bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lower Limb Comprehensive Reconstructive Surgery: Experiences from an Orthopedic Teaching Unit
Authors: Kurian Anand , Bliss Jeremy , Ganesh Krupakaran , Kumar Manisha J. , Inja Dan Barnabas , Ashok Anand 
Published: October 2024

Abstract

Introduction:
The burden of open extremity fractures is well recognized in placing a burgeoning demand on an already exhausted medical facility in low- and middle-income countries. This study aims to evaluate the functional outcome following “orthoplastic management” by orthopedic surgeons trained in limb reconstruction surgery.

Methodology:
Adult patients with open lower limb injuries treated from January 1, 2022, to December 30, 2022, who underwent single or staged fixation and reconstruction procedures were identified. Patients with Gustilo–Anderson type IIIB fractures requiring skeletal stabilization with soft-tissue cover were included. Polytrauma patients requiring multidisciplinary surgical attention were excluded. A team of orthopedic surgeons trained in limb reconstruction was involved in the management. Inpatient and outpatient department follow-up by the treating team was done to document complications (infections, reoperations, and graft failures) and functional outcomes using the Lower Extremity Function Score. The duration of mean follow-up was 1 year since index surgery.

Results:
A total of 24 adult patients with open lower limb injuries with preoperative Ganga Hospital Score (GHS) were included. Decision toward fixation with primary closure or further reconstruction was made collectively. The gray zone (GHS score of 15–16) of patients was more aggressively managed with emphasis on salvage. Additional reconstructive procedures were carried out based on the assessment at consequent follow-up. Three patients had a suboptimal joint function (less than functional range of motion for the involved joint) due to the resultant loss of compartment(s) and joint contracture. Five patients were retaken to the theater for further supplementary or corrective procedures following the index, definitive surgical procedure (bone grafting, partial flap loss, and fixator readjustment).

Conclusion:
Good-to-excellent functional outcome was demonstrated with the “orthoplastic approach” where skeletal stabilization as well as soft-tissue reconstruction was performed by trained orthopedic surgeons. This study demonstrated that orthoplastic surgery is a safe and effective method of limb salvage.
Laparoscopic Versus Open Closure of Duodenal Perforations: A Retrospective Comparative Study in a Rural Hospital, Andhra Pradesh, India
Authors: Kumar Pamisetty Anil , Dumpalapudi Ajay Babu 
Published: October 2024

Abstract

Introduction:
Evidence on the outcomes of laparoscopic surgeries, especially in emergency conditions such as peptic ulcer, remains unknown. A retrospective study was conducted in a rural surgical unit in Andhra Pradesh to compare morbidity, mortality, and duration of hospital admission in patients undergoing laparoscopic (Group L) and open (Group O) closure of duodenal perforations.

Methods:
Retrospective data of adult patients with peptic ulcer perforation treated by surgical approach during January 2012 and December 2017 were scrutinized. Pre- and postoperative records were abstracted for clinical conditions. Mortality was compared between the two groups with appropriate statistical tests.

Results:
A total of 120 patients, 60 in each group, were recruited for the study. The preoperative clinical characteristics of the two groups were similar. The mean duration of surgery was significantly higher in Group L (212.8 ± 29 min) compared to Group O (107 ± 16 min) (P < 0.001). Wound discharge (n = 3, 5%) and postoperative leak (n = 2, 3.3%) were the only complications noted in the L group. Several complications were noted in the O group including wound discharge (n = 51, 85%), wound dehiscence (n = 12, 20.0%), postoperative leak (n = 8, 13.3%), pneumonia (n = 1, 1.7%), and need for ventilation (n = 6, 10.0%). Three (5%) patients died in the hospital in Group O while none died in Group L. The average duration of hospital admission was 7.1 days (standard deviation [SD] =1.0 days) for Group L and 11.7 days (SD = 2.2 days) for Group O (mean difference: 4.6 days; 95% confidence interval: 4.6–5.2 days).

