Scripta Medica

Radiation Exposure Assessment in Coronary Angiography Computed Tomography Scan: Establishing Diagnostic Reference Level for Northeast Assam Population

Arnabjyoti Deva Sarma — 2024-04-18

Background/Aim: Coronary angiography computed tomography (CT) scans play a pivotal role in diagnosing cardiovascular diseases, providing crucial information for treatment planning. However, concerns regarding radiation exposure have prompted the need for establishing region-specific diagnostic reference levels (DRLs) to ensure patient safety. This study aimed to assess radiation exposure during coronary angiography CT scans in the northeast Assam population and establish DRLs tailored to this demographic.

Methods: A total of 380 patients were referred to the Primus Diagnostic Centre and Heath City Hospital, Guwahati Assam with coronary artery disturbances. Data on the technical parameters used in CT procedures were taken in 2021-2022. Organ and surface dose to specific radiosensitive organs (chest) estimation was done using software imPACT 1.0.4 from the National Radiological Protection Board (NRPB) SR250 Monte Carlo dataset.

Results: The study population (n = 380) comprised 190 men and 190 women with an age range from 29 to 75 years. The mean body mass index (BMI) and effective dose (ED) were 22.42 ± 1.06 kg/m² and 21.57 ± 4.27 mSv.cm, respectively. The mean the dose-length product (DLP) was 854.67 mSv.cm and the mean ED was 21.57 mSv.cm. The ED for males was 13- 27 mSv and 13-29 mSv for females. The DRL for the male population was found to be 24.26 mSv.cm² whereas for the female population was 24.69 mSv.cm².

Conclusion: This study highlights the necessity of establishing tailored DRLs for coronary angiography CT scans in the northeast Assam population. By doing so, healthcare providers can ensure optimal image quality while minimising radiation exposure, ultimately enhancing patient safety and quality of care. These findings have implications for radiological practice in the region and contribute to the ongoing efforts to standardise radiation doses in medical imaging procedures.

Unveiling the Spatial Pattern and Determinants of Child Anaemia in India - National Family Health Survey-5 Chronicles (NFHS-5)

Abhijeet Joshi — 2024-04-18

Background/Aim: Childhood anaemia continues to persist as a prominent nutritional disease and a public health challenge in India despite several initiatives by the Government of India. This study aimed to identify predictors and regional disparities for targeted interventions.

Methods: This study utilised data from a nationally representative cross-sectional survey from the fifth round of the National Family Health Survey (NFHS-5), encompassing 177,695 children aged 6-59 months across 707 districts and 36 states and union territories of India. It employed multivariate logistic regression and spatial analysis at district levels to examine socio-demographic predictors and spatial patterns of childhood anaemia in the country.

Result: Multivariate logistic results revealed, women aged 15–19 were 2.43 times more likely to have an anaemic child compared to those aged 35–49 and uneducated mothers had a 29 % higher likelihood of having an anaemic child. There was positive spatial autocorrelation (Moran’s I value = 0.579) at the district level in India, with 108 identified hotspots in regions including Jammu and Kashmir, Ladakh, Gujarat, Maharashtra, Telangana, Uttar Pradesh, Rajasthan, Jharkhand, Chhattisgarh and Bihar. The spatial error model (SEM) indicated that mother's anaemia (0.53) and maternal education (0.23) were key predictors of child anaemia in India.

Conclusion: The study findings provide valuable understanding regarding the socio-demographic predictors associated with childhood anaemia such as adolescent motherhood, low education, lack of media exposure, higher birth order and rural residence. Also, the spatial study provides the spatial heterogeneity of childhood anaemia at the district level and advocates more attention toward hotspot regions in the country.

Correlation of the Caring Behaviour of Nurses With the Motivation of Patients Undergoing Haemodialysis

Vivi Yosafianti Pohan — 2024-04-18

Background/Aim: There is a need to establish a satisfactory level of performance for nurses working in haemodialysis units, which will provide qualified competent nurses who will take care of patients. Thus, the purpose of this study was to analyse the caring behaviour of haemodialysis nurses with the motivation of patients undergoing haemodialysis.

Methods: The research design was a descriptive correlation approach. The subjects of this study were patients who were undergoing therapy in the haemodialysis room. Researchers collected data for 1 month in September 2023. The relationship between nurses' caring behaviour and haemodialysis patient motivation was determined by conducting a Spearman rank correlation analysis.

