bluuebunny/crossref_metadata_2025 huggingface dataset:
Exploring Interactive Learning Environments Based on Augmented Reality Technology
Authors: Deng Weifeng , Wang Lin , Deng Xue
Published: June 2024

With the rapid advancement of digital technology, the application of augmented reality (AR) in the field of education has emerged as a focal point of research aimed at enhancing learning efficiency and experience through innovative interactive learning environments. This study focuses on the application of AR technology in education. The goal is to address key technical issues present in existing AR interactive learning environments to promote their widespread adoption in educational settings. An analysis of the current application of AR technology in education is conducted, focusing on its potential to enhance learners’ motivation and comprehension capabilities. However, a common shortfall in existing research methodologies has been identified, namely inadequate control over node consistency and deficient design of collaborative visualization components. These limitations restrict interaction and collaborative efficiency within AR learning environments. In response, a novel predictive algorithm for node consistency control is proposed, significantly enhancing real-time interaction and coherence among multiple learners through optimized information synchronization mechanisms. Furthermore, a set of collaborative visualization components is designed to be personalized according to learners’ behavioral and cognitive characteristics, thereby supporting more effective team-based learning. The outcomes of this study not only provide new theoretical and technical support for the design and implementation of AR interactive learning environments but also offer a fresh perspective on the future direction of educational technology.
Discursos contrahegemónicos y « significantes vacíos »: análisis de la influencia de los movimientos sociales poscrisis en las estrategias discursivas de Podemos en España
Authors: Beltran Laure
Published: June 2024

En s’appuyant sur les travaux d’Antonio Gramsci, les philosophes postmarxistes Ernesto Laclau et Chantal Mouffe considèrent que la lutte politique est une lutte pour imposer à une majorité une manière particulière de percevoir un espace social complexe grâce à l’élaboration d’un réseau de signifiants permettant de le structurer. Dans leurs théories, l’ordre hégémonique est celui qui parvient à diffuser ce cadre interprétatif. Cependant, selon eux, cette symbolisation du social est le résultat d’une relation entre signifiant et signifié établie de façon arbitraire et contingente. A partir de ce postulat, ils défendent la possibilité d’élaborer des projets contre‑hégémoniques en redéfinissant cette relation. Cet article propose tout d’abord d’illustrer ces théories à partir d’une analyse du cycle de mobilisation sociale espagnol qui s’est déroulé entre 2011 et 2014 en réponse à la gestion politique de la crise économique, en considérant que ces mouvements ont permis de resémantiser certains signifiants structurants diffusés par l’ordre hégémonique grâce à leurs discours mais aussi via des pratiques politiques renouvelées. Il s’agira ensuite d’étudier dans quelle mesure le parti Podemos, en souhaitant incarner ce projet contre-hégémonique, essaie de réinvestir dans ses discours ces signifiants tels qu’ils ont été redéfinis pour tenter d’imposer un nouveau « sens commun » depuis les institutions.
Topology Optimization of Motorbike Footsteps Using Finite Element Method
Authors: Karohika I Made Gatot , Prasetyo Januar Teguh , Parwata I Made , Antara I Nyoman Gde , Budiarsa I Nyoman
Published: June 2024

Footsteps are a foothold for motorbike riders and passengers; they also play a role in maintaining stability when driving. Footsteps must have a solid and lightweight material to support the load from the feet and body of the rider and passengers. In this study, the footstep with the material made from the waste drum brake shoe varied by reducing mass through the static structural simulation process and topology optimization process using Ansys Workbench to get optimal mass, total deformation, equivalent stress, maximum principal stress, and safety factor from each variation. The footstep geometry will be subjected to a load of 1000N and provided with the necessary support. Based on the data obtained during this study, the initial footstep geometry produces data in the form of total deformation (1.383 mm), equivalent stress (21.013 MPa), and safety factor (1.227). The 10% variation produces data in the form of total deformation (1.4368 mm), equivalent stress (20,564 MPa), ,and safety factor ( 1.2538). The 20% variation yields data in the form of total deformation (0.98037 mm), equivalent stress (18.111 MPa), maximum principal stress (18.41 MPa), and safety factor (yield strength: 1.4236,. At the same time, the 25% variation produces data in the form of total deformation (1.3058 mm), equivalent stress (22.27 MPa), and safety factor (1.1577).
Analytical Prediction of Crushing Thin-Walled Square Tube with Static Axial Loads Using Elliptical Holes as Crush Initiators
Authors: Wibowo Endarto Tri , Istiyanto Jos , Sumarsono Danardono Agus , Hidayat Dony
Published: June 2024

In the structure of passenger vehicles there are components that absorb the impact load, which components are commonly thin-walled square tube. The design of the impact energy absorber model can be carry-out by experiment, simulation, and analysis. In the design of this impact energy absorbing component, an elliptical hole was used as a crush initiator to reduce peak loads and set the start of the bending pattern. Analytical predictions were made to reduce costs and speed up time to obtain mean load and peak loads values from the same shape model. In this study, a thin-walled square tubes model is used with an elliptical hole that have ratio of horizontal axis and vertical axis is from 3:7 until 7:3. The result of this study showed that the prediction of the peak load and average load by analytical means has a good conformity with the simulation. Keywords: Impact energy absorber, analytical, square tube, elliptical hole.
Onychocryptosis: a retrospective study of clinical aspects, inflammation treatment and pain management using Ozoile as a hydrogel and cream formulation
Authors: Francavilla Vincenzo , Secolo Giuseppe , D'Armetta Marianna , Toscano Rosario , Campo Angelo , Catanzaro Valentina , Manno Marina , Secolo Innocenzo , Messina Giuseppe
Published: June 2024

