bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of serum asprosin levels in women with metabolic syndrome in Duhok City-Kurdistan Region/Iraq
Authors: Sulaiman Dhia M.
Published: July 2021

Background: Serum asprosin, a recently discovered hormone as a new adipocytokine, which has been associated with the regulation of both glucose and lipid metabolism, and insulin resistance. Metabolic syndrome considered as a disorder of lipid and glucose metabolism, with impairment in insulin function, which might be associated with serum asprosin, therefore, new researches focused on the role of asprosin in the pathogenesis of metabolic syndrome to clarify such relationship. This study aimed to evaluate serum asprosin levels in women with metabolic syndrome and compared with a woman without metabolic syndrome.Methods: This study was performed at Obstetrics and Gynecology Hospital, and Mazi medical clinics in Duhok, Kurdistan Region-Iraq, the study was established from June, 2020 to January, 2021. In this cross-sectional study, serum asprosin concertation in 40 women with metabolic syndrome were compared with a 131 women without metabolic syndrome. The demographic data were collected, serum asprosin levels, lipid profile, fasting blood glucose, fasting insulin were biochemically analyzed by using the autoanalyzer machine COBASS series 6000 and ELISA technique.Results: The mean age of women with metabolic syndrome was (24.36±3.23) and women without metabolic syndrome was (23.18±3.87), serum aspersion in women with metabolic syndrome was (18.34±5.4) ng/ml, while in women without metabolic syndrome was (7.48±5.82) with significant difference (p<0.001). In study population, there was a positive correlation between asprosin and body mass index, waist circumference, triglyceride, total cholesterol, fasting blood glucose, fasting insulin, and HOMA-IR (p<0.0001), while serum asprosin was negatively correlated with high density lipoprotein- cholesterol (p<0.01).Conclusions: The study confirms that serum asprosin in women with metabolic syndrome was higher than in the control group.
Infection risk in Gustilo and Anderson type III tibia and fibular fractures treated with external fixation in a tertiary hospital of a developing country
Authors: Mancha David G. , Ode Michael B. , Amupitan Idumagbodi , Onche Icha I.
Published: July 2021

Background: Open fractures of the tibia and fibula present with multiple management challenges of wound care, bone stabilization, potential risk of infection and its control. Attempt to resolve this problem, stabilization of the fracture with external fixators was introduced. However, this procedure predisposes infection too. This was an overview of the disposition of infection in the course of managing type III fractures in our center.Methods: This was a retrospective study of disposition of infection in Gustilo and Anderson type III open fractures of the tibia and fibula treated with external fixation device over ten years in Jos university teaching hospital. Data extracted from patients records and operation notes included age, sex, nature of open fracture with respect to Gustilo and Anderson classification in theater. Wound culture reports extracted early and weeks after commencement of treatment. The findings were analyzed using Epi info statistical software version 3.5.3.Results: A total of 74 patients, 63 (85.1%) males and 11 (14.9%) females (M:F=5.7:1) with mean age of 37.97±13.57 years. The mean duration of injury-presentation time was 13.48±38.73 days, 41 (55.4%). Patients that present with clinical infection were 40 (54.1%) among which staphylococcus aureus was isolated in 21 (28.3%). While treatment was on, the flora became altered. Motor cycles were responsible for 25 (33.7%), gunshots 20 (27%), motor vehicle injuries 19 (25.6%) while pedestrians accounted for 9 (12.2%).Conclusions: Type III fractures sustained from high energy risk of infections due to late presentation in our setting. Bacterial isolates tend to alter in course of hospitalization.
Comparison of clinic-radiological and functional outcome of intra articular distal end radius fractures managed by volar locking plate versus external fixation
Authors: Singh Pankaj Vir , Singh Gagandeep , Singh Tejpal , Ghani Abdul , Lone Zubair A.
Published: July 2021

Background: Distal end radius (DER) fractures are most common fractures in upper limb. Intra articular fractures can be managed either by open reduction and internal fixation by volar locking plate or can be managed by closed reduction and external fixator application or by percutaneous pinning. The purpose of our study was to compare the functional outcome of volar locking plate with that of external fixation.Methods: A prospective cohort study was conducted between June 2019 to June 2020 in Government Medical College, Jammu on 46 patients with intra articular distal end radius fractures. Of which 26 were managed by volar locking plate and 20 were managed by external fixator. the results of both groups were compared on the basis of radiological parameter and range of motion achieved post operatively. The functional outcome was evaluated using DASH score and Gartland–Werley scale. Results: Final range of motion, grip strength were better in patients managed with volar locking plate (VLP) as compared to those who were managed with external fixator (EF). Radiographically, volar tilt, radial height were all better in VLP group than EF.Conclusions: We concluded that VLP is superior method to maintain reduction till the union occurs and prevents the fracture collapse in intra articular distal end radius fractures as compared with external fixator. Thus, giving better functional and radiological outcome than the external fixator.
Inter-state cross border superspreading event of SARS-CoV2 in Central India, May 2020
Authors: Mathur Mansi , Ramaswamy Sudarshan , Sharma Mitilesh , Dhuria Meera , Arya Sujata , Chauhan Himanshu , Jain S. K. , Singh Sujeet Kumar
Published: July 2021

