bluuebunny/crossref_metadata_2025 huggingface dataset:
Management and prevention of emotional burnout among members of the armed and special forces
Authors: Semenenko Liliia , Dobrovolskyi Uzef , Petrenko Stanislav , Yarmolchyk Maria , Ishchenko Oleksii
Published: August 2024

With the rise in cases of professional burnout, research on best practices and opportunities for implementing emotional burnout prevention and treatment among special services and military personnel became more relevant. The aim of this study is to determine the most efficient methods of therapy and to reveal the necessity of preventing and mitigating the symptoms of emotional burnout among special services and military personnel. Additionally, best practices and opportunities for their application by Ukrainian, Kazakh, Polish, British, American, Canadian, and South Korean specialists are highlighted. Experimentation is the main approach used in this problem’s investigation. As a result, the study describes the unique aspects of the jobs performed by special services and military personnel, highlights the primary approaches to treating and preventing emotional burnout, and identifies which approaches are most successful for each group of workers based on their unique personal traits. Consequently, the study delineates the particulars and attributes of the work performed by personnel in special services and military structures, outlines the primary approaches and strategies for mitigating and averting emotional exhaustion, and indicates which of these approaches work best for these groups of workers, taking into account their unique personal traits. The introduction of emotional burnout training as a preventative intervention is supported by best practices and future possibilities.
Assessment of the respiratory predicament of bus drivers in different environmental conditions
Authors: Mukherjee Sharbo , Sahu Subhashis , Pradhan Chandan Kumar
Published: August 2024

BACKGROUND:

Bus drivers work in different environmental conditions. Pollution is one of the main burdens of their day-to-day work. Traffic flow is the likely to significantly increase emissions of different types of pollutants such as carbon monoxide, particulate matter, oxides of nitrogen, and hydrocarbons. Drivers suffer from different types of respiratory problems due to exposure to these pollutants. Studies on bus drivers are rare, and reports are scanty.

METHODS:

Thus, it was necessary to study respiratory functions and environmental factors in bus drivers of West Bengal. According to the locations of work, i.e. rural and urban, 254 subjects or bus drivers were involved in this study. They were alienated into two groups: rural (n = 108) and urban (n = 146). The physical parameters of the subjects were measured. European Community Respiratory Health Survey-II questionnaire was administered to know their different respiratory responses. A lung function test was performed for all the subjects. Sputum cell was counted from the induced sputum of the subjects.

RESULTS:

It was found that symptoms such as cough, wheezing, and phlegm were three times higher in Group 2 compared to Group 1. Spirometric findings showed that slow vital capacity (SVC), forced vital capacity, and forced expiratory volume in the 1st s (FEV1) were significantly lower among the urban or Group 2 bus drivers. It was also detected that the mean value of SVC and FEV1 were significantly lower with the smoking habit. Sputum cells study showed that significant decrease in the mean value of the total count of the urban group. However, the mean value of neutrophil count was significantly increased in urban drivers’ sputum.

CONCLUSION:

From this overall study, it may be determined that the drivers of both rural and urban vicinity were prone to respiratory illness due to their regular dusty working environment. Regular exposure to this environment was the potent cause of different types of respiratory illness.
Effect of transcranial direct current stimulation on the level of arousal in hypoglycemic ischemic encephalopathy: A case study
Authors: Dharwadkar Raghavendra Singh , Mulla Neha , Chhajed Pragati
Published: August 2024

The current study presents the use of transcranial direct current stimulation (tDCS) as a novel intervention for improving the level of arousal in a patient with hypoglycemic ischemic encephalopathy (HIE). HIE is a rare but potentially devastating condition that can lead to impaired consciousness, coma, and profound neurological deficits. The Coma Recovery Scale was utilized as the primary outcome measure for arousal, along with the Oral Motor Assessment Scale for the assessment of oromotor functions as a secondary outcome to assess the effectiveness of tDCS in promoting neurological recovery.
Targeting PknL as a novel therapeutic strategy against Mycobacterium tuberculosis
Authors: Krishnakumar Vaithilingam , Munisamy Suthandhira , Pandiyan Rajesh , Velu Rajesh Kannan , Periasamy Panneerselvam
Published: August 2024

INTRODUCTION:

The bacterium “Mycobacterium tuberculosis (MTB)” causes tuberculosis, which is currently regarded as the most common cause of bacterial infection-related death globally. In addition to eukaryotes, MTB also encodes 11 “serine/threonine protein kinases (STPKs),” including PknA, B, C, D, E, F, G, H, J, K, and L that control cell division, cell development, metabolism, and dormancy.

MATERIALS AND METHODS:

The antisense and sense-orientated PknL have been cloned utilizing the shuttle mycobacterial vector-pAZI9018b, which is IPTG inducible. Utilizing the appropriate primers, the PknL (Rv2176) full-length gene from MTB has been amplified. The product which was amplified was then inoculated inside the vector at the “5’BamH1 and 3’Nde1” regions to produce PknL in the sense orientation (PknL-S) resembling PknL-S, and likewise, amplified substance was introduced into the vector at the 3’BamHI and 5’NdeI sites for producing PknL in the antisense orientation (PknL-AS).

