bluuebunny/crossref_metadata_2025 huggingface dataset:
Modelling Sand Wave Evolution and Migration in North Sea Using ROMS
Authors: Adnyani Luh Putri , Draper Scott , An Hong Wei , Cheng Liang
Published: December 2024

Sand waves are large and transverse bed features, typically with lengths and heights of about 100-500 m and 2-10 m, respectively. The height can grow up to 30% of the average water depth, especially in shallow water conditions. Sand waves can migrate up to around 10 m/year and may profoundly impact subsea infrastructure, such as offshore pipelines and cables, key elements of offshore energy development. In this study, the evolution and migration of sand waves in the Dutch shoreface, North Sea 1986, was investigated using the Regional Oceanographic Modeling System (ROMS) and validated with DELFT3D and survey results from 2000. ROMS is an open-source oceanographic model available for free, created by the United States Geological Survey (USGS) to simulate ocean circulation, sediment transport, and seabed morphodynamics. Calibration of ROMS model conducted by modelling velocity profile in different location and free surface compared to field data. Validation ROMS and DELFT3D result was conducted by comparison the sandwave profile plotting in same graph. ROMS' simulation results agree with DELFT3D's results regarding horizontal grid size; vertical grid level; stretching parameters; time step; sediment diameter; M2 tide velocity which is the most dominant tidal constituent, representing the principal lunar semi-diurnal tide that has a period of approximately 12.42 hours and is caused by the gravitational pull of the Moon; M4 tide velocity which is the overtide of M2, generated by nonlinear interactions, especially in shallow water regions, a harmonic of M2 and has a period of approximately 6.21 hours (half the period of M2); net current in tidal; water depth; and waves. It can be concluded that horizontal grid size and stretching parameters are weakly sensitive to the results. In contrast, sediment diameter, M2 tide velocity, M4 tide velocity, net current in tidal, water depth, and waves may affect the migration significantly. Even though vertical grid level and time step parameters impact the results, these parameters need to be defined with a certain value following the Courant-Friedrichs-Lewy (CFL) condition.
Design and Topological Optimization of a Wheel Upright Using Finite Element Analysis
Authors: Eltanany Ahmed S. , Hamada Ahmed T. , Kadri Khaled , Al Hussaini Osama , Alkhader Maen
Published: December 2024

Uprights are one of the most critical structural elements in vehicles suspension systems. A standard upright serves as a physical mounting for the wheel hub and brake components as well as links the axle to the control arms. Uprights are relatively bulky by design to withstand the significant loads they observe during vehicle braking, maneuvering, and driving on rough terrain. In automotive design, specifically, race car design, utilizing lightweight components and reducing fuel consumption are imperative. This weight reduction-based paradigm is being adopted by the car industry at large, particularly due to the shift towards automotive electrification. Consequently, this work investigates the potential for using topological optimization to reduce the bulkiness and weight of uprights without compromising their structural integrity and reliability. An upright designed for a racing car is selected in this study. Topological optimization is performed on the upright using the finite element software ANSYS. Results show that a considerably enhanced upright is obtained after 48 topological optimization iterations while maintaining a factor of safety of 2.5. The optimized upright exhibited less stress concentrations and 39% lesser weight than the original upright.
Mitigating High-Temperature Stress through Organic Manure Amendments on the Growth of Lunuwila (Bacopa monnieri (L.) Wettst.)
Authors: Attanayake A. M. S. U. M. , Banu M. S. A. , De Silva C. S. , Gunasekera H. K. L. K.
Published: December 2024

Lunuwila (Bacopa monnieri), typically found in semi-aquatic environments, is increasingly threatened by habitat loss due to environmental degradation and rising temperatures associated with global warming. This study aimed to identify an optimal organic manure treatment to counteract the adverse effects of increased temperatures on Lunuwila growth. The experiment was conducted at The Open University of Sri Lanka, Nawala, inside a temperature-controlled polytunnel designed to simulate the increased (34-35°C) temperature conditions and plant house at ambient (27-32°C) temperature. A two-factor factorial completely randomized design (CRD) with three replications was used to assess the interaction between temperature and organic manure on Lunuwila growth. The treatments included two temperature levels: ambient temperature (T1) and increased temperature (T2), and four organic manure levels: 100% compost (M1), 50% compost with 50% cow dung (M2), 100% cow dung (M3), and a no-fertilizer control (M0). Organic manure was applied at a rate equivalent to 10 tons per hectare for 100% treatments. Growth parameters were analysed using R Studio software (version 4.2.1), with treatment differences tested by Analysis of Variance (ANOVA) and Duncan’s Multiple Range Test (DMRT) for mean comparison at a significance level of p=0.05. Results indicated that 100% compost under elevated temperature significantly (p<0.05) enhanced shoot length (90.7% increase), leaf count (674.4±39.5), branch count (13.93±1.01), leaf area index (43.05±2.45), root length (8.54±0.05 cm), chlorophyll content (41.7±0.27 SPAD), fresh shoot weight (2583.84±0.56 g/m2), dry shoot weight (267.45±0.22 g/m2), fresh root weight (70.41±0.26 g/m2), and dry root weight (8.79±0.03 g/m2) compared to the control at p≤0.05. Conversely, stem diameter (0.381±0.01 cm) was greatest under ambient temperature with 100% cow dung, and root diameter (0.43±0.004 cm) was highest with 50% compost and 50% cow dung under ambient conditions. Therefore, even in a global warming situation 100% compost is favourable for the sustainable cultivation of Lunuwila.
Effect of Starch Based Super-Absorbent Polymer (SAP) on Growth and Yield of Sugarcane (Saccharum Hybrid Spp.) Under Different Irrigation Intervals in Udawalawe, Sri Lanka
Authors: Wijayawardhana L.  M. J. R. , De Silva A. L. C. , Chathuranga G. A. A. , Weerasinghe H. A. S.
Published: December 2024

