bluuebunny/crossref_metadata_2025_split huggingface dataset:
Role of corneal epithelial mapping, Corvis biomechanical index, and artificial intelligence-based tomographic biomechanical index in diagnosing spectrum of keratoconus
Authors: Kenia Vaishal P. , Kenia Raj V. , Maru Sneha , Pirdankar Onkar H. 
Published: September 2024

AIM:The aim of the study was to evaluate the utility of epithelial mapping, Corvis biomechanical index (CBI), and tomographic biomechanical index (TBI) in diagnosing the spectrum of keratoconus (KC).METHODS:This was a retrospective study where KC subjects with an age between 11 and 50 years were enrolled. Subjects with ocular diseases, history of previous corneal surgery, corneal scars or hydrops, ocular trauma, ocular surface disorder, systemic disease, and poor-quality scans were excluded. KC was classified using Belin ABCD classification system. Epithelial thickness, corneal tomography, and corneal biomechanical measurements were recorded using Fourier-domain optical coherence tomography Avanti with corneal adaptor module, Pentacam HR, and Corvis®ST, respectively. To understand the utility of various corneal parameters in diagnosing spectrum of keratoconus, cutoff values for epithelial thickness at the thinnest location and its standard deviation (SD) were considered 45 and 3 microns, respectively, CBI of 0.5 and TBI of 0.29 was considered.RESULTS:Sixty-five eyes (45 – KC, 10 – subclinical KC (SBKC), and 10 – forme fruste [FF]) of 34 patients with a mean ± SD age of 30.73 ± 5.71 were included. In our keratoconic sample, epithelial mapping alone helped diagnose the 77.77% of cases, however, when combined with CBI, it helped diagnose 95.5% cases and when combined with TBI, it was useful in diagnosing 100% of cases. In SBKC group, 40% of cases were detected by epithelial mapping alone, and when combined with CBI, it helped diagnose 70% of cases and TBI further helped diagnose 90% of cases. We did not see any role of epithelial mapping in detecting FFKC cases whereas CBI and TBI helped diagnose 60% and 90% of cases, respectively.CONCLUSION:The utility of epithelial mapping as a solitary tool is limited in detecting the spectrum of KC, especially SB and FFKC. However, combining it with corneal biomechanical parameters could help improve the efficacy of diagnosis of KC.
A Clinicopathological Study of Thrombocytopenia, Acute-Phase Reactants, and Blood Culture in Neonatal Sepsis
Authors: Talat Fauzia , Alam Kiran , Akhtar Kafil , Ali S. Monazir 
Published: September 2024

Introduction:
Neonatal sepsis is a clinical syndrome described as any systemic bacterial infection in neonates documented by positive blood culture. However, blood culture is positive in only 5.0%–10.0% of suspected cases. Serum concentration of many acute-phase reactants rises in response to infection, which can be used as a non-specific indicator of bacterial sepsis.

Aim and Objectives:
The aim of this study was to correlate the levels of serum markers C-reactive protein (CRP), serum ferritin, and thrombocytopenia with neonatal sepsis.

Materials and Methods:
This was a prospective cross-sectional study conducted in the Neonatal Intensive Care Unit, Department of Paediatrics and Pathology, Jawaharlal Nehru Medical College (JNMC), Aligarh from 2019 to 2021 on 172 babies (cases =142; controls = 30). Neonates with sepsis who presented with clinical signs or symptoms of sepsis were taken as case group and healthy neonates served as control.

Result:
Blood culture was positive in 58 (40.8%) neonates in the case group and Klebsiella was present in maximum number of cases. Blood culture was positive in only 8 (13.8%) cases out of 31 cases of mild thrombocytopenia. The total culture-positive organism was 58 (40.8%), with 09 (15.5%) gram-positive, 46 (79.3%) gram-negative organisms, and 03(5.2%) fungus. Positive CRP was seen in 88 (61.9%) neonates in the case group, out of which, positive culture was noted in 38 (65.5%) neonates and negative in 50 (59.5%) neonates. Serum ferritin values >400 µgm/L was seen in 97 (68.3%) neonates in the case group and 6 (20.0%) neonates in control group. The mean serum ferritin in culture positive neonates was 1024 ± 309 µgm/L and in culture-negative neonates was 999 ± 301 µgm/L.

