bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rapunzel Syndrome in a Boy
Authors: Singh Kuldeep , Kapoor Pawan , Grover Nishu , Godara Surendra 
Published: August 2023

Background:
Trichobezoar is a rare phenomenon where a ball of swallowed hair collects in the stomach. When its tail extends beyond the pylorus in to the small intestine, it is termed Rapunzel syndrome. The condition is most commonly seen in females with psychological disturbances, many of whom have trichotillomania and or trichophagia. We report Rapunzel syndrome condition in a young boy having no overt mental disturbances.

Clinical Description:
A 5½-year-old male child presented with complaints of vomiting for 20 days, associated with dull aching epigastric pain over 1 year. A lump had been noticed in the abdomen which was increasing in size for the past 5 months and decreased appetite for past 1 month. Besides pica, the child had no other significant medical or surgical illness. On examination, the child was underweight with pallor, with dry, lusterless, easily pluckable hair. His abdomen revealed a palpable lump in epigastrium, with ultrasonography showing a large gastric mass with air foci. Contrast-enhanced computed tomography abdomen revealed a large, well-circumscribed, nonhomogeneous lesion in the lumen of the stomach suggestive of bezoar. The patient underwent exploratory laparotomy, which confirmed trichobezoar with a long tail of hair extending through the pylorus into the small bowel. After successful removal of the trichobezoar, the patient was discharged with no postoperative complication and advised follow up in surgery, pediatrics, and psychiatry department.

Conclusion:
This case creates awareness of the possibility of the rare, bizarre entity of trichobezoar in a toddler presenting with nothing more than the usual common symptoms as seen in this age group. After ruling out common causes, when there is persistence of symptoms, with some clinical clues like pica, anemia, and behavior abnormalities, pediatricians may suspect an underlying atypical diagnosis like trichobezoar, even in a male child.
Hemolytic Disease of Newborn Following Anti-C and Anti-S Alloimmunization
Authors: Kar Shrutiprajna , Pradhan Monalisa , Som Tapas , Mohanty Pankaj Kumar 
Published: August 2023

Background:
Non-Rhesus D antigen non-ABO, minor blood group alloimmunization in pregnant women is being increasingly recognized as a significant contributor to the development of the hemolytic disease of the fetus and newborn (HDFN). We report severe HDFN in a neonate born to an Rh-positive mother with sickle cell disease, following anti-C and anti-S alloimmunization.

Clinical Description:
A male baby born to a repeatedly transfused mother with sickle cell disease developed severe jaundice at 22 h of life. The baby was found to have severe anemia and indirect hyperbilirubinemia, but no encephalopathy, hepatosplenomegaly, or features of sepsis.

Management and Outcome:
His blood group was O positive and the direct Coombs test was 4+. Minor blood group typing showed the presence of anti-C and anti-S antibodies. The baby improved after receiving a double-volume exchange transfusion with matched blood and phototherapy.

Conclusion:
Severe hemolytic disease of the newborn (HDN) may be caused by minor blood group alloimmunization, especially seen in mothers with a history of multiple transfusions. Antenatal screening for alloimmunization in high-risk mothers can ensure timely diagnosis and treatment of HDN and prevent the harmful effects of neonatal hyperbilirubinemia.
Mutation in Methionyl-tRNA Synthetase 1 Causing Pulmonary Alveolar Proteinosis
Authors: Madhusudan Manoj , Chandra Tejaswi , Srikanta J. T. 
Published: August 2023

Background:
A chronic history of exertional dyspnea, dry cough, and fatigue, associated with reticulonodular ground-glass opacity indicates an underlying interstitial lung disease (ILD). Pulmonary alveolar proteinosis (PAP) is a rare cause of ILD, in which there is abnormal accumulation of surfactant material in alveoli, thereby impairing gaseous exchange. In children, PAP is usually due to genetic mutations. We report a child with PAP due to mutation in methionyl-transfer RNA synthetase 1 (MARS) gene.

Clinical Description:
An 8-year-old boy presented with persistent dry cough, and exercise-induced breathlessness for 2 years of age, associated with failure to gain weight. He had multiple exacerbations in the past, requiring common symptomatic treatment, but with minimal improvement. On presentation to us, the child had tachypnea, hypoxia (oxygen saturation [SpO2]: 85%), and Grade 2 clubbing, with bilateral fine crepitation in bilateral lung fields.

