bluuebunny/crossref_metadata_2025_split huggingface dataset:
Invasive assessment of fluid therapy in hypotensive patients of postinferior wall myocardial infarction complicated by right ventricular infarction
Authors: VANKAR SAMEER GANPAT , SHARMA AKHIL KUMAR , DWIVEDI SUDDHANSHU KUMAR , CHAUDHARY GAURAV KUMAR , CHANDRA SHARAD , PRADHAN AKSHYAYA , VISHWAKARMA PRAVESH , BHANDARI MONIKA , SETHI RISHI 
Published: May 2024

Background:
Management of such patients with inferior wall myocardial infarction (IWMI) complicated by right ventricular myocardial infarction (RVMI) requires volume replacement along with the standard therapy. However, the optimum amount of fluid needed to maintain systolic blood pressure (SBP) ≥90 mmHg in such patients has not been reported yet. This study evaluates the role of graded fluid infusion in improving the hemodynamic parameters in patients of IWMI with RVMI in hypotension or shock and also optimizes the amount of fluid needed to maintain SBP ≥ 90 mmHg.

Materials and Methods:
In this single-center, prospective observational study, patients with first episode of acute coronary syndrome diagnosed as IWMI complicated by RVMI and SBP <90 mmHg were included. The hemodynamic parameters such as heart rate, SBP, cardiac output, cardiac index, and pulmonary capillary wedge pressure (PCWP) were measured at the baseline and after each 500 ml normal saline over 15 min until SBP ≥ 90 mmHg was attained. The primary objective was to study the change in cardiac output, cardiac index, and PCWP with response to fluid. The amount of fluid needed for ≥ 10 rise in cardiac output and to maintain SBP ≥ 90 mmHg was also evaluated. The secondary objectives were to study the need for inotropic support, complications such as inhospital mortality, acute pulmonary edema, and local site bleeding. Further, the predictors of early responders (<2 L of fluid) were also evaluated.

Results:
Among all 16 patients, 3 (18.7%) were excluded and the rest received graded fluid therapy. Invasively monitored and graded fluid therapy resulted a significant rise in cardiac output (2.1 ± 0.7 L/min vs. 3.7 ± 0.7 L/min), cardiac index (1.3 ± 0.3 L/min/m2
vs. 2.4 ± 0.76 L/min/m2), and PCWP (8.4 ± 3.0 mmHg vs. 17.6 ± 1.5 mmHg) in comparison to baseline parameters. On an average, 865 ± 462 mL fluid infusion was required for 10% improvement in CO from baseline. However, 2192 ± 560 mL fluid was needed for consistent maintenance of SBP ≥ 90 mmHg. The effect of fluid therapy was not significantly correlated with baseline clinical and hemodynamic parameters. There were no procedure- and therapy-related complications reported during the study.

Conclusions:
Early response to fluid therapy within 2 L of normal saline occurred independently of baseline hemodynamic parameters. However, more studies with larger number of patients would be needed to confirm the same.
A simple randomized prospective study comparing catheter-directed thrombolysis versus systemic thrombolysis in patients with massive and submassive pulmonary embolism
Authors: TATED SUYASH , JOSHI DINESH , SHUKLA ANAND , RAVAL PRATIK , NATRAJAN KARTHIK , KANABAR KEWAL , KUMAR SURENDER , PATEL JIGNESHKUMAR 
Published: May 2024

Context:
Catheter-directed thrombolysis (CDT) is a novel mode of thrombolysis where thrombolytic agents are directed through catheter to a specific area of interest; hence, low-dose thrombolytic agent will be required to produce satisfactory thrombolysis results. This will subsequently decrease the bleeding complications. With this postulation, a study was conducted to compare the outcome of CDT versus systemic thrombolysis (ST) in patients with massive and submassive pulmonary embolism (PE).

Methods:
The present study prospectively included the cases of massive and submassive (high-risk) PE and randomly distributed 25 patients into two groups each: Group A underwent CDT, whereas Group B underwent ST. The outcomes of both the groups were studied including mortality and bleeding complications, and patients were followed up for 6 months. At the end of the study, data were analyzed, and outcomes of both the groups were compared.

Results:
Baseline characteristics were similar in both the groups. The success rate was 90.4% in Group A (CDT) and 75% in Group B (ST) among patients with massive PE (P = 0.95). The mortality rate was numerically higher in the ST group (12%) than in the CDT group (8%). Bleeding complications were higher in the ST group (20%) than in the CDT group (8%).