Conclusions:
The signs and symptoms of neonatal sepsis are non-specific, leading to difficulty in diagnosis and treatment. Biomarkers such as hematological indices, blood culture, and acute-phase reactants could be more reliable in rapid evaluation and early diagnosis of sepsis and may provide a new diagnostic strategy for the neonates with sepsis.
The Relationship of Fractional Exhaled Nitric Oxide Level with Exercise-Induced Bronchoconstriction in Asian Asthmatic Children
Authors: Au Ka-Nam , Chan Eric Yat-Tung , Leung Shuk-Yu 
Published: September 2024

Background and Aims:
Exercise-induced bronchoconstriction (EIB) is associated with eosinophilic inflammation of the airway in asthmatic children and studies showed fractional exhaled nitric oxide (FeNO) is associated with it. The aim of this study was to explore the relationship between FeNO and EIB and find a cutoff reference of FeNO for EIB based on existing normative data from healthy Asian children by Yao et al. in 2012.

Materials and Methods:
Asian asthmatic children who had undergone FeNO and exercise challenge test from January 1, 2016 to December 31, 2019 in a local respiratory centre were reviewed retrospectively. The FeNO values of the individuals were converted to z-score with reference to the predicted value of FeNO in Asian children by Yao et al. in 2012. A receiver-operating characteristic (ROC) curve is plotted to identify a cutoff representing EIB.

Results:
Data of 88 Asian asthmatic children aged 5–18 were retrieved. There is a significant overlapping of the FeNO z-scores of normal and mild EIB groups. The cutoff value determined by the Youden index (0.724) to predict moderate or severe EIB in asthmatic patients is 3.276 with sensitivity of 88.9% and specificity of 83.5%

Conclusion:
High FeNO value of z-score 3.276 has high sensitivity and specificity to moderate to severe EIB in Asian asthmatic children. FeNO could be used as a simple test in clinic setting before exercise challenge test is available.
Allergic Rhinitis and Asthma Rather than Atopic Dermatitis Is a Protective Factor for Dengue Fever––A Nationwide Population
Authors: Tsai Chih-Min , Tsai Chang-Ku , Cheng Fu-Jen , Chang Chih-Hao , Yu Hong-Ren 
Published: September 2024

Background/Purpose:
Dengue fever (DF) may cause severe morbidity and mortality. Asthma has been proposed as a protective factor for DF. Asthma, allergic rhinitis, and atopic dermatitis are atopic diseases with a common background. Herein, we aimed to determine whether allergic rhinitis and atopic dermatitis are also protective factors for DF, as this aspect remained unknown.

Materials and Methods:
A resampled nationwide population-based retrospective case-control study was conducted. Multivariate logistic regression was used to identify independent protective factors of these atopic diseases for DF. The Kaplan–Meier method was used to compare dengue-free proportions between patients with or without atopic diseases.

Result:
This case-control cohort study included a total of 1119 patients with DF and 4476 age- and sex-matched patients without DF. At least one of these atopic diseases was observed in 1322 patients. Compared to patients with DF, the non-DF group had a high prevalence rate of atopic diseases (16.2% vs 25.5%, P <0.001). Both asthma and allergic rhinitis were protective factors for DF with an odds ratio (OR) of 0.40 (95% confidence interval (CI) 0.25–0.65, P<0.001) and 0.48 (95%CI, 0.38–0.61; P<0.001), respectively. Atopic dermatitis was not a protective factor for DF (OR, 0.96; 95%CI, 0.58–1.58; P=0.873).

Conclusion:
Asthma and allergic rhinitis, rather than atopic dermatitis, can be independent protective factors against DF. Our finding provides insights into the association between allergy and DF.
Comparison of nebulized fentanyl, midazolam, and dexmedetomidine as a sedative premedication in outpatient pediatric dental surgeries
Authors: Medhat Marwa M. , Abd Elnaby Sara M. 
Published: September 2024

Background
The preoperative time is traumatic for young children undergoing surgery. Parental separation and needle injection increase preoperative anxiety. Preoperative sedation in children is usually administered via the rectal, oral sublingual, and intranasal routes with different degrees of patient acceptance. Nebulized drug is an alternative method of sedation that is relatively easy to set up.

Materials and Methods
Thirty nine pediatric patients (2–6) years old scheduled for outpatient dental surgeries were randomly allocated in three groups (13 patients each); group (F) received nebulized fentanyl 2 μg/kg 30 min before surgery, group (M) received nebulized midazolam 0.2 mg/kg 30 min before surgery and group (D) received nebulized dexmedetomidine 2 μg/kg 30 min before surgery. The outcome measures included onset of sedation, parental separation, tolerance to mask induction, reaction to intravenous cannulation and preoperative hemodynamic changes (systolic blood pressure, diastolic blood pressure and heart rate).

