bluuebunny/crossref_metadata_2025_split huggingface dataset:
Revisiting the Role of Amniotic Membrane Dressing in Acute Large Traumatic Wounds: A Randomized Feasibility Study at a Level 1 Trauma Centre
Authors: Choudhary Narendra , Kumar Abhinav , Priyadarshini Pratyusha , Bagaria Dinesh , Alam Junaid , Soni Kapil Dev , Kumar Vivek , Sagar Sushma , Gupta Amit , Kumar Subodh , Mohanty Sujata 
Published: August 2023

Abstract

Introduction:
Acute large traumatic wounds require temporary dressing prior to the definitive soft tissue reconstruction, as the physiological derangement during the immediate postinjury period delays the definitive surgical intervention. Selecting an ideal dressing material from numerous available synthetic dressings and skin substitutes poses a challenge. Although amniotic membrane (AM) scaffold has a definitive role in promoting wound healing in burns and chronic wounds, however, its efficacy in acute large traumatic wound is lacking. The present trial aimed to evaluate the safety and efficacy of AM in wound bed preparation before the definitive soft-tissue reconstruction in acute large traumatic wounds.

Methods:
Sixty patients with acute large traumatic wounds (>10 cm × 10 cm) were divided into two groups (conventional dressing and AM dressing) using simple mixed block randomization. Wounds were assessed using the Bates Jensen Score at various timelines for the signs of early wound healing. The primary outcome was to evaluate the time taken for the wound bed preparation for definitive soft-tissue reconstruction. The secondary outcome was the pain assessment and complications, if any.

Results:
There was significant reduction in the wound exudate as well as peripheral tissue edema in the intervention group (P = 0.01). AM dressing was significantly less painful (P = 0.01). The incidence of wound infection and need for debridement was decreased in the intervention group. However, the time interval to definitive soft-tissue coverage was statistically insignificant and comparable in both the groups. No adverse reactions were seen in either group.

Conclusion:
AM dressings are safe and efficacious with significant reduction in wound exudates and peripheral edema. However, these dressings do not hasten the wound maturation as compared to conventional dressings. AM dressings can be used as a less painful alternative to conventional dressing in the management of large acute posttraumatic wounds.
Geriatric Intertrochanteric Fractures – A Challenge to Manage
Authors: Madhuchandra P. , Pawankumar K. M. , Manish K , Raju K. P. 
Published: August 2023

Background:
Intertrochanteric fractures are among the frequently seen fractures in the elderly population. Treating these fractures is very challenging considering the fact that the quality of bone is poor and highly osteoporotic. The high failure rates with dynamic hip screw (DHS) especially in unstable fractures lead to the development of intramedullary devices such as proximal femoral nail (PFN) which has got multiple advantages over DHS.

Materials and Methods:
This prospective study included 30 patients above the age group of 60 years with unstable intertrochanteric fractures conducted in a tertiary institute between February 2021 and June 2022. Results were analyzed clinically and radiologically using the Modified Harris hip score.

Results:
Patients' age group was 61–85 years with a mean age of 69 years, comprising 63% female and 37% male. The average Harris hip score was 83.76 at 24 weeks' follow-up with 33.33% excellent, 56.66% good, 3.33% fair, and 6.67% poor. Postoperative complications included revision surgery in two patients, superficial infection in one patient, Z effect in one patient, peri-implant fracture in one patient.

Conclusion:
Treatment with PFN for unstable intertrochanteric fracture has the advantages of closed reduction, less tissue damage, early rehabilitation, and return to work. Osteosynthesis with short PFN resulted in good-to-excellent functional and radiological outcomes.
Frailty as a Predictor of Outcome in Heart Failure in the Elderly
Authors: Kumar Pratap , Dhar Minakshi , Kumar Barun , Jain Vikram 
Published: August 2023

Introduction:
Heart failure is the leading contributor to global morbidity and mortality. Frailty is an emerging prognostic factor in heart failure. There is little data on the prognostic role of frailty in patients admitted for acute heart failure as most studies have been done on stable heart failure patients.

Methodology:
The study included elderly (age ≥60 years) patients admitted with acute heart failure at a tertiary care center in India. Patients with dementia, cognitive impairment, and documented terminal illness were excluded. The sample size was 85 patients. Frailty assessment was done using short performance physical battery (SPPB) and Fried phenotype scales and follow-up data was collected at 3 months postdischarge telephonically. The primary objective of the study was to determine the proportion of frailty in elderly in-hospital heart failure patients. The secondary objectives were to see the agreement between the frailty assessment tools used (SPPB and Fried phenotype).

