bluuebunny/crossref_metadata_2025 huggingface dataset:
Compatibility and Storage Stability of Asphalt Binder Modified by Styrene-Butadiene-Styrene (SBS) Graft Copolymer
Authors: Zhang Hong Gang , Zhang Qiang Huai , Wang Xue Ting , Tan Hua , Gao Li Ning , Cao Dong Wei
Published: June 2021

A styrene-butadiene-styrene triblock copolymer (SBS) was grafted with an unsaturated polar monomer (monomer A) composed of maleic anhydride (MAH) and methoxy polyethylene (MPEG) via a ring-opening reaction after epoxidizing styrene-butadiene-styrene triblock copolymer (ESBS). The microscopic changes of SBS before and after grafting has been characterized with Fourier transform infrared spectrum (FT-IR), X-ray photoelectron spectroscopy (XPS) and gel permeation chromatography (GPC). The results revealed that the monomer A was successfully grafted on SBS backbone, and the maximum graft ratio (GR) was 20.32%. To verify the compatibility between SBS and asphalt, solubility parameters and surface free energy (SFE) of SBS, grafted SBS and asphalt were measured. It was found that the solubility parameter and SFE of grafted SBS were closer to asphalt compared with SBS. It also has been confirmed from storage stability that the temperature susceptibility of grafted SBS modified asphalt was reduced in compare with SBS modified asphalt binder. As consequence, the use of grafted copolymer can be considered a suitable alternative for modification of asphalt binder in pavement.
Chain of Reflective Experiences: How Tourists Give Meaning to Intangible Cultural Heritage Experiences
Authors: Alahakoon Thilini
Published: June 2021

Intangible Cultural Heritage (ICH) is a tourist offer that is embedded within the people of a destination and their lifestyles. Given this nature of ICH, this paper aims to explore how tourists give meaning to ICH experiences especially in the absence of formal sources of information. It employs a qualitative phenomenological stance with a sample of 21 European tourists. The Appropriation Theory was used for theoretical support. Findings indicate that recollections and reflections of past travel experiences contribute to the interpretation of ICH experiences. Specifically, such recollections and reflections create a sense of familiarity with new ICH experiences allowing tourists to connect with them more, resulting in subjective meaning assignment which may or may not be the meaning envisioned by destination marketers and the host community. This study also initiates a discussion on ‘chain of reflective experiences’, through which further exploration of the effects of past travel experiences on new experiences are encouraged.
Empowerment of Street Vendors: An Untapped Resource in the Informal Economy
Authors: Karunaratna A. C. , Tjandra Nathalia C.
Published: June 2021

Street vending has persisted for centuries and pervasive across the globe since it plays a remarkable role in fulfilling customer needs in the context of the informal economy. In the contemporary business context, authorities have not paid sufficient attention towards street vendors. The paper addresses the specific features of street vending in the context of Sri Lanka, various challenges faced by street vendors and possible courses of action for the empowerment of street vendors. Accordingly, location issue with lack of infrastructure, less support from the government, insecurity and unstable conditions, slow growth, lack of financing opportunities and less support from banks were identified as major challenges faced by street vendors in Sri Lanka. Proper location and infrastructure development, assurance of security including a specific insurance scheme and financial assistance are proposed to empower street vendors to enhance their performance.
Effect of Dietary Supplementation of Prebiotics, Synbiotics, and Essential Oils on Growth Performance of Broiler Chicken
Authors: Sudharaka D. L. A. , Weerathilake W. A. D. V. , Samarakoon S. M. R. , Rasika D. M. D.
Published: June 2021

This study was performed to compare the effect of dietary supplementation of probiotics, prebiotics, essential oils and synbiotics on feed conversion ratio, live body weight and total feed intake of broiler chicken. A total of 800, day-old Arbor acres broiler chicks of either sex were randomly assigned into four dietary treatments. Each treatment had four replicates of 50 birds and were reared for over five weeks. Basal diet was supplemented with probiotics (control, T1), essential oils (T2), synbiotics (T3), and prebiotics (T4) as dietary treatments. The birds were provided with ad libitum feed and drinking water during the entire experimental period. At the end of 35 days experimental period there was no significant difference in live body weight, total feed intake and feed conversion ratio of broilers fed prebiotic, synbiotic and essential oil groups compared with probiotic supplemented control group. These findings reveal that, there is a potential to use prebiotics, EOs, and synbiotics as non-antibiotic growth promoters to improve broiler chicken’s growth performances.
Gas6 expression and Tyrosine kinase Axl Sky receptors: Their relation with tumor stage and grade in patients with bladder cancer
Authors: Akgül Murat , Baykan Özgür , Çağman Zeynep , Özyürek Mustafa , Tinay İlker , Akbal Cem , Uras Fikriye , Türkeri Levent
Published: June 2021

