bluuebunny/crossref_metadata_2025 huggingface dataset:
Sunray sign in chest radiograph: A marker of central airway lung malignancy!
Authors: Patil Shital , Patil Deepak
Published: August 2023

Lung cancer is usually diagnosed in the late stage due to a lack of awareness of symptoms to patient, lack of widespread screening practices, and lack of sensitization to the most common radiological signs of lung malignancy to family physicians. Radiological signs will help in suspecting lung cancer earliest and important role in guiding a protocolized workup to rule out underlying malignancy. “Sunray sign” in chest radiograph is first time described in the literature and constitutes hilar mass or radiopacity with inhomogeneous linear opacities spreading toward the peripheries like sunrays, which is a marker of interstitial lymphatic involvement due to the malignant spread of the disease. “Sunray sign” is an indicator of underlying lung malignancy with central airway or mainstem bronchus involvement with lymphatic dissemination in linear opacities. In this case report, we have reported a 59-year-old male presented with cough and hemoptysis with progressive worsening of shortness of breath. The chest X-ray documented round opacity occupying the right hilum with linear opacities emerging toward the peripheries in the lung parenchyma showing typical “sunray sign.” Bronchoscopy was done after clinical stabilization and showed endobronchial polypoidal growth in the right intermediate bronchus causing partial occlusion of the bronchial lumen. Endobronchial needle aspiration cytology and punch or forcep biopsy (FB) histopathology were suggestive of a “squamous cell” type of lung malignancy for “sunray sign” in our case. A high index of suspicion is a must to rule out underlying malignancy, and bronchoscopy is the “gold-standard” test in cases with sunray sign to confirm diagnosis.
Downregulation of E-cadherin immunohistochemical expression - Highlights its role in epithelial- to-mesenchymal transition in breast carcinomas
Authors: Adil Mohammad , Akhtar Kafil , Fahim Mazhar , Siddiqui Shahid Ali
Published: August 2023

BACKGROUND:

E-cadherin is known to have an important role in the regulation of epithelial–mesenchymal transition process and in the tumor progression.

AIMS AND OBJECTIVES:

The aim was to study the expression of immunomarker E-cadherin and evaluate its diagnostic and prognostic significance in breast carcinoma.

MATERIALS AND METHODS:

This prospective study was conducted on 90 diagnosed cases of breast carcinoma presenting clinically with breast lumps. Immunohistochemistry was performed by E-cadherin antibodies and evaluated.

RESULTS:

Majority of the cases were seen in the age group of 41–50 years, 32 (35.6%). Most of the patients were postmenopausal females, 53 (59.5%). The most common subtype involved was invasive carcinoma No special type (NST) in 78 (86.7%) with Grade 2 in 55 (70.5%) cases. E-cadherin expression was strong in Grade 1 tumors, mixed intensity in Grade 2 tumors, and weak in Grade 3 tumors. Of 11 cases of metastasis, 8 (72.7%) cases showed 1+ E-cadherin immunoexpression and 3 (27.3%) cases showed 2+ immunoexpression. The statistical correlation between E-cadherin immunoexpression with tumor recurrence and distant metastasis was found to be significant (P < 0.001).

CONCLUSIONS:

Patients with moderate-to-high expression of E-cadherin had a longer disease-free survival. High grade and advanced stage of carcinoma had absent or weak expression of E-cadherin and was associated with aggressive tumor characteristics with early recurrence, distant metastasis, and reduced disease-free survival.
Clinical profile and outcomes of multisystem inflammatory syndrome in children associated with COVID-19 virus after surgery for congenital heart defects
Authors: Sujana Chitturi Sai , Wadile Santosh , Srinivas Chitturi Subrahmanya , Banpurkar Ashishkumar Moreshwar , Murthy Prabhatha Rashmi , Kulkarni Snehal
Published: August 2023

Introduction:

To study the clinical presentation, laboratory profile, echocardiographic details, management, and outcomes of children who were diagnosed to have multisystem inflammatory syndrome in children (MIS-C) in the immediate postoperative period after surgery for congenital heart defects (CHDs).

Materials and Methods:

This is a prospective case–control study that included children diagnosed to have MIS-C in the postoperative period based on clinical signs, rise in inflammatory markers, and echocardiographic features of ventricular dysfunction or coronary involvement. Management included intravenous immunoglobulin (IVIG), steroids, and antiplatelet medications in addition to routine postoperative care. Out of the 461 children who underwent surgery for CHD between April 1st, 2021, and November 30th, 2021, 18 children were diagnosed with MIS-C. After the initial routine postoperative course, all 18 children had sudden worsening in clinical and laboratory parameters. Other causes such as bacterial infection were ruled out. All of these children had features of MIS-C with ventricular dilatation and dysfunction, coronary artery involvement, and reactive COVID-19 immunoglobulin G antibody. There was a significant improvement in coronary artery dimensions after IVIG administration (P = 0.001). The involvement of the left main coronary artery was associated with significantly increased length of intensive care unit (ICU) and hospital stay (P = 0.019). Mean ICU and hospital stay was prolonged in the MIS-C group. There were two deaths in this group due to severe left ventricular dysfunction.

