bluuebunny/crossref_metadata_2025_split huggingface dataset:
Role of serum cd4+, cd25+, and foxp3+ cells’ segmental and nonsegmental vitiligo
Authors: Mohammed Mohammed H. , Raheem Talal A.A. , Farouk Ahmed M. , Mohammed Shereen R. , Gamal Ahmed S. 
Published: September 2024

Background
Vitiligo is an autoimmune skin disease presented with depigmented macules and patches. Vitiligo has an impact on the quality of life. The etiopathogenesis of vitiligo is multifactorial, including genetic, immune dysregulation, and oxidative stress mechanisms. Lately, several researches have underlined the pivotal function of regulatory T cells (Tregs) in the vitiligo pathogenesis with lack of data regarding their role in segmental vitiligo (SV).

Objective
To investigate the role of Tregs in SV and nonsegmental vitiligo (NSV) pathogenesis and its correlation with disease activity and severity.

Patients and methods
This case–control study included 20 cases with NSV and 10 cases with SV in addition to 10 healthy volunteers. Vitiligo Area Scoring Index and Vitiligo Disease Activity scores were estimated for vitiligo cases and all the included participants were assessed for the percentage of serum CD4+, CD25+, and FOXP3+ T cells using flow cytometry staining buffer.

Results
There was significant reduction of the peripheral Tregs in NSV cases in comparison with healthy participants and negative correlation with their percentage to disease activity. On the other hand, there was insignificant difference between the percentage of peripheral Tregs in SV cases and healthy participants. Also, there was insignificant correlation between peripheral Tregs and both severity and activity of the disease among SV cases.

Conclusion
NSV cases showed significant reduction of the peripheral Tregs and negative correlation with disease activity, indicating the importance of Tregs in the etiopathogenesis of NSV and hence future targeting therapy. On the other hand, in SV cases, there was insignificant reduction of peripheral Tregs and insignificant correlation between their percentage and both severity and activity indicating mosaic etiopathogenesis.
A Cautionary Tale of an Unfortunate Testis: Testicular Infarction and Rupture as a Rare Complication of Acute Epididymitis
Authors: Xanicia Long Jiahuan , Long Welras 
Published: September 2024

Abstract
Epididymo orchitis is a common cause of unilateral scrotal pain. Infection is caused by retrograde ascent of pathogens to the epididymitis and extension to the testis. This condition typically follows an indolent course and responds well to a course of culture directed antibiotics along with analgesiaand scrotal support. Albeit rare, more severe complications such as abscess formation, testicular infarction, and testicular loss are still possible despite receiving appropriate extended antibiotic therapy. A high index of suspicion of these complications should be maintained in any presentation of acute scrotum, as early recognition could allow for salvage of the testis. We hereby present a rare case of acute epididymo-orchitis progressing to testicular infarction and rupture in a 50 year old male.
A Prospective Study of Hyperbaric Oxygen as a Treatment Option for Radiation-induced Hemorrhagic Cystitis
Authors: Stamatakos Panagiotis Velissarios , Papadimitriou Evangelia , Paizis Theodoros , Georgios Papadopoulos , Ntoumas Konstantinos 
Published: September 2024

Abstract

Introduction and Objective:
Hemorrhagic cystitis (HC) is a diffuse bladder inflammation that causes hematuria and other urinary tract complaints. Noninfectious hemorrhagic cystitis most commonly occurs in patients who have undergone pelvic radiation. In cases with refractory disease and persistent hematuria, the bladder can be irrigated with a variety of agents. Hyperbaric oxygen (HBO) therapy has been used with some success in difficult cases. In the present article, the safety and efficacy of HBO was examined as the primary treatment choice for radiation-induced HC.

Evidence Acquisition:
Prospective data were collected among patients with HC and previous radiotherapy. HBO was applied as a primary treatment. The primary endpoint of our study was the incidence of complete and partial response to treatment, whereas a variety of secondary endpoints were examined including the duration of response, blood transfusion rate, the avoidance of surgery, and the overall survival. Moreover, the correlation between the interval between the onset of hematuria and initiation of therapy and the success of treatment was recorded.

Evidence Synthesis:
A total of 20 patients participated in the study. The complete and partial response rate was 85% and 15%, respectively. All patients completed therapy while the median number of sessions needed was 31. No complications were recorded during treatment. Patients with complete response received therapy within 3 months of the hematuria onset. One patient needed cystectomy, whereas 19 patients were alive at the end of follow-up.

