bluuebunny/crossref_metadata_2025 huggingface dataset:
Indications for and Complications of Mitomycin-C in Pterygium Surgery
Authors: Anduze Alfred L , Burnett Jettie M
Published: April 2021

* BACKGROUND AND OBJECTIVE: The purposes of this study are to examine the complications and results of a novel approach to the use of mitomycin-C in pterygium surgery; to identify the lowest effective dosage required to prevent recurrence; and to select those high-risk pterygia that could benefit from mitomycin-C use.

* PATIENTS AND METHODS: One hundred thirty-five eyes of 128 patients considered at high risk for recurrence of pterygium were treated with a single, intraoperative, subconjunctival injection of mitomycin-C at the site of excision. Three different dosages-0.2, 0.1, and 0.05 ml-at a strength of 0.5 mg/ml were used. The eyes were observed for 10 months to 3 years.

* RESULTS: There were only two recurrences (1.5%); both occurred in eyes that had undergone previous pterygium surgery. One recurrence happened with the 0.2-ml dosage, and the other with the 0.1-ml dosage. These recurrences occurred in association with early wound dehiscence, which essentially became a bare sclera susceptible to pterygium regrowth. Complications included temporary and prolonged discomfort, tearing, hyperemia, subconjunctival hemorrhage, wound dehiscence, and pigment accumulation. No vision-threatening side effects were noted.

* CONCLUSIONS: The persistence and intensity of discomfort noted at the higher dosage has prompted these authors to suggest that only high-risk pterygia should receive mitomycin-C. Conjunctival flaps should always be used to cover the sclera up to the limbus and to localize the mitomycin-C to prevent its migration. A single dose of not more than 0.05 ml at a strength of 0.5 mg/ml subconjunctivally gives the same results as multiple drops, but with far less morbidity.

[Ophthalmic Surg Lasers 1996;27:667-673.]
Regression of Rubeosis Iridis After Trabeculectomy Combined With Mitomycin-C
Authors: Gaspar Ana Zulema , Flammer Josef , Hendrickson Ph
Published: April 2021

Abstract. The authors report two cases in which severe rubeosis iridis regressed after trabeculectomy with intraoperative application of mitomycin-C. Several days after the operation, the vessels were no longer perfused. Only white, empty, "ghost" vessels were visible. This phenomenon was observed in one case with well-controlled intraocular pressure (IOP) after surgery, as well as in a case in which IOP rose again to high preoperative values. The authors conclude that the regression of the rubeosis may be caused by a local, intraocular pharmacologic side effect of mitomycin-C, not by the drop in IOP alone. [Ophthalmic Surg Lasers 1996;27:709-712.]
Thelazia californiensis Conjunctival Infestation
Authors: Doezie Allen M , Lucius Richard W , Aldeen William , Hale DeVon , Smith Douglas R , Mamalis Nick
Published: April 2021

Abstract. There are few reports of Thelazia californiensis infestation in humans in the literature. The authors report the clinical and histopathologic features of two patients who presented with symptoms of a mild unilateral chronic conjunctivitis from infestation by this parasite. In each case, the symptoms resolved immediately after removal of the worms. These are the first two patients from the Rocky Mountain area to be described with an infection from this particular worm. T. californiensis should be included in the differential diagnosis of patients with chronic conjunctivitis following hiking or camping in the mountains or backcountry. [Ophthalmic Surg Lasers 1996;27:716719.]
Sustained-Release Subconjunctival 5-Fluorouracil
Authors: Smith Thomas J , Ashton Paul
Published: April 2021

* BACKGROUND AND OBJECTIVES: The purpose of this research was to obtain preliminary safety and efficacy data on a novel sustained-release 5-fluorouracil (5-FU) implant in high-risk glaucoma surgical patients.

* PATIENTS AND METHODS: The implants were placed subconjunctivally in four patients undergoing high-risk trabeculectomy. The patients have been observed for approximately 2.5 years.

* RESULTS: In three of the four patients intraocular pressure was controlled at less than 21 mm Hg, with stabilization of the visual field. One patient had early failure. No untoward events were linked to the placement of the implant.

* CONCLUSION: Sustained-release systems for subconjunctival 5-FU may be useful in filter maintenance.

[Ophthalmic Surg Lasers 1996;27:763-767.]
Recurrent Choroidal Detachment Following Combined Trabeculectomy and Cataract Extraction
Authors: Rachmiel Rony , Pollack Ayala , Oliver Moshe , Zalish Miriam
Published: April 2021

Abstract. Two patients with glaucoma, who underwent uneventful trabeculectomy and extracapsular cataract extraction with posterior chamber intraocular lens implantation, experienced late and recurrent choroidal detachment. Both patients received aqueous suppressant therapy before and after surgery. Hypotony and choroidal detachment occurred 7 months and 15 months after the combined surgery. There was no shallowing of the anterior chamber or leakage from the filtering blebs, and there were no signs of inflammation. The choroidal detachment completely resolved in the two patients 4 days and 4 weeks following discontinuation of the aqueous suppressant therapy. [Ophthalmic Surg Lasers 1996;27:795-797.]
The Usefulness of Dapiprazole, an Alpha-Adrenergic Blocking Agent, in Pigmentary Glaucoma
Authors: Mastropasqua Leonardo , Carpineto Paolo , Ciancaglini Marco , Gallenga Pier Enrico
Published: April 2021

