bluuebunny/crossref_metadata_2025 huggingface dataset:
Cases of intraocular lens opacification in pseudophakic eyes: analysis of the results of microstructural studies
Authors: Riks Inna A. , Astakhov Sergey Yu. , Ivankova Elena М. , Kuzmina Irina E. , Papanyan Sanasar S. , Boutaba Rafik , Ezugbaya Maggie B. , Akopov Evgeni L.
Published: January 2021

Relevance. Currently, all over the world, during cataract surgeries, a huge number of intraocular lenses (IOLs) made of different materials are implanted. Alongside with the development of modern IOL materials and designs, publications about their opacities appear. The nature and the localization of IOL opacities mainly depend on the properties of the material out of which the lens is made. Polymethyl methacrylate (PMMA) currently rarely used to manufacture IOLs, tends to cloud in the optical center due to structural breakdown, forming snowflake-like cracks. Opacities of acrylic IOLs depend on the degree of hydrophilic properties of the material. The deposition of crystalline deposits in the optical zone of hydrophilic acrylic lenses leads to a significant decrease in visual acuity and requires IOL explantation. There is a definite dependence of the occurrence of opacities in hydrophilic acryl on the patients concomitant diseases. In hydrophobic acrylic IOLs, vacuoles form, and glistenings occurs. Herewith, visual functions, as a rule, do not suffer.
Purpose: to find out what structural changes in the IOL led to the need to remove them from pseudophakic eyes due to a decrease in visual acuity.
Materials and methods. Four clouded IOLs made from different materials were examined. The lenses were studied using a SUPRA 55VP scanning electron microscope (Carl Zeiss, Germany) using a secondary electron detector. Element distribution maps on the surface and inside the lenses were collected using an X-max 80 mm2 energy dispersive X-ray analysis detector (Oxford Instruments, UK).
Results. A hydrophilic lens with hydrophobic coating became cloudy 5 years after implantation. Hydroxyapatite crystals were found on all parts of the IOL along its surface. In a hydrophobic acrylic IOL, microvacuoles and cavities in the optical center were found using scanning electron microscopy. Two PMMA IOLs underwent self-destruction within 8 years after implantation. Chemical analysis of PMMA lenses did not reveal any inorganic compounds.
Conclusion. One of the complications of IOL implantation is an impairment of their transparency. Factors associated with IOL material and manufacturing, as well as the patients comorbidities, can lead to lens opacification at various terms after surgery.
Choice of surgical treatment for slipped capital femoral epiphysis with severe chronic displacement of the epiphysis
Authors: Barsukov Dmitry B. , Baindurashvili Alexei G. , Bortulev Pavel I. , Baskov Vladimir E. , Pozdnikin Ivan Y. , Krasnov Andrey I.
Published: January 2021

Background. The spatial relationship between the epiphysis and the acetabulum in slipped capital femoral epiphysis (SCFE) with severe chronic epiphysis displacement is restored by different corrective extra-articular femoral osteotomies and a standard Dunn procedure. Severe residual deformity of the femoral component of the joint with symptoms of femoroacetabular impingement and a large number of severe ischemic complications forced the surgeons to improve the technique of these surgical interventions. In particular, a modified Dunn procedure was proposed using a low traumatic surgical hip dislocation. However, the selection of surgical treatment in these patients remains a subject of discussion.
Aim. This study aimed to improve the results of treatment in children with SCFE with severe chronic epiphysis displacement.
Materials and methods. Data of preoperative and postoperative clinical and radiological studies of 40 patients (24 male and 16 female) aged 1215 years who were suffering from SCFE with severe chronic epiphysis displacement were analyzed. In all cases, on the lesion side, displacement was found in typical directions (posterior-downward or only posterior), and in the contralateral joint, the disease was still at its initial stage (pre-slip). In group 1 (n = 20 children), a corrective extra-articular femoral (anterior-rotational or rotational-valgus) osteotomy was performed according to the method we have proposed in 2011 [22], and in group 2 (n = 20 children), the modified Dunn procedure that strictly followed our technique was performed. The follow-up period after surgery in both groups ranged from 1 month to 2.5 years.
Results. At 2.5 years after surgery, good anatomical and functional outcomes were observed only in 1 (12.5%) of 8 patients in group 1, while they were observed in 7 (87.5%) of 8 patients in group 2. Poor results were determined by residual epiphyseal displacement (from 22 to 28) and/or step-like transition of the anterior femoral neck surface to the head in 5 (62.5%) children in group 1 and by femoral head avascular necrosis (diagnosed in 6 months after surgery) in 1 (12.5%) child in group 2.
Conclusion. The results allow us to make a preliminary conclusion about the high efficiency of the modified Dunn procedure and the low efficiency of the corrective extra-articular femoral osteotomy in SCFE with severe chronic displacement of the epiphysis. The modified Dunn procedure corrects the pronounced deformity of the femoral component of the affected joint and femoroacetabular impingement in the above-mentioned anatomical situations.
Vertebral fractures in children during the COVID-19 pandemic
Authors: Skryabin Evgenij G. , Akselrov Mihail A. , Zotov Pavel B. , Kurmangulov Albert Ахметович , Bukseev Alexander N.
Published: January 2021