Background: During the mid-weeks of May 2020, a superspreading event occurred in a town of Central India, where breaking bread together led to an outburst of COVID-19 cases. This led to a sudden increase of the daily average number of cases later on in the month.Methods: An epidemiological investigation was done to investigate the cause. Process of the epidemic investigation done has been described under three parts namely - Case finding, Contact tracing, Public health response.Results: Our epidemiological investigation and contact tracing of the index case confirmed a superspreading event of COVID-19 which occurred due to multiple social gatherings during mid weeks of May 2020. It was estimated that 118 cases belonged to G0 and 94 cases belonged to G1 generation of the index case.Conclusions: Most likely source of infection to the index case was from the guests who came for a social gathering on May 11, 2020 (lockdown 3) from a village across the border in Rajasthan, a high COVID-19 prevalent zone (Orange) to a low COVID-19 prevalent zone (Green).
A randomized split mouth clinical trial of the application of the desensitizer agents for tooth sensitivity
Authors: Reddy K. Hanisha , Syed Afroz Kalmee , Alivelu Dasarathi , Danda Haranath , Alla Ramya
Published: July 2021

Background: Dentin hypersensitivity (DH) affects 3%-75% of the people and is one of the morbid tooth conditions. Hence in the present study we aim to examine the clinical effectiveness of 3 different desensitizing agents in decreasing pain of DH in time of 1 month.Methods: Fifty subjects with cervical DH in at least one tooth in any three of the 4 quadrants were selected. VAS was used to note the pain. Each quadrant in an individual was randomly assigned. Profluorid varnish, Admira protect, and PRG‑Barrier coat was used. VAS scores for the tactile and air stimuli were noted immediately after application, 1 week, and after 1 month. The data was analyzed keeping p<0.05 as significant.Results: VAS significantly reduced for all three groups from the base line (p<0.001). Admira protect showed significant reduction of hypersensitivity scores at 1 month compared to other groups (p<0.001).Conclusions: Admira protect was better at lowering the pain due to DH than PRG‑barrier coat and Profluorid varnish after 1 month of application.
Addition of the combination of sims technique and semi-fowler positioning to cardiorespiratory exercises in patients with myasthenia gravis: case report
Authors: Raini Putu Ayu Meka , Sundari Luh Putu Ratna , Fridayani Ni Kadek Yuni
Published: July 2021

Myasthenia gravis (MG) is an autoimmune disorder characterized by fluctuating muscle fatigue, worsening with increased activity, and improving at rest. Physiotherapy plays a role in reducing symptoms such as shortness of breath, respiratory muscle weakness, and airway obstruction due to decrease the sputum in the lung lobes and prevent of the exacerbation. Respiratory training and postural drainage techniques are part of intervention that given by physiotherapy for patients diagnosed with MG and had symptoms hospital acquired pneumonia (HAP). A male, 28 years old patient diagnosed with HAP and had history of MG hospitalized a month with dyspnoea and disable to do activity daily living. Physiotherapy treatment that given to the patient from 18th July 2018 till 28th July 2018 are respiratory training included breathing exercise, cough exercise, shoulder expansion, Active Range of motion (ROM) exercise, stretching of respiratory muscle and home program exercise that helped by nurse and caregiver. Patient had medical treatment from all medical team by pulmonologist, neurologist and nurse too. Combined this new technique postural drainage and all physiotherapy programs showed significant in patient such as dyspnoea decreased.
Salvaging collateral damage by COVID-19 pandemic in form of exposed silicone ear framework in 33-year post reconstructed ear
Authors: Tiwari Vinay Kumar , Nanda Deepak , Tandon Raman , Mula Rohit Babu
Published: July 2021

Total ear reconstruction is being practiced by different techniques. Ready to use Silicone ear framework (Silastic ear framework by Dow corning) was being used frequently by Plastic surgeons in the eighties and nineties of the twentieth century. Framework exposure, either due to skin necrosis or due to infection used to be the commonest complication in the early postoperative period. A follow-up case of a 50 year old male patient, our 33 years follow up case of Total ear reconstruction by silicone ear framework implantation presented to us with exposed silicone framework and infection. Due to constant use of facemask with elastic ear loop for support during COVID-19 pandemic. The exposed infected implant successfully salvaged using negative pressure wound therapy. In all cases of autologous or alloplastic ear reconstruction, we strictly recommend not to use facemasks with elastic ear loops. If a facemask has to be used it should have a head loop or to be used with an ear protector.
Isolated eosinophilic mastitis: a rare breast disease mimicking malignancy
Authors: Gondwal Anjula , Srivastav Srijan
Published: July 2021

Eosinophilic mastitis is a rare benign breast pathology which presents with lump breast and can mimic malignancy. So far eight reported cases have been found in literature review. All cases were associated with peripheral eosinophilia and systemic involvement except one. Isolated eosinophilic mastitis in the absence of peripheral eosinophilia or systemic involvement is a very rare presentation. Being one of the rare cases, prompted us to take up this case in our present study. A 40-year-old lady presented with progressively enlarging, slightly painful swelling in left breast of 15 days duration with no other relevant past and family history. The clinical differential diagnosis of mastitis and carcinoma was suggested. Aspiration cytology was reported as benign breast disease- fibroadenosis. Imaging studies undertaken were inconclusive. Case managed surgically with wide local excision. Post-surgical tissue specimen was subjected to histopathology examination and was diagnosed as eosinophilic mastitis. A prolonged follow-up revealed no recurrence.
A rare case report on 90 day glaucoma due to branched retinal vein occlusion
Authors: Kuli Jawahar Jyoti , Rai Utkarsh
Published: July 2021