Results
Children who received nebulized fentanyl and nebulized midazolam had early onset of sedation as compared to dexmedetomidine. In child-parent separation, quality of induction was better with fentanyl and dexmedetomidine as compared to midazolam. Intravenous cannulation score was best achieved with fentanyl as premedication.

Conclusion
Nebulized fentanyl in a dose of 2 μg/kg is better than nebulized midazolam 0.2 mg/kg and nebulized dexmedetomidine 2 μg/kg as far as premedication is concerned because of its early onset of action, deeper levels of sedation, easy child-parent separation and shorter duration of action.
A prospective randomized comparative study of dexmedetomidine versus clonidine as an adjunct to 0.75% ropivacaine in ultrasound-guided supraclavicular brachial plexus block
Authors: Fultambkar Gajanan , Chavla Pradeepa , Budi Vijayanand , Gurram Rammohan , Kukreja Vinay , Nair Abhijit 
Published: September 2024

Introduction
Alpha-2 agonists are popular adjuvants used in neuraxial anesthesia like spinal, epidural, caudal anesthesia, and peripheral nerve blocks. The authors compared the efficacy of clonidine with dexmedetomidine as an adjuvant to ultrasound (US)-guided supraclavicular brachial plexus block in adult patients undergoing elective upper limb surgeries.

Materials and methods
After obtaining Ethics Committee approval, 60 American Society of Anesthesiologists’- physical status (ASA-PS) I/II patients were randomized into two groups. Group Clonidine-Ropivacaine (CR) received 1 μg/kg clonidine as an adjuvant and group Dexmedetomidine-Ropivacaine (DR) received 1 μg/kg dexmedetomidine. Patients received an ipsilateral US-guided supraclavicular brachial plexus block with 0.75% ropivacaine (total volume of 20 ml). Demographic data, hemodynamics, the onset of block (sensory, motor), the duration of block (sensory, motor), duration of analgesia and surgery, total number of rescue analgesics, numerical rating scores, and Ramsay sedation score were compared between both groups using appropriate statistical tests.

Results
Heart rates at 30 min, 60 min, 2 h, and 3 h were lower in group DR compared with group CR, which was statistically significant (P=0.0001, 0.0001, 0.021, and 0.026, respectively). The onset of sensory and motor block, duration of sensory and motor block, and duration of analgesia were better in group DR compared with CR, which was statistically significant (P=0.00). The number of rescue analgesics required in group CR in both groups was comparable (P=0.057). Numeric rating scale scores at 12, 18, and 24 h were significantly better in group DR compared with group CR (P=0.0001, 0.039, and 0.036, respectively).

Conclusion
When added as an adjuvant to 0.75% ropivacaine in the US-guided supraclavicular brachial plexus, dexmedetomidine block produced faster onset of sensory and motor blockade, prolonged the duration of sensory and motor blockade, and also prolonged the duration of analgesia, when compared with clonidine.
Characteristics and clinical outcomes of critically ill pregnant patients with COVID-19 disease
Authors: Tharwat Ayman I. , Labib Heba A. , Ali Rania M. 
Published: September 2024

Aim
To investigate the characteristics and clinical outcomes among critically-ill pregnant patients with COVID-19 and compare them to non-pregnant critically-ill COVID-19 patients.

Settings and design
This retrospective cohort study was carried out at the ICUs of both Ain Shams University Quarantine Hospital and the Obour Specialized Hospital between April 2020 and September 2021.

Methods and material
The study included critically-ill, COVID-19 patients above 18 years old. The enrolled participants were divided into two groups, pregnant patients, and a control group of non-pregnant patients. Patient data were retrieved from the medical records. Outcomes included general outcomes (length of ICU stay, need for mechanical ventilation, thromboembolic events, and mortality), obstetric outcomes (pre-eclampsia and mode of delivery), and neonatal outcomes (preterm delivery, neonatal intensive care unit [NICU] admission, intrauterine fetal death, and total perinatal mortality).

Results
The levels of ferritin and D-dimer, length of ICU stay, need for mechanical ventilation, incidence of thromboembolic events, and mortality showed significant differences between pregnant and non-pregnant women. Women who were critically ill in the second and third trimesters had significantly higher D-dimer and ferritin levels compared to the first trimester critically ill patients. They also had significantly longer ICU stay, higher rate of cesarean delivery, and more incidence of neonatal admission to NICU.

