bluuebunny/crossref_metadata_2025 huggingface dataset:
Spherical Aberration of Astigmatic Corneas in a Cataract Population
Authors: Baur Isabella D. , Auffarth Gerd U. , Khoramnia Ramin , Łabuz Grzegorz
Published: August 2023

Purpose:

To study the distribution of spherical aberration (SA) in astigmatic corneas in a cataract population and the relationship between magnitude of corneal astigmatism and fourth-order corneal SA.

Methods:

Data routinely collected using a Scheimpflug camera (Pentacam; Oculus Optikgeräte GmbH) were retrospectively analyzed. Patients with a minimum age of 60 years were included. Total corneal SA (from anterior and posterior corneal surface) was obtained for a 6-mm cor-neal area aligned with the pupil center. Exclusion criteria were insufficient measurement quality, total deviation index (Belin/Ambrósio Deviation) greater than 1.60, and corneal thickness at the thinnest point of less than 490 μm. One eye per patient was chosen randomly. Eyes were divided into low (≤ 1.00 diopters [D]), moderate (> 1.00 to ≤ 2.00 D), and high (> 2.00 D) astigmatism groups according to the Scheimpflug measurements.

Results:

A total of 528 eyes were included in this analysis. Low astigmatism was found in 129 patients, moderate astigmatism in 265 patients, and high astigmatism in 134 patients. Mean astigmatism was 0.68 ± 0.24, 1.45 ± 0.28, and 2.91 ± 0.95 D in the low, moderate, and high astigmatism groups, respectively. Mean corneal SA in patients with moderate and high astigmatism was higher than in the low astigmatism group. The difference reached the significance level for the comparison of low and high astigmatism groups (
P
= .023). The fourth-order SA increased gradually with the magnitude of astigmatism with a slope of 0.015.

Conclusions:

SA was significantly larger in the cataract population with high corneal astigmatism. The increase of positive sign SA with the magnitude of astigmatism suggests that patients with moderate to high astigmatism may benefit more from intraocular lenses with negative sign SA correction.

[
J Refract Surg
. 2023;39(8):532–538.]
A Case Series of Infectious Keratitis After Corneal Cross-linking
Authors: Farrokhpour Hossein , Soleimani Mohammad , Cheraqpour Kasra , Masoumi Ahmad , Tabatabaei Seyed Ali , Shahriari Mansoor , Hobaby Sara , Baharnoori Seyed Mahbod , Chaudhry Ahmed , Djalilian Ali R.
Published: August 2023

Purpose:

To present the 7-year experience of a tertiary eye hospital while exploring possible risk factors and incidence of infectious keratitis in patients undergoing standard corneal cross-linking (CXL).

Methods:

This retrospective cohort study included patients with progressive keratoconus undergoing standard CXL in the Farabi Eye Hospital and all other patients who had undergone CXL in other facilities and were diagnosed as having infectious keratitis in the 7-year period of the study.

Results:

Among the total of 4,863 eyes that underwent CXL, 6 eyes developed infectious keratitis, yielding an incidence rate of 0.12%. Additionally, 13 eyes from 10 patients with a CXL history in other facilities who developed infectious keratitis were included. The mean age was 23.75 years, and 75% of patients were men and 25% were women. Gram-positive bacteria and
Staphylococcus aureus
were the most prevalent pathogens. Meibomian gland dysfunction, dry eye disease, or blepharitis were present in 12 patients. Medical treatment did not arrest the disease progress in 5 patients, which eventually required cases to undergo keratoplasty.

Conclusions:

This study supports the need for proper patient selection by using a comprehensive medical history. It also highlights the imperative role of rigorous patient education and follow-up, particularly in the first postoperative week. Finally, the study emphasizes aggressive early therapy for patients with suspicious findings.

[
J Refract Surg
. 2023;39(8):564–572.]
Exploring barriers to accessing healthcare services for older indigenous people in the Chittagong Hill Tract, Bangladesh
Authors: Hossen Md. Sohrab , Sohel Md. Salman , Horaira Gazi Abu , Laskor Md Aminul Haque , Sumi Asia Binta Amanat , Chowdhury Srima , Aktar Sima , Sifullah Md. Khaled , Sarker Md. Fouad Hossain
Published: August 2023

We aim to investigate the obstacles faced by elderly indigenous individuals in the Chittagong Hill Tracts, Bangladesh when accessing healthcare services. A qualitative research approach was utilized, and data collection was carried out in three distinct regions of the aforementioned area. A total of 30 in-depth, semi-structured interviews and participant observations were conducted to achieve the research objectives. Thematic analysis utilizing both a deductive and inductive approach was employed to analyze the data. The Granheim method and Nvivo-12 software were utilized to process, analyze and code the data. The study's findings indicate that a lack of knowledge about healthcare needs, geographical barriers, poor financial conditions, higher cost of medical services, scarcity of hospitals nearby and communication barriers all contribute to inadequate access to healthcare services. By recognizing the factors that impede access to healthcare services in this region, this study offers valuable insight for policymakers and healthcare providers on how to enhance healthcare services for the indigenous population, especially the elderly. Furthermore, the government can adopt a more efficient approach to include these elderly individuals in various social safety net programs.
Tumour induced osteopenia due to phosphaturic mesenchymal sinonasal tumour presenting with delayed onset insufficiency fractures
Authors: Jawan Freda , Lim Weiling , Francis Joe
Published: August 2023