Conclusions:
HBO consists of an effective and safe treatment option in the management of radiation-induced severe HC. Further prospective studies should be undergone in order to validate its efficacy and safety profile.
Intracorporeal Urinary Diversion versus Extracorporeal Urinary Diversion during Robot-Assisted Radical Cystectomy
Authors: Mourmouris Panagiotis , Kotrotsios Konstantinos D 
Published: September 2024

Abstract

Background/Aim:
Radical cystectomy (RC) is a fundamental step in the therapeutic plan of nonmuscle and muscle-invasive urinary bladder cancer. Open RC is a surgical procedure with high morbidity and as such robot-assisted RC (RARC) has been established as an efficient alternative. Although in the beginning, the urinary diversion step during RARC was mostly performed extracorporeally nowadays a preference of the intracorporeal approach is yearly increasing. The aim of this review is to compare these two techniques of urinary diversion and depict the latest trends of current research on this field.

Materials and Methods:
A literature search of MEDLINE database (March 26, 2022) was performed to retrieve the articles published in English that are dated between January 1, 2010 and February 28, 2022. The search strategy included terms: “intracorporeal,” “vs,” “extracorporeal,” “urinary,” “diversion,” “comparison,” “after,” “RARC” and “or”.

Results:
Intracorporeal urinary diversion (ICUD) is strongly associated with lower perioperative blood loss and blood transfusion needs compared with the extracorporeal urinary diversion (ECUD). ICUD prolongs the operative duration. However, when ICUD is performed by experienced surgeons or in high volume centers, operative duration is comparable for ICUD and ECUD. The two approaches are assessed as equal in respect of postoperative complications.

Conclusion:
The debate as to whether ICUD must replace ECUD and become the standard of care does not end with this review. Intracorporeal approach in most of the studies seems to be associated with prolonged operative duration, lower transfusion needs, and equal complication rates when compared with ECUD. However, the contradiction of the results and the low quality of the available data demand the conduction of randomized prospective studies comparing ICUD and ECUD in order to offer the best available treatment to the patient.
Comparison of percutaneous tracheostomy methods in ICU patients: Conventional anatomical landmark method versus ultrasonography method - A randomised controlled trial
Authors: Kumar Pankaj , Kumar Sanjeev , Hussain Mumtaz , Singh Ritu , Ahmed Waquas , Anand Ravi 
Published: September 2024

Background and Aiims
Percutaneous dilational tracheostomy (PDT) is a common procedure in intensive care unit (ICU) patients requiring long-term mechanical ventilation. PDT has gradually replaced surgical tracheostomy because it is associated with minimal invasiveness, reduced bleeding and simplicity in technique.This study was conducted to compare ultrasound-guided PDT versus conventional tracheostomy in terms of duration of the procedure, number of passes and immediate peri-procedural complications.

Methods
A total of 72 patients with clinical indications of tracheostomy were recruited. A total of 12 patients met the exclusion criteria. The remaining were randomly assigned into two groups of 30 each: Group A (Landmark) with traditional anatomical landmark and Group B (USG) with real-time ultrasound guidance. Puncture positions were recorded with bronchoscopy. Midline deviation was captured on a bronchoscopy image using a protractor. Data on procedural safety and efficacy were also collected.

Results
: Group B had significantly fewer cases of midline deviation (11.33 ± 9.51) in comparison to Group A (16.60 ± 12.31). Trials > 2 were equal to 11 in Group A and 2 in Group B. However, the duration of the procedure was higher in Group B (20.07 ± 3.25 min) as compared to Group A (15.20 ± 3.71 min). Peri-procedural and post-procedural complications were also higher in the Landmark group.

Conclusion
: Ultrasound-guided PDT showed superiority over landmark PDT in terms of less number of trials, midline puncture and fewer complications. However, it took a little longer to perform USG-guided PDT.
Comparison of effects of dexmedetomidine added to ropivacaine versus ropivacaine alone infiltration scalp block for attenuation of the haemodynamic response to skull pin placement in neurosurgical procedures: A double-blind, randomised clinical trial
Authors: Sahana B. N , Sri Devi Radhapuram , Samantaray Aloka , Hemanth Natham , Pasupuleti Hemalatha , Mangu Hanumantha Rao 
Published: September 2024

