bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sinonasal and Olfactory Quality of Life in Endoscopic Pituitary Surgery and Time Interval to Olfactory Recovery
Authors: Sah Monali , Mohindra Satyawati , Mohindra Sandeep , Bal Amanjit , Mahendru Shaurya , Dhaliwal Avondeep 
Published: August 2023

Background and Objective:
Superior turbinate manipulation is often required in cases of narrow cavities and expanded endonasal approaches with concern for olfaction. The objective of the study was to compare the pre- and postoperative olfactory function in patients undergoing endoscopic endonasal transsphenoidal pituitary excision with and without superior turbinectomy, using the Pocket Smell Identification Test and the quality of life (QOL) and Sinonasal Outcome Test-22 (SNOT-22) scores, irrespective of the extension (Knosp grading) of pituitary tumors. We also aimed to identify olfactory neurons in the excised superior turbinate with immunohistochemical (IHC) stains and correlate them with clinical findings.

Materials and Methods:
The study was a prospective, randomized study performed in a tertiary center. Two groups A and B, with superior turbinate preserved and resected, respectively, during endoscopic pituitary resection, were compared using pre- and postoperative Pocket Smell Identification Test and QOL and SNOT-22 scores. The superior turbinate was subjected to IHC staining to identify the presence of olfactory neurons in patients with tumors of pituitary gland requiring endoscopic trans-sphenoid resection.

Results:
Fifty patients with sellar tumors were enrolled. The mean age of patients in this study was 46.15 years. The minimum age was 18 years and the maximum was 75 years. Of the 50 patients in the study, 18 were female and 32 were male. Eleven patients had more than one presenting complaint. Loss of vision was the commonest and altered sensorium was the rarest symptom.

Conclusion:
Superior turbinectomy is a viable option to gain wider access to sella without affecting the sinonasal function, quality of life, and olfaction. There was doubtful presence of olfactory neurons in superior turbinate. The extent of tumor resection and postoperative complications were unaffected and statistically nonsignificant in both the groups.
Safety and Efficacy of Gamma Knife Radiosurgery for the Management of Trigeminal Neuralgia
Authors: Okunlola Abiodun I , Pattankar Sanjeev , Warade Anshu , Khandhar Alay , Mistry Varun , Misra Basant K 
Published: August 2023

Background:
Medical management is the first line of care for patients with trigeminal neuralgia (TN), and carbamazepine is the drug of choice used alone or in combination with other drugs. Gamma knife radiosurgery (GKRS) has been an established option in the management of refractory TN based on its noninvasiveness and robust safety profile. Our study aims to confirm the safety and assess the efficacy of GKRS in the management of TN.

Material and Methods:
A retrospective review of the patients with refractory TN treated with GKRS from 1997 to March 2019 by the senior author was carried out. Out of 194 eligible patients, detailed clinical information was not available in 41 patients. The remaining 153 patients' case files (post-GKRS cohort) were reviewed, and data obtained were collated, computed, and analyzed. An additional cross-sectional analysis was carried out telephonically in the post-GKRS cohort in January 2021 using Barrow Neurological Institute (BNI) pain scoring, to obtain the long-term efficacy of GKRS in TN.

Results:
The majority of the patients (96.1%) received a radiation dose of 80 Gy. At 6 months, 94.8% of patients had satisfactory response to GKRS. Follow-up ranged between 1 and 7.5 years. The recurrence rate was 9.2% and the complication rate was 4.6%. Facial numbness was the commonest complication. No mortality was reported. The cross-sectional arm of the study had a response rate of 39.2% (60 patients). Adequate pain relief (BNI I/II/IIIa/IIIb) was reported in 85% of patients.

Conclusion:
GKRS is a safe and effective modality of treatment for TN without any major complications. Both short-term and long-term efficacies are excellent.
Development, Validation, and Impact of Patient Information Booklet for Gamma Knife Radiosurgery
Authors: Tripathi Manjul , Jani Parth , Bhatta Rajkumar , Batish Aman , Yagnick Nishanth S , Madan Renu , Ahuja Chirag K , Mohindra Sandeep , Kaur Rupinder , Kaur Parwinder , Chauhan Rajeev 
Published: August 2023

Background:
The inadequate awareness in the general population is a primary concern for the management of various neurosurgical ailments treated with gamma knife radiosurgery (GKRS).

Objective:
Our study aimed to assess the written patient information by focusing on readability, recall, communication, compliance, and patient satisfaction.