RESULTS:

Regardless of the absence or presence of an inducer, PknL-AS had lower transcription levels than Wild type and PknL-S, but PknL-AS revealed a significant decrease in PknL expression during the end of 2nd week with 1 mM of IPTG and a further decrease on day 10 with 10 mM IPTG. In the presence of 10 mM IPTG, PknL expression has been close to, 1.8 log in Wild type, 1.4 log in PknL-AS, and 2.4 log in PknL-S.

CONCLUSION:

It has been clear that PknL may read environmental cues and respond appropriately, assisting bacteria to adapt to stressful situations in the host by lowering bacterial development, leading to a dormant state, and allowing bacteria to stay inside the host.
Neutrophil-to-lymphocyte ratio to improve the diagnostic performance of appendicitis inflammatory score and modified Alvarado score
Authors: Bansal Gagan , Dudani Sharmila
Published: August 2024

BACKGROUND:

Acute appendicitis is a surgical emergency often encountered in clinical practice. Diagnosis is usually based on clinical judgment supplemented with a few baseline investigations. Neutrophil-to-lymphocyte ratio (NLR) is a novel, stable inflammatory marker reflecting the inflammatory status, superior to individual leukocyte parameters.

OBJECTIVES:

We aimed to study the introduction of NLR as an additional parameter in the appendicitis inflammatory score and modified the Alvarado score to improve the sensitivity and specificity in the diagnosis of acute appendicitis.

MATERIALS AND METHODS:

This was a retrospective study of clinical and laboratory data of 101 consecutive patients above the age of 18 years with a sudden onset of nontraumatic abdominal pain and a provisional clinical diagnosis of uncomplicated acute appendicitis, subsequently undergoing appendectomy. Findings on histopathological examination of the resected appendix were considered the gold standard. The NLR was calculated from the hemogram parameters for all patients. The receiver operating characteristic (ROC) curve was used to determine the threshold score levels and the performance characteristics of scoring systems.

RESULTS:

The median age was 27 (12.50) years, with male predominance (77.2%). The appendicitis inflammatory response (AIR) score, modified Alvarado score, and the NLR were all significantly higher among patients with histopathologically confirmed appendicitis (P < 0.01). A new score developed by combining the NLR with the AIR score outperformed both the modified Alvarado score and the original AIR score, as evident by significant increase in the area under the ROC curve. NLR is a useful parameter, and its addition to the AIR score can help guide clinical management.

CONCLUSION:

The addition of NLR in AIR score can help in clinical management of appendicitis.
Phenotypic and Genotypic Spectrum of Children with Autosomal Recessive Hyperimmunoglobulin E Syndrome Caused by DOCK8 Mutation: A Systematic Review of Case Reports
Authors: Sampath Ananyan , Yadav Hemant , Juluri Sanjuna , Bhat Girish Chandra , Yadav Yogendra Singh
Published: August 2024

Background:

Hyperimmunoglobulin E (IgE) syndrome (HIES) is a rare primary immunodeficiency disease, with features of recurrent eczema-like rashes, skin and lung infections, and elevated serum IgE. Common genetic mutations involve STAT3 and DOCK8 in autosomal dominant and recessive types, respectively.

Objectives:

Here, we aimed to systematically review all previously published case reports/series describing the clinical features, laboratory findings, and genetic analyses of children with autosomal recessive HIES (AR-HIES) caused by DOCK8 immunodeficiency.

Methods:

A comprehensive search was done in PubMed and Google Scholar, using defined search terms encompassing case reports or case series on AR-HIES. The identified reports underwent screening by different authors for inclusion and exclusion criteria.

Results:

A review of 50 articles covering 203 patients with DOCK8 immunodeficiency syndrome was done. Most cases were reported in countries such as Turkey, the USA, and Iran, with no significant gender disparity (92 males: 111 females). Patients exhibited a broad age range and early disease onset, with consanguinity present in 82% of cases. The most common clinical features included eczema (99%), allergic manifestations (93%), and respiratory infections (91%), associated with high IgE levels and eosinophilia. Exonic deletions were the most common mutations.

Conclusion:

This is one of the largest reviews collating data on DOCK8 deficiency, leading to AR-HIES. Exonic deletions were the most common mutations, with eczema and allergy being the most consistent clinical features.
Right-sided Thyroid Hemiagenesis in a Male Newborn with Congenital Hypothyroidism: A Case Report with Review of Literature
Authors: Kar Shrutiprajna , Mishra Purbasha , Sahoo Tanushree , Devi Usha
Published: August 2024

Background:

Thyroid hemiagenesis (THA) is a rare aberration in the development of the thyroid gland, denoted by the absence of either thyroid lobe with or without the isthmus, common in females, predominantly involving left lobe of thyroid, usually maintaining a euthyroid state.

Clinical Description:

A premature male baby born at 34 weeks gestation with birth weight 1100 g was admitted in the neonatal intensive care unit (NICU) for respiratory distress soon after birth. The antenatal period was uneventful and maternal thyroid status was within normal limits.

