bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical Profile and Treatment Outcome of H-mono/Polydrug-resistant Tuberculosis: A Single-center Retrospective Study
Authors: Kabra Shital , Jadhav Snehal 
Published: August 2024

Background:
Isoniazid-monoresistant tuberculosis (Hr-TB) is the most prevalent drug-resistant TB. It often precedes multidrug-resistant TB (MDR-TB) and poses a major threat in the fight against TB control. The treatment outcome in Hr-TB and polydrug-resistant TB (PDR-TB) other than MDR still remains unclear.

Aim:
The aim of the study is to determine the clinical characteristics and treatment outcome in H-mono/PDR-TB under programmatic conditions.

Materials and Methods:
The study design was retrospective observational. It was conducted at the respiratory medicine department of a tertiary care institute in Mumbai. The medical records for bacteriologically confirmed TB patients diagnosed between July 2021 and December 2022 were reviewed. A total of 827 patients were enrolled and among them 46 patients with H-mono/PDR-TB were analyzed. The demographic data, clinical characteristics, and treatment outcomes were recorded.

Results:
Among 46 patients of isoniazid mono-resistant/PDR-TB analyzed from 827 bacteriologically confirmed TB, 24 were women with a mean age of 30.5 years. Twenty-five (54.34%) were resistant to isoniazid and the remaining 21 (45.66%) were PDR-TB. Primary Hr-TB was detected in 43 (93%) patients. The KatG mutation in 30 (65.2%) patients was the most common form of isoniazid (INH) mono resistance followed by inhA mutation 16 (34.8%). The fluoroquinolone (FQ)-based treatment regime as per national program guidelines had favorable outcomes in 42 (91.3%). However, unfavorable outcome with progression to MDR was observed in 3 (6.52%) and death in 1 (2.18%) patients.

Conclusion:
H-mono/PDR-TB is the most prevalent DRTB and most of them have primary resistance to isoniazid. Availability of first and SL LPA and limited DST with FQ-based regime under the national program has improved treatment outcomes in Hr-TB/PDR-TB.
Serum Uric Acid as a Biomarker in Patients Admitted with Acute Exacerbation of Chronic Obstructive Pulmonary Disease to a Tertiary Hospital, Kerala
Authors: Soman Mervin K. , Chakkamadathil Jesin Kumar , Noorayingarath Hafseena , Lal A. Gayathri 
Published: August 2024

Background:
Chronic obstructive pulmonary disease (COPD) is a highly prevalent and debilitating condition worldwide, imposing significant economic and social burdens on societies. Serum uric acid contributes to inflammation and is often used a biomarker.

Aims and Objectives:
This study aims to assess the potential role of serum uric acid as a cost-effective biomarker in hospitalized patients experiencing acute exacerbation of COPD. Additionally, it aims to investigate the relationship between the severity of airflow obstruction and serum uric acid levels in patients with COPD.

Materials and Methods:
The study design is a prospective cohort study involving 144 COPD patients admitted for acute exacerbation, excluding those with concurrent chronic comorbidities or receiving medications known to substantially elevate uric acid levels.

Results:
Our findings demonstrate elevated serum uric acid levels in patients with advanced-stage COPD and severe airflow obstruction. Furthermore, patients with higher levels of serum uric acid exhibit poorer prognosis compared to those with lower levels in COPD.

Conclusion:
Serum uric acid can serve as a valuable biomarker to prognosticate COPD patients and assess disease severity in patient admitted with exacerbations.
Lung Oscillometry: A Practical Solution for Overcoming Spirometry Challenges
Authors: Balachandran J. 
Published: August 2024

ABSTRACT

Background:
Lung oscillometry is an alternative pulmonary function test in patients unable to perform spirometry due to cough or dyspnea.

Objective:
The objective of the study was to study the characteristics of lung oscillometry parameters in patients with cough or dyspnea and who are unable to perform spirometry.

Methodology:
A retrospective cross-sectional study Was conducted in a pulmonology outpatient clinic. Patients during the study period were selected for lung oscillometry after fulfilling the inclusion and exclusion criteria. The resistance and reactance parameters were measured along with the demographic variables. Statistical calculations were done.

Results:
Forty-two percent patients were found to have airway obstruction if the recommended cutoff for resistance at 5 hertz (R5) was followed. However, reactance parameters were abnormal in most of the cases. The area of reactance (Ax) had a very good coefficient of correlation with R5 (0.867, P = 0.001).

