bluuebunny/crossref_metadata_2025 huggingface dataset:
A rare case of ectopic Cushing syndrome presenting with weight loss
Authors: Şah Ünal Fatma Tuğçe , Canpolat Asena Gökçay , Kıvrak Hale , Çorapçıoğlu Demet
Published: January 2023

Introduction

Cushing's Syndrome (CS) due to ectopic ACTH release, ectopic ACTH syndrome (EAS) is a rare cause of ACTH-dependent CS. Although many malignancies are associated with EAS, the most common of these is neuroendocrine tumors of the lung. EAS-induced hypercortisolism has a rapid onset and has serious life-threatening clinical consequences. The recommended first-line treatment of EAS is the surgical removal of the ectopic ACTH-secreting tumor (EAT). Despite improved imaging techniques, 10–30% of EATs cannot be located by first-line imaging methods and often require secondary evaluation or functional imaging techniques.

Clinical Case

A 26-year-old male patient with no known comorbidities, refers with complaints of weight loss, proximal muscle weakness, fatigue, dizziness, decreased voluntary attention and erectile dysfunction for 2 months. In the initial assessment, his blood pressure was 170/100 mmHg, pulse rate 85 bpm, body mass index was 24,8 kg/m2, ın physical examination nothing remarkable except dark coloured striae larger than 1 cm in the abdomen. There was no history of drug or herbal substance use. In the laboratory evaluation of the patient, hypokalemia and high fasting blood sugar were detected. The plasma ACTH and cortisol levels were elevated. 24-hour urinary free cortisol level was high. The diurnal rhythm of the cortisol was disturbed. Thereupon, no suppression was observed in blood and urine cortisol levels in the suppression test of 1 mg, 2 mg and 8 mg dexamethasone, respectively (Table 1). In the high-resonance CT imaging of the patient with suspected ectopic ACTH release, no tumor was detected in the first examination. CT imaging of the abdomen and pelvis revealed hyperplasia in the bilateral adrenal glands and an irregularly shaped nodule of approximately 7.5 mm in diameter, adjacent to the right lung lower lobe bronchus in the cross-sectional area. Gallium 68 DOTATATE PET CT was performed. In the nodular area at the base of the right lung, an increased activity was detected with a SUVMAX of 3.1. The patient was evaluated on the multidisciplinary endocrinology board and it was decided to perform a right lung lower lobectomy. The pathology result was reported as typical carcinoid tumor. A 100% ACTH positivity was detected in the immunohistochemically examination(Figure 1). Short-term low-dose steroid treatment was given to prevent adrenal insufficiency in the postoperative period. When the patient was evaluated with clinical and laboratory findings in the 3rd month, it was seen that cure was obtained in terms of CS.

Conclusion

As this case shows, EAS management is a rare condition that requires a multidisciplinary approach and can be difficult to diagnose and treat. Although weight loss appears paradoxical with CS, malignancy-related weight loss should also be considered. Early and accurate management is vital because of its course that can cause rapid clinical deterioration.
A rare reason for hospital admission with muscle weakness in the Covid-19 rra: CPT-2 deficiency
Authors: Akçay Seçkin , Talha Şişman Ibrahim , Yavuz Dilek
Published: January 2023

Introduction

Carnitine Palmitoyl Transferase-2 (CPT-2) is a mitochondrial enzyme involved in the pathway of long chain fatty acids. CPT-2 deficiency is a rare autosomal recessive disease. Except for neonatal and severe infantile hepatocardiomuscular forms, the myopathic form diagnosed at later ages often presents with attacks of muscle weakness and recurrent rhabdomyolysis attacks.

Clinical Case

A 27-year-old male patient who applied to the emergency department with complaints of pain all over the body, muscle weakness, nausea, vomiting, headache and decreased urine output in the last 2 days. He was consulted because of LDH: 456 U/L (0–248 U/L), CK: 5567 U/L (0–190 U/L), AST: 382 U/L (10–37), ALT: 89.8 U/L (10–40 U/L), creatinine: 1.23 mg/dL (0–1,2 mg/dL). He was interned with the prediagnosis of acute kidney injury secondary to rhabdomyolysis. It was learned that he had been fasting for 2 days and working at an intense physical pace. There were intensive care hospitalizations due to rhabdomyolysis at the age of 16 and 24 years and Reye's syndrome at the age of 15. It was not diagnosed at that time. His mother's cousin when he was 15 had sudden cardiac death. On physical examination, he was conscious and his general condition was poor. Blood pressure: 141/100mmHg, pulse: 76/min, and fever: 37.4. There were 4/5 muscle weakness in bilateral lower extremity proximal muscles 3/5, distal muscles 4/5, upper extremity proximal and distal muscles 4/5. Pre-diagnoses of very long chain fatty acid dehydration deficiency, CPT-2 deficiency, glutaric acidemia type-2 were considered, IV hydration and riboflavin 3×100mg, coenzyme-Q 2×100mg, carnitine 2×1gr mitochondrial cocktail were started. Tandem Mass and urine amino acid levels were requested from the patient who was in the attack period. During his hospitalization, he had increases of acute phase reactants and respiratory symptoms, Covid PCR+ was detected. Liver function tests increased under favipravir treatment. In the follow-up, the values of CK, creatinine and liver function tests ​​decreased with hydration. Homozygous c.338C>T(p.Ser113Leu) mutation was detected in the CPT-2 gene.