Abstract. The aim of this study was to increase understanding of the usefulness of an alpha-adrenergic blocking agent, dapiprazole 0.5% eyedrops, as an adjunct in antiglaucomatous therapy for 20 patients with pigmentary glaucoma receiving timolol 0.5% and pilocarpine 1%. After 12 months of dapiprazole treatment, the difference from the pretreatment mean intraocular pressure (IOP) value was statistically significant (P = .005). After 12 and 36 months of treatment, an hour-to-hour comparison of diurnal IOP curve values showed a statistically significant difference in all cases (P < .001). Although further investigations may be necessary to reach a definite conclusion, dapiprazole appeared to have a beneficial, stable in time effect in these patients. [Ophthalmic Surg Lasers 1996;27:806-809.]
Opinions of Field Experts on Practices That Will Increase the Motivation Levels of Learners During the COVID-19 Pandemic Process
Authors: Kılınç Hakan
Published: April 2021

This study aimed to determine what applications could be used to increase the motivation levels of learners during the COVID-19 pandemic process and what roles should be carried out by teachers, institutions, families, and learners in this process. In this study, phenomenology design, one of the qualitative research methods, was used. In this context, the opinions of the participants who were determined by purposeful sampling method were consulted. The opinions obtained from the participants were analyzed with content analysis. The findings obtained within the scope of the study, in order to maintain the motivation levels of the learners in the COVID-19 pandemic period, revealed the roles that teachers, institutions, families, and learners should carry out.
Intolerance of Uncertainty Experienced by Faculty of Education Students in the COVID-19 Pandemic and Their Strategies to Cope With Uncertainty
Authors: Alkış Küçükaydın Menşure
Published: April 2021

COVID-19, which emerged and turned into a global pandemic within a short time, has caused great concern in terms of health, and it has also brought some problems to the education sector. Due to some uncertain situations in this process and worries about the pandemic, students have been faced with unfamiliar situations. This study aims to determine the intolerance of uncertainty that university students in Turkey have experienced in the process of this pandemic and the strategies they have used to cope with this situation. In this context, 179 university students participated in the study. The Intolerance of Uncertainty Scale and an interview form were used. ANOVA was used with the independent samples t-test and content analysis was used in the analysis of data. The data obtained showed that third-year students in the psychological counseling and guidance program had high levels of intolerance of uncertainty and had difficulties in developing strategies to deal with uncertainty.
Psycho-Social Well-Being of Young Learners During Emergency Remote Teaching
Authors: Taskiran Ayse
Published: April 2021

The COVID-19 pandemic, which started through the end of 2019 and which seems to continue for an unknown period of time, has had unprecedented effects that are not limited to health conditions only, but also include financial, sociological, and psychological consequences. This global pandemic forced schools and universities to close their doors, causing a large-scale educational disruption for a large number of learners worldwide. Despite the measures taken to compensate for education at all levels, there still is another concern for K-12 level learners' psycho-social well-being. This chapter elaborates some points that should be considered in case of emergency remote teaching applications in terms of enhancing psycho-social well-being of young learners.
Participatory Action Research in Adult Education
Authors: Call-Cummings Meagan , Hauber-Özer Melissa
Published: April 2021

Participatory action research (PAR) is an embodied form of inquiry that engages those most affected by an issue or problem in creating knowledge and developing solutions. PAR epistemology intersects with a critical approach to adult education in its belief that programs, methods, and content must be relevant to learner needs and challenges and ought to lead to greater social justice. The purpose of this chapter is to offer a review of three critical, participatory inquiry methods that are connected to the ontological and epistemological anchors of PAR. The authors present readers with a useful description of how to enact these onto-epistemological anchors through these methods in diverse contexts. They conclude that these methods have great potential for critical educators to live out their own onto-epistemological commitments, better understand and meet learner needs, and facilitate positive social change.
Using Photo-Methods to Empower Participants in Education Research
Authors: Boucher, Jr. Michael L.
Published: April 2021

The use of photographs in ethnographic education research promises new insights and challenges to researchers who wish to do good science and good work in the communities under examination. The use of photo-elicitation is discussed as a method that can help alleviate what Foucault described as the analytical “gaze,” allowing for discussions of difficult or taboo subjects like race, sex, gender, and dis/ability. The history, uses, and techniques are examined for different photo methods including photo-elicitation, photo-elicitation interviews, and photovoice. This chapter also contributes practical suggestions for using photos in ethnographic research and illuminates new research in the field. Using photos in the reviewed studies achieved positive results for participants and revealed new understandings of communities, culture, and individuals.
Case Study and Self Study as Means for Program Improvement in Teacher Education
Authors: Wilson Jahnette , Brower Samuel R. , Edgar Teresa , Thompson Amber , Culpepper Shea
Published: April 2021

Proponents of the evidence-based movement in education maintain that decisions around policy and practice should be grounded in data outcomes. However, insufficient research exists on data use in teacher education programs as much of the research on data use is concentrated on K-12 programs. The purpose of this case study was to investigate the data use practices of an educator preparation program so as to facilitate program improvement efforts. The collective qualitative data described in this study was key to informing continuous improvement areas within this educator preparation program. Therefore, this case study offers insight as to how qualitative data can support and inform program improvement efforts.
Optimized Three-Dimensional Security Framework to Mitigate Risks Arising From BYOD-Enabled Business Environment
Authors: Ofusori Lizzy Oluwatoyin , Dlamini Ncamiso Nkululeko Jahalenkhosi , Subramaniam Prabhakar Rontala
Published: April 2021

