bluuebunny/crossref_metadata_2025_split huggingface dataset:
A novel technique for extensive submacular hemorrhage using high-dose tissue plasminogen activator
Authors: Chauhan Khushboo , Narayanan Raja 
Published: May 2024

Background:
Submacular hemorrhage (SMH) is a sight-threatening disorder. Choroidal neovascularization secondary to age-related macular degeneration, polypoidal choroidal vasculopathy, trauma, angioid streaks, and pathological myopia are a few important causes. The conventional treatment of massive SMH is vitrectomy with manual removal of the clot with extensive retinectomy with/without tissue plasminogen activator (tPA). The usual dose of subretinal tPA is 10–25 µg.

Purpose:
To describe a new surgical approach in a case of massive SMH with retinal detachment without retinectomy.

Synopsis:
In our case of near total hemorrhagic retinal detachment due to subretinal hemorrhage caused by trauma (road traffic accident), the patient presented with a visual acuity of counting fingers. Core vitrectomy was performed and posterior vitreous detachment was induced. The locations for retinotomy to inject and aspirate subretinal blood were selected at the maximum height of retinal elevation near the arcades. Recombinant tPA (10 µg/0.1 ml concentration; 0.3 ml injected in two locations) was injected subretinally with a 23-G soft tip cannula in the superotemporal and inferonasal quadrant causing subretinal bleb formation. Subsequently, the surgeon waited for approximately 20 min on the table for the liquefaction of the clot. The liquefied blood and tPA were drained with a silicone soft tip. Endolaser was performed at the retinotomy site and 1000cs silicone oil was injected. No signs of toxicity such as vitritis, vasculitis, or retinal necrosis were noted.

Highlights:
Our unique technique of high-dose intraoperative subretinal tPA (60 µg) is safe and helpful in rapid clot lysis and recovery of visual acuity. The patient gained a visual acuity of 20/80 from counting fingers after 1 month of surgery and 20/60 after silicone oil removal. A high dose of tPA aids in the immediate aspiration of blood from a small retinotomy. A 23-G soft tip was used instead of a 41-G subretinal cannula to inject a large quantity of subretinal tPA.

Video link:

https://youtu.be/JzZBDUfa3NA
Factors associated with integration of people recovering from alcohol dependence syndrome with their family: An exploratory study
Authors: Rathee Anjali , Devi Yumnam Surbala , Gupta Sandhya , Mandal Piyali 
Published: May 2024

Background:
Alcohol is the most commonly consumed psycho-active substance in India. People who use substances and are in recovery often face societal discrimination and rejection, such as difficulty in obtaining employment, poor support for treatment, and inter-personal rejection.

Aim:
To find out the factors affecting the integration of people recovering from alcohol dependence syndrome with their families.

Materials and Methods:
A cross-sectional observational study was conducted using a purposive sampling technique among 50 pairs of alcohol-dependent people and their family members. Data were collected using self-administered Family Adaptability and Cohesion Evaluation Scale (FACES IV package), Substance Abuse Self-Stigma Scale, Affiliate Stigma scale, and A Social Support Inventory for Successful Transition. Appropriate statistical tests were used to identify correlations.

Results:
A negative correlation (r = -0.313, P < 0.05) was found between affiliate stigma and integration, and a positive correlation (P < 0.05) was found between social support and integration. Alcohol-dependent people from Alcoholics Anonymous reported higher levels of perceived social support than those from a tertiary hospital (mean = 47.68 vs. 39.84, P < 0.05).

Conclusion:
Affiliate stigma negatively impacts people with alcohol dependence and contributes to increased opportunities for interventions to address stigma. Social support has a positive impact on family integration of alcohol-dependent people with Alcoholics Anonymous participants reporting higher levels of social support compared to tertiary hospital participants. Therefore, the findings of this study highlight the need to involve families more intensively to reduce affiliate stigma.
A comparative analysis of burden of care and coping styles between wives of monosubstance- and polysubstance-dependent men
Authors: Khadanga Poornima , Nadadgalli Gomati , Pawar Gaurav 
Published: May 2024

Background:
Polysubstance dependence has emerged as a clinically distinct entity from monosubstance dependence, yet its impact on patients’ wives is understudied. Wives of substance-dependent men face a tremendous burden in their social lives, leading to faulty coping and burden of care. Comparative studies between monosubstances and polysubstances are lacking.

