bluuebunny/crossref_metadata_2025 huggingface dataset:
The prevalence of internet addiction and associated factors among undergraduate medical students in government medical college, Almora
Authors: Preeti  , Masroof Hasan Khan  , Mittal Sneha , Vikram Singh Dhapola
Published: June 2024

Background: The internet, computers, smartphones, and other electronic device’s use has increased suddenly over recent decades. Although this increase has benefits to the users, but also excessive use often leads negative health consequences.
Aims and Objectives: The objective of this study was to measure the prevalence of internet addiction (IA) and stress among undergraduate medical students.
Materials and Methods: A descriptive cross-sectional study was conducted among 299 undergraduate medical students enrolled in the government medical college, Almora. A 20-item Young’s IA test which is a Likert scale-based interview schedule was used to measure the prevalence of IA and the perceived stress scale 14 scale is used to assess stress among them.
Results: Among the 299 study subjects, 49.5% were males and 50.5% were females. Males were more addicted to the internet than females. The prevalence of IA among the study subjects in the present study was 45.4% mild, 13.8% moderate, while 40.8% of students reported normal internet usage.
Conclusion: IA is a growing health problem among medical students these days, thus necessary preventive and therapeutic interventions are very important to promote healthy and safe usage of the internet.
Children with bicytopenia and pancytopenia – clinical picture, etiological spectrum, and outcome
Authors: Vijay Anand M  , Logeshwaran K  , Srenivas A  , Sathiya Suresh R
Published: June 2024

Background: Children who develop cytopenias present with several etiological causes, posing diagnosis, and management difficulties for both physicians and pathologists. With these in mind, we assessed the clinical profile and etiology of children who attended a healthcare facility in South India with bicytopenia or pancytopenia.
Aims and Objectives: (1) The primary objective of this study was to find out the clinical and etiological spectrum in children with bicytopenia and pancytopenia who were admitted to the Institute of Child Health and Research Center, Government Rajaji Hospital, Madurai. (2) The secondary objective of this study is to follow-up children with bicytopenia and pancytopenia to find out the outcome and prognosis.
Materials and Methods: This study was in the Department of Pediatrics at the Government Rajaji Hospital in Madurai, Madurai Medical College’s Institute of Child Health and Research Center, which is where we carried out the study. Two hundred and sixty-four patients with bicytopenia and 36 patients with pancytopenia were included in this study. Once in 2 weeks, all children with bicytopenia and pancytopenia were assessed in our Saturday hematology outpatient clinics.
Results: Fever was the most prevalent sign of both pancytopenia and bicytopenia in this investigation. Etiological variables among cases of pancytopenia, cancer, infections, non-infections, and idiopathic causes were recorded in 11%, 58%, 17%, and 14% of cases, respectively. Similarly, bicytopenia, malignancy, infections, non-infections, and idiopathic causes were found in 23%, 70%, 4%, and 3% of cases, respectively. According to the prognosis, 28%, 33%, 6%, and 33% of cases with pancytopenia recovered, passed away, were lost to follow-up, or were undergoing treatment, respectively. Similar to those individuals, 67%, 11%, 4%, and 18% of bicytopenia cases were treated, recovered, or lost to follow-up, respectively.
Conclusion: In children, there is a wide etiological range of cytopenias. Infections and dangerous diseases like acute leukemia are among the reasons. The geographical location of the hospital, the frequency of malnutrition, and the regional presence of certain diseases such as malaria and enteric fever determine the causes reported in a hospital environment.
Sigma metrics application in clinical biochemistry: Practical requisite or unfeasible misadventure
Authors: Bhattacharjee Debojyoti , Ghosh Bithika , Ray Chaudhuri Arghya , Chakrabarty Sebanti , Naskar Sourav , Mukherjee Kheya
Published: June 2024

Background: The application of the Six Sigma (σ) metric in biochemical laboratories is a powerful tool for reducing the occurrence of errors and prioritizing important improvements in laboratory quality control. The National Accreditation Board for Testing and Calibration Laboratories (NABL) is an accreditation body with an accreditation system established in accordance with ISO/IEC 17011, providing specialty- or scope-based certification based on the conformance of quality indices to medical laboratories. In this context, a study has been designed that considers the quality guidelines set by NABL as well as the sigma metric rule in the assessment of analytical performance.
Aims and Objectives: The aims of this study were to identify the gaps and need for strategy modification for quality improvement by assessing the performance of two NABL-accredited medical testing laboratories on a Sigma metric scale.
Materials and Methods: A retrospective analytical study was conducted over 6 months (January–June 2021). Internal quality control (IQC) and EQAS data were obtained from third-party QC providers (Bio-Rad, India) and analyzed by calculating sigma (σ) values based on the coefficient of variation, bias, and total error allowable in two NABL-accredited medical testing laboratories. To identify potential problems for analytes with poor sigma values, a quality goal index (QGI) analysis was performed.
Results: By analyzing the sigma values obtained by both NABL-accredited laboratories, we can see that laboratory 2 performed better than laboratory 1. After calculating the QGI, there was a problem of inaccuracy and imprecision in laboratory 1, and laboratory 2 had QGI values that indicated only imprecision.
Conclusion: Diagnostic laboratories should incorporate Six Sigma metrics to identify gaps in their performance to ensure better quality control and patient safety.
Cardiovascular risk score predictive accuracy and subclinical atherosclerosis correlation in the Indian population: A cross-sectional study
Authors: Selvaprakash Elanchezhian , Kumaresan Kannan , Mani Narendran , Narasimhan Viswanathan
Published: June 2024

