bluuebunny/crossref_metadata_2025 huggingface dataset:
Future Trends in AI and Digital Forensics
Authors: Zangana Hewa Majeed , Li Shuai
Published: December 2024

As artificial intelligence (AI) continues to evolve, it is reshaping the landscape of digital forensics, introducing new tools, methodologies, and challenges. This chapter explores the anticipated future trends in AI that are poised to transform digital forensic practices. Key areas of focus include the integration of machine learning for enhanced evidence analysis, AI-driven automation for streamlining investigative processes, and advances in natural language processing to improve data interpretation. The chapter also addresses emerging challenges such as adversarial AI, ethical considerations, and the complexities of handling AI-generated evidence. By examining these trends, the chapter aims to provide a comprehensive overview of the trajectory of AI in digital forensics and its potential impact on forensic methodologies, legal frameworks, and cybersecurity.
Foundations of Adaptive Technologies in Inclusive Education
Authors: Çela Eriona , Fonkam Mathias M. , Vajjhala Narasimha Rao
Published: December 2024

This chapter lays the foundation for exploring the transformative potential of adaptive technologies in inclusive education. This chapter examines the principles of adaptive education, emphasizing its role in addressing the diverse needs of learners, particularly students with disabilities. The discussion highlights the integration of assistive technologies and artificial intelligence as critical tools for fostering equity, accessibility, and engagement in educational environments. By addressing key barriers such as cost, accessibility, and teacher preparedness, the chapter advocates for the adoption of innovative and inclusive practices to empower all learners. Grounded in interdisciplinary research and ethical considerations, this chapter sets the stage for understanding how adaptive technologies can reshape education systems to create a more inclusive and equitable future for students worldwide.
The Role of Assistive Technology in Education
Authors: Chakabwata William
Published: December 2024

This chapter examines the availability and accessibility of assistive devices and technologies in four Southern African Development Community (SADC) states—Namibia, South Africa, Zambia, and Zimbabwe. While assistive devices hold great potential for enhancing learning and supporting people with disabilities, their accessibility remains limited due to high costs and reliance on imported products. Moreover, the distribution of these devices is predominantly focused in urban areas, leaving individuals with disabilities in rural settings without the essential educational and support tools they need. Grounded in the principles of Ubuntu and intersectionality, this chapter highlights the urgent need for governments to prioritize the development of locally produced assistive technologies. It also advocates increased investment in assistive devices to promote equitable access and advance the realization of inclusive education across the region.
VR Interventions for Students With Intellectual Disabilities
Authors: Göksu Hüseyin , Eryilmaz Selami
Published: December 2024

This chapter explores the development and evaluation of a virtual reality (VR) application designed to enhance learning for students with mild intellectual disabilities. The application focuses on teaching eight foundational concepts—“few,” “many,” “large,” “small,” “far,” “near,” “long,” and “short”—through an adaptive, sequential learning approach. Each concept is unlocked only after the student demonstrates mastery of the preceding one, ensuring a structured and progressive learning experience. Developed using Unity software, the application leverages immersive technology and was tested with the Oculus Quest 2 headset. A pilot test was conducted at a vocational high school in Antalya with the participation of a student with mild intellectual disabilities under the guidance and supervision of their teachers. The findings contribute to understanding how VR technology can support personalized and accessible education for students with special needs.
Use of enabling technologies with industry 5.0 to align with sustainability in the construction industry
Authors: Kavirathna A. S. , Perera B. A. K. S.
Published: December 2024

The shifting industrial landscape of Industry 5.0 demands adaptability to technological advancements, emphasising human-machine interaction. The enabling technologies facilitate the transition from Industry 4.0 to Industry 5.0, ensuring technological advancements align with human well-being and sustainability. However, limited literature exists on their application with Industry 5.0 in construction, particularly focusing on sustainability. Addressing this gap, this study investigates how to use enabling technologies with Industry 5.0 to align with sustainability in the construction industry, through a qualitative research approach, employing two rounds of semi-structured expert interviews using the Delphi technique. Manual content analysis was used to analyse the empirical data. Findings revealed that human-centricity, sustainability, and resilience are key elements of Industry 5.0 validating their applicability in construction. This study further highlights nine enabling technologies, including Artificial Intelligence, Collaborative Robots, and Digital Twins as the most impactful for transforming the construction to Industry 5.0. Detailed insights were gathered on leveraging these technologies with each Industry 5.0 element. The findings underscore the importance of integrating these advanced technologies to improve efficiency, safety, and sustainability in construction projects. This research provides strategic insights for industry stakeholders to adopt Industry 5.0 principles, promoting smarter, more resilient, and sustainable construction practices.
Analyzing numerical simulation of ventilation system and filter membrane: The exposure of airborne nanoparticles in health interior Space
Authors: Sami M. G. , Dola M. Y. , Morshed A.
Published: December 2024

