Tag: nevin manimala

Cureus. 2023 Apr 10;15(4):e37408. doi: 10.7759/cureus.37408. eCollection 2023 Apr.

ABSTRACT

Background The clinical condition of epidemic dropsy is caused by the consumption of edible oils contaminated with Argemone mexicana oil. Two of the most toxic alkaloids found in argemone oil are sanguinarine and dehydrosanguinarine, which cause capillary dilation, proliferation, and increased permeability. Extreme cardiac decompensation leading to congestive heart failure and glaucoma resulting in blindness are the most serious consequences of epidemic dropsy. Materials and methods All patients attending the medicine department of Tezpur Medical College and Hospital with clinical features of epidemic dropsy were included in the study after obtaining informed consent. All patients, after a complete history, underwent a thorough clinical examination, and findings were recorded using a pre-formed proforma. Along with routine blood examination, patients were also evaluated with echocardiography, ECG, and chest X-ray. Cooking oil samples obtained from patients were investigated for the presence of sanguinarine in a standardized laboratory with the help of the district authority. The statistical analysis was done using MS Excel 2017. Results Out of 38 patients, 36 were male (94.7%), and only two were female (5.2%). Male to female ratio was 18:1. This difference in sex ratio may be due to the fact that only severely ill patients attended our tertiary care hospital. In contrast, moderate and mildly ill patients were treated in local hospitals. The mean age of patients was 28.1 years, and the mean length of hospital stay was eight days. Bilateral pitting type of ankle edema was the most common clinical manifestation, and all 38 patients (100%) exhibited edema. A total of 76% of patients had dermatological manifestations. Sixty-two percent of patients had gastrointestinal manifestations. In cardiovascular manifestation, persistent tachycardia was seen in 52% of patients, pansystolic murmur was best heard in the apical area in 42% of patients, and 21 percent had evidence of a raised jugular venous pressure (JVP). Five percent of patients had pleural effusion. Sixteen percent of patients had ophthalmological manifestations. Eight patients (21%) required ICU care. The in-hospital fatality rate was 10.53% (n=4). Of the expired patients, 100% were male. The most common cause of death was cardiogenic shock (75%), followed by septic shock (25%). Conclusion From our study, it was found that most of the patients were male, with an age group of 25-45 years. The most common clinical manifestation was dependent edema, along with signs of heart failure. Other common manifestations were dermatological and gastrointestinal. The severity and outcome were directly related to the delay in seeking medical consultation and diagnosis.

PMID:37182084 | PMC:PMC10172017 | DOI:10.7759/cureus.37408

Cureus. 2023 Apr 11;15(4):e37444. doi: 10.7759/cureus.37444. eCollection 2023 Apr.

ABSTRACT

Background Otorhinolaryngology (ENT) illnesses commonly affect all individuals with a broad range of symptoms, and most causes are preventable. According to the WHO, more than 278 million people have bilateral hearing loss. Locally, a previously published study done in Riyadh showed that most participants (79.4%) had a poor level of knowledge on common ENT-related diseases. The current study aims to investigate and explore the knowledge of and attitudes toward common ENT problems among students in Makkah City, Saudi Arabia. Method This descriptive, cross-sectional study used an Arabic-language electronic questionnaire to assess knowledge of common ENT problems. It was distributed to medical students at Umm Al-Qura University and students attending Makkah City high schools in Saudi Arabia between November 2021 and October 2022. The sample size was calculated to be 385 participants. Results Overall 1080 respondents were enrolled in this survey from Makkah City. Participants with good knowledge of common ENT diseases were over 20 years of age with a p-value <0.001. Furthermore, females also had a significant p-value of <0.004, and those with bachelor’s or university degrees showed a statistically significant p-value of <0.001. Conclusion Female participants with bachelor’s or university degrees and participants aged 20 and older showed superior knowledge. Our findings indicate that students need educational implications and awareness campaigns to increase their knowledge, practice, and perception toward common otorhinolaryngology-related issues.

PMID:37182080 | PMC:PMC10174595 | DOI:10.7759/cureus.37444

Cureus. 2023 Apr 10;15(4):e37366. doi: 10.7759/cureus.37366. eCollection 2023 Apr.

