bluuebunny/crossref_metadata_2025 huggingface dataset:
Gut dysbiosis
Authors: Lawal Yakubu
Published: August 2024

Various reports have emerged on the possible nature of the complex and dynamic cause-effect relationship between gut dysbiosis and abnormal glucose homeostasis. These reports have suggested or experimented with diverse therapeutic strategies to tackle gut dysbiosis and glucose intolerance caused thereof. This review is aimed at re-aligning reports of pathophysiology and treatment modalities of gut dysbiosis and suggesting focal points of future research that will fast-forward a more encompassing clinical applications in the management of glucose intolerance. Literature search was done using databases including Pubmed, Pubmed Central, Embase, and Google scholar. The search terms used were (“glucose intolerance” OR “glucose dysregulation” OR “diabetes” OR “dysglycemia” OR “prediabetes”) AND (“gut dysbiosis” OR “abnormal gut microbiota” OR “gut microbiota” OR “gut microflora” OR “abnormal gut microflora”). On Initial search, the titles and abstracts of 632 literatures returned were checked for relevance to the review topic. Subsequently, 88 literatures that fulfilled the set criteria were critically reviewed and relevant contents extracted for this review. In conclusion, the treatment of gut dysbiosis can help to ameliorate glucose intolerance. These treatments include prebiotics, probiotics, synbiotics, postbiotics, antibiotics, and even antidiabetics.
Subcutaneous mycoses in a tertiary care hospital in India
Authors: Muthusamy Rajeshwari Kumaravel , Mehta Sangita S. , Thangaraju Deepak
Published: August 2024

Background:

Subcutaneous mycoses, a disease of the tropics, are usually missed or misdiagnosed in immunocompetent individuals unless sought for. The study was designed to explore the experience of diagnosing subcutaneous mycoses by histopathological examination in our institute and to find out the epidemiology, clinical features, and histopathological findings of cases with subcutaneous mycosis.

Methodology:

We reviewed the cases reported as subcutaneous mycoses in the department of pathology over 6 years (2017–2022). The slides were stained with Hematoxylin and Eosin, Periodic acid Schiff (PAS), and Gomori’s Methenamine silver (GMS) for identification of the fungi. Clinical details were obtained from the medical records.

Results:

Twenty-seven cases were retrieved from the archives, reported as subcutaneous mycoses from various sites. They presented with varying symptoms ranging from ulcers, discharging sinuses, nodular swellings, and cystic swelling. Histology from these revealed granulomas with suppuration, necrosis of subcutaneous fat, broad aseptate hyphae with angioinvasion, abscesses, and grains.

Conclusion:

Mycosis, a disease of the tropics, may manifest in immunocompetent individuals with varied clinical presentations and histology. The intact immune status of the individual results in granuloma formation along with suppuration and giant cells. Diagnosis is usually achieved by a meticulous search for fungus in such lesions. PAS and GMS stains help identify the fungus.
Heterotopic gastric mucosa of the umbilicus
Authors: Keloth Thara , Sriram V. , Gandhi Ramya , Ivan Erli Amel
Published: August 2024

Umbilical discharge is a commonly encountered problem in infants, with common causes being omphalitis and umbilical granuloma. Unusual causes of persistent umbilical discharge are remnants of the omphalomesenteric duct and the urachus. Heterotopic or ectopic tissues at the umbilicus are rare events that cause umbilical discharge and these mandate a surgical intervention. Gastric heterotopia at the umbilical region is such an unusual entity causing persistent discharge and chemical dermatitis around the region, which needs surgical intervention. We hereby report a rare case of gastric heterotopia of the umbilicus in an 8-month-old male baby.
Comparative assessment of medicinal plant extract efficacy against plaque and gingivitis: A case–control study
Authors: Agrawal Jyoti , Pant Aditya Bhusan , Agrawal Rajesh Kumar
Published: August 2024

Background:

In the last quarter of the 20th century, dedicated efforts have been made to use phytochemicals in the prevention of periodontal diseases, but the darker side of the coin is that we have hardly encountered studies with a scientific basis to prove the specific role of phytochemicals against dental plaque.

Objective:

This study aimed to assess the antiplaque activity of Curcuma longa, Spilanthes acmella, and Quercus infectoria and to determine the antigingivitis activity of the extract, which shows high antiplaque potential.

Materials and Methods:

Sixteen volunteers were selected as subjects in this biphasic study. In the first phase, 10 volunteers were subjected to topical application of aqueous ethanolic extract (1%) of C. longa, Q. infectoria, and S. acmella on the labial/buccal and lingual/palatal surfaces of 28 teeth. In the second phase, the extract showing the highest efficacy was selected to assess its antigingivitis activity on all the surfaces of six mandibular anterior teeth of six gingivitis patients. The percentage plaque reduction was calculated by dividing the difference of the base and end scores by the baseline scores.

Results:

C. longa demonstrated superior results as it showed the maximum reduction in plaque formation. Antigingivitis activity of long-term topical application of 1% C. longa was depicted in independent clusters in different volunteers selected for the study. Only after 2 weeks, the treatment score was found to be statistically significant to depict optimal results.

Conclusion:

C. longa can be considered the best at reducing plaque. The antigingivitis activity of C. longa ranked reasonably satisfactory and comparable to the existing data for commercially available drugs.
Assessment of Postoperative Venous Thromboembolic Complications
Authors: Aljiffry Murad M. , Alhazmi Mohammed F.
Published: August 2024

BACKGROUND:

Postoperative venous thromboembolic events (VTEs) are a preventable cause of death. Adherence to available guidelines and prophylactic measures is suboptimal. This study examined postoperative VTEs prevalence, prophylaxis guideline adherence, and VTEs risk factors among surgical patients at King Abdulaziz University Hospital in Saudi Arabia.

