bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of Radiofrequency Ablation and Conventional Surgery in the Treatment of Varicose Veins
Authors: Leons Jibin , Jose Jomine , John Binni 
Published: January 2023

Background:
This retrospective study was aimed to compare the outcomes between radiofrequency ablation (RFA) and conventional surgery which included the Trendelenburg procedure, multiple perforator ligation, hook phlebectomy and stripping for the treatment of varicose veins using Clinical, Etiological, Anatomical, and Pathophysiological classification (CEAP) and Venous Clinical Severity Score (VCSS) in a tertiary care centre.

Materials and Methods:
The pre-operative and post-operative CEAP classification and VCSS were calculated. The satisfaction from the surgery was assessed using a structured questionnaire and data analysed using IBM SPSS software.

Results:
The majority of the patients in the study belonged to the age group of 41–50 years. Females comprised 58% and housewives comprised 35% of the total patients. Patients with a body mass index of 18.5–24.9 constituted almost 44%. Twenty-four individuals had a family history of varicose veins. Doppler studies showed that at 83%, the most common pathology was sapheno-femoral junction (SFJ) and perforator incompetence. Five per cent of individuals had perforator incompetence alone. Thirty-four per cent of the individuals underwent RFA. The improvement in CEAP was 3.03 ± 1.513 in RFA group and 2.91 ± 1.279 in conventional surgery group; statistical analysis did not show any significant difference between the groups. The post-operative VCSS improved from 7.94 ± 1.718 in conventional surgery group and 7.38 ± 1.706 in RFA group to 1.52 ± 1.070 and 1.03 ± 0.577, respectively. The most common problem after surgery was saphenous neuralgia (8%). The severity of pain in the 1st week after the intervention was 'very mild' for most of the patients who underwent RFA (47.1%), and moderate for those in conventional surgery group (37.9%). The average days to return to normal activity were 10.26 ± 3.96 and 3.44 ± 1.637 in conventional surgery and RFA groups, respectively, whereas the average days to return to work were 17.41 ± 5.418 and 9.50 ± 1.846 days, respectively.

Conclusion:
The results indicate that both RFA and conventional surgeries in the form of the Trendelenburg procedure, stripping, phlebectomy and perforator ligation provide comparable relief of symptoms and clinical improvement when applied for the treatment of varicose veins. However, RFA may offer a significant advantage over conventional surgery in terms of faster recovery and early return to normal life and work.
Diagnostic Test Evaluation of Raja Isteri Pengiran Anak Saleha Appendicitis Score in Patients with Acute Appendicitis
Authors: Gowshika S. , Kumar S. Santhosh 
Published: January 2023

Introduction:
The diagnosis of acute appendicitis is still heavy reliant on clinical judgement as the availability and quality of imaging studies are quite variable. The Alvarado score and newer scores have been proposed in recent times, one of which is the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) score. It has been developed for a better diagnosis of acute appendicitis; the score includes 14 clinical parameters, which have higher sensitivity, specificity and diagnostic accuracy than Alvarado scoring, especially in the Asian population.

Methodology:
The objective was to evaluate the diagnostic accuracy of the RIPASA score with respect to histopathologically proven appendicitis. A diagnostic test evaluation was conducted in the surgical wards of a tertiary care centre for 1 year on patients undergoing emergency appendicectomy for acute appendicitis. Consecutive sampling was done on 132 participants. After administering the RIPASA score questionnaire to the patients, the histopathological reports were collected and the scoring system was compared to obtain sensitivity, specificity, predictive values, likelihood ratios and area under curve (AUC).

Results:
Of the 132 patients, 50.8% were male and 49.2% were female, with the majority of patients <40 years. Among components of the RIPASA score other than age, sex, anorexia, duration of symptoms and Rovsing's sign, all other components had an independent statistically significant association to histologically proven appendicitis. The receiver operating characteristic curve analysis of the RIPASA score showed an AUC of 0.915 (P < 0.0001). The negative appendicectomy rate was about 19.6%.