Conclusion

CPT-2 deficiency should be kept in mind as a rare cause of increased muscle weakness after fasting, intense exercise, and all infections, especially Covid and other upper respiratory tract infections. Intense hydration and mitochondrial cocktail therapy should be added to the patient until the diagnosis is clarified.
Injection site reaction induced by liraglutide use in a female patient with obesity
Authors: Ayhan Ihsan , Topaloğlu Ömercan , Tekin Sakin , Bayraktaroğlu Taner
Published: January 2023

Introduction

Glucagon-like peptide-1 agonists (GLP-1 agonists) are one of the top treatment options in obesity and/or type 2 diabetes (T2D) according to the guidelines. It is well tolerated in patients with cardiovascular disease or chronic kidney disease. Allergic symptoms such as rash and pruritus have been reported in some publications in the use of liraglutide. We also reported an allergic reaction in the injection site associated with liraglutide administration.

Clinical Case

A 38-year-old female patient was referred with the complaints of obesity and postprandial tremor and dizziness. She gained weight about 8 kg (from 81 kg to 89 kg) in the last year. She had been taking escitalopram and trazodone with a diagnosis of anxiety. She had no history of previous surgery, smoking or alcohol use. Family history had type 1 diabetes in her sibling and prediabetes in her mother. On physical examination, height was 175 cm, body weight 92 kilogram, BMI was 30 kg/m2, blood pressure 126/88 mmHg, and heart rate 90/min. Systemic examinations were unremarkable. Abdominal sonography revealed grade 1 hepatic steatosis. Glucose level was measured as 101 mg/dL, Hb A1C 6.1%, TSH 4.55 µIU/mL, free T4 0.88 ng/dL, LDL 142 mg/dL, total cholesterol 215 mg/dL. Glucose measurements after oral glucose load were in normal range. Levothyroxine 25 µg and liraglutide were prescribed. One month later, the patient lost weight about 4 kilograms, but a macular rash 2 cm in diameter around the umbilicus was detected on examination, consistent with an allergic reaction (Figure 1). The patient was prescribed desloratadine, and advised to continue the injections and called for close follow-up. In the follow-up, patient lost a total of 12 kg weight in 4 months, and the rash regressed and did not recur.

Conclusion

In our case, a minor allergic reaction was observed with liraglutide use, and we continued liraglutide injection. We suggest close follow-up, continuation of liraglutide and addition of antihistaminics in the development of minor allergic reactions, considering the benefits and harms on a case-by-case basis.
An unconventional case of hypokalemia
Authors: Rao Mohan K , Swarup Mirudhubashini
Published: January 2023

Hypokalaemia is a common clinical problem. The underlying pathophysiology maybe one of them: insufficient potassium intake, excessive urinary or GI losses, and transcellular shifts.

Clinical Case

36/F presented with c/o B/L lower limb weakness for 3 days. She had no respiratory or swallowing difficulty and was able to move her neck muscles. No bowel or bladder incontinence. The patient was not on diuretics. A significant past history of similar complains 4 years & 2years back. Both times, she was evaluated to have hypokalemia and was treated with oral and IV K supplements. But, cause was not determined. She was diagnosed with T2DM 4 years back when she presented with irregular menses. Her other medical problems included PCOS (on OCPS), hypertension and dyslipidemia. There is a strong family h/o diabetes, & a family h/o breast CA. There were no symptoms of recent or chronic vomiting or diarrhea. She did not have any symptoms of thyrotoxicosis and was not taking beta-adrenergic agonists. She also denied treatment with corticosteroids.

O/E, the patient was obese. BMI-29.0kg/m2, HR, 90bpm, BP 150/100mmHg. Acanthosis nigricans was + around the neck. The rest of the examination was normal. Initial lab results - K level 2.0mmol/L. 24hr urinary K-21mEq/day. ABG-Ph 7.49, bicarbonate 26.2mmol/L. S. Mg 1.5mg/dl. Plasma renin 5.09ng/dl, plasma aldosterone 0.63µiu/ml, A/R ratio of 8.08. The possibility of Cushing's syndrome was considered. Further evaluation, baseline 8am cortisol 19.6µg/dl. 1mg screening overnight dexamethasone suppression test (DST) - 17.56µg/dl (<1.8µg/dl). As it was positive, a confirmatory 0.5mg low dose DST was done. The 3rd day 8am S.Cortisol was 10.8 µg/dl (43.15% suppression). S.ACTH level-196pg/ml. A 24hr urinary cortisol-1284µg/dl. To differentiate between Pituitary and Ectopic Cushing's, overnight 8mg DST done. Baseline S.Cortisol repeated, 24µg/dl. After suppression, 15.9µg/dl (33.75%).

MRI pituitary performed, a well-defined heterogeneously enhancing mass lesion (measuring 15×13 x11 mm) was noted in the sella with mild suprasellar extension.

Cushing's disease - ACTH producing pituitary macroadenoma with mild suprasellar extension with no compressive features, presenting as hypokalemic paralysis

Treatment: Transsphenoidal resection of the tumor

S.cortisol repeated after 2 months-4.80µg/dl, after 3 months - 4.19µg/dl. T. Prednisolone 5mg was started, OD. S.cortisol repeated after 5 months - 10.65µg/dl. S. ACTH repeated after 1 month of surgery 101pg/ml. 4 months later, I/v/o persistent hyperpigmentation and poor glycemic control, MRI Pituitary repeated, some residual tissue noted. Patient was subjected to a session of radiotherapy and is currently doing well.

