bluuebunny/crossref_metadata_2025 huggingface dataset:
The Structure of a Peptide-Loaded Shark MHC Class I Molecule Reveals Features of the Binding between β2-Microglobulin and H Chain Conserved in Evolution
Authors: Wu Yanan , Zhang Nianzhi , Wei Xiaohui , Lu Shuangshuang , Li Shen , Hashimoto Keiichiro , Dijkstra Johannes M , Xia Chun
Published: June 2021

Cartilaginous fish are the most primitive extant species with MHC molecules. Using the nurse shark, the current study is, to the best of our knowledge, the first to present a peptide-loaded MHC class I (pMHC-I) structure for this class of animals. The overall structure was found to be similar between cartilaginous fish and bony animals, showing remarkable conservation of interactions between the three pMHC-I components H chain, β2-microglobulin (β2-m), and peptide ligand. In most previous studies, relatively little attention was given to the details of binding between the H chain and β2-m, and our study provides important new insights. A pronounced conserved feature involves the insertion of a large β2-m F56+W60 hydrophobic knob into a pleat of the β-sheet floor of the H chain α1α2 domain, with the knob being surrounded by conserved residues. Another conserved feature is a hydrogen bond between β2-m Y10 and a proline in the α3 domain of the H chain. By alanine substitution analysis, we found that the conserved β2-m residues Y10, D53, F56, and W60—each binding the H chain—are required for stable pMHC-I complex formation. For the β2-m residues Y10 and F56, such observations have not been reported before. The combined data indicate that for stable pMHC-I complex formation β2-m should not only bind the α1α2 domain but also the α3 domain. Knowing the conserved structural features of pMHC-I should be helpful for future elucidations of the mechanisms of pMHC-I complex formation and peptide editing.
TRAF3 in T Cells Restrains Negative Regulators of LAT to Promote TCR/CD28 Signaling
Authors: Arkee Tina , Hostager Bruce S , Houtman Jon C D , Bishop Gail A
Published: June 2021

The adaptor protein TNFR-associated factor 3 (TRAF3) is required for in vivo T cell effector functions and for normal TCR/CD28 signaling. TRAF3-mediated enhancement of TCR function requires engagement of both CD3 and CD28, but the molecular mechanisms underlying how TRAF3 interacts with and impacts TCR/CD28-mediated complexes to enhance their signaling remains an important knowledge gap. We investigated how TRAF3 is recruited to, and regulates, CD28 as a TCR costimulator. Direct association with known signaling motifs in CD28 was dispensable for TRAF3 recruitment; rather, TRAF3 associated with the CD28-interacting protein linker of activated T cells (LAT) in human and mouse T cells. TRAF3–LAT association required the TRAF3 TRAF-C domain and a newly identified TRAF2/3 binding motif in LAT. TRAF3 inhibited function of the LAT-associated negative regulatory protein Dok1, which is phosphorylated at an inhibitory tyrosine residue by the tyrosine kinase breast tumor kinase (Brk/PTK6). TRAF3 regulated Brk activation in T cells, limiting the association of protein tyrosine phosphatase 1B (PTP1B) with the LAT complex. In TRAF3-deficient cells, LAT complex–associated PTP1B was associated with dephosphorylation of Brk at an activating tyrosine residue, potentially reducing its ability to inhibit Dok1. Consistent with these findings, inhibiting PTP1B activity in TRAF3-deficient T cells rescued basal and TCR/CD28-mediated activation of Src family kinases. These results reveal a new mechanism for promotion of TCR/CD28-mediated signaling through restraint of negative regulation of LAT by TRAF3, enhancing the understanding of regulation of the TCR complex.
Complex Autoantibody Responses Occur following Moderate to Severe Traumatic Brain Injury
Authors: Needham Edward J , Stoevesandt Oda , Thelin Eric P , Zetterberg Henrik , Zanier Elisa R , Al Nimer Faiez , Ashton Nicholas J , Outtrim Joanne G , Newcombe Virginia F J , Mousa Hani S , Simrén Joel , Blennow Kaj , Yang Zhihui , Hutchinson Peter J , Piehl Fredrik , Helmy Adel E , Taussig Mike J , Wang Kevin K W , Jones Joanne L , Menon David K , Coles Alasdair J
Published: June 2021

Most of the variation in outcome following severe traumatic brain injury (TBI) remains unexplained by currently recognized prognostic factors. Neuroinflammation may account for some of this difference. We hypothesized that TBI generated variable autoantibody responses between individuals that would contribute to outcome. We developed a custom protein microarray to detect autoantibodies to both CNS and systemic Ags in serum from the acute-phase (the first 7 d), late (6–12 mo), and long-term (6–13 y) intervals after TBI in human patients. We identified two distinct patterns of immune response to TBI. The first was a broad response to the majority of Ags tested, predominantly IgM mediated in the acute phase, then IgG dominant at late and long-term time points. The second was responses to specific Ags, most frequently myelin-associated glycopeptide (MAG), which persisted for several months post-TBI but then subsequently resolved. Exploratory analyses suggested that patients with a greater acute IgM response experienced worse outcomes than predicted from current known risk factors, suggesting a direct or indirect role in worsening outcome. Furthermore, late persistence of anti-MAG IgM autoantibodies correlated with raised serum neurofilament light concentrations at these time points, suggesting an association with ongoing neurodegeneration over the first year postinjury. Our results show that autoantibody production occurs in some individuals following TBI, can persist for many years, and is associated with worse patient outcome. The complexity of responses means that conventional approaches based on measuring responses to single antigenic targets may be misleading.
Psychosocial support interventions for women with gestational diabetes mellitus: a systematic review
Authors: Jung Seulgi , Kim Yoojin , Park Jeongok , Choi Miyoung , Kim Sue
Published: June 2021