Conclusion:
The RIPASA score is a simple scoring system with high sensitivity and specificity for the diagnosis of acute appendicitis. The 14 clinical parameters are easily obtained from a good clinical history and examination and can be easily and quickly applied. Therefore, a decision on the management can be made early and complications can be prevented.
Predictive Value of Serum C-Reactive Protein and Serum Lactate in Intestinal Obstruction with Suspected Strangulation
Authors: Safwan A Mohamad , Muhammed Irfan K. P. C. , Chellapan Rajeev , Firoz Khan M. H. , Vijayan K. N 
Published: January 2023

Background:
Intestinal obstruction is one of the common clinical problems encountered in surgical practice, and the dreadful complication of intestinal obstruction is strangulation, which requires an emergency surgery for management. The main objective of our study was to evaluate patients with clinical suspicious intestinal obstruction and to find out the significant levels of serum C-reactive protein (CRP) and serum lactate in the early detections of strangulation preoperatively.

Materials and Methods:
A total of 30 patients who aged between 15 and 80 years were included in the study after excluding the patients of comorbid medical illness and patients with findings other than obstruction or strangulation. The serum values of CRP and lactate were measured pre-operatively and compared between obstruction with strangulation and obstruction without strangulation. Receiver operating characteristic (ROC) curve was drawn, and cut-off values for the diagnosis of strangulation were calculated along the calculation of sensitivity, specificity, positive predictive values (PPVs) and negative predictive values (NPVs).

Results:
Fifteen patients of strangulated bowel obstruction had significantly higher values of serum CRP and lactate when compared with 15 patients of simple bowel obstruction (99 vs. 38.3 mg/L and 35 vs. 9.9 mg/dl, respectively, P < 0.05). Using ROC analysis, the area under the curve of serum CRP and lactate was found to be 0.809 and 0.947, respectively for bowel strangulation. The serum CRP test has the sensitivity of 80.0%, specificity of 66.7%, PPV of 70.6% and NPV of 76.9% to detect the obstruction with strangulation when using a cut-off value of 49 mg/L. The serum lactate test has the sensitivity of 86.7%, specificity of 73.3%, PPV of 76.5% and NPV of 84.6% to detect the obstruction with strangulation when using a cut-off value of 19 mg/dl.

Conclusion:
The serum CRP and lactate are useful and reasonable diagnostic markers for predicting strangulation in cases of acute intestinal obstruction in an emergency setting.
Serum Bilirubin as a Predictor of Complications of Acute Appendicitis in Adults
Authors: Muhammed Irfan K P C , Rajeev C , Safwan A Mohamad , Khan Shafy Ali , Vijayan K N , Varghese Liju 
Published: January 2023

Introduction:
Acute appendicitis is a very common cause of acute abdomen and the diagnosis is essentially clinical. A decision to operate based on clinical suspicion alone can result in removal of a normal appendix; whereas, if left untreated, appendicitis can result in necrosis and perforation. Therefore, improving the diagnostic accuracy of appendicitis is a need of the hour. This study was conducted to evaluate hyperbilirubinaemia in acute appendicitis to find out its predictive value in complications like perforation.

Materials and Methods:
This prospective study for diagnostic test evaluation was conducted amongst the inpatients in the Department of General Surgery, KIMSHEALTH Trivandrum, during the period from August 2019 to August 2020. A total number of 100 patients who were admitted with the clinical diagnosis of acute appendicitis were studied, and serum bilirubin and liver function tests were carried out in all of them.

Results:
Total bilirubin levels when compared with histopathological diagnosis by unpaired samples t-test, the t-value = 0.763, P = 0.447 > 0.05 which shows no statistically significant difference between total bilirubin levels in uncomplicated and complicated acute appendicitis based on histopathological diagnosis. Sensitivity is 81.8%; specificity is 29.2%; positive predictive value (PPV) is 12.5%; negative predictive value (NPV) is 92.9%.

Conclusion:
Elevated total serum bilirubin levels have a fairly high sensitivity and NPV in predicting complications of acute appendicitis, but the specificity and PPV are quite low, and hence, hyperbilirubinaemia could be used as an aid in diagnosing complicated acute appendicitis along with the clinical findings and ultrasonography findings, but it is not reliable as a standalone diagnostic test. If the total serum bilirubin levels are low, an alternate diagnosis could be suspected, and the chances of complicated appendicitis are quite low, but elevated serum bilirubin values alone cannot confirm the presence of complications. Therefore, our study could not find any correlation between the absolute levels of elevation of total bilirubin values and the presence or absence of complications in acute appendicitis.
Therapeutic Outcome of Lateral Internal Sphincterotomy in the Treatment of Chronic Anal Fissures
Authors: Varghese Melvin , Shaju S. , Saran N. , Firoz Khan M. H. , Ali Khan S. L. Shafy 
Published: January 2023