Methodology:
The senior author formulated disease-specific patient information booklets. The booklets comprised two segments: general information about GKRS and disease-specific information. The common themes for discussion were “What is your disease?”, “What is gamma knife radiosurgery?”, “What are the alternatives to gamma knife radiosurgery,” “The benefits of gamma knife radiosurgery,” “About gamma knife radiosurgery,” “Recovering from gamma knife radiosurgery,” “Follow up,” “What are the risks,” and “Contact.” The booklet was emailed after the first consultation to 102 patients. Patients' socioeconomic status and comprehensibility were assessed on validated scoring. Post-GKRS, we emailed a custom-made Google feedback survey of 10 leading questions about the role of patient information booklet in educating and decision-making process. We tried to assess if the booklet helped the patient understand the disease and treatment options.

Results:
In total, 94% of patients read it thoroughly and understood it to their satisfaction. They also shared and discussed the information booklet with their family members and relatives (92%). Furthermore, 96% of patients found the disease-specific information informative. For 83% of patients, the information brochure cleared the doubts regarding the GKRS completely. For 66% of patients, their expectations met the reality. In addition, 94% of patients still recommended giving the booklet to the patients. All high, upper- and middle-class responders were happy and content with the patient information booklet. In contrast, 18 (90%) of the lower middle class and 2 (66.7%) of the lower class considered the information useful to the patients. Also, 90% patients found the language of the patient information booklet comprehensible and not too technical to understand.

Conclusions:
An essential component of disease management is to relieve the anxiety and confusion in the patient's mind and help one choose a treatment modality among the available options. A patient-centric booklet helps impart knowledge, clears doubts, and provides an opportunity to discuss options with family members.
Early Gamma Knife Therapy (Without EBRT) in Operated Patients of Glioblastoma Multiforme
Authors: Rai Hitesh I S , Agrawal Deepak , Singh Manmohan , Kale Shashank S 
Published: August 2023

Background:
The standard therapy for glioblastoma (GBM) has been external beam radiotherapy (EBRT) with concomitant temozolomide (TMZ) given for six cycles, after maximum possible surgical resection although recurrences after chemoradiation are mostly in-field.

Objective:
To compare the effects of early GKT (without EBRT) along with TMZ to those receiving standard chemoradiotherapy (EBRT + TMZ) after surgery.

Methods:
This was a retro-prospective study on histologically proven GBMs operated at our center between January 2016 and November 2018. The EBRT group consisted of 24 patients who received EBRT + TMZ for six cycles. The GKT arm consisted of 13 consecutive patients who received Gamma Knife within 4 weeks of surgery along with lifelong temozolomide. Patients were followed up every 3 months with CEMRI brain and PET-CT. The primary endpoint was overall survival (OS) with progression-free survival (PFS) being the secondary endpoint.

Results:
At a mean follow-up of 13.7 months, the median overall survivals in GKT and EBRT groups were 11.07 and 13.03 months, respectively (HR = 0.59; P value = 0.19; 95% CI: 0.27-1.29). The median PFS for GKT group was 7.03 months (95% CI: 4.17-17.3) as compared to 11.07 months (95% CI: 5.33-14.03) for the EBRT group. There was no statistical difference in the PFS or OS between the GKT and EBRT groups.

Conclusion:
Our study shows that Gamma Knife therapy (without EBRT) to residual tumor/tumor bed after primary surgery with concurrent temozolomide has similar progression-free (PFS) and overall survival (OS) rates when compared to conventional treatment (EBRT).
Gamma Knife Radiosurgery for Uveal Melanoma
Authors: Phalak Manoj , Lomi Neiwete , Ganeshkumar Akshay , Singh Simranjeet , Garg Kanwaljeet , Natanasabhapathi Gopishankar , Singh Manmohan , Kumar Rajinder , Kale Shashank Sharad 
Published: August 2023

Background:
Various therapies ranging from plaque brachytherapy to enucleation have been applied in uveal melanomas (UM). A gamma knife (GK) is the gold standard modality for head and neck radiation therapy with enhanced precision owing to the paucity of moving parts. The literature on GK usage in UM is rich with the methodology and nuances of GK applications undergoing constant change.

Objectives:
This article reports on the authors' experience in using GK for tackling UM followed by a thematic review of the evolution of GK therapy for UM.

Materials and Methods:
Clinical and radiological data of patients with UM treated with GK at the All India Institute of Medical Sciences, New Delhi, from March 2019 to August 2020 was analyzed. A systematic search for comparative studies and case series evaluating GK usage in UM was performed.