Purpose: This study aimed to analyze the content and effectiveness of psychosocial support interventions for women with gestational diabetes mellitus (GDM).Methods: The following databases were searched with no limitation of the time period: Ovid-MEDLINE, Cochrane Library, Ovid-Embase, CINAHL, PsycINFO, NDSL, KoreaMed, RISS, and KISS. Two investigators independently reviewed and selected articles according to the predefined inclusion/exclusion criteria. ROB 2.0 and the RoBANS 2.0 checklist were used to evaluate study quality.Results: Based on the 14 selected studies, psychosocial support interventions were provided for the purpose of (1) informational support (including GDM and diabetes mellitus information; how to manage diet, exercise, stress, blood glucose, and weight; postpartum management; and prevention of type 2 diabetes mellitus); (2) self-management motivation (setting goals for diet and exercise management, glucose monitoring, and enhancing positive health behaviors); (3) relaxation (practicing breathing and/or meditation); and (4) emotional support (sharing opinions and support). Psychosocial supportive interventions to women with GDM lead to behavioral change, mostly in the form of self-care behavior; they also reduce depression, anxiety and stress, and have an impact on improving self-efficacy. These interventions contribute to lowering physiological parameters such as fasting plasma glucose, glycated hemoglobin, and 2-hour postprandial glucose levels.Conclusion: Psychosocial supportive interventions can indeed positively affect self-care behaviors, lifestyle changes, and physiological parameters in women with GDM. Nurses can play a pivotal role in integrative management and can streamline the care for women with GDM during pregnancy and following birth, especially through psychosocial support interventions.
INTERESSI MILITARI NELLE ELLENICHE DI OSSIRINCO
Authors: Brambilla Alessandro
Published: June 2021

This paper starts from the attempt to define what is a â€œmilitary historianâ€ and tries to establish whether this definition is applicable to the author of the Hellenica Oxyrhynxhia. Moving from the analysis of the military related episodes described by the author, the paper underlines his care in relating the movements of troops throughout a campaign, in recording casualties, and his attention towards tactics, such as stratagems and abushes, or economic matters, such as the payment of troops. At the same time, this paper emphasises that the precision showed by the author in describing these warfare episodes, though possibly demonstrating the employment of good quality sources, maybe official accounts, it is not enough to define the Hellenica Oxyrhynchia as the work of a military historian.
LA FUNZIONE INTERPRETATIVA DEL PENSIERO â€˜PARLANTEâ€™ E Lâ€™INCONSCIO COGNITIVO
Authors: Macchi Laura , Bagassi Maria
Published: June 2021

Macchi and Bagassi propose a conception of mind bounded by the qualitative constraint of relevance at conscious and unconscious levels. The core of this conception is an interpretative function in language and thought as adaptive characteristic of the human cognitive system. This perspective is supported by evidence from the authors' research on insight problem solving, which they consider a privileged route to understanding what kind of special unconscious thought produces the solution. During incubation, in the absence of conscious control, relevance constraint allows multilayered thinking to discover a new interpretation of the data that finally offers an exit from the impasse. The authors speculate that the creative act of restructuring implies a form of high-level unconscious thought, the unconscious analytic thought.
Pre-clinical modelling of rectal cancer to develop novel radiotherapy-based treatment strategies
Authors: Gillespie Michael A. , Steele Colin W. , Lannagan Tamsin R.M. , Sansom Owen J. , Roxburgh Campbell S.D.
Published: June 2021

Pre-operative chemoradiotherapy reduces local recurrence rates in locally advanced rectal cancer. 10-20% of patients undergo complete response to chemoradiotherapy, however, many patients show no response. The mechanisms underlying this are poorly understood; identifying molecular and immunological factors underpinning heterogeneous responses to chemoradiotherapy, will promote development of treatment strategies to improve responses and overcome resistance mechanisms. This review describes the advances made in pre-clinical modelling of colorectal cancer, including genetically engineered mouse models, transplantation models, patient derived organoids and radiotherapy platforms to study responses to chemoradiotherapy. Relevant literature was identified through the PubMed and MEDLINE databases, using the following keywords: rectal cancer; mouse models; organoids; neo-adjuvant treatment; radiotherapy; chemotherapy. By delineating the advantages and disadvantages of available models, we discuss how modelling techniques can be utilized to address current research priorities in locally advanced rectal cancer. We provide unique insight into the potential application of pre-clinical models in the development of novel neo-adjuvant treatment strategies, which will hopefully guide future clinical trials.
Iron Chelation Therapy Needed for Serum Ferritin Overloaded Patients of Beta Thalassemia Major
Authors: Muhammad Wasim , Ishaq Muhammad , Khan Muhammad J. , Ahmad Umair , Waseem Muhammad
Published: June 2021

