bluuebunny/crossref_metadata_2025_split huggingface dataset:
Non-Surgical Management Of Mild To Moderate Splenic Injuries In Blunt Abdominal Trauma
Authors: Aparna S. , Ragesh K. V. 
Published: May 2022

Introduction:
The spleen is the most frequently injured solid organ following blunt abdominal trauma. Non-operative management (NOM), either medical or radiological intervention, is currently favoured in haemodynamically stable patients, while surgery is indicated in haemodynamic instability.

Objectives:
The objectives were as follows: (1) to study the outcome of non-surgical management of mild-to-moderate splenic injuries in blunt abdominal trauma and (2) to analyse factors affecting the outcome of NOM.

Materials and Methods:
An observational study was conducted in 63 patients with blunt splenic injury undergoing NOM in the department of general surgery from August 2019 to August 2020. All patients were monitored till discharge. Statistical analysis was done using SPSS software.

Results:
Fifty-eight out of 63 patients (92.06%) were successfully managed non-operatively. Five (7.94%) patients underwent surgical management within 48 h following trauma due to haemodynamic instability. Age group (P = 0.804), gender (P = 0.773), history of coronary artery disease (CAD) (P = 0.187) and use of antiplatelet drugs (P = 0.083) had no significant association with the outcome of NOM. Tachycardia and hypotension at admission, quantity of haemoperitoneum and contrast-enhanced computed tomography (CECT) grade of splenic injuries significantly correlated failure of NOM (P < 0.00001). Hospital stay was longer in surgical patients.

Conclusions:
NOM is successful in majority of haemodynamically stable patients. Age, gender, history of CAD and use of antiplatelet drugs had no impact on the outcome. Haemodynamic instability, severity of splenic injury in CT scan and need for transfusions predicted the need for surgery. The amount of blood in the peritoneum was more with the use of antiplatelets and higher grade of splenic injury in the CECT scan.
Effect of Perioperative Immunonutrition Supplementation in Patients Undergoing Living Donor Liver Transplantation
Authors: Agarwal Jaya , Saju Ansa , Ravindran Greeshma C. , Sudhindran S. 
Published: May 2022

Introduction:
It is pertinent to study the effect of perioperative immunonutrition (IMN) supplementation in adult patients undergoing living donor liver transplantation (LDLT).

Materials and Methods:
A randomised controlled pilot trial was conducted in 20 patients admitted at Amrita Institute of Medical Sciences, Kochi, between November 2018 and January 2019. By means of computer-generated random numbers, 20 patients were allocated to IMN (Pentasure Immunomax® containing omega-3 fatty acids, L-arginine and ribonucleic acid salts) or control (CON; Accumax Advance® which is a standard protein supplement) group in 1:1 ratio. The supplements were provided from pre-operative day 7 and restarted postoperatively as soon as oral intake was resumed for 2 weeks. The primary endpoint was the length of intensive care unit (ICU) and hospital stay. The secondary endpoints included anthropometric measurements (triceps skinfold thickness [TST], mid-upper arm circumference and weight measured on pre-operative day 1 and post-operative day [POD] 30), biochemical parameters (liver function test assessed on pre-operative day 1 and POD 9) and infectious complications.

Results:
Significant improvement in TST from pre-operative day 1 to POD 30 was seen in the IMN group (7.45 ± 5.45–9.20 ± 6.12, P = 0.049) but not in the CON group (5.40 ± 2.27–5.00 ± 3.02, P = 0.438). Weight loss percentage was also lower in IMN in comparison to CON (10.09 ± 6.01 vs. 15.56 ± 4.39, P = 0.050). However, the length of ICU and hospital stay, biochemical parameters and rate of infection were statistically similar in both the groups.

Conclusion:
In patients undergoing LDLT, perioperative IMN supplementation provided enhancement in the anthropometrical parameters, although this did not translate into lesser hospital or ICU stay. A larger sample size will help in providing more insight into the beneficial effects of the IMN supplementation.
Diagnostic Validity of X-rays in Detection of Hollow Viscus Perforation
Authors: Jose Ajay M. , Saanida M. P. , Gopi E. V. 
Published: May 2022

Introduction:
Identification of a small amount of free intra-abdominal gas remains one of the most significant signs in a perforated viscus. This paper tried to evaluate the sensitivity of chest radiographs in the detection of hollow viscus perforation and to compare the sensitivity of left lateral decubitus view and chest radiograph posteroanterior (PA) view in the detection of pneumoperitoneum.

