bluuebunny/crossref_metadata_2025_split huggingface dataset:
Duodenal diverticulum perforation: a case report and review of the literature
Authors: Mitragkas Paraskeuas , Synekidou Eirini , Hatzimisios Konstantinos 
Published: October 2022

Duodenum is the second most common site for diverticula formation. Duodenal diverticula (DD) are asymptomatic incidental findings and their complications are rare. The rarest and most severe complication is DD perforation. Until 2012, only 162 cases of DD perforation were reported in the world literature.
A woman presented with acute abdomen and peritonitis. CT scan revealed hydropneumoretroperitoneum suggestive of duodenal perforation. The patient underwent an exploratory laparotomy and the diagnosis of a DD perforation was made. A diverticulectomy with tube duodenostomy was performed, without complication.
A duodenal diverticulum perforation can be treated either surgically or conventionally. Only selected patients can be treated conventionally. Surgical treatment remains the standard option. Treatment must be individualized.
Application of odontometric dimensions of molars in sex assessment in Bulgarians
Authors: Harizanova Zdravka , Baltadjiev Atanas , Yordanova Miroslava , Ahmed-Popova Ferihan , Boyaci Emre 
Published: October 2022

Introduction: Sex estimation is an important step in developing a biological profile. Teeth are one of the most durable physical elements in the human body and thus can be used very successfully for this purpose. The aim of the present study was to determine sex differences in odontometric dimensions of maxillary and mandibular molars in Bulgarians.
Materials and methods: The study included 232 healthy subjects (121 males, 111 females) of Bulgarian origin in the age group of 20–40 years, with fully erupted, periodontal disease free, caries free, non-worn teeth. Vestibulolingual, mesiodistal and cervicoincisal (coronal height) dimensions of maxillary and mandibular molars were measured by Dentistry Sliding Vernier Caliper, Ridge Mapping Caliper Type A and Type B and analyzed with SPSS 23.0. The level of statistical significance was set at p&lt;0.05.
Results: Cervicoincisal dimensions in both maxillary and mandibular molars, except for the maxillary left second molars, were significantly higher in males compared to females. Similar statistically significant differences were found in mesiodistal dimensions in first molars from both jaws. Vestibulolingual dimensions in both maxillary and mandibular first molars and mandibular second molars were significantly higher in males compared to females as well.
Conclusions: The results of our measurements exhibited statistically significant sex differences in both maxillary and mandibular molars in people of Bulgarian origin. In accordance with similar odontometric studies, molars may successfully differentiate both sexes and thus determine the need for further investigations in this field.
Evaluating the relation of posterior occlusal plane to ala-tragal line according to age and sex
Authors: Ghodsi Safoura , Sef Omrani Soroush , Mogharrabi Sara , Valizadeh Sara 
Published: October 2022

Introduction: Occlusal plane orientation affects the esthetic, function, and success of removable or fixed prostheses. The most prevalent index for determination of this plane is the ala-tragus line while there are controversies in the exact location of tragus reference point.
Aims: This study aimed to determine the best point on tragus as the posterior reference of ala-tragal line in relation to occlusal plane according to age and sex.
Materials and methods: The study included 136 participants of both sexes who were randomly divided into three age groups: 20-35, 36-50, and older than 50. Fox plane was stabilized on incisal edge-occlusal table of maxillary teeth. A lateral photograph was obtained from each participant sitting in predetermined standard position. Using Auto-Cad software, three lines were traced from nasal ala base to superior, middle, and inferior borders of the tragus, and evaluated for being parallel to occlusal plane.
Results: The coordination between occlusal plane and ala was 20.5% for superior, 35.6% for middle, and 43.9% for inferior border of tragus. There was a significant difference in the relationship between sex and plane position (p=0.003), while the relationship between age and plane could not reach statistical significance (p=0.65). The results were analyzed using chi-square test, and ANOVA (p&lt;0.05).
Conclusions: Ala-inferior border of tragus line was the most parallel, and ala-superior border of tragus line was the least parallel line to the occlusal plane. The parallelism between occlusal plane and ala-superior border was more prevalent in women, while the men demonstrated significantly more parallelism with inferior border of tragus.
Stability study of extemporaneously compounded nitrofurantoin oral suspensions for pediatric patients
Authors: Pehlivanov Ivaylo , Stoeva Stanila , Simitchiev Apostol , Stefanov Stanislav , Andonova Velichka 
Published: October 2022

