bluuebunny/crossref_metadata_2025_split huggingface dataset:
Preoperative screening for obstructive sleep apnea in cardiovascular patients – How useful is STOP-BANG questionnaire in the Indian context?
Authors: Sreedharan Sapna Erat , Mitta Nandini , KP Unnikrishnan , Paul Rejith , Pillai Vivek 
Published: March 2023

Background:
Obstructive sleep apnea (OSA) is reported in a high proportion of cardiac surgical patients, up to 73%. STOP-BANG is a validated questionnaire for screening of outpatients for OSA with high sensitivity. There is sparse literature from India regarding the prevalence of OSA in preoperative cardiovascular patients and the utility of screening tools.

Aims:
We sought to study the utility of the STOP-BANG questionnaire as a screening tool for OSA in cardiovascular patients validating it with ambulatory level 3 polysomnography.

Materials and Methods:
It was a prospective study where consecutive patients getting admitted for coronary artery bypass surgery (CABG) from August 2017–February 2019 were recruited. All the patients were screened with the STOP-BANG questionnaire. 53 patients underwent overnight level 3 polysomnography using Apnea-Link. Correlations were made between clinical symptoms, STOP-BANG score, and OSA severity, measured using Apnea hypopnea index (AHI).

Results:
We had 120 patients(103 males) with a mean age 60 years. Snoring was the most common sleep complaint. Our cohort had a high prevalence of vascular risk factors (DM 72.3%, hypertension 59.2%, dyslipidemia 60%) and 11.7% were obese (BMI >30). The median STOP-BANG score was 3 (IQR 2) with 83 having scores ≥3. Median AHI was 5.6 with AHI ≥5 in 28 patients and AHI 15 or above in 14 patients. Among the clinical parameters, arousals with respiratory difficulty at night, higher neck circumference, and tonsillar hypertrophy showed a significant association with PSG-proven OSA.STOP-BANG scores 3 or above had a sensitivity of 75% in predicting OSA.

Conclusions:
Our study shows that in cardiovascular patients less symptomatic for sleep complaints, the STOP-BANG questionnaire is a useful screening tool for OSA in outpatient settings. Among clinical parameters, airway narrowing and neck circumference can predict OSA.
Percutaneous paravalvular leak closure with their outcomes
Authors: Garg Ankit , Azad Sushil , Radhakrishnan Sitaraman 
Published: March 2023

Background:
Transcatheter paravalvular leak (PVL) closure in recent times has emerged as a safe and effective alternate to redo-surgical repair. We sought to examine the clinical efficacy and safety of percutaneous PVL closure at our center.

Methods and Results:
A retrospective study from August 2012 to December 2019 of 19 patients who underwent 21 procedures for PVL closure. The mean age was 49.25 ± 14.72 years. The target valve was mitral in 11 (57%) and aortic in 7 (36%) cases. One (5%) patient had prosthetic valve in left atrioventricular valve with congenitally corrected transposition of great arteries. Majority of the cohort presented with heart failure without hemolysis (89%), with most of them being in NYHA functional class III (57%) or class IV (21%). A procedural success of 85% was achieved. Post procedure severity of regurgitation reduced from severe in thirteen patients and moderate in six patients to moderate in two patients and mild in fourteen patients. Symptomatic improvement was observed in all cases who had successful closure with NYHA function class improving from 3 ± 0.64 to 1.6 ± 0.94. The mean follow-up duration was 21 ± 13 months (median 24 months). There was one (4.7%) mortality with cumulative survival from all-cause mortality of 95%.

Conclusion:
The results of percutaneous PVL closure appear encouraging in our series with modest number of patients and offers a promising alternative to redo-surgery in this high-risk cohort.
A prospective study on use of thrive (transnasal humidified rapid insufflation ventilatory exchange) versus conventional nasal oxygenation following extubation of adult cardiac surgical patients
Authors: Burra Vijitha , Putta Gnapika , Prasad S.R. , Manjunatha N. 
Published: March 2023

Background:
Postoperative pulmonary complications in cardiac surgery increase mortality and morbidity. High flow nasal cannula oxygen therapy (HFNC) is one of the preventive measures to reduce the incidence of lung complications. HFNC can decrease dyspnea and improve physiologic parameters after extubation, including respiratory rate and heart rate, compared with conventional oxygen therapy. In this study, we evaluated the role of THRIVE (Transnasal Humidified Rapid Insufflation Ventilatory Exchange) after extubation.

