bluuebunny/crossref_metadata_2025_split huggingface dataset:
Optimal dose of bevacizumab in recurrent glioma
Authors: Dsouza Hollis , Singh Gunjesh Kumar , Menon Nandini , Abhyankar Anuja , Puranik Ameya , Mahajan Abhishek , Janu Amit , Kalra Devanshi , Dale Ochin , Varghese Litty , Epari Sridhar , Chatterjee Abhishek , Krishnatry Rahul , Gupta Tejpal , Jalali Rakesh , Patil Vijay M 
Published: March 2022

Background:Recurrent gliomas have a dismal prognosis. They can be treated with re-surgery and re-irradiation. Bevacizumab as a single agent or in combination with chemotherapy is an alternative treatment option. However, in our country, a considerable proportion of patients cannot afford the approved 10 mg/kg dose.Objective:This study was aimed at evaluating the efficacy of low-dose bevacizumab in recurrent gliomas.Methods:Patients with recurrent gliomas presenting to our Neuro-Medical Oncology unit between July 1, 2015, and November 30, 2018, were retrospectively analyzed. The patients were divided into two groups, those treated with ≤5 mg/kg of bevacizumab (low dose) and those treated with >5–10 mg/kg (standard dose) of bevacizumab. The status of isocitrate dehydrogenase (IDH) and O[6]-methylguanine-DNA methyltransferase was recorded. The primary endpoint of the study was overall survival (OS), and the secondary endpoints were progression-free survival (PFS) and adverse events.Results:A total of 68 patients were treated with bevacizumab, of which 23 (33.8%) received the low-dose regimen. At a median follow-up of 26.2 months, there was no difference in the median PFS (low-dose group: 3.60 months; 95% confidence interval [CI], 2.5–7.47 vs. standard-dose group: 3.67 months; 95% CI, 2.17–4.53) (P= 0.18) and median OS (low-dose group: 7.33 months; 95% CI, 3.97–9.10 vs. standard-dose group: 5.47 months; 95% CI, 4.67–6.2) (P= 0.27). In addition, the adverse events were not significantly different between the two groups.Conclusion:Low-dose bevacizumab may be effective in the treatment of recurrent gliomas and should be compared with standard dose in prospective randomized studies.
The impact of alcohol intoxication on early Glasgow Coma Scale-Pupil reactivity score in patients with traumatic brain injury
Authors: Thamminaina Abhinov , Prasad K. J. Devendra , Abhilash T. , Moorthy D. G. S. R. Krishna , Rajesh K. 
Published: March 2022

Background:
A simple arithmetic combination of the Glasgow Coma Scale (GCS) score and pupillary response, the GCS-Pupil (GCS-P), extends the information provided about the patient outcome to an extent comparable to that obtained using more complex methods. The objective of the study was to compare the changes in the GCS-P score of patients with traumatic brain injury (TBI) under alcohol intoxication and nontoxication over time.

Methods:
A prospective observational study was done in a hospital at the Level I trauma center. The patients admitted to the emergency department (ED) with TBI were the study participants. They were grouped into intoxicated and nonintoxicated based on blood alcohol concentration (BAC). BAC of 0.08% and above was considered intoxication. GCS-P score in the ED and the best day 1 GCS-P score were the outcome variables. For nonnormally distributed quantitative parameters, medians and interquartile range were compared between study groups using Mann−Whitney U-test. P <0.05 was considered statistically significant.

Results:
A total of 216 patients were included in the final analysis. There was no statistically significant difference between BAC in GCS-P score at different follow-up periods, GCS-P score (ED), and GCS-P score (best day 1).

Conclusion:
This prospective observational study showed a low GCS-P score for alcohol-intoxicated patients compared to nonintoxicated patients, which was not statistically significant. There was no significant difference in emergency GCS-P score and best day 1 score between alcohol-intoxicated and nonintoxicated patients.
Direct medical cost and cost analysis of COVID-19 in Iran
Authors: Mirhashemi Seyed Hadi , Mostafavi Hakimeh , Mollajafari Fariba , Ahmad Zohreh Zadeh , Hashempour Reza 
Published: March 2022

Background:
Although our daily life and economics were severely affected by COVID-19, cost analysis of the disease has not been conducted in Iran. Hence, we aimed to perform a cost analysis study and then estimate direct medical costs of COVID-19.

