bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical and complication outcomes of abortions in pregnant women: insights from a tertiary care center
Authors: Mellikeri Soumya , Deshpande Gururaj
Published: December 2024

Background: Abortion is a highly debated and controversial topic that has sparked intense discussions and emotions across the globe. Clinical outcomes of abortions are crucial in understanding the safety and effectiveness of different abortion methods. The present study was carried to evaluate the clinical outcomes and complications associated with the abortions in a tertiary healthcare centre.
Methods: This was a prospective observational study conducted on 115 women with a gestational age <24 weeks who were admitted to the labour room for all types of abortions. The demographics and clinical manifestation of the women were recorded. Various types and methods of abortion were recorded. The post abortion complications were also recorded.
Results: The most common method of abortion was missed abortion in 32.1% of the cases. The most prevalent method of abortion was the most common was by tablet mifepristone 200 mg tablet misoprostol 600 µg in 69% of the patients. Regarding post abortion complication, majority of the patients had anemia in 15 (30%) of the cases. There was a significant association between complication and abortion type (p<0.001).
Conclusions: Missed abortion was the most common type and the medical method of abortion is the prevalent mode of abortion. Thus, it is important to consider the long-term effects on reproductive health that may result from complications during abortion procedures.
Clinical perspectives on placenta accreta spectrum: a case series
Authors: Rajeswari K. S. Raja , Parthiban Pavithraa , Vidhyantha Kiruba Hannah
Published: December 2024

To describe the presentation and management of three cases of placenta accreta spectrum. Placenta accreta spectrum (PAS), first described in 1937, refers to the pathological invasion of placental trophoblasts into the myometrium and beyond.  While a strong association exists between PAS and uterine scarring-often attributed to defective decidualization at the endometrium-myometrium interface-this does not fully explain all cases. Here we report three cases of placenta accreta spectrum disorders, two cases with placenta accreta and one with placenta percreta. Emergency LSCS was performed for two patients with placenta accreta and emergency laparotomy proceeded to subtotal hysterectomy was done for placenta percreta. These patients had a stormy post operative period and required multidisciplinary approach for management. In our study, all three cases experienced spontaneous bleeding far from term and required a high index of suspicion for early diagnosis and effective treatment.  With rise in Caesarean sections, placenta accreta spectrum disorders are not uncommon in today’s clinical practice. The treatment option should be individualised and hysterectomy is not the only definitive treatment.
Encapsulated papillary carcinoma of the breast: a case report
Authors: Errami Lamyae , Graiti Ghizlane , Lamzouri Oussama , Bellajdel Btissam , Chatbi Zainab , Slama Loubna , Taheri Hafsa , Saadi Hanane , Mimouni Ahmed
Published: December 2024

Encapsulated papillary carcinoma (EPC) of the breast is a rare form of ductal carcinoma characterized by its development within a cystic space surrounded by a fibrous capsule. Due to its uncommon nature, the in situ or invasive status of EPC can be challenging to establish, particularly through biopsy. Surgical intervention is the primary treatment, and the need for adjuvant therapy remains a subject of debate. This case report describes the diagnosis, management, and outcome of EPC in a premenopausal woman. A 39-year-old premenopausal woman presented with a 12-month history of a painless, palpable mass in the right breast. There was no history of nipple discharge, smoking, oral contraceptive use, or familial breast or ovarian cancer. Clinical examination revealed a 4×7 cm, well-circumscribed, soft, oval, and mobile mass in the superior outer quadrant of the right breast, with no evidence of axillary, cervical, or supraclavicular lymphadenopathy. Mammography identified two adjacent retroareolar masses (47×36 mm and 43×28 mm), and ultrasonography showed one predominantly cystic lesion with a solid component and a second anechoic lesion, both classified as ACR 4, indicating suspicious malignancy. A lumpectomy was performed, and histopathological analysis confirmed encapsulated papillary carcinoma. Immunohistochemistry showed tumor cells positive for p63, p40, CK5/6, AML, and estrogen receptor (ER) with a Ki-67 proliferation index of less than 5%, suggesting a low proliferative rate. Complete surgical excision was achieved with no further adjuvant therapy deemed necessary due to the low proliferation index. At the 6-month follow-up, the patient remained asymptomatic with no evidence of recurrence. This case highlights the importance of considering EPC in the differential diagnosis of breast masses in premenopausal women. Early recognition and appropriate surgical management are crucial for favorable outcomes. Further research is needed to determine optimal management strategies for EPC, particularly in younger patients.
From perill to progress:a maternal near miss-secondary postpartum hemorrhage
Authors: Ravikumar Akshitha , Natarajan Usha
Published: December 2024

Maternal near miss (MNM) refers to a situation in which a woman nearly dies but survives a life-threatening complication during pregnancy, childbirth, or within the postpartum period. This case report describes the management of a 22-year-old, para 2, living 2 woman who presented with secondary postpartum hemorrhage (PPH) on postoperative day 13, having been transferred from another center. Initial stabilization included broad-spectrum antibiotics and vasopressors. Ultrasound revealed suspected retained products of conception or clots, leading to suction and evacuation, with laparotomy as a contingency. Despite balloon tamponade, ongoing hemorrhage required escalation to peripartum hysterectomy with concurrent bladder rent repair. A multidisciplinary approach involving obstetricians, anaesthetists, and urologists was critical to the successful outcome. The postpartum period was uneventful, and the patient made a full recovery. This case underscores the importance of timely identification, calm decision-making, and coordinated multidisciplinary care in managing MNM scenarios, ultimately saving the patient's life.
Mitochondrial disorders-challenges in pregnancy: a case report
Authors: Sukayogula Malini , Surapaneni Tarakeswari
Published: December 2024

