bluuebunny/crossref_metadata_2025 huggingface dataset:
Estado nutricional antropométrico, bioquímico e ingesta alimentaria de personas con VIH bajo tratamiento antirretroviral, Córdoba, Argentina
Authors:   Instituto Médico del Sur, Trelew, Chubut, Argentina, Bonavía Glenys Nicole , Fernández Kent Melody Ayelén ,   Ministerio de Agricultura, Ganadería, Industria y Comercio de la provincia del Chubut, Argentina, Von Borowski Valeria ,   Hospital Rawson, Baraquet María Lucía ,   Universidad Nacional de Córdoba, Oberto María Georgina ,   Universidad Nacional de Córdoba
Published: April 2024

Antecedentes: el tratamiento antirretroviral (TARV) mejora la calidad de vida y supervivencia de las personas con virus de inmunodeficiencia humana; sin embargo, su uso prolongado genera efectos metabólicos y hematológicos a largo plazo. Además, intervienen aspectos alimentarios y de la propia infección. Objetivo: analizar el estado nutricional y la ingesta de macro y micronutrientes de personas con VIH bajo este tratamiento. Materiales y métodos: estudio descriptivo, transversal y correlacional. Participaron 59 adultos con VIH bajo TARV con linfocitos T CD4 ≥ 200/mm3 y sin otra patología de base, que asistieron al servicio de infectología del Hospital Rawson de Córdoba, Argentina, en el período 2019-2020. Se registraron datos demográficos, bioquímicos (< 12 meses), inicio de TARV y esquema actual, estado nutricional antropométrico e ingesta alimentaria. Resultados: el 57,6 % presentó exceso de peso; 25,4 %, hipertrigliceridemia; 41,5 %, colesterol HDL bajo; y 27,6 %, hiperglucemia.Se registró en la mayoría de las personas una ingesta excesiva de calorías (49,2 %), lípidos (54,3 %) y sodio (57,6 %), y deficitaria en potasio (44,1 %), calcio (77,9 %), zinc (20,3 %), vitaminas A (42,4 %) y C (35,6 %). Conclusión: la alta prevalencia de sobrepeso/obesidad junto a las alteraciones lipídicas y glucémicas requiere un abordaje integral en el cual una alimentación adecuada complemente el TARV.
Rhinosinusitis in children with acute respiratory infection: quality of life and features of drug therapy
Authors: Krivopalov Alexander A. , Ryazantsev Sergey V. , Korkmazov Musos Yu. , Korkmazov Arsen M. , Lengina Maria A. , Kornova Natalia V.
Published: April 2024

BACKGROUND: The relevance of the study is due to limited information on the impact of various forms of rhinosinusitis that have arisen against the background of acute respiratory infection on the quality of life of children and effective treatment methods.
AIM: To conduct a clinical assessment of the effect on the recovery time and quality of life in children with acute rhinosinusitis and exacerbation of polypous rhinosinusitis that occurred against the background of a respiratory infection, including antiviral drugs in complex treatment in the early stages.
MATERIALS AND METHODS: A simple controlled randomized comparative clinical trial was conducted, involving 74 children aged 15 to 18 years. The clinical efficacy and safety of the use of antiviral drugs in complex therapy, which are neuraminidase inhibitors on the 5th, 7th and 10th days of treatment, were evaluated in comparison with groups receiving pentanedioic acid imidazolylethanamide. The inclusion criterion was acute rhinosinusitis and exacerbation of chronic polypous rhinosinusitis against the background of acute respiratory infection. To establish the diagnosis, an examination of ENT organs, computed tomography of the nose and paranasal sinuses were performed, patients subjectively assessed clinical complaints and quality of life in the Russian version of the standard form of the SF-36 questionnaire.
RESULTS: Positive dynamics was noted in the early stages in the 2nd subgroup of the 1st group who took neuraminidase inhibitors in addition to complex therapy. Manifested by a decrease in the average score for VAS to 80.0%, difficulty in nasal breathing to 1.7 points on the 10th day of treatment, relative to those taking imidazolylethanamide pentanedioic acid, where there was a decrease in the average score for VAS by 22.4%, difficulty in nasal breathing to 2.54 points. A similar pattern was observed with nasal congestion, rhinorrhea, and quality of life indicators according to the SF-36 questionnaires.
CONCLUSION: Improvement of clinical symptoms and quality of life indicators at an earlier date in children with polypous rhinosinusitis and acute rhinosinusitis against the background of a previous respiratory infection with the inclusion of neuraminidase inhibitors in complex therapy confirmed higher efficacy.
Investigating Relationships Between Inhibitory Control Challenges and Anxiety Symptomatology in Autistic Adults
Authors:   , O'Brien Meghan , Raitano Lee Nancy
Published: April 2024

