bluuebunny/crossref_metadata_2025 huggingface dataset:
La guerre d’Ukraine : quelles conséquences pour le système productif allemand ?
Authors: Uterwedde Henrik
Published: March 2023

Cette contribution analyse les conséquences économiques de la guerre d’Ukraine pour l’économie allemande et pour son système productif, avec la forte présence de l’industrie et son imbrication particulièrement étroite dans l’économie mondiale, qu’il s’agisse ses flux commerciaux, ses investissements ou ses chaînes de production. Certains problèmes du modèle économique allemand étaient déjà manifestes bien avant la guerre : un sous-investissement patent, un engagement trop hésitant dans la transformation énergétique et productive, des vulnérabilités résultant de dépendances fortes d’approvisionnement dans certains domaines clé (énergie, certaines matières premières et certains biens intermédiaires stratégiques). La guerre d’Ukraine a accentué ces problèmes et a démontré l’urgence d’accélérer la transformation du système productif allemand. À court terme, l’économie allemande a bien digéré le choc provoqué par la guerre et a évité une crise économique et sociale grave, grâce à sa capacité d’adaptation mais aussi aux mesures d’aide du gouvernement, qui a mobilisé des ressources financières sans précédent en faveur des ménages et des entreprises. À moyen terme, les perspectives pour l’industrie allemande sont contrastées. Pour certaines branches, la menace d’une perte de compétitivité est réelle, mais il ne faut pas sous-estimer la résilience et le fort potentiel d’innovation des producteurs industriels allemands et leur capacité de rebondir. Le véritable défi de l’industrie sera celui de sa transformation verte : arriver à la neutralité climatique de sa production tout en évitant la désindustrialisation. L’épreuve sera rude ; pourtant, fort de ses nombreux atouts toujours présents, le capitalisme industriel allemand est bien armé pour affronter ce défi. Cela demandera à la fois un nouveau volontarisme politique pour accélérer et mener à bien le tournant énergétique, un pilotage stratégique de la part des pouvoirs publics et des industriels, ainsi qu’une concertation sociale étroite.
Négociation au sein des ménages ivoiriens : résultats expérimentaux en milieu rural
Authors: Dimova Ralitza , Pokou Abou Edouard , Basu Arnab , Viennet Romane
Published: March 2023

Cet article propose une nouvelle mesure expérimentale du pouvoir de négociation de la femme, examine le lien de cette mesure avec les dépenses familiales consacrées aux différents types de biens publics, et étudie ses facteurs déterminants. Le but central de cet exercice est de vérifier s’il y a une corrélation positive entre le pouvoir de négociation de la femme et les ressources allouées aux biens publics au sein du ménage. Nous trouvons que l’homme donne la priorité aux dépenses alimentaires, la femme donne plus d’importance aux transferts à destination des parents et les deux accordent des priorités moyennes similaires à l’éducation. Le pouvoir de négociation de la femme par rapport aux trois catégories de dépenses étudiées est corrélé avec le prix de la mariée, l’éducation de la femme et le revenu de l’homme. Les résultats contribuent au débat sur l’intérêt supérieur de la femme au bien-être des enfants et pourront avoir des effets politiques intéressants. Codes JEL: C93, J43, O55.
La médecine intégrative : un écosystème méconnu
Authors: Brissaud Philippe
Published: March 2023

Tel un nouvel appel, un écho prolongeant les articles collectifs parus respectivement dans Le Journal du Dimanche « Pour une médecine intégrative » (JDD du 13 novembre 2022) 1 et dans le quotidien Le Monde, «  Il est temps d’accorder une place raisonnée pour des pratiques complémentaires dans le système de soins » (Tribune du 10 novembre 2022) 2 , la présente contribution citoyenne interroge l’analyse que porte le ministère de la Santé et de la Prévention sur le sujet. La problématique concerne l’intégration et l’encadrement des pratiques de soins non conventionnelles complémentaires en santé ainsi que les interventions non médicamenteuses (INM) 3 , évaluées, sécurisées et adaptées, à visée de prévention et de soins, dans le système de santé en France. Une recommandation cardinale s’impose : évaluer, réguler, informer pour mieux intégrer.
De la famille patriarcale à la famille postmoderne : la transition en Espagne
Authors: Meil Gerardo Landwerlin , Cadenza Academic translations  , Elmaleh Agnès , Forichon Josué , Fernández María Florencia , Mellor Mark , Collet Beate , Favier Yann
Published: March 2023

La vie familiale espagnole a profondément évolué au cours des dernières décennies, passant du modèle dominant patriarcal à des façons plus diverses de concrétiser les projets de couple et de formation d’une famille. Ces changements trouvent leur origine dans une série de réformes légales et une évolution des politiques sociales, des valeurs et des attitudes face aux mutations de la famille. Les différents gouvernements socialistes ont joué un rôle majeur dans cette transformation. Ainsi, le droit au mariage a été reconnu aux couples de même sexe, même si certains d’entre eux souffrent encore de diverses formes de discrimination. L’union libre est non seulement devenue la façon habituelle de démarrer la vie de couple, mais elle est dorénavant admise comme une alternative au mariage, même si celui-ci demeure relativement populaire. Le droit de toute femme à accéder à une forme de procréation assistée a été reconnu, indépendamment de sa situation maritale ou de son orientation sexuelle, droit qui est exercé assez fréquemment, mais pas toujours au sein du système public de santé. La généralisation de la planification familiale s’est accompagnée d’une réduction significative du nombre d’enfants par foyer, en partie en réponse aux inégalités de genre vécues dans l’emploi ou au sein des dynamiques familiales. Le divorce, d’abord freiné par un système issu de la transition démocratique, a évolué, et sa règlementation est aujourd’hui semblable à celle d’autres pays libéraux, et le principe de la garde partagée des enfants a peu à peu remplacé celui de la garde par la mère.
« Bonjour les artistes ! » : Entretien sur le couple aujourd’hui
Authors: Kaufmann Jean-Claude , Messu Michel
Published: March 2023

