bluuebunny/crossref_metadata_2025 huggingface dataset:
Study of Attitude and Knowledge toward Sexual Health among Postgraduate Medical Students
Authors: Sawant Neena S. , Singh Rashmi
Published: November 2023

Background:

The current medical curriculum for both undergraduates and postgraduates is deficient as it does not address the relevant aspects resulting in incomplete training and avoidance of asking about sexual health in routine clinical practice. This research studied the existing knowledge and comfort while taking sexual history, as well as managing the sex-related problems in patients by the medical postgraduates.

Methods:

Two hundred medical residents were recruited in the study after informed consent and ethics approval. Residents in I/II/III years in clinical and nonclinical disciplines were enrolled after systematic sampling. A semi-structured pro forma was used to collect information on knowledge, comfort, and training in sexual health with the help of open and closed-ended questions.

Results:

All knew about menstrual and reproductive health, 70% had knowledge about anatomy and sexual response cycle, 40% about sexual dysfunctions or its treatment. 76% expressed no adequate training was given and 96% felt that the lectures on sexual medicine were less useful. Ninety-one percent wanted training using videotapes, role plays, and group discussions. Sixty-eight percent were comfortable talking about sexual problems to patients of the same sex and 27% to the opposite sex. Ninety-eight percent gave the inability to maintain privacy and confidentiality while sexual history taking in both outpatient and indoor settings.

Conclusions:

Our study has highlighted some of the existing lacunae in the current Indian educational system with regard to sexual health, the existing knowledge and comfort of the postgraduates. More studies and research should be conducted to support the evidence. Curriculum changes with importance to sexual health and increased training can further be considered.
Nomophobia and Its Association with Stress and Coping Styles among Undergraduate Students of a Medical College in New Delhi: A Brief Analysis
Authors: Gupta Dimple , Bhardwaj Akansha , Prakash Rashmi , Jose Nimmi A. , Singh Farishta Hannah D.
Published: November 2023

Background:

Nomophobia or “No Mobile Phone” phobia is the fear of being detached from one’s own mobile phone. Smartphones have been proven to have numerous advantages in recent times. However, on their excessive use, it can have physical, psychological, behavioral, social, and affective effects. Since the younger generation are the latest buyers of the mobile phones, and the under-25-year age group in professional colleges like medical colleges use mobile phones quite frequently, this study was conducted to find out the prevalence of nomophobia and its association with the coping styles and the perceived stress in undergraduate medical students of a medical college in New Delhi.

Methodology:

The study was a cross-sectional study conducted for 3 months (November 2022–January 2023) on M. B. B. S students. A total of 200 students were selected by purposive sampling. The data was collected using questionnaires. Nomophobia was assessed through Nomophobia Questionnaire. Coping and stress were assessed using Brief Cope and Perceived stress scales, respectively. Data were collected and analyzed using Microsoft Excel 2010 and SPSS software Version 21 (Statistical Package for the Social Sciences, IBM Corp, USA).

Results:

The study was conducted on a total of 197 students undergraduate MBBS students. The prevalence of nomophobia was found to be 99.5% which was higher among females (56%) than males (44%). Among the students with mild (24%) and moderate nomophobia (60%), problem-focused coping mechanism was the most commonly used coping mechanism. Those with severe nomophobia (15%) were found to lean more toward emotion focused followed by problem-focused coping mechanism. A statistically significant association was found between nomophobia and perceived stress.

Conclusions:

Smartphones have many benefits when used for their intended purpose but when used in a problematic way and excessively, they can cause various problems. The higher prevalence of nomophobia among medical students is an issue of concern and has possibly affected their mental health. Strategies are to be devised on a priority basis for minimizing nomophobia among the medical students.
Polydactyly and Single Umbilical Artery
Authors: Rustogi Deepika
Published: November 2023

Background:

Beckwith–Wiedemann syndrome (BWS) is the most common genetic overgrowth syndrome characterized by the triad of macroglossia, macrosomia, and abdominal wall defects.

Clinical Description:

We report the case of a term baby girl who was born with mesoaxial polydactyly of her left foot. There were no significant antenatal events or exposure to teratogens, although a single umbilical artery (SUA) had been detected on antenatal ultrasonography. There was no evidence of in utero growth retardation. The birth weight was 3.3 kg and the perinatal transition was uneventful. The general physical and systemic examination was otherwise remarkable. Targeted search for concealed major anomalies was negative and the baby was discharged as nonsyndromic polydactyly, emphasizing the need for regular vigilant surveillance on follow-up. At 6 weeks, significant hypertrophy of the left lower limb was noted. This led the direction of evaluation toward lateralized overgrowth syndromes.

Management:

The application of the diagnostic algorithm prompted us to order first-tier genetic testing by methylation-specific multiplex ligation-dependent probe amplification assay. This identified aberrant DNA methylation in the chromosome 11p15 region, establishing the diagnosis of BWS. SUA and polydactyly have not been reported in combination in BWS earlier.