Conclusions:
Ax is a suitable lung oscillometric parameter for identifying airway obstruction in asthmatics.
Chronic Airway Obstruction in the Post-COVID-19 Era: Is There a Cause or Effect?
Authors: Desai Unnati , Utpat Ketaki , Sable Sharad 
Published: August 2024

ABSTRACT

Introduction:
Chronic airway obstruction (CAO) is the terminology used to address chronic obstructive airway diseases, namely bronchial asthma (BA), chronic obstructive pulmonary disease (COPD), bronchiectasis, and posttuberculosis (TB) COPD. We studied the profile of the CAO at the respiratory medicine department post the COVID-19 lockdown to understand any cause or effect of past COVID-19.

Materials and Methods:
This prospective observational study enrolled 164 cases of CAO. Clinical and radiological details of the two groups of CAO with and without a past history of COVID-19 were noted.

Results:
Of 164, 101 (61.59%) were men and 63 (38.41%) were women. Thirty-nine had a history of COVID-19. Of the 164 cases, 39 (23.7%) had BA, 51 (31.09%) had COPD, 61 (37.19%) had post-TB COPD, and 13 (7.92%) had bronchiectasis. In patients with a history of COVID-19, 9 (23.1%) had BA, 9 (23.1%) had COPD, 15 (38.5%) had post-TB COPD, and 6 (15.3%) had bronchiectasis. Eight had normal lung functions, 4 had mild obstructions, 75 had moderate obstruction, and 74 had severe obstructions. The clinical and spirometry differences in those with and without a history of COVID-19 were statistically insignificant. On high-resolution computed tomography thorax, 46 (28.1%) had emphysema, 16 (9.7%) had air trapping, 65 (39.7%) had fibrobronchiectasis, and 37 (22.5%) were normal. In patients with a history of COVID-19, 6 (15.3%) had emphysema, 2 (5.2%) had air trapping, 23 (58.9%) had fibrobronchiectasis, and 8 (20.5%) were normal. The difference in radiological findings was statistically significant and more in the group with a history of COVID-19 (P = 0.029).

Conclusion:
COVID-19 did not affect the distribution, clinical characteristics of CAO, however, impacted radiological findings significantly.
To Compare the Fixation of Distal Humerus Fracture by Orthogonal (90°–90°) Plating Versus Parallel Plating in Adults
Authors: Shakunt Rajendra Kumar , Mittal Vivek , Chahar Hemant , Kumar Mrityunjai 
Published: August 2024

Abstract

Introduction:
A distal humerus fracture is defined as a fracture within a square of the lower end of the humerus where the base is the distance between the epicondyles of the humerus on an anteroposterior view of the radiograph. The most distal humerus fractures are due to high-energy trauma, such as road traffic accidents in adults, and in the elderly due to low-energy injuries, such as trivial falls. The purpose of this study was to analyze and evaluate the comparison of fixation of distal humerus fracture by orthogonal and parallel plating in adults.

Materials and Methods:
A prospective study was done among 30 patients having distal humerus fractures. The distal humerus fractures were managed with anatomical locking plates by orthogonal and parallel plating techniques through posterior approach and reduction, stable fixation, and functional outcome were assessed by using Mayo Elbow Performance Score (MEPS).

Results:
The results revealed that all patients were followed up by using MEPS scoring and X-ray of the elbow in anteroposterior and lateral view. In our study, road traffic accidents were the most common mode of injury and the mean age was 43 years. By using the MEPS score, the results were excellent for 9 patients, good for 13 patients, fair for 3 patients, and poor for 5 patients. After comparison between orthogonal and parallel plating groups, there was no significant difference in the total range of flexion and extension, MEPS, and flexion–extension arc.

Conclusion:
The results conclude that in the management of distal humerus fracture, the plates applied orthogonally have no significant difference compared with the parallel plating technique. The plates applied in the orthogonal and parallel configuration by using appropriate surgical techniques provided stable fixation and anatomical reduction of distal humerus fractures.
Use of Esmarch Bandage in Adult Orthopedic Lower Limb Surgery in the Modern Era: A Review of Safeguards
Authors: Tomar Lavindra , Govil Gaurav 
Published: August 2024

