bluuebunny/crossref_metadata_2025 huggingface dataset:
The Most Economical Option for Hydrogen Production with Nearshore Hydrogen Production Platform
Authors: Hwang J. , Youn Y. , Park S. , Nam J. , Byun Y. , Yu S. , Lee G. , Alekseev A. , Göke V. , Kim Y. , Lange K. , Kühner S. , Ilse K. , Jeon H.
Published: April 2024

Hydrogen production using renewable power is becoming an essential pillar for future sustainable energy sector development worldwide. However, this way to produce green hydrogen is much expensive than traditional generation of hydrogen from fossil fuel called as gray hydrogen, so we need to identify effective pathways to lower this cost. Costs are currently driven by the price of renewable electricity and CAPEX to make hydrogen such as electrolyzers, but these prices are falling with more research and commercialization.

Most of energy consumers who use fossil fuels turns to electricity user to reduce CO2 emission. The electricity will be produced from renewable source such as solar, wind power, hydro power, etc. However, some industries including shipping and aviation cannot use electricity directly, because of energy density of batteries. Therefore, the electricity should be stored in liquid fuel for the industries through green hydrogen to LH2, MeOH or ammonia.

This study proposes the new concept for near-shore green hydrogen production platform The configuration of the platform is as follows; power rectifier, water electrolysis system, water supply system, brine desalination system (if needed) and hydrogen storage system. This study reviews the current state of green hydrogen production, including the advantages and disadvantages of different technologies and evaluates the factors that influence the installation location of green hydrogen production platforms, such as the availability of renewable energy sources, the proximity of the site to potential customers, and the availability of infrastructure. It also examines the optimization of the topside process design for green hydrogen production platforms, including the selection of the most suitable process units, the optimization of their design parameters, and the selection of the most suitable control strategies.

To develop this project, we have conducted research in collaboration with international specialized organizations from various fields. Firstly, for the topside process, we partnered with ITM Power, a specialist in electrolysis, and Linde, an expert in liquefied gases. HD KSOE participated in the design of the floating platform and the liquefied hydrogen CHS system. Economic Evaluation was handled by KENTECH and Fraunhofer. Lastly, in the field of rules and regulations, ABS (American Bureau of Shipping) was involved in the project.
Well Integrity Management Based on New Operating Limits - A New Method for Extending the Well Lifespan and Changes in Operating Conditions
Authors: Moreira Nelson , Lazaro André F. , Minucci F. R. , Aranha Pedro E. , Weidlich Marcos C. , Fernandes Fernando B. , Nardi Luiz F. B. , Radespiel Eduardo S. , Okama Charlton O. , Palmieri I. , dos Santos C. M. , Terra Felipe S.
Published: April 2024

This paper proposes to explore the application of new operational limits for wells under a life extension in mature fields and wells subjected to changes in production parameters caused by several factors. In this context, physical tests, and finite element analysis (FEA) were performed for a better understanding of its new engineering limits.

The establishment of new operational limits was based on a meticulous study of loadings, considering their frequencies of occurrence and magnitudes. Additionally, a comprehensive evaluation of the casing and packoff strengths was conducted from a limit state design perspective. The integration of these factors resulted in the determination of the design limit.

The design limit allowed for the definition of a supplementary region to the operational envelope, resulting in a significant reduction of false alarms and incident reports to the Brazilian regulatory agency.

Furthermore, to ensure the accurate implementation of the new design limit, a corrosion analysis of the production casing was conducted using computational fluid dynamics (CFD). This analysis aimed to evaluate the potential consequences of tubing failure on the remaining wall thickness of the production casing. The analysis has demonstrated that in certain situations, it is crucial to ensure the tubing string remains intact to prevent the corrosion from compromising the strength of the production casing.

The new implemented limits (Operational Envelope and Design Limit) were established within an integrity management system that aims to provide advanced real-time production data analysis, resulting in the continuous generation of well safety factors. Following the establishment of these concepts, a case study was conducted, demonstrating a significant reduction in the number of reports submitted to the Brazilian regulatory agency due to the definition of the design limit in addition to the operational envelope.
Beyond Design Criteria – Evaluating Mooring Design Integrity and Establishing Threshold Limits for Offshore Floating Structures Post-Tropical Storm PABUK
Authors: Tong W. J. , Hashim M. H. , Rahman A. R. , Mahasan S. , Taib H. , Rahman A. , Shahib N. S. , Abdullah M. N.
Published: April 2024

