bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract 28
Authors: Nehara Hardeva Ram , Agrawal Rishi , Nehara Balveer , Sihag Dharmveer , Ghiya B. C. 
Published: February 2023

Introduction: Xanthogranulomas are rare benign inflammatory lesion of skin with 5-10% systemic involvement. Sellarxanthogranulomas are extremely rare and can be associated with central diabetes insipidus (DI) and hypopituitarism [1]. We describe the case of a patient known to have central DI for last 11 years who developed skin lesions over face, and skin biopsy confirmed xanthogranuloma. MRI sella revealed a T1w and T2w hyperintense ovoid intrasellar lesion suggestive of sellarxanthogranuloma.

Case Presentation: Fifty-eight-year-old male patient known to have central diabetes insipidus for last 11 years. Plasma osmolarity 290 mOsm/kg, urine osmolarity 132 mOsm/kg, serum sodium 142 mE/l and serum potassium were 3.6 mE/l. Water deprivation test and imaging of sella were not done at that time and trial of oral desmopressin was given, and clinical and biochemical findings of DI improved, so diagnosis of central DI was kept. Patient presented to Dermatologist 2 months back with non-pruritic nodular skin lesion at malar area. Skin biopsy revealed fibrocollagenous tissue enclosing skin appendages covered by non-keratinised stratified squamous epithelium. The subepithelial tissue show variable sized xanthomatous cell admixed with lymphocytes, neutrophils and tuton giant cells suggestive of xanthogranuloma.
Patient was referred to Endocrinology Department for further evaluation. On laboratory evaluation hemogram, renal function, liver function, plasma glucose, electrolyte, calcium and angiotensin converting enzyme level were within normal limit. Hormonal evaluation revealed secondary hypothyroidism and possible growth hormone deficiency. Magnetic resonance imaging of sella revealed a well-defined 11 x 7 mm ovoid abnormal signal intensity lesion in pituitary gland appearing hyperintense on all imaging sequences causing minimal scalloping of sella, abutting right cavernous sinus, without obvious displacement of infundibulum or pituitary stalk (Figure 3a & 3b). In view of central DI, cutaneous xanthogranuloma and characteristic imaging finding diagnosis of sellarxanthogranuloma was kept. Perimetry revealed no obvious visual field defect. Patient was started oral levothyroxine 50 mcg and oral desmopressin 0.1 mg twice daily was continued. In view of no obvious compressive symptoms of sellar lesion, patient was advised yearly imaging of sella and transsphenoidal surgery whenever compressive symptoms arises.

Conclusion: Sellarxanthogranulomasshould be included in differential diagnosis of central DI. It is important to have a thorough examination of skin in patient of idiopathic central DI. Follow-up imaging of sella should also be done in patient with idiopathic central DI, despite of initial normal imaging of sella.
Abstract 48
Authors: Patra Shinjan , Patra Suman , Nehra Hardev , K Anupriya , Mittal Madhukar , Shukla Ravindra 
Published: February 2023

Introduction: Calcinosis cutis is an uncommon diseasethat results inprogressive deposition ofinsoluble calcium salts (crystals of calcium phosphate, hydroxyapatite) in the skin which can be intracutaneous, subcutaneous, intramuscular or intravisceral. Here we have described a very interesting case of idiopathic calcinosis cutis with mild hyperphosphatemia which didn’t respond to phosphate-lowering therapy.

Case description: A 12-year-old female presented with multiple cutaneous papules with chalky white discharge over both hands, left knee and both feet for last 2 years. The lesions got ulcerated and healed by hyperpigmentation. Initial metabolic workup revealed hyperphosphatemia and normocalcemia but her lesions remain unchanged after 6 months of phosphate-lowering therapy. On examination we foundmultipleerythematous firm nodule and plaqueover right 5th finger, left thumband right great toe along with multiple discharging sinuseswith bony swelling in left knee joint. There was no skin tightening or oral opening narrowing. There was no history of recurrent renal calculi, bony deformity or recurrent fragility fractures.
Our biochemical evaluation revealed mild hyperphosphatemia (6.64 mg/dl with age-specific upper limit of 5.9); Ca-9.85 mg/dl, 25 (OH) D- 14.60 ng/ml, iPTH- 92.2 pg/ml. Rest all metabolic parameters including renal functions were normal. 24 hours urinary phosphorus excretion and TmP/GFR didn’t reveal any abnormality along with normal FGF-23 (59.73 pg/ml). Markers for autoimmune diseases were non-reactive. The lesion biopsyruled out dermatomyositis. The patient was started on sodium metabisulphite along with diltiazem60 mg/day. The patient has improved significantly after 3 months of therapy.

