bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implications of Inflammatory markers for disease management in patients with chronic kidney disease and COVID-19 infection: A cross-sectional study from North India
Authors: Khurana Vatsala , Goswami Binita , Aggarwal Sunita , Kaushik Smita 
Published: August 2023

ABSTRACT

Background:
The world witnessed the emergence of a global pandemic. Individuals with chronic illnesses like chronic kidney disease (CKD), already known to be immunologically compromised, have the potential to develop a scenario of an acute-on-chronic condition on coronavirus disease 2019 (COVID-19) contraction. Measurement of serum inflammatory biomarkers like interleukin (IL-6), high-sensitivity C-reactive protein (hsCRP) and ferritin may foresee the prognosis despite the pre-existing low-grade inflammation in these patients.

Aims:
To determine the utility of serum IL-6, hsCRP and Ferritin levels to determine COVID-19 severity and probable prognosis in CKD patients with COVID-19.

Materials and Methods:
A cross-sectional study was performed on 100 adult known cases of stage 5 of CKD, recently diagnosed as COVID-19 positive by real-time reverse transcription-polymerase chain reaction. The study population was divided into two groups according to COVID-19 severity: A non-severe and a severe group based on guidelines given in the Clinical Management Protocol: COVID-19. Their clinical and laboratory data obtained on the day of admission were analysed.

Results:
The severe group (n = 17) had 65% of males and 35% of females. A significant difference was found with respect to the age, body mass index and serum IL-6, hsCRP and ferritin levels between the two groups (P < 0.05). Among the three inflammatory biomarkers, hsCRP was found to have the maximum potential to categorise COVID-19 as severe or non-severe disease.

Conclusion:
Similar to patients with uncomplicated COVID-19 disease, higher serum levels of inflammatory biomarkers – IL-6, hsCRP and ferritin are seen in patients of CKD with severe COVID-19 illness in comparison to those with non-severe COVID-19, despite having a pre-existing background of low-grade chronic inflammation. The serum levels of IL-6, hsCRP and ferritin can be utilised to determine COVID-19 severity and probable prognosis in CKD patients with COVID-19.
Advantages of Sentinel Lymph Node Mapping by Single Photon Emission Computed Tomography/Computed Tomography in Early-Stage Malignant Head-and-Neck Skin Tumors
Authors: Cadena-Pineros Enrique , Goìmez-Herrera Juliaìn , Mayo-Patiño Melissa , Carreño Alexander 
Published: August 2023

Background:
The aim of this study was to determine the advantages of preoperative sentinel lymph node mapping (SLNM) by single photon emission computed tomography/computed tomography (SPECT / CT) in patients with early-stage cutaneous head-and-neck malignancies.

Materials and Methods:
We conduct a 7-year and 6 months retrospective, cross-sectional study. Patients with early-stage malignant head-and-neck skin tumors and cutaneous adnexa who underwent SLNM by SPECT/CT from March 2012 and December 2019, were included in the study.

Results:
We retrospectively analyzed 28 patients: Melanoma was the most frequent tumor (64.2%), followed by squamous cell carcinoma (25%). The anterior cheek was the most common functional subsite (25%). Twenty-seven patients (96.4%) had a successful SLN detection with SPECT/CT. Neck lymph node dissection was performed in 23 patients (82.1%). According to the pathological specimen, lymph nodes were found in all of them; hence, the efficacy of the SPECT/CT for SLNM was 100%. At 7-year follow-up, systemic recurrence was found in one patient (3.6%), another had locoregional recurrence (3.6%), and the mortality rate was 3.6%.

Conclusions:
In early-stage malignant head-and-neck skin tumors, there is a high concordance between SLN found by SPECT/CT and the histopathological results. Preoperative SPECT/CT accurately detects the SLN, assesses unexpected lymph nodes and their drainage pathways, and facilitates their location by reliably showing the relationships between sentinel nodes and important anatomic structures. This allows to perform a clear preoperative evaluation, an accurate staging for all patients and to avoid excessive dissections that could result in cosmetic and functional deformities.
Abdominal wall closure in adult patients with untreated exstrophy of bladder
Authors: Gupta Ashish Kumar , Gohil Amish Jayantilal , Lamba Shashank 
Published: August 2023

Introduction:
Bladder exstrophy is an anomaly, which if not treated early in the age, poses a surgical challenge in providing an adequate abdominal wall closure. We report our experience in patients with untreated exstrophy of the bladder, who underwent cystectomy, ileal conduit, and abdominal reconstruction using the anterior rectus sheath turndown flap and paired inguinal skin flaps.