Sous forme de dialogue avec Michel Messu, Jean-Claude Kaufmann fait le point sur ses observations empiriques et ses conclusions sociologiques relatives au couple conjugal. Il souligne le tissu d’injonctions contradictoires dans lesquelles se trouve placé le couple contemporain. Loin de faire du couple la raison instrumentale d’un bonheur individuel autocentré, il lui préserve une fonction sociale de réconfort, d’apaisement et de protection. Mais celle-ci reste sous tension, aussi bien celle des attentes personnelles de ses composantes que celle induite de la confrontation à l’environnement social. Le « petit monde » du couple flotte, non sans difficultés et incertitudes, dans un monde social qui se voulant fluide et fortement émotionnel y projette ses propres difficultés et incertitudes.
De la puissance paternelle aux fonctions paternelles.
Authors: Hurstel Françoise , Thévenot Anne
Published: March 2023

Cet entretien avec Françoise Hurstel, professeure de psychologie clinique à l’Université de Strasbourg et psychanalyste, rend compte d’une trajectoire de recherche inscrite à la fois dans un parcours singulier et dans l’histoire collective des évolutions familiales depuis la seconde guerre mondiale. Ces réflexions permettent aussi d’entr’apercevoir les soubassements d’une recherche vivante, c’est-à-dire en dialogue avec les enjeux de son époque. Ce texte témoigne de la manière dont elle a mobilisé et mis au travail les concepts de la théorisation psychanalytique pour explorer les mutations familiales contemporaines, en particulier celles de la paternité.
L’épuration à Paris
Authors: Morin Gilles
Published: March 2023

À l’issue de la Seconde Guerre mondiale, la cour de justice de Paris, capitale de la collaboration et surtout du collaborationnisme, a jugé quelque 8 000 personnes et condamné les deux tiers d’entre elles à des peines variables. L’article établit tout d’abord les caractéristiques socioprofessionnelles de la population épurée, la chronologie et les échelles de peine, et les motifs retenus contre les condamnés. Cette échelle reflète les priorités des épurateurs et de la population et démontre que la collaboration militaire et surtout celle des auxiliaires des services de répression nazis ont été les plus sévèrement punies, devant la délation, la persécution des Juifs et la collaboration économique.
Un « organisateur collectif » : la presse et la gouvernementalité militante jeunes communistes en France
Authors: Sklower Jedediah
Published: March 2023

Dans la tradition socialiste, la presse est un outil fondamental de la « gouvernementalité militante » d’un mouvement politique, soit l’ensemble des normes, pratiques, procédures par lesquelles il cherche à « conduire les conduites » de ses troupes. Cet article décrit le dispositif médiatique de la Jeunesse communiste en France entre 1955 et 1981. Ses militants et militantes sont constamment incités à produire et à diffuser une multiplicité de supports de propagande conformément aux méthodes prescrites par le mouvement, mais aussi à faire preuve d’initiative. La mise en scène de diffuseurs modèles, les concours d’émulation, la quantification de ces activités contribuent à leur formation/subjectivation militantes et à leur intégration au conglomérat communiste.
Systematic review and meta-analysis on efficacy of various exercise programs to improve postural parameters, pain and disability in neck
Authors: Panihar U. , Joshi S.
Published: March 2023

Forward head posture is a common abnormal posture characterised by weakness of muscle around neck and shoulder. Persistent forward head posture can impair respiratory functions and cervical proprioception. The aim of this systematic review and meta-analysis is to determine the effectiveness of exercises to improve the forward head posture. The online literature search performed on various databases, i.e. PubMed, Cochrane, PEDro, Science Direct and Scopus databases resulted in 601 articles, but only 11 articles were found relevant to perform meta-analysis. The primary outcome measure was craniovertebral angle and other outcome measures were neck pain, cranial angle, cranial rotation angle and Neck Disability Index (NDI). Methodological quality of studies was assessed by PEDro scoring and risk of bias assessment was performed using Cochrane collaboration tool of risk of bias. Results of meta-analysis revealed that craniovertebral angle (CVA), cranial rotation angle (CRA), visual analogue scale and NDI improved significantly (P<0.00001) in forward head posture participants who followed any type of exercise regime compared to the participants who did not follow any exercise program. However, cranial angle was not found significantly (P=0.73) improved in exercise groups. Exercises are effective in improving postural parameters, such as CVA, CRA and pain and neck disability in subjects with forward head posture.

