bluuebunny/crossref_metadata_2025 huggingface dataset:
JWST NIRSpec Spectroscopy of the Triply Lensed z = 10.17 Galaxy MACS0647–JD
Authors: Hsiao Tiger Yu-Yang , Abdurro’uf  , Coe Dan , Larson Rebecca L. , Jung Intae , Mingozzi Matilde , Dayal Pratika , Kumari Nimisha , Kokorev Vasily , Vikaeus Anton , Brammer Gabriel , Furtak Lukas J. , Adamo Angela , Andrade-Santos Felipe , Antwi-Danso Jacqueline , Bradač Maruša , Bradley Larry D. , Broadhurst Tom , Carnall Adam C. , Conselice Christopher J. , Diego Jose M. , Donahue Megan , Eldridge Jan J. , Fujimoto Seiji , Henry Alaina , Hernandez Svea , Hutchison Taylor A. , James Bethan L. , Norman Colin , Park Hyunbae , Pirzkal Norbert , Postman Marc , Ricotti Massimo , Rigby Jane R. , Vanzella Eros , Welch Brian , Wilkins Stephen M. , Windhorst Rogier A. , Xu Xinfeng , Zackrisson Erik , Zitrin Adi
Published: September 2024

We present JWST/NIRSpec prism spectroscopy of MACS0647−JD, a triply lensed z ∼ 11 candidate discovered in Hubble Space Telescope imaging and spatially resolved by JWST imaging into two components, A and B. Spectroscopy of component A yields a spectroscopic redshift z = 10.17 based on seven detected emission lines: C iii] λ
λ1907, 1909, [O ii] λ3727, [Ne iii] λ3869, [Ne iii] λ3968, Hδ
λ4101, Hγ
λ4340, and [O iii] λ4363. These are the second-most distant detections of these emission lines to date, in a galaxy observed just 460 million years after the Big Bang. Based on observed and extrapolated line flux ratios we derive a gas-phase metallicity 12 + log(O/H) ∼ 7.5–8.0, or Z ∼ (0.06–0.2) Z
⊙, ionization parameter

log
(
U
)

= −1.9 ± 0.2, and an ionizing photon production efficiency

log
(

ξ

ion

)
=
25.2
±
0.2

erg−1 Hz. The spectrum has a softened Lyα break, evidence for a strong Lyα damping wing. The Lyα damping wing also suppresses the F150W photometry, explaining the slightly overestimated photometric redshift z = 10.6 ± 0.3. MACS0647−JD has a stellar mass log(M/M
⊙) = 8.1 ± 0.3, including ∼6 × 107
M
⊙ in component A, most of which formed recently (within ∼20 Myr) with a star formation rate ∼ 2 ± 1 M
⊙ yr−1, all within an effective radius 70 ± 24 pc. Spectroscopy of a fainter companion galaxy C separated by a distance of ∼ 3 kpc reveals a Lyman break consistent with z ∼ 10.17. MACS0647−JD is likely the most distant galaxy merger known.
Kappa-tail Technique: Modeling and Application to Solar Energetic Particles Observed by Parker Solar Probe
Authors: Livadiotis G. , Cummings A. T. , Cuesta M. E. , Bandyopadhyay R. , Farooki H. A. , Khoo L. Y. , McComas D. J. , Rankin J. S. , Sharma T. , Shen M. M. , Cohen C. M. S. , Muro G. D. , Xu Z.
Published: September 2024

We develop the kappa-tail fitting technique, which analyzes observations of power-law tails of distributions and energy flux spectra, and connects them to theoretical modeling of kappa distributions, to determine the thermodynamics of the examined space plasma. In particular, we (i) construct the associated mathematical formulation; (ii) prove its decisive lead for determining whether the observed power-law is associated with kappa distributions; and (iii) provide a validation of the technique using pseudo-observations of typical input plasma parameters. Then, we apply this technique to a case study by determining the thermodynamics of solar energetic particle (SEP) protons, for an SEP event observed on 2021 April 17, by the Parker Solar Probe (PSP)/Integrated Science Investigation of the Sun instrument suite on board PSP. The results show SEP temperatures and densities of the order of ∼1 MeV and ∼5 × 10−7 cm−3, respectively.
Influence of Black Hole Kick Velocity on Microlensing Distributions
Authors: Koshimoto Naoki , Kawanaka Norita , Tsuna Daichi
Published: September 2024

The natal kick velocity distribution for black holes (BHs) is unknown regardless of its importance for understanding the BH formation process. Gravitational microlensing is a unique tool for studying the distribution of BHs in our Galaxy, and the first isolated stellar-mass BH event, OGLE-2011-BLG-0462/MOA-2011-BLG-191 (OB110462), was recently identified by astrometric microlensing. This study investigates how the natal kick velocity for Galactic BHs affects the microlensing event rate distribution. We consider a Maxwell distribution with various average kick velocities, as well as the consequent variation of the spatial distribution of BHs. We find that the event rate for the BH lenses toward the Galactic bulge decreases as v
avg increases, mainly due to the scale height inflation. We focus on the unique microlensing parameters measured for OB110462, with microlens parallax π
E larger than 0.06 for its long timescale of t
E > 200 days. We calculate the expected number of BH events occurring with parameters similar to OB110462 during the OGLE-IV survey by Mróz et al. and compare it with the actual number that occurred, at least one. Our fiducial model predicts 0.52, 0.38, 0.18, 0.042, and 4.0 × 10−3 events occurring for v
avg = 25, 50, 100, 200, and 400 km s−1, respectively, which suggests that the average kick velocity is likely to be v
avg ≲ 100 km s−1. The expected number smaller than unity even at maximum might indicate our luck in finding OB110462, which can be tested with future surveys by, e.g., the Roman Space Telescope.
The Carousel Lens: A Well-modeled Strong Lens with Multiple Sources Spectroscopically Confirmed by VLT/MUSE
Authors: Sheu William , Cikota Aleksandar , Huang Xiaosheng , Glazebrook Karl , Storfer Christopher , Agarwal Shrihan , Schlegel David J. , Suzuki Nao , Barone Tania M. , Bian Fuyan , Jeltema Tesla , Jones Tucker , Kacprzak Glenn G. , O’Donnell Jackson H. , G. C. Keerthi Vasan
Published: September 2024