Methodology:
We prospectively randomized 60 adults aged between 18 and 65 years undergoing elective cardiac surgery to either High flow oxygen therapy using THRIVE (Group A) or conventional nasal cannula (group B). Arterial paO2, paCO2, pH at three points of time i.e., 1, 2, 4 hrs after extubation were evaluated using arterial blood gas analysis. Ventilation duration, the incidence of reintubation, sedation score, mortality, and other complications were also assessed.

Results:
Thirty adults in each group had comparable patient characteristics. There was a statistically significant decline in paCO2 in group A at 1, 2, 4 hrs post extubation (P = 0.022, 0.02, <0.001) with a significant increase in oxygenation (P < 0.001) when compared to group B.ICU stay duration was similar between two groups. No complications were noted in both groups.

Conclusion:
THRIVE is safe to use following extubation in adult cardiac surgical patients.
Intraoperative Cardiac Arrest due to Allergic Acute Coronary Syndrome (Kounis syndrome) Triggered by Cephalosporin
Authors: Kumaran Thiruthani , Damodaran Srinath , Singh Akshaya Pratap , Kanchi Muralidhar 
Published: March 2023

ABSTRACT
An acute coronary syndrome due to mast-cell activation in the presence of an allergen is known as Kounis Syndrome (KS). This relatively new entity of KS is being increasingly recognized among allergists, cardiologists, and emergency physicians; however, it is not well-known among anesthesiologists. We report here, a case of type 2 KS due to antibiotic administration causing sudden perioperative cardiac arrest.
Postoperative Atrial Fibrillation in Coronary Artery Bypass Grafting Herald Poor Outcome
Authors: Malhotra Pulkit , Pande Shantanu , Mahindru Supaksh , Thukral Ankit , Kotwal Ankush Singh , Gupta Rajan Prasad , Tewari Prabhat , Agarwal Surendra Kumar 
Published: March 2023

Introduction:
Atrial fibrillation in postoperative period is common. Although the event of atrial fibrillation is associated with reduced cardiac output and its consequences and cerebrovascular events, its effect on outcome is not clearly documented. This study is done to evaluate the effect of atrial fibrillation on outcome of the operation.

Materials and Methods:
This is a retrospective case-control study. A total of 263 patients received coronary artery bypass grafting during this period. The data for demographics, comorbidities, preoperative medications, operative details, and echocardiographic parameters of left ventricular functions were acquired. A total of 24 patients had atrial fibrillation (Group I), while 239 remained in normal sinus rhythm (Group II). The outcome is measured as combined of death and postoperative myocardial infarction (MI).

Results:
The groups are comparable in demographic, preoperative medications, operative, and left ventricular parameters. Of the 24 (9.12%) patients who had postoperative atrial fibrillation, 11 were discharged on medical management. Nine patients reverted to sinus rhythm at discharge. Atrial fibrillation persisted in 8 patients 1 week after discharge and 3 patients after 1 month. The requirement of intraaortic balloon pump (IABP) was statistically significant in group I (5 in group I vs. 10 in group II, n = 0.001). There were 4 deaths in group 1 and 7 in group 2 (P = 0.002), however, the combined end point was achieved in 4 (16.6%) vs. 22 (9.2%), respectively, P = 0.1.

Conclusion:
The appearance of atrial fibrillation heralds increased requirement of IABP, MI, and death in patients undergoing coronary artery bypass grafting.
New Combined Risk Score to Predict Atrial Fibrillation after Cardiac Surgery
Authors: Burgos Lucrecia M , Ramírez Andreína Gil , Seoane Leonardo , Furmento Juan F , Costabel Juan P , Diez Mirta , Navia Daniel 
Published: March 2023

Background and Aims:
Atrial fibrillation frequently occurs in the postoperative period of cardiac surgery, associated with an increase in morbidity and mortality. The scores POAF, CHA2DS2-VASc and HATCH demonstrated a validated ability to predict atrial fibrillation after cardiac surgery (AFCS). The objective is to develop and validate a risk score to predict AFCS from the combination of the variables with highest predictive value of POAF, CHA2DS2-VASc and HATCH models.

