bluuebunny/crossref_metadata_2025 huggingface dataset:
Vichy en de joden: onderzoek, dispuut, opinie
Authors: Van Samang Fabian
Published: July 2024

De jongste jaren verschenen heel wat essays, opiniestukken en historische werken over het Franse oorlogsverleden. Soms waren ze schokkend en controversieel, soms prikkelend, vernieuwend of zalvend. Heel wat opinies en standpunten vonden nooit hun weg naar een Nederlandstalig publiek. In dit artikel brengt historicus Fabian Van Samang enkele interessante facetten van het Vichy regime onder de aandacht die in Frankrijk weliswaar werden bediscussieerd, maar die in de Vlaamse en Nederlandse actualiteitsdebatten nauwelijks tot het brede publiek zijn doorgedrongen.
Het Centre du patrimoine arménien (CPA) in Valence: een plek gericht op de wereld
Authors: Roveda Chrystèle
Published: July 2024

Het Centre du Patrimoine Arménien werd in 2005 opgericht in het historisch centrum van Valence. Het is een openbare plaats van cultuur, gewijd aan geschiedenis, herdenking, actuele conflicten en migratiestromen. Bijzonder aan het Centrum is dat het zijn permanente tentoonstelling heeft gewijd aan de Armeense diaspora, die ze meteen ook in een ruimer historisch kader van ballingschappen en genocides van de 20e en 21e eeuw heeft ingebed. Het culturele aanbod van het Centrum biedt de bezoeker een bijzondere blik van burgerschap op onze wereld aan.
Mettre au travail les élèves en classe relais
Authors: Mayeko Teddy
Published: July 2024

Cet article se donne pour ambition de comprendre la façon dont les enseignants mettent au travail des élèves de classe relais. Pour cela, nous étudierons les types d’agencements spatiaux mis en œuvre au cours d’une leçon et leur influence sur l’activité des élèves. Plus précisément, à travers une approche descriptive et compréhensive, nous réaliserons une analyse comparative visant à mesurer l’impact des dispositifs investis pendant le cours de Sciences et Vie de la Terre (SVT) et pendant celui d’Éducation Physique et Sportive (EPS). Les résultats montrent que la manière de penser l’espace diffère au sein des deux disciplines. En outre, nous verrons que dans chacune des disciplines la question du corps est étroitement liée à la question des spatialités et apparait comme un enjeu central.
Définir la religion en droit. Effets et méfaits des dénominations juridiques des groupes et pratiques religieux
Authors: Lévy Arié
Published: July 2024

Cet article interroge les définitions jurisprudentielles du religieux en France et en Amérique du Nord. Il met en évidence les impasses des qualifications juridiques des groupes religieux et montre que les effets de mise en forme du religieux par le droit s’opèrent par les dénominations juridiques des collectifs et des pratiques, plutôt que par leur définition explicite. Ce déplacement permet de caractériser la sensibilité au contexte de ces dénominations du religieux, et d’interroger la position du droit dans ce cadre.
« Ni baptiste ni évangélique, tout simplement chrétien » : enjeux de la désignation émique au sein de deux Églises non dénominationnelles québécoises
Authors: Dejean Frédéric
Published: July 2024

Cet article prend appui sur une recherche au sein de deux Églises évangéliques québécoises qui relèvent d’un modèle dit « non dénominationnel ». Il interroge les façons qu’elles ont de s’identifier et de se présenter. Pour ce faire, nous montrons que les modes de présentation (en particulier le nom) et d’identification qu’elles mettent en œuvre visent à constituer un christianisme en phase avec un Québec sécularisé et à se distancier d’institutions (aussi bien l’Église catholique que des dénominations protestantes) dont l’image a été considérablement écornée par des scandales au cours des dernières décennies.
Navigating Behavioural Barriers to Fintech Chatbot Adoption: An Extended Innovation Resistance Theory Approach
Authors: Jisham Muhammed , Selvaraj Vanitha , John Abin
Published: July 2024

The study explores the multifaceted dimensions of user resistance through the lens of the Extended Innovation Resistance Theory (IRT), providing insight into functional, psychological and behavioural inhibitors that prevent users from integrating fintech chatbot functionality into their financial management practices. This study employed a quantitative approach and conducted PLS-SEM to analyse the data collected from 286 fintech users. Findings suggest that behavioural inhibitors and IRT variables, except image barrier, play a critical role in preventing users from adopting fintech chatbots. This study emphasises the need to address these behavioural complexities to foster a more conducive environment for the integration of fintech chatbot technology into the financial services industry. A significant contribution of this research is that it introduces a behavioural dimension to the IRT to explore factors affecting the adoption of fintech chatbots, thus contributing to the existing literature on the user adoption and resistance of technology.
Comparison of ultrasound-guided sacral erector spinae plane block and caudal epidural block for analgesia in paediatric patients undergoing hypospadias repair: A double-blind, randomised controlled trial
Authors: Bansal Teena , Kumar Praveen , Kadian Yogender , Jain Mamta , Singh Anish Kumar , Lal Jatin , Singhal Suresh
Published: July 2024

Background and Aims:

Caudal block is more frequently used in children for postoperative analgesia. However, its disadvantage is its short duration. Erector spinae plane block (ESPB) at the sacral level can potentially block the pudendal nerve. It may prove an alternative to caudal block for hypospadias repair regarding time to first rescue analgesia.