We present a case of a 48-year-old female who presented with epistaxis. Magnetic resonance imaging (MRI) revealed a mass within the left nasal cavity which was revealed to be a phosphaturic mesenchymal sinonasal tumour. The patient defaulted treatment at this stage and later re-presented with pelvic and groin pain for which plain radiographs and computed tomography (CT) scan demonstrated diffuse osteopenia and multiple pelvic fractures of varying ages. MRI of the pelvis and both thighs revealed abnormal marrow signal of the bones and confirmed the presence of pelvic fractures. Multiple pseudo-fractures were seen at both femurs and scapula. The radiological findings along with abnormal biochemical markers were attributed to the paraneoplastic entity of tumour induced osteomalacia, in the context of unresected phosphaturic mesenchymal tumour. The tumour was resected, and patient showed complete reversal of the associated biochemical abnormalities. This case exemplifies that with early identification and complete resection of the causative tumour, the prognosis is excellent.
Open-Access Theology: Introducing the St Andrews Encyclopaedia of Theology’s Digital Publishing Model
Authors: Dyer Rebekah , Wolfe Brendan
Published: August 2023

The St Andrews Encyclopaedia of Theology (SAET) is an online multi-author reference work designed as a resource for those engaged with, or wishing to learn more about, the academic study of theology. The SAET seeks to provide a suite of comprehensive, fully open-access peer-reviewed articles with no fees or sign-up requirements. In doing so, the editors aim to improve the availability of high-quality information for readers worldwide, especially those for whom access to resources through traditional academic publishing is restricted by cost, lack of institutional affiliation, or limited library resources. This article introduces the SAET’s digital publishing model, discussing the scholarly and editorial principles that have informed the development of the project. In particular, the article examines the ways in which the SAET’s commitment to providing quality open-access scholarship has significantly shaped the project’s information management and publishing processes.Technical strategies for widening access to theological knowledge are discussed, focusing on information discovery through the Encyclopaedia’s faceted search and in-article hyperlinks, as well as available article formats (HTML and PDF). This is accompanied by an explanation of strategies for long-term curation and preservation of theological knowledge within the SAET, namely capturing and preserving conceptual information through enriched XML mark-up and embedded metadata. The SAET’s article lifecycle is then conceptualized in reference to digital curation and preservation actions described by the Digital Curation Centre’s ‘DCC Curation Lifecycle Model’, leading to conclusions about the distinctive character of the SAET article workflow, in which curation and preservation of theological knowledge is integrated into its creation and production.
Using Rubrics for Language Assessment
Authors: Mendoza Laura E.
Published: August 2023

The use of rubrics for classroom assessment has been evolving rapidly during the last decades. Unfortunately, because rubrics across language classrooms are only sometimes standardized, some may provide a non-friendly language for students, which is useless for their linguistic development. In addition to defining rubrics from an array of perspectives, the present chapter presents possible benefits linked to the appropriate use of rubrics among emergent bilinguals. Shabani and Panahi highlight essential benefits for students when presented with language assessment tools, such as rubrics, and the authors use their observation for this chapter. It aims to highlight the importance of rubrics in the language classroom in an effort for educators, evaluators, and policymakers to be more conscious when creating and using rubrics.
Fostering Entrepreneurship Education by Improving Assessment Rubrics for Entrepreneurship Competence
Authors: Hämäläinen Minna , Raappana Anu
Published: August 2023

This chapter describes a tool for assessing the development of learners' entrepreneurship competence and its construction process. Competence in entrepreneurship is promoted at all school levels, but there are very few tools for teachers to assess the level or development of students' entrepreneurship competence. It can also be very unclear to teachers what should be assessed and when to assess a student's entrepreneurship competence. The rubric-based tool allows teachers to assess the development of a learner's entrepreneurship competence in an easy and simple way. The rubric also makes it possible to develop a teacher's own skills, as it gives an idea of what is being assessed when it comes to entrepreneurship competence. The tool was developed in a participatory process with teachers, students, and researchers. Another special feature of the presented tool is its internationality and the common contribution of different cultures to the development of the assessment tool.
The Importance of Student Partnership in Rubric Construction, Discussion, and Evaluation
Authors: Laville Allan Stephen , Thompson Lindsey , Yue Yue , Hayward Alexandra J. , Grace-Bland Victoria
Published: August 2023

The chapter explores the importance of utilising student-staff partnerships in the development and evaluation of rubrics. The approach followed is underpinned by the University of Reading principles for student-staff partnerships that centres student voice in the development of Teaching and Learning initiatives. The chapter explores the challenges of engaging students with assessment rubrics and through engaging in listening exercises, the actions taken to remove these barriers to engagement. The chapter provides three case studies that detail practical recommendations to improving student assessment literacy including in-class support for rubrics, additional support outside of the classroom e.g., assessment rubric screencasts and discussion boards, and the importance of co-creation in creating new rubrics. The chapter concludes by detailing the importance of student-staff partnerships in rubric development and evaluation, but also detailing the additional support mechanisms that need to be in place to effectively develop student and staff assessment literacy.
Exploring and Developing Reflective Writing Rubrics in Higher Education
Authors: Sands Martin
Published: August 2023

