bluuebunny/crossref_metadata_2025_split huggingface dataset:
Opioid-Sparing Post-Cesarean Analgesia Using Intravenous Diclofenac-Acetaminophen Combination: A Prospective, Randomized Clinical Trial
Authors: Bhatia Nidhi , Jain Kajal , Kumari Kamlesh , Ashok Vighnesh , Dhir Ankita , Kumar Mandeep 
Published: April 2023

Background:
Current research promotes opioid-sparing analgesia as an approach to enhanced recovery after cesarean (ERAC). In developing countries, non-opioid-based analgesia is routinely practiced in obstetric settings, as opioids are not freely accessible. There are no randomized trials evaluating intravenous diclofenac and acetaminophen for postoperative analgesia following elective cesarean section.

Methods:
Women scheduled for elective cesarean delivery under subarachnoid block were enrolled if they fulfilled the inclusion criteria. They were randomized to receive either intravenous diclofenac or intravenous diclofenac-acetaminophen combination at the end of surgery and at predefined time intervals during the 24-hour postoperative period. The primary outcome measure of our study was 24-hour rescue analgesic (tramadol) consumption. Secondary outcome measures included time to first request for rescue analgesia, postoperative pain at rest and on movement, episodes of nausea, retching, and vomiting during the 24-hour postoperative period and overall patient satisfaction.

Results:
The 24-hour rescue analgesic consumption was significantly lesser in the diclofenac-acetaminophen group compared to the diclofenac group (56.25 ± 47.73 mg vs. 92.86 ± 50.83 mg; P = 0.00). Time to first request for rescue analgesia was earlier in the diclofenac group compared to the diclofenac-acetaminophen group (3.96 ± 2.40 h vs. 5.64 ± 3.58 h, P = 0.01). Parturients given a combination of intravenous diclofenac and acetaminophen used 40% less tramadol in the first 24 hours following cesarean section and were more satisfied with their pain management when compared to those given intravenous diclofenac alone.

Conclusion:
Following cesarean section, intravenous diclofenac-acetaminophen combination provides superior analgesia with significantly lesser opioid consumption and higher patient satisfaction when compared to intravenous diclofenac alone. This combination is effective, easy to administer, opioid-sparing and is compatible with ERAC regimens.
Retrospective Observational Case Series of Management of Placenta Accreta at Tertiary Care Institution
Authors: Patil Yogita , Motghare Abhilasha , Walavalkar Dhwani Sanjiv , Chincholi Indrani 
Published: April 2023

Introduction:
Placenta accreta is a general term, when part of the placenta or the entire placenta invades and is inseparable from the uterine wall. The incidence is considerably higher in women with both a previous caesarean delivery and placenta praevia, occurring in around 1 in every 20 such women. Resorption of the retained, poorly perfused placenta can be augmented by concurrent treatment with methotrexate when fertility is desired. In cases where operative measures are required, placement of Internal Iliac artery (IIA) balloons preoperatively and their inflation intraoperatively, reduces maternal morbidity and mortality.

Materials and Methodology:
We present a case series of 14 patients with placenta accreta diagnosed preoperatively, 7 of whom had IIA balloons placed before undergoing Caesarean section and 7 did not have such an intervention. The maternal and foetal morbidity and mortality were studied, including the need for blood and blood product transfusions.

Results:
Internal Iliac Balloon placements did not change the requirement for blood and blood product transfudion in both groups. The group who had IIA balloon placed preoperatively had better maternal and fetal outcome as compared to the group who had no such intervention.
Height-Adjusted Dose of Intrathecal Bupivacaine on Surgical Anesthesia for the Cesarean Section
Authors: Saring Noyomi , Basar Tomar , Sanyal Ramapati , Nania Mihin 
Published: April 2023

Background:
In the spinal anesthetic technique, local anesthetic dose (concentration and volume) is the main determinant of its adequacy and success of block to be achieved. The lack of pain during surgical intervention rather than on dermatome sensory block level is considered to be an appropriate indicator of surgical anesthesia. Spinal anesthesia is the most common anesthetic technique to provide anesthesia for the elective or emergent cesarean section (CS). However, spinal block-induced maternal hypotension is the most common adverse effect during single-shot spinal anesthesia. In our study, we aim to study the height-adjusted dose of 0.5% Bupivacaine Heavy (BH) in achieving surgical anesthesia and its effect on maternal hypotension.