Methods:

Fifty children of 2–7 years of age were included. After induction of general anaesthesia, Group I (n = 25) was given ultrasound-guided sacral ESPB with 1 ml/kg of 0.25% bupivacaine and Group II (n = 25) was given caudal block with 0.5 ml/kg of 0.25% bupivacaine. Postoperatively at face, leg, activity, cry, consolability (FLACC) score ≥4, rescue analgesia was given using intravenous 15 mg/kg paracetamol. The primary outcome was to compare time to first rescue analgesia, and secondary outcomes were intraoperative haemodynamic parameters, fentanyl consumption, postoperative FLACC score and analgesic consumption in 24 h. Continuous variables were compared using the independent sample t-test or Mann–Whitney test, and categorical variables were compared using the Chi-square test.

Results:

The mean time to first rescue analgesia was 21.30 (standard deviation [SD]: 3.06) h in Group I and 9.36 (SD: 1.71) h in Group II (P < 0.001) (mean difference −11.94 [95% CI: −13.39, −10.48]). The FLACC score was significantly higher (P < 0.05) postoperatively at 8, 10, 12 and 18 h in Group II. Mean postoperative analgesic consumption was 310.5 (SD: 72.69) mg in Group I and 615.6 (SD: 137.51) mg in Group II (P < 0.001) (mean difference 30.5 [95% CI: 236.41, 373.78]).

Conclusion:

Sacral ESPB is better regarding time to first rescue analgesia than caudal block in paediatric patients undergoing hypospadias repair.
Intraoperative thoracic interfascial plane block with levobupivacaine versus levobupivacaine with dexmedetomidine for postoperative analgesia after modified radical mastectomy: A randomised controlled double-blinded trial
Authors: Arun Nidhi , Avinash Raja , Choudhary Annu
Published: July 2024

Background and Aims:

Nearly half of the patients following breast cancer surgery experience postoperative pain. The interfascial plane for the pectoral nerve (PECS) block, along with dexmedetomidine, can alleviate this pain.

Methods:

After institutional ethics committee clearance and written informed consent, this randomised, double-blind study was conducted on 60, 18–60 years female patients, who were scheduled for modified radical mastectomy (MRM) under general anaesthesia. Patients were randomised into Group L (20 ml of 0.25% levobupivacaine) and Group DL (20 ml of 0.25% levobupivacaine with 0.5 µg/kg of dexmedetomidine). After resection of the tumour and securing haemostasis, under strict aseptic precaution, 10 ml of the study drug was injected under direct vision between the pectoralis major and pectoralis minor and 10 ml between pectoralis minor and serratus anterior muscles by the operating surgeon (direct PECS block). The primary outcome was to compare the duration of analgesia. Normally distributed variables were compared using Student’s t-test, and non-normally distributed variables were compared using the Mann–Whitney U-test. Qualitative data were analysed using Chi-square/Fisher’s exact test. Statistical significance was kept at P < 0.05.

Results:

The median time of the first analgesic requirement was 8 [inter-quartile range (IQR): 6–8] h in Group L and 18 (IQR: 16–20) h in Group DL (W = 17.000, P < 0.001). The mean total opioid consumption of Group L was 12.53 [standard deviation (SD): 2.29] mg in the first 24 h and 6.93 (SD: 1.89) mg in Group DL.

Conclusion:

Adding 0.5 μg/kg dexmedetomidine to 20 ml of levobupivacaine enhances the duration of analgesia of direct PECS block in patients undergoing MRM.
Comparison of propofol versus dexmedetomidine sedation for awake C-MAC® D-Blade video laryngoscopic nasotracheal intubation in patients with difficult airway: A randomised clinical study
Authors: Vishnoi Gunjan , Shah Shagun B. , Chawla Rajiv , Bhardwaj Manoj , Patel Anil , Arora Jenna
Published: July 2024

Background and Aims:

Awake intubation is the preferred method for securing difficult airways. We compared intravenous (IV) propofol and dexmedetomidine for C-MAC® D-blade-guided anticipated difficult nasotracheal intubation under conscious sedation.

Methods:

This randomised study included 60 patients with difficult airway (El-Ganzouri Score 4–9). After adequate airway preparation with IV midazolam 0.03 mg/kg and IV fentanyl 1 µg/kg, in Group P, propofol was infused at 250 µg/kg/min and in Group D, dexmedetomidine was infused at 1 μg/kg over 10 min, then at 0.5 μg/kg/h till a bispectral index (BIS) value 65–70 was achieved. Patients underwent C-MAC® D-blade video laryngoscope-guided nasotracheal intubation. The intubation score was the primary outcome measure. Secondary outcome measures included haemodynamic parameters, intubation time, number of attempts, the incidence of failed awake intubation, glottic view, time to achieve desired BIS, complications, study drug consumption and patient-reported satisfaction with the awake intubation technique. Quantitative variables were compared between groups using unpaired t-test/Welsch test/Mann–Whitney Test. Qualitative variables were correlated using the Chi-square test/Fisher's exact test. A P value of <0.05 was considered statistically significant.

Results:

The intubation score was significantly higher in Group D versus Group P (P = 0.007). Patient reaction to intubation, haemodynamic parameters and percentage of glottis opening score were more favourable in Group P. Coughing and vocal cord movement were comparable between the groups (P > 0.05). The time to target BIS was four times longer, and the time to intubate was 6 seconds longer in Group D.

