bluuebunny/crossref_metadata_2025_split huggingface dataset:
Role of Pleural Fluid Lactate Dehydrogenase to Adenosine Deaminase Ratio in the Etiological Differentiation of Exudative Pleural Effusion
Authors: Indhu S. , Mohanraj S , Chaitanya Vishnu , Patrudu B. M. S. 
Published: May 2024

Abstract

Background:
Although pleural fluid adenosine deaminase (ADA) level >70 U/L suggestive tuberculous pleural effusion (TPE). High ADA levels can also be seen in pneumonia, empyema, lymphoma, malignancy, and rheumatoid pleuritis. Elevated pleural fluid lactate dehydrogenase (LDH) is seen in tubercular pleural effusion (TPE), parapneumonic pleural effusion (PPE), and malignant pleural effusion (MPE). Therefore, it is challenging distinguish between TPE, PPE, and MPE based on elevated pleural fluid ADA and LDH levels. In this study, we evaluated the use of pleural fluid LDH/ADA ratio as a new parameter for etiological differentiation of exudative pleural effusions.

Materials and Methods:
A retrospective hospital-based observational study conducted in GHCCD, Visakhapatnam. A total of 52 patients (TPE – 19, PPE – 16, and MPE – 17) with exudative pleural effusion who fulfilled inclusion criteria were taken into study. Qualitative variables have been described in the form of frequency and percentages. Median and interquartile ranges were used for nonnormal distribution values. Receiver operating curve (ROC) curves with area under the curve (AUC) were calculated. P ≤ 0.05 was considered statistically significant.

Results:
The mean ADA value for TPE was 75.4 U/L (25–195 U/L), PPE was 59.1 U/L (13–180 U/L), and for MPE was 35.52 U/L (10–75 U/L). The mean LDH value for TPE was 887.8 U/L (139–2213 U/L), PPE was 1128 U/L (334–3110 U/L), and for MPE was 1470 U/L (234–4285 U/L). On ROC analysis, pleural LDH/ADA ratio ≤20.81 diagnose TPE with (sensitivity – 84.2%, specificity – 63.6%) with AUC of 0.758 (95% confidence interval [CI]: 0.619–0.866) (P = 0.0001) whereas LDH/ADA ratio in the diagnosis of PPE was found to be >23.39 (sensitivity – 50%, specificity – 66.7%) with AUC of 0.535 (95% CI: 0.391–0.674) (P = 0.689) and the cutoff LDH/ADA ratio in the diagnosis of MPE was found to be >20.86 (sensitivity – 70.6%, specificity – 68.6%) with AUC of 0.724 (95% CI: 0.583–0.839) (P = 0.007). The cutoff value of the LDH/ADA ratio in PPE does not reach the statistical significant value.

Conclusion:
Pleural fluid LDH/ADA ratio ≤20.81 U/L is predictive of TPE, and >20.86 U/L is predictive of MPE and the cutoff value of 20.8 U/L can be used for etiological differentiation of pleural effusion.
Evaluating the Renal Toxicity Profile of Moringa oleifera Seed: Associating its Wide Consumption with Renal Failure – Subacute In vivo Study
Authors: Ezemagu Uchenna Kenneth , Okafor Chiagozie C. , Anibeze Chike P. , Ojobo Chioma M. , Okechukwu Getrude N. , Ezemagu Eunice I. 
Published: May 2024

Background:
The alarming rate of kidney failure in Africa and Asia could be associated with wide levels of consumption of Moringa oleifera seed preparations in the continent.

Objectives:
The study aims to ascertain the phytochemicals in aqueous and ethanol extracts of M. oleifera seed and determine how its consumption affects the histopathology and function of the kidney.

Materials and Methods:
Albino rats (32) about 7 weeks old and weight, 120 g each, were divided into Groups 1–8, using nonprobability sampling technique. The rats in Groups 2–8 were fed daily, 100 mg, 200 mg, 400 mg, 800 mg, 1600 mg, 3200 mg, and 6400 mg/kg body weight of M. oleifera seed powder dissolved in 2 mL of distilled water, respectively, for 9 days, with the aid of a syringe and cannula. Group 1 (control) received 2 mL of distilled water daily. On the 8th day, two rats were randomly selected from Group 8 and fed with 15,000 mg/kg body weight (Group 9).