Ingrown toenails account for roughly 20% of all foot problems in primary care. It is most common in young men, with nail care habits and footwear being major contributors. Onychocryptosis is typically caused by self-treatment attempts to cure the condition in its early stages. Its clinical features are frequently confused with other osseous and soft tissue abnormalities. The goal of this study was to provide perspectives on the management of pain and inflammation in Onychocryptosis using an Ozoile-based hydrogel formulation in a semi-occlusive bandage for 14 days, while incorporating natural pharmacological solutions into established protocols. The primary outcomes measured were pain reduction on NRS and stadiation according to the Al Kline Classification. The reduction was statistically significant, with a mean decrease in VAS score from 10 to 4 (p < 0.05), and Al Kline classification decreased by an average of 1.6 stages. 42% of patients recovered within the first 15 days of treatment, and 93% by the end of the scheduled treatment.
Risk analysis of critical control points of Staphylococcus aureus in layer farms and egg chicken distributors
Authors: Thaha Aminah Hajah , Malaka Ratmawati , Hatta Wahniyati , Maruddin Fatma
Published: June 2024

Microbiological criteria play a role in verifying the critical control points (CCP), which become part of the hazard analysis, and the CCP system that guarantees quality, considering possible danger points or stages in the food production chain. Studies about Staphylococcus aureus in chicken eggs more extensively discuss the path, source, and level of prevalence of contamination at the final distributor or consumer. Therefore, this study investigates CCP contamination of S. aureus in chicken eggs and their potential consumption, which could endanger human health from the layer farm until the final distributor. This study is critical in health, public health, and veterinary medicine for preventing and controlling consumers' security. This study done for CCP on the chain distribution of chicken eggs starts with preparing production and distribution process flow diagrams for livestock, agents/wholesalers, and retailers. Confirmation of operational production in the field/location study is based on the flow chart that has been arranged, identifying all potential dangers associated with each stage and analyzing potential risks considering every action for controlling identified hazards. The next step involves pinpointing the CCP to counteract the identified threat. An application tree decision defines the CCP, and the logical and final approach is the determination limit critical to the CCP. Analysis results in the determination of CCP contamination of S. aureus, indicating that chicken eggs, personal hands (farm workers, wholesalers, and retailers), shelf eggs, and feces are CCP on farms.
'Black October': the impact of the Spanish Influenza Epidemic of 1918 on South Africa from the Archives year book for South African history 53(1)
Authors: Webb Denver A.
Published: June 2024

No abstract available.
Unraveling belly dancer’s dyskinesia and other puzzling diagnostic contortions: A narrative literature review
Authors: Rissardo Jamir Pitton , Vora Nilofar Murtaza , Tariq Irra , Batra Vanshika , Caprara Ana Letícia Fornari
Published: June 2024

Belly dancer’s dyskinesia (BDD) is characterized by involuntary abdominal wall movements that are rhythmic, repetitive, and dyskinetic. The present study aims to review BDD’s etiology, pathophysiology, and management. We searched six databases to locate existing reports on BDD published from 1990 to October 2023 in electronic form. A total of 47 articles containing 59 cases were found. The majority of the patients affected by BDD were female, accounting for 61.01% (36/59) of the cases. The mean and median ages were 49.8 (standard deviation: 21.85) and 52 years (range: 7–85), respectively. The BDD was unilateral in only 3.38% (2/59). The most commonly reported causes associated with BDD were 17 idiopathic, 11 drug-induced, 11 postsurgical procedures, 5 pregnancies, and 4 Vitamin B12 deficiencies. BDD is a diagnosis of exclusion, and other more common pathologies with similar presentation should be ruled out initially. Differential diagnostic reasoning should include diaphragmatic myoclonus, cardiac conditions, truncal dystonia, abdominal motor seizures, propriospinal myoclonus, and functional or psychiatric disorders.
Effect of emotions on learning, memory, and disorders associated with the changes in expression levels: A narrative review
Authors: Johnson Jaivarsini
Published: June 2024

Emotions, in general, have no scientific definition. Emotions can be denoted as the mental state because of the neurophysiological changes. Emotions are related to mood, personality, temperament, and consciousness. People exhibit different emotions in different situations causing changes in cognitive functions. One of the major cognitive functions is the ability to learn, to store the acquired information in the parts of the brain such as the hippocampus, amygdala, cortex, and cerebellum. Learning and memory are affected by different types of emotions. Emotional responses such as fear, depression, and stress have impaired effects on cognitive functions such as learning and memory, whereas optimistic and happy emotions have positive effects on long-term memory. Certain disorders have greater effects on the regions of the brain which are also associated with synaptic plasticity and Learning and Memory(LM). Neuroimaging techniques are involved in studying the changing regions of the brain due to varied emotions and treatment strategies based on the changes observed. There are many drugs, and in advancements, nanotechnology is also utilized in the treatment of such psychiatric disorders. To improve mental health and physical health, emotional balance is most important, and effective care should be provided for people with less emotional quotient and different types of disorders to inhibit cognitive dysfunctions. In this review, emotions and their varied effects on a cognitive function named learning and memory, disorders associated with the defects of learning due to emotional instability, the areas of the brain that are in control of emotions, diagnosis, and treatment strategies for psychiatric disorders dependent on emotions are discussed.
Restoring brain health: Electroacupuncture at GB20 and LR3 for migraine mitigation through mitochondrial restoration
Authors: Luo Jianchang , Feng Liyao , Wang Luodan , Fang Zhenyu , Lang Jiawang , Lang Boxu
Published: June 2024