A 19 year old female, presented to the ophthalmology OPD with pain and redness in her left eye since 30 days. Upon examination, there was no perception of light in left eye, both the pupils were mid-dilated and non-reactive to light stimulation. The left eye intra-ocular pressure (ATn) was 60 mm of Hg. On slit lamp examination, 3600 iris neovascularisation, ciliary congestion and corneal oedema were noted. Indirect gonioscopy revealed grade I angle closure in the left eye. Fundus examination of the affected eye revealed pale optic disc, CDR of 0.9:1, multiple dot and blot hemorrhages, suggestive of supero-temporal BRVO (branched retinal vein occlusion). Fundus fluorescein angiography revealed blocked fluorescence and leakage from neovascularization in the left eye. Conservative management with anti-glaucoma drugs failed to lower the IOP. Subsequently, pan-retinal photocoagulation (PRP) with intravitreal anti-VEGF (vascular endothelial growth factor) in the left eye followed by cyclo-cryoablation helped her symptoms to subside.
Inferior vena cava filters: a review
Authors: Barajas-Colón José Ángel , Barrera-Mera Baltazar , Banegas-Ruiz Rodrigo , Vargas-Morales José Juan , Barrera-Calva Elvira , Castillo-Martínez Daniel Benito , Grajeda-Chávez Obed Horacio , Soulé-Martínez Christian E. , Gómez-Mendoza Francisco Fabián , Mendoza-Aceves Rodrigo , Radilla-Flores Mariana del Carmen , Espinosa-Queb Nelson Niels , Corona-Figueroa Alejandro Ángel , Salazar-Trujillo Bruno Andrés , Valderrama-Treviño Alan I.
Published: July 2021

Venous thromboembolism is an entity that ranges from deep vein thrombosis to pulmonary embolism, both are highly prevalent diseases in our environment and potentially fatal. The intention of this review is to compile information regarding the indications, contraindications, complications and comparison of different therapeutic methods in order to create an algorithm. An exhaustive review was performed with the available literature, using the PubMed, ScienceDirect, Scopus and Cochrane databases from 2004 to 2021. The search criteria were formulated to identify reports related to inferior vena cava filters. Venous thrombosis manifested as deep vein thrombosis or pulmonary embolism is a highly prevalent disease in our setting with high morbidity and mortality. Currently, different therapeutic options have been presented to address this pathology, in this review we focus on the developments regarding the use of vena cava filters. Reviewing the indications for the placement of a vena cava filter, we find absolute indications such as a contraindication to anticoagulation and high risk of massive pulmonary embolism. Pulmonary thromboembolism is a disease with high prevalence and mortality, we have highly effective and novel treatments such as the vena cava filter, patients should be selected carefully always taking into account the absolute and relative indications.
Impact of COVID-19 on chronic disease management
Authors: Sama Srikar , Gajjala Alekhya
Published: July 2021

Routine care for chronic disease is an ongoing major challenge. We aimed to evaluate the impact of COVID-19 on routine care for chronic diseases. A deeper understanding helps to increase the health system’s resilience and adequately prepare for the next waves of the pandemic. Diabetes, heart failure, chronic kidney disease, and hypertension were the most impacted conditions due to the reduction in access to care. It is important routine care continues in spite of the pandemic, to avoid a rise in non-COVID-19-related morbidity and mortality. This is a review article discussing the potential impact of COVID-19 on chronic disease management.
Intriguing haemorrhages: a review of last seven decades (1951-2021)
Authors: Saha Biswajit
Published: July 2021

Bleeding as a cause of underlying psychological or psychiatric disorder is hardly ever thought of mainly due to unawareness and rarity. An overview will help to understand the real problem. A detailed literature survey of different types of bleeding from various parts of the body for which the reasons could not be diagnosed easily was made over last seven decades (1951-2021). These have been presented mainly in tabular form and also, in the text as briefly as possible to have a comprehensive overview only. The contents portray the nature, triggers and spectrum of settings in which haemorrhages occurred including the explanations which were available from the articles. In addition, some of my personal conjectures as possible causes have also been included. Unexplained bleeding might be psychological or psychiatric in origin. Awareness about this will enable to diagnose the case at the earliest and accordingly, the management can be started. Different types of such haemorrhage including particularly those due to idiopathic causes are potential areas of research.
Diagnostic value of thyroid imaging reporting and data system in thyroid nodules
Authors: Mostafa Elsayed Ahmed , Atia Radwa Mohamed , Abdel-Aal Muhammad Salah Ragab
Published: July 2021

