bluuebunny/crossref_metadata_2025_split huggingface dataset:
Short-term outcomes of aortic valve neocuspidization using autologous fixed pericardium versus aortic valve replacement using mechanical prosthesis in patients with aortic valve disease
Authors: El Barbary Moustafa Gamal-Eldin , Seddik Amr Ahmed Mohamed , Hussein Mohamed Attia , Omar Ahmed Helmy 
Published: October 2023

Background
Aortic valve replacement by prosthetic valves, either mechanical or biological, is the ultimate known therapy for patients with aortic valve disease whether stenosis or regurgitation. However, these prostheses may have the concern of valve degeneration and the need for reoperation with the biological valves or the need for lifelong anticoagulation with considerable side effects with the mechanical valves. In this study, we compare the application of the new Ozaki technique in Ain Shams University Hospitals Cardiothoracic Academy to the current practice of aortic valve replacement using mechanical valve prosthesis

Aim of the work
To study the hemodynamic performance and major adverse events that are related to the valve of the novel technique in reconstructing the aortic valve using autologous pericardium (AVNeo) versus the conventional aortic valve replacement using a prosthetic mechanical valve.

Patients and methods
This was a nonrandomized clinical trial on 20 patients conducted at Ain Shams University Hospitals Cardiothoracic Academy during the period from November 2021 to December 2022. Inclusion criteria include age from 18 to 65 years, moderate to severe aortic stenosis, and sole aortic valve disease. Exclusion criteria include refusal of the Ozaki technique, concomitant intervention of the aortic arch, emergency surgery, porcelain aorta, and previous cardiac surgery. We divided the patient population into two groups through nonrandom allocation: Group I: aortic valve neocuspidization using autologous fixed pericardium and group II: aortic valve replacement using mechanical prosthesis.

Results
The hemodynamic performance of patients who underwent aortic valve replacement with either the AVNeo or AVR techniques was evaluated at discharge and 3 months postsurgery. No significant differences were observed in mean and median values of MPG, vena contracta, and coaptation length between the groups at discharge and 3 months postsurgery. However, at 3 months, the mean PPG was significantly lower in the AVNeo group compared with the AVR group (14.80±3.01 vs. 24.00±6.80, P<0.001). In addition, there was a significant decrease in mean PPG and MPG values within the AVNeo group at 3 months compared with at discharge (P=0.005 and P<0.001, respectively), whereas no significant change was observed in the AVR group. These findings suggest that the AVNeo technique may offer better hemodynamic outcomes in terms of PPG compared with the AVR technique at 3 months postsurgery.

Conclusion
Results showed that both AVNeo and AVR exhibit comparable outcomes at discharge and at 3 months after the study’s conclusion. The postoperative morbidity and mortality are low with the Ozaki procedure, making it dependable and safe.
Laser hemorrhoidoplasty combined with blind hemorrhoidal artery ligation compared to Milligan–Morgan hemorrhoidectomy in patients with second and third degree piles; a prospective randomized study
Authors: Abdelhamid Amir F. , Elsheikh Mohamed M. , Abdraboh Osama H. 
Published: October 2023

Background
Laser hemorrhoidoplasty is a relatively new management option for symptomatic hemorrhoids. Although its advantages over the Milligan–Morgan approach were highlighted in previous trials, the combination of laser and mucopexy (hemorrhoidal artery ligation) is scarcely discussed in the literature. Herein, the author compared the outcomes of the previous combination with the traditional Milligan–Morgan procedure in cases with second and third-degree piles.

Methods
The 66 included patients were randomly divided into two groups; group A underwent the combined approach, while group B underwent the Milligan–Morgan procedure. Postoperative pain, satisfaction, and complications were assessed.

Results
Preoperative data, including patient presentation and the degree of piles, were comparable between the two groups. Nonetheless, operative time and hospitalization period showed a significant increase in group B (P = 0.004 and < 0.001). Group A patients expressed significantly lower pain scores during rest and defection, as well as a better satisfaction level, compared with group B patients. The incidence of postoperative complication did not differ between the two interventions, except for urine retention, which was more frequently encountered in group B cases. An earlier return to normal daily activities was noted in group A. 1-month Wexner scores did not differ between the two groups, and no cases developed recurrence during the 1-year follow-up.

