bluuebunny/crossref_metadata_2025 huggingface dataset:
PENGEMBANGAN E-MODUL BERBASIS FLIPBOOK PADA MATERI BUMBU DASAR UNTUK SMK KULINER
Authors: Regita Cahyani Putri  , Bahar Asrul , Widagdo Andika Kuncoro , Sulandari Lilis
Published: August 2024

Pada penelitian terdapat tujuan untuk mengetahui: 1) Pengembangan e-modul berbasis flipbook, 2) Kelayakan materi dan media pada e-modul, serta 3) Respon peserta didik terhadap e-modul berbasis flipbook materi bumbu dasar untuk SMK Kuliner. Metode penelitian yang dipergunakan berupa Research and Development (R&D), dengan model ADDIE sampai dengan tahap ketiga (Analysis, Design, and Development). Subjek pada penelitian ini yakni peserta didik kelas XI dengan Konsentrasi Keahlian Kuliner di SMK Negeri 1 Lamongan dengan jumlah 32 peserta didik, sedangkan objek penelitian yakni e-modul berbasis flipbook. Instrumen penelitian ini menggunakan angket kelayakan e-modul berbasis flipbook oleh ahli materi dan media, serta angket respon peserta didik menggunakan skala likert dengan interval 1-4 (sangat layak-tidak layak). Hasil dari penelitian yang didapatkan antara lain: 1) Hasil pengembangan e-modul berbasis flipbook materi bumbu dasar dengan tampilan yang interaktif dapat diakses dengan praktis melalui Link atau QR menggunakan jaringan internet secara online, 2) Hasil rata-rata persentase kelayakan validasi materi dan media pada e-modul berbasis flipbook adalah 88% dan 95% yang di nilai “Sangat Layak” untuk digunakan pada kegiatan pembelajaran, serta 3) Hasil penilaian rata-rata persentase dari respon peserta didik adalah 98%, yang menunjukkan respon “Sangat Baik” pada e-modul materi Bumbu Dasar.
ACHIEVE THE IMPLEMENTATION OF THE INDEPENDENT CURRICULUM THROUGH THE INDEPENDENT TEACHING PLATFORM
Authors: Kurnia Titim , Prawira Kirana Qurotal Aini
Published: August 2024

Penelitian ini sebagai penyeimbang terhadap pelaksanaan program sekolah dan guru penggerak, yaitu program pemerintah untuk memahamkan dan mengimplementasikan kurikulum merdeka. Platform merdeka mengajar (PMM) yang digelar oleh kementerian pendidikan dan kebudayaan, yang pelaksanaannya dilaksanakan secara daring juga dilaksanakan untuk memahamkan para guru dan sekolah atas kurikulum merdeka sebagai kurikulum yang baru diberlakukan di Indonesia. Penelitian dilakukan dengan pendekatan penelitian kualitatif untuk mendapatkan data penelitian, namun untuk analisisnya menggunakan analisis secara kuantitatif. Sehingga data ordinal yang didapatkan terlebih dahulu dikonversikan menjadi data interval agar bisa dianalisis secara statistik inferensial.  Sumber data adalah guru-guru yang tidak termasuk dalam program guru penggerak. Hasil analisis yang dilakukan menunjukkan bahwa terdapat beberapa anomali terhadap hasil program platform merdeka mengajar (PMM). Pertama, bahwa yang semula diduga bahwa antara guru yang telah berpengalaman dengan usia yang lebih tua belum ternyata tidak selalu signifikan terhadap pemahaman dan implementasi kurikulum merdeka. Kedua, sebaliknya bahwa guru yang muda dari segi usia  maupun penngalaman, ternyata juga tidak selalu mendapatkan guru yang paham atau sebaliknya. Dengan demikian, program PMM dapat dianggap sebagai program yang sangat membantu memahamkan dan membantu guru dalam implementasi kurikulum merdeka.
To what Extent is the Best Specific Marketing Strategy from Push, Pull, or Direct
Authors: Prasad Nikhil
Published: August 2024

This study investigates the effectiveness of three distinct fundraising strategies—push, pull, and direct marketing—in non-profit organizations, with a focus on entities based in Washington D.C. A literature review highlights the significance of these strategies, noting that push marketing is often favored for generating initial awareness, while direct marketing excels in targeted outreach, and pull marketing is beneficial for building long-term engagement. To empirically assess these methods, a survey was conducted with 25 non-profit organizations to examine the prevalence and success of each strategy. The chi-squared test revealed that push marketing, often combined with direct methods, was the most prevalent and effective approach among the organizations surveyed, aligning with previous research indicating its superior efficacy in fundraising. The findings suggest that nonprofits in Washington D.C. prefer a mixed strategy approach to maximize fundraising success. This study contributes to the understanding of fundraising tactics, demonstrating the importance of selecting and combining marketing strategies based on organizational goals and target audiences.
A Systematic Review on Phytoremediation of Cadmium-Contaminated Soils: Identifying Hyperaccumulator Plants, Assessing Soil Quality, Analyzing Contamination Sources and Determining Health Risks
Authors: Andrei Estrada Carl , May Amatorio Clouie , Cacacho Ryan , Joselin Morales Jeryl , Camacho Melmar , Parmis Cristopher
Published: August 2024