Materials and Methods:
Ten previously unoperated adult patients with exstrophy with epispadias, who underwent surgery at our institute from January 2010 till January 2021, were included in this study to evaluate the adequacy of abdominal wall closure with our technique of retrograde turndown anterior rectus sheath flap with paired inguinal flap, and to document immediate and delayed complications, especially incisional hernia.

Results:
The mean follow-up period of the study was 16.5 months. We found that our technique provided adequate local tissue for a sturdy two-layered closure of the lower abdominal wall defect. Out of the ten patients, only one required an additional flap for abdominal wound closure. There were no stoma-related complications or incisional hernia.

Conclusion:
Abdominal wall reconstruction, for skin and fascial defects, in such complex cases can be performed by local skin and fascia using a relatively simple, safe, easy, and affordable technique as we have described. Our technique avoids the use of synthetic mesh, thereby reducing the chances of infection in such chronic open wounds.
Timing of intraoperative crystalloid infusion may decrease total volume of infusate without affecting early graft function in live related renal transplant surgery
Authors: Singh Abhishek , Ramachandran Rashmi , Chandralekha C. , Trikha Anjan , Ray Bikash Ranjan , Bansal Virinder Kumar , Mahajan Sandeep , Asuri Krishna , Rewari Vimi 
Published: August 2023

Introduction:
Early graft function is crucial for successful kidney transplantation. Intravascular volume maintenance is paramount in ensuring reperfusion of transplanted kidney. This study was planned to compare whether the timing of fluid infusion can help to decrease amount of fluid given without altering early graft function during renal transplantation.

Materials and Methods:
The present study included forty recipients, randomized into standard (Group-S) or targeted fluid therapy (Group-T). Group S received fluid according to conventional fasting deficit while Group T received at 1 ml/kg/h from the start of surgery till start of vascular anastomosis after which fluid infusion rate in both group was increased to maintain a central venous pressure of 13–15 mm of Hg till reperfusion. Primary outcome measured was serum creatinine level on first postoperative day while secondary outcomes were IV fluid given, perioperative hemodynamics, onset of diuresis, graft turgidity, urine output, and renal function during first 6 postoperative days.

Results:
The study showed Group T postoperatively had early fall in serum creatinine (day 3) than S (day 6) although this difference was not statistically significant. Group T had received significantly less fluid per kg of dry weight (T-42.7 ± 9.7 ml/kg, S-61.1 ± 11.1 ml/kg, P < 0.001), had early diuresis, better graft turgidity and urine output than Group S.

Conclusion:
Targeted hydration significantly decreases the total amount of fluid infused during the intraoperative period without altering early graft function. Targeted hydration during vascular anastomosis produced stable hemodynamics and early diuresis without any side-effects pertaining to hypo or hyper-volemia.
Clinical trial identifier number-CTRI/2016/07/007111.
Tubeless mini-percutaneous nephrolithotomy for renal stones larger than 20 mm
Authors: Khadgi Sanjay , Darrad Maitrey , EL-Nahas Ahmed R. , AL-Terki Abdullatif 
Published: August 2023

Introduction:
The aim of this study is to evaluate the outcomes of tubeless mini- percutaneous nephrolithotomy (PCNL) for the treatment of large (>20 mm) renal stones.

Patients and Methods:
This study included consecutive patients who underwent single-session tubeless mini-PCNL (tract size 16–20 F) for large (>20 mm) renal stones. Stone-free status meant complete clearance or residual fragments <4 mm. Complications were recorded and classified according to modified Clavien-Dindo classifications. Risk variables for significant residuals were determined with univariate (Chi-square and t-test) and multivariate logistic regression analyses.

Results:
Between July 2015 and November 2018, 225 patients were included. The mean age was 42.9 years; the mean stone size was 30.2 ± 9.6 mm and 75% of patients were males. A single renal stone was present in 54 patients (24%), multiple stones in 108 (48%), and staghorn stones in 63 (28%). The stone-free rate was 87.6%. The complication rate was 8.4% (Grade I–II in 7.5%, III in 0.9%). Three patients (1.3%) required blood transfusion. Independent risk factor for significant residual fragments was the presence of stones in multiple sites inside the pelvicalyceal system (relative risk: 13.44, 95% confidence interval: 1.78–101.43, P = 0.012).