Super absorbent polymer (SAP) can significantly improve soil moisture retention, which is an important factor in most agricultural production systems. Limited research exists on its specific application in sugarcane cultivation, particularly under the environmental conditions of the Dry Zone of Sri Lanka. Hence, the present study was conducted to evaluate the effect of starch-based SAPs, on sugarcane growth, yield, and nitrogen leaching under different irrigation intervals in Udawalawe, Sri Lanka. This study was conducted using a split-plot design with three replicates, where irrigation interval served as the main plot factor, and the levels of SAP application were treated as the subplot factor. Irrigation intervals of 10, 15, 20, and 25 d were evaluated with and without the application of SAP. The study was conducted over one crop cycle from June 2020 to June 2021 at the research farm of the Sugarcane Research Institute, Sri Lanka. The results of this study revealed that the application of SAP enhanced the sugarcane yield only under a 10-day irrigation interval. None of the other treatment combinations was significant at a probability level of 0.05. Hence, the application of SAP cannot be used as a management tool for increasing irrigation intervals aiming at reducing the irrigation water demand. While the SAP application can enhance sugarcane fresh yield in specific instances, it did not provide clear evidence of improvement in sugarcane quality under the environmental conditions in Udawalawe. However, the current study did not evident a decrease in fertilizer leaching rates in the deep-draining water or changes in soil pH due to the application of SAP. This study may not fully capture the potential benefits of the SAP application under diverse weather conditions, as the experimental location did not receive prolonged drought during the study period, which could mask the effectiveness of both SAP and irrigation treatments.
Prognostic factors and outcome in patients submitted into coronary artery bypass surgery with total arterial myocardial revascularization
Authors: Tassoulas Elias , Tasoulas Dimitrios , Papaconstantinou Christos , Chlorogiannis Ioannis
Published: December 2024

Background: Coronary artery bypass grafting relieves symptoms and improves survival in patients with severe coronary artery disease. Large series and meta-analyses show that total arterial myocardial revascularization (TAMR) may offer additional survival benefit. The primary objective of this study was to investigate long-term (>5 years) survival of patients undergoing TAMR. The change in coronary artery disease risk factors during the follow-up period was also evaluated.Methods: Forty patients undergoing coronary artery bypass grafting (CABG) with total arterial myocardial revascularization (TAMR) were studied. All patients were screened for coronary artery disease risk factors at entry and follow-up. Repeat coronary angiography at a 5-year follow-up was used to investigate the long-term patency of arterial grafts.Results: Mean patient EuroSCORE was 1.42±1.1%. Mean follow-up time was 9.3±4.8 years (range: 1 month to 15.6 years). The 30-day mortality was 2.5% (1/40 patients), while the 12-month mortality was 7.5% (3/40 patients) with an actual survival of 92.5%. The 5-year and 10-year mortality was 15.8% (6/38 patients) and 33.3% (10/30 patients) respectively, while actual survival reached 84.2% and 66.7% at 5 and 10 years respectively. A total of 10/40 patients (25%) died during follow-up. Mean time-to-event was 3.5±2.7 years (range: one month to 7.1 years); 40% of deaths occurred during the first 2 years from the procedure, and 40% occurred during the period from 4.5 to 6.5 years post-surgery. The main cause of death was cerebrovascular disease in 30% of patients, while 20% died of cancer. 40% of fatalities were cardiac-related but not due to ischemic heart disease. The incidence of major adverse cardiac and cerebrovascular events (a composite outcome of cardiac-related death, myocardial infarction, need for revascularization and stroke) was 17.5% during follow-up. Total morbidity reached 30%. The use of the radial artery resulted in a similar survival to the use of bilateral internal mammary arteries exclusively. The numbers of grafts used were 39 Left internal mammary artery grafts (LIMA), 34 right internal mammary artery grafts (RIMA) and 24 right radial artery grafts (RAD). Repeat coronary angiography at a 5-year follow-up revealed that all arterial grafts were patent. Control of arterial hypertension (blood pressure <30/80 mmHg) was achieved in 65% of patients postoperatively compared to 22.5% preoperatively (p=0.01).Conclusions: TAMR is safe and effective with encouraging results in terms of long-term survival. This is the first reported study investigating long-term outcomes in patients undergoing total arterial revascularization in Greece.
Relaxin-2 for heart failure with preserved ejection fraction: a comment on the termination of a phase-II trial investigating the relaxin-2 analogue, LY3540378
Authors: Dschietzig Thomas Bernd , Salama Guy
Published: December 2024

