Pub Date : 2023-01-01DOI: 10.7860/jcdr/2023/63922.18058
S. Chandrasekaran, J. Prabhu, A. Senthilvadivu
Introduction: Cervical assessment has moved from digital examination to sonographic evaluation in recent years. Predicting the time of onset of labour and mode of delivery at term is a great concern for both the pregnant woman and her relatives. Aim: To predict the time of onset of labour and mode of delivery by Transvaginal sonographic measurement of cervical length at term. Materials and Methods: This longitudinal study was conducted in the Department of Obstetrics and Gynaecology, SRM Medical College Hospital and Research Centre, Kattankalathur, Tamil Nadu, India, from March 2021 to August 2021. All low-risk singleton pregnancies between 38-40 weeks of gestation were included. Cervical length (in mm) was measured transvaginally by the principal investigator between 38 and 40 weeks. When the labour sets in the duration between cervical length measurement and the onset of labour, duration of labour and mode of delivery were noted. Pearson correlation coefficient was used to quantify the association between cervical length and time of onset of labour and duration of labour. Results: In the study, 164 low-risk patients (143 Primigravida patients+21 Multigravida patients) between 38-40 weeks were included. In patients with spontaneous onset of labour, 45 (70.3%) had labour onset within 120 hours (5 days) when cervical length was ≤30 mm, when compared with 7 (22.58%) when cervical length was >30 mm (p=0.001). In patients with cervical length ≤30 mm, vaginal delivery occurred in 47 (73.43%) (p=0.019). In women with induced labour with cervical length ≤30 mm, 13 (61.9%) had labour onset within 120 hours when compared to 15 (30.6%) in women with cervical length >30 mm (p=0.02). Vaginal delivery occurred in 5 (29.41%) of women when cervical length was ≤30 mm compared to 32 (65.30) in women when cervical length >30 mm which may be attributed to other causes. There was a significant positive correlation between cervical length and time of onset of labour (Correlation coefficient=0.221, p-value=0.004). There was a negative correlation between cervical length and duration of labour which was not statistically significant (Correlation coefficient=-0.108, p=0.25). There was no significant difference in mean cervical length measurement between vaginal delivery and caesarean section. Conclusion: Transvaginal cervical length measurement at term positively correlates with time of onset of labour but not with duration of labour and mode of delivery
{"title":"Cervical Length Measurement at Term Pregnancy as a Predictor of Time of Onset of Labour and Mode of Delivery: A Longitudinal Study","authors":"S. Chandrasekaran, J. Prabhu, A. Senthilvadivu","doi":"10.7860/jcdr/2023/63922.18058","DOIUrl":"https://doi.org/10.7860/jcdr/2023/63922.18058","url":null,"abstract":"Introduction: Cervical assessment has moved from digital examination to sonographic evaluation in recent years. Predicting the time of onset of labour and mode of delivery at term is a great concern for both the pregnant woman and her relatives. Aim: To predict the time of onset of labour and mode of delivery by Transvaginal sonographic measurement of cervical length at term. Materials and Methods: This longitudinal study was conducted in the Department of Obstetrics and Gynaecology, SRM Medical College Hospital and Research Centre, Kattankalathur, Tamil Nadu, India, from March 2021 to August 2021. All low-risk singleton pregnancies between 38-40 weeks of gestation were included. Cervical length (in mm) was measured transvaginally by the principal investigator between 38 and 40 weeks. When the labour sets in the duration between cervical length measurement and the onset of labour, duration of labour and mode of delivery were noted. Pearson correlation coefficient was used to quantify the association between cervical length and time of onset of labour and duration of labour. Results: In the study, 164 low-risk patients (143 Primigravida patients+21 Multigravida patients) between 38-40 weeks were included. In patients with spontaneous onset of labour, 45 (70.3%) had labour onset within 120 hours (5 days) when cervical length was ≤30 mm, when compared with 7 (22.58%) when cervical length was >30 mm (p=0.001). In patients with cervical length ≤30 mm, vaginal delivery occurred in 47 (73.43%) (p=0.019). In women with induced labour with cervical length ≤30 mm, 13 (61.9%) had labour onset within 120 hours when compared to 15 (30.6%) in women with cervical length >30 mm (p=0.02). Vaginal delivery occurred in 5 (29.41%) of women when cervical length was ≤30 mm compared to 32 (65.30) in women when cervical length >30 mm which may be attributed to other causes. There was a significant positive correlation between cervical length and time of onset of labour (Correlation coefficient=0.221, p-value=0.004). There was a negative correlation between cervical length and duration of labour which was not statistically significant (Correlation coefficient=-0.108, p=0.25). There was no significant difference in mean cervical length measurement between vaginal delivery and caesarean section. Conclusion: Transvaginal cervical length measurement at term positively correlates with time of onset of labour but not with duration of labour and mode of delivery","PeriodicalId":15483,"journal":{"name":"JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH","volume":"29 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91298803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.7860/jcdr/2023/58831.18208
A. Arora, S. Saini
