bluuebunny/crossref_metadata_2025 huggingface dataset:
Using Global Marvels Platform by Children for Learning English as a Foreign Language: Saudi Parents’ Perceptions
Authors: Journal Arab World English
Published: August 2024

This study aims to investigate Saudi parents’ perceptions of Global Marvels as a platform to improve their kids’ English as a Foreign Learning in light of the Technology Acceptance Model framework. The significance of the present study lies in that it endeavors to shed light upon how perceptions towards using an online platform correlate to using it for learning and teaching from parents’ perspectives by answering the research question: What are the Saudi parents’ perceptions of technology when using Global Marvel as an online EFL context for their kids? Two hundred and two Saudi parents responded to a survey that was used to collect data. The main findings showed significant positive correlations between the constructs of this Model. Results also revealed that the level of learners’ experience in using the platform had a significant correlation with all variables of the Model. Using a specific technology also demonstrated significant correlations with users’ skills in dealing with such a technology, attitude, perceived usefulness and ease of use. Saudi parents have perceived that Global Marvels can be beneficial in improving their kids’ language skills. Nevertheless, the program should take into consideration the possible challenges, and plan well to introduce a successful online EFL experience to kids. Some pedagogical implications are presented for a better experience of using online platforms.
Beyond Traditional Language Learning: EFL Student Views on ChatGPT in Saudi Arabia
Authors: Journal Arab World English
Published: August 2024

Artificial intelligence-based language learning tools have seen increasing adoption in recent years. ChatGPT, an AI assistant developed by OpenAI, has emerged as a popular supplemental tool for practicing English as a foreign language. However, integrating new technologies into language learning requires understanding how end users perceive and experience them. This study explored the perspectives of EFL students on using ChatGPT at three Western universities in Saudi Arabia. The main aim of this study was to explore EFL students’ perspectives on using ChatGPT at three Western universities in Saudi Arabia. This research bears critical significance in optimizing the implementation and design of AI-assisted language learning tools. The primary question addressed was “What are EFL students’ perceptions of the effectiveness and usability of ChatGPT as a supplemental language learning tool?”. A primary quantitative study methodology has been used in the paper. A questionnaire gathering data on perceptions of usability, effectiveness, and impact on learning was distributed to 299 university EFL students. Descriptive statistics and chi-square tests were conducted to analyze the responses. The findings showed that students held a moderately positive view of ChatGPT, seeing it as enhancing understanding and communication abilities in English language learning. Ease of use also significantly impacted students’ preferences and intent to continue utilization. While engagement levels varied, many reported weekly usage of ChatGPT. Gauging EFL learners’ perceptions provided insights that can help tailor AI language tools to better align with individual needs and profiles.
Challenges and Strategies for Using ChatGPT in Written Communication Assignments: A Study of University Students in Malaysia
Authors: Journal Arab World English
Published: August 2024

The development of generative Artificial Intelligence (AI) models, particularly ChatGPT, has gained considerable attention among academics and researchers in recent years. Research shows that ChatGPT can be a vital means of increasing students’ writing performance. However, students may face difficulties in developing effective strategies to incorporate ChatGPT-generated content into written tasks. Therefore, this study sought to examine the challenges and strategies employed by students to use ChatGPT-generated responses for written communication assignments. The study utilized a quantitative method, using a descriptive survey technique. A self-developed questionnaire was used to gather data from a sample of 59 communication students at a Malaysian public university. The data were examined through descriptive statistics and Pearson correlation analysis. According to the findings, students face various challenges in using ChatGPT-generated responses, such as the inability to express unique writing skills, dealing with inaccurate citation formats, as well as difficulty revising ChatGPT-generated responses. The students also employ certain relevant strategies for using ChatGPT-generated responses, such as adding ideas to already generated ChatGPT content, using ChatGPT as a means of idea generation, paraphrasing ChatGPT-generated responses, and replacing ChatGPT-generated words with synonyms. Accordingly, the analysis showed a significant association between students’ challenges and the strategies they employ to utilize ChatGPT-generated responses. This study provides valuable information that can help educators and relevant authorities review and reinforce institutional policies for quality higher education, particularly in the Malaysian context.
A Conceptual Framework for Evaluating Computer-Assisted Language Learning-Dedicated Applications
Authors: Journal Arab World English
Published: August 2024

In language teaching and learning domains, evaluation plays a prominent role in visualizing the scope of progress and achievements. Therefore, evaluation occurs constantly in all teaching aspects (materials, content, pedagogical practices, and other related issues). However, evaluating materials remains complex owing to their distinctiveness. This complexity is attributed to the excessive application of Web-based resources in teaching and learning settings to create authentic learning opportunities. Consequently, evaluating materials’ suitability requires guidance and practical frameworks that constitute common ground for evaluation. As technology offers a tremendous solution to a particular learning/ teaching context, including Computer-Assisted Language Dedicated Apps, the question of how these apps fit into specific teaching/learning contexts remains controversial. However, the evaluation frameworks that Hubbard, Chapelle, Richards, and Rodgers developed have paved the way for more effective evaluation of CALL resources and applications. In light of this, the study attempts to take part in revealing the myth of CDAPPS evaluation by adopting the conceptual research methodology in association with a systematic review of the previous models for evaluating Computer-Assisted Language Learning Dedicated Applications where a conceptual and principled framework entitled Mudawe and Maslamani Framework is proposed. The proposed framework embraces four levels of analysis for evaluation: Learner/user fit, language professional Fit, Technology fit, and institutional administrators Fit. Each consideration contains several criteria associated with the main level of the analysis that can be used through judgmental or empirical evaluation.
Can we estimate crisis death tolls by subtracting population estimates? A critical review and appraisal
Authors: Gaddy Hampton Gray , Gargiulo Maria
Published: August 2024