Autism Spectrum Disorder (ASD) is associated with elevated rates of mental health difficulties and executive function (EF) challenges. However, research on these constructs and the relation between them is limited in adulthood. There is emerging evidence that EF challenges are associated with suboptimal mental health; however, the relationship between aspects of EF (e.g., inhibitory control) and mental health (e.g., anxiety) has not been explored across adulthood in ASD. The current study seeks to bridge this gap in knowledge. Drawing upon archival data from 732 autistic adults (436 females; 18.2-83.3 years) who participated in a larger study of adult outcomes in ASD, this study examined whether autistic adults experience elevated difficulties in inhibitory control (as measured via self-report on the Barkley Deficits in Executive Functioning Scale (BDEFS) Self-Restraint subscale) relative to normative expectations. It also examined whether sex and suspected co-occurring ADHD (as measured by the Adult ADHD Self-Report Scale, A-ASRS) moderate the degree of inhibitory control challenges experienced. In addition, this research examined relations between inhibitory control challenges and self-reported anxiety symptoms (as measured via self-report using the General Anxiety Disorder 7-item scale, GAD-7, a screener for generalized anxiety symptoms). Finally, sex assigned at birth and suspected ADHD status were evaluated as moderators of this relationship. Scores on the inhibitory control measure significantly diverged from normative expectations (i.e., autistic adults endorsed significantly more challenges in inhibitory control relative to published norms from the general population). Participants assigned female at birth showed more impairment in inhibitory control relative to normative expectations for their sex than participants assigned male at birth. Participants suspected to have co-occurring ADHD reported more inhibitory control challenges than those not suspected to have ADHD. Greater endorsement of inhibitory control challenges was associated with greater anxiety symptomatology, and this relationship was moderated by suspected ADHD status, but not by sex assigned at birth. These results show that inhibitory control challenges are an area of difficulty in this group and are associated with increased anxiety symptomatology, suggesting that inhibitory control may be a valuable intervention target to improve emotional well-being in autistic adults.
Tokat İli Patates Üretim Alanlarında Patates Yumrularında Enfeksiyon Oluşturan Virüslerin Moleküler Olarak Tespiti
Authors: Engür Afide Merve , Topkaya Şerife
Published: April 2024

Tokat ilinde patates yetiştiriciliği yapılan Niksar, Erbaa ve Artova ilçelerindeki patates üretim alanlarından virüs belirtisi gösteren patates bitkilerinden 91 adet yumru örneği toplanmıştır. Yumru örnekleri, potato virus Y (PVY), potato virus S (PVS), potato virus X (PVX) ve potato leafroll virus (PLRV) etmenlerinin varlığını tespit etmek amacıyla RT-PCR testine tabi tutulmuştur. Test edilen yumru örneklerinin 68 tanesinde (%74.72) tekli ve ya karışık virüs enfeksiyonun varlığı tespit edilmiştir. Çimlendirilen 91 yumrunun 67’i PVY (%73.62), altısı PVS (%6.59) ve 1 tanesi de PLRV (%1.09) ile enfekteli bulunmuştur. Ayrıca PVS ile enfekteli bulunan yumrulardan 5 tanesinde PVY+PVS karışık enfeksiyonu belirlenirken, PLRV ile enfekteli yumruda da PVY enfeksiyonu tespit edilmiştir. Tokat ilinde farklı ilçelerden toplanan yumrularda en yaygın PVY görülürken bunu PVS’ in izlediği belirlenmiştir. Tohumluk olarak kullanılan enfekteli yumrular yıldan yıla verimde ciddi kayıplara neden olmakta ve kaybın önüne geçilmesinde virüsten ari ve sertifikalı tohumlukların kullanılması en önemli faktördür.
A Simple Handshake: Public Schools for Amish Students in a Lancaster County, Pennsylvania, School District, 1953–1994
Authors: Frick Robert A. , Nolt Steven M.
Published: April 2024

Public school consolidation during the 1950s and 1960s in Lancaster and Chester Counties, Pennsylvania, sparked an exodus of Amish children from the area’s public schools and the establishment of Amish schools. The politics of consolidation in one location, however, resulted in a unique arrangement whereby the Lampeter-Strasburg School District, formed in 1953 in southcentral Lancaster County, operated two one-room schools for Amish residents of the district for more than forty years. The positive relationship between Amish families and public school leaders exemplifies the possibility of comity and cooperation in contrast to the narrative of discord and conflict around Amish schooling in the mid-twentieth-century.
Editors’ Introduction
Authors: Donnermeyer Joseph F. , Nolt Steven M.
Published: April 2024

No abstract available.
Igou, Amish Voices: A Collection of Amish Writings; Igou, Amish Voices, Volume 2: In Their Own Words, 1993–2020
Authors: Miller Wayne R.
Published: April 2024

No abstract available.
Earl H. and Anita F. Hess Archives and Special Collections
Authors: Grove Rohrbaugh Rachel
Published: April 2024

No abstract available.
Front Matter
Authors: Donnermeyer Joseph F. , Kraybill Donald B. , Louden Mark L. , Nolt Cynthia L. , Nolt Steven M. , Yoder Marcus A.
Published: April 2024

No abstract available.
Load Pushing Capacity Analysis of Individual and Multi-Cooperative Mobile Robot through Symbiotic Application
Authors: Fernando Arvin H. , Guillermo Marielet A. , Lim Laurence A. Gan , Bandala Argel A. , Vicerra Ryan Rhay P. , Dadios Elmer P. , Naguib Raouf N. G.
Published: April 2024