Discussion: Dystrophic calcification is the commonest form which is characterized by calcification occurring in the dead or damaged tissue. Metastatic calcification occurs in calcium phosphorus combined products of more than 70. Inadvertent intake of calcium or phosphorus can lead to iatrogenic calcification. Initial mild hyperphosphatemia prompted a diagnosis of metastatic calcification in this case and the patient was put on sevelamer without any use. Mild hyperphosphatemia can be found in idiopathic calcinosis where no phosphate binder is warranted. In our case, a diligent and judicious biochemical workup ruled out hyperphosphatemic tumoral calcinosis and other causes of dystrophic calcifications.

Conclusion: The presence of mild hyperphosphatemia is red herring in our case. A judiciousapproach is prudent in any case of calcinosis to avoid over-treatment.
Abstract 50
Authors: Gaikwad Prashant Manohar 
Published: February 2023

Introduction: About 60% of patients with IHH have associated anosmia and are labeled as Kallmann syndrome. It is associated with non sexual phenotypical features such as renal agenesis, synkinesia, sensorineural hearing loss, cleft lip and cleft palate. Midline defects are known to occur in kallmann syndrome, but association with situsinversus is not found till date, we have diagnosed patient with situsinversus, may be the first case in medical literature.

Case Report: 14-year old male presented with history of –small penile length, small testes, failure to attainsecondary sexual characteristics, progressive bilateral breast enlargement since two years, history of cleft lip that is operated at 1 year of age. Hormonal profile was suggestive of hypogonadotropic, hypogonadism.
MRI-suggestive of olfactory bulb, sulcus, lobe hypoplasia
USG abdomen-spleen right side, liver on left side Chest xray-suggestive of dextrocardia

Conclusion: Situsinversus may represent spectrum of midline defect and may have association with Kallmann syndrome.
Abstract 80
Authors: Palle Sharmila , Bhandiwad Chandrashekhar , Paidipally Srinivasa Rao , Danda Vijay Sheker R. 
Published: February 2023

177Lu-DOTATATE-based peptide receptor radionuclide therapy (PRRT) is a promising therapy for metastatic and/or inoperable pheochromocytoma and metastatic insulinomas that can result in reduced tumor burden and improved quality of life. We present our experience with 2 cases of metastatic pheochromocytoma and metastatic insulinoma who received PRRT.

Case 1: A 35 year male presented with pain in left lumbar region, palpitations, episodic sweating and headache in 2017. Metanephrines and normetanephrines in urine were 587 ng/L and 1062 ng/L respectively. On CT abdomen there was a left suprarenal mass. After adequate preparation he underwent left adrenalectomy in 2017. He was lost to follow up till 4 years after surgery. Now again he presented with episodic palpitations, anxiety, sweating and headache. Metanephrines and normetanephrines in urine were 338 ng/L (7.90-88) and 809 ng/L (20-135) respectively. On Gallium 68 DOTANOC PETCT there were multiple nodular densities in postoperative bedand metastasis to left paraaortic, peripancreatic lymph nodes and multiple vertebrae. After adequate preparation he was given 150mCi Lu DOTATATEiv. After 30 minutes into transfusion, patient had sudden onset palpitations,15 episodes of vomitings, his BP was 200/150 mm Hg and heart rate was 149bpm. He was given Metoprolol and prazosin and after 10 min his BP was 76/45mm Hg and HR was 193bpm. USG abdomen showed collapsed inferior venacava. He was stabilized with iv fluids. He was under observation for 10 days. During this period he had recurrent episodes of vomitings, nausea, palipitations and fluctuating BP. At the time of discharge his BP was stable. This case illustrates the risk of crisis episodes in metastatic pheochromocytoma and the need to monitor for crisis episodes for 10 daysafter undergoing PRRT.

