bluuebunny/crossref_metadata_2025 huggingface dataset:
Rural vs. Urban Development Disparities in the Middle East
Authors: Ghosn Fadi
Published: October 2024

This chapter explores the significant disparities between rural and urban development in the Middle East, examining economic, financial, infrastructural, climate, and social dimensions. It begins with a historical overview, tracing the evolution of development patterns and key events that have influenced these disparities. By examining GDP, income levels, employment opportunities, and financial inclusion, the review highlights the stark contrasts between urban industrial centers and rural agricultural regions. The chapter delves into infrastructural discrepancies, such as transportation, education, digital divide and technological advancements, reliance on agriculture, and climate, in addition to social and financial disparities. Government policies and initiatives aimed at addressing these disparities are critically evaluated. Finally, it addresses the challenges and barriers to reducing these disparities and proposes innovative strategies for promoting inclusive and sustainable development, ensuring balanced growth across the region.
Learning Gaps and Developmental Inequities
Authors: Tajeddine Hassan
Published: October 2024

The Middle East has long grappled with the dual challenges of learning gaps and developmental inequities, which significantly hinder its progress. This chapter delves into the intricate relationship between education and development in the region, highlighting the disparities in educational access, quality, and outcomes that contribute to broader socio-economic inequities. By examining case studies from various Middle Eastern countries, the chapter explores how historical, socio-political, and economic factors have shaped the current educational landscape. It discusses the impact of conflict, political instability, and economic disparities on educational systems and their ability to provide equitable opportunities for all. The chapter further analyzes the role of government policies, international aid, and non-governmental organizations in addressing these challenges.
Strengthening Social Capital for Entrepreneurship in Building Costal Resilience
Authors: Chen Ye-Sho
Published: October 2024

Building coastal resilience in the context of rapidly increasing challenges of disturbance factors, e.g., extreme events, human impacts, and sea level rise, is becoming a necessity for coastal communities including policy makers, businesses, and researchers. In this paper, the author shows a design methodology of strengthening social capital for entrepreneurship in building coastal resilience. The methodology is grounded in the theories of social capital and community resilience, docility and entrepreneurship, distributed cognition, and input-process-output model of strategic entrepreneurship. The design is put into action to study the experiences of Louisiana in building coastal resilience responding to environmental disturbances such as Katrina, Deepwater Horizon, and Covid-19. In particular, we study how technological platforms are developed to help scale up entrepreneurship for wetland conservation.
Influence of Gas Oven Temperature on the Microstructure and Extrudability of Al-Mg-Si Aluminium Alloys
Authors: Schiffl Andreas , Tourey Serena , Riepler Patrick
Published: October 2024

The microstructure of Al-Mg-Si aluminium alloys is well characterised when it comes to the initial state of the cast billet or the artificially aged profile. Typically, a gas oven coupled with an induction oven is used to preheat the billets before extrusion. Preheating reduces the flow stress of the aluminium and dissolves the phases that have precipitated during cooling after homogenisation. In this paper, the influence of the gas oven temperature on the partial or complete dissolution of the precipitated phases will be shown. In addition, the negative effect of a wrong choice of parameters on the volume content of the MgSi phases will be shown.
Effect of h-NS Content on the Viscosity, Morphology, Gelation, and Mechanical Properties of the Modified-rPET from Bottle Waste
Authors: Roonthong Buncha , Damdenngam Sorawit , Intarasuwan Nutthanon , Parneam Nismar , Suwankan Patpimol , Ayutthaya Siriorn Isarankura Na
Published: October 2024

This research developed the modified-recycled poly (ethylene terephthalate) (modified-rPET) filament by decreasing the crosslinked-gel content inside the filament, by adding various contents of hydrophobic nanosilica (h-NS). This research also studies the viscosity, morphology, h-NS dispersion, and mechanical properties of the modified-rPET/h-NS, by using a rotational rheometer, a scanning electron microscope, a micro-XRF spectrometer, and a universal testing machine, respectively. rPET flakes were dried to deplete the moisture. Then, they were mixed with additives and h-NS at 0, 1, 2, 3, 4, and 5 pph, and were extruded to be compound using twin screw extruder. The modified-rPET/h-NS extrudates were investigated into two parts. Firstly, was observed on the process-ability, morphology, and gel content along the filament. Consequently, the viscosity, mechanical properties, and h-NS dispersion were investigated. The results showed that the best formulation that is easy to process and has the lowest gel content along the filament, was NS1. Other results, shear-thinning rheology behaviors were observed for all formulations. The mechanical properties, including ultimate tensile strength and elongation at break decreased, as the h-NS content increased. At higher content of h-NS (NS4 and NS5), the gel content increased significantly, therefore the h-NS agglomeration occurred, which was different from crosslinked gels.
Study of Structural, Thermal and Electrical Properties of Sr-Doped CaMnO3
Authors: Nurhayati Alwiyah , Venkataramana Kasarapu , Reddy C. Vishnuvardhan
Published: October 2024