BACKGROUND:

Electroacupuncture (EA) is a promising alternative therapy for migraine, with mitochondrial dysfunction hypothesized as a pivotal mechanism in migraine pathophysiology. This research endeavors to investigate the therapeutic potential of EA in addressing migraines and shed light on the associated mechanisms linked to mitochondrial anomalies.

MATERIALS AND METHODS:

Migraine in rats was induced by 10 mg/kg nitroglycerin, followed by 2/15 Hz EA treatment at GB20 and LR3. Nociceptive behavior was recorded via a camera and analyzed using EthoVision XT 12.0 software. The hind-paw withdrawal threshold was assessed using the von Frey test. We assessed the levels of calcitonin gene-related peptide (CGRP), nitric oxide (NO), and endothelin (ET) – key parameters in migraine pathophysiology using immunohistochemistry and enzyme-linked immunosorbent assay. Mitochondrial morphology in brain tissues was observed through transmission electron microscopy. Reactive oxygen species (ROS) level in mitochondria was measured by flow cytometry. The levels of PINK1 and Parkin were assessed using Western blot analysis.

RESULTS:

EA at GB20 and LR3 decreased nociceptive behaviors (resting and grooming) and increased exploratory and locomotor behaviors in migraine rats. The hind-paw withdrawal threshold in migraine rats was significantly elevated following EA treatment. Post-EA treatment, levels of CGRP and NO decreased, while ET level increased, suggesting an alteration in pain and vascular physiology. Notably, EA treatment mitigated the mitochondrial damage and reduced ROS level in the brain tissues of migraine rats. EA treatment upregulated the expression of PINK1 and Parkin in migraine rats.

CONCLUSION:

EA at GB20 and LR3 may treat migraine by alleviating PINK1/Parkin-mediated mitochondrial dysfunction.
Perception of MBBS Students to the New Competency-based Medical Education Curriculum in a Tertiary Care Hospital in North East India
Authors: Thakuria Bhaskarjyoti , Bordoloi Purnima , Pathak Pradumna
Published: June 2024

Objectives:

The objective of the study was to assess the knowledge, experience, and perception of the students of our institute toward the newly implemented competency-based medical education (CBME) curriculum.

Materials and Methods:

A prospective, cross-sectional study was conducted among the Phase II Students of Fakhruddin Ali Ahmed Medical College and Hospital, Barpeta, Assam. A self-administered feedback questionnaire was used for the study after acquiring written informed consent from the students. The responses to the questions were based on the knowledge, attitudes, and perspectives of the students and were assessed on a 3-point Likert scale.

Results:

The questions were categorized under four broad headings. Under the first category, 49.3% were in assent as to their general awareness of the new curriculum and its structure and in agreement as to the changes proposed by it. In the second category, 55.7% were in agreement as to the beneficial effects of early clinical exposure and problem-based learning. 51.7% of the students in the next category were in agreement on the role of vertical and horizontal integration in the new curriculum in making them understand the topic better. Finally, 55.2% of Phase II students were in agreement on the importance of attitude, ethics, and communication and the role of assessment to improve the learning of the students.

Conclusion:

As we got positive responses from most of the students, we can conclude that CBME is the need of the hour. The few negative and equivocal responses indicate the challenges to be considered while implementing CBME.
Primary Radical Extended Sinus Surgery for Management of Extensive Allergic Fungal Rhinosinusitis
Authors: Sara Katti Blessi , Vediappan Rajan Sundaresan , Prabaakharan J. , Thomas Regi
Published: June 2024

Introduction:

Allergic fungal rhinosinusitis (AFRS), a subset of sinusitis secondary to hypersensitivity, is clinically similar to chronic rhinosinusitis with nasal polyp but histologically different with rich eosinophils and Charcot Leyden crystals. Since the primary pathology in AFRS is immune mediated, the recurrence rates are high. In this study, we describe the application of radical extended sinus surgery (RESS) as the surgical technique with the usage of postoperative high-volume steroidal nasal irrigation and short-term oral steroid therapy – a threefold strategy – for the prevention of recurrence of this disease.

Materials and Methods:

A retrospective surgical chart audit of patients diagnosed with AFRS and treated between January 2012 and December 2019 was done. The clinical findings and postoperative outcomes performed by a single senior surgeon in a tertiary referral institution were extracted and analyzed.

