bluuebunny/crossref_metadata_2025_split huggingface dataset:
Subir les effets non voulus de notre action sur la nature
Authors: Malinge Yoann 
Published: October 2022

Face à l’épidémie de SARS-CoV-2, chacun d’entre nous se trouve démuni, faute de comprendre les causes réelles de cet événement. En utilisant des concepts issus de la philosophie de Sartre, cet article propose de mettre au jour les causes de l’épidémie à partir des actions collectives qui ont conduit au passage de la « barrière des espèces ». Ce faisant, il s’agit d’interroger les effets subis et non voulus de nos propres actions. Plutôt que de tenir pour responsables les premières victimes de l’épidémie, il faut se demander comment il serait possible de neutraliser les causes de l’épidémie. L’action collective apparaît alors non plus comme le problème mais comme la solution.
Entretenir, réparer, augmenter : trois visions du soin et de la médecine
Authors: Svandra Philippe 
Published: October 2022

Nous soutiendrons dans cet article qu’il existe une différence profonde de nature, et pas seulement de degré, entre les actions qui visent à l’entretien de la vie (« care ») ou à la réparation des hommes (« cure ») et celles qui se proposent d’augmenter le potentiel humain. Quand les deux premières cherchent à aider les humains tels qu’ils sont à mieux supporter les divers maux qui les accablent, la troisième vise à rendre possible l’émergence d’un homme nouveau, non pas réparé mais augmenté. Il faut cependant remarquer que ces trois approches partent paradoxalement du même constat : le caractère fondamentalement vulnérable de l’existence humaine.
A Systems Approach to Logistics
Authors: Dekker R. , Van den Berg P. H. 
Published: October 2022

In hierdie artikel word Logistiek as 'n stelsel benader en daar word gepoog om die interverwantskappe tussen die individuele aktiwiteite te identifiseer. Die stelsel wat in hierdie artikel bespreek word moet as 'n verwysingsraamwerk gesien word waarbinne elke firma sy eie behoeftes en stelsel kan definieer. Die eienskappe van 'n logistiese stelsel asook die verwantskappe tussen aktiwiteite word behandel.
Post-Cardiopulmonary Bypass Longitudinal Strain provides Higher Prognostic Ability than Baseline Strain or Change in Strain
Authors: Wakefield Brett J. , Artis Amanda S. , Alfirevic Andrej , Sale Shiva , Duncan Andra E. 
Published: October 2022

ABSTRACT

Context:
Global longitudinal strain (GLS) measured by speckle-tracking echocardiography demonstrates excellent prognostic ability in predicting major adverse cardiac events after cardiac surgery. However, the optimal timing of intraoperative GLS measurement that provides the best prognostic value is unclear.

Aim:
Our goal was to evaluate whether GLS measured prior to cardiopulmonary bypass (pre-CPB GLS), following CPB (post-CPB GLS), or change in GLS provides the strongest association with postoperative complications.

Setting and Design:
Post hoc analysis of prospectively collected data from a clinical trial (NCT01187329). 72 patients with aortic stenosis undergoing elective AVR ± coronary artery bypass grafting between January 2011 and August 2013.

Material and Methods:
Myocardial deformation analysis from standardized transesophageal echocardiographic examinations were performed after anesthetic induction and chest closure. We evaluated the association between pre-CPB GLS, post-CPB GLS, and change in GLS (percent change from pre-CPB baseline) with postoperative atrial fibrillation and hospitalization >7 days. The association of post-CPB GLS with duration of mechanical ventilation, N-terminal pro-BNP (NT-proBNP) and troponin T were also assessed.

Statistical Analysis:
Multivariable logistic regression.

Results:
Risk-adjusted odds (OR[97.5%CI] of prolonged hospitalization increased an estimated 27% (1.27[1.01 to 1.59];Padj=0.035) per 1% decrease in absolute post-CPB GLS. Mean[98.3%CI] NT-proBNP increased 98.4[20 to 177]pg/mL; Padj=0.008), per 1% decrease in post-CPB GLS. Pre-CPB GLS or change in GLS were not associated with any outcomes.

