bluuebunny/crossref_metadata_2025 huggingface dataset:
Pain and Palliative Management in Advanced Gastrointestinal Malignancies – How Are We Doing?
Authors: Joshi Vivek , Balkrishnan Mahadevan , Jain Mayank , Venkataraman Jayanthi
Published: September 2023

Aims:

The aim of the study is to study the different methods and their efficacy in pain management in advanced gastrointestinal (GI) malignancies.

Methods:

The study included patients with advanced and inoperable GI malignancies. Demographic data, laboratory parameters and radiological investigations, baseline visual analog scale (VAS) score, and subjective global assessment (SGA) were recorded on the first contact along with details of medical, endoscopic, and palliative interventions as performed. Analgesic pain step ladder approach was followed for pain management. Follow-up to assess response was done using VAS score and SGA at the end of 3 months or death within this period.

Results:

Seventy-one patients were included. Most of them were elderly males. Out of 7 malignancies noted, hepatocellular carcinoma (HCC) was the most common tumor (41; 57.8%). Thirty-five patients (49.3%) had vascular invasion, while 29 (40.8%) had metastatic cancer. The most common vascular invasion was the portal vein (29; 40.8%). The liver was the most common metastatic site (12; 16.9%). The baseline mean VAS score was 5.13 ± 2.38 and the highest was in carcinoma gallbladder patients (8.0 ± 2.0). Most patients were having baseline SGA rating B (69%). Tramadol was the most commonly used analgesic (35.22%) followed by a combination of tramadol and fentanyl (26.76%). The most common palliation was transarterial chemoembolization in HCC (80.5%) and biliary self-expandable metallic stent in carcinoma pancreas (77.8%). There was a statistically significant reduction in VAS score in HCC (P < 0.001), carcinoma pancreas (P = 0.009), and colorectal cancer (P = 0.022). One-sixth patients moved from SGA rating B to rating A, 9.9% moved from SGA rating B to rating C, and 9.9% moved from SGA rating C to rating B.

Conclusion:

There was an improvement in quality of life at 3-month follow-up. There was significant pain improvement in the studied patients. However, almost one-third patients did not get adequate pain relief.
A Self-Rating Scale to Measure States of Tridosha in Children
Authors: Patil Suchitra S. , Nagarathna R. , Nagendra H. R.
Published: September 2023

Background:

In Western psychology, inventories are available for state (temporary change) and trait (which is the basis of personality-character) aspects of personality. Ayurveda inventories for measuring tridosha (which is the basis of both trait and state of personality) in children have been developed and standardized, which pertains to trait aspect of personality. There is no scale to assess the state aspects of tridosha in children.

Methods:

The design of the study was descriptive type. Sampling design was purposive sampling. The 6-item Tridosha State Scale for Children (TSSC) was developed on the basis of translation of the Sanskrit verses describing the states of vāta, pitta, and kapha prakriti, which represent the temporary change in tridosha and by taking the opinions of experts (ten Āyurveda experts and three psychologists who helped in judging the items and assessed. The study was carried out in Bapuji School, Davangere. The scale was administered on 108 children in the age group of 8–12 years (mean age: 9.75 ± 1.30). Moreover, for 30 children, the scores are compared with Caraka Child Personality Inventory (CCPI) – a self-rating scale to measure the trait aspects of prakriti).

Results:

TSSC was associated with excellent internal consistency. The Cronbach's alpha forVataja, Pittaja, and Kaphajascales was 0.826, 0.885, and 0.911, respectively. Scores on Vātaja, Pittaja, and Kaphaja scales were inversely correlated, suggesting that they are mutually exclusive. Correlation of scores on subscales with CCPI was 0.97, 0.92, and 0.94, respectively, for Vata, Pitta, and Kapha.

Conclusions:

The state of tridosha in children can be measured reliably by this instrument. This can be utilized by clinicians and researchers to check the immediate effect of the interventions.
Safety Study on Novel Ayurvedic Nutritive Powder – An Experimental Study
Authors: Kulkarni Vinuta , Hiremath Rudramma R. , Buduru Sreenivasa Prasad , Kupati Veena Babu
Published: September 2023

Introduction:

It has been estimated that in India, 65%, i.e., nearly 80 million children under 5 years of age suffer from varying degrees of malnutrition. Most of the children fall into the pit of Malnutrition during the weaning phase. Mothers are expected to make this “weaning Bridge.” This includes utilization of “Supplementary Feeding Programs.” Many weaning foods are available which claims the specific dietary implementation. The development of a nutritive Powder in weaning children is need of hour. This study includes safety of novel Ayurvedic nutritive powder in Wistar rat pups.

Aim:

This study aims to evaluate its safety in experimental animals.

Materials and Methods:

Ingredients selected were Mudga, Godhuma, Rakta Shali, Ragi, Trikatu, Yastimadhu, and Khanda Sharkara. Safety study of Nutritive Powder was done in 20 days old Wistar Rat pups for 90 days. Parameters selected are HISTOPATHOLOGICAL study and biochemical investigations.

Results:

No mortality and abnormal behavioral changes were found in rat pups during experimental study. No remarkable pathological changes were observed. Biochemical Parameters revealed significant decrease in blood sugar, serum urea, and alkaline phosphatase in test group when compared to control.

