bluuebunny/crossref_metadata_2025_split huggingface dataset:
Bilastine in Refractory Chronic Spontaneous Urticaria: Disease Control and Cytokine Modulation in an Open-label Prospective Study
Authors: De Abhishek , Singh Sushil , Chakraborty Disha , Sarda Aarti , Godse Kiran 
Published: April 2024

Introduction:
The treatment options for chronic spontaneous urticaria (CSU) primarily include second generation non-sedative antihistamine (SGAHs). Bilastine is a newer, nonsedating SGAH approved for urticaria in February 2019 by the Drugs Controller General of India. Its major advantages are in terms of superior efficacy, lack of drug interactions and adverse effects, including sedation, compared to conventional SGAHs. The role of cytokines in the pathogenesis of CSU is well known. However, there is a shortage of data regarding the change in serum levels of proinflammatory cytokines following H1 antihistamines. We conducted this trial to evaluate the role of bilastine in cytokine modulation and autoimmunity, thereby explaining its role in modifying the disease process in CSU.

Materials and Methods:
This prospective study was conducted in a tertiary institute in Kolkata on patients aged 12 years and above with a CSU >6 months. These patients had an unsatisfactory response, as per the Urticaria Activity Score 7 (UAS7), to previous antihistamine therapies in standard doses. Treatment effectiveness was determined by comparing the UAS7 at baseline with that at weeks 4, 8 and 12. Also, baseline serum interleukin-6 (IL-6) and IL-17 were compared with those at the end of the study, that is, 12 weeks.

Results:
Thirty patients who matched the inclusion criteria and signed informed consent were included in the study. At the end of 12 weeks, 10% of patients (n = 3) achieved a complete treatment response (UAS = 0), whereas 43.33% of patients (n = 13) were labelled as having well-controlled urticaria (UAS <6). At 12 weeks, the mean UAS7 score (6.47 ± 4.45) was statistically significant compared to the baseline score (25.47 ± 7.74). The mean values of serum IL-6 (pg/ml) and IL-17 (pg/ml) at baseline were 5.96 ± 5.24 pg/ml and 6.96 ± 5.97 pg/ml, respectively. At the end of treatment, that is, 3 months, the mean values were reduced to 4.61 ± 4.56 pg/ml and 5.08 ± 3.87 pg/ml. The reduction was statistically significant for both serum IL-6 (P < 0.001) and IL-17 (P < 0.0001).

Conclusion:
We conclude that bilastine at a once-daily continuous dose of 40 mg for 3 months is safe and effective in CSU patients who are refractory to treatment at the standard doses of SGAHs. Improved symptomatic control with bilastine was also associated with better control over the inflammatory process, as suggested by the lowering of mean cytokine levels in our study.
Epidermal Biophysical Characteristics in Patients with Vitiligo and the Association with Thyroid Auto-immunity and Itch
Authors: Teh Yu L. , Jamil Adawiyah 
Published: April 2024

Background:
Vitiligo is characterized by depigmentation due to melanocyte destruction. Itch is an under-recognized symptom; its pathophysiology is unclear.

Aims:
To compare epidermal biophysical characteristics of the vitiligous skin and normal skin and to determine the association with thyroid auto-immunity and itch.

Methods:
A cross-sectional study involving vitiligo patients was conducted. Hydration, pH, and trans-epidermal water loss (TEWL) at the vitiligous skin and normal adjacent skin were measured. The Vitiligo Disease Activity Score (VIDA) and Vitiligo Area Scoring Index (VASI) were assessed. Itch severity and thyroid auto-antibodies were determined.

Results:
Thirty-nine (62.9%) females and 23 (37.1%) males participated. Twenty-six (41.9%) had stable vitiligo, and 36 (58.1%) had active disease with a median VASI was 0.8 (2.2). Hydration was lower [93 (83) to 125.5 (111) vs 104 (73) to 156 (100), P < 0.01] and TEWL [7.13 (6.18) to 8.86 (6.93) vs 5.54 (5.90) to 6.88 (6.37), P < 0.01] was higher at the vitiligous skin compared to the normal skin. A non-significant higher pH trend was observed in the vitiligous skin. Thyroid antibody was detected in 19.7% patients. There were no significant differences in biophysical characteristics between patients with and without thyroid antibodies, with hydration of 88 (159) to 129.5 (120) vs 91.5 (81) to 116 (101) and TEWL of 7.08 (2.03) to 9.97 (6.38) vs 7.65 (7.54) to 8.22 (6.52). Itch was reported by 14 (22.6%). Patients with itch had lower hydration and higher TEWL but were not significantly different from patients without itch.