Conclusion:
CDT was found to be noninferior to ST with respect to primary outcomes of mortality and success rate of thrombolysis. CDT had lower occurrence of bleeding episodes. CDT can be considered viable alternative to ST in patients with high bleeding risk.
Management of Uttana vatarakta (limited cutaneous systemic sclerosis): An experience through Ayurveda management strategies
Authors: Sutaria Ekta , Rajput Devendrasingh , Anagha M.S , Pandya Darshna 
Published: May 2024

Abstract
Scleroderma (systemic sclerosis) is a group of rare diseases that involve the hardening and tightening of the skin and connective tissues. Diffuse cutaneous scleroderma and Limited Cutaneous Systemic Sclerosis (LcSSC) are the two major classifications of it. LcSSc usually affects the skin and further spreads to muscles and joints, but in about 10% cases, involvement of internal organs like gastrointestinal tract and manifestations like pulmonary hypertension is seen even after 10–15 years. The prevalence of the disease is 17.6/100,000 population. As far as the management of LcSSC in conventional medicine is concerned, other than symptomatic relief; immunosuppressive drugs are given, but long-term use of such medicines suppresses the immunity of the patient and hence the patient may get affected with opportunistic infections and causes severe complications. Hence, some alternatives in this direction are being explored from other systems of medicines for the betterment of patients. The direct description of the disease scleroderma is not available in Ayurvedic literature, but based on its presentation, it can be correlated with different stages of Vatarakta (~rheumatism due to blood tissue). A 20-year-old young male patient with presentation of limited scleroderma managed with Ayurveda therapy by Virechana (~therapeutic purgation) followed by Shamana (~palliative) therapy for one and half months and obtained encouraging results, inferring that Ayurveda therapeutic protocols can be successfully adopted in cases like LcSSC.
Correlates of iron deficiency among adult patients with sickle cell nephropathy at a tertiary health facility in Lagos, Nigeria: A cross-sectional study
Authors: Orolu Muyideen Olayemi , Mabayoje Monica Omolara , Braimoh Rotimi Williams , Bello Babawale Taslim , Amira Christina Oluwatoyin , Kushimo Oyewole Adebiyi , Anyanwu Roosevelt Amaobichukwu , Orolu Adebukola Khairat , Awofeso Opeyemi Mercy 
Published: May 2024

Background:
Iron deficiency presents a muddled clinical picture in patients with sickle cell anemia (SCA). The picture is further complicated when these patients develop sickle cell nephropathy (SCN). This study aimed to identify the correlates of iron deficiency among adult patients with SCN in Lagos, Nigeria.

Methods:
This was a cross-sectional study conducted among adult patients with SCN who presented at the nephrology clinic of the tertiary health facility. Data on demographics, clinical history, laboratory investigations, and iron status were collected and analyzed using the Statistical Package for the Social Sciences (SPSS) version 28.

Results:
One hundred and nineteen adult patients with SCN were enrolled in the study. The mean age was 28.9 ± 9.5 years, and the majority were females. Iron deficiency was present in 36 (30.2%) subjects, while 7.6% had elevated iron status. Younger age and male sex were associated with iron deficiency state. Participants with an estimated glomerular filtration rate (eGFR) of ≥60 mL/min had a higher prevalence of iron deficiency (r = −0.28 P < 0.01/r = −0.32 P < 0.01). A logistic regression analysis showed no independent association between these factors and iron deficiency.

Conclusion:
This study showed that iron deficiency is common in adults with SCN, seen in one-third of participants. Therefore, although iron overload is frequently acknowledged as a significant issue in SCA, it should not be automatically assumed in cases where nephropathy is present. The study findings also highlight the need for routine screening for iron deficiency among SCN patients, especially among males, younger patients or those with an eGFR ≥60 mL/min, to optimize their management and improve their outcomes.
Assessment of knowledge and attitude toward influenza vaccinations within the adult population of Riyadh, Saudi Arabia
Authors: ElFeky Dalia S. , Ramadan Yomna K. , AlQurashi Rawabi S. , Alsarhan Alhanouf A. , Alkhodaidi Malak , Albalawi Malak 
Published: May 2024

Abstract

BACKGROUND:
The most cost-effective measure for preventing the infectious disease, influenza, is vaccination. The purpose of this research was to evaluate knowledge levels, familiarity, and attitude toward influenza and influenza vaccination of the Riyadh adult population.

