bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dental Anxiety Among 4-7-Year-Old Children Measured by Hand Gestures
Authors: Dave Bhavna Haresh , Thaker Bhriti Aditya , Inderchand Bhavana 
Published: August 2023

Introduction:
Dental Anxiety (DA) can have a serious impact on daily life and is a significant barrier for seeking and receiving dental care. Hence, our aim is to develop new scale for the assessment of DA in children between 4 and 7 years.

Methodology:
Visual analouge scale(VAS) and Dave's hand gesture scales were laminated on A2 size paper, which was shown to 60 participants before the procedure, immediately after the procedure and ½ h postprocedure and the participants were asked to show the score on the laminated sheet without the presence of any of the parent/guardian.

Result:
Descriptive analysis of all the explanatory and outcome parameters was performed. Friedman's test was used to compare the mean anxiety rating scores of both rating scales. Pearson correlation test was accustomed to correlate the anxiety rating scores. Chi-square test was used to compare the preference/liking of the different anxiety rating scales. The level of significance was set at P < 0.05. The results were statistically significant the new scale was in accordance with VAS.

Conclusion:
Dave's hand gesture scale is a reliable and valid measure of child's DA.
A short-term study of laparoscopic-dominant individualised levator ani resection in abdominoperineal resection: A retrospective investigation
Authors: Xue Xiajuan , Jian Chao , Fang Yicong , Luo Lixiong , Guo Yinzong , Ling Bijuan , Cai Mingzhi 
Published: August 2023

Objective:
The objective is to investigate if laparoscopic-dominant abdominoperineal resection (LDAPR) with individualised levator ani resection inhibits local recurrence (LR) and prolongs survival as compared to laparoscopic abdominoperineal resection (APR).

Materials and Methods:
Rectal cancer surgery cases were retrospectively identified from September 2014 to December 2019. LDAPR-treated group (55 patients) and the APR-treated group (71 patients) were included in the study. The operation time, circumferential resection margin (CRM), intraoperative tumor surgery (ITP), post-operative complications, the 2-year overall survival (OS) and LR were compared in the two groups.

Results:
The CRM and ITP were significantly reduced in the LDAPR as compared to the APR group (3.6% vs. 16.9%, t = 5.522, P = 0.019; 3.6% vs. 14.1%, t = 3.926, P = 0.048). In terms of post-operative complications, the incidence of urinary retention in LDAPR was significantly reduced than the APR group (10.9% vs. 25.4%, χ
2 = 4.139, P = 0.041). Similarly, perineal pain at 6 months or 1 year after surgery was significantly down-regulated in LDAPR than in the APR group (72.7% vs. 88.7%, χ
2 = 5.320, P = 0.021; 18.2% vs. 43.2%, χ
2 = 8.288, P = 0.004). However, there was no statistically significant difference in the post-operative complications between the LDAPR and APR groups. Finally, LDAPR led to a significantly improved 2-year OS and a reduced LR compared to APR.

Conclusion:
LDAPR reduces CMR, ITP and LR and simplified the perineum operation, subsequently protecting the pelvic autonomic nerves. Compared to the conventional APR, LDAPR is a promising procedure worth adopting for rectal cancer treatment.
Laparoscopic management of ovarian cysts during pregnancy under urgent situations
Authors: Tabatabaei Fatemeh , Hosseini Seyedeh Tala Nabipour , Hajiyar Reza 
Published: August 2023

Background:
Majority of adnexal masses are incidental findings during pregnancy and resolve spontaneously. They may complicate pregnancy due to haemorrhage, cyst rupture and ovarian torsion. Laparoscopy is the preferred surgical intervention owing to shorter operative time, quicker recovery and lower post-operative pain. However, safety and feasibility of laparoscopic surgery in the management of ovarian cysts in pregnant women is challenging especially at advanced gestational ages and in urgent situations.

Methods:
In this retrospective study, a total of 48 cases of urgent laparoscopic surgeries were evaluated in the first and second trimesters of pregnancy between March 2018 and March 2021 in Al-Zahra Hospital, Tabriz, Iran.

Results:
The operations were ended in all patients successfully. The mean operation time was 45 min. There were no foetal maternal complications. All pregnancies had been terminated after 37 weeks of gestation. Oophorectomy had been performed in six patients and six other patients needed blood transfusion. Ovarian torsion was the most common reason for emergency surgery and mature teratoma was the most commonly reported pathology. Tocolytic therapy was required in six patients, and all of the patients were prescribed 50 mg of injectable progesterone twice daily for 10 days after surgery. The mean intra-abdominal pressure was equal to 15 mmHg and the mean end-expiratory carbon dioxide (CO2) pressure was 36 mmHg. Intravenous paracetamol was used to relieve post-operative pain. The mean hospitalisation time was 1.63 days.