Introduction:
Chronic anal fissure (CAF) is one of the most common proctologic conditions seen in surgery and is the most common cause of perianal pain. The surgical procedure of choice is lateral internal sphincterotomy (LIS) which usually provides a permanent cure for CAF. The fear of causing incontinence restricts many surgeons from performing LIS for managing CAF. The objective of our study is to evaluate the outcome of LIS in treating CAF in terms of fissure healing and reduction in resting anal pressure (RAP), as well as the incidence of anal incontinence following the procedure.

Materials and Methods:
A prospective study was conducted among 43 patients with CAF who underwent LIS. Anal manometry of the patients was done and results were noted preoperatively as well as at 6 weeks postoperatively. Patients were followed up and symptom relief, healing of fissure and incontinence to flatus or stool if present were noted on post-operative day, 1 week after surgery and 6 weeks after surgery.

Results:
Fissure healed in all 43 patients who underwent LIS in our institute. Hence, we observed a 100% healing rate following the procedure. RAP was found to be raised in all patients with CAF who required surgical treatment with a mean pre-operative RAP of 86.6 mmHg (normal 40–60 mmHg.). There was a significant reduction in RAP after the LIS surgery with a P < 0.001. The mean post-operative RAP was 53.16 mmHg which is in the normal range. Only one patient (2.3%) developed post-operative anal incontinence in our study. He was also managed conservatively with no permanent incontinence.

Conclusions:
We conclude that LIS is the surgical treatment of choice for CAFs, as it gave a 100% healing rate with a very low incidence of post-operative anal incontinence and other complications.
Hypocalcaemia Following Thyroid Surgery in a Tertiary Care Centre
Authors: Vadivelu Anusha , Vijayan K. N. , Varghese Liju 
Published: January 2023

Introduction:
Hypocalcaemia may occur secondarily to surgical trauma, devascularisation, unintentional removal of parathyroid glands and ligation of both inferior thyroid arteries. The objective of the study was to evaluate the calcium level after thyroid surgery and to evaluate the clinical symptoms and signs of hypocalcaemia after thyroid surgery.

Materials and Methods:
Eighty-one patients were evaluated; post-operatively, the calcium levels were monitored and early hypocalcaemia was detected by looking for the symptoms and signs of hypocalcaemia. The calcium levels were recorded from post-operative day 1, 2, 3 and 7. By this method, low serum calcium levels are corrected by calcium supplements and can prevent the need of parental calcium.

Results:
The most common age group affected by thyroid disorders was 41–50 years and less common age group affected was above 60 years. Females (71.6%) were commonly affected by thyroid disorders compared to males (28.4%). Majority of the patients were diagnosed with multinodular goitre (42%), followed by papillary carcinoma (39.5%). Most of our study population underwent total thyroidectomy (around 90%). The number of patients who encountered carpodeal spasm was 1.2% Chovstek sign, trousseau sign, electrocardiogram changes were seen in 2.5% population Patients who received treatment for symptomatic hypocalcaemia was 2.5%.

Conclusion:
Females were more prone to hypocalcaemia compared to males. Hypocalcaemia was found to be more prevalent in those patients who underwent total thyroidectomy compared to other surgeries. This can be prevented by meticulous dissection, identification of parathyroid and serial monitoring of calcium levels. Our study also serves as a cost-effective tool for the general population and immediate intervention can be given to the patients who are at risk to become symptomatic and improve their quality of life.
Validation of a scoring system to predict difficult laparoscopic cholecystectomy
Authors: Saran N. , Khan Shafy Ali , Najeeb A. A. , Jithu T. G. , Safwan A. Mohamad , Varghese Melvin , Shaju S. , Vijayan K. N. 
Published: January 2023

Background:
Acute calculous cholecystitis is one of the common conditions. The initial radiological investigation of choice is ultrasonography of the abdomen. Cholecystectomy is the definitive treatment for acute cholecystitis. Laparoscopic cholecystectomy is the procedure of choice for acute cholecystitis. Sometimes there is a need for conversion to open cholecystectomy due to intra-abdominal adhesions which make laparoscopic cholecystectomy difficult. Hence, pre-operative prediction of the risk of conversion or difficulty of operation is an important aspect of planning laparoscopic surgery. In our study, we aimed to analyse the various risk factors and to predict the difficulty and degree of difficulty pre-operative lay by the use of a scoring system.