Sr-doped CaMnO3 materials have wide applications due to their thermal and electrical properties. The importance of the synthesis of Sr-doped CaMnO3 material for various applications encourages researchers to evaluate and refine the synthesis process. In this study, Ca1-xSrxMnO3 (x = 0; 0.05; 0.1; 0.15; 0.2) system has been prepared by sol-gel method followed by conventional sintering process at 850°C for 8 hr. A thorough discussion has been made on the outcomes derived from the investigation on the structural, electrical, and thermal properties of Sr-doped CaMnO3 system using powder x-ray diffraction, scanning electron microscopy, energy dispersive spectroscopy, DC fourprobe method, thermal expansion studies, and thermoelectric power analyses. The XRD patterns of all prepared samples exhibited single phase with orthorhombic crystal structure (space group Pnma). Rietveld refinements were performed for all the patterns by using Fullprof software to extract the structural properties. The values of unit cell volume of samples tend to increase with the increment of dopant concentration, whereas the crystallite size values were decreased with dopant concentration. The microstructures of all the samples were studied using SEM, and elemental compositions were confirmed from the EDS results. Linear thermal expansion coefficients of all the samples were found to have moderate values in the temperature range from 30°C to 800°C. The electrical properties of all the system of samples were studied in the temperature range from 30°C to 400°C using DC fourprobe conductivity setup. It was found that all the samples exhibited semiconductor nature. Sr-content on the A-site suppress the electrical resistivity up to 10% of concentration and 5% dopant content exhibited the lowest electrical resistivity. The values of Seebeck coefficient found to vary from -160 µV/K to -124 µV/K with the increase of dopant content in the parent compound.
The Influence of Surface Segregation on the Anodizing of AlSi11Cu2(Fe) Diecastings
Authors: Scampone Giulia , Russo Antonio , Muzzani Roberto , Carminati Alessio , Timelli Giulio
Published: October 2024

A positive segregation is usually formed on the casting surfaces produced by high-pressure die casting (HPDC). In diecast Al-Si-Cu alloy components, this segregation shows a higher content of Si compared to the nominal composition of the alloy and it drastically affects the anodizing response of the casting surface. In the present work, HPDC components were produced by AlSi11Cu2(Fe) alloy, grit-blasted, and then anodized in a sulfuric acid electrolyte at the temperature of -4.5°C. Before the anodizing process, some regions of the casting were also milled, in order to completely remove the surface segregation. Microstructural investigations were carried out on grit-blasted and milled surfaces to characterize the initial substrates before anodizing, and to study their effect on the growth of the anodic layer. Scratch and wear tests were also performed to investigate the surface mechanical properties after anodizing. The results show that the surface segregation and the rough surface present on grit-blasted substrate leads to the formation of a thin and homogeneous anodic layer. On the contrary, a thicker and scalloped oxide film is formed on the milled surfaces. After anodizing, grit-blasted surfaces show lower wear and scratch resistance than milled substrates. The presence of surface segregation prevents the thickening of the anodic layer, negatively affecting the surface wear resistance due to the reduced oxide thickness.
Comprehensive Strategies for Preoperative Pulmonary Risk Evaluation and Management
Authors: Lee Hyo Jin , Lee Hyun Woo
Published: October 2024

Postoperative pulmonary complications (PPCs) significantly increase morbidity and mortality in surgical patients, particularly those with pulmonary conditions. PPC incidence varies widely, influenced by factors such as surgery type, patient age, smoking status, and comorbid conditions, including chronic obstructive pulmonary disease (COPD) and congestive heart failure. While preoperative pulmonary function tests and chest radiographs are crucial for lung resection surgery, their use should be judiciously tailored to individual risk profiles. Effective risk stratification models, such as the American Society of Anesthesiologists classification, Arozullah respiratory failure index, Gupta Calculators, and Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) model, play a key role in predicting PPCs. Key strategies to diminish PPCs include preoperative optimization of respiratory conditions, smoking cessation, and respiratory rehabilitation. In patients with COPD and asthma, it is crucial to maintain optimal disease control through inhaled therapies, systemic corticosteroids, and tailored preoperative respiratory exercises. Anemia and hypoalbuminemia are significant predictors of PPCs and require meticulous management. The choice and duration of anesthesia also notably influence PPC risk, with regional anesthesia being preferable to general anesthesia when possible. Comprehensive preoperative evaluations and tailored interventions are essential for enhancing surgical outcomes and reducing PPC incidence. Additional studies involving domestic patients are necessary to refine national guidelines for managing those at risk of PPCs.
Factors influencing nursing professionalism among nursing students in South Korea: a descriptive study
Authors: Kim Bokyoung , Park Jiyoon , Ko Seon Woo , Kim Na Yeon , Park Jiyeon , Seo Gain
Published: October 2024

Purpose: This study aims to explore the factors influencing nursing professionalism among nursing students, focusing on the image of nurses, satisfaction with their major, and career metacognition.Methods: We conducted a descriptive survey with 185 nursing students from D city and K region on June 10–30, 2024. Data were analyzed using IBM SPSS ver. 27.0 (IBM Corp.), employing descriptive statistics, t tests, one-way ANOVA, Scheffé tests, Pearson’s correlation coefficients, and regression analysis. Multiple linear regression analysis was used to identify factors affecting nursing professionalism among nursing students.Results: The regression analysis revealed that the image of nurses (β=.69, p<.001) and monitoring aspect of career metacognition (β=.13, p=.025) were significant predictors of nursing professionalism, accounting for 64.5% of the variance.Conclusion: The findings indicate that the image of nurses and monitoring component of career metacognition are critical in shaping nursing professionalism among nursing students. Therefore, nursing education programs should aim to improve the image of nurses and promote self-reflective career practices as strategies to foster professionalism among nursing students.
Exploring learning capability on entrepreneurial resilience of emerging contractor firms
Authors: Baah Felix A. , Rambe Patient
Published: October 2024