Management and Outcome:
The child was stabilized by providing oxygen via high-flow nasal cannula. Blood investigations were largely normal. His chest X-ray and computerized tomography (CT) of the chest were suggestive of childhood ILD. A lung biopsy revealed periodic acid–Schiff-positive eosinophilic granular material in the alveolar spaces without any fibrosis, suggesting a diagnosis of PAP. Next-generation sequencing revealed a compound heterozygous mutation of the MARS1 gene resulting in PAP. Parental segregation analysis showed each one to be a carrier of one of the genes. Therapeutic whole-lung lavage (WLL) was carried out, following which symptoms improved markedly. SpO2 increased and the child was able to be weaned off oxygen and discharged. Three years, postdischarge, the child is asymptomatic and thriving well.

Conclusions:
PAP may be a cause of ILD in a child. Although the etiology can be ascertained by high-resolution CT of the chest and bronchoalveolar lavage, further genetic analysis should also be undertaken in children to identify the exact defect. WLL can provide a good outcome in children with PAP due to MARS mutation.
Early Onset Portal Hypertension Due to Silent Extensive Portal Vein Thrombosis Following Umbilical Vein Catheterization
Authors: Latawa Surbhi , Sharma Ritu , Rai Anuradha , Dhingra Dhulika 
Published: August 2023

Background:
Umbilical vein catheterization is a routine procedure in neonatal intensive care units. This invasive procedure, though easy and useful, can result in disastrous complications.

Clinical Description:
A 28 day old baby boy presented with umbilical sepsis along with multiple skin abscesses. He had a history of double volume exchange transfusion for Glucose 6 Phosphate deficiency induced hyperbilirubinemia, during the postnatal period. Ultrasound whole abdomen done to look for intra-abdominal abscesses revealed extensive portal vein thrombosis including the main portal vein and its branches with cavernoma formation. Upper gastrointestinal endoscopy revealed Grade II esophageal varices suggestive of the development of portal hypertension.

Management and Outcome:
Baby was started on subcutaneous enoxaparin which continued for 3 months. Follow up ultrasound showed complete obliteration of portal vein, replaced by cavernomas with development of grade II esophageal varices seen on upper gastrointestinal endoscopy.

Conclusion:
This case highlights how umbilical vein catheterization in the neonatal period can lead to catastrophic complications such as obliteration of the entire main portal vein and its branches, formation of portal cavernoma, portal hypertension, and esophageal varices, all of which can develop silently, at a very early age.
Early-Onset Virilization May Rarely be Due to an Adrenocortical Neoplasm
Authors: Nanda N , Kaur Kirandeep , Kadian Kavita , Sridharan Kalyani 
Published: August 2023

Background:
Adrenocortical tumors are rare neoplasms of childhood; most of which are functional in childhood, producing excess hormones. Virilization, precocious puberty, and Cushing's syndrome are common presenting features.

Clinical Description:
A 6-year-8-month-old girl presented with features of virilization, which started appearing at 2 ½ years of age. The mother gave a history of progressive enlargement of the clitoris with the development of pubic, axillary, and facial hair over the years. There was no history of perinatal complications, features of adrenal insufficiency, atypical external genitalia at birth, or family history of malignancy. On examination, she had features of heterosexual peripheral precocious puberty. The hormonal investigation was suggestive of cortisol and androgen excess. Radiologically, she had an adrenal tumor appearing like adrenocortical carcinoma (ACC)-large size, high noncontrast Hounsfield units, and poor washout.

Management and Outcome:
As virilization was not present since birth and there was no evidence of adrenal insufficiency, therefore, the possibility of congenital adrenal hyperplasia was unlikely. Investigations revealed that the testosterone levels were much higher than other adrenal androgen precursors like dehydroepiandrosterone sulfate. This was a clinical clue to the well-differentiated and benign nature of the tumor although radiologically it appeared like ACC. The child underwent en bloc resection of the mass, and histopathology was suggestive of a benign adrenocortical adenoma. Seven days after surgery, the serum testosterone had dropped substantially.

