bluuebunny/crossref_metadata_2025 huggingface dataset:
Case Pedagogy as a Strategy to Promote Critical Thinking Among Nursing Students
Authors: Ashipala Daniel O.
Published: October 2024

Case pedagogy remains one of the vital strategies to promote critical thinking and problem-solving abilities in nursing and midwifery education globally. In Namibia little research exists on the perspectives of nursing students on the use of a case pedagogy as a strategy to promote critical thinking in nursing and midwifery education. The purpose of this chapter is to explore the experiences of students on the use of case pedagogy as a strategy to promote critical thinking among nursing students. The study found that most students developed critical thinking skills and that they were equipped with problem solving skills which they can use for analysis and evaluations of their patients' conditions. Findings from this chapter may help identify strengths and weaknesses in the use of case pedagogy for assessment purposes in nursing and midwifery education.
Enhancing Graduates' Intercultural Competences and Awareness Through Cocreation in Higher Education
Authors: Tshabangu Icarbord , Lancaster Paul
Published: October 2024

In recent decades the world has found itself in an era of rapid globalisation and migration. In many contexts and cultures, citizens are still coming to terms with the implications of globalisation. The vital role that higher education (HE) institutions can play must not only be emphasised, but strategies, new approaches and initiatives also need to be embraced and adopted to ensure diversity is an advantage and not a source of conflict. It is further noted that notions of ‘interculturalism' are still not understood in many contexts and are still confused with ‘multiculturalism'. This chapter demonstrates that interculturalism goes beyond multiculturalism, and further locates its place and usefulness within Higher Education, particularly through co-creation efforts. The chapter posits a need for higher educational institutions to embed intercultural competencies, advance understanding of one's own culture and promote intercultural dialogue in multicultural contexts, especially in Higher education as part of bridging the skills gap and enhancing employability.
Framework for Implementing STEM Learning Technologies
Authors: Chasokela Doris
Published: October 2024

This book chapter proposes a framework for implementing STEM learning technologies to help students develop the 21st-century skills they need to succeed in the modern world. The framework focuses on four key elements: curriculum, instruction, assessment, and professional development. It also emphasizes the importance of partnerships with the community to provide students with opportunities to apply their skills and knowledge in real-world settings. This framework provides lecturers with a roadmap for integrating STEM learning technologies into the classroom in a way that is effective, engaging, and relevant to the needs of 21st-century students. The framework focuses on addressing the challenges that students face in developing these skills. The chapter outlines a step-by-step approach to implementing STEM technologies, from identifying the specific needs of students to evaluating the effectiveness of the technologies. It also discusses the importance of a collaborative approach, involving students, lecturers, and other stakeholders in the implementation process.
Leadership Perspectives on Talent Management in Saudi Universities
Authors: Subbarayalu Arun Vijay , Al Faraj Eshtiaq Abdulaziz , Al Kuwaiti Ahmed , Al-Muhanna Fahad A.
Published: October 2024

This chapter proposes an in-depth study of higher education leaders (HELs) in Saudi Arabia, with a particular focus on the challenges, obstacles and success factors of talent management (TM) in Saudi universities. A mixed methods study design was adopted in which a general literature review was conducted to uncover the skills gap in the higher education sector and its impact on university leadership, taking into account both the external and internal environments. In addition, a survey would be conducted among a wide range of university leaders, including rectors, vice-rectors, deans, vice-deans and department heads, on the existing TM practices in their respective universities. Through this approach, the authors have uncovered how HELs perceive and deal with the skills gap phenomenon, including the barriers and success factors in TM in their universities, with due consideration of the influence of both external market forces and internal institutional dynamics.
Requisite Employability Skills Among Engineering Students
Authors: Sethi Alpa , Toshniwal Ritu , Jangir Kshitiz
Published: October 2024

The role of technical education in the progress and growth of a nation is well acknowledged all over the world. In India the number of people entering into the technical education system has never been a problem. But the relevant problem has been the relative skills and employability of the people. The widening of skill gap and increase in the unemployability of engineering graduates has become a tremendous pain point for government as well as other stake holders. There is an urgent need to improve the technical education system and reducing the skill gap to convert youth into educated employable citizens for both their own development as well as the development of the Nation. The skills demanded by the industries are often not found in the engineering graduates and the skills that they possess are often termed as obsolete or are presently not needed by the employers. Hence, there is a need to identify the factors responsible for the widening gap. Therefore, paper focuses on detail analysis of various responsible factors for creating disparity between demand and supply.
Science, Technology, Engineering, and Mathematics Learning Technology Implementation to Address 21st-Century Skills
Authors: Chasokela Doris , Moyo Funa
Published: October 2024

The book chapter explores the integration of learning management systems and course/module software in science, technology, engineering, and mathematics learning and 21st-century skills in Zimbabwe's higher education. The chapter introduces the concepts of STEM and their importance for developing the skills needed for success in the 21st century. It presents an overview of the implementation of learning management systems and course/module software in the Zimbabwean higher education system. The potential benefits of these technologies for STEM are highlighted. In this chapter, it is argued that the integration of information and communication technology in the teaching of science, technology, engineering, and mathematics plays a crucial role in addressing quality-related issues. Finally, the chapter presents case studies of higher education institutions in Zimbabwe that have successfully implemented learning management systems and course/module software and describes the positive effects on student learning.
Challenges and Future Strategies for B-Schools
Authors: Zhuplev Anatoly , Valle Francisco J. , Rincón José J. , Plithides Max
Published: October 2024