Conclusion:
Laparoscopic correction of duodenal ulcer perforation is both feasible and effective in reducing morbidity and mortality and overall treatment duration at peripheral centers.
The spectrum of late radiation sequelae in head and neck cancer
Authors: Vashistha Bhanu , Negi Preety , Kingsley Pamela A. 
Published: October 2024

ABSTRACT

Introduction:
Concurrent Chemoradiation is the standard of care in the treatment of unresectable locally advanced head and neck cancer. Some of the acute side effects seen after or alongside the head and neck radiotherapy include dermatitis, mucositis, xerostomia, dysphagia and swallowing dysfunction. Evolving data demonstrate that acute toxicities may persist long-term and develop into late effects. In addition, late effects may manifest months or years after completion of therapy, persisting for years or even lifelong, far longer than previously believed. When severe, late effects may profoundly affect function and quality of life. The present study was conducted to analyze the spectrum of late radiation toxicities in head and neck cancer patients treated with radical external beam radiation therapy and to determine its prevalence and severity.

Materials and Methods:
This prospective observational study was conducted in the Department of Radiotherapy, Christian Medical College and Hospital, Ludhiana. In all patients with a histopathological diagnosis of head and neck carcinoma who have received radical radiation therapy alone or definitive chemoradiation as part of cancer-directed therapy.

Results:
Salivary gland toxicity was the most common toxicity encountered in head and neck cancer survivors resulting in dysphagia followed by dental caries, subcutaneous late effects and dysphagia. As expected, the spectrum of side effects correlated with the primary site, stage of disease and ECOG performance status.

Conclusion:
Technological advancement in radiation planning and equipment has resulted in a reduction in the most feared side effects of radiation which has led to improvement in the quality of life of the survivors. As no technology can entirely protect normal tissues from irradiation, utmost care should be taken to minimize the radiation dose received by normal tissues by following preventive and supportive measures.
Pediatric hepatocellular carcinoma in a 14-year-old boy: A rare case report
Authors: Rajpoot Jyoti , Jain Manjula , Pujani Mukta , Agarwal Charu , Wadhwa Ruchira , Sarohi Monica 
Published: October 2024

ABSTRACT
Hepatocellular carcinoma (HCC) is much rarer in children and adolescents in comparison to adults with an incidence of 0.7/1,000,000 per year. Hepatitis B virus, a known carcinogen increases the chances of HCC at a young age. Very few case reports of HCC developing in HBV-positive male children have been published.We present a case of a 14-year-old Hepatitis B–positive boy who presented with abdominal distension and jaundice. Contrast enhanced computerized tomography (CECT) whole abdomen suggested a diagnosis of multinodular HCC with no evidence of metastasis on FDG PET-CECT. Histopathology with immunohistochemistry confirmed the diagnosis of moderately differentiated HCC.Clinical presentation of HCC in children is similar to adults. Viral hepatitis, metabolic disorders, and male gender increase the risk of HCC. In our case, boy never had any prior history of jaundice, abdominal pain/distension, or any other illness suggestive of liver dysfunction. When the boy was found to be HBV positive, his mother was also screened and turned out to be Hepatitis B virus positive. Histopathology along with a panel of immunohistochemical markers clinched the final diagnosis.
Bifocal intracranial germ cell tumor: A diagnostic and therapeutic dilemma for radiation oncologists
Authors: Antony Varghese , Pahuja Anjali K. , Sethi Jaskaran S. , Suresh Tamilarasu 
Published: October 2024

ABSTRACT
An eight-year-old child presenting with increased thirst, raised intracranial tension and visual deterioration was diagnosed with synchronous suprasellar and pineal lesions, for which she underwent partial resection of the suprasellar lesion. Histopathological examination suggested pure germinoma. Tumor marker evaluation showed significantly raised levels of beta human chorionic gonadotropin (βHCG), favoring a non-germinoma germ cell tumor (NGGCT), leading to a diagnostic dilemma as the histology and βHCG levels were contradictory. Giving cognizance to the tumor marker levels, the treatment was designed on the lines of NGGCT. Planning of radiotherapy including craniospinal irradiation (CSI) and boost to both lesions was once again a challenge, given the proximity of the lesions to vital organs at risk (OAR). Given the child’s age and location of lesions, the target volumes and doses of radiation were designed to optimize between the goals of achieving long-term local control and minimizing late-onset toxicities.
The role of radiotherapy in multimodal treatment of non-rhabdomyosarcoma soft tissue sarcomas in children: A real life report from a tertiary center
Authors: Kahvecioglu Alper , Sari Sezin Yuce , Yigit Ecem , Gultekin Melis , Kosemehmetoglu Kemal , Orhan Diclehan , Kurucu Nilgun , Kutluk Mustafa Tezer , Yildiz Ferah 
Published: October 2024

