bluuebunny/crossref_metadata_2025_split huggingface dataset:
Maintaining a Bloodless Field for HeartMate 3 Placement: Splicing an RVAD Outflow Cannula into the CPB Venous Reservoir for Complete LV Emptying
Authors: Walker Justin W. , Roberts S. Michael 
Published: August 2024

ABSTRACT
Over the previous 20 years, the use of extracorporeal membranous oxygenation (ECMO) as a bridge to durable left ventricular assist device (dLVAD) increased significantly. Additionally, emerging literature has demonstrated a protective effect of biventricular decompression while on ECMO, with one such strategy including a temporary LVAD and right ventricular assist device (RVAD). The complexity of these operations is increased by the frequency of re-sternotomies, which result in adhesions and difficult access to traditional cannulation sites. In this case report, we present a patient presenting for a re-sternotomy for dLVAD on biventricular support in whom the RVAD outflow cannula was spliced into the cardiopulmonary bypass venous reservoir by the cardiac anesthesiologist. This innovative cannulation strategy allowed for continuation of RVAD flows to prevent thrombosis and active venting of the pulmonary artery to facilitate a bloodless surgical field.
The Shared Airway: Tracheal Mass Excision
Authors: Shringarpure Amruta , Saba Surendhar , Umbarkar Sanjeeta , Sarkar Manjula 
Published: August 2024

ABSTRACT
We report a case of successful airway management of a 26-year-old male patient who was posted for tracheal mass excision. The main challenge in such a case is to formulate a plan to provide maximum surgical access to the trachea for mass excision through an intraoral approach while ensuring adequate oxygenation and airway management. The patient presented with acute respiratory distress in the emergency ward. On computed tomography (CT), the patient was diagnosed with a polypoidal tracheal tumor occluding more than 90% of the tracheal lumen and 5.8 cm away from the carina. The case was successfully managed using a peripheral bypass for airway management. After the removal of the tumor, a tracheostomy tube was placed through the tracheotomy hole used for tumor excision. The whole process was uneventful.
Outcomes of Surgical Treatment of Diaphyseal Fractures of Long Bones in Children and Adolescents through Open Reduction and Intramedullary K-Wire Fixation at Yopougon Teaching Hospital, Abidjan (Côte d’Ivoire)
Authors: Thomas Helen Audrey , Bationo Elysée Yves , Mieret Jean Claude , Yaokreh Jean Baptiste , Koffi N’goran Eric , Odéhouri-Koudou Thierry Hervé , Kouamé Bertin Dibi , Ouattara Ossénou 
Published: August 2024

Background:
Nowadays, elastic stable intramedullary nailing is a well-accepted method for treating paediatric diaphyseal fractures, but it requires fluoroscopy that is lacking in our practice. For this reason, we have systematically performed open reduction and intramedullary Kirschner-wire fixation (ORIKF). The objective of this study was to assess ORIKF-related functional and radiological outcomes for the treatment of paediatric long bone fractures in the context of limited resources.

Patients and Methods:
From January 2010 to October 2019, 70 children (71 fractures) with an average age of 10.6 years sustaining closed displaced long bone diaphyseal fractures have been treated by ORIKF without fluoroscopy at Yopougon Teaching Hospital. They had their medical records reviewed retrospectively. Fractures were located in femur (n = 42), tibia (n = 11), humerus (n = 6) and forearm (n = 12). Pre-operative time, length of hospital stays, bone union time, nail removal time and complications were recorded. Functional and radiological outcomes were assessed according to Flynn’s criteria for lower limb and the Price’s criteria for upper limb.

Results:
The average follow-up time was 21 months. The results were excellent for 58 cases (81.7%), good for 8 (11.3%) and poor for 5 (7%). The average time to surgery was 10.8 days. The average in-patient stay was 11.1 days. Bone union duration was 12.3 weeks on average. The average time for nail removal was 8.1 months. According to Moroz’s system, minor complications occurred in 33 cases (46.5%); major complications were observed in four cases (5.6%) and they consisted of two cases of osteomyelitis (2.8%), 1 case (1.4%) of compartment syndrome and delayed union, respectively. Complications associated with bone recovery were reported in 10 patients (14.3%).

