bluuebunny/crossref_metadata_2025 huggingface dataset:
P-40 A RARE PRESENTATION OF PROLONGED HYPOGLYCEMIA: CONGENITAL LEPTIN DEFICIENCY AND INSULIN INTOXICATION
Authors: Kargün Sinem
Published: January 2025

Introduction

Congenital leptin deficiency (CLD) is caused by mutations in the LEP gene with an incidence of 1 in 4.4 million, presenting with symptoms such as hyperphagia, obesity. Insulin intoxication is also a rare condition that usually occurs as a result of a suicide attempt or, a medication error. There is not an algorithm for the management of insulin intoxication. Here, we report the only case in the literature presenting with congenital leptin deficiency and insulin intoxication.

Clinical Case

A 33-year-old woman was admitted to the hospital with dizziness, nausea, and unconsciousness. She had applied nearly 300 IU insulin aspart of committing suicide. She had congenital leptin deficiency, hypothyroidism, and prediabetes. She had leptin replacement during 2020-2021 and didn’t have a replacement since then. Her body mass index was 62.2. Her blood pressure was 95/60 mm/Hg, Sp02 was 88 %, and heart rate was 120 per minute. Her blood glucose was 29 mg/dl, and there was respiratory acidosis. Liver and renal function tests, electrolytes, coagulation parameters, and thyroid hormones were normal. Chest x-ray and brain tomography were normal. Despite subsequent infusion of 20% dextrose solution via central catheter, serum glucose could only be kept at 70-80 mg/dl. In the following hours patient’s consciousness, pH level, and oxygen saturation returned to normal. We had to follow the patient with a high concentration of glucose (150-200cc/h %10 dextrose) for ten days because of reappearing hypoglycemia. On the 10th day of follow-up, we stopped IV glucose for a short time and measured the fasting hormones shown in Table 1. at 7.00 a.m. As there was hypocortisolemia, we applied 5mg prednisolone twice daily in the following days. Twenty-four hours after cortisol administration, we could easily stop the IV glucose. We followed the patient with 5mg prednisolone twice daily and oral carbohydrate intake for three days and didn’t observe hypoglycemia. Afterwards, we stopped prednisolone and the patient was normoglycemic for the following days. We again measured the fasting hormones shown in Table 2. At 7.00 a.m. three days after the last dose of prednisolone. The patient was not hypoglycemic or hypocortisolemic since then; vital parameters were all normal and we discharged the patient.

Conclusion

Prolonged hypoglycemia may have occurred in different mechanisms. Our patient had a thick subcutaneous fat tissue because of CLD; therefore, absorption of insulin may have increased and half life may be prolonged. Also, high dose exogenous insulin may have triggered the production of insulin antibodies causing prolonged duration of insulin action and hypoglycemia. Moreover, deep hypoglycemia may have affected the pituitary-adrenal cortisol axis causing relative adrenal insufficiency. The steroid decreased the insulin antibodies and also corrected the relative cortisol deficiency. More cases and data are needed to shed light on this subject.Table 1:  Table 2:
O-02 A RARE COLLISION TUMOR OF THE PITUITARY: CO-EXISTENCE OF CRANIOPHARYNGIOMA AND PROLACTINOMA
Authors: Uzun Ilknur , Hacioglu Aysa , Karaca Zuleyha , Unluhizarci Kursad , Okcesiz Izzet , Oral Şükrü , Selçuklu Ahmet
Published: January 2025

Introduction

Pituitary adenomas are the most common lesions of the sellar region. The most common (40%) functional pituitary adenomas are prolactinomas. Craniopharyngiomas are epithelial tumors of embryonal origin originating from Rathke's sac. Very few cases of collision tumors co-existing with pituitary adenoma and craniopharyngioma have been described in the literature.

Clinical Case

We present a case of histopathologically proven craniopharyngioma accompanying prolactinoma in a 63-year-old female patient diagnosed with prolactinoma 40 years ago. She was treated with bromocriptine after the diagnosis, and the treatment was switched to cabergoline four years later. Although the biochemical remission was achieved, there was no significant decrease in tumor size. She had not received any treatment during last 4 years before the administration. She was admitted to our clinic with a complaint of headache. Her serum prolactin level was 1550 ng/ml ((Reference:4,79-23 ng/ml). According to the pituitary Magnetic Resonans Imaging(MRI); reports were as follows in 2007; an isolated 8x6x13 mm adenoma was observed, and then in 2015; another cystic lesion (craniopharyngioma?) was detected adjacent to the infindibular stalk in addition to the defined pituitary adenoma (Figure 1a). In the last pituitary MRI (2022); a cystic lesion extending from the sellar cavity to the suprasellar cistern and a solid mass lesion located left to the cavernous sinus, was observed (Figure 1b). Upon a dramatic increase of the tumor volume on pituitary MRI, she underwent pituitary surgery. The histopathological diagnosis was adamantinomatous craniopharyngioma. Postoperative prolactin level decreased to 10 ng/ml. Since prolactin levels decreased after the diagnosis of craniopharyngioma, the surgical material was re-evaluated by the pathologist. No evidence of prolactinoma was found. Significant regression was observed in the patient's 1st month follow-up pituitary MRI compared to the preoperative MRI. Postoperatively, prolactin levels remained within the normal range for the first 6 months. After the 6th month, cabergoline treatment was started when prolactin levels increased to 497 ng/ml.