Results:
Seven UM patients underwent GK, with the median dose being 28 Gy at 50%. All patients underwent clinical follow-up and 3 patients had a radiological follow-up. Six (85.7%) eyes were preserved at follow-up, and 1 (14.28%) patient developed radiation-induced cataract. There was a reduction in tumor volume in all patients with radiological follow-up with the minimum being a 33.06% reduction in size compared to the presenting volume and the maximum being the complete disappearance of tumor at follow-up. A total of 36 articles presenting various facets of GK usage in UM have been thematically reviewed.

Conclusion:
GK can be a viable and effective eye-preserving option for UM with catastrophic side effects becoming rare owing to progressive reduction in radiation dose.
Comparison of Phenytoin and Fosphenytoin in Treatment of Active Seizures in the Emergency Department
Authors: Madhiyazhagan Mamta , Roshan Ramgopal , Dhanapal Sudhakar G , Joseph Joshua V , Ganesan Priya , Mathew Vivek , Kundavaram Paul P A 
Published: August 2023

Background and Objective:
Ongoing seizure in the Emergency Department is a medical emergency and its aggressive management is essential. Prompt antiepileptic therapy with early cessation of seizure would minimize the morbidity and risk of recurrence. To compare time to seizure control with fosphenytoin to phenytoin protocol in the ED

Materials and Methods:
We conducted an observational study on patients with active seizure in the Emergency Department comparing phenytoin versus fosphenytoin protocol over one year.

Results:
During the study period, we recruited 121 patients in the phenytoin group and 124 patients in the fosphenytoin group. Generalized tonic-clonic seizure (73.5% in phenytoin vs. 68.5% in fosphenytoin arm) was the most common type of seizure in both the arms. The mean time taken for cessation of seizure in the fosphenytoin arm (17.48 ± 49.24) was less than half of that in the phenytoin arm (37.20 ± 58.17) (mean difference: 19.72, P = 0.004, 95% CI: −33.27 to −6.17). There was a significant decrease in recurrence rates of seizure with phenytoin compared to the fosphenytoin arm (17.7% vs. 31.4%: OR: 0.47, P = 0.013; 95% CI: 0.26–0.86). Favorable STESS (≤2) was higher with phenytoin compared to fosphenytoin (60.3% vs. 48.4%). The overall in-hospital mortality rate in both arms was negligible (0.8%).

Conclusion:
The mean time for cessation of active seizure with fosphenytoin was less than half that of phenytoin. Despite its higher cost and minor adverse effects when compared to phenytoin, benefits seem to outweigh its limitation.
Postoperative Seizure Control in Adult Diffuse Insular Gliomas Presenting with Seizures
Authors: Das Kuntal K. , Singh Amanjot , Mishra Prabhakar , Khatri Deepak , Deivasigamani Balachandar K. , Datta Aanchal , Bhaisora Kamlesh S. , Mehrotra Anant , Srivastava Arun K. , Jaiswal Awadhesh K. , Behari Sanjay , Kumar Raj 
Published: August 2023

Background:
Studies on insular gliomas (IGs) generally focus on the oncological endpoints with a relative scarcity of literature focusing on the seizure outcomes.

Objectives:
To study the predictors of long-term postoperative seizure control in IG and propose a novel risk scoring system.

Methods:
Histopathologically proven, newly diagnosed adult IGs (>18 years) operated over a 10-year period were studied for postoperative seizure control as per International League Against Epilepsy (ILAE) grades at 6 weeks and at last follow-up (minimum of 6 months, median 27 months). Logistic regression analysis was performed and regression coefficients with nearest integers were used to build a risk prediction model. Receiver operator curve (ROC) analysis determined the predictive accuracy of this model.

Results:
The 6-week postoperative seizure freedom dropped to 41% at the last follow-up. The seizure-free group lived longer (100.69 months, 95% CI = 84.3–116.99 (60%)) than those with persistent postoperative seizures (27.92 months, 95% CI = 14.99–40.86). Statistically significant predictors (preoperative seizure control status, extent of resection, tumor extension to temporal lobe, and lack of postoperative adjuvant therapy) were used to compute a risk score, the score ranging from 0 to 9. A score of four most optimally distinguished the risk of postoperative seizures with an area under the ROC of 91.4% (95% CI: 84.1%, 98.7%, P < 0.001).

