bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluación del ambiente educacional en las residencias del Hospital del Niño Dr. José Renán Esquivel de Panamá, 2023.
Authors: Diaz Atencio Virginia , McCarthy Waith Florencio A. , Lagrutta Silvestri Francisco
Published: August 2024

Objetivo Evaluar el ambiente de aprendizaje, del programa de formación de posgrado en pediatría y subespecialidades del Hospital del Niño Dr. José Renán Esquivel utilizando el cuestionario Postgraduate Hospital Educational Environment Measure (PHEEM). Método Estudio observacional, analítico, trans­versal. Resultados: Se aplicó el cuestionario a 46 (94%) de los 49 sujetos elegibles, 36 (78.2%) del sexo femenino. La edad promedio de los sujetos fue de 30.4 años ± 2.28 años con una mínima de 24 años y máxima de 34 años. Cuatro (8.6%) corresponden a residentes de primer año, 25 (54%) de segundo año, 9 (19%) de tercer año y 8 (17%) residentes de cuarto y quinto año. El resultado global del cuestionario fue de 97.80± 17.76 que indica un ambiente educacional más positivo que negativo con espacio para mejorar. El dominio de percepción de autonomía resultó en 35.58 ± 6.34 indicando una percepción más positiva del trabajo de cada uno, para percepción de la calidad de enseñanza fue de 36.84 ±7.89 indicando que está encaminado en la dirección correcta. La percepción de respaldo social fue de 25.36 ± 5.10 con más pros que contras. Se obtuvo una diferencia estadísticamente significativa según el año de residencia tanto en el global (p= 0.0003), autonomía (p= 0.0164), enseñanza (p= 0.001) y apoyo social (p= 0.0128), con resultados mayores en el grupo de residentes de 4to y 5to año. No hubo diferencias significativas según universidad de procedencia, centro de internado ni según sexo. Conclusiones: El PHEEM es un instrumento confiable y fácil de administrar, permite valorar el ambiente educacional en el que se desarrolla un programa de entrenamiento en un contexto asistencial.
Virus Sincicial Respiratorio , la tarea pendiente
Authors: Castaño Guerra Elizabeth
Published: August 2024

Según datos del Servicio de  Epidemiología del Hospital del Niño Doctor José Renán Esquivel (Panamá),  en los últimos 3 años, el VRS ha sido causante del 4.7 al 10.5% de todas las admisiones , siendo el 61% de los casos en menores de 1 año; la letalidad para el 2023 fue del 1.2%. Mientras, hasta agosto de 2024 hay confirmados  514 casos hospitalizados de VRS  y 10 defunciones ( letalidad +/-1.9%)
Development of Fibre Enriched Pasta from Brow
Authors: Swarnalatha A. , Haridas V Megha
Published: August 2024

I recently came across some interesting information about the growing popularity of millets among millennials. Brown top millets, in particular, have gained attention for their gluten-free, nutrient-dense properties and are cultivated in dry regions of India and other parts of the world. Similarly, Rajma, a crop that originated in the Indian subcontinent, is grown for food production and as a forage and cover crop. It is an excellent source of protein and is used in various food products for its therapeutic benefits. To combat nutrient- deficient diets and malnutrition, Fibre Enriched Brown Top Millet Pasta (FBTP) was developed by incorporating Brown top Millet (40%, 60%, and 80%), rajmah pulses flour (40%, 60% and 100%) grape skin powder (10% and 20%). The FBTP had a higher amount of antioxidant capacity and improved functional and nutraceutical properties. Overall, this presents a great opportunity for utilizing these crops in food products and reaping their many benefimethod's
The Pauli problem and wave function lifting: reconstruction of quantum states from physical observables
Authors: Zheng Hao
Published: August 2024

In this paper we consider the problem to determine a unique quantum state from given distribution of position (density) and momentum density of particles, namely the so called Pauli problem in quantum physics. In the first part, we will review the method of wave function lifting developed in [4,5] to construct a complex wave function $ \psi\in H^s({{\mathbf R}}^d) $, $ s = 1, 2 $, associated to given density and momentum density. The second part is focused on the dynamical version of the wave function lifting, namely we study the relation between solutions to quantum fluid models and wave functions solving the nonlinear Schrödinger equation. The uniqueness of the lifted wave function is essentially related to the structure of vacuum regions of the position density.
CD146 MOLECULE EXPRESSION IN B CELLS ACUTE LYMPHOBLASTIC LEUKEMIA (B-ALLs): A FLOW- CYTOMETRIC MARKER FOR AN ACCURATE DIAGNOSTIC WORK-UP
Authors: Laganà Alessandro , Totaro Matteo , Bisegna Maria Laura , Elia Loredana , Intoppa Stefania , Beldinanzi Marco , Matarazzo Mabel , Di Trani Mariangela , Costa Alessandro , Maglione Raffaele , Mandelli Biancamaria , Chiaretti Sabina , Martelli Maurizio , De Propris Maria Stefania
Published: August 2024

