bluuebunny/crossref_metadata_2025_split huggingface dataset:
Practice of Enhanced Recovery after Caesarean Delivery: A Randomised Controlled Clinical Trial in a Tertiary Hospital in Yaoundé-Cameroon
Authors: Emelinda Berinyuy Nyuydzefon , Amengle Ludovic Albert , Bengono Roddy Stephan Bengono , Arlette Metogo Mbengono Junette , Ngongheh Brian Ajong , Gouag  , Minkande Jaqueline Ze 
Published: March 2024

Background:
Enhanced recovery after surgery (ERAS) is a new and evolving concept whereby strategies are put in place in the perioperative period to ensure better and accelerated patient recovery with fewer complications. Being a new protocol in our milieu, the need for pre-implementation trials motivated our study in elective caesarean section (CS) in the Yaoundé Gyneco-Obstetric and Pediatric Hospital (YGOPH).

Aims:
To analyse the benefits of the enhanced recovery after caesarean section program (ERAS) over standard care in women undergoing elective caesarean section in the Yaoundé Gyneco – Obstetric and Paediatric Hospital.

Materials and Methods:
A single-blinded randomized controlled trial, in the ratio 1:1, from December 2020 to August 2021, compared the ERAS in caesarean section (ERAS-CS) treatment package, with our standard care package (Non-ERAS group). The ERAS-CS package included pre-operative counselling, reduced pre-operative fast, warming of fluids intraoperatively, use of Dexamethasone and Ondansetron (to prevent post-operative nausea and vomiting) and early oral feeding as well as early mobilisation. Satisfaction 24 hours after surgery as well as complications were evaluated in both groups. Data analysis was with STATA.

Results:
We enrolled 42 women, 21 in each arm. Average age of participants was 31.9 years. A body temperature drop of 0.6 degree Celsius in the ERAS group versus 1.7 degree Celsius in N-ERAS group, p=0.001 was noted. Intraoperative nausea and vomiting (IONV) was significantly decreased in the ERAS group (p=0.038) as well as per-operative hunger and cold. ERAS patients felt significantly more capable of looking after their personal toileting and hygiene, and in control with a greater feeling of well-being than those in the N-ERAS group, 24 hours after surgery.

Conclusion:
The ERAS-CS program led to fewer per and post-operative complications, and faster recovery of patients.
Prophylactic, Manually Titrable Variable Rate Norepinephrine Infusion for Prevention of Hypotension during Spinal Anesthesia for Cesarean Section: A Randomized, Double Blind, Controlled Study
Authors: Bedi Vikram , Thomas Chanchel Mary , Goyet Suman , Choudhary Santosh , Batcha Riyaz Ahamed Kader , Verma Reena 
Published: March 2024

Background and Aims:
Norepinephrine is recently being investigated for mitigation of spinal-induced hypotension. Our study aimed at evaluating the role of manually titrated infusion of norepinephrine in preventing hypotension in patients undergoing lower segment cesarean section (LSCS) under subarachnoid block (SAB).

Subjects and Methods:
This prospective, randomized, double-blind, placebo-controlled trial was conducted in 140 parturients undergoing LSCS under SAB. Patients were randomly allocated to two groups: group A received an infusion of 5 µg/mL norepinephrine started at 30 mL/h (2.5 µg/min) immediately after SAB and manually adjusted within the range 0–60 mL/h (0–5 µg/min), according to the values of systolic blood pressure (SBP) until delivery; in group B, no prophylactic vasopressor was given, and bolus 1 mL norepinephrine (5 µg) was given whenever the SBP decreased to <80% of the baseline value. Groups were compared with regard to the incidence of hypotension, hemodynamic parameters, and norepinephrine consumption. Categorical data were presented as number and compared using the Chi-square test. Continuous variables were presented as mean ± standard deviation (SD) and compared using t-test. P <0.05 was considered statistically significant.

Results:
Cumulative episodes of hypotension were significantly lesser in group A (eight) than group B (29) (P < 0.001). Mean time of onset of hypotension was significantly higher in group A (19.75 ± 8.24 min) compared to group B (4.36 ± 0.77 min) (P < 0.001). Mean SBP, diastolic blood pressure (DBP), and mean arterial pressure (MAP) were significantly higher in group A compared to group B intraoperatively (P < 0.001). Mean heart rate (HR) was significantly lower in group A compared to group B (P < 0.05). Neonatal outcomes were comparable between both the groups.