Methods:
A cross-sectional study was performed in Tehran and recorded medical files from March 1, 2020, to September 1, 2020, were examined. A predefined electronic form was developed and all required variables were included. All people whose both first and final diagnoses were COVID-19 positive and were admitted in governmental hospitals were considered for inclusion. Using stratified random sampling method, 400 medical records were evaluated to gather all data. STATA 14 was used for data analysis.

Results:
We evaluated 400 medical records and the age of patients ranged from 22 to 71 years. The mean cost of COVID-19 was 1434 USD. Of 400 patients, 129 of them had underlying disease and statistical significance was observed in people who had underlying diseases than people who did not have underlying disease.

Conclusion:
Beds and medications were the most important factors that added to the costs. COVID-19 has undoubtedly imposed a high financial burden on the health system. It is highly recommended that patients with positive test result be strictly encouraged to stay at home and adhere to safety protocols.
Impact of the COVID-19 lockdown on trauma team activations in a single major Lithuanian trauma center
Authors: Aukstakalnis Vytautas , Blaziene Kristina , Cepla Juozas , Vileitaite Greta , Stasaitis Kestutis , Vaitkaitis Dinas 
Published: March 2022

Background:
As a result of the coronavirus disease 2019 (COVID-19) pandemic and national quarantine, different levels of social and movement restrictions, and stay-at-home requests, trauma trends have changed. The aim of the present study was to determine the impact of lockdown on patients treated by the trauma team (TT) at a single major Lithuanian trauma center during the COVID-19 pandemic.

Methods:
This is a retrospective, descriptive study of adult (≥18 years old) trauma patients (for whom the TT was activated). Consequently, we analyzed the national lockdown periods from 16 March to 15 May 2020 and from 16 December 2020 to 28 February 2021, compared with the corresponding period of the previous year.

Results:
There was a 10% reduction in TT activations during the national lockdown period. No significant differences were noted in patient demographics. In the COVID-19 cohort, patients had higher Injury Severity Score (14 [IQR 6−21] vs. 9 [IQR 3−18], P = 0.025) and longer time to computed tomography scan (33 [IQR 25−43] vs. 23 [IQR 20−31] min, P < 0.001). Moreover, in the COVID-19 cohort, three times more patients were transferred from the emergency department (ED) straight to the operating room (n = 12 [19%] vs. n = 4 [5.7%], P = 0.018, Cramer's V = 0.21).

Conclusion:
Patients were more severely injured, and more patients required emergent surgery during the lockdown. In addition, it took longer to transfer patients to the ED and to perform a computed tomography scan.
Retrospective Validation of Global Limb Anatomic Staging System with Respect to Technical Failures in Endovascular Infrainguinal Revascularization for Critical Limb Threatening Ischemia
Authors: Fathima Shabnam , Subramanian Sairam 
Published: March 2022

Introduction:
The Global Vascular Guidelines proposed the Global limb anatomic staging system (GLASS) to overcome the shortcomings of previous multiple classification system. It grades the infrainguinal disease into three stages with a specific algorithm to score the femoropopliteal and tibial segments. We aim to retrospectively validate the GLASS staging in primary endovascular therapy with respect to immediate technical failures (ITFs).

Materials and Methods:
Retrospective data from November 2017 to September 2021 were collected from the existing clinical database. All patients who underwent primary infrainguinal endovascular intervention for critical limb-threatening ischemia were included in the study. The patient who had isolated infrapopliteal disease without a named tibial outflow and only inframalleolar disease were excluded. The GLASS scoring was applied to the angiographic details in the database. The ITFs from the database were compared to the predicted technical failure according to GLASS staging. Statistical analysis was done.

Results:
Hundred thirty-two patients were studied from clinical database. We had 13 (9.8%) ITFs. None of those in GLASS Stage I had failure. Among 26 patients in Stage II, 1 (4%) had failure, against the predicted failure rate of lesser than 20%. Among 89 patients in GLASS Stage III, only 12 (13.5%) had failures against the predicted failure rate of more than 20%. The majority of failures had occurred in higher GLASS staging.