The main objective of the current study is to evaluate the level and overload of serum ferritin in multi-transfused beta Thalassemia major patients. There is an earnest need to defend the chelation treatment and to make mindfulness about the results of serum ferritin in the patients beta Thalassemia major. This is a Cross sectional analytical study performed in Fatimid foundation Hayatabad, Peshawar, Khyber Pakhtunkhwa province of Pakistan. Those patients who has beta thalassemia major are included in this study. In this study there are total 108 patients in which 54 males and 54 females. The highest mean of serum ferritin level in the category of male was in the age of 12 years were finds 8160.5 ng/mL. Among the female the highest mean of ferritin level was in the age of 17 years were finds 13,349.5 ng/mL. In this study majority of patient’s revealed much high levels of serum ferritin. These levels reveal insufficient chelation. Appropriate chelation of iron load can improve the quality of the life of these patients. The low level of education, Poverty problems, and insufficient health care facility of are the main obstacle in the effective management of ferritin overload in thalassemia patients.
Level of Anxiety and Factors Influencing Anxiety among Orthopedic Surgical Patients in a Secondary Care Center in India
Authors: Christal Vimala T. Jeni , Martin Rajesh , Rao Anbu S , Joy Melvin
Published: June 2021

Background:

The purpose of the present study aimed to assess the level of anxiety and factors influencing anxiety among orthopedic surgical patients admitted to a secondary care center in India.

Methods:

The study was conducted for a period of 3 months. A quantitative approach with a descriptive design was used. Simple random sampling was used to select 46 orthopedic inpatients. Demographic and clinical data were collected using a self-developed pro forma. State-Trait Anxiety Inventory form Y-1 was used to assess anxiety, and factors influencing anxiety were assessed by a self-developed questionnaire.

Results:

Out of 46 participants, 60.90% have low anxiety, 15.20% have moderate, and 23.90% have severe anxiety. Regarding factors influencing anxiety, 78.30% have fear about postoperative pain; 60.90% have fear about surgery; 58.70% have fear about anesthesia, the outcome of surgery, and economic issues; and 52.20% have fear of dependency and postponement of surgery. Some other factors are fear of complications and lack of sleep during night 45.70%, fear about family issues 37%, fear of postoperative nausea 34.80%, fear of death 23.90%, fear about the structure of the ward 17.40%, and fear due to lack of preoperative instructions 13%.

Conclusions:

Anxiety is common among patients waiting for orthopedic surgery. It is important to identify the factors influencing anxiety as a routine nursing care to reduce anxiety level.
Perceptions of 1st -Year MBBS Students about the Medical Council of India Mandated Foundation Course
Authors: Sethi Sujata , Verma Piyush , Srivastava Vivek , Mittal Rakesh
Published: June 2021

Background:

Foundation course (FC) program was introduced recently by the Medical Council of India for the 1st-year of MBBS students in India to serve as a bridge into the MBBS program as well as to orient the students to various aspects of the medical college environment.

Aim:

The aim of the study was to analyze the feedback on FC by the 1st-year MBBS students.

Materials and Methods:

The study was conducted at the Pt. B. D. Sharma PGIMS, Rohtak, during August 1–31, 2019, involving 242 1st-year MBBS students. At the end of each day of the program, the students received a multiple-choice questionnaire along with a feedback form. Further, at the end of the 1-month of the FC program, the students received a final feedback form reflecting upon various aspects of the FC.

Results:

Majority of the students felt that the FC was well organized and helpful in gaining knowledge and information. Basic life support was the “most preferred” skill session (68.5%), followed by a session on immunization clinic (31.6%). Students felt that the training sessions organized under the six modules of the FC were able to impart ample information on respective topics and were considered helpful to a great extent for majority of the students. Fifty-eight percent of the students felt content overload and rushed pace of content delivery did not help in learning. Other hindering factors recognized by students included excessive use of technical/medical terminology, audio–visual disturbances, and spread out locations for small group activities.

Conclusions:

High levels of satisfaction with the FC in general and in terms of content and organization were observed. Shortcomings recognized through feedback will help us to improve.
The Utility of Ultrasound to Predict the Uncuffed Endotracheal Tube Size in Pediatric Population
Authors: Pal Reena , Joel Jerry J , Singh Anity , Gandi Rachel , Rai Ekta
Published: June 2021

Introduction:

Due to contrasting evidence for and against the age-based formulas for calculation of correct size of endotracheal tube (ETT) in children, this prospective observational study aimed at comparison of ultrasonography (USG) and age-based formula for calculation of correct ETT size in children <6 years of age.

Materials and Methods:

Following a sample size calculation of 63 children, children of <6 years of age were recruited. Age-based formula (Cole's formula) was used for predicting ETT size. Cricoid diameter was measured using USG, and USG ETT was selected. Correct tube used for the patient was confirmed by air leak test. Agreement for correct size ETT with USG and age-based method was assessed using kappa value for intraclass correlation (ICC). Subgroup analysis was carried out for age, sex, and weight.

Results:

Sixty-six children with a mean age of 27.9 months were recruited. USG method was found to be correct in 44 patients (67%), whereas age-based method selected the correct tracheal tube size in 32% (21) of patients

(

P < 0.001). Agreement of ultrasound-based method with the correct size tube was 0.902, while the same for age-based formula method and correct ETT was 0.835 proving the superiority of the USG. On subgroup analysis, ultrasound-based tube selection was accurate in children <1 year.

