bluuebunny/crossref_metadata_2025 huggingface dataset:
Optimizing Attendance Management in Educational Institutions Through Mobile Technologies: A Machine Learning and Cloud Computing Approach
Authors: Caytuiro-Silva Nicolas Esleyder , Maraza Quispe Benjamin , Castro-Gutierrez Eveling Gloria , Rosas-Paredes Karina , Sulla-Torres Jose Alfredo , Alcázar-Holguin Manuel Alfredo , Choquehuanca-Quispe Walter
Published: June 2024

The primary goal of the study is to optimize and streamline the attendance recording and monitoring process for learning sessions by leveraging advanced technologies such as machine learning and cloud computing. The methodology employed is based on the extreme programming (XP) project management approach. Throughout its phases, the entire implementation process of the application, from conception to launch, is described in detail. Firebase is used as the database manager to ensure the efficiency and security of student information and attendance records. Additionally, the Firebase machine learning kit is used to verify attendance registration through QR codes. The application was tested with fifth-year high school students from an educational institution. The user interface has been designed to be attractive, intuitive, and easy to use for both teachers and students. The study results demonstrate that the use of this application significantly reduces the time spent on attendance recording compared to traditional methods. There has been a high level of satisfaction and acceptance of the “ASYS” application among teachers and students. In conclusion, this study has successfully implemented a mobile application that revolutionizes attendance recording and monitoring in educational institutions. It harnesses the power of machine learning and cloud computing to enhance efficiency and the user experience.
O Atelier de pintura e o Museu Oceanográfico do Rei D. Carlos I no Palácio das Necessidades: contributos para a sua caracterização
Authors: Fevereiro António Cota
Published: June 2024

A história do colecionismo continua a suscitar novos olhares e a sistematização do conhecimento. Este estudo centra-se na figura do Rei D. Carlos I (1863-1908), circunscrevendo-se ao período em que o Rei ocupou o Palácio das Necessidades (Lisboa) após a morte do seu avô, D. Fernando II, em 1885. Nessa sequência, o Rei D. Carlos irá criar dois “novos” espaços privados no edificado já existente: o seu atelier de pintura e o Museu Oceanográfico, que serão mantidos (aproximadamente) até à morte do monarca, em 1908. É sobre estes dois espaços que recai a análise deste artigo. Apesar de estudos anteriores, não se conhecia suficientemente a ocupação destes espaços e a sua ambiência. Assim, este artigo pretende reconstituir a ocupação em planta destes espaços no palácio, descrevendo as suas principais características. A metodologia adoptada teve por base a análise de fontes documentais e iconográficas, assim como a revisão bibliográfica. Com este estudo foi possível estabelecer a localização exacta do atelier de pintura e do Museu Oceanográfico no Palácio das Necessidades e evidenciar as suas características principais. Desta forma, a investigação contribui para um maior aprofundamento sobre a história destes espaços, e por sua vez, para a história do colecionismo oitocentista em Portugal.
Development of Savonius Rotor Based on Bezier Curve for Vertical Axis Marine Current Turbine at Sunda Strait, Hindia Ocean
Authors: Suprayogi Dedy Triawan , Setiawan Hadi , Habibie Alwan , Adjie Muhammad , Rahman Faqih Atard
Published: June 2024

Due to its strategic location and ocean currents, the Sunda Strait has the potential to produce energy that might be used as a source of electricity. As a result, this strait area urgently needs a suitable turbine design. This strait's most significant sea current speed is 1 (one) m/s. The Savonius rotor is one of the rotor kinds of turbines that can operate in the slow sea current—modifying the rotor from semi-circular to use the Bezier curve for the shape to optimize the performance. This paper will discuss the design of the Savonius rotor using the Bezier curve, that have improved performance. The rotor with double stacking will also enhance the performance of the rotor. This design is a novelty for vertical marine current turbine applications in ocean renewable energy.
Audit Quality and Its Impact on the Earnings Management in the Post-COVID Era: Evidence from Sri Lanka
Authors: Jeevakumar J. , Mudalige H. M. N. K.
Published: June 2024

Purpose: The purpose of this study is to identify the impact of audit quality on the earnings management and explore the relationship between audit quality and earnings Management, with the main objective of identifying the impact of audit quality on the earnings management in the post-COVID era. The research utilizes a literature review that spans the recent years, focusing on audit quality-related literature and earnings management literature, such as the utilization of discretionary accruals and a modified version of the Healy’s Model.Design/Methodology/Approach: Audit quality is determined by looking at two proxies: the size of the audit firm and independence. The study was conducted using the data collected from 92 non-financial organizations with a financial year ending in March, during the post-COVID research period of 2019/20 to 2021/22. Descriptive statistics, correlation analysis, and regression analysis were among the methods utilized for analysing the acquired data.Findings: Although the results are inconclusive, the study suggests that the level of earnings management in Sri Lanka is not significantly influenced by the quality of audit conducted in the country. Therefore, this study concludes that audit quality has no significant impact on earnings management in the post-COVID era.Originality: This study focuses on the post-COVID years to examine the impact of audit quality on earnings management and the relationship between audit quality and earnings Management, given the limited research conducted in the Sri Lankan context and the inconclusive findings of previous literatures.
β2-Integrins Regulate Microglial Responses and the Functional Outcome of Hemorrhagic Stroke In Vivo
Authors: Harjunpää Heidi , Tallberg Robert , Cui Yunhao , Guenther Carla , Liew Hock-Kean , Seelbach Anna , Saldo Rubio Guillem , Airavaara Mikko , Fagerholm Susanna C
Published: June 2024