Results:

Of the 17 patients, 88% of patients were immunocompetent and Lund Mackay (LM) of 24, 16 patients had Grade 3 nasal polyps, except one with Grade 1 nasal polyps and an LM score of 8. All patients underwent RESS and received postoperative high-volume topical steroid irrigation with oral steroids in the immediate postoperative period and on follow-up, if recurrence was noted, none required revision surgery.

Conclusions:

A three-fold strategy is beneficial in the management of AFRS-RESS followed by oral steroids during the immediate postoperative period along with long-term topical high-volume steroid nasal irrigation.
Strategies for Preventing and Addressing Missing Data in Research
Authors: Chaudhuri Sirshendu , Agiwal Varun
Published: June 2024

This article addresses the pervasive issue of missing data in biomedical research and the potential solutions to prevent it. The focus is on proactive strategies for prevention at various stages of the research process. Advocating for a comprehensive study design, clear communication through information sheets during consent, and the use of well-designed data collection tools are key to preventing missing data issues in health research. In addition, the training and supervision for data collectors, especially in the context of potential biases arising from sensitive questions, are critical. Electronic data collection has the advantages of validation and checks to prevent missing data. Hence, adequate planning is a must to reduce missing values and improve the validity of the study outcome.
The Real-world Experiences of Abemaciclib for Estrogen Receptor-positive Human Epidermal Growth Factor Receptor-negative-2 Metastatic Breast Cancer – Sharing from a Single Institute in Southern Taiwan
Authors: Tsai Jui-Hung , Lee Kuo-Ting
Published: June 2024

Background:

CDK 4/6 inhibitor (CDK4/6i) is the first-line therapeutic drug to treat ER-positive (ER+) HER2-negative (HER2 -) metastatic breast cancer (MBC) now. We have three CDK4/6i: Palbociclib, Ribociclib, and Abemaciclib. In the long-term follow-up study, there are some different results among the three CDK4/6i. Some real-world reports demonstrated some patients would have clinical benefits from Abemaciclib in the ER+ HER2- metastatic BC patients who had priorly received the other CDK 4/6 inhibitor (Palbociclib). In Taiwan, Abemaciclib is the third available CDK 4/6 inhibitor behind the other two CDK4/6i. However, Abemaciclib was not reimbursed in ER+ HER2- MBC by Taiwan Health Insurance until now. Most doctors in Taiwan have the less therapeutic experiences for Abemaciclib. In this article, we would share the clinical experiences for the first thirteen patients who were prescribed with Abemaciclib to treat ER+ HER2- MBC.

Materials and Methods:

This chart review study was conducted from January 1, 2020, to May 31, 2023. We reviewed the medical charts at National Cheng Kung University Hospital (NCKUH) and identified 13 patients who had received abemaciclib treatment for ER+ HER2− MBC. The study was approved by the Institutional Review Board at NCKUH (approval number: B-ER-112-220). All of the 13 patients were treated with abemaciclib (150 mg twice daily initially), in combination with other anti-cancer medications. We recorded the clinical parameters, including sex, age, treatments in neoadjuvant/adjuvant setting, metastatic sites, other prior CDK4/6i therapy, treatment lines of abemaciclib in the metastatic setting, survival period before abemaciclib treatment, time to treatment failure for abemaciclib, causes of abemaciclib discontinuation, dose reduction, and adverse effects (AEs) related to abemaciclib.

Results:

Up to the cut-off date (May 31, 2023), four (4/13) patients were still receiving therapy and nine patients (9/13) had discontinued abemaciclib therapy. Five (5/9) patients discontinued abemaciclib due to disease progression (PD), and two (2/9) patients interrupted abemaciclib treatment due to personal reasons. Two (2/9) patients stopped abemaciclib early because of AEs, and one patient died due to PD. The time to treatment failure for abemaciclib ranged from 1 to 41 months (average: 19.2 months, median: 14 months). AEs were noted in 12 patients (no recording in one patient), of which diarrhea (10/12), anemia (4/12), and neutropenia (3/12) were the most common.

Conclusion:

According to our real-world data, Abemaciclib is effective and safe for the ER+ HER2- metastatic BC cancer patients who they were heavily treated.
Acute Abdominal Presentation of Enteropathy Intestinal T-cell Lymphoma: A Rare Case Report
Authors: Chio U-Chon , Wu Yi-Hung , Siow Tiing-Foong , Chen Kuo-Hsin
Published: June 2024

Intra-abdominal hollow organ perforation is a critical condition that requires immediate intervention. There are various causes of small bowel perforation, including benign diseases, iatrogenic procedures, and perforation associated with tumors. However, preoperative imaging alone is often insufficient to determine the underlying cause. In this report, we present a unique case involving a malignant neoplasm of the small intestine resulting in bowel perforation.
Changes in the Cutaneous Nerve Fiber Staining and Distribution of PGP9.5 in Clinically Uninvolved Skin in Leprosy Patients after Completion of Multidrug Therapy and Assessing PGP9.5 as a Marker of Treatment Response
Authors: Thakur Vishal , Narang Tarun , Bishnoi Anuradha , Dhawan Garima , Sharma Ankur , Saikia Uma Nahar , Razmi T Muhammad , Dogra Sunil , Handa Sanjeev , Modi Manish
Published: June 2024

Background:

Subclinical involvement of nerves may sometimes be present much before the overt clinical manifestations become apparent. Protein gene product (PGP) 9.5, a ubiquitin-C-terminal hydrolase, has been widely used as a marker to study the involvement of peripheral nerve fibers in many diseases.