Methodology:
Diagnostic validation study was conducted in sixty patients with clinical signs of peritonitis and strongly suspected to have perforation were evaluated with chest radiograph PA view and left lateral decubitus view in search of pneumoperitoneum and confirmed during laparotomy.

Results:
Out of sixty patients, 54 had gastrointestinal (GI) perforation and 42 out of those 54 were diagnosed in plain chest radiograph. Rest 12 required contrast enhancement computerised tomogam for diagnosis. There was only one case reported with chest radiograph showing pneumoperitoneum and the patient without any breach in the GI tract. Thirty patients with perforation took a left lateral decubitus view which showed free air only in 23 cases.

Conclusion:
Sensitivity of left lateral decubitus was around 76.6%. Overall, the sensitivity of plain chest radiograph in diagnosing perforation was 77% with specificity 83%, positive predicative value 97.6%, negative predicative value 29.4% and an accuracy of 79.6%.
Complications after Total Thyroidectomy According to Clinical and Pathological Diagnosis
Authors: Jyothin C. , Oomen Alex 
Published: May 2022

Introduction:
Total thyroidectomy carries risk of complications. Although mortality is rare, morbidity is still seen.

Objectives:
This study aimed to compare the immediate complications after total thyroidectomy in relation to pathological diagnosis.

Materials and Methods:
This paper studied 170 patients undergoing total thyroidectomy. Post-operative complications were compared according to histopathology.

Results:
Patients were grouped into benign (103), thyroiditis (13) and malignancy (47). Complications included post-operative hypocalcaemia (20%), seroma (2.4%), voice change (11.8%), dysphagia (17.6%) and post-operative haemorrhage (1.2%).

Conclusion:
There was no statistically significant difference in occurrence of complications after total thyroidectomy with respect to clinical and pathological diagnosis.
Comparative Study between Conventional Dressing and Collagen-Based Dressing in Burn Patients
Authors: Kurien Thomas , Muhammed Basheer O. T. 
Published: May 2022

Introduction:
Burn is a devastating emergency with many physical and psychological disabilities, mortality and morbidity. The conventional treatment of burns is by daily washing of wound, removal of dead tissue and saline and silver sulfadiazine dressing till formation of granulation tissue. The current trend has shifted to more holistic approach of improvement in the long-term form and function of the healed wounds and quality of life. This has demanded the emergence of various skin substitutes. The biological skin substitutes may allow the construction of a more natural new dermis and allow excellent re-epithelialisation characteristics due to the presence of a basement membrane. This study aims to compare the efficacy of collagen dressing (a biological dressing) in treating burn wounds with that of conventional dressing materials.

Objectives:
The objective was to study the efficiency of collagen dressing in reducing pain, scar formation and infection in burn patients as compared to conventional dressing.

Methodology:
A comparative study was conducted for a period of 1 year which included 42 cases in burn intensive care unit in a tertiary care hospital on patients admitted with first-degree and second-degree burns covering 10%–50% of total body surface area (BSA). Half of the patients were dressed with collagen dressing and other half received conventional silver sulfadiazine dressing. They were interviewed with series of questions and laboratory parameters were compared. The data obtained were statistically analysed.

Results:
About 43% were male and the rest were female. Majority were in category 3 (31–40 years). Almost 86% were not having any co-morbidities. Majority had category 3 BSA burns (21%–30%). Haemoglobin (Hb) on the 5th day of dressing showed that in patients with collagen dressing, only 9.5% have anaemia, as against 38% anaemic in conventional dressing, which was found statistically significant. About 62% of patients with collagen dressing and 71% of patients with conventional dressing had low albumin value. On comparing both the dressings 52.4% of patients had no pain in collagen dressing and 28.6% of patients had no pain in conventional dressing which is nearly half of collagen dressing. Only 29% of patients developed infection with collagen dressing and 57% of patients developed infection with conventional dressing. Nearly 71% of patients with collagen dressing produced less scar when compared to conventional dressing where 52% developed bad scars.

Conclusion:
Collagen-based dressing is a safe and effective alternative for treating burns. Use of collagen for dressing causes rapid epithelialisation and decreased pain though statistically not significant over conventional dressing. Other advantages of using collagen-based dressing for burn wounds include ready availability commercially; simple storage and application; prevents protein/blood loss through wound and it combats infection.
Revised Atlanta Classification for Acute Pancreatitis – A Pictorial Depiction
Authors: Athikayula Ashwin Raghavendra , Vettuparambil Ajith , Chirukandath Ravindran 
Published: May 2022

Introduction:
There are various classifications for clinical presentation of acute pancreatitis. However, most of them are not standardised.

