bluuebunny/crossref_metadata_2025_split huggingface dataset:
Incidence and Outcome of Anaphylaxis in Cardiac Surgical Patients
Authors: Norawat Rahul , Vohra Akbar , Parkes Andrew , O’Keeffe Niall J. , Anipindi Sujata , Maybauer Marc O. 
Published: July 2022

ABSTRACT

Introduction:
Anaphylaxis is a rare but serious and potentially fatal complication of anesthesia. Little is known about the incidence and outcome of anaphylaxis in cardiac surgical patients, which we aimed to investigate.

Methods:
This was a 21-year retrospective study of cardiac surgical patients at Manchester Royal Infirmary, Manchester Foundation Trust, Manchester, UK.

Results:
A total of 19 cases of anaphylaxis were reported among 17,589 patients (0.108%) undergoing cardiac surgery. The majority (15/19) occurred before cardiopulmonary bypass (CPB), mostly during or within 30 min after the induction of anesthesia (10/19). Two occurred within 15 min of going onto CPB. Of these 17 cases, 11 were abandoned, and 6 proceeded. The severity of reactions in the patients who proceeded ranged from grade II to grade IV of the Ring and Messmer classification. Two cases occurred after the completion of surgery. All patients survived to 90 days. However, this did not appear to be related to CPB or protamine as most of the reactions occurred before CPB. Instead, the most common causative agents were gelofusine, antibiotics, muscle relaxants, and chlorhexidine. In 6 cases, surgery proceeded despite the anaphylaxis, in 11 cases the surgery was postponed, and in 2 cases the procedure had already been completed.

Conclusion:
As all patients survived, our results provide preliminary support for proceeding with surgery although we cannot speculate on the likely outcomes of patients who were postponed, had their surgery proceeded. Based on our data, the incidence of anaphylaxis in cardiac surgical patients may be 10–20 times higher than in the general surgical population.
Comparative Study of Cardiac Output Measurement by Regional Impedance Cardiography and Thermodilution Method in Patients Undergoing off Pump Coronary Artery Bypass Graft Surgery
Authors: Guha Amrita , Arora Dheeraj , Mehta Yatin 
Published: July 2022

ABSTRACT

Background:
An ideal CO monitor should be noninvasive, cost effective, reproducible, reliable during various physiological states. Limited literature is available regarding the noninvasive CO monitoring in open chest surgeries.

Aim:
The aim of this study was to compare the CO measurement by Regional Impedance Cardiography (RIC) and Thermodilution (TD) method in patients undergoing off pump coronary artery bypass graft surgery (OPCAB).

Settings and Design:
We conducted a prospective observational comparative study of CO measurement by the noninvasive RIC method using the NICaS Hemodynamic Navigator system and the gold standard TD method using pulmonary artery catheter in patients undergoing OPCAB. A total of 150 data pair from the two CO monitoring techniques were taken from 15 patients between 40-70 years at various predefined time intervals of the surgery.

Patients and Methods:
We have tried to find out the accuracy, precision and cost effectiveness of the newer RIC technique. Mean CO, bias and precision were compared for each pair i.e. TD-CO and RIC-CO as recommended by Bland and Altman. The Sensitivity and specificity of cutoff value to predict change in TD-CO was used to create a Receiver operating characteristic or ROC curve.

Results:
Mean TD-CO values were around 4.52 ± 1.09 L/min, while mean RIC- CO values were around 4.77± 1.84 L/min. The difference in CO change was found to be statistically not significant (p value 0.667). The bias was small (-0.25). The Bland Altman plot revealed a mean difference of -0.25 litres. The RIC method had a sensitivity of 55.56 % and specificity of 33.33 % in predicting 15% change in CO of TD method and the total diagnostic accuracy was 46.67%.

Conclusion:
A fair correlation was found between the two techniques. The RIC method may be considered as a promising noninvasive, potentially low cost alternative to the TD technique of hemodynamic measurement.
Effect of Perioperative Use of Oral Triidothyronine for Infants Undergoing Complex Congenital Cardiac Surgeries Under Cardiopulmonary Bypass
Authors: Karri Sujithareddy , Mandal Banashree , Kumar Bhupesh , Puri Goverdandutt , Thingnam Shyam , Kumar Hemant , Unnikrishnan VS 
Published: July 2022

ABSTRACT

Background:
Thyroid hormone metabolism disrupts after cardiopulmonary bypass both in adults and pediatric patients. This is known as Euthyroid sick syndrome, and it is more evident in pediatric patients who were undergoing complex cardiac surgeries compared to adults. This decrease in serum T3 levels increases the incidence of low cardiac output, requirement of inotropes, prolonged mechanical ventilation, and prolonged intensive care unit (ICU) stay.