Cadmium is a highly toxic heavy metal found in soils due to various anthropogenic and natural sources, posing significant environmental and health risks. This systematic review aimed to identify plant species that can effectively accumulate cadmium, assess soil quality and contamination sources in cadmium- affected areas, and evaluate potential health risks within affected communities. Relevant studies and articles were methodically selected from databases such as PubMed, Science Direct, Google Scholar, Research Gate, and Zendy, following Prisma Guidelines. The reviewed studies, both local and international, were published after 2000. The review found that several plant species can accumulate high levels of cadmium, with Athyrium wardii (Hook.) (Makino) achieving a 55% removal rate, Linum usitatissimum L. (Flax) achieving 32-49% removal, and T. caerulescens (Alpine Pennycress) achieving 19-36% removal. These plants showed the highest cadmium concentrations in their roots, followed by stems and leaves. Anthropogenic sources of cadmium in farm soil include agricultural activities and emissions from fuel combustion, with petrochemical industries significantly contributing through oil and gas flares, leading to elevated levels of nickel and cadmium. The review highlighted that higher cadmium accumulation poses substantial health risks, with risk concentrations higher in agricultural lands than in urban areas, implying a higher carcinogenic risk for people in these regions.
Candidiasis and Oral Health
Authors:   Department of Oral Pathology & Microbiology, Mahe Institute of Dental Sciences & Hospital, Mahe, 673310, U.T of Puducherry, India, Roshin C N
Published: August 2024

Candidiasis, primarily caused by Candida albicans, poses significant oral health concerns. This review highlights its clinical manifestations, diagnostics, and management strategies. Predisposing factors include poor oral hygiene and systemic conditions like HIV/AIDS and diabetes. Clinical presentation varies from asymptomatic colonization to symptomatic mucosal infections, with complications such as denture stomatitis. Diagnostics encompass clinical examination and various laboratory methods, guiding tailored treatment with topical or systemic antifungals. Prevention strategies targeting modifiable risk factors are crucial. Despite challenges like antifungal resistance, interdisciplinary collaboration among healthcare providers is essential for the effective management of oral candidiasis and its impact on overall health. Keywords: Candidiasis; Candida albicans; Oral health; Diagnostics; Antifungals; Prevention strategies
Stellar Evolution in Real Time. II. R Hydrae and an Open-Source Grid of >3000 Seismic TP-AGB Models Computed with MESA
Authors: Joyce Meridith , Molnár László , Cinquegrana Giulia , Karakas Amanda , Tayar Jamie , Tarczay-Nehéz Dóra
Published: August 2024

We present a comprehensive characterization of the evolved thermally pulsing asymptotic giant branch (TP-AGB) star R Hydrae (R Hya), building on the techniques applied in Stellar Evolution in Real Time I (Molnár et al.) to T Ursae Minoris. We compute over 3000 theoretical TP-AGB pulse spectra using MESA and the corresponding oscillation spectra with GYRE. We combine these with classical observational constraints and nearly 400 years of measurements of R Hya’s period evolution to fit R Hya’s evolutionary and asteroseismic features. Two hypotheses for the mode driving R Hya’s period are considered. Solutions that identify this as the fundamental mode (FM) as well as the first overtone are consistent with observations. Using a variety of statistical tests, we find that R Hya is most likely driven by the FM and currently occupies the “power-down” phase of an intermediate pulse (TP ∼ 9–16). We predict that its pulsation period will continue to shorten for millennia. Supported by calculations from the Monash stellar evolution code, we find that R Hya has most likely undergone third dredge-up in its most recent pulse. The MESA + GYRE model grid used in this analysis includes exact solutions to the linear, adiabatic equations of stellar oscillation for the first 10 radial-order pressure modes for every time step in every evolutionary track. The grid is fully open source and packaged with a data visualization application. This is the first publicly available grid of TP-AGB models with seismology produced with MESA.
On the Doublet Flux Ratio of Mg ii Resonance Lines in and Around Galaxies
Authors: Seon Kwang-il
Published: August 2024

Observations of metallic doublet emission lines, particularly Mg ii
λ
λ2796, 2803, provide crucial information for understanding galaxies and their circumgalactic medium. This study explores the effects of resonant scattering on the Mg ii doublet lines and the stellar continuum in spherical and cylindrical geometries. Our findings show that under certain circumstances, resonance scattering can cause an increase in the doublet flux ratio and the escaping flux of the lines beyond what is expected in optically thin spherical media. As expected, the doublet ratio is consistently lower than the intrinsic ratio when the scattering medium is spherically symmetric and dusty. However, if the scattering medium has a disk shape, such as face-on disk galaxies, and is viewed face-on, the doublet ratio is predicted to be higher than 2. It is also shown that doublet ratios as low as those observed in compact star-forming galaxies cannot be explained solely by pure dust attenuation of intrinsic Mg ii emission lines in spherical models unless dust opacity deviates markedly from that expected based on the dust-to-Mg+ gas ratio of our Galaxy. The importance of the continuum-pumped emission lines and expanding media is discussed to understand observational aspects, including doublet flux ratios, which can be lower than 1.5 or higher than 2, as well as symmetric or asymmetric line profiles. It is also discussed that the diffuse warm neutral medium may be an important source of Mg ii emission. These results provide insight into the complexity of the shape and orientation of distant, spatially unresolved galaxies.
Resonant Absorption of Standing Magnetohydrodynamic Waves in Coronal Loops in the Absence of Directional Symmetry: The Effect of Plasma Flow
Authors: Bahari Karam
Published: August 2024

