bluuebunny/crossref_metadata_2025_split huggingface dataset:
3D Virtual Bronchoscopy as an Aid to Airway Management in a Patient with Anterior Mediastinal Mass
Authors: Arora Divya , Tewari Prabhat , Shamshery Chetna , Chandra Bipin , Gupta Archna , Pal Lily 
Published: April 2024

ABSTRACT
Mediastinal masses pose one of the great challenges for any anesthesiologist during airway maintenance, underlining the need to devise a well-formulated plan to avoid perioperative complications. As a general rule, such patients are managed with spontaneous ventilation without the use of muscle relaxants and awake intubation. We report a case of a 66-year-old male with severe dyspnea, having a very large invasive anterior mediastinal mass, causing left lung collapse for urgent debulking surgery. The tracheobronchial compromise was ruled out using three-dimensional reconstruction on computed tomography imaging (virtual bronchoscopy) and that helped in using general anesthesia with muscle relaxation for subsequent endotracheal intubation and surgery.
Late Migration of Fully Deployed Left Main Coronary Stent into Aortic Root: A Late Complication and Its Surgical Management
Authors: Ahmad Tanveer , Alafifi Azza Abdelalem , Aldossari Mubarak , Tasca Giordano , Aljerayed Nasser 
Published: April 2024

ABSTRACT
Migration and embolization of a deployed stent is a rare complication of percutaneous coronary interventions (PCI) and can result in serious and potentially life-threatening complications. There are many reports of intracoronary stent entrapment, stripping, and dislodgement during PCI, however, only a few reports about migration. We report a rare case of migration of the left main coronary stent into the aortic root, which happened 5 months after the procedure and was treated by its partial removal through aortotomy along with surgical revascularization. The patient was discharged 5 days later, after an uneventful hospital stay.
A Novel Case of SCN1A Mutation Presenting as Hyperkinetic Movement Disorder
Authors: Mohinish S. , Cornelius Leema P. , Elango Neeraj , Livingston Jered K. 
Published: April 2024

Abstract

SCN1A mutation is most often associated with Dravet syndrome, which is characterized by severe encephalopathy. One of the other presentations of SCN1A mutation is developmental and epileptic encephalopathy-6B (DEE6B). It is a severe neurodevelopmental disorder characterized by early-infantile seizure onset, profoundly impaired intellectual development, and a hyperkinetic movement disorder. Here we report a rare case of novel SCN1A mutation presenting as hyperkinetic movement disorder in the form of multifocal dystonia and parakinesia in a 12-year-old boy, which aggravated with the use of sodium channel blockers.
Positive Predictive Value of Computerized Tomography Coronary Angiography versus Computerized Tomography Fractional Flow Reserve in a Real-world Population
Authors: Sinclair Hannah , Yongli Reuben Loi , Farag Mohamed , Alkhalil Mohammad , Beattie Anna , Egred Mohaned 
Published: April 2024

Background:
Computed Tomography coronary angiography and fractional flow reserve (CTCA and CT-FFR) are noninvasive diagnostic tools for the detection of flow-limiting coronary artery stenoses. Although their negative predictive values are well established, there is a concern that the high sensitivity of these tests may lead to overestimation of coronary artery disease (CAD) and unnecessary invasive coronary angiography (ICA). We compared the positive predictive value (PPV) of CT-FFR with computerized tomography coronary angiography (CTCA) against the gold standard of ICA in different real-world patient groups.

Methods:
A retrospective analysis of 477 patients referred for CTCA or CT-FFR for investigation of possible coronary ischemia. Patients were excluded if the image quality was poor or inconclusive. Patient-based PPV was calculated to detect or rule out significant CAD, defined as more than 70% stenosis on ICA. A sub-analysis of PPV by indication for the scan was also performed. Patients who underwent invasive nonhyperemic pressure wire measurements had their instant wave-free ratio or resting full-cycle ratio compared with their CT-FFR values.

Results:
In a patient-based analysis, the overall PPV was 59.3% for CTCA and 76.2% for CT-FFR. This increased to 81.0% and 86.7%, respectively, for patients with stable angina symptoms. In patients with atypical angina symptoms, CT-FFR considerably outperformed CTCA with a PPV of 61.3% vs. 37.5%. There was not a linear relationship between invasive pressure wire measurement and CT-FFR value (r = 0.23, P = 0.265).