Background: The improved detection of TNs (TNs) with US has resulted in an increase in the number of thyroid fine needle aspiration biopsy (FNAB). Appropriate criteria are necessary to avoid an increase of rather unnecessary benign cytologic results in TNs. Thyroid imaging reporting and data system (TIRADS) was first used by Horvath et al in 2009. This was to standardize the reporting of results of thyroid (ultrasonography) US that can be understood by clinicians and also stratify the risk of malignancy of a lesion based on the US features of the lesion.Methods: Cases with uninodular or multinodular goiter had been included. Evaluation of cases had been done using ultrasound of the neck. TNs were classified into categories according to thyroid imaging reporting and data system of the American colleague of radiologists (ACR-TIRADS).Cases were ordered for fine needle aspiration cytology (FNAC). Operable cases were only included in the study and postoperative histopathology was revised.Results: The study included 46 patients. The different TIRADS categories were confronted with the results of cytology and histopathology. Combining TIRADS 2 and 3 as probably benign categories and TIRADS 4 and 5 as probably malignant categories, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were respectively 100%, 84.38%, 73.68% and 100%. The accuracy of ACR-TIRADS was 89.13%.Conclusions: ACR-TIRADS helps in stratifying nodular thyroid disease based on the risk of malignancy. It could lead to a significant decrease of the number of unnecessary FNABs.
An observational prospective study of microbiological profiling in necrotizing fasciitis patients at tertiary care centre
Authors: Gupta Madhusoodan , Varshney Deepti
Published: July 2021

Background: Necrotizing fasciitis (NF) is described as the most aggressive form of skin and soft tissue infections. NF requires prompt diagnosis and urgent surgical procedure along with appropriate antibiotic coverage. Still NF has high morbidity and mortality. The aim of the study was to provide microbiological profile in necrotizing fasciitis patients and discover the appropriate antibiotics regimen to treat them early and appropriately.Methods: This observational prospective study was done of patients of necrotizing fasciitis between June 2016 to June 2018 in the department of plastic surgery in the central area of India.Results: In this study monomicrobial culture was positive in 66.7%, polymicrobial culture was positive 16.7% and no organism was found in 16.7% of patients. In our study most commonly, used antibiotic was colistine followed by tigecycline.Conclusions: Microbiological profiling and early use of sensitive antibiotic is a key to treat the necrotizing fasciitis. It renders the progression of disease and decreases the morbidity and mortality in necrotizing fasciitis.
Clinical study of prevalence of malignancy in nodular thyroid swelling
Authors: Chittipotula Balaji , Patra Rajat Kumar
Published: July 2021

Background: Large proportion of thyroid cancers arose from a pre-existing adenoma or from multinodular goiters. Surgical practice of removing thyroid nodule or multiple nodules of thyroid gland has been challenged for surgeons to prevent cancer. Aim of this study is to find out the prevalence of malignancy in solitary thyroid nodule and multi-nodular goitre in relation to age and sex. The aim of the study was to determine the incidence of malignancy in patients who underwent thyroidectomies.Methods: Study of 100 cases of nodular thyroid swelling has been done during the period from November 2017 to November 2019 on inpatients admitted to GEMS Hospital, Srikakulam, and Andhra Pradesh, India. Detail clinical examination, relevant investigations, surgical management and histopathological reports were collected and analyzed using software package for statistical analysis (SPSS 20).Results: Out of 100 patients with thyroid swellings, thyroid malignancies constitute 4%. The occurrence of thyroid cancer was maximum in the 4th decade of life. Female patients outnumbered males with a ratio of 4:0. Relative frequency of malignancy in solitary thyroid nodule was 4.76% and in multi-nodular goitre was 3.03%. Most common histopathological type was papillary carcinoma thyroid (50%); followed by follicular carcinoma thyroid (25%) and medullary carcinoma (25%).Conclusions: The prevalence of thyroid malignancy in the present study is at an earlier age group due to early diagnosis and treatment. The prevalence of thyroid cancer is higher in female when compared to those reported in the literature.  The proportion of medullary cancer is more in present study.
A study on diagnostic accuracy of modified triple assessment in palpable breast lumps
Authors: K. Radha , M. Uma
Published: July 2021

Background: Breast (mammary gland) is a distinguishing feature of class Mammalia. Patients commonly present, complaining of a lump in the breast, pain, and nipple discharge. Although the most common cause of symptoms is benign breast diseases. But as the life expectancy is increasing incidence of carcinoma breast is also increasing. 1.To assess the individual component diagnostic accuracy of MTT.Methods: This was a cross-sectional study involving 50 female patients with palpable breast lumps attending the Surgical Out-Patient of the Department of General Surgery, Government Royapettah Hospital, Kilpauk medical college, Chennai between June 2020 and May 2021 over 12 months, who underwent clinical breast examination (CBE), ultrasonography (USG), and fine-needle aspiration cytology (FNAC). Results: In the study population, the breast tumor is common on the left side account for about overall 53%age of patients. The bilateral tumors are the least common. Fibroadenoma is the most common benign tumor. In our study also similar results were obtained. The next common benign tumor among the study group is a fibrocystic disease of the breast. Analysis of the above results shows that though FNAC has a sensitivity of 90%, it has a positive predictive value of 100%. The study shows that the combined results of the Modified Triple Test are comparable to the histopathological diagnosis of the biopsy specimen. Conclusions: Our study includes assessment of combined diagnostic accuracy of Modified Triple Test in women of more than 30 years of age with a palpable breast lump.
The impact of classic bladder exstrophy-epispadias repair in adult patients without continence
Authors: Shenage Vinayak J. , Dhangar Sanjay P. , Syed Awais A. , Shengal Manisha
Published: July 2021