Abstract
An Esmarch bandage has commonly been used to achieve a bloodless field during adult orthopedic limb surgery. The exsanguination achieved effectively provides a clear field during surgical procedures. In the modern era, the use of Esmarch bandage presents its own challenges. The characteristics of the bandage limit its indications. The complications and effects associated with its use further dissuade orthopedic surgeons from using it in present-day practice. The use of the bandage along with tourniquet application for lower limb arthroplasty procedures has been considered as a technique to limit blood loss, provide a bloodless field, and shorten the duration of the operation. Safeguards need utmost attention and careful execution to achieve the desired outcome in lower limb surgery.
Lumbar Epidural Abscess Presenting as Cauda Equina Syndrome: A Rare Case with Literature Review
Authors: Jilani Latif Zafar , Istiyak Mohammad 
Published: August 2024

Abstract
Pyogenic epidural abscess is a rare illness that can occasionally present like cauda equina syndrome. It may quickly advance and result in long-term neurological paraplegia. This case involves a 17-year-old female who had been experiencing backache for 2 weeks and weakness in her right lower limb for 1 week. She was managed conservatively. Our case is distinctive in that, despite a magnetic resonance imaging diagnostic of the tuberculosis spine, it was ultimately determined to be of pyogenic origin and was treated as such.
A Comparative Study of Proximal Femoral Nail Antirotation Versus Intertan Nail in the Treatment of Pertrochanteric Fractures in a Tertiary Care Center
Authors: Kumar Sanjiv , Kumar Deepak , Kumar Dharamendra , Kumar Ashish , Pratap Priyank , Gautam Nayank , Raza Muhammad Shahid , Sharma Santosh , Sharma Devendra 
Published: August 2024

Abstract

Introduction:
Intertrochanteric fractures (IT) are defined as fractures that occur between the greater and lesser trochanters of the proximal femur outside the femoral head. Most of the fractures are unstable. There are two common approaches used for IT fixation, including intramedullary nails and extramedullary fixations, using screws or plates. Internal fixation via these methods provides established benefits, such as immediate pain relief, rapid mobilization for the patient, accelerated rehabilitation, and maintenance of independent living capabilities. Various methods of internal fixation are present but we decided to compare the InterTan and proximal femoral nail antirotation (PFNA) due to a lack of research in Indian patients.

Materials and Methods:
A total of 52 patients with IT treated using InterTAN (27) and PFNA II (25) were included in the study, in the state of Uttar Pradesh, India, and the accompanying northern part of the country according to the inclusion criteria. Both groups were then clinically and radiologically followed for 2 years to evaluate outcomes.

Results:
The results revealed that patients were evaluated over 2 years using various criteria to compare the PFNA II and IT nail implants.

Conclusion:
This study concludes that the InterTan nail is a better option compared with the PFNA II in terms of the lesser cut-out rate, better reduction, and stable fixation in unstable IT in elderly patients with fewer complications. However, for patients with complex greater trochanter fractures, lateral cortex fractures of the proximal femur, or who are not fit candidates for surgery, the PFNA II implant may be a suitable treatment option due to its less operating time and simple design.
Factors Affecting Choice of Subspecialisation amongst Orthopaedic Surgery Residents in Southern Nigeria
Authors: Imediegwu Kelechi U. , Igwe Ozioma P. , Onyebuchukwu Chiamaka Q. , Okonkwo Kenechukwu J. , Ngwu Amarachi O. , Nduka Agenu P. , Okeke Kosisochukwu , Anya Jonah P. , Onyesoro Chinedu S. , Akunna James-Ibe S. , Oladiran Ajibola B. 
Published: August 2024

Abstract

Background:
As the field of surgery continues to evolve, subspecialty training is fast becoming integral to surgical education. Presently, orthopaedic surgery residents have opportunities to subspecialise in different areas.

Objectives:
The aim of this study was to determine the factors affecting the choice of desired subspecialties amongst orthopaedic surgery residents in southern Nigeria.

Materials and Methods:
This study was a cross-sectional study conducted amongst senior orthopaedic surgery residents in southern Nigeria. A well-structured questionnaire designed using the free software Google Forms was electronically distributed to senior orthopaedic residents in Nigeria through online forums (WhatsApp, email, and Telegram). Data obtained were analysed using IBM Statistical Product and Service Solutions version 26. The odds ratio and the associated 95% confidence interval were used to assess outcomes, and a P value <0.05 defined that the difference was statistically significant.