Aim and Objectives:

To evaluate the change in cutaneous nerve fiber staining and distribution from pre-treatment and post completion of multidrug therapy through the expression of PGP9.5 and to assess PGP9.5 as a marker of treatment response.

Materials and Methods:

In this prospective single-center observational study, skin biopsy was taken in patients with leprosy, having areas of nerve function impairment (NFI), based on findings of nerve conduction studies (NCSs), but not having lesions or impaired tactile or thermal impairment clinically. The thin nerve fiber density in the clinically normal skin in areas supplied by nerve showing changes of sensory neuropathy was evaluated to study the density of the fibers. A second biopsy was taken at the end of treatment from a site near the previous site to assess the changes in intra-epidermal nerve fiber staining and distribution.

Results:

Thirty-three patients were recruited in the present study (24 males and 9 females). Pre-treatment, 27 patients had abnormal NCSs, while six patients did not have any evidence of neuropathy on NCSs. Staining for nerve fibers using PGP9.5; in the epidermis was positive in five patients pre-treatment and 11 patients post treatment (P = 0.181). Staining in the dermis revealed positivity in 14 pre-treatment, which increased to 18 post treatment (P = 0.342). Adnexae showed positivity in five patients pre-treatment and increased to 17 post treatment (P = 0.005).

Conclusion:

A reduced PGP9.5 staining in the epidermal, dermal, and adnexal regions was seen in leprosy patients, which improved post treatment. Thus, PGP9.5 may serve as a marker of NFI and treatment response.
A Verrucous Plaque Healing with Cribriform Scarring
Authors: Meena Akshay , Mehta Hitaishi , Chaterjee Debajyoti , De Dipankar
Published: June 2024

Lupus vulgaris manifests with diverse clinical presentations, although the typical pattern involves a plaque that extends at one end and heals at the other, leaving behind characteristic atrophic scarring. Cribriform scarring is classically described after the healing of ulcerative pyoderma gangrenosum. In this case report, we present a noteworthy instance of lupus vulgaris that exhibited healing accompanied by cribriform scarring.
Efficacy and Safety of Topical Tofacitinib for the Treatment of Alopecia Areata
Authors: Chikhalkar Siddhi B. , Prasanna Swati , Vishwanath Tejas
Published: June 2024

Background:

Alopecia areata (AA) is an autoimmune disease of the hair follicles. Although some cases resolve spontaneously, many patients require some form of treatment, including corticosteroids and vitamin D analogues, among others. Cytokine signaling in autoimmune disorders and their inhibition have been the prime objective in therapeutic research over the past few years. Janus kinase inhibitors such as tofacitinib have shown efficacy in the treatment of AA. The present study aimed to evaluate the efficacy of a novel formulation of topical tofacitinib compared to vehicle in patients with AA.

Materials and Methods:

A prospective, non-blinded, intrasubject vehicle-controlled study was conducted in patients with AA for a total duration of 6 months. A 2% tofacitinib citrate ointment was compounded in the pharmacy. Tofacitinib tablets (5 mg) were crushed and mixed in white soft paraffin to produce 2% ointment. A thin layer of this ointment was applied to the treatment patch, while the control patches received the application of the vehicle twice daily. Both patches in each patient were evaluated for percentage change in severity of alopecia tool [SALT] score after 24 weeks as the primary outcome. This was graded as excellent response (>50% improvement), intermediate response (25–50%), mild response (5–25%), and no response (<5% improvement). Trichoscopy and hair pull test were evaluated as secondary outcomes.

Results:

The present study included 30 patients with AA having a median age of 27 years. Among 30 patients, 40% achieved excellent response (>50% change in the SALT score) over six months of treatment. The mean SALT score was significantly reduced from baseline to six months of treatment (mean [95% CI]: 4.3 [1.9–6.3]; P = 0.001). The control patch had substantially higher positive results in the final hair pull test, indicating disease activity (Treatment: 10% vs. Control: 86.7%, P < 0.001). Compared to the control patch, the prevalence of upright hair (10.0% vs. 80.0%) and terminal hair (3.3% vs. 70.0%) were significantly higher in the treatment patch (P < 0.001). No serious adverse effects were reported during the study duration.

Limitations:

Sample size was small and the followup was not long enough to study the full effects of tofacitinib, as well as maintenance of remission or relapse after discontinuation.

Conclusion:

Topical tofacitinib proved to be an efficacious and well-tolerated treatment modality for AA with no adverse effects reported during this study.
Integrating precision medicine into medical education: What does it add?
Authors: Shrivastava Saurabh RamBihariLal , Bankar Maithili , Bobhate Prateek Sudhakar , Meshram Priyanka , Badge Ankit
Published: June 2024

As the branch of medicine continues to evolve, it is our utmost responsibility to stay abreast with the recent developments and incorporate the same while training medical students. Precision medicine is a novel approach to health-care delivery that acknowledges the role of patients’ genes, environments, and lifestyles regarding each person. The rationale for moving in this direction can be attributed to two major factors, namely, the advances reported in the domain of health care and science, and the limitations that have been linked with the conventional approach of one-size-fits-all, which is not appropriate in the health sector. Precision medicine inclusion in the medical curriculum is the need of the hour, as it is bound to influence the clinical decision-making process by medical doctors, which eventually will improve health-related outcomes. In conclusion, the integration of precision medicine into medical education is expected to change the face of health-care delivery from a global perspective. As medical education embraces this evidence-driven approach, we have started our journey to move toward a future where we will not be happy with just standardization of health-care services, rather we will ensure that it becomes customized to the unique needs and characteristics of individual patients.