Bring your own device (BYOD) has infiltrated the work environment and businesses are enjoying the benefits coupled with the adoption of the trend. At the same time, the adoption of BYOD has introduced a number of security threats that businesses are failing to match. In the pursuit of addressing security threats that are introduced by the adoption of this technology trend, this chapter recommends a three-dimensional (3-D) security framework that can be used to mitigate the risks emanating from a BYOD enabled environment. Data was collected from the employees of two banks in Africa that supported BYOD trend to measure individual and organizational practices. This chapter investigates further on these practices in addressing implications of BYOD. Three categories of security threats are delineated in this chapter. A review of existing security frameworks is presented in this chapter. The chapter concludes by outlining a 3-D security framework as a potential solution to protect BYOD enabled business environment.
Coping Strategies and Paradoxes Related to BYOD Information Security Threats in France
Authors: Baillette Paméla , Barlette Yves
Published: April 2021

Bring Your Own Device (BYOD) refers to the provision and use of personal mobile devices by employees for both private and business purposes. Although there has been research on BYOD, little attention has been paid to employees' perception of threats to their personal information security (ISS) when using a BYOD, especially in a professional context. This article investigates employee coping strategies related to BYOD ISS threats in France. The results of a survey of 223 employees indicate that while perceived behavioral control exerts only direct effects on problem-focused (i.e., disturbance handling) and emotion-focused (i.e., self-preservation) coping strategies, ISS concern exhibits significant direct and moderating influences. Several security paradoxes could be identified, namely, discrepancies between the respondents' ISS concern and the adopted coping strategies. This article offers the first insights into the French context and can serve as a basis for comparisons in future research and to help improve employees' personal ISS in the professional context.
Threats and Vulnerabilities of Mobile Applications
Authors: M. Thangavel , M. Divyaprabha , C. Abinaya
Published: April 2021

Smart devices like mobile phones, tablets, and laptops have become necessities in our lives due to the services they provide. However, in recent days, mobile applications have become a major threat for an attack. One of the most attractive features of smartphones is the availability of a large number of apps for users to download and install. However, it also means hackers can easily distribute malware to smartphones, launching various attacks. Each day, a mobile device attack is changing dynamically, and it is very difficult to represent a complete set of threats and vulnerabilities. Mobile phone security has become an important aspect of security issues in wireless multimedia communications. The development of mobile applications has increased drastically; hence, it is our responsibility to protect our devices and the data within them. Being aware is the first step to protect data. Thus, to prevent the mobile from the threats, efforts are required to form the application developer, app market administrator, and user to defend against the malware. This article explores those threats and vulnerabilities of mobile applications.
How Relevant Are Risk Perceptions, Effort, and Performance Expectancy in Mobile Banking Adoption?
Authors: Shaikh Aijaz A. , Glavee-Geo Richard , Karjaluoto Heikki
Published: April 2021

This article provides a comprehensive overview of the adoption process using evidence from m-banking adoption in Pakistan. A survey design was used and 189 responses were received from across Pakistan and analyzed using Smart PLS application. Findings suggest that research on the effect of risk in the adoption process remains inconclusive. Contrarily, consumers have overcome many fears due to the usefulness, indispensability, high security features, and effort expended in the use of financial services delivered through m-banking. Perceived risk's (PR) direct influence was found to be generally weak. However, PR plays a major role in the pre-adoption process because it's weak and direct inhibiting influence become an “enhancer” in the association between effort expectancy (EE) and the three key TAM/UTAUT constructs [performance expectancy (PE), attitude (ATT), and adoption intention (INT)]. Most importantly, the role of EE as a strong driver of PE, ATT, INT, and its significant interaction with PR highlights the unique role that both risk and EE play in the adoption process.
A HEVC Video Steganalysis Against DCT/DST-Based Steganography
Authors: Shi Henan , Sun Tanfeng , Jiang Xinghao , Dong Yi , Xu Ke
Published: April 2021

The development of video steganography has put forward a higher demand for video steganalysis. This paper presents a novel steganalysis against discrete cosine/sine transform (DCT/DST)-based steganography for high efficiency video coding (HEVC) videos. The new steganalysis employs special frames extraction (SFE) and accordion unfolding (AU) transformation to target the latest DCT/DST domain HEVC video steganography algorithms by merging temporal and spatial correlation. In this article, the distortion process of DCT/DST-based HEVC steganography is firstly analyzed. Then, based on the analysis, two kinds of distortion, the intra-frame distortion and the inter-frame distortion, are mainly caused by DCT/DST-based steganography. Finally, to effectively detect these distortions, an innovative method of HEVC steganalysis is proposed, which gives a combination feature of SFE and a temporal to spatial transformation, AU. The experiment results show that the proposed steganalysis performs better than other methods.
Virtual Sample Generation and Ensemble Learning Based Image Source Identification With Small Training Samples
Authors: Wu Shiqi , Wang Bo , Zhao Jianxiang , Zhao Mengnan , Zhong Kun , Guo Yanqing
Published: April 2021