Orientation: The resilience of small businesses such as emerging contractor firms (ECFs) has been negatively affected due to problems from the environment like the coronavirus disease 2019 (COVID-19) pandemic. It is imperative for firms to navigate through this economic downturn by deploying learning capabilities to surmount these problems and boost resilience.Research purpose: This study examines the influence of learning capability on the entrepreneurial resilience.Motivation for the study: To establish the role of learning capability on entrepreneurial resilience of ECFs.Research design, approach and method: Using a quantitative research approach and a cross-sectional survey design, a structured close-ended questionnaire was administered to 400 owners and managers of ECFs. The results of the study were analysed using Statistical Package for the Social Sciences (SPSS) version 23 and Smart PLS software 3. Descriptive percentage analysis, confirmatory factor analysis (CFA), multiple regression analysis, and structural equation modelling (SEM) were performed on the data set.Main findings: The results suggest that all forms of learning have significant positive effect on entrepreneurial resilience (Transformative learning B = 0.2207, p  0.001; exploitative learning β = 0.2580; p  0.001; explorative learning β = 0.5316; p  0.001).Practical/managerial implications: The implications emphasise the different choices that small resource constrained firms must take in identifying and investing in those learning capability dimensions which best predict long term resilience.Contribution/value-add: The study demonstrates the significance of firms’ investment in learning, especially explorative learning to increase knowledge.
Corrigendum: Observing systemic conflict: The emotional affect on pastors in the Netherdutch Reformed Church of Africa
Authors: Labuschagne Frederick J. , Steenkamp Petrus L.
Published: October 2024

No abstract available.
Relationship of anthropometric indices of obesity with the Big Five personality traits and cognition among undergraduate students
Authors: Gwarzo Mukhtar Isyaku , Musa Zainab Muhammad
Published: October 2024

Background:

Obesity is associated with personality and cognition. The association remains to be investigated in the African population. In this study, we aimed to determine the prevalence of obesity and the relationship between anthropometric indices of obesity, personality traits, and cognition among undergraduate students in Kano, Nigeria.

Methods:

Two hundred and fifty-five (males = 94 and females = 161) undergraduates (17–30 years old) were recruited for the study. Anthropometric indices were measured according to the STEPwise protocol of the World Health Organization. Personality traits were assessed using the Big Five Personality Inventory, whereas cognition was assessed using the Montreal Cognitive Assessment (MoCA) tool.

Results:

The mean age of the patients was 23 years. The prevalence rates of central obesity and general obesity were 26.3% and 1.6%, respectively. Waist circumference (WC) (r = 0.14, P = 0.025) and hip circumference (HC) (r = 0.126, P = 0.045) were positively correlated with neuroticism. However, WC (r = −0.138, P = 0.028), HC (r = −0.138, P = 0.028), and waist-to-height ratio (WHtR) (r = −0.156, P = 0.011) were negatively correlated with naming (a component of MoCA) while WHtR was negatively correlated with MoCA (r = −0.126, P = 0.044). After adjusting for age, sex, and marital status, WC (odds ratio [OR] = 0.679 [95% confidence interval (CI): 0.456–1.011]; P = 0.050), HC (OR = 1.414 [95% CI: 1.007–1.986]; P = 0.045), and waist-to-hip ratio (OR = 1357 [95% CI: 6.524–28248]; P = 0.039) were significant predictors of low MoCA score.

Conclusion:

The prevalence of central obesity among our participants was high and associated with neuroticism and poor cognition.
Pretransplantation assessment of BK virus seropositivity in kidney donors and recipients
Authors: Nair Aswathi M. , Arun B. , Aziz Feroz , Vishwanath Vipin , Deepak K. S. , Anagha K. , Santheep S. , Kamalam S. Gladies
Published: October 2024

Background:

BK virus (BKV) is a member of the polyomavirus family. The determination of anti-BKV immunoglobulin G (IgG) antibody levels in kidney donors and recipients has been reported as a possible predictor of the risk of BK nephropathy. Allograft dysfunction is a significant risk factor. The main objective of this study was to address the high prevalence of renal failure due to BKV nephropathy in kidney transplant recipients. This investigation aims to determine whether donors and recipients of renal transplants had BKV IgG antibodies before transplantation.

Methods:

Blood samples were collected from 46 kidney transplant recipients and their corresponding 46 donors. An enzyme-linked immunosorbent assay was used to qualitatively analyze human BKV IgG.

Results:

Ninety-two participants, 46 kidney transplant donors, and 46 kidney transplant recipients, were analyzed. Pretransplantation anti-BKV antibody levels were higher in kidney transplant donors (73%) than in recipients (63%). Donors and recipients included in the study were grouped into seropositive and seronegative recipients, with the highest proportion of seropositive recipient-donor groups (48%) and the lowest percentages in the seronegative donor and seronegative recipient groups. Fifty-one percent of the participants were male and 49% were female. The age distribution of most subjects was >50 years old.