Background: Estimation of the risk of future atherosclerotic cardiovascular (CV) events is an important step in the primary prevention of CV events. However, the relative accuracy of the various currently available CV risk scores is not validated in Indians.
Aims and Objectives: The study was done to compare the accuracy of three clinically relevant CV risk assessment algorithms in the South Indian population and to validate the risk scores by correlating with the measures of subclinical atherosclerosis.
Materials and Methods: This cross-sectional study was conducted among patients attending a chest pain clinic at a Tertiary care center in South India. The study included subjects ≥30 years of age, with no previous coronary artery disease (CAD) and major cardiac illness. Totally 110 subjects were included in the study. Detailed clinical evaluation and routine investigations were done. The 10-year CV risk for each subject was calculated using the three risk scores – Framingham, American College of Cardiology/American Heart Association (ACC/AHA), and Q risk score. The risk scores of all patients were then correlated with their corresponding carotid intima-media thickness (CIMT) measured using carotid Doppler and coronary angiography results.
Results: The mean age of the study population was 51.45±9.01 years and the majority of them were females (57.2%). CAD patients demonstrated significantly increased CIMT. There was a significant positive correlation (P<0.001) between all three risk scores and carotid intimal medial thickness. As the carotid intimal medial thickness increases, the risk scores also increased (as shown by Pearsons’s correlation coefficient). Similarly, all three risk scores also showed a significant positive correlation (P<0.001) with the severity of CAD as assessed by CAG (as shown by one-way analysis of variance). The ACC/AHA score was the best score with a slightly higher accuracy of 69.9% than that of Q risk score (69.5%). The accuracy of Framingham’s score was found to be 68.3%.
Conclusion: ACC/AHA and Q risk score may be the most appropriate CV risk assessment algorithm for use in Indian populations at present. However, large-scale prospective studies are needed to confirm these findings.
Artificial intelligence meets medical expertise: evaluating GPT-4's proficiency in generating medical article abstracts
Authors: Sağtaş Ergin , Ufuk Furkan , Peker Hakkı , Yağcı Ahmet Baki
Published: June 2024

Purpose: The advent of large language models like GPT-4 has opened new possibilities in natural language processing, with potential applications in medical literature. This study assesses GPT-4's ability to generate medical abstracts. It compares their quality to original abstracts written by human authors, aiming to understand the effectiveness of artificial intelligence in replicating complex, professional writing tasks.
Materials and Methods: A total of 250 original research articles from five prominent radiology journals published between 2021 and 2023 were selected. The body of these articles, excluding the abstracts, was fed into GPT-4, which then generated new abstracts. Three experienced radiologists blindly and independently evaluated all 500 abstracts using a five-point Likert scale for quality and understandability. Statistical analysis included mean score comparison inter-rater reliability using Fleiss' Kappa and Bland-Altman plots to assess agreement levels between raters.
Results: Analysis revealed no significant difference in the mean scores between original and GPT-4 generated abstracts. The inter-rater reliability yielded kappa values indicating moderate to substantial agreement: 0.497 between Observers 1 and 2, 0.753 between Observers 1 and 3, and 0.645 between Observers 2 and 3. Bland-Altman analysis showed a slight systematic bias but was within acceptable limits of agreement.
Conclusion: The study demonstrates that GPT-4 can generate medical abstracts with a quality comparable to those written by human experts. This suggests a promising role for artificial intelligence in facilitating the abstract writing process and improving its quality.
Evaluation of Tumour Budding in Head and Neck Squamous Cell Carcinoma and Its Relationship with other Histological Parameters of Prognosis
Authors: Ghosh Shreshtha , Guha Priyadarshini
Published: June 2024

Background: Tumor budding (TB) is an emerging and promising histopathological prognostic parameter in oral squamous cell carcinoma (SCC). Tumour budding shows positive correlation with lymph node metastasis, higher pattern of invasion, high grade of tumor and more depth of invasion. These histopathological parameters are associated with poor prognosis, high rate of recurrence and these prognostic factors can be routinely used by clinicians for planning of multimodality treatment. Method: The present study was a cross-sectional study carried out on total of 239 patients with oral squamous cell carcinoma who attended the surgical oncology unit of Kalyan Singh Super Speciality Cancer Institute, Lucknow, Uttar Pradesh, India, from November 2020 to June 2022. Descriptive statistical analysis has been carried out in the present study. We used Fischer Exact Probability test and chi-square test analysis in order to identify relationship between different histological features, significance was considered when p<0.05. Results: Majority of study population (69.87%) were in the age group of less than 54 years of age. Age group (<54years) was significantly associated with tumor budding (p<0.05). Cases diagnosed as moderately differentiated SCC were 68.6 % and well differentiated SCC were 25.1%. 74 cases were associated with high intensity of tumor budding and 59 cases with low intensity of tumor budding (p<0.05). Most common worst pattern of invasion was type 4 (61.9%) followed by type 5 (26.4%), strong statistical association was observed with intensity of tumor budding (p<0.05). Most of the cases exhibited maximum depth of invasion (DOI) >1cm (100 cases). DOI was significantly associated with intensity of tumor budding (p<0.05). Out of 102 involved lymph node cases, 91 cases were associated with tumor budding 55 cases of these associated with high intensity tumor budding. Tumor budding was also significantly associated with lymph node metastasis (p<0.05).Conclusion: Present study showed a strong correlation of tumor budding with lymph node metastasis, depth of invasion and worst pattern of invasion. Thus, this study emphasizes the importance of tumor budding evaluation in routine pathology reporting and similar to depth of invasion TB should be included in AJCC TNM staging.
Risk Factor in Carcinoma Esophagus in Punjab Region of North India
Authors: Mahajan Divya , Makkar Nikhil , Singh Banipal Raja Paramjeet
Published: June 2024

