bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ktrans Calculation Using Reference Method Corrected Native T10 for Breast Cancer Diagnosis
Authors: Negi Pradeep Singh , Mehta Shashi Bhushan , Jena Amarnath , Rana Prerana 
Published: May 2023

Purpose:
The objective of the study is to use multiple tube phantoms to generate correction factor at different spatial locations for each breast coil cuff to correct the native T10 value in the corresponding spatial location of the breast lesion. The corrected T10 value was used to compute Ktrans and analyze its diagnostic accuracy in the classification of target condition, i.e., breast tumors into malignant and benign.

Materials and Methods:
Both in vitro phantom study (external reference) and patient’s studies were acquired on simultaneous positron emission tomography/magnetic resonance imaging (PET/MRI) Biograph molecular magnetic resonance (mMR) system using 4 channel mMR breast coil. The spatial correction factors derived using multiple tube phantom were used for a retrospective analysis of dynamic contrast-enhanced (DCE) MRI data of 39 patients with a mean age of 50 years (31–77 years) having 51 enhancing breast lesions.

Results:
Corrected and non-corrected receiver operating characteristic (ROC) curve analysis revealed a mean Ktrans value of 0.64 min−1 and 0.60 min−1, respectively. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy for non-corrected data were 86.21%, 81.82%, 86.20%, 81.81%, and 84.31%, respectively, and for corrected data were 93.10%, 86.36%, 90%, 90.47%, and 90.20% respectively. The area under curve (AUC) of corrected data was improved to 0.959 (95% confidence interval [CI] 0.862–0.994) from 0.824 (95% CI 0.694–0.918) of non-corrected data, and for NPV, it was improved to 90.47% from 81.81%, respectively.

Conclusion:
T10 values were normalized using multiple tube phantom which was used for computation of Ktrans. We found significant improvement in the diagnostic accuracy of corrected Ktrans values that results in better characterization of breast lesions.
Psychotropic medications around perioperative period: How to go about?
Authors: Naskar Chandrima , Grover Sandeep 
Published: May 2023

Abstract

Background:
Medical comorbidities are frequent in patients suffering from psychiatric disorders. Many of these patients would need emergency or elective surgeries in their lifetime. The perioperative period is a unique and critical phase, and thoughtful, informed management can prevent various medical misadventures in this period, thus improving the postoperative outcomes.

Aim:
This article attempts to provide an overview of the use of psychopharmacological agents during the perioperative period, the current recommendations about continuing or discontinuing various psychotropics in the perioperative period, and how to restart medications in the postsurgical period.

Material and Methods:
For this narrative review, literature search was done on PubMed and Google Scholar and relevant articles were identified and included.

Results:
For elective surgery, the psychiatrist should review the available investigation, severity of the physical illness, physical health status of the patient as per the American Society of Anaesthesiology (ASA) category, severity and stability of psychiatric disorder, comorbid substance use, and the ongoing psychotropics and their interactions with ongoing medications. In patients with ASA categories I and II, psychotropic medications can be continued. For patients with ASA categories V and VI, preferably psychotropics should be stopped. For patients belonging to ASA categories III and IV, antipsychotics except for clozapine can be continued; however, if feasible antidepressants and lithium should be stopped. For elective surgery, clozapine needs to be stopped 12 h before surgery, lithium 48–72 h before surgery, antidepressants to be tapered about 7–10 days before surgery, and monoamine oxidase inhibitors to be tapered and stopped 14 days before surgery. Other antipsychotics, mood stabilizers, and benzodiazepines can be continued till the day of surgery. When there is lack of time due to emergency surgery then a proper discussion with the primary team and the anesthetist need to be done about the possible risks.

Conclusion:
The psychiatrists handling patients in the perioperative period should have an idea about how psychotropics interact with different anesthetic agents and ensure that the anesthesiologist and the surgeon are made aware of the possible complications that might occur during the surgical and anesthetic procedure due to the concurrent use of specific psychotropics.
Correlation of Pericoronal Radiographic Width with Histopathology of Dental Follicle of Impacted Teeth using Modified Gallego's and H and E Stain
Authors: Tamgadge Sandhya , Pereira Treville , Venkateshwar Gokul , Waghmare Mandavi , Bhutani Hemant , Girotra Charu , Acharya Siddharth 
Published: May 2023

Background:
Dental follicles are involved the development of tooth and periodontal structures. Dental follicles are known for pleuripotency and inductive changes but are also known for origin for various pathologies.