Over the past few years alone, the lensing community has discovered thousands of strong lens candidates, and spectroscopically confirmed hundreds of them. In this time of abundance, it becomes pragmatic to focus our time and resources on the few extraordinary systems, in order to most efficiently study the Universe. In this paper, we present such a system: DESI-090.9854-35.9683, a cluster-scale lens at z
l = 0.49, with seven observed lensed sources around the core, and additional lensed sources further out in the cluster. From the number and the textbook configuration of the lensed images, a tight constraint on the mass potential of the lens is possible. This would allow for detailed analysis on the dark and luminous matter content within galaxy clusters, as well as a probe into dark energy and high-redshift galaxies. We present our spatially resolved kinematic measurements of this system from the Very Large Telescope Multi Unit Spectroscopic Explorer, which confirm five of these source galaxies (in ascending order, at z
s = 0.962, 0.962, 1.166, 1.432, and 1.432). With previous Hubble Space Telescope imaging in the F140W and F200LP bands, we also present a simple flux-based lens model consisting of two power-law profiles that, for a cluster lens, well models the five lensed arc families with redshifts. We determine the mass to be M(< θ
E) = 4.78 × 1013
M
⊙ for the primary mass potential. From the model, we extrapolate the redshift of one of the two source galaxies not yet spectroscopically confirmed to be at

z

s

=

4.52

−
0.71

+
1.03

.
A clinical case of STEMI in a 20-year-old woman, differential diagnosis – myocarditis, MINOCA
Authors: Moraliyska P. , P. Lazarov P. , Pashkuleva-Dermendzieva E. , Barakova S. , Georgieva E.
Published: September 2024

We present a clinical case of a 20-year-old woman with acute myocardial infarction with persistent ST-segment elevation (STEMI). The coronary angiography performed on the patient showed coronary vasospasm with no evidence of atherosclerotic plaque. The aim of this case report is to draw attention to the different types of myocardial infarction, other possible differential diagnoses (DD), and to the investigations necessary for determining a definitive diagnosis.
Follow-up of a pregnant patient with restrictive cardiomyopathy and neuromuscular disease – mission is possible – case report
Authors: Shomanova Z. , Welp H. , Schmitz R. , Sindermann J.R.
Published: September 2024

The follow-up of pregnant patients with cardiomyopathies is a challenge that every cardiologist will be facing sooner or later. We present the first case of a patient with restrictive cardiomyopathy and Alpha-B-crystallinopathy (distal myopathy type), who was followed up during two pregnancies. Cardiac follow-ups were carried out by short-term clinical status monitoring, echocardiography, ECG monitoring and NT-proBNP. At the same time, foetal ultrasound scans should be performed. Follow-up requires constant communication between the cardiologist and the gynaecologist. Any decision concerning the mother or the foetus should be made by consensus between both teams. Despite good follow-up, pregnancy in such complex patients remains a high risk due to heart.  Heart failure and neuromuscular symptoms can worsen during or after pregnancy.
Molecular-genetic profile in patients with cardiomyopathy in Bulgaria
Authors: Angelova P. , Stoyanov N. , Velchev V. , Atemin S. , Sleptsova M. , Todorov T. , Gencheva D. , Gospodinova M. , Pechilkov D. , Dasheva A , Tchamova T. , Taneva A. , Tournev I. , Mitev V. , Todorova A.
Published: September 2024

Introduction: Cardiomyopathies are a clinically and genetically heterogeneous group of diseases, that are associated with significant morbidity and mortality. The aim of the present study is to clarify the molecular-genetic characteristics of cardiomyopathies in patients in Bulgaria. Material and methods: In the present study, targeted analysis of an expanded panel of 242 genes, associated with cardiomyopathy, and an additional panel of 20 genes, associated with hereditary amyloidosis, was performed in a total of 20 Bulgarian patients, diagnosed with cardiomyopathy, as follows: 12 patients with hypertrophic cardiomyopathy (HCM), including 1 pediatric patient, 6 patients with dilated cardiomyopathy (DCM), of whom 2 pediatric patients, and 2 patients with restrictive cardiomyopathy (RCM). Family segregation analyses were performed by direct Sanger sequencing. Results: Genetic findings were present in 90% of the patients. Pathogenic/likely pathogenic variants were found in 12 of the patients (60%), while genetic findings related to the clinical symptoms were not detected in the RCM patients (10%). Approximately 1/3 of the patients had a family history of sudden cardiac death or cardiomyopathy. Pathogenic/likely pathogenic variants were found in 55% of HCM patients with no family history, in ~67% of HCM patients with family history or with sporadic DCM, and in 100% of DCM patients with a positive family history. A respectively 2,5 and 4-fold higher frequency of truncating variants was found in the study group compared to the reports of around 10% in the literature, both in patients with HCM, and in patients with DCM. Pathogenic/likely pathogenic variants in the MYBPC3 gene (71%) were found with the highest frequency in HCM, while DCM is characterized by a diverse genetic profile, and genetic findings in the NDUFB11 and TAZ genes were associated with severe clinical presentation in pediatric patients in the first postnatal days. Results of segregation analyses were reported in 6 of the affected families. Conclusion: The data from the present study supports the importance of conducted genetic testing and medical-genetic counseling in patients and affected families with cardiomyopathy in Bulgaria
Supra-aortic stenosis surgery: case study
Authors: Nuellari E. , Kapedani E. , Kuci S. , Kenga A.
Published: September 2024