Management and Outcome:

While the newborn was being stabilized in NICU, the results of routine cord blood screening revealed raised thyroid-stimulating hormone levels, following which an ultrasound examination showed right THA, confirmed further by technetium-99 radionuclide scan. Thyroxine was initiated for persistent hyperthyrotropinemia. The baby was eventually discharged and was doing well till 6 months of follow-up.

Conclusion:

Unlike the common scenario published in literature, our case of THA was seen in a male newborn, involving the right lobe of the thyroid along with a hypothyroid state. As THA is a state of continuous overstimulation of thyroid tissue, newborn screening and detection of this abnormality at this early age is important.
Internal Jugular Vein Phlebectasia with Situs Inversus Totalis: A Rare Association in a Child
Authors: Inamdar Nusrat Rahim , Mauskar Anupama , Mehra Manam Ravi , Pudami Chennakesava
Published: August 2024

Background:

Phlebectasia is a term used for the dilatation of a vein without tortuosity. Rarely, the condition may affect the internal jugular vein (IJV), causing prominence in the neck, which may be confused with other neck swellings.

Clinical Description:

A 6-year-old boy presented with bilateral episodic swelling in the neck noticed since 2 years of age and a hoarse voice since 3 years of age. On examination, the neck swelling was soft, cystic, compressible, nontender, and nonpulsatile, increasing in size by all maneuvers increasing intrathoracic pressure. Systemic examination revealed the apex beat was on the right side, and the liver was palpable below the left subcostal margin.

Management and Outcome:

The workup for tuberculosis was negative, and direct laryngoscopy was normal. X-ray of the chest with abdomen showed dextrocardia and stomach shadow on the right side. Color Doppler revealed nontortuous dilatation of both IJVs. Dynamic computed tomography venography confirmed the diagnosis of bilateral IJV phlebectasia (IJVP). The child was started on speech therapy. The mother was counseled regarding the benign nature of the disease and advised regular follow-up. The child had no complications, and his voice improved with speech therapy at 1-year follow-up.

Conclusion:

Pediatricians should be aware that IJVP may rarely be the cause of neck swelling associated with hoarseness of voice. Increase in the size of the swelling with Valsalva maneuvers and color Doppler ultrasound helps to confirm the diagnosis.
Lobar Emphysema Successfully Operated in an Extreme Premature Neonate
Authors: Bukelo Mario Joseph , Adavalath Shreya , Rao Sadashiva
Published: August 2024

Background:

Lobar emphysema in a newborn may be due to a rare congenital developmental anomaly of the lung, termed congenital lobar emphysema (CLE) or may develop secondary to lung damage, especially with positive airway pressures in premature newborns, known as acquired lobar emphysema (LE). They may have overlapping clinical and radiological features. However, surgical lobectomy is required whenever there is significant respiratory compromise. Reports of surgery in LE in extreme preterms are sparse.

Clinical Description:

A female newborn with gestational age of 28 weeks, weight of 1.180 kg, presented with respiratory distress after birth, initially treated as hyaline membrane disease. With worsening respiratory distress on positive airway pressures, repeat chest X-ray and computed tomography (CT) chest on day 15 of life, suggested possible LE on the left side with the tracheo-mediastinal shift to the right.

Management and Outcome:

Left thoracotomy and left upper lobectomy was done, following which, there was rapid improvement in respiratory distress, the newborn being extubated after 6 hours, and weaned off oxygen over the next 3 days. The baby was discharged after 8 weeks and at the last follow-up of 3 years of age, the child was growing well with no complications.

Conclusion:

Preterm neonates with initial radiological features of hyaline membrane disease, requiring prolonged respiratory support, may be harboring other underlying lung anomalies, which are identified by CT chest. Lobar emphysema with tracheo-mediastinal shift warrants prompt surgery, which is feasible and successful, even in a low birth-weight premature infant.
Gamut of urological diseases in a tertiary hospital in North Central Nigeria
Authors: Oyibo Ugbede Emmanuel , Onwukwe John C
Published: August 2024

Context:

Worldwide, urological disorders vary from one topography to another. An in-depth understanding of their distribution in each region could serve as a basis for the distribution of manpower, equipment’s alongside determine policy formulation and training.

Aims:

This study enumerates the annual frequency and distribution of urological disorders at the Federal Medical Centre, Keffi.

Settings and Design:

A cross-sectional retrospective study from November 2021 to November 2022 of all new patients who attended the urology outpatient clinic, emergency department as well as those who had surgical interventions at the Federal Medical Centre, Keffi, Nasarawa State.

Materials and Methods:

The pertinent records were extracted from the patient’s electronic medical records (EMR) and entered into a semistructured questionnaire.

Statistical Analysis Used:

Data were analyzed using the SPSS software version 20.