Aims and Objectives:
The revised Atlanta classification is designed to precisely describe patients with acute pancreatitis, standardise terminology across specialties and help in treatment planning.

Materials and Methods:
The revised Atlanta classification was analysed to describe the features of acute pancreatitis.

Results:
Acute pancreatitis is now divided into two distinct subtypes: necrotising pancreatitis and interstitial oedematous pancreatitis (IEP). Use of the terms such as acute pseudocyst and pancreatic abscess is currently being discouraged. Four distinct collection subtypes are identified based on the presence of pancreatic necrosis and the time elapsed since the onset of pancreatitis which include acute peripancreatic fluid collections, pseudocysts, acute necrotic collections (ANCs) and walled-off necrosis (WON).

Conclusions:
The updates in classification and terminology of local complications have clarified confusing terms from the original Atlanta classification. In this article, we report an image-rich guide to the revised Atlanta classification system to improve stratification of the patients both for clinical care and research.
Neoadjuvant Chemotherapy in Cancer Breast
Authors: Saju Jiya Mulayamkuzhiyi , Krishnakumar K. G. 
Published: May 2022

Introduction:
This observational study attempts to assess the proportion of carcinoma breast patients showing complete pathological response to neoadjuvant chemotherapy post-surgery and to study the factors contributing to complete pathological response.

Subjects and Methods:
This was conducted on 290 female patients with locally advanced breast cancer who underwent neoadjuvant chemotherapy (NACT) followed by surgery in the Department of General Surgery from April 2018 to April 2020. The post-operative histopathological specimen was checked for evidence of pathological complete response (pCR). Statistical analysis was done using SPSS software.

Results:
The proportion of breast cancer patients with pCR following NACT was 18.6% (54 out of 290 patients). Factors found to have a significant association with pCR were the clinical size of tumour, size of lump in mammogram, histological grade of tumour and duration of swelling. Clinical stage, molecular subtype of cancer and age had no significant association with pCR.

Conclusion:
Less advanced tumours i.e., those with clinical and mammogram size ≤5 cm achieved higher pCR than more advanced tumours. Higher histological grade achieved less pCR than histological Grade I tumours. Association could not be elicited between pCR and triple-negative molecular subtype.
Variations in Course of Laryngeal Nerves during Thyroid Surgery
Authors: Mohammed Hafiz , Sukumar Ranjith , Abid Ali K. P. 
Published: May 2022

Introduction:
Recurrent laryngeal nerve (RLN) is routinely exposed and traced during all thyroid surgeries. The refinement in surgical techniques has made recognition of the RLN and the external branch of superior laryngeal nerve (EBSLN) possible during surgery resulting in lesser morbidity.

Aims and Objectives:
The aim of this study is to describe the variations in surgical anatomy of both RLN EBSLN in patients undergoing thyroidectomy and to look for proportion of cases with injury to RLN.

Methodology:
It was a prospective, observational study. The demographic details of the patient, the diagnosis and the surgical findings (variants of EBSLN, branches of RLN and relation of RLN to inferior thyroid artery [ITA]) were recorded. Postoperatively, after 48 h, the vocal cords were assessed by indirect laryngoscopy. The data were analysed using the SPSS software.

Results:
Cernea type 1 is the most common position of external laryngeal nerve (67.8%). The RLN passes posterior to the ITA in 46.5% on the right side and 44.3% on the left side. RLN gives one branch in 69.3% cases. There was no injury to the laryngeal nerves noted during this study.

Conclusion:
Very meticulous dissection helps in identifying the RLN and preserving it. The best way to preserve the RLN nerves is to identify the nerve and preserve them rather than staying away.
Alterations in Liver Function Test Following Laparoscopic Cholecystectomy
Authors: Anand M. Anjin , Maliekal Joji I. 
Published: May 2022

Introduction:
CO2 pneumoperitoneum induced increased intra-abdominal pressure during laparoscopic procedures produces transient reduction in hepatic blood flow liver enzyme elevation.

