bluuebunny/crossref_metadata_2025 huggingface dataset:
Organizational Identification, Moral Identity Centrality and Organizational Engagement of Millennials: Moderating Impact of Psychological Entitlement
Authors: Udayangi K. A. D. I. , Perera G. A. T. R.
Published: July 2024

This study analyses the moderating impact of psychological entitlement on the relationships between organisational identification, moral identity centrality and organisational engagement of Millennials. It addresses the knowledge gap pertaining to the organisational engagement of Millennials. Although engagement is conceptualised as a multidimensional construct, organisational engagement has only recently received the focus of attention of researchers. Despite Millennials being considered an entitled generation, psychological entitlement remains largely an unexplored area. The survey involved 285 Millennial Master of Business Administration (MBA) students in two leading universities in Sri Lanka. The data was analysed using Structural Equation Modeling. The results indicated no support for the premise that psychological entitlement moderated the relationships between organisational identification or moral identity centrality and organisational engagement of Millennials. The results provide valuable insights into the organisational engagement of Millennials and address some of the gaps in understanding the impact of psychological entitlement on organisational engagement.
Testing the Adaptive Market Hypothesis and Time-Varying Efficiency in the Indian Equity Market
Authors: Sing Nang Biak , Singh Rajkumar Giridhari
Published: July 2024

The study examines the adaptive market hypothesis (AMH) as an evolutionary principle of the alternative efficient market hypothesis in the Indian stock market (Sensex and Nifty50) on the daily return from April 2014 to May 2020. Based on AMH, investors behave, learn, and adapt to market conditions. This distinction of dynamic market conditions is divided into bull and bear market classifications. We apply three variations of the variance ratio test and the returns have been whitened using the Autoregressive model with generalized autoregressive conditional heteroskedasticity (AR-GARCH) approach to examine the nonlinear predictability test. Further, we evaluate a fixed-length subsample window framework to detect the time-varying predictability and examine whether market conditions affect stock return predictability and market condition. The study confirms inefficient market behaviour during crises, fear, panic, macroeconomic events and each market adapts differently to certain market conditions. Furthermore, the return series exhibits significant periods of efficiency and inefficiency consistent with the adaptive market hypothesis.  The evidence of our findings sheds light on efficient market behaviour in dynamic market conditions and market environments for researchers, investors in investment strategies and policy intervention in risk containment measures and control market manipulation.
Incidence, Characterization and Pathogenicity of Seed-Borne Fungi of Lentil (Lens culinaris L.) in Pakistan
Authors: Sajjad Maham , Akhtar Khalid Pervaiz , Ullah Najeeb , Asghar Muhammad Jawad
Published: July 2024

Lentil (Lens culinaris Medik.) is an important protein-rich Rabi pulse crop after chickpea in Pakistan. Its area and production in the country is decreasing drastically due to its susceptibility to various biotic and abiotic stresses. Among biotic-stresses, seed-borne fungi are the most imperative issue and the accurate identification and characterization of target pathogen isolates/races is crucial for the management of plant diseases in lentils. Therefore, the current study was performed to identify the fungi associated with lentil seeds, to confirm their pathogenicity and to assess their incidence. For this purpose, isolation of fungal pathogens was made on potato dextrose agar medium (PDA) from 56 Lens culinaris L. genotypes. These pathogens were characterized using morphological and molecular techniques and their pathogenicity was performed following blotter paper and agar plate method. Seven fungi belonging to five genera were isolated from lentil seeds (Fusarium avenaceum, Alternaria alternata, Aspergillus flavus, Aspergillus niger, Aspergillus tubingensis, Penicillium citrinum and Bipolaris sorokiniana) of different genotypes. Of these seven fungal species, F. avenaceum, A. tubingensis and B. sorokiniana are new records for lentil seeds from Pakistan.  Aspergillus flavus was found to occur in high frequency followed by A. niger, F. avenaceum, P. citrinum, A. alternata, A. tubingensis and B. sorokiniana. Under pathogenicity test on blotter paper and on PDA F. avenaceum, A. flavus, A. niger, A. tubingensis were highly pathogenic, while A. alternata, P. citrinum and B. sorokiniana were found to be less pathogenic. The presence of well-known toxigenic fungal pathogens in lentil seeds suggests the possible risk of contamination of the seeds and enhances the possibility of pre- and post-infections of crop. Therefore, the present study will help to devise effective management strategies to reduce contamination in seeds and also to control the further spread of these pathogens to reduce crop losses.
Impact of Economic Crisis and Socio-Demographic Factors on Milk and Milk Product Consumption of Undergraduates: A Case Study of Eastern University, Sri Lanka
Authors: Nisath M. F. Vahaful , De Silva S. T. D. , Vanajah L. , Pagthinathan M. , Mithushan P.
Published: July 2024

Milk consumption is influenced by a wide range of factors, including gender, age, income, education, ethnicity, health condition, and presence of children in the household. The current study was designed to investigate the effects of the recent economic crisis and socio-demographic factors on the milk and milk product consumption patterns of undergraduates. The questionnaire survey was used as the primary data collection tool. The survey was conducted with a representative sample of undergraduates (n=238) using a self-structured online questionnaire. The collected data was analyzed using descriptive and inferential statistics. As per the results, the majority of undergraduates in the sample size consume raw milk (83%). Therefore, cattle milk was the most widely consumed type of raw milk (84%). Ice cream is the most popular milk product (99%) in sample size. Despite the economic crisis, the majority of undergraduates (53%) maintain steady milk consumption habits. However, the milk consumption of undergraduates during the financial crisis was significantly associated with factors including locality (p=0.017), family size (p=0.014), monthly family income (p=0.000), parental educational level (p=0.000), and employment status (p=0.014). Further, this study investigated the fact that the purchasing frequency of milk and milk products was not associated with socio-demographic backgrounds (P>0.05).
Development of Ready-to-Eat Breakfast Flakes with Green Banana (Musa Acuminata) and Jackfruit Seeds (Artocarpus Heterophyllus) Flour: A Comprehensive Analysis of Nutritional and Functional Properties
Authors: Banu M. W. N. , Kariyawasam K. M. G. M. M.
Published: July 2024