ABSTRACT

Background Baska Mask (BM) is a third-generation supraglottic airway device with a self-inflating cuff. This study aimed to evaluate the efficacy of the BM compared to ProSeal laryngeal mask airway (PLMA) regarding insertion time, ease of insertion, and oropharyngeal seal pressure in patients undergoing elective surgeries under general anesthesia for less than two hours. Methods This prospective, randomized, double-blind comparative study was done on 64 patients randomly divided into two groups, with 32 patients in the PLMA group (Group A) and 32 in the BM group (Group B). Individuals with a body mass index (BMI) of more than 30, a history of nausea/vomiting, or pharyngeal pathology were excluded from the trial. After induction with propofol 3-4 mg/kg, fentanyl 1-2 mcg/kg, and the neuromuscular blockade was achieved with atracurium 0.5 mg/kg, patients were inserted with either BM (n= 32) or PLMA (n= 32). The primary outcome measure was the time taken for insertion and ease of insertion. Secondary outcome measures included the number of attempts, oropharyngeal seal pressure (OSP), and laryngopharyngeal morbidity (trauma to lips, blood staining, and sore throat) immediately and 24 hours postoperatively. Results Demographic data were comparable and statistically insignificant. Regarding time and ease of insertion, the BM could be inserted in a lesser time of 24±1.136 seconds compared to PLMA which took 28.59±1.682 seconds, with a high success rate in the first attempt which was statistically significant. The BM provided a higher OSP (31.34 +1.638 cmH2O) when compared to PLMA (24.81±1.469 cmH2O) and was statistically significant. Complications associated with insertion trauma to the lip, blood staining, and sore throat were more in PLMA (15.6%, 15.6 %, 9.4%, respectively) compared to the BM (6.3%, 3.1%, 3.1%, respectively), and statistically insignificant. Conclusion BM had higher first-attempt successful insertion with better OSP compared to PLMA in patients under controlled ventilation.

PMID:37182077 | PMC:PMC10170866 | DOI:10.7759/cureus.37366

Cureus. 2023 Apr 10;15(4):e37382. doi: 10.7759/cureus.37382. eCollection 2023 Apr.

ABSTRACT

BACKGROUND: Inguinal hernia repair is one of the most common general surgical procedures. It has been performed under local, regional, or general anesthesia. We hypothesized that using regional plus general anesthesia rather than general anesthesia alone would improve outcomes in neonates and pediatric patients undergoing hernia repair.

METHODS: This is a retrospective cohort study, including all pediatric patients who underwent inguinal hernia repair from 2015-2021. We divided patients into two groups. The first group was labeled “general anesthesia” (GA), while the second group was labeled “combined general and regional anesthesia” (GA+RA). We compared both groups in terms of demographic data, intraoperative outcome variables, and postoperative outcome variables.

RESULTS: 212 children fulfilled the study criteria, with 57 in the GA group and 155 in the GA+RA group. Demographic and preoperative data were comparable between both groups except for age, which was 60.3±49.4 months in the GA group versus 26.7±33.13 months in the GA+RA group (p<.0001). Outcome variables demonstrated statistically significant improvement in postoperative pain occurrence, length of hospital stay, incidence of bradycardia, and need for mechanical ventilation in the GA+RA group in comparison to the GA group with P values of 0.031, 0.02, 0.005, and 0.02, respectively.

CONCLUSION: Using regional and general anesthesia techniques rather than general anesthesia alone is associated with a decrease in postoperative pain, length of hospital stay, incidence of bradycardia, and need for mechanical ventilation. Further studies are still warranted to validate our conclusions.

PMID:37182070 | PMC:PMC10171397 | DOI:10.7759/cureus.37382

Cureus. 2023 Apr 9;15(4):e37346. doi: 10.7759/cureus.37346. eCollection 2023 Apr.

ABSTRACT

Focal segmental glomerulosclerosis (FSGS) is a common renal disorder, characterized by progressive segmental sclerosis of renal glomeruli and clinical symptoms corresponding to proteinuria. Classically, it is not considered to be an antibody-mediated disease, however, IgM and C3 deposition may be seen in a subset of cases of FSGS. The impact of this immune deposition on histopathological features in renal core biopsies, on the urinary biochemical parameters, and the clinical outcomes, has not been previously investigated in our population. The aim of this study is to analyze the aforementioned parameters in patients with primary FSGS having antibody deposition as compared to those who do not have any antibody deposition. Some 155 patients diagnosed with FSGS were retrospectively enrolled in our study. The renal biopsies were reviewed for histopathological features and immunofluorescence (IF) findings of IgM and C3 glomerular deposition. These histological features were then compared with the biochemical parameters as well as the clinical outcomes of patients. The patients were assigned to Groups 1 and 2 based on the IF findings. The IgM and/or C3 glomerular deposition had a low incidence in patients with primary FSGS in our study (28.3%). Patients having IgM and C3 co-deposition had a significantly longer time duration since the onset of their clinical symptoms; active disease duration (42 months vs 22 months, p=0.049). The mean pre-treatment serum creatinine of patients with IgM and C3 co-deposition was 6.00 mg/dL as compared to 3.29 mg/dL in patients with no immune deposition (p=0.037). The immune deposition was associated with higher rates of segmental and global glomerulosclerosis, but this finding along with other evaluated histological parameters did not show statistical significance. The number of patients having IgM and/or C3 deposition and with active steroid use/renal dialysis was similar to patients having no IgM and/or C3 deposition. The IgM and/or C3 deposition in FSGS has a low incidence within and is not associated with any significant differences in histological parameters on renal core biopsies of patients from the Pakistani population. IgM and/or C3 deposition is also associated with a significantly longer duration of active disease and these patients may present with higher pre-treatment serum creatinine. Other biochemical parameters and clinical outcomes appear comparable between the groups based on the available clinical data.