Conclusion

An unusual case of hypokalemia with no obvious features of Cushing's Disease, presented as hypokalemic paralysis and metabolic syndrome, with features of ACTH excess.
A rare presentation of acromegaly: Hypercalcemia
Authors: Kara Zehra , Sulu Cem , Demir Ahmet Numan , Kadıoğlu Pınar
Published: January 2023

Introduction

Acromegaly is a chronic disease in which adenoma composed of somatotroph cells causes excessive GH secretion. There is an increase in morbidity and mortality with the metabolic effects of GH secretion and the mass effect due to the compression of the adenoma. Hyperphosphatemia and hypercalciuria are seen at a rate of 30–60% in Acromegaly patients, which are presenting symptoms in our case.

Clinical Case

A 56-year-old woman presented with headache, weakness, sweating, and pain in the bones of the hands and feet, which had started within last one year. In the examinations, hypercalcemia and hyperphosphatemia were detected. The patient had a history of Hashimoto's thyroiditis, Addison's disease, Sjögren's syndrome and type 2 diabetes. She uses levothyroxine, hydroxychloroquine, hydrocortisone and metformin as treatment. In our evaluation, skin turgor was found to be decreased. Laboratory tests; Ca 12.1 (8.5–10.4) mg/dl, Albumin 3.9 gr/dl, P 5.6 (2.4–5.5) mg/dl PTH 1.8 (12–72) pg/ml, PTHrP<0.5 pmol/L, 25 (OH) Vit D 34 (30–70) ng/ml, 1.25 dihydroxyvitamin D3 35 (30–70) ng/L. Multiple myeloma and other malignancies were excluded, sarcoidosis and other granulomatous causes were ruled out. The patient was euthyroid and mobile. The patient has no history of vitamin A and thiazide use. She was using hydrocortisone 30 mg/day because of Addison. Insulin-like growth factor (IGF-1) 394 ng/ml (93–245), GH 1.76 ng/ml was detected. 0, 1. and 2nd hour in oral glucose tolerance test (OGTT)-GH; hour GH/glucose values were 2.5/91, 1.07/166, 4.02ng/ml /211mg/dl, respectively. Sella MRI revealed a 5×3.5 mm adenoma in the left pituitary gland.

Figure-1 Pituitary adenoma in sella MRI (coronal and sagittal sections)

Figure 2 The course of PTH and Ca

The operation could not be performed early in the pandemic conditions, and the treatment was started with sandostatin 20 mg/28 days. Control IGF-1 was 212 ng/ml, serum Ca 9.4 mg/dl, PTH 23 ng/ml.

Conclusion

In case of hypercalcemia, it is recommended to consider also the diagnosis of Acromegaly and to check the IGF-1 level.
A rare cause of central diabetes insipidus with arthritis (Erdheim-Chester disease)
Authors: Khudhair Mahmood Shakir , Altae Gelal Abdali
Published: January 2023

Mr. Haider is a 26-year-old resident doctor who presented with intermittent fever relieved by NSAIDS fatigue, weakness, loss of libido, fever with no rigor, night sweat, bone, joint pain and knee swelling. He lost weight.

He was diagnosed with central chronic D.I for the last 3 years after several weeks history of polyurea and thirst without identifiable cause which follows elbow fracture with trivial trauma and was taking nasal desmopressin as required. His last symptoms were followed a Covid 19 attack. Physical examination reveals high fever 39 °C, pallor, thin built, no thyroid or lymph node enlargement. Chest examination is normal with no organomegaly on abdominal examination. Knee examination shows swollen red tender joint. Initial investigation shows ESR 110 mm/hr. CRP 10 mg/dl

Negative screening for tuberculosis, hepatitis, HIV, vasculitis and Brucellosis.

Normal kidney and liver function tests and electrolytes.Mild hyopochromic anemia. Normal free T4 and TSH, prolactin and cortisol.

Normal SHBG

Low morning testosterone twice 60 ng/dl. and 64 ng/dl. FSH and LH normal

Normal Dexa scan.

Thus till now there is feature of hypogonadism, D.I and arthritis.

Due to low testosterone MRI pituitary requested and reveals small size pituitary gland, absent post bight spot with mild thickening of the pituitary stalk with no mass lesion.

Suspicion of inflammatory or infiltrative lesion of pituitary was raised.

For proximal tibial lesion bone biopsy was done and revealed marked fibrosis with infiltration of bone marrow by foamy cells with multinucleated cells positive for CD 68 and negative for CD 1a by immunohistochemistry. Further evaluation by PET scan confirms the diagnosis and shows multifocal hypermetabolic symmetrical bone lesions most intense around elbows and knees consistent mostly with Erdheim Chester disease (ECD).

Patient was treated with testosterone injections with improved libido and consultation with oncologist was done to arrange the need for chemotherapy.

Molecular and genetic test is not available in Iraq and a sample was sent abroad.

To our knowledge this is the first reported case of ECD in Iraq.

Figure 1. PET image.
Exclusive Sertoli Cell Syndrome (ESCS) is a rare condition that has male infertility as its main consequence. It is one of the most serious forms of non-obstructive azoospermia, with a poor reproductive prognosis
Authors: Mohammed Adel Gassab
Published: January 2023

Exclusive Sertoli Cell Syndrome (ESCS) is a rare condition that has male infertility as its main consequence. It is one of the most serious forms of non-obstructive azoospermia, with a poor reproductive prognosis. In some cases, however, such as the type II of the syndrome, sperm can be recovered through testicular puncture and subsequent ICSI, with a 13% success rate. This article aims to report the case of an azoospermic 35-year-old patient, with no other significant changes in complementary exams. 35 years old man with history of primary infertility, he was married since 17 years with normal sexual activity and and average built. Hematologic examination and biochemistry lab data were within normal limits. LH and total testosterone values were also within normal range, together with slightly elevated FSH value (119.88mUI/ml. There was azoospermia in the first semen analysis.