Systematic analysis registry at PROSPERO: CRD42020175372
The role of information and attitudes towards more sustainable technologies in the acceptance of insects as a food ingredient
Authors: Rabadán A. , Molina A. , Bernabéu R.
Published: March 2023

Although insects are considered a healthy and more sustainable source of proteins, consumers in Western countries are still reluctant to accept them as a food ingredient to be included in food formulation. In order to improve acceptance, studies focused on identifying the drivers of the acceptance of insects have shown that environmental awareness is one of the main factors that could encourage the acceptance of insects as food. The current study analyses 435 Spanish consumers’ attitudes towards cookies prepared using insect flour compared to those made using traditional wheat flour and evaluates the influence of consumer attitudes towards sustainable technologies in the acceptance and willingness to pay (WTP) for insect-based cookies. The effect of providing information about the environmental sustainability of insect production on consumer predisposition to buy insect-based products is also considered and we present a description of the sociodemographic characteristics of the consumers that are more sensitive to such information. Our results show that consumers’ WTP falls dramatically when presented with the ‘with insect flour’ claim, with it being the most significant attribute affecting consumers’ preferences. However, the findings also suggest that a significant segment of consumers (37.0%) is more open to eating insects after being informed about their environmental benefits. Gender (women), age (younger) and education (university) are the sociodemographic factors related to a more significant effect of information on consumers’ attitudes towards insect-based foods.
Entropy formation analysis for magnetized UCM fluid over an exponentially stretching surface with PST and PSHF wall conditions
Authors: Shah Sheheryar , Abrar M. N. , Akhtar Kamran , Khan Aziz , Abdeljawad Thabet
Published: March 2023

This article aims to demonstrate the formation of entropy due to variable thermal conductivity, radiation, and fluid friction irreversibilities for a three-dimensional upper-convected Maxwell (UCM) fluid. The fluid motion occurs as a result of exponential stretching sheets. Separate discussions are held regarding the entropy generation related to the prescribed surface temperature and prescribed surface heat flux. Additionally, the heat transport mechanism is examined in the presence of thermal radiation. The governing physical situation is first modeled and then solved by using the homotopy analysis method to acquire the solution. The physical importance of relevant flow parameters is shown graphically and in tabular form. It is noted that the entropy generated is reduced with an increase in the thermal radiation parameter. Streamline patterns are also drawn for two- and three-dimensional UCM fluid models. Finally, the current analytical solution is found to be in agreement with the solutions in the literature.
RISE-based adaptive control of electro-hydraulic servo system with uncertain compensation
Authors: Yang Xiaohan , Cui Yinghao , Yuan Zhanhang , Hang Jie
Published: March 2023

Electro-hydraulic servo system (EHSS) plays an important role in many industrial and military applications. However, its high-performance tracking control is still a challenging mission due to its nonlinear system dynamics and model uncertainties. In this paper, a novel adaptive robust integral method of the sign of the error (ARISE) with extended state observer (ESO) is proposed. Firstly, the nonlinear mathematical model of typical EHSS with modeling uncurtains and uncertain nonlinear is established. Then, ESO is used to estimate the state and lumped disturbance, of which the unknown parameter estimations can be updated by the novel adaptive law. Results shows that the novel controller achieves better tracking performance in maximum tracking error, average tracking error and standard deviation of the tracking error.
Personalized Course Resource Recommendation Algorithm Based on Deep Learning in the Intelligent Question Answering Robot Environment
Authors: Sun Peng
Published: March 2023

Aiming at the problems of difficult-to-extract effective information and insufficient feature extraction in the existing intelligent question answering robot environment, a personalized course resource recommendation algorithm based on deep learning is proposed. Firstly, the potential preferences of users are obtained through course-related data. Secondly, the authors use one-hot coding and embedding to convert word vectors into low-dimensional, dense real-valued vectors and input them into the CIN-GRU model. Finally, the attention mechanism is used to improve the attention of some words and the accuracy of personalized course recommendation. The experiment shows that when the recommended list is 35, the precision, recall, and F1 value of the proposed personalized course recommendation method are 0.862, 0.851, and 0.857, respectively, which are higher than those of the comparison method. Therefore, the performance of the proposed method in sustainable personalized course resource recommendation is better than that of the comparison method.
Performing Arts Organizations' Communication Through Posters in Greece
Authors: Koloka Maria , Papadaki Eirini
Published: March 2023

This paper proposes an analysis of a sample of Greek cultural organizations' visual messages as polysemiotic, multimodal signs, in an attempt to examine the role of such messages for the communication strategy of cultural organizations. The sample constitutes visual messages from three Greek cultural organizations, each representing a different type of performing art. These organizations are Greek National Theatre, the National Opera of Greece, and the International Short Film Festival in Drama. All messages included in the study are messages promoting specific cultural events and, simultaneously, the organization as a brand. Through morphological and semiotic analysis of the respective messages of the selected organizations, a series of issues are going to be examined, including the way cultural organizations' messages are composed and projected, their relevance to the specific organization, and the impact of messages both in promoting a cultural event and the organization's brand, as well as maintaining and developing an organization's audience.
Evaluating the Lifetime of Quarto Stand Rolls on the Basis of the Contact Fatigue Criterion
Authors: Antsupov Aleksey V. , Fedulov Artem A. , Antsupov Viktor F. , Antsupov Alexander V.
Published: March 2023