Background: B-lineage acute lymphoblastic leukemias (B-ALL) harboring the t(9;22)(q34;q11)/BCR::ABL1rearrangement, represent a category with previously dismal prognosis whose management and outcome dramatically changed thanks to the use of tyrosine kinase inhibitors (TKIs) usage and more recently full chemo-free approaches. The prompt identification of these cases represents an important clinical need.
Objectives: We sought to identify an optimized cytofluorimetric diagnostic panel to predict the presence of Philadelphia chromosome (Ph) in B-ALLs cases by the introduction of CD146 in our multiparametric flow cytometry (MFC) panels. 
Methods: We prospectively evaluated a total of 245 cases of newly diagnosed B-ALLs with a CD146 positivity threshold >10% referred to the Division of Hematology of ‘Sapienza’ University of Rome. We compared results of CD146 expression percentage and its mean fluorescence intensity (MFI) between Ph+ ALLs, Ph-like ALLs and molecularly negative ALLs.
Results: Seventy-nine of the 245 B-ALL cases (32%) did not present mutations at molecular testing, with 144/245 (59%) resulted Ph+ ALL and 19/245 (8%) Ph-like ALLs. Comparing the 3 groups we found that: Ph+ B-ALL were characterized by higher expression percentage of myeloid markers such as CD13, CD33 and CD66c and low expression of CD38; Ph+ B-ALL showed a higher CD146 expression percentage  and MFI when compared with both molecular negative B-ALL and Ph-like ALLs; neither the mean percentage of CD146 expression neither CD146 MFI were statically different between molecular negative B-ALL and Ph-like ALLs.
Conclusions: Our data demonstrate the association between CD146 expression and Ph+ B-ALLs. CD146 along with myeloid markers may help to identify a distinctive immunophenotypic pattern, useful for rapid identification in diagnostic routine of this subtype of B-ALLs that benefits from a specific therapeutic approach.
UPDATE ON CYTOMEGALOVIRUS INFECTION MANAGEMENT IN ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANT RECIPIENTS.
Authors: Piñana José Luis , Giménez Estela , Vázquez Lourdes , Marcos María Ángeles , Guerreiro Manuel , Duarte Rafael , Pérez Ariadna , De Miguel Carlos , Espigado Ildefonso , González-Vicent Marta , Suarez-Lledó María , García-Cadenas Irene , Martino Rodrigo , Cedillo Angel , Rovira Monserrat , De la Cámara Rafael , Navarro David , Solano Carlos
Published: August 2024

Background: Cytomegalovirus (CMV) infection is a common complication following allogeneic hematopoietic stem cell transplantation (allo-HSCT) and in patients receiving novel hematological therapies. Its impact on morbidity and mortality necessitates effective management strategies. Despite recent advances in diagnostics and treatment, unresolved questions persist regarding monitoring and treatment, prompting the need for updated recommendations.
Methods: A consensus was reached among a panel of experts selected for their expertise in CMV research and clinical practice. Key clinical areas and questions were identified based on previous surveys and literature reviews. Recommendations were formulated through consensus and graded using established guidelines.
Results: Recommendations were provided for virological monitoring, including the timing and frequency of CMV DNAemia surveillance, especially during letermovir (LMV) prophylaxis. We evaluated the role of CMV DNA load quantification in diagnosing CMV disease, particularly pneumonia and gastrointestinal involvement, along with the utility of specific CMV immune monitoring in identifying at-risk patients. Strategies for tailoring LMV prophylaxis, managing breakthrough DNAemia, and implementing secondary prophylaxis in refractory cases were outlined. Additionally, criteria for initiating early antiviral treatment based on viral load dynamics were discussed.
Conclusion: The consensus provides updated recommendations for managing CMV infection in hematological patients, focusing on unresolved issues in monitoring, prophylaxis, treatment, and resistance. These recommendations aim to guide clinical practice and improve outcomes in this high-risk population. Further research is warranted to validate these recommendations and address ongoing challenges in CMV management with emerging antiviral combinations, particularly in pediatric populations.
Feasibility and outcome of first-line autotransplant-based treatment in newly diagnosed multiple myeloma patients aged > 65 years: monocentric retrospective real-world analysis
Authors: Stefanoni Paola , Galli Monica , Paris Laura , Rambaldi Alessandro , Pittalis Nicola , Cavallaro Gianluca , Pavoni Chiara
Published: August 2024

We performed a monocentric, retrospective real-world analysis (RWA) to evaluate the feasibility and the main results of an autologous stem cell transplantation (ASCT)-based program in a cohort of 90 newly diagnosed multiple myeloma patients aged > 65 years who were deemed eligible to such program on the basis of a simplified frailty score. Seventy-six patients received at least one ASCT and 14 patients received also the second. Median progression-free survival was 42 months and overall survival was 84 months. These results compare well with those of other RWAs, and pave the way to further improvements upon incorporation of an anti-CD38+ monoclonal antibody in the ASCT programs.
EFFECTS OF DARATUMUMAB ON HEMATOPOIETIC STEM CELLS IN PATIENTS WITH MULTIPLE MYELOMA WHO ARE PLANNED TO RECEIVE AUTOLOGOUS TRANSPLANTATION: WHAT’S THE RELEVANCE?
Authors: Musto Pellegrino , Sgherza Nicola
Published: August 2024

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Perspectives of practitioners on support for caregivers of children with intellectual disability
Authors: Molefe Lebogang L. , Sehularo Leepile A. , Koen Daleen M.
Published: August 2024