Conclusions:

During the pandemic, a proportion of patients undergoing elective cardiac surgery may develop unexpected worsening in clinical status due to MIS-C. A high index of suspicion and prompt treatment with IVIG and steroids may be helpful in improving outcomes.
Incremental value of fetal spatiotemporal image correlation echocardiography in the diagnosis of tetralogy of Fallot with disconnected pulmonary arteries with ductus arteriosus supplying the left pulmonary artery
Authors: Karapurkar Sonia , Kappanayil Mahesh , Kumar Raman Krishna , Vaidyanathan Balu
Published: August 2023

Disconnected branch pulmonary arteries are sparsely reported cases in prenatal diagnosis literature. We report a case of tetralogy of Fallot with disconnected branch pulmonary arteries, the left pulmonary artery (LPA) arising from an indirect ductus arteriosus (DA) from the base of the innominate artery in a right aortic arch, diagnosed by fetal echocardiography with 3D/4D spatiotemporal image correlation (STIC) imaging. Prenatal diagnosis led to early neonatal intervention to maintain blood flow to the LPA by stenting of the DA. Fetal echocardiographic evaluation (Voluson E10 systems, GE Healthcare, Zipf) with acquisition of images and volumes in the right ventricular outflow tract and three-vessel trachea view with rendering of 3D/4D STIC volume datasets to display images in high-definition color format. Prenatal evaluation was initially done at 17-week gestation in a 28-year-old pregnant female which showed tetralogy of Fallot (TOF). Subsequent evaluation at 34 weeks with 3D/4D STIC datasets showed a small main pulmonary artery (MPA) continuing into an adequately sized right pulmonary artery. The LPA was very small (Z-score −2.63), with no visible connection to MPA. Rendering of the 3D/4D STIC datasets revealed disconnected pulmonary arteries with the vertical DA from the base of the innominate artery in a right aortic arch, continuing as the LPA. Findings were confirmed on postnatal high-resolution CT pulmonary angiography and cardiac catheterization with subsequent stenting of the ductus. This report highlights the incremental benefit of advanced 3D/4D STIC rendering in accurate prenatal diagnosis of a rare anomaly of TOF with disconnected pulmonary arteries, leading to early neonatal intervention to preserve the blood supply to the left lung.
Clinical profile and outcome of cardiac manifestations in patients presenting with multisystem inflammatory syndrome in children associated with SARS-CoV-2 infection
Authors: Singal Gautam , Batta Akash , Bhargava Siddharth , Kumar Sushil , Tandon Rohit , Gupta Anshuman , Goyal Abhishek , Chhabra Shibba Takkar , Aslam Naved , Wander Gurpreet Singh , Mohan Bishav
Published: August 2023

Multisystem inflammatory syndrome in children (MIS-C) can cause significant morbidity and mortality in children. This study was conducted to assess the pattern and outcome of cardiac abnormalities in MIS-C. This retrospective study was conducted in children with MIS-C between 1 month and 18 years. We enrolled 53 children with a mean age of 7.78 ± 4.62 years. Overall, 35.8% of children with MIS-C had cardiac manifestations in the form of coronary artery abnormalities (CAAs) or left ventricular (LV) dysfunction. Younger age (P 0.009) and high C-reactive protein at admission (P = 0.001) were significant predictors of cardiac involvement. CAAs were seen in 11.3% of children. On follow-up, 67% and 83% of children showed regression of CAA at 1 and 6 months, respectively. 24.5% of patients had presented with LV dysfunction. LV ejection fraction improved significantly at 1 month (P = 0.002) and 6 months (P = 0.001). Cardiac outcomes in MIS-C were favorable with timely identification and treatment.
Ascending aortic pseudoaneurysm presenting as heart failure in a child – A rare complication associated with coronavirus disease 2019
Authors: Bakhru Shweta , Dhulipudi Bhargavi , Koneti Nageswara Rao
Published: August 2023

The prevalence of coronavirus disease-2019 (COVID-19) is about 2% in children. Varied manifestations including pneumonia, myocarditis, and multisystem inflammatory syndrome, namely is commonly seen in children. Aortic pseudoaneurysm due to COVID-19 is rare and carries a poor prognosis. We came across a 5-year-girl who had presented with heart failure due to a large ascending aortic pseudoaneurysm associated with COVID-19 during the first wave of the pandemic. The patient underwent successful surgical repair.
A Randomized Control Study of Oral Itraconazole versus Itraconazole with Terbinafine in the Treatment of Dermatophytosis
Authors: Sharma Divya , Saluja Amandeep , Meena Sanjay , Gupta Kalpana
Published: August 2023

Background:

Dermatophyte infections are one of the first known fungal infections of humankind and are most common throughout the world. The antifungal therapies over the past 30 years have improved, but the phenomenon of antifungal resistance is still of major concern. Combination therapies can show great promise in overcoming this problem to broaden the spectrum of activity, enhance the rate or extent of killing, and minimize the development of resistance.

Objectives:

To find out the therapeutic efficacy of itraconazole versus itraconazole with terbinafine for the treatment of dermatophytosis.

Materials and Methods:

A prospective study was conducted for a duration of 1 year on 64 patients diagnosed with dermatophytosis and was randomly divided into two groups. Group A was given oral itraconazole whereas Group B received oral itraconazole and oral terbinafine for 4 weeks along with levocetirizine daily for 2 weeks and miconazole 2% topically for 6 weeks. The measurability criteria were done on detailed clinical examination (itching, erythema, size, number, scaling, and margin) and through photographic assessment.

Results:

The mean difference and standard deviation of total scores for group A were 10.12 ± 4.09 and for group B were 9.94 and 3.75, respectively. The P value was not significant (P = 0.78). Out of 64 cases, 3 (5%) patients complained of gastric discomfort, 2 (3%) patients complained of nausea, and 1 (1%) of dizziness.

