bluuebunny/crossref_metadata_2025 huggingface dataset:
Pulseless Systemic Lupus Erythematosus
Authors: Sinha Preema , Kothari Rohit , Hegde Arun , Prateek Prateek
Published: November 2021

Vascular disease is frequent in patients with systemic lupus erythematosus, which can be related to the disease process, or can develop as an accompanying co-morbidity and represents the most frequent cause of death in established disease. However, at times the presentations can be uncommon and subtle, and warrants a thorough examination both clinically and radiologically. We report a case of a young female with photosensitive malar rash, oral ulcers, intermittent fever with joint pains, history of two abortions, and unilateral absent radial and brachial artery pulses on clinical examination. The evaluation revealed positive antinuclear antibody (4+), anti-Smith antibody (2+), direct Coomb's test (2+), and antiphospholipid antibody panel was negative. Color doppler flow imaging of right upper limb (arterial) revealed irregular wall thickening with a narrow lumen and mildly reduced peak systolic volume. Computed tomography aortogram revealed wall thickening and luminal narrowing involving the entire length of the right brachial and radial artery. We report this case for its rarity and unique presentation of medium vessel vasculopathy.
Clinical Pattern and Patch Test Profile of Hand Eczema in Hospital Employees in a Tertiary Care Hospital of North India
Authors: Zeerak Sumaya , Shah Iffat Hassan , Akhtar Saniya , Bashir Yaqzata , Bhat Manzoor A. , Jeelani Shazia , Bhat Yasmeen J. , Rather Shugufta , Devi Reeta
Published: November 2021

Introduction:

Health care workers form an important occupational group with a high risk of hand eczema. All health care professionals are exposed to a variety of allergens and irritants which can cause hand dermatitis, resulting in significant morbidity.

Aims and Objectives:

To assess the clinical profile of hand eczema in hospital employees, to perform patch test in relevant cases and to find out the most common sensitizers in them.

Materials and Methods:

This was a cross-sectional, hospital-based study in which the staff was screened for features of hand eczema and patch testing was done in the suspected cases of allergic contact dermatitis.

Results:

Out of 340 employees screened, 46 employees (13.5%) suffered from hand eczema. The most common type was wear and tear dermatitis accounting for 17 (36.9%) cases, followed by discoid eczema, pompholyx, focal palmar peeling, finger-tip eczema, hyperkeratotic eczema, ring eczema, and unspecified types. Patch testing was positive in 15 (32.6%) cases. The most common allergen was paraphenylene diamine, followed by fragrance mix, nitrofurazone, mercaptobenzothiazole, potassium bichromate, black rubber mix, and thiuram mix. A statistically significant association (0.001) was found with an underlying history of atopy.

Conclusion:

Hand eczema is a commonly encountered dermatological complaint in many hospital employees. Proper counseling, work, up, patch testing, and treatment can mitigate the symptoms in such employees.
Cyclosporine in Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis
Authors: Balai Manisha , Meena Manju , Mittal Asit , Gupta Lalit Kumar , Khare Ashok Kumar , Mehta Sharad
Published: November 2021

Background:

Stevens-Johnson syndrome and toxic epidermal necrolysis are severe, life-threatening mucocutaneous drug reactions with a high morbidity and mortality that require immediate medical care. Several immunomodulatory drugs are used for the treatment but evidence of their efficacy is limited. Cyclosporine has recently been found to have a promising role in SJS/TEN owing to its potent antiapoptotic activity.

Aims:

This open label prospective study was conducted to determine the efficacy, safety, and tolerability of cyclosporine in patients with SJS/TEN.

Methods:

This study was conducted at a tertiary care teaching hospital of South Rajasthan during a period of 4 years (August 2015 to July 2019). Data regarding clinical profile, causative drug(s), disease severity, associated comorbidities, treatment received, and outcome were recorded in a predesigned proforma. SCORTEN prognostic score was calculated for each patient at the time of admission. Cyclosporine was administered in a dose of 5 mg/kg body weight in two divided dosage until reepithelization.

Results:

Out of 16 patients 10 were males and 6 were females. Mean age of patients was 30.62 ± 16.98 years (range: 7–63). Most of the patients, i.e., 8 out of 16 had TEN, 5 patients had SJS, and 3 patients had SJS/TEN overlap. Mean ± SD delay between onset and admission was 3.812 ± 1.377 days (range: 2–7). Among the suspected drugs, antiepileptics (43.7%) formed the major group. Mean duration of reepithelization was 10.5 ± 3.46 days (range: 7–15). Based on the SCORTEN, the expected mortality was 2.55 with mean predicted mortality rate of 16.43% with SD of 19.3.

Limitations:

1) Sample size was small. 2) Placebo control trial could not be done due to the severity of the disease.

Conclusion:

We recommend cyclosporine (5 mg/kg/day) as the first line-specific immunomodulatory agent in SJS/TEN on account of its efficacy, safety, rapid reepithelization, decrease hospital stay, and reduced morbidity and mortality.
Multiple Erythematous Nodules
Authors: Supekar Bhagyashree B. , Wankhade Vaishali H. , Chopkar Apoorva D. , Singh Rajesh P. , Bhat Dharitri
Published: November 2021

Pyogenic granuloma (PG), also called a lobular capillary hemangioma, is a benign vascular proliferation of skin or mucous membrane. It classically presents as a solitary friable nodule over the face or distal extremities. Multiple disseminated PG is a rare form generally reported after trauma such as burn injury. We report two cases of spontaneous development of multiple localized PGs in immunocompetent individuals.
A Clinico-Epidemiological Study of Cutaneous Leishmaniasis in a Non-Endemic Region of South Rajasthan
Authors: Virath Rekha , Gupta Lalit K. , Mehta Sharad , Balai Manisha , Mittal Asit K. , Khare Ashok K.
Published: November 2021

Introduction:

Cutaneous leishmaniasis (CL) is a vector-borne protozoal infection of the skin with variable clinical manifestations. In Rajasthan, western Thar desert is endemic for this disease.