Conclusion:

Nutritive powder when administered in the dose of 40 g/Kg body weight of animal for 90 days. No mortality was seen in any animals of test group. No remarkable pathological changes were seen in histopathological study of liver and kidney. Significant decrease of blood glucose, serum urea serum alkaline phosphatase was seen in test group animals compared to control group animals.
Integration of Rasayana Therapy with Chemotherapy Improved Therapeutic Outcomes in a Geriatric Advanced Nonresponsive Pancreatic Cancer Patient - A Case Report
Authors: Bendale Yogesh Narayan , Birari-Gawande Poonam , Patil Anandrao , Kadam Avinash
Published: September 2023

Pancreatic cancer carries one of the most dismal prognoses. In patients, who are inoperable, the main objectives of palliation are relief from obstructive jaundice, prevention or respite from gastrointestinal obstruction, and management of pain. In the present case, the patient has not shown a satisfactory response to chemotherapy, and therefore, opted Ayurveda as integrative medicine. The treatment was initiated with herbo-mineral Rasayana formulations along with chemotherapy. These therapies have significantly reduced the symptoms in the patient and also improved the quality of life (QoL). Besides improving the QoL, this case demonstrates a very important finding that combination treatment with Rasayana therapy has the potential to cause regression of tumor metabolic activity in those patients who do not respond satisfactorily to cytotoxic regimens. Besides this, Rasayana therapy also helped in improving the health-related QoL, alleviating disease symptoms, as well as toxic manifestation of chemotherapy.
Role of Ayurveda Interventions in the Management of Primary Hypothyroidism - A Case Report
Authors: Belaguli Govardhan , Brinda G. M.
Published: September 2023

Hypothyroidism is a condition that lacks the release of thyroid hormone causing the opposition of the bodily tissues to the thyroid hormone in the view of metabolic demand. In Ayurveda, there is no exact linking term for hypothyroidism. The physiology and pathogenesis of oxidation and metabolism in each and every tissue of the body are served as chief functions by Agni (~a system concerned with digestion and metabolism) and Pittadosha (~a bodily humor). With the support of principles of Anukta Vyadhi (~unstated diseases) of Ayurveda, hypothyroidism can be diagnosed as Agni dushitajanya Rasapradoshaja vyadhi associated either with Vata, Pitta or Kapha dosha. The Ayurvedic management of hypothyroidism is to address the pathology at its root by regulating the affected immune system. A 25-year-old female student, who was a known case of hypothyroidism with polycystic ovarian syndrome (PCOS) since nearly 2 years, was successfully treated using the above principle. Her thyroid stimulating hormone (TSH) before the intervention was 6.12 μIU/ml. She was subjected to Langhana chikitsa (~depleting therapy) to correct her alleviated Pitta and Kapha Dosha. This chikitsa involved induction of Deepana-Pachana (~enhancers of digestion and metabolism), Snehapana (~therapeutic intake of medicated unctuous substance), and Vamana chikitsa (~therapeutic emesis). She attained 8 Vegas (~bouts) and was discharged with suitable Samshamana oushadhis (~palliative or discharge medications) and Samsarjana karma (~Post therapy dietetic regimen for revival). After completing 1 month of follow-up she is currently asymptomatic and her TSH level is 3.73 µIU/ml. The adoption of various classical principles of Ayurveda in diagnosing the case, the minimal intervention used and the significant results obtained motivated us to document the case. Although the present testimony is of a small sample, a plan on a large sampled pilot study on the current treatment model is intended.
An Analytical Study to Evaluate the Safety of Reusing of the Vomited Leech in Leech Therapy
Authors: Mane Vijaykumar S. , Shindhe Pradeep S. , Vedantam Giridhar , Pednekar Harsha D. , Killedar Ramesh
Published: September 2023

Background:

Leech therapy is a point of attraction in the medical as well as in the scientific world due to its various outstanding properties, while studying the Ayurveda and scientific literature one can find difference, i.e., discarding after single use as per modern literature, but in Ayurveda, it can be reused after 7 days of leech therapy. Studies of such kind were not carried or published in any scientific journals, so ethical approval and developing scientific methods for validating the study were necessary, so a pilot study began with ethical clearance.

Objective:

The objective of the study was to evaluate the bacterial and fungal count of leech saliva and blood emesis before and after leech therapy using disc diffusion method.

Materials and Methods:

Leeches were collected from the normal habitat from Mangalore region possessing the same weight and morphological characteristics as that of the Nirvisha Jalouka as mentioned in classics (Shanku-mukhi). The selected leeches were stored in well water having nonchlorinated with minimum bacterial load. The well water was selected from three geographical regions of Belagavi city, and among them, one sample was selected having minimal bacterial load. Ten patients with infectious skin diseases who were indicated for Jalaukavacharana (Vidradhi, Dushta-vrana) were selected. The experimental leech saliva was tested for total bacterial count (TBC) and total fungal count (TFC) before and on 8th day of application, along with venous blood of the patient and blood vomitus of leech after application was tested for TBC and TFC. Statistical analysis was done based on TFC and TBC before and after application.

Results:

TBC and TFC of leech saliva at 8th day and before application were similar which indicates the leech gut has destroyed the bacteria or inhibited the growth of bacteria.