Objectives: It has been shown that the dysregulation of tyrosine kinase Axl receptor and its ligand growth arrest-specific gene (Gas6) are associated with poor prognosis in various types of tumors but there is not enough study about their importance in bladder cancer (BC). We evaluated the relation of Gas6 gene expression and tyrosine- kinase Axl and Sky (Tyro 3) receptors with tumor stage and grade in patients with BC. Material and Methods: The study group consists of 55 patients whose transurethral resection of bladder (TUR-B) has been performed due to BC and the control group consists of 12 patients with normal bladder mucosa. In tissues mRNAs of Gas6, Axl, and Sky receptors were examined by quantitative (Real-Time) PCR (qPCR). Protein expression was measured by immunohistochemistry. Plasma Gas6 protein levels were compared with control group by ELISA method. Results: Patients with BC were grouped as Ta low (n=17), Ta high (n=5), T1 low (n=9), T1 high (n=8) and T2 (n=16) according to their TUR-B pathologies. The qPCR analysis showed that the expression of Gas6 gene and Axl receptor is higher in the tumor-positive group and the immune-histochemical showed that the bladder samples of the tumor-positive group stained significantly positive. When the patients are grouped according to the TUR-B pathologies, a statistical significant difference was observed among groups in the qPCR analysis ratios of Gas6 gene and Axl receptor by (p < 0.05) but no significance was found for Sky receptor (p > 0.05). When Gas6 protein levels in plasma samples were compared by ELISA method, a statistical significance was determined among groups (p = 0.001). Conclusions: Our findings indicate that mRNAs of Gas6 and Axl receptor are closely related to tumor stage and grade in patients with BC. Further studies are needed for understanding the role of Gas6 and its receptors on the neoplastic transformation in terms of novel biomarkers and potential therapeutic targets.
Obesity rates in renal stone formers from various countries
Authors: Popov Elenko , Almusafer Murtadha , Belba Arben , Bello Jibril O. , Bhatti Kamran Hassan , Boeri Luca , Davidoff Kaloyan , Hameed BM Zeeshan , Halinski Adam , Pfeferman Heilberg Ita , Hui Hongyi , Petkova Kremena , Rawa Bapir , Guedes Rodrigues Fernanda , Saltirov Iliya , Spivacow Francisco R. , Trinchieri Alberto , Buchholz Noor
Published: June 2021

Objective: To collect evidence on the rate of obesity in renal stone formers (RSFs) living in different climatic areas and consuming different diets. Materials and methods: Data of adult renal stone formers were retrospectively collected by members of U-merge from 13 participant centers in Argentina, Brazil, Bulgaria (2), China, India, Iraq (2), Italy (2), Nigeria, Pakistan and Poland. The following data were collected: age, gender, weight, height, stone analysis and procedure of stone removal. Results: In total, 1689 renal stone formers (1032 males, 657 females) from 10 countries were considered. Average age was 48 (±14) years, male to female ratio was 1.57 (M/F 1032/657), the average body mass index (BMI) was 26.5 (±4.8) kg/m2. The obesity rates of RSFs in different countries were significantly different from each other. The highest rates were observed in Pakistan (50%), Iraq (32%), and Brazil (32%), while the lowest rates were observed in China (2%), Nigeria (3%) and Italy (10%). Intermediate rates were observed in Argentina (17%), Bulgaria (17%), India (15%) and Poland (22%). The age-adjusted obesity rate of RSFs was higher than the age-adjusted obesity rate in the general population in Brazil, India, and Pakistan, whereas it was lower in Argentina, Bulgaria, China, Italy, and Nigeria, and similar in Iraq and Poland. Conclusions: The age-adjusted obesity rate of RSFs was not higher than the age-adjusted obesity rate of the general population in most countries. The relationship between obesity and the risk of kidney stone formation should be reconsidered by further studies carried out in different populations.
Optimal clamping time in meatotomy procedure for children with meatal stenosis: Experience with 120 cases
Authors: Shirazi Mehdi , Chowdhury Umayir , Ahmed Faisal , Rajabalian Mohammad-Bagher , Nikbakht Hossein-Ali , Al-Naggar Khalil , Al-Shami Ebrahim
Published: June 2021

Objective: During meatotomy procedure for children with meatal stenosis (MS), a straight clamp used as a hemostat on the ventrum of the meatus before incised with scissors for clamping and holding bleeding from the site of operation. The aim of this study was to evaluate the optimum clamping time for meatotomy in children with MS. Materials and methods: All the patients with MS between 2014 to 2019 were enrolled in this retrospective study. Patients with uncircumcised penis, traumatic catheterization, any kind of penile abnormality such as hypospadias or penile curvature, and active urinary tract infection (UTI) were excluded. The indication of meatotomy was a pinpoint meatus that develops with dorsal or lateral deflection of the urinary stream and high-velocity urine flow. During meatotomy procedure, clamping time was examined in different groups such as 2, 3, and 4 minutes. The main symptoms of presentation and ultrasonography (US) findings were recorded and compared between groups. To assess the optimum time clamping, postoperative bleeding was noted carefully in all groups. The success rate was recorded at onemonth postoperative follow-up in the clinic. Results: Of the 120 patients with MS who underwent a meatotomy procedure, there were 40 (33.3%) participants in each group. The main symptoms were painful urination and urine stream deviation that represented in 54 (46%) patients. Bladder wall thickness was the main pre-operation finding in the US which was observed in 67 (55.8%) patients. In comparison between the groups related to clamping time, bleeding was observed and required suturing when clamping was applied for 2 minutes in 4 (3.3%) patients (p = 0.016). With a minimum follow-up of 12 months, no recurrent meatal stenosis was reported. Conclusions: Clamping time for more than 2 minutes may prevent bleeding during and after meatotomy.
Infection status of hydatid cysts in Iran: A review
Authors: Khamesipour Faham , Shojaat Shadan , Basirpour Bahareh , Kheiri Parya , Afzal Sana , Chelgerdi Bahar , Nezaratizadeh Saeed , Hejazi Seyed-Hossein
Published: June 2021

