bluuebunny/crossref_metadata_2025_split huggingface dataset:
The current status and surgical outcome of the minimally invasive techniques for lumbar interbody fusion in India
Authors: Kumar Ashutosh , Sardhara Jayesh , Mishra Prabhaker , Kapoor Vishwas , Mehrotra Anant , Raiyani Vandan , Singh Mayank , Goyal Nishant , Kulkarni Arvind G. , Srikantha Umesh , Bhaisora Kamlesh Singh , Das Kuntal Kanti , Srivastava Arun K. , Behari Sanjay 
Published: September 2022

Objective
The global shift of trends to minimally invasive spine (MIS) surgery for lumbar degenerative diseases has become prominent in India for few decades. We aimed to assess the current status of MIS techniques for lumbar interbody fusion and their surgical outcomes in the Indian population.

Materials and Methods:
A systematic review (following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines) was performed using PubMed and Google Scholar till November 2020. The primary (visual analog scale [VAS] and oswestry disability index [ODI] scores; intraoperative blood loss; duration of surgery; duration of hospital stay, and fusion rate) and secondary (wound-associated complications and dural tear/cerebrospinal fluid (CSF) leak) outcomes were analyzed using Review Manager 5.4 software.

Results:
A total of 15 studies comprising a total of 1318 patients were included for analysis. The pooled mean of follow-up duration was 26.64 ± 8.43 months (range 5.7–36.5 months). Degenerative spondylolisthesis of Myerding grade I/II was the most common indication, followed by lytic listhesis, herniated prolapsed disc, and lumbar canal stenosis. The calculated pooled standard mean difference (SMD) suggested a significant decrease in postoperative ODI scores (SMD = 5.53, 95% confidence interval [CI] = 3.77–7.29; P < 0.01) and VAS scores (SMD = 6.50, 95% CI = 4.6–8.4; P < 0.01). The pooled mean blood loss, duration of postoperative hospital stay, duration of surgery, and fusion rate were 127.75 ± 52.79 mL, 4.78 ± 3.88 days, 178.59 ± 38.69 min, and 97.53% ± 2.69%, respectively. A total of 334 adverse events were recorded in 1318 patients, giving a complication rate of 25.34%.

Conclusions:
Minimally invasive transforaminal lumbar interbody fusion (TLIF) is the most common minimally invasive technique employed for lumbar interbody fusion in India, while oblique lumbar interbody fusion is in the initial stages. The surgical and outcome-related factors improved significantly after MIS LIF in the Indian population.
Comparative outcome analysis of lateral mass fixation and trans-facet fixation with posterior decompression in the management of cervical spondylotic myelopathy
Authors: Singh Deepak Kumar , Kumar Vijay , Yadav Kuldeep , Mohammad Kaif , Sharma Prevesh Kumar 
Published: September 2022

Aims and Objectives
Posterior subaxial cervical fusion with lateral mass screw and rod instrumentation is a well-established fixation technique. Subaxial transarticular facet fixation is a lesser known fusion technique that has been shown to be biomechanically equivalent to lateral mass screws. The aim of this study was to evaluate the outcome of cervical decompressive laminectomy with lateral mass fixation compared with decompressive laminectomy with trans-facet fixation.

Materials and Methods:
The study was conducted with 20 patients operated for cervical decompressive laminectomy with lateral mass fixation compared with 20 patients operated with trans-facet fixation. The modified Japanese orthopedic association score (mJOA) scale, Nurick's functional grading and neurological recovery rate (NRR) was used as the functional outcome measurement. The clinical follow-up period was 6 months.

Results:
In Group I, the mean preoperative and postoperative mJOA scores in Group I and II were 8.2 ± 2.1 and 12.7 ± 2.8 and 9.3 ± 1.9 and 13.5 ± 1.88, respectively, were statistically significant (P < 0.05). Postoperative NRR at the end of the follow-up period was satisfactory (excellent and good) 55% in Group I and 60% in Group II. Fusion was documented in all 40 patients. No patients experienced neural or vascular injury as a result of screw position.