Conclusions:

Neonates with minor anomalies should always have a detailed physical examination at birth and be actively evaluated for major concealed anomalies. Since many clinical manifestations become apparent with age, it is vital that affected babies be kept under close surveillance. A rationale, individualized, step-wise approach with multidisciplinary teamwork helps in establishing the diagnosis in infants with dysmorphic features.
Cerebral Vasculitis in a Case of Henoch–Schönlein Purpura
Authors: Chaudhuri Indrasish Ray , Bhaskar Vikram , Aggarwal Anju , Sharma Sonal
Published: November 2023

Background:

Henoch–Schönlein purpura (HSP) is the most common vasculitis seen in children that rarely involve central nervous system (CNS) (0.65%–8%). Patients with CNS vasculitis may present with symptoms such as headache, seizures, focal neurological deficit, or behavior abnormalities. We describe a case of HSP where the patient presented with developmental delay along with skin rash and renal involvement.

Clinical Description:

A 15-month-old boy presented with a history of developmental delay and skin rashes for the past 2 months. There was no significant antenatal or birth history. At the age of 15 months, the child could not sit without support, could not transfer objects from one hand to other, could only speak bisyllables, and could not wave “bye-bye.” On examination, the patient had normal vitals with equal volume peripheral pulses and normal blood pressure in all four limbs. Urine examination showed microscopic hematuria, and kidney functions were mildly deranged. Skin biopsy showed immunoglobulin A vasculitis. Magnetic resonance imaging brain was done which revealed multifocal areas of altered signal intensity in periventricular deep white matter in bilateral frontal and parieto-occipital lobes, appearing hyperintense on T2-weighted and fluid-attenuated inversion recovery sequences, showing evidence of diffusion restriction, suggestive of areas of acute ischemia. The findings were consistent with manifestations of CNS vasculitis.

Management:

The patient was managed conservatively and advised physiotherapy and follow-up for developmental delay.

Conclusion:

HSP can rarely involve CNS, however, developmental delay in HSP has never been reported before.
Desaturation during Feeding in a Term Neonate Due to 20P Duplication Syndrome
Authors: Karthikeyan Kadirvel , Natarajan Chandra Kumar , Ramachandran Sumathisri
Published: November 2023

Background:

Feeding problems are common in preterm neonates of which desaturation during direct feeding is a known entity. However, term newborns have acceptable range of fall in saturation while feeding directly. Here, we report a term newborn with dysmorphic features had desaturation during feeding.

Clinical Description:

A male baby born to second-degree consanguineous parents at term who was managed for transient tachypnea of newborn had fall in saturation beyond acceptable range during feeding. He had low set ears, high-arched palate, thin upper lip, clinodactyly, and anal tag.

Management:

The baby was subjected for thorough exploration of respiratory/gastrointestinal/neurological systems which did not reveal attributable findings. Clinical exome sequencing revealed 20p duplication. He was started on orogastric feeding and could be gradually changed to direct feeding at 4 months of age.

Conclusions:

This report may improve the understanding toward approach to feeding problems in term neonates and also about phenotypic features of 20 p duplication which is less reported.
Linezolid-Induced Ringed Sideroblastic Anemia and Thrombocytopenia in a Child with Extensively Drug-Resistant Tuberculosis
Authors: Sippy Snigdha , Nisal Amit , Sarangi Bhakti U
Published: November 2023

Background:

With the ever-evolving guidelines and changing drug regimens for pediatric tuberculosis (TB), it is paramount for treating physicians to understand the efficacy and safety profiles of the drugs being used. Linezolid is included in the treatment of multidrug-resistant and extensively drug-resistant (XDR) TB in the intensive, as well as continuation phases.

Clinical Description:

A 12-year-old child with XDR central nervous system TB was treated with second- and third-line anti-tubercular drugs including linezolid. Three weeks after therapy started the boy presented with progressive pallor for a week, lethargy for few days, and rapid breathing since that morning. He was severely pale, acidotic, and in hypotensive shock. Investigations revealed severe anemia, thrombocytopenia, reticulocytopenia, normal liver and renal function, and no evidence of sepsis. He also had severe metabolic acidosis and hyperlactatemia.

Management:

The child was mechanically ventilated and administered red blood cell and platelet transfusions. The presence of ringed sideroblasts in the bone marrow confirmed acquired sideroblastic anemia. The clinical, hematological, and metabolic toxicities were considered most likely due to linezolid. It was discontinued and his drug regime was modified. There was a rapid symptomatic improvement with supportive therapy and gradual increase in hematological parameters with cessation of linezolid.

Conclusions:

Clinicians are used to treating Gram-positive infections with short courses of linezolid. Regular and planned monitoring is required when linezolid is used at higher doses and longer durations.
Laparoscopic Surgical Management of a Gastric Dumbbell Teratoma
Authors: Ananthakrishnan Nanditha , Agarwal Prakash , Satheesa Radhakrishnan
Published: November 2023

Background:

Teratomas are totipotent tumors commonly seen in gonadal and extragonadal region. Gastric teratomas are very rare and account for <1% of the cases. Conventionally, the treatment of gastric teratoma is open excision of the tumor. We present a rare variant of a gastric teratoma managed laparoscopically.