Aims and Objectives:
The primary objective was to compare the mean Vasoactive-inotropic score (VIS) at 72 hours postoperatively between T3 and Placebo groups.

Materials and Methods:
One hundred patients were screened, and 88 patients were included in the study. Triidothyronine 1 mic/kg 10 doses 8th hourly was given orally postoperatively to cases and sugar sachets to controls. The blood samples for analysis of FT3, FT4, and TSH were taken every 24 hours postoperatively, and baseline values were taken after induction. Mean VIS scores, ejection Fraction (EF), Left ventricular outflow tract velocity time integral (LVOT VTi), hemodynamics and partial pressure of oxygen/ fraction of inspired oxygen(PaO2/FiO2) were recorded daily.

Results:
The Mean VIS scores at 72 Hours postoperatively were significantly less in the T3 group (5.49 ± 6.2) compared to the Placebo group (13.6 ± 11.7). The PaO2/FiO2 ratios were comparatively more in the T3 group than the Placebo group. The serum levels of FT3 FT4 were significantly higher in the T3-supplemented group than the Placebo group. The VIS scores were significantly lower from 48 hours postoperatively in children < 6 months of age.

Conclusion:
In this study, we observed that supplementing T3 postoperatively decreases the ionotropic requirement from 72 hours postoperatively. This is more useful in children <6 months of age undergoing complex cardiac surgeries.
Is Continuous Erector Spinae Plane Block (ESPB) Better than Continuous Serratus Anterior Plane Block (SAPB) for Mitral Valve Surgery via Mini-Thoracotomy? Results from a Prospective Observational Study
Authors: Toscano Antonio , Capuano Paolo , Costamagna Andrea , Canavosio Federico G. , Ferrero Daniele , Alessandrini Elisabetta M. , Giunta Matteo , Rinaldi Mauro , Brazzi Luca 
Published: July 2022

ABSTRACT

Aims:
Chest wall blocks are effective alternatives for postoperative pain control in mitral valve surgery in right mini-thoracotomy (mini-MVS). We compared the efficacy of Serratus Anterior plane block (SAPB) and Erector Spinae plane block (ESPB) on postoperative pain relief after mini-MVS.

Settings and Design:
It is a prospective, observational study.

Material and Methods:
A total of 85 consecutive patients undergoing continuous SAPB and continuous ESPB for mini-MVS from March 2019 to October 2020 were included. The primary outcome was the assessment of postoperative pain evaluated as absolute value of NRS at 12, 24 and 48 h. Secondary outcomes were assessment of salvage analgesia (both opioids and NSAIDs), incidence of mild adverse effects (i.e. nausea, vomiting, and incorrect catheter placement) and timing of postoperative course (ICU and hospital length of stay, duration of mechanical ventilation, ventilator-free days).

Results:
The median NRS was 0.00 (0.00–3.00) at 12 h and 0.00 (0.00–2.00) at 24 and 48 h. No significant differences were observed between groups. Postoperative morphine consumption in the first 24 h was similar in both groups (P = 0.76), whereas between 24 and 48 h was significantly less in the ESPB group compared with SAPB group, P = 0.013. NSAIDs median consumption and Metoclopramide consumption were significantly lower in the ESPB group compared to SAPB group (P = 0.002 and P = 0.048, respectively).

Conclusions:
ESPB, even more than SAPB, appears to be a feasible and effective strategy for the management of postoperative pain, allowing good quality analgesia with low consumption of opioids, NSAIDs and antiemetic drugs.
Preoperative Anxiety Among Cardiac Surgery Patients and Its Impact on Major Adverse Cardiac Events and Mortality– A Randomized, Parallel-Group Study
Authors: Mudgalkar Nikhil , Kandi Venkataramana , Baviskar Aashish , Kasturi Ravinder Reddy , Bandurapalli Bindusha 
Published: July 2022

ABSTRACT

Background:
Patients undergoing elective cardiac surgery often experience pre-operative anxiety. Preoperative anxiety influences surgical outcome. There are very few studies which have assessed the impact of clonidine and Gabapentin in the treatment of anxiety especially in Indian populations and its implications on major adverse cardiac events (MACE) and 30 days mortality.