This chapter examines the evolution of American higher education (HE) and business schools (B-schools) in the historical and contemporary strategic context. It explores the influence of the Humboldtian model on the contemporary HE industry in America. The chapter analyzes the current HE landscape, revenue sources, and global reach. The chapter investigates strategic disruptors like demographic shifts, skyrocketing costs of college and student loan burden, technological impacts, including proliferation of IT and AI, eroding public confidence in HE, and political and regulatory trends. The chapter explores solutions like accreditation reform and diversified credentials. It examines pressures on B-schools, including slow technology adoption and competition. It emphasizes the need for B-schools to embrace innovation, technology, and industry partnerships. The chapter concludes with a collaborative educational project focused on regional socio-economic development grounded in comparative analysis of best global practices, highlighting the potential of HE to address real-world issues.
The Rise of Online Learning and the Technological Revolution in Higher Education
Authors: Tshuma Lister Siphathisiwe , Chasokela Doris
Published: October 2024

The rise of online learning and the technological revolution in higher education are having a profound impact on the way learning and teaching are done. The rise of online learning has revolutionized the way students learn, with many institutions now offering a range of online courses. This shift has been driven by the increasing adoption of digital technologies, such as learning management systems, virtual and augmented reality, and artificial intelligence. The technological revolution in higher education has also enabled new models of education, such as massive open online courses (MOOCs), online degree programs, and competency-based education. Moreover, the rise of online learning has also created new opportunities for institutions to collaborate with industry partners, foster innovation, and develop new revenue streams. However, the technological revolution in higher education also poses challenges. This chapter explores the rise of online learning and the technological revolution in higher education, examining the key drivers, trends, and implications of this transformation.
Synergizing Sustainability and Innovation
Authors: Batta Kamal , Kumar Pawan
Published: October 2024

The field of transhumanism and green banking is a relatively new and important field of research that deals with the combination of cutting edge technical and human advancements with sustainable financial practices. The objective of this research study is to investigate this multidisciplinary subject through an extensive examination of the literature. The main goal is to comprehend how transhumanist technologies might assist green banking, which prioritizes ecologically friendly financial practices. The process entails a methodical examination of extant academic papers, industry reports and case studies. The selection of sources was focused and impact in the domains of transhumanism and sustainable finance. The overview identifies important ideas, practices and technical developments while highlighting the historical development of transhumanism and green finance. Results show that integrating transhumanism with green banking has a number of advantages, including improved operational effectiveness, novel financial services and favorable effects on society and the environment.
Repeated CXCR4 Blockade by Plerixafor Attenuates Transplant Vasculopathy in Murine Aortic Allografts
Authors: Theil Frank , Kuckhahn Annika , Hörning André , Völkl Simon , Knab Katharina , Fritz Niklas , Gräbner Cindy , Ramsperger-Gleixner Martina , Weyand Michael , Heim Christian
Published: October 2024

Plerixafor, a hematopoietic stem cell mobilization agent, increases the peripheral blood content of effector and regulatory T cells and may have beneficial effects on cardiac allograft vasculopathy. The aim of the current study was to evaluate its effects in a murine aortic allograft model using different application procedures. Allogeneic donor aorta grafts (n = 8/group) from C57BL/6 mice(H2b) were abdominally transplanted into CBA mice (H2k). Plerixafor application was performed either continuously for 14 d using abdominally implanted osmotic pumps (1 mg/kg/d) or i.p. with a single dose (1 and 5 mg/kg) on day 0 or pulsed injections of 1 mg/kg on days 0, 7, 14, and 21. Cell distribution was monitored by FACS. Aortic grafts were evaluated for neointima development by Elastica-van-Gieson on day 30. Immunofluorescence and intragraft gene expression analysis were performed. On day 14, significantly fewer hematopoietic stem cells were found in the bone marrow of all plerixafor-treated mice. In the pulsed application group, significantly more hematopoietic stem cells were found in the peripheral blood on day 14 (0.045 ± 0.002%; p < 0.01 [pulsed]; versus 0.0068 ± 0.002% [control]) and also more regulatory T cells. PCR revealed lower inflammatory cytokines. The luminal occlusion was significantly reduced in the pulsed treated group (33.65 ± 8.84 versus 53.13 ± 12.41) going along with decreased neointimal CD4+ T cell and plasmacytoid dendritic cell infiltration, as well as less smooth muscle cell proliferation. The application of plerixafor attenuates chronic rejection in aortic allografts via immunomodulatory effects. Injection of repeated low-dose plerixafor is the most effective application form in the aortic transplant model.
Study of an SSC-A09 Airfoil in Compressible Dynamic Stall with Freestream Mach Oscillations
Authors:   The Ohio State University, Hird Kyle , Frankhouser Matthew , Naigle Shawn , Gregory James , Bons Jeffrey
Published: October 2024