Conclusion

Pituitary adenoma and craniopharyngioma collision tumors are extremely rare. Only 6 patients with the coexistence of craniopharyngioma and prolactinoma have been reported in the literature, including our case. Histopathological diagnosis may be necessary to differentiate craniopharyngioma from cystic macroprolactinoma.Figure 1:Magnetic Resonans ImagingFigure 1: a. Post-contrast coronal pituitary MRI examination revealed a pituitary adenoma (thick arrow) located in the left cavernous sinus. aAnother cystic mass lesion (thin arrow) was detected adjacent to the infindibular stalk.; b. Coronal contrast-enhanced pituitary MRI image showed cystic (arrow) and
P-47 A CASE OF SPONTANEOUS REMISSION AFTER METYRAPONE IN CUSHING'S DISEASE
Authors: Tunç Ali , Muradov Ilkin , Sulu Cem , Çapar Mehmet Umut , Kadıoğlu Pınar
Published: January 2025

Introduction

Cushing's disease (CD) is characterized by exposure to cortisol excess and is caused by excessive secretion of adrenocorticotropic hormone (ACTH) from a pituitary adenoma. The diagnosis, management, and follow – up of patients with Cushing's disease pose significant challenge to clinicians, making it one of the most cumbersome condition in routine endocrinology practice. Here we report an unusual case of CD which underwent remission while on oral treatment.

Clinical Case

A 23-year-old male presented with hypertensive crisis and weight gain. He had a history of obesity and hypertension for the past eight years. Physical examination revealed central obesity, a buffalo hump, facial acne, and striae around the umbilicus. Initial laboratory tests showed basal cortisol levels of 9.9 and 11.56 µg/dl. Consecutive morning ACTH levels were 24 and 38 pg/ml. The 1 mg dexamethasone suppression test (DST) and the 2-day 2 mg DST showed no suppression (13 and 11 µg/dl, respectively). Urinary free cortisol and late night salivary cortisol levels were increased 2.3 and 3 folds, respectively. These results confirmed the ACTH – dependent cortisol excess.

In differential diagnosis of ACTH dependent Cushing’s syndrome, no adenoma detected by pituitary imaging, leading to inferior petrosal sinus sampling (IPSS). The results of IPSS suggested a pituitary source with a central to peripheral ratio greater than 3. Although the patient was referred for pituitary surgery, he did not provide consent for surgical intervention and preferred medical treatment. He was initially started ketoconazole and pasiretoide, but soon after switched to metyrapone due to market shortage of former drugs. The patient experienced a 6-month off period without metyrapone due to an earthquake. Remarkably, during this period without medical therapy, his blood pressure normalized without medication, and there was no recurrence of weight gain, acne, or buffalo hump. Subsequent laboratory tests showed a 1 mg DST result of 0.31 µg/dl, nocturnal serum cortisol of 1.03 µg/dl, and nocturnal salivary cortisol of 0.01 µg/dl (reference range: 0-0.14 µg/dl), and normal UFC levels.

Conclusion

Spontaneous remission in Cushing's disease is rare, with only a limited number of cases reported in the literature. There have been instances of spontaneous remission following metyrapone treatment. It is hypothesized that metyrapone inhibits steroidogenesis, reducing negative feedback on tumor cells and stimulating increased ACTH synthesis. The resultant increase in ACTH production may heighten the metabolic demands of corticotroph cells, potentially exceeding the blood supply to the pituitary gland, leading to spontaneous infarction of corticotroph cells and subsequent remission of Cushing's disease.
P-56 THE CASE OF SUBACUTE THYROIDITIS IN AN ELDERLY PATIENT MIMICKING MALIGNANCY
Authors: Rıza Baykal Gokhan , Keskin Müge , Özdemir Didem , Topaloğlu Oya , Ersoy Reyhan , Çakır Bekir
Published: January 2025

Introduction

Subacute thyroiditis is a self-limiting inflammatory thyroid disease characterized by fever, neck pain, and thyroid dysfunction. It typically appears following an upper respiratory tract viral infection. Most cases of subacute thyroiditis are diagnosed through clinical and laboratory testing. The thyroid gland is large, painful, and tender during thyroid examination. Blood tests typically reveal elevated levels of free T4 and free T3, as well as a significantly increased sedimentation rate and C-reactive protein (CRP). Ultrasonographic findings of subacute thyroiditis are well defined.

Clinical Case

A 68-year-old male was consulted by the anesthesia department before the endoscopy and colonoscopy procedure planned to screen for malignancy. He was very worried and afraid because of the possibility of cancer and was psychologically negatively affected. He presented with night sweats and 10 kg of weight loss in the last 6 weeks. He had no history of previous disease. When a detailed history was taken, he stated that he had severe pain in his neck before his complaints started and that it went away on its own after a few weeks. On examination, he had no fever, a heart rate of 90 beats per minute, and a blood pressure of 120/80 mmHg. Neck examination showed no thyromegaly or lymphadenopathy. The general and systemic examination was unremarkable. Laboratory investigations showed hemoglobin 12.2 g/dL, WBC 8380 (x109/L), erythrocyte sedimentation rate (ESR) 78 mm/hour, CRP 50.1 mg/L, thyroid stimulating hormone 0.08 mIU/L (N = 0.55 – 4.78 mIU/L), free t4 1.4 ng/dL (N = 0.89 – 1.76 ng/dL), free t3 4.34 ng/L (N = 2.3 - 4.2 ng/L), and negative anti-thyroid peroxidase and thyroid stimulating immunglobulin. Thyroid ultrasonography was suggestive for subacute thyroiditis. He was given NSAIDS. Since his free T4 and T3 levels were normal at follow-up, endocrinological approval was given for the planned procedures. It was recommended to have a beta blocker ready during the procedure if needed. No findings in favor of cancer were detected in the detailed examinations, and the weight loss was attributed to subacute thyroiditis.