The following core competencies are addressed in this article: Medical knowledge, Patient care, and Practice-based learning and improvement.
Teachers’ knowledge about communicable disease control at primary schools in Mosul City: A cross-sectional study
Authors: Ayed Alaa Yousif , Younis Nasir Muwfaq , Ahmed Mahmoud Mohammed
Published: June 2024

Introduction:

In emergency situations, particularly complicated ones including the collapse of health services and disease control programs, a major cause of mortality and morbidity is limited access to health care and communicable diseases. The aim of the study is to assess the primary school teachers’ knowledge of communicable illness control in Mosul City.

Materials and Methods:

A descriptive cross-sectional study design was employed, utilizing a purposeful sample of 149 teachers. The study was carried out at Mosul City primary schools in the first quarter of 2024. A survey was made specifically for this purpose. It was made up of two parts. The data were analyzed using SPSS version 26.

Results:

Findings of the current study showed that 7 (4.7%) teachers only had excellent knowledge of communicable disease prevention and control, while the majority of teachers, 105 (70.5%), had poor knowledge of these topics.

Conclusion:

The majority of elementary school teachers in Mosul City lack sufficient information on managing communicable diseases. The study advised the essential to work with the Ministry of Health and Environment to implement educational programs on communicable diseases and preventive measures to raise their level of awareness regarding the prevention and control of communicable illnesses.

The following core competencies are addressed in this article: Medical knowledge, Practice-based learning and improvement, Systems-based practice.
Aggressive central giant cell granuloma - A radiographic approach toward diagnosis
Authors: Nivedita Tayde , Dwivedy Shweta , Chandrashekhar Sulgante Pooja , Divekar Rohini
Published: June 2024

Central giant cell granuloma (CGCG) is a nonneoplastic proliferative lesion commonly occurring in the mandible but can also occur in the maxilla. The CGCG is divided into aggressive and nonaggressive subtypes. The aggressive type is rare and can be larger in size, rapidly growing, and has higher chances of recurrence. Here, we present a case of aggressive CGCG of the maxillary arch in a female patient with its appropriate investigation and management.

The following core competencies are addressed in this article: Medical knowledge, Patient care
Evaluation of the effects of different mouthwashes, acidic soft drinks, and herbal teas on shear bond strength of orthodontic stainless steel brackets: A stereomicroscopic study
Authors: Adika Sandeep , Venkata Kalyan Vikram , Raiyan Mohammed , Aafaque Syed , Dawood Tazeen , Sivanandam Muruganandam , Babu J. Suresh , Swarnalatha C. , Nayyar Abhishek Singh
Published: June 2024

Background:

Premature debonding of brackets often turns out into orthodontic treatment failures and actual treatment delays. The aim of the present study was to evaluate the effects of different mouthwashes, acidic soft drinks, and herbal teas on the shear bond strength of metal (stainless steel) brackets used in orthodontic practice.

Materials and methods:

For the present study, 100 therapeutically extracted healthy premolar teeth with sound enamel surface were collected from patients who were scheduled for orthodontic treatment. The select teeth were cleansed, whereas the dried enamel surface was etched with 38% phosphoric acid for 15 s following which orthodontic stainless steel brackets (MBT 0.022 SLOT) were bonded with the help of composite resin (3M Unitek Transbond XT Light Cure Adhesive). The prepared teeth were divided into four groups depending on exposure to different mouthwashes, acidic soft drinks, and herbal teas. The shear bond strength values of the specimen were measured using a universal testing machine, whereas debonded surfaces were observed under a stereomicroscope. Statistical analysis was done using the Statistical Package for the Social Sciences (SPSS) version 18.0 (SPSS Inc., Chicago, IL, USA). One-way analysis of variance and Tukey’s multiple post hoc procedures were used for statistical analysis. P <0.05 was considered statistically significant.

Results:

The results obtained in the present study suggested that the highest mean shear bond strength observed was in case of Group II specimen with a mean value of 11.83 ± 1.92 MPa, whereas the least shear bond strength was observed in case of Group III specimen with a mean value of 10.33 ± 1.31 MPa, with the results being statistically significant (P = 0.014).

Conclusions:

Within the limitations of the present study, it was concluded that comparatively lesser/weaker shear bond strength values were observed in case of specimen belonging to Group III, wherein among the 30 teeth belonging to Group III, 12 teeth showed shear bond strength value of 9 MPa which was the lowest in the study.