Results:
The seed has moderate alkaloids, saponins, glycosides, and terpenoids concentrations, and it is rich in carbohydrates, protein (aromatic amino acids), and oil. The renal tissues of rats in Groups 3–9 were distorted and necrosed. The rats in Groups 6–9 had an appreciable reduction in concentrations of blood creatinine and urea, and mortality was recorded in Groups 8 and 9.

Discussion and Conclusion:
Although subacute consumption of 100 mg/kg body weight daily of M. oleifera seed could not distort the renal architecture, blood electrolytes, creatinine, or urea concentration of the rats, relatively high-grade level of consumption could precipitate renal failure. An urgent need to standardize the consumption of the seed preparations of the “miracle plant” is required.
Role of Vermal Anteroposterior Length and Width in Age Determination of Fetus
Authors: Ahmad Nadia , Singh Deepa , Jethani Sunder Lal 
Published: May 2024

Background:
Early differentiation of the cerebellum during fetal life makes it the center of interest in the field of obstetrics and gynecology. Moreover, the cerebellar vermis develops a little ahead of the hemispheres. Hence, the morphological parameters of the vermis can be a guide to ascertaining gestational age and assessing any anomalies related to posterior cranial fossa development.

Aims and Objectives:
The study was taken up with the objective of building up a timeline for the appearance of folia and important fissures. Moreover, establishing a correlation between the growing fetus and vermal parameters.

Material and Methods:
A total of 60 human fetal fixed cerebella were included in this observational and descriptive type of study. Fetuses affected with any congenital or neurological deficit were excluded. Grouping of the fetuses was done, based on their gestational age in weeks. The first group from 13-17 weeks, the second group from 18-22weeks, the third group from 23-27 weeks, and the fourth group from 28-32 weeks.

Observation:
Time of appearance of folia and fissures were noted. Vernier calipers were used to measure vermal width and anteroposterior length. Statistical tools like IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp. and one-way analysis of variance were applied to the data obtained.

Conclusion:
A posterolateral fissure appeared at 13 weeks of gestation while folia and other fissures appeared from the 18th week onwards. Both the parameters of vermis showed a linear correlation with gestational age. Such a timeline and correlation shall prove to be helpful in calculating fetal age in the field of forensic studies.
Spinal extradural meningioma: Report of two cases
Authors: Redhu Rakesh , Pavithra H. N. 
Published: May 2024

ABSTRACT
Purely extradural spinal meningiomas are rare and often confused with metastases and schwannomas. Only a few cases have been described in the literature, and they are located mainly in the cervical and dorsal regions. We present two cases of extradural meningiomas, one well-defined nodular growth present at a cervicodorsal junction that was confused with schwannoma preoperatively and the other typical meningioma extending both intra and extradurally in the upper dorsal spine.
Posterior vertebral column resection: Exploring practical uses in clinical settings
Authors: Çaçan Mehmet Akif , Birinci Murat , Mertsoy Yilmaz , Uzel Kadir , Bostanci Bilal , Uçar Bekir Yavuz 
Published: May 2024

ABSTRACT

Background:
The purpose of this study was to present our experience in patients who had been treated with posterior vertebral column resection (PVCR) for various spinal deformities.

Methods:
Thirty-seven patients who performed PVCR between 2015 and 2018 were evaluated retrospectively. The mean follow-up period was 24 months (range: 12–50 months). The demographic data of the patients, mean blood loss, amount of blood replacement, duration of operation, intensive care and hospitalization period, PVCR level, instrumentation level, amount of preoperative curvature, amount of postoperative curvature improvement, preoperative and postoperative neurological status, and complications were examined. Angular measurements were performed on X-ray.

Results:
The mean age of the patients was 37.5 years (range: 3–80 years). PVCR was applied to patients due to different pathologies (congenital, tumor metastasis, posttraumatic kyphosis, revision scoliosis, and infection). The mean operation time was 445.5 min (260–720) with an average blood loss of 1903 ml (400–7000 ml). It was observed that the average local kyphosis angle decreased from 67.65° to 7.42° in 26 patients who were operated for advanced deformity (P < 0.001). When these values were compared in all 34 patients, the preoperative angle value decreased from 55.1° to 3.5° (P < 0.001) and decreased from 70° to 0° in 13 congenital kyphosis patients.

Conclusion:
PVCR is an effective method for correcting severe spinal deformities and can be used to correct curvature in different patient groups.