Nowadays, source camera identification, which aims to identify the source camera of images, is quite important in the field of forensics. There is a problem that cannot be ignored that the existing methods are unreliable and even out of work in the case of the small training sample. To solve this problem, a virtual sample generation-based method is proposed in this paper, combined with the ensemble learning. In this paper, after constructing sub-sets of LBP features, the authors generate a virtual sample-based on the mega-trend-diffusion (MTD) method, which calculates the diffusion range of samples according to the trend diffusion theory, and then randomly generates virtual sample according to uniform distribution within this range. In the aspect of the classifier, an ensemble learning scheme is proposed to train multiple SVM-based classifiers to improve the accuracy of image source identification. The experimental results demonstrate that the proposed method achieves higher average accuracy than the state-of-the-art, which uses a small number of samples as the training sample set.
On Generalized Correlation Coefficients of Picture Fuzzy Sets With Their Applications
Authors: Singh Surender , Ganie Abdul Haseeb , Lalotra Sumita
Published: April 2021

Picture fuzzy sets (PFSs) play a crucial role in uncertain/vague environments than intuitionistic fuzzy sets (IFSs) which do not take into consideration the degree of neutrality of an element. In this paper, the authors have proposed generalized correlation coefficients of PFSs along with some properties. The effectiveness and application of the proposed generalized correlation coefficients of PFSs in pattern recognition and multi-attribute decision making (MADM) is also discussed with the help of numerical examples.
Evaluating Recommender Systems
Authors: Alslaity Alaa , Tran Thomas
Published: April 2021

Replicating the results of the recommender system's evaluation is one of the main concerns in the area. This paper discusses this issue from different angles: 1) It investigates the uniformity of recommenders' evaluation designs presented in practice and their consistency with the theoretical side. 2) It highlights some of the issues and challenges that face recommenders' evaluators. 3) It provides stepwise guidelines for offline evaluation settings. A quantitative study of articles published in the last decade is studied. The search process is a manual search for a conference and a random search of journals. The results show a lack of uniformity and consistency in presenting the evaluation methods. Most of the articles miss at least one evaluation aspect (i.e., some aspects are not presented in the article). These discrepancies and the wide variety of evaluation settings lead to non-replicable experiments. To mitigate this issue, the paper proposes the recommender evaluation guidelines (REval), which presents a roadmap for recommender systems' evaluators.
Construction of an Ensemble Scheme for Stock Price Prediction Using Deep Learning Techniques
Authors: Appati Justice Kwame , Denwar Ismail Wafaa , Owusu Ebenezer , Soli Michael Agbo Tettey
Published: April 2021

This study proposes a deep learning approach for stock price prediction by bridging the long short-term memory with gated recurrent unit. In its evaluation, the mean absolute error and mean square error were used. The model proposed is an extension of the study of Hossain et al. established in 2018 with an MSE of 0.00098 as its lowest error. The current proposed model is a mix of the bidirectional LSTM and bidirectional GRU resulting in 0.00000008 MSE as the lowest error recorded. The LSTM model recorded 0.00000025 MSE, the GRU model recorded 0.00000077 MSE, and the LSTM + GRU model recorded 0.00000023 MSE. Other combinations of the existing models such as the bi-directional LSTM model recorded 0.00000019 MSE, bi-directional GRU recorded 0.00000011 MSE, bidirectional LSTM + GRU recorded 0.00000027 MSE, LSTM and bi-directional GRU recorded 0.00000020 MSE.
Distributed Frequent Subgraph Mining Using Gaston and MapReduce
Authors: Rao D. B. Jagannadha
Published: April 2021

This paper addresses this issue and devises a new method for frequent subgraph mining in order to retrieve the valuable information from the database that captured the attention of the users. This paper proposes the recurrent-Gaston (R-Gaston) algorithm for the frequent subgraph mining process by enhancing the existing Gaston algorithm. Moreover, the method uses support measures based on the frequency and page duration parameters in order to define the support for the proposed R-Gaston algorithm. The simulation of the proposed R-Gaston is carried out using the weblog and the MSNBC databases. The proposed R-Gaston has attained values of number of structures mined and the execution time as 184, and 1282ms for the MSNBC database, with 60 and 75ms for the weblog database, respectively.
Novel questionnaire to enhance brace wear adherence in patients with adolescent idiopathic scoliosis and the relationship of the quality of life
Authors: Lertudomphonwanit Thamrong , Pengrung Nachapan , Kriwattanapong Chaiwat , Angsanuntsukh Chanika , Leelapattana Pittavat , Chanplakorn Pongsthorn
Published: April 2021

Bracing is an effective non-operative treatment, in patients with adolescent idiopathic scoliosis (AIS). The relationship between patients’ quality of life (QOL) and brace wear adherence has been reported. This study aims to determine brace wear adherence for AIS patients with novel questionnaire. A nested case-control study was conducted, included patient age 10-18 years, coronal Cobb angle 20-50°, and Risser grade 0-3. Correlation between patients’ QOL and the average hours of daily brace-wear were determined. Patients were divided into 3 groups based on brace wear adherence and were compared. QOL domains associated with the incompleteness of brace-wearing were determined by Cox proportional-hazards regression. Mean age of patients was 13.3 years (range 11-17.3 years) with initial Cobb angle of 33.5° (range 20-48°). There were significant negative correlations between total QOL scores and brace wearing time. Increased social domain scores was significantly associated with less brace wearing time (HR 1.5, 95% CI 1.12-2.04). Significant correlations between patients’ QOL and the average hours per day of brace wear. Poor social QOL have a significant impact on brace wear adherence.
Patient-reported assessment of outcome after surgery for bone metastases
Authors: Downie Samantha , Stillie Alison , Moran Matthew , Sudlow Cathie , Simpson Hamish
Published: April 2021