MATERIALS AND METHODS:
A cross-sectional study was carried out in Riyadh and data was collected between December 2017 and March 2018. Five hundred participants were interviewed in person using a closed-ended questionnaire. Participants comprised the general population, students, and healthcare workers (HCWs), and were recruited from shopping malls, parks, Princess Nourah Bint Abdulrahman University, and King Abdullah Bin Abdulaziz University Hospital. A pilot study was conducted among 15 participants from the general population, students, and HCWs who gave verbal consent. Participants were asked if they comprehended the questionnaire and whether they felt comfortable participating. Descriptive statistics were used to describe the sample. Statistical significance was determined using t-test for quantitative variables and Chi-square test for qualitative variables.

RESULTS:
Most participants in all groups had poor knowledge. The least informed was the general population (8.8%), followed by the students (11.8%), and the most aware were the HCWs (18.5%). The social media (35%) was the main source of participants’ knowledge, followed by doctors and health educators in hospitals (33%). Only 15.6% of participants had been vaccinated this year. Even fewer (8.8%) stated that they took the vaccination every year. The most important reasons for getting vaccinated were the recommendations by the Ministry of Health or by their doctors (77.8% for each). The key barrier to vaccination was a lack of perceived benefit (the participants did not usually get influenza so they felt vaccination was unnecessary [66.2%]). About 34% of participants reported that they had the children in their families vaccinated. The main reason given was to protect their children from influenza complications (80.6%).

CONCLUSION:
Within the Riyadh adult population, there was both low compliance to take the influenza vaccinations owing to a lack of perceived benefit and insufficient knowledge of the risks of influenza.
Proteinuria and its associated factors in patients attending family medicine clinics in Dammam, Saudi Arabia
Authors: AlSinan Salma R. , Alsaigh Sukaynah A. , Al-Dawood Kasim M. , AbdelWahab Moataza M. 
Published: May 2024

Abstract

BACKGROUND:
Urinalysis is a simple, valuable, and low-cost tool for the detection of proteinuria, a significant risk factor for renal and cardiovascular diseases. The purpose of this study was to determine the rate of proteinuria and its associated risk factors in patients attending Family Medicine Clinics in Dammam, Saudi Arabia, as no study of that nature had previously been conducted.

MATERIALS AND METHODS:
In this register-based cross-sectional study, data including urinary protein and other urinalysis components ordered between January 2018 and January 2020 were collected from electronic medical records. In addition, data regarding nationality, gender, age, blood pressure, body mass index, serum human chorionic gonadotropin, fasting glucose, hemoglobin A1c (HbA1c), 25-hydroxy Vitamin D level, blood urea nitrogen (BUN), uric acid, creatinine, estimated glomerular filtration rate (eGFR), and lipid profile was also obtained. Proteinuria was classified as negative if no or trace protein was present, and positive if protein was ≥1+, and was considered overt proteinuria.

RESULTS:
In total, results of 2942 urinalysis tests were included. The mean age of the patients was 42.4 ± 14.5 years; majority of the patients were females (62.3%) and were Saudis (68.8%). The rate of proteinuria was 4.2%. Saudi nationality, female gender, age ≥ 40 years, high systolic blood pressure, high diastolic blood pressure, fasting glucose ≥126, HbA1c ≥6.5%, BUN >20 mg/dl, creatinine >1.3 mg/dl, low eGFR <60, and high low-density lipoproteins cholesterol were significantly associated with proteinuria based on bivariate analysis. Using a logistic regression model, a statistically significant association was observed between proteinuria and advancing age, the presence of urinary casts, elevated serum creatinine level, and Saudi nationality.

CONCLUSION:
The only variables that were independently associated with proteinuria using the logistic regression were the presence of casts in the urine, Saudi nationality, high creatinine level, and older age. These variables should be borne in mind by treating physicians.
Synthesis, Characterization, and Cytotoxicity Evaluation of Polyethylene Glycol-Coated Iron Oxide Nanoparticles for Radiotherapy Application
Authors: Anuje Madhuri , Pawaskar Padmaja N. , Khot Vishwajeet , Sivan Ajay , Jadhav Satish , Meshram Jagruti , Thombare Balu 
Published: May 2024

Background:
Treatment methods for cancer that are widely being utilized affect both normal and cancerous cells. We report synthesis polyethylene glycol (PEG)-coated Fe3O4 nanoparticles (NPs) and its characteristic properties and appraise its potential as a promising radiation sensitizer candidate in radiotherapy that improves cancer treatment and reduces side effects of radiation.

