bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessment of Immunomorphological Patterns in Metastatic and Non-Metastatic Lymph Nodes of Oral Squamous Cell Carcinoma Patients
Authors: Jadeja Nileshwariba , Parikh Neelampari , Nandini C 
Published: May 2024

Introduction:
Metastasis in oral epidermoid carcinoma oral squamous cell carcinoma (OSCC) can occur differently. Lymph nodes and lymphatics which drain the tumour site, serve as the most common pathway for metastasis. Lymph nodes serve as a marker of the immune status of the patient, which in response to a metastatic event, may facilitate or resist the homing of tumour cells. This host immune response is identified by examining various immunoreactive patterns in the lymph node.

Materials and Methods:
A total of 100 cases of OSCC underwent radical neck dissection and were assessed for grading of tumour histology, immunomorphological patterns (IMPs) in metastatic and non-metastatic lymph nodes as well as the pattern of tumour involvement in positive lymph nodes. All the lymph nodes were histologically evaluated and were grouped as metastatic and non-metastatic lymph nodes, showing four different patterns lymphocyte predominance (LP) pattern, germinal centre predominance (GCP) pattern, sinus histiocytosis (SH) pattern and lymphocyte depleted pattern. Metastatic positive nodes were further evaluated for the pattern of tumour cell invasion within the lymph node.

Results:
A total number of 1167 lymph nodes were histologically evaluated. Out of all, 239 lymph nodes were positive for metastasis and 928 were non-metastatic nodes. The most frequently encountered lymph node pattern was of LP (854 nodes), followed by GCP (157 nodes), SH (120 nodes) and lymphocyte depleted (36 nodes), respectively. Out of 1167, 239 nodes were positive for metastasis, indicating that as the stage advances, the GCP type predominates (the predominant IMP shifts from LP to GCP), so that facilitating or favouring metastasis. Moreover, the most common pattern seen in metastatic deposits observed was islands/sheets followed by strands/cords.

Conclusion:
IMPs of regional lymph nodes of OSCCs seem to be an essential factor in serving as a prognostic indicator. Whereas the cell-mediated immune response represented by LP and SH resist the metastasis process, the humoral reflected by GCP favours metastasis.
Distribution of Alveolar Bone Defects Associated with Periodontitis
Authors: Sachdeva Shivani V. , Mani Amit , Phadnaik Mangesh B. , Saluja Harish 
Published: May 2024

Introduction:
Periodontal disease is one of the most widespread diseases of humankind. It is a chronic destructive infectious disease that involves the resorption of bone supporting the teeth. The purpose of this study was to analyse the prevalence and distribution of different forms of bone defects amongst different demographics in the Indian population.

Materials and Methods:
The study population comprised 44 patients of different age groups with moderate and severe periodontitis chronic periodontitis. A total sample of 1041 teeth were explored surgically and classified into suprabony, infrabony, inter-radicular and other bone defects. This study focuses on the differences in the distribution of various bone defects between different groups of age and gender.

Results:
Amongst 1041 teeth, the prevalence of bone defects was 97%. Craters and intrabony defects were almost equal for the age groups of 31–40 years and 41–50 years. However, in the age group of 51–60 years, craters comprised 33.3%, and intrabony defects comprised 66.7%. Males had two times more 3-wall defects than females.

Conclusion:
The present study reveals that there is a need for applying epidemiological principles to periodontal bone defects in order to better understand the natural history of periodontal disease and eradicate the factors responsible for their commencement and progression. The following research article has been presented at the 2nd international congress of the World Academy of Growth Factors and Stem Cells in Dentistry 25–27 October 2018.
Audit of Quality Indicators of Cytology
Authors: Sinha Snigdha , Das Subhashish , Kalyani R 
Published: May 2024

Introduction:
At present, clinical laboratories play a vital role in diagnosing and providing quality treatment. Various quality control (QC) and quality assurance (QA), including the pre-analytical and post-analytical variables, were taken into consideration for the internal quality indicators in the department of cytopathology of our institution. The aim of this study is to evaluate the importance of QC and QA parameters in the routine work of the cytopathology laboratory.

Materials and Methods:
This is a prospective cross-sectional study of 24 months duration. A total of 15,520 were evaluated for quality parameters.

Results:
A total of 15,520 cytology cases were evaluated. The cyto-histo correlation, non-conformities, TAT, Repeats and redo's, critical value, quality of staining and revised report rate were noted and identified with relevant statistical analysis.