Conclusion:
Most of the ovarian cysts can be managed laparoscopically with ensured safety and lower morbidity even in emergency situations at advanced gestational ages.
Long-term outcomes of vulvar or vaginal cancer patients undergoing laparoendoscopic single-site inguinal lymphadenectomy
Authors: Xu Jing-Yun , Yu Tian-Xiang , Guan Xiao-Ming , Ding Bo , Ren Mu-Lan , Shen Yang 
Published: August 2023

Abstract

Introduction:
Laparoendoscopic single-site inguinal lymphadenectomy (LESS-IL), a minimally invasive technique, has been reported in patients with vulvar or vaginal cancer regarding its safety and feasibility. However, the long-term outcomes, especially oncologic outcomes, are still lacking. We aimed to evaluate the long-term outcomes of LESS-IL to confirm its safety further.

Patients and Methods:
Data were prospectively collected from patients with vulvar or vaginal cancer who underwent LESS-IL at our institution between July 2018 and June 2021. The patients were followed up for at least 12 months. All procedures were performed according to treatment standards. Short- and long-term complications and oncologic outcomes were analysed.

Results:
A total of 16 patients undergoing 28 LESS-IL procedures were identified, amongst whom 4 underwent unilateral LESS-IL. The median numbers of excised groin lymph nodes were 9.0 (6.5–11.8) and 10.5 (8.3–12.0) in each left and right groin, respectively. Short-term complications occurred in 4 (25%) patients, including 18.7% lymphocele and 6.3% wound infection. Long-term complications regarding lower-limb lymphoedema appeared in 6 (37.5%) patients. Most short- and long-term complications were Clavien–Dindo 1 or 2, accounting for 90% of all post-operative issues. After a median follow-up of 27 (21.3–35.8) months, only 1 (6.3%) patient had isolated inguinal recurrence at 13 months postoperatively. No local or distant recurrence occurred.

Conclusion:
Our results suggest that LESS-IL is associated with little incidence of complications and promising oncologic outcomes, further demonstrating the safety and feasibility of the LESS-IL technique in patients requiring IL.
MIS for enucleation of leiomyoma of the oesophagus-strategic approach and experience of 19 cases
Authors: Rege Sameer Ashok , Dalvi Abhay N. , Churiwala Jayati Jagdish 
Published: August 2023

Introduction:
Leiomyoma of the oesophagus, although rare, is the most common benign tumour to occur in the organ. Surgical approaches have evolved over time from an open thoracotomy or laparotomy to video-assisted thoracoscopic or laparoscopic and now robotic enucleation. We report a series of 19 cases of leiomyoma of the middle- and lower-third oesophagus treated by minimally invasive surgery.

Patients and Methods:
A retrospective analysis of 19 cases operated at a single tertiary care centre in India was performed. After the diagnosis of a benign oesophageal neoplasm on computed tomography (CT) and endosonography, laparoscopic transhiatal enucleation of the tumour for lower third (n = 16) and right-sided video-assisted thoracoscopic excision for middle-third tumours (n = 3) were performed. Dor fundoplication was done after the excision of leiomyomas from the lower oesophagus.

Results:
The most common symptom at presentation was retrosternal burning in lower oesophageal tumours, while tumours in the middle third of the oesophagus were asymptomatic and incidentally detected. The size of the tumour ranged from 3 cm to 8 cm in the largest dimension on contrast-enhanced CT scan. The mean operative time was 93 min ranging from 61 to 137 min. The average blood loss was 53 ml. No patient had an iatrogenic oesophageal mucosal injury. There were no conversions to open surgery or major complications including post-operative leak or death. Post-operative recovery was uneventful.

Conclusion:
The transhiatal approach to lower oesophageal leiomyomas is strategic to avoid complications of thoracoscopy, minimally invasive, cost-effective as compared to robotic surgery, suitable for adequate exposure and safe in the hands of an experienced laparoscopic surgeon.
Effect of combination of Curcuma longa with Emblica officinalis in females with polycystic ovarian syndrome: An open-label, randomized active-controlled, exploratory clinical study
Authors: Gupte Poonam A , Khade Kalyani N , Wagh Girija N , Deshmukh Chaya S , Pandit Vijaya A , Bhalerao Supriya S 
Published: August 2023

Abstract

Introduction:
Polycystic ovarian syndrome (PCOS) is the commonest cause of infertility due to anovulation. The combination of Curcuma longa (CL) and Emblica officinalis (EO) is known to ameliorate diabetes and, thereby, may resurrect PCOS. The present study aimed to evaluate the effect of this combination prepared by two different methods, independently and with metformin (Met), compared with Met in PCOS on glycaemic control, inflammation, adipokines, and anthropometry.

