bluuebunny/crossref_metadata_2025 huggingface dataset:
“Our Friend Wang”
Authors: Kamenskikh Mikhail S. , Avdashkin Andrey A.
Published: February 2023

The article is devoted to the visualization of the image of a Chinese in the periodical press of the Urals in the 1950s. Using the methodology of critical discourse analysis, the authors identify several target groups that form the image, describe their characteristic features and highlight the general and the special characteristics. The source base was made up of materials from the Ural periodical press. During “Great friendship” the Chinese who took part in labor training at enterprises and universities in the USSR became an object of attention of the Ural periodical press from the moment of their appearance in the region in 1954 and up to the almost complete return to their homeland. Periodical publications formed and broadcast to readers a positive image of the Chinese, using some lasting methods of description: putting in an industrial environment, displaying a certain hierarchy in the relationship “diligent” student – “wise” mentor, ‘humanizing’ the character, describing a “typical” and “correct” biography showing positive changes in China after its transition to the socialist path of development.
National Digital Infrastructure and India’s Healthcare Sector: Physician’s Perspectives
Authors: Chandwani Rajesh , Edacherian Saneesh , Sud Mukesh
Published: February 2023

Patient-centric digital infrastructure can potentially enhance the efficiency of healthcare systems. However, even in developed nations, evidence suggests low adoption rates for such infrastructure and lack of support from clinicians is considered as one of the most critical hindering factors. In this study, we examine physicians' perceptions of the proposed large-scale information technology initiative in India that aims to transform the health sector and provide universal health coverage to all residents of India. We employed the information ecology lens to understand the broader changes in the healthcare system that could result from the initiative. We use focus group discussion and in-depth interviews to comprehend the perceptions of doctors about the initiative. Drawing upon Foucault’s conceptualization of power, we find that physicians, the key stakeholders in this initiative, are skeptical about the changes in the locus of power in the new ecosystem. Specifically, they perceive that knowledge power has shifted from a historical “expert knowledge power” to power related to “data management.” The physicians believe that changes are expected to manifest through monitoring, controlling, and managing the data rather than providing knowledge-based services. We present recommendations to engage physicians' perspectives in implementing large-scale patient-centric digital infrastructure.
From a Monolingual Mind to a Multilingual Heart: An Autoethnography through Dominant Language Constellation
Authors: Xu Yaqiong
Published: February 2023

This article narrates and analyzes the author’s life experiences as a learner, teacher, and researcher of diverse languages across three contexts: mainland China, Hong Kong, and Norway. Deconstructing the influential episodes in the writer’s life trajectory, this autoethnography explores the author’s transformation from a monolingually-minded individual to a border-crossing, multilingually hearted scholar. The analysis is undertaken through the theoretical lens of language ideology and dominant language constellation (DLC) and epitomizes the profound influence of sociocultural structures on an individual’s identity search and development. Confronting the multilingual turn in education and echoing the call to centralize identity in language teaching, this self-study exemplifies autoethnography as an empowering method for an ideological shift from perceiving “language(s)-as-problem” to advocating “language(s)-as-resource.” The study also illustrates how the construct of DLC can be deployed as a tangible model of multilinguals’ ever-evolving linguistic identities.
Clean Hydrogen: Outlook for Freight Transport in the United States
Authors: Feldmann John , Byrum Zachary , Cyrs Tom
Published: February 2023

This paper discusses opportunities for clean hydrogen to decarbonize freight transport in the United States. Clean hydrogen is presented as a complementary solution to electrification and other clean fuels for the road, air, water, and rail freight segments. Each of these segments presents challenges for clean hydrogen, and the issues of each are discussed in detail, with an eye towards representing the complicated landscape of clean hydrogen, electrification, and other clean fuels that could play a role.
A Retrospective Analysis of Antifungal Susceptibilities of Candida Bloodstream Isolates From Singapore Hospitals
Authors: Tan Thean Yen , Tee Nancy WS , Ng Lily SY
Published: February 2023

Introduction: Worldwide, Candida albicans is the most common Candida species implicated in bloodstream infections. However, the proportion of non-albicans bloodstream infections is increasing. Fluconazole resistance is known to be more common in non-albicans species, but is also reported in C. albicans. This retrospective study was performed to determine the species epidemiology of Candida bloodstream infections in Singapore hospitals, and to perform susceptibility testing to a range of antifungal drugs.

Materials and Methods: Candida spp. isolated from bloodstream infections from October 2004 to December 2006 were collected from 3 participating hospitals: a tertiary referral hospital (Singapore General Hospital), a secondary referral hospital (Changi General Hospital) and an obstetrics/paediatric hospital [KK Women’s and Children’s Hospital (KKWCH)]. Isolate collection was also retrospectively extended to January 2000 for KKWCH because of the limited number of cases from this hospital. Isolates were identified by a common protocol, and antifungal susceptibility testing was performed by microbroth dilution (Sensititre One, Trek Diagnostics, United Kingdom).

Results: The most common isolates were C. albicans (37%), C. tropicalis (27%) and C. glabrata (16%). There were differences in species distribution between institutions, with C. parapsilosis and C. albicans predominant in KKWCH, and C. albicans and C. tropicalis predominant in the other 2 institutions. Fluconazole resistance was detected in 3.2% of all Candida spp., and 85.3% were classified as susceptible. All C. albicans and C. parapsilosis were susceptible to fluconazole and voriconazole, while susceptibility to fluconazole was much more variable for C. glabrata and C. krusei. Conclusion: This study shows that C. albicans remains the predominant Candida species isolated from bloodstream infections in the 3 participating hospitals. However, non-albicans species accounted for nearly two-thirds of all cases of candidaemia. Resistance to fluconazole was uncommon, and was generally confined to C. krusei and C. glabrata.

