bluuebunny/crossref_metadata_2025 huggingface dataset:
The New Chemically Resistant Material for the Invert Grouting Optimized by Secondary Raw Material
Authors: Figala Petr , Drochytka Rostislav , Černý Vit
Published: October 2021

This paper deals with the development of a new mortar, for cement-based inverse grouting, with an increased degree of chemical resistance. The aim of this work is to verify new mixtures optimized by suitable secondary raw materials. The studied parameters include selected physical-mechanical characteristics and chemical resistance of individual raw material variants is characterized by resistance to sulfate solution. The results of this work show that it is possible to increase the chemical resistance by optimizing the grouting mortar mixture with suitable secondary raw materials. The optimized mixture for the new grout will be part of a comprehensive material system for the remediation of sewers or shafts.
Prediction of Sulfate Attack Products in Portland-Limestone Cements: The Effect of Cation Type and Concentration
Authors: Sotiriadis Konstantinos , Hlobil Michal
Published: October 2021

Portland-limestone cement materials are susceptible to sulfate attack at low temperature and high humidity, because such conditions facilitate the formation of thaumasite, detriment to the structural integrity of calcium silicate hydrates (C─S─H). In this work, the effect of the cation associated with sulfates, concentration of sulfate solution, and limestone content in cement, were thermodynamically simulated. MgSO4 solution is of higher risk, degrading extensively the structural integrity of C─S─H. Although this phase is partially preserved under the effect of Na2SO4 and K2SO4 solutions, extensive expansion and thaumasite formation occur. The sulfate content of the corrosive solution and the limestone content in cement are the factors mostly intensifying the attack caused by MgSO4 and Na2SO4/K2SO4 solutions, respectively.
Use of Spongilites as Pozzolanic Additives in Cement Mortars
Authors: Vyšvařil Martin , Bayer Patrik , Žižlavský Tomáš
Published: October 2021

In this study, the utilization of two types of spongilites in various addition in cement mortars has been investigated with the purpose of exploring a new application of this natural pozzolans as cement mortar additives. The influence of the addition of spongilites on the physico-mechanical properties, frost-resistance, and microstructure of cement mortars as a function of time was studied. The results revealed that the rising proportion of spongilites in cement mortars causes increase in water retention of mortars, reduction of their bulk density, increase in porosity of mortars due to the growing predominance of capillary pores maintaining sufficient mortars strengths, and slightly increase in the frost-resistance of mortars. After initial tests, partial replacement of cement in fine-grained cement mortars with hitherto unexploited spongilites seems to be very promising. Based on the achieved results, a 20% cement replacement can be recommended as optimal.
Reflective writing: experience of first professional medical students with attitude ethics and communication module
Authors: Tikare S. N. , Dhundasi S. A.
Published: October 2021

Introduction: Teaching and learning of medical ethics, communication skills, leadership and team building skills had not received due attention in the Indian medical curriculum that we had till recently. The Medical Council of India/ Board of Governors emphasized the need for development of appropriate attitude and communication skills among the students. Thus, Attitude ethics and communication (AETCOM) module was envisaged for all phases of undergraduate medical program. Our study analyzed the response of the students to AETCOM module and their reflective writings. Materials and Methods: The study was conducted among students of 2017-18 and 2019-20 batch at a medical college in the state of Karnataka, India. It examines the response of first professional year students to AETCOM module sessions. The medical students submitted the reflective writing/ narratives, following a series of sessions on the first AETCOM module topic. The study was approved by the Institutional ethics committee. Results: The content of the narratives were analysed for the values, attitudes, roles and responsibilities of a doctor as perceived by the students using predetermined codes. A comparative analysis of the two groups yielded very usable information which could improvise the teaching–learning and assessment methods in practical implementation of AETCOM modules. Discussion: Narratives and reflective writing are important tools for learning attitudinal and ethical issues. It is a metacognitive process that creates greater understanding of self and situations and prepares for an informed future action. The MCI/ BOG envisaged AETCOM module will help students acquire necessary competence in the attitudinal, ethical and communication domains.
Human-like Response of Pig T Cells to Superagonistic Anti-CD28 Monoclonal Antibodies
Authors: Uehlein Sabrina , Ding Xin , Flößer Janina , Schmidt Selma , Steitz Julia , Bille Maya , Schnitter Florian , Baltes Steffen , Saalmüller Armin , Gerner Wilhelm , Herrmann Thomas , Frey Anna , Kerkau Thomas , Hofmann Ulrich , Beyersdorf Niklas
Published: October 2021

Because of its size, anatomical similarities, and now also accessibility to genetic manipulations, pigs are used as animal models for human diseases and immune system development. However, expression and function of CD28, the most important costimulatory receptor expressed by T cells, so far is poorly understood in this species. Using a newly generated mAb (mAb 3D11) with specificity for pig CD28, we detected CD28 on CD8+ and CD4+ αβ T cells. Among γδ T cells, CD28 expression was restricted to a small CD2+ subpopulation of phenotypically naive cells. Functionally, CD28 ligation with mAb 3D11-costimulated porcine T cells, enhanced proliferation and cytokine secretion in vitro. We used a second, likewise newly generated but superagonistic, anti-CD28 mAb (CD28-SA; mAb 4D12) to test the function of CD28 on porcine T cells in a pilot study in vivo. Injection of the CD28-SA into pigs in vivo showed a very similar dose-response relationship as in humans (i.e., 100 µg/kg body weight [BW]) of CD28-SA induced a cytokine release syndrome that was avoided at a dose of 10 µg/kg BW and below. The data further suggest that low-dose (10 µg/kg BW) CD28-SA infusion was sufficient to increase the proportion of Foxp3+ regulatory T cells among CD4+ T cells in vivo. The pig is thus a suitable animal model for testing novel immunotherapeutics. Moreover, data from our pilot study in pigs further suggest that low-dose CD28-SA infusion might allow for selective expansion of CD4+ regulatory T cells in humans.
Principal Component Analysis of the Social and Behavioral Rhythms Scale in elderly
Authors: Cossu Giulia , Agus Mirian , Atzori Laura , Aviles Gonzales Cesar Ivan , Minerba Luigi , Ferreli Caterina , Puxeddu Roberto , Orrù Germano , Scano Alessandra , Romano Ferdinando , Pintus Elisa , Penna Maria Petronilla , Carta Mauro Giovanni
Published: October 2021