Background and Aims:Skull pin head holder application is intensely painful and is accompanied with abrupt increase in heart rate and arterial blood pressure. We aimed to determine the effects of adding dexmedetomidine to ropivacaine scalp block in attenuating the haemodynamic response to skull pin insertion in neurosurgical procedures.Methods:Sixty patients were randomly allocated to receive scalp block with 25 ml of 0.5% ropivacaine added with either normal saline (control group) or dexmedetomidine (1 μg/kg) after anesthesia induction. A standard uniform general endotracheal anaesthesia protocol was followed in all study subjects. Heart rate and blood pressure measurements were made at baseline, 1, 3, 5, 10, and 15 min following skull pin placement. Student’s independentt-test, Chi-square test and repeated measure analysis of variance were used to analyse the obtained data.Results:There was no significant attenuation of heart rate (P= 0.418), systolic (P= 0.542), diastolic (P= 0.793) and mean blood pressure (P= 0.478) with addition of dexmedetomidine to ropivacaine.Conclusions:The addition of dexmedetomidine (1 μg/kg) to 25 ml of 0.5% ropivacaine offers no additional benefit over 25 ml of 0.5% ropivacaine alone scalp block in attenuating the haemodynamic response to skull pin placement in neurosurgical procedures.
Role of nebulised dexmedetomidine, midazolam or ketamine as premedication in preschool children undergoing general anaesthesia—A prospective, double-blind, randomised study
Authors: Shereef K Muhammed , Chaitali Biswas , Swapnadeep Sengupta , Gauri Mukherjee 
Published: September 2024

Background and Aims
Preschool age children are psycho-biologically vulnerable to all surgical procedures. In this study, we investigated the effect of nebulised dexmedetomidine, midazolam and ketamine as sedative premedication for alleviating parental separation anxiety, facilitating face mask acceptance and reducing emergence agitation in paediatric patients undergoing general anaesthesia.

Methods
A prospective, randomised, double-blind study was done involving 96 children of age 3–7 years, randomly allocated into three equal groups and pre-medicated with either nebulised dexmedetomidine 2 mg/kg (GroupD), midazolam 0.2 mg/kg (GroupM) or ketamine 2 mg/kg (Group K). The scores of sedation scale, parental separation anxiety scale, mask acceptance scale and emergence agitation scale were recorded along with haemodynamic parameters. Two-way repeated measures analysis of variance (ANOVA), post hoc test and Kruskal–Wallis test were used for statistical analysis.

Results
A statistically significant difference in sedation score was seen between the different study groups, χ2(2) = 8.561, P = 0.014 with mean rank sedation score of 56.50 for Group D, 38.92 for Group M and 43.84 for Group K. Parental separation anxiety scale score and Mask acceptance scale score also showed statistically significant difference between the different study groups, χ2(2) = 9.369, P = 0.009 and χ2(2) = 11.97, P = 0.003, respectively.

Conclusion
Nebulisation with dexmedetomidine produced easy parental separation, more satisfactory sedation and face mask acceptance with less postoperative agitation than nebulisation with midazolam or ketamine.
Comparison of liquid-based cytology and conventional preparations in nongynecological cytology
Authors: Buch Archana Chirag , Londhe Mangesh M. , Patil Tushar V. , Rathod Hetal , Dhaliwal Sargam , Gore Charusheela Rajesh 
Published: September 2024

Abstract

Introduction:
The liquid-based cytology (LBC) has shown significant advantages over conventional preparation in cervical cytology. The use of LBC in aspiration and exfoliative nongynecologic cytology has been on the rise since the last few years with relatively few studies being available depicting its role in fine-needle aspiration cytology (FNAC) from other sites. The study aimed to determine the diagnostic efficacy of LBC in nongynecological exfoliative as well as FNAC samples and compare the conventional and LBC methods for cytomorphological differences.

Materials and Methods:
This is a cross-sectional, analytical study that included the samples collected from two tertiary care centers over 8 months (January 2022 to August 2022). A total of 168 consecutive samples of aspiration and exfoliative nongynecological cytology were included. In each case, two passes were carried out one for a conventional smear (CS) and the other for LBC by Eziprep/Thin Prep (TP) method followed by smear staining with H and E stain and Leishman’s stain. The slides were studied by two observers for cellularity, background (blood and necrotic cell debris), informative background (such as colloid, stromal fragments, etc.), presence of monolayer cells, and cell architecture with nuclear and cytoplasmic details by a semiquantitative scoring system. Statistical analysis was performed using Wilcoxon signed-rank test on the SPSS program and histopathology correlation was attempted wherever available by using OpenEpi software version 3.

