bluuebunny/crossref_metadata_2025_split huggingface dataset:
Raised Blood Urea Nitrogen–Creatinine Ratio as a Predictor of Mortality at 30 Days in Spontaneous Intracerebral Hemorrhage
Authors: Dev Priya , Singh Varun Kumar , Kumar Amit , Chaurasia Rameshwar Nath , Kumar Anand , Mishra Vijaya Nath , Joshi Deepika , Pathak Abhishek 
Published: September 2022

Abstract

Background:
Spontaneous intracerebral hemorrhage (SICH) accounts for 7.5%–30% of all strokes and carries higher morbidity and mortality. Raised blood urea nitrogen and creatinine ratio (BUNR) is a marker of dehydration and related to poor outcome in stroke patients. However, the ratio varies between 15 and 80 in different studies. The aim of the present study was to assess BUNR as an independent predictor of mortality and its sensitivity and specificity in predicting outcome in the SICH population.

Materials and Methods:
Patients above the age of 18 years with SICH who were admitted in the Department of Neurology at Sir Sunderlal Hospital, Banaras Hindu University between January 2018 and July 2020 were enrolled in the study and prospectively followed up. Demographic, clinical, radiological, and outcome parameters were recorded.

Results:
A total of 217 patients were included. Of these, 137 (63%) were males. Seventy-one patients died during the initial 30 days. Number of patients with intraventricular hemorrhage (IVH; P = 0.003), higher mean intracerebral hemorrhage (ICH) volume (P < 0.001) and midline shift (P = 0.021), and poor Glasgow Coma Scale (GCS) score (<9) (P = 0.040) was more in the group which did not survive. Mean level of urea was significantly lower among survivors than in those who died (P = 0.001). BUNR was also significantly higher in those who died than in those who survived (P = 0.001). BUNR with a cutoff value of 39.17 was significantly associated with mortality at 30 days with a sensitivity and specificity of 61.97% and 62.33%, respectively. On performing two different multivariable logistic studies, it was found that model B with BUNR ratio as a predictor of mortality out performed model A (without BUNR).

Conclusions:
The study showed that SICH was associated with significant mortality. Independent predictors of death at 30 days were lower GCS on admission, larger hematoma volume, and BUNR of more than 39.17.
Trans-cranial Doppler Flow Characteristics of a Child with Paroxysmal Sympathetic Hyper-activity
Authors: Datta Debajyoti , Chandran Vipin , Bansal Sumit , Sahu Rabi Narayan 
Published: September 2022

Abstract

Background:
Paroxysmal sympathetic hyper-activity (PSH) is a syndrome characterized by excessive activity of the sympathetic nervous system. The cerebrovascular flow dynamics during the episodes of paroxysmal hyper-activity has also not been clearly examined in the literature.

Case History:
A 12-year-old boy with operated exophytic brain stem pilocytic astrocytoma was diagnosed with paroxysmal sympathetic hyper-activity. The trans-cranial Doppler flow characteristics of the bilateral middle cerebral artery and anterior cerebral artery are described in this report.

Conclusion:
The diagnosis of PSH requires an index of suspicion on the part of the clinician. The episodes of sympathetic hyper-activity are associated with significant changes in physiologic parameters in the patients including changes in cerebrovascular flow dynamics.
Antegrade Subperiosteal Temporalis Muscle Elevation and Posterior Retraction Technique Avoiding Muscle Incision for Pterional Craniotomy
Authors: Rai Survendra Kumar R , Dandpat Saswat K , Ranjan Shashi , Shah Abhidha , Sudarshan Nishchith , Mancarella Cristina , Pathak Harish M , Goel Atul H 
Published: September 2022

Abstract

Background:
The current technique of pterional craniotomy involves temporalis muscle incision followed by retrograde elevation. Feasibility of antegrade temporalis muscle elevation without any direct incision over its bulk is evaluated.

Objective:
Incisionless “antegrade, subgaleal, subfascial, and subperiosteal elevation” of temporalis muscle preserves vascularity and muscle bulk. Posterior maneuvering of “bare” temporalis muscle bulk either above (out rolling) or under (in rolling) the scalp for pterional craniotomy is discussed.