Conclusions:

With ICC of 0.902, ultrasound can be a useful tool for selecting pediatric ETT size as compared to age-based formula. This finding is significant, especially in children under the age of 1 year.
Chronic Myeloid Leukemia with Solitary Extramedullary Bone Deposit
Authors: Negi Preety , Jomi Chinnu , Philip Chepsy , Mahajan Anupam , Kingsley Pamela Alice
Published: June 2021

Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm, characterized by a hematopoietic stem cell carrying BCR-ABLl fusion protein. Common sites of extramedullary deposits in CML are lymph nodes, bones, and central nervous system. We present a case of a 39-year-old male diagnosed case of CML who presented with extramedullary deposit in the right femur in spite of complete hematological remission and major molecular response on real-time quantitative reverse transcriptase polymerase chain reaction in the blood. Extramedullary deposit is almost always followed by hematological reemergence of disease and is considered as an early sign of disease in the bone marrow. Bone, lymph nodes, skin and soft tissues, and central nervous system are the common sites for extramedullary deposits in a case of CML. A thorough literature review revealed limited case reports on extramedullary deposits in a case of CML in major molecular response. Therefore, the possibility of being confronted with unusual signs and symptoms which could be indicative of extramedullary deposits should be kept in mind.
Tulsi
Authors: Singh Malvika
Published: June 2021

Introduction:

Role of tulsi in periodontal disease is a polymicrobial infection primarily caused by periodontal pathogens existing within the subgingival plaque. The conventional method of lowering the bacterial load in the periodontal pocket constitutes scaling and root planning, but to prevent recolonization the use of adjunctive methods has been advocated. Tulsi (Ocimum sanctum) is being widely used in dentistry in the form of mouthwashes, dentifrice, gels, and oral irrigants.

Objective:

The objective behind writing this article was to assess the relevance of and effectiveness of Tulsi (O. sanctum) in the treatment of periodontal disease.

Data Source:

Internet database Medline/PubMed search for word “Tulsi” resulted in 1000 articles. Review Methods: Articles with Medline/PubMed were only considered in writing this review. The result showed that Tulsi has been widely used as a mouthwash, dentifrice, and oral irrigant in the field of periodontics.

Conclusions:

Although highly effective, the use of Tulsi has not been popularized in today's day and age and needs to be done the same.
Professionalism and Bioethics
Authors: Vimal Mourouguessine , Nishanthi Anandabaskar
Published: June 2021

Professionalism is applied to any field which requires a specialized body of knowledge and skill and the highest standards of conduct directed at the general benefit of the society. The principles of bioethics have always been the key component in the practice of medical profession. The authors highlight the various aspects of professionalism and characteristics of a professional. Principles of bioethics have been the key component in the practice of medical profession. The authors discuss the various ethical dilemmas which could arise in the practice of medical profession where the principles of bioethics could be applied to ensure quality assurance of health-care services. In addition, the need for teaching professionalism and bioethics, as a part of the medical curriculum, had been insisted.
A prospective observational study of chemotherapy-induced adverse drug reaction and the quality of life in cancer patients in a tertiary care hospital
Authors: Krishnarajan D. , Sivasakthi K. , Ariyamol R. , Kumar D. Naveen , Varghese Soniya
Published: June 2021

Aim:

The aim was to study the pattern of adverse drug reaction (ADR) provoked by anticancer therapy and to assess the quality of life (QoL) in cancer patients.

Materials and Methods:

This study was conducted in Tamil Nadu on 75 patients from February to July 2019 taking into account their demographic profile, ADR occurrence and its causality, outcome, organ system-wise distribution of ADRs, and others. The causality assessment was done by using Naranjo's scale and QoL was assessed by the Functional Assessment of Cancer Therapy-General (FACT-G) scale. The QoL was compared in any two consecutive cycles between the 2nd and 5th cycles of chemotherapy.

Results:

Out of the 75 patients, 17 male and 56 female patients developed ADR. A total of 228 ADRs were observed in 73 patients. The most commonly occurred ADR was nausea and vomiting (45%) and the most commonly affected system was gastrointestinal tract (37%). According to causality assessment, the ADR that occurred falls mostly in the category of probable (66.7%) followed by possible (29.3%) and the outcome of the ADR was mostly recovering (49.3%). The QoL was higher in females and in the age group of 40–49 years. The physical and emotional well-being of the patient were affected more. The overall QoL was improved in the 2nd visit when compared to the 1st visit.

Conclusion:

Cancer is known to cause a significant impact on the health and socioeconomics of a nation. To boost the QoL in patients, it is essential to identify and manage the ADRs by taking appropriate measures to promote judicious use of drugs.
Low-dose radiotherapy for COVID 19
Authors: Kumar Rishabh , Haresh Kunhi Parambath , Sharma Daya Nand , Gupta Anil , Gupta Subhash , Vellaiyan Subramani , Rath Goura Kishor
Published: June 2021