This technical paper assesses the mooring integrity of a floating structure unit in offshore Peninsular Malaysia post-Tropical Storm PABUK. The study focuses on a Floating Storage and Offloading (FSO) unit, experiencing significant forces during the storm, which recorded the highest wave height and wind speed in the region. Using industry software, the paper reviews design criteria for station-keeping analysis under intact and damage conditions during the 100-year return period. Initial analysis reveals criteria were below recent data recorded for PABUK. Sensitivity analysis studies incrementally increased environmental load cases in all directions of attacking waves and winds. Mooring line strength capacity was evaluated against Abnormal (ALS) criteria, considering survival from significant wave heights of 5m to 9m, equivalent to over a 10,000-year return period. Results indicate mooring lines could perform above design values, surviving the storm without failure. The study establishes a threshold capacity for surviving future storm events and introduces a corresponding integrity alert level for the floating structure unit. The paper highlights the novelty of determining the threshold limit for a floating structure unit, enabling data-driven decision-making for operators. Successful mitigation during the storm is attributed to a measurement system providing real-time storm characteristics for emergency response. The paper explores the historical context of tropical storms in the South China Sea, focusing on Tropical Storm PABUK's impact on PETRONAS operational waters. It discusses the development stages of tropical storms, their geographical distribution, and analyzes real-time metocean observations during PABUK's passage. The study emphasizes the importance of weather warnings, forecast accuracy, and risk assessments for enhancing preparedness in the face of tropical storms. The methodology and analysis section details mooring analysis using OrcaFlex software, considering Response Amplitude Operators (RAO) and conducting a time-domain approach. The study evaluates mooring chain tensions, rolling behavior, and excursion offsets, providing a holistic understanding of the challenges posed by tropical storms. In conclusion, the paper contributes valuable insights to offshore engineering, risk management, and weather forecasting. Recommendations include enhanced forecasting, reevaluating offshore structure resilience, continued monitoring, adaptive design strategies, and collaborative research initiatives. The findings aim to inform industries operating in tropical storm-prone regions, fostering resilience, safety, and sustainability.
Corrosion Inhibition for Sour Offshore Oil and Gas Production Facilities
Authors: Ma Zheng , de Itriago Yani C. Araujo
Published: April 2024

Corrosion is one of the major problems in offshore infrastructure due its exposure to the harsh marine environment characterized for high salinity water, non-stable weather conditions, long exposure to ultraviolet sunlight, presence of bacteria, dissolved oxygen, and carbon dioxide in seawater, etc., that is why the oil and gas industry is constantly looking for preventive and corrective solutions to extend the service life of the facilities and improve safety operation. Most common approaches to prevent corrosion in offshore infrastructure include the use of highly corrosion resistant material and the use of anticorrosive coatings. Inhibitors are also widely used as part of the injection fluids to eliminate the corrosion of infrastructure induced by its interactions with reservoir fluids and chemicals commonly appeared in offshore production.

Two of the most critical types of corrosion in oil and gas upstream are sweet corrosion that is caused by CO2 and sour corrosion that is induced by H2S. For both, most of the research is focused on their corrosion mechanisms, corrosion products, corrosion behavior modeling, and inhibitor performance. A great research effort has been directed toward CO2 corrosion, yet H2S related study is on the rise.

In this study we put together a laboratory workflow to evaluate the potential of corrosion in offshore infrastructure to reduce the risks associated to the presence of corrosion. The proposed workflow is focused on the evaluation and optimization of the selection of the inhibitors for H2S related environments.

The study started with an in-depth literature review to know the state of the art in the topic. An analysis of the finding indicates that most of the inhibitor studies reported are associated to CO2 environment, so we focused the study on inhibitors for H2S systems including types of inhibitors, their pros vs cons, and testing methods to evaluate their performance. Finally, based on our experience a laboratory workflow is proposed to mitigate corrosion in the early stage of production. This work demonstrates the importance of selecting the right laboratory protocol according to the corrosion type to save time and resources making the laboratory evaluation more useful and reliable.
The Piling in Glauconitic Sands (PIGS) JIP: Reducing Geotechnical Uncertainty for U.S. Offshore Wind Development
Authors: Westgate Z. , Rahim A. , Senanayake A. , Pisanò F. , Maldonado C. , Ridgway-Hill A. , Perikleous Y. , De Sordi J. , Roux A. , Andrews E. , Ghasemi P.
Published: April 2024

This paper presents insights from the Piling in Glauconitic Sand (PIGS) Joint Industry Project (JIP). Established in 2021, the JIP investigates geotechnical behavior of glauconite sands in relation to pile installation and long-term performance as relevant to offshore wind energy development along the U.S. Atlantic Outer Continental Shelf (OCS). The JIP comprises five energy developers and is led by the Norwegian Geotechnical Institute. The scope of work comprises (i) characterization of an onshore glauconite test site in New Jersey and glauconite/glauconitic sands from offshore lease areas, (ii) steel pipe piles driven using hydraulic and vibratory hammers, (iii) and axial tension, axial compression and lateral pile load testing. Novel site investigation methods include the effect of friction reducer geometry on cone penetration testing (CPT) resistance, cyclic CPT including water injection, and sampling of degraded glauconite sand from pile walls. The detailed instrumentation program included accelerometers and strain gauges during driving, grout-embedded sister bar strain gauges during axial compression and tension load testing, and fiber Bragg grating optical sensor measurement during axial compression and lateral load testing. In this paper, we present analysis of the CPT data and pile installation data including soil resistance to driving (SRD) and pile-soil setup during redrives/restrikes, and describe novel in situ sampling and testing of degraded glauconite sand. Degradation experienced by the glauconite sands during pile installation is consistent with observations from other regions including Belgium and is compared to artificial degradation performed in a laboratory setting. The JIP is the first comprehensive field and laboratory test program investigating glauconite sand behavior in the U.S. The data being collected is providing offshore wind developers an opportunity to reduce uncertainty and risk in pile installation and long-term performance, and gain insights into glauconite sand variability and geotechnical behavior across the U.S. Atlantic OCS to aid in future lease area development.
Stability Analysis of Submarine Hydrate-Bearing Slope During Depressurization Production
Authors: Wen Zhiliang , Yang Jin , Sun Ting , Wang Lincong , Ren Laiao , Jia Shu , Xue Rui
Published: April 2024