Conclusion:
Higher failures in higher GLASS staging have been validated by our study. However, it is limited considering the small cohort and retrospective analysis.
How to Conduct Inferential Statistics Online
Authors: Mondal Shaikat , Saha Swarup , Mondal Himel , De Rajesh , Majumder Rabindranath , Saha Koushik 
Published: March 2022

Introduction:
Research data are first organized and visualized with the help of descriptive statistics. The next step is the inferential statistics. Result of the inferential statistics helps to conclude the finding. Many researchers and medical students may not have access to dedicated software for biostatistics.

Aim:
This study aimed to provide a guide on the conduct of common inferential statistics that can be done online.

Methods:
Common inferential statistical tests for both numerical data and categorical data were described in this study. All the tests were conducted online and the process is described step by step with example data.

Results:
The following tests were described-one-sample t-test, one-sample median test, unpaired t-test, Mann–Whitney U-test, paired t-test, Wilcoxon signed-rank test, one-way analysis of variance (ANOVA), Kruskal–Wallis test, repeated-measure ANOVA, Friedman Test, Pearson correlation test, Spearman correlation test, Binomial test, Chi-square test, Fisher's exact test, and MacNemar test. All these tests could be conducted online from a computer connected to the internet.

Conclusion:
We could conduct common inferential statistical tests online without any installed software. Anyone without prior data analysis knowledge may conduct the tests with example data on any internet browser. We presume that these would help the medical undergraduate and postgraduate students.
Evolving Paradigm of Hybrid Repair for Aortic Arch Pathologies
Authors: Unnikrishnan Madathipat , Viswanathan Sidharth , Pitchai Shivanesan , Savlania Ajay , Ramachandran Harishankar , Kumar Vineeth P M , Mohanan Arun Mohan , Gopalakrishnan Praveen , R Kapilamoorthy T , Dash Prasanta Kumar 
Published: March 2022

Background:
Critical domain of thoracic aorta, the aortic arch, is affected by diverse pathologies mandating effective yet less strenuous management to save life, preserve organ function, and provide quality of life. Conventional open repair, minimally invasive total endovascular, and hybrid aortic arch repair are therapeutic options available. We present our experience and results with hybrid arch procedures.

Materials and Methods:
A cohort of 75 patients who were operated upon by the senior author from 2007 to 2020 formed the basis for this report. Male: female ratio was 11:1 for this group whose age ranged from 22 to 82 years with a mean of 70. Clinical indications were degenerative aneurysm (n = 49), Stanford B aortic dissection (n = 21), residual lesion following earlier Stanford A repair (n = 4) and a solitary patient with aortic trauma. Pan-arch debranching or hemi-arch debranching was performed in nearly all along with deployment of stent-graft at Zone 0 or Zone I, respectively. Sixty-seven elective (89.3%) procedures were staged and 8 (10.7%) were synchronous on account of being emergency interventions. Postoperative follow-up was performed at 3 and 6 months and yearly. Computed tomography aortogram was done before discharge from hospital or within 1 month followed by 1 year.

Results:
Technical success was achieved in 97.3%. Inhospital/30-day mortality was 9.3% (7/75 patients). Neurological complications, albeit less common, were the leading cause of perioperative morbidity. No endoleaks or graft migration was encountered in follow-up. Late mortality occurred in 10.3% (7/68 patients) from 6 months to 5 years, with massive hemoptysis in three despite asymptomatic clinical status and satisfactory imaging. Two patients were lost for follow-up, while the rest 59 patients are keeping well.

Conclusion:
Hybrid repair of aortic arch lesions, though initially intended to compliment stressful conventional surgery, has now evolved as the primary modality in this domain. This relatively safe therapeutic option, performed in a staged setting coupled with attention to achieve a liberal proximal seal, provided excellent initial results and long-term survival.
Use of Medial Gastrocnemius Muscle Flap in Traumatic Popliteal Artery Injury Due to Posterior Dislocation of Knee Joint
Authors: Korambayil Pradeoth Mukundan , Dilliraj Vinoth Kumar , Babu Edwina Mary , Varkey Prashanth Ambookan 
Published: March 2022

Introduction:
Injury to the popliteal region affects vascularity and soft tissue necrosis. The purpose of the study is to use the medial gastrocnemius muscle flap to enhance the soft tissue cover of the injured area.

Materials and Methods:
This retrospective study was conducted in the Department of Plastic surgery from January 2019 to December 2020. All patients admitted under the department with posterior dislocation of the knee with vascular compromise to the limb were enrolled in the study.