Mitochondrial disorders (MD) encompass a diverse group of genetic disorders affecting the intra-cellular energy-producing organelles. During pregnancy, these disorders present unique challenges that warrant special attention. Here, we report a case of a 28-year-old woman who presented with ptosis since, 11 years of age. Muscle biopsy revealed mitochondrial cytopathy, but genetic evaluation was not done. She presented to us in early pregnancy. Whole Mitochondrial genome sequencing showed no pathological / likely pathological variant. Whole Exome sequencing revealed a Homozygous missense variant in exon 6 of RRM2B gene (c.629 A>G;p.lys 210 Arg) associated with Mitochondrial DNA depletion syndrome 8A and 8B, which has an autosomal recessive pattern of inheritance. The review of literature discusses the implications of MD on pregnancy outcomes and explores the management strategies to optimize maternal and fetal outcomes.
Idiopathic spontaneous hemoperitoneum in pregnancy: a rare entity
Authors: Rai Geeta Katheit , Aggarwal Niharika , Vidyasagar Veena , Kaul Sanjeevani
Published: December 2024

Spontaneous hemoperitoneum in pregnancy (SHiP) is a very rare occurrence and is defined as sudden non-traumatic intraperitoneal bleeding in pregnancy and up to 42 days postpartum. The incidence is currently extremely difficult to estimate due to the lack of worldwide surveillance. We present a case of a 32-year-old G4P2L2A1 at 38 weeks of gestation. The patient was referred from a private hospital in a state of shock. The patient had a history of abdominal pain followed by fainting attack. The patient underwent laparotomy in view of suspected uterine rupture. Intraoperatively there was hemoperitoneum of unknown origin. The maternal and fetal outcome was poor in this case. In literature there are only very few reported cases of spontaneous hemoperitoneum in pregnancy.
Untangling the emergency: fimbrial cyst in pregnancy
Authors: B. S. Girija , V. Nayanashree
Published: December 2024

Torsion of uterine adnexa is a significant cause of acute pain abdomen, however isolated fimbrial cyst torsion without the involvement of the ipsilateral ovary is rarely reported. It is even rarer to occur during pregnancy, hence making its diagnosis a conundrum. Here is a case report of a 19 year primigravida with 18 weeks of gestation who presented with acute pain abdomen with investigations suspecting an ovarian torsion. However, on laparotomy, isolated right fimbrial cyst torsion was seen for which detorsion followed by right salpingectomy was done. Adnexal torsion is a surgical emergency requiring early intervention to salvage the tissues. An acute abdomen on the background of adnexal mass requires vigilant assessment and evaluation to ensure timely intervention and prevent further complications.
Unusual presentation of tubo-ovarian abscess in a non-sexually active adolescent girl
Authors: Ravikumar Akshitha , Natarajan Usha
Published: December 2024

A tubo-ovarian abscess (TOA) is a rare presentation in non-sexually active adolescent. The majority of the public health impact from pelvic inflammatory disease (PID)comes from its attributable long-term sequelae, including tubal-factor, infertility, ectopic pregnancy, and chronic pelvic pain. A 15-year-old girl presented with complaints of severe right sided lower abdominal pain for one day. She had dull-aching lower abdominal pain for 2 months. She had undergone appendicular abscess drainage with appendectomy three years ago. On examination she had tenderness over suprapubic and right iliac fossa region, no mass palpable. Blood investigations done showed leucocytosis with neutrophilic shift. Ultrasound abdomen done showed dilated tube measuring 5.6×1.7 cm with thick walls and internal echoes in the right adnexa. CECT abdomen done showed large, heterogenous loculated collection with thick enhancing walls seen in the retro-vaginal pouch of Douglas, features suggestive of tubo-ovarian abscess. She underwent Abscess drainage with Right tubo-ovarian abscess cavity resection with omental and bowel adhesiolysis. Histopathology was reported as Tubo ovarian abscess with no evidence of granulomatous inflammation. Pus and tissue sent for XPERT PCR showed no AFB present. She recovered well postoperatively and was discharged in healthy condition. Although PID is rare in non-sexually active girl but need to considered as a differential diagnosis.
Uterine leiomyoma-a common pathology with a rare life-threatening complication
Authors: Vihar Nuzhath Backer Subi , Mani Suja Mary , Wills Vinitha , Mathew Susan
Published: December 2024

Uterine leiomyoma, a common disease of women in reproductive age group may rarely present with a complication as an acute abdomen. We report such a case, a 40-year-old unmarried woman presented to our emergency department with acute abdominal pain, abdominal distension. Ultra sonogram abdomen revealed a large uterine leiomyoma causing small intestinal obstruction. The same was confirmed with abdominal imaging-X-ray erect and CECT. Managed by emergency exploratory laparotomy along with gastro surgical team. Small bowel obstructions are most commonly caused by postoperative adhesions, intestinal volvulus, malignancies or masses and strangulated hernias (together forming 90% of cases). The remaining are due to wide range of intrinsic and extrinsic bowel lesions. Small bowel obstruction is relatively a rare complication of uterine leiomyoma and occurring either as a result of compression of bowel loops by a large leiomyoma in the peritoneal cavity (as in this case), bowel loops incarceration between large pedunculated leiomyoma or bowel adhesions to the infarcted leiomyoma. Possibility of leiomyoma as the culprit causing intestinal obstruction to be considered especially in females with fibroid who present with an acute abdomen.
Role of isoxsuprine in acute and maintenance tocolysis
Authors: Mane Sheela , Singh Anita
Published: December 2024