Conclusions:
Mini-PCNL is an effective and safe treatment option for patients with large renal stones (>20 mm). Stones located in multiple sites is the only predictor of significant residual stones.
Thulium fiber laser versus holmium
Authors: Mahajan Abhay Dinkar , Mahajan Sumeeta Abhay 
Published: August 2023

Introduction:
We aimed to evaluate the effectiveness and safety of the newly launched thulium fiber laser (TFL) with holmium laser lithotripsy in the miniaturized percutaneous nephrolithotomy (Miniperc) procedure for renal stones.

Methods:
The prospective study included patients with renal stones of size >1 cm to ≤3 cm. The patients who opted for extracorporeal shock wave lithotripsy, retrograde intrarenal surgeries, and stones >3 cm were excluded from the study. Demographics such as patient's age, sex, stone volume, and hardness were evaluated. The patients were randomized into holmium and TFL group for stone lithotripsy. Both the procedures were evaluated for stone disintegration time, operative time, hospital stay, intra- and postoperative complications, and stone-free rate.

Results:
A total of 125 patients with renal stones who underwent Miniperc were included in this study. The average size of the stone was comparable in both the groups (P = 0.053). The median stone disintegration time with holmium laser was 20 min 45 s and with TFL, it was 11 min 19 s (P < 0.001). The most common complications were Clavien grade I and II complications (P = 0.128). Prolonged postoperative hematuria was observed in the Thulium fiber laser group, which was conservatively managed. The stone-free rate with TFL (94.9%) was better than Holmium lithotripsy (90.9%).

Conclusions:
The TFL has significant less stone disintegration time which effectively reduced the operative time of Miniperc procedure. The stone-free rate is better, but the incidence of self-limiting hematuria is higher with TFL as compared to Holmium laser.
Medical students' perception on ethics and communication module
Authors: Palimar Vikram , Gupta Chandni 
Published: August 2023

Background:
For the overall development of medical professionals, the affective domain compromising attitude, communication, and ethics needs to be taught. Hence, the aim was to analyze the perception of the students regarding the ethics and communication module “How to deal with Death?”

Materials and Methods:
A study was conducted on 81 undergraduate students of the 9th semester who attended the module. They were told to fill the questionnaire based on Likert scale regarding the module after the module was over. Later, the results were analyzed.

Results:
More than half of the respondents felt that role-play was the best method of teaching this module. This module had a positive impact on more than 90% of the students. More than 90% felt that empathy and compassion are required while dealing with death. Half of the students felt that empathy and compassion while dealing with death can be taught to medical students. More than 80% felt that this module helps them in developing patient-centered care. More than 75% felt that such modules help them to become good doctors. More than 95% of the students felt that medical students should know about euthanasia and end-of-life issues.

Conclusion:
Students feel that such a module on ethics and communication should be taught in their regular MBBS curriculum.
Usefulness of exercise stress test in early diagnosis of coronary artery disease in diabetic patients
Authors: Gupta Garima , Raina Sunil Kumar , Bhatnagar Mukul , Kapoor Dheeraj 
Published: August 2023

ABSTRACT

Introduction:
Treadmill test (TMT) is a safer, cheaper, reliable, and easily available noninvasive screening tool for the early detection of coronary artery disease (CAD) in diabetic patients.

Materials and Methods:
150 patients suffering from type 2 diabetes mellitus without established clinical diagnosis of CAD attending cardiology outpatient department at a tertiary care center of Northwest India who fulfilled the inclusion and exclusion criteria during the study period were enrolled in the study. Subjects were classified into three groups based on their symptoms and electrocardiogram (ECG) findings. Group 1 (n = 50): Cases who had no symptoms suggestive of CAD and had a normal ECG, Group 2 (n = 50): Cases who were asymptomatic but resting ECG showed some abnormality (ST-T changes), and Group 3 (n = 50): Cases who were symptomatic for CAD (typical or atypical) with either normal or abnormal resting ECG. The TMT was done using a computerized TMT machine model and continuous ECG recording was taken.

Results:
In Group 1, 18% were TMT positive and 82% were TMT negative, in Group 2, 34% were TMT positive and 66% were TMT negative, and in Group 3, 50% were TMT positive and 50% were TMT negative. Hence, out of the three groups, Group 3 has a proportionally, significantly higher number of TMT-positive cases and this difference in TMT positivity was statistically significant.