Aim:

The present study was aimed to describe clinico-epidemiological features of cutaneous leishmaniasis cases from a non-endemic area of South Rajasthan.

Materials and Methods:

A hospital-based prospective study was carried out during a period of 3 years (2017-2019). Data regarding clinical profile and treatment outcome were recorded in a predesigned proforma for analysis. Diagnosis of CL was made clinically and confirmed by demonstration of amastigotes in microscopic examination of Giemsa stained tissue smear of lesions.

Results:

Out of 24 patients, 16 (67%) were females and 8 (33%) were males. The age ranged from 3 months to 68 years (median-25). Face (67%) and extremities (29%) were the common sites affected. The most common morphological form was crusted plaques (54%) followed by nodular lesions (38%). Slit skin smear for Leishmania donovani bodies was positive in all patients (100%).

Conclusion:

This study highlights a focus of CL in non-endemic areas of South Rajasthan. Of late leishmaniasis is breaking out of its classical boundaries and is increasingly being reported from new geographic locations with a possibility of a novel parasite variant. Therefore, a high clinical suspicion of CL should be kept in non-endemic area.
Unusual Morphological Presentation of Cutaneous Malignant Melanoma
Authors: Dash Gaurav , Pradhan Swetalina , Naik Subhasini
Published: November 2021

Cutaneous malignant melanoma is a rapidly progressing skin tumor accounting for most deaths from skin malignancies. Four morphological variants (nodular, superficial spreading, lentigo maligna, and acral lentiginous) are described in the literature. Here we are reporting malignant melanoma in a 35-year-old male who presented with depigmented plaques with few hyperpigmented areas and extensive overlying scaling. The patient progressed to the nodular stage within 2 weeks and succumbed to death during chemotherapy. We are reporting such rare presentation of malignant melanoma to create awareness among dermatologists to avoid misdiagnosis and delayed treatment which can lead to rapid progression and fatal outcome.
The Role of Frozen Section in the Rapid Diagnosis of Severe Cutaneous Adverse Drug Reactions
Authors: Nicholas Rajam , Bindra Mandeep Singh , Mathew Lydia , Sathishkumar Dharshini , Lakshmanan Jeyaseelan , George Renu
Published: November 2021

Context:

Early diagnosis is the mainstay in the management of severe cutaneous adverse reactions (SCARs) to drugs.

Aims:

To study the role of frozen section in the rapid diagnosis of SCARs and the impact on outcome of the affected patients.

Settings and Design:

A single-blind, hospital-based study was conducted from December 2014-July 2016.

Methods and Material:

We biopsied 32 adults with SCARs diagnosed by clinical features and standard criteria. The histopathological features seen on frozen sections were compared to that of paraffin blocks. The impact of rapid diagnosis on the clinical outcome was studied in toxic epidermal necrolysis (TEN), Stevens-Johnson syndrome (SJS), drug rash with eosinophilia and systemic symptoms (DRESS) and acute generalized exanthematous pustulosis (AGEP).

Statistical Analysis:

Z test was used to compare two proportions. Kappa statistic, sensitivity, specificity, positive predictive value, and negative predictive value of the frozen section diagnosis were calculated in TEN/SJS and DRESS using MedCalc software.

Results:

Frozen and paraffin sections were done in TEN/SJS spectrum (13), DRESS (17), and AGEP (2). The sensitivity, specificity and kappa values for frozen section diagnosis in SJS/TEN and DRESS were 91.7%, 95%, 0.867 and 94.4%, 100%, 0.937 respectively. The concordance between frozen and paraffin section diagnosis was 100% in TEN, SJS, DRESS and AGEP. All the 6 patients with TEN and 2 with AGEP survived. Taking the worst-case scenario, the mortality in SJS was 28.6%. The mortality among patients with DRESS was 11.8%.

Conclusions:

Frozen section helps in the rapid diagnosis and early treatment of SCARs and differentiates it from diseases that mimic it.
Iatrogenic Cushing's Syndrome in Patients with Superficial Dermatophytosis
Authors: Thakran Priyesh , Agrawal Sonia , Singal Archana , Verma Shyam , Madhu S.V.
Published: November 2021

Background:

The epidemic-like scenario of superficial fungal infections in India has been complicated by the prescription of systemic and topical potent steroids. As a result, alarming number of patients are presenting with exogenous Cushing's syndrome.

Methods:

This cross-sectional study involved 23 patients of superficial dermatophytosis on steroids who presented with clinical features like that of Cushing's syndrome. Their clinical details and laboratory investigations including fungal culture and serum cortisol, were recorded on a pre-designed proforma.

Results:

There were 23 patients (14 males and 9 females) with mean age of 29.47 ± 15.5 years, majority with extensive tinea cruris and corporis. All of them received oral (Betamethasone) or parenteral corticosteroids along with potent topical steroids (clobetasol propionate and betamethasone valerate) for at least two months. In majority (56.5%), treatment was prescribed by unqualified medical practitioners and in the rest by alternative medical practitioners. Striae, buffalo hump, hirsutism were observed in 16 (69.5%), 15 (65.2%), 13 (56.5%) patients, respectively. Serum cortisol estimation revealed low levels and ranged from 0.66 to 6 μg/ml with a mean of 1.53 ± 1.27 μg/ml (normal 7-25 μg/ml).