This chapter highlights key academic contentions around assessing reflection in higher education. Through assimilating experiential, conceptual, and empirical evidence, key terms are defined: ‘reflection' as a conceptual and neuroscientific phenomenon within higher education; ‘reflective practices' as activities, models, and frameworks that facilitate it; and ‘reflective assessments' as content or process driven products of those practices. A literature review elucidates three voices that speak to reflection in higher education.
Neuromarketing vs. Brands
Authors: Küçün Nihan Tomris
Published: August 2023

Neuromarketing, which involves the application of neuroscience techniques to investigate the cognitive mechanisms of consumers, independent of their subjective self-reports, has gained significant traction among both commercial entities contending with a diverse target audience and scholars actively involved in associated inquiries. However, it is important to determine the potential and limitations of the techniques, to define the outputs that can be put into practice with research examples, and to create a methodological and ethical framework. In line with these priorities, in this section, neuromarketing instruments are explained and the integration with other methods is discussed. Then, it is detailed which components that effectuate consumer behavior can be monitored and to what extent they can be interpreted with neuromarketing methods. Finally, the criticisms within the framework of scientific ethics are evaluated and suggestions developed for both researchers and brands in the field in order to reach the targeted sustainable benefit.
Brand Activertising
Authors: Duarte Alexandre , Chambel Simão
Published: August 2023

In an era of highly polarized public opinion, organizations all over the world are now facing a great dilemma, as brand activism and CSR strategies have a stronger influence on consumer behaviors than the traditional marketing campaigns. With marketing changing from purpose to action, and consumers becoming more belief driven, companies are being asked to take a stand, and choose a side on controversial sociopolitical issues. Advertising, the spearhead of organizational communication, which has always appropriated the social codes in force in society to persuade its target audience to carry out certain actions, nowadays, can no longer be dissociated from the moral concerns of consumers who increasingly demand corporate responsibility from organizations. This chapter explores the evolution of advertising's role, in a historical and contextual approach, analyzed from the new relationship model that citizens and consumers demand from companies and the reflection that it has on the advertising message.
Fostering Pedagogical Innovation in Tourism Education Through Experiential Learning
Authors: Vasconcelos Dr Sandra Vieira , Melo Carla , Melo António
Published: August 2023

Due to its service-oriented nature, Tourism and Hospitality Education relies heavily on experimental learning (EL) approaches, that focus on real-word challenges and can replicate future professional settings. In addition to simulation, project-based learning, fieldtrips and role-play, educators are looking for alternative and innovative strategies to enhance students' learning experiences and support the development of technical and high-level skills. Recognizing the importance of EL, and aiming to contribute towards its development, and support practitioners working in Tourism Higher Education, this chapter focuses on the development of a toolkit that supports activities within this scope. Drawing from a literature and best practice review and their experience, the authors expand on Kolb's experiential learning cycle's model to frame the toolkit's principles and key concepts and describe its creation process, the target audience, and overall sections, that will include different tourism and hospitality subsectors, offering a provisional glimpse of the artefact being created.
Unlocking the Potential of Educational Escape Rooms in Higher Education
Authors: Lim Iris
Published: August 2023

This chapter investigates the potential of educational escape rooms in higher education exploring the theoretical frameworks surrounding their design, outcomes, and future directions. The primary purpose is to provide educators with an understanding of how these immersive experiences can enhance learning and engagement. The chapter delves into relevant theoretical frameworks, including constructivism, experiential learning, game-based learning, and social learning which underpin the effectiveness of educational escape rooms. The chapter also offers practical recommendations and discusses emerging opportunities for incorporating escape rooms into various educational contexts. By examining the multifaceted aspects of educational escape rooms, this chapter aims to support educators in leveraging these innovative tools to create engaging learning experiences and foster positive student outcomes.
Designing Metaverse Escape Rooms for Microlearning in STEM Education
Authors: Damaševičius Robertas , Sidekerskienė Tatjana
Published: August 2023

The use of immersive and interactive learning environments is gaining traction in science, technology, engineering and mathematics (STEM) education, as educators seek to engage students and enhance learning outcomes. We explore the potential of Metaverse for designing immersive and interactive escape rooms that leverage microlearning to teach STEM concepts and skills. We overview Metaverse and its potential as a learning environment, before delving into the use of escape rooms as a strategy for fostering critical thinking, collaboration, and problem-solving in STEM education. We examine the benefits of incorporating microlearning strategies into escape rooms, including the use of bite-sized content and personalized learning paths. Through a case study of a Metaverse escape rooms implemented in Studio Gometa as a smartphone app and aimed at mathematics education, we highlight the learning outcomes achieved and the challenges faced in the design and implementation process.
Pinpoint Particle Removal for EUV Pellicle Productivity Enhancement
Authors: Kim Tae Gon , Kang Hyun Gyu , Ha Geu Rim , Ahn Jin Ho , Lee Sang Sul , Park Jin Goo
Published: August 2023