The oscillation properties of standing magnetohydrodynamic (MHD) waves in coronal loops have been investigated. The coronal loop is modeled as a straight cylinder with a purely longitudinal magnetic field and a field-aligned plasma flow. The loop model includes an inhomogeneous transitional layer that causes the wave to be resonantly damped. Our aim is to determine the damping rate of the standing MHD waves in flowing loops, in which the directional symmetry of the loop has been broken due to the presence of plasma flow. To do this, the standing wave has been considered as the superposition of two propagating waves with opposite directions of propagation but the same oscillation frequency and damping rate. Due to the absence of directional symmetry in the loop, it seems that the propagating components of the standing wave cannot have the same oscillation frequency and damping rate. To overcome this problem, in the perturbation method employed, we let both the oscillation frequency and damping rate be perturbed. As the flow speed increases the oscillation frequency of the standing wave decreases but its damping rate increases. As a result, the ratio of the oscillation frequency to the damping rate of the standing wave becomes a more decreasing function of the flow speed. The flow is an important quantity in determining the effectiveness of resonant absorption. In flowing loops even in the case of a thin transitional layer, resonant absorption can result in a damping rate on the order of the period time, which is in agreement with observations.
Data mobilisation at the Fund of Invertebrates of the State Museum of Natural History of the NAS of Ukraine
Authors: Novikov Andriy , Rizun Volodymyr , Susulovsky Andrii , Hushtan Habriel , Hushtan Kateryna , Kuzyarin Oleksandr , Savytska Anastasiia , Nachychko Viktor , Susulovska Solomia , Leleka Dmytro
Published: August 2024

The described dataset contains occurrence records of invertebrate specimens deposited at the State Museum of Natural History of the NAS of Ukraine, Lviv, Ukraine (SMNH NASU). It combines diverse taxonomic groups, mostly belonging to the class Insecta of the phylum Arthropoda, that were selected as prioritised for digitisation in war conditions. Selected specimens were ascertained as those being the most vulnerable to hostilities and requiring virtual preservation. Such virtual preservation is essential in the war realities as collection can be lost or damaged at any moment, resulting in a significant retrospective biodiversity data gap. At the same time, collection virtualisation and its deposition on the internet grant remote access to scientists who cannot visit it in person due to the war. Moreover, we believe that the mobilisation of the data from the Ukrainian collections and their publication online are essential for the integration of Ukrainian research facilities into a global scientific biodiversity pool.

A total of 3,660 occurrence records mobilised in 2023-2024 from the collection of invertebrates of the SMNH NASU, were published. This dynamic dataset will be continually supplied by new records during further digitisation work.
Population status of the highly endangered Lycaena helle (Papilionoidea, Lycaenidae) in the Šumava Mts. two decades after establishment
Authors: Peškařová Terezie , Pavlíčko Alois , Kuras Tomáš , Fric Zdeněk Faltýnek , Konvička Martin
Published: August 2024

The process of translocation of endangered species represents a useful conservation tool, but subsequent monitoring of translocated populations is often neglected, although it may supply critical information for conservation work. The EU-protected glacial relic Lycaena helle (Lycaenidae) went extinct in the Czech Republic, where a few lowland populations historically existed, in the 1950s. In 2002, a mountain-dwelling population was established in Šumava Mts., among grasslands and fenlands surrounding the abandoned village of Nové Údolí, from 2/33 ♂♂/♀♀ originating in the Türnitz Alps, Austria. The transferred population was surveyed a decade later and again 21 years after the transfer. During the second (2023) survey, we visited 212 grassland patches to record the species’ presence and relative abundance, and to ascertain its habitat preferences. A third of the surveyed patches were occupied by L. helle, in a total area of occupied grasslands was 66.6 ha scattered over 4.5 km2, with approximately 2,400 adult individuals, recorded up to 4.2 km from the original release point. L. helle typically occupies wet tussocky grasslands with closed edges, minimum management and high cover of its larval host plant, the mid-to late-successional forb Bistorta officinalis. It avoids drier managed grasslands rich in flowering plants. The expansion rate from the release point (0.1 km/year during the first decade, 0.2 km/year over two decades) was slower than in two earlier L. helle transfers, targeting Morvan and Forez Mts., France (≈ 0.5 km/year in both cases). We attribute this to the relief of the release locality, a­ shallow depression surrounded by higher-elevated forested ridges, but we expect faster expansion once the continuous woodlands are crossed.
Two new species of the family Aoridae (Crustacea, Malacostraca, Amphipoda) from Korean waters
Authors: Kim June , Choi Jae-Hong , Kim Yu-Jin , Im Hyeong-Woo , Kim Young-Hyo
Published: August 2024

Two new species of the family Aoridae, one from the genus Aoroides Walker, 1898, and other from the genus Grandidierella Coutière, 1904, are reported from Korean waters. Aoroides gracilicrussp. nov. is similar to A. longimerus in having numerous plumose setae on the basis and carpus of gnathopod 1. However, the new species can be distinguished from A. longimerus by the numerous plumose setae on the bases of pereopods 3 and 4 and the slender basis of pereopod 7. Grandidierella naroensissp. nov. is morphologically most similar to G. pseudosakaensis. However, the new species can be distinguished by the presence of small distal and proximal processes and a large middle process on the carpus of gnathopod 1, and the subovate propodus of gnathopod 1. Both new species are illustrated and compared to related species. A key to species in the family Aoridae from Korean waters is also provided.
Rényi entropy of past lifetime from lower $ k $-record values
Authors: Shrahili Mansour , Kayid Mohamed
Published: August 2024