Repeated semen analysis, 3 months later, revealed azoospermia. The karyotype of the patient is 46, XY with no Y chromosome micro deletions. Scrotal Color Doppler ultrasound and MRI examinations revealed that both testicles were in the left hemiscrotum. The lower testis had 53×26×43 mm dimensions and the posterosuperior located testis had 27×16×25 mm dimensions. Total abdominal ultrasonic examination revealed no developmental anomaly of urinary system. Family history of the patient revealed that mother and father were cousins no family history of infertility, the picture suggestive a case of sertoli only cell syndrome.
Complicated papillary thyroid cancer in young women: Case report
Authors: Altemimi Mahmood Thamer
Published: January 2023

Introduction

Despite papillary thyroid cancer (PTC) almost has a favorable prognosis, some patients for whom standard care is not sufficient due to the aggressive nature of their disease may exist. Here, we try to present a case report of young woman with a complicated PTC.

Clinical Case

A 32-year-old woman presented with a suspicious left lobe thyroid nodule, when a fine needle aspiration (FNA) cytology revealed classical PTC then underwent thyroidectomy with suppressive levothyroxine therapy was performed. During surveillance, a left supraclavicular lymph node (LN) was detected and an excisional biopsy was revealed metastatic PTC so that a total thyroidectomy with neck dissection was done, but unfortunately it was complicated by permanent tracheostomy. Two sessions of therapeutic radioactive iodine (RAI) were initiated at 150 mCi and then treated by suppressive levothyroxine therapy.

One year later on, another palpable cervical LN (area IV) with evidence of non-sizable thyroid tissue were discovered. A stimulated thyroglobulin level=150.8 (3.5–77) ng/ml, anti-thyroglobulin=18.41 (<115) IU/mL and thyroid scintigraphy showed an intense radioiodine uptake in the thyroid bed (relatively large remnant thyroid tissue +/- residual disease), with no evidence of discrete RAI-avid cervical, mediastinal LN, or distant metastases. The patient is refusing further surgical intervention and Tyrosine kinase inhibitors may be a chance.

Early wise approach and prediction the highly prevalent factors for aggressive PTC can judge the management plan.

Conclusion

Meticulous preoperative evaluation of LN metastasis is required for PTC patients with certain criteria to assess the management plan.
Can anti-thyroglobulin antibody (anti-Tg) be a tumor marker for recurrence in papillary thyroid carcinoma (PTC) in patients without autoimmune thyroiditis (AIT)?: A case report
Authors: Begüm Bahçecioğlu Adile , Faik Erdoğan Murat
Published: January 2023

Introduction

Thyroid carcinoma is the most common malignancy of the endocrine system, accounting for 1% of all newly diagnosed cancers. Thyroglobulin (Tg) is a tumor marker for papillary thyroid carcinoma (PTC) if the anti-thyroglobulin antibody (anti-Tg) is negative. In autoimmune thyroiditis (AIT) patients with positive anti-Tg, the level of this antibody can be a marker in the follow-up of PTC, since the anti-Tg concentration depends on the amount of Tg-secreting tissue. However, there is no clear data on whether the development of anti-Tg positivity during follow-up is an indicator of recurrence in a patient who has neither AIT nor anti-Tg positivity before surgery.

Clinical Case

21-year-old male admitted to our hospital with a complaint of a palpable mass on the neck. The patient was euthyroid and thyroid autoantibodies were negative. In neck ultrasonography (US), 10 mm EU-TIRADS 5 nodule in right lobe and pathologic lymphs nodes in right cervical compartments were detected, and FNABs were done.

Results were consistent with PTC. Total thyroidectomy, central and right neck dissection were performed. Histopathology report resulted in classic variant 2 cm PTC in right lobe, one central and 10 lateral pathologic lymph nodes among a total of 41. While 150 mCi RAI was given as adjuvant therapy; TSH level was 109 µIU/ml, Tg was 11 ng/mL and anti-Tg was negative. No involvement was detected in the post-RAI whole body scan except microscopic residual RAI avid foci in the thyroid bed and upper mediastinum. No pathologic focus was observed in the upper mediastinum in thorax CT. During one year, he was followed with an excellent response. At the end of the first year after surgery, anti-Tg antibody was detected as positive with 6.63 IU/mL (0–4 normal range) when neck ultrasonography and thyroglobulin were negative (<0.1 ng/mL). At the end of the second year that the patient was under close follow-up, the anti-Tg titer increased to 8 IU/mL and neck US revealed a single suspicious 7×6mm, round lymph node, with loss of normal hilum, in the central compartment (level VI-VII). Central lymph node dissection was performed when Tg washout was positive in this lymph node. Histopathological examination resulted in two metastatic (2 and 3 mm) lymph nodes out of four lymph nodes removed. In postoperative third months, Tg and anti-Tg were negative.