Results:
The mean age was 40 years, with the majority being females (70%). The TP smears were qualitatively superior to CS with statistical differences observed in fluid cytology. There was no statistical difference observed at other sites; except TP being superior to CS with regard to the background in breast cytology. The arithmetic mean in TP was higher than CS in all the parameters.

Conclusions:
The cytology smears of TP were qualitatively superior to CS in aspiration and nongynecological cytology. Overall diagnostic accuracy was comparable in both techniques.

The core competencies addressed in this article are:
Medical knowledge, Procedural skills, Practice-based learning and improvement, and Professionalism.
Association between cumulative fluid balance and clinical outcome in patients with septic shock: A retrospective observational study
Authors: Dash Abhilash , Jena Sunil Kumar , Chhotray Pritam , Panda Sagarika , Mishra Shakti Bedanta , Nayak Biswajit 
Published: September 2024

Abstract

Introduction:
Aggressive fluid replacement is done in septic shock to compensate for the decreased stressed volume in view of peripheral vasodilatation. However, excessive fluid administration may lead to fluid overload, edema formation, and organ damage such as renal congestion and acute kidney injury. Hence, this study was conducted to estimate the effect of fluid balance in the 1st week of septic shock on mortality.

Materials and Methods:
We conducted a retrospective analysis of the use of intravenous fluids and cumulative fluid balance (CFB) during the first 7 days of septic shock in a 25-bed multidisciplinary intensive care unit (ICU) in Northern India at a tertiary care teaching hospital.

Results:
Based on the CFB, we classified patients as low CFB when CFB is <20 mL/kg and high CFB when it is >20 mL/kg. The 28-day mortality in the low CFB group was 4.7% and in the high CFB group 26.15%, which was statistically significant. With an odds ratio of 7.17, CFB in septic shock was a predictor of ICU mortality (confidence interval of 3.87–13). The length of stay between the two groups was also found to be statistically significant (11.7 ± 3.2 vs. 12.6 ± 3.8; P = 0.02).

Conclusions:
In patients with septic shock, a higher CFB on day 7 of ICU admission is independently associated with an increased risk of mortality and a longer ICU stay.

The following core competencies are addressed in this article:
Practice-based learning and improvement, Medical knowledge.
Postoperative urinary retention in colorectal surgery patients on an enhanced surgical recovery pathway
Authors: Nguyen Tuan A. , Beal Eliza W. , Gerlach Anthony T. , Shabsigh Ahmad , Husain Syed G. , Brower Kristin I. 
Published: September 2024

Abstract

Introduction:
Postoperative urinary retention (POUR) is a complication of surgery defined as the inability to empty a full bladder. POUR can prolong hospital length of stay and increase rates of urinary tract infection in the postoperative period. Risk factors for the development of POUR include male sex, older age, select medications, and certain comorbid conditions. Surgical factors may also increase the risk of POUR. POUR occurs in up to 50% of patients undergoing colorectal surgery.

Materials and Methods:
This retrospective, single-center cohort study evaluated the incidence of POUR in patients admitted for colorectal surgery and were enrolled in a Colorectal Enhanced Surgical Recovery (CERAS) protocol. Our primary objective was to determine the incidence of POUR in patients treated under the CERAS protocol. Secondary objectives included evaluating the incidence of POUR in patients receiving intrathecal anesthesia.

Results:
Two hundred and twenty-eight patients were included. Sixty-six patients (28.9%) developed POUR during their hospitalization. Patients who developed POUR were more likely to be male (61.6% vs. 44.4%, P = 0.029) and tended to be older (mean ± standard deviation age, 61.4 ± 17.7 years vs. 56.8 ± 16.4 years; P = 0.069) compared to the non-POUR group. Regional anesthesia did not affect the incidence of POUR.

Conclusions:
We identified a rate of POUR in our CERAS patients consistent with previous studies. The risk of POUR increased with increasing age, male sex, and history of benign prostatic hyperplasia and diabetes mellitus. We found no difference in POUR incidence with the type of regional anesthesia utilized.

The following core competencies are addressed in this article:
Practice-Based Learning and Improvement and Medical Knowledge.
A Comparative Evaluation of Apical Microleakage in Immediate vs Delayed Postspace Preparation using Four Endodontic Sealers seen under Stereomicroscope - An in vitro study
Authors: Megha Rani , Neetu Jindal , Renu Aggarwal , Bharati Lisam , Monika Choudhary 
Published: September 2024

Context:
An In-vitro research.