Conclusions:
The vitiligous skin has reduced hydration and increased TEWL, suggesting a defective epidermal barrier. Thyroid antibody positivity was not associated with biophysical characteristics or itch. Itch was not associated with hydration, pH, and TEWL. An impaired epidermal barrier and itch need to be addressed in vitiligo management.
Sphenopalatine Ganglion Block Using Intranasal Lignocaine Spray for Trigeminal Neuralgia: A Case Series
Authors: Dubey Preksha , Dubey Prakash K. 
Published: April 2024

Abstract
Various interventions have been tried for the management of trigeminal neuralgia which is a sharp, shooting recurrent neuropathic pain. The use of the sphenopalatine ganglion (SPG) block has been established as a fast, safe, and effective means of pain relief for these patients. Recently, 10% lignocaine spray has been described as a less invasive alternative for this block. We report seven patients of idiopathic trigeminal neuralgia with acute unilateral severe pain managed by SPG blocks using 10% intranasal lignocaine spray. Seven patients with unilateral trigeminal neuralgia were included in the study. Two puffs of 10% lignocaine were sprayed into the nostril of the affected side in a slightly medial and inferior direction. Before the procedure and 30 min later, Visual Analog Scale (VAS) scoring was done. The procedure was repeated in case of no pain relief after 1 h of nasal spray (VAS 4 or 5). All patients were observed for 2 h and oral medication was prescribed if required after assessment at 24 h. Four patients reported complete relief (VAS 0 or 1) and two of them reported pain (VAS 4 and 5) after 24 h. The procedure had to be repeated in two patients with no pain relief (VAS 4 and 5) after 1 h. There was no relief in one patient even after repeated administration (VAS 5). The findings suggest a role for intranasal lignocaine spray for SPG block in trigeminal neuralgia for alleviating acute exacerbations of pain and obtaining quick relief.
Enhancing Pediatric Regional Anesthesia: A Narrative Review of Adjuvants used with Local Anesthetics
Authors: Arora Prateek , Iqbal Javaid , Dey Samarjit , Balasubramanian Bhuvaneswari , Reddy Vamshidhar C 
Published: April 2024

Abstract
Pediatric regional anesthesia has become an integral part of perioperative pain management strategies in children. Adjuvants play a pivotal role in augmenting the efficacy and prolonging the duration of regional anesthesia techniques, thereby improving postoperative pain control, and reducing opioid consumption. This review provides a comprehensive overview of the various adjuvants utilized in pediatric regional anesthesia, highlighting their mechanisms of action, clinical applications, efficacy, and safety profiles.
Comparison between Ultrasound-guided Percutaneous Needle Tenotomy and Extracorporeal Shockwave Therapy in Reducing Pain and Functional Disability in the Management of Recalcitrant Lateral Epicondylosis: A Randomized Controlled Study
Authors: Choorapra Sreejith , Nilachandra Longjam Singh , Akoijam Joy Singh , Swami Tripti , Chabungbam Margaret , Pilania Chandrakant , Rajkumari Kanti , Janet Moirangthem 
Published: April 2024

Abstract

Background:
Tendinopathies like lateral epicondylosis (LE) are a difficult problem requiring lengthy management with patients often responding poorly to treatment. Although it is known as a tendonitis, histopathologic studies in recalcitrant LE have shown that it is associated with few inflammatory cells and more of fibroblasts. Emerging regenerative therapies such as autologous blood, platelet-rich plasma, extracorporeal shockwave therapy, and tenotomy have a significant role in the management of recalcitrant cases. The present study aimed to compare ultrasound-guided percutaneous needle tenotomy and extracorporeal shockwave therapy in reducing pain and functional disability in the management of recalcitrant LE.

Materials and Methods:
A randomized controlled study was conducted for 2 years on 82 patients recruited from the outpatient department, and they were randomly assigned to two groups – Group A (41 patients) received extracorporeal shockwave therapy, while Group B (41 patients) underwent ultrasound-guided tenotomy of the common extensor tendon. The outcome was measured by the Visual Analog Scale (VAS), grip strength, and Patient-Rated Tennis Elbow Evaluation (PRTEE) and was assessed at baseline, 4, 12, and 24 weeks.