South China Sea hydrate reservoirs, mostly weakly cemented silty sandstones, are prone to landslides during extraction. Prior studies have inadequately considered factors such as dynamic decomposition of hydrates during depressurization, and the impacts on the reservoir's geomechanical properties. In this paper, a coupled thermal-hydraulic-mechanical-chemical mathematical model of hydrate decomposition is proposed, and the dynamic geomechanical response and the effect of hydrate decomposition on seafloor settlement and slope destabilization in the process of depressurization mining are analyzed by combining the strength discount method. The results show that hydrate decomposition is non-uniform due to stratigraphic temperature gradients and gravity. In hydrate depressurization zones, a decrease in pore pressure leads to increased effective stress. Simultaneously, hydrate decomposition reduces the shear modulus of sediments, causing deformation and decreased permeability in the decomposition area. During three years of depressurization mining, the stability coefficient of hydrate-bearing slopes decreased from 1.66 to 1.41, and the maximum settlement increased to 0.864 meters, raising landslide risks. The research results have significant guiding implications for the safe exploitation of hydrate-bearing slopes.
Baby Bonds: Saving for America’s Future
Authors: Glavan Sean
Published: April 2024

Child Development Accounts are government-established and maintained savings accounts for children born to qualifying, generally low-income, families. Often seeded with a cash grant from the government, the savings account can be accessed when the child turns 18 for specific purposes such as financing education, buying a house, or opening a business. While Child Development Account policies have been implemented by some local and state governments, the American Opportunity Accounts Act (AOAA) proposes to establish a Child Development Account for all American children at birth. The sponsors of the AOAA believe that the legislation will reduce income inequality and reduce the racial wealth gap in the United States. An economic analysis of the AOAA predicts that the proposed legislation would incentivize middle-income families to have more children than they otherwise would while also reducing the private saving levels of middle-income families for future child-related expenses. Similar effects are not expected in low- and high-income families. Finally, the results of the analysis demonstrate that if policymakers wish to achieve the maximum possible reduction in the income and racial wealth gap, then AOAA benefits should be limited solely to low-income families.
Federal Minimum Wage and Poverty Alleviation
Authors: Arab Maryam
Published: April 2024

In 2022, 37.9 million people in the United States lived in poverty creating a poverty rate of 11.5 percent (US Census Bureau 2024). There are many efforts across the country to decrease poverty, one of them being increasing the minimum wage to $15 an hour. This paper examines the history of the minimum wage in the United States, its erosion over the years, and its impact on poverty alleviation. Ultimately, increasing the minimum wage to $15 an hour will not decrease poverty in the United States due to average wage rates and insufficient targeting efforts. Reference: US Census Bureau. 2024. “National Poverty in America Awareness Month: January 2024.” Census.gov, January 4, 2024. https://www.census.gov/newsroom/stories/poverty-awareness-month.html.
IS IT POSSIBLE TO PREDICT TUMOR PROGRESSION THROUGH GENOMIC CHARACTERIZATION OF MONOCLONAL GAMMOPATHY AND SMOLDERING MULTIPLE MYELOMA?
Authors: Testa Ugo , Leone Giuseppe , Pelosi Elvira , Castelli Germana , De Stefano Valerio
Published: April 2024

The study of monoclonal serum proteins has led to the generation of two major theories: one proposing that individuals who had monoclonal proteins without any symptoms or evidence of end-organ damage have a benign condition; the other one suggesting that some individuals with asymptomatic monoclonal proteins may progress to multiple myeloma and thus are affected by a monoclonal gammopathy of undetermined significance (MGUS). Longitudinal studies of subjects with MGUS have supported the second theory. Subsequent studies have characterized and defined the existence of another precursor of multiple myeloma, smoldering multiple myeloma (SMM), intermediate between MGUS and multiple myeloma. Primary molecular events, chromosome translocations, and chromosome number alterations resulting in hyperploidy, required for multiple myeloma development, are already observed in myeloma precursors. MGUS and SMM are heterogeneous conditions with the presence of tumors with distinct pathogenic phenotypes and clinical outcomes. The identification of MGUS and SMM patients with a molecularly defined high risk of progression to MM offers the unique opportunity of early intervention with a therapeutic approach on a low tumor burden.
CAR-T CELLS IN CHRONIC LYMPHOCYTIC LEUKEMIA
Authors: Testa Ugo , Pelosi Elvira , Castelli Germana , Fresa Alberto , Laurenti Luca
Published: April 2024

