bluuebunny/crossref_metadata_2025 huggingface dataset:
La diplomatie française : une posture en difficulté
Authors: Charillon Frédéric
Published: March 2024

Dans le nouveau contexte international tel qu’il se donne à voir depuis plusieurs années, la France ne bénéficie pas d’une grande marge de manœuvre. La pandémie de Covid-19 puis l’invasion de l’Ukraine par la Russie en février 2022 ont montré les nombreuses vulnérabilités de l’Europe. L’élection de Donald Trump aux États-Unis en 2016 avait également démontré que le grand allié américain pouvait faire défaut. Avec quel instrument diplomatique la France peut-elle tenter de s’adapter à ce nouveau monde ? Avec quels moyens financiers, avec quels diplomates ? Mais avec quelle posture, également ? La ligne diplomatique française telle que nous la connaissons jusqu’à 2023, atlantiste et pro-européenne, n’est sans doute pas éternelle .
La France et le Conseil de sécurité des Nations Unies
Authors: de La Sablière Jean-Marc
Published: March 2024

Sachant utiliser son statut de membre permanent, sans en abuser, la France a, le plus souvent, défendu la centralité et les compétences du Conseil de sécurité dans la gestion des crises. Elle a contribué à étendre son champ d’action, a favorisé son efficacité et a joué habilement de son propre positionnement diplomatique pour y obtenir les soutiens dont elle avait besoin. Aujourd’hui, la dégradation des relations entre les grandes puissances affectant négativement la contribution du Conseil à la paix et la sécurité internationales, la France s’efforce d’éviter la marginalisation de cet organe et certaines de ses dérives .
La France et l’Union européenne : maximiser l’intérêt national
Authors: Lequesne Christian
Published: March 2024

Depuis le début de la construction européenne, les gouvernements de la France ont toujours considéré l’engagement européen comme un moyen de maximiser l’intérêt national et de faire valoir un certain leadership. Sujet longtemps peu débattu par l’opinion publique française, la construction européenne fait pleinement partie du débat public depuis le traité de Maastricht. Comme partout en Europe, elle contraint les gouvernements français à tenir compte de la montée de l’euroscepticisme .
Les habits neufs du rayonnement français
Authors: Martin Laurent
Published: March 2024

La France est l’un des premiers pays au monde à avoir fait de sa culture un moyen d’affirmer et de consolider sa place sur la scène internationale. Cet usage a obéi à des logiques quelque peu différentes au cours du temps, passant du « rayonnement » à l’« influence » et au soft power, même s’il y eut en réalité moins substitution que sédimentation des différents objectifs et missions, à l’image de l’histoire des politiques culturelles. Il convient donc de rappeler les origines de cette diplomatie culturelle à la française, d’en analyser la doctrine et d’en présenter les moyens et les acteurs si l’on veut dessiner un bilan provisoire de cette action multiforme .
Vue des États-Unis : la France en quête d’un nouveau moment d’équilibre
Authors: Nord Philip
Published: March 2024

La France de 2023 n’a plus grand-chose à voir avec ce qu’elle était dans les années 1970. La vie politique, la société, l’économie, l’environnement européen et stratégique de l’Hexagone ont connu de profonds bouleversements qui donnent l’impression qu’à l’équilibre qui semblait régner il y a cinquant ans a succédé une période de tensions et de recompositions permanentes. Pourtant, quelques invariants existent également, qui permettent à un historien américain, observateur de longue date de la France et des Français, d’analyser le moment actuel .
La France vue d’outre-Rhin : un regard inquiet
Authors: Stark Hans
Published: March 2024

La France étant, avec les États-Unis, le principal partenaire de l’Allemagne, l’évolution de sa situation y est suivie avec une grande attention. Concernant la politique économique française, l’Allemagne juge positivement les développements récents mais craint que la volonté de réforme ne s’essouffle et que les problèmes structurels ne s’aggravent. Sur le plan de la politique intérieure, la France apparaît affaiblie depuis les élections de 2022, et la perspective d’une arrivée au pouvoir du Rassemblement national en 2027 l’inquiète profondément. En matière de politique étrangère, l’Allemagne agit généralement de manière beaucoup plus prudente que la France. Paris pourrait toutefois avoir raison quand il insiste sur la nécessité pour l’Europe d’assurer sa propre sécurité et de s’affirmer sur le plan international .
La France et la Francophonie : une dynamique complexe
Authors: Desouches Christine
Published: March 2024

Entre la France et la Francophonie, la relation a toujours été complexe. L’investissement, qui ne s’est jamais démenti en dépit de turbulences initiales, a pourtant été sujet, sur les priorités et les formes à lui accorder, à des inflexions, voire à des oscillations non négligeables selon les époques, les contextes, les milieux et selon la vision des hauts responsables concernés. Plutôt qu’une stratégie nationale intégrée constante, ce sont donc des politiques successives entre volet interne et volet international qui ont la plupart du temps prévalu .
La France et la construction européenne (1951-1992)
Authors: Warlouzet Laurent
Published: March 2024

La France a été l’un des acteurs majeurs du processus de construction européenne, qu’elle a soutenu malgré ses profondes divisions internes entre les partisans d’une Europe fédérale, d’une Europe interétatique ou du repli national. Les Français jettent les bases de l’Europe communautaire avec la déclaration Schuman de 1950, puis influencent considérablement le traité de Rome de 1957, qui reste au fondement de l’Union européenne actuelle, en offrant un compromis autour d’une ambition de promotion de la paix, de la prospérité et de lutte contre le déclin .
Le Brésil et la Chine face au défi majeur des inégalités
Authors: Gaulard Mylène
Published: March 2024