Material and Methods:
Technique of antegrade, subfascial, subperiosteal elevation, and posterior rotation of temporalis muscle without incising in its bulk by “out rolling” or “in rolling” along the posterior aspect of the scalp incision was carried out in 15 cadavers and later in 50 surgical cases undergoing pterional craniotomy. Postoperatively, patients were evaluated for subgaleal collection and periorbital edema. Operated side cosmesis and temporalis muscle bulk was compared with nonoperated temporalis muscle at 6 months interval.

Results:
Antegrade subperiosteal dissection of temporalis muscle was possible in all cases. “In-rolling” or “out rolling” technique provided adequate surgical exposure during pterional craniotomy. Postoperative subgaleal collection and periorbital edema was prevented. Facial nerve paresis or temporalis muscle-related complications were avoided.

Conclusion:
Antegrade, subgaleal, subfascial, and subperiosteal dissection techniques of temporalis muscle elevation without any direct incision in its bulk enables neurovascular and muscle volume preservation. Posterior maneuvering of elevated temporalis muscle with “out rolling” or “in-rolling” technique is easy, quick, and provides adequate exposure during pterional craniotomy. Opening and closing of scalp layers without violating subgaleal space prevent postoperative subgaleal hematoma and periorbital edema.
Rapid Recovery from Subacute to Chronic Ischemic Stroke Following Revascularization by Carotid Stenting
Authors: Ghatge Sharad B , Surya Nirmal , Modi Dhaval 
Published: September 2022

Abstract

Background:
Rapid neurological recovery from subacute to chronic ischemic stroke in subset of patients following carotid revascularization was observed.

Objective:
Retrospective analysis of data of the patients who had shown rapid recovery from subacute to chronic ischemic stroke following revascularization by Carotid stenting.

Materials and Methods:
We retrospectively analyzed pooled data from our carotid stenting patients done during January 2009 to January 2020. The inclusion criterion of the study was patients with rapid recovery within 24 h following revascularization by carotid stenting. There were total of 12 such patients. There were 8 males and 4 females. Apart from NIHSS, stroke severity was measured on MRI by ASPECTS score and cognitive function by MMSE. Each of these patients has undergone Carotid Stenting with distal protection for high-grade stenosis.

Results:
All of these 12 patients had Prestenting ASPECTS score ranging 8-10. Prestenting NIHSS score was ranging from 6-12 with an average of 8. Postprocedure NIHSS score was decreased to a range of 0-4 with average of 3. Prestenting MMSE was ranging 14-20 with an average of 18 score which turned into Post-stenting MMSE scale ranging 24-28 with an average of 26. Each of these patients shows decrease in NIHSS score by at least 50% in 24h to be called rapid recovery or Lazarus phenomenon. Additionally, they show significant improvement in cognitive function on MMSE scale.

Conclusion:
Rapid recovery from subacute to chronic ischemic stroke following revascularization by Carotid Stenting is potentially feasible in subset of patient who has mild to moderate deficit but high ASPECTS score.
Are the Pre-internship Expectations of Interns in Medical Field Met During Internship?
Authors: Sohal Karpal S , Owibingire Sira S , Garinga Philipo F , Wilson Evarist M , Shaban Shaban D 
Published: September 2022

Background:
The transition period from an undergraduate student to an independent practitioner across healthcare professionals is challenging as new graduates experience a social, professional, and economic life that may be different from their prior expectations.

Objective:
The aim of this article is to determine the pre-internship expectations of the interns and to what level these expectations were met during internship.

Materials and Methods:
The study participants were interns posted at the Muhimbili National Hospital who had completed at least 6 months of internship training. A structured questionnaire was used to collect data regarding their social, economic, and career expectations before and during the internship. Data were analyzed using Statistical Package for Social Sciences version 23. The χ2 test was used to assess the association between variables, and the significance level was set at P < 0.05.

Results:
The median age of participants was 26 years, and the male-to-female ratio was 1.7:1. The overall mean pre-internship expectation score was 9.6 ± 3.6, whereas the mean scores were 3.6 ± 2.0, 3.7 ± 1.5, and 2.2 ± 1.4 for social, career, and economic expectations, respectively. The overall average expectation score during the internship was 6.1 ± 4.2. The mean scores were 1.9 ± 2.2, 3.0 ± 1.5, and 1.2 ± 1.5 for social, career, and economic expectations, respectively. There was a significant average difference between the expectation scores before and during the internship period.

