Retrospective Sectional Study Research Articles

Clinico-pathological specificities of gingival carcinoma among 32 patients with oral cancer: a cross sectional retrospective and observational study

BackgroundThe study aimed to examine the prevalence of gingival cancers compared to other oral mucosal sites, analyze patient profiles, and identify risk factors.Materials and MethodsA retrospective monocentric study was conducted at the Department of Oral Medicine of Bretonneau Hospital in Paris, France. 32 patients diagnosed with oral mucosal cancer were included. Data extracted from electronic medical records encompassed patient demographics, cancer type, lesion location, and tobacco/alcohol use.Results46.9% were diagnosed with gingival cancer. Patients with gingival cancer had a mean age of 74.2 years old, higher than the mean age of 63.9 years old for those with non-gingival cancer. Men accounted for 60% of cases in the gingival cancer group. Squamous cell carcinoma was the predominant cancer type observed in both gingival and non-gingival cancers. Notably, 26.7% of gingival cancer patients used both alcohol and tobacco, all of them male. Among non-gingival cancer patients, 23.5% used both substances, with both sexes represented.ConclusionThis study provides insights into the higher prevalence of oral squamous cell carcinoma among men with risk factors and highlights characteristics of gingival squamous cell carcinoma. Effective management strategies should include comprehensive clinical assessments to ensure early detection and intervention for improved outcomes.

A Clinical-Electrographic Profile of Neonatal Seizures and Their Etiologies in a Single Level III Neonatal Intensive Care Unit

Background: Seizures are the most frequent neurological emergency in neonatal period and can be associated with significant mortality and subsequent neuro-developmental disability if not recognized and managed early. Repaid identification of neonatal seizures and evaluation is critically required to identify and treat the underlying etiology. Clinicians face a major challenge in diagnosing and treating neonatal seizure because of inconspicuous clinical presentation, variable electro-clinical correlation. Assessing the combination of clinical presentation, etiological factors, different diagnostic tools, and treatments, can broaden the knowledge and understanding towards neonatal seizure providing better management and outcome. Objective: To study the characteristics of clinical and electrographic profile of neonatal seizure and the relations to their etiologies in neonatal intensive care unit. Methods: This is a descriptive cross sectional retrospective study of electronic health records with ICD- 10 diagnosis of neonatal seizure from birth to 28 days, who were admitted to neonatal intensive care unit at Sheikh Shakhbout Medical City between January 2020 to December 2021. Clinical data obtained including basic demographics: gender, gestational age, mode of delivery, birth weight, and Apgar score. Onset and type seizure, type of antiepileptic drugs administered, EEG findings, brain imaging, results of relevant laboratory tests and etiology of seizure were collected. Results: Total 31 neonates included in the study. Majority were male (71%), term (87%), and birth weight >2,5 kg (90%). Seizure within 24 hours was 58% and semiology was focal clonic in 32% of patient. No events in EEG in 81% and 6% had electrographic seizure (n=2). 94 % were treated with anti-convulsant, 86% of them before EEG. The majority (86%) received phenobarbitone as 1st line treatment and 83% received monotherapy. Leading causes of seizure were HIE (48%) followed by Vascular causes (16%). Seizure within 24 hours caused mainly by HIE (61%) and 60% of neonates with vascular and all infectious and genetic causes had seizure after 24 hours. In vascular causes, (60%) presented with focal clonic seizure. 60% of Multifocal epileptiform activity seen in HIE whereas focal presented more in vascular patient (36%). In HIE cases, 53% had normal brain MRI and 47% were abnormal. All cases with vascular causes had diagnostic abnormal MRI. The majority of HIE cases (87%) and all vascular cases received monotherapy. Conclusion: In this descriptive study of neonatal seizure, certain demographic data, clinical and electrographic characteristics had established links to their etiologies. Clinical events captured during EEG with no electrographic seizure are classified as non-epileptic clinical phenomenon. Diagnostic utility of EEG is required in diagnosis of involuntary movements and avoid unnecessary anti-seizure medications. Understanding the clinical-electrographic profile of neonatal seizure helps in the early recognition of specific etiologies, allowing an early diagnosis by organized diagnostic approach and management.