Background: Children with profound intellectual disabilities are unable to do anything for themselves and require full-time care in healthcare facilities. While caring for children, secondary caregivers become overwhelmed. Coupled with little or no support, the overwhelming work affects their psychological, social and financial well-being. Mental healthcare practitioners have perspectives on conditions under which secondary caregivers work and how can they be supported. Little is known about such perspectives.Objectives: This study aims to explore and describe the perspectives of mental healthcare practitioners regarding the conditions under which secondary caregivers of children with profound intellectual disabilities work and how can they be supported.Method: A qualitative-exploratory-descriptive and contextual research design was adopted using a non-probability purposive sampling technique. This study was conducted in Gauteng province. Semi-structured individual interviews were performed to collect data. Content data analysis and ATLAS.ti were used to analyse the data.Results: Knowledge and skills development, stress reduction, resources and motivation were themes that emerged.Conclusion: This study explored and described the perspectives of mental healthcare practitioners regarding the conditions under which secondary caregivers of children with profound intellectual disabilities work and how can they be supported. If implemented, perspectives can improve the holistic well-being of secondary caregivers.Contribution: This study broadened an understanding of how secondary caregivers can be supported. Future researchers can use study results to develop programmes, intervention strategies and frameworks to support secondary caregivers.
A positive story of exciting opportunities offered by SANParks Cultural Heritage Management
Authors: Sello Hapiloe
Published: August 2024

No abstract available.
Critical analysis of drivers of employee engagement and their impact on job performance
Authors: Al-Haziazi Mohammed
Published: August 2024

Orientation: This study examines the impact of drivers of employee engagement on job performance and investigates the relationship between employee engagement and job performance.Research purpose: The purpose of this study is to assess how various factors, such as job characteristics, organisational support, support from superiors, rewards, recognition, and organisational justice, influence employee engagement and subsequently affect job performance.Motivation for the study: The researcher is motivated by the need to understand the drivers of employee engagement and their implications for job performance in organisations, particularly in the context of the Sultanate of Oman.Research approach/design and method: The study was conducted based on a closed-ended questionnaire across various industries in the Sultanate of Oman, focusing on three levels of management: junior, middle, and senior. Non-probability convenience sampling was utilised. The study employed models of drivers leading to employee engagement and assessed their impact on job performance.Main findings: The study reveals that drivers of employee engagement significantly affect job performance across all levels of management. Job characteristics and rewards and recognition emerged as strong predictors of job performance.Practical/managerial implications: Organisations are encouraged to prioritise the development and nurturing of employee engagement, fostering a two-way relationship between employers and employees. Engaged employees contribute to higher retention rates, increased productivity, profitability, growth, and customer satisfaction.Contribution/value-add: This study provides valuable insights into the relationship between employee engagement and job performance in the Sultanate of Oman, offering guidance for the development of effective employee engagement strategies aimed at improving organisational outcomes.
Proverbs 31:10–31: An antithesis of pre-exilic Hebrew womanhood?
Authors: Nyarko-Mensah Paul , Human Dirk J.
Published: August 2024

The priests and scribes were familiar with the process of applying a manuscript or prophecy to a current context to produce relevant material for the era. It is most probable that the scribes and/or priests during the post-exilic Persian period reinterpreted the prophecies of Isaiah and Amos against the moral and social decay of the women of the Hebrew nation during the 8th century BCE to create an antithesis of that situation in the form of the virtuous woman of Proverbs 31:10–31. The similarity of words in the poem and the writings of Ezra could suggest that Ezra might have had a hand in the writing or editing of the poem in Proverbs 31:10–31.Intradisciplinary and/or interdisciplinary implications: The study brings Old Testament and Ancient Near Eastern studies together, with both elucidating each other.
Die Stellenbosche Heyns: Nagedink oor die vroeë, middel en latere jare van ’n akademiese loopbaan
Authors: Conradie Ernst M.
Published: August 2024

This contribution is structured in the genre of an academic letter to a deceased colleague, in this case Prof. Johan Adam Heyns (1928–1994). He was appointed for a short period from 1966 to 1970 as a senior lecturer at the Faculty of Theology at Stellenbosch University. This contribution offers a reappraisal of this period in the academic career of Prof. Heyns. His main focus at the time, in line with his teaching duties, was on apologetics and, to some extent, also ethics. The author engages with Prof. Heyns’s views at the time and offers a sixfold mirror to position this phase of his career, namely in terms of the tensions between orthodoxy and modernity, between the philosophical influence of Henk Stoker and the theological influence of Herman Bavinck, and between the implementation of apartheid and the struggle against that. This mirror is held up in order to reflect on the early, middle and later stages of any academic career including that of the author, to contrast the radiance and risk of youthful academic rigour and the wisdom but also the rigidity that may come with mature age.Intradisciplinary and/or interdisciplinary implications: The research done, is not of an interdisciplinary nature. This article contributes to a growing corpus of literature assessing the legacy of Prof. Johan Adam Heyns.
Narratives and counter-narratives as ways of creating religious tolerance
Authors: Strydom Maryke , Beyers Jaco
Published: August 2024

This article explored the utilisation of counter-narratives in tertiary education settings with regard to pseudo-events connected to big world events. The occurrence that this article focused on was the pseudo-events connected to the Israel–Hamas war that started in October 2023. These pseudo-events refer to a surge in Islamophobic and anti-Semitic hate crimes in countries outside the warzone. Two narrative examples are given that can be utilised within education settings; however, educators can look beyond the given examples and utilise other counter-narratives. Creating awareness of surges in discriminatory occurrences with the use of counter-narratives may increase humanisation and intersectional awareness in students.Intradisciplinary and/or interdisciplinary implications: This article was written from a religious studies perspective, with the aim of increasing religious tolerance within societies. This article is based on a quantitative literature review and narrative theories.
A Rare Case Report of Malignant Peripheral Nerve Sheath Tumor Involving Both the Small Bowel and Large Bowel
Authors: Khan Nazia , Hashmi Irma , Atallah Liana , Shaaban Hamid , Guron Gunwant , Fedida Andre
Published: August 2024