Clinical Description:

An 8 months' old male was noted to have pallor and history of blood-tinged spit-ups. The child was worked up for the cause of anemia with an upper gastrointestinal disorder as the first differential. The child had significant anemia with a hemoglobin level of 6 g/dl and was transfused packed red blood cells sequential imaging with an abdominal ultrasound, contrast-enhanced computerized tomographic scan, and magnetic resonance imaging identified the presence of a gastric teratoma with both an intragastric and extragastric component (dumbbell variant). He was referred to the pediatric surgery services for further management.

Management:

The infant underwent a gastroscopy to further define the intragastric component of the mass. This revealed a sessile submucosal polypoidal lesion with multiple areas of erosions in the region of the fundus. A biopsy from this suggested a teratoma. The child underwent a total laparoscopic excision of the lesion and recovered well. The histopathology of the tumor was consistent with a mature cystic teratoma (Grade 0). The postoperative period was uneventful.

Conclusion:

Laparoscopic complete surgical excision of the dumbbell variant of gastric teratoma in this child was curative, reduced morbidity, and hospital stay compared to usual open surgery.
A Rare Case of Factor XIII Deficiency Presenting with Scrotal Hematoma in an Adolescent
Authors: Kulkarni Rajesh K. , Vartak Sagar , Karandikar Niharika , Kinikar Aarti
Published: November 2023

Background:

Factor XIII deficiency is a rare disorder that may be congenital or acquired and is considered if a coagulation disorder is suspected, but the initial laboratory investigations are normal.

Clinical Description:

A 10-year-old boy presented with a scrotal swelling and pain following minor trauma. Local examination showed redness of overlying scrotal skin with tenderness on palpation.

Management:

Initial laboratory investigations for coagulation (prothrombin time/activated partial thromboplastin time/thrombin time) were normal. The diagnosis of factor XIII deficiency was clinched by abnormal clot solubility test. Child was treated with fresh-frozen plasma.

Conclusion:

Scrotal hematoma is a rare site for bleeding in factor XIII deficiency, which must be suspected if clinical suspicion of coagulation disorder is high and initial laboratory tests for coagulation are normal.
Subacute Sclerosing Panencephalitis in Indian Children Under 5 Years during the COVID Pandemic
Authors: Kapoor Dipti , Kakkar Vanshika , Narayana Yerraguntla Venkata , Garg Divyani , Mukherjee Sharmila Banerjee
Published: November 2023

Background:

Subacute sclerosing panencephalitis (SSPE) is a progressive neurodegenerative disorder of children and young adults. In the setting of the COVID-19 pandemic, we have observed increasing admissions of SSPE and a change in the clinical profile, mainly younger age of presentation, i.e., children under the age of 5 years.

Clinical Description:

We presented the clinical and investigational characteristics of 20 children who were diagnosed as SSPE during the period March 2020–March 2021 in our hospital, based on the Dyken criteria. The mean age was observed to be 3 years 9 months and male-to-female ratio of 1:1. Most children presented with developmental regression and myoclonic jerks. The clinical details and investigations were presented and a few atypical cases were discussed.

Management:

All the patients were treated symptomatically: anticonvulsant drugs, nutritional rehabilitation and supported feeding, occupational therapy, and palliative therapy. A trial of isoprinosine was started in all the patients, but was discontinued by most due to the expense. There were no mortalities.

Conclusion:

The change in profile of SSPE to an earlier onset in the setting of the pandemic should make the clinician keep a high index of suspicion of this disorder in children under the age of five years who present with unexplained developmental regression or acute encephalopathy, before the onset of typical myoclonus.
Acute Intravascular Hemolysis in the Critical Phase of Severe Dengue
Authors: Ghosh Sonali , Mahajan Lokesh
Published: November 2023

Background:

Dengue and severe dengue have various hemorrhagic manifestations ranging from mild presentations such as petechiae, bleeding from injection sites, ecchymosis, and gum bleeding to severe presentations like major mucosal bleeding such as hematemesis, melena, menorrhagia, and concealed internal bleeding. Common causes of anemia in dengue are due to blood loss (secondary to thrombocytopenia and/or coagulopathy), transient suppression of the bone marrow, and rarely, hemolytic anemia.

Clinical Description:

We describe a 5-year-old boy who presented to us in the critical phase of severe dengue with features of capillary leakage and cola-colored urine. Salient investigation reports were anemia, thrombocytopenia, normal reticulocyte count, absence of coagulopathy, indirect hyperbilirubinemia, deranged transaminase, highly elevated lactate dehydrogenase, and low haptoglobin levels, and hemoglobinuria, suggestive of acute intravascular hemolysis (AIVH). Autoimmune and microangiopathic hemolytic anemia, malaria, ingestion of dyes, snake bite, Glucose 6 phosphate dehydrogenase deficiency, and incompatible blood transfusions were excluded. Thus, the final diagnosis was severe dengue with hemolytic anemia and AIVH.

Management:

Oxygen delivery by the Heated Humidified High-Flow Nasal Cannula, strict input/output charting, appropriate fluid therapy, and diuretic infusion were the mainstays of management in an intensive setting. The aim was to maintain ventilation, perfusion, balance hydration, achieve optimal urine output and prevent fluid overload.