Methods:
We conducted a single-center cohort study, performing a retrospective analysis of prospectively collected data. The study included consecutive patients undergoing cardiac surgery in 2010-2016. The primary outcome was the development of new-onset AFCS. The variables of the POAF, CHA2DS2-VASc and HATCH scores were evaluated in a multivariate regression model to determine the predictive impact. Those variables that were independently associated with AFCS were included in the final model.

Results:
A total of 3113 patients underwent cardiac surgery, of which 21% presented AFCS. The variables included in the new score COM-AF were: age (≥75: 2 points, 65-74: 1 point), heart failure (2 points), female sex (1 point), hypertension (1 point), diabetes (1 point), previous stroke (2 points). For the prediction of AFCS, COM-AF presented an AUC of 0.78 (95% CI 0.76-0.80), the rest of the scores presented lower discrimination ability (P < 0.001): CHA2DS2-VASc AUC 0.76 (95% CI 0.74-0.78), POAF 0.71 (95% CI 0.69-0.73) and HATCH 0.70 (95% CI: 0, 67-0.72). Multivariable analysis demonstrated that COM-AF score was an independent predictor of AFCS: OR 1,91 (IC 95% 1,63-2,23).

Conclusion:
From the combination of variables with higher predictive value included in the POAF, CHA2DS2-VASc, and HATCH scores, a new risk model system called COM-AF was created to predict AFCS, presenting a greater predictive ability than the original ones. Being necessary future prospective validations.
Inhaled Nitric Oxide before Induction of Anesthesia in Patients with Pulmonary Hypertension
Authors: Eljezi Vedat , Rochette Laetitia , Dualé Christian , Pereira Bruno , Boby Henri , Constantin Jean Michel 
Published: March 2023

Background:
The aim of this study was to examine the action of inhaled nitric oxide in the patients with pulmonary hypertension administered with a face mask before anesthesia induction.

Methods:
Ten adult patients scheduled for heart surgery with sternotomy were included in this prospective, interventional, single centre study. The inclusion criteria were patients scheduled for heart surgery with sternotomy with cardiopulmonary bypass (CPB), aged >18 years which presents a pulmonary hypertension (PH) (class 2 or 3 according to the Dana Point classification) with systolic pulmonary arterial pressure (PAPS) >40 mmHg diagnosed by preoperative right cardiac catheterization or by transthoracic echocardiography. The exclusion criteria were: heart transplant, PH of type 1, 4, 5, according to the Dana Point classification, methemoglobin reductase deficit, incapacity to understand the protocol and sign the consent.

Results:
The administration of iNO decrease pulmonary hypertension (P < 0,001 compared to room air; P = 0,01 compared to pure oxygen administration). The iNO administration did not improve arterial blood oxygenation. The hyperoxia, decrease the cardiac index even with right ventricular post charge decrease. The increased blood oxygenation content cause systemic vascular vasoconstriction and decrease the peripheral oxygen extraction showed with VO2 linear increase (P < 0,001).

Conclusions:
The administration of inhaled nitric oxide with a face mask before anaesthesia induction is safe and effective method to reduce pulmonary hypertension. The oxygen and hyperoxia influences the systemic vascular resistance and peripheral oxygen consumption.
Utility of Protocol Biopsy in the Management of Renal Allograft Recipients
Authors: Kumar K. Vinod , Sathyan Jeena J. , Prasannan Minnu , Urs Vishnu Dev , Prasannan Bipi , Unni V. Narayanan 
Published: March 2023