Case 2: A 21 year male known case of MEN 1, initially presented with pituitary microadenoma and insulinoma in 2014, underwent distal pancreatosplenectomy and in 2018 underwent parathyroid adenoma excision. After 4 years he presented with hypoglycemic episodes. Ga 68 DOTATATE PET CT showed an enhancing lesion at post operative site of 1.4 Χ 1 cm with multiple peripancreatic nodal and peritoneal metastasis. He was on injection octreotide 30 mg IM depot monthly. After stopping injection octreotide, he was given 150 mCi lutetiumiv. He did not develop any hypoglycemic or hypercalcemic crisis after PRRT. Now he was off injection octreotide and doing well with no further hypoglycemic episodes after PRRT.
As the treatment options are limited in metastatic neuroendocrine tumors, we subjected them to PRRT which is minimally invasive, improved symptoms of both the patients and both are under followup.
Abstract 88
Authors: Jain Abhilasha , Kalra Sanjay 
Published: February 2023

Background: Hypercalcemia is arelatively common conditionin hospital settings, etiology being malignancies, symptomatic PHPT and granulomatous diseases. Still, it is under evaluated in clinical practice. Awareness amongst practitioners regarding evaluation and management is far more less. We are here to report two such cases of missed hypercalcaemic crisis, where more endocrine awareness would have helped managing patients.

Methods: First case was a 54-year-old male, who presented to general practitioner with complaints of fever, weight loss, abdominal distention, and inconsolable cry for last 3-4 months. He was found to have raised ESR (82 mm/hr), raised calcium (14.1 mg/dl), ascites on USG abdomen and right upper zone infiltrates on chest radiography. Ascitic tap suggested low serum albumin, ascitic fluid albumin gradient and raised adeno-deaminase, in view of which he was started on ATT. Contrast enhanced MRI brain was normal. His neurological symptoms did not improve after 15 days of treatment. He presented to us with these complaints, diagnosis was reconfirmed but he was found to have persistent hypercalcemia (14.2 mg/dl), normal phosphate (4.5 mg/dl) and raised creatinine (1.4 mg/dl). On further evaluation, he had PTH independent hypercalcemia (6 pg/ml) with raised 1,25 (OH)D. A diagnosis of hypercalcemic crisis secondary to active tuberculosis was made and patient was given iv zoledronic acid and started on methylprednisolone. Over next one week, calcium and creatinine improved to 9.9 mg/dl and 0.9 mg/dl. Patient’s neuropsychiatric symptoms improved markedly with improvement of serum calcium.
Second case, 56-year-old female who was on hemodialysis for 3 months after being diagnosed chronic kidney disease, presented to us with complaints of altered sensorium for last 1 day. She was evaluated and found to have persistent hypercalcemia (14.1 mg/dl, 14 mg/dl), raised phosphate (5.5 mg/dl) and creatinine (6.5 mg/dl). She was found to have PTH independent hypercalcemia (PTH 3 pg/ml, raised 1,25 (OH)D). Further, myeloma workup and bone marrow biopsy revealed positive M band, raised kappa lambda free light chain ratio and bright CD 38 positivity. Bone marrow also confirmed the diagnosis of multiple myeloma (30% plasma cells). Meanwhile, she underwent dialysis, started on dexamethasone and single dose of denosumab was given with which calcium improved and sensorium of the patient improved.

Conclusions: Though hypercalcemia is not an uncommon finding in clinical practice but its evaluation is seldomdone. More awareness is needed for the evaluation and management of hypercalcemia.
Bilateral Facial Nerve Palsy as a Rare Presentation of Systemic Lupus Erythematosus
Authors: Raju Tagru , Garg Tulika , Kaur Jaspreet , Gupta Monica 
Published: February 2023

Abstract
Systemic lupus erythematosus (SLE), a disease of the immune system, has a relapsing-remitting course. It is known to affect multiple organ systems of the body, including the nervous system. Cranial neuropathy, particularly facial neuropathy, is an unusual complication of SLE whose pathogenic mechanism is still not understood. Cardiac involvement, like myocarditis and papilledema, is another rare presentation of SLE. A 23-year-old male had bilateral lower motor neuron type of facial palsy which on a thorough investigation was found to be as a manifestation of SLE confirmed by antinuclear antibodies and double-stranded DNA antibody positive test. Electrocardiogram and echocardiography were suggestive of myocarditis. Fundus examination revealed Grade 2 papilledema. The patient was managed with symptomatic treatment along with corticosteroids, to which he responded gradually. Bilateral facial nerve lower motor neuron type palsy is a rare manifestation of SLE which should be diagnosed promptly and can be managed with corticosteroids. The clinician should also keep an eye on infrequent manifestations like myocarditis and papilledema.
To Study Demographic Profile, Risk Stratification, and Response to Treatment in Chronic Myeloid Leukemia Patients
Authors: Chandey Manish , Kaur Rajandeep , Gupta Rajeev , Mohan Gurinder 
Published: February 2023

Abstract

Background:
Chronic myeloid leukemia (CML) is the most common leukemia in India. The annual incidence of CML in India was originally reported to be 0.82.2 per 100,000 population. CML is a clonal disorder that is usually easily diagnosed by the Philadelphia chromosome. The approval of tyrosine kinase inhibitors has significantly reduced the mortality rate associated with CML and revolutionized treatment.