One of the principal failures of the supporting and working rolls on the Quarto rolling system is the spalling of their surfaces due to the gradual accumulation of defects in contact volumes of a material. Nowadays to prevent such kind of degradation failures it is necessary to check out the stationary condition of the contact strength, which doesn’t answer to the question of the duration of the roll staying in the working state, i.e., its resource (lifetime). In the article a new physical-analytical model of the roll’s failure is suggested by the criterion of the surface layer fracture and the corresponding methodology of the expected resource calculation. The approach is based on the kinetic concept of damage of solid bodies, the energy (thermodynamic) condition of fracture of solid bodies and the fundamentals of reliability forecasting for technical objects. The feature of the suggested methodology is that the definition of the failure moment for the supporting or working rolls of the Quarto system derived from the condition of the current density of defects in surface layer of a material reaching the critical value, which is the function of the enthalpy of a material melting..
Friction Stir Welding of Dissimilar Materials with Reinforcement of Copper Particulates
Authors: Dhabale Rahul B. , Jatti Vijaykumar S. , Khedkar Nitin K. , Jatti Vinaykumar S.
Published: March 2023

In this study, the controlled input parameters namely welding speed and spindle speed were optimized by Taguchi method for reinforcement of copper particulates in aluminium alloy (AA6061-AA6063-T6). High carbon and high chromium steel i.e. tool steel D2 type material is used as a friction stir welding tool. Subsequently, the effects of the process parameters were investigated. The signal-to-noise ratios and analysis of variance were applied for statistical analysis. The outcome shows welding speed is the significant parameter than spindle speed. Under the optimum process parameters, 1400 rpm with 16 mm/min were shown best values such as 61.60 MPa for ultimate tensile strength and 91 hardness values. It means moderate spindle speed and lower welding speed develop higher heat. Subsequently, it is also shown that the feasibility of signal-to-noise ratio is responsible to improve welding quality after reinforcement.
Application of Taguchi’s Orthogonal Array and S/N Ratio on Surface Roughness Optimization
Authors: Rajbongshi Sanjib Kr
Published: March 2023

Surface finish plays an important role in making quality products in the manufacturing sector. A turning experiment is conducted by cutting tool of nose radii (1 mm and 0.65 mm) to find its influence on surface roughness. Eight experiments were performed with Taguchi’s Orthogonal Array (OA) technique. The prime objective was to investigate the tool nose radius effects in the prediction of the optimum value of surface roughness. Cutting speed (V), feed (F), depth of cut (D), and tool nose radius (NR) were selected for the experimental work having two levels each. To find out the influential parameters analysis of variance (ANOVA) was carried out. Signal to noise ratio and average performance graph was analyzed to obtain optimum response values. The results concluded that the large nose radius develops a superior finish in comparison to the smaller one.
The Ubiquitin Ligase Itch Skews Light Zone Selection in Germinal Centers
Authors: Renshaw Lindsay , Kim Peter , Crici Macaul , Fazelinia Hossein , Spruce Lynn , Oliver Paula , Moser Emily
Published: March 2023

Ig diversification occurs in peripheral lymphoid organs after establishment of central tolerance during B cell development. In germinal centers (GCs), somatic hypermutation of Ig genes occurs in dark zones, followed by selection of mutated clones in light zones (LZs). This generates high-affinity Ig receptors to pathogens but can also produce autoreactive Ig receptors, which are removed by selection mechanisms that are incompletely understood. The ubiquitin ligase Itch prevents the emergence of autoimmune disease and autoantibodies in humans and mice, and patients lacking Itch develop potentially fatal autoimmune diseases; yet, how Itch regulates GC B cells is not well understood. By studying Itch-deficient mice, we have recently shown that Itch directly limits the magnitude of GC responses. Proteomic profiling of GC B cells uncovered that Itch-deficient cells exhibit high mTORC1 and Myc activity, hallmarks of positive selection. Bone marrow chimera and adoptive transfer experiments revealed that B cell Itch restricts noncycling LZ cells. These results support, to our knowledge, a novel role for Itch in skewing selection of GC B cells to restrict LZ accumulation and shape GC-derived humoral immunity. Determining how B cells integrate cues within GCs to navigate through LZs and dark zones will aid in understanding how autoreactive clones emerge from GCs in people with autoimmune disease.
Evaluation of the Analgesic Effect of Oral Sucrose Solution on Neonates Undergoing a Minor Painful Procedure
Authors: Paul Kallol , Halder Pankaj Kumar , Das Rituparna , Choudhury Arpita , Goenka Prerna , Roy Sourav
Published: March 2023

Background:

Pacifying newborns by nonpharmacological methods during painful procedures is a frequent and difficult problem in routine practice.

Purpose:

The purpose of the study was to determine the analgesic effects of oral sucrose solution in comparison to placebo (sterile water) in neonates.

Materials and Methods:

A prospective, double-blinded study of 100 neonates who were divided into two groups after simple randomization, to give either 30% sucrose solution (group A) or sterile water (group B) during an intravenous catheterization. Assessment of pain by the Douleur Aigue Nouveau-ne scale (DAN) and changes in the heart rate (HR), respiratory rate (RR), or arterial oxygen saturation (SpO2) during peripheral vein catheterization were analyzed.

Results:

The mean change of HR, RR, and SpO2 was more in group B compared to group A. The mean DAN scores were 2.24 ± 2.026 and 6.92 ± 2.538 in group A and group B, respectively. None of these results were statistically significant (P > 0.05).