Key words: Antifungal agents, Antifungal drug resistance, Fungaemia
Right Atrial Isomerism – Preponderance in Asian Fetuses. Using the Stomach-distance ratio as a Possible Diagnostic Tool for Prediction of Right Atrial Isomerism
Authors: Yan Ying-Liu , Tan Kenny BL , Yeo George SH
Published: February 2023

Introduction: To present the characteristics and spectrum of associated anomalies in right- and left-sided isomerism in our local population and to assess the possibility of using stomach-distance ratio (SDR) of less than 0.34 as a diagnostic tool to predict right atrial isomerism.

Materials and Methods: This was a retrospective study of fetuses in our department over a period of 8 years with postnatally confirmed prenatal diagnosis of atrial isomerism.

Results: In 22 cases, atrial isomerism was confirmed by post-mortem or postnatal echocardiography. Eighteen (81.8%) fetuses had right isomerism. Their main abnormal ultrasound findings were pulmonary stenosis or atresia (n = 9), atrioventricular septal defect (n = 10), right-sided stomach (n = 9), transposition of great arteries (n = 6), dextrocardia (n = 8), single ventricle (n = 4), juxtaposition of inferior vena cava and descending aorta (n = 5), ventricular septal defect (n = 2), interrupted inferior vena cava with azygous drainage (n = 2) and double outlet right ventricle (n = 3). Four (18.2%) fetuses had left isomerism. Their abnormal ultrasound findings were dextrocardia (n = 3), right-sided stomach (n = 3), atrioventricular septal defect (n = 2), double outlet ventricle (n = 2), ventricular septal defect (n = 1), pulmonary stenosis (n = 2) and interrupted inferior vena cava with azygous drainage (n = 1). 66.7% (12/18) of cases with right isomerism had SDR of less than 0.34 compared to 0% (0/4) of the cases with left isomerism (P = 0.02).

Conclusion: Our study suggests an Asian predilection towards right isomerism compared to Western populations. We postulate that there may be racial differences in the expression of these 2 forms of isomerism. The ultrasound findings of complex heart disease and abnormal arrangement of great vessels in abdominal cavity, though important, are varied and non-specific evidence for either form of fetal atrial isomerism. There is a possibility of using the SDR <0.34 (representing stomach proximity to the fetal spine) as a possible diagnostic tool to predict right-sided atrial isomerism.

Key words: Azygous vein, Cardiac defects, Dextrocardia, Heterotaxy syndrome, Stomach localisation, Stomach near spine, Visceral heterotaxy
Electrocardiographic Changes in Patients with Cutaneous Leishmaniasis Treated with Systemic Glucantime
Authors: Sadeghian Giti , Ziaei Hengameh , Sadeghi Masumeh
Published: February 2023

Introduction: Antimonial compounds are regarded as the treatment of choice for cutaneous leishmaniasis (CL). Systemic administration of these drugs has some side effects including cardio toxicity and electrocardiogram (EKG) changes. The objective of our study was to evaluate EKG changes in the patients with CL treated with systemic glucantime.

Materials and Methods: Onehundred and thirty-one patients were enrolled in this prospective study. All of the selected patients had confirmed CL and were candidates for treatment with systemic glucantime. The patients were treated with systemic glucantime and EKG was performed before, during (weekly) and 1 month after cessation of the treatment. All of the collected data were analysed using SPSS software.

Results: The most common change was prolonged QT interval that was seen in 19% of the patients. ST depression occurred in 6.1% of the patients. Minimal ST elevation occurred in 3% and inverted T was observed in 7.4% of the patients. Single premature atrial contraction (PAC) and single premature ventricular contraction (PVC) occurred in 0.7% and 2.29% of patients, respectively. Bradycardia was observed in 10.6% and left bundle branch block in 0.7% of the patients. All of these changes reversed after stopping the treatment except 1 case with left bundle branch block that lasted for 1 month after the treatment.

Conclusions: Our results showed that treatment with glucantime can induce many ECG changes as QT prolongation have significant risk. We suggest that ECG monitoring should be performed in high-risk patients undergoing glucantime treatment with special attention to ECG changes mostly prolonged QT interval.

Key words: Antimonial compound, Cardiac monitoring, Toxicity
Prevalence of Refractive Error in Malay Primary School Children in Suburban Area of Kota Bharu, Kelantan, Malaysia
Authors: Hashim Syaratul-Emma , Tan Hui-Ken , WH Wan-Hazabbah , Ibrahim Mohtar
Published: February 2023

Introduction: Refractive error remains one of the primary causes of visual impairment in children worldwide, and the prevalence of refractive error varies widely. The objective of this study was to determine the prevalence of refractive error and study the possible associated factors inducing refractive error among primary school children of Malay ethnicity in the suburban area of Kota Bharu, Kelantan, Malaysia.

Materials and Methods: A school-based cross-sectional study was performed from January to July 2006 by random selection on Standard 1 to Standard 6 students of 10 primary schools in the Kota Bharu district. Visual acuity assessment was measured using logMAR ETDRS chart. Positive predictive value of uncorrected visual acuity equal or worse than 20/40, was used as a cut-off point for further evaluation by automated refraction and retinoscopic refraction.