Conclusion:

Clinicians should consider Dengue as a possible cause for AIVH in children with severe dengue and cola-colored urine.
Targeted Breast Milk Modification
Authors: Patra Saikat , Bhisikar Swapnil , Kalamdani Pavan , Kalathingal Thaslima
Published: November 2023

Background:

The management of urea cycle disorders (UCDs) needs use of nitrogen scavenger drugs and protein restricted special formulas. The latter is not easily accessible and expensive. Continued breastfeeding is poorly tolerated by most babies. In these circumstances, targeted breast milk modification can be lifesaving by reducing ammonia and preventing a catabolic state.

Clinical Description:

A term baby born by normal delivery was discharged at 48 h after successfully initiating breastfeeding. He developed lethargy, poor feeding, and seizures on the 4th day. Vitals were stable. Sepsis, hypoglycemia, hypoxic-ischemic encephalopathy, dyselectrolytemia, hepatic/renal derangement, structural brain anomalies, cerebral edema, and hemorrhage were ruled out. A UCD was suspected due to hyperammonemia without acidosis. Citrullinemia was established by elevated citrulline and no orotic acid.

Management:

Breastfeeding was stopped, nitrogen scavenger drugs started, and peritoneal dialysis performed. As specialized milk formula was unavailable, we started diluted breast milk mixed with corn starch and coconut oil to achieve protein restriction and provide appropriate carbohydrates, lipids, and energy. Dilution was gradually decreased. There was gradual improvement in sensorium with normalization of ammonia. The baby was well till 8 weeks but developed symptomatic hyperammonemia due to noncompliance with therapy.

Conclusion:

Targeted modification of breast milk may be the only viable option for feeding infants with UCD in extraordinary circumstances. However, its short- and long-term consequences need to be researched thoroughly.
Opaque Hemithorax in a Child
Authors: Kumar Ketan , Mathew Joseph L. , Muralidharan Jayashree , Singhal Kamal K. , Sodhi Kushaljit S. , Vaidya Pankaj C. , Singh Meenu
Published: November 2023

Background:

Children with acute febrile respiratory illnesses are commonly seen in the emergency department. Apart from the initial stabilization, they need to be assessed for the underlying cause, and clinicians should formulate differential diagnoses to start treatment. Radiological investigations including x-ray and ultrasonography are often used to narrow down the initial possibilities based on history and examination. A child presenting with an opaque hemithorax is one such scenario.

Clinical Description:

A 3-year-old boy presented with a short duration of fever, cough and respiratory distress. Examination showed rightward mediastinal shift with dull percussion note and reduced breath sounds over the left hemithorax, along with congested neck veins, stridor and left sided wheeze. Chest x-ray showed an opacified left hemithorax and ultrasonography suggested moderate pleural effusion.

Management:

Complicated pneumonia with parapneumonic effusion (or empyema) was considered, but a diagnostic pleural tap was dry. The possibilities were revised to include cystic space occupying lesions with mediastinal compression. Computed tomography of the chest confirmed a mass lesion with predominantly cystic components. The patient underwent surgical excision, and histopathology showed pleuropulmonary blastoma.

Conclusion:

Although respiratory infections are common in childhood, clinical evaluation and judicious use of imaging modalities can uncover less common conditions. Although bedside ultrasonography is a handy tool in the emergency department, it is not infallible.
Complex Heart Disease with Interrupted Aortic Arch
Authors: Ahmed Huda Qadeer , Malik Mahim , Mohsin Shazia Samad
Published: November 2023

Background:

Congenital heart disease (CHD) is the most common of all birth defects. Interrupted aortic arch (IAA) is rare, attributing to 1% of all CHD and exhibits left sidedness in most cases. It usually presents in the first 2 weeks of life with heart failure and shock. Early recognition, preoperative stabilization with prostaglandin infusion, and timely surgery are necessary to prevent mortality. Single-stage repair has proven to have good outcomes. However, resource constraints in low- and middle-income countries can hinder diagnosis and intervention by single-stage repair due to a paucity of state of the art centers and inventory.

Case Description:

We present the experience of a low-resource center with two children with rare complex forms of IAA, both of whom underwent successful single-stage cardiac surgeries; a 6-week-old infant was admitted with difficulty in feeding and heart failure signs. Moreover, a 2-year-old boy was referred with failure to thrive, chronic respiratory problems, and feeding problems since early infancy. Both children were diagnosed with IAA with associated defects including patent ductus arteriosus by transthoracic echocardiography.

Management:

After stabilization with anticongestive medication, single-stage repair was attempted in both. The postoperative course was uneventful, and the postsurgical echocardiogram showed no residual defect. Both cases were discharged. They are under follow-up, are symptom free, have gained weight, and have not shown any need for reintervention yet.

Conclusion:

If preparative diagnosis is made correctly and surgery planned meticulously, the immediate and short-term outcome of single-stage repair can be favorable.
Exposure to Pornography in a Young Boy
Authors: Malhi Prahbhjot , Bharti Bhavneet , Satya Dileep
Published: November 2023

Background:

Child sexual abuse is highly prevalent in India, both among boys and girls; however, few studies have studied sexual abuse of male children. The present case report highlights the challenges of diagnosis and management of a young boy who presented with marked hyperactivity and sexual acting out behaviors subsequent to his repeated exposure to pornography.