This paper explored the concept of past Rényi entropy within the context of $ k $-record values. We began by introducing a representation of the past Rényi entropy for the $ n $-th lower $ k $-record values, sampled from any continuous distribution function $ F, $ concerning the past Rényi entropy of the $ n $-th lower $ k $-record values sampled from a uniform distribution. Then, we delved into the examination of the monotonicity properties of the past Rényi entropy of $ k $-record values. Specifically, we focused on the aging properties of the component lifetimes and investigated how they impacted the monotonicity of the past Rényi entropy. Additionally, we derived an expression for the $ n $-th lower $ k $-records in terms of the past Rényi entropy, specifically when the first lower $ k $-record was less than a specified threshold level, and then investigated several properties of the given formula.
AÇÃO ALELOPÁTICA DE Holocalyx balansae Micheli SOBRE Ipomoea triloba L.
Authors: Pastorini Lindamir Hernandez , Yuiti Kawano Tiago , Gomes de Oliveira Guerreiro Renata , Martins da Silva Tatiane
Published: August 2024

A alelopatia constitui interação bioquímica, de efeito prejudicial ou benéfico, entre as plantas. Essa interação ocorre como resultado da liberação de aleloquímicos, provenientes do metabolismo secundário. Holocalyx balansae Micheli, é uma espécie arbórea, da família Fabaceae, em que estudos fitoquímicos revelaram a presença de flavonoides e glicosídeos cianogênicos em seus folíolos. Assim para avaliar a ação alelopática dos extratos de H. balansae sobre a germinação, sementes de Ipomoea triloba L. foram distribuídas em placas de Petri contendo extrato aquoso (tratamento) e água destilada (controle), sendo mantidas em câmara de germinação a 30 °C e após 48 horas verificou-se a porcentagem de germinação. Em casa de vegetação, sementes de I. triloba foram semeadas em vasos contendo areia e substrato orgânico e observou-se a emergência das plântulas, de acordo com o tratamento. No tratamento controle os vasos foram irrigados com água, no pré-emergência os vasos receberam extrato aquoso antes da emergência das plântulas e no tratamento pós-emergência houve a aplicação do extrato somente após a emergência das plântulas. Para obtenção do extrato aquoso na concentração de 10% (m/v), folíolos de H. balansae foram secos, pesados, triturados e diluídos com água destilada. O extrato aquoso inibiu a germinação de I. triloba em bioensaios laboratoriais e também afetou a emergência, quando aplicado antes da emergência das plântulas, em condições de casa de vegetação. Os resultados obtidos demonstram que H. balansae apresenta atividade alelopática sobre I. triloba, o que pode estar relacionado aos aleloquímicos dos folíolos utilizados para obtenção dos extratos aquosos.
A PERCEPÇÃO DOS ALUNOS DA REDE PÚBLICA DE ICAPUÍ SOBRE A IMPORTÂNCIA DA EDUCAÇÃO AMBIENTAL
Authors: Gomes Dantas Marcus Vinicius , França Ana Karolinne de Alencar , de Medeiros Marcelo Henrique Torres , Da Silva Marília Hellen Ferreira , da Mota Yandra Thais Rocha
Published: August 2024

O presente estudo investigou a compreensão dos alunos do ensino fundamental sobre a Educação Ambiental. Como método, foi aplicado um questionário para os alunos do ensino fundamental de uma escola localizada no município de Icapuí-Ceará. O questionário continha 10 perguntas, sendo 8 objetivas e 2 subjetivas. Os resultados obtidos na primeira questão, do 6° ano (79.55%) e do 7° (91.18%), evidenciam a compreensão dos alunos sobre a educação ambiental. A oitava questão perguntava se estudar sobre o meio ambiente reduz a degradação ambiental. 68.89% do 6° ano consideram que sim e 82.86% do 7° ano também consideram que o aprendizado e conhecimento sobre o meio ambiente são uma forma de valorizar e preservá-lo. Os resultados da pesquisa possibilitaram um melhor entendimento da compreensão dos alunos a respeito da Educação Ambiental e suas respectivas opiniões sobre o meio ambiente e problemas ambientais.
Grape detection in natural environment based on improved YOLOv8 network
Authors: Junjie Meng , Ziang Cao , Dandan Guo , Yuwei Wang , Dashan Zhang , Bingyou Liu , Wenhui Hou
Published: August 2024

In the pursuit of intelligent and efficient grape picking, rapid and precise detection of grape locations serves as the fundamental cornerstone. However, amidst the natural environment, grape detection encounters various interference factors, such as fluctuating light intensity, grape leaf obstructions, and grape overlap, all of which can undermine detection accuracy. To address these challenges, this study proposes a grape detection method leveraging an enhanced YOLOv8 network, wherein the conventional CIoU is replaced with Wise-IoU to augment network precision. Additionally, an efficient multi-scale attention module is introduced to heighten the network's focus on grapes. To expedite detection, the original network backbone is substituted with the CloFormer_xxs network. The collected grape images undergo preprocessing to ensure image quality, forming the basis of the dataset. Furthermore, the dataset is augmented using disadvantages-enhance, a novel data enhancement mode, thereby enhancing the robustness and generalization of network. The comprehensive comparison and ablation experiments are conducted to demonstrate the advantageous effects of the proposed modules on the network. Subsequently, the improved network's superiority in grape detection is validated through comparative analyses with other networks, showcasing superior accuracy and faster detection speeds. The network achieves a remarkable accuracy of 92.1%, average accuracy of 94.7%, with preprocessing and post-processing times of 15ms and 0.8ms, respectively. Consequently, the enhanced network presented in this study offers a viable solution for facilitating intelligent and efficient grape picking operations.
Antibiotic susceptibility pattern among children admitted to a hospital in Nigeria: A retrospective study
Authors: Oluwo Aderonke O. , Lawal Mary A. , Mabogunje Cecilia A. , Okurame Olubunmi T.
Published: August 2024