The aim of this study was to demonstrate a case of aorto-carotid bypass in a patient with carotid artery stenosis as a reasonable and necessary method for preventing ischemic stroke. The study was conducted at the University Hospital Center “Mother Teresa” (QSUT), Tirana. A 63-year-old patient with atherosclerotic arteriopathy and hypertension presented with episodes of dizziness and syncope. Doppler echocardiography revealed an increase in blood flow velocity in the right and left carotid arteries by more than 2.5 times. Computed tomography angiography visualised stenosis of the right and left common carotid arteries, stenosis of the brachiocephalic trunk at the beginning, and occlusion of the left subclavian artery. Performed revascularization of the common carotid arteries using a bifurcated 14×7 mm Dacron graft. The proximal end of the graft was anastomosed to the ascending aorta, and the distal ends were connected to both common carotid arteries. Follow-up Doppler echocardiography showed normalization of blood flow velocity in the carotid arteries. The patient’s neurological symptoms completely disappeared. The patient was discharged without complications after 10 days. The method of resolving complex multisegmental stenosis by aorto-carotid bypass ensures optimal perfusion of the brain and is proposed for use in appropriate conditions for the prevention of ischemic stroke.
Bloom Encodings in DGA Detection: Improving Machine Learning Privacy by Building on Privacy-Preserving Record Linkage
Authors: Nitz Lasse , Mandal Avikarsha
Published: September 2024

The use of machine learning has shown to benefit a wide range of applications, especially for classification tasks. As such, the detection of algorithmically generated domains to identify corrupted machines has proven itself to be a mature use case with good classification performance. The use of privacy and security sensitive data, however, raises concerns in scenarios that require interaction with external parties. As one of such scenarios, we consider the training of domain generation algorithm detection classifiers in a Machine-Learning-as-a-Service (MLaaS) scenario. We evaluate the use of a Bloom encoding approach from the area of privacy-preserving record linkage to prevent the MLaaS provider from getting to know the exact classification task as well as the data samples transmitted for training and classification. We investigate the threat associated with pattern mining attacks by performing a privacy analysis for two versions of these encodings (basic and randomized). We further identify sets of parameter values which we find to provide an adequate level of protection against these attacks. We see the potential for this approach in machine learning use cases dealing with sensitive data or tasks, especially for MLaaS scenarios dealing with short data samples that lack a clear structure.
Navigating Anxiety in a Cloud E-learning Virtual Environments: The Moderating Role of Anxiety on Lecturers’ Adoption of Cloud Computing E-learning
Authors: Armah Elisha D'Archimedes , Ali I. Sathik
Published: September 2024

The rapid expansion of cloud computing e-learning systems has empowered educators to reach learners worldwide. However, a critical study gap exists: the impact of lecturers’ technological anxiety on their adoption intentions remains unexplored in the technical universities in Ghana. This study addresses this gap by investigating anxiety’s influence on lecturers’ cloud computing e-learning adoption intentions within a virtual environment (VE). We examine the mediating role of competitive pressure and the moderating role of anxiety. Using PLSSEM, we analysed data from surveys conducted among 1395 lecturers across all 10 technical universities. With a high response rate of 90.2% (n = 1258), our analysis reveals moderate anxiety among lecturers regarding cloud e-learning adoption. The proposed model explains 21.1% of the variance in adoption intentions. Interestingly, competitive pressure on lecturers mediates the relationship between cloud e-learning usefulness, security, and adoption decisions. Additionally, anxiety moderates the effects of cloud computing complexity, security, and adoption intentions. We have recommended organizing regular training workshops, ensuring user-friendly platforms, implementing robust security measures, and providing psychological support for lecturers using cloud computing technologies.
Intelligent Monitoring and Optimization of Wind Turbine Operation Status on Basis of Vibration Signals
Authors: Wang Wei , Shi Yingchun , Huang Yahui
Published: September 2024

In response to the large monitoring errors and incomplete consideration of fault locations in the operation status of wind turbines, this paper combined vibration signals and used a model constructed using nonlinear state estimation technology (NSET) to monitor and optimize the operation status of wind turbines. Firstly, it collected relevant SCADA (supervisory control and data acquisition) and vibration sensor data of Unit 5 of Guangdong Yangjiang Shaba Offshore Wind Farm on site, and used wavelet transform to denoise the vibration signal. Then, full consideration can be given to the faulty parts such as wind blades and gearboxes, and a model constructed by NSET using Markov distance to construct a process memory matrix can be used to monitor the status of the wind turbine equipment. Finally, the multi-level fuzzy comprehensive evaluation method can be used to optimize the comprehensive evaluation of the operating status of wind turbines, reducing monitoring errors.
Application of Artificial Intelligence Technology in Optimizing Control Parameters of Traffic Signal Group Systems
Authors: Li Xiuli , Miao Huachang
Published: September 2024

