bluuebunny/crossref_metadata_2025 huggingface dataset:
Culture-Negative Fungal Endocarditis
Authors: Kumar Rohit , Kirtana J. , Kodan Parul , Ray Yogiraj , Kumar Prabhat , Biswas Ashutosh
Published: November 2019

A 54-year-old female, known case of hypertension and diabetes mellitus (controlled), was admitted with prolonged fever for 1½ months. On evaluation, fever workup was inconclusive and multiple cultures were negative. On re-assessment of history, she gave a history of cardiac catheterization 1 month back. Further evaluation revealed aortic valve vegetation on two-dimensional echo with raised beta-D glucan levels. She was managed with antifungal therapy followed by valve replacement surgery. The patient improved following the management and is doing fine. This case highlights the importance of detailed history-taking and evaluation. It also highlights the not uncommon occurrence of fungal endocarditis in patients with healthcare contact and the role of biomarkers as surrogate in case of culture-negative endocarditis.
ESD Ideas: It is not an Anthropocene; it is really the Technocene: names matter in decision making under Planetary Crisis
Authors: López-Corona Oliver , Magallanes-Guijón Gustavo
Published: November 2019

Abstract. We do not understand what we see but see what we understand. Words shape the comprehension of our environment and set the space of possibilities we can access when decision making. Inhere we make the case for the use of Technocene instead of Anthropocene using well-grounded arguments in basic scientific principles. We already know that the Earth system has co-evolved with life phenomena (i.e. the evolution of atmosphere chemistry). What the Technocene idea makes clear is that as modern human societies exhibit an enormous coupling with technology and for the first time in human history that technology has the potential to modify the very core processes that drive Earth System dynamics, then Technology most be considered as a new dimension of analysis in the study of Earth system in its co-evolution with life and particularly human beings.
The Risk of Contact Lens Wear and the Avoidance of Complications
Authors: Tariq Farihah , Koay Peter
Published: November 2019

Contact lenses are lenses placed on the surface of the cornea to correct refractive errors such as myopia (short-sightedness), hyper­metropia (far-sightedness) and astigmatism. Lens-related complications are becoming a greater health concern as increasing number of individuals are using them as an alternative to spectacles. Contact lenses alter the natural ocular environment and reduce the efficacy of the innate defences. Although many complications are minor, microbial keratitis is potentially blinding and suspected cases should be rapidly diagnosed and referred to an ophthalmologist for treatment. Several risk factors have been identified with extended wear, poor hand hygiene, inadequate lens and lens-case care being the most significant. Promotion of good contact lens hygiene and practices are essential to reduce the adverse effects of contact lens wear.
A Case of Hyperbaric Oxygen as Adjunct to Fascio-tomies in Compartment Syndrome, Ischemia-Re-perfusion Injury, and Delayed Secondary Infection
Authors: Endly Dawnielle C. , Eggert Joan V.
Published: November 2019

Background: Fasciotomies are a therapeutic treatment for compartment syndrome, but they also allow reperfusion to tissues that have been hypoxic. We report a case study of a 52-year-old male with an ischemic leg. Despite prophylactic fasciotomies, ischemia-reperfusion injury resulted in delayed myonecrosis and progressive necrotizing fasciitis. Results: After two hyperbaric oxygen treatments, edema was markedly reduced and all visible wound tissues were well perfused without evidence of ascending infection, allowing the patient more time for further evaluation. The patient did opt for an above the knee amputation in a non-emergent setting and now successfully utilizes a prosthesis for ambulation. Conclusion: Ischemia-reperfusion injury may result in delayed tissue loss in spite of appropriate fascioto­mies. Hyperbaric oxygen may be a useful adjunct therapy even when initiated days after the initial injury.
Training for Translation – The Physician Scientist’s Career Path
Authors: Glavey Siobhan V. , Sahin Ilyas , Bonilla-Escobar Francisco J. , Bonilla-Velez Juliana
Published: November 2019

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Direction of Umbilical Cord Twist and its Characteristics – a Pilot Study
Authors: Pinto Althea V. , Chakiath Alex X. , Dasari Prudhvi , Reddy Vilekith , George Shirley , Shankar Nachiket
Published: November 2019

Background: A right-sided umbilical cord twist is associated with the presence of a single umbilical artery, congenital malformations and placenta praevia. Methods: It was an observational study. Data was collected from 137 umbilical cords, all from live births and their patient records. The gestational ages ranged from 28 weeks to 41 weeks. The umbilical cords were categorized into right or left, based on the direction of twist. The independent sample T test and the Chi square test were used to analyze the differences between groups. Results: The prevalence of left twist was 84%. Right twist was significantly associated with a larger Hyrtl’s anastomosis (p=0.029) and gestational diabetes (p=0.027). Conclusion: Two previously unreported associations with right twist of the umbilical cord, gestational diabetes and an increase in the diameter of Hyrtl’s anastomosis, were noted in the present study.
Real-Time Polymerase Chain Reaction: Applications in Diagnostic Microbiology
Authors: Saeed Kordo B.A. , Ahmad Nusreen S.
Published: November 2019