Conclusion:
This case creates awareness about the possibility of an adrenocortical neoplasm in a child with early-onset virilization, which can be diagnosed correctly by following a step-wise, logical sequence of investigations.
Awareness and knowledge of integrated counselling and testing centres (ICTC) counsellors about depression among people with human immunodeficiency virus (HIV): A descriptive study from Karnataka
Authors: Kumar P C Pradeep , John Soyuz , Cherian Anish V. , Pandian R Dhanasekara , Anand Nitin , Rao T S Sathyanarayana 
Published: August 2023

Background:
Depression among people living with human immunodeficiency virus (PLHIV) is highly prevalent and it is associated with increased morbidity, poor adherence to antiretroviral therapy, and poor psychosocial outcomes. To address this, integrated counselling and testing centres (ICTC) counsellors provide psychosocial support to PLHIV.

Materials and Methods:
This descriptive study aims to assess the awareness and knowledge of ICTC counsellors about depression and its management. A total of 338 (n = 452) ICTC counsellors participated in the study. A demographic data sheet and a semi-structured questionnaire were used to collect data.

Results:
More than half of the participants reported that biochemical imbalances cause depression. 71.60% and 79.59% of participants reported that depression was common among PLHIV and required immediate attention. 92.60% of counsellors reported that a combination of counselling and medication would be effective to treat depression. 86.98% and 81.95% of counsellors were confident and actively screened for depression among PLHIV, and 78.11% of counsellors had access to a psychiatrist. In contrast. One-third of participants had difficulties working with PLHIV, and 55.56% of participants expressed that addressing issues of PLHIVs’ depression to be left to mental health professionals.

Conclusion:
ICTC counsellors had adequate knowledge about depression and its symptoms. However, lack of knowledge on intervention strategies, time constraints and work targets are significant barriers. These findings suggest that training on mental illness screening; brief intervention strategies may help counsellors to assist PLHIV in overcoming depression complications.
Stitch-induced caecal fecolith: An unusual long-term complication following laparoscopic appendicectomy
Authors: Subramaniyan S Sree , Gopal Sri Vengadesh 
Published: August 2023

Abstract
A fecolith is a mass of accumulated hardened faecal matter usually seen in patients with Chagas disease, Hirschsprung’s disease and inflammatory bowel disease. We report a 21-year-old female with chronic right lower abdominal pain post-appendicectomy. An abdominal computed tomography revealed a fecolith near the caecum and a right simple ovarian cyst. On diagnostic laparoscopy, a Prolene stitch in the previous appendicectomy site acting as a nidus and forming a fecolith was noted. It was excised by a small enterotomy and primary closure of the same. She had an uneventful post-operative course. This case highlights the danger of using a non-absorbable suture for appendicectomy and the rare phenomenon of fecolith formation post-appendicectomy after 4 years presenting with features of chronic recurrent abdominal pain.
Is the self-adhesive mesh a solution for chronic postoperative inguinal pain after TAPP: A single centre preliminary experience?
Authors: Kirov Kiril G. , Mihaylov Diyan M. , Arnaudov Stefan Svilenov 
Published: August 2023

Abstract

Background:
Minimally invasive surgery for groin hernia has expanded significantly over the last two decades and has demonstrated better outcomes in terms of pain and quality of life. A major contributing factor related to chronic post-operative inguinal pain (CPIP) is mesh fixation. An alternative to the standard fixation methods is the self-adhesive surgical mesh.

Patients and Methods:
Prospective data analysis was performed of all patients undergoing laparoscopic transabdominal pre-peritoneal (TAPP) inguinal hernia repair in a single centre for the period 1st January, 2022–15th December, 2022. A standardised surgical technique was used with a lightweight self-adhesive mesh without additional fixation. The analysis has encompassed early and late post-operative complications as well as the assessment of pain with an emphasis on CPIP.

Results:
The study enrolled 52 patients where a total number of 64 elective hernia repairs were performed: 92.2% (n = 59) primary and 7.8% (n = 5) recurrent. Fifty-one patients received post-operative follow-up: 100% at 1 month and 78.8% (n = 41) at 3 months. The incidence of early postoperative complications was 7.7% (n = 4): one patient developed a seroma, two patients – port site hematomas and one a transient subileus that were all managed conservatively. No patients suffered a recurrence. The average pain score according to the Visual Analogue Scale was 3.3 (0–8) at discharge, 0.6 (0–4) at 1 month and there was no incidence of CPIP after the 3rd month.