Conclusion:

There was a less prominent change in HR, RR, and SpO2 with response to noxious stimuli with oral sucrose administration in newborns when compared to placebo.
Introduction of the Jigsaw Technique of Cooperative Learning in Teaching Pathology to Medical Undergraduates
Authors: Pahwa Archna R. , Dudani Sharmila , Gangadharan Vandana , Gulati Rachna
Published: March 2023

Context:

Medical education.

Aims:

This study was an effort to sensitize students and faculty with an active learning technique known as jigsaw method and study its effectiveness and feasibility.

Settings and Design:

A prospective observational study was conducted for 2nd-year medical undergraduates in a 2 h long session.

Subjects and Methods:

Eighty out of 100 students of entry batch 2017 during the third semester in 2018 participated in this study with the supervision of five faculty members. The session was evaluated using prevalidated anonymous questionnaires filled by faculty and students.

Statistical Analysis Used:

Questionnaire used comprised nine questions for students and seven for faculty questionnaire to which the responses were to be marked on a 5-point Likert scale. The percentage of students/faculty with each response was calculated and analyzed.

Results:

More than 85% of the class agreed that jigsaw classroom guided them to take responsibility of their own learning and was helpful in developing their information-synthesizing skills. Almost the same percentage of students was interested in participating in a similar active learning technique in future as well.

Conclusions:

Student-centered learning approaches like jigsaw technique aim to develop learner autonomy and independence by putting responsibility for the learning path in the hands of the student. Such techniques promote learning and foster respect among students from diverse backgrounds.
COVID 19 Second Wave – What Has Changed Since the First Wave
Authors: Nazer Madiha Abdul , Ragunathan Latha , Bharathi P. , Deepika I.
Published: March 2023

A pandemic named SARS-COV2 COVID 19 affected many people's life in different ways globally. The normal life is still far away, lockdown rules have been relaxed in many countries. Morbidity and mortality increased a lot after the first wave. COVID-19 has affected medical education in a significant way. Most of the patients were asymptomatic during the second wave and some had symptoms such as myalgia, fever, and cough, which complicated to pneumonia, respiratory distress, and thromboembolic complications. There have been the development of many vaccines such as Covaxin, Pfizer–BioNTech, Covishield, Sputnik V, and Moderna, and these vaccinations have been given to frontline medical workers, people with comorbidities, aged people, etc., with high priority and then the general population. Many pregnant and peripartum women were put on Extracorporeal Membrane Oxygenation (ECMO) in severe to critical cases. A new black fungus was found in post-COVID 19 infections. It was named mucormycosis which usually affected immunocompromised people. There is a high importance in the examination of all the different epidemiological variables of all the places in all the regions across the world, to understand the mutations, and severity of the disease and also to be prepared. Many studies done on COVID-19 in first and the second wave was reviewed in detail and were compared for this review.
A Treatable Cause of Neuroregression
Authors: Mercy Accurate , Korula Sophy
Published: March 2023

We report the case of a 13-month-old girl with neuroregression over 3 months and encephalopathy at presentation. Marked skin hyperpigmentation and being exclusively breastfed gave the clue to B12 deficiency secondary to maternal B12 deficiency as the possible etiology which was confirmed on investigation. Upon treatment with parenteral B12 therapy she demonstrated dramatic improvement at follow-up. Nutritional B12 deficiency is an imminently treatable cause of neurocognitive dysfunction. Better awareness, healthy complementary feeding practices in infancy and perhaps maternal B12 supplementation can help prevent this disorder.
Hypertriglyceridemia Associated Acute Pancreatitis Post SARS COV-2 Infection
Authors: Vulpala Alekya , Nalla Smitha , Reddy Babul
Published: March 2023

Coronavirus disease-2019 (COVID-19) infection, caused by severe acute respiratory syndrome coronavirus 2, is primarily a respiratory illness. The sequelae have been observed affecting multiple organ systems, adding to the morbidity and mortality of the disease. It has also been shown to have adverse effects on lipid profile in some case studies. Acute pancreatitis (AP) post-COVID-19 infection has been described previously. Hypertriglyceridemia (HTG) is a well-described cause of AP. Here, we report patients presenting with post-COVID-19 infection with HTG causing AP.
Introduction of Interactive Teaching in Dermatology to Enhance Learning
Authors: Williams Abhilasha , Thomas Emy Abi , Bhatia Anuradha
Published: March 2023

Background:

Adopting interactive teaching in dermatology will encourage the students to acquire a deeper understanding of the subject, increase attention span and retention of knowledge, and enhance self-directed learning.

Aim and Objectives:

To introduce Quiz as an Interactive teaching tool in dermatology and assess the perception of the undergraduate students and faculty about using quizzes in dermatology.

Methodology:

This prospective study was conducted in the department of dermatology. Participants are the 2nd year MBBS students. After sensitizing the students and taking informed consent, quizzes were conducted on four topics, at appropriate time intervals using the “POLL EVERYWHERE” software. During the lecture, a quiz was conducted as follows: At the beginning of the lecture (a), after 20 min (b) and at the end of the lecture (c). At the end of the 4 interactive lectures, questionnaires were provided to the students and faculty to get feedback on their perception regarding the interactive teaching sessions. The responses of the feedback forms were graded using a 5-point Likert's scale.

Statistical Analysis:

The data were entered in Microsoft Excel and analyzed using SPSS (Statistical Packages for the Social Sciences, software version 21.o. Armonk, NY: IBM corp). Open-ended questions were analyzed by thematic qualitative analysis and expressed as percentages.

