bluuebunny/crossref_metadata_2025_split huggingface dataset:
Role of Bedside Transcranial Ultrasonography in the Assessment of Cerebral Hemodynamics in Decompressive Craniectomy Patients with Cranioplasty
Authors: Ravikanth Reddy , Majumdar Pooja 
Published: November 2022

Background:
Intracerebral hemorrhage is a leading cause of death and disability worldwide. After intracerebral hemorrhage, cerebral blood flow (CBF) becomes extremely low approaching ischemic thresholds. Concurrently, CBF velocities become strongly correlated to CBF itself post-injury. Identification of such hemodynamic disturbances can be used to predict outcome immediately post-injury when indices are measured using transcranial doppler ultrasonography (TCD). TCD permits non-invasive assessment of different CBF velocities as well as pulsatility index (PI). Abnormal measurement of such indices is believed to correlate to poor outcome.

Aim:
To investigate the effect of cerebral hemodynamics after cranioplasty in decompressive craniectomy patients using pre and postoperative TCD.

Materials and Methods:
This study is a prospective study of 3 years duration undertaken on 64 patients. All the patients were evaluated by TCDbefore and after decompressive craniectomy. All patients were evaluated by transcranial Doppler (TCD) 1 week before and 7–15 days after cranioplasty. TCD results were obtained though trans-temporal approach.

Results:
Statistically significant differences between the values before and after craniectomy were detected in Peak Systolic Volume (PSV) for the Anterior Cerebral Artery (ACA) (P = 0.001), in PSV for the Middle Cerebral Artery (MCA) (P < 0.004), in Mean Bloodflow Velocity (MV) for the MCA (P < 0.003), and in PSV for the Posterior Cerebral artery (PCA) (P = 0.001) on the ipsilateral side. There were statistically significant differences between the values before and after cranioplasty in PSV for the PCA (P = 0.004), on contralateral side. After decompressive craniectomy, the PI values for the MCA decreased, on average, to 31+/- 33% of the pre-surgical value in the treated side and to 28+/- 31% on the opposite side. On the other hand, the mean PI values for the extracranial ICA reduced to 34+/- 21% of the initial values in the treated side, and to 21+/- 31% on the opposite side. Cranioplasty improved CBF velocities in all major intracrainal arteries, not only on the side of the lesion adjacent to the cranioplasty, but also in distant regions, such as in the contralateral hemisphere.

Conclusion:
Decompressive craniectomy significantly improves cerebral hemodynamics both on ipsilateral and contralateral cerebral hemispheres. Concomitantly, PI values on TCD decrease significantly postoperatively, mainly in the decompressed cerebral hemisphere, indicating reduction in cerebrovascular resistance. We conclude that cranioplasty improves neurological status and the mechanism of postoperative improvement of neurological status may be due to increased CBF velocity.
Effect of Early Bedside Arm and Leg Cycle Ergometry on Sitting and Standing ability in Hospitalized acute Stroke Patients
Authors: Bharti Archana , Balaji Gandhi Karunanithi , Agrahara Sahana 
Published: November 2022

Objectives:The objective of this study was to evaluate the effect of early bedside arm and leg cycle ergometer exercises as compared to routine physiotherapy on sitting and standing ability in hospitalized acute stroke patients.Materials and Methods:Thirty-four consecutive patients with acute stroke were included in the randomized controlled trial. Patients were divided into two groups based on 1:1 simple randomization Experimental group (n= 18) and control group (n= 16). Experimental Group received arm and leg cycle ergometry along with conventional physiotherapy exercises, while the patients in the control group received conventional physiotherapy exercises. Both the groups received treatment for a total duration of 50 min session, twice a day for 7 days. Preintervention and postintervention measurements were taken for both groups using performance-oriented mobility assessment, postural assessment scale for stroke, Motricity Index, and Trunk control scale.Results:Statistically significant improvement (P< 0.05) was observed in the experimental group and control groupafter intervention among all the outcome measures.Conclusions:Early bedside intervention of cycle ergometer along with routine physiotherapy is effective in improving the sitting and standing abilities, trunk control, and motor function in acute stroke survivors.
Serum Magnesium Levels During the Ictal and Interictal Phase in Patients of Migraine
Authors: Mahajan Rahul , Anand Kuljeet Singh , Mahajan Rakesh Kumar , Garg Jyoti , Juneja Abhishek 
Published: November 2022

Background:
Migraine is one of the primary headaches having a global prevalence of 15%. It is characterized by neurovascular dysfunction and recurrent episodes of headache. The hyperexcitability of the cerebral cortex has been recognized as an important factor in the pathogenesis of migraine, and magnesium (Mg) being a regulator of neuronal excitability is thought to participate in migraine pathogenesis.