Materials and Methods:
Adult patients aged 18 to 80 years old who were scheduled to have an elective coronary artery by-pass graft (CABG) were included in the study. Those who satisfied the inclusion criteria were given either Gabapentin (800 mg) or Clonidine (300 mcg) 90-120 minutes before the induction. State trait anxiety inventory (STAI) was used to assess anxiety in baseline and taking just before operating room. The primary endpoint was a reduction in the STAI associated with the study drug, while the secondary endpoint was the incidence of MACE in the perioperative period (30 days), which included composite episodes of non-fatal cardiac arrest, chaotic rhythm, acute myocardial infarction, congestive heart failure, cardiac arrhythmia, angina, and death.

Results:
A total of 75 patients were considered for the statistical analysis. The demographic and clinical features of the study participants were similar in both groups. Nearly 75-80% of participants had severe anxiety in the preoperative period while 10-20% had moderate anxiety. While both the drugs showed a reduction in the anxiety levels, the clonidine group fared better (statistically insignificant). The incidence of MACE was similar in both groups.

Conclusion:
The preoperative anxiety levels were high among cardiac surgery patients. Both clonidine and gabapentin were equally effective in reducing the levels of preoperative anxiety. Preoperative STAI scores in the range of 32-53 is not associated with MACE and 30-day mortality among cardiac surgery patients.
Perioperative Cardiovascular Outcome in Patients with Coronary Artery Disease Undergoing Major Vascular Surgery
Authors: Thomas Diana , Sharmila S , Babu MS Saravana , Raman Suneel Puthuvassery , Gadhinglajkar Shrinivas Vitthal , Koshy Thomas 
Published: July 2022

ABSTRACT

Background:
Major adverse cardiac events (MACE) are a major contributor to morbidity and mortality in patients undergoing major vascular surgeries. We aim to assess the incidence, risk factors, and outcome of MACE in patients with coronary artery disease (CAD) undergoing aortic surgeries.

Methods:
In this retrospective observational study, we included patients with CAD who underwent elective major vascular surgery, namely, thoracoabdominal aortic aneurysm repairs and vascular bypass surgeries for aorto-occlusive disease, in our institute from January 2010 to December 2019. The association of preoperative risk factors including revised cardiac risk index factors, functional status of patients, severity of CAD, and its treatment status and technique of anesthesia with occurrence of MACE was analyzed.

Results:
Medical records of 141 patients were studied. The incidence of perioperative MACE was 11.3% (16/141) and overall in-hospital mortality was 6.4% (9/141), all of them related to MACE; implicating a 56.2% mortality in patients who develop MACE. The odds of a patient who had undergone preoperative coronary revascularization to develop a MACE was higher than a nonrevascularized patient (odds ratio: 3.9; 95% confidence interval [CI], 1.34–11.34). There was found to be no benefit in the addition of epidural analgesia to general anesthesia in reducing perioperative MACE.

Conclusions:
Major vascular surgeries in patients with CAD are a highly morbid procedure and a perioperative MACE places them at a significantly high risk of mortality. Early detection of CAD and preoperative medical optimization can play a major role in reducing the risk of MACE.
Fecal Microbiota in Inflammatory Bowel Disease
Authors: Premkumar Kalpana , Ramadass Balamurugan , Ramakrishna Balakrishnan S. 
Published: July 2022

Background:
Diversity of microbial species is a hallmark of dysbiosis in inflammatory bowel disease (IBD). This study was undertaken to determine whether the diversity of lactobacilli and bifidobacteria, two regulatory microbial genera, is altered in patients with IBD.

Methods:
DNA from fecal samples of 20 healthy volunteers, 20 patients with ulcerative colitis (UC), and 25 patients with Crohn's disease (CD) was amplified by the polymerase chain reaction (PCR) for 16S ribosomal RNA gene sequences specific to genus Lactobacillus and Bifidobacterium. Real-time PCR was done to quantitate bacterial abundance. Amplified DNA was also bar coded and sequenced on the Roche 454 platform. Individual operational taxonomic units (OTUs) were taken as sequences with at least 97% similarity.

Results:
Abundance of Lactobacillus was significantly increased in UC compared to controls; no other difference in Lactobacillus or Bifidobacterium abundance was found between the three groups. Median reads for genus Lactobacillus was similar between control (940), UC (994), and CD (960) groups. The median number of OTUs per sample was not significantly different between controls (6), UC (5.5) and CD (7). The Shannon index of community diversity was similar between controls (median 1.12), UC (median 1.13) and CD (median 1.11). The Simpson D index was also similar between controls (median 0.393), UC (median 0.439) and CD (median 0.409). Median reads for genus Bifidobacterium was similar between control (846), UC (1052), and CD (964) groups. The median number of Bifidobacteria OTUs per sample was similar for controls (6), UC (7) and CD (8.5). The Shannon index of community diversity was similar between controls (median 0.75), UC (median 1.0) and CD (median 1.14). The Simpson D index was also similar between controls (median 0.570), UC (median 0.422) and CD (median 0.409).