Results: Out of 118 patients, 48.7 % of patients thought nurses had poor caring behaviour. The research results also showed that patient motivation in undergoing haemodialysis was in the low motivation category (47.8 %). There was a significant relationship between nurses' caring behaviour and patient motivation in undergoing haemodialysis therapy (p = 0.0001). Based on the correlation coefficient value (r = 0.632), the two variables had a strong relationship.

Conclusion: Nurses' caring behaviour can increase patient motivation in undergoing haemodialysis therapy. Nurses' caring behaviour still needs to be optimised because the interaction between nurses and patients in the treatment process provides support to patients.

Association of Polymorphism (RS1800896) of IL-10 Gene and IL-10 Gene Expression in Ovarian Cancer Patients From Georgia

Pavithra Balakrishnan — 2024-04-18

Background/Aim: Ovarian cancer is one of the most important causes of tumour-associated mortality and morbidity in women. Some genetic alterations, determining predisposition to ovarian cancer have already been identified, but these are mostly syndrome-associated cases, most ovarian tumours are still regarded as sporadic. The aim of this research was to identify new predisposing factors that might increase ovarian cancer risk. Genetic variants of IL-10 gene in patients with ovarian cancer was analysed.

Methods: Forty-eight patients with ovarian cancer along with 48 age-matched controls were included in the study. Single nucleotide polymorphism (SNP) genotyping and gene expression assays for IL-10 were performed using TaqMan assay (Thermo Scientific, USA). The selected SNP was rs1800896 upstream of IL-10 gene (IL-10-1082). All statistical analyses were performed by GraphPad Prism 9.3.1 for Mac.

Results: The genotype distributions of IL-10 gene polymorphisms among cancer and control groups were all according to the expected Hardy–Weinberg equilibrium. There was no statistically significant difference in frequency of genotypes and alleles between the two study groups (p > 0.05). In another analysis, the samples were grouped according to the polymorphic variant IL-10 (− 1082) A/G. Subjects having the homozygous variant (A/A) had lower IL-10 mRNA levels than those with the homozygous wild (G/G) genotype in both, ovarian cancer patients and controls, p < 0.05. mRNA levels on IL-10 were different among cases and controls (p < 0.05). Patients with ovarian cancer had higher level of mRNA for IL-10.

Conclusions: These results support the theory that IL-10 gene expression levels differ in patients with and without ovarian cancer. Polymorphic variant IL-10 (− 1082) A/G couldn’t be confirmed to explain this difference in gene expression levels.

Eruption of First Permanent Molar Among a Group of Iraqi Children in Relation to Nutritional Status

Muna Saleem Khalaf — 2024-04-18

Background/Aim: The timing of a tooth's eruption can be affected by a variety of factors. The nutritional status has an impact on the development of a child’s body. The purpose of the study was to count the number of children aged 6 to 9 in an Iraqi Arab population who had erupted permanent first molars and to examine how nutritional status affected the timing and level of emergence.

Methods: A total of 330 boys and girls, in first grade elementary school, made up the sample. First molars that had erupted were noted, along with the level of the eruption. Each child's nutritional status was evaluated by recording their height and weight and body mass index (BMI) value was compared to the 2007 WHO reference.

Results: Girls had higher number of erupted molars than boys did and a correlation between the number of erupted teeth and nutritional condition existed, with a higher mean number of erupted molars in obese children.

Conclusion: BMI had an impact on the timing of the eruption of permanent first molars, a result that was primarily observed in females.

Effectiveness of Progressive Muscle Relaxation Compared to BL 23 and GV 3 Point Acupressure Therapy on Reducing Back Pain Intensity in Third Trimester Pregnant Women

Pawestri Pawestri — 2024-04-18

Background/Aim: Back pain is one of the most common discomforts experienced by pregnant women in the third trimester of pregnancy. Interventions that can be done to overcome this are progressive muscle relaxation or acupressure at the BL 23 and GV 3 points. The aim was to determine the effectiveness of progressive muscle relaxation with BL 23 and GV 3 acupressure to reduce low back pain in third trimester pregnant women.

Methods: Quasi-experimental research design method with a two-group pretest and post-test design approach was conducted. The total sample was 88 with inclusion criteria - third trimester pregnant women who experienced back pain. Pain was measured with numerical rating scale (NRS) and analysed using Wilcoxon test.

Results: The average reduction in back pain for pregnant women after progressive muscle relaxation was 2.12, while the average reduction in back pain for pregnant women after BL 23 and GV 3 acupressure was 1.50. There is a mean difference between the two (0.62), so it can be concluded that there was a difference in the effectiveness of reducing back pain for pregnant women in the third trimester between the progressive muscle relaxation intervention and the respondents' pain scale after the acupressure therapy intervention at points BL 23 and GV 3.