In the absence of high-quality data, death tolls are often estimated using ad hoc methods. One understudied class of methods, which we term the growth rate discontinuity method (GRDM), estimates the size of death tolls by projecting between pre- and post-crisis population estimates with crude growth rates and then subtracting the projected values. Despite its simplicity, this method is the source of prominent death toll estimates for the Black Death, the 1918 influenza pandemic, the Great Chinese Famine, and the Rwandan genocide, among others. In this article, we review the use and validity of GRDM. Using statistical simulation and comparisons to the results of well-validated demographic methods, we assess the accuracy, precision, and biases of this method for estimating mortality in absolute and relative terms. We find that GRDM requires precision in its inputs to an extent rarely possible in contexts of interest. If one has sufficient data to specify GRDM well, one can likely also use a more reliable method; if one lacks that data, the estimates produced by the method are so sensitive to data quality issues and other assumptions that they cannot be considered informative. These findings create problems for existing demographic and econometric work that has used GRDM to analyze mortality crises for which demographic data is scarce.
Hansen’s disease: Is histopathological correlation mandatory for all clinically diagnosed patients? A descriptive study in a tertiary care hospital
Authors: Sananda Koley  , Nandini Das  , Sunita Bagdi  , Sritanu Jana  , Surajit Dolui  , Sanjay Sengupta
Published: August 2024

Background: Leprosy has been historically associated with social stigma and discrimination. Leprosy, also known as Hansen’s disease, is indeed a chronic infectious disease caused by the bacterium Mycobacterium leprae. Diagnosis of leprosy is usually done by clinically and classified as multibacillary (MB) and paucibacillary (PB). The disease was also classified into different types based on histopathological findings, such as tuberculoid, borderline tuberculoid (BT), mid-borderline, borderline lepromatous, and lepromatous.
Aims and Objectives: The aim of the study was the clinicohistopathological correlation of all clinically diagnosed cases of Hansen’s disease.
Materials and Methods: The study was done at Bankura Sammilani Medical College and Hospital for a period of 18 months. Ethical approval was taken from the Institutional Ethics committee. All new patients 66 in number clinically diagnosed as leprosy attending the Dermatology Outpatient Department were included in the study. The skin biopsy and staining were done with hematoxylin and eosin staining and Fite-Faraco stain for every patient. The skin biopsy was reported according to the Ridley-Jopling classification.
Results: Males were more commonly affected than females. Most of the leprosy cases in the study were classified as MB (86.4%) and the upper extremities were the most commonly affected sites. Bacterial index was observed negative in clinically PB cases. The most common histological subtype of leprosy identified in the study was BT, Regarding bacterial index, all clinically diagnosed MB cases were smear positive and PB cases were smear negative. Out of nine clinically diagnosed PB cases, inflammatory cells were found in 3 (33.4%).
Conclusion: In a large country like India where resources are limited, no need for skin biopsy for every patient. Biopsy should do if there is any confusion with other skin lesions.
Blood group distribution and its association with bleeding time and clotting time among medical students
Authors: Adhikari Bijaya , Maharjan Niroj
Published: August 2024

Background: Blood group, bleeding time (BT), and clotting time (CT) are routinely performed tests in the hospital, especially before any surgeries and blood transfusion.
Aims and Objectives: The objective of the study is to see if there is any association of blood group with BT and CT and the gender difference in BT and CT.
Materials and Methods: A cross-sectional study was conducted among 132 medical students of 1st year in the hematology laboratory of the Department of Physiology in KIST Medical College from June 2022 to September 2022. The blood group was determined by a simple agglutination method. BT was determined by Dukes method whereas CT was determined using capillary tube method. Data were analyzed using SPSS-20 software. The difference in BT and CT among various blood groups was done using the ANOVA test and P≤0.05 was considered significant. Student’s t-test was used to find the association of gender with BT and CT.
Results: Both BT and CT were found to be more in males than females. However, the difference was significant only in the mean BT (P=0.05, Table 2). There was no significant difference in the mean BT among various blood groups but CT was found to be significant (P=0.05).
Conclusion: Our study showed the tendency of bleeding to be more in blood Group B individuals. Multicentric study including a larger population with plasma level of von Willebrand factor might be helpful to verify findings and identify the risk group.
Expression of isocitrate dehydrogenase 1 and tumor protein 53 in high-grade glioma and its correlation with the outcome – A prospective study at a tertiary care center in India
Authors: Kumar Vikas , Jaiswal Pooja , Jaiswal Somil , Tandon Pradeep , Ojha Bal Krishna
Published: August 2024