Background: The impact of antimicrobial resistance on children living in resource-limited countries has been underreported, despite its established global threat.Objective: This retrospective study aimed to describe the trend of antibiotic susceptibility in the paediatric age group.Methods: Sensitivity test report data consisting of 300 paediatric patients aged 18 hours to 192 months were retrieved from the microbiology laboratory records at a state-owned children’s hospital in Nigeria over a period of 4 months starting from December 2021 to March 2022. Five genera (Escherichia coli, Klebsiella spp., Pseudomonas spp., Staphylococcus aureus and Streptococcus spp.) were cultured as recommended by the Clinical Laboratory Standard Institute, using the Kirby Bauer disc diffusion method. Antimicrobial susceptibility testing was carried out on isolates using 15 different antibiotics.Results: Staphylococcus aureus was the most frequent pathogen isolated 32.1% (50/156) and Pseudomonas spp. was the least frequent pathogen isolated 7.1% (11/156) in all samples. The isolates with the highest rate of resistance to the tested antibiotics were S. aureus 32.1% (50/156), E. coli 28.2% (44/156) and Klebsiella spp. 20.5% (32/156). Isolates in all age groups were more resistant to ampicillin, amoxicillin + clavulanic acid, cefuroxime and cefepime.Conclusion: Antibiotic resistance is high, especially the younger Nigerian children. Strict antibiotic protocols should be adhered to especially in the use of empirical antibiotic therapy in hospitals.What this study adds: Our study reveals a higher trend of antibiotic resistance, especially in younger children. It further shows that the pathogens are most resistant to the most available empirical antibiotics in Nigeria.
Guardians’ involvement in the management of childhood illnesses in Vhembe district, Limpopo
Authors: Tshivhase Livhuwani , Magavha Tshifhiwa A. , Moloko Sophy M.
Published: August 2024

Background: Guardians’ involvement in the management of childhood illnesses plays a pivotal role in reducing mortality and morbidity among children under 5 years old. It is through the guardian’s eyes that the child can be afforded timely healthcare, prevented from contracting an illness and effectively taken prescribed medication.Aim: The study aimed to explore the guardians’ lived experiences in their involvement in managing childhood illnesses in Vhembe district, Limpopo province, South Africa.Setting: A qualitative, exploratory and descriptive study was conducted with 16 purposively sampled participants.Methods: One-on-one individual interviews were conducted with participants. Data were analysed following Braun and Clarke’s thematic analysis.Results: Guardians reported their involvement by seeking child healthcare in healthcare facilities when ill and due for immunisations. Involvement in childhood care is performed through assessment of child illness at home, follow-up, referral of children to healthcare facilities, promotion of child health and prevention of childhood illnesses.Conclusion: Children remain dependent on guardians for their well-being. Seeking care, preventing illnesses and promoting childhood health are vital in reducing child mortality and childhood morbidity.Contribution: Involving and empowering guardians regarding the care of children under 5 years old are vital in achieving Sustainable Development Goal number 3 in 2030.
Thrombolysis for Ischemic Stroke Despite Recent Ingestion of Direct Oral Anticoagulants – A Growing Dilemma Also in India
Authors: Meinel Thomas R. , Paramasivan Naveen K. , Menon Bijoy K. , Fischer Urs , Seiffge David J.
Published: August 2024

The administration of intravenous thrombolysis (IVT) for patients with acute ischemic stroke who have recently ingested direct oral anticoagulants (DOACs) presents a clinical challenge due to the perceived increased risk of intracranial hemorrhage (ICH). Traditional guidelines from the US and European authorities advise against IVT within 48 h of last DOAC ingestion, unless specific coagulation tests indicate safety. However, emerging observational studies suggest that IVT might be safe in selected patients. A US stroke registry study and a global multicenter cohort study both reported no significant increase in symptomatic ICH among patients on DOACs compared to those not on anticoagulants. A systematic review of all published observational studies further supported these findings, showing comparable bleeding rates and functional outcomes in DOAC-treated patients. Reversal agents like idarucizumab for dabigatran have demonstrated potential in facilitating safer IVT administration, though logistical and cost-related barriers limit their widespread use. The variability in global guidelines reflects differing approaches to risk assessment and resource availability, highlighting the need for individualized treatment decisions. In India, the increasing prevalence of atrial fibrillation and stroke as well as prescription of DOACs necessitate adapted guidelines that consider local health-care infrastructure. Despite the promising observational data, the lack of randomized controlled trials underscores the need for further research to establish robust evidence for IVT use in this context. Collaborative international efforts and inclusion of diverse patient populations in future studies will be crucial to refine treatment protocols and improve outcomes for stroke patients on DOACs.
A Comparative Study of the Efficacy of Intralesional Measles Mumps Rubella (MMR) Vaccine and Auto Implantation for the Treatment of Periungual and Palmoplantar Warts: A Randomized Controlled Trial
Authors: Abusaria Ravindra , Yadav Chinmai , Jain Vinod , Kachhawa Dilip , Rao Pankaj , Lamoria Anand
Published: August 2024

Background:

Warts are benign epidermal proliferations, caused by infection of keratinocytes with human papillomavirus (HPV). Auto implantation and intralesional mumps, measles, and rubella (MMR) vaccine are novel methods of immunotherapy for treating periungual and palmoplantar warts. They act by stimulating the patient’s immune system; this clears not only the local warts but also distant warts with lesser side effects.