Preterm birth (PTB) continues to be a significant global health issue, with India reporting 3.02 million PTBs, accounting for nearly 23% of all PTBs worldwide. Over the past decade, the PTB rate has remained unchanged at 13 per 100 live births. Preterm labor (PTL), a leading cause of pregnancy-related hospitalizations, poses significant challenges for healthcare providers. Effective management is essential to mitigate the complications associated with PTB, which places a considerable burden on the healthcare system. Managing PTL is particularly challenging due to the difficulty in predicting its onset, as approximately 50% of PTB cases occur without identifiable risk factors.  The current PTB detection methods, such as the transvaginal ultrasound (TVUS) examination, the fibronectin test, etc., fail to detect PTB accurately, which makes PTB a complicated condition. The primary goal of PTL management is to prolong pregnancy with tocolytics which provides an opportunity to administer antenatal corticosteroids and magnesium sulfate, if needed, as well as in utero transfer to higher care facilities, when necessary. This review delves into recommendation shared by expert gynecologists on the role of effective tocolysis in management of PTL. The experts shared insights that in India, isoxsuprine is preferred over other tocolytic agents in acute PTL management, allowing sufficient time for corticosteroids to act. However, they opined that there is a possibility of spontaneous recurrence of PTL after the cessation of active labour therapy, highlighting the importance of maintenance tocolysis. The use of oral isoxsuprine as maintenance tocolysis has been associated with improved perinatal outcomes, including lesser incidence of NICU admission, improved birth weight outcomes, and extended latency periods. Maintenance tocolysis can be given to patients of cervical cerclage, active and threatened PTL. In conclusion, while PTL remains a significant challenge, isoxsuprine use in both acute and maintenance phases of therapy can positively impact maternal and perinatal outcomes.
Enhancement of memory and reduction of amyloid plaques in alzheimer\'s disease mouse model using cyclic glycine-proline
Authors: Deeba Farah , Chouhan Anand Singh , Kushwah Vinita , Maurya Garima
Published: December 2024

Amyloid plaques and neurofibrillary tangles are two of the most important signs that can be used to diagnose Alzheimer's disease (AD), which is a neurodegenerative condition. Animal models, such as APP/PS1 mice, are extremely important for advancing our understanding of the factors that contribute to Alzheimer's disease and evaluating potential treatments.

The purpose of this study is to investigate the effects of cyclic glycine-proline (cGP), a stable cyclic dipeptide that originates from glutamate, on spatial memory and the accumulation of amyloid plaque in mice with Alzheimer's disease and Parkinson's disease type 1.

In order to evaluate the spatial memory of APP/PS1 mice, the Morris Water Maze was utilised after the mice had been administered cGP. To determine the amount of amyloid plaque in the brain, first the staining was done using thioflavin-S, then imaging was performed, and last the results were quantified.

Treatment with cGP resulted in a considerable reduction in the quantity of amyloid plaque and an improvement in spatial memory in mice with APP/PS1 mutations. There was a decline in escape latency times, amyloid plaque numbers, and plaque covering percentages in the cortex and hippocampus.

There is evidence to suggest that cGP may have therapeutic potential; in a rat model of Alzheimer's disease, it was found to improve cognitive performance and reduce amyloid pathology. The therapeutic potential of cGP in reducing AD pathology and cognitive impairment is demonstrated by these results.
Capecitabine associated acute pancreatitis: A case report
Authors: Dubey Sameeksha , Singh Sanjog
Published: December 2024

Capecitabine, an oral pro-drug of Fluorouracil, has been used in treatment of many malignancies, including colorectal. Many adverse events have been associated with capecitabine including, hand foot syndrome, mucositis, diarrhea and nausea, but association of pancreatitis with capecitabine has been reported rarely. We report here, a case of capecitabine induced pancreatitis.
Exploring Experiences of Chinese Students Studying at U.S. Universities Since COVID-19
Authors: Xie Lindai , Xu Yaoying
Published: December 2024

This paper presents a phenomenological study exploring what Chinese international students (CIS) have experienced since COVID-19. Three themes emerged through in-depth semi-structured interviews with eight participants. The first theme is the typical challenges that might be encountered by CIS such as cultural barriers. The concerns of safety and racism were illustrated in the second theme, which was amplified and intensified during the pandemic. The last theme involved support and services that need improvement. Implications of the findings are discussed to reflect on how to best support CIS after and beyond COVID-19, followed by limitations of this study.
Efeito Da Utilização Da Hiperinsuflação Pulmonar Com Ventilador Mecânico Mais Aspiração Versus Aspiração Traqueal Isolada Em Pacientes Cardiopatas
Authors: Forgiarini Junior Luiz Alberto , Olixewski Marcela Pinheiro , Pereira Daiane , Peringer Vinicius Serra , Eibel Bruna
Published: December 2024