Background

Changes in social and behavioral rhythms (SBR) in the elderly are related to health status. Nevertheless, there is no data on factor analysis of the Brief Social Rhythm Scale (BSRS) an internationally well-known tool in this field. The aim was to analyze, in the elderly, the factorial structure of the Italian version of BSRS.

Design and methods

Principal Component Analysis of the BSRS carried out in elderly living at home.

Results

Sample of 141 participants (83 Females, 58,9%), aged 72.3±4.8. All the items of the questionnaire were related and could compose a single factor, explaining 56% of variance. A solution adopting two factors, the first (including items 1,2,3,4,9,10), the second (including items 5,6,7,8), covered cumulatively 78.8% of the variance.

Conclusions

The study confirms that the BSRS is consistent with the idea for which it was built and can be useful for the study of the regularity of SBR in old adults.
The impact of preoperative glycated hemoglobin (HbA1c) on postoperative complications after elective major abdominal surgery: a meta-analysis
Authors: Wong Joanna K. L. , Ke Yuhe , Ong Yi Jing , Li HuiHua , Wong Ting Hway , Abdullah Hairil Rizal
Published: October 2021

Background: Diabetes is a risk factor for postoperative complications. Previous meta-analyses have shown that elevated glycated hemoglobin (HbA1c) levels are associated with postoperative complications in various surgical populations. However, this is the first meta-analysis to investigate the association between preoperative HbA1c levels and postoperative complications in patients undergoing elective major abdominal surgery.Methods: PRISMA guidelines were adhered to for this study. Six databases were searched up to April 1, 2020. Primary studies investigating the effect of HbA1c levels on postoperative complications after elective major abdominal surgery were included. Risk of bias and quality of evidence assessments were performed. Data were pooled using a random effects model. Meta-regression was performed to evaluate different HbA1c cut-off values. Results: Twelve observational studies (25,036 patients) were included. Most studies received a ‘good’ and ‘moderate quality’ score using the NOS and GRADE, respectively. Patients with a high HbA1c had a greater risk of anastomotic leaks (odds ratio [OR]: 2.80, 95% CI [1.63, 4.83], P < 0.001), wound infections (OR: 1.21, 95% CI [1.08, 1.36], P = 0.001), major complications defined as Clavien-Dindo [CD] 3–5 (OR: 2.16, 95% CI [1.54, 3.01], P < 0.001), and overall complications defined as CD 1–5 (OR: 2.12, 95% CI [1.48, 3.04], P < 0.001).Conclusions: An HbA1c between 6% and 7% is associated with higher risks of anastomotic leaks, wound infections, major complications, and overall postoperative complications. Therefore, guidelines with an HbA1c threshold > 7% may be putting pre-optimized patients at risk. Future randomized controlled trials are needed to explore causation before policy changes are made.
Evaluation of Neck Pain and Scapular Stability in Graduate Dental Students
Authors: Verma Chhaya V. , Bhosale Krutika S.
Published: October 2021

Background:

There is a high prevalence of work-related musculoskeletal disorders in dentists. The most commonly affected areas are the neck, low back, wrist, and hand. The symptoms of the musculoskeletal disorder occur during the educational and training course in dental students.

Aim:

The aim of this study was to assess neck pain and the scapular stability in graduate dental students.

Study Design:

This was an observational, cross-sectional study.

Study Setting:

This study was conducted at a dental college attached to a tertiary care hospital.

Methods:

The site of pain over the neck region (in subjects with pain) was assessed using body diagrams. Assessment of intensity of pain (if present) was done using Numerical Rating Scale, scapular posture using the pectoralis minor (PM) length test and resting scapular upward rotation using Baseline Bubble Inclinometer, dynamic scapular positioning using Lateral Scapular Slide Test, and muscle strength of scapular stabilizers using Lafayette Manual Muscle Tester. The outcome measures were compared between 1st-year undergraduate dental students (Group A) and dental interns (Group B).

Results:

Sixty-three female dental students (Group A, n = 32; Group B, n = 31) were included. There was a significant difference in the PM length test of left side (P = 0.02) and intensity of pain (right side P = 0.008, left side P = 0.003) in Groups A and B. The site of pain was over the lateral aspect of the neck and the character of pain was aching. We found no significant difference in other outcome measures.

Conclusion:

Dental students suffer from neck pain. Static scapular posture was affected, whereas the dynamic scapular stability was not affected.
Assessment of Level of Knowledge, Awareness, and Attitude toward “Basic Life Support” and “Cardiopulmonary Resuscitation” among Dental Students, Interns, and Dental Practitioners
Authors: Shete Anagha V. , Shete Mrinal V. , Kulkarni Tejas M. , Chinte Avanti D. , Nerkar Ashwini , Kshirsagar Kapil
Published: October 2021

Background:

Being healthcare professionals, the dentists should be aware of the basic and practical aspects of basic life support (BLS) and cardiopulmonary resuscitation (CPR). This study helps assess the knowledge and awareness of dental professionals toward it.