Stroke is one of the leading causes of death and long-term disabilities worldwide. In addition to interruption of blood flow, inflammation is widely recognized as an important factor mediating tissue destruction in stroke. Depending on their phenotype, microglia, the main leukocytes in the CNS, are capable of either causing further tissue damage or promoting brain restoration after stroke. β2-integrins are cell adhesion molecules that are constitutively expressed on microglia. The function of β2-integrins has been investigated extensively in animal models of ischemic stroke, but their role in hemorrhagic stroke is currently poorly understood. We show in this study that dysfunction of β2-integrins is associated with improved functional outcome and decreased inflammatory cytokine expression in the brain in a mouse model of hemorrhagic stroke. Furthermore, β2-integrins affect microglial phenotype and cytokine responses in vivo. Therefore, our findings suggest that targeting β2-integrins in hemorrhagic stroke may be beneficial.
Racial segregation and the origins of apartheid in South Africa, 1919-36
Authors: Minnaar A. de V.
Published: June 2024

No abstract available.
Die oorlogsherinneringe van kommandant Jacob Petrus Neser
Authors: Changuion Louis
Published: June 2024

No abstract available.
Segregation and plague: King William's Town and the plague outbreaks of 1900-1907
Authors: Caldwell Sharon
Published: June 2024

Studies in the history of bubonic plague in Cape Town and Port Elizabeth revealed the close connection between the Victorian obsession with sanitation and the development of urban segregation in South Africa. The response of the medical officials and local authorities in the cities was mirrored in King William's Town, where racial prejudges were compounded by the Town Council's incompetence and reluctance to incur any expenditure from its own coffers.
Die Bloemfonteinse oproer van 1925
Authors: Le Roux C.J.P.
Published: June 2024

This riot was one of many black riots against socio-economic problems in urban centres right through South Africa during the 1920s. The direct causes of the riot were municipal sorghum beer regulations which the blacks regarded as unfair restriction of their freedom, and low wages for blacks complicated by unemployment. Furthermore neither the Natives' Advisory Council, nor the City Council, nor the police was able to play a conciliatory role, and the City Council failed to present timely practical solutions.
Study of thyroid disorders in ankylosing spondylitis patients on anti-tumor necrosis factor treatment
Authors: Soliman Samar Gaber , Al-Sharaky Dina Rifaat , Habib Rehab M. , Omar Noha K. , Salman Maha Mohamed
Published: June 2024

BACKGROUND:

Ankylosing spondylitis (AS) is a systemic rheumatic disease characterized mainly by involvement of sacroiliac joints and axial skeleton. Tumor necrosis factor-alpha (TNF-α) inhibitors are biologic agents which are Food and Drug Administration approved to treat AS and also act as a key factor in the treatment of autoimmune thyroid disease.

OBJECTIVE:

This study aimed to evaluate the thyroid gland disorders (functions and thyroid autoantibodies) in AS patients on anti-TNF-α biologics and their relation to disease activity.

PATIENTS AND METHODS:

This comparative cross-sectional study included 75 AS patients classified into two groups: Group I: treated with NSAIDs (n = 30) and Group II: treated with anti-TNF-α biologics (n = 45). Thyroid function tests, thyroid autoantibodies, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and human leukocytic antigen B27 were measured. AS disease activity was assessed by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), and Bath Ankylosing Spondylitis Metrology Index (BASMI) scores. Thyroid ultrasonography was used to detect any thyroid gland nodularity and echogenicity.

RESULTS:

There were significant differences between both groups regarding BASDAI (P = 0.005), CRP (P = 0.005), thyroid-stimulating hormone (TSH) (P = 0.001), and anti-thyroid peroxidase (anti-TPO) (P = 0.007). A significant difference was found regarding the thyroid status, with more normal thyroid and more hyperthyroid patients in the anti-TNF-treated group (P = 0.003). There were statistically significant positive correlations between BASDAI and CRP (P = 0.007), TSH (P = 0.004), and thyroid anti-TPO antibody (P = 0.008) in the anti-TNF-treated patients. By ultrasound examination of the thyroid gland, 75.6% of the anti-TNF group had normal thyroid gland compared to 56.6% of the other group, and the reported nodules were mostly of benign TIRADS classification. Comparing different subgroups of thyroid nodularity with different treatment regimens revealed significant differences in BASDAI and different laboratory investigations in favor of the anti-TNF-treated patients.

CONCLUSION:

From this cohort study, we can conclude that thyroid autoimmune disease and thyroid nodules in AS patients can be controlled by treatment with anti-TNF-α biologic drugs better than NSAIDs alone.
The annual rate of sacroiliitis and disease detection using magnetic resonance imaging, computed tomography, and X-ray: A single-center experience
Authors: Alqarni Saher F , Addas Mohamed A , Alothimen Rayan A , Khashoggi Khalid , Attar Suzan M.
Published: June 2024