Background. The COVID-19 pandemic has had a significant influence on the main epidemiological indicators of emergency trauma, as well as on the pediatric population.
Aim. This study aimed to analyze the incidence of compression fractures of vertebral bodies in children between January and July 2020 (the first months of COVID-19 pandemic).
Materials and methods. A comprehensive examination and treatment of 82 children and adolescents aged 317 years, who received compression fractures of the vertebral bodies in the period from January 1 to July 31, 2020, was carried out. A group of 96 children of the same age who sustained a similar type of injury at the same time in 2019 was studied as a control. To make a clinical diagnosis, we used methods of traditional research examination for emergency traumatology. The severity of vertebrogenic fractures was determined according to the AO/ASIF classification.
Results. The total number of patients diagnosed with vertebral fractures during the COVID-19 pandemic was 14.58% less than that in the same period in 2019. Patients in the comparison groups were comparable in sex, average age of injury, and age group in which the spine was most often injured. The most frequent mechanism of spinal injuries in patients of the comparison groups was a fall from a height. More often than others, ThVI and ThVII vertebral bodies were broken. The severity of vertebral fractures in all cases corresponded to type A, subtypes A1 and A2. For treatment, conservative methods were used in most cases. During the period of strict self-isolation, in April 2020, no children of the main group had vertebral fracture because they were forbidden to leave their apartments unnecessarily. In May 2020, the number of children with vertebral fractures was half the number in the same month in 2019. In June 2020, the incidence of vertebral fractures was in line with the pre-crisis average.
Conclusion. Strictly following restrictive anti-epidemic measures during a pandemic is an effective method of reducing the number of cases requiring emergency treatment for compression fractures of the vertebral bodies in children.
Widening of sternoclavicular joint distances in blunt chest trauma
Authors: ÇAKMAK Vefa , TÜRKOĞLU Sefa , ÖZEN Mert , ÇAKMAK Pınar
Published: January 2021

Purpose: Blunt chest trauma has high mortality and morbidity rates. The aim of this study was to evaluate the relationship between trauma findings and sternoclavicular joint (SCJ) distances in patients with blunt chest trauma.

Materials and Methods: Between May 2019- September 2019, Thorax Computed Tomography (CT) images of 102 patients (78 males, 24 females, aged 19-88 years) with blunt chest trauma were evaluated retrospectively. Rib fractures, costal cartilage fractures and other signs of trauma were evaluated. SCJ distances were measured at the inferior, mid, and superior segments in the coronal reformatted CT images. Post-traumatic SCJ expansion was evaluated in patients with rib and costal cartilage fractures. Additionally, SCJ and the presence of other post-traumatic signs were compared. An inter-observer reliability analysis with Intraclass correlation coefficient (ICC) scores with 95% CIs were calculated.

Results: In the presence of fractures of 1st to 4th ribs a statistically significant widening of superior and mid segments of the ipsilateral SCJs were detected. A 2-mm or greater difference of widening of the superior segment of the ipsilateral SCJ compared to the contralateral joint was found statistically significant for hemothorax, pneumothorax, and wall emphysema. The inter-observer agreement was excellent for the measurements of the SCJ on coronal plane, having an ICC score ranging from 0.921 to 0.961 (95% CI).

Conclusion: The expansion of the ipsilateral SCJ distances in rib fractures in the upper part of the chest wall shows that SCJ performs an important role in the absorption of energy to the chest wall.
Clinical, hormonal, radiological and morphological comparison of patients with clinically evident Cushing's disease and patients with silent corticotroph cell adenoma
Authors: AKKUŞ Gamze , KARAGÜN Baris , ÇETİNALP Nuri Eralp , AÇIKALIN Arbil , ODABAŞ Fulya , EVRAN OLGUN Mehtap , SERT Murat , ZORLUDEMİR Suzan , TETİKER Bekir Tamer
Published: January 2021

Purpose: The aim of the study was to review our clinical 7 years experiences with silent corticotroph adenoma (SCA) and Cushing disease (CD) with regard to clinical, radiological features, immunohistochemical and surgical outcomes and compare the results between two groups.

Material and Methods: We retrospectively reviewed a series of patients (n=17; SCA 10, CD 7) with corticotroph adenomas and collected biochemical, neuroradiological and pathological data of those during follow-up time.

Results: Mean pre-operative ACTH values of the patients with CD and SCA were 60.4±29.5, 45.5±34.6 pg/mL, respectively. Mean preoperative cortisol of the patient with CD (21.2±4.4 vs 11.5±4.0 mcg/dL) was increased than the patients with SCA measurements’. Patients with SCA had larger pituitary mass (20.4±4.5 vs 8.8±4.0 mm) than the patients with CD. And cavernous sinus invasion also was determined in all patients with SCA. Sparsely granulation staining was more common in all patients with SCA (7/10) or CD (4/7).

Conclusion: SCAs are totally different from functional CD adenomas related with clinical characteristics and postoperative outcomes. SCA can be thought of as a diverse group of pituitary adenomas.
Can blood eosinophil to basophil ratio, eosinophil to lymphocyte ratio and basophil to lymphocyte ratio predict the severity of intrahepatic cholestasis in pregnancy?
Authors: KANZA GÜL Derya , ŞOLT Ayça
Published: January 2021

Purpose: The purpose of the study was to investigate the relation between inflammatory markers used for allergic diseases and intrahepatic pregnancy cholestasis (ICP).

Materials and Methods: In this retrospective case-control study, a total of 114 intrahepatic pregnancy cholestasis patients; 87 with mild cholestasis (group 1) and 27 with severe cholestasis (group 2) and 292 healthy pregnant women in the control group (group 3) were included in the study. The basophil, eosinophil, eosinophil-basophil ratio (EBR), eosinophil-lymphocyte ratio (ELR) and basophil-lymphocyte ratio (BLR), neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR) values used in this study.