The EUV lithography process is increasingly employed in the advanced semiconductor process, and high-NA EUV equipment is being developed for high-volume manufacturing. Therefore, particle contamination control for EUV masks is a key success factor for the yield increase of the EUV lithography process in the future and for this, the needs of EUV pellicle will increase. Although materials for the EUV pellicle membrane are still under development, unlike ArF pellicles, its fabrication is complicated and difficult, resulting in low production yield and high production costs. To reduce EUV pellicle operating costs, it is possible to consider ways to reduce production costs by enhancing the yield of EUV pellicle or reusing particle contaminated EUV pellicle by particle removal. Both methods require damage-free particle removal technology of EUV pellicle. Pinpoint particle removal technology, a cleaning technology that satisfies these requirements, was developed, and particles bigger than 5 μm could be removed in a cleanroom environment without damaging fragile EUV pellicle. The possibility of the damage-free EUV pellicle cleaning process was verified through the process window evaluation of Pinpoint cleaning technology.
A Cleaning Method for Post-Etch Ruthenium Residue Removal Using UV and Liquid Chemical
Authors: Nakano Teppei , Le Quoc Toan , Kawarazaki Hikaru , Tanaka Takayoshi , Altamirano-Sanchez Efrain
Published: August 2023

As semiconductor devices continue to scale, it is important to evaluate alternative metals on narrower wiring or via structures. Ruthenium (Ru) is one promising candidate because of its lower resistivity compared to the conventional metals such as copper (Cu), cobalt (Co) and tungsten (W) on narrow space. To prevent leakage problems between metal layers caused by residues on the bottom and sidewalls after the metal patterning process, a cleaning process for Ru metal lines is necessary. Although the industry standard using Ammonia Peroxide Mixture (APM) is effective for removing residues, it was ineffective for Ru semi-damascene stack. Therefore, a new cleaning method involving UV treatment followed by APM, which was tested on metal pitch 18 nm patterned structure, was developed. This method showed promising results and is expected to be used in manufacturing of future semiconductor devices.
Investigation of Effects of Sulfuric Acid in Single Wafer Cleaning Process Using Isopropyl Alcohol
Authors: Oh Seung Jun , Song Si Nae , Jeon Jong Yeong , Lee Sun Young , Kim Tae Sung
Published: August 2023

Isopropyl alcohol (IPA) was used in the drying process to remove the contamination after the wet cleaning process. Regardless of the types of chemical solutions, the IPA is more strictly controlled because it is used. However, when the IPA was exposed to low acid concentration, the IPA polymers were generated to the di-isopropyl ether, isopropyl acetate, and di-isopropoxy methane. And the pH of IPA rapidly changed by about 1.99 in ppm level concentration. Generated IPA polymers were adsorbed on the wafer surface. These polymers can occur defects, and the probability increases as the concentration increases. Scanning mobility particle sizer (SMPS) measurement system can be measured the impurity in IPA solution. The total impurity concentration was increased by the concentration of H2SO4 with the same results in both gas chromatography mass spectrometry (GCMS) and time of flight secondary ion mass spectrometry (ToF-SIMS). SMPS results can be correlated with the concentration of impurities. In this paper, IPA polymers were defined by acid contamination, and these polymers have affected the Si wafer surface. In addition, the SMPS measurement system was introduced for the detection of impurities in IPA solutions.
Highly Selective Etching of SiGe to Si for GAAFET
Authors: Lee Seung Hyo , Lee Won Je , Lim Sang Woo
Published: August 2023

Highly selective etching of SiGe over Si is required for the fabrication of gate-all-around field-effect transistors (GAAFET). A solution consisting of a mixture of H2O2, CH3COOH, and HF is known to etch SiGe with high selectivity over Si. The detailed etching mechanism of SiGe and Si in this solution was investigated in this study. The effect of each chemical species on the etching of SiGe and Si was investigated using various concentrations of H2O2, CH3COOH, and HF. It was found that the etching rate of SiGe was highly relevant to the concentration of peracetic acid (PAA) which was produced by the reaction between H2O2 and CH3COOH. In addition, various additives which can further increase the SiGe selectivity and their mechanisms were investigated.
Reaction Mechanism Analysis of Si Selective Etching for Gate-All-Around Transistors by Molecular Simulations
Authors: Yuhara Daisuke , Ikeda Kei , Mikami Masayoshi , Shiratori Kazuya , Shirae Hiroyuki , An Long Jie , Kasai Tetsuo
Published: August 2023

The selective etching of Si in multi-stacked Si and SiGe structures is a key process to fabricate the next-generation of FET, Gate-all-around FET. In this study, we investigated the mechanism of wet chemical etching process at the molecular level for two common ionic solutions, potassium hydroxide (KOH) and tetramethylammonium hydroxide (TMAH). One of the important factors in the etching process is the reaction rate between the water and Si surface. Therefore, the water dynamics in i) bulk system and ii) Si wall confined system were mainly analyzed using molecular dynamics simulations. As a feature of bulk, TMAH showed the larger hydration structure around cation and the lower mobility of water in the hydration shell compared to KOH. In the Si wall confined system, the water and ion dynamics on the OH-terminated Si surface were distinctive. TMAH showed the lower mobility of water as in bulk system. Furthermore, the concentration and long stay of cation near the Si surface were observed in TMAH. This behavior of cation may directly prevent water from contacting surface. These characteristics of TMAH may slow down the Si etching process. However, if the blocking effect for etching depends on the surface composition, it will be useful for selective etching.
Fine Edge and Bevel Film Cut Accuracy by a Novel and High Precision Wafer Centering System
Authors: Chen Fu Ping , Zhang Wei , Jia Fu Jin , Wu Kai Xuan , Wang Wen Jun , Zhang Xiao Yan , Wang David H. , Wang Jian , Wang Jane , Han Harry , Henry Sally Ann , Jia She Na
Published: August 2023