Inflammation of the sacroiliac joint (SIJ), termed sacroiliitis, commonly presents as chronic back pain. A definitive diagnosis is made using a variety of radiological techniques that differ in specificity and sensitivity. This study aims to estimate the annual incidence of sacroiliitis and to explore the frequency of multiple modalities used in its evaluation. a retrospective analytic study that examined patients’ records of diagnostic imaging of the SIJ (magnetic resonance imaging [MRI], computerized tomography, and X-ray) at a tertiary center in Jeddah, Saudi Arabia, from January 2012 to June 2016. Sacroiliitis was diagnosed in 129 patients out of 338 over 4 years, giving an annual incidence of 28.17%, with an increase of 6% reaching 36% in 2015. Patients with sacroiliitis were older and obese which was statistically significant. There was a significant risk in the white ethnic group and female gender (P < 0.005). The incidence of sacroiliitis is increasing. MRI exceeded other radiological modalities in the diagnostic process. The results are supported by existing guidelines recommending MRI for early detection; however, other modalities are to be replaced depending on the preclinical probability.
Monoclonal antibody therapy in Alzheimer’s disease: an overview and vision
Authors: Bentley Jonathan H , Bishop Lindsey E , Broussard John I
Published: June 2024

Prior attempts to treat Alzheimer’s disease have been limited to improving the function of cholinergic or glutamatergic synapses and have been largely palliative. The advent of monoclonal antibody (MAb) therapies has allowed researchers to directly test the amyloid hypothesis, that targeting the extracellular aggregation of amyloid-β (Aβ) plaques will arrest the progression of neurodegeneration. MAb therapy stimulates a patient’s immune system to eliminate Aβ plaques and thus slows the neurodegenerative progression of the disease. In this review the authors will discuss the successes and limitations of MAb therapy and the efficacy and mechanism of different treatments. The key risk associated with Mab therapy is amyloid-related imaging abnormalities that can coincide with cerebral effusion or siderosis. Deposits of Aβ oligomers can adhere to capillaries, and it is thought that immune activation targeting these oligomers can result in adverse events. With proper screening of high-risk patients (determined by either genetic testing for Aβ42/40 or cardiovascular profile), severe side effects can potentially be mitigated. This assessment of current MAb approaches concludes that progress in the neurodegeneration field will be contingent upon shifting the diagnostic framework to focus on early detection and prevention of the neurodegenerative cascade initiated by Aβ plaque formation.
Resting-state electroencephalography delta and theta bands as compensatory oscillations in chronic neuropathic pain: a secondary data analysis
Authors: Barbosa Sara Pinto , Junqueira Ygor Nascimento , Akamatsu Milena Apetito , Marques Lucas Murrins , Teixeira Adriano , Lobo Matheus , Mahmoud Mohamed H. , Omer Walid E. , Pacheco-Barrios Kevin , Fregni Felipe
Published: June 2024

Chronic neuropathic pain (CNP) remains a significant clinical challenge, with complex neurophysiological underpinnings that are not fully understood. Identifying specific neural oscillatory patterns related to pain perception and interference can enhance our understanding and management of CNP. The present study aimed to analyze resting electroencephalography data from individuals with CNP to explore potential neural signatures associated with pain intensity, pain interference, and specific characteristics of neuropathic pain. This was achieved through a secondary analysis of electroencephalography data and Brief Pain Inventory responses from 36 patients with CNP, originally collected in a previous cross-sectional study. For statistical analysis, we modeled a linear or logistic regression by dependent variable for each model. As independent variables, we used electroencephalography data with such brain oscillations: as delta, theta, alpha, and beta, as well as the oscillations low alpha, high alpha, low beta, and high beta, for the central, frontal, and parietal regions. All models were tested for confounding factors, such as age and medication. There were no significant models for pain interference in general activity, walking, work, relationships, sleep, and enjoyment of life. However, the model for pain intensity during the past 4 weeks showed decreased alpha oscillations, and increased delta and theta oscillations were associated with decreased levels of pain, especially in the central area. In terms of pain interference in mood, the model showed high oscillatory alpha signals in the frontal and central regions correlated with mood impairment due to pain. Our models confirm recent findings proposing that lower oscillatory frequencies, likely related to subcortical pain sources, may be associated with brain compensatory mechanisms and thus may be associated with decreased pain levels. On the other hand, higher frequencies, including alpha oscillations, may disrupt top-down compensatory mechanisms.
A comparative study between amniotic membrane transplantation and topical mitomycin-C in recurrent pterygium management
Authors: El-Shahed Ahmed F. , El-Shahed Fawzi S. , Yousef Walid A. , El-Shahed Reem F.
Published: June 2024

Aim

The aim of this study was to compare the outcome of amniotic membrane transplantation (AMT) and topical mitomycin-C (MMC) in the management of recurrent pterygia.

Patients and methods

This is a retrospective study that included 40 cases of recurrent pterygia. They were subjected to surgical excision of the pterygium with bare sclera technique. The cases were categorized into two groups, 20 cases in each group. Group 1 was managed with intraoperative topical MMC, while group 2 was managed with AMT at the time of surgery. The patients were followed-up for at least 6 months postoperatively. The outcome measures were visual acuity (VA), corneal astigmatism, recurrence, and postoperative complications.