Results: A total of 840 students were enumerated but only 705 were examined. The prevalence of uncorrected visual impairment was seen in 54 (7.7%) children. The main cause of the uncorrected visual impairment was refractive error which contributed to 90.7% of the total, and with 7.0% prevalence for the studied population. Myopia is the most common type of refractive error among children aged 6 to 12 years with prevalence of 5.4%, followed by hyperopia at 1.0% and astigmatism at 0.6%. A significant positive correlation was noted between myopia development with increasing age (P <0.005), more hours spent on reading books (P <0.005) and background history of siblings with glasses (P <0.005) and whose parents are of higher educational level (P <0.005). Malays in suburban Kelantan (5.4%) have the lowest prevalence of myopia compared with Malays in the metropolitan cities of Kuala Lumpur (9.2%) and Singapore (22.1%).

Conclusion: The ethnicity-specific prevalence rate of myopia was the lowest among Malays in Kota Bharu, followed by Kuala Lumpur, and is the highest among Singaporean Malays. Better socio-economic factors could have contributed to higher myopia rates in the cities, since the genetic background of these ethnic Malays are similar.

Key words: Children, Myopia, Refractive error
Return to Sports After Anterior Cruciate Ligament Reconstruction – A Review of Patients with Minimum 5-year Follow-up
Authors: Lee Dave YH , Karim Sarina Abdul , Chang Haw Chong
Published: February 2023

Introduction: It is difficult to counsel the anterior cruciate ligament (ACL) deficient patient considering surgical reconstruction on the likelihood of eventual return to sports as information on this is lacking, especially in the Asian context. We wanted to determine how many of our patients who had ACL surgery returned to their previous levels of sports, 5 years after their surgery. For those that had not returned to their previous levels of sports, we wanted to identify their reasons for not doing so.

Materials and Methods: Based on our inclusion criteria of a minimum 5-year follow-up after primary ACL reconstruction, 146 patients were identified for assessment. Sixty-four patients were successfully recalled. The mean age of our patients was 24.8 years (range, 18 to 40). The patients completed the Lysholm Knee, Tegner activity and the Subjective International Knee Documentation Committee (IKDC) questionnaires. Clinical examination of the operated knee was performed according to the Objective IKDC evaluation form and with a KT-1000 arthrometer.
Results: The mean Lysholm score was 85.2 and the mean subjective IKDC score was 79.5. 81.2% of our patients had normal or nearly normal knees (IKDC A or B) with the remaining 18.8% at IKDC grade C. The mean side-side difference for anterior translation using the KT-1000 arthrometer was 1.2 mm. The median pre-injury Tegner activity level was 7 and the median 5-year post-surgery Tegner activity level was 6. Nineteen patients did not return to their pre-injury sports levels because of social reasons and were excluded. From the remaining 45 patients, 28 patients (62.2%) returned to their previous level of sports and 17 patients (28.8%) did not return to their previous level of sports. Of whom, 9 (20%) said that they did not return due to fear of re-injury and the remaining 8 (17.8%) said they had not returned because of knee instability and pain. At 5 years, the subgroup of patients who had returned to sport had the best scores: Lysholm (88.5), subjective IKDC (84.6) and IKDC Grade A&B (89.3%). When we compared this with the subgroups that did not return to sport because of fear of re-injury and because of an unstable knee, we found that the difference in knee outcome scores between these 3 groups were statistically significant.
Conclusion: Sixty-two per cent of our patients returned to their previous level of sport at 5 years after ACL reconstruction. Fear of re-injury is an important psychological factor for these patients not returning to sports. Our results would allow the attending surgeon to counsel the ACL deficient patient who is considering surgical reconstruction the likelihood of eventual return to sports.

Key words: Ligament reconstruction, Return to sports
Plasma Endotoxin and Immune Responses During a 21-km Road Race Under a Warm and Humid Environment
Authors: Ng Qi Yin , Lee Kai Wei , Byrne Christopher , Ho Ting Fei , Lim Chin Leong
Published: February 2023

Introduction: This study investigated the responses of plasma endotoxin and pro- and anti-inflammatory cytokines during a 21-km road race in warm and humid conditions. The influence of carbohydrate-electrolyte (CE)-water (WA) drink mix ingested on leukocyte subset responses and the association between plasma lipopolysaccharide (LPS) concentration and fluid balance, exercise intensity, and body core temperature (Tc) were also studied.

Materials and Methods: Thirty runners provided blood samples before and after the half-marathon for leukocyte, LPS and cytokine analyses. Tc was measured by the ingestible telemetric temperature sensor and fluid intake and split-times were recorded at 3 km intervals. Exercise intensity was determined by matching running speed and heart rate during the race with the corresponding speed-oxygen uptake relationship and heart rate measured in the laboratory 2 to 6 weeks before the race.
Results: Plasma LPS concentration increased from 1.9 ± 1.9 pg/mL before, to 2.5 ± 1.9 pg/mL after running (P <0.05). Peak plasma LPS concentration was 7.5 pg/mL. Plasma IL-1β and TNF-concentration did not change significantly, whereas significant increases in IL-10 (50%), IL-1ra (23.2%) and IL-6 (65.2%) were observed after the race. No significant correlation between plasma LPS concentration and exercise intensity, hydration and Tc was observed.

Conclusion: Leukocyte subset responses were not related to the ratio of CE and water drink mix ingested. Running a half-marathon can induce mild endotoxaemia, which is not related to exercise intensity, fluid balance, and Tc responses. Mixing CE drink with water did not mitigate post-exercise leukocytosis and lymphopenia.

Key words: Carbohydrate-electrolyte drink, Core temperature, Cytokines, Leukocytes, Lipopolysaccharide
Recurrent Patellar Dislocation: Reappraising our Approach to Surgery
Authors: Lim Andrew KS , Chang Haw Chong , Hui James HP
Published: February 2023

Introduction: The management of recurrent traumatic patellar dislocation includes surgical realignment. There is no clear distinction whether proximal soft tissue or distal procedures produce superior results. However, distal realignment procedures are commonly associated with greater morbidity. We advocate a distal procedure only for cases which are more severe, such as the presence of patellar maltracking.