Cystic echinococcosis (CE) is a significant zoonosis, and is endemic in some parts of the world including Iran. Hydatid cyst in Iran has been studied from different aspects and has been reported from most parts of the country. But there is no comprehensive report on the appearance of pollution in the country. This study was conducted to investigate the approximate status of infection from 1985 to 2019. In this review article, various reports on hydatid cysts were collected from 1985 to 2019. According to three criteria, i.e. the rate of infection of dogs with adult worms, the rate of infection of livestock, and the rate of infection of humans with hydatid cysts, the articles were summarized and presented to approximate the status of infection in Iran. In this study, the average infection among 11593 dogs was estimated to be 11.28%. In the case of livestock, according to this review, the maximum infection of sheep was in Ardebil with 74.4%, goats and cattle were in Sari with 37.8% and 40.1%, camels in Khorasan Razavi with 40.40%, and Tabriz had the highest amount of infection in buffaloes. Out of 70907 people tested, the summary of seroepidemiological studies shows that the average infection in humans is 5.57%. The information obtained from this review article shows that despite the efforts of health organizations and veterinary organizations, the rate of infection in Iran is still high compared to some countries.
The analgesic efficacy of anterior femoral cutaneous nerve block in combination with femoral triangle block in total knee arthroplasty: a randomized controlled trial
Authors: Kampitak Wirinaree , Tanavalee Aree , Tansatit Tanvaa , Ngarmukos Srihatach , Songborassamee Nattaporn , Vichainarong Chutikant
Published: June 2021

Background: Ultrasound-guided femoral triangle block (FTB) can provide motor-sparing anterior knee analgesia. However, it may not completely anesthetize the anterior femoral cutaneous nerve (AFCN). We hypothesized that an AFCN block (AFCNB) in combination with an FTB would decrease pain during movement in the immediate 12 h postoperative period compared with an FTB alone.Methods: Eighty patients scheduled to undergo total knee arthroplasty were randomized to receive either FTB alone (FTB group) or AFCNB with FTB (AFCNB + FTB group) as part of the multimodal analgesic regimen. The primary outcome was pain during movement at 12 h postoperatively. Secondary outcomes included numeric rating scale (NRS) pain scores, incidence of surgical incision site pain, intravenous morphine consumption, immediate functional performance, patient satisfaction, and length of hospital stay.Results: The NRS pain scores on movement 12 h postoperatively were significantly lower in the AFCNB + FTB group than in the FTB group (mean difference: –2.02, 95% CI: –3.14, –0.89, P < 0.001). The incidence of pain at the surgical incision site at 24 h postoperatively and morphine consumption within 48 h postoperatively were significantly lower (P < 0.001), and quadriceps muscle strength at 0° immediately after surgery was significantly greater in the AFCNB + FTB group (P = 0.04).Conclusions: The addition of ultrasound-guided AFCNB to FTB provided more effective analgesia and decreased opioid requirement compared to FTB alone after total knee arthroplasty and may enhance immediate functional performance on the day of surgery.
68Ga-PSMA ligand PET/CT integrating indocyanine green-guided salvage lymph node dissection for lymph node metastasis after radical prostatectomy
Authors: Li Teng-Cheng , Wang Yu , Xiao Chu-Tian , Li Ming-Zhao , Liu Xiao-Peng , Huang Wen-Tao , Li Liao-Yuan , Li Ke , Di Jin-Ming , Wen Xing-Qiao , Gao Xin
Published: June 2021

To efficiently remove all recurrent lymph nodes (rLNs) and minimize complications, we developed a combination approach that consisted of 68Gallium prostate-specific membrane antigen (PSMA) ligand positron emission tomography (PET)/computed tomography (CT) and integrated indocyanine green (ICG)-guided salvage lymph node dissection (sLND) for rLNs after radical prostatectomy (RP). Nineteen patients were enrolled to receive such treatment. 68Ga-PSMA ligand PET/CT was used to identify rLNs, and 5 mg of ICG was injected into the space between the rectum and bladder before surgery. Fluorescent laparoscopy was used to perform sLND. While extensive LN dissection was performed at level I, another 5 mg of ICG was injected via the intravenous route to intensify the fluorescent signal, and laparoscopy was introduced to intensively target stained LNs along levels I and II, specifically around suspicious LNs, with 68Ga-PSMA ligand PET/CT. Next, both lateral peritonea were exposed longitudinally to facilitate the removal of fluorescently stained LNs at levels III and IV. In total, pathological analysis confirmed that 42 nodes were rLNs. Among 145 positive LNs stained with ICG, 24 suspicious LNs identified with 68Ga-PSMA ligand PET/CT were included. The sensitivity and specificity of 68Ga-PSMA ligand PET/CT for detecting rLNs were 42.9% and 96.6%, respectively. For ICG, the sensitivity was 92.8% and the specificity was 39.1%. At a median follow-up of 15 (interquartile range [IQR]: 6–31) months, 15 patients experienced complete biochemical remission (BR, prostate-specific antigen [PSA] <0.2 ng ml−1), and 4 patients had a decline in the PSA level, but it remained >0.2 ng ml−1. Therefore, 68Ga-PSMA ligand PET/CT integrating ICG-guided sLND provides efficient sLND with few complications for patients with rLNs after RP.
Comparative study between Mustarde and Stenström techniques in treatment of prominent ear
Authors: El Hariry Mohammed Nady , El Bahrawy Mahmoud Mohamed , Abu Elsoud Ahmed
Published: June 2021

Background

Numerous methods have been developed for the correction of protruding ears. However, the best technique should be the one that is simple, reliable, and reproducible. Our research aimed to compare Mustarde technique and Stenström technique used in the correction of prominent ears. We included 20 patients who were randomly assigned to Mustarde or Stenström technique. All participants underwent full history collection, general and local examinations, and full investigations. We analyzed the age, sex, surgical technique, follow-up, complications, and results.

