bluuebunny/crossref_metadata_2025 huggingface dataset:
Consumo mediático de entretenimiento y sexualización infantil: Perspectivas cualitativas de familias en Toluca, México
Authors: Calderón Martínez Estefania Elena , Santos López Aristeo
Published: December 2024

El presente estudio explora el fenómeno de la sexualización infantil, analizando como el consumo mediático de contenidos de entretenimiento que se lleva a cabo al interior de las familias interviene en este proceso. El objetivo es comprender de qué manera los contenidos de este consumo infieren en la sexualización de los niños y niñas en el municipio de Toluca México. Para ello, se llevó a cabo una investigación cualitativa a través de entrevistas semiestructuradas con 12 tutores del municipio de Toluca México. La información obtenida se analizó mediante el enfoque de codificación temática, lo que permitió identificar cinco categorías principales: películas, series de televisión, caricaturas, comics y videojuegos. Los resultados dan cuenta que el consumo mediático de entretenimiento está impregnado de estereotipos de género y de representaciones corporales sexualizadas, lo que conlleva a afectar la autoimagen de los menores. Se sugiere una educación mediática en las familias para proteger el bienestar emocional de los niños, así como su integridad.
Más Allá del Juego: Del Crunch al Consumo Consciente en la Industria de los Videojuegos
Authors: Llamas Mangin Yuritzi , Silva González Edson Javier , Tuexi Garza Elkin , Hernández Vidales Juan José , Garza Sánchez Jorge Eduardo
Published: December 2024

Este estudio explora las percepciones y comportamientos de consumo de estudiantes universitarios en relación con las prácticas laborales en la industria de los videojuegos. La investigación utilizó un enfoque cuantitativo basado en encuestas anónimas a 30 jóvenes de 16 a 25 años. Los resultados indican que, si bien la mayoría (90%) conocía populares títulos como The Last of Us 2 y Call of Duty, casi todos (94%) desconocían que fueron desarrollados mediante sobreexplotación laboral. Aún más, dos tercios de los participantes (67%) afirmaron que comprarían estos videojuegos a pesar de saber sobre las condiciones de trabajo. Estos hallazgos sugieren la necesidad de generar mayor conciencia entre los consumidores sobre las prácticas éticas en la industria del gaming, pues parecen priorizar el entretenimiento por encima de las implicaciones laborales.
Evaluación del Uso Turístico de la Parroquia Balsapamba, Provincia de Bolívar, 2024
Authors: Miranda Cárdenas Liz Jianella , Garaicoa Fuentes Freddy Leonardo , Avilés Troncoso Jaritza Jeling , Sornoza Jaime Genesis Belén
Published: December 2024

El objetivo de este estudio es evaluar el uso turístico de la parroquia Balsapamba, incluyendo a la oferta turística, caracterización de los atractivos y medición de satisfacción de los visitantes, mediante la aplicación de fichas de observaciòn estructurada se logró obtener resultados sobre el análisis actual de la planta turística, ficha metodológica de inventario de atractivos turísticos para conocer sus fortalezas y debilidades,  y encuestas que constan de 15 preguntas cerradas divididas en tres secciones: demográfica, turística y de comunicación, realizadas de manera presenciales y con la herramienta google forms, sobre calificar el nivel de satisfacción de los visitantes acerca de la oferta turística,. Se utilizó un diseño descriptivo y de campo y un método inductivo. Los principales resultados revelan deficiencias en los servicios de alimentos y bebidas, la ausencia de centros de información turística y la limitada infraestructura turística que afecta el desarrollo del sector, que a pesar de contar con atractivos naturales potenciales, la gestión local no ha mantenido un crecimiento sostenido. Los visitantes son de niveles socioeconómicos medio bajos y muestran un nivel de satisfacción neutro y se destaca que los medios online no han sido efectivos para mejorar la calidad del servicio y atraer más turistas.
FETHÎ GÂNİM’İN ER-RACULU’L-LEZÎ FEKADE ZILLEHU (GÖLGESİNİ KAYBEDEN ADAM) ADLI ROMANININ ÜSLUP VE İÇERİK AÇISINDAN İNCELENMESİ
Authors: Çelenlioğlu Asiye
Published: December 2024

Mısır’da Batılılaşmayla birlikte ortaya çıkan ve ülkenin geçirdiği sürece bağlı olarak farklı üslup ve içerikle zenginleşen roman sanatı modern dönemin yansıtma kuramından postmodernizmin kuralsız yapısına evrildiği süreçte pek çok örneğe sahne olmuştur. Romantik ve realist romanın söz konusu dönemdeki sorunsalları ön plana çıkaran öğretici rolü, post-modern romanla insana odaklanmış bireyin kendisiyle ve toplumla yaşadığı çatışma kurguda yerini almıştır. Bunlar arasında Fethî Gânim’in (1924-1969) er-Raculul’lezî Fekade Zıllehu (Gölgesini Kaybeden Adam, 1962) adlı romanı ilk sırada gelir. İki cilt ve dört bölümden oluşan romanda aynı hikâyeyi dört farklı karakter kendi bakış açısıyla anlatmış, yazar her bölüme anlatıcısının adı vermiştir. Hayatları birbiriyle kesişen bireylerin Yûsuf’a öfkesini dile getirdiği Mebrûke, Sâmiye, Nâci adını taşıyan ilk üç bölümden sonra Yûsuf’un bakış açısıyla anlatılan hikâye olayların aydınlığa kavuşmasını sağlamıştır. II. Dünya Savaşı’nın gerçekleştiği 1940’lı yıllardan büyük Mısır devriminin (1952) gerçekleştiği 1960’lı yıllara kadar Mısır toplum yapısıyla ilgili önemli içeriğe de sahip olan roman, çoğu fakirliğin meydana getirdiği yozlaşma ve tabakalaşma sorunsalına da işaret etmektedir. Çalışma Fethî Gânim’in edebî yönüne işaret ettikten sonra eseri üslup ve içerik olarak inceleyerek içerdiği çatışmayı ortaya koyacaktır.
AKİDE ŞEKERİNDEN DOĞAN BİR GELENEK: TOKAT’TA AKİT ŞERBETİ VE ETRAFINDA OLUŞAN RİTÜELLER
Authors: Özgen Mutlu
Published: December 2024