Particle image velocimetry (PIV) data was acquired over the upper surface of an SSC-A09 airfoil for the first thirty percent of chord. The test conditions included sinusoidal variation of pitch angle and Mach number, both in isolation and in tandem, in an unsteady transonic wind tunnel. The unique aspect of this study is experimental modelling of dynamic stall with oscillations of freestream velocity, along with the requisite pitch oscillations. Freestream velocity fluctuations are seldom studied in dynamic stall experimentation, but have been shown to be of first order importance to the dynamic stall characteristics. Furthermore, the time-varying freestream velocity of this work is in the compressible regime, with a mean freestream Mach number of 0.4 and fluctuation amplitude of 0.05. Other experimental conditions such as Reynolds number (1.8M to 3.7M based on chord) and reduced frequency (up to 0.05) were selected to match typical rotorcraft flight conditions. This work seeks to illuminate the physics governing formation and shedding of the dynamic stall vortex under these varying test conditions. Preliminary findings focus on the shear layer development and position, and unsteady compressibility effects that affect shedding of the dynamic stall vortex.
Passive Stabilization and Stability Quantification of Helicopter Sling Load Payloads
Authors:   US Army - NSRDEC, Nyren Daniel , Tardiff Marc , Desabrais Kenneth
Published: October 2024

Helicopter Sling Load, while the most accurate form of aerial delivery, can be the most costly and inefficient materiel delivery option due to payload instabilities. These instabilities cause a reduction in airspeed and, therefore, increase the risk of being exposed to enemy fire while in hostile areas, increase the time of delivery, reduce the effective mission range, and increase the mission cost. This paper describes the design, wind tunnel, and half-scale flight testing of several flexible (fabric) passive stability concepts, including rigging changes and materiel prototypes. The most successful device demonstrated was a fin attached between the aft two sling legs. This fin was simple to attach to the payload and could be compact enough to store in a pocket. A method of quantifying stability of tethered bluff bodies was also demonstrated as the integration of the Fast Fourier Transform in three primary load instability motions. This stability coefficient showed excellent correlation with qualitative data, and therefore could be used to rank effectiveness of stability devices.
Durable and Damage Tolerant Composite Aft Fuselage Technology
Authors:   The Boeing Company, Chiu Lisa ,   US Army AMRDEC ADD-AATD, Robeson Mark , McCarthy Dennis , Andrews Clark , Harris Aaron
Published: October 2024

Composite rotorcraft structures offer many benefits to today's warfighter. In addition to being lightweight to improve aircraft performance, structures fabricated from composites are exceptionally durable and damage tolerant. Boeing, the US Army's Aviation and Missile Research, Development and Engineering Center (AMRDEC), and the US Army's Aviation Development Directorate - Aviation Applied Technology Directorate (ADD-AATD) have proven the benefits of the Composite Aft Fuselage technology through ballistic and structural testing, culminating in the first successful live fire test and follow-on structural fatigue test of a composite tailboom for military rotorcraft. The durability and damage tolerance will be further demonstrated through an enhanced platform fatigue test, including the introduction of damage and composite field repairs. Documented herein are the background, load derivation, test setup, and results to date of two structural fatigue tests demonstrating the exceptional durability and damage tolerance of the Composite Aft Fuselage Technology through exercise of the composite tailboom.
Dynamic Wake Meandering Model Comparison with Varying Fidelity Models for Wind Turbine Wake Prediction
Authors:   Sandia National Laboratories, Ennis Brandon , Kelley Christopher , Maniaci David
Published: October 2024

The dynamic wake meandering model (DWM) is a common wake model used for fast prediction of wind farm power and loads. This model is compared to higher fidelity vortex method (VM) and actuator line large eddy simulation (AL-LES) model results. By looking independently at the steady wake deficit model of DWM, and performing a more rigorous comparison than averaged result comparisons alone can produce, the models and their physical processes can be compared. The DWM and VM results of wake deficit agree best in the mid-wake region due to the consistent recovery prior to wake breakdown predicted in the VM results. DWM and AL-LES results agree best in the far-wake due to the low recovery of the laminar flow field AL-LES simulation. The physical process of wake recovery in the DWM model differed from the higher fidelity models and resulted solely from wake expansion downstream, with no momentum recovery up to 10 diameters. Sensitivity to DWM model input boundary conditions and their effects are shown, with greatest sensitivity to the rotor loading and to the turbulence model.
Innovations in cancer diagnosis and treatment: prospects and challenges
Authors: Wisniewska Katarzyna , Marku Ervin , Ugurbas Martina Vidova , Hartmane Ilona , Shukurova Malika
Published: October 2024

The research relevance of cancer diagnostics and treatment is determined by its widespread occurrence and the lack of adequate modern diagnostic methods. The study aims to characterise new diagnostic methods, namely screenings in detecting cancer at early stages of development. To achieve this goal, the bibliosemantic and bibliographic methods were used. Main results. Cancer is the leading cause of morbidity and mortality after cardiovascular diseases and injuries in many countries around the world. Various diagnostic and treatment methods are used to combat this problem, including computed tomography, magnetic resonance imaging and positron emission tomography. In addition, modern diagnostic methods such as polymerase chain reaction, mass spectrometry and genomic sequencing play an important role in determining the types of cancer cells and their sensitivity to treatment. These advanced methods can be used to diagnose cancer more accurately and efficiently and choose the most appropriate treatment strategies for each patient. The practical significance of this topic is to ensure appropriate care for patients with cancer: providing high-quality, efficient, fast and minimally invasive diagnostics using the latest methods, as well as implementing a screening system.
Ethics and technological evolution in contemporary medicine
Authors: Martini Carlo Maria
Published: October 2024

