International Journal of Applied and Basic Medical Research最新文献

Introduction: Diagnosing diabetic neuropathy is a challenge at times as it is asymptomatic. Diagnosing diabetic neuropathy involves the use of quantitative sensory testing, nerve conduction study, and autonomic testing. Tempearture threshold testing (TTT) can aid in diagnosing small fiber neuropathy at early stages. This study aimed to assess the small fiber neuropathy using TTT in diabetes mellitus (DM) and correlate with age, duration of diabetes, and lipid profile.

Materials and methods: The study was commenced after obtaining ethics approval from the institute ethics committee. The study participants included 100 patients with type 2 DM of both genders between the ages of 40 and 65 years. The glycemic status and lipid profile were noted along with physical examination. Neuropathy assessment was done using Michigan Neuropathy Screening Instrument (MNSI) and TTT.

Results: The prevalence of small fiber neuropathy based on TTT was 63%. The lipid profile was similar in both the groups. The MNSI B scale had significantly higher scores in the neuropathy group. In the neuropathy group, the thresholds for hot were significantly greater in all four limbs and cold were significantly lower. Age and years of DM were positively correlated with the neuropathy. Hot threshold in the lower limb had shown a strong positive correlation.

Conclusion: The age and duration of diabetes are independent risk factors for diabetic peripheral neuropathy. Small fiber neuropathy is a prequel to the motor neuropathy. Hot threshold testing in the lower limb is more sensitive than cold threshold testing for diagnosing small fiber neuropathy.

Pulmonary sequestration and cystic pulmonary adenomatoid malformation are rare congenital cystic disorders of the lungs. The presence of both the diseases in the same individual is therefore very uncommon. Pulmonary sequestration is a nonfunctional pulmonary tissue mass that derives its blood supply from systemic blood supply other than pulmonary circulation. Congenital cystic pulmonary adenomatoid malformation represents a mass consisting of abnormal bronchiolar air spaces and a deficiency of functional alveoli. This is the case report of a 9-year-old girl with intermittent fever, left-sided chest pain, and cough for the past 15 days along with recurrent coughs since childhood suggestive of hybrid pulmonary sequestration, congenital cystic adenomatoid malformation, and dextrocardia.

The incisive foramen is also called as nasopalatine foramen. It is a funnel-shaped opening in the anterior maxilla which opens immediately behind the central incisor teeth through which nasopalatine blood vessels and nerves pass. The incisive foramen is continuous with the incisive canal or nasopalatine canal (NPC). Variations in size, shape, position, and number of NPCs exist. Anatomical variations in NPC cannot be appreciated on two-dimensional radiographs. A case of anatomical variation of the nasopalatine canal misdiagnosed as a periapical cyst is discussed.

Background: Standard histopathological parameters such as depth of invasion (DOI), lymphovascular invasion (LVI), and perineural invasion (PNI) are known parameters that can correlate with the prognosis and aggressiveness of oral squamous cell carcinomas (OSCCs). Tumor budding (TB) (≤5 tumor cells at infiltrating borders) and pattern of invasion (POI) are emerging histopathological parameters that have shown promising results as reliable risk factors in predicting nodal metastasis in early OSCCs.

Aim: The aim of the study was to assess TB and POI in OSCCs.

Materials and methods: A total of 33 surgical resection specimens of OSCC, including buccal mucosa and tongue with neck dissection, were selected. TB and POI along with standard parameters such as grade, DOI, LVI, PNI, lymph node status, and pathological staging were evaluated. These parameters were analyzed in comparison with lymph node involvement and pathological stage of the tumor using the Chi-square and Fischer's exact test. The SPSS software, v21, was used for statistical analyses.

Results: Most of OSCC were moderately differentiated tumors (63.64%). TB was present in 23 cases, in which 69.57% of cases showed low TB (<5 buds), while 30.43% of cases had higher TB (>5 buds). The worst POI (Patterns 4 and 5) was seen in 75.76% of cases. TB, POI, grade, PNI, DOI, and stromal pattern were significantly associated with the pathological stage of the tumor.