Aim:
The aim of the study was to evaluate the effect of the combination of CL and EO, prepared by two different methods, independently and with Met, compared with Met in PCOS.

Materials and Methods:
PCOS women aged 18–35 years were selected through Rotterdam criteria from a tertiary care teaching hospital setting post-Ethics Committee permission. They were randomized to five groups (eight per group); combination of CL and EO prepared by traditional method (TF- Traditional Formulation), standardized extraction method (PNAE- Pharmanza Nisha Amalaki Extract), standard control Metformin (M­et) and their combinations, TF + Met and PNAE + Met for 90 days. Fasting glucose, insulin, lipid profile, reproductive hormones (luteinizing hormone [LH], follicle-stimulating hormone [FSH], and free testosterone), inflammatory markers (tumor necrosis factor-alpha [TNF-α], interleukin [IL]-6), and adipokines (leptin and adiponectin) were done at baseline and day 90, whereas anthropometry was done monthly.

Results:
Of 48 randomized women, 37 completed the study. TF and Met groups demonstrated higher weight decrease, whereas TF + Met significantly decreased waist circumference. Blood glucose, insulin, and homeostasis model assessment of insulin resistance (HOMA-IR) decreased in all groups except glucose in TF + Met and HOMA-IR in the Met group. Only PNAE decreased free testosterone. TNF-α increased while leptin decreased in all groups. Both TF and PNAE, with Met reduced IL 6, significantly only in PNAE + Met group. Similarly, both TF and PNAE, with Met reduced LH/FSH ratio and significantly increased adiponectin. Two females, each, conceived in TF and PNAE, whereas one was in PNAE + Met group. No adverse events were reported.

Conclusion:
Both botanical formulations, TF and PNAE, were comparable to Met. The standardized extracts formulation PNAE seems more promising due to administration ease, smaller dose, and consistent bioactives.
Preparation, nutritional and glycemic properties of multigrain instant “adai” mix
Authors: Shobana Shanmugam , Gayathri Rajagopal , Sangavi Gopalakrishnan , Kavitha Vasudevan , Gayathri Nagamuthu , Anjana Ranjit Mohan , Sudha Vasudevan , Mohan Viswanathan 
Published: August 2023

Abstract

Background and Objectives:
“Adai” is a traditional South Indian breakfast prepared using the wet ground batter of white rice and pulses. Convenience foods are gaining popularity and owing to the increasing prevalence of noncommunicable diseases such as diabetes, there is a need for food products with lower glycemic index (GI). The current study aimed to develop an instant adai mix using brown rice, millets, pulses, and spices.

Materials and Methods:
The instant adai mix was prepared by blending pulverized brown rice, sorghum, and pulses (green gram, horse gram, decorticated and split red gram, black gram, and chickpea) along with roasted cumin, red chilies, and salt. The nutritional composition of the instant adai mix was analyzed, and GI of “adai” was evaluated in healthy human volunteers using International organization for standardization protocol.

Results:
The instant adai mix was rich in whole grains (48%) and pulses (45%). Nutritional profiling of the instant adai mix revealed that it is rich in protein and dietary fiber. One hundred grams of instant adai mix fulfill 27.8% of protein and 29.6% of dietary fiber requirements of recommended dietary allowance of adult male. Likewise, 100 g of instant adai mix fulfill 34.9% of protein requirements of the estimated average requirement of an adult male. The “adai” prepared from the instant mix exhibited medium GI (65.1).

Conclusion:
The instant “adai” mix was found to be nutritionally superior, and the adai prepared from the mix showed a medium GI. It can be a healthy option compared with instant mixes containing refined grains such as white rice. More formulation trials are needed to prepare an adai mix to achieve a low GI. Reformulation of traditional foods with nutritious ingredients and achieving a lower GI can expand the healthier food choices for this vulnerable population who are at risk for type 2 diabetes.
Structural and Functional Changes after Standard Percutaneous Nephrolithotomy
Authors: Saswade Kalpesh , Darsan Lal , Pillai Biju S. , Moorthy H. Krishna 
Published: August 2023

Introduction:
The surgical treatment of kidney stones more than 2 cm in size has been vastly simplified with the popularisation of percutaneous nephrolithotomy (PCNL) since the 1980s. However, technological revolution has witnessed miniaturisation of endoscopic instruments claiming more advantages over the usage of conventional instruments. However, the cost of smaller instruments and the higher expertise needed while using these miniature instruments have forced many surgeons to persist with the conventional procedures.

