bluuebunny/crossref_metadata_2025 huggingface dataset:
Performance of three rapid diagnostic tests for the detection of Cryptosporidium spp. and Giardia duodenalis in children with severe acute malnutrition and diarrhoea
Authors: Bitilinyu-Bangoh Joseph , Voskuijl Wieger , Thitiri Johnstone , Menting Sandra , Verhaar Nienke , Mwalekwa Laura , de Jong Daisy B. , van Loenen Merlin , Mens Petra F. , Berkley James A. , Bandsma Robert H. J. , Schallig Henk D. F. H.
Published: November 2019

Background

There is significant need for accurate diagnostic tools for Cryptosporidium spp. and Giardia duodenalis infections in resource limited countries where diarrhoeal disease caused by these parasites is often prevalent. The present study assessed the diagnostic performance of three commercially available rapid diagnostic tests (RDTs) based on faecal-antigen detection for Cryptosporidium spp. and/or G. duodenalis infections in stool samples of children admitted with severe acute malnutrition (SAM) and diarrhoea. An established multiplex PCR was used as reference test.

Methods

Stool samples from children with SAM and diarrhoea enrolled in a randomized controlled trial (registered at clinicaltrials.gov/ct2/show/NCT02246296) in Malawi (n = 175) and Kenya (n = 120) between December 2014 and December 2015 were analysed by a multiplex PCR for the presence of Cryptosporidium spp., G. duodenalis or Entamoeba histolytica parasite DNA. Cryptosporidium-positive samples were species typed using restriction fragment length polymorphism analysis. A sub-sample of the stool specimens (n = 236) was used for testing with three different RDTs. Diagnostic accuracy of the tests under evaluation was assessed using the results of PCR as reference standard using MedCalc software. Pearson Chi-square test and Fisher’s exact test were used to determine (significant) difference between the number of cryptosporidiosis or giardiasis cases found by PCR in Malawi and Kenya. The overall diagnostic accuracy of each RDT was calculated by plotting a receiver operating characteristic (ROC) curve for each test and to determine the area under the curve (AUC) using SPSS8 software.

Results

Prevalence of Cryptosporidium spp. by PCR was 20.0 and 21.7% in Malawi and Kenya respectively, mostly C. hominis. G. duodenalis prevalence was 23.4 and 5.8% in Malawi and Kenya respectively. E. histolytica was not detected by PCR. RDT testing followed the same pattern of prevalence. RDT sensitivities ranged for cryptosporidiosis from 42.9 to 76.9% and for G. duodenalis from 48.2 to 85.7%. RDT specificities ranged from 88.4 to 100% for Cryptosporidium spp. and from 91.2 to 99.2% for G. duodenalis infections. Based on the estimated area under the curve (AUC) values, all tests under evaluation had an acceptable overall diagnostic accuracy (> 0.7), with the exception of one RDT for Cryptosporidium spp. in Malawi.

Conclusions

All three RDTs for Cryptosporidium spp. and Giardia duodenalis evaluated in this study have a moderate sensitivity, but sufficient specificity. The main value of the RDTs is within their rapidness and their usefulness as screening assays in surveys for diarrhoea.
Significant artefactual noise in 90Y TOF-PET imaging of low specific activity phantoms arises despite increased acquisition time
Authors: Hesse Michel , Walrand Stephan
Published: November 2019

Volumes of usual PET phantoms are about four to sixfold that of a human liver. In order to avoid count rate saturation and handling of very high 90Y activity, reported TOF-PET phantom studies are performed using specific activities lower than those observed in liver radioembolization.

However, due to the constant random coincidence rate induced by the natural crystal radioactivity, reduction of 90Y specific activity in TOF-PET imaging cannot be counterbalanced by increasing the acquisition time. As a result, most 90Y phantom studies reported images noisier than those obtained in whole-body 18F-FDG, and thus advised to use dedicated noise control in TOF-PET imaging post 90Y liver radioembolization.

We performed acquisitions of the Jaszczak Deluxe phantom in which the hot rod insert was only partially filled with 2.6 GBq of 90Y. Standard reconstruction parameters recommended by the manufacturer for whole-body 18F-FDG PET were used.

Low specific activity setups, although exactly compensated by increasing the acquisition time in order to get the same number of detected true coincidences per millilitre, were impacted by significant noise. On the other hand, specific activity and acquisition time setup similar to that used in post 90Y liver radioembolization provided image quality very close to that of whole-body 18F-FDG.

This result clearly discards the use of low specific activity phantoms intended to TOF-PET reconstruction parameter optimization. Volume reduction of large phantoms can be achieved by vertically setting the phantoms or by adding Styrofoam inserts.
Interaction between arbuscular mycorrhizal fungi and Bacillus spp. in soil enhancing growth of crop plants
Authors: Nanjundappa Anuroopa , Bagyaraj Davis Joseph , Saxena Anil Kumar , Kumar Murugan , Chakdar Hillol
Published: November 2019