Objective:

We conducted this study to compare the efficacy and safety of both methods in treating periungual and palmoplantar warts.

Materials and Methods:

A total of 160 patients were randomly allocated into two groups of 80 patients. Group A was treated with 0.3 mL of intralesional MMR vaccine at an interval of 3 weeks or for a maximum of three sittings, and Group B was treated with auto implantation.

Results:

At the end of therapy, the result was better in group A (MMR vaccine) as 86% of cases yielded an excellent response as compared to 71% in group B (auto implantation). The recurrence rate was 5% in group A and 4% in group B. There were no serious side effects in both groups with pain during injection (70%) in group A and swelling at the recipient site (8%) in group B being the most common side effect.

Conclusion:

Both MMR and auto implantation had significant response rates. But MMR was faster and better.
An Open-Label, Investigator-Initiated, Single-Centre Pilot Study to Determine the Safety and Efficacy of Tofacitinib in Resistant Chronic Spontaneous Urticaria
Authors: De Abhishek , Pal Shrayan , Singh Sushil , Chakroborty Disha , Godse Kiran
Published: August 2024

Background:

Chronic spontaneous urticaria (CSU) is a distressing skin condition characterized by the recurrent appearance of itchy hives. A subset of CSU patients remains resistant to conventional treatment with high-dose antihistamines. Tofacitinib, a Janus kinase inhibitor, has shown promise in various inflammatory skin diseases. We aimed to evaluate the efficacy of oral tofacitinib in patients with CSU resistant to antihistamines.

Methods:

This study examined data retrospectively from seven patients who were diagnosed with CSU and were treated with tofacitinib for at least six months. These patients initially exhibited resistance to treatment with four-fold up-dosed antihistamines. One of the patients was already on omalizumab, and another was tried on cyclosporine. The patients were administered oral tofacitinib at a dosage of 5 mg twice daily for six months. Patients were followed up monthly for disease control and side effects. The response to treatment was evaluated using the urticaria activity score over 7 days (UAS7) and urticaria control test (UCT). Paired t-tests were conducted to determine the statistical significance of the results using SPSS version 25 software.

Results:

Six out of the seven patients demonstrated a significant improvement in both UAS7 and UCT scores after six months of treatment with oral tofacitinib. The mean UAS7 score decreased from 24.86 at baseline to 3.83 at the study endpoint (P < 0.0001). Similarly, the mean UCT score increased from 0.57 at baseline to 14 at the study endpoint (P < 0.0001). The standard deviations for both measures were 4.85 and 0.98 at baseline and 3.1 and 3.1 at the study endpoint for UAS7 and UCT, respectively.

Conclusion:

In this six-month follow-up study, oral tofacitinib demonstrated significant efficacy in treating CSU patients’ resistant to high-dose antihistamines. Most patients experienced a remarkable reduction in urticaria activity and an improvement in disease control. These findings suggest that tofacitinib holds promise as a potential therapeutic option for this challenging subset of CSU patients. However, larger, randomized controlled trials are warranted to further investigate the long-term safety and effectiveness of tofacitinib in this population.
Walking a Tight Rope: Occult Lymphoma in a Case of Resistant Dermatomyositis Complicated by Tubercular Lymphadenitis and Gumma
Authors: Chhabra Namrata , Rahim Jemshi S. , Ganguly Satyaki
Published: August 2024

Dermatomyositis (DM) is an autoimmune inflammatory disease, characterized by symmetrical proximal myopathy and cutaneous manifestations. DM is associated with upto a 6-fold increased risk of cancer. Complications secondary to underlying cancer are a leading cause of mortality in DM. Here, we discuss the two year clinical course of an elderly male with recalcitrant DM. This case was complicated by tubercular lymphadenitis followed by gumma. Subsequently, he was diagnosed with lymphoma and succumbed to death. This case emphasizes the need to do extensive malignancy screening at regular intervals in DM.
Comparative Study of Trichoscopic Features of Alopecia Areata between Adults and Children and between Different Body Parts (Scalp, Beard, Eyebrow, and Moustache)
Authors: Raheem Aula , Al-Dhalimi Muhsin
Published: August 2024

Background:

Round patches of baldness on the scalp or entire body are typically caused by the common, non-scarring hair loss condition known as alopecia areata (AA). Follicular units with two to four terminal hairs and one or two vellus hairs can be seen on a healthy, typical scalp trichoscopy.

Aim of the Study:

To compare trichoscopic features between adults and children and between different body parts.

Patients and Methods:

A cross-sectional observational study was performed on 90 patients; AA of the scalp and other body parts attended the dermatology out-patient clinic. A Gen Dermlite D100 Dermoscope was used to examine AA lesions and compare their features according to age and different body parts.

Results:

Scalp was the most common area among all patients, 65.6% (among adults, it was 50%, and among children, it was 85%), with a significant difference, P = 0.001. The most common trichoscopic feature among all patients was empty follicular opening in 74 (82.2%) lesions; among children, it was honeycomb pigment in 35 (87.5%) lesions, while among adults, it was empty follicular opening in 40 (80%) lesions. Tulip hair was significantly higher among adults, P = 0.036. At the same time, honeycomb pigment patterns and pohlpinkus constriction were significantly higher among children, P = 0.044 and P < 0.001, respectively.