The world is fighting the onslaught of COVID 19 for the last 10 months, ever since the first case was reported in December 2019 in Wuhan, China. Now, it has spread to over 200 countries. COVID 19-associated respiratory syndrome is causing a lot of mortality and morbidity. There are reports suggesting that the complications and ARDS associated with COVID 19 is an immune response reaction. The cytokine storm associated with severe cases of COVID 19 acts as a cause of death in many sick patients. It has been shown that COVID 19 is associated with a peculiar immune profile: Decrease in CD3, CD4, CD8, natural killer cell and B-cells; Rise in interleukin (IL)-4, IL-6 and tumor necrosis factor (TNF) alpha; Decrease in IL-10; Decrease in interferon-gamma. Low-dose radiotherapy (LDRT) immunosuppressive features resulting from M2 macrophage phenotype activation, increase in IL-10, transforming growth factor beta, a decrease in IL-6, TNF alpha and an increase in CD3, CD4, and CD8 T cell counts may negate the harmful effects of cytokine release syndrome. Literature review shows that radiation was previously used to treat viral pneumonia with a good success rate. This practice was discontinued in view of the availability of effective antibiotics and antivirals. As there are no scientifically proven treatment for severe COVID 19-associated respiratory distress today, it is prudent that we understand the benefits of LDRT at this critical juncture and take rational decisions to treat the same. This article provides an radioimmunological rationale for the treatment of immune crisis mediated complications in severe cases of COVID 19.
Impact of the COVID-19 pandemic on health care activities at a Uruguayan mastology unit
Authors: Castillo Cecilia , Camejo Natalia , Amarillo Dahiana , Rodriguez Florencia , Vitureira Florencia , Krygier Gabriel , Delgado Lucía
Published: June 2021

Purpose:

Health emergency due to COVID-19 started in Uruguay on March 13, 2020; our mastology unit tried to ensure adequate oncological care, and protect patients from the virus infection and complications.

Objective:

To assess the health care activities in the “peak” of the pandemic during 3 months.

Materials and Methods:

we collected data from the electronic health record.

Results:

There were a total of 293 medical appointments from 131 patients (221 face-to-face), that decreased by 16.7% compared to the same period in 2019 (352 appointments). The medical appointments were scheduled to evaluate the continuity of systemic treatment or modifications (95 patients; 72.5%), follow-up (17; 12.9%), first-time consultation (12; 9.1%), and assess paraclinical studies (7; 5.3%). The patients were on hormone therapy (81 patients; 74%), chemotherapy (CT) (21; 19%), and anti-HER2 therapies (9; 8%). New twenty treatments were initiated. Of the 14 patients that were on adjuvant/neoadjuvant CT, 9 (64.3%) continued with the same regimen with the addition of prophylactic granulocyte-colony-stimulating factors (G-CSF), and 5 (35.7%), who were receiving weekly paclitaxel, continued the treatment with no changes. Of the seven patients that were on palliative CT, 2 (28.5%) continued the treatment with the addition of G-CSF, 3 (42.8%) continued with weekly capecitabine or paclitaxel with no treatment changes, and 2 (28.5%) changed their treatment regimen (a less myelosuppressive regimen was selected for one and due to progression of the disease in the other patient). The ninety patients who were receiving adjuvant, neoadjuvant, or palliative criteria hormone therapy and/or anti-HER2 therapies, continued the treatment with no changes.

Conclusions:

The evidence suggests that, although medical appointments decreased by approximately 17%, we could maintain healthcare activities, continued most of the treatments while the most modified was CT with G-CSF to avoid myelosuppression.
Dosimetric impact of dwell time deviation constraint on inverse brachytherapy treatment planning and comparison with conventional optimization method for interstitial brachytherapy implants
Authors: Roy Saurabh , Subramani V. , Singh Kishore , Rathi Arun Kumar
Published: June 2021

Purpose:

High-dose rate remote afterloading brachytherapy machine and advanced treatment planning system help in getting optimum dose to tumor and low dose to normal structures. Inverse planning simulated annealing (IPSA) optimization technique has a unique feature of dwell time deviation constraint (DTDC). In this study, six IPSA-based plans having different DTDC values with routinely practiced geometric plus graphical optimization (GO + GrO) have been compared using various dosimetric parameters.

Materials and Methods:

For this retrospective study, we have generated IPSA-optimized interstitial brachytherapy plans for ten cancer cervix patients. Routinely practiced GO + GrO-based plans were compared with six different IPSA plans having varying DTDC values from 0.0 to 1.0 using different dosimetric indices.

Results:

Conformity index and homogeneity index (HI) were higher in GO + GrO plans, compared to IPSA-optimized plans. However, HI of IPSA plans was increasing with increasing DTDC values. High-dose volumes were well controllable using DTDC parameter in IPSA-optimized plans. Dose to the rectum and bladder was smaller for IPSA-optimized plans than GO + GrO plans.

Conclusions:

One of the benefits of applying DTDC in IPSA-optimized plan is that it reduces high-dose volumes. Another advantage is the reduction in rectum and bladder dose.
Diagnostic accuracy of Raman spectroscopy for the diagnosis of bladder cancer
Authors: Kim Do Kyung , Kim Yon Hee , Lee Hyun Young , Lee Soomin , Doo Seung Whan , Yang Won Jae , Song Yun Seob , Kim Ki Hyun , Kim Jae Heon
Published: June 2021

Introduction:

Although several studies have been conducted to evaluate the feasibility of Raman spectroscopy (RS) for the diagnosis of bladder cancer (BCa), it is difficult to use RS in real clinical settings based on the current limited evidence. Therefore, we performed a systematic review and meta-analysis to assess the diagnostic accuracy of RS in BCa.

Materials and Methods:

Comprehensive literature searches were performed in the PubMed/Medline, Embase, and Cochrane Library databases up to March 2019. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, this study included reports according to the participant, intervention, comparator, outcomes, and study design approach. The methodological quality of the included studies was evaluated according to questionnaires and criteria suggested by the Quality Assessment of Diagnostic Accuracy Studies-2 tool. The quantitative outcomes included diagnostic accuracy (sensitivity and specificity).