METHODOLOGY:

This retrospective study analyzed VTEs patients from August 2020 to November 2022. Medical records collected data on patients, procedures, prevention, guideline adherence, and VTEs diagnosis. The statistical analysis evaluated the link between prophylactic measures and VTEs occurrence.

RESULTS:

Thirty-one (32%) of the 97 VTEs diagnosed in patients were postoperative VTEs. Mortality rates were 18.5%, and for postoperative VTEs patients were 12.9%. Most patients (87.1%) were at high risk (Caprini score ≥ 5) for VTEs. Abdominopelvic procedures were 64.5% of cases. Approximately 60% of patients received postoperative prophylaxis. Enoxaparin was the most frequently used prophylaxis method (63.1%). Mechanical prophylaxis was used in 36.8% of patients who received prophylaxis. Compliance for extended prophylaxis was only 10.5%. Late initiation of prophylactic measures was significantly associated with deep vein thrombosis occurrence.

CONCLUSION:

The study emphasizes the need to follow prophylaxis guidelines. Improving compliance with prophylactic measures, especially for high-risk patients, can potentially reduce postoperative VTEs.
Mixed Autoimmune Hemolytic Anemia in a 2-Year-Old Girl
Authors: Alamri Asim Abdullah , AlSubhi Abdulmohsen , Bali Ibrahim , Alsarrani Abdullah , AlHujaili Arwa , Tarwah Ahmad
Published: August 2024

Immune hemolytic anemia is diagnosed when it exhibits the clinical symptoms and laboratory findings of hemolytic anemia, such as pallor, jaundice, anemia, high indirect bilirubin, increased reticulocyte count, and a positive direct antiglobulin test. Depending on the type of antigenic stimulation, this condition can be divided into three distinct subtypes: (1) autoimmune hemolytic anemia (AIHA), (2) alloimmune hemolysis, and (3) drug-induced hemolysis. In addition, the thermal amplitude of autoantibodies is used to categorize AIHA as either a warm (most common), cold, or mixed (rare) subtype. Mixed autoimmune hemolytic anemia is diagnosed when both warm and cold autoantibodies are present. Here, we report a case of a mixed AIHA in a 2-year-old girl who responded well to corticosteroids. Due to the rarity of the condition and the lack of rigorous diagnostic criteria, it is crucial to report this case.
Starry Sky Appearance of an Amyloid Heart in Plasma Cell Dyscrasias
Authors: Das Debasish , Acharya Debasis , Mahanta Dibya Sundar , Deb Pranjit
Published: August 2024

We report an extremely rare case of amyloid heart with classical “Starry Sky” appearance in echocardiography in a 52-year-old male presenting with systemic amyloidosis secondary to plasma cell dyscrasias. Interestingly, patient presented with diffuse myalgia unresponsive to traditional nonsteroidal anti-inflammatory drugs with effort dyspnea New York Heart Association Class II secondary to Grade II diastolic dysfunction of stiff myocardium infiltrated with amyloid protein. A starry sky pattern of an amyloid heart led to the retrospective diagnosis of plasma cell dyscrasias with presence of 30% plasma cells in bone marrow biopsy without the presence of M band in serum electrophoresis.
Prognostic Value of ST-segment Deviation in Lead aVR in Electrocardiogram in Acute Myocardial Infarction
Authors: Gandhi Viral , Gandhi Vicky
Published: August 2024

Background:

Acute myocardial infarction (AMI) remains a significant cause of morbidity and mortality worldwide, necessitating effective risk stratification tools for improved management. ST-segment deviation in lead augmented vector right (aVR) has emerged as a potential prognostic marker in AMI, but its clinical relevance in the Indian context requires further investigation.

Materials and Methods:

We conducted a single-center prospective observational study among patients admitted with AMI to assess the prognostic value of ST-segment deviation in lead aVR. Patients were categorized based on the presence or absence of ST-segment deviation in lead aVR, and demographic, clinical, and angiographic characteristics were compared between groups. Follow-up evaluations were performed to assess left ventricular ejection fraction (LVEF) and the incidence of ventricular tachycardia (VT).

Results:

The study enrolled 110 patients, categorizing them by ST-segment deviation in lead aVR. Patients with ST elevation in lead aVR showed higher moderate LVEF dysfunction (31%–40%) than those with isoelectric ST segments (P = 0.0058). Conversely, patients with ST depression in lead aVR had increased preserved ejection fraction compared to those with an isoelectric ST segment (P = 0.0414). <50% ST-segment resolution postpercutaneous coronary intervention (PCI) was more common among non-ST-segment elevation myocardial infarction (NSTEMI) patients. The incidence of VT was higher in ST elevation in lead aVR (P = 0.0045). Significant differences in ST-segment resolution after PCI (P = 0.0117) between STEMI and NSTEMI patients were noted.

Conclusion:

ST-segment deviation in lead aVR serves as a valuable prognostic marker in AMI, correlating with adverse outcomes such as moderate LVEF dysfunction and increased risk of VT. Furthermore, its association with ST-segment resolution post-PCI highlights its role in assessing reperfusion success and guiding management strategies. These findings underscore the importance of ST-segment deviation in lead aVR for risk stratification and personalized management in AMI patients.
Dapagliflozin in Post-Myocardial Infarction Acute Decompensated Heart Failure: Daffodil Study
Authors: Jariwala Pankaj , Kulkarni Gururaj Pramod , Punjani Arshad , Boorugu Hari Kishan , Madhawar Dilip Babu , Gude Dilip
Published: August 2024

Background:

Dapagliflozin and sodium–glucose cotransporter 2 inhibitors reduce the risk of cardiac death and hospitalization for heart failure (HF), regardless of the patient’s status with type 2 diabetes mellitus (T2D). Further investigation is required to ascertain the impact of these drugs on patients suffering from acute myocardial infarction (AMI) complicated by acute decompensated heart failure (ADHF).