Aim

The aim of this study is to compare between Mustarde and Stenström techniques in the correction of prominent ear.

Patients and methods

This study included 20 patients with prominent ear, comprising 15 males and five females, attending Al-Azhar University hospitals. The patients were divided into two groups, with each group including 10 patients: creation of antihelix was done in all cases, and conchomastoid sutures were used if needed in some cases.

Results

According to our results, comparison of these two groups showed that patient satisfaction was high in both groups. In our study, hemorrhage, hematomas, keloid formations, suture extrusion, skin and cartilage infection, skin necrosis, and relapse have not occurred in any of the patients of the two groups. Irregularity in the antihelix was not observed in any patients from group A (Mustarde technique) and observed in one (5%) patient from group B (Stenström technique).

Conclusion

Minimizing the gap between the ear and the mastoid is the most significant outcome for patients in considering the operation as a success. Mustarde technique was our favorite technique for correction of protruding ear in children with soft or thin cartilage. We also agree that the technique of Stenström was effective in adults with hard or thick cartilage.
Medicolegal aspect of maternal deaths in Assiut Governorate
Authors: Gad Allah Ahmed Mohmed , Abd El Hady Randa Hussein , Abd El Hameed Saly Yehia , Ali Wael Farahat
Published: June 2021

Background

In obstetric practice, most allegations against obstetrician–gynecologists relate in some manner to the management of labor and delivery; few solely involve perceived flaws in prenatal or postpartum care.

Objective

To evaluate the incidence and causes of maternal deaths and to evaluate the role of medical malpractice leading to maternal deaths in Assiut Governorate.

Patients and methods

Women delivered at Al-Azhar University Hospital during a 6-month period in 2013 and women delivered in the period extending from 2005 to 2010 in Assiut Governorate as documented by the local Medicolegal Department of the Ministry of Justice were the subjects of this study.

Results

Among 2556 women delivered in a 6-month period, two women died, representing a maternal mortality rate of 0.078% (a maternal mortality ratio of 78/100 000 live birth). Antepartum hemorrhage and postpartum hemorrhage were the reported causes in a case each. We also studied 50 maternal deaths referred to local Medicolegal Department of the Ministry of Justice owing to medicolegal claims. We found that the chronic hypertension was the most commonly reported morbidity (20.0%) followed by severe anemia (18.0%), diabetes mellitus (8.0%), epilepsy (2.0%), and deep vein thrombosis (2.0%). More than two-thirds (68.0%) of them had antenatal care, whereas the remainder (32.0%) did not receive it. Regarding the neonatal outcome in the studied women, we found that in 34 (68.0%) cases, women delivered a live mature baby, whereas in 15 (30.0%) cases, fetal death occurred, and in one (2.0%) case, the delivered newborn was macrosomic. In all cases, there was a civil liability. Negligence was the commonest cause (42.0%) followed by misdiagnosis (30.0%) and delayed treatment (28.0%). Regarding the qualification of the service provider, we noted that those with master qualification came on the top (52.0%) followed by general practitioners (18.0%) and diploma holders (12.0%). In 44.0% of cases, delivery took place in governmental hospital, whereas in 32.0% of cases was in health unit and in 24.0% of cases was in private clinic. In our study, surgical specialties accounted for 31.0% of claims followed by obstetrics (25.0%), anesthesia (17.5%), internal medicine (14.5%), and pediatrics (12.0%).

Conclusions

In the present study, we reported a maternal mortality rate of 0.078% (maternal mortality ratio of 78/100 000 live birth). With respect to the type of liability in the studied women, we found that in all cases, there was civil liability.
Reliability on self-adhesive mesh in inguinal and ventral hernia repair
Authors: Mohamed Amer Yehia , Shemy Gamal Galal , Hegazy Islam H.M.
Published: June 2021

Background

Surgical repair of hernia is considered to be one of the most repeatedly conducted operations all over the world.

Aim

This study has been carried out to obtain well-established information about surgery duration, hospital stay, and short-term and long-term complications, following inguinal or ventral hernia repair using ProGrip meshes.

Patients and methods

A total of 50 patients with right oblique inguinal hernia (Rt. OIH), left oblique inguinal hernia (Lt. OIH), or paraumbilical hernia and epigastric hernia (PH or EH) ventral hernia were enrolled in this study. Operative repair was performed using self-gripping polyester meshes. Follow-up to compare the anticipated outcomes of these hernia types was done.

Results

Most of the short-term and long-term complications were found to be low in Rt. OIH, Lt. OIH, and PH or EH ventral hernias. Hospital stay was found to be 1–2 days in all of them. Return to work was 10–14 days. Patient satisfaction was 100% in Rt. OIH, and a little below in other types of hernias. Hematoma was found to be 0–13.3%, seroma in 0–23.3%, pain in 10–30%, wound infection in 0–16.7%, and recurrence 0–10%.