Results: Significant differences were detected between groups in terms of ELR, NLR and PLR values. ELR, NLR, PLR values were significantly higher in the mild cholestasis group than in the control group. To predict the pregnancy cholestasis, receiver operating characteristic curve (ROC) analysis was made, which yielded 76.3% sensitivity and 56.1% specificity when ELR’s interrupt value was 0.2243, NLR interrupt value 11.27% when sensitivity was 70% and specificity 54,000 2%, and PLR cut-off value was 194.46 when sensitivity was 60% and specificity was 58%.

Conclusion: Serum inflammation markers and allergy markers may be diagnostic in intrahepatic pregnancy cholestasis; however, they are not decisive in determining the severity of the disease.
EVALUASI MATURITY LEVEL PADA DATA OPERATIONS MANAGEMENT MENGGUNAKAN CAPABILITY MATURITY MODEL INTEGRATION (CMMI): STUDI KASUS LEMBAGA PENELAAH TRANSAKSI KEUANGAN
Authors: Al Adawiyah Rabiah , Ruldeviyani Yova
Published: January 2021

Institusi Finansial XYZ merupakan sebuah lembaga penelaah transaksi keuangan yang memiliki tugas dan kewenangan untuk menerima laporan transaksi keuangan dari para pihak pelapor, melakukan analisis terhadap laporan transaksi keuangan, dan meneruskan hasil analisis kepada aparat penegak hukum. Insiden hilangnya data pernah terjadi di Institusi Finansial XYZ pada tahun 2018 yang mengindikasikan Data Operations Management masih belum berjalan dengan baik. Penelitian ini bertujuan untuk mengukur Maturity Level pada Data Operations Management di Institusi Finansial XYZ dengan menggunakan Capability Maturity Model Integration (CMMI) dan Data Management Body of Knowledge (DMBoK). Penelitian ini melakukan asesmen terhadap Maturity Level pada Data Operations Management di Institusi Finansial XYZ dan dari hasil asesmen tersebut diharapkan dapat memberikan rekomendasi untuk perbaikan Data Operations Management. Hasil penelitian menunjukkan bahwa ada dua belas sub-aktivitas Data Operations Management yang berada pada Maturity Level 2 dan ada tiga sub-aktivitas Data Operations Management yang berada pada Maturity Level 3. Rekomendasi diberikan untuk dua belas sub-aktivitas yang masih berada pada Maturity Level 2. Rekomendasi ini diharapkan dapat meningkatkan Maturity Level pada Data Operations Management sehingga Institusi Finansial XYZ dapat menjalankan tugasnya dengan baik untuk menelaah transaksi keuangan dan menghasilkan hasil analisis yang akurat.
KAJIAN ANALISIS MODEL E-READINESS DALAM RANGKA IMPLEMENTASI E-GOVERNMENT
Authors: Nugroho Rossi Adi
Published: January 2021

Penerapan e-government telah dilakukan di banyak negara namun hasilnya bervariatif karena kondisi tingkat e-readiness yang berbeda-beda. Di Indonesia banyak kegagalan penerapan e-government karena pemerintah tidak mengetahui tingkat e-readiness dan hanya mengikuti tren yang berkembang. Konsep e-readiness ini hadir karena masih banyak kegagalan e-government terutama di negara-negara berkembang. Dengan menilai e-readiness pemerintah dapat menilai tahap kesiapannya, memanfaatkan peluang TIK dan mengevaluasi penerapan e-government serta dapat merumuskan kebijakan yang tepat. Penelitian ini dilakukan dengan menggunakan studi literatur dan menilai model-model penilaian e-readiness yang paling sesuai dengan karakteristik obyek penelitian. Hasilnya dirumuskan model framework STOPE+Anggaran yang terdiri atas Strategi, Teknologi, Organisasi, People, Environment dan Budget merupakan model yang paling tepat untuk menilai e-readiness pemerintah. Framewok STOPE dipilih karena merupakan pendekatan yang paling komprehensif dan dapat dimodifikasi sesuai dengan kebutuhan pengguna. Modifikasi dengan menambahkan e-readiness anggaran sebagai domain utama merupakan hal yang sangat penting karena masalah utama penerapan e-government di negara berkembang adalah kesiapan anggaran.
Meta-analysis of various tki generations efficacy either alone or in combinations in EGFR mutated NSCLC
Authors: Moiseenko F.  V. , Bogdanov A. A. , Volkov N. . M. , Zhabina A.   S. , Fedyanin M. Yu.
Published: January 2021

Background. Multiple options of first line treatment in patients with EGFR mutated NSCLC are registered worldwide and, in particular, in Russia. The individual choice for every patient is still based primarily on personal preference of a particular physician and financial possibilities of the region, since no stratification factors are available. At the same time large randomized trials comparing various options are hardly possible in this narrow biomarker restricted population. The additional information on advantages in particular subgroups obtained via indirect comparison might be an important argument.

Materials and methods. We conducted meta‑analysis of trials studying various approaches in first line EGFR mutated NSCLC cancer.