Certain missions require multiple mobile robots working together to accomplish it. There is a need, however, to determine the optimal configuration of modular mobile robots doing cooperative tasks to ensure high utilization and efficiency rate of the individual robot. This study proposed the use of a biosystem-inspired approach in assessing the influence of multiple robots on each other in performing a cooperative pushing task. The kinematics of pushing interaction at a single contact point was first discussed in the study to provide a solid foundation of the mission to be analyzed. Various dimensions in an experimental setup were also covered to better understand how these contribute to planar pushing. Through the resulting symbiotic coefficient, the study was able to determine the optimal configuration among the two, four, and six wheeled mobile robots pushing an object with various loads. While the dominant coefficient for symbiotic relationship was classified as beneficial and only one was neutral, the decline in coefficient values of the 3rd configuration (six wheeled) with respect to the 2nd configuration (4 wheeled) implies possible negative coefficient in the next configuration (8 wheeled). The maximum level of distance at which an object can be pushed was also obtained. This was called the state of plateau wherein adding another module is no longer suggested as it will not improve the pushing capacity any further. Knowing these key points significantly helps in ensuring cost and work efficiency of a given configuration in performing different missions.
The Universal Symbolism of River Narratives in Modern Literature
Authors: García Alvaro R.
Published: April 2024

This article analyzes the use of river narratives as a symbol in literature from various regions of the world. Through the examination of works by authors such as Manuel María Madiedo (Colombia), George Eliot (United Kingdom), and Zhang Chengzhi (China), this paper demonstrates the universal nature of river symbolism and how it reflects human experiences and social realities. The authors employ literary techniques such as foreshadowing, symbolism, and metaphor to convey multifaceted images of the region and its people, exploring larger societal issues such as the struggle for individual agency, national identity, and cultural ideals. Ultimately, this paper argues that river narratives have the potential to resonate with the collective consciousness, contributing to a broader dialogue between Colombian and world literature.
Recent Challenges for Foreign English Teachers in Japan
Authors: Long Robert William , Zhang Rong
Published: April 2024

Japanese students are suffering from English learning. Data show that Japanese students fail to demonstrate desirable English proficiency despite decades-long efforts and promotion from the Japanese government. Foreign (native) teachers have helped with the development of English teaching in Japan in many respects, serving not only as teachers conveying language knowledge to students but also as representatives of foreign cultures helping students to appreciate incentives to learn about intercultural communication. The main emphasis of this study is to identify the problems with foreign English teachers in Japan to see whether there are any commonalities in the opinions of foreign EFL teachers related to cross-cultural challenges, labor concerns, workloads/working conditions, psychological and emotional well-being, which may have a negative impact on English education. The findings of surveys and semi-conducted interviews revealed that teachers’ perceptions of their teaching approaches were generally acceptable and unproblematic, and they seem to have received fair evaluation and support from their colleagues. The stress and demands on teachers were often excessive with increased administration, which consumed the energy of English teachers while not contributing to the improvement of teaching effectiveness. Although foreign teachers generally have positive outlooks on their own experience, their advice tends not to be taken seriously or given credit for their innovations or accomplishments. Cultural conflicts sometimes cause trouble for them. Foreign teachers should learn about Japanese culture and try to change their perspective in thinking to achieve a better understanding of intercultural communication.
Exploring Standard English: Its Superposed Variety, Historical Development, and Social Implications
Authors: Yan Qianwen , Ruan Hongmei
Published: April 2024

The English we learn in the classroom is called “Standard English”. In fact, Standard English is just one of the many dialectal variants of English. Although Standard English has a significant number of speakers in the UK, its relationship to other language variants of English is similar to that between Mandarin and the various dialects in China. Standard English is acknowledged as a superposed variant considering its development in the history and social context. This thesis will attempt to identify the historical and social factors that promote the continuous development and spread of Standard English through a comprehensive literature review and qualitative research, and explore the social and cultural implications of using Standard English as the normative standard.
A Preliminary Study on the Usage Behavior Pattern and Needs of the Ground Floor Entrance and Exit Section of a Detached House: Take Lǐ-Siǎng Community in Tainan as an Example to Discuss
Authors: Huang Shu-li , Tzeng Szu-yu
Published: April 2024

“Arcade (Ding-a-ka)” has been discussed in the context of Taiwan’s indigenization and modernization. In the past research. The research results include: Historical aspect’s study of planning codes and spatial form for Arcades. And other street preservation issues etc. Our research found that on the one hand, “Arcade” and “Dwelling” are related. On the other hand, it is a public space that extends from environmental-behavior. This research paper discusses the environment-behavior of dwellers in urban growth boundary. The scope of this article is to use the method of architectural facade space’s case analysis and semi-structured interviews for residents. The purpose of the study is to discover the housing with different attributes on the architectural fa-cade space’s arcade, whether it will be influenced by the usage behavior and needs or it will arise the privatization of the public sphere elements. Discuss the community repair activities by the users of the architectural fa-cade space. The anticipated research contributions are understanding the disappearance of dwellers in history through “Arcade” and “Ding-a-ka” review. And how to get fieldwork information of public sphere through grounded theory (open coding) and environment-behavior. Access to a different kind of public domain in Taiwan community discussion than in the west theory.
Multi-loop Aquaponics Systems: A Review and Proposed Multi-loop Agrogeological Aquaponics System
Authors: Mahkeswaran R. , Ng Andrew Keong , Toh Chris , Toh Brendan
Published: April 2024