Conclusions:
Both trans-facet and lateral mass fixation techniques are simple, safe, and effective procedures in achieving relief and improvement in patients with multilevel cervical spondylotic myelopathy. Trans-facetal fixation can provide a reasonable alternative to lateral mass fixation.
Polymorphisms in paired box 1 gene were associated with susceptibility of adolescent idiopathic scoliosis
Authors: Pedrosa Antônio Eulálio , Azevedo Gustavo Borges Laurindo de , Cardoso Jessica Vilarinho , Guimarães João Antonio Matheus , Defino Helton Luiz Aparecido , Perini Jamila Alessandra 
Published: September 2022

Background
Association of genetic polymorphisms in paired box 1 (PAX-1) gene can influence the development of adolescent idiopathic scoliosis (AIS). PAX-1 is mainly expressed in the region of the vertebral bodies and intervertebral discs, being important for the proper formation of spinal structures.

Objectives:
The objective of this study was to evaluate the association of polymorphisms in PAX-1 gene with the susceptibility of AIS.

Settings and Design:
This was an analytical observational case–control study.

Materials and Methods:
Samples of 59 AIS indicated for surgical treatment, and 119 controls, without spinal disease were genotyped for PAX-1 rs6137473 and rs169311 polymorphisms.

Statistical Analysis:
The association of the polymorphisms with AIS was evaluated by a multivariable logistic regression model, using odds ratios (OR) and 95% confidence intervals (CI).

Results:
According to Lenke's classification, 89.8% had Type I and 10.2% II curves. The mean value of the Cobb angle of the proximal thoracic curve was 30.8°, 58.7° thoracic, and 30.4° for the lumbar and on the bending films 14.6°, 40.7°, and 11°, respectively. Among the AIS group, there was a predominance of females (8.8:1). The PAX-1 rs169311 and rs6137473 polymorphisms were positively associated with developing the AIS (OR = 1.98; 95% CI = 1.2–3.3 and OR = 3.16; 95% CI = 1.4–7.3, respectively). The rs6137473 polymorphism was associated with the lumbar modifier B and C compared to A (OR = 2.52; 95% CI = 1.1–5.8).

Conclusions:

PAX-1 polymorphisms were associated with an increased risk of developing the AIS and with curve severity and can be used as a biomarker to map the risk of developing surgical-grade AIS, guiding the treatment of patients.
Magnetic resonance imaging anatomy of the craniovertebral ligaments
Authors: Osmotherly Peter Grant , Cowin Gary J. , Rivett Darren A. 
Published: September 2022

Background
Descriptions of the radiological appearance of the craniovertebral ligaments often lack detail. This study aimed to provide an accurate description of the morphology and radiological appearance of the alar and cruciform ligaments with confirmation of findings by fine dissection.

Materials and Methods:
Six embalmed human cadaveric specimens were reduced to an osseoligamentous arrangement spanning the C2/3 disc to the occiput. Specimens were imaged on a 4.6T Bruker magnetic resonance (MR) system using a 3D RARE multiple SE sequence with acquisition time 18 h 24 min. Acquired images were viewed in three planes, and detailed descriptions and morphometric measurement of the ligaments were obtained. Specimens were then examined and described using fine dissection. Direct comparison of the descriptions of each method was undertaken.

Results:
From imaging, detailed features of all alar ligaments could be identified in all specimens. Consistency in shape, orientation, and attachments is described. Attachment to the medial aspect of the atlantooccipital joints was evident in all specimens. Five of six alar ligament pairs contained fibers that traversed the dens without attachment. Ascending cruciform ligaments could be clearly identified in four of six specimens. No descending cruciform ligaments could be clearly delineated. Detailed features of the transverse ligaments could be identified and described in all planes. Dissection findings were mostly consistent with descriptions obtained from MR images.