Aim:

The aim of the study is to assess the level of knowledge, awareness, and attitude toward “BLS” among dental students, interns, and dental practitioners.

Materials and Methods:

This survey-based study enrolled 70 students from 3rd-year BDS, 70 students from final-year BDS, 80 interns, and 45 dental academicians/practitioners of the dental college. A semi-structured, validated, peer-reviewed questionnaire was used with three sections – demographic data, qualification, and experience; knowledge of participants regarding BLS (26 multiple-choice questions); and awareness and attitude toward BLS (7 close-ended questions).

Results:

Surprisingly, none of the 265 participants had complete knowledge of BLS and CPR. They lacked in basic knowledge of this important lifesaving protocol. The students and interns also were unaware of basic and applied knowledge of BLS, which shows the necessity of its inclusion in BDS curriculum.

Conclusion:

The understanding of lack of knowledge and awareness about BLS and CPR is alarming. Its inclusion in curriculum, training, and periodic re-training of dental undergraduates, interns, postgraduates, academicians, and practitioners is necessary.
Case report on migraine with photophobia – Is the pupil at fault?
Authors: Moharana Ruby , Bhandari Kiran Bala
Published: October 2021

Pupillary abnormalities can be a potential cause of migraine with photophobia. A 32-year-old female developed Adie's pupil following concussion injury which triggered severe episodes of migraine with extreme photophobia. We used diluted Pilocarpine drops (0.125%) for treatment and the patient had significant improvement in MIDAS (Migraine Disability Assessment) score after treatment. This case highlights the importance of pupillary examination in cases of migraine.
Solitary fibrous tumor of the lacrimal sac
Authors: Agrawal Sahil , Rathod Aishwarya , Modaboyina Sujeeth , Sen Seema , Das Deepsekhar , Bajaj Mandeep S
Published: October 2021

Solitary fibrous tumor (SFT) is a rare spindle-cell neoplasm of mesenchymal fibroblast-like cells. A 47-year-old female, with complaints of watering with left medial canthal fullness and left failed dacryocystorhinostomy, on imaging showed homogeneous well-defined lesion extending into nasolacrimal duct with adjacent bone remodeling. Excisional biopsy showed spindle-cell tumor with cellular areas showing prominent vascular pattern. On immunohistochemistry, CD-34 was positive and Ki-67 was <5%. A diagnosis of SFT was suggested. At 6 months follow-up, the patient had no recurrences.
Orbital cellulitis and exudative retinal detachment in a case of immune thrombocytopenic purpura treated with rituximab
Authors: Panigrahi Pradeep K , Minj Anita , Satapathy Jasmita , Das Suprava
Published: October 2021

An 18-year-old female with relapsed immune thrombocytopenic purpura presented with painful swelling and loss of vision in the right eye 2 days following treatment with systemic steroids and rituximab. She was diagnosed with orbital cellulitis and exudative retinal detachment in the right eye. Following cessation of systemic therapy and institution of broad-spectrum antibiotics, there was a prompt reversal of cellulitis and exudative detachment. Ocular complications can arise following treatment with rituximab. Venous congestion and reactive edema across the sclera can lead to exudative retinal detachment in orbital cellulitis. Early diagnosis and prompt treatment are associated with a good prognosis.
A case report of probable ocular tuberculosis following biologics
Authors: Ganesh Sudha K. , Thatikonda Divya
Published: October 2021

Biological drugs, especially anti-TNF-α agents, have revolutionized the treatment of chronic immune-inflammatory diseases, however complications include reactivation of tuberculosis and increased incidence of other infections.

We report a 28-year-old male, on biological agents for HLA B27 positive spondyloarthropathy, inflammatory bowel disease and psoriasis, who presented with occlusive retinal perivasculitis. Following a thorough clinical examination and ocular and systemic investigation, a diagnosis of probable ocular tuberculosis (POTB) with tubercular retinal vasculitis (TRV) was made. Biologics were temporarily withdrawn and anti-tubercular therapy (ATT) initiated with good response. Patients on biologics need close monitoring, for ocular and systemic infections especially TB.
Management of pediatric traumatic cataract with fibrovascular downgrowth over the posterior capsule
Authors: Matalia Jyoti , Basavaraj Thirumalesh Mochi , Shah Nuti , Panmand Pratibha
Published: October 2021

Penetrating injury in children resulting in a corneal tear with associated complicated cataract can present in different ways. The presence of fibrovascular downgrowth on the posterior capsule is very unusual and has never been reported before with pediatric traumatic cataract. In this study, we describe surgical management of such a case along with its postoperative course to help achieve good visual outcome.
Sequential imaging in a case of relentless placoid chorioretinitis
Authors: Ayachit Apoorva , Joshi Madan , Yadav Nishita , Joshi Shrinivas , Ayachit Guruprasad
Published: October 2021

Relentless placoid chorioretinopathy (RPC) is a relatively rare and more severe variant of acute posterior multiple placoid pigment epitheliopathy (APMPPE) and serpiginous choroidopathy (SC). The lesions can first involve the periphery and can recur in crops over months to years, causing atrophy in healed areas, thus the term relentless or ampiginous. Literature about RPC is limited to case reports and case series. The etiology and treatment of this condition are still unclear. In this illustrative essay, we demonstrate sequential clinical, autofluorescence (AF), and optical coherence tomography (OCT) imaging findings in a case of RPC that progressed over 8 weeks to cause bilateral severe vision loss.
Transcleral local resection of an ancient intraocular schwannoma
Authors: Shanmugam Mahesh P , Sridharan Preethi , Ramanjulu Rajesh , Mishra Divyansh KC
Published: October 2021