Introduction:
To evaluate the apical microleakage in immediate v/s delayed postspace preparation using four endodontic sealers; Endomethasone N, AH Plus, MTA Fillapex and Gutta Flow.

Materials and Methods:
One hundred and thirty recently excised single-rooted permanent teeth without caries were decorated. The postspace was created with a Peeso reamer from size 1–4, and 5 mm of gutta-percha was left after the root canals were biomechanically prepared up to F3 (ProTaper file) and obturated using the lateral condensation method. According to immediate and delayed postspace preparation, the samples were separated into eight groups, with 15 samples in each experimental group and 5 samples in each of the two control groups. Except for the apical 2 mm and the negative group, which were entirely sealed with two layers of sticky wax, all of the samples were covered with two layers of oppressive wax. Then, the samples were immersed in 2% methylene blue dye, centrifuged at 3000 rpm for 3 min, sectioned longitudinally and observed the extent of dye penetration under stereomicroscope. To compare the results between study groups and within each group, the Post
hoc Tukey’s honestly significant difference comparison test and one-way ANOVA were utilized. When the P value was proved to be less than 0.05, the findings were deemed statistically significant.

Results:
Between all experimental groups, all samples revealed statistically significant differences. Group V (Endomethasone N-D) 3.46 ± 0.26 showed the greatest microleakage, whereas Group II (AH Plus I) 1.50 ± 0.40 showed little microleakage.

Conclusions:
Within the constraints of this study, postspace that was promptly prepared with all sealers experienced much-reduced microleakage.
Comparing and Evaluating the Antimicrobial Efficacy of Endodontic Root Canal Sealers against Enterococcus faecalis, Staphylococcus aureus, and Candida albicans at 24, 48, and 72 h: An in vitro study
Authors: Ajisha Raju , Neetu Jindal , Aggarwal Renu , Kaur Amandeep , Monika Choudhary 
Published: September 2024

Introduction:
Examining the effectiveness of root canal sealants next to Staphylococcus
aureus, Enterococcus
faecalis, and
Candida
albicans using the agar well diffusion technique was the focus of this research.

Materials and Methods:
Antimicrobial effectiveness was evaluated using a selection of endodontic root canal sealers, including AH Plus, Endomethasone, Sealapex, and GuttaFlow. Antimicrobial zones of reserve were evaluated at 24, 48, and 72 h using the agar well diffusion method. The effectiveness of sealers against a few common germs was evaluated using the ANOVA and Tukey’s post
hoc testing.

Results:
Large antimicrobial inhibitory zones were seen across all experimental groups. Endomethasone sealer showed the largest inhibition zones, measuring 16.40 (±1.02) mm at 24 h, 23.33 (±1.66) mm at 48 h, and 28.93 (±1.97) mm at 72 h. Sealapex and AH Plus came in the second and third, respectively; GuttaFlow showed no inhibition zones.

Conclusions:
The antibacterial efficacy of Endomethasone sealer against S. aureus, E. faecalis, and
C. albicans was the greatest at 24, 48, and 72 h.
Tramadol HCL as an Effective Alternative to Lignocaine HCL for Extraction of Tooth under Supraperiosteal Infiltration
Authors: Basu Subhransu , Mukherjee Oishee , Sahu Sudipto , Banerjee Rajarshi , Pachisia Sandeep , Biswas Abhishek 
Published: September 2024

Purpose:
To evaluate the efficacy of tramadol as a local anesthetic effect.

Materials and Methods:
Fifty patients were evaluated. Group A given tramadol and Group B given lignocaine. Parameters such as pain on injection, onset of action, duration of effect, and side effects if any were recorded.

Results:
None of the patients showed any allergic response to the respective drug administered. The onset of anesthesia (objective) for tramadol and lignocaine was, respectively, 165.0 ± 39.80 s and 159.60 ± 35.09 s, not statistically significant (P = 0.613). Mean duration of anesthesia for them was 47.50 ± 7.51 min for tramadol and 45.70 ± 7.10 min for lignocaine, also statistically nonsignificant (P = 0.388). Regarding intraoperative pain, mean was 0.41 ± 1.013 of tramadol and of lignocaine was 0.31 ± 0.451, P = 0.654 also being statistically nonsignificant. Two patients receiving tramadol had nausea and 1 had pain. Those receiving lignocaine, only 1 patient had pain (P = 0.214).

Conclusion:
Tramadol has an almost similar local anesthetic efficacy with that of lignocaine.