Objectives:
To determine the serum levels of Mg in patients of migraine during the attack and in between attacks as compared to healthy controls.

Methods:
A total of 50 patients of migraine who fulfilled inclusion criteria were enrolled in the study along with the same number of healthy controls. International Classification of Headache Disorders 3rd Edition, 2013 (ICHD-III) criteria was used for the diagnosis of migraine.

Results:
The mean serum Mg in migraine cases during the interictal phase was lower than healthy controls (1.849 ± 0.135 vs 2.090 ± 0.205, P < 0.001), which was statistically significant. It was also found that mean serum Mg during attacks was significantly lower than in between attacks (1.822 ± 0.149 vs 1.849 ± 0.135, P = 0.003). Serum Mg levels in migraine cases showed an inverse linear relationship with the frequency of attacks.

Conclusion:
Relatively low serum Mg in migraine cases when compared with healthy controls and inverse relation of serum Mg levels with the frequency of migraine attacks suggests that Mg is significantly involved in mechanisms underlying migraine pathogenesis, which can be explored as a therapeutic option.
Laterality of Posterior Cerebral Artery and White Matter Hyperintensities in Patients with Severe Internal Carotid Artery Stenosis
Authors: Qiu Jianting , Ye Huirong , Wu Qing , Liang Caihong , Wang Jian , Wang Yujie 
Published: November 2022

Background:Collateral status of the circle of Willis was associated with white matter hyperintensities (WMHs) in patients with internal carotid artery (ICA) stenosis, but few have investigated the effect of leptomeningeal anastomoses.Objective:The aim of this study was to observe the association between WMHs and the laterality of the posterior cerebral artery (PCA) that presents leptomeningeal anastomoses in patients with severe ICA stenosis.Materials and Methods:WMHs and ipsilateral PCA laterality were evaluated in patients with unilateral ICA stenosis ≥70% (including occlusion) and contralateral ICA stenosis <50% or no stenosis. Ipsilateral PCA laterality was compared between two groups of no/mild and severe score of global, deep and periventricular WMHs, respectively.Results:We included 115 patients with unilateral ICA stenosis ≥70%. There were 60 patients with no/mild and 55 with severe global WMHs. The patients with severe global WMHs were older (OR = 1.849, 95% CI: 1.058–3.229,P= 0.031) and had higher incidence of negative PCA laterality (OR = 3.301, 95% CI: 1.140–9.558,P= 0.028). The patients with severe deep WMHs were also older (OR = 2.031, 95% CI: 1.130–3.651,P= 0.018) and had higher incidence of negative PCA laterality (OR = 4.250, 95% CI: 1.501–12.032,P= 0.006). There was no significant difference between the patients with no/mild and severe periventricular WMHs in the incidence of negative PCA laterality.Conclusions:The incidence of negative PCA laterality was higher in patients with severe global and deep WMHs, but not higher in patients with severe periventricular WMHs. The leptomeningeal anastomoses may affect the deep WMHs in patients with severe ICA stenosis.
Clinical Profile of Tension Type Headache in a Medical College with Special Emphasis on Triggering Factors
Authors: Guruswamy Anantha , Swamy Sreekanta , Kurpad Krishna Prasad 
Published: November 2022

