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, Erlan Pércio Lopes Rufino, Assíria Maria Santana Santos, Luana Cristina Rodrigues De Oliveira Costa, Camila Flach Weinmann, João Ribeiro Memória
Adesh University Journal of Medical Sciences & Research pp 1-5; https://doi.org/10.25259/aujmsr_24_2021

Abstract:
Cervical glioblastoma multiforme (GBM) is rare, and its early diagnosis and management is crucial to patient survival. In the young population, it’s even more difficult to diagnose. The main challenges in GBM therapy are associated with the location of the disease and its complex and heterogeneous biology. Here, we present a case of a 35-year-old female patient admitted due to complain of pain in her right lower limb. She reported the evolution of the condition for dysesthesia in upper limbs and lower limbs 4 weeks ago. MRI showed an intramedullary lesion extending from C2 to C5. The patient was managed surgically. The purpose of this report is to document this rare condition, especially in the young age group, and reveal the current knowledge regarding intramedullary GBM.
Nguyen Thai Binh, Le Viet Dung, Thieu-Thi Tra My, Nguyen Minh Duc
Journal of Clinical Imaging Science, Volume 11; https://doi.org/10.25259/jcis_179_2021

Abstract:
This case report describes a young female patient with a history of surgery to treat choledochal cyst since childhood who was admitted to our hospital with cholangitis. An imaging examination revealed giant stones that almost completely filled the intrahepatic biliary tract. The patient underwent percutaneous transhepatic lithotripsy using a holmium laser. After the lithotripsy, cholangiography showed no residual stones. The patient displayed clinical improvement and was discharged after 14 days in the hospital. This case serves as a reminder of gallstone complications that can occur subsequent to choledochal cyst surgery with biliary-enteric anastomosis and emphasizes many outstanding advantages of percutaneous transhepatic lithotripsy compared with classical surgery.
, Sushma Bhatnagar, Fiona Rawlinson
Indian Journal of Palliative Care pp 1-14; https://doi.org/10.25259/ijpc_393_20

Abstract:
In India, Palliative care remains inaccessible, especially in remote areas. This study aimed at exploring the experience of caregivers related to arranging palliative care at home, for personnel and family members of an armed force. Qualitative study based on thematic analysis of semi-structured interviews with adult caregivers - either serving personnel or their dependent family members. Lack of palliative care in rural areas makes arranging home care challenging for Indian caregivers, especially in armed forces. The families stay alone and personnel cannot be there to look after loved ones. Constraints of leave, financial and legal problems, frequent movement and social isolation disrupt care as well as family and community support systems, leading to psycho-social problems and stress for the serving personnel as well as families. Educating staff, integrating palliative care into existing medical services, coordinating with other agencies to increase awareness and provide care at home, access to opioids, timely leave, reimbursement of expenses, increased family accommodation, guidance about benefits, and considerate implementation of transfer policy can help mitigate some of their problems. These caregivers face physical exhaustion, psycho-social, financial, legal, and spiritual issues- some common to all rural Indians and others unique to the armed forces. Understanding their experiences will help the providers find solutions, especially in relation to the unique needs of the men in uniform.
Chander Grover, , Arzoo Mishra, Archana Singal
Indian Journal of Dermatology, Venereology and Leprology pp 1-14; https://doi.org/10.25259/ijdvl_514_20

Abstract:
Nail fold is one of the most accessible sites for studying changes in the microcirculation in various microangiopathies. The characterization of changes in microvasculature can provide useful clues towards the diagnosis and prognosis of a disease. The diagnostic utility of nail fold capillaroscopy has improved and expanded over the past couple of decades. Beyond connective tissue diseases, it is now explored for its role in various systemic and dermatological diseases. Incorporation of nail-fold capillaroscopy in the diagnostic criteria of systemic sclerosis has generated interest among dermatologists. The current review is aimed at providing knowledge about nail-fold capillaroscopy to dermatologists. For the purpose of review, a PubMed search was done using the keywords “nail fold capillaries” and “nail fold capillaroscopy”. All the articles were retrieved and classified into reviews and clinical studies of various types. The final data were then analyzed and presented in a narrative fashion.
, Ritu Sharma
Adesh University Journal of Medical Sciences & Research pp 1-5; https://doi.org/10.25259/aujmsr_25_2021

Abstract:
Biochemistry is one of the foundation sciences in the medical curriculum, which has immense importance in understanding the future clinical sciences, but it is generally considered to be a subject of just countless biochemical structures, pathways, and reactions. Conventionally, it was taught by means of didactic lectures, tutorials, and practical classes. These days, the education system is changing to a student-centered teaching–learning process with the use of various innovative teaching methods. Case-based learning (CBL) is one such approach which can make learning more effective and interesting. To generate interest of students in Biochemistry by correlating topics and their clinical application. After taking permission from the Institutional ethics committee, the students were given didactic lecture on the integration of carbohydrates and lipid metabolisms followed by a test (pre-test). They were then divided into small groups and given case histories which they were to discuss amongst themselves and arrive at a conclusion. These case histories were then discussed one to one with the facilitator. The students were again given a test (post-test). There was a significant difference in the marks obtained in pre and post-test. Majority of the students felt it was an enjoyable and effective way of studying Biochemistry. Faculty also gave an encouraging response. CBL can be an important way of stimulating the students for self-directed learning and integrating topics of Biochemistry so that they are easily conceptualized.
Shruti Patel,
Journal of Skin and Sexually Transmitted Diseases pp 1-3; https://doi.org/10.25259/jsstd_68_2021

Abstract:
Congenital melanocytic nevi are benign proliferations of cutaneous nevomelanocytes. Usually, they manifest at birth or become apparent within the first few years of life. The nevi show variable surface morphology (papular, rugose, verrucous, or cerebriform). Congenital melanocytic nevus showing cerebriform morphology is a rarity. Early diagnosis and surgical excision are usually recommended in congenital melanocytic nevus to prevent the future risk of malignant transformation which is higher in larger lesions, especially in giant forms (>20 cm in size). An excision of the lesion also helps to avoid the social and psychological consequences arising out of significant cosmetic deformity. We report a 21-year-old patient who presented with a cerebriform congenital melanocytic nevus measuring 10 cm × 7 cm × 2 cm in the right parietal region. Early-onset, pigmented lesion with a cerebriform surface, and the histopathology features of congenital melanocytic nevus were the points that favored the diagnosis of cerebriform congenital melanocytic nevus in our patient. He was treated with excision of the lesion and defect coverage with tissue expansion in two stages. Two rectangular tissue expanders were placed beneath the galea aponeurotica (one with a capacity of 300 cc in the left parietal region and another with 500 cc in the occipital region). Both the expanders were inflated twice to their capacity. Second stage surgery was performed after about 3 months in which the tissue expanders were removed and the pre-expanded scalp skin was used to drape the scalp defect that resulted from the excision of the lesion. An excision and a two staged reconstruction of the scalp using tissue expanders, may ensure a good aesthetic outcome in the management of intermediate to large sized congenital melanocytic nevus.
Charussri Leeyaphan, Bordeesuda Suiwongsa, Phojana Komesmuneeborirak, Rungsima Kiratiwongwan, Supisara Wongdama, Waranyoo Prasong, Salisa Supcharoenkul,
Indian Journal of Dermatology, Venereology and Leprology pp 1-6; https://doi.org/10.25259/ijdvl_359_2021