Dans les années 1990, l’effondrement du bloc communiste puis l’ouverture au monde de la Chine et de l’Inde et l’émergence de nombreux pays du Sud ont élargi l’économie capitaliste à la quasi-totalité de la planète. Mais il est vite apparu que la nouvelle dynamique qui se mettait en place à l’échelle mondiale entraînait, au sein de ces puissances émergentes, un certain nombre de déséquilibres, et notamment un creusement des inégalités. La Chine et le Brésil figurent désormais au nombre des pays les plus inégalitaires au monde, ce qui constitue pour eux un risque aussi bien social que politique .
L’inégalité entre les sexes : la première des inégalités
Authors: Lachenal Perrine
Published: March 2024

La question de l’inégalité entre les sexes transcende presque tous les domaines de la vie humaine, tels que la santé, l’éducation, l’emploi, la migration, le patrimoine, le sport ou la vie politique. Cette inégalité, profondément enracinée, structure les sociétés et semble, d’une certaine manière, organiser le monde. Il convient toutefois de souligner que les discriminations actuelles ne sont pas inévitables mais plutôt le résultat d’une absence de volonté politique. Malgré l’immensité des défis, des solutions existent pour préserver et accroître les droits des femmes, et faire de leur respect une priorité collective .
Des inégalités de santé qui perdurent
Authors: Chasles Virginie
Published: March 2024

À l’échelle mondiale, les dernières décennies ont été marquées par une amélioration constante des indicateurs de santé. Partout dans le monde, l’espérance de vie s’est, en effet, considérablement accrue. Mais les progrès accomplis restent fragiles et soumis à l’évolution des conditions de vie. C’est ce que révèlent le creusement des inégalités de santé aux échelles nationales, ainsi que la dégradation de la santé en contexte de crise .
La Chine dans le Golfe : un nouvel hégémon ?
Authors: Chaker Rachid
Published: March 2024

Le 10 mars 2023, l’Arabie saoudite et l’Iran ont signé un accord visant à rétablir leurs relations diplomatiques rompues depuis janvier 2016 et les violences commises à Téhéran par des manifestants à l’encontre de la représentation diplomatique saoudienne. Cet accord, négocié sous les auspices de la Chine qui enregistre là un premier grand succès diplomatique au Moyen-Orient, témoigne d’une volonté d’apaisement entre les deux puissances dominantes dans le golfe Persique et du changement intervenu à Washington avec la présidence Biden .
Zip-up Loop Myopexy in Heavy Eye Syndrome
Authors: Awadein Ahmed , Farag Christina S. , Maher Sara
Published: March 2024

Purpose:

To describe and report the results of a zip-up modification for loop myopexy for facilitating a muscle union procedure in heavy eye syndrome.

Methods:

A retrospective chart review was conducted on patients with heavy eye syndrome in whom the modified surgical technique was performed. Superior and lateral rectus muscle bellies were approximated using a suture 4 to 5 mm from the muscle insertion. Muscles were then zipped together by 5-0 polyester sutures placed in an anteroposterior direction using a hand-over-hand technique. Details of the surgical technique were reported. Ductions, versions, and angles of strabismus were evaluated before and after surgery. Complications were reported.

Results:

A total of 8 patients were identified (mean age: 60.8 ± 7 years). Mean axial length was 33.2 ± 1.2 mm. Mean preoperative horizontal and vertical angles of deviation were 78 ± 20 prism diopters (PD) (range: 50 to 120 PD) and 34 ± 4 PD (range: 30 to 40 PD), respectively. Preoperative limitation of abduction and elevation was −4 to −5 in all patients. An average of seven to eight sutures were used. No intraoperative complications were reported. In 7 patients, both vertical and horizontal angles of deviation were reduced to within 8 PD from orthophoria and limitation of ductions was reduced to null or −1 after surgery. Undercorrection occurred in 1 patient with bilateral heavy eye syndrome who had unilateral surgery. No recurrences developed over a median of 6 months of follow-up.

Conclusions:

A zip-up modification for loop myopexy can facilitate the surgical procedure to achieve a satisfactory outcome in heavy eye syndrome.

[
J Pediatr Ophthalmol Strabismus
. 2024;61(4):279–286.]
An abelian way approach to study random extended intervals and their ARMA processes
Authors: KAMDEM Babel Raïssa GUEMDJO , KAMDEM Jules SADEFO , OGOUYANDJOU Carlos
Published: March 2024

An extended interval is a range $ A = [\underline{A}, \overline{A}] $ where $ \underline{A} $ may be bigger than $ \overline{A} $. This is not really natural, but is what has been used as the definition of an extended interval so far. In the present work we introduce a new, natural, and very intuitive way to see an extended interval. From now on, an extended interval is a subset of the Cartesian product $ {\mathbb R}\times {\mathbb Z}_2 $, where $ {\mathbb Z}_2 = \{0, 1\} $ is the set of directions; the direction $ 0 $ is for increasing intervals, and the direction $ 1 $ for decreasing ones. For instance, $ [3, 6]\times\{1\} $ is the decreasing version of $ [6, 3] $. Thereafter, we introduce on the set of extended intervals a family of metrics $ d_\gamma $, depending on a function $ \gamma(t) $, and show that there exists a unique metric $ d_\gamma $ for which $ \gamma(t)dt $ is what we have called an "adapted measure". This unique metric has very good properties, is simple to compute, and has been implemented in the software $ R $. Furthermore, we use this metric to {define variability for random extended intervals. We further study extended interval-valued ARMA} time series and prove the Wold decomposition theorem for stationary extended interval-valued times series.
Investigation of SEIR model with vaccinated effects using sustainable fractional approach for low immune individuals
Authors: Alsaud Huda , Kulachi Muhammad Owais , Ahmad Aqeel , Inc Mustafa , Taimoor Muhammad
Published: March 2024