Results:

A total of 452 new patients were seen over the study period. There were 428 (94.5%) males and 24 (5.3%) females, with a male-to-female ratio of 17.8:1. The median age was 58 years, with the age range of 2–97 years. Urological emergencies were seen in 13.5% patients. Ninety-eight percent of cases were acquired, whereas 1.8% were of congenital etiology. Overall, the most commonly diagnosed urologic diseases among new patients in order of decreasing frequency were benign prostatic enlargement (BPE) (54.7%), urethral stricture disease (11.0%), upper tract urinary calculi (6.3%), prostate adenocarcinoma (5.9%), and male infertility (4.3%).

Conclusions:

BPE, urethral stricture disease, upper tract urinary calculi, prostate adenocarcinoma, and male infertility are common in our environment. An understanding of the urological disease distribution will enhance policy-making and drive manpower needs inspiring core areas of subspecialization with a view at improving the standard of urological care and promoting collaboration with international organizations and funding agencies.
Burn care at the National Orthopaedic Hospital, Enugu: A comparison of two 5-year periods: January 2012–December 2016 and January 2017–December 2021
Authors: Onah Ifeanyichukwu Igwilo , Okoli Chinedu Michael
Published: August 2024

Background and Objectives:

The survival rate of patients with burn injuries has increased remarkably owing to the advancements in burn management which has resulted in improved survival rates, shorter hospital stays and decreases in morbidity and mortality rates due to the development of fluid resuscitation protocols, improved respiratory support, infection control etc. This study compares the parameters of burn patients admitted in a tertiary hospital from January 2012 to December 2016 and January 2017 to December 2021.

Materials and Methods:

This study was at the National Orthopaedic Hospital Enugu, NOHE. It was a retrospective study of patients who presented with burn injuries to the burn unit between the period of January 2012 and December 2021.

Results:

A total of 771 cases were analysed. Three hundred and twenty-three were seen between January 2012 to December 2016, 448 were seen between January 2017 and December 2021. Flame remained the major cause of burn injuries with 62% occurring in the first 5-year period while 72% occurred in the second 5 years. Adults had more injuries from flames than children, while children had more scald injuries than adults. The highest percentage of Total Burn Surface Area (TBSA) salvaged was 79% in the first 5-year period while 86% was salvaged in the second. Mortality rate in the first and second 5-year periods were 12% and 19%, respectively.

Conclusions:

Flame burn injuries are the most common cause of burn injuries in adults and children. Mortality was lower in the first 5-year period. A higher TBSA was salvaged in the second 5-year period.
Massive small bowel enterolith in post cystoprostatectomy ileal cul-de-sac : A unique presentation of a rare clinical condition
Authors: Sarkar Pallab Kumar , Karanjia Rustam , Akhtar Mansoor , Streeter Edward
Published: August 2024

Enterolithiasis or formation of gastrointestinal concretions is an unusual medical entity that typically occurs in patients suffering from persistent intestinal stasis. We present a rare case of non-obstructive enterolith wedged in the blind end of bowel reconstruction following cystoprostatectomy and ileal conduit formation due to muscle-invasive bladder cancer. Although we watched it grow over the years, radiological characterisation was made possible when it grew to a significant size. We, herein, will discuss the aetiology and complexities associated with the diagnosis and management of such orphan cases given their non-specific clinical presentations in an already hostile abdomen due to multiple laparotomies.
The prevalence and management outcomes of diverticular disease in a tertiary facility in Ghana
Authors: Taah-Amoako Philip , Bediako-Bowan Antoinette Afua Asiedua , Dakubo Jonathan C. Balea
Published: August 2024

Background:

Diverticular disease of the colon, previously believed to be rare among Africans, is now an emerging disease entity in many African countries. The increasing morbidity and varied presentations are associated with this.

Objectives:

To determine the prevalence of diverticular disease among patients who underwent lower gastrointestinal endoscopies over a 5-year period and evaluate the common presentations, interventions, and treatment outcomes at the Korle-Bu Teaching Hospital (KBTH), Ghana.

Materials and Methods:

This was a retrospective cross-sectional study of patients who underwent either a colonoscopy or proctosigmoidoscopy between January 2017 and December 2021, at the KBTH. The records of patients admitted for complications of diverticular disease over the same period were also reviewed.

Results:

A total of 4266 patients underwent lower gastrointestinal endoscopy over the study period. Out of this, 380 were diagnosed with diverticular disease giving a prevalence of 8.91%. This comprised 58.95% male and 41.05% female. Their mean age was 67.02 (standard deviation ± 11.45). The age ranged from 26 to 95 years with a median of 67. Sixty-seven patients with 88 episodes of admission were managed for complications. The average age was 69.26 (SD ± 13.28) and ranged from 40 to 98 years with an interquartile range of 20 years. Complications were predominantly bleeding diverticular disease (94.32%), whereas 5.6% presented with diverticulitis. Ninety percent were managed conservatively, and 10% had surgical intervention.

