Search

Background: Primary graft dysfunction (PGD) is the leading cause of short- and long-term mortality associated with lung transplantation. The impact of pretransplantation blood transfusions for recipients is not fully elucidated. Methods: This is a retrospective review of 206 consecutive lung transplantations performed at a single academic center (Northwestern University Feinberg School of Medicine, Chicago, IL) from January 2018 to July 2022. Data on patient characteristics, pretransplantation laboratory values, transfusion requirements, and intraoperative and postoperative outcomes were collected. Results: PGD grade 3 (PGD 3) occurred in 13.2% of the cohort (n = 28). A total of 33 patients received a blood transfusion within 4 weeks, whereas 21 patients received a blood transfusion a week before their lung transplant. Pretransplantation transfusions were strongly associated with a higher incidence of PGD 3 (48.5% vs 6.9%; P < .001). There was no significant difference in 1-year survival between the pretransplantation transfused group and the nontransfused group (77.7% vs 88.0%; P = .478). The 1year survival was reduced in recipients with PGD 3 compared with recipients without PGD 3 (63.5% vs 89.9%; P = .0012). In univariate analysis, pretransplant and intratransplant predictors of PGD 3 included younger age (P < .01), pretransplant extracorporeal membrane oxygenation (ECMO) use (P < .001), higher lung allocation score (P < .001), coronavirus disease 2019 (COVID-19)–related acute respiratory distress syndrome (P < .01), blood transfusion within 4 weeks (P < .001), longer operative time (P < .001), intratransplant blood transfusion (P < .001), and intratransplant venoarterial ECMO use (P < .001). Conclusions: Pretransplantation blood transfusions could be associated with a higher rate of PGD. The findings indicated the potential risks of pretransplantation blood transfusions in lung transplant recipients.

Salivary gland neoplasms account for 3% of all head and neck tumours. Pleomorphic adenoma (PA) is the most common salivary gland tumour that mainly occurs in the parotid gland, followed by minor salivary glands of the oral cavity, however, the occurrence of PA inside the jaw bones is exceedingly rare and very few cases have been reported in the literature. Inside jaw bones these lesions tend to imitate large osteolytic lesions encompass a diagnostic challenge. An exhaustive review of the literature revealed only 10 cases of central pleomorphic adenoma. We present a rare case of primary PA that occurred inside the mandible and was provisionally diagnosed as ameloblastoma.

Abstract Background Salmonella spp. cause infectious aortitis through the hematogenous spread of an intestinal Salmonella infection. Salmonella aortitis can result in extensive tissue damage in the aorta leading to complications including dissection, abscess formation, pseudoaneurysms, and rupture, which require early diagnosis and treatment with both surgery and antibiotic therapy. Case presentation We report a case of Salmonella aortitis complicated by Stanford type A aortic dissection. A 62-year-old man with a history of heroin use presented with chest pain, epigastric pain and vomiting. The computed tomography scan showed Stanford type A aortic dissection without malperfusion. At the time of surgery, an aortic dissection with purulent fluid and contained rupture was noted in the ascending aorta. Fluid culture was consistent with Salmonella. A composite valve-graft conduit aortic root replacement with ascending aorta and hemiarch replacement was performed. The patient recovered well and was discharged on long-term antibiotics. Conclusions This rare case of a Stanford type A aortic dissection with contained rupture due to Salmonella aortitis was successfully treated with emergent surgery and antibiotic therapy.

Objective: In the evolving era of minimal access surgery, low rectal cancers still pose a challenge to laparoscopic or robotic surgeons. Hence, at our institute we intended to demonstrate the oncological efficacy of intersphincteric resection and coloanal anastomosis in the treatment of distal rectal cancers, performing the abdominal part of the procedure which includes rectal mobilization, laparoscopically. Methods: From February 2017 to March 2021, 125 patients who had undergone intersphincteric resection and coloanal anastomosis via the perineal approach at Galaxy Care Laparoscopic Institute, Pune, were included in this study. Transabdominal mobilization of the rectum was performed laparoscopically. All patients had a diversion ileostomy and a pelvic drain. Patients were followed-up for a period of 18 months post-surgery. Data on clinical and oncological outcomes were collected and analysed. The pre-operative and post-operative Wexner incontinence scores were compared. Results: The mean time taken for surgery was 181.57 ± 30.00 min. The mean blood loss was 119.76 ± 42.53 mL. Most patients (103, 82.4%) had their tumour at a distance of 1–2 cm from the anal verge. A loco-regional recurrence rate of 12.8% (16/125) was noted in our study. For the post-surgery Wexner score, 74.4% of patients (93/125) had a score of 5 or less, depicting that three-quarters of the study population had satisfactory continence. Overall, 81.6% of patients were satisfied with the functional results of surgery. Conclusion: Intersphincteric resection and coloanal anastomosis, with a 12.8% recurrence rate, can now be considered an oncological and technically feasible procedure with sphincter salvage and good continence.