Conclusion:

Successful awake C-MAC® D-blade video laryngoscopic intubation can be performed under dexmedetomidine/propofol conscious sedation, with propofol giving a better intubation score.
Biomarkers in Psoriasis: The Future of Personalised Treatment
Authors: Kar Bikash R. , Sathishkumar Dharshini , Tahiliani Sushil , Parthasarathi Anchala , Neema Shekhar , Ganguly Satyaki , Venkatachalam K. , Parasramani Shrichand G. , Komeravelli Haritha , Thomas Jaykar
Published: July 2024

Psoriasis is a chronic and complex immune-mediated papulosquamous disease affecting almost 2% of the world population. The interaction between a genetically predisposed individual and environmental triggers leads to a vicious cycle involving autoreactive T cells, dendritic cells, keratinocytes and dermal cells. Up to 40% of the psoriasis cases develop disabling psoriatic arthritis and an equal number of patients also tend to develop metabolic syndrome as well as cardiovascular comorbidities; hence, this is no more considered to be a disease limited to skin only. Being a systemic disease, there is an urgent need to develop potential biomarkers for the assessment of disease severity, prediction of outcome of the therapeutic intervention and association with various systemic comorbidities. Diverse genetic markers not only function as predictors of diseases pathogenesis, but also help to predict development of psoriasis and psoriatic arthritis. Personalised medicine is customising the therapeutic needs of a psoriasis patient and improving the outcome as per the hints we receive from the various biomarkers. This review deals with the list of potential biomarkers proposed to be useful in psoriasis, though there is limited data validating their routine use in clinical practice and the progress so far made in the field of precision medicine for psoriasis.
Important Roles of Interleukin-36, Interleukin-37, and Interleukin-38 Cytokines in the Pathogenesis of Rosacea
Authors: Ekinci Alper , Kilic Sevilay O. , Demir Nesrin , Siddikoglu Duygu
Published: July 2024

Background:

Rosacea is a chronic inflammatory skin disease. Previous studies have determined that IL-36, IL-37, and IL-38 may play a role in the pathogenesis of various inflammatory diseases.

Aims and Objectives:

The present study aims to evaluate the relationship of these cytokines with rosacea.

Materials and Methods:

A total of 100 individuals, including 50 patients with rosacea and 50 healthy controls, were included in the study. IL-36, IL-37, and IL-38 levels were measured using the ELISA method by taking serum samples from all participants.

Results:

The mean serum levels of IL-36, IL-37, and IL-38 in the patient group were 52.17 ± 24.07 pg/ml, 18.46 ± 8.18 pg/ml, and 25.74 ± 8.36 ng/l, respectively. The mean serum levels of IL-36, IL-37, and IL-38 in the control group were 32.99 ± 19.90 pg/ml, 44.61 ± 22.27 pg/ml, and 45.61 ± 17.32 ng/l, respectively. The difference between the serum levels of IL-36, IL-37, and IL-38 in the patient and control groups was statistically significant (P < 0.001).

Conclusion:

Based on these findings, an increase in IL-36 and a decrease in IL-37 and IL-38 may contribute to the pathogenesis of rosacea. Future rosacea treatments could target and/or interact with these possible steps in the pathogenesis of rosacea.
Epidemiological Profile of Breast Fibroadenoma in a Sample of Iraqi Women Attending Breast Clinic at Al-Imamaein Al-Kadhimaein Medical City in Baghdad/Iraq
Authors: Abdulkareem Elaf Hameed , Sahib Ali Abd Ali
Published: July 2024

Background:

Fibroadenoma, a type of fibroma, is the most common benign neoplasm found in the breast. It is predicted that around 10% of females globally may experience the development of fibroadenoma at some stage in their lives. Fibroids seldom become malignancies, about 5% of all cases. Fibroadenoma etiology is uncertain. However, levels of estrogen influence fibroadenomas.

Objectives:

The objectives of this study were to explore the epidemiological aspects of breast fibroadenoma.

Patients and Methods:

A cross-sectional study was conducted in the breast examination clinic at Al-Imamaein Al-Kadhimaein Medical City in Baghdad/Iraq. It included 260 female participants aged 15–35 years, diagnosed by specialists with breast fibroadenoma. A modified four-part questionnaire was used to obtain data from participants which includes sociodemographic, breast fibroadenoma risk factors, clinical presentation, and diagnostic intervention.

Results:

Participants had a mean age of 27.3 ± 6.05 years. It was found that 37.7% of participants were overweight women, 35.8% had a family history of fibroadenoma. The most common presentation was pain presented in 38.1%.

Conclusions:

The fibroadenomas that developed in the current study sample tended to increase in the second and third decades, notably among nulliparous and nonlactating women. Most participants were overweight with left-sided pain and lumps.
A Case of Tumoral Acute Coronary Syndrome – Case Report and Literature Review
Authors: Carvalho Catarina Isabel Ribeiro , Carvalho Pedro Miguel Rocha , Silveira Maria Inês Costa , Baptista Ana Isabel Santos
Published: July 2024

Cardiovascular disease and cancer constitute the most prevalent illnesses worldwide. Cancer patients show an increased risk of coronary artery disease not only due to shared cardiovascular risk factors, a pro-inflammatory and prothrombotic state induced by cancer itself, the cardiovascular toxicity of cancer therapy, or rarely, due to extrinsic compression of a coronary artery by the primary tumor or a metastatic lesion. Here, we present the case of a 59-year-old man with squamous cell carcinoma of the lung presented with asymptomatic diffuse ST segment depression and troponin T increase. Echocardiography revealed a large mass adjacent to the right atrium, atrioventricular groove, and basal segment of the anterior wall of the left ventricle, which the computed tomography scan showed to encase and probably compress the anterior descending coronary artery. Thus, the patient was diagnosed with acute coronary syndrome due to anterior descendent coronary artery compression by a neoplastic lung mass.
Modeling of Gamma Index for Prediction of Pretreatment Quality Assurance in Stereotactic Body Radiation Therapy of the Liver
Authors: Kamal Rose , Thaper Deepak , Singh Gaganpreet , Sharma Shambhavi , Navjeet  , Oinam Arun Singh , Kumar Vivek
Published: July 2024

Purpose:

The purpose of this study was to develop a predictive model to evaluate pretreatment patient-specific quality assurance (QA) based on treatment planning parameters for stereotactic body radiation therapy (SBRT) for liver carcinoma.