Aims and Objectives:
The aim of this study is to study the alteration of liver function test (LFT) parameters such as aspartate aminotransferase/serum glutamic-oxaloacetic transaminase (SGOT), alanine-aminotransferase/serum glutamic-pyruvic transaminase (SGPT), alkaline phosphatase (ALP) and serum bilirubin (total and direct) in patients undergoing laparoscopic cholecystectomy.

Materials and Methods:
A prospective, cross-sectional study was conducted. The sample size was 50. Data collected were analysed using the SSPS software version 17.

Results:
Three quarters were females. The mean age of the study population was 48.5 ± 13.1 years, males having higher mean age of 57.0 ± 8.5 years compared to 45.5 ± 13.2 years for females. The SGOT, SGPT, ALP and bilirubin levels were significantly increased on the next day of surgery. There was a significant positive correlation between SGOT and SGPT levels on day 1 to the increased duration of pneumoperitoneum with correlation coefficient of 0.859 and 0.449, respectively. SGOT and SGPT levels were increased significantly in 61–80 years age group.

Conclusion:
The duration of pneumoperitoneum had a great effect on the LFT changes after surgery. Age influenced changes in SGOT and SGPT levels.
Comparative Study on Outcome of Thyroidectomy with and Without Placement of Drain
Authors: Rahim D. Thahzina , Salim J. Muhammed 
Published: May 2022

Background:
Many surgeons routinely use drains after thyroidectomy. The present study aimed to analyse and compare the immediate post-operative outcome in patients undergoing total thyroidectomy with and without placement of drain.

Materials and Methods:
A comparative observational study was conducted in 30 patients who underwent total thyroidectomy. They were randomly allocated to drain and no drain group post-operatively, with 15 subjects in each group, and the immediate post-operative outcome was assessed on day 0, day 1 and day 3 post-operatively, based on five parameters – post-operative pain, duration of hospital stay, haematoma formation, seroma formation and wound infection. The results were analysed statistically with Chi-square test and Mann–Whitney U test.

Results and Discussion:
Mean age of the participants was 36.07. All were females. There was association between post-operative pain and placement of drain, pain being less in participants without drain. Post-operative drain had no added advantage in preventing haematoma. None of the study subjects developed wound infection following thyroidectomy in any of the categories. There was a significant statistical association between the two groups based on hospital stay, and patients without drain were discharged earlier when compared to the patients with drain.

Conclusion:
Routine drain placement after thyroid surgery is not necessary, as thyroid surgery without the drain decreased the length of hospital stay without increasing patient morbidity. Placing of drain increased post-operative pain significantly.
Intraperitoneal Saline Instillation in Reducing Shoulder Tip Pain after Laparoscopic Surgeries
Authors: Anjali R. , Salim J. Muhammed 
Published: May 2022

Introduction:
The incidence of shoulder pain after laparoscopic surgery ranges from 35 to 80%.

Objectives:
The objective of the study was to find the proportion of shoulder tip pain after laparoscopic surgeries with and without intraperitoneal subdiaphragmatic saline instillation and to compare the frequency of post-operative analgesics usage in both groups.

Methods:
A longitudinal comparative study was conducted on 56 patients undergoing laparoscopic surgeries. Twenty-eight subjects in the study group received intraperitoneal subdiaphragmatic saline wash at the end of the procedure and the control group received no wash. Post-operative shoulder pain was assessed by a visual analogue scale at fixed time intervals. Post-operative use of analgesics, length of stay in the hospital and early mobilisation and discharge from the hospital were also considered.

Results and Discussion:
Among the 56 patients, there was a statistically significant reduction in the shoulder tip pain postoperatively at 6, 12, 24 and 48 h. Additional analgesic requirement was less in the Wash group, statistically significant at 6, 12, 24 and 48 h post surgery. This significance in outcome was also reflected in the length of the hospital stay, smooth recovery, early discharge, better quality of life and early return to work.

Conclusion:
Intraperitoneal subdiaphragmatic normal saline wash significantly improved the surgical outcome after laparoscopic surgery by diminishing the shoulder tip pain, minimising analgesic requirements in the post-operative period, thus enhancing early mobilisation and discharge.
Hybrid Surgery in Hernias
Authors: Pai Madhukara , Padmakumar R. , Subin Premna 
Published: May 2022

Introduction:
Hybrid surgery is a procedure in which laparoscopic and open surgical steps are used for a better outcome to the patient. The aim of this study is to identify the factors that necessitated hybrid surgery in cases of hernia.

Materials and Methods:
It is a retrospective narrative study of 69 patients with hernia, who underwent hybrid surgery. Deciding factors and outcomes were analysed.