Green banana flour (GBF) and jackfruit seed flour (JSF) present sustainable solutions for reducing banana waste and offering a gluten-free alternative in the food industry. The present study explores the feasibility of a composite mixture of GBF and JSF as a nutritious option for preparing breakfast flakes, evaluating their proximate composition and functional properties. The flakes were formulated with 15% JSF and varying ratios of GBF and Corn flour (w/w); T1 (50:35) T2 (60:25), T3 (70:15), T4 (80:5), and a control sample (C) with 100% corn flour. Physico-functional properties of GBF and JSF, proximate composition and antioxidant activity of the breakfast flakes were determined using standard protocols. Sensory evaluation was conducted by a semi-trained panel using a 5-point hedonic scale. The physico-functional data suggested JSF had higher water absorption (24.66±0.58%) and oil absorption (52.33±2.52%) than GBF (5.08±0.38%, 6.14±0.38%). In the sensory data, the T3 sample exhibited the highest scores for taste (4.03±0.91), texture (3.73±0.87), crunchiness (4.03±0.13), and overall acceptability (3.90±0.95). Incorporating GBF and JSF positively impacted nutritional content, with T4 showing the highest crude fibre levels (5.86±0.11%) and total ash content (2.84±0.05%). Additionally, antioxidant activity was significantly elevated (P<0.05) in flakes with GBF and JSF, with the highest observed in T4 (19.70±0.14%) followed by T3 (18.66±0.13). Storage study data confirmed a shelf-life of 4 weeks for the developed flake samples without added preservatives at room temperature. Therefore, the present study demonstrates the potential of GBF and JSF as a healthy alternative in the bakery industry, offering both nutritional benefits and favourable sensory properties.
Italian adaptation to Regulation (EU) 2017/625 on food official controls: a case study
Authors: Lugli Camilla , Cecchini Marta , Maione Domenico , Marseglia Filomena , Filippini Tommaso , Vinceti Marco , Righi Elena , Palandri Lucia , De Vita Daniela
Published: July 2024

Foodborne diseases can be prevented by implementing a food safety system that manages food chain risks from producer to end-user, from a One Health perspective. In 2017, the European Parliament and the European Council adopted Regulation No. 625 on official food controls and other official activities performed to ensure the application of food and feed laws and rules on animal health and welfare, plant health, and plant protection products. Italy issued a national law, Legislative Decree No. 27/2021, to adapt and adhere to European standards. We aim to describe the adoption and implementation of the new Legislative Decree by an Italian Food Hygiene and Nutrition Service, specifically focusing on the amendments introduced by Articles 7 and 8, namely the establishment of the second expert opinion and dispute procedures, and their integration with the promulgation of Article 70 of Legislative Decree No. 150/2022. These modifications aim to reduce the number of minor offenses that proceed to trial.
Repeated platelet-rich plasma injections improve erectile dysfunction in a rat model of hyperhomocysteinemia
Authors: Yu Zhe , Xie Yuan-Zhi , Huang Xiao-Lan , Huang Su-Zhen , Luo Xiang-Min , Wu Jin-Xiang
Published: July 2024

Platelet-rich plasma (PRP) shows promise as a regenerative modality for mild-to-moderate erectile dysfunction (ED). However, its efficacy in treating severe ED remains unknown. Blood samples from 8-week-old male rats were used to prepare PRP through a two-step centrifugation procedure, followed by chitosan activation and freeze thaw cycle. A hyperhomocysteinemia (HHcy)-related ED model was established using a methionine-enriched diet, and an apomorphine (APO) test was conducted during the 4th week. APO-negative rats were divided into two groups and were injected with PRP or saline every 2 weeks. Erectile function and histological analyses of the corpus cavernosum were performed during the 16th week. The results revealed that erectile function was significantly impaired in rats with HHcy-related ED compared to that in age-matched rats but was improved by repeated PRP injections. Immunofluorescence staining revealed a reduction in reactive oxygen species and additional benefits on the recovery of structures within the corpus cavernosum in rats that received PRP treatment compared to those in the saline-injected control group. Therefore, PRP could enhance functional and structural recovery in a severe HHcy-related ED model. A notable strength of the present study lies in the use of a repeated intracavernous injection method, mirroring protocols used in human studies, which offers more reliable results for translating the findings to humans.
Vellus hair follicle diseases
Authors: Yang Hsing-San , Liu Wei-Ting , Yang Chao-Chun , Plewig Gerd , Danarti Retno , Chen WenChieh
Published: July 2024