Clinical Description:

H, a 5-year-old boy, presented with a 2 month history of hyperactivity, poor concentration, inappropriate touching, and self-stimulation. H also displayed sexual knowledge beyond that of what would be expected of his age and developmental level. The Child Sexual Behavior Inventory was administered that showed an unusually high score on the (sexual abuse specific items, sexual behaviors that are atypical for child's age and gender).

Management and Outcome:

The use of therapeutic interventions such as building a therapeutic relationship, environmental change, family counseling, and nondirective play therapy helped in remitting most of the child's behavioral difficulties.

Conclusions:

Parents need to be active participants in the digital lives of their children and exercise controls on what they view online. Since pediatricians are often the first points of contact for a child with aberrant behaviors, they need to be aware of the law on the protection of children against sexual offenses and the range of types of sexual offenses against children.
Cecal Duplication
Authors: Kaushal Monika , Kaushal Ayush , Sasidharan Karthika , Gupta Sharmishtha
Published: November 2023

Background:

Enteric duplication cysts are rare congenital malformations that are most commonly found in the ileum and ileocecal junction, followed by the esophagus, stomach, and duodenum. Although most present in the 1st 2 years, they are often difficult to diagnose as both presentation and radiological findings can be variable and nonspecific.

Clinical Description:

We present the case report of an 11-month-old child who presented with nonbilious vomiting and diarrhea. There was no fever, abdominal distension, blood in stools, or crying on defecation. A provisional diagnosis of acute gastroenteritis was kept and management started as per the standard protocol.

Management:

A series of investigations were carried out when the child did not improve and developed bilious vomiting. Ultrasound findings were suggestive of an ileal duplication cyst which was confirmed by magnetic resonance imaging. The child then underwent surgery where cecal duplication cyst was confirmed, which was previously missed due to a malpositioned cecum.

Conclusion:

Gastrointestinal duplication cysts are rare developmental anomalies that may present as an acute abdomen in a young child. The possibility of the duplication cyst should be kept as a differential diagnosis in a child presenting with unexplained vomiting, abdominal distension, or pain. Early suspicion, investigation, and intervention help in faster recovery with minimal complications.
Gorlin Syndrome – An Adult Diagnosis Made in Childhood
Authors: Mathur Surendra Bahadur , Mukherjee Sharmila Banerjee , Kapoor Dipti , Sharma Suvasini
Published: November 2023

Background:

Syndromes in which some manifestations occur later in life are difficult to diagnose in childhood. A systematic clinical approach may prove to be extremely useful. Gorlin syndrome (GS) is characterized by jaw keratocysts and/or basal cell carcinomas usually appearing in the second decade of life.

Clinical Description:

A 9-month-old girl, second born to a nonconsanguineous couple, presented with delay in attaining milestones and spinal deformities. There was no significant antenatal, perinatal, neonatal, or family history. She had no neck control, vocalization, or social smile. Fixation and tracking of objects and startle response to sound was present. Salient examination findings were macrocephaly, frontoparietal bossing, flat occiput, hypertelorism, broad nasal bridge, right preauricular pit, palmar pitting, and kyphoscoliosis. X-ray chest revealed bifid vertebra, hemivertebrae, and bifid ribs. Echocardiogram, ultrasound abdomen, magnetic resonance imaging brain, and brainstem-evoked response audiometry were normal.

Management:

A systematic clinical approach was used that included the following steps: (1) history, examination, and identification of overt anomalies; (2) searching for concealed anomalies; (3) synthesizing information; (4) literature/database search using good search handles; (5) critically analyzing the differential diagnoses; and (6) surveillance for associated morbidities of established diagnosis. We arrived at a clinical diagnosis of GS after applying diagnostic criteria and excluding differential diagnoses. Appropriate intervention was started. The child is under annual follow-up.

Conclusion:

A systematic clinical approach including an effective search strategy with good handles helps in arriving at a clinical diagnosis in children with dysmorphism.
Transient Diabetes Insipidus in a Preterm Neonate
Authors: Kartikeswar Gouda Ankula Prasad , Pandya Dhyey J. , Mehetre Ashwini T. , Kadam Sandeep
Published: November 2023

Background:

Diabetes insipidus (DI) is a disorder of water homeostasis due to insufficient production or inappropriate action of vasopressin. Central DI (CDI) develops due to intracranial causes such as hypoxic–ischemic encephalopathy, meningitis, and intraventricular hemorrhage. Manifestations such as polyuria, polydipsia, and irritability may not be obvious in preterm infants, resulting in delayed recognition and difficulty in establishing diagnosis.

Clinical Description:

A 1.4 kg preterm girl delivered by cesarean section for a significant nonstress test (but normal Apgar scores) was admitted for very low birth weight and preterm care. Initial clinical examination was normal, and the baby remained euglycemic. The neonate developed shock and fever on the 3rd day of life without any apparent cause.