Conclusion:

This study revealed that there was a highly significant improvement in both groups with no significant difference in their clinical criteria.
Estimation of Hair Cortisol Levels as a Biomarker of Chronic Stress in Psoriasis: A Pilot Study
Authors: Budamakuntla Leelavathy , Loganathan Eswari , Ramesh Heera , Karagaiah Priyanka , Somashekhar Sachin , Venkatarayaraju Shankar Kumar
Published: August 2023

Background:

Psychological stress can exacerbate many inflammatory diseases like psoriasis by dysregulation of the hypothalamic–pituitary–adrenal (HPA) axis. One method of establishing this correlation is by measuring cortisol levels. Deposition of cortisol in the hair during its growth allows for retrospective quantification and to analyze the relationship between hair cortisol levels, stress, and psoriasis.

Objective:

The objective of this study is to evaluate hair cortisol levels as a biomarker of chronic stress in psoriasis patients.

Materials and Methods:

Detailed clinical and personal history and stress-related events before the onset of the disease or any exacerbations during the disease were taken. Clinical severity was assessed using psoriasis area and severity index (PASI) scoring. Stress levels in individuals, during the previous 6 months were assessed, using Holmes–Rahe Life Stress Inventory. Following this, hair samples were collected from the vertex of the scalp and sent to the laboratory in an envelope. After extraction of the cortisol, their levels were estimated using an enzyme-linked immunosorbent assay. Statistical analyses were done.

Results:

Mean hair cortisol level per mg of hair sample was 0.92 ± 0.84 ng/mg compared to 0.50 ± 0.60 ng/mg in controls (P = 0.002). There was a significant positive correlation of hair cortisol levels with the duration of disease, PASI score, and stress level.

Conclusion:

Measurement of cortisol in hair is a novel, noninvasive method that may assess systemic cortisol levels over several weeks to months. It may potentially be used as a biomarker in psychocutaneous disorders like psoriasis.
A Cross-Sectional Survey to Evaluate the Influence of the COVID-19 Pandemic on Treatment Adherence in Chronic Dermatological Diseases
Authors: Patil Priyanka C , Viswanath Vishalakshi , Joshi Pradnya R , Dhakne Mayuri
Published: August 2023

Background:

The COVID-19 pandemic and subsequent nationwide lockdowns have contributed to complex problems in the management of chronic dermatological diseases.

Objectives:

The objective of this study is to evaluate the impact of the COVID-19 pandemic on the management of chronic dermatological diseases treated with/without systemic immunomodulators and phototherapy.

Materials and Methods:

A single-center, cross-sectional, questionnaire-based survey via telephone calls/Google Forms was conducted from May 2020 to July 2020. Multivariate correlation analysis with adherence to treatment as dependent variable was performed to study the influence of various demographic variables, treatment-related factors, and pandemic issues.

Results:

Data of 138 patients (55% with psoriasis, 21% with vesiculobullous diseases, 18.2% with connective tissue diseases, and 5.8% with conditions such as alopecia areata, vitiligo, lichen planus, and reactive arthritis) were analyzed. The study population consisted of 81.1% of patients on systemic immunomodulators. Autonomous treatment modification was reported by 77% leading to poor disease control in 53.7%. There was a statistically significant negative correlation between income loss during the pandemic and treatment adherence. Duration of illness also showed a significant negative correlation, thereby indicating that treatment adherence reduced with disease chronicity. The highest nonadherence was noted with apremilast. None of the patients reported confirmed COVID infection.

Conclusions:

The study findings emphasize the direct and indirect effects of the COVID-19 pandemic on treatment adherence in chronic dermatological diseases. It underlines the need for better pandemic response by the development of patient education programs, standard protocols, and functional teledermatology units in Indian public health-care settings.
Herpes Zoster following Recombinant COVID-19 Vaccine: A Case Series
Authors: Poddar Shreya , Podder Indrashis
Published: August 2023

The ongoing novel coronavirus pandemic caused by the SARS-COV-2 virus has severely affected the global population. As various vaccines are being introduced to combat this virus, several adverse effects are being commonly reported such as mucocutaneous reactions, local injection site reactions, and delayed hypersensitivity reactions manifesting as “COVID arm.” However, uncommon side effects like reactivation of certain viruses are also being recently reported. We are reporting three cases of herpes zoster which occurred following the first dose of the recombinant COVID-19 AZD1222 vaccine, to generate awareness about this uncommon sequel.
Holistic Approach to Management of Acne: Exploring the Evidence
Authors: Mehta Ambalal Sujata R
Published: August 2023

A shift in the understanding of acne from a skin disease to a systemic, chronic inflammatory, lifestyle disease has fueled our curiosity about holistic ways to manage it. As with other noncommunicable diseases, long-term management needs a comprehensive approach. Apart from topical and systemic medications, changes in diet and lifestyle can help us achieve superior and long-lasting results. Moreover, as the biochemical pathways linking risk factors to acne are getting clearer, the potential prospect of early holistic management of acne preventing or delaying other lifestyle disorders such as obesity, diabetes, or cardiovascular disease is encouraging.
Intriguing Nodules Mimicking as Leprosy: An Interesting Case Report
Authors: Belgaumkar Vasudha A , Bhatt Neelam , Chavan Ravindranath B
Published: August 2023