Conclusion:

This study concludes that the prevalence of diverticular disease among Ghanaians undergoing lower gastrointestinal endoscopy is still low and bleeding is the commonest indication for admission which is mostly managed conservatively.
Comparison of choroidal thickness in healthy pregnant and preeclamptic women in a tertiary eye care center in Central India: A cross-sectional study
Authors: Dhabarde Kavita A. , Rathod Sayali S. , Chaurasia Snehal Sandeep Bonde , Iyer Vandana A. , Joshi Rajesh S.
Published: August 2024

Aim:

To compare the Subfoveal Choroidal Thickness (SFCT) measured by Enhanced Depth Imaging (EDI) technique of Spectral Domain Optical Coherence Tomography (SD-OCT) in healthy pregnant and preeclamptic women.

Methods:

Our study was cross-sectional hospital-based study in which healthy pregnant women and women having preeclampsia were selected from Obstetrics and Gynecology department and enrolled in it. The guidelines of the American College of Obstetricians and Gynecologists were used to diagnose the cases of preeclampsia. The study included 100 women (200 eyes) which were grouped into 50 healthy pregnant women (group 1), i.e., n = 100 eyes and 50 preeclamptic women (group 2), i.e., n = 100 eyes. SFCT was measured using the EDI technique of SD-OCT and data were entered in a Microsoft Excel sheet. Statistical analysis was done using Epi Info. Software version 7.2.1.0 (Atlanta, Georgia, US) and the results of both the groups were compared.

Results:

The mean SFCT in both the eyes of the healthy pregnant group and the preeclamptic group was 318.12 ± 37.12 µm and 209.04 ± 26.73 µm, respectively, with a P-value 0.001 showing a statistically significant difference between both the groups.

Conclusion:

The SFCT is significantly decreased in preeclamptic pregnant women than in healthy pregnant women.
Chondroid syringoma of medial canthus—A rare case
Authors: Mittal Bharat , Singh Arun K.
Published: August 2024

Chondroid syringoma of the skin is a rare, benign skin adnexal tumor, usually exhibited as a slowly growing intradermal or subcutaneous nodule, typically located in the head-and-neck region. Chondroid syringoma usually appears on the face, the medial canthus being a rare site of predilection. The diagnosis is usually made retrospectively based on histological features of the surgically excised mass, which is usually asymptomatic. We present a rare case of an 18-year-old man who presented with a painless, subcutaneous nodule medial to the medial canthus of the left eye. The diagnosis of chondroid syringoma was rendered. To the best of our knowledge, only one case of chondroid syringoma of the medial canthus has been documented in the literature. A histopathological examination is mandatory for arriving at the diagnosis. It should be considered in the differential diagnosis of all the slowly growing nodular lesions in the face.
Waardenburg or Blepharophimosis ptosis epicanthus inversus syndrome? – An enigmatic riddle
Authors: Das Deepsekhar , Bajaj Mandeep S. , Tyagi Parag , Gupta Saloni , Agrawal Sahil
Published: August 2024

Waardenburg syndrome (WS) is a genetic disorder that may be discernible right at birth. The syndrome is well known to have heterogeneous expression; the range, and severity of which may vary greatly from case to case, even among the individuals of the same household. Here, we report a 19-year-old female who was initially diagnosed as a case of Blepharophimosis ptosis epicanthus inversus syndrome (BPES) and referred to our subspecialty clinic for undergoing surgery. On examination, she had medial canthal dystopia, telecanthus, synorphys, and similar facial features in a first-degree family member. These features were suggestive of WS. After that, the primary diagnosis was revised; systematic evaluation was performed, surgical correction for her telecanthus was ventured with a favourable outcome. Both WS and BPES may present with similar facial features and thereby pose a clinical dilemma. Such misdiagnosis may hinder proper evaluation and management of any underlying systemic associations.
Prevalence and causes of ocular morbidity among school children in urban and rural areas
Authors: Dubey Renu Shukla , Muduthanapally Charani , Navatha Kyatha , Das Sangeeta
Published: August 2024

Background:

Poor vision impairs the performance of school children and has a negative impact on their future. The prevalence of blindness in school children is estimated to be 0.8/1000 in the age group of 0–15 years. Most children with an uncorrected refractive error are asymptomatic; hence, periodic visual screening and primary eye care reduce the prevalence of refractive error and ocular morbidity.

Objective:

To study the prevalence of ocular morbidity among school children in urban and rural areas.

Methods:

Cross-sectional study was conducted in two randomly selected private schools in urban area and two randomly selected government schools in rural area among school children aged 6–15 years studying in standards I–X. They were selected from each class by systematic random sampling. Detailed history and ocular examination were carried out for all children.

Results:

The prevalence of ocular morbidity among study participants was high (20.3%). The major cause of ocular morbidity was refractive error in 17.4% of the cases. Age group of 5–7 years, being urban school child, illiterate parents were significantly associated with ocular morbidity (P < 0.05). Gender and religion were not associated with ocular morbidity. The most common ocular morbidity was refractive error (17.4%). Color blindness (1.5%), conjunctivitis (1.3%), and stye and chalazion (1.1%) were other ocular morbidities.