Conclusion:

The most common trichoscopic feature of adult lesions was empty follicular opening, while honeycomb pigment was dominant among children. Tulip hair was higher among adults, while honeycomb pigment patterns and pohlpinkus constriction were higher among children.
Comparison of the Diagnostic Accuracy of Teledermoscopy, Face-to-Face Examinations and Artificial Intelligence in the Diagnosis of Melanoma
Authors: Yazdanparast Taraneh , Shamsipour Mansour , Ayatollahi Azin , Delavar Shohreh , Ahmadi Maryam , Samadi Aniseh , Firooz Alireza
Published: August 2024

Background:

Rapid diagnosis of melanoma is necessary for a good prognosis. Using teledermatology and artificial intelligence for this issue is developing, but its diagnostic accuracy is less measured in a clinical setting.

Objective:

The purpose of this study was to assess the diagnostic accuracy of the teledermoscopy method using the FotoFinder device as well as the Moleanalyzer Pro artificial intelligence (AI) Assistant and to compare them with the face-to-face clinical examination for the diagnosis of melanoma confirmed with histopathology.

Methods:

Thirty melanocytic moles of 29 patients were included in the study. Each mole was assessed face-to-face, using FotoFinder teledermoscopy and Moleanalyzer Pro software methods. The results obtained from each method were compared with the results of the gold standard (pathology). The sensitivity and specificity of the three methods were calculated for malignant and borderline versus benign lesions. Inter-method reliability between a gold standard and other methods was evaluated using per cent agreement and Cohen’s kappa coefficient.

Results:

Five moles had a histopathological diagnosis of melanoma, and six and 19 moles were diagnosed as borderline and benign, respectively. Sensitivities and specificities were, respectively, as follows: face-to-face (90.9%, 57.9%), FotoFinder teledermoscopy (63.6%, 78.9%), FotoFinder® Moleanalyzer Pro (36.4%, 42.1%). Agreement with biopsy-obtained diagnosis categories of benign, borderline and malignant for face-to-face was 63.33%, FotoFinder teledermoscopy 73.33%, and FotoFinder® Moleanalyzer Pro 40%.

Conclusions:

Teledermoscopy had the highest agreement with reference diagnosis as well as the highest specificities that caused a reduction of biopsy referrals. The FotoFinder® Moleanalyzer Pro had the lowest agreement. Therefore, it cannot replace dermatologist decision making.
Rare Co-occurrence: A Case Report on Hemophagocytic Lymphohistiocytosis and Pulmonary Metastasis
Authors: Gulwe Vijay Kumar S. , Koleti Kranthi , Yadav Virendra Bapusaheb , Maindarkar Parth Girish , Pawar Sanket Arun , Bhosale Abhay Rajendra , Shewale Vishal
Published: August 2024

ABSTRACT

Hemophagocytic lymphohistiocytosis (HLH) is an inflammatory syndrome marked by excessive activation of macrophages and T-lymphocytes, leading to cytokine overproduction and subsequent histiocytic phagocytosis. Cancer cells spread from the primary tumor to the lungs through nearby tissues, the bloodstream, or the lymphatic system. Eventually, this may result in pulmonary metastasis. Diagnosing HLH and pulmonary metastases is challenging due to the aggressive nature of these diseases. Therefore, early diagnosis is crucial for optimal patient outcomes. Here, we present the case of a patient with no previous comorbidities who was admitted to the emergency department with chief complaints of shortness of breath and excessive sweating. Subsequent comprehensive routine clinical and physiological examinations confirmed the patient with HLH. Furthermore, we performed high-resolution computed tomography for the confirmation of pulmonary metastasis and a bone marrow biopsy, for HLH. The primary site for both HLH and pulmonary metastasis was the lung. Unfortunately, the patient succumbed to the illness before the initiation of the prescribed treatment, possibly attributable to a delayed diagnosis. In the present case presentation, we highlighted the role of comprehensive diagnostic evaluation in complex medical conditions related to HLH and pulmonary metastasis, which have rapid progression and high mortality. Further, investigations and multidisciplinary collaboration are essential in leading the development of an appropriate treatment plan for such a complicated condition, ensuring the best possible outcomes for the patient.
Clinical Profile and Treatment Outcome of H-mono/Polydrug-resistant Tuberculosis: A Single-center Retrospective Study
Authors: Kabra Shital , Jadhav Snehal
Published: August 2024

Background:

Isoniazid-monoresistant tuberculosis (Hr-TB) is the most prevalent drug-resistant TB. It often precedes multidrug-resistant TB (MDR-TB) and poses a major threat in the fight against TB control. The treatment outcome in Hr-TB and polydrug-resistant TB (PDR-TB) other than MDR still remains unclear.

Aim:

The aim of the study is to determine the clinical characteristics and treatment outcome in H-mono/PDR-TB under programmatic conditions.

Materials and Methods:

The study design was retrospective observational. It was conducted at the respiratory medicine department of a tertiary care institute in Mumbai. The medical records for bacteriologically confirmed TB patients diagnosed between July 2021 and December 2022 were reviewed. A total of 827 patients were enrolled and among them 46 patients with H-mono/PDR-TB were analyzed. The demographic data, clinical characteristics, and treatment outcomes were recorded.