Materials and Methods:

We retrospectively selected 180 cases of liver SBRT treated using the volumetric modulated arc therapy technique. Numerous parameters defining the plan complexity were calculated from the DICOM-RP (Radiotherapy Plan) file using an in-house program developed in MATLAB. Patient-specific QA was performed with global gamma evaluation criteria of 2%/2 mm and 3%/3 mm in a relative mode using the Octavius two-dimensional detector array. Various statistical tests and multivariate predictive models were evaluated.

Results:

The leaf speed (MILS) and planning target volume size showed the highest correlation with the gamma criteria of 2%/2 mm and 3%/3 mm (P < 0.05). Degree of modulation (DoM), MCSSPORT, leaf speed (MILS), and gantry speed (MIGS) were predictors of global gamma pass rate (GPR) for 2%/2 mm (G22), whereas DoM, MCSSPORT, leaf speed (MILS) and robust decision making were predictors of the global GPR criterion of 3%/3 mm (G33). The variance inflation factor values of all predictors were <2, indicating that the data were not associated with each other. For the G22 prediction, the sensitivity and specificity of the model were 75.0% and 75.0%, respectively, whereas, for G33 prediction, the sensitivity and specificity of the model were 74.9% and 85.7%%, respectively.

Conclusions:

The model was potentially beneficial as an easy alternative to pretreatment QA in predicting the uncertainty in plan deliverability at the planning stage and could help reduce resources in busy clinics.
Monte Carlo-based Investigation of Absorbed-dose Energy Dependence of Thermoluminescent Dosimeters in Therapeutic Proton and Carbon Ion Beams
Authors: Chattaraj Arghya , Mishra Subhalaxmi , Selvam T. Palani
Published: July 2024

Background:

The present study is aimed at calculating relative absorbed-dose energy response correction (R) of commonly used thermoluminescent dosimeters (TLDs) such as LiF, Li2B4O7, and Al2O3 as a function of depth in water for protons (50–250 MeV/n) and carbon ion (80–480 MeV/n) beams using Monte Carlo-based FLUKA code.

Materials and Methods:

On-axis depth-dose profiles in water are calculated for protons (50–250 MeV/n) and carbon ion (80–480 MeV/n) beams using FLUKA code. For the calculation of R, selective depths are chosen based on the depth-dose profiles. In the simulations, the TLDs of dimensions 1 mm × 1 mm × 1 mm are positioned at the flat, dose gradient, and Bragg peak regions of the depth-dose profile. Absorbed dose to detector was calculated within the TLD material. In the second step, TLD voxels were replaced by water voxel of similar dimension and absorbed dose to water was scored.

Results:

The study reveals that for both proton and carbon ion beams, the value of R differs from unity significantly at the Bragg peak position and is close to unity at the flat region for the investigated TLDs. The calculated R value is sensitive to depth in water, beam energy, type of ion beam, and type of TLD.

Discussion:

For accurate dosimetry of protons and carbon ion beams using TLDs, the response of the TLD should be corrected to account for its absorbed-dose energy dependence.
Cognitive Rehabilitation Programme (CRP): An Effective Tool Against Mild Cognitive Impairment Among Elderly
Authors: Sharma Shabnam , Kumari Vinay , Phougat Jyoti , Sarin Jyoti
Published: July 2024

Background:

With a steady increase in life expectancy seen worldwide, age-associated cognitive decline and mild cognitive impairment in old age are major public health challenges.

Objective:

To determine the effectiveness of the Cognitive Rehabilitation Program on cognition parameters in old age people with mild cognitive impairment.

Materials and Methods: Design:

This study was a quasi-experimental design using a non-equivalent control group pretest post-test design.

Setting/Location:

Mullana and Adhoya villages of Ambala, Haryana.

Subjects:

Eighty old age people with mild cognitive impairment.

Intervention:

The pre- and post-interventional cognition parameters were assessed using Addenbrooke’s cognitive examination on Day 1 and Day 29. The cognitive Rehabilitation Program was administered in the experimental group once a day for 28 days.

Outcome Measures:

Dependent variables were cognition parameters.

Results and Conclusion:

In the experimental group, a significant increase in cognition parameters score was observed from Day 1 (62.28 ± 6.23) to Day 29 (63.25 ± 5.10) after administration of the Cognitive Rehabilitation Program. In the comparison group, there was a non-significant decrease in cognition parameters score from Day 1 (56.73 ± 8.24) to Day 29 (55.85 ± 8.90). The post-implementation cognition parameters score of old age people in the experimental group (mean = 63.25) was significantly higher than in the comparison group (mean = 55.85). The mean gain in cognition scores was significantly higher in the experimental group than in the comparison group with a moderate effect size. It is concluded that the cognitive rehabilitation program is an effective tool in improving cognition parameters score among old age people with mild cognitive impairment.
The Spectrum of Neurological Manifestations in Scrub Typhus
Authors: Rehani Varun , Sreen Amit , Anadure RK , Gupta Salil
Published: July 2024

Background:

Scrub typhus is a mite-borne zoonotic disease caused by Orientia tsutsugamushi and commonly presents with fever, rash, and eschar. Systemic complications develop later in the illness including, meningoencephalitis, pericardial effusion, myocarditis, and pneumonitis. In this article, we will be presenting different neurological manifestations of scrub typhus along with functional outcomes studied at a tertiary care center in New Delhi.