As more and more wafer dies are produced at the edge of the wafer, wafer edge cleaning and etching has become increasingly important in the manufacturing process of complex thin film laminated integrated circuits. If the edge cut accuracy is not well controlled, the effective removal of film and contaminants will not be achieved. In this paper, we propose a fine edge cut control process with a novel and high precision wafer centering method. A high precision wafer centering system for determining and correcting the position of a wafer on its chuck so as to ensure the uniformity of the width of the wafer edge etched. A fine edge cut profile is beneficial for subsequent film growth, and excellent cleaning capability can prevent buildup of flakes and defects on the bevel. All the above advantages contribute to the improvement of wafer edge yield in the future of chip manufacturing.
Defect Mapping and Densification in Self-Assembled Monolayers of Octadecyltrichlorosilane on SiO2
Authors: Miyamoto Yasuharu , Yoshida Yukifumi , Utsunomiya Toru , Kunieda Shogo , Ueda Yusuke , Sanada Masakazu , Sugimura Hiroyuki
Published: August 2023

Self-assembled monolayers (SAMs) can be used for surface functional control to assist with pattern collapse prevention and as a protective layer to enable Area Selective Deposition (ASD). To be successful, these applications require the formation of a high-density, defect-free, so-called well-packed SAM at the nm scale. In this paper, we describe a method to map the nm scale defects of octadecyltrichlorosilane (ODTS) SAMs using a post-etching AFM analysis of the surface of the substrate and used this technique to develop a process to form high-density, defect-free SAM layer at the nm scale. This was achieved by optimizing the water concentration in the solvent for the precursor solution and annealing after SAM formation.
Observation of Capillary Condensation and Pattern Bending Phenomena in Si Nanopillars Using In Situ TEM
Authors: Aabdin Zainul , Xu Xiu Mei , Leong Fong Yew , Holsteyns Frank , Mirsaidov Utkur
Published: August 2023

Capillary condensation, a ubiquitous phenomenon involving the heterogeneous nucleation of liquid droplets, has significant implications in various industrial, biological, and atmospheric processes. Strong capillary forces induced by highly curved menisci of condensates can have potentially significant impact on the structural integrity and functionality of nanodevices. While the influence of surface properties on the nucleation and growth of water droplets has been extensively studied at microscale, our understanding of water condensation at the nanoscale remains limited due to experimental challenges in imaging liquids at nanometer scales. In this study, we employ in situ liquid phase TEM imaging and for the first time present real-time observations of water condensation dynamics on arrays of vertical silicon (Si) nanopillars. Experimental and simulation results show that nucleation of water droplets occurs at the edges of the nanopillars and substrate, followed by the growth of an interfacial layer resembling a corona around the nanopillars. Subsequently, the formation of bridges between adjacent growing coronas leads to the development of symmetric and asymmetric bridged nanopillar geometries. Importantly, we find that the formation of bridges can induce bending and collapse of the nanopillars, depending on their aspect ratios. Overall, this study provides valuable insights into the nanoscale dynamics of capillary condensation and paves the way for advanced engineering applications and optimization of various technological processes.
Wet Cleaning/Etching of NiAl Thin Film
Authors: Le Quoc Toan , Gül Arslan Esen , Fundu Kevin , Soulie Jean Philippe , Altamirano-Sanchez Efrain
Published: August 2023

The effect of various chemical solutions and mixtures on the etch characteristics, roughness change, and surface composition of NiAl, Al, and Ni films were investigated. Both HCl solution (1.82%) and NH4OH (0.6 and 1.45%) solutions were found to have a detrimental effect on NiAl film in terms of material etching (4-point probe results) and surface roughness change (AFM). Within the concentration range applied, adding H2O2 into the HCl or NH4OH solutions resulted in a significant increase of the etching of the NiAl film. A correlation was observed between the magnitude of etching and increase in surface roughness suggesting that a preferential etching occurred, most likely of grain boundary. Experimental results showed that in the case of 1.82% HCl-H2O2 mixture, NiAl surface can be protected up to 240 s of immersion with the use of a corrosion inhibitor such as triazole (TA).
Role of multimodal monitoring in the management of patients undergoing complex intracranial bypass procedures – A case series and literature review
Authors: Sreekumar Revikrishnan , Hrishi Ajay P , Sethuraman Manikandan
Published: August 2023