On the basis of introducing the concept of intersection signal state phase difference, the author proposes a proportional signal phase difference design scheme for traffic signal system control, on the basis of the HCM signal delay calculation formula, a standardized signal cycle and effective green signal ratio optimization design model were compiled, thus forming a complete set of optimization design modes for the control parameters of the urban main road traffic signal group system. The experimental results indicate that, the entire simulation experiment took 6000 seconds to compare the traditional fuzzy algorithm with the controller implemented by the author's fuzzy neural network, each case was simulated 5 times, the data in the Table is the average of 5 times, compared with traditional fuzzy algorithms, the author's method shows an improvement of 20.8% to 45.67% in average vehicle delay time, especially when the traffic flow is different in the east-west and north-south directions, the improvement is more significant.
GESTÃO E GERENCIAMENTOS DE RESÍDUOS SÓLIDOS NA ÁREA URBANA DE RONDONÓPOLIS, MATO GROSSO
Authors: Loverde-Oliveira Simoni , Santos Zenilda Barbosa Vilela dos
Published: September 2024

Embora o aumento de geração de resíduos sólidos cause preocupação, as ações de disposição ainda têm sido tratadas de maneira desarticulada. Conforme a Política Nacional de Resíduos Sólidos (PNRS), os municípios deverão implantar o Plano Municipal de Gestão Integrada de Resíduos Sólidos (PMGIRS). Este estudo, de natureza qualitativa e quantitativa visa descrever a gestão e gerenciamento dos resíduos sólidos urbanos de Rondonópolis (MT), analisando as normas operacionais específicas para atender as bases legais: nacional, estadual e municipal, apoiado em levantamento de dados e visitas aos locais de destinação. A gestão e gerenciamentos de resíduos sólidos da zona urbana de Rondonópolis compreendem: coleta convencional; seletiva; dos resíduos descartados irregularmente em terrenos baldios e vias públicas, os chamados bolsões, Ecopontos, transbordo dos resíduos dos Ecopontos para o Aterro Controlado ou Aterro Sanitário e transporte de resíduos sólidos até o Aterro Sanitário. A gestão de resíduos sólidos no município não é integrada e precisa ser melhorada segundo as diretrizes existentes. Os resultados demonstraram que na zona urbana de Rondonópolis, embora o órgão público tenha um sistema de gestão e gerenciamento operacional em funcionamento, ainda não trata de forma adequada, especialmente os resíduos sólidos recicláveis.
Ultrasound as a tool for the diagnosis of spondylarthritis in women
Authors: Donzella D. , Bellis E. , Iagnocco A.
Published: September 2024

Objective. The journey to a diagnosis of spondyloarthritis (SpA) can be difficult for women, who often experience delays in receiving the correct diagnosis as their symptoms are frequently misinterpreted due to other conditions like osteoarthritis, fibromyalgia, or other psychosomatic disorders. The purpose of this article is to examine the challenges in the diagnosis of SpA in women and the possible role of musculoskeletal ultrasound in early diagnosis and in avoiding misdiagnosis.
Methods. We have performed a narrative review of the currently available literature on the subject.
Results. The complexity of diagnosing SpA in women is compounded by the misconception that the disease predominantly affects men. To facilitate early diagnosis and prevent misdiagnosis, it is crucial not to overlook gender differences in the clinical presentation of SpA. Since women have more peripheral and enthesitic involvement, performing an ultrasound of entheses, tendons, and joints in women with musculoskeletal symptoms that could refer to SpA may help both in the early and differential diagnosis.
Conclusions. There is a need to increase awareness among physicians of the existence of a different clinical presentation of SpA between men and women. The use of musculoskeletal ultrasound, which allows the detection of even subclinical inflammation and structural damage since early disease at the level of joints, tendons, and entheses can help make an early diagnosis and avoid misdiagnosis. Early diagnosis and timely treatment of SpA are crucial to reducing irreversible damage.
The role of sacro-iliac joint magnetic resonance imaging in the diagnosis of axial spondyloarthritis: focus on differential diagnosis in women
Authors: Besutti G. , Marvisi C. , Muratore F. , Spaggiari L.
Published: September 2024

Objective. To review the role of sacro-iliac magnetic resonance imaging (MRI) in the diagnosis of axial spondyloarthritis (AxSpA), with a focus on gender differences.
Methods. The experience of the authors and the results of an informal literature review are reported.
Results. Inflammatory changes of the sacro-iliac joint are the hallmark of AxSpA. Early, non-radiographic sacroiliitis may be diagnosed with MRI through the assessment of bone marrow edema (BMO) as well as concomitant structural damage. The MRI protocol should include three necessary sequences, i.e., fat-saturated T2-weighted sequences on two orthogonal planes, T1-weighted semi-coronal sequence, and fat-suppressed T1-weighted semi-coronal sequence. Inflammatory changes comprise required signs (BMO and/or osteitis) and additional signs, including synovitis (better defined as joint space enhancement), enthesitis, and capsulitis. Structural changes consist of erosions, sclerosis, fat metaplasia, and ankylosis. Due to mechanical axial strain, inflammatory changes in the sacro-iliac joint can be found in healthy individuals, runners, and patients with nonspecific low back pain. The prevalence of BMO is higher in women during pregnancy and postpartum, even 12 months after childbirth, but the extent and distribution of MRI findings may help in the differential diagnosis. Other challenges in the MRI diagnosis of sacroiliitis are subchondral T2 hyperintensity during developmental age, periarticular sclerosis in healthy subjects, or osteitis condensans ilii, and several pathological conditions that may mimic AxSpA, some of which are more frequently found in women.
Conclusions. The described diagnostic challenges impose a multidisciplinary approach combining imaging findings with clinical and laboratory data.
Gender differences in clinical features and quality of life of patients with axial spondyloarthritis and psoriatic arthritis
Authors: Ristic B. , Bonetto C. , Rossini M. , Fracassi E. , Carletto A. , Tosato S.
Published: September 2024