Aim: To evaluate the stability of nitrofurantoin suspended in different extemporaneously compounded vehicles after storage at 4°C and at 25°C. To formulate an effective, readily available vehicle that can guarantee extended stability and precise dosing.
Materials and methods: Nitrofurantoin was suspended at a concentration of 10 mg/mL in seven different vehicles compounded of different blends of Syrupus simplex, sorbitol 70%, methylcellulose 1%, gummi arabici 1%, gummi xanthani 1%, and sodium carboxymethylcellulose (NaCMC) 1%. Samples of 100 mL of every compounded suspension were stored in dark in graded glass bottles at 4°C and at 25°C. Samples were analyzed at the beginning and every 10 days up to day 30 and every 30 days after. Variations of physical properties such as sedimentation, ease of resuspension, color and odor were evaluated visually and organoleptically. Rheological analysis was also performed in order to determine suspensions’ behavior during storage and dosing. Variations in nitrofurantoin concentration and pH were evaluated with suitable analytical procedure (UV-Vis; HPLC; pH/ORP). Microbiological stability was evaluated via incubation on suitable culture media.
Results: To the 30th day, only three of the compounded suspensions exhibited significant physical stability and slight change in taste and odor stored at both temperatures. Two samples stored at 25°C exhibited nitrofurantoin concentration greater than 95% and 4 samples stored at 4°C – concentration greater than 95%. All models showed no microbial growth up to day 30. At 120 days, only three of the compounded suspensions, stored at 4°C, exhibited relatively high nitrofurantoin concentrations: 88.2%, 92%, and 81.1%, respectively. Only one model suspension showed chemical and physical stability (≥95% of the initial concentration) for 102 days. No model suspension remained sterile after 30 days.
Conclusions: The suspensions compounded with vehicles of blends of syrups, xanthan, croscarmellose (NaCMC), and sorbitol exhibited low to none sedimentation, good uniformity of content and are suitable organoleptically for pediatric administration. The model suspension stored at 4°C (NTF VII 4°C – with major excipients: sucrose 16%, sorbitol 17%, xanthan gum 0.25%, NaCMC 0.25%) stands out with nitrofurantoin concentration higher than 95% along with no or little signs of sedimentation. After adding a suitable preservative agent or system, a formulation with these characteristics might have an expiration date of at least 90 days.
Low Incidence of Vitamin D Levels Deficiency in Anesthesiology Residents
Authors: Tantri Aida Rosita , Soenarto Ratna Farida , Firdaus Riyadh , Theresia Sandy , Anakotta Vircha 
Published: October 2022

Background:
Vitamin D deficiency is now a major global health problem. The prevalence of vitamin D deficiency in Indonesia is 60–90% in various studies. Age, race, sunscreen use, medication, and malabsorption diseases are all factors that affect vitamin D levels. Recent studies also show the relation between COVID-19 and vitamin D deficiency in severity and disease mortality. Vitamin D deficiency causes skeletal and extra-skeletal consequences. With limited studies on vitamin D levels of anesthesiology residents in Indonesia, we aim to determine the average vitamin D level and the affecting factors in this population.

Materials and Methods:
Sixty-nine anesthesiology residents working in a tertiary care hospital were enrolled in this study. The participants were asked to complete the questionnaire, and blood samples were drawn to measure serum 25(OH)D. The factors that influence vitamin D levels were recorded for analysis. Statistical analysis was performed using SPSS version 20.

Results:
The mean vitamin D level in anesthesiology residents was 39.99 ng/mL. There were no significant relationships between vitamin D levels among anesthesiology residents with vitamin D consumption, high-calcium foods, frequency of exercise, history of COVID-19 infection, comorbidities, and duration of exposure to sunlight.