Participants and Method:
One hundred parturients scheduled for elective CS were enrolled and were compared to the parallel arms of parturients receiving conventional BH. Fifty parturients in each group were included. In the conventional group (B), participants received spinal block with 12 mg of 0.5% BH, and in the height adjusted-dose group (H), participants received a dose of 0.5% BH in 0.06 mg per centimetre height. A sensory block level of T6 dermatome or higher was consider adequate to start surgery. The adequate surgical anesthesia is considered to be achieved if cesarean delivery can be performed without supplementary analgesia. The need of supplementary analgesia, conversion to general anesthesia, or no block till 15 min of intrathecal BH is considered spinal failure.

Results:
4% of the height-adjusted dose group have a low block level. Two cases complained of pain, and of them, one received supplementary analgesia and one was converted to general anesthesia. Systolic hypotension of a maternal blood pressure of less than 90 mm Hg was found in 19 (38%) and 10 (20%) in the conventional group and HAD group, respectively, which was highly significant statistically (p value 0.001%).

Conclusion:
Intrathecal hyperbaric bupivacaine in height adjusted 0.06 mg per cm height of patient can achieve surgical anesthesia with maintainance of systolic blood pressure. However, low dosing of intrathecal BH has higher cases of block failure in comparison to the conventional fixed dose regime of spinal anesthesia.
Comparison of Norepinephrine Bolus Versus Infusion for Prevention of Post-Spinal Hypotension in Parturients with Preeclampsia Undergoing Cesarean Section
Authors: Wakhloo Renu , Devi Ritu , Gandotra Megha , Kant Vishal 
Published: April 2023

Background:
Currently, spinal anesthesia for cesarean section is the anesthetic technique of choice for women with preeclampsia in the absence of contraindications to neuraxial anesthesia. Recently, norepinephrine has been introduced for prevention and treatment of hypotension associated with spinal anesthesia; however, only a couple of studies have compared norepinephrine infusion and bolus.

Aims:
This study aims to compare primarily the efficacy and safety of norepinephrine bolus given therapeutically and norepinephrine infusion given prophylactically for management of hypotension and effects on other hemodynamic parameters in parturients with preeclampsia undergoing cesarean section under spinal anesthesia and secondarily to determine the effects of study drugs on neonatal Apgar score and arterial blood gas analysis of neonatal blood.

Methods:
In this prospective randomized study, 100 singleton full-term pregnant females of ASA grade II, aged 18–35 years, diagnosed with preeclampsia (controlled on single antihypertensive drug with BP ≤140/90), scheduled for elective cesarean section under spinal anesthesia were randomly divided into two groups. Group A: Received therapeutic norepinephrine bolus (4 mg) only when hypotension (fall in SBP to ≤20% of baseline) was detected after spinal anesthesia. Group B: Received prophylactic intravenous norepinephrine infusion (4 mg/min) immediately after induction of spinal anesthesia.

Results:
Heart rate, systolic, diastolic, and mean blood pressure had statistically significant difference at 3,4,5,6,7,8,9, and 10 mins of surgery. Number of episodes of hypotension and number of norepinephrine boluses used in Group A were higher and statistically significant (p-value < 0.001) than Group B. Apgar score at 1 and 5 minutes as well as umbilical artery parameters in two groups was comparable and statistically insignificant (p-value 0.301 for Apgar at 1 min and P value 0.562 for Apgar at 5 mins).

Conclusion:
Although both norepinephrine bolus and infusion doses are an effective way to treat spinal anesthesia-related hypotension in patients with preeclampsia undergoing cesarean section with comparable maternal and fetal side effects, infusion dose of norepinephrine is better in maintaining hemodynamics of parturients with insignificant changes in neonatal outcomes.
The Effect of Music on Serum Cortisol Levels and Anxiety in Patients Undergoing Lower Segment Cesarean Section Under Spinal Anesthesia: A Randomized Controlled Interventional Study
Authors: Kaur Harpreet , Bansal Gopal L. , Sreehari S , Shukla Veena , Harsh Harsh K. , Pareek Ravi 
Published: April 2023

Background and Aims:
Surgical procedures performed using spinal anesthesia techniques present a special challenge to anesthesiologists, because patients are awake and exposed to multiple anxiety-provoking visual and auditory stimuli. Therefore, this study was carried out to define the effect of music on the level of cortisol and anxiety in patients under spinal anesthesia undergoing elective lower-segment cesarean section (LSCS).