Human hair follicles are composed of vellus hair follicles (vHFs), sebaceous hair follicles, and terminal hair follicles (tHFs), which share histoanatomy, but differ in biophysiology, therefore are distinctive in clinical morbidities. vHFs are much less studied, and many issues remain to be clarified, such as the expression and regulation of androgen receptors, hair follicle stem cells, immune privilege, and microbiome. Hirsutism is an example of an endocrine disorder with the pathogenesis incompletely understood, especially in idiopathic hirsutism. Interactions between androgens and other hormones deserve special attention. Treatment is unstandardized, whereas combination of antiandrogens and laser shows promise. Keratosis pilaris, a keratinization disorder, lacks clarity in etiopathogenesis, impacting esthetics and therapeutic efficacy. Among the inflammatory disorders, perioral/periorbital dermatitis arises from vHFs irritation, categorized into papular, eczematous, and granulomatous forms. This necessitates varied differential diagnoses and therapeutic approaches. Follicular eczema, a variant of atopic dermatitis in children, is also associated with xerotic dermatitis and allergic contact dermatitis in adults. Bacterial infections rarely target vHFs, in contrast to tHFs. Trichodysplasia spinulosa (TdS) links to TdS-associated polyomavirus infection localized to the inner root sheath cells of vHFs, underdiagnosed in immunocompromised patients. The varying manifestation and pathogenic significance of Malassezia furfur in Malassezia (pityrosporum) folliculitis, pityriasis versicolor, and seborrheic dermatitis remain debated. Proliferative/neoplastic entities of vHFs include vellus hair cyst, pilomatrixoma, trichoepithelioma, and trichostasis spinulosa. Follicular spiny hyperkeratosis, lichen spinulosus, and lichen scrofulosorum are reactive conditions of vHFs. Recognizing vHF-associated diseases helps us to better understand the human hair follicles and to enhance daily dermatological practices.
Idiopathic Eruptive Macular Pigmentation with Papillomatosis: A Common but Underdiagnosed Entity
Authors: Relhan Vineet , Agrawal Ishan , Yadav Rekha
Published: July 2024

Idiopathic Eruptive Macular Pigmentation (IEMP) is an uncommon and possibly underdiagnosed dermatosis. It manifests as asymptomatic pigmented macules over the face, trunk and proximal extremities among children and adolescents. Degos et al. first documented this condition in 1978, unveiling its distinct characteristics. The macules, initially dark brown-black, naturally diminish over several months to years, with no lasting pigmentation or scarring. In this report, we highlight the case of a 14-year-old girl displaying all the distinctive traits of IEMP.
Dermoscopy and In Vivo Confocal Microscopy Findings of Basal Cell Carcinomas in Xeroderma Pigmentosum Patients
Authors: Duman Nilay , Oraloğlu Göktürk , Yaman Banu , Karaarslan Işıl
Published: July 2024

Background:

Xeroderma pigmentosum (XP) is a rare inherited disorder with a high incidence of malignant tumours. Literature data on dermoscopic and in vivo reflectance confocal microscopy (RCM) findings in patients with XP are very limited.

Methods:

Dermoscopic findings in 32 biopsy-proven BCCs and RCM findings in 10 biopsy-proven BCCs developed in seven XP patients were reviewed.

Results:

Of 32 BCCs, 28 were pigmented. On dermoscopy, BCCs exhibited multiple grey-blue globules/dots (81, 3%), short-fine telangiectasias/fine arborising vessels (65, 6%), multiple grey-blue ovoid nests (53, 1%), white structures (white-red structureless areas/shiny white areas/lines/strands) (56, 3%), arborising vessels (37, 5%), brown nests/globules/dots (28, 1%), spoke-wheel structures (9, 4%), leaf-like areas (9, 4%), ulceration (28, 1%), peripheral network (21, 9%), and multiple aggregated yellow-white globules (3, 1%). In 10 lesions in which further imaging with RCM was performed, RCM findings differentiated BCC from other tumours, including primary melanoma.

Conclusions:

Although the dominancy of pigmented structures may imitate melanoma clinically, dermoscopy is a valuable tool in the early diagnosis of BCCs in patients with XP. For suspicious lesions, RCM can help in differentiating pigmented BCC from primary melanoma.
A Prospective Randomized Non-Blinded Study of Safety and Efficacy of Bilastine Up-Dosing (40 mg) Versus Combination of Bilastine 20 mg With Levocetirizine 5 mg in the Treatment of Chronic Spontaneous Urticaria
Authors: Sneha Boggarapu , Narasimhan Murali , Durai Priya Cinna T. , Ramakrishnan Ramachandran
Published: July 2024

Introduction:

Chronic spontaneous urticaria (CSU) is the most commonly diagnosed skin condition in dermatology outpatient departments. Second-generation antihistamines are shown to be effective in the control of CSU. As per the guidelines, a combination of antihistamines is less recommended due to the lack of synergistic effect, though used widely. Exploring effective treatment options are crucial, given the challenges posed by CSU.

Aims and Objectives:

To assess the safety and efficacy of Bilastine up-dosing versus combination of 20 mg Bilastine with 5 mg Levocetirizine in the treatment of CSU.

Materials and Methods:

This prospective randomized non-blinded comparative trial involved 62 patients, with 32 in group A and 30 in group B. Group A received Tablet Bilastine 20 mg bd, while Group B received a combination of Tablet Bilastine 20 mg and Tablet Levocetirizine 5 mg. Urticarial Activity Score 7 was performed at baseline and follow-up visits (every 2 weeks for 6 weeks).

Results:

Both groups had a higher number of male patients in the 20–30 years age group. Angioedema was present in 15.6% of group A and 23.3% in group B. After 6 weeks, both the groups showed a significant improvement in UAS 7 scores (P value <0.05). Group A demonstrated a remarkable reduction in UAS 7 from 19.4% to 0.03% with minimal side effects.