Conclusion
The combination of laser with hemorrhoidal artery ligation is associated with multiple advantages over surgical hemorroidectomy manifested in a better analgesic profile, better satisfaction, and an early restoration to daily activities.
Single-team transanal total mesorectal excision for mid and lower rectal cancer: Snow Leopard approach
Authors: Farag Ahmed F.A. , Abdelhamid M.S , El shafie Mohammed M. , Mostafa Mahmoud , Ibrahim Abulfetouh M. , Abdallah Abdallah B. , Ammar S.A. , Elbarmelgi Mohamed Y. , Daoud Sahar A. , Lotfallah Israa M. , Abdelmawla Mohamed H. 
Published: October 2023

Background
Transanal total mesorectal excision (TaTME) is a recently developed technique to overcome difficulties of rectal cancer resection spatially in male patients, large tumors, high body mass index, and low rectal cancer.

Methods
From April 2018 to March 2021, 30 patients were included. Single-team TaTME was done, using traditional Laparoscopic instruments and a two-dimensional HD camera, starting with the abdominal phase. The analysis focused on operative data and short-term surgical outcomes.

Results
30 taTME procedures were performed, 16 (53.3%) males and 14 (47.7%) females, with a mean age of 50.43 years. There were 21 (70%) patients with tumors in the middle part of the rectum and 9 (30%) patients with tumors in the low rectum. All patients received Long Course Neoadjuvant CRT. The duration of hospital stay was 5.27±1.08 days. The median operative time was 135.27 min the estimated blood loss was 133.67 66.59 ml.
Complete mesorectal excision was achieved in all patients. Circumferential radial margin (CRM) was negative in all cases. 1 (3.3%) case needed conversion to an open approach. The overall postoperative complications rate was 6.6% (2 cases).
Postoperative ileus occurred once, and anastomotic leakage occurred in one patient.

Conclusions
In experienced hands, TaTME is a safe technique but still a challenging procedure. The author suggest that single team approach is not time-consuming (operative time was less than what had been reported by other authors using the two-team approach), and dissection should be done through the proper plane (TME planes) lateral to the urosacral ligament in females and its analog in males named prostatosacral ligament as described in the Paper to minimize the incidence of local recurrence.
Evaluation of the role of autologous fat transfer in reduction of radiation complications in implant based breast reconstruction
Authors: Elmedany Sherif A. , Salem Iman L. , Ghozlan Nasser A. , Alhussini Mahmoud A. 
Published: October 2023

Background
Implant-based breast reconstruction (IBBR) is the most common method of reconstruction after mastectomy.(1) Postoperative radiotherapy is associated with a significant increase in complications. We report our experience with the use of autologous fat transfer (AFT) to reduce radiation complications in (IBBR) and assess survival of the transferred fat after breast radiation.

Patient and methods
This study was a prospective comparative study of 20 patients who were divided into two groups using the closed envelope technique: group (A) consisted of 10 patients treated with (AFT) during the first phase of (IBBR), group (B) consisted of 10 patients not treated with (AFT) during the first phase of (IBBR), both groups underwent postmastectomy radiotherapy (PMRT).
A survey was done to analyze radiation complications and assessment of fat survival using computed tomography.

Results
Both groups (A) and (b) consist of 10 patients (9 unilateral and one bilateral) with 11 treated breasts in both groups Mean follow-up was 6 months. Complication rates in group (A) versus group (B) were as follows: surgical-site infection, 0% versus 9.1%; Superficial mastectomy flap necrosis, 9.1% versus 18.2%; wound dehiscence, 0% versus 9.1%; minor capsular contracture grade 1 2, 36.4% versus 54.5%; major capsular contracture grade 3,4 0 percent versus 18.2%; Radiation dermatitis 9.1% versus 27.3%; no hematoma, Seroma, Full-thickness mastectomy flap necrosis nor extrusion in both groups
The average fat retention percentage after radiation was 74.82±4.21%.