Introduction: Dental professionals play an important role in an individual's appearance which can affect the perception of others that can vary greatly depending on their educational and socioeconomic background. Aim and Objective: The purpose of this study was to determine an insight of recognizing ability of dental professionals and laypersons toward facial aesthetics with different types of orthodontic malocclusion. Materials and Methods: A questionnaire-based study was conducted on 90 dental professionals and 90 laypersons. The perceptions differences between groups were assessed using visual analogue scale on 11 photographs. Kolmolgorov-Smirnov was used for normality test. Results: The perceptions of facial aesthetics showing various malocclusions were significantly different between dental professionals and laypersons. Conclusion: The dental professionals and layperson perceptions regarding the facial particularly in central Indian population are significantly different for most of the malocclusion types.

Introduction: Lower limb veins are most prone to having venous disorders and varicose veins are the biggest issue. Varicose veins can be grouped into Primary or Secondary Varicose veins. Secondary Varicose veins are associated with acquired factors causing stasis and hypercoagulable state. This study addresses the various associated risk factors for secondary varicose veins such as age, sex, Body Mass Index (BMI), pregnancy, prolonged standing, tobacco use, and deep vein thrombosis history and family history of secondary varicose veins. Methods: A prospective non-randomized study of fifty patients was carried out between August 2015 and July 2016. Demographic details of all patients were recorded. Detail history and examination of both lower limbs were performed. Descriptive statistics were calculated by measuring means, standard deviation (SD), and proportions with 95% confidence interval. Results: Tobacco chewing in any form was the most common associated risk factor of secondary varicose vein in our study of 50 patients and it was observed in 46% of patients. We found that varicose veins were more common in males and it was especially predominant in the over fifty years of age. Amongst them, twenty patients were obese with body mass index of more than 25 kg/m2. Past history of varicose veins and treatment for same was not associated significantly with varicose veins prevalence. More than two numbers of pregnancies were found in 26% females with varicose veins. Conclusion: We found that prolong standing, smoking (> 10 cigarettes/day), more than two pregnancies, and family history of deep venous thrombosis were some of the major associated risk factors for varicose veins. We couldnt establish any strong association between previous history of deep venous thrombosis and varicose vein surgery with respect to recurrence of it. Among modifiable risk factors, tobacco chewing and smoking should be abandoned to decrease the incidence of varicose veins. [Arch Clin Exp Surg 2018; 7(3.000): 104-107]

Introduction: Breast cancer is the most common cancer in females worldwide. The presentations of breast cancer patients are varied, and available treatment options are many. Management of breast cancer has changed over the period of years from radical surgeries to more of conservative approaches. The present study was undertaken to evaluate the role of neoadjuvant chemotherapy therapy in downstaging large operable breast cancer (LOBC) in the Indian population and usefulness of less radical, breast conservative surgery (BCS) in these patients. Materials and Methods: A prospective nonrandomized study of 32 patients with LOBC was carried out between September 2014 and August 2015. Patients with stage IIIA disease of 18–70 years of age were included. Clinical tumor response was graded according to the World Health Organization Criteria for clinical tumor response. Locoregional management consisted of either BCS (wide local excision, complete axillary dissection, postoperative radiotherapy) or modified radical mastectomy (MRM), depending on feasibility for BCS and patients' choice about the type of surgery to undergo. Data collected was documented and analyzed. Results: The mean age of patients was 43.73 years. Most of the patients were premenopausal. About 75% of patients achieved maximal response after 4 cycles neoadjuvant chemotherapy. Statistically significant response was achieved in downstaging the breast cancer. Complete clinical response was seen in 12.5%, and partial clinical response (cPR) was seen in 75% patients after neoadjuvant systematic chemotherapy. Postneoadjuvant chemotherapy, 68.75% patients became feasible for BCS. There was no statistically significant association between age, initial tumor size, and menstrual status with tumor response to chemotherapy and feasibility for BCS. Conclusions: To conclude, Neoadjuvant Systemic Therapy is effective in the management of LOBC. BCS is feasible in the majority of LOBC after downstaging by Neoadjuvant Systemic Therapy, which otherwise would require MRM.