Conclusion:
In our experience, around 60% of patients obtained seizure freedom after surgery, which reduces over time. Control of seizures paralleled survival outcomes. Our proposed scoring system may help tailor management strategies for these patients.
Cuteness and the Power of Emotion
Authors: Paz Esteban Vaucheret , Leis Mariana , Garcia Basalo María José , Giacchino Mariana , Agosta Guillermo 
Published: August 2023

Background:
There is an agreement among individuals from different cultures in how they judge the cuteness of a face. There are observations suggesting that some preferences may be neurobiological rather than cultural. Most of the studies conducted use adult faces with a neutral expression; however, the mechanisms involved in rating cuteness are not exactly the same as those involved in the perception of attractiveness. Furthermore, it is not always taken into account that emotional expressions influence the impression on the beauty of a face. The objective of the study is to evaluate the influence of the different emotions on the perception of cuteness of children's faces.

Materials and Methods:
We included 60 adults and 21 children who observed 150 photographs of children's faces expressing the six basic emotions and had to rate facial cuteness.

Results:
Participants gave the highest cuteness score to faces with happy emotions (mean [M] = 6.89, 95% confidence interval [CI] 6.48–7.30) and the lowest to those that expressed negative emotions (M = 5.32, 95% CI 4.87–5.78, t(160) = 5.08, P <.001). This was evidenced in adults and children of both genders, regardless of the gender of the stimulus.

Conclusions:
In our study, we found that facial expression generates an impact on the perception that a subject has on the cuteness of the face. The faces that show happiness were scored as more cute compared to those that expressed anger, disgust, or sadness. We suggest that expression of positive emotions, like a smile, could increase the conducts associated with caring, placing the child in a more favorable situation for the future.
Comparing T2-T3 staging of penile cancer according to the American Joint Committee on cancer 8th edition with two modified staging systems in predicting survival outcome
Authors: Kakoti Shitangsu , Sureka Sanjoy Kumar , Pathak Abhishek , Shah Utsav Shailesh , Mishra Navneet , Puneeth Kumar K. M. , Srivastava Aneesh , Singh Uday Pratap 
Published: August 2023

ABSTRACT

Introduction:
Penile cancer is a rare malignancy of the genitourinary tract. We aimed to validate the recent changes in the T2 and T3 stages of penile cancer in the American Joint Committee on Cancer (AJCC) 8th edition and to compare its predictive ability with two other modified staging systems for survival outcomes.

Methods:
This is a retrospective study of patients diagnosed with penile cancer from June 2015 to March 2020. The AJCC 8th edition and two other newly proposed systems by Li et al. and Sali et al. were used for staging the tumor. All variables were categorized and correlated with lymph node (LN) metastases and overall survival (OS).

Results:
Fifty-four patients were eligible for this study. The mean age was 58 years (range 46–72 years). The tumor stage (P = 0.016), clinical LN stage (P = 0.001), the involvement of the spongiosa (P = 0.015) and the cavernosa (P = 0.002), lymphovascular invasion (LVI) (P = 0.000), and PNI (P = 0.021) were found to be the significant predictors of LN metastases. When the 5 year OS was compared between the T2 and T3 stages of the AJCC 8th edition, Li staging and the Sali staging systems, it was 91% and 50.1% (P = 0.001), 97.5% and 10.3% (P = 0.000), 94.4% and 14.7% (P = 0.000), respectively. The presence of LVI (P = 0.001) was the most significant independent predictor of OS.

Conclusions:
The recent changes in the AJCC 8th edition pertaining to the T2-T3 stage are relevant, although the other two newly proposed staging systems were more precise in predicting the survival outcomes.
Pediatric robotic urologic procedures: Indications and outcomes
Authors: Hou Sean W. , Xing Monica H. , Gundeti Mohan S. 
Published: August 2023

ABSTRACT

Introduction:
Robotic-assisted laparoscopic surgery (RALS) has revolutionized minimally invasive surgery in pediatric urology. The robotic platform allows surgeons to maintain the benefits of laparoscopic surgery while having enhanced three-dimensional view, dexterity, range of motion, and control of high-resolution cameras. In this review, we summarize the indications and recent outcomes for various pediatric urologic RALS procedures to illustrate the current state of robotics in pediatric urology.