Conclusion:

TBC and TFC help to produce evidence that after application of leech and proper vomiting will not allow the growth of bacteria. Hence, safely, it can be reused after 7 days.
A study on the Ayurveda Intervention (Virechana - therapeutic purgation and Rasayana - rejuvenation) on molecular gene expression profiling in familial breast cancer patients
Authors: Shetty Akshay , Buduru Sreenivasa P , Kulkarni Suyamindra S , Gai Pramod B , Sambrekar Pratibha
Published: September 2023

Background:

The study was conducted to assess the ayurvedic intervention Virechana- therapeutic purgation and Rasayana- rejuvenation on predisposed familial breast cancer expression profiling of BRCA1 and BRCA2 genes.

Materials and Methods:

The total RNA was extracted from blood of five subjects of familial breast cancer predisposition patients using PAX Gene Blood RNA Kit who had undergone the ayurvedic intervention Virechana- therapeutic purgation and Rasayana- rejuvenation therapy. BRCA1 and BRCA2 gene expression was assessed by reverse transcription polymerase chain reaction and quantitative polymerase chain reaction (qPCR). The qPCR-based BRCA1 gene expression results were analyzed for fold variation based on Ct values using the following formula: 2 (−ΔΔCt), where ΔCt is the Ct (GOI) − avg.(Ct (HKG)), GOI is the gene of interest, and HKG is the housekeeping gene.

Results:

In one subject (S1), the upregulation (61.82) showed further increase (843.36) by therapeutic purgation and then decreased below the baseline level (11.3) in the rejuvenation phase. In three subjects (S2, S3, and S5), the upregulated genes (1488.87, 15825.9, and 19.16) showed down trend continuously till rejuvenation phase (1.92, 4.17, and 3.97) but not to downregulation. Another subject (S4) showed reversal of genetic expression, i.e., downregulated gene (−1) showed upregulation (237,900.70) continuously throughout the therapy, which is in conformity of the proposed hypothesis, i.e., biopurification (therapeutic purgation) followed by rejuvenation leads to upregulation of gene.

Conclusion:

With the available limited and diversified data, it may be concluded that therapeutic purgation followed by rejuvenation (Narasimha Rasayana) therapy exerted effect on gene expression, but further study needs to be conducted with more number of samples.
Management of Autism Spectrum Disorder through Ayurveda - A Case Report
Authors: Masooda  , Pathak Vijay Kumar , Mahapatra Arun Kumar , Shrikrishna Rajagopala
Published: September 2023

Autism spectrum disorder (ASD) is a group of neurodevelopmental disorders marked by impairment in varying degrees of social communication and interaction, repetitive behaviors, and restricted interests. Based on clinical characteristics, ASD can be correlated with Unmada mentioned in Ayurveda classics. In clinical practice, there is a paucity of standard treatment protocols and effective care for the prevention of ASD. The present case report discusses a 5-year-old male patient who presented with poor eye contact, no communication, no social skills, poor speech, repetitive play activity, hyperactivity, constipation, and sleep disturbances reported at Kaumarabhritya outpatient department. Diagnosis of ASD was established using the Indian Scale for Assessment of Autism (ISAA) test manual. Abhyanga with Ksheerbala Taila and Nasya with Saraswata Ghrita along with other internal medications i.e., Saraswata Ghrita, Ashwagandharista, Guduchi Churna, Madhuyashthi Churna, and Vacha Churna were given. Remarkable improvement was noted in overall ISAA scores as well as clinical improvement noted in poor eye contact, hyperactivity, and peer relationship. “Child Sleep Habit Questionnaire (CSHQ)” was used to assess the child’s sleep pattern and improvement was noted. The stress level of the parent also decreased which was assessed using the “Autism Parenting Stress Index.” No adverse effects were reported during the treatment period and follow-up.
An Ayurvedic Approach to a Case of Primary Infertility
Authors: Hosur Asha , Uppin Swarda Ravindra
Published: September 2023

Infertility is a multifactorial condition affecting both partners, of which the female contributes about 40% cases of infertile couples. Of all the various factors, the most frequently contributing factors are those of ovarian and uterine. Polycystic ovarian disease is the most common cause of an ovulatory infertility, being found in 75% of cases. It now proves to be a significant factor in female infertility with the prevalence of 0.6%–3.4% in infertile couples. While uterine or endometrial polyps are one among those that can affect the shape and functioning of the uterus, thereby leading to infertility. On an average, the prevalence of endometrial polyps can vary from 7.8% to 34.9%. The contemporary medical science extends hormonal and surgical intervention as the prime line of the management. Ayurvedic treatment modalities can bypass the surgical management to avoid the related burden and provide a fruitful outcome in such conditions. Here, we present a case of primary infertility with a known polycystic ovarian disease and sonologically diagnosed endometrial polyp. The case was successfully treated with Ayurvedic treatment modalities such as virechana karma, uttara basti, nasya karma, and shaman aushadi. The treatment course resulted in the regression of the polyp, re-established ovulation, and a successful conception with full-term normal labor.
Romantic Relationships during the COVID-19 Pandemic
Authors: Choudhury Shyamolima Ghosh , Chaudhary Shweta , Phogat Poonam
Published: September 2023

Introduction:

The coronavirus pandemic and the resultant lockdown had been harsh on many people especially those in romantic relationships. There was increase in psychological issues such as anxiety, stress, depression, alcoholism, and problematic eating behaviors which resulted in conflicts and breakdown in relationships.

Aim and Objectives:

The present cross-sectional exploratory study investigated how individuals in romantic dating relationships have coped during the times of COVID-19. The objectives were to examine the stressors faced by romantic dating couples during the pandemic, the differences among them with respect to dyadic coping, conflict, and resolution strategies employed.