Background: Bladder exstrophy-epispadias complex is a rare congenital anomaly. Very few patients grow with the condition intact in their adulthood which lead to compromise in the results of repair. We herein report our experience of correction of the defects in the adult patients in single stage without doing osteotomy andurinary diversion. Methods: The sample size was 13 patients over ten years. All were treated in single stage. Bladder neck repair was done using paraurethral tissue, primary abdominal closure was done without flap, epispadias repair was done using modified Cantwell-Ransley procedure and hernial repair was done without mesh. No osteotomy was done. All the patients were followed regularly. Minimum period of follow-up was one year. Urinary continence, change in habits and subjective assessment of well-being were also noted.Results: 86.4% patients were totally incontinent. Bladder and anterior abdominal wall were closed in all the patients. Complete epispadias was possible in15.3% patients and rest were converted into coronal hypospadias. Hernia was repaired in 23% patients. All the patients were satisfied with their cosmetic results and they were able to interact socially. Conclusions: Surgical correction of the exstrophy-epispadias complex is possible in adulthood in the hands of experts in single stage without osteotomy. Regular cystoscopic examination and urine cytology yearly are recommended to diagnose the malignant changes in the native bladder as early as possible. Psychological, social and self-level of satisfaction is high among these patients after the surgical correction.
Limberg flap versus primary closure in the treatment of pilonidal sinus: a randomised clinical study
Authors: M. Devaprashanth , M. Srinivas N. , N. Akhihlandeshwari
Published: July 2021

Background: Pilonidal sinus is a chronic disease usually involving the sacrococcygeal area. Various treatment modalities exist, yet few comparison studies exist to compare the efficacy of one modality over the other. Hence this randomized clinical study was undertaken as an attempt to compare the outcomes of pilonidal sinus following Limberg flap procedure and primary closure.Methods: 60 patients undergoing surgery for pilonidal sinus disease were considered for the study. 30 patients underwent excision and primary closure and 30 patients underwent Limberg flap repair. They were followed up for 1 year. Duration of hospital stay, duration of inability to work, postoperative infection, wound dehiscence, and postoperative recurrence in a follow up period were recorded. Descriptive statistics, chi- square tests and independent t-test are the statistical tools employed.Results: Mean age was 29.83±4.99 years. Male:female ratio was 5.66:1. The mean duration of hospitalization in group A was significantly less (p<0.05) than group B. The patients in group B returned early to routine work (21.56±3.92 days) as compared to 30.5±5.92 days in group A (p<0.05). 5 of 30 patients in group A and 2 of 30 in group B developed surgical site infection. (p>0.05. 4 patients developed wound dehiscence in group A only which was found to be statistically significant.Conclusions: Limberg flap in treatment of pilonidal sinus is associated with shorter hospitalization, early return to routine work and less wound dehiscence as compared with excision and primary closure. Wound infections are comparable with both the modalities.
Abdominal cocoon syndrome with enigmatic etiology
Authors: Viswanathan Naveenkumar , M. Sabari Girieasen , Mukharjee Sourabh
Published: July 2021

Abdominal cocoon is a rare condition leading to acute or chronic bowel obstruction. Though multiple etiologies have been defined, many are idiopathic. We had three different cases of intestinal obstruction. First one was a case of intestinal obstruction in a young female and was diagnosed to have tuberculosis. She had abdominal cocoon along with perforation where even adhesiolysis was unsuccessful. Second one was a cause of right inguinal hernia in a 62-year-old male. Bowel was enclosed in a membrane and diagnosed as localised variant of abdominal cocoon. Membrane was removed and right herniorrhaphy was done. Third one was a 35-year-old male with abdominal cocoon. No previous tuberculosis history was noted and adhesiolysis was done. Thus, abdominal cocoon can present with enigmatic etiology and presentation. Only an occasional case can be due to tuberculosis as described in literature. It must always be a differential diagnosis for a case of acute or chronic intestinal obstruction.
The application of completion mastectomy and immediate reconstruction in a patient unable to undergo radiotherapy following breast conserving surgery: a case report
Authors: Sawyer Emily , Bartlett Nita , Warry Simon
Published: July 2021

Breast conserving surgery (BCS) with adjuvant radiotherapy (RT) confers an equivalent 20 year survival rate to mastectomy. Concerningly, 15% of BCS patients do not receive RT. Several barriers to completing RT have been described. However, non-compliance with post-BCS radiotherapy due to severe claustrophobia is not well documented in the literature. We report the case of a patient who declined radiotherapy following BCS due to severe claustrophobia. With advances in oncoplastic breast surgery, completion nipple-sparing mastectomy (NSM) may be an alternative to simple mastectomy in BCS patients unable to undergo RT. NSM is an oncoplastic procedure that involves attaining complete oncologic resection whilst sparing the nipple-areolar complex. Recent literature highlights that NSM has more favourable aesthetic outcomes and improves quality of life compared to simple mastectomy. This report further describes the novel use of NSM and reconstruction for the case patient and highlights its potential use in patients who are unable to undergo neoadjuvant RT.
Gallstone ileus: the importance of individualized management
Authors: Enrique Soulé-Martínez Christian , David Alfaro-Ponce , Leonel Castellanos-Aguilar , Michel Jaimes-Durán Edwing , Rodrigo Banegas-Ruíz , Angel Barajas-Colón Jose , Issac Valderrama-Treviño Alan
Published: July 2021