Conclusion:

Bilastine up-dosing proved to be efficient, secure, and well tolerated when compared to the combined dose of Levocetirizine 5 mg and Bilastine 20 mg, suggesting that up-dosing of Bilastine could be a valuable addition to the current medication arsenal with the minimal side effects.
Management of Pustular Psoriasis; The Way Ahead
Authors: Parasramani Shrichand G. , Kar Bikash R. , Tahiliani Sushil , Parthasarathi Anchala , Neema Shekhar , Ganguly Satyaki , Sathishkumar Dharshini , Venkatachalam K , Komeravelli Haritha , Thomas Jayakar
Published: July 2024

Pustular psoriasis is a specialized variant of psoriasis which can be life threatening if not treated at the earliest. The pathogenesis has been recently linked to the role of interleukin 36. Apart from the corticosteroids, systemic antipsoriatics like acitretin, cyclosporine and methotrexate have been used with some success though unpredictable. With recent identification of role of IL-36 in the pathogenesis of pustular psoriasis, biologics targeting the IL-36 receptors have been used to manage the situation with high degree of success. This narrative review deals with the recent concepts of pathogenesis of pustular psoriasis as well as the current management scenario.
Small Molecules in the Management of Psoriasis and Psoriatic Arthritis
Authors: Konakanchi Venkata Chalam , Kar Bikash R. , Sathishkumar Dharshini , Tahiliani Sushil , Parthasarathi Anchala , Neema Shekhar , Ganguly Satyaki , Parasramani Shrichand G. , Komeravelli Haritha , Thomas Jayakar
Published: July 2024

Psoriasis is a common chronic, immune-mediated inflammatory skin disease associated with various comorbidities. Managing psoriasis is often challenging as the therapy is decided based on the area of the disease, associated comorbidities and impairment in quality of life, besides the patient’s preference. Making progress in the development of new molecules that can be used topically or orally, effectively controlling the disease with minimal side effects and providing long-lasting remissions are the needs of the hour. Recent developments in understanding the complexities of the pathogenesis of psoriasis have resulted in the reinforcement of treatment modalities, leading to the evolution of various biologics and small-molecule inhibitors. In comparison with biologics, both patients and treating physicians prefer small molecules for various reasons such as avoiding injections and side effects that are associated with biologics biologics. Moreover small molecules are economical than biologics. Newer small molecules, both topical and oral, are promising additions to the therapeutic arsenal in the management of psoriasis in the future.
Study of Haemolysis in Patients of Leprosy Being Administered Multi-Drug Therapy at a Tertiary Care Hospital in Western Maharashtra: A Prospective Study
Authors: Bhatt Siddharth , Radhakrishnan Subramaniyan , Vasudevan Biju , Neema Shekhar , Kothari Rohit
Published: July 2024

Introduction:

Dapsone forms the backbone of multi-drug therapy (MDT) in leprosy and many other dermatological disorders. Haemolysis is its common side effect which often necessitates drug stoppage. Currently, wide variation in data of haemolysis with dapsone exists in literature ranging from 24.7% to 83% and none of the studies point towards the timing of onset of haemolysis/timing of maximal haemolysis which is important in therapeutic decision making regarding continuing or stopping the drug. This study aimed to answer such unanswered questions.

Objectives:

Primary: To estimate the fall in haemoglobin (Hb) levels after administering MDT for 3 months in patients with leprosy. Secondary: To determine factors associated with Hb change – age, glucose-6-phosphate dehydrogenase (G6PD) status, pole of leprosy and duration of MDT taken (if any).

Materials and Methods:

All freshly diagnosed cases of Hansen’s disease were studied for 3 months. At baseline, demographic data (age, sex), skin biopsy, slit skin smear and G6PD were taken. Haemoglobin (Hb), serum glutamate oxaloacetate transferase (SGOT), serum glutamate pyruvate transferase (SGPT), serum bilirubin, lactate dehydrogenase (LDH), reticulocyte count, peripheral blood smear (PBS) along with clinical photography was done at baseline, 1, 2 and 3 months.

Results:

Out of the 48 patients who completed the study: Mean Hb (g/dL) decreased from 13.37 at baseline to a minimum of 12.08 at 2 months, and then increased to 12.34 at 3 months. Of 42 patients (87.5%) with a fall in Hb, 13 (27.1%) had severe (fall >20%), 17 (35.4%) had moderate (fall 10–20%), 12 (25%) had mild fall (fall <10%) and in 6 (12.5%), there was no haemolysis. Reticulocyte count, LDH, SGOT and SGPT were significantly associated with haemolysis. Severe haemolysis occurred more frequently in the lepromatous spectrum.

Conclusion:

Dapsone causes maximal fall of hemoglobin by 1.29 g/dl at two months following which it increases. The fall of hemoglobin is reversible and hemoglobin starts to increase by 3 months of therapy making cessation of the drug unnecessary in most of the patients.
Impact of Chemotherapy-Induced Nail Changes on Quality of Life: A Cross-Sectional Study from a Tertiary Care Centre
Authors: Trivedi Madhvi , Mehta Rajesh D. , Ghiya B. C. , Soni Prasoon
Published: July 2024

Background:

Chemotherapy has increased survival rate in patients but is associated with systemic as well as cutaneous adverse effects. Among cutaneous adverse effects, nail changes caused by chemotherapy are often overlooked. But these changes are a major cause of cosmetic concern and negatively affect the quality of life (QoL) of patients.

Aim:

This study was conducted to evaluate the impact of chemotherapy-induced nail changes on QoL of patients with malignancy and to compare the severity of impact on QoL in various nail changes.