Conclusion:

Most cases of ocular morbidity were preventable or treatable if detected early. Hence, strategies including prevention at the primary and secondary level form core of any strategies to reduce ocular morbidities in school going children.
Ocular toxicity of daily anti-tubercular treatment regimen: A prospective observational study
Authors: Arun K. T. Sreelakshmi , Kumar Praveena S. , Rajan Ann R. , Mathai Monsy T. , Kakkanat C. V. Andrews , Adiody Supriya B.
Published: August 2024

Context:

India carries a significant burden of TB which is the commonest cause of infectious disease-related mortality. Anti-tubercular drugs can cause serious ocular toxic effects. Optical coherence tomography (OCT) can be used as a valuable tool in the quantitative analysis of anti-tubercular treatment (ATT)-induced toxic optic neuropathy.

Aims:

To study the changes in visual parameters in patients on ATT and to analyze the OCT changes in patients by taking measurements once before initiation of treatment and once during ongoing treatment (between three and six months).

Settings and Design:

Tertiary care center, Prospective observational study.

Methods and Material:

A prospective observational study was conducted in 140 eyes of 70 subjects undergoing ATT as per the latest RNTCP guidelines where the following determinants were examined, and the corresponding values were taken once before initiation of treatment and once during ongoing treatment (between three and six months) and results were analyzed. Around 90% of the subjects were examined at the end fourth month. Visual acuity was taken using the Log Mar chart, color vision using Ishihara’s chart, and slit lamp examination and fundus evaluation using a 90 D lens. OCT was done and average nasal, temporal, superior, and inferior quadrant retinal nerve fiber layer (RNFL) measurements were taken. Perimetry was also done; however, findings were not included in this study.

Statistical Analysis Used:

Frequency and percentage were applied to study the changes in visual parameters in patients on ATT. A paired t-test was applied for numerical variables to analyze the OCT changes in patients undergoing ATT. A P value < 0.05 was considered statistically significant.

Results:

Despite a near-normal appearance of the fundus on ophthalmoscopy, OCT clearly demonstrated and quantified the loss of retinal nerve fibers. Statistically significant RNFL thinning (P value < 0.001) was noted in the superior, temporal, and inferior quadrants and least in the nasal quadrant (P = 0.005). Significant deterioration in visual acuity was observed following three months of ATT (P = 0.001). Red-green color vision abnormalities were detected in 14 out of 140 eyes (10%).

Conclusions:

RNFL thickness was reduced on OCT. RNFL thickness quantification and assessment of other visual parameters especially color vision help in the early diagnosis of ocular toxic effects of ATT. Hence, awareness and active screening are imperative in preventing visual impairment and blindness.
Right inferior rectus palsy – An unusual initial presentation of a case of disseminated fungal infection
Authors: Ranjan Rahul S. , Singh Anil K. , Namrata  , Agarwal Ruchika
Published: August 2024

Orbital Aspergillosis is a rare life-threatening fungal infection that is often misdiagnosed due to its nonspecific clinical and radiological appearance. In this case report, we present a case of disseminated aspergillus infection initially presenting as right inferior rectus palsy.
Mask-associated dry eyes in Indian population: A patient-reported web-based survey
Authors: Karunakaran Anjana , Krishnan Aparna , Mohan Prashobh , Sheth Jay U.
Published: August 2024

Purpose:

To present the outcomes of the mask-associated dry eyes (MADE) survey in an Indian scenario.

Methods:

An online survey was conducted amongst general population from May to July 2021 to assess the burden of dry eyes and MADE. To summarize the findings, descriptive statistics were employed, and statistical significance was determined between various mask practices and dry eye symptoms. A P value of <0.05 was considered statistically significant.

Results:

Four hundred and ten respondents are participated in this survey. Almost two third of patients (62.3%) used masks every day, and 50.7% wore them for more than six hours. Approximately 36% never experienced dry eye, 24% experienced it occasionally, and 41% experienced dry eye symptoms, with seven percent of patients experiencing it regularly. Around 30% of patients feel their symptoms started after they used the mask, whereas 70% believed that they existed before. About half of the patients (51.5%) feel that wearing the mask made their symptoms worse. Dryness symptoms, higher lubricant usage, and difficulties with air conditioning were found to be statistically significant when the frequency and hours of mask wear were increased. Furthermore, an increase in screen time was linked to an increase in eye tiredness (P = 0.018).

Conclusion:

The survey demonstrates that increased frequency and hours of mask usage leads to a worsening of dry eye symptoms. Additionally, worsening of eye tiredness was associated with increased screen time. The survey results are important for fellow ophthalmologists to better understand the impact of MADE on the quality of life of general population. This can be utilized to counsel the patients regarding the preventive and supportive eye care.
Dr ALM’s Medicolegal Series Part 1 - Supreme Court Judgement - Informed Consent
Authors: Sundaram Alagappan Meenakshi
Published: August 2024