Gallstone ileus represents a complication of cholelithiasis, which in the literature has been reported as a rare cause of mechanical intestinal obstruction, however, the reported incidence is not so low, especially after 65 years of age. The formation of a bilioenteric fistula allows the passage of a large gallstone into the intestine, usually impacting the distal intestine. It is associated with a mortality that ranges between 12 and 27%. Treatment is surgical, although there is no consensus on which of the surgical techniques is the one of choice. We report the case of an 87-year-old male patient who was admitted to the emergency department with intestinal obstruction. He was diagnosed with gallstone ileus and was treated surgically with exploratory laparotomy, enterotomy with stone extraction, and primary closure. The evolution was favorable and without complications.
An unusual presentation of very early onset metastatic pancreatic adenocarcinoma in a young man: case report
Authors: Arora Abhishek , Jha Ashesh K. , Kumar Manoj , Kumar Manoj
Published: July 2021

Pancreatic ductal adenocarcinoma (PDAC) is rare below 45 years of age and usually presents with constitutional symptoms, pain and jaundice. A 25 year old man, non-smoker, non-alcoholic presented to us with a lump in central upper abdomen of 1 month duration. Abdominal examination revealed a hard epigastric mass of size 7×10 cm. There were no other associated symptoms and no history of any similar illnesses in the family members. All laboratory parameters were within normal limits. Computed tomography showed a heterogeneous mass of size 7×13×15 cm arising from the head and neck of pancreas abutting the anterior abdominal wall with multiple abdominal and pelvic peritoneal deposits. Ultrasound guided core needle biopsy suggested PDAC. Hence, a diagnosis of very early onset metastatic PDAC was rendered and the patient was referred for palliative chemotherapy. PDAC below 45 years of age is known as very early onset PDAC. It is usually associated with family history of PDAC and known risk factors. This case was unique because of absence of the characteristic clinical features and known risk factors, early onset of occurrence and negative family history, which led to a diagnostic dilemma.
A unique case of classic pleomorphic sarcoma restricted to the toes
Authors: Siddiqui Abdul Rehman , Akbar Suha Mohammed
Published: July 2021

Over 50% of soft tissue sarcomas occurring in older adults are histologically pleomorphic and high grade. Most have traditionally been classified as malignant fibrous histiocytoma (MFH). MFH was originally defined as a malignant pleomorphic spindle cell neoplasm showing fibroblastic and histiocytic differentiation. More recently, pathologists have accepted that this morphology may be shared by a wide range of malignant neoplasms. Many sarcomas that were previously classified as pleomorphic MFH, on careful immunohistochemical and histopathologic analyses, revealed a specific line of differentiation and could be reclassified as myxofibrosarcoma (30%), myogenic sarcoma (30%), liposarcoma (4%), malignant peripheral nerve sheath tumor (2%), or soft tissue osteosarcoma (3%), whereas about 30% had no specific line of differentiation or were myofibroblastic. The term undifferentiated pleomorphic sarcoma (UPS) is now reserved for pleomorphic sarcomas that show no definable line of differentiation by current technology. The majority of extremity sarcomas occur in the lower extremity (74 vs. 26% in the upper limb). According to one of the studies conducted on 315 patients, non-metastatic soft tissue sarcoma of the lower extremity who were treated at one institution over a ten-year period. Sixty-six percent of the lesions were above the knee, and 60% were high grade. This case had a 3x3 cm ulcer at the 3rd toe in a 30-year-old male patient who subsequently underwent midfoot ampuatation.
Testicular non-Hodgkin’s lymphoma – a rare tumor
Authors: Chatterjee Debarghya , Vakil Rakesh , Jindal Richa
Published: July 2021

Primary lymphoma of the testis is an exceedingly rare disease. We present a case of a 65 years old gentleman who presented with a brief history of testicular pain. Imaging studies and serum tumour markers indicated a testicular lesion of suspicious aetiology. High inguinal orchidectomy was performed. Histopathology and immunohistochemistry revealed diffuse large B-cell lymphoma. Positron emission tomography (PET) scan revealed a metabolically active retroperitoneal lymph node in aortocaval location. Subsequently he underwent chemotherapy with Rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) regimen plus intravenous Methotrexate, following which PET scan showed disappearance of the previously detected metabolically active lesion.
Cutaneous mucormycosis or black fungus of right shoulder region- rare case report
Authors: Gupta Madhusoodan , Varshney Deepti
Published: July 2021

Cutaneous mucormycosis or black fungus is a fungal infection which is caused by fungi of class zygomycetes and having high morbidity and mortality. It is an opportunistic infection, which is prevalent in immunocompromised patients. Risk factors associated with mucormycosis are diabetes mellitus, organ transplant, trauma, burn and long-term steroid use. Here author reports a case of mucormycosis of right shoulder complicated with necrotizing fasciitis in a diabetic patient. Patient underwent multiple sittings of radical debridement along with empirical therapy of liposomal Amphotericin B followed by skin grafting.
Editorial
Authors: Zuluaga Hoyos Gustavo
Published: July 2021