Conclusions:

Corticosteroids are life saving for many dermatological diseases; their injudicious use (topical, oral, and parenteral) for prolonged periods in the treatment of superficial dermatophytosis can lead to Cushing's syndrome.
Factors Predicting the Outcome of Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis
Authors: Thakur Vishal , Vinay Keshavamurthy , Kumar Sheetanshu , Choudhary Rajat , Kumar Ashok , Parsad Davinder , Kumaran Muthu Sendhil
Published: November 2021

Background:

Clinicodemographic and laboratory parameters predicting the outcome of Stevens–Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) may vary among populations owing to genotypic and environmental variations. There is a scarcity of studies evaluating these parameters in Indian population.

Aims:

To analyze clinicodemographic and laboratory parameters predicting disease outcome in patients of SJS/TEN.

Materials and Methods:

Clinical records of patients admitted with a diagnosis of SJS/TEN from January 2014 to December 2018 were reviewed retrospectively with respect to data pertaining to clinicodemographic details, laboratory parameters, and disease outcome.

Results:

Of 51 patients included in the study, 24 (47.06%) were females. Anticonvulsants [phenytoin (19.6%), carbamazepine (13.7%), others (5.88%)] were the most commonly implicated drugs followed by NSAIDs (19.6%). The overall mortality was 21.6% [SJS (0%), SJS-TEN overlap (18.8%), and TEN (28.6%)]. The mean detached body surface area (BSA) (35.4% ± 10.4% vs. 25.7% ± 11.8%; P = 0.02) was significantly higher among patients with mortality. Blood urea nitrogen, serum HCO3
− levels, and random blood sugar were significantly associated with mortality. Presence of sepsis during the disease course was associated with higher mortality (9/12 vs. 2/39; P = 0.001). Other components of SCORTEN like age and heart rate were not significantly associated with poor outcome in our study. None of our patients had associated malignancy.

Conclusion:

A higher detached BSA, presence of sepsis, higher blood urea nitrogen and random blood sugar, and lower serum HCO3
− levels were associated with mortality. Refinement of scoring systems predicting the outcome of SJS-TEN is needed for better disease prognostication.
Clinico-Epidemiological Profile of Childhood Alopecia Areata Along with Dermoscopic Correlation
Authors: Bhardwaj Pallawi , Basu Dibyendu , Podder Indrashis , Gharami Ramesh C.
Published: November 2021

Background:

Childhood alopecia areata (AA) is a common cause of dermatologic consultation; however, data is scarce in the present set-up.

Objectives:

To evaluate the clinico-epidemiological profile of childhood AA along with dermoscopic correlation.

Methods:

We conducted a cross-sectional study including 50 new cases of childhood AA for 1 year. Dermoscopy was performed in each child and findings recorded.

Results:

Childhood AA was more common in girls (M: F 1:1.4), mean age being 11.1 ± 3.7 years. Scalp was commonest site of involvement in 86% cases, while 32 (64%) children had mild disease (<25% involvement). Localized circumscribed patch was the commonest presentation in 37 (74%) children, while sisaipho was the least (2%). A positive family history of AA was noted in 5 (10%) children. Twenty-four children (48%) provided a history of atopic disorders, while 30% had a positive family history of atopy. Stress was the commonest precipitating factor in 13 (26%) subjects. Nail involvement was observed in 19 (38%) children (pitting >thinning), while systemic associations like vitiligo and thyroid dysfunction were present in 26% and 24% cases, respectively. Dermoscopy revealed yellow-dots to be the commonest finding in 44 (88%) cases, followed by short vellus hair and black dots in 76% and 28% children, respectively, while exclamation-mark hair was rare.

Conclusion:

Female gender, younger age, nail involvement, and presence of concomitant atopy, vitiligo, and thyroid dysfunction were associated with severe disease, but not statistically significant (p > 0.05). Regression model failed to detect any risk factors for severe AA. Dermoscopy is an important non-invasive tool for evaluating childhood AA.
Clinical and Dermoscopic Features of a Case of Idiopathic T-Cell Pseudolymphoma
Authors: Behera Biswanath , Kumari Rashmi , Thappa Devinder Mohan , Toi Pampa Ch
Published: November 2021

Cutaneous pseudolymphomas are a group of benign lymphocyte-rich infiltrates that can mimic cutaneous lymphomas either clinically and/or histologically. Idiopathic T-cell pseudolymphoma (TCPL) usually presents as a solitary nodule or plaque on the trunk or head. A clinicopathologic correlation is mandatory to arrive at a final diagnosis and rule out true lymphomas. There are only sparse dermoscopic reports on cutaneous pseudolymphomas. Hereby, we describe the clinical and dermoscopic features of a case of idiopathic TCPL in a 26-year-old man who presented with an asymptomatic thin reddish-brown “table tennis racquet”-shaped plaque on the right inframammary area.
9 Tips and Pearls for Safer Performance of Dermatological Procedures during Covid-19 Pandemic
Authors: Mysore Venkataram , Venkataram Aniketh , Jindal Anuradha , Hirevenkangoudar Ashwini L , Malayanuru Deepthi , Noronha Malcom , Alexander Sajin
Published: November 2021