44 year old unmarried female attended a Gynaecologist clinic for excess bleeding per vaginum . Patient was advised to undergo Diagnostic Laparoscopy and consent was obtained for Laparoscopy/Laparptomy if needed. When Laparoscopy was performed under General Anaesthesia it was found that the patient was found to have endometriosis and while the patient was under anaesthesia ,the assistant surgeon obtained consent from the mother of the patient for Hysterectomy with Bilateral salphingo oophorectomy. The patient sued the Gynaecologist for removing her uterus with ovaries which has led to premature menopause and Hormone Replacement Therapy. The National Consumer Council dismissed the appeal and the patient appealed in Supreme Court. Honourable Supreme Court held that in Medical Law, where a surgeon is consulted by a patient, and consent of the patient is taken for diagnostic procedure/surgery, such consent cannot be considered as authorisation or permission to perform therapeutic surgery either conservative or radical (except in life threatening or emergent situations). Similarly where the consent by the patient is for a particular operative surgery, it cannot be treated as consent for an unauthorized additional procedure involving removal of an organ, only on the ground that such removal is beneficial to the patient or is likely to prevent some danger developing in future. Honourable Supreme Court allowed this appeal and set aside the order of the Commission and allow the appellant’s claim in part. If the respondent has already received the bill amount or any part thereof from the appellant (either by executing the decree said to have been obtained by her or otherwise), the respondent shall refund the same to the appellant with interest at the rate of 10% per annum from the date of payment till the date of re-payment. The Respondent shall pay to the appellant a sum of Rs.25, 000/- as compensation with interest thereon at the rate of 10% per annum from 19.11.2003 (the date of the order of Commission) till date of payment. The appellant will also be entitled to costs of Rs.5, 000 from the respondent.
Nutritional and Biological Applications of Pectinases: A Comprehensive Overview
Authors: Charumathi G. , Suchitra M. R.
Published: August 2024

Pectinases, a diverse group of enzymes known for their ability to degrade pectic substances, have many biological and nutritional functions. Derived from sources such as fungi, bacteria, and yeast, these enzymes are instrumental in accelerating processes such as extraction, filtration, and clarification in fruit juice and wine production, as well as in tea, cocoa, and coffee concentration. These substances, found in plant cell walls, consist of various monosaccharides and polysaccharides, classified based on their solubility. Production of pectinases primarily occurs through solid-state fermentation and submerged fermentation, utilizing agricultural wastes such as orange peels and sugarcane bagasse. Pectin, a complex polysaccharide from plants, modulates immune responses by enhancing macrophage activity and cytokine production. Pectinases degrade pectin, yielding bioactive oligosaccharides with anti-inflammatory effects, suppressing cytokines like tumor necrosis factor-alpha and interleukin-6. These enzymes also exhibit hypoglycemic effects by inhibiting digestive enzymes, aiding in managing blood glucose levels. Moreover, pectinases display antibacterial activity by disrupting bacterial growth, relevant in food preservation. Their antioxidant properties, facilitated by phenolic compound release, combat oxidative stress. In addition, pectinase-treated pectin shows promise in inhibiting tumor proliferation and enhancing drug delivery in tablet formulations, illustrating their multifaceted therapeutic potential.
On local well-posedness of problems with characteristic free boundary for hyperbolic systems of conservation laws
Authors: Trakhinin Yuri Leonidovich
Published: August 2024

The proof of the local-in-time existence and uniqueness of a smooth solution to a free boundary problem for a hyperbolic system of conservation laws has some additional difficulties if the free boundary is a characteristic of this system. They are connected with the loss of control of the normal derivatives and the possible non-ellipticity of the symbol of the free boundary. Another peculiarity of problems with characteristic free boundary is that usually a loss of derivatives of the coefficients and source terms occurs in a priori estimates for the corresponding linearized problems. Moreover, the boundary conditions in the linearized problem can be non-dissipative, which makes it difficult to use the energy method. We describe methods for overcoming these difficulties. Our main examples are free boundary problems for Euler's equations and the equations of ideal compressible magnetohydrodynamics, for which we review the results on their local well-posedness.
Bibliography: 61 titles.
Ewolucja rynku telewizyjnego w Polsce po roku 1989 (ze szczególnym uwzględnieniem kanału TVP Kultura)
Authors: Kuchta Maja , Mętel Sara
Published: August 2024

The Polish media market underwent a significant transformation after 1989, with state media, including Telewizja Polska (TVP), at its core. Over the years, changes in the legal system, audience expectations, and growing competition from commercial stations have influenced TVP’s operations. This article examines the evolution of public television in Poland, considering cultural and technological changes. Additionally, it includes a case study focusing on TVP Kultura, exemplifying a thematic channel fulfilling the public television mission. Through a literature review and audiovisual analysis, the article attempts to answer how the transformation occurred in the Polish television market and the position of TVP within it. The research aims to identify development strategies and how Telewizja Polska maintains its presence in the media market.
The Effectiveness of the Quantum and Discovery Learning Models on Learning Achievement of Islamic Education in Junior High Schools
Authors: Wati Ifa Lidia , Daryono Rihab Wit
Published: August 2024