Objective. The aim of the current study was to compare the clinical and treatment characteristics and dimensions of health-related quality of life between female and male patients with axial spondyloarthritis (SpA) and psoriatic arthritis (PsA).
Methods. The present study is cross-sectional and comprises 119 patients with axial SpA and 198 patients with PsA. Clinical data were collected by standardized and self-reported instruments. Disease activity was evaluated by the Ankylosing Spondylitis Disease Activity Score with C-reactive protein and the Disease Activity in PSoriatic Arthritis (for SpA and PsA, respectively). Health-related quality of life was assessed with the Medical Outcomes Study 36-item Short Form Survey. Patients were stratified by gender, and the socio-demographic, clinical, and quality-of-life data were compared.
Results. Women with axial SpA and PsA had significantly lower education (p<0.001, p=0.004, respectively) and higher disease activity (p<0.001, p=0.003, respectively). Female patients with axial SpA were more frequently under second-line therapy (p=0.026) and glucocorticoid treatment (p=0.005), while women with PsA had more radiographic progression (p=0.006). Female patients with axial SpA and PsA had worse scores in the dimensions of quality of life regarding physical role, bodily pain, vitality, and mental health. Women with axial SpA had lower scores in general health, while women with PsA had lower scores in physical and social functioning.
Conclusions. Women with axial SpA and PsA had worse scores than men in most clinical and treatment characteristics and health-related quality of life dimensions.
Treatment of spondyloarthritis with disease-modifying anti-rheumatic drugs during pregnancy and breastfeeding: comparing the recommendations and guidelines of the principal societies of rheumatology
Authors: Manara M. , Bruno D. , Ferrito M. , Perniola S. , Caporali R.F. , Gremese E.
Published: September 2024

Objective. This paper aims to provide an overview of the use of treatments available for axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA) during pregnancy and breastfeeding, according to current national recommendations and international guidelines, as well as data on the impact on pregnancy outcomes of paternal exposure to treatment.
Methods. We performed a narrative review of national and international recommendations and guidelines on the reproductive health of patients suffering from rheumatic diseases. The last updated recommendations and guidelines were considered source data.
Results. We reported updated information regarding the treatment of axSpA and PsA with nonsteroidal anti-inflammatory drugs, intra-articular glucocorticoids, conventional synthetic disease-modifying antirheumatic drugs (DMARDs), biologic DMARDs, and targeted synthetic DMARDs during the preconception period, pregnancy, and breastfeeding, as well as data related to paternal exposure. We highlighted any medications that should be discontinued and/or not used in the reproductive age group and also treatments that may be continued, avoiding the withdrawal of drugs that can be used in the different phases, thus preventing the risk of increasing disease activity and flares before, during, and after pregnancy in SpA patients.
Conclusions. The best management of pregnancy in patients with SpA is based on knowledge of updated drug recommendations, a careful and wise evaluation of the risks/benefits of starting or continuing treatment from the SpA diagnosis in a woman of childbearing age through pregnancy and lactation, and sharing therapeutic choices with other healthcare providers (in particular, gynecologists/obstetricians) and the patient.
Study Assessing Use of Mood Stabilizers (Sodium Valproate and Oxcarbazepine) as an Augmentation Strategy in Patients of Treatment-resistant Depression
Authors: Chugh Priya , Mahapatro Fiona
Published: September 2024

Background:

Treatment-resistant depression (TRD) is a major challenge, with a significant proportion of patients failing to achieve remission with initial antidepressant treatment. As per literature, augmentation strategies using nonantidepressant agents have been explored to overcome partial or lack of response. This study aimed to determine the efficacy of adding mood stabilizers, sodium valproate, and oxcarbazepine as augmenting agents in patients with TRD.

Methodology:

This prospective and observational study recruited 106 patients with TRD from a tertiary care center in Navi Mumbai, India. Patients were augmented with either sodium valproate (n = 53) or oxcarbazepine (n = 53) in addition to their ongoing antidepressant and anti-anxiety medications. The Hamilton Depression Rating Scale (HAM-D) and Hamilton Anxiety Rating Scale (HAM-A) were administered at baseline, at 2 weeks, and at 4 weeks after augmentation. Treatment response was documented, and results were statistically analyzed.

Results:

Both augmentation groups showed significant improvements in HAM-D and HAM-A scores at 2 and 4 weeks compared to baseline (P < 0.001). However, the sodium valproate group demonstrated superior efficacy, with a greater reduction in HAM-D scores as compared to the oxcarbazepine group at 2 weeks (25.60 vs. 21.98, P = 0.001) and 4 weeks (34.06 vs. 30.64, P = 0.001).