Malignant peripheral nerve sheath tumor (MPNST) contains properties and histologic markers of both neural crest cells and mesenchymal cells. It is a rare diagnosis, with an incidence of 1:100,000/year or 4%–10% of soft-tissue sarcomas. There are very few cases reported and studied. Therefore, establishing a proper diagnosis and treatment of MPNST provides a challenge. We present this unique and rare case of metastatic MPNST of the small and large bowel with bone, pulmonary, liver, and splenic metastases. The patient subsequently developed hemorrhagic brain metastases and died 6 months after THE initial diagnosis.
Fiber-Optic-Assisted Endotracheal Intubation Complicated by Iatrogenic Right Main Bronchus Obstruction
Authors: Kumar Sanjay , Waindeskar Vaishali , Aggrawal Deepti
Published: August 2024

Several aids have been designed for helping anesthetist in managing the difficult airway. Oral carcinomas often distort the airway anatomy and present as difficult airway usually with restricted mouth opening. In these scenarios, elective nasotracheal intubation with fiberoptic is done to secure the airway as well as to provide the full surgical field to the surgeon. Vertically split nasopharyngeal airway is one of the popular aids used as a conduit to pass fiber-optic bronchoscope. Timely removal of the split nasopharyngeal airway is must and if missed, and pushed inside bronchus leading to iatrogenic complication.
Perspectives of Buruli Ulcer Patients toward Informed Consent – An Insight from Nigeria
Authors: Meka Ijeoma Angela , Kanu Okezie Obasi , Adagba Kenneth O. , Offor Jonah , Emodi Nwamaka R. , Iseoluwa-Adelokiki Adebola O. , Meka Anthony O.
Published: August 2024

Introduction:

Informed consent is a basic ethical requirement in situations involving sharing of patients' data. It supports and upholds the ethical principle of respect for persons and individual autonomy. For Buruli ulcer (BU) patients, associated stigma renders them vulnerable, hence the need for emphasis on additional protection by ensuring obtaining informed consent before third party use of their data. The authors therefore sought to determine willingness of these patients to give informed consent to the third party use of their data before and after treatment.

Methodology:

This cross-sectional study was carried out between February and August, 2019. The study involved BU patients from three endemic states in Nigeria. Data were collected using pretested, researcher-administered semi-structured questionnaires.

Results:

A total of 92 respondents participated in the study. The median age was 23.5 years (range 4–74 years) with the age group <15 years being the modal age group 36 (39.13%). About a quarter of the respondents (23.91%) had suffered some form of discrimination in the course of their disease. Majority 86 (93.48%) were favorably disposed to allowing the use of their data for donor drive, policy development, and teaching/training purposes. A significant greater proportion of respondents 90 (97.83%) were willing to give consent for the use of their oral interview as against pictures and videos both in the pre- and post-treatment periods.

Conclusion:

The present study provides evidence that majority of the respondents were positively inclined to give consent to use of their data by a third party. However, intrusion into privacy and anonymity were major concerns for the respondents.
Rehabilitation Protocol after Osteotomy of the Tibia and Varus Femur - Case Study
Authors: Santos Sebastião
Published: August 2024

The knee rehabilitation in the aquatic environment has been used to start the rehabilitation of the lower limb earlier and improve joint movements, as it reduces pain and allows for earlier weight loading. The aim of the study was to develop and describe the effects of a therapeutic exercise program in an aquatic environment, in a clinical case of osteotomy of the tibia and the varus femur. A 15-year-old girl, submitted to an osteotomy of the tibia and the varus femur, completed a therapeutic exercise program in aquatic environment for a total of 30 sessions (3 sessions/week of 60 min). The subject was evaluated in two moments (at the beginning and at the end of the intervention). The results showed an improvement in the various parameters evaluated (knee flexion: 66° vs. 125°, knee extension: −7° vs. −1°, and pain on movement: 6/10 vs. 0/10). We concluded the therapeutic exercise program in the aquatic environment used in this study had beneficial effects in the clinical case of tibial osteotomy and varus femur.
The Relationship between Body Weight and Dietary Habits with Respect to the Timing of Puberty among Saudi Children and Adolescents
Authors: Shahatah Mashael AbdulAziz , Jadkarim Alaa Mubarak , Banjar Revan Zeiny , Kabli Yousof O. , Milyani Asmaa A. , Al-Agha Abdulmoein E.
Published: August 2024

Objective:

The objective is to investigate the timing of pubertal onset as determined by the development of secondary sexual characteristics in relation to body weight and dietary patterns among Saudi females.

Methods:

Children/adolescents visiting general and endocrinology pediatric clinics in King AbdulAziz University Hospital were invited to participate in this study. Female subjects between the ages of 5 and 20 years were included in this study, and those with syndromic disease, chronic comorbidities, endocrinopathies, organic causes of precocious puberty, positive family history of early pubertal onset, and under chronic medication were excluded from the study. Data were collected through clinical interviews with the consent of the legal guardians, and physical examinations were conducted.