Background: Central nervous system tumors are the 10th most prevalent cause of mortality worldwide. The 2016 World Health Organization (WHO) classification of high grade gliomas (HGG) has identified Isocitrate dehydrogenase 1 (IDH 1) mutation as one of the primary molecular markers. Tumor protein 53 (p53) mutation is also closely associated with HGG.
Aims and Objectives: The current study intended to ascertain the expression of IDH1 and P53 in patients with HGG and correlate that expression with clinical prognosis.
Materials and Methods: The study included 34 patients with histopathological proven HGG. Relevant clinical information was recorded. The immunostaining results with anti-mouse monoclonal antibody for IDH 1 (R132H) and rabbit polyclonal antibody for p53 (RP 106-05) were statistically analyzed. Patients were followed up through telephone for a period of 1 year. Mortality within 1 year was regarded as a poor outcome.
Results: About 85.29% (29/34) of the patients had Grade IV glioma, while only 14.71% (5/34) had Grade III glioma. Most patients with Grade III (3/5) (60.00%) and Grade IV (21/29) (72.41%) gliomas had p53 positivity. The majority of the patients with grade-III glioma (3/5) (60.00%) had IDH1 positivity, while most of the patients (23/29) (79.31%) with Grade IV gliomas had IDH1 negativity (P=0.0658). Age, gender, WHO grade, and adjuvant therapy did not show significant association with the outcome except for the p53 expression (P=0.0011*) and IDH1 expression (P=0.0025*). Correlation analysis showed a significant positive correlation between p53 makers with poor outcome (r=0.4781) and glioma grade (r=0.4028). Further, a negative yet insignificant correlation was recorded between IDH1 with age (r=−0.2285), p53 expression (r=−0.2568), and grade (r=−0.2988), although it showed a significant correlation with poor outcome (P=0.0001).
Conclusion: p53-positive and IDH1-negative HGG had a significant correlation with the poor outcome. Thus, IDH1 and p53 are reliable markers for prognostication of HGG.
Comparison of nebulization with lignocaine and dexamethasone for attenuation of post-operative sore throat: A randomized controlled trial
Authors: Rahul Saini  , Sanjay Johar  , Rahul Deora  , Pritam Yadav  , Preeti Gehlaut  , Prashant Kumar
Published: August 2024

Background: Post-operative sore throat (POST) is a very common anesthesia-related event which may hamper patient satisfaction and increase treatment cost.
Aims and Objectives: This study aimed to compare the effectiveness of nebulization with dexamethasone and lignocaine to prevent POST.
Materials and Methods: This randomized controlled study involved 135 patients randomly divided into three equal groups: Group D – (n=45) received 8 mg (2 mL) dexamethasone plus 3 mL of distilled water, Group L – (n=45) received 80 mg (4% lignocaine 2 mL) plus 3 mL distilled, and Group S – (n=45) received nebulization with 5 mL normal saline.
Results: At 4 h postoperatively, the incidence of POST was 15.6% in the dexamethasone group, 33.3% in the lignocaine group, and 73.3% in the saline group. The score was significantly higher in the saline group (P=0.001) compared to the dexamethasone and lignocaine group, while it was comparable between dexamethasone and lignocaine group (P=0.188). Similarly, dexamethasone and lignocaine groups were comparable at immediately post-operative, 2, 8, 12, and 24 h post-operative time points. Post-operative hoarseness scores of all three groups were comparable at all-time points. A significant increase in the heart rate (HR) and mean arterial pressure (MAP) after intubation was observed in the saline and dexamethasone group as compared to the lignocaine group (P=0.001) while HR and MAP were comparable in dexamethasone and saline group (P=1.000).
Conclusion: Dexamethasone and lignocaine nebulization are both effective and comparable prophylaxis for POST and lignocaine nebulization has added advantage of blunting pressor response to endotracheal intubation over dexamethasone nebulization.
To find the correlation between transverse cerebellar diameter measured by cranial ultrasound within 48 h of birth and gestational age as estimated by last menstrual period
Authors: Monit Kumar Goyal  , Harish Kumar Mourya  , Saroj Mourya  , Bharatendu Dave  , Pokar Chand  , Sundaramoorty T  , Vipin Kumar Kasana
Published: August 2024

Background: Gestational age (GA) may be assessed at any time during pregnancy, and several modes of assessment exist, each requiring better diagnostic techniques that may result in more precise estimates of GA, which could lead to quicker medical management of a pregnant patient. The largest diameter across both hemispheres, measured from outer to outer margin, is the transverse cerebellar diameter (TCD).
Aims and Objectives: We aimed to predict the correlation between TCD measured by cranial ultrasound within 48 h of birth and GA as estimated by the last menstrual period.
Materials and Methods: The present study was conducted in the Department of Pediatrics, Dr. S. N. Medical College, Jodhpur, Rajasthan. Ethical clearance was obtained from the Institutional Ethical Committee. It was a cross-sectional observational study and the duration of the study was 6 months. We split the population into three groups based on GA: (a) <32 weeks of GA, (b) 32–36+6 days of GA, and (c) 37–42 weeks of GA. We enrolled 25 neonates from each group.
Results: A very strong positive correlation between TCD and GA in infants was <32 weeks of gestation age, in infants 32–36 weeks+6 days of gestation age, and in infants 37–42 weeks of gestation age. Regression analysis shows a very strongly significant relationship. Hence, the TCD is a better predictor of GA in the third trimester. Our study reported that there is a close relationship between TCD and GA, with TCD increasing linearly from <32 weeks to 42 weeks. GA can be predicted to be 1.43 weeks by assessing TCD on neonatal cranial ultrasonography images.
Conclusion: The TCD is a better predictor of GA in the third trimester. Our study reported that there is a close relationship between TCD and GA, with TCD increasing linearly from <32 weeks to 42 weeks.
Effectiveness and safety of bortezomib-dexamethasone regimen in patients with multiple myeloma: A prospective observational study
Authors: Nijisha N  , Sanitha Kuriachan  , Mahesh Kumar D  , Jumi Jacob
Published: August 2024