Materials and Methods: Between January 2002 and June 2007, all patients who had a history of traumatic patellar dislocation with recurrent symptoms and failed conservative management underwent surgical realignment. Patients who had evidence of lateral patellar subluxation on computed tomography (CT) scan were offered a distal realignment procedure using the Elmslie-Trillat or Roux Goldthwaite procedure. All other patients underwent proximal soft tissue medial patellofemoral ligament (MPFL) reconstruction. Pre and postoperative functional International Knee Documentation Committee (IKDC), Lysholm and Tegner score assessments were performed for a minimum follow-up period of 6 months. The mean scores for each group were analysed using the Wilcoxon Matched-Pairs Signed-Ranks test and the Mann-Whitney U test was used to evaluate the difference between the groups.
Results: A total of 23 patients underwent surgery for patellar realignment. Of whom, 14 patients had a distal realignment procedure while 9 patients had a proximal procedure of MPFL reconstruction. There was greater morbidity reported with distal realignment procedures. Pre and postoperative IKDC, Lysholm and Tegner scores showed significant improvement for both treatment arms. However, there was no significant difference between the improvement scores for both groups.
Conclusion: Patients with significant patellar maltracking following traumatic patellar dislocation would benefit from distal realignment using the Elmslie-Trillat or Roux Goldthwaite procedure. Otherwise, a proximal soft tissue procedure involving MPFL reconstruction would be adequate. A management algorithm is proposed for clinical use.

Key words: Algorithm, Distal realignment, Medial patellofemoral ligament
Isokinetic Dynamometry in Anterior Cruciate Ligament Injury and Reconstruction
Authors: Pua Yong-Hao , Bryant Adam L , Steele Julie R , Newton Robert U , Wrigley Tim V
Published: February 2023

The use of isokinetic dynamometry has often been criticised based on the face-validity argument that isokinetic movements poorly resemble the everyday multi-segmented, dynamic activities of human movements. In the anterior cruciate ligament (ACL) reconstruction or deficiency population where muscle deficits are ubiquitous, this review paper has made a case for using isokinetic dynamometry to isolate and quantify these deficits in a safe and controlled manner. More importantly, the usefulness of isokinetic dynamometry, as applied in individuals with ACL reconstruction or deficiency, is attested by its established known-group and convergent validity. Known-group validity is demonstrated by the extent to which a given isokinetic measure is able to identify individuals who could and could not resume pre-morbid athletic or strenuous activities with minimal functional limitations following an ACL injury. Convergent validity is demonstrated by the extent to which a given isokinetic measure closely associates with self-report measures of knee function in individuals with ACL reconstruction. A basic understanding of the measurement properties of isokinetic dynamometry will guide the clinicians in providing reasoned interventions and advancing the clinical care of their clients. Key words: Biomechanics, Knee, Validity
Superior Sagittal Sinus Thrombosis: Subtle Signs on Neuroimaging
Authors: Tang Phua Hwee , Chai Josiah , Chan Yiong Huak , Chng Soke Miang , Lim CC Tchoyoson
Published: February 2023

Introduction: The aim of this study was to review the clinical, computed tomography (CT) and magnetic resonance imaging (MRI) diagnosis and the frequency of positive neuroimaging findings in patients with cerebral venous thrombosis (CVT) involving the superior sagittal sinus. Materials and Methods: A clinical and radiological database of patients with final diagnosis of CVT was compiled from the inpatient hospital information service of a tertiary neurological hospital over 5 years. CT and MRI studies in 22 patients were retrospectively examined for direct signs of venous sinus thrombosis and for complications of CVT. The diagnosis of CVT before and after CT and MRI was reviewed. Results: Clinical diagnosis of possible CVT was suspected in only 1 patient. When the diagnosis was not suspected, CT diagnosis was difficult and there was a high false negative rate of 52.6%. MRI fared better, but the false negative rate was still 11%. Directs signs of venous sinus thrombosis such as the triangle sign, empty delta sign on CT and loss of the normal flow voids on MRI, could be retrospectively detected in 57.9%, 100% and 100% of patients respectively. Although 4 patients presented with subarachnoid haemorrhage, these direct signs were present in 3 patients. Conclusion: Clinical diagnosis of CVT is rarely suspected before CT and MRI, and although subtle positive signs are often present, these may not be appreciated unless there is a high index of suspicion or image review at multidisciplinary team meetings. Key words: Cerebrovascular disorders, Cerebral venous thrombosis, Magnetic resonance imaging, Venous infarction
The 2005 Dengue Epidemic in Singapore: Epidemiology, Prevention and Control
Authors: Koh Benjamin KW , Ng Lee Ching , Kita Yuske , Tang Choon Siang , Ang Li Wei , Wong Kit Yin , James Lyn , Goh Kee Tai
Published: February 2023

Introduction: We investigated the 2005 outbreak of dengue fever (DF)/dengue haemorrhagic fever (DHF) to determine its epidemiological, virological and entomological features to further understand the unprecedented resurgence.

Materials and Methods: All physician-diagnosed, laboratory-confirmed cases of DF/DHF notified to the Ministry of Health, Singapore during the outbreak as well as entomological and virological data were analysed retrospectively.