Soil microorganisms play an important role in enhancing soil fertility and plant health. Arbuscular mycorrhizal fungi and plant growth promoting rhizobacteria form a key component of the soil microbial population. Arbuscular mycorrhizal fungi form symbiotic association with most of the cultivated crop plants and they help plants in phosphorus nutrition and protecting them against biotic and abiotic stresses. Many species of Bacillus occurring in soil are also known to promote plant growth through phosphate solubilization, phytohormone production and protection against biotic and abiotic stresses. Synergistic interaction between AMF and Bacillus spp. in promoting plant growth compared to single inoculation with either of them has been reported. This is because of enhanced nutrient uptake, protection against plant pathogens and alleviation of abiotic stresses (water, salinity and heavy metal) through dual inoculation compared to inoculation with either AMF or Bacillus alone.
Mental Health In Elite Athletes: Increased Awareness Requires An Early Intervention Framework to Respond to Athlete Needs
Authors: Purcell Rosemary , Gwyther Kate , Rice Simon M.
Published: November 2019

Abstract

The current ‘state of play’ in supporting elite athlete mental health and wellbeing has centred mostly on building mental health literacy or awareness of the signs of mental ill-health amongst athletes. Such awareness is necessary, but not sufficient to address the varied mental health needs of elite athletes. We call for a new model of intervention and outline the backbone of a comprehensive mental health framework to promote athlete mental health and wellbeing, and respond to the needs of athletes who are at-risk of developing, or already experiencing mental health symptoms or disorders. Early detection of, and intervention for, mental health symptoms is essential in the elite sporting context. Such approaches help build cultures that acknowledge that an athlete’s mental health needs are as important as their physical health needs, and that both are likely to contribute to optimising the athlete’s overall wellbeing in conjunction with performance excellence. The proposed framework aims at (i) helping athletes develop a range of self-management skills that they can utilise to manage psychological distress, (ii) equipping key stakeholders in the elite sporting environment (such as coaches, sports medicine and high-performance support staff) to better recognise and respond to concerns regarding an athlete’s mental health and (iii) highlighting the need for specialist multi-disciplinary teams or skilled mental health professionals to manage athletes with severe or complex mental disorders. Combined, these components ensure that elite athletes receive the intervention and support that they need at the right time, in the right place, with the right person.
Use of Photovoice to engage stakeholders in planning for patient-centered outcomes research
Authors: Nault Connors Jill D. , Conley Marshall J. , Lorenz Laura S.
Published: November 2019

Background

Research is needed to inform patient and provider decisions about how to best care for patients who go to the emergency department with complaints of chest pain when their symptoms are due to anxiety rather than a heart problem. However, this research may not be a high priority due, in part, to a lack of awareness for the severity of anxiety symptoms and the impact of anxiety on peoples’ daily lives. In this commentary article, we highlight the use of Photovoice as a unique method to share patients’ lived experience of anxiety with providers, researchers, and health system leaders.

Main text

A brief background on Photovoice methods, the process of patient partner involvement in Photovoice, and the project’s Photovoice results (posters, photos and captions) is presented.

Conclusion

Photovoice achieved its intended effects of increasing awareness of all stakeholders about the burden of anxiety in patients’ lives and the imperative of improving emergency department care for anxiety. This resulted in increased participation in a multi-stakeholder research partnership, critical health system support that included costs to the health system associated with implementing interventions to be tested, and submission of a patient-centered outcomes research proposal that is currently under review. In addition, Photovoice had positive benefits for participants including a therapeutic effect, may have increased group cohesion, and empowerment of patients as partners in the research process.
A case of amniotic fluid embolism successfully treated by multidisciplinary treatment
Authors: Kinishi Yuki , Ootaki Chiyo , Iritakenishi Takeshi , Fujino Yuji
Published: November 2019

Background

Amniotic fluid embolism (AFE) is a life-threatening obstetric emergency. Because the maternal mortality associated with AFE is very high, early recognition and prompt treatment are important for improving the prognosis. We report a case of amniotic fluid embolism successfully treated by multidisciplinary treatment.

Case presentation

A 39-year-old woman with fetal congenital heart anomaly and polyhydramnios was scheduled for induction of delivery at 37 weeks of gestation with labor epidural analgesia. Uncontrollable bleeding occurred 30 min after vaginal delivery. Based on the clinical diagnosis of AFE, massive blood transfusion, insertion of an aortic occlusion balloon catheter, and hysterectomy was performed. Total blood loss was 12,000 mL. The diagnosis of AFE was confirmed by pathological examination. She was discharged with no complications.

Conclusion

We report a case of AFE who were rescued by prompt diagnosis and treatment.
Predictive value of C-reactive protein and carotid intimal medial thickness in acute ischemic stroke
Authors: Elbelkimy Mahmoud , ELkhayat Naglaa , ElSadek Ahmed , Mansour Alia , Aboutaleb Mariam
Published: November 2019

Background

Elevated CRP and increased CCA-IMT are both associated with the occurrence of stroke. CRP and IMT are closely associated; the higher the CRP, the greater the carotid atherosclerosis as measured by carotid IMT.

Objectives

To study the relationship between elevated C-reactive protein as a blood biomarker and increased intimal media thickness of carotid artery, and its relation to infarct size and its impact on prognosis.

Materials and methods

This study is an analytical observational study, in which 73 patients who have recently suffered first-ever acute ischemic stroke in the anterior circulation within 72 h were recruited. Only 64 of them were able to continue the study with follow-up during the 1 month and 3 months durations. Magnetic resonance imaging for the brain was done and the infarct volume was measured. All patients had quantitative Serum CRP level within 72 h from stroke onset and carotid duplex with assessment of carotid intimal media thickness (IMT).