Conclusion:
Routine QC and QA will ensure better diagnostic services and promote accreditation of laboratory activities.
Cardiovascular involvement in patients with COVID-19 pneumonia
Authors: ROY RAMMOHAN , MAJI BAISAKHI , RAY YOGIRAJ , SINHA ARIJIT 
Published: May 2024

Background:
Covid 19 pneumonia presents with various cardiovascular manifestations. The proposed mechanisms of cardiovascular involvement in COVID-19 are direct invasion of myocardial cell by the virus, hyper- inflammatory state secondary to cytokine storm, increased angiotensin II, low ACE2 levels, antiphospholipid antibodies and increased platelet reactivity which contribute significantly to thrombus formation in systemic and pulmonary vasculature.

Objectives:
To find out various cardiovascular manifestation of patients admitted with covid 19 pneumonia.

Methodology:
A retrospective observational study had been conducted in a tertiary care infectious disease hospital from July 2020 to December 2020 that included a total of 108 patients.

Results:
Most common risk factor were combination of hypertension and diabetes(40.7%) followed by hypertension alone (28.7%)and diabetes in 18.5% patients. Most common presentation was asymptomatic myocarditis found in 37 patients followed by sinus tachycardia in 34, sinus bradycardia in 18, Orthostatic hypotensionin in 16, Atrial fibrillation in 14, cerebrovascular accident in 9, Acute limb ischemia in 7, and acute coronary syndrome in 4 patients. Asymptomatic diastolic dysfunction (Grade 2 or more) found in 17 patients without any overt features of heart failure (all have raised NTproBNP and HSTrop I along with clinical features). A positive correlation was found between D- dimer level and severity of pneumonia by CT severity score.

Conclusion:
A high index of suspicion and necessary investigation may be needed for early detection of myocarditis and to prevent any complication particularly fatal arrhythmia and sudden cardiac death.
Recent trends, clinical characteristics, and outcome of infective endocarditis among intravenous drug users of a tertiary hospital in the east region of Malaysia
Authors: MOHD SAID MOHD RIDZUAN , FIRDAUS MOHD AL-BAQLISH MOHD , JALIL MUHAMMAD ATEEQ MD , IBRAHIM ISMAIL , WAN RAMLI WAN NURLIYANA , ZAKARIA NURUL AULIA 
Published: May 2024

Background:
Infective endocarditis (IE) is an infection affecting the endocardial lining and contributed to socioeconomic burden due to prolonged admission, invasive procedure, and expensive treatment. The high prevalence of intravenous drug user intravenous drug user (IVDU) shifts the paradigm of the disease, and thus, we aim to determine the clinical characteristics, outcome, and inhospital mortality of IE among IVDU patients.

Materials and Methodology:
This is a retrospective cohort by analyzing case records for IVDU patients admitted to Hospital Tengku Ampuan Afzan diagnosed with IE from January 2014 until June 2017.

Results:
A total of 32 patients were included, with a median age of 35 years old (standard deviation: 6.5). Only 56.3% presented with fever, whereas most of them complained of nonspecific symptoms such as reduced exercise tolerance (59.4%) and weight loss (56.3%). Seventy-five percent had concomitant hepatitis C, but only 6.3% of them were HIV positive. Valvular heart disease accounted for 46.9%, while chronic rheumatic heart diseases and previous IE infection accounted for 28.1% and 18.8%, respectively. For microbiological characteristics, Staphylococcus aureus accounted for 62.5%, followed by streptococci (15.4%) and others (2%). The most common valve affected in IVDU was tricuspid valve (62.5%), followed by mitral valve (21.9%) and pulmonary valve (9.4%). Furthermore, mortality was reported at 25%, while severe valvular complications (62.5%) were observed with elevated episodes of emboli (62.5%) and cardiogenic shock (40.6%).

Conclusion:
Hence, IVDU is an essential predictive factor and is associated with various severe complications and thus warranted for aggressive preventive measurement to reduce the morbidity.
Coronary endarterectomy – A way to complete revascularization
Authors: Patel Herin , Gohil Ishan , Kothari Jignesh , Shah Pratik 
Published: May 2024

Background and Aim of the Study:
Coronary endarterectomy (CE) is performed adjacent to coronary artery bypass grafting (CABG) grafting to aid complete revascularization. However, the purpose of CE in surgical management of diffuse coronary artery disease (CAD) is controversial. The objective of this study was to highlight the operative outcomes, safety, and complications associated with CE.

Methods:
An observational, prospective research was carried out in the Department of Cardiovascular and Thoracic Surgery at our institute. All patients undergoing isolated CABG + CE from 2019 till 2021 were evaluated. Patients undergoing urgent, emergency, or elective CABG + CE off-pump/on-pump surgery were enrolled.