Level of Evidence:
Level 3.
Understanding spinal gout: A comprehensive study of 88 cases and their clinical implications
Authors: Nazwar Tommy Alfandy , Bal’afif Farhad , Wardhana Donny Wisnu , Panjaitan Christin 
Published: May 2024

ABSTRACT

Background:
Spinal gout, a rare and often underdiagnosed condition, significantly impacts patients’ quality of life. Therefore, the aim of the research is to analyze cases of spinal gout, including clinical features, anatomical location of spinal gout, laboratory studies, imaging studies, treatment choices, and outcomes from various cases of spinal gout.

Methods:
The author conducted a systematic literature search in the PUBMED and Science Direct databases from 2013 to 2023. We included clinical case presentations of spinal cases in adults, published in English. The three researchers independently reviewed the title and abstract of each article, and any differences in opinions were resolved through consensus. The extracted data were subsequently analyzed descriptively.

Results:
A total of 88 cases of spinal gout were obtained and studied. Out of the total reviewed cases of spinal gout, 89.77% of the subjects were male, with an average age of 51.9 years (age range 16–87 years). Common symptoms include back/neck pain (78.41%) and lower extremity weakness (37.50%). The lumbar spine is the most frequently affected region (62.50%), diagnosed primarily through magnetic resonance imaging (MRI) scans. Surgery, performed in 61.36% of cases, commonly involves decompressive laminectomy. Posttreatment, symptoms resolve in 87.50% of cases.

Conclusion:
Cases of spinal gout present with a variety of symptoms, including back pain and weakness. Diagnosis typically involves an MRI examination and synovial fluid analysis for confirmation. Treatment varies and includes medication therapy and surgical interventions. A deeper understanding of these cases can assist healthcare practitioners in the management and diagnosis of spinal gout cases.
Calcified Thoracic Disc – A descriptive classification with clinical and management implications
Authors: Haleem Shahnawaz , Adlan Amirul , Azzopardi Christine , Botchu Rajesh 
Published: May 2024

ABSTRACT

Introduction and Objective:
Thoracic disc calcification is a radiological finding which may be incidental or diagnosed in patients presenting with myelopathy due to spinal cord compression. We performed a study to analyze the imaging patterns of calcified thoracic discs (CTDs).

Patients and Methods:
A retrospective review of the spinal and radiology database of a tertiary referral orthopedic hospital was conducted for the incidence of CTDs between 2007 and 2020. Patients’ demographics and radiological findings were recorded. The relationship between disc size, morphology, spinal cord compression, and management was assessed.

Results:
Fifty-one cases of CTDs were identified. The mean size of CTD was 806.2 mm3 (range: 144–2340). The most common level of disc calcification was T9–T10 (24%) in 12 patients. Thoracic disc calcifications in our series commonly involved disc “protrusion” in 67% (34 patients), followed by “mushroom” type in 31% (16 patients) and “extrusion” in 2% (1 patient). 37% (19 patients) had spinal cord compression with 12% (6 patients) undergoing surgical interventions. There was no statistically significant difference in the mean sizes of CTD between the groups with and without spinal cord compression (P = 0.566, independent sample t-test). Patients with “mushroom” type calcification were more likely to have surgical intervention (P = 0.01, Fisher’s exact test).

Conclusion:
Thoracic disc calcifications, while common, can still be underdiagnosed till late myelopathic deterioration. Care of the elderly physicians, spinal surgeons, and radiologists need to be aware of them to guide diagnosis and management. Our study demonstrates that disc morphology plays a vital role in myelopathic presentation and therefore determines the need for surgical intervention instead of the absolute size of disc calcification.
A systematic review of risk factors and adverse outcomes associated with anterior cervical discectomy and fusion surgery over the past decade
Authors: Rai Vikramaditya , Sharma Vipin , Kumar Mukesh , Thakur Lokesh 
Published: May 2024

ABSTRACT

Background:
Anterior cervical discectomy and fusion (ACDF) is one of the most frequently performed cervical surgeries in the world, yet there have been several reported complications.

Objective:
To determine the actual incidence of complications related to ACDF as well as any risk variables that may have been identified in earlier research.

Methods:
To evaluate the origin, presentation, natural history, and management of the risks and the complications, we conducted a thorough assessment of the pertinent literature. An evaluation of clinical trials and case studies of patients who experienced one or more complications following ACDF surgery was done using a PubMed, Cochrane Library, and Google Scholar search. Studies involving adult human subjects that were written in the English language and published between 2012 and 2022 were included in the search. The search yielded 79 studies meeting our criteria.