Background and Objectives:Tension type headache is one of the costliest primary headaches which can cause a significant impact on an individual's life. Healthcare professionals are exposed to multiple trigger factors which give rise to an increase in headache frequency, most notable reasons being sleep disturbances, stress and untimely food habits. With this background, we conducted this study of detailed clinical profile and trigger factors among the 2050 subjects (MBBS students: 909, BDS students: 323, nursing students: 268, postgraduates students and staff: 550) in our medical institute.Materials and Methods:Subjects were given questionnaires on headache and were instructed to give the details of their clinical symptoms along with relevant questions on trigger factors. The assessment tools used were the Visual Analogue Scale (VAS) and Migraine Disability Assessment Scale (MIDAS).Results:Out of 2050 subjects, 464 patients suffered from tension type headache. Overall prevalence of tension type headache was 22.6%. Prevalence was higher in females (57.9%) as compared to males (42.1%). Headache experienced by majority of the student population was unilateral (31.4%), pulsating type (51.6%) and of moderate intensity (77.1%). Common associated symptoms were nausea associated with other factors (40%) and photophobia and phonophobia (18.6%). Stress (72.1%) and decreased sleep (49.4%) were the most common triggering factors. Practice of self-medication was reported by 80.2% of subjects.Conclusion:Our study noted a high frequency of trigger factors in medical professionals, the most common triggering factors being stress and disturbed sleep. To our knowledge this is the first large study to evaluate headache and specifically tension type headache among medical professionals.
Folate Receptor Alpha is Decreased in Pregnancy Affected with Fetal Neural Tube Defect
Authors: Singh Neeta , Mishra Richa , Misra Prabhaker , Shaleen Archita , Pradhan Mandakini 
Published: November 2022

Background:Neural tube defect (NTD) is a multifactorial disorder. Decrease transfer of folate to the developing embryo is one of the etiologies. It could be due to decrease folate receptors resulting in NTD in fetus.Objective:To analyze serum folate receptor alpha (FOLR1) concentration in women having fetus with NTD and compare it with women having normal fetus during and after pregnancy.Material and Methods:This was a prospective case control study conducted in a tertiary care hospital. Pregnant women with detected isolated NTD in fetus were enrolled as cases and equal number of matched pregnant women without any fetal congenital malformation were recruited as controls. Serum FOLR1 levels were analyzed in cases and controls during pregnancy and 6 weeks after delivery.Results:Mean serum FOLR1 concentration during pregnancy was 70.5 pg/mL (range: 23.8–98.5 pg/mL) and 103.9 pg/mL (range: 70-110 pg/mL) in cases and controls, respectively. Serum level of FOLR1 was 448.9 pg/mL (range: 133.5–475) and 414.5 pg/mL (range: 269.7–412.5) in cases and controls at 6 weeks postpartum, respectively. There was statistically significant difference (P< 0.001) between cases and control during pregnancy but not in postpartum (P= 0.092). There was significant increase in level of FOLR1 in both cases and control at 6 weeks postpartum as compared to antenatal period.Conclusions:Maternal serum FOLR1 is significantly reduced in pregnancy with fetal NTD as compared to normal pregnancy. The level is significantly increased in postpartum period in both groups. FOLR1 level being similar in both groups in postpartum indicates that it is not influenced by the history of fetal NTD.
Rituximab in Myasthenia Gravis- Experience from a Low- and Middle-Income Country (LMIC) Setting
Authors: Shivaram Sumanth , Nagappa Madhu , Varghese Nibu , Seshagiri Doniparthi V , Duble Shishir , Siddappa Shreedhara Anjanapura , Hesarur Nagabushan , Sinha Sanjib , Taly Arun B 
Published: November 2022

Background:
Myasthenia gravis (MG) is an immune-mediated disorder of the neuromuscular junction. About 10% are refractory to immunosuppressive therapy.

Aims:
To analyze the response of patients with generalized MG to rituximab.

Methods and Materials:
A retrospective review of patients with MG who received rituximab was carried out (n = 13, M:F = 6:7, mean age: 44.84 ± 15.73 years). Myasthenia Gravis Foundation of America (MGFA), MGFA post-intervention status (MGFA-PIS), and Myasthenia Gravis Status and Treatment Intensity (MGSTI) were assessed before and after rituximab.

Results:
The duration of MG was 104.07 ± 92.25 months. Before rituximab, the MGFA was IIA/IIB/IIIA/IIIB/IVB/V in 1/1/2/6/2/1 patients and MGSTI was four in eight patients and six in three patients. The mean duration of follow up was 20.92 ± 14.06 months (range, 4 to 42 months). Dose reduction or discontinuation of cholinesterase inhibitors could be achieved 12 patients. Complete stable remission (CSR) and pharmacologic remission (PR) were achieved in one and four patients respectively and five patients had minimal manifestations. Most patients attained level 0, 1 or 2 MGSTI at last follow up. No rituximab infusion-related adverse events were noted. Three patients had exacerbation of MG between one to five weeks after rituximab administration. Three patients died, one each due to a cardiac event unrelated to MG or treatment, complications related to myasthenic crisis, and coronavirus disease.