La Revista Hojas de El Bosque que hoy presentamos a la comunidad universitaria nace con una vocación pluralista. Busca constituirse como un espacio en el que puedan dialogar las diversas dependencias de nuestra Institución, y fomentar un pensamiento interdisciplinar e integrador. Hace tiempo que las ciencias, las artes y las humanidades rompieron los diques que antes las fijaban a espacios de saber autoclausurados y estables; de suerte que hoy se ven obligadas a tender puentes entre sí, en aras de iluminar una realidad ciertamente compleja. Los textos reunidos en este primer número son un fiel reflejo de esta aspiración a la interdisciplinariedad. Conjugan aportes sobre temas de actualidad elaborados desde diversas perspectivas: física, ingenieríaambiental, inmunología, ciencias de la salud, humanidades, artes y derecho.
Adopción igualitaria en Colombia
Authors: Luna Tania
Published: July 2021

A principios de este año, luego de un intenso debate público, la Corte Constitucional se pronunció en contra de la adopción de niños por parte de parejas del mismo sexo, y dejó la responsabilidad de tomar una decisión definitiva en manos del Congreso. Este análisis sitúa el debate sobre la adopción igualitaria en Colombia en el contexto de una lucha histórica por el reconocimiento jurídico de la diversidad sexual
Del conflicto armado al conflicto político
Authors: Hojas de El Bosque Revista
Published: July 2021

Con ocasión del XX Seminario Internacional de Bioética «Del conflicto armado al conflicto político», realizado en octubre de 2014 por el Departamento de Bioética de la Universidad El Bosque, concurrieron a nuestra Institución varios expertos nacionales e internacionales, como Sergio de Zubiria, Xavier Etxeberria o Volnei Garrafa, entre otros, que plantearon aportes desde la ética, la salud, la política, la filosofía, las organizaciones privadas y la educación para enfrentar los desafíos del conflicto político que vendrá después del conflicto armado. El texto que presentamos a continuación, preparado por docentes del Departamento, recoge de forma resumida las reflexiones que suscitaron las ponencias centrales y los tres conversatorios que se llevaron a cabo durante el evento. Hay que subrayar que este texto ya ha sido enviado a la Mesa de Diálogos de La Habana, con el fin de ampliar el espectro de la discusión acerca del posconflicto que, de acuerdo con los ponentes de este Seminario Internacional, no puede ser entendido como un periodo en que se extinguirán de una vez por todas las confrontaciones, sin más, sino como una fase en la que estas deberán ser gestionadas de una manera abierta y constructiva.
El nuevo proceso de medición de Colciencias
Authors: Andrade Rivas Federico
Published: July 2021

Mucha es la polvareda que ha levantado el nuevo sistema de medición de grupos establecido por Colciencias, pues algunos investigadores consideran que adopta criterios de calidad que no se ajustan a las condiciones de nuestro contexto. El artículo que presentamos a continuación, escrito por un asesor de laVicerrectoría de Investigaciones de la Universidad, examina las características, fortalezas y debilidades de dicho sistema.
Dejemos de hacer parte del “insensible precariado“
Authors: Aguilera Natalia
Published: July 2021

En algún momento muchos de nosotros hemos tenido dificultades para acceder a un empleo estable y digno. Sin embargo, cuando lo conseguimos, a menudo somos indiferentes frente a nuestros compañeros y las personas que necesitan de nuestra labor. Esta actitud insensible, sumada a la poca oferta de empleo y a las altas tasas de profesionales que buscan uno, ha generado las condiciones para el surgimiento de una nueva clase social, el “precariado”. Sobre este tema profundizará el siguiente artículo.
El reconocimiento de la autoridad indígena
Authors: Murcia Diana Milena
Published: July 2021

Las organizaciones y autoridades indígenas gozan de una jurisdicción especial en materia penal y administrativa. Esto debe tenerse siempre presente en el momento de la construcción de la paz. Considerando lo anterior, la autora de este artículo hace un balance sobre los derechos que les fueron reconocidosa los pueblos indígenas en 1991 y cómo se han cumplido hasta ahora.
Creación con código
Authors: Grillo Gálvez Clementina
Published: July 2021

La era de la tecnología ha traído nuevas opciones a la ciencia, al conocimiento y también a la creación. En el siguiente texto, nos encontramos con una apuesta audaz e interesante, producto de la combinación entre ciencia, arte y diseño en las aulas: una muestra de que el entrecruzamiento de disciplinas, modalidades y herramientas brinda miles de posibilidades hoy.
New Approaches for Protecting the Computer and Electronic Devices Against Heat Dissipation
Authors: Medjahed Driss Meddah , Lorenzini Giulio , Rebhi Redha , Ahmad Hijaz , Menni Younes
Published: July 2021