Mathematical formulations are crucial in understanding the dynamics of disease spread within a community. The objective of this research is to investigate the SEIR model of SARS-COVID-19 (C-19) with the inclusion of vaccinated effects for low immune individuals. A mathematical model is developed by incorporating vaccination individuals based on a proposed hypothesis. The fractal-fractional operator (FFO) is then used to convert this model into a fractional order. The newly developed SEVIR system is examined in both a qualitative and quantitative manner to determine its stable state. The boundedness and uniqueness of the model are examined to ensure reliable findings, which are essential properties of epidemic models. The global derivative is demonstrated to verify the positivity with linear growth and Lipschitz conditions for the rate of effects in each sub-compartment. The system is investigated for global stability using Lyapunov first derivative functions to assess the overall impact of vaccination. In fractal-fractional operators, fractal represents the dimensions of the spread of the disease, and fractional represents the fractional ordered derivative operator. We use combine operators to see real behavior of spread as well as control of COVID-19 with different dimensions and continuous monitoring. Simulations are conducted to observe the symptomatic and asymptomatic effects of the corona virus disease with vaccinated measures for low immune individuals, providing insights into the actual behavior of the disease control under vaccination effects. Such investigations are valuable for understanding the spread of the virus and developing effective control strategies based on justified outcomes.
Platforming the past: Nostalgia, video games, and A Hat in Time
Authors: Griffin Matt , Loring-Albright Greg
Published: March 2024

Research on nostalgia has shown how media texts can promote ideological visions of the past. The 2017 3D platformer video game A Hat in Time (AHIT) is a case study in this nostalgic construction of values in a contemporary, postmodern, convergence-culture context. The game's marketing and text discursively and materially construct AHIT as a continuation of video games from the 1990s and early 2000s in a way that creates a communal nostalgia. Fans have also used the game itself as a platform by creating a library of more than five thousand modifications, or mods, many of which are based on 1990s and 2000s texts; these mods allow the game to serve as a platform for postmodern remixes of nostalgic texts. AHIT shows how contemporary convergence culture and media platforms allow for communal, customizable nostalgia.
The fading of the elves: Techno-volunteerism and the disappearance of Tolkien fan fiction archives
Authors: Walls-Thumma Dawn
Published: March 2024

The online Tolkien fandom has historically supported dozens of fan-run community fan fiction archives, but recent years have seen a sudden loss of most of those remaining. While platform preferences account for some loss, eroding technology and the invisibility of archivists' and developers' work are areas that can be addressed to preserve existing fan cultures.
Discord as a fandom platform: Locating a new playground
Authors: Wagenaar Welmoed Fenna
Published: March 2024

The VoIP and instant messaging platform Discord has seen immense user growth over the past few years, including among fans involved with transformative works. Analyzing Discord from a framework of polymedia and play provides new insights into what Discord affords these fans and how they navigate the platform as part of their fan practices. It shows how the platform has been adopted and adapted in ways that facilitate fan play and allow for play moods to be created, strengthened, or maintained. Discord provides a suitable playground for fans, because it allows fans to negotiate closed online spaces where they can play freely, without outside disruption. These spaces can be organized in ways that distinguish between play and nonplay and maintain fannish principles of warning and consent. In addition, Discord provides an extra dimension to the experience of taking part in fan fiction exchanges, creating a compelling, collective mood in servers that people can continually come back to. Positioning this within a broader network of platforms and affordances that fans navigate shows how Discord fulfills particular needs and niches, especially with regard to Not Safe For Work material. More generally, this study provides a framework for understanding the reciprocal and dynamic relationships between users, affordances, rules, and structures in contemporary platform society.
Shear strength and microstructural investigation on high-volume fly ash self-compacting concrete containing recycled concrete aggregates and coal bottom ash
Authors: Meena A. , Singh N. , Singh S. P.
Published: March 2024

This article presents the experimental outcomes of the shear strength and microstructural characteristics of high-volume fly ash self-compacting concrete (HVFYA-SCC) containing recycled concrete aggregates and coal bottom ash as partial replacements for natural coarse aggregates and natural fine aggregates. A total of ten numbers of mixes were produced, including HVFYA-SCC made without recycled concrete aggregates and coal bottom ash (as control) along with HVFYA-SCC mixes made with recycled concrete aggregates (from 25% to 50%) and coal bottom ash (from 10% to 30%). The compressive and shear strength of the HVFYA-SCC mixes were improved by 7% and 4%, respectively, with the incorporation of 20% coal bottom ash and 25% recycled concrete aggregates after 120 days of curing. On the other hand, scanning electron microscopic analysis revealed that incorporating coal bottom ash exhibited the pozzolanic reactions with fly ash densified the binder-aggregate matrix of the resulting HVFYA-SCC.
Qui a bâti Bruxelles ? Profil des artisans et entrepreneurs du secteur bruxellois de la construction vers 1865
Authors: Degraeve Matthijs
Published: March 2024