Results:
Eighty seven patients were included in the study. The majority were male (n = 45) and had heart failure with reduced ejection fraction (n = 56). Coronary artery disease (CAD) (n = 60) was the most common cause of heart failure. Eighty-two patients had at least one comorbidity. The proportion of frailty as per the SPPB was 43.67%, and as per the Fried phenotype was 68.9%. A total of 4 deaths and 15 re-admissions occurred during the follow-up period of 3 months. The majority belonged to the frail category as per both the frailty scales (P < 0.001 for SPPB, P = 0.087 for Fried phenotype). Fleiss's kappa coefficient for agreement between the scales was 0.373 (SE = 0.106, P < 0.001), which signifies that there was a fair agreement between the two scales. The Spearman Rank correlation coefficient was −0.691 (P < 0.01) between the two scales. Hence, the SPPB score inversely correlated with the Fried phenotype.

Conclusion:
Frailty is largely prevalent in elderly heart failure patients. It can be used to predict poor outcomes in these patients. Clinicians should identify these high-risk patients at the time of discharge from their facility and consider interventions (tailored rehabilitation programs) to minimize the adverse outcomes.
Factors Predicting Mortality in Elderly Patients Hospitalized for Congestive Heart Failure
Authors: Sharda Meenaxi , Vijay Ankit , Gandhi Nikhil , Aggarwal Meghna 
Published: August 2023

Background:
Heart failure (HF) is a complex clinical syndrome that results from any structural or functional impairment of ventricular filling or ejection of blood. There are range of factors that predict the mortality, morbidity, and outcome in congestive HF (CHF) patients.

Objectives:
The objective was to study the clinico-epidemiological characteristics and predictors of inhospital mortality of elderly patients ≥60 years hospitalized for HF.

Subjects and Methods:
A complete medical history of enrolled patients and physical examination inclusive of etiology, New York Heart Association (NYHA) grade, heart rate (HR), and systolic blood pressure (SBP) were noted. Complete blood count, blood urea, serum creatinine, serum sodium, serum potassium, 12-lead electrocardiogram, X-ray of the chest, and echo were obtained in all patients. Outcomes were analyzed till the study endpoints.

Results:
Compared to normal comparators, a higher mortality was observed in patients with age >75 years (33.3%), HR >100 beats per min (27.14%), SBP <80 mmHg (60%), NYHA IV HF (37.1%), hemoglobin (Hb) <12 mg/dl (31.25%), blood urea ≥40 mg/dl (26.39%), serum creatinine >1.30 mg/dl (29.17%), serum sodium <135 meq/L (26.69%), and ejection fraction (EF) <50% (26.39%).

Conclusion:
Increasing age, prior history of CHF on admission, higher NYHA grade on admission, higher HR, lower SBP, lower EF, low Hb, higher blood urea, serum creatinine, and low serum sodium levels are statistically significant predictors of inhospital mortality of elderly CHF patients.
Anemia in Elderly Patients ≥65 Years of Age
Authors: Kadhiravan E. , Devi Agalya , Mohan Reenaa , Sindhuri R. , Abdula Shiek , Devi D. S. Karthika 
Published: August 2023

Introduction:
Anemia in elderly patients of any degree contributes significantly to morbidity and mortality and has a significant effect on the quality of life. Despite of high prevalence, very few studies have examined the effect of anemia in elderly patients in India. Hence, this study is undertaken to know the prevalence and clinicopathological pattern of anemia in elderly patients.

Objectives:
1. To estimate the prevalence of anemia in the elderly aged 65 years and above. 2. To determine the severity, clinicohematological patterns, and causes of anemia in the elderly aged 65 years and above.

Materials and Methods:
A hospital-based descriptive cross-sectional study was done

.
The study was conducted for 1 year; during this period, elderly patients aged 65 years and above admitted for other medical conditions were recruited in the study using consecutive sampling technique until the desired sample size of 236 was achieved and they were evaluated for anemia. Among them with hemoglobin cutoff value <13 g% for men, <12 g% for women were further evaluated to known the cause of anemia and its clinicohematological pattern. Ethical committee approval was obtained. Data were analyzed using SPSS Software version 23.0.