Conclusion

When elderly patients have complaints of weight loss or fatigue, it is important to exclude thyrotoxicosis and make a diagnosis by performing the necessary examinations. Subacute thyroiditis may not be severe; it is easy to diagnose with careful history-taking and simple laboratory examinations, and clinicians should keep it in mind in the differential diagnosis of weight loss.
P-59 A CASE REPORT: A RARE CASE OF PAPILLARY THYROID CARCINOMA WITH BRAIN METASTASIS WITHOUT LOCAL RECURRENCE
Authors: Şakar Kenan , Altundal Aslı Akıncı , Şimşek Hakan , Cinar Nese
Published: January 2025

Introduction

Papillary thyroid carcinoma (PTC) is the most common type of thyroid malignancy and generally has an excellent prognosis. However, distant metastases, particularly to the brain, are rare and associated with poor outcomes. This case report presents a 67-year-old female patient with a history of PTC, who developed brain metastasis in the follow-up.

Clinical Case

A 67-year-old female patient presented four years ago with a rapidly growing 4 cm mass, extending from the right thyroid gland to the right jugular vein. Fine-needle aspiration biopsy (FNAB) of the lesion was reported as suspicious for follicular neoplasm. Ultrasound imaging revealed pathological lymphadenopathy in the bilateral cervical chains. The patient underwent total thyroidectomy and bilateral neck dissection. Pathology confirmed the diagnosis of the follicular variant of papillary thyroid carcinoma (PTC), with extrathyroidal extension into muscle and adipose tissue, as well as lymph node metastases.

After surgery, while the patient's TSH level was 68.6 µIU/ml, her thyroglobulin (Tg) level was 1.02 ng/ml, with negative anti-Tg antibodies. The patient received 150 mCi of radioactive iodine (RAI) approximately 3 months after surgery. One year after RAI therapy, a whole-body iodine scan showed no evidence of residual disease or metastasis. Follow-up Tg levels of the patient remained around 0.04 ng/ml. 3.5 years after surgery, there was a slight increase in thyroglobulin levels (0.26 ng/ml), although no recurrent disease was detected on ultrasound of the thyroid bed. The patient was planned to be under close surveillance but she did not come to visits regularly. The patient subsequently presented with complaints of imbalance and brain MRI revealed a mass lesion measuring 46x43x55 mm in the frontal region. The mass was surgically resected, and the pathology confirmed metastatic papillary thyroid carcinoma (PTC). A postoperative whole-body iodine scan was negative for metastatic disease. At that time, the TSH level was 0.5 µIU/ml, and thyroglobulin (Tg) was 0.04 ng/ml. Cranial radiotherapy was planned for the patient.

Conclusion

Approximately 10% of patients with PTC develop distant metastases, most commonly to the lungs and bones. Brain metastasis from PTC is extremely rare, occurring in less than 1% of cases. Due to its rarity, brain metastasis from PTC is not typically considered in the differential diagnosis for patients presenting with new neurological symptoms, potentially delaying diagnosis. Despite aggressive treatment, the prognosis for patients with PTC and brain metastasis remains poor, with a median survival of approximately 17 months. This case highlights the importance of considering the possibility of brain metastasis in high-risk PTC patients who present with neurological symptoms despite the lack of significant elevation in thyroglobulin (Tg) levels or evidence of recurrence on neck ultrasound.
P-76 UNEXPECTED RAISE OF PROCALCITONIN IN PATIENT WITH TREATED FOR DF INFECTION REVEALED MEDULLARY THYROID CANCER
Authors: Bublik Evgeniya , Vanushko Vladimir , Victorovna Shmyreva Maria , Ryzhkova Ekaterina , Терёхин Сергей , Фарманов Александр , Vinogradskaya Olga , Zilov Aleksey
Published: January 2025

Introduction

To demonstrate the importance of differential diagnosis of rare causes of procalcitonin (PCT) elevation.

Materials-Methods

Case of patient with diabetic foot infection, knee joint injury, and persistent elevation of PCT level on antibiotic therapy.

Results

PCT and C-reactive protein (CRP) are biomarkers of sepsis. Raised PCT and CRP after antibacterial therapy (ABT) can be associated with different factors.

Reviewed publications suggest the following causes of elevated PCT: ketoacidosis, liver diseases, acute kidney injury, trauma, burns, calcitonin-secreting neuroendocrine tumors, medullary thyroid cancer (MTC).

Clinical Case

70-year-old woman with type 2 diabetes mellitus was admitted for closed fracture of the right patella. Persistent wound of the right foot after a forefoot amputation in 2022, dry necrosis of the 4th toe of the left foot was found. Tests detected: PCT - 7.3 ng/mL (0-0.5), CRP - 156 mg/L (0.0-5.0). ABT and local wound care were initiated. A left lower limb revascularization and a 4th left toe disarticulation were performed. In 5 days open reduction and osteosynthesis of the right patella were performed.

After 2 weeks of ABT there were no signs of wound infection, CRP level decreased but PCT was still high, 5.7 ng/mL (0-0.5). One of the hypotheses was that the raised PСT was not related to infection. The patient had previously had a multinodular goiter so the calcitonin level was checked (above 950 pg/mL). Thyroid biopsy detected medullary carcinoma (MTC).

Later total thyroidectomy and central neck dissection were performed. Histology: medullary thyroid carcinoma (MTC) (pT2N0(0/2), Lv0, Pn0, R0). No pathogenic or probably pathogenic mutations were found. In 1 month, calcitonin was 3.7 pg/mL.

Conclusion

Causes of elevated procalcitonin (PCT) may be not related to infections, which is an important finding for physicians treating comorbid diabetic patients with infection. This case underscores the role of PCT in the diagnosis of MTC.