The treatment outcomes of patients with chronic lymphocytic leukemia (CLL) have considerably improved with the introduction of targeted therapies based on Bruton kinase inhibitors (BTKIs), venetoclax, and anti-CD20 monoclonal antibodies. However, despite these consistent improvements, patients who become resistant to these agents have poor outcomes and need new and more productive therapeutic strategies.
Among these new treatments, a potentially curative approach consists of the use of chimeric antigen receptor T (CAR-T) cell therapy, which achieved remarkable success in various B-cell malignancies, including B-cell Non-Hodgkin Lymphomas (NHLs) and B-acute lymphoblastic Leukemia (ALL). However, although CAR-T cells were initially used for the treatment of CLL, their efficacy in CLL patients was lower than in other B-cell malignancies. This review analyses the possible mechanisms of these failures. It highlights some recent developments that could offer the perspective of the incorporation of CAR-T cells in treatment protocols for relapsed/refractory CLL patients.
Keywords: Chronic Lymphoid Leukemia; CLL; CAR-T Cells; Relapsed/resistant CLL:
Changes in parents’ health concerns by post-preterm birth period in South Korea: a cross-sectional study
Authors: Jung Yu Jin , Cho Hun Ha
Published: April 2024

Purpose: This study aimed to examine the health concerns of parents regarding their premature infants and to identify changes in these concerns during perinatal period and after discharge.Methods: This was a retrospective study performed at a single tertiary center that enrolled 119 premature infants who were discharged from the neonatal intensive care unit (NICU) and visited the outpatient pediatrics department between December 2018 and October 2021. Data on the concerns of 176 parents regarding enrolled premature infants’ health from before birth to 1 week after NICU discharge were obtained from outpatient records. The t test and with the chi-squared test were used to analyze the data for this study.Results: The consistently greatest focus of parents' health concerns was the respiratory system. The second focus of parents' health concerns before discharge was the central nervous system. However, during the first week after NICU discharge, the gastrointestinal system was the second-most frequent focus of parents’ health concerns among parents of infants without diseases related to prematurity and infants with older gestational ages. Conclusion: The results of this study offer insights into the health concerns among parents of premature infants. Parental health concerns about premature infants vary over time, from before birth to post-discharge, necessitating supportive interventions to enhance parental understanding of their child's health status.
The role played by women in the Uitlander refugee crisis, 1899-1902: A case study of the East London humanitarian effort
Authors: Tankard Keith
Published: April 2024

No abstract available.
The Making of a Town
Authors: Van Eeden Elize S.
Published: April 2024

No abstract available.
Incipient Local Economic Development in the Eastern Cape, 1909-1947
Authors: Nel E. , Rogerson C.M.
Published: April 2024

No abstract available.
“A marionette in the hands of masterful men” the sage murder of 1893
Authors: Vernon Gillian
Published: April 2024

No abstract available.
Whose story is it? The construction and presentation of history
Authors: Allsup-Shangwaukoonz Carl
Published: April 2024

Historie, of dan die storie van menslike gebeure, is 'n universele menslike aktiwiteit. Wat is die basisbeginsels waarop hierdie narratief vertel word, die hoek van die vertelling, die perspektief? Wie se storie is historie? Daar word allerweë aanvaar dat twee van die vaste beginsels van die dissipline Geskiedenis objektiwiteit en kritiese beoordeling is. In hierdie artikel wil ek probeer aantoon dat die twee beginsels in 'n groot mate 'n denkparadigma van kolonialisering veronderstel. Sodanige aanvaarding van 'n oorsigtelike en universele waarheid is niks anders nie as 'n selfgeïmponeerde, ondemokratiese vooropstelling. Ek verduidelik my teoretiese lese van hierdie denkparadigma en metodologie aan die hand van 'n spesifieke voorbeeld en die proses waarin en -deur dit manifesteer. Ek kies 'n baie spesifieke gedeelte van die VSA geskiedenis, vanaf 1865-1890, die "Iaaste" van die sogenaamde Indiaanoorloë in die VSA en die nederlaag van die laaste Negeramerikaanse groep wat onafhanklik van Europese dominasie was.
Use of Badges as Achievements to Enhance Online Learning
Authors: Raj B. V. Swaroop , Divya C.
Published: April 2024

Background and Aim:

Digital badges are electronic symbols used as microcredentials to document achievement or skills mastered such as course completion, professional development participation, or training completion. The use of digital badges is trending upward in higher education. This study was undertaken for digital badge creation and implementation and investigated the effects of a digital badge system, on three aspects of undergraduate learners: levels of intrinsic motivation, participation in online learning, and general attitudes toward digital badges. This study aimed to implement digital badges for online learning by medical undergraduates and evaluate student perception regarding digital badges.

Materials and Methods:

A study was conducted on 150 students of 1st MBBS 2020–2021 batch. WordPress platform was used to design website with additional plugins for registration, discussion forum, and achievement badges. Students were sensitized to digital badge system. Students gained points for posting replies to online discussion, viewing content and clarifying doubts, answering quizzes, and online submission of assignments. Using the points scored, a scale was designed for awarding badges. Student feedback on Likert scale and perception regarding satisfaction, and motivation toward academics by digital badges were collected and analyzed.

Results:

Participants had positive perceptions of the badges, finding them authentic and innovative. The respondents agreed that digital badges helped to set goals and motivated to achieve these goals. Most students who earned digital badges agreed that badges helped increase their confidence in course material (78%), focus on specific learning objectives (65%), look deeper into course competencies (71%), and motivated to attend online classes regularly (83%).