Conclusion

This case shows that anti-Tg can be used as a tumor marker for PTC in patients without AIT. It was thought that the autoimmunity that developed afterwards against the thyroglobulin antigen might have been triggered by the thyroglobulin that passed into the serum after the adjuvant rai treatment, and it might have turned into a tumor marker in this way for this patient. Therefore, we recommend that anti-Tg testing should be continued in the follow-up of patients with PTC whose anti-Tg were not positive before surgery.
Difficult situation in treatment of medullary thyroid carcinoma in patient with multiple endocrine neoplasia type 2 B(MEN2B)
Authors: Mohammed Adel Gassab
Published: January 2023

Introduction

Multiple endocrine neoplasia type 2B (also known as ‘MEN2B’,‘Multiple endocrine neoplasia type 3′ or ‘Wagenmann–Froboese syndrome’) is a genetic disease characterized by the presence of medullary carcinoma of the thyroid, pheochromocytoma, mucosal neuromas, marfanoid features and multiple skeletal abnormalities such as kyphoscoliosis and pes cavus.

Clinical Case

A 16 years male presented with neck swelling and dysmorphic feature in the form of marfanoid habitus, including multiple tongue and oral mucosal swelling with mucosal neuromas on the anterior third of the tongue, the lips and the inner eyelid. Lips are thickened and bumpy. Visible neck swelling, palpable solid neck mass, high arm span to height ratio at >1.05, elongated fingers, pes cavus and positive wrist sign which is defined as when the distal phalanges of the thumb and fifth finger overlap on encircling the opposite wrist, were present. Ultrasound of the neck revealed a left solid irregular mass (57mmx33mm), that is hypoechoic, has coarse calcification, hypervascularity, that is mostly central, Multiple cervical lymph node(abnormal nodes include shape (round), absent hilum, intranodal necrosis, reticulation, calcification, peripheral vascularity),Investigation at beginning, Normal thyroid function test and biochemical and electrolyte were observed, Chest x ray was normal, FNAC done for thyroid nodule that showed multiple clumps of large hyperchromatic oval cells picture suggesting high suspicion of thyroid malignancy, thyroid biopsy advised, The patient was referred the FDEMC center for further evaluation and investigation prior to the surgery. During investigation at FDEMC center, thyroid function test normal, biochemistry normal, including PTH and electrolytes, Calcitonin was very high 465 pg/mL (0.2–27.7 pg/mL),GH under GTT was normal, IGF 1 182µg/L (150–350),Plasma metanephrine 40 pg/ml(<90pg/ml),and Plasma normetanephrine 27pg/ml(<196pg/ml) were normal.

The patient referred to surgery, total thyroidectomy with radical neck dissection with multiple lymph node resection was performed.

The biopsy revealed medullary thyroid carcinoma with cervical lymph node secondaries (bilateral multiple foci in both lobes).

The patient kept on levothyroxine tab 100mcg.The follow up of the patient after one month by ultrasound and calcitonin level revealed residual thyroid tissue and two large cervical LN in the the ultrasound and a calcitonin level of 322 pg/mL

Another surgical neck dissection to the metastatic LN <multiple LN 7×5cm, multiple suprasternal mass dissection 3×2.5cm,remnant of thyroid tissue 0.8cm,Follow up the patient after one month by ultrasound and calcitonin level still showed that there is residual pathological cervical LN, while the calcitonin level still high 412 pg/mL. PET scan done for him showed there is uptake in the head, neck and chest. The calcitonin was repeatedly was high.
Systematic Review Reporting - Writing concisely and precisely
Authors: Chien Patrick , Khan Khalid
Published: January 2023

Systematic reviews rank at the top of the evidence hierarchy. Concise writing implies drafting the systematic review article succinctly, i.e. using as few words to express as full an extent of the research effort as possible. Precise writing means drafting the text with accuracy especially with respect to the methodological and statistical aspects. The Abstract ought to be succinct and structured to allow for editors, peer reviewers and readers to get the gist of the key aspects of the systematic review with a quick read. The readership needs to be able to critically appraisal systematic reviews for their internal and external validity rapidly. The Abstract also needs to be standalone, representing an independent summary that can be fully understood without the need for reading the full paper. The standard structure of the main text of a scientific article called IMRaD (Introduction, Methods, Results and Discussion) applies equally to systematic reviews in the same way as it does to any other kinds of research manuscripts whether related to laboratory experiments or clinical trials. Restricting the word count limits to those imposed by journals may at first seem difficult, even unfair, to systematic reviewers. However, with the availability of online appendices to transparently and fully report the details of the methods, results and other aspects of the work undertaken allows for a succinct print or PDF article. Writing a shorter manuscript is more effortful than writing a longer report. This commentary is aimed at novice systematic reviewers to help them learn the written and unwritten writing rules in order to assist them in producing impactful publications to support evidence-based medicine.

doi: https://doi.org/10.12669/pjms.39.2.7428

How to cite this: Chien PFW, Khan KS. Systematic Review Reporting - Writing concisely and precisely. Pak J Med Sci. 2023;39(2):---------. doi: https://doi.org/10.12669/pjms.39.2.7428

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.
THE FIRST REPORT ON THE MYCOPARASITE TRICHOTHECIUM ROSEUM (PERS. 1809) ON VENTURIA INAEQUALIS (COOKE) G. WINTER IN RUSSIA
Authors: Yakuba Galina V. , Astapchuk Irina L. , Mazurin Evgeny S. , Nasonov Andrei I. , Milovanov Aleksandr V.
Published: January 2023

A hyperparasite was observed on Venturia inaequalis during a survey in Krasnodar region, South Russia. Morphological characterization using light microscopy and molecular characterization by sequencing ITS region of nuclear ribosomal DNA and phylogenetic analysis revealed the identity of the pathogen as Trichothecium roseum. This is the first record of hyperparasite Trichothecium roseum on Venturia inaequalis from Russia.
CHARACTERISTICS OF INTER-SYSTEM INTERACTIONS BETWEEN MORPHOTYPE AND NEURODYNAMIC OF STUDENTS WITH DIFFERENT BMI LEVELS
Authors: Maltsev Victor P. , Govorukhina Alena A. , Malkov Oleg A.
Published: January 2023

Purpose. To study morphotype and neurodynamic peculiarities and their intersystem relationship in students with different BMI levels living in Khanty-Mansi Autonomous Okrug – Yugra.