Not available.
Ethical aspects of hormonal and mechanical contraception
Authors: Boiardi Giuseppe
Published: October 2024

Not available.
Hygiene today: achievements and perspectives
Authors: Vanini Giancarlo
Published: October 2024

Not available.
Sexually transmitted diseases: epidemiology, therapy and prevention
Authors: Rotoli Maurizio
Published: October 2024

Not available.
Humanisation of medicine
Authors: Morgante Giuseppe
Published: October 2024

The approach to the subject of humanising medicine is, in my view, obligatory. The demand for humanisation, which can also have ambiguous and equivocal aspects, arises from a society that is ill in many ways and is directed at a structure, the healthcare system, which is its mirror. The sickness of society has the symptoms and disturbing manifestations of the loss of values, of deresponsabilisation, of the pursuit of consumerist models, of peregrine fashions, of the culture of youthfulness, of activism as an end in itself.
Comparative Efficacy of Self-ligating Bracket Systems versus Conventional Bracket Systems in Orthodontic Treatment: A Systematic Review
Authors: Kambale Sahil Sunil , Handa Amit , Mane Dipali , Akansha Katkar , Srivastava Himanshu , Sarda Aditi
Published: October 2024

This systematic review aimed to compare the efficacy of self-ligating bracket (SLB) systems with conventional bracket systems in orthodontic treatment. A comprehensive search of electronic databases was conducted to identify relevant studies published up to 11. Inclusion criteria encompassed comparative studies evaluating orthodontic treatment outcomes between SLB and conventional bracket systems. Data extraction and quality assessment were performed independently by two reviewers. Key outcome measures included treatment duration, complications, patient-reported outcomes and clinical effectiveness. A total of 11 studies met the inclusion criteria and were included in the systematic review. Findings indicated comparable treatment durations between SLB and conventional bracket systems, with significant differences in complication rates. Patient-reported outcomes suggested more levels of comfort and satisfaction with SLB systems. In addition, clinical effectiveness measures, such as tooth alignment and occlusal outcomes, showed significant discrepancies in favour of SLB systems. However, there was variability amongst studies regarding specific clinical parameters assessed. Based on the findings of this systematic review, SLB systems demonstrate comparable efficacy to conventional bracket systems in orthodontic treatment. While both SLB systems exhibit lesser treatment durations, complication rates and patient-reported outcomes, further research is warranted to elucidate potential differences in specific clinical parameters and long-term treatment outcomes.
Exploring the Clinical Disconnect in Integrated Treatment Pathways for Craniofacial Structural and Functional Anomalies: Collaboration Challenges between Orthopaedic Surgeons, Paediatricians and General Practitioners Referring to Orthodontists
Authors: Sharma Richa , Joneja Purva , Sharma Durgesh Kumar
Published: October 2024

Introduction:

Orthodontic problems extend beyond mere tooth ailments, affecting overall bodily health. Neglecting them can result in severe illnesses, reducing quality of life and lifespan. Physicians must educate patients about the link between orthodontic health and general well-being, stressing the importance of treating dental issues to restore both oral health and smiles.

Materials and Methods:

This cross-sectional investigation included orthopaedic surgeons, paediatricians and general practitioners working in the government and private sectors. Knowledge, attitude and practice surveys were used for the study. Our analysis included 25 clinicians (n = 75) from each speciality.

Results:

Among the 25 paediatricians surveyed, only 52% (13) are referring patients to orthodontists, as indicated in the study. Of the 25 general physicians included in the survey, merely 12% (03) are sending patients to orthodontists, with the remaining 88% not making any referrals. Similarly, among the 25 orthopaedic surgeons surveyed, 52% (13) refer patients to orthodontists, while the rest do not refer to orthodontic specialists.

Conclusion:

A multidisciplinary approach is crucial in bridging the clinical gap among paediatricians, general physicians, orthopaedic surgeons and orthodontists. Integrated care models, through specialised clinics, provide comprehensive evaluations and patient treatment plans. Care coordination mechanisms such as joint consultations and shared decision-making platforms facilitate seamless communication among healthcare providers and empower patients in their care. Continuing education and technological advancements enhance collaboration, fostering teamwork and improving patient outcomes.
A Classical Manifestation of Eosinophilic Granulomatosis with Polyangiitis with an Unusual Catastrophic Outcome
Authors: Bhat Balachandra S , Imthiaz Niha Fathima , Shenoy Manjunath M. , Shariff MH
Published: October 2024

A 57-year-old male patient, with a known case of bronchial asthma presented with acute dyspnea, cough with expectoration, fever, severe myalgia, and pedal edema. On physical examination, he had tachypnea, high temperature, bilateral polyphonic rhonchi, audible wheeze, and asymmetric sensory and motor neuropathy. Cutaneous examination revealed multiple palpable purpuric lesions with few hemorrhagic bullae and crusted erosions distributed symmetrically over bilateral limbs suggestive of cutaneous small vessel vasculitis. Investigations showed elevated total counts, eosinophilia, deranged electrolytes, and abnormal liver and renal function tests. Histopathology revealed eosinophilic predominant vasculitis. Testing for perinuclear anti-cytoplasmic antibody was positive. A diagnosis of eosinophilic granulomatosis with polyangiitis (Churg–Strauss disease) was thus confirmed. The patient succumbed in 2 weeks due to multi-organ failure. All the characteristic findings were found in our patient, but a fatal outcome in a very short period after diagnosis was an unusual presentation.
Recurrence Rate and Associated Factors of Primary Fallopian Tube Carcinoma in the South of Vietnam
Authors: Vo Tuan , Nguyen Duy , Ho Thang , Tran Hoang , Nguyen Dat , Bui Thuong , Cao Thinh , Vo Brian
Published: October 2024

Objectives:

This study aimed to determine the recurrence rate and related risk factors of primary fallopian tube cancer (PFTC).