Materials and Methods:

This hospital-based cross-sectional observational study was conducted for a period of 12 months. Only patients on chemotherapy who developed nail changes were included in the study. A nail-specific QoL questionnaire was used. Statistical analysis was conducted to evaluate the impact of nail changes on QoL.

Results:

The mean QoL score of 188 patients was 32.37 ± 7.9. The mean QoL score of females was more than that of males. QoL was statistically more significant in younger age groups [<20 years: 46.71 ± 1.7] (P < 0.001). Patients with pigmentary nail changes (melanonychia and leukonychia) had more significant impact on QoL (P < 0.001).

Conclusion:

There is a significant impact of chemotherapy-induced nail changes on QoL of patients leading to psychological distress, reduced self-confidence and social limitation. This highlights the importance of proper counselling of patients beforehand regarding the possibility of associated nail changes during and after the chemotherapy regimens.
Androgenetic Alopecia in Men: An Update On Genetics
Authors: Sadasivam Ilakkia Priya , Sambandam Ravikumar , Kaliyaperumal Damayandhi , Dileep Jude Ernest
Published: July 2024

Androgenetic alopecia (AGA) is defined as the alopecia induced by androgens in genetically predisposed individuals. AGA results in progressive miniaturization of the hair follicles leading to vellus transformation of terminal hair. The high prevalence and wide range of expressed phenotypes in AGA is a result of a polygenic inheritance mode. The androgen receptor (AR) gene located on the X chromosome at Xq11-12 is the first gene to show genetic association with AGA. Newer genetic associations with AGA are under study. In early-onset AGA, obesity, diabetes, hypertension, dyslipidaemia, insulin resistance, benign prostatic hyperplasia (BPH), prostate cancers and coronary artery disease (CAD) are associated with AGA. Screening of early-onset AGA patients and intervention for metabolic syndrome and insulin resistance can prevent the development of cardiovascular disease (CVD) at an early stage. As effective treatments continue to be topical minoxidil, systemic finasteride and hair transplantations, newer modalities are under investigation. Understanding the genetic factors involved in AGA and continued research into newer therapies, such as cell-based therapies, will lead to effective treatment and improve the quality of life in patients with AGA.
Comparison of Socio-demographic Characteristics, Tumour Features, and Surgical Treatment Outcomes in Phenotypic Variants of Basal Cell Carcinoma
Authors: Ürün Yıldız Gürsel , Ürün Mustafa
Published: July 2024

Background:

Basal cell carcinoma (BCC) cases exhibit variations in tumour number, location, and growth patterns. While some patients develop only one BCC, approximately one-third of patients later develop one or more additional lesions.

Aims:

The aim of the study was to identify risk factors for further BCC lesions in patients with different phenotypic presentations.

Materials and Methods:

We retrospectively evaluated 1052 histopathologically diagnosed tumours of 861 patients, who were divided into four phenotypic presentation groups according to tumour number at initial diagnosis and during follow-up. Age, sex, tumour characteristics, surgical margins, re-excision and residual tumour rates were compared. Univariate and multivariate logistic regression analyses were performed to determine risk factors for multiple tumour development.

Results:

There were 723 patients in the single presentation phenotype 1 (SPP1) group, 19 in the SPP-more group, 114 in the multiple presentation phenotype (MPP)-cluster initial group, and five patients in the MPP-cluster later group. Male sex was more common in the MPP-cluster later group (P = 0.028). The mean age was lower in the SPP1 and SPP-more groups (P = 0.002). Ear involvement was more common in the MPP-cluster later group (P < 0.05). Superficial and basosquamous subtypes were more common in the SPP-more and MPP-cluster later groups (P < 0.05). Re-excision and residual tumour rates were lowest in the SPP1 group (P < 0.05). Age over 69 years, male sex, and periorbital or upper extremity location were significant risk factors for multiple tumour development (P < 0.05).

Limitations:

The limitations of our study include the inability to evaluate environmental risk factors, phenotypic and ethnic characteristics, and the short follow-up period for newly added patients.

Conclusions:

Predicting different phenotypic presentations by taking the age, gender, and tumour characteristics (localization, histopathological subtype) of the patients into account may allow new tumours to be detected at an early stage.
Fever with Rash in a Child: Revisited
Authors: Sarkar Rashmi , Yadav Anukriti , Maheshwari Apoorva
Published: July 2024

Rash and fever are some of the most common chief complaints present in paediatric dermatology emergencies. The spectrum of differential diagnosis is broad, including many different infectious and some non-infectious agents. A systematic approach involving detailed history taking, careful clinical examination along with particular attention to epidemiological features are the most important factors to make a diagnosis. This article reviews the morphological patterns of various causes of fever with rash in children, including infectious as well as non-infectious causes, with special emphasis on the Indian scenario. We intend to highlight the clinical characteristics of each cause, which will not only help make a clinical diagnosis but also distinguish benign versus life-threatening causes of skin rash in febrile paediatric patients and provide early medical intervention.
Dermoscopy of Amyloidosis Cutis Dyschromica
Authors: Rane Meghana C. , Mahajan Sunanda A.
Published: July 2024

Amyloidosis cutis dyschromica is a very rare form of primary cutaneous amyloidosis characterized by prepubertal onset of hyper and hypopigmented spots and amyloid deposits in the papillary dermis. We report two cases of this condition highlighting its dermoscopic findings.
Nodal T-Follicular Helper Cell Lymphoma, Angioimmunoblastic-Type, Diagnosed in a Patient with Psoriasis Following COVID-19 Vaccination under Adalimumab Treatment: A Causal Association?
Authors: Hsieh Chang-Yu , Yu Shan-Chi , Lee Jia-Arng , Tsai Tsen-Fang
Published: July 2024