Conclusions:
Rituximab was effective in bringing about remission in MG and can be considered as a first-line agent. However, it has to be administered under close supervision as some patients develop exacerbation of MG akin to steroid-induced worsening.
Post-Traumatic Stress Disorder after Stroke
Authors: Tang Wai Kwon , Wang Lisha , F Tsoi Kelvin KF , Rutovic Stela , Kim Jong S 
Published: November 2022

Background:Post-traumatic stress disorder (PTSD) is a common and debilitating illness that accompanies many neurological disorders, including stroke.Objective:The aim of this systematic review was to identify and critically appraise all published studies that have reported the frequency, severity, and time course of PTSD after stroke, the factors associated with its development, and its impact on patients' lives.Material and Methods:The PubMed EMBASE, PsycINFO, and Ovid Nursing databases were searched for studies published in English that had recruited at least 10 patients (>18 years old) after stroke and who were also diagnosed with PTSD.Results:Twenty studies covering a total of 1785 patients met the study inclusion criteria. The frequency of PTSD ranged from 3% to 31%, with a weighted proportion of 16.5%. PTSD runs a chronic course. PTSD after stroke was associated with premorbid neuroticism, negative affect, and maladaptive coping styles. Comorbid depression and anxiety also increased the risk of PTSD. Psychological factors such as negative appraisal and perceived high risk of recurrence and distress were associated with PTSD. Good social support reduced the risk of PTSD. PTSD reduced patients' quality of life, physical functioning, and medication compliance.Conclusions:PTSD is common after stroke. Further research is needed to clarify its time course and identify the neurochemical factors and brain circuits associated with the development of post-stroke PTSD. Randomized controlled treatment trials targeting PTSD in stroke are warranted.
Fluoro-2-Deoxyglucose-Positron Emission Tomography/Computed Tomography in the Diagnosis and Management of Adrenocortical Carcinoma
Authors: Krishnaraju Venkata Subramanian , Kumar Rajender , Subramanian Karthikeyan , Mittal Bhagwant Rai , Singh Harmandeep , Chatterjee Debajyoti , Walia Rama 
Published: November 2022

Purpose:
Adrenocortical carcinoma (ACC) is a rare primary malignancy of the adrenal gland. The present study was aimed to compare the performance of fluoro-2-deoxyglucose-positron emission tomography–computed tomography (FDG-PET-CT) compared to contrast-enhanced computed tomography (CECT) in diagnosis and management of ACC.

Materials and Methods:
A retrospective analysis of the PET-CT studies from January 2010 to October 2020 was performed. Patients with adrenal lesions suspicious of ACC and diagnosed cases of ACC who underwent PET-CT for staging, restaging, and surveillance were reanalyzed. The PET-CT parameters were compared with the clinical, biochemical, histopathological, and CECT parameters.

Results:
The study included 96 scans performed in 77 patients (36 males, aged 40.4 ± 17.9 years). Of these, 55 scans were performed to diagnose and stage suspected ACC (30 of them diagnosed as ACC), 31 for restaging, and 10 scans for surveillance of ACC. PET/CT revealed metastases from an extra-adrenal primary in 5/55 patients. FDG-PET-CT had a sensitivity and specificity of 100% and 70% to diagnose ACC. Standardized uptake value-peak more than 5.4 had a sensitivity of 90.9% and specificity of 91.7% for differentiating ACC from non-ACC lesions, while tumor-to-liver ratio peak (TLRpeak) of 3.3 was most specific. PET-CT changed the staging in 23.3% of the patients with an accuracy of 100%. PET-CT changed the management plan in 25.8% of the patients during restaging with a sensitivity and specificity of 95.6% and 100%, respectively. For surveillance, CECT was as sensitive as PET-CT; however, PET-CT was more specific (100% vs. 97.9%).