Conclusion:

BKV can cause kidney transplant rejection. Routine screening of transplant recipients and donors for BKV IgG seropositivity is recommended before renal transplantation. This can improve transplant outcomes and prevent rejection.
Knowledge, Attitude, Practice, and Perceived Barriers toward Smoking Cessation among Community Pharmacists Services in Al-Karak Governorate
Authors: Alnawaiseh Nedal Awad , Al-Hroub Reem Sager
Published: October 2024

ABSTRACT

Background:

There are about a billion smokers in the world, 80% of whom are from developing countries, and also the World Health Organization stated that smoking is considered a global health problem. Jordan is one of the countries with the highest rates of tobacco smoking in the world. However, interventions related to tobacco use, which can reduce diseases resulting from or associated with smoking and thus reduce health-care costs, are still rare in Jordan.

Objective:

This study aimed to evaluate community pharmacists’ knowledge, attitudes, and practices toward smoking cessation (SC) and to identify the most important barriers they face in providing SC counseling in community pharmacies in Alkarak, Jordan.

Materials and Methods:

The study used a cross-sectional design based on a descriptive approach and included community pharmacies in April 2021. Data were collected from 199 participating pharmacists on duty in 76 pharmacies. A structured, reliable, English-language, and valid questionnaire was used to collect data consisting of five parts. The questionnaire included pharmacists’ sociodemographics, knowledge, attitudes, and practices, as well as barriers associated with SC services. The data and differences in participants’ responses were analyzed using descriptive statistics SPSS version 19, analysis of variance, and the confidence level was 80%.

Results:

One hundred and ninety-nine pharmacists completed the survey. The mean age of the pharmacists was 30.05 ± 7.15 years. Eighty-one percent of participating pharmacists had high knowledge regarding SC and SC products, and 80% of them agreed that it was their responsibility to advise smoking patients regarding SC. Multivariate analysis showed a statistically significant relationship between attitude and practice.

Conclusions:

Our study concluded from the overall findings that pharmacists generally have the knowledge and attitudes required to play an important role in counseling patients about SC. Community pharmacists in Alkarak, Jordan, generally expressed positive attitudes regarding tobacco cessation counseling. We recommend opening the way for researchers to pay attention to this topic and publish many researches on the impact of educational training programs for pharmacy students by raising their level of knowledge about SC.
In vitro and In silico Network Pharmacology Analysis of Eugenol from Syzygium aromaticum Against Escherichia coli
Authors: Kumar A. Santhosh , Suvetha N. , Kannan Kannika Parameshwari , Gunasekaran Shoba , Girija A. S. Smiline
Published: October 2024

ABSTRACT

Background:

In this era, Escherichia coli is an ambivalent microbe and commonly causes fecal contamination. Eugenol from clove oil has also demonstrates antibacterial effects that may aid in combating against the microorganisms that cause tooth infections.

Aim and Objectives:

The current study provides a comprehensive analysis of the pharmacological characteristics of eugenol, a significant bioactive substance extracted from clove (Syzygium aromaticum). The present study aimed to target the genes from E. coli identified through network pharmacology analysis of eugenol and antibiofilm effect of eugenol from clove oil against E. coli.

Materials and Methods:

In the present study, eugenol was isolated from clove identified through Fourier transform infrared spectroscopy analysis. The antibacterial and antibiofilm activity of eugenol was performed against E. coli were investigated. Targets were identified for Eugenol from clove oil through string database and mapped with E. coli pathway. Molecular docking analysis was carried out for the identified targets and eugenol.

Results:

The best antibacterial activity of eugenol from clove oil was found against E. coli and evaluated by zone of inhibition and minimum inhibitory concentration analysis at 10 μL. The antibiofilm assay against resistant E. coli was determined by concentration of 10 μL and inhibited in 100% dilution. The top five active targets from E. coli was identified by network pharmacology and docking analysis shows the good binding interaction between targets and eugenol.

Conclusion:

The research provided in this study lays the foundation for eugenol’s anti-bacterial property with various biofilm forming targets namely Acetyl-CoA acetyltransferase, Acetyl-CoA carboxylase-B, Acetyl-CoA carboxylase-C, Enoyl-[acyl-carrier-protein] reductase [NADH], and 3-oxoacyl-[acyl-carrier-protein] synthase 1. Additional in vivo approach validation is required in future to support the current study.
In situ Gels for Periodontitis: An Overview
Authors: Mallamma T. , Rehman S. Abdul , Goudanavar Prakash , Akondi Butchi Raju
Published: October 2024

ABSTRACT

A successful approach for periodontitis treatment isin situgel administration, which delivers medication to the site of infection in a controlled and continuous manner. Researchers used components such as zein, borneol, piperine, and curcumin to create a formulation. The formulations demonstrated antimicrobial effects and were designed to target the inflammatory condition associated with dysbiosis in periodontitis. Polymers such as gellan gum, alginic acid, xyloglucan, pectin, chitosan, poly (D Lactic acid), poly (DL-lactide co glycolide), and polycaprolactone are commonly used polymers to prepare the In situ gel formulation , which enables prolonged medication and Controlled release. In the presence of ions, alginic acid gels are biocompatible. Whereas pectin gels are used in the presence of calcium ions, xyloglucan gels are used in response to temperature fluctuations. To increase the efficacy of the treatment, the studies sought to enhance gel characteristics such as gelation temperature, thickness, and drug release rate. The improved formulations showed anti-inflammatory solid effects and efficient drug delivery for periodontal conditions by significantly reducing pocket depth, plaque, and gum inflammation. The direct application ofin situgels offers targeted delivery, few side effects, and self-administration; the review focuses on the benefits, advantages, and disadvantages ofin situgel administration for periodontitis, as well as the characteristics of tooth physiology, preparation techniques, and polymers and biomarkers used. Assessments ofin situgels: To significantly improve periodontitis treatment, future research should focus on clinical studies to contribute substantially to periodontitis treatment.
Phytocompounds and lipid-based drug delivery system for neurodegenerative diseases
Authors: Ozay Cennet , Karpuz Merve
Published: October 2024