Conclusions:
In patients undergoing SAB for LSCS, a manually titrated infusion of 5 µg/mL of norepinephrine was effective for maintaining BP and decreasing the incidence of hypotension, with no detectable detrimental effect on neonatal outcome.
Comparison of Epidural, Combined Spinal Epidural, and Dural Puncture Epidural Techniques for Labor Analgesia
Authors: Khetarpal Ranjana , Chatrath Veena , Grover Suparna , Kaur Puneetpal , Taneja Ankita , Madaan Aishwarya 
Published: March 2024

Background:
Lumbar epidural analgesia is a safe, effective, and beneficial technique for both the parturient and the fetus. Dural puncture epidural has been claimed to be better than combined spinal epidural and epidural techniques by many. We undertook this study to compare the three techniques regarding duration, quality of analgesia, and side effects. Debate regarding the best neuraxial technique for labor analgesia continues.

Materials and Methods:
The parturients of ASA grade I and II of age group 20–35 years were randomly divided into three groups of 20 each. Group E (epidural group) received 15 ml of 0.125% isobaric levobupivacaine with 30 µg fentanyl in the epidural space. Group CSE (combined spinal epidural group) received 2.5 mg of intrathecal isobaric levobupivacaine with 25 µg fentanyl and epidural top up of 15 ml of 0.125% levobupivacaine with 30 µg fentanyl. Group DPE (dural puncture epidural group) received 15 ml of 0.125% isobaric levobupivacaine with 30 µg fentanyl in epidural space; intrathecal medication was withheld. Epidural top-up doses were given as per Visual Analog Scale (VAS). Analgesic efficacy, extent of sensory and motor block, maternal and fetal outcome, duration of analgesia, and maternal satisfaction score were compared among three groups and analyzed statistically.

Results:
The onset and symmetry of sensory blockade and VAS score were better in CSE group. DPE group had better sacral coverage and less asymmetric blockade. Groups CSE and DPE had superior maternal and surgeon satisfaction scores in comparison to group E. Both groups E and DPE provided analgesia with minimal motor blockade and ambulation.
Primary Ileopsoas Abscess in Neonate
Authors: Pattanshetti Swapnil Annasaheb , Bagalkotkar Apoorva Gopal , Ruge Abhinandan , Mudakanagoudar Mahantesh Shivangouda , Metgud Tanmaya S. 
Published: March 2024

Abstract
We report the case of a 22-day-old boy baby, and he was brought to us with fever and vague rapidly growing mass in the lower abdomen eventually diagnosed as iliopsoas abscess (IPA). Ultrasonography (USG) and computed tomography were of help in making diagnosis. USG-guided aspiration failed; hence, the baby was treated by extraperitoneal drainage. IPA in neonates is uncommon. This rare disease presentation with confined review of literature is set out in this case report.
Hemangiomatous Ameloblastoma: A Case Report with a Review of Literature
Authors: Trimukhe Akshay Chandrakant , Bhavthankar Jyoti D. , Mandale Mandakini Subhash , Humbe Jayanti Govind , Nandkhedkar Vaishali Anil , Wagh Savita P. 
Published: March 2024

Abstract
Ameloblastoma, a benign epithelial odontogenic tumor, has an intriguing feature by virtue of its diverse histopathologic variants. One such variant that is not yet acclimatized in the literature due to the paucity of cases is “hemangiomatous ameloblastoma” (HA). HA exhibits the histology of conventional ameloblastoma with marked vascularity, which resembles the enamel organ and dental sac. Herein, we present the case of a 33-year-old male patient with swelling of the lower left back region of the jaw for 6 months, which on imaging presented multilocular radiolucency. Incisional biopsy was suggestive of ameloblastoma, and an excisional procedure showed odontogenic epithelial islands with marked vascular proliferation, based on which the diagnosis of HA was rendered. The rarity of this histologic variant and lack of long-term follow-up records in the literature challenges the clinician to predict its biological behavior. Hence, further research is required to understand the same.
Strengthening Workplace Learning in Medical and Health Profession Education: Medical Educators’ Perspective
Authors: Shrivastava Saurabh RamBihariLal , Suhoyo Yoyo 
Published: March 2024