Conclusions
Early data of the use of AFT as a protective measure in prepectoral IBBR in Patients with postmastectomy radiation therapy show promising results.
The outcomes of laparoscopic versus open appendectomies for complicated appendicitis
Authors: Sabry Ahmed A. , Menesy Mahmoud , Kassem Mohamed , Elkeleny Mostafa R. 
Published: October 2023

Background
The role of laparoscopic appendectomy remains controversial in the context of complicated appendicitis. This study aimed to compare the clinical outcome of laparoscopic versus open appendectomy (OA) in patients with complicated appendicitis regarding operative time, morbidity, hospital stay, postoperative pain, ileus, 1-month follow-up, and need for readmission.

Methods
A randomized controlled study was performed on 40 patients presenting with complicated appendicitis. 20 patients were subjected to laparoscopic appendectomy (LA) and 20 patients underwent traditional OA.

Results
25 (62.5%) patients were female, and 15 (37.5%) patients were male. A significant difference was noted in the domains of postoperative pain, return of peristalsis, time to start oral, hospital stay, and return to daily activities. The mean operative time was shorter in OA 91.4±11.99 min than in LA 109.1±16.71 min No statistically significant difference between both groups was calculated as regards the occurrence of intraabdominal collection.

Conclusion
Based on its clinical outcomes, laparoscopy should be considered in the setting of complicated appendicitis. The possibility of intraabdominal collection should not be a barrier against the widespread practice of this surgical procedure among laparoscopic surgeons if adequate precautions were employed.
Safely managing pain in hospitalized older adults
Authors: Alban Heather L. , Krasa Heather E. , Deringer Peter W. , Kumar Kushee-Nidhi 
Published: October 2023

Introduction:
Opioid pain medications carry serious risks when not used properly. Tools should be used to establish individualized, multimodal pain treatment plans that use opioids judiciously and effectively. This study aimed to explore outcomes of older adult patients who experience acute pain and determine if implementation of a Geriatric Acute Pain Management Order Set reduces opioid consumption during hospitalization, length of stay, unnecessary readmissions, and discharges to skilled nursing facilities.

Materials and Methods:
This was a retrospective chart review over 12 months at a Level I trauma center. Implementation of Geriatric Acute Pain Management Order Set on adults ≥70 years admitted to services diagnosed with long bone, rib, vertebral, or pelvic fracture. Exploratory analysis using the order set was compared to standard pain management practices.

Results:
Nonsignificant association was found between order set usage and average oral morphine equivalents (OMEs), consumption per day (P = 0.08), length of stay (P = 0.45), and number of days to readmission (P = 0.70). Hip/femur/pelvic fractures showed higher median OME/day (14.2 mg) compared to patients with humerus/scapula/clavicle fracture(s) (8.9 mg). Median OME/day was statistically different between types of service lines (P < 0.01), with orthopedics having the highest daily OME (30.4 mg). Most patients were discharged to skilled nursing facilities (n = 277) and homes (n = 114) with no demonstrated correlation between the amount of opioids consumed and discharge disposition.

Conclusions:
Order set integration into practice guides safe and effective care of older adults experiencing pain. Optimization of pain management modalities in the hospital serves to restore mobility and function, reduce patient harm, and improve quality of life.

The following core competencies are addressed in this article:
Practice-based learning and improvement, Patient care and procedural skills, and Systems-based practice.
Role of Desmopressin Acetate before Percutaneous Ultrasound-Guided Kidney Biopsy in Patients with Kidney Dysfunction
Authors: Sethi Jasmine , Bansal Sandeep , Lal Anupam , Kohli Harbir Singh , Rathi Manish 
Published: October 2023

Abstract

Introduction:
The most common complication of percutaneous kidney biopsy is bleeding, which can be seen in up to one-third of cases. The aim of this study was to evaluate the effect of prebiopsy administration of intranasal desmopressin acetate in reducing the incidence of biopsy-related bleeding complications.

Methods:
This was a prospective randomized double-blind pilot study conducted at our center from January 2021 to September 2022. Consecutive adult patients who underwent native percutaneous kidney biopsy with an estimated glomerular filtration rate (eGFR) ≤45 ml/min/1.73 m2 were randomized into a placebo (saline intranasal spray) group versus intranasal desmopressin group. The bleeding complications were compared between the two groups.