Objetivos: Avaliar a segurança e eficácia da manobra de hiperinsuflação pulmonar com o ventilador mecânico em pacientes cardiopatas.  Métodos: Trata-se de um ensaio clínico randomizado cruzado, onde foram incluídos 31 indivíduos, ventilados por mais de 48 horas, estáveis hemodinamicamente e foram exclusos indivíduos com diagnóstico de pneumonia associada ao ventilador, pneumotórax e hemotórax não drenado, enfisema subcutâneo, pressão de pico > 40 cmH2O, diagnóstico de doença neurológica recente (˂72h). No grupo controle, os pacientes eram ventilados por 1 minuto com fração inspirada de oxigênio (FiO2) a 100%, seguidos de três aspirações durante 15 segundos e com intervalo de 30 segundos. Nos participantes do momento intervenção, a pressão inspiratória foi aumentada a 10 cmH2O ou o volume foi aumentado 50% do volume corrente pelo período de 10 minutos e em seguida foi realizado uma nova aspiração da mesma maneira do grupo controle. Resultados: Os participantes tinham idade média de 71 anos, 58% eram mulheres. As variáveis hemodinâmicas não apresentaram alteração significativa no contexto clinico. Observou-se aumento das complacências estática (p=0,006) e dinâmica (p=0,013), e diminuição das pressões de pico (p=0,040) e platô (p=0,020). Conclusão: Aparentemente a técnica de hiperinsuflação pulmonar mecânica se mostrou segura para a remoção de secreção em pacientes cardiopatas.
Ḥasan b. Ömer es-Sunkūrî ve İslâm Mezheplerine Bakışı
Authors: Küllü Cebrail
Published: December 2024

Bu çalışmada XIX. yüzyıl Osmanlı âlimlerinden Ḥasan b. Ömer es-Sunkūrî’nin, Zübdetü’l-‘aḳāid nuḫbetü’l-fevâ’id adlı eseri bağlamında İslâm mezheplerine bakışı konusu ele alınmıştır. İslâm düşünce tarihinde itikadî ve siyasî gayelerle vücut bulan mezhepler farklı geleneklere mensup âlimler tarafından tavsif ve tasnif edilmişlerdir. Söz konusu mezheplerin tasnifi hususunda yetmiş üç fırka hadisi belirleyici bir etkiye sahip olmuştur. Farklı varyantları olan bu rivayeti esas alarak itikadî ve siyasî İslâm mezheplerine dair eser telif edenlerden biri de Ḥasan b. Ömer es-Sunkūrî’dir. Hanefî-Mâtürîdî bir kimliğe sahip olan Sunkūrî’nin, Eş‘arî makâlât geleneğinin tasnif sistemini esas alarak telif ettiği Zübdetü’l-‘aḳāid nuḫbetü’l-fevâ’id adlı eseri bağlamında İslâm mezheplerine yaklaşımının arka planını yansıtma ve eserin özgünlüğünü ortaya koyma amacına matuf olan bu çalışmada Sunkūrî’nin; hayatı, ilmî şahsiyeti, eserleri vb. konular ele alınmış, İslâm mezheplerine yaklaşımı ve mezhepleri tasnifi üzerinde durulmuştur. Hanefî-Mâtürîdî bir âlimin, eserinde Eş‘arî geleneğe ait tasnif sistemini benimsemesi ve fırka tasnifini bu geleneğe göre sistematize etmesi çalışmanın önemini ortaya koymakta olup onun, “Âmidî tasnifi” adıyla şöhret bulan ve Adudüddîn el-Îcî (ö.756/1355) ve Seyyid Şerîf el-Cürcânî (ö. 816/1413) ile Osmanlı medreselerinde yaygınlık kazanan tasnif sistemi bağlamında fırkaları ele aldığı sonucuna ulaşılmıştır. Söz konusu çalışmada tasvir edici/betimleyici anlatım esas alınmıştır.
An Overview of Adjuvants and Their Interaction with the Immune System
Authors: Mahmoudzadeh Leila , Froushani Seyyed Meysam Abtahi , Falsaf Monireh
Published: December 2024

Vaccines have been under development for over two centuries and have significantly contributed to the decline in infectious diseases and mortality rates by eliciting targeted immune responses against pathogens. Adjuvants, while typically non-immunogenic, play a vital role in modulating immune responses when combined with vaccines, reducing the necessary vaccine dosage and enhancing immune memory. Generally, vaccines are formulated with appropriate adjuvants to strengthen the immune response to the vaccine antigen and to assess their potential in preventing disease spread. Additionally, adjuvants are crucial in steering both humoral and cell-mediated immune responses to foster pathogenspecific immunity. There is an increasing emphasis on utilizing advanced technologies to develop novel vaccines aimed at problematic pathogens, particularly those that show limited efficacy with conventional vaccines and outdated production techniques. An ideal adjuvant should exhibit minimal to no adverse effects and ensure safety for both short-term and long-term applications. This article provides a concise overview of adjuvants, examining their significance in autoimmune diseases, especially concerning disease progression and related challenges. Acknowledging the growing skepticism surrounding vaccines in recent years is important, with some research supporting this perspective. Furthermore, we explore the function of adjuvants in cancer vaccines, categorized as therapeutic rather than preventive, noting the substantial advancements achieved in this area.
Challenges Affecting Quality Services Delivery from the Perspective of Pre-Hospital Emergency Personnel: A Qualitative Content Analysis
Authors: Hamidizadeh Saeed , Zarei Ali , Parviniannasab Ali Mohammad , Marzaleh Milad Ahmadi , Rahimi Ebrahim , Bijani Mostafa
Published: December 2024