Conclusion:

The digital badges were positively received by students who commented favorably about digital badges in their learning. Digital badges were perceived by students as a positive adjunct to learning and may provide a novel mechanism to enhance online learning.
Training 1st-Year Medical Undergraduates in Doctor–Patient Relationships Using Gagne’s Model of Instructional Design
Authors: Shrivastava Saurabh RamBihariLal , Shrivastava Prateek Saurabh
Published: April 2024

The doctor–patient relationship is an extremely important and indispensable aspect of health-care delivery. Instructional design refers to a structured strategy that a teacher adopts to develop and deliver any educational program or a specific topic in a streamlined manner. Gagne’s model of instructional design has been employed to deliver a wide range of skills in different settings. The topic of the doctor–patient relationship can be explained to the 1st-year undergraduate medical students as a part of the attitude, ethics, and communication module training. The proposed time for the session is 1 h, and we intend to employ a wide range of teaching–learning methods (namely flipped classroom; interactive discussion using case vignettes; employment of movies depicting a doctor–patient relationship; and role play, use of pear deck) to promote interaction and active engagement, and reflective writing. To summarize, the doctor–patient relationship is an integral part of health-care delivery and we must train students in this regard. Gagne’s model of instructional design provides both teachers and students an opportunity to learn the knowledge in a comprehensive and student-centered manner.
Anatomical Considerations of Costal Abnormalities with its Clinical Significance
Authors: Jazeela B. F. , Jacob Meera , Shetty Ashwini
Published: April 2024

Synostosis is an immobile joint created by the ossification of two bones. About 0.3% of ribs have synostosis, an unexpected radiographic finding. The present study aims to detail every instance of rib synostosis and provide an overview of its evolutionary, morphological, and clinical significance for anatomists, radiologists, and surgeons. Four hundred dry specimens of adult ribs of anonymous sex and origin in the Yenepoya Medical College, Department of Anatomy’s osteological collections, were subject to the current investigation. In addition to one forked and bridged rib and two occurrences of costovertebral synostosis, we discovered five examples of manubriocostal synostosis. All synostotic bones underwent morphological analysis, and measurements were taken using vernier calipers. There is limited research on rib abnormalities in clinical medicine. Clinicians and radiologists must be conversant with how these variances look on imaging. These anomalies highlight the early organogenesis changes that may be associated with stillbirths, cancer, and other defects.
Comparison of Prevalence of blaNDM-1 Gene among Metallo-Beta Lactamase-Producing Multidrug-Resistant Fermenters and Nonfermenters in a Tertiary Care Hospital
Authors: Kataria Shaveta , Galhotra Shipra , Kumar Mohit , Thandi Priyanka , Jindal Neerja
Published: April 2024

Background and Aim:

Metallo-beta-lactamases (MBLs) which open β-lactam ring with help of metal cofactor degrade all the classes of β-lactams except monobactams and are notable for their constant and efﬁcient carbapenemase activity. New Delhi Metallo-beta-lactamase (NDM) is type of carbapenemase which is able to inactivate all β-lactams except aztreonam. Combined disk synergy test (CDST) and polymerase chain reaction (PCR) analysis are used for the detection of MBL production.

Materials and Methods:

All clinical specimens received in the microbiology department for culture and sensitivity from indoor patients were included in study. Brief history and related data of the patients was being recorded. The direct Gram staining and samples were inoculated on culture media and incubated at 37°C for 18–24 h. Biochemical reactions were performed and the antibiotic susceptibility test was performed by Kirby–Bauer Disk-Diffusion method and VITEK 2. All the multidrug-resistant (MDR) Gram-negative bacteria (GNB) which were carbapenem resistant subjected to CDST and Genotypic detection of NDM-1 by PCR was done. The association between categorical variables was explored using the Pearson’s Chi-square test.

Results:

The present study was conducted on 260 GNB isolated from 5307 specimens, 164 were MDR, 68 were carbapenem resistant, and 48 were found to be MBLs (19 were fermenters; 29 were nonfermenters). Thirty-six blaNDM-1 gene was isolated from both MDR fermenters and nonfermenters. The positivity of CDST in detecting blaNDM-1 positive MBLs taking PCR as the gold standard was 75%.

Conclusion:

NDM-1 carrying isolates disseminate quickly even among the organisms of different genera, their presence in high proportion could further threaten the public health and put an end to our current pharmacopoeia.
Stress and insomnia – A vicious circle
Authors: Dube Shruti , Babar Anuradha
Published: April 2024

Insomnia is experiencing unsatisfactory sleep, typically characterised by difficulties initiating or maintaining sleep. Individuals with insomnia are dissatisfied with their sleep quality and perceive it as hindering their ability to perform well in work, school and social settings. The common symptoms of insomnia include fatigue, decreased mood, irritability, general discomfort and cognitive difficulties. On the other hand, stress results from emotional or physical tension triggered by various events that can make a person feel frustrated, angry or anxious. Stress is the body’s response to a challenge or demand, accompanied by the release of hormones. The specific physiological response to stress depends on factors such as the type of stress, the individual’s characteristics, their neuroendocrine system and the combination of these elements, collectively determining how the brain and body react to a particular stressor. The activation of the hypothalamic–pituitary–adrenal axis is a response mechanism triggered by stress. Disturbed sleep, particularly insomnia, is a common side effect of stress, varying in intensity. Sleep plays a crucial role in maintaining both physical and mental well-being, making the physiological connections between sleep and stress vital in understanding the development of stress-induced pathophysiology. Current treatments for insomnia include cognitive behavioural therapy, improving sleep hygiene and employing psychological and pharmacological interventions. However, these approaches aim to improve insomnia symptoms rather than address its underlying cause. In the context of homoeopathy, the concept of constitution refers to an individual’s unique structure, composition, nature and physical makeup, influenced by both inherited qualities and environmental factors. Therefore, it is essential to individualise each case and administer a simillimum remedy, the remedy most likely to restore health, and achieve complete healing according to homoeopathic principles. This review explores the physiological and neuroendocrine changes that occur due to the interplay between stress and the development of insomnia.
A common tumour at an uncommon location: Lesser trochanter osteochondroma
Authors: Nandan Brajesh , Dhawan Manish , Saraf Aman , Yogesh V.
Published: April 2024