Conclusion

For the ProGrip meshes, they are recommended to be used in both Rt. OIH and Lt. OIH, as well as EH and PH.
Interest in research among female medical students at Al-Azhar University in Cairo, Egypt
Authors: Elhassan Hanaa A.E.A. , Elsheikh Asmaa A.
Published: June 2021

Background and aim

Early research activities during medical education years are an important factor for attracting a greater number of physicians to careers in research. In the current study, the authors aimed to investigate the interest in research among medical students at the Faculty of Medicine for Girls, Al-Azhar University, Cairo, to explore the factors that contribute to emergence of interest in research and those that contribute to no interest. The authors also aimed to determine factors that prevent those who are interested in research from engaging in research activities.

Participants and methods

The current study is a cross-sectional one that was carried out on 420 female students who were chosen randomly from all study years. Students responded to a self-administered questionnaire.

Statistical analysis Data

were analyzed using statistical package for the social sciences program version 16. Testing of the hypothesis was performed at the 95% confidence level, and a P value less than 0.05 was considered significant.

Results

The authors found that 73.3% of the students were interested in research. A total of 62.9% of the students reported interest in research because they believed that it could be beneficial for their careers; however, the most common reasons for no interest in research was that they were more interested in clinical work (73.6%), while the most commonly cited factor for not being able to engage in research among those who were interested was lack of time (90.3%).

Conclusion

Despite the high interest in health research, medical students did not report any actual publication of research papers. Consequently, the authors recommend provision of a favorable research environment and assembly of a research team to support students in all steps of their research.
Does isotretinoin affect spermatogenesis? a rat study
Authors: Önder Sevda , Çırakoğlu Abdullah , Nalbant İsmail , Benli Erdal , Yüce Ahmet , Hancı Hatice , Baş Orhan , Ozturk Murat
Published: June 2021

Aim

Inthe literature, studies investigating the effects of isotretinoin on spermatogenesis are controversial and there is no consensus. In this study, the aim was to investigate whether isotretinoin has any effects on spermatogenesis and, if present, whether these effects are dose linked or not.

Materials and methods

Twenty-two rats were divided into four groups. The first group (n=5) was administered 7.5 mg/kg/day and the second group (n=5) was administered 30 mg/kg/day isotretinoin dissolved in sunflower oil orally for 4 weeks. Group 3, the sham group (n=6), was administered only sunflower oil. Group 4 was the control group and was administered standard feed and water. At the end of the fourth week, all rats were killed and histologic investigation was performed. Sperm motility, sperm count, sperm vitality, seminiferous tubule diameters, germinal epithelium thickness, and apoptotic indices were assessed. Follicle-stimulating hormone, luteinizing hormone (LH), and testosterone levels were measured in serum.

Results

There was a significant degree of reduction in sperm motility, sperm viability, seminiferous tubule diameters, and germinal epithelium thickness in the first and second groups compared with the control group. Sperm count was found to be significantly reduced in the second group compared with the other groups. Follicle-stimulating hormone and luteinizing hormone values were not observed to change in all groups.

Conclusion

This study concluded that both high-dose and low-dose isotretinoin disrupted spermatogenesis; however, it did not affect the hypothalamic–pituitary–gonadal axis.
Overlapping of Steven-Johnson syndrome and the drug rash with eosinophilia and systemic symptoms during the treatment of carbamazepine
Authors: Mohammed Osama Salih , Osman Abdelrahman Babiker Abdelrahman , Amirthalingam Palanisamy , Alatawi Amirah Salem , Mirghani Hyder Osman , Elseed Mohamed Wajdi Hashim G.
Published: June 2021

The Stevens-Johnson syndrome (SJS) and the drug rash with eosinophilia and systemic symptoms (DRESS) are part of a spectrum of severe adverse cutaneous drug reactions. It is prudent to differentiate between the two syndromes, as the management and prognosis are different. Carbamazepine is one of the common culprit drugs for both SJS and DRESS. This case study is of a 45-year-old Indonesian women who developed atypical presentation of SJS following carbamazepine therapy. However, it is essential to distinguish between the SJS and DRESS. Moreover, carbamazepine-induced SJS is strongly linked to specific human leukocyte antigen alleles in the South Asian people. Henceforth, this case emphasizes the importance of differentiating SJS from DRESS and substantiates other studies that strongly recommend testing for human leukocyte antigen alleles before initiating carbamazepine in a susceptible population.
Male ejaculation may enhance woman’s orgasm and satisfaction
Authors: Younis Ihab , Ibrahim Samah E. , Habib Amany K.M.
Published: June 2021

Objective

This study aimed to assess the importance of male ejaculation on female satisfaction and orgasm.

Background

Although links between ejaculatory control or intravaginal ejaculatory latency time and female sexual function have been reported in the past, little research has focused on the effect of ejaculation on female satisfaction and orgasm.

Methods

The study was carried out on 221 of married women aged 18-50+ years. The tool used was a self-report questionnaire written in English and translated into Arabic.

Results

More intense orgasm and more satisfaction was reported by 58.4% of women if husbands ejaculated intravaginally without a condom. Among participants 47.1% didn’t perceive the quantity of husbands ejaculate as an expression of their own sexual attractiveness.

Male condom was used by 34.8% of husbands and frequency of reaching orgasm was lower in women of these men. Although use of condom prolongs intravaginal latency time, 60% of participants were unsatisfied with their sexual life if husbands ejaculate in condom.