Conclusion:
Despite the open reduction of the fractures, the results were satisfactory in 9 out of 10 patients with few major complications in a context of limited resources.
A Comparative Study on the Effect of Different Management Options on Body Mass Index in Overweight Polycystic Ovarian Syndrome Patients at a Tertiary Care Hospital
Authors: Krishna U. R. Namrutha , Nazrin T. M. Safhana , Biju Abin , Joseph Merrin 
Published: August 2024

Introduction:
According to the data from the World Health Organization, polycystic ovarian syndrome (PCOS) may affect as many as 116 million women worldwide (3.4%). The main objective of the study was to determine the effectiveness of treatment on the body mass index (BMI) of overweight PCOS patients.

Materials and Methods:
This prospective, observational study was conducted from December 2022 to February 2023 and 252 PCOS patients were included in the study.

Results:
A detailed analysis of the risk factors in the study population concluded that a family history of the PCOS, lack of exercise, regular consumption of fast food, broiler chicken, high sugar, soft drinks, and packed foods had contributed to the lifestyle syndrome, where each showed a P = 0.0001.

Conclusion:
The comparative analysis of the treatment effectiveness in terms of BMI among three treatment strategies—(1) medication, (2) lifestyle, and (3) medication along with lifestyle established the conclusion that the treatment with lifestyle alone and lifestyle along with medication together showed similar extend in weight reduction in overweight PCOS patients after performing post hoc statistical analysis. However, a greater proportion of people who experienced weight reduction falls under lifestyle + exercise.
A Prospective, Randomized, Comparative Study between Dexmedetomidine and Buprenorphine as an Adjuvant to Ropivacaine in Ultrasound-guided Supraclavicular Brachial Plexus Block for Upper Limb Orthopaedic Surgeries
Authors: Sangeetha C. , Kumar Malathi Anil , Bathalapalli Aparna , Kumar K Bharath , Malashree G , Heggeri Vijayakumar M 
Published: August 2024

Introduction:
Supraclavicular approaches serve as a common method for administering regional anesthesia in upper limb procedures. In improving the impact with a length of pain relief, medical professionals frequently include additional substances such as dexmedetomidine, buprenorphine, dexamethasone, clonidine, sodium bicarbonate, and tramadol alongside local anesthetics. The intent of this study was to evaluate its impact of incorporating buprenorphine and dexmedetomidine into ropivacaine 0.5%.

Materials and Methods:
The trial of 90 patients between the ages of 18 and 60, who were identified as American Society of Anesthesiologists Grade 1 and 2, and scheduled upper limb surgery using the supraclavicular approach, were included. They were assigned into distinct groups, each of the groups consisting of thirty individuals. Group R was administered anesthesia consisting of 25 ml of ropivacaine 0.5% along with 1 ml of saline. Group B was administered anesthetics containing ropivacaine 0.5% and buprenorphine, which was diluted in saline. Group D was administered a solution containing ropivacaine 0.5% and dexmedetomidine, which was diluted in saline.

Results:
Group D had an earlier sensory blockade onset (8.25 min) compared to Group B (9.64 min) and Group R (12.89 min). Group D demonstrated a notably quicker motor blockade onset (9.21 min) in contrast to Group B (12.07 min) and Group R (15.03 min). In contrast with the other groups, Group D exhibited a more longer time frame of both sensory and motor blockades and also an extended period of anesthesia after the surgery.

Conclusion:
Dexmedetomidine was a more effective adjuvant over buprenorphine in the brachial plexus blocks. This resulted in significantly lower postoperative pain scores at 407.67 min and 612.32 min for the plain ropivacaine and buprenorphine groups, respectively.
To Evaluate the Impact of Pneumoperitoneum on Oropharyngeal Seal Pressure of Proseal™ LMA and Baska™ mask in Patients Undergoing Laparoscopic Cholecystectomy: A Randomized Controlled Trial
Authors: Balakrishnan N. , Kumar Rakesh , Kumar Mritunjay , Kamal Manoj , Mohammed Sadik , Mishra Akash , Bhatia Pradeep 
Published: August 2024

Abstract

Background:
Newer supraglottic airway devices (SGADs) are becoming more and more popular as a means of maintaining the airway during laparoscopic procedures. The present study’s aim was to compare the impact of pneumoperitoneum on the oropharyngeal seal pressure (OPSP) of Proseal™ laryngeal mask airway (PLMA) and Baska™ Mask (BM) in patients undergoing laparoscopic cholecystectomy.

Methods:
We enrolled 60 American Society of Anesthesiologists physical Status I and II patients and randomised to either the PLMA group or the BM group. After induction of anaesthesia using a standardised protocol, one of the SGADs was inserted. The primary outcome was the effect of pneumoperitoneum on the OPSP of the two devices. The secondary outcomes were the time required for insertion of the airway devices, OPSP, fibre-optic view of the vocal cord, ease of insertion and any laryngopharyngeal morbidity.

