bluuebunny/crossref_metadata_2025_split huggingface dataset:
Raised prostate-specific antigen alone may not be a true predictor in high-risk prostate cancer
Authors: Garg Harshit , Seth Amlesh , Kumar Rajeev 
Published: August 2023

Introduction:
Prostate-specific antigen (PSA) >20 ng/mL in isolation is a criterion for classification as “high-risk” prostate cancer (PCa). However, among Indian men, PSA elevation is often seen even in the absence of PCa and patients with PSA as the sole criterion for the high-risk disease may have different outcomes from those categorized as high risk due to adverse pathological features. We compared the operative, oncological, and functional outcomes after robot-assisted radical prostatectomy (RARP) in men with high-risk PCa categorized using PSA alone versus clinical and histopathological findings.

Materials and Methods:
In an Institute Review Board-approved study, men undergoing RARP with high-risk PCa with at least 2-year follow-up were categorized into those with PSA >20 ng/ml being the sole criteria for being high risk (Group A) versus those with Gleason score ≥8 or ≥T2c disease but any PSA level (Group B). The two groups were compared for perioperative, oncological, and functional outcomes.

Results:
Fifty-three patients with high-risk disease were included. Twenty-six patients (48.9%) were classified into Group A while 27 patients (50.9%) were classified into Group B. The median PSA was significantly higher in Group A (31 [26–35] ng/ml in Group A vs. 21 [12–34] ng/ml in Group B, P = 0.006) and on histopathology of radical prostatectomy specimen, 24 (92.3%) patients had GG ≤3 disease in Group A versus 10 (37%) patients in Group B (P < 0.001). Patients in both the groups had similar perioperative and continence outcomes. However, Group A had significantly lower biochemical recurrence rate (3/26 [11.5%]) as compared to Group B (11/27 [40.7%]) (P = 0.012).

Conclusions:
PSA >20 ng/ml is the single most common criterion for stratification as high-risk PCa. However, men with PSA >20 ng/ml in isolation, without another adverse criterion, have better outcomes than men with adverse clinical or pathological criteria for high-risk disease.
Minimal invasive approaches in lymph node management of carcinoma of penis
Authors: Kandasamy Shreedhar Gurunathan , Chandran Kosur Ravi , Pooleri Ginil Kumar 
Published: August 2023

Introduction:
Inguinal lymph node dissection (ILND) is an integral part in the management of carcinoma penis. The concerns about the postoperative morbidity associated with open ILND led to modification in the template of dissection and adoption of minimally invasive techniques such as video endoscopic inguinal lymphadenectomy (VEIL) and robotic-assisted VEIL (R-VEIL). In this review, we aim to describe the techniques, case selection, perioperative outcomes, and oncological outcomes of VEIL and R-VEIL and to compare it with open ILND.

Methods:
Databases of PubMed, Embase, and Google Scholar were searched to identify the articles for VEIL and R-VEIL. Using PRISMA guidelines, literature search yielded 3783 articles, of which 32 full-text articles relevant to the topic were selected and reviewed, after consensus from authors.

Results:
After the first description of VEIL, various modifications in port placements and approaches were described. Several studies have shown, VEIL and R VEIL are safe and feasible in both node-negative and node-positive Ca penis patients. Compared to open ILND, VEIL had fewer wound infections and skin necrosis, minimal blood loss, shorter mean hospital stays, and reduced duration of drain kept. There is no difference in mean lymph node yield and recurrence rates between open ILND, VEIL, R-VEIL.

Conclusion:
VEIL and R-VEIL are safe and have comparable oncological outcomes with open ILND.
Refractory Seizures with Encephalopathy May be Due to Hashimoto Encephalopathy
Authors: Samanta Atraya , Deb Agniva , Karmakar Indranil , Roy Santanu 
Published: August 2023

Background:
Hashimoto's encephalopathy, also known as steroid-responsive encephalopathy associated with autoimmune thyroiditis, is a relatively uncommon neurological disorder, mostly in adults, with an extremely rare occurrence in children.

Clinical Description:
A 9-year-old girl presented with unprovoked seizures and encephalopathy. She had been diagnosed with hypothyroidism, at around 6 ½ years of age, though was noncompliant to therapy with levothyroxine.

