with SCFE and 30 control patients with approximate body mass index (BMI) matching. BMI percentiles were calculated according to Centers for Disease Control and Prevention population data by patient age and sex. Patients were compared by demographic characteristics, leptin levels, odds of leptin elevation, and odds of SCFE.

Results:
The odds of developing SCFE was increased by an odds ratio of 4.9 (95% confidence interval [CI], 1.31 to 18.48; p < 0.02) in patients with elevated leptin levels, regardless of obesity status, sex, and race. When grouping patients by their obesity status, non-obese patients with SCFE showed elevated median leptin levels at 5.8 ng/mL compared with non-obese controls at 1.7 ng/mL (p = 0.006). Similarly, obese patients with SCFE showed elevated median leptin levels at 17.9 ng/mL compared with equally obese controls at 10.5 ng/mL (p = 0.039). Serum leptin levels increased in association with obesity (p < 0.001), with an increase in leptin of 0.17 ng/mL (95% CI, 0.07 to 0.27 ng/mL) per BMI percentile point.

Conclusions:
To our knowledge, this study is the first to clinically demonstrate an association between elevated serum leptin levels and SCFE, regardless of BMI. This adds to existing literature suggesting that SCFE is a multifactorial process and that leptin levels may have profound physiological effects on the development of various disease states. Despite a strong association with adiposity, leptin levels vary between patients of equal BMI and may be a vital resource in prognostication of future obesity-related comorbidities.

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Changes by the Accreditation Council for Graduate Medical Education: Success or Failure?
Authors: Thompson Terry L. , Wright Rick W. , Nasca Thomas J. 
Published: May 2017

Abstract:
The Accreditation Council for Graduate Medical Education has introduced far-reaching changes to the educational requirements for postgraduate trainees over the past 15 years. These steps were taken to improve the quality of education and to enhance patient safety. This symposium will explore the design and implementation of these changes and determine if they are succeeding.
Sclerostin Antibody Treatment Enhances Rotator Cuff Tendon-to-Bone Healing in an Animal Model
Authors: Shah Shivam A. , Kormpakis Ioannis , Havlioglu Necat , Ominsky Michael S. , Galatz Leesa M. , Thomopoulos Stavros 
Published: May 2017

Background:Rotator cuff tears are a common source of pain and disability, and poor healing after repair leads to high retear rates. Bone loss in the humeral head before and after repair has been associated with poor healing. The purpose of the current study was to mitigate bone loss near the repaired cuff and improve healing outcomes.Methods:Sclerostin antibody (Scl-Ab) treatment, previously shown to increase bone formation and strength in the setting of osteoporosis, was used in the current study to address bone loss and enhance rotator cuff healing in an animal model. Scl-Ab was administered subcutaneously at the time of rotator cuff repair and every 2 weeks until the animals were sacrificed. The effect of Scl-Ab treatment was evaluated after 2, 4, and 8 weeks of healing, using bone morphometric analysis, biomechanical evaluation, histological analysis, and gene expression outcomes.Results:Injury and repair led to a reduction in bone mineral density after 2 and 4 weeks of healing in the control and Scl-Ab treatment groups. After 8 weeks of healing, animals receiving Scl-Ab treatment had 30% greater bone mineral density than the controls. A decrease in biomechanical properties was observed in both groups after 4 weeks of healing compared with healthy tendon-to-bone attachments. After 8 weeks of healing, Scl-Ab-treated animals had improved strength (38%) and stiffness (43%) compared with control animals. Histological assessment showed that Scl-Ab promoted better integration of tendon and bone by 8 weeks of healing. Scl-Ab had significant effects on gene expression in bone, indicative of enhanced bone formation, and no effect on the expression of genes in tendon.Conclusions:This study provides evidence that Scl-Ab treatment improves tendon-to-bone healing at the rotator cuff by increasing attachment-site bone mineral density, leading to improved biomechanical properties.Clinical Relevance:Scl-Ab treatment may improve outcomes after rotator cuff repair.