Patients undergoing complex intracranial neurovascular procedures continue to have a high mortality rate. Individualised goal-directed cerebral resuscitation employing multimodality neuromonitoring may impact these patients’ treatment and prognosis. Advanced monitoring methods aid in the early identification of secondary brain insults and serve as endpoints for goal-directed therapy in the perioperative period. Unfortunately, there is a paucity of literature exploring the impact of multimodality monitoring and its outcome in these patients. We aim to present this case series wherein the patients had a favourable outcome post-intracranial complex bypass procedure, owing to goal-directed management guided by multimodality monitoring in the perioperative period.
Ultrasound-guided erector spinae plane block versus port site infiltration for postoperative pain and quality of recovery in adult patients undergoing laparoscopic cholecystectomy: An assessor-blinded randomised controlled trial
Authors: Joshi Yashita , Ramakrishnan Priya , Jindal Parul , Sachan Praveendra K.
Published: August 2023

Background and Aim:

Pain following laparoscopic cholecystectomy (LC) is common and results in poor quality of recovery. Our study aimed to compare the analgesic efficacy of port site local infiltration, novel erector spinae plane (ESP) block, and standard regimen in patients undergoing LC and its impact on functional recovery.

Methods:

After ethical approval and registering the trial, we randomly allocated 105 adult patients undergoing LC to three groups: Group II (n = 35), received multimodal analgesia; Group II (n = 35), received pre-incisional port site infiltration with 20 ml of 0.375% bupivacaine; and Group III (n = 35), preoperative bilateral ESP block with 20 ml of 0.375% bupivacaine bilaterally was administered. Pain severity, fentanyl consumption, and time to first rescue analgesia were recorded over 24 h. Quality of recovery (QoR-15) was assessed at baseline and 24 h postoperatively.

Results:

Pain in the first 6 h was lowest in the ESP group (P < 0.001). Although static pain in the infiltration group was comparable with that in the ESP group after 6 h (P > 0.05), dynamic pain was better in the ESP group till 20 h postoperatively (P < 0.05). Fentanyl consumption was significantly lower in the ESP group (P < 0.001). Global and sub-dimensional QoR-15 scores were significantly higher only in the ESP group at 24 h compared to the other two groups (P < 0.001). The infiltration group did better than the control group in terms of total opioid requirement (P < 0.001) and Visual Analogue Scale (VAS) score after 6 h (P < 0.001).

Conclusion:

ESP block provided lower postoperative pain scores with opioid-sparing and better quality of recovery in patients undergoing LC.
Effect of Pranayama as per Trishikhbrahmana Upanishad on Sleep Quality in Adults: An Experimental Study
Authors: Tyagi Prakhar , Dubey Arpit Kumar , Pal Rameswar
Published: August 2023

Context:

The Upanishads are primary texts of Yoga philosophy and practices. Various Yoga Upanishads have given detailed description of various yogic practices along with their spiritual and physical benefits. This study aims to assess the effect of one Pranayama practice from Trishikhbrahmana Upanishad on sleep quality in adults.

Aim:

The aim of the study was to assess the effect of a Pranayama technique (described in the Trishikhbrahmana Upanishad) on sleep quality in adults.

Settings and Design:

An experimental study was conducted on volunteer participants from North India.

Subjects and Methods:

A pretest–posttest control group study was designed where the participants (n = 30) were randomized into study (n = 15) and control (n = 15) groups. The study group was given the Pranayama intervention for 30 days whereas the control group was not given any intervention throughout the study. The sleep quality was assessed by using the Pittsburgh Sleep Quality Index (PSQI).

Statistical Analysis Used:

GraphPad Instat Software was used to carry out independent t-test. The mean and standard deviation were also calculated.

Results:

The results showed a significant improvement in the postglobal PSQI score in the study group (P < 0.001) whereas there was no significant change in the pre- and postglobal PSQI score in the control group (P = 0.941).

Conclusion:

The results suggest that the Pranayama technique from the text and its effects are true in improving the sleep quality in adults but future studies with a larger sample size and some other physiological parameter assessments may further support the textual claim.
Effect of Mirror Therapy on Upper Extremity Function in a Patient with Humeral Fracture: A Case Study
Authors: Bansal Kshitija , Bansal Nitesh
Published: August 2023

Mirror therapy is the intervention aimed to improve functional aspects by creating a reflective illusion and mirror neuron system. Although there are many researches stating its effectiveness in neurological and orthopedic injuries, it has not been used widely in clinical settings for upper-limb fracture cases. A 69-year-old female sustained a right humeral shaft fracture and underwent open reduction internal fixation. Following the surgery, the patient was referred to the physiotherapy (PT) department for wrist drops, pain, and stiffness in the shoulder joint. The patient received conventional PT (electrical stimulation and exercises) for the first 3 weeks. Later, mirror therapy was introduced for wrist and shoulder movements. She was evaluated for pain, range of motion of shoulder and wrist joints, and functional ability at baseline, at 3 weeks, and at 6 weeks. There was an improvement in all outcome measures predominantly within 3rd week–6th week. Mirror therapy showed positive effects on upper-limb functions when combined with conventional therapy.
Recurrent Bleeding in a Healthy Child-A Case of Lupus Anticoagulant-Hypoprothrombinemia Syndrome
Authors: Kumar Sudesh , Bhattacharya Piyali , Gautam Shreemant , Chattopadhyay Nandita
Published: August 2023

Background:

Although lupus anticoagulant (LA) is known to be associated with an increased risk of thrombosis and obstetric complications, typically seen in antiphospholipid syndrome, the presentation of LA-hypoprothrombinemia syndrome (LA-HPS) is different with bleeding manifestations more common than thrombosis. We report such a rare disorder in an otherwise healthy boy, who presented with subcutaneous bleeding and was treated successfully.