Background:Many studies suggest that early rejection episodes and chronic changes in the allograft kidneys were often subclinical without a concomitant rise in the serum creatinine or proteinuria. Early identification of subclinical pathology by doing protocol biopsy and appropriate intervention is likely to improve long-term graft outcomes. However, it is often not done, out of concern about the procedure-related complications.Methods:All patients who underwent live donor kidney transplantation at Aster Medcity from September 2019 to August 2021 with stable graft function were included in the study. Stable graft function is defined as variation in the creatinine values of <25% from the nadir creatinine. Protocol biopsies were taken at 3 months after transplant surgery. Biopsies were done using spring-loaded biopsy guns percutaneously under ultrasound guidance, and patients were observed for 24 h in the hospital for any complication. Biopsies were analyzed by light microscopy and C4d staining and scored based on the Banff classification 2017 update.Results:Seventy patients underwent protocol kidney biopsy at a prespecified time of 3 months. Majority of our patients (74.3%) received a kidney from the first-degree blood relatives, and the rest (25.7%) of the patients received kidneys from spouses. Induction therapy was given in 57% of the patients, and the rest (43%) were transplanted without an induction agent. Of 70 specimens studied, 44 (62.9%) had normal histology and 26 (37.1%) had varying degrees of histological abnormalities. Thirteen (18.6%) had evidence of subclinical rejection, of which 12 (17.2%) showed borderline rejection and 1 (1.4%) had acute T-cell-mediated rejection (acute TCMR). Other histological findings include chronic active TCMR in 1 (1.4%), varying degrees of interstitial fibrosis and tubular atrophy in 5 (7.1%), evidence of BK virus nephropathy in 2 (2.8%), features of tacrolimus toxicity in 2 (2.8%), and acute interstitial nephritis in one patient. None of the patients developed any complication after the procedure. With appropriate treatment interventions, all patients had stable graft functions at 6-month follow-up.Conclusions:Protocol graft biopsy under real-time ultrasound guidance has a very good safety profile and can help the clinician optimize the immunosuppression with more precision, and on a long term, it might prove cost effective to the patient.
Comparative Evaluation of Titer Estimation of ABO Isoagglutinins using Three Different Methods
Authors: Ranjan Shweta , Pandey Prashant , Setya Divya , Kumari Supriya 
Published: March 2023

Background and Aims:
While automation has the advantage of objectivity, ease of use, and reproducibility with well-defined end points of agglutination reaction, standardization of these methods has still not been possible. The aim of the present study was to compare results obtained by manual conventional test tube technique (CTT) with semi-automated, column agglutination technique (CAT), and fully automated hemagglutination/solid-phase red cell adherence (HA/SPRCA) by calculating and comparing correlation and median immunoglobulin M (IgM) and immunoglobulin G (IgG) titer.

Materials and Methods:
This was a prospective, observational study conducted from October 2019 to March 2020. All consecutive A, B, and O group donors who consented to participate were included in the study. All samples were consecutively tested by CTT, CAT, and HA/SPRCA.

Results:
A total of 300 (100 each from A, B, and O blood groups) donors were included. IgG titers were higher than IgM titers in most group O individuals. This difference was more evident with the use of CAT. The correlation between CTT and CAT was found to be strong, whereas the correlation between CTT and HA/SPRCA was found to be variable for anti-A and anti-B IgG and IgM titers. When measured by CTT and CAT, median anti-A and anti-B titer results for group O individuals were similar. Anti-A and anti-B median titer results obtained by CTT and CAT for group A and B individuals were also similar.

Conclusion:
Semi-automated method (CAT) shows higher ability in detecting ABO isoagglutinins than the manual method (CTT) and automated method (HA/SPRCA). These methods cannot be used interchangeably.
Renal Transplant Outcomes in Allografts with Multiple versus Single Renal Arteries
Authors: Rathi Deepak Kumar , Bansal Somendra , Zafar Feroz Amir , Ghosh Prasun , Khera Rakesh , Ahlawat Rajesh 
Published: March 2023

Context:
Anatomical variations of the grafts are one of the challenging problems in renal transplantation. Among these anatomical variations, multiple renal arteries (MRAs) are considered the most common.

Aims:
The aim of the study was to find out the outcome of recipient’s receiving multiple artery renal allografts.

Settings and Method:
This was a single-institutional, prospective, observational study of 212 patients who underwent open live renal allografting after exclusion criteria. All patients were followed up for a minimum of 12 months, and serum creatinine was done at 1 month, 3 months, 6 months, and at 12 months of follow-up.

Statistical Analysis Used:
Quantitative data have been presented in terms of means and standard deviation. Categorical data have been presented in terms of proportions and percentages. Student’s t-test has been used for the comparison of individual quantitative parameters. Value of P < 0.05 was considered statistically significant.

Results:
Serum creatinine on the postoperative day-1 was found to be higher in the MRAs group compared to single renal artery (SRA) group (2.25 mg/dl vs. 2.02 mg/dl, P = 0.178). During follow-up of the recipients, there was no statistically significant difference in serum creatinine between the two groups when measured at 1, 3, and 6 months and at 1 year.