Introduction: It is a well known fact that diverse nutritional issues are associated with advanced Head and Neck Squamous Cell Cancer (HNSCC). In addition to poor nutrition, varying degrees of immunocompromisation has been noted in these patients and hence is important to study malnutrition and systemic immunity together. Aim: To determine correlation between nutritional status and systemic immunity in patients being treated for HNSCC. Materials and Methods: A prospective observational study was conducted at Cancer Research Institute (CRI) Dehradun, India for a period of 30 months (December 2018 and June 2021). A total of 159 HNSCC patients planned for treatment, were enrolled in the study. Data was collected pre-and posttreatment for disease based on the parameters- Performance Status (PS), nutritional status (weight, Body Mass Index (BMI), Mid Upper Arm Circumference (MUAC) and haemoglobin. Subjective Global Assessment (SGA) Score and systemic immunity {Neutrophil/Lymphocyte Ratio (NLR)} were measured too. Analysis was planned for node negative (N-) and node positive (N+) groups. One-sample Kolmogorov-Smirnov test was used to check for normality of data, parametric and non parametric tests were used for association, Cochran's and Mantel-Haenszel Statistic was used to calculate Risk Ratio (RR), Pearson’s and Spearman’s coefficient test was used to assess the correlation. A p-value <0.05 was considered significant. Results: Total 159 patients were analysed, 72 in N- and 87 in N+ group. Mean age was 56.3±13.27 years, 142 (89.3%) patients were males, 57 (35.8%) patients were cT1/2, 97 (61%) cT3/4 and 5 (3.2%) cTx stage, 146 (92%) were PS 0-2 and 104 (65.4%) received multi-modality treatment. In pretreatment, malnutrition was found in 75 (47.2%) patients and median NLR was 3 (range 1-37). In N+ patients, median NLR was significantly higher in patients with ≥10% pretreatment weight loss, low MUAC and high SGA score pretreatment; in N- patients this association was present with only PS. A mild but statistically significant linear correlation was found for NLR with % pretreatment weight loss, BMI, haemoglobin; moderate correlation with weight, MUAC and SGA score in N+ group, but not in N- group. Conclusion: Poor nutritional status was significantly associated with raised NLR in node positive HNSCC patients with mild to moderate correlation, but this was not found in the node negative group.
{"title":"Correlation between Nutritional Status and Neutrophil/Lymphocyte Ratio in Patients being Treated for Head and Neck CancerA Prospective Observational Study","authors":"A. Arora, S. Saini","doi":"10.7860/jcdr/2023/58831.18208","DOIUrl":"https://doi.org/10.7860/jcdr/2023/58831.18208","url":null,"abstract":"Introduction: It is a well known fact that diverse nutritional issues are associated with advanced Head and Neck Squamous Cell Cancer (HNSCC). In addition to poor nutrition, varying degrees of immunocompromisation has been noted in these patients and hence is important to study malnutrition and systemic immunity together. Aim: To determine correlation between nutritional status and systemic immunity in patients being treated for HNSCC. Materials and Methods: A prospective observational study was conducted at Cancer Research Institute (CRI) Dehradun, India for a period of 30 months (December 2018 and June 2021). A total of 159 HNSCC patients planned for treatment, were enrolled in the study. Data was collected pre-and posttreatment for disease based on the parameters- Performance Status (PS), nutritional status (weight, Body Mass Index (BMI), Mid Upper Arm Circumference (MUAC) and haemoglobin. Subjective Global Assessment (SGA) Score and systemic immunity {Neutrophil/Lymphocyte Ratio (NLR)} were measured too. Analysis was planned for node negative (N-) and node positive (N+) groups. One-sample Kolmogorov-Smirnov test was used to check for normality of data, parametric and non parametric tests were used for association, Cochran's and Mantel-Haenszel Statistic was used to calculate Risk Ratio (RR), Pearson’s and Spearman’s coefficient test was used to assess the correlation. A p-value <0.05 was considered significant. Results: Total 159 patients were analysed, 72 in N- and 87 in N+ group. Mean age was 56.3±13.27 years, 142 (89.3%) patients were males, 57 (35.8%) patients were cT1/2, 97 (61%) cT3/4 and 5 (3.2%) cTx stage, 146 (92%) were PS 0-2 and 104 (65.4%) received multi-modality treatment. In pretreatment, malnutrition was found in 75 (47.2%) patients and median NLR was 3 (range 1-37). In N+ patients, median NLR was significantly higher in patients with ≥10% pretreatment weight loss, low MUAC and high SGA score pretreatment; in N- patients this association was present with only PS. A mild but statistically significant linear correlation was found for NLR with % pretreatment weight loss, BMI, haemoglobin; moderate correlation with weight, MUAC and SGA score in N+ group, but not in N- group. Conclusion: Poor nutritional status was significantly associated with raised NLR in node positive HNSCC patients with mild to moderate correlation, but this was not found in the node negative group.","PeriodicalId":15483,"journal":{"name":"JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH","volume":"230 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76809829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Head and Neck Squamous Cell Carcinoma (HNSCC) is the sixth most common cancer globally and the seventh most common cause of cancer-related mortality. Tobacco use, alcohol consumption, and Human Papillomavirus (HPV) infection are prominent risk factors for HNSCC. HPVpositive Oral Squamous Cell Carcinoma (OSCC) differs from HPV-negative OSCC in terms of risk factors, preferential site of origin, age, histomorphological features, molecular genetic alterations, and prognosis. The prominent basaloid morphology and lobular growth of OSCCs are associated with p16 positivity and p53 negativity, respectively. Aim: To establish the immunohistochemical expression of p16 (p16INK4a) and p53 in OSCC and to assess their relationship with specific histomorphological features, in the form of solid growth of cells in a lobular configuration, small crowded cells with scant cytoplasm, dark hyperchromatic nuclei without nucleoli. Materials and Methods: The cross-sectional study involved fifty cases of OSCC over a two-year period from January 2017 to January 2019 at Army Hospital (R and R) Delhi Cantt. The intensity of p16 and p53 protein expression was graded as follows: no staining (0), weak staining (1), moderate staining (2), and strong staining (3). The proportion/percentage of staining for p16 and p53 protein expression was calculated as follows: 1-4% (1), 5-19% (2), 20-39% (3), 40-59% (4), 60-79% (5), and 80-100% (6) cells stained. A quick score of 0-1 (negative), 2-3 (weak positive), 4-5 (moderate positive), and >6 (strong positive) was assessed. Cross tables were generated and the Chi-square test was used for testing associations. The Statistical Software for Data Science (STATA)-14 was used for statistical analysis. Results: A total of 50 