Abstract:
Although topical amphotericin B cream is effective for the treatment of nondermatophyte mold onychomycosis in vitro, studies of its effectiveness and safety in vivo are limited. We studied the effectiveness and safety of topical 0.3% amphotericin B in 30% dimethyl sulfoxide cream (amphotericin B cream) in nondermatophyte mold onychomycosis using the vehicle cream 30% dimethyl sulfoxide cream as control. This randomized controlled study was conducted between January 2019 and November 2020. Patients diagnosed with nondermatophyte mold onychomycosis were randomly divided into two groups of ten patients each: one treated with amphotericin B cream and the other with the vehicle cream. Clinical and mycological cure as well as safety were evaluated. Ten patients each treated with amphotericin B cream and the vehicle cream were included in the study, but only nine patients in the vehicle cream group were available for follow up. All the 19 evaluable patients had distal lateral subungual onychomycosis and the great toenails were affected in 18 (94.7%) of these. Mycological cure was achieved in 8 (80%) patients treated with amphotericin B cream and in 4 (44.4%) patients using the control (vehicle) cream. Clinical cure was achieved in 7 (70%) patients treated with amphotericin B cream, but only in 2 (22.2%) patients on the control cream. No adverse events were observed. The small sample size and the fact that PCR fungal identification that provides accurate identification of fungal species was not performed are limitations of our study. Topical amphotericin B cream was both very effective and safe in the treatment nondermatophyte mold onychomycosis. The control (vehicle) cream containing 30% dimethyl sulfoxide also demonstrated some antifungal activity.
Nalla Deepak, , M. Shyam Sundar, David V. Rajan
Journal of Arthroscopic Surgery and Sports Medicine pp 1-5; https://doi.org/10.25259/jassm_15_2021

Abstract:
With the well-established fact that meniscectomy predisposes patients to early osteoarthritis, there has been an increase in the incidence of meniscal repairs in recent years, even in active older patients, and in avascular zones. Although many techniques have been described for meniscal repair, even experienced surgeons face difficulties in certain scenarios. In this technical note, we present some techniques to facilitate the arthroscopic treatment of meniscal repair in general and introduce some novel techniques in some special scenarios.
Surgical Neurology International, Volume 12; https://doi.org/10.25259/sni_917_2021

Abstract:
Acrometastases, secondary tumors affecting oncological patients with systemic metastases, are associated with a poor prognosis. In rare cases, acrometastases may precede establishing the primary tumor diagnosis. A 72-year-old female heavy smoker presented with low back pain, and right lower extremity sciatica/radiculopathy. X-rays, CT, MR, and PET-CT scans documented primary lung cancer with multi-organ metastases and accompanying pathological fractures involving the sacrum (S1) and right 4th digit. She underwent a S1 laminectomy and amputation of the distal phalanx of the right fourth finger. The histological examination documented a poorly differentiated pulmonary adenocarcinoma infiltrating bone and soft tissues in the respective locations. The patient was treated with a course of systemic immunotherapy (i.e. pembrolizumab). At 6-month follow-up, the patient is doing well and can stand and walk without pain. Spontaneous sacral fractures may be readily misdiagnosed as osteoporotic and/or traumatic lesions. However, in this case, the additional simultaneous presence of a lytic finger lesion raised the suspicion that these were both metastatic tumors. Such acrometastases, as in this case attributed to a lung primary, may indeed involve the spine.
, , , Mohammad Ashraf, , Abubakar Siddique
Surgical Neurology International, Volume 12; https://doi.org/10.25259/sni_790_2021

Abstract:
As part of the ‘small round-cell tumor’ family, Ewing’s sarcoma (ES) is a malignant mesenchymal tumor classified as a primitive neuroectodermal tumor (PNET). Within the PNETs, spinal extraosseous extradural lesions are exceedingly rare. A 19-year-old male presented with a one-month history of back pain and paraparesis with loss of urinary control. The MRI revealed an intradural, extramedullary mass at the T3-T4 level. Intraoperatively, the tumor was solely extradural, without evidence of local invasion; it was entirely removed. Due to the high risk of metastasis, the patient was subsequently treated with chemotherapy and radiation. In addition, similar studies on PNETs were reviewed. A 19-year-old male presented with a paraparesis attributed to an extraosseous extradural ES at the T3-T4 level. Following total gross resection, he was successfully managed with chemotherapy and radiation. The patient has been in remission for one month.
Surgical Neurology International, Volume 12; https://doi.org/10.25259/sni_896_2021

Abstract:
Carotid endarterectomy (CEA) using conventional surgical microscope has been already established as golden standard. Recently, exoscope was introduced into the field of neurosurgery, and various merits of it have been reported. We report the experiences of exoscopic CEA using a movable 4K 3D monitor and discuss the feasibility of it. We report a consecutive series of 15 cases of exoscopic CEA for internal carotid artery (ICA) stenosis using a movable 4K 3D monitor between January 2020 and April 2021. We utilized ORBEYE as an exoscope system and a 31-inch movable 4K 3D monitor, which was installed in the Maquet Moduevo ceiling supply unit. In all 15 cases, the procedures were accomplished only using the ORBEYE. There were no operative complications due to the use of the exoscope. In response to the operative site, the 4K 3D monitor was moved to face the operator. Even when the angle of the visual axis of the exoscope against the horizontal plane was small during the surgical manipulation in the distal portion of ICA, the operator was able to maintain a comfortable posture. Using the movable 4K 3D monitor, exoscopic CEA can be performed ergonomically. The operator can manipulate the distal portion of the ICA or proximal portion of the common carotid artery in a comfortable posture and face the monitor by adjusting its position.
Surgical Neurology International, Volume 12; https://doi.org/10.25259/sni_712_2021

Abstract:
Arachnoid cysts (AC) may cause hydrocephalus and neurological symptoms, necessitating surgical intervention. Cyst drainage may result in postoperative complications, however, these interventions are not normally associated with the subsequent development of acute hydrocephalus. Herein, we present two unique cases of AC drainage with postoperative development of acute communicating hydrocephalus. Case 1. A 75-year-old female presented with progressive headaches, cognitive decline, and questionable seizures. Her neurological examination was non-focal, but a head computed tomography scan (CT) identified a large right frontal AC with mass effect. She subsequently underwent craniotomy and decompression of the cyst. Postoperatively, her neurological examination deteriorated, and a head CT demonstrated new communicating hydrocephalus. The opening pressure was elevated upon placement of an external ventricular drain. Her hydrocephalus improved on follow-up imaging, but her neurological examination failed to improve, and she ultimately expired. Case 2. A 61-year-old female presented with headache and seizures attributed to a left parietal AC. She underwent open craniotomy for fenestration of the cyst into the Sylvian fissure. Postoperatively, her neurologic examination deteriorated, and she developed acute communicating hydrocephalus. She was initially managed with external ventricular drainage (EVD). The hydrocephalus resolved after several days, and the EVD was subsequently removed. Late follow-up imaging at 2 years showed that the regression of the AC was maintained. Acute development of hydrocephalus is a potential complication of intracranial AC fenestration. A better understanding of intracranial cerebrospinal fluid flow dynamics may better inform as to the underlying cause of this complication.
Surgical Neurology International, Volume 12; https://doi.org/10.25259/sni_630_2021

Abstract:
Giant pituitary adenomas are a rare finding and the literature is inconclusive regarding the most appropriate approach. In supergiant adenomas, where the size of the tumor is exceptional, both a combine approach versus a solely transcranial or endoscopic approach have been reported.[2,3,5] In this video, an entirely endoscopic resection of a supergiant pituitary adenoma is demonstrated. The exceptional size (4.5 × 5.8 × 5.4 cm) of the tumor and the peculiarity of the anatomical relations are documented in the video. The anterior cerebral arteries, both the A1 and A2 tracts, as well as the anterior communicating arteries are shown to be posteriorly dislocated and encased by the tumor which is pealed from the arteries themselves. Furthermore, the optic nerves are decompressed and cleaned from any residual tumor. The procedure is highly technically challenging since the furthermost part of the adenoma is also the one attached to the great intracranial arteries. A 45 optic and angle instruments were used for the major part of the surgery. Considering the high risk of postoperative CSF leak, a multilayer closure with nasoseptal flap was chosen. The postoperative MRI showed a gross total resection of the lesion in the absence of any complications and no new neurological nor endocrinological deficit appeared. Expanded endoscopic endonasal approach could represent a valuable way to face giant adenoma, providing a direct corridor toward the lesion and safe control of both the chiasmatic vasculature and the anterior communicating artery complex. Multilayer reconstruction is mandatory to avoid postoperative CSF leak.[1,4]
, Kaushik Ishore, Arunangshu Ghoshal
Indian Journal of Palliative Care pp 1-7; https://doi.org/10.25259/ijpc_40_2021