The differential diagnosis of disseminated infiltrated cutaneous nodules includes a plethora of disorders ranging from the more frequently encountered infective and granulomatous conditions to the obscure ones with proliferative and malignant origin. Histiocytosis can be divided into those involving dendritic cells and those involving the macrophage–monocyte lineage. Sinus histiocytosis with massive lymphadenopathy (Rosai–Dorfman disease) is a rare benign disease of unknown etiology. It is imperative to distinguish this from lymphoma and other types of histiocytosis because of the vast differences in management strategies and prognosis. We hereby report an elderly woman who presented with erythematous infiltrated nodules, previously diagnosed and treated unsuccessfully as leprosy. However, her clinical examination revealed cervical and axillary lymphadenopathy which led us to the final diagnosis of Rosai–Dorfman disease on the basis of emperipolesis with lymphohemophagocytosis on histopathology with positive staining for CD 68, S100, and negative CD 1a staining on immunohistochemistry.
Knowledge, Attitude, and Practices Regarding COVID-19 among Patients Attending the Dermatology Outpatient Department: A Cross-Sectional Study
Authors: Sarkar Rashmi , Sanke Sarita , Samudrala Suvarna , Mendiratta Vibhu , Yadav Kartikey , Chander Ram
Published: August 2023

Background:

The current trend in the declining rates of new COVID-19 case detection may be attributed to better awareness and more robust screening and testing programs all across the country. Although there have been many studies on the impact of COVID-19 in India and its management, there are no studies currently regarding the knowledge, attitudes, and practices (KAP) among the community.

Objective:

This study aims to study the KAP regarding COVID-19 attending the dermatology outpatient department in a tertiary care center.

Materials and Methods:

A cross-sectional, descriptive study was conducted on 202 patients attending the dermatology outpatient department. After taking consent, the enrolled patients were directed to complete the COVID-19 KAP questionnaire, which was adapted from a previous study, and was translated into Hindi.

Results:

Our study showed a good knowledge score of 8.01 ± 1.94 for males and 7.71 ± 2.4 for females. The knowledge scores were similar in both genders and across all age groups and employment groups. The knowledge scores were significantly higher in those with higher education levels.

Conclusion:

Male gender, with higher education and a higher COVID-19 knowledge score, was also associated with a significantly more positive attitude. Females, with higher education and a higher COVID-19 knowledge score, were also found to have better protective measures against COVID-19.
Computerised tomography brain findings in male patients with alcohol dependence syndrome: A hospital based cross sectional study
Authors: Suchak Vatsal , Kakunje Anil , Reddy Vishwanath
Published: August 2023

Background:

Alcohol dependence syndrome (ADS) is a set of mental, emotional and physiological effects of drinking alcohol daily. This study aimed to assess the computerised tomography (CT) brain findings in patients with ADS and to compare it with age-matched controls.

Aims:

To study the relationship of CT-Brain findings in Male patients with alcohol dependence syndrome and compare it with controls.

Materials and Methods:

This retrospective study was carried out after obtaining clearance from the institution’s ethics committee between 1 January 2021 and April 2022. Medical records of 64 patients were examined, of which 32 patients with the diagnosis of ADS who had already undergone CT brain Neuroimaging and 32 age- and sex-matched normal controls, were randomly selected and parameters were compared to look at cortical atrophy, cella media index (CMI), the maximum width of the third, fourth ventricle, frontal subarachnoid space, Evans ratio, the maximum width of the anterior interhemispheric fissure and maximum width of the Sylvian fissure (MSF).

Results:

The study detected that the mean age of cases was 41.96 years, and in controls, it was 40.91 years with no significant difference. There was a significant difference in the mean level of CMI, the maximum width of the third and fourth ventricle, frontal subarachnoid space, the maximum width of the anterior hemispheric fissure and the MSF amongst the cases compared to controls.

Conclusion:

Compared to controls, there was a significant change in CT brain findings amongst the ADS patients.
An intriguing case of episodic hypersomnolence- Kleine–Levin syndrome, a diagnosis often missed
Authors: Chauhan Shreya , Sabharwal Ramakant K. , Kumar Praveen , Paul Paramita
Published: August 2023

A sleep disorder is characterised by alteration in normal pattern of sleep enough to interfere with the normal functioning of an individual. Sleep disorders are broadly classified as primary sleep disorders such as dyssomnias, hypersomnia and parasomnias and secondary due to medical and mental disorders such as anxiety or substance abuse. We report the case of a 12-year-old boy who presented to us with episodic hypersomnolence, hyperphagia and behavioural abnormalities and was initially managed as epilepsy at another hospital. He was subsequently diagnosed as primary sleep disorder, Kleine–Levin syndrome. We also describe the diagnostic approach to such a case and the crucial role of functional brain imaging in it.
The pattern of antimicrobial resistance and the presence of the vaginolysin gene in Gardnerella vaginalis isolates from pregnant women
Authors: Tripathi Deepika , Saxena Rishi Kumar , Agarwal Sippy
Published: August 2023

Background:

Bacterial vaginosis (BV) is a common vaginal infection, with Gardnerella vaginalis being the predominant microorganism responsible. BV causes vaginal discharge and irritation and is associated with adverse pregnancy outcomes. Vaginalis produces a pore-forming protein toxin, vaginolysin (VLY), which is essential for virulence and plays a role in the pathogenesis of BV.

Aim:

This study aimed to investigate the prevalence of the VLY gene in isolates of G. vaginalis from pregnant women and to determine their antibiotic sensitivity patterns.