SARS-CoV2 pandemic has affected dermatologypractice greatly. In view of the risk of transmission, physicians need to devise methods to perform procedures in a safer way. Our institute has adopted a number of innovative safety precautions steps, which are being outlined here.
Super Bioavailable Itraconazole and Its Place and Relevance in Recalcitrant Dermatophytosis
Authors: Sardana Kabir , Mathachan Sinu Rose
Published: November 2021

Itraconazole, is the most commonly prescribed oral antifungal agent in India, and has a low minimum inhibitory concentration as compared to other oral antifungals, and in conjunction with the markedly high skin levels, the drug should have a predictably good clinical response which is not the consistent experience of clinicians. Probably the variation in pelletization parameters might affect the bioavailability of the drug and consequently affect the serum levels. The maximum bioavailability of conventional itraconazole is 55 percent, which is neither consistent nor predictable. However, the novel itraconazole (Super bioavailable Itraconazole) with targeted drug release in the small intestine has predictable serum levels with minimum interindividual variability, which could make it a potentially useful drug in recalcitrant dermatophytosis.
Impact of a Psychodermatological Education Package on the Subjective Distress, Family Burden, and Quality of Life among the Primary Caregivers of Children Affected with Epidermolysis Bullosa
Authors: Manomy P. A. , Yenamandra Vamsi K. , Dabas Garima , Joshi Poonam , Ambekar Atul , Sreenivas Vishnubhatla , Sharma Vinod K. , Vatsa Manju , Ravindran Surya , Sethuraman Gomathy
Published: November 2021

Background:

Epidermolysis bullosa (EB) has profound effect on the subjective distress, family burden, and quality of life (QOL) of the primary caregivers (PCG). Knowledgeable PCG can efficiently manage children with these skin diseases and also improve their QOL.

Objectives:

To assess the subjective distress, family burden, and QOL, to develop and assess the short-term effectiveness of a psycho-dermatological education package (PDEP) for the PCG of children with EB.

Methods:

In this interventional study, 30 PCG of EB were assessed for subjective distress, family burden, and QOL. PDEP, a structured educational tool explaining the disease and its care and stress management, was developed by the authors for the PCG and administered to them after one month of enrolment. They were reassessed after three months and compared with the baseline assessment scores. For comparison, 37 PCG of CI were also studied.

Results:

The mean age (years) of the subjects was 28.7 ± 6.7 for EB and 30.5 ± 4.6 for CI. The mean or median (range) baseline scores for subjective distress, family burden and QOL of PCG (n = 20) of EB were 8.4 ± 7.9, 6.5 (0-30); 28.5 ± 17.5, 24 (7-77) and 12.6 ± 6.7, 11.5 (4-28) and for PCG (n = 14) of CI were 12 ± 4.3, 38.9 ± 16.2 and 17.7 ± 3.6 respectively. The PDEP improved the QOL (p = 0.01), knowledge (p < 0.01) and practices (p < 0.001) for PCG of EB and it improved subjective distress (p < 0.001), QOL (p < 0.01) and knowledge (p < 0.01) for PCG of CI.

Conclusions:

PDEP is an effective educational tool in improving the QOL and knowledge of PCG, which in turn provides efficient management and psychological support to children affected with EB and CI. It should, therefore, be routinely used for educating the PCG of children with EB and CI.
Non-Infectious Granulomatous Dermatoses
Authors: Chatterjee Debajyoti , Bhattacharjee Rajsmita , Saikia Uma Nahar
Published: November 2021

Granulomatous dermatitis (GD) is one of the commonest tissue reaction patterns encountered in dermatopathology practice. Granulomatous inflammation in the skin can be seen in a wide range of conditions, thus, granulomatous dermatitis always poses significant challenge even to the astute dermatologists and dermatopathologists. Broadly, granulomatous dermatitis is divided into two groups—infectious and non-infectious, the prevalence of both highly variable and show overlapping pathology. However, there are subtle histological clues, which when combined with clinical features, help to narrow down the differential diagnosis. Thus, a good Clinicopathological correlation (CPC) along with histochemical stains, culture and ancillary techniques including molecular studies are required for arriving at a definite diagnosis. In this review, we shall discuss the histological clues to diagnose non-infectious granulomatous dermatitis (NIGD) and their differential diagnoses.
Clinico-Epidemiological Characteristics of Hidradenitis Suppurativa
Authors: Kamat Divya , Gaba Sunil , Kumaran Muthu S.
Published: November 2021

Background:

Hidradenitis suppurativa (HS) is a chronic debilitating disease with a relapsing and remitting course. Due to delay in diagnosis, patients are often referred when the disease is very severe. Management strategies vary across multiple guidelines.

Aims:

The aim of this study was to analyze the demographic and clinical characteristics of patients with HS among our outpatient attendees and to study the outcomes of various treatments offered.

Methodology:

This was a retrospective cohort study analyzing case files and photographic records of all patients diagnosed with HS, presenting to our tertiary care institute over 18 months.

Results:

A total of 22 patients (10 males and 12 females) of HS were studied with majority having Hurley stage 2 and 3 diseases. The most common site affected was axilla. Overweight and obese patients were 45.4% and 18.1%, respectively. Rifampicin–clindamycin combination or doxycycline was the first line therapy offered. Adalimumab was given in only two patients but could not be continued for long term due to financial issues. Surgery was performed in six patients. Procedures included wide local excision and deroofing which is left to heal by secondary intention. Least number of remissions and most satisfactory improvement was seen with a combination of antibiotics and surgery compared to medical treatment alone.

Limitations:

Retrospective nature and a single center study were the major drawbacks.