cases of OSCC were analysed for histomorphological features and immunohistochemical patterns of p16 and p53. The age distribution showed that 8 (16%), 9 (18%), 18 (36%), 13 (26%), and 2 (4%) of the patients were in the age groups of 31-40 years, 41-50 years, 51-60 years, 61-70 years, and above 70 years, respectively. The gender distribution noted 42 (84%) males and 8 (16%) females. Genital and nongenital mucosa are usually involved by HPV subtypes 6, 11, 16, 18, and 16, 18, 11, 13, 2, respectively. HPV-16 has been demonstrated in 90-95% of all HPV-positive HNSCC cases, followed by HPV-18, HPV-31, and HPV-33. p53 is considered the guardian of the genome and controls the expression and activity of proteins involved in cell cycle regulation, DNA repair, cellular senescence, and apoptosis. More than 50% of all primary HNSCC exhibit p53 mutation. Conclusion: A significant correlation was observed between age, dysplasia, keratinisation, basaloid morphology versus p16 expression, and lobular growth, histological grade versus p53. An inverse relationship between p16 and p53 expressions was observed. The immunohistochemical expression of p16 as an immunohistochemical marker of HPV, along with p53, is recommended. Du
{"title":"Immunohistochemical Expression of p16 and p53 as Prognostic Indicator in Oral Squamous Cell Carcinoma: A Cross-sectional Study","authors":"Neeti Sindhwani, Vishal Sharma, Nitu Singh, Beenu Singh, Kavita Sahai, Bhu-shan Asthana, Ankur Ahuja, Gaurav PS Gahlot","doi":"10.7860/jcdr/2023/64769.18408","DOIUrl":"https://doi.org/10.7860/jcdr/2023/64769.18408","url":null,"abstract":"Introduction: Head and Neck Squamous Cell Carcinoma (HNSCC) is the sixth most common cancer globally and the seventh most common cause of cancer-related mortality. Tobacco use, alcohol consumption, and Human Papillomavirus (HPV) infection are prominent risk factors for HNSCC. HPVpositive Oral Squamous Cell Carcinoma (OSCC) differs from HPV-negative OSCC in terms of risk factors, preferential site of origin, age, histomorphological features, molecular genetic alterations, and prognosis. The prominent basaloid morphology and lobular growth of OSCCs are associated with p16 positivity and p53 negativity, respectively. Aim: To establish the immunohistochemical expression of p16 (p16INK4a) and p53 in OSCC and to assess their relationship with specific histomorphological features, in the form of solid growth of cells in a lobular configuration, small crowded cells with scant cytoplasm, dark hyperchromatic nuclei without nucleoli. Materials and Methods: The cross-sectional study involved fifty cases of OSCC over a two-year period from January 2017 to January 2019 at Army Hospital (R and R) Delhi Cantt. The intensity of p16 and p53 protein expression was graded as follows: no staining (0), weak staining (1), moderate staining (2), and strong staining (3). The proportion/percentage of staining for p16 and p53 protein expression was calculated as follows: 1-4% (1), 5-19% (2), 20-39% (3), 40-59% (4), 60-79% (5), and 80-100% (6) cells stained. A quick score of 0-1 (negative), 2-3 (weak positive), 4-5 (moderate positive), and >6 (strong positive) was assessed. Cross tables were generated and the Chi-square test was used for testing associations. The Statistical Software for Data Science (STATA)-14 was used for statistical analysis. Results: A total of 50 cases of OSCC were analysed for histomorphological features and immunohistochemical patterns of p16 and p53. The age distribution showed that 8 (16%), 9 (18%), 18 (36%), 13 (26%), and 2 (4%) of the patients were in the age groups of 31-40 years, 41-50 years, 51-60 years, 61-70 years, and above 70 years, respectively. The gender distribution noted 42 (84%) males and 8 (16%) females. Genital and nongenital mucosa are usually involved by HPV subtypes 6, 11, 16, 18, and 16, 18, 11, 13, 2, respectively. HPV-16 has been demonstrated in 90-95% of all HPV-positive HNSCC cases, followed by HPV-18, HPV-31, and HPV-33. p53 is considered the guardian of the genome and controls the expression and activity of proteins involved in cell cycle regulation, DNA repair, cellular senescence, and apoptosis. More than 50% of all primary HNSCC exhibit p53 mutation. Conclusion: A significant correlation was observed between age, dysplasia, keratinisation, basaloid morphology versus p16 expression, and lobular growth, histological grade versus p53. An inverse relationship between p16 and p53 expressions was observed. The immunohistochemical expression of p16 as an immunohistochemical marker of HPV, along with p53, is recommended. Du","PeriodicalId":15483,"journal":{"name":"JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135749962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Acute Pancreatitis (AP) is an inflammatory condition with cumbersome side effects. Gastropancreatic (GI) fistula is a rare complication seen in cases with infected pancreatic or peripancreatic necrosis. GI fistulas can result in severe haemorrhage and septicemia. Hereby, the authors present a case of 36-year-old male with a chief complaint of abdominal pain associated with abdominal distension and non bilious vomiting after binge consumption of alcohol for the past 10 days. Computed Tomography (CT) scan showed the presence of free gas in the abdomen. Contrast-Enhanced CT (CECT) imaging revealed diffuse enlargement affecting the head, uncinate process, body, and tail of the pancreas. There were also a few necrotic peripancreatic fluid collections with extensive peripancreatic fat stranding. Based on these findings, the diagnosis of acute necrotising pancreatitis was suggested. Despite treatment with antibiotics and necrosectomy with drainage of the abscess collection, the patient showed no improvement. A repeat CECT examination was performed due to the deterioration of the patient’s clinical condition, which showed a complete non enhancing pancreas. Additionally, a large defect measuring approximately 16 mm was observed in the posteroinferior wall of the stomach at the middle third of the body, with extravasation of contrast material into the pancreatic collection, suggestive of fistula formation. Subsequently, the patient underwent pancreatic necrosectomy with closure of the gastric perforation using feeding jejunostomy. A follow-up CT examination was performed four days later due to the deteriorating status of the patient, as well as new onset haematemesis and bloody discharge from the surgical drain. The CT scan revealed a few peripancreatic soft tissue infiltrates adjacent to the pancreatic head. Persistent collections were noted along the anterolateral surface of the right psoas, extending to the adjoining right anterior pararenal space and the left anterolateral abdominal wall in the left hypochondriac region. Thickening of the bilateral lateroconal fascia and anterior and posterior renal fascia was observed, likely due to inflammation. Following this, the patient underwent another surgery, and percutaneous drainage was performed with antibiotic coverage. The patient showed a significant reduction in the collection and improved clinical condition after 10 days. Imaging plays a crucial role in diagnosing such complications, enabling early detection and reducing mortality in these patients.