Methods:

In retrospective research comprising 371 patients with AMI complicated by ADHF of Killip class II–IV and left ventricular ejection fraction ≤40%, the effectiveness of dapagliflozin at a dosage of 10 mg once a day was compared to standard of care alone. The main results consisted of a primary composite outcome, which encompassed either cardiovascular (CV) mortality or hospitalization due to HF. Additional clinical outcomes assessed were CV mortality, hospitalization due to HF, and changes in laboratory measurements, including glycosylated hemoglobin, N-terminal prohormone B-type natriuretic peptide, and estimated glomerular filtration rate (eGFR).

Results:

In the group that received dapagliflozin, 10.7% of patients experienced a primary composite outcome event, while in the group that did not receive dapagliflozin, 24.9% of patients experienced one. The median follow-up period was 12.4 months, and the hazard ratio for CV death or hospitalization for HF was 0.67 (95% confidence interval [CI], 0.65–0.86; P < 0.001). Hazard ratio, 0.68; 95% CI, 0.55–0.69; P < 0.001), the group given dapagliflozin had fewer HF hospitalizations overall than the group given a placebo. Dapagliflozin decreased the likelihood of serious kidney outcomes and decelerated the yearly decline in the eGFR (2.1% vs. 7.6%; P < 0.001).

Conclusions:

Patients with AMI complicated by ADHF who received dapagliflozin had a lower risk of CV death or HF hospitalization, regardless of their T2D status.
Open Surgery for Pseudoaneurysm after EVAR: A Unique Surgical Challenge
Authors: Ananthanarayanan Chandrasekaran , Patel Kartik , Doshi Chirag , Shah Jigar , Sheth Megha , Shah Ritesh , Shah Pratik
Published: August 2024

Endovascular repair of abdominal aneurysm (EVAR) has become the main stay of treatment for abdominal aortic aneurysm. Long-term follow-up studies have shown a variety of complications following EVAR, few of which are dangerous with high morbidity and mortality. Open surgery for complications of EVAR poses unique challenges to the surgeon. We present one of the serious complications following EVAR which was successfully managed by open surgery.
Laser-Cut Stent-Assisted Coiling of Wide-Necked Giant Cavernous ICA Aneurysm: Inviting a Catastrophe
Authors: Jani Parth , Purkayastha Sukalyan
Published: August 2024

Management of wide-necked aneurysms in cavernous ICA has significantly evolved in the endovascular era, with flow diverters and stent-assisted coiling being an effective modality. It is vital to select the type of stent according to the arterial anatomy, hemodynamics, and device characteristics. We report a catastrophic complication of laser-cut stent used for SAC of cavernous ICA aneurysm performed at another center 5 years back, presenting with regrowth and massive life-threatening epistaxis managed successfully. In tortuous angulated anatomy, laser-cut stents are difficult to place, poorly visible, and the device opening is uncertain. Unlike braided stents, laser-cut stents do not provide flow diversion effect, stent migration, and buckling phenomena are more likely to occur with laser-cut stents. We intend to discuss the technical fallacies behind using laser-cut stents in such case scenarios and the optimal treatment approach for such cases with an attitude to learn from such complications.
A Cross-Sectional Study of Clinical Spectrum and Outcome of Pure Midbrain Strokes
Authors: Sheetal S , Thomas Reji , Byju P , Sasidharan Aswathy , Mathew Finu , Madhusudanan M
Published: August 2024

Background:

Pure mesencephalic infarcts are uncommon, the main clinical manifestations being oculomotor signs and ataxia.

Objectives:

Primary objective was to determine the incidence of pure midbrain strokes. We also evaluated the clinical spectrum, syndromes, arterial territories involved, risk factors, and outcome at 3 months.

Settings and Design:

This cross-sectional study was conducted at the Neurology department of a tertiary teaching hospital in Kerala.

Methods and Material:

We recorded clinical examination and radiological details of all the patients who presented with isolated midbrain strokes from December 2014 to December 2019. The clinical spectrum and outcomes of the patients at 3 months were analyzed.

Results:

Of the 520 posterior circulation stroke patients, 48 (9.2%) had isolated mesencephalic infarcts. Clinical manifestations included gait ataxia in 40 patients (83.3%), third nerve palsy in 29 (60.41%), fourth nerve palsy in 4 (8.3%), internuclear ophtalmoplegia in 9 (18.8%), upgaze paresis in 3 (6.3%), hemiparesis in 4 (8.3%), and cheiro-oral paraesthesia in 4 (8.3%). Of the 48 patients, 21 (43.8%) had Claude syndrome, 9 (18.8%) had Wernekink commisure syndrome, 6 (12.5%) had ataxic hemiparesis, 3 (6.3%) had Parinaud syndrome, 3 (6.3%) had Weber syndrome, 4 (8.3%) had Nothnagel syndrome, and 1 patient had a pure sensory stroke (2.1%). The anteromedial territory was frequently affected, in 37 (77%), characterized by oculomotor manifestations and ataxia. Posterior lesions were noted in three (6.3%), anterolateral lesions in three (6.3%), and lateral lesion in one (2.1%) patient. Combined lesions in posterior and paramedian territory were seen in four (8.3%). At the end of 3 months, 30 patients (62.5%) had a modified Rankin score of one.

Conclusions:

Our study provides the incidence of midbrain stroke over 5 years. It also highlights the heterogeneity of clinical features of pure midbrain infarcts.
Facial Nerve Preserving Subtotal Excision for Large Vestibular Schwannoma: An Institution-Based Functional Outcome Study
Authors: Annayappa Santhosh K. S. , Prabhuraj A R , Arivazhagan A , Bhat Dhananjaya I , Shukla Dhaval , Srinivas Dwarkanath , Rao K V L N , Vikas V , Devi Indira B
Published: August 2024

Background:

The ideal goal of treatment for medium to large vestibular schwannoma is complete tumor removal with preservation of all cranial nerves. However, despite the advancements in microsurgery and intraoperative monitoring, the risk of facial nerve dysfunction following total resection varies between 31% and 57%. Currently, the goal of treatment for large tumors is shifting from total excision to facial nerve preservation.