Results

The results showed there is a significant positive correlation between highly sensitive C-reactive protein (hs-CRP) and MRS after 1 month yet no significant correlation was found between hs-CRP and IMT.

Conclusion

Highly sensitive C-reactive protein (hs-CRP) could serve as prognostic blood biomarker in long-term follow-up of stroke patients. Non-significant correlation was found in our study between increased hs-CRP and increased intima-media thickness (CCA-IMT).
Biochar application and no-tillage practices to minimize the residues of herbicides in the seeding hole
Authors: Singha Ashutus , Rahaman Md. Arifur , Jiku Md. Abu Sayem , Faruquee Muhiuddin , Alam Md. Ashraful , Sinha Shata Rupa
Published: November 2019

Background

No-tillage is considered as a promising alternative for conventional farming by saving energy input and time, reducing groundwater pollution, and counteracting soil erosion and losses of soil-organic matter. Therefore, this study was carried out in north-eastern Sylhet of Bangladesh during the period of 2015–2016 to evaluate the multiple techniques of implementation in order to find a practically appropriate way to apply biochar.

Results

In this study, successfully applied of biochar and glyphosate in holes with seeds and consisted of one control (pure soil), glyphosate control, biochar control, and four glyphosate treatments with 1, 2.5, 5, and 10% biochar addition. The Gly + ch1% and Gly + ch2.5% treatments demonstrated a better emergence rate than all treatments, and at the end of the emergence, they reached more than 95%. There was no important distinction found among all the treatments in the event of shooting fresh and dry biomass. Biochar amendment treatments did not show any influence on shoot fresh biomass compared to glyphosate control and biochar 5% treatment, respectively. Gly + ch2.5% treatment showed slightly better performance than all the other treatments. The similar performance was shown in case of shoot dry weight. In case of root fresh weight, there was only a significant different observed between Gly + ch1% and Gly + ch10%. However, Gly + ch1% treatment revealed slightly higher root fresh weight compared to all the other treatments. Considering the results of the germination percentage and root morphology, it could be suggested that lower rate of biochar application showed better performance on root length and development.

Conclusions

It could be concluded that glyphosate application has mitigation effect to absorb herbicidal residues. For successful introduction of biochar application in agriculture, field acts as a huge amount of carbon sink and has also a positive effect to mitigate climate change.
Epidemiological, clinical and immune factors that influence the persistence of antiphospholipid antibodies in leprosy
Authors: Ribeiro Sandra Lúcia Euzébio , Pereira Helena Lúcia Alves , Boechat Antonio Luiz , Silva Neusa Pereira , Sato Emilia Ionue , das Graças Souza Cunha Maria , de Souza Passos Luiz Fernando , Dos-Santos Maria Cristina
Published: November 2019

Introduction

Antiphospholipid antibodies (aPL) are described in individuals with leprosy without the clinical features of antiphospholipid antibody syndrome (APS), a condition involving thromboembolic phenomena. We have described the persistence of these antibodies for over 5 years in patients with leprosy after specific treatment.

Objectives

To determine whether epidemiological, clinical and immunological factors played a role in the long-term persistence of aPL antibodies in leprosy patients after multidrug therapy (MDT) had finished.

Methods

The study sample consisted of 38 patients with a diagnosis of leprosy being followed up at the Dermatology and Venereology Outpatient Department at the Alfredo da Matta Foundation (FUAM) in Manaus, AM. ELISA was used to detect anticardiolipin (aCL) and anti-β2 glycoprotein I (anti-β2GPI) antibodies. Patients were reassessed on average of 5 years after specific treatment for the disease (MDT) had been completed.

Results

Persistence of aPL antibodies among the 38 leprosy patients was 84% (32/38), and all had the IgM isotype. Mean age was 48.1 ± 15.9 years, and 23 (72.0%) were male. The lepromatous form (LL) of leprosy was the most common (n = 16, 50%). Reactional episodes were observed in three patients (9.4%). Eighteen (47.37%) were still taking medication (prednisone and/or thalidomide). Mean IgM levels were 64 U/mL for aCL and 62 U/mL for anti-β2GPI. In the multivariate binary logistic regression the following variables showed a significant association: age (p = 0.045, OR = 0.91 and CI 95% 0.82–0.98), LL clinical presention (p = 0.034; OR = 0.02 and CI 95% = 0.0–0.76) and bacterial index (p = 0.044; OR = 2.74 and CI 95% = 1.03–7.33). We did not find association between prednisone or thalidomide doses and positivity for aPL (p = 0.504 and p = 0.670, respectively). No differences in the variables vascular thrombosis, pregnancy morbidity, diabetes, smoking and alcoholism were found between aPL-positive and aPL-negative patients.