Results:
The demographic parameters were comparable between the study groups. The insertion time was 18.034 ± 7.73 and 18.7 ± 6.96 s for the PLMA group and BM group, respectively (P = 0.7255). The OPSP in each group was not significantly impacted by pneumoperitoneum, although it remained the same throughout the procedure. Compared to the PLMA group, OPSP was higher in the BM group at all three time intervals (5 min after the insertion of the device [T1], 10 min after pneumoperitoneum [T2] and 5 min after the revoking of pneumoperitoneum [T3]).

Conclusion:
Pneumoperitoneum had no effect on OPSP in either group. Significantly higher OPSP was noted in the BM group (both before and following pneumoperitoneum) compared to the PLMA group.
Venous Malformation in Upper Airway - Anaesthetic Challenges and Management
Authors: Sankarlal Nirmal Kumar , Kaliannan Senthil Kumar , Eliyas NoorMohamed Mohamed , Sherfudeen Khaja Mohideen 
Published: August 2024

Abstract
We present a patient with a venous malformation involving the upper airway, who developed airway obstruction immediately after extubation, requiring reintubation and tracheostomy. Our reflection on the management of this case highlights several important learning points. These include: (i) the importance of clear communication between different medical specialties to promote shared situation awareness, (ii) limitations in training anaesthesiologists beyond standard difficult airway management algorithms and (iii) the implications of the skillset mix of doctors responding to airway emergencies.
High-flow Nasal Oxygen in a Physiologically Difficult Airway for Awake Craniotomy: Optimising the Highs and Lows
Authors: Thakur Nimisha , Rebello Joslita , Monteiro Joseph Nascimento , Desai Ketan 
Published: August 2024

Abstract
Respiratory failure is a major risk factor for perioperative pulmonary complications, requiring mechanical ventilation following general anaesthesia. Awake craniotomy avoids physiological derangements related to general anaesthesia, while facilitating continuous neurological monitoring of eloquent areas. High-flow nasal oxygen (HFNO) provides effective oxygenation with CPAP of 3–4 cmH2O, along with providing a favourable interface for communication. We present a 53-year-old female with carcinoma breast having brain and lung metastases with malignant pleural effusion and superimposed pulmonary infection, posted for parietal lobe metastasis excision. Due to her pulmonary comorbidities with an oxygen saturation of 88%, she was posted for an awake craniotomy. HFNO was used to maintain her oxygenation intraoperatively. In this patient, HFNO effectively improved the patient’s oxygenation, comfort and compliance without compromising her involvement in neurological testing.
Awake Look-assisted Intubation in a Patient with Antiretroviral Therapy-induced Neck Lipodystrophy Posted for Liposuction Surgery
Authors: Vaswani Geeta , Parikh Devangi , Patil Shruti 
Published: August 2024

Abstract
Highly active antiretroviral therapy (HAART)-induced lipodystrophy refers to a serious metabolic syndrome in human immunodeficiency virus-infected patients, characterised by the development of dyslipidaemia, insulin resistance, glucose intolerance and abnormal redistribution of body fat (peripheral lipoatrophy and lipohypertrophy). Lipohypertrophy refers to abnormal fat accumulation occurring commonly in the intra-abdominal compartment, breast, dorsocervical area (buffalo hump) or under the skin (lipomas). We report a case of HAART-induced lipodystrophy with a massive accumulation of adipose tissue in the dorsocervical region posted for liposuction.
Lingual Thyroid: Concerns for the Anaesthesiologist
Authors: Paul Bitty , Rajasree O. , Sreelekshmi P. R. 
Published: August 2024

Abstract
The lingual thyroid gland is rare, and it occurs due to failure of the thyroid gland to descend to its normal cervical location during embryogenesis. It can be associated with an increase in levels of thyroid-stimulating hormone. Lingual thyroid can be challenging to the anaesthesiologist as it poses difficulties while securing the airway. The lingual thyroid gland may present with dysphagia, dysphonia, upper airway obstruction or haemorrhage. Oropharyngeal mass can cause difficult intubation and failure to ventilate. Preoperative airway evaluation and indirect laryngoscopy will indicate the need for fibreoptic bronchoscopy-guided intubation. We report the case of a 50-year-old female with a lingual thyroid gland for breast surgery under general anaesthesia.
Grief and bereavement support amidst palliative care in the paediatric intensive care unit
Authors: Charan Gopal Singh , Kalia Raman , Kumar Atul , Sharma Karuna 
Published: August 2024