A 24-year-old male presented to us with a slow growing, painless mass lesion in his left eye. A dome-shaped, well-defined, nontender, nodulocystic, immobile, transilluminant subscleral mass was seen in the nasal quadrant. Infiltration of ciliary body, iris, choroid, and sclera by a suprachoroidal mass of variable echogenicity was noted on B scan ultrasonography (USG). Incisional biopsy hinted toward intraocular schwanomma. Considering the infiltration seen on USG B scan, progressive increase in size, and relatively good prognosis if intervened early, a transcleral local resection was performed. Histopathology and immunohistochemistry confirmed an ancient schwannoma. Patient recovered without complications.
Delayed phacoemulsification in femtosecond laser-assisted cataract surgery
Authors: Shekhar Madhu , Muthukrishnan Gomathi R , Choudhary Payal , Kohli Piyush , Sankaranathan R , Nagu Kamatchi
Published: October 2021

A diabetic and asthmatic patient was planned to undergo femtosecond laser-assisted cataract surgery in his left eye. At the end of femtosecond procedure, he developed breathlessness due to noncardiogenic pulmonary edema. The second procedure was postponed for 3 weeks till he received fitness for undergoing further ocular surgery. The second surgery was uncomplicated. There was no corneal decompensation, exaggerated inflammation, intraocular pressure spike, diabetic retinopathy progression, or postoperative cystoid macular edema till 6 months of follow-up. Although not recommended, such a delay may be unavoidable. The delayed surgery is unlikely to compromise the surgical outcome or increase the chances of intra- or postoperative complications.
Rare ocular manifestation of papilledema and bilateral choroidal tubercles in disseminated miliary tuberculosis
Authors: Reddy Subhakar , Murthy Somasheila I , Badakere Akshay , Tyagi Mudit , Agarwal Hitesh
Published: October 2021

An 11-year-old female on treatment for miliary tuberculosis presented with decreased vision. Examination revealed bilateral disc edema, granulomatous uveitis, and multiple choroidal tubercles. Oral steroids were added. She was lost to follow-up, and 3 months later she had further visual loss due to optic atrophy. Repeat imaging of the CNS showed regression of the brain parenchymal lesions. This is a rare presentation of ocular tuberculosis in the setting of disseminated TB. While the mainstay of therapy is antitubercular therapy, this case highlights the importance of systemic corticosteroids to decrease both ocular and CNS inflammation and halt further vision loss.
Lesson to be learned
Authors: Gupta Saroj , Soni Deepak
Published: October 2021

Pediatric ocular chemical injuries constitute a true ocular emergency and require urgent evaluation and treatment. We report a case of ocular chemical burn in an 11-month-old infant following contamination of ophthalmic eye drop vial with trichloroacetic acid. The child developed superficial corneal burn which was managed successfully with a favorable outcome.
Cuticular drusen
Authors: Hansraj Saarang , Sultana Aliya , Vairagyam Rajalingam
Published: October 2021

A 30-year-old woman presented to the OPD, and during the course of her retinal examination she was seen to have multiple drusen in both the eyes. Based on her age, drusen appearance, distribution, autofluorescence, star in the sky appearance on angiography, and sub-RPE location on SD-OCT, she was diagnosed as having Cuticular drusen also called Basal laminar drusen. The perifoveal drusen had clustering and confluence with intermediate-stage AMD features. Thus, we report a rarely seen phenomenon of macular degeneration in a young woman with Cuticular drusen phenotype, which has genetic and systemic implications.
Candida Prevalence in the Saliva of Controlled and Uncontrolled Diabetic Patients – A Clinical Study
Authors: Ruchi Mehta , Sandeep K. Bains , Archana Bhatia , Nisha Dua , Sukriti Mahajan , Deepika
Published: October 2021

Context:

Diabetes mellitus is a major cause of mortality and morbidity worldwide. The health of oral tissue is related to saliva and both the composition and flow of saliva are altered in diabetic patients.

Aim:

This study aims to assess the prevalence of Candida in diabetic patients and non-diabetic controls and to assess the relationship between the candidal carriage and glycemic control, the relationship between the oral prevalence of Candida species, and clinical candidal infection, and the effect of antidiabetic therapy and smoking on candidal infection.

Settings and Design:

This cross-sectional population-based study was conducted on 100 diabetic and 50 non-diabetic (control) patients.

Methods and Material:

Saliva samples were collected and the concentrated oral rinse technique was used for quantitative oral candidal isolation. A digital colony counter enumerated several candidal colonies on each plate.

Statistical Analysis Used:

Chi-square test and Mann–Whitney test are used.

Results:

Colony-forming units (CFU/ml) in diabetics were 3131.14 and in control was 986.8. Out of 55 diet control patients, 30 had a candidal carrier; out of 44 patients on oral hypoglycemic, 30 had candidal carrier; and out of 1 patient on insulin, 1 had a candidal carrier. Out of 19 diabetics (good control), 8 had candidal carrier; out of 28 (moderate control), 12 had candidal carrier; and out of 53 (poor control), 41 had a candidal carrier. Out of 14 smokers, 8 had candidal carriers, and out of 36 nonsmokers, 11 had candidal carriers.