The polymerase chain reaction (PCR) has revolutionized the detection of DNA and RNA. Real-Time PCR (RT-PCR) is becoming the gold standard test for accurate, sensitive and fast diagnosis for a large range of infectious agents. Benefits of this procedure over conventional methods for measuring RNA include its sensitivity, high throughout and quantification. RT-PCR assays have advanced the diagnostic abilities of clinical laboratories particularly microbiology and infectious diseases. In this review we would like to briefly discuss RT-PCR in diagnostic microbiology laboratory, beginning with a general introduction to RT-PCR and its principles, setting up an RT-PCR, including multiplex systems and the avoidance and remediation of contamination issues. A segment of the review would be devoted to the application of RT-PCR in clinical practice concentrating on its role in the diagnosis and treatment of infectious diseases.
Artist Featured in Volume 1 IJMS: Rebecca Plummer-Rohloff, PhD
Authors: Gharaibeh Aisha , Bonilla-Velez Juliana
Published: November 2019

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Instructions for Authors
Authors: IJMS Executive Board of
Published: November 2019

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Cover, Credits, & Content
Authors: IJMS Executive Board of
Published: November 2019

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Key aspects of an effective surgical curriculum for medical students
Authors: O. Okonkwo Arthur C. , C. Okonkwo Okechukwu
Published: November 2019

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Postoperative and Postpartum Onset of Chronic Parkinsonism: Four Case Reports
Authors: Ramani B. Manish , Rabin L. Marcie , Kurlan Roger
Published: November 2019

Background: Certain environmental exposures have been linked to the development of parkinsonism. We report four cases in which the onset of chronic parkinsonism occurred immediately or soon after surgery or childbirth. Results: Exposure to certain anesthetic agents in susceptible individuals or the physiological changes associated with surgery or childbirth may have contributed to or precipitated the development of parkinsonism. Conclusion: Clinicians should be aware that postoperative or postpartum settings are potential precipitants of chronic parkinsonism.  More research is needed to clarify contributing factors.
Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) in the International Journal of Medical Students
Authors: Gharaibeh Aisha , Koppikar Sahil , J. Bonilla-Escobar. Francisco
Published: November 2019

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Common ECG Lead Placement Errors. Part I: Limb lead Reversals
Authors: V. Rosen Allison , Koppikar Sahil , Shaw Catherine , Baranchuk Adrian
Published: November 2019

Background: Electrocardiography is a very useful diagnostic tool. However, errors in placement of ECG leads can create artifacts, mimic pathologies, and hinder proper ECG interpretation. This is the second of a two-part series discussing how to recognize and avoid these errors. Methods: 12-lead ECGs were recorded in a single male healthy subject in his mid 20s. Various precordial lead misplacements were compared to ECG recordings from correct lead placement. Results: Precordial misplacements caused classical changes in ECG patterns. Techniques of differentiating these ECG patterns from true pathological findings were described. Conclusion: As in Part I of this series, recognition and interpretation of common ECG placement errors is critical in providing optimal patient care.
Shared Decision Making and Effective Physician-Patient Communication: The Quintessence of Patient-Centered Care
Authors: Ming Lim Huy , Siste Kurniasanti Kristiana
Published: November 2019

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Frequency of Congenital Anomalies in Newborns and Its Relation to Maternal Health in a Tertiary Care Hospital in Peshawar, Pakistan
Authors: Khan Adnan , Zuhaid Muhammad , Fayaz Maria , Ali Faryal , Khan Arsalan , Ullah Raza , Zafar Javariya , Ullah Hakeem , Baloch Saiqa , Gandapur Sanam
Published: November 2019

Background: Congenital anomalies are a major cause of perinatal and neonatal deaths, both in low- and high-income countries. They are relatively common worldwide, affecting 3% to 5% of live births. Methods: A cross-sectional study was conducted from January 2014 to June 2014 at the Khyber teaching hospital in Peshawar. Specific patient information was obtained from patient records at the beginning of the study. Those individuals found to have at least one birth defect were approached and their attendants (mothers) were interviewed. Information regarding various risk factors was collected. Descriptive analyses were carried out. Results: Out of 1062 deliveries, 2.9% (31) of newborns had various congenital anomalies.b Hydrocephalus (22.6%), anencephaly (12.9%), and spina bifida (9.7%) were major anomalies. The maternal age ranged from 18 years to 46 years (mean: 30 ± 8). Most of the anomalies (35.5%) were present in the 26-30 years age group. Out of 31 babies, 6.4% had multiple anomalies. The preponderance of various congenital anomalies was seen in parity 1 (35.4%); parities 2 to 4 had lower incidences (35.4%). The consanguinity rate was 67.7%; only 32.3% of patients were using folic acid. History of passive smoking was positive in 16.1% of cases. Conclusion: Anencephaly and hydrocephalus were the most prominent anomaly detected; early prenatal diagnosis may be helpful in decreasing mortality by offering early termination. Low intake of folic acid and a high consanguinity rate were the most common associated risk factors for congenital anomalies. These risk factors may be reduced by creating awareness regarding the avoidance of consanguineous marriage and promoting the use of folic acid during pregnancy.
Antimicrobial Sensitivity Pattern of Microorganisms Isolated from Vaginal Infections at a Tertiary Hospital in Bangalore, India
Authors: Narayana-Swamy Nagalakshmi , Ramalingappa Padmasri , Bhatara Urvashi
Published: November 2019