Conclusion: Back pain for pregnant women in the third trimester can be treated with progressive muscle relaxation therapy or acupressure at points BL 23 and GV 3 to reduce back pain. Progressive muscle relaxation therapy was more effective. Progressive muscle relaxation can be done by pregnant women themselves when back pain occurs.

Prevalence of Vitamin B12 Deficiency in Patients Treated With Metformin

Bruno Daniel Oliveira Peixoto — 2024-04-18

Background/aim: Metformin has been associated with vitamin B₁₂ (cobalamin) deficiency, pushing scientific societies such as the American Diabetes Association and the European Association for the Study of Diabetes to emphasise the need for screening B₁₂ levels, without specific metformin doses or exposure durations triggering this screening. Robust data regarding the prevalence of B₁₂ deficiency in metformin-treated patients in Portugal are currently lacking. Aim of this study was to identify the prevalence of B₁₂ deficiency in a sample of diabetic patients taking metformin. Secondary objectives were determining the minimum dose and minimum and median time exposure time leading to this deficiency and identifying the average duration of metformin use in the patients with this deficiency.

Methods: Descriptive and cross-sectional observational study was performed on a sample of 79 users from a population of 714 diabetic patients on metformin. Inclusion criteria comprised individuals aged 18 or older, receiving metformin for at least 1 month and voluntarily participating in the study. Exclusion criteria included a history of gastrectomy or B₁₂ supplementation.

Results: A prevalence of 25.3 % of vitamin B₁₂ deficiency was identified in the study sample. Minimum doses of 500 mg of metformin per day and a minimum exposure period of 1 year were associated with B₁₂ deficiency. An average exposure time of 5.33 years was identified.

Conclusion: These results align with the prevalence described in the few international studies and should alert physicians to potential clinical manifestations of this deficiency, such as anaemia and neurological symptoms like neuropathy.

The Comparison of Streptokinase, an Old Agent, Versus Reteplase for the Re-Tunnellisation of Blocked Cuffed Haemodialysis Catheter

Abbas Saroukhani — 2024-04-18

Background/Aim: Catheter occlusion is the most common complication occurring in patients with end-stage renal disease (ESRD) who undergo haemodialysis. The management typically involves the use of local fibrinolytic agents. However, with the emergence of novel agents, the use of older agents has declined. The purpose of the study was to compare the effectiveness of reteplase versus streptokinase (SK) in resolving haemodialysis catheter occlusion.

Methods: This randomised clinical trial involved 100 patients with catheter occlusion who were equally divided into two groups of 50. One group received treatment with reteplase, while the other group received treatment with SK. The occluded catheter in the first group was instilled with 250,000 units (U) of SK, while the second group received 2 U of reteplase and the catheters were left in place for 2-6 h. Successful flushing of the catheter with a velocity of ≥ 200 rounds per minute was considered successful re-tunnelling. The study also evaluated the frequencies of re-injections and drug-related adverse effects.

Results: The success rate of SK versus reteplase did not differ significantly (p = 0.48). However, the required time to inject the agents to achieve appropriate luminal patency was statistically higher in the reteplase-treated group (p = 0.018). None of the patients experienced major adverse effects such as bleeding or anaphylactic reactions.

Conclusion: According to the findings of this study, both reteplase and SK resulted in significant recovery of luminal patency with no adverse effects. However, the lower frequency of re-injections required with SK to achieve successful rationalisation favoured the use of this agent over reteplase. Further studies are strongly recommended.

Initial Clinical Manifestations and Early Diagnosis of Basal Cell Skin Carcinoma

Đuka Ninković Baroš — 2024-04-18

Background/Aim: Basal cell carcinoma (BCC) is the most common cancer of the skin. It is believed that increased UV radiation from the sun accounts for almost 90 % of the risk of BCC. There is a growing trend in the incidence of BCC in a younger population. The aim of study was to analyse the initial clinical symptoms of BCC that may be important for the early detection of this skin tumour.

Method: The study was a prospective, multicentre study performed in the period from March 2017 to February 2022. A total of 69 respondents with BCC were analysed. Respondents applied for a targeted examination to examine a suspicious skin lesion (due to certain symptoms) or were diagnosed with BCC by accident, when examining other skin changes. Respondents were divided into 2 groups. The first, Group I (35 respondents), consisted of respondents with nodular BCC. The second, Group II (34 respondents), consisted of respondents with superficial spreading BCC. Initially, a careful history and data on the characteristics, shape and character of the tumour were taken from all respondents. Data on all (even the smallest) initial symptoms and relevant signs of evolution, as well as subjective problems related to the tumour were noted. All respondents underwent dermoscopy of suspected skin changes.