Materials and Methods:

We conducted a retrospective study of 47 patients with histopathological diagnosis of PFTC treated at Tu Du Hospital between January 1, 2015, and July 31, 2022. The cumulative recurrence rate was estimated using the life table method, and recurrence-associated factors were determined using the Log–rank test and Cox proportional hazard model.

Results:

The median follow-up period was 40 months (range, 7–96 months). Eight patients (17.0%) experienced recurrence. The cumulative recurrence rate of PFTC patients at 12 months was 4.4% (95% confidence interval [95% CI]: 1.12–16.45), at 24 months was 9.1% (95% CI: 3.52–22.5), at 36 months was 14.9% (95% CI: 6.92–30.41), at 48 months was 19.3% (95% CI: 9.35–37.24), and at 60 months was 25.7% (95% CI: 12.68–47.88). A higher recurrence rate was significantly associated with elevated pretreatment CA 125 level (<35 U/mL vs. ≥35 U/mL, hazards ratio [HR] = 36.9, 95% CI: 1.47–921.37), advanced FIGO stages (Stage I-II vs. stages III, HR = 6.61, 95% CI: 1.18–36.93), and suboptimal debulking surgery (residual disease ≤1 cm vs. residual disease >1 cm, HR = 7.52, 95% CI: 1.47–38.49).

Conclusion:

The overall recurrence rate of PFTC patients in Southern Vietnam was 17.0%. Appropriate follow-up strategies for patients with high-risk factors are needed for early detection and management of recurrence.
Management of Large Ovarian Tumors in Elderly Patients Using the Aron Alpha Method and Principles of Enhanced Recovery after Surgery
Authors: Kakinuma Kaoru , Kakinuma Toshiyuki , Kaneko Ayaka , Takeshima Nobuhiro , Yanagida Kaoru , Ohwada Michitaka
Published: October 2024

Objectives:

We performed preoperative evaluations of giant ovarian tumors in older adult patients using the comprehensive geriatric assessment (CGA) and estimation of physiologic ability and surgical stress (E-PASS) scoring systems. We report a case in which the Aron Alpha method was performed, and perioperative management was performed using enhanced recovery after surgery (ERAS).

Materials and Methods:

We performed preoperative evaluations using the E-PASS scoring system and CGA on older adult patients with giant ovarian tumors, followed by the minimally invasive Aron Alpha method and perioperative management using ERAS.

Results:

The mean patient age was 75.8 ± 8.8 years; comorbidities included hypertension in three patients, hyperlipidemia in two, angina pectoris in one, cholecystitis in one, and lower extremity varicose veins in one. The mean tumor size was 21.0 ± 5.4 cm. The E-PASS scoring system showed a preoperative risk score of 0.7 ± 0.4, a surgical stress score of 0, and a comprehensive risk score of 0.3 ± 0.3. CGA showed that two patients had problems with activities of daily living and cognitive function. The mean duration of surgery was 89.0 ± 16.6 min, and the mean blood loss was 56.0 ± 65.4 mL. No surgery-associated complications were observed. No patients had prolonged hospitalization or a decline in activities of daily living.

Conclusion:

We showed the usefulness of performing detailed preoperative evaluations using CGA and the E-PASS system, followed by the minimally invasive Aron Alpha surgical method and perioperative management using ERAS in improving surgical outcomes in older adult patients with giant ovarian tumors.
Cardiac Magnetic Resonance Imaging Findings in COVID-19: Experience from a Tertiary Care Center of North India
Authors: Singhal Manphool , Sharma Arun , Devkota Shritik , Bhatia Harsimran , Barwad Parag , Otaal Parminder Singh , Bahl Ajay
Published: October 2024

Purpose:

Here, we describe cardiac magnetic resonance imaging (CMR) findings in patients with proven COVID-19 infection and presenting with cardiac problems both at presentation and in convalescence from a tertiary care center, in North India. A pertinent review of the literature is also discussed.

Materials and Methods:

Retrospective analysis of patients with real-time reverse transcriptase-polymerase chain reaction proven COVID-19 infection either at presentation or convalescence referred for CMR at our facility from January 2021 to December 2023 was done. CMR was performed on a 3T system (Ingenia, Philips Healthcare, Best, The Netherlands) and examinations were customized according to the clinical indications.

Results:

Retrospective analysis yielded 14 patients (4 at presentation; 10 in convalescence). Patients at presentation 4/14 had clinically presented with chest pain with raised troponins and electrographic abnormalities, while 10/14 patients had presented with clinical features of heart failure with two-dimensional transthoracic echocardiography demonstrating systolic dysfunction with reduced left ventricular ejection fraction. Out of 14, 4 patients at presentation, CMR showed features of acute myocarditis in three patients, while one had inferior wall myocardial infarction (MI) (this patient on catheter angiogram had aneurysmally dilated coronary arteries with thrombus and stenosis in the mid right coronary artery which was successfully stented). Out of 14, 10 patients on CMR had features of dilated cardiomyopathy (DCMP).