Abstract
The profession of medicine is a challenging one considering the pace with which medical knowledge continues to expand on a daily basis. The purpose of the current review was to explore the significance of workplace learning from the perspective of different stakeholders. An extensive search of all materials related to the topic was carried out on the PubMed and Google Scholar search engines, and a total of 26 articles were selected based on their suitability with the current review objectives. Keywords used in the search include workplace learning and medical education in the title alone only. The workplace offers an opportunity for medical students to apply their acquired knowledge and participate in the process of patient care. Workplace learning gives a platform for medical students to not only participate in patient care but also gradually move forward on the path to becoming an effective member of the health workforce. We must realize that it is not only the students who derive benefits from workplace learning but also the teachers who can optimize their teaching and facilitation skills. To conclude, acknowledging the scope and merits attributed to workplace learning for different stakeholders, there is a definitive need to strengthen the overall process. Medical teachers have a crucial role to play in the strengthening and reinforcement of workplace learning in different contexts, and thus, they should be supported in their task to eventually improve the quality of medical doctors that we are producing.
Streamlining Medical Journey: Leveraging Portfolios for Mentoring Medical Students
Authors: Shrivastava Saurabh RamBihariLal , Maulida Anisa Putri 
Published: March 2024

Abstract
Mentoring in the field of medical education plays a defining role in ensuring the personal and professional growth of medical students by creating a nurturing environment for them to thrive and prosper. Portfolio mentoring is a relatively novel approach to mentor students, wherein a portfolio occupies the central stage to ensure interaction between the two stakeholders. The employment of a portfolio as a tool for mentoring gives precise, concrete details about the work and accomplishments of the student, which was missing in traditional mentoring. Whenever an institution takes a call to introduce mentoring through a portfolio, prerequisites should be met before the start of them. If we want mentoring through portfolio to work in our settings, the most essential factor will be the amount of trust and rapport between the mentors and the mentees. In conclusion, the use of portfolios for mentoring medical students can be acknowledged as a wonderful approach to augment their educational experience. Portfolio provides them an opportunity to showcase their work, achievements, and growth, and through effective mentoring, we can empower future doctors and shape their path to success in years to come.
Molar Pregnancy with a Coexistent Fetus following Assisted Reproductive Techniques: A Review of Literature of the Clinical Course and Sequelae
Authors: Rai Seema , Yasaswi K. , Hiremath Ravishekar N. , Raj Rishi 
Published: March 2024

Abstract
The clinical course and sequelae of molar pregnancy pose several diagnostic and management challenges, especially conceiving after assisted reproductive technology. A review of the literature was conducted on molar pregnancy with a coexistent fetus following assisted reproductive techniques, its clinical course, and sequelae. The literature review was conducted using search terms “coexistent fetus,” “hydatidiform mole,” “twin,” “assisted conception” AND “persistent gestational trophoblastic disease (PGTD)” OR “chemotherapy” in PubMed. A literature search identified 26 reported cases conceived following assisted conception. Management guidelines for hydatidiform mole with live fetuses are very vague and do not give specificity due to the fact that it is often associated with complications and bad obstetric outcomes. It also requires continuous monitoring and follow-up in a tertiary care center anticipating disease progression to postnatal PGTD. To assess the risk of continuation of pregnancy, multicentric studies with larger sample sizes are required to have a valid finding.
Advanced Prospects for Management of Obstructive Sleep Apnea: An Updated Comprehensive Review
Authors: Khan Mohammad Kamran 
Published: March 2024

AbstractObstructive sleep apnea (OSA) is negatively affecting the health of people and their quality of life. This breathing disorder has a multifactorial etiology. However, orofacial factors in OSA patients have been reported to be relatively more significant factors for its etiopathogenesis and its progression. Polysomnography has been a conventional diagnostic modality for OSA. However, in recent years, various novel and modern detection and diagnostic options have been reported in the current literature. Adenotonsillectomy, positive airway pressure therapy, oral appliances (e.g. mandibular advancement device), and pharmacological drugs (intranasal corticosteroids, etc.) have been known as some of the common treatment modalities for OSA. However, recently several modern therapeutic ways for OSA have been reported in the current literature. The aim of this review article is to comprehensively appraise and highlight the current and recent literature about several aspects of OSA, particularly its modern and novel detection methods and therapeutic options.
Efficacy of Dexmedetomidine versus Clonidine in Attenuating Hemodynamic Instability in Surgeries Performed Laparoscopically: A Randomized Single-Blinded Trial
Authors: Prasad T. Krishna , Rahul S. S. , Lysander Sheerin , Priyadharsini K. Soundarya 
Published: March 2024

Abstract

Background:
Various surgeries are being performed laparoscopically since the last decade owing to its collective benefits, yet pneumoperitoneum-related complications are plenty. Hemodynamic instability that is observed in surgeries performed laparoscopically impacts clinical recovery to a greater extent. Therefore, this study was devised to tackle this complication using drugs that suppressed this sympathetic response using alpha-2 sympatholytic agents.