ABSTRACT

Objective:
The current treatment of pediatric non-rhabdomyosarcoma soft tissue sarcomas (NRSTS) is a multimodal risk-based approach. Today, smaller fields and lower doses of radiotherapy (RT) have become standard. In this study, it was aimed to evaluate the treatment outcomes and toxicity profile in children with NRSTS that received RT as a part of multimodal therapy.

Methods:
Twenty-nine patients with pediatric NRSTS treated with neoadjuvant or adjuvant RT between 1998 and 2022 were evaluated retrospectively. Kaplan-Meier method was used for survival analyses.

Results:
Median follow-up was 36 months (range, 6-291 months). The median neoadjuvant and adjuvant RT doses were 50 Gy (range, 45–66 Gy) and 54 Gy (45–66 Gy), respectively. During follow-up, six (21%) patients developed a local recurrence and 10 (35%) had distant metastasis. The 5-year local control, overall survival (OS), local recurrence-free survival, and distant metastasis-free survival rate was 79%, 67%, 59%, and 61%, respectively. In multivariate analysis, a ≤5-cm tumor, gross tumor resection, Children’s Oncology Group (COG) low-risk group, and absence of neoadjuvant chemotherapy were independent favorable prognostic factors for OS. Severe (≥ grade 3) late toxicity was observed in 6 (20%) patients.

Conclusions:
RT is a crucial component in the multimodal risk-based treatment approach for pediatric NRSTS. However, late toxicity rates are still high and should be improved. Patients with a ≤5-cm tumor, COG low-risk group and treated with gross tumor resection have increased survival rates.
Novel swing lock denture design utilizing magnets for a patient with mandibular resection
Authors: Jing Kweh T. , Buzayan Muaiyed M. A. 
Published: October 2024

ABSTRACT
Mandibular defects requiring reconstructions may result from mandibular resections due to benign or malignant lesions. Prosthesis-based rehabilitation of such cases represents a challenge due to various anatomical and functional limitations. Here we present a novel design for the fabrication of a swing lock denture utilizing a simplified hinge and magnets for a patient who had undergone hemimandibulectomy.
Adrenal ganglioneuroma with retroperitoneal lymph node metastasis: A rare scenario
Authors: Kamboj Meenakshi , Gupta Gurudutt , Pasricha Sunil , Sharma Anila , Durga Garima 
Published: October 2024

ABSTRACT
Ganglioneuroma (GN) is the most differentiated and benign variant of neuroblastic tumors, most commonly located in the posterior mediastinum, followed by the retroperitoneum and adrenal gland. Children of <10 years of age are more commonly affected than adults. Though benign, GNs can very rarely metastasize to regional lymph nodes or distant sites like liver, bone, spleen, and soft tissues. Metastatic lesions are assumed to represent neuroblastomas in which the metastasis and the primary tumor, both have matured. This differentiation can occur spontaneously or after treatment. We present a primary ganglioneuroma of adrenal gland in a 4-year-old child with nodal metastasis, without any blastemal component at any site.
Study of non-invasive follicular thyroid neoplasm: A borderline entity
Authors: Bavikar Rupali , Randive Ruchi S. , Verma Anubhaw , Singh Madhuri , Viswanathan Vidya , Dharwadkar Arpana 
Published: October 2024

ABSTRACT

Background:
Non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) is a newly added entity in the fourth edition of the WHO Classification of Tumors of Endocrine Organs (2017). It is regarded as a neoplasm with very low malignant potential, thus affecting further treatment of the patients.

Aims:
To study the recently diagnosed entity, NIFTP, as not many cases have been reported of the same.

Materials and Methods:
A retrospective analysis of all thyroid neoplasms received in the Department of Pathology of our institute over two years was done. Out of the 188 cases that we reported, 38 were of non-invasive follicular neoplasms.