On November 25, 2024, Eli Lilly and Company informed the public about the decision to terminate their phase-2 study, J3E-MC-EZDB with the relaxin-2 analogue, LY3540378, after data analysis of 40% of participants had indicated futility without immediate signs of patient risk. The study enrolled patients with heart failure with preserved ejection fraction within 2 weeks of an event of worsening heart failure with volume overload to receive 3 different doses of LY3540378 or placebo as weekly subcutaneous injection.In this Editorial, we compare LY3540378 and related long-acting relaxin-2 analogues with native relaxin-2. It is demonstrated that the modifications to native relaxin-2 to increase its half-life in circulation have been achieved at the cost of i) safety and ii) signalling pathways pivotal to the treatment of HFpEF.  In terms of safety concerns, elevated immunogenicity attributed to the fusion to Fc or antibody fragments is forwarded, as well as impairment of therapy control in blood pressure-labile HFpEF patients due to overly prolonged administration intervals. With respect to signalling, we elaborate on the glucocorticoid-receptor and Wnt1 pathways that control anti-inflammatory and anti-arrhythmic therapy effects. It is highly unlikely that those pathways are activated by the long-acting relaxin-2 analogues. Using the Wn1 pathway, native relaxin-2 increases markedly the expression of the fast sodium channel, Nav1.5 in cardiomyocytes from aged rats, to ~200 % after 48 hours. In contrast, increasing doses of a single-chain analogue of relaxin-2, B(7-33) have no effect on Nav1.5.In summary, we make a case for the therapeutic use of full-length, native-structure human relaxin-2 in HF, especially in HFpEF. We need the full pleiotropy of the native peptide for a most complex clinical syndrome.
Assessing the Quantity of Neuropeptide Y in the Serum of Patients Referred to Baqiyatallah Hospital with Covid-19 Concerning Inflammatory Factors Following Steroid Therapy
Authors: Mousavi Navid , Shankayi Zeynab , Bahrami Farideh , Mohammadzadeh Tahereh , Alishiri Gholam Hossein , Rezaei Milad Asghardoust , Saberi Mohsen
Published: December 2024

Purpose:

With the extensive presence of Covid-19, it is imperative to find compounds that can obstruct the virus’s inflammatory activity and perhaps even stop the inflammatory phase from occurring. Several neuropeptides act as immune system regulators, which nerve terminals release as co-transmitters. It has been suggested that Neuropeptide Y (NPY) may be involved in inflammatory diseases through its ability to regulate the function of inflammatory cells. Consequently, the present study was designed to examine the changes in this neuropeptide in the serum of patients with Covid-19 disease, particularly following anti-inflammatory treatment, and its relationship with other inflammatory factors such as TNF-α.

Methods:

The demographic information, vital and clinical signs (blood oxygen saturation level, blood pressure, heart rate, and body temperature), laboratory factors such as blood factors, inflammation, and blood electrolytes, as well as the use of steroids, were collected before and after steroid treatment the patient files. As part of the study, serum samples from patients were used to measure levels of NPY and TNF-α inflammatory factors using an ELISA kit. Additionally, the correlation between NPY values, other inflammatory factors, and other variables was examined before and after treatment.

Results:

NPY, TNF-α, c-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) levels were significantly reduced after steroid treatment. But the blood urea nitrogen (BUN) factor level increased after treatment compared to the initial evaluation. Lymphocytes and neutrophils also changed after drug treatment. Results indicated a high correlation between NPY and TNF-α. In addition to TNF-α, NPY, creatinine, and BUN presented a direct and significant relationship. ESR and BUN factors showed a positive and significant correlation regarding the length of hospitalization. However, the correlation between NPY and TNF-α with hospitalization length was insignificant.

Conclusion:

Since the current study had a significant association between NPY and TNF-α, the regulating function of this peptide in Covid-19 inflammatory processes may be validated. Enough that it is crucial to consider NPY as a marker and its antagonist as a potential Covid-19 therapy. Also, the considerable reduction in NPY levels after steroid therapy to lower inflammatory variables supports the regulatory function of this peptide in inflammatory processes.
Association between Health Literacy with Stress, Anxiety and Depression in Multiple Sclerosis Patients: A Cross Sectional Analytical Study
Authors: Dehghani Ali
Published: December 2024

Objective:

Multiple sclerosis is one of the diseases of the central nervous system, which causes numerous physical and mental problems. Since stress, anxiety and depression are effective in various dimensions of chronic diseases management and considering that health literacy plays a decisive role in the quality of life of these patients. Therefore, this study was conducted with the aim of determining the association between health literacy and stress, anxiety and depression.

Materials and Methods:

The current research is a cross-sectional analytical study that was conducted with the participation of 164 patient’s from the MS society of Jahrom city with convenience sampling. The data collection tool was the health literacy questionnaire of multiple sclerosis patients and a 21-question stress, anxiety and depression questionnaire. SPSS - 21 software, descriptive statistics and spearman and chi-square tests were used to analyze the data.

Results:

The findings showed that the majority of patients had a borderline health literacy (53.7%). 43.3% of patients had adequate level of health literacy. Also, the findings showed that the stress, anxiety and depression levels of the majority of patients were moderate. Spearman’s test showed that there is a negative and significant correlation between health literacy and stress in multiple sclerosis patients (p=0.03) (r=-0.37). While there was no significant correlation between health literacy and anxiety and depression of patients.