Conclusion

Persistence of positivity for aPL antibodies was influenced by age, clinical presentation and bacterial index. However, further studies are needed to elucidate the reason for this persistence, the role played by aPL antibodies in the disease and the B cell lineages responsible for generation of these antibodies.
Learning progressions: framing and designing coherent sequences for STEM education
Authors: Duschl Richard A.
Published: November 2019

The coupled influences of scholarship in the fields of Psychology, Philosophy, and Pedagogy beginning in the 1950s, set in motion the emergence of new images, methodological perspectives, theories, and design principles about learners and learning. Advances in cognitive and sociocultural psychology, shifting images of the nature of science, recognition of the importance of disciplinary discourse practices in learning, the scaffolding of learning by tools and technologies, along with the adoption of ‘assessment for learning’ instructional strategies are among the factors that have led researchers and practitioners to advance positions that learning ought to be coordinated and sequenced along conceptual trajectories, developmental corridors, and learning progressions (LP). Following opening Introduction and LP Research Framework sections that provide an overview of the runup to LP research and development, I then turn to future research discussions and implications targeting five LP domains:Using Knowledge with Scientific Practices; Instructional Pathways – Early Childhood Learning; Teaching Experiments – Science and Mathematics; Upper/Lower Anchors for Measuring Progress; and Concepts & Practices. The Conclusion section points to overarching challenges for researchers, planners, and teachers in STEM education. There is much to learn for all!
Argumentation and interdisciplinarity: reflections from the Oxford Argumentation in Religion and Science Project
Authors: Erduran Sibel , Guilfoyle Liam , Park Wonyong , Chan Jessica , Fancourt Nigel
Published: November 2019

Argumentation has emerged as a key area of research and development in science education in recent years. Simply defined, argumentation is about the justification of knowledge claims with evidence and reasons. Although there is now a vast amount of work in argumentation, much research remains to be pursued. Given the interdisciplinary nature of argumentation, the dialogue between science education and other relevant domains can potentially produce constructive research agendas that could profit argumentation research and lead to practical applications. Following an overview of the relevant interdisciplinary investigations that can be pursued in science education, the paper subsequently focuses on the interphase of science and religion. Although science education research has witnessed considerable debate about particular issues related to science and religion such as the teaching and learning of evolution and creationism, the role of argumentation remains an uncharted territory. Hence, the paper focuses on how argumentation may be explored in science and religious education in comparison. Some preliminary observations from theOxford Argumentation in Religion and Science(OARS) Project are reported including a comparative analysis of curricula and teachers’ views. Implications for interdisciplinarity in the context of argumentation in science education are discussed.
Physics education research for 21st century learning
Authors: Bao Lei , Koenig Kathleen
Published: November 2019

Education goals have evolved to emphasize student acquisition of the knowledge and attributes necessary to successfully contribute to the workforce and global economy of the twenty-first Century. The new education standards emphasize higher end skills including reasoning, creativity, and open problem solving. Although there is substantial research evidence and consensus around identifying essential twenty-first Century skills, there is a lack of research that focuses on how the related subskills interact and develop over time. This paper provides a brief review of physics education research as a means for providing a context towards future work in promoting deep learning and fostering abilities in high-end reasoning. Through a synthesis of the literature around twenty-first Century skills and physics education, a set of concretely defined education and research goals are suggested for future research, along with how these may impact the next generation physics courses and how physics should be taught in the future.
Promoting deep learning through project-based learning: a design problem
Authors: Miller Emily C. , Krajcik Joseph S.
Published: November 2019

In this paper, we present a design solution that involves the bringing together of Project-based Learning (PBL) with the theory of usable knowledge (Pellegrino & Hilton, Developing transferable knowledge and skills in the 21st century, 2012). Usable knowledge is the ability to use ideas to solve problems and explain phenomena, an approach to science learning put forth by the Framework for K-12 Science Education (National Research Council (NRC), A framework for K–12 science education: Practices, crosscutting concepts, and core ideas, 2012) to optimize science learning environments. We offer a process for designing a curricular system that enhances how students learn science as a progression toward sophisticated practice of usable knowledge by focusing on coherence, depth, and motivation. We saw the potential of these distinct approaches for informing one another, and we extrapolate on 4 years of research that involves the process of iterating on our curricular design to best integrate the two approaches to support student learning.
Reimagining public science education: the role of lifelong free-choice learning
Authors: Falk John H. , Dierking Lynn D.
Published: November 2019

Profound changes are occurring in society, disrupting current systems and institutions; these disruptions also are affecting science education practice and research. Science learning is becoming a lifelong, self-directed process, dominated by out-of-school, free-choice learning experiences. By necessity these disruptions in the science learning narrative necessitate that societies rethink what constitutes public science education in the twenty-first century. Rather than focusing only on schooling and university/post-secondary training, public science education should include meeting the lifelong science learning needs of all people, at all stages of life, wherever a person is, whenever she faces a learning need. In this context, public science education must be learner-centered and equitable, serving the real lifelong needs, realities and motivations of all people, not just those of children and youth or the most privileged. Such a comprehensive approach to public science education does not currently exist. The key to enacting such a comprehensive approach requires thinking outside of the current educational box, moving beyond Industrial-Age top-down, one-size-fits-all command and control approaches that center on schooling and higher education. A reimagined approach to public science education would embrace more distributed, synergistic, personalized, just-in-time approaches that emphasize and reward lifelong learning, including learning beyond school. This article discusses the scope and scale of free-choice public science learning across a range of informal contexts – museums, zoos and aquariums; broadcast media such as television and radio; hobby groups; electronic media such as social networks, educational games, podcasts and the Internet. In addition, the paper considers the challenges faced by both practitioners and researchers attempting to promote and reform science education in more systemic and comprehensive ways. As the what, where, when, how and with whom of science learning continues to evolve, new educational practices and research approaches will be required; approaches that place the individual and her lifelong, free-choice learning at the center, rather than the periphery of the public’s lifelong science education.
Detection of some metabolic disorders in suspected neonates admitted at Assiut University Children Hospital
Authors: Khalaf Shaimaa Mohamed , El-Tellawy Mohamed Mahrous , Refat Nafisa Hassan , El-Aal Amal Mohammed Abd
Published: November 2019