Materials and methods:
PEG-coated Fe3O4 NPs were synthesized by chemical coprecipitation method and characterized by studying their size, structure, functional group, stability, magnetization, and cytotoxicity using different techniques. X-ray powder diffraction, Fourier transform infrared spectroscopy, and thermogravimetric analysis results show that Fe3O4 NPs have been functionalized with PEG molecules during the course of synthesis.

Results
Synthesized NPs have good stability based on zeta-potential study. Dynamic light-scattering results reveal that PEG-coated Fe3O4 has a greater hydrodynamic size than bare Fe3O4. Transmission electron microscopy (TEM) micrograph exhibited that NPs are roughly spherical with size in range of 10–20 nm. Saturation magnetization value of PEG-coated and bare Fe3O4 also confirms coating and shows superparamagnetic behavior. Cytotoxicity evaluation study indicated that PEG-coated Fe3O4 is biocompatible on L929 and toxic on Michigan Cancer Foundation-7 (MCF-7) (breast cancer cells).

Conclusion:
These characterized properties of PEG-coated Fe3O4 NPs show that it could be used as a potential radiosensitizer candidate in radiotherapy to significantly improve cancer treatment and minimize painful side effects of radiation.
Deep Learning Approach for Analyzing the COVID-19 Chest X-Rays
Authors: Manav Mohini , Goyal Monika , Kumar Anuj , Arya A. K. , Singh Hari , Yadav Arun Kumar 
Published: May 2024

Purpose
The purpose of this study is to analyze the utility of Convolutional Neural Network (CNN) in medical image analysis. In this study, deep learning (DL) models were used to classify the X-ray into COVID, viral pneumonia, and normal categories.

Materials and Methods
In this study, we have compared the results 9 layers CNN model (9 LC) developed by us with 2 transfer learning models (Visual Geometry Group) 16 and VGG19. Two different datasets used in this study were obtained from the Kaggle database and the Radiodiagnosis department of our institution.

Results
In our study, VGG16 yields the highest accuracy among all three models for different datasets as the Kaggle dataset-94.96% and the department of Radiodiagnosis dataset 85.71%. Although, the precision was found better while using 9 LC and VGG19 for both datasets.

Conclusions
DL can help the radiologists in the speedy prediction of diseases and detecting minor features of the disease which may be missed by the human eye. In the present study, we have used three models, i.e.,, CNN with 9 LCs, VGG16, and VGG19 transfer learning models for the classification of X-ray images with good accuracy and precision. DL may play a key role in analyzing the medical image dataset.
Estimating Absorbed Dose to Breast Adipose Tissue from Mammograms
Authors: Rashid Al Maqsudur , Dhakal Rabin , Moussa Hanna 
Published: May 2024

Purpose
Breast cancer usually originates in the glandular tissue of the breast. However, inflamed adipose tissue surrounding glandular tissue may expedite the local growth of cancerous cells. Exposing adipose tissue to radiation during mammography might cause inflammation in adipose tissue. This inflammation depends on the dose, and thus on the energy deposited from the X-ray mammography. Therefore, estimating the absorbed dose to adipose tissue during mammography is essential in breast cancer research.

Materials and Methods
Absorbed dose to adipose tissue in the breast is determined using a new geometrical (semi-elliptical) model and Monte Carlo N-Particle transport code (MCNP6). X-ray mammogram images of patient breasts were taken as the basis of the new compressed breast geometry. The source probability density used in the MCNP6 code was generated from a published X-ray spectrum corresponding to tube voltage and air kerma. The relationship between various mammogram parameters such as peak tube voltage, compressed breast thickness, and adipose tissue weight fraction versus estimated absorbed dose is established for analysis.

Results
Significant influences of adipose tissue weight fraction on absorbed dose were observed.