Management:

DI was suspected on identification of hypernatremia (150 mEq/L) and polyuria (9 mL/kg/h). The urine osmolality was low (62.54 mOsmol/kg), despite high serum osmolality (312 mOsmol/kg) confirming the diagnosis. An increase in urine osmolality by >50% following oral desmopressin (5 μg/kg/day) suggested CDI. This was continued until the baby became asymptomatic and urine/serum osmolality normalized. A trial of discontinuation of desmopressin did not lead to recurrence of symptoms. Magnetic resonance imaging brain showed features of subacute hypoxic insult and absent posterior pituitary bright spot. After 7 months of follow-up, she is asymptomatic without any treatment, and her growth and development are age appropriate.

Conclusion:

A high index of suspicion of CDI should be kept in neonates presenting with unexplained shock, fever, hypernatremia, and polyuria.
Recurrent Primary Mucinous Carcinoma of the Skin
Authors: Tambe Swagata Arvind , Patil Priyanka Deelip , Jerajani Hemangi
Published: November 2023

ABSTRACT

Primary cutaneous mucinous carcinoma of the skin is an adenocarcinoma of eccrine glands. However, it may be locally aggressive and can metastasize to lymph nodes. Differential diagnosis especially from metastatic mucinous carcinomas of other organs such as breast, gastrointestinal tract, lung, prostate, and ovary may be difficult. Here we report a case of mucinous eccrine carcinoma with multiple recurrences even after surgical excision and radiotherapy. The patient also concomitantly diagnosed to have chronic lymphocytic leukemia after five years of diagnosis of mucinous carcinoma.
Laparoscopic Inguinal Hernia Repair- Transabdominal Preperitoneal (TAPP) versus Totally Extraperitoneal (TEP) Approach: A Comparative Analysis
Authors: Trehan Munish , Garg Sahil , Singh Jaspal , Singla Sanjeev , Garg Ramneesh , Rakesh Devika , Aggarwal Kunwar
Published: November 2023

ABSTRACT

Background and Aim:

Totally extraperitoneal (TEP) repair and transabdominal preperitoneal (TAPP) repair are the two standardized laparoscopic techniques for inguinal hernia repair. Although several studies were conducted in the past, there are still no certain answers regarding the best laparoscopic approach for inguinal hernia repair. Therefore, our aim was to compare the outcomes of the TAPP versus TEP for inguinal hernia.

Materials and Methods:

This prospective study was conducted at Dayanand Medical College and Hospital, Ludhiana, from January 1, 2018 to March 31, 2019 and included 54 patients admitted with unilateral or bilateral uncomplicated inguinal hernia. Patients undergoing laparoscopic TEP or TAPP inguinal hernia repair were compared on various intraoperative and postoperative parameters.

Results:

Fifty-four patients were included in the study (TEP, 27; TAPP, 27). Both groups were comparable in terms of demographic profile and hernia characteristics. TEP had significantly less mean operative time compared to TAPP. Pain scores and injectable analgesics’ requirement were significantly higher in TAPP compared to TEP. Postoperative stay was significantly higher in TAPP than TEP. Surgical outcome in terms of intraoperative and postoperative complications, hernia recurrence, and chronic pain for the two laparoscopic techniques was comparable.

Conclusion:

The lesser intraoperative duration of surgery with lesser postoperative pain scores and lesser postoperative hospital stay favor the use of TEP over TAPP for repair of inguinal hernia.
A Rare Case of Congenital Corneal Anesthesia
Authors: Naik Kunj , Garlapati Aditya Ganesh , Anand Shailaja , Magdum Renu , Dhore Nilay
Published: November 2023

ABSTRACT

A 12-year-old male, who had a history of trauma in his right eye at 2 years of age, presented to the clinic with diminution of vision and whitish discoloration in his right eye. Detailed history and clinical examination confirmed findings of congenital corneal anesthesia due to hereditary sensory autonomic neuropathy type 4, a rare genetic disorder.
On subspace designs
Authors: Santonastaso Paolo , Zullo Ferdinando
Published: November 2023

Guruswami and Xing introduced subspace designs in 2013 to give the first construction of positive rate rank metric codes list-decodable beyond half the distance.
In this paper we provide bounds involving the parameters of a subspace design, showing they are tight via explicit constructions.
We point out a connection with sum-rank metric codes, dealing with optimal codes and minimal codes with respect to this metric.
Applications to two-intersection sets with respect to hyperplanes, two-weight codes, cutting blocking sets and lossless dimension expanders are also provided.
Constructing pseudo-Anosovs from expanding interval maps
Authors: Farber Ethan
Published: November 2023

We investigate a phenomenon observed by Thurston wherein one constructs a pseudo-Anosov homeomorphism on the limit set of a certain lift of a piecewise linear expanding interval map. We reconcile this construction with a special subclass of generalized pseudo-Anosovs, first defined by de Carvalho. From there we classify the circumstances under which this construction produces a pseudo-Anosov. As an application, we produce for each

g \geq 1

, a pseudo-Anosov

\phi_g

on the closed surface of genus

g

that preserves an algebraically primitive translation structure and whose dilatation is a Salem number.
Communication for Plug-in Vehicles as a Distributed Energy Source
Authors:   Hybrid - EV Committee
Published: November 2023

This SAE Recommended Practice applies to a plug-in electric vehicle (PEV) which is equipped with an onboard inverter and communicates using IEEE 2030.5-2018. It is a supplement to the SEP2 standard, which supports the use cases defined by SAE J2836/3. It provides guidance for the use of the SEP2 distributed energy resource function set with a PEV. It also provides guidance for the use of the SEP2 flow reservation function set, when used for discharging. It is not intended to be a comprehensive guide to the use of SEP2 in a PEV.