Conclusion:
The abundance of Lactobacillus was increased in UC. Diversity of genus Lactobacillus and Bifidobacterium was not altered in either UC or CD.
A Comparison of Clinical Profile and Treatment Outcomes of Phacomorphic and Phacolytic Glaucoma in a Tertiary Eye Care Hospital of India
Authors: Khan Sardar , Roy Avik Kumar , Rao Aparna 
Published: July 2022

Abstract

Objective:
To compare the clinical features, and treatment outcomes of phacomorphic glaucoma (PMG) versus phacolytic glaucoma (PLG) in a tertiary care eye hospital in India.

Methods:
A retrospective review of electronic medical record data of all patients operated for phacolytic and PMGs, between March 2013 and March 2020, was performed. Patients with a history of trauma pre-existing glaucoma or who were blind at presentation were excluded. Patients’ demographic data, clinical features, visual and surgical outcomes were analyzed.

Results:
There were 78 and 86 eyes with a mean age of 69.0 and 70.3 years for PMG and PLG, respectively. Time from onset of symptoms to presentation in the clinic was longer in PMG group of patients (30.7 ± 53.2 days) compared to the PLG group (15 ± 17.5 days). Visual acuities and/or intraocular pressures (IOPs) at presentation were comparable in the two groups. Corneal decompensation or scarring was 3.8% in PMG versus 2.8% in PLG. About 24.4% patients in PMG group were initially misdiagnosed and treated as either primary open angle or closed angle glaucoma, whereas there was no misdiagnosis in the PLG group. Small incisional cataract surgery (SICS) with posterior chamber intraocular lens implantation was performed in 65.4% of phacomorphic and 68.6% of phacolytic groups. Combined cataract and trabeculectomy were carried out in 8.9% of phacomorphic and 4.6% of phacolytic. Vitrectomy was required in 17.9% in phacomorphic and 12.8% in PLG, statistically significant improvement in overall mean logMAR visual acuity improved from 1.5 to 1.4, and IOP reduced by 53% by postoperative 1 week.

Conclusion:
Both PMG and PLG respond favorably to standard SICS, irrespective of their duration of symptoms. The final visual acuity gain and control of IOPs were comparable in the two groups.
Assessment of Retinal Nerve Fiber Layer Thickness in Nigerian Adults Using Spectral-Domain Optical Coherence Tomography
Authors: Daromosu Habibat Y. , Babalola Olufemi E. , Morgan Regina E. , Adewara Bolajoko A. 
Published: July 2022

Abstract

Objective:
To measure the circumpapillary retinal nerve fiber layer (RNFL) thickness in normal eyes of Nigerian adults using spectral-domain optical coherence tomography (SD-OCT).

Materials and methods:
This was a cross-sectional study of normal eyes of Nigerian adults between July and September 2016 at the eye clinic of a tertiary hospital in Nigeria. Sociodemographic data, clinical history, and examination findings were obtained. Dipstick urinalysis and blood pressure measurements were performed. Circumpapillary RNFL thickness was measured with the Topcon 3D OCT-1 Maestro version 8.30 (Topcon Medical Systems, Inc., Oakland, NJ, USA), using the 3D optic nerve head analysis. Data were analyzed using the International Business Machine (IBM) Statistical Package for the Social Sciences (SPSS) Statistics, version 25.0 (IBM Corp., Armonk, NY, USA) and the level of significance was set at P ≤ 0.05.

Results:
The study included 120 participants (240 eyes) with an age range of 18 to 53 years and a mean age of 34.06 ± 7.64 years. There were 59 (49.17%) males and 61 (50.83%) females. The average RNFL thickness in the right and left eyes was 112.26 ± 9.6 and 110.53 ± 9.14 μm, respectively. The average RNFL thickness for the Igbo ethnic group was 117.5 ± 7.69 and 115.04 ± 7.18 μm in the right and left eyes, respectively. The mean RNFL thickness for the inferior, superior, nasal, and temporal quadrants was 148.92 ± 15.77, 142.59 ± 16.48, 85.3 ± 15.39, and 71.89 ± 9.35 μm in the right eyes and 149.28 ± 16.03, 141.69 ± 13.33, 81.82 ± 13.59, and 68.8 ± 10.17 μm in the left eyes, respectively.