Conclusion:

Cardiac involvement in COVID-19 can have vivid clinicoradiological presentations with features of myocarditis and MI at presentation or DCMP in convalescence. CMR in such cases is a problem-solving tool where myocarditis is candidly differentiated from MI. Moreover, follow-up CMR demonstrates temporal changes in COVID-19-associated myocarditis and evaluation of cardiac structure and function in patients presenting with DCMP.
Impact of Insurance Status on Clinical Management and Outcomes of Patients with ST-Segment Elevation Myocardial Infarction: Findings from the Kuwait Catheterization Laboratory Project Registry
Authors: Almoosawy Sayed Abdulmotaleb , Esmaiel Abdullah , Farrag Ibrahim , Al Jarallah Mohammad , Zubaid Mohammad
Published: October 2024

Background:

Emerging evidence from various countries suggests that ST-segment elevation myocardial infarction (STEMI) patients with differing health-care insurance types experience discrepancies in clinical management and outcomes. Kuwait government provides free essential treatments and medications to noninsured patients with certain emergency conditions. We aimed to compare differences in clinical management and in-hospital and 30-day outcomes in STEMI patients with different insurance types in Kuwait.

Methods:

Data were derived from Kuwait Catheterization Laboratory Project (Kuwait CLAP) registry. Adult patients (≥18 years) diagnosed with STEMI were enrolled in Kuwait CLAP registry between February 2020 and February 2021. Patients were categorized into insured and noninsured. The coprimary outcomes were the in-hospital and 30-day mortality in insured versus noninsured patients with STEMI. In-hospital and 30-day adverse cardiac outcomes were also compared.

Results:

Of 668 patients with STEMI, 116 (17%) were insured and 552 (83%) were not insured. Three (2.6%) of the insured and 9 (1.6%) of the noninsured patients suffered in-hospital mortality, while no patients in the insured group and four patients (0.7%) patients in the noninsured group suffered 30-day mortality, with no significant difference between the two groups (P = 0.447 and P = 1, respectively). The rates of in-hospital complications and 30-day adverse events were similar between the two groups.

Conclusions:

Our findings suggest no differences in acute or short-term outcomes among patients with different insurance status in Kuwait. These findings are reassuring knowing that the free essential services provided by Kuwait government for STEMI patients did not compromise the outcomes of noninsured compared to insured patients.
Acute Pericarditis Manifesting as Persistent Chest Pain Following Primary Percutaneous Coronary Intervention: A Missed Diagnosis
Authors: Mohanty Vivek , Goswami Sourabh , Choudhary Rahul
Published: October 2024

Percutaneous coronary intervention (PCI) is a very rare cause of acute pericarditis. It usually develops after a latent period but can present early in case of procedural complications. A high degree of suspicion is required for diagnosis as most cases can be easily missed. Here, we highlight a case of 54-year-old admitted as a case of non-ST elevated myocardial infarction who in view of ongoing chest pain underwent urgent coronary angiography, followed by the primary PCI to left anterior descending artery after which the patient became pain-free. However, 12 h after the procedure, the patient developed severe persistent chest pain with positional and respiratory variation. He was suspected to have reinfarction and treated accordingly but had no symptomatic improvement and was planned for check angiography. However, based on dynamic electrocardiogram (ECG) changes, new echocardiographic findings aided laboratory parameters, he was diagnosed with acute pericarditis. He was treated with nonsteroidal anti-inflammatory drugs following which his pain resolved and ECG returned to baseline after 4 days. His follow-up echocardiography showed complete resolution of pericardial effusion. This case highlights the importance of keeping acute pericarditis as a differential diagnosis of chest pain in PCI patients. A high degree of suspicion is required, as most cases are easily missed to diagnose.
Sociodemographic Factors and Antenatal Service Utilization among Severe Acute Malnutrition Children under 2 Years of Age, Western India (Rajkot, Gujarat) – A Hospital-based Case-Control Study
Authors: Bhitora Rujal D. , Gosalia Vibha V. , Solanki Harsha M.
Published: October 2024

Severe Acute Malnutrition (SAM) is multifactorial including poor maternal health, sociodemographic factors, and poor quality of diet of both the mother and child. Present study was carried out to determine sociodemographic factors and antenatal service utilization for SAM occurrence. This hospital-based case-control study was carried out from April 2021 to April 2022. Cases (77) and controls (77) were matched for age and sex with 1:1 ratio. Cases were selected from Nutritional Rehabilitation Centre and controls from an immunization clinic using WHO’s Multicentric Growth Reference Study Criteria 2006. Mothers of study participants were interviewed by using semistructured questionnaires. The weight and height of study participants were measured. The odds of children having SAM increased significantly with illiterate parents, working mothers, and labor work of fathers. The absence of toilet facility at home and poor hygienic practices of mothers were significant risk factors. Mother’s <4 antenatal visits, home deliveries, and participants with low birth weight were associated with SAM. Logistic regression stated laborer fathers, poor hand washing practices of mothers, absence of toilet facility at home, and low birth weight of study participants were found independent determinants for SAM. Risk factors identified in the present study are modifiable and can be addressed through health system interventions.
Influence of Health-Seeking Behavior on Treatment Initiation of Cancer Patients at a Tertiary Care Hospital in Varanasi
Authors: Kesh Nishu , Pandey Manoj , Kansal Sangeeta
Published: October 2024

Background:

Cancer is one of the leading causes of death worldwide, and in order to prevent it, it is vital to understand cancer patients’ health-seeking behavior that contributes to patient delays in receiving cancer treatment globally; however, no similar studies have been conducted in India. Therefore, this study made an effort to know health-seeking behavior among delayed cancer patients receiving treatment at a tertiary care hospital, Varanasi.