Results:

About 44.6% agreed that quizzes do make dermatology more interactive. Around 53% students agreed that interactive learning helps in better retention of knowledge. All faculty perceived that interactive learning is an appropriate motivator for the undergraduate students to do self-directed learning and that quiz is an effective tool.

Conclusions:

Interactive teaching learning methods such as quizzes will encourage the students in the better understanding of dermatology.
Effect of Injection Bleomycin on Lymphangioma Circumscriptum with Keloid Formation and Secondary Infection
Authors: Thomas Ann Willie , Thomas Emy Abi , Williams Abhilasha
Published: March 2023

Lymphangioma circumscriptum is a microcystic lymphatic malformation localized to an area of the skin, subcutaneous tissue, and muscle which presents with vesiculo-papules or warty lesions, resembling a “frog spawn.” Keloids develop due to the proliferation of dermal tissue following skin injury. We present a case of lymphangioma circumscriptum with secondary infection and keloid formation treated with intralesional bleomycin.
A Giant Posterior Mediastinal Goiter
Authors: Anto Ajin , Dwivedi Surjeet , Mohan Raj , Jha Rakesh
Published: March 2023

Goiter is defined as abnormal (either nodular or diffuse) growth of the thyroid gland. The normal thyroid gland is located in neck, caudal to larynx in anterolateral portion of the trachea. Intrathoracic goiter, defined as growth of more than 50% of the thyroid gland below the thoracic operculum, mostly located in anterior mediastinum and is seen in only 8%–15% of all goiters. Posterior mediastinal goiters (PMGs) are rare and accounts for only 2% of intrathoracic goiters. Patients usually present with a cervical mass and local pressure symptoms due to tracheal, esophageal, or superior vena cava compression. The diagnosis is established by chest X-ray, computed tomography scan, and fine-needle aspiration cytology. A combined cervicothoracic approach is the procedure of choice as it provides easy access, better visualization, and optimal control of blood vessels. We, hereby, describe a case of giant PMG, which was managed successfully at our center.
Sciatica masquerading parathyroid carcinoma
Authors: Nellaiappar P , Hussain Zahir , Parvathy N. Ananda , Venkatesh N. Susruta , Ramalingam A. Karthick
Published: March 2023

Primary hyperparathyroidism is detected in the Western world in an asymptomatic stage due to routine calcium screening. In India, patients are still diagnosed with various symptoms such as bone disease and renal disease and only 5.6% are in the asymptomatic stage. A 48-year-old female came with complaints of right hip pain of 1-month duration. She had low back pain a year ago radiating to both thighs. The pain was not suggestive of inflammatory arthritis, and the autoimmune profile was negative. The pain progressively worsened, and the patient became bedridden. General examination revealed left-sided neck swelling that moved with deglutition. Right lower-limb movement was restricted by severe pain. Magnetic resonance imaging of the lumbar spine revealed a diffuse altered signal intensity involving the entire spine, bilateral pelvis, and femur with hypointense on both T1 and T2 images suggestive of marrow infiltrative disorder. Her serum calcium was 12.7 mg/dl and serum phosphorus was 1.9 mg/dl. The patient's alkaline phosphatase was 2919 IU/L. Her parathyroid hormone level was 2095 pg/ml. The patient was diagnosed to have hyperparathyroidism. 99mTc-sestamibi parathyroid single-photon emission computed tomography–computed tomography was suggestive of left superior parathyroid adenoma. The surgical endocrinologist did a left superior parathyroidectomy. Postoperatively, she developed hypocalcemia. It was managed with intravenous calcium infusion, oral calcium, and oral calcitriol. Six weeks after surgery, the pain in the right hip decreased significantly, and she was able to walk without support. Histopathological examination of the removed parathyroid was suggestive of parathyroid carcinoma.

The following core competencies are addressed in this article:

Practice-based learning and improvement, Medical knowledge.
The effect of social media addiction on burnout among health-care students and professionals in Saudi Arabia
Authors: Badri Hatim Matooq , Aboalshamat Khalid Talal , Abdouh Ismail Mahmoud , Quronfulah Baraa Sami , Mahmoud Mahmoud Abdulrahman , Rajeh Mona Talal , Badawoud Amal Mohammad , Alzhrani Abdullah Muhammad
Published: March 2023

Introduction:

The rapid growth of information technology and the widespread use of smartphones has created the perfect environment for social media addiction, a condition that affects all members of society, including health-care students and professionals. Current evidence suggests that the direct and indirect effects of social media addiction on human health could include, among other things, burnout. This study aimed to investigate the possible relationship between social media addiction and burnout among health-care students and professionals in Saudi Arabia.

Materials and Methods:

A cross-sectional study design was used with an online questionnaire distributed to health-care students and professionals via social media platforms. A convenience sampling method was used to collect the data. The questionnaire consisted of three sections measuring demographic variables, social media addiction, and burnout.

Results:

The 789 participants who completed the questionnaire had a mean age of 25.77 years (± 8.26) and came from 22 cities in Saudi Arabia. Students had significantly higher scores for social media addiction than interns/residents (P = 0.018) or specialists/consultants (P < 0.001). Participants were found to experience different levels of burnout, reporting no/mild burnout (34.98%), moderate burnout (35.49%), high levels of burnout (23.83%), and severe burnout (5.7%). A significant direct relationship between social media addiction and burnout was found (F [1,787] = 91.877, P < 0.001, R
2 = 0.105).