Improving air quality in indoor areas or interior spaces is a vital need. High PM 2.5 concentration or excessive air pollution causes severe damage to human health and the respiratory system. Air ventilation systems in health spaces are more necessary as there is a higher human crowd flow in viral-susceptible areas. The recent COVID situation has made us rethink the re-arrangement of hospitals' interior space and air ventilation systems. For that reason, improving high-efficiency particulate air filters is the need of the hour. The main objective of this research is the optimization and redesign of the air filtration system in health centers by integrating a hybrid combination system of HEPA filters based on computer modeling and numerical simulation. To analyze the effectiveness of the hybrid system, first, we simulated the existing air filtration system by using a successful and proven air filtering computational model in COMSOL Multiphysics. After that, we generated comparative numerical results and graphical analysis obtained by COMSOL to demonstrate the competency of the hybrid system over the conventional air filtration system. Finally, we have shown the most optimum and effective way to implement the hybrid system in health centers by analyzing the Computational Fluid Dynamics of different types of opening and ventilation systems. This research will play an essential role in future interior air quality improvement and effective anti-viral design of health spaces.
The Darkness Inside: A Case Report of a Rare Case of Black Pleural Effusion
Authors: Saikia Manashjyoti , Hazarika Basanta , Begum Farjana
Published: December 2024

Abstract

Black pleural effusion (BPE) is an extremely rare entity. This report aims to increase the attention of chest physicians to the differential diagnosis and management of unfamiliar cases of BPE. BPE may occur as a result of fungal Aspergillus niger or Rhizopus oryzae infection, metastatic melanoma, adenocarcinoma, pancreaticopleural fistula (PPF), hemolysis after massive intrapleural bleeding, or other miscellaneous causes. A stepwise approach is needed to evaluate the proper diagnosis including chest X-ray, diagnostic thoracocentesis, cytology and culture of the pleural fluid, thoracic or thoracoabdominal computed tomography, and tissue biopsy for pathological examination. BPE is not a common entity and may hide critical diseases including invasive pulmonary aspergillosis, metastatic melanoma, lung cancer, and PPF, thus awareness of this rare entity is crucial to prevent subsequent complications and to avoid delayed diagnosis of the underlying cause.
Hematological Abnormalities in Patients with Chronic Kidney Disease (Stage V): A Cross-Sectional Observational Study
Authors: Bhattacharyya Purnakshi , Thakur Subrata , Das Dwijen
Published: December 2024

Abstract

Background:

With over 10% of the global population affected, chronic kidney disease (CKD) has become one of the leading causes of death and suffering in the twenty-first century.[1] The Global Burden of Disease studies indicate that CKD has become a major cause of death globally, despite a decrease in mortality among individuals with end-stage CKD.[2-4] To lower the death rate, prompt implementation of all preventative and therapeutic measures, early diagnosis, monitoring, and treatment is necessary. The hematological markers change with CKD progression and are useful in determining the disease’s prognosis.

Aims:

We aimed to study abnormalities in various hematological parameters in patients with stage V CKD undergoing maintenance hemodialysis.

Settings and Design:

Hospital-based cross-sectional observational study.

Materials and Methods:

Hematological parameters such as red blood cell (RBC) count, hematocrit (HCT), Hb%, mean corpuscular volume, mean corpuscular hemoglobin (MCH), MCH concentration, RDW, platelet count, and WBC count along with patient’s age and gender were assessed in CKD patients.

Statistical Analysis Used:

P value and linear progression curve have been used.

Results:

Out of 71 patients, 65% were males and 35% were female with an average age of 48 years. The mean hemoglobin concentration was 10.7%, with a mean RBC count of 3.121 million, mean hemotocrit value of 26.05%, and decrease in platelet count with average of 1.34 lakhs. In 55% patients, the RDW value was more than normal limit with a linear progression, with an increase in the serum creatinine value.

Conclusions:

All hematological parameters showed significant variation, whereas the RDW value showed a linear progression with serum creatinine.
Value of neutrophil gelatinase-associated lipocalin in the diagnosis of renal disorders in children with glycogen storage disease
Authors: Mohamed Nashwa F. , Behairy Ola G. , Assar Effat H. , Fayek Hend T. , Abdelmotaleb Dina S.
Published: December 2024

Purpose

This study aimed to evaluate the value of urinary neutrophil gelatinase-associated lipocalin (NGAL) in the diagnosis of renal disorders in children with glycogen storage disease (GSD).

Patients and methods

This cross-sectional study, which was conducted at Benha University Hospital, Egypt, included 50 children with GSD and apparently healthy 50 children as a control group. The level of NGAL was measured in urine by enzyme-linked immunosorbent assay and compared between groups.

Results

The GSD group had statistically significant higher urinary NGAL (147.6±38.8 ng/ml) compared to the control group (102.1±11.4 ng/ml, P<0.001). Urinary NGAL was higher in patients with microalbuminuria, kidney injury (RIFLE >2), and patients with a higher degree of liver fibrosis. At a cutoff point more than or equal to 154 ng/ml, urinary NGAL could detect cases with microalbuminuria with a sensitivity of 83.3% and specificity of 94.7%. At a cutoff point more than or equal to 172 ng/ml, urinary NGAL could detect cases with acute kidney injury (RIFLE >2), with a sensitivity of 100% and specificity of 100%.