Vers 1865, Bruxelles était une ville en pleine mutation. De récentes études nous éclairent sur le rôle qu’ont joué divers acteurs dans le développement de la ville, tels que les pouvoirs publics et les propriétaires fonciers. Toutefois, nous en savons encore peu sur les artisans et les entrepreneurs du bâtiment qui ont physiquement façonné la ville. À l’aide des almanachs, registres des patentables, registres des électeurs et matrices cadastrales, cet article met en lumière le profil professionnel, sociodémographique et spatial de 2 445 entrepreneurs du secteur bruxellois de la construction vers 1865. Il s’en détache un groupe très hétérogène, actif dans toute la palette des métiers du bâtiment. Si quelques entrepreneurs fortunés étaient à la tête de grandes entreprises, l’organisation à forte main-d’œuvre et à petite échelle de la plupart des entreprises du bâtiment ouvrit également les portes de l’entrepreneuriat à un groupe considérable d’artisans relativement démunis, y compris des femmes et des migrants. Il en découla aussi une forte dispersion spatiale, permettant à ces entrepreneurs d’opérer sur les chantiers de leur quartier. Ces résultats contribuent à la connaissance historique de la formation du tissu urbain et du patrimoine bruxellois, de même qu’ils situent dans une perspective à long terme le besoin contemporain d’un ancrage local pour le secteur urbain de la construction.
Experiences, challenges, and solutions of physical educators in online teaching
Authors: Martin Jonar
Published: March 2024

The study aimed to determine the lived experiences of physical education teachers in online teaching during the pandemic. This study is qualitative in nature, utilizing phenomenological research design to identify the experiences of physical educators teaching online. The participants in the study consisted of four physical education teachers from two private schools, who are experienced in teaching PE in an online class environment. A semi-structured interview was conducted with an open-ended questionnaire. Transcribing, coding, and thematic analysis were used to analyze the data. From the analysis, themes emerged based on the experiences encountered by PE teachers in teaching online in terms of positive experiences, problems encountered, and solutions taken in dealing with problems or difficulties in online teaching. The findings of the study showed that PE teachers had expressed their lived experiences in teaching PE online, with benefits and problems encountered, as well as solutions and best teaching practices during the COVID-19 pandemic.
Identidade do professor de educação física: uma revisão narrativa da literatura
Authors: Correa Pábula Nataely Ferreira , Quinaud Ricardo Teixeira , Galvão Luciano Gonzaga , Carvalho Humberto Moreira
Published: March 2024

O estudo identitário por muito tempo vem ganhando novos paradigmas, gerando inclusive crises identitárias. O objetivo do estudo foi encontrar publicações desta temática em estudos brasileiros, com a pretensão de discutir o processo de (re)construção da identidade do Professor de Educação Física. Foi realizada uma revisão narrativa da literatura, para discutir junto as temáticas da Teoria conceituais da identidade, Contributos para a construção da identidade do professor, e a identidade do professor de Educação Física. Face aos achados, vale dizer que o cenário atual requer um debate mais reflexivo sobre o direcionamento e desenvolvimento da identidade profissional do professor de Educação Física. Em relação a literatura científica, ainda há muito a ser estudado, pois foi possível identificar algumas limitações nos estudos sobre identidade, como por exemplo, a falta de consenso sobre a definição e conceituação da identidade do professor de Educação Física, que podem dificultar a comparação e generalização de futuros resultados. Espera-se que pesquisadores e organizações públicas a privadas, se atentem aos cuidados necessários quanto à formação do docente, assim para qualquer desenvolvimento profissional, e que esses achados ganhem espaços nas discussões relacionadas a identidade profissional do professor de Educação Física.
As motivações da prática de atividade física durante a graduação de alunos de psicologia
Authors: De Andrade Ana Júlia Leal , Coutinho Ana Queren Olegário , Ribeiro Davi Barbosa , Brandão Giovanna Oliveira , Faiete Luara Boschi Paulinelli , Moraes Maria Júlia Garcia Teixeira , Reis Cassio Pinho dos
Published: March 2024

O trabalho em questão, tem como objetivo central apresentar uma pesquisa voltada às principais motivações relacionadas à prática de atividades físicas durante o período de graduação no curso de Psicologia na Universidade Federal de Mato Grosso do Sul (UFMS). Desse modo, o instrumento utilizado será um questionário realizado e formulado pelos alunos pesquisadores, assim, pretende-se analisar o principal interesse precursor da prática, sendo as opções: diversão, hobby, descontração, competência, autoestima, saúde física ou influência social, além do levantamento da frequência da atividade realizada. Além disso, como fator secundário, procura-se perceber as razões daqueles que não realizam nenhum tipo de atividade, tendo como questões de escolha: motivos financeiros, falta de tempo, escolha própria e falta de motivação por parte da universidade. O questionário irá aborda ainda se os entrevistados pretendem iniciar alguma prática futuramente. Com base nos resultados, será possível deduzir a importância da prática de atividades físicas e principalmente seus benefícios, que se enquadram na melhora inclusive do desempenho acadêmico, e associar tais questões com os motivos dos não- praticantes também.
A case of grade 3 squamous cell carcinoma successfully treated with methotrexate
Authors: Sarracco Giovanni , Rinaldi Fabio , Cusano Francesco
Published: March 2024