Across the annals of time, organic molecules sourced from nature have found innumerable uses within the realms of healthcare, pharmaceuticals, and the study of living organisms. This abundant source of natural compounds has exhibited immense promise in the cure of diverse ailments, mainly neurodegenerative diseases owing to their minimum toxic and adverse effects. However, different challenges exist with phytocompounds from plants such as poor permeation, poor solubility (water/lipid), unsteadiness under extremely acidic pH conditions, and lack of targeting specificity. Furthermore, as a result of the existence of blood-brain barrier membrane and inconvenient pharmacokinetics characteristics of phytocompounds, their passage into the brain is constrained. In order to address this issue and augment the transportation of medications into the brain at a therapeutically effective level, it is imperative to formulate an innovative and pragmatic strategy. Many papers have shown that nanoformulations containing phytocompounds (resveratrol, quercetin, ferulic acid, curcumin, berberine, etc.) effectively improved many neurodegenerative diseases such as Parkinson’s, Alzheimer’s and Huntington’s diseases. This study provides an overview of phytocompounds that are used in nanosized lipid drug delivery systems. These systems are categorized according to lipid types and preparation techniques used in the formulation. Some studies regarding these systems and phytocompounds are also summarized.
Breast cancer referrals to NHS Tayside genetic service: Are we meeting target timelines?
Authors: Swan Rebecca E , Pitcathley Madeleine , Dunlop Jacqueline , Choong Wen Ling
Published: October 2024

Abstract

Introduction:

Mutations in BRCA1 and BRCA2 account for 5%–10% of all female breast cancers. Identifying these mutations at diagnosis can aid shared decision-making in the surgical and oncological setting. This study aims to assess the results of genetic testing at diagnosis and the time taken to receive results.

Materials and Methods:

A prospective database of all patients with newly diagnosed breast cancers who met the criteria and were referred for urgent genetic testing in National health service (NHS) (Tayside) between December 2017 and December 2020 was analyzed for results of genetic testing and time from referral to the result of genetic test.

Results:

Twelve of 116 patients (10.3%) had a mutation detected. Six had BRCA2 mutation (5.2%), four had BRCA1 mutation (3.4%), and two had PALB2 mutation (1.7%). Of patients with a mutation, six (50%) had triple-negative breast cancer aged <40 years, four (33.3%) had triple-negative breast cancer aged >40 years, and two (16.7%) had breast cancer aged <40 years. The median time from referral to test result was 28 days [interquartile range (IQR) 22–36.5 days]. Of 12 patients with a mutation, seven (58.3%) chose risk-reducing breast surgery at the primary operation with immediate reconstruction.

Conclusions:

Triple-negative receptor status was common in patients who had gene mutations, including those aged over 40, and this group of patients should be considered for genetics referral. The time to receive the genetic test result may add delay to subsequent surgical management. Urgent genetic testing led to risk-reducing breast surgery and immediate reconstruction in a minority of patients tested.
Beyond boundaries: An exploration of general surgery education in Canada and India
Authors: Patel Prachikumari , Ray Samrat , Rajendran Luckshi , Muaddi Hala , Coe Taylor M. , Irfan Ahmer , Shwaartz Chaya
Published: October 2024

General surgery is a dynamic and multifaceted field influenced by diverse factors, ranging from cultural norms to healthcare system structures and technological advancements. This review paper delves into a comparative exploration of the educational landscapes in Canada and India, unravelling the intricacies of training aspiring general surgeons. As two nations with distinct healthcare systems and educational frameworks, Canada and India offer unique perspectives on the journey from medical school to independent surgical practice. This article compares the residency application process, training structure, assessment methods, challenges faced during clinical training and the role of research in surgical programmes between the two nations. Through this comparative lens, we seek to provide valuable insights that may inform future developments in surgical education, fostering a global exchange of knowledge and practices to advance healthcare systems worldwide.
Comparison of ten formulae for calculating low-density lipoprotein cholesterol with direct low-density lipoprotein cholesterol measurement
Authors: Nair Suriyan S. , Kiran Reshma , Jisna K. K. , Prathima M. B. , Sushith P , D’sa Janice
Published: October 2024

Background:

Accurate lipid profile assessment, mainly low-density lipoprotein cholesterol (LDL-C) measurement, is crucial for diagnosing and managing cardiovascular disease (CVD). The widely used Friedewald formula for LDL-C calculation has limitations, prompting the exploration of alternative equations.

Aims:

This study aims to compare ten LDL-C calculation formulas with direct measurement among study participants attending a tertiary care centre.