Conclusion:
The PPV of CTCA and CT-FFR is lower in the real world than in previously published trials, partly due to the heterogeneity of indication for the scan. However, in patients with typical angina symptoms, both are reliable diagnostic tools to determine the presence of clinically significant coronary stenoses. CT-FFR significantly outperforms CTCA in patients with more atypical symptoms and the targeted use of CT-FFR in this group may help to avoid unnecessary invasive procedures.
Emergence characteristics comparing endotracheal tube to reinforced laryngeal mask airway during endoscopic sinus surgery – A randomised controlled study
Authors: Raokadam Vasanth , Thiruvenkatarajan Venkatesan , Bouras George S. , Zhang Alex , Psaltis Alkis 
Published: April 2024

Background and Aims:
During endoscopic sinus surgery, anaesthetic conditions significantly impact the intraoperative surgical field and bleeding during emergence. While the endotracheal tube (ETT) has been traditionally used in sinus surgery, a reinforced laryngeal mask airway (RLMA) that produces less upper airway stimulation may result in smoother emergence.

Methods:
A randomised controlled trial of 72 patients undergoing elective sinus surgery was conducted, with the allocation of airway technique to either ETT with a throat pack or RLMA. The primary outcome measure was emergence time, measured by time to opening eyes on commands at the cessation of anaesthesia, and the secondary outcomes were time to removal of airway device, remifentanil use, procedure times, mean arterial pressure (MAP) and the RLMA grade of blood contamination. The continuous variables were analysed using Student’s t-tests and discrete variables, count tables were analysed using Fisher’s exact tests.

Results:
There was no significant difference in the emergence time between the ETT and RLMA groups (P = 0.83). Remifentanil use was significantly higher in the ETT group than in the RLMA group (P = 0.022). The ETT group showed a significantly increased total anaesthetic time (P = 0.01). MAP was not significant during preinduction, maintenance or post-RMLA removal. The highest grade of contamination was grade 2 in RLMA. RLMA had lower rates of postoperative adverse events.

Conclusions:
RLMA comparable to ETT in terms of emergence time. The RMLA group had lower remifentanil use, anaesthesia duration and fewer postoperative adverse events such as cough and throat pain.
A Clinical, Dermoscopic, and Histopathological Study of Follicular Psoriasis
Authors: Saep Maqbool , Shenoy Manjunath Mala , Rao Anuradha C. K. , Pinto Malcolm , Hegde Spandana Prakash , Iqbal Amina Asfiya M. 
Published: April 2024

Introduction:
Follicular psoriasis is one of the underdiagnosed clinical types of psoriasis. Literature is grossly limited to anecdotal case reports and series. Clinical and investigational aspects are not studied in depth.

Materials and Methods:
A study was conducted to determine the frequency of follicular psoriasis, which includes cases with an exclusive or substantial number of follicular lesions. We analyzed the clinical, dermoscopic, and histopathological features of follicular psoriasis in a descriptive study.

Results:
A total of 117 patients with psoriasis were screened. An exclusive or substantial number of follicular lesions were found in 22 patients. Four patients had exclusively follicular lesions and others were psoriasis vulgaris with follicular psoriasis. Dermoscopy revealed perifollicular scaling and white homogeneous area with normal terminal hair in all cases. Vascular features were visible in 14 cases and all had dotted vessels, with four having additional globules. Twenty patients revealed one or more features suggestive of follicular psoriasis on histopathology.

Conclusion:
Follicular lesions can appear exclusively or can coexist with plaque type of lesions in psoriasis. They may indicate early psoriasis lesions. Dermoscopy is a useful and rapid tool to confirm the diagnosis of follicular psoriasis. Histopathology, though confirmatory, demands an astute interpretational skill. Diagnosis of follicular psoriasis can have therapeutic implications.
Treatment Response to Diphenylcyclopropenone in Patients with Alopecia Totalis/Universalis
Authors: Varghese Smitha Ancy , Nair Sandhya S. , George Anuja Elizabeth , Yadev Induprabha 
Published: April 2024

Introduction:
Alopecia totalis (AT) and Alopecia universalis (AU) are forms of Alopecia areata (AA) which represent the strongest predictor of poor prognosis since spontaneous regrowth is <10%. Topical immunotherapy agent, diphenylcyclopropenone (DPCP) has shown clinical efficacy with limited side effects in severe forms of AA. However, its specific role in AT/AU characterized by complete hair loss over the scalp can help highlight the efficacy of the drug with fewer confounders.