Regardless of prognosis, surgery is often considered in metastatic bone disease (MBD) as a palliative procedure to improve function and quality of life. Traditional focus on objective outcomes such as mortality is inappropriate in this group, and there is a drive to assess outcomes via patient-reported outcome measures (PROMs). This is an overview of current understanding of MBD outcomes and how this should influence future decision-making and research. The objectives of this review were to identify difficulties in measuring PROMs in the MBD patient population and explore alternatives to patientreported outcomes. We also provide an overview of current understanding of outcomes in MBD and how this should influence decision-making and direct research.
Volar locking plate versus external fixation in distal radius fractures: A meta-analysis
Authors: Maccagnano Giuseppe , Noia Giovanni , Vicenti Giovanni , Baglioni Marco , Masciale Maria Rosa , Cassano Giuseppe Danilo , Vitiello Raffaele , Moretti Biagio , Pesce Vito
Published: April 2021

The purpose of this meta-analysis is to evaluate the efficacy of plate or external fixator treatments in distal radius fractures, based not only on clinical and radiographic parameters but on Health Related Quality of Life (HRQOL) parameters. The Preferred Reporting Items for Systematic Reviews and Metanalyses (PRISMA) guidelines were followed when conducting this systematic review. The Revised Assessment of Multiple Systematic Reviews (RAMSTAR) checklist was additionally consulted in order to ensure a high-quality methodological process, encompassing such elements as an ‘a priori’ design, independent reviews and comprehensive search. The literature search was carried out on PubMed, MEDLINE and Scopus. The search terms used were “Radius fracture AND osteosynthesis”, “Wrist fracture AND external fixator” and “Wrist fracture AND plate”. Two reviewers independently screened titles, abstracts and full texts. To determine inter-reviewer agreement, a k score was calculated after each screening state. Of the 5753 studies collected through the initial databases search, two studies were included in the final meta-analysis (125 treated with external fixator vs 132 with volar plate). There was a substantial inter-reviewer agreement as to the title (0.73; 95% confidence interval, 0.67-0.79) abstract (0.65; 95% CI, 0.46-0.83) and fulltext screening stages (0.89; 95%CI, 0.67-1). The meta-analysis reported a mean difference equal to 0.00 (95%CI= -0.05 – 0.05), in accordance with I2= 0% and p test for the heterogeneity value=0.089. This meta analysis confirms and quantifies that the two techniques are superimposable as regards the quality of life reported by patients at least one year of follow-up.
Practical guidance in the use of image-guided radiotherapy systems
Authors: Pastorino A. , Todisco L. , Cazzulo E. , Berretta L. , Orecchia A. , Pozzi G. , Barbero M.P. , Franzone P. , Corvò R.
Published: April 2021

From mega-voltage portal images acquired on an electronic system (EPID), technological research has developed 3D and recently 4D volumetric verification modalities, allowing a direct visualization of the target, a direct comparison with the planning-TC and an optimization of the treatment (reduction of set-up errors, verification of the need for re-planning), leading to the very modern Image Guided RadioTherapy (IGRT). IGRT allows different technical solutions through direct or indirect visualization of the tumor and the acquisition of pre-treatment verification images, allowing to identify, quantify and correct errors related to set-up and organ-tumor motion, obtaining a greater compliance of the delivered dose, decreasing the risk of "geographic miss" and toxicity to healthy tissues and reducing the margins from CTV to PTV for the implementation of "dose escalation" protocols.
Increasing Age Associated with Higher Dipeptidyl Peptidase-4 Inhibition Rate Is a Predictive Factor for Efficacy of Dipeptidyl Peptidase-4 Inhibitors
Authors: Hong Sangmo , Jung Chang Hee , Han Song , Park Cheol-Young
Published: April 2021

Background: It is not known which type 2 diabetes mellitus (T2DM) patients would most benefit from dipeptidyl peptidase-4 (DPP-4) inhibitor treatment. We aimed to investigate the predictors of response to DPP-4 inhibitors considering degree of DPP-4 inhibition.Methods: This study is a post hoc analysis of a 24-week, randomized, double-blind, phase III trial that compared the efficacy and safety of a DPP-4 inhibitor (gemigliptin vs. sitagliptin) in patients with T2DM. Subjects were classified into tertiles of T1 <65.26%, T2=65.26%–76.35%, and T3 ≥76.35% by DPP-4 inhibition. We analyzed the change from baseline in glycosylated hemoglobin (HbA1c) according to DPP-4 inhibition with multiple linear regression adjusting for age, ethnicity, body mass index, baseline HbA1c, and DPP-4 activity at baseline.Results: The mean age was greater in the high tertile group compared with the low tertile group (T1: 49.8±8.3 vs. T2: 53.1±10.5 vs. T3: 55.3±9.5, P<0.001) of DPP-4 inhibition. Although HbA1c at baseline was not different among tertiles of DPP-4 inhibition (P=0.398), HbA1c after 24-week treatment was lower in the higher tertile compares to the lower tertile (T1: 7.30%±0.88% vs. T2: 7.12%±0.78% vs. T3: 7.00%±0.78%, P=0.021). In multiple regression analysis, DPP-4 enzyme inhibition rate was not a significant determent for HbA1c reduction due to age. In subgroup analysis by tertile of DPP-4 inhibition, age was the only significant predictor and only in the highest tertile (R2=0.281, B=–0.014, P=0.024).Conclusion: This study showed that HbA1c reduction by DPP-4 inhibitor was associated with increasing age, and this association was linked with higher DPP-4 inhibition.
Pulmonary Artery Sheath Hematoma
Authors: Plack Daniel L. , Rehfeldt Kent H. , Nelson James A. , Kauss Marissa L.
Published: April 2021