Background

Inborn errors of metabolism are genetically inherited diseases which can lead to accumulation of toxic metabolites in the body. Inborn errors of metabolism have a high morbidity and mortality in neonates. Many inborn errors of metabolism are amenable to treatment with early diagnoses. Till now, more than 500 metabolic disorders have been detected. Although individual metabolic disorders are rare, the incidence of overall metabolic disorders is high.

Results

It was found that 70/200 cases (35 %) had confirmed inborn errors of metabolism, and another 8 cases (4%) suspected to have inborn errors of metabolism; 15/200 (7.5%) cases had mild elevation of phenylalanine level, while 107/200 (53.5%) had another diagnosis rather than metabolic disorders. Urea cycle defect was diagnosed in 20/70 (28.5%), maple syrup urine disease in 18/70 (25.7%), organic acidemia in 15/70 (21.4%), and non-ketotic hyperglycinemia in 1/70 (1.4 %) case. Also, 15/70 (21.4 %) cases had fatty acid oxidation defect. Lastly, one female case (1.4 %) was diagnosed to have disorder of pyrimidine deficiency.

Conclusion

Diagnosis of inborn errors of metabolism was confirmed in 35% of neonates, and 4% was suspected to have metabolic disorders. These results showed that inherited metabolic disorders are not rare. The development of a nationwide screening program for metabolic disorders is mandatory for early detection of these potentially treatable disorders.
In vitro application of Ceratonia siliqua improved sperm parameters and chromatin quality after vitrifacation in normozoospermic aged men
Authors: Faramarzi Azita , Aghaz Farank , Bakhtiari Mitra , Khazaei Mozafar
Published: November 2019

Background

Vitrification is the main technique in the assisted reproductive technique (ART) labs. Sperm vitrification exposes sperm to damage. The aim of the present study was to evaluate the in vitro effect of Ceratonia siliqua (C. siliqua) application on sperm parameters and chromatin quality in normozoospermic aged men. Semen samples (n = 40) were collected from normozoospermic men over 45 years old. Each specimen was divided into four aliquots to form the subsequent groups: fresh (group I), vitrification without treatment (group II), vitrification with the medium supplemented by 20 μg/ml C. siliqua (group III), and vitrification with the thawing medium supplemented by 20 μg/ml C. siliqua (group IV). Sperm progressive motility, normal morphology and viability were assessed. Also, sperm chromatin quality was evaluated by aniline blue (AB), toluidine blue (TB), and sperm chromatin dispersion (SCD) staining.

Results

Vitrification caused a significant decrease in sperm progressive motility, normal morphology and viability as well as chromatin quality compared to fresh samples (p < 0.05). Supplementation of vitrification/thawing medium with C. siliqua significantly improved sperm progressive motility, normal morphology, viability, and chromatin quality compared to vitrification without any supplementation (p < 0.05).

Conclusions

The study showed that C. siliqua can improve the detrimental effect of vitrification on sperm parameters and chromatin quality of normozoospermic aged men.
The diagnostic efficacy of Gynecology Imaging Reporting and Data System (GI-RADS): single-center prospective cross-sectional study
Authors: Khalaf Lamiaa M. R. , Desoky Hagar H. M. , Seifeldein Gehan S. , El-Sharkawy Mostafa , Sayed Mona M. , Ahmed Shimaa , Rezk Khalid , Hussien Marwa T.
Published: November 2019

Background

To assess the validity and accuracy of GI-RADS classification in the prediction of malignancy and in triaging the management protocol in ovarian lesions.

Results

One hundred fifty-six ovarian lesions were detected in the examined 116 women. The prevalence of malignant tumors was 44%. Overall GI-RADS classification rates were as follows: 41 cases (26.3%) were classified as GI-RADS 1, 26 cases (16 .7%) as GI-RADS 2, 34 cases (21.8%) as GI-RADS 3, 14 cases (8.9%) as GI-RADS 4, and 41 cases (26.3%) as GI-RADS 5. No follow-up was done in GI-RADS 1 patients. A final diagnosis of all GI-RADS 2 ovarian masses such as functional cyst (n = 10), hemorrhagic cysts (n = 8), corpus luteal cysts (n = 6), and some GI-RADS 3 as simple cysts (n = 10) was made by spontaneous resolution of these masses at follow-up after 6 weeks. Fifteen cases of GI-RADS 3 as mature teratoma, serous and mucinous cystadenoma, endometrioma, and ovarian torsion and all GI-RADS 4 and 5 underwent laparoscopic or surgical removal of the ovarian mass with histopathological examination. The diagnostic performance of the GI-RADS in predicting the risk of malignancy in ovarian masses was as follows: 98.11% sensitivity, 95.15% specificity, 91.2% positive predictive value (PPV), 99.2% negative predictive value (NPV), and 20.2 positive likelihood ratio, and the overall accuracy was 96.2% (area under receiver operating curve (AUC) = 0.96, P < 0.001).