Objective:

To evaluate the facial nerve outcome in patients who underwent subtotal excision with or without subsequent gamma knife radiosurgery for large vestibular schwannomas in our institute.

Methods and Material:

All patients who underwent primary surgery for large vestibular schwannomas between January 2012 and December 2016 were analyzed retrospectively. Cases where total excision was not done and a residue was left behind to prevent facial nerve injury during surgery were included in the study.

Results:

A total of 52 patients who met the inclusion criteria were analyzed. At final follow-up, 70% of patients had good facial nerve function (H-B grade 1 and 2). In patients with normal facial nerve function preoperatively, 81% (25/31) of them had good facial nerve outcomes (H-B grade 1 and 2), whereas in patients with preexisting facial nerve deficits, nearly 62% (13/21) of them either maintained or had improvement in their facial nerve grades.

Conclusion:

Good facial nerve outcomes and tumor control rate is obtained by subtotal excision of VS followed by upfront or delayed GKRS; however, there is a need for long-term follow-up to detect recurrences in these slow-growing tumors.
Clinical outcomes and safety of external beam radiotherapy with extensive intrahepatic targets for advanced hepatocellular carcinoma: A single institutional clinical experience
Authors: Park Sunmin , Rim Chai Hong , Yoon Won Sup
Published: August 2024

Background:

This study observed the clinical outcome of radiotherapy to extensive intrahepatic targets for advanced hepatocellular carcinoma (HCC) in a single institution.

Methods:

From September 2009 to July 2021, patients who underwent fractionated radiotherapy to a planning target volume (PTV) of over 100 ml with biological effective dose >30 Gy10 for advanced HCC were enrolled. Overall survival (OS) and radiation-induced liver toxicity (RILD) were evaluated. RILD was defined as an increase in Child-Pugh (CP) score ≥2 or liver function tests ≥2.5 times at 3 months after the end of radiotherapy.

Results:

A total of 136 patients were evaluated. Eighty-nine patients had portal vein tumor thrombus (PVTT), 37 patients were in CP B stage, and the median radiation dose to PTV was 48.8 Gy10. The median OS was 12.3 months. The factors most affecting OS were PVTT (P = 0.001), PTV (>500 ml, P = 0.001), incomplete coverage of the intrahepatic tumor (P = 0.004), and CP B (P = 0.006) in Cox regression. RILD occurred in 22.4% of the patients and was affected by PVTT (P = 0.003), PTV (P = 0.010), pretreatment bilirubin levels (>1.5 mg/ml, P = 0.016), and the mean normal liver dose (MNLD) (≥ EQD2 18 Gy3, P = 0.021) in binary logistic regression. As the PTV was in excess of >500 ml, RILD developed in 30.2% of patients and the prognostic importance of pretreatment bilirubin levels (P = 0.006) and the MNLD (P = 0.014) increased.

Conclusions:

As PTV is more extensive, the bilirubin level and the MNLD have to be taken into consideration for safe radiotherapy, in addition to the traditional prognostic factors.
Synthesis and toxicity evaluation of a spray consisting of silver nanoparticles, ethylenediaminetetraacetic acid, methylsulfonylmethane, and xylitol on vero cell line
Authors: Hedayatipanah Morad , Niaee Morteza Shakhsi , Torkzaban Parviz , Farmany Abbas , Najafi Rezvan , Farhadian Maryam
Published: August 2024

Introduction:

Dental plaque is a biofilm or an accumulation of bacteria that grows in the internal surfaces of the mouth and can be observed as a white to pale yellow layer over or between teeth. The continuous formation and accumulation of dental plaque lead to oral diseases. As a result, it is necessary to prevent the aggregation of dental plaque and clean it daily. Recently, ethylenediaminetetraacetic acid (EDTA) has been utilized in toothpaste to prevent plaque formation as an EDTA-transporting enhancer, methylsulfonylmethane (MSM) can effectively increase its local effect. Xylitol decreases the Streptococcus mutans count by changing the metabolic pathways.

Aims:

In the present study, we synthesized a solution containing silver nanoparticles, EDTA, MSM, and xylitol and evaluated its toxicity on the Vero cell line through the MTT assay.

Materials and Methods:

To produce silver nanoparticles, we dissolved silver nitrate in sodium citrate. Then we used a solution of distilled water and polyvinylpyrrolidone, which resulted in the encapsulation and stabilization of silver nanoparticles, and the solution was made by mixing other ingredients. We evaluated the cytotoxicity of this spray using the Vero cell line. We cultured the cells in the 10% FBS-containing RPMI culture medium. For performing the cytotoxicity test, we put 10,000 cells in each well of the 96-well plate, and the next day added the synthesized solution to each well at dilutions 0.05%, 0.1%, 0.2%, 0.5%, 1%, 2%, 5%, and 10%. As the control group, we used 4 wells containing live Vero cells without adding the solution. After 24, 48, and 72 h, we added the MTT solution to each well and incubated the plates at 37°C for 4 h. Finally, we evaluated the rate of living cells by reading the absorbance with an ELISA device at 570 nm.