ABSTRACT
In paediatric intensive care units (PICUs), advanced medical care meets deeply emotional human experiences. This review examines grief and bereavement support in PICUs, emphasising its significance in extending palliative care beyond end-of-life scenarios. A comprehensive literature search of PubMed and Google Scholar from 2014 to 2023 yielded 50 relevant studies. The findings illustrate the unique challenges in PICUs, such as children’s limited communication abilities, parental distress and emotional burden on healthcare providers. Our review revealed the multifaceted nature of grief in PICUs, including anticipatory and complicated grief, and its profound impact on families and siblings of PICU patients. We identified diverse emotional, psychological, cultural and spiritual support needs that underscored the importance of continuous bereavement care and access to resources. Current support practices, including counselling, support groups, memorial services and interdisciplinary teamwork, are explored. Challenges such as resource limitations, healthcare providers’ emotional toll and communication barriers are discussed. The study also highlights emerging trends such as digital tools, innovative therapies and policy changes to enhance holistic, family-centred care in PICUs.
Valproate-induced leucocytoclastic vasculitis: A rare case report
Authors: Bollapally Naveen Goud , Kumar Rahul , Batra Tanvi , Kakar Atul 
Published: August 2024

ABSTRACT
Drug-induced vasculitis is essentially a small-vessel vasculitis. Histopathological changes in this condition are characterised by neutrophilic leucocytoclasia of the small vessels. To label it leucocytoclastic vasculitis, one must exclude other types of vasculitis where autoimmune workup comes into play. Antiepileptics, although rare, are also known to have such a presentation. We present a case of a 35-year-old male, a known case of hypertension and seizure disorder (on regular treatment), with a recent history of generalised tonic–clonic seizures, leading to a change in his antiepileptics. This was followed by extensive rash development, predominantly on his lower limbs, which was diagnosed as leucocytoclastic vasculitis, with sodium valproate (VPA) being the aetiology for the same. The offending drug was removed, and after treatment with steroids, the patient’s condition significantly improved.
Evaluation of polymerase chain reaction and adenosine deaminase levels for rapid diagnosis of clinically suspected tuberculous pleural effusion
Authors: Shashidhara K. C. , Reddy Rajashekar , Vijayakumar Savitha , Joseph Jerin Abraham , Meghana B. S. 
Published: August 2024

ABSTRACT

Background:
Tuberculosis (TB) often leads to pleural effusion, particularly prevalent in developing nations such as India. There has been a global rise in TB cases. Although lymphocytic predominant fluid is commonly associated with tubercular pleural effusion, it is essential to note that not all lymphocytic predominant fluids indicate TB. The diagnosis of pleural TB has benefited significantly from the use of biochemical markers. Conventional bacteriological methods are not very useful in diagnosing tubercular effusion and rarely identify Mycobacterium tuberculosis in pleural fluid. Owing to diagnostic difficulties, newer investigations, such as TB polymerase chain reaction (TB-PCR), adenosine deaminase (ADA) and culture, are amongst the most recent techniques currently used due to the challenges associated with diagnosis.

Aims:
This study aimed to measure the sensitivity and specificity of TB-PCR and compare them with those of ADA and TB cultures for suspected TB pleural effusion.

Methods:
This study included 50 patients diagnosed with pleural effusion who underwent pleural fluid analysis. Patients exhibiting exudative effusion with lymphocyte predominance also underwent a pleural biopsy. Pleural fluid ADA levels were also measured, and TB-PCR tests were conducted.

Results:
Eighteen patients were confirmed to have TB by biopsy. ADA was both sensitive and specific at 67% and 62.5%, respectively. However, PCR showed a sensitivity of 16.6% and a specificity of 100%.

Conclusion:
This study found a statistically significant association (P < 0.05) between ADA levels and distinguishing pleural effusion, which is tubercular in origin, from non-tubercular effusion. Therefore, the pleural ADA estimate appears to have the potential to be a reliable test for diagnosing TB pleural effusion. It has sufficient sensitivity and specificity while being cost-effective and easily executable compared to pleural biopsy. Our study also compared the sensitivity of PCR with pleural biopsy and discovered that PCR was more specific and less sensitive.
Association between Iron deficiency and hypothyroxinemia in first-trimester pregnant women: A study from a tertiary care hospital
Authors: Vijayakumar Savitha , Madhu B , Sree M. Mounika , Mahadevaiah Mahesh , Basavanagowdappa H 
Published: August 2024

ABSTRACT

Background:
Iron deficiency (ID) is a common nutritional concern worldwide. Hypothyroidism during pregnancy also has harmful effects on both mother and child, such as post-partum hemorrhage, pre-eclampsia, low-birth weight, pre-term labour and abruptio placenta. Few articles have shown an association between ID and hypothyroidism.