Results:

Fifteen studies were included for qualitative analysis and four studies (BCa cases, n = 139; control cases n = 107) were included in this analysis by screening the full text of the remaining articles based on the inclusion and exclusion criteria through a systematic review. The pooled sensitivity and specificity of RS were 0.91 (95% confidence interval [CI]: 0.85–0.95) and 0.93 (95% CI: 0.86–0.97), respectively. The among-study heterogeneity was statistically significant in the specificity results (Cochran Q statistic, P = 0.015; I2 statistic, 71.3%) but not in the sensitivity results (Cochran Q statistic, P = 0.189; I2 statistic, 37.2%).

Conclusions:

RS showed the potential to be an efficient tool with high accuracy for detecting malignant bladder lesions. More studies with in vivo real-time settings are warranted to validate our results.
Estimation of endoplasmic reticulum aminopeptidase 1 level of expression in lesional and nonlesional skin of psoriatic patients and healthy controls
Authors: Metwally Dina , Rashed Laila A. , Badr Amul M. , Elqadi Doaa M. , Hilal Rana F.
Published: June 2021

Background

Psoriasis is a chronic inflammatory autoimmune disease of the skin, in which an elevated expression of endoplasmic reticulum aminopeptidase 1 (ERAP1), an enzyme involved in the final processing of major histocompatibility complex-I ligands, was reported. No previous reports studied the level of ERAP1 in lesional and nonlesional skin of psoriatic patients.

Objective

To estimate the level of ERAP1 expression in lesional and nonlesional skin of psoriatic patients and the skin of healthy controls to define its role in the pathogenesis of psoriasis.

Patients and methods

In this case–control study, 25 psoriatic patients and 30 healthy, age-matched and sex-matched controls were enrolled. All patients were subjected to detailed history and clinical examination, including Psoriasis Area and Severity Index (PASI) score to determine severity of psoriasis. Skin biopsies were obtained from all participants: two from psoriatic patients (lesional and nonlesional) and one from healthy controls. ERAP1 level was measured using PCR technique.

Results

There was a highly significant level of expression of ERAP1 in psoriatic lesions when compared with control skin (P<0.001). Moreover, ERAP1 in nonlesional tissue in psoriatic patients was significantly higher than in controls (P<0.001). ERAP1 expression in lesional tissue was higher than that in nonlesional tissue, but without a significant difference. Moreover, a positive correlation was detected between lesional tissue ERAP1 level and PASI score. Nonlesional tissue ERAP1 also correlated positively with the PASI score.

Conclusion

This study, which is the first to measure tissue ERAP1 expression, demonstrated an increased expression in psoriatic skin, in addition to its positive correlation with disease severity. This implied the role of ERAP1 in the pathogenesis of psoriasis, thus encouraging the study of future treatment modalities targeting ERAP1 pathway that could revolutionize treatment for psoriasis.
Nondrug-related erythema multiforme-like eruption in a mild case of COVID-19
Authors: El-Kalioby Mona
Published: June 2021

The diagnostic and prognostic significance of cutaneous affection in COVID-19 remains unclear. Some of the reported skin manifestations including erythema multiforme were considered associated cutaneous adverse drug reactions. Furthermore, it was suggested that erythema multiforme can be associated with good prognosis for COVID-19 infection. This case report, likewise, describes a patient with mild symptoms of COVID-19, presenting with localized erythema multiforme-like lesions of the palms. The skin lesions appeared before receiving any medications. This supports that erythema multiforme can be a cutaneous presentation of COVID-19, rather than a drug eruption.
Fluoroscopy-induced chronic radiodermatitis
Authors: El-Enany Galal , El Hoshy Khaled , Youssef Randa , Nagui Noha , Nada Hanan , Halim Mona Abdel , Nada Ahmed , Elantably Dina , Sany Iman
Published: June 2021

Fluoroscopy-induced chronic radiodermatitis is a rare complication that is now encountered more often owing to the increasing use of fluoroscopy in radiological procedures. The long duration between radiation exposure and development of condition, patient unawareness of exposure to radiation along with lack of clinical suspicion of the condition among dermatologists, all make the diagnosis difficult. We report three cases of male patients who presented with a clinical picture suggestive of fluoroscopy-induced chronic radiodermatitis backed up by history of cardiac catheterization procedures confirming the diagnosis. Awareness of this entity among dermatologists is important for early recognition and proper management.
Demand of ophthalmic services in a rural district of Costa Rica
Authors: Acon Dhariana , Crim Nicolas , Wu Lihteh
Published: June 2021

Purpose:

To report the demand of ophthalmic services and the prevalence of the main ophthalmic pathologies in a rural population of Costa Rica.

Study Design:

A cross-sectional study of all individuals seen at the ophthalmology outpatient clinic during March 2016 to February 2017.

Methods:

All cases presenting to the ophthalmology outpatient clinic during March 2016 to February 2017 were reviewed (n = 895 patients, 1790 eyes). Visual acuity was measured using the Snellen chart.