Materials and Methods:

Conducted from September 2021 to July 2022 at a tertiary healthcare centre in India, the study involved 114 participants aged 18 years or older. The exclusion criteria were high-serum triglyceride (TG) levels, renal failure, diabetes, liver diseases or unwillingness to participate. Blood samples were analysed for total cholesterol, TG, high-density lipoprotein cholesterol and LDL-C. The very-low-density lipoprotein cholesterol level was calculated. The LDL-C formulas evaluated were Friedewald, Anandaraja, De Cordova, Vujovic, Ahmadi, Puavillai, Chen, Hattori, Martin–Hopkin and Sampson.

Results:

Vujovic’s formula showed a negligible mean difference and strong correlation (r = 0.916, P < 0.001) with direct LDL-C estimation across TG concentrations. Sampson’s formula performed best for TG <150 mg/dL, whereas Vujovic’s formula excelled for 151–399 mg/dL TG concentrations. All formulas were highly correlated with direct LDL-C levels (P < 0.001). Bland–Altman analysis indicated Vujovic’s formula as the closest match to direct measurement, with a mean bias of −1.42 ± 20.59 mg/dL.

Conclusion:

Vujovic’s formula demonstrated the slightest difference and strong correlation with direct LDL-C measurement, outperforming other formulas. This finding enhances the accuracy of LDL-C assessment and improves CVD risk management in clinical practice.
Microneedling and 5-Fluorouracil in Treating Stable Vitiligo in Hitherto Unstudied High Prevalence Population
Authors: Abhirami B , Kumar Prabhat , Mishra Dharmendra K.
Published: October 2024

Background:

Vitiligo, affecting 0.25% in India (>1% in Jharkhand), stigmatises and devastates self-esteem/relationships causing depression. Apart from medical treatment, surgical procedures like applying 5-fluorouracil after microneedling are to be confirmed in unstudied populations and across time periods. An interventional study was conducted among out-patients of a tertiary hospital in a high-prevalence population wherein earlier attempts were not conducted.

Aims/Objectives:

To assess the effect of microneedling and applying 5% 5-fluorouracil on stable vitiligo patches.

Methods and Materials:

Microneedling and topical application of 5-fluorouracil was planned on 30 subjects of 10–50 age-groups with stable vitiligo, from September 2019 to September 2021 every 15 days for 12 visits. Age, gender, site, size/stability of vitiligo patches, leukotrichia and vitiligo family history were studied. Repigmentation (overall and variable-wise) was measured at each visit using 76–100% (excellent), 51–75% (very good), 25 to 50% (good) and <25% (poor). Data was analysed with the Chi-square test or Standard Error of Difference between two proportions.

Results:

Under COVID restrictions (2020–2021), sample coverage was 77% (23/30) comprising 13 females and 10 males. Visits varied for each subject totalling 185 visits out of an expected 276 (67%). Significantly, 3 (13%) achieved excellent repigmentation, 10 (43%) very good, 8 (35%) good and only 2 (9%) poor repigmentation. Cumulatively, 13 (56%) attained excellent/very good repigmentation and 21 (91%) had excellent/very good/good repigmentation. Repigmentation ranged from 10% to 100% among 23 subjects, averaging 54% in average 8 visits (4 months). Repigmentation was equally achieved irrespective of age, gender, site, size and stability of the vitiliginous patch, presence/absence of leukotrichia and family history of vitiligo. Manageable pain (100%), itching (4%) and hyperpigmentation 43%, were side effects.

Conclusion:

Cumulative 91% (excellent/very good/good) repigmentation despite COVID-19 in the study period, and its comparability with other studies, strengthens evidence that microneedling and 5% 5-fluorouracil is effective in treating stable vitiligo in a high prevalence population.
Autologous Serum Therapy in Recalcitrant Chronic Spontaneous Urticaria: Experience from Three Dermatology Clinics in Malaysia
Authors: Ting Pao Lin Ingrid , Ghazali Nurul Izyan , Teo Yan , Lai Siaw Ling , Bakhtiar Mohammed Faizal , Tang Min Moon
Published: October 2024

Autohemotherapy is a commonly used treatment for recalcitrant chronic urticaria in some countries. Herein we report our experience using autologous serum therapy in eight patients with recalcitrant chronic spontaneous urticaria. Autologous serum therapy was initiated weekly for nine weeks followed by every fortnightly. Urticaria Activity Score (UAS) 7, Dermatology Life Quality Index (DLQI), and reduction of antihistamine usage were used to assess the treatment response. Eight patients (age range: 25–76 years old; four females and four males) had one to ten years of duration of recalcitrant chronic spontaneous urticaria. All failed to respond to high doses of second-generation antihistamines and five to immune-modulating agents. Three did not respond to omalizumab. At week nine, the reduction of UAS7 ranged from 76.2% to 100%. There was more than an 80% improvement in DLQI in all patients. The number of wheals seemed to be reduced first followed by pruritus. Three patients had stopped antihistamines by week eight of treatment. No adverse events were reported in all eight patients. Autologous serum therapy may serve as an alternative treatment for recalcitrant chronic spontaneous urticaria. Apart from the practicality, which requires frequent clinic visits, venipuncture, and centrifugation, it is cheap and effective with minimal adverse events.
Role of Probiotic in Vulvovaginal Candidiasis: A Randomised Controlled Non-blinded Trial from India
Authors: Thekho Apaopa Jemima , Mendiratta Vibhu , Garg Taru , Kaur Ravinder , Yadav Vidya
Published: October 2024

Background:

Vulvovaginal candidiasis (VVC) is a prevalent form of vaginitis, and most patients show improvement when treated with antifungal medications. However, recurrence may affect a minority. It has been found through previous research that the concomitant utilisation of probiotics during acute VVC leads to early relief of symptoms and signs and offers a preventive measure against recurrences.

