bluuebunny/crossref_metadata_2025_split huggingface dataset:
Exploring the Spectrum: An Original Observational Study of Posterior Reversible Encephalopathy Syndrome from Tertiary Center in Kerala
Authors: Sasidharan Aswathy , Pranaav S. Arun , Ghafoor P. A. Fazal 
Published: August 2024

Introduction:
Posterior reversible encephalopathy syndrome (PRES) is a disorder of subcortical vasogenic edema causing reversible neurologic dysfunction which includes headache, altered sensorium, seizures, and visual disturbances. It is a relatively rare disease with a myriad of nonspecific symptoms with similar presentations to that seen in other diseases such as stroke and cortical venous thrombosis. Hence, accurate diagnosis is needed for early detection to guide the management of such patients. This is a single-center retrospective study from June 2022 to May 2024 to identify the demographic profile, etiologies, imaging features, and prognosis of patients diagnosed with PRES.

Materials and Methods:
Diagnosis of PRES was made on the basis of clinical history, neurological examination, and magnetic resonance imaging brain after ruling out other possible differential diagnoses. The patients who satisfied Fugate et al. criteria were included in the study. The data were collected from the hospital database. Patients with alternate diagnoses were excluded from the study.

Results:
There were 22 patients diagnosed with PRES. There were 20 (91%) females among the cohort. Eighteen (82%) patients had headache. Fourteen (64%) patients had seizures all of which were generalized tonic–clonic seizures. All had positive imaging findings with 2 patients having leptomeningeal enhancement in the presence of normal cerebrospinal fluid findings. Blood pressure (BP) was normal in 5 (22%) patients. Most of the patients were postpartum without a prior history of hypertension or preeclampsia.

Conclusion:
PRES is a reversible entity with the imaging findings primarily involving the posterior part of the brain. It can also involve anterior circulation and spinal cord. Normotensive PRES is possible and should not be overlooked if the patient has all features of PRES but has normal BP. It has a female predilection with the most vulnerable state being immediate postpartum. Although recurrence is possible, PRES does not require long-term medications. Complicated PRES presents with SAH and intracranial hemorrhage.
Endometrial Hormonal Receptor Expression and Blood Vessel Density in Abnormal Uterine Bleeding: A Cross-sectional Descriptive Study
Authors: Jetley Sujata , Bushra Bushra , Ahmad Nehal , Elahi Arifa Anwar , Jairajpuri Zeeba S. , Rana Safia , Khetrapal Shaan 
Published: August 2024

Introduction:
Abnormal uterine bleeding (AUB) is bleeding which is abnormal in amount, duration, frequency, and cyclicity and differs from the normal pattern. The aim of the study is to evaluate the expression of endometrial estrogen (ER) and progesterone receptor (PR) immunohistochemically and blood vessel density in AUB patients. Furthermore, we will correlate hormonal receptor expression and blood vessel density with various endometrial pathologies presenting with AUB.

Materials and Methods:
A cross-sectional study of 60 cases with clinical diagnosis of AUB, (30 cases of cyclical endometrium and 30 cases of hyperplasia/carcinoma) was done. Histological typing of endometrial lesions was done. Microvessel density (MVD) was calculated by counting the average number of blood vessels/10 HPFs. Evaluation of MVD was done on hematoxylin and eosin (H and E) stain and also reticulin stain which highlighted the basement membrane. Immunohistochemistry for steroid hormone receptors, ER and PR was done as per avidin-biotin technique with Diaminobenzidine as the chromogen. Carcangiu scoring system for semiquantitative analysis of ER/PR expression in endometrial samples was adopted.

Results:
There was a significant difference in microvessel density between different histopathology microscopic diagnoses (P < 0.05). The mean value of microvessel density on reticulin stain was significantly higher as compared to the mean value of MVD on H and E. A decrease of the hormonal receptor expression, ER and PR was observed in parallel with the decreased histological degree of differentiation, the lowest values occurring in the case of endometrioid Grade 3 carcinomas.