Conclusion:
The pre-internship expectations of students in the field of health sciences are not met during the internship. The career expectations are relatively better met; however, social and economic expectations are largely not achieved during the internship period.
Facial chondroid syringoma
Authors: Elbalka Saleh S. , Hassan Amany , Hamdy Mohamed , Metwally Islam H. 
Published: September 2022

Abstract
Chondroid syringomas (CSs) are benign adnexal skin tumors usually affecting adolescent females in the periorbital region, and may have calcifications. Malignant transformation is very rarely encountered. There is a tendency to either medical treatment or intralesional injection of these lesions when confirmed benign especially if multiple. We herein describe a female with a periorbital benign CS. The presurgery cytology failed to predict the diagnosis, but surgical excision was attempted with good result. Both pathologists and surgeons are encouraged to add this differential in their diagnostic package of facial subcutaneous swellings.
Change of neutrophil-to-monocyte ratio to stratify the mortality risk of adult patients with trauma in the intensive care units
Authors: Tsai Ching-Hua , Liu Hang-Tsung , Hsieh Ting-Min , Huang Chun-Ying , Chou Sheng-En , Su Wei-Ti , Li Chi , Hsu Shiun-Yuan , Hsieh Ching-Hua 
Published: September 2022

Abstract

Background:
The subtypes of circulating white blood cells undergo relative changes under systemic inflammation; thus, the derived ratio may reflect patients' immunoinflammatory status. Under the hypothesis that change in segmented neutrophil-to-monocyte (SeMo) ratio, delta-SeMo ratio, may reflect the host's immunoinflammatory response against illness, this study aims to investigate the effectiveness of using delta-SeMo ratio to assess the mortality risk of patients with trauma and critical illness.

Materials and Methods:
A total of 1476 adult patients with trauma admitted to the intensive care unit (ICU) between January 1, 2009, and December 31, 2020, were enrolled in this study. Delta-SeMo ratio was defined using the following formula: SeMo ratio at day 3 (72–96 h after admission into ICU) – SeMo ratio at admission (at admission into ICU). The primary outcome was inhospital mortality.

Results:
There was no significant difference in the SeMo ratio at admission between death and survival patients (18.7 ± 11.0 vs. 18.7 ± 18.4, P = 0.974); however, SeMo ratio at day 3 (20.3 ± 15.5 vs. 15.7 ± 16.0, P = 0.002) and delta-SeMo ratio (1.6 ± 19.5 vs.–3.0 ± 24.2, P = 0.034) of the patients who died were significantly higher than those of the patients who survived. The patients with delta-SeMo ratio ≥1.038, an estimated cutoff value for best predicting mortality by the plotted receiver operating characteristic curve, sustained an approximately 2-fold adjusted mortality (adjusted odds ratio [AOR]: 1.84, 95% confidence interval [CI]: 1.27–2.66, P = 0.001) than those with a delta-SeMo ratio <1.038. Furthermore, when the delta-SeMo ratio was set at 0, a threshold value indicating a condition with an increase or decrease in the SeMo ratio at day 3 than the SeMo ratio at admission, there was a 1.7-fold higher adjusted mortality (AOR: 1.70, 95% CI: 1.18–2.46, P = 0.004) of the patients with delta-SeMo ratio ≥0 than those with delta-SeMo ratio <0.

Conclusion:
Following trauma injury, critically ill patients with an increased SeMo ratio present with a higher rate of mortality and longer stay in the hospital and ICU than those with a decreased SeMo ratio. The use of the delta-SeMo ratio may help physicians quickly identify patients at higher risk of inhospital mortality.
A Clinical Study of Premature Canities and Its Association with Hemoglobin, Ferritin and Calcium Levels
Authors: Chandran Sruthi , Simon Sheena Ann , George Anuja Elizabeth 
Published: September 2022

Background and Objectives:
Greying of hair is a regular feature of chronological aging that occurs in all regions and races. Premature canities is defined as minimum of five grey hairs in a person less than 20 years in Whites, 25 years in Asians, and 30 years in Africans. Premature canities is a common yet incompletely understood dermatological entity. This study aims at finding any association between premature hair greying (PHG) and parameters like hemoglobin (Hb), ferritin and calcium levels as well as its clinical profile.