Results:
At the end of the study period, 53 orthopaedic surgery senior residents completed and submitted the questionnaire with a response rate of 73.6%; 50.9% were married with children and 49.1% were single. The most agreed key factor influencing the choice of orthopaedic surgery subspecialisation from the study was lifestyle considerations (79.2%). Other major factors considered to be also very important were the needs of the region (73.6%), active mentorship (71.7%), ergonomics (64.6%), rotation experiences (47.2%), cost of acquiring the training (41.5%), and salary and financial privileges (37.7%). Overall, 24.5% of respondents chose spine surgery as their desired subspecialty, 18.9% arthroplasty, 17% arthroscopy, 17% paediatrics, 13.2% reconstructive orthopaedics, 5.7% musculoskeletal oncology, and 4.7% hand and foot surgery. Our study revealed a significant statistical relationship between having children and choice of a subspecialty (Fischer’s = 0.032; χ2 = 0.033), as the married female residents tend to have more family considerations in their final choice of subspecialisation.

Conclusion:
The choice of orthopaedic surgery subspecialisation amongst orthopaedic surgery residents in southern Nigeria is affected by different factors, such as mentorship, needs of region, desire to work in academic settings, and ergonomics.
Educational Intervention Can Improve the Pilot Balloon Palpation Method of Tracheal Tube Cuff Pressure Monitoring: An Experimental Study
Authors: Nwosu Arinze Duke George , Ossai Edmund Ndudi , Ejezie Chijioke , Obodo Odichimma Callista 
Published: August 2024

Abstract

Background:
Considerable morbidity is attributable to inappropriate tracheal cuff pressure. An earlier study undertaken in our hospital revealed that a normal cuff pressure of 20–30 cm H2O was achieved in only 6% of intubated patients using subjective estimation methods.

Objective:
To determine whether a training intervention could improve the accuracy of the subjective estimation method in our tracheal cuff monitoring.

Materials and Methods:
A 1-day training session was conducted in April 2022 for our anaesthesia providers. The cuffs of different sizes of endotracheal tubes were inflated to 25 cm H2O, and each staff was requested to feel the turgor of the pilot balloon. Subsequently, anaesthesia providers used pilot balloon palpation for the regulation of the tracheal cuff pressure in consecutive patients undergoing general anaesthesia with endotracheal intubation. During each intubation, a manometer was used to crosscheck the inflated cuff pressure objectively. The incidence of post-operative sore throat was also evaluated. The obtained outcomes were compared with pre-intervention data obtained from an earlier study conducted in the health facility from October 2020 to September 2021. Significant differences were considered when P < 0.05.

Results:
The mean tracheal cuff pressure was improved post-intervention (49.2 ± 24.1 cm H2O versus 77.1 ± 31.1 cm H2O; P < 0.001). A significantly higher proportion of tracheal cuffs (20%; 31/156) were inflated within the normal range compared to 6% (9/141) prior to the intervention (P = 0.003). Fewer patients developed post-operative sore throat following the educational intervention (32.8%; 41/125) versus pre-intervention (47.7%; 53/111; P = 0.019).

Conclusion:
The educational intervention improved the safety of tracheal cuff management, which could positively impact airway management, especially in poor resource settings without cuff manometers.
Total Femur Replacement as a Salvage Procedure for Failed Distal Femur Megaprosthesis: A Case Report and Literature Reviews
Authors: Ugbeye Michael Ebiyon , Alatishe Kehinde Adesola , Lawal Wakeel Olaide 
Published: August 2024

Abstract
Total femoral replacement (TFR) is not a common surgery and most indications are for oncological pathologies. However, there are few instances where non-oncological indications might necessitate TFR; this may be a salvage surgery for failed previous hip and/or knee surgeries with consequent significant femur bone loss. We present a 59-year-old obese woman with right thigh pain and difficulty with walking of 5 years duration. She had undergone bilateral total knee replacement 10 years earlier on account of severe knee osteoarthritis. She had a fall 3 years prior to presentation and sustained a periprosthetic fracture around the right knee which was managed with a fixed angle blade plate and screws. This was complicated by implant breakage and non-union. She subsequently had implant removal and a right distal femur replacement (DFR) surgery 2 years prior to presentation. A year after the DFR surgery, she began to experience “start-up” pain, instability around the knee and difficulty with walking without support. A clinical and radiologic diagnosis of aseptic loosening of the distal femur megaprosthesis was made and she was offered a revision DFR surgery which also failed due to poor cementing technique, bone loss at the proximal femur, and severe osteoporosis. Patient ended up with a right total femur replacement to salvage the limb. She had improved Lower Extremity Functional Score of 27 after 12-month follow-up. TFR is a viable salvage procedure for severely compromised femur and/or significant bone loss from multiple non-oncological surgeries of the femur.
Case Finding and Management of Childhood Cataracts: The Role of a Child Eye Health Programme in Kaduna State, Nigeria
Authors: Aminatu AbdulRahman , John Buchan , Nazaradden Ibrahim , Sunday Isiyaku , Richard Bowman , Amina Hassan , Mahmoud Alhassan , Bunce Catey 
Published: August 2024