Aim:
The aim was to compare the efficacy of dexmedetomidine and clonidine infusion in maintaining stable hemodynamics during the intraoperative period and possible adverse effects in the postoperative period in patients undergoing laparoscopic surgeries.

Materials and Methods:
This was a randomized single-blinded trial done in a tertiary care center. We included 52 patients (26 patients per group) who underwent laparoscopic surgeries, fit under the American Society of Anesthesiologists (I and II), and 18–60 years age group. Group 1 received intravenous (IV) infusion of dexmedetomidine at 0.3 μg/kg/h, and Group 2 received IV infusion of clonidine at 2 μg/kg/h. The baseline vital parameters and the changes after pneumoperitoneum were systematically recorded and compared.

Results:
Group 1 had significantly lower blood pressure with the similar trend even during the latter part of the surgery. Whereas pain scores were lower in Group 2.

Conclusion:
We conclude that both the drugs were similarly effective in attenuating the hemodynamic changes in response pneumoperitoneum with quite minimal or no apparent adverse effects.
COVID-19 Vaccine-induced Guillain-Barre Syndrome
Authors: Sajan Cyril , Saggu Varun Singh , Maheshwari Rajesh , Jacob Elizabeth 
Published: March 2024

Abstract
First case of severe acute respiratory syndrome coronavirus-2 was detected in Wuhan province of china. Within a year, the vaccine development process accelerated and emergency approval was rolled out for vaccines. Covishield, an adenovirus vector-based vaccine manufactured by Serum Institute of India, was granted emergency use approval by the subject expert committee under Drug Controller General of India in India in the month of January. Numerous adverse effects are still under study following vaccination. Among them, a very rare complication reported is Guillain-Barre syndrome (GBS). The relation between coronavirus disease 19 (COVID-19) vaccine and GBS is still not clear. Here, we present a case of a 32-year-old female with no comorbidities, presented with complaints of bilateral weakness in lower limbs which gradually progressed to upper limbs along with bilateral facial palsy. She had taken her first shot of Covishield vaccine last month. She has no risk factors for GBS, which suggests that it was caused by the vaccine. She was admitted to intensive care unit for further management. This report might help physicians to be more vigilant in evaluating GBS cases especially in the current COVID-19 pandemic era.
Psychiatric Disorders and Brain-Derived Neurotrophic Factor Test: A Summary on Clinical Reports
Authors: puntipantip Rujittika Mungmun , Wiwanitkit Viroj 
Published: March 2024

Abstract
Brain-derived neurotrophic factor is a neurotrophin that is related to canonical nerve growth factor (BDNF). The protein BDNF is produced by the human nervous system. Many clinical problems, including psychiatric ailments, have been linked to Brain-Derived Neurotrophic Factor (BNF). The writers of this article summarize key reports on important psychiatric illnesses.
Comparison of Levobupivacaine over Lignocaine for Peribulbar Anesthesia in Cataract Surgery – A Randomized Control Study in a Tertiary Care Hospital
Authors: Abdullah K. Sheik , Prasad T. Krishna , Narayanan S. Vijay , Jaffar Mahnoor 
Published: March 2024

Abstract

Introduction:
Regional anesthesia is a better alternative whenever general anesthesia is undesirable or contraindicated. Peribulbar block is considered preferable over retrobulbar block in achieving anesthesia for intraocular and extraocular surgeries. It is widely used because it is easier to perform.

Objectives:
This study compares the efficacy of levobupivacaine over lignocaine for peribulbar anesthesia in cataract surgery.

Methods:
A prospective, randomized double-blinded study comparing levobupivacaine for peribulbar anesthesia in cataract surgery was done with 30 patients in each group. Included patients were randomly categorized into Group 1 and Group 2. Group 1 received lignocaine with adrenaline and Group 2 received 0.5% levobupivacaine with main outcome variables of the study intraoperative and postoperative pain, motor sensory onset, akinesia score, and analgesia duration.