Results:
A total of 80 patients who underwent kidney biopsy at our center from January 2021 to September 2022 with eGFR ≤45 ml/min/1.73 m2 were included (40 patients in desmopressin group and 40 patients in non-desmopressin group) in the study. The mean age of the patients was 44 ± 12 years with a mean eGFR of 20.82 ± 12.64 ml/min/1.73 m2. Intranasal desmopressin administration before kidney biopsy was associated with a significantly higher number of minor bleeding complications (P = 0.02) and no significant reduction in major complications (P = 0.15) when compared with a group that did not receive desmopressin. Other complications like hypotension, flushing, and vasovagal syncope were not statistically significantly associated with the use of desmopressin.

Conclusions:
Our study did not find any utility of prophylactic desmopressin use before kidney biopsy in patients with kidney dysfunction.
A Randomized Controlled Trial Comparing Remission Induction with Modified Multitarget Therapy with Intravenous Cyclophosphamide in Proliferative Lupus Nephritis
Authors: Pal Atanu , Chaudhury Arpita Ray , Bhunia Abhirup , Bhattacharya Koushik , Chatterjee Suparna , Divyaveer Smita Subhash , Sircar Dipankar , Sen Debabrata 
Published: October 2023

Introduction:
Therapy of proliferative lupus nephritis (PLN) is yet to be optimized. Standard of care for induction consists of intravenous (IV) cyclophosphamide (CYC) and steroids, which shows an improved outcome, but end-stage renal disease (ESRD) progression, increased mortality, and therapy-related adverse effects remain a major concern. The other treatment reported to induce early remission was the multitarget therapy comprising tacrolimus, mycophenolate, and steroid, but infections were high in the multitarget therapy. Considering azathioprine as a potentially safer and effective alternative anti-B-cell therapy, modified multitarget therapy (MMTT) was planned replacing mycophenolate with azathioprine.

Material and Methods:
A single-center, 24-week, open-label, randomized controlled trial comprising adults of age 18–65 years with biopsy-proven PLN was carried out. The intervention groups were 1) MMTT: tacrolimus 0.075 mg/kg/day and azathioprine 2 mg/kg/day and 2) IV CYC group with a starting dose of 0.75 (adjusted to 0.5–1.0) g/m2 every 4 weeks for 6 months. Both groups received 3 days of pulse methylprednisolone followed by a tapering course of oral prednisone therapy.

Results:
Among 100 randomized patients, 48 were in MMTT arm and 52 were in IV CYC arm. At the end of 24 weeks, overall remission (complete and partial) was comparable in both the arms: MMTT (86.36%) and IV CYC (87.75%). There was comparable proteinuria reduction and systemic lupus erythematosus disease activity index (SLEDAI) score improvement with recovery of complement level C3 in both groups. Major adverse events were numerically more in the IV CYC group, including one death from pneumonia.

Conclusion:
The MMTT arm is as effective as IV CYC in improving short-term outcome in PLN, with a comparable safety profile.
Longitudinal Assessment of Health-Related Quality of Life in Three Different Hyperphosphatemia Management Groups of Stage Ⅲ and Ⅳ Chronic Kidney Disease Patients
Authors: Kaur Navjot , Mahapatra Himansu S. , Pursnani Lalit , Muthukumar B , Singh Mansi , Gupta Yadunandan P. 
Published: October 2023