Conclusion: TB and POI are important and reliable in histopathological parameters in OSCCs.

Background and aim: Agile methodology (AM) is an innovative, active, team-based learning method that enhances higher-order thinking (metacognitive ability), collaboration, hands-on training, and student engagement in the classroom and clinical environment. Exploring the student's opinions of AM in teaching helps understand how agile can be utilized in higher education to positively improve learning ability, leadership, and teamwork. Hence, the study aimed to develop the agile scrum perception tool (ASPT) to evaluate the opinions on AM among nursing students.

Materials and methods: A cross-sectional design was carried out to develop ASPT in different phases. The tool was initially derived from focus group discussion and literature review. The preliminary draft was revised and modified based on expert review and suggestions by content and construct validity. Reliability was calculated in terms of internal consistency. The developed tool was evaluated using data from 200 4^th-year nursing students.

Results: A total of 23 items of ASPT have adequate psychometric properties in terms of reliability and validity. Internal consistency was checked by coefficient alpha, which was 0.87. Construct validity was analyzed by factor analysis; all items were loaded in 6 factors, accounting for 54% of the variance in the total ASPT score.

Conclusion: ASPT has good validity, reliability, and broader scope in medical and allied education related to project management, clinical teaching, and classroom teaching.

Background: The Ring Finger 43 (RNF43) is a tumor suppressor gene that negatively regulates the Wnt/β-catenin signaling. The p.G659fs is a recurrent RNF43 C-terminal truncating variant frequent in colorectal cancer (CRC) patients. We aimed to identify this hotspot variant in CRC patients and assessed the relationship between the mutation, clinical characteristics, and tumor β-catenin localization.

Materials and methods: Formalin-fixed, paraffin-embedded tissue samples of upfront, surgically resected, sporadic colorectal adenocarcinoma cases were selected. The p.G659fs mutation was determined by capillary sequencing with sequence-specific primers. Tissue microarray and immunohistochemistry were employed to analyze nuclear β-catenin expression and the expression of mismatch repair (MMR) proteins, respectively. In addition, clinical details were retrieved from the hospital medical records and data were analyzed.

Results: The RNF43 p.G659fs mutation was observed in 8% of CRC patients. In total, 25% of tumors showed a loss of immunostaining for one or more MMR proteins and 14.6% of tumors showed positive nuclear β-catenin staining. The p.G659fs variant was significantly enriched in MMR-deficient tumors (P = 0.04). Importantly, no correlation was observed between the variant and nuclear β-catenin localization (P = 0.48), indicating a Wnt-independent role of this variant in CRC tumors.

Conclusions: To the best of our knowledge, this is the first study from North India to show the involvement of RNF43 p.G659fs variant in CRC patients. The mutation correlated with MMR protein deficiency and seems to be conferring tumorigenicity independent of the Wnt pathway.

Background: Burns is one of the leading causes of mortality in developing countries like India. Most of the major burns requiring hospital care are not triaged adequately for the use of medical resources. An efficient mortality predicting scale would not only help in better care to those who will benefit the most but also make it easy to explain to patient's attendants. Among the various tools, revised Baux (rBaux) and modified Abbreviated Burn Severity Index (ABSI) are two most commonly used scales in developed nations. We proposed this study to analyze the reliability of these two scoring scales in our burn population.

Aim: This study aimed to retrospectively study the two scoring systems and analyze them for their reliability in predicting mortality compared to actual observed mortality in each case.

Materials and methods: This study was conducted on all burn patients admitted to the intensive care unit of our hospital. Data on their demographic profile, total burn surface area, thickness of burns, inhalational injury, and other comorbidities were collected from files. rBaux and modified ABSI (mABSI) were calculated. The end result in the form of survival or nonsurvival was also recorded. Appropriate statistical analysis using Mann-Whitney U-test, Chi-square test, and receiver operator characteristic curve was done to look for a better scoring system out of the two.