Akit şerbeti Tokat halkı arasında ticari ilişkilerde, sosyal ritüellerde ve geçiş dönemlerinde önemli bir işlev üstlenmiştir. Bu şerbetin Tokat’a özgü bir gelenek olarak ortaya çıkışı, Osmanlı dönemindeki akide şekeri kullanımına dayanmaktadır. Osmanlı İmparatorluğu’nda akide şekeri, ulufe törenlerinde sadakat ve güvenin sembolü olarak kullanılmış özellikle Yeniçeriler ile padişah arasında bir sözleşme aracı işlevi görmüştür. Tokat’ta ise bu işlev, Akit şerbeti olarak karşımıza çıkmaktadır. Akit şerbeti, toplumsal uzlaşma, ticari anlaşmalar ve önemli ritüellerde içilen sembolik bir içecek haline gelmiştir. Tokat’ın özellikle Meydan semtinde, köyden gelen esnaf ve köylüler arasında ticari ilişkilerin önemli bir parçası olan bu şerbet, ticaretin güvenilirliğini sağlamak amacıyla kullanılmıştır. Akit şerbeti, aynı zamanda lohusa şerbeti, söz kesme ve düğün gibi sosyal ritüellerde de önemli bir yere sahiptir. Bu gelenek, Osmanlı’dan miras alınan ve Tokat halkının hayatına entegre edilmiş bir içecek kültürünü temsil etmektedir. Bu çalışma, Tokat’a özgü bir gelenek olan bu Akit şerbeti içmenin toplumsal ve kültürel bağlamını kapsamlı bir şekilde ele almaktadır. Tokat örneği üzerinden yapılan incelemeler sonucunda akide şekeri ve şerbet kültürünün, toplumsal dayanışma, sözleşme ve güven sembolü olarak nasıl kullanıldığı tespit edilmiştir. Çalışmada elde edilen veriler literatür taramasına ve 2019 yılının mayıs ayında Tokat merkezde kaynak kişilerle yapılan görüşme notlarına dayanmaktadır.
Diplomatie culturelle britannique et captation artistique dans la ville du pape
Authors: Amblard Marion
Published: December 2024

En 1686, le roi Jacques II d’Angleterre, aussi appelé Jacques VII d’Écosse, nomme le comte de Castlemaine ambassadeur à Rome afin de renforcer les liens de la dynastie des Stuarts avec le Saint-Siège. Castlemaine est accompagné par un portraitiste écossais anciennement formé à Rome, John Michael Wright, appelé à publier le récit de cette ambassade et à mobiliser un réseau formé d’artistes romains et étrangers pour en soutenir les missions. L’article examine la composition de ce réseau et les résultantes de son fonctionnement, par-delà l’échec final de l’entreprise de Castlemaine visant à rapprocher l’Angleterre des Stuarts avec la Rome d’Innocent XI.
L’« axiome » de Banks
Authors: Beaurepaire Pierre-Yves
Published: December 2024

Cette contribution se focalise sur la proposition faite en 1796 par sir Joseph Banks, figure centrale des sciences impériales et naturalistes britanniques, d’« a complete armistice to science » durant les guerres franco-britanniques. Sans se laisser abuser par les postures de neutralité d’une République des sciences qui maintiendrait ses connexions transnationales pour favoriser le progrès universel des savoirs, il est intéressant d’étudier à partir de cas concrets, comme l’herbier de Jacques-Julien Houtou de La Billardière ou les collections d’André Michaux, la manière dont des dispositifs diplomatiques et consulaires spécifiques sont activés afin d’obtenir la restitution de spécimens naturalistes et de documents interceptés à bord de navires étrangers, mais également afin de garantir la circulation d’agents ou de savants à travers les mers et les continents lointains.
L’identification des princes étrangers
Authors: Le Gall Jean-Marie
Published: December 2024

Rien de moins anonyme qu’un prince. Pourtant, ils sont de plus en plus nombreux, du XVIe au XVIIIe siècle, à voyager en changeant de titulature, incognito, afin de rester dans leur liberté. Des exilés du Maghreb, dont la parenté royale est difficile à établir, viennent aussi en Europe. Enfin, des imposteurs rencontrent de vrais princes pour en être reconnus. Aussi est-il important pour les cours d’Europe d’identifier ceux qui vont être reçus, afin de leur accorder les honneurs dus à leur rang et éviter les parasites. Cette identification repose moins sur des papiers que sur la déclaration personnelle et sur l’interconnaissance. Un face-à-face avec un témoin crédible, souvent un diplomate, garantit l’identité véritable de celui qui a de vrais papiers portant une fausse titulature. Dans cette opération de dévoilement, les services des maîtres de cérémonie sont bien plus impliqués que ceux de la police.
La protection litigieuse
Authors: Trampus Antonio
Published: December 2024