Background: Bortezomib and dexamethasone (BD) regimen offers a promising therapeutic approach in multiple myeloma (MM) by inhibiting the proteolytic pathway of tumor cells.
Aims and Objectives: This study aims to assess the safety profile and treatment outcomes of MM patients undergoing the BD regimen.
Materials and Methods: This prospective observational study included MM patients who received BD regimen. Patients received bortezomib (1.3 mg/m2 intravenous) weekly for 4 weeks along with dexamethasone (40 mg orally) weekly for 4 weeks. Clinical assessments were performed after each cycle, and adverse drug reactions were graded according to National Cancer Institute criteria. Treatment outcomes were evaluated after the 4th cycle based on specific parameters.
Results: Thirty-seven patients, with a mean age of 56.2 years, predominantly male (56.8%), were included. Common symptoms included bone pain, fatigue, weight loss, and appetite loss. Toxicities were mainly grade 1 and 2, with peripheral neuropathy (PN) being the most prevalent. The BD regimen exhibited a response rate of 65%, accompanied by significant improvements in bone marrow plasma cells, β2 microglobulin, immunoglobulin assay, and erythrocyte sedimentation rate. In addition, treatment improved performance status, in 51.4% of patients achieving scores above 90 on the Karnofsky scale.
Conclusion: The BD regimen demonstrated notable efficacy and tolerability in MM treatment. However, it is associated with a higher risk of PN.
Utilization of blood and blood components in the department of clinical hematology of a tertiary care hospital: A prospective hospital-based study
Authors: Rubiya Ryhan  , Mohd Zubair Qureshi  , Fayaz Ahmad Bhat  , Rumana H Makhdoomi  , Reashma Roshan  , Afaq Ahmad Khan  , Sajad Ahmad Rather  , Kaneez Fatima
Published: August 2024

Background: To have proper utilization of blood and its components adherence to established guidelines is essential. Hence, periodic review of blood components is necessary to improve transfusion practices and decrease the inappropriateness of blood components.
Aims and Objectives: Our study aims to assess the utilization and appropriateness of blood and blood components in the Department of Clinical Hematology SKIMS, Soura, Srinagar.
Materials and Methods: This prospective observational study was conducted in the Department of Blood Transfusion and Immunohematology, SKIMS, Soura, Srinagar, over a period of 1 year from August 2020 to July 2021 on patients admitted in Clinical Hematology requiring transfusion therapy. The number of all blood and blood component units supplied over a period of 1 year was assessed. The usage of different types of blood component was recorded and correlated with the patient’s diagnosis and indications for transfusion.
Results: A total of 250 patients were transfused with 2099 blood and blood components, among them 64.32% (1350) units were used appropriately and 35.68% (749) units were used inappropriately. Transfusions of packed red blood cells were found to be inappropriate in patients with asymptomatic chronic anemia with Hemoglobin >7 g/dL. Fresh frozen plasma was given inappropriately in cases of bleeding without derangement of coagulation tests. Inappropriate use of platelets was seen in patients who had received platelets prophylactically with platelet count above 10,000/μL.
Conclusion: Proper implementation of guidelines for the use of various blood components would help reduce their inappropriateness.
Granulomatous mastitis and other inflammatory mastitis simulating breast neoplasms – A retrospective study in the fine needle aspiration cytology clinic of a tertiary care center in eastern India
Authors: Pamela Nayak  , Meghadipa Mandal  , Srishtidhar Mangal
Published: August 2024

Background: Fine needle aspiration cytology (FNAC) is an important diagnostic modality in palpable breast lesions. This together with imaging modality is important in distinguishing benign from malignant lesions of the breast. Granulomatous/inflammatory mastitis forms a small subset of breast lesions that may present as a breast lump. Clinical and radiological features in these cases may mimic malignant breast pathology.
Aims and Objectives: The aim of this study was to study the frequency of granulomatous mastitis and other inflammatory mastitis with respect to other neoplastic lesions of the breast, presented in FNAC clinics and to correlate the cytological findings with the clinical presentation of granulomatous and other inflammatory mastitis.
Materials and Methods: A retrospective study was conducted in the Department of Pathology in a tertiary care center in Eastern India for duration of 4 years 5 months. Details of all patients who underwent FNAC for breast lesions during the study period were recorded in terms of their clinical presentation, cytological findings, imaging, and ancillary investigations. The findings were then tabulated in a master sheet and analysis done by descriptive statistics using SPSS 25.
Results: A total of 154 cases were included with 5 cases (3.2%) of granulomatous and 12 cases (7.8%) of inflammatory mastitis. Age range for granulomatous/inflammatory mastitis was 20–70 years. Lump and pain were the most common complaints followed by inflammatory skin changes and nipple discharge. Very few cases also showed nipple retractions and very occasional systemic symptoms like fever. History of lactation was seen among five cases. Three cases showed positive acid-fast bacilli in Ziehl–Neelsen stain. Radiology was discordant with cytological findings in three cases, where the former suggested a breast neoplastic process.
Conclusion: Granulomatous/inflammatory mastitis is a rarely diagnosed entity in breast cytopathology with no standard guidelines for management. Antibiotics antitubercular therapy and corticosteroids are some proposed lines of medical management. In treatment-resistant cases, wide local excision may be done depending on available resources and surveillance opportunities.
How maternal caring affects longevity
Authors: Ruby Dhar  , Arun Kumar  , Subhradip Karmakar
Published: August 2024