Conclusion:
4.6T MR images provide accurate detail of the structure, dimensions, and attachments of the craniovertebral ligaments. The morphology of the craniovertebral ligaments assessed radiologically was consistent with findings on gross dissection.
Cervical deformity patients with baseline hyperlordosis or hyperkyphosis differ in surgical treatment and radiographic outcomes
Authors: Passias Peter Gust , Alas Haddy , Kummer Nicholas , Tretiakov Peter , Diebo Bassel G. , Lafage Renaud , Ames Christopher P. , Line Breton , Klineberg Eric O. , Burton Douglas C. , Uribe Juan S. , Kim Han Jo , Daniels Alan H. , Bess Shay , Protopsaltis Themistocles , Mundis Gregory M. , Shaffrey Christopher I. , Schwab Frank J. , Smith Justin S. , Lafage Virginie , International Spine Study Group  
Published: September 2022

Background
Patients with symptomatic cervical deformity (CD) requiring surgical correction often present with hyperkyphosis (HK), although patients with hyperlordotic curves may require surgery as well. Few studies have investigated differences in CD corrective surgery with regard to HK and hyperlordosis (HL).

Objective:
The objective of the study is to evaluate patterns in treatment for CD patients with baseline (BL) HK and HL and understand how extreme curvature of the spine may influence surgical outcomes.

Materials and Methods:
Operative CD patients with BL and 1-year (1Y) radiographic data were included in the study. Patients were stratified based on BL C2–C7 lordosis (CL) angle: those >1 standard deviation (SD) from the mean (−6.96 ± 21.47°) were hyperlordotic (>14.51°) or hyperkyphotic (<−28.43°) depending on directionality. Patients within 1SD were considered control group.

Results:
102 surgical CD patients (61 years, 65% F, 30 kg/m2) with BL and 1Y radiographic data were included. 20 patients met definitions for HK and 21 patients met definitions for HL. No differences in demographics or disability were noted. HK had higher estimated blood loss (EBL) with anterior approaches than HL but similar EBL with posterior approach. Operative time did not differ between groups. Control, HL, and HK groups differed in BL TS-CL (36.6° vs. 22.5° vs. 60.7°, P < 0.001) and BL-SVA (10.8 vs. 7.0 vs. −47.8 mm, P = 0.001). HL patients had less discectomies, less corpectomies, and similar osteotomy rates to HK. HL had 3x revisions of HK and controls (28.6 vs. 10.0 vs. 9.2%, respectively, P = 0.046). At 1Y, HL patients had higher cSVA and trended higher SVA and SS than HK. In terms of BL-upper cervical alignment, HK patients had higher McGregor's slope (MGS) (16.1° vs. 3.3°, P = 0.002) and C0–C2 Cobb (43.3° vs. 26.9°, P < 0.001), however, postoperative differences in MGS and C0–C2 were not significant. HK drivers of deformity were primarily C (90%), whereas HL had primary CT (38.1%), UT (23.8%), and C (14.3%) drivers.

Conclusions:
Hyperlodotic patients trended higher revision rates with greater radiographic malalignment at 1-year postoperative, perhaps due to undercorrection compared to kyphotic etiologies.
Development of neural network models for prediction of the outcome of COVID-19 hospitalized patients based on initial laboratory findings, demographics, and comorbidities
Authors: Pasic Mirza , Begic Edin , Kadic Faris , Gavrankapetanovic Ali , Pasic Mugdim 
Published: September 2022

Background:
During the process of the treatment of COVID-19 hospitalized patients, physicians still face a lot of unknowns and problems. Despite the application of the treatment protocol, it is still unknown why the medical status of a certain number of patients worsens and ends with death. Many factors were analyzed for the prediction of the clinical outcome of the patients using different methods. The aim of this paper was to develop a prediction model based on initial laboratory blood test results, accompanying comorbidities, and demographics to help physicians to better understand the medical state of patients with respect to possible clinical outcomes using neural networks, hypothesis testing, and confidence intervals.

Methods:
The research had retrospective-prospective, descriptive, and analytical character. As inputs for this research, 12 components of laboratory blood test results, six accompanying comorbidities, and demographics (age and gender) data were collected from hospital information system in Sarajevo for each patient from a sample of 634 hospitalized patients. Clinical outcome of the hospitalized patients, survival or death, was recorded 30 days after admission to the hospital. The prediction model was designed using a neural network. In addition, formal hypothesis tests were performed to investigate whether there were significant differences in laboratory blood test results and age between patients who died and those who survived, including the construction of 95% confidence intervals.