Results:

A total of 164 females were investigated. The mean age of thelarche, adrenarche, and menarche was 10, 11.3, and 12.2 years, respectively. We found a significant correlation between higher weight standard deviation and an earlier age of both thelarche and adrenarche. In addition, daily consumption of fast foods was significantly associated with an earlier menarchal age. Consumption of nonorganic poultry was linked to early thelarche.

Conclusion:

Efforts should be directed to increase public and community awareness that fast food consumption, inorganic poultry, and higher body weight are important modifiable factors that lead to an earlier onset of female puberty across different parameters: breast development, adrenarche, and menstruation.
Quality Improvement Project to Assess Patient Satisfaction Towards Outpatient Services of a Tertiary Care Teaching Hospital, South India – A Cross-sectional Study
Authors: Nilakantam Sathish Raju , Madhu B. , Prasad M. C. , Dayananda M. , Basavanagowdappa Hathur , Bahuguna Jayati , Rao Jagiri Narotham
Published: August 2024

Background:

Patient satisfaction survey is a valuable tool to measure the outcomes of care rendered by hospitals. Outpatient department (OPD) is a very crucial area of any hospital services as huge number of patient's visits this area for clinical services. Information about quality of services in OPD will serve two purposes, i.e., identifying areas of improvement in the services offered and highlighting the need for corrective actions. Patient satisfaction is the key determinant for assessing the quality of patient care and is the desired outcome of every hospital. The present study was conducted to measure the levels of patient satisfaction and to ascertain any service gaps in OPD of a tertiary care teaching hospital, Mysuru, India.

Materials and Methods:

This cross-sectional, descriptive study was conducted among 600 patients using a structured questionnaire for assessing the levels of patient satisfaction.

Results:

The overall satisfaction rate in this study was 97.2%, with major satisfiers being clinical care provided by doctors and nursing staffs and few patients were not satisfied with cleanliness of toilets and medications' availability.

Conclusion:

Patient satisfaction survey may be a good audit tool and it should be used to improve the standard of services. According to the patient's opinion, the study showed good satisfaction with respect to reception and registration services, physical facilities, doctor's services, nursing services, laboratory services, and pharmacy services. Few deficient areas are identified in terms of service delivery and the same will be bridged as early as possible to achieve universal patient satisfaction.
Prevalence of Obstructive Sleep Apnea in Diabetic Patients
Authors: Singh Ankita , Chaudhary Shyam Chand , Gupta Kamlesh K. , Sawlani Kamal K. , Singh Abhishek , Singh Abhishek B. , Verma Ajay K.
Published: August 2024

Context:

Obstructive sleep apnea (OSA)-related hypoxemia stimulates release of acute-phase proteins and reactive oxygen species that exacerbate insulin resistance and lipolysis and cause an augmented prothrombotic and proinflammatory state which can leads to premature death.

Aims:

This study aims to study the prevalence of OSA in diabetic patients.

Setting and Design:

It was a cross-sectional study, done over a period of 1 year in a tertiary care hospital.

Materials and Methods:

A total of 149 type 2 diabetic patients were enrolled after taking written consent. All patients were subjected to STOP BANG questionnaire and patients falling in intermediate-high risk (score 3–8), were taken for overnight polysomnography to confirm the diagnosis of OSA (apnea hypopnea index ≥ 5).

Statistical Analysis Used:

Statistical Package for Social Sciences (SPSS) Version 21.0 statistical analysis software.

Results:

Fifty-five percent of our diabetic population were having OSA. The age of patients enrolled in the study ranged between 30 and 86 years and prevalence increases with an increase in age groups. Majority (61.7%) of our cases were males. Incremental trend in weight, body mass index (BMI), neck circumference, and waist circumference of OSA cases were found with increasing in severity of OSA. Mean levels of raised blood sugar and HbA1c were higher in severe OSA cases.

Conclusions:

OSA has a high prevalence in patients with type 2 diabetes mellitus. Patients with type 2 diabetes should be screened for OSA, even in the absence of symptoms, especially in individuals with higher waist circumference and BMI.
Cervical Cytopathological Changes in Pregnancy
Authors: Rasheed Fatima Abubakar , Yakasai Ibrahim Adamu , Takai Idris Usman , Yusuf Ibrahim , Ibrahim Usman Muhammad
Published: August 2024

Background:

Cervical cancer is the leading cause of death among women in developing countries. It is preventable through effective cervical cancer screening program. However, in Nigeria, screening programs are opportunistic and coverage is insufficient to make an impact.

Aim:

This study assessed the cervical cytopathological changes among pregnant women at booking using liquid-based cytology (LBC) in Aminu Kano Teaching Hospital (AKTH).

Methodology:

This was a cross-sectional study that was carried out at the antenatal Clinic of AKTH, Kano, Nigeria. A total of 161 pregnant women who fulfilled the criteria and gave their consent were recruited into the study using systematic sampling technique at booking for antenatal care. LBC was employed using standard procedure and samples sent to histopathology department for analysis. Pro forma developed for the study was used to obtain the socio-demographic and reproductive characteristics of the women and the risk factors for abnormal cervical cytology.