Materials and Methods:
Fifty eight asymptomatic dental follicle tissues were examined histologically and radiographically wherein orthopantomogram radiographic width was correlated with various histological parameters of dental follicle and evaluated for the presence of various pathologies using modified Gallego's stain.

Observation and Results:
There was evidence of pathological changes associated with asymptomatic dental follicle. We also found variations in epithelial lining, stromal calcifications, and variable compositions.

Conclusion:
We encourage researchers to examine this peculiar tissue as a unique model and explore its potential to avoid future complications.
Evaluation of Insulin Resistance and Beta-Cell Dysfunctions in Newly Diagnosed Polycystic Ovarian Syndrome Patients
Authors: Ghatnatti Vikrant , Patil Shwetha , Kour Harpreet 
Published: May 2023

Introduction:
Women with polycystic ovary syndrome (PCOS) are at increased risk of developing glucose intolerance and diabetes attributed to increased insulin resistance (IR). However, it is not clear whether β-cell dysfunction has a central role in pathogenesis. The distinction has important implications for the prevention of type 2 diabetes in PCOS with interventions that ameliorate IR. This study aimed to find if IR differs among the various phenotypes of PCOS and perform a quantitative estimation of β-cell dysfunction versus IR in patients of PCOS participants.

Materials and Methods:
This case–control study was conducted for 1 year in the Endocrinology and Gynaecology outpatient departments at Gauhati Medical College. Fifty women newly diagnosed with PCOS, as per the Rotterdam criteria, were considered cases. Fifty, age- and body mass index-matched healthy females were taken as controls. Fasting and postprandial blood glucose, serum insulin, testosterone, and oral glucose tolerance test values were taken. Impaired fasting glucose, impaired glucose tolerance (IGT), and type 2 diabetes mellitus T2DM were diagnosed according to ADA 2011 criteria. IR and β-cell function were determined by “homeostasis model assessment (HOMA)”.

Results:
We observed an altered relationship between IR and insulin secretion, consistent with an intrinsic β-cell defect, wherein IR led to a decreased amount of compensatory insulin secretion in PCOS compared with normal women. The correlation coefficients relating HOMA%B to HOMA-IR were lower in PCOS, indicating less compensatory insulin secretion for a given increment in IR.

Conclusion:
PCOS patients are at increased risk of developing glucose intolerance and diabetes.
Peritoneal Closure versus Nonclosure in Cesarean Delivery
Authors: Quraishi Azhar Un Nisa , Farooq Ruksana , Andrabi Syed Aadil , Quraishi Athar Un Nisa , Quraishi Kamran Ahmad 
Published: May 2023

Background:
Routine closure of parietal peritoneum during cesarean section has been a custom. However, current evidence argues against peritoneal closure.

Methods:
A total of 100 pregnant women who had to undergo cesarean delivery were taken for the study. They were divided into two groups: Group C (50 patients) and Group NC (50 patients). Group C included the patients in whom parietal peritoneum was sutured during cesarean delivery, whereas, Group NC included the patients in whom parietal peritoneum was left unsutured during cesarean delivery. The two groups were then compared in terms of postoperative morbidity and outcome.

Results:
The mean operating time was significantly less in Group NC than in Group C (P < 0.001). The mean analgesia requirement in Group C was 210.4 ± 31.45 mg, whereas it was 178.5 ± 28.63 mg in Group NC (P < 0.001). Mean time for ambulation after cesarean delivery in Group C was 12.9 ± 3.42 h, whereas it was 10.1 ± 3.19 h in Group NC (P < 0.001). There was a longer duration of hospital stay in the C group (mean = 4.3 ± 1.07 days) than NC group (mean = 2.9 ± 0.95 days).

Conclusion:
Nonclosure of parietal peritoneum at cesarean delivery is associated with reduced operation time, lesser postoperative analgesia requirement, and lesser duration of hospital stay with no increased morbidity.
Incidence, Risk Factors, and Microbiology of Central Venous Catheterization-Associated Bloodstream Infections at a Surgical Tertiary Intensive Care Unit
Authors: Shrivastava Abhishek , Singh Shalendra , Taank Priya , Kaur Kaminder Bir , Pradip KC , Marwah Vikas , Sood Munish 
Published: May 2023

Background:
Central venous catheters (CVCs) can act as a portal for bloodstream infections, which increases the morbidity and mortality in intensive care units (ICUs).