Results:

The most common reasons for consultation were decreased visual acuity in 37.7% (326/865), foreign-body sensation 20.2% (175/865), glaucoma control 5.9% (51/865), screening or follow-up of diabetes mellitus (DM) 5.8% (50/865), and blunt trauma in 5% (43/865) of patients. A total of 252 (14.1%) eyes presented with a best-corrected visual acuity (BCVA) ≤20/200; 357 (19.9%) eyes had a BCVA <20/40 and >20/200; and 1181 (65.9%) had a BCVA ≥20/40. There were 40 (4.5%) patients that had a BCVA ≤20/200 bilaterally. The most common ophthalmic findings included cataract in 552 (30.8%) eyes, pterygium in 296 (16.5%) eyes, primary open angle glaucoma (POAG) in 187 (10.4%) eyes, age-related macular degeneration in 168 (9.4%) eyes, and 131 (7.3%) eyes with diabetic retinopathy (DR).

Conclusions:

The most common cause of ophthalmic consultation was decreased vision, of which 14% had a BCVA ≤20/200. The common findings included cataract, pterygia, POAG, age-related macular degeneration, and DR. Seventy-five percent of bilateral visual loss is avoidable.
Corneal dystrophies
Authors: Mora Matilde , Mejia Maria Elisa , Martinez-Ceballos Maria Alejandra , Roca Daniela
Published: June 2021

Purpose:

To describe sociodemographic findings, frequency, and clinical characteristics of patients with corneal dystrophy who consulted an ophthalmologic national reference center in Bogotá-Colombia in 10 years.

Methods:

Observational, descriptive case series study was carried out. The information was obtained from reviewing medical records of patients who consulted the cornea service at an ophthalmologic national reference center in Bogotá-Colombia between 2008 and 2018. The diagnosis of corneal dystrophy was done according to the International Committee for Corneal Dystrophies classification, as well as the currently accepted specific name of the dystrophy. The type of dystrophy, clinical, diagnostic findings, sociodemographic characteristics, and type of treatment were evaluated.

Results:

A total of 151 eyes of 79 patients were analyzed; 68.3% of subjects were female. The mean age was 57.6 ± 18.9 years, with a range between 2 and 95 years. The median best-corrected visual acuity (BCVA) in all the groups at diagnosis was 0.30 LogMAR (interquartile range 0.5) or 20/40 Snellen. Lattice dystrophy type 1 and its variants had the worse BCVA. Fuchs' dystrophy (FD) was the most frequently identified. Regarding treatment, 80.1% (n = 121) did not require any, and 11.9% (n = 18) had a corneal transplant. Thirteen underwent penetrating keratoplasty. Of those, two had a clinical diagnosis of TGFB1 dystrophy, three of stromal dystrophy, and eight of endothelial dystrophy. DSAEK was performed in 5 eyes four had endothelial dystrophy and one had unclassified dystrophy.

Conclusions:

Adults and females were the most affected groups. FD was the most frequent and unclassified dystrophies were the second most frequently diagnosed. This highlights the importance of complementary studies such as optical coherence tomography of the anterior segment and genetic markers which are not currently universally available in our healthcare system.

Ethical considerations:

This study was approved by the Institutional Ethics Committee and was conducted in accordance with the principles of the Declaration of Helsinki.
Keloid – A case report and its limited management brief overview
Authors: Khan Zibran , Mukherji Aveek , Shah Kashyap , Malik Prashant , Haroon T. Mohamed , Joshi Sidharth
Published: June 2021

Keloids are an unorganized proliferation of fibrous tissue, usually arising from a site of injury due to an aberrant healing process. Clinically, it presents as ugly scar tissue on the skin and shows genetic predilection. They cause esthetic, physical, and psychological disturbances in the affected individuals. Such patients require special precautions during routine surgical procedures. Its treatment is associated with a high degree of resistance and recurrence. In this article, one such case is reported along with a literature review discussing the nature of the lesion, treatment options, and the recommended precautions.
Assessment of three modes knowledge, attitude and enthusiasm of dental postgraduates towards scientific research in private dental college at Kanpur district - A cross-sectional study
Authors: Mehrotra Vishal , Sachdev Rohan , Garg Kriti , Srivastava Rahul , Sambyal Sheenam , Chauhan Shiv Singh
Published: June 2021

Context:

Scientific research is an indispensable part of health-care curricula and a crucial exercise to help evolve clinician's research adroitness.

Aims:

The survey was planned to gauge and assess the postgraduates (PGs) dental students knowledge, attitude, and interest toward scientific research and to determine the factors and their perception for the dearth of research interest.

Settings and Design:

A cross-sectional, questionnaire-based research was done after the approval from the Institutional Ethics Committee and obtaining written informed consent from participants.

Subjects and Methods:

A cross-sectional survey was conducted among 224 (1st year, 2nd year, and 3rd year PGs) dental students of a private dental college in Kanpur city with a prevalidated structured questionnaire on the research principles was developed, and the students were asked to fill the questionnaire.

Results:

In the present study, 73% of the PGs did not know the definition of the research hypothesis. Ninety-two percent of PGs do not know the significance of scale 0–5 in researches, and 75% of PGs were unaware of the value of taking approval for conducting a research study. These results were statistically significant (P < 0.05). PGs have not participated in any research projects during their under-graduation or internship (93%) nor have written any scientific publication (94%), and the results obtained were statistically significant. The lack of time due to the vast curriculum of PG students (55%) and lack of interest (52%) were the personal reasons, whereas inadequate financial support (47%) and lack of time (49%) were among the institutional reasons for not conducting the research.