Results: A significant difference was found between the examined groups in the characteristics of bleeding, crust formation and tendency to injury in lesions, where they occur more often in patients with nodular BCC. Symptoms such as burning and flaking occurred significantly more often in patients with superficial spreading BCC (p < 0.01), as well as the diameter of lesions over 5 mm (p < 0.05).

Conclusion: Early clinical diagnosis of BCC is possible with a tumour diameter of only a few mm. The predominant initial (highly susceptible) symptoms of nodular BCC were initial bleeding and / or scab formation on the lesions, as well as propensity to injury. The superficial spreading form of BCC was often larger than 5 mm in diameter, with more frequent scaling of the lesion, as well as burning and stinging sensations in the tumour area. Itching was observed to be a very common previous occurrence in the BCC initial focus zone in subjects of both study groups. Dermsocopy is a highly reliable diagnostic method for early detection of BCC.

The Involvement of Reactive Oxygen Species in Causing Chronic Cardiovascular and Neurodegenerative Diseases and Some Cancers

Jasneet K Tiwana — 2024-04-18

An increase in the occurrence of different infectious and chronic diseases as well as aging population has resulted in poor human health and decline in the quality of life all over the world. In fact, chronic diseases, which are partially resistant to currently available drugs are long lasting health hazards and require ongoing medical attention. Major causes of increase in these diseases are considered to be changes in the environment as well as diets and lifestyle. Particularly, there has been changes from a simple, nutritious, low- calorie diet and active lifestyle to a complex and processed food rich in high calories accompanied by a sedentary lifestyle and unhealthy living habits. Since high-calorie diets and inactive lifestyle are known to promote the production of reactive oxygen species (ROS) in the body, it is likely that oxidative stress and associated inflammation may be intimately involved in enhancing the resistance of several disorders to the existing therapeutic interventions and thus promoting the occurrence of chronic diseases. A thorough review of literature regarding the pathogenesis of some major chronic diseases including cardiovascular disease like heart failure, neurodegenerative disorder like Alzheimer’s disease and various types of cancer has revealed that these health hazards are associated with increased oxidative stress, production of pro-inflammatory chemicals such as nitric oxide and some cytokines, as well as formation of some toxic substances such as advanced glycation end products. It is thus evident that extensive research work by employing genetic, immunological and nutraceutical approaches, needs to be carried out for developing some novel antioxidants with anti-inflammatory activities for reducing the incidence of chronic diseases. In the meantime, it would be prudent for patients with chronic diseases to pursue the preventive measures involving reduced intake of high calorie diet and following an active lifestyle.

Discovering the Impact of Bullying on Adolescents Through Bibliometric Analysis

Sri Wahyuni — 2024-04-18

In recent years, the number of bullying cases, especially among teenagers, has been increasing, with many mass media reports on bullying cases that have resulted in the death of the victim. The aim of the study was to explore the impact of bullying on adolescents by analysing of network visualisation, overlay visualisation and density visualisation on the topic through bibliometric analysis. Records were identified through a database search at https://app.dimensions.ai/. The data obtained was then selected further by the preferred reporting items for systematic reviews and meta-analyses (PRISMA) flow diagram. Papers were limited to publication years 2019-2023 and focussed on the fields of psychology, human society, health science, clinical biomedicine, clinical education and health psychology. Data were analysed using VOSviewer, then reviewed by co-occurrence and co-author.After identifying the clusters,the impacts of bullying on adolescents were suicidal behaviour, mental disorders, non-suicidal self-injury (NSSI), loneliness, psychological distress and adolescent childhood experiences (ACEs). From the overlay visualisation, it was indicated that the newest topics that were being widely researched related to the impact of bullying on adolescents were social anxiety, suicidal ideation, depressive symptoms, suicidal thought, integrated behaviour change (IBC) and peer victimisation. From density visualisation, it was indicated that topics that were rarely researched related to the topic of the impact of bullying on adolescent were suicide attempts, early victimisation, post-traumatic stress disorder (PTSD) and suicidality. The theme regarding the impact of bullying needs and developed to be researched more deeply, especially on themes with low visualisation found in density visualisation, in order to enrich the variety of research.