Ce travail explore la figure de Giacomo Casanova en tant qu’« agent diplomatique », et repose sur une documentation inédite conservée aux archives de Venise, Vienne et Amsterdam. Entre 1784 et 1785, Casanova fut l’un des principaux témoins d’une controverse opposant la république de Venise et les Provinces-Unies. Il joua d’une part un rôle d’observateur passant au crible les intérêts commerciaux des différentes nations et, de l’autre, celui d’un journaliste engagé par l’ambassadeur de Venise pour défendre les intérêts de la Sérénissime face à l’opinion publique européenne, alors que les outils dont disposait la diplomatie n’étaient pas capables de résoudre à eux seuls ce litige international. Dans ce cadre, il fut chargé de rédiger des textes sur la controverse dans le sens des intérêts de la république de Venise.
La disparition de Sorel
Authors: Lepape Pierre
Published: December 2024

Homme libre, écrivain né au tout début du xviie siècle, mort en 1674, Charles Sorel connut un immense succès avec l’Histoire comique de Francion publiée dans sa jeunesse, en ce temps de liberté de la pensée que le classicisme et l’absolutisme royal viendraient très vite entraver. Plutôt que de se soumettre aux nouvelles lois de la littérature, Sorel a préféré mutiler son texte, jusqu’à le faire disparaître et disparaître lui-même.« Effectuée de son vivant même, exécutée sans appel, la disparition de Sorel efface avec lui un territoire entier de notre littérature. La part obscure du désordre. »
Embarrassment and wild caught meat
Authors: Zong Chenyu
Published: December 2024

In the initial COVID-19 pandemic, much speculation was made about what, exactly, Chinese appetites involved, and whether Chinese had a penchant for sourcing and consuming wild caught meat. Accusations abounded, principally (but not exclusively) from the West, as well as from inside China itself. An old adage resurfaced: Chinese people will eat anything. This paper examines how this old saying is responded to in China in ways that became important to national pride during COVID-19. I found Chinese eaters as a collective are not as much co-transgressors bound in collective embarrassment against their countryfolk as they are bound together, eaters of wild meat or not, by the intensity of the judgement of those beyond China, from the Western world. It is to this audience that China principally performs its adherence to the state-declared norm of avoidance of wild meat.
Adoption and Use of Public Hospital Information Systems in Croatia Based on PLS-SEM Analysis
Authors: Galic Josipa Osvaldic , Pejic-Bach Mirjana , Khawaja Sarwar , Qureshi Fayyaz Hussain , Dwivedi Pradeep
Published: December 2024

The Hospital Information System (HIS) is a key digital platform facilitating communication and information sharing. Despite its potential, full utilization of HIS remains limited. This study explores factors influencing HIS adoption in Croatia, focusing on expected performance, expected effort, social influence, and system support. Data from a survey conducted at General Hospital Bjelova was analyzed through Partial Least Squares Structural Equation Modelling (PLS-SEM). Results show that expected performance and effort significantly enhance the intention to use HIS. Social influence from colleagues positively impacts intention, while administrative processes negatively affect it, fostering resistance among users. Intention to use HIS positively correlates with its intensity in daily operations but negatively affects occasional usage. These findings provide insights into optimizing HIS implementation and enhancing user engagement, offering practical recommendations for healthcare administrators and policymakers.
Semantic Web-Driven Hybrid Adaptive Control System for Trajectory Tracking in Robotic Arms
Authors: Guo Wanqi , Tateno Shigeyuki
Published: December 2024

In modern industrial production, trajectory tracking control of multi-degree-of-freedom robotic arms entails safety and efficiency. This study focuses on a two-degree-of-freedom manipulator, developing a mechanical dynamics model and implementing a parallel Linear Active Disturbance Rejection Controller (LADRC) for joint control. To enhance robustness and responsiveness, a hybrid adaptive control method is introduced, integrating adaptive laws (AL) for online tuning of parameters and offline optimization using the Deep Deterministic Policy Gradient (DDPG) algorithm. This improves tracking control efficiency and effectiveness. Additionally, offline reinforcement learning refines parameters without adding real-time computational demands. Finally, semantic web principles ensure interpretability and transparency of the control flow. Compared to traditional LADRC, the proposed method shows superior anti-interference capabilities and dynamic performance.
Movement disorders in autoimmune encephalitis: Clinical spectrum, prognosis, and outcomes from an Indian cohort
Authors: Jha Shreyashi , M Netravathi , Holla Vikram Venkappayya , Kamble Nitish , Mahadevan Anita , Pal Pramod Kumar
Published: December 2024

BACKGROUND:

Antibody-mediated autoimmune encephalitis (AE) encompasses inflammatory central nervous system disorders linked etiologically with neuronal autoantibodies. Movement disorders (MDs) are common and diverse in AE, and their early identification can expedite effective management. Current literature on MDs in AE is limited to a few case reports and series, synthesized into multiple systematic reviews. Furthermore, there is a lack of literature on MDs in seronegative AE and their prognostic factors. We aimed to characterize the age-specific phenomenology, therapeutic responses, outcomes, and prognostic factors of MDs in a large cohort of patients with seropositive and seronegative AE.

METHODS:

This was a chart review of all patients with AE over three years (January 2018 to January 2021) at a tertiary center in Southern India.

RESULTS:

MDs were found to be prevalent among 47 (72.3% females) of 74 patients (63.5%) with AE. Dystonia was the most common (31.9%). Oro-facial-lingual-dyskinesias (OFLD), opsoclonus-myoclonus syndrome (OMS), and tics were prevalent in patients aged below 18 years. The most common MDs among patients with NMDAR antibody encephalitis were OFLD (60%), facio-brachial-dystonic seizures (FBDS) among all four patients with LGI-1 antibody encephalitis, myoclonus (50.0%) in the CASPR2 antibody encephalitis cohort and dystonia (80%) among patients with seronegative AE. Parkinsonism and FBDS were commonly observed in patients above 45 years of age (P < 0.001). Good response to immunotherapy was observed in 91.4%. Multivariate regression analysis demonstrated that preceding Japanese encephalitis infection, ICU stay, and delay in immunotherapy were poor prognostic factors.