Materials and Methods:
Eighty patients diagnosed with CML were studied. Investigations were done and with European Treatment and Outcome Study (EUTOS) patients were stratified into low- and high-risk group and then treatment with Imatinib was given to all patients and molecular response was evaluated.

Results:
In the study population, out of 80 patients, 40 were female and 40 were male with M: F is 1:1. Out of total 80 patients’, maximum patients (54) were in 31-60 years age group. Our study showed that the most common symptom of presentation is abdominal discomfort followed by fever. Out of total 80 patients, 25 (31.3%) patients had high EUTOS score and 55 (68.8%) patients had low EUTOS score. On 6 months’ follow-up, 36.3% patients had complete molecular response, 16.3% patients had major molecular response and 47.5% patients had no molecular response, but on 12 months’ follow-up, 71.3% patients had complete molecular response, 16.25% patients had major molecular response, and 12.5% patients had no molecular response.

Conclusion:
In this observational study, we found a significant correlation between EUTOS score and molecular response at 6 months and 12 months follow-up after Imatinib therapy.
Chronic myeloid leukemia, European treatment and outcome study score, response, tyrosine kinase inhibitor
Pre-treatment “Lung Cancer Imaging - Reporting and Data System” (LCI-RADS) and “Post-therapy Lung Cancer Imaging - Reporting and Data System” (pLCI-RADS): A narrative review of comprehensive synoptic reporting formats for lung cancer imaging
Authors: Chakrabarty Nivedita , Mahajan Abhishek 
Published: February 2023

ABSTRACT
A synoptic reporting template is pivotal in influencing patient management by effectively and comprehensively communicating relevant imaging findings to the treating physician. Proper cancer image reporting requires two separate templates, one for recording baseline findings and the other for conveying the post-therapy response. However, no such separate reporting templates have been prepared to date. In this manuscript, through the synoptic reporting template 1 on “Pre-treatment Lung Cancer Imaging - Reporting and Data System (LCI-RADS)”, we intend to provide the tumor node metastasis (TNM) stage at the end of the report, with a provision for mentioning pertinent clinical/laboratory findings as well as information on the molecular testing. Through the synoptic reporting template 2 on “Post-therapy Lung Cancer Imaging - Reporting and Data System (pLCI-RADS),” we intend to describe the post-therapy response after comparison with the previous scan following surgery/chemotherapy/targeted therapy/immunotherapy/radiotherapy. Besides, the categories of post-therapy lung injury and follow-up recommendations will also be provided at the end of pLCI-RADS. Both LCI-RADS and pLCI-RADS will require acute (urgent) findings to be mentioned at the beginning of the report. We believe the implementation of these two comprehensive synoptic reporting templates will positively impact patient management. To prepare this review, we searched the internet using Google and referred to all the relevant articles and their references published in the preceding 25 years. In addition, we referred to the management guidelines of the National Comprehensive Cancer Network, version 2.2022, for formulating the synoptic reporting formats.
Second opinion interpretations by specialty radiologists in head-and-neck oncology and their impact on clinical management: A retrospective observational study
Authors: Mahajan Abhishek , Shukla Shreya , Mali Raghvendra , Agarwal Ujjwal , Sable Nilesh , Vaish Richa , Ankathi Suman Kumar , Patil Vasundhara , Janu Amit K. , Prabhash Kumar , Noronha Vanita , Pai Prathamesh , Laskar Sarbani G. , Patil Asawari , Patil Vijay , Menon Nandini , Thiagarajan Shivakumar , Chaturvedi Pankaj 
Published: February 2023

ABSTRACT

Background:
Patients with medical imaging performed and interpreted elsewhere often come to tertiary referral centers for further management. At our tertiary cancer hospital, external imaging studies of patients with head-and-neck cancer undergo formal second opinion reporting by subspecialty oncoradiologists.

Objectives:
We aimed to audit the second in-house review of outside scans by specialized head-and-neck radiologists to estimate the potential impact on patient management. Our secondary objective was to determine the direct impact of the second opinion by head-and-neck specialist radiologists on the change in diagnosis, stage, and management of patients. We also aimed to determine the indirect impact on the cost–benefit ratio and the time taken for decision making.