Conclusion:
Prevalence of vitamin D deficiency/insufficiency was low among anesthesiology residents. Vitamin D levels were optimal in professionals who are taking vitamin D supplements.
Comparison of Intraperitoneal Dexamethasone, Dexmedetomidine, and Dexamethasone–Dexmedetomidine Combination on Postoperative Nausea, Vomiting, and Analgesics Requirement after Gynecological Laparoscopy
Authors: Srivastava Vinit Kumar , Shree Pooja , Agrawal Sanjay , Pandey Ambikesh , Babbar Kavita , Manju Kumari 
Published: October 2022

Background:
Female patients who undergo gynecological laparoscopic surgery are more likely to suffer from postoperative nausea and vomiting (PONV). The study aimed to probe and investigate the effectiveness of intraperitoneal administration of dexamethasone, dexmedetomidine, and combination in reducing the incidence of PONV and postoperative analgesic requirements in laparoscopic hysterectomies.

Materials and Methods:
One hundred ninety-two female patients undergoing laparoscopic hysterectomies were randomly assigned to four groups. Anesthesia was identical in each group. Patients in the group D1 received dexamethasone 8 mg, group D2 received dexmedetomidine 1 μg/kg, group D3 received dexamethasone 8 mg + dexmedetomidine 1 μg/kg combination, and group D4 received 20 mL normal saline intraperitoneally at the end of the surgery, before trocar removal. The primary outcome was the incidence of PONV experienced by the patients within 24-h postoperative period.

Results:
In the first 24 h postoperatively, the incidence of PONV was significantly reduced in D1, D2, and D3 groups compared with D4 (P = 0.001); however, there were no significant differences among the three groups. The requirement for rescue antiemetic and rescue analgesic was similar among the groups but significantly decreased compared with the control group (group D4) (P = 0.002 and P = 0.0003, respectively).

Conclusion:
Intraperitoneal administration of dexamethasone, dexmedetomidine, and a combination of dexamethasone–dexmedetomidine in laparoscopic hysterectomies significantly reduces both PONV and postoperative analgesics requirements compared with the control group.
Corneal endothelial changes following cataract surgery in hard nuclear cataract
Authors: Singh Ritu , Sharma Arun K , Katiyar Vishal , Kumar Gaurav , Gupta Sanjiv K 
Published: October 2022

Purpose:
To evaluate and compare endothelial cell changes in phacoemulsification and manual small-incision cataract surgery (MSICS) in patients with uncomplicated senile cataracts.

Methods:
This was a prospective, tertiary care hospital-based, randomized, double-blinded interventional study. In total, 152 patients with an uncomplicated senile cataract of nuclear grade III and above were recruited. Exclusion criteria included patients with preoperative endothelial cell density (ECD) less than 1500 cells/mm3, a history of previous ocular surgery, any other coexisting ocular disease, and intraoperative or postoperative surgical complications. Preoperative and postoperative values of ECD and central corneal thickness (CCT) were measured, analyzed, and correlated with various factors.

Results:
Patients were randomized into two interventional groups-MSICS and phacoemulsification. Factors associated with significant drop in postoperative ECD following phacoemulsification were patients with advanced age (P = 0.01), higher grades of cataract (P = 0.01), and longer effective phacoemulsification time (P = 0.007). Shallow anterior chamber depth (ACD) was strongly associated with greater ECD loss in both groups (P < 0.0001). A threshold value of 2.86 mm of ACD was defined for minimal endothelial cell loss following phacoemulsification. CCT was observed to slightly increase postoperatively in both groups but was insignificant (P > 0.05).

Conclusion:
Both MSICS and phacoemulsification have similar postoperative visual outcomes. An increase in postoperative CCT is insignificant following surgery. Greater postoperative ECD loss is associated with phacoemulsification with advanced age, hard nuclear cataracts, and longer effective phacoemulsification time. ACD can be used as an essential parameter preoperatively to determine the choice of surgical technique between MSICS and phacoemulsification.
Incidence of vitreous loss and visual outcome following cataract surgery by surgeons with various levels of experience at a tertiary eye care center in North India
Authors: Sharma Dushyant Kumar , Bharti Gaurav , Pegu Julie , Bhumbla Shayana , Paul Lagan , Agarwal Manisha , Shah Gaurav , Mathur Umang 
Published: October 2022

Purpose:
To determine the incidence of vitreous loss and visual outcome after a vitreous loss during cataract surgery performed by surgeons with various levels of experience in adults >40 years of age at a tertiary eye care center in North India.