Diagnostic Accuracy of Mammography and Ultrasonography Screening for Breast Cancer in Pregnant and Lactating Women

Breast cancer was of significant health concern affecting women worldwide. Objective: To assess diagnostic accuracy of mammography and ultrasonography in differentiating malignant and benign breast lesions in pregnant and lactating women. Methods: A cross sectional retrospective study was conducted at Radiology department of Shahida Islam Medical Complex, Lodhran from May 2023 to April 2024. A sample size of 242 females was calculated. Electronic medical records were reviewed for radiological examination including screening ultrasound and mammography. All those pregnant and lactating females on which ultrasound and mammograms were performed were included. SPSS version 23.0 was used for data analysis. Diagnostic accuracy of both ultrasound and mammography were calculated in terms of malignant or benign and sensitivity and specificity. Mann-Whitney U test was applied between mammography, ultrasonography and BI-RADS categories. Results: Of 242 females, 110 underwent mammography and 132 underwent ultrasound. Negative mammography was observed in 71 females in which at biopsy, 24 were benign. Negative ultrasound with only benign lesion was seen in 68 females and 10 of which were confirmed at biopsy. Specificity of ultrasonography was 100 %, sensitivity 85.7 %, positive predictive value of 100 % while negative predictive value of 25 %. Specificity of mammography was 100 %, sensitivity 92.3 %, positive predictive value of 100 % while negative predictive value of 42.8 % (p<0.001). Conclusions: Although both ultrasound and mammography were found to be specific, use of mammography was considered better in terms of sensitivity and diagnostic accuracy.

The Relationship Between Craniocervical Morphology and the Presence and Level of Cervical Facet Joint Degeneration.

To investigate the relationship between craniocervical morphology and the presence and level of cervical facet joint degeneration (FJD). A total of 108 consecutive female patients aged 45-55 years who had undergone neck + brain CT angiography were included in this retrospective sectional study. Only patients of a certain age and of the same gender were included in order to eliminate the differences that create a disposition to the development of spinal degeneration. The presence of facet joint (FJ) arthritis (grade ≥2 degeneration in at least one affected facet joint) and the grade of the facet joint degeneration for each patient were recorded. A total of 20 lengths and 3 angles of craniocervical morphology were measured. The differences between the individuals with and without FJ arthritis were investigated with the independent-sample t test, and the relationship between the FJD grade and craniocervical morphology was investigated using the Spearman correlation test. Individuals with FJ arthritis were found to have longer Grabb-Oakes measurement, shorter FM AP length, lower ADI, lower EOP thickness, higher clivus length, higher crista gall-ATS distance, lower CCA angle, lower distance between the C1 vertebra lateral masses, and higher BAI than those without FJ arthritis (P ˂ 0.05). Besides, we found that the FJD grade increased as the Grabb-Oakes measurement increased, ADI distance decreased, FM AP length decreased, EOP thickness decreased, clivus length increased, basal angle increased, distance between the C1 vertebra lateral masses decreased, and BAI increased (P ˂ 0.05). Differences in craniocervical morphology are statistically associated with degenerative processes that result in degenerative changes in the facet joint. Therefore, some morphological changes in craniocervical anatomy cause changes in the momentum and distribution of the load on the facet joints, predisposing the patient to facet arthropathy and osteoarthritis.

To study the haemoglobin levels in patients with hypomagnesemia suffering from type 2 diabetes mellitus.

Objective: To study the association of anemia with serum magnesium levels in diabetic type 2 patients. Study Design: Cross Sectional Retrospective study. Setting: Department of Physiology of Sindh University Jamshoro in collaboration with the Diabetic OPD of Liaquat University Hospital Hyderabad. Period: January 2022 to June 2022. Methods: The data size comprised 300 patients suffering from diabetes mellitus type 2. They were divided into two groups. The control group comprised of 160 type 2 DM patients with normal serum magnesium levels and the test group comprised of 140 patients with decreased serum magnesium levels. The serum magnesium level was determined by Roche C311 auto analyzer while the hemoglobin level was measured by Sahli’s hemoglobinometer. Results: Type 2 Diabetic patients with normal serum magnesium level shows 18.75% decrease haemoglobin level while Type 2 Diabetic patients with hypomagnesemia showed 32.15% decrease in haemoglobin level. The P value was 0.01. The odds ratio was 2.05. Conclusion: Diabetes mellitus leads to hypomagnesemia and Hypomagnesia produces anemia due to hemolysis.