Dissection of the ascending aorta (AA) represents a life-threatening condition typically treated by emergent surgical repair. A rare, potential complication of AA dissection is pulmonary artery (PA) sheath hematoma. Due to the presence of a common adventitial layer between the proximal AA and the PA, dissection can propagate between both vessels, potentially compromising the PA lumen. The resultant acute narrowing of the PA lumen may abruptly increase right ventricular (RV) afterload. Recognition of PA sheath hematoma is important; when seen on echocardiography it is suggestive of AA dissection and has the potential to result in RV hypertension and dysfunction if significant PA compression occurs.
Less is More
Authors: De Simone Francesco , Nardelli Pasquale , Licheri Margherita , Frau Giovanna , Redaelli Martina Baiardo , Monaco Fabrizio , Zangrillo Alberto , Landoni Giovanni
Published: April 2021

Context:

Protamine is routinely administered to neutralize the anticlotting effects of heparin, traditionally at a dose of 1 mg for every 100 IU of heparin—a 1:1 ratio protamine sparing effects—but this is based more on experience and practice than literature evidence. The use of Hemostasis Management System (HMS) allows an individualized heparin and protamine titration. This usually results in a decreased protamine dose, thus limiting its side effects, including paradox anticoagulation.

Aims:

This study aims to assess how the use of HMS allows to reduction of protamine administration while restoring the basal activated clotting time (ACT) at the end of cardiac surgery.

Settings and Design:

A retrospective observational study in a tertiary care university hospital.

Subjects and Methods:

We analyzed data from 42 consecutive patients undergoing cardiopulmonary bypass (CPB) for cardiac surgery. For all patients HMS tests were performed before and after CPB, to determine how much heparin was needed to reach target ACT, and how much protamine was needed to reverse it.

Results:

At the end of cardiopulmonary bypass, 2.2 ± 0.5 mg/kg of protamine was sufficient to reverse heparin effects. The protamine-to-heparin ratio was 0.56:1 over heparin total dose (a 44% reduction) and 0.84:1 over heparin initial dose (a 16% reduction).

Conclusion:

A lower dose of protamine was sufficient to revert heparin effects after cardiopulmonary bypass. While larger studies are needed to confirm these findings and detect differences in clinically relevant outcomes, the administration of a lower protamine dose is endorsed by current guidelines and may help to avoid the detrimental effects of protamine overdose, including paradox bleeding.
Posterior Mediastinal Mass in a Neonate Causing Airway Compression
Authors: Rastogi Amit , Nasar Nishat , Mandelia Ankur , Singh Tapas K
Published: April 2021

Posterior mediastinal masses by their location pose a risk of compression of heart, great vessels and airway. These risks are further exaggerated, with the use of neuromuscular relaxants and lateral positioning during anesthesia. We report a case of a 2.5 months old baby with posterior mediastinal mass causing compression of left bronchus and significant mediastinal shift with respiratory distress as a primary complaint. This posterior mediastinal Mass (PMM) was removed by right lateral thoracotomy without the initial use of neuromuscular blockade till the pleura was opened.
Pulsatile Flow in Descending Aorta
Authors: Diwakar Anitha , Chalam Kolli S. , Hiremath C S , Dash P K
Published: April 2021

A 5-year-old child with L posed great arteries, large subpulmonic ventricular septal defect (VSD), atrial septal defect (ASD), and a large patent ductus arteriosus (PDA) with mild isthmic narrowing was scheduled for surgical correction. Intraoperatively, it was a case of anatomically corrected malposition of great arteries. Due to abnormal positioning of great vessels, the isthmus was ligated instead of the large PDA. The postoperative transesophageal echocardiography showed pulsatile flow in descending aorta as it was being filled by large PDA, and thus iatrogenic coarctation (CoA) was missed. It was detected in the intensive care unit due to the onset of acidosis on blood gas analysis and the presence of gradient between radial and femoral arterial line pressures. The patient was taken for redo surgery, the PDA was then ligated, resection of the isthmic narrowing and repair by end-to-end anastomosis was done.
Internship Orientation: An Essential Facilitatory Bridging Step for Medical Students
Authors: Kathrotia Rajesh , Huda Farhanul , Rao Shalinee , Bahadur Anupama , Kant Ravi , Naithani Manisha
Published: April 2021