Objective:
The primary aim of this study was to find out the incidence, to ascertain risk factors of bloodstream infections related to CVC, and to know the microbiological profile of organisms causing catheter-related bloodstream infection (CRBSI) in an ICU of a tertiary level hospital.

Methodology:
All patients who had CVC insertion in the operation theater before the procedure and were later transferred to ICU, and those patients who were directly admitted to the ICU and had CVC inserted were included in the study. On suspicion of an insertion-site infection, site swabs were sent for microbiological analysis. If catheter tip colonization/infection or CRBSI was suspected, the CVC was removed, and the tip of the catheter along with two sets of blood (peripheral and central) was sent for culture analysis. A semi-quantitative culture analysis was done to confirm CRBSI.

Results:
On review of data, 150 patients with cumulative 1056 catheter surveillance days revealed an incidence of 24.66% for CVC-related infections, which included exit site infections (5.33%), catheter tip infections (13.33%), and CRBSI (6%). The rate of CRBSI associated with CVCs placed in the surgical ICU was 35.3 per 1000 catheter surveillance days. Staphylococcus aureus was the most common organism causing CRBSI and CONS (coagulase-negative staphylococcus) was the most common organism causing catheter tip and exit site infections.
Perceptions about Nonpharmacological Interventions in the Prevention of COVID-19 in the Field Practice Area of Jawaharlal Nehru Medical College
Authors: Manimaran N S , Kadeangadi Deepti M , Manoli Aniket D , Shivaswamy M S , Patil Anjali J 
Published: May 2023

Introduction:
COVID-19 pandemic is a major global public health threat. Coronavirus includes a large group of viruses, which infects both humans and animals. China reported the outbreak on December 31, 2019, to World Health Organization. Center for Disease Control and Prevention, USA, has published nonpharmacological interventions such as social distancing, zonal lockdown, rolling lockdown, wearing masks, and washing hands to combat the spread of COVID-19. The present study was conducted to assess the perceptions of people about nonpharmacological interventions in the prevention of COVID-19.

Materials and Methods:
A facility-based study was conducted among 220 participants from December 01, 2020, to February 28, 2021, among outpatients in the field practice area of urban primary health care Rukmini Nagar, under the administrative control of J. N. Medical College in Belagavi district, Karnataka.

Results:
A total of 220 participants were interviewed and analyzed for the study. Out of which, 36 (16.4%) were male and 184 (83.6%) were female. One hundred and seventy (77.2%) of the participants practiced good hand hygiene and personal hygiene. One hundred and forty-five (65.9%) of the participants always wore a face mask, when they were going outside. One hundred and eighty-one (82.2%) of the participants started drinking more fluids in the form of water compared with normal days.

Conclusion:
There was a lack of awareness about face protection and the use of hand sanitizer among the common public. Grassroots level health-care workers such as Accredited Social Health Activist, Anganwadi workers, and community volunteers should be trained for giving health education about nonpharmacological interventions to the public for COVID-19 prevention.
Iron and Zinc Deficiency in Children with Febrile Convulsions Aged 6[FIGURE DASH]60 Months [FIGURE DASH] A 1-Year Hospital-Based Case[FIGURE DASH]Control Study
Authors: Mallela Jyothirmai , Metgud Tanmaya , Kamate Mahesh , Kadeangadi Deepti M. 
Published: May 2023

Context:

Febrile seizures are one of the most common seizures in childhood. Febrile seizures occur in 2%–5% of children who are younger than 5 years of age. Studies have shown that iron, zinc, selenium, copper, and magnesium play a significant role in febrile seizures. This study was intended to study the relationship between iron and zinc deficiency with febrile seizures. Aim: To find the association of febrile convulsions with iron and zinc deficiency.

Methodology:

This hospital-based case[FIGURE DASH]control study was done in a tertiary care center in North Karnataka from January 2017 to December 2017. A total of 52 children fulfilling the inclusion criteria were included in case group. Control group contained 52 children who had fever without convulsions and matched for age, sex, and background disease with respective cases.