Materials and Methods:
All 100 patients were evaluated and their clinical and ultrasound parameters were recorded. They received symptomatic treatment with antibiotics and analgesics preoperatively. Following that, they were subjected to laparoscopic cholecystectomy, time taken, bile spillage, stone spillage, injury to duct, artery and conversion to open cholecystectomy were noted. All patients were operated by similarly experienced surgeons. Postoperatively, cases were followed up for any complications and they were discharged on recovery.

Results:
Receiver operating characteristic curve analysis of pre-operative with an intraoperative score in our study with area = 0.846, P = 0.0005 <0.01 is highly statistically significant at P < 0.01 level. The sensitivity and specificity of the scoring system at score 0–5 for the prediction of easy laparoscopic cholecystectomy are 89.2% and 80.0%, respectively, and the sensitivity and specificity of the scoring system at score 6–10 for the prediction of difficult laparoscopic cholecystectomy are 80.0% and 89.2%, respectively.

Conclusion:
Our study concludes that the scoring system evaluated is robust, reliable and useful to predict difficult laparoscopic cholecystectomy.
Predictors of surgical outcomes in patients with drug-resistant temporal lobe epilepsy
Authors: Shelyagin I. S. , Akimova P. O. , Stefanov S. Zh. , Sufianov R. A. 
Published: January 2023

Aim. To identify predictors of surgical outcomes in patients with drug-resistant temporal lobe epilepsy in a multivariate model.Materials and methods. Aretrospective study included 69 patients with drug-resistant temporal lobe epilepsy who underwent microsurgical anterior temporal lobectomy. The study included 31 (45%) men and 38 (55%) women. The median age was 28 (21; 36). Surgical treatment outcomes were assessed at 6, 12, 36, and 60 months after surgical intervention according to the Engel Epilepsy Surgery Outcome Scale. Logistic regression equations were calculated, a ROC curve was constructed, and odds ratio (OR) with 95% confidence interval (CI), sensitivity, specificity, area under the ROC curve (AUC) were calculated.Results. In all assessed time periods, 88.3–93.0% of patients had outcomes consistent with Engel classes I and II. The distribution of patients by outcome classes did not change statistically significantly over the entire follow-up period. There were the following predictors of high efficacy of surgical treatment at 6 months after surgery: relatively shorter duration of active disease course (OR 0.719, 95%, CI: 0.437–0.966, p < 0.05), absence of status epilepticus (OR 0.048, 95% CI: 0.002–0.472, p < 0.05), absence of subdominant foci of irritative activity (OR 0.123, 95% CI: 0.012–0.845, p < 0.01), presence of mesial temporal sclerosis (OR 1008, 95% CI: 21.59–1310851, p < 0.01), a relatively longer resection margin on the temporal lobe (OR 637.32, 95% CI: 5.43–1960062, p < 0.05), lateralization of epileptogenic zone in subdominant hemisphere (OR 0.103, 95% CI 0.004–0.937, p = 0.0532). AUC was 0.957 (0.917–0.997), p < 0.0001; sensitivity 87.5%, and specificity 82.8%.Conclusion. Independent predictors of the efficacy of microsurgical anterior temporal lobectomy in patients with drug-resistant temporal lobe epilepsy are the following: shorter duration of active disease course, absence of status epilepticus in the history, absence of subdominant foci, presence of mesial temporal sclerosis, a relatively longer resection margin on the temporal lobe, and lateralization of the epileptogenic zone in the temporal lobe of the subdominant hemisphere.
Cytokine profile of gingival crevicular fluid in children with impaired immunological surveillance system
Authors: Kozlitina Iu. A. , Admakin O. I. , Morozova N. S. , Zakharova N. B. , Morozova O. L. 
Published: January 2023