Results and Discussion:

We used the Mann–Whitney nonparametric test to evaluate the cytotoxicity of different concentrations of the synthesized spray solution and compare the cell viability rate of groups with the controls in various periods. According to the cytotoxicity results of different concentrations of the spray solution on the Vero cell line, there was no significant difference in cytotoxicity between the 0.05%, 0.1%, 0.2%, and 0.5%, and control groups at 24, 48, and 72 h (P > 0.05). No significant difference existed in cytotoxicity between 1% and 2% concentrations and the controls 24 h after exposure; this became significant after 48 and 72 h (P = 0.014). However, a significant difference existed in cytotoxicity between 5% concentration and the controls 24, 48, and 72 h after exposure (P = 0.014). The CC50 of the spray solution was calculated at 3.51%.

Conclusion:

The findings of this study showed that the synthesized solution is nontoxic; therefore, this spray solution can be used safely as an oral mouthwash and spray.
Undifferentiated pleomorphic sarcoma of maxilla
Authors: Abbas Rezhat , Latoo Suheel Hamid , Dar Mohammad Shafi , Nadaf Afreen
Published: August 2024

Undifferentiated pleomorphic sarcoma (UPS) formerly known as malignant fibrous histiocytoma is a high-grade aggressive soft-tissue sarcoma. UPS is a soft-tissue sarcoma without a definable line of differentiation. Men between the ages of 50 and 70 are frequently affected by it. In adults, the lower extremity and retroperitoneum are the most affected sites, while the paranasal sinus is affected in younger individuals. A 16-year-old male patient reported with swelling in his left posterior maxilla for 2 months. The swelling began quickly and gradually expanded to its current size. On examination, an ill-defined, deep-seated exophytic, ovoid growth was seen on the left maxillary alveolus. Histopathological findings indicated UPS. UPS is a rare malignancy that typically originates in the body’s soft tissues. The treatment for UPS is determined on the site of the cancer, but it typically includes surgery and radiation.
The Glasgow Coma Scale and Full Outline of Unresponsiveness score evaluation to predict patient outcomes with neurological illnesses in intensive care units in West Bank: a prospective cross-sectional study
Authors: Omar Wourod Mahmoud , Khader Imad Rasheed Abu , Hani Salam Bani , ALBashtawy Mohammed
Published: August 2024

Background: Determining the clinical neurological state of the patient is essential for making decisions and forecasting results. The Glasgow Coma Scale and the Full Outline of Unresponsiveness (FOUR) Scale are commonly used tools for measuring behavioral consciousness. This study aims to compare scales among patients with neurological disorders in intensive care units (ICUs) in the West Bank.Methods: A prospective cross-sectional design was employed. All patients admitted to ICUs who met inclusion criteria were involved in this study. Data were collected from from An-Najah National University, Al-Watani, and Rafedia Hospital. Both tools were used to collect data. Result: A total of 84 patients were assessed, 69.0% of the patients were male, and the average length of stay was 6.4 days. The mean score on the Glasgow Coma scale was 11.2 on admission 11.6 after 48 hours, and 12.2 on discharge. The mean FOUR Scale score was 12.2 on admission, 12.4 after 48 hours, and 12.5 at discharge.Conclusion: This study indicates that both the Glasgow Coma Scale and the FOUR scale are effective in predicting outcomes for neurologically deteriorated critically ill patients. However, the FOUR scale proved to be more reliable when assessing outcomes in ICU patients.
Critical illness-related corticosteroid insufficiency: latest pathophysiology and management guidelines
Authors: Fredrick Fremita Chelsea , Meda Anish Kumar Reddy , Singh Bhupinder , Jain Rohit
Published: August 2024

Intensive care unit (ICU) admissions in the United States exceed 5.7 million annually, often leading to complications such as post-intensive care syndrome and high mortality rates. Among these challenges, critical illness-related corticosteroid insufficiency (CIRCI) requires emphasis due to its complex, multiple-cause pathophysiology and varied presentations. CIRCI, characterized by adrenal insufficiency during critical illness, presents in up to 30% of ICU patients and may manifest as an exaggerated inflammatory response. Factors such as dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, altered cortisol metabolism, tissue corticosteroid resistance, and drug-induced suppression contribute to CIRCI. Diagnosis is a complex process, relying on a comprehensive assessment including clinical presentation, laboratory findings, and dynamic stimulatory testing. Treatment involves intensive medical care and exacting glucocorticoid therapy. Recent guidelines advocate for individualized approaches tailored to patient presentation and etiology. Understanding the pathophysiology and treatment of CIRCI is vital for clinicians managing critically ill patients and striving to improve outcomes. This research paper aims to explore the latest developments in the pathophysiology and management of CIRCI.
MOSQUE AND ITS ROLE IN THE PROTECTION OF ORPHANS (Study at BKM Nurul Hidayah Jl. Garu II-A No. 26 Harjosari-I sub-district, Medan Amplas District)
Authors: Alkausar Saragih Ismed Batubara, Yeltriana,
Published: August 2024

The mosque is a ritual place of worship for the Islamic community which was ordered by Allah and His Messenger to prosper. In addition, the function of the mosque can also be maximized as a place to build social piety. Social piety is a good or pious deed that has a positive/beneficial impact on other people or society, for example helping the poor, giving scholarships for children from underprivileged families, for people who have abundant wealth, can do charity by wealth, alleviating poverty, building mosques, madrasas and others. For officials with power, he can make and oversee policies or rules that can improve the welfare of the people, help people who are left behind to get up and move forward. Piety descriptively is the embodiment of the concept of hablumminnas. so that they are classified as religious liars who are warned by Allah in Surah Al Maun (1-7). The purpose of this study was conducted to find out how the role of BKM Nurul Hidayah Jl.Garu II-A No.26 Harjosari-I Village, Medan Amplas District. The research method used is a qualitative research method with collection through observation, interviews, and documentation. Data analysis uses descriptive qualitative analysis techniques which are carried out by giving meaning to the data that has been collected, and then conclusions are drawn. That the function of the mosque has experienced a shift from a mere place of worship to a channel or channel of social piety in the form of protecting orphans in the form of sponsorship for orphans. Such a shift actually existed in the Age of Rasulullah SAW and BKM Nurul Hidayah Jl. Garu II-A No.26, Harjosari-I sub-district, Medan Amplas sub-district, has done this not to say, but to repeat what Rasulullah SAW has exemplified.
THE PROFILE AND CLINICAL EVIDENCE OF EFFECTIVENESS OF OLAPARIB IN TRIPLENEGATIVE BREAST CANCER: A REVIEW
Authors: Faathiansyah Muhammad Reza Al
Published: August 2024