Conclusions:
Outcomes in recipients receiving multiple artery renal allografts were similar compared to the cohort of allografts with SRA. Hence, transplantation of renal allograft with MRAs is safe, and the recipient in need should not be denied of a graft with multiple vessels.
Rare diagnosis of an Epstein-Barr virus-positive extracavitary/solid variant of primary effusion lymphoma by duodenal endoscopic biopsy in a human immunodeficiency virus-seronegative and immunocompetent patient: A case report
Authors: Guler Beril , Cetin Guven 
Published: March 2023

ABSTRACT
Primary effusion lymphoma and its tissue-based subtype extracavitary/solid variant was first described in human immunodeficiency virus (HIV)-seropositive patients. We report the case of a 50-year-old HIV-seronegative male patient who presented with icterus and cholestasis. Computed tomography revealed a 80 × 56 mm abdominal mass. Fine-needle aspiration biopsy was performed from the celiac lymph nodes and pancreatic head, under endoscopic ultrasonography guidance. A duodenal endoscopic biopsy was taken from the infiltration area, and a core biopsy was performed for the portal hilar mass. All biopsies showed similar cytohistopathological features. LCA-positive lymphoid neoplasia had a plasmacytoid/anaplastic morphology and null cell phenotype. HHV-8 and Epstein-Barr virus-encoded small RNAs (EBER) were diffuse positive. The patient, who did not have an effusion, was diagnosed with an extracavitary/solid variant of primary effusion lymphoma. Virus-associated lymphoproliferative disorders should be considered in the differential diagnosis of patients without a history of immunosuppression or HIV infection.
Comparative Evaluation of Remineralization Potential of Shelcal, Calcium Sandoz and Shelcal with Vitamin C on Artificially Induced Carious Lesions in Permanent Teeth: An in vitro Study
Authors: Shrienitha DN , Prasad V , Iyer K , Jagadeson M , Priyadharshini KI , Gomathi MS 
Published: March 2023

Background:
The invitro study was done to find out the efficacy of shelcal, shelcal with Vitamin C and calcium sandoz in remineralizing enamel surfaces on which artificial carious lesions had been created. The changes were analyzed using Vickers Hardness Testing Machine.

Materials and Methods:
A total of 45 permanent teeth were selected and divided into three groups: Group I – Shelcal, Group II – Shelcal with Vitamin C, and Group III – Calcium sandoz tablets. All samples were subjected to deminralization and assessed using Vickers Hardness Testing Machine. Each demineralized sample was randomly divided into three groups: Group I – Shelcal, Group II – Shelcal with Vitamin C, and Group III – Calcium sandoz tablets. After the 10 days of remineralization, the obtained data were analyzed statistically. The significance of mean difference between the groups was done by post
hoc Bonferroni test and repeated measures ANOVA. All analyses were performed on SPSS software (Windows version 20.0).

Results:
Statistical analysis showed that shelcal remineralizes artificially induced carious lesions in permanent teeth.

Conclusion:
Shelcal (Group I) exhibited superior remineralization potential.
Knowledge, Attitude, and Practice of Oral Hygiene Aids and its Role in the Prevention of COVID-19 Transmission: A Hospital-Based Questionnaire Study
Authors: Penmetsa GS , Vundavalli S , Boddeda A , Sruthima NV , Veluri SV , Praveen G 
Published: March 2023

Introduction:
The novel coronavirus disease has brought to the forefront the importance of oral hygiene aids and its role in the prevention of COVID-19 transmission.

Objectives:
The objective is to assess knowledge, attitude, and practice of oral hygiene aids and its role in COVID-19 transmission.

Materials and Methods:
This was a cross-sectional study conducted on 385 patients visiting Vishnu dental college. The questionnaire included demographic data, history of COVID, and vaccination status. The second part included questions regarding knowledge, attitude, and practice of oral hygiene aids and its role in COVID-19 transmission.

Results:
Mean age of the population was 40.11 years, and had almost equal proportions of males and females. About 22.6% of the population had suffered from COVID-19 and 92.7% of men got fully vaccinated. Knowledge of COVID-19 transmission through oral hygiene aids was found in 57.4% of the population. No difference in knowledge of occupational health advisor (OHA) and its role in COVID transmission was found between gender, COVID, and vaccination status (P > 0.05). About 22.9% of graduates had higher knowledge than others (P = 0.00).

Conclusions:
The use of appropriate oral hygiene aids and practices could prevent the transmission of COVID-19.