Results:
One hundred patients with CABG + CE were evaluated based on symptomatology with sequential electrocardiogram monitoring and blood samples for cardiac biomarkers. The blood samples were taken 6, 12, 24, 48, and 72 h following surgery. Eighty-five patients required single CE and 15 patients required double CE. We noticed a rising trend of cardiac markers in the first 6 h, reaching its peak level at 24 h, and downward trend following 72 h following surgery. Although patients had a tremendous rise in the cardiac biomarker values, clinically patients were stable with operative mortality of 5%.

Conclusions:
We believe CE helps in complete revascularization in patients with diffuse CAD. CE should be given due consideration in an era where it has been neglected due to its complexities and accompanying myths. CE is an important and integral weapon in a surgeon's armamentarium, and we should not hesitate to perform CE due to associated myths.
Association of Structure and Function of left atrial Appendage with Left atrial appendage Thrombus formation in patients with Rheumatic Heart Disease
Authors: NATARAJAN KARTHIK , MANSURI ZEESHAN , JOSHI DINESH , SHUKLA ANAND , SHARMA VISHAL , PANDEY VIMLESH , BHATIA SANJEEV , PATEL KRUTIKA 
Published: May 2024

Context:
In patients with rheumatic heart disease (RHD), left atrial appendage (LAA) dilation and thrombus formation is widely known. LAA thrombus formation is a risk factor for stroke even in patients with sinus rhythm. The aim of this study was to determine an association between LAA structure and function with respect to thrombus formation and differences in LAA size and velocity between patients with sinus rhythm and those with atrial fibrillation (AF).

Materials and Methods:
We prospectively studied LAA structure and function in 120 patients with RHD by transthoracic echocardiography and/or transesophageal echocardiography by measuring left atrial (LA) dimension, LA area, LAAmax/min, LAA ejection fraction (EF), and LAA emptying velocity.

Results:
Four out of 48 patients with sinus rhythm had LAA thrombus. In 72 patients with AF, 32 had LAA thrombus. Patients with LAA thrombus had lower mean LAA EF and emptying velocity both variables P-value is same (P<0.0001 and P<0.0001) Patients with LAA thrombus had increased mean LAA max and LAA min as compared to LAA max and LAA min in patients without LAA thrombus (P 0.008 for mean LAA max and P<0.0001 for LAA min respectively). Patients with AF with LAA thrombus had greater LAAmax compared to that in patients with AF without LAA thrombus (P < 0.0001). Doppler demonstrated a recognizable sawtooth LAA outflow velocity pattern in 32 of 36 (88.9%) patients with LAA thrombus versus 32 of 84 (38.1%) patients without LAA thrombus.

Conclusions:
We conclude that LAA contractility is reduced in RHD with LAA thrombus, and loss of both contractility and LAA dilation is associated with increased risk of thrombus formation and hence the risk of stroke.
The impact of administering intraoperative dexamethasone versus placebo on major complications and mortality in patients undergoing cardiac surgery
Authors: Madkaiker Ashish , Mehta Tania , Manek Pratik , Doshi Chirag , Shah Pratik , Patel Sanjay 
Published: May 2024

Background:
Inflammations resulting from cardiac surgical procedures have traditionally been controlled with corticosteroids such as dexamethasone. However, the use of these medications to attenuate the inflammatory responses from cardiac surgery remains contentious. The aim of this systematic review and meta-analysis was to evaluate the effect of administering dexamethasone intraoperatively on major complications and mortality compared to placebo interventions.

Study Design:
This was a systematic review and meta-analysis.

Methods:
The research was conducted on online databases such as PubMed, Google Scholar, EMBASE, and the Cochrane Central Register of Control Trials until August 5, 2022. The studies in the online databases were written between January 1, 2000, and August 1, 2022. The studies that were selected were scanned and analyzed based on an established eligibility criteria for the study.