Results: A total of 14,006 cases of DF/DHF comprising 13,625 cases of DF and 381 cases of DHF, including 27 deaths were reported, giving an incidence rate of 322.6 per 100,000 and a case-fatality rate of 0.19%. The median age of the cases and deaths were 32 and 59.5 years, respectively. The incidence rate of those living in compound houses was more than twice that of residents living in public and private apartments. The distribution of DF/DHF cases was more closely associated with Aedes aegypti compared to Aedes albopictus breeding sites and the overall Aedes premises index was 1.15% (2.28% in compound houses and 0.33% to 0.8% in public and private apartments). The predominant dengue serotype was DEN-1. A significant correlation between weekly mean temperature and cases was noted. The correlation was strongest when the increase in temperature preceded rise in cases by a period of 18 weeks.

Conclusion: The resurgence occurred in a highly densely populated city-state in the presence of low Aedes mosquito population. Factors contributing to this resurgence included lower herd immunity and change in dominant dengue serotype from DEN-2 to DEN-1. There was no evidence from gene sequencing of the dengue viruses that the epidemic was precipitated by the introduction of a new virulent strain. The current epidemiological situation is highly conducive to periodic dengue resurgences. A high degree of vigilance and active community participation in source reduction should be maintained.

Key words: Dengue haemorrhagic fever, Dengue fever, Outbreak
Healthcare Workers and HIV Health Issues
Authors: Chua Arlene , Leo Yee Sin , Kurup Asok , Chlebicki Maciej Piotr , Lee Cheng Chuan
Published: February 2023

Should healthcare workers (HCWs) be routinely tested for HIV? The authors reviewed the literature on the risk and incidence of HIV transmission from HCW to patients and offer recommendations for HIV testing in HCWs in Singapore. Management of HCWs who are tested seropositive for HIV infection is also discussed in this paper.

Key words: AIDS, HIV testing, occupational, transmission
Self-directed Learning in Health Professions Education
Authors: Murad M Hassan , Varkey Prathibha
Published: February 2023

Introduction: Self-directed learning has been recommended as a promising methodology for lifelong learning in medicine. However, the concept of self-directed learning continues to be elusive, with students and educators finding difficulty in defining it and agreeing on its worth. Methods: In this paper we review the literature of self-directed learning in health professions education and present a framework based on Malcolm Knowles’ key components of self-directed learning. Results: The key components of self-directed learning are: the educator as a facilitator, identification of learning needs, development of learning objectives, identification of appropriate resources, implementation of the process, commitment to a learning contract and evaluation of learning. Several but not all of these components are often described in the published literature. Conclusion: Although the presented framework provides some consistency for educators interested in applying SDL methods, future studies are needed to standardise self-directed learning curricula and to determine the effectiveness of these components on educational outcomes. Key words: Independent study, Medical education, Self-assessment, Self-directed learning, Selfeducation
Holoprosencephaly: An Antenally-diagnosed Case Series and Subject Review
Authors: Lim Alvin ST , Lim Tse Hui , Kee Su Keyau , Chia Patrick , Raman Subramaniam , Eu Elizabeth LP , Lim Jessie YC , Tien Sim Leng
Published: February 2023

Introduction: Holoprosencephaly (HPE) is an uncommon congenital failure of forebrain development. Although the aetiology is heterogeneous, chromosomal abnormalities or a monogenic defect are the major causes, accounting for about 40% to 50% of HPE cases. At least 7 genes have been positively implicated, including SHH, ZIC2, SIX3, TGIF, PTCH1, GLI2, and TDGF1.

Clinical Picture: Twelve antenatally- and 1 postnatally-diagnosed cases are presented in this study. These comprised 6 amniotic fluid, 3 chorionic villus, 2 fetal blood, 1 peripheral blood, and 1 product of conception.

Outcome: The total chromosome abnormality rate was 92.3%, comprising predominantly trisomy 13 (66.7%). There was 1 case of trisomy 18, and 3 cases of structural abnormalities, including del13q, del18p, and add4q.

Conclusion: Despite the poor outcome of an antenatally-diagnosed HPE and the likely decision by parents to opt for a termination of pregnancy, karyotyping and/or genetic studies should be performed to determine if a specific familial genetic or chromosomal abnormality is the cause. At the very least, a detailed chromosome analysis should be carried out on the affected individual. If the result of highresolution karyotyping is normal, Fluorescence in situ hybridisation (FISH) and/or syndromespecific testing or isolated holoprosencephaly genetic testing may be performed. This information can be useful in making a prognosis and predicting the risk of recurrence.

Key words: Chromosomes, Genes, Karyotyping, Trisomies
Sleep Disorders in Children: The Singapore Perspective
Authors: Chng Seo Yi
Published: February 2023

This review article summarises the current available literature on sleep patterns and sleep problems in Singapore children. Co-sleeping is a culturally dependent practice and its prevalence in Singapore has been determined to be 73%. Co-sleeping is not associated with significant sleep problems in Singapore children. Snoring and habitual snoring occur in 28.1% and 6.0% of Singapore children, respectively. Habitual snoring in Singapore children was significantly associated with obesity, allergic rhinitis, atopic dermatitis, maternal smoking and breastfeeding. Atopy was the strongest risk factor for habitual snoring in Singapore, and the effect was cumulative. Children attending psychiatric services in Singapore may also have sleep disorders, the highest prevalence being in children with attention deficit hyperactivity disorder. The knowledge on childhood sleep disorders (including obstructive sleep apnoea) amongst the public, patients, parents and future doctors in Singapore are inadequate and there is an urgent need for increased education in this area given the importance of good sleep in children. There is also a need to change parental attitudes about sleep disorders and encourage early medical consultation.