PMID:37182061 | PMC:PMC10169510 | DOI:10.7759/cureus.37346

Cureus. 2023 Apr 11;15(4):e37448. doi: 10.7759/cureus.37448. eCollection 2023 Apr.

ABSTRACT

BACKGROUND: Refractive error is the most common cause of decreased visual acuity. Refractive measurement in adults consists of cycloplegic (objective) and manifest (subjective) refraction. Although the effectiveness of autorefraction is a crucial factor, there needs to be more information on its accuracy and precision on each autorefractor compared with subjective measurement in Thai patients.

OBJECTIVE: To compare the accuracy and precision of the two autorefractors’ findings in Rajavithi Hospital, OptoChek Plus, and TOMEY Auto Refractometer RC-5000, with each other and with those of the subjective method.

MATERIALS & METHODS: An observational study was conducted at the Ophthalmology clinic in Rajavithi Hospital from March 1, 2021, to March 31, 2022. All subjects were tested using the two autorefractors (OptoChek Plus and TOMEY Auto Refractometer RC-5000) and subjective refraction. One eye per subject was included in the study.

RESULTS: Forty-eight patients (48 eyes) were enrolled in the study. The difference between spherical powers obtained by OptoChek and subjective refraction was not significantly different; however, there was a significant difference between those calculated by Tomey and the subjective method (p=0.77, p=0.04 respectively). The variations between cylindrical powers arrived at by the two autorefraction techniques and those calculated by the subjective method were significantly different (OptoChek and Tomey p-=0.01, p-value<0.001, respectively). In addition, 95% of the limit of agreement (95% of LOA) was low in the cylindrical measurement of each autorefractor compared with subjective refraction. (84.61%, 86.36%, respectively). No statistically significant difference between the spherical equivalent calculated by the two autorefractors and that of subjective refraction was observed in the present study (OptoChek: p-value=0.26 and Tomey: p-value=0.77).

CONCLUSIONS: There was a clinically significant difference between the cylindrical power calculated by the two autorefractors and those obtained from subjective refraction. Patients with high astigmatism should be monitored closely when measured by autorefractors, as there can be a slightly lower agreement between objective and subjective refraction.

PMID:37182059 | PMC:PMC10174683 | DOI:10.7759/cureus.37448

Cureus. 2023 Apr 11;15(4):e37432. doi: 10.7759/cureus.37432. eCollection 2023 Apr.

ABSTRACT

Background Chatbots are computer programs that use artificial intelligence (AI) and natural language processing (NLP) to simulate conversations with humans. One such chatbot is ChatGPT, which uses the third-generation generative pre-trained transformer (GPT-3) developed by OpenAI. ChatGPT has been praised for its ability to generate text, but concerns have been raised about its accuracy and precision in generating data, as well as legal issues related to references. This study aims to investigate the frequency of AI hallucination in research proposals entirely drafted by ChatGPT. Methodology An analytical design was employed to investigate AI hallucination by ChatGPT. A total of 178 references listed by ChatGPT were verified for inclusion in the study. Statistical analysis was performed by five researchers who entered their data into a Google Form, and the final results were represented using pie charts and tables. Results Out of the 178 references analyzed, 69 references did not have a Digital Object Identifier (DOI), and 28 references neither turned up on Google search nor had an existing DOI. Three references were listed from books and not research articles. These observations suggest that ChatGPT’s ability to generate reliable references for research topics may be limited by the availability of DOI and the accessibility of online articles. Conclusions The study highlights the potential limitations of ChatGPT’s ability to generate reliable references for research proposals. AI hallucination is a problem that may negatively impact decision-making and may give rise to ethical and legal problems. Improving the training inputs by including diverse, accurate, and contextually relevant data sets along with frequent updates to the training models could potentially help address these issues. However, until these issues are addressed, researchers using ChatGPT should exercise caution in relying solely on the references generated by the AI chatbot.

PMID:37182055 | PMC:PMC10173677 | DOI:10.7759/cureus.37432

Cureus. 2023 Apr 11;15(4):e37442. doi: 10.7759/cureus.37442. eCollection 2023 Apr.