Results. Our meta‑analysis revealed unequal influence of different treatment approaches on OS according to clinical stratification factors. In females (HR 0.79, 95 % CI 0.63–0.99; p = 0.04), patients younger than 65 y. o. (HR 0.66, 95 % CI 0.52–0.83; p = 0.0004), with exon 21 mutations (HR 0.76, 95 % CI 0.59–0.99; p = 0.04) and ECOG 1 (HR 0.72, 95 % CI 0.59–0.89; p = 0.002) OS benefit can be achieved with 2nd generation TKI. In the rest of patients (males, ECOG 0, ex19 deletions) increase in OS necessitates more aggressive treatment with TKI and chemotherapy combination (HR 0.57, 95 % CI 0.41–0.79; p = 0.0008). No influence on OS was observed for TKI and angiogenesis inhibitors. Interestingly, the observed advantage in OS and PFS was not accompanied by response that did not differ between regimens (OR 1.55, 95 % CI 0.86–2.80; p = 0.14).

Conclusions. We showed the importance of individualized approach in the first line EGFR mutated NSCLC selection. Our results underline the need for the new data on various approaches comparison.
Is it necessary to add anti-angiogenic therapy to chemotherapy in patients with metastatic colorectal cancer and BRAF mutation? The systematic review and meta-analysis results
Authors: Fedyanin M. Yu. , Polyanskaya E. M. , Elsnukaeva H. H M. , Tryakin A. A. , Pokataev I. А. , Ignatova Е. О. , Sergeev U. S. , Bulanov A. A. , Tjulandin S. A.
Published: January 2021

Introduction: targeted anti‑angiogenic drugs are the integral component of systemic therapy for metastatic colorectal cancer. To date, there have been no prospective studies that would directly answer the question of the need to add anti‑ angiogenic agents to chemotherapy for BRAF‑mutated metastatic colorectal cancer. We performed a systematic review and meta‑analysis to evaluate the efficacy of adding anti‑angiogenic therapy to chemotherapy in patients with metastatic colorectal cancer harboring a mutation in the BRAF gene.

Materials and methods: We searched for articles and abstracts in the PubMed, ASCO and ESMO databases, published before September 2020 and containing information on the results of prospective randomized trials comparing the combination of anti‑angiogenic agents (bevacizumab, aflibercept or ramucirumab) in the first‑or second‑line therapy for metastatic colorectal cancer, which indicate the efficacy depending on the presence of mutations in the BRAF gene. The primary endpoint was the risk ratio (RR) for progression or death with a 95 % confidence interval (95 % CI). The meta‑analysis was carried out using the Review Manager, version 5.3.

Results: 4 studies met the selection criteria (AVF2107 g, AGITG MAX, VELOR and RAISE), which included data from 120 patients with the BRAF mutation, 65 (54 %) patients received a combination of chemotherapy with an anti‑angiogenic agent, and 55 (46 %) patients received only chemotherapy. The meta‑analysis showed improved progression‑free survival (RR 0.64, 95 % CI 0.4–1.02; p = 0.06; I 2 = 0 %, p for heterogeneity = 0.7; 3 studies) and overall survival (RR 0.51, 95 % CI 0.32–0.82; p = 0.005; I 2 = 0 %, p for heterogeneity = 0.54; 4 studies) in the group treated with anti‑angiogenic agents.

Conclusions: the combination of chemotherapy with anti‑angiogenic agents in the first‑or second‑line therapy improves progression‑free survival and overall survival in patients with BRAF‑mutated metastatic colorectal cancer. Prospective randomized trials in this patient population are needed to determine the optimal first‑line treatment regimen.
The role of pet in the treatment of B-cell lymphoproliferative disorders in a real-world clinical setting in Russia
Authors: Babicheva L. G. , Poddubnaya I. V.
Published: January 2021

Objective. Assessment of the role of positron emission tomography (PET) in the diagnosis and treatment of B‑cell lymphoproliferative disorders (B-LPD) in Russian real‑world clinical practice from 2014 to 2017.

Materials and Methods. The EQUILIBRIUM, a post marketing multicenter study, included 1000 patients aged 21 to 91 years with a verified diagnosis of B‑cell non‑Hodgkin»s lymphoma (B-NHL) or chronic lymphocytic leukemia (CLL) who received at least 4 cycles of rituximab‑containing therapy with Acellbia®. The main method for the assessment of the disease dissemination, the size and location of the lesions was computed tomography, which was used in 76.2 % of patients. PET was performed in 324 (32.4 %) patients: in 152 (47 %) cases during initial diagnosis, PET during treatment in 102 (31 %) patients and — in the vast majority, i. e. 310 (96 %) patients — after completion of induction chemo‑immunotherapy.

Results. According to the results of interim PET, complete remission was achieved in 44 (43 %) of 102 patients, partial remission — in 53 (52 %) cases, stabilization of the disease was observed in 5 (5 %) patients, and no cases of progression among patients who underwent interim PET was detected. The main evidence of the final PET assessment efficacy was the achievement of complete remission (CR) in 235 (75.8 %) cases; partial remission (PR) was observed in only 61 (19.7 %) patients, and disease progression was reported in 14 (4.5 %) of cases. The median follow‑up was 15 months (range from 1 to 42 months). As expected, the median overall survival (OS) as well as the median event‑free survival (EFS) has not been reached for this period of time. There was a statistically significant effect of the results of interim PET on event‑free survival (p = 0.07661) without a significant effect on overall survival (p = 0.69868). The depth of response recorded during the final PET scan turned out to be a prognostically significant factor for both EFS and OS (p = 0.00000).