Osteochondromas are benign osteocartilaginous tumours, which are developmental abnormalities rather than actual neoplasms. The lesser trochanter is an extremely rare location for a solitary osteochondroma, and depending on the tumour’s size, the patient can exhibit various symptoms, including a limited range of motion. This case study describes a rare instance of a benign solitary osteochondroma of the lesser trochanter identified and managed using an excisional biopsy following Ludloff’s approach. With intraoperative fluoroscopy, we could accurately outline and remove the entire tumour mass without endangering the nearby essential tissues.
Association between Uterine Adenomyosis and Infertility: Role of Axonemal Alteration in Apical Endometria
Authors: Khan Khaleque N.
Published: April 2024

Uterine adenomyosis is an estrogen-dependent chronic inflammatory condition and may cause painful symptoms, abnormal uterine bleeding, and/or subfertility/infertility. It is characterized by the presence of endometrial glands and stroma within the myometrium causing enlargement of the uterus as a result of reactive hyperplastic and/or hypertrophic change of the surrounding myometrium. Similar to endometriosis, adenomyosis has a negative impact on female fertility. Abnormal uterotubal sperm transport, tissue inflammation, and the toxic effect of chemical mediators have been proposed as contributing factors. Inflammation-induced damage of the mucosal cilia in the fallopian tube has been reported. Besides other proposed mechanisms, our most recent study with transmission electron microscopy analysis indicated that microvilli damage and an axonemal alteration in the apical endometria occur in response to endometrial inflammation. This may be involved in the negative fertility outcome in women with adenomyosis. We present a critical analysis of the literature data concerning the mechanistic basis of infertility in women with adenomyosis and its impact on fertility outcome.
Generation of South Indian Data for Normal Clitoral Dimensions and Anogenital Ratio in Term Neonates
Authors: Priyadarshini K , Padankatti Swathi , Mahadevan Shriraam
Published: April 2024

Introduction:

Assessment of genitalia is an important part of the neonatal examination. Regional, racial, and ethnic variations in phallic length have been documented. Clitoral dimensions may also show similar variations. Normal values for neonatal clitoral measurements may help the pediatrician/neonatologist to accurately diagnose clitoromegaly and underlying etiology to guide appropriate investigations. Data on clitoral measurements is limited with only one study from India (Kolkata). Hence we aimed in this study to generate south Indian data on neonatal clitoral dimensions, anogenital distance, and anogenital ratio. Two hundred and fifty two hemodynamically stable term female neonates without ambiguous genitalia/vulval masses born in a community hospital. Hospital-based cross-sectional study. 1. To measure clitoral dimensions, anogenital distance, and anogenital ratio in female neonates. 2. To correlate clitoral dimensions, anogenital distance, and ratio with anthropometric measurements, gestational age, and maternal comorbidities.

Methods:

Measurements were recorded using a digital vernier caliper, under strict aseptic precautions with labia majora gently separated and the baby held in a frog-leg position. Clitoral length, width, and anogenital distance were measured and anogenital ratio and clitoral index were calculated.

Results:

In term neonates, the mean ± SD of clitoral length (CL), clitoral width (CW), anogenital ratio (AGR) were 6.34 ± 1.75 mm, 6.39 ± 1.27 mm and 0.39 ± 0.05, respectively. The 3rd and 97th centiles for mean clitoral length were 3.55 and 9.93 mm, for mean clitoral width were 3.37 and 8.35 mm, and for AGR were 0.28 and 0.48, respectively. These clitoral dimensions in south Indian neonates were higher than those from East India (Kolkata), lower than Nigerian babies, and similar to Israeli neonates. Mean CL and CW had no statistical correlation with birth weight, gestational age, head circumference, or length in term neonates. A significant correlation was noted between pregnancy-induced hypertension and mean clitoral width, and between gestational diabetes and AGR.