Background: The vagina contains dozens of microbiological species in variable quantities and is, therefore, considered a complex environment. Among the microorganisms, bacteria have important repercussions on women’s health. The present study was conducted to elucidate this type of vaginal isolates and their sensitivity towards currently used antibiotics. Methods: This was a retrospective study conducted at the Department of Obstetrics and Gynaecology, Sapthagiri Hospital, Bangalore, India from January 2012 to December 2013. All symptomatic women who had a high vaginal swab taken for culture and sensitivity testing were included in this study. Antibiotic susceptibility was tested using disc diffusion method (modified Kirby-Bauer’s method). The antibiotic sensitivity patterns of isolated microorganisms were studied. Results: Out of 200 patients, 95% had positive vaginal cultures. Fifteen types of microorganisms were isolated. The highest frequency of infection was seen at the age of 20-30 years, followed by 41-50 years and 31-40 years, and a low frequency of infection was observed above 50 years of age. The most prevalent pathogen was Escherichia coli, followed by Streptococcus agalactiae and diphtheroids with equal incidence. Among the antibiotics tested, isolated pathogens were completely resistant to nalidixic acid and highly sensitive to meropenem and imepenem. Conclusion: The high prevalence of gynaecological infections demands that patients with symptoms undergo thorough investigation with cultures and sensitivity essays. Changes in treatment protocols are required to treat

vaginal infections effectively.
Interviewing Dr Felipe Fregni: A Pathway to a Research Career
Authors: Bonilla-Velez Juliana , Cordoba-Grueso Whitney Stefanny
Published: November 2019

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Romantic Name for a Deadly Condition: Kissing Aneurysms of the Pericallosal Artery – A Case Report
Authors: M. Waszak, Przemyslaw , Paturej Agnieszka , Springer Janusz , Baranowska Katarzyna , Brzeska Barbara , Aleksandrowicz Katarzyna , Szmuda Tomasz , Garnier Hanna
Published: November 2019

Background: Kissing aneurysms are two independent but adjacent aneurysms protruding from two contralateral arterial locations. This report describes a successfully treated case of kissing aneurysms at the Department of Neurosurgery, Medical University of Gdansk. Case: A 45-year-old asymptomatic woman was diagnosed with unruptured bilateral aneurysms located in the pericallosal-callosomarginal division. Her medical history included a previous intracranial aneurysm and arterial hypertension. The patient underwent a successful treatment by surgical clipping and was discharged in good condition; neither disability nor neurologic deficit was noticed upon discharge. Surgical wound healing was complicated by an infection and resulted in a reoperation for the patient. Conclusion: The etiology of kissing aneurysms is still unknown and the best treatment method stills remains unclear. Thus, every case has to be carefully and individually assessed by an interdisciplinaryteam. As a result, patient transfer to an experienced neurosurgical center could be beneficial.
Chronic Fatigue Syndrome: Where Do Your Views Lie? An Experience from a UK Medical Student
Authors: L. Lambson Rebecca
Published: November 2019

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A Call for Action for Mental Health: Medical Students and Physicians' roles
Authors: J. Bonilla-Escobar Francisco , Ming Lim Huy
Published: November 2019

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The Allele Distribution for the rs7250346 SNP in SLC5A5 among Saudis
Authors: T. Eissa Abdullah
Published: November 2019

Background: The sodium/iodide cotransporter solute carrier family 5 member 5 (SLC5A5) is found in the basolateral cell membrane of thyroid follicular epithelial cells as a sodium iodide symporter. It helps in the secretion of triiodothyronine (T3) and tetraiodothyronine (T4). Polymorphisms in SLC5A5 result in hypothyroidism. The aim of the study is to estimate the frequency of rs7250346, a single nucleotide polymorphism (SNP) associated with thyroid disease, in a Saudi population and to compare it to other populations. Methods: Two hundred and forty Saudi patients from King Faisal Specialist Hospital and Research Centre provided samples for the genetic analysis. Samples were genotyped for target SNPs by real time polymerase chain reaction (PCR), and the resultant rs7250346 frequency in the Saudi population was compared to other populations using HapMap. Results: Out of the 240 Saudi samples, 64% had C genotype and 35% had G genotype in the rs7250346. Conclusion: The Saudi frequency of the rs7250346 SNP of SLC5A5 differs from that of European, Chinese, Japanese, or Sub-Saharan populations in HapMap (http://hapmap.org).
Challenges Faced by International Medical Students Due to Changes in Canadian Entrance Exam Policy
Authors: Gouda Pishoy , Fanous Samuel , Gouda John
Published: November 2019

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Grains of Sand and an Artist’s Hands
Authors: Mihalic Angela Peterman
Published: November 2019

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Seroprevalence of Hepatitis B Infection among First-Time Blood Donors in Faridpur, Bangladesh: A Cross-sectional Study
Authors: Biswas Tonmoy , Kumar Biswas Sunil , Biswas Tonmoy
Published: November 2019