Aims:
This study compared the burden of care and coping styles between wives of monosubstance- and polysubstance-dependent men.

Materials and Methods:
A comparative analysis was performed between wives of 70 monosubstance-dependent and 70 polysubstance-dependent patients. The burden of care was assessed by the Burden Assessment Schedule (BAS), whereas coping styles were assessed using the Brief Coping Orientation to Problems Experienced (Brief COPE) Inventory.

Results:
Both groups faced a moderate burden of care, which was significantly higher in wives of polysubstance abusers as compared to monosubstance abusers (U = 366.50, P < 0.01). The difference was mainly seen in their impact on well-being and relationships with others. Avoidant coping was significantly higher in wives of polysubstance abusers (U = 341.00, P < 0.01), whereas emotion-focused and problem-solving coping styles were equally represented. Avoidant and problem-solving coping styles positively correlated with the burden of care (P < 0.01).

Conclusion:
The burden of care and avoidant coping strategies are higher in wives of polysubstance-dependent men. An increased burden of care is associated with increased use of both avoidant coping and problem-solving coping.
Lipoid Pneumonia: Siphoning of Gasoline
Authors: Prakash Keerthi A. , Narasimhan Aarthi , Mehrin Riha 
Published: May 2024

Abstract
Lipoid pneumonia is a rare condition that accounts for 1%–2.5% of all pneumonia. There are two types – exogenous and endogenous. In recent days, exogenous lipoid pneumonia has been on an increasing trend due to the exponential use of vaping. Exogenous lipoid pneumonia usually presents with cough, fever, breathlessness, chest pain, and weight loss. Usually, it is a diagnosis of exclusion and the presence of lipid-laden macrophages is required for its diagnosis. Here, we present a case of lipoid pneumonia which showcased the importance of detailed clinical history elicitation, approach, and management of lipoid pneumonia.
Embryogenesis and Histogenesis of the Human Fetal Liver at Various Stages of Gestation
Authors: Bhadoria Pooja , Modi Kavita , Singh Brijendra , Chaturvedi Jaya , Chaturvedi Amarjyoti , Mahindrakar Bhavaniprasad 
Published: May 2024

Background of Study:
To assess the prenatal development of the human liver at gestation ages (GAs) 12–36 weeks using microscopic parameters and their correlation to predict the GA. The observation of microscopic features such as Kupffer cells (KCs), hematopoietic activity, stellate cells, glycogen granules, central vein (CV), and portal triad (PT) carries immense importance for its use in the estimation of fetal GA, detection of anatomical variations, and identification of congenital anomalies concerning branches such as anatomy, surgery, forensic sciences, radiology, pediatrics, and phytopathology.

Materials and Methods:
The present study was conducted in the department of anatomy on 33 normal fetuses of GA 12–36 weeks and classified them into 5 groups as A (12–16 weeks), B (17–21 weeks), C (22–26 weeks), D (27–31 weeks), and E (32–36 weeks). The general parameters were measured. Slides were prepared as per standard protocol and observed under a light microscope.

Results:
Microscopic observation reveals CV and PT in 15 weeks, dominant hematopoiesis till 21 weeks and then declines gradually, KC in 16 weeks, sinusoids in 19 weeks, glycogen granules deposition from 36 weeks, and hepatic lobule and portal lobule appears at 31 weeks.

Conclusion:
The knowledge of morphological features with respect to gestational age is a reliable reference help to prevent misdiagnosis of various pathological conditions of the liver such as cirrhosis, hepatomegaly, fetal anemia, intrauterine growth retardation, and congenital anomalies.
A Morphological Study of Cadaveric Liver
Authors: Sar Mamata , Singh Sabita , Behera Sarita , Bara Dibya Prabha , Baa Jeneeta , Mishra Srikanta Kumar , Soy Arpita 
Published: May 2024

Background:
Liver is anatomically divided into right, left, quadrate, and caudate lobes. Functionally, it is divided into four portal sectors by four branches of portal vein. Three hepatic veins lie between these sectors as intersectoral veins and these intersectoral plains are called portal fissures. Minor fissures like umbilical fissure, venous fissure, and Rouviere’s sulcus are visible clefts on the visceral surface of the liver. Morphological variations in size, shape, lobes, and fissures are frequently found during routine dissection. This study is focused mostly on the surgical anatomy of lobes and fissures relevant for hepatic surgery.