Biologics have expanded the armamentarium for psoriasis, but there has been a growing concern about the risk of lymphoma in patients under tumour necrosis factor (TNF)-α inhibitor and methotrexate. Besides, the mRNA-based coronavirus disease 2019 (COVID-19) vaccination was known to stimulate the proliferation of T-follicular helper cells. We report a case of a patient with psoriasis under adalimumab developing nodal T-follicular helper cell lymphoma, angioimmunoblastic-type following the mRNA-1273 COVID-19 vaccine. We suspect that adalimumab, methotrexate, Epstein-Barr virus (EBV) reactivation, previous reactive lymphoid hyperplasia and psoriasis per se predispose our patient to a lymphoma-prone condition, and the two doses of the mRNA vaccine act as the last straw.
A retrospective analysis of surgical outcome in sutureless glueless scleral fixation of foldable intraocular lens
Authors: Kannan Naresh Babu , Dey Sarkar Avik , Vallinayagam MuthuKrishnan
Published: July 2024

Introduction:

Cataract surgery constitutes one of the highest volume surgeries performed worldwide approximating 10 million annually, varying from 100 to 6000 per million population. Implantation of scleral fixated intra-ocular lens (SFIOL) is getting popular in managing difficult situations like aphakia, subluxated lens, and dislocated cataracts.

Objective:

This retrospective series evaluated our experience with foldable 3-piece acrylic SFIOL implantation for various challenging surgical scenarios in a tertiary care ophthalmic institute in the southern part of India.

Results:

The data from the first 150 patients, those operated in our hospital in the aforementioned technique, have been reviewed and analyzed. The mean age of the population was 46.43 years. The most common indication was found to be surgical aphakia (34.66%) followed by traumatic subluxated lens (8.33%). Postoperative BCVA at 3 months improved to 0.255 on the LogMAR scale from preoperative BCVA of 0.795 (P < 0.01). Intraocular pressure was found to stabilize over 3 months follow-up (P = 0.002). The various intraoperative and postoperative complications have been recorded. Ten patients required resurgery out of which eight had postoperative haptic dislocation. A detailed comparison of the role of a surgeon’s experience in influencing outcomes has been evaluated.

Conclusion:

The technique offers physiological IOL placement using minimal surgical maneuvers. We strongly recommend this as a technique of choice for the surgical management of complicated scenarios with inadequate capsular bag support.
Comparison of diagnostic capability of macular ganglion cell complex vs retinal fiber layer thickness in primary open angle glaucoma patients of Indian origin
Authors: Srivastava Arpit , Sharma Vikas , Kapoor Gaurav , Kamal V K B Muthu , Baranwal Vinod K , Singh Ankita
Published: July 2024

Purpose:

Comparison of diagnostic capability of macular ganglion cell complex thickness vs. retinal nerve fiber layer (RNFL) thickness in patients of primary open-angle glaucoma (POAG).

Settings and Design:

This cross-sectional observational study was carried out between June 2021 and October 2022 at a tertiary care hospital in North India.

Methods:

A total of 118 eyes were included in the study with 30 control and the rest 88 eyes with POAG were divided into three groups based on visual field loss Group 1 (30 eyes): early field loss with mean deviation (MD) < −6 dB; Group 2 (30 eyes): moderate field loss with MD −6 to −12 dB; and Group 3 (28 eyes): severe field loss with MD > −12 dB. Optical coherence tomography (OCT) scans to measure RNFL loss and ganglion cell inferior plexiform layer (GCIPL) loss were taken for each patient.

Statistical Analysis Used:

Categorical variables were analyzed using either the Chi-square test or Fisher’s exact test. A receiver operating characteristics analysis was calculated to determine optimal cut-off values of superior, inferior, and average GCIPL and RNFL for determining the severity of field loss as compared to controls (30 normal eyes).

Results:

In the mild field loss group the sensitivity of superior, inferior, and average GCIPL was 86.7, 96.7, and 96.7%, respectively. Similarly, the specificity was 96.7, 93.3, and 100%, respectively. In the same group, the sensitivity of superior, inferior, and average RNFL was 70, 93, and 66%, respectively. Similarly, the specificity was 46.7, 83.3, and 70%, respectively. In the moderate and severe groups, the results were comparable.

Conclusion:

The sensitivity and specificity of GCIPL loss are significantly better than that of RNFL parameters in the mild field loss group.
Double peak sign on ultrasonography: A new prognostic marker before surgery for white cataract
Authors: Nayak Bhagabat , Lalitha C S , Moharana Bruttendu , Panda Bijnya B
Published: July 2024

A mature, hypermature, or white cataract needs posterior segment evaluation before surgery for prognostification. Ultrasonography is the preferred method for this. White cataract or intumescent cataract risks intraoperative capsulorhexis running out leading to devastating complications due to high intralenticular pressure. Altghough sligh-lamp examination before surgery can gives clue regarding fluid pockets under anterior capsule in these types of cataract, fluid in posterior compartment of lens can be detected by ultrasonography. The author here described a new sign, the double peak sign which can predict the high intra-lenticular pressure especially in posterior compartment of the lens. So if it detected before surgery, all precautions can be taken during surgery to prevent complications. The A-scan overlay on the B-scan in ultrasonography can detect the hypoechoic area corresponding to the lequified cortex in between solid lens nucleus and posterior capsule, so giving rise to the double peak sign which is described here as an innovation.
Role of IgG avidity in eyes with active Toxoplasma retinochoroiditis
Authors: Lakhmawar Pratik , Kelgaonkar Anup , Patel Anamika , Khalsa Ashish , Basu Soumyava
Published: July 2024

Purpose:

To study the role of Toxoplasma IgG avidity in evaluating the stage of systemic infection during manifestation as toxoplasma retinochoroiditis and its clinical implications in eastern India.