While the current findings highlight its utility in clinical practice, further studies are needed to explore full potential and establish standardised guidelines for use PCT in MTC management.
Fabrication and characterization of nano-structures to be used as anodes for lithium-ion batteries
Authors: Αργυρόπουλος Δημήτριος-Παναγιώτης
Published: January 2025

Αυτή η εργασία στοχεύει στη διερεύνηση των ηλεκτροχημικών ιδιοτήτων διαφόρων νανοδομημένων σωματιδίων πυριτίου. Για το σκοπό αυτό, παρασκευάστηκαν νανοσωματίδια πυριτίου ενθυλακωμένα από ένα πέπλο γραφενίου μέσω μιας διαδικασίας άλεσης σφαιρών. Επιπλέον, δημιουργήθηκαν σωματίδια τυλιγμένο με γραφένιο και ενδιάμεσο κενό χώρο, με δύο διαφορετικούς όγκους κενού χρησιμοποιώντας θερμικά αναπτυγμένο διοξείδιο του πυριτίου ως στρώμα θυσίας, άλεση σφαιρών για την επικάλυψη με γραφένιο και υδροφθόριο (HF) για την χάραξη του SiO2. Επιπλέον, προκειμένου να προσφέρουμε μια ευρύτερη εικόνα για την ηλεκτροχημική συμπεριφορά του κοίλου εξωτερικού κελύφους Si nps, ετοιμάσαμε επίσης όλα τα ενδιάμεσα στάδια της διεργασίας και των αντίστοιχων ηλεκτροδίων. Η μορφολογία όλων των σωματιδίων αποκάλυψε την ύπαρξη ενθυλάκωσης γραφενίου, κενού και υπολειμματικού στρώματος διοξειδίου του πυριτίου ανάλογα με τη διαδικασία κάθε νανοσωματίδιο. Αντίστοιχα ηλεκτρόδια παρασκευάστηκαν και μελετήθηκαν σε με γαλβανοστατικούς κύκλους φόρτισης/εκφόρτισης, κυκλικής βολταμετρίας και φασματοσκοπίας ηλεκτροχημικής σύνθετης αντίστασης. Παρατηρήθηκε ότι τα νανοσωματίδια που ενθυλακώθηκαν με γραφένιο επέδειξαν υψηλή ειδική χωρητικότητα αλλά περιορισμένη διάρκεια ζωής. Αντίθετα, τα νανοσωματίδια με κενό χώρο ή/και SiO2 ήταν σε θέση να προσφέρουν βελτιωμένη διάρκεια ζωής. Προτείνεται ότι η ύπαρξη κενού και/ή υπολειμματικού στρώματος SiO2 περιορίζει το σχηματισμό πλούσιων σε λίθιο κραμάτων LiXSi στο νανοσωματίδιο πυριτίου, παρέχοντας υψηλότερη μηχανική σταθερότητα κατά τη διάρκεια των διαδικασιών λιθοποίησης και αποφόρτισης.
Μητροπολίτης Σερβίων και Κοζάνης Διονύσιος Ψαριανός
Authors: Σταθόπουλος Γεώργιος
Published: January 2025

Η εργασία, με θέμα «Ο Μητροπολίτης Σερβίων και Κοζάνης Διονύσιος Ψαριανός. Το μουσικολογικό και λειτουργικό έργο του» ασχολείται με μια από τις σημαντικότερες εκκλησιαστικές μορφές του 20ου αιώνα, τον Άνδριο στην καταγωγή Μητροπολίτη Σερβίων και Κοζάνης κυρό Διονύσιο Ψαριανό, ο οποίος υπήρξε πολυγραφότατος και πολυπράγμων. Ο Κοζάνης Διονύσιος Ψαριανός διαδραμάτισε σημαίνοντα ρόλο στην Ε. τ. Ε. κατά το 2ο μισό του 20ου αιώνα, όταν δηλαδή η Εκκλησία βρέθηκε μπροστά στην απειλή της αλλοτρίωσης του ορθοδόξου φρονήματός της, από την κλίση και προσήλωσή των περισσοτέρων εκ των ποιμένων και διδασκάλων της, προς την δυτική νοοτροπία και τέχνη. Ο κίνδυνος αυτός υπήρξε ορατός και άμεσος, κάνοντας πολλούς να συγχέουν τί είναι Ορθόδοξο και τί έρχεται από τη Δύση. Για το λόγο αυτό ιδρύει το 1970 το Ίδρυμα Βυζαντινής Μουσικολογίας της Εκκλησίας της Ελλάδος. Στην εργασία αυτή αναδεικνύονται σε βάθος οι μουσικολογικές αντεγκλήσεις και ανησυχίες της εποχής του Διονυσίου, τόσο στην Ελλάδα όσο και στο εξωτερικό, για να μπορέσουμε να κατανοήσουμε την αγωνία του Διονυσίου για μια σοβαρή και επιστημονική ενασχόληση με αυτά τα ζητήματα από Έλληνες ερευνητές και υπό την υψηλή μέριμνα της επίσημης Εκκλησίας. Ο ίδιος έγραψε ένα μεγάλο σε όγκο και ρεπερτόριο μουσικό υμνογραφικό έργο, τα οποία αποδελτιωμένα και κατηγοριοποιημένα επιστημονικά πλέον παρουσιάζονται στην εργασία αυτή και ολοκληρωμένα για πρώτη φορά δίνονται προς το φιλόμουσο και φιλακόλουθο κοινό, με σκοπό να αναδειχθεί η δημιουργικότητα και η έμπνευση του φωτισμένου Ιεράρχη της Κοζάνης, καθώς και η αναθεωρητική παρέμβαση του σε αυτούς τους τομείς.
Δημιουργία και αξιολόγηση ενός αυτόνομου, δικτυακού αλλά και διαδικτυακού λογισμικού λογοθεραπευτικής παρέμβασης
Authors: Χατζηγιαννάκογλου Παύλος
Published: January 2025