Methodology:
Data were collected from 18 patients diagnosed with AT/AU and treated with topical immunotherapy with DPCP as per protocol by Happle et al. Baseline Severity of Alopecia Tool (SALT) score and subclass was recorded. In the case of AU, baseline body hair loss score was also recorded. Patients were reassessed after 6 months of treatment in terms of change in SALT score and hair regrowth was assessed using the Global Assessment Score. The side effects during treatment were also assessed and recorded.

Results:
Eighteen patients of whom eleven (61.1%) were diagnosed as AU and seven (38.9%) as AT were treated. The mean age was 21.6, with a male: female ratio of 3:2. The comorbidities noted were atopy in six (33.3%), atopy and hypothyroidism in one (5.5%), Down’s syndrome in two (11.1%), and hypothyroidism alone in one (5.5%) patient. The mean duration of disease at the time of presentation was 3 years and all patients had remained refractory to various other modalities of treatment. All patients had a baseline SALT score of 100 corresponding to S5. After 6 months of treatment, 27.7% of patients did not show any response (SALT score S5), 16.6% had a score of S4, 11.1% had a score of S3, 11.1% had a score of S2, 22.2% had a score of S1, and 11.1% had a score of S0. On assessing improvement in body hair loss score, 36.3% of patients showed no improvement, 36.3% showed partial improvement, and 27.2% of patients showed complete body hair regrowth. About 55.5% of patients developed notable side effects that included severe local reactions, cervical lymphadenopathy, acne and pigmentation at the site of application as well as untreated sites.

Conclusion:
The AT/AU subtypes of AA, was amenable to treatment with contact immunotherapeutic agent DPCP with a >75% hair regrowth in 33.3% of patients. The castling phenomenon was seen in 63.6% of AU patients. The adverse effects noted were not severe enough to deter treatment.
Effectiveness of Ayurvedic medicines in iron deficiency anemia: A review
Authors: Agarwal Bhawana , Singh Naimish R , Varsakiya Jitendrakumar N 
Published: April 2024

Abstract
Anemia is a major global public health issue that mostly affects young children, menstruating adolescent girls and women, and pregnant and postpartum women. The most typical kind of anemia worldwide is iron deficiency anemia (IDA). According to a World Health Organization report, IDA accounts for half of all cases of anemia. The emphasis is moving toward investigating alternative therapy modalities as a result of an expanding amount of data on the adverse effects and long-term implications of conventional treatments for IDA. Ayurveda offers several formulations for the management of IDA. This study will provide the strength of evidance based Ayurveda herble remedies to manage the IDA by the review of published clinical trials which has been competed. Data searches were conducted using databases, including Medline, Cochrane Database, Embase, AYUSH research portal, and many others. All randomized controlled trials involving individuals with IDA using Ayurveda formulations (alone or in combination) with an exposure period of ≥4 weeks were included. The primary outcome assessed was hemoglobin levels. Ten clinical studies were selected, evaluating various Ayurvedic formulations including Aamalki Rasayan, Dhatri Avleha, Dhatri Lauha, Opuntia elatior juice, Trikatrayadi Lauha suspension, Dhatryarishta, Trikatrayadi Lauha, Kasisa Bhasma, Punarnava Mandura, and Pandughni Vati, all of which were found effective in treating IDA. No untoward effects were observed. Most of the Ayurvedic formulations showed statistically significant improvements in subjective and hematological parameters. From this review, it can be concluded that the results of clinical studies conducted on IDA demonstrate the definite role of Ayurveda medication in managing the condition.
Efficacy of Ayurveda medicine in renal calculi (Ashmari) with hydronephrosis: a case study
Authors: Gill Dimpal , Yadav Minu , Choudhary Amit , Sharma Rituraj , Mishra Pramod Kumar , Sharma Indumati 
Published: April 2024

Abstract

Introduction:
Renal stone (Mutrashmari) is one of the most common diseases of Mutravaha Srotas (urinary system). It occurs when the formation of crystals, such as calcium, oxalate, uric acid, etc., takes place due to improper functioning of the filtration in the kidney.