Results:

Out of the 161 pregnant women that had cervical cytology screening using LBC on their first prenatal visit during the study, 22 had abnormal cervical cytology, giving a prevalence rate of 13.7%. Out of this, six (27.3%) were atypical squamous cells of undetermined significance, 3 (13.6%) were Atypical Squamous Cells, Cannot Rule Out HSIL (ASC-H), 11 (50.0%) were low-grade Squamous Intraepithelial Lesions while 2 (9.1%) were high grade squamous intraepithelial lesions. Negative smears were seen in 104 women (64.6%). Inflammatory and other conditions of the cervix which are technically negative smears made up the remaining 21.7%. There was a statistically significant association between cervical cytology results and advanced age (P < 0.01), increasing number of lifetime sexual partners since coitarche (P < 0.01), high parity (P < 0.01), absent previous Pap test (P < 0.027), previous history of sexually transmitted infections (P < 0.040), and positive HIV status (P < 0.001). Following binary logistic regression, advanced maternal age, increasing number of sexual partners, high parity, and positive HIV status stood out to be independent predictors of premalignant lesions of the cervix in pregnancy in this study.

Conclusion:

Advanced maternal age, increasing number of sexual partners, high parity, and positive HIV status stood out to be independent predictors of premalignant lesions of the cervix in the study. Routine cervical cytology screening using LBC should be offered to all antenatal clients in our setting to increase coverage and detection rate of preinvasive lesions of the cervix, and/or pregnant women with increased risk of abnormal cervical cytology from this study.
Palliative Care in Advanced Kidney Disease: The Approach for a Nephrologist
Authors: Khanna Smriti , Khanna Umesh
Published: August 2024

ABSTRACT

Advanced kidney disease presents a significant burden to patients, often leading to a complex array of symptoms and challenges that impact their quality of life. Palliative care (PC), with its focus on symptom management, communication, and holistic support, plays a crucial role in enhancing the well-being of these patients. This article explores the principles of PC in the context of advanced kidney disease, highlighting the need for early integration into standard nephrology care. It also discusses PC interventions such as symptom management, psychosocial support, advanced care planning (ACP), withdrawal of dialysis, and end-of-life care. Symptom management is an essential aspect of kidney-supportive care. The psychosocial burden of advanced kidney disease on the patient and the family needs to be adequately explored along with optimum utilization of local and institutional resources. The option of withdrawal of dialysis should be considered and discussed with patients where applicable. The Supreme Court has laid down guidelines for ACP which include both medical and legal processes to be followed. End of life is a sentinel event that needs adequate medical and nursing support which should be offered keeping in mind the principle of nonabandonment.
Japanese Encephalitis in a Renal Transplant Recipient
Authors: Venkatasubramanian Vaishnavi , Garg Sahil , Bora Ishani , Sethi Jasmine
Published: August 2024

ABSTRACT

Infectious complications are a common cause of neurological abnormality in the postrenal transplant setting, often leading to considerable morbidity and mortality. This is the first published report of Japanese encephalitis in a renal transplant recipient. It is particularly relevant for low- and middle-income countries like ours. Timely imaging and lumbar puncture examination in a renal transplant recipient presenting with altered sensorium is crucial for early diagnosis and treatment.
A Rare Case of Rifampicin-induced Drug Reaction with Eosinophilia and Systemic Symptoms Syndrome
Authors: Kumar Sunil , Chander Ayushi , Taneja Sheena , Purohit C. S.
Published: August 2024

ABSTRACT

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is an idiosyncratic adverse drug reaction that can be lethal in up to 20% cases. The commonest culprit drug includes phenytoin, allopurinol, phenobarbital, sulfasalazine and lamotrigine. DRESS syndrome due to antitubercular medicines is rarely reported. In India despite the widespread use of antitubercular medicines, only few cases of DRESS syndrome have been reported. Here we report an interesting case of a 23 year old girl who presented to us with complaints of high grade fever, cough, GI discomfort, numbness, severe pruritus and burning skin sensation. She was receiving antitubercular medicines for tubercular pleural effusion for the last three weeks. She was hospitalised for a suspected adverse drug reaction which was diagnosed as DRESS syndrome on the basis of RegiSCAR criteria. On re-challenge testing the culprit drug was found to be rifampicin. In this case the severity of skin involvement was much higher as compared to organ involvement.
Tracheal Pseudocyst: A Rare Case Report
Authors: George Angel , Anoop M. P. , Rajan P. , Kuruvilla Shalini
Published: August 2024

ABSTRACT

Tracheal pseudocysts are rare benign lesions that can affect individuals of all age groups. In this report, we present a case of tracheal pseudocyst that, to the best of our knowledge, has not been previously reported. A 63-year-old female presented with stridor caused by a cystic mass involving the trachea. The patient underwent cystectomy, and histopathological examination confirmed the presence of a tracheal pseudocyst. Subsequent regular follow-up examinations revealed no recurrence of the lesion.
Cystic Diseases of the Lung and Cystic Bronchiectasis – Why Do We Differentiate?
Authors: Chetambath Ravindran
Published: August 2024

ABSTRACT

Multiple cystic lung diseases represent a group of uncommon disorders that can present a diagnostic challenge due to their resemblance with much more common conditions such as cystic bronchiectasis. It is a common practice that cystic lung diseases without other systemic features are often diagnosed as bronchiectasis. This is very often encountered in conditions such as congenital pulmonary airway malformations. Ignorance about the existence of this lung condition can lead to missed or delayed diagnosis. High-resolution computed tomography of the chest helps to define the morphological aspects and distribution of lung cysts, as well as associated findings.
COVID-19 infection-triggered complicated childhood-onset systemic lupus erythematosus
Authors: Jose Priya , Kotai Ramesh , Raja Jude Antonieo , Kommu Peter Prasanth Kumar
Published: August 2024