Outcome of Severe Acute Malnutrition in Children Aged 6-59 Months Before and After the Institution of the Malnutrition Treatment Centre in the Regional Hospital Limbe, Southwest Region of Cameroon

Background: Malnutrition occurs when nutrient and energy intake do not meet, or exceed an individual’s requirements to maintain growth, immunity, and organ function. In 2020, among children 0-59 months worldwide, 21.3% (144 million) were stunted and 6.9% (47 million) were wasted. The Malnutrition Treatment Centre’s (MTC) establishment in the Regional Hospital Limbe in 2019 brought major changes in management such as free and continuous supply of therapeutic food and basic drugs, the expertise of a nutritionist and closer follow up of patients after discharge. The aim of this research was to evaluate the outcome of children with severe acute malnutrition aged 6-59 months treated at the MTC differed from those treated before the MTC’s creation. Methodology: An analytic cross sectional retrospective study was conducted from February to March 2022. The study period was from March 2016 to February 2019 (before the MTC) and March 2019 to February 2022 (after the MTC). A predesigned data extraction form was used to obtain sociodemographic data of the children and their parents, clinical findings on admission and hospital outcome. The data was entered into CDC Epi info 2.4 and analysed using SPSS. A p-value of <0.05 was considered statistically significant. Results: Out of 129 files included in the study, 35 were pre-MTC and 94 after its creation. The hospital prevalence of SAM increased from 4% to 7% after the MTC’s creation. The mean MUAC (mid-upper arm circumference) was 11.1 ± 0.98 cm. Marasmus was the most common form of SAM (90.7%). The most common admission symptoms were fever (74.4%), diarrhoea (47.2%) and vomiting (32.6%). The most common comorbidities were malaria (29.5%), gastrointestinal infection (20.9%), sepsis (18.6%) and pulmonary infection (14%). There was an increase in the recovery rate (from 71.4% to 76.6%) and the rate of weight gain (from 3.5 g/kg/day to 8.7 g/kg/day). There was also a reduction in the death rate (from 14.3% to 9.6%) and length of in-hospital admission (from 10.24 ±5.4 days to 7.3 ±3.6 days) Conclusion: The MTC led to an increase in the influx of patients with SAM at the RHL, marasmus was the most common form of SAM. There was an increase in the rate of weight gain, a decreased mortality rate and decreased length of hospital stay, thus revealing the pertinent relevance of the MTC in the management of SAM.

Renal Assessment in the Setting of Pediatric Living Related Liver Transplantation

Abstract Background Liver transplantation in the pediatric age group has become the last resort and yet the preferred option for many end stage liver disorders. This field shows a great improvement and is considered a breakthrough achievement for previously fatal liver diseases. Renal functions are not thoroughly studied in pediatric patients undergoing liver transplantation. Aim of the Work To determine the prevalence and risk factors of renal dysfunction among pediatric living related liver transplantation (LRLT). Patients and Methods This was a cross sectional retrospective and prospective cohort study in which a pilot study for a six-month duration is estimating the incidence of renal dysfunction among LRLT. A total of 40 patients were enrolled during the duration of the study from Ain Shams University, pediatric hospital and Dr. Yassin Abdel Ghaffar charity center for liver disease and research. Full history and clinical examination was performed as well as base line investigations preoperatively including: Serum Creatinine, Urea, Na, K, PO4, Ca, corrected creatinine clearance and urine analysis. Post-operative assessment was done to same parameters in addition to: Serum Mg, Cl, HCO, uric acid, drug trough level of used immunosuppressive drugs, 24 hours’ urinary proteins, and 24 hours’ assessment of electrolytes (Na, K, Ca, PO4, HCO3) in case of lowered serum levels. Moreover, pre and postoperative pelviabdominal U/S to check kidney status (size, echogenicity, RI of renal arteries) was assessed. Results Forty patients were analyzed of which 70% of the patients were males. The mean age at transplantation was 6.84±3.3 years. The commonest diagnosis of the studied group was high gamma-glutamyl transferase (GGT) cholestasis (35%) followed by Biliary atresia (22.5%). Of the enrolled patients, 50% were CHILD-B score, the median of the CHILD Score prior to transplantation was 8 and the median of the PELD score was 7.4. 87.5% of the patients had normal urine analysis, and normal proteinuria in 100% of the patients. The postoperative laboratory investigations were within the normal ranges. Mg was low in 67% of patients while Ca was low in 42.5%.The mean of creatinine, K and Ca levels are significantly elevated after LT (P < 0.05). After a mean duration since transplantation of 4 years, we found that 82.5% of our patients were CKD G1. S. creatinine was positively correlated with the patient age, duration of transplantation, s. uric acid, and average Fk level over the past year(P < 0.05 for all). Conclusion Renal dysfunction is a common, yet may be an underestimated, problem after pediatric liver transplant. Renal impairment was limited in our patients probably due to favorable perioperative conditions. Our pediatric recipients require mandatory and planned nephrologic evaluation to early detect any renal impairment which may develop into an end-stage renal disease and eventually increase the patient mortality rate. Further studies with larger cohort of patients and more advanced methods of assessment of renal functions are recommended.