{"title":"Gastroinstestinal Fistula in Acute Necrotising Pancreatitis with Septicaemia: A Case Report","authors":"Tushar Kalekar, Shreeya Goyal, Rupa Madhavi Kopparthi, Varsha Rangankar, Parag Patil","doi":"10.7860/jcdr/2023/61306.18419","DOIUrl":"https://doi.org/10.7860/jcdr/2023/61306.18419","url":null,"abstract":"Acute Pancreatitis (AP) is an inflammatory condition with cumbersome side effects. Gastropancreatic (GI) fistula is a rare complication seen in cases with infected pancreatic or peripancreatic necrosis. GI fistulas can result in severe haemorrhage and septicemia. Hereby, the authors present a case of 36-year-old male with a chief complaint of abdominal pain associated with abdominal distension and non bilious vomiting after binge consumption of alcohol for the past 10 days. Computed Tomography (CT) scan showed the presence of free gas in the abdomen. Contrast-Enhanced CT (CECT) imaging revealed diffuse enlargement affecting the head, uncinate process, body, and tail of the pancreas. There were also a few necrotic peripancreatic fluid collections with extensive peripancreatic fat stranding. Based on these findings, the diagnosis of acute necrotising pancreatitis was suggested. Despite treatment with antibiotics and necrosectomy with drainage of the abscess collection, the patient showed no improvement. A repeat CECT examination was performed due to the deterioration of the patient’s clinical condition, which showed a complete non enhancing pancreas. Additionally, a large defect measuring approximately 16 mm was observed in the posteroinferior wall of the stomach at the middle third of the body, with extravasation of contrast material into the pancreatic collection, suggestive of fistula formation. Subsequently, the patient underwent pancreatic necrosectomy with closure of the gastric perforation using feeding jejunostomy. A follow-up CT examination was performed four days later due to the deteriorating status of the patient, as well as new onset haematemesis and bloody discharge from the surgical drain. The CT scan revealed a few peripancreatic soft tissue infiltrates adjacent to the pancreatic head. Persistent collections were noted along the anterolateral surface of the right psoas, extending to the adjoining right anterior pararenal space and the left anterolateral abdominal wall in the left hypochondriac region. Thickening of the bilateral lateroconal fascia and anterior and posterior renal fascia was observed, likely due to inflammation. Following this, the patient underwent another surgery, and percutaneous drainage was performed with antibiotic coverage. The patient showed a significant reduction in the collection and improved clinical condition after 10 days. Imaging plays a crucial role in diagnosing such complications, enabling early detection and reducing mortality in these patients.","PeriodicalId":15483,"journal":{"name":"JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH","volume":"28 10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135799101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.7860/jcdr/2023/62752.18434
SR Resmi, Anil Thomas, Ani Thampi, SK Mathew, Sunil Antony
Introduction: Hyponatraemia is a frequently occurring electrolyte abnormality. Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) is one of the common causes of hyponatraemia. SIADH is a disorder of impaired water excretion caused by the inability to suppress the secretion of Antidiuretic Hormone (ADH). The importance of determining the cause of hyponatraemia as SIADH is not only to seek the aetiology of SIADH but also to treat appropriately. Aim: To determine the prevalence of SIADH in patients with hyponatraemia and its causes in these patients. Materials and Methods: A cross-sectional study was conducted in the Department of General Medicine at Jubilee Mission Medical College and Hospital, Thrissur, Kerala, India. The study duration was one year and six months, from December 2014 to June 2016. A total of 100 individuals over the age of 18, who were admitted with serum sodium levels under 135 mEq/L, were chosen. Data on the causes of hyponatraemia and SIADH, laboratory evaluations, and assessments based on SIADH criteria were gathered using a structured proforma. The primary outcome variables included the aetiology of SIADH and the causes of hyponatraemia. Frequency and percentages were used to represent the data. The data were analysed using MS Excel. Results: Among 100 patients, the maximum number of patients with hyponatraemia were in the 59-78 years age group. Fortytwo (42) had severe hyponatraemia (Na < 120 mmol/L). The most common cause of hyponatraemia was drug intake (diuretics + antihypertensives), which constituted 42 (42%) of the total 100 patients, followed by SIADH in 33 (33%) patients. Among the aetiologies of SIADH, cerebrovascular accident was the most common (9/100), followed by pneumonia and Selective Serotonin Reuptake Inhibitors (SSRIs) in five patients each. Among the non neurological symptoms, vomiting was the most common symptom in 28 (28%) patients, followed by lethargy in 15 (15%). Among the neurological symptoms associated with hyponatraemia, confusion was the predominant one seen in 10 (10%) patients, followed by drowsiness in 7 (7%). Conclusion: SIADH is an important cause of hyponatraemia with a high prevalence. The prevalence of SIADH in hyponatraemic patients was 33%. Among the aetiologies of SIADH, cerebrovascular accident was the most common.