Results:
In this paper, 11 neural networks were developed with different threshold values to determine the optimal neural network with the highest prediction performance. The performances of the neural networks were evaluated by accuracy, precision, sensitivity, and specificity. Optimal neural network model evaluation metrics are: accuracy = 87.78%, precision = 96.37%, sensitivity = 90.07%, and specificity = 62.16%. Significantly higher values (P < 0.05) of blood laboratory result components and age were detected in patients who died.

Conclusion:
Optimal neural network model, results of hypothesis tests, and confidence intervals could help to predict, analyze, and better understand the medical state of COVID-19 hospitalized patients and thus reduce the mortality rate.
Hospital-Based Retrospective Cross-sectional Study to Analyse the Causes of Maternal Deaths at a Tertiary Health Care Facility
Authors: Singh Naresh Pal , Jain Pankaj Kumar , Saxena Deepanshi , Takhelchangbam Nilima Devi , Singh Anamika 
Published: September 2022

Context:
Maternal mortality is considered a key health indicator of Maternal and Child Health. Considering the fact that complications are preventable and most of them are modifiable, the study has been planned to analyse maternal deaths in order to suggest recommendations for preventing it. There are various delays according to the three-delay model at primary and secondary level; therefore, interventions are needed at those levels to prevent maternal deaths.

Aims:
To determine the various direct and indirect causes of maternal deaths, analyse the association of medical and social factors with maternal deaths and ^to determine the predictors of maternal deaths.

Settings and Design:
Hospital-based retrospective cross-sectional study of all the maternal deaths occurring in the last 4 years at a tertiary health care facility.

Methods and Material:
Data were collected from the Facility Based Maternal Death Review forms.

Statistical Analysis Used:
Data were entered and analysed by IBM SPSS version 25.0 software.

Results:
For maternal deaths, direct obstetric causes were responsible in 128 (74.4%) and indirect causes in 45 (26.2%) cases followed by unspecified causes in 78 (45.3%) and 1 (0.6%) coincidental cause. Statistically significant associations were observed between maternal death and period of gestation, mode of delivery and outcome of delivery (P = 0.12, P = 0.04 and P < 0.001, respectively).

Conclusions:
The health professionals of primary and secondary level should be well equipped to diagnose the complications and to manage it as early as possible. Thus, maternal mortality rates can be decreased to significant level.
Evaluation of the diagnosis and treatment options for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
Authors: Kouhpayeh Hamidreza 
Published: September 2022

Abstract
Viruses are non-living organisms that cause many problems for human societies annually. The outbreak of some dangerous viruses causing acute pneumonia has been the leading cause of death in the world. The epidemiological findings showed that the virus is developing different and dangerous species by creating new mutations, which makes it difficult to treat. The diagnosis and treatment of corona virus disease (COVID-19) has been one of the most important topics in the scientific community for the past 2 years. There are several diagnostic methods available for the detection of COVID-19 that are highly accurate and require less time. The use of some therapies such as remdesivir with basic therapy has shown high therapeutic effectiveness, but the therapeutic side effects such as decreased glomerular filtration rate, decreased lymphocyte count, respiratory failure, and increased blood creatinine levels in most treatments have been observed. The COVID-19 infection and the associated deaths are still very worrying, therefore, rapid diagnosis and timely management of this deadly infection and the necessary measures for eradicating COVID-19 are important.
The epidemiology and dynamics of COVID-19 disease transmission among healthcare workers of a tertiary healthcare setting in India
Authors: Singh Mahendra , Dhankar Anushikha , Sharma Megha , Agarwal Shreya , Panda Prasan K. , Bahurupi Yogesh , Aggarwal Pradeep 
Published: September 2022

Context:
The novel coronavirus disease 2019 (COVID-19) that has emerged as a pandemic now has put health care workers (HCWs) at great risk as they are the warriors in frontlines screening and treating the infected patients. When a COVID-19-positive HCW is identified, its contacts need to be traced to check the spread of the infection among patients and other HCWs.

Aims:
This study was aimed to study epidemiology and risk factors associated with severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) infection among HCWs and to quantify the risk of infection among HCWs in a tertiary level health care setting.