Diagnostic Accuracy of Ultrasound in Evaluation of Obstructive Jaundice with MRCP as a Gold Standard

Abstract Background MRCP has high sensitivity for CBD stones, strictures and malignancies in cases of obstructive jaundice especially cases with suspicion (clinical/CBD-IHBR dilatation on USG). As MRCP has more diagnostic accuracy compared to ultrasound in detecting the cause of obstruction in cases of obstructive jaundice, USG may be considered as an initial screening test and MRCP for definitive treatment planning. The limitation of the study is the small sample size. Objective To evaluate cross sectional retrospective study was done From June 2021 to June 2022 on 31 patients (17 females and 14 males) presenting with obstructive jaundice were referred from Internal Medicine, General Surgery and Clinical Oncology Department to Diagnostic Radiology Department in Ain Shams University hospitals, MRCP were done for all the patients and then Abdominal US examination were performed and then comparison between US & MRCP result were done. Results The US has sensitivity of 100.0%, specificity of 100.0% and accuracy of 100.0 % in detection of level of obstruction and also has sensitivity of 71.0% and accuracy of 71.0% in detecting cause of obstruction taking MRCP as a gold standard. Conclusion MRCP is an excellent tool for detecting the cause of obstructive jaundice, Use of MRCP could therefore spare the patients from invasive preoperative endoscopic procedures and it can also most likely reduce overall surgical costs. We propose MRCP as the method of choice for the diagnostic imaging of obstructive jaundice.

Central Lung Cancer Location Along with Bronchoscopic Correlation- A Retrospective Cross-Sectional Study

Background: Lung cancer is currently the leading cause of death from neoplastic diseases worldwide. During the preceding decades, it was the most commonly occurring malignant disease, both in terms of impact and mortality. Fiberoptic bronchoscopy is the most important diagnostic tool for lung cancer. Early tissue diagnosis and proper staging remains the key to the management of the lung cancer patient. Endobronchial forceps biopsy has high diagnostic yield from the visible lesions. The aim of the study was to evaluate diagnostic yield of endobronchial biopsy. Methods: A Cross Sectional Retrospective study of all patients with provisional diagnosis of lung cancer based on computed tomography (CT) scan of chest undergoing fiberoptic bronchoscopy was done at Department of Respiratory Medicine, Ibn Sina Diagnostic & Consultation Center, Chattogram, Bangladesh from July 2022 to June 2023. All fiberoptic bronchoscopy was done in endoscopy suite under local anesthesia. Patients were explained about the procedure thoroughly. Endobronchial biopsy was the main procedure performed. Results: A total of 120 patients underwent bronchoscopy for suspected lung cancer. The mean age of the patients was 58 years with range of 18 to 75 years. Among them 93 (77.5%) were male and 27 (22.5%) were female. Majority of the patients, 108 (90%) were smoker with a mean pack year of 42. The lesion was present more in right side (N=65) than the left side (N=55). Majority of the lesion was present in lobar bronchus followed by main bronchus. Bronchoscopy was normal in 10 patients (8.3%). 12 patients had lesion in multiple locations. The diagnostic yield of endobronchial biopsy was 75%. The diagnostic yield for central tumor was 81.6% which was statistically significant (p<0.001) compared to peripheral tumor and extrinsic compression. Conclusion: Endobronchial biopsy provides good diagnostic yield especially in central tumors. Fiberoptic bronchoscopy is a safe procedure.