Triple-negative breast cancer (TNBC) is one of the most common malignancies in women. The majority of patients with TNBC have a poor prognosis. The main objective of this study is to review the profile and clinical evidence of the effectiveness of Olaparib in treating TNBC. A literature search was conducted using multiple electronic databases, including PubMed, Google Scholar, JSTOR, and Scopus. The search was focused on articles published up to June 2024, ensuring the inclusion of the latest and relevant studies. The primary objective was to investigate the mechanism of action, toxicity profile, resistance mechanisms, and therapeutic effectiveness of olaparib in the treatment of TNBC, regardless of their prior chemotherapy treatment for metastatic breast cancer, prior platinum-based chemotherapy, or usage of cyclin-dependent kinase 4/6 inhibitors (Balmana et al., 2022). The results of this research suggest that the pharmacological efficacy and safety characteristics of this medication in TNBC patients are similar to those reported in the OlympiAD study. Furthermore, stratification of patients for this medication is possible due to the diagnostic techniques that can predict the presence of the BRCA mutation in order to optimize its efficacies. Additionally, developing and validating new biomarkers beyond BRCA mutations for patient stratification could optimize targeted therapy approaches.
MISKOMUNIKASI (Studi Kegagalan Komunikasi Antara Mahasiswa dan Dosen STAIN Majene Melalui Media WhatsApp)
Authors: Syahrul  , Fathiyah  , Jumarlis Mila
Published: August 2024

Miskomunikasi dosen dengan mahasiswa melalui media WhatsApp, Bertujuan untuk mengetahui bagaimana bentuk miskomunikasi yang dialami dosen ataupun mahasiswa melalui chat WhatsApp, faktor apa saja yang menjadi pendukung dan penghambat mahasiswa dan dosen dalam berkomunikasi melalui aplikasi WhatsApp, bagaimana upaya dosen dan mahasiswa mengatasi miskomunikasi melalui pesan WhatsApp.
Jenis penelitian yang peneliti gunakan adalah metode penelitian kualitatif dengan jenis penelitian deskriptif. Metode pengumpulan data berupa wawancara dan dokumentasi, dengan menggunakan sampling Snowball yaitu metode memutuskan sampel yang pada awalnya sedikit jumlahnya kemudian pada saat itu berkembang ke tingkat yang semakin meningkat.
Hasil penelitian yang didapatkan adalah bentuk miskomunikasi Referensial diantaranya: miskomunikasi kata tunggal/frasa pendek, dan miskomunikasi kebingungan topik percakapan. Miskomunikasi Afektif diantaranya: salah mengartikan emosi atau nada pesan, dan salah menafsirkan humor. Faktor pendukung komunikasi yakni kemudahan penggunaan whastApp, menjaga privasi pengguna, kepopuleran WhatsApp, beragam fitur. Faktor penghambat yakni jaringan tidak stabil, etika, persepsi, perbedaan budaya, perbedaan jenis kelamin, perbedaan usia, dan perbedaan bahasa. Upaya mengatasi miskomunikasi langsung menegur mahasiswa, bertemu secara langsung, menelpon, memperjelsan maksud pesan yang dikirim, menghightlight inti pesan.
Pelatihan Kurikulum Merdeka di SMP Swasta Jakarta
Authors: Seruni Ayu Putri , Agustina Karnawati Rita , Latief Abdul
Published: August 2024

Abstrak: Kurikulum Merdeka yang diwacanakan oleh Mendikbud ristek diterapkan diberbagai sekolah. Karakteristik kurikulum ini mendukung pemulihan belajar terkait pembelajaran berbasis projek dengan softskill dan karakter profil Pancasila, fokus pada materi esensial dan pembelajaran terdiferensiasi. Pencapaian pembelajaran Merdeka memerlukan pengembangan perencanaan kurikulum Merdeka dengan baik. Permasalahan mitra SMP di Jakarta berkaitan dengan pengembangan perencanaan kurikulum Merdeka, (1) Penerapan kurikulum Merdeka belajar baru akan diterapkan, (2) Belum semua guru memahami bagaimana perangkat kurikulum diterapkan dalam perencanaan belajar. (3) Pembuatan modul ajar diperlukan kesamaan pemahaman satu sekolah. Sebagai perangkat kurikulum yang utuh, memerlukan kerjasama sumber daya manusia yakni guru di sekolah dalam mengupayakan terlaksananya kurikulum Merdeka belajar. Solusi dari kami dengan memberikan pelatihan kurikulum merdeka kepada guru-guru di SMP Muhammadiyah 2 Jakarta mencapai perencanaan pembelajaran.
Kata Kunci: Kurikulum Kurikulum Merdeka, SMP
Abstract:  The Independent Curriculum discussed by the Minister of Education and Culture for Research and Technology is applied in various schools. The characteristics of this curriculum support the recovery of learning related to project-based learning with soft skills and Pancasila profile characters, focusing on essential materials and differentiated learning. The achievement of Merdeka learning requires the development of Merdeka curriculum planning properly. The problems of Junior High Scholl in Jakarta partners are related to the development of Merdeka curriculum planning, (1) The implementation of the new Merdeka learning curriculum will be implemented, (2) Not all teachers understand how curriculum tools are applied in learning planning. (3) Making teaching modules requires a common understanding of one school. As a complete curriculum tool, it requires the cooperation of human resources, namely teachers in schools in striving for the implementation of the Merdeka Belajar curriculum. Our solution is to provide independent curriculum training to teachers at Junior High Scholl in Jakarta to achieve lesson planning.
Keywords: Curriculum, Curriculum Merdeka, Junior High School
Taboo As A Character Education Means
Authors: Ringgi’ Ismail Banne
Published: August 2024