Η παρούσα διατριβή επικεντρώνεται στην ανάπτυξη και την αξιολόγηση λογισμικών παρέμβασης για παιδιά προσχολικής ηλικίας με διαταραχές λόγου και επικοινωνίας, αντιμετωπίζοντας τις προκλήσεις που ανέδειξε η πανδημία COVID-19 στην παροχή λογοθεραπευτικών υπηρεσιών. Η πανδημία ανέδειξε την ανάγκη για απομακρυσμένη πρόσβαση σε υπηρεσίες λογοθεραπείας και για τη χρήση ψηφιακών εργαλείων και διαδικτυακών συστημάτων λογοθεραπείας (OST). Ωστόσο, αυτά τα συστήματα παρουσιάζουν τεχνικά εμπόδια, όπως το ψηφιακό χάσμα και η πολυπλοκότητα στην πλοήγηση, ιδιαίτερα για προσχολικής ηλικίας με γνωστικές διαταραχές ή περιορισμένη τεχνολογική επάρκεια. Η έρευνα αναπτύσσει δύο λογισμικά που προσομοιώνουν ρεαλιστικές καταστάσεις: το πρώτο λογισμικό είναι κλειστού τύπου και προσομοιώνει τη διαδικασία του πρωινού, μεσημεριανού και βραδινού γεύματος, ενώ το δεύτερο λογισμικό είναι ανοικτού τύπου και προσομοιώνει το θεραπευτικό περιβάλλον και τα διάφορα παιχνίδια που παίζουν τα παιδιά κατά τη διάρκεια μιας κλασικής παρέμβασης . Αυτά τα λογισμικά είναι σχεδιασμένα να λειτουργούν σε συσκευές με λειτουργικά συστήματα Windows, macOS, Android και iOS και μπορούν επίσης να λειτουργήσουν διαδικτυακά, προσφέροντας απρόσκοπτη προσβασιμότητα, ανεξαρτήτως συσκευής και γεωγραφικής τοποθεσίας.
Utilizing Machine Learning and causal graph approaches to Address Confounding Factors in Health Science Research: A Scoping Review
Authors: Hossain Ahmed
Published: January 2025

Confounding can significantly distort the findings of studies examining cause-and-effect relationships, especially in etiological research. To mitigate this issue, researchers must carefully assess potential confounding variables that may relate to both the exposure and outcome but are not directly influenced by the exposure itself. It is essential that these variables truly impact the outcome rather than simply being correlated with the exposure to avoid false associations. Strengthening confidence in the actual relationship between exposure and outcome requires an understanding of biological mechanisms and the application of various methods to adjust for confounders. The oversight of confounding often arises from inappropriate statistical tests and the aggregation of data across multiple studies. This scoping review article discusses the challenges posed by confounding and presents machine learning approaches for effective control in health science research. Directed acyclic graphs (DAGs) serve as causal graph tools to identify potential confounding variables in health research. By mapping presumed relationships between variables, DAGs enable researchers to estimate causal effects more accurately. While traditional methods such as randomization, matching, and stratification remain effective for controlling confounding, newer techniques like latent variable modeling with negative controls and machine learning methods such as LASSO, Ridge regression, and random forests offer enhanced flexibility and adaptability.
Management of microbial keratitis by private pharmacies in Uganda: a study of knowledge, attitude, and practice.
Authors: Ebong Abel , Arunga Simon , Mtuy Tara B. , Birungi Angela Meric , Onyango John , Arinda Gilbert , Orishaba Francis , Kwaga Teddy , Kageni Rita , Macleod David , Yadav Reena , Sanyam Sandip Das , Hoffman Jeremy J. , Mohamed Ahmed Abeer H. A. , Leck Astrid , Burton Mathew J.
Published: January 2025

Purpose To determine the knowledge, attitude, and practice of pharmacy attendants in the management of microbial keratitis. Methods This mixed-methods study was conducted in selected pharmacies and drug shops located in Mbarara City between March and May 2022. We administered questionnaires assessing the knowledge, attitudes, and practices (KAP) related to microbial keratitis (MK) to 140 pharmacy attendants (PAs) in the drug shops and pharmacies. We also conducted 40 in-depth interviews (IDI) and three focus group discussions (FGD) with pharmacy attendants to discuss practices, challenges, and opportunities to improve the management of MK. Results Of the 140 pharmacy attendants, almost half (49.29%) reported that they were not confident when making diagnoses in patients with eye problems, and 19.29% were uncertain of which drug to prescribe. In the IDIs and FGDs, the pharmacy attendants reported that they receive and manage patients with MK. Some immediately refer any patients they receive with eye complaints without prescribing any medication while others only refer those who are not responding to medication. The challenges faced in managing patients with MK included inadequate knowledge of managing eye diseases including MK, patients presenting with severe diseases because of delays in seeking healthcare, and the use of traditional eye medicine. The pharmacy attendants suggested ways of improving the management of MK and other eye diseases in the community including community sensitisation on eye diseases and conducting continued professional development lecture sessions on MK in pharmacies, drug shops, and clinics. Conclusion The study showed that probable MK was a common presentation among patients seeking to buy drugs from pharmacies and drug shops. Pharmacies are key stakeholders in the health seeking journey of patients and hence need to be supported through capacity building and strengthening the referral network to improve the outcomes of patients with eye diseases and MK.
Przemilczane historie. Rdzenna perspektywa w poezji Karenne Wood
Authors: Jeleńska Gabriela
Published: January 2025