Conclusion:
Angiogenesis is significantly correlated with increasing severity of the lesion. The correlation of immunohistochemical findings with histologic grade can be useful in predicting biological behavior in patients.
Modified Mallampati Test in Supine versus Sitting Position as a Predictor for Difficult Intubation – An Observational Study
Authors: Kotwani Manish , Kawale Netraj Namdev , Nam Pranav Balu , Kotwani Deepti 
Published: August 2024

Abstract

Background:
The modified Mallampati test (MMT) is routinely employed to predict difficult laryngoscopy and tracheal intubation. This test, as a standard, when conducted with a patient in a sitting position, exhibits limited practicality due to its relatively low sensitivity and specificity in predicting difficult tracheal intubation (DTI). It is hypothesised that MMT, when performed with a patient lying supine, may improve its efficacy as a predictor of DTI.

Methods:
This single-centre prospective observational study was conducted involving 455 adult patients requiring general endotracheal anaesthesia. During preanaesthetic evaluation, MMT was performed in the sitting position as a standard (sitting MMT). Subsequently, independent observers recorded the MMT in the supine position (supine MMT) before administering general anaesthesia. The sitting and supine MMT were correlated with Cormack and Lehane grades using the Chi-square test. Diagnostic performance metrics, including the area under the receiver operating characteristic (ROC) curve, sensitivity, specificity, positive predictive values (PPV) and negative predictive values, were employed to assess the predictive capabilities of MMT in both positions.

Results:
Out of 455 patients, 72 (15.8%) experienced difficult intubation (defined as Cormack–Lehane Grade III and above). Both MMT in the sitting and supine positions demonstrated strong predictive capabilities for DTI, with areas under the ROC of 0.799 and 0.779, respectively. While sitting in the MMT position exhibited higher sensitivity (55.6% vs. 28.8%), supine MMT demonstrated a superior PPV (86.1% vs. 55.6%).

Conclusion:
MMT, when conducted with a patient in a supine position emerges as an alternative and a reliable predictor for predicting DTI.
Exploring the incidence of balance and coordination deficits amongst obese adolescents attending school: Insights from an online cross-sectional survey
Authors: Choudhary Smriti , Sharma Abhishek 
Published: August 2024

ABSTRACT

Background:
Balance is maintained through automatic postural adjustments that ensure stability during various activities. Developmental Coordination Disorder (DCD) is often associated with other developmental issues, such as attention-deficit hyperactivity disorder (ADHD), learning disabilities, speech-language delays, and behavioral and emotional difficulties. Body mass index (BMI) for age is widely used in clinical and public health settings to determine whether a child or adolescent is overweight or obese.

Aims:
This study aimed to systematically examine the prevalence of balance and coordination impairments among obese adolescents attending school.

Materials and Methods:
A cross-sectional survey was conducted on a sample of 368 school-going obese adolescents. A self-developed questionnaire assessing balance and coordination was administered to the participants. The BMI was calculated for each participant to confirm obesity status.

Results:
The study found a significant prevalence of balance and coordination impairments among the obese school-going adolescents surveyed. These impairments were observed across various activities requiring postural adjustments and motor skills.

Conclusions:
The findings suggest a notable incidence of balance and coordination deficits in obese adolescents, highlighting the need for targeted interventions in this population to address these motor skill challenges.
Oral transmucosal fentanyl citrate as breakthrough pain relieving medication: A pilot study
Authors: Dua Naresh , Annaram Randheer Kumar , Jain Pradeep , Yadav Priya , Dua Shubh , Sood Jayashree 
Published: August 2024

ABSTRACT

Background:
Breakthrough pain in cancer patients is a common and distressing symptom that significantly impacts their quality of life. Traditional pain management strategies often fail to provide adequate relief. Oral transmucosal fentanyl citrate (OTFC) has emerged as a rapid-onset opioid analgesic, offering a potential solution for managing this challenging condition in home care settings.

Aims:
This study aims to evaluate the efficacy of OTFC in managing breakthrough pain and its effects on the quality of life in cancer patients treated at home.

Materials and Methods:
A pilot study was conducted with 40 cancer patients experiencing more than one episode of breakthrough pain daily. These patients were administered OTFC 400 μg for pain management. Degree of pain (NRS) and modified ‘Quality of Well-being’ (QWB) scores were analysed using data filled in by patients. Data were collected and analysed using paired t-tests to compare pre- and post-treatment scores.

Results:
The administration of OTFC resulted in a significant reduction in pain, as indicated by the decrease in NRS scores from 9.9 ± 0.304 to 0.5 ± 0.906 within 30 minutes (P < 0.0001). Additionally, there was a marked improvement in QWB scores, which increased from 26.18 ± 2.8 to 36.3 ± 3.16 over the same period (P < 0.001). Mild side effects, such as nausea, headache, and somnolence, were reported, but no serious adverse events were observed.