Conclusions
Pregnant, critically ill women are more prone to adverse pregnancy and neonatal outcomes compared to non-pregnant women. Critical illness in the second and third trimesters poses a higher risk in terms of length of ICU stay and NICU admission.
Comparative study between different approaches for the management of postdural puncture headache
Authors: Hassan Ahmed H. , Refaie Bahaa M. , Ahmed Islam M. , Abdelkareem Ayman M. 
Published: September 2024

Introduction
The postdural puncture headache (PDPH) is one of the spinal and epidural anesthesia complications. It can be induced by using large gauge-cutting needles or performing numerous trials. Conservative treatment was the primary option for the management of PDPH, sphenopalatine ganglion block (SPGB) can be a suitable and safe option for the treatment of PDPH.

Aim
The aim was to verify the efficacy and safety of transnasal SPGB using either lidocaine 2% or bupivacaine 0.5% as a treatment line for PDPH versus the conventional conservative treatment.

Patients and methods
In total, 120 patients with PDPH following cesarean section under spinal anesthesia were assigned and divided into three groups. Group L (n=40) received transnasal SPGB (lidocaine 2%), group B (n=40) received transnasal SPGB (bupivacaine 0.5%), and group C (n=40) received conservative treatment for 24 h [intravenous (IV) paracetamol 1 g/8 h]. The headache severity was measured by the visual analog scale (VAS) at 0 min, 30 min, 6 h, 12 h, and 24 h post treatment.

Results
No significant difference in the VAS from the baseline between the groups L and B was observed. VAS values were significantly lower in both groups when compared with patients in group C (P<0.05). No significant differences from baseline mean blood pressure, heart rate, or other complications (such as bleeding), were observed between the three groups at any timepoint.

Conclusion
The headache severity in PDPH cases might be reduced more efficiently through SPGB using either lidocaine or bupivacaine, unlike other conservative treatments such as paracetamol.
Comparison between the effect of ketamine-dexmedetomidine versus ketamine-propofol on emergence agitation in pediatrics undergoing adenotonsillectomy by sevoflurane anesthesia
Authors: Aly Amani A. , Rifky Mohamed A. , Adwibi Adnan M. , Elhossieny Khadeja M. 
Published: September 2024

Background
Pediatric Emergence Agitation (PEA) Emergence agitation (EA) is a state of anxiety, irritability, non-purposeful movement, thrashing, and disorientation during early recovery from general anesthesia. it can be harmful for the children and their family, causing bleeding at the surgical site, parental unhappiness, and anxiety.

Aim
To decrease the incidence of emergence agitation (EA) in pediatrics undergoing adenotonsillectomy under sevoflurane anesthesia, by using ketamine-dexmedetomidine (KD) or ketamine-propofol (KP).

Patients and methods
In this prospective randomised controlled clinical trial, 63 children were randomly assigned to one of three groups of similar size: group C (Control group) (n=21), who received a single intravenous bolus of 10 ml 0.9% normal saline; group KD (n=21), who received 0.15 mg/kg ketamine and 0.3 μg/kg dexmedetomidine; 10 min before the end of surgery, and group KP (n=21), who received 0.15 mg/kg ketamine and 0.5 mg/kg propofol, 10 min before the end of surgery.
The primary outcome was the post anesthesia EA which was evaluated using the pediatric anesthesia emergence agitation scale (PAED) score out come was assessment of OPS and complications.

Results
There were significant difference between the groups regarding the heart rate which was faster in the control group immediately, 5, 10, and 15 min post extubation. In the KD group the extubation time was the longest compared with the KP group and the control group. The PAED scores were significantly different among the three studied groups at 10, 20, 25, 30, 35, 40, 45, 50, 55, and 60 min.

Conclusion
The combination of ketamine (0.15 mg/kg) and dexmedetomidine (0.3 μg/kg) given 10 min before the completion of surgery was more effective in preventing emerging agitation than ketofol.
Potential effect of agomelatine versus dexmedetomidine during awake fiberoptic intubation; role of catacholamine
Authors: Attia Josef Z. , Hassanine Ahmed 
Published: September 2024

Background
Awake fiber-optic intubation is one of the recommended strategies for surgical patients with suspected difficult airway, especially when simultaneous difficult ventilation is anticipated.