Conclusion. Positron emission tomography is a modern and effective method for diagnosing and assessing the efficacy of therapy in B‑cell lymphoproliferative disorders, which is used for only 1 / 3 of patients in a real‑world clinical practice. Nevertheless, the role of this method in assessing the effectiveness of therapy is beyond doubt.
The Association of Pepsin and Reflux in US Individuals Self-diagnosing their Reflux like Symptoms
Authors: Boulton Katie , Fisher Jeanine , Woodcock Andrew , Dettmar Peter
Published: January 2021

Background: A high number of US citizens experience gastroesophageal reflux disease (GERD) symptoms at least once a month. These symptoms have a great impact on an individual’s quality of life and present a huge burden on healthcare systems. Diagnosis of GERD like symptoms is not straight forward and many individuals do not have a diagnosis with current tests being invasive, expensive and often with low patient compliance. To speed the diagnosis process up there are many individuals seeking self-diagnosis and it became apparent that an easily accessible, rapid, non-invasive and cost-effective diagnostic test would be well received by individuals. Methods: Seven hundred and ninety-three self-referral individuals experiencing reflux like symptoms provided up to three saliva samples. The first on waking, the other two samples provided either post-prandial or post-symptom. All saliva samples were sent to a central laboratory for pepsin analysis using a lateral flow device containing two unique human monoclonal antibodies (Peptest). Following analysis, the pepsin concentration in each saliva sample was determined using a PepCube reader and expressed in ng/ml. Results: A total of 1834 saliva samples were analysed for pepsin. Sixty-two percent of individuals tested had one or more saliva sample pepsin positive and 38% of individuals had all samples pepsin negative. The highest pepsin concentrations were seen in post-prandial samples with the lowest pepsin concentrations significantly lower (p=0.0127) in the on waking samples. The US interstate pepsin concentration data is limited due to low numbers of self-diagnosing individuals tested to date. There was no difference in pepsin concentrations between genders. Conclusion: The individuals self-diagnosing their reflux like symptoms were mostly those aged 40 to 70 years. The availability of a simple easy to use non-invasive test for self-diagnosis is now widely accessible across all states of the US.
Information and Communication Technologies Effects on Mental and Physical Health
Authors: Solomon Arieh
Published: January 2021

In our everyday life we use a wide range of technologies for communication and information purpose, ranging from established audiovisual devices, such as the television, followed by the personal computer (PC) and later tablets, mobiles and other types of electronic aides .Indeed parents increasingly expose young children to mobiles to keep them entertain and quite, so that they would not disturb the parent's daily routines. The use of such technologies leads to objective behavioral and clinical changes in both children and adults. Excessive use of these technologies leads to addictive behaviors followed by pathological changes in eye function, with clinical repercussion. This article presents a detailed review of all the symptoms of information and communication technologies' misuse by children and adults.
Acetylcholinesterase Inhibitors for Alzheimer’s disease: Past, Present, and Potential Future
Authors: Truong Brandon , Quiroz Jose , Priefer Ronny
Published: January 2021

Alzheimer’s Diseases (AD) is a neurodegenerative disorder characterized by progressive neuronal loss leading to cognitive decline. Although there is yet to be a cure nor a way to reverse the neuronal damage, there are current treatments to amend some of the cognitive symptoms associated with AD. Acetylcholinesterase inhibitors (AChEi) are the primary agents of choice and have had profound implications throughout the past decades. AChEi such as donepezil, rivastigmine, and galantamine mediates and increases cholinergic activities in the central nervous system (CNS), and have been shown to improve and preserve cognition in AD patients. Beyond the current drugs on the market, investigational discoveries continue to explore the potential of safer and more efficacious AChEi agents for the treatment of AD. There have been quite a few challenges, given the high failure rates. Yet, these very trials and studies have been a fundamental step towards better understanding the treatments of AD and have provided some insight on the potential to surpass what is currently available.
Utility of Video Consultation in Digestive Diseases
Authors: Lorenzo Modesto , Serra Tania , Serra César
Published: January 2021

Introduction: Despite the rise of video consultation, most consultations in patients with digestive diseases tend to be face-to-face. Objective and Methods: In 2016, gastroenterology video consultation was implemented in the hospital. A prospective and descriptive study of a series of patients attended consecutively by video consultation by a gastroenterology specialist for 50 months. We have analyzed which syndromes and digestive diseases are susceptible to being performed by video consultation. Results: Two hundred fifty patients were selected (100 during the first three months of the COVID-19 pandemic), 50.4% men and 49.6% women, with a mean age of 48 (SD 18-9) years. The main reason for the consultation of the 142 patients (56.8%) with definitive diagnoses was: dyspepsia, hepatobiliary disease, diarrhea, gastroesophageal reflux, and irritable bowel syndrome. The final diagnosis was dyspepsia (21%), hepatobiliary disease (16%), diarrhea (9%), irritable bowel syndrome (8.4%), intolerances (including gluten intolerance and sensitivity) (8.4%), gastroesophageal reflux disease (7,7%), and inflammatory bowel disease (6.3%). The concordance between the diagnostic impression and the definitive diagnosis was 60%. Conclusions: Video consultation in gastroenterology is an effective alternative to the face-to-face visit, used equally in patients of both sexes, where dyspepsia is the main reason for consultation and diagnosis. During the first 3 months of the COVID-19 pandemic, the number of video consultations increased 10 times. The main pathologies diagnosed were dyspepsia and hepatobiliary diseases.
Detoxication by Medicinal Leeches (Hirudo medicinalis)
Authors: Habrmanova Maria , Cechova Anna , Cickova Helena , Takac Peter
Published: January 2021