Conclusion:

Patients undergoing procedural intervention in addition to pharmacotherapy have best overall outcomes and involvement of a multidisciplinary team plays a key role, however a larger follow-up study is required.
Prospective Study of Growth Factor Concentrate Therapy for Treatment of Melasma
Authors: Sthalekar Bindu , Agarwal Madhuri , Sharma Vijay , Patil Chetan Y. , Desai Maulek
Published: November 2021

Background:

Melasma is a common acquired pigmentary skin disorder. Currently, there are various treatment options available but none is effective universally.

Objective:

Assess the role of Yuskin®, a growth factor concentrate (GFC) therapy, a modified platelet rich plasma (PRP) technique for the treatment of melasma.

Materials and Methods:

Subjects of Fitzpatrick skin type IV–V, of either gender, more than equal to 18 years of age, with a clinical diagnosis of melasma were enrolled in the study. Total three sessions of GFC monotherapy were given with one-month interval (day 0, day 30, and day 60) and follow up of subjects was done at day 90 for the final clinical assessment.

Results:

Out of 40 subjects enrolled, 30 subjects completed three GFC sessions and 26, completed day 90 follow-up. Statistically significant decrease in the mean mMASI scores was observed at all visits compared to baseline (P < 0.005 for each visit). Totally, 66.7% of severe melasma subjects showed improvement to mild to moderate category. Significant improvement in mean mMASI score was seen in subjects who had mild to moderate melasma at baseline (P < 0.05). Overall, aesthetic improvement was reported in 88.5% of subjects. Side effects reported were mild such as injection site pain, erythema, oedema and bruising, and resolved spontaneously within a few hours to few days of onset.

Conclusion:

Significant improvement in melasma was observed with GFC monotherapy, which needs further confirmation in larger randomized controlled studies. Overall, it was well tolerated. Thus, GFC therapy can be a safe, effective, and new option in the armamentarium of melasma management.
Informed Consent in Biomedical Research
Authors: Chatterjee Kingshuk , Das Nilay K.
Published: November 2021

Medical science is evolving constantly and this evolution cannot happen without biomedical research involving human participant. Owing to a tumultuous history, importance of ethical research cannot be over emphasized in today's world and the concept of informed consent becomes the guardian of ethics, not only to improve the bonding between the participant and researcher aiding a wholehearted involvement but also ensuring safety for the participants from research related injury/loss. Subject information sheet (SIF) and Informed consent form (ICF) are the fundamental elements of informed consent document. Process of obtaining them from illiterate and vulnerable populations involves the legally authorized representative (LAR) and impartial witness. Audiovisual recording becomes important in case of clinical trials. Process of obtaining informed consent becomes challenging for vulnerable populations as well as during pandemic situations. A comprehensive informed consent is essential for a credible and ethical research.
Skin as a Mirror to Internal Malignancy
Authors: Batra Jayati , Aulakh Shayna , Chopra Dimple , Sarangal Rishu , Puri Sulabh
Published: November 2021

Squamous cell carcinoma (SCC) of the nail bed is not encountered commonly although it is the most common primary malignancy at this site. In general, it has a low rate of spread, except for high risk types which carry a greater risk of spread. Screening for systemic tumours should be done in all cases especially in the elderly. We present the case of a 67 year old male who was otherwise healthy and presented with just nail discoloration associated with pain and occasional profuse bleeding with minor trauma which turned out to be SCC of nail bed on biopsy. Subsequently, he was screened for internal malignancies and was found to have clear cell Renal cell carcinoma of right kidney and a metastatic nodule in right lung. This presentation has not been previously described in literature.
Ileal gastrointestinal stromal tumor presenting as retroperitoneal mass
Authors: Ergenç Muhammer , Uprak Tevfik Kivilcim
Published: November 2021

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal (GI) tract. It represents a wide range of clinical tumors with different clinical presentations, locations, and prognoses. Retroperitoneal GISTs are rarely seen and may be associated with the GI system. In this case report, we present the laparoscopic excision of retroperitoneal ileal GIST in a patient who was admitted to the outpatient clinic with abdominal pain.
Histopathological and immunohistochemical features of 14 peritoneal mesotheliomas with clinical outcomes and recent updates
Authors: Karmarkar Srushti , Rekhi Bharat , Deodhar Kedar K. , Menon Santosh
Published: November 2021

Background:

Malignant peritoneal mesotheliomas (MPMs) are rare tumors with overlapping clinical and histopathological features, especially with epithelial ovarian carcinomas (EOCs). There is no substantial documentation on these rare tumors from our country.

Objective:

To study the clinicopathological features including immunohistochemical (IHC) profile and clinical outcomes of 14 MPMs, diagnosed at our institution.

Materials and Methods:

This was a retrospective study, wherein 14 cases of MPM, occurring in female patients, diagnosed at our institution, between January 2008 and May 2019 were included, after a critical review.

Results:

Median age was 54.5 years. Most patients presented with ascites, omental nodularity, and fat stranding. Microscopically, most cases (11, 78.6%) displayed epithelioid morphology, followed by biphasic pattern (2, 14.3%) and a single case of well-differentiated MPM. IHC, diagnostic sensitivity and specificity of calretinin were 100% (13/13) and 85.7%; of HBME1 were 100% (5/5) and 100%; and of podoplanin (D2–40) were 60% (2/5) and 100%. Other positively expressed immunomarkers were epithelial membrane antigen (n = 2/5, 40%), cytokeratin 5/6 (n = 4/4, 100%), and WT1 (n = 9/10, 90%). Most patients (5/12, 41.7%) were treated with chemotherapy. The 3-year disease-free and overall survival rates were 25.7% and 54%, respectively, including improved survival trend in patients with epithelioid type of MPMs.