Conclusion:

Normative values for clitoral dimensions (length and width) and AGR for south Indian term female neonates have been established. 97th centiles of 9.93 mm (CL) and 8.35 mm (CW) and 0.48 mm (AGR) may be used as practical cut-offs to diagnose clitoromegaly and virilization. Clitoral measurements had no statistical correlation with birth weight, gestational age, or anthropometry. Clitoral measurements exhibit ethnic and racial differences, thus emphasizing the importance of regional cut-offs and need for more studies from different parts of India on CL.
Congenital Adrenal Hyperplasia – A Comprehensive Review of Genetic Studies on 21-Hydroxylase Deficiency from India
Authors: Ravichandran Lavanya , Asha Hesarghatta S. , Mathai Sarah , Thomas Nihal , Chapla Aaron
Published: April 2024

Congenital adrenal hyperplasia (CAH) comprises a heterogeneous group of autosomal recessive disorders impairing adrenal steroidogenesis. Most cases are caused by mutations in theCYP21A2gene resulting in 21-hydroxylase (21-OH) deficiency (21-OHD). The genetics of 21-OH CAH is complexed by a highly homologous pseudogeneCYP21A1Pimposing several limitations in the molecular analysis. Therefore, genetic testing is still not a part of routine CAH diagnosis and is mainly dependent on 17-hydroxy progesterone (OHP) measurements. There are very few reports ofCYP21A2gene analysis from India and there is no comprehensive review available on genetic testing and the spectrum ofCYP21A2mutations from the country. This review focuses on the molecular aspects of 21-OHD and the genetic studies onCYP21A2gene reported from India. The results of these studies insist the compelling need for large-scaleCYP21A2genetic testing and newborn screening (NBS) in India. With a high disease prevalence and consanguinity rates, robust and cost-effective genetic testing for 21-OH CAH would enable an accurate diagnosis in routine clinical practice. Whereas establishing affordable genotyping assays even in secondary care or resource-poor settings of the country can identify 90% of the mutations that are pseudogene derived, initiatives on reference laboratories for CAH across the nation with comprehensive genetic testing facilities will be beneficial in those requiring extended analysis ofCYP21A2gene. Further to this, incorporating genetic testing in NBS and carrier screening programmes will enable early diagnosis, better risk assessment and community-based management.
A Systematic Review on Prevalence of Overweight and Obesity among School Children and Adolescents in Indian Population
Authors: Sharma Nidhi , Sanjeevi Ramya Ramasamy , Balasubramanian Karthick , Chahal Aksh , Sharma Abhishek , Sidiq Mohammad
Published: April 2024

Obesity has erupted as an epidemic around the world. It has set itself as a fast wave among other prevailing specific clusters of non-communicable diseases. The current study reviews and presents an updated meaningful review of the vast research work performed at schools located in different cities of India. A systematic search was conducted in PubMed, Scopus, Google Scholar and PEDro. Studies representing data on obesity and overweight among children in Indian cities were included in the review. A total of 21 articles with 71,466 participants were included in the review for analysis. Obesity developed in childhood and adolescence is greatly associated with heart disease, stroke and cancer (breast and ovarian in women and prostate in men) in the late stage of life. In India, despite being a country with a faster rate of population becoming overweight and obese in urban areas, in contrast, rural areas are still struggling with malnutrition.
Use of a novel four-point iris fixated IOL to manage aphakia and to prevent angle closure glaucoma after therapeutic penetrating keratoplasty
Authors: Singh Kiranjit , Mahajan Gaurav , Prasher Pawan , Herekar Sujay , Singh Sukarma , Singh Kunwar Kiranjit , Kaur Harmit
Published: April 2024

Glaucoma after penetrating keratoplasty (PKP) is a well-known complication that may be associated with significant visual morbidity and graft failure. Herein, we report the successful use of a novel four-point iris-fixated intraocular lens (IOL) in two patients who presented with aphakia and uncontrolled glaucoma secondary to synechial angle closure after therapeutic PKP. Having an IOL device that corrects aphakia, as well as mechanically opens the angle by keeping the peripheral iris away from the cornea, can be another valuable alternative in the armamentarium of surgeons managing the twin problems of aphakia and angle-closure glaucoma.
Atypical manifestation of orbital dermoid: A case study
Authors: Jain Vivek K , Durairaj Rajakannan , Aggarwal Priyanka , Bhalla Saurabh
Published: April 2024

Dermoids are choristomas, which originate from aberrant primordial tissue and are often evident soon after birth. They can be found anywhere in the body, but are seen near the bony suture line. They are categorized into superficial and deep. Superficial orbital dermoids usually occur in the area of the lateral brow adjacent to the frontozygomatic suture. Infrequently, a dermoid may be encountered in the medial canthal area, which is the second most common site of orbital dermoid. We report this case of orbital dermoid in an adult male on the upper lid presenting with unilateral mechanical ptosis of the left eye affecting vision.
Bilateral congenital microblepharon in a neonate and review of literature
Authors: Venugopal Anitha , Ravindran Meenakshi , Patwardhan Veena
Published: April 2024

Microblepharon is a congenital condition characterized by severe vertical shortening of the upper and lower lid length. It is associated with lagophthalmos and exposure-related corneal complications like infections. It occurs either as an isolated condition or in association with multiple systemic abnormalities. The prognosis depends upon the severity of the defect and age at which the child is presented to an ophthalmologist. Further, this condition has to be differentiated from ablepharon, which needs immediate attention with surgical intervention. This case report emphasizes the need for early intervention in such case scenarios and provides a review of literature.
Pupil peaking/suture track bleed as a sign of suture extrusion into the anterior chamber in suture GATT
Authors: Rajamani Muralidhar , Chitra R
Published: April 2024