Conclusions:
Post-CPB GLS provides the best prognostic value in predicting postoperative outcomes. Measuring post-CPB GLS may improve risk stratification and assist in future study design and patient outcome research.
Patent Vertical Vein Device Closure
Authors: Bhosale Pankaj P. , Chokhandre Manish , Prassana Salvi 
Published: October 2022

ABSTRACT
We present the peri-procedural anesthetic management in a case of transcatheter closure of an unligated patent vertical vein (VV) in a 2-year-old male child operated case of obstructed supra cardiac total anomalous pulmonary venous connection (TAPVC) who presented with significant left to right shunt causing symptoms of right heart failure. The procedure was carried out successfully under deep sedation and monitored anesthesia care (MAC) and had some specific clinical implications from the anesthetic management perspective which are highlighted and discussed in this report.
Perioperative Dexmedetomidine Reduces Delirium after Coronary Artery Bypass Graft Surgery
Authors: Singh Ajmer , Garg Vinit , Mehta Yatin , Bhan Anil , Trehan Naresh 
Published: October 2022

ABSTRACT

Background:
Delirium is a commonly seen complication of cardiac surgery. Dexmedetomidine, by its anti-inflammatory properties and other effects, can attenuate postoperative delirium.

Aims:
The aim of this work was to study the incidence of delirium after coronary artery bypass graft surgery, and to compare the effects of dexmedetomidine and propofol on the incidence of postoperative delirium in coronary artery bypass graft surgery patients.

Materials and Methods:
A prospective, observational study was conducted on 180 consecutive patients undergoing off-pump or on-pump coronary artery bypass graft surgery. The patients were administered either intravenous dexmedetomidine (n = 90) or propofol (n = 90) after hemostasis was achieved, till they were ready for weaning from the ventilator. The Confusion Assessment Method was used to assess the incidence of postoperative delirium.

Measurements and Main Results:
A total of 25 (13.8%) patients developed delirium after coronary artery bypass graft surgery. Sedation with dexmedetomidine was associated with a significantly reduced incidence of postoperative delirium (8.9% v 18.9% propofol, P = 0.049). Subgroup analyses showed reduced incidence of postoperative delirium in off-pump patients compared to on-pump coronary artery bypass graft patients (3.3% vs. 20%, P = 0.009 dexmedetomidine group and 11.6% vs. 33.3%, P = 0.047 propofol group respectively). The mean age of the patients who had delirium was significantly more (64.9 ± 8.1 years vs. 52.5 ± 5.8 years, P = 0.046) compared to those who did not have delirium.

Conclusion:
Administration of dexmedetomidine-based sedation resulted in the reduced incidence of postoperative delirium compared to propofol-based sedation in patients after coronary artery bypass graft surgery.
Measures to Improve In-Hospital Outcomes of Patients Undergoing Surgical Repair for Anomalous Origin of Left Coronary Artery from Pulmonary Artery
Authors: Shukla Kamayani , Surti Jigar , Dubey Gajendra , Mishra Amit , Gajjar Trushar , Jain Imelda , Pandya Himani 
Published: October 2022

ABSTRACT

Background:
Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital anomaly leading to progressive left ventricular dysfunction and mitral regurgitation. We conducted this study to investigate various measures to optimize the outcomes of surgical correction for ALCAPA.

Materials And Methods:
This was a single-centre, retrospective, observational study including consecutive patients operated for ALCAPA. The main outcomes evaluated were in-hospital mortality, duration of mechanical ventilation, and duration of intensive care unit (ICU) stay. Independent sample t- test and Fisher's exact test were used for the analysis of continuous and categorical variables respectively.

Results:
31 patients underwent surgical correction for ALCAPA during the study duration. The median age was 7.3 months with a range of 21 days to 25 months. All patients underwent coronary re-implantation with the coronary button transfer technique. There was no in-hospital mortality, the mean duration of mechanical ventilation and ICU stay was 117.6 hours and 10.7 days respectively. Age at admission, development of acute kidney injury after surgery, lactate levels at 12- and 24-hours post-surgery, and heart rate at ICU admission and 12-hours post-surgery were significantly associated with mechanical ventilation duration longer than 48 hours. Use of a combination of levosimendan and milrinone and elective intermittent nasal continuous positive airway pressure ventilation after extubation in all patients with severe left ventricular dysfunction were helpful in preventing low cardiac output and need for reintubation post-surgery respectively.

Conclusion:
Surgical correction for ALCAPA by coronary re-implantation has an excellent short-term outcome. Optimal postoperative management is of utmost importance for achieving the best results.
A Prospective Study of Various Anesthetic Techniques in Patients with Acyanotic Congenital Heart Diseases Undergoing Device Closure
Authors: Sultania Nidhi , Jambotkar Tejaswini C. , Basantwani Shakuntala N. 
Published: October 2022

ABSTRACT

Background and Aims:
Transcatheter device closure of congenital heart defects (CHD) has recently gained popularity. As limited literature exists regarding the ideal anesthetic technique for these procedures, we studied the perioperative anesthetic management and its effects on hemodynamics and complication rate in patients undergoing device closure.