Conclusion

GI-RADS classification performs well as a reporting system of the ovarian masses with high diagnostic performance in the prediction of malignancy, and it seems to be a helpful tool in triaging management in patients with ovarian masses.

Trial registration

The trial was registered in the US National Library of Medicine, under clinical trial number NCT03175991. Also, the ethical committee approval number of the Faculty of Medicine, Assiut University, was 17100016 on February 28, 2017.
Embolization for delayed arterial bleeding after percutaneous self-expandable metallic stent placement in patients with malignant biliary obstruction
Authors: Kim Pyeong Hwa , Kim Jong Woo , Gwon Dong Il , Ko Gi-Young , Shin Ji Hoon , Yoon Hyun-Ki
Published: November 2019

Objectives:

To retrospectively evaluate the safety and efficacy of transcatheter arterial embolization (TAE) for delayed arterial bleeding secondary to percutaneous self-expandable metallic stent (SEMS) placement in patients with malignant biliary obstruction (MBO).

Methods:

From January 1997 to September 2017, 1858 patients underwent percutaneous SEMS placement for MBO at a single tertiary referral center. Among them, 19 patients (mean age, 70.2 [range, 52–82] years; 13 men) presented with delayed SEMS-associated arterial bleeding and underwent TAE.

Results:

The incidence of delayed arterial bleeding was 1.0% (19/1858) after SEMS placement, with a median time interval of 225 days (range, 22–2296). Digital subtraction angiography (DSA) showed pseudoaneurysm alone close to the stent mesh (n = 10), pseudoaneurysm close to the stent mesh with contrast extravasation to the duodenum (n = 3), pseudoaneurysm close to the stent mesh with arteriobiliary fistula (n = 1), in-stent pseudoaneurysm alone (n = 4) and in-stent pseudoaneurysm with arteriobiliary fistula (n = 1). Bleeding was stopped after the embolization in all patients. Overall clinical success rate was 94.7% (18/19). One patient with recurrent bleeding was successfully treated with a second embolization. Overall 30-day mortality rate was 26.3% (5/19). A major procedure-related complication was acute hepatic failure in one hilar bile duct cancer patient (5.3%), which was associated with an obliterated portal vein.

Conclusion:

TAE is safe and effective for the treatment of delayed arterial bleeding after percutaneous SEMS placement for MBO.

Advances in knowledge:

This study demonstrated TAE is safe and effective for arterial bleeding after SEMS placement after MBO through the largest case series so far.
Modulation of nanoparticle uptake, intracellular distribution, and retention with docetaxel to enhance radiotherapy
Authors: Bannister Aaron Henry , Bromma Kyle , Sung Wonmo , Monica Mesa , Cicon Leah , Howard Perry , Chow Robert L , Schuemann Jan , Chithrani Devika Basnagge
Published: November 2019

Objective:

One of the major issues in current radiotherapy (RT) is the normal tissue toxicity. A smart combination of agents within the tumor would allow lowering the RT dose required while minimizing the damage to healthy tissue surrounding the tumor. We chose gold nanoparticles (GNPs) and docetaxel (DTX) as our choice of two radiosensitizing agents. They have a different mechanism of action which could lead to a synergistic effect. Our first goal was to assess the variation in GNP uptake, distribution, and retention in the presence of DTX. Our second goal was to assess the therapeutic results of the triple combination, RT/GNPs/DTX.

Methods:

We used HeLa and MDA-MB-231 cells for our study. Cells were incubated with GNPs (0.2 nM) in the absence and presence of DTX (50 nM) for 24 h to determine uptake, distribution, and retention of NPs. For RT experiments, treated cells were given a 2 Gy dose of 6 MV photons using a linear accelerator.

Results:

Concurrent treatment of DTX and GNPs resulted in over 85% retention of GNPs in tumor cells. DTX treatment also forced GNPs to be closer to the most important target, the nucleus, resulting in a decrease in cell survival and increase in DNA damage with the triple combination of RT/ GNPs/DTX vs RT/DTX. Our experimental therapeutic results were supported by Monte Carlo simulations.

Conclusion:

The ability to not only trap GNPs at clinically feasible doses but also to retain them within the cells could lead to meaningful fractionated treatments in future combined cancer therapy. Furthermore, the suggested triple combination of RT/GNPs/DTX may allow lowering the RT dose to spare surrounding healthy tissue.

Advances in knowledge:

This is the first study to show intracellular GNP transport disruption by DTX, and its advantage in radiosensitization.
Donut rush to laparoscopy: post-polypectomy electrocoagulation syndrome and the ‘pseudo-donut’ sign
Authors: Plumptre Isabella , Tolppa Timo , Jawad Zaynab A.R. , Zafar Noman
Published: November 2019

Colonoscopic polypectomy is a routine procedure with the potential for rare but well-known complications, including perforation and bleeding. Post-polypectomy electrocoagulation syndrome (PPES) is a less recognized cause of abdominal pain following this procedure. However, it is important to diagnose PPES in order to avoid unnecessary intervention. We present the case of a patient with abdominal pain after polypectomy. The patient underwent an unnecessary diagnostic laparoscopy on the basis of misinterpreted radiological findings. Her CT scan demonstrated the "donut" sign that was suggestive of ileocaecal intussusception. This case highlights the importance of recognizing PPES as a possible cause for abdominal pain after colonoscopic polypectomy and that it may also present with a "pseudodonut" sign on CT scan. It also demonstrates the importance of communicating and then integrating full clinical details with radiological findings when formulating a differential diagnosis.
Cone beam CT and treatment decision of mandibular third molars: removal vs. coronectomy—a 3-year audit
Authors: Matzen Louise Hauge , Villefrance Julie Suhr , Nørholt Sven Erik , Bak Jesper , Wenzel Ann
Published: November 2019

Objectives:

To assess: (1) the workflow in the treatment decision process of mandibular third molars based on a panoramic image and CBCT and (2) the impact of radiographic markers in CBCT on the decision to perform coronectomy.