Results:

Both the groups were matched for age and gender. Majority of the children (76.92%) had a simple seizure. Cases had lower serum (Sr.) ferritin levels compared to controls with high odds ratio (OR) (25% vs. 1.92%; P < 0.001; OR = 17.00; P = 0.0075). Furthermore, cases had zinc deficiency compared to controls (84.62% vs. 25%; OR = 12.269; P < 0.001). The mean Sr. zinc levels (37.16 ± 22.07 vs. 75.75 ± 15.25 μg/dL; P < 0.001) were significantly low in cases.

Conclusion and Interpretation:
There was a significant association between febrile seizures with iron and zinc deficiency.
Microscopic Structural Changes in Osteoarthritic Menisci of the Human Knee Joint
Authors: Yadav Sanjay Kumar , Shirol Veereshkumar S. , Chavan Ramesh , Bhimalli Shilpa M. 
Published: May 2023

Background:
Osteoarthritis (OA) is a degenerative joint disease for which there is currently no cure. It is characterized by degeneration of articular cartilage and changes in other joint tissues, including subchondral (substance) bone and menisci. It is one of the leading causes of chronic disability. Patients affected by this disease experience pain and loss of function. OA can be caused by a variety of factors, including diet, injury, stress, and genetic abnormalities. However, the molecular mechanisms driving the disease onset and progression are not fully understood. Therefore, this study is undertaken to estimate a large number of human OA menisci for microscopical structural changes in osteoarthritic menisci by histological techniques.

Materials and Methods:
Medial and lateral osteoarthritic menisci were collected from 110 human knee joints. After collecting the meniscal samples were stored in 10% formalin for 3–5 days. For each meniscus, three separate (anterior, middle, and posterior) parts were processed. The menisci were sectioned in two places vertically at 45° and 135° angles relative to the sagittal plane. After that, each part was sectioned along the horizontal plane from the inner border to the outer border. Then, tissues were fixed in 10% buffered formalin for 24 h. Tissue samples were brought in for routine tissue processing and studied for histological stain with hematoxylin and eosin (H and E) and Alcian blue pH 2.5, to find surface integrity, cellularity, fibrous organization and collagen orientation, and mucoid degeneration.

Results:
Meniscal degeneration begins with the tissue material rather than the surface. Tissue fibrillation and tears were first observed at the inner border, spread over time to the articular surface of the meniscus, and progressed to complete destruction or loss of meniscal tissue. The left side knee menisci have more OA than the right side. OA cases were more common in both legs, in the age group 60–69 years. Women and Hindus have higher OA cases than men and other religions, respectively. Nonvegetarian and physically inactive individuals were more susceptible to OA, and B +ve and O +ve were more prone to OA than other blood groups.

Conclusion:
Significant cellular and matrix differences were observed in the meniscus during degeneration. These findings may contribute to further understanding of knee OA and the search for biological treatments. OA was associated with religions, family history, dietary habits, exercise, blood types, and age groups. Hence, there is a need for a program on the care of dietary habits and physical activities for reducing the progression of OA.
Endobronchial ultrasound-guided intranodal forceps biopsy (EBUS-IFB) using 19G needle tract: First case series from India
Authors: Dhamija Amit , Guliani Abhinav , Basu Arup K. 
Published: May 2023

ABSTRACT
EBUS-TBNA is a well-established procedure for diagnosis of mediastinal lymphadenopathy replacing the need for mediastinoscopy. In certain diseases like lymphomas, the yield is reportedly 50%, sarcoidosis lymph nodes also give a yield of 80% with EBUS and at times, more material is needed for better characterization of malignancies. EBUS-intranodal forceps biopsy may be useful in these situations. In our series of seven cases, we describe a unique and safe technique of obtaining forceps biopsy from mediastinal lymph nodes under real-time endobronchial ultrasound guidance using a 19G EBUS-TBNA needle tract and thin biopsy forceps. Lymph node biopsy was able to give a conclusive diagnosis in 42% patients negative with TBNA, and was able to suggest a diagnosis in one case. No complications were seen. Thus, surgical biopsy can be avoided in nearly 50% of failed EBUS-FNAC cases.
Early versus non-early desaturation during 6MWT in COPD patients: A follow-up study
Authors: Agarwal Mohit , Anand Shweta , Patro Mahismita , Gothi Dipti 
Published: May 2023

ABSTRACT

Introduction:
Six-minute walk test (6MWT) has a significant prognostic value in chronic obstructive pulmonary disease (COPD). Those who desaturate early during 6MWT are likely to have frequent exacerbations.