Conclusion:

The findings showed that with the increase in the health literacy, the rate of stress in patient’s decreases.
The Effect of 5A Self-management Program on Medication Adherence of Epileptic Patients During the COVID – 19 Pandemic: A Randomized Controlled Trial
Authors: Moosavimoghadam Seyede Fateme , Dehghani Ali , Akbar Rasool Eslami
Published: December 2024

Background:

Adherence to medication adherence plays a vital role in controlling the problems and complications of epilepsy. During the COVID – 19 pandemic and limitations of face-to-face education, the use of distance education can play an important role in providing education to patients. The aim of this study is the effect of model 5A self-management training on medication adherence in epileptic patients.

Methods:

In this single-blind randomized controlled trial, 56 epileptic patients referred to Shiraz Namazi Hospital were divided into intervention and control groups using random allocation. Thereafter, 5A self - management training sessions were virtually held in 5 sessions in WhatsApp application for intervention group. The data collection tool was MMAS-8 at two stages of before and two months after intervention. Data analysis was performed using SPSS 21 software.

Results:

The results of Wilcoxon test showed that in intervention group, the mean drug adherence in patients after intervention significantly increased compared to before intervention (p = 0.005). But in control group, this was not significant (p = 0.909). According to results of Mann-Whitney test, there was no significant difference between intervention and control groups before intervention (p = 0.632). However, by passing two months from intervention, a significant difference was found between intervention and control groups (p = 0.041).

Conclusions:

Based on results, the implementation of model 5A can be effective on medication adherence in epileptic patients. This program can be considered as a suitable method in epileptic patients during COVID – 19 pandemic.
Tumefactive Demyelination Lesions: Report on Three Cases
Authors: Lin Chi-Ju , Lin Shih-Chieh , Yu Kai-Wei , Yang Wen-Yu Ou , Lee Yi-Chung , Liao Yi-Chu
Published: December 2024

Purpose:

Tumefactive demyelination (TD) lesion and its subtype Balo’s concentric sclerosis (BCS), are rare manifestations of central nervous system demyelinating disease. Because of its rarity, physicians might hesitate in reaching a diagnosis or initiating steroid pulse therapy. This study aims at pinpointing the key neuroimaging features to distinguish TD lesions from surgical conditions, and illustrating the clinical outcomes of patients with TD lesions.

Case report:

Two of the three patients had solitary TD lesions, one 47-year-old man presenting with newly onset seizure and another 54-year-old women suffering from progressive hemiparesis. The male patient underwent craniotomy for mass excision without further steroid therapy, while the female patient received methylprednisolone pulse therapy only. Both patients remained free of clinical and radiological relapses over the past 6-7 years, leading to the diagnosis of clinically isolated syndrome. The third case is a 30-year-old woman with subacute onset of dysarthria and hemiparesis. She had two BCS lesions along with other demyelinating lesions in the juxtacortical and periventricular regions, cerebellar peduncles, and spinal cord, fulfilling dissemination in time and space. Her neurological deficits resolved after pulse therapy, and she received long-term disease modifying therapy for multiple sclerosis.

Conclusion:

This study underscores the diverse neuroimaging and clinical presentations of patients with TD lesions, and emphasizes the importance of clinical vigilance regarding this rare condition.
Effective of Nonextraction Orthodontic Treatment of Angle Class I Malocclusion: A Nonrandomized Pre–post Interventional Study
Authors: Chau Diem Hong , Le Lam Nguyen , Do Thao Thi , Le Khanh Phuong Vu
Published: December 2024

Introduction: We aimed to evaluate the effectiveness of nonextraction orthodontic treatment for Angle class I malocclusion. Methods: A nonrandomized pre–post interventional study was conducted on patients diagnosed with Angle class I malocclusion, crowding (≤9 mm), and instructed for nonextraction orthodontic treatment. The weighted PAR (Peer Assessment Rating) Index is employed to determine the outcome of orthodontic treatment. Also, soft tissue and bone indexes were assessed before and after intervention. Data were analyzed by linear regression and T-test statistical test using R software version 4.3.0 by a blinded statistician. Results: Thirty-three participants (mean age: 20.5 ± 0.5, 75.6% female) completed the intervention and were included in the analyses. Linear regression showed there was a significant difference between before and after intervention regarding the weighted PAR Index (p < 0.001). Conclusion: It was possible to complete orthodontic treatment with nonextraction. For cases of minor malocclusion and generally symmetrical characteristics, nonextraction orthodontics was recommended.
Evaluation of the Guiding Groove Technique in Periapical Endodontic Surgery: A Single-Blinded Randomized Controlled Trial
Authors: Sun Jinghua , Li Xiaolin , Zhang Chen , Hou Benxiang
Published: December 2024