Cutaneous squamous cell carcinoma (cSCC) is a nonmelanoma skin cancer whose lesions mostly arise on lightexposed sites. Patients with compromised immunity, Fitzpatrick I or II skin phototype, and previous burn scars or radiations are more at risk of developing it. The treatment of choice for cSCC is surgery; however nonsurgical options are generally reserved for patients who refuse a very invasive treatment or cannot tolerate a surgical procedure. We report a case of cSCC successfully treated with intralesional methotrexate.
Mexicans’ Emotion Regulation Strategies and Relationship Satisfaction by Gender
Authors: Rivera-Aragón Sofía , Díaz-Loving Rolando , Claudia Claudia , Tonatiuh Villanueva-Orozco Gerardo Benjamín , Wolfgang Velasco-Matus Pedro , Cruz-Martínez Luz Maria , Romero-Palencia Angélica
Published: March 2024

Vater and Schröder-Abé (2015) found that suppressing expression can potentially interrupt couple communication, therefore producing negative interpersonal behavior and diminishing satisfaction in the relationship. Considering that emotional regulation and relationship satisfaction have shown cultural variations, the object of the study was to assess the relationship of these two constructs in 166 male and 231 female Mexican young adults. Sánchez-Aragón’s (2012) Emotional Regulation Strategies Scale, adapted for couples, and Córtes, Reyes, Díaz-Loving, Rivera-Aragón, and Monjaraz’s (1994) Relationship Satisfaction Inventory were administered to the sample. Negative and significant correlations were found between both expressive suppression strategies and relationship satisfaction. Data is discussed in terms of the Mexican culture and in terms of gender differences, emphasizing the importance of acquiring skills and abilities to regulate emotions in close relationships. Emotion regulation becomes essential as it fulfills an important social function: it encourages the use of adequate strategies that allow couples’ better communication skills, better interpersonal resources and the possibility of solving and/or managing any conflict that may arise in a relationship. Therefore, the use of proper emotion regulation strategies becomes essential in promoting relationship satisfaction, diminishing the odds of deteriorated relationships, and promoting well-being and quality of the relationship.
Mutual Perception and Relational Strategies of Hindus and Muslims in India
Authors: Bano Shabana , Mishra R. , Tripathi C.
Published: March 2024

The present study examines mutual perception and relational strategies of the Hindu and Muslim groups in the cultural context of India by focusing on religion-based “othering.” A sample of 264 participants belonging to Hindu and Muslim groups was studied in Varanasi City. An instrument developed and used in an international project was adapted and given to participants (age range 20–60 years) for measuring their relational strategies, mutual perceptions and perceived discriminations. The findings revealed the ‘Coexistence’ relational strategy to be strongly placed in both Muslim and Hindu participants. Both ‘Integration’ and ‘Assimilation’ strategies were stronger in Muslim participants than in Hindu participants. Hindus preferred the ‘Separation’ strategy, perceived greater discrimination and held less positive views of Muslims. The findings are discussed along with their implications for dealing with the problem of Hindu-Muslim relationships in India.
Adult Onset Orbital Xanthogranuloma, a Variant of Adult Orbital Xanthogranulomatous Disease: An Infrequent Entity
Authors: Lakavarapukota Satyanka , Gopal K V T , Karri Sudhir Babu , Bulla Rekha Rani
Published: March 2024

Adult orbital xanthogranulomatous diseases (AOXGD) present clinically with symmetrical swellings around the eyes and are collectively considered within the broader group of non-Langerhans cell histiocytosis. A 45-year-old female presented with asymptomatic progressive, skin-colored, thick raised lesions around the eyes of 1 year duration. On dermatological examination, large indurated, lobulated, skin-colored thick plaques were seen bilaterally over infraorbital areas, along with a few hard, discrete nodules over the left infraorbital area. Histopathology showed pan-dermal infiltration with foamy histiocytes, non-lipidized histiocytes, a few multinucleate giant cells, lymphocytes, and a few plasma cells, with immunohistochemistry showing CD68 and S100 positivity. Laboratory and imaging studies did not show any abnormality. Based on the above findings and the absence of internal organ involvement, the patient was diagnosed with adult-onset orbital xanthogranuloma (AOX). The patient was treated with three monthly sessions of intralesional corticosteroid injections, along with methotrexate 12.5 mg per week for 8 weeks, resulting in a moderate reduction in the size of the plaques. The patient is under regular follow-up. The present case highlights the rare case of AOX and the importance of prompt recognition and evaluation in view of its potential hematological and systemic associations.
A Real-World Study of Steroid-Free Monotherapy with Tofacitinib in Severe and Therapy-Recalcitrant Alopecia Areata, Alopecia Totalis, and Alopecia Universalis Cases: A Retrospective Analysis
Authors: Sharath Savitha , Sardana Kabir , Khurana Ananta
Published: March 2024

Background:

Alopecia areata (AA) presents with noncicatricial alopecia and has multifactorial etiology. Janus Kinase inhibitors (JAKibs) with potential efficacy and favorable side-effect profile are the first class of drugs to receive FDA approval in AA.

Objectives:

Our primary objective was to assess the complete response rates to tofacitinib monotherapy in severe and recalcitrant AA, alopecia totalis (AT), and alopecia universalis (AU) patients using the latest percentage change in Severity of alopecia tool (SALT) score. We also aimed to analyze the various systemic agents used by these patients prior to the use of tofacitinib.

Materials and Methods:

Institutional records of 17 patients with severe or refractory AA, AT, and AU treated with tofacitinib monotherapy were analyzed, retrospectively. The response to tofacitinib therapy was determined after calculating percentage change in SALT score. End of treatment was defined as the dose which resulted in a significant response (complete/near complete response was ≥75% hair regrowth from baseline as determined by SALT score).