Settings and Design:
This cross-sectional study enrolled all the HCWs who were exposed to a patient with COVID-19 in a tertiary level health care center, Rishikesh, Uttarakhand from 1st May to 30th July, 2020.

Methods and Material:
All the exposed HCWs were followed up for 14 days after the last exposure to a patient with confirmed COVID-19 infection. Epidemiological data were obtained using structured interviews.

Statistical Analysis Used:
The data were analyzed using SPSS 23.0. Frequencies and proportions were calculated for descriptive variables, and risk ratios were calculated for risk factors affecting the transmission of disease.

Results:
We observed that 1,141 HCWs of the tertiary level health care hospital were exposed to COVID-19 patients during the study period. A total of 22 HCWs were tested COVID-19 positive among these exposed HCWs. Univariate analysis revealed a high risk of exposure to be significantly associated with a higher secondary attack rate of SARS CoV-2.

Conclusions:
The study demonstrates the risk of COVID-19 transmission through asymptomatic carriers. Therefore, periodic testing of all health care workers is necessary to ensure early mitigation of the shortage of health care providers.
Knowledge of the primary healthcare physicians in the Al-Baha Region about COVID-19 personal protective measures
Authors: Alzahrani Mona Saeed , Hakeem Alaaeden A. L. , Talmesany Terad A. 
Published: September 2022

Background:
Healthcare professionals are particularly more vulnerable to Covid-19 pandemic infection, since they are on the front lines. The relatively high morbidity and mortality among healthcare workers all over the world because of Covid-19 is a major cause of concern.

Objectives:
To explore the awareness of the healthcare workers in primary care settings regarding COVID-19 as well as the role of personnel protective equipment (PPE) as protective measures and to discover any defects for further intervention.

Material and Methods:
Cross-sectional study design was carried out in the Al-Baha Region, Southwest of Saudi Arabia. It included a representative random sample of healthcare workers working at primary health care (PHC) centers belonging to the Ministry of Health. A self-administered valid questionnaire was utilized in the present study, which included three main parts: demographic data of the healthcare workers; questions to assess their knowledge about the current COVID-19 pandemic (four multiple choice questions); and questions to assess knowledge about personal protective measures and hand hygiene (ten questions).

Results:
The study included 451 participants. The age of more than half of the participants (51.7%) ranged between 31 and 45 years. Females represented 53.2% of them. Physicians, nurses, and pharmacists represented 36.1%, 24.2%, and 23.3% of the participants, respectively. History of attending infection control training activity in the previous 12 months was reported by 38.1% of the participants. Overall, 74.5% and 19.1% of the participants expressed a poor level of knowledge regarding the current COVID-19 pandemic and PPE/personal hygiene, respectively. Older healthcare workers (HCWs) (> 45 years), non-Saudi nationals, dentists, moderately experienced healthcare workers (6–10 years), and those who attended infection control training courses were more knowledgeable about the current COVID-19 pandemic and its self-protective measures compared to others.

Conclusion:
Most of the primary healthcare staff in the Al-Baha Region expressed a poor level of knowledge about the current COVID-19 pandemic and a moderate level regarding PPE and personal hygiene. Some indicators for poor knowledge were identified.
Primary hepatic tuberculosis presenting as fever of unknown origin diagnosed by Positron emission tomography/computed tomography scan (PET/CT)
Authors: Puri Saurabh , Grover Ashok , Choudhary Pankaj Nand , Singh Purneetha , Gupta Arjun Prem 
Published: September 2022

Abstract
Tuberculosis (TB), especially extrapulmonary tuberculosis (EPTB), is an important cause of fever of unknown origin (FUO) in areas endemic to TB. Liver involvement in TB in the absence of miliary TB is rare. A definitive diagnosis of primary hepatic TB can be challenging and relies on the histological and/or bacteriological findings of the liver tissue obtained by biopsy. TB should be considered in the differential diagnosis of space-occupying lesions and abscesses of the liver. In our case of a 52-year-old adult male with FUO, a positron emission tomography/computed tomography (PET/CT) scan was used, due to lack of any potential diagnostic clues, and a focal lesion was identified as a potential biopsy site.