Conclusion
Estimating the absorbed dose to breast adipose tissue during mammography and patients' degree of obesity are important factors in breast cancer research.
Dosimetric Comparison of Robotic and Linear Accelerator Multi-Leaf Collimator-Based Stereotactic Radiosurgery for Arteriovenous Malformation
Authors: Kaliyaperumal Venkatesan , Abraham Susan , Veni Maragatha , Banerjee Susovan , Tamilselvan S , Gupta Deepak , Dayanithi K. , Manigandan D. , Mishra Saumyaranjan , Bisht Shyam Singh , Kataria Tejinder 
Published: May 2024

Purpose:
To investigate the dosimetric comparison of different collimators which are used in robotic radiosurgery (cyberknife-CK) and linear accelerator (LINAC) for stereotactic radiosurgery (SRS) in arteriovenous malformation (AVM).

Materials and Methods:
Twenty-five AVM patients were planned in CK using FIXED cone, IRIS collimator, and multi-leaf collimator (MLC) based in LINAC. Dosimetric comparison was performed using Paddick conformity index (CIPaddick) and International Commission on Radiation Units and measurements (ICRU) homogeneity index (HIICRU), gradient score (GS), normal brain dose received by 10cc (D10cc) and critical structure (brain stem, optic chiasma, optic nerves) doses. Paired sample t-test was used for statistical analysis.

Results:
Mean treatment volume was 3.16cc (standard deviation ± 4.91cc). No significant deviation (P =0.45, 0.237 for FIXED vs. IRIS and FIXED vs. MLC, respectively) was found in target coverage. For CIPaddick, the mean difference (MD) between FIXED- and MLC-based plans was 0.16(P = 0.001); For HIICRU, difference between FIXED and IRIS was insignificant (0.5, P = 0.823); but, when FIXED versus MLC, the deviation was 7.99% (P = 0.002). In FIXED- and MLC-based plans, significant difference was found in GS70 and GS40 (P < 0.041 and 0.005, respectively). MD between FIXED- and MLC-based plans for normal brain for 5Gy, 10Gy, 12Gy, and 20Gy were 36.08cc (P = 0.009), 7.12cc (P = 0.000), 5.84cc (P = 0.000) and 1.56cc (P = 0.000), respectively. AVM volume <0.7cc should be treated with CK FIXED and >0.7cc were treated by using FIXED or IRIS collimators. AVM volume > 1.4cc can be treated by either LINAC MLC-based SRS or CK.

Conclusion:
Our study shows CK collimator (IRIS and FIXED) could be able to treat brain AVMs in any size. Linac MLC-based SRS has some limitations in terms of conformity and low-dose spillage, and advantages like reduced treatment time and MU.
Establishment and Dissemination of Radiological Standards in the Field of Diagnostic Radiology in India
Authors: Panyam Vinatha Sumanth , Rakshit Sougata , Dhole Sanjay Daga , Patil Bhushankumar Jagnnath , Das Amaren Prasanna , Kossery Greeshma Anantharaman , Vilippalil Sathian , Chaudhury Probal 
Published: May 2024

Background:
The increased use of ionizing radiation for diagnostic purpose has resulted in an increase in the world population dose. Patient dosimetry in X-ray diagnostic radiology is required to establish diagnostic reference levels (DRLs) and to assess the average dose received by organs and tissues. International bodies have recommended DRLs to be based on dosimetric quantities.

Aim:
To cater to the increased requirement for dosimetry in diagnostic radiology, international guidelines are provided to establish and disseminate traceable calibration for dosimeters used in X-ray diagnostic radiology. X-ray diagnostic beams established are standardized using a diagnostic range free-air ionization chamber (DFAIC) (20-150 kV).

Materials and Methods:
Characterization of the DFAIC and determination of the correction factors for the air kerma measurements were evaluated experimentally and by theoretical calculations.

Results:
The paper details the establishment of 18 diagnostic beam qualities using DFAIC along with the associated uncertainties. The overall uncertainty for the air kerma measurements was within ±0.5% at 1 sigma level. Eight diagnostic range air kerma measurements using DFAIC were compared with the medium energy primary standard FAIC (50–300 kV) maintained in the laboratory.

Conclusion:
The air kerma rates agreed within ±1% and are within the overall standard uncertainty of both the chambers at the time of the comparison. Dissemination to the users in the field of diagnostic radiology in the country has been carried out by calibrating their ionization chambers and solid-state detector-based instruments against the DFAIC. The methodology followed to standardize the beams using DFAIC and calibration of dosimeters is presented in this work.