Results: A total of 504 patients were included in the study, out of which 337 were survivors. Female gender was not a risk factor for mortality in our study. The median rBaux score in the survivor group was 100 (80-110) and in nonsurvivor group was 111 (103-123). The median mABSI score in the survivor group was 8 (7-9) and in nonsurvivor group was 10 (9-11). The area under the receiver operating characteristic curve shows mABSI having better specificity for predicting mortality. rBAUX, though more sensitive, overestimates mortality than actual observed mortality.

Conclusion: mABSI predicts mortality better than rBaux. A multicentric prospective study is recommended for mABSI to be used as a standard mortality predictor in burns in India.

Background: The reliability of dynamic pupillometry parameters varies from one pupillometer to another, making it difficult to standardize the values for any particular device. Hence, further studies are required to evaluate the agreement of various pupillometer devices and explore their utility in routine clinical settings.

Aim: This study sought to evaluate the agreement between smartphone and commercial pupillometer measurements in routine clinical settings.

Methods: The study included pupillary measurements obtained by a single investigator from 100 healthy participants (200 eyes) with each pupillometer. Pupillary measurements taken by a smartphone pupillometry application (reflex pupillary light reflex analyzer by Brightlamp [Indianapolis, IN, USA]) were compared with a commercial pupillometer (neurological pupil index-200, NeurOptics Inc., Irvine, USA).

Results: The comparison of descriptive statistics revealed a statistically significant difference between the smartphone and commercial pupillometers for various parameters, including maximum diameter, minimum diameter, constriction velocity (CV), maximum CV, and dilatation velocity (P < 0.05), except for latency (P = 0.36). The intraclass correlation coefficient revealed poor agreement between the two devices (<0.50).

Conclusion: The measurements by smartphone pupillometry application were found to be unreliable, indicating that they may not be an ideal substitute for commercial pupillometers in their present form in the Indian population. Further studies with larger sample size as well as improvements in the processing and interpretation of the measurements by the software, are needed to determine its utility in routine clinical settings.

Background and aim: Respiratory complications in liver cirrhosis can occur due to various mechanisms, such as ascites causing restricted lung expansion and opening of intrapulmonary vascular shunts due to high portal pressures. We aimed to study the effects of the liver dysfunction on the lungs by evaluating arterial blood gas (ABG) and pulmonary function test (PFT) of all study subjects.

Subjects and methods: A cross-sectional study was done between August 2020 and September 2022. Diagnosed cases of the liver cirrhosis were enrolled in the study after informed consent and were subjected to the following investigations: chest X-ray, oximetry, spirometry, diffusing capacity of the lung for carbon monoxide (DLCO), two-dimensional echocardiography, and ABG analysis (ABGA). The cases were divided into three groups based on their Child-Pugh staging, and statistical analysis was done on the collected data.

Results: A total of 64 (53 males and 11 females) patients with an average age of 49.82 ± 9.89 years were studied. Alcoholism was the most common cause of cirrhosis in males. Breathlessness (65.6%) and pleural effusion (26.6%) were the most common respiratory symptoms and signs, respectively. Seventeen patients had hepatic hydrothorax, eight patients had hepatopulmonary syndrome (HPS), and six patients had portopulmonary hypertension. Low pH (17.2%) and oxygen partial pressure (PaO₂) (20.3%) were the most common ABGA findings. The pH, PaO₂, forced expiratory volume in 1 s (FEV₁)/forced vital capacity (FVC), and DLCO were significantly low in Child Pugh Stage C (P < 0.05). The pH, pO₂, HCO₃, FEV₁, FVC, FEV₁/FVC, and DLCO were significantly lower in patients with HPS (P < 0.05).

Conclusion: Metabolic acidosis and low FEV₁/FVC and DLCO were the common findings in study subjects. Pulmonary dysfunction was common in advanced liver cirrhosis. Patients with HPS had worse ABG and PFT parameters than those without HPS.