Conclusion:

The addition of mood stabilizers, sodium valproate, and oxcarbazepine, as augmentation agents led to significant improvement in patients with TRD. Sodium valproate exhibited superior efficacy as compared to oxcarbazepine, suggesting its potential as a valuable augmentation strategy in the management of TRD.
Cardiometabolic Crossroads: Obesity, Sleep-Disordered Breathing, and Epicardial Adipose Tissue in Heart Failure with Preserved Ejection Fraction – A Mini-Review
Authors: Cacciapuoti Fulvio , Mauro Ciro , Capone Valentina , Sasso Angelo , Tarquinio Luca Gaetano , Cacciapuoti Federico
Published: September 2024

Abstarct

Obesity, a multifaceted metabolic disorder, stands out as a significant risk factor in the development of heart failure with preserved ejection fraction (HFpEF). Its involvement in HFpEF pathogenesis encompasses a complex interplay with adipose tissue, particularly epicardial adipose tissue (EAT), and the effects of sleep-disordered breathing (SDB). Understanding these intricate relationships is pivotal for devising targeted therapeutic approaches to alleviate the burden of HFpEF in individuals with obesity. EAT assumes a central role in linking obesity to HFpEF. As it expands in the context of obesity, EAT contributes to systemic inflammation and insulin resistance, fostering an environment conducive to cardiac remodeling and dysfunction. Furthermore, SDB, prevalent comorbidity in the obese population, emerges as a significant mediator in HFpEF pathogenesis through various mechanisms. The convergence of obesity, EAT expansion, and SDB creates a synergistic effect, heightening the risk of HFpEF development. On the pharmaceutical front, ongoing investigations explore novel strategies targeting inflammation, oxidative stress, and metabolic pathways associated with obesity. These include the potential roles of sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide-1 receptor agonists, offering innovative therapeutic avenues for managing HFpEF in individuals with obesity. In addition, lifestyle modifications such as weight management and interventions addressing SDB and EAT reduction emerge as promising approaches for preventing and managing HFpEF in the obese population. These interventions hold the potential to mitigate obesity-related cardiac risks and improve HFpEF outcomes.
Evaluation of late effects during a 21-year follow-up of pediatric Hodgkin lymphoma survivors: Experience of a pediatric cancer center in Turkey, as a developing country model
Authors: Tacyildiz Nurdan , Cakmak Hatice M , Unal Emel , Dincaslan Handan , Tanyıldız Gulsah , Özdemir Sonay İ , Kartal Ömer , Yılmaz Yasin , Yavuz Gulsan , Kuzu Işınsu
Published: September 2024

Background:

Long-term survivors of Hodgkin lymphoma (HL) are at risk of developing a range of late effects, with a second malignant neoplasm and cardiovascular diseases being the leading causes of death in these patients. The present study aims to evaluate the late side effects in children with HL.

Materials and Methods:

Out of 53 HL patients, we assessed the long-term effects of childhood HL survivors (HLSs; n = 50) diagnosed between 1998 and 2019. Patient data related to chronic health conditions, and sociodemographic characteristics were compared with their siblings (n = 56).

Results:

The cumulative overall survival (OS) at 1, 5, and 10 years from diagnosis was 98.1 ± 1.9%, 93.3 ± 3.8%, and 93.3 ± 3.8%, respectively. Groups of HLSs and their siblings were matched according to age and gender. Compared with siblings, survivors had will be changed as ‘a higher frequency of nephrotoxicity (P = 0.02)’, cardiotoxicity (P = 0.12), thyroid dysfunction (P = 0.001), health care service usage (P < 0.01), limitation of physical function (P = 0.01), and pulmonary disease (P = 0.01). The control group of siblings had a higher incidence of marital status (P < 0.01), parenthood (P = 0.01), and smoking habit (P = 0.03). Thyroid dysfunction was associated with neck radiotherapy (P < 0.01). No secondary neoplasm was detected. In relapsed, refractory setting (n = 10), autologous transplantation (n = 9) is performed after a complete remission. Brentuximab vedotin with or without bendamustine and rituximab is also used in selected patients.

Conclusions:

Increased number of chronic health conditions and social problems point to the significance of long-term follow-up of HLSs. We are currently preparing a survivorship guideline appropriate for Turkey’s conditions.

Implications for Cancer Survivors:

Renal, heart, pulmonary impairment, thyroid dysfunction, limitation in physical functioning, and deterioration in social status (marriage, having children, education).
Tracing ocular biometry and their heritability in twins in a hospital-based cohort in South India
Authors: Paul Padma , Amritanand Anika , Jasper Smitha , Doss Prem , Samuel Prasanna , Chelliah Hepsy , Antonisamy Belavendra , Mackey David A
Published: September 2024

Purpose:

Twin studies, in the background of lack of twin registry in India, are a challenge. We report the response rates in tracing a hospital birth register-based cohort of twins using mail and door to door survey, ocular parameters influencing refractive errors, and their heritability.

Methods:

Twins born from 1991 to 1995 in a tertiary hospital in the Vellore District of South India from a database were traced by mail and home survey from March 2011 to September 2013. Consenting live twin pairs who presented to the eye department were examined, including best corrected visual acuity, cycloplegic refraction, slit lamp examination, measurements of intraocular pressure (IOP) by Goldmann Applanation tonometry, axial length (AL) and anterior chamber depth (ACD), central corneal thickness (CCT), specular microscopy for endothelial count (EC), and a dilated fundus examination. Zygosity was determined by a validated zygosity questionnaire. Heritability was determined using the Falconers formula.