Case Study:
The present study deals with a 20-year-old female patient having complaints of burning micturition, acute left flank pain in the abdomen and back which was radiating from the loin to the groin region, nausea, vomiting, dysuria. She was already diagnosed with renal calculi and was taking allopathic medications since for the last 1 month. Later she encountered the same problem and consulted an Ayurvedic physician. Ayurveda management primarily focuses on Samprapti Vighattana (breaking down the pathogenesis).

Diagnosis:
It was done on the basis of symptoms and USG reports.

Intervention:
By considering the Nidana, Dosha, and Dushya, a judicial combination of Ayurveda drugs-Gokshuradi Guggulu, Varunadi Kwatha, Tab. Cystone, Syp Neeri and Pasanbhedadi Churna were advised to take orally in morning and evening with lukewarm water.

Outcomes:
At the time of consultation her USG finding showed 8 mm calculus with nephrosis. After taking the prescribed formulation for 2 months, her USG report came to normal.

Conclusion:
The prescribed Ayurvedic herbal medicines are seen to be effective in managing the day-to-day life of an Ashmari patient.
Ayurveda intervention in Riehl’s melanosis- A case report
Authors: Raut Disha Anil , Patil Divya Deepak 
Published: April 2024

Abstract
Riehl’s melanosis (RM) is frequently identified as a kind of facial melanosis known as pigmented contact dermatitis (PCD). It results from cosmetic fragrances and their other products. The pigmentation on the forehead, temporal, and zygomatic areas of the face ranges from dark brown to grayish-brown. Satisfactory treatments are presently lacking leading to the psychological suffering of the patient. This study aims to find a promising solution for the RM WSR Dushi Visha. In the present case study, a 45-year-old female patient suffered from RM with blackish discoloration over the periorbital region, cheeks, and in the middle of the eyebrows with severe itching and dryness for the past 22 days. The patient was managed effectively with classical Ayurveda medications. In Ayurveda, this condition can be correlated with the symptoms of Mukhalepajanya Dushi Visha (artificial poison in the form of facial cosmetics), characterized by Mukhashyavata (blackish discoloration of the face), Kotha (round patches and rashes on the skin), intense Rukshata (dryness), and Kandu (itching sensation) followed by Daha (burning sensation). The principle of treatment is Raktamokshana (bloodletting) and drugs having Kushthaghna (antidermatosis), Kandughna (antipruritic), Raktashodhaka (blood purifier), Twak Prasadana (skin quality enhancer), and Varnyakara (promotes complexion) properties. The outcome of the assessment was based on the changes in the symptoms after 15 days of treatment. Recurrence of itching and burning was not observed during the follow-up period. The case sheds on the excellent management of RM by Ayurveda modalities.
Malnutrition and Refeeding Syndrome: Report of Three Patients on Jejunostomy Feeding Following Corrosive Oesophageal Injury
Authors: Jose Toney , John Jose 
Published: April 2024

Abstract
Patients with alternative enteral access for corrosive oesophageal stricture are a particularly sensitive group of patients requiring dedicated nutritional care. The COVID-19 pandemic and the resulting lockdown, restrictions, financial constraints and delayed surgeries have resulted in nutritional deprivation. Many of these patients present late to healthcare institutions with severe malnutrition. Refeeding should be done carefully in them to prevent refeeding syndrome. Here, we describe the clinical course of three patients who were on jejunostomy feeds for corrosive injury of the oesophagus, developed feeding tube-related complications and presented with severe malnutrition during the COVID-19 pandemic.
Hormone Receptor Status in Histologically Proven Carcinoma Breast
Authors: Sivakumar Anoop , Ganapath Aravind S. 
Published: April 2024

Abstract

Background:
Carcinoma breast is considered a heterogeneous disease with a varied spectrum of clinical, pathological and molecular features. The molecular classification of breast carcinoma is becoming the gold standard for its complete characterisation. Oestrogen receptor (ER) and progesterone receptor (PR) are routinely performed on all breast cancer specimens and are reliable, inexpensive and useful for therapeutic decision-making.

Aim:
The aim of the study was to find out the proportion of hormone receptor positivity in cases of breast cancer.

Materials and Methods:
This is a 1-year cross-sectional study conducted in general surgical wards of our institution. The sample size was 50. The selected patients were subjected to either of the following surgical treatments which are simple mastectomy, modified radical mastectomy or breast conservation surgery. After the surgery, the histopathological specimens were reviewed, and hormone receptor status was studied.