CONCLUSIONS:

Patients above 45 years of age presented with hypokinetic MD while hyperkinetic MD were frequent in patients below 18 years of age. Hypokinetic MD had a worse prognosis.
Potential Factors Associated with Undernutrition in Children Under 5 years and its Patterns in Bangladesh: Insights from Four Cross-Sectional Studies
Authors: Nabeen A H M Musfiqur Rahman , Khatun Mosammat S. , Islam Md. Akhtarul , Akanda Md. Abdus S. , Sharp Julia L.
Published: December 2024

Background:

Undernutrition in children under 5 years of age is one of the most important measurements of assessing the excellence of human life as it confirms healthy growth in early childhood. The main objective of this study is to understand the potential patterns and factors of undernutrition in children under 5 years of age in Bangladesh from 2007 to 2017.

Methods:

Four cross-sectional rounds of data from the Bangladesh Demographic and Health Survey (2007, 2011, 2014, and 2017) were used for this study. The ordinal logistic regression model was applied to explore the association between selected factors and undernutrition status (stunting, wasting, and underweight).

Results:

For stunting, the age of the child emerged as a significant factor. Between 2007 and 2017, older children (12–59 months) consistently exhibited a higher likelihood of severe stunting. In 2017, children aged 48–59 months had an odds ratio (OR) of 1.61 [confidence interval (CI): 1.34, 1.94] compared to those aged 0–11 months, a decrease from 3.04 (CI: 2.50, 3.71) in 2007. Regional disparities were notable, with children from the Sylhet division increasingly at risk. The OR for Sylhet rose from 1.02 (CI: 0.85, 1.22) in 2007 to 1.66 (CI: 1.35, 2.04) in 2017. In addition, socioeconomic factors shifted over time: OR for the poorest households decreased from 1.45 (CI: 1.21, 1.74) in 2007 to 1.18 (CI: 0.99, 1.42) in 2017, while children of mothers with higher education saw a consistent effect, with OR of 0.55 (CI: 0.38, 0.77) in 2007 and 0.49 (CI: 0.37, 0.66) in 2017. Over the survey years 2007, 2014, and 2017, girls were consistently less likely to be wasted than boys. In 2007, OR for girls was 0.86 (CI: 0.74, 0.99), slightly decreasing to 0.81 (CI: 0.68, 0.96) in 2017. Children of mothers with higher education were also less likely to be wasted compared to those of mothers without education. OR for children of mother with higher education was 0.79 (CI: 0.52, 1.20) in 2007, decreasing to 0.51 (CI: 0.35, 0.75) in 2017. In 2017, children aged 48–59 months had an OR of 1.84 (CI: 1.51, 2.24) for being underweight compared to those aged 0–11 months, slightly lower than the OR of 2.10 (CI: 1.75, 2.53) in 2007. In addition, in 2017, children from the richest families had OR of 0.68 (CI: 0.53, 0.87), consistent with that of 0.65 (CI: 0.52, 0.80) observed in 2007.

Conclusion:

These findings underscore the importance of targeted interventions addressing the specific needs of older children, those from low-income families, and regions with persistent disparities. Strengthening educational initiatives, enhancing nutritional programs, and promoting equitable healthcare access are crucial for sustaining the progress in reducing undernutrition in children under 5 years in Bangladesh.
Exploring the Impact of Artificial Intelligence on Pain and Anxiety in Surgical Patients: A Systematic Review
Authors: El-Helou Etienne
Published: December 2024

This systematic review investigates the efficacy of artificial intelligence (AI) in alleviating pain and anxiety among patients undergoing surgical procedures, aiming to provide a comprehensive understanding of how AI-based approaches may improve patient outcomes and enhance the surgical experience. A comprehensive search was conducted following PRISMA guidelines, using the PubMed database to identify relevant articles published up to May 1, 2024. The search included keywords related to “anxiety,” “pain,” “surgery,” and “artificial intelligence” encompassing clinical trials, meta-analyses, randomized controlled trials, reviews, and systematic reviews published in English and French. Studies examining the effects of AI interventions on pain and anxiety in surgical settings were included, narrowing an initial 1814 records down to 12 eligible studies. Results showed that AI interventions in pain management include machine learning models that predict recovery outcomes, personalize pain management, and optimize opioid dosages. AI also detects pain through facial expressions and predicts postoperative complications, enabling proactive interventions that improve patient outcomes. Technologies like the MEDiV robot and virtual reality have effectively reduced pain and anxiety, particularly in pediatric and postoperative care settings, while AI-driven mobile messaging has successfully reduced opioid use and pain intensity. However, research specifically addressing AI’s role in managing postoperative anxiety is limited, with only two studies focused on pediatric anxiety management using interactive robots. In conclusion, AI shows significant promise in enhancing pain management for surgical patients, offering tailored solutions that improve treatment efficacy and patient satisfaction. Despite encouraging results in pain management, the application of AI in anxiety management remains underexplored, revealing a critical research gap. Further studies are needed to fully harness AI’s potential, particularly for managing postoperative anxiety, to revolutionize patient care in surgical settings.
Laser Interstitial Thermal Therapy (LITT) in Brain Tumors: A Narrative Review
Authors: Alashkar Abdulrahman H. , Ahmed Hassan M. , Aljawash Mohammad A. , Muhsen Bahaeddin
Published: December 2024