Abstract Background The open preperitoneal repair offers the benefits of placing the mesh in the preferred position while avoiding the disadvantages of laparoscopic repair. Methods A total of 60 patients with bilateral inguinal hernias were randomized to undergo either the standard Lichtenstein meshplasty or the modified iliopubic tract repair in a teaching hospital. Outcomes measured were immediate postoperative pain, return to activity, and delayed neurological complications. Results Patients who underwent the iliopubic tract repair walked out of bed faster than the Lichtenstein group (6.3 hours vs 7.4 hours, p 0.05). Conclusion The iliopubic tract repair offers an excellent alternative to the Lichtenstein meshplasty, and is associated with lower postoperative pain, earlier return to work, and lower delayed neurological complications.

Introduction: Dental professionals play an important role in an individual's appearance which can affect the perception of others that can vary greatly depending on their educational and socioeconomic background. Aim and Objective: The purpose of this study was to determine an insight of recognizing ability of dental professionals and laypersons toward facial aesthetics with different types of orthodontic malocclusion. Materials and Methods: A questionnaire-based study was conducted on 90 dental professionals and 90 laypersons. The perceptions differences between groups were assessed using visual analogue scale on 11 photographs. Kolmolgorov-Smirnov was used for normality test. Results: The perceptions of facial aesthetics showing various malocclusions were significantly different between dental professionals and laypersons. Conclusion: The dental professionals and layperson perceptions regarding the facial particularly in central Indian population are significantly different for most of the malocclusion types. [ABSTRACT FROM AUTHOR]

Blunt abdominal trauma can injure any abdominal organs which had significant morbidity and mortality in paediatric age group. It can lead to duodenal, jejunal or rather any bowel perforation. Isolated jejunal perforation still remains rare entity with less documented reports in specifically paediatric age group. We hereby present a case of three-year-old female child with isolated jejunal perforation, post history of fall from height. Early exploration and prompt surgical intervention led to successful outcome in this patient.

Purpose: Managing acute respiratory distress syndrome (ARDS) patients on venovenous extracorporeal membrane oxygenation (V‐V ECMO), without sedation/neuromuscular blockade to allow physical and occupational therapy (PT/OT) participation, is untraditional. Here, we investigate the impact of early PT/OT initiation on discharge functional activity for ARDS patients managed on V‐V ECMO. Methods: This is a retrospective review of 67 ARDS patients managed with V‐V ECMO at a single academic center from February 2018 to June 2021. Data collected included patient characteristics, days of V‐V ECMO support, day of PT/OT initiation, and ambulation distance and Activity Measure for Post‐Acute Care (AMPAC) Six‐Clicks score on day of discharge. Results: Patients with >7 days of V‐V ECMO support had decreased ambulation and AMPAC scores compared to those with <7 days (70.5 vs. 162.1, p < 0.01 and 12.3 vs. 16.4, p = 0.01, respectively). PT/OT initiation within 7 days after starting V‐V ECMO significantly improved ambulation and AMPAC scores (163.5 vs. 59.5, p < 0.001, and 16.6 vs. 11.8, p < 0.01, respectively). Additionally, in patients with >7 days of V‐V ECMO support, those who began PT/OT within 8 days of V‐V ECMO cannulation had significantly improved ambulation and AMPAC scores (151.8 vs. 44.2, p < 0.01, and 16.5 vs. 11.0, p < 0.01, respectively). Conclusion: Early PT/OT initiation in severe ARDS patients managed on V‐V ECMO is associated with improved patient functional activity on day of discharge. Our study further supports the use of V‐V ECMO in treatment of severe ARDS without sedation/neuromuscular blockade and specifically demonstrates PT/OT should be started early following V‐V ECMO cannulation. [ABSTRACT FROM AUTHOR]

Purpose: Efficacy evaluation of casein phosphopeptide amorphous calcium phosphate complex (CPP-ACP), casein phosphopeptide amorphous calcium fluoride phosphate complex (CPP-ACFP), fluoride mouthrinse, and fluoride containing toothpaste as compared to control group for the remineralization of white spot lesions (WSLs) in orthodontic patients with fixed brackets in an in vivo study. Methods: Seventy-five subjects with WSL determined by DIAGNOdent were randomly divided into 5 groups. The WSLs DIAGNOdent values for 0, 3, 6, 9, and 12 months were tabulated and subjected to statistical analysis. Results: Among the groups, the remineralizing potential of fluoride mouth rinse, fluoride containing toothpaste, and CPP-ACP were similar; however, CPP-ACFP value was superior in comparison to all other groups. Conclusion: The CPP-ACFP technique is highly beneficial for the remineralization of WSL in an orthodontic patient when compared to fluoride mouth rinse, fluoride-containing toothpaste, and CPP-ACP paste. [ABSTRACT FROM AUTHOR]