Background: Hepatitis B infection is a global threat for people of all age groups and is common in Bangladesh and other South Asian countries. Blood donors and blood donation can present important risk for hepatitis B infection. Our objective was to identify seroprevalence of hepatitis B virus among blood donors in Faridpur, Bangladesh. Methods: A cross-sectional study was conducted among 719 blood donors in the Faridpur district of Bangladesh from April to July 2013. Data was collected by non-probability convenient sampling maintaining inclusion and exclusion criteria. Face-to-face interview, blood grouping test, and hepatitis B surface antigen (HBsAg) screening were conducted. Results: About 30% of the blood donors were between 19 and 23 years of age, and 87.5% of them were males. Two-thirds (64.1%) of the donors were replacement donors, while the remaining 35.9% of them were voluntary donors. The overall seropositivity of HBsAg was found to be 1.5%. All infected blood donors were males. Hepatitis B infection was more prevalent in the 34–38 years age group and least prevalent among those older than 48 years of age. About 2% of replacement blood donors were infected with hepatitis B virus, compared to 0.7% among voluntary blood donors. Conclusion: Hepatitis B infection among blood donors is relatively lower than in other high-risk groups for hepatitis B infection in Bangladesh. Predominance of HBsAg among older adult groups, replacement donors, and the male gender can be a matter of public health concern.
The Role of the Human Papillomavirus (HPV) in Cervical Cancer: A Review about HPV-Induced Carcinogenesis and Its Epidemiology, Diagnosis, Management and Prevention
Authors: Bonello Karl , Blundell Renald
Published: November 2019

The human papillomavirus (HPV) was the first virus known to induce carcinogenesis and is associated with cancers of the uterine cervix, anogenital tumors and malignancies of the head and neck. This paper reviews the structure and basic genomic characteristics of the virus and outlines the clinical involvement of the main HPV serotypes, focusing on the carcinogenic role of HPV-16 and 18. The mechanisms that occur in the development of cervical neoplasia due to the oncogenic proteins E6 and E7 which interfere with the regulation of the cell cycle through their interaction with p53 and retinoblastoma protein are described. Epidemiological factors, diagnostic tools and the management of the disease are also reviewed, along with the available vaccines to prevent the viral infection. Insights on current research on involvement of oxidative stress and micro-RNAs in cervical carcinogenesis are also explored as they may unlock new means of diagnosis and treatment in the future.
Acute Oxalate Nephropathy Due to Bilimbi Poisoning: A Case Report
Authors: Das Gupta Rajat , Datta Debashis , Datta Debashis , Kumar. Suranjan
Published: November 2019

Background: The concentrated juice made from Averrhoa bilimbi is rich in oxalic acid. It can cause acute oxalate nephropathy by blocking the tubules with calcium oxalate crystals. Case: An elderly woman was admitted to the hospital with a history of swelling of the legs, facial puffiness, and abdominal distention. Her biochemical study revealed features of acute renal failure. She gave history of taking half liter of bilimbi juice. Renal biopsy confirmed it was a case of acute oxalic nephropathy, which made it the second case of acute oxalic nephropathy due to ingestion of bilimbi juice ever reported from Bangladesh. Conclusion: It is not safe to consume high oxalate-containing fruits in large quantities.
Medical Students’ Experience: Community Engagement and Advocacy through Photovoice
Authors: Charlotte Hunter Heather , Jaiswal Deep , Cameron Brittany , J. To Matthew , Kathleen Clarke Suzanne , Cox Catherine , Lane Ciaran , States Cinera
Published: November 2019

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Men’s Experiences with the Hockey Fans in Training Weight Loss and Healthy Lifestyle Program
Authors: Brianne Muise Stephanie , Gill Dawn P. , De Cruz Ashleigh , Riggin Brendan , Pulford Roseanne , Sibbald Shannon L. , Petrella Robert J.
Published: November 2019

Background: Increasing rates of chronic disease, especially in men, have led to an increased effort to implement lifestyle interventions focusing on healthy eating and physical activity. Men are underrepresented in lifestyle programs and some studies have observed that males prefer men-only programs that occur in the context of sports. This paper reviews men’s feedback regarding motivation for joining and overall experience in a 12-week lifestyle intervention in the context of junior level ice hockey teams. Methods: Men age 35-65 with a BMI ≥28 were recruited from local ice hockey team fan bases in London and Sarnia Ontario, Canada and randomized to the 12-week lifestyle intervention or control group. Those who attended at least 6 of the 12 weekly sessions, including at least one session in the final six weeks (n=30) were asked to complete an online questionnaire upon finishing the active phase of the intervention. The questionnaire elicited reasons for joining the program, changes seen following their participation, and the usefulness of specific components of the program. Results: For the 27 men who completed the questionnaire, weight loss and a desire to increase physical activity were the two main reasons cited for joining the program. After the intervention, 100% of the men reported eating a healthier diet and 78% increased their activity level. Program satisfaction was high and 96% of men believed both the classroom and exercise components were useful. Conclusion: Our results support previous research showing increased levels of satisfaction in men when lifestyle interventions are run in a sporting context and incorporate both an educational component and an exercise component.
Participatory Learning of Medical Students through Development of Innovative Training Modules for Community Health Workers
Authors: Ramesh Bogam Rahul , Saoji Vivek , Sahasrabudhe Ranjana , Saoji Apoorva
Published: November 2019