Management:
The child was managed with intravenous (IV) antiepileptics and other supportive care. Seizures were refractory and with worsening sensorium, she required mechanical ventilation. The magnetic resonance imaging of the brain was unremarkable, as also the cerebrospinal analysis. Autoimmune encephalitis panel was negative. The electroencephalogram showed background activity of 10–11 Hz and few areas with generalized slow waves. As she was a known case of hypothyroidism without taking thyroid supplements for the past few months, thyroid profile was sent. Reports showed FT3-1.1 pg/dL, FT4-0.515 ng/dL, and thyroid-stimulating hormone (TSH) - 107.3 μIU/mL. Thyroid antibody profile revealed antithyroid peroxidase antibody >500 IU/mL and antithyroglobulin antibody >1000 IU/mL. Following this, an ultrasound of the neck was done which showed features of thyroiditis. Considering the possibility that the underlying thyroiditis could explain the obtunded state and refractory seizures, the patient was started on levothyroxine and IV methylprednisolone. The sensorium of the child improved dramatically, and she got extubated. There were no further seizures and her TSH level reduced gradually and eventually, she was discharged.

Conclusions:
In a child with altered sensorium and refractory seizures, Hashimoto encephalopathy is a diagnosis of exclusion and may be considered when most of the common causes of encephalopathy and seizures have been ruled out, especially in the setting of some clinical clues of hypothyroidism. The condition is often reversible with good response to steroid therapy.
Resolution of Fetal Hydrops-not a Favorable Outcome in Congenital Pulmonary Malformation Type 1
Authors: Gobbi Dalia , Filippi Elisa , Bracalente Gabriella , Baciorri Francesca , Midrio Paola 
Published: August 2023

Background:
Congenital pulmonary airway malformations (CPAMs) comprise a spectrum of anatomical anomalies of the lungs and respiratory tree. The natural history of prenatally diagnosed CPAM varies from in utero resolution to progression to hydrops and intrauterine death. The majority of fetuses (90%) have a good outcome. However, in a minority (10%), the mass may grow so large that it is associated with complications and becomes life-threatening to the fetus.

Clinical Description:
Prenatal diagnosis of giant left CPAM type 1 was made at 24 weeks of gestation in a 29-year-old primigravida woman. The lesion consisted of multiple large cysts with a CPAM volume ratio of 4.7. Since the diagnosis, the mass was associated with nonimmune fetal hydrops and polyhydramnios which got worse throughout the following 4 weeks of gestation. Doppler studies remained normal until term.

Management:
The family received prenatal counseling. Parents refused termination of pregnancy and any other invasive or pharmacological therapy in light of the bad prognosis. The pregnancy was strictly monitored using standard fetal lung parameters. By 31 weeks' gestation, hydrops spontaneously improved to resolution but without any change in the size of the cysts. A baby girl was delivered at term, with birth asphyxia, who, despite all efforts by a multidisciplinary team, could not be revived. Autopsy and histopathological findings were compatible with type 1 CPAM.

Conclusion:
Hydrops is a well-known complication in fetuses with congenital cystic adenomatoid malformation. The present case reminds the possibility of its spontaneous resolution during pregnancy, even though the cyst size remains unaltered. The eventual neonatal survival depends not on the presence of hydrops but on the cyst volume and underlying lung hypoplasia.
Double-site Intussusception in an Infant
Authors: Gupta Rahul , Raj Monish , Shukla Arvind Kumar , Sevar Ravindra 
Published: August 2023

Background:
Although intussusception is a well-known phenomenon in childhood, double-site intussusception is rarely encountered. We report an interesting case of idiopathic double-site, two ileoileal intussusceptions.

Clinical Description:
An 11-month-old baby girl presented with acute-onset vomiting and abdominal distension over 3 days. There was no associated history of fever, respiratory tract infection, or gastroenteritis. The infant was otherwise healthy, thriving well, without any significant medical or surgical illness in the past. On examination, the infant was alert, but irritable, hemodynamically stable, with abdominal distension without any lump or organomegaly.

Management:
The infant was stabilized with supportive care initially. The abdominal radiograph revealed multiple air–fluid levels with a paucity of distal gas shadows. Ultrasound showed a single-target sign in the right lumbar region. At laparotomy, an ileoileal intussusception was detected. During manual reduction, another intussusception was identified; the distal one was also ileoileal at the terminal ileum with its apex at the ileocecal junction. Both intussusceptions were successfully reduced. No pathological lead point was observed for each intussusception. Symptoms resolved, and there was no recurrence.