Materials and Methods:

A total of 232 individuals (males = 104, females = 128) were assessed on a semi-structured Stressor Checklist, the Dyadic Coping Inventory, and Romantic Partner Conflict Scale. Descriptive statistics, Pearson's correlation, ANOVA, and Tukey's honestly significant difference were calculated.

Results:

45% of participants reported growing closer to their partners during the pandemic; others reported strained relationships or break-ups. Distance, difficulty in in-person meetings, reduced communication emerged as the most reported stressors among participants. Dyadic coping was found to be significantly better in the closer group than in the strained group or the break-up group (t = −1.89,P< 0.05). Stress communication by partner was found to be significantly better in closer couples (t = −2.38,P< 0.01). With respect to conflict resolution, significant differences were found among the three groups on compromise (r = 0.459,P< 0.01) avoidance (r = 0.224,P< 0.01), interactional reactivity (r= −0.446,P< 0.01), domination (r = −0.223,P< 0.01), and submission (r = −0.491,P< 0.01). No difference was found among the groups on separation (r = −0.07; NS).

Conclusion:

Individuals who found themselves in strained relationships or breakups during COVID-19 attributed negative outcome in relationship to factors internal to the relationship. Individuals with positive relationship outcomes engaged in positive dyadic coping; conflict resolution strategies employed by them were positive. The limitations, mental health implications and suggestions for further research have been discussed.
Depression, Anxiety, Insomnia, and Distress among Health-Care Workers Posted in COVID-19 Care
Authors: Sharma Kamlesh Kumari , Srinivasan Muthuvenkatachalam , Sarkar Siddarth , Kaur Ravneet , Sharma Yamya , Venkatesan Latha , Gupta Sandhya , Venugopal Ambili
Published: September 2023

Background and Aims:

Health-care professionals have been at the forefront of facing the COVID-19 pandemic. However, the stresses of dealing with patients affected by COVID-19 and concern about their own well-being are likely to lead to psychological distress among them. This study looked at depression, anxiety, insomnia, and significant distress among doctors and nurses working in COVID-19 services at a tertiary care facility.

Methods:

Depression, anxiety, insomnia, and significant distress were assessed through Primary Health Questionnaire-9, generalized anxiety disorder-7 scale, insomnia severity index (ISI), and impact of events scale-revised, respectively, using an online pro forma.

Results:

A total of 504 participants (53.2% females, 70.8% nurses) provided complete responses. Depression, anxiety, insomnia, and distress symptoms above the threshold were present in 36.7%, 29.6%, 31.9%, and 11.7% of participants, respectively. Single marital status, lack of access to appropriate personal protective equipment (PPE), distance to work more than 10 km, and being diagnosed with a mental illness were independent predictors of depression. Lack of access to appropriate PPE and being diagnosed with a mental illness were independent predictors of anxiety. Lack of access to adequate PPE emerged as the only independent predictor of insomnia and significant distress symptoms, respectively.

Conclusion:

Considerable proportion of health-care professionals posted in COVID-19 care had symptoms of psychological distress. Addressing the concerns of health-care professionals is important and probably needs effective collaboration of mental health-care professionals and administrators.
Immediate Effect of Gratitude Journal on Mental Well-Being of College Students in Kerala
Authors: James Jasmin , George Augustine , Alphonse Sunil , Saheedha A
Published: September 2023

Background:

COVID-19 has led to economic slowdown, loss of life, loss of livelihood, health complications, poor quality of life, deteriorated mental health, and poor education. One of the critical issues is decreased mental health among adolescents. Mental health was indeed a problem even before COVID-19, and the pandemic has substantially raised or catalyzed it to another level. Teachers reported that many college students who came to college after a long period of lockdown seem to be very confused, anxious, emotionally exhausted, and stressed. Parents are of the opinion that their children show irritation, anger, and frustrations at home. This study is an offshoot of this concern.

Aim:

This study aims to know the immediate effect of gratitude journals on mental well-being.

Settings and Design:

The study was conducted at the University Institute of Technology (UIT), Karuvatta, Alappuzha, Kerala. The experimental design was used for the study.

Materials and Methods:

One hundred and eight college students (F = 50 and M = 58) aged between 18 and 25 years from UIT, Alappuzha, Kerala, were selected randomly for this study. Students were divided equally into two groups, experimental group (n = 54) and control group (n = 54); both groups were tested to analyze mental well-being using Warwick Edinburgh Mental Well-being Scale. Experimental group was made to fill the gratitude journal immediately after the pretest and the control group was allowed to do their daily routine. Posttest was conducted to find if there was any significant difference in the experimental group.

Statistical Analysis Used:

Paired sample “t”-test and ANCOVA were used for the statistical analysis.

Results:

It shows a significant difference at a 0.05 level. When the outcome was compared between experimental and control group, the experimental group showed an increase in their mental well-being score (P < 0.01), whereas the control group did not show any difference in mental well-being, (P = 0.540).

Conclusions:

This implies that a gratitude journal could be a good intervention even in short run to improve the mental well-being among college students and hence students can be better prepared for learning.
A study to Assess Knowledge, Attitude toward Mental Illness, and Mental Health Help-Seeking among the Adult Population in a Selected District of Assam
Authors: Ngatey Junti , Baruah Arunjyoti , Kollipara Sandeep
Published: September 2023

Background:

Mental health problems are neither a new disorder nor a disease condition. However, it has been ignored or neglected since the older days. People with adequate knowledge and positive attitude toward mental illness only will lead to increase their intention of seeking help for it.