The success of body detoxification by medicinal leeches (Hirudo medicinalis) depends on the rich bioactive composition of the medicinal leeches salivas. There is a total of 150 identified bioactive substances that have detoxifying and regenerative effects on the human body. However, the human organism has its own regulatory mechanisms for removing toxic products from the body: detoxification. The aim of our explorative study was to advance these mechanisms and demonstrate the efficiency of the bioactive substances of leech saliva to support the regulation of selected blood parameter levels, i.e. lower cholesterol, triglycerides and glucose levels, and to ensure the prevention of diseases caused by the fluctuation of the levels of these blood components. The participants in our study numbered 17. None of them had presented any significant medicinal complications from or contraindications to leech therapy. They participated in a total of seven leech procedures. After the therapy, blood tests for the patients were carried out to compare the blood counts before therapy and after. Using the results, we evaluated the outcomes of the detoxification therapy by using statistical analysis in the R program, version 3.0.0. Detoxication therapy using medicinal leech (Hirudo medicinalis) had no significant effect on the level of blood components provided to us, but its effect was observed in the subjective health improvements reported by patients.
Sleep impairment in Attention Deficit Hyperactivity Disorder (ADHD) Is it an additional symptom of ADHD or the result of comorbidities?
Authors: Gadoth N.
Published: January 2021

Attention Deficit Hyperactivity Disorder (ADHD) is a quite common neuropsychiatric ailment affecting all ages. The diagnosis is based on clinical judgement without a biological diagnostic marker. Thus, both over – and – underdiagnoses are not a rarity. Since it is a developmental disorder the clinical features are altered with age but the classical “triad” of inattention, hyperactivity and impulsivity remain in the majority of the patients throughout their life span. A number of comorbidities are associated with the disorder and in many patients their presence imposes a negative effect on life quality which may be more prominent than that caused directly by the classical "triad". Although cases with the triad have been reported during the last 200 years, the concept of ADHD was solidified in 1987. Sleep impairment as an important comorbidity of ADHD has been slowly unrevealed. Surprisingly, even in DSM-5, any form of sleep impairment was not mentioned in ADHD. This paper is a review of the prevalence, characteristics and possible aetiology of sleep impairment in youngsters and adults with ADHD. Also, the bidirectional association between impaired sleep quality and ADHD is discussed in an attempt to clarify whether impaired sleep is an additional symptom of “pure” ADHD, is the sole result of associated comorbidities or is the result of both.
Role of inflammatory biomarkers in the prediction of ICU admission and mortality in patients with COVID-19
Authors: Ahmad Qamar , DePerrior Sarah , Dodani Sunita , Edwards Joshua , Marik Paul
Published: January 2021

Background: Inflammatory cytokines have been implicated in the pathophysiology and prognosis of severe COVID-19. Inflammatory biomarkers may guide the clinician in making treatment decisions as well as in the allocation of resources. Objective: This study aimed to assess how levels of inflammatory biomarkers predict disease severity and mortality in patients with COVID-19 by testing a predictive scoring model developed by Zhou et al and further refining the model in a population of patients hospitalized with COVID-19. Study Design and Methods: This retrospective study included patients with COVID-19 admitted to ten Virginia hospitals from January 1, 2020, to June 15, 2020. Inflammatory markers including CRP, D-Dimer, ferritin, N/L ratio, and procalcitonin were studied and logistic regression models were applied to ascertain the risk of ICU admission and mortality with elevated markers. Results: Data from a total of 701 patients were analyzed. In bivariate tests age, CRP, D-Dimer, and N/L ratio were associated with in-hospital mortality as well as admission to the ICU. Procalcitonin was associated with admission to the ICU but not mortality. Males and African Americans were more likely to require ICU-level care. In final models, age and CRP were significantly associated with mortality (OR 1.06, 95% CI 1.04-1.08, and OR 1.06, 95% CI 1.03-1.10 respectively) as well as ICU admissions (OR 1.02, 95% CI 1.01-1.03 and OR 1.03, 95% CI 1.01-1.06 respectively). The previously established composite scores of CRP, D-Dimer, and N/L ratio were predictive of mortality (Area under the curve [AUC] 0.69 for multiplicative score) as well as ICU admissions (AUC 0.61 for multiplicative score). However, improved accuracy was obtained with age and CRP for predicting mortality (AUC 0.77) and ICU admission (AUC 0.62). Conclusions: CRP and age appear to be the strongest predictors for ICU admission and mortality compared to D-Dimer, Ferritin, Procalcitonin, and N/L ratio in patients with COVID-19.
Hepatic epithelioid angiomyolipoma: a case report
Authors: Logrado Ana , Pereira Raquel , Constantino Júlio , Sá Milene , Pereira Jorge , Oliveira Rui C. , Casimiro Carlos
Published: January 2021

Angiomyolipoma (AML) is a rare benign solid tumor, of mesenchymal origin. Angiomyolipomas can be subdivided, according to their predominant component. The predominance of epithelioid cells characterizes the epithelioid variant (EAML). These express a more aggressive clinical behaviour with a greater potential for malignant transformation. In the absence of specific radiological features, the diagnosis of hepatic EAML depends on the pathological and immunohistochemical study. We present the case of an 80 years old female with a computed tomography (CT) scan showing a hepatic nodule at the transition of segments 5 and 8, and a left kidney nodule previously biopsied and confirmed to be a renal angiomyolipoma. A liver nodule biopsy was performed, whose histology revealed a probable gastrointestinal stromal tumor (GIST). The patient underwent a 5/8 subsegmentectomy and pathology report revealed epithelioid angiomyolipoma. After discussion of the case in the multidisciplinary tumor board, it was decided to perform a left nephrectomy, whose pathology revealed leiomyomatous angiomyolipoma. No further treatment and surveillance on outpatient clinic were decided. Hepatic EAML is a rare lesion that, although mostly benign, can exhibit malignant behavior with distant metastasis and local invasion. Its identification is of paramount importance. The definitive diagnosis is only possible through histological and immunohistochemical analysis. Additional studies are needed in order to establish diagnostic criteria and predictive characteristics of malignancy.
Unusual foreign body in rectum: a surgical curiosity
Authors: M. Soujanya , Kulkarni Srinivas B. , S. R. Kruthi , M. P. Santosh , Prakash O. G.
Published: January 2021