Results:

Postal contact was made in 14%, and a home visit was successful in another 23% of the cohort. Of those presenting for examination, 51.3% were found to be monozygous. Heritability (h2) of IOP was 0.34, that of ACD was 0.88, that of AL was 0.92, that of CCT was 0.96, and that of EC was 0.58.

Conclusion:

Tracing of twins using postal and home visits is challenging. Heritability for AL and CCT was found to be high, similar to that reported in other studies. This implies that a large proportion of variation found in AL and CCT is due to genetic causes as seen in twins from South India.
Advances in retina genetics: Progress, potential, and challenges
Authors: Bansal Mayank
Published: September 2024

The field of retinal genetics has seen remarkable advancements lately, reshaping our understanding of various retinal conditions, including age-related macular degeneration, diabetic retinopathy, and inherited retinal dystrophies. The purpose of this review is to provide an overview of the current status of genetics in the retina, covering the progress made, the expected future developments, and the challenges yet to be overcome. We highlight key advancements such as the advent of next-generation sequencing, which has exponentially enhanced the discovery of genetic mutations, thus also enabling personalized medicine/therapeutic approaches. Stem cells, gene augmentation, and gene-editing techniques such as CRISPR/Cas9 are discussed, in which we highlight ongoing research as well as their potential in the targeted treatment of retinal diseases. Despite these promising advancements, the field faces significant challenges, such as the complex interpretation of genetic data, ethical considerations, and the translational gap from bench to bedside. This review serves as a comprehensive guide not only to ophthalmologists but also to other healthcare professionals, scientists, and policymakers, providing insights into the rapidly evolving landscape of retinal genetics. It aims to stimulate further research and collaboration to surmount existing challenges and harness the full potential of genetic advancements for retinal health.
Corneal densitometry changes post-CXL for keratoconus: Comparative evaluation of epithelium-off, contact lens-assisted, and transepithelial techniques
Authors: Gupta Barkha , Malhotra Chintan , Dhar Supriya , Abhyapal Khushdeep , Jain Arun K. , Gupta Amit
Published: September 2024

Purpose:

To evaluate changes in corneal backscattering after collagen cross-linking (CXL) for progressive keratoconus and compare its course with different techniques – standard epithelium-off CXL (SCXL), contact lens-assisted CXL (CACXL), and transepithelial CXL (TECXL).

Setting:

Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

Design:

Retrospective comparative study.

Methods:

Ninety-four eyes (SCXL: 47, CACXL: 30, and TECXL: 17) were compared. Corneal haze was quantified using Scheimpflug tomography, pre- and post-CXL at 1, 3, 6, and 12 months.

Results:

The baseline mean density score of the central anterior stromal layer was 16.14 ± 7.07, 15.85 ± 7.89 and 15.89 ± 7.21 in SCXL, CACXL, and TECXL groups, respectively (P 0.93). After SCXL, the score increased to 28.83 and 31.34 at 1 and 3 months, respectively (both P < 0.001) and dropped at 6 months (28.66, P < 0.001) and 12 months (23.72, P 0.003). Post-CACXL, the mean densitometry peaked at 3 months (20.35, P 0.14) and returned toward baseline at 6 months (18.82, P 0.15). After TECXL, it increased slightly at 1 month (18.47, P 0.17), decreased at 3 months (14.88, P 0.7), and plateaued over 1 year. No correlation with visual acuity was seen.

Conclusion:

Corneal haze increased significantly after SCXL, peaking at 3 months, declining over 6–12 months, and returning to baseline at 12 months. In contrast, post-TECXL and -CACXL, there was an insignificant increase in anterior corneal haze, which returned to baseline within 3–6 months.
Bedside bilateral sequential intravitreal anti-VEGF injections for retinopathy of prematurity
Authors: Bajgai Priya , Satavisa Susree , Das Taraprasad , Jalali Subhadra , Samanataray Balakrushna , Nayak Sameera , Padhi Tapas Ranjan
Published: September 2024

Purpose:

To evaluate the outcome and ocular adverse events of bedside bilateral sequential intravitreal anti-vascular endothelial growth factor injections for retinopathy of prematurity (ROP) (BBSIR).

Methods:

This retrospective interventional study included infants who received BBSIR with a follow-up of at least 1 month. Clinical history, intravitreal injection details, indications, intraoperative and postoperative ocular adverse events, and outcomes were analyzed.

Results:

The study cohort included 192 babies (384 eyes) spread over 9 years. The mean gestational age was 30.2 ± 2.6 weeks (28.8–34.1), and the birth weight was 1098.11 ± 271.65 g (650–2000). The indications for BBSIR were as follows: 73.4% (n = 141 infants) were too sick to transfer to an ophthalmic unit, 10.9% (n = 21 infants) due to the parents’ inconvenience of traveling to the ophthalmic center, and 15. 6% (n = 30 infants) due to both reasons. The injections were given by an ROP specialist/ROP-trained ophthalmologist after due parental consent, considering each eye as a fresh eye with separate scrubbing and draping. Light from the head-worn indirect ophthalmoscope served as the source of illumination. The retinopathy was regressing/regressed in 92.4% of babies until the last follow-up. The major ocular complication was cataract in 2 eyes (0.5%). There was no incidence of endophthalmitis till last follow-up (median 5.7 months).