Results:

Majority of patients had severe AA (SALT ≥ 50) (n = 9/17, 52.94%), while five patients had AT and three had AU. All patients had received either systemic glucocorticoids (GCS), which included oral mini pulse (OMP) (n = 8), intravenous pulse steroids (n = 4), and daily oral GCS (n = 6) or immunosuppressive agents (ISAs) which included cyclosporine (n = 14) followed by methotrexate (n = 6) and azathioprine (n = 6). Mean SALT score prior to starting tofacitinib was 74.23. Mean dose of tofacitinib used was 13.23 mg (10–15 mg) and mean duration of treatment was 9.23 months. Latest percentage change of SALT score ranged from 70.58% to 100%, with an average of 91.47%. Most patients showed complete/near complete response (13/17, 76.47%).

Conclusion:

Tofacitinib was found to be safe and effective in severe/refractory AA, AU, and AT patients recalcitrant to other treatment modalities in our study. Further studies are needed to assess the effect of these targeted drugs on JAK-STAT expression or tissue cytokines involved in the pathogenesis of AA using immunohistochemistry.
Extralymphatic Filariasis
Authors: Srinivasan Padmapriya , Ray Rahul , Jandhyala Sridhar , Agarwal Reetu
Published: March 2024

Filariasis caused by nematodes affects the structure and function of lymphatic vessels. Lymphedema due to lymphatic blockage and lymphadenitis is the usual mode of presentation of filariasis. However, rarely extralymphatic filariasis has been reported in uncommon sites, including skin and soft tissue. Wuchereria (W.) bancrofti is the most common nematode causing extralymphatic filariasis. We report a rare case of a 25-year-old man with live extralymphatic filarial infestation presenting as a facial subcutaneous soft-tissue swelling confirmed by ultrasonography (USG), which revealed the filarial dance sign. Filariasis can present in many different ways and pose a significant dilemma for the clinician. It is essential to be aware of atypical presentations of filariasis for prompt diagnosis and further treatment.
A Study of Community-Acquired Pyodermas with Special Reference to Panton–Valentine Leukocidin (PVL)-Positive Methicillin-Resistant Staphylococcus Aureus
Authors: Kamath Prashanth R. , Imthiaz Niha F. , Razak Ashmiya A. , Pai Vidya , Shenoy Manjunath M.
Published: March 2024

Background:

Community-acquired (CA) pyodermas are one of the most common infections encountered in the dermatology outpatient clinics. A significant number of these conditions are caused by Staphylococcus aureus. CA-methicillin-sensitive Staphylococcus aureus (MSSA) and CA-methicillin-resistant Staphylococcus aureus (MRSA) have specific virulence genes which are associated with these diseases, particularly the Panton–Valentine leukocidin (PVL) genes. The presence of the PVL gene as a virulence factor may be associated with recurrent and severe skin infections.

Materials and Methods:

A prospective study was conducted with 205 cases of CA pyodermas, of which five were discarded due to mixed isolates. Clinical details were taken and wound exudate was sent for bacteriological examination. Further, the molecular study was performed on all MRSA (7) isolates and 13 randomly selected MSSA isolates using polymerase chain reaction for mecA and PVL genes.

Results:

Staphylococcus aureus was the most common organism (90%) isolated from primary or secondary CA pyodermas. The prevalence of CA-MRSA among all pyodermas was 3.5% in our community. The PVL gene was not detected in all tested CA-MRSA and CA-MSSA isolates.

Conclusion:

While pyodermas are common, the prevalence of MRSA is low in the CA pyodermas in our region. PVL does not appear to be a virulence factor among the isolated MRSA. Larger, multicentric, and periodic studies are, however, required to further justify these claims.
Syphilis: Is it Back with a Bang?
Authors: Kamat Shruti , Vaghasia Aditi , Dharmender J , Kansara Kajal G. , Shah Bela J.
Published: March 2024

Background:

Syphilis was brought under control with the advent of penicillin. However, in recent times, a rise in the incidence of syphilis has been reported by Centers for Disease Control and Prevention (CDC).

Aim:

To study the clinical and epidemiological profile of patients with syphilis attending sexually transmitted infection (STI) clinic at tertiary care center.

Materials and Methods:

Observational, cross-sectional analysis of sociodemographic, clinical, and investigational data of all syphilis patients visiting STI clinic from August 2019 to July 2021 was done and analyzed.

Results:

Out of 1330 STI patients that attended the clinic, 15.04% (n = 200) were diagnosed with syphilis, among them 72% (n = 144) were males, and 28% (n = 56) were females, with male-to-female ratio of 2.5:1. Of these 24.5% (n = 49) had primary, 44.5% (n = 89) had secondary, 30.5% (n = 61) had latent, and 0.50% (n = 1) had congenital syphilis. Among secondary syphilis patients, rash was the most common presentation seen in 43 patients, followed by condyloma lata in 30, palmoplantar syphilis in 17, oral mucous patch in 3, and iridocyclitis in 3 patients. Human immunodeficiency virus (HIV) was positive in 16.5% (n = 33). Herpes genitalis was the most common coinfection among 25 patients who were diagnosed with mixed venereal disease. RPR titer was positive in all 200 patients, with 1:16 titer being most common.