Conclusions:

Diabetic patients carry a higher number of candida in their oral cavity.
Hidden Pathologies of Maxillary Sinus using CBCT Scans
Authors: Sanaullah Md , Sinha Abhishek , Srivastava Sunita , Mishra Anuj , Singh Yakshi , Basu Shalini
Published: October 2021

Introduction:

Diagnosis of orofacial pathologies is difficult with the 2 dimensional (2D) images taken from conventional radiography. Cone-beam computed tomography (CBCT) has been developed with 3 dimensional (3D) modalities and has become a better alternative to conventional radiography. Highre solution axial, coronal, and sagittal sections are the most revealing, noninvasive techniques for assessing the maxillary sinus anatomical variations, pathology, and its adjacent structures and areas.

Aim:

This study aimed to analyze the prevalence of pathological changes in the maxillary sinus of asymptomatic cases using CBCT for diagnostic purposes.

Materials and Methods:

This study was evaluated among 200 patients for hidden pathologies in the maxillary sinus. Pathological findings were categorized as a mucosal thickening, polypoid mucosal thickening, radiopacification, and no pathological findings.

Results:

In the present study, the overall prevalence of the mucous retention cyst was found to be 30.25%, the polyp was 4.25%, the mucocele was 0.50%, and the overall mucosal thickenings was 35%.

Conclusions:

In our study, the mucosal thickening has a very high rate of incidental maxillary sinus pathologies in asymptomatic patients. Therefore, a detailed three-dimensional imaging using CBCT is stated in most patients for proper treatment planning. A careful review of the entire CBCT scans is essential to avoid under-or overestimation of potential complications in providing comprehensive health care.
Analysis of Downregulated Salivary Proteins in Oral Submucous Fibrosis – A Quantitative Proteomic Pilot Study
Authors: Babu Anu , Chatra Laxmikanth , Shenoy Prashanth
Published: October 2021

Background:

Oral submucous fibrosis (OSMF) is a chronic debilitating disease of the oral cavity which is strongly associated with chewing of areca nut. The rate of malignant transformation varies between 3% and 19%. As oral lesions are in direct contact with saliva, the altered composition of saliva has shown promising results in surveillance of malignant transformation. Aim: To do quantitative proteomic profiling of saliva in OSMF and to study the downregulated proteins.

Methodology:

Quantitative proteomic profiling was carried out using Liquid chromatography with Tandem mass spectroscopy (LC–MS/MS) on saliva obtained from patients with OSMF.

Results:

A total of 172 proteins were identified in saliva samples. Five proteins were downregulated in the samples (fold change average of disease vs. control ratio ≤0.6).

Conclusion:

Downregulated proteins could serve as potential biomarkers in the early detection of malignant transformation in OSMF.
Pregraduation Online Curriculum Delivery of Internal Medicine Course during the COVID-19 Pandemic
Authors: Aljarallah Salman , Bedaiwi Mohammed , Alrashed Rashed , Omair Mohammed A. , Soliman Mona , Alfadda Assim A.
Published: October 2021

Background:

The COVID-19 pandemic has challenged medical education and resulted in a rapid and unexpected global shift toward online education. The study presents the experience of the College of Medicine of King Saud University in delivering a comprehensive internal medicine course for final-year medical students, which includes the implementation of novel methods of assessment.

Methods:

A 2-week revision of the internal medicine course was conducted for 70 pregraduation medical students. Lectures and focused case-based tutorials were conducted online. Novel assessment methods included brief written essays summarizing the tutorials, open-book short-answer question (SAQ) examination, and a virtual standardized oral examination (vSOE). A questionnaire was sent to the students (n = 70) on the contents of the course, clarity of objectives, duration, and online platform.

Results:

The response rate was 99.3%. Students scored higher in the SAQs compared with traditional multiple-choice tests (mean score: 92.3% vs. 69.8%). The vSOE was efficient, and grades were comparable to traditional objective structured clinical examination. The majority of students (93%) reported the scientific content as good or excellent, whereas approximately 30% found the course goals lacked a clear description. The majority (76%) found the course length appropriate, and 94% reported the online platform installation and operation easy or very easy.

Conclusions:

The comprehensive online internal medicine course was successfully delivered to pregraduation students. Innovative online examination methods can be a reasonable alternative in the case of lockdown. This modality of teaching and assessment was considered useful and met the expectations of students.
Coronary Angiographic Characteristics of Type 2 DM Compared with Nondiabetic Patients in Benghazi-Libya. A Cross-Sectional Study
Authors: Bettamer Zaki , Elkadiki Abdelhadi H. , Alsaeiti Khaled D.
Published: October 2021

Background/Aim:

The absolute risk of death due to coronary artery disease (CAD) is two to five times higher in patients with diabetes than in those without diabetes regardless of the cholesterol concentration, and females with diabetes have the worst prognosis. The aim of the current study was to investigate the angiographic severity and extent of CAD in patients with Type 2 diabetes mellitus, compared with nondiabetic patients.

Patients and Methods:

A hospital-based retrospective cross-sectional study was performed on 340 patients who were diagnosed with CAD. The two groups were matched for age, gender, and other major risk factors. Data collected include demographic data, distribution, and extent of coronary artery involvement.

Results:

Three hundred and forty patients were included in the study, 175 of them (51.4%) were diabetics, and 165 (48.5%) were nondiabetics, comparing coronary angiographic results of both groups: One hundred and twenty-six patients (73%) of the diabetic patients have multivessel diseased (P = 0.003), 49 patients (27%) have a single-vessel diseased and none of them have a normal coronaries (0%). While for the nondiabetic patients 82 (50%) of them have a multivessel diseased, 63 patients (38%) have a single-vessel diseased, and 20 patients (12%) have normal coronaries.