Aims:
To evaluate the association between hypothyroidism, hypotriiodothyroninemia and ID in pregnant women.

Materials and Methods:
This cross-sectional study was conducted between January 2017 and June 2019 at JSS Hospital, a Tertiary Care Teaching and Research Hospital attached to JSS Medical College in Mysuru City, South India. Five hundred consecutive pregnant women aged 18–45 years in the first trimester of pregnancy were recruited. A venous blood sample of approximately 5 mL was drawn and sent for analysis of haemoglobin, thyroid-stimulating hormone (TSH), T3, T4, anti-thyroid peroxidase (TPO) antibodies and serum ferritin. T3, T4, TSH, anti-TPO antibody and serum ferritin levels were measured by chemiluminescence for all pregnant women. Correlation and linear regression analyses were performed to determine the association between ID and T3, T4 and TSH levels.

Results:
Out of 500 women, nine were excluded because of pre-analytical errors; hence, there were 491 pregnant women in the first trimester. Mean values of T3, T4, TSH and ferritin in the study were 1.45 ± 0.72, 9.29 ± 2.53, 2.37 ± 3.17 and 31.54 ± 30.28. There was a positive correlation between serum ferritin and T4 levels, with a correlation coefficient of 0.135. The scatter plot also showed a linear relationship between serum ferritin and T4 levels. There was no significant correlation between serum ferritin, T3 and TSH levels. Linear regression analysis also showed an association between ferritin and T4 levels, with a significance of 0.003. Linear regression analysis was insignificant for TSH, T3 and serum ferritin levels.

Conclusion:
ID anaemia (IDA) is associated with hypothyroxinemia in pregnant women. Further extensive studies are needed to evaluate the causal association between hypothyroidism and IDA. Iron therapy might improve thyroid parameters in patients with subclinical hypothyroidism and ID without thyroxine, which requires further research.
Isolation and characterization of human periodontal ligament stem cells under the terms of use in clinical application: A pilot study
Authors: Behfarnia Parichehr , Fazlalizadeh Sheida , Nasr-Esfahani Mohammad Hossein , Ejeian Fatemeh , Mogharehabed Ahmad 
Published: August 2024

ABSTRACT

Background:
The aim of the present study is to determine the possibility of isolation and characterization of the human periodontal ligament stem cells (hPDLSCs) using limited harvested periodontal ligament (PDL) tissue of only one patient’s wisdom teeth (2–4 teeth) under the more compatible terms of use in clinical application without using the fetal bovine serum (FBS).

Materials and Methods:
In this pilot study, hPDLSCs were isolated from the impacted third molar, and tissue was scraped from the roots of the impacted third molar of 10 volunteers to enzymatically digest using collagenase. The cells were sub-cultured. The samples of the first seven patients and half of the eighth patient’s sample were cultured in alpha modified of Eagle’s medium (α-MEM) (−FBS) medium and the other part of the eighth patient’s sample was cultured with prior medium supplemented with +FBS 15% as a control of the cultivation protocol. While for the past two patients (9th and 10th the α-MEM medium was supplemented with L-Glutamine, anti/anti 2X, and 20% knock-out serum replacement (KSR). Two more nutritious supplements (N2 and B27) were added to the medium of the tenth sample. Flow-cytometric analysis for the mesenchymal stem cell surface markers CD105, CD45, CD90, and CD73 was performed. Subsequent polymerase chain reaction was undertaken on three samples cultured with two growth media.

Results:
Cultivation failed in some of the samples because of the lack of cell adhesion to the culturing dish bottom (floating cells), but it was successful for the 9th and 10th patients, which were cultured in the α-MEM serum supplemented with KSR 20%. Flow cytometry analysis was positive for CD105, CD90, and CD73 and negative for CD45. The PDL stem cells (PDLSCs) expressed CD105, CD45, and CD90 but were poor for CD73.

Conclusion:
According to the limited number of sample tests in this study, isolation and characterization of PDLSCs from collected PDL tissue of one patient’s wisdom teeth (2–4) may be possible by the proper setup in synthetic FBS-free serum.