Methods:
The study was conducted at a tertiary eye care center in North India. This was an observational, retrospective, cross-sectional study of patients who underwent cataract surgery from August 1, 2011 to July 31, 2014. All adult cataract cases who were operated on from August 1, 2011 to July 31, 2014 and who experienced vitreous loss during their surgery were included in the study. The visual outcomes of these patients who experienced vitreous loss during cataract surgery in uncomplicated cataract and were managed using standard automated vitrectomy techniques were assessed for different cataract surgical techniques (extracapsular, small-incision, and phacoemulsification) as well as at different levels of skill of the operative surgeon (consultant, short term fellow, and long-term fellow). Details of the postoperative period and best-corrected visual acuity (BCVA) were collected from patient records by the principal investigator on day 1, 1 week, 4 weeks, 6 weeks, and 3 months post cataract surgery.

Results:
Vitreous loss occurred in 374 out of 18,430 patients who underwent cataract surgery from August 1, 2011 to July 31, 2014. The overall incidence of vitreous loss in our study was found to be 2.03% with consultants having a rate of 1.66%, short-term fellows at 5.19%, and long-term fellows at 2.02%. Two hundred eighty-eight patients of the 374 cases followed up for 3 months at the hospital and 75.69% of these patients had a final visual acuity of ≥6/18.

Conclusion:
In an institute with a structured training program for residents/trainees, the vitreous loss rate is low during cataract surgery. Early intervention and proper management with the standard microsurgical technique by experienced hands can improve the final visual outcome in eyes with vitreous loss. Cystoid macular edema and corneal edema were the most common causes of poor postoperative vision.
An objective evaluation of simulated surgical outcomes among surgical trainees using manual small-incision cataract surgery virtual reality simulator
Authors: Sankarananthan R , Prasad R Senthil , Koshy Tony Alex , Dharani Padam , Bacchav Ashish , Lansingh Van Charles , Ahiwalay Chetan , Balagiri K , Shekhar Madhu 
Published: October 2022

Purpose:
The purpose of this study was to evaluate trainee performance across six modules of a virtual reality (VR) simulator.

Methods:
A retrospective observational study was conducted on 10 manual small-incision cataract surgery (MSICS) trainees who practiced cataract surgery on an MSICS VR simulator for one month. They were assessed in six major steps which included scleral groove, tunnel dissection, keratome entry, capsulorhexis, nucleus delivery, and intraocular lens (IOL) insertion under a trainer’s supervision. The information included in their score metrics was collected, and their overall performance was evaluated.

Results:
Thirty attempts were evaluated for scleral groove, tunnel dissection, and capsulorhexis and 15 attempts for keratome entry. Candidates had varied results in the dimensional aspects and their rates of complications with a mean satisfactory score of 3.1 ± 4.17, 6.8 ± 5.75, 5.8 ± 7.74, and 1.8 ± 2.57, respectively. Nucleus delivery (n = 5) had more of iris pull and IOL insertion (n = 5) had more of lost IOL as complications but both had a higher satisfactory outcome.

Conclusion:
A VR simulator is a useful tool for training surgeons before their entry into live surgery. It is an effective method for evaluating objectively the structural characteristics of each phase in MSICS and their associated complications, helping them anticipate it earlier during live surgery by giving them a near real world experience.
Outcome of superior manual small-incision cataract surgery in pediatric age group - A five year retrospective study at a tertiary eye hospital in Karnataka
Authors: Gangrade Aashish Kumar , Kavitha V , Heralgi Mallikarjun M 
Published: October 2022

Purpose:
To analyze intraoperative difficulties and visual and surgical outcomes following pediatric cataract surgery.

Methods:
This five-year retrospective study (2014–2019) included 138 eyes (85 children) with cataract aged between 12 months and 18 years (either sex). All children had undergone best-corrected visual acuity (BCVA), anterior and posterior segment evaluation, intraocular lens (IOL) power calculation, superior manual-small-incision cataract surgery (MSICS) with or without posterior capsulotomy/anterior vitrectomy and IOL implantation under general or local anesthesia, visual rehabilitation, and had been followed up for a minimum period of 12 months.