Conclusion:
Exercise stress test can be widely used test as a test for early diagnosis of ischemic heart disease in diabetic patients.
The Dosimetric Comparison Between Tandem-Ovoid and Tandemring Applicator in Cervical Cancer Brachytherapy
Authors: Prakash Aaditya , Mandal Kaustav , Pokala Neelima , Amanapu Govinda Rao 
Published: August 2023

Aim:
The study aims to evaluate the differences in dosimetry between tandem-ovoid (TO) and tandem-ring (TR) gynecologic brachytherapy applicators using different optimizing techniques in image-based brachytherapy.

Background:
Conventionally, TO applicators are in use to deliver doses to tumor in intracavitary brachytherapy. Nowadays, different types of applicators are available for cervical cancer brachytherapy treatment such as TR, tandem-cylinder, hybrid intracavitary, and interstitial applicators.

Materials and Methods:
In the present study, we used a TR and Fletcher-style TO applicator in the same patient, in two different sessions of brachytherapy. Four plans were generated for each patient, utilizing two different optimization techniques for each applicator used. A dose of 9 Gy (Gray) was prescribed and plans were normalized to left point A, and in other techniques, the optimization is done to achieve the recommended organ at risk (OAR) dose–volume constraints. Dose–volume and dose point parameters were compared.

Results:
The results indicate that the (OAR doses assessed by dose–volume histogram criteria were lower than the International Commission on Radiation Units and Measurements (ICRU) point doses for bladder and rectum with both TO and TR applicators for point A normalized plans. Both bladder and sigmoid received higher doses in TO than in TR but were statistically not significant (NS), but the rectum doses are higher in TR than in TO and it was statistically significant. The isodose volumes are higher in point A normalized plans than in OAR-based optimized plans in both applicators. The ICRU point doses are lower in OAR optimized plans than in point A normalized plans in both applicators.

Conclusions:
TO and TR applicators are commonly used gynecological intracavitary applicators. In this present study we did not find any significant difference between doses delivered to ICRU Point and Isodose volumes, after using both applicators .Critical OAR doses were also comparable. The only advantage of the ring applicator is, it provides an additional degree of freedom to load the vaginal sources over the ovoids and easy application in cases of narrow fornices with greater reproducibility.
Residents’ Report of COVID-19 Associated Training Disruptions, Stressors, and Opportunities During the Pandemic—The Singapore Experience
Authors: Koh Samuel Ji Quan , Woon Ting Hui , Fong Warren , Kwan Yu Heng , Lim Swee Han , Lee Jodie Ling Horng , Tan Hak Koon 
Published: August 2023

Background The COVID-19 pandemic has disrupted residency training. Several studies have been performed to investigate the impact of the pandemic on residency training in Accreditation Council for Graduate Medical Education–International (ACGME-I)-accredited institutions. However, these were either limited to certain specialties or failed to consider possible opportunities from the pandemic.
Objective To determine the stressors on residents as well as the opportunities that arose from the COVID-19 pandemic across multiple specialities in Singapore.
Methods A cross-sectional survey among SingHealth residents was conducted between July and September 2020. The survey assessed the balance between service and training during hospital postings, the pandemic’s influence on examination and teaching, the psychological impact of the pandemic, the level of burnout, and the effect on morale of residents during the pandemic.
Results The response rate was 27.1% (253 of 934). Out of the 253 residents, 136 (53.8%) felt stressed during the pandemic. Concerns about family’s health and safety pertaining to potential COVID-19 infection, progression in training, and completion of examinations were the top 3 stressors. One-hundred and three residents (40.7%) had their training disrupted either by being placed in an interim posting not part of their residency requirements or being deployed to care for patients with COVID-19. Although administrative support and information for virtual teaching were sufficient, only 108 (42.7%) agreed it had the same value as face-to-face sessions. Despite the challenges, 179 (70.8%) thought that experiencing this crisis provided more meaning in their career.
Conclusions The COVID-19 pandemic has brought about challenges and learning opportunities for residents.
Atividade física e aptidão funcional em pessoas idosas que vivem em lares e em utentes de centro de dia: um estudo exploratório
Authors: Ferreira Soraia , Leite Nilton , Marmeleira José , Raimundo Armando 
Published: August 2023