Rectal foreign bodies represent a unique and challenging field of surgical management which includes a careful history, physical examination and a high index of suspicion for complications. Foreign bodies are rarely seen in lower GI or rectum, inserted either accidently or for sexual satisfaction or to inflict harm. We have 3 case scenarios of unusual foreign body in rectum with varied clinical presentation, findings and three different methods of management/extraction done in our Institution. Patients present with common complaints of rectal or abdominal pain, constipation or obstipation, bright red blood per rectum, or incontinence. Initial step is to assess for peritonitis which is suggestive a perforation with intraperitoneal contamination and requires emergency exploratory. Erect Xray abdomen can reveal the presence of free air and the location of the object relative to the pelvic floor. A careful digital rectal examination is the most informative component of the evaluation process. Impacted foreign bodies may result in complications like intestinal obstruction, perforation of gut and peritonitis. Rectal foreign body is a diagnostic and management dilemma due to the delayed presentation owing to associated social stigma. Patients require a detailed examination and radiographic evaluation with resuscitation. Surgical intervention should be planned based on hemodynamic stability and presence/absence of perforation. Patient has to be referred to the psychiatrist for his perversion disorder, which is also mandatory for preventing recurrences.
Urothelial carcinoma in the ureteral stump of a nefrectomized patient by kidney exclusion: a case report
Authors: Campos Tadeu J. F. L. , Leandro Plinio H. F. , Lima Lucas de O. , Lima André C. M. , Aquino Lucas de A. , Rocha Marcos F. H.
Published: January 2021

Urothelial carcinoma of the upper urinary tract is a rare and potentially aggressive disease. It rarely affects the ureter and is quite uncommon in the ureteral stump of a patient who has already undergone nephrectomy for benign disease. We, herein, describe a case of a male patient who underwent total left nephrectomy owning to renal exclusion. After three years, owning to an episode of hematuria, he was diagnosed with a urothelial tumor of the ureteral stump, and he underwent ureterectomy and excision of the bladder cuff. The involvement of the ureteral stump by urothelial tumor is an extremely rare event and is normally associated with poor prognosis owning to the delay in diagnosis inherent to atypical presentation. The most common symptom is hematuria. Pain is uncommon because of the absence of a renal unit and consequently, hydronephrosis. Although rare, we must remember the possibility of the appearance of primary tumors in the ureteral stump and maintain a high degree of diagnostic suspicion to avoid diagnosis in advanced stages.
Prevalence of exclusive breastfeeding and factors associated with faulty feeding in southwest Bihar
Authors: Kumar Vijay , Kumar Sanjay , Nitin Gandhi Devdarshan , Kumar Mani Kant
Published: January 2021

Background: Exclusive breastfeeding has been defined by WHO as “When an infant has been given only breast milk from his/her mother or a wet nurse or expressed breast milk during first six month of life and no other liquids/solids except necessary medicine and nutrional supplements in form of drops or syrup”. Aim was to Assess the prevalence and factors associated for faulty feeding on exclusive breast feeding practices of children less than six Months.Methods: An institution-based cross-sectional survey was conducted from May 2020 to October 2020 at Narayan medical college, Jamuhar, Rohtas, South Bihar. All mothers who visited for immunization and/or postnatal care services were considered as the study population. Lactating mothers who had under six-month infants were included. We observe the breastfeeding process for five minutes and record as per the WHO B-R-E-A-S-T feed observation form. The observation was done by asking the mother to put her infant to the breast.  Results: In this present study 58.5% study subjects were given exclusive breast feeding, 36.25% study subjects were given exclusive breast feeding only for some period and rest 5.25% had not given exclusive breast feeding since birth. In this study 46% study subjects had bottle feeding habit, whereas rest 54% do not had Bottle feeding habit.  Conclusions: The Exclusive Breast Feeding was satisfactory (58.5%). Some basic reason for faulty feeding were mothers’ belief that no milk, insufficient milk, baby is sick, mother is working/studying.
Effect of glycemic control on diabetic retinopathy and diabetic macular edema: a prospective observational study
Authors: S. Kajal Seema , T. Jayalekshmi , S. Manasa , M. Prasenna
Published: January 2021