Conclusion:
Laparoscopic TAPP repair for inguinal hernia with a self-adhesive mesh is an adequate surgical technique with the potential to reduce CPIP, but more research is needed to evaluate this method.
Multidetector computed tomography evaluation of normal thymus and variations with age
Authors: Naik Suprava , Shri Aishvarya , Sidhu Simran , Lahre Yuvraj , Bag Nerbadyswari Deep , Bhoi Sanjeev Kumar , Mohakud Sudipta 
Published: August 2023

Abstract

Background:
Thymus is a T-cell-producing lymphoid organ that appears prominent in the paediatric population and involutes in size with ageing. The gland shows a wide variety of appearances across different age groups. The purpose of the study is to evaluate the computed tomography (CT) appearance of thymus gland in the normal population with a focus on size, CT attenuation and fatty infiltration in different age groups.

Patients and Methods:
This is a retrospective study done after taking approval from the Institutional Ethics Committee. Patients undergone CT scans of the thorax were identified from our database. All evaluations were done in non-contrast CT scans. Patients having underlying diseases that may have associated thymic abnormality were excluded. The appearance of thymus and the presence of fatty replacement were assessed. The size of thymus (length and thickness of right limb and left limb) and non-contrast CT Hounsfield unit (HU) value of thymic tissue were measured and compared in various age groups.

Results:
Four hundred and fifty patients were included, 262 (58.2%) were male. Mean age was 33.6 ± 17.1 years, range (3 months–80 years). The size of thymus was observed to decrease with increasing age. The mean age of complete fatty replacement in our study was 45 years. Complete fatty replacement was noted in all cases with an age of more than 60 years. The most common shape was arrowhead, and the most common location was pre-aortic and para-aortic location. Non-contrast CT HU value was maximum in infants and gradually decreased with advancing age.

Conclusion:
Even normal thymus can show varied appearance on CT which changes with the age of the patient being imaged. A comparison with normative data could help differentiate normal from abnormal glands to avoid unnecessary intervention.
Effect of perioperative application of dexmedetomidine on post-operative stress reaction, pain and prognostic adverse effects in patients undergoing gynaecological laparoscopy
Authors: Wu Xing , Xing Yuhang , Pan Lili , Chai Mao 
Published: August 2023

Abstract

Introduction:
The aim of this study was to analyse the effect of perioperative dexmedetomidine (DEX) application on stress response, post-operative pain and prognosis in patients undergoing gynaecologic laparoscopy.

Patients and Methods:
One hundred and sixty-eight patients admitted for gynaecologic laparoscopic surgery from May 2020 to November 2022 were included in the study. The patients were randomly divided into pre-operative DEX group (n = 56), intraoperative DEX group (n = 56) and post-operative DEX group (n = 56) according to the application of DEX in the perioperative period. The visual analogue scale (VAS), time awake, extubation time, pneumoperitoneum time, post-anaesthesia care unit (PACU) stay time and Richmond agitation-sedation scale score (RASS) were recorded.

Results:
Patients in both the pre-operative and intraoperative DEX groups had substantially shorter wakeup and extubation times than those in the post-operative DEX group. Patients in the pre-operative DEX group had considerably shorter wakeup and extubation times than those in the intraoperative DEX group, and their pneumoperitoneum time was significantly shorter than that of the post-operative DEX group (P < 0.001). The RASS scores of the pre-operative DEX group and intraoperative DEX group were significantly lower than those of the post-operative DEX group at 1 h, 6 h and 12 h after surgery. Meanwhile, at all time periods, the RASS scores of patients in the pre-operative DEX group were considerably lower than those in the intraoperative DEX group (P < 0.01). The VAS scores of patients in the pre-operative DEX group and intraoperative DEX group were evidently lower than those in the post-operative DEX group at 0.5 h, 2 h and 12 h postoperatively, and the VAS scores of patients in the pre-operative DEX group were markedly lower than those in the intraoperative DEX group (P < 0.001). The incidence of nausea and vomiting was significantly lower in the pre-operative DEX group than in the intraoperative DEX group and the post-operative DEX group at 0–2 h, >2–12 h and >12–24 h postoperatively (P < 0.001). The incidence of nausea and vomiting in the intraoperative DEX group was significantly lower than that in the post-operative DEX group from 0 to 2 h after surgery (P < 0.05). The incidence of adverse reactions was not significantly different amongst the three groups of patients (P > 0.05).