Laser interstitial thermal therapy (LITT) emerged in 1990 as a promising treatment for brain tumors. It is a minimally invasive procedure that has many advantages over conventional craniotomy and has various applications in the management of brain neoplasms. It has been used in the treatment of radiation necrosis, glioblastoma multiforme, metastatic brain tumors, and posterior fossa tumors. Two main LITT platforms are available commercially in the United States: the Visualase system and the Monteris NeuroBlate platform. LITT has become increasingly popular in recent years due to its preciseness and minimal invasiveness. In this review, we scope the literature for the use of LITT in brain tumors, and we present a sample of studies that addressed its applications in this area.
Assessment of Insulin Resistance using the Glucose Tolerance Insulin Response (GTIR) Test and Homeostasis Model Assessment-Estimated Insulin Resistance (HOMA-IR) Test
Authors: Kardus Mona F. , Hallak Rana A. , Alakedi Ahmed , Abdulkarim Alaa S , Alsheddi Shaykhah , Farhan Fouzah S. , Alyousef Othman Y. , Alturki Ruwayda A. , Kurdi Youssef , Mewally Salma A.
Published: December 2024

Background:

The rising global number of Diabetes mellitus (DM) cases indicated the significance of early detection of insulin resistance trying to decrease the economic and healthcare burden caused by DM.

Objectives:

This study aimed to evaluate the efficacy of using Homeostasis Model Assessment-Estimated Insulin Resistance (HOMA-IR) and to define a suitable HOMA-IR cut-off value. The difficulty of performing a euglycaemic-hyperinsulinaemic clamp in extensive studies has stimulated the importance of using and developing surrogate insulin sensitivity indices.

Design:

Retrospective cohort study.

Setting:

Involved 397 participants referred from outpatient clinics at Dr. Sulaiman Alhabib Hospital between January 2011 and December 2021 for a Glucose Tolerance/Insulin Response test.

Methods:

Data was obtained from the electronic medical system in Dr. Sulaiman Alhabib hospital. Insulin response interpretation was based on the Kraft pattern, classifying insulin patterns into five types. HOMA-IR was calculated using the formula HOMA-IR = (FPI*FPG)/22.5. Statistical analyses were performed using MedCalc Statistical Software version 20. Receiver Operating Characteristic curves were plotted to assess the diagnostic performance of HOMA-IR in distinguishing between cases and non-cases of insulin resistance. The area under the curve and 95% confidence intervals were calculated. The Youden index was used to select the optimum cut-off points.

Results:

Youden index was used for selecting the optimum cut off points. For the combined dataset, a cut-off value of >1.93 showed a sensitivity of 66.91% and specificity of 71.31%. The logistic regression was used to assess various predictors of the development of diabetes mellitus. impaired glucose tolerance, impaired fasting glucose, or gestational diabetes. Insulin resistance based on HOMA-IR was a significant predictor.

Conclusion:

Insulin resistance is a hallmark of type 2 diabetes. Establishing and using a sensitive and specific population-based cut-off for HOMAIR is highly recommended for early detection of insulin resistance. The study faced some challenges such as limited participants and incomplete follow-up.
A Comparison of Effective doses for the 16, 64, and 128-slice Computed Tomography Scanners: A First Health Cluster Study in Riyadh
Authors: Al Moudi Mansour , Al Dosari Sultan , Al Hussain Abdullah Ibrahim , Abounassif Mazen
Published: December 2024

Objective:

This study aimed to compare the effective doses among 16, 64, and 128-slice computed tomography (CT) scanners. Several strategies have been implemented to reduce the radiation dose from CT, including a low tube voltage, a high pitch protocol, automatic tube current modulation, and iterative reconstruction algorithms. These strategies have reduced the radiation dose from the previously reported >20 mSv to <3–5 mSv or even <1 mSv. This study compared the radiation doses associated with routine CT scans performed using various multi-slice CT scanners.

Materials and Methods:

A total of 330 patients who underwent CT scans as part of their routine clinical diagnoses from December 4, 2018, to March 26, 2019, were screened cross-sectionally. CT scans were performed using 16-slice GE HealthCare BrightSpeed, 64-slice GE HealthCare Discovery CT750 HD, and 128-slice Siemens Healthineers SOMATOM Definition Flash CT scanner systems. The parameters considered in the analysis were age, sex, body region, scanner type (16, 64, and 128 slices), dose length product, and the estimated mean ED. The effective radiation dose was calculated using the dose length product and compared among the scanner types.

Results:

We evaluated the CT scans of 166 men (50.3%) and 164 women (49.7%) patients. Among the three types of CT scanners used, the 16-slice CT scanner had the highest effective radiation dose for brain (P = 0.024), paranasal sinus (P = 0.027), cervical spine (P = 0.04), chest (P < 0.001) and pelvis (P = 0.014).