Conclusion

Urine NGAL demonstrates superior efficacy as a biomarker for the precocious identification of renal dysfunction in pediatric patients afflicted with GSDs.
Endocan as a diagnostic and prognostic biomarker for pediatric sepsis in Mansoura University Children’s Hospital
Authors: Abdallah Fatima I. , Elbayoumi Mohamed A. , Elshabrawy Walaa O. , Zeid Mayada S.
Published: December 2024

Background

Sepsis is a life-threatening condition causing high mortality in pediatrics with challenging diagnosis and increasing real need for sepsis markers. Endocan is a promising marker for diagnosis and prognosis of adult sepsis with the scarcity of published data in pediatrics.

Aim

To reveal the diagnostic and prognostic role of serum Endocan level as a biomarker for pediatric sepsis.

Patients and methods

In an observational, prospective cohort study, from November 2021 to October 2022, on 60 patients; 30 were diagnosed with sepsis according to the presence of proven infection plus two signs of systemic inflammatory response and revised by The Phoenix Sepsis Score. Those patients admitted to pediatric intensive care unit in Mansoura University Children’s Hospital, serum Endocan level was measured first 3 days and after 7 days of admission and compared to 30 control nonseptic patients.

Results

Serum Endocan level among patients on the third and seventh days of admission was significantly higher than the control group (P≤0.001). Serum Endocan decreased in septic patients on the seventh day in comparison to the third day but with no statistical significance. There was a statistically significant positive correlation between serum Endocan on the seventh day and PRISM score, capillary refill time, mechanical ventilation stay, C-reactive protein, and liver function. There was a statistically significant negative correlation between serum Endocan after 7 days and hemoglobin, platelet, and neutrophil count. Serum Endocan level after 7 days was statistically significantly higher in dead or worsening patients. The cutoff point for diagnosis of sepsis on the third day and seventh days was 17.55 and 13.6 pg/ml, with sensitivity 78.3 and 78.3%. Specificity 87.7 and 80%, respectively.

Conclusion

Endocan is a good diagnostic and prognostic marker for pediatric sepsis.
Clinical Characteristics and Risk Factors for Seizures to Recur in Calcified Neurocysticercosis: Prospective Cohort Study
Authors: Verma Archana , Kumar Alok , Sachan Divyata
Published: December 2024

Aim:

Calcification of degenerating neurocysticercosis (NCC) is common and likely to occur late in the degenerative process and is important for seizure foci. The present study was aimed at identifying the clinical and radiological variables associated with seizure recurrence in people with single or multiple calcified NCC lesions.

Material and Methods:

We evaluated 85 adult patients with calcified NCC lesions for recurrence of seizures during the follow-up period of one year.

Results:

The mean age of the study population was 24.49 ± 9.17 years. Nocturnal seizures were present in 43.5% and serial seizures in 42.4%. A single calcified lesion was present in 61 (71.8%), and perifocal oedema surrounding the calcified lesions was present in 38 (44.7%). Recurrence of seizures was noted in 37 (43.5%) of the cases. On multivariate analysis, the factors that were significantly associated with the recurrence of seizures were: nocturnal seizures [OR: 0.054 (0.015–0.199)], serial seizures [OR: 0.141 (0.041–0.485)], and perifocal oedema [OR: 0.031 (0.008–0.129)].

Conclusion:

In our study, serial seizures, nocturnal seizures, and perifocal oedema were linked with the recurrence of seizures in calcified NCC lesions. Perilesional oedema should be treated aggressively with anti-inflammatory/immunosuppressive therapy as well as with anti-seizure medication.
Challenges in The Diagnosis of Ischemic stroke, Tuberculous Meningitis, and Co-Infection with HIV in a Socially Isolated Elderly Patient
Authors: Huang Han-Ke , Chuang Chieh-Sen
Published: December 2024

Background:

Ischemic stroke has been a common cause of death and disability in Taiwan, particularly among the elderly. Social isolation is a significant issue in an aging society, which can be associated with delayed medical care and difficulties in diagnosis.

Case:

A 76-year-old man presented with altered mental status, left-sided weakness, and declining cognitive function over three months. He had limited social connections and an unknown medical history. Initial brain imaging showed communicating hydrocephalus. Cerebrospinal fluid analysis revealed increased lymphocytes and high protein levels. Further imaging revealed multiple hyperintense lesions in the brain’s white matter and acute ischemic stroke in specific areas. The patient was diagnosed with tuberculosis and HIV coinfection, leading to probable tuberculous meningitis, HIV encephalopathy, and pneumocystis jirovecii pneumonia. Treatment with antituberculous agents, antibiotics, and steroids improved the patient’s level of consciousness.

Conclusion:

Addressing social isolation and altered consciousness in elderly individuals requires a thoughtful approach. Reconsidering the differential diagnosis is crucial when it doesn’t match the clinical severity. Clinicians should consider rare co-occurrences like ischemic stroke, TBM, and HIV infection in atypical TBM cases. A biopsychosocial perspective helps gather a comprehensive medical history for holistic care. Early diagnosis and timely intervention are vital for better outcomes in severe infections.
Dengue hemorhagic fever associated hemophagocytc lymphohistiocytosis in primigravida: A case report
Authors: Bhellum Pyrus , Kumar Rakesh , Bora Rishabh , Kumar Bharat
Published: December 2024

Rationale:

Hemophagocytic lymphohistiocytosis (HLH) is a rare but severe complication of dengue virus infection, associated with high mortality. We report a case of a 9-week primigravida presenting with high grade fever spikes and a positive Dengue NS1 antigen. The patient exhibited worsening clinical parameters, including cytopenias.