The achievement of the second sustainability development goal, targeting zero hunger by 2030, faces considerable challenges if the current food security landscape persists. Traditional agricultural practices remain inefficient and compete for space with the expanding global population. In contrast, urban agriculture presents a more resource-efficient and high-yield alternative by exploring soilless or alternative growing mediums in urban areas. Among the urban farming methods, aquaponics emerges as a noteworthy technique. A recent development in decoupled or multi-loop aquaponics systems aims to address the shortcomings of traditional systems. This paper, therefore, reviews various implementations of multi-loop aquaponics systems in literature, delving into their advantages and limitations. Incorporation of agrogeology into multi-loop aquaponics systems is potentially a strategy to tackle potential nutrient deficiencies that aquaponics systems may encounter. The design and construction of a proposed conceptual multi-loop aquaponics system with agrogeology are presented and discussed with suggestions for future research and development.
Comparative study on outcome of intralesional steroid and combination of intralesional steroid with 5-fluorouracil in keloid treatment
Authors: Augustine Thara , Murali Biju
Published: April 2024

Background: Though the definitive management of keloids are not yet established, many treatment modalities have been described which are being used alone or in combination all over the world with some promise. This study aims to assess the effect of intralesional steroids and 5-fluorouracil (5-FU) in the treatment of keloids.
Methods: The study included 40 patients with keloids, out of which 20 received 6 doses of intralesional steroid and the other 20 received alternating three doses of intralesional steroid and three doses of 5-FU. The size of the keloid and the POSAS (Patient observer scar assessment scale) score were marked on the proforma and the patient was reassessed after 6 months. The decrease in volume and POSAS score was statistically analysed using paired and unpaired t tests. 
Results: There is a statistically significant decrease in POSAS score after intervention in both the steroid and steroid+5 FU groups. However, the decrease in POSAS score is significantly more in the group that received steroids alone. The group that received steroids had a greater decrease in volume (50% reduction) compared to the group that received the steroid-5FU combination (27% reduction).
Conclusions: There is a statistically significant decrease in POSAS score after intervention in both the steroid and steroid+5 FU groups. However, the decrease in POSAS score is significantly more in the group that received steroids than the group that received steroid-5 FU combination.
Outcome of stapled haemorrhoidopexy versus open haemorrhoidectomy in grade third and fourth haemorrhoids
Authors: Gani Mubashir , Illahi Mir Fazil , Wani Rauf A. , Chowdri Nisar Ahmad
Published: April 2024

Background: Haemorrhoids are one of the most common benign anorectal problems worldwide.
Methods: This study was conducted in the department of General Surgery, Sher e Kashmir Institute of Medical Sciences and SKIMS Medical College from April 2021 to October 2022. The study included 80 patients which were randomly divided into two groups. Group A was offered Stapled Haemorrhoidopexy and Group B underwent open hemorrhoidectomy. All relevant data was collected and final inferences were drawn
Results: In our study there were 80 patients with mean age of 45 years with male preponderance. Majority of patients were having duration of symptoms for 6-12 or >12 months. The most common presenting complaint was prolapsed mass, followed by bleeding per rectum. 50 patients had grade 3, 30 patients had grade 4 haemorrhoids. Mean operative blood loss, operative time, wound healing time and mean duration of hospital stay was less in MIPH group. Post procedure complications were present in 12 patients in group A and 32 patients in group B. Most common complication in group B was urinary retention. There was no recurrence in both groups up to 6 months. Post-operative pain was significantly less in MIPH group.
Conclusions: Stapled Haemorrhoidopexy has less, post-operative pain, operative time, hospital stay, complications and less wound healing time. However, there is no significant difference in long term complications when compared with Miligan-Morgan technique. Cost of Stapler gun used for MIPH may be a limiting factor.
Clinical insights into liver abscess: a comprehensive analysis of presentation, etiology and management in Northeastern India, Silchar, Assam
Authors: Venugopal Vivek , Mazumder Asik Ikbal , Pal Dipankar
Published: April 2024

Hepatic abscess is a prevalent disease in Northeastern India with a myriad clinical feature. The present study is aimed to understand the clinical profile, microbiological aetiologies, and management outcomes in patients with hepatic abscesses in Northeastern India, Silchar. In the surgery department of Silchar medical college and hospital, 20 cases of hepatic abscess were studied from January 2022 to October 2023. Records were kept for history, examination, and laboratory investigations. Ultrasound-guided aspiration of the abscess was done, and samples were subject to relevant investigation. The mean age of patients was 33 years, 2/3rd of the patients were from lower socioeconomic status. Alcoholic history was elicited from 45% of the patients. The abscesses were predominantly in the right lobe (70%) and solitary (65%). Etiology of the cases, 55% amoebic, 40% pyogenic, and 5% were tubercular in origin. Pigtail catheterization was done in 70% of the patients; percutaneous needle aspiration was done in 25% of the cases. No cases of mortality were noted. Amoebic and tubercular abscess were solitary in nature whereas pyogenic abscesses were multiple. The amoebic and pyogenic abscess had right lobe predominantly affected whereas in tubercular abscesses left lobe involvement was more common. The most common presentation was young male of low socioeconomic status having solitary amoebic abscess usually in the right lobe of liver
True pylorus duplication: a case report
Authors: Mandora Hala H. , Al Nafisah Turki I. , Bamajboor Abdullah Y.
Published: April 2024