Conclusion:
This case creates awareness about the rare occurrence of double-site intussusceptions, which are not always detected by imaging methods. A careful inspection of the entire gut intraoperatively is essential to avoid missing such unsuspected second intussusceptions.
Global Longitudinal Strain Right Ventricle (GLS RV) as a Predictor for Mean Pulmonary Artery Pressure (MPAP) on Secundum Atrial Septal Defect (ASD) with Pulmonary Hypertension
Authors: Rahmianti Nia Dyah , Dinarti Lucia Kris , Mumpuni Hasanah , Triastuti Fita 
Published: August 2023

Objectives:
The objectives of the study were to determine the association between global longitudinal strain right ventricle (GLS-RV) and mean pulmonary artery pressure (mPAP) on secundum atrial septal defect (ASD) with pulmonary hypertension (PH).

Methods:
This study was an analytic observational with the cross-sectional approach. This study was conducted with secundum ASD patients who underwent right heart catheterization (RHC) from February 2019 to July 2019 at Sardjito General Teaching Hospital Yogyakarta. Demographic data were collected and echocardiographic parameters were evaluated based on the standard examination. The results were statistically analyzed using the correlation hypothesis test. If the data were normally distributed, the Pearson’s correlation test was used, if the data were not normally distributed, Spearman’s correlation test was used to analyze the correlation.

Results:
Thirty-four patients were enrolled in this study. There was strongly significant positive correlation between GLS-RV and mPAP found in patients with Secundum ASD (P = 0.0001, r = 90.5%).

Conclusions:
This is the first study in Indonesia that analyzed the association between GLS-RV and mPAP in Secundum ASD patients. There was a strongly significant positive correlation between GLS-RV and mPAP in patients with Secundum ASD after RHC. We assume that the association is influenced by progressivity and degree of disease severity.
Comparison of spinal anaesthesia and erector spinae plane block in unilateral inguinal hernia: Randomised clinical trial
Authors: Kaçmaz Mustafa , Bolat Hacı , Erdoğan Alirıza 
Published: August 2023

Abstract

Introduction:
The objective of our study was to compare erector spinae plane block (ESP) with spinal anaesthesia (SA) for inguinal hernia repair with respect to anaesthetic efficacy, post-operative analgesia, mobilisation, discharge, complication and side effects.

Patients and Methods:
The study included 52 patients over 50 years of age, with the American Society of Anaesthesia physical status Class I-III. Group ESP (n = 26) was applied 30 ml of mixed local anaesthetic mixture applied at the L1 level to the plane of the erector spinae and 10 ml of tumescent when necessary, while Group SA (n = 26) was applied 3 ml of 0.5% bupivacaine at the L3–L4/L2–L3 level.

Results:
Intraoperative Visual Analogue Scale (VAS) value was lower in Group S, whereas the 6th-h VAS value was lower in Group ESP (P < 0.05). There was no significant difference between the VAS values at hour 12 and 24 (P > 0.05). Reaching post-anaesthesia discharge criteria 9 and time to mobilisation and oral feeding was shorter in Group ESP, whereas post-procedure waiting time was shorter in Group S (P < 0.05). While the need for post-operative analgesics was higher in Group S (P < 0.05), there was a high level of patient satisfaction in Group ESP (P = 0.05). Intraoperative midazolam requirement was lower in Group S, post-operative diclofenac requirement was lower in Group ESP (P < 0.05), post-operative urinary retention and tremor were higher in Group S (P = 0.05).

Conclusion:
ESP block provides adequate surgical anaesthesia compared to SA (non-inferiority) for inguinal hernia repair. It is associated with less analgesic requirement, low post-operative pain, less complication rate and high patient satisfaction in the post-operative period.
Application of self-pulling and latter transection in totally laparoscopic total gastrectomy
Authors: Zhao Yang , Bai Zhi-Xia , Wang Tao , Song Dong , Li Tao 
Published: August 2023

Abstract

Background:
Recent years have seen an increase in gastric cancer incidence. The most effective method of treating gastric cancer is still surgical resection. Over the past few decades, minimally invasive surgery has rapidly developed, reducing post-operative complications and speeding up recovery. However, the technical difficulties, especially during anastomosis, hinder the widespread use of this advanced surgery. The aim of this study was to investigate the safety and efficacy of self-pulling and latter transection in totally laparoscopic total gastrectomy (SPLT-TLTG).