Abstract:
Malignant fungating breast cancers are a definite challenge to treatment due to limited knowledge and prevailing distressing symptoms. Various treatment protocols with regard to radiotherapy (RT) and chemotherapy have been reported in the literature but the knowledge of proper integration of these regimes with effective palliative care nursing care, particularly in resource poor settings, is not well understood. Hence, this study was undertaken to assess the change in the degree of comfort achieved before and after treatment of these fungating breast cancer wounds along with issues regarding compliance to such treatment in a peripheral rural medical college hospital. A total of 20 patients were selected from the medical records files of the RT department of North Bengal Medical College and Hospital who were registered and treated during the period 1 June 2019– 31 July 2021. Palliative care nursing of malodour, bleeding, maggots, pain and assessment of psychological parameters was done based on the 11-point revised Edmonton Symptom Assessment Scale at the beginning and at each subsequent follow-up visits. Patients were also individualised for receiving palliative RT, chemotherapy, surgery and hormone therapy based on their clinicodemographic profiles. Informed consent was taken from all patients and every treatment was in accordance with the ethical permissions as sought from the Institutional Ethics Committee. Statistical analysis was done based on descriptive statistics and SPSS version 22. Median follow-up was 13 months. Overall, there was a significant improvement in comfort and well-being as assessed by paired t-test before and after treatment (paired t-test = 16.548; P = 0.000). However, there was no significant correlation with palliative radiation dose and schedule as per spearman’s correlation coefficient. The mean radiation dose was BED 48.56 Gy3 (EQD2 = 29.3 Gy3) and the median number of fractions used was 10. Almost 50% of patients were noncompliant to treatment and this might be attributed to the prevailing COVID-19 pandemic situation. There was maximum relief with regard to bleeding control (100%), malodour dissipation (76.9%) and control of maggots infestation (71%) and these results were also found to be strongly associated with treatment as per analysis done by Chi-square test of difference of proportions. Effective comfort can be achieved with proper judicious combination of palliative care nursing and other oncological treatment such as radiation, chemotherapy and surgery.
Kaviraj Kaushik, , , Rahul Varshney, Rajesh Sharma
Surgical Neurology International, Volume 12; https://doi.org/10.25259/sni_512_2021

Abstract:
Hydatid cyst is a common zoonotic condition in endemic areas. Intraventricular hydatid cyst is a rare entity with less than 50 cases published in literature. Floating water lily sign (also called Camalote sign) is very rare in intracranial hydatid cysts. Only a single case report of this sign exists in literature in intraventricular hydatidosis suggesting rupture of hydatid cyst leading to CSF dissemination and frequent poor outcome. This case report describes the successful management of a 5-year-old child who presented with signs and symptoms of raised intracranial pressure due to large intraventricular hydatid cyst in the right frontal horn, and magnetic resonanace imaging of the brain showed hydatid cyst with typical camalote sign. Although very rare, the presence of camalote sign in intraventricular cysts is very categorical in establishing preoperative diagnosis of hydatid cyst, especially in endemic areas.
Surgical Neurology International, Volume 12; https://doi.org/10.25259/sni_664_2021

Abstract:
Malignant craniopharyngioma is a rare tumor with few published case reports. It can form de novo or transform from a benign variant and is associated with a dismal survival rate. We reviewed the literature for all published cases and studied the effect of radiation on the rate of malignant transformation. We analyzed the effect of chemotherapy on survival. We used various search engines to locate literature from 1980 onward and identified 31 case reports, one of which was excluded. Statistical analysis using the SAS software was conducted, and a significant value was identified if P< 0.05. There was equal distribution among male and female patients. The average age at malignant diagnosis is 31.11 years (±15.16) and 12.19 years (±8.41) for the average interval of benign tumor progression to malignancy. The most common clinical presentation was visual loss and/or field deficits in 26/30 patients (86%). Almost 11/30 patients (37%) had endocrinological deficits, with panhypopituitarism as the most common in 8/11 patients (73%). Fifteen patients received radiation before malignant transformation (47%) and demonstrated no effect on malignant transformation (P = 0.379). Gross total resection was achieved in 2/30 patients. The average time to mortality postoperatively is 5.3 months ± 4.3. Ten patients received chemotherapy, and five were alive at last follow-up (P = 0.115). Malignant craniopharyngioma carries a dismal prognosis with no apparent benefits of radiation therapy and chemotherapy on survival.
Surgical Neurology International, Volume 12; https://doi.org/10.25259/sni_906_2021

Abstract:
The Aztec civilization has been one of the most powerful and organized cultures in the pre-Columbian era in America. Its fall was due to many factors, including the incursion of Spanish colonization and its violent transculturation, associated with the strong influence of its theological traditions and beliefs, which generated a new configuration in its social structure. Through a qualitative analysis and a systematic review based on the keywords Montezuma and TBI (Traumatic Brain Injury), we found 70 texts of interest, of which 32 were selected for their anthropological and medical content and their relationship with the history of neurosurgery. The traumatic brain injury (TBI) controversy and its consequences on this leader’s decision-making capacity and personal and social repercussions is evident. There are basically two versions of the story. That of the TBI was caused by his own people, and the other is the death due to injuries caused by the Spaniards. Historical texts that confirm these findings are presented. There is documentary evidence of TBI in the Aztec emperor, which partly explains his decision making behavior in the face of the invading Europeans. However, there is no forensic evidence to determine the causes of his death,
Sofia Athanasiou, , Vasileios Mamalis, , , Eftichios Arhontakis
Surgical Neurology International, Volume 12; https://doi.org/10.25259/sni_837_2021

Abstract:
Noonan syndrome (NS) is a rare autosomal-dominant neurodevelopmental disorder, which typically develops abnormalities of the craniofacial development and congenital heart defects. A number of cerebrovascular anomalies have also been occasionally described previously in the setting of NS. The assumption that NS can induce the formation of intracranial pseudoaneurysm (IAP) or the rupture of an already existing abnormality is yet unknown. We encountered a rare case of a 9-year-old NS patient with two IAPs presenting with episodes of intracerebral hemorrhage that were successfully managed with endovascular embolization. This case represents a possible association between NS and the presence of ruptured IAPs.
, Sanjeev Dua, , Anil Dhar, Vikram Bhadauria, Amit Garg, , Sumit Sharma,
Surgical Neurology International, Volume 12; https://doi.org/10.25259/sni_772_2021