True pylorus duplication cysts are particularly rare, the literature describes only a small number of cases. They account for nearly 2.2% of all alimentary tract duplications. Most of the gastric duplications presents at an age younger than one year with one-third diagnosed in the neonatal period. However, they are not limited to that period. We report a case of a true pyloric duplication cyst in a 3-year-old girl who had been experiencing frequent vomiting with occasional abdominal pain for about 15 days prior to her presentation. The patient had an abdominal ultrasound that showed an epigastric cystic mass. CT of the abdomen demonstrated a 3.8×3.8 cm mass with a claw sign proximal to the first part duodenum. The diagnosis of pyloric duplication cyst was confirmed during the operation and with the histopathological examination following the resection. The patient is doing well with an appropriate weight gain at the follow-up appointments. The patient is doing well with an appropriate weight gain at the follow-up appointments. In summary, this is an an unusual case of gastric outlet obstruction that presented outside the usual age period caused by a pyloric duplication cyst. Imaging studies including US and CT are useful aids in the diagnoses of gastrointestinal duplication cysts.
One-step approach by enterolithotomy as surgical treatment of biliary ileus associated with bridle: case report and literature review
Authors: Blaz Zavala Rogelio A. , Trejo Sandra Lara , Cerda Abril E. Gracia , Chávez David J. Ampudia
Published: April 2024

Gallstone ileus is a rare cause of intestinal obstruction, more common in adults and in the context of late complications due to gallbladder stones. The pathophysiology describes long-term inflammatory processes of the gallbladder, with biliodigestive fistula development and passage of the gallstone into the intestine, impacting the terminal ileum in most cases. It manifests with data of intestinal obstruction in patients with a chronic history of gallbladder lithiasis. The ideal imaging study is a computed tomography (CT) scan of the abdomen to identify pneumobilia, intestinal obstruction and the lithiasis impacting on the bowel. The surgical approach depends on the context of each patient through laparoscopy or laparotomy in order to perform enterotomy and extraction of the stone or by performing also the management of the fistula and cholecystectomy at the same surgical time. Management must be individualized for each patient. We present the case of a patient in her tenth decade of life with a history of recurrent biliary colic without management, who was admitted to the general surgery department with data of probable intestinal occlusion. Imaging studies were performed, with radiographic evidence of distension of the small bowel loops and tomography with findings suggestive of biliary ileus. Due to the clinical context and comorbidities of the patient, laparotomy with enterotomy and extraction of the stone was performed.
Laparoscopic sleeve gastrectomy in a young female with Guillain-Barré syndrome and situs inversus totalis: a case report
Authors: Almalki Owaid M.
Published: April 2024

Laparoscopic sleeve gastrectomy (LSG) has emerged as a prominent bariatric surgery (BS) procedure due to its efficacy in weight reduction and improvement of associated co-morbidities. Although BS can be an underlying cause of Guillain-Barré syndrome (GBS), it's influence on those with a history of GBS remains uncertain. GBS is a rare autoimmune disorder characterized by symmetrical muscle weakness, and its coexistence with situs inversus totalis (SIT), a congenital condition involving mirrored organ placement, poses unique surgical challenges. We present a case of a 24-year-old female with a history of GBS and SIT seeking LSG for obesity management. Preoperative assessment involved multidisciplinary collaboration, and surgical adaptation was necessary due to anatomical anomalies. Trocar placement mirrored organ positions, facilitating successful surgery. Postoperative recovery was uneventful. At the one-year follow-up, she had a discernible improvement in the weakness that she expressed in her lower limbs. Obesity exacerbates GBS-related complications, necessitating careful consideration of surgical interventions. SIT presents technical challenges during laparoscopic procedures, demanding surgical expertise. Multidisciplinary assessment and surgical adaptation are crucial for optimizing outcomes. This case demonstrates the successful management of obesity in a patient with GBS and SIT through LSG, highlighting the importance of a comprehensive approach and surgical adaptation. LSG proves effective in promoting weight loss and improving mobility in such complex cases. Continued documentation of unique cases is essential for guiding future interventions in this challenging patient population.
Multiple spinal schwannomas of multiple intradural extramedullary tumors: a case report
Authors: Mewara Deepak , Jain Vartika , Hritika  , Gupta Abhishek Kumar , Singh Nisha , Kundan  , Shukla Shiwani , Kumar Pintu
Published: April 2024

We describe the case of a 30-year-old male patient who was brought to the hospital's general surgery department with a four-month history of low back pain, numbness, and paraesthesia in both legs, history of weakness in both legs is also present. Magnetic resonance imaging revealed multiple Intradural extramedullary tumors at the C3/C4, D1-D2, D4, and D8 levels- likely nerve sheath tumors (schwannomas). The patient underwent surgery for the removal of tumors. The diagnosis was validated by histopathological examination. Post-operative recovery was uneventful and the patient improved gradually and recovered fully in 10-15 days.
Severe hypoalbuminemia complicating a successful atrial switch operation (Senning) with cardiopulmonary bypass - report on a rare case
Authors: Datt Vishnu , Datt Diksha , Agarwal Vijay , Yadav Bharti , Vachhani Parth
Published: April 2024