Methods:

This ambispective observational study was conducted at Army Hospital Research and Referral, New Delhi, during January 2018- January 2020. Febrile illness, serologically confirmed as scrub typhus and developing neurological complications were included. A predesigned clinical proforma was recorded for demographics, clinical features, neurological examination, supported with laboratory and/or radiology evaluation, and functional outcomes using the modified Rankin Scale (mRS).

Results:

In our cohort of 7 patients’ majority were male (71%) with mean age at presentation being 42.5 years. Eschar was present in only 2 cases (28%) and a syndromic clinical diagnosis of meningoencephalitis was made in 3 (43%), acute flaccid quadriparesis in 2 (28%); and symptomatic seizure and parkinsonism in 1 patient each (14%). CSF showed lymphocytic pleocytosis with protein elevation in 57% cases. Systemic dysfunction was noted in the form of thrombocytopenia (57%), hyponatremia (42%), elevated transaminases (57%). Symptoms resolved with Doxycycline ± Rifampicin therapy in all cases, with good functional outcomes in majority of (89%) cases.

Conclusion:

Neurological complications in scrub typhus have a wide spectrum involving meninges, encephalon, basal ganglia, cranial, and peripheral nerves. High index of suspicion with early serological testing (ELISA) is a must in undifferentiated fevers. Timely initiation of appropriate therapy leads to good clinical outcomes, in majority of cases with neurological involvement.
Role of Multimodal Monitoring in the Management of Massive Blood Transfusion in Pediatric Patients Undergoing Excision of Choroid Plexus Carcinoma – A Case-Based Review of a Novel Perioperative Protocol
Authors: Surendran Sarath , Hrishi Ajay P , Suresh Sapna , Sethuraman Manikandan , Divakar Ganesh
Published: July 2024

Choroid plexus carcinomas (CPCs) are rare intraventricular lesions encountered in the pediatric population. The dreaded perioperative complication causing high mortality and morbidity in patients undergoing excision of CPC is massive intraoperative hemorrhage, which results in massive blood transfusion, and coagulopathy. Hence, the main crux of perioperative management is to tackle intraoperative hemorrhage and coagulopathy by instituting goal-directed blood transfusion guided by multimodality monitoring. This case series and literature review aims to present our institutional experience wherein the patients had a favorable outcome post-excision of CPC owing to goal-directed blood transfusion protocol guided by multimodality monitoring in the perioperative period.
Zoster-associated Limb Paralysis: Clinical and Electrophysiological Data of 15 Cases with Segmental Zoster Paresis with the Literature Review
Authors: Aykac Seyma Ciftci , Arı Abdullah , Ozoglan Habibe , Dibek Dilara Mermi , Bademkıran Fikret , Uludag Burhanettin , Çolakoglu Zafer , Oztura Ibrahim , Aydogdu Ibrahim
Published: July 2024

ABSTRACT

Background:

Herpes zoster (HZ) is a viral disease characterized by skin eruptions and pain in specific dermatomes. Focal motor weakness that appears in the segment of skin eruptions is a rare complication of this infection. Because of the difficulty in clinically diagnosing thoracic or upper cervical motor weakness and due to the pain that causes overlooking of weakness, the true incidence of this complication is not known. In this study, we want to review the clinical presentation of segmental zoster paresis and also discuss electrophysiological findings with the involvement of nerve, plexus parts, or spinal roots.

Methods:

Electromyography records were examined retrospectively from 2010 to 2023 for patients who had HZ-associated limb paresis. Clinical data were reviewed and abstracted, and patients whose clinical limb weakness and sensory deficits conformed to the distribution of peripheral nerve (s) or spinal root and whose electrodiagnostic evaluation corroborated the localization, were included in the series.

Results:

Fifteen patients were included in our study. Ten of them were men and five of them were women. Paresis and neuropathic pain are the main complaints. In all patients, the distribution of paresis was consistent with the area of skin eruptions. C8–T1 in the upper extremity and L5–S1 in the lower extremity are the most commonly involved segments. Electrophysiological findings showed radicular involvement in three cases, brachial plexus in six cases, ulnar nerve in one case, sciatic nerve in two cases, and fibular nerve in three cases. Axonopathy is the main detected pathology in all cases.

Conclusion:

Segmental zoster paresis is a rare complication of cutaneous zona zoster and it affects different nerve segments. Clinicians should be aware of clinical and electrophysiological findings of this disease for the appropriate management of the patients.
A Comparative Study on the Efficacy of Wound Infiltration of Tramadol versus Bupivacaine for Postcesarean Section Pain Control in a Tertiary Hospital in Manila, Philippines: A Double-blind Randomized Controlled Trial
Authors: Bolinao Jamie Marie Nacilla , Morala-Caranto Melissa
Published: July 2024

ABSTRACT

Background:

In developing countries, postcesarean pain control remains a challenge due to the limited supply of medication and medical equipment. Wound infiltration provides a cost-effective, easy-to-administer postoperative analgesia with a high safety of margin. Several studies suggest that tramadol and local anesthetics have similarities in terms of its action. The study aims to compare the efficacy of tramadol and bupivacaine administered through wound infiltration in postcesarean patients aged 18-40 years old at a tertiary hospital in Manila, Philippines.

Methods:

Using a double-blind randomized controlled trial, study participants for low transverse cesarean section (CS) were allocated to either Group A or Group B. Group A (n = 20) received a local infiltration of 2 mg/kg tramadol diluted to 20 ml of 0.9% saline solution. Group B (n = 20) received a local infiltration of 0.5 ml/kg of 0.25% bupivacaine isobaric diluted to 20 ml of 0.9% saline solution. All wound infiltrations were performed once at the postoperative site to establish cost-effectivity. Pain severity was assessed using the Visual Analogue Scale (VAS) scoring at rest and at movement done by the anesthesiologist at 4, 8, 16 and 24 h post-CS. A significance level of 0.05 was set and P<0.05 was considered statistically significant. Before inclusion in the study, informed consent was secured from the study participants. The research protocol and informed consent were submitted for ethical review and were subsequently approved.