Aims and Objectives:
This study was intended to evaluate the structural and functional changes occurring in the kidneys after performing standard PCNL.

Materials and Methods:
Standard PCNL was done in 92 patients with renal stones of more than 2 cm using 25 Fr adult nephroscope. Pre-operative estimated glomerular filtration rate (eGFR) was calculated a day before the procedure and compared with post-operative eGFR estimated at 3 months. Structural changes occurring after PCNL were studied using USG renal morphometry and scarring at 3 months and compared these observations with pre-operative findings.

Results:
It was observed that the mean eGFR post-operative was 84.48 ± 32.18 ml/min (at 3 months) versus 77.61 ± 30.15 ml/min preoperatively (P < 0.05). The mean change of renal parenchymal thickness on post-operative USG versus pre-operative USG was insignificant (2.19 ± 0.32 cm vs. 2.22 ± 0.34 cm). There was no correlation between age and gender for change in eGFR. A mild positive correlation (correlation coefficient [r] = 0.065) was found between eGFR change and stone burden. Sixteen patients out of 92 were found to have renal scarring (>10% decrease in parenchymal thickness).

Conclusions:
We conclude that standard PCNL could be performed in indicated patients without apprehensions about functional loss or structural damage due to the procedure.
Arterial pH, Bicarbonate Levels and Base Deficit as Predictors of Morbidity and Mortality in Acute Pancreatitis
Authors: Jojo Joicy Els , Prabhu Satish G , Paul Vergis , Jayan MG 
Published: August 2023

Background:
Although multiple criteria are available for prognosis and determination of severity of acute pancreatitis (AP), there is a need to identify better predictors of developing complications. Arterial pH is a component of the APACHE-II scoring system, commonly used in AP.

Aim:
The aim of this article is to study the diagnostic accuracy of arterial pH, bicarbonate levels and base deficit in predicting morbidity and mortality in AP.

Materials and Methods:
A cross-sectional study (agreement analysis) was performed on inpatients with AP in a tertiary hospital. One hundred and forty patients based on clinical, biochemical and radiological findings were included in this study. Patients with AP following trauma/surgical intervention, tumours of pancreas and patients with age ≤18 years were excluded all categorical variables were summarised using frequency and percentage. All quantitative variables were summarised using mean and standard deviation sensitivity, specificity, positive predictive value and negative predictive value were estimated. Statistical analysis was performed using EZ R software.

Results:
All participants who required ventilatory support, haemodialysis or blood product transfusion had a pH of <7.35. 12/13 (92.3%) of patients who were on haemodynamic supports had bicarbonate levels <22mmol/L. Those who required respiratory support had bicarbonate level <22 mmol/L and base deficit <–4 mmol/L. 11/13 (84.6%) who required haemodynamic supports had base deficit <–4 mmol/L. All 5 of the 140 (3.57%) participants who expired had an arterial pH <7.35, bicarbonate level <22 mmol/L and base deficit <–4 mmol/L.

Conclusion:
In patients with AP, low arterial pH, low bicarbonate levels and high base deficit at presentation predict an adverse outcome with a higher frequency of organ failure and mortality.
Comparison of Surgical Outcomes in Laser Haemorrhoidectomy and Stapler Haemorrhoidopexy for Grade II and III Haemorrhoids – A Prospective Cohort Study
Authors: Akshay Viswanath U. V. , Kuruvilla Rojan , Sajan P. , George Amal , Thomas Jinto Augustine 
Published: August 2023

Background:
Haemorrhoids often necessitate surgical intervention. Laser haemorrhoidectomy and stapler haemorrhoidopexy are two alternative techniques that may be employed for the resolution of symptoms.

Aim:
The current study aims to compare the two modalities of treatment in terms of post-operative pain, post-operative complications and recurrence at 6 months.

Methodology:
It was a hospital-based prospective cohort study done in the department of general surgery at a tertiary care centre. Patients were included if they were symptomatic with Grade II or III haemorrhoids in ano and underwent surgery in the same institute. Patients were excluded if they were <18 years of age, had co-existing anorectal diseases (perianal fistula, anal fissure or abscess), had a previous history of anorectal surgery or open haemorrhoidectomy, had a history of recurrent haemorrhoids, had regular use of medications such as analgesics or immunosuppressants, had a history of neurologic deficit or chronic pain syndrome, was unfit for surgery or anaesthesia, or if they were pregnant. Post-operative pain was evaluated using visual analogue scale.