Aim:

To assess knowledge, attitude toward mental illness, and mental health help-seeking among the adult population in the selected district of Assam.

Materials and Methods:

A quantitative research approach with a descriptive research design was adopted. There were a total of 100 adult participants. The data were collected by using the Modified Version of the Knowledge of Mental Illness Questionnaire, Community Attitudes toward the Mentally Ill Scale, and Mental Help-Seeking Intention Scale (MHSIS).

Results:

The study revealed that participants have adequate knowledge of mental illness (17.92 ± 4.607) and have a positive attitude toward it which includes authoritarianism (31.54 ± 3.295), benevolence (BE 33.93 ± 3.307), social restrictiveness (SR 24.74 ± 4.550), and community mental health ideology (CMHI 34.34 ± 4.326) and also shows high intention to seek help for mental health problems (6.53 ± 1.436). There was a statistically significant association of knowledge with occupation (χ
2 = 15.203,P= 0.001). It also showed a significant positive correlation between knowledge and BE domains (r = 0.242,P= 0.015) followed by a significant negative correlation between knowledge and SR domains (r= −0.345,P= 0.000) and a significant positive correlation between MHSIS score and CMHI domains (r = 0.207,P= 0.039) of attitude scale.

Conclusion:

The adults from the selected areas have an adequate knowledge on mental illness, positive attitude toward it and a high intention to seek help for mental health problems.
Nursing Management of Deaf-and-Dumb Psychiatric Patients
Authors: Humane Sushil , Khaire Prachi
Published: September 2023

Nursing management of the deaf and dumb psychiatric patient is a challenging task. The patient may not be able to communicate with nurse or others, which makes it difficult for you to know what is happening during treatment. Nurse must be able to communicate with the patient and understand their needs in order to provide effective care. A deaf and dumb psychiatric patient who can't communicate well with others will have a hard time getting along with other people in his/her surroundings. This will make him/her feel isolated which may lead him/her to become depressed as well as anxious because he/she won't know what's going on around him/her. This article discusses the ways to provide nursing care to deaf and dumb psychiatric patient in psychiatric unit.
Knowledge and Dealing Strategies Regarding Learning Disability in Students Among Teachers at Selected Schools of Jodhpur
Authors: Dhama Varsha , Parihar Aashish , Pandey Vandna , Rani Raj
Published: September 2023

Background:

Learning disability is a heterogeneous group of disorders manifested by significant difficulties in the acquisition and use of listening, speaking, reading, writing, reasoning, or mathematical abilities. Literature reports that in India prevalence of learning disability is 10% and there is approximately 90 million people with varying degrees of learning disabilities. Teachers play an important role in identifying and managing learning disabilities by using proper dealing strategies.

Aim:

The aim of this study is to assess the knowledge and dealing strategies regarding learning disabilities in students among teachers.

Methods:

250 teachers who were engaged in teaching students from 1st to 5th standards were selected by convenient sampling technique from selected schools of Jodhpur. Results: A self-structured knowledge questionnaire found that 62.4% of teachers had inadequate and 37.6% had adequate knowledge regarding learning disabilities. Self-structured dealing strategy rating scale had seven domains and out of them, the preventive dealing strategies domain are more evidently used by the teachers as compared to other domains.

Conclusions:

Study concluded that most of the teachers had inadequate knowledge regarding the learning disability and there is a great need to plan and implement awareness program for teachers about learning disabilities.
Tricuspid Atresia with Double-outlet Left Ventricle and Pulmonary Stenosis
Authors: Singhi Anil Kumar , Mohapatra Soumya Kanti , Nath Anish , Das Soumen
Published: September 2023

Tricuspid atresia is typically classified according to the relationship with the great arteries, the location of the ventricular septal defect, and the nature of the pulmonary flow. A condition where both great arteries arise from the left ventricle is an exceedingly uncommon occurrence. In this case study, we present a unique case of a young infant diagnosed with tricuspid atresia accompanied by a double-outlet left ventricle and pulmonary stenosis. We showcase this rare scenario through detailed multimodality imaging.
Libman–Sacks Vegetation, Infective Vegetation, and Pulmonic Valve Abscess in a Systemic Lupus Erythematosus Patient on Immunosuppressive Therapy
Authors: Nair Rajesh Gopalan , Veedu Praveen Rermal , Haridasan Vellani
Published: September 2023

A 14-year-old girl, who is a known case of systemic lupus erythematosus and lupus nephritis, was admitted with complaints of fever for 10 days. Clinical examination did not show any focus of infection. Blood culture and sensitivity showed Staphylococcus aureus septicemia. She was started on antibiotics and subjected to routine transthoracic echocardiography. Transthoracic echocardiography showed Libman–Sacks vegetations (also known as nonbacterial thrombotic endocarditis) on all the cusps of both mitral and tricuspid valves, along with sessile freely mobile infective vegetation attached to the right ventricular free wall, and pulmonic valve abscess moving to and fro about the pulmonic annulus. Surgery was deferred due to poor general condition, and the patient was continued on parenteral therapy. The girl succumbed to her illness on the 6th day of her illness.
Optical coherence tomography angiography and fundus fluorescein angiography in diabetic macular ischemia
Authors: Alam Mostafa M. , AbdEl_AzimEl_Koumy Hamdy , Serag Yasser R. , ElMhalawy Shaimaa R.M.
Published: September 2023

Background

Diabetic macular ischemia (DMI) has not received attention despite its importance. The presence of DMI in the context of diabetic maculopathy affects visual acuity and changes management decisions.