Background: World over, esophageal cancer is the seventh most common cancer. It accounts for sixth most common deaths related to cancer. Studies have included various risk factors such as tobacco consumption, unhealthy diet like spicy food, alcohol, and diet deficient in trace elements mostly selenium, alkalinity of soil, genetic variation and low socio-economic status, have been implicated in the etiology of esophageal cancer.Method: A descriptive observational study of carcinoma esophagus patients between May, 2019 to October, 2020 was performed. A total of first consecutive 70 patients meeting the eligibility criteria were considered for study. Data was collected by personal interview.Results: Data was collected by personal interview. 82.9% of population resided in rural areas. 100% of patients consumed hot beverages with 70% of patients consumed tea, 11.4% consumed coffee and 18.6% consumed both. 60% of patient population used wood for cooking, 22.9% used liquefied petroleum gas (LPG), and 17.1% used cow dung. 25.7% of population consumed cigarette/Bidi, 10% consumed hookah, 7.1% consumed jarda and 28.6% consumed alcohol. 42.9% of patients had pesticide exposure. 47.6% of squamous cell type had pesticide exposure which was statistically significant. Conclusion: General public should also be made aware of the harmful effects of consuming spicy, high salt diet and hot beverages along with cigarette smoking and alcohol.
Significance and Impact of Changing WHO Classification Systems on Glial Tumors with Special Reference to IDH1 Mutation in Resource-Limited Setups
Authors: Singh Divya , Misra Vatsala , Varma Kachnar
Published: June 2024

Objectives: To reclassify glial neoplasms according to the 2021 WHO CNS tumor classification and to study the expression pattern of Isocitrate dehydrogenase 1 (IDH1) mutation by immunohistochemistry(IHC) and to categorize these tumors on the basis of IDH1 mutation. Methods: This retrospective study included patients who were diagnosed as glial tumors on histology (n=60). A detailed clinical history and radiological findings were obtained. Patients above 18 years were taken as adults while age upto 18 years were included in pediatric group. IHC for IDH1 mutation was done using Anti-IDH1 (R132H) antibody. Results: Among all glial tumors, 51.7% (31/60) were assigned IDH1 mutant status and the remaining i.e. 48.3% (29/60) were assigned IDH1 wildtype status. While classifying diffuse gliomas according to age, site and morphology, it was observed that the relative proportion of IDH1 mutant and IDH1 wildtype categories in the adult age group was 56.8% (25/44 cases) and 43.2% (19/44 cases) respectively while in the pediatric age group it was 45.5% (5/11 cases) and 54.5% (6/11 cases) respectively. Among the other glial and glioneuronal tumors majority were IDH1 wildtype (80.0%). Most of the WHO grade 1 tumors were IDH1 wildtype (71.4%, 5/7) whereas Grade 2 and 3 tumors were IDH1 mutant (83.3%, 15/18 and 100.0%, 5/5 respectively). On the other hand in Grade 4 tumors there was a higher proportion of neoplasms exhibiting IDH1 wildtype status (70.0%, 21/30). Conclusion: Identification of IDH status as mutant and wildtype is crucial in glial tumors (especially glioblastoma) because both these groups are clinically, genetically, biologically and prognostically different. IHC provides a standard alternative for molecular studies with high sensitivity and specificity with quick, economical and standard results especially useful in resource-poor countries. Reclassification according to the latest WHO classification appears to confer a overall better prognosis than the previous classifications and this study can also provide a base for future larger research avenues and treatment based on IDH1 mutation.
Long non-coding RNA Panel on Prognosis of Glioma in Iranian Patients
Authors: Esmaeili Sara , Kazerani Mahsa , Arjmandrad Elham , Pourzarin Amin , Falahati Alimohammad , Khosravani Amin , Sarli Abdolazim , Ashoori Hasan
Published: June 2024