Aims and Objectives:
To follow-up and compare exacerbations and hospitalisations of COPD patients having early desaturation versus nonearly desaturation determined during baseline 6MWT.

Methods:
It was a longitudinal follow-up study conducted in a tertiary care institute from November 1, 2018 to May 15, 2020 involving 100 COPD patients. A decrease in SpO2 by ≥4% in baseline 6MWT was considered a significant desaturation. If the desaturation occurred within first minute of the 6MWT, the patient was called early desaturator (ED); if it occurred later, the patient was called nonearly desaturator (NED). If the saturation did not fall, then the patient was called nondesaturator. During the follow-up, 12 patients dropped out and 88 remained.

Results:
Of 88 patients, 55 (62.5%) were desaturators and 33 were nondesaturator. Of 55 desaturators, 16 were ED and 39 were NED. EDs had significantly higher number of severe exacerbations (P <.05), higher hospitalisation (P <.001), and higher BODE index (P <.01) compared to NEDs. The receptor operating characteristic curve and multiple logistic regression analysis showed that previous exacerbations, presence of early desaturation, and distance saturation product during the 6MWT were significant predictors for predicting hospitalizations.

Conclusion:
Early desaturation can be used as a screening tool for assessing the risk of hospitalization in COPD patients.
Biological therapy for severe asthma – Indian perspectives and challenges
Authors: Venkitakrishnan Rajesh , Augustine Jolsana , Ramachandran Divya , Cleetus Melcy 
Published: May 2023

ABSTRACT
Asthma is a complex and heterogeneous disease. Severe asthma makes up only a minority of asthma patients encountered in clinical settings but accounts for substantial healthcare utilisation in terms of manpower as well as economic allocation. The availability of monoclonal antibodies has a major impact on severe asthmatics and has provided excellent clinical results in properly selected patients. The discovery of new molecules might present uncertainties to clinicians as to the best agent to institute in an individual patient. The practice scenario in India is unique when it comes to the commercial availability of monoclonal antibodies, patient attitudes, and allocation of the healthcare budget. The present review dissects and summarises the available monoclonal antibodies for asthma treatment in India, the perspectives of Indian patients on biological therapy, and the challenges encountered by patients and physicians in this regard. We provide practical suggestions for utilising monoclonal antibodies and deciding on the optimal agent for a given patient.
Incidence and outcomes following pulmonary barotrauma in COVID-19 ventilated and non-ventilated patients with acute respiratory failure: A retrospective study
Authors: Vadi Sonali , Suthar Durga , Sanwalka Neha , Sanghani Gordhan , Ravi R 
Published: May 2023

ABSTRACT

Background and Objectives:
Alveolar rupture following increased transalveolar pressure on positive pressure ventilation is associated with pulmonary barotrauma (PB). The spectrum varies from pneumothorax, pneumomediastinum, pneumopericardium, pneumoperitoneum, retro-pneumoperitoneum and subcutaneous emphysema. We studied the incidence of PB and their clinical characteristics in patients with coronavirus disease 19 (COVID-19)-associated acute respiratory failure.

Methods:
Patients aged >18 years with COVID-19-associated acute respiratory distress syndrome were included in the study. We recorded demographics (age, gender, comorbidities), severity scores (APACHE II on admission, SOFA on the day of barotrauma), type of PB and outcomes at discharge from the hospital. Patient characteristics are descriptively reported. Survival analysis was done using Kaplan–Meier survival tests after classifying by various factors. Survival was compared using the log-rank test.

Results:
Thirty-five patients experienced PB. Eighty per cent of patients in this cohort were males with mean age of 55.89 years. The commonest comorbidities were diabetes mellitus and hypertension. Twelve spontaneously breathing patients developed barotrauma. Eight patients experienced sequential events. In all, 18 patients required insertion of pigtail catheters. The median survival time in patients was 37 days (95% CI: 25–49 days). The overall survival rate was 34.3%. Mean serum ferritin levels were six times upper limit of normal in deceased, reflecting the severity of lung involvement.

Conclusion:
A high incidence of PB was noted following severe acute respiratory syndrome coronavirus (SARS CoV-2) infection even in the non-ventilated patients, a consequence of SARS CoV-2 effects on the pulmonary parenchyma causing widespread lung injury.