When it comes to longevity, everyone wants to live for eternity. Longevity research has often led scientists to dark alleys with several candidate molecules responsible for aging. Pioneering genetic studies on model organisms like Caenorhabditis elegans and Drosophila melanogaster discovered the most well-conserved longevity pathways, mainly caloric restriction and the insulin/insulin-like growth factor 1signaling pathways. Apart from these complex molecular circuitries that drive longevity, a recent study published by Zipple et al. (Proceedings of the National Academy of Sciences, 2024) showed that the relationship between mother and grandmother with the child may determine why some animals and humans live longer than expected for their size. Animals that spend more time with their mothers during early life end up living longer but with reduced capacity to produce offspring.
This exciting piece of research has far more consequences than just these findings. It implies the importance of the mother in one’s life and the role of parental care in providing longevity and reproductive success.
Fetal autopsy: Clinicopathologic correlation in consecutive cases
Authors: Shunmuga Priya V  , Revathy M  , Chandramouleeswari K
Published: August 2024

Background: Fetal and neonatal mortality serves as the most sensitive index of maternal and neonatal care. Congenital malformations remain a common cause of perinatal deaths and account for 10–15% in developing countries. Antenatal anomaly scan has become a standard element of obstetric care and their time for a fetal malformation is about 18 weeks. Fetal autopsy serves as a methodology to confirm the sonogram findings with regard to fetal anomalies.
Aims and Objectives: The aim of our present study is to review and evaluate fetal autopsy of stillbirth/fetal losses and to confirm the malformations that were diagnosed by ultrasound.
Materials and Methods: A cross-sectional study of a total of 10 cases received during the period of September 2023–October 2023 at the Institute of Obstetrics and Gynaecology. All the cases were spontaneous fetal losses. A standard protocol of autopsy procedure was followed which included external, internal, and histopathological examination. In fetuses with prenatally diagnosed malformations, ultrasound findings were compared with autopsy findings.
Results: We analyzed a total of 10 fetuses, which included one chromosomal abnormality, four cardiac anomalies, one multiple anomaly, three central nervous system (CNS) anomalies, and one lethal skeletal dysplasia. The fetal autopsy confirmed the prenatal ultrasound findings in eight cases. Fetuses with CNS abnormality were not appreciated grossly due to early autolysis of the brain in the post-mortem.
Conclusion: Prenatal imaging and screening are considered milestone development which detects fetal anomalies. However, the time-tested clinical autopsy which used to be conducted for all hospital deaths to find the cause of death was the norm of yesteryears which threw light on many unidentified causes and many syndromic associations not detected antemortem. Likewise, this case highlights the importance of autopsy correlation with prenatal imaging to highlight the same findings and to detect findings not picked up during imaging.
Patient factors that lead to presentation delay in breast cancer among Sri Lankan women: A cross-sectional study
Authors: Senavirathna Jeewantha , Gavesha De Silva  , Yohan Chamara  , Gamage Hasangi , Heiyanthuduwa WR  , Jeyakumaran N  , Maheeka Seneviwickrama  , Kanchana Wijesinghe
Published: August 2024

Background: Breast cancer (BC) poses a significant public health concern as it is the most common cancer detected among women worldwide. Early detection and intervention are associated with better prognosis and survival. A primary reason for the rising mortality and morbidity in developing countries is the lack of patient education and practice early detection programs and presentation.
Aims and Objectives: The main objective of this study is to evaluate the prevalence of delayed presentation and the factors lead to delay among BC patients in Sri Lanka.
Materials and Methods: A descriptive cross-sectional study was conducted from January 01, 2023, to June 30, 2023 among women diagnosed with BC attending two selected state hospitals in Sri Lanka. All women with histological diagnosis of early, locally advanced, or metastatic BC attending for treatment were included and women with recurrent BC and concomitant other cancers were excluded. Presentation delay was defined as ≥3 months. The calculated sample size was 396.
Results: About 47.5% of our study population (n=188) had a presentation delay of more than 3 months. The main reasons for the delay in presentation were, being unaware that BC is a major problem in Sri Lanka, difficulty in accessing healthcare, and not being able to find time due to family and social commitments. Women who had not been practicing self-breast examination had a significant association with presentation delay (OR=3.26, 95% CI - 0.090–0.362, P=0.001). The participants who were having a presentation delay were also more likely to be diagnosed with an advanced stage of cancer (OR=2.86, 95% CI - 2.573–3.153, P=0.000).
Conclusion: Our study population depicts a good knowledge related to BC symptoms, risk factors, and early detection methods. However, very few are practicing them. There is also a significant delay of presentation due to various factors. Awareness and good practices would lead to early detection and diagnosis and improve overall survival.
Granulomatous response within draining axillary lymph nodes in patients with Breast cancer: A series of 4 cases
Authors: Pradhan Rajashree , Mondal Sajeeb , Chatterjee Suman , Upasana Mukherjee
Published: August 2024