Background: Internship is a facilitatory period that hones skills and helps in the evolution of a qualified medical student to a competent doctor. The feeling of a final year student joining as a fresh intern after successfully completing the final professional examination will be directionless without a bridging initiative through a buffer program. Fresh interns need to be oriented to the fundamentals of working effectively with a patient as a whole and not as a separate discipline. This study was done to evaluate the effectiveness of the internship orientation program and to assess the feedback of participants about this program. Methodology: This was a study conducted on 235 freshly joined medical interns. The process included evaluation of a well-structured seven-day orientation program by prevalidated structured Multiple Choice Questions (MCQs) and feedback. Results: All interns performed satisfactorily in the post-test with a mean score of 74.13 ± 7.18. Post-test scores were highest for procedure skills and communication skills, including medical ethics. Overall, 232 (99%) of interns responded that the program was useful and it successfully enhanced their clinical skills; 221 (94%) of interns expressed that the content of the program was excellent to good; and 228 (97%) of interns felt that the method used for training was appropriate. Interns also documented that there were a few new skills that were acquired by attending this program. Conclusion: There is an unmet need for an internship orientation program across all medical colleges to lay a strong foundation for naive interns. Based on the results, we recommend an internship orientation program for a smooth and swift transition from that of a medical student to professional life. It will orient the interns and lay the foundation for the next level of assignment in building their professional career.

Key Messages: Internship orientation programs are recommended for a smooth and swift transition from that of a medical student to professional life.
Newborn screening for congenital hypothyroidism
Authors: Gupta Vinay , Sood Ashwani , Sood Mangla
Published: April 2021

Background:

Incidence of congenital hypothyroidism (CH) varies across countries and different geographic regions.

Aims and Objectives:

This study was conducted to find prevalence of CH in iodine-deficient district of North Indian hilly state Himachal Pradesh, India.

Materiala and Methods:

A prospective analysis of cord blood thyroid-stimulating hormone (TSH) and T4 hormone values on 4057 neonates was done in the delivery hospital.

Results:

No CH was detected among 3964 neonates; with limitation of losing 93 newborns with high cord blood TSH >20 uIU/l who could not be recalled for serum testing.

Conclusion:

With known benefits of CH screening, a properly implemented neonatal screening program for CH at all levels of health care is definitely the need of the hour.
Long-term hypocalcemia prediction post thyroidectomy
Authors: Janardhan Deepak , Suresh Sandeep , Balagopal P. G. , George Nebu Abraham , Jagathnath Krishna K. M.
Published: April 2021

Introduction:

Hypocalcemia is a common sequela of total thyroidectomy and is usually transient (30%), only a few develop permanent hypoparathyroidism. Till date, no effective risk stratification score to predict hypocalcemia is available that can predict postoperative hypocalcemia.

Materials and Methods:

This was a prospective observational study including all patients who underwent total or completion thyroidectomy with initial parathormone (PTH) within the normal range in our institution during a 1 year period. Postoperative 6th h PTH fall was noted in all patients and cutoff point for the prediction of long-term hypocalcemia (LTHP) was determined using a paired t-test.

Results:

Postoperatively, calcium supplementation was initiated in 52% of patients. In 7.6% of patients who had a fall in PTH to more than 80% of preoperative value, calcium supplementation could not be tapered even after 3 months postoperatively. About 66% of patients <20 years of age developed hypocalcemia in the postoperative period. Patients who developed delayed hypocalcemia with initial normal calcium levels had fall in PTH of at least 45%. For individuals below 20 years, a PTH fall of 56% or more required calcium supplementation. The various variables studied failed to attain statistical significance.

Conclusions:

More than 82% fall in 6th h postoperative PTH predicts long-term hypocalcemia. Post total thyroidectomy, adolescent individuals are at a higher risk of developing hypocalcemia; hence, early calcium supplementation is recommended based on fall in PTH. Weighted score to predict LTHP could not be developed, as none of the risk factors evaluated were statistically significant.
Korea National Health and Nutrition Examination Survey, 20th anniversary: accomplishments and future directions
Authors: Oh Kyungwon , Kim Yoonjung , Kweon Sanghui , Kim Soyeon , Yun Sungha , Park Suyeon , Lee Yeon-Kyeng , Kim Youngtaek , Park Ok , Jeong Eun Kyeong
Published: April 2021

The Korea National Health and Nutrition Examination Survey (KNHANES) was initiated in 1998 to provide evidence for the development and evaluation of health policies and programs. The Korea Disease Control and Prevention Agency is responsible for the KNHANES and has conducted it as a series of surveys. Over the past 20 years, efforts to produce accurate, timely, and nationwide health statistics have been refined by establishing a continuous annual survey system with full-time field staff, incrementally expanding survey components, collaborating with relevant academic societies for quality control, and revising the survey methods. Additionally, the utility of the collected data was increased by linking the KNHANES data with related data from other government agencies or institutions and making the overall data publicly available on the official website of KNHANES (https://knhanes.kdca.go.kr). Additional long-term plans are being developed, including plans to continue producing nationwide health indicators and invigorating the utilization of the KNHANES data.
Prevalence of Diabetes, Prediabetes, and Associated Risk Factors Among Agricultural Village Residents in the Dominican Republic
Authors: Madsen Beau De Rochars Valery E. , Keys Hunter , Samuels Shenae K. , Jo Ara , Noland Gregory S. , Gonzales Manuel , Blount Stephen , Mainous Arch G.
Published: April 2021