Advent of Artificial Intelligence in Orthognathic Surgery: Advancements and Challenges

Anju Sharma — 2024-04-18

Orthognathic surgery is a procedure used to correct facial deformities and jaw bone misalignment. The use of technology, specifically virtual surgical planning (VSP), has become increasingly prevalent in preoperative planning for orthognathic surgery. High-resolution computed tomography (CT) imaging has enabled computer-aided modelling. Artificial intelligence (AI) implementation has transformed orthognathic surgery methodology. This article highlights the latest market trends and modern-day advancements in the field, including the conventional and surgery first approach for orthognathic surgery. The use of computer-aided surgical simulation (CASS) in VSP for orthognathic surgery was studied. The different software used for orthognathic surgical planning and the detailed protocol followed during the surgery, including the preoperative procedure were discussed along with utilisation of 3-dimension cone-beam computed tomography (3D CBCT) images for surgical planning. The implementation of VSP with CASS had significantly enhanced the accuracy and efficiency of orthognathic surgery for dentofacial deformity correction. The use of technology allowed improved preoperative planning, resulting in better outcomes for patients. The study of different software for orthognathic surgical planning and the protocol followed during surgery has provided valuable insight into the surgery. The continued advancement of technology in orthognathic surgery is promising for the field and for the patients.

Aspects and Dilemmas of Euthanasia in Modern Times

Alen Greš — 2024-04-18

Euthanasia is a very complex medical and moral issue. The name has taken throughout history quite different meanings especially in recent decades. There have been many controversial debates and ethical questions raised in modern society. The aim of the paper was to introduce in more detail the issue of euthanasia in the modern world and to review the decisions on this issue. The end of life is still a part of life. It is of great importance for every person and requires true compassion and solidarity. The task is to restore human dignity, by respecting the will of the sedating patient. It is the responsibility of doctors and medical staff to use their comprehensive knowledge and ethical approach to provide calm patients with peace and tranquillity. Euthanasia is a discipline. It is also a concept and a term full of conflicts, which need to be analysed. Therefore, it is necessary to consider the criteria of the bioethical aspect of this activity. The right to euthanasia is not ethically indifferent. We can expect in the near future a deeper understanding of the euthanasia issue.

Ocular and Eyelid Surgical Anatomy in Georg Bartisch’s “Ophthalmodouleia”

Efstathia Lagiou — 2024-04-18

Georg Bartisch, a 16th century barber surgeon, published in 1583 his treatise entitled “Ophthalmodouleia” (Greek term meaning eye service), a work in German to promote ophthalmology for his countrymen barber surgeons. Hadn’t had an academic education nor knew classical languages, he had used a triplet in terminology by using German, Hellenic and Latin nomination in his anatomical descriptions. Various accurate illustrations and a peculiar system of presentation with flap to liken an in-depth presentation were demonstrated to add prestige in his work. This raises concerns for another medical surgeon to have helped for this publication. Bartisch innovative approaches introduced various surgical tools. Cataract surgery was the epitome of his work. Anatomy of both the eye and the eyelids was there for only to serve the operation. Religion, magic and Galenic views presented barriers for Bartisch’s scientific development. However, he is considered as the patron of German School of Ophthalmology.

Computed Tomography Imaging Characteristics of Neck Paragangliomas: A Retrospective Analysis

Dev Ravishankar — 2024-04-18

Background/Aim: Paragangliomas are rare neuroendocrine tumours arising from paraganglia of the autonomic nervous system. Computed tomography (CT) imaging plays a crucial role in the evaluation and characterisation of neck paragangliomas. This retrospective study aimed to analyse the CT imaging features of neck paragangliomas to enhance diagnostic accuracy and delineate the radiological characteristics associated with these tumours.

Methods: A retrospective review of CT imaging studies of patients diagnosed with neck paragangliomas from March 2021 to October 2023 was conducted. Imaging characteristics including tumour location, size, enhancement pattern, vascularity, calcifications, adjacent tissue involvement and relationship with surrounding structures were analysed.

Results: A total of 87 patients with histologically confirmed neck paragangliomas were included in the study. CT imaging revealed typical findings of neck paragangliomas ie well-defined hyper-vascular masses with avid contrast enhancement, commonly located at the carotid bifurcation or along the carotid sheath. In addition, characteristic flow voids and the presence of feeding vessels were observed on CT angiography in a significant number of cases. The imaging analysis also identified calcifications and encasement of adjacent structures as frequent features of advanced-stage paragangliomas.

Conclusions: CT imaging of neck paragangliomas demonstrated consistent radiological features, including hypervascularity, contrast enhancement and distinct anatomic locations. Knowledge of these imaging characteristics is essential for accurate diagnosis and preoperative planning. Recognition of these features on CT imaging can aid in differentiating paragangliomas from other neck masses and facilitate appropriate management strategies.