Results:
Ten randomized and controlled trials were included in this systematic review and meta-analysis. The incidence of mortality was 2.2% (154 out of 7007 patients) in the dexamethasone group and 2.3% (164 out of 7038 patients) in the placebo group (odds ratio [OR],0.94; 95% confidence interval [CI], 0.75–1.01; P = 0.73; I
2 = 0%). Myocardial infarction incidence was 1.88% (88 out of 4685 patients) in the dexamethasone group and 2.12% (100 out of 4708 patients) in the placebo group (OR, 0.88; 95% CI, 0.66–1.18; P = 0.39; I
2 = 9%). The incidence of stroke for the dexamethasone group was 1.56% (70 out of 4488 patients) and 1.82% (82 out of 4511 patients) in the placebo group (OR, 0.86; 95%CI, 0.62–1.18; P = 0.34; I
2 = 0%). The prevalence of new onset atrial fibrillation was 32.3% (797 out of 2469 patients) for dexamethasone and 34.7% (859 out of 2478 patients) for placebo (OR, 0.90; 95%CI, 0.80–1.01; P = 0.08; I
2 = 0%). The incidence of renal failure was slightly higher in the placebo group with 1.58% (108 out of 6857 patients) compared to the dexamethasone group 0.97% (66 out of 6823 patients) (OR, 0.61; 95% CI, 0.45–0.83; P = 0.002; I
2 = 0%).

Conclusion:
According to this review, dexamethasone does not result in a significant decrease in incidences of mortality, myocardial infarction and stroke. However, the medication was associated with decreased incidences of renal failure and atrial fibrillation in a majority of the studies.
Acute and short-term outcomes of balloon aortic valvuloplasty in patients with significant aortic stenosis
Authors: PRAJAPATI JAYESH , SINGH PARMINDER , VYAS POOJA , PATEL IVA 
Published: May 2024

Background:
The optimal treatment for congenital aortic stenosis (AS) remains in debate over the past three decades of practice with both balloon aortic valvuloplasty (BAV) and surgical aortic valvotomy. BAV has been the palliative therapy with AS in most centers. The present study aimed to provide role and short-term outcomes of BAV in AS patients.

Methods:
We enrolled 58 patients aged ≤20 years of AS from July 2017 to November 2019. All patients were evaluated by echocardiography at 1, 3, and 6 months.

Results:
From the total of 58 patients, there were 38 male and 20 female patients. BAV could be successfully completed in 56 patients (96.5%). Pre-BAV mean left ventricle systolic pressure (LVSP) was 187.85 ± 53.75 mmHg and transaortic gradient (TAG) was 90.67 ± 42.77 mmHg. LVSP and TAG were reduced significantly (P = 0.0001) post procedure (133.85 ± 41.33 mmHg and 28.11 ± 23.22 mmHg, respectively). Echocardiographic parameters such as V max, aortic valve (AV) G max, and AV G mean were significantly decreased post procedure and AVA was increased significantly post procedure. Ten (17.86%) patients had developed significant (more than or equal to moderate) aortic regurgitation post procedure (17.24%). About 66% of our patients had no complication post procedure. At 1, 3, and 6-month follow–up, AV G max and G mean and V max increased but were not statistically significant.

Conclusion:
BAV via transarterial route in pediatric population with significant AS is safe, effective palliation with good immediate and midterm follow-up results with minimum complications. We did not face any major complications except for development of variable degrees of aortic regurgitation and access site complications.
Periprocedural and short-term outcomes of stenting of coarctation of the aorta in adults
Authors: Vijay Sudarshan Kumar , Jha Ashish , Tiwari Bhuwan Chandra , Singh Amresh Kumar , Jamwal Naveen 
Published: May 2024

Background:
Coarctation of the aorta (CoA) is a rare congenital heart disease for which ballooning or surgery is recommended in the early stages of life, however, in adult patients, stenting has emerged as the treatment of choice. Data on various techniques and outcomes of stenting in CoA in Indian patients are scarcely available.

Materials and Methods:
Seven adult patients of CoA treated at our center with stenting between the years 2018 and 2022 were retrospectively studied. All patients were analyzed for their clinical presentation, coarctation segment anatomy, use of various techniques for stent deployment, perioprocedural outcomes, and 3-month echocardiography (ECHO)-based follow-up with the study of gradients and clinical features. The use of various hardware to facilitate stenting was studied, and predictors of successful stenting were also defined in the analysis.

Results:
The mean age of the coarctation patients was 19.1 ± 3.7 years with a male-to-female ratio of 3:4. The mean systolic blood pressure at baseline was 162.5 ± 12.6 mm of Hg and mean diastolic blood pressure of 95.7 ± 5.3 mm of Hg. The mean peak systolic gradient across the coarctation segment at baseline was 46 ± 8.2 mm of Hg. Combined antegrade and retrograde access was used for stenting of CoA in four patients (57%). Good-sized isthmus was present in only three patients (42%), and balloon predilatation was required in three patients (42%). The use of combined antegrade and retrograde route, good-sized isthmus, and adequate balloon predilatation were predictors of successful wire crossing and stent deployment across the coarctation segment. The mean ECHO-based follow-up gradient at 3 months was 9.2 ± 2.5 mm of Hg.