Methods:
The study was conducted on 60 patients undergoing LSCS under spinal anesthesia. The patients were divided into two groups containing 30 patients each. Group A received music through headphones and group B did not receive any music. Blood samples for serum cortisol and visual analog score for anxiety (VASA) were evaluated in both groups in pre-operative and post-operative periods.

Results:
Student’s t-test was used for comparison of serum cortisol levels. The mean cortisol levels in group A were 32.44 ± 14.42 mg/dl in the pre-operative and 33.59 ± 12.74 mg/dl in the post-operative period (P = 0.583). However, in group B, the mean cortisol levels were 25.24 ± 13.54 mg/dl in the pre-operative period and 30.22 ± 17.04 mg/dl in the post-operative period. The difference was highly significant (P = 0.023). The mean VASA 1 score in group A as 5.22 ± 0.73 and in group B was 6.00 ± 0.82. The difference was not significant (P = 0.608). However, VASA 2 in group A was 4.90 ± 0.66 and group B was 5.89 ± 0.99. This difference was highly significant (P = 0.0001).

Conclusion:
This study›s results showed that listening to music during surgery under spinal anesthesia significantly reduces cortisol levels (P = 0.023) as well as anxiety score (P = 0.0001).
Computed Tomographic Study on the Prevalence of the Onodi Cell
Authors: Ominde Beryl S. , Ikubor Joyce , Igbigbi Patrick S. 
Published: April 2023

Context:
The prevalence of the Onodi cell varies in different populations. Its involvement in sinus pathology is characterized by varied clinical symptoms due to its proximity to the internal carotid artery and optic nerve. Endoscopic surgical management of sinus pathologies poses a great risk of injury to these neurovascular structures.

Aim:
This study elucidates the prevalence of the Onodi cell in a Nigerian Teaching Hospital.

Setting and Design:
This was a retrospective cross-sectional study conducted in the Radiology unit of a Teaching Hospital in Nigeria.

Materials and Methods:
Brain computed tomography (CT) images of 336 patients aged ≥20 years were evaluated for the presence of the Onodi cell. The study was approved by the institution before accessing the digital images. The age and gender of patients and the presence and location of the Onodi cell were recorded.

Statistical Analysis Used:
Data were entered in Statistical Package for Social Sciences version 23 for analysis of prevalence and subsequent comparisons using the Chi-square test. The significance level was considered at P < 0.05.

Results:
The prevalence of Onodi cell was 16.4% and was only observed unilaterally with a slightly lower frequency on the right (27, 8.0%) than the left (28, 8.3%). The prevalence did not show any significant side or gender differences (P > 0.05).

Conclusion:
The Onodi cell was present in the studied population, thus highlighting the need for their preoperative recognition on CT to abate iatrogenic complications during endoscopic surgeries.
Relationship of Serum Adiponectin Levels with Lipid Profile in Diabetic and Non-Diabetic Pregnant Women
Authors: Akhtar Yasmin , Khan Mudassir A. , Khan Muhammad S. , Malik Muhammad K. , Rehman Gulalai , Kashif Seemin 
Published: April 2023

Context:
Adiponectin levels correlate positively with high-density lipoprotein (HDL), and negatively with serum triglyceride (TAG), low-density lipoprotein (LDL), and serum total cholesterol (TC).

Aims:
To find the relationship of serum adiponectin levels with lipid profiles in diabetic and non-diabetic pregnant women.

Settings and Design:
The study was performed in four public hospitals and one private tertiary care hospital in Peshawar, Pakistan. This study was a cross-sectional study.

Methods and Material:
Group A included 100 non-diabetic pregnant women, and Group B included 100 women with gestational diabetes mellitus. Inclusion criteria were a single fetus, 24 to 40 weeks pregnancy, with or without gestational diabetes. Exclusion criteria were multiple pregnancies, pre-existing diabetes, and other comorbidities. The serum adiponectin level and lipid profile of both groups were measured.

Statistical Analysis Used:
Descriptive analysis of all the variables was done. Independent-sample T-tests, Pearson's correlations, and binary logistic regression analyses were performed on SPSS version 20.

Results:
Adiponectin level was significantly lower in Group B (2.17 ± 1.84 μg/mL) as compared to Group A (9.94 ± 4.81 μg/mL). HDL level was significantly lower than normal in Group B. TC and LDL levels were higher than normal in both groups. A statistically significant relationship was found between adiponectin and HDL only. Binary logistic regression analysis showed that low adiponectin levels could predict diabetes in pregnancy.