Background: Community Medicine is a subject which receives relatively less attention in medical curriculum. Active participation of students in preparation of training modules for Community Health Workers (CHWs) could facilitate their learning in topics related to Community Medicine. This study aimed to involve medical students in the preparation of training modules for CHWs and assess the effects of their participation on their knowledge about targeted diseases. Methods: An interventional study where all 144 undergraduate fifth-semester students from Bharati Vidyapeeth University Medical College, Pune, India posted at Community Medicine Department participated in the preparation of training modules for CHWs on HIV/AIDS, tuberculosis, malaria and diabetes and completed pre- and post-intervention questionnaire. Each completed questionnaire was assigned a score based on a marking system. The data was analysed using paired t test. Results: Statistically significant improvement in knowledge was found (pre-test mean score: 5.79, post-test mean score: 14.15, t = 26.93, p<0.001). All faculty opined that community visits followed by health education module preparation activity were innovative components in this study. All 119 participants agreed that their knowledge about targeted diseases improved due to module preparation activity. Conclusion: Active participation of students can facilitate their learning behavior. Students became aware of the principles of ‘Group Dynamics’ as a result of active involvement in training module preparation.
Structured Didactic Education Program for Writing Case Reports Can Motivate Medical Students
Authors: Kakisaka Yosuke , Fujikawa Mayu , Gaillard Schuyler
Published: November 2019

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Abstracts of the Congress of Medical Students of Unicamp – Brazil, CoMAU, 2017
Authors: IJMS Executive Board of
Published: November 2019

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How does the Extracellular Matrix Change in the Setting of Heart Failure?
Authors: Argyriou Amerikos
Published: November 2019

The Extracellular Matrix is a dynamic entity, showing constant degradation and deposition while providing the framework for the cardiomyocytes and interstitial proteins to lie on. Its function is important for the proper myocyte alignment within the heart and for internal communication from cell to matrix. Dysregulation of the remodeling process resulting in the breakdown of collagen by matrix metalloproteinases is a hallmark of heart failure pathophysiology and produces functional changes encompassing all matrix proteins. Several etiologies with distinct mechanisms ultimately bring about signs of heart exhaustion such as reduced ejection fraction, reduced compliance and ventricular dilatation. Discussed in this paper is the role of inflammation, collagen cross-linking and of myofibroblasts in matrix dysfunction and the mechanisms with which these changes occur in heart failure. Understanding extracellular protein roles within this context would allow for specific drug targeting and thus prevention of heart failure in the early stages of the disease. More studies must be conducted to discover the specific matrix proteins and cytokines that modulate the pathological remodeling process. Serum biomarkers of extracellular degradation products, selective metalloproteinase inhibitors and a personalized treatment approach with a revisal of the current classification of heart failure are topics requiring further exploration.
Assessment of Healthful Lifestyle Behaviors between Graduate Programs
Authors: Vincek Erik , White Dana Angelo , Feinn Richard
Published: November 2019

Background: Heart disease is a condition with many etiologies, some of which include genetics, obesity, exercise, diet, smoking, and alcohol use. Studies show that increased years of education lead to better health outcomes, specifically lower rates of heart disease and obesity. Despite their high level of education, physicians have been shown to have a disproportionally higher rate of heart disease. Our objective was to determine whether there are particular lifestyle habits present among medical students that may lead to increased risk of heart disease as their academic and clinical futures progress. Methods: 201 Quinnipiac University medical, law, and education graduate students were recruited to this survey study. Descriptive statistics were used to present the data. Chi-squared test and Kruskal-Wallis tests were used to test the significance and a p-value <0.05 was considered significant. Results: Medical students were able to answer health-related questions correctly more than their law and education student counterparts (p-value <.001), felt able to explain the terms saturated fat (p-value <.001) and trans-fat (p-value <.001) and give an accurate estimate of personal BMI status better than their counterparts in the law and education programs, but did not significantly differ in meeting Dietary Approaches to Stop Hypertension (DASH) diet recommendations or American Heart Association (AHA) recommendations for physical activity. Conclusion: Increased health-related knowledge has little bearing on individual dietary and physical activity habits of graduate students. We found no evidence to show that increased medical knowledge leads individuals to pursue lifestyle habits that lower the risk of heart disease.
Frequency and Correlation of Body Mass Index and Waist-Hip Ratio with Fasting Glycemia and Blood Pressure in High School Students from Mexico
Authors: Medina-Gaona Lourdes Adriana , Enríquez-Sánchez Nallely , Mejía- Ramírez Carla Elizabeth , De Jesús Orueta-Mondragón Nathalia , Medina-Franco Heriberto , Sandoval-Morales Yareri , Plett-Torres Tanya
Published: November 2019

Background: Overweight/obesity is a global public health problem in adolescents. Its frequency is increasing as similar to diabetes, hypertension, health expenses, and poor quality of life. Thus, detecting overweight/obesity early in life promises a positive impact on the world’s health.

Methods: In a cross-sectional study, differences were explored between glycemia and blood pressure according to BMI, WHR, age, sex, number of daily meals and family history of chronic diseases in high school students from Mexico City.

Results: The prevalence of overweight and obesity in the participants (115) was 26% and 7%, respectively. Fasting glycemia (mg/dL) was higher in students aged ≤17 vs. ≥18 (91.45±7.96 vs 87.59±10.06, p=0.038). All hyperglycemic students and with android adipose distribution were women. Compared to the other participants, overweight students had higher systolic (107.24±12.31 vs 115.73±15.28, p=0.003) and diastolic (70.99±10.93 vs 76.27±13.02, p=0.033) mean values (mmHg). Systolic values were higher in obesity (108.77±13.03 vs 118.63±18.38, p=0.048). Men had a higher frequency of systolic (32%, p=0.001) and diastolic (37%, p=0.023) prehypertension/hypertension than women (8% and 17%, respectively). Systolic prehypertension/hypertension was common in overweight (47% vs 53%, p=0.008). Skipping meals was common in students with family history of hypertension (13% vs 87%, p=0.005).