Conclusion:

MPMs are diagnosed with a combination of clinicopathological features and optimal IHC markers. Their differentiation from EOCs and other metastatic carcinomas is imperative in view of significant treatment implications.
Hepatoprotective and immune-reconstitution potentials of carrot-ginger blend among HIV-infected patients taking antiretroviral therapy in Kaduna, Nigeria
Authors: Joshua Zamani Pius , Abarshi Muawiyam Musa , Sani Ibrahim , Olumuyiwa Owolabi Adeyemi , Mada Sanusi Bello , Dallhatu Rhoda Yakubu
Published: November 2021

Hepatotoxicity, micronutrients insufficiency and cost of micronutrient supplements are challenges faced by HIV infected patients on antiretroviral therapy (ART). This study investigated the effect of natural plant micronutrients (vitamins A, C, and E, selenium and Zinc supplements from carrot-ginger (75:25) blend on liver enzymes: Alanine transaminase (ALT) and Aspartate transaminase (AST), CD4 +  T lymphocytes and body mass index (BMI) of HIV-infected-patients taking ART. Ninety HIV-infected-patients attending Special Treatment Clinic, Kafanchan General Hospital, Kaduna State, Nigeria, were randomized into three groups of thirty patients each: Group 1 is control group and received ART alone, Group 2 is standard group and received ART with ready to use commercial micronutrient supplement (SelACER supplement) while Group 3 is supplement group and received ART + Carrot-Ginger blend for 90 days. Serum Alanine, Aspartate transaminase, CD4 + T lymphocytes and BMI were assessed using standard methods at baseline (day 0), 30 days, 60 days and 90 days. The results indicated that patients on CarrotGinger blend and SelACER micronutrients supplements show significant (p<0.05) reduction in ALT and AST level. However, there was no significant (p>0.05) difference in patients treated with ART alone when compared to their baseline values. The results indicated that patients on carrot-ginger blend and SelACE® supplements had significant (p<0.05) increase in BMI, CD4+ T-cell counts, serum vitamins A, C, E, selenium and zinc from day zero. There was no significant (p>0.05) difference in patients treated with ART alone compared to their baseline values. In addition, patients on SelACE® supplement revealed significant (p<0.05) difference in their mean BMI, CD4+ T-cell counts, serum vitamins A, C, E, Selenium and Zinc compared to patients on carrot-ginger blend after 90 days. The results also indicated a strong positive association (r=0.97) between serum ALT and AST activity and between CD4+ T cell counts and body mass index (r=0.77) after 90 days. Therefore, micronutrients supplementation of HIV patients during ART treatment with Carrot-Ginger blend could also be a beneficial adjunct to ART due to its potentials to reconstitute the immune system and protect the liver in HIV individuals on ART.
Relaciones intergeneracionales del adulto mayor en la familia actual: una mirada contextual
Authors: Sánchez-Rogel Hugo , Zambrano-García Jorge , Sosa-Arteaga Francisco
Published: November 2021

Las relaciones intergeneracionales, tanto en el sistema familiar como en los sistemas que la rodean, se presentan como un elemento clave en la provisión de cuidados, intercambio de experiencias y convivencia social del adulto mayor. A partir de la presente revisión bibliográfica descriptiva que involucra estos conceptos, el objetivo se centra en sintetizar y analizar los diferentes factores contextuales que inciden en los vínculos intergeneracionales del adulto mayor y cómo éstas interacciones han ido cambiando a través del tiempo hasta la época actual. Se llegó a la conclusión que la diversidad de formas de vinculación intergeneracional, en paralelo a la interacción con la sociedad moderna, no garantiza que exista un intercambio de beneficio mutuo, el adulto mayor sigue en desventaja al evidenciarse una tendencia cada vez mayor a la libertad individual, la búsqueda funcionalidad social por parte de los miembros jóvenes, la percepción de la vejez como un “problema” dentro de la familia y en la sociedad.

Palabras clave: Adulto mayor, relaciones intergeneracionales, familia moderna, sistema familiar.
Pertinencia de la maestría en Psicología de la Universidad Técnica de Manabí
Authors: Rodríguez-Álava Leonor Alexandra , Quiroz-Fernández Luis Santiago , Zambrano-Acosta Jimmy Manuel
Published: November 2021

Para la creación de un programa tanto de pregrado como de posgrado, es necesario contar con una serie de requerimientos que permitan evidenciar la necesidad de ese proyecto en un contexto específico. En este trabajo se presenta un análisis del estudio de pertinencia de un programa educativo de posgrado realizado en la Universidad Técnica de Manabí (UTM). Los resultados obtenidos a partir del análisis estadístico descriptivo, permitió definir el perfil de salida del egresado de la maestría con Trayectoria de Investigación en Psicología, Mención Psicoterapia con orientaciones que pertenecen tanto al campo de la Psicología como de la Investigación.