Results:
Thirty-two patients were female, whereas six patients were male. Thirty-five patients presented with solitary thyroid nodule and the others had an ill-defined thyroid swelling. Thirty-four patients had normal thyroid profile while two patients each presented with hypothyroidism and hyperthyroidism.

Conclusion:
It is crucial to carefully study the histopathological features of solitary thyroid swellings and correlate with clinical and radiological findings. The recently added diagnostic category of NIFTP helps clinicians prevent over-treatment of a group of low-risk thyroid tumors.
Custom made brachytherapy applicator for squamous cell carcinoma of oral commissures
Authors: Gupta Lokendra , Mukherji Ashutosh , Pujari Lincoln , Maknikar Ved Prakash , Zaidi Asim , Kumar Avinash 
Published: October 2024

ABSTRACT
Primary treatment with brachytherapy for oral cancer is uncommon in large malignant lesions; however, it is preferred by radiation oncologists for initial and smaller-sized lesions in compromised anatomical locations. The purpose of this report is to introduce and discuss the fabrication of a customized brachytherapy applicator for a case of well differentiated squamous cell carcinoma (SCC) of the oral commissures using a radiotherapy thermoplastic mold (RTM). The RTM was molded into the shape of tongs and two acrylic wings were attached to these customized tongs to secure five high-dose radiotherapy catheter tubes. A mouth-stabilizing stent was used to stabilize the oral cavity throughout the brachytherapy process. A total dose of 45.5 Gy was delivered in 13 fractions to the lesion using a Cobalt-60 source over 35 days. At the end of the brachytherapy treatment and a follow-up period of 3 months, the patient responded well, and complete remission of the lesion was observed. The current brachytherapy applicator technique is a simple, viable, and curative option for patients with lesions in difficult -to- access anatomic locations.
Utility of morphological markers of chromosomal instability in breast cytology- A study of 100 cases
Authors: Londhe Mangesh M. , Jain Khushi , Buch Archana C. , Gore Charusheela R. 
Published: October 2024

ABSTRACT

Aim:
Carcinogenesis is associated with multiple mutations that lead to chromosomal instability (CIN). Our aim was to study the role of markers of CIN on breast cytology and correlate with histopathological diagnosis.

Materials and Methods:
A retrospective observational study was conducted over a year on 100 breast cytology cases. Leishman-stained smears were examined for the number of micronuclei (MN), chromatin bridge (CB), and multipolar mitosis (MPM). MNs were counted manually in 1,000 cells under oil immersion (1000×). The frequency of CB and MPM was also noted. The malignant cases were graded as low (grades 1 and 2) and high (grade 3).

Results:
The mean age of the patients was 43.47 ± 15.81 years. The mean MN score for fibroadenoma cases was 4.54 (±1.5) and for malignant cases was 29.32 (±8.15). The receiver-operator curve (ROC) curve analysis confirmed >9 MN score as 100% specific and 100% sensitive for malignancy (area under the curve [AUC] =1). A significant comparison was noted between the mean MN of benign and malignant cases (P < 0.000001). The mean MN score for low-grade cases was 26.64 (±5.85) and for high-grade cases was 33.68 (±5.85) with a significant difference observed on comparing the population mean MN with a grade of malignancy (P-value = 0.01886). The difference between the frequencies of CB in low and high-grade cases was also found to be significant (P-value = 0.04135).

Conclusion:
The presence and scoring of markers of CIN (MN, CB, and MPM) on breast cytology have potential significance in the diagnosis of breast lesions.
Effectiveness and Perception of Collaborative Learning among Undergraduates Students: Introduction of Jigsaw Method in Forensic Toxicology
Authors: Kumar R. Chetan , Bansal Prerna , Shandilya Hemant , Singhal Aparna , Bansal Anupam Kumar , Agarwal Harish Kumar S 
Published: October 2024

Background:
Didactic teaching being teacher centric usually does not generate sense of responsibility for learning among the students. The Jigsaw method is a form of cooperative learning that improves not only the cognitive but also the affective and psychomotor skills, which are required by a student to become an Indian Medical Graduate. Thus, this study was aimed at assessing the effectiveness of Jigsaw strategy in comparison to didactic teaching and to understand the perception of the students.