People always crave harmony in their daily lives through harmony with God, others and other creatures. In order to maintain this harmony, in society, rules that should not be violated are passed down from one generation to the next. Taboo can be a means to develop the character of everyone in society. Unfortunately, in today's Toraja society, it seems that taboo is no longer being cared for. There is a lot of disharmonies with God, fellow beings, and other creations. Taboo is regarded as just a myth that does not make sense or the boast of parents to scare children into doing what their parents want. So, how can this taboo become a means of character building? By using a qualitative-descriptive method, it was found that taboo became a means of character education through strict enforcement in people's lives through the provision of strict sanctions, exemplary parents, habituation, and strict enforcement of taboo.
The Thermal Effects of Coastal Nuclear Power Plant Thermal Discharge on Two Fish Species Based on the Probabilistic Frequency of Temperature Increment
Authors: Li Lei , Shao Chenshan , Cai Jiaying , Tang Baojun , Su Weiwei , Zou Weiyi , Jiang Mei
Published: August 2024

This study selected Trachinotus ovatus and Nibea albiflora as the focal subjects to investigate the impacts of probabilistic frequency of temperature increment through laboratory simulations that mimicked the seasonal water elevated temperature adjacent to two coastal nuclear power plants. This research was underpinned by the probabilistic analysis of temperature increase frequencies, aiming to evaluate the thermal tolerance of these species across different seasonal contexts. Results demonstrated that the T. ovatus did not exhibit mortality in the spring, autumn, and winter. Mortality in T. ovatus occurred only during the summer in temperature-duration probability experimental groups subjected to 8.5ºC above ambient temperature with exposure probabilities of 50%, 75%, and 100%. The average survival rates were (93.3±3.3) %, (93.3±5.1) %, and (86.7±2.9) % respectively. The N. albiflora experienced mortality in spring, summer, autumn, and winter, with the highest mortality rate in summer. Compared to N. albiflora, T. ovatus exhibited significantly higher thermal tolerance across all seasons. As the experimental temperature increased and the duration probability rose, the mortality rates of both fish species showed an upward trend. There was an interaction between elevated temperature and duration probability, with the duration of different elevated temperature amplitudes significantly impacting the fish’s survival rates.
Leptospira infection of rodents captured at the slaughterhouses and their risk to public health in Unguja island, Tanzania
Authors: Ngecha Bakari , Katakweba Abdul , Mkupasi Ernatus
Published: August 2024

Background: Leptospira infection is an invasion of animal or human body with the pathogenic spirochete bacteria of the genus Leptospira resulting to a disease called leptospirosis. This study aimed to investigate Leptospira infection and the carrier status of rodents caught near slaughterhouses at Unguja Island, Tanzania.
Methods: This cross-sectional study was conducted from January to April 2022 at Unguja Island to determine the seroprevalence of Leptospira infection in rodents captured in and around the slaughterhouse’s compounds. A total of 302 sera samples from four slaughterhouses were tested for anti-leptospiral antibodies using microscopic agglutination test (MAT) with a panel of 5 Leptospira serovars: Pomona, Lora, Hebdomadis, Grippotyphosa and Sokoine; and were considered positive at MAT titer ≥1:20. Chi-square test and the Fisher exact test were used to assess the statistical association between variables at a p value of < 0.05.
Results: The overall seroprevalence of Leptospira infection in rodents was 10.6% (32/302). Individual rodent species had seroprevalence of 8.5% for Mus musculus, 0.0% for Mastomys natalensis, 20.8% for Rattus norvegicus, 9.3% for Rattus rattus and Cricetomys gambianus at 12.5%. However, the apparent seroprevalence in the individual slaughter facilities was 15.0% (15/100) Kinyasini, 10.4% (5/48) Mfenesini, 9.3% (5/54) Kisakasaka, and 7.0% (7/100) Muwanda.
Conclusion: With over ten percent of rodents testing positive for Leptospira infection, it is crucial to implement rodent control measures to prevent the spread of the disease to those working in or around the slaughterhouses in Unguja Island.
Strategi Menghadapi Tantangan Dalam Memberikan Pendidikan Seks Pada Anak Usia Dini
Authors: Fauziyah Syarifatul Huriyah  , Siti Lulu Ulfiyah  , Sopi Masturoh  , Syifa Faujiyah
Published: August 2024

Pendidikan seks pada anak usia dini merupakan isu yang semakin relevan dalam konteks global saat ini. Penelitian ini menggunakan pendekatan kualitatif untuk menganalisis tantangan yang dihadapi dalam pendidikan seks pada anak usia dini dan mengidentifikasi strategi serta solusi yang efektif. Data diperoleh dari literatur yang telah dipublikasikan dalam dua dekade terakhir tentang pendidikan seks pada anak usia dini, meliputi studi, artikel ilmiah, dan laporan riset dari sumber-sumber seperti jurnal ilmiah dan buku. Sasaran penelitian ini adalah pendidik, orang tua, dan tenaga kesehatan yang terlibat dalam pendidikan seks pada anak usia dini . Metode yang digunakan adalah metode literatur review dengan menganalisis berbagai referensi dari artikel jurnal dan buku yang relevan dengan topik tersebut. Hasil analisis menunjukkan bahwa pendidikan seks pada anak usia dini memiliki peran yang signifikan dalam mencegah pelecehan seksual, mengembangkan identitas gender, dan membentuk keterampilan perlindungan diri. Strategi yang dapat diberikan dalam memberikan pendidikan seks anak usia dini mencakup penggunaan buku cerita bergambar, underwear rules program, beragam permainan interaktif, metode pembelajaran yang kreatif, dan optimalisasi program toilet training. Penelitian ini memberikan pemahaman yang lebih   dalam tentang pentingnya pendidikan seks pada anak usia
The Impact of Directors with Foreign Experience and Foreign Institutional Ownership on Tax Avoidance
Authors:   State University of Malang, Indonesia, Cahyani Widyana Rahma , Larasat Ika Putri ,   State University of Malang, Indonesia
Published: August 2024