Introduction: We aimed to assess the clinical and radiographic outcomes following the use of the guiding groove technique in periapical endodontic surgery. Methods: Subjects with intact labial and buccal bone walls or defects with a maximum diameter of <3 mm, who met the inclusion criteria, were randomized into two groups using www.random.org. The experimental group (n = 15) underwent the “guiding groove” technique, while the control group (n = 15) underwent the traditional bone-removing fenestration. A total of 36 affected teeth were included. Follow-up visits were conducted at 1 week, and at 3, 6, and 12 months post-surgery, and efficacy was assessed through clinical and radiological examinations. Results: The success rate in the experimental group was 100%, while in the control group, it was 94.4% (P > 0.05). In the experimental group, 11.1% (2/18) of the teeth had a reverse preparation deviation angle of >15°, and 44.4% (8/18) in the control group (P = 0.016). Conclusion: The modified osteopathic fenestration method of “guiding groove” is safe and feasible, preserving more labiobuccal cortical plate for the affected tooth and effectively reducing the surgical trauma of patients.
Er: YAG Laser Minimally Invasive Tooth Extraction
Authors: Ouyang Wenjun , Tao Jiang
Published: December 2024

Introduction: Er: YAG laser has characteristics such as efficient cutting, promoting healing, controlling inflammation, and reducing pain, making it widely used in the resection of oral soft and hard tissue. The Hypothesis: Conventional tooth extraction may result in alveolar bone resorption, infection, bleeding, and pain. Most minimally invasive extraction methods aim to sever the periodontal ligament while reducing lateral pressure. The Er: YAG laser can remove oral soft and hard tissues with minimal heat-induced damage. Therefore, we propose the hypothesis that using the Er: YAG laser to assist in cutting periodontal soft and hard tissues during minimally invasive tooth extraction could not only improve extraction efficiency but also reduce intraoperative and postoperative complications, potentially ushering in a new era for minimally invasive extractions. Evaluation of the Hypothesis: The Er: YAG laser has demonstrated benefits in cutting efficiency, reducing bleeding, promoting healing, controlling inflammation, and alleviating pain in oral soft and hard tissue surgeries. A few studies have explored its use in severing the periodontal ligament near the tooth neck to assist in extractions. Therefore, we speculate that by increasing the laser power and adjusting other parameters, it may be possible to achieve a greater and deeper severance of the periodontal ligament, thereby accomplishing the goal of minimally invasive tooth extraction.
Evaluation of Impact, Tensile, and Flexural Strength of Natural Wool Fiber Reinforced Polymethyl Methacrylate Denture Base Material: An In Vitro Study
Authors: Abdulrazzaq Zahraa Abdulwahab , Khalaf Bayan S.
Published: December 2024

Introduction: This study was carried out to assess the effect of natural wool fiber addition on the impact, tensile, and flexural strengths of the heat-cured acrylic denture base material. Methods: Short wool fibers with and without chemical surface treatment were added to polymethyl methacrylate (PMMA) at a percentage of 0.25% by weight. A total of 90 acrylic specimens were prepared and divided into three groups according to the tests performed. Impact strength, tensile strength, and flexural strength tests were evaluated. The statistical analysis of the results data was performed using the one-way analysis of variance (ANOVA) test and Tukey’s post hoc test. Results: Impact strength improved significantly after adding silane-treated natural wool fibers to PMMA. However, the tested groups did not have significant differences in tensile and flexural strengths. Conclusion: Natural wool fibers in a percentage of 0.25% by weight could improve the impact strength of the acrylic denture base material after treatment with the silane coupling agent. At the same time, they did not significantly affect the tensile and flexural strengths with or without surface treatment.
Oxygen Saturation and Perceived Discomfort with Different Face Masks among Dental Professionals – A Cross-sectional Study
Authors: Manoharan Prarthana , Gunasekaran Lalithambigai , Shavi Girish R. , Shanmugam Shankar , Sennan Senthil Kumar
Published: December 2024

Introduction:

The protection and efficacy of face masks during the COVID-19 pandemic have been well-documented. COVID-19 is spread by respiratory droplets, and dental professionals are mandatory to wear masks for protection. Post-COVID, it is new normal to wear a face mask in day-to-day life.

Objective:

It was a cross-sectional study conducted among dental professionals at Vivekananda Dental College for Women. We sought to evaluate the impact of masks on health-care workers and their arterial saturation during periods of active clinical hours.

Methodology:

A self-constructed pretested questionnaire of 16 queries regarding the effects of prolonged use of masks, after being analyzed by the experts of our institution, was used. People who are all dentists by profession can participate in this study. All the collected information was sent for statistical analysis.

Results:

The result obtained shows that the majority were using surgical reusable masks, without proper maintenance and disposal, with associated discomfort and breathlessness after wearing them for 6 h a day. While comparing the individual’s oxygen saturation levels, <95 saturation was highly correlated with N95 mask wearers, using more than 6 h/day.

Conclusion:

Since face masks are part of the new normal world, certain strategies can be followed to reduce the discomfort by prolonged usage such as nasal breathing, taking short breaks from wearing masks in a safe environment, and maintaining proper hydration.
Acute kidney injury in pediatric hematopoietic stem cell transplantation patients
Authors: Matbouly Safa , Mohamed Wafaa E.I. , Nabil Esraa , Sallam Dina E.
Published: December 2024

Background

Acute kidney injury (AKI) is still a common complication in children receiving hematopoietic stem cell transplantation (HSCT), and it is an independent risk factor for survival as well as a predictor of progression to chronic kidney disease. However, the reasons for these issues are varied, often overlapping, and poorly understood.