This study examined the prevalence and risk factors of prediabetes and type 2 diabetes among residents of agricultural settlement villages (bateyes) in the Dominican Republic. From March to April 2016, a cross-sectional, multi-stage cluster survey was conducted across the country’s three agricultural regions (southwest, east, and north). At selected households, an adult completed a questionnaire to assess demographics, diabetes knowledge, and care, and two household residents of any age provided finger-prick blood samples that were analyzed for hemoglobin A1c (HbA1c). HbA1c was categorized as normal (< 5.7%), prediabetic (5.7–6.4%), or diabetic (≥ 6.5%). The prevalence rates of diabetes and prediabetes were 8.6% (95% confidence interval [CI], 6.2–11.8%) and 20.4% (95% CI, 17.9–23.2%), respectively, among all participants (N = 1293; median age, 35 years; range, 2–96 years), and 10.0% (95% CI, 7.2–13.8%) and 20.0% (95% CI, 17.4–23.0%), respectively, among adults 18 years or older (N = 730). The average age of participants with diabetes was 47.2 years. The average age of participants with prediabetes was 40.7 years. Among adult questionnaire respondents, 64.8% of all participants and 39.4% of patients with diabetes had not been tested for diabetes previously. Among patients with diabetes, 28.4% were previously diagnosed; 1.2% of prediabetes patients were previously diagnosed. Half (50.7%) of the respondents had heard of diabetes. The majority (94.1%) of patients previously diagnosed with diabetes reported using diabetes medication. Among both undiagnosed and previously diagnosed patients with diabetes, diabetes knowledge, previous diabetes testing, and diabetes care-seeking were lowest among Haitian-born participants. A high burden of undiagnosed diabetes and deficiencies in diabetes knowledge, access to care, and diagnosis exist among all batey inhabitants, but most acutely among Haitians. Improvements will require a multi-sectoral approach.
Case Report: Fulminant Infantile Beriberi: A Report of Six Cases
Authors: Samprathi Madhusudan , Mohammad Faisal , M Sridhar , Ramachandra Prakash , Vemgal Prakash
Published: April 2021

Thiamine deficiency disorders are an under-recognized public health problem in low- and middle-income countries. Infantile beriberi, the most important symptom for children, is suspected to significantly contribute to infant mortality and lifelong neurodevelopmental morbidity. Lack of awareness, varied clinical presentation, and lack of a readily available diagnostic marker lead to frequent misdiagnoses. We report six thriving infants who presented with an acute fulminant illness with varied clinical manifestations mimicking common childhood illnesses like pneumonia and sepsis. Four of them presented with the severe cardiovascular form, called Shoshin beriberi, and severe pulmonary arterial hypertension. Empirical intravenous thiamine administered to four of the six infants resulted in dramatic recovery. Awareness of the clinical definition of infantile beriberi and treatment with empirical thiamine can be lifesaving.
Pathogenesis of Pulmonary Hemorrhagic Syndrome in Human Leptospirosis
Authors: Nicodemo Antonio C. , Duarte-Neto Amaro Nunes
Published: April 2021

Based on a previous study and by incorporating new knowledge, the goal of our study was to understand more fully the pathogenesis of hemorrhagic pneumonia of severe human leptospirosis, highlighting the onset of capillary lesions by Leptospira itself and/or its antigenic/toxic products acting on the endothelium and binding to cadherins. Both events lead to loss of endothelial integrity, alter permeability, cause rupture, and open intercellular junctions, contributing to the hemorrhagic phenomena associated with severe leptospirosis.
Real-Time Fluorimetry Loop-Mediated Isothermal Amplification for Diagnosis of Leishmaniasis and as a Tool for Assessment of Cure for Post–Kala-Azar Dermal Leishmaniasis
Authors: Dixit Keerti Kaumudee , Ramesh Venkatesh , Gupta Ratan , Negi Narendra Singh , Singh Ruchi , Salotra Poonam
Published: April 2021

Despite the dwindling number of visceral leishmaniasis (VL) cases in India, there is an urgent need for early and unequivocal diagnostics for controlling and preventing the reemergence of VL. Post–kala-azar dermal leishmaniasis (PKDL), a dermal sequela of VL, serves as a reservoir of the parasite. Diagnosis of PKDL, especially the macular variant, is challenging and poses impediment toward attainment of VL elimination. In this study, a real-time fluorimetry loop-mediated isothermal amplification (RealAmp) assay has been established for the detection of different clinical manifestations of leishmaniasis. The study included 150 leishmaniasis patients (25 VL, 25 cutaneous leishmaniasis [CL], and 100-PKDL) along with 120 controls. The assay demonstrated sensitivity of 100% (95% CI: 86.68–100) for diagnosis of VL and PKDL (95% CI: 79.61–100) and 96% (95% CI: 86.68–100) for CL with 100% specificity. Moreover, considering the cardinal role of PKDL, diagnosis using minimally invasive slit aspirate was explored, which demonstrated remarkable sensitivity of 96% (95% CI: 87.64–98.47). As a test of cure for PKDL, RealAmp successfully detected parasite in two of posttreatment cases who later reported relapse on follow-up. Also, direct sample lysis using slit aspirate was attempted in a small group that yielded sensitivity of 89% (95% CI: 67.20–96.90). RealAmp depicted excellent diagnostic accuracy in the diagnosis of leishmaniasis in concordance with the established SYBR Green I–based (Molecular Probes, Eugene, OR) visual loop-mediated isothermal amplification (LAMP) and the reference comparator real-time PCR. The study endorsed the employment of LAMP either as visual-LAMP or RealAmp for an accurate and expeditious diagnosis of PKDL and as a tool for assessment of cure.