Patient concerns:

A primigravida at 9th week of gestation and this condition has limited diagnostic modalities and treatment options for HLH.

Diagnoses:

HLH secondary to dengue hemorrhagic fever.

Outcomes:

Intravenous steroids were initiated with monitoring of laboratory and clinical parameters. The patient recovered successfully after initiation of intravenous steroids. Oral steroids were subsequently tapered over an next eight-week period, leading to a successful recovery.

Lessons:

This case is unique due to the interplay between dengue virus infection, HLH, and early pregnancy, characterized by overlapping clinical symptoms and limited treatment options. Prompt initiation of intravenous steroid therapy resulted in significant clinical improvement. This case highlights the critical importance of early identification and treatment of dengue associated HLH to reduce mortality. Furthermore, it underscores the urgent need for focused research on HLH in pregnant patients, particularly in low and middle income countries.
Clinical characteristics and outcome of pregnant women presented with thrombocytopenia: an Egyptian single-center prospective study
Authors: Abdelaty Mona M. , Gamaleldin Sally M , Haider Mostafa H. , Aboelagha Ahmed S. , Abdeen Nashwa S. M. , Abdalla Reham M. A.
Published: December 2024

Background

Thrombocytopenia during pregnancy has a wide range of etiologies and clinical manifestations. A benign course is usually expected in most pregnancies. However, it can be associated with major obstetric complications. Early interdisciplinary approach of thrombocytopenia in pregnancy is necessary for the best care of the expectant mothers and neonates. We evaluate the etiologies, severity of thrombocytopenia, clinical characteristics, and their impact on feto-maternal outcomes in 60 Egyptian pregnant women.

Results

The maternal age ranged from 19 to 41 years and the majority were primigravida 55%. Mild thrombocytopenia was found in 45% of patients and 20% presented with platelet counts less than 50 × 109/L. Gestational thrombocytopenia was the most common cause followed by hypertensive pregnancy disorders. Immune thrombocytopenia affected 11.7%, systemic lupus erythematosus was documented in three patients and acute leukemia in one patient. Pregnancy unrelated causes were associated with significant earlier presentation, higher incidence of bleeding symptoms, and lower platelet counts. No significant association between maternal thrombocytopenia and neonatal complications was noted.

Conclusion

Maternal/neonatal complications depend primarily on the etiology of thrombocytopenia. Gestational thrombocytopenia was the most prevalent cause and was associated with better feto-maternal outcomes compared with other causes. Hematologists, nephrologists, and rheumatologists should be consulted for cases with a severe or atypical presentation due to pregnancy unrelated causes as early management may significantly improve the outcomes of pregnant women and their offspring.
Evaluation of metabolic syndrome and growth disorder in long-term survivors of hematopoietic stem cell transplantation in children
Authors: Ibrahim Wafaa E. , Abdelmakhsood Abeer A. , Moharram Wessam A. , AbouSaleh Asmaa I.B. , El Kader Salwa M.A.
Published: December 2024

Background

Treatment improvement in hematopoietic stem cell transplantation (HSCT) in children has lowered HSCT-associated mortality rate, with increased long-term survivors’ complications. The metabolic syndrome (MetS), as well as growth failure observed among HSCT survivors, can be related to the patient’s primary illness or a complication of the HSCT.

Aim

To assess the frequency and possible risks of MetS and growth failure among HSCT survivors treated at our center.

Patients and methods

This study included 22 patients who underwent HSCT between 2011 and 2020 at the Pediatric Blood and Marrow Transplant Unit, Ain Shams University Hospital and survived for more than 1 year after HSCT with a mean age of 12.95 years, and a mean duration posttransplant of 5.95 years. Three patients were transplanted for malignant diseases, and all patients received chemotherapy only in a conditioning regimen. Detailed medical history, physical examination, and laboratory assessment, including complete blood count, fasting plasma glucose, fasting insulin, homeostatic model assessment of insulin resistance, glycated hemoglobin, fasting lipid profile, thyroid function and growth hormone stimulation tests for patients with height less than −3 SD were done.

Results

The frequency of MetS in our study was 4.5%, with 40.9% showing two components of MetS and 18.1% having one component of MetS. Dyslipidemia was detected in 68.2% with 50% developed hypertriglyceridemia, 45.4% had low high-density lipoprotein-cholesterol. 36.4% showed insulin resistance, 4.5% had impaired fasting glucose, yet none was diabetic. 9.1% had elevated blood pressure, and 4.5% had abdominal obesity. Multivariate analysis confirmed a significant positive association (P=0.019) between acute graft-versus-host disease and insulin resistance and a significantly elevated free T3 among patients with insulin resistance (P=0.011).