Microplastics are small plastic particles that can pose a threat to the environment and human health. One of the sources of microplastics that has not been widely studied is orthodontic rubber bands, which are used to correct misaligned teeth. This paper aims to investigate the potential release of microplastics and nanoplastics from orthodontic rubber bands and their chemical composition. The authors used scanning electron microscopy (SEM) and Raman spectroscopy to analyze the debris left behind by new and used rubber bands after rinsing with water and ethanol. They found that the rubber bands contained natural latex and other additives, such as ethylene propylene diene monomer (EPDM), polyisoprene, and silicone. They also observed that the rubber bands could release microscopic particles ranging from 10 nm to 10 μm in size, which could be ingested by the patients or enter the aquatic environment. The paper suggests that more research is needed to assess the environmental and health impacts of microplastics and nanoplastics from orthodontic rubber bands, and that alternative materials should be considered to reduce plastic pollution. [ABSTRACT FROM AUTHOR]

Introduction: Miconazole Nitrate is prescribed as an antifungal agent in conventional dosage forms. To mask the disadvantages of sticky creams and their tendency to rub off, an intelligent dosage regimen needs to be designed. Objectives: The present study aimed to design, develop, and characterize Miconazole Nitrate (0.5% w/v) film-forming spray for the treatment of superficial fungal infections in nails, such as Tenia and Onychomycosis. Materials and Methods: Eutectic mixture of Menthol and Camphor in the ratio of 1:1 was used to enhance permeation and solubilize film-forming polymers, i.e., Eudragit L-100 and Ethyl Cellulose, and provide a cooling effect. Results: The prepared formulations were evaluated for various critical parameters, and based on the results obtained, Formulation F1 exhibited a drug content of 91.82% and 83.75% of % Cumulative drug release through Eggshell membrane and was found to be the best-suited formulation. Formulation F1 was further chosen for carrying out in-vitro permeation studies through shed snakeskin of Ophiophagus Hannah (Cobra), which gave % a cumulative drug release of 72.453 %, exhibited pH of 5.8 and evaporation time of four minutes yielding a non-sticky film. The prepared formulations were clear in appearance and formed Uniform, non-sticky, flexible films. The average time required for the release of 50% drug was found to be 120-180 min, and the drug transport kinetic was best fitted into the Korsmeyer's-Peppas model. Conclusion: The study concluded that the prepared transdermal film-forming spray formulations would be efficient for treating fungal infections of superficial nature and will prove to be a practical approach in the delivery of topical antifungal agents. [ABSTRACT FROM AUTHOR]

Background: Veno‐venous extracorporeal membrane oxygenation (V‐V ECMO) support is increasingly used in the management of COVID‐19‐related acute respiratory distress syndrome (ARDS). However, the clinical decision‐making to initiate V‐V ECMO for severe COVID‐19 still remains unclear. In order to determine the optimal timing and patient selection, we investigated the outcomes of both COVID‐19 and non‐COVID‐19 patients undergoing V‐V ECMO support. Methods: Overall, 138 patients were included in this study. Patients were stratified into two cohorts: those with COVID‐19 and non‐COVID‐19 ARDS. Results: The survival in patients with COVID‐19 was statistically similar to non‐COVID‐19 patients (p =.16). However, the COVID‐19 group demonstrated higher rates of bleeding (p =.03) and thrombotic complications (p <.001). The duration of V‐V ECMO support was longer in COVID‐19 patients compared to non‐COVID‐19 patients (29.0 ± 27.5 vs 15.9 ± 19.6 days, p <.01). Most notably, in contrast to the non‐COVID‐19 group, we found that COVID‐19 patients who had been on a ventilator for longer than 7 days prior to ECMO had 100% mortality without a lung transplant. Conclusions: These findings suggest that COVID‐19‐associated ARDS was not associated with a higher post‐ECMO mortality than non‐COVID‐19‐associated ARDS patients, despite longer duration of extracorporeal support. Early initiation of V‐V ECMO is important for improved ECMO outcomes in COVID‐19 ARDS patients. Since late initiation of ECMO was associated with extremely high mortality related to lack of pulmonary recovery, it should be used judiciously or as a bridge to lung transplantation. [ABSTRACT FROM AUTHOR]