ABSTRACT

Osteosarcomas are a type of bone cancer that typically affect young adults, often in the bones of the arms and legs. To treat osteosarcoma, doctors typically use a combination of chemotherapy, radiotherapy, and surgery, with External Beam Radiation Therapy (EBRT) being the most commonly used form of radiotherapy. EBRT involves directing high-energy photons, X-rays, gamma rays, protons, and electrons at the tumor to induce cancer cell death. Additionally, healthcare providers use imaging techniques to monitor treatment success. This literature review aims to explore the relationship between osteosarcomas and EBRT, investigate the impact of the delayed diagnosis on survival rates, and examine the effectiveness of innovative uses of EBRT for treating osteosarcomas in unusual locations using comprehensive diagnostic techniques. To achieve these objectives, the review examines case studies and literary analyses and categorizes them based on the delay between symptom onset and diagnosis. The null hypothesis is that the presence or absence of a delay in diagnosis does not significantly impact outcomes for the “Delay” category. A lack of delay results in a more favorable outcome in the “Lack of Delay” category. However, the data and statistical results suggest that additional follow-up care in patients with rare or commonly recurring cancers could benefit outcomes. It is important to note that due to the rarity of osteosarcoma with EBRT, the small sample size in the studies warrants further investigation. Interestingly, many patients presented with head and neck tumors despite the most common location of osteosarcoma being in the long bones.

PMID:37182042 | PMC:PMC10174335 | DOI:10.7759/cureus.37442

Cureus. 2023 Apr 11;15(4):e37426. doi: 10.7759/cureus.37426. eCollection 2023 Apr.

ABSTRACT

Background The orthopedic surgery workforce constitutes a vital role in the healthcare system, with data being scarce. Therefore, through this study, we share an overview of the orthopedic workforce distribution, demographic trends, and changes over the past decade in Saudi Arabia. Methods All practicing orthopedic surgeons in Saudi Arabia from January 1, 2010, to December 31, 2021, were included in the study. Data regarding orthopedic surgeons’ demographics and numbers were obtained from the Saudi Commission for Health Specialties (SCFHS), whereas the data related to the geographical distribution of orthopedic surgeons was obtained from the Ministry of Health Statistical Yearbook of 2020. Results The ratio of orthopedic surgeons per 100,000 people was 5.42 in 2010, which grew subsequently to 12.29 in 2021. The number of Saudi orthopedic surgeons has been noticeably rising through the years, while a slowly growing pattern can be seen among non-Saudi orthopedic surgeons. In addition, the highest ratios of orthopedic surgeons per 100,000 were in Makkah (1.72), Riyadh (1.26), and the Eastern Region (1.06). Conclusion In this study, we demonstrate the progress of the orthopedic workforce in Saudi Arabia over a period of 12 years. The number of orthopedic surgeons per 100,000 people showed a significant rise due to several factors, one of which is road traffic accidents. Also, although the number of female orthopedic surgeons has been rising lately, they are still much fewer than males in this field. In addition, Saudi Arabia has been developing a new healthcare system via the privatization of some of the governmental hospitals, which will lead to changes in the future workforce and its accommodations.

PMID:37182036 | PMC:PMC10173370 | DOI:10.7759/cureus.37426

Cureus. 2023 Apr 11;15(4):e37447. doi: 10.7759/cureus.37447. eCollection 2023 Apr.

ABSTRACT

Background The outcomes after fixation of the supracondylar humerus fracture (SCHF) are not documented in the current literature. In our study, we endeavour to determine the factors that influence the functional outcome and gauge their respective impact. Methodology We retrospectively reviewed the outcomes of patients who presented to our tertiary care centre (Royal London Hospital) with SCHFs between September 2017 and February 2018. We analysed patient records to assess several clinical parameters, including age, Gartland’s classification, comorbidities, time to treatment, and fixation configuration. We conducted a multiple linear regression analysis to determine each of the clinical parameter’s impact on the functional and cosmetic outcome, as reflected in Flynn’s criteria. Results We included 112 patients in our study. Pediatric SCHFs had good functional outcomes based on Flynn’s criteria. There was no significant statistical difference in functional outcomes with respect to sex (p= 0.713), age (p= 0.96), fracture type (p= 0.14), K-wire configuration (p=0.83), and time elapsed since surgery (p= 0.240). Conclusions Our results demonstrate that good functional outcomes can be expected with paediatric SCHFs based on Flynn’s criteria, regardless of age at injury, sex, or pin configuration, provided satisfactory reduction is achieved and maintained. The only variable with statistical significance was Gartland’s grade; Grades III and IV were correlated with poorer outcomes.

PMID:37182015 | PMC:PMC10174634 | DOI:10.7759/cureus.37447