Conclusion: The prevalence of overweight was higher and of obesity was lower than the one reported in ENSANUT 2016 (22.4% and 13.9%, respectively). Sex differences in blood glucose and pressure were obtained: men had higher blood pressures and women with abdominal fat had higher fasting glycemia. Systolic blood pressure was higher in overweight and obesity.
Recurrent Subacute Subdural Hematoma in a 67-Year-Old Female with Late Alzheimer’s Disease: A Case Report
Authors: Morgan Paul Marcel
Published: November 2019

Background: Chronic Subdural Hematoma (CSDH) is becoming an urgent public health issue due to an increase of incidence in aging populations like Taiwan. Though trauma still stands as the primary mechanism of CSDH, it is often overlooked in the elderly, especially those with mid-to-late stage Alzheimer’s Disease (AD). Coincidentally, the clinical presentation of mid-to-late stage AD shares significant overlap with CSDH. AD creates an immense challenge for physicians and family members to identify early signs of CSDH.

The Case: We report a peculiar case of a 67-year-old female with a history of AD who presents to the Emergency room in Belmopan City, Belize, with recurrent CSDH. On admission her consciousness was disturbed and late stage dementia presented an enormous challenge for logical and meaningful history taking. Axial non-contrast computed tomography showed a crescent-shaped isodense subdural hematoma in the left hemisphere of the parietal lobe. She was stabilized and treated conservatively with corticosteroids, beta blockers, angiotensin-converting enzyme (ACE) inhibitors and diuretics.

Conclusion: It is important for physicians to recognize and develop protocols to identify early signs of CSDH in patients with late stage AD. Early management is a key factor in minimizing more serious complications like recurrence, seizures, and tension pneumocephalus.
Spine ABC, A Multidimensional Case Report from A to Z: Aneurysmal Bone Cyst of the Spine
Authors: Georgiou Eliza (Eleni-Zacharoula) , Prapiadou Savvina , Kourea Helen
Published: November 2019

Background: Aneurysmal bone cysts (ABC) are uncommon entities which cause expansile and destructive bone lesions and are characterized by reactive proliferation of connective tissue. They usually grow rapidly with hypervascularity. ABC’s incidence on the spine is 1.5 in 10 million. Most cases present with pain of unexplained origin.

The Case: Presented in this paper is an ABC case in the spinous process of the L2 vertebra of a 20-year-old Greek female patient. The main symptom was persistent back pain, without neurological symptoms, of four years’ duration. Treatment consisted of surgical curettage of the lesion. In this case report, we tried to describe not only the pathology of this disease but also the subsequent psychosocial symptoms that accompany it. We managed to accomplish that by exploiting the knowledge of an experienced pathologist, the help of the physicians responsible for this case, the interest of some sensitized medical students, and of course, the experience of the patient herself since the patient is also the lead author.

Conclusion: The focal point of this article is that even though ABCs might lead to excruciating pain, this pain can be alleviated with the proper treatment, especially if the communication between physician and patient is optimal.
Blockchain Implications for the Monetization of Identity Governed by Individuals
Authors: Smith Sean Stein
Published: November 2019

Blockchain technology has been discussed and analyzed throughout numerous practitioner and scholarly applications, but the majority of said analysis has tended to focus on the financial services space. From a blockchain and broader cryptoasset space this seems to make logical sense, but overlooks other potential applications. Specifically, as intellectual assets and intangible property assume greater importance in virtually aspect of the economy, the potential for blockchain and cryptoassets does appear to be increasing. Written in a tone and manner of interest to both practitioner and academic audience, this analysis examines how the Brave browser attempts to rebalance the proverbial scale between who controls the valuable information that continues to dominate the business landscape. In addition this research presents a potential framework for how organizations and individuals can monetize what potentially may be the most value resource going forward – digital information - and do so in a manner that is both equitable as well as leveraging the emerging technology of blockchain.
Inhibition of Pancreatic Lipase and Characterization by Extracts From Fruit Pomaces Cultivars Grown in Brazilian Semiarid
Authors: Borges Josileide Gonçalves , Almeida Jackson Roberto Guedes da Silva , De Sá Juliana Anielle Ribeiro , Bezerra Kaline Stela Pires , Damasceno Patricia Kauanna Fonseca , Reis Isabela Mary Alves , Moura Marigilson Pontes De Siqueira
Published: November 2019