Granulomatous response associated with breast cancer and within the draining lymph nodes is an extremely rare phenomenon. In this study, we are presenting a series of 4 cases of invasive ductal carcinoma showing both caseating and noncaseating granulomas within the ipsilateral draining axillary lymph nodes. We also discussed the pathogenesis of granulomatous response and its clinicopathologic significance.
Serum Vitamin D level in sepsis patients and its correlation with clinical outcome
Authors: Anand Singh  , Baghel PK  , Karan Sharan Kapur
Published: August 2024

Background: Serum Vitamin D plays an important role in sepsis; lack of Vitamin D has been linked to a higher risk for the progression of infections, as it signifies an immune system mediator.
Aims and Objectives: In this study, our aim is to evaluate the correlation between serum levels of Vitamin D and clinical outcome in sepsis patients.
Materials and Methods: The present prospective cohort study was performed on patients over 18 years of age suspected of sepsis presenting to an emergency department during 1 year. For all eligible patients, the blood sample was drawn for the measurement of serum level of Vitamin D3, and its correlation with outcomes such as mortality, renal failure, and liver failure was assessed.
Results: One hundred and sixty patients with a mean age of 48.5±20.587 years were studied (60.0% males). The mean serum level of Vitamin D3 in the studied patients was 32.0±12.54 ng/mL. By considering 30–100 ng/mL as the normal range of Vitamin D, 70% of the patients had Vitamin D deficiency. Only age (r=−0.261, P=0.037) and mortality (r=−0.426, P=0.025) showed a significant correlation with mean Vitamin D.
Conclusion: Based on the result of this study, out of 160 patients, 61.25% of patients with sepsis are Vitamin D deficient. There is a significant and inverse relationship between mortality and advanced age which were associated with serum Vitamin D3 levels. Hence, supplementing with Vitamin D appears to have potential benefits in reducing infection rates, sepsis-related deaths, and infection prevalence, particularly in the elderly.
A comparative study of the outcome of unilateral versus bilateral internal anal sphincterotomy in treatment of chronic anal fissure
Authors: Partha Pratim Mandal  , Shivaji Mandal  , Chowdhury Debayan
Published: August 2024

Background: Gold standard treatment for chronic anal fissure is lateral internal sphincterotomy. Bilateral internal sphincterotomy (BIS) as a treatment option for chronic anal fissure has not been evaluated.
Aims and Objectives: The aims and objectives of the study are to compare the efficacy of unilateral versus bilateral internal anal sphincterotomy in treatment of chronic anal fissure.
Materials and Methods: Study design: A prospective randomized comparative study. Study area: Patients coming to General Surgery outpatient department at College of Medicine and Sagore Dutta Hospital with chronic anal fissure. Study period: July 2022 to December 2023 (18 months). Sample Size: 100 patients. Study Group: Group A=Patients who had undergone unilateral internal sphincterotomy (UIS)=50 patients and Group B=Patients who had undergone BIS=50 patients.
Results: 2 (4%) patients in Group A and 3 (6%) patients in Group B developed incontinence for flatus postoperatively. No patients in either group developed incontinence for stools. The Mean Fissure Healing Time (Mean±SD) (Weeks) post-sphincterotomy was 4.32±0.91339 in Group A and 2.66±0.65807 in Group B. There were 6 cases of recurrence in the unilateral sphincterotomy group. Second surgery was needed in 4 patients who underwent unilateral sphincterotomy.
Conclusion: As compared to UIS, BIS results in a faster healing of chronic anal fissure, with no increase in incontinence, decreased pain score, and less recurrence rates.
A study of diabetic retinopathy in diabetic foot syndrome in Western Regional Institute of India
Authors: Sipra S Engineer  , Vipul K Prajapati  , Nilesh J Paraskar  , Kinjal Y Trivedi  , Nirali P Siddhpura  , Supriya H Rawat  , Priyank Y Nenuji  , Neha D Laspal
Published: August 2024

Background: Diabetes is a rapidly growing health challenge and potential epidemic across low-and-middle-income countries like India. Diabetic retinopathy (DR) is a consequence of diabetic microangiopathy, which may cause visual deterioration due to macular edema in any stage and vitreous hemorrhage or tractional retinal detachment in the advanced proliferative retinopathy stages.
Aims and Objectives: The aim was to study the retinopathy status in diabetic patients with a risk of diabetic foot syndrome (DFS) visiting a western regional hospital in India.
Materials and Methods: In this cross-sectional study, all patients with diabetes mellitus (DM) with a risk of DFS, visiting a tertiary care hospital during the study period, underwent an ophthalmological evaluation for documentation of their retinopathy status.
Results: One hundred and fourteen patients diagnosed to have a risk profile for DFS were included in the study. Their mean age was 61.22 years and 81.6% were males. The mean duration of DM was 12.24 years, respectively. Of the 114 patients, 72 had DR. An increased presence of retinopathy in patients with an increased risk grade of diabetic foot (DF) was found significant by the Chi‐square test. (P<0.001).
Conclusion: Our study found an increased presence of DR in Western Indian cohort with DFS. The severity of retinopathy was greater in patients with higher grades of risk for DF, therefore establishment of an association between DR and DFS will help in developing an integrated management strategy for these two grave consequences of diabetes.
Profile of spontaneous bacterial peritonitis in non-alcoholic fatty liver disease cirrhosis
Authors: Zeeshan Ahmad Wani  , Mohamad Muzzafer Mir  , Nissar Hussain Hamadani  , Umer Amin Bhat  , Waseem Imtiyaz Khuroo
Published: August 2024