Results:
At the end of 24 weeks, the VAS score was 1.34 ± 0.48 in Group B, while it was still 3.44 ± 0.59 in Group A. The PRTEE score reduced to 24 ± 1.74 in Group B compared to 40.91 ± 2.94 in Group A.

Conclusion:
Percutaneous tenotomy provides significant improvement in pain and elbow activities as measured by VAS and PRTEE at 24 weeks, and thus, a single percutaneous tenotomy may be considered as a cheap and easy novel alternative in resistant cases of LE.
Best Practices for the Evaluation and Management of Low Back Pain in Primary Care: A Multidisciplinary Expert Consensus
Authors: Srinivasan A. V. , Dureja G. P. , Banerjee Tapas Kumar , Chaudhuri Jaydip Ray , Benny Rajesh , Archik Shreedhar , Mascarenhas Amrithlal A. , Marthala Pradeep Reddy , Agarwal Amit Kumar , Shah Dhara , Rajgopal Jayesh 
Published: April 2024

Abstract

Purpose:
International guidelines for the management of patients with low back pain (LBP) are available, but there are no India-specific guidelines for the diagnosis and management of LBP in primary care. This article aims to provide clinical insights for the diagnosis and treatment of LBP for primary care practitioners in India.

Methods:
A 3-step modified Delphi method was used to get insights and opinions from a panel of 9 multidisciplinary specialist (neurology, orthopedics, and pain management). In rounds 1 and 2, 203 and 60 statements, respectively, were circulated to the expert panel and they were asked to respond with an “agree” or “disagree” to each statement and provide comments. At least 80% of the experts had to agree for a statement to reach a concordance. More than 80% concordance was reached for 175 and 32 statements in rounds 1 and 2, respectively. Round 3 was a direct interaction with the experts.

Results:
There was good agreement among the expert panelist in round 3 for the consensus-derived statements from the earlier two rounds of the survey. The panel agreed that diagnostic triage is important to exclude specific spinal pathology, routine imaging is not recommended unless suspecting serious pathology, specialist referral is needed for serious pathologies/no improvement in pain with treatment, and management is to be individualized depending on etiology and patient factors.

Conclusions:
Primary care physicians are the first point of contact for patients with back pain. These consensus recommendations will assist primary care physicians in India to choose an appropriate course of action for managing patients with LBP.
Predictive Value of Perfusion Index for Assessing Success of Supraclavicular Brachial Plexus Block: A Prospective Observational Study
Authors: Chatterjee Sourav , Majumdar Uma , Gupta Debjani , Sarkar Chiranjib , Chatterjee Subhadeep 
Published: April 2024

Abstract

Background:
Perfusion index (PI) is a simple, objective, and noninvasive method for evaluating the success of brachial plexus blocks. There is only one study which assessed the time point at which the PI had the best predictive value.

Aims:
Of the 5 measured outcome variables (i.e.; PI at baseline, at 5 min, at 10 min, and at 15 min and PI ratio), we wanted to determine the one which had the best predictive value for block success.

Materials and Methods:
It is a prospective observational study done in a tertiary care teaching hospital. Sixty-nine patients of either sex, American Society of Anesthesiologists Physical Status I and II, between the ages of 18 and 65 years posted for elective upper limb surgery were included. Patients were given supraclavicular blocks with a peripheral nerve stimulator. PI recorded at baseline, 5 min, 10 min, and 15 min. A PI ratio was calculated. Sensory and motor blocks were assessed at 5-min intervals.

Statistical Analysis:
Descriptive analysis was applied by mean and standard deviation for quantitative variables and frequency and proportion for categorical variables. Receiver operating characteristic (ROC) curves were constructed. SPSS version 22 was used to detect an area under the ROCs (AUROC) curve and calculated to assess how good a test PI at 10 and 15 min and PI ratio are in predicting the outcome of a block.

Results:
The mean PI increased continuously from the baseline till 15 min in successful blocks, but in unsuccessful blocks, the rise was not seen. ROC curves showed an AUROC curve of 0.93 in case of PI at 15 min and 0.84 for PI ratio.