Objectives:

This study aimed to assess the efficacy of the combination of oral probiotics with conventional antifungal treatment as compared to conventional antifungal treatment alone.

Methods:

Sixty patients who were newly diagnosed with VVC were enrolled in a randomised controlled trial. They were divided into two groups. Group A included 30 cases treated with conventional antifungal medication (oral fluconazole 150 mg single dose), while Group B included 30 cases treated with conventional antifungal medication (oral fluconazole 150 mg single dose) alongside oral probiotic capsules (Lactobacillus rhamnosus, L. crispatus, L. gasseri, L. jensenii) for 2 months. The clinical and mycological findings were recorded before and after treatment. The relapse rate and side effects were recorded during the period of our study.

Results:

No significant difference between the clinical cure rate, mycological cure, and relapse rate was seen between the two groups. (P < 0.05). However, a larger proportion of patients in Group B (97%) achieved complete remission compared to Group A (90%). No side effects were noted in either of the groups.

Conclusion:

Based on the findings, it can be concluded that the addition of probiotics to conventional antifungal treatment led to better rates of clinical and mycological cure and a lower likelihood of relapse compared to conventional antifungal treatment alone.
Verruciform Xanthoma Presenting Within an Ear Piercing
Authors: Myers Hannah E. , Rangarajan Subhapradha , Roberts Michael , Buckley Christopher , Hammel Josh
Published: October 2024

Verruciform xanthomas are rare lesions affecting 0.025-0.5% of the population. They present as an asymptomatic, slow growing solitary lesion on the oral mucosa. Commonly misdiagnose as squamous cell carcinoma, verruca vulgaris, leukoplakia, and lichen planus. Presented is a 22 year old male with a painful verruciform xanthoma on the posterior ear lobe in a prior ear piercing.
Seronegative and Low Seropositive Treatment-Naive Secondary Syphilis in India: A Cross Sectional Study
Authors: Ghosh Aparajita , Panda Saumya , Bhattacharyya Surjyamukhi
Published: October 2024

The non-treponemal tests like VDRL and RPR hold an important place in the diagnosis of syphilis. In many countries, these tests are used for screening, with positive results being subsequently confirmed by treponemal or specific tests like TPHA or FTA-ABS. Recent observations of low-titer VDRL or RPR positivity (<1:8) or negative results in patients with clinically active syphilis are becoming a cause for concern especially in the backdrop of a resurgence of the disease. Such a scenario might undermine the usefulness of VDRL or RPR as effective screening test and for treatment monitoring. We studied the titers of non-treponemal serological test (VDRL) in non-HIV-positive, untreated cases of secondary syphilis (diagnosed clinically and confirmed serologically with specific treponemal tests like TPHA or FTA-ABS). It was an OPD-based cross-sectional study, which included patients presenting with muco-cutaneous lesions suggestive of secondary syphilis, confirmed serologically with positive specific treponemal tests, who were seronegative for HIV1 and 2 and had not received treatment with injectable benzathine penicillin. Their VDRL titers were noted. Information regarding duration of lesions and any previous genital ulcer was obtained, and additional information was sought regarding any medications taken during the last two months. Nineteen patients (12 males, 4 females, and 3 transgender individuals) between the ages of 18 and 46 years were included in the study. Ten of these cases (52.63%) had a VDRL titer of less than 1:8 (non-reactive in 5 patients, titer of 1:4 in 5 patients). Among the remaining nine cases, a titer of 1:8 was observed in six, 1: 16 in two, and 1:32 in one case. Our observations raise concerns regarding the possibility that a significant number of patients with active syphilis and potential to transmit the disease are being left untreated because of low or negative titers in the screening tests. This may account for the slow resurgence of syphilis as documented by increase in case rates and incidence of congenital syphilis in different parts of the world.
miRNA: The Next Frontier in Dermatology Research and Therapeutics
Authors: Sil Abheek , Chakraborty Disha
Published: October 2024

Engagement of microribonucleic acids (miRNA) in the regulation of cutaneous cellular health and diseases is a rapidly advancing niche in dermatology basic research. miRNAs have been identified to play a key role in the pathogenesis of various cutaneous inflammatory, autoimmune and neoplastic conditions, among others. In addition, their purported role as therapeutic targets and biomarkers in diseased conditions harbours exciting news for the approaching years in clinical research. The current review outlines the possible translational role of miRNA in skin health and diseases (encompassing pathogenesis, diagnosis, biomarkers and therapy) from bench to bedside.
Combination Therapy for Post-Kala-Azar Dermal Leishmaniasis: A Literature Review of Current Evidence
Authors: Kumari Alka , Siddiqui Niyamat A. , Kumari Sweta , Murti Krishna , Kumar Rishikesh , Pandey Krishna , Padmakar Somanaboina , Pal Biplab
Published: October 2024