Background & Objectives: The pre-hospital emergency medical service (EMS), serving as the first line of care and treatment for patients and injured individuals, holds paramount importance in the healthcare system. Identifying the challenges and problems facing this system is crucial for its improvement. This study aimed to elucidate the challenges affecting the delivery of quality services from the perspective of pre-hospital EMS personnel in southern Iran.
Materials & Methods: This qualitative descriptive study investigated the views of prehospital EMS personnel (N=23) selected through purposive sampling. Data were collected via semi-structured in-depth interviews and analyzed using conventional content analysis methods as described by Graneheim and Lundman
Results: The analysis revealed three main themes: organizational challenges (encompassing lack of human resources, equipment shortages, and structural-administrative issues), human resources challenges (including individual characteristics of personnel and staff dissatisfaction), and cultural-social challenges (comprising cultural barriers and environmental-social obstacles). These themes were further divided into seven subthemes.
Conclusion: Organizational, human resources, and socio-cultural challenges emerged as the most significant factors affecting the delivery of quality services in Iran’s prehospital EMS system. Policy-makers and administrators can leverage these findings to develop strategies aimed at addressing the challenges impacting the delivery of quality pre-hospital emergency services.
Evaluation of Age, Education, Trace Elements and Vitamins in Men with Toxoplasma Gondii in Maysan, Iraq
Authors: Hameedi Zahraa Hatem , Kesmati Mahnaz , Hammadi Muttlaq Alawadi Haitham Mohammed , Shafiei Mohammad
Published: December 2024

Background & Objectives: Toxoplasmosis is a disease caused by the intracellular protozoan Toxoplasma gondii (T. gondii). The parasite’s presence within cells affects various cellular activities and mechanisms. While evidence suggests that certain vitamins and trace elements can alleviate the disease and its complications, the impact of toxoplasmosis on these factors remains unclear. This study aims to evaluate the relationship between age, education, trace elements and vitamins and toxoplasmosis in men with toxoplasmosis from Maysan city, Iraq.
Materials & Methods: This study involved 200 participants, comprising 150 men infected with toxoplasmosis and 50 healthy men as a control group. Various measurements were conducted, including serum levels of trace elements (Mg, Zn, Fe) and vital vitamins (C, D, E) in both the toxoplasmosis-infected and healthy groups.
Results: The findings revealed that toxoplasmosis prevalence was highest among men aged 31-40 years with low educational attainment (up to diploma level). Furthermore, toxoplasmosis was associated with significant decrease in mean serum levels of trace elements (Mg, Zn, Fe) and vitamins (C, D, and E) (P<0.05).
Conclusion: Our results suggest that higher education levels may reduce the incidence of toxoplasmosis. Additionally, the complications caused by T. gondii may be related to the reduction in the aforementioned trace elements and vitamins. Evaluation of these factors could prove beneficial in the diagnosis and treatment of this disease.
The Effect of Probiotic Bacteria on the Reduction of 3-Monochloropropane-1,2- Diol (3-MCPD) in Powdered Infant Formula
Authors: Shariat Elnaz , Rashidi Ladan , Harzandi Naser
Published: December 2024

Background & Objectives: 3-Monochloropropane-1,2-diol (3-MCPD) is a chemical contaminant found in many food products, including infant formulas. Given the vital contribution of milk and its products to the human diet, particularly for children, the presence of 3-MCPD in dairy products poses a significant public health concern. Therefore, it is crucial to explore natural compounds for 3-MCPD removal. This study investigates the effect of probiotic microorganisms (Lactobacillus plantarum, Lactobacillus murinus, and Yarrowia lipolytica) on reducing 3-MCPD levels in infant formula containing various 3-MCPD concentrations.
Materials & Methods: L. plantarum, L. murinus bacteria , and Y. lipolytica yeast were prepared as active cultures. Subsequently, various 3-MCPD concentrations were added to the infant formula, and the effect of the bacteria and the yeast on 3-MCPD reduction was investigated using gas chromatography with flame ionization detection (GC-FID).
Results: L. plantarum, L. murinus, and Y. lipolytica demonstrated the ability to reduce 3-MCPD levels in the infant formula at different concentrations and contact times. L. plantarum and Y. lipolytica were found to be more effective in reducing 3-MCPD in the infant formula compared to L. murinus .
Conclusion: The results indicate that probiotic bacteria can effectively mitigate the toxic effect of 3-MCPD. These findings have potential applications in the food industry, particularly in dairy products.
Detection of Coronavirus Disease 2019 (COVID-19) Virus on the Surface of Hospital Settings by Quantitative Real-Time Polymerase Chain Reaction
Authors: Ghanbariasad Ali , Ghasemian Abdolmajid , Mansoori Yaser , Montaseri Zahra , Alinejad Navid , Doustan Mohammad , Hayati Ramin
Published: December 2024