Conclusion

The current study proved a high prevalence of MetS components, specifically dyslipidemia (68.2%) and insulin resistance (36.4%) among HSCT survivors, mandating regular screening of MetS components in the long-term follow-up of those survivors.
Evaluation of serum ferritin and its correlation with biomarkers of early onset neonatal sepsis
Authors: Abdou Rania M. , Hamza Mohamed T. M. , Iskander Sandra M. , Hussein Mohamed H. M.
Published: December 2024

Background

A clinical illness known as neonatal sepsis is defined by disseminated infection symptoms and bacteremia during the first 30 days of life. It is categorized as early-onset neonatal sepsis and late-onset neonatal sepsis It is one of the leading causes of mortality and morbidity worldwide. Neonatal sepsis can be diagnosed by blood culture but it takes a lot of time. Serum ferritin as an acute phase Reactant can be used as a Marker of neonatal sepsis, also it is found to be a better indicator of mortality in neonatal sepsis.

Aim

Examine the diagnostic usefulness of procalcitonin, interleukin-6 (IL-6), C-reactive protein (CRP), and serum ferritin as indicators of early-onset neonatal sepsis and compare these markers with various clinical and laboratory analysis results of neonatal sepsis.

Patients and methods

A total of 40 newborns admitted to the Intensive Care Unit of Neonates (Ain Shams Pediatrics Hospital) took part in the study. Aged from 1 to 3 days of life, 20 neonates were proven Neonatal sepsis, and the other 20 as control Age-matched neonates without any major clinical or laboratory evidence of Sepsis. All children underwent a clinical evaluation that involved taking their history, routine investigation (CBC, CRP, and blood culture) also determination of serum ferritin, IL-6, and procalcitonin

Results

Procalcitonin and IL-6 both showed higher specificity as well as sensitivity than serum ferritin.

Conclusion

A positive correlation has been shown between CRP and serum ferritin. Furthermore, there is a positive association between procalcitonin and IL-6.
Clinical characteristics and outcomes of severe acute respiratory infections in a resource-limited pediatric hematology oncology setting
Authors: Ebeid Fatma S.E. , Makkeyah Sara , Tolba Marwa W. , Saber Nouran , Agwa Sara H.A.
Published: December 2024

Objective

To examine the spectrum of pathogens and outcome of severe acute respiratory infections (SARIs) among admitted children with hematology/oncology disorders who presented with SARIs in low-middle income countries.

Patients and methods

The prospective observation study recruited 52 children, clinically assessed, and their nasopharyngeal and oropharyngeal swabs were examined and analyzed by real-time multiplex PCR.

Results

The children were 27 females and 25 males, mean age of 5.2 ± 2.9 years, 36 (69.2%) had pediatric malignancies, mostly (67%) hematologic malignancies, eight (15.4%) had chronic hemolytic anemia. Forty-eight (92.3%) presented with fever, 42 (80.7%) had a cough at the time of presentation. The median time from onset of symptoms till admission was 3.0 (1–6) days, and the median length of hospital stay was 9.0 days (4–16.5). Respiratory pathogens were detected in 39 (75%) samples, mostly Klebsiella pneumoniae (50%), Streptococcus pneumoniae (30.8%), Pdm H1N1 (33.3%), rhinoviruses (25.6%). Bacterial and viral pathogens codetected in 19 (48.7%) of cases. Five (9.6%) required pediatric ICU admission, four (7.7%) patients died during the study period; one died of respiratory failure, one of septic shock, and two died of their primary disease in the pediatric ICU.

Conclusion

The present study added more insights about the viral and bacterial agents involved in SARI cases in Egypt in vulnerable pediatric groups.
Complement regulatory proteins in hepatitis-induced thrombocytopenia
Authors: Aziz Shereen P. , Sayed Sherif A. , Mohamed Nermeen G. , Ali Amal H. , Elsharkawy Ramy , Hefny Hesham M.
Published: December 2024

Background

Thrombocytopenia is a significant concern in individuals with chronic hepatitis infections, especially those who have advanced liver injury. Complement regulatory proteins, namely, CD55 and CD59, may directly disrupt the proper functioning of the complement system. Both proteins are found on platelets and, as a result, might be subjected to autoantibody targeting. This work aimed to assess the expression of complement regulatory proteins (CD59 and CD55) on the platelet surface in patients with hepatitis-associated thrombocytopenia.

Methods

This case-control study was performed on 90 patients aged 4 to 80. The patients were divided into three equal groups. Group I: included 30 chronic hepatitis patients with hepatitis B virus and thrombocytopenia. Group II: included 30 chronic hepatitis C virus patients with thrombocytopenia. Group III: 30 immune thrombocytopenia patients were used as controls.

Results

Compared with those in group III CD55, CD59, CD61, and CD42 did not substantially differ among group I and group II patients, however, they significantly decreased when group I was compared with group III control subjects, and they significantly differed when group II was compared group III control subjects. A statistically significant positive correlation existed between absolute counts of CD55+ platelets and CD59+ platelets as well as between the absolute counts of CD61+ platelets and CD42+ platelets.

Conclusion

CD55 and CD59 could be predictors of late-stage hepatitis accompanied by thrombocytopenia, and this information is important for determining the diagnosis and treatment choice.
Impact of serum albumin and prealbumin as well as anthropometric measurements on long-term survival outcomes after allogeneic stem cell transplantation
Authors: El Afifi Amal M. , Ali Saad Ahmed E.M. , El-Ghammaz Amro M.S. , Ahmed Alia M.S. , Abdallah Nour E.H.H.
Published: December 2024

Background

Allogeneic hematopoietic stem cell transplantation is the treatment of choice for treatment of patients with high-risk features of acute leukemia or those who are relapsed after standard treatment. By now, there are few studies on nutritional assessment of hematological patients before and after hematopoietic stem cell transplantation, and additionally, most rely on one single assessment method.