Results:
The mean age of the participants was 73.9 ± 7.4 (standard deviation [SD]) years. Majority, 53.8%, of the participants were males. Among the 236 elderly patients, recruited in the study 65.3% were anemic and among them 44.2 had mild anemia and 37% had moderate anemia. Mean hemoglobin value of the participants was 10.7 ± 2.83 SD and it ranged from 3 to 16.3 g/dl. There was no significant difference in the hematological parameters between male and female elderly patients in the study. The main cause of anemia was found to be due to chronic diseases followed by iron-deficiency anemia.

Conclusion:
This study concludes that anemia was highly prevalent among elderly patients and most of them had identifiable and treatable etiology. Hence, all elderly patients with anemia should be evaluated properly for underlying etiology and treated accordingly to reduce the mortality and morbidity in elderly patients with multiple comorbidities.
Psychiatric Presentations and Factors Associated with Suspected Organicity in Elderly Attending a Tertiary Care Facility in South India
Authors: Srisudha B. , Nandyal Munaf Babajan , Kolloju Naveen , Joseph Rachna George , Karuppusami Reka , Kurian Suja 
Published: August 2023

Objectives:
The objectives were to determine the proportion of elderly among the new psychiatry outpatient attendees, identify their sociodemographic profile and clinical presentations, and determine risk factors associated with suspected organic conditions in patients presenting with acute onset and chronic presentations.

Methodology:
This retrospective cross-sectional study focused on the elderly presenting with psychiatric symptoms to a psychiatric setting. The onset of symptoms at presentation was divided into acute and chronic conditions. Clinical symptom clusters and the risk factors associated with organic conditions were identified. The Chi-square and Fisher's exact test were used to find an association between factors and outcome (organic/functional).

Results:
Elderly seeking consultation constituted < 10% of total new case registration. Acute onset was seen in one-third and chronic presentation constituted nearly two-thirds of the group. The common clinical presentations with acute onset were acute psychosis, altered sensorium, and psychosis due to an organic etiology. The most common clinical presentation with chronic course was chronic psychosis. Nearly 40% had suspected organicity. Increasing age, structural abnormality in brain imaging, and the presence of stressors were risk factors for the onset of psychiatric presentation in the elderly (P = 0.001).

Conclusion:
Early detection of the clinical syndrome, identification of organic conditions, and appropriate and prompt referral to the general physician should be the rule for the care of the elderly presenting to a psychiatric facility.
Prognostic Value of Serum Albumin and C-reactive Protein Levels in the Elderly for Assessing Morbidity and Mortality in a Tertiary Care Center
Authors: John Sanjo K. , Padmaja N. , Rao I. V. Ramachandra , Priya Subalin , John Centina Rose , James Tittu Thomas 
Published: August 2023

Introduction:
There is an increased population of elderly globally due to advancement of technology in health care. Elderly individuals are susceptible to various diseases, owing to deficits in nutrition or healthy lifestyle. Serum albumin and C-reactive protein (CRP) are found to be sensitive to nutritional status as well as inflammation. This study is an attempt to analyze the prognostic value of CRP and serum albumin and analyze its usefulness as a prognostic marker in assessing morbidity and mortality in elderly patients.

Methodology:
One hundred patients above the age of 65 years and were admitted to the emergency care facilities of our tertiary care center were recruited for the study. Serum albumin and CRP estimation was done on the day of admission along with Charlson Comorbidity Index (CCI), and was follow-up till discharge. Statistical analysis was performed to evaluate relationship between the serum values and CCI scores.

Results:
It was observed that 83.3% (10/12) of deaths occurred in those with low serum albumin levels, and 91.6% (11/12) with high CRP levels. The hazard ratio shows a 6% increased probability of death with one unit increase in CRP, whereas a one unit increase in serum albumin value decrease the probability of death.

Conclusion:
The present study concludes that low serum albumin and high CRP levels at the time of admission in the elderly population are associated with high CCI scores, longer hospital stay, and increased risk of mortality, demanding their estimation in the elderly in emergency and acute care facilities.
Strengths, Weaknesses, Opportunities, and Threats Analysis of the National Program for Health Care of the Elderly
Authors: Joshi Nitin Kumar , Joshi Vibha , Bajaj Komal 
Published: August 2023

Background:
The National Program for the HealthCare of the Elderly (NPHCE) was adopted by the Ministry of Health and Family Welfare in 2010 to provide promotional, preventive, curative, and rehabilitative health-care services for the fast-growing older population in India. As literature about the assessment of NPHCE is lacking, the present study was conducted to perform a strengths, weaknesses, opportunities, and threats (SWOT) analysis of the program.