Note that in this document, SEP2 is used interchangeably with IEEE 2030.5-2018.
Measures of association between algebraic varieties, II: self-correspondences
Authors: Lazarsfeld Robert , Martin Olivier
Published: November 2023

Following a suggestion of Jordan Ellenberg, we study measures of complexity for self-correspondences of some classes of varieties. We also answer a question of Rhyd concerning curves sitting in the square of a very general hyperelliptic curve.

Comment: This article is dedicated to Claire Voisin on the occasion of her birthday. 12 pages
Rate of chainsaw vibrations in laboratory conditions and level of chainsaw noise at different distances
Authors: Staněk Luboš , Nevrkla Pavel , Jankových Lukáš , Zemánek Tomáš
Published: November 2023

The study is focused on the rate of vibrations and level of noise in the chainsaw model Stihl MS 362 which belongs in the group of the best-selling professional chainsaws in the world with a highly efficient anti-vibration system. Testing cuts to determine the rate of vibrations were made on the stems of two tree species: sessile oak (Quercus petraea (Matt.) Liebl.) and Norway spruce (Picea abies (L.) H. Karst.). The purpose of noise level measurement was to compare the influence of chainsaw noise on its operator and on the person occurring behind the zone of protection (5 and 10 metres) from the source of noise. Then a distance from the chainsaw was measured where the level of noise reached 80 dB. The measurements were performed according to ČSN EN ISO 22868:2021. At measuring the chainsaw vibrations, the rate of vibrations acting on both operator’s hands (front and rear grip) was examined. Vibrations were measured according to ČSN EN ISO 22867 (2012). It was found out that the rate of vibrations on the rear handle was in both cases of measurements higher than the rate of vibrations on the front handle. At the same time, a higher rate of vibrations was recorded in sessile oak. As to the level of noise, results of measurements indicated that at working with the chainsaw, hearing protectors have to be used at all three measured distances (close proximity, 5 m from the operator, 10 m from the operator) in order to reduce high noise level as the average noise level was higher than permissible in all measurements. The highest possible tolerable level of acoustic noise (80 dB) at which permanent damage of hearing does not happen was measured at a distance of 21 m from the working place of chainsaw operator. Keywords: chainsaw, Stihl MS 362, vibrations, noise, occupational hygiene, forestry
PRAVNOISTORIJSKI OSVRT NA USTANOVU BRANIOCA U SRPSKOM PRAVU
Authors:   University of Kragujevac, Faculty of Law, Gavrilović Grbović Biljana
Published: November 2023

The paper provides a legal-historical overview of the institution of defense counsel in criminal proceedings, which were applied in the territory of Serbia, from the second half of the 19th century to the first half of the 20th century. The institution of a defense attorney was introduced on the territory of Serbia on the basis of the Code of Judicial Procedure in Criminal Offenses from 1865. According to the Code from 1865, the institution of the defender was regulated very narrowly; defense counsel was provided only for a certain group of defendants. In 1868, the Code was amended, introducing a mandatory formal defense for those accused of a crime and a group of people determined by the Code, while an optional formal defense was possible for anyone accused of a crime, but only during the main proceedings. The shortcoming, which implied the impossibility of the defense counsel's participation in the previous proceedings, was remedied on the territory of Serbia only on the basis of the Yugoslav Code of Criminal Procedure. However, the Yugoslav Code of Criminal Procedure also had certain shortcomings regarding the institution of defense counsel. Therefore, the paper will analyze the question of which European models the domestic legislator looked up to and what shortcomings were observed in terms of the way of regulating the institution of the defender, both in the Principality and the Kingdom of Serbia, and in the Kingdom of Yugoslavia.
VANREDNO STANjE I VANREDNA SITUACIJA U REPUBLICI SRBIJI 2020. GODIN
Authors:   University of Kragujevac, Faculty of Law, Đorđević Srđan
Published: November 2023

During the spring of 2020, the social life in Serbia was enriched by the new experience of the state and legal order due to the pandemic caused by the "corona" virus. A sufficiently large provocation of danger caused the central government to react by introducing a state of emergency, which at the same time raised a number of issues (perhaps less legal and more political). Additional problematization of the state of emergency in Serbia was caused by the previously announced regular parliamentary and local elections. The President of Serbia called parliamentary elections, and the President of the National Assembly called local elections, and these facts should also be taken into account when analyzing the critical dilemmas about whether the state's response to the threat of the "corona" virus was justified by introducing a state of emergency, or it was enough to declare emergency situation? Then, questions were raised about the legitimacy of the way the state of emergency was declared, and whether the measures adopted during the state of emergency were in accordance with legal regulations? In addition, an initiative to assess the constitutionality and legality of the state of emergency was officially submitted. The complex of questions in question gives us the right to look at them and try to give answers that can satisfy the interest of the professional and general public. For these reasons, the motivation to tackle the issues in question and research the topic of the work is instructive and expedient, because as a result of the conducted research, one of the possible opinions appears, of which there are and will be more among the professional public. Of course, politics is present as an inevitable companion of opinion on important public problems, whereby our primary goal will be legal elaboration and legal argumentation when establishing final positions on the central theme of the paper.
Deficient Play-Derived Experiences in Juvenile Long Evans Rats Reared with a Fischer 344 Partner: A Deficiency Shared by Both Sexes
Authors: Stark Rachel Anne Marie , Ramkumar Raksha , Pellis Sergio M
Published: November 2023