Background & Objectives: Coronavirus disease 2019 (COVID-19) has had a profound impact on human health, with over 704,753,890 confirmed cases and 7,010,681 deaths reported to date. This study aimed to evaluate the contamination rate of COVID-19 on high-risk surfaces at Valiasr Hospital in Fasa, Iran, using molecular testing.
Materials & Methods: A total of 142 surface swabs, immersed in viral transport medium (VTM), were collected and transported to the Virology Reference Laboratory at the Cohort Center of Fasa University of Medical Sciences for COVID-19 virus testing. The presence of the virus was assessed using the real-time polymerase chain reaction (RT- qPCR) technique (QIAquant 96 5plex), following the manufacturer’s protocol (Qiagen, MD, USA).
Results: Among the 142 samples obtained from surfaces and equipment in the COVID-19 ward, two samples tested positive for COVID-19. Similarly, two samples from the coronavirus isolation ward were found to be positive using RT-qPCR. The positive samples were collected from a patient’s bed and the interior bed of an insulated room. No COVID-19 contamination was detected on hospital surface samples outside these areas.
Conclusion: This study identified a low rate of COVID-19 contamination on hospital surfaces and equipment in Fasa city. The findings suggest that the hospital environment could serve as a potential source of COVID-19 transmission, particularly among healthcare providers, visitors, and patients.
Glide Docking for Prediction of Potential Inhibitors of ATP7B Protein in Wilson Disease
Authors: Shalbafan Monir , Sadeghpour Mahdieh , Olyaei Abolfazl
Published: December 2024

Background & Objectives: Wilson’s disease is a genetic disorder marked by the pathological accumulation of copper in the liver and brain due to malfunctioning of the ATP7B protein. This study employed virtual screening and glide docking techniques to explore potential therapeutic agents targeting ATP7B using natural compounds from the ZINC15 database.
Materials & Methods: A virtual screening protocol was implemented to rapidly identify promising drug candidates with inhibitory activity against ATP7B. The glide docking program (Schrödinger Maestro 2018-1) was used to screen natural compounds, followed by ADME analysis to assess drug-likeness and pharmacokinetic properties.
Results: Three lead compounds—Tobramycin, Streptomycin, and Metyrosine— were identified with the most negative G-scores and docking scores among screened compounds, signifying strong binding affinities for ATP7B. Tobramycin showed superior performance with a glide score of -6.426, accompanied by favorable ADME properties and high similarity to the reference ligand, oxaliplatin.
Conclusion: Tobramycin was identified as a promising candidate for therapeutic intervention in Wilson’s disease, exhibiting robust binding affinity to ATP7B and drug-like characteristics. Future experimental studies are necessary to validate its clinical potential and safety.
A Review of AI-based Gamification Software and Websites in Medical Education: From Theory to Practice
Authors: M Maleki , M Alizadeh
Published: December 2024

Introduction: Gamification, the application of game design elements in non-game contexts, has been revolutionized by the rapid advancement of technology, particularly artificial intelligence (AI). By providing real-time feedback and personalized learning experiences, AI-powered gamification has emerged as a pivotal tool in enhancing medical education. This approach leverages both intrinsic and extrinsic motivation to facilitate the learning process and bolster cognitive and practical skills among medical students.
Method: This scoping review comprehensively examined software and websites that integrate AI and gamification elements in medical education. Data were sourced from diverse academic databases including PubMed, Scopus, Google Scholar, and other reputable repositories. Studies published between 2008 and 2024 were included if they directly addressed the application of AI and gamification in medical education.
Results: Among 3075 identified articles, 22 were selected for analysis. Nine software tools and websites incorporating gamification and AI in education were identified. These tools, underpinned by gamification elements and learning theories, foster enhanced motivation and individualized learning experiences.
Conclusion: The findings underscore the potential of AI-powered gamification to significantly improve learning outcomes and strengthen cognitive and practical skills among medical students. By providing immediate feedback and creating interactive learning environments, these tools render the learning process more engaging. Further research is warranted to explore their applications across diverse educational contexts
Investigating the Causes of Attrition among Nursing Graduates of Tehran University of Medical Sciences: A Mixed-Methods Study
Authors: M Montaseri , F Bahramnezhad
Published: December 2024

Introduction: Considering the complex factors contributing to Nursing Attrition, we decided to conduct research aimed at "explaining and determining the reasons for the Attrition of undergraduate nursing graduates from Tehran University of Medical Sciences.
Method: This study was conducted in two phases: qualitative and quantitative. In the qualitative phase, semi-structured interviews, each lasting an average of 60-90 minutes, were conducted. The interview transcripts were analyzed using the Granheim and Lundman approach. In the quantitative phase, based on the findings from the qualitative phase, questionnaires on job communication, perceived social support, and professional communication were administered.
Result: In the qualitative phase, the main themes identified were internal and external factors. Based on the findings, 78% of nurses reported weak social support. Only 4.3% reported a high level of social support, and 17.7% reported a moderate level. The overall job stress score was 180.05 ± 23.43. Regarding professional communication, 80.4% of nurses reported poor communication quality, 13.4% indicated it was good, and 6.2% reported excellent communication.
Conclusion: Given the current nursing shortage the country is facing, it is crucial to increase nurses' salaries and benefits, improve social support, and revise the nursing curriculum. Planning and necessary actions by the authorities are essential.
Hueter-Volkmann Law; How It Influences the Correction of Scoliosis Curves with Braces
Authors: Karimi Mohammad Taghi
Published: December 2024