Abstract:
The gravity of “second wave” of COVID-19 has effaced many new challenges in India; mucormycosis being a recent one. Diabetes mellitus (DM) is a known significant risk factor for mucormycosis. Here, we present our experience with rhino-orbital-cerebral mucormycosis (ROCM) during the “second wave of COVID-19” at a tertiary health care centre in North India. This case series includes four cases of ROCM that were managed by our neurosurgical team in view ofcerebral involvement. All the cases with an exception of one (Case 1), had a history of treatment for COVID-19 pneumonia. Case 2, 3 had undergone functional endoscopic sinus surgery (FESS) and orbital decompression before the onset of cerebral involvement; Case 4 underwent FESS and cranial surgery in the same sitting. All the patients had a history of DM and all the cases treated for COVID-19 pneumonia had a history of treatment with corticosteroids. Two patients underwent surgery with the exception of one patient, who did not provide consent for the same. One patient expired before surgical excision could be attempted. Regular and intensive follow-up is the key in swift detection and management of ROCM in post-COVID patients. While surgical excision is advisable in the fungal lesion, it must be borne in mind that radical excision of cerebral lesions is associated with morbidity, delayed recovery, and prolonged ICU stay. Culture and sensitivity-based antibiotics should be used judiciously as fever is a common postoperative complication. Blood sugar monitoring and control of DM are paramount in this condition. Steroids should be avoided in the management of cerebral edema with judicious use of hypertonic saline or mannitol.
Kiran Godse, Gauri Godse, Anant Patil
Published: 23 October 2021
Abstract:
Unwanted hair growth on certain body parts is a common aesthetic concern. Different options including shaving, waxing, and chemicals are used for hair removal. These options provide temporary results; hence, laser therapy has become a popular option for hair removal among people. Significant advancements have taken place in laser devices for improving the results of hair removal. One of the recent developments in this area is introduction of triple wavelength diode laser for hair removal. This technology combines the benefits of three wavelengths in a single device. The triple wavelength laser device may particularly be beneficial for people with darker skin. Available limited evidence from small clinical studies suggests its efficacy and safety for hair removal in people with skin type III to V. Studies in Indian population are needed to provide further insights about its efficacy and safety in patients and acceptance by the clinicians.
, Monica Davies Genekah, Sainabou Njie, Momodou Kumba Jallow, Alhaji Jobe, Abdoulie Tunkara, Awa Touray, Madeline Isatou Gibba, Salieu Barry, Gambia Sowe, et al.
Journal of the Pan African Thoracic Society pp 1-9; https://doi.org/10.25259/jpats_22_2021

Abstract:
Health education and awareness campaigns about tuberculosis (TB) can empower adolescents on different aspects of the disease and its management, resulting in early and appropriate care seeking behavior through their advocacy in the community. We assessed the impact of educational intervention on knowledge and awareness about TB among adolescents in the greater Banjul area of The Gambia where approximately 70% of national TB cases are notified. A school-based, interventional analytical study, and interactive educational workshop was conducted among grade 12 students of the Methodist Academy Secondary School in Bakau, Banjul The Gambia. The workshop activities included illustrative demonstrations using posters, flipcharts, infographics, and games to convey TB messages in six domains: (1) Basic knowledge; (2) symptoms; (3) risk factors (4) modes of transmission; (5) treatment; and (6) care and support. Structured questionnaires were used to assess changes in the student’s knowledge and awareness about TB in the six domains before and after the workshop. Data were analyzed using proportional percentages, mean (95% CI) and differences standard error (SE) and student paired t-test. Ninety-six students participated in the workshop out of which 92 (96%) students completed both pre- and post-test questionnaires. Sixty-eight percent of the students were females and 58% were from the science stream of the grade 12 students who participated in our workshop. The mean difference and SE between the pre- and post-workshop test scores in the six domains were: basic knowledge: +1.4 (0.2; P< 0.0001); symptoms: +1.5 (0.2; P< 0.0001); risk factors: +3.1 (0.3; P< 0.0001); modes of transmission: +1.2 (0.2; P< 0.0001); treatment: +0.8 (0.1; P< 0.0001); and care and support of TB: +0.5 (0.1; P = 0.0001). This school-based educational interactive workshop significantly improved the knowledge and awareness of the students especially in understanding the causative agent and risk factors of TB disease. We recommend exposure of students to TB educational activities as part of the school curriculum. The knowledge acquired in this workshop is likely to have impact on the wider community and should be assessed in future follow-up studies to determine if it impacts positively on views held within the wider community.
, Erere Otrofanowei, Iorhen Ephraim Akase, Patricia E. Akintan, Uyiekpen E. Ima-Edomwonyi, Bolaji O. Olopade, Osigwe Paul Agabi, Danladi A. Nmadu, Gbemileke O. Akinbode, Adefolarin Opawoye, et al.
Journal of the Pan African Thoracic Society pp 1-9; https://doi.org/10.25259/jpats_25_2021

Abstract:
The coronavirus disease 2019 (COVID-19) pandemic is the current public health concern. Hypoxemia has been identified as an independent risk factor for mortality in COVID-19 patients regardless of age or sex. This study therefore aimed to assess the profile of COVID-19 patients with hypoxemia in Lagos, Nigeria and identify their associated socio-demographic and clinical risk factors, predictors, and outcomes. This was a retrospective cohort study in which data were extracted from medical records of real-time polymerase chain reaction confirmed COVID-19 positive patients admitted between April and October 2020. Data extracted included age, sex, comorbidities, disease category/classification, symptoms, lowest oxygen saturation (SPO2), and outcomes. Bivariate analysis was done to test associations between hypoxemia and other variables. Multivariate analysis was done to determine significant predictors of hypoxemia. A total of 266 patients were included in the study; mean (SD) 49.80 (± 16.68) years. Hypoxemia (lowest SPO2 ≤ 90 in adults and < 92% in children) was found in 102 (38.3 %) of the cases. SPO2 of hypoxemic patients ranged from 33% to 90%, Mean ±SD of 77±13%. About half of the hypoxemic cases, 53 (52%) were ≥ 60 years and mostly male 70 (68.6%). Difficulty breathing was present in 56 (55%), while the common comorbidities were hypertension 86 (32.3%) and diabetes mellitus 47 (17.7%). Age ≥ 60, difficulty breathing, and fever were independent predictors of hypoxemia. Hypoxemia was significantly associated with death (X2-42.13; P< 0.001); odds ratio 14.5 (95% CI: 5.4–38.8). Hypoxemia occurred in 1 out of every 3 COVID-19 patients with poor prognosis. SPO2 monitoring and early presentation in hospital for those 60 years and above or with dyspnea may be essential for early identification and treatment of hypoxemia to reduce mortality.
Anand Murugesan, , Srinivas Chilukuri, Thirumalai Raja
Indian Journal of Palliative Care pp 1-3; https://doi.org/10.25259/ijpc_114_21

Abstract:
Neuropathy of dorsal scapular nerve (DSN) following neck dissections or radiotherapy has not been reported so far nor has its treatment in the form of hydro-dissection. Hydro-dissection of nerve under ultrasound guidance has been receiving more attention in the recent past and it is a minimally invasive procedure. We report here a case of neuropathy of DSN following radiotherapy in a patient for whom we could at least provide pain relief as a palliative measure during his past 6 months of life.
Dhanshree R. Gunjawate,
Indian Journal of Palliative Care pp 1-8; https://doi.org/10.25259/ijpc_135_21

Abstract:
Psychosocial adjustments are alterations needed by a person after a life-altering event. The present review explored the psychosocial adjustments after advanced laryngeal cancer treatment. Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, PubMed and Scopus were searched. Two hundred and three hits, after the three-stage screening, 13 articles were included. Mixed methods appraisal tool was used to perform the quality appraisal. The findings from 1109 laryngeal cancer survivors and 154 spouses of total laryngectomy patients helped to identify the barriers and coping mechanism toward psychosocial adjustments. The barriers included reactions of spouse or family members, effect of voice, communication and speech intelligibility and work and family relationships. The coping was enhanced with a better awareness, motivation and support system. These findings would help in improving the training programs and enhance the pre- and post-treatment counselling based on the priorities and demands of the patient.
Indian Journal of Palliative Care pp 1-4; https://doi.org/10.25259/ijpc_426_20