Conclusions:
We conclude that OTFC 400 μg is an effective and well-tolerated option for managing breakthrough pain in cancer patients and in improving the quality of life in home care settings.
Predictability of Nailfold Capillaroscopic Score in Diagnosing Retinopathy in Patients with Type 2 Diabetes Mellitus and its Utility as a Non-Invasive Tool for Differentiating from those Not Having Retinopathy
Authors: Raina Rohit , Chhabra Neha , Barnwal Shruti , Vasisht Shivani , Kansal Naveen Kumar , Kant Ravi 
Published: August 2024

Background:
Diabetes mellitus (DM) is a chronic hyperglycaemic state associated with microvascular structural alterations. Nailfold capillaroscopy (NFC) is an in vivo study of microvascular circulation.

Aims and Objectives:
This study aimed to investigate the diameters of capillary loops and morpho-structural changes using a handheld dermatoscope in patients with type 2 DM (T2DM) with and without diabetic retinopathy (DR) and to establish nailfold capillary changes and NFC score as a non-invasive method to identify microvascular complication in T2DM patients.

Material and Methods:
A cross-sectional observational study was conducted in AIIMS Rishikesh for 6 months from August 2022 to February 2023. Our study participants were 100 adults more than 18 years of age diagnosed with T2DM, based on the American Diabetes Association (ADA) criteria. All patients were evaluated thoroughly for the presence of microvascular complications in the form of retinopathy. Based on this, they were divided into two groups—group 1 (T2DM with retinopathy) and group 2 (T2DM without retinopathy). Both groups were further subdivided into three subgroups based on haemoglobin A1c (HbA1c): the first group with HbA1c <7%, the second group with HbA1c 7–8.9% and the third group with HbA1c >=9%. For all the study participants, a detailed NFC was done for all 8 fingernails (excluding the thumb), using a handheld dermatoscope. Abnormal capillary shapes (ACS) were recorded by semi-quantitative score (NFC score).

Results:
A significant association was seen in capillary density (loops/mm) (5.83 ± 0.72 in the DR group and 6.3 ± 0.89 in the no-DR group) (P value = 0.005), capillary density (loops/3 mm) (P value = 0.005), total number of microhaemorrhages/3 mm (P value < .0001), total number of giant capillaries/3 mm (P value = 0.0004), total number of avascular areas/3 mm (P value = 0.0005), enlarged capillaries/3 mm (P value = 0.002), tortuous capillaries/3 mm (P value < .0001), abrogated/bushy capillaries/3 mm (P value = 0.004), number of fingers involved excluding the thumb (P value < .0001) and total nailfold capillaroscopic score (P value < .0001) between the two groups, one with DR and another without DR. Furthermore, the proportion of patients with abnormal nailfold capillaroscopic findings, abnormal NFC score, was significantly higher in patients with DR as compared to patients without DR (51.85% vs 4.35%, respectively) (P value < 0.0001).

Conclusion:
Our results suggest that NFC could possibly be used as an adjunctive tool in diabetics for diagnosing or monitoring microvascular complications with total NFC score being the significant predictor of DR at a cut-off point of >0 with the area under the curve (AUC) of 0.745 for correctly predicting DR.
Frontal Executive Function Assessment in Patients with Parkinson Disease Using Frontal Assessment Battery (FAB) at a Tertiary Care Center in Western India
Authors: Saini Pankaj Kumar , Gupta Gaurav Kumar 
Published: August 2024

Background:
Cognitive impairment in Parkinson disease (PD) primarily consists of executive dysfunction. Frontal Assessment Battery (FAB), composed of six subsets to explore different functions related to the frontal lobe is a validated and easily performed tool for executive function assessment.

Aims and Objectives:
We performed this study to evaluate the clinical utility of the FAB for the assessment of executive dysfunction in PD and to study the correlation of FAB with other tests of executive functions such as fluency tests (lexical and semantic) and trail making tests (TMT A and B) in a group of Indian patients with PD.

Material and Methods:
We included 60 patients diagnosed with PD per the UK PD Brain Bank criteria. Our study included 40 healthy age, sex, and education-matched controls. We recorded clinical characteristics of patients [age, sex, disease duration, Hoehn and Yahr stage, and Unified Parkinson disease Rating Scale (UPDRS) scores] and Mini-Mental State Examination (MMSE) and FAB scores of both patients and controls in a prescribed pro forma.