Materials and Methods:

Vaginal secretions were collected from 250 pregnant women and processed for G. vaginalis isolation. Presumptive identification of the isolates was done by Amsel’s criteria, b▯haemolysis and oxidase and catalase tests. A polymerase chain reaction was used to confirm the bacterial identity and detect the VLY gene. Anti▯microbial susceptibility patterns were determined for metronidazole, nitrofurantoin, sulphonamides, chloramphenicol and ampicillin.

Results:

Out of 250 swabs examined, 72 (28.8%) were positive for G. vaginalis, with 59 from BV patients and 13 from non▯BV patients. The VLY gene was detected in 33.3% of G. vaginalis isolates from non▯BV patients and in 66.6% of those from BV symptomatic patients. Metronidazole and chloramphenicol showed a high sensitivity of 66.6%.

Conclusion:

The study concludes that regional drug susceptibility studies should be conducted to reduce the phenomenon of bacterial resistance. Further prospective research is needed to understand the function of G. vaginalis in the pathogenesis of BV.
His Bundle Pacing and its Alternatives
Authors: Li Zeyi , Zhao Shuang
Published: August 2023

Cardiac pacing remains the only definitive therapy for nonreversible bradycardia. The deleterious effects of long-term right ventricular (RV) apical pacing have been well recognized. Physiological pacing is to mobilize the intrinsic conduction system as much as possible or mimics a full cycle of atrioventricular activation and would provide an optimal clinical outcome and improve traditional RV apical and cardiac resynchronization therapy biventricular pacing modalities. His bundle pacing (HBP) and bundle area pacing are emerging modalities for a possible better electrophysiological performance. In this review, definition, characteristics, and evidence on the advantages or disadvantages of HBP and its alternatives are discussed.
The Ring of Fire – Substrate Isolation in Ischemic Heart Disease and Recurrent Ventricular Tachycardia
Authors: Kany Shinwan , Rillig Andreas , Metzner Andreas , Ouyang Feifan
Published: August 2023

We present a case of a 79-year-old man with slow ventricular tachycardia (VT) storm and ischemic heart disease despite antiarrhythmic drug therapy, implantable cardioverter defibrillator (ICD), and two VT catheter ablations. He presented with stable ischemic heart disease and a large apical aneurysm along with a left ventricular ejection fraction of 30%. We performed catheter ablation in conscious sedation. After substrate-based mapping, we identified a large scar area in the region of the aneurysm. Only the cycle length of the clinical VT was known but not inducible. Two other VTs were inducible. As the slow VTs were not accessible through the ICD due to slow heart rate, we performed an encirclement of the whole scar tissue. After that, no VTs were inducible anymore and the patient remained free of symptomatic episodes thereafter. The best strategy in substrate-based ablation is still not clear. Prospective clinical trials are needed to identify the right strategy for the right patient.
Data quality – The foundation of real-world studies
Authors: Bhatt Arun
Published: August 2023

Real-world data, routinely collected from multiple sources outside typical clinical research settings, are useful in conducting real-world studies. Sub-optimal and inconsistent data quality is a challenging issue which should be addressed whilst planning and conducting real-world studies. This brief review discusses the quality aspects of data needed for RWS.
Emergency use authorization of medicines: History and ethical dilemma
Authors: Bishnoi Mamta , Sonker Aniket
Published: August 2023

The regulatory approval process of the United States Food and Drug Administration and European Union is the most demanding and challenging worldwide. They have the provision of the expedited approval pathways, i.e., “Emergency use authorizations” and “Conditional marketing authorizations,” respectively, to give approval to novel therapeutics agents during emergency situations. India, firstly formalized the accelerated pathway named “Accelerated Approval Process” as per the New Drugs and Clinical Trials rule 2019 to address unmet medical needs that was implemented by the Central Drug Standard Control Organization to approve the novel therapeutics agents during COVID-19. Hence, our aim is to understand and compare the different emergency approval processes in the world, their underlined claims and conditions with the list of approved products under this concept. All the information collected and analyzed from different official websites of regulatory bodies. In this review, we have enlightened on all these processes with their few approved products.
Introduction to qualitative research methods: Part 2
Authors: Surawy-Stepney Nick , Provost Fabien , Bhangu Shagufta , Caduff Carlo
Published: August 2023

Qualitative research methods are typical of the social sciences and humanities, but they can also be highly useful in clinical research. This article is an introduction to six key qualitative methods: surveys and interviews, participant observation and focus groups, and document and archival research. We discuss the important features of each method, as well as how and when they might be employed.
Prevention and treatment of noncognitive complications
Authors: van Zundert André , Gatt Stephen P. , van Zundert Tom Christophe
Published: August 2023

Patients aged 65 and older are the fastest growing segment in the population of many countries. Based on evolving demographics showing increasing life expectancies, it is expected that there will be a concurrent rise in the demand for a large variety of surgical and anesthesia services. Surgery offers definitive management of many age-related diseases and provides symptom-relieving (morbidity) and life-extending (mortality) benefits. However, elderly adult surgical patients, especially the frail ones, often require a different level of care than younger patients during the perioperative period. As many have chronic illnesses and acquired deconditioning and functional decline, older patients are prone to develop untoward outcomes such as postoperative complications and loss of independence. This manuscript focuses on the holistic quality person-centered care, supported by a wide stakeholder team of health-care workers, ensuring fidelity to comprehensive geriatric assessment and optimization services where possible, offering a systematic approach to early health risk assessment and risk modification in the perioperative period, with the ultimate goal of reducing postoperative complications and health-care costs. The “comprehensive geriatric assessment and optimization” cost-effective approach builds on robust evidence with older people more likely to be alive, a shorter length of hospital stay due to fewer postoperative medical complications, and improved rates of return to usual residence. Prehabilitation programs are delivered focusing on primary (through counseling) and secondary prevention (through screening) with an aim to improve fitness for surgery, by evaluating functional capacity, nutritional and psychological health, prompting interventions, targeting physical exercise, lifestyle and nutritional advice, and psychological support.
A systematic review of predictive accuracy via c-statistic of preoperative frailty tests for extended length of stay, post-operative complications, and mortality
Authors: Dunlop Richard A. N. , Van Zundert André
Published: August 2023