Post-operative hypoalbuminemia has been reported in 12% of neonates and 20% of infants; 97% occurs in the first 48 hours in neonates and infants undergoing cardiac surgery with cardiopulmonary bypass (CPB). Perioperative hypoalbuminemia is not independently associated with any post-operative morbidity. However, when analysed as a continuous variable, lower serum albumin levels have been reported to be associated with increased post-operative morbidity. Pre-operative low serum albumin level is independently associated with increased odds of post-operative hypoalbuminemia, and prolonged length of hospital stay. Immediate post-CPB (0-24 hour), lower serum albumin level is independently associated with an increased duration of mechanical ventilation. There is a relative paucity of literature on the impact of hypoalbuminemia in the paediatric population. Hypoalbuminemia is a marker of poor outcome in critically ill children and those undergoing a wide range of medical interventions. Albumin infusions may be an effective therapy for fluid resuscitation and for patients with severe hypoalbuminemia. We present a successful perioperative management of a 3 months old-male child, weighing 3.5 kg with dextro-transposition of great arteries (D-TGA) with regressed LV undergoing an atrial switch (Senning) procedure, and uneventful intraoperative course i.e. easy weaning from CPB. However, in the ICU, the baby suffered an unusual complication as severe hypoproteinaemia resulting in acute kidney injury (AKI) with complete anuria, generalized anasarca, hypotension requiring inotropes and vasopressors, and difficult weaning from ventilator.
The use of arthroscopy in diagnosing and treating sports-related cartilage lesions
Authors: Al Mamun Abdullah , Al Muti Abdullah , Monir M. Moniruzzaman , Hannan Abdul , Rahman M. Mofizur
Published: April 2024

Background: Sports-related cartilage lesions pose challenges for athletes. Cartilage, vital for smooth joint movement, can be damaged. Arthroscopy, a minimally invasive procedure, allows precise diagnosis and treatment of joint issues, offering quicker recovery and minimal scarring, enhancing orthopedic interventions. This study aimed to assess the use of arthroscopy in diagnosing and treating sports-related cartilage lesions.
Methods: This prospective observational study was conducted at the department of orthopaedics and traumatology, Life Line Hospital Moulovibazar, Mount Adora Hospital Sylhet, MAG Osmani Medical College Hospital Sylhet, Bangladesh from January 2022 to December 2023. As the study subjects, a total of 58 patients with non-surgically treated acute or chronic sports-related cartilage lesions were enrolled by using a purposive sampling technique. After 6 months, a follow-up report was recorded. Data were analyzed by using Microsoft Office tools.
Results: In this study, 72% of participants underwent cuff repair, with the remaining 28% opting for loop repair. The arthroscopic assessment revealed anterior medial cartilage lesions in 34% and anterior lateral lesions in 28%. Posterior medial, posterior lateral, and mid-talus dome cartilage lesions were observed in 17%, 5%, and 16%, respectively. Capsule repair was employed in 86% of cases. Significant improvement in hip range of motion, as well as radiological parameters like lateral center-edge angle, alpha angle (anteroposterior), and alpha angle (Dunn), was observed 6 months postoperatively (p<0.001).
Conclusions: In detecting and treating sports-related cartilage lesions, arthroscopy is an effective method. This minimally invasive less painful treatment approach contributes to faster rehabilitation and a quicker return to normal activities.
Physical examination, magnetic resonance imaging and the arthroscopy of the shoulder: a correlation of diagnostic tests
Authors: Canchan Jose E. , Camara Felipe , Martinez Felipe , Bobadilla Guillermo , Trujillo Eduardo , Esperon Ramon
Published: April 2024

Background: Shoulder pathology is the third cause of consultation for musculoskeletal disorders; it is a cause of disability and economic losses. The gold standard for its diagnosis and treatment is arthroscopy. However, arthroscopy is an invasive diagnostic technique. Therefore, clinical and imaging methods may be useful as diagnostic techniques before considering arthroscopy. Nevertheless, these non-surgical diagnostic methods may present a poor correlation in diagnostic accuracy when compared to the arthroscopic diagnostic method in the context of shoulder pathology.
Methods: A retrospective study including 123 patients who presented shoulder complains, underwent physical examination and a shoulder magnetic resonance imaging (MRI) study prior to a shoulder arthroscopy. A clinical correlation was made using the kappa index, sensitivity and specificity of the clinical and imaging tests were also calculated.
Results: The correlation between arthroscopy and the clinical assessment showed a kappa index of 0.25 for rotator cuff injuries, 0.41 biceps pathology, 0.51 sub acromial impingement, 0.51 acromioclavicular arthrosis, 0.28 for SLAP injury. MRI diagnostic method showed a kappa correlation of 0.24 for rotator cuff injuries, 0.59 biceps pathology, 0.39 sub acromial impingement, 0.46 acromioclavicular arthrosis and 0.34 for superior labral anterior posterior (SLAP) injury.
Conclusions: After comparing arthroscopy with clinical assessment and the MRI diagnostic method we found that clinical assessment is useful to diagnose biceps pathologies, subacromial impingement, and acromioclavicular arthrosis. On the other hand, MRI studies and diagnosis made by a radiologist showed to be a valuable tool for the diagnosis of biceps pathology and acromioclavicular arthrosis.
Comparison of pain relief among patients with chronic plantar fasciitis treated with intralesional platelet-rich plasma injection versus corticosteroid injection in a tertiary care centre in Kerala - a prospective study
Authors: Christhudasan Chrisphin C. , Thangaraja Acksen , Hameed Hany
Published: April 2024