Methods:
The SWOT of the NPHCE program is analyzed using available literature and relevant documents.

Results:
Although this program embraces strategies to provide specialized training and services at primary health center, community health center, and district levels, including dedicated bedded wards, equipment, consumables, and pharmaceuticals but home-based care for the elderly, and the role of caregivers is overlooked in this program. NPHCE program can utilize the framework and take support of various ongoing healthy aging initiatives of international agencies to augment the health-care strategies for the elderly in India. Integrating schemes developed by the government for the upliftment of the elderly and the inclusion of traditional medicine systems in the program can serve as an opportunity for meeting unmet needs and improving the quality of life and well-being of the elderly. However, the growing elderly population, rise in nuclear families, and dual disease burden are significant threats to the program's implementation.

Conclusion:
This program can be more effective in providing comprehensive health care to the elderly if more emphasis is given to community participation, home-based care, and integrating digital health technologies and other existing welfare schemes.
Nuclear aberrations in the gingival epithelium of patients with chronic periodontitis
Authors: Serikova Olga Vasil’evna , Shumilovich Bogdan Romanovich , Filippova Zoya Alexandrovna , Kalaev Vladislav Nikolaevich , Kalaeva Elena Anatol’evna , Larina Anna Viktorovna 
Published: August 2023

Context:
Periodontitis characterized by mild symptoms in the early stages, which makes diagnostics problematic. The gingival epithelium can be used for micronucleus assay since gums are the area affected by the disease.

Aims:
The aim of the study was to study the frequency of occurrence and the range of nuclear anomalies in gingival epithelium of healthy people and people with periodontitis.

Settings and Design:
Scrapings of the gingival epithelium were made next to the central incisors (1.1) and molar teeth (1.7) in control and experimental groups (ten healthy males 35–50 years old and 10 males with periodontitis).

Materials and Methods:
The preparations were stained by Romanowsky–Giemsa. The frequency of nuclear aberrations (‰), the accumulation index, and the repair index were determined.

Statistical Analysis Used:
The differences in the medians of nuclear aberrations were determined using Wilcoxon and the Van-der-Waerden tests. The pathology proportions were compared using the Z-test. To determine the predictors of periodontitis, receiver operator characteristic analysis was used. For multiple comparisons, the Bonferroni correction was used.

Results:
In the experimental group, the range of nuclear aberrations was wider, the ratio of karyolysis in the unaffected area was higher, than that in control; perinuclear vacuoles were fewer and macronuclei were more in the affected area. The frequency of cells with micronuclei over 1.33‰ in the affected area is the periodontitis marker.

Conclusions:
Gingival epithelium can be used in micronucleus assay. Micronucleus test revealed a wider range of nuclear aberrations in the cells of the gingival epithelium and a higher frequency of occurrence of micronuclei in patients with periodontal disease compared to healthy subjects. Therefore, cytological signs of the inflammation appear earlier than the clinical ones and are verified more clearly. The markers of apoptosis and destruction of nuclei, and low repair index indicate normal elimination of damaged cells. An increased accumulation index in people with periodontitis may indicate the risk of malignant tumors.
Comparison of clinical indices with halitosis grading in chronic periodontitis: A randomized control trial
Authors: Veeray Junaid Mushtaq , Gupta K. K. , Soni Sweta , Kothari Divya 
Published: August 2023

Background:
Oral malodor is a major periodontal complaint, but the best method for assessing the halitosis grade is still undefined. The primary objective of the study was to detect the halitosis grade in the exhaled breath using the three distinct techniques and to compare the readings with different clinical indices to find out the best method of halitosis grading.

Materials and Methods:
A total of 90 patients with chronic periodontitis having oral malodor were included in the study. The subjective assessment of the exhaled breath (halitosis grading) was done by three different methods; using a handheld portable Tanita FitScan sulfide monitor, by Halitox toxin assay, and by organoleptic (Sniff test) method. The findings were then compared with the clinical parameters of poor oral hygiene like plaque index (PI), gingival index (GI), gingival bleeding index (BI), and pocket depth (PD) to detect the best method of halitosis grading.