Materials and Methods:
This was a retrospective review of original and second opinion reports for consecutive patients that came with films/compact discs (CDs) and reports of computed tomography (CT), magnetic resonance imaging (MRI), or positron resonance imaging - computed tomography (PET-CT), initially performed and interpreted at another institution, and later, a second opinion review of imaging was done by the in-house subspecialty radiologists in head-and-neck onco-imaging between May 2016 and December 2017. The rates of discrepancy for staging and recommended management and the report accuracy were determined and compared to the gold standard: pathological staging.

Results:
Following the specialist in-house radiologist’s second opinion review, the cancer stage changed in 28% (139/492) cases, and the management recommendation changed in 6.7% (67/492) of the patients with head-and-neck cancer. Compared to the histopathology results that were available for 93/492 (19%) cases, the second opinion interpretation was correct 87% of the time (81/93). The average time saved by the second radiology opinion was 8.6 days. Significant monetary savings amounting to

JOURNAL/crsat/04.03/02201859-202205040-00007/652FF01/v/2023-03-21T130949Z/r/image-tiff

11,35,590 ($13,788.3) were achieved.

Conclusion:
A second opinion review of outside imaging in patients with head-and-neck cancer by expert in-house onco-radiologists results in a change in the stage of cancer and the management plan in a significant number of cases, saves time by expediting the work-up, and helps to avoid expenditure on repeat imaging.
Comparison of oropharyngeal leak pressure of LMA Protector and LMA-ProSeal in different head and neck positions in anaesthetized and paralyzed patients; A prospective randomized study
Authors: Kerai Sukhyanti , Bhatt Garima , Saxena Kirti N , Gaba Prachi , Wadhwa Bharti 
Published: February 2023

ABSTRACT

Background and Aims:
Oropharyngeal leak pressure (OLP) of LMA Protector is reported to be higher compared to other second generation supraglottic devices (SGDs) indicating better seal with patient’s airway and hence enhanced safety. To ascertain its benefit in patients undergoing surgeries where head and neck position other than neutral is required, we conducted a prospective randomized study to compare OLP of LMA Protector with LMA-ProSeal (PLMA) with head and neck in neutral, extension, flexion, and rotation position.

Methods:
80 American Society of Anesthesiologists (ASA) I-II patients aged more than 18 years undergoing elective surgery under general anaesthesia were recruited. Patients were randomized in the LMA Protector or PLMA group. After induction of anaesthesia, OLP was measured in both the groups in different head and neck position. The insertion characteristics of both SGDs were also recorded and compared.

Results:
The OLP of LMA Protector and PLMA was found to be comparable in neutral head position (p = 0.08). There was no significant difference in OLP of both devices in extension, flexion, or head rotation. In both the study groups, head extension position led to significant decrease in OLP compared to supine position. With the flexion and rotation positioning of head and neck, significant increase in OLP in each group was noted.

Conclusion:
The OLP of LMA Protector and PLMA are comparable in different head and neck position. With both the devices, there was significant decrease in OLP with extension whereas significant increase was noted in flexion and rotation of head and neck.
Identifying strategies for dealing with the aging population from the perspective of health system experts
Authors: Samouei Rahele , Keyvanara Mahmoud 
Published: February 2023

BACKGROUND AND AIM:
Given the growing trend of aging and the limited resources of the health system, the lack of long-term prior government planning, and reduced growth of the productive force of society, identifying strategies for planning and action to deal with future aging is very important. In this regard, the study was conducted to identify strategies for dealing with the aging population from the perspective of health system experts.

METHODS:
The qualitative content analysis study was performed on 29 Iranian male and female experts in the aging and health scope from Isfahan, Tehran, Tabriz, and Babol who purposefully participated in the semi-structured interview. Data were classified by qualitative content analysis.

RESULTS:
Two concepts emerged according to the participated experts’ opinions, regarding the strategies of the Iranian health system in dealing with future aging: “executive policy” strategies, including “design, planning and implementation,” “evaluation and standardization,” “strengthening demand-driven” and “modeling national and international experiences,” “preventive policies” strategy, which includes “Focus on prevention,” “Focus on values and competencies,” “Educational empowerment,” “Knowledge-based empowerment,” “Empowerment of age-related groups,” “Economic empowerment,” and “Social support.”

CONCLUSION:
The diversity and breadth of the mentioned strategies indicate the necessity of comprehensive readiness and adaptation of health services to the elderly conditions and characteristics. Purposeful planning and timely implementation of programs and policies to better address the health system with future aging will be possible by using practical strategies.