Abstract:
Unique reports of suicide and euthanasia date back more than 2 millennia, reflecting evolving philosophies of death and dying as expressions of the mores dominating a given era. One longstanding theme in the history of decisions to die has been staunch opposition founded in religious claims that one’s body is a trust from the divine (and therefore not wholly in their ownership). The role of the physician has also been traditionally estranged from participation in such decisions, dating back to rudimentary conceptions of medical ethics in the Hippocratic notion primum non nocere (‘first, do no harm’). However, fundamental principles in the modern philosophy of medicine lend support to the idea that physicians can be justified in actions which cause some harm, in so far as they are acting to fulfil a greater ethical imperative. This brief historical review explores the inception of modern North American medical assistance in dying (MAiD) policy through a series of critical case studies in the unfolding of its practice. Medically assisted dying has presently been legalised in Canada and some United States jurisdictions, but with critical caveats surrounding circumstances of mature minors, advance directives and mental illness as participants’ sole underlying medical condition. While the modern regulations surrounding MAiD continue to take shape, the palliative care community is well-positioned to both guide and scrutinise the ethics of this practice.
Satheesan Balasubramanian, , M. K. Ranjith, S. S. Abhina
Indian Journal of Palliative Care pp 1-6; https://doi.org/10.25259/ijpc_36_2021

Abstract:
Objectives: e-palliative care (PC) is an evolving concept wherein technological interface is used to deliver PC to the patients with advanced cancer at their doorstep. This study aims to find out the level of satisfaction of patients receiving e-palliative homecare (e-PHC) service from a tertiary Cancer Center using the validated e-Palliative Patient Satisfaction Questionnaire –Malayalam (PSQM). Materials and Methods: In this prospective study, patients/caregivers on home care were given the e - Palliative PSQM by the homecare nurse after the patient had consulted the doctor through e-PHC service. The questionnaire had 15 statements with response graded using Likert scale. Descriptive analysis was performed to compute the distribution of observed responses to obtain the level of satisfaction among patients or caregivers receiving e-PHC service. Results: This study was done among 120 homecare patients whose median age was 69 (62-79) with almost equal prevalence of both genders. Stage 4 malignancy was seen in 107 (89.2%) patients with the commonest being gastrointestinal malignancy (N=34, 28.3%) The mean score of response for General satisfaction, Technical quality, Communication, Financial aspect, Time spent with doctor and Accessibility and convenience were observed as 4.52, 3.92, 4.48, 4.55, 4.52 and 4.49 respectively. The overall satisfaction was found to be 4.39. Conclusion: The overall satisfaction of patients receiving e-PHC service from our Institution is seen to be high. e- palliative care is a feasible option for providing excellent PC in developing countries with limited resources and financial constraints.
Anusha Paul, M. Abdul Razak, Ameya Binoy, Padma Uma Devi,
Indian Journal of Palliative Care pp 1-4; https://doi.org/10.25259/ijpc_41_2021

Abstract:
Objectives: Paclitaxel and docetaxel are two commonly used chemotherapeutic agents in the treatment of various types of cancers. However, debilitating taxane-induced arthralgia and myalgia are among the most common adverse reactions associated with taxanes, which has greatly influenced medical practitioners. Most of the mild and moderate analgesics were found to be less effective in the management of taxane induced pain. So we used flupirtine, a non-opioid analgesic, in the treatment of taxane-induced pain. Materials and Methods: In this study, we analysed the baseline pain score and follow-up data of 60 patients receiving a taxane-based chemotherapy regimen. Baseline data of these study populations experiencing significant taxane-induced pain were compared with follow-up data after treating them with analgesic flupirtine (200 mg/day). The baseline and follow-up data representing pain were assessed with the help of the Visual Analogue Scale (VAS), and the quality of life was determined using the Brief Pain Inventory (BPI) scale questionnaire. Results: The mean baseline and follow-up VAS score was compared using paired sample t-test, which showed a significant reduction in taxane-induced pain after treatment with flupirtine (P < 0.001). Similarly, the mean BPI score representing the quality of life before and after treatment with flupirtine was compared, and a notable improvement in quality of life was seen after treatment with flupirtine. The mean and follow-up data of aspartate aminotransferase and alanine aminotransferase levels of patients were also compared to assess the adverse drug reaction profile of the drug, and the analyzed data was found to be statistically insignificant (no significant liver toxicity) which indicates that drug can be used effectively for a period of <2 weeks. Conclusion: We believe that flupirtine can be used as an effective analgesic in dire situations where patients require opioid analgesics for the management of taxane-induced pain, provided that the drug is given for <2 weeks to avoid drug-related hepatotoxicity.
Journal of Integrated Standardized Homoeopathy, Volume 4, pp 80-85; https://doi.org/10.25259/jish_8_2021

Abstract:
A 14-year-old boy was brought to us with complaints of recurrent fleeing episodes with confusion, short-term amnesia and behavioural problems, including restlessness, obstinacy and temper tantrums. He was diagnosed with dissociative fugue based on the DSM IV criteria. He had undergone counselling with his school counsellor, without much benefits. His illness was affecting his academic performance and relationships with parents and friends. The case was explored from the point of psychosocial stresses and the child’s disposition with characteristic expressions. The homoeopathic remedy Cuprum Metallicum was selected using Kent’s approach, as predominant mental characteristics were available. The selected remedy brought changes at the level of the disease expression (fleeing episodes) as well as the deeper aspect of his sensitivity and behaviour. Improvements occurred in his academic performance, social relationships, behaviour at school as well as his relationship with his parents. This experience emphasises the role of homoeopathy in mental disorders, especially dissociative fugue and also demonstrates the importance of characteristic mental state and expressions when selecting a similimum using Kent’s approach.
, Bikash Biswas, Jahir Abbas
Journal of Integrated Standardized Homoeopathy, Volume 4, pp 86-93; https://doi.org/10.25259/jish_13_2021

Abstract:
Atopic dermatitis (AD) is a chronic, relapsing pruritic skin condition which is accompanied by inflammation of the affected parts. It usually develops during early childhood and has a predilection for the skin flexures. Approximately 70% of cases start before the age of 5 years: Only 10% begin in adulthood. Asthma and allergic rhinitis are comorbid in most cases. This is a case report of a 2-year-old child who presented with reddish elevated papular eruptions on the skin with severe itching. After thorough case taking and examination, the diagnosis was AD, based on the Hanifin and Rajka criteria. The patient underwent individualised homoeopathic treatment. In subsequent follow-ups, the patient’s improvement was monitored using the PO-SCORAD scale and the subjective symptoms. Marked improvement was noted within a few months. Homoeopathic treatment is effective in these cases to yield rapid improvement without any adverse effects.
, Rajesh Kumar Kumawat, Mratyunjay Rajkumar Gupta
Journal of Integrated Standardized Homoeopathy, Volume 4, pp 67-74; https://doi.org/10.25259/jish_5_2021

Abstract:
Objectives: Homoeopathic dilutions are used to increase active principles in medicinal plants, detoxify plants, increase plant growth rate and fruit production, improve plant metabolism and control diseases. This controlled experimental prospective study was conducted to evaluate the effect of homoeopathic medicines Zincum metallicum 6CH and Z. metallicum 12CH on plant growth of Abelmoschus esculentus L. in a natural environment. This study helps assess and establish the role of homoeopathy in propagating plant growth. Materials and Methods: A. esculentus seeds were cultivated in a designated area of the Homoeopathy University campus. Among these, 30 received Zincum 6CH (20 drops in 1 litre water), while 30 received Zincum 12CH (20 drops in 1 L water) and 30 received normal water. After 60 days, the entire plant was measured for height, pod length and productivity. Results: After 60 days, the number of fruits (plant productivity) in the groups receiving Zincum 6CH and 12CH was 335 and 267, respectively; in the group receiving normal water, the number of fruits was 159. The heights of plants receiving Zincum 6CH (M = 48.4 cm, SD = 2.65) and 12CH (M = 40.1 cm, SD = 2.39) were comparatively more than in plants receiving normal water (M = 31.6 cm SD = 2.26). The length of pods in plants receiving Zincum 6CH (M=13.3 cm, SD = 0.96) and 12CH (M = 10.3 cm, SD = 0.97) was comparatively more than in plants receiving normal water (M = 8.9 cm SD = 0.62). Conclusion: The application of potentised homoeopathic medicines Zincum 6CH and 12CH on A. esculentus demonstrated a beneficial result, as observed through significant differences in plant productivity, mean plant height and mean pod length among the experimental and control groups. Zincum 6CH showed more efficacy than 12CH in all aspects of growth.
, Sanjukta Mandal
Journal of Integrated Standardized Homoeopathy, Volume 4, pp 75-79; https://doi.org/10.25259/jish_14_2021