The 2017 and 2022 ILAE epilepsy classification systems identify needs and opportunities in care: A paediatric hospital-based study

ObjectivesThere is a paucity of studies reporting the epilepsy spectrum using the 2017 and 2022 ILAE classification systems in everyday clinical practice. To identify gaps and opportunities in care we evaluated a hospital-based cohort applying these epilepsy classification systems, including aetiology and co-morbidity, and the utility of molecular genetic diagnosis to identify available precision therapies. MethodsCross sectional retrospective study of all children with epilepsy (≤16 years) attending University Hospital Galway (2017–2022). Data collection and analysis of each case was standardised to ensure a systematic approach and application of the recent ILAE categorisation and terminology (2017 and 2022). Ethics approval was obtained. ResultsAmong 356 children, epilepsy was classified as focal (46.1 %), generalised (38.8 %), combined (6.2 %), and unknown (9 %). Epilepsy syndrome was determined in 145/356 (40.7 %), comprising 24 different syndromes, most commonly SeLECTS (9 %), CAE (7 %), JAE (6.2 %) and IESS (5.9 %). New aetiology-specific syndromes were identified (e.g. CDKL5-DEE). Molecular diagnosis was confirmed in 19.9 % (n = 71) which encompassed monogenic (13.8 %) and chromosomopathy/CNV (6.2 %). There was an additional 35.7 % (n = 127) of patients who had a presumed genetic aetiology of epilepsy. Remaining aetiology included structural (18.8 %, n = 67), infectious (2 %, n = 7), metabolic (1.7 %, n = 6) and unknown (30.3 %, n = 108). Encephalopathy categorisation was determined in 182 patients (DE in 38.8 %; DEE in a further 11.8 %) associated with a range of co-morbidities categorised as global delay (29.2 %, n = 104), severe neurological impairment (16.3 %, n = 58), and ASD (14.6 %, n = 52). Molecular-based “precision therapy” was deemed available in 21/356 (5.9 %) patients, with “molecular precision” approach utilised in 13/356 (3.7 %), and some benefit noted in 6/356 (1.7 %) of overall cohort or 6/71 (8.5 %) of the molecular cohort. ConclusionApplying the latest ILAE epilepsy classification systems allow comparison across settings and identifies a major neuro-developmental co-morbidity rate and a large genetic aetiology. We identified very few meaningful molecular-based disease modifying “precision therapies”. There is a monumental gap between aetiological identification, and impact of meaningful therapies, thus the new 2017/2022 classification clearly identifies the major challenges in the provision of routine epilepsy care.

Programmed death ligand I (PDL-1) Expression in renal cell carcinoma: A retrospective cohort study

Background and objectives: Inhibition of programed death -1and programed death ligand-1 pathway enhances antitumor activity of T lymphocytes, therefore, provides a new strategy for tumor treatment utilizing immunotherapy. The aim of this study to assess the frequency of programed death ligand-1 expression in renal cell carcinoma by using the immunohistochemistry and to correlate the results the clinicopathologic parameters. Methods: This is a cross sectional retrospective study performed in Duhok City from 2017-2022 on fifty-four formalin fixed paraffin embedded blocks of nephrectomy specimens diagnosed as renal cell carcinoma and collected from central lab of Duhok and some private labs. Two sections were prepared from each block, one section was stained with hematoxylin and eosin for histological analysis and the other one was used for immunohistochemical assessment of programed death ligand-1then the results were correlated with various clinicopathological parameters. Results: Programed death ligand -1; membranous expression was positive in 19 cases (35.2%) of renal cell carcinoma out of 54 cases. There was no significant correlation between programed death ligand -1 expression and age (p= 0.991), gender (p= 0.272), multifocality (p= 0.607), tumor size (p= 0.796), histological subtype (p= 0.107), tumor stage (p= 0.546), nuclear grade (p= 0.781), surgical margins involvement (p= 0.119) and lymphovascular invasion (p= 0.4), but there was statistically significant correlation with nodal metastases (p= 0.039). Conclusion: Programmed death ligand -1/ Combined positive score was ?1 in about one third (35.2%) of renal cell carcinoma cases and this result can be utilized for the provision of immune checkpoint inhibitor (ICIs), regardless the age, gender, histological type, stage, nuclear grade, and the presence of lymphovascular invasion (LVI).