Results:
Of the 69 cases, 32 were open surgery followed by laparoscopy (OL)/open surgery followed by laparoscopy and then by open surgery again (OLO) and 37 were laparoscopy followed by open surgery (LO)/laparoscopy followed by open surgery and then by laparoscopy once more (LOL). Incorporating laparoscopic steps during open surgery helped in combining multiple surgeries, intra-abdominal adhesiolysis, etc., without enlarging the incision. Open surgical steps incorporated during laparoscopy, helped in reduction of irreducible hernia, darning of defects from outside, etc., Ventral hernia with apron and need for combining other surgeries had an association with OLO (P < 0.001). Inguinal hernia or ventral hernia without apron, irreducibility and need for omentectomy had an association with LO/LOL (P < 0.001). Factors having statistically significant association with sandwich repair were large defect size, multiple previous open surgeries, presence of precipitating factors and recurrent hernias.

Conclusion:
Hybrid surgery offers definite benefits in select cases of hernias. Case-to-case planning is needed preoperatively and should be based on the difficulties anticipated. It will help the surgeon perform a safe procedure.
Evaluation of Cardiovascular Biomarkers and Lipid Regulation in Lactation Friesian Holstein at Different Altitude in West Java, Indonesia
Authors: Tanuwiria Ujang Hidayat , Susilawati Iin , Tasripin Didin , Salman Lia Budimulyati , Mushawwir Andi 
Published: May 2022

Altitude contributes and plays an important role in the development dairy cows in Indonesia. Altitude is directly related to temperature and humidity, both of which affect cardiovascular function and energy metabolism in dairy cattle. The 120 samples, consisted of 4th-5th lactation Friesian Holstein dairy cows were used in this study. The 40 samples of cattle each spread in three maintenance sites with different altitudes, namely 300 to 500 m above sea level (a.s.l.); 600-900 m a.s.l. and >1,000 m a.s.l. All the study sites located in West Java, Indonesia, to study the effect of altitude on the cardiovascular biomarker and lipid regulation in the dairy cow. Based on the result in this experiment showed that the CRP high sensitivity, H-FABP, homocysteine, and γ-Glutamyl Transpeptidase in Frisian Holstein dairy cows expressed higher levels (P <0.05) at low altitude site (300-500 m a.s.l.) than dairy cows at altitude sites higher (600-900 and >1,000 m a.s.l.), These results indicated, these compounds can be biomarkers for cardiovascular function. This study also showed, the lipid regulation also showed higher levels (P <0.05) at low altitude sites than altitude sites higher.
Gynura procumbens Adventitious Root Extract Altered Expression of Antioxidant Genes and Exert Hepatoprotective Effects Against Cadmium-Induced Oxidative Stress in Mice
Authors: Sugiharto  , Winarni Dwi , Wibowo Anjar Tri , Islamatasya Ufairanisa , Bhakti Idqa Nurtri , Nisa Nabilatun , Tan Boon Chin , Manuhara Yosephine Sri Wulan 
Published: May 2022

Exposure to cadmium (Cd) could increase of reactive oxygen species (ROS) and changes in expression of antioxidant genes. Gynura procumbens is a medicinal plant that is rich in phenolic and flavonoid compounds. The aimed of study to evaluate the hepatoprotective effect of G. procumbens adventitious root (GAR) extract against Cd toxicity, especially expression rate of hepatic antioxidant genes. Twenty-five male mice were treated as follows: P1 (control), P2 (Cd100mg/L), P3 (GAR100mg/L + Cd100mg/L), P4 (GAR200mg/L + Cd100mg/L), and P5 (GAR300mg/L + Cd100mg/L). The samples (blood and liver) were collected for analysis of malondialdehyde (MDA) levels, superoxide dismutase (SOD) and catalase (CAT) activities, and their relative gene expression were determined. The hematological assay showed Cd-treated administered with GAR extract increased the number of red blood cells (RBC), haemoglobin concentration (HGB), hematocrit (HCT), mean corpuscular volume (MCV), and mean corpuscular haemoglobin (MCH), but reduced the level of alanine aminotransferase (ALT) and aspartate aminotransferase (AST). In addition, the GAR extract decreased the MDA production, but increased the activities of SOD and CAT. These enzymatic activities were positively correlated with their respective gene transcripts. Our study revealed that GAR extract administration showed marked hepatoprotective effects against Cd-induced oxidative stress.