Key words: Disorders, Knowledge, Patterns, Prevalence
Mental Health Professionals’ Perceived Barriers and Benefits, and Personal Concerns in Relation to Psychiatric Research
Authors: Pek Elaine , Subramaniam Mythily , Vaingankar Janhavi , Chan Yiong Huak , Mahendran Rathi
Published: February 2023

Aim: Mental health professionals can contribute to generating a strong evidence base for policy and practice in psychiatry. An insight into their perception of psychiatric research is important for planning support strategies. This study explored healthcare professionals’ perceptions of barriers, benefits and concerns about psychiatric research in a Singapore psychiatric hospital.

Materials and Methods: Self-administered questionnaire was employed to collect socio-demographic data and opinions on research. Likert scale was used for the responses and descriptive statistics and ordinal regression were used for data analysing.

Results: 93.8% respondents perceived “contribution to medical knowledge/ public health” to be a major benefit of conducting research. 86.7% respondents felt that “learning experience” was important. “Prestige/publication” (52.7%) and “financial gain” (76%) were perceived to be unimportant. “Clinical load of patients”, “lack of skilled personnel to assist in research” and “insufficient funding” were identified as important barriers by 72.4%, 70.6% and 68.9% respondents. “Time constraints”, “patient and family readiness to research participation”, “insufficient training” and “concerns about patient welfare” are major concerns while conducting research.

Conclusion: To the study team’s best knowledge, this is the only study of mental health professionals’ perceptions on psychiatric research. It is useful for strategising research planning and enhancing the research culture in the hospital.

Key words: Healthcare professionals, Mental health research, Research planning strategies
Intracranial Aspergilloma in Immunocompetent Patients Successfully Treated with Radical Surgical Intervention and Antifungal Therapy – Case Series
Authors: Srinivasan US
Published: February 2023

Introduction: Aspergillosis of the central nervous system is an uncommon infection, mainly occurring in immunocompromised patients with a high mortality. Surgical excision of the intracranial lesion combined with oral voriconazole has been proposed to improve the outcome in immunocompromised patients. Itraconazole has been considered not to be effective because of poor penetration into the brain tissue. We report the long-term outcome of 3 cases of intracranial aspergilloma in immunocompetent patients who were successfully treated with radical surgery combined with oral itraconazole.

Materials and Methods: This is a retrospective study in which chronic invasive intracranial aspergilloma was successfully treated in 3 apparently immunocompetent patients and followed-up for more than 5 years.

Results: Near complete or radical surgical removal of this localised chronic invasive intracranial aspergilloma whenever possible is the definitive treatment. When combined with the oral antifungal drug itraconazole, the management regimen is effective in achieving near complete long-term cure of more than 5 years. Oral itraconazole 200 mg twice daily should be given for a prolonged period of at least 6 months.

Conclusion: In chronic invasive intracranial aspergilloma in an immunocompetent patient, it was suggested that radical excision of the intracranial aspergilloma combined with oral antifungal drug belonging to triazole group that can be either itraconazole or voriconazole given for a period of 6 months was likely to improve the long-term outcome.

Key words: Central nervous system aspergillosis, Aspergilloma, Itraconazole, Voriconazole
Correlação entre características físicas e atributos sensoriais de Coffea arabica L. por meio de análise de fatores
Authors:   , Moreira Daniele Birck
Published: February 2023

Atualmente há um crescente esforço na seleção de genótipos de cafeeiros para a qualidade de bebida. Uma vez que a qualidade é influenciada por muitas variáveis, é importante avaliar o grau de correlação entre as mesmas, bem como testar a eficiência de estratégias de seleção multivariada na obtenção de genótipos com melhor qualidade. Sendo assim, o presente trabalho teve como objetivo estudar a associação entre a produção, características físicas e sensoriais por meio de análise fatorial, bem como testar a seleção, com base em variáveis latentes, de genótipos de Coffea arabica para a qualidade de bebida. Utilizou-se o delineamento de blocos ao acaso com 59 genótipos de C. arabica, em três repetições. Foram analisadas as variáveis produção e rendimento médio, peso de 100 grãos, grau Brix, percentagem de grãos do tipo cereja, verde, verde-cana, frutos passa, frutos boia, percentagem de defeitos e a percentagem de grãos retidos em um conjunto de peneiras (15, 17, 19 e fundo). Além disso, atributos sensoriais foram avaliados pela metodologia proposta pela Specialty Coffee Association of America (SCAA): fragrância/aroma, sabor, acidez, corpo, padrão geral, balanço, xícara limpa, uniformidade, doçura, finalização e nota final. Os coeficientes de herdabilidade e acurácia obtidos indicam condições favoráveis à seleção de materiais para as características avaliadas, com exceção à variável fragrância/aroma. As correlações obtidas e a análise de fatores indicaram a formação de três grupos de variáveis latentes: qualidade sensorial, estádio de maturação e peneiras. Nenhum dos grupos exibiu correlação significativa com a produção. As estimativas de ganhos preditos com 15% de intensidade de seleção foram baseadas nas respostas correlacionadas estabelecidas nas cargas fatoriais de cada fator, com o acréscimo das cargas fatoriais para grãos cereja, produção, rendimento, grau Brix, peneira 19 e atributos sensoriais e decréscimo para as características grãos verdes, verde-cana, frutos passa, fração boia, percentagem de defeitos, peneira 15 e fundo de peneira. A resposta correlacionada baseada nas cargas fatoriais proporcionou ganhos de seleção para grãos cereja, peneiras menores e atributos desejáveis para qualidade de bebida. Palavras-chave: Melhoramento genético. Parâmetros genéticos. Qualidade de bebida. Ganho de seleção. Rede de correlação.
A Pilot Study to Analyse the Effectiveness of Dendritic Cell Immunotherapy in Ovarian Cancer
Authors:   MBBS, MD, Cancer Immunotherapist, India, Khan Jamal A , Yaqin Sharmin ,   MBBS, MD, Radiation Oncologist, India, Deswal Monika ,   MBBS, MD, Pain and Palliative Care Physician, India
Published: February 2023