Tekst jest próbą przybliżenia polskiemu czytelnikowi twórczości zmarłej w 2019 r. rdzennej poetki z narodu Monakanów, Karenne Wood. Poezja stanowiła w życiu tej artystki działalność niejako poboczną, głównym jej środkiem wyrazu był bowiem szeroko pojęty aktywizm. Poetka przez lata działała w Komisji Repatriacyjnej Krajowego Kongresu Indian Amerykańskich, aby następnie skupić swój wysiłek na zmianach w podstawie programowej nauczania historii, tak aby uwzględniała głos tubylczy i tworzyła miejsce dla alternatywnych, często przemilczanych wersji wydarzeń. Tekst przygląda się punktom stycznym tych dwóch działalności: wierszom, w których znane karty z historii kolonialnej zyskują nowe znaczenie poprzez odwrócenie perspektyw, a także tym utworom, które swą wymową całkowicie kontestują historię głównego nurtu. Ze względu na jasno określony, prospołeczny wydźwięk twórczości Wood celem tekstu jest próba wpisania jej poezji w koncepcję trybalografii, autorstwa pisarki z narodu Choctaw, LeAnne Howe. Według jednego z założeń tego pojęcia droga do utwierdzenia się rdzennej tożsamości oraz symbolicznego zadośćuczynienia wiedzie przez ciągłe negocjowanie przeszłości, a także uznania tradycji ustnej jako równoprawnego źródła historycznego.
Naszyjnik z zębów rekina. Indiańska Oklahoma w opowieściach Eddie’go Chuculate’a
Authors: Hlebowicz Bartosz
Published: January 2025

Cheyenne Madonna (2010), opowiadania Eddie’ego Chuculate’a, pisarza, w którego żyłach płynie krew Krików i Czirokezów, oraz jego autobiograficzna powieść This Indian Kid (2023), są z pozoru mocno osadzone w indiańskim świecie Oklahomy, Nowego Meksyku i Arizony. Nie są jednak peanem na cześć tubylczych wspólnot. Te praktycznie u Chuculate’a nie występują, jego indiańscy bohaterowie zamieszkują raczej małomiasteczkowy i podmiejski wariant amerykańskiego świata. Nie ma tu rozpamiętywania krzywd kolonizacji i zanurzania się w „tubylczą traumę”, rozterek dotyczących tożsamości indiańskich bohaterów, ich zawieszenia między światem rdzennych Amerykanów i białych. Chuculate pokazuje, że o współczesnych Indianach można opowiadać świeżym językiem, unikając balastu „historii”, „dziedzictwa” i „tradycji”. Jego znaki rozpoznawcze to ironia i dystans (choć zdarza się gorzka zaduma), a nie cierpienie, bohaterstwo i mitologizowanie przeszłości. Jeśli próbuje rozliczać się z przeszłością, to jest to przeszłość jego własnej rodziny, a nie tubylczego narodu, do którego należy. To właśnie próba zrozumienia relacji z najbliższymi osobami i przechowania o nich pamięci stanowi esencję dotychczasowej twórczości Chuculate’a, zakorzenionej w tradycjach zarówno indiańskiej, jak i amerykańskiej prozy. Chuculate jest przede wszystkim znakomitym, zajmującym opowiadaczem, który podtrzymuje świetne tradycje tubylczoamerykańskiej prozy z Oklahomy, by wspomnieć znanych u nas Navarre’a Scotta Momadaya i Brandona Hobsona.
Zaproszenie na dobre ścieżki
Authors: Mączkowski Krzysztof M.
Published: January 2025

Autor omawia nowe książki trzech tubylczoamerykańskich pisarzy - N. Scotta Momadaya, Richarda Wagamese oraz Claytona Thomasa-Müllera - wskazując, że łączy je wspólna tematyka. Dotyczą one bowiem kwestii związanych z tubylczą filozofią oraz refleksją dotyczącą relacji człowieka z naturą.  W konkluzji autor sugeruje, że recenzowane książki ułatwiają czytelnikom zrozumienie reguł tubylczego świata, poprzez zwrócenie uwagi na cechy, takie jak uważności, wrażliwość i pokora.
Hohe Feste, niedere Feste. Der liturgische Festalltag in den Konventen des Deutschen Ordens
Authors: Löffler Anette
Published: January 2025

High feasts, low feasts. The everyday liturgical festivities in the convents of the Teutonic Order
 
The liturgical life of the priest brothers of the Teutonic Order took place to a considerable extent in the convents and castles. Depending on the degree of celebration, the daily festivities in the Teutonic Order were organized. Complex liturgical regulations regarding the prioritization of the feasts had to be followed, which resulted from the degree of the feast. The higher the degree of celebration, the more extensive and complex the liturgy was on this and other days. The existing festival calendar also had to be taken into account, in which men's feasts, Sundays, movable feasts and saints’ feasts had to be classified.
However, the definition of a feast by its degree of celebration was already recorded differently in the underlying liturgical manuscripts. The forms in the liturgical manuscripts, in turn, sometimes differed from the entries in the calendars. Even with a requirement in the standards code, the range was wide. The example of the fixed degree commemoratio shows very clearly what deviations can occur.
Over time, the liturgy of the Teutonic Order changed, so that new festivals were added and the degree of celebration of existing festivals was changed. This is also shown by the feast of St. Barbara of Nicomedia, in which, despite all the uniformity, individual characteristics came into play. This means an elevation from the lowest level of celebration, the commemoratio, to a solemnity with its own rhyme office.
Between ideal and reality: Concubines, prostitutes, and dishonest women in the military orders’ everyday lives ‒ some considerations on an old issue
Authors: Toomaspoeg Kristjan
Published: January 2025

Women were present in the lives of the military orders, but not every single woman had a positive role to play in the orders’ reputation. Some brethren did not respect the vow of chastity, in given periods and contexts not even a majority. There were two major issues related to that: the frequenting of prostitutes and living with concubines. In some orders, such as Santiago and later also the other Iberian congregations, it was permitted for the brethren to take wives, but this did not stop all those illicit practices. Generally, in the military orders, breaking the vow of chastity was considered much less of an offence than breaking the vows of obedience and poverty. Though, in all the orders, it was important to avoid the scandals and to judge the transgressions inside the convent. Those communities had a basic ideal of life, be it within the walls of a convent or in the theatre of battle, but circumstances also changed. The brothers’ everyday life was quite different from an ideal which was markedly monastic. Everyday life in a military order was much too complicated and related to the secular world to strictly follow those ideals. This does not mean that the brethren of the military orders were lascivious sinners and womanisers, but that, in some way, the spiritual and natural ways of life could coexist in those institutions.
Alltag und Lebensverhältnisse des Hochmeisters in der Marienburg in der ersten Hälfte des 15. Jahrhunderts
Authors: Herrmann Christofer
Published: January 2025