Play fighting during the juvenile period has been shown to be an important experience for the development of sociocognitive skills and the underlying neural mechanisms that support them. Various paradigms have been used to deprive rats of play while still providing social contact. We used the paradigm of rearing a playful rat with a low-playing Fischer 344 (F344) partner to limit the play experienced by Long Evans (LE) rats during the juvenile period. This rearing paradigm has previously been shown to cause sociocognitive impairments in adulthood. In the present paper, we examined the play of same sex LE rats with LE or F344 partners at the peak juvenile period (around 35 days of age). F344 rats launched fewer playful attacks and when attacked, defended atypically compared to how LE do in LE-LE pairs. Playing with an F344 partner afforded LE rats fewer opportunities to engage in prolonged wrestling and fewer opportunities to ward off counterattacks (in which the defending rat becomes the attacker). In addition, there are fewer vocalizations emitted during the encounters in LE-F344 pairs and the types of calls most often emitted differed to those between LE-LE pairs. The altered play and communication experiences were equally present in male and female pairs. These findings are consistent with the hypothesis that, in such rearing paradigms, it is impoverished play experiences in the juvenile period that lead to impaired sociocognitive skills in adulthood.
Humans Discriminate Individual Large-Billed Crows and Individual Cats by Their Respective Vocalizations
Authors: Schalz Sabrina , Meekings Sophie , Dickins Thomas E.
Published: November 2023

Previous research has shown that human adults can easily discriminate two individual zebra finches (Taeniopygia guttata) by their signature songs, struggle to discriminate two individual rhesus monkeys (Macaca mulatta) by their calls, and are unable to discriminate two individual dogs (Canis familiaris) by their barks. The purpose of the present experiment was to examine whether acoustic discrimination of individual non-primate heterospecifics is limited to species producing stereotyped signature songs, or whether it is possible with the vocalizations of other species as well. This was tested here with the calls of individual large-billed crows (Corvus macrorhynchos) and the meows of individual domestic cats (Felis catus) using a forced-choice Same-Different Paradigm. Results show a high discrimination accuracy without prior training, although the scores obtained here for both species were lower than those in the zebra finch discrimination task. Discrimination accuracy of cat voices decreased when mean pitch was equalized between individuals, but was still possible without this cue. The removal of formant frequencies did not influence the discrimination, and there was no significant performance improvement across trials. These experiments suggest that individual acoustic discrimination is possible not only with species producing signature songs, but also with unlearned vocalizations of both birds and non-human mammals.
Metode dan Strategi Guru PAI dalam Penanaman Nilai-Nilai Pendidikan Karakter (Studi Kasus di SMPN 6 Taman Kabupaten Pemalang)
Authors: Prayogi Arditya , Fina Firqotun Najiyah
Published: November 2023

This article was written with the aim of describing the strategies used by Islamic religious education teachers at SMP Negeri 6 Taman, Pemalang Regency in instilling character education values. Apart from that, various supporting and inhibiting factors are also described in instilling character education values for class VIII students at SMP Negeri 6 Taman, Pemalang Regency. This is because character development is an important thing that must be done by teachers, especially Islamic religious education (PAI) teachers. This is because through religious education (Islam), teachers can introduce students to and at the same time instill social values that live and are maintained in people's lives which are part of good human character and personality. This article uses a type of field research by applying a qualitative approach. Data collection techniques are carried out through observation, interviews and documentation. Meanwhile, the data analysis technique goes through three stages, namely data reduction, data presentation process, and conclusion drawing process. The results of the study in this article show that the PAI teacher's strategy in instilling character education values in class VIII students at SMP Negeri 6 Taman, Pemalang Regency uses several strategies, namely through habituation activities, being a model and role model, mentor and motivator, and giving punishment. The supporting factors in instilling character education values in students are teachers who can be role models, parental education at home, school facilities, routine and extracurricular school activities. Meanwhile, the inhibiting factors are lack of teacher competence, lack of parental education, environmental and social factors.
Directive Speech Act used in WA (WhatsApp) Messenger in Academic Discourse
Authors:   Student of Master of English Education, University of Lampung, Indonesia, Sulamah Sulamah
Published: November 2023

This research studies about directive speech act in WhatsApp (WA) messengers. The objectives of the research is to describe the type of directive speech act. This research is descriptive qualitative research. The subject of this research is the chat online via WhatsApp. The data were analyzed by qualitative descriptive technique which resulted in descriptive, data descriptive in the form of sentence or word contained in WA messengers. The way of data collection is done by reading technique and technique of note. In this research, the researcher used documentation as the instrument. The results of the research show that, first, the types of directive speech acts were command, request, permission, reminding, suggestion and question. Second, the types of directive speech acts that most frequently used were command type.