Results:
Five patients were included in the study. In all the five cases, the limb was salvaged with reverse saphenous vein graft harvested from the thigh region of the opposite limb with soft tissue cover of medial gastrocnemius muscle flap. Postoperative limb movements were satisfactory. The average duration of hospital stay was approximately 21 days.

Conclusion:
Usage of medial gastrocnemius flap serves an adequate soft tissue coverage in traumatic popliteal artery injury
Nosocomial infections-related antimicrobial resistance in a multidisciplinary intensive care unit
Authors: Kumar Amit , Tanwar Shweta , Chetiwal Rajesh , Kumar Rohit 
Published: March 2022

Background:
Intensive care units (ICUs) have become hubs of nosocomial infections worldwide. There has been a continuous rise in the development of antimicrobial resistance among ICU-acquired infections. Particularly, the Gram-negative bacteria implicated in ICU-acquired infections have become resistant to the majority of the antibiotics leading to a critical therapeutic problem. The present study was conducted to determine the antimicrobial resistance pattern of microorganisms causing nosocomial infections (ventilator-associated pneumonia [VAP], central line-associated bloodstream infection [CLABSI], and catheter-associated urinary tract infection [CAUTI]) in a multidisciplinary ICU.

Materials and Methods:
This prospective observational cohort study included the patients with ICU stay ≥ 48 h and any of the ICU-acquired infections: VAP, CLABSI, or CAUTI. The appropriate specimen was collected as per the standard procedure and cultured. The antimicrobial susceptibility of all the bacterial isolates recovered from the samples was performed according to the Clinical and Laboratory Standards Institute (CLSI) recommendations. The antimicrobial resistance data were analyzed using WHONET Microbiology Laboratory Database software 5.6 (WHONET 5.6).

Results:
Gram-negative microorganisms were the principal pathogens causing various infections in the ICU, out of which Pseudomonas aeruginosa and Klebsiella pneumonia were the commonest. Most of the Gram-negative bacteria showed a high degree of resistance to the majority of the antibiotics. Colistin was observed to be the most effective antimicrobial for Gram-negative pathogens followed by doripenem, meropenem, and tigecycline. The majority of Staphylococcus aureus isolates (71.4%) were methicillin-resistant S. aureus; however, all were sensitive to vancomycin and linezolid. Vancomycin-resistant Enterococci constituted 43% of Enterococcus isolates and were sensitive to linezolid and tigecycline.

Conclusion:
Antimicrobial resistance was very high among the pathogens causing nosocomial infections in the ICU, especially Gram-negative bacteria demonstrated a substantially high degree of resistance to the majority of the antibiotics. Antibiotic stewardship will help control the emergence of multidrug-resistant microbes.
Evaluation of the efficacy of levonorgestrel intrauterine system in the management of heavy menstrual bleeding
Authors: Halder Koyel , Ray Rathindra Nath , Biswas Priyam , Kolay Pritha , Kumari Shefali , Das Dibyojyoti 
Published: March 2022

Background:
Heavy menstrual bleeding (HMB) poses threat to the quality of life among women. To prevent HMB, the levonorgestrel-releasing intrauterine system (LNG-IUS) is a well-known nonsurgical, long-performing, and alternative method.

Objectives:
The objective of this study was to determine the efficacy of LNG-IUS in women with HMB through an analytical observational study.

Materials and Methods:
This study was performed among 60 patients who visited the gynecology and obstetrics outpatient department (OPD) at the Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital (IPGMER and SSKMH), Kolkata, West Bengal, India from May 2019 to April 2020 due to HMB. The mean demographic and clinical profiles were evaluated, and comparative analysis was performed for hemoglobin (Hb), spotting, pain, and endometrial thickness on day 0 and follow-up 3 months, 6 months, and 12 months.

Results:
The mean age of patients was 37.77 ± 4.58 years was obtained. The Hb level was significantly (P < .001) increased, whereas pictorial blood loss assessment chart (PBAC) score, endometrial thickness, spotting, and pain were significantly (P < .01 and P < .001) reduced. The majority of patients had pallor, but the rates of spontaneous expulsion and hysterectomy were observed lower after using LNG-IUS among studied patients.