Materials and methods. The research covered 174 first-year students of Surgut State Pedagogical University: 33 male and 141 female students. The study was conducted on a voluntary basis, with written informed consent to be examined. Anthropometric indices, body composition (Tanita BC-601), neurodynamic parameters (“NS-PsychoTest”) were evaluated. Statistical analysis was performed using the application package Statistica 7.0 (StatSoft, USA).

Results. Students with different BMI levels did not differ significantly in body length. The differences in mean body weight of the examined students (with low and high BMI values) were due to the combined increase of fat mass (49.6%) and muscle mass (34.3%) in the males and the predominant increase of fat mass (96.7%) in the females, as well as to a decrease of body water content (by 23.4% in the females and 12.1% in the males). The neurodynamic characteristics of the students surveyed reflect statistically greater velocity-strength performance in young males, with less reliability in the executive systems of neurodynamic reactions. The obtained results indicate a strong correlation between morphotype and neurodynamic indices in students with low BMI (R=0,77; χ2=78,527, p=0,016), and a moderate strength relationship in the groups with medium and high BMI (R=0,64; χ2=84,688, p=0,036 and R=0,61; χ2=78,040, p=0,028 respectively).

Conclusion. Values of the morphological indices of the examined students reflect the prevalence of meso- and macrosomatotypes. There is a prevalence of anthropometric indices and higher velocity and force indices of neurodynamic in males in comparison with females. In the complex of morphological and neurodynamic processes, the studied students act as a heterogeneous group, the heterogeneity of which is due not only to age-sex-specific morphotype and neurodynamic, but also to their joint interdependence.
ANTIOXIDANT ACTIVITY OF DAIRY PRODUCTS FOR BABY FOOD
Authors: Vysokogorsky Valery E. , Rosenfeld Julia G. , Sokolova Maria A.
Published: January 2023

Increasing the biological and nutritional value of breast milk substitutes by enriching different macro- and micronutrients is an important issue. To a certain extent, the nutritional value of milk is determined by its antioxidant activity.

The research aims to compare the antioxidant activity of dairy products for baby food and breast milk.

The current research studied cow pasteurized milk, drinking ultra-pasteurized “Tyoma,” sterilized milk for baby food “Agusha,” “NAN,” “Nutrilon,” and “Malyutka” milk mixtures, as well as breast milk of 17 women. The antioxidant activity was determined by the titrimetric permanganate method in aqueous and alcoholic milk extracts. The content of antioxidants in alcoholic extracts of milk and all dairy products significantly exceeds their levels in aqueous solutions. The content of water-soluble antioxidants in breast milk is significantly lower than in cow’s milk “Luzhaykino” and “Agusha,” but in infant formula, it corresponds to the indicators of breast milk. The level of alcohol-soluble antioxidants is lower in NAN and Nutrilon milk mixtures when compared with cow and breast milk. The milk mixture “Malyutka” does not differ from breast milk in terms of the antioxidant activity of alcohol- and water-soluble components.

Discussion. The use of separate determination of hydrophilic and hydrophobic antioxidants revealed significant differences between breast and cow’s milk. The enrichment of milk with easily destructible, water-soluble ascorbic acid did not affect the antioxidant activity of dairy products for baby food (“Agusha” and “Tyoma”).

The results obtained on the significant differences in the antioxidant properties of dairy products based on cow’s milk from breast milk indicate the need to optimize the composition of milk antioxidants for baby food and the creation of breast milk substitutes.
THE USE OF NATURAL ZEOLITES AS STATIONARY FILTERS FOR DISINFECTION AND PURIFICATION OF INDOOR AIR
Authors: Kondratyuk Elena V. , Maltseva Svetlana M. , Stroganov Dmitry A. , Ryabkova Elena A. , Trubina Irina S.
Published: January 2023

In this study, from an ecological and hygienic point of view, the possibilities of using a natural mineral – zeolite – in indoor air filters are considered.

The purpose of the work: based on the analysis of the adsorbing and disinfecting properties of various types of air filters to show the undoubted advantages of stationary filters based on natural zeolites. As methods, the researchers relied on methods of comparative analysis, description and characteristics.

Results. Ventilation systems even in a small building are quite complex and require regular cleaning and disinfection. The study showed that the filters traditionally used for this purpose of absolute purification, bactericidal treatment or carbon filters have significant disadvantages (high cost, complexity of maintenance and disposal), while stationary filters based on natural zeolites, mined including in Russia, are inexpensive, hypoallergenic, easy to maintain, regenerable, have a disinfecting and deodorizing effect. However, today they are practically not used, and the technology of regeneration of natural zeolites for air filters has not yet been worked out, although such a possibility exists.
PECULIARITIES OF MORPHO-ANATOMICAL STRUCTURE OF GYPSYWORT (LYCOPUS EUROPAEUS L.) IN RESPONSE TO TREATMENT WITH SILICON-BASED MICROFERTILIZER
Authors: Savchenko Olga M. , Kovalev Nikita I.
Published: January 2023

Background. For the comprehension the mechanisms of adaptation and increasing the bioproductivity of the Gypsywort, at the level of variability of micromorphological and anatomical features of the epidermis of the leaf plate and stem, it is proposed to study the reactions of plants to the use of micronutrients with adaptagenic properties.