Methods:

Retrospective chart review of Toxoplasma retinochoroiditis cases with Toxoplasma serology for IgG, IgM, and IgG avidity.

Results:

Included in this study were 17 eyes of 17 patients who had active retinitis located in the macula (14), mid-periphery (2), or periphery (1). They were either primary lesions (12) or reactivations (5). All the cases had Toxoplasma IgG positive; one case had IgM positivity, while all the cases had high IgG avidity values. IgG avidity had a positive correlation with the duration of symptoms.

Conclusion:

We observed high IgG avidity values in active retinochoroiditis in both primary ocular Toxoplasmosis and reactivation subgroups. These results indicate a late ocular manifestation after initial systemic infection with a possible incubation period ranging from 5 weeks to 5 months.
Nerve Sheath Tumours In and Around Spine—A Series of 50 Cases
Authors: Sulaiman Saad , Pillai Suresh S , A. Akashdeep A , Nambiar Harilal V
Published: July 2024

Background:

Nerve sheath tumours in and around the spine, especially in the junctional zones, are a challenging endeavour for the surgeon, because of the difficulty in approaching these structures as well as their close proximity to the major vessels and nerves. Most of these tumours are benign in nature. They are usually very slow growing, and hence the tumour may be detected very late in its clinical course unless it compresses or encircles any of the major neurovascular structures early in its course. The surgical results after the excision of these tumours are excellent. Most of the patients get completely cured by prompt treatment. Here we present a series of 50 nerve sheath tumours in and around the spine operated over a period of 21 years.

Materials and Methods:

A retrospective study was done for 50 patients who underwent an operation for nerve sheath tumours in and around the spine, over a period of 21 years. Patient’s clinical and radiological data were extracted from the Medical Record Department (MRD) of our hospital and analysed.

Results:

Out of the 50 cases of nerve sheath tumours, 40 patients (80%) were of schwannoma and 10 patients (20%) were of neurofibroma. Overall, 10 patients had dumbbell tumours (neurofibroma+schwannoma). The mean age group was between 4th and 6th decade. Patients were followed up for a minimum of 1 year and a maximum of 20 years period. All of these tumours were benign except one patient who had a malignant neurofibroma of the C-8 nerve root. 15 out of 50 patients presented with paraparesis, 5 with paraplegia and another 5 with quadriparesis. All these patients had complete neurological recovery after surgical removal of the tumours.

Conclusion:

This case series brings out the nuances in the management of nerve sheath tumours in and around the spine and their results.
Correlation between Quality of Evidence and Number of Citations in Top 100 Cited Hallux Valgus Articles
Authors: Panchbhavi Vishank Ved
Published: July 2024

Background:

The measurement of a scientific article’s impact has frequently relied on the quantity of citations it garners. Analyzing citations can be instrumental in identifying influential work within medical specialties. This study aims to elucidate the metrics and levels of evidence pertaining to articles concerning Hallux valgus.

Materials and Methods:

This study conducted an extensive review of the 100 most-cited articles concerning “hallux valgus” and “bunion” by performing electronic database searches. Each article underwent a thorough examination, encompassing factors such as the number of citations, publication type, journal specialty, authorship, country of origin, publication year, level of evidence, and total sample size.

Results:

The citations for the reviewed articles ranged from 68 to 424. These 100 most-cited articles were found across 24 different journals, covering a spectrum from general to more specialized subspecialty journals. Around 45% of these articles were published in Foot & Ankle International. In terms of the level of evidence, the majority of articles (34 of 100) were classified as level V. Additionally, a significant number of articles were categorized as case series (n = 28) and expert opinions (n = 19). The median sample size for experimental studies was 44. Notably, only 3 of the 100 articles qualified as randomized controlled trials.

Conclusions:

The median year of publication for the most-cited articles, 2003, indicates a requirement for more recent studies investigating hallux valgus. The scarcity of articles with high evidence levels (1 or 2) and the small median sample size highlight the lack of scientifically robust research on hallux valgus. Furthermore, the analysis reveals a weak positive correlation (r = 0.149) between the strength of evidence and the number of citations in the top 100 articles related to hallux valgus.
Surgical Management of Metastatic Spine Fracture
Authors: Samanta Sudipta , Mukhopadhyay Kiran Kumar
Published: July 2024

The spine is a very frequent site of metastasis from solid tumors. World Health Organisation estimated an exponential increase of 29.4 million new cases of cancer in 2040. The incidence of solid tumors metastasizing to the spinal column is from the breast, prostate, kidney, and lung. The need for treatment lies in different factors, and proper evaluation of the disease requires a “multidisciplinary team” approach. The MDT contains tumor surgery, oncology medicine, tumor radiotherapy, radiology, and pathology departments.
Current Concepts in the Surgical Management of Metastases to the Spinal Column
Authors: Shamim Parvez , Ahmed Abrar , Nath Chinmay
Published: July 2024

Spinal metastasis is a common malignant bone tumour that often causes compression of the spinal cord and nerve roots. It has a high mortality rate and is primarily treated palliatively. A multidisciplinary approach is recommended. The treatment methods include surgery, minimally invasive treatment and radiotherapy, each having its own clinical effects, advantages and limitations.
Investigating the Diagnostic Value of MRI in the Diagnosis of Rotator Cuff Tears Compared with Findings from Arthroscopy or Open Surgery
Authors: Parhamfar Mohammad , Dehghani Mohammad , Shirazinejad Somaye , Hooshmandi Mohammadali
Published: July 2024

Introduction:

Rotator cuff tear is amongst the most common shoulder diseases and a principal reason for orthopaedic consultations. Currently, magnetic resonance imaging (MRI) is one of the most common diagnostic methods for rotator cuff tears and has been compared with direct observation methods, such as arthroscopy and open surgery, in this study.