Methods:

1437 teeth in 917 patients (mean age 27.8 years, range 18–72) underwent clinical and panoramic examination. If there was an indication for removal of the tooth, and signs of a close relation to the inferior alveolar nerve were present in the panoramic image, a CBCT was performed. Treatment decision based on panoramic image and CBCT was calculated. Statistical analyses were performed to assess whether signs in CBCT had an impact on the treatment decision “coronectomy”. Moreover, the actually operated teeth and post-operative sensory disturbances were assessed and discussed in relation to the radiographic method.

Results:

Based on the panoramic image, in 462 cases it was decided not to treat, 553 were scheduled for surgery, and 422 referred for a CBCT examination. “No bony separation between the tooth and mandibular canal” seen in CBCT was the main factor influencing the decision to perform a coronectomy (odds ratio = 56.8, p < 0.001). 840 mandibular third molars had undergone surgical intervention, 152 had a coronectomy and 688 were fully removed. Six patients perceived a sensory disturbance of the inferior alveolar nerve: one permanent and five temporary.

Conclusion:

29% of the examined cases were referred for a CBCT and of these, the majority were scheduled for coronectomy based on the sign “no bony separation between the tooth and mandibular canal” seen in CBCT.
Frequency, clinical characteristics, risks, and outcomes of Paradoxical upgrading reactions during anti-tuberculosis treatment in tuberculous lymphadenitis
Authors: Sarfaraz Samreen , Iftikhar Sundus , Salahuddin Naseem
Published: November 2019

Objectives: To investigate the clinical characteristics, risks and outcomes of Paradoxical upgrading reactions (PUR) during anti-tuberculosis treatment (ATT) in superficial tuberculous lymphadenitis (TBLA).

Methods: In this nested case-control study, all patients diagnosed with TBLA based on combinations of histopathology, acid-fast bacilli (AFB) microscopy, AFB culture, and GeneXpert, between February 2013 and April 2016, were enrolled. Standard ATT was given. Demographics, clinical characteristics, occurrence of PUR and outcome were recorded.

Results: TBLA was diagnosed and treated in 189 patients. PUR developed in 33 (17%), of which 77% developed new inflamed glands, 20.6% had increased size and inflammation of pre-existing glands and 5.9% had superficial chest wall abscesses requiring aspiration. All responded to regular NSAIDs except one, where a steroid course was effective. No change in dose or duration of ATT was required. Presence of anorexia (OR; 95%CI: 2.6; 1.003-6.74), bilateral extensive lymphadenopathy (OR; 95%CI: 2.9; 1.1-7.5) and lymph node specimen positive for AFB (OR; 95%CI: 3.2; 1.04-10.1) were significantly associated with PUR.

Conclusion: PUR is common in TBLA. It responded to NSAIDS and does not need any modification in ATT.

doi: https://doi.org/10.12669/pjms.36.ICON-Suppl.1711

How to cite this:Sarfaraz S, Iftikhar S, Salahuddin N. Frequency, clinical characteristics, risks, and outcomes of Paradoxical upgrading reactions during anti-tuberculosis treatment in tuberculous lymphadenitis. Pak J Med Sci. Special Supplement ICON 2020. 2020;36(1):S27-S32.  doi: https://doi.org/10.12669/pjms.36.ICON-Suppl.1711

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Minimal residual disease in childhood B Lymphoblastic Leukemia and its correlation with other risk factors
Authors: Meraj Fatima , Jabbar Naeem , Nadeem Kishwer , Taimoor Momal , Mansoor Neelum
Published: November 2019

Objective: To determine frequency of post induction and post consolidation minimal residual disease (MRD) in pediatric B-lymphoblastic leukemia (B-ALL) patients and its association with clinical risk factors.

Methods: This is a retrospective, cross sectional study carried out at the Indus Hospital on paediatric patients (1-17 years) was performed from May 2015 to January 2018. On day 35, MRD testing was done on bone marrow aspirate using 4 color flow cytometer with 0.01% cut off. Positive cases were retested at post consolidation. Data was collected for demographics, total leukocyte count (TLC), central nervous system status (CNS), Cytogenetics for BCR-ABL, MLL, TEL-AML by FISH and prophase response then analyzed in association to MRD status.

Results: Out of 362 patients, 133 (37%) were post induction MRD positive, with no statistically significant association to age, gender, TLC, CNS status, prophase response, BCR-ABL and TEL-AML1. However, MLL showed closely significant association (p-value=0.05). Post consolidation, 49 (44%) were MRD positive; age, National cancer institute (NCI) risk groups and CNS status showed statistical significance (p-value <0.05).