The objective of this study is to investigate how directors with foreign experience and foreign institutional ownership affect tax avoidance in Indonesia. The samples for this study were manufacturing sector companies listed on the Indonesia Stock Exchange from 2018-2021. This study used the explanatory quantitative research method with multiple linear regression analysis. It was found that directors with foreign experience who return to Indonesia have a mindset of maximizing shareholder wealth and thus attempt to avoid taxes. Foreign institutional ownership did not have a significant impact on tax avoidance for manufacturing companies listed on the IDX from 2018-2021.
Terapia Ocupacional e saúde mental na Atenção Primária de Saúde: reflexões teórico-práticas à luz de um estudo de caso
Authors: Zacchi Farias Aline , Fornereto Alana de Paiva Nogueira , Cruz Márcia Cristina Carneiro , Ferigato Sabrina Helena
Published: August 2024

Contextualização: Esta experiência baseia-se na intervenção e formação em Terapia Ocupacional (TO) em Saúde Mental em uma Unidade de Saúde da Família (USF) localizada em um município de médio porte do interior de São Paulo. O objetivo foi compartilhar vivências de Terapia Ocupacional no acompanhamento de um caso e, a partir dele, refletir sobre as potencialidades da profissão na Atenção Básica de Saúde (ABS) voltada para as demandas de saúde mental. Análise crítica da prática: foram apresentadas em dois eixos: (1) O núcleo da terapia ocupacional na ABS, (2) As contribuições da TO para o fortalecimento da Saúde Mental na atenção primária. Considerações finais: Concluímos que parte importante dos objetivos da atenção primária (a ação territorial, a intervenção domiciliar/familiar, o vínculo, a formação e a co-gestão do cuidado e a produção de redes) são potencialmente abordadas em profundidade por meio de uma clínica que tenha nas atividades significativas sua centralidade.
Terapia Ocupacional assistida por cães para adolescente com Paralisia Cerebral
Authors: de Oliveira Figueiredo Mirela , dos Santos Gomes Ana Beatriz , Giampá Roiz Roberta
Published: August 2024

Introdução: A literatura internacional da Terapia Ocupacional indica efeitos positivos da prática da Terapia Assistida por Cães para diferentes populações com resultados no desempenho ocupacional e no engajamento. No Brasil, o conhecimento sobre o tema é ainda incipiente, especificamente para a população com paralisia cerebral (PC). Objetivo: Apresentar plano de intervenção em Terapia Ocupacional Assistida por Cães (TOAC) para adolescente com PC, relatando as atividades e o papel do cão, e identificar os benefícios conforme os resultados das avaliações pré e pós-intervenção. Método: Estudo de caso com design quase-experimental com uma adolescente de 12 anos. Coleta de dados por meio da Medida Canadense de Desempenho Ocupacional pré e pós-intervenção e observação das reações da participante. Dados analisados quantitativamente conforme procedimentos aritméticos do instrumento sendo comparados os escores pré e pós-intervenção. Resultados: Na comparação dos resultados pré e pós-intervenção sobre o desempenho e a satisfação houve uma mudança clinicamente significativa. Com base nas reações da adolescente, houve um aumento da autoestima e autoconfiança e maior uso funcional de membro superior direito para o manuseio de objetos, para a escrita e tarefas relativas à alimentação e se arrumar. Discussão: A eficácia da TOAC fundamenta-se na teoria da biofilia, no suporte social e nos efeitos positivos no sistema neuroendócrino. Conclusão: A Terapia Ocupacional Assistida por Cães se mostrou benéfica para a adolescente com PC, com o cão fomentando a motivação, o engajamento e a perseverança na realização das atividades mesmo diante de dificuldades motoras por parte da adolescente.
Fraud Detection using Cloud-Based ML
Authors:   New York Mets, USA, Soma Venkata
Published: August 2024

The present research paper focuses on analysing the fraud detection processes by using the cloud-based ML system. The current business processes are shifting from traditional to digital business operations; hence, they fetch, use, and manage crucial information online.
The SRE Playbook: Multi-Cloud Observability, Security, and Automation
Authors:   USA, Sikha Vijay Kartik
Published: August 2024

Site Reliability Engineering (SRE) is a modern practice that merges software engineering and IT operations to ensure highly reliable, scalable, and efficient systems at scale. Originally developed at Google in the mid-2000s, SRE places a strong emphasis on reliability, scalability, and efficiency, aiming to create self-managing and self-healing systems. This approach fosters a culture of safety, shared responsibility, continuous learning, and a blame-free environment. Key focus areas within SRE include observability, operations at scale, security, resilience, and cloud-agnostic requirements. SRE leverages automation, AI, and ML to enhance system robustness and proactive issue management. As SRE practices evolve, they are proving to be essential for various industries, such as finance, healthcare, and e-commerce, by offering improved service availability, reduced incident handling time, and promoting environmental sustainability. Future growth areas for SRE include edge computing, AI/ML integration, and managing hybrid and multi-cloud environments. Strong SRE teams, supported by tools and frameworks from cloud providers, bring significant value to organizations by improving user experience, increasing revenue streams, and maintaining the company's reputation.