Conclusion:
This study showed the normal circumpapillary RNFL thickness values in Nigerian adults using SD-OCT. There were variations based on ethnicity that suggest it may be important to use ethnic-specific benchmarks when interpreting OCT results for the management of glaucoma.
How has COVID-19 affected dentistry practice? The perspective of future changes in a comprehensive literature review
Authors: Soheilifar Sanaz , Soheilifar Sara , Fahimipour Farahnaz , Soheilifar Jafar , Soheilifar Sepideh , Bidgoli Mohsen , Ghaedi Fatemeh Baharak 
Published: July 2022

Background:
During the early stages of the COVID-19 pandemic, new guidelines were provided for dental offices to prevent the disease transmission. Dentists suffered a lot of financial and psychological damage as a result of the pandemic.

Aim:
In this article, the authors reviewed the guidelines provided by the Centers for Disease Control (CDC) and the prevalence of the disease among dentists and their patients, COVID-19 vaccination, emerging new variants of the virus, and future perspective.

Methods:
PubMed, Scopus, Embase, Web of Science, and Cochrane databases were used to find the publications published from December 2019 to the end of December 2021, discussing the challenges that dentists encountered in the COVID-19 pandemic. Interventional, observational, and review articles in any language were included. The contents were analyzed, and results of the original papers were obtained.

Results:
A total of 94 articles were found through electronic and hand searching. From them, 59 studies were excluded and 35 fulfilled the inclusion criteria. Publications on the prevalence of COVID-19 cross-infection in dental settings reported a low incidence of the disease while adhering to the CDC guidelines.

Conclusion:
This shows that the special precautions released for the preventive transmission of COVID-19 in dental clinics are effective measures and while high transmissible variants are circulating in the populations, the guidelines should be followed by dental health-care workers, even in communities with high vaccination rates.
New Genotypes and Diversity of Orientia tsutsugamushi DNA samples from Patients with Scrub Typhus in South Korea as Determined by Multilocus Sequence Typing
Authors: Hwang Joo-Hee , Kim Jeongsik , Sun In O. , Lee Tae Hee , Chung Kyung Min , Lee Chang-Seop 
Published: July 2022

ABSTRACT.
Orientia tsutsugamushi, an obligate intracellular organism, is the causative agent of scrub typhus. Multilocus sequence typing (MLST) is a genetic typing method that provides a unified bacterial isolate characterization approach. However, there are no comparative studies in South Korea on the genotypic properties of O. tsutsugamushi based on MLST. To conduct a comparative analysis with previous data collected from Thailand, Laos, and Japan, we investigated the genetic diversity of O. tsutsugamushi from 51 patients with scrub typhus in South Korea by using MLST. The MLST analysis revealed 10 new alleles in the housekeeping genes: gpsA, n = 2; mdh, n = 1; nrdB, n = 1; nuoF, n = 1; ppdK, n = 1; sucB, n = 2; and sucD, n = 2. These novel alleles led to the assignment of six new sequence types (STs) (ST93–98). The 51 samples corresponded to seven different STs (ST48 and ST93–98), with ST48 accounting for the largest proportion (49.0%) of O. tsutsugamushi STs in South Korea. Interestingly, O. tsutsugamushi from patients with scrub typhus in South Korea were clustered in two different clades, and the five Korean STs (ST48, ST93, ST94, ST95, and ST98) were close genetically to ST80, which was isolated from Laos. The remaining two STs (ST96 and ST97) were close genetically to ST49 (Ikeda, Japan). Overall, our results suggest that the relative genetic stability and the clonal populations of O. tsutsugamushi strains in South Korea have remained mostly conserved.
Call for Consensus in the Evaluation of Circulating Matrix Metalloproteinases in Chagas Disease
Authors: Bautista-López Norma L. , Schulz Richard 
Published: July 2022

ABSTRACT.
Infection with the Trypanosoma cruzi parasite is endemic in parts of America. Approximately 30% of people infected develop Chagas cardiomyopathy, the most common cause of heart failure in these regions. No suitable biomarker that reflects the evolution of the disease has been widely accepted as of yet. There is substantial evidence, however, of a strong inflammatory reaction following infection with T. cruzi that could activate matrix metalloproteinases (MMPs). Emerging research suggests the involvement of MMPs in Chagas cardiomyopathy and there is a growing interest in measuring the blood levels of MMPs as diagnostic and/or prognostic indicators of heart damage in Chagas patients. This perspective discusses the lack of consensus on the best method for MMP evaluation. Some studies are based on MMP concentrations and activities in serum whereas others use plasma. We believe that these different methods of evaluation have led to incongruent and poorly comparable data on the blood levels of MMPs in Chagas patients. A standard for the preparation of blood samples needs to be adopted for the study of MMPs as markers of Chagas cardiomyopathy to ensure better comparability of research results.