Abstract

Objective:
To evaluate the output of a child eye health programme in terms of identification, referral, and volume of paediatric cataract surgeries in Kaduna State, Nigeria.

Materials and Methods:
This was a retrospective review of the North-West Nigeria Child Eye Health Initiative programme referral registers at primary, secondary and tertiary hospitals in Kaduna State. Theatre registers of children 0–16 years who had cataract surgery at National Eye Centre Kaduna between 2016 and 2019 were also reviewed. Information on numbers of children, age, sex, laterality of cataract and programme status were summarised as frequencies, percentages and mean ± standard deviation. The initial 2 years of the programme (2018–2019) were compared with the 2 years (2016–2017) preceding them.

Results:
Between January 2018 and December 2019; primary health workers screened 41,552 children and referred 2,316 (5.6%). Of those referred 1772 (76.5%) presented at one of three zonal secondary hospitals where nurses identified 492 (27.8%) with leukocoria using torchlights and referred them to the tertiary hospital. At the tertiary hospital, 364 (74.0% of 492) attended and 262 (72.0% of 364) were confirmed to have operable cataracts after dilated slit lamp examination by ophthalmologists. Between 2016 and 2017 (pre-programme years), 201 children had cataract surgery compared to 352 in 2018 and 2019 (programme years) of whom 239 (67.9% of 352) were beneficiaries of the programme. The proportion of girls who had cataract surgery declined from 39.8% to 35.0%, while mean age increased from 5.7 ± 4.2 years to 7.5 ± 4.1 over 4 years. More children with unilateral cataracts (214 [60.8%]) presented during the programme years (Fishers exact test, P = 0.004), whereas unilateral cataract (207 [60.2%]) was significantly more common in males than females (Fisher’s exact P = 0.017).

Conclusion:
The programme has resulted in improved case detection of childhood leukocoria at primary eye care level. additionally, the eye health referral system in Kaduna State has been strengthened with increasing numbers of children accessing services: majority boys, older children, and unilateral cataracts.
Soluble triggering receptor expressed on myeloid cells: a marker for diagnosis of spontaneous bacterial peritonitis
Authors: Mohamed Mahmoud H. , Attia Taher E.-D. , Ghafar Muhammad T.A. , Elkholy Reham A.K. 
Published: August 2024

Background
Spontaneous bacterial peritonitis (SBP) affects patients with liver cirrhosis. Many studies investigated Triggering receptor expressed on myeloid cells-1 (TREM-1) for diagnosis of bacterial infections.

Aim
To assess the value of serum and ascitic fluid (sTREM-1) for the detection of SBP among cirrhotic patients with ascites.

Patients and method
sTREM-1 level was measured in the serum and ascitic fluid of 25 ascitic patients with SBP (group 1) who were compared with 20 ascitic patients without SBP (group 2).

Results
STREM-1 in ascitic fluid and in serum, were significantly higher in group 1 than in group 2 (P value <0.001 and P value <0.001), respectively. STREM-1 in ascitic fluid can significantly predict SBP at cut-off greater than 123.8 pg/ml with 80% sensitivity, 70% specificity. STREM-1 in serum can significantly predict SBP at cut-off greater than 121.7 pg/ml with 68% sensitivity, 65% specificity. The combination of sTREM-1 in ascitic fluid and sTREM-1 in serum using receiver operating characteristic (ROC) curve analysis for SBP detection was calculated as (P<0.001 and area under the curve = 0.894) with 80% sensitivity, 75% specificity. The combination of sTREM-1 in ascitic fluid and serum did not differ significantly as regards area under the curve when compared with sTREM-1 in ascitic fluid alone (P=0.110).

Conclusion
sTREM-1 in serum and ascitic fluid may be considered as markers to identify SBP. Combined sTREM-1 in ascitic fluid and serum had no additional benefit.