Objective: Glioma is one of the most malignant brain tumors, accounting for about half of the gliomas that occur in central nervous system (CNS), originates from the glial tissue of the brain. The aim of the present study was to determine the expression levels of 3 lncRNAs (AGAP2-AS1, LINC01446 and HOTAIRM1) in patients with high grade glioma in comparison with low grade glioma. Methods: Case group consisted of 70 high grade glioma patients control group consisted of 70 patients affected with low grade glioma. RNA extraction was performed using a RNA extraction kit. Result: Our results showed that the expression of AGAP2-AS1 and LINC01446 genes significantly increased with increasing tumor grade (with fold-change ratio of 2.1 and 3.8 respectively). Also the expression of HOTAIRM1 gene increased with increasing tumor grade but this increase was not statistically significant (P value=0.6). Conclusion: We concluded that AGAP2-AS1 and LINC01446 are promising lncRNA markers in prognosis of glioma.
Effectiveness of Bacillus thuringiensis (Bt) application in controlling mortality of Spodoptera litura on rice plants (Oryza sativa L.)
Authors: Sembiring Jefri , Mendes Johana , Kusumah Rangga , Susanti Diana Sri , Anwar Anwar , Sarijan Abdullah , Yusuf Mani
Published: June 2024

Rice (Oryza sativa L.) is the primary commodity for the Indonesian people because most of the Indonesian population depends on rice. The armyworm pests Spodoptera litura causes irregular holes in the leaves, thus disrupting the photosynthesis process and reducing rice production, so it is necessary to treat the pest. Bacillus thuringiensis is a pathogenic bacterium for insects, such as S. litura. This study aimed to look at the effectiveness of B. thuringiensis on the mortality of S. litura on a laboratory and field scale. The research was conducted in the Agrotechnology Laboratory, Faculty of Agriculture, Musamus University. The research design was a complete randomized design (RAL). The research study was conducted on five treatment doses of B. thuringiensis, which were 20 g/500 ml of water; 40g/500 ml of water; 60 g/500 ml of water; 80 g/500 ml of water; 100 g/500 ml of water. Each treatment was repeated five times. The results showed that, applying B. thuringiensis can significantly decrease the population and intensity of S. litura. The highest mortality rate in laboratory trials was observed at a dose of 100 grams/500 ml of water, with 50 dead individuals. In contrast, the lowest mortality rate was recorded at a dose of 20 gram of material/500ml of water, with only 12 death S. litura larvae. In field testing, the best dose was 50 gram/14 liters of water, and it caused the death of 50 S. litura larvae. Spraying B. thuringiensis on rice plants can reduce the population and intensity of S. litura.
The Influence of Sleep Hygiene on the Sleep Disorders of Elderly at Integrated Long Term Care
Authors: Andas Amzal Mortin , Sansuwito Tukimin , Said Faridah Mohd , Wada Fauziah H , Purnamasari Anisa , Prima Ashar , Andas Netty Huzniaty
Published: June 2024

Sleep hygiene is the most effective non-pharmacological therapy as a simple behavior of several individual environmental factors and as a healthy sleep aid. Sleep hygiene is a very easy, inexpensive, and comprehensive therapy that can be used to improve sleep disorders in the elderly. Methods:The design of this study used a quantitative method. Quasi Experiment: Pre-test and Post-test with a control group. Results: Showed that the average value of the control group before was 3.42 and the average value afterward was 3.76, which means there's no significant relationship between sleep hygiene and sleep disorders, but in the intervention group, the average value before the sleep hygiene intervention was carried out was 3.88 and the average value after the sleep hygiene intervention was carried out was 8.48, which means that there was an increase in the average value before and after the sleep hygiene intervention was given. Based on statistical calculations using the Wilcoxon test, a P-value of 0.000 <0.05 was obtained, so there was a relationship between sleep hygiene and sleep disorders. Conclusion:Regular application of sleep hygiene is effective in promoting good sleep and can overcome sleep disturbances in various populations of the elderly age group
Nurses'Attitudes,Knowledge,andPracticesConcerning Evidence-Based Practice: A Cross-Sectional Study
Authors: Abdullah Mohanned Khaleel , Abdulghani Mohammad Faris , Ibrahim Radhwan Hussein , Mahmood Hanady Jabbar , Mohsen Ommar Akram , Jassim Raghad Saad
Published: June 2024

The objective of this study is to analyze the impact of individual variables among staff nurses on their knowledge, attitudes, and implementation of evidence-based practice in the City of Mosul, Iraq. Additionally, the study aims to identify the characteristics that either facilitate or hinder the implementation of evidence-based practice. Methods: Across-sectional, correlational design was used. The principles outlined in the STROBE Checklist is followed while sharing this study. Asample of 250 staff nurses was conveniently picked from five hospitals in Mosul, Iraq. The survey consisted of the Evidence-Based Practice Questionnaire and individual variables as questions. The data were analyzed using multiple linear regression models. Results:The average age of the participants was 31.0 years, with a standard deviation of 5.5 years. The majority of participants indicated a lack of knowledge, abilities, and experience in evidence-based practice (EBP), while expressing moderate views towards EBP. The area of study revealed distinct disparities in average scores for knowledge or skills, attitudes, and practice. Nurses had significantly greater knowledge, abilities, and practice of evidence-based practice (EBP) compared to midwives (p<0.001). Nurses andmidwiveswhohadmaster'sdegreesdemonstratedsuperiorknowledge,abilities,and implementation of evidence-based practice (EBP), as well as more favorable attitudes compared to nurses with bachelor's degrees (p<0.001). Conclusion:Nurses in the city of Mosul are eager to participate in the evidence-based practice approach. Nevertheless, nurses have recognized the need to enhance their knowledge and abilities to actively engage in the process.
Prevalence and Determination of Hypertension among Diabetes Mellitus Patients Attending Primary Health Care Centres
Authors: Ibrahim Radhwan H , Hashim Al - Nuaimy² Hashim Mustafa
Published: June 2024