Aim. To study the cytokine profile of the gingival crevicular fluid (GCF) in children with a juvenile rheumatoid arthritis (JRA).Materials and methods. We examined 20 children with JRA and 10 patients without somatic pathology aged 6 to 16 years old. The condition of periodontal tissues was assessed by periodontal indices – gingival index GI (Loe, Silness, 1963) and gingival bleeding index GBI. Biomaterial sampling from the gingival sulcus was carried out using special endodontic absorbent paper points. Enzyme immunoassay for IL-18, IL-10, IL-1ß, IL-1RA, MCP-1, VEGFs in the GCF was performed using the test kits of Vector-Best LLC (Novosibirsk, Russia).Results. Mean GI index in the JRA group was 0.31 ± 0.10 and in the control group – 0.20 ± 0.05 (p < 0.05), mean GBI index – 19.90 ± 3.14 and 10.80 ± 2.60 respectively (p < 0.05), which was accompanied by a more pronounced degree of inflammation of periodontal tissues. The GCF concentration of IL-18 in the JRA group was 6.70 (4.97–7.92) pg/ml, in the control group – 11.25 (8.70–13.10) pg/ml (p < 0.05), while the concentration of IL-1ß was 15.30 (13.79–17.18) pg/ml in the JRA group and 5.36 (5.32–5.54) pg/ml in the control group.The IL-10 concentration in the JRA group was 3.60 (2.89–4.45) pg/ml, which was comparable to the values of the control group. The concentration of IL-1RA was lower in the JRA group than in the control group: 3638.5 (2397.5–4133.5) pg/ml and 4951.0 (4303.0–5455.0) pg/ml respectively. The total GCF chemokine concentration for MCP-1 was determined at the level of 15.65 (14.15–17.39) pg/ml and 15.50 (12.80–21.20) pg/ml for the main and control groups and for VEGF – 49.60 (41.95–54.50) pg/ml in the JRA group and 12.00 (11.00–13.00) pg/ml in control group.Conclusion. In children with juvenile rheumatoid arthritis, an imbalance of pro- and anti-inflammatory cytokines in GCF plays a role in the development of gingivitis: an increased of IL-1ß concentration – a triggering factor of pro-inflammatory chains, a decreased concentration of IL-1RA – an anti-inflammatory cytokine, an increased concentration of VEGF – a marker of hypoxia.
Towards a Collaborative Learning Framework for D-learning based on improving the teamwork skills of adolescents
Authors: Martínez-Venegas Liliana 
Published: January 2023

Collaborative learning (CL) and Computer Supported Collaborative Learning (CSCL) are educational models that significantly improve students' higher-order, digital, and transversal skills if employed appropriately. Experts and industry members have named the CL and CSCL essential strategies to solve the deficiencies detected in the skills of professionals working in a digital economy profoundly accelerated by technological advances and the consequences of the COVID-19 pandemic. This document presents a project’s path and current status to create a framework for collaborative learning among adolescents, focused on developing their team skills and robust support in the principles of d-learning. This research seeks to formulate a model for face-to-face learning at first, but that can evolve to be implemented in both online and hybrid courses.
Two multi-wavelength interferometers for large-scale surveying
Authors: Sauthoff Anni , Köchert Paul , Prellinger Günther , Meyer Tobias , Pilarski Frank , Weinrich Stephanie , Schmaljohann Frank , Guillory Joffray , Truong Daniel , Silbermann Jakob , Kallio Ulla , Jokela Jorma , Pollinger Florian 
Published: January 2023

Deformation monitoring requires the detection of smallest changes, always at the limits of technical feasibility. Trying to push these limits further, we have realised two terrestrial ranging instruments: a long-range 1D electro-optic distance meter and a 3D multilateration-capable sensor system of 50 m range. The former one is intended as primary standard for the calibration of geodetic instrumentation with low uncertainty to the SI definition of the metre. The latter one is intended for monitoring larger monuments like VLBI antennas. In this contribution, we describe the technical challenges and our solutions for such instrumentation. We use the two-colour method for inline refractive index compensation. As common optical source, we developed a versatile multi-wavelength generator based on two Nd:YAG lasers stabilised by a phase-locked loop realised by Field Programmable Gate Arrays (FPGA). The 1D interferometer uses custom-designed achromatic optics and a mechanical frame optimised for form stability under field conditions. The phase demodulation system allows for maximum range flexibility from several meters up to several kilometres. The base ranging unit of the 3D multilateration system adheres to a different demodulation technique, which allows a relatively simple interferometer head design. This approach requires a sophisticated source modulation scheme limiting the applicability to distances over 15 m up to approximately 50 m in our case.