Frailty, as an age-related syndrome of reduced physiological reserve, contributes significantly to post-operative outcomes. With the aging population, frailty poses a significant threat to patients and health systems. Since 2012, preoperative frailty assessment has been recommended, yet its implementation has been inhibited by the vast number of frailty tests and lack of consensus. Since the anesthesiologist is the best placed for perioperative care, an anesthesia-tailored preoperative frailty test must be simple, quick, universally applicable to all surgeries, accurate, and ideally available in an app or online form. This systematic review attempted to rank frailty tests by predictive accuracy using the c-statistic in the outcomes of extended length of stay, 3-month post-operative complications, and 3-month mortality, as well as feasibility outcomes including time to completion, equipment and training requirements, cost, and database compatibility. Presenting findings of all frailty tests as a future reference for anesthesiologists, Clinical Frailty Scale was found to have the best combination of accuracy and feasibility for mortality with speed of completion and phone app availability; Edmonton Frailty Scale had the best accuracy for post-operative complications with opportunity for self-reporting. Finally, extended length of stay had too little data for recommendation of a frailty test. This review also demonstrated the need for changing research emphasis from odds ratios to metrics that measure the accuracy of a test itself, such as the c-statistic.
Regional anesthesia for geriatric population
Authors: Al Harbi Mohammed K. , Alshaghroud Salah M. , Aljahdali Mohammed M. , Ghorab Fadi A. , Baba Fayaz , Al Dosary Rayan , Bahadeq Mohammed
Published: August 2023

Advancements in modern health care over 20 years have substantially increased the average lifespan in developed countries, and the fastest growing population is the elderly population. The proportion of people in Saudi Arabia aged 60 or more is predicted to be 25 percent of the total population of 40 million by the end of 2050. Moreover, the number of people aged 80 or more is expected to reach 1.6 million or 4 percent of the total population in the same period. Improvements in surgical techniques, anesthesia, and intensive care units make surgical interventions in older and sicker patients possible. It is estimated that over half of the population older than 65 years will require surgical intervention at least once during the remainder of their lives. Therefore, elderly patients are becoming an even larger part of anesthetic practice. Regional anesthesia (RA) is frequently used in elderly patients, especially during orthopedic surgery, genitourologic and gynecologic procedures, and hernia repair. Although age can no longer be considered a contraindication to anesthesia and surgery, anesthesia-related morbidity and mortality remain higher among elderly than among young adult surgical patients. Undoubtedly, peripheral nerve (PN) blocks improve analgesia and reduce opioid consumption and their associated side effects. This is beneficial in the perioperative care of elderly patients who may have less physiologic reserve to withstand the side effects of general anesthesia (GA).
Postoperative cognitive recovery and prevention of postoperative cognitive complications in the elderly patient
Authors: Almuzayyen Hisham A. , Chowdhury Tumul , Alghamdi Abdulkareem S.
Published: August 2023

Elderly patients undergoing surgery are at higher risk of life-altering and costly complications. This challenge is increasingly recognized with the growing geriatric surgical population. Advanced age and comorbid conditions, such as disability and frailty that often develop with age, are all independent risk factors of postoperative morbidity and mortality. A common factor in this age group is cognitive impairment, which poses a challenge for the patient and clinician in the perioperative setting. It affects the capacity for informed consent and limits optimization before surgery; furthermore, an existing impairment may progress in severity during the perioperative period, and new onset of signs of delirium or postoperative cognitive dysfunction may arise during postoperative recovery. In this article, we aim to review the current literature examining the latest definitions, diagnostic criteria, and preventive strategies that may ameliorate postoperative cognitive complications.
Preoperative evaluation of the elderly patient
Authors: Schipa Chiara , Luca Ersilia , Ripa Matteo , Sollazzi Liliana , Aceto Paola
Published: August 2023

Nowadays, the pre-operative evaluation of older patients is a critical step in the decision-making process. Clinical assessment and care planning should be considered a whole process rather than separate issues. Clinicians should use validated tools for pre-operative risk assessment of older patients to minimize surgery-related morbidity and mortality and enhance care quality. Traditional pre-operative consultation often fails to capture the pathophysiological and functional profiles of older patients. The elderly’s pre-operative evaluation should be focused on determining the patient’s functional reserve and reducing any possible peri-operative risk. Therefore, older adults may benefit from the Comprehensive Geriatric Assessment (CGA) that allows clinicians to evaluate several aspects of elderly life, such as depression and cognitive disorders, social status, multi-morbidity, frailty, geriatric syndromes, nutritional status, and polypharmacy. Despite the recognized challenges in applying the CGA, it may provide a realistic risk assessment for post-operative complications and suggest a tailored peri-operative treatment plan for older adults, including pre-operative optimization strategies. The older adults’ pre-operative examination should not be considered a mere stand-alone, that is, an independent stage of the surgical pathway, but rather a vital step toward a personalized therapeutic approach that may involve professionals from different clinical fields. The aim of this review is to revise the evidence from the literature and highlight the most important items to be implemented in the pre-operative evaluation process in order to identify better all elderly patients’ needs.
Anesthesia and perioperative pain relief in the frail elderly patient
Authors: Van Zundert Tom C.R.V. , Gatt Stephen P , van Zundert André A.J.
Published: August 2023