The primary objective of this investigation was to identify the root causes of hypertension in individuals with diabetes, as it represents a significant modifiable risk factor for various cardiovascular diseases and poses a major global public health challenge. Aim:To identify the prevalence and determination of hypertension among diabetes mellitus patients in Mosul City. Methods: This study is a data analysis that was obtained from primary health care centers based on a cross-sectional study. The study period was from the 1st of January to the 1st of July 2022. The study examined the prevalence of hypertension among diabetes mellitus patients attending primary health care centers: 303 patients with diabetes mellitus and 300 patients's hypertensions with diabetes mellitus. Patients' ages ranged from 40 to over 70 years, divided as follows: 40-49, 50-59, 60-69, and over 70 years old. As well as their genders, males, and females, who visited the primary health care centers in the right and left sectors and the Al-Wafaa Centre for Diabetes and Endocrinology in the city of Mosul, Iraq. Results:The study shows 15 determinants of hypertension among diabetes mellitus patients who are age (the highest rate is among patients 50-59years with 37.1%), gender (the highest rate among females with 64.3%), marital status (the highest rate among married with 45.2%), employment (the highest rate is among unemployed with 77%), duration of diabetes (the highest rate is among patients with diabetes and hypertension less than 5 years with 46.8%),smoking (the highest rate is among never smoking), BMI (the highest rate is among obese patient with 54.3%), family history with hypertension (96.7% of patients have family history), sedentary activity (52.2% of patients set less than 4 hours ), sleep duration (66.6% of patients sleep more than 7 hours), stress (63.2% of patients have moderate to high stress), salt consumption after diabetes (33.4% of patients stopped salt consumption at all), physical activity (62.7% of patients do moderate physical activity ), level of education (52.7% of patients educated with primary school ),and residency (52.6% of patients live in the left side of Mosul city). Conclusion:This study concluded that the factors most affected by high blood pressure that affected patients were age, especially 50-59, BMI (obesity), occupation (for non-workers), family history, high stress, and little physical activity
Utilization of Health Services by Stunting Families in Tasikmalaya
Authors: Fitriani Sinta , Herliana Lia
Published: June 2024

Stunting is a national issue that attracts a lot of attention. Several factors are the cause of stunting in Indonesia, namely: bad parenting, including deficit knowledge about health and nutrition before and during pregnancy and after the mother gives birth; limited health services, including ANC-Ante Natal Care services (health services for mothers during pregnancy); Post Natal Care and quality early learning: deficit nutrition; and difficulty accessing clean water and sanitation.Aim: The research aims to describe the utilization of health services by families with stunting and the factors that influence it. Methods:This research design is quantitative with descriptive methods. The population was families with stunting in the Sukamulya Village area, namely 18 people. The sampling technique is total sampling. Data collection is done directly using the univariate data analysis technique. Results:The results showed that 44.4% of families with stunting did not use health services for treatment, and 22.2% of families with stunted toddlers rarely used posyandu services. Predisposing characteristic factors that influence visits to health services in this study are age > 35 years and junior high school graduates. Conclusion:In this study, the characteristic factor that influences the ability to visit health services is that the majority of family income is <UMR (unit market reference), and 38.9% do not have health insurance. The factor that influenced visits to health services in this study showed that 61.2% of families with stunting had a negative perception of stunting, such as the perception that stunting was not a serious problem that did not require immediate action.
Incidence of Violence and Sexual Dysfunction among Infertile Women Attending Women's Health Hospital, Assiut University
Authors: Fawzy Aisha Abdelnaser , Mostafa Manal Farouk , Ahmed Nadia Hussien , Abbas Ahmed Mohamed
Published: June 2024

In the present day, people view infertility as a social issue that can result in psychological instability, relationship problems, and divorce. Consequences of infertility, such as low self-esteem, anxiety, and sexual relationship disturbances associated with failure in reproduction, have a major impact on sexual satisfaction. Aim:This study aims to assess the incidence of violence and sexual dysfunction among infertile women. Methods:Apurposive sample of 60 infertile women was enrolled; a cohort design was used. The outpatient gynecological clinic and ARTunit at Women's Health Hospital, Assiut University served as the study's sites. Data collection tools include a structured interview questionnaire, the Arabic version of the female sexual dysfunction index, and the WHO women domestic violence scale. Results:The study findings illustrate that the majority (85%) of infertile women experience violence, and a vast majority (93.3%) of them have sexual dysfunction. a highly statistically significant relationship between exposure to violence and occupation (p= 0.004) as well as type of family (p=0.001). Another highly statistically significant relationship exists between sexual dysfunction and occupation (p=0.004), in addition to educational level (p=0.009). Conclusion:Various forms of intimate partner violence and sexual dysfunction afflict infertile women. So, nurses should consider routine screening for domestic violence victims in infertility clinics. Recommendation:Providing marital counseling as a general course in higher institutions of learning to prepare couples to have positive sexual behaviour.
A Case of Thymoma Masquerading as Hiatus Hernia, Pericardial Effusion: A Diagnostic Dilemma
Authors: Raut Dipti , Raut Arti , Gujar Samruddhi
Published: June 2024