Conclusion:
We conclude that PI at 15 min is the best in our study and PI ratio is the next best as a predictor for evaluating success of supraclavicular blocks.
Utility of Ultrasound-Guided Continuous Lower Limb Perineural Catheters for Treatment of Pediatric Complex Regional Pain Syndrome Type I: A Primary Case Report from India
Authors: Subhasree N. , Anuradha Ganigara , Shruthi A. H. , Sharmila Somayaji 
Published: April 2024

Abstract
Complex regional pain syndrome (CRPS) is a chronic localized pain condition affecting all age groups with more propensity toward adolescent girls. This disease has a multifactorial pathophysiology involving the sympathetic and central nervous system, along with psychosocial, immune, and genetic factors. We reported a case of CRPS Type I in an adolescent boy who was successfully managed by continuous lower limb nerve blocks through perineural catheters along with the continuation of pharmacological management.
Cyberknife Stereotactic Radiosurgery for Trigeminal Neuralgia: A Single-Institution Retrospective Analysis of Clinical Outcomes
Authors: Pillai Rajkumar Sangaiah 
Published: April 2024

Abstract

Introduction:
CyberKnife stereotactic radiosurgery (CKSRS) is recognized as a highly efficient intervention for refractory trigeminal neuralgia (TN). Our study aims to evaluate the clinical outcomes of CKSRS in treating medically refractory TN. By assessing these results, we aim to understand CKSRS efficacy and its potential as an alternative for nonresponsive patients to traditional medical treatments.

Methods:
In a retrospective study carried out at my institution, 25 patients with refractory TN were treated between 2018 and 2020. Clinical outcomes, including pain control and hypoesthesia/numbness, were assessed at 6, 12, and 24 months after CKSRS. The study employed the Barrow Neurological Institute pain intensity and facial numbness scores acquired through a telephone questionnaire to assess pain relief and the onset of facial hypoesthesia, thus establishing the effectiveness of the treatment.

Results:
There were 14 male and 11 female patients. Among all the patients, 44% experienced relief from pain and were not on any medication for pain, whereas 52% reported occasional pain that did not require medication at the end of the study period. The adverse effect of CKSRS, facial numbness, was observed in 58% of patients as mild facial numbness and in 44% as bothersome facial numbness. Moreover, a higher dose of CKSRS administered to the trigeminal nerve was associated with statistically significant pain control (P < 0.05).

Conclusion:
The study concludes that CKSRS is a safe and effective treatment option for refractory TN. It is worth noting that the occurrence or progression of facial hypoesthesia posttreatment was identified as a predictor of prolonged pain relief.
PRP and its benefit as an adjunctive therapy with subcision and microneedling in atrophic scars: a comparative study
Authors: Vashisht Aditi , Krishna Arvind , Chugh Robin , David Abhinav , Srivastava Divyanshu 
Published: April 2024

Abstract

Context:
Scarring is a biological process of wound repair which leads to a difference in the normal structure and function of the skin and manifests as a depressed or raised area. Treatment of scars is challenging. A number of therapeutic approaches like surgical techniques and non-surgical techniques are performed to improve scarring.

Aims and Objectives:
The aim of this study was to compare the outcome of subcision followed by microneedling versus subcision followed by microneedling and topical platelet-rich plasma (PRP) in atrophic scars.

Materials and Methods:
A comparative prospective study was conducted at a tertiary care hospital in North India to compare the efficacy of subcision followed by microneedling versus subcision followed by microneedling and topical PRP. A total of 40 cases were taken and were randomly divided into two groups, A and B of 20 patients in each group. Topical PRP was applied as an additional therapy in Group B in the same sitting. Minimum three sittings were done in each patient at an interval of 4 weeks and results were assessed after 1 month of the third session. The statistical software used is Microsoft Excel and SPSS software program, version 24.0 for analysis of data and Microsoft Word to generate graphs and tables.

Results:
Improvement in scar grading was more in Group B as compared to Group A with statistically significant difference (P = 0.032). There was an improvement in scar grading from grade 4 scar to grade 2 in 15% and 30% patients of Groups A and B, respectively, with improvement in skin texture and pigmentation more in Group B.

Conclusion:
PRP proved to add to the improvement of grade of atrophic scars when combined with subcision and microneedling.
Chrono Dentistry and the association between shift work and oral health in a representative sample population: An Internet survey
Authors: Gupta Rashi M. , Jha Suraj M. , Nimma Vijayalaxmi 
Published: April 2024

Background:
Most physiological processes in mammals display circadian rhythms that are driven by the endogenous circadian clock. Disruptions of the circadian clock have been associated with nearly every major human disease. With that as the central idea, this study attempted to see the variations in the form and function of the oral cavity with respect to the circadian cycle by comparing the oral health problems of daytime-only workers with those who worked night shifts.