Results

The duration of postoperative pain was significantly shorter in the AMT group (6.8±1.0 days) than in the MMC group (10.45±1.5 days, P<0.0001). In addition, postoperative photophobia and lacrimation persisted for a significantly longer period in the MMC group (mean=10.0±1.03 days) compared to the AMT group (mean=7.85±0.81 days, P<0.0001). At the end of follow-up period, VA improvement occurred in 60% of group 1 and in 70% of group 2 patients. However, the preoperative and postoperative decimal VA were not significantly different between the two study groups (P=0.6684 and 0.7302, respectively). In group 1, there was a significant difference between the preoperative corneal astigmatism [−3.74±2.19 diopter (D)] and the postoperative astigmatism (−2.31±1.46 D) after 6 months (P<0.01). Similarly, in group 2, there was also a significant difference between the preoperative corneal astigmatism (−3.83±2.32 D) and the postoperative astigmatism (−2.12±1.60 D) after 6 months (P<0.01). However, the difference between the two groups was statistically insignificant. In the first postoperative 2 weeks, there was a statistically insignificant higher incidence of delayed wound healing and superficial punctate keratitis in the MMC group. The corneal wound healing was faster in the AMT group (mean=4.2±0.69 days) than in the MMC group (mean=4.6±o.6 days). However, the difference was not statistically significant (P=0.0578). At 2 weeks postoperatively, there were two cases of conjunctival defect and one case of scleral thinning in the MMC group only. At the end of the follow-up period, another case, in the MMC group, developed scleral thinning; however, the cornea was clear.

Conclusion

AMT and MMC could be used in the management of recurrent pterygia. The AMT group showed better visual outcome without postoperative complications. However, the difference between the two groups was statistically insignificant.
Evaluation of glaucomatous macular and optic nerve vascular damage by optical coherence tomography angiography
Authors: Hatata Ragai M. , Nan Heba M. , Kamal Mahmoud A. , Elghonemy Hanan M. , Taha Reham H.
Published: June 2024

Purpose

The aim of this study was to compare the macular and optic nerve head vessel perfusion density in mild primary open-angle glaucoma (POAG) and moderate–severe POAG patients to normal eyes as a control cohort.

Patients and methods

This is a retrospective comparative case–control study that included 80 eyes of 46 participants. The study included 60 eyes of 36 POAG patients and 20 eyes of 10 healthy participants (control group). The patients underwent 3.0×3.0 mm optical coherence tomography angiography (OCTA) scans centered on the macula and 4.5×4.5 mm scans on the optic disc.

Results

The OCTA scans of the glaucomatous eyes revealed a reduction in microvasculature in the peripapillary area, which was absent in the control cohort. The whole disc vessel density (VD) was significantly less in the glaucomatous eyes (mean=38.02±8.74) compared to the control cohort (mean=50.41±2.58, P<0.001). The severity of glaucoma was linked to a decrease in macular VD percentage, with a mean superficial VD of 36.09±5.67 in the glaucoma cohorts and 46.64±5.53 in the control cohort (P<0.001), which was more pronounced than in the deep layer (P<0.008). There was no statistically significant difference in the foveal avascular zone size between the control and glaucoma cohorts at any stage (P=0.999).

Conclusion

The OCTA vascular density accurately distinguished the glaucoma from healthy eyes, with superior performance in the peripapillary region. The foveal avascular zone size did not indicate glaucoma severity. The OCTA noninvasive assessment of the capillary networks showed a potential for managing the glaucoma patients by characterizing the retinal vascular changes.
Prevalence and surgical complications of pseudoexfoliation syndrome among rural population presenting with senile cataract in South India
Authors: Govind Indu , Reddy Manjoo S. , Roche Anjali L.
Published: June 2024

Purpose

The aim of this study was to evaluate the prevalence of pseudoexfoliation (PEX) among patients presenting with cataract in rural South India and to assess the perioperative complications encountered during cataract surgery.

Patients and methods

This prospective, observational, cross-sectional study was conducted at the Department of Ophthalmology, East Point College of Medical Sciences and Research Centre, Bangalore, India. A total of 2708 patients with senile cataract attending the camps conducted by the department were selected for the study. Patients aged between 50 and 90 years, planned for cataract surgery were consecutively included and a complete ophthalmic evaluation was done for the presence of PEX. The complications encountered during cataract surgery were noted and assessed.

Results

The study included 4390 phakic eyes of 2708 patients. The prevalence of PEX, observed in this study population, was 4.62%. The mean age of the patients with PEX was 67±7.5 years, with 66.4% of the patients being males and 33.6% being females. Unilateral involvement was observed in 63.2% of the patients, whereas 36.8% had bilateral PEX. The mean pupillary dilation was 5.2±1.01 mm in the patients diagnosed with PEX. The presence of nondilating pupils was statistically significantly higher (P=0.000) in the PEX group compared to the non-PEX patients. Increased preoperative intraocular pressure was observed in 22.4% of the PEX patients. Vitreous loss (in 7.2%), zonular dehiscence (in 6.4%), and intraocular lens decentration (in 4.8%) were the most encountered complications with a statistically significant higher occurrence in the PEX group (P<0.05). In addition, capsular rent was observed in 1.6% of the PEX cases.

Conclusion

The prevalence of PEX among patients presenting with cataract in this South Indian study was similar to other published Indian studies. There were comparable rates of complications in cataract surgery among the PEX patients to the existing literature.
Three-snip punctoplasy with everting interrupted sutures versus three-snip punctoplasty with mini-Monoka stent for management of punctal stenosis (prospective comparative study)
Authors: Radi Yomna E. , Elmatbouly Essam S. , Daifalla Ahmed , Bayoumy Ahmed Sherin M.
Published: June 2024

Purpose

To compare the results of three-snip punctoplasty with the placement of three everting interrupted sutures versus three-snip punctoplasty with mini-Monoka stent in managing punctual stenosis.