Conclusions:
Regression analysis could not establish any relationship between adiponectin and lipid profile. However, adiponectin levels could show a relationship with the diabetic group. Hence adiponectin levels could possibly prove to be a biomarker of GDM.
Investigation of Long-Term COVID-19 Patients’ Quality of Life and Affecting Factors: Data from Single COVID-19 Follow-Up Center
Authors: Uçan A , Güven ŞE , Mutlu FŞ , Bakılan F , Bildirici Y 
Published: April 2023

ABSTRACT

Background:
Patients with COVID-19 experienced changes in their quality of life. However, far less is known about how quality of life changes in long-term COVID-19 follow-ups.

Aim:
This article aims to explore the relationship between quality of life change and long-term COVID-19 patient status in the COVID-19 follow-up center.

Patients and Methods:
This study was designed retrospectively with patients admitted to the COVID-19 follow-up center between January and May 2021. The single group consisted of 125 patients. Their status and 36-Item Short-Form Health Survey (SF-36) variables were compared at two different time intervals. The first admission indicates the first 3 months, and the second admission covers 3–6 months after being diagnosed with COVID-19.

Results:
Cough and chest pain increased in the second admission (P < 0.001). No significant differences were found in SF-36 change according to age. The general health subgroup scores were lower in females than males (P = 0.004). The SF-36 Form’s subgroups for physical function, physical role, emotional role, bodily pain, energy, mental health, general health, and social function showed improvement (P = 0.001, P = 0.001, P = 0.026 P < 0.001, P = 0.007, P = 0.031, P <0.001, P <0.001, respectively). In addition, comparing with the SF-36 subgroups in terms of treatment places, a significant result was found between the inpatient and intensive care unit (ICU) in the general health subgroup (P = 0.044).

Conclusions:
The results show that quality of life may worsen during follow-up for COVID-19. In summary, these findings have significant implications for understanding long-term COVID-19 patients with a multidisciplinary approach and the necessity of follow-up centers to detect the unpredictable results of long-term COVID-19.
Can Malocclusion among Children Impact their Oral Health-Related Quality of Life? Parents’ Perspective
Authors: AlJameel AH , Almoammar K , Alfawaz NF , Alqahtani SA , Alotaibi GA , Albarakati SF 
Published: April 2023

ABSTRACT

Background and Aim:
Malocclusion can negatively impact the quality of life of children. Therefore, this study assesses the impact of proxy-reported malocclusion and oral health-related quality of life among children in Riyadh, Saudi Arabia, from the parents or guardians’ perspectives.

Materials and Methods:
A self-administered electronic questionnaire was used to assess the correlation between proxy-reported malocclusion conditions during the early mixed dentition stage (children age 6-12 years) and oral health-related quality of life using the OHIP-14 measure. All collected data were analyzed using SPSS.

Results:
Among the 353 participants in the study, anterior open-bite was the most common proxy-reported malocclusion with a prevalence of 19%, followed by unilateral posterior cross bite (13.3%). Furthermore, 31% reported that their children sometimes experienced negative impacts on quality of life from malocclusions. The results also show that OHIP-14 scores were significantly associated with all proxy-reported malocclusion (p < 0.05). The highest OHIP-14 score was found to be significantly associated with the presence of deep-bite from parents’ or guardians’ perspective.

Conclusion:
The presence of some proxy-assessed malocclusion was associated with negative impacts on children’s oral health-related quality of life. This is very important to consider when assessing the need for orthodontic intervention, especially at this stage as this age is critical in building a child’s confidence and self-esteem.
Significance of Immunohistochemical Markers in Women with Breast Cancer
Authors: Çaparlar MA , Dokcu Ş , Eroğlu A 
Published: April 2023

ABSTRACT

Background and Aims:
This study aimed to investigate the importance of immunohistochemical (IHC) markers and other prognostic variables in the definition of breast cancer.

Patients and Methods:
Two hundred female patients who underwent breast cancer surgery were classified into two groups according to age: young women (≤45 years; n = 104) and older women (≥65 years; n = 96). Molecular subtypes and local stages were determined. The Kaplan–Meier method was used to estimate the survival curves. The relationships among categorical variables were analyzed using the Chi-square test.