Everyday life and living conditions of the Grand Master in Marienburg (Malbork) in the first half of the 15th century
 
On the basis of a wide range of sources (rules of the order, accounts, letters, deeds/notarial instruments, chronicles, envoy reports, minutes of the estates and town meetings), a wealth of information can be gleaned about the everyday and private life of the Grand Master at Marienburg Castle in the first half of the 15th century. The letter from the Grand Master’s personal physician is particularly fruitful, as it provides numerous references to the lifestyle of the head of the Order. This source is included as an edition in the appendix to the article. Overall, it can be stated that the usual daily routine of a Grand Master was essentially characterised by three components:
- Religious acts that were spread throughout the course of the day (participation in masses and prayers of the hours, in particular the daily night orthros between 11 p.m. and 2 a.m.).
- Eating and drinking (court meals at midday and in the evening, morning soup, collacia).
- Political and administrative activities (consultations, negotiations, councils with the dignitaries, envoy receptions, meetings of cities and estates, etc.), mainly in the mornings and afternoons.
In addition to these three main areas of daily activity, which were largely of a public-representative nature, there was also a private sphere in the life of the Grand Master. The time for relaxing or entertaining activities was very limited, but the sources give partial insights into this personal sphere (e.g. pets, music, studies, amusement).
Non-Templar witnesses in the Templar Trial
Authors: Forey Alan
Published: January 2025

Although non-Templars were questioned about various matters during the Templar trial, including the location of brothers and their property, they were most frequently asked about alleged Templar wrongdoing. It was, however, only in areas where Templars denied the charges or where few Templars were arrested that many outsiders were interrogated. Varying measures were adopted to secure their assistance. Eye-witnesses often spoke favourably of the Templars’ conduct, although some did express concerns. The strongest criticism was voiced by those relying on second-hand reports and rumour; but their testimony is not convincing. Non-Templars were questioned two or more years after Philip IV had initiated proceedings against the Order, and there was plenty of time for rumours to be spread and elaborated. Some non-Templar witnesses were also influenced by matters unrelated to the charges against the Templars. Witnesses in some western countries, where Templars had no military role and were known mainly as landowners, were much more hostile than those in Cyprus. It has also been claimed that it was in the interests of the orders of friars to denigrate the Templars, although this may be questioned. Non-Templar evidence, however, was of little importance in determining the fate of the Templars: it was only in the British Isles that it may have had some significance.
Blasphemie vor den Toren zur islamischen Welt: Die Gesetzgebung der Johanniter auf Rhodos um 1500
Authors: Sarnowsky Jürgen
Published: January 2025

Blasphemy at the gates to the Islamic World: the legislation of the Hospitallers on Rhodes around 1500
 
The term ‘blasphemy’ is today used as basis to justify repression and terror. Its roots go back to antiquity. While in the Old Testament everyone who blasphemes God or disregards the divine order is to be punished by death, the medieval concept of blasphemy is wider, including less severe ‘offences by the tongue’ which are prosecuted in different ways. The article discusses the accusation of blasphemy in the military orders, especially for the Hospitallers on Rhodes around 1500. Since the sources from the law courts and the inquisition are lost, the paper focusses on the normative sources, both on the statutes of the order as well as on the legislation for the order’s subjects. The Hospitallers used ‘blasphemy’ explicitly mainly for the ‘offences of the tongue’, both for their subjects as for the members of the order, partly punished with ‘mirror punishments’ like the splitting of the tongue. But heresy, apostasy, and sodomy appear at least implicitly as forms of blasphemy which were more severe and thus heavily punished, mostly by death. Muslim slaves were also threatened by lapidation when accused of blaspheming God, St Mary, the saints, the cross, etc. Since the legislation against blasphemy was intensified after 1480, it seems to have been an instrument of discipling the order’s subjects in times of external danger.
Dynamic Robot Routing and Destination Assignment Policies for Robotic Sorting Systems
Authors: Fang Yuan , De Koster René , Roy Debjit , Yu Yugang
Published: January 2025

Robotic sorting systems (RSSs) use mobile robots to sort items by destination. An RSS pairs high accuracy and flexible capacity sorting with the advantages of a flexible layout. This is why several express parcel and e-commerce retail companies, who face heavy demand fluctuations, have implemented these systems. To cope with fluctuating demand, temporal robot congestion, and high sorting speed requirements, workload balancing strategies such as dynamic robot routing and destination reassignment may be of benefit. We investigate the effect of a dynamic robot routing policy using a Markov decision process (MDP) model and dynamic destination assignment using a mixed integer programming (MIP) model. To obtain the MDP model parameters, we first model the system as a semiopen queuing network (SOQN) that accounts for robot movement dynamics and network congestion. Then, we construct the MIP model to find a destination reassignment scheme that minimizes the workload imbalance. With inputs from the SOQN and MIP models, the Markov decision process minimizes parcel waiting and postponement costs and helps to find a good heuristic robot routing policy to reduce congestion. We show that the heuristic dynamic routing policy is near optimal in small-scale systems and outperforms benchmark policies in large-scale realistic scenarios. Dynamic destination reassignment also has positive effects on the throughput capacity in highly loaded systems. Together, in our case company, they improve the throughput capacity by 35%. Simultaneously, the effect of dynamic routing exceeds that of dynamic destination reassignment, suggesting that managers should focus more on dynamic robot routing than dynamic destination reassignment to mitigate temporal congestion.

Funding: This work was supported by The Fundamental Research Funds for the Central Universities [Grant WK2040000094] and the National Natural Science Foundation of China [Grants 71921001 and 72091215/72091210].