Results:
Ninety-six per cent of the study population had infiltrating ductal carcinoma and mucinous and metaplastic carcinoma constituted the remaining 4%. In this study, 35 (70%) had ER positivity and 28 (56%) had PR positivity on immunohistochemistry. Of all the factors studied, only age at first childbirth had a significant association with hormone positivity. 52.9% of women in the ER-positive group had first childbirth at or after 23 years. Only 14.3% of women with first childbirth at or after 23 years had ER negativity.

Conclusion:
The prevalence of hormone receptor positivity obtained in this study is more when compared to most of the studies from India and is comparable to the studies in Western literature.
Investigating the Potential Mechanism of Huazhi Rougan Granules Against Alcoholic Liver Disease by Network Pharmacology and Experiment
Authors: Tan Ying-Ying , Liu Ying-Ying , Zhai Yi-Yan , Wang Yi-Xuan , Wu Zhi-Shan , Stalin Antony , Cheng Guo-Liang , Li Bing , Wu Chao , Huang Zhi-Hong , Lu Shan , Fan Xiao-Tian , Zhao Zheng , Wu Jia-Rui 
Published: April 2024

Abstract

Objective:
Huazhi Rougan granules (HRGs) are a promising drug to improve alcoholic liver disease (ALD), but its mechanism remains unclear.

Materials and Methods:
Network pharmacology, molecular docking, and animal experiments were used to reveal the potential mechanism of HRG against ALD.

Results:
A total of 245 potential targets of HRG against ALD were obtained. Functional enrichment analysis suggests that HRG could synergistically regulate various biological pathways to exert therapeutic effects on ALD. Molecular docking showed that the key targets exhibited the good binding ability with the key compounds. The in vivo experiments showed that HRG can effectively alleviate pathological changes in liver tissue, improve blood lipid levels, antioxidant stress ability, and liver function, and reduce the release of inflammatory cytokines in the liver.

Conclusions:
This study reflects that HRG is an effective strategy for treating ALD, providing a basis for revealing the prevention and treatment mechanisms of ALD.
Carolingian and Ottonian Brass Production in Westphalia Evidence from the Crucibles and Slag of Dortmund and Soest
Authors: Merkel Stephen 
Published: April 2024

The abundant new crucible and slag finds from the Thier-Brauerei excavation in the center of medieval Dortmund have provided a stimulus to revive the discussion of Westphalian brass cementation technology in the Carolingian and Ottonian periods and to explore unanswered questions concerning the process and its potential outcome. A total of sixteen crucibles and slag samples from stratified deposits in the Dortmund-Thier-Brauerei and Soest-Plettenberg excavations were prepared for optical and scanning electron microscopy to analyze metallic inclusions, slag phases and crucible ceramic. The copper and brass inclusions within the crucibles and their adhering slag from Dortmund show a relationship between lead and zinc contents and indicate that lead-bearing calamine ore was heated with charcoal and copper metal to produce leaded brass. Ternary Cu-Zn-Pb alloys are common for contemporary bar-shaped ingots, which supplied casting industries in early medieval Northern European towns like Hedeby and Kaupang. Concerning the zinc-rich black slag lining the interior of some crucible fragments, they regularly showed increases in lime and iron oxides in relation to the crucible ceramic and thus reflect impurities coming from the zinc ore. The lead-silicate slags often found in association with crucible finds in Dortmund have yet to have a clear interpretation; although the lead isotope analysis of crucibles and lead-silicate slag shows they may have the same source of lead, the production of the lead-silicate slag is definitely unrelated to the metallurgical process occurring inside the cementation crucibles themselves.
Editorial
Authors: Piedimonte Fabián César 
Published: April 2024

Estimados colegas, amigos, lectores de NeuroTarget:
Este número inicia con la fascinante y atrapante historia de vida en lo personal y profesional del Dr. George Udvarhelyi, neurocirujano de origen húngaro que se desempeñó en nuestro país entre los años 1948 y 1952.Estuvo involucrado en el ambiente de la neurocirugía funcional y estereotaxia durante este período, participando nada más y nada menos que en el procedimiento de lobotomía pre frontal con fines antálgicos, realizado a la primera dama Eva Duarte de Perón en el año 1952.