Methodology:
This was a hospital-based cross-sectional analytical study conducted in the Department of Dermatology and Venereology, Trivandrum over one and half years. The study population consisted of 40 cases and 40 controls. Severity assessment, calculation of body mass index, and estimation of hemoglobin, serum ferritin, calcium, Random blood sugar, Anti Thyroid Peroxidase antibody, T3, T4, and TSH were done.

Results:
The mean age of the 40 patients was 17.14 years and most patients had onset of greying between 16 and 20 years. The male to female ratio was 1.2:1. A positive family history with a paternal predominance was noted. Vertex was the most common site of onset (42.5%), diffuse pattern was the most common clinical pattern (47.5%) and 60% had involvement of mild grade. Fourteen patients (35%) had abnormal investigations reports, in terms of low ferritin levels in 7 (17.5%), low calcium in 4 (10%) and a low Hb levels in 3 (7.5%) patients. Six (15%) patients had raised Anti TPO values. The association of PHG with low ferritin and raised anti-TPO levels were statistically significant.

Conclusion:
Low serum ferritin and raised Anti TPO levels may have a role in premature hair greying.
Oxidative Stress and Thiol/Disulfide Homeostasis in Human Papillomavirus Infections
Authors: Sener Sertac , Kilinc Fadime , Akbas Ayse , Erdogan Serpil , Erel Ozcan , Metin Ahmet 
Published: September 2022

Introduction:
Viral warts are a group of dermatological diseases caused by human papillomavirus (HPV). Several studies have demonstrated an association between HPV infections and oxidative stress. Thiols are important components of cellular redox homeostasis as antioxidant molecules in the organism.

Aim:
This study aimed to investigate the role of oxidative stress in patients with HPV infection by analyzing native thiol/disulfide homeostasis.

Material and Methods:
Forty-two patients with HPV infection and 40 healthy subjects were analyzed for the levels of native thiols, total thiols, and disulfide. Disulfide/native thiol, disulfide/total thiol, and native thiol/total thiol ratios were also calculated.

Results:
Disulfide and total thiol levels were higher in the patients compared to the healthy controls. The disulfide/native thiol ratio was also higher in the patient group. Native and total thiol levels decreased with the increasing duration of the disease.

Conclusion:
The native thiol/disulfide homeostasis was shifted toward disulfide in the patients' group, indicating the existence of oxidative stress in HPV infection.
Comparison of Cone Beam Computed Tomography Performance at Different Voxel Sizes in the Evaluation of Mandibular Canal – An In vitro Study
Authors: Joy Rini , Kannan A. , Lakshmi Krithika C. , Lakshminrusimhan D.K.S. , Roy Anitha 
Published: September 2022

Background and Aim:
Even though cone beam computed tomography (CBCT) imaging is a propitious tool to track the mandibular/ inferior alveolar canal (MC) course, documentation regarding indefectible CBCT imaging strategy for MC localization is sparse. This study aimed to appraise CBCT's functioning at specified voxel sizes for deducing an explicit voxel size setting that simplifies MC evaluation in individual imaging sections.

Materials and Methods:
CBCT scan of 12 dry human mandibles was produced at 0.5, 0.3, 0.25, and 0.2 mm voxel settings. Two specialists/assessors explored the generated images in coronal (buccolingual) and curved (anterior-posterior) sections.

Statistical Analyses:
Mann–Whitney U, Kruskal–Wallis, post-hoc Tukey HSD, and Kappa statistics.

Results:
All voxel specifications revealed appreciable statistical variance; coronal sections comparatively excelled in serving the study objective. Statistical authentication was spotted among voxel sizes 0.5–0.2 mm and 0.5–0.25 mm (both assessors, either section), 0.3–0.2 mm (first specialist, curved), and 0.3–0.5 mm (second specialist, curved). Inter-observer agreement was excellent for voxels 0.25 mm (coronal) and 0.2 mm (curved).

Conclusion:
Precise voxel setting to trace MC is 0.3 mm and the suitable imaging section is coronal.
Prevalence and Anatomic Variations of Lingual Foramina and Lingual Canal in Anterior Mandible Using Cone Beam Computed Tomography – A Cross-Sectional Study
Authors: Poovannan Sindhu , Sarumathi T 
Published: September 2022

Introduction:
Rich neurovascular supply in the anterior mandible necessitates a preoperative radiological assessment of the lingual foramina/canal where cone beam computed tomography (CBCT) could produce promising results.