Results:
The overall rates of complications were as follows: Dysphagia 7.9%, psudarthrosis 5.8%, adjacent segment disease (ASD) 8.8%, esophageal perforations (EPs) 0.5%, graft or hardware failure 2.2%, infection 0.3%, recurrent laryngeal nerve palsy 1.7%, cerebrospinal fluid leak 0.8%, Horner syndrome 0.5%, hematoma 0.8%, and C5 palsy 1.9%.

Conclusion:
Results showed that dysphagia was a common postoperative sequelae with bone morphogenetic protein use and a higher number of surgical levels being the major risk factors. Pseudarthrosis rates varied depending on the factors such as asymptomatic radiographic graft sinking, neck pain, or radiculopathy necessitating revision surgery. The incidence of ASD indicated no data to support anterior cervical plating as more effective than standalone ACDF. EP was rare but frequently fatal, with no correlation found between patient age, sex, body mass index, operation time, or number of levels.
Construct length analysis of type B and C cervical and thoracolumbar fractures
Authors: Heard Jeremy C. , Lambrechts Mark J. , Lee Yunsoo , Ezeonu Teeto , Trenchfield Delano R. , D’Antonio Nicholas D. , Dees Azra N. , Wiafe Bright M. , Mangan John J. , Canseco Jose A. , Woods Barrett I. , Kaye Ian David , Hilibrand Alan S. , Vaccaro Alexander R. , Kepler Christopher K. , Schroeder Gregory D. 
Published: May 2024

ABSTRACT

Objectives:
The purpose of this study is to identify if construct length affects the rate of surgical complications and instrumentation revision following surgical fixation of subaxial and thoracolumbar Type B and C fractures. This study evaluates the effect of ankylosing spondylitis/diffuse idiopathic skeletal hyperostosis (AS/DISH) within this population on outcomes.

Methods:
Retrospective review of 91 cervical and 89 thoracolumbar Type B and C fractures. Groups were divided by construct length for analysis: short-segment (constructs spanning two or less segments adjacent to the fracture) and long-segment (constructs spanning more than two segments adjacent to the vertebral fracture).

Results:
For cervical fractures, construct length did not impact surgical complications (P = 0.641), surgical hardware revision (P = 0.167), or kyphotic change (P = 0.994). For thoracolumbar fractures, construct length did not impact surgical complications (P = 0.508), surgical hardware revision (P = 0.224), and kyphotic change (P = 0.278). Cervical Type B fractures were nonsignificantly more likely to have worsened kyphosis (P = 0.058) than Type C fractures. Assessing all regions of the spine, a diagnosis of AS/DISH was associated with an increase in kyphosis (P = 0.030) and a diagnosis of osteoporosis was associated with surgical hardware failure (P = 0.006).

Conclusion:
Patients with short-segment instrumentation have similar surgical outcomes and changes in kyphosis compared to those with long-segment instrumentation. A diagnosis of AS/DISH or osteoporosis was associated with worse surgical outcomes.
Lumbar parafacetal cyst-spinal segmental instability is the cause and stabilization is the treatment: A clinical report of eight surgically-treated patients
Authors: Goel Atul , Vutha Ravikiran , Shah Abhidha , Prasad Apurva , Abhinav Kumar , Shukla Ashutosh Kumar 
Published: May 2024

ABSTRACT

Objective:
The authors report the results of “only-fixation” of the affected spinal segment without any decompression of the bones or soft tissue or manipulation of the cyst wall or contents in eight cases having lumbar parafacetal cyst (LPFC). This surgical strategy was based on the concept that LPFCs are secondary to spinal instability, has a protective or adaptive role, and is reversible following stabilization.

Materials and Methods:
During the period from January 2018 to January 2023, eight consecutive patients having LPFC were surgically treated. There were 5 males and 3 females, and their ages ranged from 48 to 72 years (average 63 years). Seven patients had a single cyst and one patient had multiple cysts. The patients presented with symptoms classically attributed to lumbar canal stenosis. Apart from the cyst-affected spinal segment, degenerative alterations were observed in adjoining spinal segments in six out of seven patients having a single cyst. All patients underwent “only fixation” of the unstable spinal segments without any kind of bone or soft-tissue resection and without any manipulation or handling of the cyst wall or contents.

Results:
During the follow-up period that ranged from 12 to 57 months (average 29 months), all patients improved from their symptoms. The recovery was observed in the immediate postoperative period and was lasting.