Aims:
To study the relationship between the circadian clock and oral diseases by comparing the oral health problems and lifestyle of daytime-only and night shift workers.

Methods and Material:
A pre-validated questionnaire containing 12 close-ended questions was circulated among 40 night and 40 day shift workers. Appropriate statistical analysis was carried out.

Results:
Increased incidence of extractions and decay was found in night shift workers. Of all, 65% of the day shift workers had lost a few of their teeth to decay and extractions while the same was found in 70% of the night shift workers. Pain in teeth was also found to be prevalent in night shift workers with 80% of the participants claiming that they experienced pain in their teeth while 60% of the day shift workers experienced such pain. 90% of the participants claimed to be non-smokers in the day shift work. In the night shift, 52.5% of participants were current smokers. Smoking was prevalent among night shift workers.

Conclusions:
The results of this study show a clear relationship between night shift work and oral health problems. Hence, stronger measures to provide oral health maintenance support for night shift workers are needed.
Evaluation of autologous platelet rich fibrin in chronic non-healing leg ulcers
Authors: Jakkampudi Anusha , Atluri Swetha C. , Salecha Akshay J. , Haritha S 
Published: April 2024

Context:
Chronic non healing leg ulcers cause psychological, social, and financial burden to the patient. Platelet rich fibrin (PRF), a biological membrane with plethora of growth factors acts as a cheaper and simpler option for the management of non-healing leg ulcers.

Aims:
To evaluate the effectiveness of PRF in the treatment of chronic nonhealing leg ulcers of varying etiologies.

Material and Methods:
It was a prospective study conducted in 30 patients in a tertiary care center. PRF dressing was done weekly for the chronic non healings ulcers of various etiologies for 6 weeks. Response to therapy was assessed by calculation of wound area and volume and digital photographs before each treatment session. Statistical analysis was done using Chi-square test, paired t-test and ANOVA test to get P values.

Results:
In our study, the mean age of subjects was 55.9 ± 14.08. 21 (70%) subjects were male and 9 (30%) were female. Majority of the ulcers were trophic ulcers due to hansen’s disease (n = 11, 36.7%), followed by diabetic ulcers (n = 9, 30%), venous ulcers (n = 6, 20%) and traumatic ulcers (n = 4, 13.3%). Percentage decrease of mean ulcer area and volume were 92.3% and 97.6%, respectively. There was significant decrease in the mean area and volume (P < 0.0001) of the ulcer from 2nd week onwards till the end of 6th week.

Conclusions:
PRF can be used as an adjuvant along with standard treatment in the management of chronic non healing ulcers to reduce the duration of healing.
A study on the relation between preoperative serum albumin levels and postoperative outcome in emergency abdominal surgeries
Authors: Kiran Simhadri Uday , Tribhuneswari Marreddy , Dunga Swetha , Sanath Sai , Minhaaj Minhaaj , Naren Surapaneni Sai Venkata 
Published: April 2024

Background:
Nutritional evaluation is critical for identifying patients who are at risk of developing postoperative complications as a result of severe malnutrition. One of the routinely used markers to assess nutritional status is serum albumin.

Aims and Objectives:
The aim of the study is to evaluate the relationship between preoperative serum albumin levels and postoperative outcomes in emergency abdominal surgeries.

Materials and Methods:
This prospective analytical observational study was conducted on 50 patients who underwent major emergency abdominal surgeries under the department of general surgery in Dr. PSIMS and RF from January 2021 to January 2023.

Results:
In our study majority of the cases were in the 4th and 5th decade of life. 73.33% of the patients were male and 26.66% were female. Preoperative mean serum albumin level in males was 3.22 ± 0.54 mg/dl and 3.41 ± 0.32 mg/dl in females. The rate of postoperative complication was nearly similar in both groups, that is, 14 male patients (36.36%) and 4 female patients (37.50%). The 30-day mortality rate was strongly linked (P = 0.001) to lower serum albumin levels (<3.2 gm/dl).

Conclusion:
Serum albumin is an excellent prognostic predictor due to its capacity to detect PEM, which is not always linked with reduced body weight and may not be clinically recognized, but is associated with a considerable increase in morbidity. Serum albumin level below the threshold of 3.2 g/dl was found to be a major determinant of subsequent squeal as well as mortality in the postoperative period.