Thymoma is a rare neoplasm of the thymus gland, and as an adult, it accounts for 30% of anterior mediastinal tumors. The peak incidence is between 55 and 65 years old. Thymoma is a cancer that is extremely uncommon, accounting for just 0.2-1.5% of all malignancies, with an estimated incidence of between 0.13 and 0.32 per 100,000 people each year. We discuss a rare instance of a 58-year-old female patient who was admitted after complaining of multiple joint pain, gastroesophageal reflux disease (GERD), and generalized weakness. She was initially diagnosed with hiatus hernia and pericardial effusion based on imaging studies. However, her symptoms persisted despite treatment, and further evaluation revealed the presence of a thymoma. It was hard to make a diagnosis because the patient had a thymoma, a hiatus hernia, and pericardial effusion all at the same time. The initial diagnosis was complicated by the fact that the patient had unusual and refractory symptoms, which means they needed a thorough evaluation and follow-up. The case highlights the diagnostic complexity associated with thymoma, especially when coexisting with other conditions such as hiatus hernia and pericardial effusion. Despite its rarity, thymoma necessitates considerations in patients presenting with nonspecific symptoms, emphasizing the importance of thorough evaluation and follow-up. This underscores the need for a comprehensive diagnostic approach to ensure timely and accurate management, particularly in cases with an atypical and refractory presentation. In the described case, nurses' initial assessment skills are crucial for identifying the need for critical care intervention. Their role extends beyond the perioperative phase, encompassing patient education on procedures and potential outcomes.
Accessibilities and Challenges in Curriculum and Instructional Activities for Students with Visually Impairments in Gilgit Baltistan
Authors: Abbas Syed Zaheer , Shoaib Almas , Asif Qurat Ul Ain
Published: June 2024

The study aims to find the challenges and accessibility of curriculum and instructional activities of visually impaired students in Gilgit Baltistan. It adopted the qualitative approach and included the teachers of students with visual impairments from the Public Special Education Complex. Purposive sampling was used where six teachers were chosen from separate classes. Qualitative data was analyzed using thematic analysis. The major challenges were accessing materials, teaching Braille, and catering to the multiple learning needs of the students. However, the determination of teachers showed a high sense in changing the teaching practices so that the students who had visual impairment access the curriculum. It was found that the use of multi-sensory approaches that incorporate, for instance, the use of auditory, tactile, and kinesthetic features in a lesson to enhance learning can help in tackling the challenges which could be achieved through assistive technologies, hands-on activities, and interactive learning materials.
A Tendency to Lingual Shift in Pothohari Urban-Living Community
Authors: Tabassum Samina , Amin Qadir Samina
Published: June 2024

In this globalized era, many languages of the world are in the process of language shift. In the Pakistani multilingual context, a rapid language shift to dominant languages is taking place among the indigenous communities. This research paper in particular investigates the lingual shift among the Pothohari community living in urban areas of Rawalpindi and Islamabad by analyzing the everyday speech practices of the native Pothohari speakers. Live dinner-time conversations and semi-structured interviews of the participant families are the main data sources for the study. Karan and Stadler's (2000) Perceived benefit model of language choice and stability provides theoretical underpinnings to study the language situation and unveil the complex social, political, and economic factors regarding language change and shift. The findings revealed that language shift is swift and there is a lack of conformity among the native community towards the heritage language.
Neurosurgical treatment of spasticity: a potential return to the cerebellum
Authors: Cummins Daniel D. , Park Hyun Joo , Panov Fedor
Published: June 2024

OBJECTIVE

Neurosurgical targeting of the cerebellar dentate nucleus via ablative dentatotomy and stimulation of the dentate nucleus was historically used for effective treatment of spasticity. Yet for decades, neurosurgical treatment of spasticity targeting the cerebellum was bypassed in favor of alternative treatments such as intrathecal baclofen pumps and selective dorsal rhizotomies. Cerebellar neuromodulation has recently reemerged as a promising and effective therapy for spasticity and related movement disorders.

METHODS

In this narrative review, the authors contextualize the historical literature of cerebellar neuromodulation, comparing it with modern approaches and exploring future directions with regard to cerebellar neuromodulation for spasticity.

RESULTS

Neurosurgical intervention on the cerebellum dates to the use of dentatotomy in the 1960s, which had progressed to electrical stimulation of the cerebellar cortex and dentate nucleus by the 1980s. By 2024, modern neurosurgical approaches such as tractography-based targeting of the dentate nucleus and transcranial magnetic stimulation of cerebellar cortex have demonstrated promise for treating spasticity.

CONCLUSIONS

Cerebellar neuromodulation of the dentate nucleus and cerebellar cortex are promising therapies for severe cases of spasticity. Open areas for exploration in the field include the following: tractography-based targeting, adaptive cerebellar stimulation, and investigations into the network dynamics between the cerebellar cortex, deep cerebellar nuclei, and the subcortical and cortical structures of the cerebrum.
Actigraph-based quantification of sleep in children with dystonia undergoing deep brain stimulation
Authors: Zhang Frederick , Mithani Karim , Breitbart Sara , Yan Han , Fasano Alfonso , Ibrahim George M. , Gorodetsky Carolina
Published: June 2024

OBJECTIVE

Dystonia is among the most common pediatric movement disorders and can manifest with a range of debilitating symptoms, including sleep disruptions. The duration and quality of sleep are strongly associated with quality of life in these individuals and could serve as biomarkers of dystonia severity and the efficacy of interventions such as deep brain stimulation (DBS). Thus, this study investigated sleep duration and its relationship to disease severity and DBS response in pediatric dystonia.