Post-kala-azar dermal leishmaniasis (PKDL) is a neglected skin disease that has tremendous epidemiological significance as a reservoir of Leishmania parasites. Relapse, drug resistance, non-compliance to prolonged treatment, poor health-seeking behaviour, along with limited therapeutic options pose a significant impact on the management of PKDL. In this study, we aimed to review the efficacy, safety and tolerability data of combination therapies for PKDL in the published literature. We have also described patients’ compliance with treatment and associated co-infections in PKDL. A comprehensive literature search was conducted in PubMed, Scopus and Google Scholar to identify the relevant articles. A total of nine studies were eligible for inclusion in this review. Drug combinations used in India were miltefosine-liposomal amphotericin-B, miltefosine-paromomycin, miltefosine-amphotericin-B, sodium stibogluconate (SSG)-immunotherapy and SSG-rifampicin. However, in Sudan, except one, all studies have used SSG-based combinations viz. SSG-rifampicin, SSG-paromomycin and SSG-immunotherapy. The efficacy and safety of miltefosine in combination with liposomal amphotericin-B as well as conventional amphotericin-B were found to be excellent in a limited number of patients. These combinations are said to have better patient compliance and shorter treatment duration. Another combination of miltefosine and paromomycin was found to be satisfactory with a final cure rate of 83.3%. SSG in combination with paromomycin had a good clinical outcome among severe PKDL patients in Sudan, though pain at the injection site was experienced by all patients. There is a lack of data on combination therapies for PKDL through large-scale randomised controlled trials (RCTs). Therefore, multicentric randomized controlled trials with a sufficiently large sample size are urgently needed to verify the efficacy, safety, and other advantages of combination therapies for PKDL. With the availability of liposomal amphotericin-B, miltefosine and immunotherapy, clinical management of PKDL appears promising.
Pulmonary Rehabilitation Effect on Physiological and Biochemical Parameters Occupationally Exposed to Silica Workers: A Quasi-Experimental Study
Authors: Tasrufoon K. , Bhuvaneswari G. , Rao K.Srinivas. , Vijayaraghavan R.
Published: October 2024

Occupational workers are at health risk due to exposure to silica dust, which is present in the construction and manufacturing sectors, masonry works, as well in mining sectors. Silicosis is a type of pulmonary fibrosis, a lung disease caused by breathing in tiny bits of silica, a common mineral found in sand, quartz, and many other types of rock. Materials and methods: Occupational workers who are exposed to silica and working in cement factories. Who fulfills the inclusion criteria, the sample size was (n = 160) divided into a control group (n =8 0) and an experimental group (n = 80). A pretest was conducted on to control and experimental groups. Pulmonary parameters, baseline clinical variables, spirometry to check pulmonary function, 6-MWT stress tolerance test, Hemoglobin (HB), Erythrocyte Sedimentation Rate (ESR), Random Blood Sugar (RBS) blood investigations, pranayama (yoga), and nutritional education were done for the experimental group. Supervised pulmonary rehabilitation was carried out, and the posttest was done after 12, 18, and 24 weeks. The results were analyzed by descriptive and inferential statistical methods using the SPSS statistical package (Systat Software Inc., San Jose, USA). Conclusion: Pulmonary rehabilitation (pranayama and nutritional education) showed significant improvement in lung capacity and pulmonary functions, and improved quality of life showed statistical significance (P < 0.001).
Ketogenic Diet as a Therapeutic Intervention for Doose Syndrome: A Case Report and Review of Current Evidence
Authors: Basu Soma , Manokaran Ranjith Kumar , Hemamalini Arambakkam Janardhanam
Published: October 2024

Epilepsy with myoclonic-atonic seizures, also known as Doose syndrome or myoclonic–astatic epilepsy (MAE), represents a challenging pediatric epilepsy syndrome, initially described by Doose et al. in 1970. MAE accounts for 1%–2.2% of juvenile-onset epilepsy cases, characterized by normal early development, followed by seizure onset between 7 months and 6 years. Seizure types include myoclonic, myoclonic-atonic, generalized tonic–clonic, and atypical absences, often accompanied by nonconvulsive status epilepticus. Electroencephalogram typically shows parietal-dominant rhythmic theta activity or a posterior 4 Hz pattern. While conventional antiseizure medications (ASMs) offer some efficacy, outcomes vary widely, and up to 50% of patients may experience refractory seizures and poor intellectual outcomes. The ketogenic diet (KD), a high-fat, low-carbohydrate diet inducing ketosis, has shown promise in reducing seizure frequency and severity in refractory epilepsy, including MAE. This case report describes a successful outcome with a South Indian style KD in a 3-year-old boy with Doose syndrome presenting with 20–25 daily head drop seizures despite multiple ASMs and steroid therapy. Initiation of a home-based KD utilizing traditional household ingredients significantly reduced seizure frequency by 60% within 1 month and 80% within 2 months and was 100% seizure-free in 3rd month following KD, alongside developmental improvements. The KD was well-tolerated, with improved nutritional status. This case underscores KD’s potential as a viable complementary therapy for MAE, emphasizing the need for ongoing parental support and supervision to ensure dietary adherence and optimize outcomes. It is commonly believed that the KD is challenging for the South Indian population to follow due to the high carbohydrate content in South Indian cuisine. However, this case demonstrates that a KD can indeed be tailored around South Indian dishes, highlighting the uniqueness of this approach. When the diet is customized to consider a child’s dietary habits, culture, and cuisine, it becomes easier to follow over the long term, leading to effective seizure control. Further research is necessary to refine dietary protocols and evaluate long-term efficacy in MAE management.