Conclusion:

The findings provide insight into the prevalence of social media addiction and burnout among health-care students and professionals and the possible association between two variables. There is a need for further research comparing the correlation between social media addiction and burnout in different groups (i.e., students, interns/residents, and specialists/consultants), as well as identifying factors that affect social media addiction and burnout among these groups.

The following core competencies are addressed in this article:

Medical knowledge, Interpersonal and communication skills, and Professionalism.
The Status of Insulin Access in Middle East-North Africa Region
Authors: Odhaib Samih Abed , Masood Shabeen Naz , Shegem Nadima , Khalifa Suha Falah , Abi Saad Michele , Eltom Mohamed , Belkhadir Jamal , Sandid Mohammad , Iraqi Hinde , Sedaghat Sara , Abdul-Kareem Hazim , Ali Mansour Abbas , Kamel Mesbah Sayed , Bilal Ahmed
Published: March 2023

Background and Objective:

The current situation in the Middle East-North Africa (MENA) region makes it very difficult for many countries to have an effective policy to ensure the availability and affordability of different insulin types for many individuals with diabetes mellitus in any individual country. This article comprehensively reviews the possible barriers to insulin access in countries of this region and provides some solutions to mitigate these barriers.

Materials and Methods:

The framework for understanding the life-cycle of medicines of the World Health Organization (WHO) was adopted for this review with country-specific modifications. PubMed was used as an initial search builder using the country name and insulin as query terms in (title/abstract) for articles written in (English and French) which dealt with humans only between (2000–2022). Out of (578) published articles, only (42) articles were relevant and dealt with insulin access. Additional search through references of these articles and the websites of international health organizations added additional (32) references to have (79) references for the review.

Review (Results):

The countries in the MENA are lagging in the (Research, Development, and Innovation) and production of insulin and insulin delivery systems. There are some attempts by some countries to develop their national plan with the help of some big insulin manufacturers, with a suboptimal outcome. The local insulin production in some countries did not reach full national coverage. The difficult regional economic and political situations in many countries in the MENA imposed negatively on their citizens’ insulin access, availability, affordability, cost, and insurance plans.

Conclusions:

There is a suboptimal level of insulin access for individuals with diabetes in the MENA countries, especially in the low-resourced countries. There is an urgent need to adopt country-specific healthcare policies to ensure uninterrupted insulin access and improved availability, with a lower affordable cost for individuals with diabetes from the public and private sectors.
Serum Human Placental Lactogen and Prolactin May Not Be Associated with Aberrant Glucose Homeostasis in GDM
Authors: Alam Mohammad Fakhrul , Jahan Sharmin , Hasan Mashfiqul , Sultana Nusrat , Hossain Mahmudul , Uddin Mohammad Farid , Hasanat Muhammad Abul
Published: March 2023

Background:

Gestational diabetes mellitus (GDM) shows insufficient β-cell compensation for insulin resistance (IR) during late pregnancy, whereupon derangements of human placental lactogen (hPL) and prolactin (PRL) have a presumed role in its pathogenesis.

Aims:

To assess the relationship of serum hPL and PRL with IR and β-cell function in GDM and pregnant women with normal glucose tolerance (NGT).

Materials and Methods:

This cross-sectional study was performed with 40 women with GDM and an equal number of pregnant women with NGT who were diagnosed on the basis of the WHO 2013 criteria during 24–40 weeks of gestation. hPL was measured by an enzyme-linked immunosorbent assay (ELISA); PRL and fasting insulin were measured by a chemiluminescent immunoassay. Equations of homeostatic model assessment (HOMA) were used to calculate the indices of IR (HOMA-IR) and β-cell function (HOMA-B).

Results:

No statistically significant difference was found between the GDM and NGT groups in circulating concentrations of either hPL (6.01 ± 1.76 vs. 5.92 ± 2.10 mg/L, mean ± SD; P = 0.852) or PR [180.27 (125.95–306.20) vs. 166.87 (134.24–284.70) ng/mL, median (IQR); P = 0.704]. There was no relationship of circulatory levels of hPL and PRL with glucose values at different time points during oral glucose tolerance test as well as with AUCglucose (P = NS for all). On multiple regression analysis, neither hPL nor PRL emerged as a significant predictor for fasting insulin, HOMA-IR, and HOMA-B in GDM (P = NS for all).

Conclusions:

Circulating concentration of hPL and PRL may not be a potential determinant of IR and β-cell dysfunction in GDM.
Relationship between Serum Sialic Acid Concentration and Diabetic Nephropathy in Egyptian Patients with Type 2 Diabetes Mellitus
Authors: El Badawy Ayman M. , Mansour Ahmed E. , Elsayed Marwa S. , Abdelmoniem Rasha O.
Published: March 2023

Aim:

Diabetic nephropathy is a major microvascular complication of diabetes mellitus (DM), and it is the most common cause of end-stage renal disease worldwide. Sialic acid is considered as an acute-phase reactant. Serum sialic acid level was found to be increased in diabetic nephropathy patients. We aimed to measure the serum sialic acid concentration in patients with type 2 DM and to assess if it could be used as an early marker of diabetic nephropathy.