Supplemental Material: The online appendices are available at https://doi.org/10.1287/trsc.2023.0458 .
Percutaneous management of paravalvular leak-related hemolytic anemia after transcatheter aortic valve replacement
Authors: Idowu Abiodun , Witzke Christian
Published: January 2025

We present a case of a patient with severe intravascular hemolytic anemia from a paravalvular leak after transcatheter aortic valve replacement and describe a technique of percutaneous repair of the leak with a vascular plug that resolved the patient’s transfusion-dependent hemolysis.
Women’s empowerment and social work practice in Iran: understanding and addressing women’s vulnerability
Authors: Sadeghi Sabereh , Salomoni Fatima , Rømer Mette
Published: January 2025

Following the Islamic Revolution in 1979, and due to traditional values, social workers who provide support for vulnerable women in Iran must navigate within a system that often limits women’s agency and autonomy. Based on ten semi-structured interviews with experienced Iranian social workers, this article illuminates how women’s vulnerability and empowerment are perceived and how women’s vulnerability is addressed in the empowerment process. The findings offer valuable insights to enhance empowerment practice by reflecting on the impacts of cultural norms and values on women’s empowerment. They contribute to a more nuanced understanding of how social workers in Iran perceive and address vulnerability and empowerment.
Nonlinear interferometry-based metrology of magneto-optical properties at infrared wavelengths
Authors: Chakraborty Tanmoy , Produit Thomas , Krishnamoorthy Harish N. S. , Soci Cesare , Paterova Anna V.
Published: January 2025

Magneto-optical properties of materials are utilized in numerous applications both in scientific research and industry. The novel properties of these materials can be further investigated by performing metrology in the infrared wavelength range, thereby enriching their potential applications. However, current infrared metrology techniques can be challenging and resource-intensive due to the unavailability of suitable components. To address these challenges, we propose and demonstrate a set of measurements based on nonlinear interferometry, which allows us to investigate magneto-optical properties of materials at infrared wavelength range by performing optical detection at the visible range. For a proof-of-principle study, we measure the Verdet constant of a bismuth iron garnet crystal, over a spectral bandwidth of 600 nm in the near-infrared range.
Explore barriers to using the internet for health information access in African countries: A systematic review
Authors: Chereka Alex Ayenew , Shibabaw Adamu Ambachew , Butta Fikadu Wake , Tadesse Mathias Nega , Abebe Mekashaw Tareke , Atanie Fekadu Ayelgn , Kitil Gemeda Wakgari
Published: January 2025

Background

The Internet is a crucial source of health information, providing access to vast volumes of high-quality, up-to-date, and relevant healthcare information. Its impact extends beyond information access, influencing medical practice through the widespread adoption of telemedicine and evidence-based medicine. Despite the significant global increase in internet usage, Africa lags in internet penetration, particularly in utilizing the internet for health information. This study aims to systematically review the literature to explore barriers to accessing health information on the Internet in African countries.

Methods

The study was conducted from January 1 to February 28, 2023. It followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline to systematically review published studies investigating the utilization of the Internet for health information in African countries. A comprehensive search was conducted across various databases, including Google Scholar, PubMed, Cochrane Library, Hinari, CINAHL, and Global Health. The inclusion criteria were applied, resulting in the selection of six studies that formed the basis for our analysis.

Result

This systematic review identifies eleven barriers to accessing health information on the internet. These include a lack of ownership of smart electronic devices, infrequent internet use, limited internet access, low E-health and computer literacy, slow internet connection, high cost of internet access, insufficient information search skills, residing in rural areas, dealing with diverse fields, and having low perceptions.

Conclusion

Improving our understanding of barriers to accessing health information online is essential for policymakers, governments, academics, and healthcare professionals. To enhance the use of the Internet for health information and strengthen the overall health system, policymakers should prioritize increasing Internet accessibility, reducing costs, improving connections, offering basic computer skills training, and ensuring the availability of electronic devices in all institutions.
Minimization of the Bacillus subtilis divisome suggests FtsZ and SepF can form an active Z-ring, and reveals the amino acid transporter BraB as a new cell division influencing factor
Authors: Gulsoy Ilkay Celik , Saaki Terrens N. V. , Wenzel Michaela , Syvertsson Simon , Morimoto Taku , Siersma Tjalling K. , Hamoen Leendert W.
Published: January 2025

Bacterial cytokinesis begins with polymerization of the tubulin homologue FtsZ into a ring-like structure at midcell, the Z-ring, which recruits the late cell division proteins that synthesize the division septum. Assembly of FtsZ is carefully regulated and supported by a dozen conserved cell division proteins. Generally, these proteins are not essential, but removing more than one is in many cases lethal. Therefore, it is still not fully clear how the different protein components contribute to cell division, and whether there is a minimal set of proteins that can execute cell division. In this study, we tried to find the minimal set of proteins that is required to establish an active Z-ring in the model bacterium Bacillus subtilis. By making use of known suppressor mutations we were able to find a gene deletion route that eventually enabled us the remove eight conserved cell division proteins: ZapA, MinC, MinJ, UgtP, ClpX, Noc, EzrA and FtsA. Only FtsZ and its membrane anchor SepF appeared to be required for Z-ring formation. Interestingly, SepF is also the FtsZ anchor in archaea, and both proteins date back to the Last Universal Common Ancestor (LUCA). Viability of the multiple deletion mutant was not greatly affected, although the frequency of cell division was considerably reduced. Whole genome sequencing suggested that the construction of this minimal divisome strain was also possible due to the accumulation of suppressor mutations. After extensive phenotypic testing of these mutations, we found an unexpected cell division regulation function for the branched chain amino acid transporter BraB, which may be related to a change in fatty acid composition. The implications of these findings for the role of SepF, and the construction of a minimal cell division machinery are discussed.