Examining the impact of the COVID-19 pandemic on homecare services among individuals with traumatic and non-traumatic spinal cord injuries.

Descriptive repeated-cross sectional retrospective longitudinal cohort study. To investigate the impact of the COVID-19 pandemic on homecare services in individuals with traumatic or non-traumatic Spinal Cord Injury (SCI). Health administrative database in Ontario, Canada. A repeated cross-sectional study using linked health administrative databases from March 2015 to June 2022. Monthly homecare utilization was assessed in 3381 adults with SCI using Autoregressive Integrated Moving Average (ARIMA) models. Compared to pre-pandemic levels, between March 2020 to June 2022, the traumatic group experienced a decrease in personal and/or homemaking services, as well as an increase in nursing visits from April 2020-March 2022 and June 2022. Case management increased at various times for the traumatic group, however therapies decreased in May 2020 only. The non-traumatic group experienced a decrease in personal and/or homemaking services in July 2020, as well as an increase in nursing visits from March 2020 to February 2021 and sporadically throughout 2020. Case management also increased at certain points for the non-traumatic group, but therapies decreased in April 2020, July 2020, and September 2021. The traumatic group had decreases in personal and/or homemaking services. Both groups had increases in nursing services, increases in case management, and minimal decreases in therapies at varying times during the pandemic. Investigation is warranted to understand the root cause of these changes, and if they resulted in adverse outcomes.

A Study on the Clinical Profile of Non-Organophosphorus Poisoning in a Tertiary Care Hospital

Poisoning is emerging as a very important global health issue particularly in agricultural countries like India. Although wide range of data is available on organophosphorus poisoning cases, studies and data are limited on non-organophosphorus compound poisoning like paraquat, rodenticide (zinc phosphide, yellow phosphorus, sodium monofluroacetate, fluroacetamide, arsenic, warfarins, and scilliroside etc.), pyrethroid, carbamate etc. The present study aims to study the clinical presentation and outcome of the non-organophosphorus poisoning cases. A cross sectional retrospective study was conducted at Assam Medical College and Hospital, Dibrugarh. In this study the data of the patients with nonorganophosphorus poisoning admitted to Assam Medical College from July, 2022 to July, 2023 were collected and analysed. A total of 104 patients were included in the study and most patients belonged to the age group of below 30 years. Out of all the cases highest number patients presented with Paraquat poisoning (48.1%), while distribution of other cases was as follows- Phenyl (12.5%), Pyrethroid (23.1%), Rodenticide (10.6%), Carbamate (1.9%) and Organochloride (3.6%). Vomiting was the most common presenting symptom. Hepatic and renal impairment was observed only in the paraquat poisoning cases and it was also associated with high mortality rate (88%). Acute Hepatitis and Acute kidney Injury was quite common among paraquat poisoning patients and mortality was mainly observed in paraquat, rodenticide and carbamate poisoning cases. Comprehensive care and awareness among general public is necessary for prevention and better management of poisoning cases. Development of proper rational management guidelines is also pivotal for reducing mortality in these cases.

Semenology of Infertile Men Reported at a Tertiary Level Military Hospital of Bangladesh