Objective

Evaluating nutritional indicators as well as anthropometric measurements in long-term survivors posttransplant, identifying their relationship on transplant outcomes.

Patients and methods

The present work included 30 patients with two or more years after allogeneic stem cell transplantation who were following up at Bone Marrow Transplantation Unit, Ain-Shams University Hospitals, from January 2019 till January 2023. We assessed nutritional laboratory parameters, including albumin, prealbumin as well as anthropometric measurements, including BMI, waist, circumference, waist–hip ratio, and body fat percentage, using bioelectric impendence in long-term survivors as well as assessment of the quality of life (QoL) using the FACT-BMT questionnaire.

Results

We found a statistically significant association between nutritional laboratory parameters as well as anthropometric measurements with late transplant outcomes, including the incidence of chronic graft-versus-host disease, disease relapse, and transplant-related mortality as well as posttransplant QoL.

Conclusion

Nutritional laboratory biomarkers and anthropometric measurements in long-term survivors postallogeneic stem cell transplantation were low-cost, noninvasive biomarkers for early and late transplant complications, patients’ survival, and QoL.
Serum cereblon level in Egyptian patients with multiple myeloma post autologous stem cell transplantation
Authors: Mostafa Nevine N. , El-Ghammaz Amro M. S. , Mohammed Abulmaged Dina F. A.-G. , Abdalla Nour E.-H. H.
Published: December 2024

Background

In Multiple myeloma (MM) there is increase in number of malignant plasma cells within the bone marrow, and these cells secrete a monoclonal paraprotein and later on these proteins causes end organ damage. MM is a common hematological malignancy, and it is also one of the diseases that is difficult to follow-up accurately, especially when trying to know the possibilities of relapse after treatment proactively, and for this reason, the need for ways to follow-up patients with MM after treatment emerged proactively. Accurate evaluation of the depth of response to treatment, especially posttreatment with an autologous bone marrow transplant.

Aim

To measure cereblon (CRBN) in MM patients postautologous stem cell transplantation to determine its prognostic impact, to do correlation with other prognostic factors and to detect its influence on maintenance treatment response.

This study had 20 myeloma patients after autologous stem cell transplantation. All patients received the same treatment; induction by VCD for 6 cycles (28 days-cycle) until CR/very good partial remission. Serum CRBN was measured in all patients post-ASCT to assess the response and to check for any sign of relapse. Diagnosis and response evaluation were applied according to International guidelines.

Results

This study was carried on 20 MM patients, the age ranged from 42 to 69, and most of them were males. CRBN ranged from 2.4 to 3.9 with mean of 3.1. All patients were CMV, HIV, HBV negative and 15% of them had HCV positive. In our study when comparing the complete blood count (CBC) results between 3 and 6 months after treatment, there is statistically significant increase in Hb, and Platelet; while the other complete blood count results showed no statistically significant difference.

Conclusion

There is studies found a linkage between high levels of CRBN and attainment of a favorable treatment response however no important association between the presence of high levels of this marker and overall survival OS, in our study we could not prove or deny that CRBN can be used as a reliable prognostic marker and this may be because this study requires a larger number of patients.
Role of Indian Association of Preventive and Social Medicine in Community Based Palliative Care - A Position Statement
Authors: Srinivasan Srikanth , Venugopal Vinayagamoorthy , Elayaperumal Suguna , Singh Mahendra , Kataria Priya , Radhakrishnan Rehana Vanaja
Published: December 2024

Currently, access to palliative care is a challenge for the majority of people with serious health suffering in India. Most of the existing palliative care services are available at tertiary healthcare facilities in urban areas. The National Program of Palliative Care (NPPC) envisages incorporating palliative care in undergraduate medical education to improve the knowledge and skills of primary care physicians to provide quality palliative care in the home setting of patients. Additionally, NPPC also aims to promote community awareness and ownership in palliative care. Community-based palliative care (CBPC) provides holistic support for patients with serious illnesses. This position statement intends to address possible considerations on the role of the Indian Association of Preventive and Social Medicine (IAPSM) on CBPC in the country. A team of members of IAPSM trained in essential palliative care attempted to develop this position statement. The team explored the existing status of palliative care in India and feasible solutions through IAPSM for CBPC by the objectives of NPPC. The team applied and analyzed the WHO framework of public health approach to palliative care – amalgamation in primary health care, integration with specialists for continuum of care, public awareness, training of primary care physicians and community volunteers, and supportive supervision in community initiatives. IAPSM can effectively contribute to CBPC through capacity building of the primary health care team, awareness generation, promoting community ownership, and development of standards of care through community-based research. Implementing the aforementioned recommendations would contribute to achieving the target of Sustainable Development Goal 3.8, which addresses the need for pain relief and palliative care to all needy patients. The IAPSM recognizes palliative care as a vital component of Universal Health Coverage and holds the capacity to bring about substantial changes in the promotion of CBPC in India.
Tribal Health: A Public Health Exigency and Road Map to Future
Authors: Sahu Monalisha , Kujur Anit , Venugopal Vinayagamoorthy , Govil Parag , Sinha Ratnesh , Mathur Medha , Rehman Tanveer , Rana Rishabh Kumar , Kumar Dewesh
Published: December 2024