Scientific originality. For the first time in the conditions of crop rotation, the adaptogenic effect of the micro-fertilizer Siliplant on the plants of the Gypsywort at the degree of the epidermal structures of the leaf and stem was shown and confirmed.

This work aim is to identify the morpho-anatomical features of Gypsywort, emerged as the result of exogenous treatment of plants with microfertilizer Siliplant.

Materials and methods. The Gypsywort’s plants, growing in the conditions of field crop rotation at the experimental field, were treated in the budding by micro-fertilizer Siliplant (0.055 gallons per acre). The control variant was treated with water. The consumption of the solution was 32,07 gallons per acre. The research material was collected under the second-year plants during the mass flowering phase. Leaf plates of the middle part of the shoots (10 pcs.) were taken from plants (5 pcs. of each variant). The anatomical method of analysis included microscopy and microphotography. A 9x Ernst Zeits Wetzlar light microscope and a 14.0 Mp USB 2.0 C-Mount camera were used for the study. The sample consisted of 10 measurements, statistical processing of the results was performed in Microsoft Excel. For each studied trait, its average value (M), the error of the mean (m) and the coefficient of variation (Cv%) were determined.

Results. The number and size of stomata were determined, the classification of trichomes was refined, their distribution, the density of pubescence and the number of essential oil glands were studied explored depending on the treatments of plants with Si-based microfertilizer. It has been found out that in plants growing in the field practically do not have hydathodes and pubescence increases.

Conclusion. Treatment of plants with silicon Si-based microfertilizer contributes to their adaptation to xeromorphic conditions: pubescence decreases, the number of essential oil glands increases, the growth of the bark and xylem elements intensifies. The increased number of stomates and their sizes in the variant with silicon-containing microfertilizer, compared to the control samples indicates its anti-stress effect on the gypsywort plants. The established features of the anatomical structure of plants can also be important in determining the authenticity of medicinal raw materials of Lycopus europaeus L. plants during microscopic analysis.
Involvement of Stakeholders in the Transformation of Educational Services via Taking Advantage of Extra-Curriculum Educational Activities in the Settings of Education Reform
Authors: Bobrytska Valentyna I. , Krasylnykova Hanna V. , Ladohubets Nataliia V. , Vorona Larysa I. , Lysokon Illia О.
Published: January 2023

The purpose of the study is to explore the ways of involving university stakeholders specifically in updating educational services. It combined exploratory and observational research methods which relied on qualitative or quantitative data gathered through the researcher-designed and validated tools which were the empirical and methodological contributions to the previous research. The five most frequent choices that might encourage the stakeholders to donate or invest in an educational institution were as follows: a portfolio of the use of donations, investments, or grants, having a stake in the educational services of more than 7%, having access to budgeting and cost reporting, having a share in the institutions’ profit and being one of the decision-makers. The factors that discouraged investors from investing in education were as follows: distrust of the activity of the educational institutions in terms of addressing the stakeholders’ needs or interests, lack of engagement or cooperation, institutional and government-imposed barriers between them and the institutions, uncertainty concerning the efficiency of the institutions and inefficient use of the resources by the institutions. The initiative was complimentarily perceived by stakeholders in terms of collaboration and investment opportunities. It was also found beneficial by the sampled students.
Path Planning and Smoothing for 4WDs Hydraulic Heavy-Duty Field Robots
Authors: Mäenpää Pekka , Mattila Jouni
Published: January 2023

This paper discusses the path planning and path-following control for a four wheel drive (4WD), steer-articulated boom lift driven by hydraulic actuators. The environment is assumed to be both static and known. The path planning will be done in two phases, where the first one finds a crude, collision-free path accounting for the vehicle dimensions, and this path will be smoothed with a path smoothing algorithm to satisfy the kinematic and dynamic constraints imposed by the vehicle and its actuators. The path smoothing algorithm will be chosen from several candidates by using a simulated test scenario. Then, the simulation results will be used to verify the path planners feasibility in heavy-duty, four-wheel-steered field robots having hydraulic actuators and high inertia.
Virtual Design and Analysis of the Balancing Element of an External Gear Machine Considering Cavitation and Mixed Lubrication Effects
Authors: Ransegnola Thomas , Vacca Andrea
Published: January 2023

This paper presents a simulation based approach for sizing the axial balance elements of a pressure compensated external gear machine. The reference hydraulic unit must be able to guarantee operation in two quadrants, as either a pump or a motor. It also needs to operate in a wide operating range of speed and pressure, as it is to be used as primary hydraulic unit for an electro-hydraulic actuator (EHA). The design procedure builds upon past work at the author’s center, but it extends it to the case of multiple quadrant units. Also, a unique method for modeling of both mixed lubrication and cavitation that might occur in the lubricating film is used. After describing the design procedure, the paper discusses the features of the balancing of a reference unit, along with the effects of both cavitation and mixed lubrication.
Experimental and Modelling Analysis of a Downstream Compensation System: Energy Optimization of the Directional Control Valves
Authors: Bonavolontà Antonella , Frosina Emma , Marani Pietro , Mesturini Davide , Dolcin Cesare , Busani Ulderico
Published: January 2023