Conclusion:

The 16-slice CT scanner has the highest effective radiation dose compared to the 64 and 128-slice scanners. When performing routine CT scans with low-end CT scanner systems, dose-reduction strategies should be considered.
Understanding the Multifaceted Factors Contributing to Autism Spectrum Disorder: A Comprehensive Evidence-Based Narrative Review
Authors: Alsawadi Razan Adib , Jihwaprani Muhammad Candragupta , Sula Idris , Hafez Bushra , Alkhatib Muhannad Mamoun , Qadri Mohammed Arshad
Published: December 2024

Autism spectrum disorders (ASD) are among the most prevalent chronic neurodevelopmental conditions, typically manifesting early in life. They are characterized by challenges in communication and social interaction, as well as repetitive and restrictive behaviors. One of the key features of ASD is its heterogeneity, which indicates a broad spectrum of presentations and predisposing factors. Despite the numerous associated factors that have been studied and proposed to influence the etiology of ASD, the exact cause has not yet been determined. In this work, we undertake a thorough evidence-based study of the risk factors based on systematic reviews and meta-analysis from current literature. We examine the complexity and diversity of genetic risk factors associated with ASD to highlight the wide range of genetic variations and alterations implicated in the development of the condition. Furthermore, we consider familial risk factors and environmental influences, including pre-conception and prenatal factors, obstetrics-related conditions, and early childhood environmental risks. Identifying the at-risk population provides valuable insights for improving understanding, raising awareness, and supporting primary prevention efforts.
Clinical Utility of Systemic Inflammation Markers in Identifying Endometrial Hyperplasia and Adenocarcinoma
Authors: Bıldacı Tevfik B. , Ata Can , Avsar Huseyin A. , Atlıhan Ufuk , Erkılınc Selcuk
Published: December 2024

Introduction:

Inflammation and its associated factors play a pivotal role in the development and progression of cancer. Inflammation markers, such as neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, and the systemic immune-inflammation index can be readily calculated to gauge the level of inflammation. This study aimed to investigate the correlation between these inflammation markers and their role in the progression stages of endometrial cancer.

Methods:

A retrospective analysis was conducted on data collected from 154 patients. The patients were categorized into three groups: normal endometrium, hyperplasia with atypia, and endometrioid-type endometrial cancer. The differences in inflammation marker values among these groups were examined and identified.

Results:

The systemic immune-inflammation index (SII) findings revealed a nonsignificant trend in differentiation between the study groups; however, a significant inverse relationship was observed in the lymphocyte-to-monocyte ratio (LMR) values across the groups (P = 0.037). Post hoc analysis further demonstrated a significant difference in SII values between the group with normal endometrium and group with endometrial cancer (P = 0.042).

Conclusion:

These findings suggest that the SII and LMR show potential as biomarkers for distinguishing between endometrial pathologies in age-controlled patient cohorts.
Wind Instrumentalist’s Magnet-assisted Embouchure Denture
Authors: Pugazhendhi Prakash , Putta Sai Pranathi , Gujjari Anil Kumar , Raghavendraswamy K. N.
Published: December 2024

Musicians who play wind instruments have been rehabilitated with complete dentures and often feel discomfort while playing their instruments. The difficulty arises during treatment planning owing to the intense physiological demands imposed on the oral and perioral structures, notably the facial muscles when a wind musician blows. Embouchure dentures are designed for their carrier purpose, primarily to suit the functional needs of the orofacial muscles, ensuring that there is no dislodgment of the dentures during the blowing of wind instruments. An embouchure denture for a 50-year-old male patient is developed in this case report with a system of inclined planes in the posterior tooth region and a pair of magnets to repel the retentive trait. A properly constructed embouchure denture can help the musician continue their career, along with functional rehabilitation. This case report aims to describe the process of fabricating a specially engineered prosthesis for a completely edentulous wind instrument player, “the embouchure denture, magnet assisted.”
Microneedling: An Innovative Technique for Gingival Depigmentation
Authors: Bhambhu Chetna , Sheokand Vidushi , Sharma Shikha , Bhardwaj Amit
Published: December 2024

Microneedling is a form of therapy that creates a controlled skin injury using a device consist rows of microneedles that puncture a uniform depth into the dermis creating micropuncture that heals quickly, stimulating the formation of collagen and elastin fibers and ultimately leads to remodeling of the skin. It was originally introduced for skin rejuvenation including acne scars, acne, posttraumatic/burn scars, hyperhidrosis, and stretch marks. In a brief period, this technique has become popular and widely accepted because it is an easy, cheap, efficient method that requires very little training. Conventionally, collagen induction has been used in the treatment of facial scars and skin rejuvenation, but it is being switched to dental procedures as a new technique for depigmentation, target drug delivery devices, collection of diagnostic fluids, etc.
Variations of Root Canal Morphology in Permanent Anterior and Posterior Teeth Found in Indian Population: A Narrative Review
Authors: Magar Rohit P. , Margasahayam Sumanthini V. , Patil Anuradha , Naik Divya
Published: December 2024

Atypical tooth or root anatomy should be identified as a variation when it is observed frequently in a particular community or ethnic group. The root canal morphology depends on demographic factors such as age, gender, and ethnicity. There are differences in the morphology of the root canal that are inherent to different racial and ethnic groups. Knowing this helps clinicians understand root canal anatomy leading to better endodontic treatment outcomes. The studies reviewed had reported predominantly Vertucci type I in upper and lower anterior teeth. Considering the upper back region of the jaw, first and second premolars often had single-rooted type IV canals, followed by Vertucci type I and type III configurations. Mandibular premolars mainly featured type I canals. Maxillary molars typically had three roots, with the mesiobuccal (MB) root primarily classified as type I. Compared to second molars, first molars were more likely to have second MB canal. There are two roots found in mandibular molars; the first molar’s root that is distal was type I, and the proximal root was classified as type II. Accessory canals, including the middle mesial canal, were more prevalent compared to other populations, whereas C-shaped canals were relatively infrequent, varying from 7.53% to 13.12%. These results demonstrate the variety of root canal shapes, which can impact dental treatment approaches.
Isolation, Culture, and Characterization of Primary Kidney Fibroblasts from Human Patients with Chronic Antibody-mediated Kidney Transplant Rejection
Authors: Singh Mantabya Kumar , Rai Mohit Kumar , Agarwal Vikas , Prasad Narayan
Published: December 2024

Background:

Inflammation and fibrosis are the primary occurrences of chronic antibody-mediated rejection (CABMR) in kidney transplant patients. Fibroblasts are the primary cell type involved in allograft rejection and play a crucial role in the pathogenesis and progression of chronic antibody-mediated rejection (CABMR). The in vitro study of the fibroblast is essential for comprehending biological processes and molecular reasons for CABMR and creating innovative treatment methods. However, establishing primary cultures from the kidney tissue is challenging.