The following core competencies are addressed in this article: Practice-based learning and improvement, Patient care and procedural skills, Systems-based practice, Medical knowledge.
Abdominal Wall Reconstruction: Advances in the Last Decade
Authors: Sureshkumar Sathasivam , Sudharsanan Sundaramurthi , Vijayakumar Chellappa , Anandhi Amaranathan
Published: June 2024

The incidence of abdominal wall hernia (AWH) is increasing because of the aging population, obesity, and the increasing number of abdominal surgeries performed. Over the last decade, there have been many improvements with the introduction of novel techniques in the management of AWH. The development of component separation and bioprosthetic mesh has transformed the management of complex ventral hernias. An increased number of complex ventral hernia repairs are being done using minimally invasive methods, including component separation. With the introduction of three-dimensional laparoscopic technique and robotic platform, the technique of component separation for abdominal wall reconstruction (AWR) has become more reproducible. In the past decade, the prosthetic materials have greatly improved, including bioengineered smart scaffold tissues such as hydrogel and electrospun fibers that have shown promising results even in infected environment. Apart from advances in complex abdominal wall repair, patient-centric outcomes and the cost-effectiveness of hernia surgery also have gained focus in the management of AWH. Today, the field of hernia has become a discipline in itself due to a better understanding of the biomechanics and pathophysiology of AWHs. There has been a tremendous development in diverse surgical techniques for complex abdominal wall repair with huge advancements in the development of hernia implants transforming it from a simple hernia repair to the science of AWR. This review aims to summarize recent developments in the field of AWR, incorporating a brief overview of the management of AWH.
Occupational injuries and health-seeking behavior of informal sector waste collection workers in Nellore, India
Authors: Chinthapatla Sai Divya , Tiwari Rajnarayan Ramshankar
Published: June 2024

Introduction:

Waste collection workers are exposed to occupational injuries at every step in the process of waste collection and disposal, from the point of collection at homes, during transportation, and at the sites of recycling or disposal. This study was undertaken to assess the prevalence of injuries among municipal waste collection workers and their health-seeking behavior for the injuries.

Methods:

This cross-sectional study included 422 workers from randomly selected 20 wards in four zones of Nellore. The information regarding sociodemographic, occupational, and injury characteristics were collected using a pre-tested questionnaire by conducting a face-to-face interview with each of the study participants.

Results:

Two hundred and four (48.3%) workers suffered from injury in the past 12 months. A shorter duration of the job, a lack of safety training, and a lack of awareness about the risk of injury on the job were significantly associated with the occurrence of injuries. The health-seeking behavior was found to be poor, with only 40.7% of those who suffered injury and 30.6% of overall workers preferring to approach any health-care facility for the treatment of wounds.

Conclusion:

The informal sector waste collection workers are at risk of injuries while pursuing their occupation. The health seeking behavior was found to be poor among them.
Full Outline of Unresponsiveness Score versus Glasgow Coma Scale in Predicting Clinical Outcomes in Altered Mental Status
Authors: Pandey Savan , Sahu Ankit Kumar , Ekka Meera , Modi Priyanka , Aggarwal Praveen , Jamshed Nayer , Bhoi Sanjeev
Published: June 2024

Introduction:

Full outline of unresponsiveness (FOUR) score has advantages over Glasgow Coma Scale (GCS); as it can be used in intubated patients and provides greater neurological details. It has been studied mainly in the trauma and neuroscience setting. Our primary objective was to compare the FOUR versus GCS score as predictors of mortality at 30 days and poor functional outcome at 3 months among nontrauma patients in the emergency department (ED).

Methods:

This prospective observational study was conducted on adult patients presenting with altered mental status (duration <7 days) in the ED (March 2019–November 2020). Data collection included demographic and clinical features, the GCS and FOUR scores, the feasibility of acquiring and interpreting FOUR on a Likert scale, duration of hospital stay, 30-day mortality, and functional outcome at 3 months on the modified Rankin Scale. Trained emergency medicine residents managing the patient collected the data. The area under receiver’s operating characteristics curve (AUROC) was used to compare the accuracy of the GCS and FOUR scores in predicting outcomes. The FOUR score equivalent of GCS cutoffs for categorizing neurological impairment (mild, moderate, and severe) was also investigated.

Results:

Two hundred and ninety-one patients were included, with a mean age of 50.3 years and 67.4% males. Most patients (40.2%) had altered mental status for 1–3 days and hepatic encephalopathy was the most common ED diagnosis. The mortality at 30 days was 66.7% (194 of 291), and 88% (256 of 291) of patients had poor functional outcomes at 3 months. The AUROCs for predicting 30-day mortality were similar for both the scores (GCS: 0.70, FOUR: 0.71, and the P value for difference: 0.9). Similarly, the AUROCs for predicting 3-month poor functional outcome were 0.683 and 0.669 using GCS and FOUR, respectively, with a nonsignificant difference (P = 0.82). The FOUR score strata of 14–16, 11–13, and 0–10 were found to be equivalent to the GCS scores of 13–15 (mild), 9–12 (moderate), and 3–8 (severe). The feasibility of acquiring and interpreting GCS and FOUR scores on the Likert scale was found to be “easy.”