Palabras clave: posgrado, psicología, psicoterapia, investigación.
Estrés laboral y clima organizacional en el personal operativo del Cuerpo de Bomberos
Authors: Moreira Darwin , Rodríguez-Álava Alexandra
Published: November 2021

El artículo se realiza con el objetivo de analizar el estrés laboral del personal operativo del Cuerpo de Bombero de Portoviejo y cómo esto podría estar influenciando en el clima laboral dentro de la institución. Por lo que fue necesario utilizar un método cualitativo para realizar un estudio de estas variables, a través del método descriptivo y analítico se ha podido analizar cada una de las interrogantes realizadas en el cuestionario aplicado al personal. Los resultados demostraron que le 56% presenta un nivel bajo de estrés y el 3% expresó tener un alto nivel a causa del trabajo realizado dentro de la institución. Con respecto al clima laboral el personal manifestó sentirse cómodos dentro de la institución, puesto que las personas que les dirigen son líderes comprometidos con el buen desarrollo de la institución y mantienen un alto nivel de compañerismo e inclusión entre el personal, sin embargo, un grupo minoritario expresó no sentirse muy a gusto con las actividades internas realizadas frecuentemente. Por lo que se pudo concluir que a pesar de contar un alto nivel de aceptación, es necesario tener en cuenta los valores de las personas para poder trabajar en el futuro en nuevas acciones o estrategias que puedan beneficiar al personal operativo del Cuerpo de Bomberos.

Palabras clave: Personal, Estrategias, Estrés, Clima Laboral, Satisfacción.
Psicoterapia sistémico familiar en el rendimiento académico
Authors: Célleri-Catigua Lennín , Barcia-Briones Marcelo Fabián
Published: November 2021

El objetivo del artículo es analizar la aplicación de la psicoterapia sistémica familiar en el rendimiento académico de los alumnos de educación básica que pertenecen a la Unidad Educación Girón de la cuidad de Manta, provincia de Manabí, Ecuador en el año 2021. En el proceso de la investigación se aplicó una metodología de carácter descriptivo, analítica y deductiva, con enfoque mixto; la técnica de la encuesta dirigida a los maestros sobre el rendimiento de los alumnos fue imprescindibles en esta investigación. En este estudio se tomó como población 43 personas distribuidos en 20 alumnos, 20 padres de familias a los que se les realizó psicoterapia sistémica familiar y 3 docentes, se aplicó la técnica de la entrevista, para obtener los resultados pertinentes, los cuales evidenciaron la relevancia de la psicoterapia sistémica familiar y su influencia en el desarrollo académico, centrando su accionar en el fortalecimiento emocional, cognitivo y psicológico que permita al infante desempeñar adecuadamente el rol que tiene que cumplir dentro del ámbito escolar, utilizando los recursos existentes en la búsqueda de mejorar su rendimiento académico, capacidades y habilidades de los seres humanos.

Palabras clave: Rendimiento Académico, Psicoterapia Sistémica Familiar, Vinculación, Desempeño, Evolución Familiar.
Psicoterapia a Superviviente de Suicidio con Trastorno Mixto de Ansiedad - Depresión mediante orientación Cognitiva
Authors: Gómez-Reyna Robert Rafael
Published: November 2021

Se describe un tratamiento desde la perspectiva cognitiva conductual a un paciente adolescente de sexo masculino, cuyo padre se suicidó cuando él tenía 6 años de edad. Joven que ha sufrido desde los doce años de edad múltiples episodios depresivos recurrentes y en la actualidad se suman síntomas característicos de ansiedad, reincidiendo en psicoterapias por el mismo motivo de consulta sin rehabilitación a su demanda. En el presente trabajo se plantean los objetivos y propuesta de sesiones para la intervención terapéutica del cuadro ansioso depresivo.

Palabras clave: suicidio, trastornos mentales, psicoterapia.
Producción de etanol celulósico a partir de la conversión de residuos agrícolas
Authors: Monroy-Intriago Luigi , Zambrano-Zambrano María , Latorre-Castro Gisela , Rosero-Delgado Ernesto
Published: November 2021

Los residuos agrícolas constituyen una fuente abundante de material lignocelulósico. Según su conversión física, química o biológica, el material lignocelulósico permite la obtención de etanol. Ésta es una solución al problema de la eliminación final de residuos celulósicos. El objetivo de este trabajo radicó en la determinación de condiciones adecuadas de pretratamiento (% de humedad y tamaño de partícula) para residuos agrícolas (maní, fréjol y arroz). Además, se evaluó el efecto de las condiciones básicas de hidrólisis a 2, 3 y 4% de NaOH a 25, 73 y 121 ºC durante 1 hora, en relación a la cantidad de azúcares reductores. Como resultado, la temperatura influye significativamente en la extracción de azúcares reductores. La fermentación alcohólica de cáscara de maní con S. cerevisiae produjo 4.579 mg de etanol/100 mg de azúcares reductores, en condiciones adecuadas de temperatura alta y concentraciones bajas de NaOH. Este resultado fue comparable al obtenido por otros autores.

Palabras clave: residuos agrícolas, conversión, etanol celulósico, azúcares fermentables.
My First Phone: Smartphones Android for Kids
Authors: Santos Álvaro , Gomes João , Gomes Anabela
Published: November 2021

Anybody can question the advantages of a kid having and starting to use a mobile phone. Nevertheless, from a certain age parents consider the use of mobile phones by kids quite useful. The mobile phone allows an easy communication between parents and children and permits child control. Furthermore, nowadays some Android smartphones have affordable prices that can bring new technologies and other opportunities to this domain. In this paper we present a system, that includes several new easy to use applications but with a set of advanced parent control features, to adapt the phone for child use and to minimize the risks.
Identification of Effective Leadership Indicators in Ghanaian Retail Banks Using AMOS Based Confirmatory Factor Analysis
Authors: Sanda Aminu , Kuada John
Published: November 2021