Investigate action of pancreatic lipase inhibition and characterization of extracts obtained from fruit pomace cultivars grown in Brazilian semiarid. Phytochemicals of Vitis labrusca, Passiflora edulis flavicarpa Deg., Citrus sinensis L Osbeck, and Punica granatum L. were extracted by maceration in a hydroethanolic solution. Inhibition activity of pancreatic lipase was performed by ELISA reader. To identify which compounds would probably be responsible for inhibitory activity, extracts were characterized by method of total phenolics using folin ciocalteau, phenolic acids and flavonoids were identified by HPLC, antioxidant potential was quantified by DPPH. With exception of pomegranate seed, all other pomace showed potential for inhibition of lipase. However, V. labrusca had higher percentage of inhibition (89.74%), this percentage similar to that obtained by commercial orlistat inhibitor, which would indicate its use as an efficient inhibitor. For all extracts were found several phytochemical compounds with phenolic characteristics, however, pomaces of P. granatum peel and V. labrusca showed best results in total phenolic and antioxidant activity. P. granatum peel had a high content of total phenolics (82.50 EAG g-1) and the best antioxidant activity (IC50 = 1.47 µg mL-1). All pomace extracts showed varied secondary metabolites, although antioxidant activity from grape and passion fruit pomaces showed potential for inhibition of lipids absorption.
Palliative chemotherapy decision-making: A holistic perspective
Authors: Streck Brennan Parmelee , LoBiondo-Wood Geri
Published: November 2019

Palliative chemotherapy can be conceptually confusing to patients and their families. When presented as an option at end of life, the decision-making process can be particularly stressful as patients and their families struggle to understand the goals of palliative chemotherapy, and examine their own values, wishes, and expectations for care. Lacking a clear definition in the literature, palliative chemotherapy is highly individualized to patients. However, applying holistic strategies during the decision-making process can mitigate stress, protect patients and families from misinformation, and ensure that they do not miss the opportunity to evaluate their options. In this narrative review for clinical application, the authors highlight key issues in palliative chemotherapy and palliative chemotherapy decision-making, and present evidence-based strategies for supporting patients and families through the decision-making process from a holistic perspective.
Peer tutoring in nursing: Quantitative evaluation of a formalized undergraduate tutoring program
Authors: Sand-Jecklin Kari , Huber Stacy
Published: November 2019

Background and objective: Based on the limited literature, a formalized peer tutoring program was developed at the study institution’s School of Nursing to promote the success of academically at-risk students.  The evaluation process was designed to guide program improvement as well as to contribute to the available literature related to peer tutoring in programs of nursing. The purpose of this study was to formally evaluate a newly developed formalized peer tutoring program for undergraduate nursing students, to inform other undergraduate nursing programs considering implementing a peer tutoring program.Methods: The peer tutoring program was evaluated using parallel post-experience surveys for tutors and tutees. Participants also completed a Learning and Studying Strategies Questionnaire, to determine if strategy use differed between the two groups.Results: There were no statistically significant differences in learning/studying strategies used by tutors and tutees, with both being predominantly superficial strategies. Tutors and tutees evaluated the tutoring program overwhelmingly positively. A few students did make suggestions for improvements in the payment system and suggested making tutoring more widely available.Conclusions: The formalized peer tutoring program is a valuable asset in promoting the academic success of undergraduate nursing students.  Minor changes to the program have been made according to student suggestions.
A Comparative Study of Critical Thinking Skills Between English and Japanese Majors in a Normal University
Authors: Zhou Fenglin , Lin Yuewu
Published: November 2019

Critical thinking is one of the core objectives of talent training in higher education. Meanwhile, the cultivation of critical thinking skills in foreign language teaching has become more and more urgent, and it has also been written into the national standards for the training of foreign language talents. A good critical thinking includes both a skill dimension (Critical Thinking Skills) and a disposition dimension (Critical Thinking Dispositions). Critical Thinking Skills include interpretation, analysis, evaluation, inference, explanation and self-regulation. This study intends to explore the current situation of the critical thinking skills of undergraduates in foreign language majors (English and Japanese) in a Normal University, and then attempts to find out the similarities and differences in critical thinking skills between English majors and Japanese majors after years of study at college. The results show that a clear difference exists between English majors and Japanese majors in overall critical thinking skills. In particular, English majors are superior to Japanese majors. Another finding is that there are also differences between the two majors in the three core sub-skills of critical thinking skills, analysis, evaluation and inference.
Here to Stay!
Authors: Schädel Andreas
Published: November 2019

Ever since its first appearance on the world stage, nationalism has had violent consequences. There is reason to worry that its current resurgence is no exception and will eventually also result in violent conflicts within and possibly even across European borders. To understand why this might be the case, and to identify ways that could contain renewed nationalist violence, this article looks beyond the populist nationalism of the past years and provides a nuanced picture of the nationalist principle and its macro-historical significance. Looking at evidence from research and remembering empirical examples from the inclusive, liberal post-Cold War period, it shows that violence is not inevitable and that the most heinous forms of nationalism can successfully be contained through accommodative and inclusive power-sharing arrangements. The article ends with some preliminary policy proposals and a first glimpse at alternative forms of identities that allow embedding the nationalist principle in an inclusive European framework of peace.
Évaluation de la qualité des eaux de la nappe de Téboulba : risque de contamination des sols agricoles
Authors: Souguir Dalila , Hörmann Georg , Hachicha Mohamed
Published: November 2019