Results:
The difference between the tumor diameter and distribution of Ki-67 levels was significant (P = 0.001, P < 0.05). T stage, local stage, histological grade, estrogen receptor status, lymphovascular invasion status, axillary nodal state, human epidermal growth factor receptor 2 status, and distribution of molecular subtypes were correlated (P < 0.05). The mean disease-free survival rates (DFS) at 1, 2, and 5 years were found 92.9%, 86.5%, and 70.1%, respectively, in the young female group. The DFS rates of older patients were 96.7%, 95.4%, and 84.6%, respectively.

Conclusion:
This study showed that young age was associated with poor prognostic features at the IHC marker level.
Comparative Histopathological Analyses of Non-Scarring Alopecia in Systemic Lupus Erythematosus Patients in Lagos Nigeria
Authors: Anaba EL , Dawodu OO , Cole-Adeife O , Olaosebikan H 
Published: April 2023

ABSTRACT

Background:
Systemic lupus erythematosus (SLE) is known to cause non-scarring alopecia. However, histopathological evaluation is uncommon.

Aim:
The objective of this study was to document the histopathology of non-scarring alopecia and to compare histopathology of alopecic and normal appearing scalp areas in SLE hair loss patients.

Patients and Methods:
A cross-sectional comparative evaluation of scalp biopsies from 23 SLE patients; 12 with hair loss and 11 without was conducted over a 7-month period in 2020. A total of 58 scalp biopsies stained with H and E (23 vertical and 35 cross-sectional) were evaluated. Mucin deposit evaluation was done using Alcian blue (pH 2.5).

Results:
There were no significant differences in the sociodemographic data between the patients. The SLE hair loss patients demonstrated mucin deposition (91.7%), reduced size/number of sebaceous glands (58.3%), epidermal atrophy (50.0%), naked arrector pili muscles (50.0%), lymphocytic infiltration (33.3%), pigment incontinence (16.7%), fibrous stellae (16.7%), increased telogen percentage, and increased terminal versus vellus hair ratios. On comparing the histopathology of those who had hair loss to those without hair loss, the only significant difference was in the number and size of sebaceous gland. There were no significant differences between scalp areas with and without hair loss in the SLE hair loss patients.

Conclusion:
There are differences in size and number of sebaceous glands on histopathology between SLE patients who have hair loss and those who do not. Also, there are no histopathological differences between alopecic and non-alopecic scalp areas of SLE patient.
Are Patients with Covid-19 at Risk of Long-Term Chronic Kidney Disease?
Authors: Kemeç Z , Akgül F 
Published: April 2023

ABSTRACT

Background:
The relationship between Coronavirus Disease 2019 (COVID-19) and acute kidney injury (AKI) is well-established. However, a comprehensive evaluation of kidney outcomes in the long-term course of COVID-19 is not yet been performed. The aim of this study is to investigate whether chronic kidney disease (CKD) develops within six months after hospital discharge in COVID-19 patients who did not have kidney damage at the time of admission to the hospital.

Patients and Methods:
This single-center retrospective study investigated a total of 1008 participants selected from 7500 COVID-19 patients with real-time reverse transcription-polymerase chain reaction (RT-PCR) positivity. All patients had mild/moderate or severe COVID-19. Patients were randomly selected from inpatient and outpatient settings. Critical COVID-19 patients were not included.

Results:
The mean age of the patients was 56.57 ± 16.30 years, and 69.9% of them were male. The comorbidity percentages of the participants were as follows; 19.5% coronary artery disease (CAD), 28.6% diabetes mellitus (DM), 36.2% hypertension (HT), 3.1% cerebrovascular obstruction (CVO), 1.7% malignancy, 2.6% chronic obstructive pulmonary disease (COPD), 9.4% asthma, % 1.7 dementia, 9.9% hyperlipidaemia, and 1.7% hepatitis B virus (HBV). Kidney function tests of these patients at first admission and 6 months later were compared to reveal the relationship between COVID-19 and CKD. Serum glucose, sodium estimated glomerular filtration rate (eGFR), and uric acid levels were found to be high in the post-COVID-19 period (P = 0.001). However, there were a decrease in serum albumin, potassium, alanine aminotransferase (ALT), C-reactive protein (CRP), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), and gamma-glutamyl transferase (GGT) levels (P = 0.001). The difference between the first measurement of serum urea and creatinine (Cr) levels and the measurement 6 months later was not statistically significant (P = 0.102 and P = 0.300, respectively).

Conclusions:
Those who survived the mild/moderate and severe clinical manifestations of COVID-19 did not exhibit any risk of kidney outcomes after the acute phase of the disease, suggesting that the kidney can protect itself over a long period of time.