Results:

There is no significant difference between the VAS scores of patients treated with tramadol and those treated with bupivacaine across all times of recording except for VAS scores at movement during the 16th and 24th hours. Results of the study revealed that the VAS scores in the tramadol group are lower at all times than those of the bupivacaine group. In general, it is also observable that the VAS scores are higher when the patient is moving than when at rest. There were no observed effects in breastfeeding and no allergic, cardiovascular or central nervous system side effects were observed among all study participants.

Conclusion:

Because of its mechanism similar to that of local anesthetics, tramadol wound infiltration is a suitable, safe and cost-effective alternative to bupivacaine for pain control after CS.
Challenging Airway Management in a 5-year-old Male Child with Sublingual Lymphovascular Malformation
Authors: Bonifacio Karl Gabriel Alferi , Prudente Monace Zephyr S. , Masa Jorge Edward T.
Published: July 2024

ABSTRACT

We report a 5-year-old male child with a large lymphovascular malformation of the tongue presenting with signs of airway obstruction scheduled for bleomycin sclerotherapy and tracheostomy. Anesthetic concerns include limited mouth opening, airway obstruction, poor visualization, bleeding, and distorted anatomy, thereby rendering mask ventilation, laryngoscopy, intubation, and possible invasive airway access difficult. While awake airway management options are ideal for difficult airways in general, these techniques may be inapplicable to pediatric patients. Management options are further constrained in resource-limited clinical settings where critical equipment may be unavailable. By conducting a thorough preoperative evaluation and by adopting a multidisciplinary approach to case planning, preparation, and management, a strategy was developed, enabling successful airway management. The use of this approach may facilitate the successful anesthetic management of a difficult pediatric airway in austere clinical environments.
Comparing prognostic scoring systems in acute pancreatitis: Bedside Index of Severity in Acute Pancreatitis, WL, and Chinese Simple Scoring System Scores
Authors: Güzel Yunus Emre , Çolak Nese , Okuv Ahmet Can , Teymuroğlu Sefer , Teke Muhammet İkbal
Published: July 2024

OBJECTIVES:

Several scoring systems are used to predict prognosis in acute pancreatitis (AP), but their predictive success varies. This study compares the validity of the commonly used Bedside Index of Severity in AP (BISAP) score with the newly developed WL score and the Chinese Simple Scoring System (CSSS) score in predicting mortality and unfavorable prognostic outcomes in AP patients.

METHODS:

This retrospective descriptive study included all AP patients presenting to the emergency department from June 2, 2019, to June 2, 2022. Patient demographics, vital signs, laboratory values, and imaging findings were recorded, and WL, CSSS, and BISAP scores were calculated. The effectiveness of these scores in predicting adverse outcomes and mortality was compared.

RESULTS:

Among 357 patients, 53.2% were male, with a median age of 62 years (interquartile range: 48–75). Area under the curve (AUC) values for 7-day outcomes were 0.956 for WL, 0.759 for CSSS, and 0.871 for BISAP; for 30-day outcomes, AUC values were 0.941 for WL, 0.823 for CSSS, and 0.901 for BISAP; and for poor prognostic outcomes, AUC values were 0.792 for WL, 0.769 for CSSS, and 0.731 for BISAP.

CONCLUSION:

In AP patients, WL, CSSS, and BISAP scores are effective predictors of unfavorable prognosis and mortality. WL score outperforms the CSSS and BISAP scores in predicting 7-day and 30-day mortality and poor prognosis. After WL, BISAP is the second-best system for predicting mortality. For predicting unfavorable prognoses, CSSS is the second-best system after WL. The simplicity of calculating the WL score based on four laboratory parameters makes it a preferable choice.
Comparison of dental force applied during endotracheal intubation with hyper-angulated and macintosh-type video laryngoscopy blades used by emergency medicine trainees: A randomized cross-over manikin study
Authors: Karabacak Ali Rıza , Özturan İbrahim Ulaş , Şefoğlu Ömer Faruk , Doğan Nurettin Özgür , Yaka Elif , Yılmaz Serkan , Pekdemir Murat
Published: July 2024

OBJECTIVES:

This study aimed to compare the effects of Macintosh-type and hyperangulated video laryngoscopy (VL) blades on dental force during endotracheal intubation (ETI) using Glidescope and McGrath VL devices.

METHODS:

In this randomized, crossover, manikin study conducted at a university emergency medicine (EM) program, 65 EM trainees included interns and residents performed 520 intubations using four different VL blades (GlideScope VL with Macintosh-type Mac T3 and hyperangular Lo Pro T3 blades and McGrath VL Macintosh-type MAC 4 and hyperangular McGrath X3 blades) in normal and difficult airway scenarios. The primary outcome of this study was the dental pressure (Newton) exerted during ETI. The secondary outcomes included c-spine motion (degree), intubation success (%), duration (seconds), successful glottic view (%), and intubator comfort (7-point Likert).

RESULTS:

Significant differences were observed in dental force (H(3) = 11.7, P = 0.008), c-spine motion (H(3) = 8.34, P = 0.039), duration (H(3) = 16.56, P = 0.001), and comfort (H(3) = 174.96, P < 0.001) across blade types. Glidescope LoPro T3 provided a significant lower dental force (adjusted P = 0.01), less c-spine motion (adjusted P = 0.031), and shorter intubation duration (adj P < 0.01) than the McGrath Mac 4. First attempt success and intubator comfort were significantly better with all Glidescope blades (z score of 3.7 and 4.7) than with McGrath blades (z score of-4.1 and-4.4).