Demand for anesthesia and analgesia for the frail elderly is continuously increasing as the likelihood of encountering very elderly, very vulnerable, and very compromised patients has, ever so subtly, increased over the last three decades. The anesthesiologist has, increasingly, been obliged to offer professional services to frail patients. Fortunately, there has been a dramatic improvement in medications, methods of drug delivery, critical monitoring, and anesthesia techniques. Specific methodologies peculiar to the frail are now taught and practiced across all anesthesia subspecialties. However, administering anesthesia for the frail elderly is vastly different to giving an anesthetic to the older patient. Frail patients are increasingly cared for in specialized units—geriatric intensive therapy units, post-acute care services, palliative, hospices, and supportive care and aged care facilities. Several medications (e.g., morphine-sparing analgesics) more suited to the frail have become universally available in most centers worldwide so that best-practice, evidence-based anesthesia combinations of drugs and techniques are now increasingly employed. Every anesthetic and pain management techniques in the frail elderly patient are going to be discussed in this review.
Cosimplicial monoids and deformation theory of tensor categories
Authors: Batanin Michael , Davydov Alexei
Published: August 2023

We introduce the notion of

n

-commutativity (

0\le n\le\infty

) for cosimplicial monoids in a symmetric monoidal category

\mathbf{V}

, where

n=0

corresponds to just cosimplicial monoids in

\mathbf{V}

, while

n=\infty

corresponds to commutative cosimplicial monoids. When

\mathbf{V}

has a monoidal model structure, we endow (under some mild technical conditions) the total object of an

n

-cosimplicial monoid with a natural and very explicit

E_{n+1}

-algebra structure.

Our main applications are to the deformation theory of tensor categories and tensor functors. We show that the deformation complex of a tensor functor is a total complex of a

1

-commutative cosimplicial monoid and, hence, has an

E_2

-algebra structure similar to the

E_2

-structure on Hochschild complex of an associative algebra provided by Deligne's conjecture. We further demonstrate that the deformation complex of a tensor category is the total complex of a

2

-commutative cosimplicial monoid and, therefore, is naturally an

E_3

-algebra. We make these structures very explicit through a language of Delannoy paths and their noncommutative liftings. We investigate how these structures manifest themselves in concrete examples.
Divje živali v družbenih razredih
Authors: Kozorog Miha
Published: August 2023

Avtor predstavi tri lastne etnografske raziskave, v katerih so imele vidno mesto divje živali. Ugotavlja, da je vsaka od teh raziskav obravnavala drugačno modalnost živali, in sicer simbolno, predstavno in živo žival. S slednjimi so povezana različna razmerja z ljudmi: simbolni živali ustreza pripisano, predstavni zamišljeno, živi pa neposredno razmerje. S temi razmerji oziroma ljudmi v razmerjih pa so povezljivi različni koncepti družbenega razreda, ki jih v prvih dveh primerih lahko povežemo z idejami Webra, v tretjem pa Marxa: pripisano je povezljivo z razredom kot družbenim statusom; zamišljeno z razredom kot izrazom kulturnega kapitala; neposredno pa z razredom, ki je rezultat produkcijskih razmerij. Avtor ta članek razume kot igrivo eksperimentalno antropološko modeliranje ob inavguraciji nove antropološke revije Svetovi/Worlds, ki je pričujočo številko posvetila živalim v človeških svetovih.
Mesto kmetijskih živali v »večvrstni etnografiji«
Authors: Baskar Bojan
Published: August 2023

Kmetijske (oziroma »koristne«) živali niso deležne povečanega splošnega zanimanja za živali, ki je v družboslovnih in humanističnih vedah dobilo ime »zasuk k živalim« (animal turn). Nasprotno, zdi se, da zanimanje za kmetijske živali kljub temu celo usiha in da se to dogaja tudi v etnologiji-antropologiji – vedi, ki je med vsemi temi vedami tradicionalno kazala največ zanimanja zanje. Članek analizira genealogijo, okoliščine in vzroke historičnega procesa postopnega marginaliziranja, izključevanja in izrinjanja kmetijskih živali v bogatih zahodnih družbah ter posveti posebno pozornost tem procesom v antropologiji.
Uvodnik
Authors: Svetel Ana , Simonič Peter
Published: August 2023