Aim

This study was done to evaluate optical coherence tomography angiography (OCTA) in the detection of macular ischemia compared with fluorescein angiography (FFA).

Patients and methods

This prospective study was done on 70 eyes (50 eyes of diabetic patients who were diagnosed of macular ischemia by OCTA and 20 control eyes of healthy subjects matched for age and sex) at the outpatient clinic of the Ophthalmology Department, Tanta University, during the period from November 2017 to October 2018.

Results

In this study, OCTA and FFA were able to detect macular ischemia in all patients, and in most cases, macular ischemia was more evident on OCTA imaging compared with FFA. The two OCTA parameters that were used in this study to evaluate the degree of macular perfusion and ischemia [FAZ area (mm)2 and VDZ% for both superficial capillary plexus (SCP) and deep retinal capillary plexus (DCP)] were found to have a statistically significant difference between patient and control groups. Moreover, we used FAZ area (mm)2 to evaluate macular ischemia in FFA images.

Conclusion

OCTA allows early diagnosis of DMI. Unlike FFA, OCTA allows us to evaluate ischemia in SCP and DCP with high-resolution images and allows detection of retinal and choroidal structures, and its images are not affected by leaking vessels. It is better in the evaluation of FAZ area measurements.
Correlation between serum ascites albumin gradient and esophageal varices in patients with chronic liver disease
Authors: El-Latif Salama Mohamed A.E.-M.A. , Negm Manal S. , Elbedewy Mohamed M. , El-Naggar Mousa M.
Published: September 2023

Background

Liver cirrhosis is a major source of morbidity and mortality. Esophageal varices and ascites are common complications of portal hypertension. In newly diagnosed cirrhotic patients, endoscopic screening for varices is suggested. This increases the costs and overloads endoscopy units.

Aim

To study the relationship between serum ascites albumin gradient (SAAG) and presence and severity of esophageal varices in patients with chronic liver disease to validate the use of SAAG as an indirect indication of varices existence.

Patients and methods

The study was done on 50 adult cirrhotic patients presenting with ascites. Patients were evaluated for laboratory investigations and abdominal ultrasonography. Esophagogastroduodenoscopy was done to find out if varices are present and their severity. Diagnostic paracentesis was done for ascitic fluid examination, and SAAG value was calculated. Based on SAAG value, patients were divided into three groups.

Results

There was a significant difference in the distribution of varices between SAAG groups. At cutoff value of SAAG of greater than equal to 1.5, the occurrence of varices can be predicted with 76% accuracy, sensitivity of 77%, and specificity of 75%.

Conclusions

There is a directly proportional significant relation between SAAG value and the presence of esophageal varices, as well as their severity. A cutoff value of SAAG of greater than equal to 1.5 can be used for prediction of varices existence. Accordingly, SAAG could be used to predict the development of varices among other noninvasive predictors.
Comparison of tadalafil and sildenafil in controlling neonatal persistent pulmonary hypertension
Authors: Abdel Monem Marwa A. , El Sharkawy Hamed M. , Abo ELezz Ahmed A. , Ibrahim Ashraf M.
Published: September 2023

Background

Persistent pulmonary hypertension of the newborn (PPHN) is a multifactorial syndrome, with 0.43–6.8/1000 live birth incidence and 10–20% mortality rate.

Aim

To compare the efficacy of tadalafil and sildenafil in controlling PPHN.

Patients and methods

This prospective study was carried out on 40 neonates with PPHN. Patients were equally divided into two groups: group 1 received tadalafil (Cialis 10 mg), 1 mg/kg as a single dose for 48 h, and group 2 received sildenafil (Silden 25 mg), 1 mg/kg/8 h for 48 h. Echocardiography was done at the time of enrollment and 48 h after starting treatment measuring the change in estimated systolic pulmonary artery pressure (ESPAP), patent ductus arteriosus assessment, assessment of left ventricle functions, changes in oxygen saturation, and oxygen requirements.

Results

Both drugs were successful in improving oxygen saturation, decreasing oxygen requirements, and decreasing ESPAP. There was a significant difference before and after treatment in both groups, whereas the difference between the two groups was statistically insignificant (P>0.05).

Conclusion

Tadalafil and sildenafil can similarly reduce ESPAP in neonates with PPHN. No serious short-term adverse effects of tadalafil and sildenafil were observed.
The protective effect of chrysin on oxidative stress, inflammation, and apoptosis in lithium-induced hepatotoxicity in rats
Authors: Elsayed Raghda A.E. , Atef Marwa M. , Shafik Noha M. , El-Dardiry Samia A.H.
Published: September 2023

Background

Drugs are an important cause of liver injury. Chrysin is a flavonoid and the main constituent of Oroxylum indicum. Many pharmacological and biological benefits have been attributed to it. These include anti-apoptotic, anti-inflammatory, and antioxidant effects.

Aim

We intended investigating the anti-apoptotic, anti-inflammatory, in addition antioxidant influence of chrysin on lithium-induced hepatotoxicity in rats.