Patients and methods

Fifty adult patients underwent three-snip punctoplasty with three everting interrupted sutures in one eye (right eye) (group A), and the other eye (left eye) (group B) underwent three-snip punctopasty with mini-Monoka stent. The sutures and stent were removed 6 weeks after the surgery. Epiphora, punctal opening, tear height meniscus, fluorescein and disappearance test results were analyzed and compared to preoperative information.

Results

Hundred eyes of 50 patients with a median age of 59 years, and females accounted for 56% of the sample. Anatomical and functional success in the right eye (group A) was 87.8 and 85.7%, respectively. On the other hand, the left eye (group B) anatomical and functional success were 89.7 and 87.7%, respectively. Regarding epiphora, there was a statistically significant difference between presurgical and postsurgical follow-up examinations in both right and left groups regarding Munk score. Tear Meniscus Height (TMH) decreased all through the follow-up visits between the two groups, almost to half, with no significant difference between both groups.

Conclusion

Both three-snip punctoplasty with everting sutures and three-snip punctoplasty with mini-Monoka stent are successful techniques in the management of punctal stenosis.
Practise Updates: Diagnosis and Management of Idiopathic Hirsutism
Authors: Khare Vibhu R. , Sinha Binayak , Sengupta Nilanjan , Chatterjee Sudip , Maji Debasish , Majumder Anirban , Guha Prathama , Datta Sujata , Hawelia Dinesh K. , Bhattacharyya Supratik , Chaudhuri Soumyabrata R. , Batin Masood
Published: June 2024

Idiopathic hirsutism (IH) is a common clinical condition with multiple diagnostic and therapeutic uncertainties. There are no clear recommendations for the diagnosis and management of the condition. This practice update was developed to guide the primary care physicians and the specialists in better and more systematic management of IH particularly in the Indian context. Twelve experienced members consisting of eminent endocrinologists, physicians, a dermatologist, a gynaecologist and a psychiatrist were invited by the Integrated Diabetes and Endocrine Academy (IDEA). A literature search was performed using online databases from PubMed, Cochrane Library and Google Scholar. Published articles from peer-reviewed indexed journals, with a preference for meta-analyses and randomized controlled trials, were selected. A meeting took place with all the 12 members individually giving their opinions on predetermined questions of interest. After the initial meeting during IDEACON 2023, two more meetings were held and the practice update was formulated after voting. Practice updates were made on important areas such as the cut-off for modified Ferriman-Gallwey Score for the Indian population, conditions to be excluded before diagnosing IH, when to refer to specialists, investigations in a suspected case of IH and choice of therapies for its management.
A Comparison of 06:00 AM Versus 09:00 AM Serum Cortisol as a Basal Morning Cortisol in Guwahati, Assam: A Pilot Study
Authors: Saikia Uma K. , Nagarajaiah Praveen , Baro Abhamoni , Bhuyan Ashok K.
Published: June 2024

Introduction:

Cortisol secretion is regulated by circadian rhythm, which is influenced by zeitgebers like light. In India, the entire country operates under a single time zone, Indian Standard Time, which may not align with the local sunrise timing across different regions.

Aims:

This study aimed to compare the basal serum cortisol levels between 06:00 AM and 09:00 AM in Guwahati, Assam, where sunrise occurs earlier compared with the western part of the country. A cross-sectional pilot study was conducted from December 2022 to June 2023 in a tertiary care hospital in Guwahati.

Methods:

Serum cortisol samples were collected at 06:00 AM and 09:00 AM from 25 healthy adult participants once in winter and again in summer. Descriptive statistics and paired Student’s t-tests were used.

Results:

The mean serum cortisol levels at 06:00 AM in winter, summer and overall were 13.2, 13.4 and 13.3 μg/dL, respectively. At 09:00 AM, the mean serum cortisol levels in winter, summer and overall were 8.2, 7.7 and 8.0 μg/dL, respectively. Significant differences were observed between the 06:00 AM and 09:00 AM cortisol levels in both winter and summer (P <0.001).

Conclusion:

This study highlights the importance of considering the influence of earlier sunrise on circadian rhythm, cortisol secretion and sampling protocols. Recognising the impact of earlier sunrise on cortisol secretion and adapting sampling protocols accordingly to align with the local sunrise can provide a more accurate assessment of basal cortisol levels and help avoid potential misinterpretation and diagnostic challenges associated with low values.
Spontaneous Hypoglycaemia due to Insulin Autoimmune Syndrome in Six Cases, Response to Steroid Therapy and Rituximab
Authors: Batra Chandar M. , Jain Savita , Kumar Kiran P. , Goyal Monika , Kachroo Varsha , Takkar Simran , Yadav Rini
Published: June 2024

Introduction:

Dr. Hirata of Japan first described insulin autoimmune syndrome (IAS) in 1970. Seven hundred ninety-five cases of this rare syndrome have been reported from Japan and China and 29 from India. IAS has the following characteristic features 1) severe spontaneous attacks of hyperinsulinemic hypoglycaemia, 2) high total immunoreactive insulin levels, 3) elevated insulin autoantibody (IAA) titres, 4) no prior exposure to exogenous insulin, and 5) no pathological abnormalities of the pancreatic islet cells.