Introduction: A very simple, cheap, easily available and non-invasive approach has made routine semen analysis the most important tool for diagnosis of male fertility. Objective: To determine I) the percentage of abnormality in semen parameters present in the husbands of infertile couples, II) the effect of occupation on abnormal parameters and iii) the effect of increasing age on semen quality. Methods: A cross sectional retrospective study was designed in a period of April 2019 to March 2020 on the basic semen analysis reports of the husbands of infertile couples reporting to the fertility clinic of a tertiary level military hospital of Bangladesh. Results: Out of 851 couples only 372 were excluded from female cause. At least 44% husbands showed at least one abnormality in their semen parameters according to WHO 2010 criteria and out of them 3.8% were azospermic. Almost all abnormalities showed more severity in the patients reporting from non-military background. Significant differences were demonstrated in the mean values in semen parameters like volume, concentration and motility between different occupational groups. Mean values of sperm concentration between different age groups showed significant changes. Values of other parameters also showed gradual decrease with increase of age but differences were not significant. Conclusions: The present study showed that even 56% normozoospermic husbands can be partners of infertile couples. Occupation and age affect male fertility. JAFMC Bangladesh. Vol 19, No 1 (June) 2023: 66-71

Perceptual-Auditory and Acoustic Analysis of Breathiness in Cis and Transgender Men and Women

ObjectiveTo verify breathiness in the cisgender and transgender men and women’s voices, compare values of acoustic and perceptual indicators of breathiness and fundamental frequency (f0) between groups, and compare them between the voices attributed as female and male. Study designCross sectional retrospective study. MethodsThe study as approved by the Research Ethics Committee (4,937,140). Sustained vowel /a/ and continuous speech recordings of 21 cisgender men (CISM), 31 transgender men (TM), 32 cisgender women (CISW) and 31 transgender women (TW) were analyzed. Three judges conducted a perceptive-auditory analysis regarding the degree breathiness, using visual analogue scale, and attributed gender (female or male). The ABI (Acoustic Breathiness Index) was extracted using the PRAAT software (6.1.16). The f0, Harmonic-Noise Ratio (HNR), Voice Turbulence Index (VTI) and Soft Phonation Index (SPI) were analyzed using the Multi-Dimensional Voice Program (KayPentax). ResultsThe ABI value for CISM was lower than for TM and CISW. CISW had the higher f0 than; TM had a higher f0 than CISM; and TW had a higher f0 than CISM. The groups did not differ for HNR and VTI. Regarding the SPI, CISM had higher values than CISW. Regarding the auditory perception, TM presented more intense breathiness than CISM in the vowel. Regarding gender attribution by voice, the voices CISM and CISW were 100% identified as male and female. On the other hand, in the vowel analysis, 45.2% of the TM voices were perceived as female and 59.4% of TW voices as male. ConclusionBreathiness occurs differently between groups and the voices perceived as male and female. Even when TM are submitted to the use of testosterone and undergo vocal changes, the transglottal airflow remains, which is a female characteristic of phonation.

Computer Assisted Bone Age Estimation Using Dimensions of Metacarpal Bones and Metacarpophalangeal Joints Based on Neural Network.

Bone age is a more accurate assessment for biologic development than chronological age. The most common method for bone age estimation is using Pyle and Greulich Atlas. Today, computer-based techniques are becoming more favorable among investigators. However, the morphological features in Greulich and Pyle method are difficult to be converted into quantitative measures. During recent years, metacarpal bones and metacarpophalangeal joints dimensions were shown to be highly correlated with skeletal age. In this study, we have evaluated the accuracy and reliability of a trained neural network for bone age estimation with quantitative and recently introduced related data, including chronological age, height, trunk height, weight, metacarpal bones, and metacarpophalangeal joints dimensions. In this cross sectional retrospective study, aneural network, using MATLAB, was utilized to determine bone age by employing quantitative features for 304 subjects. To evaluate the accuracy of age estimation software, paired t-test, and inter-class correlation was used. The difference between the mean bone ages determined by the radiologists and the mean bone ages assessed by the age estimation software was not significant (p Value= 0.119 in male subjects and p= 0.922 in female subjects). The results from the software and radiologists showed a strong correlation -ICC=0.990 in male subjects and ICC=0.986 in female subjects (p< 0.001). The results have shown an acceptable accuracy in bone age estimation with training neural network and using dimensions of bones and joints.