Background: The objective of the study was to examine the effect of long-term glycemic control, as measured by glycated hemoglobin levels (HbA1C), on the onset and progression of diabetic retinopathy (DR) and diabetic macular edema (DME) over a period of 10 years.Methods: Patients who were diagnosed to have type 2 diabetes mellitus participated in this cross-sectional observational study. Duration of onset of diabetes and the glycemic control status were analyzed. Fasting and postprandial blood sugar levels and HbA1C levels were tested for every participant. Diabetic retinopathy was graded as per the ETDRS guidelines using stereoscopic fundus photographs. In addition to the clinical evaluation, optical coherence tomography was done to confirm the presence of DME.Results: A total of 212 diabetic patients were enrolled in this study. One sixty-four patients (78.1%) had DR, out of which 71 patients (43.3%) had mild non proliferative diabetic retinopathy (NPDR), 42 patients (25.6%) had moderate NPDR, 31 patients (18.9%) had severe NPDR, and 20 (12.2%) had proliferative diabetic retinopathy (PDR). Fifty-nine patients with DR (36%) had DME. Duration of diabetes (14.62±6.18 vs 9.72±3.68 years, p<0.001), higher fasting blood glucose (176.79±59.13 vs 138.46±49.44 mg/dl, p<0.001) and higher HbA1c levels (8.21±1.38 vs 7.48±1.25 %, p=0.002) were significantly associated with DR.Conclusions: The stage of diabetic retinopathy rather than metabolic status is a strong predictive factor for the development of diabetic macular edema.
Challenges and ways for pain assessment of children in the primary health care
Authors: Alkhuzaie Hisham Fayiz , Alhabib Yaqoub Yousef , Alanazi Aysar Farhan , Ali Mahmoud Ibrahim , Alqahtani Abdullah Ali , Noorelahi Sulafa Khaled , Daiwali Ibrahim Ghaleb , Alawadh Fatimah Mohammed , Kashmiri Mohammed Emad , Alyaseen Salman Mesfer , Alyaseen Mohsen Mohammed , Alsulaiman Ali Abdulmajid , AlQarni Hamed Mohammed
Published: January 2021

Pain assessment and management have shown great advances in recent decades regarding the treatment protocols and the various assessment approaches that have been developed and validated to specific for pediatric patients. In this literature review, we aim to shed more light on the assessment of pain in pediatric patients and the challenges that healthcare workers might face during the process in primary healthcare centers. In neonates, the crying, require O2 to reach a saturations more than 95%, increasing vitals, expressionless, and sleepless score shows the greatest advantage over other scores (COMFORT and distress for mechanically ventilated neonates), while in infants the face, leg, activity, cancelability, and cry scale shows promising results. In older children, self-reporting by the visual analogue scale should be standardized whenever possible or facial, and behavioral assessment should be used. Assessment of pain in patients with cognitive and intellectual disabilities might be challenging, and therefore, it should be interpreted carefully not to be misdiagnosed, in addition to trying to obtain relevant information from a well-trained accompanying caregiver. Further investigations are needed, however, to standardize these scores and to spread awareness among clinicians and caregivers about the importance of appropriate pain assessment.
Etiology of thumb sucking habit and its effect on developing malocclusion
Authors: Ahmed Zahid Nisar , Hussin Ahmed Mahmoud , Alanazi Anoud Fahad , Alhuraish Abdullah Mohammed , Abomelha Sarah Abdullah , Tulbah Thabt Hassan , Alshahrani Aidel Abdullah , Alotaibi Alanoud Fahad , Alkheshail Walaa Amer , Almalki Waleed Khalid , Alshaikh Waed Shaker , Aldossari Ali Mohammed
Published: January 2021

The persistence of thumb sucking might also be harmful as it might be associated with the development of complications seen on the thumb as paronychia and nail deformities and in the mouth level as malocclusions. In this review, we have looked up studies in the literature to identify the effect of thumb sucking on the development of malocclusion. Thumb sucking in children usually occurs as a primitive reflex that appears in early childhood with no apparent causative factors. Children usually develop this thumb sucking habit because in this way they feel more comfortable and secure. The main cause behind the development of thumb sucking is the prolonged presence of the thumb in the mouth which creates pressure against the developing jaw and teeth. This may interfere with the process of tooth eruption leading to delayed or abrupt eruption events and malformations. The severity of malocclusion deformities is significantly associated with the chronicity and period of thumb-sucking habits. Other forms of occlusions secondary to thumb sucking include: anterior open bite, exaggerated overjet, posterior crossbite, retrognathic mandible, a diastema, temporomandibular joint disorders and the retroclined low anterior. Thumb sucking, however, is a self-limiting phenomenon and usually disappears as children grow older. However, when persistence is noticed, immediate management should be approached to avoid any potential complications.
Management of androgenetic alopecia: a review
Authors: Chhetri Deepa Dev , Huang Xin
Published: January 2021

Androgenetic alopecia is a patterned hair loss disorder affecting approximately 73% of men and 57% of women in their lifetime, this affection can cause psychological effects like low self-stem and depression diminishing the quality of life. Currently, finasteride and minoxidil are the only two drugs approved by the food and drug administration (FDA), and devices of low-level laser therapy are FDA cleared. Alternative therapies for androgenetic alopecia treatment include a drug like dutasteride, botulinum toxin A, cell-based therapies like adipose-derived stem cell-conditioned medium and platelet-rich plasma protocols. A combination of two or more therapies can be found in the literature, the general consent indicates that any combination has higher efficiency than a single therapy. Finasteride is in less use due to the related sexual side effects, some adjuvant techniques have emerged to improve the delivery and effectiveness of minoxidil, i.e. micro needling. The surgical approach is mainly focused on hair transplant surgery, which offers relatively less invasive procedures and is a more suitable option for long time results, however, it is expensive. Recently, drug-assisted delivery techniques have emerged to improve the efficiency of conventional drugs; transdermal drug delivery through ultrasound pressure waves means creating diffusion channels, increasing skin permeability and stimulating cell differentiation and growth factor utilization along with minoxidil absorption. Another approach for drug-assisted delivery is the embodiment of finasteride in polymer-based microspheres aiming for a sustained and controlled delivery, which can be beneficial to reduce the regular doses decreasing adverse effects.