Methods:

We treated six cases of IAS with high doses of prednisolone for 4-6 weeks and then gradually reduced the doses. Diagnosis of IAS was established by documenting Whipple’s triad of symptoms and signs of hypoglycaemia, blood sugar <55 mg/dl, improvement of symptoms with dextrose infusion, inappropriately increased insulin levels >3 uU/ml, C-peptide levels >0.6 ng/ml, and increased titres of anti-insulin autoantibodies. Insulinoma and non-pancreatic tumours were ruled out by CECT (contrast-enhanced computerised tomography) or MRI (magnetic resonance imaging) of the abdomen and if necessary endoscopic ultrasonography and gallium 68 Dotanoc PET (positron enhanced tomography). Autoimmune screening and serum electrophoresis were done to rule out multiple myeloma. Monitoring of the patient’s blood sugars was done by the laboratory, glucometer readings, and a freestyle libre glucose monitoring system.

Results:

Remission of hypoglycaemic episodes, hyperglycaemic episodes, and marked reduction of serum insulin and insulin autoantibodies in four out of six patients with diet therapy and steroids. Two patients resistant to steroids were treated with rituximab successfully. Patient 6 developed serious complications of cytomegalovirus and Pneumocystis carnii after rituximab, which were treated successfully.

Conclusion:

A careful history including recent infections, medications, and vaccinations provides vital clues in the evaluation. An increased awareness of IAS will prevent unnecessary and costly investigations and surgery. Although it is often self-remitting, steroids are contributory in severe cases. Immunosuppressives are used successfully in cases refractory to steroids. Continuous glucose monitoring system (CGMS), by freestyle libre glucose monitoring system, provided real-time blood sugar values, total time in hypoglycaemia, and total time in the range (TIR), which proved very valuable in managing IAS patients. Low CGMS values should be corroborated clinically and with laboratory or glucometer values.
Clinical Profile and Efficacy of Long-Acting Octreotide in Hyperinsulinemic Hypoglycaemia
Authors: Kubsad Payal. S , Vani. H.N , Sheshadri Tejasvi , Palany Raghupathy
Published: June 2024

Introduction:

Hyperinsulinemic hypoglycaemia (HH) is characterised by unregulated insulin secretion, leading to persistent non-ketotic hypoglycaemia with a lack of alternate fuel that induces a severe risk for brain damage and neurodevelopmental abnormalities. Octreotide, a somatostatin analogue, has been effectively administered as subcutaneous injections or depot preparations in diazoxide-unresponsive HH.

Methods:

Children and infants with HH receiving short-acting octreotide injections were included. Anthropometric values, hypoglycaemic episodes, HbA1C, and side effects were noted from the records and were followed up for 12 months. Informed written consent was obtained from the parents before administration of a single dose of LAR (long-acting octreotide). Based on home-based glucose monitoring (HBGM), the dosage of LAR was modified, and short-acting octreotide was eventually withdrawn. The patients shared the injection’s cost for cost-effectiveness. HH affects the quality of life (QoL) if not diagnosed and controlled adequately. A QoL questionnaire was given before starting LAR and after 6 months of receiving LAR, and the changes were noted accordingly.

Results:

Twenty-two patients were diagnosed with HH, of which 11 infants and children were included in the study. Mutations were identified in 7 (63.63%) children. Daily octreotide could be tapered and stopped with the addition of sirolimus in one patient with an increasing dose of LAR to maintain euglycaemia. The hypoglycaemic episodes decreased with increasing dose of LAR with a decrease in the severity. Eight (72.7%) patients showed an improved lifestyle on LAR quantified through a QoL questionnaire.

Conclusion:

LAR was found effective in reducing hypoglycaemic episodes with no adverse effects. The patient’s parent’s satisfaction was higher. Given its high cost, this trial achieved cost-effectiveness by sharing a single sitting of LAR injection.
Long-term successful use of belinostat in a patient with relapsed-refractory angioimmunoblastic lymphoma who has previously been heavily treated
Authors: Atalay Figen , Yeşilaltay Alpay
Published: June 2024

Angioimmunoblastic T-cell lymphoma (AITL) is one of the sub-types of peripheral T-cell lymphomas (PTCLs) that are remarkably refractory and has the potential to have a poor prognosis. The treatment process includes a wide range of treatment modalities, from anthracycline-based regimens that have been used for years to novel agents, such as histone deacetylase inhibitor romidepsin and belinostat. Increased treatment response rates and prolonged survival have been reported in studies with belinostat. Similarly, in this case report, we wanted to share a patient of an advanced age and with a high IPI score, whom we had treated in many treatment lines and maintained a long-term treatment response by administering belinostat.
KRAS and BRAF genetic alterations in lung cancer: A case − control study
Authors: Sawal Humaira Aziz , Shah Syeda Ibtesam , Malik Saima Shakil , Mehmood Sarmad , Baig Mehreen , Rasool Ehtsham , Masood Nosheen
Published: June 2024

Context:

Lung cancer (LC) is one of the most critical neoplastic abnormalities, having globally a high mortality rate. Knowledge about its genetic mutations and their association with clinically pathological features of LC is very important. Here, we describe the epidemiological molecular study of genetic mutations in KRAS and BRAF genes and their relationship with the demographic and clinical characteristics of Pakistani patients with lung adenocarcinoma.

Aim:

To analyze the mutations of KRAS and BRAF in LC patients among Pakistani population.

Settings and Design:

The study has been carried out at universities and health institutes of Islamabad, Pakistan.