Methods:
We systematically searched the PubMed and EMBASE databases. We extrapolated and summarized recent evidence on RALS in pediatric urology patients, with an emphasis on indications and outcomes, with regard to the following procedures and search terms: pyeloplasty, kidney stone surgery, partial nephrectomy, nephroureterectomy, ureteral reimplantation, appendico-vesicostomy, augmentation cystoplasty, bladder neck reconstruction, and Malone antegrade continence enema. Additional Medical Subject Headings terms used to augment the search included “Treatment Outcome” and “Robotic Surgical Procedures.”

Results:
Increasing usage of RALS has shown many benefits in perioperative and postoperative outcomes. In addition, there is growing evidence that robotic procedures in pediatric urology result in similar or better surgical outcomes when compared to the standard of care.

Conclusions:
RALS has shown considerable effectiveness in pediatric urologic procedures and may achieve surgical outcomes comparable to the standard approaches of open or laparoscopic surgery. However, larger case series and prospective randomized controlled trials are still necessary to validate the reported outcomes, in addition to cost analyses and studies on the surgical learning curve. We believe that the continuous evolution of robotic platforms will allow for enhanced care and quality of life for pediatric urology patients.
Giant pouch stones as a surgical challenge decades after a continent ileal pouch
Authors: Abdulla Adil , Venugopalan A V , Farzana T C 
Published: August 2023

ABSTRACT
Continent cutaneous urinary diversion pouches are prone to complications like stoma blockage by mucus, metabolic derangements, infection, renal derangements and urolithiasis. Pouch urolithiasis is not uncommon, but presentation of a huge stone burden is rare. We report a case of giant pouch stones in a continent pouch which was a surgical challenge. We also highlight the need for adequate hydration, pouch irrigation and drainage by clean intermittent catheterization and regular follow-up, to prevent such a condition from arising.
A rare case of air cysto-uretero-pyelogram due to emphysematous cystitis
Authors: Sarangi Shakti Swarup , Bhirud Deepak Prakash , Navriya Shiv Charan , Sandhu Arjun Singh 
Published: August 2023

ABSTRACT
Emphysematous infection of the urinary tract is a hazardous condition and is life-threatening if not managed quickly. We report an 82-year-old woman with uncontrolled diabetes mellitus and urethral stricture who presented with emphysematous cystitis with the gas reaching up to the pelvicalyceal system on the left side (emphysematous pyelonephritis) and appearing in X-ray as air pyelogram. The patient was managed with drainage and intravenous antibiotics and she recovered.
A Comparative Study of Mixed Connective Tissue Disease and Overlap Syndromes – A Single-Center Study from India
Authors: Maikap Debashis , Deosale Shreyansh , Singh Pratima , Panda Sudhansu Sekhar , Padhan Prasanta 
Published: August 2023

Introduction:
Mixed connective tissue disease (MCTD) a classical overlap syndrome with four different defining criteria. The present study attempts to compare the clinical features and autoantibodies for MCTD and overlap syndromes.

Methods:
In this observational study from October 2018 to August 2020, we included all the patients of MCTD and overlap syndromes. Alarcon–Segovia criteria was used as defining criteria for MCTD patients while the patients meeting diagnostic criteria for more than 1 of 6 classical autoimmune rheumatic diseases were selected in the overlap syndromes group. We compared their clinical features, laboratory parameters, and autoantibody profiles. MS Excel, STATA were used for statistical analysis, and comparison between the groups was done with t-test, Chi-square test, and Wilcoxon rank sum test. P < 0.05 was considered as statistically significant.

Results:
The study consisted of 60 consecutive patients (MCTD, n = 30 and overlap syndromes, n = 30) with higher female population in both groups (90% in MCTD and 84% in the overlap syndromes group) compared to males. The incidence of fever (83.3% vs. 46.6%), weight loss (60% vs. 26.6%), trigeminal neuralgia (76.6% vs. 13.3%), and myositis (63.3% vs. 20.0%) was significantly higher in MCTD than overlap syndromes whereas the incidence of cough (66.6% vs. 90.0%) and dry mouth (20.0% vs. 53.3%) was higher in overlap syndromes than MCTD (P < 0.05). Anti-U1 RNP antibodies were seen in all MCTD (100.0%) patients while anti-Scl 70 antibodies (60%) and anti-ribosomal-p-protein antibodies (13.3%) were seen in overlap syndromes.

Conclusion:
Fever and weight loss, trigeminal neuralgia, and myositis were more common in MCTD than overlap syndromes. Anti-U1 RNP antibodies seen in MCTD while Anti-Scl 70 antibodies and anti-ribosomal-P antibodies were commonly were seen in overlap syndromes.