The commonest coital frequency was once/week (45.2%). Dyspareunia was a complaint of 40.7% of participants. Coital frequency declined with advance in age, vaginal intercourse was the preferred sexual activity in almost all age groups and only 35.7% of the participants could reach orgasm in almost each intercourse most commonly because of life problems and work tensions

Conclusion

Intravaginal male ejaculation may give women more intense orgasm and satisfaction.
Third dose of injection rituximab 500 mg in patients with pemphigus vulgaris based on clinical follow-up, value of anti-desmoglein antibodies and CD-19 level
Authors: Singh G.K. , Sharma Vishal , Arora Sandeep , Mitra Debdeep , Singh Teghveer
Published: June 2021

Rituximab is a monoclonal antibody directed against CD20 antigens in B lymphocytes, producing selective depletion of B cells, now considered as Ist line in management of Pemphigus vulgaris. Current guideline has no consensus views on when or at what clinical severity the third dose of rituximab can be administered. Few studies, have highlighted the role of anti- desmoglein 1 & 3 antibodies (anti-dsg 1&3 Ab) and CD19 as immunobiological markers in prognosticating the relapse, remission and severity of pemphigus vulgaris. We report five cases of pemphigus treated with third dosage of rituximab 500 mg taking account of clinical symptoms, level of anti-dsg 1&3 Ab and CD19.
Molecular basis of ectodermal dysplasia
Authors: Dorgaleleh Saeed , Naghipoor Karim , Hajimohammadi Zahra , Oladnab Morteza
Published: June 2021

Ectodermal dysplasia (ED) syndrome is a rare genetic disease that involves a heterogeneous group of hereditary disorders that occur as a result of mutations in genes that code for development of fetal ectoderm and lead to numerous disorders. Defects in the development of the ectoderm cause symptoms in tissues derived from the ectoderm layer, such as skin, nails, hair, and teeth. Because many pathways are involved in the development of the ectoderm, there are mutations in many genes that cause ED. Owing to the heterogeneity of ED, there are different types of the disease that have different symptoms. These symptoms include sparse hair, abnormal or missing teeth, nail dystrophy, lack of sweating owing to the absence of sweat glands, and cancer. In this review, in addition to discussing the role and pathway of each of the genes involved in ED, the incidence of cancer in these patients, diagnostic methods and differentiation from other similar diseases, and the treatments currently being performed for ED are discussed.
A cross-sectional online survey of relationship between the psychological impact of coronavirus disease 2019 and the resilience among postgraduate health sciences students from Maharashtra, India
Authors: Ghogare Ajinkya Sureshrao , Aloney Swapnil Arun , Spoorthy Mamidipalli Sai , Patil Pradeep Shriram , Ambad Ranjit S. , Bele Ashish Wasudeorao
Published: June 2021

Introduction:

Because of the rapid global spread, coronavirus disease 2019 (COVID-19) has caused a state of an emergency situation. Postgraduate (PG) health sciences students (HSSs) are the frontline healthcare workers who are susceptible to psychological issues like depression, anxiety and stress during such stressful pandemic period. The objective of this study was to assess the relationship between the psychological issues such as depression, anxiety and stress and the level of resilience among PG HSSs during the COVID-19 pandemic.

Materials and Methods:

The present cross-sectional online survey was conducted by the department of Psychiatry of tertiary health care center from Maharashtra state of India over a 10 days period (from April 15, 2020 to April 24, 2020), with a sample size of 195 which was calculated by using the formula of sample size calculation for the cross-sectional study design. Data were collected using the purposive sampling method from the PG HSSs. Data were recorded from the study participants in an online structured questionnaire prepared for the study using the sociodemographic details and the two scales namely Depression, Anxiety, and Stress Scale-21 item (DASS-21) and Brief Resilience Scale (BRS). DASS-21 scale was used to assess the presence and severity of depression, anxiety, and stress, while BRS scale was used to assess the level of resilience among the PG HSSs. Data were collected and analyzed using the SPSS software version 15.0, Fisher's exact test, and Pearson's correlation test.

Results:

Prevalence of depression, anxiety, and stress were 43.1%, 68.7%, and 11.3%, respectively. There was a high positive correlation between all three subscales of DASS-21 (depression, anxiety, and stress subscales). On BRS, 2 (1.0%) study participants had high resilience, 120 (61.5%) had normal resilience, and 73 (37.5%)

Conclusion:

Study concluded that significant proportion of PG HSSs had psychological impact of COVID-19 in the form of depression, anxiety and stress. Programs such as timely evaluation of mental health status and stress management to address these psychological issues should be a priority. In long terms, increasing the resilience of PG HSSs can have protective value against the psychological issues during the stressful events of infectious disease outbreaks like COVID-19 pandemic.

The following core competencies are addressed in this article:

Medical knowledge, Patient care, Professionalism, Practice based learning and improvement.
A cross-sectional study to evaluate the knowledge and attitude of medical students concerning antibiotic usage and antimicrobial resistance
Authors: Sannathimmappa Mohan B. , Nambiar Vinod , Aravindakshan Rajeev
Published: June 2021

Introduction:

Antimicrobial resistance (AMR) is a major global health problem, which is mainly promoted by injudicious antibiotic usage. The main strategy to control AMR is to emphasize the appropriate use of antibiotics, which can be achieved by creating awareness about AMR, changing the attitude of medical students who are the future prescribers. This study aimed to evaluate the knowledge and attitude of fifth-year medical students regarding antibiotic use and AMR.

Materials and Methods:

A descriptive cross-sectional study was conducted among 125 fifth-year medical students of the College of Medicine and Health Sciences, Sohar. A self-administered questionnaire was used to assess the knowledge and attitude regarding antibiotic use and AMR. The data were statistically analyzed and expressed as numbers and percentages.