Tribal health is a special concern for India as it has not been addressed holistically in last 75 years of post-independence era. The evidence of present status of health of tribal people which constitutes more than 8.6% of total population is not convincing. Although the information available in bits and pieces shows a dismal picture of their health. They suffer from triple burden of disease and the morbidity profile is poorer than the non-tribal population. Though the tribal people have poor health but it was assumed that uniform national pattern of healthcare would address their unmet health needs. The different terrain, different social environment, and different culture make their healthcare needs different and hence their health remains an unsolved problem. Although, there has been push from government toward their health but a holistic approach to understand their need is important. Collaborative partnerships between tribal communities, healthcare providers, and government agencies are essential to developing culturally appropriate and sustainable solutions that honor their traditional knowledge and provide modern healthcare to them which is accessible and acceptable to them.
The Effectiveness of Vitamin C for Postoperative Pain Relief in Patients Undergoing Laparoscopic Cholecystectomy: A Prospective Randomized Double-blind Trial
Authors: Bala Renu , Saini Ram Murti , Kiran Shashi , Bansal Priyanka , Kshetrapal Kirti , Kataria Pulkita
Published: December 2024

Background:

Laparoscopic cholecystectomy is associated with postoperative pain in the upper and lower abdomen, back, and shoulder region which persist for 2–3 days. Vitamin C is a powerful reductant with antioxidant, neuroprotective, and neuromodulation effects. It is successfully used in complex regional pain syndrome and few surgeries. In the present study, its effect on postoperative pain after laparoscopic cholecystectomy has been assessed.

Materials and Methods:

The present, prospective, randomized double-blind study was conducted following approval from the institutional ethics committee. Sixty adult patients either sex, the American Society of Anesthesiologists I or II were randomized to group C who received 1 g Vitamin C intraoperatively, whereas Group N received normal saline (control group). Standardized anesthesia protocol was followed in all patients. Postoperative pain was assessed as per the numeric rating scale. For rescue analgesia acetaminophen, ketorolac and diclofenac were given. Follow-up period was 24 h after surgery.

Results:

The demographic profile was comparable into two groups. Postoperative pain scores were lower in Group C as compared to Group N. There was reduced demand for rescue analgesic in Group C. None of the patients reported any adverse event.

Conclusion:

A single dose of 1 g Vitamin C intraoperatively helped in obtunding pain following laparoscopic cholecystectomy with no side effects. Hence, it may be incorporated as a component of multimodal analgesic regimen.
A Quasi-experimental Study to Assess the Effectiveness of Reminiscence Therapy on Depression among Hospitalized Elderly Undergoing Abdominal Surgery Admitted in Nehru Hospital, PGIMER, Chandigarh
Authors: Tandon Ritika , Gupta Rajesh , Sharma Sunita , Thakur Mukta
Published: December 2024

ABSTRACT

Background:

Improved health-care quality has led to a global increase in the elderly population. With the increase in life expectancy, the number of elderly patients with surgically correctable diseases has also increased. Abdominal operations are common among the elderly due to the increased incidence of gastrointestinal tract disorders. It is not uncommon for older adults who are undergoing abdominal surgery to experience depression during their hospital stay. Reminiscence therapy is one of the most widely used interventions to alleviate depressive feelings among older adults. Being aware of this risk and providing therapeutic intervention such as reminiscence therapy is crucial to ensure patients make a full and successful recovery.

Objective:

The objective of the study was to assess the level of depression among the elderly undergoing abdominal surgery and to assess the effectiveness of reminiscence therapy on depression among hospitalized elderly undergoing abdominal surgery admitted in Nehru Hospital, PGIMER, Chandigarh.

Materials and Methods:

A quasi-experimental study was conducted in the surgical unit of Nehru Hospital at PGIMER, Chandigarh. The institute ethics committee granted ethical approval for the project with the reference number INC/IEC/2021/SPL.1146. The approval was issued on July 28, 2021. Written consent was obtained from all 60 participants who were selected using a purposeful sampling approach. Randomization was done through an alternate allocation method, assigning each group of 30 participants to both the experimental and control groups. Data were collected from patients through interviews conducted between July 2021 and September 2021. The interviews covered their sociodemographic background, clinical profile, and geriatric depression scale scores. Reminiscence therapy was only provided to the experimental group, which underwent four sessions lasting 45–60 min. The control group had no intervention.

Results:

After undergoing reminiscence therapy, subjects in the experimental group exhibited a significant reduction in depression levels. About 83.4% of the subjects had no depression, while 16.6% had mild depression. No change was observed in the control group. There was a significant decrease in depression scores in postassessment in the experiment group, P value (<0.001) as compared to the control group.