Conclusions:

A positive attitude but with a deficient level of knowledge and interest in context to research was found among PG dental students. Various factors such as vast PG syllabus, lack of time, deficient financial support, and lack of proper seemed to be the barriers in pursuing research.
Photostress Recovery Time Among Welders in Owerri Municipal Council, Southeast, Nigeria
Authors: Akujobi Augustine U. , Uzomah Gift O. , Ike Oforbuike O. , Ekenze John C. , Obioma-Elemba Jacqueline E. , Akogu Okechukwu A.
Published: June 2021

Purpose: The photostress recovery time (PSRT) scores of welders were measured based on age, workexperience and welding-method.Methods: A quasi-experimental study was conducted among 50 purposively sampled welders, who had clear ocular media, healthy fundi and visual acuities of 6/6 or better in the tested eyes. The pre-bleach distant visual acuity of the right eye was determined with the Snellen’s visual acuity chart, while direct ophthalmoscopy was done to rule out media opacities, retinopathies and maculopathies. The  right eye was dazzled for 10 seconds with the light of a direct ophthalmoscope held at 2cm from the eye. The time required in seconds to read at least, three optotypes on the line directly above the baseline acuity was recorded as the PSRT.Results: The 22-31 years age group recorded the least mean PSRT (16±8.8seconds), followed by the 32-41 age group (19.9±6.8 seconds), while the 42-51 years category had the highest mean PSRT (31.4±10.5seconds). Age associated significantly (p˂0.05) with mean PSRT. Welders within the 1-12 years’ work experience had the least mean PSRT (15.9±8.1seconds) while those within the 25-36 years recorded the highest mean PSRT (33.4±9.3seconds). The observed difference in mean PSRT with years of work experience was statistically significant (p˂0.05). Gas welders had significantly (p˂0.05) higher mean PSRT (26.6±9.9secs) than electric arc welders (16.6±9.2secs).Conclusion: Gas welding, increasing age and work-experience were found to be predictive markers of elevated photostress recovery time (PSRT) among welders. This underscores the need for eye-care practitioners to routinize PSRT tests in the ocular assessment of welders.

Keywords: Photostress recovery time (PSRT); electric-arc; gas welding; welders; age.
Evaluating the Effect of Retinal Defocus (Blur) on Lateral Heterophoria
Authors: Atuanya George Nnamdi , Ero Osayimwen Osas , Akpalaba Raphael Uchenna Enyinnaya
Published: June 2021

Purpose: This study was conducted to ascertain the effect of retinal defocusing or retinal blur on lateral heterophoria at far and near.Methods: This was a quasi-experimental study involving 57 participants aged 5 to 35 years, who were selected based on the inclusion criteria of being myopes and emmetropes who had a normal general and ocular health. The Von Graefe technique was used for measuring phoria under standard testing conditions.Results: The mean baseline lateral phoria for emmetropes were 0.53 ± 1.14∆ exophoria and 2.47 ± 2.08∆ exophoria at far and near respectively, while after defocusing, it was 2.80 ± 0.88∆ exophoria and 4.34 ± 1.70∆ exophoria at far and near respectively. For myopes, the baseline lateral phoria was 1.52 ± 1.09∆ exophoria and 4.76 ± 1.13∆ exophoria at far and near respectively while after defocussing, it was 3.39 ± 0.92∆ exophoria at far and 7.60 ± 1.00∆ exophoria at near. The mean difference in lateral phoria was found to be significant at the 95% confidence level (P = 0.000). There was no statistically significant difference in lateral phoria change at far (P = 0.072), while the near phoria difference was significant (P = 0.002).Conclusion: Gas Retinal defocusing with +2.50D resulted in a shift towards exophoria at both far and near, with myopes experiencing more exophoric shift. This is because they are less sensitive to the presence of blur. This will enable practitioners to be cautious of the inhibition of accommodation due to higher exophoria at near when prescribing lenses.

Keywords: Retinal Defocus, Myopia, Emmetropia, Near lateral phoria, Distance lateral phoria.
Catching Ghosts and Consecrating the Forgotten: The Seen and Unseen in the Work of Diane Victor
Authors: Human Deléne
Published: June 2021

Since pre-history, humankind has relied on archetypes and myths to describe the ineffable and has made use of fictional and mythological narratives to understand the meaning of life and death. Dying and death are topics reluctantly discussed in open society. Yet, the global COVID-19 pandemic has drawn attention to the process of dying and death, and hence the survival of humankind. By embracing their finitude, humans attempt to create meaningful experiences in life and, therefore, attain “freedom towards death” (Heidegger, 1962: 311).

This paper investigates how South African artist Diane Victor uses universally known myths and symbols of Christian iconography within a South African context to create meaning, as well as how she uses medium and exhibition sites to evoke intense emotions within viewers urging them to consider their finitude. By recognising how fragile and vulnerable life is, the artist captures the ephemeral in a poignant way. In this paper, I argue that Victor embraces the challenge of consecrating the forgotten or lost. Through incorporating religious icons, signs, and symbols in her work, Victor ‘catches ghosts’ of the ‘seen’ and ‘unseen’ in, about, of and from South Africa. Her works are understood through a contemporary reading of religious (Christian) iconography and interpreted in the symbolic and fragile mediums of smoke, stain, ash, charcoal, light and shadow, emphasising the ephemerality and impermanence of the human condition.