Patients and Methods:
A retrospective study compared the outcomes of laparoscopic-assisted total gastrectomy (LATG) and SPLT-TLTG in patients with gastric cancer. Eighty patients who underwent either LATG or SPLT-TLTG between January 2016 and June 2018 were included in the study. Clinical information was used to compare patients who underwent these surgeries.

Results:
Compared to LATG, patients who received SPLT-TLTG surgery recovered faster than those who received LATG time (operation and digestive tract reconstruction), blood loss, rehabilitation, first flatus, oral food intake, average pain score and hospital stay were significantly shorter in the SPLT-TLTG group than in the LATG group (P < 0.05). However, the two groups had no significant differences in LNs and baseline characteristics.

Conclusions:
The findings of this study provide significant evidence in support of the use of self-pulling and the latter transection procedures in total laparoscopic gastrectomy.
Analysis of ligature marks in hanging
Authors: Singh Salam Bitam , Devi Seram Elizabeth , Phanjoubam Memchoubi , Devi Th. Meera 
Published: August 2023

Background:
Many times, a ligature mark may be the only evidence available in cases of asphyxial deaths due either to hanging or strangulation. A thorough examination of the ligature mark and analysis of the information provided by it is, therefore, a must to confirm the death as due to hanging.

Materials and Methods:
A retrospective study was conducted at the Department of Forensic Medicine and Toxicology, Regional Institute of Medical Sciences, Imphal, between 2011 and 2019 to assess the information provided by a ligature mark in such cases.

Results:
We found that deaths due to hanging constituted 7.1% of the total unnatural deaths subjected to medicolegal autopsy. Rope (34.93%) was the most common ligature material used. Majority of the victims preferred slip knots (53.61%), followed by fixed knots (46.38%). In most of the cases, the mark was obliquely placed (83.73%) and above the larynx (77.1%). Imprint over the groove when present corresponded with the ligature material used in all the cases.

Conclusion:
It was concluded that a thorough, scientific examination of the ligature mark, though not conclusive, is the most important part of the postmortem examination of deaths due to hanging.
Dyserythropoiesis: A morphology-based study on bone marrow specimens
Authors: Misra Sunayana , Bharati Purnima , Majumder Ankur , Kumar Vijay 
Published: August 2023

ABSTRACT

Background and Aims:
Dyserythropoiesis is an altered state of erythropoiesis in bone marrow, classically seen in myelodysplastic syndrome (MDS) and congenital dyserythropoietic anemia. However, it can manifest in a variety of other disorders like stress erythropoiesis resulting from intense erythropoietic proliferative drive. We aim to quantify and study the light microscopic dyserythropoietic features in various reactive hematological and nonhematological disorders on bone marrow aspirates.

Materials and Methods:
Of a total of 150 bone marrow aspirate smears showing dyserythropoietic features, 132 smears met the adequacy criteria and were included. They were categorized into seven broad groups based on bone marrow diagnosis. The percentage of erythroid cells showing dyserythropoiesis on bone marrow aspirate, and the morphological features of dyserythropoiesis, including nuclear budding, multinuclearity, internuclear bridging, karyorrhexis, megaloblastosis, and cytoplasmic vacuoles, were scored semiquantitatively in each case. These features were compared between the above-mentioned groups.

Results:
Bone marrow diagnoses included erythroid hyperplasia, megaloblastic erythroid hyperplasia, reactive marrow, megakaryocytic thrombocytopenia, acute lymphoblastic leukemia in remission, hemophagocytic lymphohistiocytosis, and eosinophilia. The maximum dyserythropoietic changes were noted in erythroid and megaloblastic erythroid hyperplasia (75%–90%). Nuclear budding was the most frequent change seen through all groups, while cytoplasmic vacuoles followed by internuclear bridging were less frequently observed.

Conclusions:
Of all three hematopoietic lineages, erythroid series is the most prone to dysplasia. Erythroid hyperplasia, due to an increased erythropoietic drive, can show prominent dyserythropoietic changes on bone marrow aspirate and is indicative of reactive rather than neoplastic process. Therefore, the use of isolated dyserythropoiesis in diagnosing clonal disorders (MDS) warrants an extreme caution.
Estimation of systemic and mucosal toll-like receptors 4 and 6 in women with breast tumor
Authors: Shaheed Thamer Shather , Barem Wala Noori Majeed , Abd Frial Gemeel , Al-Khikani Falah Hasan Obayes 
Published: August 2023

ABSTRACT

Background:
Toll-like receptors (TLRs) have generated an extraordinary amount of interest in cancer research in the last decade. More recently, TLR-mediated signaling pathways have been shown to support tumor cell growth in vitro and in vivo.