Conclusions:
LPFCs are one of the several secondary alterations observed in spinal degeneration. Identification of unstable spinal segments and their fixation constitutes rational treatment of lumbar parafacetal cysts. Direct handling and resection of cysts are unnecessary.
Analyzing results of cervical sagittal parameters in patients operated with polyetheretherketone cages without plate
Authors: Olivares-Camacho Jorge Luis , Olivares Peña Jorge Luis , Cuevas-Hernández Aldo Adrián , Hernández-Alcázar Edgar De Jesús , Jiménez-Ponce Fiacro 
Published: May 2024

ABSTRACT

Study Design:
This was a retrospective longitudinal observational study.

Purpose:
The purpose of this study was to analyze the results of cervical sagittal parameters on preoperative and postoperative lateral radiographs in anterior cervical discectomy and fusion (ACDF). ACDF is believed to change craniocervical parameters and thus cervical curvature using polyetheretherketone (PEEK) or titanium cages with or without self-locking as well as an anterior plate, the latter of which has not been shown to provide better clinical or radiological results.

Overview of Literature:
Cervical spondylotic myelopathy (CSM) is a common degenerative pathology that can affect one or more levels and treatment has varied over time trying to maintain sagittal parameters within acceptable values where the ACDF is the main treatment.

Materials and Methods:
The study was performed in patients with CSM who underwent anterior cervical discectomy, and their pre- and postoperative radiographs were analyzed using Surgimap software a few days before and 3 months after surgery.

Results:
Fifteen files were included in the study. Statistically significant sagittal balance variables were observed in cervical lordosis (CL) with an increase of 4.73° (P = 0.019) and T1 slope (T1S)-CL with a decrease of –5.93° (P = 0.007).

Conclusions:
CL and T1S-CL showed favorably modified values when performing ACDF using stand-alone PEEK cages without the need for self-blocking or an anterior plate.
Perioperative complications associated with fluoroscopy C1 lateral mass screw fixation (Goel technique) versus computed tomography-guided navigation technique: A review of 202 cases from the German Spine Registry (DWG-Register)
Authors: Vinas-Rios Juan Manuel , Heck Vincent J. , Eysel Peer , Walter Sebastian Gottfried , Babasiz Tamara , Kernich Nikolaus ,   DWG-Registry Group
Published: May 2024

ABSTRACT

Background:
Overview of the literature – Fractures of the C1 constitute 3%–13% of all cervical spine injuries in adults. Most isolated C1 fractures are stable and can be treated nonoperatively with external immobilization. Traditional surgical options for C1 fracture treatment are occiput-to-C2 fusion or C1 with lateral mass screws (LMSs). Purpose – The aim is to assess the management and perioperative complications of C1 fractures undergoing LMS fusion between fluoroscopy and computed tomography (CT)-guided navigation.

Methods:
This was a retrospective multicenter study of data from the DWG-Register of patients who underwent operative treatment for C1 traumatic fracture with LMSs from January 2017 to September 2022. Inclusion criteria – traumatic injury and age > 18 years old.

Results:
In total, 202 patients with traumatic C1 fracture requiring spinal surgery were identified in the registry; n = 175 (Group 1) were treated conventionally without CT-guided navigation and n = 27 were treated with CT-guided navigation (Group 2). C1-LMS was principally performed by spine surgeons n = 90 (53.4%) and n = 72 (18.5%) by neurosurgeons in both the groups. Intraoperative adverse events were as follows: dural tear in group 1 n = 0 and in group 2 n = 1, vascular injury, with one case in group 1 and no cases in group 2. General complications were: cardiovasculars in group 1 n = 6 (3.4%) and Group 2 n = 4 (14.8%) (P = 0.03), pulmonary complications in group1 n = 2 (1.1%) and n = 9 in group 2 (33.3%) (P < 0.001), stroke n = 1 (0.57%) in group1 and n = 4 in group 2 (14.8%) (P < 0.001), gastrointestinal bleeding n = 1 (0.57%) in group1 and no cases in group 2, renal insufficiency n = 2 (1.1%) in group 1 and n = 3 (11.1%) in group 2 (P = 0.01) .One death was recorded in group 2 (3.7%).

Conclusion:
This series of 404 screws placed in 202 patients over 5 years who underwent two types of C1 fracture fixation had a considerably lower incidence of screw malposition and vertebral artery injury than has previously been reported in the literature. C1 screws can be safely placed with a low risk of vertebral artery and neurologic injury with and without CT-guided navigation support.