Conclusion:
FDG-PET-CT performs better than CECT in the diagnosis, staging, restaging, and surveillance of ACC.
Unusual presentation of cribriform adenocarcinoma of salivary glands: A case report
Authors: Kamal Noura M. , Nahla Mohamed F. , Mahmoud Sarah A.M. 
Published: November 2022

ABSTRACT
According to the last edition of the World Health Organization classification, cribriform adenocarcinoma of salivary glands (CASGs) was considered a variant of polymorphus adenocarcinoma although many authors proposed CASG as a distinct neoplasm. The aim of this study was to report an unusual presentation of CASG in the buccal mucosa of a 63-year-old male patient that showed signs of encapsulation and no evidence of lymph node metastasis. The lesion was composed of lobules of tumoral cells arranged in solid nests, sheets, papillary, and cribriform or glomeruloid patterns. Most of the peripheral cells show palisaded arrangement with peripheral clefting from the adjacent stroma. Surgical resection of the lesion was done and further neck dissection was recommended.
Psychological distress and coping styles among baccalaureate nursing students
Authors: Sharma Ankita , Kumar Rajesh 
Published: November 2022

BACKGROUND:
Coronavirus disease (COVID-19) causes significant psychological distress among nursing students. College-bound nursing students might have preferred different types of coping strategies to deal with psychological distress. This study aims to measure the psychological distress and role of coping styles to mediate the stress level among the baccalaureate nursing students amid the COVID-19 pandemic.

MATERIAL AND METHODS:
A cross-sectional online survey was conducted in December 2020 at a nursing college attached to a tertiary care teaching hospital, North India. Nearly 251 baccalaureate nursing students completed the Impact of Event Scale-Revised (IES-R) and Coping Orientation to Problems Experienced Inventory (Brief-COPE) scale to report their psychological distress and coping styles, respectively. Chi-square test, independent sample t-test followed by binary and multivariable regression were used to identify the factors associated with distress in students during the pandemic.

RESULTS:
Students' mean age was 22.22 ± 1.24 years. The mean IES-R was 19.59 ± 12.45 in nursing students. Psychological distress found a significant association with age (P = 0.022), academic class (P = 0.016), travel history (P = 0.034), and being positive reverse transcription–polymerase chain reaction (RT-PCR) for COVID-19 status of self (P = 0.018) and family members in the medical profession (P = 0.013). In binary logistic regression, stress level found a significant association with first-year academic level (OR: 3.250, 95% CI: 1.429–7.390, P = 0.005) and family members in the medical profession (OR: 4.44, 95% CI: 1.019–19.382, P = 0.047). Adaptive coping styles were more frequently preferred than maladaptive coping styles (54% vs 41%). Adaptive (r = 0.295, P < 0.001) and maladaptive coping (r = 0.403, P < 0.001) shows a significant positive relationship with stress in students, respectively.

CONCLUSIONS:
Coronavirus pandemic causes significant distress among nursing students. Students were able to manage stress using acceptance and religious/spiritual coping strategies. During the pandemic, stress management to support mental health is highly recommended.
An overview and analogy of pedagogical approaches in online–offline teaching tactics in COVD-19 pandemic
Authors: Daulatabad Vandana , Kamble Prafull , John Nitin , John Jyoti 
Published: November 2022

BACKGROUND:
Learning helps acquire knowledge or skills. COVID-19 outbreak severely affected the progress of education all across the globe. Pandemic-induced alternative methods of teaching promoted the progress of online education. Hence, this study is undertaken to assess an overview of teaching learning strategies in the COVID-19 pandemic so as to explore the direction of medical education and help perk up the teaching learning methods in medical education.

MATERIAL AND METHODS:
The cross-sectional study involves first year medical undergraduate students of 2020–2021 batch studying at Dr. VMGMC, Solapur. It involves complete enumeration of students of 2020-2021 batch. Due to the second wave of COVID-19 pandemic hematology, classes were continued and completed by the same faculty by online live teaching using Microsoft teams. As this being an online survey, it was ethically exempted. A comparison of questionnaires between offline and online classes was done by using χ2test and a P value less than 0.05 was considered as significant. Quantitative data generated by the dichotomous question and five-point Likert scale questions were analyzed using descriptive statistics and frequency analysis. Out of 189 respondents, majority of students preferred traditional offline classes over online classes. Self-directed learning was feasible in both methods of teaching.

DISCUSSION:
Traditional offline classes were more interactive and enthusiastic than online classes. Offline classes helped students to revise, recollect, and reproduce necessary information as their attention span was better in offline teaching than online teaching.

CONCLUSION:
Holistic understanding and better learning were experienced through traditional offline classes. Although teachers take double efforts for online teaching, the overall learning effect and impact of traditional offline classes were much better than online classes. It definitely motivates andrgaogy and helps understand the concept on their own.