Materials and Methods:
This was a cross-sectional descriptive study conducted on 50 formalin-preserved specimens of liver. The details of morphological features of lobes and fissures were examined and compared with the findings of previous studies.

Results:
Out of 50 liver specimens studied, in 8% of cases left lobe and quadrate lobe and in 12% of cases caudate lobe were hypoplastic. Accessory liver lobes were found in 12% of cases, most of which were small except 2 cases of large tongue shaped projections of accessory lobes attached to the left lobe and 2 on the right lobe. Diaphragmatic sulci were found in 12% of cases and Rouviere’s sulcus in 64% of cases. Accessory fissures were also found in quadrate and caudate lobes in 24% and 22% of cases, respectively. Pons hepatis was found in 20% of cases.

Conclusion:
Awareness about prevalence of morphological variations of liver can help avoiding errors in diagnosis and unwanted complications during surgery.
Evaluation of the Ponticulus Posticus with Cone-beam Computed Tomography in a Turkish Population
Authors: Erdem Suheda , Gündüz Kaan , Kasap Pelin 
Published: May 2024

Introduction:
The aim of this study was to investigate the incidence of ponticulus posticus (PP) in a sample population with cone-beam computed tomography (CBCT).

Materials and Methods:
The images of 1000 patients who were examined CBCT were analyzed retrospectively. The frequency of PP was evaluated. The presence of complete or partial PP in the atlas was examined on reformed sagittal cross-sectional images.

Results:
It was found that PP was detected in 250 patients (25%). When the prevalence of PP among gender was examined, it was found that 129 (24.2%) of 533 females and 121 (25.9%) of 467 males had PP. Complete PP was detected in 142 patients and partial PP was detected in a total of 151 patients.

Discussion and Conclusion:
In conclusion, PP is a common variation of the atlas. The increase in the frequency of complete PP and the decrease in the frequency of partial PP in older age groups suggested that there may be a correlation between age and PP formation.
Laparoscopic Gastrogastrostomy – An Alternative Procedure for Stenosis after Sleeve Gastrectomy
Authors: Mercado Melanie , Alhayo Sam , Talbot Michael 
Published: May 2024

Abstract

Introduction:
Reflux symptoms associated with stenosis after laparoscopic sleeve gastrectomy can occur secondary to anatomical abnormality including mechanical stenosis and axial deviation, commonly occurring mid-sleeve. Treatment options include endoscopic intervention, including dilatation, stenting, myotomy, and surgical revision, with Roux-en-Y gastric bypass (RYGB) being preferred by many. In this case series, we report six patients who have undergone laparoscopic gastrogastrostomy (GG) for gastric stenosis and propose this as a possible surgical alternative for appropriately selected patients with symptomatic angularis stenosis.

Patients and Methods:
Medical records for six patients who underwent laparoscopic GG for treatment of persistent reflux symptoms due to angularis stenosis were reviewed. All patients were preoperatively investigated with endoscopy and abdominal three-dimensional computed tomography. Hiatal hernia and esophageal dilation were excluded. After further consultation, patients proceeded to laparoscopic GG.

Results:
Complete resolution of symptoms was reported in three of six patients, with Visick score 1, while the other three reported significantly improved symptoms. Postoperative body mass index remained similar to prerevision baseline. There were no postoperative complications.