Methods:
In this prospective observational study, all patients of 1 month to 50 years of age with acyanotic congenital heart diseases undergoing device closure were included. The anesthesia technique, i.e., general anesthesia with endotracheal tube (GETA)/supraglottic airway device (SGD) or conscious sedation with face mask (S-FM), and intravenous induction agent used was noted. Intraoperatively vital parameters, use of transesophageal echocardiography (TEE), and perioperative complications if any, were noted. Descriptive statistical analysis was done using a statistical package for the social sciences (SPSS) version 15.

Results:
GETA was used in the atrial septal defect (ASD) (62.8%), patent ductus arteriosus (PDA) (66.7%), ventricular septal defect (VSD) (65%) patients, SGD in ASD (6.3%), PDA (16.7%), and VSD (13.3%) patients. S-FM in ASD (31.3%), PDA (16.7%) and VSD (21.7%) patients. Etomidate was used as an induction agent in 30.61% of the patients and propofol in 69.39% of the patients. The mean arterial pressure (MAP) in the etomidate and propofol groups was statistically insignificant while decreased heart rate was noted in both groups. Complications like SGD dislodgement, supraventricular tachycardia, and device dislodgements were seen.

Conclusion:
In PDA device closure patients, GETA should be preferred. Patients for VSD device closure should receive general anesthesia as complications are common. In ASD device closure, patients without TEE use can be done under general anesthesia with SGD.
Incidence and profile of severe exacerbations of chronic obstructive pulmonary disease due to biomass smoke or tobacco
Authors: Golpe Rafael , Blanco-Cid Nagore , Dacal-Rivas David , Martín-Robles Irene , Veiga Iria , Guzmán-Peralta Indhira , Castro-Añón Olalla , Pérez-de-Llano Luis A. 
Published: October 2022

INTRODUCTION AND OBJECTIVES:
Stable chronic obstructive pulmonary disease (COPD) caused by biomass smoke (B-COPD) has some differences from tobacco-induced-COPD (T-COPD), but acute exacerbations (AECOPD) have not been well characterized in B-COPD.

OBJECTIVE:
To compare the incidence, characteristics and outcomes of AECOPD in B-COPD with those of T-COPD.

METHODS:
A retrospective observational study that included consecutive patients seen at a specialized COPD clinic (2008–2021). The incidence of severe AECOPD that required hospital admission was studied. For the first AECOPD, the following variables were recorded: fever, coexistence of pneumonia, purulent sputum, eosinophil count, neutrophil to lymphocyte ratio, hypercapnia, and respiratory acidosis. Outcome variables were intensive care unit (ICU) admission, length of hospital stay, and mortality within 1 month of hospital admission.

RESULTS:
Of 1060 subjects, 195 (18.4%) belonged to the B-COPD group and 865 (81.6%) to the T-COPD group. During a follow-up of 67.9 (37.8–98.8) months, 75 (38.4%) patients in the B-COPD group and 319 (36.8%) in the T-COPD group suffered at least one severe AECOPD. The only difference between groups was in a higher risk of ICU admission for the T-COPD group. The incidence, characteristics, and the rest of the outcomes of AECOPD were similar for both groups.

CONCLUSION:
AECOPD are similar events for B-COPD and T-COPD and should be managed similarly.
The efficiency of high-flow nasal cannula for adult patients with coronavirus disease 19 in Jeddah, Saudi Arabia
Authors: Al-Thaqafy Majid S. , Alzahrani Saleh , Alghamdi Abdulwahab , Alselemi Saleh , Alshebani Khalid , Bugis Bussma Ahmed , Bugis Alaa , Al-Shareef Ali S. 
Published: October 2022

CONTEXT:
Early use of a high-flow nasal cannula (HFNC) provides positive outcomes for preventing the risk of intubation. However, the efficiency and usage of HFNC in the case of coronavirus disease 2019 (COVID-19) among adult patients with multiple risk factors remain debatable and require more investigation.

AIMS:
The aim of this study was to determine the efficiency of HFNC in preventing the possible risk of intubation.

SETTINGS AND DESIGN:
This study was an observational cross-sectional study that was conducted at a selected hospital in Jeddah, Saudi Arabia, from July 2020 to August 2021.