Background: Aim of the study was to compare pain relief and functional outcome and between intralesional autologous platelet rich plasma injection (PRP) versus corticosteroid injection in the treatment of plantar, and fasciitis by using visual analogue score and American Orthopaedic Foot and Ankle Society (AOFAS) score.
Methods: The sample size for the study was 30 patients attending Dr. Somervell Memorial CSI Medical College. Patients were divided into two groups (PRP versus steroid) of 15 each. The study follows a prospective observational design with follow up at 2 weeks, 2 months and 3 months post procedure. The functional outcome of patients in each group was assessed using the visual analog scale and AOFAS score.
Results: Post-procedure, a significant decrease in VAS score was seen in patients treated with PRP injection (8.73 to 2.27) than those treated with Steroid injection (8.8 to 3.53). Also, there was a significant improvement in the AOFAS score from 72.73 to 88.67 while for those patients treated with steroid injection, the AOFAS score was comparatively low (65.87 to 82.2).
Conclusions: Plantar fasciitis is a prevalent condition in our community, and many treatment options typically offer only temporary relief from symptoms. Intralesional PRP injection emerges as a dependable treatment method that fosters the healing process of the affected fascia, resulting in improved functional outcomes. Our study indicates that a singular administration of platelet-rich plasma injection for plantar fasciitis yields substantial pain relief compared to the local steroid injection.
Comparison of Singh’s index in view of osteoporosis in patient with in tertrochanteric fracture and intracapsular fracture
Authors: Basha Mohammed Jaan , Mansufa Hunaina , Mohiuddin Mohammed Jalal , Salman Sajid , Shamsunder C.
Published: April 2024

Background: Osteoporosis is a progressive, systemic, skeletal disease with low bone mass. Diagnosing osteoporosis in practice is a major challenge, where resources are limited and costly. Measurement of osteoporosis through Singh’s index in proximal femur fracture patients is consistent with Bone Mineral Density estimation like DEXA scan. Singh’s index is a reliable, reproducible and easily available investigation for osteoporosis. The aim of this study is to evaluate the Singh’s index of the patients with inter-trochanteric and intra-capsular fracture.
Methods: A retrospective observational study of 20 IT and IC fracture each. Singh’s index evaluated from the X-rays at time of fracture presentation. Other required information collected at presentation.
Results: Out of 40 Patients, 6 had Singh's Index Grade 1 (15%), 11 had Grade 2 (27.5%), 10 had Grade 3 (25%), 7 had Grade 4 (17.5%), 6 had Grade 5 (15%), 0 Patients had Singh’s index Grade 6. There was no noticeable significant variation in relation of gender with the type of fracture. Patients with higher age tend to have a lower grade of Singh’s index.
Conclusions: Singh’s Index indeed represents bone quality and a fall in the grades predisposes to fractures. Inter trochanteric fractures are common in the older age group with poor Singh’s index (<3) compared to the relatively younger age group with Singh’s index around 3. Gender, exercise, history of hypertension and diabetes, sunlight exposure, etc. has no significant impact on Singh's Index. Age is deciding factor for Singh’s Index.
Chondral lesion of the patella in a junior football player: chondral-only fragment fixation
Authors: Seiça Emanuel C. , Armada Lucas , Canhoto Joana , Santos Hugo Vaz dos , Viegas Rui , Barbosa Luís
Published: April 2024

Chondral lesions of the patella are a relatively common pathology that can cause pain and impairment in active young individuals. These lesions can have lifelong consequences, with increased risk of osteoarthritis in some cases. Surgical excision of medium to large fragments is associated with poor long-term outcomes. There is a general belief that fixation of purely chondral lesions in the absences of subchondral bone is associated with low integration rates, however recent case reports and basic science studies have been challenging this belief. In this case report, we describe a young patient with a chondral lesion of the patella and a fragment without subchondral bone, who underwent open fragment reduction and fixation using bioabsorbable pins. The patient had a successful outcome with significant fast improvement in pain and function and full return to practice. This case highlights the potential benefits of conservative surgical management with preservation of the native cartilage, even in the absence of subchondral bone, especially in the young active patient.
A case of primary skeletal muscle lymphoma mimicking cellulitis
Authors: Sahu Alok
Published: April 2024