Conclusion:

Multivessel disease with diffuse lesion is more prevalent among diabetic Libyan patients compared with nondiabetics. The affected vessels in diabetic patients are diffusely diseased more than nondiabetic.
Lower Gastrointestinal Endoscopy
Authors: Ashour Guheina A. R. , Muftah Abir A , Gheryani Nabeia A
Published: October 2021

Background:

Histopathological examination of endoscopic biopsy specimens support diagnosis, monitoring the course of the diseases and recognize complications. The aim of this study was to determine the type and frequency of histopathological change in colonic biopsies and its correlations with age and sex.

Materials and Methods:

Two hundred and fifty-eight colonic biopsies were collected from January 2016 to December 2017. The tissue was subjected to histopathological examination, the data collected and statistically analyzed.

Results:

Neoplastic colonic lesions form 52% and nonneoplastic form 48%. Cases of adenocarcinoma form 39.1%, nonspecific colitis form 29.1%, adenoma form 12.8%, ulcerative colitis was seen in 7.4% of cases, hyperplastic polyps form 6.2%, and Crohn's disease from 5.4%. Most of adenocarcinomas were moderately differentiated, the grade was higher in females (P = 0.032). Most of nonspecific colitis cases showed mild inflammation. Most of the adenomas were tubular type. More than 90% of neoplastic lesions were in patients above 40 years and 45.5% of inflammatory bowel disease (IBD) cases were present in the age group of between 20 and 39 years (P = 0.001). Most of the cases of adenomas were seen in the age group between 40 and 80 years and (P = 0.018)

Conclusion:

Adenocarcinoma is the most frequent abnormality, mainly above 40 years of age. IBDs were seen below 40 years of age. In general, in all lesions, males were more affected than females except in cases of IBD and moderately differentiated adenocarcinoma.
Assessment of Adherence to Antiretroviral Therapy, Associated Factors, and Relationship to CD4 Cell Count Recovery among HIV-Positive Adolescents
Authors: Ogbuefi Nonso Anthony , Ugochukwu Ebelechuku Francesca , Onubogu Chinyere Ukamaka , Edokwe Emeka Stephen , Okeke Kenneth Nchekwube
Published: October 2021

Background:

Adherence to antiretroviral therapy (ART) in HIV-positive adolescents (HPAs) is an enormous challenge in pediatric HIV management. Suboptimal adherence (OA) encourages treatment failure and HIV transmission. Several factors are inimical to OA, among HPA.

Objective:

The factors which influence adherence to ART in HPA accessing care in Nnewi, Nigeria, were determined.

Subjects and Methods:

One hundred and fifty HPAs, aged 10–19 years, who had been on ART for at least 6 months were recruited; 75 each for groups 10–14 and 15–19 years. Sociodemographic data were collected using interviewer-administered questionnaires. Relevant clinical data were retrieved from medical records, and current CD4 cell counts assayed.

Results:

There were 77 males and 73 females. OA to ART was defined as intake of ≥95% of antiretrovirals over a given period. Using pill count (PC), 74.7% (112/150) had OA. Using the preceding 28-day self-report (P28DSR), 84.0% (126/150) had OA, while for the preceding seven-day self-report (P7DSR), it was 89.3% (134/150). Factors significantly associated with sub-OA were tertiary education, missed clinic visits, travel time to facility ≤1 h, persistent feeling of sadness, and fear of death. Subjects with OA had a significantly higher rate of CD4 cell count recovery compared to those having sub-OA.

Conclusion:

Sub-OA is common in HPA and can be assessed with a combination of PC and preceding P28DSR, in resource-poor settings. As OA is crucial to CD4 cell count recovery, the latter can be useful in monitoring adherence in HPA.
Predictors of Anemia in Type 2 Diabetes Mellitus Without Renal Disease
Authors: Yorke Ernest , Barnes Nana Ama , Akpalu Josephine , Boafo Eunice , Amoah Albert G. B.
Published: October 2021

Background:

Among type 2 diabetes mellitus (T2DM) patients without renal disease, hemoglobin levels tend to be lower than their counterparts without diabetes mellitus with a similar estimated glomerular filtration rate. Low hemoglobin levels have been associated with increased morbidity.

Objective:

We sought to determine the predictors of anemia among T2DM patients without renal disease attending the diabetes center at a tertiary teaching hospital in Accra, Ghana.

Materials and Methods:

One hundred and ninety-five type 2 diabetes patients aged 35 years and above without overt nephropathy and 184 controls without diabetes were recruited from the National Diabetes Management and Research Center and Orthopedic Outpatients Clinic of the KBTH, respectively. Both groups had full blood count, red cell indices, serum creatinine, and glycated hemoglobin determination as well as medical history and anthropometric measurements.

Results:

Seventy-nine percent of cases and 75.5% controls were females. The prevalence of anemia among participants with diabetes mellitus was 53.1% compared with 20.5% among controls (P = 0.00). In both groups, more males than females were anemic (68.3% cases, 51.1% controls). The mean duration of diabetes was 9.6 ± 6.22 years among the cases. Logistic regression revealed male gender and diabetes duration >10 years as significant predictors of anemia without renal disease in individuals with T2DM.

Conclusion:

The prevalence of anemia among T2DM participants without overt renal disease was two and half times the rate in control participants without diabetes mellitus. Physicians would be aware and take appropriate steps to identify and manage it to reduce associated morbidity.
Pattern of Diabetic Retinopathy in a Tertiary Healthcare Facility in Southern Nigeria
Authors: Agweye Chineze Thelma , Ibanga Affiong Andem , Udoh Martha-Mary Ekong , Enang Ofem E , Nwajei Anthony Ikechukwu , Nkanga Dennis George
Published: October 2021

Objective:

The objective is to determine the pattern and prevalence of diabetic retinopathy (DR) among patients living with diabetes mellitus.