METHODS:
The data were collected from patients’ medical records through the hospital health information system. Adult COVID-19 patients who used HFNC were included, while those who used bilevel positive airway pressure or continuous positive airway pressure without any trials of HFNC and neonatal or pediatric patients were excluded. The exposure of HFNC setting which included variables such as percentages of the fraction of inspired oxygen and the duration of using HFNC were measured to find the relation with respiratory rate oxygenation (ROX) index as a measurement of patient outcome.

STATISTICAL ANALYSIS USED:
The data were analyzed by using the online calculator socscistatistics. com for prevalence statistics, and correlation tests of significance. Prevalence statistics were presented in mean, median, frequencies, and percentages. Statistical tests were used to measure correlations of key variables. P < 0.05 of ANOVA and t-tests was considered statistically significant.

RESULTS:
A total of 159 adult COVID-19 patients using HFNC were included, and most of these patients were male. The median age was 64 years. Most of patients were reported to have hypertension and diabetes mellitus. The majority (94.34%) of patients were successfully weaned from HFNC and shows effective intervention with a mean of 7.53 of ROX score. Appropriate implementation of HFNC might be a successful intervention for preventing the risk of intubation.

CONCLUSIONS:
According to the success rate of HFNC, which was considered a positive outcome, there might be a promising intervention for HFNC to prevent the risk of intubation and decrease the mortality rate.
Comparing the characteristics of positional and nonpositional sleep apnea patients among the Jordanian population
Authors: Oweidat Khaled Al , Toubasi Ahmad A. , Albtoosh Asma S. , Al-Mefleh Eyad , Hasuneh Manar M. , Abdulelah Ahmed A. , Sinan Rima A. 
Published: October 2022

BACKGROUND:
Obstructive sleep apnea (OSA) is a common cause of sleep-disordered breathing with a large proportion of the patients exhibiting positional OSA (POSA). In this study, we aimed to evaluate the differences in the demographics, comorbidities, and polysomnographic features between POSA and non-POSA (NPOSA) in a Jordanian sample to further discern the propulsive elements for each group.

METHODS:
In this study, we evaluated 1037 adult patients with OSA. POSA was defined as an overall apnea and hypopnea index (AHI) >5, an overall AHI severity at least 1.4 times the nonsupine severity (overall/NS-AHI), and a minimum amount of time (i.e., 20 min) in the supine and nonsupine positions. To compare the clinical characteristics between POSA and NPOSA patients, statistical analyses were performed.

RESULTS:
The prevalence of POSA was 41.7%. In comparison to NPOSA patients, POSA patients had higher female sex prevalence, milder OSA, lower body mass index, lower hypertension prevalence, and lower hemoglobin A1C levels compared to NPOSA patients. Moreover, sleep efficiency, total sleep time, and supine sleep time were significantly higher in POSA patients. Nonsupine sleep time, total AHI, rapid eye movement (REM) AHI, non-REM (NREM) AHI, supine AHI, nonsupine AHI, left and right AHI, mean oxyhemoglobin saturation (SpO2) awake, mean REM and NREM SpO2, SpO2 nadir, and time SpO2 below 90% were significantly lower among POSA patients. The multivariate regression analysis showed that only female gender and hypertension were significantly associated with POSA.

CONCLUSION:
POSA is common among OSA patients and demonstrates different clinical characteristics in comparison to NPOSA. Future prospective studies are needed to better characterize the POSA patients and investigate the benefit of positional therapy.
A Clinico-Trichoscopic Analysis of Hair Density and Diameter Variability in Relation to Severity Grading of Female Pattern Hair Loss
Authors: Michelle Vishu , Shilpa Kanathur , Leelavathy Budamakuntala 
Published: October 2022

Context:
Hair loss is a common complaint among Indian women. For female pattern hair loss (FPHL), diagnosis is primarily clinical. In the early stages, it can be confused with other conditions. Histopathology is the diagnostic method of choice but requires multiple biopsies and can be disfiguring. Trichoscopy is an alternative noninvasive, rapid tool.

Aim:
The aim of this study is to study the hair density and hair diameter variance in relation with severity grading of FPHL.

Settings and Design:
Cross-sectional study.

Materials and Methods:
Ninety women aged 18 years and above were included in this cross-sectional study conducted at the dermatology department of Bangalore Medical College and Research Institute. Trichoscopic examination was done with a videodermoscope (Firefly DE300) at 20 and 70-fold magnification. Only those patients who met the trichoscopic diagnostic criteria for FPHL were included.