{"title":"Prevalence and Aetiology of Syndrome of Inappropriate Antidiuretic Hormone in Hyponatraemia: A Cross-sectional Study","authors":"SR Resmi, Anil Thomas, Ani Thampi, SK Mathew, Sunil Antony","doi":"10.7860/jcdr/2023/62752.18434","DOIUrl":"https://doi.org/10.7860/jcdr/2023/62752.18434","url":null,"abstract":"Introduction: Hyponatraemia is a frequently occurring electrolyte abnormality. Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) is one of the common causes of hyponatraemia. SIADH is a disorder of impaired water excretion caused by the inability to suppress the secretion of Antidiuretic Hormone (ADH). The importance of determining the cause of hyponatraemia as SIADH is not only to seek the aetiology of SIADH but also to treat appropriately. Aim: To determine the prevalence of SIADH in patients with hyponatraemia and its causes in these patients. Materials and Methods: A cross-sectional study was conducted in the Department of General Medicine at Jubilee Mission Medical College and Hospital, Thrissur, Kerala, India. The study duration was one year and six months, from December 2014 to June 2016. A total of 100 individuals over the age of 18, who were admitted with serum sodium levels under 135 mEq/L, were chosen. Data on the causes of hyponatraemia and SIADH, laboratory evaluations, and assessments based on SIADH criteria were gathered using a structured proforma. The primary outcome variables included the aetiology of SIADH and the causes of hyponatraemia. Frequency and percentages were used to represent the data. The data were analysed using MS Excel. Results: Among 100 patients, the maximum number of patients with hyponatraemia were in the 59-78 years age group. Fortytwo (42) had severe hyponatraemia (Na < 120 mmol/L). The most common cause of hyponatraemia was drug intake (diuretics + antihypertensives), which constituted 42 (42%) of the total 100 patients, followed by SIADH in 33 (33%) patients. Among the aetiologies of SIADH, cerebrovascular accident was the most common (9/100), followed by pneumonia and Selective Serotonin Reuptake Inhibitors (SSRIs) in five patients each. Among the non neurological symptoms, vomiting was the most common symptom in 28 (28%) patients, followed by lethargy in 15 (15%). Among the neurological symptoms associated with hyponatraemia, confusion was the predominant one seen in 10 (10%) patients, followed by drowsiness in 7 (7%). Conclusion: SIADH is an important cause of hyponatraemia with a high prevalence. The prevalence of SIADH in hyponatraemic patients was 33%. Among the aetiologies of SIADH, cerebrovascular accident was the most common.","PeriodicalId":15483,"journal":{"name":"JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH","volume":"63 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135911618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Percutaneous drains are commonly used to drain collections in surgical patients. The choice of drain can determine the potential complications. Herein, the authors presented a case of a 32- year-old female with a drain complication and its management in a posttransplant patient. The patient developed a post-transplant perigraft lymphocele and underwent drainage using Malecot’s catheter. However, during the removal of drain, the Malecot catheter accidentally broke, leaving the tip inside the perigraft region. To locate the tip, a non-contrast Computed Tomography (CT) scan was performed. Subsequently, the patient underwent a transperitoneal reexploration, successfully removing the tip. It was discovered that the catheter tip had ingrown tissue between the prongs, impeding its removal. It is crucial to exercise caution in such situations as Malecot catheters may sometimes have ingrown tissue between the prongs, hindering their removal.