Materials and Methods:

The present study is a cross-sectional analytical type conducted retrospectively from the beginning of 2018 to the end of 2020 in Al-Zahra and Kashani Hospitals in Isfahan, Iraq, covering 86 patients including 54 men and 32 women with criteria for rotator cuff tear who underwent MRI and subsequently arthroscopy or open surgery. MRI images were interpreted by a radiology specialist, and physical examinations, arthroscopy and surgery were performed by two orthopaedic specialists, calculating sensitivity, specificity, accuracy, positive predictive value and negative predictive value for rotator cuff tears.

Results:

A total of 29 cases of partial tear and 37 cases of complete tear were observed, with sensitivity, specificity, positive predictive value, negative predictive value and accuracy obtained as 93.9%, 60%, 88.6, 75% and 86%, respectively.

Conclusion:

MRI is a highly reliable diagnostic tool for diagnosing rotator cuff tears, although correlation with clinical symptoms and physical examinations is essential for this diagnosis.
Distal Radioulnar Joint Instability in Distal Radius Fractures Managed with Volar Locking Plates
Authors: Singh Param Jit , Jain Sanjay , Barwar Nilesh , Das Lakshman , Bhat Burhan , Kumar Pankaj Sharma
Published: July 2024

Introduction:

Distal radioulnar joint (DRUJ) injuries are the most common cause of residual wrist disability after fractures of the distal radius. There is a lack of consensus regarding the diagnosis of these injuries along with their management when being accompanied by a fracture of the distal radius. The present prospective study aimed to assess the effect of the involvement of DRUJ on the outcome of distal radius fractures. The study also evaluated the role of clinical and radiographic indices in the diagnosis, management and outcome of these injuries.

Materials and Methods:

This prospective study involved 51 patients aged >18 years with distal radius fractures treated using volar plating. The intra-operative assessment was done clinically using a piano key or ballotment test after fixation of distal radius fracture using K-wire stabilisation. The mean follow-up was 24 months. The patients were all clinically evaluated using the Modified Gartland and Werley scoring system. Radiographically, we calculated the dorsal/volar tilt, radial inclination, radial height and the ulnar variance.

Results:

A total of 44 patients with distal radius fractures were managed with the volar plate. The mean age was 45 years (range = 18–77; SD = ±13.6). The majority were men. The maximum cases were found to be of 2R3C type of AO/OTA fractures. Axial instability was observed in 12 cases, with 5 having negative and 7 showing positive axial instability. No statistically significant correlation was identified between the instability of the DRUJ and the overall outcome of distal radius fractures treated with volar plating (P = 0.241). However, a significant association was observed between fractures involving the base of the ulnar styloid (US) and the final clinical outcome (P = 0.023). The mean modified Gartland and Werley score was calculated at 6.09 ± 5.36, and 28.9% of cases suffered from loss of dorsiflexion.

Conclusion:

The present study revealed that it is important to recognise DRUJ instability in both axial and anteroposterior (AP) planes through clinical and radiological parameters. US base fractures cause DRUJ instability and also create a negative impact on the outcome of distal radius fracture fixed with volar plating. Ulnar variance is a good marker for checking instability in the AP plane by ballotment test. We found that in cases of DRUJ instability, fractures of the ulnar base should be examined and fixed if needed.
Primary Ewing sarcoma/primitive neuroectodermal tumors of the kidney: Case series of eight cases from a single center with follow-up details
Authors: Pathak Niramya J. , Singh Abhishek G. , Surwase Pavan J. , Agrawal Sahil A. , Ganpule Arvind P. , Sabnis Ravindra B. , Desai Mahesh R.
Published: July 2024

Introduction:

We aim to share the experience of a single center in the management of eight cases of renal primitive neuroectodermal tumor (PNET) which are uncommon, aggressive tumors. The objectives were to study the presentation of the disease, the treatment offered and its outcomes, and the comparison of the treatment with published literature.

Methods:

The single-center renal PNET data of all patients were retrospectively reviewed from 2011 to 2022. Renal PNET was seen in eight patients. Minimum follow-up period of 1 year was required.

Results:

Male-to-female ratio was 7:1. The mean age was 26.5 years. All were locally advanced tumors on presentation. One patient had an inferior vena cava thrombus, one patient had metastases on presentation, and two patients had tumor extending to paranephric space. The diagnosis was made by histopathology supported by immunohistochemistry showing CD99 positivity. All patients were treated with radical nephrectomy, followed by chemotherapy in all and radiotherapy in three patients. Two patients expired at 3½ and 6 years after surgery, the remaining six are alive at a median follow-up period of 34.5 months.

Conclusion:

Renal PNET is an uncommon renal tumor which is aggressive and requires multimodal therapy for prolonged survival.