The COVID-19 pandemic in children had a variable presentation in each wave globally, ranging from flu-like symptoms to death due to multi-organ dysfunction. Even though systemic lupus erythematosus (SLE) is a rare chronic autoimmune disease with multisystem involvement, its correlation with an altered immune response post-COVID infection is still debatable. We report an 11-year-old boy who presented with fever, arthritis, a skin rash, tender lymph nodes, positive antinuclear antibodies, and anti-double-stranded DNA. The SLEDAI-2000 scoring was 11, which indicated an active disease of childhood SLE with lupus nephritis and Kikuchi disease possibly triggered by COVID-19. There are no similar reports in the literature for children or adults. COVID-19-triggered complicated SLE should be suspected in all children with prolonged fever and multisystem involvement. More research is needed to determine the autoimmune disease trigger.
Intolerance to uncertainty among the medical professionals in Central Kerala – Did COVID-19 make us intolerant?
Authors: Varghese Sangeetha Merrin , John Anulekha Mary , Abraham Jithin Mathew , Ann Irene , Abraham Alena T. , Mateethra George Chandy , Thomas Pramod , Thomas George , Thomas Mini Sarah , Benjamin Anoop Ivan
Published: August 2024

Background:

With the COVID-19 threat that was looming large, uncertainty prevailed in every sphere of life. Medical professionals were feverishly trying to contain the pandemic and were under tremendous mental pressure. Intolerance to uncertainty (IU) is well known to affect the behavior of health-care professionals and is associated with lower levels of confidence and a propensity to behave overcautiously, leading to undue stress and anxiety. We assessed the IU and worry of health-care workers in a teaching institute in Central Kerala, during the COVID pandemic.

Methodology:

An online cross-sectional survey was done using the IU survey-12 scale and an ultra-brief version of the Penn State Worry Questionnaire, after conducting a pilot study. The form was sent to the doctors’ and nurses’ WhatsApp groups both in English and Malayalam translation attached to each question. Data were analyzed using the SPSS software version 21. The Chi-square test and logistic regression analysis were done.

Results:

A total of 431 participants took part in the survey. Their mean age was 34.54 ± 8.6 years. The study showed that 27.8% of the participants had high levels of IU. Troublesome worry was a problem in 10.4%. Logistic regression analysis showed that “Worry” and “being a nurse” were the factors that were significantly associated with high levels of IU.

Conclusion:

Although some IU is expected at the time of a pandemic, 27.8% of health-care professionals being intolerant is a matter of concern. It is high time we break the cycle of events – Worry and IU, that leads to stress but rather make the health workers resilient and tolerant, spreading positive uplifting influences throughout our communities, much faster than the virus.
Study of microvessel density in breast carcinoma with CD34 immunostaining – An institutional experience in Puducherry
Authors: Vinayagamoorthi Vigneswaramoorthi , Ivan Erli Amel , Revathi G. , Sriram V. , Gandhi Ramya , Mohan Reenaa , Arokiam Roy
Published: August 2024

Background:

Breast carcinoma is one of the most common neoplasms in women. It is most commonly seen in the age group of 30–90 years of age. The evaluation of microvessel density is one of the frequently used methods to quantify intratumoral angiogenesis in breast cancer.

Methodology:

Analytical cross-sectional study was done in the Department of Pathology, Sri Manakula Vinayagar Medical College and Hospital for 1½ years after getting ethics committee approval. All cases diagnosed with breast carcinoma in the Department of Pathology were included, and the sample size was 62. The study tools used were requisition form, Hematoxylin and Eosin, and immunohistochemistry CD34 staining in the excised specimen.

Results:

It was found the present study included 62 cases of modified radical mastectomy done for various grades and stages of breast carcinoma. The common age group in this study was found to be 40–60 years (40 cases). The most common quadrant involved by the tumor is the upper outer quadrant (31 cases). In this study, 48 cases (77.42%) had tumor size of 2–5 cm, 10 cases had tumor size of >5 cm and 4 cases had tumor size of <2 cm. The most common type of tumor seen in this study is invasive ductal carcinoma (IDC) Not otherwise specified (NOS). The most common tumor grade present in this study is grade II tumors (38 cases). In this study, the correlation of histopathological grade with tumor size and microvessel density was found to be statistically significant (P < 0.05).

Conclusion:

In this study, a higher mean microvascular density value is seen in Grade III tumor and the value decreased as the tumor grade decreases. In the future, antibodies specific to proliferating endothelium, together with the development of automated image analysis, may improve the accuracy and value of measuring angiogenesis-induced microvessel density. Then, these specific antibodies can be used in used in targeted therapies.
Anesthetic challenges in a child with congenital pulmonary airway malformation for right lower lobectomy
Authors: Natarajan Sumitha , Palanisamy Nagalakshmi , Zachariah Mamie , Johny Pradeesh T
Published: August 2024