Conclusions:

As per this study, BBSIR was observed to be effective and safe if given by those fully trained in the management of ROP. Though the rate of complications like cataract is small, they can pose management challenges and impact vision in a growing child.
Retinopathy and vision-related quality of life in blood dyscrasias
Authors: Mohanty Lipa , Kachhwaha Appurv , Sharma Alokit
Published: September 2024

Purpose:

To study the association of retinopathy with vision-related quality of life in patients with blood dyscrasias.

Settings and Design:

A cross-sectional observational study was conducted at a university-based hospital.

Methods:

Two hundred patients with blood dyscrasias underwent comprehensive ocular examination, including dilated fundus examination. Vision-related quality of life was assessed using the National Eye Institute Visual Functioning Questionnaire-25 (NEI-VFQ-25).

Results:

Retinopathy was observed in 99 out of 200 patients (49.50%) with blood dyscrasias. The most common retinal findings were venous tortuosity with dilation (31.70%), intraretinal hemorrhages (27.88%), soft exudates (12.50%), white-centered hemorrhages (12.50%), and arteriolar attenuation (12.50%). A significant association was found between retinopathy in blood dyscrasias and NEI-VFQ subscales of general vision (P value: 0.01**), near activities (P value: 0.04*), distance activities (P value: 0.01**), mental health (P value: 0.01**), color vision (P value: 0.01**), peripheral vision (P value: 0.01**), role difficulties (P value: 0.01**), and social functioning (P value: 0.01**).

Conclusion:

The study highlights the prevalence of retinopathy in blood dyscrasia patients and its detrimental impact on vision-related quality of life. Regular fundus examinations are imperative for early detection and management of retinopathy to prevent significant visual impairment. Further research is warranted to elucidate underlying mechanisms and improve clinical management strategies.
Chronic Migraine: Diagnosis, Characteristics, Lifestyle Modification, Trigger Reduction and Treatment
Authors: Jha Roshan Kumar , Ambad Ranjit , Chandi Dhruba Hari , Noman Obaid
Published: September 2024

ABSTRACT

The most prevalent brain condition that impairs function is migraine. A chronic migraine is a very incapacitating disorder that is defined by having a migraine that lasts for at least 10 days every month. Chronic migraine patients commonly visit primary care, are advised to seek treatment in secondary care, and account for a large portion of the patient population in specialized headache clinics. Using a triptan, opioid, compound analgesic, or ergot derivative. A significant, curable cause of neurological impairment is chronic migraine. Making a diagnosis is essential, as is ensuring that any coexisting medical or psychiatric disorders are addressed concurrently with efforts to lessen the biological propensity for headaches. Setting patients’ expectations for what is possible is also crucial. Migraine cannot be “fixed” in any way; it is a hereditary propensity that fluctuates throughout a person’s life.
Multidisciplinary Approach to Bilateral Pneumonia in a Toddler with Foreign Body Inhalation
Authors: Alshehri Abdulaziz Ahmed , Alshahrani Khalid Abdulaziz Abdullah , Alamrai Bandar Mahfouz Hamed , Alharthi Bassam Turki Matouq , Alotaibi Ghaida Hassan , Asiri Majed M. , Pullishery Fawaz
Published: September 2024

Foreign body inhalation (FBI) is a critical pediatric emergency that requires prompt recognition and intervention to prevent significant morbidity and mortality. It often presents with respiratory distress and can lead to complications such as pneumonia, atelectasis, and respiratory failure. While common in children aged 1–3 years, FBI is a rare occurrence necessitating immediate medical attention. We present a case of a 2-year-old male child admitted to the pediatric intensive care unit due to bilateral pneumonia complicated by a history of FBI. The management of such cases involves a multidisciplinary approach, including pediatricians, pulmonologists, and otolaryngologists, with bronchoscopy being the mainstay diagnostic and therapeutic procedure. This case underscores the importance of vigilance in diagnosing FBI in pediatric patients presenting with respiratory symptoms. Prompt identification and removal of the FB are crucial in preventing further complications and ensuring optimal patient outcomes.
Referral Policies for Patients with Hearing Difficulties: The Recommendations of the Saudi Otorhinolaryngology Society
Authors: Aljazeeri Isra , Abdelsamad Yassin , Altamimi Fahad , Alshehri Hassan , Telmesani Laila M , Alsabilah Rabea , Alenzi Saad , Alghamdi Saeed , Alahmari Yahya Dhafer , Hagr Abdulrahman , Alzhrani Farid
Published: September 2024

Background:

The management options for hearing difficulties and the indications for implantable hearing devices have expanded greatly over time, providing an opportunity to treat most hearing disabilities. However, the current clinical practice can miss a large number of potential candidates due to improper referrals. Up until today, the referral criteria in Saudi Arabia are not well defined and depend on the judgment of the referring practitioner. This study aims to provide a guide for the referral of patients with hearing difficulties.

Materials and Methods:

An expert panel of practicing professionals formed a core committee to carry out the process of developing this study. A comprehensive review was carried out to identify the current best evidence on the topic and to guide the core committee in developing the statements. For statement evaluation, we employed the Delphi consensus method, where the practicing otologists were invited to vote.

Results:

Seventeen preliminary statements were included in the original draft. Thirty-seven otologists were invited to vote, out of which 33 provided their responses. In the first voting round, consensus was reached on 16 statements (94%). The mean level of agreement was 95% (±5) for all the preliminary statements.

Conclusion:

This paper includes recommendation statements developed and approved by the SORL Society after review of the existing literature, using the Delphi consensus process. These statements may provide utility as evidence-based guide to improve patients’ access to hearing care services.