Methods and Material:

Deoxyribonucleic acid (DNA) was extracted from the patient samples by using the standard protocol and amplified by using the specific primers. Later on, the Polymerase Chain Reaction (PCR) products were examined with the help of single stranded conformational polymorphism (SSCP).

Statistical Analysis:

Relationship between KRAS, BRAF mutations, and LC risk was accessed by conditional logistic regression using SPSS version 24.0. Results were illustrated by odds ratio (OR), 95% confidence interval (CI), and P value.

Results:

LC is more common in male population and smoking is one of the leading risk factors for (p < 0.0001) LC. KRAS and BRAF mutations were found to be contributing factors toward LC development and showed statistically significant results along with conformation through computational analysis.

Conclusions:

It can be concluded that smoking is lethal and cancer causing. The concomitant mutations found in KRAS and BRAF were infrequent, and they probably have a very unusual effect on the clinical management of Pakistani patients with lung adenocarcinoma.
Prediction of auditory brain stem responses damage in patients with head-and-neck cancers receiving radiotherapy using the functional assays of normal tissue complication probability models
Authors: Firoozabad Leila Alipour , Cheraghi Susan , Farahani Saeid , Nikoofar Alireza , Rezaeijo Seyed Masoud , Bakhshandeh Mohsen , Paydar Reza
Published: June 2024

Aim:

The purpose of this study was to set four NTCP models on clinical data and develop a model that calculates the possibility of hearing damage due to irradiation of healthy and at-risk brainstem tissue.

Materials and Methods:

ABR tests were performed on 50 head-and-neck cancer patients three years after radiotherapy for evaluation of lesions in a part of the auditory nerve or the auditory pathway in the brainstem.

Results:

It indicated a significant difference in the latency of the waves assessed by the ABR test between the two groups. The paired sample t-test indicated the latency time of waves I, III, V, I-III, and I-V (P < 0.001) in the right ear, and in the left ear latency time of waves III, V, I-III, I-V, and III-V (P < 0.001) were significantly higher in the case group’s ear than those in the control group. The confidence interval of the fitted parameters was 95% for NTCP models. ABR test’s binary outcome with differential dose-volume histograms (dDVHs) was calculated and imported as input to the NTCP modeling. The values of the parameters n = 2.3-2.9 and the value s = 1 were obtained, which indicated that the brainstem organ is seriality.

Conclusion:

The best model ranked for the prediction of brainstem hearing damage was the logit model, which had the lowest Akaike value. The nervousness of the auditory organ of the brainstem (VIII nerve) can be declared as one of the reasons for being independent of the received dose.
Bilateral metaplastic squamous cell breast cancer
Authors: Ertaş Gülçin , Kandemir Olcay , Azak Can
Published: June 2024

Metaplastic breast cancer is a rare and heterogeneous breast cancer group that encompasses both malign epithelial and mesenchymal tissue components. Squamous cell breast cancer (SCC) is one of the types of metaplastic breast cancer, and diagnosis is established when more than 90% of the malignant cells are of squamous cell origin. Squamous cell metaplastic breast carcinoma is considered an aggressive tumor because of the risk of distant metastases, and there are limited data on treatment patterns. In this study, we report patient characteristics and treatment results of one patient with bilateral metaplastic squamous cell breast cancer.
Pulmonary fibrosis prevalence after adjuvant radiotherapy of Iranian patients with breast cancer: A single-center cross-sectional study
Authors: Rakhsha Afshin , Farahani Sara , Moghani Mona Malekzadeh , Siavashpour Zahra , Mahboubi-Fooladi Zahra
Published: June 2024

Aims:

This study aims to investigate the incidence rate of pulmonary fibrosis as a late radiotherapy complication and identify the associated dosimetric and demographic factors using radiological findings between Iranian patients with breast cancer.

Methods and Material:

Breast cancer patients treated at the education hospital of Shohada-e Tajrish Hospital, Tehran, Iran, from 2017 to 2021 were considered. Patients have included for whom a secondary chest CT scan was available at least six months after radiotherapy. Dose-volume histogram (DVH) parameters of three-dimensional conformal radiotherapy (3D-CRT) treatment plans were exported. Demographic features and data on underlying lung diseases, diabetes, and smoking history were extracted.

Results:

A total of 250 patients were included in the study with a mean age of 46.1 ± 7.5 yrs and a mean body mass index (BMI) of 24.5 ± 4.2 kg/m2. Pulmonary fibrosis was detected for sixty-two cases. A significant relationship was obtained between the ipsilateral lung DVH parameters of patients with pulmonary fibrosis (P value < 0.05). The V5Gy, V10Gy, V13Gy, V20Gy, V30Gy, MLD, and DMax for individuals with pulmonary fibrosis were significantly higher than those without this injury.

Conclusions:

Pulmonary fibrosis was distinguished for 25% of the breast cancer cases at least six months after adjuvant radiotherapy. A significant relationship between the DVH parameters, underlying lung disease, diabetes, radiotherapy fields (i.e., Breast + LN + SC or Breast/Chest-wall only), age, and BMI with the frequency of the ipsilateral pulmonary fibrosis was obtained. V13Gy and V30Gy of the ipsilateral lung may be the most predictor of pulmonary fibrosis incidence.
Small cell carcinoma esophagus-A tertiary cancer center experience of a rare variant
Authors: Kumar Divyesh , Dey Treshita , Sekar Aravind , Khosla Divya , Periasamy Kannan , Kapoor Rakesh
Published: June 2024

Background:

Esophageal cancer is quite prevalent worldwide and usually carries a poor prognosis. Histologically, although squamous cell carcinoma and adenocarcinoma predominate, small cell carcinoma (SmCC) cases have been reported. Overall, there is a paucity of literature regarding this variant. In this article, we aim to highlight this uncommon entity of carcinoma esophagus and share our experience of SmCC patients seen over a decade at our institute.