Materials and methods

The present research was conducted at the Medical Biochemistry Department, Faculty of Medicine, Tanta University, Egypt. A total of 40 albino male rats weighing between 150 and 200 g were included in this experiment and were split randomly into 4 equal groups (each group involved 10 rats): group I (control), group II (lithium treated), group III (lithium+chrysin), and group IV (chrysin treated). All rats that were acquired originated in the laboratory’s animal colony at Tanta University. Liver function tests, total and direct bilirubin, malondialdehyde, superoxide dismutase, reduced glutathione, caspase-3, and nuclear factor-kappa B levels were measured.

Results

Chrysin treatment resulted in significant decrease in liver functions, total and direct bilirubin, caspase-3, nuclear factor-kappa B, and malondialdehyde levels and significant increase in superoxide dismutase activity, with reduced glutathione intensity.

Conclusion

Based on these correlating findings, it is possible to conclude that chrysin has protective potential on lithium-induced hepatotoxicity; therefore, it represents a promising therapeutic strategy in its management.
Unusual sources of hospital-acquired infections in intensive care units and operating rooms at Tanta University Educational Hospital
Authors: Mansour Norhan Ahmed Abo , Ramadan Mona O. , Ezz Hoda A. Ahmed , Hussein Mohamed Z.
Published: September 2023

Background

Fomites can serve as a vehicle in transmission of health care-associated pathogens especially in intensive care units (ICUs) and operating rooms (ORs) where the patients are immunocompromised and at high risk of acquiring multidrug-resistant bacteria.

Aim

To assess bacterial contamination on inanimate surfaces and equipment in ICUs and ORs at Tanta University Educational Hospital to detect the potential reservoirs of hospital-acquired infections (HAIs) and to give appropriate recommendations for corrective actions.

Materials and methods

The samples were collected in sterile nutrient broth and incubated for 24 h. The isolation and identification of pathogenic bacteria were done through standard microbiological methods. Antibiotic susceptibility tests of the isolates were assessed by disc diffusion method.

Results

The contamination levels from group I (hospital samples) and group II (control samples) were 88.3% and 84%, respectively. In group I, Gram-negative bacilli were the most frequent isolates followed by Gram-positive cocci then Gram-positive bacilli, fungi, and lastly Gram-negative cocci that represented 35.7%, 34.4%, 25.9%, 3.2%, and 0.8%, respectively. In group II, all bacterial isolates were Gram-positive bacilli that represented 100%.

Conclusion

The presence of potential pathogenic-resistant bacteria on inanimate surfaces in hospital is of great health concern and these surfaces can serve as sources of HAIs.
The gallbladder wall thickness in correlation with portal hemodynamic changes in cirrhotic patients
Authors: El Sawaf Ahmed M. , Rabee Mohamed Y. , Amin Mohamed A.M. , Ismail Saber A.E.
Published: September 2023

Background

The gallbladder wall thickness (GBWT) is affected by portal hypertension, so GBWT can predict portal hemodynamic changes.

Aim

To determine whether noninflammatory GBWT correlates with portal hemodynamic changes and esophageal varices (EV) in cirrhotic patients.

Patients and methods

A total of 80 patients were enrolled in this cross-sectional study. Patients consisted of 30 cirrhotic patients with EV, 30 cirrhotic patients without EV, and 20 noncirrhotic individuals as a control group. Complete blood count, liver function tests, hepatitis C virus antibody, and HBsAg were assessed. Child–Pugh score was calculated in cirrhotic patients. Moreover, abdominal ultrasonography was performed for measuring wall thickness of the gallbladder, spleen length, and portal vein diameter. Moreover, portal vein Doppler was done for portal blood mean flow velocity measurement. Upper gastrointestinal tract endoscopy was done.

Results

GBWT was significantly increased in cirrhotic patients with EV compared with cirrhotic patients with without EV and noncirrhotic individuals (P<0.001). Moreover, GBWT was significantly correlated with spleen length, portal vein diameter, and portal velocity in cirrhotic patients with EV (P<0.001).

Conclusion

The GBWT could be one of the simple noninvasive predictors of portal hypertension and EV as it was positively correlated with portal hemodynamic changes that accompany cirrhotic portal hypertension.
Early ischemic stroke predictors after transient ischemic attacks among Egyptians
Authors: Basiouny Mohamed A. , Ragab Osama A.A.
Published: September 2023

Background

The frequency of early stroke occurrence after transient ischemic attacks (TIAs) has been poorly studied.

Aim

This work aimed to determine the possible predictors of early ischemic stroke within 90 days of the first attack of TIA among Egyptians.

Patients and methods

A total of 80 patients presented with acute ischemic stroke or TIAs were recruited and were divided into group A, which included 40 patients presented with ischemic stroke preceded by TIAs within the last 3 months, and group B, which included 40 patients who had one or more TIAs and were asymptomatic for more than 3 months. All patients were subjected to the following: neurological assessment, laboratory investigations, cardiologic assessment, and brain imaging.

Results

Older patients were more liable to stroke occurrence after TIAs. Hospital admission during TIAs significantly reduced the risk of early stroke occurrence. Receiving medical treatment during TIAs significantly reduced the risk of early stroke occurrence. Hypertension was the only significant modifiable risk factor for early stroke occurrence. Multiple TIAs were significant predictors of early stroke recurrence. The rate of stroke occurrence was higher during the short-term follow-up, especially during the first week. Magnetic resonance diffusion changes were significant predictors of early stroke occurrence.