Results:
In the study group, mean age was 52.53 ± 10.42 years, mean disease duration was 5.77 ± 3.27 years, mean MMSE was 28.4 ± 1.53, and mean FAB was 11.53 ± 2.30, and they had significantly decreased mean FAB scores as compared to controls. FAB scores also correlated significantly with age, disease duration, Hoehn and Yahr stage, UPDRS score, MMSE, fluency tests, and TMT.

Conclusion:
FAB is an easily performed bedside screening test for executive function assessment in PD, and it can be used to detect early and subtle cognitive impairments in PD.
Effect of Lockdown in the COVID-19 Pandemic on Dietary Habits and Self-Medication Practice in People Living in Jordan
Authors: Angor Malak M. , Nawasreh Areen O. 
Published: August 2024

Background:
The pandemic of the coronavirus disease 2019 (COVID-19) has impacted Jordanian society, particularly on health.

Aims:
This study examined the effect of the COVID-19 pandemic lockdown on Jordanian society’s dietary habits and self-medication practices.

Methods:
We surveyed 1252 Jordanians of both genders between the ages of 18 and 65 years by questionnaire. Three questions were asked to evaluate the frequency of foods/drinks consumption, general eating habits, and self-medication practice of individuals of both genders during the lockdown.

Results:
Dietary habits and food quality affected weight (increase or decrease) by 69.5% during the lockdown. The highest percentages of “very high” consumption per week for fruits, processed juices, and fried foods were 37.6 %, 36.7%, and 29.4%, respectively. The highest percentage of “very little” consumption per week for drinking water, milk, and soft drinks were 12.5%, 8.5%, and 7.4%, respectively. The percentage of respondents who had taken medicine without a doctor’s prescription was 84.7%. The highest percentage (74%) was in using self-medication as a preventive measure against the coronavirus, followed by treating a cold/flu (61.4%), in both genders and age groups. The largest percentage (78.5%) was for using paracetamol, followed by ibuprofen and azithromycin (78.1% and 77.1%), respectively.

Conclusion:
Dietary habits and the quality of the foods consumed during lockdown affected participants’ weight (increase or decrease) by 69.5%. The percentage of participants who self-medicated was 84.7%.
Hypertension Severity and Inflammatory Burden as Evaluated by Neutrophil–Lymphocyte Ratio
Authors: Fahad Esraa H. , Al-Niemi Marwa S. , Hussain Nawar R. , Al-Kuraishy Hayder M. , Al-Gareeb Ali I. 
Published: August 2024

Background:
Different studies implicated inflammation as associative or causative factor in the development of hypertension (HT). It has been reported that low-grade inflammation enhances development of HT, as high blood pressure is linked with high neutrophils, lymphocytes, C-reactive protein, and interleukin 6. Neutrophil–lymphocyte ratio (NLR) may reflect underlying chronic low-grade inflammation in different inflammatory disorders and cardiovascular diseases including HT. Telmisartan (TLS), which is an angiotensin II receptor type 1 blocker that used in the management of HT, may reduce the associated inflammatory disorders. Thus, the aim of the present study was to assess the level of NLR in relation to the HT severity in patients treated with TLS.

Methods:
Forty-four patients with severe HT compared with matched 20 patients with mild HT as controls were recruited. Anthropometric and biochemical variables as well as NLR were measured.

Results:
Blood pressure and lipid profile were higher in patients with severe HT on antihypertensive therapy other than TLS. TLS treatments had improved blood pressure; lipid profile and low NLR compared to patients with severe HT not were on TLS treatment.

Conclusion:
TLS reduces HT severity through reduction of NLR; therefore, it regarded the optimum angiotensin receptor blocker (ARB) drug in the management of HT. Thus, preclinical and prospective studies are warranted in this regards.
Prevalence and risk factors of Helicobacter pylori infection in military personnel
Authors: Wang Chunmei , Liu Jun , An Yang , Zhang Dan , Ma Rui , Guo Xiaozhong , Qi Xingshun 
Published: August 2024

Background and Aims:

Helicobacter pylori infection is prevalent and recognized as a major cause of gastrointestinal diseases in the world. Previous studies on the prevalence of H. pylori infection in military personnel have shown some conflicting results. This study aimed to estimate the pooled prevalence of H. pylori infection and evaluate its risk factors in military personnel.