Aim and Objective:

This protocol describes a simple and reproducible method for selective propagation and culture of primary human kidney fibroblasts from kidney cortex tissue. Techniques for their isolation and characterization are described in detail.

Material and Methods:

Primary kidney fibroblast cell culture was performed with a single core of fresh allograft biopsy tissue collected from the patients with CABMR. The biopsy tissue was collected in normal saline or phosphate buffer saline (PBS) and transported immediately on ice to the cell culture laboratory of the department.

Results:

An inverted microscope imaging shows the fibroblast cells during the first passage at 14th day, the cells were characterized by fingerprint monolayers when they were more than 80 % confluent. During the fourth passage at day 90, these cells took on the appearance of a long, elongated, spindle shaped. The immunofluorescence (IF) staining, shows the primary kidney fibroblast cells at the fourth passage were strongly positive for the fibroblast marker, Collagen I (fibrogenic cells), α-SMA (Resident fibroblast to active myofibroblasts conversion), and Vimentin (mesenchymal cells). On the other hand, the epithelial marker, cytokeratin-8, and E-cadherin were found to be very weak positive.

Conclusion:

This study provides an optimized, simple, and cost-effective method for primary fibroblast cultures from kidney tissue that may be reproducible easily at various laboratories and will provide a rich resource for future studies and research.
Renal Transplantation in Patients with Cystinosis – A Case Series
Authors: Thiagarajan Yashwanth Raj , Kannabhiran Dinesh , Arumugham Kanakaraj , Ravichandran Rajan
Published: December 2024

Cystinosis is a rare autosomal recessive lysosomal storage disorder causing intracellular accumulation of cystine in different organs, leading to several organ dysfunctions. Renal involvement is the most serious manifestation of cystinosis leading to end-stage kidney disease (ESKD). Here, we report the outcomes of four patients with cystinosis who underwent kidney transplantation. All the patients were young males. Renal manifestation included Fanconi syndrome and progressive decline in glomerular filtration rate (GFR). One of the patients had nephrotic syndrome with focal segmental glomerulosclerosis. The median age at ESKD was 10 years. Post-transplant, all patients were maintained on tacrolimus-based triple immunosuppression. All patients received cysteamine therapy. The median follow-up duration was 7.5 years. All patients maintained excellent graft function during follow-up except one. The median estimated GFR was 92.6 mL/min/1.73 m2. One patient lost the graft 6 years after transplant due to T-cell-mediated rejection. Kidney transplantation can be safely performed in patients with cystinosis with good long-term outcomes. This is the first case series regarding cystinosis patients who received kidney transplantation from India.
Intraoperative Cardiac Complications in Liver Transplantation: Preoperative Evaluation – A Narrative Review
Authors: Çekmen Nedim , Uslu Ahmed
Published: December 2024

The decisive treatment for end-stage liver disease (ESLD) is liver transplantation (LT). Perioperative management of LT is one of the most challenging issues for anesthesiologists. The heart and liver are organs that are closely related to both health and disease. Cardiac actions are the most essential cause of mortality during LT and have a significant impact on overall outcomes. The pathophysiological effects of ESLD on the circulatory system cause critical difficulties in perioperative treatment. In order to perform correct anesthesia management in LT, it is crucial to understand and know the multiplex pathogenesis of ESLD and the changes in the afflicted systems, especially the heart. LT is a dynamic process and one of the most stressful cardiovascular events an ESLD patient can experience. Anesthesia management of LT is a highly complex procedure requiring an exact multidisciplinary team attitude. A comprehensive cardiovascular system (CVS) assessment, planning, coordination, collaboration, and optimization with a multidisciplinary team in the preoperative period is essential for the management and treatment of possible intraoperative cardiac complications (ICCs). In light of the literature, our review focuses on the value and importance of detailed preoperative CVS evaluation in anesthesia management in preventing significant ICCs that may occur in the intraoperative period in LT patients.
To Determine Factors Causing Difficulty in Laparoscopic Donor Nephrectomy – Prospective Analytic Study
Authors: Dokania Manoj Kumar , Anshu  , Kumar Peeyush , Ranjan Gyan , Agarwal Nitin , Goel Hemant Kumar , Jain Atul
Published: December 2024

Background:

Concerns about laparoscopic donor nephrectomies exist. First and foremost, donor safety is a top priority. Second, the kidneys obtained through laparoscopic donor nephrectomy should provide recipients of kidney transplants with excellent short- and long-term renal function. This study aimed to determine the preoperative and intraoperative factors that affect the variation in the laparoscopic donor nephrectomy operative time, as well as the factors that contribute to the difficulty of the procedure.

Materials and Methods:

This prospective analytical study was carried out in the transplant unit over a 2-year period. The study involved all healthy adult donors scheduled for a left-sided laparoscopic nephrectomy. Another parameter used to evaluate the procedure’s results was a difficulty index.