Primary skeletal muscle lymphoma is a rare entity. Their presentation can be easily confused with a wide variety of inflammatory conditions, neoplasia as well as infectious diseases. We came across a 65-year-old lady who presented to us with complains of pain and swelling in the right thigh, leg and foot and fever-on and off for 20 days. She was initially managed elsewhere on the line of cellulitis with incision and drainage of right leg 15 days back but there had been no clinical improvement. We took her detailed history and examined her thoroughly. Relevant blood investigations were sent. However, the clinical examination findings and history were suggestive of an infective cause, blood investigations were suggestive of an acute inflammatory pathology, whereas radiological investigations (NCCT and X-ray) and cytological investigations (FNAC) which were performed at the previous place of treatment were inconclusive. We then did a CE-MRI of the right lower limb which showed centrally necrotic, enhancing mass lesion involving peroneal muscles with multiple enlarged inguinal and popliteal lymph nodes. Based on this finding, biopsy was performed and specimen was sent for histopathological examination which revealed “malignant small round cell tumor”. Immunohistochemistry was then done and tumor cells were found to be positive for vimentin, LCA, CD20 and negative for PANCK and CD3. Based on the above findings it was diagnosed as “non-hodgkin’s lymphoma (NHL) B-cell type” of right leg. Considering the confusing clinical presentation of this entity and inconclusiveness of blood and basic radiological investigations, lesions of extremities presenting with features of cellulitis must be carefully assessed.
One year old misdiagnosed penetrating injury of sacrum with a retained knife: a case report and review of literature
Authors: Kumar Anand , Meena Umesh Kumar , Meena Ram Prasad , Karir Ekaansh
Published: April 2024

Penetrating injuries to the spine, although less common than blunt trauma from motor vehicle accidents, are important causes of injury to the spinal cord. They are essentially of two varieties-gunshot or stab wounds. Gunshot injuries to the spine are more commonly described and are associated with a higher incidence of neurological damage. On the contrary, the prognosis is better in stab wounds where surgery plays a greater role. Here we report a case of a 31 year old male with a history of penetrating injury with knife in lower back 1 year ago comes with complaints of pain and pus discharge since 2 weeks. On detailed history taking, clinical examination and investigations it was found that knife was left in situ which was causing symptoms. Surgical exploration was done. Foreign body (knife) was removed keeping all the neurovascular complications in check. Post operatively patient is doing good with no neurological deficits. A timely intervention in removing foreign body is necessary for preventing for complications.
Functional outcome in case of surgically and conservatively treated bilateral distal end radius and scaphoid fracture: a rare case report
Authors: Sadar Amey , Roy Mainak , Das Deepanjan , Aradhya Bhikshavarthi Math Suhas , Dwidmuthe Samir , Sah Saurabh
Published: April 2024

Bilateral fractures of the distal radius and scaphoid are extremely rare injuries. Proper preoperative evaluation is a must to know the orientation of the fracture. Treatment must be based on displacement of the fracture. If fracture is displaced, internal fixation is needed but if its stable with minimal displacement, we can conserve it. A patient with displaced distal radius fractures and displaced scaphoid fracture on one side, along with displaced distal end radius fracture and undisplaced scaphoid fracture on the other side, was treated via internal fixation of the scaphoid fractures with Herbert screws and internal fixation of the distal radius fractures with locked volar plating on the right side and below elbow cast in cup holding position on the left side which was non-dominant. The approach to treating fractures hinges on several factors: the specific location and alignment of the fracture, the patient's characteristics, and the surgeon's expertise. For fractures in the distal radius and scaphoid, employing a rigid internal fixation method allows for the early initiation of active wrist rehabilitation, eliminating the necessity for wrist immobilization using a plaster cast or external skeletal fixation. On the other hand, a conservative treatment approach involving a below-elbow cast offers certain advantages, such as minimal blood loss and fewer complications related to wound healing, particularly for undisplaced fractures, especially when they occur in the non-dominant hand.
Initiating the EFL University Students' Critical Thinking in Oral Mode through Pragma-Stylistic Strategies
Authors: Andania Ruqoyyah Amilia , Romadhoni Mohammad , Nita Fatma Rahayu , Setiawan Slamet , Yen Ai-Chun
Published: April 2024

Critical Thinking (Hereafter, CT) significantly correlates to the EFL students' speaking ability; students with high critical thinking perform better than students with low critical thinking. Several strategies can be implemented for initiating CT in the classroom. One of them is using language style conveyed by the teachers. However, few studies concern about this pragma-stylistic usage in the teaching-learning process. Therefore, this current study aims to analyze (1) types of pragma-stylistics strategies used by teachers in initiating the EFL university students' CT in oral mode; (2) the ways teachers use pragma-stylistics strategies in initiating the EFL university students' CT in oral mode; and (3) the teachers' perception of the students' response towards initiating the CT in oral mode. Qualitative descriptive using Interview was conducted to collect the data.  The result showed that teachers prefer using Assertive-Stating, Assertive-Suggesting, Directive-Advising and Prolepsis strategies to initiate students' CT in their speaking classroom. They implement those strategies through some activities during the class, such as giving stimulus (text, audio, and video) in a particular theme, conducting group discussions or speaking club, providing instructions or questions, and giving feedback. Besides, the teachers pointed out that most students positively respond to the strategies that they have utilized. The strategies effectively motivate and encourage the students to enhance their CT. Furthermore, this study suggests language teachers initiate their students' CT through the pragma-stylistic strategies mentioned. Finally, further researchers are expected to discuss the same field in more comprehensive scopes with different language skills.