Methods:
The PubMed, EMBASE, and Cochrane Library databases were searched. We pooled the prevalence of H. pylori infection in military personnel using a random-effect model. Metaregression analysis was used to explore the sources of heterogeneity. Pooled proportion of H. pylori infection with 95% confidence interval (CI) was calculated.

Results:
Sixteen studies were included. Meta-analysis showed that the overall prevalence of H. pylori infection was 32% (95% CI = 31–33) in military personnel. There was a significant heterogeneity. Metaregression analysis showed that study region (P = 0.0004) and publication year (P = 0.023) were the potential sources of heterogeneity. In the subgroup analysis by study region, the highest prevalence was found in Asia (50.2%; 95% CI = 49–51.4). In the subgroup analysis by diagnostic methods for H. pylori, the highest prevalence was found when urea breath test was employed (47.9%; 95% CI = 46.5–49.3). The most common risk factor for H. pylori infection was familial aggregation, followed by living environment and age.

Conclusion:

H. pylori infection is common in military personnel. In future, we may require appropriate population screening for H. pylori infection by multiple diagnostic tests and increase the knowledge and awareness of the bacterial transmission among military personnel.
The occult rheumatic scourge
Authors: Daga Pawan , Vaideeswar Pradeep , Goyal Ashutosh , Marathe Supreet P. , Bhargav Rishi 
Published: August 2024

Aims:
To study the clinical and pathological manifestations of missed cases of rheumatic heart disease (RHD) and postulate possible reasons behind a missed diagnosis.

Materials and Methods:
Retrospective 20-year (2000–2019) autopsy data of chronic RHD were reviewed and patients, in whom the valvular deformities had been incidental autopsy findings, were selected. The clinical details of these patients were correlated with the morphology of the affected valves. On this pathological analysis, the patients were assigned to a category of subtle or significant valvular deformity. By clinically correlating, the latter group was subdivided into clinically misdiagnosed, clinically undiagnosed, and sudden cardiac death.

Statistical Analysis:
Nil.

Results:
Among the 475 cases of chronic RHD identified at autopsy in the study period, the disease was diagnosed incidentally in 69 patients (14.5%). Significant valvular deformity was noted in 61 cases while the other 8 cases had subtle valvular deformity. The most common cause of death was cardiac failure in 39 out of 69 patients (56%). Eleven (16%) patients had experienced sudden cardiac death. Among the undiagnosed cases, 5 (7%) of them had a diagnosis of non-rheumatic cardiac disease, while the other 14 (20.5%) patients had overwhelming non-cardiac diseases.

Conclusions:
Our study indicates that mortality and morbidity due to RHD are underdetermined. The patients remain undiagnosed due to either insignificant valvular involvement, clinically silent in the presence of significant valvular deformity, presence of other overwhelming diseases or misdiagnosis partly due to the resemblance with the other pathologies.
Cystic hypersecretory carcinoma with invasion
Authors: Yami Hibu , Thambi Renu , Priya PV , Sundaram Sankar 
Published: August 2024

Background:
Cystic Hypersecretory Carcinoma (CHC) is a rare subset of breast carcinoma. It is part of a spectrum of cystic hypersecretory lesions which includes cystic hypersecretory hyperplasia (CHH), CHH with atypia, CHC in situand CHC with invasion. Approximately 65 cases of cystic hypersecretory lesions have been reported; most of them were CHC in situand only 19 cases of CHC with invasion have been reported so far.

Case Presentation:
We are reporting 2 cases of 47 and 62 year old women with a palpable breast mass for 6 and 1 month duration respectively. Trucut biopsy was carried out for both which showed high grade ductal carcinoma in situwith microinvasion in the first patient and the latter showed a tiny focus of invasive carcinoma. Simple mastectomy and modified radical mastectomy (MRM) were done for the respective cases; both showed dilated cystic spaces filled with eosinophilic secretions (thyroid colloid-like), lining neoplastic cells that showed variable degrees of proliferation, atypia and in situcarcinoma. There were foci of invasion in both cases and hence a morphological diagnosis of CHC with invasion was made.

Conclusion:
Owing to a smaller number of reported cases, little is known about the biological behavior, prognosis and molecular profile of cystic hypersecretory carcinoma.