Method:

Records of patients with SmCC histology from 2010 to 2020 were assessed. Patients’ demographic characteristics, clinical characteristics, treatment received, and outcomes were taken into consideration. Results were analyzed statistically using SPSS version 22.

Results:

Fourteen patients (nine males and five females) with a median age of 57 years (range: 35 – 72 years) were analyzed. The majority of the patients 10/14 (71.4%) received palliative radiotherapy of either 30Gy/10 fractions or 35Gy/15 fractions. Only 1/14 (7.14%) patients received neoadjuvant chemotherapy and concurrent chemoradiation (CCRT). Overall, partial response was noted in all 11 patients (78.6%) who received treatment. The average median survival was 5 months (range: 1-11 months).

Conclusion:

Although the small sample size of the study prevents us from drawing a firm conclusion, we propose national and international collaborative prospective studies for framing definitive oncologic management strategies for this rare histological variant of esophageal cancer.
Intramuscular injections of human placental extract versus conventional symptomatic approaches in radiation-induced oral mucositis, in patients with head and neck cancers, on definitive chemoradiotherapy – A ray of hope?
Authors: Prasad Priyanka Manchenahalli Venkatesh , Chelakkot Prameela G. , Narayan Geetha S.
Published: June 2024

Background:

Despite the availability of a wide range of agents, no single treatment exists for the management of radiation-induced oral mucositis, in patients, with head and neck malignancies, on radical chemoradiation; a debilitating and limiting sequela. Human placental extract is one option that has been proposed.

Aims and Objectives:

This study aimed at evaluating the therapeutic benefits of human placental extract (Placentrex) in the management of radiation-induced oral mucositis in patients on curative intent treatment for head and neck cancers with concurrent chemoradiation, and to compare the observations with other conventional approaches.

Material and Methods:

Patients presenting to the Department of Radiation Oncology, of a tertiary cancer care center, with biopsy-proven carcinoma of the oral cavity, oropharynx, and hypopharynx, planned for definitive, curative intent chemoradiation, between January 2020 and June 2021, were recruited for this study. The interventional group received a deep intramuscular injection of 2 ml of Placentrex to the deltoid muscle, once-a-day from the 11th fraction of radiation till completion, on treatment and non-treatment days. The control group received supportive, symptomatic, conventional treatments for mucositis. The response was assessed every week during treatment and at the third and sixth months of follow-up and was compared.

Results:

The study comprised 26 patients, 15 in the interventional group and 11 in the control group. On completion of treatment, 40% in the interventional arm and 81.82% in the control arm had progressed to grade 2 and 3 mucositis (P < 0.05). Treatment interruption was seen in 13% in the interventional arm and 55% in the control arm (P < 0.001).

Conclusions:

Results from this study show that human placental extract, injection Placentrex, had a significant effect in decreasing the severity of radiation-induced mucositis and thereby reducing any interruption or delay in treatment when compared to other conventional methods.
Primary mucosal malignant melanoma (PMMM) of nasal cavity: A report of two cases
Authors: Chaturvedi Anubhuti , Mallya Varuna , Mandal Shramana , Khurana Nita , Meher Ravi , Singh Kishore
Published: June 2024

Primary mucosal malignant melanoma of the nasal cavity is a rare tumor with aggressive behavior and a dismal prognosis. An extremely rare tumor that accounts for 0.7% to 1% of all melanomas in Caucasian populations and between 4% and 8% of malignant tumors of the nasal cavity and paranasal sinuses. Taking into account the rarity, it is important to note that malignant melanoma should be considered when making a differential diagnosis of tumors of the nose and paranasal sinuses. Two cases of primary malignant melanoma of the nasal cavity both arising in females, one in a 60-year-old and the other in a 64-year-old, both of whom presented with nasal obstruction and brief symptomatic epistaxis are being presented here. The diagnosis being confirmed by a histopathological examination along with an immunohistochemical analysis by using S100 and HMB45.
Complete and rapid response with the combination of immunotherapy and chemotherapy in a young adult patient with microsatellite instability-high metastatic gastric cancer
Authors: Kazaz Seher Nazlı
Published: June 2024

Gastric cancer (GC) is an aggressive malignancy; 5.0% of GC patients are diagnosed before the age of 40. These patients are more aggressive and advanced stage at the diagnosis. Microsatellite instability-high (MSI-H) status is usually seen in relatively older patients. We report a 31-year-old male patient presenting with an intra-abdominal mass and spleen lesions that radiologically mimic a gastrointestinal stromal tumor (GIST). He underwent surgery. Histological examination revealed poorly differentiated adenocarcinoma starting from the deep gastric mucosa. After surgery, rapidly progressive disease was observed. The patient with MSI-H and combined positive score (CPS) of 65% was treated with a combination of immunotherapy and chemotherapy; complete response was observed in approximately 3 months. This is a very rare GC case in young adult age with MSI-H status and responds to treatment in a short time. Predictive markers for immunotherapy efficacy are still being discussed; this case supports the predictive role of high CPS score and MSI-H phenotype in demonstrating treatment efficacy.