Patients and methods

This is a retrospective analysis of children undergoing HSCT at the Pediatric Bone Marrow Transplantation (BMT) Unit, Faculty of Medicine, between April 2011 and February 2020. The development of AKI, defined according to the Pediatric Risk, Injury, Failure, Loss, and End-stage renal disease, was recorded and correlated to different demographics, medications, complications, and other risk factors.

Results

We included 29 patients (16 boys, 13 girls) with a median age of 6.2 years, where AKI developed in 22/29 (75.9%) individuals within the first 90 days of HSCT. The most predominant complication post-HSCT was infections which happened in 20/29 (69%) patients, followed by acute graft-versus-host disease (aGvHD) (19/29, 65.5%), while neurological complications (in the form of disturbed conscious level and convulsions) occurred in 6/29 (20.7%), and hematological complications (thrombocytopenia) in 1/29 (3.4%). Posttransplant AKI was linked to the age of the patients, where younger patients were more susceptible to developing AKI in addition to aGvHD and infections (P=0.03 and 0.001, respectively).

Conclusion

Posttransplant AKI was common and correlated strongly with younger age group infections, aGvHD, and combinations of antibiotic and antifungal medications. Controllable measures like reducing anti-infective doses, minimizing infections, and aGvHD incidence are required to avoid late renal injury in children posttransplantation.
Correlation of intensive care coronavirus disease 2019 infected patients with ABO blood group system as regards morbidity and mortality in single center, King Fahd Hospital of the University, Saudi Arabia
Authors: Osman Yasser , Alhashem Fatema
Published: December 2024

Objective

Exploring the risk factors for coronavirus disease 2019 (COVID-19) morbidity and mortality is an objective for many investigators.

Current study aims to find the possible relation of the ABO blood group system with COVID-19 morbidity, and mortality in our ICU patients at King Fahd Hospital of University, Kingdom of Saudi Arabia.

Methods

This is a retrospective cohort study. Data were collected from the Quadra Med electronic system by reviewing patients’ files over two years from January 1st, 2020, to December 31st, 2021. Data were analyzed using IBM SPSS (version 20, Chicago, USA).

Results

The study sample consisted of 130 patients admitted to ICU. Patients mean age (62.2 ± 15.3-year-old). 62% males and 38% females. Patients with blood group O+ had the longest hospital stay (35.5 days), followed by A+ patients (34.3 days), and B+ patients (33.3 days), while A– blood group patients had the minimum hospitalization (24 days). The O+ blood group patients had the highest rate of emergency airway intubation, and thrombotic complications compared with patients with other blood groups (P<0.05). In addition, the O+ blood group had the highest mortality rate of 42.6%, whereas AB+ blood group patients had the lowest mortality rate of 2% (P<0.05).

Conclusion

Patients with O+ blood group are more susceptible to COVID-19 infection, morbidity, and mortality compared with patients with other blood groups. The outcomes of this research suggest earlier vaccination, intensive management, and close monitoring of O+ blood group patients for their higher risk of developing serious COVID-19 complications. Our results could be implemented through better management approaches, especially for seriously ill COVID-19 patients in our local community.
Groin lumps during pregnancy: Exploring the knowledge gap among surgeons and obstetricians regarding round ligament varicosities
Authors: Malaibari Zaid , Aldemyati Razaz , Alrahil Reham H. , Alshehri Shumoukh H. , Alrahil Rahaf H. , Alghabban Ahmed T. , Alshamrani Salman A. , Alzubaidi Salihah S.
Published: December 2024

BACKGROUND:

This cross-sectional pilot study aimed to evaluate awareness and management strategies among obstetricians and surgeons in the Kingdom of Saudi Arabia for round ligament varicosities (RLV) during pregnancy.

MATERIALS AND METHODS:

An online questionnaire was distributed through convenience sampling to surgeons and obstetricians across the Kingdom of Saudi Arabia. It assessed demographics, clinical knowledge, experience in diagnosing and managing groin lumps during pregnancy, and engagement in continuing medical education.

RESULTS:

Of the 39 participants, 56.41% (n = 22) were obstetricians and 43.59% (n = 17) were surgeons, with the majority having 5–10 years of practice (35.90%, n = 14). Groin hernia was reported as the most frequent diagnosis for groin lumps during pregnancy (43.59%, n = 17), whereas only 7.69% (n = 3) identified RLV, indicating a significant gap in recognizing RLV. Furthermore, 35.90% (n = 14) recognized RLV as a differential diagnosis, but only 25.64% (n = 10) were aware of its management.