Conclusion:

Reminiscence therapy appeared to be successful in reducing depression in hospitalized elderly patients undergoing abdominal surgery. The use of nonpharmacological methods, such as reminiscence therapy, can be a cost-effective way to manage depression.
Severe Anaphylaxis Following Intradermal Test Dose of Ceftriaxone
Authors: Parthasarathy Srinivasan , Chandramohan T.
Published: December 2024

Ceftriaxone is a third-generation cephalosporin antibiotic used commonly for treating infections; however, hypersensitivity reactions, including anaphylaxis, occur in approximately 1%–3% of patients. Anaphylaxis can vary from minor skin rashes to life-threatening events affecting multiple organ systems, making it challenging for anesthesiologists. We present a case of severe anaphylaxis resulting in anaphylactic shock after an intradermal test dose of ceftriaxone in a 55-year-old female undergoing umbilical hernia mesh repair. The patient was a well-controlled hypertensive who came with stable vital signs before surgery. However, soon after administering the test dose, she began to exhibit asystole and unresponsiveness; hence, cardiopulmonary resuscitation immediately commenced, along with intravenous administration of adrenaline. Although consciousness returned, she failed to show palpable pulses while maintaining adequate respiratory effort. She was put on 100% oxygen with noninvasive ventilation and managed on noradrenaline and adrenaline infusions due to significant hypotension. After 6 days in critical care, the patient’s condition improved, allowing for weaning from the ventilator and eventual discharge. This incident, despite a negative history of allergy testing, points to the unpredictable nature of drug hypersensitivity and the importance for anesthesiologists and surgical teams to be keen on monitoring patients. As there was normal recovery with adequate left ventricular function, we did not think in terms of any other cause. Clear documentation of such reactions is essential for future medical care, underlining the importance of complete allergy reviews to avoid similar life-threatening events. This case is also an important reminder about the vigilance that should be maintained during the perioperative period.
Compliance of cardiopulmonary resuscitation during in hospital cardiac arrest in a teaching institution
Authors: Kumar R. Arun , Chandresh S. , Ali Ahamed Ashar
Published: December 2024

Background:

Cardiopulmonary resuscitation (CPR), the essential part of emergency care, is defined as chest compressions and ventilation for survival of cardiac arrest patients, which indicates the influence of outcome and exerts a significant survival benefit after cardiac arrest.

Aims:

The primary objective of this audit is to determine compliance with the American Heart Association 2020 guidelines by measuring multiple parameters of in hospital CPR quality.

Settings and Design:

In hospital cardiac arrest (IHCA) patients from all wards of a tertiary care medical college institution was selected for this observational analytic study between January 1, 2019 and December 31, 2021.

Materials and Methods:

Our study was conducted without randomization, blinding, or control groups, in all code blue victims aged between 20 and 80 years, who suffered cardiac arrest. The results of the compliance of CPR during IHCA in a teaching institution are discussed based on the CPR audit findings under the quality indicators such as protocol deviations, documentation issues, and resource issues.

Statistical Analysis:

Evaluation, analysis, compilation, and statistical reporting were done on documentation based on these quality indicators.

Results and Conclusions:

Over a three-year period, 672 cardiac arrest victims analyzed. Of these, 30.91% demonstrated protocol deviation compliance, 15.97% had documentation issues, 12.27% had resource issues, and 40.85% had excellent documentation with no errors or corrections in the critical event monitoring. Out of 672 victims, only 15.62% of cardiac arrest patients achieved spontaneous circulation. The patients who had shockable initial rhythm on the monitor had better outcomes than those who did not have shockable rhythm. Our study revealed that the issues with resuscitation performance in an algorithmic approach were more significant than those with documentation and resource issues. The quality of CPR performance can be improved by demonstrating live and practicing on a mannequin with appropriate teamwork and knowledge sharing.
The Mediating Effect of Social Cognition on Neurocognition and Community Functioning in Outpatients with Schizophrenia in Taiwan
Authors: Ku Yung-Li , Lin Ming-Teng , Li Cheng , Hwang Shyh-Jou
Published: December 2024

Objectives:

Patients with schizophrenia often suffer from a wide range of functional impairments. The underlying cognitive factors that cause functional impairments have been a focus of clinical research. We hypothesized that social cognition in outpatients with schizophrenia would mediate the relationship between neurocognition and community functioning. In this study, we intended to use structural equation modeling (SEM) to test the hypothesized mediation relationship.

Methods:

We recruited 52 patients with schizophrenia from a community psychiatric rehabilitation institute in Taiwan. Neurocognitive latent construct was established on the basis of the measures of processing speed, vigilance, working memory, reasoning, and problem-solving. Social cognitive latent construct was established on the measures of emotional perception, social perception, and theory of mind. Community functioning latent variable was established on the subscales of interpersonal communication, recreation, and occupation/employment of the Chinese version of the Social Functioning Scale.

Results:

According to the results of SEM, a mediation model was obtained by the analysis of sample data. The model showed that the relationship between neurocognition and community functioning was fully mediated by social cognition. The model explained 55% of variance in community functioning.

Conclusion:

This study identified important cognitive components of neurocognition and social cognition associated with community functioning in outpatients with schizophrenia. Implications for the therapeutic targets and intervening steps of the cognitive rehabilitation to improve community functioning in schizophrenia are discussed and suggested.