Methodology:

Descriptive cross-sectional study in a tertiary hospital. Questionnaires were used to obtain data from eligible participants. Visual acuity measurement, fundal examination, and photography were performed together with fasting blood glucose and glycated hemoglobin A1c. The Statistical Package for Social Sciences (SPSS) for Windows version 20 was used for data analysis.

Results:

Overall 200 patients were enrolled of which 75.5% were female. The participant's mean age was 53.8 ± 11.7 years. DR was present in 53/200 (26.5%) of participants, of which 52 (98.1%) had nonproliferative DR (NPDR), and 1 (1.9%) had proliferative DR (PDR). NPDR was mild in 44/53 (83.0%) and moderate in 8/53 (15.1%) patients. Evidence of sight-threatening DR was found in 37/200 (18.5%) of participants (36 had diabetic macular edema and 1 had PDR + DMO).

Conclusions:

DR was present in 26.5% of the study participants, and 18.5% had sight-threatening DR mainly due to DMO. This finding underscores the need for routine screening of all people living with diabetes to detect early DMO and provide treatment to prevent visual loss.
Prevalence and Predictors of Gaming Disorder among Undergraduate Medical Students in Enugu, Nigeria
Authors: Chime Onyinye H. , Chinawa Awoere T. , Nduagubam Obinna O.
Published: October 2021

Objective:

The objective of the study was to determine the factors and predictors of gaming disorder among medical students in Enugu, Nigeria.

Methods:

A cross-sectional study design involving undergraduate medical students in Enugu. Addiction to video games was measured using a Video game Addiction Test. This was used to obtain information from 400 respondents.

Results:

Addiction to video games was recorded in 158 students (39.5%). On both bivariate analyses, gender and academic level were associated with being addicted to video games while on the multivariate analysis being male (adjusted odds ratio [AOR] = 3.95, confidence interval [CI] = 2.52–6.20) in 300 academic levels and below (AOR = 2.03, CI = 1.29–3.19) and sponsorship were predictors.

Conclusion:

The majority of students in this study are not addicted to video games. Being males predicted video game addiction. Since this disorder is yet to be fully explored in this setting, there is a need for health-care workers to create awareness about the effects and means to mitigate against the disorder in this setting. Further research is needed on the physical and psychological health effects of this form of addiction on the players.
Postgraduate Career and Emigration Intentions
Authors: Ezeike Azuka Chinweokwu , Ebong Akanimo Onaolapo
Published: October 2021

Background:

Postgraduate career decisions and emigration intentions of medical graduates determine the quality of a nation's health system. Evaluating these choices help in developing evidence-based health plans and reforms.

Objective:

The aim of this study was to evaluate the postgraduate career and emigration intentions of House Officers in National Hospital Abuja.

Methodology:

This was a cross-sectional study of postgraduate career and emigration intentions of medical interns done in National Hospital Abuja from June to July 2020. Using a structured questionnaire, information was obtained on the sociodemographic data, undergraduate and internship experience, postgraduate career intention, specialty preference, and emigration intentions of the interns. Data were analyzed with SPSS version 23.

Results:

A total of 90 questionnaires were distributed with a 76% response rate. The mean age of the respondents was 26.23 ± 1.77 years with mean internship duration of 10.51 ± 1.58 months. Most were single 63 (91.3%) and 44 (63.8%) were females. While 52 (75.4%) opted to specialize, 50 (78.1%) had intention to emigrate. Surgery (32.7%) and obstetrics and gynecology (28.9%) were the most commonly desired specialties. Personal interest was the greatest determining factor for specialty choice (90.4%), while better working conditions were the most commonly reported driving force for emigration (51.6%), and the United Kingdom (52%) was the most commonly desired emigration destination.

Conclusion:

A high number of respondents had interest in specialization with a greater interest in the surgical specialties. Most also had the intention to immigrate to Western countries with the United Kingdom as the most preferred destination.
Clinical Presentation of COVID-19-Positive and -Negative Patients in Lagos Nigeria
Authors: Adejumo Olusola Adedeji , Ogunniyan Tope , Adesola Sunday , Gordon Igbodo , Oluwadun Oluwayemisi Bamidele , Oladokun Oluwaseun David , Abdulsalam Ismail Adeshina , Falana Ayodeji Anthony , Anderson Omolebi Shina , Anumah Alphonsis , Dawodu Olusola Taiwo , Owuna Henry John , Osoba Efunshade Ganiat , Disu Ahmed Ola-Ayinde , Adetola Adeife Valentina , Oloniniyi Nifemi Bukola , Fadoju Patrick Kayode , Ogunsanya Ayodele Oloruntoba , Osundaro Oluwatomilola Aanuoluwapo , Bowale Abimbola
Published: October 2021

Background:

A lot has been documented about the pathophysiology and clinical presentation of coronavirus disease 2019 (COVID-19). We compared the clinical features of real-time reverse transcriptase polymerase-chain-reaction (RT-PCR) confirmed COVID-19 positive and negative patients admitted in Lagos State.

Methods:

Medical records of all patients admitted in 15 isolation centres across Lagos state between 27th February 2020 and 30th September 2020, were abstracted and reviewed. We compared the clinical features, co-morbidities and clinical outcomes of COVID-19 positive and negative patients.