Results:
The mean age of the patients included was 38.23 ± 8.83 (mean ± standard deviation) years. The median value of halitosis grading as obtained by Tanita FitScan was 3.0 (95% confidence interval as 2 and 4) which was then compared with clinical indices (PI, GI, BI, and PD) and the results were statistically significant (P < 0.05), whereas the other two techniques of halitosis grading gave insignificant results.

Conclusion:
The results confirmed that the halitosis grading done using Tanita FitScan sulfide monitor is more appropriate with respect to clinical indices when compared with the other two techniques.
Adjunctive benefit of probiotic supplementation along with nonsurgical therapy for peri-implant diseases – A systematic review and meta-analysis
Authors: Ambili R. , Nazimudeen Nias Bin 
Published: August 2023

Peri-implant diseases are prevalent conditions, but a predictable management strategy is still lacking. The objective of the present article was to evaluate the adjunctive benefits of probiotics with nonsurgical therapy in the management of peri-implant diseases. The review protocol was registered in PROSPERO and prepared according to PRISMA guidelines. Randomized controlled clinical trials in patients diagnosed with the peri-implant disease where probiotic was used as an adjunct to nonsurgical therapy were included in the study. The risk difference of percentage reduction in bleeding on probing, plaque accumulation, and mean difference in probing pocket depth reductions at implant level were estimated using a random effect model due to high heterogeneity among studies. Four studies fulfilled the criteria for selection. Two of them presented data on both peri-implantitis and peri-implant mucositis and they were considered separate studies during meta-analysis. Significant reduction in percentage of bleeding on probing was noticed at 1 and 3 months (−0.28 [−0.48, −0.09], P = 0.004 and − 0.19 [−0.35, −0.02], P = 0.03, respectively), but the reduction was not statistically significant at 6 months. Similar results were also observed for plaque accumulation. No statistically significant reduction in probing pocket depth was observed in the probiotic group during any of the re-evaluations.

Conclusion:
Adjunctive therapy of probiotics may improve the efficacy of nonsurgical therapy of peri-implant diseases for up to 3 months. However, moderate certainty was observed for a reduction in bleeding on probing after 1-month re-evaluation alone.
In vitro evaluation of remineralizing agents on dentinal tubule occlusion: A scanning electron microscopic study
Authors: Sathish Akanksha Kidiyur , Gopalkrishna Pratibha , Kumar Santhosh 
Published: August 2023

Context:
Over the years, numerous treatment modalities have been researched for the management of dentinal hypersensitivity. A recent remineralizing agent containing a phase of amorphous calcium phosphate combined with fluoride has shown the ability to rapidly convert into biomimetic hydroxyapatite. This potential can be utilized in occluding the dentinal tubules for the treatment of hypersensitivity.

Aims:
The present study aims to compare the effectiveness of biomimetic hydroxyapatite-based tooth mousse and casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) tooth mousse as desensitizing agents on dentinal tubule occlusion.

Materials and Methods:
The in vitro study design involved 30 prepared dentin specimens that were divided into three groups: Group A: negative control, Group B: CPP-ACP tooth mousse (GC tooth mousse™), and Group C: fluoride-doped amorphous calcium phosphate (F-ACP) tooth mousse (Curasept Biosmalto Denti Sensibili Tooth Mousse). The specimens were observed under a scanning electron microscope (SEM) and an attached energy-dispersive X-ray (EDX) spectroscopy apparatus after 1 week.

Statistical Analysis:
The data were analyzed using Kruskal–Wallis test and post hoc Mann–Whitney test for intragroup and intergroup analysis, respectively.

Results:
The SEM analysis of the F-ACP group showed statistically greater percentage of tubule occlusion (40.21%) compared to the CPP-ACP group (38.15%). EDX analysis of both F-ACP and CPP-ACP groups revealed calcium, phosphorus, carbon, oxygen, and silica with an additional fluoride element in the F-ACP group.

Conclusions:
In the present study, both remineralizing agents were able to occlude the dentinal tubules. Among the two, the F-ACP tooth mousse showed greater tubule occlusion, and therefore, appears promising as an upcoming remineralizing agent in the management of dentinal hypersensitivity.