Methods:

A cross-sectional study was conducted at the Department of Surgical Oncology OPD, Sir Sunder Lal Hospital, IMS, BHU, Varanasi. Randomly selected 440 registered patients were interviewed with the help of semi-structured questionnaire. Binary logistic regression analysis and 2-test were used in this study.

Results:

Out of total 440 patients included in this study, 207 (47.05%) were males and 233 (52.95%) were females. The majority (59.32%) of patients were more than 45 years of age group. Most (80%) of the patients had delay in cancer treatment of more than 60 days from onset of symptoms. Only 29.55% of patients were aware of any symptoms of Cancer. Those patients who were doing self-medication (P=0.03) and did not attend any cancer screening program (P=0.04) showed a statistically significant association with delayed initiation of treatment. Patients referred from another centre (P = 0.03) also show a significant association with delayed treatment initiation. Cancer patients who visited the screening program (AOR= 0.22, P=0.003) were significantly associated with a lower likelihood of delayed treatment initiation.

Conclusion:

The study showed that 80% of patients were delayed in seeking treatment for Cancer and highly influenced by low awareness, self-medication and visiting multiple health centres for diagnosis and treatment. Therefore, there is a strong need to address the reasons for the delay in seeking treatment.
Microneedling - A Novel Cosmetic Therapeutic Approach for Management of Gingival Hyperpigmentation and Review of Literature
Authors: Mangal Srashti , Lele Priya , Dodwad Vidya , Yewale Manasi
Published: October 2024

A beautiful smile boosts an individual’s self-confidence. The harmony of a smile depends on the shape, colour, and position of teeth, as well as the gingival tissue. Excessive gingival pigmentation is a major aesthetic concern for many people. Gingival hyperpigmentation is usually caused by an abnormal accumulation of melanin in the gingival tissue, which gives the gingiva a dark appearance. A variety of different modalities have been proposed for removing hyperpigmentation like Scalpel technique, LASER, Radiotherapy, Electrocautery, Bur abrasion, Chemical methods etc. Though the initial results of depigmentation procedures are promising, repigmentation is a common problem associated with them which poses a financial burden to the patient. To overcome this hurdle, a promising novel technique which is in vogue in cosmetic dermatology is Microneedling. Microneedling is a minimally invasive, cost effective, simple procedure that creates microholes to facilitate the penetration of topical medications across the connective tissues. The procedure activates the natural healing process, promoting the regeneration of epithelial cells and the breakdown of clusters of melanin pigment. This article gives an insight regarding microneedling technique and also discusses in depth regarding melanin synthesis, classification, indices, etiology, gingival depigmentation procedures, and repigmentation.
Surgical Management of Impacted Supernumerary Tooth and Odontome under General Anesthesia in an Emotionally Immature Child: A Case Report
Authors: Dua Rasleen , Vashisth Pallavi , Naik N. Sathyajith , De Sriparna
Published: October 2024

The disorder known as hyperdontia is characterized by an excess of teeth or teeth that appear to be added to the normal amount of teeth. With a frequency ranging from 0.1% to 3.9% in permanent dentition and from 0.3% to 1.8% in deciduous dentition, it affects males more often than women. Since children’s cognitive abilities are still developing in comparison to adults’, children freely communicate their worry and anxiety and frequently exhibit uncooperative behavior patterns while undergoing treatment. A 7-year-old child who was emotionally immature reported with a principal complaint of missing tooth in his left upper front tooth area for 2 years. Cone-beam computed tomography was advised to verify location and structural interaction with neighboring structures. Due to his lack of emotional sensitivity and cooperation with others, we planned the surgical extraction under general anesthesia. In the present case, it was deemed preferable to wait for a spontaneous eruption, and the patient was observed for a month on a regular basis.
History of Diabetes: Series 1 Diabetes Care in Antiquity and Beyond: The Preinsulin Era
Authors: Johnson Brijit , Krishnan Gopika , Kesavadev Jothydev
Published: October 2024

Diabetes as a disease dates back to ancient times. Before the 1920s, treatment was rudimentary and largely ineffective, focusing primarily on dietary management, herbal remedies, and lifestyle modifications. Ancient civilizations, including the Egyptians, Greeks, Chinese, and Indians, recognized diabetes through symptoms such as excessive thirst and urination. They used “natural” treatments, such as dietary restrictions, physical exercise, and medicinal herbs such as fenugreek and bitter melon. Islamic scholars in the medieval period made significant advancements, recommending balanced diets and specific herbal treatments. In Europe, the preinsulin era saw the implementation of starvation diets in the early 20th century, aiming to control blood glucose by severely restricting caloric intake, though often at the cost of malnutrition. These historical approaches reflect the evolving understanding of diabetes and underscore the desperate need for effective treatments, setting the stage for the revolutionary discovery of insulin in the early 20th century.
Evaluation of the level of tumor necrosis factor-alpha and lactate dehydrogenase in acute lymphoblastic leukemia patients
Authors: Ahmed Raghad Yaarob , Al Hatem Zainab Issam
Published: October 2024