Clinical Description:

A 9-year-old boy presented with acute-onset swelling in the popliteal fossa region of the left leg and left great toe. History of fever, trauma, drug intake, joint pain, epistaxis, or melena was absent. Since 6 months of age, he had recurrent episodes of multiple, painful joint, and soft-tissue swellings and ecchymotic patches which subsided spontaneously. Examination showed a tense, shiny bluish patch over the left popliteal fossa and a swollen tender left great toe, without any lymphadenopathy, hepatosplenomegaly, or arthritis.

Management and Outcome:

Routine hemogram and liver function tests were normal. Furthermore, antinuclear antibody and rheumatoid factor were within normal limits. Coagulation studies showed prolonged prothrombin time (PT) and activated partial thromboplastin time (APTT), though bleeding and coagulation times were normal. Administration of Vitamin K and fresh frozen plasma (FFP) showed no improvement. Further investigations revealed normal values of von Willebrand Factor collagen binding, Factor VIII, Factor XIII, and fibrinogen, whereas prothrombin levels were reduced. The partial thromboplastin time-LA specific was high (170.10), suggesting a diagnosis of LA-HPS. The symptoms responded to prednisolone therapy, and there was complete recovery.

Conclusion:

A recurrent bleeding disorder with increased PT/APTT, not responding clinically to FFP transfusion, should raise suspicion of LA-HPS and appropriate tests need to be done. The prognosis of this disorder is good with corticosteroid therapy.
Simultaneous Occurrence of Noma in Identical Twin Brothers
Authors: Bala Mujtaba , Braimah Ramat Oyebunmi , Bello Abubakar Abdullahi , Taiwo Abdurrazaq Olanrewaju , Suleiman Ibrahim Kayode
Published: August 2023

Background:

Noma is a devastating orofacial gangrenous condition that may cause significant mutilation of the facial anatomy. The pathogenesis is poorly understood and has been reported in a setting of low socioeconomic and unhygienic conditions with associated malnutrition. We present this condition in identical twin brothers.

Clinical Description:

Two identical twin brothers presented with painful swelling of the cheek with ulcerative defects in their upper lips. Both belonged to an impoverished family, and were malnourished, unimmunized, with poor oral hygiene. The typical anatomical presentation of the lesions with the characteristic family setting made the diagnosis consistent with noma (cancrum oris). Other siblings living in the same family with similar background conditions were unaffected.

Management:

After clinical stabilization, definitive surgical care, including debridement and regular dressings was done under the cover of intravenous antibiotics. With aggressive management along with nutritional rehabilitation and oro-muscular physiotherapy, the acute phase subsided and the patients were discharged in the scarring phase, with a plan for surgical reconstruction of the defect at a later date.

Conclusions:

The simultaneous presentation of noma in identical twins, with the sparing of other siblings living in the same contributing circumstances, raises suspicion of a genetic basis for this condition, which is as yet unknown. As the etiopathogenesis of noma is evolving, further evidence is needed to establish a genetic predisposition.
Acute Liver Failure as a Presenting Feature in an Adolescent with Acute Lymphoblastic Leukemia
Authors: Bhatnagar Simran , Kumar Bharat , Kumar Nitish , Hemal Alok
Published: August 2023

Background:

Acute lymphoblastic leukemia (ALL) is a common pediatric malignancy, typically manifesting with symptoms of bone marrow and hematolymphoid organ infiltration. Although hepatic involvement in the form of hepatosplenomegaly is seen in nearly two-thirds of the patients, primary presentation as acute liver failure is rare.

Clinical Description:

A 12-year-old boy presented with complaints of abdominal distention with jaundice for the past 15–20 days, associated with transient fever of 6 days. Examination revealed pallor, icterus, and hepatosplenomegaly. A possibility of acute infectious or autoimmune hepatitis or hemolytic anemia was considered.

Management:

Liver function tests were deranged with hyperbilirubinemia with modest increase in transaminases and serum alkaline phosphatase along with deranged prothrombin time. The complete blood count showed pancytopenia with normal peripheral smear. Investigations for common infectious causes were noncontributory, as also those for autoimmune hepatitis. The direct Coombs test was also negative. In view of persistent pancytopenia with hyperbilirubinemia and hepatosplenomegaly, a bone marrow evaluation was done, which revealed B-cell ALL (B-ALL). Thus, the child was diagnosed with a case of ALL presenting with acute liver failure. The child was initially managed as a case of acute liver failure and on diagnostic confirmation, he was started on the B-ALL chemotherapy protocol as per his risk stratification with hepatic dose modification of chemotherapy. The child showed complete normalization of the liver functions by about 4 weeks of induction chemotherapy and achieved remission.