Background: According to the Hueter-Volkmann law, there is asymmetry in the loads applied to the spinal structure on the convex and concave sides, which can increase the severity of scoliosis and its progression. The purpose of this review was to examine the asymmetry of vertebrae in subjects with scoliosis and explore how this theory can be utilized to enhance the effectiveness of braces in controlling and reducing scoliosis curves. A search was conducted in databases such as Google Scholar, PubMed, and ISI Web of Knowledge using keywords like Hueter-Volkmann law and asymmetry in relation to scoliosis. While there were limited studies on the asymmetry of vertebrae in individuals with scoliosis, the findings indicated significant differences in the height of vertebrae and discs between the concave and convex sides. Additionally, the degree of asymmetry was found to be correlated with the severity of scoliosis. It appears that the design of scoliotic braces is influenced by the Hueter-Volkmann law. It is recommended that new brace designs be developed based on the principles of this law to minimize the impact of gravity on the spine.
External Validity of the Novel Surrogate Measures for Occipitocervical Alignment
Authors: Mirbolook Ahmadreza , Raoufi Masoomeh , Yousefifar Yeganeh , Forghan Mobin , Fakhari Mohammad Sadegh , Bozorgmanesh Mohammadreza
Published: December 2024

Background: Occipitocervical fusion (OCF) is a rare and often challenging surgical procedure. Several methods have been introduced to obtain the best measures for occipitocervical alignment. The mandible-C2 angle was first introduced in 2020. In this study, we aimed to evaluate the out-of-sample validity of these measures.
Methods: We retrospectively studied 274 lateral cervical radiographs of patients aged 1 to 87 years with no cervical pathology evident on X-ray. A board-certified radiologist and a second-year radiology resident performed the measurements on five specific angles as suggested by Bellabarba. The five angles measured consisted of: 1) anterior C2 body/anterior mandible angle (AB/AM), 2) anterior C2 body/posterior mandible angle (AB/PM), 3) posterior C2 body/anterior mandible angle (PB/AM), 4) posterior C2 body/posterior mandible angle (PB/PM), and 5) occipito-C2 angle (OC2A).
Results: Inter-rater correlation data were calculated for single and average measures. The inter-rater agreement for individual angle measures of O-C2A, AB/AM, AB/PM, PB/AM, and PB/PM were 0.49, 0.11, 0.25, 0.33, and 0.49, respectively. The intraclass correlation coefficient (ICC) for average measures of O-C2A, AB/AM, AB/PM, PB/AM, and PB/PM were 0.66, 0.20, 0.40, 0.50, and 0.66, respectively.
Conclusion: Our study did not find statistically significant evidence to confirm that these angles were dependable indicators of occipitocervical alignment, except for the PB/PM angle, which showed a validity comparable to our reference angle
A Survey on Outcomes of Patients Operated with Kocher Approach in the Posterior Acetabulum Wall Fractures
Authors: Jamshidi Seyed Mir Mansour Moazen , Ghorbani Shayan
Published: December 2024

Background: There are many challenges in using the type of treatment method for acetabular fractures, and the incorrect treatment of these fractures can have many complications for the patient. Therefore, we decided to do some research to examine the treatment results of patients who underwent surgery with a posterior approach.
Methods: The files of patients admitted to the orthopedic department of the hospital were examined. After contacting the patients, performance outcomes were examined six months after the treatment results and final follow-up using the Harris Hip Score (HHS).
Results: In this study, the total number of patients was 25, of which 80% were men and 20% were women. Treatment results were evaluated as good or excellent in 15 (60%) patients and had no statistically significant relationship with age and gender. 48% had no pain and lameness, and the others showed different degrees of pain. 96% of the people were able to climb the stairs, but 4% were unable to climb the stairs. 76% of the people could use public transportation, and the rest of the people could not. 40% of the people did not need to use crutches, and the rest depended on crutches to varying degrees.
Conclusion: According to the therapeutic results obtained from the surgery, it can be concluded that this surgery has acceptable results.
Diagnosis and Management of Freeman-Burian Syndrome: A Case Report
Authors: Arabzadeh Aidin , Azaditalab Hossein , Alitaleshi Hesam , Abbaszadeh Mohammadreza
Published: December 2024

Background: Freeman-Burian syndrome (FBS) is a rare genetic disorder characterized by facial deformities, arthrogryposis, and difficulties in orthopedic management.
Case Report: A case study of a nine-month-old female patient with FBS is presented, who exhibited facial abnormalities and contractures of the hands and feet. Non-operative treatment, including stretching, massage, and splinting, was initially advised. At nine months, bilateral Achilles tenotomy was performed under local anesthesia due to anesthetic risks. Serial casting and bracing were used to maintain the correction.
Conclusion: The authors recommend prompt treatment, especially with non-operative methods, and early training of parents in non-operative therapy for optimal results, as multiple surgeries and anesthetic complications can lead to suboptimal outcomes. Massage, stretching, and achieving stable plantigrade feet are crucial for independent walking in patients with FBS.
Management of a Garré Sclerosing Osteomyelitis of Forearm: Report of a Resistant Case
Authors: Kamrani Reza Shahryar , Azaditalab Hossein , Alitaleshi Hesam , Abbaszadeh Mohammadreza
Published: December 2024

Background: Garre’s sclerosing osteomyelitis (GSO) is a rare chronic inflammatory condition characterized by sclerosis and thickening of bone cortices with mandibular affection in children and young adults. It involves periosteal reactions without abscess formation in young adults. Treatment typically includes analgesics and antibiotics, with surgery for non-responders. In this study, we report a rare case of GSO of the upper extremity involving radius and ulna bones.
Case Report: A young man with a history of forearm trauma treated by a bonesetter developed worsening pain and swelling over two years. At age 34, he underwent debridement for chronic osteomyelitis, followed by four additional surgeries. In 2004, a non- vascularized fibular graft was applied, achieving union, but persistent pain led to further interventions. By 2011, lab tests showed increased C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), and the lesion had recurred, necessitating resection and a free vascularized fibular graft. In 2013, after irrigation and debridement, the Masquelet technique was utilized. Four years post-surgery, the patient reports no pain or symptoms.
Conclusion: On the basis of this case, we suggest that in extreme cases of chronic GSO, when bone resection remains the chosen treatment option, and we have a significant bone defect, a Masquelet technique is a valid and possible method.
Quantity Surveying and its Association with Building Information Modeling (BIM) and Digital Twin (DT)
Authors: Wao Joel Ochieng’
Published: December 2024