METHODS

Actigraphs (wearable three-axis accelerometers) were used to record multiday sleep data in 22 children with dystonia, including 6 patients before and after DBS implantation, and age- and sex- matched healthy controls. Data were preprocessed, and metrics of sleep duration and quality were extracted. Repeated-measures statistical analyses were used.

RESULTS

Children with dystonia slept less than typically developing children (p = 0.009), and shorter sleep duration showed trending correlation with worse dystonia severity (r = −0.421, p = 0.073). Of 4 patients who underwent DBS and had good-quality data, 1 demonstrated significantly improved sleep (p < 0.001) postoperatively. Reduction in dystonia severity strongly correlated with increased sleep duration after DBS implantation (r = −0.965, p = 0.035).

CONCLUSIONS

Sleep disturbances are an underrecognized marker of pediatric dystonia severity, as well as the effectiveness of interventions such as DBS. They can serve as objective biomarkers of disease burden and symptom progression after treatment.
Evaluation of the long-term effect of selective tibial neurotomy for the treatment of spastic foot using a personal goal-centered approach
Authors: Dauleac Corentin , Luaute Jacques , Rode Gilles , Sindou Marc , Mertens Patrick
Published: June 2024

OBJECTIVE

The objective of this study was to evaluate the long-term effectiveness of selective tibial neurotomy (STN) for the treatment of the spastic foot using a goal-centered approach.

METHODS

Between 2011 and 2018, adult patients with a spastic foot (regardless of etiology) who received STN followed by a rehabilitation program were included. The primary outcome was the achievement of individual goals defined preoperatively (T0) and compared at 1-year (T1) and 5-year (T5) follow-up by using the Goal Attainment Scaling methodology (T-score). The secondary outcomes were the presence of spastic deformities (equinus, varus, and claw toes), modified Ashworth scale (MAS) score for the targeted muscles, and modified Rankin Scale (mRS) score at T0, T1, and T5.

RESULTS

Eighty-eight patients were included. At T5, 88.7% of patients had achieved their goals at least "as expected." The mean T-score was significantly higher at T1 (62.5 ± 9.5) and T5 (60.6 ± 11.3) than at T0 (37.9 ± 2.8) (p < 0.0001), and the difference between T1 and T5 was not significant (p = 0.2). Compared to T0, deformities (equinus, varus, and claw toes; all p < 0.0001), MAS score (p < 0.0001), and mRS score (p < 0.0001) were significantly improved at T1 and T5. Compared to T1, MAS score increased slightly only at T5 (p = 0.05) but remained largely below the preoperative value. There was no difference between T1 and T5 regarding other clinical parameters (e.g., deformities, walking abilities, mRS score).

CONCLUSIONS

This study found that STN associated with a postoperative rehabilitation program can enable patients to successfully achieve personal goals that are sustained within a 5-year follow-up period.
Spinal catheter revision in pediatric intrathecal baclofen pumps: risk factors and postoperative outcomes
Authors: Mosher Amanda M. , Hartman Emma , Keusch Dylan , Papadakis Joanna E. , Buxton Kristin , Morgan Ann , Stone Scellig S. D. , Northam Weston T.
Published: June 2024

OBJECTIVE

Intrathecal baclofen (ITB) pumps are commonly used in pediatric patients with cerebral palsy (CP) and medically refractory spasticity. However, catheter malfunction and associated risk factors are not well understood. The aim of this study was to examine potential risk factors for spinal catheter malfunction and characterize postoperative follow-up to understand the clinical consequences.

METHODS

Patients who received ITB pump replacement or revision at Boston Children’s Hospital between 2010 and 2023 were retrospectively reviewed. The spinal catheter revision cohort (SCRC) included patients whose spinal catheter was occluded requiring lumbar catheter revision. The second cohort included abdominal pump replacements only (APRC). Between-group comparisons and multivariable regression identified factors associated with catheter revision and postoperative outcomes.

RESULTS

Forty-one (33.6%) patients underwent spinal catheter revision and were compared with 81 patients (66.4%) who underwent abdominal pump replacement only. Younger age at surgery and an elevated preoperative lower-extremity modified Ashworth scale grade were associated with spinal catheter revision (p < 0.05). Catheter model type, tip location, and history of spinal fusion were not associated with obstruction. Postoperatively, SCRC patients experienced a higher rate of infection (17.1%) relative to APRC patients (0%) within 30 days from their ITB pump replacement procedure (p < 0.05) and greater likelihood of subsequent ITB system removal compared with the APRC (24.4% vs 7.4%, p < 0.05). Although not differing preoperatively, SCRC patients had lower postoperative ITB doses when compared with the APRC group (median dose 143 vs 350 µg/day, p < 0.05) at hospital discharge and remained statistically different at the 6-month and 1-year follow-ups (p < 0.05). There were no postoperative differences in baclofen overdose, withdrawal, or median number of hospital readmissions within 30 days. Overall, 31.7% of spinal catheter revisions were unanticipated by the clinical team at time of surgery.