Abstract:
Objectives: The objectives of the study were to evaluate the effects of homoeopathic treatment on patient distress, sociodemographic factors and outcomes in patients with gout. Materials and Methods: This was an observational study conducted using secondary data from hospital records, pathological reports, patient prescription sheet and the sociodemographic data from computerised records in Mahesh Bhattacharyya Homoeopathic Medical College and Hospital. Results: A total of 150 patients (94 men and 56 women) were included in the study. Gout was diagnosed based on clinical symptoms and laboratory reports. All patients were prescribed homoeopathic medicines along with dietary management. The patients were prescribed Lycopodium (n=22, 14.67%), Colchicum (n=17, 11.38%), Natrum sulph (n=18, 12%) and nitric acid (n=14, 9.38%) on the basis of totality and symptoms and individualisation. Improvement was assessed in four different categories: Marked, moderate, mild and no improvement. The patients improved clinically as well as pathologically. Uric acid (UA) reduction was marked in 26 (17.33%) patients, moderate in 67 (44.67%) patients and mild in 25 (16.67%) patients. Almost 125 (83.33%) among the 150 reported reduction in physical discomfort and have been doing well after treatment. Conclusion: This study showed that homoeopathic treatment is very effective in reducing clinical symptoms and serum UA levels in subjects having gout.
, Femil E. Sahaya, Kshitija Kulkarni, E. Vidhubala, Hemant D. Shewade, Jeyashree Kathiresan
Indian Journal of Palliative Care pp 1-10; https://doi.org/10.25259/ijpc_142_21

Abstract:
Objectives: Routine screening for distress is a guideline prescribed by the National Comprehensive Cancer Network (NCCN) to adequately assess distress in a cancer setting. Our centre conducted routine screening but failed to utilize psycho-oncology services. Our aim was to assess the extent of self-reported distress, referrals to psycho-oncology services and healthcare provider perspectives about the existing distress management system and psycho-oncology services. Materials and Methods: We conducted a record review of adult patients (n=372) who reported to the Out-patient department of the tertiary cancer centre. Semi-structured interviews were conducted with fourteen healthcare providers. We used a concurrent mixed methods study design. Adult patients were screened for distress using NCCN-Distress Thermometer and problem checklist. Healthcare providers from different oncology specialties were interviewed and the data was analyzed using descriptive thematic analysis. Results: Patients screened for distress were found to report moderate to extreme levels of distress (53.5%). The total referrals to psycho-oncology support services were low (8.6%). Interviews with healthcare providers revealed three major themes: Enablers, barriers and solutions for utilization of distress management system and psycho-oncology services. Conclusions: Moderate to extreme distress was found among patients routinely screened for distress, although there was poor utilization of distress management system and psycho-oncology support services due to time constraints, patient’s negative attitudes towards mental health referrals, generic screening tools and use of own clinical judgement to make referrals by healthcare providers. Future research warrants implementation of strategies to integrate psycho-oncology services into routine cancer care by focusing on improving visibility of services.
Ravi Gupta, , Bharath Mali Patil, Akash Singhal, Manharjot Malhi
Journal of Arthroscopic Surgery and Sports Medicine pp 1-4; https://doi.org/10.25259/jassm_1_2021

Abstract:
Objectives: Kabaddi is a commonly played sport in Asia and now it is getting recognition worldwide. With the emergence of this sport, concern related to injuries associated with this sport is also increasing. For uniform reporting of injuries and illness in the epidemiological study (Kabaddi), it desired to have standard definitions on Kabaddi-related injuries. Materials and Methods: After the initial review of various studies on other sports; the definitions and terms which can be valid for Kabaddi were selected and modified according to this sport. These definitions were then reviewed by experts, who have an abundance of experiences in the treatment of injuries related to this sport. After multiple meetings among the expert panel final definitions, terms, and methodology for injury surveillance studies were laid down. Results: Only new and modified definitions were used in this paper, therefore, it is advised to use this paper in conjunction with STROBE-SIS. Injury rates were defined per 1000 raids or 1000 tackles. Various definitions like match time loss, general time loss, match injury incidence, training injury incidence, match injury prevalence, etc. were included in this paper. Conclusion: These standard definitions will help inconsistent and better data collection in injury surveillance studies. This will also help in a better understanding of injury patterns.
Danusa Neves Somensi, Emanuel De Jesus Soares De Sousa, Geovanna Lemos Lopes, Gustavo Celeira de Sousa, Marilia Brasil Xavier
Indian Journal of Dermatology, Venereology and Leprology pp 1-4; https://doi.org/10.25259/ijdvl_917_19

Abstract:
Introduction: Neuropathic pain is a common and disabling late complication of leprosy. We investigated the clinical and electrophysiological characteristics of neuropathic pain in leprosy patients by evaluating nerve conduction, sympathetic skin response (SSR) and A-waves. Methods: Twenty one leprosy patients with neuropathic pain validated by the Douleur Neuropathique en 4 (DN4)Questionnaire were selected for study. Pain intensity was measured by the visual analog scale. Demographic and clinical data were collected for all patients. Clinical data included appraisal of the median, ulnar, radial, tibial and common peroneal nerves, assessment of the sympathetic skin response and conventional electrophysiological recordings. Results: Among all electroneuromyographic presentations, multifocal mononeuropathy was still the most prevalent. Sensory loss was observed more frequently than motor deficits. As most patients presented advanced clinical forms of leprosy and were under treatment, this high mean was found and the ulnar nerve was most frequently affected. The sympathetic skin response was absent in 16 patients. Higher DN4 Questionnaire scores were observed in women and in those receiving corticosteroid therapy. These inferences are possible to be made, but our study's limitations don't allow us to be certain about it. The statistical significance found only permits us to evidence what we related on the textual part of the study. Limitations: The small number of patients studied, the lack of sophisticated diagnostic methods for leprosy, as well as the difficulties in assessing nerve conduction were the main limitations of this study. Conclusion: The neurophysiological and clinical findings in leprous neuropathy were modest despite the conspicuous neuropathic pain. Although electrophysiological studies are a vital tool to verify nerve damage, variations in the clinical presentation of leprosy neuropathic pain render the diagnosis challenging. Further studies are needed to describe the neurophysiological evolution of this disease.
Surgical Neurology International, Volume 12; https://doi.org/10.25259/sni_666_2021

Abstract:
Background: Cerebral arteriovenous malformations (AVMs) are pathologic communications between veins and arteries of the brain vasculature. Its spontaneous regression is rare, and many factors have been described in the effort to explain this phenomenon, including a hypercoagulable state. Case Description: We present the case of a spontaneous unruptured AVM regression in a patient where thrombosis of the malformation was found, probably due to a prothrombotic state associated with multiple myeloma (MM). Conclusion: We aim to contribute to the study of this rare phenomenon, presenting the relationship between a hypercoagulable state caused by MM and the spontaneous AVM regression that has not been previously reported.
, Ikwo Jonathan Kudamnya, Uchechukwu Brian Eziagu, Elizabeth Enene Inoh
Calabar Journal of Health Sciences, Volume 5, pp 66-74; https://doi.org/10.25259/cjhs_23_2021