Results:
In both the groups, there was no significant difference in terms of age and gender. There was statistical significance between the two groups in terms of motor blockade. There is a significant mean difference between Group 1 and Group 2 when compared with akinesia score with P < 0.05. The pain was less in Group 2 than Group 1. There is no significant difference in both when compared with verbal pain score. Heart rate and blood pressure showed a difference.

Conclusion:
Topical anesthesia with levobupivacaine was more effective than lignocaine surgeries with better analgesia and lesser complication.
Impact of the COVID-19 Pandemic on Rate of Complete Treatment for Syphilis among Pregnant Women in Indochina: A Preliminary Report
Authors: Sookaromdee Pathum , Wiwanitkit Viroj 
Published: March 2024

Abstract

Background:
The COVID-19 outbreak has had a negative influence on common public health services in a number of ways. The authors of this particular study discuss the impact of the COVID-19 pandemic on antenatal care programs used to treat syphilis in pregnant women in areas where the illness is a major problem.

Materials and Methods:
In Southeast Asia, where syphilis is extremely prevalent, data on the treatment of syphilis among pregnant women in accordance with normal prenatal care programs are examined.

Results:
The total treatment rate has decreased as compared to the period before COVID-19.

Conclusion:
According to the regular antenatal care program, the COVID-19 pandemic had an impact on how pregnant women were treated for syphilis in the research area. The reduced coverage is a severe issue that has to be effectively addressed.
A Prospective Study to Evaluate the Use of Neutrophil-to-Lymphocyte Ratio as a Prognostic Marker for Severe Acute Cholecystitis
Authors: Prabhu Tanvi Pravinkumar , Togale Manoj D. 
Published: March 2024

Abstract

Context:
Acute cholecystitis (AC) is one of the most common afflictions of the gastrointestinal system presenting to hospitals whose delayed diagnosis can lead to severe complications. Neutrophil-to-lymphocyte ratio (NLR) is a new and inexpensive predictor of severe AC that can be used as prognostic biomarker for the stratification of patients for appropriate management.

Aims:
The aims of the study are to determine the usefulness of the NLR as a prognostic marker and to find range that distinguishes between grades of AC and to compare NLR use with white blood cell, high sensitivity C-reactive protein, and radiological modalities in the diagnosis of severe AC.

Settings and Design:
This is a 1-year prospective observational study in tertiary care center.

Subjects and Methods:
Demographic data, investigations, and management of 110 patients diagnosed with AC were collected. Categorization in mild, moderate, or severe AC group was based on Tokyo guidelines and NLR was calculated as absolute neutrophil count/absolute lymphocyte count.

Statistical Analysis Used:
One-way analysis of variance.

Results:
Sixty-four were male and 46 were female. 23.64% had severe AC, 30.91% had moderate, and 45.45% had mild AC. Mean hospital stay and intensive care unit stay were more in severe cholecystitis group. Diabetes mellitus was commonly associated comorbidity in severe cholecystitis (35.48%). As per the study, NLR ranges <6.5 in mild, 6.5–10 in moderate, and >10 in severe AC (sensitivity of 97% and specificity of 88%). The cardiovascular system was most commonly affected in severe AC, followed by renal derangement.

Conclusions:
NLR has proved to be a prognostic marker to determine disease severity in patients with AC which will help in appropriate management and better patient outcome.
Structure of singularities in the nonlinear nerve conduction problem
Authors: Karakhanyan Aram 
Published: March 2024

We give a characterization of the singular points of the free boundary

\partial \{u>0\}

for viscosity solutions of the nonlinear equation

F(D^{2} u)=-\chi_{\{u>0\}},

where

F

is a fully nonlinear elliptic operator and

\chi

is the characteristic function. This equation models the propagation of a nerve impulse along an axon. We analyze the structure of the free boundary

\partial\{u>0\}

near the singular points where

u

and

\nabla u

vanish simultaneously. Our method uses the stratification approach developed in Dipierro and the author’s 2018 paper. In particular, when

n=2

we show that near a flat singular free boundary point,

\partial\{u>0\}

is a union of four

C^{1}

arcs tangential to a pair of crossing lines.