Results:

Of 125 participants, the majority (>90%) were aware of AMR and its global impact. Nearly three in four knew that antibiotics are used to treat bacterial infection. However, most of the students had lacunae in their knowledge regarding contributing factors and consequences of AMR. A minority of students lack the right attitude toward rational antibiotic usage and adequate infection control practices. The majority of them were unaware of strict guidelines pertaining to judicious antibiotic usage and adequate infection control policies implemented in hospitals, as recommended by the World Health Organization.

Conclusion:

The results of our study reflect lacunae in students' knowledge regarding antibiotic usage and AMR. Therefore, there is a need for an implementation of effective medical curricula to improve medical students' knowledge regarding AMR and the appropriate use of antibiotics.

The following core competencies are addressed in this article:

Patient care, Medical knowledge, Professionalism, Systems-based practice, Practice-based learning and improvement, Interpersonal and communication skills.
Utility of acute-phase reactants testing in clinical practice
Authors: Prabhala Shailaja , Sivakoti Sumitra , Sahoo Bijayalaxmi
Published: June 2021

Acute-phase proteins (APPs) or acute phase reactants (APRs) are diverse biochemical proteins which are seen as a response in inflammatory processes due to varied etiologies. Some of these proteins increase and some decrease due to various mechanisms during inflammation. The secretion, time to attain peak concentrations, half-life, and degradation are different for different APPs. Some of the markers can be easily tested with minimum equipment whereas, others require sophisticated instruments. They are not pathognomonic for any one particular disease but their elevation may point toward a bacterial, viral, or noninfectious inflammatory process. Testing for APPs and interpreting the result in correlation with results of other tests and clinical details can help in arriving at a diagnosis, in ordering further appropriate tests and in taking treatment decisions. We attempted to look at the present published literature and summarize the different APRs in inflammation. A MEDLINE search for articles published in the English language, with acute-phase proteins [MeSH Terms] OR acute phase reactants [Text Word] was done for the years between 1985 and 2019. In addition, other cross-referenced articles were also searched for relevant data.
Neti Kriya as a therapeutic intervention for chronic allergic rhinitis
Authors: Rajbhoj Pratibha Hemant , Bhogal Ranjeet Singh , Bhalekar Sharadchandra D.
Published: June 2021

Allergic Rhinitis is a recurrently occurring respiratory disorder, therefore the technique of Neti Kriya might be helpful to cure it. This case report describes the effect of Neti Kriya on a single patient of Acute Rhinitis, with the help of RQLQ, CQQ, and AEC. The patient reported to be asymptomatic post-intervention, with improved domains of RQLQ and CQQ. The raised AEC at the baseline showed normal range post-intervention. This case report showed that the regular practice of Neti Kriya could be effective in treating chronic AR.
Limb salvage following snakebite using acute limb shortening and secondary lengthening
Authors: Mahakalkar Sameer Sharad , Choudhury Arghya Kundu , Vathulya Madhubari , Goyal Tarun , Chattopadhyay Debarati
Published: June 2021

A case of 16-year-old boy from the remote tribal population of Uttarakhand is described, who sustained a viper snakebite. The patient after various interventions and referrals developed locoregional and systemic complications. He not only had an open tibiofibular fracture but a large bimalleolar defect over his lower limb. The wound infection with underlying osteomyelitis progressed to septic shock and failure of the conventional cross-leg flap. Computed tomography scan of the limb revealed a single patent vessel, eliminating the option of microvascular flap. Limb amputation was considered for source control; however, in an attempt to salvage the limb, the novel approach of acute limb shortening with secondary limb lengthening was performed with parental consent, an approach not previously reported in the management of snakebite injuries. Adequate infection control was achieved following removal of the osteomyelitic bone, and the defect was covered with overlapping tissue from the docked limb and a cross-thigh flap. Secondary lengthening was performed after 3 months, and following extensive surgical and rehabilitative interventions, the boy's limb was salvaged and he retains a near-normal gait. This case report entails a detailed account of how mutilating a snakebite injury could be and how unconventional techniques like acute limb shortening with secondary lengthening can be used in such injuries.
Reconstruction of Scalp Defects in Electrical Burns
Authors: Aithal Karthik , Jena Unmesh Kumar , Vasireddy Sravya , Muddada Sravani , Sudhakar P. V.
Published: June 2021

Introduction:

Electrical burn injury in India comprises a fair percentage of overall burn injuries, and they cause significant morbidity. Reconstruction of scalp defects often poses challenges to the plastic surgeon regarding the timing of surgery, choice of reconstruction, and postoperative management. The objective of this article is to throw light on various options for reconstruction of scalp defects as the involvement leads to significant morbidity.

Materials and Methods:

The study was conducted at a tertiary burn care unit. The period of this study was from 2016 to 2019. Retrospective analysis was done.

Results:

In this study, retrospective analysis of 40 cases of scalp burns was evaluated from 2016 to 2019. Out of these, 6 patients were managed with primary suturing, 8 patients underwent split-thickness skin graft, 24 patients required local flaps, and 2 patients were managed with extracorporeal radial forearm flap. There were no major complications. Minor complications like wound infection were seen in five of the local flap patients which were managed with antibiotics and regular dressing. Two patients had partial flap loss which was revised and managed conservatively. All flaps healed well. There was hair loss patch evident in patients where split-thickness graft was used.