Conclusions:
Stenting for native CoA with the use of Cheatham-platinum stents in adult patients is a highly effective and safe therapy. Longer-term follow-up studies are required to show the exact incidence of stent fracture and aneurysm formation after stenting.
Clinical outcomes with the use of ticagrelor or clopidogrel after fibrinolytic therapy in patients with ST-elevation myocardial infarction – A prospective observational study
Authors: Agarwal Bibek , Vijay Sudarshan Kumar , Singh Amresh Kumar , Jha Ashish , Tiwari Bhuwan Chandra , Jamwal Naveen 
Published: May 2024

Background:
Thrombolytic therapy in the appropriate window period remains the most commonly used therapy in ST-elevation myocardial infarction patients, despite the advantage of primary percutaneous coronary intervention (PCI) over it. Use of newer more potent antiplatelets agents early after thrombolysis carries the chance of increasing bleeding complications, thus we planned to have a study to assess the safety and efficacy of ticagrelor as compared to clopidogrel in thrombolysed patients.

Materials and Methods:
This was a prospective observational study in Indian patients. A total of 142 patients were enrolled in the study with 76 in the ticagrelor group and 66 in the clopidogrel group. All patients received thrombolysis as the primary reperfusion strategy. Patients receiving either clopidogrel or ticagrelor after thrombolysis irrespective of the subsequent PCI status were followed up for any bleeding events (primary endpoints) as per thrombolysis in myocardial infarction (TIMI) definition and Bleeding Academic Research Consortium (BARC) definition. Major adverse cardiac events (MACE) including death from cardiovascular causes, myocardial infarction (MI), and stroke were also assessed as markers of efficacy and secondary endpoints.

Results:
Mean time from thrombolysis to study drug use was 18.9 ± 2.1 h in the ticagrelor group as compared to 14.8 ± 3.3 h in the clopidogrel group (P > 0.05). For major bleeding events (TIMI major), no statistically significant difference was observed between groups (2.6% in ticagrelor vs. 1.5% in clopidogrel) (P = 0.6). BARC 3–5 bleeding at 1-month follow-up was significantly higher in the ticagrelor group compared to the clopidogrel group (P = 0.04). At 1-month follow-up, BARC 1–2 or 3–5 bleeding events in the subjects who underwent PCI were higher in the ticagrelor group than the clopidogrel group (P = 0.03). Patients in the clopidogrel group have more major adverse cardiac events than the ticagrelor group especially driven by more fatal and nonfatal MI in the clopidogrel group (P = 0.04).

Conclusions:
Ticagrelor can be safely administered in postthrombolytic patients similar to clopidogrel albeit at the cost of slightly increased minor bleeding events in short-term follow-up.
A study on hospitalized patients of junctional rhythm with reference to the prevalence of different underlying etiologies
Authors: SINHA PULAKESH , MOULICK AVIJIT , MAJHI BHUBAN 
Published: May 2024

Introduction:
Junctional rhythm (JR) is a rescue rhythm where the upstream impulse generators fail to pace the heart and atrioventricular (AV) junction takes up that function. The presentation is variable ranging from totally asymptomatic cases, where it is a manifestation of heightened vagal tone, to life-threatening bradycardia, resulting from some serious underlying pathologies. JR results from diverse causes such as sick sinus syndrome, acute myocardial infarction (AMI), dyselectrolytemia, drugs, and toxins. Understanding the etiologic factor has immense implication in the management as the prognosis is related mainly to the primary pathology rather than JR itself.

Subjects and Methods:
In this observational study, we evaluated 100 hospitalized patients of JR over a period of 1 year regarding their symptoms, signs, and underlying pathology.

Results:
Among 100 patients, 38 had a history of syncope and 42 had angina. Twenty-four patients had hyperkalemia (22 of them had renal dysfunction). Thirty patients had elevated troponin-T and/or CK-MB. The most common etiology was AMI responsible in 28% patients followed by hyperkalemia (24%), sick sinus syndrome (20%), and medication drug use (16%) as the principal causes of JR. Myocarditis, toxin, and hypothyroidism were uncommon association. Accelerated JR and junctional tachycardia were associated with AV nodal ablation and postsurgical patients, respectively.

Conclusion:
JR is a manifestation of several diverse etiopathologies, and elucidation of them is extremely important for the patient management. We estimated the prevalence of various underlying etiologies which should be considered during the management of such patients.