BACKGROUND:

Acute lymphoblastic leukemia (ALL) is an abnormal clonal proliferation of early hemopoietic precursor cells in bone marrow (BM). There are certain cytokines like tumor necrosis factor alpha (TNF-α) which plays a crucial role in the development and progression of malignant process, and other enzymes like lactate dehydrogenase (LDH) which has prognostic value.

OBJECTIVE:

The aims of this study were to evaluate the level of serum TNF-α and LDH in ALL patients at diagnosis and post-induction chemotherapy.

PATIENTS, MATERIALS, AND METHODS:

This was an observational–analytical study, which was done in Ibn-Sina Teaching Hospital in the period between May 2023 and November 2023. It included 22 newly diagnosed patients with ALL. All patients underwent complete blood count, bone marrow examination, flowcytometry, serum TNF-α and LDH at diagnosis and post induction chemotherapy.

RESULTS:

In 22 patients with ALL, at diagnosis, the means of serum TNF-α (97.89 ± 52.945 ng/l), serum lactate dehydrogenase(1138.94 ± 430.10 IU/l), and percentage of blasts cells in BM (0.742 ± 0.181) in B-ALL. The means of serum TNF-α (165.33 ± 23.437 ng/l), serum lactate dehydrogenase (1633.33 ± 497.426 iu/l), and percentage of blasts cells in BM (0.816 ± 0.125) in T-ALL were statistically higher than those among the controls (s.TNF-a (18.09 ± 6.795 ng/l), s.LDH (142.59 ± 61.626 IU/l), and percentage of blasts cells in BM 0.0 ± 0.0) with P = 0.000 for all parameters mentioned, respectively. After induction phase chemotherapy in B-cell ALL , there were a significant reduction noted for serum TNF-α (29.26 ± 18.648 ng/l) and LDH levels (245.47 ± 154.592 IU/l) and a significant decrease in the percentage of blasts cells (0.07 ± 0.060).also in T-cell ALL there were a significant reduction noted for serum TNF-a (26.00 ± 11.135 ng/l) serum LDH (347.66 ± 160.300 IU/l) and percentage of blasts cells in bone marrow (0.06 ± 0.046). All of the postchemotherapy acute leukemia cases with lower TNF-α levels had complete remission (100%).

CONCLUSIONS:

There were significant increases in serum TNF-α and LDH in ALL patients at diagnosis; while after induction, there was a significant reduction in their levels. Complete remission from the disease was associated with lower levels of serum TNF-α in newly diagnosed patients.
Lysine (K)-specific methyltransferase 2A (KMT2A) rearrangements among Iraqi de novo acute myeloid leukemia
Authors: Al Jadir Riyam Qusay , Abdulameer Saba Abdulmahdi , Alalsaidissa Jaffar Nouri , AlJabban Ali
Published: October 2024

BACKGROUND:

The classification of acute myeloid leukemia (AML) has evolved extensively over the last 20 years significantly, impacting the diagnosis and prognosis of the patients. The lysine (K)-specific methyltransferase 2A (KMT2A) gene, which has more than 80 gene fusions, is present in approximately 10% of all leukemias. Most KMT2A rearrangements are associated with adverse prognosis and need heavy chemotherapy protocol upfront.

OBJECTIVE:

This study aims to study the prevalence of KMT2A gene fusion among Iraqi patients with AML and its association with clinical and hematological parameters and patients’ outcomes.

PATIENTS, MATERIALS, AND METHODS:

A prospective cohort study conducted between December 2020 and May 2022 enrolled 115 Iraqi adults newly diagnosed with AML at the Hematology Unit of Baghdad Teaching Hospital. The patients were also monitored at this facility during the study period. Genetic rearrangements were detected using the Leukemia Q-Fusion Screening Kit through Real-Time Quantitative Reverse Transcription PCR (RT-qPCR) analysis.

RESULTS:

KMT2A rearrangements were identified in 23 (20%) patients. The most common was t(10;11) which presented in 15 (13%) patients, followed by t(9;11) in 5 (4.3%) patients and t(11;17) in 3 (2.6%) patients. Patients with KMT2A rearrangements were significantly older and more likely to have splenomegaly. At 1-month posttreatment, they had significantly lower red blood cell counts and hemoglobin levels and higher blast percentages. Only 4.3% achieved complete remission (CR) compared to 76.1% without KMT2A rearrangements, with a significantly higher mortality rate (30.4% vs. 5.4%, P = 0.0001). Regarding the treatment response, no significant differences were observed among the different fusion types of KMT2A rearrangements.

CONCLUSION:

KMT2A rearrangements are more prevalent among Iraqi AML patients compared to the global trend and are associated with older age, higher rates of splenomegaly, poorer hematological recovery, and worse outcomes, regardless of the KMT2A rearrangement fusion type.