Objective: Low student learning outcomes in Islamic religious education lessons so that the required learning competencies are not achieved. This research aims to improve students' cognitive learning outcomes through QL and DL learning models. Method: The research used in this research is experimental research with the type of research used as Quasi Experiment using a non-random pretest-posttest control group design. Pretest-Posttest Non-Equivalent Control Group Design. The data collection technique used in this research was pretest and posttest in experimental classes 7A and 7B. Results: The results of this study show that the QL and DL methods can improve students' cognitive abilities with learning outcomes for experimental class 7A (QL) while for experimental class 7B (Discovery Learning). Meanwhile, the Independent Sample T-test results show significant differences in learning outcomes between experimental class 7A (QL) and experimental class 7B (Discovery Learning) with Sig. (2-tailed) smaller than 0.05. So, the QL learning model is more effectively used to improve students' cognitive learning outcomes than the DL learning model. Novelty: The application of QL in this research and the Discovery of Learning to improve student outcomes can be explored in particular educational contexts, such as STEM, arts, or foreign language learning. Both models can be adapted or modified to achieve optimal learning outcomes.
Implementation of an Internal Quality Assurance System (IQAS) in Vocational Schools
Authors: Jannah Siti Miftakhul , Karwanto Karwanto , Izzati Umi Anugerah
Published: August 2024

Objective: This research aims to understand and analyze content related to implementing an internal quality assurance system based on eight national education standards in Vocational High Schools (VHS) with CIPP model evaluation metrics. The evaluation was conducted to see the results of implementing the internal quality assurance system in vocational schools by eight national education standards. Methods: The type of research used is evaluation research. In this research, researchers used quantitative methods with the CIPP (Context, Input, Process, Product) evaluation model developed by Stufflebeam. The population in this research is the academic community of VHS Sunan Giri Menganti Gresik, which knows and understands the implementation of the internal quality assurance system (IQAS). Based on existing data, the population in this study was 72 people, including the school principal, curriculum leader, teacher council, education staff, and head of the school quality assurance team. Result: IQAS provides services by eight National Education Standards (SNP) to exceed the expectations of educational service users. School Self-Evaluation (EDS) describes the quality and produced information processed using government information systems. This mutual mapping is explained to identify areas of improvement using the IQAS Vocational School Transformation guide. Novelty: Implementing the quality assurance system in model schools and its impact is carried out through four stages: Setting Standards, Fulfilling Standards, Continuous Evaluation, and Quality Improvement. Decentralization of education encourages school autonomy to improve the quality of institutions and their graduates with strategies such as school reviews, benchmarking, quality assurance, and quality control.
Whole Brain Teaching and Multi-Sensory Environments on Cognitive Science Development: Moderated by Children's Learning Preferences
Authors: Aulina Choirun Nisak , Masitoh Siti , Arianto Fajar
Published: August 2024

Objective: This study aims to determine the impact of whole-brain learning and a multi-sensory environment on developing cognitive abilities in early childhood. Method: This research method uses a quantitative, quasi-experimental approach. The State University of Malang Laboratory Kindergarten's classes B and C served as the population for this study. The sample was determined by purposive sampling, so there were 60 children. We carried out the data collection process in this study using observation and closed interviews. We conducted observations to evaluate children's cognitive science abilities, encompassing information processing, intelligence, reasoning, language development, and memory. We used closed-ended interviews to measure the children's visual, audio, and kinesthetic learning styles. We processed the data using the SPSS 17.0 program, which included a validity test to determine the product moment, a reliability test with alpha Cronbach, a normality test with Kolmogorov-Smirnov, a homogeneity test with the Levene test, and hypothesis testing to test a two-way ANOVA. Results show a positive relationship between cognitive science development and learning preferences in children's learning styles, whether visual, audio, or kinesthetic. Novelty: This research can improve children's effective recall of information and open opportunities for more inclusive and adaptive learning according to each child's cognitive needs. Therefore, further research in this area has the potential to shape educational practices that are more effective in recognizing the development of cognitive science in children's learning.
Supply, Demand and Distribution of Physicians in Japan
Authors: Nishiyama Hiroyasu , Mizuma Yoshihiro , Handa Nobuo , Shin Ryong-moon
Published: August 2024

The number of physicians in Japan has been and will continue to be lower than that in other the Organization for Economic Co-operative and Development (OECD) countries. The admission capacity of medical schools, which has the greatest impact on the number of physicians, has been determined through discussions among the Ministry of Health, Labour and Welfare, medical associations, medical organizations, universities, and academics, depending on the medical supply-demand status on that era. In recent years, the maldistribution of medical specialties and regions has become an issue. For the involving this issue, Japanese government takes from multiple perspectives to address this problem, including “regional quotas” in admission quotas for university medical school and, setting a ceiling on the number of residency positions available in each prefecture as well as on recruitment capacity in the specialist physician system. The implementation of “work style reform” for physicians, focuses on shortening physicians’ working hours and has raised concerns regarding a shortage and regional maldistribution of physicians. The government’s policy is based on a key concern: rising healthcare costs could seriously threaten the country’s financial health. Therefore, the government has limited the increase in the number of physicians. Conversely, this year, the government has begun to argue that a regulatory approach is necessary to address the uneven distribution of physicians. Our proposition is to achieve a number of physicians comparable to that of other OECD countries and to create an environment that enables physicians to voluntarily address their regional and departmental maldistribution.