After breast and cervical cancers, ovarian cancer ranks third among gynaecological cancers in terms of prevalence. Those with metastatic ovarian cancer have a five-year survival rate of less than 27%. The likelihood of survival is almost 90% for people with confined or primary illness. In reality, only 20% of cancers are found at that early stage. Others were found after the tumour had already invaded the whole peritoneal cavity. Chemotherapy is ineffective against cancer cells at this stage, resulting in low survival rates and high recurrence rates. The ability of immune cells to eradicate cancerous cells is inhibited by ovarian tumours’ severe immunosuppressive nature and many immune-suppressing mechanisms. In addition to conventional therapy, dendritic cell immunotherapy has been shown to be one of the most effective ways to prevent recurrence and improve overall survival by utilising the immune system’s capacity to attack malignant cancers. We conducted a study on individuals with ovarian cancer while keeping in mind the tumour microenvironment and dendritic cell functionality in ovarian cancer. Individualized autologous dendritic cell immunotherapy was given to each patient. With regard to the response rate and overall survival, the study’s findings and ramifications are examined.
Recent Advancements in Gremlin-1: Breast cancer
Authors: Nimrah Inam  , Ayesha Hameed  , Lubna Vohra  , Sana Zeeshan
Published: February 2023

One of the bone’s morphogenic protein (BMP) antagonists, Gremlin-1 or GREM-1, can bind directly to BMPs. GREM-1 can act in either BMP-dependent or -independent pathways, according to research. It reinforces organogenesis, tissue differentiation, and organ fibrosis. Recent research from numerous studies has demonstrated the significance of GREM-1 in the initiation, progression, and even metastasis of different cancers, including breast, cervical, gastric, and colorectal cancers. This review highlights the function of GREM-1 in the development of breast cancer and its effect on the cellular procedures and signalling pathways involved in carcinogenesis.

Keywords: Bone Morphogenetic, Carcinogenesis, Organogenesis, Colorectal Neoplasms, breast cancers, stem cells
Pembinaan, Kesahan dan Kebolehpercayaan Modul Penulisan Karangan Bahasa Melayu Tingkatan Dua
Authors: Raman Subramaniam , Zainal Muhammad Zuhair , Amzah Fadzilah
Published: February 2023

Pelaksanaan kajian ini adalah untuk membina modul penulisan karangan, menentukan kesahkan modul dan juga kebolehpercayaan modul dalam meningkatkan pencapaian penulisan karangan Bahasa Melayu murid tingkatan dua. Modul ini telah dibina berteraskan model ADDIE yang mempunyai lima fasa pembinaan. Reka bentuk kajian ini ialah kajian deskriptif menggunakan pendekatan kuantitatif. Instrumen yang digunakan untuk kajian ialah borang soal selidik kesahan kandungan modul dan kebolehpercayaan. Pengesahan modul telah dibuat oleh 8 orang pakar penilai yang terdiri daripada pensyarah universiti awam dan guru pakar. Mereka mempunyai kepakaran dalam kandungan, bahasa, modul dan pedagogi serta kurikulum. Manakala kebolehpercayaan modul diperoleh daripada 26 orang murid tingkatan dua yang telah menyertai pelaksanaan kajian rintis. Skor Alpha Cronbach yang diperoleh untuk kesahan modul ialah 0.86 manakala untuk kebolehpercayaan ialah 0.91. Pandangan pakar terhadap kesahan modul ini adalah tinggi. Manakala maklum balas positif diterima daripada responden berkaitan kebolehpercayaan modul dan mendapat nilai kebolehpercayaan yang tinggi. Dapatan ini mencerminkan modul ini boleh diterima pakai dalam kalangan murid untuk meningkatkan pencapaian penulisan mereka.
Pentingnya Penyuluhan Pemeriksaan Kesehatan Rutin pada Lansia dalam Upaya Peningkatan GERMAS di Desa Tapak
Authors: Marsanti Avicena Sakufa , Astuti Bunga Harum , Rahmaanjali Anggit Lukyta , Andini Dhinda Ibram Putri , Utomo Ilham Ibnu , Maharani Laisa , Wardani Novelia Eka Pri , Febrianti Rizqi Isna , Fitriani Sonia
Published: February 2023