Quantity surveyors (QS) have many roles in the construction industry, and one of such roles is preparing bills of quantities that mainly entails taking measurements and pricing of construction work. They also develop schedule of project work, engage in construction project management, arbitration as well as dispute resolutions. Quantity take-off was their original role during 1820s when QS profession first came into existence. Critical observations brought criticisms that the profession would not survive if a tool could be developed that substituted QS roles in construction. Contingent to that criticism has seen the emergence of Building Information Modeling (BIM) that has specific attributes where the BIM technology can be used to quantify building works and produce schedule of works including cost loaded schedule in a 4D and 5D model interface respectively. Thus far, has the BIM technological innovation posed threats to the QS roles and/or to the profession? What of digital twin (DT)? The aim of this research was to investigate the QS and its association with BIM and DT innovation in the construction industry and to evaluate their future in the industry. Are they a bane or boon to the QS profession? Specific objectives were to determine the extent of BIM usage by QS, the level of the current usage and the future of QS considering BIM growth in the construction field. Strength, Weakness, Opportunity and Threat (SWOT) analysis was conducted about BIM usage. Survey questionnaire was administered to investigate the use of BIM and DT, current usage and future standing in construction. The results showed that BIM and DT were opportunities that added to the progress of QS. It was concluded that QS needed to embrace BIM technology more with integration of digital twins for full benefits in the construction industry.
Development of Patchwork Craft Industry Engineering on Sofa Cushions
Authors: Juliana Netty
Published: December 2024

The development of patchwork craft engineering on sofa cushions is a creative activity of students in Medan. The development of sofa cushion crafts uses an explosive qualitative application, namely creating a new design that has never been designed by someone. The purpose of this activity is to increase the creativity and imagination of the younger generation by producing innovative, creative works that have functional value for human life. The concept of developing patchwork sofa cushion crafts starts fro: studying the theory of craft art, literature studies, designing concept maps, shape sketches, designing motifs, the process of making sofa cushions, and presentation of craft results. So this creative activity can increase knowledge and skills in the field of craft art, especially household linen. Thus, the younger generation is expected to be able to become entrepreneurs and be ready to compete in the business world professionally and independently.
ISOLAMENTO SOCIAL E SOLIDÃO EM ESTUDANTES UNIVERSITÁRIOS: REVISÃO INTEGRATIVA DE LITERATURA
Authors: Jantara Romario Daniel , Porto Gautério Abreu Daiane , Paula Ana Cláudia Schuab Faria de , Jantara Adrieli , Ziani Jarbas da Silva
Published: December 2024

Objetivo: identificar as publicações sobre o isolamento social e a solidão em estudantes universitários e os fatores relacionados a essas problemáticas de saúde. Método: Revisão integrativa de literatura, realizada a partir de uma busca em cinco bases de dados: Medline, PsycInfo, Science Direct, Web of Science e LILACS, a partir dos seguintes termos: Social Isolation, Loneliness e Students. Após aplicação de critérios de inclusão e exclusão, foram selecionados 28 artigos de diferentes nacionalidades. Resultados: Evidenciou-se que o isolamento social e a solidão em universitários estão associados a inúmeras condições negativas e comportamentos de risco à saúde. Em contrapartida, identificou-se o importante papel do apoio social e do senso de comunidade no enfrentamento da solidão. Conclusões: observa-se impactos do isolamento social e solidão na saúde dos universitários, caracterizando esses dois fenômenos como importantes problemas de saúde pública, que demandam atenção de pesquisadores e trabalhadores da saúde.
GESTÃO EM ENFERMAGEM ASSOCIADA À QUALIDADE DA ASSISTÊNCIA NA ATENÇÃO PRIMÁRIA À SAÚDE
Authors: Dias Gonçalves Mirielle , Henrique Oliveira Stênio , Santos Silva Brener , Nunes Andrade Silmara , Conrado Silva Barbosa Amanda , Carvalho Pinto Ione , Gonçalves Amaral Gabriela
Published: December 2024

Objetivo: Analisar as evidências científicas sobre o papel da gestão em enfermagem para a qualidade da assistência na Atenção Primária à Saúde. Método: Revisão integrativa realizada por meio das bases de dados da Biblioteca Virtual em Saúde (LILACS, BDENF e MEDLINE). Incluiu-se estudos originais, com textos completos, nos idiomas português, inglês e espanhol, publicados entre 2016 e 2021. Excluíram-se protocolos, normas técnicas e revisões. Os estudos foram avaliados para sumarização de dados e classificação dos níveis de evidências. Resultados: A busca resultou em 145 estudos, excluíram-se três duplicados e, após leitura de título e resumo, excluíram-se 112. Trinta foram selecionados para leitura na íntegra, excluindo-se 22. A amostra constituiu-se por oito estudos. Conclusão: Para a oferta de uma assistência qualificada torna-se necessário, para os enfermeiros gestores, motivação, compromisso e apoio da equipe multiprofissional.