Introdução. A perda da função física, problemas de saúde, apoio limi[1]tado das famílias e poucos recursos financeiros levam à institucionali[1]zação. Atualmente, um dos problemas associados à institucionalização é o maior comportamento sedentário e consequente perda de autono[1]mia. Portanto, o principal objetivo deste estudo foi examinar os níveis de atividade física (PA) e aptidão funcional de idosos que vivem em lares de idosos ou em creches. Método. Trinta e dois idosos (85,5 ± 5,7 anos) de ambos os sexos (mulheres = 24; homens = 8) participaram deste estudo; 14 residentes em casas de saúde e usuários de centros de cuidados de 18 dias. Dados de atividade física foram recolhidos por meio de acelerometria. A aptidão funcional foi avaliada com testes de aptidão física. Resultados: Os participantes deste estudo apresentam níveis extrema[1]mente baixos de aptidão funcional e AF e altos níveis de comportamento sedentário. Nos residentes de asilos (NH), o tempo médio em compor[1]tamento sedentário e PA moderado foi de 9h48min / dia e 2,2min / dia, respetivamente. No mesmo grupo, o tempo médio gasto em PA leve foi de 77,5 min / dia. Nos usuários de creche (DCC), o tempo médio em comportamento sedentário e PA moderado foi de 7h48min / dia e 1,6min / dia, respetivamente. Os idosos que compareceram ao DCC apresentaram melhores resultados do que os residentes do asilo na cadeira teste de sentar e alcançar (DCC = -12,4 ± 15,7 cm, NH = -22,3 ± 4,1 cm, p = 0,037), teste de caminhada de 6 min (DCC = 270 ± 73,9 min, NH = 167,7 ± 84,4 min, p <0,001) tempo sedentário (DCC = 7,48 ± 0,2 horas, NH = 9,48 ± 0,94 horas, p <0,01) e PA médio (DCC = 82,6 ± 18 contagens / min, NH = 58,5 30,5 contagens / min, p = 0,03). O desempenho em outros testes (suporte para cadeira de 30 segun-dos; arranhão para as costas; braçadeira para os braços; com 8 pés para cima e para baixo) de aptidão funcional não foi estatisticamente diferente.Conclusões: A aptidão funcional e os níveis de AF são muito baixos, tanto em idosos que vivem em lares de idosos como naqueles que são usuários de CDC. Programas de intervenção são necessários para que esses grupos possam reverter a diminuição da aptidão física e da AF e promover a saúde e o status funcional.
Efektivitas Self Esteem Dengan Pendekatan Rational Emotive Behavior Therapy (Rebt) Pada Kesehatan Mental Remaja Yatim Di Desa Pulukan, Bali
Authors: Amalia Meila , Sahara Erlina Rita , Rizqina Dwi Latifa , Zuhro’ Fitriana Ani Qotuz 
Published: August 2023

This study aims to investigate the effectiveness of the Rational Emotive Behavior Therapy (REBT) approach in improving the self-esteem and mental health of orphaned adolescents in Pulukan Village, Bali. Orphaned youth often face psychological challenges, including low self-esteem and mental health problems. Therefore, an effective approach is needed to help them overcome this problem. The research methods used in this study are interview and observation methods. The research participants consisted of orphaned youth in Pulukan Village, Bali. This implementation uses the Rational Emotive Behavior Therapy (REBT) approach. First, changing irrational thoughts, second, building self-confidence third, overcoming trauma and sadness fourth, learning healthy coping fifth, improving social relations sixth, increasing self-understanding REBT implementation which must be carried out by a therapist who is trained and has experience in working with children orphan REBT services are carried out in experimental groups over a certain period, with a focus on self-understanding, recognition of irrational thought patterns, and replacement of irrational thought patterns with healthier rational thoughts. After the intervention was completed, both groups were again measured using the same scale to measure changes in self-esteem and mental health.
Data analysis in this study, namely content data analysis and thematic data analysis, are two techniques commonly used in qualitative research to analyze data in the form of text, images, audio, or video. The results of this study are expected to provide evidence about the effectiveness of the REBT approach in increasing self-esteem and mental health of orphaned adolescents in Pulukan Village, Bali. If this approach proves to be effective, the implication is the importance of expanding access to REBT-based psychotherapy services for orphaned youth in improving their mental well-being.