Methodology:
This was a quasi-experimental study conducted among second year MBBS students. They were randomly assigned to lecture and Jigsaw groups. A topic on general toxicology was chosen. Handouts were prepared which were given to all the students. The lecture group was taught using audio visual aids. The topic was sub divided into five subtopics for Jigsaw group. A post test consisting of MCQs was used to assess the effectiveness of the method. A validated questionnaire was used to gather feedback from the students belonging to Jigsaw Group. Descriptive statistics were used to analyze responses to the Likert scale questions.

Results:
The present study included a total of 65 II year MBBS students, out of which 30 students were in Jigsaw group. A total of 94% students agreed to participate actively in the Jigsaw session. Most of the students (93%) students listened to and respected the ideas of their peers. A total of 72% students found this method of learning useful in Forensic Medicine and Toxicology. Only 53% of the students felt that the time for preparation and presentation of the topic was sufficient.

Conclusions:
The present study advocates this cooperating learning method to be an effective tool in better understanding of the subject, to improve communication skills and to inculcate lifelong learning attitude among the medical graduates. The jigsaw method, however, requires more time for planning and execution, to yield positive outcomes.
Comparative Evaluation of a Leadership Skills Module among Male and Female Junior MBBS Students in a West Bengal Medical College
Authors: Baral Sampad Kumar , Chaudhuri Arunima , Adhya Debasis 
Published: October 2024

Background:
A competent Indian medical graduate must fulfill five roles: clinician, leader and member of the health-care team, communicator, lifelong learner, and professional. Leadership and management skills are essential for physicians to take responsibility as team leaders.

Aims:
The aim of the study was to evaluate the impact of a leadership skills module among male and female junior MBBS students in a medical college in West Bengal.

Methodology and Participants:
This observational cross-sectional study included male and female junior MBBS students, following institutional ethical clearance and informed consent. Students were divided into eight groups, provided with recorded YouTube videos, and participated in live interactive sessions and a fishbowl game to demonstrate leadership skills. Three online questionnaires assessed leadership skills, personality types, and leadership styles. Feedback was collected from students. Data were analyzed and compared between male and female students.

Results:
Out of 257 students who completed all tasks, personality types were assessed: ENFJ was the most common among males (25%), while ESTP and INFP were the least common (0.65% each). Among females, INFJ and INTJ were the most common (19.23% each), and ESTJ and ESFJ were the least common (0.96% each). Leadership scores (mean ± standard deviation) for males: authoritative 7 ± 2.30, democratic 9 ± 2.06, facilitative 9 ± 1.94, situational 9 ± 1.93, and leadership skills 65.05 ± 15.33. For females: authoritative 7 ± 2.21, democratic 9 ± 1.77, facilitative 9 ± 1.31, situational 9 ± 1.65, and leadership skills 64.15 ± 14.87. No significant differences were found between male and female students in these scores.

Conclusion:
Workshops on leadership skills improved student motivation and made learning enjoyable. Students were satisfied with the leadership skills taught, and the study increased awareness about leadership skills among students.
Questionnaire to Assess the Knowledge, Attitude, and Awareness Regarding Coma among the Informal Caregivers of Comatose Patients: An Observational Study
Authors: Kumar Sanjiv , Swaminathan Aishwarya 
Published: October 2024

Background:
Comatose is a perilous state that is contemplated as a medical emergency. Coma impacts the primary caregiver’s daily living that has debilitating effects. Informal caregivers of comatose patients experience emotional symptoms or grief due to the prolonged illness of an individual. As there is a lack or deficient awareness and knowledge regarding the condition, the attitude toward the condition or grief could be a contributory factor. Considering these factors, the knowledge, attitude, awareness-comatose caregiver questionnaire (KAA-CCQ) was developed for evaluation.

Methodology:
The KAA-CCQ was developed in two stages. Stage 1 - Development of the questionnaire included conceptualization and item generation. Stage 2: - Expert review, content validity, and item modification. Content validity index (CVI) was analyzed using Microsoft Excel sheet 2013.

Results:
The computed CVI final score for the questionnaire was 0.91.

Conclusion:
The KAA-CCQ developed to assess the knowledge, attitude, and awareness regarding coma in informal caregivers of comatose patients achieved a statistically satisfactory content validity.