Subjects and Methods:

This was a cross-sectional study that was carried out on 40 patients subdivided into 3 groups, first group involved 25 patients with diabetic nephropathy, second group involved 15 patients without diabetic nephropathy and the third group involved 10 patients serving as control group. All patients were selected from those attending the outpatient diabetic clinic at Benha University Hospital between July 2017 and July 2018. Mean and standard deviation (±SD) were used for quantitative data, and t test, Fisher extract test, and regression analysis were used for statistical analysis. A P value <0.05 was considered statistically significant, whereas >0.05 statistically insignificant.

Results:

On comparing patients with diabetic nephropathy with the control group patients we found that serum sialic level is increased and this was statistically significant and also in diabetic patients with nephropathy when compared to diabetic patients without nephropathy. The age of the onset of the discovery of diabetes and the duration of diabetes had no impact on serum sialic acid level.

Conclusion:

This study showed that serum sialic acid level is significantly increased in patients with diabetic nephropathy, and it is positively correlated with the glycemic control parameters and negatively correlated with estimated glomerular filtration rate, and it could be used as an early predictor of albuminuria and decrease of creatinine clearance.
Real-World Evidence of Generic Dapagliflozin
Authors: Sethi Bipin K. , Kalra Sanjay , Bhattacharya Supratik , Kumar Anand , Rai Madhukar , Srivastava Manoj Kumar , A Srinath , Budhwar Ajay , Jain Savita , Rastogi Harish Mohan , Gandhi Pramod , Kumar G. Vijay , Georje Joe , Abhyankar Mahesh V. , Prasad Ashish , Sarda Prashant
Published: March 2023

Objective:

The objective was to evaluate the clinical experience and treatment patterns of generic dapagliflozin usage in different patient profiles in Indian settings.

Materials and Methods:

A retrospective, multicentric, real-world study included patients with type 2 diabetes mellitus (T2DM) (aged >18 years), inadequately controlled by existing antidiabetic therapy and receiving generic dapagliflozin as an add-on to existing oral antidiabetic drug(s) with or without insulin or switch therapy. Baseline characteristics and treatment-related outcomes were retrieved from the medical records and analyzed.

Results:

A total of 1935 patients were included, of which 1279 (66.1%) were males. The mean age was 57.4 years, and around half of the patients (51.4%) were aged from 45 to 60 years. Hypertension (55.9%) and dyslipidemia (19.8%) were the common comorbidities. The majority (n = 1122; 60%) of patients received dapagliflozin in combination with one or two antihyperglycemic drugs. More than half of the patients received metformin (56.8%) or sulfonylurea (52.3%) in combination with dapagliflozin. A dose of 10 mg (93.4%) was the most commonly used dose of dapagliflozin. The mean levels of glycated hemoglobin, fasting plasma glucose, and postprandial plasma glucose were significantly reduced to 1.1% (1.0–1.1), 30.5 mg/dL (29.2–31.9), and 57.5 mg/dL (55.1–59.9), respectively, after the initiation of dapagliflozin. A total of 1935 patients experienced weight changes during the treatment, of which 90.5% of patients showed weight loss. Hypoglycemic events were reported in 12.5% of patients. Physician global evaluation of efficacy and tolerability showed a majority of patients on a good-to-excellent scale (97.3% and 97.1%).

Conclusion:

Generic dapagliflozin showed a significant improvement in glycemic parameters and reduced body weight with low hypoglycemic events. The administration of dapagliflozin provided a good-to-excellent efficacy and tolerability profile in patients with T2DM. To the best of our knowledge, this is the first study confirming the efficacy, safety, and usefulness of generic dapagliflozin in patients with T2DM.
A Challenge to Achieve Glycemic Control in a Patient with Diabetes Mellitus
Authors: Batra Nisha , Kant Ravi , Sethi Prativa
Published: March 2023

Secondary diabetes mellitus (DM) is a known identity with multiple causes. Acromegaly, a state of growth hormone (GH) excess, is a rare but an established cause of DM. Dysglycemia is present in approximately 50% of patients of acromegaly with impaired glucose tolerance (IGT) or impaired fasting glucose (IFG) ranging from 6% to 45% and from 7% to 22%, respectively, and DM has been reported in 16%–56% of patients (Alexopoulou O, Bex M, Kamenicky P, Mvoula AB, Chanson P, Maiter D. Prevalence and risk factors of IGT and DM at diagnosis of acromegaly: A study in 148 patients. Pituitary 2014;17:81-9; Dal J, Feldt-Rasmussen U, Andersen M, Kristensen LØ, Laurberg P, Pedersen L, et al. Acromegaly incidence, prevalence, complications and long-term prognosis: A nationwide cohort study. Eur J Endocrinol 2016;175:181-90). Diabetes in these patients is usually severe and difficult to treat. Glycemic control in these patients is best achieved by treating the underlying GH excess. We report a 60-year-old female patient, case of somatotropinoma, who was referred to diabetic clinic in view of persistent hyperglycemia despite taking multiple antidiabetic medications along with high-dose basal-bolus insulin regimen. Patient had residual pituitary tumor with GH excess and clinically active disease. She was started with somatostatin analogs for the residual disease. Her blood sugar values improved dramatically with episodes of hypoglycemia in between. Patient was shifted to single oral hypoglycemic (OHA) along with low dose insulin. This case highlights the direct association between GH excess and its hyperglycemic effects. Following successful treatment of acromegaly with surgery, irradiation, or medical management, glucose tolerance improves; although complete resolution is rare, OHA/insulin requirement is dramatically reduced.