Background: Etiology of chronic liver disease (CLD) has an impact on the profile of spontaneous bacterial peritonitis (SBP) in terms of infection acquisition, resistance pattern, and treatment outcome.
Aims and Objectives: This study aimed to study infection acquisition, antibiotic resistance pattern, and treatment outcome in patients with non-alcoholic fatty liver disease (NAFLD) cirrhosis with SBP.
Materials and Methods: This observational prospective study was carried out in Government Medical College; Srinagar: over a period of 2 years from 2017 onward. We did analysis of patients with NAFLDs cirrhosis. We studied infection acquisition, antibiotic resistance pattern, and treatment outcome in this group of patients.
Results: Over 2-year period, 246 patients were enrolled. The mean age of patients was 57.09±13.90 years. Hepatitis B virus and NAFLD were the major etiological contributors to the burden of CLD amounting to 51.20% in Kashmir. SBP was present in 33/57 (57.90%) of NAFLD cirrhosis patients. Child-Turcotte-Pugh Class C was 63.60%. Patients with culture-positive SBP (CP-SBP) were 45.45%. In patients of SBP with etiology other than NAFLD, CP-SBP was 61% whereas culture-negative SBP was 38.77%.
Conclusion: In our region, NAFLD is one of the leading contributors to CLD. In this study, the trend toward worse treatment outcome and mortality in the patients with NAFLD SBP was observed.
Characterization of biofilm-forming ability and antibiotic resistance profiles of clinical Pseudomonas aeruginosa isolates from patients with cystic fibrosis
Authors: M Anjaneya Swamy  , Kanumuru Balu Mahendran  , Nethala Ravi Kumar  , Ketha Venkateswarlu
Published: August 2024

Background: Pseudomonas aeruginosa is a key pathogen in cystic fibrosis (CF) associated infections, known for its biofilm-forming ability and resistance to multiple antibiotics. Understanding the relationship between biofilm production and antibiotic resistance profiles in clinical isolates can guide treatment strategies.
Aims and Objectives: The aims of this study were to investigate the biofilm-forming abilities and antibiotic resistance profiles of clinical P. aeruginosa isolates from patients with CF and to determine the relationship between these two factors and their impact on treatment efficacy.
Materials and Methods: A cross-sectional study was conducted on 100 clinical isolates of P. aeruginosa from CF patients. Biofilm-forming capacity was categorized as strong, moderate, or weak based on quantitative assays. Antibiotic resistance was assessed for ciprofloxacin, tobramycin, ceftazidime, meropenem, and piperacillin/tazobactam. Multi-drug resistance was defined as resistance to three or more antibiotic classes. Statistical correlations between biofilm-forming capacity and resistance levels were evaluated using the Chi-square tests.
Results: Fifty-six percentages of isolates were strong biofilm producers, while 34% and 10% were moderate and weak producers, respectively. The highest antibiotic resistance was observed against ciprofloxacin (60%), followed by tobramycin (50%) and ceftazidime (45%). Forty percentages of the isolates were classified as multi-drug resistant. Strong biofilm producers demonstrated a significantly high correlation with antibiotic resistance (P<0.05). Two predominant clonal groups were identified among the isolates, suggesting a possible clonal spread of resistance traits.
Conclusion: The study confirms a strong association between robust biofilm production and heightened antibiotic resistance in P. aeruginosa isolates from CF patients. These findings highlight the need for targeted therapeutic strategies to disrupt biofilm formation and curb resistance spread.
Perioperative infusion of magnesium sulfate versus dexmedetomidine on the hemodynamic responses in patients undergoing laparoscopic cholecystectomy: A randomized controlled trial
Authors: Shefali Singh  , Anju R Bhalotra
Published: August 2024

Background: Laparoscopic cholecystectomy is associated with less post-operative pain, shorter hospitalization, and a faster functional recovery as compared to the open procedure. However, like any other surgery, a stress response is induced. Anesthesia interventions such as direct laryngoscopy, tracheal intubation, and extubation involve severe sympathetic stimulation. Magnesium can block the release of catecholamines from both the adrenal gland and adrenergic nerve terminals by inhibiting of activation of membrane Ca²⁺-ATPase and Na⁺-K⁺-ATPase.
Aims and Objectives: Both magnesium sulfate and dexmedetomidine decrease the release of catecholamines and attenuate pressor responses to anesthesia and surgery.
Materials and Methods: Eighty-four ASA I/II patients were randomly allocated to two groups. Group D received dexmedetomidine 1 μg/kg followed by 0.4 μg/kg/h and Group M received 2 g MgSO₄ followed by 15 mg/kg/h. hemodynamic variables were recorded as T0 (after loading dose of study drug), just before (T1) and 1, 2, and 3 min after ProSeal laryngeal mask airway (PLMA) insertion (T2 [i] [ii] [iii]), before and after peritoneal insufflation (T3 and T4), before and after table tilt (T5 and T6), after resuming flat position (T7), peritoneal deflation (T8), PLMA removal (T9), and on post-anesthesia care unit admission (T10). Data were collected and analyzed using SPSS 17 statistical software.
Results: The demographic profile was comparable. After the study drug administration, there was a fall in mean arterial pressure (MAP) in both groups (Group D > Group M) and no pressor response to PLMA insertion. At peritoneal insufflation, the MAP increase was significantly more in Group M at T6, T7, and T8 (31.9%, 27.9%, and 35.6% above baseline, respectively). Although there was a fall in systolic blood pressure (SBP) from the baseline throughout the procedure in both groups, SBP was significantly higher at most times in Group M as compared to Group D (P<0.05). In both groups, there was a similar rise in diastolic blood pressure after peritoneal insufflation. The mean heart rate was significantly lower in Group D at all time points.
Conclusion: Dexmedetomidine seemed to be superior to MgSO₄ for ameliorating hemodynamic responses in patients undergoing laparoscopic cholecystectomy.
Comparative study on outcomes between open reduction and internal fixation with plating and K-wires plus casting for distal end radius fractures
Authors: Sudheer Kumar  , Vijaya Kumar Gannu  , Raju Rayapuram  , Muralidhar Bandi
Published: August 2024