Results:

Among 46 patients of isoniazid mono-resistant/PDR-TB analyzed from 827 bacteriologically confirmed TB, 24 were women with a mean age of 30.5 years. Twenty-five (54.34%) were resistant to isoniazid and the remaining 21 (45.66%) were PDR-TB. Primary Hr-TB was detected in 43 (93%) patients. The KatG mutation in 30 (65.2%) patients was the most common form of isoniazid (INH) mono resistance followed by inhA mutation 16 (34.8%). The fluoroquinolone (FQ)-based treatment regime as per national program guidelines had favorable outcomes in 42 (91.3%). However, unfavorable outcome with progression to MDR was observed in 3 (6.52%) and death in 1 (2.18%) patients.

Conclusion:

H-mono/PDR-TB is the most prevalent DRTB and most of them have primary resistance to isoniazid. Availability of first and SL LPA and limited DST with FQ-based regime under the national program has improved treatment outcomes in Hr-TB/PDR-TB.
Serum Uric Acid as a Biomarker in Patients Admitted with Acute Exacerbation of Chronic Obstructive Pulmonary Disease to a Tertiary Hospital, Kerala
Authors: Soman Mervin K. , Chakkamadathil Jesin Kumar , Noorayingarath Hafseena , Lal A. Gayathri
Published: August 2024

Background:

Chronic obstructive pulmonary disease (COPD) is a highly prevalent and debilitating condition worldwide, imposing significant economic and social burdens on societies. Serum uric acid contributes to inflammation and is often used a biomarker.

Aims and Objectives:

This study aims to assess the potential role of serum uric acid as a cost-effective biomarker in hospitalized patients experiencing acute exacerbation of COPD. Additionally, it aims to investigate the relationship between the severity of airflow obstruction and serum uric acid levels in patients with COPD.

Materials and Methods:

The study design is a prospective cohort study involving 144 COPD patients admitted for acute exacerbation, excluding those with concurrent chronic comorbidities or receiving medications known to substantially elevate uric acid levels.

Results:

Our findings demonstrate elevated serum uric acid levels in patients with advanced-stage COPD and severe airflow obstruction. Furthermore, patients with higher levels of serum uric acid exhibit poorer prognosis compared to those with lower levels in COPD.

Conclusion:

Serum uric acid can serve as a valuable biomarker to prognosticate COPD patients and assess disease severity in patient admitted with exacerbations.
Lung Oscillometry: A Practical Solution for Overcoming Spirometry Challenges
Authors: Balachandran J.
Published: August 2024

ABSTRACT

Background:

Lung oscillometry is an alternative pulmonary function test in patients unable to perform spirometry due to cough or dyspnea.

Objective:

The objective of the study was to study the characteristics of lung oscillometry parameters in patients with cough or dyspnea and who are unable to perform spirometry.

Methodology:

A retrospective cross-sectional study Was conducted in a pulmonology outpatient clinic. Patients during the study period were selected for lung oscillometry after fulfilling the inclusion and exclusion criteria. The resistance and reactance parameters were measured along with the demographic variables. Statistical calculations were done.

Results:

Forty-two percent patients were found to have airway obstruction if the recommended cutoff for resistance at 5 hertz (R5) was followed. However, reactance parameters were abnormal in most of the cases. The area of reactance (Ax) had a very good coefficient of correlation with R5 (0.867, P = 0.001).

Conclusions:

Ax is a suitable lung oscillometric parameter for identifying airway obstruction in asthmatics.
Chronic Airway Obstruction in the Post-COVID-19 Era: Is There a Cause or Effect?
Authors: Desai Unnati , Utpat Ketaki , Sable Sharad
Published: August 2024

ABSTRACT

Introduction:

Chronic airway obstruction (CAO) is the terminology used to address chronic obstructive airway diseases, namely bronchial asthma (BA), chronic obstructive pulmonary disease (COPD), bronchiectasis, and posttuberculosis (TB) COPD. We studied the profile of the CAO at the respiratory medicine department post the COVID-19 lockdown to understand any cause or effect of past COVID-19.

Materials and Methods:

This prospective observational study enrolled 164 cases of CAO. Clinical and radiological details of the two groups of CAO with and without a past history of COVID-19 were noted.

Results:

Of 164, 101 (61.59%) were men and 63 (38.41%) were women. Thirty-nine had a history of COVID-19. Of the 164 cases, 39 (23.7%) had BA, 51 (31.09%) had COPD, 61 (37.19%) had post-TB COPD, and 13 (7.92%) had bronchiectasis. In patients with a history of COVID-19, 9 (23.1%) had BA, 9 (23.1%) had COPD, 15 (38.5%) had post-TB COPD, and 6 (15.3%) had bronchiectasis. Eight had normal lung functions, 4 had mild obstructions, 75 had moderate obstruction, and 74 had severe obstructions. The clinical and spirometry differences in those with and without a history of COVID-19 were statistically insignificant. On high-resolution computed tomography thorax, 46 (28.1%) had emphysema, 16 (9.7%) had air trapping, 65 (39.7%) had fibrobronchiectasis, and 37 (22.5%) were normal. In patients with a history of COVID-19, 6 (15.3%) had emphysema, 2 (5.2%) had air trapping, 23 (58.9%) had fibrobronchiectasis, and 8 (20.5%) were normal. The difference in radiological findings was statistically significant and more in the group with a history of COVID-19 (P = 0.029).

Conclusion:

COVID-19 did not affect the distribution, clinical characteristics of CAO, however, impacted radiological findings significantly.