CONCLUSIONS

Younger age at surgery and increased preoperative lower-extremity tone may be risk factors for catheter obstruction, resulting in a higher rate of postoperative infection and subsequent ITB pump removal compared with pump replacement alone. Spinal catheter occlusion can complicate revision or replacement procedures, especially when unanticipated. Routine clinical assessment may be inadequate for diagnosing insidious catheter malfunction. Catheter occlusion deserves further study, and routine assessment of catheter patency may be warranted to prevent suboptimal tone therapy.
Ventriculoperitoneal shunt placement following endoscopic third ventriculostomy failure in the treatment of pediatric hydrocephalus
Authors: Evans Alexander R. , Villeneuve Lance , Bowen Ira , Carter Lacey , Chen Sixia , Kimmell Marianne , Gernsback Joanna , Balsara Karl , Jea Andrew , Desai Virendra R.
Published: June 2024

OBJECTIVE

The goal of this study was to evaluate the impact of endoscopic third ventriculostomy (ETV) failure on subsequent risk of ventriculoperitoneal shunt (VPS) placement.

METHODS

A retrospective chart review was performed to identify pediatric patients receiving ETV followed by a VPS at Oklahoma Children’s Hospital between January 1, 2016, and December 31, 2021. A control group of patients receiving a VPS alone was also gathered. Complication and shunt failure rates were compared between the 2 groups at 12 months postoperatively.

RESULTS

A total of 222 patients were included in this study. The VPS placement after ETV failure (VPSEF) group included 21 patients; 53% were male and 47% were female, with a mean age of 2.2 years and standard deviation of 4.3 years. The etiology of hydrocephalus was chiefly intraventricular hemorrhage (43%) and neural tube defects (19%). At 12 months after VPS placement, the complication rate was 24%, predominantly including infection (19%) or CSF leakage (10%).

The VPS-only (VPSO) group included 201 patients; 51% were male and 49% were female, with a mean age of 4.2 years and standard deviation of 6.5 years. The etiology of hydrocephalus was chiefly intraventricular hemorrhage (26%) and neural tube defects (30%). At 12 months postoperatively, the complication rate was 10%, predominantly including infection (6%) or catheter-associated hemorrhage (3%). The difference in complication rates between the VPSEF and VPSO groups was not significant at 12 months postoperatively (p = 0.07); however, on subgroup analysis there was a significantly higher rate of CSF leakage at 12 months in the VPSEF group compared to the VPSO group (p = 0.0371).

CONCLUSIONS

There was no difference in overall complication rates for the treatment of pediatric hydrocephalus by VPS following failed ETV compared to VPS placement alone, yet prior ETV may predispose patients to a higher rate of CSF leaks within 12 months of VPS placement. Further study is indicated to determine whether a prior ETV procedure predisposes patients to a higher complication rate on VPS placement.
КОМПОЗИЦІЙНІ В’ЯЖУЧІ НОВОГО ПОКОЛІННЯ: ДОСВІД, СТАН ПИТАННЯ
Authors: Гусейнов О. А. , Запорожець В. І.
Published: June 2024

У статті розглянуто досвід отримання композиційного в’яжучого. Застосування композиційних в'яжучих різних складівдозволяє створювати композити із заздалегідь заданими фізикомеханічними властивостями та експлуатаційними характеристиками. Однак, необхідно науково-експериментальне проектування складу, а також вибір технології модифікування та виготовлення в'яжучих. При виборі сировини для композиційного в'яжучого найбільш ефективними є компоненти, що зазнали впливу геологічних та техногенних процесів. З усіх сучасних методів активації в'яжучого, що найповніше відтворюються в промислових умовах, найкращу ефективність дає механічна та механохімічна активація в млинах різного принципу дії. Однак, необхідно визначити спосіб подрібнення та оптимальну тонину помелу, щоб зберегти частину відносно великих зерен (мікробетон), відповідальних за збільшення міцності бетону в ході експлуатації.
Vol. 62 No. 274 (2024): JNMA: Published Monthly
Authors: Journal of Nepal Medical Association
Published: June 2024

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Investigating Pedagogies in Undergraduate Precalculus and their Relationships to Students’ Attitudes Towards Mathematics and Perseverance in Problem-Solving
Authors: Daniel Amy , DiNapoli Joseph
Published: June 2024

This exploratory study investigated the relationships between professors’ enactments of a research-based precalculus curriculum (Pathways) and changes observed in students’ attitudes towards mathematics and perseverance in problem-solving. While much research focuses on improving student achievement in undergraduate STEM courses, it is also important to support students in developing the positive dispositions and practices needed to sustain them through years of mathematics-based STEM coursework. We therefore investigated the way three professors implemented Pathways, assessing via observation their pedagogical choices across three Pathways-aligned dimensions; we also investigated the changes in attitudes and perseverance of students in these professors’ classes. Our results suggest that although the Pathways precalculus curriculum may support the development of positive attitudes toward mathematics and improved perseverance in problem-solving, this potential is influenced by professors’ pedagogical choices. This research helps us better understand the connections between pedagogies enacted in STEM-gateway courses and students’ development of productive ways of engaging with mathematics.