CONCLUSION:

The Glidescope LoPro T3 blade demonstrated advantages in dental force, c-spine motion, and intubation duration compared with McGrath Mac 4. Overall, the Glidescope blades provided superior comfort and higher first attempt success rates.
Obstructive shock induced by internal thoracic artery injury with traumatic sternal fracture
Authors: Konno Halleluyah , Nitta Masakazu , Watanabe Norihiro , Miyazato Mitsuyuki , Horiuchi Akane
Published: July 2024

Internal thoracic artery (ITA) injuries associated with sternal fractures can lead to shock. Several studies have documented injuries resulting in hemorrhagic shock, yet there is limited reporting on obstructive shock. Opinions differ regarding which is superior between transcatheter arterial embolization (TAE) and open thoracotomy. We report the case of an 80-year-old female patient presented with blunt chest trauma when driving. Her vital signs were normal. However, ultrasonography revealed a hypoechoic anterior mediastinal lesion. Her blood pressure decreased immediately before undergoing a computed tomography (CT) scan. The CT scan showed a sternal fracture, anterior mediastinal extravasation, and dilation of the inferior vena cava. TAE was performed on both internal thoracic arteries, and the patient was transferred to a hospital where an open thoracotomy could be performed. The patient was treated conservatively and discharged without sequelae. Obstructive shock caused by an ITA injury with a sternal fracture can be successfully treated using TAE.
Sporadic Optic Nerve Glioma Causing Bitemporal Hemianopia
Authors: Sharanya R , Shah Virna M. , Ramasamy Rajkumar , Mani Karthik Kumar
Published: July 2024

Primary tumours of the optic nerve are relatively rare. Optic nerve gliomas are usually seen in children under the age of 10 and present with gradual vision loss followed by proptosis. A 19-year-old female presented to our neuro-ophthalmology clinic with chief complaints of disturbances in vision in both eyes and headache. Ocular examination showed best corrected visual acuity (BCVA) of 6/6 in both eyes and visual field analysis revealed bitemporal hemianopia. Urgent neuroimaging was advised and her MRI brain revealed optic pathway glioma involving the intracranial segment of right optic nerve and optic chiasma. Improvement in vision was noted during post-surgical follow-up. We present this case to highlight the importance of visual field examination in a young patient with headache, even with a BCVA of 6/6.
Conjunctival Epithelial inclusion Cyst after Strabismus Surgery: A Case Report
Authors: Khadia Anjali , Moutappa Fredrick , Kannusamy Veena , Lavanya G. S.
Published: July 2024

We present a case of a 26-year-old man with outward deviation of left eye since birth, diagnosed with exotropia underwent squint correction surgery, and later developed a conjunctival cyst. The histopathological findings from the biopsy indicated an epithelial inclusion cyst with retention.
“Blow-in” Fracture of Orbital Roof – A Rare Case Report
Authors: Yogeswari A , Sujatha R , Abrar Mohamed
Published: July 2024

We report a rare case of orbital roof “blow-in” fracture in a 27-year old with concomitant communited fractures of frontal and ethmoid bones. A 27-year-old male presented with a history of assault by unknown persons and sustained injury to the left eye. Computed Tomography (CT) head revealed a blow-in fracture of the orbital roof on the left side with bony fragment displacement noted in the intraconal compartment. Surgical intervention was indicated and performed in order to prevent any visual complications arising due to the displaced bony fragment. The case report is followed by a brief overview of orbital fractures.
Optic Neuritis in the New Millennium
Authors: Hoffman Clarissa M. , Tang Rui , Alryalat Saif A. , Al Deyabat Osama , Alchaki Abdul R. , Lee Andrew G.
Published: July 2024

Optic neuritis (ON) is a common cause of acute visual loss due to optic neuropathy in adults. Although typical demyelinating ON usually recovers, some forms of autoimmune inflammatory ON may result in permanent disability. The relatively recent discovery of novel autoantibodies and their roles in the pathogenesis of ON, including aquaporin 4 (AQP4) in neuromyelitis optica spectrum disorders (NMOSD) and myelin oligodendrocyte glycoprotein (MOG) antibody in MOG-associated disease (MOGAD) has led to paradigm shifts in both the acute and chronic management of ON. We performed a comprehensive literature review to assess current and upcoming perspectives on ON by searching for contemporary articles (from 2015 to 2024) for articles that reported updates in diagnostic tools and methods, such as antibody testing. This monograph reviews these recent advances in the evaluation and management of ON.
Association of Inflammatory Markers and Diabetic Retinopathy
Authors: Dharwadkar Sandhya , Ram Deepa , Ramakrishna Swati , Hegde Shubhratha S. , Shilpa M
Published: July 2024

Introduction:

Diabetic retinopathy is a micro-angiopathy, the pathogenesis of which is manifold. Chronic inflammation releasing various mediators has been proposed to cause micro-angiopathy in long-term diabetics. These markers can be easily measured in serum and may serve as a risk factor for progression as well as allow newer modalities of management aimed at this pathology.

Aims and Methodology:

The aim of the study was to determine the association between different inflammatory markers and diabetic retinopathy. A total of 100 eyes in diabetic patients, 20 each with no retinopathy, mild NPDR, moderate NPDR, severe NPDR, and PDR were included. The serum levels of C-reactive protein (CRP) and absolute neutrophil count were recorded and compared across each of these groups.