Statistical Analysis Used:
Descriptive statistics, ANOVA, and Spearman's correlation test for fitness of good, using Microsoft Excel data analysis tools.

Results:
Increase in disease severity from grade one to grade three positively correlated with a decrease in hair density over the frontal scalp (P < 0.001) and the occipital scalp (P < 0.001), decrease in average hair shaft diameter over both frontal and occipital scalp (P < 0.001).

Conclusion:
Trichoscopic tools, particularly hair density and hair diameter variance over both frontal and occipital scalp can be useful to help determine FPHL disease severity and its progression.
Robotic surgery for malignant and large adrenal masses: A doable and safe option
Authors: Ayhan Erdemir , Rasa Kemal Hüseyin 
Published: October 2022

Background:
Laparoscopic adrenalectomy is currently considered the gold standard method for adrenal surgery. Open surgery is the most frequent technique preferred amongst surgeons who are faced with tumours of larger sizes or challenging lesions. Despite the increasing interest in laparoscopy, most centres still utilise open surgery for challenging adrenal cases.

Patients and Methods:
We retrospectively evaluated our successive 30 robotic adrenalectomies performed in the past 10 years and assigned the patients into ‘difficult’ and ‘easy’ groups. Patients with malignant tumours or tumour size of over 8 cm were assigned to the ‘difficult group’ and others to the ‘easy group’. Groups were evaluated according to the demographic features of the patients, side of the operation, the body mass index (BMI) and laparotomy history. The duration of anaesthesia, amount of bleeding during surgery and the hospitalisation periods were also evaluated.

Results:
There is no statistically significant difference between the two groups considering age, gender, BMI value, operation side, presence or absence of a laparotomy history, the amount of bleeding during the operation and hospitalisation duration (P > 0.05). The anaesthesia duration was found to be higher in the ‘difficult’ patient group (P < 0.05).

Conclusion:
Our results present robust evidence to support the idea that robotic adrenalectomy is not only a doable but also a safe option for malignant and large adrenal masses.
Clinical characteristics, management, and outcome of gestational trophoblastic neoplasia patients with brain metastasis
Authors: Gonzales-Acantilado Gisele V. , Juan Filomena S. , Cagayan Maria S. 
Published: October 2022

OBJECTIVE:
This study aimed to determine the clinical characteristics, management, and outcome of gestational trophoblastic neoplasia (GTN) patients with brain metastasis.

MATERIALS AND METHODS:
This was a 10-year descriptive study that included all patients with brain metastasis from GTN. Patients' sociodemographic and clinicopathological profiles were described. Using Kaplan–Meier survival curve, the survival time was determined.

RESULTS:
From January 1, 2010, to December 31, 2019, there were 33 GTN patients with brain metastasis. Four were excluded from the study due to incomplete records. Twenty-nine patients were included in the study. Nineteen (65.51%) patients presented with neurologic symptoms upon diagnosis and one (3.44%) during treatment. All received etoposide, methotrexate, actinomycin, oncovin (EMACO) as first-line treatment. Five (17.24%) patients were given induction chemotherapy with low-dose etoposide–cisplatin. Seventeen (58.62%) patients underwent whole-brain radiation and two (6.89%) were given intrathecal methotrexate. Thirteen patients (44.82%) achieved biochemical remission with EMACO chemotherapy. Four patients (13.79%) had resistance to EMACO and were given Etoposide Cisplatin Etoposide Methotrexate Actinomycin (EP EMA). Four patients (13.79%) underwent an adjunctive hysterectomy. Four patients (13.79%) died during treatment. One patient (3.44%) was unable to continue her chemotherapy because she got pregnant before her first consolidation course. There were eight early deaths (<4 weeks of admission) and hence were excluded in the analysis. Three patients who went into biochemical remission relapsed on the 1st, 2nd, and 3rd months after their last consolidation course, respectively. The median follow-up time was 27 months. After excluding early deaths, the survival rate between 3 and 7 years after treatment is at 61.9%. The mean survival time was 5.43 years. Six surviving patients were contacted. Five (17.24%) of them had resumed their everyday life, and one is currently undergoing chemotherapy.

CONCLUSION:
The study was able to document brain metastasis from GTN to be 14.28% (29/203) among metastatic high-risk admissions. The biochemical remission rate from first-line treatment was of 61.90% (13/21) and resistance rate was 19.04% (4/21). Lost to follow up after achieving biochemical remission was a challenge encountered.