Conclusion:
Revision to RYGB is effective for stenosis and reflux but can be challenging with the potential for long-term nutritional deficiencies and surgical complications. For patients with angularis stenosis, laparoscopic GG is a simpler revisional procedure that has shown adequate initial outcomes with no short or anticipated long-term complications in this case series. Patients with persisting symptoms could undergo subsequent gastric bypass if needed.
Evaluation of surgically treated primary spinal cord tumors in a single Indian institution: A case series study of 178 patients
Authors: Jignesh Joshi K. , Balasubramaniam Srikant , Devendra Tyagi K. , Nakul Rathore R. , Monali Patil M. , Nadkarni Trimurti D 
Published: May 2024

ABSTRACT

Introduction:
Primary spinal cord tumors are rare tumors that are usually heterogeneous having variable histopathological subtypes. Rapidly, growing space-occupying lesions in the spinal canal cause severe loss of function. This study aimed to analyze all adult patients diagnosed with primary spinal cord tumors and to describe their location, symptoms, histopathological types, surgical outcome, complications, recurrence in a single institution, and prognostic factors.

Materials and Methods:
The study was a retrospective study of 178 patients with spinal tumor who underwent surgical intervention at the department of neurosurgery at a tertiary care institute from 2014 to 2021. Patient demographic characteristics, symptoms, radiological features, spinal level of tumor, spinal compartment, preoperative and postoperative McCormick grade, and complications were recorded, and a comparison of outcomes after surgical intervention was done.

Results:
In our study, 97 patients were males and the rest of the 81 patients were females. The mean age at the time of surgery was 43.5 years. The thoracic region of the spinal canal was the most involved with 67 (37.64%) cases, whereas intradural extramedullary was the most common (65.73%). Schwannoma was the most common histopathological subtype (46.06%). Total excision was achieved in 154 cases. A total of 37 patients were in Grades 4 and 5 of modified McCormick’s grade preoperatively. However, postoperatively, there were only 17 patients in this group. Two patients with cervical intramedullary tumor expired in the postoperative period.

Conclusion:
Early surgical intervention with sound microneurosurgical skills gives good outcomes independent of the type and location of tumor. Better outcomes are seen in extradural tumors, early surgical intervention, tumors better amenable to total resection, and in patients with better preoperative neurological status.
The Diagnostic and Predictive Value of Biomarkers for Pulmonary Fibrosis in Patients with Coronavirus Disease 2019
Authors: Lv Jiapei , Liping Chen , Huaying Wang 
Published: May 2024

Abstract

Introduction:
In coronavirus disease 2019 (COVID-19), particularly in older people, dysregulated immune response and aberrant repair can result in varied severity secondary pulmonary fibrosis (PF). By detecting some indicators, the occurrence and prognosis of fibrosis can be measured, providing directions for COVID-19 treatment.

Methods:
The research study lasted for 3 months and involved 88 COVID-19 patients. According to the chest radiological examination, 47 (53.41%) individuals were found to have no PF, while 41 (46.59%) showed PF. Clinical data such as inflammation markers, imaging findings, blood gas analysis, and hospital stay length were collected.

Results:
With area under the curve values of 0.7413, 0.7741, and 0.7048, respectively, and the study of the receiver operating characteristic curve demonstrated that mucin 1 (MUC1), carcinoembryonic antigen (CEA), and CXC chemokine receptor 10 (CXCL10) could diagnose the presence of COVID-19 PF. To evaluate the possibility of PF following severe acute respiratory syndrome coronavirus-2 infection, we established particular values for MUC1, CEA, and CXCL10 (1.296 ng/ml, 4.315 ng/ml, and 32.77 ng/ml, respectively). The survival curve for hospital days indicated that the length of hospital stays positively correlated with these three factors (P < 0.01). Transforming growth factor-beta did not correlate significantly with the severity of COVID-19 or PF.

Conclusion:
The results of this study suggested that the MUC1, CEA, and CXCL10 can be employed to explore the severity of secondary PF in COVID-19.
Pediatric Malignant Sacrococcygeal Germ Cell Tumor with Intraspinal Extension
Authors: Maddileti Varunkumar , Gazula Suhasini 
Published: May 2024

Aims:
The study aimed to evaluate the presentation, management, and outcome of patients of sacrococcygeal malignant germ cell tumors (SC-MGCTs) with intraspinal extension.

Materials and Methods:
Case records of all cases of SC-MGCT were reviewed to identify cases with intraspinal extension. They were evaluated in terms of their presentation, response to therapy, extent of surgical resection, recovery of neurological symptoms if any, and outcome.