GERMAS (Gerakan Masyarakat Hidup Sehat) merupakan suatu tindakan sistematis dan terencana yang dilakukan secara bersama-sama oleh seluruh komponen bangsa dengan kesadaran, kemauan dan kemampuan berperilaku sehat dengan tujuan untuk meningkatkan kualitas hidup masyarakat. Pemeriksaan kesehatan rutin merupakah salah satu indikator dalam GERMAS. Berdasarkan hasil survei dan hasil Musyawarah Masyarakat Desa (MMD) dengan metode USG yaitu metode penentuan prioritas masalah berdasar pada Urgency (urgensi), Seriousness (keseriusan) dan Growth (perkembangan) dari suatu masalah, permasalahan pemeriksaan kesehatan rutin menjadi prioritas utama yang harus diselesaikan karena kesadaran masyarakat melakukan pemeriksaan kesehatan masih rendah. Pemecahan masalah yang dapat dilakukan adalah melakukan penyuluhan pentingnya pemeriksaan kesehatan rutin dengan sasaran lansia di Posyandu Lansia Wijayakusuma 1 dan Wijayakusuma 2. Kegiatan ini dirasa tepat karena penyuluhan dapat menjadi ajang bersosialisasi pada lansia. Kegiatan penyuluhan berjalan dengan lancar dan memenuhi target capaian berupa tingkat kehadiran di posyandu mengalami kenaikan jumlah partisipan melebihi 60%sehingga dapat dikatakan bahwa penyuluhan yang dilakukan berhasil. Upaya Indonesia dalam mengatasi permasalahan keluarga sehat masih menjadi fokus yang diselesaikan saat ini terutama permasalahan kesadaran masyarakat tentang melakukan pemeriksaan kesehatan rutin bagi lansia di Desa Tapak. Upaya pendukung dari pihak puskesmas setempat harus lebih sering dan gencar melakukan penyuluhan terkait pentingnya pemeriksaan kesehatan rutin kepada masyarakat.
CÂNCER DE PRÓSTATA E PLANTAS MEDICINAIS: UMA ALTERNATIVA TERAPÊUTICA
Authors: Ventura Caroline , Pereira Danielle Cristina , Gomes Cezário Fernanda , Santos Laise Aparecida , Furlani Zoccal Karina , Tefé-Silva Cristiane
Published: February 2023

O câncer de próstata é considerado um câncer da terceira idade, ocorrendo em maioria a partir dos 65 anos, sendo, na população masculina, a forma de câncer mais frequente, com alta incidência e taxa de mortalidade. Por ser considerado um problema de saúde pública, as plantas medicinais, que sempre estiveram presentes na terapêutica auxiliar de certas doenças, podem servir como ferramenta no tratamento desta neoplasia. Sendo assim, este estudo tem como objetivo estudar as propriedades das plantas medicinais como alternativa terapêutica no tratamento do câncer de próstata. Foi feito uma revisão de literatura estudando a funcionalidade dos bioativos de plantas como forma de auxílio na resolução e melhora do quadro clínico no câncer de próstata, pesquisando em bibliotecas virtuais, como o PubMed, com as palavras "Medicinal plants" OR "Prostate Cancer" OR “Prostate AND treatment”. Foi visto que as substâncias estudadas apresentaram uma relevante proteção contra metástase e crescimento tumoral, levando a uma boa ação terapêutica. Pela curcumina se observou por inibir a ação de NFkB e estímulo RA, além de regulação de Bax e Bcl-2, e também a atividade do PSA e TGF-B. Ademais, foi visto que componentes do alho também possuíram atividade benéfica, principalmente o Trisssulfeto de Dialila, e em igual importância, a Epigalocatequina-3-galato, presente no Chá-verde, que também apresentou desfechos benéficos para o controle de crescimento tumoral. Com isso, a fitoterapia é vista como forma relevante no tratamento alternativo, ou em associação, desse tumor, propiciando redução da morbimortalidade e melhora do prognóstico clínico.
First record of the flying fox bat fly Cyclopodia horsfieldi de Meijere, 1899 (Diptera: Hippoboscoidea: Nycteribiidae) on Ursula Island, Philippines
Authors: Amarga Ace Kevin S. , Hastriter Michael W.
Published: February 2023

Cyclopodia horsfieldi de Meijere, 1899 is an Old World nycteribiid bat fly primarily ectoparasitic to flying foxes (Pteropodidae). This is the first record of C. horsfieldi on Ursula Island, Philippines. This represents the first report of an ectoparasitic arthropod on bats in this protected area.
The Effect of Rigid Inclusions on the Dynamic Response of Highway Embankment
Authors: Bouabdallah Faris , Goudjil Kamel , Messast Salah
Published: February 2023

Soft soils are widespread in many areas of the East-West highway of Algeria, covering large areas. Construction projects such as highway embankments, airfields, roads, and railways in such areas experience several problems due to their low strength and permeability. This study used a fully dynamic analysis to evaluate the dynamic response of a highway embankment. The numerical analysis was carried out using the FLAC 2D version 8.10 software. The main objective was to evaluate the effect of rigid inclusions on the dynamic response of highway embankments by monitoring settlement, shear-strain curves, and maximum soil accelerations and displacements at different depth points. The obtained results showed that the configuration of the rigid inclusions significantly influences the dynamic response of the model. For instance, the settlement at 0.9m is 16% higher than at 0.2m from rigid inclusion.
Bridging the Effect of the Impactor Head Shape to the Induced Damage during Impact at Low Velocity for Composite Laminates
Authors: Rabouh Mustapha , Guerraiche Khelifa , Zouggar Kamel , Guerraiche Djemaa
Published: February 2023

The present paper presents an investigation and analysis study of the effect of the head shapes of the impactor on the damages observed during low-velocity impact on T700/Epoxy composite laminate. Two types of impactors were investigated: hemispherical and flat-face. A new criterion based on the LARC05 damage model was linked as a LARC_VUMAT subroutine to simulate the impact and explore the effects of the head form shape through a three-dimensional finite element model. To properly analyze the problem, the history time of the mechanical responses, such as impact forces, bending, principal, and residual stresses, are highlighted and assessed. Additionally, a comparison with the experimental data found in the literature was performed to check the validity and accuracy of the considered finite element model. The damage occurring in the T700/Epoxy plates is illustrated for each impactor head shape. The mechanical response curves and all kinds of damage of the presented simulations are in perfect agreement with the experiments. The proposed VUMAT is efficient in the prediction of fiber kinking, matrix cracking, fiber splitting, and fiber tension of a laminate, and more importantly, it is easy to implement for other types of materials and the reproducibility of the analysis is assured.