Results:
The mean age was 111.27 ± 4.84 months. Preoperative BCVA distance: 113 (81.88%)eyes had BCVA < 6/60; near BCVA: 114 (82.6%) eyes had ≤N36. At last postoperative follow-up (mean: 20.98 ± 13.08 months): distant BCVA- ≥6/60 had been recorded in 120 (86.96%) eyes; near BCVA- >N36 in 123 (89.13%) eyes. Improvement in BCVA was statistically significant. Intraoperative scleral tunnel difficulties were seen in three eyes (thin flap in two, and buttonhole in one eye); in the majority of the eyes 113 (81.88%), IOL was placed in the bag. Twenty eyes had early postoperative inflammation. At last follow-up: posterior capsular opacity was recorded in six eyes, IOL decenteration in two eyes, secondary glaucoma in six eyes, and severe amblyopia in 36 (26.09%) eyes. The mean myopic shift was − 1.11 ± 0.89 D and was statistically significant.

Conclusion:
Superior MSICS as a treatment for pediatric cataract has minimal intraoperative complications and satisfactory visual and surgical outcomes.
Evaluation of scleral incisions and their effects on corneal curvature in manual small-incision cataract surgery
Authors: Nada Manisha , Rohit D , Singh SV , Khurana AK , Lochab Sakshi , Kharolia Anjali 
Published: October 2022

Purpose:
Incisions in cataract surgery can be modified in various ways in terms of size, shape, and axis to reduce or tailor astigmatism. This study was conducted to examine the effect of site (superior vs, temporal) and shape (frown vs. V-shaped, chevron) of scleral incisions for cataract surgery on corneal curvature.

Methods:
The prospective study was carried out on 200 consecutive patients with senile cataract and who were planned for surgery at a tertiary eye hospital in north India. The placement of the incision was decided by the steeper corneal meridian—whether superior or temporal—and then patients of these two groups were randomized for frown and V-shaped incision; in this way, four groups of 50 patients each were formed. Follow-up was done on day 1, at 2 weeks, 4 weeks, 8 weeks, and 12 weeks. At each follow-up, post-operative keratometry with routine postoperative examination was done. The results were statistically analyzed by using student’s t-test, Chi-squared test, and the Pearson correlation coefficient.

Results:
In all the four groups, the difference of preoperative astigmatism and surgically-induced astigmatism was statistically highly significant. The analysis of uncorrected visual acuity (UCVA) was statistically significant (P < 0.05) on postoperative day 1 and at 2, 4, and 12 postoperative weeks; it was statistically insignificant (P > 0.05) at postoperative week 8.

Conclusion:
Temporal incisions result in lesser postoperative surgically induced astigmatism (SIA) than superior incisions. Chevron incisions result in minimal change in corneal curvature. This effect can be utilized to tailor the postoperative astigmatism.
Evaluation of striate keratopathy after manual small-incision cataract surgery and its final outcomes in a tertiary hospital
Authors: Rajappa Suresha A , Bhatt Kunal P 
Published: October 2022

Purpose:
To study the demographic profile, contributing and precipitating factors, the severity of striate keratopathy and its relation with endothelial cell count, and evaluate the final treatment outcome of striate keratopathy.

Methods:
This observational analytical cohort study was conducted on 75 patients developing striate keratopathy after MSICS in the immediate postoperative period. Demographic profile, preoperative risk factors, and intraoperative complications were evaluated retrospectively. Postoperatively, slit-lamp grading of striate keratopathy was done, and specular microscopy of both eyes was taken. Treatment of striate keratopathy was initiated, and patients were followed up for 6 to 10 weeks for improvement.

Results:
Striate keratopathy was most commonly associated with surgeries performed by resident surgeons (92%), longer duration of surgery, associated predisposing factors, and intraoperative or postoperative complications. On postoperative day 1, the majority of patients had moderate and severe striate keratopathy (66% and 32%, respectively). It was associated with significant endothelial cell loss (ECL) at the final follow-up (P = 0.0016). Striate keratopathy resolved in 97.3% of patients, irrespective of the treatment with hypertonic saline. At 6 to 10 weeks, 92% of patients achieved a BCVA of ≥6/9.

Conclusion:
A careful preoperative evaluation, adequate training of resident surgeons, meticulous surgical technique, and prompt management of postoperative complications can lead to a decrease in the incidence of striate keratopathy in the majority of cases. The use of hypertonic saline eye drops does not change the final outcome, and most cases resolve spontaneously during follow-up.