Background: Distal end radius fractures are common injuries treated in orthopedic practice, with varying treatment modalities influencing outcomes.
Aims and Objectives: The study was designed to compare the outcomes between open reduction and internal fixation (ORIF) with plating and K-wires plus casting in patients treated for distal end radius fractures.
Materials and Methods: One hundred patients with distal end radius fractures were included and divided into two groups: Group A (ORIF with plating) and Group B (K-wires plus casting), with 50 patients in each group. Parameters included were healing time, complication rates, functional recovery, patient satisfaction scores, pain levels during recovery, and the time to return to daily activities.
Results: Group A demonstrated a shorter average healing time (8 weeks) compared to Group B (9 weeks). Complication rates showed 5% malunion and 4% delayed union in Group A, against 12% and 6%, respectively, in Group B. Functional recovery was higher in Group A, with 93% grip strength and 88% range of motion recovery. Patient satisfaction was also higher in Group A (8.5 out of 10) compared to Group B (7.5 out of 10). Pain levels during recovery were lower in Group A, and the time to return to daily activities was shorter (8 weeks for Group A versus 10 weeks for Group B).
Conclusion: The study suggests that ORIF with plating offers better outcomes in terms of healing time, complication rates, functional recovery, patient satisfaction, pain management, and quicker return to daily activities than K-wires plus casting for distal end radius fractures.
Comparison of acromio-axillo-suprasternal notch index with thyromental height test to predict difficult visualization of larynx
Authors: Nandini CV  , Mohan Kumar KS  , Deeksha BG  , Santosh Kumar  , Harsoor SS
Published: August 2024

Background: Securing and maintaining a patent airway for the conduct of general anesthesia are a major concern for an anesthesiologist. Unanticipated difficult intubation in anesthetized patients is the main cause of morbidity or mortality. Several predictors are proposed to anticipate difficult tracheal intubation, but no predictor is found to be 100% accurate. Acromio-axillo-suprasternal notch index (AASI) is a recent addition to the list of predictors.
Aims and Objectives: The current study compared the usefulness of AASI and thyromental height test (TMHT) as predictors of difficult visualization of larynx (DVL).
Materials and Methods: Following approval by the Institutional Ethics Committee and CTRI registration, written informed consent was taken. The study was conducted on 300 patients aged 18–65 years belonging to American Society of Anesthesiologists’ physical status I and II, with modified Mallampati (MMP) Scores of 1 and 2, over a period of 6 months. Preoperatively all patient’s airway was evaluated using AASI and TMHT. The DVL during direct laryngoscopy was noted as assessed by Cormack and Lehane grading. We compared the sensitivity and specificity for DVL with regard to AASI and TMHT.
Results: The incidence of unanticipated DVL was 14%. The sensitivity, specificity, positive predictive value, and negative predictive value of AASI were 86.4%, 38.1%, 89.6%, and 31.4%, respectively, and for TMHT, they were 94.6%, 4.8%, 85.9%, and 12.5%, respectively. Pearson correlation coefficient was r = −0.068 (P=0.243) when AASI was compared with TMHT.
Conclusion: AASI was found to be less sensitive when compared to TMHT and there was statistically no significant correlation between the two parameters to predict the DVL.
A histomorphological and immunohistochemical analysis of invasive lobular carcinoma of breast: A case series
Authors: Suchiang Meera , Das Gunabhi Ram , Dowerah Swagata , Saikia Julee , Rahman Washima , Borgohain Mondita , Gogoi Gayatri
Published: August 2024

Invasive lobular carcinoma (ILC) is the second most common special subtype of invasive breast carcinoma comprising 5–15%. ILC defines as invasive carcinoma comprising non-cohesive single-file linear pattern in fibrous stroma. The aim of the study was to evaluate the histomorphological features and immunohistochemical analysis of ILC. A total of 19 cases were encountered from March 2020 to February 2024 out of 129 breast cancers. The sociodemographic profiles and clinicopathological parameters of the patients were studied with special emphasis on their morphology and hormone receptor status. The mean age of patients is 42.8 years. Out of 19 cases, 84.2% showed feature of classic type, 5.2% of tubule-lobular, and 10.5% of pleomorphic lobular carcinoma. The majority of cases (63.2%) showed histologic Grade 2, and 10.5% showed Grade 3. On immunohistochemistry examination, 79% were estrogen receptor (ER) and progesterone receptor (PR) positive with 10.5% of cases was human epidermal growth factor receptor 2/neu (HER2/neu) positive. Our study showed higher cases of classic type ILC, mostly of histologic Grade 2; higher ER-PR receptor positivity and HER2/neu negativity.