Patients and methods
In all, 90 patients of both sexes aged between 20 and 55 years, American Society of Anesthesiologist I and II stages were scheduled for elective abdominal surgeries. Patients were randomized into three equal groups. Group A: oral agomelatine at a dose of 10 mg administered with a sip of water 120 min before surgery. Group B: agomelatine+dexmedetomidine. Group C: dexmedetomidine infused at a dose of 1 μg/kg loading infusion per 10 min followed by a continuous infusion of 0.2 μg/kg/h. The following variables (mean arterial pressure, heart rate, oxygen saturation, cough score, postintubation score) and Richmond agitation sedation scale score were recorded in addition to the serum level of norepinephrine.

Conclusion
Agomelatine is more effective than dexmedetomidine in making better intubation state with sedation, less desaturation, and hemodynamic stability during awake fiber-optic intubation. Synergestic effect between agomelatine and dexmedetomidine was detected.
Effect of lignocaine versus sodium bicarbonate on reducing pain due to intravenous injection of propofol: a prospective randomised double-blinded, controlled study
Authors: Mourad Karim Hussein , Marzouk Sahar Ali , Mohammed Aliaa Helmy , Abougabal Ayman 
Published: September 2024

Context
Propofol is the most commonly used intravenous (IV) anesthetic drug for induction of anaesthesia and for sedation, but pain which occur during its injection still remains a problem. Approximately 70 to 90% of patients who receive propofol for anaesthesia induction experience pain during injection and this pain can be quite severe. The most frequently used drug to alleviate pain in propofol injection is IV Lignocaine which acts through the local anesthetic effect on the veins. Administration of sodium bicarbonate with lidocaine was proved to reduce pain in propofol injection through increasing sodium ions concentration as well as increasing serum pH through its buffering effect.

Aims
To compare the effect of adding lignocaine vs sodium bicarbonate to propofol in reducing pain on propofol injection.

Settings and design
A randomized, controlled, double-blinded trial.

Methods and material
One hundred and eighty patients underwent conscious sedation during surgical procedures were randomly divided into three equal groups as follows: Group (L) 3 ml (60 mg) of lignocaine 2% premixed with propofol, group (B) 3 ml of sodium bicarbonate 8.5% premixed with propofol and group (S) 3 ml of normal saline premixed with propofol. The 3 groups were compared regarding pain intensity immediately after IV injection of propofol using the four-point verbal rating and BP.

Results
The incidence of pain and the pain score were significantly lower in the lignocaine group (43%) in comparison to both group (Saline 81% and bicarbonate 71%) P value < 0.001. However, no difference in pain score or the incidence of pain were found between Group S and Group B.

Conclusions
Our study demonstrated that mixing lignocaine with propofol appears to be effective in reducing both the incidence and severity of the pain during propofol injection when compared to mixing propofol with sodium bicarbonate or normal saline.
Sacrococcygeal local anesthesia versus spinal anesthesia for pilonidal sinus surgery: a prospective randomized controlled study
Authors: Ali Hani G. , Elatief Elnegeery Naglaa A. 
Published: September 2024

Background
Spinal anesthesia is the most common anesthetic technique applied for patients undergoing surgery for pilonidal disease. However, it has multiple disadvantages like hypotension and headache. This prospective study was designed to compare the outcomes of sacrococcygeal local anesthesia technique versus spinal anesthesia for surgical treatment of patients with pilonidal disease.

Patients and methods
The included 220 patients diagnosed with the pilonidal disease were assigned into two groups according to the method of anesthesia, the spinal and local groups. The primary outcome was pain score, whereas other outcomes included duration of stay in the operative theater, recovery room, postoperative opioid consumption, time to first analgesic request, complications, and patient satisfaction.

Results
Age and sex distribution showed no significant difference between the two groups. Time spent inside the operative room and total hospital stay showed a significant decrease in the local group. Postoperative pain was statistically comparable between our groups, apart from the six-hour reading, which was higher in the local group. The spinal group showed superior analgesic outcomes regarding the first analgesic request and total opioid consumption. Likewise, patient satisfaction was significantly higher in the same group. Postoperative nausea was more encountered in the local group.

Conclusion
When compared with spinal anesthesia, sacrococcygeal local anesthesia seems to have a weaker analgesic profile manifested in increased opioid requirements and earlier rescue analgesia. However, it is associated with comparable pain scores, less operative time, and shorter hospitalization.