This research is based on an experimental investigation of four different types of heatsinks, which was backed up by a simulation analysis. The goal of this study is to determine the relevance of various heatsink forms and sizes, as well as to enhance the best situation. The cooling strength of these heatsinks was next investigated experimentally and then numerically, while adjusting in the same initial conditions, finding in principle that the experimental and numerical results agree, with a contrast ratio of less than 10.24%. As a consequence, we concluded that the coolant D3, which is circular and has a heat resistance of 0.582 K. W-1, is stronger than the D2 compact circular cooler, which has a resistance of 0.590 K. W-1. These two varieties were far superior to the regular D1 heatsink, which first debuted in the early days of computers and had a resistance of 0.595 K. W-1, but the best was the mixed engineering D4 heatsink, which had a heat resistance of 0.50 K. W-1. Changes were also made to the geometry of the best heatsink D4, by varying its heights (28, 23, 19, and 15 mm). The heat resistors were arranged in sequence (0.50, 0.560, 0.568, 0.586 kg/s), and the weights were arranger in order (3.12N, 2.56N, 2.11N and 1.67N).
Aplicabilidade de extratos de erva-mate (Ilex paraguariensis) em diferentes alimentos
Authors: Chaicouski Adeline , Lazzarotto Marcelo
Published: July 2021

A erva-mate é uma árvore do Sul do Brasil, Paraguai, Argentina e Uruguai. Estudos demonstram diversas propriedades da erva-mate, como estimulante, antioxidante e anti-inflamatório, devido aos compostos bioativos como metilxantinas, saponinas e compostos fenólicos. Recentes descobertas tem propiciado o desenvolvimento de pesquisas em diversas áreas do conhecimento, como farmacêutica e alimentícia. Pesquisas têm sido desenvolvidas com alimentos comum do dia a dia buscando torna-los alimentos funcionais com adição de extratos de erva-mate. O objetivo deste trabalho foi realizar uma pesquisa bibliográfica de pesquisas que utilizaram erva-mate na formulação de alimentos. Foram encontrados trabalhos entre 2003 e 2020 totalizando 34 estudos. Os alimentos desenvolvidos foram os mais diversos, como geleias, pães, bebidas, chocolate branco, bolo, barra de cereal, iogurte, gelatina e filmes biodegradáveis com ação antioxidante na conservação de produtos cárneos. O resultado mostra que a área de desenvolvimento de produtos com erva-mate é promissora. Percebeu-se que os alimentos produzidos são bem formulados e apresentam estabilidade química e microbiológica.
Navigating Tensions Associated with Smartphone Use in Outdoor Recreation Settings
Authors: Shepherd Craig , Johnson Kilty Trina , McCoy Dan , Bolliger Doris
Published: July 2021

Smartphones are increasingly appearing in outdoor recreation settings despite controversy surrounding their appropriateness. This study examined the perceptions of eight instructors of an outdoor leadership development program regarding appropriate and inappropriate smartphone use, tensions and boundaries that arise during outdoor activities, and how those tensions are navigated. Results indicate that instructors often welcomed smartphones for photography, navigation, and limited communication. In addition to travel and down time, instructors allowed those who participated in program activities to use smartphones during main activities so long as it did not interfere with program goals, distract others, or present safety concerns, even in high-risk and back-country areas. When uses were deemed inappropriate, reminders of established policies, increased communication, and social policing by other group members often resolved concerns.
A Model for the Flash Technique Based on Working Memory and Neuroscience Research
Authors: Wong Sik-Lam
Published: July 2021

Research has shown that the Flash Technique (FT) appears to reduce memory-related disturbance and may reduce symptoms of posttraumatic stress disorder. This paper discusses the connections between FT and eye movement desensitization and reprocessing (EMDR) therapy. In FT, clients remind themselves of a traumatic memory without dwelling on it and focus instead on a positive engaging focus and then blink their eyes when prompted. This paper summarizes numerous models describing how the brain processes traumatic material and presents a model for how FT may work in the brain. It proposes that during the blinking, the patient’s periaqueductal gray (PAG) may take over, sensing the reminder of the traumatic memory and reflexively triggering the amygdala. In Porges’s neuroception model, the PAG assesses danger without going through the conscious brain. Recent fMRI data show that for patients with posttraumatic stress disorder, there is enhanced connectivity from the amygdala to the left hippocampus. Thus, triggering the amygdala may, in turn, activate the left hippocampus, which may then provide a brief access to the traumatic memory. Given the brief access, there is insufficient time for the amygdala to go into overactivation. The client remains calm while accessing the traumatic memory, thus setting up the prediction error necessary for possible memory reconsolidation. This process is repeated during blinking in FT allowing memory reconsolidation to proceed. This model requires experimental confirmation.
Withholding Emotional Expression can Hurt Heart: A Cross-Sectional Study of Attention and Emotion Regulation after Coronary Angioplasty
Authors: Agarwal Anchal , Mathur Kamayani
Published: July 2021

Emotions and physical health are entwined with each other. Much importance is being given lately in understanding the role of emotions and its management in chronic illnesses, especially cardiovascular disease (CVD), which is one of the leading causes of fatality in the present times. There is already burgeoning literature available with regards to coronary artery bypass grafting(CABG), but scarcely on percutaneous coronary intervention (PCI) patients.
New-Onset Type 1 Diabetes in Children and COVID-19
Authors: Alexandre Maria Inês , Henriques Ana Raquel , Cavaco Daniela , Rodrigues Luís , Costa Sara , Robalo Brígida , Pereira Carla , Sampaio Maria de Lurdes
Published: July 2021

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