Dental treatment provided to special needs children under general anesthesia in a tertiary care hospital – A cross sectional retrospective study

Dental general anesthesia (DGA) can be a preferred approach for treating children with special health needs (CSHCN). It has many benefits, most importantly, the support of the anesthesia team to control the medical status and treat the patient safely. The aim of this study was to evaluate the dental treatment provided to (CSHCN) under (DGA) in a tertiary-care hospital. Moreover, to compare the dental procedures between different medical conditions. This retrospective study involves a sample of 730 children aged between (1–16 years) with complex medical conditions treated under DGA between January 2009 until April 2022. The results show that 4.93 % of these patients had DGA twice. For those children who had DGA only once, the most frequent medical conditions were neuro-developmental disorders (31.8 %), pediatric oncology (17.4 %), and behavioral disorders (autism, ADHD, etc.) (15.1 %). The average age was 6.9 years; almost half were preschool children (4–6 years old, 48.41 %) followed by younger school children (7–9 years old, 28.82 %). The most common dental procedures done were extractions followed by restorative procedures. The use of fissure sealant was significantly higher in neuro-developmental and behavioral disabilities patients than other medical conditions.

A Single Centre Retrospective Study to Access the Frequency of Congenital Anomalies in a Tertiary Care Hospital

Objectives: The objective of our study was to determine the frequency and types of congenital fetal anomalies among pregnant patient in tertiary care hospital. Methodology: This is descriptive, cross sectional retrospective study conducted in obstetrics and gynecology and radiology department of HBS General hospital Islamabad from January 2021 to January 2023.It includes all booked and unbooked antenatal patients Results: Over a period of two years total 3723 antenatal patients included in our study out of which 2.01% were diagnosed with congenitally structurally malformed fetuses. Commonly observed congenital abnormality in our study was CNS anomaly which was observed in 26 patients followed by congenital cardiac defects (16 patients), renal abnormality in 8 patients, and skeletal anomalies in 6 patients and respiratory tract anomalies in 2 patients. Conclusion: Congenital anomalies are a major cause of stillbirth and infant mortality. Patients history of medical disorders, previous anomalous baby, consanguinity, advanced maternal age and drug history have strong association with congenital fetal anomalies.

Factors associated with the indication of neonatal echocardiography in the investigation of congenital heart diseases.

To analyze the factors associated with the indication of echocardiography for the investigation of congenital heart disease among newborns. Retrospective sectional study through the collection of 848 medical records of patients admitted to maternity hospitals in Rio de Janeiro-Brazil, respecting the time frame from September to December 2022. The average age of mothers was 26.5±6.3 years; 52.7% were classified as brown. The average age of the newborns was 3.5±5.6 days. Maternal variables: gestational age (OR=6.93, CI:3.76-12.80), number of gestational risk factors (1.90: 1.47-2.45) and number of medications (1. 97: 1.40-2.77); and neonatal variables: age (1.07: 1.03-1.02), prematurity (10.55: 5.29-21.03) and number of risk factors (2.62: 2.03-3 .38) were significantly associated with the indication for echocardiography (p<0.001). It is concluded that the different maternal and neonatal variables, gestational age, number of gestational risk factors, number of medications, age, prematurity and number of risk factors, respectively, showed a significant association for the indication of echocardiography. Therefore, the identification of these factors will enable the investigation of congenital heart disease at an opportune time among newborns.

Ischemic Stroke and its Correlation with Low Blood Cholesterol Levels

Ischemic stroke occurs as a result of blockage of blood supply to the brain. It causes damage of brain tissue due to less availability of oxygen and nutrients. HDL-C is a significant risk factor for ischemic stroke. Objective: To evaluate the low HDL-C levels in ischemic stroke hospitalized patients. Methods: It is a descriptive cross sectional retrospective study conducted at Liaquat University Hospital, Hyderabad, Pakistan. The anticipated association of abnormal HDL-C levels in ischemic stroke was assessed in 200 cases. The data were collected from hospital records, patients were confirmed for stroke on the basis of CT scan. This descriptive analysis was performed based on the lab findings of patients from hospital records. Medical history, CT scans and demographic information of patients was obtained from hospital records after taking data collection permission from hospital. Results: A low level of HDL-C was identified in 126 patients (64%) according to the study's results. When the HDL-C values of ischemic stroke patients were compared using the Chi-Square Test, the p value obtained was 0.0001. Conclusions: The majority of ischemic stroke patients had low serum HDL-C levels. This study suggests an association of low serum HDL-C levels with susceptibility or risk for ischemic stroke.