Conclusions

The main prognostic factors for early stroke occurrence after TIAs were age, hypertension, hospital admission, early medical treatment after TIAs, duration and frequency of TIAs symptoms, ABCD2 score, and positive findings in brain imaging.
Gradient flow for $\beta$-symplectic critical surfaces
Authors: Han Xiaoli , Li Jiayu , Sun Jun
Published: September 2023

In this paper we consider a gradient flow for the

L_{\beta}

-functional introduced by the authors in Han–Li–Sun (2018). We first prove that the “symplectic” property is preserved along the gradient flow. Then we prove a monotonicity formula and an

\varepsilon

-regularity theorem for the flow. As consequences, we show that the

\lambda

-tangent cone of the flow consists of finite flat planes. Another application is that we can show that the flow exists globally and converges to a holomorphic curve if the initial surface is sufficiently close to a holomorphic curve and the ambient Käher–Einstein
surface has positive scalar curvature.
Editar la Palestina
Authors: King Gretchen , Jegić Denijal
Published: September 2023

Introduction. The purpose of journalistic style guides is to provide media practitioners with guidance on language to convey a neutral and objective presentation of information. This paper investigates thematic style guides published with a focus on Palestine and analyzes how these style guides construct media bias. Literature Review. In the literature reviewed a structural media bias against Palestinians that favors Israeli narratives is documented in research as an integral part of anglophone mainstream media through the reproduction of Orientalism, Zionist narratives, and anti-Palestinian racism. Methodology. A comparative content analysis was conducted on four thematic style guides, sampling common terms through a grounded theory approach. Results. The results show similarities and differences in the style guides’ definitions, sourcing, and explanations of key terms related to Palestine and its historical, legal, and geographic contexts. Discussion. The style guides notably differ in their content with some perpetuating anti-Palestinian bias in various implicit and explicit ways, such as Nakba denial, questioning Palestinian history, and reproducing Israeli sources and narratives. Conclusions. Our analysis concludes that anti-Palestinian bias and racism are an integral part of some anglophone newsroom policies and practices as implemented in style and editorial guidelines. Thematic style guides on Palestine thus can further perpetuate colonial conquest and anti-indigenous violence.
Log adjunction: moduli part
Authors: Shokurov Vyacheslav Vladimirovich
Published: September 2023

Upper moduli part of adjunction is introduced and its basic property are discussed. The moduli part is b-Cartier in the case of rational multiplicities and is b-nef in the maximal case.
Ramification filtration and differential forms
Authors: Abrashkin Viktor Aleksandrovich
Published: September 2023

Let $L$ be a complete discrete valuation field of prime characteristic $p$ with finite residue field. Denote by $\Gamma_{L}^{(v)}$ the ramification subgroups of $\Gamma_{L}=\operatorname{Gal}(L^{\mathrm{sep}}/L)$. We consider the category $\operatorname{M\Gamma}_{L}^{\mathrm{Lie}}$ of finite $\mathbb{Z}_p[\Gamma_{L}]$-modules $H$, satisfying some additional (Lie)-condition on the image of $\Gamma_L$ in $\operatorname{Aut}_{\mathbb{Z}_p}H$. In the paper it is proved that all information about the images of the groups $\Gamma_L^{(v)}$ in $\operatorname{Aut}_{\mathbb{Z}_p}H$ can be explicitly extracted from some differential forms $\widetilde{\Omega} [N]$ on the Fontaine etale $\phi $-module $M(H)$ associated with $H$. The forms $\widetilde{\Omega}[N]$ are completely determined by a canonical connection $\nabla $ on $M(H)$. In the case of fields $L$ of mixed characteristic, which contain a primitive $p$th root of unity, we show that a similar problem for $\mathbb{F}_p[\Gamma_L]$-modules also admits a solution. In this case we use the field-of-norms functor to construct the corresponding $\phi $-module together with the action of the Galois group of a cyclic extension $L_1$ of $L$ of degree $p$. Then our solution involves the characteristic $p$ part (provided by the field-of-norms functor) and the condition for a "good" lift of a generator of $\operatorname{Gal}(L_1/L)$. Apart from the above differential forms the statement of this condition uses the power series coming from the $p$-adic period of the formal group $\mathbb{G}_m$.
Special Bohr-Sommerfeld geometry: variations
Authors: Tyurin Nikolai Andreevich
Published: September 2023

This work continues investigations of special Bohr-Sommerfeld geometry
for compact symplectic manifolds. By using natural deformation parameters we circumvent
the difficulties involved in the definition of moduli spaces of special
Bohr-Sommerfeld cycles for compact simply connected algebraic varieties. As a byproduct,
we present some ideas of how our constructions can be exploited in the studies
of Weinstein structures and Eliashberg conjectures.
On higher-dimensional del Pezzo varieties
Authors: Kuznetsov Alexander Gennad'evich , Prokhorov Yuri Gennadievich
Published: September 2023

We study del Pezzo varieties, higher-dimensional analogues of del Pezzo
surfaces. In particular, we introduce ADE classification of del Pezzo
varieties, show that in type $\mathrm A$ the dimension of non-conical del Pezzo
varieties is bounded by $12 - d - r$, where $d$ is the degree and $r$ is the
rank of the class group, and classify maximal del Pezzo varieties.