Results:

A total of 3157 records of patients admitted in 15 isolation centres in Lagos State were reviewed of which 302 (9.6%) tested negative to RT-PCR COVID-19. There was no gender difference between COVID-19 positive and negative patients (P = 0.687). The average age of the negative patients was higher (46.8 ± 18.3 years) than positive patients (41.9 ± 15.5 years) (P < 0.001). A higher proportion of the COVID-19 negative patients had co-morbidity (38.1% vs. 27.8%), were symptomatic (67.5% vs. 44.6%) and higher mortality (21.9% vs. 6.6%) than positive patients (P < 0.001). The percentages with hypertension (26.2% vs. 21.0%, P = 0.038), diabetes (17.2% vs. 9.4%, P < 0.001), cardiovascular disease (2.3% vs. 0.9%, P < 0.029) and cancer (2.3% vs. 0.5%, P < 0.002) were more among patients without COVID-19. More patients without COVID-19 presented with fever (36.1% vs. 18.8%), cough (33.7% vs. 23.1%) and breathlessness (40.8% vs. 16.1%) than the positive patients (P < 0.001).

Conclusion:

Anosmia and dysgeusia were strongly associated with COVID-19. Clinical decision-making should only be used to prioritise testing and isolation of patients suspected to have COVID-19, especially in settings with limited access to diagnostic kits.
On the Stokes Geometry of Perturbed Tangential Pearcey Systems
Authors: Hirose Sampei , Kawai Takahiro , Sasaki Shinji , Takei Yoshitsugu
Published: October 2021

In this paper we investigate the Stokes geometry of a perturbed tangential system of the Pearcey system to a hyperplane, in particular, the effect of a new kind of virtual turning point of the system that originates from its multiple-characteristic property at a non-hereditary turning point. We also study the activity of Stokes curves of the system by using the exact steepest descent method.
Versal Unfolding of Irregular Singularities of a Linear Differential Equation on the Riemann Sphere
Authors: Oshima Toshio
Published: October 2021

For a linear differential operator

P

on

\mathbb{P}^1

with unramified irregular singular points, we examine a realization of

P

as a confluence of singularities of a Fuchsian differential operator

\widetilde{P}

having the same index of rigidity as

P

, which we call an unfolding of

P

. We conjecture that this is always possible. For example, if

P

is rigid, this is true and the unfolding helps us to study the equation

Pu=0

.
Global Health Education during the COVID-19 Pandemic: Challenges, Adaptations, and Lessons Learned
Authors: Krohn Kristina M. , Sundberg Michael A. , Quadri Nasreen S. , Stauffer William M. , Dhawan Adriana , Pogemiller Hope , Tchonang Leuche Viviane , Kesler Sarah , Gebreslasse Tsige H. , Shaughnessy Megan K. , Pritt Bobbi , Habib Alma , Scudder Beth , Sponsler Sarah , Dunlop Stephen , Hendel-Paterson Brett
Published: October 2021

Global health education programs should strive continually to improve the quality of education, increase access, create communities that foster excellence in global health practices, and ensure sustainability. The COVID-19 pandemic forced the University of Minnesota’s extensive global health education programs, which includes a decade of hybrid online and in-person programing, to move completely online. We share our experience, a working framework for evaluating global health educational programming, and lessons learned. Over the decades we have moved from a predominantly passive, lecture-based, in-person course to a hybrid online (passive) course with an intensive hands-on 2-week requirement. The pandemic forced us to explore new active online learning models. We retained our on-demand, online passive didactics, which used experts’ time efficiently and was widely accessible and well received. In addition, we developed a highly effective synchronous online component that we felt replaced some of the hands-on activities effectively and led us to develop new and innovative “hands-on” experiences. This new, fully online model combining quality asynchronous and synchronous learning provided many unanticipated advantages, such as increasing access while decreasing our carbon footprint dramatically. By sharing our experience, lessons learned, and resources, we hope to inspire other programs likewise to innovate to improve quality, access, community, and sustainability in global health, especially if these innovations can help decrease negative aspects of global health education such as its environmental impact.
Hybrid Powered Vehicles
Authors:   American Honda Motor Co. Inc., German John M
Published: October 2021

Increased concern with global warming and energy security renewed interest in hybrid vehicles. This report explores the basis of hybrid components and system engineering, and then delves into the design constraints, challenges and opportunities. Hybrid Powered Vehicles concludes with an expert's outlook on developments in the technology, its applications and potential markets.
An Enduring Path for National Unity and Human Rights Protection in Ethiopia: A Case for Human Dignity Centered Constitutional Design and Interpretation
Authors: Gelaye Tsega Andualem
Published: October 2021

Ensuring National Unity and upholding Human Rights have always been a big challenge in Ethiopia, since the establishment of the modern Ethiopian state. These problems are still troubling the country, long after the adoption of the present Federal Democratic Republic of Ethiopia (FDRE) Constitution, which is claimed to have addressed them once and for all. This article seeks to revisit the historical underpinnings of the FDRE Constitution and its ethnic-centered design, in relation to its actual capacity to achieve national unity and adequate protection of human rights. The article demonstrates how human dignity centered constitutional design and interpretation could advance both national unity and adequate protection of rights. It argues that the historical foundation of the FDRE Constitution and the design that came out of it is backward looking, exclusionary and inadequate to address both challenges for a number of reasons. As a possible alternative, it proposes a human dignity centered re-reading of history, constitutional design and interpretation. Since Ethiopia is in a process of reform in various spheres, the issues raised and discussed in the article deserve serious attention as they are essential to move forward.