Results:

A total of 33 transplant donors in all who met the requirements for inclusion were included. A laparoscopic left-sided donor nephrectomy was performed on 31 donors, while two donors underwent an open donor nephrectomy conversion. The average age of donors is 43.4 ± 5.65 years, with females outnumbering males. Males had a mean surgery duration of 163.8 min, while females had a mean of 148.4 min. The maximum patient’s body mass index ranges from 24 to 27.9 kg/m2, and the mean operating time is between 158.5 and 149.7 min. The likelihood of conversion and complications rises with the difficulty index, resulting in longer hospital stays.

Conclusion:

The difficulty of a laparoscopic live donor nephrectomy can be predicted by a number of factors, including sex, anatomical variance of multiple vessels, and pyelonephric adhesions, which continue to be important parameters.
Early Recurrence of C3 Glomerulopathy Postrenal Transplant Manifesting as Atypical Hemolytic Uremic Syndrome: A Phenotype Switch
Authors: Siddini Vishwanath , Nikumbhe Anand , Khan Mohammed Fahad , Vankalakunti Mahesha , Ballal H. Sudarshan
Published: December 2024

Kidney transplantation is the best treatment option for end-stage kidney disease patients. Long-term survival of the allograft is a crucial component of medical care because of the expense and complications of the surgical procedure. C3 glomerulopathy (C3G) is the primary glomerular disease with a very high recurrence rate postrenal transplantation. Atypical hemolytic uremic syndrome (aHUS) shares common genetic risk factors with C3G. Few cases were reported earlier regarding phenotype shifts between C3G and aHUS. However, recurrence of C3G immediate postrenal transplant as aHUS is an extremely rare phenomenon. This patient did not respond to plasmapheresis but showed excellent response to eculizumab and completely recovered the graft function. There are no guidelines for the prevention or treatment of the recurrence of C3G in kidney transplant patients and requires further discussion.
Anti T-lymphocyte Globulin (Grafalon®) Use during Rabbit Anti-thymocyte Globulin (Thymoglobulin®) Shortage – A Single-center Experience
Authors: Tiwari Shailendra , Rao Namrata S , Chandra Abhilash , Ansari Majibullah , Singh Sanjeet Kumar
Published: December 2024

Introduction:

During a period of local nonavailability of rabbit anti-thymocyte globulin (rATG) in India, anti-T-lymphocyte globulin (ATLG) was utilized in high-risk renal transplantation. The study aimed to compare renal transplant recipients (RTRs) in two study periods with rATG and ATLG induction use, in terms of biopsy-proven acute rejection (BPAR) rates, patient and graft survival and infectious complications in the 1st year and beyond.

Methods:

This retrospective, single-center study compared two time periods: June 2019–June 2021 (Period I – rATG induction) and July 2021–October 2022 (Period II – ATLG induction). Only immunologically high-risk, ABO-compatible living donor RTRs were included. Clinical data were sourced from hospital information system, and only infections requiring hospital admissions were collected. Missing information was collected telephonically.

Results:

A total of 78 RTRs were included in the analysis, of whom 28 received rATG at a dose of 3 mg/kg (Period I) and 50 received ATLG at a dose of 5–6 mg/kg (Period II). Delayed and slow graft function (SGF) were significantly increased in Period II (12%, 12% vs. 10.7%, 7.1%, respectively, P < 0.001), trend toward increased BPAR episodes in Period II (12% vs. 10.7%, P = 0.155) and similar death-censored graft survival [60.6 months in Period I vs 73.4 months in Period II (P=0.66)]. Infection-related admissions were significantly lower in Period II. First year rejection-free and infection-free survival plots were similar in the two periods (log-rank test P > 0.05).

Conclusion:

The use of 5–6 mg/kg dose of ATLG (a relatively low dose) during rATG nonavailability, was associated with higher delayed and SGF, similar BPAR, graft and patient survival rates, and lower risk of infectious complications in immunologically high-risk patients.
Auto-delineation of the hippocampus using Mask R-CNN for radiation oncology: A cross-sectional observational study
Authors: Laud Adwait , Talapatra Kaustav , Sankhe Manoj , Gupte Ajinkya , Shetty Ashish , Bardeskar Nikhil , Kanikar Prashasti , Rout Abhishek , Barsing Shubhangi , Tiwari Pranjal , Shah Arya , Patkar Deepak
Published: December 2024

Objective:

Radiotherapy is an effective treatment for brain tumors, but it can lead to adverse side effects, particularly neurocognitive dysfunction. The hippocampus, a crucial structure for memory formation, is vulnerable to radiation-induced damage. To reduce the risk of adverse effects, the precise delineation of the hippocampus is necessary for radiation therapy planning. Automated hippocampal delineation using deep learning and mask regions with convolution neural networks (R-CNN) algorithm reduces the manual delineation time, ensures accuracy, and supports its implementation in radiation therapy. This study aimed to develop an automated method for hippocampal delineation and assess its feasibility for brain radiation treatment using deep learning and Mask R-CNN algorithm.

Materials and Methods:

The study applied several pre-processing techniques, including thresholding, Canny edge detection, and keypoint detection, to enhance the input images of patient hippocampal scans. The processed images were then analyzed using the Mask R-CNN algorithm for automated hippocampal delineation. The Mask R-CNN algorithm was assessed using the following metrics: accuracy, recall, intersection over union (IoU), and mean average precision (mAP).

Results:

The proposed network achieved a mAP of 96.2% and average sensitivity of 0.93, indicating high segmentation accuracy. Moreover, the recall was 0.87 and specificity was 0.96, indicating the high specificity of the method to segment the hippocampus.

Conclusions:

The results of this study suggest that the developed automated method is highly sensitive and specific for delineating the hippocampus. This automated segmentation method may be used to complement the manual review of hippocampal scans during radiotherapy planning for brain tumors.