Results:
Seventy-two patients were included in the study, and no one was lost to follow-up. The mean age was 51.8 (13.9) years and ranged from 22 to 77 years. Majority were males (80.6%). Post-operative pain was lower in the laser group at all time points. Surgical complications were slightly lower in the stapler group. Recurrence at 6 months of follow-up was noted in only one patient belonging to the stapler group.

Conclusion:
Laser haemorrhoidectomy has significantly lower post-operative pain, but stapler haemorrhoidopexy had lesser post-operative complications, though not statistically significant. Both surgical techniques have low recurrent rates.
Laparoscopic Submucosal Appendectomy for Complicated Appendicitis
Authors: John Jimmy C. , Srinivas I. C. , Arjunith PK 
Published: August 2023

Background:
Complicated appendicitis with delayed presentations is difficult to manage surgically due to dense adhesions and distorted anatomy. Submucosal appendectomy could be an option in these cases.

Materials and Methods:
Out of 789 laparoscopic appendectomies, 239 were complicated cases. In 79 of these cases, no plane could be established between the appendix and adjacent bowel. Hence, the mucosa was identified by blunt dissection through the wall of intact appendix or through the perforation site and the mucosal tube was pulled out, and then dissected out fully from the tip and up to the base by blunt dissection, leaving behind the muscular wall. The base was then ligated and divided distally. Post-operatively, the patients were managed with ERAS protocol.

Results:
Out of 79 cases, 56 were male. Age ranged from 14 to 55 years. Forty-six cases were perforated, and 33 had mass formation. Submucosal appendectomy was done in all. There were no intra-operative complications. The average operating time was 56 min. In 68 cases, oral feeds were tolerated early, 11 cases suffered from prolonged ileus and one case had post-operative faecal leak, which settled on conservative management for 10 days. The average post-operative hospital stay was 3–5 days. Follow-up ranged from 2 months to 2 years. Three cases required re-admission, reported occasional abdominal pain, which on clinical evaluation and imaging showed no residual collection or stump appendicitis. Two cases presented with residual abscesses, which were managed with image-guided tube drainage.

Conclusions:
Submucosal appendectomy minimises bowel injury, avoids the need for conversion, and is a safe option for difficult cases during laparoscopy and also an alternative for the Ochsner–Sherren regimen.
Disparities in ethnicity and metabolic disease burden in referrals to nephrology
Authors: Chua Yan Ting , Leo Cheang Han , Chua Horng Ruey , Wong Weng Kin , Chan Gek Cher , Vathsala Anantharaman , Gan Ye Lu Mavis , Teo Boon Wee 
Published: August 2023

Abstract

Introduction
The profile of patients referred from primary to tertiary nephrology care is unclear. Ethnic Malay patients have the highest incidence and prevalence of kidney failure in Singapore. We hypothesised that there is a Malay predominance among patients referred to nephrology due to a higher burden of metabolic disease in this ethnic group.

Methods
This is a retrospective observational cohort study. From 2014 to 2018, a coordinator and physician triaged patients referred from primary care, and determined co-management and assignment to nephrology clinics. Key disease parameters were collated on triage and analysed.

Results
A total of 6,017 patients were studied. The mean age of patients was 64 ± 16 years. They comprised 57% men; 67% were Chinese and 22% were Malay. The proportion of Malay patients is higher than the proportion of Malays in the general population (13.4%) and they were more likely than other ethnicities to have ≥3 comorbidities, including diabetes mellitus, hypertension, hyperlipidaemia, coronary artery disease and stroke (70% vs. 57%, P < 0.001). Malay and Indian patients had poorer control of diabetes mellitus compared to other ethnicities (glycated haemoglobin 7.8% vs. 7.4%, P < 0.001). Higher proportion of Malay patients compared to other ethnicities had worse kidney function with estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m2 on presentation (28% vs. 24%, P = 0.003). More ethnic Malay, Indian and younger patients missed appointments.

Conclusion
A disproportionately large number of Malay patients are referred for kidney disease. These patients have higher metabolic disease burden, tend to miss appointments and are referred at lower eGFR. Reasons underpinning these associations should be identified to facilitate efforts for targeting this at-risk population, ensuring kidney health for all.