Aim:
Estimating the concentrations of TLR6 and TLR4 in serum and breast tissue of women with breast tumors.

Materials and Methods:
Blood and breast tissue were collected from 50 women (14–60 years) undergoing breast surgery at AL-Hilla Teaching Hospital and Al-Sadiq Hospital in Babylon Province. Histological confirmation of breast diseases, whether benign or malignant tumors, was done by the histological laboratory in the hospital. Twenty blood samples were collected from healthy women as controls. TLR4 and TLR6 were determined by the enzyme-linked immunosorbent assay in the serum of patients and controls as well as they were also determined in supernatant of cells in patients’ breast tissues.

Results:
The mean of TLR4 concentration was nonsignificantly increased in the serum of patients 4.58 ± 1.60 pg/ml than controls 4.18 ± 0.72 pg/ml (P = 0.28). The systemic mean of TLR6 in the serum of the patient was 2.11 pg/ml, while in control was 1.58 pg/ml with significant differences (P = 0.01). TLR4 concentrations also appeared systemically higher than local in different diseases. TLR6 concentrations were increased in local (tissue) than systemic with different disease types. There was a significant positive correlation between the concentration of TLR4 and TLR6 in the serum (systemic) of women with breast tumors (r = 0.353; P = 0.04).

Conclusions:
The systemic mean of TLR6 in the serum of the patient was 2.11 pg/ml, while in control was 1.58 pg/ml with significant differences (P = 0.01).
Filicide in Northeast India: A study of 10 cases
Authors: Neha Soibam , Phanjoubam Memchoubi 
Published: August 2023

ABSTRACT

Background:
Filicide, or the murder of one’s own child, is an unfathomable crime. Every now and then, filicide gets media attention. One positive outcome that may be derived from this factor is practitioners’ heightened awareness that parents may, for a variety of reasons, be compelled to kill their children.

Materials and Methods:
This article presents 10 cases of paternal filicide to spread awareness about the concept of filicide, its prevalence, modus operandi, and causes in contemporary times. These cases were studied from the postmortem records of a tertiary health-care center in Northeast India during the past 10 years, i.e., from 2012 to 2022.

Results:
All the cases were paternal filicides. The ages of the victims ranged from newborns to adolescents. The motives were usually associated with mental and social disturbances in the family life of the perpetrators. Modus operandi ranged from smothering to the use of blunt and sharp weapons and from impulsive to calculated acts. Many factors are involved in the dynamics of a filicidal situation. It is therefore difficult to identify specific warning signals for the prevention of this type of homicide.

Conclusion:
The knowledge of filicide will hopefully bring about clinicians’ increased exploration of patients’ thoughts of harming their children, which may ultimately lead to the prevention of these senseless crimes. Mental health professionals and the general population must be made aware of the importance of early assessment of possible filicidal tendencies when a man verbalizes delusional ideas about his child and/or if he manifests disorganized and bizarre behavior.
Maternally inherited diabetes mellitus and deafness (MIDD): A case report and review of literature
Authors: Agrawal Prabhat K , Pursnani Nikhil , Gautam Ashish , Singh Akhil P , Singh Awadhesh K 
Published: August 2023

Abstract
Maternally inherited diabetes and deafness (MIDD) is a rare subtype of diabetes with a prevalence of up to 1% globally but often missed if not suspected. We present a case of MIDD and a thorough review of the literature related to it. The phenotypic presentation of diabetes depends on heteroplasmy levels of m.3243A>G mutation of the individual patient. Patients with MIDD may have involvement of other organs such as eye, muscles, kidney, and heart. In our patient, along with diabetes and deafness, there was also an associated vision loss with a strong maternal inheritance of diabetes. A young male who presented with diabetic ketoacidosis (DKA) and hearing and vision impairment and on further diagnostic work up turned out to be a case of genetically confirmed (m.3243A>G mutation) MIDD. To the best of our knowledge, this should be the first case of MIDD presenting as DKA being reported from India.