{"title":"Retained Malecot’s Drain Tip after Percutaneous Drainage of Post-transplant Lymphocele: A Case Report","authors":"Madhur Anand, Sanchit Rustagi, Uday Pratap Singh, Hira Lal, Aneesh Srivastava","doi":"10.7860/jcdr/2023/64620.18441","DOIUrl":"https://doi.org/10.7860/jcdr/2023/64620.18441","url":null,"abstract":"Percutaneous drains are commonly used to drain collections in surgical patients. The choice of drain can determine the potential complications. Herein, the authors presented a case of a 32- year-old female with a drain complication and its management in a posttransplant patient. The patient developed a post-transplant perigraft lymphocele and underwent drainage using Malecot’s catheter. However, during the removal of drain, the Malecot catheter accidentally broke, leaving the tip inside the perigraft region. To locate the tip, a non-contrast Computed Tomography (CT) scan was performed. Subsequently, the patient underwent a transperitoneal reexploration, successfully removing the tip. It was discovered that the catheter tip had ingrown tissue between the prongs, impeding its removal. It is crucial to exercise caution in such situations as Malecot catheters may sometimes have ingrown tissue between the prongs, hindering their removal.","PeriodicalId":15483,"journal":{"name":"JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135913138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.7860/jcdr/2023/63928.18456
Manju Bala, Rashmi ., Rishmeet Kaur, Ajith kumar, Vinay Jangra
Wolf-Hirschhorn Syndrome (WHS), also known as Chromosome 4 deletion syndrome, is a rare hereditary disease with a prevalence of 1 in 50,000. It occurs due to the microdeletion of the short arm of chromosome 4, specifically the 4p16.3 domain. Patients with WHS exhibit diverse phenotypes, including growth retardation, developmental delay, congenital heart disease, and convulsions, depending on the amount of deleted genetic material. This case report focuses on a 25-year-old male who was admitted for cataract extraction and posterior chamber intraocular lens implantation. Through gene analysis, the patient was diagnosed with WHS. He exhibited micrognathia, a short neck, kyphoscoliosis, seizure disorder, and mental retardation. Additionally, he had severe kyphoscoliosis, which resulted in restrictive lung disease. These abnormalities posed significant challenges for anaesthetic management. To ensure a successful general anaesthesia, adequate preparedness for difficult airway management was crucial. A thorough cardiovascular and neuromuscular examination was conducted preoperatively to rule out associated anomalies and minimise complications. The patient’s perioperative antiepileptic cover was continued. Extubation proved challenging due to the patient’s mental retardation and restrictive lung disease. This case underscores the importance of effective anaesthetic management for patients with this rare condition undergoing cataract surgery under general anaesthesia.
{"title":"Anaesthetic Considerations for General Anaesthesia in an Adult Patient with Wolf-Hirschhorn Syndrome and Kyphoscoliosis: A Case Report","authors":"Manju Bala, Rashmi ., Rishmeet Kaur, Ajith kumar, Vinay Jangra","doi":"10.7860/jcdr/2023/63928.18456","DOIUrl":"https://doi.org/10.7860/jcdr/2023/63928.18456","url":null,"abstract":"Wolf-Hirschhorn Syndrome (WHS), also known as Chromosome 4 deletion syndrome, is a rare hereditary disease with a prevalence of 1 in 50,000. It occurs due to the microdeletion of the short arm of chromosome 4, specifically the 4p16.3 domain. Patients with WHS exhibit diverse phenotypes, including growth retardation, developmental delay, congenital heart disease, and convulsions, depending on the amount of deleted genetic material. This case report focuses on a 25-year-old male who was admitted for cataract extraction and posterior chamber intraocular lens implantation. Through gene analysis, the patient was diagnosed with WHS. He exhibited micrognathia, a short neck, kyphoscoliosis, seizure disorder, and mental retardation. Additionally, he had severe kyphoscoliosis, which resulted in restrictive lung disease. These abnormalities posed significant challenges for anaesthetic management. To ensure a successful general anaesthesia, adequate preparedness for difficult airway management was crucial. A thorough cardiovascular and neuromuscular examination was conducted preoperatively to rule out associated anomalies and minimise complications. The patient’s perioperative antiepileptic cover was continued. Extubation proved challenging due to the patient’s mental retardation and restrictive lung disease. This case underscores the importance of effective anaesthetic management for patients with this rare condition undergoing cataract surgery under general anaesthesia.","PeriodicalId":15483,"journal":{"name":"JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH","volume":"73 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136002997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.7860/jcdr/2023/63898.18449
Somnath Maitra, Ratul Seal, Koushik Ray
Dengue is a viral illness in humans caused by the bite of infected Aedes mosquitoes, mostly Aedes aegypti and also Aedes albopictus. There are four serotypes of the Dengue virus that cause infection in humans and may lead to a variety of complications. Myocarditis and cardiomyopathy can occur in several viral and non viral infections, increasing morbidity and mortality. Nephropathy may also arise in dengue fever, causing complications. The case presented here involved both complications, nephropathy and cardiomyopathy, posing treatment challenges in terms of altering fluid and electrolyte status, which hindered fluid therapy as fluid overload would be detrimental. However, the complications were reversible with the normalisation of echocardiography and urea and creatinine levels. Long-term follow-up is necessary to monitor cardiac and renal function, as some patients may progress to Chronic Kidney Disease (CKD). The patient presented with fever, headache, vomiting, and haematuria, along with signs of fluid overload. There was a past history of fever, and since both Immunoglobulin G (IgG) and IgM Dengue antibodies were positive, this may be a case of a second episode of dengue fever causing complications. This case report emphasises the diagnostic and treatment challenges in a dengue patient with cardiomyopathy and nephropathy, where excessive fluid replacement may increase morbidity and mortality. Additionally, long-term follow-up of these patients is necessary.