CONCLUSION:

RLV, which is more common than hernias during pregnancy, is often misdiagnosed due to its similar presentation. Accurate differentiation, often achieved through ultrasound, is crucial as management strategies significantly differ. This study underscores the need for enhanced awareness and training among obstetricians and surgeons to accurately diagnose and manage RLV. The observed knowledge gaps highlight the critical role of continuous medical education in improving patient care. These findings will guide a larger study to assess practices across the Kingdom and develop national recommendations for the management of RLV and groin hernias during pregnancy.
IAPSM’s Position Paper on Pneumococcal Vaccine (PCV) for Adult Immunization in India
Authors: Rao Chythra R. , Kamath Veena G. , Nadda Anuradha , Parida Swayam P. , Sharma Nikita , Goel Kapil , Shetty Ranjitha S. , Verma Madhur , Singh Arvind Kumar , Mishra Abhisek , Kiran Swosti , Sankhe Lalit , Gupta Madhu
Published: December 2024

Pneumococcal infection among adults is associated with invasive disease and poor outcomes. Pneumococcal vaccine (PCV) introduction has significantly reduced disease burden, invasive disease and reduced the rates of antimicrobial resistance. Of the various vaccines licensed, PCV 13 and PPSV 23 are available for use in India. Pneumococcal vaccination is suggested for people aged 19–64 years with immunosuppression, chronic cardiac, lung and hepatic disease, impaired splenic function, uncontrolled diabetes mellitus, current smokers, and those abusing alcohol. It is recommended that people >65 years of age are vaccinated with PPSV23. The suggested regimen is to administer PCV13 followed by PPSV23 after one year. The vaccines have minimal side effects and tolerated well. Data on vaccine effectiveness from Indian studies is limited. Hence, documenting population demographics with surveillance on serotype specific pneumococcal disease burden in adults is needed. Following this, studies on safety, immunogenicity, and cost-effectiveness of the available vaccines need to be designed and implemented. It is suggested that in the initial phase, PCV needs to be made available for high-risk population followed by vaccination roll-out for adult population of India.
IAPSM’s Position Paper on Influenza Vaccines for Adult Immunization in India
Authors: Sharma Nikita , Verma Madhur , Goel Kapil , Kulkarni Muralidhar M. , Bhardwaj Anu , Sharma Sahil , Singh Tejbeer , Gupta Madhu , Nadda Anuradha , Sankhe Lalit R.
Published: December 2024

Influenza causes significant morbidity, hospitalizations, and mortality due to lower respiratory tract infections in India. This paper reviews the current evidence regarding influenza epidemiology, the need for vaccination, immunogenicity, and efficacy of available vaccines and provides recommendations for influenza vaccination for adults by the Indian Association of Preventive and Social Medicine (IAPSM). The risk group among adults includes people with chronic disease, the elderly, immunocompromised individuals, pregnant women, travelers, and healthcare workers. Influenza activity is affected by seasons, humidity, and latitude, leading to variability in influenza peaks in different regions of India. The most effective preventive intervention against influenza is vaccination. Current influenza vaccines have good safety profiles, vaccine efficacy, and acceptable cost-effectiveness. As the virus mutates, the vaccine composition should follow WHO recommendations for the current influenza season. Introducing readily available, conventional, and less expensive trivalent influenza vaccines under the national program can achieve maximum impact on the adult population and potentially prevent future outbreaks and pandemics. IAPSM recommends considering routine use of IIV for all individuals above 60 years, adults with comorbidities, and pregnant women in India. The program managers should consider the pattern of influenza seasonality in a particular region. Influenza surveillance conducted through a structured network of laboratories in India has the potential to provide information about circulating strains, morbidity, and mortality. IAPSM emphasizes conducting community-based studies regarding influenza’s burden, vaccine efficacy, timing of vaccination, and cost-effectiveness among Indian adults to generate evidence.
Developing an Emergency Medical Services Resilience Assessment Tool in Climate Change: A Study Protocol
Authors: Mohammadi-Janbazloufar Kamran , Atighechian Golrokh , Ostadtaghizadeh Abbas , Rezaei Fatemeh , Hirshon Jon Mark
Published: December 2024

Background:

Climate change poses significant threats to the health and safety of communities worldwide. Extreme weather events can disrupt critical infrastructure and overwhelm emergency medical services (EMS) systems. As the frequency and intensity of these climate-related disasters continue to increase, it is essential that EMS organizations develop robust strategies to enhance their resilience. One important step in building climate-resilient EMS systems is the development of comprehensive assessment tools. Developing a comprehensive tool for assessing the resilience of EMS in the face of climate change.

Methods:

This research employs an applied, mixed-methods approach to investigate the development and validation of the Emergency Medical Services Resilience Assessment (EMSRA) tool. The study will be executed across four key phases: (a) A scoping review will be conducted to identify the global dimensions and components of EMS systems that demonstrate resilience to the impacts of climate change. (b) A qualitative study, involving semistructured interviews, will be undertaken to explore the specific dimensions and components of EMS resilience within the Iranian context. (c) Based on the findings from the scoping review and qualitative inquiry, assessment items related to EMS resilience in climate change will be extracted and synthesized to develop a pilot version of the EMSRA tool. (d) The pilot EMSRA tool will undergo a rigorous process of quantitative and qualitative validation, including an evaluation of its psychometric properties, to assess the resilience of EMS systems in the face of climate-related challenges.