Conclusion:

The FOUR score is similar to GCS in predicting mortality at 30 days and poor neurological outcomes at 3 months among nontrauma patients of ED. Moreover, it was found that the FOUR score is “easy” to assess and interpret by the emergency residents.
Common pathogens associated with infected diabetic foot ulcers: A retrospective cohort study in a specialized medical center in Jeddah, Saudi Arabia
Authors: Alkhatieb Maram T. , Alkhatieb Mahmood T. , Abideen Raseel K. , Alkhalifah Hussain A. , Alnahdi Haifa M. , Edrees Khalid M.
Published: June 2024

ABSTRACT

Background:

Foot infections, a frequent complication of diabetes mellitus, are associated with heavy resource utilization, including antibiotic therapy and surgeries. However, the most common type of isolated pathogen in diabetic foot infections remains unknown. We aimed to identify the most common types of isolated pathogens in diabetic foot infections.

Methods:

This retrospective cohort study was conducted in a specialized medical center in Jeddah, Saudi Arabia. A total of 96 patients diagnosed with diabetes and presented with a foot ulcer showing clinical signs of infection were included.

Results:

The mean age was 63.03 ± 10.88 years, and 67.7% were males. The mean duration of diabetes diagnosis was 21.86 ± 9.66 years, and the majority had foot ulcers for over six weeks. Bacteria were present in 65 patients (67.7%), Gram-negative organisms were observed in 37 patients (38.5%), and Gram-positive organisms were present in 28 patients (29.2%). In the 65 patients with bacterial culture, Staphylococcus aureus was the most common isolated organism and was observed in 18 patients (27.7%), followed by Escherichia coli in 11 (16.9%) and Pseudomonas aeruginosa in 10 (15.4%). Binary regression analyses found that Gram-negative organisms were significantly more multidrug-resistant than Gram-positive organisms (P = 0.012, OR = 7.172, 95% CI = 1.542–33.352). Patient outcomes included healed ulcers (n = 10, 10.4%), minor amputation (n = 16, 16.7%), major amputation (n = 1, 1%), and debridement (n = 48, 50%).

Conclusion:

Gram-negative organisms were predominant in patients with diabetes and foot ulcers having clinical signs of infection. Treatment with an individualized antibiotic regimen is vital in ensuring optimal outcomes and preventing major amputations.
Management of immune check-point inhibitor-associated colitis in patients with advanced metastatic cancers: A review article
Authors: Tauseef Abubakar , Zafar Maryam , Siddiqui Sameed Abdul Hameed , Dufani Jalal , DeVrieze Bradley , Mirza Muazzam , Thirumalareddy Joseph , Sood Akshat , Mirza Mohsin
Published: June 2024

ABSTRACT

Immune check-point inhibitors (ICPi) are immunomodulating agents, which have revolutionized the management of advanced metastatic cancers. Being immunomodulating agents, they are predisposed to causing colitis. This descriptive review article emphasized on the management of ICPi-associated colitis in advanced metastatic cancers. We used PubMed, Google Scholar, Scopus, and Embase databases for literature review, and terminologies commonly searched were “management,” “immune check-point inhibitors,” “colitis,” “metastatic,” “cancers,” “literature,” and “review.” We reviewed a total of 11 articles done in the last 15 years relevant to ICPi colitis and its management; all the articles showed that diarrhea and colitis are the most common adverse effects observed in patients on ICPi, but prior to establishing the diagnosis of ICPi-causing colitis, possibility of Clostridium difficle or cytomegalovirus infections should be ruled out. Once the diagnosis of ICPi colitis is established, treatment should be started depending upon the severity of colitis. In mild severity, discontinuation of ICPi can resolve the symptoms but, in most of the patients with moderate to high severity of colitis, corticosteroids are considered a cornerstone treatment. Patients unresponsive to steroid treatment should be re-evaluated for infections after which anti-TNF therapy—infliximab or vedolizumab, cyclosporine, mycophenolate mofetil—can be considered.
Healthcare professionals’ perspective on psychosocial support: Lessons learned during a pandemic
Authors: Jan Ghadeer M. , Agha Sajida , Alharbi Shaden , Aldihan Sara , Alghufaili Deema , Farghal Ayah , Alzahrani Teaf
Published: June 2024

ABSTRACT

Purpose/Background:

Assessing the level of psychosocial assistance provided for healthcare workers (HCWs) at and outside of work is crucial. This study aimed to evaluate the psychosocial support provided to HCWs and analyze its effectiveness during COVID-19 at one of the biggest hospitals in Saudi Arabia, King Abdulaziz Medical City, Riyadh. In this study, we hypothesized that psychosocial support for HCWs will enhance their performance and total welfare.

Methods:

This study followed a cross-sectional analytic design, and its sample comprised 380 HCWs from many specialties. Two well-known psychosocial scales, DASS-21 and MSPSS, were used to assess the availability of institutional psychosocial support and the levels of depression, anxiety, and stress among HCWs,

Results:

The majority of HCWs reported a tremendous increase in working hours and level of anxiety during COVID-19, and they denied receiving institutional support at work. Moreover, the majority reported receiving support from family and friends. Primarily, the most statistically significant finding in this study was that female HCWs had much higher levels of stress and anxiety during COVID-19 than their equivalent male colleagues. In addition, a significant difference was found regarding the presence of immediate supervisors for HCWs and its effectiveness in burden relief.

Conclusions:

The results show a marginally significant association between psychosocial support and the mental health of HCWs during COVID-19. However, we found a slightly favorable effect on the minority of HCWs who received regular check-ins or targeted interventions or had immediate supervisors.