AbstractIntroduction:Health-related quality of life (HRQoL) has emerged as an important outcome measure inpatients with CKD. The lack of prospective studies on HRQoL and its relation with hyperphosphatemia control measures among pre-dialysis patients necessitated the need for this study.Methods:This isa prospective, randomized, controlled, open-labelled studythat was conducted for one year on 120 CKD stages Ⅲ and Ⅳ patients divided equally into three groups: Group 1, in which patients under went dietary phosphorus modification; Group 2, in which they were administered calcium-based phosphate binders; and Group 3, in which they were administerednon-calcium-based phosphate binders. Patients were assessed for HRQoL, fibroblast growth factor 23 (FGF 23), intact parathyroid hormone (iPTH), phosphorus, and nutritional status, and dietary phosphorus control strategies at 0, 6, and 12 months. HRQoL was measured by using the 36-item Short Form Survey (SF-36) that included a physical component score (PCS) and mental component score (MCS). The scores is ranging from0 to 100. Higher scores indicate better health status. Usingthe two-wayand one-way repeated measure ANOVA, we analyzed equality of group means, time intervals, and interactions.Results:At baseline, the mean PCS and MCS were equal in three groups. PCS improved significantly (P< 0.00) from baseline to one year in all the three groups: ingroup 1, the PCS score was 66.5 ± 13.5to 75.1 ± 9.76; in group 2, it was 68.9 ± 11.80 to 77.2 ± 7.50;and in group 3, it was 66.2 ± 12.16 to 73.8 ± 9.27. Initially, MCS declined substantially on the sixth month but recovered afterone year. Multiple regression analysis in 13 associated parameters yieldedR2of 13.7% and 18.1% in PCS and MCS, respectively, indicating little contribution of various parameters.Conclusion:There has been a significant positive change in PCSs in three hyperphosphatemia management groups over a period of 12 months. Among the three study groups, the incremental changes in PCS and MCS scores were insignificant.
Loss of working length in curved canals with rotary nickel–titanium instruments and reciprocating files
Authors: Jenaki E. V. , Sreelekshmi V. , Yadav B. Akhil , Aswathy Y. , Amal P. Fathima , Noora M. 
Published: October 2023

ABSTRACT

Aim:
The aim of the study was to investigate the change of working length in curved molar root canals after preparation with rotary nickel–titanium instruments and reciprocating files.

Materials and Methods:
Thirty human-extracted maxillary and mandibular molars with curved roots were selected, with the help of a radiographic platform, a constant object sensor distance was arranged to take a digital radiograph of each tooth for determining the angle of curvature of the roots by Schneider’s method. The teeth were divided into Groups I, II, and III based on the instrumentation, ProTaper group, Reciproc group, and control group, respectively. Preoperative and postoperative working length was determined and compared using cone-beam computed tomography. The difference was determined statistically using one-way anova analysis.

Results:
There was minimum loss of working length found when instrumentation was done with Reciproc files compared with ProTaper.

Conclusion:
Reciprocating instruments can be an effective alternative used in the preparation of severely curved canals.
A review on understanding the risk factors for coronary heart disease in Indian college students
Authors: Ghosh Joyeta 
Published: October 2023

ABSTRACT
College students shift from being adolescents to becoming adults, and they are more likely to embrace habits that increase the risk of coronary heart disease (CHD). India has 253 million teenagers and is the second-most populous nation in the world. The current situation in India shows that young people there are at risk for CHD-related diseases. The long-term CHD risk in the future is highly predicted by the current risk factors in young people. The purpose of the current study is to describe all the research that was done among Indian college students to show the depth of CHD exposure in young people. This analysis emphasizes the demand for better risk assessment techniques and more youth awareness among Indians. The evidence of the persistence of CHD risk factors in these college-bound students comes from various cross-sectional studies. However, they are largely modifiable risk factors for diabetes, hypertension, and CHD that are very common among India’s student population. These CHD risks can be changed in 80% of cases. Therefore, a community-based approach will be helpful in this multicultural nation to prevent CHD. To correctly identify and manage CHD, increased screening should play a crucial role in tandem with education.
Pain as a presenting symptom of hypothyroidism
Authors: Kumar Nishant , Kamal Mrinal , Kohli Pramod 
Published: October 2023

Abstract
Chronic back or limb pain is often debilitating and disabling resulting in loss of efficiency, depression, and low self-esteem. Diagnosis usually suggests arthritis or nerve root pathology and patients receive long-term oral analgesics and invasive procedures with little or no relief. Hypothyroidism may present as peripheral neuropathy which may be clinically indistinguishable from entrapment neuropathy as occurs with neural canal stenosis. Muscle cramps, aches, proximal symmetrical muscle weakness, stiffness, polymyositis, and exercise intolerance may be the only presenting symptom indicating hypothyroidism. We present five cases of acute on chronic pain that improved significantly on treatment with thyroxine. Neuromuscular pain may be the only presenting symptom of hypothyroidism. Thyroid profile (TSH, FT3, FT4) and anti-thyroid peroxidase (anti-TPO) antibodies should be screened before subjecting the patient to multiple analgesics and procedures.