Abstract:
Objectives: Head and neck (HN) lesions occur globally, with remarkable morbidity and mortality. However, in our setting, relevant data are lacking to show its clinicopathologic nature. Hence, we aimed to review the clinicopathological patterns and incidence of HN lesions within a 10-year (January 2010 to December 2019) period as well as provide useful data/information to help in better future management of patients with HN lesions. Material and Methods: A retrospective cross-sectional study of HN lesions (with respect to age, gender, site of lesion, and histopathological diagnosis) at the University of Uyo Teaching Hospital Uyo from January 2010 to December 2019. Results: A total of 276 HN lesions were analyzed over a 10-year period, with a prevalence of 0.004. Patients with the highest volume of HN lesions were within the 30–<40 age group. The lesions were more in females (53.6%) with M: F ratio of 1:1.2. There were more neoplastic HN lesions (85.1%) than non-neoplastic HN lesions (14.9%). The benign HN lesions (67.7%) were also more frequent than the malignant HN lesions (32.3%). And the benign neoplastic HN lesions (79.5%) were more than benign non-neoplastic HN lesions (20.5%). Conclusion: The most common HN lesions, respectively, in different subcategories, found in this study were squamous cell carcinoma, nodular goiter, inflammatory nasal polyps, and cystic hygroma. We recommend study of HN lesions’ possible etiologic/risk factors as well as a nationwide survey to determine a national prevalence of HN lesions.
Grace Ben Inah,
Calabar Journal of Health Sciences, Volume 5, pp 45-52; https://doi.org/10.25259/cjhs_26_2021

Abstract:
Objectives: Radiology education in the undergraduate level imparts in medical students the basic knowledge to interpret common pathological conditions, know the right imaging requests to make and the right order in which they should be made when they become physicians and the degree of this knowledge is influenced by several factors. The aim of this study was to evaluate the knowledge of radiology in exiting medical students and to identify the challenges of undergraduate radiology education. Material and Methods: This was a prospective cross-sectional observational study that was conducted in a 2-month period in the Radiology Department of the University of Calabar Teaching Hospital. The year 6 medical students of the University of Calabar, who were 79 in number, participated in the study. Relevant questions covering the major areas of radiology were presented to each participant by the use of a pre-test questionnaire. SPSS version 23.0., Pearson’s Chi-square test, and t-tests were used to analyze the data. Results: The medical students had a mean score of 66.5% in radiology knowledge. A significant relationship was observed between diagnostic radiology knowledge and the duration of radiology posting (P = 0.029), radiology teaching methods (P = 0.001), and the quality of learning environment (P = 0.002), respectively. Conclusion: The final year medical students in University of Calabar have an appreciable knowledge of radiology. This can be improved if the duration of radiology education increases by early introduction into the pre-clinical class or other clinical courses, if the radiology teaching methods are updated, and if the quality of the learning environment is improved.
, Kazeem Arogundade, Ezukwa Omoronyia, Atim Udo, Mabel Ekott, Saturday Etuk
Calabar Journal of Health Sciences, Volume 5, pp 53-60; https://doi.org/10.25259/cjhs_2_2021

Abstract:
Objectives: Intimate sexual partners’ disclosure of HIV positive status is vital in the control of HIV/AIDS pandemic globally. The disclosure rates vary from region to region. The aim of this study was to document the prevalence of HIV serodiscordance and partners disclosure rate; and also determine the associated factors among HIV positive married women living in Calabar region of Nigeria. Material and Methods: A cross-sectional survey was conducted among 260 married women, 18 years and above, receiving HIV care at various health institutions in the region. Data were analyzed using SPSS VERSION 23. Their demographic and health profile were presented in simple proportion and percentages while Chi-square test and logistic regression were used to determine the factors influencing patient’s HIV status disclosure with the level of significance set at 0.05. Results: A total of 254 compiled questionnaires were included in the analysis (response rate-97.7%). The serodiscordant rate was 50%. HIV status disclosure to partner was high, 89.4%. The main determinants of HIV status disclosure were good level of education (AOR = 2.2, 95% CI: = 1.75–2.53, P = 0.007) and long duration of ART use (AOR = 3.23, 95% CI = 2.78–4.15, P = 0.001) while women with high discordant rate were more likely to be divorced/separated (P = 0.012, OR = 1.67). Conclusion: Female education is an important factor in HIV control. Disclosure of HIV status is beneficial to the partner as it promotes safe sex practices and increases adherence to ART.
Surgical Neurology International, Volume 12; https://doi.org/10.25259/sni_723_2021

Abstract:
Background: Incomplete resection of neurenteric cysts (NCs) has been associated with increased recurrence rates in patients compared to complete resection (CR) and information on intracranial NCs appearance on diagnostic imaging is scarce. We sought to identify factors associated with CR and provide the largest up-to-date review of NCs appearances on various diagnostic images. Methods: Data from Medline, EMBASE, and Web of Science were extracted. Univariate and multivariate logistic regression models were used to analyze factors associated with CR. Results: A total of 120 publications reporting 162 original cases on posterior fossa NCs met the inclusion criteria for analysis. Eighty-nine (55.6%) of the patients were female, the mean (SD) age of the patients’ during operation was 34.3 (16.9) years, and CR was achieved in 98 (60%) of patients. Univariate analysis identified male sex as a statistically significant predictor for complete reaction (OR 2.13, 95% Cl 1.10–4.11, P = 0.02). The retrosigmoid approach (OR 1.89, 95% Cl 0.98–3.63, P = 0.06), far lateral approach (OR 0.46, 95% Cl 0.21–1.02, P = 0.06), and pediatric patient (OR 2.45, 95% Cl 0.94–6.56, P = 0.07) may be possible predictors for CR, however, they were not statistically significant. NCs are mainly hypodense on CT (32 [61.5%]), varied greatly in intensity on T1WI, hyperintense on T2WI magnetic resonance imaging (98 [67.1%]), and hyperintense on fluid-attenuated inversion recovery (17 [63.0%]). Conclusion: We recommend utilizing various diagnostic imaging tests to help reduce misdiagnoses when identifying intracranial NCs. For patient safety, CR should be achieved when possible, to reduce risk of additional operations due to recurrence.
, John Lancione Esq
Surgical Neurology International, Volume 12; https://doi.org/10.25259/sni_875_2021

Abstract:
Background: The package insert for DuraSeal (Integra LifeSciences, Princeton NJ) states it is Contraindicated for use in the anterior cervical spine (confined space): “Do not apply DuraSeal® hydrogel to confined bony structures where nerves are present since neural compression may result due to hydrogel swelling (…up to 12% of its size in any direction).” Further, it should not be used to treat massive unrepaired cerebrospinal fluid (CSF) leaks in any location; “…(it) is indicated as an adjunct to sutured dural repair during spine surgery to provide watertight closure,” but it is not to be used “...for a gap greater than 2 mm….” Methods: A spinal surgeon interpreted a geriatric patient’s MR as showing severe C3-C4 to C5-C6 anterior cord compression due to disc disease/spondylosis. However, he never reviewed the CT report/images that documented marked ossification of the posterior longitudinal ligament (OPLL) with multiple signs of dural penetrance. Results: The anterior C4, C5 corpectomy, and C3-C6 strut fusion/plating resulted in a massive, irreparable cerebrospinal fluid (CSF) leak. Despite the contraindications, the surgeon mistakenly applied DuraSeal which caused the patient’s postoperative quadriplegia (i.e., as documented on the delayed postoperative MR scan). Following a secondary surgery consisting of a laminectomy/posterior fusion, the patient was still quadriplegic. Further, as he requested no postoperative MR scan and performed no subsequent corrective surgery (i.e., anterior removal of DuraSeal), the patient remained permanently quadriplegic. Conclusion: DuraSeal is directly contraindicated for use in the anterior cervical spine, with/without a CSF leak. Here, utilizing DuraSeal for anterior cervical OPLL surgery resulted in permanent quadriplegia, and was below the standard of care.
Surgical Neurology International, Volume 12; https://doi.org/10.25259/sni_194_2021