Conclusion:
the usage of LNG-IUS is potential in the treatment of HMB in women, which may lead to a better quality of life. This can be the alternative to hysterectomy and oral pills for long-term use. It is suggested in a future study with larger sample size and multicentric approach to minimize hospital biasness.
Methylene blue treatment for moderate-to-severe cases of acute respiratory syndrome due to COVID-19 infection
Authors: Ghodke Babita A. , Ghodke Ashok , Mahadik Virendra , Thorat Pooja 
Published: March 2022

Background:
We studied the real-life experience with Methylene blue administration among the moderate and severe cases of acute respiratory distress syndrome due to Covid-19 infection with the standard of care.

Materials and Methods:
This study is a prospective, single-center study including 103 hospitalized patients conducted in a tertiary healthcare center from June 2020 to July 2021. The route of administration of Methylene blue was through nebulization (0.5 mL 0.5% solution of Methylene blue + 2.5 mL of distilled water) three times a day as long as the patient was admitted. An ampoule of 10 mL of Methylene blue with 90 mL of potable water through oxygen port was administered as long as they needed oxygen. About 2 mg/kg body weight of Methylene blue in 300 mL of N.S. over 3 h was given once a day for 5 days.

Results:
Approximately 103 patients were seen with a mean age of 56.49 years. The most prevalent comorbid condition was diabetes. The SpO2 improved by 7.827%. On post-Methylene blue administration, the serum ferritin, C-reactive protein, lactate dehydrogenase, and D-dimer were reduced in comparison to pre-Methylene blue administration. Also, the average total length of stay was 14

±
4.20, 13

±
5.66, and 14

±
3.50 days in 26.78% of patients in intensive care unit, 17.51% of patients in high dependency unit, and 58.71% of patients in Covid general ward, respectively. About 86.4% of the patients recovered and got discharged post-Methylene blue administration. The all-cause mortality was 13.59%, which could be due to underlying comorbidities and complications of Covid-19 infections.

Conclusion:
Methylene blue administration accelerated recovery in our patients with moderate and severe Covid-19 disease by controlling the hyperimmune response. The clinical improvement was seen by decreased levels of inflammatory markers, improved oxygen saturation, reduced length of hospital stay, and clinical improvements. Methylene blue administered in nebulization form, through oxygen port, and through intravenous infusion in the dose of 2 mg/kg body weight for 5 days and improved patients’ recovery, so it can be considered as a therapeutic option in moderate and severe Covid-19 disease.
A cross-sectional study of immunohistochemical evaluation of surface epithelial ovarian tumors
Authors: Pandey Vikas , Mishra Jyotirmayee , Potdar Pralhad S. 
Published: March 2022

Background:
Ovarian cancer is one of the most common malignancies in female patients. In recent years, immunohistochemistry (IHC) has emerged as an important tool in the diagnosis of ovarian tumors. The study aimed to assess estrogen receptors (ERs), progesterone receptors (PRs), Her-2-neu, and Ki-67 by IHC in surface epithelial ovarian tumors and to correlate the findings with different variables.

Materials and Methods:
It was a cross-sectional study. Oophorectomy/salpingo-oophorectomy/cystectomy specimens were included in this study. IHC was done on 10% neutral buffer formalin-fixed paraffin-embedded tissue sections by using Dako FLEX Ready to use mouse monoclonal antibodies and DakoEnvisionTM FLEX/HRP detection reagent.

Results:
The study includes 81 cases of surface epithelial ovarian tumors (a benign serous tumor [20], a benign mucinous tumor [18], a borderline mucinous tumor [5], low-grade serous carcinoma [8], high-grade serous carcinoma [19], mucinous carcinoma [7], endometrioid carcinoma [2], borderline Brenner tumor [1], and malignant Brenner tumor [1]. ER had higher expression in malignant cases (51.33%) than in benign cases (15.8%). PR had higher expression in malignant tumors (54.05%) incomparable to benign (18.42%) and borderline tumors (16.66%). PR had higher expression in high grade. Expression of Her-2-neu positivity was found to be 29.7% out of the total 81 cases. Her-2-neu was found in 11 high-grade tumors among 31 malignant cases. CA-125 levels were significantly higher in malignant ovarian tumors (P = 0.0143). Proliferation activity was considered low if proliferation index (PI) <10% and high if PI >10%. The study showed high PI in malignant tumors.

Conclusion:
Expression of these marks in adjunct to H&E diagnosis may prove beneficial in differentiating benign, borderline, and malignant cases, in which a diagnosis of borderline cases based on sole H & E is doubtful.