Aim:
To assess the prevalence of lingual foramina and canal in mandible and variations in their anatomy in a hospital-based population in Chennai.

Methodology:
Sagittal sections of the anterior mandible from CBCT images of 140 patients were evaluated for number, location of the lingual foramen, length of the lingual canal, a distance of lingual foramen from the alveolar crest and inferior border of the mandible, and thickness of the lingual cortex.

Results:
A total of 166 lingual foramina-canals were identified in 140 individuals; 82.1% presented with one, 15.1% with two, and 2.1% with three lingual foramina canals. The majority of foramina (79.51%) were located above the genial tubercles. The mean lengths of the superior, middle, and inferior canals were 5.45 ± 1.34, 5.00 ± 1.73, and 3.92 ± 1.10 mm, respectively. The mean thickness of the lingual cortex was 2.35 ± 0.55 mm. The distance from the inferior lingual foramina to the alveolar crest was significantly greater in males (P = 0.001).

Conclusion:
Anatomical characteristics of lingual foramen-canal varied significantly across the total sample.
Prevalence of Temporomandibular Disorders and Their Correlation with Gender, Anxiety, and Depression in Dental Students − A Cross-Sectional Study
Authors: Kumar Lokesh S , Naik Zameera , Panwar Arun , Sridhar M , Bagewadi Anjana 
Published: September 2022

Context:
The role of anxiety and depression in causing temporomandibular disorders (TMDs) has been well established in the past; however, there are no studies on dental students that evaluate both the TMD and psychological factors.

Aim:
To determine the prevalence of TMD among dental students and its correlation with gender, anxiety, and depression.

Materials and Methods:
The study included 384 dental students (both undergraduates and postgraduates). The prevalence and severity of TMD were assessed with an anamnestic questionnaire. The severity of anxiety and depression was evaluated by Hospital Anxiety and Depression Scale after eliciting a detailed case history to include/exclude the participants. Statistical tests, including Shapiro-Wilk's, Chi-square, and Spearman's rank correlation coefficient, were done to check the normality distribution, association, and correlation, respectively.

Results:
The results revealed that 52.9% of the students had some degree of TMD. There was no statistically significant difference in the TMD severity between different gender (P = 0.373). About 51% of the students had anxiety, and 24% had depression. There was a statistically significantly high level of anxiety in females than in males (P = 0.046); however, not for depression (P = 0.312). There was a significant positive correlation between TMD severity and anxiety (P < 0.001) but not depression (P = 0.10).

Conclusions:
A high TMD prevalence was observed in dental students. There was a significant positive correlation between TMD severity with anxiety but not gender and depression. Psychological counseling and appropriate management are the need of the hour to prevent further complications.
Early Classical Authors on Jesus
Authors: Williams Margaret H. 
Published: September 2022

Margaret H. Williams examines how classical writers saw and portrayed Jesus, engaging with the fact that as the originator of a new (and still existing) world religion, Jesus of Nazareth, otherwise known as Christus (Christ), is an individual of indisputable historical significance.
Williams shows how from the outset Jesus was a controversial figure. Contemporary Jews in the Roman province of Judaea tended either to adore or to abhor him. When indue course his fame spread throughout the wider Roman empire, reactions to him there among both Jews and non-Jews were no less divergent. Each of the early classical writers who makes mention of him, the historian Tacitus, the biographer Suetonius, the epistolographer Pliny and the satirist Lucian, takes a different view of him and presents him in a different way. Williams considers these different depictions and questions why these writers had such differing views of Jesus. To answer this question Williams examines not only to the different literary conventions by which each of these writers was bound but also to the social, cultural and religious contexts in which they operated.
Disrupting Leadership in Entrepreneurial Universities
Authors: Blackmore Jill 
Published: September 2022

What is the future of the contemporary university and for those who wish to lead them?
Considering leadership in the broadest sense, including academic leadership (teaching and research) as well as leadership practices of those in formal management positions, Jillian Blackmore outlines how multiple pressures on universities have produced leadership practices in management and research which are more corporate than collegial, and which discourage many academics from aspiring to leadership. She uses range of theoretical tools, informed by critical and feminist organisational studies, to unpack higher education and how it is being transformed. Drawing from three Australian university case studies, this book uses leadership as a lens through which to investigate the effects of restructuring of the higher education sector has impacted differently on academic identities and careers.