Conclusions:

A child presenting with acute liver failure may be having an underlying undiagnosed, clinically silent ALL. After ruling out common causes of acute liver failure, one must not forget the possibility of leukemic blast infiltration of the liver as a cause of liver failure. With early initiation of advanced chemotherapeutic induction regimens, there can be dramatic resolution of liver injury and remission of ALL.
Jarcho–Levin Syndrome
Authors: Prabhakar Nishant , Patel Brijesh
Published: August 2023

Background:

Jarcho–Levin syndrome (JLS) is a rare, congenital skeletal disorder involving the spine and the ribs, resulting in varying degrees of thoracic insufficiency, presenting at birth. We report such a case in a tribal population in India.

Clinical Description:

A newborn baby was referred on the 2nd day of life with respiratory distress and abnormal thoracic anatomy. Radiographs of the chest showed anomalies of the spine and ribs and decreased lung volume, the features being consistent with JLS (spondylocostal dysostosis).

Management:

The baby was provided respiratory support initially with continuous positive airway pressure and then shifted to oxygen by nasal prongs by 7 days of life. Ultrasound cranium and abdomen did not reveal any other associated anomalies and routine blood investigations were within normal limits. Respiratory distress settled and the baby was finally discharged successfully on the 12th day, on breastfeeds.

Conclusion:

Respiratory distress in a newborn, soon after birth, may be due to thoracic insufficiency. The case creates awareness among pediatricians and neonatologists regarding this rare disorder which can be identified by specific vertebral and rib abnormalities. Survival depends on the severity of the bony abnormality and compromise in lung volume.
Isolated Scalp Hematoma
Authors: Ghorui Arnab , Kumar Chandra Mohan , Banerjee Amrita
Published: August 2023

Background:

Congenital fibrinogen disorder is a rare autosomal recessive blood coagulation disorder, where majority of patients present with bleeding, whereas a few may paradoxically develop thrombosis. While many of the affected children have prolonged umbilical cord bleeding during the neonatal period, manifestations may go unnoticed till adolescence. We describe such a child with congenital afibrinogenemia

Clinical Description:

A 12-year-old boy presented with painless diffuse scalp swelling for 2 weeks without any antecedent history of trauma, hemarthrosis, muscle hematoma, or any skin bleed, except a history of prolonged bleeding post trauma since toddler age. Examination revealed diffuse, boggy, nonpulsatile swelling over the entire scalp, more prominent on the right side, without any focal neurological deficit. A noncontrast computed tomography head showed a scalp hematoma without any intracranial bleeding. Blood investigations revealed extremely elevated prothrombin time (PT) and activated partial thromboplastin time (aPTT) with normal platelet counts and normal platelet morphology on peripheral smear. A detailed coagulation work-up revealed an extremely high thrombin time and an almost undetectable Factor I (fibrinogen) level. Genetic analysis revealed a homozygous single-base pair deletion in exon 5 of the fibrinogen gene of alpha chain, thus confirming the diagnosis of congenital afibrinogenemia.

Management:

The child was managed with multiple fresh frozen plasma transfusions and serial PT/aPTT monitoring. Once PT and aPTT were normalized, transfusions were discontinued. The child is currently on regular follow-up maintaining a fibrinogen level of more than 0.5 g/L. Genetic counseling was done for the family.

Conclusion:

Congenital afibrinogenemia may be detected late in adolescence with atypical bleeding manifestations. Awareness of this entity may help the physician to suspect this disease. Early and appropriate investigations can be conducted to identify the condition, so that appropriate management can be initiated.
Psychiatric comorbidity in patients with migraine: A standardized interview-based study
Authors: Sharma Preeti , Kumar Santosh , Dixit Vidhata , Sharma Chandra Shekhar , Chaudhury Suprakash
Published: August 2023

Background:

Comorbidity of various psychiatric conditions with migraine is common and important. A thorough analysis of mental conditions in migraine is essential to encourage the holistic care of such patients.

Aim:

To assess psychiatric comorbidity in patients with migraine using a well-standardized clinical diagnostic tool.

Methods:

This cross-sectional study was conducted in the outpatient department of a tertiary care hospital in North India. Persons with migraine attending the facility were enrolled as per the inclusion and exclusion criteria set for this study. The ICD-10 mental disorder symptom checklist was the principal tool to assess the psychiatric comorbidity in the patients.

Results:

Total Patients recruited were 146 out of which 70.5% had a psychiatric comorbidity. Depressive disorder (17.1%) was the most common while delusional disorder (4.1%) was the least common psychiatric disorder comorbid with migraine. Other comorbid psychiatric diagnoses were recurrent depressive episodes (6.8%), dysthymia (10.3%), bipolar affective disorder (7.5%), panic disorder (5.5%), generalized anxiety disorder (8.2%), mixed and other anxiety disorders (6.2%), obsessive-compulsive disorder (6.2%), post-traumatic stress disorder (4.8%), adjustment disorders (5.5%), dissociative (conversion) disorders (6.8%), and somatoform disorders (6.2%). Lower socioeconomic status and the presence of aura with migraine are two important patient-related factors linked with the occurrence of any psychiatric comorbidity in migraine.

Conclusion:

The prevalence of comorbid psychiatric disorders in migraine patients is very high. The relationship between demographic and medical information of people with migraine with individual psychiatric comorbidities is complex.