Abstract:
Background: Pediatric abusive head trauma (AHT) represents 80% of nonaccidental trauma deaths, remaining a lead cause of death among infants and young children. Furthermore, neurosurgical intervention can ameliorate damage from secondary injury, but we are currently unable to alter the impact of the primary injury. Thus, prevention through increased public awareness is imperative. This study identifies injuries and predictors of outcomes in pediatric AHT and highlights the importance of partnering with our community through ThinkFirst, a national injury prevention foundation, to educate parents and caregivers about prevention. Methods: This single-institution retrospective review identifies injuries and predictors of outcomes in pediatric AHT and highlights the importance of partnering with our community to raise awareness and educate parents and caregivers about prevention. Results: The number of pediatric AHT cases continues to steadily increase over time (P < 0.001), and over 70% of these patients are <1 year of age (P < 0.001). Patients suffering AHT have a mortality rate of nearly 10%. In addition to morbidity and mortality, the economic burden of caring for abused children is high as they often require high levels of care, long hospital stays, and extensive rehabilitation. Furthermore, Medicaid pays for nearly 80% of these patients. Conclusion: The population of patients with AHT is unique, and one that will benefit from continued efforts at increased multidisciplinary and public awareness. Prevention of AHT through awareness is critical. Through partnering with ThinkFirst, a national injury prevention foundation, we aim to educate parents and caregivers about prevention.
Surgical Neurology International, Volume 12; https://doi.org/10.25259/sni_613_2021

Abstract:
Background: Normal pressure hydrocephalus (NPH) is a common neurodegenerative syndrome among the elderly characterized by ventriculomegaly and the classic triad of symmetric gait disturbance, cognitive decline and urinary incontinence. To date, the only effective treatment is a cerebrospinal fluid shunting procedure that can either be ventriculo-atrial, ventriculo-peritoneal, or lumbo-peritoneal shunt. The conventional ventriculo-atrial shunt uses venodissection, whereas the peel-away is a percutaneous ultrasound (US)-guided technique that shows some advantages over conventional technique. We sought to compare perioperative complication rates, mean operating time and clinical outcomes for both techniques in NPH patients at our institution. Methods: A retrospective cohort-type analytical study was conducted, using clinical record data of patients diagnosed with NPH and treated at our center from January 2009 to September 2019. Parameters to be compared include: Perioperative complication rates, intraoperative bleeding, mortality, and mean operating time. Perioperative complication rates are those device-related such as shunt infection, dysfunction, and those associated with the procedure. Complications are further classified in immediate (occurring during the first inpatient stay), early (within the first 30 days of surgery), and late (after day 30 of surgery). Results: A total of 123 patients underwent ventriculo-atrial shunt. Eighty-two patients (67%) underwent conventional venodissection technique and 41 patients (33%) underwent a peel-away technique. Immediate complications were 3 (3.6%) and 0 for conventional and peel-away groups, respectively. Early complications were 0 and 1 (2.4%) for conventional and peel-away groups, respectively. Late complications were 5 (6.1%) and 2 (4.9%) for conventional and peel-away groups, respectively. Mean operating time was lower in the peel-away group (P = 0.0000) and mortality was 0 for both groups. Conclusion: Ventriculo-atrial shunt is an effective procedure for patients with NPH. When comparing the conventional venodissection technique with a percutaneous US-guided peel-away technique, the latter offers advantages such as shorter operating time and lower perioperative complication rates.
Surgical Neurology International, Volume 12; https://doi.org/10.25259/sni_931_2021

Abstract:
Background: Robotic assisted (RA) spine surgery was developed to reduce the morbidity for misplaced thoracolumbar (TL) pedicle screws (PS) resulting in neurovascular injuries, dural fistulas, and/or visceral/other injuries. RA is gaining the attention of spine surgeons to optimize the placement of TL PSs, and to do this more safely/effectively versus utilizing stereotactic navigation alone, or predominantly free hand (FH) techniques. However, little attention is being focused on whether a significant number of these TL RA instrumented fusions are necessary. Methods: RA spine surgery has been developed to improve the safety, efficacy, and accuracy of minimally invasive TL versus open FH PS placement. Results: Theoretical benefits of RA spine surgery include; enhanced accuracy of screw placement, fewer complications, less radiation exposure, smaller incisions, to minimize blood loss, reduce infection rates, shorten operative times, reduce postoperative recovery periods, and shorten lengths of stay. Cons of RA include; increased cost, increased morbidity with steep learning curves, robotic failures of registration, more soft tissue injuries, lateral skiving of drill guides, displacement of robotic arms impacting accurate PS placement, higher reoperation rates, and potential loss of accuracy with motion versus FH techniques. Notably, insufficient attention has been focused on the necessity for performing many of these TL PS instrumented fusions in the first place. Conclusion: RA spinal surgery is still in its infancy, and comparison of RA versus FH techniques for TL PS placement demonstrates several potential pros, but also multiple cons. Further, more attention must be focused on whether many of these TL PS instrumented procedures are even warranted.
Surgical Neurology International, Volume 12; https://doi.org/10.25259/sni_805_2021

Abstract:
Background: Pure epidural spinal cavernous hemangiomas (SCH) account for only 4% of all spinal epidural lesions. Our literature review identified 61 publications reporting on, a total of 175 cases in the magnetic resonance imaging era. Here, we reviewed those cases, and have added our case of what appeared to be a multifocal SCH. Case Description: A 72-year-old male presented with a progressive paraparesis attributed to a T5/T6 dorsolateral extradural mass extending into the right T5/6 foramen. Surgical excision documented the lesion, histologically, was a SCH. A second similar lesion was noted involving the left C7/T1 foramen; as the patient was asymptomatic from this lesion, and no additional biopsy was performed. The patient returned to normal neurological function within 2 months postoperatively. Conclusions: Here, a 72-year-old male presented with a pathologically confirmed T5/T6 epidural SCH and a secondary C7/T1 foraminal lesion suspected to represent a secondary focus of an epidural SCH.
, Toshiki Endo, , , , , Hidenori Endo, Shunji Mugikura, , Teiji Tominaga
Surgical Neurology International, Volume 12; https://doi.org/10.25259/sni_887_2021

Abstract:
Background: The subcallosal artery (ScA) is a single dominant artery arising from the anterior communicating artery. Its injury causes amnesia and cognitive disturbance. The conventional computed tomographic angiography (C-CTA) is a common evaluation method of the intracranial artery. However, to image tinny perforating arteries such as the ScA is technically demanding for C-CTA. The purpose of this study is to investigate whether the ultra-high-resolution CTA (UHR-CTA) could image the ScA better than C-CTA. UHR-CTA became available in clinical practice in 2017. Its novel features are the improvement of the detector system and a small X-ray focus. Methods: Between April 2019 and May 2020, 77 and 49 patients who underwent intracranial UHR-CTA and C-CTA, respectively, were enrolled in this study. Two board-certified neurosurgeons participated as observers to identify the ScA based on UHR-CTA and C-CTA images. Results: UHR-CTA and C-CTA detected the ScA in 56–58% and 30–40% of the patients, respectively. In visualization of the ScA, UHR-CTA was better than C-CTA (P < 0.05, Fisher’s exact test). Between the two observers, the Cohen’s kappa coefficient was 0.77 for UHR-CTA and 0.78 for C-CTA. Conclusions: UHR-CTA is a simple and accessible method to evaluate intracranial vasculature. Visualization of the ScA with UHR-CTA was better than that with C-CTA. The high quality of UHR-CTA could provide useful information in the neurosurgery field.
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