Results:

The mean ANC among these groups, respectively, was 5525, 5162, 5374, 5239, and 5313 (per microlitre), and neither were these raised significantly nor was the difference between groups statistically significant. Mean CRP levels were within normal limits in all groups (2.56, 2.87, 4.06, 5.15, 6.97 mg/dl), although there was a steady increase with each grade of retinopathy, and this was found statistically significant.

Conclusion:

There was no association between absolute neutrophil count and diabetic retinopathy. Serum CRP levels may guide progression of retinopathy and can be monitored to help management protocols.
Sweet’s Syndrome and Active Retinal Vasculytis: A Case Report
Authors: Das Sujit , Balasubramanian Pradeep
Published: July 2024

Sweet’s syndrome is an uncommon skin disorder of unknown aetiology characterised by fever and painful skin lesions along with marked leucocytosis and elevated erythrocyte sedimentation rate. Women between 30 and 50 years of age are at risk. The most common ocular involvement is conjunctivitis and episcleritis. Here, we present a 39-year-old lady with Sweet’s syndrome who presented with active retinal vasculitis and had dramatic improvement with systemic corticosteroids.
Fundus Bleeding
Authors: Sethi Sahebaan
Published: July 2024

Fundus bleeding, commonly known as retinal haemorrhage, is a significant ocular manifestation associated with various systemic and ocular conditions. This abstract provides a comprehensive overview of the pathogenesis, diagnosis and management strategies of fundus bleeding. The abstract begins by discussing the underlying pathophysiology of fundus bleeding, which involves the rupture of retinal blood vessels leading to the extravasation of blood into the retinal layers. It highlights the diverse aetiologies of retinal haemorrhage, including trauma, vascular diseases, hypertension, diabetes, blood dyscrasias and ocular conditions such as retinal vein occlusion and macular degeneration. The manuscript further delves into the diagnostic modalities used to assess fundus bleeding, including fundus examination, optical coherence tomography (OCT), fluorescein angiography (FA) and fundus photography. It emphasizes the importance of accurate diagnosis to identify the underlying cause and guide appropriate management. The management strategies for fundus bleeding are discussed, considering both the underlying aetiology and severity of the haemorrhage. This includes conservative approaches, such as observation and control of systemic risk factors, as well as specific interventions like antivascular endothelial growth factor (anti-VEGF) therapy, laser photocoagulation and vitrectomy. In conclusion, this abstract provides a comprehensive overview of the pathogenesis, diagnosis and management of fundus bleeding or retinal haemorrhage. It serves as a valuable resource for clinicians and researchers involved in the care of patients with retinal haemorrhage, aiding in the understanding of its multifactorial aetiology and guiding evidence-based management strategies for improved visual outcomes.
Reliability and Validity of the Chen Depression Scale: A Preliminary Study
Authors: Chen Yi-Lung , Liang Sophie Hsin-Yi , Lu Mong-Liang , Chen Vincent Chin-Hung
Published: July 2024

Objective:

Major depressive disorder (MDD) is an important psychiatric illness worldwide. We developed the Chen Depression Scale (CDS) based on the criteria of the Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition. In this study, we intended to evaluate the psychometric properties of the CDS.

Methods:

The sample consisted of 135 adult participants aged between 20 and 64 years, including 85 individuals with MDD recruited at a teaching hospital, and 50 community-based non-MDD controls. Depressive symptoms were assessed using CDS and the Chinese version of the Patient Health Questionnaire 9 (C-PHQ-9). We investigated the psychometric properties of CDS, including test–retest reliability, internal consistency reliability, sensitivity and specificity, convergent validity, discriminant validity, and construct validity.

Results:

The result showed that the CDS had excellent internal reliability (Cronbach’s α = 0.957) and test–retest reliability (intraclass correlation coefficient = 0.843). Construct validity was examined with confirmatory factor analyses to verify the factor structure of the CDS and convergent validity with C-PHQ-9 with a statistically high correlation with Pearson’s r with p < 0.001. When evaluating the impairment criterion for identifying individuals with MDD, those who reported impairment in MDD symptoms and scored a CDS of 17 or above exhibited a sensitivity of 0.86 and a specificity of 0.96 for CDS.

Conclusion:

The CDS has good psychometric properties, including excellent reliability and sensitivity and diagnostic properties at cutoff point 17. It serves effectively as a screening tool for both clinical diagnosis and academic study of depression.
The Performance of ChatGPT on Short-answer Questions in a Psychiatry Examination: A Pilot Study
Authors: Lin Chao-Cheng , Plooy Kobus du , Gray Andrew , Brown Deirdre , Hobbs Linda , Patterson Tess , Tan Valerie , Fridberg Daniel , Hsu Che-Wei
Published: July 2024

Objectives:

We compared ChatGPT’s performance to medical students’ on psychiatry examinations and investigated whether raters could distinguish answers between them.

Methods:

We used a copy of short-answer questions from a psychiatry examination to compare the performance of three randomized groups – ChatGPT, student, and hybrid (student-modified ChatGPT responses). Furthermore, we investigated raters’ ability to identify response origins.

Results:

ChatGPT-assisted answers, both ChatGPT alone (p < 0.001) and hybrid (p < 0.001), had significantly better examination performance than did independent students work. Raters showed high accuracy in identifying the origin of the responses, correctly identifying 92% of both students’ and ChatGPT-assisted responses. But raters were only 61% accurate in making the distinction between ChatGPT and hybrid answers.

Conclusion:

ChatGPT showed superior performance in a psychiatry examination compared to students’ work, but raters showed high accuracy in distinguishing them. Further investigation is warranted to optimize the advantages and mitigate the drawbacks of incorporating such technology into psychiatric education and health care.