Congenital pulmonary airway malformation is a rare benign airway malformation, affecting the trachea, bronchi, bronchiolar, or alveolar systems with cystic and adenomatous lesions. This sequestered part of the lung becomes nonfunctioning and causes recurrent pulmonary infections. The definitive treatment is surgical resection of the diseased segments by thoracotomy requiring general anesthesia and controlled ventilation. The anesthetic challenges in pediatric lung surgeries are airway management, the requirement of one-lung ventilation, and maintaining saturation. The lung separation maneuvers in pediatric patients are difficult due to the nonavailability of appropriate size double-lumen endotracheal tube (ETT) or one-lung ventilation with bronchial blockers. We present how we managed to provide general anesthesia and controlled ventilation using single-lumen ETT to provide a good operating condition for right lower lobectomy.
A case report of Rosai–Dorfman disease of the breast
Authors: Francis Rini , Thaj Riyana R. , Anu J. , Mathew Apuca Susan
Published: August 2024

Rosai-Dorfman disease (RDD), or sinus histiocytosis with massive lymphadenopathy, is a benign, self-limiting disease. In the majority of cases, there is massive and painless lymphadenopathy in any lymph node group but most commonly in the cervical lymph nodes, associated with constitutional symptoms. Extranodal involvement has been reported to occur in almost every organ system, with or without concomitant nodal disease. The breast is a rare site of presentation of this disease. A 52-year-old female presented with a hard, nodular swelling(3x2cm) in the left breast, with a clinical suspicion of malignancy. Atypical cells were note in fine needle aspiration smears. Histopathology and immunohistochemistry were of critical importance and showed a specific pattern of histiocytosis. A diagnosis of Rosai-Dorfman disease (RDD) was made. RDD of the breast is a rare form of histiocytosis, with fewer than 100 globally published cases. Although the management of this disease is not established yet by guidelines, a follow-up approach should be enough for these patients, and surgery might be overtreatment. Mortality from RDD is very low due to comorbidities. A multidisciplinary team decision is important, and abstinence might significantly benefit these patients.
Evaluation of quality assurance in the cytopathology laboratory of a tertiary care hospital in Eastern India
Authors: Mallick Debjani , Kundu Sayan , Chakrabarti Sudipta
Published: August 2024

Background:

In this era of evidence-based medicine, clinical laboratories play a critical role in patient diagnosis and management.

Aims:

The present study aims to study the quality assurance in the cytopathology laboratory of a tertiary care hospital in the Eastern region of India.

Materials and Methods:

An observational, retrospective, and analytic study for 1 year was conducted. The sample size was 600. Simple random samples were selected including pleural fluids, ascitic fluids, cerebrospinal fluids, cervical cytology Pap smears, fine needle aspiration (FNA) cytology, and guided FNA samples.

Results:

Maintenance of authentication of reports and ISO accreditation showed no deficiency, whereas report generation, dispatch, and documentation of duplicate reports showed the highest deficiency (593, 98.8%) in maintaining quality assurance. Incomplete requisition was the most common cause of registration failure (3, 42.8%), whereas samples sent in wrong vials was the most common cause of sample collection failure (3, 37.5%). The presence of artifacts was the major factor affecting smearing technique (3, 50%). Lack of compliance to standardized protocol in manual staining and mechanical factors of automated strainers affected the staining quality (3, 37.5% each). Power cut and lack of adequate UPS backup affected the productivity of equipment mostly (3, 50%). Technical issues were the major factor affecting turnaround time (3, 50%). Lack of manpower at the report dispatch counter and logistics affected report generation and dispatch (2, 33.3% each). Randomly selected reports were crosschecked with histology and prediction accuracy measures were calculated.

Conclusion:

The preanalytical, analytical, and postanalytical factors have to be maintained adequately for ensuring quality assurance.
Evaluation of ocular manifestations of patients with pathological myopia at a tertiary eye care institute in Western India
Authors: Trivedi Kinjal , Madhani Charmi , Kondapurkar Aditi , Aggarwal Somesh
Published: August 2024

Introduction:

Pathological myopia (PM) is defined as a refractive error ≥(−6) D or an axial length >26 mm causing complications such as early nuclear sclerosis, zonular dehiscence, macular hole, lacquer cracks, Forster-Fuchs spots, myopic traction maculopathy, macular choroidal neovascularization, and peripheral degenerations predisposing to rhegmatogenous retinal detachment (RRD).

Materials and Methodology:

In this cross-sectional observational study, we have studied 106 eyes of 56 patients. After history and examination, axial length was measured using A-scan biometry. Patients having myopic maculopathy underwent optical coherence tomography and fundus fluorescein angiography and were treated appropriately. The data were entered into Microsoft Excel sheet for statistical analysis.

Results:

Incidence of high myopia was maximum in 21–30 years (36%). Eighteen percent had positive family history, and in 89%, the presentation was bilateral. About 43.39% eyes had refraction value in the range of −6 to −10 D and 70.75% eyes had axial length between 26 and 30 mm. Nearly 39.62% eyes had best-corrected visual acuity in the range of 6/18–6/36. Fifty-two percent eyes had some vitreous degeneration. Myopic choroidal neovascular membrane (CNVM) was seen in 4.71% eyes. Lattice degeneration was the most common (43.39%) lesion predisposing to RD, majority seen in superotemporal quadrant (63.04%). Incidence of RRD was 6.52% and 15% in eyes with refractive error less than and more than −10 D, respectively.

Conclusion:

PM can cause irreversible vision loss with its complications such as CNVM and RRD. Awareness among myopic population regarding visual hygiene, safety precautions, risks, and complications involved can detect complications at the earliest helping in retaining useful ocular function.