Results:
Of the three cases of SC-MGT, two had intraspinal extension. One had Altman Type 3 disease and another had Altman Type 4 disease; both had Stage 4 disease. The intraspinal extension in both patients was detected on contrast computed tomography scan and magnetic resonance imaging. One patient had bladder and bowel incontinence. All the tumors responded to preoperative chemotherapy. Gross complete local resection could be achieved in all patients. Neurological recovery was complete. All were alive with no recurrence on follow-up.

Conclusions:
Malignant sacrococcygeal GCTs with intraspinal extension are rare and can be managed with neoadjuvant chemotherapy which obviates the need for extensive exploration for excision and has got good neurological and oncological prognosis.
Appendectomy in Management of Malrotation of Gut is it Necessary?
Authors: Sthapak Eti , Kanneganti Pujna , Upadhyaya Vijai Datta , Kumar Basant , Agarwal Nishant , Mishra Ashwini 
Published: May 2024

Introduction:
Malrotation is a congenital anatomical anomaly that affects the normal positioning of the intestines. Traditional management of malrotation, as described by Ladd, consists of detorsion of the volvulus if present, division of Ladd's bands, widening of the mesenteric root, proper positioning of the small and large bowels, and a prophylactic appendectomy. This study was done to determine whether appendectomy should be an integral part of the Ladds procedure or if it can be avoided.

Materials and Methods:
This retrospective observational study was conducted in one pediatric surgical unit in the tertiary care center of North India. All the cases of malrotation of the gut managed from January 2008 to December 2018 were reviewed. The details of the patients were recovered from the electronic data recording system of the hospital and manual operation theater records. The cases that have a follow-up of <5 years were not included in the study. The details were charted in an Excel Sheet for the analysis. No statistical test was performed because there was no event in patients in whom prophylactic appendectomy was not done.

Results:
The data analysis revealed that a total of 66 malrotation patients were managed during this period, those who fulfilled the inclusion criteria. Among 66 cases included in the study, in 41 cases, prophylactic appendectomy was done, whereas in the rest 25, prophylactic appendectomy was not done. During the follow-up, none of the patients in whom the appendix was preserved presented with signs or symptoms related to appendicitis or any other complications.

Conclusion:
Ladds procedure without appendectomy can be performed in view of the potential use of the appendix in the future, and with the fact that in the current era of advanced medicine, appendicitis can be diagnosed early due to the advancement of imaging and better record keeping.
Allaying Pediatric Preoperative Anxiety, Where are we now? – A Nationwide Survey
Authors: Shah Shreya Bharat , Sinha Renu , Hussain Sana Yasmin , Kumar Amit , Gupta Anju 
Published: May 2024

Background:
Preoperative anxiety (PA) in children is a common phenomenon associated with various negative patient outcomes. Allaying PA is accepted as a standard of care, but its use is not universal and often overlooked. This survey is designed to evaluate the nationwide current practice patterns and attitudes of anesthesiologists toward the practice of allaying PA in children.

Materials and Methods:
A questionnaire of 25 questions, including information on methods of relieving PA in children, reasons for noncompliance, and associated complications, was framed. It was circulated among members of the Indian Society of Anaesthesiologists through an online survey of Google Forms and manually.

Results:
Four hundred and fifty anesthesiologists were surveyed. Responses were predominantly from anesthesiologists practicing in medical colleges across the country. Although 97% of the surveyed respondents practiced anxiety-relieving strategies, only 37% used it consistently. Seventy-three percent of anesthesiologists practiced both pharmacological and nonpharmacological techniques. The most common reason for avoiding premedication was an anticipated difficult airway (88%). Inadequate sedation was a commonly reported problem. Ninety-five percent of participants felt that PA-relieving strategies should be integral to pediatric anesthesia practice. The most common reason for not following these practices was an inadequate hospital infrastructure (67%). Ninety-seven percent of the participants believed that more awareness is required on this crucial perioperative issue.

Conclusion:
Only 37% of the surveyed anesthesiologists consistently used some form of PA-relieving strategy and the practice varied widely. Further improvement and team approach involving anesthesiologists, surgeons, and nurses is required to ensure the quality of pediatric PA-relieving services and establish it as a standard of care.