K nastanku tematske številke sta prispevali dve okoliščini. Prva je povečano antropološko zanimanje za življenjski prostor in druge vrste, ki bivajo v njem. Živali postajajo priljubljen medij in merilo človeških odnosov z naravnimi in družbenimi okolji. V zadnjih dveh desetletjih je izšla cela vrsta revij in zbornikov, posvečena vprašanjem pravic živali, njihovega umetniškega upodabljanja, reje in prehrane, organizacije vsakdanjega življenja, vzgoje ipd. Ontološki obrat je prinesel novo specializacijo – t. i. večvrstno etnografijo, ki preizprašuje osrednje mesto ljudi in predstavlja preučevanje neudomačenih (nekoristnih) ali neopaznih živalskih in rastlinskih vrst ter procesov. Izbrani naslov tematske številke revije Svetovi izpostavlja spremembe znanstvene paradigme in jih prenaša v slovensko in evropsko etnologijo ter socialno/kulturno antropologijo. Druga spodbuda za pričujočo tematsko številko je bila priložnostna in domača. V projektu Evropske noči raziskovalcev – Humanistika, to si ti!, ki ga na Univerzi v Ljubljani vodi Filozofska fakulteta, je leta 2022 osrednji tematski fokus povzemal slogan Človek, žival.
As características do idoso dependente e a sobrecarga no cuidador informal: um estudo em Belmonte
Authors: Martins Julieta , Fonseca Cecília , Barbosa Maria
Published: August 2023

Os cuidados prestados informalmente por familiares, a um Idoso Dependente (ID), geralmente, acarretam uma sobrecarga intensa ao Cuidador Informal (CI). Nesta investigação pretendeu-se perceber se a sobrecarga do CI é influenciada pelas caraterísticas sociodemográficas e pela situação clínica dos ID. Realizou-se um estudo quantitativo transversal com base numa amostra constituída por 34 CI e respetivos ID. O instrumento de colheita de dados, de administração indireta, integrou o Questionário Geral para o CI e para o ID, a Escala de Pfeiffer Portable Mental Status Questionary, a Escala de Sobrecarga do Cuidador de Zarit e o Índice de Barthel. Os dados foram recolhidos entre novembro de 2012 e fevereiro de 2013 e foram respeitados todos os procedimentos de natureza ética. Os resultados revelaram que a maioria dos CI apresentava nível de sobrecarga intensa ou ligeira, principalmente os CI de ID do género masculino, solteiros, que auferiam pensão de reforma/aposentação, que exerceram a sua atividade profissional no setor secundário ou terciário, que se encontravam dependentes há mais de 10 anos, com menor nível de dependência e com doenças clinicamente diagnosticadas. Conclui-se que a parametrização da ESC de Zarit nos sistemas informáticos, utilizados no âmbito da saúde, seria uma mais valia, já que permitiria uma avaliação efetiva da sobrecarga sentida pelos CI. Desta forma, existiria a possibilidade de identificar os CI com sobrecarga e de desenvolver estratégias de intervenção, por forma a potenciar as suas competências.
Propriedades biológicas das sementes da papaia (carica papaya l.): valorização de um resíduo alimentar
Authors: Maia Mariana , Sousa Carla , Vinha Ana
Published: August 2023

O interesse pelo reaproveitamento das diferentes partes dos frutos e vegetais tem vindo a aumentar, não só com o intuito de promover a sustentabilidade ambiental, como também pelas demais propriedades benéficas, que vários autores já identificaram. A concentração em compostos bioativos das sementes da papaia, que são quase sempre desperdiçadas, levou ao estudo de usos alternativos das mesmas. Neste âmbito, quantificou-se a concentração de compostos não-nutritivos das sementes da Carica papaya L., nomeadamente fenólicos e flavonoides totais, avaliando-se também a atividade antioxidante das mesmas. Os resultados obtidos permitiram concluir que a concentração em compostos bioativos é influenciada pelo tipo de solvente extrator utilizado (água ou etanol). O extrato aquoso evidenciou maior concentração de flavonoides, enquanto o extrato etanólico mostrou maior quantidade de compostos fenólicos. A atividade antioxidante foi avaliada, usando-se o ácido ascórbico como controlo. Apesar de a atividade antioxidante do ácido ascórbico ter sido superior à observada nos dois extratos, estes últimos poderão ser utilizados como antioxidantes naturais, sendo o extrato etanólico o que permite tirar maior partido da atividade antioxidante dos compostos bioativos das sementes da Carica papaya L.. Apesar das evidências de que as sementes da papaia podem ser utilizadas como antioxidantes naturais, nas indústrias alimentar e farmacêutica, torna-se necessário aprofundar a investigação no sentido de avaliar a toxicidade das mesmas.
Implementação do método FMEA numa PME
Authors: Baía Amândio , Silva Ana
Published: August 2023

As Micros e as Pequenas e Médias Empresas (PME) em Portugal assumem um papel de destaque no contexto empresarial português. Contudo, diversos fatores aliados a uma conjuntura económica delicada tornam estas organizações vulneráveis. A presente investigação teve como objetivo aplicar uma ferramenta de diagnóstico e avaliação de potenciais falhas num processo de uma PME, Empresa GORT, que simultaneamente integrasse as áreas da Qualidade, Ambiente e Segurança. Com base na metodologia FMEA (Failure Mode and Effect Analysis) - Análise dos Modos de Falha e seus Efeitos foram identificados os modos de falha ao nível da Qualidade (defeitos), Ambiente (impactes ambientais) e ao nível da Segurança, Higiene e Saúde do trabalho (riscos profissionais), em cada fase de um processo de injeção de um componente em borracha e avaliados os respetivos índices de gravidade, ocorrência e deteção. A simplicidade de aplicação desta metodologia permitiu a sua otimização traduzida na avaliação simultânea dos riscos de qualidade, ambiente e segurança, reduzindo o tempo, otimizando recursos e traduzindo-se em ações de melhoria efetiva do processo, tornando-o mais estável e robusto em todas as suas vertentes e, consequentemente, contribuindo para a obtenção de resultados benéficos para a organização.