Conclusion:

India is experiencing a new trend in the prevalence of syphilis, mainly due to the changes in risk behavior, misconceptions, and social stigma associated with STIs, improved laboratory diagnosis, and increased public awareness. Particularly secondary and latent stages have shown a rising trend over the past few years. Awareness about safe sexual practices and contraception is very important to control the current resurgence.
Evaluation of Efficacy and Safety of Empagliflozin in Bangladeshi Patients with Type 2 Diabetes Mellitus (EFFISAEM Study)
Authors: Saifuddin Mohammad , Paul Ajit K. , Shefin Sultana M. , Alam Md. Jahangir , Selim Shahjada , Islam Sunjida , Hossain Tanjina , Tuqan Sadiqa , Sultana Nusrat , Mustari Marufa , Basak Ramen C. , Aftab Kazi A. , Prasad Indrajit , Uddin Mohammad R. , Sharker Shoma , Gaffar Md. Abu Jar , Rahman Mohammad M. , Hannan Mohammad A. , Ahammed Afsar , Kamrul-Hasan ABM
Published: March 2024

Background:

Empagliflozin is a relatively newer glucose-lowering drug (GLD) with many extra-glycemic benefits. To date, no study has evaluated the efficacy and safety of empagliflozin in Bangladeshi patients with type 2 diabetes mellitus (T2DM).

Objectives:

To assess the efficacy and safety of empagliflozin as an add-on to ongoing GLDs in Bangladeshi adults with uncontrolled T2DM.

Materials and Methods:

This real-world, multicenter, open-label, prospective study was carried out at 21 sites throughout Bangladesh from 1 February 2022 to 31 July 2022. Patients with T2DM who met the criteria had Empagliflozin added to their existing GLD treatment, with necessary modifications to their ongoing medication regimen. The efficacy and safety data were collected 12 weeks after empagliflozin initiation.

Results:

Out of 1449 subjects initiating empagliflozin, 1340 subjects [age 50.3 ± 9.0 years, male 52.5%, overweight/obese 94.4%, insulin-treated 25.7%, baseline hemoglobin A1c (Hba1c) 9.9 ± 1.4%] completed the study. At 12 weeks, the reduction in HbA1c was 1.6% (95% CI 1.5-1.6, P < 0.001); 12.5% of the study subjects achieved HbA1c < 7%. There were also significant (P < 0.001 in all instances) reductions in fasting plasma glucose (3.0 mmol/L), plasma glucose 2 hours after breakfast (4.8 mmoL/L), body weight (1.9 kg), body mass index (0.8 kg/m2), systolic blood pressure (BP) (10 mmHg), diastolic BP (7 mmHg), insulin dose (3 U), serum creatinine (0.06 mg/dL), total cholesterol (18 mg/dL), low-density lipoprotein cholesterol (13 mg/dL), high-density lipoprotein cholesterol (1 mg/dL), and triglyceride (42 mg/dL) and an increase in estimated glomerular filtration rate (4.2 mL/min/1.73 m2) from the baseline values. 6.62% experienced adverse events (lightheadedness 2.21%, genital tract infection 0.97%, urinary tract infection 1.24%, generalized weakness 0.48%, and nocturia 0.48%). 1.1% of subjects experienced hypoglycemia, and other 0.12% reported severe hypoglycemic events.

Conclusion:

Empagliflozin is effective, safe, and tolerable for treating Bangladeshi patients with uncontrolled T2DM as add-on therapy in routine clinical practice with favorable effects on body weight, BP, lipid profile, and renal function.
Ayurvedic management of Dome-shaped maculopathy: A case report
Authors: Sharma Shikha , Tripathi Ankur , Bavalatti Narayan , Rajagopala Manjusha
Published: March 2024

Dome-Shaped Maculopathy (DSM) is a rare condition characterized by the anterior convex elevation of the macula toward the vitreous cavity. Due to a lack of available data about DSM, the exact cause is not known. In Ayurveda, analysis of DSM can be done on the basis of the predominance of aggravated Dosha (~regulatory functional factors of the body) and their specific Gunas (~properties). This condition can be taken as a result of the vitiation of all three Doshas with the dominancy of Vata. Timira (~one of the diseases causing visual disturbance) is one of the Drishtigata roga (~ eyesight disorders). A 31-year-old female presented to the Shalakya tantra outpatient department with blurred vision in her left eye and headache that had persisted for four years. On the basis of the optical coherence tomography, she was diagnosed with DSM along with subretinal fluid. Ama pachana (~enhancing digestion), Vatanulomana (~pacification of obstructed Vata), Tridosha shamaka (~reducing alleviated regulating functional factors), Rasayana (~rejuvenation therapy), and Shothahara chikitsa (~anti-inflammatory) were adopted in the management that was focused in reducing the subretinal fluid and preventing further complications such as retinal detachment. In this case, subretinal fluid was decreased after Virechana karma, but the level of subretinal fluid was noticed again after Tarpana. The visual acuity was improved from 6/24 to 6/12 in the left eye and was maintained after one month of follow-up and the complaint of headache was also resolved. The patient in this case was nonmyopic with dome-shaped macula and subretinal fluid and with Ayurvedic intervention; the subretinal fluid was lessened, resulting in an improvement in visual acuity.
Ayurvedic management of Ankylosing Spondylitis (Kati prishtha trika graha): A case report
Authors: Bhatted Santosh Kumar , Sharma Priyanka
Published: March 2024