Suture GATT is a cost-effective option to treat glaucoma; however, there are limited means to track progress of the suture. We describe pupil peaking/suture track bleed during surgery as a sign of suture extrusion into the anterior chamber. This sign was noted when the surgeon removed the surgical goniolens. The suture was then retrieved through a goniotomy. It is important to withdraw the suture before attempting retrieval to avoid damage to the iris. Recognizing this sign in time can prevent damage to anterior segment structures.
Role of polymerase chain reaction from aqueous humor in a suspected case of ocular toxocariasis – A report of a case
Authors: Jadhav Sourabh , Eswaran Bhuvaneshwaran V , Raman M , Biswas Jyotirmay
Published: April 2024

An 8-year-old girl presented with unilateral panuveitis with a retinochoroidal lesion superior to disc with overlying vitritis. Laboratory workup was done, and a clinical diagnosis of toxoplasma retinochoroiditis was considered. Based on this initial diagnosis of toxoplasma retinochoroiditis empirically the patient was started on tablet clindamycin along with sulfamethoxazole and trimethoprim and oral steroids. On subsequent follow up, patient developed worsening of lesion. Intraocular fluid was collected from anterior chamber and sample revealed a positive polymerase chain reaction for toxocara canis. The diagnosis of ocular toxocariasis was made. This case highlights the use of aqueous fluid from polymerase chain reaction (PCR) to diagnose ocular toxocariasis.
A pilot image-based analysis of changes in pigment epithelial detachment composition in neovascular age-related macular degeneration
Authors: Singh Sumit Randhir , Shah Stavan V. , Ahmed Abrahim , Vannavong Jordyn , Sulharia Hamza , Fong Rodney , Romero Cecilia , Wadsworth Adam , Gahn Greggory , Khanani Arshad M. , Chhablani Jay
Published: April 2024

We report changes in pigment epithelial detachment composition indices (PEDCI), derived using an automated algorithm, in six eyes with neovascular age-related macular degeneration (nAMD) through 84 months. Changes in serous, neovascular, and fibrous components (PEDCI-S, N, and F, respectively) were compared. PEDCI-S reduced from 0.60 ± 0.21 (baseline) to 0.17 ± 0.20 (84 months; P = 0.03). PEDCI-N showed a significant increase from 0.30 ± 0.15 to 0.71 ± 0.21 (P = 0.01), whereas PEDCI-F changed minimally (0.10 ± 0.09 to 0.13 ± 0.11; P = 0.69) at 84 months. Overall, PEDCI-S showed a gradual reduction, whereas PEDCI-N increased relative to other constituents through 84 months. PEDCI-F, a surrogate marker of scarring, was not predictive of final visual acuity.
Endogenous Serratia marcescens endophthalmitis in an 11-year-old immunocompetent boy – A case report and review of literature
Authors: Ezhilan Rajashree , Sivakumar Rathinam , Parida Haemoglobin , Kumar Ramesh , Prajna S Lalitha
Published: April 2024

The authors report a rare case of successfully treated endogenous endophthalmitis in an 11-year-old healthy child who presented with a sudden decrease in vision associated with redness and pain in his left eye. There was no history of ocular trauma or recent hospitalization. The patient had acute severe panuveal inflammation with white hypopyon. Emergency pars plana vitrectomy with lensectomy was done and intravitreal antibiotics were administered. Vitreous biopsy grew Serratia marcescens on blood agar. The patient was treated with multiple intravenous, oral, and topical antibiotics based on VITEK 2 antibiotic susceptibility testing. Secondary intraocular lens implantation resulted in a best corrected visual acuity of 20/60.
Management of traumatic dislocated polymethyl methacrylate intraocular lens following globe rupture in a monocular patient: A case report
Authors: Saeed Safa , Dai Xi , Ali Muhammad , Wenick Adam , Woreta Fasika A
Published: April 2024

A 72-year-old monocular male with no light perception in the left eye and a history of cataract extraction with polymethyl methacrylate (PMMA) intraocular lens (IOL) implantation and retinal detachment repair with scleral buckling in the right eye presented after a forward fall and hitting his face with a large iris defect, irregular pupil, superior zone 2 globe rupture, dense vitreous hemorrhage, and a 1-piece PMMA IOL dislocated in the posterior chamber in the right eye. His visual acuity on presentation was hand motion with directionality, with no improvement on pinhole. PMMA IOLs are difficult to cut and require larger incisions for removal, which was difficult in our patient with open-globe rupture. His large iris defect and minimal capsular support ruled out other options such as the implantation of a new IOL. IOL repositioning with scleral suturing resulted in the successful salvation of his IOL and visual acuity.
More than “just a red eye”: A case series of Oestrus ovis ocular infestation
Authors: Agrawal Saumya , Joshi Hema
Published: April 2024

This case series intends to highlight clinical signs and symptoms of external ophthalmomyiasis caused by larvae of Oestrus ovis. Data were collected from January 2022 to January 2023 at a tertiary eye care center in central India regarding presenting features of patients with external ophthalmomyiasis. In total, 59 cases of established ophthalmomyiasis with a similar organism were recorded. An acute red eye can be caused by a wide spectrum of pathologies, some being as uncommon as a fly larva. Hence, it is important to perform a thorough ophthalmic examination in all patients presenting with inflamed red eyes of unknown cause.