In the light of the importance of banks to the economic growth process in Ghana, this study sought to identify the determinants of effective leadership style that is appreciated by employees in retail banking firms in Ghana, towards providing practitioners with crucial information that could enable them make informed decisions towards improving the workplace. Using data collected from employees in eleven firms which were analyzed using the AMOS programme, minimum was achieved for the leadership measurement model and the goodness of fit statistics showed that the overall model fit quite well to the data. Based on the findings from both factor analysis and Confirmatory factor analysis, the study established that managers of retail banks in Ghana could be perceived by their employees as good leaders if they give employees full credit for the work that they do. Handling employee issues very well and taking care of their complaints as well as putting in place systems for enhancing employees’ career advancement into specialist departments or management positions are also perceived as good determinant of leadership. It is therefore hypothesized that managers of retail banks in Ghana could be perceived as good leaders by employees if they are seen as giving employees full credit for the work that they employees do at the workplace, handling employee issues very well and taking care of complaints brought up by employees, as well as putting in place systems for enhancing employees’ career advancement into specialist departments or management positions are also perceived as good leaders.
Sparsity Enhanced Beamforming in The Presence of Coherent Signals
Authors: Xu Bao Gen , Wan Yi He , Tang Si Long , Ding Xue Ke , Wan Qun
Published: November 2021

In order to find the directions of coherent signals, a sparsity enhanced beam-forming method is proposed. Unlike the conventional minimum variance distortless response (MVDR) method, the minimum variance in the proposed method corresponds to the orthogonal relationship between the noise subspace and the sparse representation of the received signal vector, whereas the distortless response corresponds to the nonorthogonal relationship between the signal subspace and the sparse representation of the received signal vector. The proposed sparsity enhanced MVDR (SEMVDR) method is carried out by the iterative reweighted Lp-norm constraint minimization. for direction finding of coherent signals. Simulation results are shown that SEMVDR has better performance than the existing algorithms, such as MVDR and MUSIC, when coherent signals are present.
EVALUASI SISTEM MANAJEMEN SUMBER DAYA MANUSIA PADA PENEMPATAN KERJA PETUGAS DI UPT PUSKESMAS MALINGPING
Authors: Febriani Mita Melisa , Hidayat Syamsul , Saepudin Saepudin
Published: November 2021

One of the important resources in management  is human  resources. The importance of human resources needs to be realized by all levels of management. However advanced technology is today, the human factor still plays an important role for the success of a Puskesmas. The study aims to evaluate the HR management system in planning, organizing, directing, and contolling the work placement of officers at Puskesmas Malingping. The type of research used in the research is qualitative fenomenology research, namely observation, in-depth  interviews and documentation. The resuls showed that the Puskesmas Malingping reports the shortage to the health office by looking at the vacancies in the health center. Health workers, midwives and nurses who do not have competence in the fields of management, UKP Pharmachy and laboratory analysis are forced to fill the vacancies in these sections due to a lack of manpower.
The conclusion of this researcher shows that the human resource management system at the puskesmas Malingping four aspects, namely planning, organizing, directing and controlling and its evaluation shows that the human resource management system in work placements at the puskesmas Malingping has not been maximized due to the lack of health works resulting in placement work that is not in accordance with the disiplince of science
ANALISIS KINERJA BPSPAMS TIRTO SUMBER MULYO SEBAGAI PERTIMBANGAN MENJADI UNIT BUMDES DI DESA MIJEN KECAMATAN KEBONAGUNG KABUPATEN DEMAK
Authors: Astohar Astohar , Savitri Dhian Andanarini Minar , Ristianawati Yuyun , Nugroho Prihansantyo Siswo
Published: November 2021

BPSPAMS Tirto Sumber Mulyo Mijen Village is one of the BPSPAMS in the District Kebonagung which has the task of managing water and sanitation at the village level. In the management of water and sanitation facilities at the village level it is necessary to assess the performance so that it can be evaluated for future follow-ups for the strategy or position of the management group that has been included in the BUMDes  Maju Lancar unit. This performance appraisal standard uses the performance appraisal standard from the 2020 Technical Guidelines for SPAMS Management. The results of the performance appraisal show that in general the performance of BPSPAMS Tirto Sumber Mulyo is in the medium category. Partially, it shows the performance of planning in the low category, in the high-performance administration and finance, on the performance of drinking water and sanitation services in the medium category and for the performance of the partnership in the low category. The hope in the future for improving the performance of BPSPAMS together with BUMDes Maju Lancar needs to collaborate or increase cooperation with external parties such as academics, practitioners and government institutions that can increase benefits and benefits for the public
Improvement of Information Technology and Its Impact on Information Security
Authors:   Yugra State University, Chekhov Street, 16, Khanty-Mansiysk, 628012, Russia, Avdeev Vadim Avdeevich , Avdeeva Olga Anatolievna , Smirnova Vera Vladimirovna , Rassolov Ilya Mihajlovich , Khvatova Maria Alekseevna
Published: November 2021

The article reveals the problems of information security in modern conditions with the globalization of international life, changing polycentric relations, taking into account the high rates of development in technical and information resources. The special importance of ensuring information security as an object of legal protection protected by international and national law is noted. The issues of eliminating conflicts in the norms of international law, preventing the possibility of their spreading to the territory of individual sovereign states, are being addressed. The correlation between the norms of international and national law emphasizes the expediency of improvement and adoption of new normative legal acts of universal and regional significance which can be used by member states when innovating national criminal and other sectoral legislation. It is a priority to improve international and national legal policy for the modernization of national legal systems for the prevention and combating of cybercrime. An effective mechanism of legal regulation for the objects to be legally protected is of fundamental importance for ensuring information security. Particular attention is focused on solving the issues of detection, disclosure and accurate legal evaluation of crimes and offences committed in cyberspace. The importance of the international community to establish universal standards to ensure information security is emphasized