Conclusion:

Thorough debridement of the wound is necessary in electrical burns. Smaller scalp wounds can be managed with split-thickness skin graft and local flaps, but larger defects should be managed with distant flaps and free flaps. This study shows that local flaps are the ideal choice for reconstruction of scalp defects due to their easy availability, minimal complications, and acceptable cosmesis.
Management of Surgical Complication during Dental Implant Placement
Authors: Kale Preeti Prakash , Mani Ameet , Anarthe Raju , Pendyala Gowri , Thakkur Pranay , Sekharamantri Anuraga Vidyasagar
Published: June 2021

Replacement of missing teeth with dental implant is now preferred treatment option for edentulous space. Treatment with dental implants has evolved much in recent times and has good success rates which have sometimes led to unfortunate outcomes during procedure or after procedure. The present review gives insight about complications of dental implants associated with surgical procedures and its management in brief.
Occult serious congenital heart disease and tracheoesophageal fistula repair
Authors: Singh Jyoti , Kumari Nidhi , Bankar Prashant , Kaur Mohandeep
Published: June 2021

A 1-day-old neonate presented to the emergency after vaginal delivery with tracheoesophageal fistula (TEF) and hemivertebra. As the neonate was not maintaining saturation, immediate intubation was done in neonatal ICU, and the infant was shifted to operation theater for emergency TEF repair. Basic screening and auscultation was done for any other coexisting congenital anomaly, which did not reveal any obvious cardiac defects. Neonate was hemodynamically stable. Anesthetic management focused on adequate ventilation and avoidance of gastric distension during positive pressure ventilation. TEF can cause several complications including aspiration, reduction in ventilation, and problems from concomitant congenital anomalies, mostly of cardiac origin. Intraoperatively, the patient may develop hypoxia owing to lung retraction and hemodynamic instability from bleeding or hypothermia. Here, we present a case of a newborn who underwent emergency type-C TEF repair, in which patient had multiple episodes of desaturation, which were managed successfully with Jackson Rees circuit ventilation allowing definitive repair of the TEF. Postoperatively, patient could not be weaned off from ventilator and was diagnosed with total anomalous pulmonary venous connection on echocardiography. This could explain the recurrent intraoperative oxygen desaturations.
A Hypoxia-Induced SCFFBXL1 E3 Ligase Ubiquitinates and Degrades the MEN1 Tumor Suppressor to Promote Colorectal Cancer Tumorigenesis
Authors: Zeng Jun , Xiao Xiao-qing , Zhou Zhi-yong
Published: June 2021

PurposeEmerging evidence has shown that SKP1-cullin-1-F-box-protein (SCF) E3 ligases contribute to the pathogenesis of different cancers by mediating the ubiquitination and degradation of tumor suppressors. However, the functions of SCF E3 ligases in the pathogenesis of colorectal cancer (CRC) remain obscure. Materials and MethodsThe cancerous and adjacent noncancerous tissues from CRC patients were collected, and protein levels were analyzed. Lentiviral short hairpin RNA (shRNA) and plasmid transfection were used to knock down and overexpress gene expression in CRC cell lines. Immunoprecipitation (IP), mass spectrometry, and co-IP analyses were used to determine protein interactions and the assembly of the SCF complex. Cell proliferation, migration, and tumor xenograft assays were performed to examine the effects of SCF members on CRC cell growth in vitro and in vivo.ResultsHypoxia activated the docking of hypoxia-inducible factor 1α (HIF1α) onto the CUL1 promoter and induced CUL1 expression in CRC cells. CUL1 coupled with RBX1, SKP1, and FBXL1 to assemble the SCFFBXL1 complex in CRC biopsies and cells. The SCFFBXL1 E3 ligase specifically ubiquitinated and degraded the MEN1 tumor suppressor. Knockdown of HIF1α or SCFFBXL1 members, or blockage of SCFFBXL1 by two inhibitors (DT204 and SZLP1-41) caused the accumulation of MEN1 protein and led to a significant decrease in cell proliferation and migration in vitro and tumor growth in vivo.ConclusionThe SCFFBXL1 E3 ligase is required for the ubiquitination of MEN1, and disruption of this complex may represent a new therapeutic strategy for the treatment of CRC.
Galois-theoretic features for 1-smooth pro-pgroups
Authors: Quadrelli Claudio
Published: June 2021

Letpbe a prime. A pro-pgroupGis said to be 1-smooth if it can be endowed with a continuous representation$\theta \colon G\to \mathrm {GL}_1(\mathbb {Z}_p)$such that every open subgroupHofG, together with the restriction$\theta \vert _H$, satisfies a formal version of Hilbert 90. We prove that every 1-smooth pro-pgroup contains a unique maximal closed abelian normal subgroup, in analogy with a result by Engler and Koenigsmann on maximal pro-pGalois groups of fields, and that if a 1-smooth pro-pgroup is solvable, then it is locally uniformly powerful, in analogy with a result by Ware on maximal pro-pGalois groups of fields. Finally, we ask whether 1-smooth pro-pgroups satisfy a “Tits’ alternative.”
Hodge theory of the Turaev cobracket and the Kashiwara–Vergne problem
Authors: Hain Richard
Published: June 2021

In this paper we show that, after completing in the

I

-adic topology, the Turaev cobracket on the vector space freely generated by the closed geodesics on a smooth, complex algebraic curve

X

with a quasi-algebraic framing is a morphism of mixed Hodge structure. We combine this with results of a previous paper on the Goldman bracket to construct torsors of solutions to the Kashiwara–Vergne problem in all genera. The solutions so constructed form a torsor under a prounipotent group that depends only on the topology of the framed surface. We give a partial presentation of these groups. Along the way, we give a homological description of the Turaev cobracket.