{"title":"Treatment Dilemma in an Unusual Case of Dengue Fever with Cardiomyopathy and Nephropathy: A Case Report","authors":"Somnath Maitra, Ratul Seal, Koushik Ray","doi":"10.7860/jcdr/2023/63898.18449","DOIUrl":"https://doi.org/10.7860/jcdr/2023/63898.18449","url":null,"abstract":"Dengue is a viral illness in humans caused by the bite of infected Aedes mosquitoes, mostly Aedes aegypti and also Aedes albopictus. There are four serotypes of the Dengue virus that cause infection in humans and may lead to a variety of complications. Myocarditis and cardiomyopathy can occur in several viral and non viral infections, increasing morbidity and mortality. Nephropathy may also arise in dengue fever, causing complications. The case presented here involved both complications, nephropathy and cardiomyopathy, posing treatment challenges in terms of altering fluid and electrolyte status, which hindered fluid therapy as fluid overload would be detrimental. However, the complications were reversible with the normalisation of echocardiography and urea and creatinine levels. Long-term follow-up is necessary to monitor cardiac and renal function, as some patients may progress to Chronic Kidney Disease (CKD). The patient presented with fever, headache, vomiting, and haematuria, along with signs of fluid overload. There was a past history of fever, and since both Immunoglobulin G (IgG) and IgM Dengue antibodies were positive, this may be a case of a second episode of dengue fever causing complications. This case report emphasises the diagnostic and treatment challenges in a dengue patient with cardiomyopathy and nephropathy, where excessive fluid replacement may increase morbidity and mortality. Additionally, long-term follow-up of these patients is necessary.","PeriodicalId":15483,"journal":{"name":"JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH","volume":"363 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136005154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Endophthalmitis is a serious, sight-threatening purulent inflammation of the intraocular cavities of the eyeball. It greatly affects vision and can lead to severe complications such as panophthalmitis. The prevalence of endophthalmitis varies from one place to another. Aim: To identify the various aetiological and predisposing factors that contribute to endophthalmitis and to assess the visual outcomes following medical intervention (intravitreal antibiotics only) and surgical intervention (both intravitreal antibiotics and pars plana vitrectomy). Materials and Methods: The present study was conducted in the Department of Ophthalmology at Trichy SRM Medical College Hospital and Research Centre, Trichy, Tamil Nadu, India between January 2023 and February 2023. Demographic and clinical data of patients diagnosed with endophthalmitis over a two year period from October 2020 to September 2022 were collected from the Medical Records Department of the Institution for analysis. A total of 50 case records were selected using convenience sampling. Demographic details such as age, gender, predisposing risk factors, visual acuity, microbiological profiles, treatment modalities, and final visual acuity were collected from the present study. Quantitative data was presented as Mean and Standard Deviation (SD), while qualitative data was presented as frequencies and percentages. Summary statistics were analysed using Microsoft Excel version 2018. Results: In present study, 29 (58%) were males and 21 (42%) were females, with the majority falling within the age group of 50-70 years. The mean age of the sample was 53.8±16.1 years. Postoperative causes accounted for 39 (78%) of the cases, with phacoemulsification surgery with foldable intraocular lens implantation being the leading cause in 23 (58.7%) cases. Culture positivity was observed in only 22 (44%) cases, with Staphylococcus (Staph) epidermidis as the major causative organism. The best visual acuity achieved was 6/12 for two patients. Conclusion: Postoperative endophthalmitis remains the most common cause of endophthalmitis. Additionally, patients who presented with better visual acuity had a better visual outcome after treatment. Therefore, patients should be educated about the early signs of endophthalmitis to ensure prompt medical attention and improve visual recovery
{"title":"Microbiological Profile and Visual Recovery in Various Clinical Types of Endophthalmitis at a Tertiary Eye Care Hospital of Tamil Nadu, India: A Retrospective Cohort Study","authors":"Vinnarasi Rayar, Ajay Venkat Anandhan, Padmashri ., Poomalar Periasamy, Josephine Priya Kumar","doi":"10.7860/jcdr/2023/64927.18461","DOIUrl":"https://doi.org/10.7860/jcdr/2023/64927.18461","url":null,"abstract":"Introduction: Endophthalmitis is a serious, sight-threatening purulent inflammation of the intraocular cavities of the eyeball. It greatly affects vision and can lead to severe complications such as panophthalmitis. The prevalence of endophthalmitis varies from one place to another. Aim: To identify the various aetiological and predisposing factors that contribute to endophthalmitis and to assess the visual outcomes following medical intervention (intravitreal antibiotics only) and surgical intervention (both intravitreal antibiotics and pars plana vitrectomy). Materials and Methods: The present study was conducted in the Department of Ophthalmology at Trichy SRM Medical College Hospital and Research Centre, Trichy, Tamil Nadu, India between January 2023 and February 2023. Demographic and clinical data of patients diagnosed with endophthalmitis over a two year period from October 2020 to September 2022 were collected from the Medical Records Department of the Institution for analysis. A total of 50 case records were selected using convenience sampling. Demographic details such as age, gender, predisposing risk factors, visual acuity, microbiological profiles, treatment modalities, and final visual acuity were collected from the present study. Quantitative data was presented as Mean and Standard Deviation (SD), while qualitative data was presented as frequencies and percentages. Summary statistics were analysed using Microsoft Excel version 2018. Results: In present study, 29 (58%) were males and 21 (42%) were females, with the majority falling within the age group of 50-70 years. The mean age of the sample was 53.8±16.1 years. Postoperative causes accounted for 39 (78%) of the cases, with phacoemulsification surgery with foldable intraocular lens implantation being the leading cause in 23 (58.7%) cases. Culture positivity was observed in only 22 (44%) cases, with Staphylococcus (Staph) epidermidis as the major causative organism. The best visual acuity achieved was 6/12 for two patients. Conclusion: Postoperative endophthalmitis remains the most common cause of endophthalmitis. Additionally, patients who presented with better visual acuity had a better visual outcome after treatment. Therefore, patients should be educated about the early signs of endophthalmitis to ensure prompt medical attention and improve visual recovery","PeriodicalId":15483,"journal":{"name":"JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH","volume":"74 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136005770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.7860/jcdr/2023/61907.17782