Conclusions:

The development of EMSRA tool will enable the assessment and enhancement of climate change resilience within the national and provincial EMS systems, providing critical data to inform evidence-based strategies and plans for strengthening EMS against the impacts of severe climate changes.
Insulin Resistance Mediates the Association Between Vitamin D and Non-Alcoholic Fatty Liver Disease
Authors: Zou Caiyan , Liu Xuekui , He Maosheng , Sun Yan , Sang Yiquan , Peng Gangshan , Ma Yamei , Geng Houfa , Liang Jun
Published: December 2024

Background:

Vitamin D (VD) deficiency and insulin resistance (IR) increase the risk of non-alcoholic fatty liver disease (NAFLD), but few studies have explored the potential mechanisms by which IR mediates the association between VD and the pathogenesis of NAFLD at the genetic level using publicly available databases.

Methods:

This is a cross-sectional study, and we utilized the National Health and Nutrition Examination Survey (NHANES) dataset, as well as data from GSE200765 obtained from the Gene Expression Omnibus (GEO) website. A total of 723 individuals who had completed liver ultrasound examination and the detection of VD levels were included in the final analysis. A gene expression dataset, GSE200765, was also downloaded from the GEO website, to explore the potential mechanism of VD and NAFLD.

Results:

In the NHANES data, covariates significantly differed in four VD categories, and the controlled attenuation parameter (CAP), vibration-controlled transient elastography-liver stiffness measurement (VCTE-LSM), and IR were reduced with an increase in VD levels. Mediation analysis revealed that IR mediated the association between VD and both CAP and LSM, and the estimated mediation effects were 29.0% and 39.8%, respectively. Bioinformatics analysis showed that seven differentially expressed genes (DEGs) (solute carrier family 2 member 2 [SLC2A2], protein phosphatase 1 regulatory subunit 3E [PPP1R3E], CAMP responsive element binding protein 3-like 3 [CREB3L3], Interleukin-6 [IL-6], peroxisome proliferator-activated receptor gamma coactivator 1-alpha [PPARGC1A], nuclear factor kappa B inhibitor alpha [NFKBIA], and phosphoenolpyruvate carboxykinase 2 [PCK2]) were enriched in the IR pathway in comparison groups (VD group vs. lipid group), suggesting that VD improved NAFLD via changed IR.

Conclusions:

VD deficiency and IR were the risk factors for NAFLD, and increased VD levels improved the status of NAFLD. The underlying mechanism may be that elevated VD levels reduced IR, which improved the expression of DEGs involved in the IR pathway.
Dispositional Hope and Self-Regulation among Graduate Students in Karnataka
Authors: Gujjar Malasa , Shetty Kannappa V. , Prabhu G , Srivastava Prerna
Published: December 2024

ABSTRACT

Background:

Dispositional hope and self-regulation have been hypothesized to be associated with each other. The current study aimed to assess the same in graduate students.

Materials and Methods:

One hundred and fifty-eight students were recruited. Sociodemographic Performa, Adult Hope Scale, and Self-Regulation Scale were administered to them.

Results:

The results indicated a significant relationship between dispositional hope and self-regulation. Thus, it can be said that there exists a mutual relationship between the two, with each one strengthening the other.

Conclusion:

The results thus indicate that there is a mutual relationship between the level of dispositional hope and self-regulation.
Midlife Crisis
Authors: Balamurugan G. , Vijayarani M. , Radhakrishnan G.
Published: December 2024

ABSTRACT

Midlife is a pivotal stage of adulthood, characterized by biological, psychological, and social transitions that often lead to a “midlife crisis.” This phenomenon, while not universal, manifests as a period of self-reflection, reassessment, and potential turmoil, influenced by personal and societal factors. This paper explores the complexities of midlife, including its impact on mental health, relationships, careers, and overall well-being. Key themes include the transition through ego mastery stages, the interplay of physical health, mortality awareness, and evolving roles, as well as gender-specific experiences. While midlife crises may result in emotional upheaval and dissatisfaction, they also offer opportunities for growth and self-discovery. Coping strategies, such as reframing challenges, seeking support, and prioritizing physical activity, are highlighted as transformative tools. The role of healthcare professionals in normalizing this experience and fostering resilience is emphasized. Ultimately, this study underscores midlife as both a challenging and enriching phase, inviting further research into its nuanced dynamics..
Health for All: Medical Tourism as a Resource
Authors: Amalorpavanathan Joseph , Ananthakrishnan Gopalakrishnan
Published: December 2024

India has been formulating policies for more than three decades to grow medical tourism as a significant globalised service through a well-trained set of clinicians and hospitals. After its economy became globally integrated, the country has attracted capital investment to the health sector through automatic approval of 100% foreign direct investment in hospitals. India is implementing an online portal-based system with the aim of removing information asymmetry and lack of predictability and transparency for visitors. The expansion of the hospital and wellness service sectors serving foreign tourists, who come for specific medical treatments as well as rejuvenation holidays, is marked by several challenges. The patients and visitors often encounter non-standard facilitation arrangements for accommodation, fixing of medical appointments, legal compliance, cost of treatments, post-procedure follow-up and recourse to remedies for defaults and deficiencies. We evaluate policy interventions made to help the medical tourists, the regulatory deficiencies and negative perceptions of the sector and propose prospective remedies. We conclude that the opportunity to attract foreign medical tourists is significant, but policy shortcomings need to be addressed to realise the potential without diverting resources away from public health care. Higher revenues from medical tourism can help expand healthcare access for Indian citizens.