Conclusion: Despite high frequency of MRD positivity, significant association is not observed between post induction MRD and risk factors. However, post consolidation MRD has a significant association with NCI risk groups, age and CNS status.

doi: https://doi.org/10.12669/pjms.36.ICON-Suppl.1721

How to cite this:Meraj F, Jabbar N, Nadeem K, Taimoor M, Mansoor N. Minimal residual disease in childhood B Lymphoblastic Leukemia and its correlation with other risk factors. Pak J Med Sci. Special Supplement ICON 2020. 2020;36(1):S20-S26.  doi: https://doi.org/10.12669/pjms.36.ICON-Suppl.1721

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Mechanism, spectrum, consequences and management of hyponatremia in tuberculous meningitis
Authors: Misra Usha K. , Kalita Jayantee ,   Tuberculous Meningitis International Research Consortium
Published: November 2019

Hyponatremia is the commonest electrolyte abnormality in hospitalized patients and is associated with poor outcome. Hyponatremia is categorized on the basis of serum sodium into severe (< 120 mEq/L), moderate (120-129 mEq/L) and mild (130-134mEq/L) groups. Serum sodium has an important role in maintaining serum osmolality, which is maintained by the action of antidiuretic hormone (ADH) secreted from the posterior pituitary, and natriuretic peptides such as atrial natriuretic peptide and brain natriuretic peptide. These peptides act on kidney tubules via the renin angiotensin aldosterone system. Hyponatremia <120mEq/L or a rapid decline in serum sodium can result in neurological manifestations, ranging from confusion to coma and seizure. Cerebral salt wasting (CSW) and syndrome of inappropriate secretion of ADH (SIADH) are important causes of hyponatremia in tuberculosis meningitis (TBM). CSW is more common than SIADH. The differentiation between CSW and SIADH is important because treatment of one may be detrimental for the other; evidence of hypovolemia in CSW and euvolemia or hypervolemia in SIADH is used for differentiation. In addition, evidence of dehydration, polyuria, negative fluid balance as assessed by intake output chart, weight loss, laboratory evidence and sometimes central venous pressure are helpful in the diagnosis of these disorders. Volume contraction in CSW may be more protracted than hyponatremia and may contribute to border zone infarctions in TBM. Hyponatremia should be promptly and carefully treated by saline and oral salt, while 3% saline should be used in severe hyponatremia with coma and seizure. In refractory patients with hyponatremia, fludrocortisone helps in early normalization of serum sodium without affecting polyuria or functional outcome. In SIADH, V2 receptor antagonist conivaptan or tolvaptan may be used if the patient is not responding to fluid restriction. Fluid restriction in SIADH has not been found to be beneficial in TBM and should be avoided.
Rating nurses' knowledge of basic steps of cardiopulmonary resuscitation
Authors: Stocka Joanna , Simińska Joanna , Bukowska Weronika , Porzych Piotr , Ogurkowski Karol , Nowacka Krystyna , Hagner Wojciech
Published: November 2019

First aid is provided by the witnesses in this connection it is important to ensure that every citizen of the aid granted in a correct and effective until the arrival of emergency medical team. From witnesses to a large extent depend on the survival chances of the victim or his injury. Education in first aid begins in elementary school, however, important that the students of these classes were able to use the knowledge in practice
Therapeutic procedures in shoulder impingement syndrome (SIS) for professionally active people: randomized research
Authors: Skopowska Agnieszka , Biernacki Maciej , Dekowska Monika , Łukowicz Małgorzata , Łukasz Sielski , Filarecka Agnieszka
Published: November 2019

Objectives. Pain and limitation of motions in the glenohumeral joint are frequently the consequence of the shoulder impingement syndrome (SIS). Misdiagnosis or improper treatment of the illness may effect in a serious functional impairment of the upper limb. The treatment, dependent on the medical condition, involves: rest, NSAID therapy, physiotherapy as well as kinesitherapeutic procedures. The aim of the research was to conduct a detailed diagnosis of the shoulder impingement syndrome and the efficacy assessment of the matched rehabilitating procedures considering the symptoms.Material and methods. The research was conducted in 39 people aged 30 to 81 treated for SIS. 85% of the respondents were professionally active.In order to assess the efficacy of the therapy the following were carried out: the pain assessment test, functional tests (Neer’s, Ludington’s, Hawkins’, Apley’s, Job’s and the active painful arc test) as well as measurements of the active range of motion of the joint. The patients were subjected to two kinds of physiotherapy – ultrasound therapy (US) procedures and the short wave diathermy (SWD), both connected with procedures aiming at mobilization of the shoulder complex and off-load exercises. The outcome was submitted to statistic analysis. Results. The results obtained in both groups of patients were compared via the Mann-Whitney U test. No significant differences between the SWD and the US groups in the efficacy of the conducted procedures were observed. The data analysis within therapeutic groups revealed the existence of significant differences (p<0,01) before and after the therapy, in the VAS and Laitinen scales as well as in the measurements of the range of motions. Conclusions. The outcome of both conducted therapies in both research groups included: decrease in pain, increase in the range of motions of the glenohumeral joint and improved function of the upper limb. Both procedures may be successfully employed in the treatment of SIS in professionally active people.