K. Ajini, S. Jyotsna, JS Ajith Prasad
Introduction: Stillbirth is defined as a baby born with no signs of life after a given threshold. It is a sensitive indicator of quality of care received by the mother during antepartum and intrapartum period. There has been a renewed focus on stillbirth in the backdrop of COVID-19 pandemic, as pregnant women are at an increased risk for severe form of COVID-19 and are associated with adverse perinatal outcomes. Aim: To estimate the prevalence of stillbirths and its characteristics during the pandemic and also, to classify the causes of stillbirths according to the International Classification of Diseases for use in Perinatal Mortality (ICD-PM) classification. Materials and Methods: This cross-sectional study was conducted in the Department of Obstetrics and Gynaecology at Government Medical College, Thrissur, Kerala, India, during the COVID-19 pandemic from 1st August 2021 to 30th July 2022. A total of 106 mothers, who gave birth to stillbirths after 28 weeks of gestation were included in the study. When gestational age was not sure, stillbirth weighing more than 500 grams was considered as the inclusion criteria. Foetus, placenta, cord and membranes were examined after the delivery. The parameters studied were age, domicile, income, gestational age, order of pregnancy, mode of delivery, timing of foetal death, baby weight, gender, presence of anomalies and maternal medical complications. The causes were classified according to International Classification of Diseases-10-to Perinatal Mortality (ICD-PM) classification system. Categorical variables were assessed by Chi-square test and continuous variables were assessed by unpaired Student’s t-test. Results: There were 106 stillbirths with a Stillbirth Rate (SBR) of 38.78 per 1000 births. Major proportions of stillbirths were antepartum. Mean maternal age was 28.7±4.7 years. There were 73 (68.86) rural women and 33 (31.1%) urban women with stillbirths. A total of 90 (84.9%) cases were referral, while 16 (15.1%) were registered in the Institute for antenatal care. A total of 67 (63.2%) stillborns were male babies, but there was no significant difference in SBR, according to the order of pregnancy. Causes were classified according to the ICDPM classification system. Hypertensive disorders in pregnancy (36.79%) and the foetal growth restriction (39.62%) were the common maternal and foetal condition identified among the cases. There were 22 COVID-19 positive cases, but they were also having hypertension as co-morbidity. Conclusion: In present study, antepartum stillbirth was the commonest type and occurred mostly in referral cases from periphery. Hypertensive diseases in pregnancy and foetal growth restriction were the leading causes. Early detection of high-risk conditions and timely referral, may reduce the rate of stillbirth.
{"title":"Prevalence of Stillbirths during COVID-19 Pandemic at a Tertiary Referral Centre in Central Kerala, India: A Cross-sectional Study","authors":"K. Ajini, S. Jyotsna, JS Ajith Prasad","doi":"10.7860/jcdr/2023/61907.17782","DOIUrl":"https://doi.org/10.7860/jcdr/2023/61907.17782","url":null,"abstract":"Introduction: Stillbirth is defined as a baby born with no signs of life after a given threshold. It is a sensitive indicator of quality of care received by the mother during antepartum and intrapartum period. There has been a renewed focus on stillbirth in the backdrop of COVID-19 pandemic, as pregnant women are at an increased risk for severe form of COVID-19 and are associated with adverse perinatal outcomes. Aim: To estimate the prevalence of stillbirths and its characteristics during the pandemic and also, to classify the causes of stillbirths according to the International Classification of Diseases for use in Perinatal Mortality (ICD-PM) classification. Materials and Methods: This cross-sectional study was conducted in the Department of Obstetrics and Gynaecology at Government Medical College, Thrissur, Kerala, India, during the COVID-19 pandemic from 1st August 2021 to 30th July 2022. A total of 106 mothers, who gave birth to stillbirths after 28 weeks of gestation were included in the study. When gestational age was not sure, stillbirth weighing more than 500 grams was considered as the inclusion criteria. Foetus, placenta, cord and membranes were examined after the delivery. The parameters studied were age, domicile, income, gestational age, order of pregnancy, mode of delivery, timing of foetal death, baby weight, gender, presence of anomalies and maternal medical complications. The causes were classified according to International Classification of Diseases-10-to Perinatal Mortality (ICD-PM) classification system. Categorical variables were assessed by Chi-square test and continuous variables were assessed by unpaired Student’s t-test. Results: There were 106 stillbirths with a Stillbirth Rate (SBR) of 38.78 per 1000 births. Major proportions of stillbirths were antepartum. Mean maternal age was 28.7±4.7 years. There were 73 (68.86) rural women and 33 (31.1%) urban women with stillbirths. A total of 90 (84.9%) cases were referral, while 16 (15.1%) were registered in the Institute for antenatal care. A total of 67 (63.2%) stillborns were male babies, but there was no significant difference in SBR, according to the order of pregnancy. Causes were classified according to the ICDPM classification system. Hypertensive disorders in pregnancy (36.79%) and the foetal growth restriction (39.62%) were the common maternal and foetal condition identified among the cases. There were 22 COVID-19 positive cases, but they were also having hypertension as co-morbidity. Conclusion: In present study, antepartum stillbirth was the commonest type and occurred mostly in referral cases from periphery. Hypertensive diseases in pregnancy and foetal growth restriction were the leading causes. Early detection of high-risk conditions and timely referral, may reduce the rate of stillbirth.","PeriodicalId":15483,"journal":{"name":"JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH","volume":"84 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73548252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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