Conclusion:
Pre-operative and intraoperative application of DEX can help reduce post-operative pain and stress responses, help patients recover quickly after surgery and improve patient prognosis, especially the pre-operative application of DEX.
Case report on laparoscopic management of congenital peritoneal encapsulation: A rare cause of small bowel obstruction
Authors: Dey Sumanta , Roy Sreetama , Guhathakurta Abhishek , Ghosh Debarchan 
Published: August 2023

Abstract
Peritoneal encapsulation (PE) is a rare congenital disorder described as an accessory peritoneal lining covering a part or whole of the small bowel. Some theorise the encapsulation is due to the formation of adhesion between the physiological hernia and the caudal duodenum. While others have stated it is a defect in the reduction of the physiological hernia. Patients usually present at different stages of intestinal obstruction at any point of time during life. There are also reports on post-humous diagnosis on autopsy. PE is a rare surgical entity, hence not much evidences are available on how to tackle this condition by minimally invasive approach. Here, we report a case of PE in a 43-year-old male who presented with features of intermittent sub-acute intestinal obstruction and was managed by laparoscopic surgery at our institute.
Management of type 2 diabetes: Self-management education and clinical findings
Authors: Türe Aysun , Demirsoy Nilufer , Gökalp Deniz 
Published: August 2023

Abstract

Aim:
The purpose of this study is to determine the effects of the self-management education provided to patients with type 2 diabetes under the leadership of a nurse on the perceptions of self-management and clinical findings of patients.

Materials and Methods:
The sampling of the research comprises 281 patients who received a diagnosis of type 2 diabetes and whose treatment is being conducted. The self-management perceptions, body mass index, preprandial blood glucoses, and glycolyzed hemoglobin levels of the patients were measured before and after the intervention and 3 months later.

Results:
It was determined as a result of the comparison of the scores before and after the nursing education provided to the patients that the patients’ self-management perception scale scores increased significantly and that the body mass index, preprandial blood glucose, and glycolyzed hemoglobin levels reduced significantly (P < 0.01).

Conclusions:
It is determined in research that the self-management education provided to patients with type 2 diabetes under the leadership of a nurse had a meaningful impact on the diabetes self-management skills and clinical findings of the patients.

Practice Implications:
It was determined that the average diabetes self-management education scores increased significantly when comparing before and after the self-management provided to patients and that the body mass index, preprandial blood glucose, and glycolyzed hemoglobin levels decreased at a statistically meaningful level.
Prevalence and risk factors of peripheral neuropathy among young type 2 diabetes mellitus patients attending a tertiary care hospital in upper Assam: A cross-sectional study
Authors: Dutta Suruj Jyoti , Dutta Pranjal Kumar , Dutta Anupam , Ahmed Sultana Jesmin , Sonowal Sarojmoni , Boruah Angshuman 
Published: August 2023

Abstract

Background:
Diabetic peripheral neuropathy (DPN), being the most common and early complication of diabetes mellitus, results in significant morbidity and debilitating sequelae in the form of foot ulcers, infection, and amputation. Due to the disease’s longevity, young type 2 diabetes constitutes a high risk for developing neuropathy, and screening of patients for DPN becomes crucial.

Objectives:
This study aimed to estimate the prevalence and identify the associated risk factors of peripheral neuropathy among young type 2 diabetes mellitus patients attending a tertiary care hospital in upper Assam.

Materials and Methods:
This cross-sectional study was conducted from July 1, 2022 to September 30, 2022 in the Department of Medicine. A total of 165 participants attending the outpatient Department and the Diabetic clinic, diagnosed with type 2 diabetes below the age of 45 years were recruited using non-random consecutive sampling. Patients were then interviewed using a pre-designed, pre-tested schedule. DPN was assessed by detection of vibration perception threshold (VPT) using a biothesiometer, the cutoff value for which was taken as 15 V.

Results:
The prevalence of DPN as assessed by VPT using biothesiometer was 13.9%. The prevalence of mild, moderate, and severe neuropathies was 9.1%, 3.6%, and 1.2%, respectively. DPN was found to have a significant association with the duration of diabetes and hypertension. Socio-demographic characteristics, smoking, alcohol intake, physical activity, anti-diabetic medication, and dyslipidemia were not found to have a significant association with DPN.

Conclusion:
This study has stressed the importance of screening for hypertension even in the younger age groups as well as the need for early detection of DPN, which can aid in taking necessary actions to impede the disease’s progression.