Through a study on the Fluid Power innovations in the last years emerged that still few solutions have been successfully implemented for the optimization of the hydraulic circuits. The recent machine electrification offers a potential for investment in energy-saving hydraulic systems to ensure greater performance and higher battery autonomy. From different studies emerged that in the specific field of ICE Off-road Vehicles, only about 10–15% of the available power at fuel level is actually transformed into useful energy for the actuators. Particularly the losses in the Directional Control Valves represent about 35–40% of the hydraulic energy available at the pump level. The traditional Directional Control Valves design solutions, in fact, neglects important opportunities for reducing losses and improving internal regeneration. Especially, energy recovery is rarely applied and in any case by means of important superstructures which considerably increase the costs of the system. This paper presents a new hydraulic architecture: an original Directional Control Valve layout based on a Downstream Compensation approach. In particular, a Flow Sharing system is implemented in this new architecture with the goal to minimize the wasted energy. In fact, this system realizes an important energy recovery from both the inertial loads and the simultaneous use of multiple actuators at different pressure level. The circuit enables recovered energy to be stored in a high-pressure accumulator. The paper presents the simulation results and the energy saving estimation realized through a lumped parameter environment “Amesim Simcenter”. Additionally, the results of experimental activities show the innovative system performance, benefits and physical applicability. This idea is based on concrete objectives and pays particular attention to cost sustainability, industrial manufacturability and system scalability.
Analysis of Frequency Adjustable Control of Permanent Magnet Synchronous Motor for Pump-controlled Actuators
Authors: Zakharov Viacheslav , Minav Tatiana
Published: January 2023

Recently the pump-controlled system has actively been proposed as a replacement for conventional valve-controlled systems, to improve the energy efficiency in non-road mobile machinery. Earlier research demonstrated that a pump-controlled hydraulic system combines the best properties of traditional hydraulics and electric intelligence. This pump-controlled system can be realized via direct control of hydraulic pimp/motor by varying speed of electric motor without complex servo valves. Nowadays, a wide range of different electric motors is known and available with efficiency higher than 95% One of the most attractive option of electric motor is Permanent Magnet Synchronous Motor (PMSM) due to its size, power, and high efficiency.

However, control of electric motors in pump-controlled systems has are not yet considered and not well researched.

In this paper, the main objective of this investigation is determination of control values for the pump-controlled actuator and analysis of system’s behavior in different applications.

Therefore, model of PMSM drive with pump-emulated load is proposed. Field Oriented Control (FOC) gives wide range of the speed regulation and smooth characteristics, but tuning of controllers is challenging.

Case of the steering-modeled load represented that such operations need more power than other modes. More complex frequency converters allow to reach higher level of accuracy and decrease torque ripples, but complexity of such systems increases rapidly.
Manajemen Berbasis Masyarakat dalam Pengelolaan Lembaga Pendidikan Anak Usia Dini
Authors: Kahfi Muhammad Alim
Published: January 2023

This study aims to describe the basic concepts of community-based education management both theoretically and practically and explain how community-based management is implemented in the management of early childhood education institutions. This study uses a type of library research (library research). The results of the study show that there are at least eight types of community that play a role in community-based management in PAUD management, including individuals (religious leaders), families, Education Implementation Support Agencies (BP3) or school committees, professional organizations (GOPTKI, IGTKI, IGPAUD), entrepreneurs, community organizations, quality control of educational services, non-governmental organizations (NGOs).
STUDY OF THE PASSAGE OF ELECTRONS WITH ENERGY OF 12 – 15 keV THROUGH GLASS TAPERED CAPILLARIES
Authors: Piatigor A. D. , Myshelovka L. V. , Vokhmyanina K. A. , Sotnikova V. S. , Kubankina A. A. , Grigoriev Yu. V.
Published: January 2023

This paper presents the results of experimental studies on the passage of an electron beam with an energy of 12 and 15 keV through glass tapered macrocapillaries. As a result of the measurement, the absence of an explicit dependence of the output current on the electron energy was shown. Time-dependent measurements of the beam current at the exit from the capillaries were carried out.
POLARIZATION CONTROLLED BIREFRINGENCE IN SODIUM ALUMINOBORATE GLASS
Authors: Fedotov S. S. , Lipatiev A. S. , Lipateva T. O. , Lotarev S. V. , Prichach N. K. , Sigaev V. N.
Published: January 2023

The formation of birefringent nanogratings by a femtosecond laser beam in the volume of sodium aluminoborate glasses is demonstrated. The dependences of the optical retardance of the nanogratings on the parameters of laser exposure and the chemical composition of the glass are determined. It was shown that an increase in the Al2O3 concentration at a constant [Na2O]/([B2O3 + Al2O3]) molar ratio does not affect the ranges of laser exposure parameter for nanogratings formation but leads to an increase in the retardance of the nanogratings.
PHYSICO-CHEMICAL PROPERTIES OF MINERAL FIBERS OBTAINED ON THE BASIS OF ANDESIBASALTS
Authors: Niyazova Sh. M. , Kadyrova Z. R. , Usmanov Kh. L. , Eminov A. A. , Khomidov F. G.
Published: January 2023

The article presents the results of research on the development of prototypes for obtaining mineral fibers based on the andesibazalt–slag–dolomit composition and the results of testing their physicochemical properties. Tests of chemical resistance of optimal compositions in aggressive conditions showed that the chemical resistance of the fibers depends on the content of metal oxides in the glass and their ratios that take into account the mutual influence of SiO2, Al2O3, Fe2O3, CaO, MgO, Na2O, K2O. It has been established that the studied andesibasalt of the Karahtay field is a promising raw material component for obtaining mineral fibers.