Ankylosing Spondylitis (AS) is a chronic systemic inflammatory disease affecting the axial (sacroiliac and spinal), girdle (hip and shoulder), peripheral joints, and the entheseal sites (such as heel, ankles, and patellar region). The condition manifests in chronic inflammatory back pain. As the disease progresses, patients develop a loss of flexibility due to spinal fusion. Considering the clinical features, the condition can be correlated with Kati prishtha trika graha in Ayurveda. This study presents a case of a 28-year-old male, who started with gradually progressing low backache with spinal stiffness for the last ten years, kyphosis, and morning stiffness (>30 min). The patient was admitted to the hospital for management. Panchakarma (~five internal bio-cleansing therapies) procedures including Ruksha churna pinda swedana (~dry fomentation), Snehapana (~internal oleation), Virechana (~therapeutic purgation), Kala basti (~course of 16 therapeutic enemas), Snigdha churna pinda swedana (~bolus fomentation with oil), and Kati prishtha greeva basti (~therapeutic retention of oil over vertebral column) were adopted strategically along with Shamana chikitsa (~palliative management). The assessment was made using Bath AS Metrology Index, Bath AS Functional Index, and Bath AS Disease Activity Index. Encouraging results in the management of pain, stiffness, and spinal mobility were observed with the treatment, while no adversities were noticed during the treatment period.
16s metagenomic sequencing and analysis of plaque sample around dental implants using nanopore sequencing platform - A preliminary report
Authors: Prakash P. S. G. , Crena Jasmine , Singh Akanksha , Subramanian Sangeetha , Appukuttan Devapriya
Published: March 2024

Aim:

The aim of the study was to evaluate the peri-implant microbiome in relation to the dental implant status such as plaque status, peri-implant sulcus depth, and bleeding on probing.

Materials and Methods:

Peri-implant subgingival biofilm samples were collected from three patients who received laser micro-grooved implants 18 months back, with paper points, and analyzed using 16s metagenomic sequencing and analyzed using nanopore sequencing platform. The microbial profile analysis based on the DNA classification of the microbial samples was done using the Burrows–Wheeler transform and Ferragina-Manzini index and optimized for metagenomic classification. Pavian was used to estimate and explore the taxonomic content.

Results:

The study results suggest that the microbiome diversity and species abundance showed high proportions of Veillonella, Streptococcus, Selenomonas, Fusobacterium, which could be considered as preliminary data for three different patients, one being diabetic, the other a smoker, and healthy control.

Conclusions:

The diabetic patients had predominantly Streptococcus (10%), whereas the smokers had predominantly Veillonella (18%) and Streptococcus (14%). The peri-implant sulcus region of diabetics and smokers shows a predominance of Gram-negative bacteria.
Comparison of weight-based and pinna size method for ProSeal laryngeal mask airway size selection in children receiving general anesthesia: A randomized clinical study
Authors: Mishra Rajesh , Kaur Ranvinder , Suri Aditi , Yadav Rupesh , Wasnik Seema
Published: March 2024

Background and Aims:

Several methods are in use for LMA ProSeal™ size selection in pediatric patients. Weight-based method is most commonly used. Pinna size–based method is a promising new technique for accurate size selection.

Material and Methods:

A total of 146 children aged between 6 months and 12 years undergoing surgery under general surgery were included. They were randomized into either pinna-based group (group X) or weight-based group (group Y). Both groups were compared for accurate placement of ProSeal™ laryngeal mask airway (PLMA), ease of insertion, number of attempts needed, and peak airway pressures.

Results:

A Comparable number of patients had a Brimacombe score of 3 and above, indicating correct placement in both groups (P = 0.407). PLMA was easily inserted in 79.5% and 87.7% of patients of groups X and Y, respectively (P = 0.180). Insertion was found to be difficult in 20.5% of patients in group X, whereas it was difficult in only 12.3% of patients of group Y (P = 0.180). The two groups were comparable as per the number of attempts needed for insertion (P = 0.161). Mean peak airway pressures too were comparable between both groups. Ease of insertion too, was statistically insignificant between both groups.

Conclusions:

Pinna size–based estimation of LMA size is an effective alternative method to weight-based selection.
The effect of adding dexmedetomidine or dexamethasone to bupivacaine–fentanyl mixture in spinal anesthesia for cesarean section
Authors: Ahmed Sameh Abdelkhalik , Lotfy Hashem Adel , Mostafa Tarek Abdel Hay
Published: March 2024

Background and Aims:

Many strategies are available to prevent spinal-induced hypotension in cesarean section, especially the use of a low dose of spinal anesthesia combined with adjuvants. This study investigated the effect of adding either dexmedetomidine or dexamethasone to the intrathecal bupivacaine–fentanyl mixture on the postoperative analgesia duration, after elective cesarean section.

Material and Methods:

This prospective, randomized, double-blind study was conducted on 90 full-term parturients undergoing elective cesarean section, who were randomly distributed into three groups. They all received spinal anesthesia with the bupivacaine–fentanyl mixture (2.5 ml), in addition to 0.5 ml normal saline (control group), 5 μg dexmedetomidine dissolved in 0.5 ml normal saline (dexmedetomidine group), or 2 mg dexamethasone (dexamethasone group). The time to the first request of morphine rescue analgesia was recorded, in addition to the total dose of morphine consumed in the first 24 h after surgery, the postoperative numerical rating score (NRS), and maternal and fetal outcomes.

Results:

As compared to the control group and the dexamethasone group, the use of dexmedetomidine as an additive to the bupivacaine–fentanyl mixture significantly prolonged the time to the first request of rescue analgesia, decreased postoperative morphine consumption, and decreased the pain score 4 and 6 h after surgery. There was an insignificant difference between the control and dexamethasone groups.

Conclusion:

The use of dexmedetomidine as an additive to bupivacaine–fentanyl mixture in spinal anesthesia for cesarean section prolonged the postoperative analgesia and decreased the postoperative opioid consumption in comparison to the addition of dexamethasone or normal saline.