Cette étude concerne la nappe côtière de Téboulba étant donné son importance pour l’agriculture locale. Dans un suivi de la qualité des eaux de cette nappe, une expérimentation a été entamée chez trois agriculteurs se servant de leurs puits pour l’irrigation en période de manque d’eau. Les cinq puits étudiés ont révélé des eaux basiques avec une salinité élevée (3,61-7,26 dS∙m-1) dominée par des ions Na+ et Cl-. La composition métallique est marquée par des teneurs inférieures aux limites recommandées dans les eaux d’irrigation pour le Pb, Zn, Cu et Mn. Cependant, des teneurs proches ou dépassant les limites ont été enregistrées pour le Cr, Cd et Co. Vu cette contamination, une évaluation de la qualité des sols irrigués par les eaux de la nappe a été entreprise. L’évaluation a été basée sur le test de micronoyaux à travers une exposition des racines de Vicia faba aux lixiviats de ces sols. Les lixiviats n’ont pas montré de différences significatives de leur indice mitotique et du nombre de micronoyaux formés comparés aux lixiviats contrôles. Cependant, des aberrations chromosomiques et nucléaires ont été observées chez tous les lixiviats. Malgré une contamination des eaux de puits, probablement due aux activités industrielles et agricoles dans la région et aux alentours, les sols ne présentaient pas de signes de génotoxicité. Les résultats de ce travail incitent à une étude plus approfondie sur les origines d’une telle contamination dans un but de minimiser à la source les risques d’aggravation de l’état de la nappe.
Risk and protective factors for childhood asthma and wheezing disorders in the first 1,000 days of life: a systematic review of meta-analyses
Authors: Santos Karoliny dos , Isoppo Nicolas
Published: November 2019

Introduction: The first 1,000 days of life of a child, the period from conception to the end of the second year, is a critical stage for the development of respiratory and immune systems. Many factors occurred in this period may be associated to risk of asthma in childhood. Objective: To condense evidence about risk and protective factors for childhood asthma and/or wheezing disorders occurred in the first 1,000 days of life. Methods: MEDLINE, CINAHL, and SCOPUS databases were searched. Systematic reviews with meta-analysis, or metaanalysis of observational and interventional studies on risk or protective factors for childhood asthma/wheeze, emphasizing the period between the conception and two first years of age, were included. The quality of studies was evaluated by the Assess Systematic Reviews tool. The pooled odds ratio, 95% confidence interval and homogeneity among studies were analyzed. Results: Thirty-five studies met the inclusion criteria, with good methodological quality. Parental history of asthma; maternal weight gain during pregnancy, urogenital infections, psychological stress, and smoking; caesarean section; preterm birth; birth weight; and neonatal hyperbilirrubinemia are risk factors for asthma/wheeze in childhood. Intake of fish oil, zinc and vitamin E during pregnancy appear as protective factors, as well as breastfeeding, fish intake in the first two years, and BCG vaccination. Conclusion: Several modifiable behaviors or exposures can be  associated with asthma and wheezing in childhood. The knowledge about these behaviors and exposures can improve early prevention strategies with a view to ensuring a beneficial impact on respiratory health.
Evidence of training influence on infant manual behavior: a systematic review
Authors: Nascimento Andressa Lagoa , Tedesco Natália Matos , Soares-Marangoni Daniele de Almeida
Published: November 2019

Introduction: Researchers have widely investigated how interventions by means of training can improve manual behaviors in infants. However, no systematic review has been found on this topic. Objective: To analyze the quality of scientific evidence considering the methodological quality and level of evidence by type of study in research on training of object-directed manual behaviors in infants in the first 18 months of life. Methods: National Library of Medicine (PubMed/MEDLINE), Latin American and Caribbean Health Sciences (LILACS), Virtual Health Library (BIREME/BVS), Science Direct, SciELO, and Physiotherapy Evidence Database (PEDro) databases were used. Only clinical trials that assessed the benefits of manual object-directed training in infants and were published up to February 2018, in English, were included. The Cochrane Collaboration Model was adapted to extract bibliographical data from the articles and their methodological quality was assessed using the PEDro scale and the Oxford Centre for Evidence-Based Medicine’s Levels of Evidence. Results: Twenty one clinical trials were included. Studies investigated typically developing full-term infants, preterm infants, and infants at risk for autism spectrum disorders. Trainings were administered to infants by means of “sticky mittens” paradigm, task-specific practice, or contingency reinforcement. Most of the studies presented fair or poor methodological quality. Only studies that used task-specific active practice presented high methodological quality. Conclusions: The results indicate there is high quality evidence that task-specific training improves object-directed manual behaviors in typically developing infants and preterm infants in the first 2-4 months of life. Studies addressing infants with established diagnoses of developmental dysfunction are lacking.
One-shot learning and behavioral eligibility traces in sequential decision making
Authors: Lehmann Marco P , Xu He A , Liakoni Vasiliki , Herzog Michael H , Gerstner Wulfram , Preuschoff Kerstin
Published: November 2019

In many daily tasks, we make multiple decisions before reaching a goal. In order to learn such sequences of decisions, a mechanism to link earlier actions to later reward is necessary. Reinforcement learning (RL) theory suggests two classes of algorithms solving this credit assignment problem: In classic temporal-difference learning, earlier actions receive reward information only after multiple repetitions of the task, whereas models with eligibility traces reinforce entire sequences of actions from a single experience (one-shot). Here, we show one-shot learning of sequences. We developed a novel paradigm to directly observe which actions and states along a multi-step sequence are reinforced after a single reward. By focusing our analysis on those states for which RL with and without eligibility trace make qualitatively distinct predictions, we find direct behavioral (choice probability) and physiological (pupil dilation) signatures of reinforcement learning with eligibility trace across multiple sensory modalities.